Myeloma

Question 1

myeloma =

Answer 1

clonal proliferation of abnormal proliferating plasma cells that are producing a monoclonal paraprotein

Question 2

main Igs involved in myeloma

Answer 2

IgG -50%

IgA -20%

Question 3

if IgM raised more likely

Answer 3

Waldenstrom’s macroglobulinaemia

Question 4

mean age of presentation of myeloma=

Answer 4

60

Question 5

bone destruction in myeloma leads to

Answer 5

• fractures of long bones, vertebral collapses
• back ache
• hypercalcaemia
• pepperpot skull

Question 6

pepperpot skull =

Answer 6

punched out lesions of the skull = pathognomonic of myeloma

Question 7

Old CRAB for myeloma

Answer 7

old age 
calcium elevated 
renal failure 
anaemia 
bone lytic lesions

Question 8

why do you get kidney failure in myeloma

Answer 8

deposition of light chains in tubules

Question 9

what happens to the plasma in myeloma

Answer 9

hyper-viscosity (ESR high)

Question 10

bad prognostic sign for myeloma

Answer 10

beta 2 microglobulin raised

Question 11

urine findings of myeloma

Answer 11

bence jones proteins (excretion of light chains)

Question 12

blood film of myeloma

Answer 12

rouleaux RBCs (coated Ig) =RBCs stick together forming chains

Question 13

marrow aspiration of myeloma shows

Answer 13

infiltration with plasma cells

Question 14

diagnostic criteria for myeloma requires

Answer 14

1 major + 1 minor

or 3 minor

Question 15

major criteria for myeloma (3)

Answer 15

• plasmacytoma
• 30% plasma cells in bone marrow sample
• elevated levels of M protein in urine or blood

Question 16

minor criteria for myeloma (4)

Answer 16

• 10-30% plasma cells in bone marrow
• minor elevations in levels of M protein in blood or urine
• osteolytic lesions
• low levels of Ig in blood

Question 17

myeloma curable?

Answer 17

no

Question 18

first line myeloma treatment

Answer 18

thalidomide