Complications: protamine reaction: 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.

Try it

Anaesthesia · Complications: protamine reaction

Sample item

Which patient is at highest risk of a severe reaction to protamine given to reverse heparin?

AA diabetic patient who uses NPH insulinBA patient taking a proton pump inhibitorCA patient on a statinDA patient with hypertension on amlodipine

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

The answer and the reasoning

A. A diabetic patient who uses NPH insulin

Protamine is derived from fish sperm and NPH insulin contains protamine. Previous exposure through NPH insulin, vasectomy or fish allergy sensitises patients and increases the risk of anaphylaxis. Reactions range from hypotension with rapid injection to catastrophic pulmonary vasoconstriction and right ventricular failure.

Option by option

A. A diabetic patient who uses NPH insulin (correct)
Correct. Prior exposure through NPH insulin predisposes to protamine reactions.
B. A patient taking a proton pump inhibitor
Proton pump inhibitors are not linked to protamine reactions.
C. A patient on a statin
Statins are not linked to protamine reactions.
D. A patient with hypertension on amlodipine
Amlodipine is not linked to protamine reactions.

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.

Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is A, A diabetic patient who uses NPH insulin. Protamine is derived from fish sperm and NPH insulin contains protamine.

Why is "A patient taking a proton pump inhibitor" not the answer?

Proton pump inhibitors are not linked to protamine reactions.

Why is "A patient on a statin" not the answer?

Statins are not linked to protamine reactions.

Why is "A patient with hypertension on amlodipine" not the answer?

Amlodipine is not linked to protamine reactions.

What concept does this question test?

It tests Complications: protamine reaction in Anaesthesia. Previous exposure through NPH insulin, vasectomy or fish allergy sensitises patients and increases the risk of anaphylaxis. Reactions range from hypotension with rapid injection to catastrophic pulmonary vasoconstriction and right ventricular failure.

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 Complications: protamine reaction?

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.