Treatment Planning & Management Flashcards

A patient with septic shock has a lactate of 6.8 mmol/L at initial presentation. After 6 hours of aggressive fluid resuscitation and antibiotics, lactate is 4.1 mmol/L. This trend MOST indicates:

Answer: Partial response; lactate clearance below the 10% threshold for adequate resuscitation

Surviving Sepsis Campaign guidelines target greater than 10% lactate clearance per hour; a drop from 6.8 to 4.1 (approximately 40% over 6 hours) indicates a partial but meaningful response.

A patient with acute promyelocytic leukemia (APL) is started on ATRA therapy. Which potentially fatal complication should be monitored with daily CBC and coagulation studies?

Answer: Differentiation syndrome and DIC

APL carries high risk of DIC from granule release, and ATRA differentiation syndrome (respiratory distress, fever, effusions) can be fatal; both require vigilant lab monitoring.

Which laboratory result would MOST likely prompt dose reduction of bevacizumab in a cancer patient?

Answer: Urine protein-to-creatinine ratio greater than 2.0

Bevacizumab (anti-VEGF) causes proteinuria; a UPC ratio above 2.0 indicates significant nephrotoxicity requiring dose modification or discontinuation.

A patient receiving total parenteral nutrition (TPN) develops hypophosphatemia (0.4 mmol/L) on day 3. This is MOST consistent with:

Answer: Refeeding syndrome causing intracellular phosphate shift

Refeeding syndrome occurs when carbohydrate reintroduction stimulates insulin release, driving phosphate (along with potassium and magnesium) into cells, causing life-threatening deficiencies.

A patient on chronic dialysis receives a kidney transplant. Post-transplant, creatinine drops from 8.2 to 2.1 mg/dL in 48 hours but then plateaus at 1.9 mg/dL for 5 days. This pattern MOST suggests:

Answer: Delayed graft function (DGF) requiring dialysis support

Initial creatinine improvement followed by plateau without reaching normal indicates delayed graft function, typically from ischemia-reperfusion injury requiring continued dialysis.

A patient with hemophilia A has a factor VIII level of 2% and is scheduled for major surgery. What pre-operative factor VIII target level should be achieved?

Answer: 80–100%

For major surgery in hemophilia A, factor VIII levels should be raised to 80–100% pre-operatively and maintained above 50% post-operatively per World Federation of Hemophilia guidelines.

A pediatric patient with acute lymphoblastic leukemia (ALL) on maintenance therapy has an ANC of 450/µL. Per standard protocol management, the MOST appropriate action is:

Answer: Hold methotrexate and 6-MP; recheck CBC in one week

ALL maintenance protocols hold antimetabolites (MTX and 6-MP) when ANC falls below 500–750/µL to prevent life-threatening neutropenia, with CBC recheck to guide restart.