Toxicology: Cleistanthus collinus poisoning: 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: Cleistanthus collinus poisoning

Sample item

After a family quarrel a farmer drinks a decoction of the leaves of a forest shrub. The next day he has vomiting and marked limb weakness. Serum potassium is 2.1 mEq/L and there is a normal anion gap metabolic acidosis with alkaline urine. Which plant was most likely taken?

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

The answer and the reasoning

B. Cleistanthus collinus

Cleistanthus collinus leaves are used in some parts of southern India for self-poisoning. Its lignans cause severe hypokalaemia, distal renal tubular acidosis, hypotension, arrhythmia and respiratory failure. Oleander, in contrast, causes hyperkalaemia and heart block.

Option by option

  • A. Abrus precatorius

    Abrus seeds cause haemorrhagic gastroenteritis and later multi-organ injury, not a hypokalaemic tubular acidosis.

  • B. Cleistanthus collinus (correct)

    Correct. Hypokalaemia with distal tubular acidosis is the signature of this plant.

  • C. Ricinus communis

    Castor seeds cause gastroenteritis and later hypovolaemia and organ injury, not distal tubular acidosis.

  • D. Nerium oleander

    Oleander has a digoxin-like action and produces hyperkalaemia with conduction block.

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 B, Cleistanthus collinus. Cleistanthus collinus leaves are used in some parts of southern India for self-poisoning.

Why is "Abrus precatorius" not the answer?

Abrus seeds cause haemorrhagic gastroenteritis and later multi-organ injury, not a hypokalaemic tubular acidosis.

Why is "Ricinus communis" not the answer?

Castor seeds cause gastroenteritis and later hypovolaemia and organ injury, not distal tubular acidosis.

Why is "Nerium oleander" not the answer?

Oleander has a digoxin-like action and produces hyperkalaemia with conduction block.

What concept does this question test?

It tests Toxicology: Cleistanthus collinus poisoning in Forensic Medicine. Its lignans cause severe hypokalaemia, distal renal tubular acidosis, hypotension, arrhythmia and respiratory failure. Oleander, in contrast, causes hyperkalaemia and heart block.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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: Cleistanthus collinus poisoning?

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.