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Multiple Myeloma — MRCP Part 1 MCQ

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HardHaematologyMultiple MyelomaMRCP Part 1UKMLA

A patient with known myeloma develops severe thoracic pain, progressive leg weakness and urinary retention. Plain radiography shows no vertebral collapse. What is the next imaging action?

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Correct answer: D — Urgent whole-spine MRI for suspected cord compression

The best answer is “Urgent whole-spine MRI for suspected cord compression”. Neurological deficits with sphincter disturbance make malignant spinal cord compression the immediate concern. MRI of the whole spine is required urgently because plain radiographs can miss epidural soft-tissue disease and non-collapsed lesions. Bone scintigraphy is insensitive for purely lytic myeloma, and staging investigations must not delay emergency spinal imaging.

Reference: NICE NG35, Myeloma: diagnosis and management: https://www.nice.org.uk/guidance/ng35/chapter/Recommendations