Revise MBBS

Paper I — 2024 March (Supplementary) (2010 Scheme) — Q2

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Paper I
2024 March (Supplementary) (2010 Scheme) · 40 marks · 120 min

Question

A 22-year-old farmer was brought to the casualty with symptoms of nausea, vomiting, severe abdominal pain, lacrimation, salivation, blurring of vision, muscular twitches and weakness. He was suspected to have consumed Organo-phosphorous compound.

  • (a) Outline the management of this poisoning 2 mark(s)
  • (b) Discuss the mechanism of action and rationale for using the specific antidotes 4 mark(s)
Q26 marksEssays

Answer

a) Management

  • Remove from the contaminated area, remove and discard contaminated clothing, decontaminate skin (soap and water) to halt continued absorption
  • Maintain airway, breathing, circulation — suction secretions, give oxygen, ventilatory support if needed
  • Administer specific antidotes (atropine, pralidoxime) promptly, titrated to response
  • Continuous monitoring of vitals, pupil size, and secretions to guide ongoing dosing

b) Mechanism of action and rationale for specific antidotes Organophosphates irreversibly inhibit acetylcholinesterase, causing accumulation of acetylcholine at both muscarinic and nicotinic synapses — producing the muscarinic toxidrome (salivation, lacrimation, bronchorrhoea, bronchospasm, GI hyperactivity, miosis) and nicotinic effects (muscle fasciculations progressing to weakness/paralysis, as seen here).

  • Atropine — competitively blocks muscarinic receptors, reversing bronchorrhoea, bronchospasm, salivation, and GI hyperactivity; titrated to effect (drying of secretions) and often requires large repeated doses. Does not reverse nicotinic effects (muscle weakness) since it has no action at nicotinic receptors.
  • Pralidoxime (2-PAM) — a cholinesterase reactivator; it displaces the organophosphate from the active site of acetylcholinesterase, regenerating functional enzyme and reversing both muscarinic and nicotinic effects (including the muscle weakness atropine cannot address), but only if given before the enzyme-organophosphate complex “ages” (becomes irreversibly bound) — most effective when given early, alongside atropine, not as a substitute for it.
  1. 1Cholinergic System

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  1. 1(2024 March (Supplementary) (2019 Scheme)Short Essay · 8 marks
  2. 2(2023 July (Supplementary) (2019 Scheme)Short Essay · 8 marks
  3. 3A man aged 45 years presented with complaints of gradual onset double vision, drooping eyelids, difficulty in chewing food and weakness of limbs which is accentuated by exercise. The symptoms fluctuate in intensity over time. A provisional diagnosis of Myasthenia gravis is made.2025 March (Supplementary) (2010 Scheme)Essay · 6 marks
  4. 4Enumerate the topical group of agents used in the treatment of open angle glaucoma. Give examples and explain the mechanism of action of each group of drugs. (2+2+2)2019 February (2010 Scheme)Essay · 6 marks
  5. 5Read the clinical problem and answer the following questions:2017 August (Supplementary) (2010 Scheme)Essay · 6 marks
  6. 6min. He gives history of spraying a strong insecticide in his agricultural field. (2023 March (Supplementary) (2010 Scheme)Essay · 6 marks
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  12. 12Pharmacotherapy of Organophosphorous poisoning2022 July (Supplementary) (2019 Scheme)Short Answer · 4 marks
  13. 13Pharmacological basis for the use of Timolol in glaucoma.2024 June (Supplementary) (2019 Scheme)Short Answer · 4 marks
  14. 14Pharmacological management of Myasthenia gravis.2022 July (Supplementary) (2019 Scheme)Short Answer · 4 marks
  15. 15Treatment of organophosphorus poisoning2013 September (Supplementary) (2010 Scheme)Short Note · 3 marks
  16. 16Drug treatment of anti cholinesterase poisoning2013 April (2010 Scheme)Short Note · 3 marks
  17. 17Neostigmine2021 December (Supplementary) (2010 Scheme)Short Note · 3 marks
  18. 18Treatment of organophosphorous poisoning2014 September (Supplementary) (2010 Scheme)Short Note · 3 marks
  19. 19Atropine2015 February (2010 Scheme)Short Note · 3 marks
  20. 20Therapeutic uses and adverse effects of atropine.2016 October (Supplementary) (2010 Scheme)Short Note · 3 marks
  21. 21Neostigmine.2017 August (Supplementary) (2010 Scheme)Short Note · 3 marks
  22. 22Edrophonium2018 February (2010 Scheme)Short Note · 3 marks
  23. 23Pralidoxime in organophosphate compound poisoning2021 December (Supplementary) (2010 Scheme)Short Answer · 1 mark
  24. 24Toxicities of atropine include the following: 1. Bradycardia 2. Dry mouth 3. Miosis 4. Psychotic behavior2024 December (Supplementary) (2019 Scheme)MCQ · 1 mark
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  27. 27Explain briefly why physostigmine is preferred over neostigmine for the treatment of glaucoma.2015 February (2010 Scheme)Short Answer · 1 mark
  28. 28Anti- muscarinic drugs2017 August (Supplementary) (2010 Scheme)Short Answer · 1 mark
  29. 29Drugs used in myasthenia gravis.2016 October (Supplementary) (2010 Scheme)Short Answer · 1 mark
  30. 30Assertion (A): Pralidoxime is most specific drug for organophosphate poisoning. Reason (R): Organophosphates block AChE enzyme2025 March (Supplementary (SAY)) (2019 Scheme)MCQ (A/R) · 1 mark
  31. 31Management of organophosphorus poisoning.2016 February (2010 Scheme)Short Answer · 1 mark
  32. 32Trihexyphenidyl in the treatment of Drug induced parkinsonism2024 August (Supplementary) (2010 Scheme)Short Answer · 1 mark
  33. 33Explain the rationale for the use of oximes in organophosphorus poisoning.2017 August (Supplementary) (2010 Scheme)Short Answer · 1 mark
  34. 34Rationale for use of pilocarpine in glaucoma2018 July (Supplementary) (2010 Scheme)Short Answer · 1 mark
  35. 35Two uses and two adverse effects of atropine2014 March (2010 Scheme)Short Answer · 1 mark
  36. 36Rationale for use of physostigmine in atropine poisoning2015 September (Supplementary) (2010 Scheme)Short Answer · 1 mark
  37. 37Rationale for the use of glycopyrrolate in pre-anesthetic medication.2016 October (Supplementary) (2010 Scheme)Short Answer · 1 mark
  38. 38Cholinesterase reactivators2015 September (Supplementary) (2010 Scheme)Short Answer · 1 mark
  39. 39Atropine as antisecretory agent2019 February (2010 Scheme)Short Answer · 1 mark
  40. 40The preferred first-line pharmacologic treatment for open-angle glaucoma is:2025 March (Supplementary (SAY)) (2019 Scheme)MCQ (Case) · 1 mark
  41. 41Used in treatment of acute congestive glaucoma2018 February (2010 Scheme)Short Answer · 1 mark
  42. 42Why is benzhexol used in the treatment of drug induced Parkinsonism.2018 February (2010 Scheme)Short Answer · 1 mark
  43. 43Drugs used in Myasthenia gravis2013 April (2010 Scheme)Short Answer · 1 mark
  44. 44Trihexyphenidyl in drug induced extrapyramidal syndrome2021 May (Supplementary) (2010 Scheme)Short Answer · 1 mark
  45. 45The Vasicoselective anticholinergic used in urinary frequency, urgency, and dysuria is2025 March (Supplementary (SAY)) (2019 Scheme)MCQ · 1 mark
  46. 46Bronchodilators (of two different groups)2013 September (Supplementary) (2010 Scheme)Short Answer · 1 mark
  47. 47Vesico-selective anticholinergics2020 February (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
  48. 48Levodopa in Drug induced parkinsonism. Name the following (Two examples for each): (5x1=5)2025 March (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
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  50. 50Drugs for open angle glaucoma2019 July (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
  51. 51 Neostigmine in glaucoma management Name the following (Two examples for each): (5x1=5)2020 February (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
  52. 52Anticholinesterases2024 August (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
  53. 53Neostigmine in atropine poisoning2022 May (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
  54. 54Neostigmine for Atropine poisoning2022 October (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
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  57. 57Pyridostigmine for the diagnosis of Myasthenia gravis.2022 February (2019 Scheme)Short Answer · 0.2 marks
  58. 58Drugs used to treat Organophosphorus poisoning2022 February (2019 Scheme)Short Answer · 0.2 marks
  59. 59Vasicoselective anticholinergics.2023 January (Supplementary) (2019 Scheme)Short Answer · 0.2 marks
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