USMLE step 2 Mcq 255:A 60yr old man presented with severe back pain after a long distance travel in a bus

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Question:
A 60yr old man presented with severe back pain after a long distance travel in a bus. On x-ray of the vertebral column the man was shown to have a fracture of the first lumbar vertebra with associated punched out lesions of the other vertebrae. The physician became suspicious and ordered other investigations. Investigations: Serum uric acid 11mg/dl (3--6mg/dl); Serum Calcium 7.2mEq/L(4.5--5.7mEq/L); Serum phosphate 3.5mEq/L (1.45-2.76mEq/L); Blood urea 30mg/dl(10-20mg/dl); Serum Creatinine 1.7mg/dl(0.7-1.5mg/dl); 24hr urine specimen showed presence of casts and Bence-Jones protein. Serum electrophoresis for immunoglobulins showed the presence of abnormal amounts of IgG immunoglobulin.The most likely diagnosis is :

a) Osteoporosis
b) Multiple myeloma
c) Hyperparathyroidism
d) Chronic renal failure
e) metastatic bronchogenic carcinoma


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