Previous year question on poisoninig part i and ii based on neet pg, usmle, plab and fmge or mci screening exams

Which is the investigation of choice in a case of stricture esophagus caused by corrosive poisoning ?

A: EndoscopyB: Barium mealC: PharyngoscopyD: X rays

Correct Ans:AExplanation

The corrosive injury is more common in females. Most of the patients were of younger ages. Acid ingestion was more common than alkali ingestion, and most had suicidal intentions. Early upper G.I. endoscopy has a definite role in diagnosing the severity of the injury and in planning the management. The best time to assess the injury is by 12-48 hours of ingestion of the corrosive substances. Most of the patients with corrosive injuries can be managed conservatively with follow up for the stricture, which is the most common complication that is often treated by dilatation.

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 one of the following condition is not associated with cupping and fraying of metaphyses of long bones in children?

A: RicketsB: Lead poisoningC: Metaphyseal dysplasiaD: Hypophosphatasia

Correct Ans:BExplanation

Cupping and fraying of metaphysis of long bones does not occur in lead poisoning. In lead poisoning bone changes become radiologically evident 3 months after chronic lead poisoning. Changes include dense metaphyseal bands exceeding cortical density of same bone, found in growing skeleton. Interference with normal modeling may result in splaying of the metaphysis resulting in Erlenmeyer flask deformity.

Ref: Bone and Joint Disorders By Francis A. Burgener, Martti Kormano, Tomi Pudas, 2nd Edition, Pages 316, 332; Radiology Review Manual By Wolfgang Dähnert, 7th Edition, Page 159; Pediatric Endocrine Disorders By Desai, Meena P, Page 73.


A patient with theophylline poisoning developed hypotension. Drug of choice in theophylline poisoning with hypotension is:

A: CortisoneB: PropranololC: ThyroxineD: PhenobarbitoneCorrect Ans:BExplanationAcute overdose of theophylline is characterized by hypotension, tachycardia, and hypokalemia. Treat hypotension with intravenous fluids. Propranolol, 0.02–0.05 mg/kg,

or esmolol, 25–50 g/kg/min, intravenously, may reverse hypotension associated with tachycardia, both of which are mediated by excessive beta adrenergic stimulation.

By contrast, chronic intoxication more commonly results in seizures and arrhythmias with much lower serum levels (ie, 20–70 mg/L). Hypotension and hypokalemia are uncommon.

Must know:

Theophylline, caffeine, and other methylxanthines cause bronchodilatation; gastric, central nervous system, and cardiac stimulation; and vasodilatation.

The minimum acute toxic dose is over 10 mg/kg, or 700 mg, in the average adult.

Ref: Morgan D.L., Borys D.J. (2011). Chapter 47. Poisoning. In R.L. Humphries, C. Stone (Eds), CURRENT Diagnosis & Treatment Emergency Medicine, 7e.


In which of the following poisoning is dimercaprol (BAL) contraindicated?

A: CadmiumB: Organic mercuryC: LeadD: ArsenicCorrect Ans:AExplanation

Dimercaprol will increase the excretion of cadmium, there is a concomitant increase in renal cadmium concentration, so that its use in case of cadmium toxicity is to be avoided. Dimercaprol also enhances the toxicity of selenium and tellurium, so it is not to be used to remove these elements from the body.

Ref: Gunnar Nordberg (2007), Chapter 15, “DIagnosis and Treatment of Metal Poisoning”, In the book, “Handbook on The Toxicology of Metals”, USA, Elsevier Publications, Page 313 ; KD Tripathy, 4th Edition, Page 873


Centrilobular zonal necrosis in liver is seen with which of the following drug?

A: Carbon tetrachlorideB: Rifampicin

C: INHD: Yellow phosphorus poisoningCorrect Ans:AExplanation

Carbon tetrachloride characteristically produce a centrilobular zonal necrosis, whereas yellow phosphorus poisoning typically results in periportal injury.

Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 2558.


In which of the following poisoning, pralidoxime is ineffective?

A: OrganophosphorusB: Carbaryl

C: Both of the aboveD: None of the aboveCorrect Ans:BExplanationOximes are used to displace organophosphates from the active site of acetylcholinesterase, thus reactivating the enzyme. Pralidoxime is a specific antidote that restores acetylcholinesterase activity by regenerating phosphorylated acetylcholinesterase and appears to prevent toxicity by detoxifying the remaining organophosphate molecules.

Clinically, pralidoxime ameliorates muscarinic, nicotinic, and central neurologic symptoms. Pralidoxime is not recommended for asymptomatic patients or for patients with known carbamate exposures presenting with minimal symptoms. There is increased toxicity of pralidoxime in carbaryl poisoning.

Ref: Robey III W.C., Meggs W.J. (2011). Chapter 195. Pesticides. In J.E. Tintinalli, J.S. Stapczynski, D.M. Cline, O.J. Ma, R.K. Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e.


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

A: SalicylateB: BarbituratesC: MethanolD: NifedipineCorrect Ans:DExplanation

Hemodialysis is the most effective and rapid method of removing dialysable poisons provided they are not irreversibly bound to tissue proteins. Hemodialysis is indicated in case of life threatening poisoning with ethanol, ethylene glycol, methanol, isopropanol, lithium, barbiturates, bromide and salicylates.

In hemoperfusion blood is perfused through a column containing activated charcoal or resin. It is simpler, less expensive, provides higher clearance rates and is better for lipid soluble toxins compared to hemodialysis. It is used for treating barbiturate, glutethimide or paracetamol poisoning. Ref: Drug Actions: Basic Principles and Therapeutic Aspects edited by Ernst Mutschler, page 631. Textbook of Medicine By Vasan, R.S. page 1330.


A patient is brought to the emergency department following carbon monoxide poisoning. Hyperbaric oxygen was given, following which patient developed oxygen toxicity. What is the likely mechanism of the toxicity?

A: Direct DNA damageB: Apoptosis

C: Nuclear fragmentationD: Mediated by free radicalsCorrect Ans:DExplanation

The free radical theory of oxygen toxicity explains the mechanism of oxygen toxicity. According to the theory, various highly reactive and potentially cytotoxic free-radical products of oxygen are generated metabolically in the cell.

These short-lived oxygen metabolites, including superoxide anion, hydroxyl radical, hydrogen peroxide, and singlet oxygen, have been shown to be capable of effects such as inactivation of sulfhydryl enzymes, interaction with and disruption of DNA, and peroxidation of unsaturated membrane lipids with resultant loss of membrane integrity.

The cell is also equipped with an array of antioxidant defenses, including the enzymes superoxide dismutase, catalase, glutathione peroxidase, vitamin E, and ascorbate. Under hypoxia, the intracellular generation and influx of free radicals is believed to increase markedly and may overwhelm the detoxifying capacity of the normal complement of antioxidant defenses, with resultant cytotoxicity.

The pathology of oxygen toxicity in the lungs is non-specific and consists of atelectasis, edema, alveolar hemorrhage, inflammation, fibrin deposition, and thickening and hyalinization of alveolar membranes.

Ref: Yao & Artusio's Anesthesiology: Problem-Oriented Patient Management By Fun-Sun F. Yao, Vinod Malhotra, M.D., 2012, Page 67 ; Pulmonary physiology by Michael G. Levitzkypage, 2007, Page 245


Which of the following cause of death would cause an elevated level of cyanide?

A: ColdB: StarvationC: Thermal bumsD: Poisoning

Correct Ans:CExplanation

During smoke inhalation in thermal deaths apart from CO, the other factors which contribute to death are oxygen deprivation, cyanide, free radicals (inactive surfactants, thus preventing oxygen from crossing the alveoli into the blood), and non-specific toxic substances.

Ref: The Essentials of Forensic Medicine and Toxicology by Narayan Reddy, 27th edition, Page 285.


‘Boxer’s attitude’ is seen in person dying of the following condition:

A: FearB: PoisoningC: BurnsD: StrangulationCorrect Ans:CExplanationPugilistic Attitude (boxing, fencing or defence attitude):

The posture of a body which has been exposed to great heat is often characteristic. The legs are flexed at the hips and knees, the arms are flexed at elbows and wrists and held out in front of the body, head slightly extended, all fingers are hooked like claws. Contraction of paraspinal muscles often causes a marked opisthotonus, in an attitude commonly adopted by boxers. This stiffening is due to the coagulation of proteins of the muscles and dehydration which cause contraction.

Ref: Essentials of Forensic Medicine and Toxicology by KS Narayan Reddy, 27th edition, Page 286.


Gettlers test is done for detecting death by:

A: DrowningB: Hanging

C: BurnsD: Phosphorus poisoningCorrect Ans:AExplanation

Gettlers test is done for detecting death due to drowning.

According to this test, if death occured in salt water, the blood chloride concentration was greater in the left heart chambers when compared to right due to hemoconcentration.

If death occured in fresh water, the blood chloride concentration was greater in the right heart chambers due to hemodilution.

Diatom test can be used to differentiate between drowning and non drowning cases. According to this test if a person dies from drowning in water containing diatoms, it can be demonstrated in the lung parenchyma and in distant organs such as heart, brain, kidney and bone. Whereas if a dead body is immersed in water, diatoms can be demonstrated only in the lung parnchyma and not in other organs. Because diatoms reach the lungs by passive percolation but not to distant organs because of absent circulation. Ref: Parikh's Textbook of Medical Jurisprudence Forensic Medicine and Toxicology, 5th Edition, Page 216 and 6th Edition, Page 3.68


At autopsy, a body is found to have copious fine leathery froth in mouth and nostrils which increased on pressure over chest. Which of the following was the most likely cause of death?

A: EpilepsyB: Hanging

C: DrowningD: Opium poisoningCorrect Ans:CExplanation

Presence of fine, white, leathery froth seen at the mouth and nostrils is one of the most characteristic external signs of drowning. It is white or rarely blood stained, lather-like, abundant and increase in amount with compression of chest. Even after wiping it gradually reappears, especially if pressure is applied to the chest.

Froth is also seen in strangulation, acute pulmonary edema, electric shock, during epileptic fit, in opium poisoning and putrefaction. But in all these cases the quantity of froth is not as large as in drowning, and the bubbles are also much smaller.

Ref: Parikh’s Textbook of Medical Jurisprudence, Forensic Medicine and Toxicology, 6th Edition, Pages 3.66-3.67 ; Essentials of Forensic Medicine and Toxicology By Dr K S Narayan Reddy, 27th Edition, Pages 325-6


Tardieu spots are a feature of which of the following forms of death?

A: Cyanide poisoningB: Mechanical asphyxiaC: Cobra biteD: Organophosphate poisoningCorrect Ans:BExplanation

Tardieu spots or petechial haemorrhages are pinhead size bleeding spots occurring as a result of rupture of venules and are most commonly seen in sclera, conjunctiva or on serous membranes. It is seen in case of mechanical asphyxia.

Ref: Textbook of Forensic Medicine and Toxicology By V.V Pillay, 15th Edition, Page 275


In which of the following conditions postmortem caloricity may be seen in death due to:

A: Massive haemorrhageB: Cyanide poisoningC: Corrosive poisoningD: Septicemia

Correct Ans:DExplanation

In this condition, the temperature of the body remains raised for the first two hours or so after death.

Ref: The Essentials of Forensic Medicine and Toxicology By K S Narayan Reddy, 27th Edition, Pages 136


All of the following causes decreased clotting of blood after death, EXCEPT:

A: CO poisoningB: Amniotic fluid embolismC: Puerperal sepsisD: None of the aboveCorrect Ans:DExplanationDecreased clotting of blood is seen certain case of rapid death from asphyxia. It is also seen in death due to CO poisoning, certain cases of septicaemia, amniotic fluid embolism, hypofibrinogenemia, retained abortion, puerperal sepsis etc. Ref: The Essentials of Forensic Medicine and Toxicology by Narayana Reddy, Edition 21, Page 95


Suppose a body is lying in a desert and the person had been suffering from chronic arsenic poisoning while alive. Which one of the following is the MOST possible finding in the body?

A: Adipocere formationB: MummificationC: Aseptic acetolysisD: Saponification


The conditions ideal for mummifications are high temperature, dry environment and freely circulating air around the body. Chronic arsenic and antimony poisoning also inhibit bacterial growth and promote mummification. So in this scenario mummification is most likely.

Also knowSaponification or adipocere formation occurs in warm and humid region in the absence of free circulation of air.

Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 23, Page - 138.


A dead body found to have cadaveric spasm after strychnine poisoning. Which one of the following is TRUE regarding cadaveric spasm?

A: It occurs immediately after deathB: Affects all groups of muscles simultaneouslyC: After passing of rigor mortisD: None of the above


Cadaveric spasm or Instantaneous rigor or Cataleptic rigidity:

In this, the muscles that were contracted during life become stiff and rigid immediately after death without passing into the stage of primary relaxation.

This is usually limited to a single group of voluntary muscles and frequently involves the hands.

It occurs especially in cases :

Sudden death Excitement Fear Severe pain Exhaustion Cerebral hemorrhage Injury to the nervous system Firearm wound of the head Convulsant poisons such as strychnine

It passes without interruption into normal rigor mortis and disappears when rigor disappears.

Ref: The Essentials of Forensic Medicine and Toxicology by Dr K. S.Narayan Reddy, 27th edition, Page 143.


A dead body is having cadaveric lividity of greenish-purple colour. The most likely cause of death is by poisoning due to:

A: Hydrocyanic acidB: Hydrogen sulphideC: OleanderD: Sodium nitriteCorrect Ans:BExplanation

Post mortem appearances of hydrogen sulphide (H2S) poisoning:

Rotten egg odour General signs of asphyxia The colour of the blood and viscera and bronchial secretions is

greenish-purple.

In hydrocyanic acid poisoning the colour is bright red. In poisoning by nitrites, potassium chlorate, potassium bicarbonate, nitrobenzene, acetanilide, bromates, and aniline the colour is chocolate or copper brown. There is no characteristic appearance in oleander poisoning. Ref: Textbook of Forensic Medicine and Toxicology by K S Narayan Reddy, 27th edition, Page 557.


All of the following factors accelerate the development of rigor mortis in a dead body, EXCEPT:

A: Thin body builtB: Aerobic exerciseC: Cold temperatureD: Strychnine poisoningCorrect Ans:CExplanationCold temperature slows the onset and progression of rigor mortis. It is because of the slow onset and breakdown of ATP in cold weather. Rigor mortis usually has an onset 1-2 hours after death and gets well established in the entire body in about 9-12hrs. Factors accelerating the onset of rigor mortis are:

Warm temperature Thin body built Aerobic exercise Strychnine poisoning (produces convulsions)

Ref: Forensic Science: Fundamentals & Investigations By Anthony J. Bertino, page 315.


Carbon monoxide poisoning shows the following post-mortem staining:

A: Cherry red postmortem stainingB: Pink postmortem stainingC: Chocolate coloured postmortem stainingD: Blue postmortem staining

Correct Ans:AExplanationIn carbon monoxide poisoning, the colour of post mortem staining is cherry-red.

In poisoning by nitrites, potassium chlorate, potassium bicarbonate, nitrobenzene, acetanilide, bromates, and aniline the colour is chocolate brown. In asphyxia, the colour of the stains is deeply bluish-violet or purple. A bright pink colour is seen in hypothermia and bodies taken from cold water. Ref: The Essentials of Forensic Medicine and Toxicology by KS Narayan Reddy, 27th edition, Page 139.


Tardieu spots are seen in?

A: Cyanide poisoningB: Mechanical asphyxiaC: Cobra biteD: Organophosphate poisoningCorrect Ans:BExplanation

Tardieu spots or petechial haemorrhages are pinhead size bleeding spots occurring as a result of rupture of venules and are most commonly seen in sclera, conjunctiva or on serous membranes. Their distribution lies above the level of obstruction. A hand lens is used to identify petechial haemorrhages. It is seen in case of mechanical asphyxia.

Ref: Textbook of forensic medicine and toxicology by V.V Pillay, 15th edition, P-275.


You are the CMO of a government district hospital. A young girl is brought to you with history of poisoning. It is a case of attempted suicide. Patient and guardian have asked you to keep it a secret. What should you do in the scenario?Note: She was not in critical condition and was cured completely.

A: Treat the patient and inform the policeB: Treat the patient and inform the police only if she diesC: Since it is a case of attempted suicide you are not bound to inform the policeD: Inform the magistrate


Here since you are a doctor in charge of a government hospital you should inform the police. If you were a private doctor you are not bound to inform the police or magistrate in case of suicidal or accidental poisoning. But if the patient dies or food poisoning is suspected or homicidal poisoning is suspected you must inform the police.

Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 23, Page - 27


A body is brought to you for autopsy. The apparent cause of death is snake bite. On examination there is a haemorrhagic region surrounding a puncture mark over his left shoulder region. The area surrounding the puncture mark is necrosed and subsequent examination of his stomach contents and blood revealed that he had consumed significant amount of alcohol just prior to death. Since he is an officer working in a city you suspect foul play. Poisoning with which of the following resemble a viper snake bite?

A: Abrus precatoriusB: CalotropisC: Capsicum annuumD: Strychnine


When extract of Abrus precatorius is injected subcutaneously there is painful swelling, inflammation, ecchymosis and necrosis of the surround tissue. The features may resemble that of viperine snake bite. Injection of 90 – 120 mg is fatal. Capsicum annuum is chilli powder. Strychnine produces features similar to tetanus. Ref: The Essentials of Forensic Medicine and Toxicology by Narayana Reddy, Edition 21, Page 479


In a case of suspected poisoning, the preservative used for vitreous during autopsy is:

A: FluorideB: HC1C: PhenolD: Xylol

Correct Ans:AExplanationFluoride should be added to urine, CSF, and vitreous humour if alcohol estimation is required, and also to samples for analysis for cocaine, cyanide and CO. Sodium or potassium fluoride should be used for preserving blood. Ref: The essentials of forensic medicine and toxicology by Dr K S Narayan Reddy, 27th edition, Page 111.


Deep blue colour of hypostasis is seen in death due to poisoning by:

A: Potassium cyanide

B: Phosphorus

C: Aniline dyesD: Carbon monoxideCorrect Ans:CExplanation

Aniline dye poisoning causes methaemoglobinaemia which gives deep blue colour hypostasis after death. Other poisonings which cause methaemoglobinaemia are, nitrites, potassium chlorate, potassium bicarbonate, nitrobenzene, acetanilide and bromates.

Ref: The Essentials of Forensic Medicine and Toxicology By K S Narayan Reddy, 27th Edition, 136, 137,139


Autopsy of a case of cyanide poisoning shows all of the following features, EXCEPT:

A: Congested organsB: Characteristic bitter lemon smellC: The skin shows pinkish or cherry red colourD: Erosion and hemorrhages in oesophagus and stomachCorrect Ans:BExplanation

Cyanide poisoning is associated with a characteristic smell of bitter almonds and not of bitter lemon.

Mechanism: Cyanide inhibits the action of enzymes such as cytochrome oxidase,

carbonic anhydrase. It blocks the final step of oxidative phosphorylation and prevent the formation of ATP.

Ref:The Essentials of Forensic Medicine and Toxicology By Dr KS Narayan Reddy, Pages 560-1


In methyl alcohol poisoning CNS depression, cardiac depression and optic nerve atrophy results from the production of which of the following metabolites?

A: Acetic acidB: AcetaldehydeC: PyridineD: Formaldehyde and Formic acidCorrect Ans:DExplanation

Clinical features of methyl alcohol poisoning results from formaldehyde and formic acid. Methyl alcohol is oxidized by liver to formaldehyde which is then oxidized to formic acid which results in metabolic acidosis & retinal toxicity.

Formate inhibits cytochrome oxidase chain increasing lactate production and resulting in metabolic acidosis. When the central nervous system is affected it results in delirium and coma. It can also cause cardiac and respiratory depression. Visual disturbances include photophobia, blurry vision, central or peripheral scotoma, sudden loss of vision due to optic neuritis and atrophy due to the effect of formic acid on optic nerve.

Ref:The Essentials of Forensic Medicine and Toxicology By Dr KS Narayan Reddy, Pages 512-3


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


A young person was brought by police from the railway platform. He is talking irrelevant. He is having dry mouth with hot skin, dilated pupils, staggering gait and slurred speech. The most probable diagnosis is:

A: Alcohol intoxicationB: Carbamates poisoningC: Organophosphorous poisoningD: Datura poisoning


This young person with dry mouth with hot skin, dilated pupils, staggering gait and slurred speech and irrevelant talking suggestive of Datura poisoning. These symptoms are described as: "Dry as a bone, Red as a beat, Blind as a bat, Hot as a hare, and Mad as a wet hen".

Ref: The Essentials of Forensic Medicine and Toxicology By K S Narayan Reddy, 27th Edition, Pages 458, 461, 502, 503, 532


Yellow Fatty liver is characteristic of poisoning with:

A: ArsenicB: MercuryC: PhosphorusD: Oxalic AcidCorrect Ans:CExplanation

Yellow fatty liver is characteristic of poisoning with Phosphorus. Mercury and arsenic may have fatty liver, but is most characteristic with the poisoning of phosphorus.

Ref: The Essentials of Forensic Medicine and Toxicology By Dr K S Narayan Reddy, 27th Edition, Page 474, 484, 485; Harrison’s Principles of Internal Medicine, 16th Edition, Page 1870


Which of the following heavy metal poisoning may cause colitis that resembles diptheritic colitis?

A: LeadB: ArsenicC: MercuryD: Copper

Correct Ans:CExplanation

Mercury colitis may resemble diptheritic colitis.

Ref: Environmental and Chemical Toxins and Psychiatric Illness By James S Brown, Page 162; The Journal of Experimental Medicine


Alkalinisation of urine may be done in cases of poisoning with:

A: BarbituratesB: AmphetaminesC: AlcoholD: MorphineCorrect Ans:AExplanation

Achieving a urinary pH of 7.5 to 9 promotes excretion of drugs that are weak acids such as long acting barbiturates (phenobarbital).

Ref: The Essentials of Forensic Medicine and Toxicology By Dr K S Narayan Reddy, 27th Edition, Pages 456, 519; Parikh's Textbook of Medical Jurisprudence and Toxicology, 6th Edition, Page 8.17; Modi's Medical Jurisprudence and Toxicology, 23rd Edition, Page 17; KDT, 6th Edition, Page 392


Why is gastric lavage ideally indicated in all cases of acute poisoning?

A: Fear of aspirationB: Inadequate ventilationC: Danger of cardiac arrestD: Danger of respiratory arrestCorrect Ans:AExplanation

One of the main danger of consuming poison is aspiration pneumonitis. It is because of this that gastric lavage is indicated most cases of acute poisoning.

Ref: Parikh’s Textbook of Medical Jurisprudence, Forensic Medicine and Toxicology, 6th Edition, Pages 8.3-9.2 ; Forensic Medicine and Toxicology By R.N. Karmakar, Page 48


Which type of cattle poisoning occurs due to ingestion of LINSEED plant?

A: AconiteB: AtropineC: PilocarpineD: Hydrocyanic acidCorrect Ans:DExplanation

Hydrocyanic acid is also used as cattle poison. Cattle poisoning has been known to occur from eating linseed plant because of the natural development of a cyanogenic glycoside which may liberate hydrocyanic acid.

Ref: Essentials of Forensic Medicine and Toxicology By Dr K S Narayan Reddy, 27th Edition, Pages 559-60


Aconite poisoning causes all, EXCEPT:

A: HypersalivationB: Tingling and numbnessC: Increased BPD: Chest pain

Correct Ans:CExplanationAconite poisoning is characterized by hypotension and hypertension. Tingling, numbness, hypersalivation and chest pain is usually seen in all cases of aconite poisoning.The aconite leaves when rubbed or handled on the skin, produces tingling and numbness. The eyes on exposed to pollen, becomes painful and swollen. It gives rise to gastro-intestinal symptoms like burning sensation of the mouth and stomach, nausea, vomiting, diarrhea and tingling sensation of the mouth, tongue and pharynx. The tingling and numbness then progresses all over the body. The general symptoms include pallor, giddiness, profuse sweating, headache and weakness. The neurological symptoms are dimness of vision, diplopia and hallucinations. The cardiovascular symptoms are hypotension, cardiac arrhythmia and AV block. Death occurs from paralysis of the cardiac centre and respiratory centre. Ref: The Essentials of Forensic Medicine and Toxicology By Dr. K. S. Narayan Reddy, 27th Edition, Pages 551-552.


A factory worker has come to the OPD complaining of excessive salivation, blue lines on gums, tremors, disturbed personality, insomnia and loss of appetite. The physician is suspecting it to be a case of metallic poisoning. Which of the following metals the physician has in his mind?

A: IronB: BariumC: MercuryD: ThalliumCorrect Ans:CExplanationThe patient with a positive history of working in a factory and now having presented with the classical symptoms (excessive salivation, tremors, disturbed personality and blue lines on gums) points towards the diagnosis of chronic mercury poisoning. The mercury poisoning can occur from various mercuric compounds. They are Mercuric chloride, Mercuric oxide, Mercuric oxide, Mercuric cyanide, Mercuric sulphide, Mercuric nitrite, Mercuric sulphate, Mercurous chloride, Sulphate of mercury, Ammoniomercuric chloride and organic compunds of mercury. Elemental mercury is found in glass thermometers, electrical switches, fluorescent light bulbs, older dental fillings and few medical equipments. Inorganic mercury is found in batteries, chemistry labs, disinfectants, folk culture medicines and red cinnabar mineral. Organic mercury is found in older germ-killers (antiseptics), thimerosal, fumes from burning coal and in a few fishes that have consumed organic mercury. Mercury poisoning can occur as acute poisoning or chronic poisoning. The mercuric ion tends to bind with the sulphydryl groups of cellular proteins, enzymes, nucleic acids and mitotic apparatus thus interferes with the cellular and enzymatic functions. Renal tubular function get affected and in the parts of the central nervous system that are mainly targeted are cerebellum, basal ganglia, temporal lobe and corpus callosum. In acute poisoning the symptoms are bronchitis, constriction in throat, hoarse voice, dyspnea, pulmonary edema, fibrosis, abdominal pain associated with nausea, vomiting, blood stained diarrhea, glossitis, ulcerative gingivitis, renal tubular necrosis, cylinduria, uraemia and acidosis. Chronic mercury poisoning is also known as hydrargyrism. The common symptoms are sore mouth, gingivitis, salivation, formation of blue lines at the

junction with teeth (Burtonian line), Danbury tremors, Glass blower’s shakes (hatter’s shakes), Concussio mercurialis, Mercurial erethism, Mercuria lentis (brownish deposition of mercury on anterior lens capsule) and Acrodynia or pink disease. Ref: The Essentials of Forensic Medicine and Toxicology By Dr. K. S. Narayan Reddy, 27th Edition, Pages 473-483.


Which of the following poisoning is associated with the development of Burtonian line?

A: ZincB: LeadC: ArsenicD: MercuryCorrect Ans:BExplanation

Burtonian line is a stippled bluish black line due to epithelial deposition of lead sulphide granules on the gums at the junction with the teeth. It is seen in about 50 - 70% of the cases of Lead poisoning.

Lead is a typical cumulative poison. Lead poisoning occurs from the toxic effects of the following principle lead salts:

Lead acetate - white crystalsLead carbonate - white crystalline powderLead chromate - bright yellow powderLead monoxide - pale brick-redLead tetroxide - red lead/sindurLead sulphide - least toxic

Ref: The Essentials of Forensic Medicine And Toxicology by Dr. K. S. Narayan Reddy 27th edition, Pages 464; 475-9; 473.


Which of the following poison is associated with the development of Acrodynia?

A: MercuryB: Oxalic acidC: Phenolic acidD: Carbolic acid poisoningCorrect Ans:AExplanation

Acrodynia also known as pink disease is characterised by a generalised pink rash. It is a idiosyncratic hypersensitivity reaction of insidious onset with anorexia, insomnia, sweating, skin rash, photophobia, puffy hands and feet and peeling of skin. It occurs as a result of chronic exposure to mercury and usually in children.

Ref: The Essentials of Forensic Medicine And Toxicology by Dr. K. S. Narayan Reddy 27th edition; Pages 468; 469; 476.


The drug of choice for mushroom poisoning is which of the following?

A: AtropineB: CarbacholC: AdrenalineD: PhysostigmineCorrect Ans:AExplanation

Symptoms of mushroom poisoning are due to excess of muscarine. The polypeptides from these mushrooms are inhibitors of cellular protein synthesis

and stimulates post ganglionic cholinergic fibres. Atropine sulphate is the preferred drug of choice to counteract the muscarinic effects.

Ref: The Essentials of Forensic Medicine And Toxicology by Dr. K. S. Narayan Reddy 27th edition; Pages 564 - 565; K D Tripathi Texbook of Pharmacology 5th edition; page 100.


Which of the following poisoning is associated with the development of Burtonian line?

A: ZincB: LeadC: ArsenicD: MercuryCorrect Ans:BExplanation

Burtonian line is a stippled bluish black line due to epithelial deposition of lead sulphide granules on the gums at the junction with the teeth. It is seen in about 50 - 70% of the cases of Lead poisoning.Lead is a typical cumulative poison. Lead poisoning occurs from the toxic effects of the following principle lead salts:

Lead acetate - white crystalsLead carbonate - white crystalline powderLead chromate - bright yellow powderLead monoxide - pale brick-redLead tetroxide - red lead/sindurLead sulphide - least toxic

Ref: The Essentials of Forensic Medicine And Toxicology by Dr. K. S. Narayan Reddy 27th edition; Pages 464; 475-9; 473.


Which of the following poisonings causes the blood to become cherry red?

A: CyanideB: H2SC: Potassium per chlorateD: Nitrite


Cyanide stops respiration at mitochondrial level so the O2 in the blood is not used and hence a high saturation of O2 in the blood gives it the bright red color.

H2S changes the red blood pigment; blood turns brown to olive in color. In potassium per chlorate poisoning, the blood is of a chocolate color. Nitrite poisoning causes methemoglobinemia and anemic anoxia. Signs are dyspnea and coffee color of mucosae and blood.


Which of the following is the earliest sign of lead poisoning?

A: Facial pallorB: Colic and constipationC: Punctate basophiliaD: Encephalopathy


Facial pallor particularly of the mouth is the earliest and most consistent sign of chronic lead poisoning and is due to vasospasm. Chronic poisoning results from a daily intake of 1-2mg of lead. Other characteristic features of chronic lead poisoning are anaemia (punctate basophilia), lead line, colic and constipation, lead palsy and encephalopathy.

Reference:Essentials of Forensic Medicine and Toxicology by Dr K.S Narayan Reddy 27th edition page 479.


Which of the following is not a feature of organophosphorous poisoning?

A: MiosisB: Increased salivationC: AsthmaD: TachycardiaCorrect Ans:DExplanation

Organophosphorous poisoning causes bradycardia and not tachycardia. Manifestations of organophosphorous poisoning includes muscarinic and nicotinic. Muscarinic manifestations includes bradycardia, vomiting, diarrhea, abdominal cramps, miosis, bradycardia, sweating and excess salivation. Nicotnic effects includes muscle fasciculations, tremors and weakness.


A person was found dead with bluish green frothy discharge seen at the angle of mouth and nostrils. What is the most likely cause of his death?

A: Arsenic poisoningB: Copper sulphate poisoningC: Mercury poisoningD: Lead poisoning


This man is showing features of copper sulphate (blue vitriol) poisoning as indicated by bluish green discharge from mouth and nostrils. Main features of copper sulphate poisoning are vomiting, abdominal pain and sometimes diarrhea. Vomitus usually have a bluish green hue. Later patients develop renal and hepatic damage with hemolytic anemia.

Fatal dose of copper sulphate is 30gm. Treatment: involves chelation with penicillamine or EDTA or BAL.


A 25 year old plumber comes to the clinic with complaints of abdominal colic, constipation, weakness of hand and anemia since 2 years. What would be the most probable diagnosis in this patient?

A: Lead poisoningB: Gastric carcinomaC: Chronic pancreatitisD: Hookworm infestationCorrect Ans:AExplanation

The occupational history and clinical features of this patient suggest that he is suffering from chronic lead poisoning.

Characteristic features of chronic lead poisoning includes:

Facial pallor: Particularly of the mouth is the earliest and most consistent sign.

Anemia: Anemia associated with polychromasia, punctate basophilia, reticulocytosis, poikolocytosis, anisocytosis and sideroblastosis. Basophilic stippling refers to the presence of dark blue pin head sized spots in the cytoplasm of red blood cells.

Lead line or Burtonian line: seen on gums in 70% cases. Colic and constipation seen in 85% cases. Lead palsy: Radial nerve is most commonly involved resuling in

wrist drop. Encephalopathy: It is seen in every case of plumbism. Lead

encephalopathy is irreversible and 85% have permanent brain damage.


Delayed onset polyneuropathy after organophosphorous poisoning is seen after a period of:

A: 1-2 weeksB: 2-4 weeks

C: 4-6 weeksD: 6-8 weeksCorrect Ans:BExplanation

Organophosphate-induced delayed polyneuropathy (OPIDP) occurs 2-3 weeks after exposure to large doses of certain organophosphates (OPs) and is due to inhibition of neuropathy target esterase. Distal muscle weakness with relative sparing of the neck muscles, cranial nerves, and proximal muscle groups characterizes OPIDP. Recovery can take up to 12 months.


Which of the following antidote is used in methyl alcohol poisoning?

A: EDTAB: Alpha methyl dopaC: Acetyl cysteineD: Fomepizole


Among the options given fomepizole is the antidote used in methyl alcohol poisoning. Fomepizole acts by inhibiting the conversion of methanol into toxic metabolites by antagonizing the enzyme alcohol dehydrogenase.

Other commonly used antidotes in this case are: intravenous infusion of ethanol or oral administration of 60ml of ethyl alcohol in 200ml fruit juice. In severe cases hemodialysis is the treatment of choice.


Which of the following poisoning is associated with 'phossy jaw'?

A: MercuryB: Yellow phosphorousC: Red phosphorousD: Tetanus


Phossy jaw is a condition in which osteomyelitis and necrosis of jaws occurs with multiple sinuses discharging foul smelling pus. It is observed in chronic cases of yellow phosphorus poisoning. It occurs with chronic inhalation of fumes of

yellow phosphorus over a period of years causing necrosis of the lower jaw in the region of a decayed tooth.


What is the colour of post mortem staining seen in carbon monoxide poisoning?

A: Deep blueB: Bark brownC: Bright redD: Cherry redCorrect Ans:DExplanation

Post mortem staining seen in carbon monoxide poisoning is cherry red colour. A cherry red colouration of skin, mucous membrane, conjunctiva, nail beds, areas of hypostasis, blood tissues and internal organs are seen in only 15 - 20% cases of carbon monoxide poisoning.

Post mortem staining in various poisons: ? In asphyxial death: Bluish violet or deep purple? Potassium chlorate, bichromates, nitrobenzene and aniline: Chocolate coloured? Phosphorus poisoning: Dark brown? Bluish green: Hydrogen sulphide? Bright red: HCN/Cyanide


A body is brought for autopsy to the medical college hospital. The death was allegedly due to poisoning. The medics noted a scent of shoe polish on the body, on initial examination. What is the possible toxin involved?

A: NitrobenzeneB: Chloral hydrateC: Hydrogen SulphideD: Lacquer


Chloral hydrate acrid pear like smell. H2S smells like rotten eggs. Lacquer smells like acetone (apple like).

Ref: Textbook of Forensic Medicine and Toxicology by V.V Pillay, 15th Edition, Page 430.


Health & Medicine

Previous year question on poisoninig part i and ii based on neet pg, usmle, plab and fmge or mci screening exams