Cardiovascular: loop diuretic ototoxicity: practice question

A Pharmacology 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.

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Pharmacology · Cardiovascular: loop diuretic ototoxicity

Sample item

A patient with sepsis on gentamicin is given high-dose intravenous furosemide and complains of ringing in the ears. What explains the risk?

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

The answer and the reasoning

C. Additive ototoxicity from loop diuretics inhibiting the Na-K-2Cl transporter in the stria vascularis plus aminoglycoside

Loop diuretics inhibit Na-K-2Cl cotransport in the inner ear and rapid high-dose injection can cause reversible hearing loss. Aminoglycosides cause cochlear hair cell damage, so combined use is additive and demands monitoring.

Option by option

  • A. Sulfonamide hypersensitivity

    Hypersensitivity does not explain tinnitus.

  • B. Furosemide is metabolised to a neurotoxin

    There is no neurotoxic metabolite.

  • C. Additive ototoxicity from loop diuretics inhibiting the Na-K-2Cl transporter in the stria vascularis plus aminoglycoside (correct)

    Correct. Both drugs injure the cochlea and effects add.

  • D. Aminoglycoside inhibits furosemide excretion only

    Reduced excretion is not the main mechanism.

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.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is C, Additive ototoxicity from loop diuretics inhibiting the Na-K-2Cl transporter in the stria vascularis plus aminoglycoside. Loop diuretics inhibit Na-K-2Cl cotransport in the inner ear and rapid high-dose injection can cause reversible hearing loss.

Why is "Sulfonamide hypersensitivity" not the answer?

Hypersensitivity does not explain tinnitus.

Why is "Furosemide is metabolised to a neurotoxin" not the answer?

There is no neurotoxic metabolite.

Why is "Aminoglycoside inhibits furosemide excretion only" not the answer?

Reduced excretion is not the main mechanism.

What concept does this question test?

It tests Cardiovascular: loop diuretic ototoxicity in Pharmacology. Aminoglycosides cause cochlear hair cell damage, so combined use is additive and demands monitoring.

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 Cardiovascular: loop diuretic ototoxicity?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology 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.