Myeloma

Question 1

What is myeloma

Answer 1

cancer of plasma cells secreting IgG or IgA

Question 2

What is paraprotein

Answer 2

Monoclonal gammopathy

Question 3

Rx for myeloma

Answer 3

MGUS predisposition
old age
men
obesity

Question 4

What might you see in the serum

Answer 4

excess of light chains without heavy chains

so you get high serum free light chains

Question 5

Presentation mnemonic

Answer 5

Calcium abnormalities (due to osteolysis causing weak bone and fractures and release of calcium)
Renal impairment
Anaemia
Bone lesions

plus circulating monoclonal protein

Question 6

X ray findings of myeloma

Answer 6

Osteolytic punched out lesions of proximal skeleton, back, chest wall and pelvis

Question 7

Free light chains in urine =

Answer 7

Free light chains in urine = Bence Jones protein

Note: normal

Question 8

Hypercalcemia presentation

Answer 8

Drowsiness
Constipation
Fatigue
Weakenss

Question 9

Hypercalcemia presentation

Answer 9

Drowsiness
Constipation
Fatigue
Weakness

Bones
Stones
Abdo groans

Question 10

Why do myeloma patients present with AKI?

Answer 10

Cast nephropathy - when pH of nephron changes due to light chain deposition

Question 11

Treatment

Answer 11

Steroids
IMIDs - thalidomide
MoAbs?
Melphalan - alkylating agent found in mustard gas in ww1 and ww2 - causes lymphopenia 
Stem cell transplant

Question 12

Key tests for diagnosing multiple meyloma

Answer 12

FBC
ESR
Film

Creatinine
Calcium
Globulins

Serum immunoglobulins
Protein electrophoresis

Serum free light chains - important