Chapter·SurgeryTransplant medicine

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1

A 31-year-old female receives a kidney transplant for autosomal dominant polycystic kidney disease (ADPKD). Three weeks later, the patient experiences acute, T-cell mediated rejection of the allograft and is given sirolimus. Which of the following are side effects of this medication?

ANephrotoxicity, hypertension

BHyperlipidemia, thrombocytopenia

CNephrotoxicity, gingival hyperplasia

DPancreatitis

ECytokine release syndrome, hypersensitivity reaction

2

A 42-year-old woman presents to the physician with symptoms of vague abdominal pain and bloating for several months. Test results indicate that she has ovarian cancer. Her physician attempts to reach her by phone multiple times but cannot reach her. Next of kin numbers are in her chart. According to HIPAA regulations, who should be the primary person the doctor discusses this information with?

AThe patient's brother

BThe patient's husband

CThe patient's daughter

DAll of the options

EThe patient

3

A 66-year-old man is transferred from another hospital after 3 days of progressively severe headache, vomiting, low-grade fever, and confusion. According to his partner, the patient has been dealing with some memory loss and complaining about headaches for the past 2 weeks. He has a history of interstitial pulmonary disease that required lung transplantation 2 years ago. Upon admission, he is found with a blood pressure of 160/100 mm Hg, a pulse of 58/min, a respiratory rate of 15/min, and a body temperature of 36°C (97°F). During the examination, he is found with oral thrush and symmetric and reactive pupils; there are no focal neurological signs or papilledema. A lumbar puncture is performed. Which of the following features would be expected to be found in this case?

AAspect: clear, opening pressure: normal, cell count: < 5 cells/µL, protein: normal, glucose: normal

BAspect: clear, opening pressure: normal, cell count: ↑ lymphocytes, protein: normal, glucose: normal

CAspect: cloudy, opening pressure: ↑, cell count: ↑ neutrophils, protein: ↑, glucose: ↓

DAspect: xanthochromic, opening pressure: normal, cell count: ↑ red blood cells, protein: normal, glucose: normal

EAspect: clear, opening pressure: ↑, cell count: ↑ lymphocytes, protein: ↑, glucose: ↓

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