Malaria complications: blackwater fever: practice question

A Microbiology 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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Microbiology · Malaria complications: blackwater fever

Sample item

A man with repeated falciparum malaria who took quinine irregularly develops fever, jaundice, passage of dark red-brown urine and oliguria. What is the principal underlying process?

AImmune complex glomerulonephritis from quartan malariaBCerebral microvascular sequestration of parasitised red cellsCRhabdomyolysis with myoglobinuriaDMassive intravascular haemolysis with haemoglobinuria

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

The answer and the reasoning

D. Massive intravascular haemolysis with haemoglobinuria

Blackwater fever is a complication of falciparum malaria in which massive intravascular haemolysis causes haemoglobinuria and acute kidney injury. It is linked to repeated infection with irregular quinine use and sometimes G6PD deficiency. Management is antimalarial treatment, fluids and renal support.

Option by option

A. Immune complex glomerulonephritis from quartan malaria
Immune complex nephropathy characterises P. malariae, with nephrotic syndrome rather than dark urine and haemolysis.
B. Cerebral microvascular sequestration of parasitised red cells
Cerebral sequestration causes coma, not haemoglobinuria.
C. Rhabdomyolysis with myoglobinuria
Rhabdomyolysis is not the mechanism and has a different clinical context.
D. Massive intravascular haemolysis with haemoglobinuria (correct)
Correct. Haemolysis releases haemoglobin, producing dark urine and tubular injury.

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.

Questions about this Microbiology question

What is the answer to this Microbiology question?

The best answer is D, Massive intravascular haemolysis with haemoglobinuria. Blackwater fever is a complication of falciparum malaria in which massive intravascular haemolysis causes haemoglobinuria and acute kidney injury.

Why is "Immune complex glomerulonephritis from quartan malaria" not the answer?

Immune complex nephropathy characterises P. malariae, with nephrotic syndrome rather than dark urine and haemolysis.

Why is "Cerebral microvascular sequestration of parasitised red cells" not the answer?

Cerebral sequestration causes coma, not haemoglobinuria.

Why is "Rhabdomyolysis with myoglobinuria" not the answer?

Rhabdomyolysis is not the mechanism and has a different clinical context.

What concept does this question test?

It tests Malaria complications: blackwater fever in Microbiology. It is linked to repeated infection with irregular quinine use and sometimes G6PD deficiency. Management is antimalarial treatment, fluids and renal support.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Malaria complications: blackwater fever?

Make a one-line identity card for each organism: shape and stain, defining test, toxin, disease and drug. Then use the flashcards and the other Microbiology 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.