This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Miscellaneous, Subject name: Medicine
Punched out appearance in skull seen in 
Select and explain. 
A. Multiple myeloma, B. Thalassemia, C. Carcinoma lung, D. Hyperparathyroidism
A: Multiple myeloma
Answer: A: Multiple myeloma 
Explanation: i.e. (Multiple myeloma): (679-Robbins 7th)MULTIPLE MYELOMA - presents as multifocal destructive bone tumours composed of plasma cells throughout the skeletal system* The bone lesions appears radiographically as punched out defects usually 1 -4 cm in diameter and grossly consists of gelatinous soft red tumour masses* Hyperparathyroidism - "pepper pot skull", The mandible a common site for Frown ' tumours* Moth - eaten appearance - syphilis* Rugor Jersy spine - Osteopetrosis* Beheadedscortish terrior sign - Spondylolisthesis