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Stem
A candidate is asked to manage a classic presentation of Asplenia and Post-Splenectomy Care in an exam setting. Use precise definitions, scores, doses, and decision thresholds.
Core knowledge (model answer backbone)
Asplenia (surgical, congenital, or functional from sickle cell) predisposes to overwhelming post-splenectomy infection (OPSI) from encapsulated organisms (Strep pneumoniae, Neisseria meningitidis, Haemophilus influenzae). Management: vaccination (PCV13, PPSV23, MenACWY, MenB, Hib) at least 2 weeks before elective splenectomy or 2 weeks after emergency; lifelong daily antibiotic prophylaxis (phenoxymethylpenicillin 250 to 500 mg BD, or amoxicillin); patient education and alert card; prompt empirical antibiotics for fever (ceftriaxone 2 g IV/IM).
Red flags
- Fever in an asplenic patient = OPSI until proven otherwise - empirical ceftriaxone 2 g IV/IM and admit; do not wait for blood cultures
- Purpura fulminans (rapidly spreading purpura + shock + DIC) in an asplenic patient = pneumococcal sepsis - aggressive resuscitation, empirical antibiotics, ICU
- Patient with splenectomy and severe sepsis from Capnocytophaga canimorsus after dog bite - amoxicillin-clavulanate covers; add in penicillin-allergic
- Vaccination not given before emergency splenectomy - vaccinate 2 weeks post-splenectomy; lifelong daily antibiotics until then
High-yield structure examiners expect
Cover: Overview & Definition, Classification, Epidemiology & Risk Factors, Pathophysiology, Clinical Presentation, Differential Diagnosis.
Key doses / thresholds (from topic teaching)
- with empirical ceftriaxone 2 g IV/IM
- weighs about 150 to 200 g in an adult, and receives roughly **5 p
- often under 1.0 g/L), elevated D-dimer, a **falling p
- over 2 mmol/L** that fails to clear with resuscitat
- over 0.35 micrograms per millilitre** for at least 70 pe
- over 1.0 micrograms per millilitre** across the majorit
Questions
a) Define the condition and give the most important classification or severity framework used in exams. (3 marks)
- Clear one-line definition matching standard teaching.
- Named classification / stages / types with discriminating features.
- One sentence on why classification changes management.
b) Outline pathophysiology in a mechanism chain that explains the main clinical features. (3 marks)
- Initiating insult → intermediate pathway → end-organ effect.
- Link at least two symptoms/signs to mechanism.
- Mention one complication pathway (e.g. shock, perforation, herniation, arrhythmia).
c) List discriminating clinical features and bedside assessment. (3 marks)
- Classic presentation plus one atypical group (elderly, pregnancy, child, immunocompromised).
- Named signs/manoeuvres if relevant.
- What must never be missed on exam/bedside (pregnancy test, airway, glucose, etc.).
d) Investigations with thresholds and one named score if applicable. (3 marks)
- First-line tests and what positive findings mean.
- Gold-standard or definitive investigation when needed.
- Score components reproduced exactly if a named score is standard for this topic.
e) Immediate resuscitation and definitive management with doses where standard. (3 marks)
- ABC / time-critical steps first.
- First-line drug(s) with agent + dose + route (or procedure steps).
- Escalation triggers (theatre, ICU, thrombolysis window, antidote, etc.).
- Disposition and safety-netting.
Marking tips
Full marks require specificity (numbers, names, doses) not generic "give antibiotics/fluids." Regional practice (ICMR / NICE / AHA) may be cited as alternative where relevant.