Critical care: organophosphate poisoning: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Critical care: organophosphate poisoning

Sample item

A farmer has miosis, salivation, bronchorrhoea, bradycardia and fasciculations after pesticide exposure. What is the treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Atropine until bronchial secretions dry, with pralidoxime

Organophosphates inhibit acetylcholinesterase, causing muscarinic and nicotinic toxicity. Atropine in repeated doses until secretions are controlled treats the muscarinic effects, and pralidoxime reactivates the enzyme before it ages. Neostigmine and physostigmine would worsen cholinergic toxicity.

Option by option

  • A. Naloxone

    Naloxone reverses opioids and not organophosphates.

  • B. Neostigmine

    Neostigmine is an anticholinesterase and would worsen toxicity.

  • C. Atropine until bronchial secretions dry, with pralidoxime (correct)

    Correct. Atropine and an oxime treat the poisoning.

  • D. Physostigmine

    Physostigmine is an anticholinesterase and would worsen toxicity.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is C, Atropine until bronchial secretions dry, with pralidoxime. Organophosphates inhibit acetylcholinesterase, causing muscarinic and nicotinic toxicity.

Why is "Naloxone" not the answer?

Naloxone reverses opioids and not organophosphates.

Why is "Neostigmine" not the answer?

Neostigmine is an anticholinesterase and would worsen toxicity.

Why is "Physostigmine" not the answer?

Physostigmine is an anticholinesterase and would worsen toxicity.

What concept does this question test?

It tests Critical care: organophosphate poisoning in Anaesthesia. Atropine in repeated doses until secretions are controlled treats the muscarinic effects, and pralidoxime reactivates the enzyme before it ages. Neostigmine and physostigmine would worsen cholinergic toxicity.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Critical care: organophosphate poisoning?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.