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Approach to the patient with Neutropenic Sepsis
Stem 1, question 1 of 4
David, a 64 year old male, presents to GP feeling generally unwell with chills and a fever. David is day 5 post fluorouracil infusion.
Which of the following is NOT a diagnostic criteria for neutropenic sepsis?
A decreased urine output
A neutrophil count of 0.8 x10 ^9 per litre
A temperature higher than 38C
Stem 1, question 2 of 4David is admitted to hospital with neutropenic sepsis and a cannula is inserted into his cephalic vein. Which of the following describes the relationship between the cephalic vein and the anatomical snuffbox?
The cephalic vein passes below the roof of the anatomical snuffbox from the lateral side of the dorsal venous network
The cephalic vein passes over the roof of the anatomical snuffbox from the medial side of the dorsal venous network
The cephalic vein crosses the of the anatomical snuffbox from the lateral side of the dorsal venous network
The cephalic vein passes under the floor of the anatomical snuffbox from the medial side of the dorsal venous network
The cephalic vein crosses the anatomical snuffbox from the lateral side of the dorsal venous network
Stem 1, question 3 of 4David had previously had a fluorouracil infusion, what is the mechanism of action of fluorouracil?
Inhibition of microtubule assembly in the mitotic spindle
Inhibition of dihydrofolate reductase and DNA synthesis
Inhibition of RNA and DNA synthesis
Targeting of cells over expressing Human Epidermal Growth Factor Receptor-2 (HER-2)
Stem 1, question 4 of 4What imaging is appropriate to order in a patient presenting with neutropenic sepsis?
CT thorax, abdomen, pelvis
Ultrasound of abdomen
Stem 2, question 1 of 4
Priya, a 48 year old female, received her first dose of doxorubicin 4 days ago. She is presenting with fever, cough and malaise.
Priya is diagnosed with neutropenic sepsis and antibiotic therapy is started. What is a loading dose?
A small initial dose of a drug given rapidly to achieve therapeutic concentration in the plasma
A dose given to achieve steady-state concentration
A drug given through the parenteral route to achieve a steady-state concentration
A large initial dose of a drug given to rapidly achieve therapeutic concentration in the plasma
A large maintenance dose to ensure plasma levels remain within a therapeutic concentration
Stem 2, question 2 of 4How does chemotherapy produce neutropenia?
Destroying myeloid progenitor cells
Destroying neutrophils directly
Destroying lymphoid progenitor cells
Destroying pluripotent stem cells only
Stem 2, question 3 of 4Priya is treated with piperacillin and tazobactam as empirical therapy. Which of the following is a side effect of this class of drug?
Stem 2, question 4 of 4Priya has her neutropenic sepsis treated, but then develops voluminous diarrhoea and crampy abdominal pain. What is the likely diagnosis?
Antibiotic-induced fungal overgrowth
New onset colitis
Antibiotic-induced Clostridium difficile colitis