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Surgical-Specialties-Organ-Transplant Test Bank
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MyPasTest: MRCS A Online - Jan Exam 201529. Surgical Specialties- Organ Transplantation (15Qs)
01. Theme: Drug therapy for suspected transplant rejection-
A Antithymocyte globulin (ATG)
B Azothioprine
C Ciclosporin
D Methotrexate
E Mycophenolate
F Methylprednisolone. Page |
For each of the clinical scenarios listed below, select the most appropriate first-line drug therapy. 1646
Each option may be used once, more than once, or not at all.
Scenario 1
You receive a histopathology report for a patient who you suspect is rejecting the renal allograft they received
90 days ago. The findings are of ‘transmural arteritis and transmural fibrinoid change with necrosis of smooth
muscle cells’.
A - Antithymocyte globulin (ATG)« YOUR ANSWER
F - Methylprednisolone« CORRECT ANSWER.
First-line therapy in acute rejection is high-dose steroids in addition to the original
immunoprophylaxis.
Scenario 2
You review a 45-year-old woman on the ward round. She had a renal transplantation one week ago. She is
now complaining of discomfort in the region of the transplant. Her renal function had been improving but has
deteriorated over the last two days.
B - Azothioprine« YOUR ANSWER
F - Methylprednisolone« CORRECT ANSWER.
First-line therapy in acute rejection is high-dose steroids in addition to the original
immunoprophylaxis.
Scenario 3
A patient with established acute graft versus host rejection is 30 days following renal transplantation. They
have been receiving first line therapy for 7 days but there has been no change in their condition
C - Ciclosporin« YOUR ANSWER
A - Antithymocyte globulin (ATG)« CORRECT ANSWER.
Failure of first-line therapy is defined as progression of acute graft versus host disease after 3 days,
no change after 7 days, or incomplete response after 14 days of methylprednisolone. Secondary
therapy includes ATG and monoclonal antibody therapy.
02. Theme: Types of tissue transplantation
A Autograft
B Allograft
C Monograft
D Isograft
E Xenograft.
For each of the clinical scenarios listed below, select the most appropriate description of the
transplanted tissue. Each option may be used once, more than once, or not at all.
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Dr Mohammed Shamsul Islam Khan, Medical Officer, Clinical Neuro-Surgery, National Institute of Neuro-Sciences and Hospital
Sher-E-Bangla Nagar, Dhaka-1207, Bangladesh. Mobile: +880 1713 455 662, +880 1685 811979. E-mail: drsikhan@gmail.com
, MyPasTest: MRCS A Online - Jan Exam 2015
29. Surgical Specialties- Organ Transplantation (15Qs)
Scenario 1
A patient receives a porcine aortic valve replacement.
A - Autograft« YOUR ANSWER
E - Xenograft« CORRECT ANSWER.
A xenograft (or heterograft) is an organ or tissue transferred from one species to another species.
Page |
Scenario 2
A 25-year-old woman with end-stage renal failure receives a kidney for transplantation from her identical twin 1647
sister.
B - Allograft« YOUR ANSWER
D - Isograft« CORRECT ANSWER
An isograft is an organ or tissue obtained from a donor genetically identical to the recipient.
Scenario 3
A woman undergoes renal transplantation. The kidney had been harvested from a patient with confirmed
brainstem death.
C - Monograft« YOUR ANSWER
B - Allograft« CORRECT ANSWER.
An allograft (or homograft) is an organ or tissue transplanted from a donor of the same species but
different genetic make-up.
Scenario 4
A 16 year-old boy suffers burns to h is chest. A part ial-th ickness sk in graft is harvested from h is th igh and
used to cover part of h is chest.
D - Isograft« YOUR ANSWER
A - Autograft« CORRECT ANSWER.
An autograft is tissue taken from one site and grafted to another site on the same person.
03. A 54-year-old female with chronic glomerulonephritis requires a renal transplant as she has end-
stage renal failure. The renal artery and vein of the donor are most likely to be anastomosed to which
vessels of the recipient in end to side anastomosis? Select one answer only.
Aorta and inferior vena cava« YOUR ANSWER
External iliac artery and vein« CORRECT ANSWER
Femoral artery and vein
Internal iliac artery and vein
Renal artery and vein.
The kidney is placed extraperitoneally in the right or left iliac fossa, usually on the right side (dictated
by existing scars or previous transplants and because it is relatively straightforward to access for
biopsies and surgery in the event of post-operative problems). Renal vessels are anastomosed (end to
side) to the recipient‟s external iliac verssels.
The ureter is taken down into the pelvis where it is anastomosed to the bladder mucosa, either directly
(extravesical approach) or by threading it through a submucosal tunnel and suturing from inside the
bladder through a separate incision in the bladder wall (intravesical approach).
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Dr Mohammed Shamsul Islam Khan, Medical Officer, Clinical Neuro-Surgery, National Institute of Neuro-Sciences and Hospital
Sher-E-Bangla Nagar, Dhaka-1207, Bangladesh. Mobile: +880 1713 455 662, +880 1685 811979. E-mail: drsikhan@gmail.com
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