American Board of Internal Medicine (ABIM) Certification Practice Exam

Management for most patients with smoldering myeloma primarily involves?

1. Immediate chemotherapy

2. Frequent imaging studies

3. Regular evaluations every 3 to 6 months

4. Surgical intervention

The correct answer is: Regular evaluations every 3 to 6 months

Management for most patients with smoldering myeloma primarily involves regular evaluations every 3 to 6 months. Smoldering myeloma is a precursor to multiple myeloma, characterized by the presence of abnormal plasma cells and/or monoclonal protein in the blood without the symptoms that define multiple myeloma (such as bone lesions, anemia, hypercalcemia, or renal failure). The goal in managing smoldering myeloma is to monitor the patient's condition for any progression to symptomatic myeloma rather than to initiate aggressive treatment. Regular evaluations help in assessing any changes in the patient's status and determining if and when to start treatment based on specific criteria, such as increased monoclonal protein levels or the development of symptoms. This watchful waiting approach is essential because most patients with smoldering myeloma will not require immediate therapy and can maintain a good quality of life without treatment for years. In contrast, options such as immediate chemotherapy, frequent imaging studies, or surgical intervention are not appropriate for smoldering myeloma. Immediate chemotherapy is reserved for symptomatic myeloma patients, while frequent imaging might lead to unnecessary anxiety and healthcare utilization, given that the condition is typically stable over time. Surgical intervention is not indicated