🏥 USMLE Exam Prep

A 60-year-old male, 7 days post-chemotherapy for acute myeloid leukemia, presents with a temperature of 101.8°F (38.8°C). His absolute neutrophil count (ANC) is 250 cells/µL. He denies any localizing symptoms. His blood pressure is 110/70 mmHg, and heart rate is 98 bpm. What is the most appropriate immediate management?

A Administer acetaminophen and monitor closely for 24 hours
B Obtain blood cultures from two sites and immediately start empiric broad-spectrum intravenous antibiotics
C Order a chest X-ray and urinalysis before starting any antibiotics
D Obtain blood cultures and wait for the results before initiating antibiotics

✓ Correct Answer: Option B

Neutropenic fever is a medical emergency. Immediate management involves obtaining blood cultures from at least two sites and promptly initiating empiric broad-spectrum intravenous antibiotics (e.g., an anti-pseudomonal beta-lactam) within an hour, regardless of localizing symptoms, due to the high risk of rapid progression to sepsis.

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