WBR0954

Author	[[PageAuthor::Mugilan Poongkunran M.B.B.S [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Primary Care Office
Sub Category	SubCategory::Hematology, SubCategory::Oncology
Prompt	[[Prompt::A 65 year old female comes to the office with complaints of back pain and fatigue. On further review of history, she says she had a hip fracture 6 months back and unable to do day to day activities. She denies any weakness of her extremities. She attained menopause at the age of 48 and not on any estrogen pills. Her past history is otherwise insignificant and her family history is unremarkable. Her vitals are temperature: 36.7 C, blood pressure: 140/80 mmHg, pulse: 80/min and respiration's: 15/min. All system examinations are normal except pallor. Her laboratory values are : Hb : 10 g/dl RBC’s : 2.5 million/cmm WBC’s : 6000/cmm Neutrophils : 60 % Eosinophils : 2 % Lymphocytes : 32 % Monocytes : 6 % MCHC : 34 % MCV : 85 fl ESR : 15mm/hr Serum creatinine : 2.3 mg/dl Serum calcium : 11.7 g/dl Bone marrow biopsy done reveals 20% plasma cells. What is the most appropriate investigation to find potential skeletal lesions in this patient?]]
Answer A	AnswerA::Whole body MRI
Answer A Explanation	[[AnswerAExp:: Incorrect  : Whole body MRI are helpful in patients who have bone pain but no abnormalities on routine roentgenograms.]]
Answer B	AnswerB::Whole body CT
Answer B Explanation	[[AnswerBExp:: Incorrect  : Whole body CT are helpful in patients who have bone pain but no abnormalities on routine roentgenograms.]]
Answer C	AnswerC::Whole body X-ray
Answer C Explanation	AnswerCExp::''' Correct ''' : Skeletal surveys reveal punched-out lytic lesions, diffuse osteopenia, or fractures in nearly 80 percent of patients with MM at the time of diagnosis.
Answer D	AnswerD::Whole body technitum-99 scan
Answer D Explanation	AnswerDExp::''' Incorrect ''' : Whole body technitum-99 scan are less sensitive in picking up lytic lesions.
Answer E	AnswerE::Whole body PET scan
Answer E Explanation	[[AnswerEExp:: Incorrect  : Positron emission tomography (PET) plays an integral role in the detection of solid malignant disease and less sensitive in picking up lytic lesions.]]
Right Answer	RightAnswer::C
Explanation	[[Explanation::Multiple myeloma is a type of cancer of plasma cells which are immune system cells in bone marrow that produce antibodies. Its prognosis, despite therapy, is generally poor, and treatment may involve chemotherapy and stem cell transplant. It is part of the broad group of diseases called hematological malignancies. Early multiple myeloma does not have any symptoms. As the tumor grows larger, people may notice bone pain, broken bones, numbness and/or muscle weakness, confusion, dizziness and edema in legs. Laboratory results include high erythrocyte sedimentation rate (ESR), hypercalcemia, raised serum creatinine due to reduced renal function and high serum protein (especially raised immunoglobulin) may prompt further testing. Protein electrophoresis of the blood and urine might show the presence of a paraprotein (monoclonal protein, or M protein) band, with or without reduction of the other (normal) immunoglobulins (known as immune paresis). One type of paraprotein is the Bence Jones protein which is a urinary paraprotein composed of free light chains. Staining particular cell types using antibodies against surface proteins can detect plasma cells which express immunoglobulin in the cytoplasm but usually not on the surface and myeloma cells are typically CD56, CD38, CD138 positive and CD19 and CD45 negative. Cytogenetics may also be performed in myeloma for prognostic purposes. The skeletal survey for patients with MM includes a posteroanterior view of the chest, anteroposterior and lateral views of the cervical spine, thoracic spine, lumbar spine, humeri and femora, anteroposterior and lateral views of the skull and anteroposterior view of the pelvis. Conventional skeletal surveys reveal punched-out lytic lesions, diffuse osteopenia, or fractures in nearly 80 percent of patients with MM at the time of diagnosis. Computed tomography (CT), magnetic resonance imaging (MRI), and PET/CT scans are helpful in patients who have bone pain but no abnormalities on routine roentgenograms. Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Multiple myeloma
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