Multiple Myeloma

Question 1

‘CRAB’ features of multiple myeloma
What are they?

Answer 1

hyperCalcaemia, Renal failure, Anaemia (and thrombocytopenia) and Bone fractures/lytic lesions

Question 2

the patient is demonstrating many of the CRABBI signs of myeloma (hypercalcaemia, renal failure, anaemia/thrombocytopaenia, bleeding/bruising, bony lesions and infection).

Hypercalcaemia can cause constipation, drowsiness and nausea, as is the case here.

Infiltration of the cancerous cells into the bone marrow results in suppressing other cell types, leading to anaemia and thrombocythaemia, which commonly manifests as fatigue and easy bruising/bleeding. A common place for the cancer to infiltrate bone and cause lesions in the lumbar spine, causing persistent, worsening pain. It also increases the risk of pathological fractures. No infective symptoms are present in this case, but can often be part of the initial presentation.

Answer 2

Multiple Myeloma

Question 3

The acronym CRAB summarises the most typical clinical manifestations of multiple myeloma. What does it stand for?

Answer 3

Hypercalcaemia, Renal Impairment, Bone Pain and Anaemia (Thrombocytopenia)

Question 4

Which of the following investigation findings is most associated with multiple myeloma?

Answer 4

Bence Jonce Protein in urine.

Question 5

Which of the following is the diagnosis test for multiple myeloma?

Answer 5

Bone Marrow Biopsy and Aspiration

Question 6

RED FLAG KNOW THIS

Answer 6

Concerning for myeloma as back pain that wakes a patient from sleep, or gets worse on lying down on their back, is a red flag for malignancy and in particular myeloma.

Question 7

‘CRABBI’ features of multiple myeloma

Answer 7

‘CRAB’ features of multiple myeloma = hyperCalcaemia

Renal failure

Anaemia (and thrombocytopenia)

Bleeding

Bone fractures/lytic lesions

Infection

Question 8

What is Multiple Myeloma?

Answer 8

Multiple myeloma (MM) is a haematological malignancy characterised by plasma cell proliferation. It arises due to genetic mutations which occur as B-lymphocytes differentiate into mature plasma cells.

Question 9

Renal impairment in myeloma has 4 causes:

Answer 9

AL type amyloidosis, Bence Jones nephropathy, nephrocalcinosis, nephrolithiasis

Question 10

has AKI + hypercalcaemia + proteinuria + anaemia + thrombocytopenia

Answer 10

RAISE FLAGS FOR MYELOMA!!!!!