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Multiple myeloma — USMLE Step 3 MCQ

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ModerateInternal Medicine (chronic management)Multiple myelomaUSMLE Step 3

A 69-year-old woman has back pain, anemia, calcium 11.8 mg/dL, creatinine 2.1 mg/dL, and lytic lesions on imaging. Serum protein electrophoresis shows an M-spike. Which of the following is the most likely diagnosis?

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Correct answer: B — Multiple myeloma

An M-spike with anemia, renal dysfunction, hypercalcemia, and lytic bone lesions supports symptomatic multiple myeloma.

Reference: International Myeloma Working Group diagnostic criteria