Physical Findings

Stop & Think

Lab and X-Ray

Differential Diagnosis

The Disease

Treatment

Conclusions

Quiz & Evaluation

• If you suspect multiple myeloma, be prepared to look at both urine and serum for the protein spike.
• Approximately 17% of cases are pure light chain myelomas.
• The smaller light chain clears in the urine and may not produce a plasma spike on electrophoresis.
• Serum gamma globulin level will be low in this case.
• Do an electrophoresis on the urine and you'll see it.
• Bone marrow is essential.
• Typing the immunoglobulin is essential.
• Monitoring serum calcium and renal function is essential.
• A skull X-Ray is an inexpensive way to get a picture of bone loss.