Devita, Hellman, and Rosenberg's Cancer

LWBK1006-43 LWW-Govindan-Review December 14, 2011 15:38

540 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Question 43.4. A cytomegalovirus (CMV)-seronegative patient is about to receive an

allogeneic hematopoietic stem cell transplant (HSCT) from a CMV-

seropositive donor. Which of the following strategies are acceptable for

the prevention of CMV disease?

A. Prophylaxis with an antiviral agent such as ganciclovir.

B. Treatment when CMV antigen is detected by highly sensitive poly-

merase chain reaction (PCR).

C. Both A and B. Both are acceptable strategies.

D. Neither A nor B. The transplantation should not be performed.

Question 43.5. A 54-year-old male patient with stage IV diffuse large B-cell lymphoma

calls with fevers and chills 9 days after receiving his third cycle of

R-CHOP chemotherapy. Which of the following is the Infectious Dis-

eases Society of America (IDSA) definition of fever in a patient with severe

neutropenia?

A. Single oral temperature greater than 38.0◦C

B. Single oral temperature greater than 38.3◦C or greater than 38.0◦C

for more than 1 hour

C. Oral temperature greater than 38.3◦C for more than 1 hour

D. Oral temperature greater than 37.0◦C for any duration

Question 43.6. A 56-year-old patient with breast cancer receives chemotherapy and

1 week later experiences a fever of 39.1◦C (102◦F). She has a complete

blood count drawn that reveals a total white blood count of 1000/L and

an absolute neutrophil count of 200/L. She has an indwelling central

venous catheter that appears normal and has no localizing symptoms.

Appropriate antibiotic therapy could consist of which of the following

options?

A. Cefepime or ceftazidime

B. Choice A plus vancomycin

C. Choice A plus an aminoglycoside

D. Choice A plus ciprofloxacin

Question 43.7. This patient is started on appropriate empiric antibiotics and remains

clinically stable but with persistent fever after 4 days. The addition of

what agent would be indicated at this time?

A. Caspofungin

B. Liposomal amphotericin B

C. Voriconazole

D. Any of the above

Question 43.8. A 70-year-old man with metastatic non-small cell lung cancer presents

with fever and neutropenia 1 week after chemotherapy. He is admitted

and started on appropriate empiric antibiotics, and his fevers resolve after

his first dose. For how long should his antibiotic therapy be continued?

A. Discontinue immediately

B. Until 24 to 48 hours after the last fever

C. For a total of 7 days

D. Until resolution of neutropenia