1. As the functional anatomy of the spleen is divided into red pulp, white pulp, and marginal zone, what function is incorporated into the anatomy of the cortical zone that relates to infection control?
A. Filtration of red cells, encapsulated bacteria, and other foreign material.
B. Red pulp for formation of red cells.
C. White pulp for its role in formation of granulocytes.
D. Gray areas, so formed because of the production of platelets.
E. Fibrous trabeculae.
2. During the evolution of the understanding of hematologic diseases, the indications for splenectomy have changed. The most common indications for splenectomy are, in descending order of frequency:
A. Traumatic injury, immune thrombocytopenia, hypersplenism.
B. Immune thrombocytopenic purpura, traumatic injury, hypersplenism.
C. Hypersplenism, traumatic injury, immune thrombocytopenia.
D. Immune thrombocytopenia, hypersplenism, traumatic injury.
E. None of the above.
3. Useful methods for detection of splenic injury, in descending order of sensitivity, are:
A. Diagnostic peritoneal lavage.
D. Isotope scan.
E. Magnetic resonance imaging (MRI).
4. The following statements about splenosis are correct:
A. Autotransplantation of splenic tissue is an etiology.
B. May protect against OPSS.
C. May over time be “born again” and regain some immune function.
D. May produce tuftsin and properdin.
E. All of the above.
5. The following comments about immune thrombocytopenic purpura (ITP) are accurate:
A. Platelet count is low.
B. Circulating antiplatelet factor is present.
C. Antiplatelet factor is immunoglobulin G (IgG) antibody.
D. Purpura is directed against a platelet-associated antigen.
E. May be fatal.
F. All of the above.
A. Is most common in men in their 20s.
B. Is frequently cured in adults by corticosteroid administration.
C. Usually requires splenectomy in children.
D. Is most common in the sixth decade of life.
E. Is in remission in more than 80% of patients with splenectomy.
7. Splenectomy and perioperative therapy for ITP:
A. Follow successful steroid therapy.
B. Respond permanently to high-dose intravenous gamma globulin.
C. Are best preceded by polyvalent vaccines for Pneumococcus, Haemophilus influenzae, and Neisseria meningitidis.
D. Cannot be done laparoscopically.
E. Are associated with splenomegaly.
8. Thrombotic thrombocytopenic purpura (TTP) is a syndrome characterized by all of the following except:
B. Microangiopathic hemolytic anemia.
C. Deposition of platelet microthrombi.
D. Fluctuating neurologic abnormalities.
E. Renal failure.
9. Which of the following comments does not describe hypersplenism?
A. It may occur without underlying disease identification.
B. It may be secondary to many hematologic illnesses.
C. It is associated with work hypertrophy from immune response.
D. It requires evaluation of the myeloproliferation.
E. It is associated with antibodies against platelets.
10. Hyposplenism is a potentially lethal syndrome. Which of the following statements is incorrect?
A. It is confirmed by isotope scan.
B. It is always associated with an atrophic spleen.
C. It may be associated with overwhelming post-splenectomy sepsis syndrome (OPSS).
D. It is associated with thyrotoxicosis, corticosteroid administration, and some contrast agents.
E. It may be associated with ulcerative colitis or sickle cell anemia.
11. Hodgkin’s disease is a malignant lymphoma with four histologic subtypes. Which of the following is not one of the subtypes?
A. Lymphocyte predominance.
B. Nodular sclerosis.
C. Mixed cellularity.
D. Lymphocyte depletion.
E. Leukocyte-lymphocyte dominance.
12. Which of the following statements about lymphatic capillaries are true?
A. These vessels have delicate tricuspid valves every 2 to 3 mm.
B. Lymphatic capillaries are more permeable than blood capillaries.
C. Lymphatic capillaries are less permeable than blood capillaries.
D. Lymphatic capillaries contain gaps large enough to admit particles as large as lymphocytes.
13. Which of the following forces do not promote the formation of interstitial fluid?
A. Increased venous pressure.
B. Constrictive pericarditis.
14. The most frequent cause of primary lymphedema is:
A. A deficiency of transporting lymphatic channels.
B. Valvular incompetence in lymphatic channels.
C. Obstruction or removal of regional lymph nodes.
D. Thrombosis of lymphatic channels.
15. Most patients with lymphedema can be managed by:
A. Pedicle transfer of lymphatic bearing tissue into the affected area.
B. Elevation, elastic support garments, and massage therapy or mechanical pneumatic compression.
C. Lymphatic bypass using an autogenous vein graft.
D. Excision of hypertrophic scarred fibrotic skin and subcutaneous tissue down to muscle fascia and coverage with split-thickness skin grafts.
16. Which statements about lymphangiomas are true?
A. Most lesions appear during puberty.
B. These lesions frequently respond to small doses of radiation therapy.
C. The lesions usually grow slowly but may infiltrate local tissues.
D. Malignant transformation is frequent.
17. The two primary causes of death from sickle cell disease in the first decade of life are which of the following?
b. Splenic sequestration crisis
c. Acute chest syndrome
d. Heart failure
Answer: a, b
18. The best therapy for a patient with thrombotic thrombocytopenic purpura is which of the following:
d. Intravenous immune globulin
19. Which of the following statements regarding post splenectomy sepsis are true?
a. The incidence in children is generally reported as less than 5%
b. Haemophilus influenzae, Streptococcus pneumoniae and Neiseria meningitidis are the most common causative organisms
c. Autotransplantation techniques eliminate this risk
d. The mortality rate is now approximately 50%
e. The incidence in adults in approximately 1%
Answer: a, b, d, e
20. You are consulted regarding a 50-year old male with Laennec’s cirrhosis, portal hypertension and hypersplenism. He has no history of gastrointestinal bleeding. You would recommend which of the following?
b. Prophylactic sclerotherapy for esophageal varices
c. Portosystemic shunt
21. Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an abnormality of erythrocyte metabolism associated with hemolytic anemia. Pharmocologic agents which induce hemolysis include which of the following?
a. Acetylsalicylic acid
b. Vitamin E
Answer: a, c, e
22. Hypersplenism is associated with which of the following diseases?
a. Portal hypertension
d. Systemic lupus erythematosus
e. Gaucher disease
Answer: a, b, c, d, e
23. A 40-year old woman with chronic immune thrombocytopenic purpura (ITP) is refractory to corticosteroids. The approximate likelihood she will benefit from a splenectomy is approximately which of the following?
a. Less than 20%
24. Which of the following statements regarding splenic function in humans are true?
a. The specific immune function of the spleen is principally related to its antigen processing role
b. The spleen is the major site of synthesis of complement pathway proteins
c. The spleen is more efficient than the liver at removing bacteria with a high density of surface opsonins
d. The spleen serves as a principal source of nonspecific opsonins
Answer: a, d