Donor selection criteria — MCQs

A 60-year-old rock musician presents to the office because he has been feeling increasingly tired for the past 6 months. He has a history of intravenous drug use and alcohol abuse. He states that he feels quite tired, but he otherwise has no complaints. Physical examination is noncontributory. His laboratory values are normal other than moderately elevated liver enzymes. Which of the following additional tests should you order first?

An investigator is conducting a study to identify potential risk factors for post-transplant hypertension. The investigator selects post-transplant patients with hypertension and gathers detailed information regarding their age, gender, preoperative blood pressure readings, and current medications. The results of the study reveal that some of the patients had been treated with cyclosporine. This study is best described as which of the following?

A 45-year-old woman comes to the physician because of a 3-month history of worsening fatigue, loss of appetite, itching of the skin, and progressive leg swelling. Although she has been drinking 2–3 L of water daily, she has been passing only small amounts of urine. She has type 1 diabetes mellitus, chronic kidney disease, hypertension, and diabetic polyneuropathy. Her current medications include insulin, torasemide, lisinopril, and synthetic erythropoietin. Her temperature is 36.7°C (98°F), pulse is 87/min, and blood pressure is 138/89 mm Hg. She appears pale. There is 2+ pitting edema in the lower extremities. Sensation to pinprick and light touch is decreased over the feet and legs bilaterally. Laboratory studies show: Hemoglobin 11.4 g/dL Leukocyte count 6000/mm3 Platelet count 280,000/mm3 Serum Na+ 137 mEq/L K+ 5.3 mEq/L Cl− 100 mEq/L HCO3− 20 mEq/L Urea nitrogen 85 mg/dL Creatinine 8 mg/dL pH 7.25 Which of the following long-term treatments would best improve quality of life and maximize survival in this patient?

A 50-year-old morbidly obese woman presents to a primary care clinic for the first time. She states that her father recently died due to kidney failure and wants to make sure she is healthy. She works as an accountant, is not married or sexually active, and drinks alcohol occasionally. She currently does not take any medications. She does not know if she snores at night but frequently feels fatigued. She denies any headaches but reports occasional visual difficulties driving at night. She further denies any blood in her urine or increased urinary frequency. She does not engage in any fitness program. She has her period every 2 months with heavy flows. Her initial vital signs reveal that her blood pressure is 180/100 mmHg and heart rate is 70/min. Her body weight is 150 kg (330 lb). On physical exam, the patient has droopy eyelids, a thick neck with a large tongue, no murmurs or clicks on cardiac auscultation, clear lungs, a soft nontender, albeit large abdomen, and palpable pulses in her distal extremities. She can walk without difficulty. A repeat measurement of her blood pressure shows 155/105 mmHg. Which among the following is part of the most appropriate next step in management?

A 50-year-old man presents to a clinic with oliguria. Four weeks ago, he had a kidney transplant. Postoperative follow-up was normal. He is currently on cyclosporine and admits that sometimes he forgets to take his medication. On physical examination, the vital signs include: temperature 37.1°C (98.8°F), blood pressure 165/110 mm Hg, heart rate 80/min, and respiratory rate 16/min. There is mild tenderness on renal palpation. His serum creatinine level is 4 mg/dL, well above his baseline level after the transplant. Which of the following best describes the histological finding if a biopsy is taken from the transplanted kidney?

A student health coordinator plans on leading a campus-wide HIV screening program that will be free for the entire undergraduate student body. The goal is to capture as many correct HIV diagnoses as possible with the fewest false positives. The coordinator consults with the hospital to see which tests are available to use for this program. Test A has a sensitivity of 0.92 and a specificity of 0.99. Test B has a sensitivity of 0.95 and a specificity of 0.96. Test C has a sensitivity of 0.98 and a specificity of 0.93. Which of the following testing schemes should the coordinator pursue?

A 27-year-old G1P0 female presents for her first prenatal visit. She is in a monogamous relationship with her husband, and has had two lifetime sexual partners. She has never had a blood transfusion and has never used injection drugs. Screening for which of the following infections is most appropriate to recommend this patient?

A 34-year-old man comes to the physician for a routine health maintenance examination. He was diagnosed with HIV 8 years ago. He is currently receiving triple antiretroviral therapy. He is sexually active and uses condoms consistently. He is planning a trip to Thailand with his partner to celebrate his 35th birthday in 6 weeks. His last tetanus and diphtheria booster was given 4 years ago. He received three vaccinations against hepatitis B 5 years ago. He had chickenpox as a child. Other immunization records are unknown. Vital signs are within normal limits. Cardiopulmonary examination shows no abnormalities. Leukocyte count shows 8,700/mm3, and CD4+ T-lymphocyte count is 480 cells/mm3 (Normal ≥ 500); anti-HBs is 150 mIU/mL. Which of the following recommendations is most appropriate at this time?

A 58-year-old man is brought to the emergency department because of confusion, weight loss, and anuria. He has chronic kidney disease, hypertension, and type 2 diabetes mellitus. He was diagnosed with acute lymphoblastic leukemia at the age of 8 years and was treated with an allogeneic stem cell transplantation. He is HIV-positive and has active hepatitis C virus infection. He drinks around 8 cans of beer every week. His current medications include tenofovir, emtricitabine, atazanavir, daclatasvir, sofosbuvir, insulin, amlodipine, and enalapril. He appears lethargic. His temperature is 36°C (96.8°F), pulse is 130/min, respirations are 26/min, and blood pressure is 145/90 mm Hg. Examination shows severe edema in his legs and generalized muscular weakness. Auscultation of the lung shows crepitant rales. Laboratory studies show positive HCV antibody and positive HCV RNA. His HIV viral load is undetectable and his CD4+ T-lymphocyte count is 589/μL. Six months ago, his CD4+ T-lymphocyte count was 618/μL. An ECG of the heart shows arrhythmia with frequent premature ventricular contractions. Arterial blood gas analysis on room air shows: pH 7.23 PCO2 31 mm Hg HCO3- 13 mEq/L Base excess -12 mEq/L The patient states he would like to donate organs or tissues in the case of his death. Which of the following is an absolute contraindication for organ donation in this patient?

A 38-year-old kidney transplant recipient maintained on tacrolimus presents with a 2-week history of progressive confusion, ataxia, and visual disturbances. MRI shows multifocal white matter lesions without mass effect or enhancement. CSF analysis reveals mild pleocytosis with elevated protein. JC virus DNA is detected in CSF by PCR. Serum tacrolimus level is therapeutic at 8 ng/mL. Apply knowledge of this condition to determine the appropriate management strategy.