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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.
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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