Question 1

Which of the following is the standard immunosuppressive drug used to prevent organ graft rejection?&#10;A) tacrolimus&#10;B) cyclosporine&#10;C) cyclophosphamide&#10;D) daclizumab

Accepted Answer

Since the 1980s,cyclosporine has been the standard immunosuppressive drug used to prevent organ graft rejection.The immunosuppressive agents used for most heart,liver,kidney,and pancreas trAnswerplantations are cyclosporine,prednisone,and an antilymphocyte agent.Antilymphocyte agents include the Minnesota antilymphocyte globulin,equine antithymocyte globulin,rabbit antithymocyte globulin,and Orthoclone monoclonal antibody.The best results are obtained with triple-drug immunosuppressive therapy-cyclosporine,prednisone,and azathioprine or mycophenolate mofetil (MMF).

Question 2

Which of the following is the most common viral infection in the posttransplant patient?&#10;A) hepatitis B&#10;B) hepatitis C&#10;C) cytomegalovirus (CMV)&#10;D) Epstein-Barr virus (EBV)

Accepted Answer

Cytomegalovirus (CMV)is the most common infection in posttrAnswerplant patients.Effective infection control procedures must be used when trAnswerplant patients receive dental treatment.Viral infections found in posttrAnswerplant patients include herpes simplex viruses (HSV),Epstein-Barr virus (EBV),cytomegalovirus (CMV),hepatitis B and hepatitis C virus (HBV,HCV),and human immunodeficiency virus (HIV).

Question 3

Overimmunosuppression increases the risk for ____________,and underimmunosuppression increases the risk for ________________ during the stable posttransplantation period.&#10;A) acute rejection; acute rejection&#10;B) acute rejection; infection&#10;C) infection; acute rejection&#10;D) infection; infection

Accepted Answer

Medical considerations during the stable posttrAnswerplantation period relate to the effects of immunosuppressive agents.The patient will still be susceptible to infections,but at this time the major concern is overimmunosuppression,which increases the risk for infection,and underimmunosuppression,which increases the risk for acute rejection.If rejection of the graft occurs,the organ begins to fail,and the problems associated with end-stage heart,liver,kidney,and pancreas failure will have to be considered and managed when present.

Question 4

During the immediate posttransplantation period,the patient will be started on immunosuppressive therapy to prevent which of the following types of cells from destroying the graft?&#10;A) plasma cells&#10;B) cytotoxic T cells&#10;C) polymorphonuclear leukocytes (PMNs)&#10;D) monocytes

Accepted Answer

During the immediate posttrAnswerplantation period,which generally encompasses the first 3 months after the trAnswerplant procedure,the patient will be started on immunosuppressive therapy to prevent cytotoxic T cells from destroying the graft.During this period,the patient is at greatest risk for technical complications,acute rejection,and infection.

Question 5

If the level of anticoagulation of a transplant patient is greater than that for an international normalized ratio (INR)of ___,the dosage of medication may need to be reduced by the patient's physician.

A) 1.5
B) 2.5
C) 3.5
D) 4.5

Accepted Answer

If the INR is greater than 3.5,the dosage of the medication may need to be reduced.At least 3 to 4 days are required for the effect of the reduced dosage to lower the PT.When the patient's INR has been appropriately reduced,the surgery can be performed.After surgery,the dentist must be prepared to deal with excessive bleeding,by use of splints,thrombin,hemostatic agents,or antifibrinolytic agents.

Question 6

Patients with ___________ have the greatest chance of success from bone marrow transplantation (BMT).&#10;A) aplastic anemia&#10;B) chronic myelogenous leukemia&#10;C) lymphoma&#10;D) Hurler syndrome

Accepted Answer

The greatest chance of success from BMT is for patients with chronic myelogenous leukemia.Commonly,patients with aplastic anemia,lymphoma,Hodgkin disease,neuroblastoma,or genetic diseases (i.e.,immunodeficiency,Hurler syndrome)undergo BMT as well.Chronic myelogenous leukemia is 100% fatal without BMT,but with BMT,the cure rate is approximately 60% to 70%.

Question 7

A bone graft from a donor who is a parent would be an example of (a/an)__________ bone graft.&#10;A) syngeneic&#10;B) autologous&#10;C) allogeneic&#10;D) xenograft

Accepted Answer

An allogeneic marrow graft involves a donor and a recipient of different genetic origins within the same species (usually 50% to 70% of trAnswerplant procedures).Siblings provide grafts with the best chance of survival,which are a partial match (haploidentical),or parents may donate the marrow (providing usually 30% to 50% of bone marrow trAnswerplants).Allogeneic grafts also may involve unrelated donors (usually 10% to 15%).

Question 8

It is best to avoid any dental treatment for how long a period following transplantation?&#10;A) 7 to 10 days&#10;B) 2 to 4 weeks&#10;C) 6 months&#10;D) 2 years

Accepted Answer

It is best to avoid any dental treatment for about 6 months after trAnswerplantation,owing to many associated potential complications aside from infections,such as fatigue,medication interactions and side effects,and inadvertent saliva aspiration leading to aspiration pneumonia.During the first 3 months after an organ trAnswerplant procedure,the patient should receive only emergency dental treatment as required,and elective procedures should be postponed.

Question 9

Which of the following types of transplant recipients has the highest reported 1-year patient survival rate?&#10;A) liver&#10;B) intestine&#10;C) kidney&#10;D) lung

Accepted Answer

Reported 1-year patient survival rates are highest for kidney and pancreas recipients,ranging from 95% to 98%; the median survival rate with renal trAnswerplantation from living donors has increased from 17 years in 1988 to nearly 38 years at present.Corresponding survival rates at 1 year for liver,intestine,and heart trAnswerplant recipients were approximately 86% to 88%,about 83% for lung,and lowest for the small number of heart-lung recipients,at around 58%.

Question 10

The &#34;implantation response&#34; may be seen with which of the following types of transplantation?&#10;A) kidney&#10;B) spleen&#10;C) heart-lung&#10;D) liver

Accepted Answer

The implantation response is an additional complication that may be seen with heart-lung combination trAnswerplantation.It is a reversible condition characterized by fever,tachypnea,diffuse pulmonary infiltrates on the chest radiograph,decreased partial pressure of oxygen in arterial blood (PaO₂),and increased partial pressure of carbon dioxide in arterial blood (PaCO₂).The cause is multifactorial,involving lymphatic interruption,ischemia,denervation,and surgical trauma.

Question 11

Which of the following are oral findings that may indicate overimmunosuppression?&#10;A) leukoedema&#10;B) aphthous ulcers&#10;C) lingual varicies&#10;D) ranula

Accepted Answer

The answer of Which of the following are oral findings...

Question 12

Which of the following is true of graft-versus-host disease (GVHD)as a consequence of allogenic bone marrow transplantation?&#10;A) It is treated by increasing the dosage of immunosuppressive agents and is rarely fatal.&#10;B) Acute GVHD will appear within 7 to 10 days following the transplant.&#10;C) Acute GVHD is characterized by mucosal, skin, liver, and gastrointestinal tract involvement.&#10;D) Chronic GVHD occurs within the first 3 months after transplantation.

Accepted Answer

The answer of Which of the following is true of...

Question 13

Which of the following types of organ transplants has the best chance for success?&#10;A) allogeneic&#10;B) syngeneic&#10;C) xenograft

Accepted Answer

The answer of Which of the following types of organ...

Question 14

What test is performed following heart transplantation in order to check for signs of acute or chronic rejection?&#10;A) computed tomography (CT) scan&#10;B) magnetic resonance imaging (MRI)&#10;C) right ventricular biopsy&#10;D) stress-test electrocardiogram (ECG)

Accepted Answer

The answer of What test is performed following heart transplantation...

Deck 21: Organ and Bone Marrow Transplantation