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+--- Thread: q.18 - meti (/showthread.php?tid=448166)
q.18 - meti - ArchivalUser - 09-15-2009
A 23-year-old woman presents to your acute care
clinic with a complaint of fever, sore throat, and
malaise of sudden onset. Her prior medical history
is significant for schizophrenia. Her vitals signs are:
BP 116/80, HR 112, RR 26, Temp 100.6 degrees
Fahrenheit. On physical examination, her oral cavity
features painful aphthous ulcers as well as swollen
gums. Initial laboratory testing includes a CBC
which returns with the following results:
¢ Leukocyte count 800/mm3
¢ Hgb 12.1 g/dL
¢ HCT 37.0%
¢ Platelet count 212 × 109/L
¢ Differential:
¢ Neutrophils, segmented 52%
¢ Neutrophils, bands 3%
¢ Lymphocytes 35%
¢ Monocytes 7%
¢ Eosinophils 3%
¢ Basophils 0%
1. Use of which of the following must be considered
when formulating a differential diagnosis
to explain this patient™s symptoms?
(A) haloperidol
(B) chlorpromazine
© risperidone
(D) thioridazine
(E) clozapine
2. Which of the following best describes the
expected course of the patient™s condition?
(A) The condition is usually self-limiting
and requires no intervention.
(B) Use of G-CSF has been shown to speed
recovery.
© Dose reduction of the offending agent
often leads to resolution of symptoms.
(D) If discovered earlier, discontinuation of
the offending agent would have prevented
progression of the condition to
its current severity.
(E) Tardive dyskinesia usually develops as
a late finding.
0 - ArchivalUser - 09-15-2009
E/D
0 - ArchivalUser - 09-15-2009
E/D
0 - ArchivalUser - 09-15-2009
E/B
0 - ArchivalUser - 09-16-2009
ed
0 - ArchivalUser - 09-16-2009
E
D
0 - ArchivalUser - 09-16-2009
E...
B..
1)
agranulocytosis, which is defined by an absolute neutrophil count (ANC) of fewer
than 500/mm3. ANC is defined as the percentage of the WBC count that is accounted
for by segmented neutrophils and bands. In the case of this patient, the ANC is 55% of the
WBC count or 440/mm3.
Suppression of the bone marrow, including agranulocytosis, is associated
with the use of clozapine. The incidence approaches 1% within several months of
treatment, independent of dose.
Patients on clozapine should be monitored closely with
weekly measurement of the CBC. Mild leukocytosis and other blood dyscrasias occur much less frequently with other antipsychotic drugs. (Cecil Textbook of Medicine,p. 2221; Hardman et al., 2001, p. 503)
2)
Patients with druginduced neutropenia recover more quickly
with the assistance of granulocyte colonystimulating factor (G-CSF).
(Harrison™s Internal Medicine online, Chap. 100 œHematopoietic
Cell Transplantation)
0 - ArchivalUser - 09-17-2009
shuun- you are the rock, as usual!!!