Multiple Myeloma

Question 1

What is multiple myeloma?

Answer 1

Cancer of plasma cells leading to Ig secretion causing organ dysfunction

Question 2

Multiple myeloma commonly affects which group?

Answer 2

Adults 75+

Question 3

What are the clinical presentations of multiple myeloma? (4)

Answer 3

CRAB
Calcium > 2.75mmol/L
Renal impairment
Anaemia
Bone lesions (pepperpot skull, cord lesions, BACK PAIN)

Question 4

When should you always suspect multiple myeloma?

Answer 4

A patient over 50y comes in with new back pain

Question 5

What investigations would you carry out for multiple myeloma? (3)

Answer 5

FBC: persistently high ESR
Blood screen: rouleaux
Screening test: serum/ urine electrophoresis

Question 6

What would you find in the urine of a pt with multiple myeloma?

Answer 6

Bence Jones protein

Question 7

What would you see on an x-ray of a pt with multiple myeloma?

Answer 7

Lytic ‘punched-out’ lesions eg pepperpot skull

Question 8

How would you treat multiple myeloma? (4)

Answer 8

Analgesics for bone pain (avoid NSAIDs)
Bisphosphonates + radiotherapy for bones
Transfusions/ EPO for anaemia
Chemotherapy