Toxicology and antidotes: chelator adverse effects: practice question

A Pharmacology 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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Pharmacology · Toxicology and antidotes: chelator adverse effects

Sample item

A woman on long-term treatment for Wilson disease develops 4 g per day of proteinuria and oedema. A renal biopsy shows membranous nephropathy. Which drug is the likely cause?

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

The answer and the reasoning

C. Penicillamine

Penicillamine causes immune-mediated membranous nephropathy, as well as rash, lupus-like syndrome, myasthenia and bone marrow suppression. Trientine is better tolerated and used when penicillamine is not, and zinc blocks copper absorption. Dimercaprol is an injection used in acute arsenic and mercury poisoning.

Option by option

  • A. Dimercaprol

    Dimercaprol is given by injection for acute metal poisoning, not long-term Wilson therapy.

  • B. Zinc acetate

    Zinc acetate causes gastric irritation and does not cause nephropathy.

  • C. Penicillamine (correct)

    Correct. Penicillamine is a recognised cause of membranous nephropathy and nephrotic syndrome.

  • D. Trientine

    Trientine is less likely to cause immune-mediated renal disease and is the usual alternative.

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 Pharmacology question

What is the answer to this Pharmacology question?

The best answer is C, Penicillamine. Penicillamine causes immune-mediated membranous nephropathy, as well as rash, lupus-like syndrome, myasthenia and bone marrow suppression.

Why is "Dimercaprol" not the answer?

Dimercaprol is given by injection for acute metal poisoning, not long-term Wilson therapy.

Why is "Zinc acetate" not the answer?

Zinc acetate causes gastric irritation and does not cause nephropathy.

Why is "Trientine" not the answer?

Trientine is less likely to cause immune-mediated renal disease and is the usual alternative.

What concept does this question test?

It tests Toxicology and antidotes: chelator adverse effects in Pharmacology. Trientine is better tolerated and used when penicillamine is not, and zinc blocks copper absorption. Dimercaprol is an injection used in acute arsenic and mercury poisoning.

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 Toxicology and antidotes: chelator adverse effects?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology 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.