<prompt> A 58 year old woman, who had backache and recurrent chest Infections for 6 months, develops sudden weakness of the legs and urinary retention. Her investigations show a hemoglobin of 7.3 gm dl, serum calcium 12.6 mgdl, phosphate-2.5 mg dl, alkaline phosphatase-1OOul, serum albumln- 3 gmdi, globulin - 7.1 gmdl and urea - 178 mgd. What is the most likely diagnosis -Lung cancerDisseminated tuberculosisMultiple myelomaOsteoporosis  <response>: Diagnosis is Multiple myeloma : Patient is having backpain and hypercalcemia because in multiple myeloma the malignant plasma cells produce cytokines, which stimulate osteoclasts and result in net bone reabsorption. The resulting lytic lesion causes bone pain, fractures and hypercalcemia. Patient is having recurrent infection, due to pancytopenia Anemia is a feature of multiple myeloma In Multiple myeloma globulin level increases, here there is increased level of globulin and AlbuminGlobulin ratio is decreased. Reference : Davidson, 23rd Edition, page no : 967. 