Rheumatology: methotrexate toxicity: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Medicine · Rheumatology: methotrexate toxicity

Sample item

A patient on weekly methotrexate develops mouth ulcers, pancytopenia and dry cough with diffuse infiltrates. What should be given?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Stop methotrexate and give folinic acid rescue

Methotrexate toxicity includes mucositis, myelosuppression, hepatotoxicity and pneumonitis. Folic acid prevents mild toxicity, and leucovorin (folinic acid) rescues acute severe toxicity. Co-trimoxazole increases toxicity because both inhibit folate metabolism.

Option by option

  • A. Give iron

    Iron does not treat the toxicity.

  • B. Stop methotrexate and give folinic acid rescue (correct)

    Correct. Stop the drug and give folinic acid.

  • C. Increase the dose

    Increasing the dose would worsen toxicity.

  • D. Add trimethoprim-sulfamethoxazole

    Co-trimoxazole raises the risk of marrow suppression.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Stop methotrexate and give folinic acid rescue. Methotrexate toxicity includes mucositis, myelosuppression, hepatotoxicity and pneumonitis.

Why is "Give iron" not the answer?

Iron does not treat the toxicity.

Why is "Increase the dose" not the answer?

Increasing the dose would worsen toxicity.

Why is "Add trimethoprim-sulfamethoxazole" not the answer?

Co-trimoxazole raises the risk of marrow suppression.

What concept does this question test?

It tests Rheumatology: methotrexate toxicity in General Medicine. Folic acid prevents mild toxicity, and leucovorin (folinic acid) rescues acute severe toxicity. Co-trimoxazole increases toxicity because both inhibit folate metabolism.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Rheumatology: methotrexate toxicity?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.