Intravenous and inhalational agents: mechanism of halothane hepatitis: practice question

A Anaesthesia 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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Anaesthesia · Intravenous and inhalational agents: mechanism of halothane hepatitis

Sample item

A middle-aged obese woman develops fever and jaundice a week after her second halothane anaesthetic in two months, with eosinophilia. What is the proposed mechanism of the liver injury?

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

The answer and the reasoning

C. An immune reaction to liver proteins altered by an oxidative halothane metabolite

Halothane is oxidised to trifluoroacetyl chloride, which binds liver proteins and creates neoantigens, so repeat exposure causes an immune-mediated fulminant hepatitis. Risk factors include repeated exposure, obesity, female sex and middle age.

Option by option

  • A. Injury from compound A in the absorbent

    Compound A is produced by sevoflurane and its concern is renal.

  • B. Direct hepatocyte toxicity from fluoride ions

    Fluoride toxicity affects the kidney and is associated with methoxyflurane.

  • C. An immune reaction to liver proteins altered by an oxidative halothane metabolite (correct)

    Correct. Haptenised liver proteins provoke an immune reaction, especially on re-exposure.

  • D. Hypoxic injury from carbon monoxide production

    Carbon monoxide from dry absorbent is associated with desflurane, not halothane hepatitis.

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 Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is C, An immune reaction to liver proteins altered by an oxidative halothane metabolite. Halothane is oxidised to trifluoroacetyl chloride, which binds liver proteins and creates neoantigens, so repeat exposure causes an immune-mediated fulminant hepatitis.

Why is "Injury from compound A in the absorbent" not the answer?

Compound A is produced by sevoflurane and its concern is renal.

Why is "Direct hepatocyte toxicity from fluoride ions" not the answer?

Fluoride toxicity affects the kidney and is associated with methoxyflurane.

Why is "Hypoxic injury from carbon monoxide production" not the answer?

Carbon monoxide from dry absorbent is associated with desflurane, not halothane hepatitis.

What concept does this question test?

It tests Intravenous and inhalational agents: mechanism of halothane hepatitis in Anaesthesia. Risk factors include repeated exposure, obesity, female sex and middle age.

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 Intravenous and inhalational agents: mechanism of halothane hepatitis?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia 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.