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Multiple myeloma — ABIM Board MCQ

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ModerateHematology/OncologyMultiple myelomaABIM Board

A 59-year-old woman has back pain, hemoglobin 9.2 g/dL, creatinine 2.0 mg/dL, calcium 11.6 mg/dL, and total protein 10.1 g/dL. Serum protein electrophoresis shows an M spike. Which of the following is the most appropriate diagnostic study?

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Correct answer: C — Bone marrow biopsy with plasma cell assessment and myeloma-defining studies

An M protein plus CRAB features suggests multiple myeloma. Evaluation includes bone marrow biopsy, serum free light chains, immunofixation, and whole-body imaging to define disease and risk.

Reference: International Myeloma Working Group Criteria; NCCN Multiple Myeloma Guidance