BMTCN FINALS QUESTIONS AND ANSWERS SURE
A+
✔✔Acute GVHD grade 1 skin - ✔✔vacuolation of epidermal basal cells
✔✔Acute GVHD grade 2 skin - ✔✔presence of individually necrotic keratinocytes
✔✔Acute GVHD grade 3 skin - ✔✔formation of bullae on confluent areas of
keratinocytes necrosis
✔✔Acute GVHD grade 4 skin - ✔✔sloughing of the epidermis with desquamation
✔✔In the rule of nines, the front trunk gets_____, the posterior trunk - ✔✔18
✔✔rule of nine each leg gets - ✔✔9
✔✔rule of nine head and hands - ✔✔4.5
✔✔acute gvhd liver stage 1 - ✔✔bilirubin 2-3 mg/dl
✔✔acute gvhd liver stage 2 - ✔✔bilirubin 3.1-6 mg/dl
✔✔acute gvhd liver stage 3 - ✔✔bilirubin 6.1-15 mg/dl
✔✔acute gvhd liver stage 4 - ✔✔bilirubin >15 mg/dl
✔✔acute gvhd gut stage 1 - ✔✔diarrhea >500 ml/day or 30 ml/kg
✔✔acute gvhd gut stage 2 - ✔✔diarrhea >1000 ml/day or 60 ml/kg
✔✔acute gvhd gut stage 3 - ✔✔diarrhea >1500 ml/day or 90 ml/kg
,✔✔acute gvhd gut stage 4 - ✔✔diarrhea >2000 ml/day or 120 ml/kg
✔✔gvhd diet regimen stage 1 - ✔✔bowel rest npo, tpn
✔✔gvhd diet regimen stage 2 - ✔✔liquids,isotonic, lactose free, low residue continue
tpn
✔✔gvhd diet regimen stage 3 - ✔✔introduce solid foods, low fiber lactose free, fat free
✔✔gvhd diet regimen stage 4 - ✔✔solid food with fat intake slowly increased
✔✔gvhd diet regimen stage 5 - ✔✔advance to regular diet
✔✔a pt with maculopapular rash covering 40%. stage 2. the skin is consistent woth
GVHD, what is management? - ✔✔check tacrolimus level and start topical steroids
✔✔waterry diarrhea five times a day how should be managed? - ✔✔add antidiarrheal
agents
rule of infectious etiology of diarrhea
change po to iv medications
request GI consults
obtain accurate measurement of stool volume
✔✔diagnosed with acute stage 2 gvhd management? - ✔✔add systemic steroids
(methylprednisolone 1-2 mg/kg per day)
✔✔volume of diarrhea increase to 3000 ml per day how should the pt be treated? -
✔✔add infliximab or ATG and attempt to taper steroids
✔✔what is the standard regimen of immunosuppression for myeloablative transplant? -
✔✔tacrolimus and mehrotrexate
✔✔rahs in her arms and chest using the rule of nine what stage is the pt? - ✔✔stage 1-
2
✔✔rash all over the body, diarrhea 1-2 l bilirubin 2 what stage? - ✔✔stage 3
✔✔YR is 25 pt who has never been pregnant and will be receiving unrelated transplant
form 40 y man, the graft is 9/10 HLA matched. both donor and recipient are CMV
postive.YR has been transfused prior to transplant. what is the biggest risk factor for YR
developing GVHD? - ✔✔HLA mismatch
, ✔✔cyclosporine and tacrolimus have many drug to drug interaction. a major iteration is
with voriconazole. when calculating the dose of calcineurin inhibitors for
immunosuppression what should be done? - ✔✔give drugs at least four hours apart to
avoid interaction, dose reduce CNI by one third to one-quarter and follow levels closely.
✔✔which graft source is higher of developing acute GVHD? - ✔✔peripheral blood stem
cells.
✔✔what is the first organ usually involves with acute GVHD? - ✔✔skin
✔✔what is the phenomenon that occurs app 7-14 days post HSCT and has the
following symptoms fever, erythomema and noncardiogenic pulmonary edema? -
✔✔hyperacute GHVD
✔✔gvhd can occur at the time of immunosuppression taper. what is this type of acute
GVHD referred as ? - ✔✔classic acute gvhd
✔✔what immunosuppressant can cause serum sickness? - ✔✔ATG
✔✔Long term use of CNI affects what part of the body? - ✔✔bones
✔✔sirolimus can cause which of the following? - ✔✔pulmonary toxicity
✔✔with which of the following does transplant associated microangiopathy occur? -
✔✔CNI(tacrolimus and cyclosporine)
✔✔which immunosuppressant can cause hirsutism? - ✔✔cyclosporine
✔✔which drug is used to both prevent graft and rejection and GVHD? - ✔✔ATG
✔✔overlap syndrome is a classification of GVHD that consist of which of the following ?
- ✔✔features of both acute and chronic gvhd
✔✔chronic gvhd carries a reduced risk of recurrent disease by allowing the benefits of
graft versus leukemia effect (true or false) - ✔✔true
✔✔although the pathophysiology of chronic gvhd is unclear some hypothesis include
which of the following ? - ✔✔b cells
cytokines including interleukin (il)- 2, il -6 and tumor necrosis factor alpha(tnf-a)
✔✔patient with chronic gvhd are at an increase risk for - ✔✔infections
✔✔chronic gvd occurs most frequently when? - ✔✔whitihn a year
A+
✔✔Acute GVHD grade 1 skin - ✔✔vacuolation of epidermal basal cells
✔✔Acute GVHD grade 2 skin - ✔✔presence of individually necrotic keratinocytes
✔✔Acute GVHD grade 3 skin - ✔✔formation of bullae on confluent areas of
keratinocytes necrosis
✔✔Acute GVHD grade 4 skin - ✔✔sloughing of the epidermis with desquamation
✔✔In the rule of nines, the front trunk gets_____, the posterior trunk - ✔✔18
✔✔rule of nine each leg gets - ✔✔9
✔✔rule of nine head and hands - ✔✔4.5
✔✔acute gvhd liver stage 1 - ✔✔bilirubin 2-3 mg/dl
✔✔acute gvhd liver stage 2 - ✔✔bilirubin 3.1-6 mg/dl
✔✔acute gvhd liver stage 3 - ✔✔bilirubin 6.1-15 mg/dl
✔✔acute gvhd liver stage 4 - ✔✔bilirubin >15 mg/dl
✔✔acute gvhd gut stage 1 - ✔✔diarrhea >500 ml/day or 30 ml/kg
✔✔acute gvhd gut stage 2 - ✔✔diarrhea >1000 ml/day or 60 ml/kg
✔✔acute gvhd gut stage 3 - ✔✔diarrhea >1500 ml/day or 90 ml/kg
,✔✔acute gvhd gut stage 4 - ✔✔diarrhea >2000 ml/day or 120 ml/kg
✔✔gvhd diet regimen stage 1 - ✔✔bowel rest npo, tpn
✔✔gvhd diet regimen stage 2 - ✔✔liquids,isotonic, lactose free, low residue continue
tpn
✔✔gvhd diet regimen stage 3 - ✔✔introduce solid foods, low fiber lactose free, fat free
✔✔gvhd diet regimen stage 4 - ✔✔solid food with fat intake slowly increased
✔✔gvhd diet regimen stage 5 - ✔✔advance to regular diet
✔✔a pt with maculopapular rash covering 40%. stage 2. the skin is consistent woth
GVHD, what is management? - ✔✔check tacrolimus level and start topical steroids
✔✔waterry diarrhea five times a day how should be managed? - ✔✔add antidiarrheal
agents
rule of infectious etiology of diarrhea
change po to iv medications
request GI consults
obtain accurate measurement of stool volume
✔✔diagnosed with acute stage 2 gvhd management? - ✔✔add systemic steroids
(methylprednisolone 1-2 mg/kg per day)
✔✔volume of diarrhea increase to 3000 ml per day how should the pt be treated? -
✔✔add infliximab or ATG and attempt to taper steroids
✔✔what is the standard regimen of immunosuppression for myeloablative transplant? -
✔✔tacrolimus and mehrotrexate
✔✔rahs in her arms and chest using the rule of nine what stage is the pt? - ✔✔stage 1-
2
✔✔rash all over the body, diarrhea 1-2 l bilirubin 2 what stage? - ✔✔stage 3
✔✔YR is 25 pt who has never been pregnant and will be receiving unrelated transplant
form 40 y man, the graft is 9/10 HLA matched. both donor and recipient are CMV
postive.YR has been transfused prior to transplant. what is the biggest risk factor for YR
developing GVHD? - ✔✔HLA mismatch
, ✔✔cyclosporine and tacrolimus have many drug to drug interaction. a major iteration is
with voriconazole. when calculating the dose of calcineurin inhibitors for
immunosuppression what should be done? - ✔✔give drugs at least four hours apart to
avoid interaction, dose reduce CNI by one third to one-quarter and follow levels closely.
✔✔which graft source is higher of developing acute GVHD? - ✔✔peripheral blood stem
cells.
✔✔what is the first organ usually involves with acute GVHD? - ✔✔skin
✔✔what is the phenomenon that occurs app 7-14 days post HSCT and has the
following symptoms fever, erythomema and noncardiogenic pulmonary edema? -
✔✔hyperacute GHVD
✔✔gvhd can occur at the time of immunosuppression taper. what is this type of acute
GVHD referred as ? - ✔✔classic acute gvhd
✔✔what immunosuppressant can cause serum sickness? - ✔✔ATG
✔✔Long term use of CNI affects what part of the body? - ✔✔bones
✔✔sirolimus can cause which of the following? - ✔✔pulmonary toxicity
✔✔with which of the following does transplant associated microangiopathy occur? -
✔✔CNI(tacrolimus and cyclosporine)
✔✔which immunosuppressant can cause hirsutism? - ✔✔cyclosporine
✔✔which drug is used to both prevent graft and rejection and GVHD? - ✔✔ATG
✔✔overlap syndrome is a classification of GVHD that consist of which of the following ?
- ✔✔features of both acute and chronic gvhd
✔✔chronic gvhd carries a reduced risk of recurrent disease by allowing the benefits of
graft versus leukemia effect (true or false) - ✔✔true
✔✔although the pathophysiology of chronic gvhd is unclear some hypothesis include
which of the following ? - ✔✔b cells
cytokines including interleukin (il)- 2, il -6 and tumor necrosis factor alpha(tnf-a)
✔✔patient with chronic gvhd are at an increase risk for - ✔✔infections
✔✔chronic gvd occurs most frequently when? - ✔✔whitihn a year
