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12 Cards in this Set

  • Front
  • Back
Hallmark feature of plasma cell dyscrasia:

M-protein in serum or urine without identifiable disease:

MGUS appearance on electrophoresis?
isolated peak of M-protein (single IG) on serum electrophoresis

MGUS - monoclonal gammopathy of unknown significance

"shoulder" on gamma peak
75% of MGUS secrete what IG?

Treatment for MGUS?

What are some critera for solitary plasmacytoma of bone?
IGG

supportive care only - NOT CANCER

single area of bone destruction, negative bone survey, MRI, normal marrow, no/low level of M-protein
Clinical presentation of indolent myeloma?

When should you treat indolent myeloma? Why?
asymptomatic, coincidental dx

don't treat until you see symptoms; pts still sensitive to chemo
Disseminated malignancy, proliferation of transformed plasma cells in bone marrow:

Median age of onset of multiple myeloma? Morbidity?

Pathophysiology of multiple myeloma?
multiple myeloma

median age 60; 75% morbidity

neoplasm originates from single malignant plasma cell, progressive growth into the marrow
Clinical manifestation of muyltiple myeloma?

How is the hypercalcemia from multiple myeloma different from other cancers?
inhibition of erythropoiesis, marrow structure altered, *LYTIC BONE LESIONS* from OAF-mediated resorption of bone

result of OAF activity/bone resorption, not PTH-related protein
Most common infections in MM?

Complications of M-protein?

Most common cause of renal failure?

Hallmark appearance of renal failure?
pneumonias, pyelonephritis

hyperviscosity, coagulation problems, cryoglobulin --> Raynaud's, gangrene

Calcium nephropathy

"blocked pipe" - distal tubules blocked by eosinophilic casts
Classic triad for diagnosis of MM?

How do you evaluate for MM?
marrow plasmacytosis, lytic bone lesions, serum/urine M-protein

CBC, renal function, serum Ca++/albumin, *skeletal XR survey*, SPEP, UPEP
Which plasma cell dyscrasias should you not treat?

Which one is treated with radiotherapy?

What is the new standard of care for MM?

What drug is a purified form of thalidomide?

Complications of thalidomide?
indolent myeloma, MGUS

solitary plasmacytoma

thalidomide/dexamethasone

lenalidomide

somnolence, neuropathy, fluid retention, weight gain
Explain hypercalcemia and MM.

What should you consider in a MM patient with developing neuro symptoms in LE's + back pain? Which test should you order? How do you treat it?
25% of patients get high Ca++, ionized Ca++ correlated better than total Ca++;
Modest increases can be treated with hydration; high levels (>16 mg/dl) - medical emergency

extradural cord compression - EMERGENCY - order MRI

Tx with high dose steroids + radiotherapy
Plasma cell malignancy in which affected cells screte IGM, lymphadenopathy and hepatosplenomegaly:

What is the major feature? What do you see in patient's eyes?
Waldenstrom's Macroglobulinemia

hyperviscosity syndrome - segmental dilation of reitinal veins
Disease characterized by lymphadenopathy, fever, anemia, weakness, palatal edema involving Waldeyer's ring:

Most common heavy chain disease, related to Mediterranean lymphoma:
Gamma Heavy Chain disease (Franklin's disease)

Alpha Heavy Chain disease (Seligmann's disease)
Systemic illness resulting from deposition of B-pleated sheets of IG fragments:

Clinical features?

sign from shoulder muscle infiltration:

sign from periorbital hemorrhage:
amyloidosis

organ infiltration - GI, renal, cardiac

"Shoulder pad sign"

"raccoon sign"