In which of the following individuals would a clinician most suspect multiple myeloma as a diagnosis?
A)
A 40-year-old man who has had three broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated
B)
A 68-year-old former coal miner who has white cell levels exponentially higher than normal ranges
C)
An 81-year-old male resident of a long-term care home who has an uncommon bacterial pneumonia and who is unable to produce a fever
D)
A 70-year-old woman whose blood work reveals large numbers of immature granulocytes
Ans:
A
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The main sites involved in multiple myeloma are the bones and bone marrow. In addition to the abnormal proliferation of marrow plasma cells, there is proliferation and activation of osteoclasts that lead to bone resorption and destruction. This increased bone resorption predisposes the individual to pathologic fractures and hypercalcemia. Many patients also present with renal insufficiency. Leukostasis, susceptibility to infection, and disorders of granulocyte development are not hallmarks of multiple myeloma.
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