Revise MBBS

Paper I — 2023 March (Supplementary) (2010 Scheme) — Q2

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Paper I
2023 March (Supplementary) (2010 Scheme) · 40 marks · 120 min

Question

A farmer was brought to the emergency department of the hospital presenting with lacrimation, salivation, sweating and breathlessness. O/E he is having miosis, blurring of vision, bronchospasm with copious trachea-bronchial secretions with BP- 100/60mmHg and PR-60/min. He gives history of spraying a strong insecticide in his agricultural field. (

  • (a) What is the likely diagnosis ( 1 mark(s)
  • (b) Briefly outline the general measures of management ( 2 mark(s)
  • (c) Discuss in detail the drugs used to manage this condition with its rationale for use 3 mark(s)
Q26 marksEssays

Answer

a) Diagnosis Organophosphate (insecticide) poisoning — the muscarinic toxidrome (lacrimation, salivation, sweating, miosis, bronchorrhoea, bronchospasm, bradycardia) following occupational insecticide spray exposure is classic.

b) General measures of management

  • Remove the patient from the contaminated area, remove and discard contaminated clothing
  • Decontaminate skin (wash thoroughly with soap and water) to halt continued absorption
  • Maintain airway, breathing, and circulation — suction copious secretions, give oxygen, ventilatory support if needed
  • Continuous monitoring of vitals and pupil size to titrate antidote therapy

c) Drugs used, with rationale

  • Atropine — competitively blocks muscarinic receptors, reversing bronchorrhoea, bronchospasm, bradycardia, and excessive secretions; titrated to effect (drying of secretions), often requiring large repeated doses. Does not reverse nicotinic effects (muscle weakness/fasciculations).
  • Pralidoxime (2-PAM) — a cholinesterase reactivator that reverses both muscarinic and nicotinic effects by displacing the organophosphate from acetylcholinesterase, but only if given before the enzyme-organophosphate complex “ages” (becomes irreversibly bound) — most effective when given early, alongside atropine.
  • Diazepam — controls seizures/agitation and has been shown to reduce mortality when given alongside atropine and pralidoxime.
  1. 1Cholinergic System

Other Years Asked

  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. 6A 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.2024 March (Supplementary) (2010 Scheme)Essay · 6 marks
  7. 7Classify anticholinergic drugs. Describe the pharmacological actions, therapeutic uses and contraindications of atropine. (2+2+1+1)2021 February (Supplementary) (2010 Scheme)Essay · 6 marks
  8. 8Classify atropine substitutes, explain their uses and adverse effects (3+2+1)2022 May (Supplementary) (2010 Scheme)Essay · 6 marks
  9. 9A patient suffering from schizophrenia was being treated with haloperidol for the last four weeks. Now he developed rigidity, tremors, hypokinesia and classical gait. Answer the following:2017 February (2010 Scheme)Essay · 6 marks
  10. 10What is the rationale of using Beta-blockers in Glaucoma.2023 July (Supplementary) (2019 Scheme)Short Answer · 4 marks
  11. 11Therapeutic uses and adverse effects of Neostigmine2022 February (2019 Scheme)Short Answer · 4 marks
  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
  25. 25Assertion (A): Neostigmine and its congeners are the first line drugs used to restore muscle strength in myasthenia gravis. Reason (R): They improve muscle contraction by allowing acetylcholine released from prejunctional endings to accumulate and act on the nicotinic receptors over a wider area.2024 December (Supplementary) (2019 Scheme)MCQ · 1 mark
  26. 26The drug that should be used cautiously in Mrs. Rose, who has a history of bronchial asthma2025 March (Supplementary (SAY)) (2019 Scheme)MCQ (Case) · 1 mark
  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
  49. 49 Ketoconazole in fungal meningitis Name the following (Two examples for each) (5x1=5)2019 July (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
  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
  55. 55 Phenylephrine for refraction testing.2024 June (Supplementary) (2019 Scheme)Short Answer · 0.2 marks
  56. 56Drugs used to treat Alzheimer’s disease.2024 June (Supplementary) (2019 Scheme)Short Answer · 0.2 marks
  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
  60. 60Benzhexol in chlorpromazine induced Parkinsonism Name the following (Two examples for each): (8x1=8)2023 January (Supplementary) (2019 Scheme)Short Answer · 0.2 marks

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