# The nurse is conducting an initial assessment on a client with suspected multiple myeloma. Which assessment finding would be most characteristic of this condition? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=540684 > language: ko > subject: Adult Health ## 문제 The nurse is conducting an initial assessment on a client with suspected multiple myeloma. Which assessment finding would be most characteristic of this condition? ## 보기 1. Enlarged lymph nodes and splenomegaly 2. Bone pain and pathological fractures **✔ 정답** 3. Petechiae and excessive bruising 4. Fatigue and shortness of breath **정답: 2** ## 해설 Bone pain and pathological fractures are hallmark signs of multiple myeloma due to osteolytic lesions from plasma cell infiltration. Other options are more typical of other hematologic conditions like lymphoma or bleeding disorders. ## 심화 해설 Understanding the Core Pathology To understand why bone pain and pathological fractures are the hallmark presentation, you must first grasp the fundamental pathophysiology of multiple myeloma. This condition is a malignant proliferation of plasma cells within the bone marrow. These abnormal cells disrupt the delicate balance of bone remodeling. They secrete cytokines that massively upregulate osteoclast activity (the cells that break down bone) while simultaneously suppressing osteoblast function (the cells that build new bone) [2]. This uncoupling results in a net loss of bone matrix, leading to the characteristic osteolytic bone disease. Why Bone Pain and Fractures are the Most Characteristic Finding The clinical consequence of this lytic process is the correct answer: bone pain and pathological fractures. The bone pain is typically deep, persistent, and often localized to the back or ribs, directly correlating with sites of active marrow involvement and bone destruction. Pathological fractures occur because the bone's structural integrity is compromised by the punched-out lytic lesions, meaning a fracture can happen with minimal or no trauma. This is not just a common symptom; it is the defining clinical feature. Research indicates that osteolytic lesions are present in up to 80-90% of patients, either at diagnosis or during the disease course [2]. These skeletal-related events, including severe bone pain and fractures, are directly linked to reduced quality of life and potentially decreased survival [2]. A retrospective study further confirms that pathological fracture represents the most severe complication of this bone disease [3]. Differentiating from the Other Options A systematic assessment allows you to confidently rule out the other choices by linking them to their respective pathological mechanisms, which are secondary in multiple myeloma: - Option 1 (Enlarged lymph nodes and splenomegaly): While plasma cell tumors (plasmacytomas) can occur, generalized lymphadenopathy and splenomegaly are not the most characteristic initial presentation of classic multiple myeloma. The disease primarily resides in the bone marrow microenvironment, not the lymphatic system. A case report even highlights that unusual soft-tissue swellings can mimic lymphoma, causing a diagnostic delay, which underscores that it is an atypical, not characteristic, finding [1]. - Option 3 (Petechiae and excessive bruising): This finding is more indicative of thrombocytopenia or platelet dysfunction. In multiple myeloma, bone marrow infiltration by malignant plasma cells can eventually crowd out normal hematopoietic cells, including megakaryocytes. However, this is a later-stage complication of marrow failure. The hallmark presentation is driven by the direct bone destruction, not initially by bleeding tendencies. - Option 4 (Fatigue and shortness of breath): These are classic symptoms of anemia, which is indeed a common finding in multiple myeloma. The myeloma cells replace normal erythroid precursors in the bone marrow, leading to anemia of chronic disease and marrow infiltration. However, anemia is a nonspecific finding common to many chronic illnesses and hematologic disorders. The osteolytic bone disease with its associated pain and fractures is far more specific and characteristic, forming the diagnostic hallmark alongside laboratory findings like hypercalcemia and renal impairment [1][2]. The assessment of a patient with suspected multiple myeloma should therefore prioritize a thorough pain history and musculoskeletal evaluation. Advanced imaging to detect lytic lesions is critical, especially since modalities like PET/CT and whole-body MRI are considered reference techniques for disease assessment [4]. The presence of pathological fractures, particularly in the spine or long bones, is a sentinel event that confirms the destructive nature of the disease and necessitates immediate intervention with bone-targeted therapy, such as bisphosphonates, to prevent further skeletal-related events [2].References (research sources) - [1]An Unusual Presentation of Plasma Cell Myeloma with Multiple Extramedullary Soft- Tissue Swellings: A Case ReportCase reportKarunathilake P, Abeysinghe N, Bowatte S, Kumarihamy P, Madegedara D, Karunarathna H, Katugahage K, Mallikarachchi V, Gardhiyawasam A, Rajapaksha I. (2026) · DOI: 10.21203/rs.3.rs-10096825/v1 - [2]Effective treatment with preventing skeletal-related event development in multiple myeloma patients.Research articleGiuliani N, Scita M, Dalla Palma AB, Notarfranchi L, Iannozzi NT. (2026) · DOI: 10.1080/17474086.2026.2708711 - [3]Factors influencing the occurrence of fractures in patients with multiple myeloma: a single-center retrospective study of 692 patientsResearch articleTAN S, YANG X, Li M, RUAN C, LI L, ZHANG A. (2026) · DOI: 10.21203/rs.3.rs-9688769/v1 - [4]Uptake of Technetium-99m Sestamibi (99mTc-MIBI) as a Predictor of Fracture Risk in the Appendicular Skeleton of Multiple Myeloma Patients at a National Reference Center.Research articleBañuelos Balderas RS, Linares González LM, Arguelles Pérez DA, Bastidas Martínez MG, Baranzini CD, Galicia-Zamalloa AL. (2026) · DOI: 10.7759/cureus.105969 ## 임상 시나리오 Multiple Myeloma: Recognizing the HallmarkBone Pain and Pathological Fracture Assessment Suspect multiple myeloma in older adults presenting with persistent bone pain, especially in the back or ribs. The pain is caused by osteolytic lesions from malignant plasma cells. A pathological fracture with minimal trauma is a defining skeletal-related event. Assess for this by asking about sudden, severe pain or new immobility. CautionDo not dismiss back pain as routine aging. Osteolytic lesions are present in up to 80-90% of patients and can lead to spinal cord compression. Prioritize a skeletal survey and safety measures to prevent falls. ## 핵심 개념 - **Osteoclast** — A bone cell that breaks down bone tissue, leading to bone resorption; its activity is upregulated by cytokines from myeloma cells. - **Pathological Fracture** — A bone fracture caused by a disease weakening the bone, occurring with minimal or no trauma, common in osteolytic conditions. - **Osteolytic Lesion** — A 'punched-out' area of bone destruction visible on imaging, caused by excessive osteoclast activity and suppressed bone formation. - **Plasma Cell** — A type of white blood cell that produces antibodies; its malignant proliferation in the bone marrow defines multiple myeloma. - **Bone Remodeling** — The lifelong process of bone resorption and formation; disrupted in myeloma, leading to net bone loss. ## 같은 주제 문제 - [A nurse is assessing a 68-year-old client who has been diagnosed with multiple myeloma. 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