wk 5

Question 1

What do most multiple myeloma (MM) patients have on protein electrophoresis?

Answer 1

An M-spike. Immunofixation is done alongside it.

Question 2

What is the significance of Bence-Jones proteins in MM?

Answer 2

Found in 15-20% of MM patients, only contains light chains.

Question 3

What imaging technique is used to examine bone lesions in MM?

Answer 3

Skeletal survey (most used).

Question 4

What is the most common presentation of MM?

Answer 4

Bone pain.

Question 5

What are the CRAB features of multiple myeloma?

Answer 5

• C: Calcium elevation (>10 mg/L) - R: Renal dysfunction (creatinine >2 mg/dL) - A: Anemia (Hgb <10 g/dL or >/= 2 g/dL decrease) - B: Bone disease (lytic lesions or osteoporosis).

Question 6

What blood smear finding is seen in MM?

Answer 6

Rouleaux formation of RBCs with background basophilia.

Question 7

What is the supportive treatment for asymptomatic myeloma?

Answer 7

EPO and bisphosphonates.

Question 8

What is Lenalidomide used for in MM?

Answer 8

Prophylaxis for DVT.

Question 9

What defines MGUS (Monoclonal Gammopathy of Undetermined Significance)?

Answer 9

M protein in serum <30 g/L, clonal plasma cells <10%, NO CRAB features.

Question 10

What defines smoldering MM?

Answer 10

M protein >30 g/L, clonal plasma cells >10%, NO CRAB features.

Question 11

What defines active MM?

Answer 11

Any level of M protein, clonal plasma cells >10%, with CRAB symptoms.

Question 12

What immunoglobulin is associated with Waldenstrom macroglobulinemia? + manifestations

Answer 12

IgM

Sx:
- HYPERVISCOSITY syndrome: bleeding, neuropathy, vision
- hepatosplenomegaly
- lymphadenopathy

Question 13

What is hyperviscosity syndrome in Waldenstrom macroglobulinemia?

Answer 13

Triad: neurological abnormalities, vision changes, mucosal bleeding.

Question 14

How does Waldenstrom differ from MM?

Answer 14

• Waldenstrom: IgM, hyperviscosity, hepatosplenomegaly. - MM: IgG, IgA, light chains, osteolytic lesions/fractures, CRAB features.

Question 15

What causes Superior Vena Cava Syndrome (SVCS)?

Answer 15

External compression or intrinsic obstruction of the SVC.

Question 16

What are the symptoms of SVCS? gold standard dx?

Answer 16

Headache, lightheadedness, distorted vision, JVD, UE swelling, syncope, facial/upper body plethora, cyanosis, papilledema, dyspnea, cough, chest pain.

get a CONTRAST VENOGRAPHY - gold standard

Question 17

What is the diagnostic test of choice for SVCS?

Answer 17

Contrast venography (gold standard).

Question 18

What are the symptoms of cardiac tamponade?

Answer 18

Beck’s triad: muffled heart sounds, hypotension, raised JVP

Dyspnea, orthopnea, , pericardial rub, pulsus paradoxus, chest pain, cough,

Question 19

What is the xray and treatment for cardiac tamponade?

Answer 19

Pericardiocentesis and catheter drainage. “Water bottle sign” on CXR.

Question 20

What is a key EKG finding in hypercalcemia?

Answer 20

Short QT interval.

Question 21

What causes tumor lysis syndrome (TLS)?

What are the key lab findings in TLS?

Answer 21

Sudden release of cellular lysis products due to tumor destruction, often from treatment.

Hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia. Can lead to renal failure.

Question 22

What is the prophylactic treatment for hyperuricemia in TLS?

Answer 22

Allopurinol.

Question 23

What defines neutropenic fever?

dx?

Answer 23

ANC <1500 cells/mL (severe <500) and single oral temperature >38.3°C or sustained for 1 hour at >38°C.

dx: Blood culture with a minimum of 2 sets.

Question 24

What are the symptoms of acute PE? and gold standard dx?

Answer 24

Dyspnea, chest pain, calf/thigh pain/swelling, tachypnea, DVT signs, hypoxia, tachycardia, respiratory alkalosis, S1Q3T3.

dx: spiral CT