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CONDITION/DISORDER SYNONYMS

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  • Plasma cell myeloma

  • Kahler’s disease

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ICD-9-CM CODES

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  • 140-239 Neoplasms

  • 200-209 Malignant neoplasm of lymphatic and hematopoietic tissue

  • 203 Multiple myeloma and immunoproliferative neoplasms

  • 203.0 Multiple myeloma

  • 203.00 Multiple myeloma without remission

  • 203.01 Multiple myeloma in remission

  • 203.02 Multiple myeloma, in relapse

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ICD-10-CM CODES

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  • C90.00 Multiple myeloma not having achieved remission

  • C90.01 Multiple myeloma in remission

  • C90.02 Multiple myeloma in relapse

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FIGURE 67-1

Section of a needle biopsy of bone marrow from a patient with marrow involvement by multiple myeloma. A. Numerous plasma cells have replaced most of the marrow; a few fat cells remain. B and C. Same case after staining for immunoglobulin light chains by the immunoperoxidase technique. In B, staining with anti-kappa reveals a positive reaction (black) in the plasma cells, whereas in C, staining with anti-lambda shows no reactivity. This demonstrates the monoclonal nature of this neoplasm. An IgA-kappa monoclonal spike was detected in serum. (From Chandrasoma P, Taylor CR. Concise Pathology. 3rd ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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PREFERRED PRACTICE PATTERNS1

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  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

  • 6B: Impaired Aerobic Capacity/Endurance Associated with Deconditioning

  • 6H: Impaired Circulation and Anthropometric Dimensions Associated with Lymphatic System Disorders

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PATIENT PRESENTATION

A 62-year-old female that is retired, complains of a recent onset of left-sided back pain that radiates from her left lower scapula area down the left side of her back and into her left leg. The pain began about 5 weeks ago after she was hospitalized for pneumonia. She was admitted for 3 weeks. She did not receive her monthly chemotherapy treatment during this time. The pain is worse when she does activities that require her to use her arms. She describes it as aching pain in the middle back and she feels weak and stiff in the lower left side of her back and left thigh. She lives alone, however, has a caregiver who assists as need. She is able to perform her self-care independently; however, she is not able to vacuum, sweep, or mop, as these activities increase her pain.

The patient has a moderately kyphotic posture with a flattened lumbar curve. The thoracic and lumbar paraspinals are tight with greater tightness in the right thoracic paraspinals. Strength is WNL in bilateral UE except for left scapular muscle weakness. She has LE weakness in left hip muscles (abduction and extension), as well as bilateral ankle plantar flexion (PF). She is unable to perform unilateral heel raise on right or left. She complains of increased pain with UE and LE testing. The pain complaint was greater with UE testing, particularly shoulder MMT. She presents with postural muscle ...

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