Muscle relaxants: renal excretion of gallamine: 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 · Muscle relaxants: renal excretion of gallamine

Sample item

A patient in renal failure needs a non-depolarising relaxant. Which agent, almost entirely excreted unchanged by the kidney, must be avoided?

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

The answer and the reasoning

D. Gallamine

Gallamine is excreted almost completely by the kidney and is vagolytic, causing tachycardia, so it is contraindicated in renal failure. Atracurium and cisatracurium undergo Hofmann elimination, which is independent of organ function.

Option by option

  • A. Atracurium

    Atracurium is broken down by Hofmann elimination and ester hydrolysis.

  • B. Cisatracurium

    Cisatracurium is eliminated mainly by Hofmann degradation.

  • C. Mivacurium

    Mivacurium is hydrolysed by plasma cholinesterase.

  • D. Gallamine (correct)

    Correct. Gallamine depends on renal excretion and will accumulate.

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 D, Gallamine. Gallamine is excreted almost completely by the kidney and is vagolytic, causing tachycardia, so it is contraindicated in renal failure.

Why is "Atracurium" not the answer?

Atracurium is broken down by Hofmann elimination and ester hydrolysis.

Why is "Cisatracurium" not the answer?

Cisatracurium is eliminated mainly by Hofmann degradation.

Why is "Mivacurium" not the answer?

Mivacurium is hydrolysed by plasma cholinesterase.

What concept does this question test?

It tests Muscle relaxants: renal excretion of gallamine in Anaesthesia. Atracurium and cisatracurium undergo Hofmann elimination, which is independent of organ function.

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 Muscle relaxants: renal excretion of gallamine?

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.