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NBME 17 Answers

nbme17/Block 1/Question#23 (reveal difficulty score)
A 60-year-old man comes to the physician for ...
Surface kappa:surface lambda ratio ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: pathoma repeat

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submitted by โˆ—bingcentipede(355)

Not in First Aid, but Drs. Sattar and Goljaan emphasize this point

In B-cell neoplasms (lymphoma, MM), the ratio of immunoglobulins is thrown off. Kappa and lambda refer to the Ig light chain genotypes, and is normally 2-3:1 for kappa to lambda. Here, it's almost 16:1, and this is a huge sign that there is a monoclonal proliferation of one cell type.

The other answer choices could refer to polyclonal proliferations, but a (mono)clonal neoplasm would be reflected in the surface k:l ratio as well as the G6PD isoforms for androgen receptors.

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dermgirl  Pathoma 2019- page.23 +1

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