A 65-year-old man presents with fatigue, bone pain, and recurrent infections. Laboratory studies show anemia, hypercalcemia, and elevated total protein. Skull radiograph reveals multiple well-defined punched-out lytic lesions without sclerotic margins. Which of the following is the most likely diagnosis?

• A Metastatic carcinoma
• B Hyperparathyroidism
• C Paget's disease of bone
• D Multiple myeloma ✓

Explanation

Multiple myeloma classically presents with punched-out lytic lesions without sclerotic margins on skull radiograph. The clinical picture of anemia, hypercalcemia, recurrent infections, and elevated total protein supports this diagnosis. Metastatic carcinoma typically shows blastic or mixed lesions. Paget's disease shows bone enlargement and cotton-wool appearance. Hyperparathyroidism shows subperiosteal resorption and brown tumors.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.