Methotrexate Management — ORE Part 1 MCQ
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Correct answer: C — Full blood count with platelet count
A full blood count with platelet count is the best answer. Methotrexate can cause unpredictable bone-marrow suppression, including neutropenia and thrombocytopenia. These abnormalities are directly relevant to surgical extraction because they increase the risks of postoperative infection and bleeding. Liver and renal tests are important components of routine methotrexate monitoring, but they do not identify the immediate haematological complications most relevant to an invasive dental procedure. A chest radiograph is principally a baseline investigation for potential pulmonary toxicity, not a routine pre-extraction test. Methotrexate does not primarily produce a coagulation-factor defect, so a coagulation screen is not the key test. Serum methotrexate concentrations are used in selected high-dose or toxicity settings and are not routine monitoring for stable low-dose therapy.
Reference: Electronic Medicines Compendium. Methotrexate 2.5 mg Tablets — Summary of Product Characteristics, section 4.4: special warnings and precautions for use; accessed July 2026. https://www.medicines.org.uk/emc/product/511/smpc