Toxicology: sudden sniffing death: 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: sudden sniffing death

Sample item

A 17-year-old who has been inhaling butane from a lighter refill collapses and dies after being startled and running away. Autopsy shows no cause. What is the most likely mechanism of death?

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

The answer and the reasoning

A. Cardiac arrhythmia from myocardial sensitisation to catecholamines

Sudden sniffing death occurs with volatile solvents and gases such as butane and toluene. The solvent sensitises the myocardium to catecholamines, so a sudden fright or exertion can trigger a fatal ventricular arrhythmia, with no specific autopsy findings. Hypoxia and vagal inhibition may also contribute.

Option by option

  • A. Cardiac arrhythmia from myocardial sensitisation to catecholamines (correct)

    Correct. Sensitisation to catecholamines leads to fatal arrhythmia after a startle.

  • B. Acute liver failure

    Liver failure develops over days from chronic exposure and not as a sudden collapse.

  • C. Cerebral venous thrombosis

    Cerebral venous thrombosis is not a feature of solvent inhalation.

  • D. Massive pulmonary haemorrhage

    Pulmonary haemorrhage is not the usual mechanism and would be visible at autopsy.

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 A, Cardiac arrhythmia from myocardial sensitisation to catecholamines. Sudden sniffing death occurs with volatile solvents and gases such as butane and toluene.

Why is "Acute liver failure" not the answer?

Liver failure develops over days from chronic exposure and not as a sudden collapse.

Why is "Cerebral venous thrombosis" not the answer?

Cerebral venous thrombosis is not a feature of solvent inhalation.

Why is "Massive pulmonary haemorrhage" not the answer?

Pulmonary haemorrhage is not the usual mechanism and would be visible at autopsy.

What concept does this question test?

It tests Toxicology: sudden sniffing death in Forensic Medicine. The solvent sensitises the myocardium to catecholamines, so a sudden fright or exertion can trigger a fatal ventricular arrhythmia, with no specific autopsy findings. Hypoxia and vagal inhibition may also contribute.

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: sudden sniffing death?

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.