Myeloma

Question 1

What is Myeloma?

Answer 1

Cancer of the plasma cells

Question 2

What does cancer of a specific type of plasma cell result in?

Answer 2

Large quantities of a single type of antibody being produced.

Question 3

What is multiple myeloma?

Answer 3

Myeloma which affects multiple areas of the body

Question 4

What is the pneumonic for the presentation of myeloma?

Answer 4

CRABBI

Question 5

What does CRABBI stand for?

Answer 5

C- Calcium 
R- Renal 
A- Anaemia 
B- Bleeding
B- Bones
I-Infections

Question 6

How is the calcium level in myeloma affected?

Answer 6

Hypercalcaemia

Question 7

What type of anaemia occurs in myeloma?

Answer 7

Normocytic

Normochromic

Question 8

What is anaemia in myeloma due to?

Answer 8

Bone marrow failure

Question 9

What type of bone lesions and bone pain is present?

Answer 9

Lytic bone lesions
Pathological fractures
Spinal cord compression

Question 10

When should you consider myeloma in a patient?

Answer 10

Over 60 with persistent bone pain, particualrly in the back or unexplained pathological fractures

Question 11

What would be raised in myeloma?

Answer 11

Calcium
ESR
Plasma viscosity

Question 12

What would be low in someone with myeloma?

Answer 12

Low white cell count

Question 13

What is the mnemonic for the investigations for myeloma?

Answer 13

BLIP

Question 14

What does BLIP stand for?

Answer 14

B- Bence-Jones protein (urine)
L- Serum free Light chain assay
I- Serum immunoglobulins
P- Serum protein electrophoresis

Question 15

What is necessary for the diagnosis of myeloma?

Answer 15

Bone marrow biopsy

Question 16

What investigation is done to assess for bone lesions?

Answer 16

Whole body MRI

CT if MRI not available

Question 17

What would you find on an x-ray of someone with myeloma?

Answer 17

Raindrop skull

Question 18

What is a raindrop skull due to?

Answer 18

Punched out lytic lesions throughout the skull

Question 19

Is myeloma a curable disease?

Answer 19

No

Question 20

What is the management of myeloma for?

Answer 20

To control the disease

Question 21

What type of course does myeloma take?

Answer 21

Relapsing-remitting course

Question 22

What is the induction therapy for patients who are suitable for autologous stem cell transplantation?

Answer 22

Bortezomib and Dexamethasone

Question 23

What is the induction therapy for patients who aren’t suitable for autologous stem cell transplantation?

Answer 23

Thalidomide + an Alkylating agent + Dexamethasone

Question 24

What do patients on thalidomide require?

Answer 24

Venous thromboembolism prophylaxis with aspirin or low molecular weight heparin

Question 25

What is the management of myeloma bone disease?

Answer 25

Bisphosphonates Radiotherapy for bone lesions Orthopaedic surgery for bone fractures

Question 26

What are some complications of myeloma and the treatment for myeloma?

Answer 26

Infection Pain Pathological fractures

Question 27

What is an effect of the paraprotein?

Answer 27

Amyloidosis

Question 28

What is amyloidosis?

Answer 28

Group of diseases characterised by deposition of the fibrillar protein

Question 29

What is the commonest cause of amyloidosis?

Answer 29

Paraprotein or light chain (AL amyloid)

Question 30

What can the amyloid cause depending on where it forms?

Answer 30

* Nephrotic syndrome * Cardiac failure * Carpal tunnel syndrome * Autonomic neuropathy * Cutaneous infiltration

Question 31

What is the commonest type of myeloma?

Answer 31

IgG myeloma

Question 32

What might you see on a peripheral blood film in someone with multiple myeloma?

Answer 32

Rouleaux formation

Question 33

What would you see with protein electrophoresis in someone with multiple myeloma?

Answer 33

raised concentrations of monoclonal IgA/IgG proteins will be present in the serum in the urine, they are known as Bence Jones proteins

Question 34

Wat would you find in a bone marrow aspiration in someone with multiple myeloma?

Answer 34

Significant increase in plasma cells

Question 35

What is the now the recommended imaging used in multiple myeloma?

Answer 35

Whole-body MRI