Neuromuscular blockers: practice question

A Anaesthesia 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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Anaesthesia · Neuromuscular blockers

Sample item

A man with 30% burns, 3 weeks old, needs an emergency re-grafting under general anaesthesia. Which drug is best avoided for intubation?

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

The answer and the reasoning

C. Succinylcholine

After major burns, denervation injury, prolonged immobilisation or spinal cord injury, there is proliferation of extrajunctional acetylcholine receptors. Succinylcholine depolarises them and causes massive potassium efflux, risking cardiac arrest, usually from about 24 to 48 hours until months later. A non-depolarising agent such as rocuronium is used instead (higher doses may be required in burns).

Option by option

  • A. Cisatracurium

    Cisatracurium does not cause hyperkalaemia and is organ-independent.

  • B. Vecuronium

    Vecuronium is non-depolarising and not associated with hyperkalaemia.

  • C. Succinylcholine (correct)

    Correct. Upregulated extrajunctional receptors cause life-threatening hyperkalaemia.

  • D. Rocuronium

    Rocuronium is a non-depolarising agent and does not cause this potassium surge.

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 Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is C, Succinylcholine. After major burns, denervation injury, prolonged immobilisation or spinal cord injury, there is proliferation of extrajunctional acetylcholine receptors.

Why is "Cisatracurium" not the answer?

Cisatracurium does not cause hyperkalaemia and is organ-independent.

Why is "Vecuronium" not the answer?

Vecuronium is non-depolarising and not associated with hyperkalaemia.

Why is "Rocuronium" not the answer?

Rocuronium is a non-depolarising agent and does not cause this potassium surge.

What concept does this question test?

It tests Neuromuscular blockers in Anaesthesia. Succinylcholine depolarises them and causes massive potassium efflux, risking cardiac arrest, usually from about 24 to 48 hours until months later. A non-depolarising agent such as rocuronium is used instead (higher doses may be required in burns).

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 Neuromuscular blockers?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia 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.