When I grow up.. I wannabe a Dr.

Five guys. Malaysians. Once medical students. Once stuck in a house in Summerstown Cork. NOW all Doctors, going separate ways. What will they be up to?? ish macam macam.....

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Friday, October 3


cakap-cakap brainbarrier

Multiple Myeloma

-Due to osteolytic bone lesion ( back pain, pathological fractures of long bones)
-Hypercalcaemia ( bones,stones,groans,pyschic moans, sytemic feat ie:
constipation, aneroxia, weight loss, polyuria, polydipsia)
-Due to marrow infiltration (anaemia, neutropenia-infections, thrombocytopenia- bleed
-Renal impairment
-Systemic amylodosis

FBC (anaemia,infection,platelet)
blood film (rouleaux formation)
U+E and Creat
Calcium levels
Serum n Urine electrophoresis
B2 microglobulin level (prognostic)
Marrow biopsy

Diagnosis :
>Monoclonal protein band on electrophoresis
>Increased plasma cells on BM biopsy
>End organ damage (hyperCa2+, renal damage, anaemia, bone lesion)

a) Supportive
- Analgesics for bone pain (avoid NSAID's)
- Bisphosphonate ie pamidronate to reduce fracture rates
- Local radiotherapy
- Transfusion/erytropoeitin for anaemia
- Rehydration/dialysis in renal failure
- Broad spec antibiotics ie cefuroxime for infections / IV IG if recurrent

b) Chemo
- Elderly : melphalan/cyclophosphamide with prednisolone +/- thalidomide
- Young : High dose therapy and stem cell rescue
> VAD regime Vincristine, Adriamycin, Dexamethasone
> Autologus/allogenic stem cell transplant

yours truly

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