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Medical Termination Of Pregnancy (Mtp) Act

MEDICAL TERMINATION OF PREGNANCY (MTP) ACT

Q. 1

For MTP consent is taken from

 A

Wife only

 B

Husband only

 C

Both

 D

Neither

Q. 1

For MTP consent is taken from

 A

Wife only

 B

Husband only

 C

Both

 D

Neither

Ans. A

Explanation:

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.


Q. 2

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

Q. 2

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. D

Explanation:

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.


Q. 3

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

Q. 3

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. C

Explanation:

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.

Quiz In Between


Q. 4

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

Q. 4

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. C

Explanation:

Ans. 20 weeks


Q. 5

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

Q. 5

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. C

Explanation:

Ans. > 12 weeks


Q. 6

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

Q. 6

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. B

Explanation:

Ans. Any RMP with MD/MS degree in Obs and Gynae

Quiz In Between


Q. 7

Indication of MTP-

 A

Pregnancy due to rape

 B

Contraceptive failure

 C

Pregnancy endangering mother’s life

 D

All of the above

Q. 7

Indication of MTP-

 A

Pregnancy due to rape

 B

Contraceptive failure

 C

Pregnancy endangering mother’s life

 D

All of the above

Ans. D

Explanation:

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 :
  1. Medical – Where continuation of the pregnancy might endanger the mother’s life or cause grave injury to her physical or mental health.
  2. Eugenic – Where there is substantial risk of the child being born with serious handicaps due to physical or mental abnormalities.
  3. Humanitarian – Where pregnancy is the result of rape.
  4. 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

Q. 8

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

Q. 8

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. C

Explanation:

Ans. is ‘c’ i.e., 20 weeks 

Medical termination of pregnancy act (19711

  • 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.
  4. The conditions under which a pregnancy can be terminated under the MTPAct. 1971 :
  5. 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.

Quiz In Between



Medical Termination Of Pregnancy (Mtp) Act

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.
Don’t Forget to Solve all the previous Year Question asked on MEDICAL TERMINATION OF PREGNANCY (MTP) ACT

Module Below Start Quiz

Undertaker Fracture,Stalking,para-suicide, heat and cold stoke

Undertaker Fracture,Stalking,para-suicide, heat and cold stroke

Q. 1

Which among the following sites are involved in “undertakers fracture”?

 A

Skull

 B

Cervical spine

 C

Pelvis

 D

Mandible

Q. 1

Which among the following sites are involved in “undertakers fracture”?

 A

Skull

 B

Cervical spine

 C

Pelvis

 D

Mandible

Ans. B

Explanation:

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


Q. 2

In heat stroke, skin will be:               

September 2012

 A

Warm

 B

Normal

 C

Cold

 D

Cyanosis

Q. 2

In heat stroke, skin will be:               

September 2012

 A

Warm

 B

Normal

 C

Cold

 D

Cyanosis

Ans. A

Explanation:

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.


Q. 3

NOT seen in heat stroke: 

Kerala 06

 A

Hypovolemic shock

 B

Rhabdomyolysis

 C

Pancreatitis

 D

Cerebral edema

Q. 3

NOT seen in heat stroke: 

Kerala 06

 A

Hypovolemic shock

 B

Rhabdomyolysis

 C

Pancreatitis

 D

Cerebral edema

Ans. A

Explanation:

Ans. Hypovolemic shock

Quiz In Between


Q. 4

Undertaker’s fracture is seen at the level of cervical vertebra:

 A

C1-C2

 B

C3-C4

 C

C5-C6

 D

C6-C7

Q. 4

Undertaker’s fracture is seen at the level of cervical vertebra:

 A

C1-C2

 B

C3-C4

 C

C5-C6

 D

C6-C7

Ans. D

Explanation:

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.

Q. 5

What is the most common cause of parasuicide?

 A

Drug ingestion

 B

Hanging

 C

Cutting wrist

 D

Firearms

Q. 5

What is the most common cause of parasuicide?

 A

Drug ingestion

 B

Hanging

 C

Cutting wrist

 D

Firearms

Ans. A

Explanation:

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.

Quiz In Between



Undertaker Fracture,Stalking,para-suicide, heat and cold stoke

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
  1. Upto 3 years + Fine for first conviction
  2. 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
  1. Upto 3 years + Fine for first conviction
  2. 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.
Don’t Forget to Solve all the previous Year Question asked on Undertaker Fracture,Stalking,para-suicide, heat and cold stoke

Module Below Start Quiz

Ethylene glycol & Boric acid poisoning

Ethylene glycol & Boric acid poisoning

Q. 1

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

Q. 1

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

Ans. B

Explanation:

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


Q. 2

Antidote for Ethylene glycol poisoning-

 A

Methyl violet

 B

Methyl violet

 C

Fomepizole

 D

All

Q. 2

Antidote for Ethylene glycol poisoning-

 A

Methyl violet

 B

Methyl violet

 C

Fomepizole

 D

All

Ans. C

Explanation:

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.


Q. 3

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

Q. 3

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. B

Explanation:

Ans. Higher affinity for alcohol dehydrogenase

Competitive inhibitor of alcohol dehydrogenase [Ref Lehninger Principles of Biochemistry 4th/e p. 336]


Q. 4

Ethylene glycol when ingested affects kidney by forming:      

NEET 13

 A

Formaldehyde

 B

Oxalates

 C

Phytates

 D

Phosphates

Q. 4

Ethylene glycol when ingested affects kidney by forming:      

NEET 13

 A

Formaldehyde

 B

Oxalates

 C

Phytates

 D

Phosphates

Ans. B

Explanation:

Ans. Oxalates

Quiz In Between



Ethylene glycol & Boric acid poisoning

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.
Don’t Forget to Solve all the previous Year Question asked on Ethylene glycol & Boric acid poisoning

Module Below Start Quiz

Miscellaneous Poisoning

MISCELLANEOUS POISONING

Q. 1

Sewer gas is:

 A

Phosgene

 B

H2S

 C

CO2

 D

b and c

Q. 1

Sewer gas is:

 A

Phosgene

 B

H2S

 C

CO2

 D

b and c

Ans. D

Explanation:

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


Q. 2

Orange-skin cornea results due to:

 A

Chalcosis

 B

Siderosis

 C

Ammonia burn

 D

Mustard gas

Q. 2

Orange-skin cornea results due to:

 A

Chalcosis

 B

Siderosis

 C

Ammonia burn

 D

Mustard gas

Ans. D

Explanation:

Ans. Mustard gas


Q. 3

Blistering war gas is:

Maharashtra 09

 A

Chlorine gas

 B

Mustard gas

 C

HCN gas

 D

Tabun

Q. 3

Blistering war gas is:

Maharashtra 09

 A

Chlorine gas

 B

Mustard gas

 C

HCN gas

 D

Tabun

Ans. B

Explanation:

Ans. Mustard gas

Quiz In Between



Miscellaneous Poisoning

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
  1. Ectasy (also  called  MDMA,  XTC,  Adam, Hug drug  or love  drug.
  2. Gamma-hydroxybutyrate  (liquid  ectasy  or scop  water).
  3. Rohypnol  (also called  roofie,  ropes,  races)

Exam Important

Sewer gas : H2S  with CO 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

Don’t Forget to Solve all the previous Year Question asked on MISCELLANEOUS POISONING

Module Below Start Quiz

DELIRIANT POISONS: Dhatura,Strychnine

DELIRIANT POISONS: Dhatura,Strychnine

Q. 1

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

Q. 1

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

Ans. C

Explanation:

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.
 
Ref: Nordt S.P. (2012). Chapter 145. Strychnine. In K.R. Olson (Ed), Poisoning & Drug Overdose, 6e.

Q. 2

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

Q. 2

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

Ans. B

Explanation:

Strychnine competitively blocks ventral horn motor neuron postganglionic receptor sites in the spinal cord and prevents the effects of glycine, an inhibitory neurotransmitter released by postsynaptic inhibitory neurons in the spinal cord.
Strychnine binds to the chloride ion channel, causing increased neuronal excitability and exaggerated reflex arcs.
This results in generalized seizure-like contraction of skeletal muscles.
Simultaneous contraction of opposing flexor and extensor muscles causes severe muscle injury, with rhabdomyolysis, myoglobinuria, and, in some cases, acute renal failure.
 
Ref: Nordt S.P. (2012). Chapter 145. Strychnine. In K.R. Olson (Ed), Poisoning & Drug Overdose, 6e.

Q. 3

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

Q. 3

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

Ans. A

Explanation:

A i.e. All muscles affected at same time

Quiz In Between


Q. 4

Nux vomica seeds contain 2 alkaloids, strychnine and :

 A

Hyoscine

 B

Hyoscyamine

 C

Brucine

 D

Atropine

Q. 4

Nux vomica seeds contain 2 alkaloids, strychnine and :

 A

Hyoscine

 B

Hyoscyamine

 C

Brucine

 D

Atropine

Ans. C

Explanation:

C i.e. Brucine


Q. 5

The active principles of Dhatura are all of the following except :

 A

Pyricatachol

 B

Hyoscyamine

 C

Atropine

 D

Hyoscine

Q. 5

The active principles of Dhatura are all of the following except :

 A

Pyricatachol

 B

Hyoscyamine

 C

Atropine

 D

Hyoscine

Ans. A

Explanation:

A i.e. Pyricatachol


Q. 6

All the following are characteristic of Dhatura poisoning except:

 A

Delirium

 B

Diplopia

 C

Pin-point pupils

 D

Dysphagia

Q. 6

All the following are characteristic of Dhatura poisoning except:

 A

Delirium

 B

Diplopia

 C

Pin-point pupils

 D

Dysphagia

Ans. C

Explanation:

C i.e. Pinpoint pupil

Quiz In Between


Q. 7

Following is not present in dhatura:           

JIPMER 11

 A

Hyoscine

 B

Hyoscyamine

 C

Muscarine

 D

Atropine

Q. 7

Following is not present in dhatura:           

JIPMER 11

 A

Hyoscine

 B

Hyoscyamine

 C

Muscarine

 D

Atropine

Ans. C

Explanation:

Ans. Muscarine


Q. 8

Treatment of dhatura poisoning is done with:

NEET 15

 A

Pilocarpine

 B

Naloxone

 C

Physostigmine

 D

Neostigmine

Q. 8

Treatment of dhatura poisoning is done with:

NEET 15

 A

Pilocarpine

 B

Naloxone

 C

Physostigmine

 D

Neostigmine

Ans. C

Explanation:

Ans. Physostigmine


Q. 9

Strychnine acts by inhibiting:       

COMEDK 15

 A

GABA

 B

Glycine

 C

Acetylcholine

 D

Dopamine

Q. 9

Strychnine acts by inhibiting:       

COMEDK 15

 A

GABA

 B

Glycine

 C

Acetylcholine

 D

Dopamine

Ans. B

Explanation:

Ans. Glycine

Quiz In Between


Q. 10

Antidote for strychnine poisoning is:          

NEET 13

 A

Fomepizole

 B

Physotigmine

 C

Barbiturates

 D

Naloxone

Q. 10

Antidote for strychnine poisoning is:          

NEET 13

 A

Fomepizole

 B

Physotigmine

 C

Barbiturates

 D

Naloxone

Ans. C

Explanation:

Ans. Barbiturates


Q. 11

In dhatura poisoning 9 ‘Ds’ include all except ‑

 A

Diarrhea

 B

Dysphagia

 C

Dilated pupil

 D

Drowsiners

Q. 11

In dhatura poisoning 9 ‘Ds’ include all except ‑

 A

Diarrhea

 B

Dysphagia

 C

Dilated pupil

 D

Drowsiners

Ans. A

Explanation:

Ans. is ‘a’ i.e., Diarrhea

9-D’ manifestations of Dhatura (anticholinergic) poisoning

  1. Dry hot skin i.e. ‘Hot as a hare’.
  2. Dialation of cutaneous blood vessels 1/t facial i.e. ‘Red as a beet’.
  3. Dialation of pupils with loss of accomodation and unresponsiveness to light i.e. ‘Blind as a bat’.
  4. Dryness of mouth and throat i.e. ‘Dry as a bone’.
  5. Difficulty in talking.
  6. Dysphagia (difficulty in swallowing)
  7. Drunken gait
  8. Drowsiness
  9. 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’.

Quiz In Between



DELIRIANT POISONS: Dhatura,Strychnine

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:

  1. levohyoscyamine,
  2. Hyoscine (scopolamine) 
  3. Atropine

Clinical features:poisoning is due to Anticholinergic;  These  features  are described  as ‘9D’

  1. Dry  hot skin: Hot  as a hare.
  2. Dilatation  of cutaneous  blood  vessels  causing  facial  Flush; Red as a beet.
  3. Dialtion  of pupil with loss accommodation and unresponsive to light (dilated and fixed Pupil); Blind  as a hat.
  4. Dryness of throat  and mouth: Dry as a bone.
  5. Delirium (muttering  delirium): Mad as a wet hen.
  6. Drowsiness
  7. Drunken  gait
  8. Dysphagia (difficulty  in  swallowings)
  9. 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:

  1. levohyoscyamine,
  2. Hyoscine (scopolamine) 
  3. Atropine

Clinical features: poisoning is due to Anticholinergic;  These  features  are described  as ‘9D’

  1. Dry  hot skin: Hot  as a hare.
  2. Dilatation  of cutaneous  blood  vessels  causing  facial  Flush; Red as a beet.
  3. Dialtion  of pupil with loss accommodation and unresponsive to light (dilated and fixed Pupil); Blind  as a hat.
  4. Dryness of throat  and mouth: Dry as a bone.
  5. Delirium (muttering  delirium): Mad as a wet hen.
  6. Drowsiness
  7. Drunken  gait
  8. Dysphagia (difficulty  in  swallowings)
  9. 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.
Don’t Forget to Solve all the previous Year Question asked on DELIRIANT POISONS: Dhatura,Strychnine

Module Below Start Quiz

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