Which immunosuppressive drug(s) has/have been associated with severe malformations and is/are therefore strictly contraindicated in pregnancy?

• a)
  

  Steroids

  
  
• b)
  

  Tacrolimus

  
  
• c)
  

  Cyclosporine

  
  
• d)
  

  Mycophenolate Mofetil

  
  
• e)
  

  Azathioprine

Which statement(s) regarding monitoring and counselling of pregnant transplant recipients is/are correct?

• a)
  

  For early detection of fetal malformations, a computer tomography of pregnant women should be performed within the first 3 months of pregnancy.

  
  
• b)
  

  The levels of immunosuppressive drugs Cyclosporine and Tacrolimus should be monitored more frequently during a pregnancy.

  
  
• c)
  

  In transplanted women who become pregnant within the first 5 years after transplantation, termination of pregnancy should be considered as rejection is higher closer to transplantation.

  
  
• d)
  

  Women using Sirolimus can reassured that there is good safety data available regarding its use in pregnancy.

  
  
• e)
  

  Women using Everolimus can reassured that there is good safety data available regarding its use in pregnancy.

Which statement(s) regarding treatment decisions in transplant patients is/are correct?

• a)
  

  Birth via Caesarean Section is generally preferred in contrast to vaginal delivery.

  
  
• b)
  

  It is strictly prohibited to give vitamin D to pregnant transplant patients.

  
  
• c)
  

  A pregnancy with a duration of more than 8 months is potentially dangerous as the transplant organs might be harmed by displacement by the growing fetus, thus a preterm delivery is generally favoured.

  
  
• d)
  

  Morning sickness with vomiting may lead to decreased levels of immunosuppressive medication.

  
  
• e)
  

  Pregnant transplant recipients should take antibiotics during the whole pregnancy as prophylaxis.

Which statement(s) regarding possible complications during a pregnancy in transplant recipients is/are correct?

• a)
  

  Malformations in newborn babies of transplant recipients occur in approximately 30%.

  
  
• b)
  

  A rejection in the context of pregnancy is more likely in kidney than in liver transplant recipients.

  
  
• c)
  

  Clarithromycin should generally be avoided as a choice of antibiotic.

  
  
• d)
  

  CMV re-activation during pregnancy in transplant recipients may affect the transplant organ and harm the fetus.

  
  
• e)
  

  The outcome of pregnancies in organ recipients is essentially comparable to the outcome of pregnancies in healthy women

Which method(s) of birth control is/are considered acceptable after organ transplantation?

• a)
  

  Combined oral contraceptive pill (COCP)

  
  
• b)
  

  Depot-medroxyprogesterone-acetate (Depo-Provera)

  
  
• c)
  

  Copper Intrauterine devices (Cu-IUDs)

  
  
• d)
  

  Levo-norgestrel releasing IUD (LNG-IUD)

  
  
• e)
  

  Condoms

Which statement(s) is/are true concerning anaemia and it’s therapy in pregnant women after organ transplantation?

• a)
  

  Iron deficiency is much more pronounced in these women in comparison to healthy pregnant women

  
  
• b)
  

  Women with kidney transplants (KTRs) and reduced renal function have a reduced ability to correct their anaemia

  
  
• c)
  

  A haemoglobin value of 8-9 g/dl is sufficient during pregnancy for KTR transplanted women as usually have a lower background haemoglobin

  
  
• d)
  

  High dosages of erythropoietin have to be applied to reach a haemoglobin level of 10-12g/dl during pregnancy.

  
  
• e)
  

  Erythropoietin therapy is teratogenic and should therefore be avoided.

Most transplant centres would recommend delaying conception for at least 1 year after transplantation because of which of the following?

• a)
  

  Recipients are receiving higher doses of immunosuppression and, therefore, at decreased risk of developing rejection

  
  
• b)
  

  Liver recipients have achieved optimal liver graft function and are on a stable immunosuppressive regimen

  
  
• c)
  

  The incidence of viral infections, specifically cytomegalovirus (CMV), which are associated with a high incidence of graft failure and maternal mortality, commonly occur 3-months post-OLT

  
  
• d)
  

  Kidney recipients have usually achieved stable renal function with well controlled hypertension

  
  
• e)
  

  Kidney recipients have usually achieved stable renal function with well controlled diabetes

Which of the following commonly used maintenance immunosuppressive drugs is/are correctly paired with it’s FDA category of fetal risk classification?

• a)
  

  Tacrolimus – Category C

  
  
• b)
  

  Cyclosporine – Category C

  
  
• c)
  

  Prednisone – Category B

  
  
• d)
  

  Mycophenolic acid – Category D

  
  
• e)
  

  Azathioprine – Category D

What is the most common cause of liver disease in female OLT recipients?

• a)
  

  Hepatitis C cirrhosis

  
  
• b)
  

  Primary biliary cirrhosis

  
  
• c)
  

  Alcoholic cirrhosis

  
  
• d)
  

  Autoimmune hepatitis

  
  
• e)
  

  Biliary atresia

Which of the following statements is/are true regarding pregnancy outcomes post-OLT?

• a)
  

  The incidence of structural malformations in the newborn of female OLT recipients is similar to the US general population.

  
  
• b)
  

  The most frequent maternal complication is pregnancy-induced hypertension, which is significantly higher than the rates reported in the general population.

  
  
• c)
  

  The frequency of Caesarean Section among OLT recipients is relatively higher than the rate observed in the general population.

  
  
• d)
  

  There is a higher incidence of preterm delivery among transplant recipients compared to the general population.

  
  
• e)
  

  Pregnancy-related maternal death in OLT recipients is uncommon.

The following statement(s) is/are true about immunosuppressive therapy during pregnancy in solid organ transplant recipients:

• a)
  

  Mycophenolate should be discontinued at least 6 weeks before conception

  
  
• b)
  

  Sirolimus should be discontinued at least 6 weeks before conception.

  
  
• c)
  

  Cyclosporine and Tacrolimus should be continued.

  
  
• d)
  

  Azathioprine should be discontinued.

  
  
• e)
  

  Studies have demonstrated an increased incidence of fetal congenital malformations with maternal corticosteroid use.

The following statement(s) is/are true about pre-conceptual counselling in solid organ transplant recipients:

• a)
  

  Transplant recipients should be advised to wait 1 to 2 years after a transplant to become pregnant.

  
  
• b)
  

  Genetic counselling is recommended for all transplant recipients who pursue pregnancy.

  
  
• c)
  

  Vaccination status should be checked and, if needed, vaccinations should be completed before pregnancy.

  
  
• d)
  

  Screening for Hepatitis B and C should be performed prior to pregnancy

  
  
• e)
  

  Assisted reproductive technologies are contra-indicated in transplant recipients who want to become pregnant.

Concern over the use of mycophenolic acid-based immunosuppressants (MPA) during pregnancy have arisen because

• a)
  

  There is an increased risk of spontaneous miscarriage in pregnancies exposed to MPA

  
  
• b)
  

  There is an increased risk of superimposed pregnancy-induced hypertension while taking MPA

  
  
• c)
  

  It is difficult to monitor levels of mycophenolic exposure during pregnancy

  
  
• d)
  

  Doses of MPA are adjusted based on trough levels.

  
  
• e)
  

  There is an increased risk of gestational diabetes while taking MPA

Which of the following class(es) of medications is/are used to suppress the immune system?

• a)
  

  Calcineurin inhibitors

  
  
• b)
  

  Interleukin-2 (IL-2) receptor blockers

  
  
• c)
  

  Corticosteroids

  
  
• d)
  

  Anti-lymphocyte sera

  
  
• e)
  

  Granulocyte-colony stimulating factors

Expected pregnancy outcomes in kidney transplant recipients with exposure to immunosuppression include:

• a)
  

  Hypertension rates between 25-60%

  
  
• b)
  

  A high rate of rejection during pregnancy

  
  
• c)
  

  A live birth rate between 71-80%

  
  
• d)
  

  A significantly lower rater of prematurity compared to the general population

  
  
• e)
  

  A three-fold higher rate of pre-eclampsia compared to the general population

What percentage of female infertility is considered due to a uterine factor?

• a)
  

  1%

  
  
• b)
  

  4%

  
  
• c)
  

  6%

  
  
• d)
  

  10%

  
  
• e)
  

  15%

The following is/are true regarding uterine factor subfertility?

• a)
  

  Uterine factor related infertility (UFI) is either congenital or acquired

  
  
• b)
  

  Absolute uterine factor infertility (AUFI), affects around 1 in every 500 women of fertile age

  
  
• c)
  

  Mayer – Rokitansky – Küster – Hauser (MRKH) syndrome results in a lack of uterus and upper two-thirds of the vagina but the presence of normal ovaries

  
  
• d)
  

  MRKH is characterised by a 46XX karyotype

  
  
• e)
  

  Androgen insensitivity syndrome (AIS) results in a lack of uterus and upper two-thirds of the vagina but the presence of normal ovaries

The following is/are true regarding uterine factor subfertility?

• a)
  

  Myomas represent the most common cause of acquired UFI.

  
  
• b)
  

  There is a clear causal association between myomas and subfertility

  
  
• c)
  

  Intrauterine adhesions can occur secondary to genital tract tuberculosis most commonly in the developed world

  
  
• d)
  

  After adhesiolysis around 50 % of women with adhesions remain infertile

  
  
• e)
  

  Fertility-sparing surgery (trachelectomy) for cervical cancer is restricted to tumours with an invasion of less than 10 mm and a diameter not exceeding 20 mm

The following is/are true regarding Uterine transplantation (UTx)?

• a)
  

  All females with uterine factor infertility should be transplanted with a uterus

  
  
• b)
  

  More than half of the multi-organ donors are non-eligible for uterus donation

  
  
• c)
  

  The graft survival will be worse if the donor/recipients are haplo-identical

  
  
• d)
  

  Embryo transfer should not be performed less than one year after UTx

  
  
• e)
  

  Live off-spring after UTx has been reported in baboons

Which of the following method(s) of contraception is/are absolutely contraindicated among women with a history of uncomplicated solid organ transplantation?

• a)
  

  Combined hormonal contraceptive pills

  
  
• b)
  

  Contraceptive vaginal ring

  
  
• c)
  

  Sub-dermal implant

  
  
• d)
  

  Intrauterine Device

  
  
• e)
  

  LNG-releasing IUD

Estrogen containing contraception may be contraindicated in which of the following medical condition(s)?

• a)
  

  Migraine with aura

  
  
• b)
  

  Uncontrolled hypertension

  
  
• c)
  

  Lupus

  
  
• d)
  

  Longstanding diabetes

  
  
• e)
  

  Obesity

The use of intrauterine devices (IUDs) is proven to be safe and effective in which of the following patient populations?

• a)
  

  Nulliparas

  
  
• b)
  

  Immunosuppressed women

  
  
• c)
  

  Active PID

  
  
• d)
  

  Organ recipients

  
  
• e)
  

  Previous treated PID

A primary infertility 29-year-old female with long standing ESRD on dialysis has developed meno-metrorrhagia. Which of the following would be plausible explanation(s) for her menstrual irregularity?

• a)
  

  The main aetiology is secondary to metabolic disturbance.

  
  
• b)
  

  It is explained by high corticotrophin levels.

  
  
• c)
  

  It is usually secondary to alterations in the HPO-axis that are dependent on the duration of the disease.

  
  
• d)
  

  Immunosuppression therapy explains the majority of cases of menstrual irregularity.

  
  
• e)
  

  Hyperprolactinaemia is a major cause of meno-metrorrhagia in women with end-stage renal disease.

A 26-year-old, two years after a successful liver transplant for autoimmune hepatitis, desires fertility after 12 months of unprotected intercourse. Overall, her functional status is good with excellent graft function and no episodes of rejection since her transplant. Which of the following would be considered appropriate advice to her regarding pregnancy?

• a)
  

  The patient should wait at least five years from her transplant before attempting to get pregnant.

  
  
• b)
  

  The patient does not need a reproductive consultation at this stage and should continue to try to conceive for the next 12 months before consultation.

  
  
• c)
  

  The patient should have her partner checked out for infertility before proceeding with a reproductive assisted consultation for herself.

  
  
• d)
  

  It is recommended that the patient has a reproductive medicine consultation as soon as possible with the involvement of her partner and her primary caretaker.

  
  
• e)
  

  The patient should first seek out her primary caretaker and the patient should self-refer to a reproductive specialist.

A 16 years-of-age male underwent immediate life-saving chemotherapy after diagnosis of acute myeloid leukaemia (AML) and later received sequential immunosuppressive therapy and stem cell transplant. He is now 28 years-of-age and after a year of not being able to conceive with a partner for a year, a semen analysis reveals oligo-astheno-teratozoospermia. Which of the following statement(s) is/are true about the reproductive options in this case?

• a)
  

  Upon the diagnosis, the family should have been counselled on fertility cryopreservation.

  
  
• b)
  

  Currently the patient needs a comprehensive fertility assessment.

  
  
• c)
  

  Fertility cryopreservation should have been recommended upon diagnosis.

  
  
• d)
  

  In vitro fertilization is recommended for the couple with the addition of intracytoplasmic sperm injection (ICSI).

  
  
• e)
  

  The best choice upon diagnosis would have been a testicular biopsy for collection of sperm and use of ART for the creation of embryos with donor eggs.

Increasingly, a quality of life assessment is integrated into clinical practice and decision-making. In the absence of graft rejection pregnant transplant recipients may be concerned about which of the following psychosocial issues that may affect quality of life and clinical decision-making?

• a)
  

  Depression and anxiety

  
  
• b)
  

  Family and marital strain

  
  
• c)
  

  Immunosuppressant medications affecting the fetus

  
  
• d)
  

  The child outliving the graft survival

  
  
• e)
  

  Concerns about mode of delivery

The social studies literature on organ transplantation can contribute to bio-ethical considerations of pregnancy after transplant by which of the following?

• a)
  

  By suggesting the complexity of lived moral experience

  
  
• b)
  

  By evoking new research questions and providing new methodologies to pursue them

  
  
• c)
  

  By ensuring that philosophical theories do not trump the ethical concerns of the populations involved

  
  
• d)
  

  By providing empirical data to show when recipients should and should not pursue pregnancy

  
  
• e)
  

  By bringing social contexts and conditions to the forefront of ethical formulations

According to the National Transplantation Pregnancy Registry (NTPR) approximately what percentage of pregnancies that occur after organ transplantation result in a successful live birth?

• a)
  

  10

  
  
• b)
  

  20

  
  
• c)
  

  30

  
  
• d)
  

  70

  
  
• e)
  

  90

Non-melanocytic skin cancers (NMSC) are the most common DNM found in transplanted patients. Which of the following statements is/are true regarding NMSC in transplanted patients?

• a)
  

  Within 20 years of transplantation 40-50% of Caucasian recipients in Western Countries are affected by NMSC

  
  
• b)
  

  NMSC occur most commonly on sun exposed areas

  
  
• c)
  

  Light-skinned individuals are more at risk

  
  
• d)
  

  NMSC are more frequently found in transplant recipients in Scandinavian countries

  
  
• e)
  

  Cumulative UV exposure increases the risk

Which of the following is/are important considerations regarding the treatment of hypertension after kidney transplantation in cases of planned conception?

• a)
  

  Maternal age

  
  
• b)
  

  Parity

  
  
• c)
  

  Treatment starting before pregnancy

  
  
• d)
  

  Treatment only for increasing hypertension

  
  
• e)
  

  Treatment even for women with subclinical hypertension