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NBME 21 Answers

nbme21/Block 3/Question#38

A 28-year-old man develops a temperature of 39.9°C ...

Granulocyte colony-stimulating factor

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submitted by yotsubato(380),

The patient has Neutropenic fever. GSCF will restore his neutrophils.

yotsubato  His RBC and platelets are low, but at acceptable levels for someone undergoing chemotherapy. +1  

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submitted by haliburton(106),

I chose G-CSF because the granulocytes seemed to me more of a risk than the moderate anemia. Erythropoietin seems like an appropriate choice as well but G-CSF more critical.

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) +4  

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submitted by rainlad(1),

would we be worried about using G-CSF given that he has acute leukemia? would it stimulate growth of his cancer cells?

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. +