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Flashcards in Multiple Myeloma Deck (27)
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0
Q

Common chromosome affected in multiple myeloma patients? How is it affected?

A
  1. Deletions and translocations
1
Q

Multiple myeloma Patients usually present with?

A

Monoclonal proliferation (M-spike)

CRABBI
hyperCalcemia
Regional efficiency
Mia
Bone clinic lesions
Back pain
Infections
2
Q

Typical patient affected by multiple myeloma?

A

70-year-old black male

3
Q

Growth of multiple myeloma cells are due to induction of what cytokines?

A

IL –6, insulin like growth factor, VEGF

4
Q

The bone lesions of myeloma are caused by?

A
  1. Proliferation of tumor cells
  2. Activation of osteoclasts
  3. Suppression of osteoblast
5
Q

Why use plain film over radioisotopic bone scan for multiple myeloma?

A

Rarely associated with osteoblastic new bone formation, so decreased uptake of radio isotopes

6
Q

Localized bone lesions multiple myeloma may lead to palpable masses on what bones? And collapse of what?

A

Skull, clavicles, sternum.

Collapse of vertebrae leading to spinal cord compression

7
Q

Most common infections of multiple myeloma patients?

A

Pneumonias and pyelonephritis.

Due to Strep pneumonia, Staph aureus, Klebsiella, E. coli, and other gram-negative organisms in the urinary tract

8
Q

Causes of increased susceptibility to infection multiple myeloma?

A
  1. Diffuse hypogammaglobulinemia
    2 CD4 cells may be decreased
  2. Granulocyte lysozyme content is low
  3. Treatment if myeloma with steroids
9
Q

Factors contributing to renal failure?

A

Key: Excretion of light chains (Bence-Jones)

  1. Hypercalcemia
  2. Amyloid deposits
  3. Hyperuricemia
  4. Infections
  5. NSAIDs
  6. Contrast dye for imaging
  7. Bisphosphonate use
10
Q

Earliest manifestation of tubular damage of the kidney in multiple myeloma?

A

Adult Fanconi syndrome

  1. loss of glucose and amino acids in urine
  2. kidney can’t acidify urine (RTA)
11
Q

Why do patients have a decreased anion gap in multiple myeloma? Often accompanied with?

A

M component is catatonic, resulting in retention of chloride. HypoNa.

Anion gap is Na - Cl - HCO3

12
Q

Why do patients with multiple myeloma have normocytic anemia?

A
  1. Replacement of normal marrow with expanding tumor
  2. Inhibition of hematopoiesis by factors made by the tumor
  3. Reduce production erythropoietin by the kidney
13
Q

Why might a patient with multiple myeloma have clotting abnormalities?

A

Interaction of the M component but clotting factors I, II, V, VII, VIII

14
Q

Why might a patient with multiple myeloma get Raynaud’s phenomenon?

A

M component forms cryo globulins

15
Q

Causes of neuro symptoms in multiple myeloma?

A
  1. Hypocalcemia (lethargy weakness, depression, confusion)
    2 hyperviscosity (headache, fatigue, retinopathy)
  2. Bone damage (Cord compression, radicular pain, loss of bowel and bladder control)
  3. Infiltration of peripheral nerves amyloid (carpal tunnel syndrome, polyneuropathy)
16
Q

Classic triad of multiple myeloma?

A
  1. Marrow plasmacytosis
  2. Lytic bone lesions
  3. Serum/urine M-component
17
Q

Therapy for patients with MGUS?

A

None

18
Q

Elevated labs in multiple myeloma?

A

Calcium, urea nitrogen, creatinine, uric acid

19
Q

To quantify Bence-Jones protein excretion need?

A

24 hour urine specimen

20
Q

Alkaline phosphate level in multiple myeloma?

A

Normal (no osteoblast activity)

21
Q

Which type of Bence-Jones protein is worse?

A

Lambda chains are more likely to cause renal damage and form amyloid than kappa chains

22
Q

Single most powerful predictor of survival in multiple myeloma?

A

Beta2-microglobulin

23
Q

Therapy that achieves close to 100% response rate?

A

Lenalidomide, bortezomib, dexamethasone

24
Q

Thalidomide mechanism of action?

A

Anti-inflammatory Properties

25
Q

Bortezomib MoA?

A

Protease inhibitor

26
Q

Lenalinomude MoA?

A

Anti-angiogenic and modulates immune system

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