ESHPLENđź‘˝ Flashcards
Which of the following is NOT A LOCATION where accessory spleens can be found?
A. Gastrocolic ligament
B. Gerotas fascia
C. Large bowel mesentery
D. Broad ligament
B Gerotas fascia
—-
Descending order
1 hilum (80%)
2 pedicle (80%)
Gastrocolic ligament
Tail
Greater omentum
Greater curvature
Splenocolic ligament
SI and LI mesentery
Left broad ligament
Left spermatic cord
WhichofthefollowingsplenicligamentsisNOTanavas cular plane?
A. Gastrosplenic B. Splenocolic
C. Phrenosplenic D. Splenorenal
Gastrosplenic has short gastric vessels
All of the following are functions of the spleen EXCEPT
A. Clearance of damaged or aged red blood cells (RBCs) from the blood.
B. Extra medullary sitefor hematopoiesis and recycling iron
C. Initiation of adaptive immune response from filtration of lymph
D. Clearance of encapsulated bacteria from the bloodstream
C. Not lymph but BLOOD
Which of the ff protein is not altered in Hereditary spherocytosis
A pyruvate kinase
B. Spectrin
C. Ankyrin
D. Band 3
D. Band 3
As well s protein 4.2
Splenectomy is indicated as a treatment in which ofthe folÂlowing conditions?
A. Cold antibody autoimmune hemolytic anemia
B. Hodgkins disease
C. G6PD
D. Abscess of the spleen
D. Abscess of the spleen
—
AIHA- corticosteroids
Hodgkin- MIS
G6PD- drugs
The disproportionately high rate of overwhelming post splenectomy infection (OPSI) in thalassemia patients is thought to be due to an immune deficiency. Which of the following strategies has been shown to reduce mortality?
A. Partial splenectomy.
B. Prophylactic antibiotic therapy.
C.Delaying splenectomy until after 2years of age.
D. Transfusion to maintain a hemoglobin (HGB) of >9 mg/dL
A. Partial splenectomy
—-
B. Little evidence
C. 4 yrs old
D. Doesnt reduce complications
A 30-year-old woman presents to her primary care proÂvider with complaints of bleeding gums while brushing her teeth as well as menorrhagia and several episodes of epistaxis within the past month. She has been previously healthy with no prior medical problems or surgeries. Examination reveals petechiae and ecchymosis over the lower extremities. Laboratory results show white blood cell (WBC) count 7000/mm3, HGB 14 g/dL, hematocrit (HCT) 42%, and platelet count 28,000/mm3 with numer ous megakaryocytes on peripheral smear. First-line ther apy for this condition would be
A. Oral prednisone
B. IV IG
C. RITUXIMAB
D. Splenectomy
A. O prednisone
The MC Physical finding in a px w hairy cell leukemia HCL
A. Massive splenomegaly
B. Shortness of breath
C. Abdominal pain
D. Joint pain
A. Massive splenomegaly
Which of the following is an indication for splenectomy in a patientwith chronic myelogenous leukemia (CML)?
A. Failure of chemotherapy to decrease splenomegaly
B. Sequestration requiring transfusion
does N I comut Hel
C. Symptomatic relief of early satiety
D. Presence of bcr gene mutation
C symptomatic relief of early satiety
Which of the following is an indication for splenectomy in polycythemia vera (PV) ?
A. Failure of aspirin to prevent thrombotic complications
B. Frequent need for phlebotomy
C. Symptoms related to splenomegaly
D. Prevention ofprogression to myeloid metaplasia
C. Symptoms related to splenomegaly
Which of the following is the most common etiology of splenic cysts worldwide?
A. Bacterial infection
B trauma
C parasitic infx
D congenital anomaly
C. Parasitic inf (like echinococcus)
Which of the following is an indication for surgical tx of a splenic aneurysm
A. Pregnancy
B. >2.0 cm
C. History of thrombocytopenia
D. History of neutropenia
A. Pregnancy
A 45-year-old man presents to the emergency depart ment with emesis of bright red blood. Laboratory results include HGB 10 g/dL, HCT 30%, platelets 300,000/mm3, international normalized ratio (INR) 1 .0, aspartate trans aminase (AST) 30 U/L, alanine transaminase (ALT) 45 U/L, and albumin 4.0 g/dL. After appropriate resusci tation he undergoes esophagogastroduodenoscopy (EGD) which is notable for gastric varices. What is the appropriatetreatmentforhiscondition?
A. Transjugular intrahepatic portosystemic shunt B. Variceal band ligation
C. Splenorenal shunt.
D. Splenectomy
D. Splenectomy
Which ofthe following is NOT part ofthe triad seen with FELTY SYNDROME
A. RA
B. SPLENOMEGALY
C. NEUTROPENIa
D. Thrombocytopenia
D. Thrombocytopenia
What is the most common complication following open
splenectomy?
A. Pancreatitis
B. Left lower lobe atelactasis
C. Pleuraleffusion
D. Wound infection
B. LLL atelectasis
Which of the following patients is at highest risk for OPSI?
A. A30-year old who underwent splenectomy for ITP.
B. A25-year old who underwent splenectomy for iatrogenic bleeding after a total colectomy.
C. A3-yearold who underwent splenectomy for herediÂTary spherocytosis.
D. A 4-year old who underwent splenectomy due to Bleeding aftera motor vehicle crash
C. 3 yr old splenectomy for HS
Which of the following asplenic patients should receive prophylactic antibiotic therapy to protect against 0PSI?
A. A35-year-old man undergoing a tooth extraction.
B. A4-year old child who recently underwent plenectomy.
C. A 15-year-old boy who underwent splenectomy at age 13.
D. There is little evidence supporting efficacy ofprophyÂlactic antibiotics.
D
More than 80% of accessory spleens are found in the splenic hilum. What is the
common location for an accessory spleen?
A. The greater omentum
B. The gastrocolic ligament
C. The tail of the pancreas
D. The splenocolic ligament
B. Gastrocolic ligament
Which of the following is the primary function of the spleen in humans?
A. Production of red cells
B. Production of white cells
C. Storage of blood
D.Hostdefense
D. Host defense
Approximately what volume of aged red blood cells are removed by the spleen every day?
A. 2 mL
B. 20 ml
C. 100 ml
D. 250 ml
B. 20 ml
In a normal patient what percentage of platelets are sequestered in the spleen?
A. 2%
B. 16%
C. 33%
D.50%
C. 33% or 1/3 of platelet pool
,
Which of the following proteins is abnormal in patients with hereditary spherocytosis?
A. Tuftsin
B. Ankyrin ,
C.Opsonin
D. Properdin
B. Ankyrin
Also band 3, protein 4.2
Transposition between the bcr gene on chromosome 9 and the abl gene on chromosome 22 is the hallmark of which of the following conditions?
A. Chronic myeloid leukemia
B Chronic myelomonocytic leukemia
C. Acute myeloid leukemia
D. Polycythemia vera
A. CML
. Abnormal storage of sphingomyelin is found in
A. Gaucher’s disease
B. Niemann pick disease
C. Amyloidosis
D. Feltys syndrome
B. Neimann pick dse
Which of the following is the most common cause of congenital hemolytic anemia?
A. Glucose-6-phosphate dehydrogenase deficiency
B. Pyruvate kinase deficiency
C. Hereditary spherocytosis
D. Hereditary elliptocytosis
B pyruvate kinase deficiency
An 18-year-old otherwise healthy woman is incidentally found to have a 2-cm splenic aneurysm of the mid portion of the splenic artery. Which of the following is the treatment of choice for this patient?
A. Observation only
B. Embolization
C. Ligation or resection of the aneurysm
D splenectomy
Answer:C. Ligation or resection of aneurysm for mid splenic
B: painful splenic infarction and absces
D: distal lesions that are close to the hilum
Mid=LIGATE
Distal= SPLENECTOMY
A 48-year-old patient presents with isolated bleeding gastric varices, splenic vein thrombosis, and normal liver function. Which of the following is likely to be the treatment of choice?
A. Beta blockers and banding
B. Splenorenal bypass
C. Splenic vein ligation
D. Splenectomy
D. Splenectomy
Thrombosis= resect
Splenectomy is indicated in a child with sickle cell following
A. 1 episode of sequestration
B. 2 episodes of sequestration
C. 3 episodes of sequestration
D. None of the above
A. 1 ep of sequestration
Which of the following is associated with an increased risk for pulmonary hypertension following splenectomy?
A. Sickle cell disease
B. Warm antibody auto-immune hemolytic anemia
C.Thalassemia
D. Idiopathic thrombocytopenic purpura
C. Thalassemia
What percentage of patients referred for surgery for idiopathic thrombocytopenic purpura will have a permanent response (i.e., not need further steroids)?
A. 15% B. 35% C. 55% D. 75%
D. 75%
A px who presents with altered mental status thrombocytopenia and lower ex petechia will most likely benefit from
A.Steroids
B. Methotrexate
C. Plasma exchange
D. Splenectomy
C. Plasma exchange
THIS IS TTP, w petechia as the MC presenting sign
Which of the following is a common indication for splenectomy in a patient with AGNOGENIC myeloid metaplasia?
A. Early satiety
B. Thrombocytopenia
C. Neutropenia
D. Splenic rupture
A. Early satiety
Others
Poor gastric emptying
LUQ heaviness or pain
Diarrhea
The treatment of choice in an otherwise healthy 22-year-old patient with a large, sepatated splenic abscess is
A. Antibiotic therapy only
B. Antibiotics + percutaneous drainage
C. Antibiotics + partial splenectomy
D. Antibiotics + splenectomy
D. 14 days antibiotics w splenectomy (TOC)
Patients undergoing elective splenectomy should receive vaccinations against Streptococcus pneumoniae, H. influenzae type B, and meningococcus
A. 2-4 wks before surgery
B. The day of surgery
C. 1 week after surgery
D. 1 month after surgery
A. 2-4 weeks before surgery
The most common early complication after open splenectomy is
A. Atelectasis
B. Hemorrhage
C. Subphrenic abscess
D. Wound infection
A. Atelactasis
Regarding risk factors for developing OPSI, a female patient has
A NO RISK
B high risk
C Low risk
No risk
Low risk : Trauma
Intermediated risk: SIP
SPHEROCYTOSIS
ITP
PORTAL HTN
High risk: MA THAHO
MALIGNANCY
THALASSEMIA
HODGKINDS DISEASE
This is the term for a group of inherited disorders of hemoglobin synthesis prevalent among people of Mediterranean extraction and classified according to the hemoglobin chain affected.
Idiopathic Thrombocytopenic Purpura ( ITP)
Felty’s Syndrome
Thalassemia
Lymphoma Amyloidosis
Thalasemmia