Toxicology: intermediate syndrome: practice question

A Forensic Medicine 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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Forensic Medicine · Toxicology: intermediate syndrome

Sample item

A farmer treated with atropine and pralidoxime for organophosphate poisoning recovers from the cholinergic crisis. On day 3 he develops weakness of neck flexion and proximal limbs with difficulty breathing. What is this condition?

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

The answer and the reasoning

C. Intermediate syndrome

Intermediate syndrome appears 24 to 96 hours after poisoning, after the acute crisis has resolved, with weakness of neck flexors, proximal muscles, cranial nerves and respiratory muscles. It does not respond to atropine, and treatment is supportive ventilation until recovery over days. Delayed polyneuropathy appears 2 to 3 weeks later and affects distal limbs.

Option by option

  • A. Organophosphate-induced delayed polyneuropathy

    Delayed polyneuropathy occurs weeks later and is distal and sensorimotor.

  • B. Myasthenic crisis

    Myasthenic crisis occurs in a patient with myasthenia gravis, which is not present here.

  • C. Intermediate syndrome (correct)

    Correct. Timing and proximal and respiratory weakness define intermediate syndrome.

  • D. Cholinergic crisis from under-dosed atropine

    Under-dosed atropine would give muscarinic signs such as secretions and bradycardia, not isolated weakness.

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 Forensic Medicine question

What is the answer to this Forensic Medicine question?

The best answer is C, Intermediate syndrome. Intermediate syndrome appears 24 to 96 hours after poisoning, after the acute crisis has resolved, with weakness of neck flexors, proximal muscles, cranial nerves and respiratory muscles.

Why is "Organophosphate-induced delayed polyneuropathy" not the answer?

Delayed polyneuropathy occurs weeks later and is distal and sensorimotor.

Why is "Myasthenic crisis" not the answer?

Myasthenic crisis occurs in a patient with myasthenia gravis, which is not present here.

Why is "Cholinergic crisis from under-dosed atropine" not the answer?

Under-dosed atropine would give muscarinic signs such as secretions and bradycardia, not isolated weakness.

What concept does this question test?

It tests Toxicology: intermediate syndrome in Forensic Medicine. It does not respond to atropine, and treatment is supportive ventilation until recovery over days. Delayed polyneuropathy appears 2 to 3 weeks later and affects distal limbs.

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 Toxicology: intermediate syndrome?

Learn postmortem changes with their timelines, and toxicology as poison, sign, test and antidote. Then use the flashcards and the other Forensic Medicine 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.