Loading....
Coupon Accepted Successfully!

Surgery

Open Flashcards

General Surgery

Question
129 out of 142
 

Pt. presents with punched out lesion on X-ray with Serum Na-144, K+-4.5, Ca-12, Globulin-8.4, alls 5.4, what will be next investigation to do?



A Serum protein electrophoretic studies

B Alk PO4- levels

C Bone scan

D ESR

Ans. A Serum protein electrophoretic studies (REF. HARRISON INTERNAL MEDICINE 18TH EDN. )

a. The presence of unexplained anemia, kidneydysfunction, a high erythrocyte sedimentation rate (ESR) and a high serum protein (especially raised immunoglobulin) may prompt further testing.

b. One type of paraprotein is the Bence Jones proteinwhich is a urinary paraprotein composed of free light chains.

c. Quantitative measurements of the paraprotein are necessary to establish a diagnosis and to monitor the disease.

d. The paraprotein is an abnormal immunoglobulin produced by the tumor clone.

e. Multiple myeloma can produce all classes of immunoglobulin, but IgG paraproteins are most common, followed by IgA and IgM. IgD and IgE myeloma are very rare.

f. In addition, light and or heavy chains (the building blocks of antibodies) may be secreted in isolation: κ- or λ-light chains or any of the five types of heavy chains (α-, γ-, δ-, ε- or μ-heavy chains).

g. Additional findings include: a raised calcium (when osteoclasts are breaking down bone, releasing calcium into the bloodstream), raised serum creatinine due to reduced renal function, which may be due to paraprotein deposition in the kidney.

h. Myeloma activity appear as "lytic lesions" (with local disappearance of normal bone due to resorption), and on the skull X-ray as "punched-out lesions" (pepper pot skull).

i. Magnetic resonance imaging (MRI) is more sensitive than simple X-ray in the detection of lytic lesions, and may supersede skeletal survey, especially when vertebral disease is suspected.

j. Bone scans are typically not of any additional value in the workup of myeloma patients.

Diagnostic criteria

A. Symptomatic myeloma

a. Clonal plasma cells >10% on bone marrow biopsy or (in any quantity) in a biopsy from other tissues (plasmacytoma)

b. A monoclonal protein (paraprotein) in either serum or urine

c. Evidence of end-organ damage (related organ or tissue impairment, ROTI):

d. Hypercalcemia (corrected calcium >2.75 mmol/L)

e. Renal insufficiency attributable to myeloma

f. Anemia (hemoglobin <10 g/dL)

g. Bone lesions (lytic lesions or osteoporosis with compression fractures)

h. Frequent severe infections (>2 a year)

i. Amyloidosis of other organs

j. Hyperviscosity syndrome

B. Asymptomatic myeloma:

Serum paraprotein >30 g/L AND/OR

a. Clonal plasma cells >10% on bone marrow biopsy AND

b. NO myeloma-related organ or tissue impairment

Monoclonal gammopathy of undetermined significance (MGUS):

Serum paraprotein <30 g/L AND

i. Clonal plasma cells <10% on bone marrow biopsy AND

ii. No myeloma-related organ or tissue impairment

General Surgery Flashcard List

142 flashcards
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
15)
16)
17)
18)
19)
20)
21)
22)
23)
24)
25)
26)
27)
28)
29)
30)
31)
32)
33)
34)
35)
36)
37)
38)
39)
40)
41)
42)
43)
44)
45)
46)
47)
48)
49)
50)
51)
52)
53)
54)
55)
56)
57)
58)
59)
60)
61)
62)
63)
64)
65)
66)
67)
68)
69)
70)
71)
72)
73)
74)
75)
76)
77)
78)
79)
80)
81)
82)
83)
84)
85)
86)
87)
88)
89)
90)
91)
92)
93)
94)
95)
96)
97)
98)
99)
100)
101)
102)
103)
104)
105)
106)
107)
108)
109)
110)
111)
112)
113)
114)
115)
116)
117)
118)
119)
120)
121)
122)
123)
124)
125)
126)
127)
128)
129)
130)
131)
132)
133)
134)
135)
136)
137)
138)
139)
140)
141)
142)