Answer :USMLE step 2 Mcq 275:A patient with a long history of hemodialysis




Correct Answer: D

In amyloidosis carpal tunnel syndrome is a common clinical entity that is seen very frequently in patients undergoing hemodialysis for longer than 8 to 10 years .It is mainly characterized by rheumatic manifestations, including generalized arthralgias, scapulohumeral periarthritis, noninflammatory joint effusions, chronic synovitis, progressive bone destruction (destructive spondyloarthropathy), bone cysts, pathologic fractures, and carpal tunnel syndrome (CTS).  The diagnosis of dialysis arthropathy associated with beta 2-microglobulin-associated (A beta 2M) amyloidosis mostly relies on indirect clinical and radiological evidence. Histologic proof is rarely obtained in vivo.  Bone X-ray examination reveals characteristic cystic radiolucency (CRL) of the carpal bone, shoulder joint, hip joint and knee joint, and destructive spondylarthropathy (DSA) of cervical vertebrae.


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