toxicology is a very important topic for pg entrance.....so all about it has been discussed in detail as required for pg entrance....do make use of it...
2. Note : Toxicology is a very important topic and if u try reading each
poisons Separately , u will definitely forget them.
So best way to remember them more is to practice
MCQs and then read topics by correlating.
That’s what I think….
It may or may not apply for u…..
But atleast try once like this and then choose your own way .
3.
4. 1) Gastric lavage is indicated in all cases of acute poisoning ideally because of:
A Fear of aspiration
B Danger of cardiac arrest
C Danger of respiratory arrest
D Inadequate ventilation
5. Ans. A Fear of aspiration
The main danger of consuming a poison, other than
reducing the effects of poison itself on the body due to
absorption, is death due to aspiration pneumonitis.
It is because of this that gastric lavage is indicated in all
cases of acute poisoning wherever possible.
6. -Ideal time = <3hrs
-Initially lavage should be done with plain water since the poison need to be
sent to lab for tests.
-MC substance used for gastric Lavage = KMnO4
- Ideal tube = Lavacutor
- Position of Patient during lavage = Prone/Left lateral
- Contra Indicated in = Corrosives except Carbolic acid
(Since Increase chance of aspiration)
8. -Measure from tip of nose to ear lobe first……
- then measure from ear lobe to xiphoid process….
- add both measurements and mark it on Ryle’s tube….
-Insert Ryle’s tube upto that level.
9. -Government doctor should inform all cases
of poisoning to Police
- Private practitioner should inform only in
Homicidal cases.
10.
11. Opium is always secreted into G.I.T doesn’t matter from which route it is taken/
administered. So gastric lavage is compulsory for opium poisoning.
12. Q.2) A 60 year old man presents in OPD with history of opium
addiction for the last 20 yrs. He has given up opium for 2 days.
Withdrawal symptoms will include:
A )Drowsiness
B )Constricted pupil
C) Rhinorrhoea
D)↓ed Blood pressure
13. Ans. C Rhinorrhoea
Withdrawal symptoms due to any drug of addiction are usually
same, barring minor differences- Chilliness/ sensation of cold,
uneasiness, yawning, rhinorrhoea, lacrimation, goose-skin,
tremors, dilated pupils, anorexia, tachypnoea, ↑ sleep, fever,
HT, cramps legs/abdomen, diarrhoea.
-All secretions are increased like lacrimation, Rhinorrhea ,
vomitings,etc.
14. -Derived from Poppy plant
- Unriped fruit is Toxic
-Seeds are not toxic
-Lethal dose : 2gms
- Lethal dose of Morphine = 0.2gms
-Active principle = Endorphin
-Black color postmortem lividity
NATURAL SYNTHETIC
Morphine Bupronorphine
Codeine Methadone
Heroin Dextromethorphine
Thebaine
Poppy plant
15.
16. 1) Stage of Excitement = Hallucination
2) Stage of stupor
3) Stage of coma = Pin point non reacting pupil,hypotension, bradycardia,
Respiratory depression
- There may be whit froth from mouth , in PM examination.
18. 1) Acute Intoxication = I.V Naloxone followed by Naltrexone
2) Withdrawal symptoms = Methadone> Buprenorphine
Since methadone is a opioid agonist and it produces all effects of morphine/heroin
except dependence
3) Maintenance therapy = Methadone> Buprenorphine
4) Aversion therapy = Naltrexone
19. -Di acetyl Morphine
-Addiction is known as Cutting-In
-Also k/a Brown sugar/smack/junk
-Smoking Heroin is k/a Chasing The Dragon
-Speed ball = Heroin + Cocaine
20. -CNS Stimulant
-Mech. ; Dopamine/Serotonin/Nor epinephrine
-Vasoconstrictor
-Derives from leaves of erythoxylum cocca
-Tactile hallucinations: also k/a Cocaine bugs/magnan bugs
-Paranoid delusions : is the fixed, false belief that one is being
harmed or persecuted by a particular person or group of people.
-If sniffed can cause Nasal septum perforation
-On oral intake : Black jet tongue
-Antidote = Amyl Nitrate
23. 3.Q. The sensation of creeping, bugs over the body is a feature
of poisoning with:
A Cocaine
B Diazepam
C Barbiturates
D Brown sugar
24. Ans. A Cocaine
‘Cocaine bugs’/ Magnan’s symptoms,
+ ulceration of the nasal septum due to sniffing.
Cocainism= Cocaine habit
Cocainomania- chr. abusers tolerate upto 10gms/day.
Antidote- amyl nitrite.
25. 4.Q. Which type of cattle poisoning occurs due to ingestion
of LINSEED (Alsi) plant:
A Aconite
B Pilocarpine
C Atropine
D Hydrocyanic acid
27. 5.Q) Heera Lals’s 10 year old child presented in casualty with
snakebite since six hours. On examination no systemic signs
are found & lab investigation are normal except localized
swelling over the leg <5 cms. Next step in management
would be:
A Incision & suction of local swelling
B I/V anti-venom serum
C S/c anti-venom at local swelling
D Observe the patient for progression of symptoms wait for
anti-venom therapy
28. Ans. D Observe the patient for progression of symptoms
wait for anti-venom therapy
Since there no systemic signs & lab investigation are
normal and there is only mild swelling over the leg <5 cms
….
These is considered non toxic and swelling is a reaction
of inflammation….
so we can wait till further symptoms arrives…
29. -Ophistoxemia
- Cobra
-Common Krait
-King Cobra
-Viper : Russel viper
Saw scaled Viper
-Sea Snake = Myotoxic
- In Krait local symptoms are absent
Elipidae group
- Neurotoxic
Hemotoxic
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42. Krait is most poisonous but still Cobra is considered more
dangerous since it inserts 40times more poison than KRAIT
Fatal dose= Cobra=12mg
Krait = 6mg
Fatal Period= ½ -6hrs
43.
44.
45. 1) Immobilise the limb as movement may aggrevate spread
2) Bite site shouldn’t be cleaned or sucked
3) Tourniquet is of no use as poison spreads from lymphatics and not from
blood vessels but still if it is applied ,it shouldn’t be very tight.
The pressure should be less than 70mmHg.
4) Antisnake Venom : Produced in Hoffkin Institute Bombay
48. 6.Q.Cherry-red colour in post mortem staining is a feature of
poisoning with:
A Nitrites
B Aniline
C Phosphorus
D Carbon Monoxide
49. Ans. D Carbon Monoxide
(Colour of post-mortem staining in poisoning-
1) Dark brown or yellow- Phosphorus or acute copper poisoning,
2)Cherry red- CO & Cold storage,
3) Bluish-green- H2S,
4) Bright red- HCN/ Cyanides,
5) Chocolate/Red-brown coloured- Nitrites/Nitrates, aniline, Nitrobenzene,
Acetanilide, Bromates, Chlorates (due to formation of Methaemoglobin.)
50. 7.Q. In exhumed bodies, poison likely to be detected:
A Dhatura
B Mercury
C Arsenic
D Cocaine
51. Ans. C (Arsenic is the poison likely to be detected in exhumed bodies as it
undergoes post-mortem imbibition.)
52.
53. Metallic Arsenic is not poisonous since it is not absorbed in intestines
Arsenic oxide or arsenic trioxide is poisonous and it occurs in powder form.
It has no smell,no taste and partly soluble in water.
-Copper arsenite - Scheele’s Green
- copper acetoarsenite – Paris green
-It reacts with sulfhydryl group and interferes
with cell metabolism
-Fulminant dose: 3-5gms
- fulminant period: 1-3hrs
Fatal dose – 100-200mg
Fatal period: 1-2days
54.
55. Aldrich mee lines
- Rain drop pigmentation/rash/Red velvety Mucosa
Sub endocardial hemorrhage
Excessive pigmentation
Neuritis
Iron Oxide + BAL : Treatment
Mimics Cholera
56.
57.
58. 1) Hemodialysis
2) Gastric lavage– but do not mix alkali as it may increase solubility
of arsenic
3) Chelating agent : BAL+ Iron Oxide
4) arsine binds to and causes rapid destruction of red blood cells, so blood
transfusions and exchange transfusions may help the patient
59. ARSENOPHAGISTS – Persons who can tolerate Arsenic in high doses
-Mimics Cholera/Measles/addison’s disease
- may cause basal cell carcinoma
- also causes fatty infiltration of liver/NCPF
- Ideal Test: Gutzeit Test > Reinsch Test
- In chronic poisoning arsenic may be found in Bones/nails/hairs
-Can be detected even in decomposed body/bones/ashes
- delays putrifaction
60. 8.Q.Which of the following poisons has only local action?
A Sulphuric acid
B Carbolic acid
C Oxalic acid
D Phosphorus
61. Ans. A Sulphuric acid
Sulphuric acid - effect on the system.
Extract the water from the tissues
Fixes, destroys and erodes the tissues
Converts haemoglobin in to heamatin
Causes coagulation necrosis by precipitation of proteins
62. -Oil of Vitriol
-Vitriolage : Throwing corrosive on another person
-MC symptom dur to ingestion : Pharyngeal Pain
-Brown discoloration of stomach
-Only local symptoms…no systemic effects
-Maximum chance of stomach perforation among all corrosives
-Mucosa will be burnt : Bloating Paper appearance
-Gastric lavage and alkali administration is contra indicated
-Antidote = MgO
63.
64. -PHENOL
-Only corrosive where gastric lavage can be done.
-Metabolites : Pyrocatechol
Hydroquinone
-Ochronosis : Hydroquinone deposits in cartilages.
-Carboluria : Both metabolites when excreted in urine gives Green colour
-Delays decomposition
-Causes miosis
-Fatal dose : 1-2ml
-Fatal period: 3-4hrs
Mnemonic : 1-2-3-4
65. -Acid of Sugar/ Acid of Sorrel
-Presnt in Tomato/ Cabbage/ Spinach
-Oxalate reacts with calcium and thus causes Hypocalcemia
-Used as Ink remover
-Coffee ground vomiting: Blood + vomiting
-Antidote: Calcium Gluconate
Coffee ground vomiting
66. -Aqua Fortis
-Gives brown color to urine
-Xanthoproteic reaction : Skin becomes Yellow
-Brown mucosa
70. -MC route of poisoning = Inhalation
-Sindhur = Lead Tetraoxide
-Antidote = E.D.T.A ( In children: DMSA (succimer)
-MC lead leading to toxicity= Lead acetate
-Lethal dose = 20gm
-Chronic poisoning is known as Plumbism/Saturnism
75. LAB PARAMETER VALUES REMARK
1) Coproporphyrin in
Urine
>150mcg/l Exposure to lead
2) Amino Levulinic Acid
in Urine
>5mg/l Indicates lead
absorption
3) Lead in blood >70mcg/100ml Clinical symptoms
appears
4) Lead in urine >0.8mg/l Lead exposure and
absorption
5) Basophilic stippling
of RBCs
Punctate basophilia
76. 10)Q. An addicted patient presenting with visual and tactile
hallucinations, has black staining of tongue and teeth,
the agent is:
A Cocaine
B Cannabis
C Heroin
D Opium
77. Ans. A Cocaine
COCAINE POISONING-
tactile hallucinations (Magnan's symptoms = Cocaine bugs),
visual hallucinations,
black staining of tongue & teeth,
ulceration of the nasal septum due to sniffing.
78. 11)Q. A farmer was brought to the casualty with restlessness and
agitation. Examination shows temp 1030 F, flushed face, pupils
dilated and fixed. The diagnosis is:
A Dhatura poisoning
B Organophosphorus poisoning
C Diazepam poisoning
D Opium poisoning
79. Ans. A Dhatura poisoning
Hot as a hare,
Blind as a bat,
Dry as a bone,
Red as a beet,
Mad as wet hen.
Pyrexia + contracted pupils = Phenobarbitone poisoning;
Pyrexia + dilated pupils = Datura poisoning.
82. 12) Q.BAL is used as an antidote poisoning for:
A Morphine
B Aconite
C Phenol
D Mercury
83. Ans. D Mercury B.A.L. = Dimercaprol = British anti-lewisite = As, Pb, Bi, Cu, Hg, Gold.
Action- heavy metals combine with the two –SH groups on BAL.
Dose- 3-4 mg/kgbw of 10% BAL
84. 1) British Anti Lewisite (B.A.L)
(Dimercaprol)
Given in = Arsenic
Mercury
C.I in = Iron/Cadmium