Haematology: Waldenstrom macroglobulinaemia: practice question

A General Medicine 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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General Medicine · Haematology: Waldenstrom macroglobulinaemia

Sample item

A 70-year-old man has fatigue, recurrent epistaxis, headaches and blurred vision. Fundoscopy shows dilated, segmented retinal veins. Serum protein electrophoresis shows an IgM kappa paraprotein of 5.5 g/dL and marrow shows lymphoplasmacytic infiltration. What is the most appropriate immediate treatment?

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

The answer and the reasoning

C. Plasmapheresis

Waldenstrom macroglobulinaemia produces IgM, a large pentameric molecule that remains largely intravascular and raises serum viscosity, causing mucosal bleeding, visual disturbance and neurological symptoms. Symptomatic hyperviscosity is treated by urgent plasmapheresis, followed by cytotoxic or targeted therapy. Rituximab alone can cause a transient IgM flare, and transfusion increases viscosity.

Option by option

  • A. Packed red cell transfusion

    Transfusion increases blood viscosity and can precipitate worsening symptoms.

  • B. Zoledronic acid

    Zoledronic acid treats bone disease and hypercalcaemia in myeloma, which is not the problem here.

  • C. Plasmapheresis (correct)

    Correct. Plasma exchange rapidly removes IgM and relieves hyperviscosity symptoms.

  • D. Rituximab alone

    Rituximab alone can cause an IgM flare that worsens hyperviscosity, so it is not used as the sole first step.

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 General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Plasmapheresis. Waldenstrom macroglobulinaemia produces IgM, a large pentameric molecule that remains largely intravascular and raises serum viscosity, causing mucosal bleeding, visual disturbance and neurological symptoms.

Why is "Packed red cell transfusion" not the answer?

Transfusion increases blood viscosity and can precipitate worsening symptoms.

Why is "Zoledronic acid" not the answer?

Zoledronic acid treats bone disease and hypercalcaemia in myeloma, which is not the problem here.

Why is "Rituximab alone" not the answer?

Rituximab alone can cause an IgM flare that worsens hyperviscosity, so it is not used as the sole first step.

What concept does this question test?

It tests Haematology: Waldenstrom macroglobulinaemia in General Medicine. Symptomatic hyperviscosity is treated by urgent plasmapheresis, followed by cytotoxic or targeted therapy. Rituximab alone can cause a transient IgM flare, and transfusion increases viscosity.

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 Haematology: Waldenstrom macroglobulinaemia?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine 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.