MEDICAL TERMINATION OF PREGNANCY (MTP) ACT
For MTP consent is taken from
| A |
Wife only |
|
| B |
Husband only |
|
| C |
Both |
|
| D |
Neither |
For MTP consent is taken from
| A |
Wife only |
|
| B |
Husband only |
|
| C |
Both |
|
| D |
Neither |
A i.e. Wife only
– MTP Act 1971 allows registered medical practioner with certified experience (by CMO, of assisting 25 MTP cases) to perform abortion in a licenced setup (Governement or private). The consent of only women is required before conducting abortion; written consent of guardian is required if the women is a minor or mentally ill. Consent of husband is not necessaryQ.
– MTP Act 1971 does not allow abortion on poor socioeconomic grounds and if only husband (not mother) is willingQ. Rape; contraceptive failure, use of cytotoxic drugs, risk of delivering seriously handicapped baby, and injury to physical & mental health of mother are valid grounds for MTP.
The MTP act defines the following –
| A |
Who should do termination of pregnancy |
|
| B |
Where it should be done |
|
| C |
When it should be done |
|
| D |
All of the above |
The MTP act defines the following –
| A |
Who should do termination of pregnancy |
|
| B |
Where it should be done |
|
| C |
When it should be done |
|
| D |
All of the above |
Ans. is ‘d’ i.e., All of the above
Medical termination of pregnancy act (1971)
o The MTP act, 1971 lays down ‑
1. The conditions under which a pregnancy can be terminated.
2. The person or persons who can perform such terminations.
3. The place where such terminations can be performed.
Consent from guardian/husband for MTP is required if –
| A |
Female is below 28 years of age |
|
| B |
Female is below 23 years of age |
|
| C |
Female is below 17 years of age |
|
| D |
All |
Consent from guardian/husband for MTP is required if –
| A |
Female is below 28 years of age |
|
| B |
Female is below 23 years of age |
|
| C |
Female is below 17 years of age |
|
| D |
All |
Ans. is ‘c’ i.e., Female is below 17 years of age
The conditions under which a pregnancy can be terminated under the MTP Act. 1971 :
There are 5 conditions that have been identified in the Act :
a. Medical – where continuation of the pregnancy might endanger the mother’s life or cause grave injury to her physical or mental health.
b. Eugenic – where there is substantial risk of the child being born with serious handicaps due to physical or mental abnormalities.
c. Humanitarian – where pregnancy is the result of rape
d. Socio-economic – where actual or reasonably foreseeable environments (whether social or economic could lead to risk of injury to the health of the mother).
e. Failure of contraceptive devices – The anguish caused by an unwanted pregnancy resulting from a failure of any contraceptive device or method can be presumed to constitute a grave mental injury to the health of the mother. This condition is a unique feature of the Indian law and virtually allows abortion on request, in view of the difficulty of proving that a pregnancy was not caused by failure of contraception.
The written consent of the guardian is necessary before performing abortion in women under 18 years of age, and in lunatics even if they are older than 18 years.
MTP Act in India does not permit termination of pregnancy after:
Delhi 06; AP 06; JIPMER 14
| A |
12 weeks |
|
| B |
16 weeks |
|
| C |
20 weeks |
|
| D |
24 weeks |
MTP Act in India does not permit termination of pregnancy after:
Delhi 06; AP 06; JIPMER 14
| A |
12 weeks |
|
| B |
16 weeks |
|
| C |
20 weeks |
|
| D |
24 weeks |
Ans. 20 weeks
According to MTP Act, 2 doctors opinion is required when pregnancy is:
Maharashtra 09
| A |
6 weeks |
|
| B |
10 weeks |
|
| C |
> 12 weeks |
|
| D |
> 20 weeks |
According to MTP Act, 2 doctors opinion is required when pregnancy is:
Maharashtra 09
| A |
6 weeks |
|
| B |
10 weeks |
|
| C |
> 12 weeks |
|
| D |
> 20 weeks |
Ans. > 12 weeks
Under the MTP Act, termination of pregnancy can be done by:
Rohtak 08
| A |
Any registered medical practitioner (RMP) |
|
| B |
Any RMP with MD/MS degree in Obs and Gynae |
|
| C |
Any RMP with 6 months residency in any depar intent |
|
| D |
Any RMP with a minimum of 3 months residency in Obs and Gynae |
Under the MTP Act, termination of pregnancy can be done by:
Rohtak 08
| A |
Any registered medical practitioner (RMP) |
|
| B |
Any RMP with MD/MS degree in Obs and Gynae |
|
| C |
Any RMP with 6 months residency in any depar intent |
|
| D |
Any RMP with a minimum of 3 months residency in Obs and Gynae |
Ans. Any RMP with MD/MS degree in Obs and Gynae
Indication of MTP-
| A |
Pregnancy due to rape |
|
| B |
Contraceptive failure |
|
| C |
Pregnancy endangering mother’s life |
|
| D |
All of the above |
Indication of MTP-
| A |
Pregnancy due to rape |
|
| B |
Contraceptive failure |
|
| C |
Pregnancy endangering mother’s life |
|
| D |
All of the above |
Ans. is ‘d’ i.e., All of the above
The conditions under which pregnancy can be terminated under the MTPAct
- There are 4 conditions that have been identified in the Act :
- Medical – Where continuation of the pregnancy might endanger the mother’s life or cause grave injury to her physical or mental health.
- Eugenic – Where there is substantial risk of the child being born with serious handicaps due to physical or mental abnormalities.
- Humanitarian – Where pregnancy is the result of rape.
- Failure of contraceptive devices – The anguish caused by an unwanted pregnancy resulting from a failure of any contraceptive device or method can be presumed to constitute a grave mental injury to the health of the mother. This condition is a unique feature of the Indian law and virtually allows abortion on request, in view of the difficulty of proving that a pregnancy was not caused by failure of contraception
MTP Act of 1971 provides for termination of pregnancy till how many weeks of pregnancy ‑
| A |
12 weeks |
|
| B |
16 weeks |
|
| C |
20 weeks |
|
| D |
24 weeks |
MTP Act of 1971 provides for termination of pregnancy till how many weeks of pregnancy ‑
| A |
12 weeks |
|
| B |
16 weeks |
|
| C |
20 weeks |
|
| D |
24 weeks |
Ans. is ‘c’ i.e., 20 weeks
Medical termination of pregnancy act (19711
- The MTP act, 1971 lays down ‑
- The conditions under which a pregnancy can be terminated.
- The person or persons who can perform such terminations.
- The place where such terminations can be performed.
- The conditions under which a pregnancy can be terminated under the MTPAct. 1971 :
- There are 5 conditions that have been identified in the Act :
- Medical – where continuation of the pregnancy might endanger the mother’s life or cause grave injury to her physical or mental health.
- Eugenic – where there is substantial risk of the child being born with serious handicaps due to physical or mental abnormalities.
- Humanitarian – where pregnancy is the result of rape
- Socio-economic – where actual or reasonably foreseeable environments (whether social or economic could lead to risk of injury to the health of the mother).
- Failure of contraceptive devices – The anguish caused by an unwanted pregnancy resulting from a failure of any contraceptive device or method can be presumed to constitute a grave mental injury to the health of the mother. This condition is a unique feature of the Indian law and virtually allows abortion on request, in view of the difficulty of proving that a pregnancy was not caused by failure of contraception.
- The written consent of the guardian is necessary before performing abortion in women under 18 years of age, and in lunatics even if they are older than 18 years.
- The person or persons who can perform abortion The Act provides safeguards to the mother by authorising only a Registered Medical Practitioner having experience in gynaecology and obstetrics to perform abortion where the length of pregnancy does not exceed 12 weeks. o However, where the pregnancy exceeds 12 weeks and is not more than 20 weeks, the opinion of two Ragistered o Medical Practitioners is necessary to terminate the pregnancy.
- Where abortion can be done
- The Act stipulates that no termination of pregnancy shall be made at any place other than a hospital established or maintained by Government or a place approved for the purpose of this Act by Government.
- Abortion services are provided in hospitals in strict confidence. The name of the abortion seeker is kept confidential, since abortion has been treated statutorily as a personal matter.
MEDICAL TERMINATION OF PREGNANCY (MTP) ACT
MEDICAL TERMINATION OF PREGNANCY (MTP) ACT
- The MTP act was introduced in 1971
- Consent of husband is not required.
- Abortion cannot be performed on request of husband, if women herself is not willing.
- Under MTP Act, pregnancy cannot be terminated after 20 weeks of pregnancy.
- Above 20 weeks, the pregnancy can be terminated only on therapeutic considerations.
- It is necessary to save the life of pregnant woman.
- Upto 12 weeks of pregnancy, pregnancy can be terminated on the opinion of a single doctor AND 2 DOCTORS > 12 weeks.
- Consent of woman is mandatory.
- When she is minor (< 18 years) or mentally ill, where consent of the guardian is obtained.
- Where there is substantial risk of the child being born with serious handicaps due to physical or mental abnormalities.
- Pregnancy caused as a result of failure of a contraceptive.
- only a Registered Medical Practitioner (RMP with MD/MS degree in Obs and Gynae) having experience to perform abortion (below 12 wks pregnancy).
- MTP can be conducted at only Govt hospitals, or a District level committee with chief medical officer.
- Section 312 to 316 of IPC deal with criminal abortions.
- Section 312: when a woman is with child and quick with child,
- Section 313:It penalises causing miscarriage of a woman with child (whether she has attained the stage of quickening or not) without her consent.
- Section 314:It prescribes punishment in the situation where death of a woman has occurred in causing miscarriage.
- Section 315:It is aimed at ‘foeticide’ while in the womb, after the foetus has developed sufficiently.
- Section 316:It finds its application wherein death of a child is caused when the pregnancy had advanced beyond the stage of ‘quickening’. It differs from the preceding Section
- Methods used in criminal abortion: 1) Drugs (ecbolics (ergot, quinine) and emmenagogues). 2) Abortion stick (by inducing uterine contraction).
- Most common cause of death in criminal abortion is hemorrhage and shock
Exam Important
- The MTP act was introduced in 1971
- Consent of husband is not required.
- The MTP act was introduced in 1971
- Consent of husband is not required.
- Upto 12 weeks of pregnancy, pregnancy can be terminated on the opinion of a single doctor AND 2 DOCTORS > 12 weeks.
- Consent of woman is mandatory.
- only a Registered Medical Practitioner (RMP with MD/MS degree in Obs and Gynae) having experience to perform abortion (below 12 wks pregnancy).
- MTP can be conducted at only Govt hospitals, or a District level committee with chief medical officer.
- Section 312 to 316 of IPC deal with criminal abortions.
Undertaker Fracture,Stalking,para-suicide, heat and cold stroke
Which among the following sites are involved in “undertakers fracture”?
| A |
Skull |
|
| B |
Cervical spine |
|
| C |
Pelvis |
|
| D |
Mandible |
Which among the following sites are involved in “undertakers fracture”?
| A |
Skull |
|
| B |
Cervical spine |
|
| C |
Pelvis |
|
| D |
Mandible |
The so called undertaker fracture is caused due to the head falling backward forcibly after death.
It usually causes one of intervertebral discs (usually around C6 or C7) to tear open and results in the subluxation of the lower cervical spine.
Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 21, Page – 92
In heat stroke, skin will be:
September 2012
| A |
Warm |
|
| B |
Normal |
|
| C |
Cold |
|
| D |
Cyanosis |
In heat stroke, skin will be:
September 2012
| A |
Warm |
|
| B |
Normal |
|
| C |
Cold |
|
| D |
Cyanosis |
Ans. A i.e. Warm
Heat stroke presents with a hyperthermia of greater than 40.6 °C (105.1 °F) in combination with confusion and a lack of sweating.
NOT seen in heat stroke:
Kerala 06
| A |
Hypovolemic shock |
|
| B |
Rhabdomyolysis |
|
| C |
Pancreatitis |
|
| D |
Cerebral edema |
NOT seen in heat stroke:
Kerala 06
| A |
Hypovolemic shock |
|
| B |
Rhabdomyolysis |
|
| C |
Pancreatitis |
|
| D |
Cerebral edema |
Ans. Hypovolemic shock
Undertaker’s fracture is seen at the level of cervical vertebra:
| A |
C1-C2 |
|
| B |
C3-C4 |
|
| C |
C5-C6 |
|
| D |
C6-C7 |
Undertaker’s fracture is seen at the level of cervical vertebra:
| A |
C1-C2 |
|
| B |
C3-C4 |
|
| C |
C5-C6 |
|
| D |
C6-C7 |
Ans. C6-C7
- It is caused clue to the head falling backwards forcibly after death, which tears open one of the intervertebral discs, usually around C6 and C7.
- Due to the prolapse of the cervical intervertebral disc, there is increased tendency of subluxation of the lower cervical spine.
What is the most common cause of parasuicide?
| A |
Drug ingestion |
|
| B |
Hanging |
|
| C |
Cutting wrist |
|
| D |
Firearms |
What is the most common cause of parasuicide?
| A |
Drug ingestion |
|
| B |
Hanging |
|
| C |
Cutting wrist |
|
| D |
Firearms |
Ans. a. Drug ingestion
Parasuicide is a suicide attempt or gesture and self-harm where there is no result in death. It is a non7fatal act in which a person deliberately causes injury to him or herself or ingests any prescribed or generally recognized therapeutic dose in excess. It is considered to be a serious public health issue. Parasuicide is the strongest known indicator for a future successful suicide attempt. Examples of suicidal gestures include cutting, where the cut is not deep enough to cause significant blood loss, or taking a non-lethal overdose of medication.’- http://en.wikipedia.org/wiki/Parasuicide
`Maximum cases of near-suicides are due to drug overdose. In India, wrist cutting is equally common, but drug overdose is by far the most common cause of parasuicide in the world.’- Methods used for parasuicide: results of the WHO/EURO Multicentre Study on Parasuicide.
Undertaker Fracture,Stalking,para-suicide, heat and cold stoke
Introduction:
- Undertaker’s fracture is an artifact related to poor handling of the corpse characterized by subluxation of the lower cervical spine from tearing of the intervertebral disc at C6-C7 vertebral level. It occurs due to sudden fall of the head over occipital region.
- stalking – physical or electronic via phone calls, text messages, or emails — is a criminal offence. It is punishable with one to three years in jail.
- IPC sec 354D- stalking
- Upto 3 years + Fine for first conviction
- upto 5 years + Fine for second or subsequent conviction
PARA-SUICIDE
- parasuicide also known as attempted suicide or pseudosuicide is a conscious often impulsive, manipulative act in which the aim is not death.
- Drug ingestion is the commonest form followed by cutting wrist.
- previous parasuicide is a predictor of suicide. The risk of subsequent suicide persists for at least two decades.
HEAT AND COLD STOKE:
- Exposure to high atmospheric temperatures causes three clinical conditions :-
1) Heatcramps/Miner,scramps/Stoker’scramp/Firemen’scramp
- These are painful spasm of voluntary muscles which follow sternous work in a hot atmosphere.
- These are caused by toss of water and salt in profuse prespiration (sweating)’
2) Heat exhaustion/heat collapse/heat syncope/heat prostration
- There is collapse without any elevation of body tempetature’
- It occurs drr.io e*pogre to high temperature in closed environment and is precipitated by muscular exercise and unsuitable clothing.
- There is extreme exhaustion with peripheral vascular collapse with scanty perspiration (sweating)’
3) Heat stroke (heat hyperpyrexia/sunstroke)
- It is due to failure of heat regulating mechanism caused by failure of cutaneous circulation and sweating’
- It occurs due to exposure to heat in open and humid environment.
- There is sudden collapse with loss of consciousness.
- Skin is dry, hot flushes and there is no sweating.
- AII signs of shock are present, i.e. low urine out put, low BP, rapid irregular pulse etc.
COLD STROKE
- The localized effects of cold are frost-bite, trench foot, and immersion foot’
- Trench foot and immersion foot (wet cold) result due to prolonged exposure to severe cold (5-80C) and dampness.
- Blister formation with ulceration and localized dry gangrene occurs.
- Frost bite is infarction of peripheral digits with oedena, redness and later necrosis of tissue beyond a line of inflammatory demarcation.
- It occurs due to exposure to greater extremes (-2.5″ C) of cold. Necrosis with blister formation and gangrene occur.
- Skin becomes hard and black in about two weeks.The sequence of events is
| 1 | Erythematous patches | Few hours |
| 2 | Soft blisters | 24-36 hours |
| 3 | Hard and black | 2 weeks |
| 4 | Deep upto the none | 1 month |
Exam Important
- Undertaker’s fracture is an artifact related to poor handling of the corpse characterized by subluxation of the lower cervical spine from tearing of the intervertebral disc at C6-C7 vertebral level. It occurs due to sudden fall of the head over occipital region.
- stalking – physical or electronic via phone calls, text messages, or emails — is a criminal offence. It is punishable with one to three years in jail.
- IPC sec 354D- stalking
- Upto 3 years + Fine for first conviction
- upto 5 years + Fine for second or subsequent conviction
PARA-SUICIDE
- parasuicide also known as attempted suicide or pseudosuicide is a conscious often impulsive, manipulative act in which the aim is not death.
- Drug ingestion is the commonest form followed by cutting wrist.
Ethylene glycol & Boric acid poisoning
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 |
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 |
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
Antidote for Ethylene glycol poisoning-
| A |
Methyl violet |
|
| B |
Methyl violet |
|
| C |
Fomepizole |
|
| D |
All |
Antidote for Ethylene glycol poisoning-
| A |
Methyl violet |
|
| B |
Methyl violet |
|
| C |
Fomepizole |
|
| D |
All |
Ans. is ‘c’ i.e., Fomepizole
o I.V. fomepizole or ethanol is given in ethylene glycol poisoning.
o Fomepizole (an alcohol dehydrogenase inhibitor) is the DOC.
Ethanol is used for ethylene glycol poisoning because it is a:
JIPMER 13
| A |
Competitive inhibitor of aldehyde dehydrogenase |
|
| B |
Higher affinity for alcohol dehydrogenase |
|
| C |
Chemically combines and neutralizes ethylene glycol |
|
| D |
A and B |
Ethanol is used for ethylene glycol poisoning because it is a:
JIPMER 13
| A |
Competitive inhibitor of aldehyde dehydrogenase |
|
| B |
Higher affinity for alcohol dehydrogenase |
|
| C |
Chemically combines and neutralizes ethylene glycol |
|
| D |
A and B |
Ans. Higher affinity for alcohol dehydrogenase
Competitive inhibitor of alcohol dehydrogenase [Ref Lehninger Principles of Biochemistry 4th/e p. 336]
Ethylene glycol when ingested affects kidney by forming:
NEET 13
| A |
Formaldehyde |
|
| B |
Oxalates |
|
| C |
Phytates |
|
| D |
Phosphates |
Ethylene glycol when ingested affects kidney by forming:
NEET 13
| A |
Formaldehyde |
|
| B |
Oxalates |
|
| C |
Phytates |
|
| D |
Phosphates |
Ans. Oxalates
Ethylene glycol & Boric acid poisoning
Ethylene glycol
- It is used as an antifreeze.
- It is not absorbed through skin.
- It is metabolised to glycoaldehyde, glycolic acid and oxalic acid.
- Ethylene glycol when ingested affects kidney by forming oxalates.
- It inhibits oxidative phosphorylation.
- Symptoms: vomiting, lethargy, ataxia, convulsions & coma.
- ln l2-24hrs, tachycardia, tachyapnea,electrolyte imbalance& metabolic acidosis.
- In 1-3 days, hypocalcemia, oliguria, tubular necrosis & renal failure occurs due to formation of calcium oxalate crystals.
- Antidote for ethylene glycol poisoning:Fomepizole.
- I.V. fomepizole or ethanol is given in ethylene glycol poisoning.
- Fomepizole (an alcohol dehydrogenase inhibitor) is the DOC.
Treatment– gastric lavage, activated charcoal, ethanol, hemodialysis.
Boric acid poisoning
- Boric acid poisoning is rarely fatal
- Most serious intoxications occur in infants and young children
- The initial phase of poisoning consists of nonspecific gastrointestinal symptoms.
- The ‘boiled lobster’rash an intense generalized erythrodema, manifests shortly thereafter, with extensive desquamation within 1-2 days.
- serious effect
- cardiovascular collapse.
- seizures, and renal failure.
Treatment: The only potential therapy is dialysis or exchange transfusion which has been effective
Exam Important
Ethylene glycol
- It is used as an antifreeze.
- It is not absorbed through skin.
- It is metabolised to glycoaldehyde, glycolic acid and oxalic acid.
- Ethylene glycol when ingested affects kidney by forming oxalates.
- It inhibits oxidative phosphorylation.
- Symptoms: vomiting, lethargy, ataxia, convulsions & coma.
- ln l2-24hrs, tachycardia, tachyapnea,electrolyte imbalance& metabolic acidosis.
- In 1-3 days, hypocalcemia, oliguria, tubular necrosis & renal failure occurs due to formation of calcium oxalate crystals.
- Antidote for ethylene glycol poisoning:Fomepizole.
- I.V. fomepizole or ethanol is given in ethylene glycol poisoning.
- Fomepizole (an alcohol dehydrogenase inhibitor) is the DOC.
- Treatment– gastric lavage, activated charcoal, ethanol, hemodialysis.
MISCELLANEOUS POISONING
Sewer gas is:
| A |
Phosgene |
|
| B |
H2S |
|
| C |
CO2 |
|
| D |
b and c |
Sewer gas is:
| A |
Phosgene |
|
| B |
H2S |
|
| C |
CO2 |
|
| D |
b and c |
B i.e. H2S > C i.e. CO2
|
Name |
Composition |
|
Sewer gas |
– H2S, with CO2 & MethaneQ |
|
Marsh gas |
– Methane |
|
War gases |
|
|
– Blistering |
– Mustard gas & |
|
gas |
B.A.L (lewisite gas) |
|
– Tear gas |
– BBC (Bromo |
|
|
Benzyl Cyanide) |
|
|
– CAP (Chlor Aceto |
|
|
Phenone) |
|
|
– KSK (Ethyl lido acetate) |
|
– Sickening |
– Diphenyl amine |
|
gas |
chlor arsine |
Orange-skin cornea results due to:
| A |
Chalcosis |
|
| B |
Siderosis |
|
| C |
Ammonia burn |
|
| D |
Mustard gas |
Orange-skin cornea results due to:
| A |
Chalcosis |
|
| B |
Siderosis |
|
| C |
Ammonia burn |
|
| D |
Mustard gas |
Ans. Mustard gas
Blistering war gas is:
Maharashtra 09
| A |
Chlorine gas |
|
| B |
Mustard gas |
|
| C |
HCN gas |
|
| D |
Tabun |
Blistering war gas is:
Maharashtra 09
| A |
Chlorine gas |
|
| B |
Mustard gas |
|
| C |
HCN gas |
|
| D |
Tabun |
Ans. Mustard gas
MISCELLANEOUS POISONING
MISCELLANEOUS POISONING
5pecial gases
Sewer gas : H2S with CO2 and methane.
Marsh gas → Methane
War gases :
- Tear gas → (i) Bromobenzylcyanide (BBC), (ii) Chloroacetophenone (CAP)
- Blister gas →: Mustard gas (also called Blistering war gas), this results in Orange-skin cornea, and BAL (Lewisite) gas
- Sickening gas → Diphinyl-amine-chlor-arsine
- Laughing gas → N2O
Narcoanylasis
- It is a test to detect truth, by making a person subconscious. Drugs used are sodium pentothal (thiopental), sodium amytal, sodium siconal and scopolamine.
- Few crystals of ferrous sulfate is added to 5 ml of the gastric content. To it, 5 drops of sodium hydroxide is added. The mixture is boiled and cooled. To it, 10 drops of 10% hydrochloric acid is added. Greenish blue colour indicates cyanide and purplish colour indicates salicylate.
Section 39 CrPC
- A doctor working in a government setup has to inform the police all confirmed and suspected cases of poisoning- where as a private practitioner can withhold information regarding suicidal poisoning but not homicidal. And autopsy is must in all cases of death due to poisoning.
Rave drugs
- These are the drugs which are commonly abused in ‘rave parties’ for their euphoric and hallucinogenic properties. The drugs are
- Ectasy (also called MDMA, XTC, Adam, Hug drug or love drug.
- Gamma-hydroxybutyrate (liquid ectasy or scop water).
- Rohypnol (also called roofie, ropes, races)
Exam Important
Sewer gas : H2S with CO2 and methane.
Marsh gas → Methane.
Tear gas → (i) Bromobenzylcyanide (BBC), (ii) Chloroacetophenone (CAP)
Blister gas →: Mustard gas (also called Blistering war gas), this results in Orange-skin cornea, and BAL (Lewisite) gas
DELIRIANT POISONS: Dhatura,Strychnine
Signs and symptoms usually develop within 15–30 minutes of strychnine ingestion. What is the fatal dose of strychnine?
| A |
10-15 mg |
|
| B |
20-40 mg |
|
| C |
60-100 mg |
|
| D |
100-120 mg |
Signs and symptoms usually develop within 15–30 minutes of strychnine ingestion. What is the fatal dose of strychnine?
| A |
10-15 mg |
|
| B |
20-40 mg |
|
| C |
60-100 mg |
|
| D |
100-120 mg |
Strychnine poisoning:
- It is an alkaloid derived from the seeds of the tree Strychnos nux-vomica.
- The potentially fatal dose of strychnine is approximately 50–100 mg (1 mg/kg) and fatal period is 1-2 hours.
- Strychnine competitively antagonizes glycine, an inhibitory neurotransmitter released by postsynaptic inhibitory neurons in the spinal cord.
- Muscular stiffness and painful cramps precede generalized muscle contractions, extensor muscle spasms, and opisthotonus.
- Death usually is caused by respiratory arrest that results from intense contraction of the respiratory muscles.
Which of the following is the site of action of strychnine poison for its toxicity?
| A |
Heart |
|
| B |
Anterior horn cells |
|
| C |
Posterior horn cells |
|
| D |
All of the above |
Which of the following is the site of action of strychnine poison for its toxicity?
| A |
Heart |
|
| B |
Anterior horn cells |
|
| C |
Posterior horn cells |
|
| D |
All of the above |
True about strychnine poisoning is :
| A |
All muscles affected at the same time |
|
| B |
Shoulder girdle affected first |
|
| C |
Pelvic girdle affected first |
|
| D |
None of the above |
True about strychnine poisoning is :
| A |
All muscles affected at the same time |
|
| B |
Shoulder girdle affected first |
|
| C |
Pelvic girdle affected first |
|
| D |
None of the above |
A i.e. All muscles affected at same time
Nux vomica seeds contain 2 alkaloids, strychnine and :
| A |
Hyoscine |
|
| B |
Hyoscyamine |
|
| C |
Brucine |
|
| D |
Atropine |
Nux vomica seeds contain 2 alkaloids, strychnine and :
| A |
Hyoscine |
|
| B |
Hyoscyamine |
|
| C |
Brucine |
|
| D |
Atropine |
C i.e. Brucine
The active principles of Dhatura are all of the following except :
| A |
Pyricatachol |
|
| B |
Hyoscyamine |
|
| C |
Atropine |
|
| D |
Hyoscine |
The active principles of Dhatura are all of the following except :
| A |
Pyricatachol |
|
| B |
Hyoscyamine |
|
| C |
Atropine |
|
| D |
Hyoscine |
A i.e. Pyricatachol
All the following are characteristic of Dhatura poisoning except:
| A |
Delirium |
|
| B |
Diplopia |
|
| C |
Pin-point pupils |
|
| D |
Dysphagia |
All the following are characteristic of Dhatura poisoning except:
| A |
Delirium |
|
| B |
Diplopia |
|
| C |
Pin-point pupils |
|
| D |
Dysphagia |
C i.e. Pinpoint pupil
Following is not present in dhatura:
JIPMER 11
| A |
Hyoscine |
|
| B |
Hyoscyamine |
|
| C |
Muscarine |
|
| D |
Atropine |
Following is not present in dhatura:
JIPMER 11
| A |
Hyoscine |
|
| B |
Hyoscyamine |
|
| C |
Muscarine |
|
| D |
Atropine |
Ans. Muscarine
Treatment of dhatura poisoning is done with:
NEET 15
| A |
Pilocarpine |
|
| B |
Naloxone |
|
| C |
Physostigmine |
|
| D |
Neostigmine |
Treatment of dhatura poisoning is done with:
NEET 15
| A |
Pilocarpine |
|
| B |
Naloxone |
|
| C |
Physostigmine |
|
| D |
Neostigmine |
Ans. Physostigmine
Strychnine acts by inhibiting:
COMEDK 15
| A |
GABA |
|
| B |
Glycine |
|
| C |
Acetylcholine |
|
| D |
Dopamine |
Strychnine acts by inhibiting:
COMEDK 15
| A |
GABA |
|
| B |
Glycine |
|
| C |
Acetylcholine |
|
| D |
Dopamine |
Ans. Glycine
Antidote for strychnine poisoning is:
NEET 13
| A |
Fomepizole |
|
| B |
Physotigmine |
|
| C |
Barbiturates |
|
| D |
Naloxone |
Antidote for strychnine poisoning is:
NEET 13
| A |
Fomepizole |
|
| B |
Physotigmine |
|
| C |
Barbiturates |
|
| D |
Naloxone |
Ans. Barbiturates
In dhatura poisoning 9 ‘Ds’ include all except ‑
| A |
Diarrhea |
|
| B |
Dysphagia |
|
| C |
Dilated pupil |
|
| D |
Drowsiners |
In dhatura poisoning 9 ‘Ds’ include all except ‑
| A |
Diarrhea |
|
| B |
Dysphagia |
|
| C |
Dilated pupil |
|
| D |
Drowsiners |
Ans. is ‘a’ i.e., Diarrhea
‘9-D’ manifestations of Dhatura (anticholinergic) poisoning
- Dry hot skin i.e. ‘Hot as a hare’.
- Dialation of cutaneous blood vessels 1/t facial i.e. ‘Red as a beet’.
- Dialation of pupils with loss of accomodation and unresponsiveness to light i.e. ‘Blind as a bat’.
- Dryness of mouth and throat i.e. ‘Dry as a bone’.
- Difficulty in talking.
- Dysphagia (difficulty in swallowing)
- Drunken gait
- Drowsiness
- Delirium i.e. ‘Mad as wet hen’
- So symptoms are described as ‘Dry as a bone, Red as a beet, Hot as hare, Blind as a bat and Mad as a wet hen’.
DELIRIANT POISONS: Dhatura,Strychnine
DELIRIANT POISONS
Dhatura {thorn apple}
- Dhatura (thorn apple) grows on waste land all over india and is of two types
(i) Dhatura alba and (ii) Dhatura niger
All parts of plant is poisonous, especially seeds and fruits.
Active principles of dhatura:
- levohyoscyamine,
- Hyoscine (scopolamine)
- Atropine
Clinical features:poisoning is due to Anticholinergic; These features are described as ‘9D’
- Dry hot skin: Hot as a hare.
- Dilatation of cutaneous blood vessels causing facial Flush; Red as a beet.
- Dialtion of pupil with loss accommodation and unresponsive to light (dilated and fixed Pupil); Blind as a hat.
- Dryness of throat and mouth: Dry as a bone.
- Delirium (muttering delirium): Mad as a wet hen.
- Drowsiness
- Drunken gait
- Dysphagia (difficulty in swallowings)
- Difficulty in talking.
- Earliest symptom is bitter taste in the mouth
- After delirium passes of patient may progress to stupor or coma and rarely death may occur from respiratory paralysis.
- Cornpicker’s pupil : It is unilateral mydriasis caused by pollen.
Treatment: physostigmine is the drug of choice.
- The seeds of dhatura closely resemble those of the capsicum
STRYCHNINE (NUX VOMICA / KUCHILA)
- spinal poison.
- powerful alkaloid obtained from the seeds of strychnos nux vomica.
- seeds are poisonous which contain active principles strychnine, brucine and loganin.
- The main poisonous alkaloid is strychnine.
- Strychine is used as a respiratory stimulant, rodenticide, cattle poison, and for killing stray dogs.
- Strychine stimulates all parts of CNS and particularly the anterior horn cells causing greatly increased reflex
- Cerebral cortex (brain) and respiratory center are stimulated.
- It causes great incresed reflex activity by antagonizing the action of glycine.
Clinical features :
- Prodromal symptoms, e.g. incresed activity of perception, rigidity of muscles and twitching’
- Convulsions afiecting all muscles at s time, they are initially clonic and eventually become tonic.
- Between convulsions, muscles are completely relaxed
- Due to spasm of jaw and facial muscles, corners of mouth are drawn back → Risus sardonicus.
- Hyperextention of whole body → Opisthotonus.
- Spasm of abdominal muscles my bend the body forward (emprosthotonus) or to the side (pleurosthotonus)
- Mind (consciousness) remains clear throughout till death
- Fatal dose is one crushed seed ( 50–100 mg (1 mg/kg)) and fatal period is 1-2 hours’
- Antidote
- short acting barbiturate, e.g. phenobarbital.
- Brain and spinal cord should be preserved for analysis (in addition to usual viscera) in deaths from suspected strychnine poisoning.
- Strychnine resist putrefaction.
- Rigor mortis sets in almost immediately and passes off early.
Exam Important
Active principles of dhatura:
- levohyoscyamine,
- Hyoscine (scopolamine)
- Atropine
Clinical features: poisoning is due to Anticholinergic; These features are described as ‘9D’
- Dry hot skin: Hot as a hare.
- Dilatation of cutaneous blood vessels causing facial Flush; Red as a beet.
- Dialtion of pupil with loss accommodation and unresponsive to light (dilated and fixed Pupil); Blind as a hat.
- Dryness of throat and mouth: Dry as a bone.
- Delirium (muttering delirium): Mad as a wet hen.
- Drowsiness
- Drunken gait
- Dysphagia (difficulty in swallowings)
- Difficulty in talking.
Treatment: physostigmine is the drug of choice.
STRYCHNINE (NUX VOMICA / KUCHILA)
- Fatal dose is one crushed seed ( 50–100 mg (1 mg/kg)) and fatal period is 1-2 hours’
- Antidote
- short acting barbiturate, e.g. phenobarbital.
