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

Which muscle relaxant is the best choice for a patient with combined renal and hepatic failure because it is degraded by spontaneous chemical breakdown?

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

The answer and the reasoning

B. Cisatracurium

Cisatracurium and atracurium are eliminated mainly by Hofmann elimination, a pH- and temperature-dependent non-enzymatic degradation. Their duration is therefore independent of renal or hepatic function. Pancuronium relies largely on renal excretion.

Option by option

  • A. Pancuronium

    Pancuronium is mainly renally excreted and is prolonged in renal failure.

  • B. Cisatracurium (correct)

    Correct. Hofmann elimination makes its action organ-independent.

  • C. Vecuronium

    Vecuronium depends on hepatic metabolism and biliary excretion.

  • D. Rocuronium

    Rocuronium is eliminated mainly by the liver and its action is prolonged in hepatic failure.

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 B, Cisatracurium. Cisatracurium and atracurium are eliminated mainly by Hofmann elimination, a pH- and temperature-dependent non-enzymatic degradation.

Why is "Pancuronium" not the answer?

Pancuronium is mainly renally excreted and is prolonged in renal failure.

Why is "Vecuronium" not the answer?

Vecuronium depends on hepatic metabolism and biliary excretion.

Why is "Rocuronium" not the answer?

Rocuronium is eliminated mainly by the liver and its action is prolonged in hepatic failure.

What concept does this question test?

It tests Neuromuscular blockers in Anaesthesia. Their duration is therefore independent of renal or hepatic function. Pancuronium relies largely on renal excretion.

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 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.