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Hyperviscosity from myeloma — SCE Acute Medicine MCQ

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ModerateHaematological EmergenciesHyperviscosity from myelomaSCE Acute Medicine

A 72-year-old man is assessed on the acute medical unit. He has myeloma with headache, blurred vision and mucosal bleeding. Fundoscopy shows venous engorgement and serum paraprotein is very high. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most likely diagnosis?

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Correct answer: B — Hyperviscosity syndrome

Hyperviscosity syndrome is the best answer because neurological symptoms, visual changes and mucosal bleeding with high paraprotein suggest hyperviscosity. Tumour lysis syndrome is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Plasma exchange may be needed urgently.

Reference: https://b-s-h.org.uk/guidelines#acute-medicine-order-51-1