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Chronic kidney disease — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Chronic kidney diseaseUSMLE Step 3

A 54-year-old woman is 8 days after induction chemotherapy for acute myeloid leukemia. Temperature is 39.2°C, blood pressure is 104/62 mm Hg, and absolute neutrophil count is 80/mm³. She has painful oral mucositis but no focal infiltrate or catheter-site infection. Blood cultures have been drawn. Which initial antimicrobial strategy is most appropriate?

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Correct answer: B — Begin intravenous cefepime now without waiting for culture results

The best answer is “Begin intravenous cefepime now without waiting for culture results”. Profound neutropenia after intensive chemotherapy makes this a high-risk febrile-neutropenia episode requiring immediate inpatient antipseudomonal beta-lactam therapy. Cefepime is an accepted monotherapy. Vancomycin is added only for defined indications such as suspected catheter infection, pneumonia, skin infection, or hemodynamic instability; oral outpatient therapy and empiric antifungal monotherapy are inappropriate here.

Reference: IDSA Guideline: Neutropenic Patients With Cancer: https://www.idsociety.org/practice-guideline/neutropenic-patients-with-cancer/