Previous year question on poisoninig part iii and iv based on neet pg, usmle, plab and fmge or mci...

Which of the following clinical manifestation is seen in severe copper sulphate poisoning?

A: Acute hemolysisB: High anion gap acidosisC: Peripheral neuropathyD: Rhabdomyolysis

Correct Ans:AExplanationIngestion of copper sulfate or other salts causes the rapid onset of nausea and vomiting with characteristic blue-green vomit. Gastrointestinal bleeding may occur. Fluid and blood loss from gastroenteritis may lead to hypotension and oliguria. Intravascular hemolysis can result in acute tubular necrosis. Multisystem failure, shock, and death may occur. Ref: Buchwald A. (2012). Chapter 56. Copper. In K.R. Olson (Ed), Poisoning & Drug Overdose, 6e.

Sample Previous Year Question on Toxicology based on previous Year Questions of NEET PG, USMLE,PLAB,FMGE (MCI Screening). Please visit www.medicoapps.org for more such Quizzes

Which of the following is a manifestation of Copper sulphate poisoning?


Correct Ans:AExplanation

Acute copper sulphate poisoning can manifest with acute hemolysis. The pathogenesis of this effect is not known but may be related to copper induced oxidation of intracellular glutathione, hemoglobin and NADPH as well as inhibition of Glucose 6 phosphate dehydrogenase by copper.

Patients with acute copper poisoning presents with severe nausea, vomiting, thirst, metallic taste in mouth, burning pain and salivation. Oliguria, hematuria, uremia and albuminuria is also seen. Patients usually die of shock.

Ref: Toxicology of Metals, Volume 1 edited by Louis W. Chang, page 941. Concise Textbook Of Forensic Medicine & Toxicology By Sharma page 267.


Copper sulphate poisoning manifests with which of the following feature?



Acute copper sulphate poisoning can manifest with acute hemolysis. The pathogenesis of this effect is not known but it may be related to copper induced oxidation of intracellular glutathione, hemoglobin and NADPH as well as inhibition of Glucose 6 phosphate dehydrogenase by copper. Patients with acute copper poisoning also presents with severe nausea, vomiting, thirst, metallic taste in mouth, burning pain and salivation. Oliguria, hematuria, uremia and albuminuria is also seen. Patients usually die of shock. Ref: Toxicology of Metals, Volume 1 edited by Louis W. Chang, page 941. Concise Textbook Of Forensic Medicine & Toxicology By Sharma page 267.


Which of the following enzyme is affected in cyanide poisoning?

A: G-6-P dehydrogenase deficiencyB: IsomeraseC: Cytochrome oxidaseD: None of the above

Correct Ans:CExplanation Cyanide inhibits the action of cytochrome oxidase and carbonic anhydrase. It blocks the final step of oxidative phosphorylation and prevents the formation of ATP and its use as energy source. Cyanide acts by reducing the oxygen carrying capacity of blood, and by combining with the ferric iron atom of intracellular cytochrome oxidase, preventing the uptake of oxygen for cellular respiration. Ref: The Essentials of Forensic Medicine and Toxicology by KS Narayan Reddy, 27th edition, Page 558-559.


Which of the following poisoning is demonstrated by Kunkel's test?

A: LeadB: CuSO4C: COD: DhaturaCorrect Ans:CExplanationKunkel's test or tannic acid test: If tannic acid is added to blood it remains cherry-red in CO poisoning, where oxyhemoglobin turns deep brown. Hoppe-Seyler’s test is also used to identify CO poisoning. Few drops of blood are added to a solution of 10% sodium hydroxide. Normal blood turns brownish-green, but if CO is present, the color will remain pink. Ref: The Essentials of Forensic Medicine and Toxicology by KS Narayan Reddy, 27th edition, Page 555.


A patient in emergency department shows Mc Ewan sign. This sign is positive in the following condition:

A: Cyanide poisoningB: Alcoholism

C: LeadD: Arsenic poisonCorrect Ans:BExplanationMc Ewan sign is seen in stage of coma of acute alcohol intoxication. Stage of coma of alcohol intoxication: In this stage, the motor and sensory cells are deeply affected, speech becomes thick and slurring, coordination is markedly affected, causing the patient to become giddy, stagger and possibly to fall. The person passes into a state of coma with stertorous breathing. The pulse is rapid and temperature subnormal. The pupils are contracted, but stimulation of the person, e.g., by pinching or slapping, causes them to dilate with slow return (Mc Ewan Sign). Ref: The Essentials of Forensic Medicine and Toxicology by KS Narayan Reddy, 27th edition, Page 502.


Mechanism of action of ethyl alcohol in methyl alcohol poisoning is:

A: Saturate alkaline phosphataseB: Blocks formation of formaldehydeC: Inhibit Ca releaseD: All of the above

Correct Ans:BExplanationEthanol is the antidote for methyl alcohol poisoning. Methyl alcohol is oxidized to formaldehyde by the enzyme catalase. This catalase can also oxidize ethyl alcohol to acetaldehyde. In methyl alcohol poisoning, ethyl alcohol by competition for catalase, blocks the formation of formaldehyde and allows the less toxic methyl alcohol to be excreted unmetabolized. Ref: The Essentials of Forensic Medicine and Toxicology by KS Narayan Reddy, 27th edition, 13.


Which of the following enzyme is affected by cyanide poisoning?

A: G-6-P dehydrogenase deficiencyB: IsomeraseC: Cytochrome oxidaseD: None of the above

Correct Ans:CExplanationCyanide is a chemical asphyxiant; binding to cellular cytochrome oxidase, it blocks the aerobic utilization of oxygen. Unbound cyanide is detoxified by metabolism to thiocyanate, a much less toxic compound that is excreted in the urine. Ref: Blanc P.D. (2012). Chapter 57. Cyanide. In K.R. Olson (Ed), Poisoning & Drug Overdose, 6e.


In which of the poisoning, gastric wash is contraindicated?

A: Oxalic acidB: Sulphuric acidC: OpiateD: DhaturaCorrect Ans:BExplanationGastric lavage is useful any time within 3 hours after ingestion of a poison. The only absolute contraindication of gastric lavage is corrosive poisoning (except carbolic acid), owing to the danger of perforation. Precautions should be taken for convulsant poisons, in comatose patients, volatile poisons, upper alimentary diseases, marked hypothermia, and hemorrhagic diathesis. Ref: Essentials of Forensic Medicine and Toxicology by KS Narayan Reddy, 27th edition, Page 453.


A teenager brought to the emergency room is noted to be hyperventilating. Blood gas studies demonstrate both a respiratory alkalosis and a metabolic acidosis. This presentation is most suggestive of poisoning with which of the following

agents?

A: AcetaminophenB: Carbon monoxideC: LeadD: SalicylatesCorrect Ans:DExplanationIt is worth learning the presentations of the common poisons listed in the answer choices, because a timely diagnosis can sometimes save a patient's life. The presentation of the teenager in the question is typical for salicylate poisoning, including poisoning with aspirin. Fatalities are typically due to dehydration and hypokalemia. In contrast to the acute toxicity of salicylates, acetaminophen poisoning produces nausea, vomiting, abdominal pain, and shock in some cases; it can cause irreversible hepatic failure (which can be prevented or ameliorated by

administration of N-acetylcysteine) 2-6 days after ingestion. Carbon monoxide causes hypoxia, and a cherry red coloration of the lips and mucous membranes may be evident. Lead and mercury poisoning are both usually seen in their chronic forms, although mercury ingestion can produce an acute toxicity with renal tubular necrosis and necrosis of gastrointestinal epithelium. Chronic lead poisoning can cause anemia (with basophilic stippling of RBCs), neuropathy, and abdominal pain. Ref: Corbridge T., Murray P., Mokhlesi B. (2005). Chapter 102. Toxicology in Adults. In J.B. Hall, G.A. Schmidt, L.D. Wood (Eds), Principles of Critical Care, 3e.


In which of the following condition nails and hairs are commonly preserved?

A: Acute lead poisoningB: Acute arsenic poisoningC: Chronic arsenic poisoningD: All of the above

Correct Ans:CExplanationIn chronic arsenic poisoning, arsenic is seen in the muscles for days, in the bones and in the keratin tissues, hair, nails and skin for years. It replaces phosphorus in the bone where it may remain for years. It can appear in hair and nails within hours of ingestion. Neutron activation analysis and atomic absorption spectroscopy helps in estimating concentration of arsenic in hair, nails, bones, etc. Ref: The Essentials of Forensic Medicine and Toxicology by K S Narayan Reddy, 27th edition, Page 423.


TRUE about Aluminium phosphide poisoning is all, EXCEPT:

A: Subendocardial infarctionB: Inhibits cytochrome A of respiratory chainC: Causes esophageal strictureD: Liberates phosphine gas

Correct Ans:CExplanationAluminium phosphide is a solid fumigant pesticide, insecticide and rodenticide.Mild intoxication produce nausea, vomiting, headache and abdominal pain and the patient usually recover. In moderate and severe poisoning, systemic manifestations are early and progressive and mostly fatal. G.I.T: Nausea,vomiting,diarrhoea,retrosternal pain.C.V.S: Hypotension, shock, arrhythmias, myocarditis, pericarditis, acute congestive heart failure.R.S: Cough, dyspnoea, cyanosis, pulmonary edema, respiratory failure.Hepatic: Jaundice, hepatitis, hepatomegaly.Renal: Renal failureC.N.S: Headache, dizziness, altered mental state, restlessness, convulsions, acute hypoxic encephalopathy, coma. Cardiogenic shock is the most common cause of death. Ref: K.S.N.Reddy 29th Ed Page 473


In a case of chronic arsenic poisoning all of the following samples are sent for laboratory examination, EXCEPT:

A: Nail clippingsB: Hair samples

C: Bone biopsyD: Blood sampleCorrect Ans:DExplanation

Arsenic is present in blood only during acute poisoning. In chronic poisoning arsenic gets deposited in the bone, keratin tissues, hair, nail and skin for many years. In the bone arsenic replaces phosphorous and remains for many years. Arsenic appear in the hair and nails within hours of ingestion. Neutron activation analysis and atomic absorption spectroscopy helps to estimate concentration of arsenic in hair, nails, bone etc.

Ref:The Essentials of Forensic Medicine and Toxicology By Dr KS Narayan Reddy, Page 475


Which among the following is the most common mode of lead poisoning?

A: IngestionB: DermallyC: InhalationD: None of the aboveCorrect Ans:CExplanationLead poisoning (Plumbism) may occur in 3 ways:

Inhalation - Most cases of industrial lead poisoning is due to inhalation of fumes and dust of lead or its compounds.

Ingestion - Small quantities of lead trapped in the upper respiratory tract may be ingested. Contaminated hands may also lead to ingestion.

Skin - Only organic lead (e.g., tetraethyl lead) is absorbed dermally.

Ref: Park’s Textbook of Preventive and Social Medicine, 19th edition, Page 662.


International lead poisoning prevention week is celebrated in:

A: JanuaryB: March

C: OctoberD: DecemberCorrect Ans:CExplanation“Eliminate lead in paint” is this year's theme for the International Lead Poisoning Prevention Awareness Campaign Week of Action on 20–26 October. During the campaign week, WHO and UNEP will encourage and facilitate efforts globally to eliminate lead paint and to:

raise awareness about lead poisoning; highlight countries and partners' efforts to prevent childhood

lead poisoning; and urge further action to eliminate lead paint.

Ref: http://www.who.int/mediacentre/events/meetings/2013/lead_poisoning/en/index.html


True about Minamata disease are all except:

A: Caused by methyl mercury toxicityB: First occurred in JapanC: Found in babies born to mothers with overt symptoms of mercury poisoningD: Babies characterised by microcephaly, cerebral palsy, severe mental retardation

Correct Ans:CExplanation

Knowledge about the extreme vulnerability of the fetus to methylmercury began with the Minamata Bay, Japan experience. The bay was heavily contaminated with methylmercury from industrial discharge. Fish bioconcentrated the toxicant and mothers acquired high blood levels from eating fish from the bay. While the mothers were usually without symptoms of mercury poisoning, their babies were born severely damaged with microcephaly, cerebral palsy, severe mental retardation, seizure disorders, blindness, deafness and other malformations. Ref : http://www.who.int/mediacentre/factsheets/fs361/en/index.html


Which of the following statements is true regarding enzyme inhibition?

A: Sulfonamides inhibit folate reductase irreversibilyB: Ethanol inhibits aldehyde dehydrogenase when used in methanol poisoning

C:Acetylcholinesterase inhibition by malathion can be reversed by increasing the levels of Acetylcholine

D: Fluoroacetate competitively inhibits Aconitase

Correct Ans:DExplanation

Sodium flouroacetate compete with acetic acid and form flouroacetic acid .This inhibit TCAcycle by poisoning aconitase enzyme activity.

Ref: Perspective in mycological research by Perspective in mycological research, The encyclopedia of nutrition and good health By Robert A. Ronzio page 436; Medical toxicology By Richard C. Dart page 65.


Mary, a 45-year-old lady from Bangalore suffers from botulism poisoning. This toxin blocks the release of acetylcholine and has the effect of:

A: Inhibiting adrenergic synapse transmissionB: Facilitating adrenergic synapse transmissionC: Inhibiting cholinergic synapse transmissionD: No effect on synaptic transmission


The botulinum toxin blocks the release of acetylcholine and has the effect of inhibiting cholinergic synapse transmission. Because there is an insufficient quantity of acetylcholine to open channels that allow for the influx of sodium ions into the muscle fiber, the end-plate potential is inadequate to cause an action potential. The neurotransmitters located at adrenergic synapses include epinephrine and norepinephrine but not acetylcholine.


Which of the properties accounts for ethanol's use in ethylene glycol poisoning?

A: Competitive inhibitor of NADPH oxidaseB: Competitive inhibitor of alcohol dehydrogenaseC: Competitive inhibitor of aldehyde dehydrogenaseD: Non-competitive inhibitor of aldehyde dehydrogenaseCorrect Ans:BExplanation

Ethanol acts by competing with ethylene glycol for alcohol dehydrogenase, the first enzyme in the degradation pathway. Because ethanol has a much higher affinity for alcohol dehydrogenase, about a 100-times greater affinity, it successfully blocks the breakdown of ethylene glycol into glycoaldehyde, which prevents the further degradation.

Ref: Lehninger Principles of Biochemistry, 4th Edition, Page 336; Updates in Emergency Medicine By John Cahill, 2002, Page 115


Which is false regarding Phenol poisoning?

A: Stomach wash may be given with charcoalB: Urine may turn blueC: Death may be due to respiratory failureD: CNS depression may occur

Correct Ans:BExplanation

Phenol is oxidized into hydroquinone and pyrocatechol, further oxidation of hydroquinone and pyrocatechol in urine causes a green colouration and is known as carboluria.

Ref: Essentials of Forensic Medicine and Toxicology by Narayan Reddy, 21st Edition, Page 459.


Prolonged administration of Sodium nitroprusside can cause poisoning of:

A: CyanideB: MethanolC: ArsenicD: Phenol


Cyanide poisoning can occur in rapid or excessive administration of sodium nitroprusside. The breakdown of nitroprusside in the body leads to dissociation into the components cyanide and nitric oxide. Accumulation of cyanide is more common in infusions of sodium nitroprusside exceeding 2g/kg/min.

Guidelines for safe administration of sodium nitroprusside has been established to prevent the risk of cyanide toxicity:

Maximum acute dose: 1.5 mg/kg for 1-3 hours

Maximum chronic dose: 0.5 mg/kg/hr


You are performing an autopsy on a person suspected to have died from arsenic poisoning. Which of the following tissues will hold the maximum concentration of arsenic?

A: LiverB: KidneyC: SpleenD: Bone


Metallic arsenic is non toxic since it is not absorbed in the GIT. Compounds like arsenic trioxide is absorbed after consumption and initially the largest concentration is seen in the liver followed by kidney and spleen. If death doesn’t occur in a few weeks it will be present in bones, hair, nails etc. The arsenic in the bones may be detected even in the charred bones or ash obtained after cremation.

Ref: Textbook of Forensic Medicine by Narayana Reddy, Edition 20, Page - 465


A patient who was on treatment for weakness of legs developed spastic gait and later paraplegic. Later he died and autopsy showed sclerosis of the lateral column of spinal cord. Assuming the reason for death is poisoning, which of the following could be responsible for the above mentioned findings?

A: Lathyrus sativusB: LeadC: StrychnineD: Thallium


Thallium poisoning causes pain in the legs, stomatitis, vomiting and features of peripheral neuritis. Lead poisoning causes anemia, colic, lead palsy etc. Strychnine causes muscle spasms and convulsions. The condition described in this case is neurolathyrism caused by BOAA. Though death is not very common, when it occurs autopsy shows sclerosis of the lateral column of the spinal cord.

Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 21, Page - 562


4 people in a family comes to you with burning sensation over the extremities. Some of them have also got vomiting, diarrhea. The pupils are dilated and occasional twisting of the muscles are present. What is the MOST likely cause of the symptoms?

A: Organophosphate poisoningB: Carbamate poisoning

C: Ergot poisoningD: Abrus precatorius poisoningCorrect Ans:CExplanation

This is a case of ergot poisoning usually as a result of eating contaminated rye bread. The burning sensation described is also called St. Anthony's fire. Due to the effect of the alkaloids ergotoxine, ergotamine, ergometrine and about 30 alkaloids present in the fungi, all the symptoms described in the question may be present.

Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 21, Page - 479


All the following are TRUE regarding lead poisoning, EXCEPT:

A: At a cellular level it interacts with the sulfhydryl groupB: Facial pallor is one of the earliest and most consistent signC: Initially there may be polycythaemiaD: None of the above


Though lead poisoning is associated with anemia, polychromasia, punctate basophilia, reticulocytosis and increased mononuclear cells ; it may also be associated with polycythaemia and polychromatophilia in the early stages. The facial pallor (mainly circum oral) seen in lead poisoning is believed to be due to vasospasm.

Also knowLead interacts with sulfhydryl groups and interferes with the enzymes essential for heme synthesis. Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 21, Page - 467.


Dicobalt EDTA is used for treating a poisoning case effectively. Which of the following poisoning is treated by dicobalt EDTA?

A: Cyanide

B: Sulfuric acidC: Nitric acidD: H2S


aerobic utilization of oxygen.

Dicobalt EDTA acts by chelating cyanide to form a harmless product that is excreted in the urine.

Cobalt EDTA and aminophenols are more rapid in action, efficacious, and less toxic than nitrites.

Ref: The essentials of forensic medicine and toxicology by Narayan Reddy, 27th edition, Page 560.


Oximes are mainstay of treatment in toxicology. All of the following poisonings are indications for using oximes, EXCEPT:

A: Tik20B: BaygonC: MalathionD: Parathion


Oximes are used in OPC poisoning and Baygon is a carbamate compound.

Oximes reactivate inhibited cholinesterase, remove the block at neuromuscular junction, prevent formation of phosphorylated enzyme, and directly detoxify organophosphates.

Oximes therefore counteracts nicotinic effects of organophosphorous poisoning which includes muscle fasciculation, muscle fatigue, muscle cramps, loss of deep

tendon reflexes, paralysis.

Ref: The essentials of forensic medicine and toxicology by Narayan Reddy, 27th edition, Page 460.


A patient presented with Aldrich-Mee's lines which are characteristic of which heavy metal poisoning?

A: LeadB: MercuryC: ArsenicD: Copper


Aldrich-Mee's lines:

Hyperkeratosis of the palms and soles with irregular thickening of the nails and development of bands of opacity in the fingernails.

It is seen in prolonged contact of Arsenic.

Ref: The essentials of forensic medicine and toxicology by Narayan Reddy, 27th edition, Page 475


A man who is working in marine timbers presented with a particular appearance on nails which is diagnosed as Mee's lines. Mee’s lines are seen in poisoning

with:

A: Arsenic

B: LeadC: MercuryD: Copper


Dermatologic effects of Arsenic poisoning:

Findings occasionally appear after a delay of 1–6 weeks.

Desquamation (particularly involving the palms and soles) A diffuse maculopapular rash Periorbital edema Transverse white striae in the nails (Aldrich-Mees lines) may

become apparent months after an acute intoxication.

Ref: Kosnett M.J. (2012). Chapter 24. Arsenic. In K.R. Olson (Ed), Poisoning & Drug Overdose, 6e.


Which of the following poisoning gives ‘Bitter almond smell’?

A: LeadB: CyanideC: MercuryD: OrganophosphorusCorrect Ans:BExplanation

Cyanide is having the classic "bitter almond" odor. Cyanide is a chemical asphyxiant; binding to cellular cytochrome

oxidase, it blocks the aerobic utilization of oxygen. Unbound cyanide is detoxified by metabolism to thiocyanate, a

much less toxic compound that is excreted in the urine.

Ref: Blanc P.D. (2012). Chapter 57. Cyanide. In K.R. Olson (Ed), Poisoning & Drug Overdose, 6e.


An alcohol addict consumed methyl alcohol contained ethanol. All of the following are TRUE about methanol poisoning, EXCEPT:

A: Symptoms may appear within one hourB: Cyanosis and dyspnoea

C: Urine is alkalineD: Hyperemia of optic discCorrect Ans:CExplanation

Methanol poisoning:

Symptoms may appear within an hour; they include:

Nausea and vomiting Abdominal pain Headache and neck stiffness Vertigo Confusion Muscular weakness Dyspnoea and cyanosis

Urine is strongly acid and may contain acetone.

Fundoscopy shows hyperaemia of optic disc followed by retinal oedema.

Ref: The Essentials of Forensic Medicine and Toxicology by Dr. K. S. Narayan Reddy, 27th edition, Page 512.


In CO poisoning all of the following clinical features are seen, EXCEPT:

A: CyanosisB: Cerebral edemaC: ConvulsionsD: Bradycardia


Carbon monoxide (CO) is a colorless, odorless, tasteless, and non irritating gas produced by the incomplete combustion of any carbon-containing material. CO binds to hemoglobin with an affinity 250 times that of oxygen, resulting in reduced oxyhemoglobin saturation and decreased blood oxygen-carrying capacity. CO may also directly inhibit cytochrome oxidase, further disrupting cellular function, and it is known to bind to myoglobin, possibly contributing to impaired myocardial contractility. Symptoms of intoxication are predominantly in organs with high oxygen consumption, such as the brain and heart.

The majority of patients describe headache, dizziness, and nausea. Patients with coronary disease may experience angina or myocardial infarction. With more severe exposures, impaired thinking, syncope, coma, convulsions, cardiac arrhythmias, hypotension, and death may occur. Cerebral edema (swelling of the brain) is also a common result of severe carbon monoxide poisoning. Survivors of serious poisoning may experience numerous overt neurologic sequelae consistent with a hypoxic-ischemic insult, ranging from gross deficits such as parkinsonism and a persistent vegetative state to subtler personality and memory disorders.Cyanosis is not seen in CO poisoning.

Ref: Olson K.R. (2012). Chapter 44. Carbon Monoxide. In K.R. Olson (Ed), Poisoning & Drug Overdose, 6e.


A child was dead in an fire accident department following CO poisoning. Which of the following is a feature of death due to CO poisoning?

A: Cherry red colourB: CyanosisC: Petechial haemorrhage over conjunctivaD: Frothing at the mouth


Above 80% of COHb% causes rapid death from respiratory arrest.

A cherry-red colouration of the skin, mucous membranes, conjunctiva, nail beds, areas of hypostasis, blood, tissues, and internal organs is seen in CO poisoning.

This colour changes to dark-green, then to brown with the onset of decomposition.

Ref: The Essentials of Forensic Medicine and Toxicology by Dr K. S.Narayan Reddy, 27th edition, Page 555.


A man working as a pest killer comes to OPD with pain abdomen, garlic odour in breath and transverse lines on nails. MOST likely the person is suffering from:

A: Arsenic poisoningB: Lead poisoning

C: Mercury poisoningD: Cadmium poisoningCorrect Ans:AExplanation

Garlic odour and transverse lines on nails i.e. Mee's lines are features of chronic arsenic poisoning.

Constitutional symptoms of chronic arsenic poisoning:

Fatigue Weight loss Weakness Anemia Nonspecific gastrointestinal complaints Sensorimotor peripheral neuropathy, particularly featuring a

stocking glove pattern of dysesthesia Skin changes—among the most characteristic effects—typically

"raindrop" pattern of hyperpigmentation, and hyperkeratoses involving the hands and feet

Transverse white striae (Aldrich-Mees lines) on nails.


A 48 year old man working as glass bangle maker presented with tremors of his hands. In which of the following heavy metal poisoning ‘Hatter's shakes’ are

seen?

A: ArsenicB: MercuryC: CopperD: Lead


Danbury tremors are seen with chronic mercury poisoning (hydrargyrism). It occur first in the hands, then progress to lips and tongue and finally involves arms and legs. The advanced condition is called Hatter's shakes or glass-blower’s shakes, because they are common in persons working in glass-blowing and hat industries. The most severe form is known as concussio mercuralis, in which no activity is possible.

Ref: The Essentials of Forensic Medicine and Toxicology, 27th edition, Page 477.


A man working as a pest killer comes to OPD with pain abdomen, garlic odour in breath and transverse lines on nails. Most likely the person is having:

A: Arsenic poisoningB: Lead poisoning

C: Mercury poisoningD: Cadmium poisoningCorrect Ans:AExplanation

In acute arsenic poisoning, there is usually a metallic taste in the mouth and some odour of garlic in the breath. Nausea, vomiting, abdominal pain, and watery diarrhea are common. Transverse white striae in the nails (Aldrich-Mees lines) may become apparent months after an acute intoxication.

Ref: Kosnett M.J. (2012). Chapter 24. Arsenic. In K.R. Olson (Ed), Poisoning & Drug Overdose, 6e.


In which of the following poisoning formication and insanity occurs together?

A: LSDB: AmphetamineC: CannabisD: Cocaine


In chronic cocaine users, degeneration of central nervous system will result in hallucinations, convulsions, delirium and insanity.

Magnan’s symptom or cocaine bugs is characteristic of chronic cocaine users, in which there is feeling as if grains of sand are lying under the skin or small insects are creeping on the skin giving rise to itching sensation (formication, tactile hallucination).

Ref: The Essentials of Forensic Medicine and Toxicology by Narayan Reddy, 27th edition, Page 536.


What is the case fatality rate of organophosphorous poisoning in India?

A: 15-30%B: 5-10%C: 40-50%D: 2-4%


poor intensive care management. Treatment for acute poisoning is essentially supportive, with atropine, oximes, and diazepam.

Atropine is the mainstay of treatment but there are no clear guidelines on dose and duration. Early resuscitation with atropine, oxygen, respiratory support, and fluids improves oxygen delivery to tissues.

A 2009 double blind randomised placebo controlled trial showed that pralidoxime, commonly given in acute poisoning, does not improve survival. New agents such as magnesium sulphate are in use, but clinical efficacy has not been shown.

Ref: 1. Srinivas Rao CH, Venkateswarlu V, Surender T, Eddleston M, Buckley NA. Insecticide poisoning in south India—opportunities for prevention and improved medical management. Trop Med Int Health 2005;10:581-8.

2. Eddleston M, Buckley NA, Checketts H, Senarathna L, Mohamed F, Sheriff MH, et al. Speed of initial atropinisation in significant organophosphorus pesticide poisoning—a systematic comparison of recommended regimens. J Toxicol Clin Toxicol2004;42:865-75;

3. M, Eyer P, Worek F, Juszczak E, Alder N, Mohamed F et al. Pralidoxime in acute organophosphorus insecticide poisoning— a randomised controlled trial. PLoS Med 2009;6:e1000104; Death by insecticide; BMJ 2013;346:f2029.


Dialysis is useful in poisoning with all of the following, EXCEPT:

A: Methyl alcoholB: Barbiturates

C: Ethylene glycolD: Copper sulphateCorrect Ans:DExplanation

Dialysis is useful in poisoning with ethanol, methanol, salicylates, theophylline, ethylene glycol, phenobarbitone and lithium.

Peritoneal and hemodialysis are useful in:

Poisoning with water soluble compounds of low molecular weight Toxin with low volume of distribution Toxin with low serum protein binding Toxin not irreversibly bound to the tissues

Properties of drugs or toxins eliminated by dialysis are:

Water soluble Low degree of protein binding Low molecular weight (less than 500 Da) Small volume distribution (less than 1 litre/kg) Enhanced clearance by dialysis over native clearence

Ref: Medicine By Mathew K.G., 3rd edn page 562.


Hemoperfusion with charcoal is useful in poisoning with which of the following?

A: Barbiturate poisoningB: Methyl alcohol

C: LithiumD: Ethylene glycolCorrect Ans:AExplanation

Hemoperfusion is used in poisoning with lipid soluble drugs such as barbiturates, glutethimide and theophylline.

Hemoperfusion is the technique of passing blood through a bed of particles contained within a device to which blood lines and a blood pump are attached. It differs from hemodialysis in that blood comes in direct contact with the membrane coated sorbent particle and not a continuous dialysis membrane, from plasma pharesis in that no plasma is separated from blood. Clinical indications of hemoperfusion: Poisoning (drug and chemical exposure), hepatic failure (drug induced, fulminant hepatic failure), treatment of uremia and its complications (aluminium toxicity).

Poisoning by water soluble drugs such as lithium and chemicals which cause acidosis (methanol, ethylene glycol, salicylate) are best treated with hemodialysis. Ref: Complications of Dialysis edited by Norbert Lamiere, page 127.


In which of the following poisonings Mc Ewan Sign is seen?

A: Acute alcohol intoxicationB: Carbon Monoxide poisoningC: Barbiturate poisoningD: Carbolic acid poisoningCorrect Ans:AExplanation

In acute alcohol intoxication when patient goes to the stage of coma, the pupils are contracted but stimulation of the patient cause them to dilate with slow return. This is known asMc Ewan Sign.

Carbolic acid poisoning: Odour of breath, white patches on lips and mouth and carboluria.Carbon Monoxide poisoning: History of exposure to poisoning with gas, intermittent convulsions, cherry red colour of skin and carboxyhemoglobin in blood.Barbiturate poisoning: Shallow respiration, deep coma, no response to painful stimuli, deep reflexes are depressed, subnormal temperature, low blood pressure, dilated pupils. Ref: The Essentials of Forensic Medicine and Toxicology 29th Ed Page 511.


MacEwen’s sign is seen in:

A: Lead poisoningB: Arsenic poisoningC: Ethanol poisoningD: Copper poisoning


MacEwen signs (MacEwen pupil) The pupil of a patient comatose from alcohol intoxication dilates briefly when the patient is stimulated but not awakened,

while that of a patient comatose from structural disease does not get dilated for mild stimulation.

Ref: Principles of forensic medicine, Apurva nandy, 3rd Edition,Page 847.


Which of the following poisoning causes priapism and increased desire to pass urine?

A: SnakebiteB: Ratti poisoningC: Cantharide poisoningD: Arsenic poisoning


Symptoms of cantharide poisoning:

Burning sensation in the mouth and throat, followed pain in the stomach

Severe thirst, difficulty in swallowing and speech Dull pain in the loins Scanty, and blood stained urine with increased desire to pass urine Priapism Prostration, convulsions and death Abortion in pregnant female

Ref: Textbook of Forensic Medicine and Toxicology by K S Narayan Reddy, 27th edition, Page 490.


Magnan’s symptom is seen in?

A: Datura poisoningB: Cocaine poisoningC: Cannabis sativa poisoningD: Cannabis indica poisoningCorrect Ans:BExplanation

Magnan’s or cocaine bugs is characteristic of cocaine poisoning, in which there is a feeling as if grains of sand are lying under the skin or some small insects are creeping on the skin giving rise to itching sensation with resultant excoriation, leading to irregular scratches and ulcers.

Ref: The Essentials of Forensic Medicine and Toxicology 29th Ed Page 545.


Previous year question on poisoninig part iii and iv based on neet pg, usmle, plab and fmge or mci...

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Transcript of Previous year question on poisoninig part iii and iv based on neet pg, usmle, plab and fmge or mci...