Chemotherapy: cisplatin nephrotoxicity: practice question

A Pharmacology 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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Pharmacology · Chemotherapy: cisplatin nephrotoxicity

Sample item

A 50-year-old man with a testicular germ cell tumour is to receive cisplatin. Which measure best reduces its nephrotoxicity?

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

The answer and the reasoning

B. Pre- and post-treatment hydration with normal saline

Cisplatin accumulates in proximal tubular cells and causes dose-related renal injury, hypomagnesaemia and ototoxicity. Vigorous saline hydration, sometimes with mannitol, lowers the intratubular concentration of the drug. It is also strongly emetogenic, and an antiemetic regimen is needed.

Option by option

  • A. Mesna co-administration

    Mesna binds acrolein from cyclophosphamide and ifosfamide.

  • B. Pre- and post-treatment hydration with normal saline (correct)

    Correct. High urine flow and chloride lower drug concentration in the tubules.

  • C. Dexrazoxane co-administration

    Dexrazoxane protects against anthracycline cardiotoxicity.

  • D. Leucovorin rescue

    Leucovorin rescues methotrexate toxicity.

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 Pharmacology question

What is the answer to this Pharmacology question?

The best answer is B, Pre- and post-treatment hydration with normal saline. Cisplatin accumulates in proximal tubular cells and causes dose-related renal injury, hypomagnesaemia and ototoxicity.

Why is "Mesna co-administration" not the answer?

Mesna binds acrolein from cyclophosphamide and ifosfamide.

Why is "Dexrazoxane co-administration" not the answer?

Dexrazoxane protects against anthracycline cardiotoxicity.

Why is "Leucovorin rescue" not the answer?

Leucovorin rescues methotrexate toxicity.

What concept does this question test?

It tests Chemotherapy: cisplatin nephrotoxicity in Pharmacology. Vigorous saline hydration, sometimes with mannitol, lowers the intratubular concentration of the drug. It is also strongly emetogenic, and an antiemetic regimen is needed.

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 Chemotherapy: cisplatin nephrotoxicity?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology 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.