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NBME 18 Answers

nbme18/Block 2/Question#18 (reveal difficulty score)
Researcher testing new cancer drug
Neutrophil counts ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +6  upvote downvote
submitted by โˆ—jurrutia(47)
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Pathoma 2018 pg. 53. Chemotherapy hurts neutrophils the most. Radiation hurts lymphocytes the most.

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 +1  upvote downvote
submitted by sunny(9)
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why is this so //i know its basic but still...??

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krewfoo99  I think its neutrophils because they mention myelosupression and rapidly dividing cells. +2
wishmewell  Ya, Neutrophils, basophils, macrophages, eosinophils are considered Myeloid cells. While the rest of the T cells are from the Lymphoid lineage, The Immunoglobulins come from B cells ( lymphoid lineage). +10
cuthbertallg0od  Myelosuppression refers to bone marrow suppression as a whole, including lymphocytes. I got it wrong too and no clue why its neutrophils, but I don't think that's why +1
cuthbertallg0od  Maybe they're looking for us to pick "losing innate immunity" (maybe worse than losing adaptive?), which wouldn't refer to complement here since the problem isn't in the liver +
scrambledeggs  FA2020 p.424 Neutropenia: Absolute neutrophil count < 1500 cells/mm3. Severe infections typical when < 500 cells/mm3. Causes: Sepsis/postinfection, drugs (including chemotherapy), aplastic anemia, SLE, radiation +1
kmichaels  Pretty sure the idea is that it's just the fact that you classical follow neutrophils. All cytotoxic T-cell activity is talking about ACTIVITY not counts. NK cells we just don't really measure those I think haha +2
drjmrt26  Remember that Lymphocytes are quiescent cells. The stem says that it shows little effect on quiescent cells. +1
plaguedbyspleen  Maybe another helpful tidbit. For preface, I worked on clinical trials at a children's hospital. In the pediatric oncology world, immunosuppressed kids are automatically admitted to the hospital for febrile neutropenia and don't get considered for discharge until their ANC (absolute neutrophil count) is greater than 200. Neutrophils are usually the first to show up to the party and in high numbers (important primary defense against infection). +1



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submitted by โˆ—beastaran1(2)
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From what I understand, chemo patients are at risk for floral sepsis (staph A/Gram negative enterics); these are regulated by neutrophil surveillance of blood (basically want to prevent sepsis/neutropenic fever). Might also be half life of neutrophil is the shortest (8 hours)

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