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Created page with "{{WBRQuestion |QuestionAuthor={{Rim}} |ExamType=USMLE Step 1 |MainCategory=Pathophysiology |SubCategory=Oncology |MainCategory=Pathophysiology |SubCategory=Oncology |MainCateg..."
 
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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{SSK}} (Reviewed by Serge Korjian)
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
Line 8: Line 8:
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
|SubCategory=Oncology
|SubCategory=Oncology
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
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|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
|SubCategory=Oncology
|SubCategory=Oncology
|Prompt=A 69 year old man is being worked up for recent onset renal insufficiency. As part of his work-up his nephrologist orders a blood smear with a photomicrograph presented below. Which of the following conditions can explain the patient’s findings?
|Prompt=A 69-year-old man is being worked up for recent onset renal insufficiency. As part of his work-up, his nephrologist orders a blood smear with a photomicrograph presented below. Which of the following conditions can explain the patient’s findings?
 


[[Image:WBR0785.jpg]]
[[Image:WBR0785.jpg]]
|Explanation=Multiple myeloma is a malignant plasma cell proliferation clincially characterized by anemia, bone pain, and renal insufficiency. Diagnosis is usually supported by multiple tests including serum and urine assays for monoclonal protein M spike, light chain assays, serum Beta-2-microglobulin, bone marrow biopsy, and skeletal imaging. A classical finding of multiple myeloma on  peripheral smear is rouleaux formation of red blood cells due to the aggregation with serum paraproteins. Other diseases with elevated serum proteins can exhibit rouleaux formation although MM is a classical example tested on board examinations.
|Explanation=[[Multiple myeloma]] is a malignant plasma cell proliferation clinically characterized by anemia, bone pain, and [[renal insufficiency]]. Diagnosis is usually supported by multiple tests including serum and urine assays for monoclonal protein M spike, light chain assays, serum beta-2-microglobulin, bone marrow biopsy, and skeletal imaging. A classical finding of multiple myeloma on  peripheral smear is rouleaux formation of red blood cells due to the aggregation with serum paraproteins. Other diseases with elevated serum proteins can exhibit rouleaux formation although MM is a classical example tested on board examinations.
 
 
Learning objective: The increase in serum proteins in multiple myeloma leads to RBC rouleaux formation on peripheral smear.
 
 
Reference:
 
San miguel JF, Gutiérrez NC, Mateo G, Orfao A. Conventional diagnostics in multiple myeloma. Eur J Cancer. 2006;42(11):1510-9.
|AnswerA=Hairy cell leukemia
|AnswerA=Hairy cell leukemia
|AnswerAExp=Hairy cell leukemia is not associated with rouleaux formation on peripheral smear. Typical findings include lymphocytes with irregular hair-like borders.
|AnswerAExp=Hairy cell leukemia is not associated with rouleaux formation on peripheral smear. Typical findings include lymphocytes with irregular hair-like borders.
|AnswerB=Chronic lymphocytic leukemia
|AnswerB=Chronic lymphocytic leukemia
 
|AnswerBExp=CLL is not associated with rouleaux formation on peripheral smear.
 
|AnswerBExp=CLL is not associated with rouleaux formation on peripheral smear.  
|AnswerC=Hemolytic uremic syndrome
|AnswerC=Hemolytic uremic syndrome
 
|AnswerCExp=HUS is not associated with rouleaux formation on peripheral smear. Schistocytes are classically found in patients with HUS.
|AnswerCExp=HUS is not associated with rouleaux formation on peripheral smear. Schistocytes can usually be found.
|AnswerD=Disseminated intravascular coagulopathy
|AnswerD=Disseminated intravascular coagulopathy
|AnswerDExp=DIC is not associated with rouleaux formation on peripheral smear. Schistocytes can also be found in DIC.
|AnswerDExp=DIC is not associated with rouleaux formation on peripheral smear. Schistocytes can also be found in DIC.
|AnswerE=Multiple myeloma
|AnswerE=Multiple myeloma
|AnswerEExp=MM is usually associated with rouleaux formation on peripheral smear due to the associated hypergammaglobulinemia.
|AnswerEExp=MM is usually associated with rouleaux formation on peripheral smear due to the associated hypergammaglobulinemia.
|EducationalObjectives=The increase in serum paraproteins in multiple myeloma leads to RBC rouleaux formation on peripheral smear.
|References=San miguel JF, Gutiérrez NC, Mateo G, Orfao A. Conventional diagnostics in multiple myeloma. Eur J Cancer. 2006;42(11):1510-9.
|RightAnswer=E
|RightAnswer=E
|WBRKeyword=Multiple myeloma, Rouleaux,  
|WBRKeyword=Multiple myeloma, Rouleaux, MM, Hypergammaglobulinemia,  
|Approved=No
|Approved=Yes
}}
}}

Revision as of 19:15, 7 October 2014
Author [[PageAuthor::Serge Korjian M.D. (Reviewed by Serge Korjian)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathophysiology
Sub Category SubCategory::Oncology
Prompt [[Prompt::A 69-year-old man is being worked up for recent onset renal insufficiency. As part of his work-up, his nephrologist orders a blood smear with a photomicrograph presented below. Which of the following conditions can explain the patient’s findings?

]]

Answer A AnswerA::Hairy cell leukemia
Answer A Explanation AnswerAExp::Hairy cell leukemia is not associated with rouleaux formation on peripheral smear. Typical findings include lymphocytes with irregular hair-like borders.
Answer B AnswerB::Chronic lymphocytic leukemia
Answer B Explanation AnswerBExp::CLL is not associated with rouleaux formation on peripheral smear.
Answer C AnswerC::Hemolytic uremic syndrome
Answer C Explanation AnswerCExp::HUS is not associated with rouleaux formation on peripheral smear. Schistocytes are classically found in patients with HUS.
Answer D AnswerD::Disseminated intravascular coagulopathy
Answer D Explanation AnswerDExp::DIC is not associated with rouleaux formation on peripheral smear. Schistocytes can also be found in DIC.
Answer E AnswerE::Multiple myeloma
Answer E Explanation AnswerEExp::MM is usually associated with rouleaux formation on peripheral smear due to the associated hypergammaglobulinemia.
Right Answer RightAnswer::E
Explanation [[Explanation::Multiple myeloma is a malignant plasma cell proliferation clinically characterized by anemia, bone pain, and renal insufficiency. Diagnosis is usually supported by multiple tests including serum and urine assays for monoclonal protein M spike, light chain assays, serum beta-2-microglobulin, bone marrow biopsy, and skeletal imaging. A classical finding of multiple myeloma on peripheral smear is rouleaux formation of red blood cells due to the aggregation with serum paraproteins. Other diseases with elevated serum proteins can exhibit rouleaux formation although MM is a classical example tested on board examinations.

Educational Objective: The increase in serum paraproteins in multiple myeloma leads to RBC rouleaux formation on peripheral smear.
References: San miguel JF, Gutiérrez NC, Mateo G, Orfao A. Conventional diagnostics in multiple myeloma. Eur J Cancer. 2006;42(11):1510-9.]]

Approved Approved::Yes
Keyword WBRKeyword::Multiple myeloma, WBRKeyword::Rouleaux, WBRKeyword::MM, WBRKeyword::Hypergammaglobulinemia
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