Toxicology: beta-blocker overdose: 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: beta-blocker overdose

Sample item

A woman who swallowed her father's propranolol tablets has a heart rate of 38 per minute, hypotension and hypoglycaemia, and does not respond to atropine. Which drug is the preferred next antidote?

APralidoximeBProtamineCDigoxin-specific antibody fragmentsDGlucagon

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

The answer and the reasoning

D. Glucagon

Glucagon stimulates cardiac adenylate cyclase through its own receptor, bypassing the blocked beta receptors, and raises heart rate and contractility. It is the preferred antidote in beta-blocker overdose after atropine fails. Antibody fragments, pralidoxime and protamine act on other poisons.

Option by option

A. Pralidoxime
Pralidoxime reactivates cholinesterase in organophosphate poisoning.
B. Protamine
Protamine neutralises heparin.
C. Digoxin-specific antibody fragments
Digoxin Fab fragments bind digoxin and do not reverse beta-blockade.
D. Glucagon (correct)
Correct. Glucagon increases cyclic AMP independently of the beta receptors.

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.

Questions about this Forensic Medicine question

What is the answer to this Forensic Medicine question?

The best answer is D, Glucagon. Glucagon stimulates cardiac adenylate cyclase through its own receptor, bypassing the blocked beta receptors, and raises heart rate and contractility.

Why is "Pralidoxime" not the answer?

Pralidoxime reactivates cholinesterase in organophosphate poisoning.

Why is "Protamine" not the answer?

Protamine neutralises heparin.

Why is "Digoxin-specific antibody fragments" not the answer?

Digoxin Fab fragments bind digoxin and do not reverse beta-blockade.

What concept does this question test?

It tests Toxicology: beta-blocker overdose in Forensic Medicine. It is the preferred antidote in beta-blocker overdose after atropine fails. Antibody fragments, pralidoxime and protamine act on other poisons.

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: beta-blocker overdose?

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.