Transplant medicine Practice Questions

Question 1

A research team develops a new monoclonal antibody checkpoint inhibitor for advanced melanoma that has shown promise in animal studies as well as high efficacy and low toxicity in early phase human clinical trials. The research team would now like to compare this drug to existing standard of care immunotherapy for advanced melanoma. The research team decides to conduct a non-randomized study where the novel drug will be offered to patients who are deemed to be at risk for toxicity with the current standard of care immunotherapy, while patients without such risk factors will receive the standard treatment. Which of the following best describes the level of evidence that this study can offer?

Accepted Answer

Level 3

Answer

Level 1

Answer

Level 5

Answer

Level 4

Answer

Level 2

Question 2

A 22-year-old man is brought to the emergency department by ambulance 1 hour after a motor vehicle accident. He did not require any circulatory resuscitation at the scene, but he was intubated because he was unresponsive. He has no history of serious illnesses. He is on mechanical ventilation with no sedation. His blood pressure is 121/62 mm Hg, the pulse is 68/min, and the temperature is 36.5°C (97.7°F). His Glasgow coma scale (GCS) is 3. Early laboratory studies show no abnormalities. A search of the state donor registry shows that he has registered as an organ donor. Which of the following is the most appropriate next step in evaluation?

Accepted Answer

Evaluation of brainstem reflexes

Answer

Brain MRI

Answer

Electroencephalography

Answer

Cerebral angiography

Answer

Apnea test

Question 3

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?

Accepted Answer

Lymphocytic infiltration of graft vessels and endothelial damage

Answer

Thrombosis and occlusion of vessels

Answer

Atherosclerosis on angiography

Answer

Necrosis with granulation tissue

Answer

Thickening of blood vessels, fibrosis of graft vessels, and parenchymal atrophy

Question 4

A 14-year-old boy has undergone kidney transplantation due to stage V chronic kidney disease. A pre-transplantation serologic assessment showed that he is negative for past or present HIV infection, viral hepatitis, EBV, and CMV infection. He has a known allergy for macrolides. The patient has no complaints 1 day after transplantation. His vital signs include: blood pressure 120/70 mm Hg, heart rate 89/min, respiratory rate 17/min, and temperature 37.0°C (98.6°F). On physical examination, the patient appears to be pale, his lungs are clear on auscultation, heart sounds are normal, and his abdomen is non-tender on palpation. His creatinine is 0.65 mg/dL (57.5 µmol/L), GFR is 71.3 mL/min/1.73 m2, and urine output is 0.9 mL/kg/h. Which of the following drugs should be used in the immunosuppressive regimen in this patient?

Accepted Answer

Basiliximab

Answer

Belatacept

Answer

Sirolimus

Answer

Omalizumab

Answer

Daclizumab

Question 5

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?

Accepted Answer

Childhood leukemia

Answer

HIV infection

Answer

Alcoholism

Answer

No absolute contraindications

Answer

Acute kidney injury

Question 6

A 68-year-old woman comes to the physician for a follow-up examination. Three months ago, she underwent heart transplantation for restrictive cardiomyopathy and was started on transplant rejection prophylaxis. Her pulse is 76/min and blood pressure is 148/82 mm Hg. Physical examination shows enlargement of the gum tissue. There is a well-healed scar on her chest. Serum studies show hyperlipidemia. The physician recommends removing a drug that decreases T cell activation by inhibiting the transcription of interleukin-2 from the patient's treatment regimen and replacing it with a different medication. Which of the following drugs is the most likely cause of the adverse effects seen in this patient?

Accepted Answer

Cyclosporine

Answer

Mycophenolate mofetil

Answer

Azathioprine

Answer

Tacrolimus

Answer

Prednisolone

Question 7

A 66-year-old man presents to the emergency department for a 1-hour history of right arm weakness. He was having breakfast this morning when his right arm suddenly became weak, causing him to drop his coffee mug. He also noticed that he was slurring his speech and had some additional weakness in his right leg. He had no symptoms prior to the onset of the weakness and noted no other unusual phenomena. These symptoms lasted for about 30 minutes, but they resolved completely by the time he arrived at the emergency department. His medical history is notable for hypertension and hyperlipidemia, but he does not receive close follow-up from a primary care physician for these conditions. The patient currently is not taking any medications. His pulse is 75/min, the blood pressure is 160/95 mm Hg, and the respiratory rate is 14/min. Physical exam is remarkable for a high-pitched sound heard on auscultation of the neck, the remainder of the exam, including a complete neurological exam, is entirely unremarkable. CT angiography of the head and neck shows no active hemorrhage and 80% stenosis of the left internal carotid artery. Which of the following is the next best step in the long-term management of this patient?

Accepted Answer

Initiation of aspirin and atorvastatin

Answer

Administration of tissue plasminogen activator (tPA)

Answer

Brain MRI

Answer

Initiation of lisinopril

Answer

Carotid endarterectomy

Question 8

A 35-year-old man arrives at the emergency department within minutes after a head-on motor vehicle accident. He suffered from blunt abdominal trauma, several lacerations to his face as well as lacerations to his upper and lower extremities. The patient is afebrile, blood pressure is 45/25 mmHg and pulse is 160/minute. A CBC is obtained and is most likely to demonstrate which of the following?

Accepted Answer

Hb 15 g/dL, Hct 45%

Answer

Hb 17 g/dL, Hct 20%

Answer

Hb 5 g/dL, Hct 30%

Answer

Hb 20 g/dL, Hct 60%

Answer

Hb 5 g/dL, Hct 20%

Question 9

A 63-year-old man presents to the ambulatory medical clinic with symptoms of dysphagia and ‘heartburn’, which he states have become more troublesome over the past year. Past medical history is significant for primary hypertension. On physical exam, he is somewhat tender to palpation over his upper abdomen. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 74/min, and respiratory rate 14/min. Barium swallow fluoroscopy demonstrates a subdiaphragmatic gastroesophageal junction, with herniation of the gastric fundus into the left hemithorax. Given the following options, what is the most appropriate next step in the management of this patient’s underlying condition?

Accepted Answer

Surgical gastropexy

Answer

Lifestyle modification

Answer

Antacid therapy

Answer

Cimetidine

Answer

Omeprazole

Question 10

A 55-year-old woman who works as a chef is brought to the hospital for evaluation of burns sustained in a kitchen accident. Physical examination reveals 3rd-degree burns over the anterior surface of the right thigh and the lower limbs, which involve approx. 11% of the total body surface area (TBSA). The skin in the burned areas is thick and painless to touch, and the dorsalis pedis pulses are palpable but weak. Initial fluid resuscitation has been started and the patient is hemodynamically stable. Which of the following is the most appropriate next step in management?

Accepted Answer

Early excision and split-thickness skin grafting

Answer

Delayed excision and skin grafting

Answer

Fluid resuscitation with Ringer’s lactate solution per the Parkland formula

Answer

Topical antibiotic application of mafenide acetate

Answer

Early excision and full-thickness skin grafting

Transplant medicine

Study Resources

Lessons

Questions

Flashcards

Lessons

Donor selection criteria

Brain death criteria

Organ preservation techniques

Immunosuppression principles

Rejection diagnosis and management

Liver transplantation

Kidney transplantation

Heart transplantation

Lung transplantation

Pancreas and islet cell transplantation

Small bowel transplantation

Post-transplant infections

Long-term complications of transplantation

Practice Questions

Flashcards

About Transplant medicine for USMLE

Lessons in Transplant medicine

Master Transplant medicine