hi everybody... - stefan78

[ArchivalUser]

Q NO 775: A 30-year-old Caucasian female patient is seen at the rheumatology clinic. She has a 4-year history of rheumatoid arthritis. Over the past year, she has noticed an improvement in her symptoms. Examination of her joints reveals less swelling and erythema than on the previous visit. Laboratory studies show:
Hb 10.8g/dL
Ht 32%
MCV 104 fl
Platelet count 226 000/cmm
Leukocyte count 7500/cmm
Neutrophils 65%
Eosinophils 1%
Lymphocytes 28%
Monocytes 6%
Serum
Serum Na 140 mEq/L
Serum K 3.9 mEq/L
Chloride 100 mEq/L
Bicarbonate 18 mEq/L
BUN 16 mg/dL
Serum Creatinine 1.1 mg/dL
Calcium 9.8 mg/dL
Blood Glucose 98 mg/dL
Which of the following medications is this patient most likely taking?

A. Hydroxychloroquine
B. Prednisone
C. Cyclosporin
D. Azathioprine
E. Methotrexate

[ArchivalUser]

eeeee

[ArchivalUser]

E.

[ArchivalUser]

e.

[ArchivalUser]

ans is eeeeeeeee

This patient™s laboratory results reveal macrocytic anemia (Hb < 12 g/dl and MCV> 100), which is one of the adverse effects of methotrexate. Methotrexate is a disease-modifying anti-rheumatic drug (DMARD) which works by inhibiting dihydrofolate reductase. Hematologic toxicity with macrocytic red blood cells may occur with its usage, and one of the more serious abnormalities is development of pancytopenia. In an attempt to prevent these complications, the American College of Rheumatology recommends routine peripheral blood counts every three months. Other side effects of methotrexate include: nausea, stomatitis, rash, hepatotoxicity, interstitial lung disease alopecia and fever. Methotrexate acts by interfering with the cellular utilization of folic acid, and folate depletion is considered to be the cause of most of these complaints. Some of these reactions can be alleviated or prevented by the addition of supplemental folic acid, without changing the efficacy of MTX.

[ArchivalUser]

eee