BOF:
127
A 62
year old male presents with a history of progressive breathlessness of 3
months duration. The patient is a diet controlled diabetic. He smokes 5
cigarettes a day and has done so for 40 years. He drinks 20 units of alcohol
per week.
On
examination you note that he is breathless at rest, pulse rate 110 beats per
minute, BP 120/70, JVP elevated to the angle of the jaw, predominant V wave,
the apex beat is in the 6th intercostal space anterior axillary
line, there is a 3rd heart sound and a blowing pan systolic murmur
that radiates to his axilla and a soft systolic murmur at the left sternal
edge.
Investigations:
Hb
6.6 g/dL
MVC
90 fl
WBC
8.2 x 109 /L
Platelets 180 x109/L
ESR120
Blood film show rouleaux formation
In
this patient which one of the following tests would you arrange in order to
confirm the pathogenesis of the breathlessness?
a)
Bone
marrow examination
b)
ECHO
cardiogram
c)
Plasma protein electrophoresis
d)
Bence Jones protein
e)
Rectal biopsy
