new_n_lost
Politically InCorrect
Topics: 650
Posts: 6,058
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I found this a toughie
A 46-year-old man on hemodialysis for 12 years complains of insidious onset of painful nocturnal dysesthesias involving the thumb and three fingers, relieved by shaking the hand. Physical examination of the hand reveals thenar wasting and numbness over the fingers. Each of the following statements is true, except
A) Deposits of β2-microglobulin AH (amyloidosis associated with hemodialysis) amyloid compressing the median nerve could produce these findings.
B) An entrapment neuropathy could explain these findings.
C) Paresthesias involving the radial side of the thumb, second, third, and fourth fingers suggest compression of the medial nerve.
D) Carpal tunnel syndrome could explain these findings.
E) Deposits of amyloid of the primary type AL (amyloidosis associated with light chains) would be typical.
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| shalini.ravi
Forum Senior
Topics: 17
Posts: 153
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e is the only untrue one   
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mediocricity aint my style
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| usmle4me
Forum Elite
Topics: 6
Posts: 283
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CTS caused by b2 deposits...
46 yrs...amylodosis!
Shall chose E
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| keepgoing
Forum Guru
Topics: 62
Posts: 1,673
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yes e agree with u4m
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| new_n_lost
Politically InCorrect
Topics: 650
Posts: 6,058
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Answer: E
Explanation: Clinically, the patient has carpal tunnel syndrome, an entrapment neuropathy in which the median nerve is compressed within the carpal tunnel area. A new type of amyloid protein identified as β2-microglobulin has been demonstrated in bone and carpal tunnel tissue of patients undergoing long-term (usually greater than 10 years) hemodialysis. It is hoped that modifications of the dialysis membranes may result in improved β2-microglobulin clearance with diminished tissue deposition.
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| verapamil
Forum Newbie
Topics: 2
Posts: 43
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the answer is "A"
 like what NNL said, B2 type is hemodialysis associated amyloidosis that can cause carpal tunnel syndrome and joint dse (kaplan pg 67)
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