MM NM

Question 1

Bone marrow location

Answer 1

Skull
Clavicle
Sternum
Humerus
Pelvis
Femur
Vertebrae

Question 2

Associated disease

Answer 2

Myelofibrosis

Question 3

MM mechanism

Answer 3

Activate osteoclasts
Inhibit osteoblast
Bone resorption
Hypercalcemia

Question 4

Presentation

Answer 4

Bone pain
Pathologic fracture
Beta2 microglobulin
M-protein IgG>IgA - - increase viscosity in eye and CNS - - visual impairment, hearing loss, dizziness
LDH
Spinal cord compression - - collapse of vertebral body in response to therapy
Immunodeficiency

Question 5

MGUS

Answer 5

<10% plasma cells
Serum M-protein <3 g/dL
Normal bone on X-ray

Question 6

Smoldering MM (stage IA)

Answer 6

> 10% plasma cells
Serum M-protein >3 g/dL or urine M-protein >1 g/dL
Single plasmacytoma

Question 7

End organ damage CRAB

Answer 7

Calcium elevation
Renal insufficiency
Anemia
Bone abnormalities

Question 8

MM characteristics

Answer 8

> 10% plasma cells or plasmacytoma
End organ damage

Question 9

MM stage I lab

Answer 9

Hb >10 g/dL
Calcium <12 mg/dL
IgG <5 g/dL
IgA <3 g/dL
Urine M-protein < 4 g/24 h

Question 10

MM stage IB

Answer 10

< 5 focal lesions >5 mm
On T1 MRI: micronodular or salt and pepper

Question 11

MM stage III lab

Answer 11

Hb <8.5 g/dL
Calcium >12 mg/dL
IgG >7 g/dL
IgA >5 g/dL
Urine M-protein >12 g/24 h

Question 12

MM stage II

Answer 12

5-20 focal lesions
On T1 MRI : contrast between vertebral bone marrow and disc

Question 13

MM stage III

Answer 13

> 20 focal lesions
On T1 MRI : T1 signal less than disc

Question 14

MM stage A

Answer 14

Creatinine <2 mg/dL
No extramedullary disease

Question 15

MM stage B

Answer 15

Creatinine >2 mg/dL
Extramedullary disease

Question 16

MGUS = monoclonal gammopathy of undetermined significance
Progression

Answer 16

Progression to MM 1% per year or Waldenstrom macroglobulinemia
Can progress to Primary Amyloidosis, CLL, lymphoma

Question 17

MGBS

Answer 17

Macroglobulinemia of borderline significance
Higher risk of progression
10-30% plasma cells

Question 18

SMM = smoldering MM

Answer 18

Asymptomatic (no end organ damage)
Higher risk of progression to MM

Question 19

MM overview

Answer 19

Symptomatic
CRAB
Non-secretory - - no elevated M-protein
Micromolecular - - only light chains secreted
IgD MM

Question 20

POEMS sy 1%

Answer 20

Polyneuropathy - symmetric, distal
Organomegaly
Endocrinopathy
M-protein
Skin changes + sclerotic bone lesions

Question 21

Plasma cell leukemia

Answer 21

> 20% plasma cells

Question 22

PCLI

Answer 22

Plasma cell labeling index
Correlated with neoangiogenesis
MGUS and SMM - - <1% PCLI
40% MM normal PCLI

Question 23

Solitary plasmacytoma image

Answer 23

MRI, PET, DMSA

Question 24

RAS = Radiographic skeletal survey

Answer 24

Punched - out Lytic lesions
Osteopenia
Fracture
MRI, PET
Bone scan insensitive
CT more sensitive - - >5 mm

Question 25

Bone scan positive

Answer 25

Osteoblastic response to compression fracture or pelvic fracture Soft tissue calcification Tumor associated Amyloidosis

Question 26

Ga67- citrate

Answer 26

Areas of active tumor Low resolution Multi day

Question 27

Tc-DMSA

Answer 27

Accumulate in plasmacytoma

Question 28

Tc-Sestamibi

Answer 28

Semiquantitative degree of bone marrow infiltration Always negative in MGUS False negative due to overexpression of P-glycoprotein (ass with multidrug resistant MM)

Question 29

FDG indication

Answer 29

Initial staging Early bone marrow infiltration (false positive young and anemia) Extramedullary involvement (poor prognosis) Negative in MGUS, MM stage I

Question 30

Active transformed plasma cells

Answer 30

Glucose avid Focal or diffuse uptake

Question 31

Lesions <10mm

Answer 31

Not detected on FDG

Question 32

FDG after surgery

Answer 32

At least 4 weeks

Question 33

FDG after radio

Answer 33

2-3 months

Question 34

Impetus = interpretative criteria for FDG in MM

Answer 34

Metabolic state of bone marrow Number and site of positive lesions Extramedullary disease Paramedullary disease Fractures

Question 35

Choline

Answer 35

Higher sensitivity than FDG High physiological liver uptake

Question 36

C-Methionine

Answer 36

Incorporate into Ig New Lytic lesions positive, recurring - negative

Question 37

FLT

Answer 37

High uptake in myelodysplasia Lower-absent uptake in MM, myelofibrosis, aplastic anemia

Question 38

MGUS treatment

Answer 38

Long term observation

Question 39

Solitary plasmacytoma treatment

Answer 39

Radio

Question 40

MM treatment

Answer 40

Systemic therapy

Question 41

Effective response

Answer 41

FDG rapidly declines

Question 42

Persistent positive FDG

Answer 42

Early recurrence

Question 43

M-protein

Answer 43

IgG 52 % IgA 21 %

Question 44

At diagnosis

Answer 44

10% diffuse osteopenia

Question 45

Plasmacytoma

Answer 45

Solid lesion + soft tissue outside of bone or from preexistent bone lesion No systemic spread

Question 46

Minimum criteria for MM

Answer 46

At least 10% plasma cells Or M-protein >3 g/dL in serum or >1g excreted in 24h urine

Question 47

Poor prognosis

Answer 47

Translocation Chromosomal alteration Elevated PCLI

Question 48

High risk SMM

Answer 48

Should be treated 80% CRAB in a short period

Question 49

FDG focal uptake in MGUS

Answer 49

Transformation into active myeloma

Question 50

>10 spine lesions on MRI

Answer 50

6-11 fold risk of fracture

Question 51

Radionuclide therapy

Answer 51

Anti CD45, CD66, CD138 CXCR4

Question 52

Epidemiology

Answer 52

Number 1 primary tumor of bone

Question 53

MRI detect

Answer 53

Iron overload Amyloid Marrow hyperplasia

Question 54

Low sensitivity MRI

Answer 54

Sternum and ribs PET better