Match each patient's clinical presentation of an oncologic or hematologic emergency with t… — USMLE Step 2 CK

Match each patient's clinical presentation of an oncologic or hematologic emergency with the most appropriate immediate medical intervention.

A 34-year-old male evaluated for unremitting epistaxis and profound fatigue. Labs show a leukocyte count of $32,000/\mu\text{L}$ , hemoglobin of $8.2 \text{ g/dL}$ , and platelets of $24,000/\mu\text{L}$ . Coagulation profile reveals prolonged prothrombin and activated partial thromboplastin times with marked hypofibrinogenemia. A peripheral smear shows atypical promyelocytes containing numerous Auer rods.Immediate initiation of all-trans retinoic acid
A 68-year-old male with a history of advanced prostate carcinoma who develops progressive bilateral lower extremity weakness over three days, accompanied by new-onset urinary retention. Examination demonstrates a sensory level at the umbilicus and absent deep tendon reflexes in the legs.Immediate intravenous administration of high-dose dexamethasone
A 52-year-old female returning to the clinic eight days after receiving cytotoxic therapy for breast cancer. She reports sudden-onset chills. Her oral temperature is $38.7^\circ \text{C}$ ( $101.7^\circ \text{F}$ ). Complete blood count reveals an absolute neutrophil count of $200/\mu\text{L}$ . She has no localizing signs of infection on exam.Prompt initiation of empiric intravenous cefepime
A 14-year-old boy preparing to undergo aggressive induction chemotherapy for a large, bulky intra-abdominal mass confirmed as Burkitt lymphoma. Baseline laboratory studies demonstrate a serum uric acid of $11.5 \text{ mg/dL}$ , potassium of $5.4 \text{ mEq/L}$ , and creatinine of $1.8 \text{ mg/dL}$ .Intravenous administration of rasburicase and vigorous hydration

Answer

Acute Promyelocytic Leukemia requires immediate ATRA; Epidural Spinal Cord Compression requires immediate dexamethasone; Neutropenic Fever requires prompt empiric cefepime; Tumor Lysis Syndrome requires rasburicase and vigorous hydration.

Each presentation describes a classic oncologic emergency that dictates a specific, immediate pharmacologic intervention to prevent irreversible morbidity or mortality. Matching correctly demonstrates mastery of acute management protocols.

Step-by-Step Solution

Analyze the first vignette (pancytopenia, coagulopathy, promyelocytes with Auer rods).

Diagnosis is Acute Promyelocytic Leukemia (APL) with DIC.

Recognizing APL is critical because it carries a high risk of fatal hemorrhage if not immediately treated with the differentiating agent, ATRA.

Analyze the second vignette (prostate cancer, lower extremity weakness, sensory level, urinary retention).

Diagnosis is Malignant Epidural Spinal Cord Compression.

The sudden onset of neurologic deficits requires immediate mitigation of spinal cord edema using high-dose corticosteroids before obtaining definitive imaging.

Analyze the third vignette (chemotherapy, fever

>38.3^\circ \text{C}

, ANC

<500/\mu\text{L}

Diagnosis is Febrile Neutropenia.

Febrile neutropenia is a medical emergency requiring rapid administration of anti-pseudomonal beta-lactams to prevent lethal septic shock.

Analyze the fourth vignette (Burkitt lymphoma, hyperuricemia, hyperkalemia, elevated creatinine).

Diagnosis is Spontaneous Tumor Lysis Syndrome.

Rapid degradation of established hyperuricemia with rasburicase is essential to prevent permanent acute renal failure prior to massive cell lysis from chemotherapy.

Key Concept

Recognition and emergent pharmacological management of acute oncologic and hematologic emergencies.

Estimated Time:2m 0s

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