Multiple Myeloma Quiz
Created by Connor Bohlken and Chris Galbraith
Edited by Dr. Paris Ingledew
You have traveled far and wide to do an elective hematology rotation with physician extraordinaire, Dr. Mile Loma: fanatic of all things to do with blood or Nintendo. Of course, they are also known to ask lots and lots of questions in a kind helpful manner. On arrival, a question is quickly fired your way: “What are the two most common immunoglobulins produced by myeloma cells”? You answer:
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Which of the following is NOT a risk factor for Multiple Myeloma?
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You have been enjoying your first couple of days with Dr. Loma, and are beginning to think maybe hematology is for you. Today Dr. Loma wants to focus on classification of multiple myeloma, a topic many students have struggled with in the past. To begin, he wants to discuss the precancerous condition known as monoclonal gammopathy of undetermined significance (MGUS). In particular, which of the following is NOT seen with MGUS?
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Dr. Loma seems impressed by your answer. He has always struggled to show that he is impressed with students, so he opts instead to ask another question. Oddly, this may be his way expressing his happiness with regards to your interest in Hematopathology. He states: following MGUS, the next step in the spectrum is Smoldering Multiple Myeloma, can you tell me which of the following is key in the differentiation of Smoldering Multiple Myeloma (SMM) and Active Multiple Myeloma (AMM)?
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Something about Dr. Loma seems happy. Perhaps, it is how well you are answering his questions. Perhaps it is that his Toon Link Amiibo has finally arrived. Either way he sees you looking at him and takes the opportunity to ask you another question. “Which of the following is a sign of end organ damage in multiple myeloma”?
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Of the following patients, which should you be most concerned about Multiple Myeloma?
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You are R2 family practice resident working in clinic. You have a patient who has “CRAB” symptoms which has led you to highly suspect Multiple Myeloma (MM). You ordered a Serum Protein Electrophoresis (SPEP) and a Urine Protein Electrophoresis (UPEP) to look for M-proteins but these came back as negative… Your suspicion still remains high for MM. What test could you still order which would lead to the diagnoses of MM?
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You are working again with Dr. Loma. Today he wants to discuss staging of multiple myeloma. In particular he wants to focus on the Durie and Salmon Staging System, and figures the International Staging System can be tackled another day. He asks you which of the following is NOT part of the Durie and Salmon Staging System. You answer:
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You are nearing the end of your time with Dr. Loma. Both of you are rather sad, as during lunch breaks you had taken to playing Super Smash Bros together in the lounge. Dr. Loma wants to make sure you continue to see interesting patients. He hands you the case of Mrs. Crabbi, a nice lady despite her name. She presented recently to Dr. Loma’s clinic with bone pain, abdominal pain, frequent urination, constipation, fatigue, and weight loss. A diagnosis of active multiple myeloma was established and Mrs. Crabbi would like to pursue treatment. Dr. Loma asks you what would be an appropriate first treatment modality. You answer:
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Which of the following patients with MM has the best prognosis?
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