Chapter 3: Transplant and Immunology

Chapter 3. Transplant and Immunology

Pancreatic transplantation is considered a lifesaving procedure in which of the following patients?

A. 32-year-old female on dialysis secondary to diabetic nephropathy

B. 46-year-old male with high insulin requirements to maintain normoglycemia

C. 37-year-old female with episodes of severe hypoglycemic unawareness

D. 21-year-old female with brittle diabetes

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.

Which virus is associated with PTLD?

A. EBV

B. HSV

C. RSV

D. HIV

Answer: A. EBV. Immunosuppression allows B cells that are infected with EBV to proliferate.

Which of the following is a complication of calcineurin inhibitors that is LESS pronounced in sirolimus?

A. Hyperlipidemia

B. Thrombocytopenia

C. Rash

D. Nephrotoxicity

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.

If a patient has tertiary hyperparathyroidism, when should he or she undergo total parathyroidectomy with autotransplantation?

A. In 3 months if moderate hypercalcemia persists

B. In 12 months if hypercalcemia and elevated PTH levels persist

C. In 6 months if PTH levels are twice normal

D. Immediately after transplant if PTH levels are greater than normal

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.

Which of the following are the most common indications for liver transplantation in adults and children, respectively?

A. Autoimmune hepatitis and inborn errors of metabolism

B. Malignant neoplasms and biliary atresia

C. Cholestatic cirrhosis and viral hepatitis

D. Noncholestatic cirrhosis and biliary atresia