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: Endoscopy
B: Barium meal
C: Pharyngoscopy
D: X rays
Correct Ans:A
Explanation
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: Rickets
B: Lead poisoning
C: Metaphyseal dysplasia
D: Hypophosphatasia
Correct Ans:B
Explanation

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: Cortisone
B: Propranolol
C: Thyroxine
D: Phenobarbitone
Correct Ans:B
Explanation
Acute 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: Cadmium
B: Organic mercury
C: Lead
D: Arsenic
Correct Ans:A
Explanation
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 tetrachloride
B:
Rifampici
n
C: INH
D: Yellow phosphorus poisoning
Correct Ans:A
Explanation
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: Organophosphorus
B: Carbaryl
C: Both of the above
D: None of the above
Correct Ans:B
Explanation
Oximes 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: Salicylate
B: Barbiturates
C: Methanol
D: Nifedipine
Correct Ans:D
Explanation

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 damage
B: Apoptosis
C: Nuclear fragmentation
D: Mediated by free radicals
Correct Ans:D
Explanation
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: Cold
B: Starvation
C: Thermal bums
D: Poisoning
Correct Ans:C
Explanation
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: Fear
B: Poisoning
C: Burns
D: Strangulation
Correct Ans:C
Explanation
Pugilistic 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: Drowning
B:
Hangin
g
C: Burns
D: Phosphorus poisoning
Correct Ans:A
Explanation
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: Epilepsy
B:
Hangin
g
C: Drowning
D: Opium poisoning
Correct Ans:C
Explanation
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 poisoning
B: Mechanical asphyxia
C: Cobra bite
D: Organophosphate poisoning
Correct Ans:B
Explanation
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 haemorrhage
B:
Cyanide
poisoning
C: Corrosive poisoning
D: Septicemia

Correct Ans:D
Explanation
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 poisoning
B: Amniotic fluid embolism
C: Puerperal sepsis
Correct Ans:D
Explanation
Decreased 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 formation

B:
Mummificatio
n
C: Aseptic acetolysis
D: Saponification
Correct Ans:B
Explanation
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 know
Saponification 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 death
B: Affects all groups of muscles simultaneously
C: After passing of rigor mortis
Correct Ans:A
Explanation
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 acid
B: Hydrogen sulphide
C: Oleander
D: Sodium nitrite
Correct Ans:B
Explanation
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 colouris bright red. In poisoning by nitrites,
potassium chlorate, potassium bicarbonate, nitrobenzene, acetanilide, bromates,
and aniline the colouris 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 built
B: Aerobic exercise
C: Cold temperature
D: Strychnine poisoning
Correct Ans:C
Explanation
Cold 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 staining
B:
Pink postmortem
staining
C: Chocolate coloured postmortem staining
D: Blue postmortem staining
Correct Ans:A
Explanation
In 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 colouris chocolate brown.
In asphyxia, the colour of the stains is deeply bluish-violet or purple.
A bright pink colouris 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 poisoning
B: Mechanical asphyxia
C: Cobra bite

D: Organophosphate poisoning
Correct Ans:B
Explanation
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 police
B: Treat the patient and inform the police only if she dies
C: Since it is a case of attempted suicide you are not bound to inform the police
D: Inform the magistrate
Correct Ans:A
Explanation
Here since you are a doctorin charge of a government hospital you should
inform the police. If you were a private doctoryou 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 precatorius
B:
Calotropi
s
C: Capsicum annuum
D: Strychnine
Correct Ans:A
Explanation
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: Fluoride
B:
HC
1

C: Phenol
D: Xylol
Correct Ans:A
Explanation
Fluoride 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:
Phosphoru
s
C: Aniline dyes
D: Carbon monoxide
Correct Ans:C
Explanation
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.
Reddy, 27th Edition, 136, 137,139

Autopsy of a case of cyanide poisoning shows all of the following features,
EXCEPT:
A: Congested organs
B: Characteristic bitter lemon smell
C: The skin shows pinkish or cherry red colour
D: Erosion and hemorrhages in oesophagus and stomach
Correct Ans:B
Explanation
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 acid
B: Acetaldehyde
C: Pyridine
D: Formaldehyde and Formic acid
Correct Ans:D
Explanation
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.
Reddy, Pages 512-3
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.
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 intoxication
B: Carbamates poisoning
C: Organophosphorous poisoning
D: Datura poisoning
Correct Ans:D
Explanation
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".
Reddy, 27th Edition, Pages 458, 461, 502, 503, 532
Yellow Fatty liver is characteristic of poisoning with:

A: Arsenic
B: Mercury
C: Phosphorus
D: Oxalic Acid
Correct Ans:C
Explanation
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: Lead
B: Arsenic
C: Mercury
D: Copper
Correct Ans:C
Explanation
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: Barbiturates
B: Amphetamines
C: Alcohol
D: Morphine
Correct Ans:A
Explanation
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 aspiration
B: Inadequate ventilation
C: Danger of cardiac arrest
D: Danger of respiratory arrest
Correct Ans:A
Explanation
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: Aconite
B: Atropine
C: Pilocarpine
D: Hydrocyanic acid
Correct Ans:D
Explanation
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: Hypersalivation
B: Tingling and numbness
C: Increased BP
D: Chest pain
Correct Ans:C

Explanation
Aconite 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: Iron
B: Barium
C: Mercury
D: Thallium
Correct Ans:C
Explanation
The 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:
Zin
c
B: Lead
C: Arsenic
D: Mercury
Correct Ans:B
Explanation
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 crystals
Lead carbonate - white crystalline powder
Lead chromate - bright yellow powder
Lead monoxide - pale brick-red
Lead tetroxide - red lead/sindur
Lead 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: Mercury
B: Oxalic acid
C: Phenolic acid
D: Carbolic acid poisoning
Correct Ans:A
Explanation

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.
Reddy 27th edition; Pages 468; 469; 476.
The drug of choice for mushroom poisoning is which of the following?
A: Atropine
B: Carbachol
C: Adrenaline
D: Physostigmine
Correct Ans:A
Explanation
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.
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:
Zin
c
B: Lead
C: Arsenic
D: Mercury
Correct Ans:B
Explanation
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 crystals
Lead carbonate - white crystalline powder
Lead chromate - bright yellow powder
Lead monoxide - pale brick-red
Lead tetroxide - red lead/sindur
Lead sulphide - least toxic
Reddy 27th edition; Pages 464; 475-9; 473.
Which of the following poisonings causes the blood to become cherry red?
A: Cyanide
B:
H2
S
C: Potassium per chlorate
D: Nitrite

Correct Ans:A
Explanation
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 colorof mucosae and blood.
Which of the following is the earliest sign of lead poisoning?
A: Facial pallor
B: Colic and constipation
C: Punctate basophilia
D: Encephalopathy
Correct Ans:A
Explanation
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: Miosis
B: Increased salivation
C: Asthma
D: Tachycardia
Correct Ans:D
Explanation
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 poisoning
B: Copper sulphate poisoning
C: Mercury poisoning
D: Lead poisoning

Correct Ans:B
Explanation
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 poisoning
B: Gastric carcinoma
C: Chronic pancreatitis
D: Hookworm infestation
Correct Ans:A
Explanation
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 weeks
B:
2-4
weeks
C: 4-6 weeks
D: 6-8 weeks
Correct Ans:B
Explanation
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: EDTA
B: Alpha methyl dopa
C: Acetyl cysteine
D: Fomepizole
Correct Ans:D
Explanation
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: Mercury
B: Yellow phosphorous
C: Red phosphorous
D: Tetanus
Correct Ans:B
Explanation
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 colourof post mortem staining seen in carbon monoxide poisoning?
A: Deep blue
B: Bark brown
C: Bright red
D: Cherry red
Correct Ans:D
Explanation
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: Nitrobenzene
B: Chloral hydrate

C: Hydrogen Sulphide
D: Lacquer
Correct Ans:A
Explanation
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.

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