1. Which of the following clinical conditions are often expected in a patient with multiple myeloma?
a. anemia, thrombocytopenia, and leukopenia
b. recurrent infections, obesity, and weakness
c. renal failure, osteopenia, and visual disturbances
d. fatigue, fever, and weight loss
e. nosebleeds, bone pain, and heart failure
2. A 77 year old male is brought into the Accident and Emergency department having been found at home collapsed. It was established from the history that the patient had been lying in the same place for over 14 hrs. His routine bloods on admission were as follows:
Sodium 131 mmol/L
Potassium 5.2 mmol/L
Chloride 98 mmol/L
Urea 7.4 mmol/L
Creatinine 60 umol/L
C-Reactive Protein 96 mg/L
Troponin I <0.04 ug/L
a. Why was troponin I was measured in this case?
Ans: To exclude myocardial infarction as a cause for the patient's collapse
b. Using the information provided, what condition is the patient at risk of developing?
Ans: Rhabdomyolysis
c. Name one additional test that would be useful to check on this specimen to confirm the condition in (b) above. Give a reason for your choice.
Ans: Total creatine kinase (CK)
If the patient has rhabdomyolysis, then large amounts of CK will be released in response to breakdown of skeletal muscle tissue
d. The patient's urine was noted to be brown in color. What compound is responsible for this? Suggest a simple test that could be carried out to confirm its presence?
Ans: Myoglobin
Urine dipstick for presence of heme (both myoglobin and hemoglobin will be positive)
e. Suggest why routine laboratory tests for compound mentioned in (d) above are largely no longer available?
Ans: Measurement of myoglobin has been largely replaced by serum total CK
Total CK is representative of the degree of muscle damage and has a long half-life in serum
f. What major complication is this patient at risk of developing?
Ans: Acute renal failure
a. anemia, thrombocytopenia, and leukopenia
b. recurrent infections, obesity, and weakness
c. renal failure, osteopenia, and visual disturbances
d. fatigue, fever, and weight loss
e. nosebleeds, bone pain, and heart failure
2. A 77 year old male is brought into the Accident and Emergency department having been found at home collapsed. It was established from the history that the patient had been lying in the same place for over 14 hrs. His routine bloods on admission were as follows:
Sodium 131 mmol/L
Potassium 5.2 mmol/L
Chloride 98 mmol/L
Urea 7.4 mmol/L
Creatinine 60 umol/L
C-Reactive Protein 96 mg/L
Troponin I <0.04 ug/L
a. Why was troponin I was measured in this case?
Ans: To exclude myocardial infarction as a cause for the patient's collapse
b. Using the information provided, what condition is the patient at risk of developing?
Ans: Rhabdomyolysis
c. Name one additional test that would be useful to check on this specimen to confirm the condition in (b) above. Give a reason for your choice.
Ans: Total creatine kinase (CK)
If the patient has rhabdomyolysis, then large amounts of CK will be released in response to breakdown of skeletal muscle tissue
d. The patient's urine was noted to be brown in color. What compound is responsible for this? Suggest a simple test that could be carried out to confirm its presence?
Ans: Myoglobin
Urine dipstick for presence of heme (both myoglobin and hemoglobin will be positive)
e. Suggest why routine laboratory tests for compound mentioned in (d) above are largely no longer available?
Ans: Measurement of myoglobin has been largely replaced by serum total CK
Total CK is representative of the degree of muscle damage and has a long half-life in serum
f. What major complication is this patient at risk of developing?
Ans: Acute renal failure
