L1 Question 1: What is the primary cause of splenosis?
- A) Congenital abnormality
- B) Splenic trauma or splenectomy
- C) Hematological malignancy
- D) Infection
Answer: B) Splenic trauma or splenectomy
Comment: Splenosis occurs after splenic trauma or splenectomy, when splenic fragments seed the peritoneal cavity and develop into functional splenic tissue.
Reference: Maghrebi H, Ketari S, Bouhoula A et al. “Splenosis: Clinical Features and Imaging Characteristics.” Radiographics. 2016;36(2):335-340.
L1 Question 2: Which imaging modality is considered the gold standard for confirming splenosis?
- A) CT
- B) MRI
- C) Tc-99m sulfur colloid scan
- D) PET-CT
Answer: C) Tc-99m sulfur colloid scan
Comment: Tc-99m sulfur colloid scans are highly sensitive and specific for confirming functional splenic tissue due to their uptake in reticuloendothelial cells.
Reference: Karlo CA, Stolzmann P, Do RK et al. “Nuclear Imaging in Splenosis: A Diagnostic Tool for Functional Splenic Tissue.” Radiographics. 2012;32(5):1453-1460.
L1 Question 3: What is the typical appearance of splenosis on CT imaging?
- A) Calcified nodules
- B) Heterogeneous masses with necrosis
- C) Well-circumscribed soft tissue nodules
- D) Fat-containing lesions
Answer: C) Well-circumscribed soft tissue nodules
Comment: On CT, splenosis typically presents as multiple, non-calcified, well-circumscribed soft tissue nodules.
Reference: Case TA, Ochsner JE, Greenblatt M et al. “CT Imaging Features of Splenosis: Diagnostic Clues and Pitfalls.” AJR Am J Roentgenol. 2018;210(2):123-129.
L1 Question 4: Which of the following statements about splenosis is true?
- A) It always results in complete immunological function
- B) It can be confused with peritoneal carcinomatosis on imaging
- C) It is always symptomatic
- D) It cannot occur without splenectomy
Answer: B) It can be confused with peritoneal carcinomatosis on imaging
Comment: Splenosis can mimic peritoneal carcinomatosis due to multiple nodular appearances; however, history of trauma helps differentiate.
Reference: Maghrebi H, Ketari S, Bouhoula A et al. Radiographics. 2016;36(2):335-340.
L1 Question 5: Which of the following best describes the pathophysiology of splenosis?
- A) Congenital migration of splenic cells
- B) Seeding of splenic tissue fragments after trauma
- C) Splenic hyperplasia
- D) Hematological spread of splenic cells
Answer: B) Seeding of splenic tissue fragments after trauma
Comment: Splenosis results from seeding and revascularization of splenic fragments after trauma.
Reference: Karlo CA, Stolzmann P, Do RK et al. Radiographics. 2012;32(5):1453-1460.
L2 Question 6: A patient with a history of splenectomy undergoes CT for abdominal pain. Multiple soft tissue nodules are identified. What is the next best step to confirm splenosis?
- A) Biopsy of the nodules
- B) PET-CT
- C) Tc-99m sulfur colloid scan
- D) MRI with contrast
Answer: C) Tc-99m sulfur colloid scan
Comment: Tc-99m sulfur colloid scans are highly specific for identifying functional splenic tissue and can avoid invasive procedures.
Reference: Case TA, Ochsner JE, Greenblatt M et al. AJR Am J Roentgenol. 2018;210(2):123-129.
L2 Question 7: Does a patient with confirmed splenosis require pneumococcal vaccination?
- A) Yes, because splenosis provides no immunological function
- B) No, functional splenosis offers partial immune protection
- C) Only if the splenic nodules are calcified
- D) Only in cases of recurrent infections
Answer: B) No, functional splenosis offers partial immune protection
Comment: Functional splenic nodules can provide partial immunologic defense, though not as effective as an intact spleen.
Reference: Maghrebi H, Ketari S, Bouhoula A et al. Radiographics. 2016;36(2):335-340.
L2 Question 8: What is a potential complication of intra-abdominal splenosis?
- A) Small bowel obstruction
- B) Renal failure
- C) Portal hypertension
- D) Ascites
Answer: A) Small bowel obstruction
Comment: Adhesions or compression from splenic nodules can lead to small bowel obstruction.
Reference: Case TA, Ochsner JE, Greenblatt M et al. AJR Am J Roentgenol. 2018;210(2):123-129.
L2 Question 9: Which of the following best differentiates splenosis from peritoneal carcinomatosis on imaging?
- A) Enhancement pattern on MRI
- B) Presence of prior splenic trauma history
- C) Calcification patterns
- D) Size of nodules
Answer: B) Presence of prior splenic trauma history
Comment: A history of trauma combined with nuclear imaging can help distinguish splenosis from malignancy.
Reference: Karlo CA, Stolzmann P, Do RK et al. Radiographics. 2012;32(5):1453-1460.
L2 Question 10: Which of the following best describes the immunologic capacity of splenosis?
- A) Provides full immune protection similar to an intact spleen
- B) Provides partial immune protection
- C) Provides no immune protection
- D) Only protects against viral infections
Answer: B) Provides partial immune protection
Comment: Functional splenosis may partially restore immune defense but is often insufficient compared to a healthy spleen.
Reference: Maghrebi H, Ketari S, Bouhoula A et al. Radiographics. 2016;36(2):335-340.
L2 Question 10: Which of the following best describes the immunologic capacity of splenosis?
- A) Provides full immune protection similar to an intact spleen
- B) Provides partial immune protection
- C) Provides no immune protection
- D) Only protects against viral infections
Answer: B) Provides partial immune protection
Comment: Functional splenosis may partially restore immune defense but is often insufficient compared to a healthy spleen.
Reference: Maghrebi H, Ketari S, Bouhoula A et al. Radiographics. 2016;36(2):335-340.