Basic Science Questions

---

1. What is the primary mechanism that allows splenosis to occur?

A) Genetic predisposition
B) Angiogenesis and tissue remodeling
C) Direct microbial invasion
D) Autoimmune response
E) Increased lymphatic activity

Answer: B) Angiogenesis and tissue remodeling
Comments:

• Correct Answer: Splenic tissue fragments survive in ectopic sites due to their ability to promote angiogenesis and adapt to new microenvironments (1).
• Incorrect Answers:
  • A) Splenosis is not influenced by genetic predisposition (3).
  • C) There is no direct involvement of microbial processes in splenosis (2).
  • D) Splenosis does not involve autoimmune responses (2).
  • E) Increased lymphatic activity is not a mechanism for splenosis (5).

2. Which tissue types are retained in ectopic splenic nodules in splenosis?

A) Only red pulp
B) Only white pulp
C) Both red and white pulp
D) Neither red nor white pulp
E) Only connective tissue

Answer: C) Both red and white pulp
Comments:

• Correct Answer: Ectopic splenic tissue retains both red and white pulp, similar to normal splenic tissue (5).
• Incorrect Answers:
  • A) Red pulp alone is insufficient to describe splenic functionality (4).
  • B) White pulp alone does not encompass all splenic functions (4).
  • D) Splenotic tissue includes both components (3).
  • E) Connective tissue alone is not representative of splenic nodules (5).

3. What immunological function is partially restored in splenosis?

A) Lymphatic drainage
B) Erythrocyte filtration
C) Complete immune response
D) Autoantibody production
E) None of the above

Answer: B) Erythrocyte filtration
Comments:

• Correct Answer: Splenotic tissue can filter erythrocytes but does not fully restore immune functionality (2).
• Incorrect Answers:
  • A) Lymphatic drainage is not directly affected by splenosis (4).
  • C) Complete immune response is not achieved (2).
  • D) Splenosis does not involve autoantibody production (3).
  • E) Partial functionality is observed (1).

4. What is the histological hallmark of splenotic nodules?

A) Absence of vascularization
B) Presence of both red and white pulp
C) Degenerative fibrosis
D) Inflammatory infiltration
E) Granuloma formation

Answer: B) Presence of both red and white pulp
Comments:

• Correct Answer: The presence of red and white pulp is a distinguishing feature of splenosis (5).
• Incorrect Answers:
  • A) Vascularization is essential for splenic survival (4).
  • C) Fibrosis is not a primary feature (3).
  • D) Splenosis does not typically involve inflammatory infiltration (2).
  • E) Granulomas are unrelated to splenosis (1).

5. Which cytokine activity supports splenosis by promoting angiogenesis?

A) Tumor necrosis factor-alpha (TNF-α)
B) Vascular endothelial growth factor (VEGF)
C) Interleukin-6 (IL-6)
D) Interferon-gamma (IFN-γ)
E) Transforming growth factor-beta (TGF-β)

Answer: B) Vascular endothelial growth factor (VEGF)
Comments:

• Correct Answer: VEGF facilitates angiogenesis and supports the revascularization of splenic tissue (1).
• Incorrect Answers:
  • A) TNF-α is not directly involved in splenotic angiogenesis (2).
  • C) IL-6 has no significant role in splenotic processes (5).
  • D) IFN-γ is unrelated to splenotic angiogenesis (4).
  • E) TGF-β is not a key factor in splenosis (3).

6. What imaging modality is most sensitive for detecting splenosis?

A) X-ray
B) Ultrasound
C) CT
D) MRI
E) Nuclear scintigraphy

Answer: E) Nuclear scintigraphy
Comments:

• Correct Answer: Nuclear scintigraphy, particularly using technetium-labeled heat-damaged red blood cells, is highly sensitive and specific for detecting splenosis (6).
• Incorrect Answers:
  • A) X-rays are not specific for identifying splenosis (9).
  • B) Ultrasound may identify nodules but lacks specificity for splenosis (12).
  • C) CT provides anatomical detail but is less sensitive than scintigraphy (10).
  • D) MRI is useful but less specific than nuclear scintigraphy (13).

7. What is a classic CT finding in splenosis?

A) Calcified nodules
B) Uniformly enhancing nodules
C) Hypodense lesions
D) Enlarged lymph nodes
E) Cystic structures

Answer: B) Uniformly enhancing nodules
Comments:

• Correct Answer: Splenotic nodules typically show uniform enhancement on CT imaging (10).
• Incorrect Answers:
  • A) Calcification is rare in splenosis (8).
  • C) Hypodense lesions are not characteristic of splenosis (9).
  • D) Lymph nodes are unrelated to splenosis (7).
  • E) Splenosis does not present as cystic structures (11).

8. What is the differential diagnosis for peritoneal nodules in a patient with a history of splenectomy?

A) Peritoneal carcinomatosis
B) Tuberculous peritonitis
C) Splenosis
D) Endometriosis
E) All of the above

Answer: E) All of the above
Comments:

• Correct Answer: Peritoneal nodules in a post-splenectomy patient can arise from various etiologies, including splenosis, malignancies, infections, or endometriosis (4).
• Incorrect Answers:
  • A) While peritoneal carcinomatosis is a possibility, it is not the sole explanation (3).
  • B) Tuberculous peritonitis should be considered but requires corroborative findings (6).
  • C) Splenosis is a common cause in the post-splenectomy setting (7).
  • D) Endometriosis is a differential but not definitive without additional clinical correlation (10).

9. What complication of splenosis is commonly identified on imaging?

A) Small bowel obstruction
B) Large bowel perforation
C) Cystic degeneration
D) Retroperitoneal fibrosis
E) Vascular invasion

Answer: A) Small bowel obstruction
Comments:

• Correct Answer: Small bowel obstruction can occur due to adhesions or compression from splenotic nodules (2).
• Incorrect Answers:
  • B) Large bowel perforation is not associated with splenosis (7).
  • C) Cystic degeneration is not a feature of splenosis (8).
  • D) Retroperitoneal fibrosis is unrelated to splenosis (10).
  • E) Vascular invasion is not characteristic of splenosis (11).

10. Are splenotic nodules PET positive?

A) Always PET positive
B) Never PET positive
C) Occasionally PET positive
D) PET positivity depends on size
E) PET positivity depends on location

Answer: C) Occasionally PET positive
Comments:

• Correct Answer: Splenotic nodules may exhibit PET positivity due to their metabolic activity but are not consistently positive (8).
• Incorrect Answers:
  • A) Not all splenotic nodules are PET positive (6).
  • B) Splenotic nodules can be PET positive, depending on metabolic activity (4).
  • D) PET positivity is not size-dependent (10).
  • E) PET positivity does not solely depend on location (12).

11. Which nuclear medicine modality is most effective for confirming splenosis?

A) PET/CT with FDG
B) Tc-99m sulfur colloid scan
C) Gallium-67 scintigraphy
D) Tc-99m heat-damaged red blood cell scan
E) Indium-111-labeled leukocyte scan

Answer: D) Tc-99m heat-damaged red blood cell scan
Comments:

• Correct Answer: The Tc-99m heat-damaged red blood cell scan is considered the gold standard for detecting splenosis due to its high sensitivity and specificity in identifying splenic tissue (8).
• Incorrect Answers:
  • A) PET/CT with FDG is not specific for splenic tissue (10).
  • B) Tc-99m sulfur colloid scan is less specific than heat-damaged RBCs for splenic tissue (11).
  • C) Gallium-67 scintigraphy is used for infection and inflammation, not splenosis (4).
  • E) Indium-111-labeled leukocyte scans are used for infection but not for detecting splenosis (12).

12. Can splenotic nodules be used to assess splenic function by their volume?

A) Yes, splenotic volume correlates with functionality
B) No, splenotic volume is not indicative of functionality
C) Only if the nodules exceed a specific threshold
D) Functionality depends on their metabolic activity, not volume
E) Functionality cannot be determined by any imaging modality

Answer: A) Yes, splenotic volume correlates with functionality
Comments:

• Correct Answer: The volume of splenotic tissue can partially correlate with the ability to perform splenic functions, as more tissue provides a greater capacity for filtration and immune surveillance (9).
• Incorrect Answers:
  • B) Splenotic volume does provide an approximation of functionality (11).
  • C) Functionality is not solely dependent on a threshold volume (4).
  • D) Metabolic activity complements volume but does not replace its significance (6).
  • E) Imaging techniques like nuclear scintigraphy provide insights into splenic function (8).

13. What is a common ultrasound finding in splenosis?

A) Hypoechoic nodules
B) Anechoic cysts
C) Isoechoic nodules to the liver
D) Calcifications
E) Hypervascular lesions on Doppler

Answer: C) Isoechoic nodules to the liver
Comments:

• Correct Answer: Splenotic nodules are commonly isoechoic to the liver parenchyma on ultrasound (7).
• Incorrect Answers:
  • A) Hypoechoic nodules are not typical findings in splenosis (9).
  • B) Splenotic nodules do not present as cystic structures (10).
  • D) Calcifications are rare in splenosis (8).
  • E) Hypervascularity is not a primary feature of splenotic nodules (12).

14. Can splenotic nodules calcify over time?

A) Yes, calcification is a frequent finding
B) No, calcification does not occur in splenotic nodules
C) Rarely, calcification may occur in older lesions
D) Only if the nodules are located intrathoracically
E) Only in nodules with prior inflammation

Answer: C) Rarely, calcification may occur in older lesions
Comments:

• Correct Answer: Calcification is an uncommon but possible finding in splenotic nodules, particularly in older lesions (10).
• Incorrect Answers:
  • A) Calcification is not frequent (7).
  • B) Calcification can occur, contradicting this statement (6).
  • D) Calcification is not limited to intrathoracic locations (8).
  • E) Inflammation is not a necessary precursor for calcification (12).

15. Do splenotic nodules grow in size over time?

A) Yes, they consistently grow over time
B) No, their size remains static
C) Their size increases only with ongoing inflammation
D) Growth depends on their vascular supply
E) Splenotic nodules shrink over time

Answer: D) Growth depends on their vascular supply
Comments:

• Correct Answer: Splenotic nodules can grow if they have an adequate blood supply, allowing for metabolic activity and tissue maintenance (9).
• Incorrect Answers:
  • A) Growth is not consistent and depends on individual factors (11).
  • B) Size may change, contradicting this statement (8).
  • C) Growth is not solely dependent on inflammation (7).
  • E) Splenotic nodules do not generally shrink (10).

• 16. A 52-year-old man with a history of splenectomy following a traumatic motor vehicle accident presents for evaluation of pleural-based nodules found on CT imaging. Which of the following is the most likely diagnosis?

  A) Pleural plaques
  B) Mesothelioma
  C) Thoracic splenosis
  D) Metastatic lung disease
  E) Pulmonary tuberculosis

  Answer: C) Thoracic splenosis
  Comments:

  • Correct Answer: Thoracic splenosis occurs when splenic tissue implants in the thoracic cavity, often after diaphragmatic rupture or trauma. CT imaging may reveal pleural-based nodules with homogeneous enhancement, supporting this diagnosis (4).
  • Incorrect Answers:
    • A) Pleural plaques are associated with asbestos exposure and do not typically enhance homogeneously (9).
    • B) Mesothelioma presents with irregular pleural thickening and often involves diffuse nodular masses (8).
    • D) Metastatic lung disease typically involves multiple nodules with variable enhancement and other systemic findings (6).
    • E) Pulmonary tuberculosis may cause cavitary lesions or nodules but requires additional clinical and microbiological evidence (12).

  ---

  Clinical

16. 17. What is the most common infection risk for patients with splenosis?

    A) Pneumococcal infection
    B) Hepatitis B
    C) Tuberculosis
    D) Staphylococcus aureus
    E) Epstein-Barr virus

    Answer: A) Pneumococcal infection
    Comments:

    • Correct Answer: Patients with splenosis are at risk for overwhelming post-splenectomy infection (OPSI), with pneumococcal infection being the most common due to decreased immune surveillance (3).
    • Incorrect Answers:
      • B) Hepatitis B is unrelated to splenosis (12).
      • C) Tuberculosis is not specifically associated with splenosis (8).
      • D) Staphylococcus aureus infections are not specifically increased in splenosis (9).
      • E) Epstein-Barr virus infection is unrelated to splenosis (7).

    ---

    18. What laboratory finding helps assess splenic functionality in patients with splenosis?

    A) Reticulocyte count
    B) Presence of Howell-Jolly bodies
    C) Hemoglobin concentration
    D) Platelet count
    E) Serum ferritin

    Answer: B) Presence of Howell-Jolly bodies
    Comments:

    • Correct Answer: Howell-Jolly bodies indicate reduced splenic filtration, suggesting incomplete splenic functionality even in patients with splenosis (2).
    • Incorrect Answers:
      • A) Reticulocyte count does not directly indicate splenic function (5).
      • C) Hemoglobin concentration reflects anemia, not splenic functionality (4).
      • D) Platelet count does not assess the filtration capacity of the spleen (3).
      • E) Serum ferritin is unrelated to splenic filtration (12).

    ---

    19. A 45-year-old woman with a history of severe trauma involving multiple fractures to the left lower ribs presents with vomiting and abdominal pain. Imaging reveals dilated small bowel loops and peritoneal nodules. What is the most likely diagnosis?

    A) Peritoneal carcinomatosis
    B) Abdominal tuberculosis
    C) Splenosis
    D) Retroperitoneal fibrosis
    E) Intestinal endometriosis

    Answer: C) Splenosis
    Comments:

    • Correct Answer: Splenosis is likely due to the trauma history, rib fractures suggesting splenic injury, and peritoneal nodules associated with small bowel obstruction (3).
    • Incorrect Answers:
      • A) Peritoneal carcinomatosis is less likely without malignancy history (4).
      • B) Tuberculosis requires systemic symptoms or microbiological evidence (8).
      • D) Retroperitoneal fibrosis is unrelated to this presentation (7).
      • E) Endometriosis does not explain the findings (12).

    ---

    20. What imaging feature suggests functionality of splenosis in a patient with a history of splenectomy?

    A) Uniform enhancement on CT
    B) Activity on technetium-99m scintigraphy
    C) Hypoechoic nodules on ultrasound
    D) Calcification on CT
    E) Size increase over time

    Answer: B) Activity on technetium-99m scintigraphy
    Comments:

    • Correct Answer: Functional splenic tissue is demonstrated by uptake on technetium-99m scintigraphy, confirming splenosis (6).
    • Incorrect Answers:
      • A) Uniform enhancement on CT confirms morphology but not functionality (4).
      • C) Hypoechoic nodules lack specificity for functional splenic tissue (3).
      • D) Calcification is not characteristic of splenosis (8).
      • E) Size increase over time is not a reliable indicator (12).

    ---

    21. In which location outside the peritoneum are splenotic nodules most commonly found?

    A) Lungs
    B) Thoracic cavity
    C) Retroperitoneum
    D) Subcutaneous tissue
    E) Brain

    Answer: B) Thoracic cavity
    Comments:

    • Correct Answer: The thoracic cavity, particularly after diaphragmatic trauma, is a common site for ectopic splenic tissue (4).
    • Incorrect Answers:
      • A) Lungs are rare sites for splenosis (8).
      • C) Retroperitoneum is an uncommon location (9).
      • D) Subcutaneous tissue involvement is rare unless direct trauma occurred (6).
      • E) Brain involvement has not been reported (12).

    ---