QuestionSBA
QuestionChoice
Spherocytes are found in some immune-mediated haemolytic anaemias and in hereditary spherocytosis. They are misshapen but otherwise healthy red blood cells which are broken down by the spleen (auto-haemolysis). Increased reticulocytes would also be seen - a marker of increased red blood cell turnover.
10006764
d
Spherocytes
QuestionChoice
Urinary catecholamines would be investigated in a patient with suspected phaeochromocytoma - a rare catecholamine-secreting tumour causing the triad of headache, palpitations and diaphoresis. These would not be raised in a patient with multiple myeloma.
10006765
e
Urinary catecholamines
QuestionChoice
These are pathognomonic findings in Hodgkin lymphoma, following a core needle biopsy of an affected lymph node. These are not associated with multiple myeloma.
10006763
c
Reed-Sternberg cells
QuestionChoice
This patient is likely to have multiple myeloma. This typically presents with hypercalcaemia, renal impairment, anaemia, and bone lesions (mnemonic - CRAB). The most common presenting complaint in patients with multiple myeloma is back pain, which may be accompanied by frequent infections (bone marrow suppression). Bence-Jones proteins form a part of regular antibodies called light chains, which are not normally found in urine. In multiple myeloma, plasma cells divide uncontrollably increasing the total number of antibodies as well as the amount of free Bence-Jones protein. These proteins are small enough to be filtered out by the kidneys on their own which can be detected.
10006761
a
Bence-Jones protein
QuestionChoice
Smear cells are associated with chronic lymphoid leukaemia (CLL), not multiple myeloma. CLL is the most common form of leukaemia in older people, and is often found incidentally in asymptomatic patients. It typically presents with bone marrow failure causing anaemia, infections and bleeding, and may also have lymphadenopathy and hepatosplenomegaly. Smear cells are lymphpocytes whose cell membranes have ruptured during the preparation of the blood film.
10006762
b
Smear cells
Concept
Chapter
2693
3923
myeloma
Topic
157
Haematology
13899
A 71-year-old lady presents to her GP complaining of worsening back pain and fatigue over the last three months. She has a past medical history of depression, multiple hip fractures, and pneumonia for which she was hospitalised earlier this year.
Blood tests are performed which show the following: 


||||
|--------------|:-------:|---------------|
|Haemoglobin|101  g/L|(M) 130 - 170, (F) 115 - 155|
|Platelets|109x10<sup>9</sup>/L|150 - 400|
|Creatinine|134 µmol/L|60 - 120|
|Calcium|3.2 mmol/L|2.2 - 2.6|


The GP suspects myeloma and organises an urgent referral for the patient to receive further investigations. Based on the diagnosis, investigations looking for which of the following is most likely to be positive?
a