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:
IgG and IgA
IgA and IgD
IgD and IgE
IgE and Light Chains
Light Chains and IgG
Which of the following is NOT a risk factor for Multiple Myeloma?
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?
M-Protein Level of 20g/L
IgG Type M-Protein
IgA Type M-Protein
Absence of Tumors
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)?
The presence of high levels of M-Protein in AMM.
Plasma cells make up more than 10% of the blood cells in the bone marrow in AMM.
The free light chain ratio is more than 90 in AMM.
Plasma cells make up more than 50% of the blood cells in the bone marrow in AMM.
The presence of end organ damage in AMM.
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”?
Of the following patients, which should you be most concerned about Multiple Myeloma?
25 year old male, bilateral swelling around the face and neck, following a dental infection.
58 year old female, presenting with vague abdominal and lower back pain, weakness, and pruritus.
62 year old male, severe abdominal pain, diarrhea, and a small perianal fistula.
28 year old female, just returned from sub-Saharan Africa, recurrent fevers.
42 year female, known SLE, new onset periorbital edema and +++ protein on dipstick.
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?
Serum Free Light Chain Assay
Anti-tissue Transglutamanase Antibodies
Thyroid Stimulating Hormone
Anti-Cyclic Citrullinated Peptide
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:
Urine or Blood M-protein Level
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:
Hematopoietic Stem Cell Transplant
Which of the following patients with MM has the best prognosis?
Patient A: Stage I MM, high LDH levels.
Patient B: Stage I MM, high creatinine levels.
Patient C: Stage I MM, low albumin levels.
Patient D: Stage I MM, high beta-2 microglobulin levels.
Patient E: Stage I MM, low LDH levels.
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