Nephrology: rhabdomyolysis: practice question

A General 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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General Medicine · Nephrology: rhabdomyolysis

Sample item

A 28-year-old labourer was trapped under rubble for six hours. He passes dark brown urine. The dipstick is strongly positive for blood, yet microscopy shows no red cells. Creatine kinase is 48,000 U/L. Which is the most important initial measure to prevent acute kidney injury?

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

The answer and the reasoning

B. Early aggressive intravenous isotonic saline

Myoglobin causes tubular injury through obstruction, direct toxicity and renal vasoconstriction, and volume depletion worsens it. The dipstick detects haem, but no red cells are seen. Early vigorous isotonic saline, started before extrication if possible, maintains urine flow, and potassium and calcium are monitored closely.

Option by option

  • A. Intravenous furosemide to wash out pigment

    Furosemide may worsen volume depletion and acidify urine, favouring myoglobin precipitation.

  • B. Early aggressive intravenous isotonic saline (correct)

    Correct. Rapid volume expansion with saline dilutes and flushes the pigment and protects the tubules.

  • C. Urinary alkalinisation with bicarbonate as the first measure

    Alkalinisation has no proven benefit over saline and can worsen hypocalcaemia, so it is not first.

  • D. Early haemodialysis to remove myoglobin

    Myoglobin is poorly removed by standard dialysis, which is reserved for the usual life-threatening indications.

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 General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Early aggressive intravenous isotonic saline. Myoglobin causes tubular injury through obstruction, direct toxicity and renal vasoconstriction, and volume depletion worsens it.

Why is "Intravenous furosemide to wash out pigment" not the answer?

Furosemide may worsen volume depletion and acidify urine, favouring myoglobin precipitation.

Why is "Urinary alkalinisation with bicarbonate as the first measure" not the answer?

Alkalinisation has no proven benefit over saline and can worsen hypocalcaemia, so it is not first.

Why is "Early haemodialysis to remove myoglobin" not the answer?

Myoglobin is poorly removed by standard dialysis, which is reserved for the usual life-threatening indications.

What concept does this question test?

It tests Nephrology: rhabdomyolysis in General Medicine. The dipstick detects haem, but no red cells are seen. Early vigorous isotonic saline, started before extrication if possible, maintains urine flow, and potassium and calcium are monitored closely.

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 Nephrology: rhabdomyolysis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General 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.