Forensic Toxicology Practice Questions

Q: The seeds of the plant shown below resemble which of the following? (Recent NEET Pattern 2016-17)

Ricinus communis. ***Ricinus communis*** - The image displays a **spiny fruit** containing numerous **brown, mottled seeds** that are characteristic of the *Ricinus communis* plant, also known as the **castor bean plant**. - **Castor seeds** are highly toxic due to the presence of **ricin**, a potent protein toxin. *Semecarpus anacardium* - This plant, commonly known as **marking nut** or **Bhallataka**, produces an **oval-shaped, black nut** with a cup-shaped fleshy receptacle. - Its seeds are generally **kidney-shaped** and black, differing from the seeds shown in the image. *Capsicum* - *Capsicum* refers to **chili peppers**, which produce berries containing small, **flat, pale yellow or white seeds**. - The seeds in the image are **dark brown and irregular**, not consistent with *Capsicum* seeds. *Nerium odorum* - *Nerium odorum* is a species of **oleander**, a highly toxic plant whose seeds are typically found in **long, narrow follicles**. - The seeds are usually **light brown to reddish-brown**, often with hairy tufts, which do not match the appearance of the seeds in the image.

Q: Which of the following poisonings will lead to the skin appearance shown below?

Arsenic poisoning. ***Arsenic poisoning*** - Chronic arsenic exposure can lead to characteristic **rain-drop hyperpigmentation** (scattered spots of hyperpigmentation on a hypopigmented background), and **keratoses** on the palms and soles, as seen in the image. - This **skin manifestation** is a strong indicator of arsenic toxicity and can progress to skin cancers like squamous cell carcinoma and basal cell carcinoma. *Mercury poisoning* - **Mercury poisoning** typically manifests with neurological symptoms like tremors, ataxia, and psychological disturbances, as well as kidney damage. - Dermatological signs are less common but can include acrodynia (pink disease) in children, characterized by a **diffuse red rash**, swelling, and pain in the extremities, which is not depicted. *Cadmium poisoning* - Chronic exposure to **cadmium** primarily affects the kidneys (leading to renal dysfunction), bones (causing osteomalacia and osteoporosis), and lungs (emphysema). - While skin pigmentation changes can occur in some heavy metal poisonings, they are not a prominent or pathognomonic feature of cadmium toxicity. *Antimony poisoning* - **Antimony poisoning**, often from occupational exposure or specific medications, can cause gastrointestinal symptoms (nausea, vomiting), cardiac abnormalities (arrhythmias), and liver dysfunction. - Skin manifestations are not a common or characteristic feature of antimony toxicity.

Q: What is the function of the tube shown below?

Gastric lavage. ***Gastric lavage*** - The pictured device is a historical form of a **stomach pump**, featuring a funnel, tubing, and a rubber bulb, consistent with instruments used for **gastric lavage**. - **Gastric lavage** involves flushing the stomach with fluid and then suctioning it out to remove ingested toxins or substances, often performed in cases of poisoning or overdose. *Barium enema* - A barium enema involves introducing a **contrast agent (barium sulfate)** into the colon via the rectum, not the stomach, for radiographic imaging of the lower gastrointestinal tract. - The device used for a barium enema is typically a bag or container for the barium mixture connected to a rectal tube, which is different from the pictured instrument. *Soap water enema* - A soap water enema is administered rectally to stimulate bowel movements, primarily to relieve **constipation** or to cleanse the colon before medical procedures. - While it involves fluid administration, the device used is usually a more simple enema bag and rectal tube, not this specialized stomach pump. *Nasogastric feeding* - **Nasogastric feeding** involves delivering nutritional formulas directly into the stomach (or small intestine) through a tube inserted via the nose. - The device pictured is not a modern nasogastric feeding tube or its delivery system; these typically involve smaller bore tubes and often use gravity or pumps for continuous administration.

Q: Effects of which poisoning are shown below?

Arsenic poisoning. ***Arsenic poisoning*** - The image depicts severe **hyperkeratosis** and **hyperpigmentation** of the palms and soles, which are classic cutaneous manifestations of chronic arsenic poisoning. - Chronic exposure to arsenic often leads to these skin changes, along with other systemic effects like **neuropathy** and increased cancer risk. *Mercury poisoning* - Chronic mercury poisoning (e.g., Minamata disease) primarily affects the **nervous system**, causing **ataxia**, **paresthesias**, and psychiatric disturbances. - While skin changes can occur (e.g., acrodynia in children), they are typically not characterized by this specific pattern of palmar/plantar hyperkeratosis and hyperpigmentation. *Cadmium poisoning* - Cadmium poisoning mainly affects the **kidneys** (proximal tubular dysfunction), **bones** (osteomalacia, osteoporosis, "itai-itai" disease), and lungs. - Skin manifestations similar to those shown in the image are not typical features of cadmium toxicity. *Antimony poisoning* - Acute antimony poisoning typically causes **gastrointestinal symptoms** (nausea, vomiting, diarrhea) and cardiac effects. - Chronic exposure can lead to irritation of the skin and mucous membranes, but the prominent palmar/plantar hyperkeratosis and hyperpigmentation shown are not characteristic.

Q: An unconscious patient was brought to the casualty. ABG reveals metabolic acidosis with hypocalcemia. The urine specimen from this patient is shown below. Identify the substance:

Ethylene glycol. ***Ethylene glycol*** - The image shows **calcium oxalate crystals** (both monohydrate, "dumbbell" shapes, and dihydrate, "envelope" shapes), classical findings in **ethylene glycol poisoning**. - Ethylene glycol is metabolized into **oxalic acid**, which precipitates with calcium, leading to **hypocalcemia** and metabolic acidosis due to accumulating organic acids. *Methyl alcohol* - Methyl alcohol poisoning is characterized by metabolites like **formic acid**, causing severe **metabolic acidosis** and visual disturbances, but does not typically lead to calcium oxalate crystalluria. - While it causes profound acidosis, the diagnostic urine crystals seen in the image are not associated with methyl alcohol intoxication. *Formaldehyde* - Formaldehyde poisoning is generally due to ingestion or inhalation, leading to immediate toxicity, often with severe gastrointestinal and respiratory symptoms. - It does not typically metabolize into substances that form **calcium oxalate crystals** in the urine or cause hypocalcemia in this manner. *Paraldehyde* - Paraldehyde is an older sedative/hypnotic that can cause **metabolic acidosis** due to its metabolism into acetic acid, especially in large doses. - However, it does not lead to the formation of **calcium oxalate crystals** in the urine or associated hypocalcemia as seen in the image.

Q: Identify the flowers shown below:

Aconite. ***Aconite*** - The image displays characteristics consistent with **Aconite** (monkshood) flowers, which are typically **dark purple to blue** and have a distinctive **hooded shape**. - Aconite is known for its **highly toxic** alkaloids, especially **aconitine**, which can cause rapid and severe symptoms upon ingestion or skin contact. *Cerbera Thevetia* - **Cerbera Thevetia** (yellow oleander) flowers are typically **yellow or orange** and are bell-shaped, which differs significantly from the flowers shown. - Poisoning from *Cerbera Thevetia* is primarily due to **cardiac glycosides**, leading to symptoms like bradycardia, nausea, and vomiting. *Datura* - **Datura** flowers are typically **large, trumpet-shaped**, and vary in color from white to purple, but lack the distinctive hooded appearance seen in the image. - *Datura* species contain **tropane alkaloids** (e.g., scopolamine, atropine), which cause anticholinergic effects like mydriasis, delirium, and tachycardia. *Nerium Odorum* - **Nerium Odorum** (pink oleander) flowers are typically **pink, red, or white** and have a pinwheel shape with five petals, which does not match the flowers in the image. - Like *Thevetia*, *Nerium Odorum* is toxic due to **cardiac glycosides**, causing similar cardiovascular and gastrointestinal symptoms.

Q: The following presentation occurs due to? (AIIMS Nov 2018)

Long term ingestion of arsenic in drinking water. ***Long term ingestion of arsenic in drinking water*** - The image shows **hyperpigmentation and hyperkeratosis** on the palms, often described as "raindrop pigmentation" or diffuse darkening with scattered paler lesions (leukomelanosis). This is a classical dermatological manifestation of **chronic arsenic poisoning**, particularly from contaminated drinking water. - **Arsenicosis** can also cause palmar and plantar keratoses, which can progress to malignant skin lesions over time. *Chronic Copper sulfate poisoning* - Chronic copper poisoning is rare and typically affects the liver, leading to conditions like **cirrhosis** and **hepatitis**, as seen in Wilson's disease. - Skin manifestations from copper poisoning are not typically characterized by the diffuse hyperpigmentation and hyperkeratosis seen in the image. *Application of mercury ointment* - Topical mercury exposure can cause localized skin irritation, dermatitis, or systemic toxicity with features like **acrodynia** (pink disease) in children, characterized by a pink rash, irritability, and hypertension. - It does not typically lead to the described pattern of diffuse hyperpigmentation and hyperkeratosis on the palms. *Application of Calotropis* - **Calotropis** (such as *Calotropis gigantea* or *procera*) is a plant known for its toxic latex, which can cause intense local irritation, vesication, or ulceration upon skin contact. - Its effects are primarily acute irritant or allergic reactions and do not produce the chronic skin changes of hyperpigmentation and hyperkeratosis seen in the image.

Q: A 40-year-old farmer tried committing suicide by consuming two Sulphas (aluminium phosphide) tablets. On admission pulse is 110 bpm with BP of 80 / 60 mm Hg and GCS of 7 / 15 . SpO2 in room air is 80 %. ECG was performed. All are true about this poisoning except:

Emergent gastric lavage. ***Emergent gastric lavage*** - **Gastric lavage is contraindicated** in aluminum phosphide poisoning due to the risk of **phosphine gas release** upon contact with stomach acid, which can exacerbate lung injury or expose healthcare workers. - The use of **emetics** or **charcoal** is also generally not recommended for the same reasons. *Sodium bicarbonate* - **Sodium bicarbonate is indicated** in aluminum phosphide poisoning to help neutralize gastric acid, which reduces the release of toxic phosphine gas. - It also aids in managing metabolic acidosis, a common complication of severe poisoning. *Toxic agent is phosphine* - When **aluminum phosphide** reacts with **gastric acid**, it releases the highly toxic gas **phosphine (PH3)**, which is responsible for the systemic effects of the poisoning. - Phosphine gas causes **cellular dysfunction** by inhibiting cytochrome c oxidase, leading to **multiorgan failure**. *ECG in lead II shows sinus tachycardia and ST segment depression* - The provided ECG image indeed shows evidence of **sinus tachycardia** (increased heart rate) and **ST segment depression**, which are common findings in aluminum phosphide poisoning. - These ECG changes reflect **cardiac toxicity**, including myocardial injury and ischemia, due to the metabolic disturbances and direct cellular damage caused by phosphine.

Question 1

The seeds of the plant shown below resemble which of the following? (Recent NEET Pattern 2016-17)

Accepted Answer

Ricinus communis

Answer

Semecarpus anacardium

Answer

Capsicum

Answer

Nerium odorum

Question 2

Which of the following poisonings will lead to the skin appearance shown below?

Accepted Answer

Arsenic poisoning

Answer

Mercury poisoning

Answer

Cadmium poisoning

Answer

Antimony poisoning

Question 3

What is the function of the tube shown below?

Accepted Answer

Gastric lavage

Answer

Barium enema

Answer

Soap water enema

Answer

Nasogastric feeding

Question 4

Effects of which poisoning are shown below?

Accepted Answer

Arsenic poisoning

Answer

Mercury poisoning

Answer

Cadmium poisoning

Answer

Antimony poisoning

Question 5

An unconscious patient was brought to the casualty. ABG reveals metabolic acidosis with hypocalcemia. The urine specimen from this patient is shown below. Identify the substance:

Accepted Answer

Ethylene glycol

Answer

Methyl alcohol

Answer

Formaldehyde

Answer

Paraldehyde

Question 6

Identify the flowers shown below:

Accepted Answer

Aconite

Answer

Datura

Answer

Nerium Odorum

Answer

Cerbera Thevetia

Question 7

The following presentation occurs due to? (AIIMS Nov 2018)

Accepted Answer

Long term ingestion of arsenic in drinking water

Answer

Chronic Copper sulfate poisoning

Answer

Application of mercury ointment

Answer

Application of Calotropis

Question 8

A 40-year-old farmer tried committing suicide by consuming two Sulphas (aluminium phosphide) tablets. On admission pulse is 110 bpm with BP of 80 / 60 mm Hg and GCS of 7 / 15 . SpO2 in room air is 80 %. ECG was performed. All are true about this poisoning except:

Accepted Answer

Emergent gastric lavage

Answer

Sodium bicarbonate

Answer

Toxic agent is phosphine

Answer

ECG in lead II shows sinus tachycardia and ST segment depression

Question 9

A child was bitten by this snake while playing. He develops blurred vision and develops hypotension with respiratory difficulty. On examination two fang marks are seen on his left foot. All are true about the management except: (Recent NEET Pattem 2016-17)

Accepted Answer

Dose of ASV in children is 1 mL/kg body weight

Answer

Give neostigmine and check for improvement in the form of millimeters of iris covered

Answer

Fasciotomy to be performed in case of compartment syndrome

Answer

ASV reaction managed with temporary discontinuation and adrenaline usage

Question 10

A snake charmer was bitten by a snake in the evening hours while catching a snake which had entered in the bathroom of the village sarpanch. He was brought to the hospital late at night with inability to talk and breathing difficulty. On examination gag reflex was absent, neck floppiness and tongue flaccidity was noted. His wife identified the snake from the pictures shown by the doctor as the one shown below. Which of the following should not be done in this case? (Recent NEET Pattem 2016-17)

Accepted Answer

Intravenous neostigmine

Answer

Urgent intubation and ventilation

Answer

ASV within four hours and upper limit of 24 hours

Answer

20WBCT

Forensic Toxicology — MCQs

Forensic Toxicology — MCQs

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