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  #1  
Old 10-29-2012
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Arrow Billy Step 1 Questions # 55

A 79-year-old man has had increasing back pain and fatigue for the past 6 months. On physical examination, there are
no remarkable findings. Laboratory studies include a CBC with hemoglobin of 9.6 g/dL, platelet count of 241,600/mm3, and
WBC count of 7160/mm3. The serum total protein is 9.8 g/dL, albumin is 3.6 g/dL, glucose is 72 mg/dL, creatinine is
3.3 mg/dL, and urea nitrogen is 30 mg/dL. A dipstick urinalysis shows a pH of 7; specific gravity 1.011; and no blood,
protein, or glucose. One month later, he develops a cough with fever, and Streptococcus pneumoniae is cultured from his
sputum. Despite antibiotic therapy, he develops sepsis and dies. At autopsy, the kidneys are normal in size, but
microscopic examination shows dilated tubules filled with amorphous blue-to-pink casts and occasional multinucleated
giant cells. What is the most likely underlying cause of this patient's death?


□ (A) Cystinuria
□ (B) Diabetes mellitus
□ (C) Gout
□ (D) Multiple myeloma
□ (E) Parathyroid adenoma
□ (F) Systemic lupus erythematosus
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Old 10-29-2012
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my ans is multiple myeloma
-old age
-h/o back pain+fatigue
-anemia
-normal albumin+increased globulin
-increased creatinine
-sepsis
-renal amyloidosis
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  #3  
Old 10-29-2012
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Default DD

Multiple myeloma.
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Old 10-29-2012
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Quote:
Originally Posted by billy View Post
A 79-year-old man has had increasing back pain and fatigue for the past 6 months. On physical examination, there are
no remarkable findings. Laboratory studies include a CBC with hemoglobin of 9.6 g/dL, platelet count of 241,600/mm3, and
WBC count of 7160/mm3. The serum total protein is 9.8 g/dL, albumin is 3.6 g/dL, glucose is 72 mg/dL, creatinine is
3.3 mg/dL, and urea nitrogen is 30 mg/dL. A dipstick urinalysis shows a pH of 7; specific gravity 1.011; and no blood,
protein, or glucose. One month later, he develops a cough with fever, and Streptococcus pneumoniae is cultured from his
sputum. Despite antibiotic therapy, he develops sepsis and dies. At autopsy, the kidneys are normal in size, but
microscopic examination shows dilated tubules filled with amorphous blue-to-pink casts and occasional multinucleated
giant cells. What is the most likely underlying cause of this patient's death?


□ (A) Cystinuria
□ (B) Diabetes mellitus
□ (C) Gout
□ (D) Multiple myeloma
□ (E) Parathyroid adenoma
□ (F) Systemic lupus erythematosus
(D) Multiple myeloma>>>>>>produce secondary amyloidosis due to deposition of light chain>>>>evidenced from renal biopsy.
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Old 10-29-2012
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Correct Answer D is correct

This patient has a high serum globulin level from the presence of a monoclonal protein, and the back pain is
probably caused by lytic lesions in the spine. Patients with myeloma often have Bence Jones proteinuria (not detected by
the standard dipstick urinalysis), and some have cast nephropathy (as in this case), which can cause acute or, more
commonly, chronic renal failure (as in this case). Cystinuria is an uncommon condition arising from defective transport of
the amino acids cystine, lysine, arginine, and ornithine by the brush borders of renal tubule and intestinal epithelial cells.
Excessive amounts of these amino acids are lost in the urine, leading to stone formation (the distinctive crystals look like
miniature “stop” signs). Diabetic nephropathy can take many forms, but cast nephropathy is not one of them. Gouty
deposits in the kidney are not in the form of casts, and uric acid crystals form at acidic pH. Hypercalcemia from a
parathyroid adenoma can increase urine calcium excretion, favoring formation of stones, but not casts. Systemic lupus
erythematosus is more likely to cause glomerulonephritis.
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  #6  
Old 10-30-2012
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Default my answer :)

(D) Multiple myeloma
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  #7  
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yes its multiple myeloma
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Increased gamma globulins
Multiple myeloma
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One day i will infect these microbes and they will search for "Anti-MEbiotic"....
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