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Nocturnal falls related to zopiclone — SCE Geriatric Medicine MCQ

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HardFallsNocturnal falls related to zopicloneSCE Geriatric Medicine

An 84-year-old with HFpEF, bilateral carpal-tunnel surgery and lumbar stenosis has increased ventricular wall thickness and apical strain sparing. DPD scintigraphy shows grade 2 myocardial uptake. Serum and urine immunofixation and serum free-light-chain ratio are normal. What is the next diagnostic conclusion?

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Correct answer: C — Diagnose ATTR cardiac amyloidosis non-invasively and arrange TTR genotyping

Explanation lettering: D = shown as B · B = shown as C · E = shown as D · C = shown as E

A conflicts with the negative monoclonal screen. B is correct: typical cardiac findings plus grade 2–3 bone-tracer uptake and a complete negative monoclonal screen establish ATTR non-invasively; TTR genotyping distinguishes variant from wild-type disease. C is too absolute. D relies on a non-essential sign. E ignores multiple extracardiac ATTR red flags.

Reference: ESC position statement on cardiac amyloidosis: https://academic.oup.com/eurheartj/article/42/16/1554/6212698