Devita, Hellman, and Rosenberg's Cancer

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

Chapter 43•Infections in the Cancer Patient 541

Question 43.9. A 68-year-old man with metastatic colon cancer receiving FOLFOX

chemotherapy has a fever to 102.5◦F. Examination reveals tenderness

and warmth at the infusion port site of his surgically implanted catheter.

Blood cultures are positive forStaphylococcus aureus,and sensitivities

are pending. What is the MOST appropriate management strategy?

A. Vancomycin

B. Vancomycin and imipenem

C. Vancomycin and removal of catheter

D. Await drug sensitivity testing for the isolated organism

Question 43.10. A 52-year-old man with AML who has received an allogeneic HSCT

presents with sinus congestion, fever, and headaches. Sinus computed

tomography (CT) reveals a maxillary sinus mass with bone erosion.

Zygomycosis (or mucormycosis) is isolated on fungal culture. What is

the MOST appropriate management?

A. Amphotericin B, with surgical debridement as salvage therapy, if

necessary

B. Amphotericin B and early surgical debridement

C. Voriconazole and early surgical debridement

D. Voriconazole, with surgical debridement as salvage therapy, if

necessary

Question 43.11. A 61-year-old woman with non-Hodgkin’s lymphoma presents with fever,

cough, and prolonged neutropenia. A chest CT reveals bilateral lung nod-

ules with the “halo sign.” A serum galactomannan assay is positive. What

is the MOST likely causative agent?

A. Aspergillus species

B. Pneumocysistis jiroveci

C. S. aureus

D. Zygomycetes

Question 43.12. A 56-year-old man with stage III non-small cell lung cancer is being treated

with concurrent chemotherapy and radiation therapy. He has odynopha-

gia and retrosternal chest pain that have gradually worsened over the past

few weeks. He has an absolute neutrophil count of 800/L. Which of the

following causes is the LEAST likely cause of his symptoms?

A. Candida

B. Herpes simplex virus (HSV)

C. CMV

D. Radiation esophagitis