Question 1

Bacterial infection is the most common cause of death in multiple myeloma patients due to __________.

Accepted Answer

Multiple myeloma patients have a weakened immune system due to decreased production of normal immunoglobulin, which makes them more susceptible to bacterial infections. This is the most common cause of death in these patients. Increased production of normal immunoglobulin is not a cause of bacterial infections, and anemia is not directly related to bacterial infections.

Question 2

Macroglobulinemia refers to the overproduction of monoclonal __________.

Accepted Answer

Macroglobulinemia refers specifically to the overproduction of monoclonal IgM.

Question 3

Which name is given to multiple myeloma in which there is a low rate of cell turnover at time of diagnosis, and there is no evidence of abnormalities such as lytic bone lesions, hypercalcemia, or significant marrow compromise?

Accepted Answer

Smoldering myeloma is a subtype of multiple myeloma in which there is a low rate of cell turnover at the time of diagnosis and no evidence of abnormalities such as lytic bone lesions, hypercalcemia, or significant marrow compromise. It is sometimes referred to as asymptomatic myeloma or indolent myeloma. Treatment is usually deferred until symptoms or disease progression occur.

Question 4

Myeloma patients treated with alkylating agents have a significant risk of developing treatment-related __________.

Accepted Answer

Alkylating agents are known to increase the risk of developing secondary cancers, particularly acute myelogenous leukemia.

Question 5

__________ light chains are most commonly found in patients with myeloma-related amyloidosis.

Accepted Answer

Lambda light chains are most commonly found in patients with myeloma-related amyloidosis. Epsilon, delta, and mu light chains are not typically associated with this condition.

Question 6

Which variant of multiple myeloma produces a malignant clone of plasma cells that are too immature to secrete immunoglobulins and does not produce an M-spike by electrophoretic studies?

Accepted Answer

Nonsecretory myeloma is a variant of multiple myeloma in which there is a malignant clone of plasma cells that are too immature to secrete immunoglobulins and do not produce an M-spike by electrophoretic studies. This type of myeloma is diagnosed based on other laboratory and imaging findings, such as anemia, hypercalcemia, bone lesions, and elevated serum levels of beta-2 microglobulin and lactate dehydrogenase.

Question 7

A __________ is a protein that precipitates on exposure to cold, causing such symptoms as Raynaud's phenomenon and thrombosis of small arteries in Waldenström's macroglobulinemia.

Accepted Answer

Cryoglobulin is a protein that undergoes precipitation on exposure to cold temperatures. This can lead to the formation of clumps that can block small blood vessels, causing symptoms such as cold sensitivity, Raynaud's phenomenon, and thrombosis. Cryoglobulins are commonly associated with certain diseases such as Waldenström's macroglobulinemia, hepatitis C, and autoimmune disorders. Microglobulins and gammaglobulins are different types of proteins that are not specifically associated with cold-induced precipitation.

Question 8

What is the etiology of macroglobulinemia?

Accepted Answer

Macroglobulinemia is caused by the loss of regulation of a clone of cells that are staged between the mature lymphocytes and early plasma cells, leading to the production of excessive amounts of immunoglobulin M (IgM) monoclonal antibodies. This results in thickening of the blood and can lead to various complications such as hyperviscosity syndrome. There is no involvement of granulocytic cells in the etiology of macroglobulinemia.

Question 9

The presence of __________ circulating in the blood is a late finding seen in advanced multiple myeloma.

Accepted Answer

Plasma cells are the malignant cells responsible for multiple myeloma, and their proliferation leads to the characteristic symptoms such as bone pain and pathological fractures. However, the presence of these cells in the blood is not typically seen until the late stages of the disease when extensive bone marrow involvement has already occurred.

Question 10

β₂-Microglobulin used in conjunction with serum __________ may be the best system for staging myeloma based on prognosis.

Accepted Answer

Microglobulin is a protein that is produced by myeloma cells and is released into the blood. The levels of β₂-microglobulin are considered to be a reliable indicator of the tumor burden in multiple myeloma. However, the use of serum albumin along with β₂-microglobulin has been found to be a better predictor of survival and disease progression in myeloma patients. Therefore, the best choice would be to use β₂-microglobulin in conjunction with serum albumin for staging myeloma based on prognosis.

Question 11

A patient suspected of multiple myeloma presents with the following results: Hb 12 g/dL; corrected serum calcium, 11 mg/dL; one lytic bone lesion; and small M-spike by SPEP, with IgG <5 g/dL; urine light chains 2 g/24 hr. Which stage in multiple myeloma is consistent with the given results?

Accepted Answer

The patient's presentation is consistent with low myeloma mass according to the criteria which include a hemoglobin level >10 g/dL, serum calcium normal or slightly elevated, one lytic bone lesion, small M-spike by serum protein electrophoresis (SPEP), and urine light chains <4 g/24 hr.

Question 12

Neurologic manifestations such as blurred vision, headaches, and episodes of consfusion occur in patients with Waldenström's macroglobulinemia due to __________.

Accepted Answer

Neurologic manifestations in Waldenström's macroglobulinemia are due to hyperviscosity syndrome caused by excess amounts of IgM in the blood. This can lead to decreased blood flow to the brain and other organs, resulting in symptoms such as blurred vision, headaches, and confusion. Splenomegaly, bone lesions, and renal failure are not typically associated with neurologic manifestations in Waldenström's macroglobulinemia.

Question 13

Which multiple myeloma manifestation describes the formation of abnormal proteins in organ systems due to deposition of immunoglobulin light chains leading to kidney and renal dysfunction?

Accepted Answer

Amyloidosis is the deposition of abnormal proteins, such as immunoglobulin light chains, in different organs that lead to dysfunction. This condition is commonly associated with multiple myeloma, where plasma cell overproduction results in the overproduction of light chains. When these chains accumulate and deposit in organs, it damages the organ's structure and function. Kidney dysfunction is one of the most common conditions associated with amyloidosis in multiple myeloma patients.

Question 14

Which monoclonal gammopathy occurs in the sixth to eighth decade of life and is characterized by the presence of an M-spike with IgG < 3.5 g/dL, IgA < 20 g/dL, urinary light chains < 1.0 g/24 hr, and < 10% plasma cells in the bone marrow?

Accepted Answer

The description matches with the diagnostic criteria of monoclonal gammopathy of undetermined significance (MGUS), which is a common asymptomatic disorder observed in the elderly population. Other monoclonal gammopathies such as multiple myeloma, Waldenström's macroglobulinemia, and solitary plasmacytoma have different clinical and laboratory presentations.

Question 15

What is the cause of decreased production of formed elements in the marrow (red cells, white cells, platelets) seen in patients with multiple myeloma?

Accepted Answer

Multiple myeloma is a malignancy of plasma cells that leads to the replacement of normal bone marrow tissue with a malignant plasma cell mass. This results in a decrease in the production of all types of formed elements in the marrow, including red cells, white cells, and platelets. Stem cell defects and growth factor deficiencies may also play a role in the pathogenesis of multiple myeloma, but they are not the primary cause of the decreased production of formed elements.

Question 16

Myeloma cells may diffusely infiltrate organs such as the __________ resulting in enlargement and dysfunction.

Accepted Answer

Myeloma cells have the potential to infiltrate various organs leading to organ enlargement and dysfunction. The liver, spleen, and kidney are among the organs that can be affected by myeloma cells. Therefore, the best choice is D, all of the above.

Question 17

The clone of cells produced in Waldenström's macroglobulinemia is an intermediate stage of development between the mature lymphocytes and the early plasma cells. These cells are commonly referred to as:

Accepted Answer

The answer of The clone of cells produced in Waldenström's...

Question 18

Which light chain protein is characteristically present in multiple myeloma?

Accepted Answer

Bence-Jones proteins are characteristically present in the urine of patients with multiple myeloma. They are light chain proteins produced by the malignant plasma cells.

Question 19

Multiple myeloma can be differentiated from primary plasma cell leukemia by which of the following?

Accepted Answer

The answer of Multiple myeloma can be differentiated from primary...

Question 20

A patient suspected of multiple myeloma presents with the following results: Hb 8.0 g/dL; corrected serum calcium, 11 mg/dL; two lytic bone lesions, and a large M-spike by SPEP, with IgG 8 g/dL. Which stage in multiple myeloma is consistent with the given results?

Accepted Answer

The given results indicate the presence of lytic bone lesions, a high M-spike by SPEP, and elevated corrected serum calcium levels, which are consistent with the criteria for Stage III or high myeloma mass. The low Hb level is also indicative of disease severity. Therefore, choice C is the best option.

Quiz 22: Multiple Myeloma and Related Plasma Cell Disorders