A 63-year-old man develops edema, and dyspnea on exertion. He has no prior cardiac or renal conditions, and his examination is significant for macroglossia, elevated jugular venous pressure (JVP), hepatomegaly, and 3+ pedal edema. His investigations reveal 3.5 g/d of protein in the urine, anemia, normal fasting glucose, and serum immunoelectrophoresis is positive for a monoclonal immunoglobulin. Which of the following is the most characteristic neurologic finding associated with this condition?
A 63-year-old man develops edema, and dyspnea on exertion. He has no prior cardiac or renal conditions, and his examination is significant for macroglossia, elevated jugular venous pressure (JVP), hepatomegaly, and 3+ pedal edema. His investigations reveal 3.5 g/d of protein in the urine, anemia, normal fasting glucose, and serum immunoelectrophoresis is positive for a monoclonal immunoglobulin. Which of the following is the most characteristic neurologic finding associated with this condition?
π‘ Explanation
**Core Concept**
This question tests the student's knowledge of a rare systemic disorder characterized by the triad of edema, anemia, and monoclonal immunoglobulin production, leading to various systemic complications.
**Why the Correct Answer is Right**
The condition described is multiple myeloma (MM) with associated amyloidosis. The production of a monoclonal immunoglobulin leads to the deposition of amyloid fibrils in various tissues, including the kidneys, heart, and nerves. This deposition disrupts normal organ function, leading to the observed symptoms. The characteristic neurologic finding associated with this condition is peripheral neuropathy, specifically a stocking-glove distribution sensory loss and weakness due to amyloid deposition in the peripheral nerves.
**Why Each Wrong Option is Incorrect**
**Option A:** Autonomic dysfunction is not the most characteristic neurologic finding in multiple myeloma-associated amyloidosis.
**Option B:** Cranial nerve palsies can occur in amyloidosis, but are not the most characteristic finding.
**Option C:** Myelopathy can occur in various conditions, including multiple myeloma, but is not the most specific neurologic finding in amyloidosis.
**Clinical Pearl / High-Yield Fact**
In multiple myeloma, the presence of amyloidosis can be suggested by the presence of a monoclonal immunoglobulin on serum immunoelectrophoresis, and confirmed by biopsy of affected tissues.
**Correct Answer:** C.
β Correct Answer: A. peripheral motor and sensory neuropathy
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