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Cyclophosphamide toxicity — SCE Rheumatology MCQ

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HardRheumatological PharmacologyCyclophosphamide toxicitySCE Rheumatology

A 42-year-old woman requires cyclophosphamide for organ-threatening vasculitis and is concerned about bladder and fertility toxicity. What is the most appropriate management?

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Correct answer: D — Use hydration, mesna where indicated and fertility counselling

The best answer is “Use hydration, mesna where indicated and fertility counselling”. Use hydration, mesna where indicated and fertility counselling is the most appropriate next step after the disease phenotype, previous treatment and safety constraints in the stem are considered. The remaining choices—“Start methotrexate with folic acid and monitoring, within a rheumatology pathway”, “Begin high-dose glucocorticoids immediately, after safety review”, “Urgent joint aspiration and culture, after specialist assessment”, “Use NSAID therapy and physiotherapy, with clinical reassessment”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: BSR csDMARD prescription and monitoring guideline: https://academic.oup.com/rheumatology/article/65/2/keaf522/8322743