toxicology is a very important topic for pg entrance.....so all about it has been discussed in detail as required for pg entrance....do make use of it...

1. - DR.AKIF A.B

2. Note : Toxicology is a very important topic and if u try reading each
poisons Separately , u will definitely forget them.
So best way to remember them more is to practice
MCQs and then read topics by correlating.
That’s what I think….
It may or may not apply for u…..
But atleast try once like this and then choose your own way .

4. 1) Gastric lavage is indicated in all cases of acute poisoning ideally because of:
A Fear of aspiration
B Danger of cardiac arrest
C Danger of respiratory arrest
D Inadequate ventilation

5. Ans. A Fear of aspiration
The main danger of consuming a poison, other than
reducing the effects of poison itself on the body due to
absorption, is death due to aspiration pneumonitis.
It is because of this that gastric lavage is indicated in all
cases of acute poisoning wherever possible.

6. -Ideal time = <3hrs
-Initially lavage should be done with plain water since the poison need to be
sent to lab for tests.
-MC substance used for gastric Lavage = KMnO4
- Ideal tube = Lavacutor
- Position of Patient during lavage = Prone/Left lateral
- Contra Indicated in = Corrosives except Carbolic acid
(Since Increase chance of aspiration)

7. Position of Patient during lavage
Prone/Left lateral

8. -Measure from tip of nose to ear lobe first……
- then measure from ear lobe to xiphoid process….
- add both measurements and mark it on Ryle’s tube….
-Insert Ryle’s tube upto that level.

9. -Government doctor should inform all cases
of poisoning to Police
- Private practitioner should inform only in
Homicidal cases.

11. Opium is always secreted into G.I.T doesn’t matter from which route it is taken/
administered. So gastric lavage is compulsory for opium poisoning.

12. Q.2) A 60 year old man presents in OPD with history of opium
addiction for the last 20 yrs. He has given up opium for 2 days.
Withdrawal symptoms will include:
A )Drowsiness
B )Constricted pupil
C) Rhinorrhoea
D)↓ed Blood pressure

13. Ans. C Rhinorrhoea
Withdrawal symptoms due to any drug of addiction are usually
same, barring minor differences- Chilliness/ sensation of cold,
uneasiness, yawning, rhinorrhoea, lacrimation, goose-skin,
tremors, dilated pupils, anorexia, tachypnoea, ↑ sleep, fever,
HT, cramps legs/abdomen, diarrhoea.
-All secretions are increased like lacrimation, Rhinorrhea ,
vomitings,etc.

14. -Derived from Poppy plant
- Unriped fruit is Toxic
-Seeds are not toxic
-Lethal dose : 2gms
- Lethal dose of Morphine = 0.2gms
-Active principle = Endorphin
-Black color postmortem lividity
NATURAL SYNTHETIC
Morphine Bupronorphine
Codeine Methadone
Heroin Dextromethorphine
Thebaine
Poppy plant

16. 1) Stage of Excitement = Hallucination
2) Stage of stupor
3) Stage of coma = Pin point non reacting pupil,hypotension, bradycardia,
Respiratory depression
- There may be whit froth from mouth , in PM examination.

17. 1) Lacrimation
2) Vomiting
3) Rhinorrhoea
4) Sweating
5) Diarrhoea
6) Piloerection(goose flesh)
7) Raise in B.P

18. 1) Acute Intoxication = I.V Naloxone followed by Naltrexone
2) Withdrawal symptoms = Methadone> Buprenorphine
Since methadone is a opioid agonist and it produces all effects of morphine/heroin
except dependence
3) Maintenance therapy = Methadone> Buprenorphine
4) Aversion therapy = Naltrexone

19. -Di acetyl Morphine
-Addiction is known as Cutting-In
-Also k/a Brown sugar/smack/junk
-Smoking Heroin is k/a Chasing The Dragon
-Speed ball = Heroin + Cocaine

20. -CNS Stimulant
-Mech. ; Dopamine/Serotonin/Nor epinephrine
-Vasoconstrictor
-Derives from leaves of erythoxylum cocca
-Tactile hallucinations: also k/a Cocaine bugs/magnan bugs
-Paranoid delusions : is the fixed, false belief that one is being
harmed or persecuted by a particular person or group of people.
-If sniffed can cause Nasal septum perforation
-On oral intake : Black jet tongue
-Antidote = Amyl Nitrate

22. COCAINE ORAL INTAKE
Black Jet Tongue /Teeths

23. 3.Q. The sensation of creeping, bugs over the body is a feature
of poisoning with:
A Cocaine
B Diazepam
C Barbiturates
D Brown sugar

24. Ans. A Cocaine
‘Cocaine bugs’/ Magnan’s symptoms,
+ ulceration of the nasal septum due to sniffing.
Cocainism= Cocaine habit
Cocainomania- chr. abusers tolerate upto 10gms/day.
Antidote- amyl nitrite.

25. 4.Q. Which type of cattle poisoning occurs due to ingestion
of LINSEED (Alsi) plant:
A Aconite
B Pilocarpine
C Atropine
D Hydrocyanic acid

26. Ans. D Hydrocyanic acid
-Also k/a Prussic Acid
-Derived from Linseed Plant
-Bitter almond smell
-Inhibits enzymes of respiratory chain : 1) Carbonic anhydrase
2) superoxide dismutase
3) Cytochrome oxidase
4) Succinate dehydrogenase
-Rx: Amyl Nitrite
+
Vit. B12
+
Na. Thiosulphate
Triple Antidote
Amyl nitrite + CN = Meth-Hb
Vit.B12 + CN = Cyanocobalamine
Na.thiosulphate +CN= Thiocyanate

27. 5.Q) Heera Lals’s 10 year old child presented in casualty with
snakebite since six hours. On examination no systemic signs
are found & lab investigation are normal except localized
swelling over the leg <5 cms. Next step in management
would be:
A Incision & suction of local swelling
B I/V anti-venom serum
C S/c anti-venom at local swelling
D Observe the patient for progression of symptoms wait for
anti-venom therapy

28. Ans. D Observe the patient for progression of symptoms
wait for anti-venom therapy
Since there no systemic signs & lab investigation are
normal and there is only mild swelling over the leg <5 cms
….
These is considered non toxic and swelling is a reaction
of inflammation….
so we can wait till further symptoms arrives…

29. -Ophistoxemia
- Cobra
-Common Krait
-King Cobra
-Viper : Russel viper
Saw scaled Viper
-Sea Snake = Myotoxic
- In Krait local symptoms are absent
Elipidae group
- Neurotoxic
Hemotoxic

42. Krait is most poisonous but still Cobra is considered more
dangerous since it inserts 40times more poison than KRAIT
Fatal dose= Cobra=12mg
Krait = 6mg
Fatal Period= ½ -6hrs

45. 1) Immobilise the limb as movement may aggrevate spread
2) Bite site shouldn’t be cleaned or sucked
3) Tourniquet is of no use as poison spreads from lymphatics and not from
blood vessels but still if it is applied ,it shouldn’t be very tight.
The pressure should be less than 70mmHg.
4) Antisnake Venom : Produced in Hoffkin Institute Bombay

47. ASV should be given over 1hour infusion

48. 6.Q.Cherry-red colour in post mortem staining is a feature of
poisoning with:
A Nitrites
B Aniline
C Phosphorus
D Carbon Monoxide

49. Ans. D Carbon Monoxide
(Colour of post-mortem staining in poisoning-
1) Dark brown or yellow- Phosphorus or acute copper poisoning,
2)Cherry red- CO & Cold storage,
3) Bluish-green- H2S,
4) Bright red- HCN/ Cyanides,
5) Chocolate/Red-brown coloured- Nitrites/Nitrates, aniline, Nitrobenzene,
Acetanilide, Bromates, Chlorates (due to formation of Methaemoglobin.)

50. 7.Q. In exhumed bodies, poison likely to be detected:
A Dhatura
B Mercury
C Arsenic
D Cocaine

51. Ans. C (Arsenic is the poison likely to be detected in exhumed bodies as it
undergoes post-mortem imbibition.)

53. Metallic Arsenic is not poisonous since it is not absorbed in intestines
Arsenic oxide or arsenic trioxide is poisonous and it occurs in powder form.
It has no smell,no taste and partly soluble in water.
-Copper arsenite - Scheele’s Green
- copper acetoarsenite – Paris green
-It reacts with sulfhydryl group and interferes
with cell metabolism
-Fulminant dose: 3-5gms
- fulminant period: 1-3hrs
Fatal dose – 100-200mg
Fatal period: 1-2days

55. Aldrich mee lines
- Rain drop pigmentation/rash/Red velvety Mucosa
Sub endocardial hemorrhage
Excessive pigmentation
Neuritis
Iron Oxide + BAL : Treatment
Mimics Cholera

58. 1) Hemodialysis
2) Gastric lavage– but do not mix alkali as it may increase solubility
of arsenic
3) Chelating agent : BAL+ Iron Oxide
4) arsine binds to and causes rapid destruction of red blood cells, so blood
transfusions and exchange transfusions may help the patient

59. ARSENOPHAGISTS – Persons who can tolerate Arsenic in high doses
-Mimics Cholera/Measles/addison’s disease
- may cause basal cell carcinoma
- also causes fatty infiltration of liver/NCPF
- Ideal Test: Gutzeit Test > Reinsch Test
- In chronic poisoning arsenic may be found in Bones/nails/hairs
-Can be detected even in decomposed body/bones/ashes
- delays putrifaction

60. 8.Q.Which of the following poisons has only local action?
A Sulphuric acid
B Carbolic acid
C Oxalic acid
D Phosphorus

61. Ans. A Sulphuric acid
Sulphuric acid - effect on the system.
Extract the water from the tissues
Fixes, destroys and erodes the tissues
Converts haemoglobin in to heamatin
Causes coagulation necrosis by precipitation of proteins

62. -Oil of Vitriol
-Vitriolage : Throwing corrosive on another person
-MC symptom dur to ingestion : Pharyngeal Pain
-Brown discoloration of stomach
-Only local symptoms…no systemic effects
-Maximum chance of stomach perforation among all corrosives
-Mucosa will be burnt : Bloating Paper appearance
-Gastric lavage and alkali administration is contra indicated
-Antidote = MgO

64. -PHENOL
-Only corrosive where gastric lavage can be done.
-Metabolites : Pyrocatechol
Hydroquinone
-Ochronosis : Hydroquinone deposits in cartilages.
-Carboluria : Both metabolites when excreted in urine gives Green colour
-Delays decomposition
-Causes miosis
-Fatal dose : 1-2ml
-Fatal period: 3-4hrs
Mnemonic : 1-2-3-4

65. -Acid of Sugar/ Acid of Sorrel
-Presnt in Tomato/ Cabbage/ Spinach
-Oxalate reacts with calcium and thus causes Hypocalcemia
-Used as Ink remover
-Coffee ground vomiting: Blood + vomiting
-Antidote: Calcium Gluconate
Coffee ground vomiting

66. -Aqua Fortis
-Gives brown color to urine
-Xanthoproteic reaction : Skin becomes Yellow
-Brown mucosa

67. Seen in Boric Acid
Poisonings

68. 9.Q) All are features of lead poisoning, EXCEPT:
A Diarrhoea
B abdominal pain
C Encephalopathy
D Nephropathy

69. Ans. A Diarrhoea

70. -MC route of poisoning = Inhalation
-Sindhur = Lead Tetraoxide
-Antidote = E.D.T.A ( In children: DMSA (succimer)
-MC lead leading to toxicity= Lead acetate
-Lethal dose = 20gm
-Chronic poisoning is known as Plumbism/Saturnism

71. Anemia/Amenorrhoea
Basophilic stippling/Burtonian lines
Colic/Constipation
Drop(Wrist/foot)
Encephalopathy
Facial pallor

72. Basophilic stippling
Blue dots on RBCs

73. Burtonian lines
- Blue lines on Gums.

74. Drop(Wrist/foot)

75. LAB PARAMETER VALUES REMARK
1) Coproporphyrin in
Urine
>150mcg/l Exposure to lead
2) Amino Levulinic Acid
in Urine
>5mg/l Indicates lead
absorption
3) Lead in blood >70mcg/100ml Clinical symptoms
appears
4) Lead in urine >0.8mg/l Lead exposure and
absorption
5) Basophilic stippling
of RBCs
Punctate basophilia

76. 10)Q. An addicted patient presenting with visual and tactile
hallucinations, has black staining of tongue and teeth,
the agent is:
A Cocaine
B Cannabis
C Heroin
D Opium

77. Ans. A Cocaine
COCAINE POISONING-
tactile hallucinations (Magnan's symptoms = Cocaine bugs),
visual hallucinations,
black staining of tongue & teeth,
ulceration of the nasal septum due to sniffing.

78. 11)Q. A farmer was brought to the casualty with restlessness and
agitation. Examination shows temp 1030 F, flushed face, pupils
dilated and fixed. The diagnosis is:
A Dhatura poisoning
B Organophosphorus poisoning
C Diazepam poisoning
D Opium poisoning

79. Ans. A Dhatura poisoning
Hot as a hare,
Blind as a bat,
Dry as a bone,
Red as a beet,
Mad as wet hen.
Pyrexia + contracted pupils = Phenobarbitone poisoning;
Pyrexia + dilated pupils = Datura poisoning.

80. -Principle : Hyoscine/Atropine/Hyoscyamine/Scopola
-So all anti-cholinergic effects are seen
-Lethal Dose = 100-125seeds
-Seeds resembles chilly seeds
Antidote: Physostigmine/Pilocarpine

81. DATURA SEEDS
CHILLY SEEDS

82. 12) Q.BAL is used as an antidote poisoning for:
A Morphine
B Aconite
C Phenol
D Mercury

83. Ans. D Mercury B.A.L. = Dimercaprol = British anti-lewisite = As, Pb, Bi, Cu, Hg, Gold.
Action- heavy metals combine with the two –SH groups on BAL.
Dose- 3-4 mg/kgbw of 10% BAL

84. 1) British Anti Lewisite (B.A.L)
(Dimercaprol)
Given in = Arsenic
Mercury
C.I in = Iron/Cadmium

85. D-PENICILLAMINE
-Given in Copper Poisoning
-C.I in Arsenic Poisoning
EDTA
-Given in Lead poisoning
-C.I in Mercury

86. CHELATING AGENT USED IN CONTRAINDICATED
IN
1) B.A.L MERCURY
ARSENIC
IRON
CADMIUM
2) EDTA LEAD MERCURY
3) D-PENICILLAMINE COPPER ARSENIC

87. Magnesium Oxide = 1 part
Tannic Acid = 1 part
Charcoal =2 parts
Adsorps poison
Precipitates Poison

88. 13) Q. Necrosis of Proximal convoluted tubules is caused by:
A Arsenic
B Phenol
C Alcohol
D Amanita phalloides

89. Ans. A Arsenic
PCT necrosis is caused by-
Carbon tetra Chloride, Cantharidine,
Lysol,
Arsenic,
Mercury,
Phenol.

90. 14)Q. Smell of bitter almonds is seen in poisoning with:
A Phosphorus
B Hydrocyanic acid
C Nitric acid
D Oxalic acid

91. Ans. B Hydrocyanic acid
Smell about mouth & Nose-
Garlic-like – Phosphorus, Arsenic, Parathion, Malathion,
Sweetish or fruity- Ethanol, Chloroform, Nitrites.
Acrid- Paraldehyde, Chloral hydrate.
Rotten eggs- Hydrogen Sulphide, Mercaptans, Disulfiram.
Fishy or musty- Zn Phosphide, Cyanides, Phenol, Opium, Ether.
Bitter almonds- Cyanides, HCN

92. 15) Q.Haemodialysis is may be used for each of the following
poisonings EXCEPT:
A Kerosene oil
B Barbiturates
C Alcohol
D Aspirin

93. Ans. A Kerosene oil
Hemoperfusion is done for = Barbiturates
Exchange Transfusion is done for = Arsenic

94. B = Barbiturates
L = Lithium
A = Alcohol
S = Salicylates
T = Thiophylline/Thiocyanate

95. HEMODIALYSIS IS C.I
in POISONS
erosene
enzodiaepine
hloroquine/CuSO4
eroin

96. GIVE YOUR 200%
IN EVERYTHING U
DO………
PUSH YOUR
LIMITS