Pathology EMQ template.

Name: Ashwin Krishnamoorthy

Theme: MULTIPLE MYELOMA

 

OPTION LIST

 

A	Asymptomatic (smouldering) myeloma	I	Heavy Chain disease
B	Chronic Alcohol use	J	Solitary plasmacytoma
C	Amyloidoisis	K	β2-Microglobulin
D	Hyperviscosity syndrome	L	Albumin
E	Thrombocytopenia	M	Melphalan, prednisolone and thalidomide (MPT)
F	Hypercalcaemia of myeloma	N	Bortezomib
G	Renal Failure	O	Allogeneic Stem Cell Transplant (SCT)
H	Monoclonal gammopathy of undetermined significance (MGUS)	P	Autologous Stem Cell Transplant (SCT)

 

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

 

1.  A 76-year old retired accountant with a family history of polycystic kidney disease presents to his GP with intermittent back pain and vomiting. He states that he has been drinking a lot of fluids recently and has also been visiting the toilet more often.       Urea: 25mmol/l, Creatinine: 130µmol/l  

 

2. A 55-year old homeless male is found, on investigation for peripheral neuropathy, to have a monoclonal immunoglobulin or “M-band” on serum electrophoresis, according to your keen and annoying Firms partner to be indicative of a “benign paraproteinaemia”. No other signs of organ or tissue damage are present. Investigation of his urine sample shows free light chains present.

 

3. A 52-year old Greek female presents with pale, foul-smelling stools, intermittent abdominal cramps, and a feeling of “bloatedness”.

 

4.  A 72-year old retired publican with a long history of alcohol use presents having fainted at the retirement home he lives in. He appears slightly confused and is lethargic, yet complains of tingling in his fingers and profound difficulty in “moving his muscles”. The Registrar present suggests carrying out a fundoscopy.

 

5. A 42-year old engineer has recently been diagnosed with a plasma cell myeloma. Your Consultant informs him that there is only one potentially completely curative treatment option open to him but it carries a high risk of procedure-related mortality as well as recurrence. 

 

ANSWERS

1. G

2. A

3. I

4. E

5. O