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1. How large must the spleen be before it is clinically palpable?
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Correct answer:
The spleen must be enlarged to about three times its normal size before it becomes clinically palpable.
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2. Where can the enlarged spleen be felt?
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Correct answer:
It forms a swelling that descends below the left costal margin, moves on respiration and has a firm lower margin, which may or may not be notched. The mass is dull to percussion, the dullness extending above the costal margin.
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3. What are the three differential diagnosis of an enlarged spleen?
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Correct answer:
(1) An enlarged left kidney.
(2) Carcinoma of the cardia or upper part of the stomach.
(3) An enlarged left lobe of liver.
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4. What are the general causes of splenomegaly?
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Correct answer:
(1) Infections.
(2) Haematological disorders.
(3) Portal hypertension.
(4) Metabolic and collagen disease.
(5) Cysts, abscesses and tumours of the spleen.
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5. Which infections can cause splenomegaly?
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Correct answer:
(1) Viruses: glandular fever.
(2) Bacterial: typhus, typhoid, septicaemia (‘septic spleen’).
(3) Protozoal: malaria, kala-azar, Egyptian splenomegaly (schistosomiasis).
(4) Parasitic: hydatid.
The two most common causes are gallstones and alcohol.
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6. Which viral infections can cause splenomegaly?
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Correct answer:
Glandular fever.
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7. Which bacterial infections can cause splenomegaly?
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Correct answer:
Typhus; typhoid; septicaemia (‘septic spleen’).
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8. Which protozoal infections can cause splenomegaly?
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Correct answer:
Kala-azar; Egyptian splenomegaly (schistosomiasis); malaria.
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9. Which parasitic infections can cause splenomegaly?
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10. Which haematological diseases can cause splenomegaly?
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Correct answer:
(1) Leukaemia: chronic myeloid and chronic lymphocytic. (2) Lymphoma: Hodgkin’s and non-Hodgkin’s lymphoma. (3) Myelofibrosis, idiopathic thrombocytopenia, polycythaemia rubra vera. (4) Haemolytic anaemias, e.g. spherocytosis, β-thalassaemia.
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11. Which types of leukaemia can cause splenomegaly?
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Correct answer:
Chronic myeloid and chronic lymphocytic.
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12. Which types of lymphoma can cause splenomegaly?
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Correct answer:
Hodgkin’s and non-Hodgkin’s lymphoma.
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13. Which haemolytic anaemias can cause splenomegaly?
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Correct answer:
Spherocytosis and β-thalassaemia.
