Oncology: tumour lysis syndrome: practice question

A Pediatrics 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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Pediatrics · Oncology: tumour lysis syndrome

Sample item

Within 24 hours of starting chemotherapy for a high-burden lymphoma, a child develops hyperkalaemia, hyperphosphataemia, hyperuricaemia and hypocalcaemia. Which drug is used for prevention in high-risk patients?

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

The answer and the reasoning

A. Rasburicase with hydration

Rapid lysis of tumour cells releases potassium, phosphate and nucleic acids that convert to uric acid. Aggressive hydration and rasburicase, which converts uric acid to allantoin, are used to prevent acute kidney injury in high-risk patients. Rasburicase is contraindicated in G6PD deficiency.

Option by option

  • A. Rasburicase with hydration (correct)

    Correct. Rasburicase with hydration is preventive.

  • B. Potassium supplements

    Potassium supplements would worsen hyperkalaemia.

  • C. Calcium gluconate routinely

    Calcium is avoided unless symptomatic because it promotes precipitation.

  • D. Allopurinol after the event

    Allopurinol only prevents new uric acid formation and acts slowly.

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 Pediatrics question

What is the answer to this Pediatrics question?

The best answer is A, Rasburicase with hydration. Rapid lysis of tumour cells releases potassium, phosphate and nucleic acids that convert to uric acid.

Why is "Potassium supplements" not the answer?

Potassium supplements would worsen hyperkalaemia.

Why is "Calcium gluconate routinely" not the answer?

Calcium is avoided unless symptomatic because it promotes precipitation.

Why is "Allopurinol after the event" not the answer?

Allopurinol only prevents new uric acid formation and acts slowly.

What concept does this question test?

It tests Oncology: tumour lysis syndrome in Pediatrics. Aggressive hydration and rasburicase, which converts uric acid to allantoin, are used to prevent acute kidney injury in high-risk patients. Rasburicase is contraindicated in G6PD deficiency.

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 Oncology: tumour lysis syndrome?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics 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.