Trauma: crush injury: practice question

A General Surgery 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 Surgery · Trauma: crush injury

Sample item

A man is extricated after 8 hours under a collapsed building. He is hypotensive, his limbs are swollen, urine is dark brown, and the ECG shows tall peaked T waves and a widened QRS. What is the most urgent immediate treatment?

AImmediate dialysis before any other treatmentBIntravenous calcium gluconate with aggressive isotonic fluid resuscitationCFurosemide aloneDOral potassium binders alone

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

The answer and the reasoning

B. Intravenous calcium gluconate with aggressive isotonic fluid resuscitation

Crush injury causes rhabdomyolysis, releasing potassium, myoglobin and phosphate, leading to life-threatening hyperkalaemia and myoglobinuric kidney injury. Calcium stabilises the myocardial membrane, and early vigorous isotonic fluids maintain urine flow and clear myoglobin, with insulin and glucose, salbutamol and later dialysis as needed.

Option by option

A. Immediate dialysis before any other treatment
Dialysis is valuable but takes time, and cardiac membrane stabilisation cannot wait.
B. Intravenous calcium gluconate with aggressive isotonic fluid resuscitation (correct)
Correct. Calcium protects the heart, and fluids prevent pigment nephropathy.
C. Furosemide alone
A diuretic alone in a hypovolaemic patient worsens renal perfusion and does not treat the ECG changes.
D. Oral potassium binders alone
Oral binders act too slowly for an arrhythmogenic potassium level.

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 General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Intravenous calcium gluconate with aggressive isotonic fluid resuscitation. Crush injury causes rhabdomyolysis, releasing potassium, myoglobin and phosphate, leading to life-threatening hyperkalaemia and myoglobinuric kidney injury.

Why is "Immediate dialysis before any other treatment" not the answer?

Dialysis is valuable but takes time, and cardiac membrane stabilisation cannot wait.

Why is "Furosemide alone" not the answer?

A diuretic alone in a hypovolaemic patient worsens renal perfusion and does not treat the ECG changes.

Why is "Oral potassium binders alone" not the answer?

Oral binders act too slowly for an arrhythmogenic potassium level.

What concept does this question test?

It tests Trauma: crush injury in General Surgery. Calcium stabilises the myocardial membrane, and early vigorous isotonic fluids maintain urine flow and clear myoglobin, with insulin and glucose, salbutamol and later dialysis as needed.

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 Trauma: crush injury?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.