This quiz is just for fun. Test your diagnostic skills with the photos, then separate truth from fiction in the statements about methotrexate and hepatitis C. Any of the statements below might be true… and any might just be us pulling your leg. Answers are below.
1. The eyes have it. These 12 eyes reveal signs of the conditions listed below. Match the photo to the condition.
a) Graves’ exopthalmos
b) Trichofolliculoma
c) Staphylococcus blepharitis
d) Cataract
e) Angle-closure glaucoma
f) Eyelid melanoma
g) Eyelid basal cell cancer
h) Eyelid cystic squamous cell cancer
i) Wilson’s disease
j) Eccrine cyst
k) Sebhorreic keratosis
l) Herpes simplex 1
2. Methotrexate for rheumatoid arthritis
True False
a) Patients should have hepatitis B and C serology before starting the drug
b) They should expect to wait three months before seeing a benefit
c) Toxicity can be reduced by giving folate supplements
d) Patients should be asked to report cough or dyspnea to the doctor
e) Methotrexate therapy should be started through the intramuscular or subcutaneous route, switching to oral if there are problems
3. Patients with chronic hepatitis C
True False
a) Can’t donate organs
b) Can’t donate semen
c) Should avoid all alcohol
d) Cannot breastfeed
e) Should generally be vaccinated against Hep A and B
1. (1) Angle-closure glaucoma; (2) Eccrine cyst; (3) Eyelid basal cell cancer; (4) Eyelid cystic squamous cell cancer; (5) Eyelid melanoma; (6) Herpes simplex 1; (7) Cataract; (8) Graves’ exopthalmos; (9) Sebhorreic keratosis; (10) Staphylococcus blepharitis; (11) Trichofolliculoma; (12) Wilson’s disease.
2. a) True. They should also have chest x-ray, full blood cell count, serum transaminase levels, and serum creatinine with computation of creatinine clearance. Serum albumin assay is also useful; b) False. Benefits are usually seen after about a month to six weeks; c) True. About 5 mg/week, ideally separated in time from the weekly methotrexate dose; d) True. It might be a sign of pneumonitis; e) False. Guidelines generally recommend trying the oral route first, and switching if there are GI complications.
3. a) True; b) True; c) True; d) False, though other household contact like sharing toothbrushes should be avoided; e) True, unless they have demonstrated immunity.
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