Question

a 72 - year - old male patient presents with low back pain. he is pale and tires easily. he states that he just sat down on his favorite chair and got sudden back pain that wraps around his back. his urinalysis reveals negative protein, ssa + 2, increased esr, and rouleaux formation. skull x - ray indicates a raindrop pattern. choose two answers related to this case. (pick two)
multiple myeloma
hematuria
renal calculi
ketones
grey turner sign
acute pancreatitis
punched - out lesion
type ii diabetes

Explanation:

• Multiple myeloma: Common in older adults (72 - year - old in this case). Symptoms like bone pain (low back pain here), fatigue (pale and tires easily), increased ESR (erythrocyte sedimentation rate, a marker of inflammation often elevated in myeloma), rouleaux formation (due to abnormal proteins coating red blood cells), and "raindrop" or "punched - out" (though the option here is "Punched - out lesion") patterns on skull X - ray (related to bone involvement in myeloma) are associated with it.
• Punched - out lesion: A characteristic radiological finding in multiple myeloma where there are lytic (bone - destroying) lesions in the bone, which can present as "punched - out" on X - rays (the "raindrop" pattern is also related to bone marrow involvement in myeloma and can be a precursor or associated finding with the more classic punched - out lesions in later stages).

Answer:

Multiple myeloma, Punched - out lesion