Multiple Myeloma

Question 1

Myeloma is a malignant clonal proliferation of ? cells (derived from ? lymphocytes).
In myeloma, a single clone of plasma cells produce a single ? which can be seen as a ? band, or ?, on serum / urine ?.
The average age of presentation is ?0, and it is more common in ? populations.

Answer 1

plasma
B
immglob
monoclonal
paraprotein
electrophoresis
70
black

Question 2

Clinical features (CRAB - ?, ?, ?, ?);

Answer 2

calcium
renal
anaemia
bone

Question 3

? bone lesions due to osteoclast activation;
o ?-ache.
o ? fractures.
o Hypercalcaemia (?, ?, ? and ?).
Bone marrow failure;
o ?.
o Symptoms of ?.
o ?.
Renal impairment;
o Seen in ?% at diagnosis, due to light chain deposition.

Answer 3

osteolytic
back
patho
bones, stones, moans, groan
infection
anaemia
bleeding
20

Question 4

Ix

FBC: ? ? anaemia, leuko-?.
- Blood film: ? formation.
- ?: raised.
- ?: often deranged.
- ?: raised.
- Alkaline Phosphatase: ?.
Serum/? ?: paraprotein monoclonal band seen.

Answer 4

normochromic normocytic
penia
rouleux
esr
u+E
calcium
normal
urine electrophoresis

Question 5

Ix

Urine ?-? protein: positive.
—o Free ? light chains present in the urine that precipitate and then ? again on ? the urine.

Skeletal XR: ? ? ? lesions, e.g. ‘pepper pot skull’.

Bone marrow ?: increased clonal plasma cells >?0%.
—o If under ?0% then the disease may be termed ‘monoclonal ? of uncertain significance’: MGUS

Answer 5

bence-jones
Imglob
disappear
heating
punched out lytic
biopsy
10
10
gammopathy

Question 6

Management;
? therapy.
?.
?.
Bone marrow ? cell ? used if <70, as this allows higher dose ?.

Answer 6

supportive
CTx
RTx
stem
transplant
CTx

Question 7

Complications include hyper?, spinal cord ?, hyper? and ? ? failure.

Prognosis;
The original myeloma cell is very ? so often returns.
Median survival is ?-? years.
Death is usually from ? failure or ?.

Answer 7

ca
compression
viscosity
acute renal
resistant
3-4
renal
infection