Surgery MCQs Q30

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SURGERY • HEMATOLOGY

A 28-year-old woman presents with easy bruising and recurrent epistaxis. Laboratory evaluation shows isolated thrombocytopenia. She is diagnosed with immune thrombocytopenic purpura (ITP) and initially treated medically. Due to poor response, surgical management is considered.

What is the most common indication for splenectomy?

A Idiopathic thrombocytopenic purpura (ITP)

B Viral infections

C Leukemia

D Trauma

E Protozoal infections

The most common elective indication for splenectomy is Idiopathic thrombocytopenic purpura (ITP).

Decoding the Stem

1

CLUE "Asking 'most common indication'"

TRANSLATION The most frequent elective indication is sought.

Explanation

A. ITP: ✅ Correct. It is the most common indication for elective splenectomy. In ITP, the spleen is the primary site of antibody-coated platelet destruction and anti-platelet antibody production. Splenectomy is indicated for steroid-resistant or recurrent cases.

D. Trauma: ❌ Incorrect in this context. Trauma is the most common cause of emergency splenectomy, but not the overall most common elective indication.

B & E. Infections: Viral and protozoal infections are managed medically; splenectomy is not a routine treatment.

C. Leukemia: ❌ Rare indication, typically only considered if symptomatic hypersplenism occurs.

🧠 Splenectomy Pearls

Condition Type	Most Common Indication
Elective/Overall	ITP
Emergency	Trauma (Splenic Rupture)
Immunology	Removes site of IgM production

Integrated Clinical Questions

1. What is the most feared long-term complication after splenectomy?

Answer: Overwhelming Post-Splenectomy Infection (OPSI), which has a high mortality rate.

2. Which organisms are primarily responsible for OPSI?

Answer: Encapsulated bacteria: Streptococcus pneumoniae (most common), Haemophilus influenzae, and Neisseria meningitidis.

3. What preventive measure must be taken prior to an elective splenectomy?

Answer: Vaccination against pneumococcus, meningococcus, and Hib, preferably 2 weeks before the surgery.

4. What characteristic finding on a peripheral blood smear is seen after splenectomy?

Answer: Howell-Jolly bodies (nuclear remnants in RBCs) and Pappenheimer bodies.

5. What is the role of the spleen in immune clearance?

Answer: It clears opsonized bacteria from the circulation through splenic macrophages.

⚡ Exam Pearls

• ITP = Most Common Elective Indication (Favorite MCQ point).
• Trauma = Most Common Emergency Cause.
• Vaccination: Essential pre-op step for all elective cases.

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