Devita, Hellman, and Rosenberg's Cancer

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

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

Question 43.13. A 34-year-old woman diagnosed with AML receives induction chemother-

apy. Ten days later, she experiences severe right-sided abdominal pain with

nausea, vomiting, and diarrhea. On examination, she has a fever to 101◦F

and her abdomen is tender without rebound or guarding. Absolute neu-

trophil count is 0/L. Lactic acid is not elevated, and stoolClostridium

difficiletoxin assay is negative on three separate samples. What is the

MOST likely diagnosis?

A. CMV colitis

B. Typhlitis

C. Bowel ischemia

D. Bowel perforation

Question 43.14. A 64-year-old man with pancreatic cancer is diagnosed withC. difficile

colitis. He is treated with a course of oral metronidazole 500 mg three

times per day, but he continues to have diarrhea and stoolC. difficile

toxin remains positive. What is the MOST appropriate treatment at this

time?

A. Intravenous metronidazole

B. Oral vancomycin

C. Intravenous vancomycin

D. Probiotic agents

Question 43.15. A 47-year-old woman with metastatic colorectal cancer is treated with

systemic chemotherapy. She develops pain on defecation along with low-

grade fevers. Laboratory tests are obtained, and her white blood cell count

is 1000/L (20% neutrophils). Visual inspection reveals a perianal fissure

with erythema and induration. What should you do next?

A. Digital rectal examination to rule out rectal abscess

B. Recommend stool softeners, sitz baths, and analgesics

C. Administer broad-spectrum antibiotics without anaerobic coverage

D. Administer broad-spectrum antibiotics with anaerobic coverage

Question 43.16. A 48-year-old man received allogeneic bone marrow transplant 2 months

ago for his relapsed AML. He now presents with mental status changes,

fever, and rash. A lumbar puncture reveals cerebrospinal fluid pleocytosis

(mostly neutrophils) and slightly elevated protein. Gram stain is negative

and cultures are pending. What would be an appropriate initial antibiotic

therapy?

A. Acyclovir, ceftriaxone, and vancomycin

B. Acyclovir, ceftriaxone, ampicillin, and vancomycin

C. Acyclovir, ampicillin, cefepime, and vancomycin

D. TMP/SMX, vancomycin, and cefepime