Deck 22: Multiple Myeloma and Related Plasma Cell Disorders

Question 1

Wright's stains of peripheral blood smears from some patients with myeloma are bluish. This coloration is due to increased background staining of the high level of __________ in the plasma portion of the blood.

A) Fibrinogen
B) Immunoglobulin
C) Calcium
D) Lymphocytes
E) None of the above

Answer 1

Immunoglobulin

Question 2

A 63-year-old black man presents with an elevated ESR, 10-30% plasma cells in the bone marrow, M-spike by SPEP, and 4.0 g/dL of serum IgG by radial diffusion. Which plasma cell disorder is implicated?

A) Solitary plasmacytoma
B) Multiple myeloma
C) Waldenström's macroglobulinemia
D) Alpha heavy chain disease
E) Gamma heavy chain disease

Answer 2

Multiple myeloma

Question 3

What is the definition of a solitary plasmacytoma?

A) A benign clone of cells localized to one area
B) A malignancy composed of a clone of cells that is systemically exacerbated
C) A malignancy composed of a clone of cells localized to one area
D) A benign clone of cells systemically exacerbated
E) None of the above

Answer 3

A malignancy composed of a clone of cells localized to one area

Question 4

The plasma cell disorders are characterized by:

A) Excess production of immune globulins
B) Decrease production of immune globulins
C) Normal production of immune globulins
D) Decreased erythrocyte sedimentation ratio
E) None of the above

Question 5

Immune globulins (antibodies) are proteins produced by __________.

A) B lymphocytes
B) T lymphocytes
C) NK cells
D) Granulocytes
E) None of the above

Question 6

An evaluation of multiple myeloma includes:

A) Bone marrow biopsy
B) SPEP
C) Immunoelectrophoresis and immunofixation
D) Serum free light chain (FLC) assays
E) All of the above

Question 7

Serum protein electrophoresis (SPEP) demonstrates the absence of a gamma peak. This finding is consistent with which plasma cell disorder?

A) IgG myeloma with M-spike
B) Hypergammaglobulinemia
C) Hypogammaglobulinemia
D) Waldenström's macroglobulinemia
E) None of the above

Question 8

Which laboratory test(s) should be ordered to evaluate a patient suspected of having plasma cell disorder?

A) Serum protein electrophoresis (SPEP)
B) Calcium
C) Blood urea nitrogen (BUN)
D) Erythrocyte sedimentation (ESR)
E) All of the above

Question 9

In multiple myeloma, a plasma cell will sometimes contain clumps of aggregated immunoglobulin that stain red with Wright-Giemsa stain. These aggregates are referred to as:

A) Russell bodies
B) Howell-Jolly bodies
C) Flame cells
D) Basophilic stippling
E) Döhle bodies

Question 10

When rouleaux is present, the erythrocyte sedimentation rate (ESR) will be ____________.

A) Increased
B) Normal
C) Decreased
D) Variable
E) None of the above

Question 11

Which test is the most useful predictor of tumor load and disease activity, and in predicting the prognosis of multiple myeloma patients?

A) Albumin
B) LDH
C) BUN
D) Calcium
E) Beta-2-microglobulin

Question 12

Multiple myeloma affects which age group?

A) Children
B) Elderly
C) Newborns
D) Adolescents
E) None of the above

Question 13

Which class of immunoglobulin has the largest molecular weight?

A) IgG
B) IgA
C) IgM
D) IgD
E) IgE

Question 14

What does immunoelectrophoresis determine?

A) The specific antibody class present in the serum
B) The presence or absence of a lipoprotein
C) Osteoblast activating factor
D) 24-hour urine protein
E) None of the above

Question 15

Another name used in describing the plasma cell disorders is __________.

A) Lymphoma
B) Myeloproliferative disease
C) Monoclonal gammopathies
D) All of the above
E) None of the above

Question 16

When evaluating a plasma cell disorder, which immunologic technique is capable of quantitating a monoclonal immunoglobulin?

A) Radial immunodiffusion
B) Immunoelectrophoresis
C) Immunofixation
D) SPEP
E) All of the above

Question 17

What signs and symptoms are consistent with plasma cell disorders?

A) Fatigue
B) Hypercalcemia
C) Bone pain
D) Serum hyperviscosity
E) All of the above

Question 18

The plasma cell is the fully differentiated __________.

A) T lymphocyte
B) B lymphocyte
C) Null killer (NK) cell
D) Granulocyte
E) None of the above

Question 19

Urine immunoelectrophoresis is used to distinguish between __________ and __________ light chains in urine.

A) Kappa/epsilon
B) Kappa/lambda
C) Kappa/mu
D) Gamma/lambda
E) None of the above

Question 20

What is a plasmacytoma?

A) A disease affecting the blood clotting process
B) A fully differentiated T lymphocyte
C) A fully differentiated B lymphocyte
D) Tumors composed of plasma cells
E) None of the above

Question 21

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

A) Decreased production of normal immunoglobulin
B) Increased production of normal immunoglobulin
C) Anemia
D) All of the above
E) None of the above

Question 22

Macroglobulinemia refers to the overproduction of monoclonal __________.

A) IgG
B) IgM
C) IgE
D) IgD
E) IgA

Question 23

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?

A) Classic multiple myeloma
B) Smoldering myeloma
C) Advanced myeloma
D) Nonsecretor myeloma
E) None of the above

Question 24

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

A) Acute myelogenous leukemia
B) Chronic myelogenous leukemia
C) Chronic lymphocytic leukemia
D) Acute lymphoblastic leukemia
E) None of the above

Question 25

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

A) Epsilon
B) Delta
C) Lambda
D) Mu
E) None of the above

Question 26

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?

A) Smoldering myeloma
B) Classic multiple myeloma
C) Advanced myeloma
D) Nonsecretory myeloma
E) None of the above

Question 27

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.

A) Microglobulin
B) Macroglobulin
C) Cryoglobulin
D) Gammaglobulin
E) None of the above

Question 28

What is the etiology of macroglobulinemia?

A) Loss of regulation of a clone of immature lymphocytes
B) Loss of regulation of a clone of cells that are staged between the mature lymphocytes and early plasma cells
C) Loss of regulation of granulocytic cells
D) All of the above
E) None of the above

Question 29

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

A) Megakaryocytes
B) Plasma cells
C) Neutrophils
D) Eosinophils
E) None of the above

Question 30

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

A) α₂ macroglobulin
B) Albumin
C) Calcium
D) Creatine
E) None of the above

Question 31

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?

A) Low myeloma mass
B) Intermediate myeloma mass
C) High myeloma mass
D) All of the above
E) None of the above

Question 32

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

A) Hyperviscosity syndrome
B) Splenomegaly
C) Bone lesions
D) Renal failure
E) None of the above

Question 33

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?

A) Spherocytosis
B) Amyloidosis
C) Osteocytosis
D) Thrombocytosis
E) None of the above

Question 34

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?

A) Multiple myeloma
B) Waldenström's macroglobulinemia
C) Solitary plasmacytoma
D) Monoclonal gammopathy of undetermined significance
E) None of the above

Question 35

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

A) Stem cell defect
B) Malignant plasma cell mass replaces normal marrow
C) Growth factor deficiency
D) All of the above
E) None of the above

Question 36

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

A) Liver
B) Spleen
C) Kidney
D) All of the above
E) None of the above

Question 37

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:

A) Plasmacytoid lymphocytes
B) Prolymphocytes
C) Reed-Sternberg cells
D) A and B
E) A and C

Question 38

Which light chain protein is characteristically present in multiple myeloma?

A) Protein C
B) Protein 4.1
C) Tamm-Horsfall
D) Bence-Jones
E) None of the above

Question 39

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

A) Hyperviscosity
B) Platelet dysfunction
C) Presence of plasma cells in circulation
D) Splenomegaly
E) Hypercalcemia

Question 40

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?

A) Low myeloma mass
B) Intermediate myeloma mass
C) High myeloma mass
D) All of the above
E) None of the above

Question 41

Which of the following is characterized by the excessive production of the heavy chain portion of the antibody subunit?

A) Waldenström's macroglobulinemia
B) Heavy chain disease
C) Monoclonal gammopathy of undetermined significance (MGUS)
D) Solitary plasmacytoma
E) Multiple myeloma

Question 42

What is the benefit of plasmapheresis used for treating patients with Waldenström's macroglobulinemia?

A) Removes IgM from circulation
B) Removes IgG from circulation
C) Removes IgA from circulation
D) Removes IgD from circulation
E) Removes IgE from circulation

Question 43

Which hemostasis parameter is usually normal in patients with Waldenström's macroglobulinemia?

A) Bleeding time
B) Platelet count
C) Prothrombin time (PT)
D) Activated partial thromboplastin time (APTT)
E) None of the above

Question 44

Extramedullary infiltration of plasmacytoid lymphs in Waldenström's macroglobulinemia occurs in the __________.

A) Liver
B) Spleen
C) Lymph nodes
D) All of the above
E) None of the above

Question 45

Which of the following immunoglobulins are associated with heavy chain disease?

A) IgG, IgD, IgE
B) IgG, IgM, IgE
C) IgG, IgM, IgA
D) IgA, IgD, IgE
E) None of the above