oncology
Multiple Myeloma
advanced
6 min
28 marks
6 questions
Clinical Scenario
A 68-year-old man presents with progressive low back pain for 3 months. He feels fatigued and has lost 8kg. He has noticed increased thirst and urination. On examination, he appears pale and has tenderness over the lumbar spine. X-rays show multiple lytic lesions throughout the spine with a compression fracture at L2. Laboratory tests show normocytic anemia (Hb 95), hypercalcemia (3.2), elevated creatinine (180), and total protein 95 with low albumin.
Lateral skull radiograph demonstrating classic multiple punched-out lytic lesions ('raindrop skull') characteristic of multiple myeloma. The lesions have well-defined margins without sclerotic rim. No periosteal reaction. Similar lesions are present throughout the axial skeleton. SPEP shows M-spike and bone marrow biopsy confirms >10% clonal plasma cells.
Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License
Questions
Question 1 (4 marks)
Describe the clinical features and diagnostic criteria for multiple myeloma.
Question 2 (5 marks)
What is the investigation workup for suspected myeloma?
Question 3 (6 marks)
Describe the orthopaedic management of myeloma bone disease.
Question 4 (5 marks)
Compare multiple myeloma and solitary plasmacytoma.
Question 5 (4 marks)
Discuss medical management and prognosis.
Question 6 (4 marks)
What are the complications of myeloma?
Exam Day Cheat Sheet
Must Mention
- •CRAB: Calcium, Renal, Anemia, Bone
- •M-spike on SPEP, ≥10% plasma cells BM
- •Bone scan FALSE NEGATIVE (no osteoblasts)
- •Punched-out lytic lesions, no sclerosis
- •Solitary plasmacytoma: radiation may cure
- •Haematology leads treatment
Common Pitfalls
- •Using bone scan
- •Missing CRAB
- •Wrong plasma cell %
- •Not knowing plasmacytoma
- •Missing false negative scan
- •Wrong treatment lead