Nephrology and electrolytes: gadolinium in advanced kidney disease: 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 and electrolytes: gadolinium in advanced kidney disease

Sample item

A 58-year-old man on haemodialysis has an MRI with a gadolinium-based agent. Weeks later he develops thickened, woody skin over the limbs with joint contractures, but the face is spared. Which diagnosis is most likely?

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

The answer and the reasoning

B. Nephrogenic systemic fibrosis

Gadolinium exposure in patients with severe kidney impairment can cause nephrogenic systemic fibrosis, with progressive skin thickening and contractures sparing the face. Group II macrocyclic agents and avoiding contrast in severe CKD reduce the risk.

Option by option

  • A. Calcific uraemic arteriolopathy (calciphylaxis)

    Calciphylaxis causes painful necrotic skin ulcers with vascular calcification.

  • B. Nephrogenic systemic fibrosis (correct)

    Correct. The timing after gadolinium in a dialysis patient with facial sparing fits this condition.

  • C. Eosinophilic fasciitis with eosinophilia

    Eosinophilic fasciitis follows exertion and shows peripheral eosinophilia, with no gadolinium link.

  • D. Diffuse cutaneous systemic sclerosis

    Systemic sclerosis typically involves the face and has Raynaud and autoantibodies.

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 B, Nephrogenic systemic fibrosis. Gadolinium exposure in patients with severe kidney impairment can cause nephrogenic systemic fibrosis, with progressive skin thickening and contractures sparing the face.

Why is "Calcific uraemic arteriolopathy (calciphylaxis)" not the answer?

Calciphylaxis causes painful necrotic skin ulcers with vascular calcification.

Why is "Eosinophilic fasciitis with eosinophilia" not the answer?

Eosinophilic fasciitis follows exertion and shows peripheral eosinophilia, with no gadolinium link.

Why is "Diffuse cutaneous systemic sclerosis" not the answer?

Systemic sclerosis typically involves the face and has Raynaud and autoantibodies.

What concept does this question test?

It tests Nephrology and electrolytes: gadolinium in advanced kidney disease in General Medicine. Group II macrocyclic agents and avoiding contrast in severe CKD reduce the risk.

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 Nephrology and electrolytes: gadolinium in advanced kidney disease?

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.