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A 61-year-old male has a 6 month history of low back pain with increasing left sciatic leg pain for 5 weeks. On examination, he has bone tenderness in the lumbar and thoracic spine. Neurological examination shows 4/5 weakness in the L5 distribution in the left leg. MRI images of the thoracic and lumbar spine are shown in Figures A. Follow-up laboratory studies show anemia associated with the presence of a serum monoclonal protein. What would be the next most appropriate investigation in the diagnostic work-up of this patient?
CT scan of head
Lower extremity electromyelography
Bone marrow aspiration and biopsy
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Lytic bone lesions, commonly seen in metastatic bone disease or multiple myeloma, are due to which of the following mechanisms?
RANK ligand action on neoplastic cells
RANK action on neoplastic cells
Osteoprotegrin action on osteoclastic cells
RANK ligand action on osteoclastic cells
RANK action on osteoclastic cells
A 55-year-old male with chronic low grade back pain, intermittent fevers, and anemia underwent a bone biopsy for a lytic lesion in the spine. The biopsy is seen in Figure A. A urine protein electrophoresis is likely to show which of the following?
Polyclonal heavy chain immunoglobins
Polyclonal light chain immunoglobins
Monoclonal heavy chain immunoglobin
Monoclonal light chain immunoglobin
Decreased urine albumin
A 55-year-old male has chronic thoracic back pain and undergoes a biopsy of a suspicious lesion in the T6 vertebral body seen in Figure A. The asterisk in Figure B represents what type of cell seen by the pathologist?