An elderly male presents with headache, recurrent infections and multiple punched out lytic lesions of x-ray skull. The investigation that will best help in establishing a diagnosis is:
Answer is A (Protein Electrophoresis) Presence of symptoms of hyperviscocity syndrome (Headache), recurrent infections (ineffective defense against infections) and multiple punched out lytic lesions in the skull suggest a diagnosis of Multiple myeloma Protein electrophoresis will help demonstrate a characteristic 'M spike' and help in establishing the diagnosis of inultipk myeloma. Serum Calcium is likely to be elevated while serum alkaline phosphatase levels are likely to be normal. Although both serum calcium and serum alkaline phosphatase levels may be done to suppo a diagnosis of Multiple Mveloma, demonstration of the charachteristic 'M spike' on protein electrophoresis is the single preferred investigation. Classic Triad of Multiple Myeloma Relevant investigations Marrow plasmacytosis > 10% (Bone Marrow examination: Not provided in options) Lytic bone lesions (X-Ray skull: Already performed in patient) Serum/urine M component (Protein Electrophoresis: Suggested next investigation)
Protein Electrophoresis
Serum calcium
Alkaline phosphatase levels
Acid phosphatase levels