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  #1  
Old 08-03-2011
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Question old man with back pain.

A 62-year-old man has had back pain for the past 8 months. He has had a productive cough for the past 2 days. On physical examination his temperature is 39 C and there is dullness to percussion at the right lung base. Laboratory studies show 4+ gram-positive diplococci in the sputum. A chest radiograph shows right lower lobe consolidation. An abdominal CT scan shows multiple lytic lesions of the vertebrae. On the day prior to death his serum urea nitrogen was 63 mg/dL with creatinine 7.1 mg/dL. A dipstick urinalysis was normal. At autopsy, his kidneys are firm and pale. Microscopically, there is abundant pink hyaline material in glomeruli and around small vessels. This material stains positively with Congo red. Which of the following laboratory findings was most likely to have been present in this patient in the week prior to death?

A Positive antinuclear antibody test
B Serum glucose of 210 mg/dL
C CD4 lymphocyte count of 110/microliter
D Total serum protein of 9.2 g/dL
E Serum prostate specific antigen of 11.8 ng/mL
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Old 08-03-2011
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the ans is D
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Old 08-03-2011
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D Total serum protein of 9.2 g/dL
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Old 08-03-2011
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amyloidosis so D
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Old 08-03-2011
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Its DDDDDDDDDDDDDDDDDDDD
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Old 08-04-2011
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you are talkin about multiple myeloma, so the ans is d!
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definitely d
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Old 08-04-2011
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Correct Answer correct answer is D

correct answer is D
The findings are consistent with renal amyloid deposition with multiple myeloma. The total protein is elevated from increased serum monoclonal immunoglobulin. Myeloma can produce lytic bone lesions and patients often develop infections with encapsulated bacteria. The excessive light chain production leads to amyloid deposition. Bence-Jones proteinuria is often present, but the dipstick is most sensitive for albumin, not globulins.
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