RADD 2712 Lecture Notes - Final Exam Review 1

RADD 2712 Lecture Notes - Final Exam Review 1 - FINAL EXAM...

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FINAL EXAM INFORMATION (Remember the Final is comprehensive!) Multple Myeloma – (pg 1168) sometimes called Kahler’s disease. This is the most common primary malignant bone tumor. There are 3 cases in every 100,000 people over 40 every year. The age range is 50-70, but start looking for it at ages over 40. It comes from the B-cells of the plasma. It is a malignancy of a single clone of B-cells that produce the same immunoglobulin with out any antigenic stimulation, monoclonal gamopathy. There will be a large spike in one immunoglobulin. Loves the axial skeleton where you have red marrow. There is bone pain, weakness, fatigue, and anemia because you can’t produce enough blood cells. MM usually presents axial just like metastasis. The classical presentation is the rain drop skull with well defined punched out lesions with no sclerosis. The lesions range from 5-20mm in size. Metastasis may also have the same punched out appearance, but only in the skull. The average survival rate is 2 ½ years. There are 4 basic appearances, but the classical appearance is the punched out lesions. It may look just like osteoporosis with a loss of bone density. There is a 2:1 male to female ratio. If you see a pathological collapse of a vertebra in a patient over 40, you think either MM or mets, and mets is much more common. Compression fractures are also seen with MM and osteoporosis. MM isn’t usually found in the posterior arch unless it has already destroyed the body, so for a missing pedicle think mets before MM. For diagnosis there will be one sharp spike on electrophoresis and a bone biopsy. Radionuclide bone scans are commonly negative with multiple myeloma because the vascularity of the bone marrow may not be changed enough to be detected. Bence Jones proteins will be found in the urine in a patient with multiple myeloma along with renal disease. The patient will also have an anemia due to replacement or alteration of hematopoietic tissues by proliferating plasma cells. The cardinal initial symptom is pain that suggests arthritis or neuralgia that is initially intermittent and becomes continuous. Pain is worse during the day and aggravated by exercise and weight bearing, and better at night with rest. Pathological fractures occur in 20% of patients in the late stages of MM and are indicated by a rapid onset of severe pain after slight strain or mild trauma. Skeletal involvement distal to the elbow and knee occur in only 10% of cases. Serum calcium is sometimes elevated due to the lytic destruction. Also, there is a reversal of the albumin globulin ratio, with 50% of the cases being IgG, 25% IgA, 1-2% IgD, and IgE and IgM being rare. Uric acid is commonly high in the blood with
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MM. The most common cause of death in MM patients is pneumonia and respiratory failure followed by renal failure. Classical Multiple Myeloma
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This note was uploaded on 11/23/2011 for the course RADD 2712 taught by Professor R.brucefox during the Winter '11 term at Life Chiropractic College West.

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RADD 2712 Lecture Notes - Final Exam Review 1 - FINAL EXAM...

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