Haematology and oncology: preparation for splenectomy: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Haematology and oncology: preparation for splenectomy

Sample item

A 25-year-old is scheduled for elective splenectomy for refractory immune thrombocytopenia. Against which organisms should vaccination be arranged at least two weeks beforehand?

AIntracellular organisms such as Mycobacteria and Listeria speciesBEncapsulated bacteria such as pneumococcus and meningococcusCEnteric bacilli such as Salmonella and ShigellaDAnaerobes such as Clostridium species

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Encapsulated bacteria such as pneumococcus and meningococcus

The spleen clears encapsulated bacteria by opsonisation, so asplenic patients risk fulminant sepsis from pneumococcus, meningococcus and Haemophilus influenzae type b. Conjugate vaccines against these are given before elective splenectomy, with antibiotic prophylaxis and education afterwards.

Option by option

A. Intracellular organisms such as Mycobacteria and Listeria species
Intracellular bacteria are handled by cell-mediated immunity, not the spleen.
B. Encapsulated bacteria such as pneumococcus and meningococcus (correct)
Correct. Encapsulated organisms are the main threat after splenectomy.
C. Enteric bacilli such as Salmonella and Shigella
Enteric bacilli are not the targeted risk of asplenia.
D. Anaerobes such as Clostridium species
Anaerobic clostridial infection is not the vaccine target in asplenia.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Encapsulated bacteria such as pneumococcus and meningococcus. The spleen clears encapsulated bacteria by opsonisation, so asplenic patients risk fulminant sepsis from pneumococcus, meningococcus and Haemophilus influenzae type b.

Why is "Intracellular organisms such as Mycobacteria and Listeria species" not the answer?

Intracellular bacteria are handled by cell-mediated immunity, not the spleen.

Why is "Enteric bacilli such as Salmonella and Shigella" not the answer?

Enteric bacilli are not the targeted risk of asplenia.

Why is "Anaerobes such as Clostridium species" not the answer?

Anaerobic clostridial infection is not the vaccine target in asplenia.

What concept does this question test?

It tests Haematology and oncology: preparation for splenectomy in General Medicine. Conjugate vaccines against these are given before elective splenectomy, with antibiotic prophylaxis and education afterwards.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Haematology and oncology: preparation for splenectomy?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.