[Seetal]

A 68-year-old man has had low back pain over the past 2 months. Laboratory studies show a normochromic, normocytic anemia and azotemia. Serum and urine calcium concentrations are abnormally increased, and urinalysis shows excessive protein (4+) and proteinaceous casts. Bone marrow examination is most likely to show uncontrolled proliferation of which of the following cells?

(A) Basophils
(B) Lymphocytes
(C) Macrophages
(D) Plasma cells
(E) Reticulocytes

 

[ath.pantelis]

Oh, Dr. Seetal, you are posting a series of classic questions! I wonder if you should make some flash cards containing such questions; you are soooooo good at making flash cards!!! (I have created a special "Seetal" folder in my Step 1 Notes archive in my PC ).

Look at the following mnemonic:
Calcium elevation
Renal disease
Anemia
Bone/back pain.

Cancer is the latin name for CRAB & multiple myeloma is a common type of hematologic cancer in the elderly. The monoclonal cell line that overdevelops in multiple myeloma is the plasma cell (answer D is correct). The proteinaceous casts consist of light Ig chains, aka Bence-Jones protein.

 

[Seetal]

thank u Dr. ath.pantelis!

haha.. thanks for the compliment!

yes the answer is plasma cells. am i posting typical usmle style questions? this comes under pathology ryte? i havent studied pathology but i was giving it a try anyways and i couldnt find y the answer was plasma cells here. but when u mention MM, its all there!!! thanks for the awesome mnemonic. im stealing that too. lol..

 

[ath.pantelis]

What I meant is that the questions you are posting, dear Dr. Seetal, entail classical concepts. The actual questions are much larger in size, usually demand 2- or even 3-step thinking, and, in Step 1, focus on basic science (this very question could also be a candidate for Step 2CK).

Nevertheless, if you can afford the time, it would be worth giving it a try to gather them in a concise flash-card series.

 

[achistikbenny]

the ans is plasma cells. the patient mostly likely has multiple myeloma.