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Multiple myeloma — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Multiple myelomaUSMLE Step 3

A 67-year-old has back pain, anemia, hypercalcemia, kidney impairment, recurrent infections, and an M-spike on serum protein electrophoresis. Which diagnosis is most likely?

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Correct answer: D — Multiple myeloma

The CRAB features plus monoclonal protein support multiple myeloma and warrant prompt hematology evaluation with confirmatory marrow and imaging studies. MGUS lacks myeloma-defining organ injury.

Reference: National Cancer Institute: Multiple Myeloma Diagnosis: https://www.cancer.gov/types/myeloma/hp/myeloma-treatment-pdq