Hematology MCQ’s ( Enlargement of Lymph Nodes & Spleen ) With Answers
131 Generalized adenopathy means involvement of how many noncontiguous lymph node areas ?
A. One or more
B. Two or more
C. Three or more
D. Four or more
Explanation:- Generalized adenopathy is defined as involvement of three or more noncontiguous lymph node areas. Localized or regional adenopathy implies involvement of a single anatomic area.
132 Which of the following is a cause of generalized lymphadenopathy ?
A. AIDS
B. Systemic lupus erythematosus (SLE)
C. Mixed connective tissue disease
D. All of the above
Explanation:- Generalized lymphadenopathy is frequently associated with infectious mononucleosis (EBV) or cytomegalovirus (CMV), toxoplasmosis, AIDS, systemic lupus erythematosus (SLE), and mixed connective tissue disease. Acute and chronic lymphocytic leukemias and malignant lymphomas also produce generalized adenopathy in adults.
133 Occipital lymphadenopathy accompanies which of the following ?
A. Scalp infection
B. Ear infection
C. Conjunctival infections
D. Tooth infection
Explanation:- Occipital adenopathy often reflects infection of the scalp.
134 Preauricular lymphadenopathy accompanies which of the following ?
A. Scalp infection
B. Ear infection
C. Conjunctival infections
D. Tooth infection
Explanation:- Preauricular adenopathy accompanies conjunctival infections and cat-scratch disease.
135 Most frequent site of regional lymphadenopathy is ?
A. Axilla
B. Neck
C. Groin
D. Abdominal
Explanation:- Most frequent site of regional lymphadenopathy is neck.
136 Which of the following about lymphadenopathy is false ?
A. Most frequent site of regional lymphadenopathy is neck
B. Enlargement of supraclavicular and scalene nodes is always abnormal
C. Virchow’s node is enlarged right supraclavicular node
D. Sarcoidosis can cause supraclavicular adenopathy
Explanation:- Virchow’s node is an enlarged left supraclavicular node infiltrated with metastatic cancer from a gastrointestinal primary.
137 Metastases to supraclavicular nodes occur from ?
A. Lung
B. Breast
C. Testis
D. Any of the above
Explanation:- Metastases to supraclavicular nodes occur from lung, breast, testis or ovarian cancers.
138 Which of the following is a cause of supraclavicular adenopathy ?
A. Tuberculosis
B. Sarcoidosis
C. Toxoplasmosis
D. All of the above
Explanation:- TB, sarcoidosis & toxoplasmosis are causes of supraclavicular adenopathy.
139 Benign lymphadenopathy is assumed when lymph node area is ?
A. < 0.25 cm2
B. < 0.50 cm2
C. < 0.75 cm2
D. < 1.00 cm2
Explanation:- Lymph nodes <1.0 cm2 in area (1 x 1 cm or less) are almost always secondary to benign, nonspecific reactive causes. Lymph node size of 2.25 cm2 (1.5 x 1.5 cm) is the best size limit to differentiate malignant or granulomatous from other causes of lymphadenopathy.
140 Tenderness of lymph node is due to ?
A. Inflammation of capsule
B. Rupture of capsule
C. Stretching of capsule
D. All of the above
Explanation:- Lymph node tenderness occurs when the capsule is stretched during its rapid enlargement, usually secondary to an inflammatory process.
141 Which of the following is not a characteristic of enlarged lymph nodes in lymphoma ?
A. Discrete
B. Asymmetric
C. Rubbery
D. Nontender
Explanation:- Lymph nodes involved by lymphoma tend to be large, discrete, symmetric, rubbery, firm, mobile, and nontender.
142 Which of the following is characteristic of enlarged lymph nodes in metastatic cancer ?
A. Hard
B. Nonmovable
C. Nontender
D. All of the above
Explanation:- Lymph nodes containing metastatic cancer are hard, nontender & nonmovable.
143 Which parameter is used in ultrasonography of cervical nodes for distinguishing benign from malignant nodes ?
A. Area
B. Volume
C. Ratio of long to short axis (L / S ratio)
D. Sonodensity
Explanation:- On Ultrasonography of cervical nodes, a ratio of long to short axis of <2.0 is useful in distinguishing benign & malignant nodes in patients with head & neck cancer.
144 Winterbottom’s sign is a classic finding of ?
A. Giardiasis
B. Toxoplasmosis
C. Human African Trypanosomiasis
D. Balantidiasis
145 In Winterbottom’s sign, location of lymph node enlargement is ?
A. Axilla
B. Posterior cervical triangle
C. Submental
D. Inguinal
Explanation:- Lymphadenopathy of the posterior cervical triangle, or Winterbottom’s sign, is a classic finding in T. b. gambiense trypanosomiasis.
146 Romana’s sign is a feature of ?
A. Acute Chagas’ disease
B. Cutaneous leishmaniasis
C. Visceral leishmaniasis
D. Babesiosis
Explanation:- Romaña’s sign is a classic finding in acute Chagas’ disease, and consists of unilateral painless edema of palpebrae & periocular tissues when conjunctiva is the portal of entry. Generalized lymphadenopathy & hepatosplenomegaly may develop.
147 Enlarged, grayish yellow or orange tonsils are pathognomonic of ?
A. Waldenström’s macroglobulinemia
B. Polycythemia vera
C. Wolman disease
D. Tangier disease
Explanation:- Tangier disease is associated with cholesterol accumulation in reticuloendothelial system with hepatosplenomegaly & enlarged, grayish yellow or orange tonsils.
148 Painful preauricular lymphadenopathy is a feature of ?
A. Cat-scratch disease
B. Tularemia
C. Tuberculosis
D. Syphilis
Explanation:- Painful preauricular lymphadenopathy is unique to tularemia and distinguishes it from catscratch disease, tuberculosis, sporotrichosis, and syphilis.
149 Accessory spleens are seen in what percentage of persons ?
A. 5 %
B. 10 %
C. 15 %
D. 20 %
Explanation:- Embryologic origin of spleen is in dorsal mesogastrium at about 5 weeks’ gestation as a series of hillocks that migrates to left upper quadrant. When these hillocks fail to unify into a single tissue mass, accessory spleens may develop in ~20% of persons.
150 Which of the following about structure of spleen is false ?
A. White pulp is lymphoid in nature
B. To return to circulation, RBCs traverse sinusoidal pores
C. Pulp cords are dead ends
D. None of the above
Explanation:- Spleen comprises many units of red and white pulp centered around small branches of splenic artery, called central arteries. White pulp is lymphoid in nature & contains B cell follicles, a marginal zone around the follicles, and T cell rich areas sheathing arterioles. Red pulp areas include pulp sinuses & pulp cords. Cords are dead ends. In order to regain access to the circulation, red blood cells must traverse tiny openings in the sinusoidal lining. Stiff, damaged, or old red cells cannot enter the sinuses.
151 Which of the following is a ‘Red cell inclusion body’ ?
A. RBC parasites
B. Howell-Jolly bodies
C. Heinz bodies
D. All of the above
Explanation:- Red cell inclusion bodies like parasites, nuclear residua (Howell-Jolly bodies, or denatured hemoglobin – Heinz bodies) are pinched off while passing through slits, a process called pitting.
152 Which of the following is false about spleen ?
A. Normal spleen contains ~one-third of total body platelets
B. Normal spleen contains significant no. of marginated neutrophils
C. Spleen is in the portal circulation
D. None of the above
153 Weight of a normal spleen is ?
A. < 150 grams
B. < 250 grams
C. < 350 grams
D. < 450 grams
Explanation:- Normal spleen weighs <250 grams.
154 Which of the following is false about spleen ?
A. Decreases in size with age
B. Lies entirely within rib cage
C. Maximum cephalocaudad diameter is 13 cm by USG
D. Maximum width of 14 cm by radionuclide scan
Explanation:- Spleen decreases in size with age, lies entirely within rib cage, has a maximum cephalocaudad diameter of 13 cm by USG or maximum length of 12 cm and/or width of 7 cm by radionuclide scan, and is normally not palpable.
155 Katayama fever is characterized by all except ?
A. Fever
B. Generalized lymphadenopathy
C. Lymphocytosis
D. Hepatosplenomegaly
Explanation:- Acute schistosomiasis is called Katayama fever. It is a serum sickness like syndrome with
fever, generalized lymphadenopathy, hepatosplenomegaly & high peripheral blood eosinophilia.
156 Middleton maneuver is used for splenic ?
A. Inspection
B. Palpation
C. Percussion
D. Auscultation
Explanation:- Palpation of spleen can be done by bimanual palpation, ballotment, and palpation from above (Middleton maneuver).
157 Which of the following is false in spleen examination ?
A. Auscultation may reveal venous hum or friction rub
B. Bimanual palpation in right lateral decubitus position adds nothing to supine examination
C. Reproducibility among examiners is better for palpation than percussion
D. None of the above
158 Nixon, Castell, or Barkun methods are used for splenic ?
A. Inspection
B. Palpation
C. Percussion
D. Auscultation
Explanation:- Percussion for splenic dullness is accomplished with either Nixon, Castell, or Barkun technique.
159 In Nixon’s method, splenic enlargement is indicated when upper border of dullness above costal margin is ?
A. > 4 cm
B. > 8 cm
C. > 12 cm
D. > 16 cm
Explanation:- In Nixon’s method, patient is in right decubitus. Percussion begins at lower level of pulmonary resonance in posterior axillary line & proceeds toward lower midanterior costal margin. Upper border of dullness is normally 6-8 cm above costal margin. Dullness >8 cm in adult indicates splenic enlargement.
160 In Castell’s method, percussion in the lowest intercostal space is done in ?
A. Midclavicular line
B. Anterior axillary line
C. Midaxillary line
D. Posterior axillary line
Explanation:- In Castell’s method, patient is supine, percussion is done in lowest intercostal space in anterior axillary line. A dull percussion note on full inspiration suggests splenomegaly.
161 Massive splenomegaly is defined as spleen extending ?
A. > 2 cm below left costal margin
B. > 4 cm below left costal margin
C. > 6 cm below left costal margin
D. > 8 cm below left costal margin
162 Massive splenomegaly is defined as spleen that weighs ?
A. > 250 gram
B. > 500 gram
C. > 750 gram
D. > 1000 gram
Explanation:- Massive splenomegaly refers to spleen that extends >8 cm below left costal margin and/or weighs (drained) more than 1000 grams.
163 Causes of massive splenomegaly include ?
A. Chronic myelogenous leukemia
B. Lymphomas
C. Hairy cell leukemia
D. All of the above
164 Causes of massive splenomegaly include ?
A. Myelofibrosis with myeloid metaplasia
B. Polycythemia vera
C. Gaucher’s disease
D. All of the above
165 Causes of Massive splenomegaly include ?
A. Chronic lymphocytic leukemia
B. Sarcoidosis
C. Autoimmune hemolytic anemia
D. All of the above
Explanation:- Causes of massive splenomegaly fall into four main categories: infectious diseases such as chronic malaria, kala-azar, and leishmaniasis; infiltrative diseases such as Gaucher’s disease and Niemann-Pick disease; portal hypertension; and hematologic diseases, including myeloproliferative and lymphoproliferative disorders (N Engl J Med. 2001:345, 682).
166 ‘Abscopal effect’ refers to ?
A. Ultrafiltration of abnormal RBCs
B. Regression of systemic disease after splenectomy
C. Increased tendancy of enlarged splenic rupture
D. Peritoneal seeding of splenic fragments
167 Term “splenosis” best relates to ?
A. Regression of systemic disease after splenectomy
B. Ultrafiltration of abnormal RBCs
C. Iatrogenic splenic rupture
D. Ectopic spleen tissue
Explanation:- At times in patients with splenic rupture, peritoneal seeding of splenic fragments can lead to splenosis i.e. presence of multiple collections of spleen tissue not connected to portal circulation. This ectopic spleen tissue may cause pain or gastrointestinal obstruction, as in endometriosis.
168 Which out of the following is a contraindication for splenectomy ?
A. Iatrogenic splenic rupture
B. Thrombocytopenia
C. Presence of bone marrow failure
D. Hairy cell leukemia
Explanation:- The only contraindication to splenectomy is the presence of marrow failure, in which the enlarged spleen is the only source of hematopoietic tissue.
169 Chronic manifestations of splenectomy include ?
A. Howell-Jolly bodies
B. Heinz bodies
C. Basophilic stippling
D. All of the above
Explanation:- Chronic manifestations of splenectomy include anisocytosis, poikilocytosis, presence of Howell- Jolly bodies (nuclear remnants), Heinz bodies (denatured hemoglobin), basophilic stippling.
170 Frequency of a serious infection following splenectomy is highest within ?
A. First 6 months
B. First 1 year
C. First 3 years
D. First 5 years
Explanation:- Frequency of a serious infection following splenectomy is highest within first 3 years.
171 Which of the following is false in postsplenectomy period ?
A. Increased susceptibility to capsulated bacterial infections
B. No increased risk of viral infection
C. Increased susceptibility to babesiosis
D. None of the above
172 In elective splenectomy, pneumococcal vaccine should be administered how many weeks before surgery ?
A. 1 weeks
B. 2 weeks
C. 3 weeks
D. 4 weeks
Explanation:- Pneumococcal vaccine (23-valent polysaccharide vaccine) should be administered to all patients 2 weeks before elective splenectomy.
