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 BOF 127

 

   

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BOF: 127

A 62 year old male presents with a history of progressive breathlessness of 3 months duration. The patient is a diet controlled diabetic. He smokes 5 cigarettes a day and has done so for 40 years. He drinks 20 units of alcohol per week.

On examination you note that he is breathless at rest, pulse rate 110 beats per minute, BP 120/70, JVP elevated to the angle of the jaw, predominant V wave, the apex beat is in the 6th intercostal space anterior axillary line, there is a 3rd heart sound and a blowing pan systolic murmur that radiates to his axilla and a soft systolic murmur at the left sternal edge.

Investigations:

Hb 6.6 g/dL

MVC 90 fl

WBC 8.2 x 109 /L

Platelets 180 x109/L

ESR120

Blood film show rouleaux formation

In this patient which one of the following tests would you arrange in order to confirm the pathogenesis of the breathlessness?

a)    Bone marrow examination

b)    ECHO cardiogram

c)     Plasma protein electrophoresis

d)    Bence Jones protein

e)    Rectal biopsy

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