每日一题_2022.11.24

A 66-year-old man is seen in the emergency department after an acute episode of severe hip pain that caused him to fall while walking at home. X-ray shows the presence of a pathological fracture of the pelvis. On questioning, the man reports that in recent months he has felt very fatigued and has been bothered by constant dull pain in his hips, back, and head. A radiograph of his skull is shown in the image. Laboratory studies show a serum calcium of 13.5 mg/dL and alkaline phosphatase of 60 U/L. Which of the following is an additional finding that would be likely in this patient?

患者男，66岁，因严重髋部疼痛急性发作，在家行走时致跌倒，急诊就诊。X 线显示存在骨盆病理性骨折。经询问，该男子报告，近几个月来他感到非常疲劳，一直受到髋部、背部和头部持续隐痛的困扰。影像中显示了他的颅骨 X 线片。实验室检查显示血清钙为13.5 mg/dL，碱性磷酸酶为60 U/L。以下哪一项是该患者可能出现的其他结果？

(A) Blue sclerae 蓝巩膜

(B) Facial muscle contraction on tapping the facial nerve面神经轻敲时面部肌肉收缩

(C) Hard prostatic nodule on digital rectal examination直肠指检时前列腺硬结节

(D) Palpable parathyroid nodule 可触及甲状旁腺结节

(E) Proteinuria蛋白尿

答案解析：

该患者患有多发性骨髓瘤。x 线显示颅骨多发性溶解性“穿凿样”病变，这是这种浆细胞恶性肿瘤的经典发现。骨骼的其他区域通常被骨髓瘤细胞浸润，包括椎骨、肋骨和骨盆，这解释了患者在无明显创伤的情况下发生骨折的原因。在碱性磷酸酶水平正常的情况下，溶骨性病变是导致该患者高钙血症的原因。尿蛋白（在这种情况下称为本周蛋白）是多发性骨髓瘤的常见结果，因为肿瘤浆细胞分泌大量免疫球蛋白，轻链易于排泄。免疫球蛋白血清水平过高可导致这些患者发生肾病或淀粉样变性。

答案解析：E