USMLE-Rx Step 2 Practice Q's

USMLE-Rx Step 2 Qmax Challenge #21237

Check out today’s Step 2 CK Qmax Question Challenge.

Know the answer? Post it in the comments below! Don’t forget to check back for an update with the correct answer and explanation (we’ll post it in the comments section below).

USMLE-Rx Step 2 Qmax Challenge #21237A 10-year-old boy with newly diagnosed acute lymphoid leukemia requires placement of a permanent intravenous access device.

Which of the following sets of laboratory values will allow the boy to undergo the procedure safely?

A. A
B. B
C. C
D. D
E. E

———————–

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9 replies »

  1. The correct answer is B. In patients with acute leukemia, the risk of surgery is acceptable if certain parameters are met within the laboratory evaluation. These include an absolute neutrophil count of at least 1000/mm³, a hemoglobin of at least 10 g/dL, and a platelet count of at least 100,000/mm³. In addition, the WBC count should not be above the normal range for the hospital’s laboratory. Other coagulation factors are generally not disturbed.

    A is not correct. Patients generally should not undergo surgery with hemoglobin of <10 g/dL. The patient would benefit from a transfusion of packed red blood cells prior to the procedure.

    C is not correct. Although the absolute neutrophil count is very safe in this group of laboratory values, a platelet count of 69,000/mmm³ is a contraindication to surgery. The patient should be transfused prior to the procedure.

    D is not correct. A WBC count of 20,300/mm³ is excessive and would increase the risk of surgery by predisposing the patient to thrombotic events. In addition, the excessive WBC count implies active leukemia that is most likely affecting the function of other blood cells.

    E is not correct. A WBC count of 60,000/mmm³ is considered excessive and would increase the risk of surgery by predisposing the patient to thrombotic events. In addition, the excessive WBC count implies active leukemia that is most likely affecting the function of other blood cells.

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