A 54-Year-Old Man Comes to the Emergency Department After an Episode

question 76

Multiple Choice

A 54-year-old man comes to the emergency department after an episode of bloody vomiting.  He has had no fever, chills, abdominal pain, diarrhea, or constipation.  The patient has a history of alcohol abuse with multiple previous hospital admissions due to alcohol withdrawal and generalized tonic-clonic seizures.  He also has a history of intravenous drug abuse and is currently enrolled in a methadone maintenance program.  Blood pressure is 96/62 mm Hg and pulse is 102/min.  On examination, the patient appears comfortable but develops dizziness when asked to sit up.  There is no jugular venous distension.  The abdomen is distended with dullness to percussion at both flanks.  The liver is enlarged on palpation, and the tip of the spleen is also palpable.  There is trace pedal edema.  Laboratory studies show: Histopathologic examination of this patient's spleen is most likely to show which of the following?

• A)Extramedullary hematopoiesis
• B)Histiocytic proliferation
• C)Lymphoid follicle expansion
• D)Metastatic deposits
• E)Red pulp expansion