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NBME 21 Answers

nbme21/Block 3/Question#38 (31.3 difficulty score)
A 28-year-old man develops a temperature of ...
Granulocyte colony-stimulating factor🔍
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 +5  upvote downvote
submitted by yotsubato(778),
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hTe tenaitp sah rceitepnuoN er.efv CSGF illw soreetr his .lpoisnrueth

yotsubato  His RBC and platelets are low, but at acceptable levels for someone undergoing chemotherapy. +7  



 +3  upvote downvote
submitted by rainlad(17),

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. +  



 +1  upvote downvote
submitted by haliburton(191),
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I ohsec CFS-G abceuse eth syneatolurcg esedem ot em oerm of a ikrs htan the emoeardt a.meian rorEipyehtoitn sseem ilek an prapaprtoie hoicec sa elwl tbu CFSG- moer tic.irlca

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  upvote downvote
submitted by anjum(9),

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.