American Board of Internal Medicine (ABIM) Certification Practice Exam

What is essential to monitor during the management of patients with smoldering myeloma?

1. Serum electrolyte levels

2. Hematocrit and platelet counts

3. CBC, serum calcium, creatinine levels, and M protein

4. Liver function tests

The correct answer is: CBC, serum calcium, creatinine levels, and M protein

Monitoring certain laboratory values is crucial for patients with smoldering myeloma to assess disease progression and to identify any signs of transformation to active myeloma or related complications. The essentials include a complete blood count (CBC) to track the levels of hemoglobin and the presence of any cytopenias, which can suggest hematological issues related to myeloma. Serum calcium levels are monitored because hypercalcemia is a common complication in myeloma and can have significant clinical implications. Assessing creatinine levels is important to evaluate kidney function, as myeloma can lead to renal impairment due to light chain deposition and other mechanisms. Finally, monitoring M protein levels helps evaluate the tumor burden and the effectiveness of any interventions, as increases in M protein can signify progression of the disease. The necessity of these parameters in the management of smoldering myeloma relates directly to the need for proactive identification of any changes in the patient's condition that may warrant treatment initiation or modification.