[MCQs] Plasma Cell Disorders- Part 2

I. Start the exam by click the “Start” button

Plasma Cell Disorders- Part 2

Please wait while the activity loads.
If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled.

If loading fails, click here to try again

Start

Congratulations - you have completed Plasma Cell Disorders- Part 2. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

Your answers are highlighted below.

Question 1

Most common translocation in multiple myeloma is ?

A	t(10;14)
B	t(11;14)
C	t(12;14
D	t(13;14)

Question 1 Explanation:

The most common translocations in multiple myeloma are t(11;14)(q13;q32) and t(4;14)(p16;q32). Specific translocations in the immunoglobulin heavy chain region that are detected on fluorescence in situ hybridization (FISH), such as t(4;14), deletion 17p13, and chromosome 1 abnormalities, are associated with a poor prognosis. High risk disease and poor prognosis are defined by the presence of one of the following in each category: hypodiploidy, t(4;14), or deletion 17p13; high levels of serum 2-microglobulin or lactate dehydrogenase; and International Staging System stage III. Standard-risk disease is defined by the presence of hyperdiploidy or t(11;14), normal levels of serum 2-microglobulin or lactate dehydrogenase, and International Staging System stage I

Question 2

In Stage III of International Staging System for Multiple Myeloma, 2-microglobulin levels is more than ?

A	2.5 mg / liter
B	3.5 mg / liter
C	4.5 mg / liter
D	5.5 mg / liter

Question 3

Which of the following about myeloma is false ?

A	Rare under the age of 40 years
B	Median age at diagnosis is 70 years
C	More common in males than females
D	None of the above

Question 3 Explanation:

Myeloma is uncommon under age 40, increases in incidence with age. Median age at diagnosis is 70 years. It does not occur in children. Males are more commonly affected than females.

Question 4

Drug resistance in multiple myeloma is mediated by ?

A	Ras/Raf/mitogen-activated protein kinase
B	PI3-K/Akt
C	Protein kinase C signaling cascades
D	None of the above

Question 4 Explanation:

Growth, drug resistance, and migration in multiple myeloma are mediated via Ras/Raf/mitogenactivated protein kinase, PI3-K/Akt, and protein kinase C signaling cascades, respectively.

Question 5

Which of the following is not a feature of myeloma cells in bone marrow ?

A	Round or oval shape
B	Eccentric nucleus with coarsely clumped chromatin
C	Densely eosinophilic cytoplasm
D	Perinuclear clear zone containing Golgi apparatus

Question 5 Explanation:

Myeloma cells in bone marrow are round or oval cells in shape, with eccentric nucleus having coarsely clumped chromatin, a densely basophilic cytoplasm, and a perinuclear clear zone (hof) containing Golgi apparatus.

Question 6

Which of the following about bone pain in myeloma is false ?

A	Affects ~ 70% of patients
B	Located to back and ribs
C	Precipitated by movement
D	Worse at night

Question 6 Explanation:

Bone pain is the most common symptom in myeloma, affecting nearly 70% of patients. Pain usually involves the back and ribs, and unlike the pain of metastatic carcinoma, which often is worse at night, the pain of myeloma is precipitated by movement. Persistent localized pain in a patient with myeloma usually signifies a pathologic fracture

Question 7

Which of the following about bony lesions in myeloma is false ?

A	Due to bony destruction by osteoclasts
B	Suppression of osteoblastic new bone formation
C	Serum alkaline phosphatase is usually normal
D	None of the above

Question 7 Explanation:

Bone lesions of myeloma are caused by proliferation of tumor cells, activation of osteoclasts that destroy bone & suppression of osteoblasts that form new bone. Serum alkaline phosphatase is normal even with extensive bone involvement because of the absence of osteoblastic activity

Question 8

Osteoclast activating factors (OAF) from myeloma cells are mediated by ?

A	IL-1
B	Receptor activator of NF-B (RANK) ligand
C	Tumor necrosis factor (TNF)
D	All of the above

Question 8 Explanation:

Osteoclasts are activated by osteoclast activating factors (OAF) from myeloma cells. OAF activity is mediated by IL-1, lymphotoxin, VEGF, receptor activator of NF-B (RANK) ligand, macrophage inhibitory factor (MIP)-1, & TNF. Bone lesions are caused by an imbalance in the function of osteoblasts and osteoclasts. The inhibition of the Wnt pathway suppresses osteoblasts, whereas the amplification of the RANK pathway and the action of macrophage inflammatory protein 1  (MIP1) activate osteoclasts.

Question 9

Dickhoff-1 (DKK-1) produced by myeloma cells causes ?

A	Dickhoff-1 (DKK-1) produced by myeloma cells causes ?
B	Osteoblastic suppression
C	Osteoclastic suppression
D	Osteoblastic activation

Question 9 Explanation:

Bone lesions are lytic in nature and are rarely associated with osteoblastic new bone formation due to their suppression by dickhoff-1 (DKK-1) produced by myeloma cells. Multiple myeloma lesion represents a purely osteolytic lesion with little or no osteoblastic activity.

Question 10

In multiple myeloma, localized bone lesions may be palpated on ?

A	Skull
B	Clavicles
C	Sternum
D	All of the above

Question 10 Explanation:

Localized bone lesions in multiple myeloma may cause mass lesions that may be palpated on the skull, clavicles, and sternum. The collapse of vertebrae may lead to spinal cord compression.

Question 11

In myeloma, most common infection is ?

A	Osteomyelitis
B	Otitis
C	Cholecystitis
D	Pyelonephritis

Question 11 Explanation:

In myeloma, most common infections are pneumonias and pyelonephritis.

Question 12

In myeloma, the most frequent pathogen in lungs is ?

A	Pseudomonas aeruginosa
B	Klebsiella pneumoniae
C	Haemophilus influenzae
D	Legionella pneumophila

Question 12 Explanation:

In myeloma, most frequent pathogens are Streptococcus pneumoniae, Staphylococcus aureus, and Klebsiella pneumoniae in the lungs and Escherichia coli in urinary tract.

Question 13

Immune deficiency in myeloma patients is due to ?

A	Diffuse hypogammaglobulinemia
B	Low granulocyte lysozyme content
C	Abnormalities in complement functions
D	All of the above

Question 14

Renal failure in myeloma patients is mainly due to ?

A	Recurrent Infections
B	Hypercalcemia
C	Hyperuricemia
D	. Infiltration of kidney by myeloma cells

Question 14 Explanation:

Hypercalcemia is the most common cause of renal failure. Excretion of light chains is almost always present that causes tubular damage either directly from light chain toxic effects or indirectly from the release of intracellular lysosomal enzymes

Question 15

The earliest manifestation of tubular damage in MM is ?

A	Medullary cystic kidney disease
B	Adult Fanconi syndrome
C	Nephronophthisis
D	All of the above

Question 15 Explanation:

In MM, earliest manifestation of tubular damage is adult Fanconi syndrome (a type 2 proximal renal tubular acidosis), with loss of glucose & amino acids, along with defects in the ability of kidney to acidify & concentrate urine.

Question 16

Which of the following regarding renal failure in myeloma patients is false ?

A	Protein in urine is nearly all light chains
B	Proteinuria is not accompanied by hypertension
C	Susceptible to acute renal failure if dehydrated
D	None of the above

Question 17

Anion gap in patients with myeloma is ?

A	Increased
B	Decreased
C	Normal
D	Any of the above

Question 17 Explanation:

Patients with myeloma have a decreased anion gap because M component is cationic, resulting in retention of chloride.

Question 18

Which of the following is false about anemia in myeloma patients ?

A	Normocytic, normochromic
B	Granulocytopenia very rare
C	Thrombocytopenia very rare
D	None of the above

Question 18 Explanation:

Normocytic & normochromic anemia occurs in 80% of myeloma patients. It is due to replacement of normal marrow by expanding tumor cells, to inhibition of hematopoiesis by factors made by the tumor, and to reduced production of erythropoietin by kidney. Granulocytopenia and thrombocytopenia are very rare

Question 19

Normal relative serum viscosity is ?

A	1.2
B	1.4
C	1.6
D	1.8

Question 19 Explanation:

Normal relative serum viscosity is 1.8 (i.e., serum is normally almost twice as viscous as water)

Question 20

Symptoms of hyperviscosity occur at a level of ?

A	1 to 2
B	3 to 4
C	4 to 5
D	5 to 6

Question 20 Explanation:

Symptoms of hyperviscosity occur at a level of 5 - 6, a level usually reached at paraprotein concentrations of ~4 g/dL for IgM, 5 g/dL for IgG3, & 7 g/dL for IgA

Question 21

Hyperviscosity may lead to which of the following ?

A	Headache
B	Visual disturbances
C	Retinopathy
D	All of the above

Question 21 Explanation:

Hyperviscosity may lead to headache, fatigue, visual disturbances, and retinopathy

Question 22

In myeloma, which of the following paraproteins leads to hyperviscosity ?

A	IgM
B	IgG3
C	IgA
D	IgA

Question 22 Explanation:

Most commonly, IgM, IgG3, and IgA paraproteins of the M component favour development of hyperviscosity syndromes.

Question 23

Hyperviscosity is most common with which of the following paraproteins?

A	IgA
B	IgG
C	IgD
D	IgM

Question 23 Explanation:

About half of patients with IgM paraproteins develop hyperviscosity compared with only 2 - 4% of patients with IgA and IgG M components.

Question 24

Hyperviscosity is most common with which of the following paraproteins ?

A	IgG1
B	IgG2
C	IgG3
D	IgG4

Question 24 Explanation:

Among IgG myelomas, it is IgG3 subclass that has the highest tendency to form both concentration- and temperature-dependent aggregates, leading to hyperviscosity and cold agglutination at lower serum concentrations.

Question 25

Sensory neuropathy occurs in which of the following ?

A	Multiple myeloma
B	Monoclonal gammopathy of undetermined significance
C	Thalidomide & Bortezomib therapy
D	All of the above

Question 25 Explanation:

Neuropathy associated with monoclonal gammopathy of undetermined significance (MGUS) and myeloma is more frequently sensory than motor neuropathy and is associated with IgM more than other isotypes. Sensory neuropathy is also a side effect of thalidomide & bortezomib therapy.

Question 26

Myeloma causes enlargement of which of the following ?

A	Spleen
B	Lymph nodes
C	Gut-associated lymphatic tissue
D	None of the above

Question 26 Explanation:

In myeloma, tumor expansion is dominantly in bone & bone marrow and rarely causes enlargement of spleen, lymph nodes or gut-associated lymphatic tissue.

Once you are finished, click the button below. Any items you have not completed will be marked incorrect. Get Results

There are 26 questions to complete.

←

List

→

Return

Shaded items are complete.

1	2	3	4	5
6	7	8	9	10
11	12	13	14	15
16	17	18	19	20
21	22	23	24	25
26	End

Return

See all quizzes of the Plasma Cell Disorders at here:

Plasma Cell Disorders Part 1 | Plasma Cell Disorders Part 2 | Plasma Cell Disorders Part 3 | Plasma Cell Disorders Part 4

II. Preview all questions below

1. Which of the following interleukins may play a role in driving myeloma cell proliferation ?
A. 1
B. 2
C. 4
D. 6

2. Most common translocation in multiple myeloma is ?
A. t(10;14)
B. t(11;14)
C. t(12;14)
D. t(13;14)

3. In Stage III of International Staging System for Multiple Myeloma, 2-microglobulin levels is more than ?
A. 2.5 mg / liter

B. 3.5 mg / liter
C. 4.5 mg / liter
D. 5.5 mg / liter
4. Which of the following about myeloma is false ?
A. Rare under the age of 40 years
B. Median age at diagnosis is 70 years
C. More common in males than females
D. None of the above

5. Drug resistance in multiple myeloma is mediated by ?
A. Ras/Raf/mitogen-activated protein kinase
B. PI3-K/Akt
C. Protein kinase C signaling cascades
D. None of the above

6. Which of the following is not a feature of myeloma cells in bone marrow ?
A. Round or oval shape
B. Eccentric nucleus with coarsely clumped chromatin
C. Densely eosinophilic cytoplasm
D. Perinuclear clear zone containing Golgi apparatus

7. Which of the following about bone pain in myeloma is false ?
A. Affects ~ 70% of patients
B. Located to back and ribs
C. Precipitated by movement
D. Worse at night

8. Which of the following about bony lesions in myeloma is false ?
A. Due to bony destruction by osteoclasts
B. Suppression of osteoblastic new bone formation
C. Serum alkaline phosphatase is usually normal
D. None of the above

9. Osteoclast activating factors (OAF) from myeloma cells are mediated by ?
A. IL-1

B. Receptor activator of NF-B (RANK) ligand
C. Tumor necrosis factor (TNF)
D. All of the above

10. Dickhoff-1 (DKK-1) produced by myeloma cells causes ?
A. Osteoclastic activation
B. Osteoblastic suppression
C. Osteoclastic suppression
D. Osteoblastic activation

11. In multiple myeloma, localized bone lesions may be palpated on ?
A. Skull
B. Clavicles
C. Sternum
D. All of the above

12. In myeloma, most common infection is ?
A. Osteomyelitis
B. Otitis
C. Cholecystitis
D. Pyelonephritis

13. In myeloma, the most frequent pathogen in lungs is ?
A. Pseudomonas aeruginosa
B. Klebsiella pneumoniae
C. Haemophilus influenzae
D. Legionella pneumophila

14. Immune deficiency in myeloma patients is due to ?
A. Diffuse hypogammaglobulinemia
B. Low granulocyte lysozyme content
C. Abnormalities in complement functions
D. All of the above

15. Renal failure in myeloma patients is mainly due to ?
A. Recurrent Infections

B. Hypercalcemia
C. Hyperuricemia
D. Infiltration of kidney by myeloma cells

16. The earliest manifestation of tubular damage in MM is ?
A. Medullary cystic kidney disease
B. Adult Fanconi syndrome
C. Nephronophthisis
D. All of the above

17. Which of the following regarding renal failure in myeloma patients is false ?
A. Protein in urine is nearly all light chains
B. Proteinuria is not accompanied by hypertension
C. Susceptible to acute renal failure if dehydrated
D. None of the above
18. Anion gap in patients with myeloma is ?
A. Increased
B. Decreased
C. Normal
D. Any of the above

19. Which of the following is false about anemia in myeloma patients ?
A. Normocytic, normochromic
B. Granulocytopenia very rare
C. Thrombocytopenia very rare
D. None of the above

20. Normal relative serum viscosity is ?
A. 1.2
B. 1.4
C. 1.6
D. 1.8

21. Symptoms of hyperviscosity occur at a level of ?
A. 1 to 2

B. 3 to 4
C. 4 to 5
D. 5 to 6

22. Hyperviscosity may lead to which of the following ?
A. Headache
B. Visual disturbances
C. Retinopathy
D. All of the above

23. In myeloma, which of the following paraproteins leads to hyperviscosity ?
A. IgM
B. IgG3
C. IgA
D. All of the above

24. Hyperviscosity is most common with which of the following paraproteins ?
A. IgA
B. IgG
C. IgD
D. IgM

25. Hyperviscosity is most common with which of the following IgG subclass paraproteins ?
A. IgG1
B. IgG2
C. IgG3
D. IgG4

26. Sensory neuropathy occurs in which of the following ?
A. Multiple myeloma
B. Monoclonal gammopathy of undetermined significance
C. Thalidomide & Bortezomib therapy
D. All of the above

27. Myeloma causes enlargement of which of the following ?

A. Spleen
B. Lymph nodes
C. Gut-associated lymphatic tissue
D. None of the above

Plasma Cell Disorders

[MCQs] Plasma Cell Disorders- Part 2

I. Start the exam by click the “Start” button

Plasma Cell Disorders- Part 2

II. Preview all questions below

Share this:

Related

[MCQs] Plasma Cell Disorders- Part 1

[MCQs] Plasma Cell Disorders- Part 3

You may also like

Leave a Comment Cancel Reply