Capsule cases - multiple myeloma

Question 1

What is myelofibrosis?

Answer 1

Chronic leukemia whereby bone is replaced with fibrous tissue

Question 2

Symptoms of myelofibrosis

Answer 2

Bone pain

FLAWS

Question 3

Signs of myelofibrosis (explain)

Answer 3

Splenomegaly (extramedullary haematopoesis)

Anaemia

Question 4

Weight loss, raised ESR, anaemia and renal impairment - differentials in a 70yr/o man

Answer 4

Carcinomatosis

Multiple myeloma

Question 5

Investigations

Answer 5

Serum calcium
LFT
CXR (to exclude primary/secondary malignancy)
Renal ultrasound

PTH
PSA
MRI if not contraindicated (contraindicated in pacemaker)

Question 6

What tests would you specifically do to check for myeloma in the serum?

Answer 6

Serum electrophoresis

Serum free light chains

Question 7

What might you see in multiple myeloma in serum electrophoresis?

Answer 7

large monoclonal IgG band

Question 8

Initial management for hypercalcemia of malignancy

Answer 8

IV fluids

Bisphosphonates

Question 9

Final diagnostic procedure

Answer 9

Biospsy

Question 10

Treatment of myeloma

Answer 10

Chemo

radio only used if spinal involvement

Question 11

Why might you hesitate to give blood transfusions to someone with myeloma and anaemia?

Answer 11

Hyperviscosity risk

Question 12

Epidemiology of multiple myeloma

Answer 12

M:F

Question 13

Is alk phosph raised in multiple myeloma?

Answer 13

NO

Question 14

Name a complication of multiple myeloma

Answer 14

Amyloidosis