NEW
Font size
WorksheetsSpleen
Total questions: 18
Worksheet time: 9mins
A young woman is interested in spleen-preserving management of her symptomatic cyst. On review of her CT scan, you note that the cyst is solitary, occupies less than one-third of the splenic volume, and lies approximately 4 cm beneath the capsule. Which of the following possible surgical management options for splenic cysts is best while providing the smallest risk of recurrence?
Deroofing
Partial splenectomy
Total splenectomy
Fenestration
Aspiration
A patient presents to the hospital with left upper quadrant pain and fever following surgery for perforated appendicitis 1 week ago. Which of the following series of initial investigations would be most appropriate to identify a possible splenic abscess?
A. Complete blood count, blood culture, and abdominal ultrasound
B. Blood culture, abdominal ultrasound, and chest x-ray
C. Complete blood count, blood culture, chest x-ray, and CT of the abdomen/pelvis
D. Complete blood count, blood culture, abdominal x-ray, and chest x-ray
What is the most common causative organism for postsplenectomy sepsis?
A. Neisseria meningitidis
B. Haemophilus influenzae
C. Staphylococcus aureus
D. Streptococcus pneumoniae
E. Influenza H1N1
A 22-year-old woman status post–splenectomy returns to the emergency department on postoperative day 5 complaining of left upper quadrant pain, fever, and leukocytosis. Computed tomography demonstrates a 4-cm left upper quadrant fluid collection. What is the most appropriate next step in managing this patient?
A. Discharge to home with follow-up in 6 weeks
B. Discharge to home with oral antibiotics
C. Interventional radiology for percutaneous fluid sampling, with the fluid sent for amylase and cultures
D. Endoscopic retrograde cholangiopancreatography (ERCP) to drain the collection
E. Urgent return to the operating room for intraoperative drainage
A patient with known immune (idiopathic) thrombocytopenic purpura, on whom you performed a splenectomy 5 years previously, presents with bleeding symptoms and thrombocytopenia. Which of the following would be the most helpful initial steps?
A. Trial of steroids
B. Abdominal ultrasound
D. Radionucleotide imaging and blood smear
A 33-year-old woman who is G6, P6 presents to the emergency department for severe abdominal pain. This is her fifth visit in 2 months for the same complaint; previous workups have been negative. A mobile mass is palpated in the left upper quadrant. Computed tomography (CT) demonstrates a whorled appearance of the vascular pedicle of the spleen. What other finding does the CT scan demonstrate?
A. A hypoattenuated spleen
B. A hyperattenuated spleen
C. An atrophied spleen
D. A long splenic pedicle
E. A thrombosed splenic pedicle
A patient with glucose-6-phosphate dehydrogenase deficiency develops acute jaundice and fatigue and is found to be anemic. Which of the following is a common trigger for hemolysis in this disease?
A. Recent infection
B. Vitamin K
C. Colchicine
D. Penicillins
You are asked to see a 16-year-old patient with newly diagnosed hereditary spherocytosis. He has required three transfusions this year. On examination, he is pale and has a palpable spleen tip. Blood work shows significant anemia. How should you counsel the patient?
A. Splenectomy will significantly improve anemia and may eliminate it altogether.
B. Splenectomy can be performed to reduce his discomfort but will not affect the transfusion requirement.
C. Splenectomy is not indicated at this time. Refer the patient to hematology for medical management and then reassess.
D. Splenectomy should be delayed until age 21.
After undergoing splenectomy for ITP, a patient has persistent disease concerning for a missed accessory spleen, and a technetium scan is ordered to localize it. Which is the most common location for an accessory spleen?
A. Mesentery
B. Hilar region
C. Lesser sac
D. Diaphragm
E. Tail of pancreas
A patient is admitted 2 months after splenectomy and presumed to have postsplenectomy sepsis. The risk of overwhelming postsplenectomy infection is greatest in which of the following patients?
A. A 2-year-old child who is status post–elective splenectomy for idiopathic thrombocytopenic purpura
B. A 16-year-old girl who is status post–traumatic rupture of the spleen after a motor vehicle crash
C. A 30-year-old man with HIV who is status post–splenectomy after a motor vehicle crash
D. A 20-year-old man who is status post–elective splenectomy for thalassemia
E. A 10-year-old boy who is status post–elective splenectomy for hereditary spherocytosis
Which of the following is the correct set of vaccines to administer to a patient who is asplenic?
A. Pneumococcal, herpes zoster, meningococcal, and influenza
B. Pneumococcal, hepatitis B, meningococcal, and Haemophilus influenzae
C. Pneumococcal, Haemophilus influenzae, meningococcal, and influenza
D. Pertussis, Haemophilus influenzae, meningococcal, and influenza
E. Pneumococcal, influenza, MMR, and herpes zoster
A patient presents to your clinic with a CT report showing a 4cm incidental simple splenic cyst. Which of the following is an indication for management?
A. The patient reports a history of long-standing left upper quadrant discomfort and early satiety.
B. The patient is concerned about malignancy.
C. The cyst is 4 cm in size.
D. The patient is planning to become pregnant.
A 14-year-old boy with sickle cell disease presents to the hospital with acute, progressive lethargy, left upper quadrant pain, and lightheadedness. On examination he is tachycardic and hypotensive. His oxygen saturation is normal. He is found to be profoundly anemic. What is the most likely diagnosis?
A. Acute chest syndrome
B. Pulmonary embolus
C. Hand-and-foot syndrome
D. Sequestration crisis
E. Splenic rupture
You are planning to discharge a patient who underwent splenectomy for treatment of a splenic pseudocyst. Which of the following applies to postsplenectomy management?
A. Guidelines suggest that this patient will require lifelong antibiotic prophylaxis following splenectomy.
B. It is recommended that the patient receive postsplenectomy vaccines on postoperative day 1 to decrease the risk of overwhelming postsplenectomy sepsis.
C. If partial splenectomy was performed, the patient will not require postsplenectomy vaccination if one-half of the spleen is preserved.
D. Overwhelming postsplenectomy sepsis most commonly occurs many years following splenectomy.
When is the ideal time to give vaccinations to prevent postsplenectomy sepsis for an elective splenectomy?
A. Two weeks after splenectomy
B. Two weeks prior to splenectomy
C. Two days after splenectomy
D. Two days prior to splenectomy
A 52-year-old man with a history of diabetes mellitus, hypertension, and hepatitis C cirrhosis status post–motor vehicle crash is taken to the operating room after failure of nonoperative management for a grade III splenic injury. Intraoperatively, a capsular tear of approximately 2 cm is noted. Your attending decides to attempt a salvage procedure. Which of the following is a relative contraindication for partial splenectomy in this patient?
A. Platelets less than 200 × 103/µL after 24 hours
B. Cirrhosis
C. Diabetes
D. Grade III splenic injury
You are asked to see a 19-year-old man with thalassemia in the emergency department. Which of the following physical examination findings would suggest that he has hypersplenism?
A. Abdominal tenderness and splenomegaly
B. Fever, hypotension, and chest pain
C. Fever and splenomegaly
D. Jaundice and hepatosplenomegaly
Which of the following hematologic disorders is unlikely to respond to splenectomy?
A. Idiopathic thrombocytopenic purpura
B. Autoimmune hemolytic anemia
C. Thalassemia
D. Sideroblastic anemia
E. Hereditary spherocytosis
