Spine: pathological fracture and myeloma screen: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

Orthopaedics · Spine: pathological fracture and myeloma screen

Sample item

A 68-year-old develops sudden back pain after a minor strain. A radiograph shows a compression fracture of L2 with generalised osteopenia. Haemoglobin is 8.5 g/dL, ESR is 110 mm in the first hour, creatinine is raised and alkaline phosphatase is normal. What is the best next test?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Serum protein electrophoresis with free light chains

An unexplained vertebral fracture with anaemia, very high ESR and renal impairment strongly suggests multiple myeloma. Serum protein electrophoresis and free light chains are the diagnostic screening tests. The alkaline phosphatase is typically normal because osteoblasts are suppressed, and bone scans are often falsely normal.

Option by option

  • A. Serum protein electrophoresis with free light chains (correct)

    Correct. The picture suggests myeloma and serum protein electrophoresis with light chains screens for it.

  • B. Bone scan with technetium

    A bone scan is often normal in myeloma because there is little osteoblastic activity.

  • C. DEXA scan of the hip and spine

    DEXA would only confirm low bone density and would not explain anaemia and renal failure.

  • D. Serum parathyroid hormone

    PTH measurement addresses hyperparathyroidism, which causes high calcium and a high alkaline phosphatase.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Orthopaedics questions

Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is A, Serum protein electrophoresis with free light chains. An unexplained vertebral fracture with anaemia, very high ESR and renal impairment strongly suggests multiple myeloma.

Why is "Bone scan with technetium" not the answer?

A bone scan is often normal in myeloma because there is little osteoblastic activity.

Why is "DEXA scan of the hip and spine" not the answer?

DEXA would only confirm low bone density and would not explain anaemia and renal failure.

Why is "Serum parathyroid hormone" not the answer?

PTH measurement addresses hyperparathyroidism, which causes high calcium and a high alkaline phosphatase.

What concept does this question test?

It tests Spine: pathological fracture and myeloma screen in Orthopaedics. Serum protein electrophoresis and free light chains are the diagnostic screening tests. The alkaline phosphatase is typically normal because osteoblasts are suppressed, and bone scans are often falsely normal.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Spine: pathological fracture and myeloma screen?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.