Clinical Toxicology: MANOR Review Center

Clinical Toxicology
B 1. A specialized field of toxicology that designates an area of professional emphasis within the realm of medical
science
a. Forensic toxicology c. Environmental toxicology
b. Clinical toxicology d. Regulatory toxicology
C 2. This is an area of toxicology which is concerned directly with toxicity testing, which provide necessary
information for safety evaluation and regulatory requirements.
a. mechanistic toxicology c. descriptive toxicology
b. regulatory toxicology d. forensic toxicology
A 3. The quantity of medicine that can kill an organism

a. fatal dose b. LD50 c. Teratology d. Threshold Limit Value
C 4. Acute poisoning includes, except:

a. taking a strong poison c. taking several small doses at long intervals
b. taking several small doses but frequent d. taking excessive single doses
C 5. This is obtained from an examination of the tissues and organs of the dead.
a. Experimental evidence c. Post-Mortem evidence
b. Chemical evidence d. Circumstantial evidence
C 6. Death may result from poisoning due to the following causes, except:
a. due to interference with the carriage of oxygen
b. due to inhibition of the respiratory movements by neuromuscular agents
c. due to interference with the enzyme system utilizing it
d. circulatory failure as a result of cardiac glucosides
D 7. Catharsis as a way of removing a poison includes, except:

a. increases intestinal injury when a corrosive is ingested
b. is avoided in a patient showing disturbed electrolyte imbalance
c. hypertonic cathartic and enemas are hazardous in the presence of impaired renal function
d. all of the above
B 8. This is recommended in phenol poisoning as a cathartic but is contraindicated in poisoning by chlorinated

insecticide, since it may increase intestinal absorption
a. magnesium sulfate b. castor oil c. mannitol d. Fleet’s Phospho-soda
B 9. A poison which increases suddenly in its intensity of action after slow or gradual addition of it is
a. corrosive poison b. cumulative poison c. true poison d. irritant poison
B 10. The most serious potential consequence of ingestion of liquid hydrocarbon such as kerosene or gasoline is:
a. paralysis of the peristaltic motion of the GI tract
b. the aspiration of the poison into the respiratory tract
c. destruction of body enzymes by the poison
B 11. The specific antidote for the treatment of poisoning due to oral ingestion of silver nitrate would be the oral
administration of:
a. acetic acid solution b. normal saline c. sodium bicarbonate
C 12. Streptomycin can cause:

a. 4th cranial damage b. 7th cranial damage c. 8th cranial damage d. 6th cranial damage
E 13. Most accidental poisoning in children is caused by:

a. detergents b. bleaches c. crayons d. insecticides e.salicylate analgesics
B 14. Antidote for iodine poisoning:

a. silver nitrate b. starch c. potassium nitrate d. sugar
A 15. The evidences to be saved in nonfatal poisoning are the following, except:
a. lung b. urine c. food d. blood e. body fat
D 16. When reporting cases of poisoning like eating in public restaurant, the cases should be reported to the:
a. nurse b. family doctor c. pharmacist d. public health officer e. BFAD
A 17. The major routes by which toxic agents gain access to the body are through the ff. except:
a. blood b. GIT c. lungs d. skin e. parenteral route
C 18. Acute exposure by inhalation refers to continuous exposure for less than 2 hours, most frequently for:
a. 2 b. 3 c. 4 d. 5 e. 6 hrs.
A 19. Dryness of the mouth is a side effect of

a. atropine b. aspirin c. acetaminophen d. cimetidine
A 20. One group of thiol-containing enzymes that may play a critical role in cell injury and death as a result of
oxidative inactivation (oxidative stress) is:
a. Ca b. Na c. K d. Mg e. A1 transportation Alpase
A 21. The ff. are mechanisms of poison absorption, except:
MANOR Review Center 308

Clinical Toxicology
a. hydrolysis b. endocytosis c. filtration d. passive diffusion
D 22. An example of a Phase 1 Reaction in the metabolism of substances is/are:

a. oxidation b. hydrolysis c. reduction d. all of the above
A 23. Pneumomediastenum is a complication of the use of:

a. gastric lavage b. hemodialysis c. hemoperfusion d. emetics
C 24. Constipation caused by active charcoal can be relieved by concomitant administration of

a. glycerol b. water c. laxative d. none of the above
D 25. Contraindication to the use of cathartics are the ff. except:

a. GI hemorrhage b. corrosive agents c. renal failure d. none of the above
C 26. The percentage of oxygen which is indicated for carbon dioxide poisoning to increase the conversion of
carboxyhemogloblin to hemogloblin and myoglobin and to increase oxygen saturation of the plasma is:
a. 50% b. 75% c. 100% d. 10%
C 27. Nail polish remover contain

a. aniline b. ammonium hydroxide c. acetone d. phosphoric acid
C 28. Convulsions caused by drug poisoning are most commonly associated with:
a. Phenobarbital b. diazepam c. strychnine d. chlorpromazine
A 29. Alkalinizing the urine with sodium bicarbonate is useful in the treatment of poisoning with:
a. ASA and barbiturates b. phencyclidine c. amphetamines d. morphine
D 30. Activated charcoal may be used in the treatment of these poisoning, except:
a. Phenobarbital b. propoxyphene c. aspirin d. methanol
D 31. These statements regarding carbon monoxide poisoning are true, except:
a. the oxygen carrying capacity of the blood is decreased
b. the oxyhemoglobin dissociation curve becomes shifted to the left, releasing less oxygen to the tissues
c. a carboxyhemoglobin level of less than 30% produces minimal symptoms
d. treatment with 100% carbon dioxide is effective
D 32. Ototoxicity may be an adverse reaction of the following, except:

a. streptomycin b. ethacrynic acid c. furosemide d. tetracyclines
D 33. Individuals who are deficient in glucose-6-dehydrogenase experience hemolysis following the treatment with
these drugs, except:
a. dapsone b. ethacrynic acid c. primaquine d. tetracyclines
B 34. Acute intermittent porphyria is an absolute contraindication to the use of:

a. nitrous oxide b. enflurane c. ketamine d. thiopental sodium
A 35. Direct hepatotoxicity has been observed with the following anesthetics agents:
a. halothane b. nitrous oxide c. thiopental d. all of the above
A 36. A patient has resulted in acute hypertensive crisis after eating cheese. This interaction is possible if the
patient is on:
a. MAO inhibitor b. aspirin c. tetracyclines d. all of the above
C 37. It is used in the manufacture of smoke bomb, antiseborrheic shampoos, in the treatment of bone fracture and
rickets.
a. bismuth b. boron c. cadmium d. cesium e. chromium
E 38. Its deficiency mimics diabetes mellitus, it is found in brown sugar and butter
A 39. It is used in silvering of mirror and it causes metal line gum.

C 40. It is the poison found in rust and ink eradicator.

a. nitrite b. naphthalene c. oxalate d. lead e. mercury
A 41. It is used to preserve the color of meat in pickling.

a. nitrite b. naphthalene c. oxalate d. lead e. mercury.
E 42. It is used in fingerprint photography

a. nitrite b. naphthalene c. oxalate d. lead e. mercury.
D 43. It is the choice of professional poisoners.

a. nitrite b. naphthalene c. oxalate d. arsenic e. berrylium
E 44. It is the most toxic metal.

a. nitrite b. naphthalene c. oxalate d. arsenic e. berrylium

Clinical Toxicology
E 45. Ammonium salt is the antidote for

a. aniline b. cyanide c. ethyl alcohol d. iodine e. formaldehyde
A 46. Methylene blue is the antidote for

B 47. It is known as the prussic acid
C 48. It is known as the Neutral spirit

A 49. It is also known as the stink damp

a. hydrogen sulfide b. carbon monoxide c. carbon disulfide d. nitrogen oxide
B 50. It is known as the rodent poison

a. hydrogen sulfide d. carbon tetrachloride
b. phosphorus e. carbon monoxide
c. carbon disulfide
D 51. The abuse of this drug is responsible for major medical and socio-economic problems:
a. chloral hydrate b. chloral hydrate and ethanol c. nitrous oxide d. ethanol
B 52. Poisoning due to anticholinesterase is the best managed by the administration of:
a. theophylline b. atropine c. salbutamol d. ethanol
B 53. Conjuctival and bronchial irritation are primary signs of exposure to:
a. ergot b. sulfur dioxide c. ethyl alcohol d. mercury
A 54. Deferoxamine is an antidote for:

a. iron b. methanol c. calcium d. iodine
A 55. These are simple asphyxiants which are gases, except:

a. ethyl alcohol b. methane c. nitrogen d. none of these
A 56. Toxic substance found in “tulingan” tuna and:

a. sourine b. nenerupin c. gemblid d. potassium bromate
C 57. Effective therapy to rattle snake bite:

a. suction and tourniquet b. antivenin c. antivenin and suction and tourniquet d. none of
these
B 58. A type of poison that causes blackening and severe corrosion in the mouth:
a. nitric acid b. sulfuric acid c. phenol d. hydrochloric acid
D 59. It causes the Minamata disease:

a. Nickel b. manganese c. molybdenum d. mercury
D 60. Examples of herbicides, except:

a. phenoxyacetic acid b. paraquat c. diquat d. nicotine
C 61. Mushroom poisoning comes from:

a. belladonna b. digitalis c. Amanita phalloides d. all of these
C 62. It is the poison in toilet bowl deodorant:

a. Nitrite b. lead c. naphthalene d. oxalate
b.
B 63. Lead can be effectively detoxified by:
a. barium sulfate b. BAL with EDTA c. ethanol d. deferroxamine
A 64. An antidote to methanol poisoning:

a. ethanol b. digoxin c. atropine d. naloxone
A 65. Induction of vomiting is accomplished by administering:

a. Syrup of ipecac b.Ginger ale c.Peppermint syrup d.None of these
C 66. Banned toxic substance in “pandesal”, cakes and other bakery products:
a. gemblid b. venrupin c. potassium bromate d. sourine
B 67. Fatal dose of aspirin:

a. 5 grains b. 5 grams c. 5 mg d. all of these
B 68 Lysergic acid poisoning has this toxic syndrome/s:.

a. dilated pupil b. hallucinations and dilated pupil c. hallucinations d. none of these
D 69. Death due to strychnine poisoning is from:

a. fatigue c. cardiac failure
b. fatigue of respiratory muscle d. exhaustion of respiratory center
B 70. Litharge is also known as:

Clinical Toxicology
a. magnesium oxide b. lead oxide c. arsenic trioxide d. nitrous oxide
B 71. Manihot toxin is found in this crop root:

a. yam b. cassava c. sweet potatoes d. none of these
C 72. Best known physiological antidote for strychnine:

a. codeine b. pilocarpine c. barbiturate d. morphine
C 73. Phencyclidine has this toxic syndrome:

a. violent syndrome c. coma with open eyes and violent syndrome
b. coma with open eyes d. none of these
A 74. Poisonous fishes contain unedible organs or toxins such as:

a. ciguatoxin b. saxitoxin c. aflatoxin d. scombroid
A 75. Activated charcoal is specifically helpful in the treatment of poisoning from:

a. aromatic compound b. all of these c. alkaloid d. none of these
B 76. Convulsions caused by drug poisoning are commonly associated with:

a. diazepam b. strychnine c. phenobarbital d. chlorpromazine
C 77. A carcinogenic substance found in stale peanut:

a. peroxide b. glyceryl ester c. aflatoxin d. fatty acid
B 78. Black widow spider venom is called:

a. neostigmine b. lactrotoxin c. carbachol d. all of these
D 79. The antidote for DDT poisoning:

a. adrenaline b. atropine c. amphetamine d. barbiturate
C 80. Causes digitalis-like toxicity and baritosis:

a. antimony b. aluminum c. barium d. arsenic
B 81. Metal used in water purification:

a. lead b. copper c. gold d. gallium
B 82. Bitter almond odor is symptoms of this poisoning:

a. mercury b. cyanide c. lead d. none of these
D 83. Paraquat poisoning is characterized by:

a. bloody stool b. none of these c. hematemesis d. bloody stool and hematemesis
C 84. The universal antidote usually contains tannic acid, activated charcoal and:
a. calcium hydroxide b. aluminum hydroxide c. magnesium hydroxide d. all of these
C 85. A poisonous principle of Coalculus indicus used as fish poison:

a. Phenacetin b. picric acid c. picrotoxin d. colchicines
D 86. Principal active alkaloid of ipecac:

a. caffeine b. apomorphine c. ergonovine d. emetine
C 87. Sweet odor of vomitus is/are due to this type of poison/s:

a. chloroform and acetone b. turpentine c. acetone d. chloroform
A 88. A common household substance given as antidote is milk because:

a. it is amphoteric and coats the stomach b. coats the stomach c. it is amphoteric d. nota
A 89. It causes shellfish toxicity:

a. dinoflagellates b. snails c. jellyfish d. octopus
B 90. Treatment of bismuth poisoning involves the use of:

a. morphine b. dimercaprol c. EDTA d. none of these
C 91. Side effects frequently seen with benzodiazepines, except:

a. ataxia b. drowsiness c. seizures d. none of these
D 92. Most commonly known animal poison:

a. scombroid b. venom c. saxitoxin d. tetrodotoxin
B 93. A botanical insecticide:

a. malthion b. pyrethrum c. parathrion d. none of these
A 94. An enzyme found in the snake venom is:

a. hyaluronidase b. urease c. steapsin d. ptyalin
A 95. The effects that occurs at the site of the first contact between the biological system and the toxicant.
a. local toxicity b. economic toxicity c. systemic toxicity d. cumulative toxicity
A 96. The effects that occur at the site of the first contact between the biological system and the toxicant.
a. local toxicity b. economic toxicity c. systemic toxicity d. cumulative toxicity

Clinical Toxicology
B 97. One of the ingredients in mothballs
a. oxalic acid b. naphthalene c. activated charcoal d. arsenic e. none of these
C 98. Poison that converts the red hemoglobin to chocolate brown color
a. aniline b. nitrobenzene c. both a and b d. ether
A 99. Dilution with water is contraindicated in the poisoning with

a. sulfuric acid b. acetic acid c. hydrochloric acid d. none of the above
A 100. The poisonous substance in Lysol:
a. cresol b. phenol c. resorcinol d. thymol
C 101. Saxitoxin is the poison found in:

a. mushroom b. dried nuts c. marine animal d. snake
D 102. Cobra’s venom is composed of:

a. toxin b. phytotoxin c. bufotoxin d. syntoxin
A 103. Which of the following is the toxic action of antimony?

a. inhibition of enzymes through combination with –SH group
b. combines with hemoglobin to form carboxyhemoglobin
c. both a and b
d. none of these
A 104. Yellow or disturbed vision, disturbed respiration, epileptiform convulsion can be caused by:
a. santonin b. muscarine c. atropine d. all of these e. none of these
D 105. Oxidation of pyrocatechol and hydroquinol may tint the urine with color _______
a. black b. yellow c. blue d. green e. none of these
B 106. Best known physiological antidote for strychnine:

a. pilocarpine b. atropine c. morphine d. codeine
C 107. A branch of toxicology which is concerned with the medical and legal consequences of poisoning:
a. environmental toxicology c. forensic toxicology
b. experimental toxicology d. economic toxicology
D 108. Mineral oil is an antidote for poisoning by kerosene.

a. adsorption c. inactivation
b. neutralization d. lessen respiratory hazard by increasing viscosity of kerosene
C 109. A CNS stimulant, fish or bird poison, adulterant of beverage

a. muscarine d. both a and b
b. atropine e. none of these
c. picrotoxin
E 110. Brown color of smog

a. nitrogen pentoxide b. nitric oxide c. nitrogen oxide d. all of these e. none of these
B 111. Specific antidote for silver poisoning

a. lemon juice b. saline solution c. ammonia
C 112. Which of the following metals coagulate protein:

a. lead b. mercury c. copper d. silver
B 113. The alkaloid found in Ipecac used for amoebic dysentery were evident poisoning symptom is violent
purging with bloody stools:
a. ephedrine b. emetine c. isoquinoline d. methylxanthine
A 114. Surface contaminated with phenol can be washed by:

a. water b. ethanol c. soap d. all of these
A 115. Peculiar stimulation (tingling) and paresthesia (numbness) of the sensory in nerves are symptoms of
poisoning due to:
a. aconite b. muscarine c. atropine d. physostigmine
C 116. Potent cord convulsant, increases the excitability of the CNS at all level
a. morphine b. opium c. strychnine d. both a and b
B 117. Obtained from coal tar

a. kerosene b. naphthalene c. both a and b d. none of these
C 118. Intermediate acting barbiturate/s, except:

a. amobarbital b. butabarbital c. pentobarbital d. vinbarbital
D 119. Entrance or outlet of any body cavity is termed as:

a. media b. meatus c. oral d. orifice
A 120. Atropa belladonna belongs to the family

a. Solanaceae b. Rutaceae c. Ranunculaceae d. all of the above e. none of the above

Clinical Toxicology
A 121. Poisonous substance in Paris green is:
a. arsenic b. cyanide c. antimony d. mercury
B 122. Insecticide, fungicide, alloys in medicine, emetic drug, astringent and caustic, purification of water,
escharotic
a. cadmium b. copper c. lead d. mercury d. none of the above
A 123. Ultra short acting barbiturates are highly lipid soluble and rapidly penetrate the brain, and is capable of
inducing:
a. anesthesia b. paralysis c. none of the above
D 124. Cocaine is commonly known as:
a. coke b. lady c. crystals d. all of the above
A 125. Tetracyclines tend to form complexes with the following, except:

a. belladonna b. calcium ions c. magnesium ion d. iron ions
B 126. Which of the ff. symptoms is not present in digitalis intoxication?

a. vomiting b. vagal arrest of the heart c. visual disturbance
A 127. The first toxic symptoms of digitalis poisoning is:

a. gastrointestinal irritation d. cerebral excitement
b. undue depression of heart rate e. colored vision
c. flushing of skin
B 128. A type of insulin which causes exceptionally few allergic reactions is:
a. protamine zinc insulin d. lente insulin
b. NPH insulin e. salicylate analgesics
c. globulin unsulin
D 129. One of the ff. should not be listed below as a volatile poison
a. chloroform d. di-fluorocarboxyl
b. benzene e. petroleum ether
c. carbolic acid
B 130. Cases of heavy metal poisoning are concrete examples of:

a. sub-acute poisoning b. chronic poisoning c. acute poisoning d. unknown
B 131. Calcium disodium edetate is:

a. BAL b. Ca-EDTA c. Desferal d. Penicillamine
C 132. Example of poison which exhibits both local and remote types of effects
a. arsenic b. cantharides c. both a and b d. none of the above
C 133. Substance intended to prevent, destroy, repel or mitigate rats, mice, etc
a. herbicides b. hematocides c. rodenticides d. molluscides
B 134. fatal dose of nitrobenzene

a. 2-3 drops b. 8-15 drops c. 60-80 drop d. 0-1 drops
A 135. Characteristic odor of phosphorous intoxication

a. garlic odor b. mousey odor c. odor of bitter almonds d. odor of chico
A 136. The only poisonous variety of phosphorous

a. yellow b. red c. black d. all of the above
A 137. Systemic emetics act by:

a. direct stimulation c. indirect stimulation
b. reflex stimulation d. none of the above
D 138. Water is avoided in poisoning by:

a. acetic acid b. nitric acid c. milk d. tea
D 139. Which of the ff preparations contains arsenic?

a. Fehling’s solution c. Nylander’s solution
b. Benedic’s solution d. Fowler’s solution
B 140. Source of phytotoxin

a. animals b. plants c. minerals d. insects
C 141. Which of the ff animals used for flocculant precipitates with human blood?
a. cat b. dog c. rabbit d. monkey
C 142. The organ of elimination for metallic poisons

a. mouth b. rectum c. liver d. skin
A 143. Strong black coffee of subcutaneous injection of caffeine citrate in the treatment of acute alcohol
poisoning is attributed to
a. antagonistic stimulant effect of caffeine
b. oxidation of alcohol
c. depressant action of caffeine
d. hypotensive effect of caffeine

Clinical Toxicology
A 144. The cardinal rule or the first step to be considered in the treatment of poisoning is to:
a. remove the poison from contact with the victim
b. stop the action of the poison by giving the specific antidote
c. provide symptomatic of supportive care
d. fight against the tendency of death
A 145. Activated charcoal is used in the treatment of phenol poisoning as

a. mechanical antidote b. chemical antidote c. physiological antidote
B 146. Morphine as a physiological antidote in methanol poisoning acts by:

a. reversing acidosis c. antagonizing the action of methanol
b. relieving abdominal pain d. inducing intestinal evaluation
A 147. Nalorphine acts as a specific antagonist for opium poisoning by:

a. competitive inhibition c. non-competitive inhibition
b. stimulation d. sedation
C 148. The mechanism of action involved in the use of EDTA as antidote for heavy metal poisoning is:
a. adsorption b. oxidation c. chelation d. precipitation
C 149. The ff symptoms of poisoning from antimony are similar to those of arsenic poisoning, except:
a. diarrhea of rice-water stool c. garlic odor of breath and suppression of urine
b. severe dehydration and great thirst d. nausea and vomiting
D 150. Metallic poisons are classified as

a. corrosive poison b. irritant poison c. cerebral neurotic poison d. all
C 151. Prussian blue is the antidote for what poisoning?

a. lithium b. nitrites c. thallium d. cyanide
A 152. Whole Bowel Irrigation is preformed using

a. PEG b. Sodium phosphates enema c. Magnesium citrate d. NaSO4
B 153. The ff compounds have 2 sulfhydryl (-SH) groups, except:

a. DMSA b. penicillamine c. DMPS d. BAL
B 154. Which of the following can be used for carbamate poisoning?

a. pralidoxime b. neostigmine c. atropine d. all of the above
B 155. Poison present in Dora rat killer

a. diphenhydramine b. coumarin c. heavy metals d. 2,4-D
D 156. The ff. are used to treat anaphylaxis

a. diphenhydramine b. dopamine c. cortisone d. epinephrine
C 157. Calcium gluconate precipitates the ff. salts, except

a. oxalate b. fluoride c. sulfate d. none of the above
C 158. Causes liquefaction necrosis

a. silicones b. acids c. alkali d. paraquat
D 159. Street names of marijuana, except:

a. grass b. mary jane c. pot d. ice
A 160. Ecstasy is related to what drug?

a. amphetamine b. opioids c. acetylcholinesterase d. anorectic
B 161. Antidote for cyanide poisoning, except:

a. methemoglobin producers c. hydroxycobalamine
b. EDTA d. none of the above
A 162. FPN test indicates the presence of:

a. chlorpromazine b. imipramine c. ferric chloride d. salicylic acid
B 163. A red color in the pyridine layer after adding NaOH develops in the presence of
a. nitrobenzene b. chloroform c. ethylene d. phenacetin
B 164. Present in tear gas:

a. cyanide b. capsaicin c. alloin d. cysteine sulfoxide
A 165. Muscarinic antagonists, except:

a. hyoscine b. arecoline c. pilocarpine d. NOTA
A 166. Which of the ff. conditions can cause convulsions?

a. hypoglycemia b. coma c. isopropyl alcohol toxicity d. lactic acidosis
A 167. A warfare gas:

a. phosgene b. COCl2 c. sarin d. all of the above
B 168. A patient passing out a yellow-green vomitus can be poisoned by:

a. iron b. chromium c. phosphorous d. cyanide

Clinical Toxicology
C 169. Triad of opioid/opiate toxicity, except:

a. respiratory depression b. pin-point pupil c. convulsion d. coma
A 170. Toxic metabolite of CCl4

a. epoxides b. phosgene c. nitrite d. cyanide
D 171. Toxic metabolite of acetonitrile

a. epoxides b. phosgene c. nitrite d. cyanide
A 172. Enzyme which catalyzes conversion of paracetamol to n-acetyl-paraamino-benzoquinone imine
a. cytochrome P-450 b. superoxide dismutase c. hyaluronidase d. glucuronide transferase
A 173. Poison from black widow spider:

a. α-latro toxin b. saxitoxin c. α-bungarotoxin d. picrotoxin
B 174. Protamine sulfate is a/an:

a. anticoagulant b. antidote for heparin toxicity c. basic protein d. all of the above
C 175. Capable of measuring serum concentration levels of poisons, except:

a. HPLC b. RIA c. TLC d. GLC
B 176. Digoxin FAB comes from

a. pigeons b. sheep c. fish d. cats
D 177. Thallium toxicity causes:

a. coma b. respiratory depression c. metabolic acidosis d. hair loss
A 178. Penicillin is used to treat poisoning with:

a. Amanita mushrooms c. Botulinus toxin
b. Silibinin d. Salmonella enterotoxin
B 179. The process of detoxification wherein the drug/ substance of abuse is withdrawn gradually:
a. “cold turkey” b. “warm turkey” c. “lukewarm turkey” d. “hot turkey”
C 180. “Angel dust”:

a. MDMA b. LSD c. PCP d. THC
C 181. “Roofies”
a. alprazolam b. cannabis c. flunitrazepam d. heroin
A 182. A toxic insult on the developing organism may cause adverse effect during:
a. prenatal development c. prior to conception
b. postnatal development d. all of the above
A 183. Fetal alcohol syndrome is characterized by following, except:

a. long palpebral fissures c. intellectual growth retardation
b. retarded psychomotor development d. microcephaly
A 184. Pralidoxime can be used for poisoning from:

a. parathion b. aldicarb c. either a or b d. neither a nor b
D 185. All of the ff metals have been found with substantial evidence to be carcinogenic in humans, except
a. arsenic b. beryllium c. cadmium d. manganese
D 186. The organs adversely affected by lead, except:

a. brain b. kidneys c. blood d. lungs
B 187. causes fetal hydantoin syndrome:

a. heroin b. phenytoin c. penicillin d. tamoxifen
A 188. Exposures at any time during pregnancy poses a high risk of congenital structural abnormalities
a. tretinoin b. cyclophosphamide c. carbamazepine d. tamoxifen
A 189. Enters the breast milk and can cause neonatal narcotic dependence
a. heroin b. codeine c. both a and b d. none of these
C 190. A characteristic of arsenic poisoning

a. black gum lines b. wrist drop c. Mee’s lines d. acrodynia
C 191. The major target organ of toxicity of benzene:

a. blood b. liver c. bone marrow d. heart
D 192. Morphine and its derivatives can cause

a. dyspnea b. diarrhea c. constipation d. respiratory paralysis e. all of these
A 193. An agent that neutralizes a poison or counteracts its effects is a/an:

a. antidote b. antiemetic c. counterirritant d. antibiotic
C 194. Ethanol acts by preventing the conversion of this drug to formaldehyde by competing for dehydrogenase
a. chlorine b. iodine c. methanol d. all of these

Clinical Toxicology
C 195. Signs of barbiturate poisoning
a. alkalosis b. diuresis c. decrease respiratory minute volume d. hypertension
A 196. An antidote for heparin overdosage

a. protamine sulfate b. dicumarol c. calcium salts d. atropine
D 197. Angina pectoris is a type of pain seen in this type of poisoning

a. hydrochloric acid b. lead c. mercury d. nicotine
D 198. Nicotinic acid produces which of the ff. effects:

a. decreases VLDL clearance c. increases VLDL clearance
b. Increases VLDL production d. none of these
B 199. An antidote for acetaminophen overdosage

a.. atropine b. n-acetylcysteine c. physostigmine d. all of these
C 200. Aflatoxin is found in
a. nux vomica b. mushrooms c. improperly dried nuts d. shellfish
C 201. A specific antidote for metallic poisoning like arsenic

a. sodium nitrate b. copper sulfate c. dimercaprol d. activated charcoal
D 202. Enhancement of elimination of poisoning include:

a. manipulation of urine pH to accelerate urinary excretion
b. hemoperfusion
c. hemodialysis
d. all of these
D 203. These are chelating agents used as antidotes

a. penicillamine b. calcium edentate c. dimercaprol d. all of these
C 204. Atropine is useful in treating poisoning by organophosphate insecticides because it

a. stimulates receptors directly
b. reactivates inhibited acetylcholinesterase
c. blocks the action of acetylcholinesterase at both central and peripheral sites
d. inhibits normal ganglionic transmission
C 205. Iron poisoning gives ____ coloration of stool and urine

a. brown b. blue c. black
A 206. Antidote for monomethylhydrazine

a. pyridoxine b. thiamine c. riboflavin d. all of these
B 207. Caffeine can cause

a. respiratory paralysis c. drowsiness
b. restlessness d. all of these
D 208. An antidote for curare poisoning

a. atropine b. neostigmine c. homatropine d. all of these
B 209. Rotten egg odor is a characteristic of poisoning with

a. heroin b. hydrogen sulfide c. lead d. ethylene glycol
A 210. Drugs of high addicting property

a. amphetamines b. scopolamine c. chloral hydrate d. ketamine
B 211. the following are important air pollutants except

a. carbon monoxide b. malathion c. ozone d. sulfur dioxide
A 212. Antipyrine has been known to cause

a. blood dyscrasia b. non-electrolyte c. fever d. high incidence of rashes
B 213. The following antidotes could be used to treat carbamate insecticide poisoning except
a. atropine b. pralidoxime c. physostigmine d. all of these
D 214. An antidote that acts by adsorption and is usually given when the nature of the poison is unknown
a. KMnO4 b. ipecac syrup c. tannic acid d. charcoal
D 215. The basis of understanding drug reaction is:

a. pharmacokinetics b. pharmacodynamics c. toxicodynamics d. all of these
D 216. Non-therapeutic chemical most commonly involved in poisoning are the ff., except
a. corrosives b. insecticides c. solvents d. analgesics
B 217. Emetics act in the ff. manner except:

a. centrally b. peripherally c. locally d. none
A 218. Ipecac syrup has the ff. adverse effect except:

a. blurred vision b. persistent GI upset c. hemorrhagic gastritis d. all of these
B 219. the most toxic veratrine alkaloid is:

a. pseudoveratrine b. protoveratrine c. veratrine d. pseudogerbine

Clinical Toxicology
B 220. This gas is used for execution in so-called gas chambers:

a. nitrous oxide b. nitrous oxide and cyanide c. cyanide d. ozone
B 221. eating of rotten canned goods can cause:

a. salicylism b. botulism c. cinchonism d. none of these
For questions 222-226, choose from the ff:

A. normal saline
B. dimercaprol
C. atropine
D. lead
E. neostigmine
A 222. the specific antidote for the treatment of poisoning due to he oral ingestion of silver nitrate
D 223. Ethylendiamine-tetraacetic acid is an antidote for this poison
E 224. Antidote for curare poisoning
B 225. The most effective antidote for arsenic, gold and mercury poisoning, which is a metal complexing agent
C 226. The best known physiological antidote for strychnine

A. diazoxide
B. diazepam
C. syrup of ipecac
D. charcoal
E. sodium bicarbonate
E 227. This is indicated for severe metabolic acidosis resulting fro intoxication by methanol, ethylene glycol,
salicylates, and excessive lactic acid.
B 228. This is indicated for anxiety, convulsions, muscle relaxant and chloroquine poisoning to antagonize
cardiac toxicity.
A 229. The drug is used as an oral hypoglycemic agent.
D 230. An antidote that acts by adsorption and is usually given when the nature of the poison is unknown.
C 231. This is usually given in poisoning to induce vomiting.

A. ammonia water
B. 2.5% sodium thiosulfate
C. atropine
D. BAL with EDTA
E. Pyridoxine
C 232. the best antidote for organosphoshate poisoning.

B 233. The antidote for treating poisoning with bleaching agents like Zonrox.
A 234. The best antidote for formaldehyde poisoning, since it forms a non-poisonous product which is
methenamine.
E 235. The antidote for isoniazid poisoning.

A. Acetylcysteine
B. Weak acid
C. Starch
D. activated charcoal
E. Folic acid
B 236. Antidote for magnesium salts

D 237. Universal antidote contains this substance
C 238. Antidote for iodine poisoning
E 239. This B-complex vitamin, when administered to patients with methanol and ethylene glycol poisoning,
may enhance the elimination of the toxic metabolite, formic acid.
A 240. This drug is indicated for acetaminophen overdose, which acts as a sulfhydryl group donor, substituting
for the liver’s usual sulfhydryl donor glutathione.

A. acetylcysteine
B. physostigmine
C. potassium salt
D. thiamine
E. ethanol
B 241. This drug could be used to treat hydrocarbon insecticide poisoning.

E 242. The antidote for ethanol and ethylene glycol poisoning.
D 243. Glucose with this drug is given to alcoholic and malnourished patient but may aggravate hyperglycemic
ischemia and brain injury.
C 244. Used for the treatment of digitalis poisoning.

A. Vitamin K
B. Nalorphine

Clinical Toxicology
C. Apomorphine HCl
D. BAL
E. Citric acid
B 245. The specific antagonist for narcotic poisoning.

C 246. A local emetic.
E 247. An antidote for sodium hydroxide poisoning
A 248. An antidote for warfarin poisoning
For questions 249-253 choose from the ff:
A. CuSO4
B. Nalorphine
C. Sodium bicarbonate
D. KCl
E. Chlorpromazine
C 249. This is the antidote for chlorine gas poisoning

A 250. This is an antidote for phosphorous poisoning
E 251. A systemic antidote for amphetamine poisoning
D 252. A physiological antagonist for digitalis
B 253. Acts as a specific antagonist for opium poisoning.
For questions 254-258 choose from the ff:
A. Atropine/ pralidoxime
B. Magnesium hydroxide
C. Ethanol
D. Naloxone
E. Sodium bicarbonate
D 254. Poisoning by narcotics can be best treated by giving this drug.

C 255. Surface contamination with phenol can be washed using this substance
B 256. The universal antidote usually contains tannic acid, activated charcoal and this drug.
A 257. These drugs can treat poisoning with organphosphates like parathion and malathion.
E 258. This drug is used for effective excretion of absorbed barbiturates.
D 259. One should not e listed below as a volatile poison:

a. chloroform b. benzene c. carbolic acid d. di-fluorocarboxyl
C 260. The botanical origin of the very toxic ergonovine:

a. Papaver somniferum b. Croton tiglium c. Claviceps purpurea d. Cantaris vesicatoria
B 2671. The best method of isolating non-volatile poisons is by:

a. distillation with a current of steam
b. distillation without current of steam
c. extraction with water or oxalic acid
d. extraction with organic acids
B 262. Cases of heavy metal poisoning are concrete examples of:

a. sub-acute poisoning b. chronic poisoning c. acute poisoning d. unknown
D 263. Local action of poisons are best characterized by:

a. Cantharidin b. phosphorous c. corrosive acids d. both a and c
B 264. Digitoxin goes this kind of physiological action.

a. local b. remote c. both a and b d. none of these
B 265. Spoiled food brings about:

a. botulism b. ptomaine c. tinnitus cureum d. none of these
B 266. Best known physiological antidote for strychnine

a. pilocarpine b. atropine c. morphine d. codeine
B 267. Oil of mirbane is a synonym for:

a. sulfuric acid b. nitrobenzene c. potassium hydroxide d. potassium nitrate
B 268. Antidote for magnesium salts

a. 4% tannic acid solution c. nalorphine
b. activated charcoal d. copper sulfate
B 269. The primary toxicity of carbon tetrachloride

a. nephrotoxicity b. hepatotoxicity c. cardiotoxicity d. pulmonary toxicity
D 270. Washing out an organ such as the stomach or bowel

a. intravenous b. irrigation c. labyrinth d. lavage
B 271. This poison particularly affects cardiac muscles

a. strychnine b. digitoxin c. theophylline d. pilocarpine

Clinical Toxicology
C 272. Exerts their effects by interfering with the oxidation of the tissues
a. narcotics b. irritants c. asphyxiants d. convulsants
C 273. The function of the toxicologist covers:

a. diagnosis of a poisoning case
b. detection and treatment of an identified poisoning case
c. all of the above
d. none of the above
B 274. Food poisoning is an example of:

a. organic alkaloidal poisoning c. organic animal poisoning
b. organic bacterial poisoning d. none of the above
C 275. A condition of more or less complete suspension of respiration and death may begin at the lungs:
a. syncope b. coma c. asphyxia d. drowning
C 276. Agents which produce exhaustion and cause marked loss of vital or muscular power
a. tetanics b. neurotics c. asthenics d. stimulants
C 277. Agents which produce stupor

a. abortives b. stimulants c. narcotics d. convulsants
C 278. Evidence obtained by examination of body organs and tissues after death
a. experimental evidence c. post-mortem evidence
b. chemical evidence d. pre-mortem evidence
C 279. Evidence contributed by the symptoms

a. chemical evidence c. symptomatic evidence
b. post-mortem evidence d. experimental evidence
C 280. Evidence obtained by administering the suspected substance to some living animal and observing the effects
a. circumstantial evidence c. experimental evidence
b. symptomatic evidence d. chemical evidence
C 281. A type of poisoning produced by taking or absorbing for a protracted period small doses of a poison, thereby
producing gradual deterioration of function of tissues
a. acute poisoning b. sub-acute poisoning c. chronic poisoning d. none of the above
C 282. Dose which may be expected ordinarily to produce the therapeutic effects for which the preparation is
employed.
a. maximum dose b. minimum dose c. average dose (median) d. above average dose
C 283. Atmospheric substance with an oxidizing power which liberates iodine from the solution of KI
a. carbon monoxide b. oxidants c. particulates d. hydrogen sulfide gas
C 284. This substance is produced by the incomplete combustion of carbon or carbonaceous materials
a. nitrogen materials b. sulfur oxides c. carbon monoxides d. hydrogen sulfide
C 285. Characteristic color of the ammonium phosphor-molybdate precipitate for the presence of phosphorous
a. violet precipitate b. black precipitate c. yellow precipitate d. maroon precipitate
C 286. Characteristic type of precipitate of magnesium ammonium phosphate for the presence of phosphorous
a. curdy, white precipitate c. crystalline, white precipitate
b. heavy, white precipitate d. white solution
C 287. Distinguishing test of carbon disulfide fro hydrogen sulfide

a. sulfocyanate test b. hypochlorite test c. xanthogenate test
B 288. Aniline + bromine water gives this characteristic precipitation

a. pinkish red precipitate c. blue green precipitate
b. flesh-colored precipitate d. yellowish globules
B 289. In order to detect with certainty nitrobenzene, one must

a. steam distill the sample
b. reduce the sample first to aniline with iron and HCL, then test it for aniline
c. smell the liquid
C 290. Nitrobenzene odor resembles that of

a. chico b. garlic c. bitter almonds d. oil of sulfates

Clinical Toxicology
1. B
 Forensic toxicology- focuses on legal and medical consequences of the poison.
 Environmental toxicology-primarily deals with the identification and medical consequences of the
poison.
 Regulatory toxicology-concerned with the toxicity of testing in order to provide information for the
safety evaluation and regulation of poisons.
 Clinical toxicology-focuses on the effects of substances in patients caused by accidental
poisonings or intentional overdoses of medications, drugs of abuse, household products or various
other chemicals (Clinical Toxicology, John J. Pnzillo) Shargell
(Klaassen; p13-14)
2. C.
 Descriptive toxicology is concerned directly with toxicity testing which provide information for
safety evaluation and regulatory requirements. (Klaassen p.13)
 Mechanistic toxicology is concerned with the identification of the mechanisms by which
chemicals exert toxic effects on living organisms (same reference).
 Forensic toxicology-is concerned with the medicolegal aspects of the harmful effects of the
harmful effects of chemicals on humans and animals.
3. A. LD50 –the single dose of a chemical that can cause death in 50% of the exposed population.
Teratology-the study of defects induced during development between conception and birth
(Klaassen p.3)
Threshold dose/threshold limit value- the minimally effective dose of any chemical that works as
stated all-or-none response is called the threshold dose (Klaassen).
4. C. *Taking several doses at long intervals is classified as chronic poisoning.
Acute exposure Exposure to a chemical for

less than 24 hours and0(i.e. of
exposure routes are
intraperitoneal. IV, SQ inj., oral
intubation and dermal
application).
Subaccute exposure Repeated exposure to a
chemical for a month or less.
Subchronic 1-3 months
Chronic 3 months
(Klaassen p.15)
5. C. Definition of post- mortem evidence
6. C.
7. D. Contraindications for catharsis are those cases in which the patient has ingested corrosive
substances; for patients with electrolyte imbalance (for those with impaired renal failure especially).
Hypertonic cathartics and enemas are specifically hazardous in the presence of renal dysfunction.
Irritant cathartics such as vegetable cathartics (aloes, cascara) should not be used in any type of
poisoning. (Dreisbach; p.27).
8. B. Castor or olive oil can be used for skin decontamination in phenol poisoning (Flanagan; p.203)
Castor oil is a stimulant cathartic (Tyler; Pharmacognosy p.88) Its clinical effects are self-limited
irritation of small intestine (Dreisbach).
In halogenated hydrocarbon poisoning, stimulants are contraindicated (Dreisbach).
Mannitol is an osmotic laxative while MgSO4 as well as Fleet Phosphosoda are saline cathartics
(Rogers; p. 265).
9. B. Definition of cumulative poison
10. B. Direct aspiration of petroleum distillates (i.e. kerosene, and gasoline) into the lungs during
ingestion appears top be the principal cause of pulmonary irritation. The extent of pulmonary
involvement (pneumothorax, bronchial pneumonia, and pulmonary edema ) indicates severity of the
poisoning. (Dreisbach; p. 191)
11. B. Sodium chloride solution (in water) 10g/lL precipitates the silver ion in silver nitrate, forming the
insoluble silver chloride (Dreisbach;p.375).
12. C. Aminoglycosides such as Streptomycin, Vancomycin, Kanamycin (Kantrex), Amikacin (Amikin),
Gentamicin (Garamycin) and Tobramycin (Nebcin) can cause paresthesias, eight cranial nerve
injury with tinnitus, deafness, loss of sense of balance renal damage, neuromuscular blockade and
vertigo after parenteral administration (Dreisbach; p.40).
13. E. Salicylates have widespread availability, are found in numerous propriety and nonpropriety
products and preparations and receive mass promotion through advertising media (Mc Guigan).
Most salicylate poisonings involve the use of aspirin or acetyl salicylic acid (Klaassen).
14. B. Starch complexes with iodine forming a deep blue colored product. Starch solution is prepared by
adding 15g of cornstarch or flour to 500 ml of water (Dreisbach).
Clinical Toxicology
15. A.
16. D.
17. A.
18. C. Acute poisoning by inhalation refers to a continuous exposure for less than 24 hours, most
frequently for 4 hours (Klaassen)
19. A. Toxic doses of atropine, scopolamine, or other anticholinergic drugs (5-10 mg or higher) may
cause hot, dry red skin, dry mouth, disorientation, delirium and aggressive behavior (Dreisbach)
20. A. Ca2+ activated neutral proteases or calpains (Saido et al) convert xanthine dehydrogenase to
xanthine oxidase whose by products are the superoxide radical (O2.-) and hydrogen peroxide which
contribute to cell injury by oxidative stress. Many integral membrane proteins are targets for calpains
(Klaassen; pp.41, 56-57).
21. A. Absorption of toxicants through a membrane can be (1) passive, which follows Fick’s Law of
Diffusion or (2) Specialized transport.
 Passive Transport involves simple diffusion/ passive diffusion, and filtration.
 Specialized Transport involves active transport and facilitated diffusion.
 Additional Transport processes includes endocytosis (phagocytosis and pinocytosis)
Hydrolysis is n example of Phase I biotransformation process (Klaassen; pp.92-94).
22. D. Biotransformation Reactions Examples
Phase I Hydrolysis, Reduction, Oxidation
Phase II Glucoronoside, Glutathione, Amino acid acylation, and

methylation conhugation reactions
23. A. Pneumomediastinum is a condition in which air is present in the mediastinum (the space in the
chest between the two lungs). It may be caused by a disease or trauma. Gastric lavage may induce
this effect since it entails passing a large-bore tube through the mouth and esophagus into the
stomach. Esophageal rupture and aspiration could possibly lead to more serious cardio-respiratory
dysfunctions such as pneumomediastinum.
24. C.
25. D. Refer to # 7
26. C. Carbon monoxide (CO) has a stronger affinity to hemoglobin than oxygen (about 210 times). It also
attaches to myoglobin and certain enzymes. 100 % oxygen and hyperbarric oxygen (2-3 atm) dilutes
the CO attached to hemoglobin, myoglobin, and cytochromes by mass action, therefore reversing the
effects of the CO (Dreisbach; p.)
27. C.
28. C. Strychnine is a highly toxic alkaloid derived from Strychnos nux vomica and other Strychnos
species It increases in the reflex excitability of the spinal cord, so that all the muscles contract
simultaneously. It causes Clinical presentation of strychnine toxicity includes convulsions, and
notably opisthotonos.
Diazepam and Phenobarbital are used as anti-convulsants and Chlorpromazine is an antipstchotic
drug.
29. A. ASA and Salicylates are weak acids. Alkalinizing the urine with NaHCO3 (75 meq/L) increases
excretion of these (Dreisbach). The reaction is neutralization, forming a salt, which is ionized and
easily excretable.
30. D. Absorption of drugs such as Phenobarbital, Aspirin, and Propoxyphene is delayed by giving
activated charcoal (Dreisbach;p. 299,323). For narcotic overdose such as Propoxyphene, 5-20 times
the estimated weight of the ingested drug (minimum of 10 g) is instilled after emesis or lavage
(Klaassen; p. 981).
Methanol is one of the drugs, which are sometimes cited as not being adsorbed to activated charcoal
(Klaassen; p. 973).
31.D. Refer to #26
32.D. Aminoglycosides are known to be ototoxic, causing 8 th cranial nerve damage. Diuretics (loop
diuretics such as Furosemide and Ethacrynic Acid) are also known to have the same effects.
33. D. In G-6PD deficient patients, hemolytic reactions in the red blood cells are precipitated by drugs
such as naphthalene, nitrofurantoin, salicylazosulfapyridine, sulfisoxazole and other sulfa drugs
(Dapsone), diuretics like furosemide, primaquine, water-soluble vitamin K and uncooked fava beans
(Dreisbach; p. 81).
34. B. Acute intermittent porphyria (AIP) is one of the porphyrias, a group of diseases involving defects in heme
metabolism and that results in excessive secretion of porphyrins and porphyrin precursors. AIP manifests itself by
abdomen pain, neuropathies, and constipation, but, unlike most types of porphyria, patients with AIP do not have a
rash. Examples of drugs that cause AIP are enflurane, sulfa drugs, etc.
35. A. The incidence of severe heptotoxicity following exposure to halothane is probably in the range of 1
in 20,000-35,000. After halothane anesthesia, the sera of patients who develop halothane hepatitis
have trifluoroacetylated proteins, which are believed to be formed during the biotransformation of
halothane.
36. A. Monoamine oxidase A is the one responsible for the metabolism of norepinephrine, serotonin, and
tyramine. If this enzyme is inhibited by drugs such as the MAO inhibitors, there will be an increase of
these neurotransmitters. MAO inhibitors allow significant accumulation of tyramine and loss of first-
pass metabolism that protects against tyramine rich food such as cheese. The result is a very high
risk of hypertensive crisis.
37. C. Uses of Cadmium (Rogers)
38. E. Chromium is also known as “glucose tolerance factor”
39. A. Uses of Bismuth (Rogers)
40 C.
. Toxicant Uses
Mercur - manufacture of thermometers felt, paint, electrical
y apparatus and in fingerprint photography

Clinical Toxicology
Lead -storage batteries, electric cable covering, solder,
toys, and gasoline
Nitrites
- coronary artery dilator, preservatives in meat
Oxalat
es - bleaches and metal cleaners/ rust and ink eradicators
Naphthalene - moth repellent, deodorizer, and as synthetic
precursors
41. A. Refer to # 40
42. E.Refer to # 40
43. D. Ingestion of large doses of Arsenic (70-180 mg) may be fatal (Klaassen). As causes toxicity by
binding with sulhydryl groups of enzymes therefore interfering with cellular metabolism. If death
occurs, the stomach mucosa shows inflammation but other pathologic changes are absent
(Dreisbach;p.221)
44. E. Beryllium is uncommon metal with a few specific industrial uses. The fatal dose is no known. The
exposure limit in air for Beryllium is 0.002mg/m3 (Dreisbach;p.225 and Klaassen; p.698).
45. E.
Poison Antidote
Aniline and Nitrites 1 % Methylene Blue (0.1mg/kg)
Cyanide 3 % sodium nitrite followed by sodium thiosulfate
(25 %)
Ethyl alcohol 5-10 % glucose (for hypoglycemia) + thiamine
Iodine 1 %sodium thiosulfate
Formaldehyde Diluted ammonia; Ammonium carbonate
Iron Deferroxamine
Methanol Ethanol (50% or 100 proof)
47. B. Hydrocyanic acid (Prussic acid ) is a colorless, transparent liquid and extremely volatile, has a
sweetish odor of bitter almonds (Brundage; p. 44).
48. C.
49. A. Hydrogen sulfide is produced by bacterial action in sewage effluents containing S compounds,
when oxygen has been consumed owing to the excessive organic loading of the surface water
(Dreisbach; p.257). This must be the reason behind the other name for the compound which is stink
damp, due to the unpleasant odor, detectable at 0.05 ppm.
50. B. Phosphorous has been used in rat poisons, which have been named “electric rat paste” because
of their phosphorescence (Rogers; p537).
51. D.
52. B. Toxicity from anticholinesterases (Organophosphates and Cabamates) can be managed by giving
Atropine. Atropine has an anti-cholinergic action that counteracts the initial muscarinic effects of the
accumulating neurotransmitter. Muscarinic effects include lacrimation, miosis (pinpoint pupils),
diarrhea, urinary incontinence, bronchoconstriction, bradycardia, and salivation (Klaassen; p. 657-
659).
53. B.
Clinical manifestations upon Acute exposure Toxicant
Inhalation – Bronchial irritation, Sulfur Dioxide

pulmonary edema
Eye- Conjunctival edema
Rise or fall of Blood Pressure, Ergot
convulsions, loss of consciousness
a. Mild – Decreased inhibitions,
slowing of muscle coordination and
reaction time Ethanol
b. Moderate- definite visual
impairment, sensory loss, slurring of
speech
c. Severe- approaching stupor,
muscular incoordination,
hypoglycemia
d. COMA
Metallic taste, bloody diarrhea upon
ingestion Mercury
Upon inhalation of vapors-
immediate dyspnea, stomatitis and
salivation
(Dreisbach; pp.171, 241,357)

55. A. Asphyxiants are materials that deprive the body of oxygen. Chemical asphyxiants are substances
that render the body incapable of utilizing an adequate supply of oxygen (i.e. CO, CN) (Klaassen).
Ethanol cannot be classified as an asphyxiant because it does not exhibit these effects and
generally, asphyxiants are in gaseous form.

Clinical Toxicology
56. A. Fish poisoning occurs after consumption of improperly prepared tuna due to the growth of surface
organisms in fish stored at ambient temperature (Dreisbach; p. 492-493). The toxic substance is
sourine Venerupin is obtained from sardines, while Gemblid is from mackerel.
57. C. Constricting bands or suction tourniquet is not helpful if they are applied 30 minutes after the bite
or after giving an anti-serum. They must be applied immediately. For rattle snake (Crotalus) bites
with minimal systemic symptoms, give 3-5 vials of antivenom (Dreisbach; p.472-473).
58. B.
Toxicant Pathologic Findings
Nitric Acid Area of contact (i.e. mouth) is
colored yellow
Sulfuric acid Blackening of the mouth; severe
corrosion
HCL Complete destruction of the skin and
mucosa
Phenol Painless blanching with erythema
(Dreisbach)
. 59. D. Mercury- Minamata Disease
Cadmium- Itai- itai Disease
Mn- Progressive CNS Deterioration
Nickel – Hypersensitivity reactions, Lung Cancer
Molybdenum- Deleterious effects in the reproductive system
60. D. Nicotine is a contact insecticide. Paraquat, Diquat, phenoxy acetic acid and TCDD are
herbicides
(Klaassen; pp.669-671).
61.C. The most dangerous species among the poisonous mushrooms are Amanita phalloides, Amanita
verna, Amanita virosa, Gyromitra esculenta and Galerina species (Dresbach; p. 504).
62. C. Refer to # 40
63. B. Antidote for Lead poisoning (Pb) consist of BAL or Dimercaprol (4mg/kg) every 4 hours for 30
doses + Calcium Disodium Edetate (EDTA) (12.3 mg/kg IM) every 4 hours for 30 doses.
Penicillamine is later given (Dreisbach; p. 234).
64. A. Administration of Ethanol reduces the toxic effect of Methanol by blocking the matabolism of
methanol to formaldehyde and formic acid; this allows the excretion of unchanged methanol by the
kidneys (Dreisbach; p. 168).
65. A. Ipecac, in the form of syrup, is used in the treatment of drug overdose and in certain poisonings. It
produces emesis through a local effect by stimulation of the gastrointestinal mucosa and a medullary
effect by stimulation of the chemorecceptor trigger zone ( Tyler; p.211)
67. B. The estimated lethal dose of ASA is 15 g (Flanagan; p.213).
68. B. Lysergic acid diethylamide (LSD) is an example of a psychotomimetic agent. Other examples are
DMT (dimethyl tryptamine) and MDMA or Ecstasy. Clinical findings of toxicity from these include
convulsions, come, fever, and prolonged psychotic states. Additional findings (for LSD) include
mydriasis or DILATED PUPILS, psychopathic personality disorders, increased homicidal/suicidal
risk, and HALLUCINATIONS (Dreisbach; pp.418-419).
69. D. Strychnine causes increased reflex excitability in the spinal cord; this results in a loss of the normal
inhibition of spread of motor cell stimulation. Spasms increase in severity and frequency so that all
muscles contract simultaneously. Death is from respiratory failure (Dreisbach; pp.418-419).
70. B. MgO- Calcined Magnesia
Lead Oxide- Litharge
Arsenic trioxide- White Arsenic
Nitrous Oxide – Laughing gas
71. B. Scientific name of cassava is Manihot esculenta.
72. C. Since convulsions is the primary manifestation of strychnine poisoning, Babiturates, which are anti
convulsants are useful as physiological antidote, Succinyl choline and Diazepam are also used to
manage the convulsions.( Further explanation on # 266)
73. C. Doses fewer than 5 mg in adults causes hyperactivity, incoordination, nystagmus and violent
movements. At 5-10 mg, stupor or coma occurs, and doses greater than 10 mg, convulsions and
respiratory depression may happen (Dreisbach; p. 425).
74. A.
Toxin Source
Ciguatoxin B inedible organs of barracudas, snappers, sugeon
fish etc
Lactrotoxin Black widow spider or “hourglass spider”
Saxitoxin Mollusks (clam, mussels), arthropods
Aflatoxin Stale nuts (peanuts, almonds, walnuts), grains, oil
seeds
Scromboid Improperly prepared tuna, bonitos, skipjacks etc.
75.A.
76.B. Refer to #74
77.C. Refer to # 74
78.B. Refer to # 74
79.D. For Halogenated Pesticide Poisoning (i.e. DDT) give Diazepam 10 mg slow IV. If convulsion
pesist, give neuromuscular blocking agent and controlled respiration. For hyperactivity or tremors, give
Phenobarbital sodium 100 mg SQ (Dreisbach; p.102).
80. C.

Clinical Toxicology
81. B. Copper, in the form of Copper sulfate is used externally for its fungicidal action (1- 5% solutions).
Copper sulfate has been used to purify water for drinking in swimming pools, usually in conjunction
with Chlorine.
82. B Clinical manifestation of Nitrobenzene and Cyanide poisoning is bitter almond breath.
83. D. Pathologic findings in paraquat poisoning include hemorrhagic necrotic areas in the brain,
distention of the intestines, severe renal tubular necrosis, pulmonary edema and broncho pneumonia
(Dreisbach; p.136). These are manifested by hemoptysis, hematemesis, diarrhea with bloody stools
etc.
84.C.Universal antidote contains activated charcoal, tannic acid, and MgO.
85. C. Picrotoxin is a nonnitrogenous compound of known structure obtained from Cocculus indicus (fish
berries), the berry of Anamirta cocculus, an East Indian plant (Dreisbach; p. 420)
86. D. 3 principal alkaloids of ipecac are emetine, cephaeline, and psychotrine (Tyler; p.211).
87. C. Acetone possesses a sweet peasant odor.
88. A. Milk is amphoteric since it is composed of amino acids, which are zwitterions, and can either act
as acids or bases. Milk also coats the stomach.
89. A. Paralytic shellfish poisoning, variously known as saxitoxin, are caused by ingestion of
dinoflagellates such as Gonyaulax sp. By clams or mussels etc (Klaassen; p.813).
90. B.
Chelating Agents Indications
BAL/Dimercaprol For inorganic mercury, arsenic,
antimony, cadmium, cobalt,
bismuth, chromium, gold and
nickel poisoning
EDTA For lead toxicity
DMSA For lead toxicity
Penicillamine For copper poisoning (Wilson’s
disease)
DTPA For chelation of Plutonium and
other actinide elements
Desferrioxamine For Iron toxicity
Dithiocarbamate / DTC DOC for acute nickel carbonyl
poisoning
(Klaassen; pp.694-698)
91.C. Benzodiazepines have anti-convulsant properties (i.e. diazepam) so they are indicated for
seizures.
92. D. Tetrodotoxin, or puffer or fugu poison, is found in certain puffers, ocean fishes, and porcupine
fishes. It is also found in some amphibians and blue-ringed octopus. The puffers or puffer-like fishes
appear to be the only fishes universally regarded as poisons (Klaassen; p.825).
93. B. Pyrethrum is a mixture of six insecticidal esters (pyrethrines, cinerins and jasmolines) extracted
from the dried pyrethrum or chrysanthemum flowers (Chrysanthemum cinerariaefolium etc.)
(Klaassen; p.666).
Malathion and parathion are both synthetic pesticides.
94. A. Snake venom contains hyaluronidase enzyme (“spreading factor”) that catalyzes the cleavage of
the internal glycoside bonds in certain acid mucopolysaccarides. This results in the decrease in
viscosity of the connective tissues (Klaassen; p.805).
95 A. Definition of local toxicity
96. Same as #95
97. B. Refer to # 40
98. C. Both aniline and nitrobenzene produce methemoglobinemia as clinical manifestations of poisoning.
It is characterized by chocolate- colored blood (Dreisbach; p. 14-1450).
99. A. Although it is universally agreed that one best treatment for acid burns is rapid irrigation with large
volumes of water, in concentrated sulfuric acid burns, dilution with water would generate heat.
Remedy for this is by using large amounts of water and fast irrigation to immediately dissipate the
heat as well as wash out the acid (Klaassen;p.585).
100. A. Lysol contains saponated cresol (Liquor Cresoli Saponarus).
101. C. Refer to # 74
102. D.
103. A. Antimony (Sb) probably acts by binding to the sulfhydryl groups and inactivating key enzymes.
CO (carbon monoxide), having a high affinity to hemoglobin, combines with it, producing
carboxyhemoglobin.
104. A.
TOXICANT EFFECTS
Muscarine Diarrhea, salivation, sweating,
urination, miosis, bronchconstriction,
bradycardia, lacrimation
Atropine Dry mouth, mydriasis, red skin,
delirium, fever, convulsions and coma
Epileptiform convulsion, yellow or
Santonin disturbed vision, and disturbed
respiration, vomiting, diarrhea
Aconitine Numbness/ paresthesias and tingling

Clinical Toxicology
of the mouth, throat and hands
Physostigmine Tremor, marked peristalsis with
involuntary defecation and urination,
miosis, bronchoconstriction…
(Klaassen; p. 847 and Dreisbach p. 351, 357, 409, and 435)
105. D.
106. B. Refer to #72 and 266
108. D. Mineral oil and kerosene are both hydrocarbon in nature. Lubricating oils such, as mineral seal
oil and petrolatum are nontoxic by ingestion, unless aspiration occurs. Therefore mineral oil can be
used to dilute kerosene (“like dissolve like”) to decrease its viscosity, allowing the easy elimination of
poison (Dreisbach; 189-191).
109. C. Uses of picrotoxin as well as pentylenetetrazol and nikethamide (Dreisbach; pp. 420-421)
110. E. On reaching the air, nitric oxide oxidizes spontaneously to nitrogen dioxide (NO2), which gives
smog its brown color (Dreisbach; p. 202-203).
111.Refer to # 11
112.C. Copper is a protein precipitant, and therefore it is used as an astringent when applied to mucous
membranes and abraded surfaces (Rogers; p.331)
113. Refer to # 86
114. A. Surface contamination of phenol- Remove the poison by washing skin or mucous membranes
with large amounts of water for at least 15 minutes. Follow by repeated application of castor oil
(Dreisbach; p. 368).
115.A. Refer to #104
116.C. Refer to # 28
117.B. Naphthalene is obtained from coal tar. It is used as moth repellent, and synthetic intermediate
118. C. Barbiturates
Long-acting Intermediate- Short-acting Ultra short-
acting acting
Barbital Amobarbital Pentobarbital Na Thiopental
Phenobarbital Amobarbital Na Secobarbital Thiamylal
Metharbital Butabarbital Methohexital
Talbutal
119. D. Definition of orifice.
120. A. Atropa belladonna (Linné) or Deadly nightshade belongs to the family Solanaceae (Tyler; p.192).
121. A. Paris green (copper arsenite) was introduced as a pesticide in the late 1800s (Klaassen; p.643).
122. B. Refer to #s 81 and 112.
123. A. When agents such as Thiopental, Thiamylal, and Methohexital are administered intravenously,
they quickly enter the CNS and depress function, often in less than 1 minute (Myceck;p.115).
124. D.
125. A. Tetracycline forms nonabsorbable chelates with Calcium ions, as well as other divalent and
trivalent cations (Mg and Al antacids and Fe preparations) (Myceck; p. 313).
126 B. Among the early symptoms of acute poisoning are nausea, vomiting, diarrhea, aberrant colored
vision, delirium, and fall of blood pressure. Death is due to ventricular fibrillation (Dreisbach,
p.377).
127. A. The principal manifestations of digitalis poisoning are vomiting and irregular pulse (Dreisbach,
p.377).
128. B. NPH/ Isophane Insulin Injection is a sterile suspension of zinc-insulin crystals and protamine
sulfate in buffered water for injection, combined in a manner such that the solid phase of the
suspension consists of crystals composed of insulin, protamine, and zinc. An insoluble repository
insulin, which is intermediate-acting. There may be occasional hypersensitivity reaction to the
protamine sulfate. Protamine is obtained from the testis or the mature sperm of the fish belonging to
the Oncorhynchus Suckley or Salmo (Linnẻ) Fam. Salmonidae.
129. D. Typical examples of volatile poisons are alcohols, aldehydes, chlorinated hydrocarbons (i.e.
chloroform), phenols (carbolic acid), aromatic hydrocarbons (i.e. benzene) and ether.
130. B. Most of the cases of heavy metal poisoning are considered chronic types of toxicity, that is, they
have been associated with long-term toxicities such as carcinogenicity or teratogenicity.
131. B. BAL – 2,3-dimercaptopropanol; Ca- EDTA- calcium disodium edetate; Penicillamine- β, β-
dimethylcysteine; Desferal- Deferoxamine ( Klaassen; p. 694-695,and Dreisbach; p. 451).
132.C. Acute Arsenic exposure (by ingestion) includes violent gastroenteritis and esophageal pain; (by
inhalation)- acute pulmonary edema and cyanosis. Chronic exposure includes paresthesias and
polyneuritis. (CNS); alopecia Mee’s lines (transverse white bands across the fingernails) liver
cirrhosis, aplastic anemia (Dreisbach; p. 222).
Acute Cantharidin exposure includes severe irritation of the skin and mucous membranes
followed by formation of bullae, abdominal pain, fall of BP, hematuria, uremia and death from
respiratory failure. In Chronic exposure, similar symptoms are observed (Dreisbach; p. 429).
133. C. Definition of rodenticides
134. B.
135. A. Garlic odor - Phosphorous, Selenium fumes, Tellurium fumes
Mousy urine – Coniine
Odor of bitter almonds – cyanide and nitrobenzene
136. A. Phosphorous exists in two forms: a red, granular, nonabsorbed and non-poisonous form; and a
yellow, waxy, water-insoluble and fat-soluble, highly poisonous form that will burn on contact with air
(Dreisbach; p243).
137.A. Systemic emetics act by direct stimulation ( i. e. systemic effect of ipecac syrup- refer to # 68 ).
138. D.

Clinical Toxicology
139. D. Fehling’s and Benedict’s solution contains copper; while Fowler’s solution contains potassium
arsenite.
140. B. phyto- plants
141. C.
142. C. Metals- (i.e. Cu and Mn xenobiotics)are eliminated in the liver through biliary excretion
( Klaassen; p. 404).
143. A. Caffeine has a stimulating action on the CNS which counteracts the depressant effects of
alcohol- physiological antagonism.
144. A. Summary of emergency management of poisoning
I. When notified that poisoning has occurred
1. Give first aid advice
2. Give instructions to save the suspected poison in original container
II. Maintain respiration and control shock
III. Identify the poison if possible
IV. Remove poison to minimize further absorption and injury
V. Give specific antidote, if available while proceeding with the removal of the poison
VI. Give supportive treatment
145. A. Mechanical antidote- examples are cathartics, emetics, demulcents, ligatures and poultices.
Chemical antidotes – examples are oils, milk, charcoal, carbonates, etc. (Brundage; p. 45)
146. B. Morphine, being a narcotic analgesic, can be used to relieve abdominal cramps due to methanol
poisoning.
147. A. Receptor antagonism occurs between morphine or morphine-like narcotics, and naloxone/
nalorphine. Competitive binding on the same receptor results in competitive inhibition (Klaassen; p.
18).
148.C. Treatment of exposure to toxic metals by chelating agents or antagonists is sometimes warranted
to prevent reverse toxicity. Chelation is the formation of a metal ion complex in which a metal ion is
associated with a charged or uncharged electron donor, referred to as a ligand (i.e. BAL, British Anti-
Lewisite; DMPS; and Ca- EDTA) 9klaassen; 694-695).
149. C. Garlic odor of breath is a characteristic symptom of As and Selenium poisoning. Oliguria and
anuria (manifestations of urine suppression) is also a manifestation of As poisoning (Dreisbach; p.
221).
150. D. (Klaassen; pp. 691-694).
151.C. Prussian blue (ferric ferrocyanide) is the mainstay of therapy for Thallium poisoning in Europe. This
compound has a crystal lattice structure, which binds thallium ions and interrupts enterohepatic recycling
(Olson, 3rd ed., p. 303). There is no specific antidote for Li + intoxication (p.449). Methemoglobinemia resulting
from nitrates or nitrites poisoning may be treated with methylene blue. It is a redox dye that reverses drug-
induced methemoglobinemia by increasing the conversion of methemoglobin to hemoglobin. This requires the
presence of adequate amounts of the enzymes methemoglobin reductase and glucose-6-phosphate
dehydrogenase (G6PD) (p. 381). The cyanide antidote package (Taylor Pharmaceuticals) consists of amyly
and sosium nitrites which produce cyanide scavenging methemoglobinemia and sodium thiosulfate which
accelerates the conversion of cyanide to thiocyanate. Hydroxocobalamin is the most promising alternative
antidote for cyanide poisoning that exchanges its hydroxyl group with free cyanide in the plasma to produce
non-toxic cyanocobalamin (pp. 151, 374).
152.A. Whole Bowel Irrigation involves the enteral administration of large volumes of isosomotic
electrolyte lavage solution containing Polyethylene Glycol (PEG-ELS) by nasogastric or orogastric
tube at a rapid rate until the rectal effluent becomes clear (Klaassen; p. 972).
153. B
H2C ---- SH COOH CH3

| | |
HC ---- SH CH ---- SH H3C – C – CH – C -- OH
| | | |
H2C ---- OH CH ---- SH SH NH2
|
COOH
Dimercaprol, BAL, Succimer, DMSA, Penicillamine

2,3 – dimercaptopropanol Dimercaptosuccinic acid
154. B. For carbamate poisoning, Atropine is given (2 mg IM and repeat every 3-8 minutesa) until signs of
parasympathetic toxicity are controlled. Cholinesterase reactivators (Pralidoxime) should not be used in the
presence of carbaryl intoxication (Dreisbach;p. 117).
155. B. Coumarin and other related drugs are used medicinally to inhibit the clotting mechanism. The coumarin and
indandione anticoagulants inhibit formation in the liver of a number of clotting factors, whose formation is dependent
on vitamin K.
156. D. Epinephrine is the drug of choice for the treatment of anaphylaxis (Myceck; p.218).
157. C. Calcium sulfate is appreciably soluble. It requires a fairly high concentration of sulfate ions to form an insoluble
calcium sulfate (Rogers; p. 384).
158. C Alkalis causes a liquefaction necrosis with saponification and continued penetration into deeper tissues,
resulting in extensive damage while acids cause an intermediate coagulation-type necrosis that creates an eschar,
which tends to self-limit further damage (Olson, 3rd ed., p. 130).
159. D.
160.A Ecstasy or MDMA (methylenedioxymetamphetamine) is one of the analogs of metamphetamine (Katzung, 9th
ed., p. 521).
161. B Refer to number 151.
162. A. FPN (ferric chloride, perchloric acid, and nitric acid) color test is used for the detection of phenothiazine drugs
and immunoassays for the detection of barbiturates, benzodiazepines, and opiate derivatives (i.e.
chlorpromazine) are present (Dreisbach; p. 333 and Klaassen; 957).

Clinical Toxicology
163. B. This is called the Fujiwara test. Indaication for the presence of trichloro compounds such as CHCl 3 is an
intense red/purple color in the upper pyridine layer upon addition of NaOH solution (Flanagan; p. 105).
164. B. Capsaicin is extremely irritating which can cause cough, pain followed by reversible local anesthesia, as well
as skin vessication (Klaassen; p. 850).
165. A. Hyoscine or scopolamine is an alkaloid that is particularly abundant in Datura fastuosa and D. metel.
Scopolamine hydrobromide or hyoscine hydrobromide is classified as an anti-cholinergic (Tyler; p. 196).
166. A. Coma and convulsions resulting from hypoglycemia have been reported to occur occasionally as a result of
exposure to toxic substances (Dreisbach; p. 56). The principal manifestation of acute isopropyl alcohol poisoning
is CNS depression (Dreisbach; p. 178).
167. A. Phosgene (COCl2) is a gas that liquefies at 8O. It is used in chemical synthesis and also results from high
temperature decomposition of chlorinated hydrocarbons.
168. B. Chromium toxicity shows a yellow-green vomitious. Chromic acid produces a yellow stain on cloth (Brundage;
p. 68).
169. C The triad of coma, pinpoint pupils and depressed respiration strongly suggests opiod poisoning (Goodman and
Gilman’s, 9th ed., p. 537).
170. A. Toxicity from CCL4 appear to result from the intracellular breakdown of CCl 4 to more toxic intermediates,
including epoxides particularly in the liver (Dreisbach; p. 148).
171. D. acetonitrile, cyanogens chloride, and nitroprussides are cyanide- producers/ releasers (Dreisbach; p. 251-
253).
172. A One of the minor products of normal metabolism of paracetamol by the cytochrome P-450 mixed function
oxidase system to NAPQ is highly toxic (Olson, 3rd ed., p. 63).
173. A Latrodectus (black widow) spider contains alpha-latrotoxin (Olson, 3 rd ed., p. 296). Dinoflagellatres (“red tide”)
produce saxitoxin, which is concentrated by filter-feeding clams and mussels (p. 175).
174. B Protamine is a highly basic peptide that combines with heparin as an ion pair to form a stable complex devoid of
anticoagulant activity. For every 100 units of heparin remaining in the patient, administer 1mg of protamine sulfate
intravenously.; the rate of infusion should not exceed 50 mg in any 10-minute period (Katzung, 9th ed., p. 548).
175. C. TLC is relatively inexpensive and simple to perform and can be a powerful qualitative technique of separation
of constituents by partition (Flanagan; p. 26).
176. B Digitalis antibodies (digoxin immune fab) are produced in sheep and are extremely useful in reversing severe
intoxication with most glycosides (Katzung, 9th ed., p. 212).
177. D Thallium acetate has been used in creams as depilatory. However, it has very toxic effects and may be
absorbed through the skin and exert a systemic action. In such cases or when taken orally it causes the loss of
body hair (Roger’s, 8th ed., p. 479).
178. A. Penicillin 250 mg/kg/day is given by IV infusion to interfere with the binding of amatoxins to albumin, making
the toxin more available (Viccellio; p. 726-727).
179. B.
180. C Phencyclidine (PCP, “angel dust”) is a synthetic phenycyclohexylamine derivative originally used as veterinary
anesthetic. LSD is Lysergic acid diethylamide; MDMA is the popular ecstasy and THC (∆ 9-tetrahydrocannabinol).
(Katzung, 9th ed., pp. 524-525).
181. C Very rapid onset benzodiazepines have been widely reported as a means of “date rape,” by using a small
tasteless dose of the drug to make the victim incapable of protecting himself. This produces intoxication but not
dependence. The drug most commonly used in this situation has been flunitrazepam (Rohypnol, “roofies”)
(Katzung, 9th ed., p. 520).
182. A. Environmental/ toxicological insult may interfere with the homeostasis, growth, differentiation and development.
Its main targets include the fertilized egg or zygote, the embryo during the period of major organ formation (i.e.
organogenesis), or during the establishment of the 3 germ layers (collectively considered as prenatal
development).
183. A Fetal alcohol syndrome consists of CNS dysfunction (such as low IQ and microcephaly), slowness in growth, a
characteristic cluster of facial abnormalities (such as short palpebral fissures, hypoplastic upper lip, and short
nose), and a variable set of major and minor malformations (Goodman and Gilman’s, 9th ed., p. 388).
184. A. Parathion is an Organophosphate pesticide. Cholinesterase reactivators are used in this type of poisoning
( i.e. pralidoxime). Aldicarb is a carbamate pesticide. Generally, cholinesterase reactivators are not used on
carbaryl poisoning (Dreisbach; p. 114, 117).
185. D. Chronic Mn poisoning stimulates parkinsonian effects and not carcinogenicity. Symptoms include weakness
and increased muscle tone, hand tremor, slurred speech, etc. (Dreisbach; p. 237).
186. D Signs and symptoms of chronic lead poisoning (plumbism) can be divided into six categories: gastrointestinal,
neuromuscular, CNS, hematological and renal and the other. They may occur separately or in combination. The
neuromuscular and CNS syndromes usually result from intense exposure, while the abdominal syndrome is a
more common manifestation of a very slowly and insidiously developing intoxication (Goodman and Gilman’s, 9 th
ed., p. 1650).
187. B. Phenytoin causes teratogenic effects in offspring of mothers given the drug during pregnancy. “ Fetal
hydantoin syndrome” includes cleft tip, cleft palate, congenitall heart disease as slowed growth and mental
deficiency ( Myceck; p. 146-147).
188. A. Teratogenicity is a significant risk in patients taking isotretinoin; therefore, women of childbearing potential must
use an effective form of contraception for at least 1 month before, throughout isotretinoin therapy, and for one or
more menstrual cucles following discontinuance of treatment (Katzung, 9th ed., p. 1024).
189. A. Heroin, like fentanyl, is more fat-soluble opioids and readily penetrate into the neonates’s brain, causing
narcotic dependence.
190. C. Mee’s lines are characteristically found in the fingernails (white transverse lines of deposited arsenic that
usually appear 6 weeks after exposure.) Wrist drop and to a lesser extent, foot drop with the appropriate history of
exposure have been considered almost pathognomonic for lead poisoning (Goodman and Gilman’s, 9 th ed., pp.
1650, 1661).
191. C. Long-term exposure to benzene usually is due to inhalation of vapor or to contact with the skin. Signs and
symptoms of long-term exposure to benzene include effects on the CNS and the gastrointestinal tract (headache,
loss of appetite, drowsiness, nervousness, and pallor), but the major manifestation of toxicity is aplastic anemia.
Bone-marrow cells in early stages of development are the most sensitive to benzene and arrest of maturation
leads to gradual depletion of circulating cells (Goodman and Gilman’s, 9th ed., p. 1683).
192. D. Respiratory depression is produced by inhibiting brainstem respiratory mechanisms.
193. A. Antidote is a drug or substance that opposes the action of a poison. An antiemetic pertains to a substance or
procedure that prevents or alleviates nausea and vomiting.

Clinical Toxicology
194. C. Ethanol acts as a competitive substrate for the enzyme alcohol dehydrogenase, preventing the metabolic
formation of toxic metabolites from methanol or ethylene glycol (Olson, 3rd ed., p. 367).
195. C In barbiturate poisoning, respiration is affected early. Breathing may be either slow or else rapid and shallow.
Superficial observation of respiration may be misleading with regard to actual minute volume and to the degree of
respirator acidosis and cerebral hypoxia (Goodman and Gilman’s, 9th ed., p. 379).
196. A. Refer to number 174.
197. D. Nicotine mimics the action of acteylcholine, therefore it increases the heart rate and blood pressure. It also
causes respiratory stimulation as well as irregular heart rhythm (Klaassen; p. 519). The symptoms may be similar
to that of angina pectoris.
198. D. Niacin (nicotinic acid) but not niacinamide decreases VLDL and LDL levels in most patients. It inhibits VLDL
secretion, in turn decreasing production of LDL. Increased clearance of VLDL via the LPL pathway contributes to
triglyceride reduction (Katzung, 9th ed., p. 570).
199. B. Acetylcysteine (N-acetylcysteine [NAV]) is a mucolytic agent that acts as a sulfhydryl group donor, substituting
for the liver’s usual sulfhydryl donor, glutathione. It rapidly binds (detoxifies) the highly reactive electrophilic
intermediates of metabolism. It is most effective in preventing acetaminophen induced liver injury when given early
in the course of intoxication (within 8 to 10 hours), but may also benefit in reducing the severity of liver injury even
when given after 24 hours (Olson, 3rd ed., p. 334).
200. C. Aflatoxins, a group of highly toxic metabolites produced by Aspergillus flavus, and probably responsible for high
incidence of liver cancer in some parts of Africa. These compounds were first detected following the deaths of
young turkeys fed on mould-contaminated peanuts (Arachis hypogaea; Leguminosae) (Dewick, p. 74).
201. C. BAL (British anti-Lewisite, Dimercaprol) is a dithiol-chelating agent used in the treatment of poisoning by the
heavy metals arsenic, mercury, lead and gold. It is given IM. (Olson, 3rd ed., p. 341).
202. D. In hemodialysis, blood is circulated past a semipermeable mambrane and substances are removed by
diffusion down a concentration gradient. In hemoperfusion, adsorptive materials filter blood such as resins or
charcoal present in the filter. (Viccellio; p. 110-112) Alteration of the urine pH based on the nature of the toxicant
facilitates formation of ionized species, which are readily excitable.
203. Refer to 148
204. C. Atropine blocks the action on effector cells of the acetylcholine released at the nerve endings ( Dreisbach; p.
346)
205. C. From ingestion, iron salts can cause abdominal pain, tarry stools, hypotension, and dehydration ( Dreisbach;
p. 450).
206. A. Overdose involving isoniazid or other monomethylhydrazines ( eg, gyromitrin mushrooms) may cause seizures
by interfering with pyridoxine utilization in the brain, and pyridoxine given in high doses can rapidly control these
seizures (Olson, 3rd ed., p. 407).
207. B. Caffeine is the most widely used psychoactive substance. It is widely used as anorexiant, a coanalgesic, a
diuretic and a sleep suppressant. The earliest symptoms of acute caffeine poisoning are usually anorexia, tremor
and restlessness (Olson, 3rd ed., p. 118).
208. D. For curare derivatives or gallamine triethiodide poisoning, give either of the ff (1) Edrophonium ( Tensilon)
chloride, 10 mg ( 1 ml of 1% sol’n); (2) Neostigmine ( Prostigmine) methyl sulfate, 1-2 ml of 1 : 2000 sol’n IV
with atropine, 1 mg ( Dreisbach; p. 340). Homatropine is a synthetic substitute of atropine (Dreisabach; p. 345).
209. B.
SOME COMMON ODORS CAUSED BY TOXINS AND DRUGS
ODOR DRUG OR TOXIN
Acetone Acetone, isopropyl alcohol
Acrid or pearlike Chloral hydrate, paraldehyde
Bitter almonds Cyanide
Carrots Cicutoxin (water hemlock)
Garlic Arsenic, organophospahates, selenium, thallium
Mothballs Napthalene, paradichlorobenzene
Pungent aromatic Ethchlorvynol
Rotten eggs Hydrogen sulfide, stibine, mercaptans
Wintergreen Methyl salicylate
210. A.
211. B. Generally, cholinesterase enzyme inhibitors are in the form of liquid (i. e. parathion and TEPP) (Dreisbach;
p.110).
212. A. Drugs such as Aminopyrine, Antipyrine, phenylbutazone, dichlorophenazine and dipyrone are used as
analgesics and for the treatment of rheumatic disorders. These drugs produces agranulocytosis ( an example of
blood dyscrasias),
presumably on the basis of hypersensitivity reaction. Only antipyrine is likely to cause methemoglobinemia. Other
examples of blood dyscrasias are luekopenia, and aplastic anemia (Dreisbach; p. 303-304).
213. C. Physostigmine is a parasympatomimetic agent which when concomitantly used in carbamate poisoning, would
only worsen the condition of the patient, due to their similar effects.
214. D. Refer to # 145
215. D.
216. D.
217. B. Emetics are substances that cause regurgitation of gastric contents by either locally irritating the stomach or
stimulating the medullary chemoreceptor trigger zone (Viccellio; p. 96).
218. A. Pathologic findings of ipecac and emetine are gastrointestinal congestion and degenerative changes in the
heart, kidney and liver (Dreisbach; p. 404). Adverse effects of ipecac are related to myocardial depression as well
as abdominal pain, diarrhea, coma, shock and seizures (Viccellio; p. 97).
219. B. White hellebore contains a complex mixture of ester alkaloids, and 2 of these, protoveratrie A and
protoveratrine B are the most active (Tyler; p. 239).
220. B. These gases ( Nitrous oxide and cyanide ) are classified as asphyxiants which impair cellular respiration and
can lead to cell death.
221. B. Botulinum toxin is a heat- labile protein that can be destroyed by boiling at 100 0 for 1 minute or heating in
water at 800 for 10 min. Botulism is caused by the exotoxin produced by anaerobic growth of Clostridium
botulinum at pH above 4.6. Such growth frequently occurs in underprocessed food, and non-acid foods.
222. A. Refer to # 11
223. D. Refer to # 63
224. E. Refer to # 208

Clinical Toxicology
225. B. Refer to # 90
226. C. Refer to # 266
227. E. In metabolic acidosis, the metabolic processes must be altered to reduce the production of excess hydrogen
ions. Administration of NaHCO3 is at best only temporizing step and is unlikely to overcome the basic effect
(Dreisbach; p. 40).
228. B. Diazepam (Valium) is most commonly used in the management of convulsions secondary to drug toxicity
(Dreisbach; p. 51 and 69). Diazepam is the agent of choice for convulsions associated with poisonings, however,
for recurrent seizures, phenytoin, Phenobarbital and neuromuscular blockers such as succinylcholine are preferred
(Viccellio; p. 71).
229. A. Diazoxide is used for hypertensive emergencies as an arteriolar vasodilator.
230. D. Refer to # 145
231. C. Ipecac is used as an emetic in its syrup form, never in its fluidextract form; emetine, the alkaloid from ipecac is
used in the treatment of amoebiasis (Dreisbach; p. 404).
232. C. Refer to # 204
233. B. Sodium Hypochlorite ( NaClO), is the main ingredient in bleaching solutions (i.e. Zonrox). Upon contact with
gastric acid, hypochlorous acid (HClO) is liberated which is extremely irritating to skin and mucous membranes.
Sodium thiosulfate immediately reduces the hypochlorite to nontoxic products, but may produce H 2S when in
contact with acid (Dreisbach; p. 286).
234. A. Refer to # 145
235. E. Give pyridoxine, 5 g IV to control convulsions, repeat as necessary; the amount of pyridoxine should at least
equal the amount of isoniazid igested (Dreisbach; p. 411).
236. B. Antidote for Magnesium sulfate and other Magnesium salts is Calcium Gluconate, 1 ml of 10 % sol’n/ kg IV
up to a total of 10 ml (Dreisbach; p. 436- 437).
237. D. Refer to # 84
238. C. Refer to # 45
239. E. Folinic acid ( Leucovorin) and folic acid are needed in ethylene glycol and methanol poisoning in order to
convert formic acid to carbon dioxide and water. Leucovorin is the active form of folic acid. It does not require
reduction by the enzyme dihydrofolate reductase to provide one carbon moiety. In asymptomatic patients it is
possible o use folic acid alone, as the body has enough time to perform the necessary conversion (Viccellio; p.
192).
240. A. Refer to # 199
241. B.
242. E. For methanol and ethylene glycol poisoning, give ethanol, 50 proof, 1.5 mg/ kg orally (Dreisbach; p. 169).
243. D. In the presence of hypoglycemia, 5-10 % glucose is administered IV plus thiamine 100 mg IM (Dreisbach;
174).
244. C. Digitalis increases the force of contraction of the myocardium due to an increase in the nitacellular calcium.
For cardiac arrhythmias in the presence of hypokalemia, if renal functio is normal, give KCl 5g dissolved in fruit
juices every hour orally, or 20 mEq in 500 ml of 5 % dextrose slowly intravenously ( IV) at a rate not exceeding 0.4
mEq/ min ( Dreisbach; p. 378).
245.B. Refer to # 147
246.C. Apomorphine is a morphine derivative altered to increase its emetic properties and decreases its analgesic
properties. It stimulates the medullary chemoreceptor to induce vomiting but also depresses the remainder of the
CNS(Viccellio; p.97). It therefore exerts central effects.
247. E. According to older references,, for chemical burns (lye, acid and phenol), wash the affected area with water for
at least 15 minutes. Burn by acids may subsequently be washed with 0.5% with 0.5% NaHCO 3 and burns by
alkalies be washed with 1% acetic acid or Citric acid (Deichmann; p. 17). However, according to more recent
references, Neutralizing agents such as weak acids and bases are absolutely contraindicated. These
reactions are exothermic in nature, and heat generated causes additional tissue destruction. Other procedures
such as gastric lavage, emesis, and the use of cathartics are also contraindicated (Viccellio; p. 256-257).
248. A. Phytonadione (vit. K), 0.1 MG/KG IM is given for coumarin anticoagulant overdosage (Dreisbach; p. 387).
249. C. Please refer to the explanation on acid and alkali poisoning management at # 247.
250. A. In treating phosphorous poisoning, the cupric ion oxidizes the phosphorous thereby inactivating the
unabsorbed particles by forming a coating of metallic copper over them (Rogers; p. 335).
251. E. Patients with amphetamine-induced psychotic hallucination behavior may need haloperidol or droperidol
(Viccellio; p. 609). Chlorpromazine is an anti-psychotic drug, so it may also be used for the stated condition.
252. D. Refer to # 244
253. B. Refer to # 147
254. D. Refer to # 147
255. C. Water, or PEG (Polyethylene glycol). PEG helps prevent phenol absorption (Viccellio; p.97iccellio; p. 268).
Refer also to # 114.
256. B. Refer to # 84
257. A. Refer to # 204 and 184
258. E. For barbiturate poisoning, a forced alkaline diuresis can significantly increase the barbiturate clearance since
the amount of the ionized drug is increased in alkaline urine. Forced alkaline diuresis can be accomplished with a
combination of intravenous fluids and a diuretic (Viccellio; p. 583). NaHCO3 is one of the most frequently used
substances for serum alkalinization or in the induction of alkaline diuresis for various types of poisoning.
259. D.
260. C. Ergot alkaloids are derived from the rye fungus Claviceps purpurea . Several indication for these alkaloids are:
(1) for migraine (ergotamine, methysergide), (2) for orthostatic hypotension (dihydroergotamine),(3)control of
postpartum hemorrhage and assessment of coronary artery disease ( ergonovine) etc (Viccellio; p.523).
261. B.
262. B. Refer to # 130
263. D. Cantharidine, the most important active principle from Cantharis vesicatoria is known to cause skin irritation
and vessication upon contact. Corrosives also cause irritation of the specific area in contact. On the other hand,
Phosphorous has a generalized effect, which is manifested by skin burns, luminescent vomitus and
jaundice(Dreisbach; p. 330).
264. B.
265. B. Ptomaines are alkaloidal substances resulting from the decomposition of albuminous materials under the
influence of bacteria. Ptomaines have been found in mussels, oysters, eels, sausage, ham, canned meats etc.
Tyrotoxicon is a ptomaine found in poisonous milk, cheese, cream, etc (Brundage; p. 26). Ptomaines are
examples of organic bacterial poisoning.

Clinical Toxicology
266. B. Strychnine poisoning manifests spinal convulsions due to the competitive blocking of the motorneuron
postsynaptic receptor sites for glycine, an inhibitory neurotransmitter, by strychnine. Diazepam, Phenobarbital
and Succinylcholine has been useful to control the convulsions (Viccellio; p. 326 and Dreisbach; p. 418).
267. B. Refer to # 290
268. B. The antidote for Magnesium sulfate and other magnesium salts is Calcium gluconate (refer to # 236).
269.B. CCL4 (carbon tetrachloride) depresses and injures almost all cells in the body, but the liver is said to be more
susceptible to damage because it is in the liver that CCl 4 is biotransformed into toxic metabolites such as epoxides
270. D. Definition of lavage
271. B. Digitoxin is an example of a cardiac glycoside, which has a stimulating effect on the myocardium. Fatal dose is
3-5 mg.
272. C. Refer to # 55
273. C.
274. B. Refer to # 265
275. C. Refer to # 55
276. C. Asthenics or Exhaustives are agents that produce exhaustion, or cause a marked loss of vital or muscular
power , such as HCN (Brundage; p. 31).
277. C. Narcotics have a depressing effect on the CNS. Stupor, coma and respiratory depression are the clinical
findings of such poisoning.
278. C. Experimental evidence - evidence that is obtained by administering the suspected substance to some living
animal, and observing its effects.
Circumstantial/Moral evidence- that which is contributed by circumstance or deduced from various
occurrences and facts. Examples are motives of poisoning, and possession or purchase of the particular poison.
Chemical evidence- that which is obtained by means of a chemical analysis of the substance supposed to
have caused the poisoning, or of that which has been vomited, or material found in some part of the body, or in its
secretions.
Post-Mortem Evidence- obtained by an examination of the organs and tissues of the body after death.
Symptomatic evidence- that which is contributed by symptoms, which can either be objective or subjective
(Brundage; p. 22-25, 45)
279. C. Refer to # 278
280. C. Refer to # 278
282. C.
283. C.
284. C. CO is a tasteless, odorless, and colorless gas produced by the incomplete combustion of carbon compounds.
There are endogenous and exogenous sources of carbon monoxide. Inside the body, CO can be produced from
the catabolism of protoporphyrin ring of hemoglobin to a small extent of nonhemoglobin heme. The concentration
of carboxyhemoglobin in normal subjects is 0.4-0.7 %. Exogenous sources of CO include internal combustion
engine and tobacco/ cigarettes (Viccellio; p. 639).
285. C. Ammonium molybdate test for Phosphorous produces yellow crystalline precipitate. P is converted to PO 4 and
precipitated as ammonium phosphomolybdate, (NH4)3PO4. 12 MoO3.
286. C.
287. C.
288. B. aniline + bromine water produces a flesh-colored precipitate of tribromoaniline.
289. B. After reduction of benzene to aniline, test for azo formation is done by adding 1% ammonium sulfamate, 0.2%
N-(1-naphthyl) ethylenediamine dihydrochloride and 1% NaNO2. Visible result is blood red coloration.
290. C. Nitrobenzene: Essence of Mirbane; Nitrobezol; Oil of Mirbane; colorless to pale yellow oily liquid having an
odor of bitter almonds (Budavari:p. 1132).
References:
Brundage, A: A Manual of Toxicology.15th ed.1926.
Budavari, Susan: The Merck Index.12th ed.Merck & Co. Inc.New Jersey.1996.
Deichmann, William: Symptomatology and Therapy of Toxicological Emergencies.Academic Press Inc.New
York.1964.
Dreisbach, Robert H: Handbook of Poisoning: Prevention, Diagnosis and Treatment. 12th ed. Prentice – Hall
International Inc.1987.
Flanagan, R.J: Basic Analytical Toxicology. World Health Organization. Geneva. 1995.
Genaro, Alfonso: Remington: The Science and Practice of Pharmacy.20th ed.University of the
Sciences.Philadelphia.2000.
Hardman, Joel and Lee Limbrid: Goodman and Gilman’s the Pharmacological Basis of Therapeutics.9th ed.
Mc Graw- Hill.New York. 1996.
Katzung, Bertram: Basic and Clinical Pharmacology. 9th ed.Mc Graw-Hill.Boston.2004.
Klaassen, Curtis: Casarett and Doull’s Toxicology The Basic Science of Poisons.5th ed.Mc Graw-Hill.USA.1996.
Olson, Kent: Poisoning and Drug Overdose.3rd ed.Prentice-Hall International, inc.1999.
Rogers, Charles: A Textbook of Inorganic Pharmaceutical Chemistry.7th ed. Lea and Febiger.Philadelphia.
Tyler, Varro: Pharmacognosy.9th ed.Lea and Febiger.Philadelphia.1988.
Viccellio, Peter: Handbook of Medical Toxicology. Little, Brown and Company.Boston.1993.

Clinical Toxicology

Clinical Toxicology: MANOR Review Center

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Clinical Toxicology

A 3. The quantity of medicine that can kill an organism

C 4. Acute poisoning includes, except:

D 7. Catharsis as a way of removing a poison includes, except:

B 8. This is recommended in phenol poisoning as a cathartic but is contraindicated in poisoning by chlorinated

C 12. Streptomycin can cause:

E 13. Most accidental poisoning in children is caused by:

B 14. Antidote for iodine poisoning:

A 19. Dryness of the mouth is a side effect of

A 21. The ff. are mechanisms of poison absorption, except:

MANOR Review Center 308

D 22. An example of a Phase 1 Reaction in the metabolism of substances is/are:

A 23. Pneumomediastenum is a complication of the use of:

C 24. Constipation caused by active charcoal can be relieved by concomitant administration of

D 25. Contraindication to the use of cathartics are the ff. except:

C 27. Nail polish remover contain

D 32. Ototoxicity may be an adverse reaction of the following, except:

B 34. Acute intermittent porphyria is an absolute contraindication to the use of:

A 39. It is used in silvering of mirror and it causes metal line gum.

C 40. It is the poison found in rust and ink eradicator.

A 41. It is used to preserve the color of meat in pickling.

E 42. It is used in fingerprint photography

D 43. It is the choice of professional poisoners.

E 44. It is the most toxic metal.

MANOR Review Center 309

E 45. Ammonium salt is the antidote for

A 46. Methylene blue is the antidote for

C 48. It is known as the Neutral spirit

A 49. It is also known as the stink damp

B 50. It is known as the rodent poison

A 54. Deferoxamine is an antidote for:

A 55. These are simple asphyxiants which are gases, except:

A 56. Toxic substance found in “tulingan” tuna and:

C 57. Effective therapy to rattle snake bite:

D 59. It causes the Minamata disease:

D 60. Examples of herbicides, except:

C 61. Mushroom poisoning comes from:

C 62. It is the poison in toilet bowl deodorant:

A 64. An antidote to methanol poisoning:

A 65. Induction of vomiting is accomplished by administering:

B 67. Fatal dose of aspirin:

B 68 Lysergic acid poisoning has this toxic syndrome/s:.

D 69. Death due to strychnine poisoning is from:

B 70. Litharge is also known as:

MANOR Review Center 310

B 71. Manihot toxin is found in this crop root:

C 72. Best known physiological antidote for strychnine:

C 73. Phencyclidine has this toxic syndrome:

A 74. Poisonous fishes contain unedible organs or toxins such as:

A 75. Activated charcoal is specifically helpful in the treatment of poisoning from:

B 76. Convulsions caused by drug poisoning are commonly associated with:

C 77. A carcinogenic substance found in stale peanut:

B 78. Black widow spider venom is called:

D 79. The antidote for DDT poisoning:

C 80. Causes digitalis-like toxicity and baritosis:

B 81. Metal used in water purification:

B 82. Bitter almond odor is symptoms of this poisoning:

D 83. Paraquat poisoning is characterized by:

C 85. A poisonous principle of Coalculus indicus used as fish poison:

D 86. Principal active alkaloid of ipecac:

C 87. Sweet odor of vomitus is/are due to this type of poison/s:

A 88. A common household substance given as antidote is milk because:

A 89. It causes shellfish toxicity: