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Seetal 04-19-2010 07:17 AM

Normochromic Normocytic Anemia + Azotemia
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 04-19-2010 08:23 AM

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
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 04-20-2010 02:16 AM

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..:D

ath.pantelis 04-20-2010 04:37 AM

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 04-20-2010 10:53 PM

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

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