11-21-2011, 06:44 AM
48-year-old female presents with a chief complaint of shortness of
breath with exercise. Her past medical history is significant for
rheumatoid arthritis, for which she takes non-steroidal anti-inflammatory
agents. Physical examination is remarkable for slightly muffled heart
sounds and fine bilateral rales in her lungs. A chest x-ray reveals
cardiomegaly and evidence of mild pulmonary edema; an echocardiogram
demonstrates a reduced ejection fraction. Examination of a hematoxylin
and eosin-stained section of biopsy material from her right ventricle
reveals moderate amounts of a homogenous pink material infiltrating the
heart muscle. The pink material is most likely composed of which of the
following proteins?
A. AA amyloid protein
B. AE amyloid protein
C. AF amyloid protein
D. AL amyloid protein
E. Beta amyloid precursor protein
breath with exercise. Her past medical history is significant for
rheumatoid arthritis, for which she takes non-steroidal anti-inflammatory
agents. Physical examination is remarkable for slightly muffled heart
sounds and fine bilateral rales in her lungs. A chest x-ray reveals
cardiomegaly and evidence of mild pulmonary edema; an echocardiogram
demonstrates a reduced ejection fraction. Examination of a hematoxylin
and eosin-stained section of biopsy material from her right ventricle
reveals moderate amounts of a homogenous pink material infiltrating the
heart muscle. The pink material is most likely composed of which of the
following proteins?
A. AA amyloid protein
B. AE amyloid protein
C. AF amyloid protein
D. AL amyloid protein
E. Beta amyloid precursor protein