NEET-PG 2017 Practice Questions

Q: Which of the following food adulterant leads to this clinical finding? (Recent NEET Pattern 2016-17)

Argemone mexicana. ***Argemone mexicana*** - The image on the left shows the seeds of *Argemone mexicana*, which are known to be adulterants in mustard oil. - Consumption of mustard oil adulterated with *Argemone mexicana* seeds (or their oil) causes **epidemic dropsy**, characterized by **edema** (swelling), particularly in the lower extremities, as depicted in the right image of swollen feet. *Lathyrus sativus* - Consumption of *Lathyrus sativus* (Khesari dal) causes **lathyrism**, which primarily affects the **nervous system**, leading to **paralysis** of the lower limbs, rather than edema. - The clinical findings of lathyrism do not typically include the widespread edema shown in the image. *Aflatoxin* - **Aflatoxins** are mycotoxins produced by fungi, commonly found in contaminated crops like peanuts, corn, and spices. - Aflatoxin poisoning primarily causes **hepatotoxicity** (liver damage), including cirrhosis and liver cancer, and does not commonly present with widespread edema as seen in the clinical image. *Pyrrolizidine alkaloids* - **Pyrrolizidine alkaloids** are found in various plant species and can contaminate food products. - These alkaloids are primarily known for causing **veno-occlusive disease of the liver**, leading to liver damage and portal hypertension, but not the general anasarca pictured.

Q: Identify the seeds shown below that produce artificial bruises with their juice? (Recent NEET Pattern 2016-17)

Semecarpus anacardium. ***Semecarpus anacardium*** - The juice of *Semecarpus anacardium* (also known as **marking nut** or **bhilawa**) contains **bhilawanol**, a vesicant oil that causes severe **blistering and inflammation** on contact with skin. - This irritant effect leads to dark, reddish-brown stains that can mimic **contusions or bruises**, hence its use in creating "artificial bruises" for forensic purposes or in cases of simulated injury. *Nux vomica* - *Nux vomica* seeds contain **strychnine** and **brucine**, potent neurotoxins that primarily affect the central nervous system, leading to **convulsions and muscle spasms**. - Its effects are systemic and neurological, and it does not produce localized skin reactions resembling bruises. *Calotropis* - *Calotropis* plants, such as *Calotropis gigantea* (giant milkweed), contain **cardiac glycosides** that are highly toxic if ingested. - While contact with the latex can cause skin irritation, it typically presents as **redness and stinging** rather than dark, bruise-like lesions. *Ricinus communis* - *Ricinus communis* (castor bean) seeds contain **ricin**, a highly potent **protein toxin** that inhibits protein synthesis in cells and can be fatal if ingested or inhaled. - Although the plant can cause allergic reactions on contact, its primary toxic effect is systemic and it does not produce artificial bruises.

Q: The seeds of the plant shown below resemble which of the following? (Recent NEET Pattern 2016-17)

Ricinus communis. ***Ricinus communis*** - The image displays a **spiny fruit** containing numerous **brown, mottled seeds** that are characteristic of the *Ricinus communis* plant, also known as the **castor bean plant**. - **Castor seeds** are highly toxic due to the presence of **ricin**, a potent protein toxin. *Semecarpus anacardium* - This plant, commonly known as **marking nut** or **Bhallataka**, produces an **oval-shaped, black nut** with a cup-shaped fleshy receptacle. - Its seeds are generally **kidney-shaped** and black, differing from the seeds shown in the image. *Capsicum* - *Capsicum* refers to **chili peppers**, which produce berries containing small, **flat, pale yellow or white seeds**. - The seeds in the image are **dark brown and irregular**, not consistent with *Capsicum* seeds. *Nerium odorum* - *Nerium odorum* is a species of **oleander**, a highly toxic plant whose seeds are typically found in **long, narrow follicles**. - The seeds are usually **light brown to reddish-brown**, often with hairy tufts, which do not match the appearance of the seeds in the image.

Q: What is the nature of the venom produced by the snake shown below? (Recent NEET Pattern 2016-17)

Neurotoxic. ***Neurotoxic*** - The image shows a **Banded Krait** (*Bungarus fasciatus*), identified by its distinctive alternating bands of yellow and black. - Kraits belong to the **Elapidae family** (along with cobras and coral snakes) and produce **predominantly neurotoxic venom**. - The venom contains **α-bungarotoxin** and **β-bungarotoxin**, which block neuromuscular transmission causing **descending paralysis**. - **Clinical features** include ptosis, ophthalmoplegia, paralysis, respiratory failure, and minimal local swelling - classic neurotoxic presentation. - In forensic medicine classification, kraits are categorized as **neurotoxic snakes**, unlike vipers which are hemotoxic/vasculotoxic. *Vasculotoxic and hemotoxic* - This describes **viper venom** (Russell's viper, Saw-scaled viper), not krait venom. - Vipers cause **extensive local tissue damage, bleeding, coagulopathy**, and necrosis - features NOT seen with krait bites. - Krait bites show **minimal local effects** with predominantly systemic neurotoxic manifestations. *Vasculotoxic* - Vasculotoxic effects (endothelial damage, vascular permeability) are characteristic of **viper envenomation**, not kraits. - Banded Krait venom acts primarily on the **nervous system**, not blood vessels. *Hemotoxic* - Hemotoxic effects (hemolysis, coagulopathy, thrombocytopenia) are features of **viper venom**. - Kraits produce **neurotoxic venom** that causes paralysis without significant hematological effects. - The absence of bleeding and coagulation defects helps differentiate krait from viper bites clinically.

Q: What is the type of venom of the snake shown below? (Recent NEET Pattern 2016-17)

Vasculotoxic and hemotoxic. ***Vasculotoxic and hemotoxic*** - The image displays a **Russell's viper** (*Daboia russelii*), identified by its characteristic chain of three prominent, dark, oval, or rhomboidal spots. - The venom of the Russell's viper is primarily **vasculotoxic** (affecting blood vessels) and **hemotoxic** (affecting blood components), causing symptoms like local pain, swelling, blistering, and coagulopathy leading to bleeding. *Vasculotoxic* - While Russell's viper venom is indeed vasculotoxic, this option is incomplete as it lacks the hemotoxic component which is also significant. - **Vasculotoxicity** leads to damage to blood vessel walls, causing leakage and local tissue damage. *Neurotoxic* - Neurotoxic venom primarily affects the nervous system, leading to paralysis and respiratory failure, which is characteristic of snakes like **cobras** and **kraits**. - The Russell's viper venom does not have significant neurotoxic effects in humans. *Hemotoxic* - While Russell's viper venom is hemotoxic, this option is incomplete as it misses the **vasculotoxic** effects that are a crucial part of its pathology. - **Hemotoxicity** impacts blood clotting factors and red blood cells, leading to internal and external bleeding.

Q: All are true about the poisoning caused by following plant except: (Recent NEET Pattern 2016-17)

Urine alkalization. ***Urine alkalization*** - There is **no specific role** for **urine alkalization** in the management of castor bean (ricin) poisoning. - Management is primarily **supportive**, including gastrointestinal decontamination, fluid resuscitation, and symptomatic treatment. - Urine alkalization is used in salicylate or barbiturate poisoning, **not in ricin poisoning**. *Toxic principle is ricin* - The castor bean plant (**Ricinus communis**) contains **ricin**, a highly potent **lectin** and protein synthesis inhibitor. - Ricin causes severe **cellular toxicity** leading to gastrointestinal, hepatic, renal, and systemic manifestations. - This is a **TRUE statement**. *Fatal dose is 1 mg/kg body weight* - The **fatal dose of ricin** is approximately **1 mg/kg body weight** when ingested. - Ingestion of even **1-3 chewed castor beans** can be fatal in adults, making it one of the most poisonous plants. - This is a **TRUE statement**. *Opisthotonus* - **Opisthotonus** (backward arching due to severe muscle spasm) can occur in **severe cases** of ricin poisoning as a neurological manifestation. - While more classically associated with **tetanus** or **strychnine poisoning**, severe ricin toxicity can cause convulsions and opisthotonus. - This is considered a **TRUE statement** in the context of severe ricin poisoning.

Q: The seeds shown in the image below have which toxin? (Recent NEET Pattern 2016-17)

Abrin. ***Abrin*** - The seeds shown in the image are characteristic of **Rosary Pea (Abrus precatorius)**, known for their bright red color with a black spot. - These seeds contain the potent **ribosome-inactivating protein toxin** called abrin. *Ricin* - **Ricin** is a toxin derived from the seeds of the **castor oil plant (Ricinus communis)**, which look different from the seeds pictured. - Castor seeds are typically mottled brown, black, and white, not bright red with a black spot. *Calotoxin* - **Calotoxin** is a cardiac glycoside found in plants like **Calotropis (milkweed)**. - The seeds of Calotropis are flat, brown, and have a tuft of silky hair, which is completely different from the seeds shown. *Plumbagin* - **Plumbagin** is a naphthoquinone compound found in plants like **Plumbago zeylanica**. - This compound is not associated with the red and black seeds depicted in the image.

Q: Identify the toxin shown below which causes the given ECG changes. (Recent NEET Pattern 2016-17)

Yellow Oleander. ***Yellow Oleander*** - The image displays the **yellow oleander plant** (*Thevetia peruviana*), which contains cardiac glycosides like **thevetin, neriifolin, and thevetoxin**. - These toxins inhibit the **Na+/K+ ATPase pump**, leading to increased intracellular calcium and characteristic ECG changes similar to **digitalis toxicity** (e.g., **bradycardia**, **AV block**, scooping ST-segment depression, ventricular arrhythmias, and T-wave changes). - Yellow oleander is a common cause of poisoning in **tropical regions** and presents with gastrointestinal symptoms followed by life-threatening cardiac arrhythmias. *Aconite* - Aconite (*Aconitum* species) is a cardiotoxic plant but causes toxicity through **sodium channel activation** rather than cardiac glycoside effects. - Presents with **paresthesias, ventricular arrhythmias**, but ECG shows different patterns (polymorphic VT, not typical digitalis-like changes). - The plant morphology is distinct from yellow oleander, with characteristic hood-shaped flowers. *Dhatura* - Dhatura (*Datura stramonium*) is an **anticholinergic poison** containing tropane alkaloids (atropine, scopolamine, hyoscyamine). - Causes **tachycardia** (not bradycardia), mydriasis, dry mouth, hallucinations, and hyperthermia. - ECG shows sinus tachycardia, not the bradycardia and AV blocks seen with cardiac glycosides. *Abrus precatorius* - Abrus precatorius (rosary pea, jequirity bean) contains **abrin**, a **ribosome-inactivating protein toxin**. - Causes severe **gastroenteritis, hepatotoxicity**, and multiorgan failure, not primarily cardiac toxicity. - Does not produce the characteristic digitalis-like ECG changes shown in the image.

Q: The toxin shown below will lead to the development of:

Basophilic stippling of RBC. ***Basophilic stippling of RBC*** - The image depicts **lead powder**, a known cause of **lead poisoning** - **Lead inhibits pyrimidine 5'-nucleotidase**, leading to accumulation of ribosomal RNA aggregates in red blood cells - These aggregates appear as **basophilic stippling** on peripheral blood smear - a characteristic hematological finding - This is the **most direct and consistent laboratory marker** of lead poisoning *Burtonian line* - The **Burtonian line** (Burton's line or lead line) is a **blue-black line on the gingival margin** due to lead sulfide deposition - While this IS associated with lead poisoning, it is a **clinical sign requiring poor oral hygiene** and is less consistently present - **Basophilic stippling is the more specific hematological finding** directly caused by lead's effect on RBC metabolism *Clapton line* - **Clapton's line** is a **greenish-blue gingival line** seen in **copper poisoning**, not lead poisoning - This is a distractor referring to a sign of a different heavy metal toxicity *Danbury tremor* - **Danbury tremor** (also called "hatter's shakes") refers to tremors associated with **mercury poisoning**, not lead poisoning - Historically seen in hat-makers who used mercury in felt production - While lead can cause neurological symptoms including tremors, this specific term refers to mercury toxicity

Q: Identify the plant shown in the image:

Calotropis. ***Calotropis*** - The image distinctly shows the **thick, milky white latex** oozing from a broken stem or leaf of a plant, which is a characteristic feature of **Calotropis** species (e.g., *Calotropis procera* or *Calotropis gigantea*). - These plants are common in arid and semi-arid regions and are known for their **toxic latex** containing cardenolides. *Plumbago* - This plant does not produce a significant amount of **milky white latex** when damaged. - *Plumbago* species are known for their distinct flower clusters and root extracts used in traditional medicine. *Croton* - While some *Croton* species do produce latex, it is often **reddish or clear**, not typically the thick, milky white consistency seen in the image. - *Croton* plants vary widely in appearance, but the latex type helps differentiate them. *Abrus* - *Abrus precatorius* (Rosary Pea) is known for its highly **toxic seeds** and does not produce milky latex from its leaves or stems. - It is a vine with characteristic pinnate leaves and brightly colored seeds.

Question 1

Which of the following food adulterant leads to this clinical finding? (Recent NEET Pattern 2016-17)

Accepted Answer

Argemone mexicana

Answer

Lathyrus sativus

Answer

Aflatoxin

Answer

Pyrrolizidine alkaloids

Question 2

Identify the seeds shown below that produce artificial bruises with their juice? (Recent NEET Pattern 2016-17)

Accepted Answer

Semecarpus anacardium

Answer

Nux vomica

Answer

Calotropis

Answer

Ricinus communis

Question 3

The seeds of the plant shown below resemble which of the following? (Recent NEET Pattern 2016-17)

Accepted Answer

Ricinus communis

Answer

Semecarpus anacardium

Answer

Capsicum

Answer

Nerium odorum

Question 4

What is the nature of the venom produced by the snake shown below? (Recent NEET Pattern 2016-17)

Accepted Answer

Neurotoxic

Answer

Vasculotoxic

Answer

Vasculotoxic and hemotoxic

Answer

Hemotoxic

Question 5

What is the type of venom of the snake shown below? (Recent NEET Pattern 2016-17)

Accepted Answer

Vasculotoxic and hemotoxic

Answer

Vasculotoxic

Answer

Neurotoxic

Answer

Hemotoxic

Question 6

All are true about the poisoning caused by following plant except: (Recent NEET Pattern 2016-17)

Accepted Answer

Urine alkalization

Answer

Toxic principle is ricin

Answer

Fatal dose is 1 mg/kg body weight

Answer

Opisthotonus

Question 7

The seeds shown in the image below have which toxin? (Recent NEET Pattern 2016-17)

Accepted Answer

Abrin

Answer

Ricin

Answer

Calotoxin

Answer

Plumbagin

Question 8

Identify the toxin shown below which causes the given ECG changes. (Recent NEET Pattern 2016-17)

Accepted Answer

Yellow Oleander

Answer

Aconite

Answer

Dhatura

Answer

Abrus precatorius

Question 9

The toxin shown below will lead to the development of:

Accepted Answer

Basophilic stippling of RBC

Answer

Burtonian line

Answer

Clapton line

Answer

Danbury tremor

Question 10

Identify the plant shown in the image:

Accepted Answer

Calotropis

Answer

Plumbago

Answer

Croton

Answer

Abrus

NEET-PG 2017

Community Medicine

Forensic Medicine