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Cyclophosphamide toxicity — SCE Rheumatology MCQ

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ModerateRheumatological PharmacologyCyclophosphamide toxicitySCE Rheumatology

A 31-year-old woman requires cyclophosphamide for organ-threatening vasculitis and is concerned about bladder and fertility toxicity. What is the most appropriate investigation?

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Correct answer: CUrinalysis, FBC and infection monitoring during treatment

Urinalysis, FBC and infection monitoring during treatment is the single best answer because cyclophosphamide can cause haemorrhagic cystitis, infertility and malignancy risk. The stem is testing investigation selection, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Synovial fluid microscopy, Gram stain and culture is less suitable because it fits a different clinical pattern or a different treatment threshold; MRI of the sacroiliac joints, High-resolution CT chest and Renal biopsy do not address the key discriminator in this vignette. Clinical pearl: in SCE-style rheumatology questions, autoantibodies, imaging and synovial fluid findings should be interpreted with the whole phenotype.

Reference: BNF; BSR DMARD and biologic safety guidance