Endocrinology and diabetes: antithyroid drug agranulocytosis: 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 · Endocrinology and diabetes: antithyroid drug agranulocytosis

Sample item

A woman started on carbimazole for Graves disease five weeks ago develops fever and a severe sore throat. What is the best next step?

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

The answer and the reasoning

C. Stop carbimazole and check the neutrophil count urgently

Agranulocytosis is a rare but serious reaction to thionamides, usually in the first three months. Patients are warned to report fever or sore throat at once. The drug is stopped, a full blood count is checked and, if neutropenic, broad-spectrum antibiotics are started, and alternative treatment such as radioiodine or surgery is planned.

Option by option

  • A. Continue carbimazole and give throat lozenges

    Continuing the drug risks fatal sepsis in a neutropenic patient.

  • B. Add oral prednisolone and continue carbimazole

    Steroids do not reverse drug-induced agranulocytosis and continuing the culprit drug is unsafe.

  • C. Stop carbimazole and check the neutrophil count urgently (correct)

    Correct. Suspected agranulocytosis needs the drug stopped and an urgent blood count.

  • D. Switch immediately to propylthiouracil

    Propylthiouracil cross-reacts with carbimazole and may cause agranulocytosis too.

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.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Stop carbimazole and check the neutrophil count urgently. Agranulocytosis is a rare but serious reaction to thionamides, usually in the first three months.

Why is "Continue carbimazole and give throat lozenges" not the answer?

Continuing the drug risks fatal sepsis in a neutropenic patient.

Why is "Add oral prednisolone and continue carbimazole" not the answer?

Steroids do not reverse drug-induced agranulocytosis and continuing the culprit drug is unsafe.

Why is "Switch immediately to propylthiouracil" not the answer?

Propylthiouracil cross-reacts with carbimazole and may cause agranulocytosis too.

What concept does this question test?

It tests Endocrinology and diabetes: antithyroid drug agranulocytosis in General Medicine. Patients are warned to report fever or sore throat at once. The drug is stopped, a full blood count is checked and, if neutropenic, broad-spectrum antibiotics are started, and alternative treatment such as radioiodine or surgery is planned.

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 Endocrinology and diabetes: antithyroid drug agranulocytosis?

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.