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Retired NBME 18 Answers

nbme18/Block 1/Question#7 (reveal difficulty score)
a 67-year-old woman comes to the physician ...
amyloid infiltration ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—nbmeanswersownersucks(158)
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monoclonal IgG kappa (light chain) spike on electrophoresis, lytic bone lesions in the spine, cardiomegaly all point to multiple myeloma. Causes a primary amyloidosis that can deposit in multiple tissues, like the heart in this patient.

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underd0g  Why can't the answer be plasma cell infiltration? +2
notyasupreme  @underd0g I put that too, but I think if you look at the histo picture, it literally shows all the eosinophilic looking bullshit from amyloidosis, and it was specifically asking the cardiac symptoms. The cause of MM is plasma cell, but the cause of the cardiac is the primary amyloid deposition = restricitive cardiomyopathy +
trishasingh  In multiple myeloma there is overproduction of immunoglobulin light chain that causes majority of the symptoms, like bence jones proteins in the urine and infiltration of organs like the kidneys and the heart. It causes diastolic dysfunction of the heart. Other infiltrative diseases, like haemochromatosis and sarcoidosis also cause diastolic dysfunction of the heart. +
ih8payingfordis  This is a case of primary amyloidosis from deposition of Ig Light chains (AL). FA 2019 pg 212 +



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