Lung Transplantation — MCQs
Which one of the following is not a wound closure technique?
Procedure of choice for control of massive hemoptysis?
Which of the following is markedly decreased in restrictive lung disease?
All of the following are true about the history of transplantation except:
Which of the following is not a risk factor for postoperative pulmonary complication?
All of the following are absolute contraindications for renal transplantation except:
Dr. Christiaan Barnard performed the 1st heart transplant in the year -
Which of the following is an indication for lung transplantation?
Which of the following diseases is appropriately treated with combined heart-lung transplantation?
Which of the following is true regarding extended criteria donors for liver transplantation?
Lung Transplantation Indian Medical PG Practice Questions and MCQs
Question 1: Which one of the following is not a wound closure technique?
- A. Composite graft
- B. Vascular graft (Correct Answer)
- C. Partial thickness skin graft
- D. Musculocutaneous flap
Explanation: ***Vascular graft*** - A **vascular graft** is a tube-like structure used to bypass or replace a diseased or damaged blood vessel. - Its primary purpose is to **restore blood flow**, not to close a wound on the body surface or replace missing tissue. *Partial thickness skin graft* - A **partial thickness skin graft** involves transplanting the epidermis and a portion of the dermis to cover a wound. - This is a common and effective technique for **wound closure**, particularly for large surface area wounds or burns. *Composite graft* - A **composite graft** is a graft consisting of multiple tissue types, such as skin, cartilage, and fat, often used for reconstruction. - This is a direct method of **wound closure** and tissue replacement, particularly in areas requiring structural support and soft tissue coverage. *Musculocutaneous flap* - A **musculocutaneous flap** involves the transfer of skin, subcutaneous tissue, and an underlying muscle to cover a wound. - This is a versatile **wound closure technique** that provides robust soft tissue coverage and blood supply to complex defects.
Question 2: Procedure of choice for control of massive hemoptysis?
- A. Rigid bronchoscopy and Photocoagulation
- B. Bronchial artery embolization (Correct Answer)
- C. Balloon catheter tamponade
- D. Flexible bronchoscopy and cautery
Explanation: ***Bronchial artery embolization*** - **Bronchial artery embolization (BAE)** is the preferred initial treatment for **massive hemoptysis** due to its high success rate and minimally invasive nature. - It works by identifying and occluding the bleeding bronchial arteries, which are the most common source of massive hemoptysis. *Rigid bronchoscopy and Photocoagulation* - **Rigid bronchoscopy** is primarily used for **airway control**, foreign body removal, and occasionally for direct visualization and tamponade in massive hemoptysis. - While **photocoagulation** can be used to treat small bleeds, it is generally ineffective for massive or widespread hemorrhage. *Balloon catheter tamponade* - **Balloon catheter tamponade** can provide temporary control of bleeding by compressing the bleeding site but is not a definitive long-term solution. - It carries risks of tracheal injury and can obstruct the airway, making it a bridging measure until a more definitive treatment can be performed. *Flexible bronchoscopy and cautery* - **Flexible bronchoscopy** is useful for localizing the bleeding site but is **less effective** for controlling massive hemoptysis due to limited suction and instrument channels. - **Cautery** applied through a flexible bronchoscope is generally insufficient for significant bleeding and carries a risk of worsening the hemorrhage.
Question 3: Which of the following is markedly decreased in restrictive lung disease?
- A. FVC (Correct Answer)
- B. RV
- C. FEV1/FVC
- D. FEV1
Explanation: ***FVC*** - In **restrictive lung disease**, there is a reduction in lung volume due to various causes, leading to a markedly decreased **Forced Vital Capacity (FVC)**. - **FVC** directly measures the total amount of air a person can exhale after a maximal inhalation, which is inherently limited in restrictive conditions. - This is the **hallmark finding** in restrictive lung disease and the most clinically significant decrease. *FEV1* - While **FEV1** (Forced Expiratory Volume in 1 second) is also decreased in restrictive lung disease, its decrease is proportional to the FVC decrease. - A decrease in FEV1 alone is less specific, as it could also indicate obstructive lung disease. - The key is that both FEV1 and FVC decrease together, maintaining a normal or increased ratio. *FEV1/FVC* - The **FEV1/FVC ratio** is typically **normal or even increased** in restrictive lung disease, as both FEV1 and FVC decrease proportionally or FEV1 decreases slightly less. - A decreased FEV1/FVC ratio is characteristic of **obstructive lung disease**, not restrictive. *RV* - **Residual Volume (RV)** is also **decreased** in restrictive lung disease, along with all other lung volumes (TLC, VC, FRC). - However, RV is not measured by standard spirometry and requires body plethysmography or gas dilution techniques. - While RV does decrease, **FVC** is the more clinically significant and readily measurable parameter that is "markedly decreased" and defines restrictive disease on routine pulmonary function testing.
Question 4: All of the following are true about the history of transplantation except:
- A. First pancreas transplantation by Kelly & Lillhei
- B. First successful intestinal transplantation by Hardy (Correct Answer)
- C. First lung transplantation by Fritz Derom
- D. First heart & lung transplantation by Reitz & Shumway
Explanation: ***First successful intestinal transplantation by Hardy*** - The **first successful intestinal transplantation** was **NOT performed by Hardy**. - **Hardy** is famous for the **first human lung transplant** in **1963** and the **first heart xenotransplant** (chimpanzee to human) in **1964**. - **Intestinal transplantation** had its first long-term success in the late **1980s** (notably by **Starzl** and others after the introduction of cyclosporine). - This statement is **FALSE**, making it the correct answer to this "EXCEPT" question. *First pancreas transplantation by Kelly & Lillhei* - The **first successful human pancreas transplant** was indeed performed by **William Kelly** and **Richard Lillehei** at the University of Minnesota in **1966**. - This was a **simultaneous pancreas-kidney transplant** for a patient with diabetes and renal failure. - This statement is **TRUE**. *First lung transplantation by Fritz Derom* - This is **contextually TRUE** when referring to the **first successful lung transplant with meaningful survival**. - **James Hardy** performed the **first human lung transplant** in **1963**, but the patient survived only **18 days**. - **Fritz Derom** (Belgium) performed a lung transplant in **1968** with the patient surviving **10 months**, representing the first case with significant survival. - In transplant history, Derom is often credited as this represented a more meaningful milestone. - This statement is generally considered **TRUE**. *First heart & lung transplantation by Reitz & Shumway* - **Bruce Reitz** and his team at Stanford University, working under **Norman Shumway**, performed the **first successful combined heart-lung transplant** in **1981**. - The patient, Mary Gohlke, survived for **5 years** post-transplant. - This statement is **TRUE**.
Question 5: Which of the following is not a risk factor for postoperative pulmonary complication?
- A. Normal BMI (18.5-24.9) (Correct Answer)
- B. Age 25-40 years
- C. Upper abdominal surgery
- D. Patient with 20 pack years of smoking
Explanation: ***Patient with 20 pack years of smoking*** - This is a significant risk factor for postoperative pulmonary complications, as **chronic smoking** impairs lung function and mucociliary clearance. - Patients with a history of **20 pack-years or more** are at a substantially increased risk of developing atelectasis, pneumonia, and respiratory failure after surgery. *Normal BMI (18.5-24.9)* - A **normal BMI** is not considered a risk factor for postoperative pulmonary complications; instead, it is associated with a lower risk compared to obesity or underweight states. - Patients with a normal BMI generally have **better respiratory mechanics** and lung volumes, reducing their susceptibility to pulmonary issues. *Age 25-40 years* - This age range is generally associated with a **lower risk** of postoperative pulmonary complications compared to very young or elderly patients. - Younger adults typically have **better physiological reserves** and healthier lungs, contributing to a reduced incidence of respiratory problems post-surgery. *Upper abdominal surgery* - **Upper abdominal surgery** is a significant risk factor for postoperative pulmonary complications due to its proximity to the diaphragm. - It often leads to **diaphragmatic dysfunction**, reduced lung volumes, and increased pain, all of which predispose patients to atelectasis and pneumonia.
Question 6: All of the following are absolute contraindications for renal transplantation except:
- A. Active infection
- B. Active malignancy
- C. Active drug abuse
- D. Reduced life expectancy (Correct Answer)
Explanation: ***Reduced life expectancy*** - While a significantly reduced life expectancy due to certain **comorbidities** may influence the decision to transplant, it is not an absolute, but rather a relative, contraindication, as individual cases vary. - Ethical considerations and the potential for improved quality of life may still support transplantation in some cases, even with a **limited prognosis**. *Active infection* - An **active systemic infection** is an absolute contraindication due to the high risk of severe complications, including sepsis and infection of the transplanted organ, especially with immunosuppression. - The patient must be free of active infection before transplantation to ensure the safety and success of the procedure. *Active malignancy* - The presence of an **active malignancy** is an absolute contraindication because immunosuppressive therapy post-transplant can accelerate cancer progression and metastasis. - Patients typically require a **disease-free interval** (e.g., 2-5 years) after cancer treatment before being considered for transplantation. *Active drug abuse* - **Active illicit drug abuse** is an absolute contraindication due to concerns about adherence to the complex post-transplant medical regimen, potential for infections, and overall poor health outcomes. - Successful transplantation requires strict adherence to medication schedules and follow-up, which is jeopardized by **active substance use**.
Question 7: Dr. Christiaan Barnard performed the 1st heart transplant in the year -
- A. 1962
- B. 1965
- C. 1969
- D. 1967 (Correct Answer)
Explanation: ***1967*** - Dr. Christiaan Barnard performed the **first human heart transplant** on December 3, 1967, at Groote Schuur Hospital in Cape Town, South Africa. - The recipient, Louis Washkansky, lived for 18 days after the surgery. *1962* - While significant advancements in medicine occurred in 1962, the **first heart transplant** had not yet been performed. - This year saw the approval of the **measles vaccine** and the publication of Rachel Carson's "Silent Spring," but not the seminal heart transplant. *1965* - The year 1965 was a period of continued research and experimentation in organ transplantation, but the **first successful human heart transplant** took place later. - Prior to 1967, xenotransplantation experiments in humans involving animal hearts were attempted, but a human-to-human transplant was still pending. *1969* - By 1969, **several hundred heart transplants** had already been performed worldwide following Barnard's pioneering surgery. - Dr. Denton Cooley performed the **first implantation of a total artificial heart** in a human in 1969, indicating that heart transplantation was already established.
Question 8: Which of the following is an indication for lung transplantation?
- A. COPD
- B. Alpha-1 antitrypsin deficiency
- C. Cystic fibrosis and bronchiectasis
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - **COPD**, **Alpha-1 antitrypsin deficiency**, and **Cystic fibrosis** with **bronchiectasis** are all common indications for lung transplantation when medical management fails and the patient meets other criteria. - Lung transplantation is considered for patients with **end-stage lung disease** who have a high risk of death within 1-2 years without transplantation, and who have no significant comorbidities. *COPD* - While many patients with **COPD** manage with medical therapy, those with severe disease, frequent exacerbations, and **declining lung function** despite maximal treatment can be candidates for lung transplantation. - **End-stage COPD** is a significant cause of morbidity and mortality, making transplantation a viable option for selected patients. *Alpha-1 antitrypsin deficiency* - This genetic disorder primarily affects the lungs, leading to **early-onset emphysema** and **bronchiectasis**, particularly in non-smokers. - When the lung damage progresses to a severe and life-threatening stage, **lung transplantation** becomes a treatment option. *Cystic fibrosis and bronchiectasis* - **Cystic fibrosis** often leads to severe, progressive **bronchiectasis** and chronic lung infections, resulting in **end-stage lung disease**. - For these patients, especially those with intractable daily symptoms and **declining respiratory function**, lung transplantation can significantly improve quality of life and survival.
Question 9: Which of the following diseases is appropriately treated with combined heart-lung transplantation?
- A. End-stage emphysema
- B. Idiopathic dilated cardiomyopathy with long-standing secondary pulmonary hypertension (Correct Answer)
- C. Primary pulmonary hypertension
- D. Cystic fibrosis
Explanation: ***Idiopathic dilated cardiomyopathy with long-standing secondary pulmonary hypertension*** - In cases of severe **idiopathic dilated cardiomyopathy**, the failing left ventricle can lead to **long-standing secondary pulmonary hypertension**. - This persistent high pressure in the pulmonary circulation results in **irreversible damage** to the pulmonary vasculature, creating fixed pulmonary vascular resistance. - When the pulmonary hypertension becomes fixed and irreversible, isolated heart transplantation would fail as the new heart would face the same elevated pressures, necessitating **combined heart-lung transplantation**. *End-stage emphysema* - **End-stage emphysema** primarily affects the lungs, causing destruction of alveolar walls and airflow obstruction. - While a **bilateral lung transplant** is the standard treatment for severe emphysema, the heart is typically not primarily affected to the extent that it would require combined transplantation. *Primary pulmonary hypertension* - **Primary pulmonary hypertension** is a disease of the pulmonary arteries, where blood vessels in the lungs become narrowed, stiff, or destroyed. - In most cases, **bilateral lung transplantation** alone is sufficient, as the new lungs provide healthy pulmonary vasculature. - While combined heart-lung transplantation may be considered in severe cases with established irreversible right ventricular failure, the more definitive indication is when secondary pulmonary hypertension is caused by primary cardiac disease (as in option A). *Cystic fibrosis* - **Cystic fibrosis** is a genetic disorder that predominantly causes severe lung disease due to thick, sticky mucus buildup. - It primarily necessitates a **bilateral lung transplant** to replace the diseased lungs; the heart is generally not directly affected to the point of requiring a combined transplant.
Question 10: Which of the following is true regarding extended criteria donors for liver transplantation?
- A. Donors with well-controlled diabetes mellitus
- B. Hepatitis C antibody positive donors
- C. Donors with significant uncontrolled comorbidities
- D. Donors aged >60 years with no significant comorbidities (Correct Answer)
Explanation: ***Donors aged >60 years with no significant comorbidities*** - **Advanced donor age** is a key characteristic of an extended criteria donor (ECD), especially when coupled with other factors like **ischemic time** or comorbidities. - While age alone might not prohibit donation, it puts the donor liver into the ECD category, requiring careful recipient selection and possibly increasing the risk of **post-transplant complications**. *Donors with well-controlled diabetes mellitus* - **Well-controlled diabetes mellitus** in a donor does not automatically classify them as an extended criteria donor, if there are no other significant associated comorbidities or organ damage. - The focus is generally on signs of significant end-organ damage or poorly controlled disease that could impact graft function. *Hepatitis C antibody positive donors* - **Hepatitis C antibody positive donors** are traditionally considered extended criteria donors and remain classified as such. - However, with the advent of highly effective **direct-acting antiviral (DAA) therapies**, HCV-positive organs can now be safely transplanted into both HCV-positive and HCV-negative recipients with excellent outcomes. - While still technically ECD, the clinical significance has diminished significantly with modern treatment availability, making **donor age >60 years** the more universally recognized ECD criterion in current practice. *Donors with significant uncontrolled comorbidities* - **Significant uncontrolled comorbidities** would generally render a donor **unsuitable for donation**, rather than classify them as an extended criteria donor. - Extended criteria typically refer to factors that increase risk but are still acceptable under specific circumstances, whereas uncontrolled comorbidities often pose too high a risk for successful transplantation.
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