Question 1

Which of the following medications have the highest potential toxicity?&#10;A) Cyclosporine and tacrolimus&#10;B) Azathioprine and mycophenolate mofetil&#10;C) Prednisone and azathioprine&#10;D) Prednisone and azithromycin

Accepted Answer

All immunosuppressive regimens place the patient at risk for infection. In addition, each arm of the regimen may cause other complications from side effects or drug toxicity. Cyclosporine and tacrolimus have the highest potential toxicity.

Question 2

Which of the following problems is associated with long-term heart transplant patients?&#10;A) Graft atheroxclerosis&#10;B) Recurrent pulmonary edema&#10;C) Coronary revascularization&#10;D) Cardiac dysrhythmias

Accepted Answer

A troublesome and life-limiting problem in long-term heart transplant survivors, regardless of age, is the development of premature coronary artery disease or coronary vasculopathy, also known as graft atherosclerosis.

Question 3

When could kidneys, liver, and lungs be procured for transplantation from a patient with circulatory arrest?&#10;A) Within 30 minutes&#10;B) Within 30 to 60 minutes&#10;C) Within 2 hours&#10;D) Within 4 hours

Accepted Answer

If circulatory arrest is anticipated within minutes of withdrawal of ventilatory support, organ donation may be possible. In that situation, the organ procurement center is contacted, and recovery surgeons are notified and present in a nearby operating room at the time of extubation. If circulatory arrest occurs within 30 to 60 minutes, kidneys, livers, and most recently lungs may be procured for transplantation.

Question 4

What are some reasons for the decline in heart-lung transplants among infants?
I. Difficulty in obtaining a donor
II. Decreased risk of cardiac rejection
III. Increased risk of premature coronary artery disease
IV. The practical advantage of using the heart-lung block for three separate donations

A) I and IV only
B) II and III only
C) I, II, and III only
D) I, II, and IV only

Accepted Answer

Heart-lung transplantation involves a sternotomy and surgical anastomoses of the trachea, superior and inferior venae cavae, and aorta and is a technically less challenging operation compared with lung transplantation. With the ability to successfully transplant a single lung or two lungs, the use of heart-lung transplantation for pulmonary disease has dramatically decreased.There are multiple reasons for this, including the following: $\bullet$ The limited availability of satisfactory coupled heart-lung donations from a single donor (governed in part by the distribution algorithm unique to each country) $\bullet$ The practical advantage of using the heart-lung block for three separate donations (one heart and two single lungs) $\bullet$ The decreased risk of cardiac rejection if isolated lung transplantation is performed $\bullet$ The decreased risk of premature coronary artery disease $\bullet$ The high demand for donor hearts by very ill heart transplant candidates with ventricular assist devices or artificial hearts in place.

Question 5

What is the predominant problem leading to heart transplantation in children younger than 1 year of age?&#10;A) Cardiomyopathy&#10;B) Congenital cardiac lesions&#10;C) Valvular problems&#10;D) Lethal cardiac dysrhythmias

Accepted Answer

Congenital lesions are the indication for heart transplantation in 55% of patients younger than 1 year, worldwide, but in only 25% of older children.

Question 6

Why does the pulmonary infection rate for lung transplantation appear to be higher than with other solid organ transplants?&#10;A) Because the lung is in direct contact with the external environment&#10;B) Because the entire cardiac output flows through the lungs multiple times per minute&#10;C) Because the pulmonary circulation is more prone to hypertensive episodes than other organs&#10;D) Because lung chemotaxis is compromised and fewer neutrophils populate the transplanted lungs

Accepted Answer

Although pulmonary infections are common because of the immunosuppression required with any solid organ transplant, the pulmonary infection rate for lung transplantation appears to be high. This may be partially explained by the fact that the lung is the only solid organ that, after transplantation, is regularly in direct contact with the external environment and multiple potential pathogens. Many pulmonary bacterial infections are readily identified but often require bronchoalveolar lavage (BAL) and culture for accurate diagnosis and treatment with antibiotics.

Question 7

Months after receiving a lung transplant a patient with cystic fibrosis exhibits the following signs and symptoms:
Increasing dyspnea
Increased coughing with sputum production
Colonization with Pseudomonas species
The patient also appears to be in respiratory failure. Which of the following conditions is likely developing?

A) Bronchiolitis obliterans
B) Bronchorrhea
C) Acute respiratory distress syndrome
D) Pulmonary hypertension

Accepted Answer

In the majority of patients, bronchiolitis obliterans is a progressive disease manifested by increasing dyspnea, increased coughing with sputum production, colonization or infection with Pseudomonas species, and eventual respiratory failure and death.

Question 8

The therapist notices the following signs in a pediatric patient who recently had a heart transplant:
Decreased cardiac contractility
Congestive heart failure
Tachycardia
Tachypnea
Malaise
How should the therapist interpret these signs?

A) These signs are normal and expected after heart transplantation.
B) The patient has become hypovolemic.
C) The patient requires cardioversion.
D) The patient is in rejection.

Accepted Answer

In the lung transplant patient, tachypnea, bibasilar inspiratory crackles on auscultation, increased interstitial infiltrates on chest radiography, and hypoxemia by pulse oximetry are often associated with acute rejection (see Figure 21-6 in the textbook). For older patients who can perform spirometry, a drop in pulmonary function, either restrictive or obstructive, is often the most sensitive indicator of acute rejection.

Question 9

What is the predominant cause of late postoperative deaths associated with heart transplantation?&#10;A) Cardiac dysrhythmias&#10;B) Sepsis&#10;C) Seizures&#10;D) Chronic rejection

Accepted Answer

Late deaths are caused primarily by coronary vasculopathy (chronic rejection).

Question 10

Which of the following chronic lung diseases is the most common indication for bilateral lung transplantation?&#10;A) Severe asthma&#10;B) Cystic fibrosis&#10;C) Acute respiratory distress syndrome&#10;D) Tetralogy of Fallot

Accepted Answer

Cystic fibrosis is the most common indication for bilateral lung transplantation, almost exclusively above 6 years of age.

Question 11

Which of the following microorganisms is associated with increased mortality among patients with cystic fibrosis?&#10;A) Serratia marcescens&#10;B) Staphylococcus aureus&#10;C) Haemophilus influenza&#10;D) Burkholderia cepacia

Accepted Answer

The answer of Which of the following microorganisms is associated...

Question 12

Which of the following conditions are considered complications of thoracic organ transplantation?
I) Respiratory failure
II) Bronchiolitis obliterans
III) Lung allografts
IV) Infection

A) III and IV only
B) I, II, and III only
C) I, II, and IV only
D) II, III, and IV only

Accepted Answer

The answer of Which of the following conditions are considered...

Question 13

Which of the following conditions typically makes lungs unsuitable for donation?&#10;A) Pulmonary edema&#10;B) Platelike atelectasis&#10;C) Tracheal tear&#10;D) Tracheitis

Accepted Answer

The answer of Which of the following conditions typically makes...

Question 14

Which of the following forms of interaction tend to occur between the respiratory therapist and a patient who receives a lung transplant?
I) Mechanical ventilation
II) Pulmonary rehabilitation
III) Bronchopulmonary hygiene
IV) Hyperbaric oxygenation

A) I and III only
B) II and III only
C) I, II, and III only
D) I, II, and IV only

Accepted Answer

The answer of Which of the following forms of interaction...

Question 15

Which of the following medications are used as part of the immunosupressive regimen?
I) Trimethoprim-sulfamethoxazole
II) Cyclosporine
III) Azathioprine
IV) Prednisone

A) I and III only
B) II and III only
C) I, II, and IV only
D) II, III, and IV only

Accepted Answer

The answer of Which of the following medications are used...

Question 16

Which of the following cardiac problems is responsible for the vast majority of neonatal cardiac transplants?&#10;A) Cardiomyopathy&#10;B) Ventricular septal defect&#10;C) Cardiac pacemaker abnormalities&#10;D) Hypoplastic left ventricle

Accepted Answer

The answer of Which of the following cardiac problems is...

Question 17

Which of the following is the most common indication for heart transplantation?&#10;A) Cardiomyopathy&#10;B) Massive myocardial infarction&#10;C) External pacemaker placement&#10;D) Primary pulmonary hypertension

Accepted Answer

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

Question 18

Twenty-four hours after a pediatric patient has undergone lung transplantation, the therapist notices on the patient's chest X-ray features consistent with pulmonary edema. How should the therapist interpret this finding?

A) The patient has experienced ischemia-reperfusion injury.
B) The patient is developing bronchiolitis obliterans.
C) A pneumonia-like infection has occurred.
D) Graft failure is present.

Accepted Answer

The answer of Twenty-four hours after a pediatric patient has...

Deck 21: Thoracic Organ Transplantation