A 58 years old woman, who had backache and recurrent chest infections for 6 months, develops sudden weakness of the legs and urinary retention. Her investigations show hemoglobin of 7.3 gm/d1, serum calcium 12.6 mg/d1, phosphate 2.5 mg/dl, alkaline phosphatse 100 uil, serum albumin 3 gm/d1, globulin 7.1 gm/d1, and urea 178 mg/dl. What is the most likely diagnosis ?

Answer is C (Multiple myeloma) Backache and Recurrent infections in the backdrop of normal alkaline phosphatase levels and a reversed albumin globulin ratio (A : G ratio) is highly suggestive of the diagnosis of multiple myeloma. Interpretation of information provided in the question Clinical information Laboratory parameters Infomation Interpretation Parameter Normal Patients Interpretation * Backache * Bony pains * Haemoglobin 12 - 16gm 7.3 Anemia * Weakness of legs * Cord * Serum Ca"- 9.0 - 10.5mg/d1 12.6 Hypercalcemia & urinary retention compression * Alkaline phosphatase 30-120 U/I 100 Normal * Chest infection * Ineffective * Albumin 3.5 - 5.5 gm/dl 3.0 Normal (recurrent) defence against * Globulin 2.0 - 3.5 gm/di 7.1 Elevated infection * Urea 20 - 40 mg/dl 178 Elevated Both clinical findings and laboratory data suggest the diagnosis of Multiple Myeloma Serum Alkaline Phosphatase is usually normal even with extensive bone involvement.-- Harrison Serum Albumin is normal or low, Total protein is normal or raised.-- Kumar 5th/501