This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Medicine
Ramesh 60 years, presents with generalized bone pain. On examination there is elevated ESR of 100 mm, serum globulin 7, lytic lesions in the skull, serum creatinine of 3.5 mg/dL and serum calcium of 11 mg/dL. What is the most likely diagnosis : 
Select and explain. 
A. Waldenstrom's macroglobulinemia, B. Multiple myeloma, C. Hyperparathyroidism, D. Osteomalacia
B: Multiple myeloma
Answer: B: Multiple myeloma 
Explanation: Answer is B (Multiple myeloma) This is a 60 year patient presenting with generalized bone pain and lytic lesion in skull with blood parameters indicating a markedly raised ESR, Hrnercalcetnia, Hyperglobulinemia and raised serum creatinine. All these suggest a diagnosis of multiple myeloma. Patient Normal Interpretation & inference Age 60 years - 60 years ESR 100 < 15 (male) Markedly increased Serum globulin 7 2.5 to 3.5 Increased Serum creatinine 3.5 < 1.5 mg/dl Increased: Renal failure Serum calcium 11.0 9 mg/dl Increased hypercalcemia Distinguishing features between W. Macroglobulinemia from multiple mveloma Does not cause lytic bone lesions Does not cause hypercalcemia* serum calcium is usually not elevated* Serum 'M' component is IgM - IgM being large in size undergoes Less renal excretion - Renal disease is not common Q - Serum creatinine is usually not elevated. - Hepatomegaly, splenomegaly and lymphadenopathy are common unlike in multiple myeloma where they are uncommon. - Symptoms due to hyperviscocity are more prominent as compared to those in multiple myeloma - Epistaxis visual disturbance and neurological symptoms are more common. - Rouleaux formation and positive Coombs test are more common.