<prompt> Multiple Punched out lesions on skull X-Ray is found in:DownsHyperParathyroidismMultiple MyelomaAll  <response>: C i.e. Multiple myeloma Features Disease Multiple punched out lesions Multiple myelomaQ Hair on end skull vault ThalessemiaQ, Sickel cell Anemia Erosion of dorsum sella Raised ICT earliest most common Silver Beaten app. of vault Raised ICT Sunray calcification with spicules Meningioma 