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

Which of the following clinical manifestation is seen in severe copper sulphate
poisoning?
A: Acute hemolysis
B: High anion gap acidosis
C: Peripheral neuropathy
D: Rhabdomyolysis
Correct Ans:A
Explanation
Ingestion 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?
A: Acute hemolysis
D: Rhabdomyolysis
Correct Ans:A
Explanation
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?
A: Acute hemolysis
D: Rhabdomyolysis
Correct Ans:A
Explanation
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 deficiency
B: Isomerase
C: Cytochrome oxidase
D: None of the above
Correct Ans:C
Explanation
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: Lead
B: CuSO4
C: CO
D: Dhatura
Correct Ans:C
Explanation
Kunkel'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 colorwill remain pink.

27th edition, Page 555.
A patient in emergency department shows Mc Ewan sign. This sign is positive in
the following condition:
A: Cyanide poisoning
B:
Alcoholis
m
C: Lead
D: Arsenic poison
Correct Ans:B
Explanation
Mc Ewan sign is seen in stage of coma of acute alcohol intoxication.
Stage of coma of alcohol intoxication:
In this stage, the motorand 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).

Mechanism of action of ethyl alcohol in methyl alcohol poisoning is:
A: Saturate alkaline phosphatase
B: Blocks formation of formaldehyde
C: Inhibit Ca release
D: All of the above
Correct Ans:B
Explanation
Ethanol 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.
Which of the following enzyme is affected by cyanide poisoning?
A: G-6-P dehydrogenase deficiency
B: Isomerase
C: Cytochrome oxidase
Correct Ans:C
Explanation
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.

In which of the poisoning, gastric wash is contraindicated?
A: Oxalic acid
B: Sulphuric acid
C: Opiate
D: Dhatura
Correct Ans:B
Explanation
Gastric 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: Acetaminophen
B: Carbon monoxide
C: Lead
D: Salicylates
Correct Ans:D
Explanation
It 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 poisoning
B: Acute arsenic poisoning
C: Chronic arsenic poisoning
D: All of the above
Correct Ans:C
Explanation
In 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,
TRUE about Aluminium phosphide poisoning is all, EXCEPT:
A: Subendocardial infarction
B: Inhibits cytochrome A of respiratory chain
C: Causes esophageal stricture
D: Liberates phosphine gas
Correct Ans:C
Explanation
Aluminium 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 failure
C.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 clippings
B:
Hair
samples
C: Bone biopsy
D: Blood sample
Correct Ans:D
Explanation
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: Ingestion
B: Dermally
C: Inhalation
Correct Ans:C
Explanation
Lead 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: January
B:
Marc
h
C: October
D: December
Correct Ans:C
Explanation
“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/in
dex.html

True about Minamata disease are all except:
A: Caused by methyl mercury toxicity
B:
First occurred in
Japan
C: Found in babies born to mothers with overt symptoms of mercury poisoning
D:
Babies characterised by microcephaly, cerebral palsy, severe mental
retardation
Correct Ans:C
Explanation
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 irreversibily
B: 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:D
Explanation
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 transmission
B: Facilitating adrenergic synapse transmission
C: Inhibiting cholinergic synapse transmission
D: No effect on synaptic transmission
Correct Ans:C
Explanation
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 oxidase
B: Competitive inhibitor of alcohol dehydrogenase
C: Competitive inhibitor of aldehyde dehydrogenase
D: Non-competitive inhibitor of aldehyde dehydrogenase
Correct Ans:B
Explanation
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 charcoal
B: Urine may turn blue
C: Death may be due to respiratory failure
D: CNS depression may occur
Correct Ans:B
Explanation
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: Cyanide
B: Methanol
C: Arsenic

D: Phenol
Correct Ans:A
Explanation
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: Liver
B: Kidney
C: Spleen
D: Bone
Correct Ans:A
Explanation
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 sativus
B: Lead
C: Strychnine
D: Thallium
Correct Ans:A
Explanation
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 poisoning

B:
Carbamate
poisoning
C: Ergot poisoning
D: Abrus precatorius poisoning
Correct Ans:C
Explanation
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.
21, Page - 479
All the following are TRUE regarding lead poisoning, EXCEPT:
A: At a cellular level it interacts with the sulfhydryl group
B: Facial pallor is one of the earliest and most consistent sign
C: Initially there may be polycythaemia
Correct Ans:D
Explanation
Though lead poisoning is associated with anemia, polychromasia, punctate
basophilia, reticulocytosis and increased mononuclearcells ; 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 know
Lead interacts with sulfhydryl groups and interferes with the enzymes essential
for heme synthesis.

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 acid
C: Nitric acid
D: H2S
Correct Ans:A
Explanation
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: Tik20

B: Baygon
C: Malathion
D:
Parathio
n
Correct Ans:B
Explanation
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.
edition, Page 460.
A patient presented with Aldrich-Mee's lines which are characteristic of which
heavy metal poisoning?
A: Lead
B: Mercury
C: Arsenic
D:
Coppe
r
Correct Ans:C
Explanation
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.
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:
Lea
d
C: Mercury
D: Copper
Correct Ans:A
Explanation
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: Lead
B: Cyanide
C: Mercury
D: Organophosphorus
Correct Ans:B
Explanation
 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 hour
B:
Cyanosis and
dyspnoea
C: Urine is alkaline
D: Hyperemia of optic disc
Correct Ans:C

Explanation
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: Cyanosis
B: Cerebral edema
C: Convulsions
D:
Bradycardi
a
Correct Ans:A
Explanation
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 colour
B:
Cyanosi
s
C: Petechial haemorrhage over conjunctiva
D: Frothing at the mouth
Correct Ans:A
Explanation
 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 colourchanges 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 poisoning
B:
Lead
poisoning
C: Mercury poisoning
D: Cadmium poisoning
Correct Ans:A
Explanation
Garlic odourand 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: Arsenic
B: Mercury
C: Copper
D: Lead
Correct Ans:B
Explanation
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 poisoning
B:
Lead
poisoning
C: Mercury poisoning
D: Cadmium poisoning
Correct Ans:A
Explanation

In acute arsenic poisoning, there is usually a metallic taste in the mouth and
some odourof 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: LSD
B: Amphetamine
C: Cannabis
D: Cocaine
Correct Ans:D
Explanation
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,

What is the case fatality rate of organophosphorous poisoning in India?
A: 15-30%
B:
5-
10%
C: 40-50%
D: 2-4%
Correct Ans:A
Explanation
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 alcohol
B:
Barbiturate
s
C: Ethylene glycol
D: Copper sulphate
Correct Ans:D
Explanation
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 poisoning
B:
Methyl
alcohol
C: Lithium

D: Ethylene glycol
Correct Ans:A
Explanation
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 intoxication
B: Carbon Monoxide poisoning
C: Barbiturate poisoning
D: Carbolic acid poisoning
Correct Ans:A
Explanation
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 colourof 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 poisoning
B: Arsenic poisoning
C: Ethanol poisoning
D:
Copper
poisoning
Correct Ans:C
Explanation
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: Snakebite
B: Ratti poisoning
C: Cantharide poisoning
D: Arsenic poisoning
Correct Ans:C
Explanation
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 poisoning
B: Cocaine poisoning
C: Cannabis sativa poisoning
D: Cannabis indica poisoning
Correct Ans:B
Explanation

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.

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