a) Outline the pathogenesis of Graft Versus Host Disease (GVHD). (20% marks)
b) List four common risk factors for developing acute GVHD. (20% marks)
c) Outline the clinical presentation of GVHD. Include details of system involvement and timing of acute, chronic and late onset GVHD presentations in your answer. (30% marks)
d) Discuss your diagnostic evaluation of suspected acute GVHD, including the rationale for your approach. (30% marks)
A detailed knowledge on GVHD was lacking for many candidates, and many candidates did not recognise GVHD as different from graft failure/graft rejection. Many candidates could not outline the different clinical pictures in acute vs chronic GVHD. Whilst most candidate mentioned skin/liver/GIT involvement, very few
candidates recognised bronchiolitis obliterans and neuromyopathy as part of the clinical picture of chronic GVHD. Poorer answers in evaluation did not include the need for the differential diagnosis of sepsis to be excluded, and the rationale for diagnostic evaluation was commonly omitted.
As about 85% of the large ICUs around Australia NZ and Hong Kong do not have bone marrow transplant services, it is in fact surprising that a detailed knowledge on GVHD was not lacking for even more of the candidates. That 25% had passed is remarkable.
a) Pathogenesis of GVHD, in under two minutes:
b) Risk factors for GVHD:
c) Clinical presentation of GVHD:
d) Diagnostic evaluation
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