American Board of Internal Medicine (ABIM) Certification Practice Exam

What diagnostic tool is important for the initial evaluation of multiple myeloma?

1. CT scan of the abdomen

2. Bone marrow biopsy

3. Skeletal survey

4. Magnetic resonance imaging

The correct answer is: Skeletal survey

The diagnostic tool that is important for the initial evaluation of multiple myeloma is the skeletal survey. Multiple myeloma is characterized by the proliferation of abnormal plasma cells in the bone marrow, leading to bone lesions and destruction. A skeletal survey helps identify lytic bone lesions, which are a common finding in patients with multiple myeloma. This imaging technique involves a series of X-rays that can reveal the distribution and extent of skeletal involvement. While bone marrow biopsy is critical for confirming the diagnosis of multiple myeloma by obtaining a sample of the bone marrow to analyze plasma cells, it is not typically the first step in evaluating the extent of the disease. The skeletal survey provides a broader view of skeletal damage and is often performed before or alongside other diagnostic tests to assess the extent of bone involvement. CT scans and magnetic resonance imaging can also be useful in certain scenarios, particularly for evaluating specific areas of concern or assessing soft tissue involvement, but they are not the primary tools for initial evaluation. The skeletal survey, with its focus on revealing lytic bone lesions, plays a pivotal role in the initial imaging workup for multiple myeloma.