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NBME 21 Answers

nbme21/Block 3/Question#38 (36.1 difficulty score)
A 28-year-old man develops a temperature of ...
Granulocyte colony-stimulating factorπŸ”
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 +5 
submitted by yotsubato(1030),
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ehT eanttpi hsa eueNrnicpot erv.ef CFSG lwil retsoer ihs ns.troelhiup

yotsubato  His RBC and platelets are low, but at acceptable levels for someone undergoing chemotherapy. +20  



 +4 
submitted by rainlad(23),
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ulowd we eb iowrrde uaotb iusgn FCSG- eignv atth he hsa tueac meau?lkei uwold ti uiattemls ohtwgr of hsi cnerca lles?c

suckitnbme  I think we're assuming that we eradicated the leukemia with the chemo. However at the same time a lot of normal stem cells were also killed off so we give GCSF to help recovery especially since they have an infection. +  



 +1 
submitted by haliburton(214),
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I hosce -CSGF seebauc het teuglyoanrcs deemse to me orem fo a krsi hnta eht etdaemro maia.ne iootthiprEenry semse ilek an atapiorperp hcoeci as llew btu -CFGS mreo acrct.lii

kentuckyfan  I think it's also because he has an infection (since he was prescribed antibiotics) boosting the immune system is more important than increasing platelet count E) or RBC count A) +5  



 +1 
submitted by anjum(17),

EPO --> RBC's

TPO (romiplostim --> Platelets

G-CSF (filgrastim)--> Myeloblasts (neutrophil, basophil, eosinophil)

INFy --> granulomas

IL-8 --> neutrophil chemotaKxis

As @yotsubato mentioned, pt has neutropenic fever. That is priority for someone undergoing chemo.

djeffs1  I just didn't know which was more important, fixing his low hemoglobin or his leukopenia +