PreTest Surgery: Transplants, Immunology, and Oncology

Question 1

_____________ has been postulated to be the main cytokine involved in sepsis.

Answer 1

TNF (released by macrophages)

Question 2

Chronic rejection of a liver transplant will show what on pathologic examination?

Answer 2

A paucity of bile ducts

Question 3

Describe how a cross-match occurs.

Answer 3

You want to know if the recipient has antibodies against the HLA of the donor, so you mix donor lymphocytes with the recipient’s serum.

Question 4

Tumor lysis syndrome is mediated by which cell type?

Answer 4

Cytotoxic T lymphocytes

Question 5

A ____________ cross-match means the transplant cannot occur.

Answer 5

positive

So you say “cross-match was negative” when there was no antibody activation.

Question 6

A patient develops oliguria and fever three weeks after transplantation of kidney. What is this and how do you treat?

Answer 6

Acute graft failure

Biopsy, increase steroids, and give IVIG.

Question 7

The model for end-stage liver disease (MELD) score depends on what three variables?

Answer 7

• INR
• Total bilirubin
• Creatinine

It is used to predict 3-month mortality.

Question 8

Graft-versus-host disease is common in what two transplants?

Answer 8

Bone marrow and liver

Question 9

What are some absolute contraindications to liver transplantation?

Answer 9

• Ongoing substance abuse
• Extrahepatic malignancy
• HCC with metastasis
• Severe cardiac or pulmonary impairment

Question 10

_____________ can be used to treat severe acute organ rejection when steroids fail.

Answer 10

Muromonab (an antibody to CD3)

Question 11

Inflamed cervical lymph nodes in an adult are most often what type of cancer?

Answer 11

SCC of the aerodigestive tract (like nasopharyngeal cancer or SCC of the esophagus)

Question 12

Grading is most helpful in predicting the prognosis of which type of cancers?

Answer 12

Sarcomas

Question 13

Differentiate incisional vs. excisional biopsy.

Answer 13

• Incisional: removing a piece of something, but not the whole
• Excisional: removing the entirety of something, including margins

Question 14

Masses growing out of muscles should be treated with ____________ biopsy.

Answer 14

incisional

They are most often not malignant and can be treated with debulking resection.

Question 15

True or false: invasion of the deep lobe of the parotid requires excision of the facial nerve.

Answer 15

False

Unless the tumor encases the nerve, it can usually be preserved in a deep parotid resection.

Question 16

How is early-stage seminoma treated?

Answer 16

Orchiectomy with external radiation of the retroperitoneal lymph nodes

Seminoma is exquisitely sensitive to radiation so biopsy is unnecessary.

Question 17

Give the Amsterdam criteria.

Answer 17

• 3 relatives
• Across 2 generations
• At least 1 first degree

Question 18

What is a low anterior resection?

Answer 18

Resection of the rectum with anastomosis of the colon to the rectum

Question 19

What is an abdominoperineal resection?

Answer 19

Resection of the rectum and anus with end colostomy placement

Question 20

Transanal excision can be used to treat _______________.

Answer 20

non-invasive anal and rectal cancers within 10 cm of the anus

Question 21

Sentinel lymph node biopsy should only be done in cases of breast cancer in which ________________.

Answer 21

there is biopsy showing invasive cancer and no clinical evidence of metastasis (i.e., palpable lymph nodes, bone pain)

Question 22

Unlike renal allografts, cardiac allografts are matched only by _______________.

Answer 22

ABO type and size –not HLA type (as in renal transplants)

Question 23

Hearts have an ischemic time of ____________.

Answer 23

4-5 hours

Question 24

Women with BRCA mutations should get prophylactic mastectomies. If a woman with BRCA mutations does not want a prophylactic mastectomy, then she should be screened _____________.

Answer 24

with mammography at 6 month intervals starting at age 25

Question 25

A patient s/p renal transplant develops fever, fatigue, and pulmonary nodules on CT. What is the likely diagnosis?

Answer 25

Post-transplant lymphoproliferative disorder (PTLD) caused by EBV

Question 26

Autonomous parathyroid function can arise after a _________________.

Answer 26

renal transplant

Treat with resection and transplant of one parathyroid lobe to the forearm.

Question 27

Which chemotherapy regimen is used for colon cancer?

Answer 27

5-fluorouracil and leucovorin

Question 28

A patient has a rising creatinine after a renal transplant but no CVA tenderness. What is the likely cause?

Answer 28

Cyclosporine toxicity

Question 29

Which post-transplant drugs are the most likely offenders for a low WBC?

Answer 29

The antimetabolites: mycophenolate mofetil, azathioprine, methotrexate.