07/05/2026
PLAB 1 & UKMLA AKT frequently test febrile neutropenia as a medical emergency — recent chemotherapy + fever should immediately trigger suspicion for neutropenic sepsis.
• Core exam pattern:
Recent chemotherapy + fever + unwell patient → start IV antibiotics immediately.
• Definition:
• Fever:
≥38.5°C once OR ≥38.0°C on 2 consecutive readings.
• Neutropenia:
Absolute neutrophil count ≤0.5 × 10⁹/L.
• Most important next-best-step:
Do NOT delay treatment waiting for investigations.
Start empirical IV antibiotics immediately.
• First-line empirical treatment:
IV Tazocin (Piperacillin + Tazobactam).
• Why it happens:
Chemotherapy → bone marrow suppression → ↓ neutrophils → severe infection risk.
• Another major exam point:
If still febrile after 48 hours:
→ Escalate antibiotics.
Possible answer:
Meropenem ± Vancomycin.
• Persistent fever after 4–6 days despite antibiotics?
Think fungal infection.
→ Investigate for fungal infection + add IV antifungals.
• High-yield PLAB pearl:
Even if the stem does NOT explicitly provide neutrophil count, chemotherapy + fever should still make you treat as neutropenic sepsis.
• Easy memory rule:
Chemo + Fever = Tazocin first.
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