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Foriensic Medicine > Toxicology > Flashcards

Toxicology Flashcards

1
Q

Father of toxicology

A

Paracelsus

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2
Q

Father of Modern toxicology

A

Mathieu Orfila

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3
Q

Classification of poisons (CINCAM)

A

Corrosives
Strong acids (organic/inorganic)
Strong alkalis
Irritants
Inorganic (metallic/non-metallic)
Organic (plant/animal)
Mechanical
Neurotoxic
Cerebral (stimulant/depressants)
Spinal (stimulant/depressant)
Organ affecting
Cardiotoxic
Hepatotoxic
Nephrotoxic
Asphyxiants
Others /miscellaneous
Hydrocarbons
Agrochemical
Domestic

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4
Q

Types of nature of poisoning

A

Accidental
Suicidal
Homicidal

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5
Q

Types of poisoning

A

Fulminant
Acute
Subacute
Chronic
Secondary (Minamata Bay Disaster)

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6
Q

Stupefying poisons

A

Stun or put victim in state of little or no sensibility.
For kidnapping,rape,robbery

Datura
Cannabis
Chloral hydrate

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7
Q

Ordeal poison

A

To prove or disprove the innocence or guilt of a suspect.
Given to suspect accused of crime

Calabar beans
Ordeal tree
Cerbera tanghin
Croton seeds

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8
Q

Toxalbumin

A

Resemble bacterial toxin in action
Inhibits protein synthesis
Inactivate ribosomes
Antigenic in nature
Produce antibody
Agglutinate and lyse the RBCs
Similar to viperine snake venom

Ricin (castor)
Crotin (croton)
Abrin (ratti)

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9
Q

Coma cocktail

A

To poisoned comatose patient
Three substance combination
Dextrose + Naloxone + Thiamine
In any hypoglycemic agent poisoning

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10
Q

Characteristic odours of poisons

A

Garlic
Fishy
Kerosene like
Phenolic smell
Burnt rope
Bitter almond
Sweet pungent

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11
Q

Signs and symptoms of acute poisoning

A

Abdominal pain
Vomiting
Diarrhoea
Haematemesis
Constipation
Jaundice
Paralysis
Tremors
Convulsion
Seizures
Peripheral neuropathy
Oliguria
Haematuria
Coma

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12
Q

Affects of poison on skin

A

Alopecia
Blister
Bullae
Dry
Hot skin
Formification

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13
Q

Affects of poisons on CNS

A

Ataxia
Muscle fasciculations
Muscular rigidity
Paraesthesia
Peripheral neuropathy
Coma

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14
Q

Condition + accumulation of poison in hair

A

Chronic heavy metal poisoning
Arsenic

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15
Q

Removal of unabsorbed poison from the body

A

Emesis
Gastric lavage
Catharsis
Whole bowel irritation
Endoscopic/surgical removal

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16
Q

Characteristics of non-Over the counter drugs

A

Cant be purchased without prescription.
Labelled with Rx
Schedule H drug warning
Red vertical line on left side of container.

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17
Q

Removal of absorbed poison

A

Urine alkalinisation
Urine acidification
Dialysis
Haemoperfusion
Exchange perfusion
Purging
Diaphoretics
Antidotes
Symptomatic treatment
Follow up

18
Q

Copper poisoning

A

Metallic copper is non - poisonous
Copper sulphate (astringent, emetic, irritant)
Copper subacetate/ verdigris (bluish green)
Cupric acetoarsenite (emerald green)
Cupric arsenite (Scheele’s green)

19
Q

MOA in copper Poisoning

A

Act on sulphydril group
Inhibit G6PD + glutathion reductase

20
Q

Symptoms of acute copper sulphate poisoning

A

Metallic taste
Throat constriction (sense)
Mouth - burning pain
Nausea
Increased salivation
Vomiting (repeated + voilent)
Vomitus - bluish / greenish blue
Purging ( repeated)
Abdomen - Colicky pain
Tenesmus
Renal failure
Hemolysis ( jaundice, Hb uria, myoglbinuria)

21
Q

Autopsy features in acute copper poisoning

A

Yellow skin (jaundice)
Greenish gastric mucosa (congested + swollen + eroded)
Liver - soft
Kidney - PCT degenration

22
Q

Management of Acute copper poisoning

A

Stomach wash (vomit)
Castor oil (purgative)
Chelation ( cuprimine / EDTA / BAL)
Fluid + electrolyte

23
Q

Chronic copper poisoning

A

Vineyard sprayer’s Lung
Wilson’s disease
Chalcosis (Cu in tissues)
Metal Fume Fever (Brass founder’s ague

24
Q

Postmortem appearance in chronic copper poisoning

A

Yellow skin
Greenish blue froth (mouth + nose)
Rectal perforation
Liver
Enlarged
Soft
Greasy
Fatty infiltration
Fatty degenration
Centrilobular necrosis
Kidney
Congested
PCT degeneration
Copper deposition

25
Q

Arsenic posoning

A

Metallic non- poisonous
Water insoluble

Oxidise on heating form arsenic trioxide (poisonous)

Arsenic trioxide
Arsenic disulphides (Realgar)
Arsenic trisulphide
Copper arsenite (scheele’s green)
Copper arsetoarsenite( paris green)
Arsenic trichloride
Arsine gas

Fatal Dose - 200-300mg (trioxide)
Fatal period - 1-2 days

26
Q

MOA in arsenic poisoning

A

Attach sulphydryl grp
Inhibit pyruvate dehydrogenase
(No oxidative phosphorylation)
(Reduced cellular ATP)
(Apoptosis)

27
Q

Clinical features of acute arsenic poisoning

A

Metallic taste
Increased salivation
Garlicy breath
Dysphagia
Irritation / burning pain (Throat)
Colicky abdominal pain
Thirst
Vomiting ( dark brown)
Purging (rice watery stools + bloody)
Anus - pain, tenesmus, irritation
CVS (arrhythmia, cardiomyopathy, subendocardial haemorrhage)
Renal - painful micturition
CNS
Liver - fatty degeneration

28
Q

Investigations in acute arsenic poisoning

A

ECG
QT prolongation
ST depression
T wave flattening

29
Q

Postmortem findings in acute arsenic poisoning

A

Sunken eyes
Cyanosis
Longer + early rigor
Delayed putrefaction (antibac. arsenic)
Organs - congested enlarged
Lungs - subpleural ecchymoses
Brain
Edematous
Patchy necrosis
Haemorrhagic encephalitis
Congested meninges
Heart
Subendocardial haemorrhage
Stomach
Erosion
Ulceration
Congested
Inflammation
Red velvety apperance
Lines of redness (walls)
Mucosa
Swollen edema
Bright red
Desquamated

30
Q

Management of acute arsenic poisoning

A

Gastric lavage (warm water / milk)
Antidotes
Dimercaprol i.m. gluteal region
Sodium thiosulphate
Penicillamine
Sodium thiosulphate
Continued Nasogastric secretion (re-secreted in GIT )
Cathertics
Castor oil
MgSO4
Whole bowel irrigation

31
Q

MOA of chronic arsenic poisoning

A

Chronic Repeatative inhalation
Chronic repeatative ingestion (occupational)

32
Q

Clinical features of chronic arsenic poisoning

A

1st stage (gastrointestinal)
Oedema (eye lid + ankles)
Loss of appetite
Weight loss
Vomiting
Colicky pain
Constipation / diarrhoea
Black line - Gums
White silver fur - Tongue
2nd stage (dermatological)
Rain drop pigmentation
Hyperkeratosis
Aldrich - Mee’s line (white nail plate)
Alopecia
Nasal septum - perforated
Liver - enlarged, cirrhotic
Kidneys - damaged
Voice - Hoarse + Husky
3rd stage (neurological)
CNS
Polyneuritis
Hyperaesthesia (skin)
Encephalopathy
Muscle tenderness. + Cramps
Arthralgia
Impotence
Bone marrow suppression
Aplastic + Megaloblastic anaemia
4th stage (neuromuscular)
Neuropathy (resemble GBS)
Cardiac failure (cause of death)

33
Q

Treatment of chronic arsenic poisoning

A

British anti -Lewisite
Vit B1 injection (peripheral neuritis)

34
Q

Mercury poisoning

A

Bright silvery
Not absorbed from GIT
Deadning (fingerprints)
Sindoor
Attach Sulphydryl grp
Highest concentration in kidneys

35
Q

Acute mercury poisoning

A

Methyl mercury deposits in hair 250 times
Fatal Dose - 1-2g

36
Q

Clinical features of acute mercury poisoning

A

1st phase
Hot burning pain
Throat constriction (sense)
Dysphagia /Dyspnoea
Epigastric pain
Abdominal pain afterwards
Vomit
Purging (liquid bloody faeces)
Mouth + tongue - corroded + swollen
2nd phase
Glossitis
Gingivitis
Teeth loosening
Jaw necrosis
Renal tubular necrosis
Membranous colitis (dysentery)
Resembles Kawasaki disease

37
Q

Management of mercuric chloride poisoning

A

Chelating agent (BAL + DMSA)
Gastric lavage (5% sodium formaldehyde sulphoxylate)
Penicillamine
DMPS
Fluids

38
Q

Postmortem findings in acute merucury poisoning

A

White + swollen Mucous membrane
GIT (haemorrhagic necrosis)
Heart ( subendocardial haemorrhages)
Liver (fatty changes)
Kindney (PCT necrosis)

Deposition in cortex

39
Q

MOA of Lead poisoning

A

Inhibits
Ala - dehydratase
Coproporphyrinogen -III oxidase
Ferrochelatase
Sulphydryl group

40
Q

Acute lead poisoning

A

FD - 20g lead acetate
40g lead carbonate
FP - 2-3 days
Symptoms
Metallic taste
Vomit / nausea
Thirst
Paraesthesia
Cerebellar ataxia
Renal damage

Cause of death is hypovolaemic shock due to gastroenteritis.

41
Q

Management of acute lead poisoning

A

Gastric lavage
Mg / Na sulphate (form lead sulphate) Convulsions
Diazepam
Phenytoin
Phenobarbitol
Peritoneal / haemodialysis

42
Q

Clinical features of chronic lead poisoning (Plumbism) (FLARE)

A

Facial pallor (earliest sign) (vasospasm)
Lead / Burtonian line

Lead palsy (peripheral neuropathy)
Wrist drop
Foot drop
Due to action on ant. Horn cells (spinal cord) and interference in phosphocreatinine metabolism.

Lead encephalopathy
Inactivates monoamine oxidase(SH)
Lead osteopathy
Deposition promoted by Ca + Vit D
Anaemia + basophilic stippling
Abdominal colic

Retinal stippling (glistening grey lead particles)

Foriensic Medicine (10 decks)

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