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
True regarding multiple myeloma is all. except : 
Select and explain. 
A. Bone pain, B. Lytic lesion, C. Increased alkaline phosphatase, D. Taerate resistance acid phosphatase positive
C: Increased alkaline phosphatase
Answer: C: Increased alkaline phosphatase 
Explanation: Answer is C (Increased alkaline phosphatase) Serum Alkaline phosphatase is usually normal even with extensive bone involvement because of absence of osteoblastic activity - Harrisons 16th/ 659 Bone pain is the most common symptom in myeloma Q Bone lesions are lytic in nature and are rarely associated with osteoblastic new bone formation. Therefore Radioisotope bone scanning is less useful in diagnosis than plain radiography c) No hot spot is seen on bone scan Q Alkaline phosphatase (marker of osteoblastic activity) is not raised.