Name: Jack Martin

Theme: Myeloma

OPTION LIST

A	Multiple myeloma	I
B	Waldenstrom’s macroglobulinaemia	J
C	Primary amyloidosis	K
D	Secondary amyloidosis	L
E	Monoclonal gammopathy of undetermined significance	M
F	Metastatic carcinoma	N
G	Chronic lymphocytic leukaemia	O
H		P

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 52 yr old woman who has a 5 yr history of rheumatoid arthritis and has recently been found to have proteinuria. Further examination revealed hepatosplenomegaly. A rectal biopsy stained with Congo Red showed apple green birefringence in polarised light.

2. A 60 yr old woman presents to her GP with fatigue and bone pain. Examination of her bone marrow demonstrated >10 % plasma cells, and a monoclonal protein in the serum. Further investigations showed a hypercalcaemia.

3. A 65 yr old man presents to his GP with general malaise, weight loss and visual disturbances that he likens to looking through a watery car windscreen. On examination he has peripheral lymph node enlargement. Protein electrophoresis shows an IgM paraprotein.

4. A 73 yr old man is shown to have paraprotein in blood <2g/L. Further investigations reveal no renal impairment or bone destruction.

5. A 60 yr old woman presents to her GP with shortness of breath and ankle oedema. When examined the patient has bilateral weakness and paraesthesia of her hands. Investigations revealed a monoclonal proliferation of plasma cells and the presence of Bence Jones proteins.

ANSWERS

1. D

2. A

3. B

4. E

5. C