Rheumatology & Haematology — Flashcards

Flashcard 81: What is used to monitor treatment in haemochromatosis?

Answer: • Ferritin and Transferrin saturation

Flashcard 82: Chronic kidney disease causes _____cytic normochromic anaemia from ↓ production of erythropoietin (EPO)

Answer: normo

Flashcard 83: _____ can cause class V lupus nephritis with a membranous pattern on biopsy

Answer: SLE

Flashcard 84: Minimal change disease is rarely associated with _____

Answer: Hodgkin lymphoma

Flashcard 85: Loss of _____ in nephrotic syndrome results in a hyper-coaguable state

Answer: antithrombin III

Flashcard 86: What medication should never be prescribed with methotrexate?

Answer: Trimethoprim (or trimethoprim-containing medications like Co-trimoxazole)

Extra: Both Methotrexate and Trimethoprim are folate antagonists. Methotrexate inhibits dihydrofolate reductase (DHFR). Combining them leads to synergistic bone marrow suppression (pancytopenia) and increased risk of methotrexate toxicity.

Flashcard 87: What is the advice regarding pregnancy and conception for patients (both male and female) taking Methotrexate?

Answer: • MTX is contraindicated in pregnancy (Teratogenic/Abortifacient). • Stop MTX at least 3 months prior to conception (for both women and men). • High-dose Folic acid (5mg) is recommended pre-conceptionally.

Extra: Methotrexate (MTX) is a dihydrofolate reductase inhibitor. It is highly teratogenic (causes 'fetal methotrexate syndrome'). Current guidelines (e.g., BSR, ACR): • Discontinue MTX at least 3 months before attempting pregnancy. • While the 6-month rule was older practice, 3 months is the current standard in most contemporary guidelines. • Men should also ideally stop for 3 months due to theoretical risk of oligospermia and chromosomal damage, though evidence is weaker than for women. • Ensure adequate contraception while on MTX.

Flashcard 88: What imaging is required for a Rheumatoid Arthritis (RA) patient before undergoing surgery with general anesthesia/intubation?

Answer: Anteroposterior and lateral cervical spine radiographs (Flexion/Extension views) to screen for atlantoaxial subluxation.

Extra: Patients with Rheumatoid Arthritis (RA) are at risk for atlantoaxial (C1-C2) instability due to erosion of the transverse ligament and odontoid process. Pre-operative assessment is crucial before intubation to prevent spinal cord injury during neck manipulation.

Flashcard 89: What is the antidote for Methotrexate overdose?

Answer: • Folinic Acid

Flashcard 90: What cardiovascular disease do RA patients have an increased risk of?

Answer: • IHD due to systemic inflammation