Metabolic bone disease: dialysis-related amyloidosis: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Metabolic bone disease: dialysis-related amyloidosis

Sample item

A man on haemodialysis for 12 years has carpal tunnel syndrome, shoulder pain and cystic lesions in the carpal bones. Which protein forms the deposits?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Beta-2 microglobulin

Beta-2 microglobulin is not cleared well by conventional dialysis membranes and accumulates as amyloid in synovium, tendons and bone. It causes carpal tunnel syndrome, arthropathy and subchondral cysts after about 5 to 10 years of dialysis.

Option by option

  • A. Transthyretin

    Transthyretin amyloid occurs in hereditary and senile forms.

  • B. Immunoglobulin light chain

    Light chain amyloid occurs in plasma cell disorders.

  • C. Serum amyloid A

    Serum amyloid A causes reactive amyloidosis in chronic inflammation.

  • D. Beta-2 microglobulin (correct)

    Correct. Beta-2 microglobulin amyloid builds up in long-term dialysis patients.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is D, Beta-2 microglobulin. Beta-2 microglobulin is not cleared well by conventional dialysis membranes and accumulates as amyloid in synovium, tendons and bone.

Why is "Transthyretin" not the answer?

Transthyretin amyloid occurs in hereditary and senile forms.

Why is "Immunoglobulin light chain" not the answer?

Light chain amyloid occurs in plasma cell disorders.

Why is "Serum amyloid A" not the answer?

Serum amyloid A causes reactive amyloidosis in chronic inflammation.

What concept does this question test?

It tests Metabolic bone disease: dialysis-related amyloidosis in Orthopaedics. It causes carpal tunnel syndrome, arthropathy and subchondral cysts after about 5 to 10 years of dialysis.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Metabolic bone disease: dialysis-related amyloidosis?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.