Haematopathology: plasma cell neoplasms: practice question

A Pathology 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.

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Pathology · Haematopathology: plasma cell neoplasms

Sample item

An elderly woman has bone pain, anaemia, hypercalcaemia and renal failure. Serum electrophoresis shows an M spike. Which finding is expected on the peripheral smear and bone marrow?

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

The answer and the reasoning

C. Rouleaux formation and clonal plasma cells in the marrow

Multiple myeloma produces monoclonal immunoglobulin, which coats red cells and causes rouleaux formation. Bone marrow has 10 percent or more clonal plasma cells, with lytic lesions, hypercalcaemia, renal injury (cast nephropathy) and anaemia.

Option by option

  • A. Auer rods in myeloblasts

    Auer rods suggest acute myeloid leukaemia.

  • B. Smudge cells with small lymphocytes

    Smudge cells suggest chronic lymphocytic leukaemia.

  • C. Rouleaux formation and clonal plasma cells in the marrow (correct)

    Correct. Rouleaux and clonal plasma cells are classic.

  • D. Teardrop cells and marrow fibrosis

    Teardrop cells and fibrosis suggest myelofibrosis.

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.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, Rouleaux formation and clonal plasma cells in the marrow. Multiple myeloma produces monoclonal immunoglobulin, which coats red cells and causes rouleaux formation.

Why is "Auer rods in myeloblasts" not the answer?

Auer rods suggest acute myeloid leukaemia.

Why is "Smudge cells with small lymphocytes" not the answer?

Smudge cells suggest chronic lymphocytic leukaemia.

Why is "Teardrop cells and marrow fibrosis" not the answer?

Teardrop cells and fibrosis suggest myelofibrosis.

What concept does this question test?

It tests Haematopathology: plasma cell neoplasms in Pathology. Bone marrow has 10 percent or more clonal plasma cells, with lytic lesions, hypercalcaemia, renal injury (cast nephropathy) and anaemia.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Haematopathology: plasma cell neoplasms?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology 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.