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PA H11 | Plasma Cell Dyscrasias (Multiple Myeloma) — Practice Quiz
Practice
10 questions · Untimed · Unlimited attempts
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Multiple myeloma is best defined as a malignant neoplasm of:
A
Immature B-lymphoblasts in bone marrow
B
Terminally differentiated plasma cells secreting a monoclonal immunoglobulin
✓
C
Follicular centre B-cells in lymph nodes
D
Natural killer cells in peripheral blood
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Which set of findings constitutes the 'CRAB' criteria used to diagnose symptomatic multiple myeloma?
A
Cough, Renal failure, Anaemia, Bone pain
B
HyperCalcaemia, Renal insufficiency, Anaemia, Bone lesions
✓
C
HyperCalcaemia, Raised ESR, Albuminuria, Bone lesions
D
Coagulopathy, Renal failure, Autoimmunity, B-symptoms
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A 62-year-old man presents with back pain and fatigue. Serum protein electrophoresis (SPEP) shows a sharp, narrow peak in the gamma region. Which additional test best characterises the specific heavy- and light-chain class of this abnormal protein?
A
Serum immunofixation electrophoresis
✓
B
Serum protein electrophoresis repeated with higher voltage
C
Urine dipstick for proteinuria
D
Flow cytometry of peripheral blood
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Bence-Jones protein found in the urine of multiple myeloma patients consists of:
A
Intact monoclonal IgG molecules filtered by the glomerulus
B
Free monoclonal light chains (κ or λ) filtered by the glomerulus
✓
C
Albumin lost due to glomerular basement membrane damage
D
β2-microglobulin shed from plasma cell surfaces
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A peripheral blood smear from a suspected myeloma patient shows red cells arranged in long chains resembling a stack of coins. This finding is called:
A
Spherocytosis
B
Rouleaux formation
✓
C
Schistocytosis
D
Target cell formation
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Bone marrow examination is central to the diagnosis of multiple myeloma. The minimum percentage of clonal plasma cells required to diagnose myeloma (in the presence of end-organ damage) is:
A
>2%
B
>5%
C
>10%
✓
D
>25%
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Skeletal X-rays in multiple myeloma classically show:
A
Sclerotic (dense) bony lesions throughout the axial skeleton
B
Periosteal new bone formation (sunray appearance) at tumour margins
C
Multiple 'punched-out' lytic lesions, most prominent in skull, spine, pelvis, and ribs
✓
D
Bilateral symmetric osteoarthritis of large joints
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In multiple myeloma, serum β2-microglobulin (β2M) is used primarily as a:
A
Diagnostic marker to confirm monoclonality
B
Prognostic marker — elevated levels correlate with high tumour burden and worse survival
✓
C
Treatment response marker replacing serum-free light chains
D
Screening test to distinguish MM from reactive plasmacytosis
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A 58-year-old woman is found incidentally to have a serum M-protein of 1.8 g/dL (IgG-κ) on electrophoresis done for fatigue. Bone marrow biopsy shows 7% plasma cells. Haemoglobin is 13.2 g/dL, calcium is normal, renal function is normal, and skeletal survey shows no lytic lesions. The most accurate diagnosis is:
A
Symptomatic multiple myeloma requiring immediate chemotherapy
B
Monoclonal gammopathy of undetermined significance (MGUS)
✓
C
Waldenström macroglobulinaemia
D
Smouldering multiple myeloma (asymptomatic myeloma)
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A 70-year-old man with known multiple myeloma presents acutely with severe headache, blurred vision, and epistaxis. Blood film shows marked rouleaux. He has an IgM paraprotein of 5.8 g/dL on immunofixation (a finding atypical for standard MM). This clinical picture suggests complication by:
A
Hypercalcaemic crisis requiring bisphosphonate infusion
B
Hyperviscosity syndrome, most typically associated with Waldenström macroglobulinaemia and IgM paraprotein
✓
C
Acute renal failure due to cast nephropathy
D
Spinal cord compression from a vertebral plasmacytoma
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