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20 Cards in this Set
- Front
- Back
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1. The 32-year-old woman presents with easy bruisability, gum bleeding and petechiae, and thrombocytopenia. The bone marrow aspirate shows increased number of megakaryocytes (normal functions). Diagnosis?
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a. Immune thrombocytopenia purpura (ITP).
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2. Pathophysiology of ITP?
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a. ITP is associated with production of antiplatelet IgG by the spleen.
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3. Mechanisms of thrombocytopenia with ITP?
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a. Inadequate production because of primary or secondary bone marrow dysfunction
b. Splenic sequestration (hypersplenism) (not splenomegaly). c. Increased platelet destruction |
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4. Aetiology of ITP?
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a. ITP is an acquired disorder!
b. 2-3x more common in women. |
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5. Initial treatment of ITP?
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a. Corticosteroids.
b. 75% of patients responded corticosteroids c. But the best long-term results are achieved with splenectomy. d. Laparoscopic |
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6. Symptoms of ITP?
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a. Ecchymosis
b. Gum bleeding c. Purpura d. Excessive vaginal bleeding e. GI tract bleeding |
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7. Diagnosis of ITP?
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a. Is a diagnosis of exclusion
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8. The diagnosis requires demonstration of a normal to hypercellular megacaryocyte count in the bone marrow, indicating a response to increased peripheral obstruction
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8. The diagnosis requires demonstration of a normal to hypercellular megacaryocyte count in the bone marrow, indicating a response to increased peripheral obstruction
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9. Other treatment options for ITP?
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a. IVIG
b. Plasmapheresis c. Chemotherapeutic agents |
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10. When is splenectomy recommended for ITP?
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a. Nonresponsive to steroids
b. Chronic steroid therapy (>1 yr) c. Those who require excessively high steroid dose |
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11. What is the best indication of splenectomy will be of lasting benefit?
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a. An increase in the platelet count with corticosteroid therapy
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12. What is better laparoscopic or open splenectomy?
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a. Laparoscopic:
1. Tolerate feeding sooner 2. Require less pain medication 3. Discharged from the hospital sooner cease b. Splenomegaly is rare in ITP, and presence should suggest another source of thrombocytopenia, such as hemolytic disease. |
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13. What is produced in the spleen?
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a. Opsonins (Tuftsin and properdin)
b. Antibodies (particularly IgM). |
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14. Most common indication for splenectomy?
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a. Trauma.
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15. Non-traumatic indications for splenectomy?
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a. Red cell, white cell, completely related disorders such as:
i. Congenital hemolytic anemias such as hereditary spherocytosis and thalassemia major. ii. Myeloproliferative disorders which may lead to massive splenomegaly (symptomatic relief) cysts |
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16. Overwhelming post splenectomy sepsis (OPSS)?
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a. An uncommon but well-recognized potential complication associated with splenectomy.
b. More common when splenectomy is performed for hematologic disease compared to splenectomy for trauma! |
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17. Presentation of Overwhelming post splenectomy sepsis (OPSS)?
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a. Commonly develops within the 1st 2 years after splenectomy, although it can occur later
b. Presentation includes Insidious onset and marked by nonspecific symptoms, such as: 1. Malaise 2. Headache 3. Nausea 4. Confusion c. It can progress rapidly to shock and death. |
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18. Which should all patients undergoing splenectomy receive prior to surgery?
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a. Polyvalent pneumococcal vaccination 2 weeks for surgery.
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19. In whom does Overwhelming post splenectomy sepsis (OPSS) have a higher incidence?
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a. Children
b. Also more common when splenectomy is performed for hematologic disease compared to splenectomy for trauma! |
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20. Complete.
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20. Complete.
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