1. Most commonly presents with anemia, bone pain, elevated creatinine, fatigue, and asymptomatic hypercalcemia.
2. Suspect in elderly who present with vertebral or chest pain with anemia, hypercalcemia, or elevated creatinine.
3. Multiple myeloma emergencies include acute/chronic renal failure, infection, and more rarely hypercalcemia and spinal cord compression.
4. Best imaging for punched out lesions are plain films of axial skeleton and proximal humerus/femur.