Question 1:
What is the most common indication for lung transplantation worldwide?

A) Chronic obstructive pulmonary disease (COPD)
B) Cystic fibrosis
C) Idiopathic pulmonary fibrosis
D) Pulmonary arterial hypertension
E) Alpha-1 antitrypsin deficiency

Question 2:
Post-transplant lymphoproliferative disorder (PTLD) after lung transplantation is primarily associated with which infection?

A) Cytomegalovirus (CMV)
B) Epstein-Barr virus (EBV)
C) Human immunodeficiency virus (HIV)
D) Hepatitis C virus (HCV)
E) Human papillomavirus (HPV)

Question 3:
Which of the following is a contraindication for lung transplantation?

A) Age under 65
B) Active smoking
C) Diabetes mellitus
D) Single lung transplantation in COPD
E) Use of supplemental oxygen

Question 4:
In lung transplant recipients, which organism is most commonly responsible for early post-transplant pneumonia?

A) Pseudomonas aeruginosa
B) Aspergillus species
C) Staphylococcus aureus
D) Legionella species
E) Mycobacterium tuberculosis

Question 5:
What is the primary goal of immunosuppressive therapy in lung transplant recipients?

A) Preventing acute rejection
B) Treating chronic rejection
C) Managing infection
D) Reducing malignancy risk
E) Improving lung function

Question 6:
Bronchiolitis obliterans syndrome (BOS) is a form of chronic lung allograft rejection characterized by:

A) Bronchiectasis
B) Pulmonary fibrosis
C) Airway inflammation and obliteration
D) Pleural effusion
E) Lung nodules

Question 7:
Which lung transplantation approach is typically preferred for patients with cystic fibrosis?

A) Single lung transplantation
B) Bilateral lung transplantation
C) Heart-lung transplantation
D) Lobar transplantation
E) No preference

Question 8:
What is the most common early complication following lung transplantation?

A) Acute rejection
B) Airway dehiscence
C) Pulmonary edema
D) Renal failure
E) Infection

Question 9:
The use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation is indicated in which situation?

A) Severe pulmonary hypertension
B) Chronic obstructive pulmonary disease
C) Acute respiratory distress syndrome
D) Stable interstitial lung disease
E) Bronchiectasis

Question 10:
Which of the following is a major risk factor for developing primary graft dysfunction after lung transplantation?

A) Donor age over 60
B) Recipient’s gender
C) Ischemia-reperfusion injury
D) Type of immunosuppression
E) Underlying disease

Question 11:
Post-transplant diabetes mellitus in lung transplant recipients is primarily caused by:

A) The underlying lung disease
B) Corticosteroid use
C) Calcineurin inhibitors
D) Anti-thymocyte globulin
E) Sirolimus

Question 12:
Which imaging modality is preferred for routine surveillance of chronic lung allograft rejection?

A) Chest X-ray
B) High-resolution CT scan
C) Pulmonary function tests
D) Positron emission tomography (PET) scan
E) Magnetic resonance imaging (MRI)

Question 13:
For lung transplantation, what is the preferred donor-recipient size match criterion?

A) Donor lung volume greater than recipient’s chest cavity
B) Donor and recipient body surface area within 10%
C) Donor lung smaller than recipient’s chest cavity
D) Donor and recipient body weight within 20%
E) No specific size match required

Question 14:
Which of the following pathogens is most commonly associated with late-onset infections in lung transplant recipients?

A) Cytomegalovirus
B) Pneumocystis jirovecii
C) Nocardia species
D) Aspergillus species
E) Community-acquired respiratory viruses

Question 15:
In lung transplant patients, the most common cause of death in the first 30 days post-transplant is:

A) Infection
B) Acute rejection
C) Primary graft dysfunction
D) Cardiac complications
E) Hemorrhage

Question 16:
What is the role of induction therapy in lung transplantation?

A) To provide immediate postoperative analgesia
B) To reduce early acute rejection episodes
C) To treat chronic lung allograft rejection
D) To manage post-transplant infections
E) To improve long-term survival

Question 17:
Which of the following is a typical finding in lung transplant recipients with chronic rejection?

A) Increased FEV1/FVC ratio
B) Decreased total lung capacity
C) Obstructive pattern on pulmonary function testing
D) Elevated diffusion capacity
E) Restrictive pattern on pulmonary function testing

Question 18:
The risk of developing renal dysfunction in lung transplant recipients is increased by the use of:

A) Antivirals
B) Antifungals
C) Calcineurin inhibitors
D) Monoclonal antibodies
E) Corticosteroids

Question 19:
Which prophylactic strategy is essential in lung transplant recipients to prevent Pneumocystis jirovecii pneumonia?

A) Lifelong azithromycin therapy
B) Annual influenza vaccination
C) Trimethoprim-sulfamethoxazole prophylaxis
D) Regular IVIG administration
E) Long-term antifungal therapy

Question 20:
Following lung transplantation, surveillance bronchoscopies are typically performed to:

A) Assess for anastomotic healing
B) Monitor for airway stenosis
C) Detect acute rejection
D) Evaluate pulmonary function
E) Rule out infection

Question 21:
Which type of hypersensitivity reaction is acute lung transplant rejection primarily classified as?

A) Type I
B) Type II
C) Type III
D) Type IV
E) Type V

Question 22:
What is the most common cause of death beyond the first year after lung transplantation?

A) Infection
B) Chronic lung allograft rejection
C) Cardiovascular disease
D) Malignancy
E) Renal failure

Question 23:
What is the primary indication for lung transplantation in pediatric patients?

A) Cystic fibrosis
B) Pulmonary hypertension
C) Interstitial lung disease
D) Bronchopulmonary dysplasia
E) Congenital heart disease

Question 24:
For patients undergoing lung transplantation, which pre-existing condition is considered a significant risk factor for postoperative complications?

A) Gastroesophageal reflux disease
B) Hypothyroidism
C) Osteoporosis
D) Chronic anemia
E) Hyperlipidemia

Question 25:
In lung transplant recipients, which medication is commonly used to prevent cytomegalovirus (CMV) infection?

A) Acyclovir
B) Ganciclovir
C) Amphotericin B
D) Ribavirin
E) Oseltamivir

Question 26:
What is the primary mechanism of chronic lung allograft rejection?

A) Cellular rejection
B) Antibody-mediated rejection
C) Autoimmune response
D) Ischemic injury
E) Infectious etiology

Question 27:
After lung transplantation, which pulmonary function test finding is indicative of bronchiolitis obliterans syndrome (BOS)?

A) Decreased FEV1
B) Increased FVC
C) Increased TLC
D) Decreased RV
E) Increased DLCO

Question 28:
Which of the following is a relative contraindication for lung transplantation?

A) Age over 70
B) History of smoking
C) Stable diabetes mellitus
D) Previous chest surgery
E) Controlled psychiatric illness

Question 29:
What is the most effective method for diagnosing acute rejection in lung transplant recipients?

A) Spirometry
B) Chest X-ray
C) Bronchoscopy with transbronchial biopsy
D) High-resolution CT scan
E) Serum biomarkers

Question 30:
Which of the following is a common cardiovascular complication after lung transplantation?

A) Atrial fibrillation
B) Ventricular tachycardia
C) Heart block
D) Myocardial infarction
E) Pericarditis

Question 31:
In lung transplantation, what is the main purpose of using a cardiopulmonary bypass (CPB) during the surgery?

A) To reduce bleeding
B) To stabilize hemodynamics
C) To facilitate anastomosis
D) To prevent air embolism
E) To decrease operative time

Question 32:
Which of the following is a common metabolic complication in the first year after lung transplantation?

A) Hypercalcemia
B) Hypoglycemia
C) Hyperkalemia
D) Hypomagnesemia
E) Hyperglycemia

Question 33:
A lung transplant recipient develops dyspnea and a decline in FEV1 six months post-transplant. Chest CT shows patchy ground-glass opacities. What is the most likely diagnosis?

A) Acute rejection
B) Chronic rejection
C) Infection
D) Pulmonary embolism
E) Lymphangioleiomyomatosis

Question 34:
What is the recommended prophylactic strategy against Aspergillus infection in lung transplant recipients?

A) Itraconazole
B) Fluconazole
C) Amphotericin B
D) Voriconazole
E) Nystatin

Question 35:
Which immunosuppressive agent used in lung transplantation is known for its renal-sparing effect?

A) Cyclosporine
B) Tacrolimus
C) Mycophenolate mofetil
D) Sirolimus
E) Azathioprine

Question 36:
In lung transplant recipients, which of the following is the most common cause of late graft dysfunction?

A) Acute rejection
B) Chronic rejection (bronchiolitis obliterans syndrome)
C) Infection
D) Drug toxicity
E) Recurrence of primary disease

Question 37:
What is the primary role of induction immunosuppression in lung transplantation?

A) To reduce the risk of early graft rejection
B) To treat established acute rejection
C) To decrease the incidence of chronic rejection
D) To prevent opportunistic infections
E) To enhance long-term graft survival

Question 38:
Which of the following is an early sign of bronchiolitis obliterans syndrome in lung transplant recipients?

A) Hemoptysis
B) Pleuritic chest pain
C) Wheezing
D) Decline in FEV1
E) Stridor

Question 39:
For lung transplant recipients, what is the most effective strategy for reducing the risk of cytomegalovirus (CMV) infection?

A) Prophylactic antiviral therapy
B) CMV immunoglobulin
C) Annual CMV vaccination
D) Isolation from CMV-positive individuals
E) Regular CMV PCR monitoring

Question 40:
A lung transplant recipient presents with a new-onset tremor and hypertension six months post-transplant. Which immunosuppressive drug is most likely responsible?

A) Prednisone
B) Mycophenolate mofetil
C) Azathioprine
D) Tacrolimus
E) Cyclosporine

Answers

Question 1:
Correct Answer: C) Idiopathic pulmonary fibrosis
Explanation: Idiopathic pulmonary fibrosis (IPF) is currently the most common indication for lung transplantation worldwide, owing to its progressive nature and limited treatment options.
Teaching Point: Lung transplantation is often the only viable treatment for end-stage lung disease in IPF, with a focus on improving quality of life and prolonging survival.

Question 2:
Correct Answer: B) Epstein-Barr virus (EBV)
Explanation: Post-transplant lymphoproliferative disorder (PTLD) is primarily associated with Epstein-Barr virus (EBV) infection, especially in patients who are EBV seronegative before transplant and receive an organ from an EBV-positive donor.
Teaching Point: Monitoring for EBV viremia is important in transplant recipients, as it can lead to PTLD, a potentially life-threatening complication.

Question 3:
Correct Answer: B) Active smoking
Explanation: Active smoking is a contraindication for lung transplantation due to increased risks of postoperative complications, poor graft function, and overall worse outcomes.
Teaching Point: Candidates for lung transplantation are required to have abstained from smoking for at least 6 months prior to being listed for transplant.

Question 4:
Correct Answer: A) Pseudomonas aeruginosa
Explanation: Pseudomonas aeruginosa is the most common pathogen responsible for early post-transplant pneumonia, particularly in cystic fibrosis patients who are often colonized with this organism pre-transplant.
Teaching Point: Early post-transplant infections are often due to bacteria present pre-transplant or acquired in the hospital setting, necessitating appropriate prophylaxis and monitoring.

Question 5:
Correct Answer: A) Preventing acute rejection
Explanation: The primary goal of immunosuppressive therapy in lung transplant recipients is to prevent acute rejection of the transplanted organ.
Teaching Point: Immunosuppression in lung transplant recipients typically involves a combination of drugs to minimize the risk of acute rejection while balancing the risk of infections and other side effects.

Question 6:
Correct Answer: C) Airway inflammation and obliteration
Explanation: Bronchiolitis obliterans syndrome (BOS) is a form of chronic lung allograft rejection characterized by progressive airway inflammation leading to fibrosis and obliteration of the small airways.
Teaching Point: BOS is a major complication post-lung transplant and is diagnosed based on declining lung function, particularly a decrease in FEV1.

Question 7:
Correct Answer: B) Bilateral lung transplantation
Explanation: Bilateral lung transplantation is typically preferred for patients with cystic fibrosis to remove all diseased tissue and reduce the risk of infection from the remaining native lung.
Teaching Point: Bilateral lung transplantation in cystic fibrosis patients offers better outcomes compared to single lung transplantation, due to the diffuse nature of the disease.

Question 8:
Correct Answer: E) Infection
Explanation: Infection is the most common early complication following lung transplantation, due to high-dose immunosuppression and the presence of indwelling medical devices.
Teaching Point: Vigilant infection prophylaxis and early aggressive treatment of infections are crucial in the early post-transplant period.

Question 9:
Correct Answer: C) Acute respiratory distress syndrome
Explanation: Extracorporeal membrane oxygenation (ECMO) is indicated as a bridge to lung transplantation in patients with severe, acute respiratory failure such as in acute respiratory distress syndrome (ARDS).
Teaching Point: ECMO can support gas exchange in critically ill patients while waiting for lung transplantation, improving survival in selected patients.

Question 10:
Correct Answer: C) Ischemia-reperfusion injury
Explanation: Ischemia-reperfusion injury is a major risk factor for developing primary graft dysfunction, a form of acute lung injury occurring shortly after transplantation.
Teaching Point: Minimizing ischemia time and careful donor-recipient matching are important strategies to reduce the risk of primary graft dysfunction.

Question 11:
Correct Answer: B) Corticosteroid use
Explanation: Post-transplant diabetes mellitus in lung transplant recipients is often caused by the use of corticosteroids, a common component of post-transplant immunosuppressive regimens.
Teaching Point: Monitoring for and managing metabolic side effects like diabetes is important in post-transplant care, especially given the use of corticosteroids.

Question 12:
Correct Answer: B) High-resolution CT scan
Explanation: High-resolution CT scan is preferred for routine surveillance of chronic lung allograft rejection, as it can detect subtle changes in lung parenchyma indicative of chronic rejection.
Teaching Point: Regular monitoring with imaging and pulmonary function tests is key in the early detection and management of chronic lung allograft rejection.

Question 13:
Correct Answer: C) Donor lung smaller than recipient’s chest cavity
Explanation: The preferred donor-recipient size match criterion is for the donor lung to be slightly smaller than the recipient’s chest cavity, ensuring a good fit without excessive compression.
Teaching Point: Appropriate size matching is crucial in lung transplantation to ensure optimal graft function and reduce the risk of complications like atelectasis or hyperinflation.

Question 14:
Correct Answer: D) Aspergillus species
Explanation: Aspergillus species are most commonly associated with late-onset infections in lung transplant recipients, presenting a risk for invasive aspergillosis.
Teaching Point: Prophylactic antifungal therapy and regular monitoring are important in lung transplant recipients to prevent Aspergillus infections.

Question 15:
Correct Answer: C) Primary graft dysfunction
Explanation: Primary graft dysfunction is the most common cause of death in the first 30 days post-lung transplant, manifesting as severe acute lung injury.
Teaching Point: Primary graft dysfunction is a form of reperfusion injury and is a significant predictor of short-term morbidity and mortality after lung transplantation.

Question 16:
Correct Answer: B) To reduce early acute rejection episodes
Explanation: Induction therapy in lung transplantation is used to reduce the incidence of early acute rejection episodes by providing a high level of immunosuppression immediately after transplantation.
Teaching Point: Induction therapy, often with agents like antithymocyte globulin or interleukin-2 receptor antagonists, is used to provide potent initial immunosuppression.

Question 17:
Correct Answer: C) Obstructive pattern on pulmonary function testing
Explanation: Chronic rejection in lung transplant recipients, particularly bronchiolitis obliterans syndrome, is characterized by an obstructive pattern on pulmonary function testing, notably a decline in FEV1.
Teaching Point: Regular pulmonary function testing is essential in lung transplant recipients to monitor for signs of chronic rejection, with a focus on changes in FEV1.

Question 18:
Correct Answer: C) Calcineurin inhibitors
Explanation: Calcineurin inhibitors, such as tacrolimus and cyclosporine, used in lung transplant recipients are known to increase the risk of renal dysfunction.
Teaching Point: Renal function should be closely monitored in lung transplant recipients, especially those on calcineurin inhibitors, to detect and manage nephrotoxicity early.

Question 19:
Correct Answer: C) Trimethoprim-sulfamethoxazole prophylaxis
Explanation: Prophylaxis with trimethoprim-sulfamethoxazole is essential in lung transplant recipients to prevent Pneumocystis jirovecii pneumonia, a potentially life-threatening infection.
Teaching Point: Pneumocystis prophylaxis is standard in the post-transplant immunosuppressive regimen due to the high risk of this opportunistic infection.

Question 20:
Correct Answer: C) Detect acute rejection
Explanation: Surveillance bronchoscopies are typically performed post-lung transplant to detect acute rejection by allowing for visual assessment of the airways and transbronchial biopsy.
Teaching Point: Regular bronchoscopies in the first year post-transplant are crucial for early detection and treatment of acute rejection.

Question 21:
Correct Answer: D) Type IV
Explanation: Acute lung transplant rejection is primarily classified as a Type IV hypersensitivity reaction, which is cell-mediated and involves T lymphocytes attacking the transplanted lung tissue.
Teaching Point: Early detection and treatment of acute rejection, typically with increased immunosuppression, are crucial for graft survival.

Question 22:
Correct Answer: B) Chronic lung allograft rejection
Explanation: Beyond the first year after lung transplantation, chronic lung allograft rejection, particularly bronchiolitis obliterans syndrome (BOS), is the most common cause of death.
Teaching Point: Long-term management post-lung transplant focuses on monitoring for and managing chronic rejection, infections, and other complications.

Question 23:
Correct Answer: A) Cystic fibrosis
Explanation: Cystic fibrosis is the primary indication for lung transplantation in pediatric patients, given its progressive nature and lack of curative treatments.
Teaching Point: Lung transplantation in cystic fibrosis patients can significantly improve survival and quality of life, especially in advanced disease stages.

Question 24:
Correct Answer: A) Gastroesophageal reflux disease
Explanation: Gastroesophageal reflux disease (GERD) is considered a significant risk factor for postoperative complications in lung transplantation, including an increased risk of chronic rejection.
Teaching Point: Management of GERD is important in lung transplant candidates and recipients due to its association with allograft dysfunction.

Question 25:
Correct Answer: B) Ganciclovir
Explanation: Ganciclovir is commonly used to prevent cytomegalovirus (CMV) infection in lung transplant recipients, given the high morbidity associated with CMV in this population.
Teaching Point: Prophylaxis against CMV post-transplant reduces the incidence of CMV disease, which can lead to direct viral effects and increased risk of acute rejection and other infections.

Question 26:
Correct Answer: B) Antibody-mediated rejection
Explanation: The primary mechanism of chronic lung allograft rejection is antibody-mediated rejection, characterized by the development of donor-specific antibodies leading to chronic injury of the transplanted lung.
Teaching Point: Chronic lung allograft rejection is a complex process involving both cellular and humoral immunity, with antibody-mediated processes playing a key role.

Question 27:
Correct Answer: A) Decreased FEV1
Explanation: A decrease in FEV1 (Forced Expiratory Volume in 1 second) is indicative of bronchiolitis obliterans syndrome, a form of chronic lung allograft rejection characterized by obstructive lung disease.
Teaching Point: Monitoring FEV1 is essential in lung transplant recipients for early detection of BOS, which can manifest as a progressive decline in lung function.

Question 28:
Correct Answer: A) Age over 70
Explanation: Age over 70 is considered a relative contraindication for lung transplantation due to higher associated risks and generally poorer outcomes compared to younger recipients.
Teaching Point: Age alone is not an absolute contraindication, but older patients are carefully evaluated for comorbidities and overall health status.

Question 29:
Correct Answer: C) Bronchoscopy with transbronchial biopsy
Explanation: Bronchoscopy with transbronchial biopsy is the most effective method for diagnosing acute rejection in lung transplant recipients, allowing for direct visualization and tissue sampling.
Teaching Point: Routine surveillance bronchoscopies with biopsies are often performed post-transplant to detect acute rejection and other complications.

Question 30:
Correct Answer: A) Atrial fibrillation
Explanation: Atrial fibrillation is a common cardiovascular complication after lung transplantation, often related to surgery, high-dose steroids, and other postoperative factors.
Teaching Point: Management of post-transplant atrial fibrillation involves rate control, rhythm control, and anticoagulation, considering the increased risk of thromboembolism.

Question 31:
Correct Answer: B) To stabilize hemodynamics
Explanation: The use of cardiopulmonary bypass (CPB) during lung transplantation is mainly to stabilize hemodynamics, particularly in patients with severe pulmonary hypertension or compromised cardiac function.
Teaching Point: CPB can support the patient’s circulation and oxygenation during the critical phases of lung transplantation surgery.

Question 32:
Correct Answer: E) Hyperglycemia
Explanation: Hyperglycemia is a common metabolic complication in the first year after lung transplantation, often related to high-dose corticosteroid therapy and other immunosuppressive medications.
Teaching Point: Managing hyperglycemia in post-transplant patients is important to reduce the risk of infections and other complications associated with poor glycemic control.

Question 33:
Correct Answer: C) Infection
Explanation: In a lung transplant recipient with dyspnea, decline in FEV1, and patchy ground-glass opacities on CT scan, infection is the most likely diagnosis, especially considering the immunocompromised state.
Teaching Point: Infections are a major complication post-lung transplant and can present with various radiographic patterns, necessitating prompt investigation and treatment.

Question 34:
Correct Answer: D) Voriconazole
Explanation: Voriconazole is recommended for prophylaxis against Aspergillus infection in lung transplant recipients, given the high risk of invasive aspergillosis in this population.
Teaching Point: Prophylactic antifungal therapy, particularly against Aspergillus, is important in lung transplant recipients due to their increased susceptibility to fungal infections.

Question 35:
Correct Answer: D) Sirolimus
Explanation: Sirolimus is known for its renal-sparing effect among immunosuppressive agents used in lung transplantation, making it a preferred choice in patients with or at risk for renal dysfunction.
Teaching Point: Sirolimus may be used as an alternative to calcineurin inhibitors in lung transplant recipients to reduce the risk of nephrotoxicity.

Question 36:
Correct Answer: B) Chronic rejection (bronchiolitis obliterans syndrome)
Explanation: Chronic rejection, specifically bronchiolitis obliterans syndrome (BOS), is the most common cause of late graft dysfunction in lung transplant recipients.
Teaching Point: BOS is a significant long-term complication post-lung transplant and is a leading cause of morbidity and mortality in this patient population.

Question 37:
Correct Answer: A) To reduce the risk of early graft rejection
Explanation: Induction immunosuppression is used in lung transplantation to reduce the risk of early acute graft rejection by providing intense initial immunosuppression.
Teaching Point: Induction therapy typically involves potent immunosuppressive agents administered perioperatively to minimize the early risk of rejection.

Question 38:
Correct Answer: D) Decline in FEV1
Explanation: A decline in FEV1 is an early sign of bronchiolitis obliterans syndrome in lung transplant recipients, indicating obstructive airway changes characteristic of chronic rejection.
Teaching Point: Regular monitoring of pulmonary function, especially FEV1, is crucial in detecting early signs of chronic lung allograft rejection.

Question 39:
Correct Answer: A) Prophylactic antiviral therapy
Explanation: Prophylactic antiviral therapy is the most effective strategy for reducing the risk of cytomegalovirus (CMV) infection in lung transplant recipients.
Teaching Point: CMV prophylaxis is essential in the post-transplant period, typically with antiviral agents like ganciclovir or valganciclovir, to prevent CMV disease.

Question 40:
Correct Answer: D) Tacrolimus
Explanation: Tacrolimus, a commonly used immunosuppressive drug in lung transplantation, can cause side effects like tremor and hypertension, as seen in this patient.
Teaching Point: Managing the side effects of immunosuppressive medications, including tacrolimus, is a key aspect of post-transplant care, requiring careful monitoring and dose adjustments.