Ramla, 65 yrs old male, presents with low back pain especially at L3, anaemia and fatigability. His investigation profile reveals - Hb = 7 gm%, TLC9000/cmm, DLC -N- 55%, L-30%, M-10%, E-1%, B2%, Serum proteins-8 gm %, ratio-2.9/5.9, ESR-90 and serum creatinine-3.2 mg%. Likely diagnosis is :

Answer is B (Multiple myeloma) This is a 65 year old patient presenting with low back pain along with-a reversed A: G ratio. This indicates an excess of globulin fraction or a possible gammopathy. These findings along with an elevated ESR and Renal involvement (indicated by increased creatinine levels) suggest a diagnosis of Multiple Myeloma.