Oncology: febrile neutropenia: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Oncology: febrile neutropenia

Sample item

A 50-year-old woman is admitted 10 days after chemotherapy for breast cancer. Her temperature is 38.6 degrees Celsius, blood pressure 100/60 mmHg and heart rate 110 per minute. The absolute neutrophil count is 200 per microlitre and there is no localising focus. What is the most appropriate immediate management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Blood cultures, then empirical intravenous antipseudomonal beta-lactam such as piperacillin-tazobactam within an hour

Fever with an absolute neutrophil count below 500 per microlitre is an oncological emergency, as bacteraemia can kill within hours. After cultures, empirical broad-spectrum antibiotics covering Pseudomonas are started immediately. Antifungal cover is added if fever persists after 4 to 7 days.

Option by option

  • A. Blood cultures, then empirical intravenous antipseudomonal beta-lactam such as piperacillin-tazobactam within an hour (correct)

    Correct. Prompt empirical therapy lowers mortality in neutropenic sepsis.

  • B. Wait for culture results before starting antibiotics

    Delaying antibiotics until cultures return risks overwhelming sepsis.

  • C. Granulocyte colony-stimulating factor alone

    G-CSF may shorten neutropenia but does not treat infection and does not replace antibiotics.

  • D. Oral paracetamol and review the next day

    Antipyretics and delay are unsafe for an unstable neutropenic patient.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Blood cultures, then empirical intravenous antipseudomonal beta-lactam such as piperacillin-tazobactam within an hour. Fever with an absolute neutrophil count below 500 per microlitre is an oncological emergency, as bacteraemia can kill within hours.

Why is "Wait for culture results before starting antibiotics" not the answer?

Delaying antibiotics until cultures return risks overwhelming sepsis.

Why is "Granulocyte colony-stimulating factor alone" not the answer?

G-CSF may shorten neutropenia but does not treat infection and does not replace antibiotics.

Why is "Oral paracetamol and review the next day" not the answer?

Antipyretics and delay are unsafe for an unstable neutropenic patient.

What concept does this question test?

It tests Oncology: febrile neutropenia in General Medicine. After cultures, empirical broad-spectrum antibiotics covering Pseudomonas are started immediately. Antifungal cover is added if fever persists after 4 to 7 days.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Oncology: febrile neutropenia?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.