Injuries: crush syndrome: practice question

A Forensic Medicine 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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Forensic Medicine · Injuries: crush syndrome

Sample item

A man trapped for 8 hours under a collapsed wall has both thighs compressed but is conscious and haemodynamically stable. Rescuers can see him. What is the most important measure to start before and during extrication?

AHigh-dose intravenous steroids to reduce limb swellingBOral potassium restriction aloneCImmediate application of a tight tourniquet and no fluidsDIntravenous isotonic saline to prevent myoglobin-induced kidney injury and hyperkalaemia

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

The answer and the reasoning

D. Intravenous isotonic saline to prevent myoglobin-induced kidney injury and hyperkalaemia

In crush syndrome, release of the compressed muscle floods the circulation with myoglobin, potassium and acid, risking acute kidney injury and fatal hyperkalaemia and shock. Aggressive intravenous isotonic saline should be started before release, with monitoring of the ECG and potassium. A tourniquet may be considered in selected cases, but fluids remain essential.

Option by option

A. High-dose intravenous steroids to reduce limb swelling
Steroids have no role in preventing the metabolic effects of crush injury.
B. Oral potassium restriction alone
Restricting dietary potassium cannot prevent the sudden release from damaged muscle.
C. Immediate application of a tight tourniquet and no fluids
Withholding fluids would worsen shock and kidney injury.
D. Intravenous isotonic saline to prevent myoglobin-induced kidney injury and hyperkalaemia (correct)
Correct. Early saline resuscitation protects the kidney and limits hyperkalaemia.

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 Forensic Medicine question

What is the answer to this Forensic Medicine question?

The best answer is D, Intravenous isotonic saline to prevent myoglobin-induced kidney injury and hyperkalaemia. In crush syndrome, release of the compressed muscle floods the circulation with myoglobin, potassium and acid, risking acute kidney injury and fatal hyperkalaemia and shock.

Why is "High-dose intravenous steroids to reduce limb swelling" not the answer?

Steroids have no role in preventing the metabolic effects of crush injury.

Why is "Oral potassium restriction alone" not the answer?

Restricting dietary potassium cannot prevent the sudden release from damaged muscle.

Why is "Immediate application of a tight tourniquet and no fluids" not the answer?

Withholding fluids would worsen shock and kidney injury.

What concept does this question test?

It tests Injuries: crush syndrome in Forensic Medicine. Aggressive intravenous isotonic saline should be started before release, with monitoring of the ECG and potassium. A tourniquet may be considered in selected cases, but fluids remain essential.

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 Injuries: crush syndrome?

Learn postmortem changes with their timelines, and toxicology as poison, sign, test and antidote. Then use the flashcards and the other Forensic Medicine 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.