Week 3 - Multiple Myeloma Flashcards
What is the most common presenting problem in multiple myeloma?
Bone pain
In a patient with MM, what symptom is likely to be directly attributable to hypercalcaemia?
Confusion
What class of drugs does pamidronate (used to treat MM) belong?
Bisphosphonates
What is the mechanism of renal failure in MM?
Hypercalcaemia due to bone lysis
“Red flag” in back pain
Presence of neurological deficit
A definitive diagnosis of multiple myeloma is made on the basis of which of the following investigations?
Bone marrow biopsy
What is the pathological process underlying the development of MM?
Monoclonal proliferation of plasma cells
What pathophysiological processes can cause hypercalcaemia?
Primary hyperparathyroidism (most common), malignancy, renal failure, other endocrine disease, drugs (thiazides, lithium), granulomatous diseases such as TB and sarcoid, Vit D and Vit A toxicity, prolonged immobilisation, rare familial diseases, excessive calcium intake
Symptoms of hypercalcaemia
Dehydration, lethargy
GIT: anorexia, nausea, vomiting, constipation, abdominal pain
Renal: polyuria, polydipsia
CNS: irritability, cognitive dysfunction, depression, confusion, coma
GUS: symptoms of urinary calculi
MSK: weakness, muscle twitches, atrophy, bone pain
Rickets
Form of osteomalacia in children. Due to Vit D deficiency and renal tubular acidosis
What XR changes are seen in rickets?
Bone poorly mineralised, widening of the epiphyseal line and eventual cupping of the epiphyses
Paraproteins
Abnormal immunoglobulins produced by a single clone of antibody producing cells, most frequently plasma cells
How are paraproteins detected?
By electrophoresis where they appear as a single band
What are Bence-Jones proteins?
Light chains of abnormal globulins which can be filtered by the kidneys and hence can be detected in the urine. They are particularly found in MM.
Pathophysiology of MM?
Haematological malignancy of plasma cells arising from a single clone. Characterised by malignant infiltration of the bone marrow and the appearance of monoclonal antibody in the serum and/or urine.
