BOF:
34
A 72
year old female is admitted with confusion. Her daughter tells you that she
had been complaining of backache and had been very thirsty.
The
patient was known to have cerebrovascular disease and was on aspirin and a
statin.
On
examination you note that she looked unwell ,was pale , her tongue was dry ,
skin turgor was diminished pulse 110 beats per minute regular, BP 110/80 lying
,80 /40 standing .
In
this patient which one of the following investigation would you arrange next?
a)
Plasma protein electrophoresis
b)
Bone marrow aspiration
c)
Urine for Bence-Jones protein
d)
Skeletal survey
e)
Calcium studies
Answer: e)
The
patient has clinical features of salt and water loss and with a preceding
history of thirst and backache one should consider multiple myeloma with
hypercalcaemia.
The
first step would be to establish that the patient has hypercalcaemia and treat
this before embarking on tests to prove that the patient has myeloma
Revision Tip
Revise
multiple myeloma KEYS to SUCCESS in Medicine
page 404-406
