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Chapter 3. Transplant and Immunology
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Pancreatic transplantation is considered a lifesaving procedure in which of the following patients?
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A. 32-year-old female on dialysis secondary to diabetic nephropathy
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B. 46-year-old male with high insulin requirements to maintain normoglycemia
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C. 37-year-old female with episodes of severe hypoglycemic unawareness
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D. 21-year-old female with brittle diabetes
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Answer: C. 37-year-old female with episodes of severe hypoglycemic unawareness. Over time, patients with multiple episodes of hypoglycemia may not experience typical symptoms. Therefore, hypoglycemia can become severe, resulting in neurologic injury.
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Which virus is associated with PTLD?
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Answer: A. EBV. Immunosuppression allows B cells that are infected with EBV to proliferate.
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Which of the following is a complication of calcineurin inhibitors that is LESS pronounced in sirolimus?
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Answer: D. Nephrotoxicity. Sirolimus can be used for immunosuppression in patients with renal transplants if there is evidence of calcineurin inhibitor–induced nephropathy on biopsies.
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If a patient has tertiary hyperparathyroidism, when should he or she undergo total parathyroidectomy with autotransplantation?
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A. In 3 months if moderate hypercalcemia persists
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B. In 12 months if hypercalcemia and elevated PTH levels persist
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C. In 6 months if PTH levels are twice normal
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D. Immediately after transplant if PTH levels are greater than normal
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Answer: B. In 12 months if hypercalcemia and elevated PTH levels persist. A diagnosis of tertiary hyperparathyroidism warrants surgical correction so that consequences (osteomalacia and renal osteodystrophy) of the disease do not ensue.
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Which of the following are the most common indications for liver transplantation in adults and children, respectively?
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A. Autoimmune hepatitis and inborn errors of metabolism
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B. Malignant neoplasms and biliary atresia
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C. Cholestatic cirrhosis and viral hepatitis
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D. Noncholestatic cirrhosis and biliary atresia
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