Mcq

70 year Male, (comorbidities are controlled hypertension and severe depression) with history of productive cough, no fever, sweating profusely in winter. His first CBC was hb 12 and esr 150 in first hour, 120 In second hour, 3 months back. Subsequently his creatinine started rising, first report being 1.9 , lft showed slightly raised globulin, normal ALP, normal calcium. Subsequent cbc reported hb 11.2, WBC 15000 with predominant neutrophilia , and no sign of fever, profuse sweating was present, sputum AFB and gram stain was negative and sputum c/s was negative, no other focus of neutrophilia could be found. LFt again showed mild raised globulin, esr was still raised till 90, creat was 1.6. So anemia, raised creat, slightly raised globulin, with raised esr led me to send serum protein electrophoresis which brought back M band of 3g/L. So immunofixation studies and free light chain assay and 24 hr urinary protein was sent, reports are attached. Kappa and lambda are raised, serum microglobulin is raised. Its not multiple myeloma as immunofixation almost rules out....but I am not sure why is light chain high, why is microglobulin high, Can it be light chain disease? Because his creat is raised and egfr is 41..... Or is it amyloidosis? I can't seem to understand more than what I have done. I leave interpretation to teachers here to tell me what to think and how to proceed...where all I went wrong....what all should I think? Was my approach right?

A child with macroglossia with superficial ulceration. MRI of the tongue done. MRI plate photograph is attached. Please give your valuable opinion for management of this patient.

male..35 years old...c/o massive tongue swelling for 2 days. Diagnosis and management????

A 46-year-old male presents with firm, round, papules on his scrotum since 1 month The patient is otherwise asymptomatic. No aggravation or amelioration The papules on scrotal region and tender. There is no other relevant history of DM or HTN. Appetite, thirst, urine- normal stool- constipated desire- sweet things, non-veg aversion- no Thermals- hot Please help with the diagnosis? Suggest Medicine Doctors

pt is hvng fvr wth jnts pain since a month anable to lift her both uppr lmb