<prompt> Ramla, 65 yrs old male, presents with low back pain especially at L3, anaemia and fatigability. His investigation profile reveals - Hb 7 gm, TLC9000cmm, DLC -N- 55, L-30, M-10, E-1, B2, Serum proteins-8 gm , ratio-2.95.9, ESR-90 and serum creatinine-3.2 mg. Likely diagnosis is :Waldenstroms macroglobulinemiaMultiple myelomaTB spineSecondaries in spine  <response>: Answer is B Multiple myeloma This is a 65 year old patient presenting with low back pain along with-a reversed A: G ratio. This indicates an excess of globulin fraction or a possible gammopathy. These findings along with an elevated ESR and Renal involvement indicated by increased creatinine levels suggest a diagnosis of Multiple Myeloma. 