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A 57-year-old man presents to his internist because of abnormal bleeding following a routine dental cleaning. Over the past several months he has experienced symptoms of headache, dizziness, fatigue, decreased vision, and occasional epistaxis. He has also begun noticing “lumps” on his armpits and groin region. The spleen tip is palpable on physical examination. Laboratory tests show a hemoglobin level of 11 g/dL, blood urea nitrogen of 25 mg/dL, calcium of 9.1, and total protein of 15 g/dL. Immunofixation shows high levels of IgM.
Which of the following is the most likely explanation for the patient's symptoms?
A. Heavy chain disease
B. Monoclonal gammopathy of undetermined significance
C. Multiple Myeloma
D. Primary Amyloidosis
E. Waldenstrom's Macroglobulinemia
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No lab data to pull up. To make it fair, everything is abnormal except calcium. Calcium level is normal.
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right its E.
Trick is to look at the calcium levels at all times. I didn't know the symptoms of hyperviscosity.
Hyperviscosity syndrome is a group of symptoms triggered by increase in the viscosity of the blood. Symptoms of high blood viscosity include spontaneous bleeding from mucous membranes, visual disturbances due to retinopathy, and neurologic symptoms ranging from headache and vertigo to seizures and coma.
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m sorry but how will you differentiate it from option BB?i think
hypercalcemia is absent there also
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hyperviscosity symptoms is associated with waldenstrom..
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its also there in MGUS and multiple myeloma too
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ALso, IgM spikes usually in Waldestrom as compared to MM (where its either IgG or IgA)
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Thank you! this is a great question
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the thing i want to point is we cant go by HYPERCALCEMIA the protein levels should also be considered while ruling out the monoclonalgammopathy.
Igm spikes are there in waldenstrom and monoclonal as well..
thanks
