06-20-2007, 05:28 AM
19. A 62-year-old woman with ovarian cancer comes
to the emergency
department because of fever for 2 days. Ten days ago,
she received
chemotherapy with paclitaxel and carboplatin. She
feels tired but has not
had nausea or vomiting. Her temperature is 39.5 C
(103.1 F), blood
pressure is 100/60 mm Hg, and pulse is 115/min. The
lungs are clear to
auscultation. Examination shows a soft, nontender
abdomen. Her
hematocrit is 32%, leukocyte count is 800/mm3, and
platelet count is
105,000/mm3. Serum electrolyte levels are within
normal limits. Which of the
following is the most appropriate next step in
treatment?
A
) Plasmapheresis
B
) Additional chemotherapy
C
) Intravenous antibiotic therapy
D
) Intravenous corticosteroid therapy
E
) Transfusion of 2 units of leukocytes
F
) Transfusion of 2 units of packed red blood cells
20.
A 47-year-old woman who is visiting from Australia
comes to the
physician because of increasing urine output over the
past month. She has had
no dysuria or hematuria. She has a history of chronic
headaches,
peptic ulcer disease, and urinary tract infections.
An evaluation 18 months
ago for headaches, including CT scan of the head,
showed no
abnormalities; treatment with ibuprofen and phenacetin
was initiated at that time,
and her headaches have been well controlled. Her
temperature is 37.1 C
(98.8 F), blood pressure is 140/82 mm Hg, pulse is
78/min, and
respirations are 14/min. Examination shows no
abnormalities. Laboratory
studies show:
Hematocrit 32%
Mean corpuscular volume 88 µm3
Serum
Glucose 130 mg/dL
Creatinine 1.7 mg/dL
Urine
Protein 2+
WBC 8“10/hpf
RBC none
Bacteria none
Nitrates none
Test of the stool for occult blood is negative. Which
of the following
is the most appropriate next step in management?
A
) Intravenous pyelography
B
) Discontinue current medication
C
) Antibiotic therapy for recurrent urinary tract
infections
D
) Insulin therapy for diabetes mellitus
E
) Upper endoscopy
to the emergency
department because of fever for 2 days. Ten days ago,
she received
chemotherapy with paclitaxel and carboplatin. She
feels tired but has not
had nausea or vomiting. Her temperature is 39.5 C
(103.1 F), blood
pressure is 100/60 mm Hg, and pulse is 115/min. The
lungs are clear to
auscultation. Examination shows a soft, nontender
abdomen. Her
hematocrit is 32%, leukocyte count is 800/mm3, and
platelet count is
105,000/mm3. Serum electrolyte levels are within
normal limits. Which of the
following is the most appropriate next step in
treatment?
A
) Plasmapheresis
B
) Additional chemotherapy
C
) Intravenous antibiotic therapy
D
) Intravenous corticosteroid therapy
E
) Transfusion of 2 units of leukocytes
F
) Transfusion of 2 units of packed red blood cells
20.
A 47-year-old woman who is visiting from Australia
comes to the
physician because of increasing urine output over the
past month. She has had
no dysuria or hematuria. She has a history of chronic
headaches,
peptic ulcer disease, and urinary tract infections.
An evaluation 18 months
ago for headaches, including CT scan of the head,
showed no
abnormalities; treatment with ibuprofen and phenacetin
was initiated at that time,
and her headaches have been well controlled. Her
temperature is 37.1 C
(98.8 F), blood pressure is 140/82 mm Hg, pulse is
78/min, and
respirations are 14/min. Examination shows no
abnormalities. Laboratory
studies show:
Hematocrit 32%
Mean corpuscular volume 88 µm3
Serum
Glucose 130 mg/dL
Creatinine 1.7 mg/dL
Urine
Protein 2+
WBC 8“10/hpf
RBC none
Bacteria none
Nitrates none
Test of the stool for occult blood is negative. Which
of the following
is the most appropriate next step in management?
A
) Intravenous pyelography
B
) Discontinue current medication
C
) Antibiotic therapy for recurrent urinary tract
infections
D
) Insulin therapy for diabetes mellitus
E
) Upper endoscopy