Forensic medicine 7

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prem.sigdel7
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273594
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Forensic medicine 7
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2015-04-03 08:06:57
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Cerebral poison Cardiac
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  1. Name cardiac poisons, cerebral poisons and asphyxients?
    • A. Cardiac poisons [AI 94] – Aconite,[IOM 10]  Digitalis, Oleander, Tobacco
    • B. Cerebral poison – Opium, barbiturates, alcohol, dhatura, belladonna, cannabis, Nux vomica, Curare
    • C. Asphyxiants [AIIMS 05]  – Carbon monoxide, Carbon dioxide, Coal gas, cyanide, phosgene, other poisonous gases.
  2. What are the features of aconite poisoning? [AI 10]
    Gastrointestinal effects - Tingling, numbness and burning sensation of lips, mouth and tongue after ingestion, hypersalivation 

    Neuromuscular and CNS effects - Limbs become weak and patient is unable to walk and stand, alternate contraction and dilatation of pupils (hippus). 

    Cardiovascular effects - Hypotension, chest pain 
  3. Name stupidifying poisons?  [DNB 91]
    • Belladona 
    • Cannabis
    • Dhatura 
    • [@ BCD]
  4. What is the effect of methyl alcohol on eye? [UP 96]
    • Methyl alcohol causes either temporary blindness or in severe cases, atrophy of the optic nerves resulting in permanent blindness.
    • The toxic effects of methyl alcohol is due to accumulation of  Formaldehyde and formic acid. [AI 05, AIIMS 04]
  5. What is Widmark’s formula?
    • It is the formula   for estimation of alcohol (ethyl alcohol) in blood [AIIMS 00,97, ROHTAK 86]. 
    • i.e. a = cpr   where,  
    • c  = conc. of alcohol in blood (gm/kg)  ,    
    • p  = body weight in kg
    • r  = constant(0.6 for male & 0.5  for female) 
    • a = total amount of alcohol (in  gm) absorbed in body
  6. Which of the following cannot occur in contaminated liquor poisoning? [SGPGI 02]
    A) Toxicity is due to methanol
    B) Blindness 
    C) Metabolic alkalosis
    D) Treatment is due to ethanol 
    C) Metabolic alkalosis
    (this multiple choice question has been scrambled)
  7. Which drug is used for Methanol poisoning?
    • Ethanol or fomepizole 
    • Fomepizole is drug of choice among these two.
  8. Which of the following causes optic atrophy? [CUPGMEE 03]
    A) Methanol 
    B) Ethanol 
    C) Vitamin A 
    D) Vitamin C
    A) Methanol

    In methanol poisoning, there is ocular lesion, which involves chiefly the ganglion cells of the retina, is a destructive inflammation followed by atrophy.
    The final result is bilateral blindness, which usually is permanent.
    (this multiple choice question has been scrambled)
  9. What is Mc Ewan’s sign?
    • It is a pupillary sign seen in ethyl alcohol  poisoning. [AI 93,95]
    • After the stage of excitement and the  stage of incoordination, there is a stage of  coma in which pupil are constricted.
    • On stimulation of the person by pricking or slapping, pupil dilates initially and then  slowly returns to their original size
  10. Which of the following sweet tasted  poison  produces peri-oral sensation and tingling? [UP 01]
    A) Nerium odorum
    B) Aconite 
    C) Yellow oleander 
    D) Digitalis purpura
    B) Aconite

    (this multiple choice question has been scrambled)
  11. Mydriasis is not caused by [IOM 11]
    A) Cocaine
    B) Phentolamine
    C) Epinephrine
    D) All
    B) Phentolamine

    Phentolamine - a nonselective α-adrenergic antagonist.
    (this multiple choice question has been scrambled)
  12. What are the clinical features of acute carbon monoxide poisoning? [IOM 09]
    Headache, nausea, vomiting, ataxia, and nystagmus
  13. Which of the following is not done in corrosive alkali poisoning? [IOM 08]
    A) Catharsis
    B) Charcoal feeding 
    C) Emesis
    D) Diuresis
    C) Emesis
    (this multiple choice question has been scrambled)
  14. What is the most common cause of poisoning in Nepal? [IOM 01]
    Organophosphate poisoning
  15. What is the toxic dose of Acetaminophen? What blood level of acetaminophen is associated with hepatotoxicity?
    • Toxic  dose - 150mg/kg
    • Blood level causing hepatotoxicity -150μg/ml

    • The sample should be taken only after 4 hrs because acetaminophen peaks only after 4 hrs of ingestion.  Below 150μg/ml, there is no need of treatment.   
    • For aspirin also, the toxic dose is > 150mg/kg. 

    [Remember 150 as a magic  number]
  16. What are the  stages of acetaminophen poisoning?
    • A. First 24 hrs
    • - nausea, vomiting, diaphoresis
    • B. 24-48 hrs
    • – clinical improvement, RUQ pain (also called as honeymoon phase as the patient is clinically stable) 
    • C. 72-96 hrs
    • - peak abnormalities of LFT, more GI symptoms
    • D. 4days to weeks
    • - resolution
  17. The first sign of salicylism is [IOM 05]
    A) Hyperventilation 
    B) Acidosis
    C) Hypoventilation 
    D) Alkalosis
    A) Hyperventilation

    Initially, respiratory alkalosis develops secondary to direct stimulation of the respiratory centers (hyperventilation).
    This may be the only consequence of mild salicylism.
    The toxic effects of salicylates are complex.
    Respiratory centers are directly stimulated.
    Salicylates cause an inhibition of the citric acid cycle and an uncoupling of oxidative phosphorylation.
    A severe metabolic acidosis (ketolactic) acidosis with compensatory respiratory alkalosis may develop with severe salicylate intoxication.
    (this multiple choice question has been scrambled)
  18. What are the enzymes for acetaminophen metabolism? What is major and minor product?
    • Major pathway by Glucoronyl transferase to form inactive conjugate. 
    • Minor pathway by P450 enzymes leading to reactive metabolites, a free radical. (inactivated by GSH)
  19. Why is there increased toxicity of acetaminophen in chronic alcohol users?
    There is induction of P450 in chronic alcohol users leading to more production of reactive metabolites leading to increased toxicity.
  20. What is the effect of acetaminophen in liver?
    Centrilobular necrosis
  21. What is the treatment of  acetaminophen toxicity?
    N-acetylcysteine given within 12 hrs
  22. What is the test that detects the presence of Aspirin?
    Ferric chloride test
  23. What are the features of barbiturate poisoning? [AIIMS 02]
    • Giddiness, ataxia, and slurred speech, a short period of confusion, excitement, and delirium, followed by stupor and later coma
    • Limbs become flaccid, reflexes are lost and pupil reacts to light  by alternate contraction and dilatation. 
    • The face becomes cyanotic. 
    • Hypothermia, hypotension, pulmonary edema, and cardiac arrest may occur in severe cases. 
    • Pupil are generally constricted but  may dilate in terminal phases. 
    • Pressure sores and bullous skin can develop with prolonged coma.
  24. What are the two most important features in TCA poisoning?
    • Seizures 
    • Arrythmia - always obtain ECG
  25. What are the drugs/poisons whose secretion is enhanced by forced alkaline diuresis?
    • Forced alkaline diuresis may be used to enhance elimination of drugs/poisons that are weak acids. These drugs are 
    • - Phenobarbitone [AI 08,12] 
    • - Salicylates 
    • - Chlorpropamide 
    • - Methotrexate [AI 11]
  26. What are the different poisoning that benefit form Hemodialysis?  [AI 93]
    • Bromide, Borate, Barbiturate [AIIMS 97,96] 
    • Lithium,
    • Alcohol, [AIIMS 01]
    • Strychnine, Salicylate,
    • Theophylline, Thiocyanate
    • [ @ BLAST]
  27. What are the poisons in which hemodialysis is contraindicated?
    • Digitalis
    • Kerosene
    • Bzd
    • Organophosphates
    • [@ D K BOSe]
  28. What is the fatal period of sulphuric acid poisoning?  [BIHAR 90]
    12 hrs
  29. What is the color of mucous membrane and stomach in nitric acid poisoning?
    • Skin and mucous membrane - yellow 
    • Stomach – green, if bile is present [AIIMS 99]
  30. Fatal dose of various poisons.
    Copper sulphate - 30 gms [WB 93]
  31. What is the fatal period of Copper poisoning?
    Upto 72 hrs

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