Membership of the Royal Colleges of Physicians (MRCP) Practice Exam

In the context of a patient with rheumatoid arthritis presenting with lower leg edema and proteinuria, performing serum protein electrophoresis is likely to provide significant diagnostic value. This test allows for the assessment of various proteins in the blood, helping to identify any alterations in protein levels or types that may suggest underlying conditions such as amyloidosis.

Rheumatoid arthritis can be associated with secondary conditions, including renal complications like amyloidosis, which occurs when abnormal protein deposits accumulate in tissues and organs. Patients with chronic inflammatory diseases are at increased risk for amyloidosis, leading to kidney involvement, which explains the proteinuria observed in this patient. Serum protein electrophoresis can identify monoclonal proteins or abnormal levels of specific proteins that would indicate such a condition.

In contrast, while the other options might seem relevant in other contexts—such as venography in the case of suspected deep vein thrombosis or renal angiography for visualizing blood vessels in the kidneys—they would not directly address the potential risk of amyloidosis related to the patient’s existing rheumatoid arthritis. A rectal biopsy would not typically be warranted for the presented symptoms and is less likely to yield any relevant information about the renal issues indicated by proteinuria. Thus, serum protein electrophoresis stands out

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