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
Ramla, 65 yrs old male, presents with low back pain especially at L3, anaemia and fatigability. His investigation profile reveals - Hb = 7 gm%, TLC9000/cmm, DLC -N- 55%, L-30%, M-10%, E-1%, B2%, Serum proteins-8 gm %, ratio-2.9/5.9, ESR-90 and serum creatinine-3.2 mg%. Likely diagnosis is : 
Select and explain. 
A. Waldenstroms macroglobulinemia, B. Multiple myeloma, C. TB spine, D. Secondaries in spine
B: Multiple myeloma
Answer: B: Multiple myeloma 
Explanation: 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.