Cardiology: digoxin toxicity: 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 · Cardiology: digoxin toxicity

Sample item

A 70-year-old woman with heart failure and atrial fibrillation takes digoxin and furosemide. She has nausea, yellow-tinged vision and palpitations. Her ECG shows frequent ventricular ectopics and an atrial tachycardia with 2:1 block, and serum potassium is 6.2 mmol/L. What is the most appropriate specific treatment?

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

The answer and the reasoning

A. Digoxin-specific antibody (Fab) fragments

Life-threatening digoxin toxicity (arrhythmia, hyperkalaemia from Na-K ATPase inhibition) is treated with digoxin-specific Fab fragments, which bind the drug and reverse the effects. Calcium has been associated with refractory ventricular arrhythmias in digitalised patients. Digoxin has a large volume of distribution and is poorly removed by dialysis, and cardioversion in this setting can precipitate ventricular fibrillation.

Option by option

  • A. Digoxin-specific antibody (Fab) fragments (correct)

    Fab fragments bind free digoxin and rapidly reverse arrhythmias and hyperkalaemia.

  • B. Intravenous calcium gluconate to stabilise the myocardium

    Calcium is best avoided in digoxin toxicity because it may precipitate refractory ventricular arrhythmias; it is used for hyperkalaemia from other causes.

  • C. Haemodialysis to remove digoxin

    Dialysis is ineffective because digoxin is widely distributed in tissues and is poorly dialysable.

  • D. Synchronised direct current cardioversion

    Cardioversion of a digitalised myocardium risks ventricular fibrillation and the rhythm is likely to recur while the drug level is high.

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 A, Digoxin-specific antibody (Fab) fragments. Life-threatening digoxin toxicity (arrhythmia, hyperkalaemia from Na-K ATPase inhibition) is treated with digoxin-specific Fab fragments, which bind the drug and reverse the effects.

Why is "Intravenous calcium gluconate to stabilise the myocardium" not the answer?

Calcium is best avoided in digoxin toxicity because it may precipitate refractory ventricular arrhythmias; it is used for hyperkalaemia from other causes.

Why is "Haemodialysis to remove digoxin" not the answer?

Dialysis is ineffective because digoxin is widely distributed in tissues and is poorly dialysable.

Why is "Synchronised direct current cardioversion" not the answer?

Cardioversion of a digitalised myocardium risks ventricular fibrillation and the rhythm is likely to recur while the drug level is high.

What concept does this question test?

It tests Cardiology: digoxin toxicity in General Medicine. Calcium has been associated with refractory ventricular arrhythmias in digitalised patients. Digoxin has a large volume of distribution and is poorly removed by dialysis, and cardioversion in this setting can precipitate ventricular fibrillation.

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 Cardiology: digoxin toxicity?

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.