Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Surgery, Trauma, and Transplantation--->Transplantation
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Question 1# Print Question

30-year-old multiparous female with left ventricular noncompaction cardiomyopathy presents to the intensive care unit (ICU) from the operating room after undergoing an orthotopic cardiac transplantation. The donor organ was retrieved from a 20-year-old brain dead man. Preoperatively, the recipient was on chronic intravenous dobutamine therapy. Intravenous basiliximab was administered immediately prior to her transplant for induction of immunosuppression. Post termination of cardiac bypass in the operating room, temporary pacing was initiated in view of persistent bradyarrhythmia.

The MOST likely cause of her posttransplant bradyarrhythmia is:

A. Basiliximab induction
B. Surgical trauma
C. Donor age and gender
D. Preoperative dobutamine therapy

Question 2# Print Question

A 40-year-old male with known nonischemic cardiomyopathy and pulmonary hypertension returns to the ICU intubated and sedated after undergoing an orthotopic heart transplant. Graft ischemia time was 4 hours. On arrival, he is on high-dose intravenous vasopressor support including 0.5 µg/kg/min norepinephrine, 0.5 µg/kg/min epinephrine, and 0.1 units/h of vasopressin. He is receiving inhaled nitric oxide 40 ppm. Monitoring reveals the following:

  • Cardiac index of 1.6 L/min/m2
  • invasive arterial pressure of 80/40 mm Hg
  • central venous pressure of 18 mm Hg
  • heart rate 130 beats/min

The LEAST likely cause of his cardiogenic shock is:

A. T-lymphocyte–mediated rejection of allograft
B. Mediastinal bleeding with regional cardiac tamponade
C. Ischemia-reperfusion injury–related primary graft failure
D. Acute on chronic pulmonary hypertension

Question 3# Print Question

50-year-old male with end-stage lung disease and pulmonary hypertension secondary to emphysema is admitted to ICU after undergoing bilateral lung transplantation on cardiopulmonary bypass. His body mass index (BMI) is 22 kg/m2 . The lungs were retrieved from a 25-year-old brain dead man. The donor was a nonsmoker. On POD 2, the recipient’s PaO2 /FiO2 ratio is 150 and bilateral lung opacities consistent with pulmonary edema are noted on chest x-ray suggesting a diagnosis of grade 3 primary graft dysfunction (PGD).

The risk factor MOST likely associated with PGD in this scenario is:

A. Donor’s nonsmoker status
B. Recipient and donor age mismatch
C. BMI less than 25 kg/m2
D. Preexisting pulmonary hypertension

Question 4# Print Question

40-year-old male underwent liver transplant 20 years ago due to biliary cirrhosis. He is now listed for a redo liver transplant in view of recurrent cirrhosis. He is admitted to the ICU with upper gastrointestinal variceal bleeding requiring massive transfusion. He is intubated and on mechanical ventilation. Bedside echocardiography reveals an ejection fraction of 70% and absence of diastolic dysfunction. Electrocardiogram exhibits sinus tachycardia with a normal QT interval. Chest x-ray appears normal. Patient’s invasive arterial pressure is 100/60 mm Hg and central venous pressure is 8 mm Hg. A pulmonary artery catheter is inserted and the following values are obtained: Cardiac output of 10 L/min, mean pulmonary artery pressure of 30 mm Hg, and pulmonary artery occlusion pressure of 10 mm Hg. This is MOST likely due to:

A. Porto pulmonary hypertension
B. Hyper dynamic circulation
C. Transfusion-associated circulatory overload
D. Cirrhotic cardiomyopathy

Question 5# Print Question

A 45-year-old male with hepatitis C–related cirrhosis presents to the ICU from the operating room after undergoing orthotopic liver transplantation. At reperfusion, he suffered a brief asystolic arrest due to hyperkalemia. The donor liver was MOST likely preserved in which preservative solution

A. Celsior
B. Histidine-tryptophan-ketoglutarate (HTK)
C. Institut Georges Lopez-1 (IGL-1)
D. University of Wisconsin

Category: Critical Care Medicine-Surgery, Trauma, and Transplantation--->Transplantation
Page: 1 of 2