Myeloma

Question 1

What are the two main roles of B cells?

Answer 1

Antibody production

Antigen-presenting cells

Question 2

What are immunoglobulins?

Answer 2

Antibodies produced by B cells and plasma cells

Question 3

Immunoglobulins are made up of what?

Answer 3

2 heavy and 2 light chains

Question 4

Which immunoglobulins are monomers?

Answer 4

IgE
IgG
IgD

Question 5

Which immunoglobulin has a dimer shape?

Answer 5

IgA

Question 6

What is the structure of IgM?

Answer 6

Pentamer

Question 7

The variable element of immunoglobulins is generated from what?

Answer 7

VDJ region recombination in early development

Question 8

A normal B lymphocyte will fully mature into which cell?

Answer 8

Plasma cell

Question 9

A plasma cell is essentially a factory cell which produces what?

Answer 9

Antibodies

Question 10

On H&E, a plasma cell’s nucleus has what appearance?

Answer 10

Clock face nucleus

Question 11

What occurs in a monoclonal rise in immunoglobubins?

Answer 11

One B cell produces multiple immunoglobulins of the same structure and specificity

Question 12

What is a monoclonal immunoglobulin known as?

Answer 12

Paraprotein

Question 13

What is a paraprotein a marker of?

Answer 13

Underlying clonal B cell disorder

Question 14

What is used to detect immunoglobulins?

Answer 14

Serum electrophoresis

Question 15

What is used to classify the abnormal protein band in immunoglobulins?

Answer 15

Serum immunofixation

Question 16

Excess light chain production by plasma cells can leak into the urine as what?

Answer 16

Bence Jones protein

Question 17

Give some direct tumour cell effects of myeloma

Answer 17

Bone lesions/pain
Hypercalcaemia
Marrow failure

Question 18

Give some paraprotein mediated effects of myeloma

Answer 18

Renal failure

Immunosuppression

Question 19

How is myeloma classified?

Answer 19

By the type of antibody produced by the plasma cell

Question 20

What is the most common type of myeloma?

Answer 20

IgG

Question 21

What are the main symptoms of hypercalacaemia?

Answer 21

Stones
Bones
Abdominal groans
Psychiatric moans

Question 22

How does myeloma affect the kidneys?

Answer 22

Excess light chains causes tubular cell damage

Question 23

What is the mainstay treatment for myeloma?

Answer 23

Combination chemotherapy

Question 24

What treatments are available for myeloma?

Answer 24

Corticosteroids
Cyclophosphamide
Lenalidomide/thalidomide
High dose chemo/stem cell transplant

Question 25

What is used to monitor response to myeloma treatment?

Answer 25

Paraprotein levels

Question 26

What can be used for symptom control in myeloma?

Answer 26

Opiate analgesia Local radiotherapy Bisphosphonates

Question 27

What is monoclonal gammopathy of undetermined significance?

Answer 27

When paraproteins are in the blood but there is no evidence of myeloma end organ damage

Question 28

What occurs in amyloidosis?

Answer 28

A light chain mutation causes an insoluble beta-pleated sheet to precipitate in tissues

Question 29

How can organs be damaged in amyloidosis?

Answer 29

``` Nephrotic syndrome Cardiomyopathy Hepatomegaly Malabsorption CNS damage ```

Question 30

How is amyloidosis diagnosed?

Answer 30

Congo red stain on organ biopsy

Question 31

Waldenstrom's macroglobulinaemia is caused by which paraprotein?

Answer 31

IgM

Question 32

In Waldenstrom's macroglobulinaemia there is a clonal disorder of which cells?

Answer 32

Lymphocytes and plasma cells

Question 33

What are the effects of the tumour in Waldenstrom's macroglobulinaemia?

Answer 33

Lymphadenopathy Splenomegaly Marrow failure

Question 34

Hyperviscosity caused by IgM paraprotein can cause what symptoms??

Answer 34

Fatigue Visual disturbance Bleeding Cardiac failure

Question 35

How is Waldenstrom's treated?

Answer 35

Chemotherapy | Plasmapheresis