Bone tumours: multiple myeloma: 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.

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Orthopaedics · Bone tumours: multiple myeloma

Sample item

A 60-year-old has back pain, anaemia and multiple punched-out lytic lesions of the skull. Why is a technetium bone scan often normal in this disease?

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

The answer and the reasoning

C. Lesions show little osteoblastic reaction, so there is little tracer uptake

Myeloma bone disease is driven by osteoclast activation with suppressed osteoblast activity, so bone scans, which depend on osteoblastic activity, can be falsely negative. Skeletal survey, whole-body low-dose CT or MRI are preferred.

Option by option

  • A. Technetium is rapidly cleared by the kidneys in all patients

    Renal clearance does not explain false negatives.

  • B. Myeloma causes only osteoblastic lesions

    Myeloma lesions are lytic, not sclerotic.

  • C. Lesions show little osteoblastic reaction, so there is little tracer uptake (correct)

    Correct. Limited osteoblastic response gives poor tracer uptake.

  • D. Lytic lesions are too small

    Lesions can be large and still show no uptake.

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 Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is C, Lesions show little osteoblastic reaction, so there is little tracer uptake. Myeloma bone disease is driven by osteoclast activation with suppressed osteoblast activity, so bone scans, which depend on osteoblastic activity, can be falsely negative.

Why is "Technetium is rapidly cleared by the kidneys in all patients" not the answer?

Renal clearance does not explain false negatives.

Why is "Myeloma causes only osteoblastic lesions" not the answer?

Myeloma lesions are lytic, not sclerotic.

Why is "Lytic lesions are too small" not the answer?

Lesions can be large and still show no uptake.

What concept does this question test?

It tests Bone tumours: multiple myeloma in Orthopaedics. Skeletal survey, whole-body low-dose CT or MRI are preferred.

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 Bone tumours: multiple myeloma?

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.