A 5yo girl is seen by her pediatrician for purpuric lesions on her arms and legs following an acute viral upper respiratory illness. Her PE shows few petechiae in addition to the purpuric lesions. Rest of exam is normal. Plt count is 44K. BM aspirate shows slight increase in number of megakaryocytes. What is most appropriate next step in management?
A 23yo woman is referred by her hematologist for splenectomy for ITP. She has hx of easy bruising and heavy menstrual bleeding. She did not respond well to corticosteroids. A complete w/u including BM aspirate is consistent with ITP. Her plt count is 27K. When is the best time to administer polyvalent pneumococcal vaccine?
2 weeks before splenectomy
Which one of the following is most appropriate for nonoperative management of splenic trauma?
A 4yo girl fell from a swing. Her vital signs are stable. CT scan shows subcapsular splenic hematoma involving 10% of the splenic surface
A33yo woman is undergoing a laparoscopic splenectomy for ITP. She has not responded to corticosteroids. Just prior to surgery, her plt count is 22K. There is persistent oozing from her trocar sites and w/in her abd as the spleen is being isolated from the surrounding structures. Her vital signs are stable. When is the most appropriate time to transfuse platelets?
After the splenic artery has been clamped
A 56yo woman being seen in office in f/u of leg ulcer for past 6mo. Despite abx and optimal local wound care, her ulcer has not healed. Her PMH is significant for RA and HTN. There is no hx of DVT. She takes methotrexate, cefocoxib, hydrochlorothiazide, and lisinopril. She is afebrile. Her vital signs are normal. On PE there is an enlarged spleen. There is a large chronic ulcer on her left shin. Pedal pulses are normal. Lab studies show neutropenia. Her Hct and plt count are normal. What is the next best step in management?
A 26yo woman has a chronic cough and decreased exercise tolerance for the past few months. She has otherwise been healthy and takes no meds. She has two cats. PE is normal. Blood work is normal. A CXR shows bilateral hilar adenopathy. Mediastinoscopy and bx is performed. Pathology shows noncaseating granulomas. What is most likely dx?
A 44yo man is seen in the office b/c of abd pain. He has thalassemia major. Vital signs are normal. His spleen is massively enlarged. In addition to decreasing the risk for splenic rupture, what is the most likely benefit of splenectomy for this pt?
Decrease transfusion requirements
A 62yo man comes to the office b/c of a mass in his right neck that he noticed 4 weeks ago. He has a hx of HTN and had a coronary artery stent 2 years ago. He doesn’t smoke but he has chewed tobacco for 45 yrs. He is afebrile. Vital signs are normal. He takes a B daily. On PE he has poor dentition w/ severe tooth decay and gingivitis. There is a mild tender ulcer on the posterior lateral tongue on the left. There is a hard 2cm node high in the anterior cervical triangle near the angle of the jaw. AFNA is most likely to show which of the following?
A 70yo man has massive upper GI bleeding while he is in the surgical ICU, where he is being txd for severe pancreatitis w/ necrosis. Arterography shows bleeding form the splenic artery into the pancreatic phlegmon w/ a fistula to the stomach. Splenic artery embolization is performed. If the spleen completely infarcts, which of the following would you expect to see on the peripheral blood smear?
Increased Howell-Jolly bodies
A 18yo man is admitted to SICU following surgery for injuries sustained in a MVC. He underwent splenectomy for Grade 5 splenic rupture and open reduction and internal fixation of compound right tibia and fibula fractures. He has multiple fractured ribs on the left and a pulmonary contusion on the left. He is intubated. Vital signs are stable. What is the optimal timing for administering polyvalent pneumococcal vaccine for this pt?
On the day of d/c from the hospital