Haematology: monoclonal gammopathy of undetermined significance: 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 · Haematology: monoclonal gammopathy of undetermined significance

Sample item

A 72-year-old woman has an incidental IgG M-protein of low concentration on electrophoresis. Marrow plasma cells are fewer than 10 percent, and she has no anaemia, hypercalcaemia, renal impairment or bone lesions. What is the diagnosis and the risk?

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

The answer and the reasoning

D. MGUS, with a small yearly risk of progression to myeloma

MGUS is the commonest plasma cell disorder in older people and needs no treatment, only periodic monitoring. The risk of progression to myeloma or a related disorder is about 1 percent per year.

Option by option

  • A. AL amyloidosis, since a monoclonal protein is present

    A monoclonal protein alone does not establish amyloidosis, which requires tissue deposits of amyloid.

  • B. Smouldering myeloma, requiring immediate combination chemotherapy

    Smouldering myeloma has higher M-protein or plasma cell burden and is observed rather than treated immediately.

  • C. Multiple myeloma, since an M-protein is present

    Myeloma requires end-organ damage or a high marrow plasma cell burden, which are absent.

  • D. MGUS, with a small yearly risk of progression to myeloma (correct)

    Correct. A low M-protein, few marrow plasma cells and no end-organ damage define MGUS, which needs follow-up and not treatment.

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 D, MGUS, with a small yearly risk of progression to myeloma. MGUS is the commonest plasma cell disorder in older people and needs no treatment, only periodic monitoring.

Why is "AL amyloidosis, since a monoclonal protein is present" not the answer?

A monoclonal protein alone does not establish amyloidosis, which requires tissue deposits of amyloid.

Why is "Smouldering myeloma, requiring immediate combination chemotherapy" not the answer?

Smouldering myeloma has higher M-protein or plasma cell burden and is observed rather than treated immediately.

Why is "Multiple myeloma, since an M-protein is present" not the answer?

Myeloma requires end-organ damage or a high marrow plasma cell burden, which are absent.

What concept does this question test?

It tests Haematology: monoclonal gammopathy of undetermined significance in Pathology. The risk of progression to myeloma or a related disorder is about 1 percent per year.

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 Haematology: monoclonal gammopathy of undetermined significance?

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.