Emergency Pharmacology — MCQs

Which of the following statements are correct regarding the use of benzodiazepines in the initial management of status epilepticus? I. Upto two doses may be used 5 minutes apart, if seizures are not controlled II. For Lorazepam, only a single dose should be used, even if seizures are not controlled III. Dose of midazolam at this stage is 1-15 mcg / kg / min infusion IV. Dose of both lorazepam and midazolam is 0.1 mg / kg Select the answer using the code given below :

Q35

What is the antidote for belladonna poisoning?

Q36

What is the drug of choice for emergency contraception ?

Q37

Which of the following drugs is not used for the emergency (immediate) management of hyperkalaemia?

Q38

A patient presented with dizziness, cool clammy skin, pinpoint pupil with blue lips and fingernails suffering from respiratory depression. The patient was producing a pink frothy sputum on coughing. The drug used to reverse the effects is?

Q39

A female was given morphine sulphate during labour for pain but she developed respiratory distress. Which of the following will be the correct antidote?

Q40

A 55-year-old man presents to the emergency department with acute confusion, visual disturbances, and difficulty breathing. His wife reports he was working with industrial cleaning supplies in an unventilated space. Laboratory analysis reveals severe metabolic acidosis and elevated anion gap. Which of the following antidotes should be administered immediately?

Emergency Pharmacology Indian Medical PG Practice Questions and MCQs

Question 31: Which of the following conditions can the shown injection be used for emergency management?

A. Hay fever
B. Snake bite
C. Flushing episodes in carcinoid
D. Brittle asthma (Correct Answer)

Explanation: ***Brittle asthma*** - The image shows an **EpiPen auto-injector**, which contains **epinephrine** (adrenaline). - Epinephrine is a potent **beta-2 agonist** with strong bronchodilatory effects, making it useful in severe acute asthma exacerbations, including **brittle asthma**, when immediate bronchodilation is needed. - While the **primary indication** for EpiPen is anaphylaxis, epinephrine's mechanism (beta-2 receptor stimulation causing bronchodilation, alpha-1 receptor stimulation reducing mucosal edema) provides life-saving relief in severe bronchoconstriction. - In emergency settings with severe asthma unresponsive to standard therapy, subcutaneous or intramuscular epinephrine may be administered. *Hay fever* - Hay fever (allergic rhinitis) involves mild symptoms like sneezing, rhinorrhea, and conjunctival irritation. - Management includes **antihistamines** (e.g., cetirizine, loratadine) and **intranasal corticosteroids** (e.g., fluticasone). - Epinephrine is vastly excessive for routine allergic rhinitis and is reserved only for severe systemic allergic reactions (anaphylaxis). *Snake bite* - Snake bite management centers on **species-specific antivenom** administration plus supportive care (fluid resuscitation, monitoring for coagulopathy, compartment syndrome). - Epinephrine is **not** a primary treatment for envenomation itself. - It may be used only if the patient develops an **anaphylactic reaction to antivenom**, which is a separate indication. *Flushing episodes in carcinoid* - Carcinoid syndrome involves episodic flushing, diarrhea, and bronchoconstriction due to **serotonin, histamine, and vasoactive peptides** released by neuroendocrine tumors. - Treatment involves **somatostatin analogs** (octreotide, lanreotide) which inhibit hormone release from tumor cells. - Epinephrine would not address the underlying mediator release and could potentially worsen hemodynamic instability.

Question 32: A 3-year-old child presents with febrile seizures. All are correct about the route of drug administered except:

A. Call for help, keep airway open and turn to lateral position
B. Use midazolam provided in the plastic vial
C. Insert mucosal atomizer device loosely into nostril
D. Press the plunger slowly to give the complete prescribed dose (Correct Answer)

Explanation: ***Press the plunger slowly to give the complete prescribed dose*** - This statement is incorrect because the plunger of a **mucosal atomizer device** should be pressed **firmly and quickly** to create a fine mist for optimal absorption. - A slow press would result in a stream of liquid rather than an atomized spray, which reduces the effectiveness of absorption through the **nasal mucosa**. *Call for help, keep airway open and turn to lateral position* - These are appropriate initial steps for managing a child having a seizure to ensure **safety** and prevent **aspiration**. - **Maintaining an open airway** is crucial, and the **lateral recovery position** helps prevent aspiration of vomit or secretions. *Use midazolam provided in the plastic vial* - **Midazolam** is commonly used for **febrile seizures** and is often supplied in a plastic vial designed for easy administration. - It can be administered via the **buccal** or **intranasal route** in pediatric emergencies, making it a suitable choice. *Insert mucosal atomizer device loosely into nostril* - The **mucosal atomizer device (MAD)** should be inserted **loosely** into the nostril, not tightly, to allow for proper dispersion of the mist. - This position ensures that the medication can effectively cover the **nasal mucosa** for absorption.

Question 33: A child with acute lymphoblastic leukemia was given Vincristine in V.A.L.P regimen. However there was an extravasation of the drug. All should be done for management of the same except?

A. Aspiration of drug from the extravasated site
B. Keep limb dependant (Correct Answer)
C. Hyaluronidase injections
D. Apply warm compresses

Explanation: ***Keep limb dependant*** - Keeping the limb dependent will **increase blood flow** and venous congestion at the extravasation site, potentially worsening tissue damage. - The affected limb should be **elevated** to minimize swelling and promote lymphatic drainage. - This is the **INCORRECT** management step. *Aspiration of drug from the extravasated site* - This is an appropriate **immediate step** for managing extravasation. - Use a small syringe to attempt to **withdraw residual drug** from the subcutaneous tissue to minimize further tissue damage. *Apply warm compresses* - **Warmth is recommended** for vinca alkaloid extravasation (vincristine, vinblastine). - Warm compresses promote **vasodilation and drug dispersion**, enhancing absorption and reducing local tissue injury. - Apply for **15-20 minutes several times daily**. *Hyaluronidase injections* - **Hyaluronidase is the specific antidote** for vinca alkaloid extravasation. - It breaks down **hyaluronic acid** in connective tissue, increasing tissue permeability. - This facilitates **dispersion and absorption** of the extravasated drug, thereby reducing tissue necrosis. - Typical dose: **150-900 units subcutaneously** around the extravasation site.

Question 34: Which of the following statements are correct regarding the use of benzodiazepines in the initial management of status epilepticus? I. Upto two doses may be used 5 minutes apart, if seizures are not controlled II. For Lorazepam, only a single dose should be used, even if seizures are not controlled III. Dose of midazolam at this stage is 1-15 mcg / kg / min infusion IV. Dose of both lorazepam and midazolam is 0.1 mg / kg Select the answer using the code given below :

A. II and IV
B. I and IV (Correct Answer)
C. I and III
D. II and III

Explanation: ***I and IV*** - According to current guidelines, **up to two doses** of a benzodiazepine may be administered 5 minutes apart if the **seizures are not controlled** after the initial dose. - The recommended dose for both **lorazepam and midazolam** in the initial management of status epilepticus is **0.1 mg/kg**. *II and IV* - This option is incorrect because statement II is false, as **multiple doses of lorazepam** can be administered if seizures are not controlled. - While statement IV is correct regarding the dosage of lorazepam and midazolam. *I and III* - This option is incorrect because statement III is false, as **1-15 mcg/kg/min infusion** is the dose for **continuous infusion** of midazolam in refractory status epilepticus, not the initial bolus dose. - Statement I is correct but paired with an incorrect statement. *II and III* - This option is incorrect because both statements II and III are false regarding the initial management of status epilepticus. - As previously stated, **multiple doses of lorazepam** can be used, and the given midazolam dose is for **continuous infusion**, not the initial bolus.

Question 35: What is the antidote for belladonna poisoning?

A. Atropine
B. Amitriptyline
C. Physostigmine (Correct Answer)
D. Flumazenil

Explanation: ***Physostigmine*** - **Physostigmine** is a **reversible acetylcholinesterase inhibitor** that increases acetylcholine levels at the muscarinic and nicotinic receptors. - This effectively counteracts the **anticholinergic effects** of belladonna, which contains atropine and scopolamine, by overcoming the competitive blockade. *Atropine* - **Atropine** is the primary toxic component in belladonna, acting as a **muscarinic acetylcholine receptor antagonist**. - Administering atropine would worsen the existing anticholinergic toxidrome, making it a contraindicated treatment. *Amitriptyline* - **Amitriptyline** is a **tricyclic antidepressant** and has significant **anticholinergic properties** itself. - Using amitriptyline would exacerbate rather than treat the symptoms of belladonna poisoning due to its similar mechanism of action. *Flumazenil* - **Flumazenil** is an **antagonist of benzodiazepine receptors** and is used to reverse benzodiazepine overdose. - It has no effect on the muscarinic receptor blockade caused by belladonna alkaloids and would not be effective in this poisoning.

Question 36: What is the drug of choice for emergency contraception ?

A. High dose oestrogen alone
B. Danazol
C. Levonorgestrel only pill (Correct Answer)
D. Yuzpe regimen (combined oral pill)

Explanation: ***Levonorgestrel only pill*** - **Levonorgestrel-only pills (LNG-EC)** are the most common and effective form of emergency contraception globally, available over-the-counter in many regions. - It works primarily by **inhibiting or delaying ovulation** and is most effective when taken as soon as possible after unprotected intercourse. *High dose oestrogen alone* - High-dose estrogen alone is **not used** for emergency contraception due to its high incidence of side effects like severe nausea and vomiting. - While estrogens can affect implantation, their use without progestin for EC is **ineffective and unsafe** compared to other methods. *Danazol* - **Danazol** is an attenuated androgen that was explored for emergency contraception but has been largely **abandoned** due to variable efficacy and a high incidence of side effects like androgenic effects. - It works by suppressing ovulation and endometrial development but is **inferior** to levonorgestrel or ulipristal acetate. *Yuzpe regimen (combined oral pill)* - The **Yuzpe regimen** uses a combination of estrogen and progestin from regular oral contraceptive pills, which is **less effective** and has more side effects (nausea, vomiting) than levonorgestrel-only pills. - This method requires taking **two doses 12 hours apart**, making it less convenient than single-dose levonorgestrel.

Question 37: Which of the following drugs is not used for the emergency (immediate) management of hyperkalaemia?

A. 10% calcium gluconate over 10 min
B. Insulin-dextrose
C. Injection MgSO4 (Correct Answer)
D. Salbutamol nebulisation

Explanation: ***Injection MgSO4*** - Magnesium sulfate is not a direct treatment for hyperkalaemia; its primary use is for conditions like **eclampsia**, **asthma exacerbations**, or **torsades de pointes**. - It does not directly affect potassium levels or cardiac membrane stability in the context of hyperkalaemia. *10% calcium gluconate over 10 min* - **Calcium gluconate** is used for immediate cardioprotection in hyperkalaemia by stabilizing the **cardiac membrane**, thereby reducing the risk of arrhythmias. - It does not lower serum potassium levels but mitigates the dangerous cardiac effects. *Insulin-dextrose* - This combination is an effective treatment for hyperkalaemia as **insulin** drives potassium from the extracellular to the intracellular space. - **Dextrose** is administered concurrently to prevent hypoglycaemia induced by insulin. *Salbutamol nebulisation* - **Beta-2 agonists** like salbutamol promote the uptake of potassium into cells, thus lowering serum potassium levels. - While effective, its action is generally less rapid and potent than insulin-dextrose or calcium gluconate in severe cases.

Question 38: A patient presented with dizziness, cool clammy skin, pinpoint pupil with blue lips and fingernails suffering from respiratory depression. The patient was producing a pink frothy sputum on coughing. The drug used to reverse the effects is?

A. Atropine
B. Naloxone (Correct Answer)
C. Physostigmine
D. Phentolamine

Explanation: ***Naloxone*** - This patient's presentation with **pinpoint pupils**, **respiratory depression**, and **pink frothy sputum** is highly suggestive of **opioid overdose**. - **Naloxone** is a competitive opioid receptor antagonist used specifically to reverse the effects of opioid-induced respiratory depression and central nervous system depression. *Atropine* - **Atropine** is an anticholinergic drug used to treat **bradycardia** and **organophosphate poisoning**. - It would worsen opioid-induced respiratory depression and is not indicated for this presentation. *Physostigmine* - **Physostigmine** is a cholinesterase inhibitor used to reverse the effects of anticholinergic toxicity, such as from **tricyclic antidepressants** or **atropine overdose**. - It would not treat opioid toxicity and could exacerbate some symptoms. *Phentolamine* - **Phentolamine** is an **alpha-adrenergic blocker** primarily used to treat hypertensive crises, particularly those due to **pheochromocytoma** or in extravasation of vasopressors. - It has no role in the management of opioid overdose.

Question 39: A female was given morphine sulphate during labour for pain but she developed respiratory distress. Which of the following will be the correct antidote?

A. Naloxone (Correct Answer)
B. Epinephrine
C. Pralidoxime
D. Atropine

Explanation: ***Naloxone*** - **Naloxone** is a pure opioid antagonist that rapidly reverses the effects of **opioid overdose** [1, 3], including **respiratory depression** [2], by competitively binding to opioid receptors [1]. - Its short half-life may necessitate repeated doses, especially with longer-acting opioids like morphine, to prevent recurrence of respiratory depression [1]. *Epinephrine* - **Epinephrine** is an adrenergic agonist used to treat **anaphylaxis** and severe allergic reactions, as it causes **vasoconstriction** and **bronchodilation**. - It is not an antidote for opioid-induced respiratory depression, which primarily results from central nervous system effects rather than allergic reactions. *Pralidoxime* - **Pralidoxime** is a **cholinesterase reactivator** used to treat poisoning by **organophosphates**, which inhibit acetylcholinesterase, leading to cholinergic crisis. - It works by restoring the function of the enzyme, thereby breaking down excess acetylcholine, and is not indicated for opioid overdose. *Atropine* - **Atropine** is an **anticholinergic agent** that blocks muscarinic acetylcholine receptors, used to treat **bradycardia** and **organophosphate poisoning**. - It would not reverse opioid-induced respiratory depression, as it primarily affects the parasympathetic nervous system and does not antagonize opioid receptor effects.

Question 40: A 55-year-old man presents to the emergency department with acute confusion, visual disturbances, and difficulty breathing. His wife reports he was working with industrial cleaning supplies in an unventilated space. Laboratory analysis reveals severe metabolic acidosis and elevated anion gap. Which of the following antidotes should be administered immediately?

A. Hydroxocobalamin (Correct Answer)
B. Flumazenil
C. Fomepizole
D. Naloxone

Explanation: ***Hydroxocobalamin*** - The patient's presentation with **acute confusion**, **visual disturbances**, **difficulty breathing**, and exposure to industrial cleaning supplies in an **unventilated space**, along with **severe metabolic acidosis** and an **elevated anion gap**, is highly suggestive of **cyanide poisoning**. - **Hydroxocobalamin** is a preferred antidote for cyanide poisoning because it directly binds to cyanide, forming cyanocobalamin (vitamin B12), which is then safely excreted, without interfering with oxygen transport in the blood. *Flumazenil* - **Flumazenil** is a benzodiazepine receptor antagonist used to reverse the sedative effects of **benzodiazepine overdose**. - The patient's symptoms (confusion, visual disturbances, metabolic acidosis) are not consistent with benzodiazepine overdose. *Fomepizole* - **Fomepizole** is an alcohol dehydrogenase inhibitor used to treat poisoning by **ethylene glycol** and **methanol**. - While both ethylene glycol and methanol poisoning cause severe metabolic acidosis and elevated anion gap, the patient's exposure to industrial cleaning supplies and the specific symptoms of visual disturbances point more directly towards cyanide than these alcohols. *Naloxone* - **Naloxone** is an opioid antagonist used to reverse **opioid overdose**. - The patient's clinical presentation, including metabolic acidosis and exposure history, does not indicate opioid overdose.

Practice by Chapter

Management of Anaphylaxis

Practice Questions

Drugs in Cardiac Arrest

Practice Questions

Status Epilepticus Management

Practice Questions

Acute Stroke Therapeutics

Practice Questions

Toxicological Emergencies

Practice Questions

Antidotes in Emergency Medicine

Practice Questions

Pain Management in Emergency

Practice Questions

Sedation and Paralysis in Emergency

Practice Questions

Drugs in Traumatic Emergencies

Practice Questions

Thrombolysis in Emergency Settings

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free