Emetics: Copper sulphate* MCQs With Answer

Emetics: Copper sulphate MCQs With Answer

Copper sulphate (CuSO4), historically used as an emetic and disinfectant, is a key topic in pharmacology and toxicology for B. Pharm students. This introduction covers mechanism of emesis, corrosive and systemic toxicity, clinical features like gastrointestinal irritation, hemolysis, methemoglobinemia and renal/hepatic injury, as well as emergency management, chelation and contraindications for inducing vomiting. Understanding copper sulphate’s pharmacodynamics, routes of exposure, laboratory diagnosis and modern treatment protocols is essential for safe clinical practice and poison management. This set of focused MCQs reinforces core concepts, clinical reasoning and therapeutic strategies for undergraduates. ’Now let’s test your knowledge with 50 MCQs on this topic.’

Q1. What is the chemical formula of copper sulphate pentahydrate commonly encountered in pharmacy?

• Copper(II) sulfate (CuSO4)
• Copper(II) sulfate pentahydrate (CuSO4·5H2O)
• Cuprous oxide (Cu2O)
• Copper chloride (CuCl2)

Correct Answer: Copper(II) sulfate pentahydrate (CuSO4·5H2O)

Q2. Which common name is used for copper sulphate used historically as an emetic?

• Blue vitriol
• Green vitriol
• White vitriol
• Red oxide

Correct Answer: Blue vitriol

Q3. What is the primary mechanism by which copper sulphate induces vomiting when ingested?

• Central stimulation of the chemoreceptor trigger zone only
• Irritation of gastric mucosa and stimulation of vagal afferents
• Inhibition of gastric acid production
• Activation of opioid receptors in the gut

Correct Answer: Irritation of gastric mucosa and stimulation of vagal afferents

Q4. Which systemic toxic effect is most characteristic of acute copper sulphate poisoning?

• Neuroleptic malignant syndrome
• Oxidative hemolysis
• Pancreatitis
• Pulmonary fibrosis

Correct Answer: Oxidative hemolysis

Q5. Which clinical sign is commonly seen early after copper sulphate ingestion?

• Dry skin and hyperthermia
• Severe abdominal pain and vomiting
• Polyuria and polydipsia
• Bradykinesia

Correct Answer: Severe abdominal pain and vomiting

Q6. Which laboratory finding is typical in copper sulphate poisoning due to hemolysis?

• Elevated hemoglobin and polycythemia
• Hemoglobinuria and elevated indirect bilirubin
• Decreased lactate dehydrogenase (LDH)
• Increased platelet count

Correct Answer: Hemoglobinuria and elevated indirect bilirubin

Q7. Which condition often accompanies severe copper sulphate toxicity and contributes to mortality?

• Acute kidney injury
• Chronic obstructive pulmonary disease
• Hypothyroidism
• Rheumatoid arthritis

Correct Answer: Acute kidney injury

Q8. What is the role of induced emesis (vomiting) in modern management of copper sulphate ingestion?

• Strongly recommended to reduce absorption in all cases
• Contraindicated because of corrosive injury and aspiration risk
• Only performed after activated charcoal administration
• Mandatory if more than 1 hour has passed since ingestion

Correct Answer: Contraindicated because of corrosive injury and aspiration risk

Q9. Which antidotal therapy is preferred initially for severe acute copper poisoning?

• Dimercaprol (British anti-Lewisite, BAL)
• Vitamin C
• Flumazenil
• Naloxone

Correct Answer: Dimercaprol (British anti-Lewisite, BAL)

Q10. Which chelating agent is commonly used orally for ongoing copper chelation after initial therapy?

• D-penicillamine
• Deferoxamine
• Protamine sulfate
• Atropine

Correct Answer: D-penicillamine

Q11. Which of the following is an immediate supportive measure for a patient with suspected copper sulphate ingestion?

• Gastric lavage in an unconscious patient without airway protection
• Ensure airway protection, IV fluids and monitoring
• Administer syrup of ipecac at home
• Give activated charcoal and send home

Correct Answer: Ensure airway protection, IV fluids and monitoring

Q12. Methemoglobinemia in copper sulphate poisoning is treated with:

• Methylene blue
• Hydroxocobalamin
• Vitamin K
• Calcium gluconate

Correct Answer: Methylene blue

Q13. Which organ accumulates copper and is a primary site of toxicity in chronic exposure?

• Thyroid
• Liver
• Spleen
• Pancreas

Correct Answer: Liver

Q14. Which sign suggests hemolytic anemia following copper sulphate ingestion?

• Elevated oxygen saturation on pulse oximetry
• Sudden drop in hemoglobin with jaundice
• Hypercalcemia
• Decreased serum creatinine

Correct Answer: Sudden drop in hemoglobin with jaundice

Q15. What is a contraindication to giving activated charcoal after copper sulphate ingestion?

• Presentation within 30 minutes
• Ingestion of a highly adsorbable toxin
• Unprotected airway or risk of aspiration
• Presence of vomiting

Correct Answer: Unprotected airway or risk of aspiration

Q16. The blue color of copper sulphate solution is due to:

• Formation of cuprous oxide in solution
• Hydrated copper(II) ions absorbing visible light
• Presence of sulfate radicals
• Colloidal iron impurities

Correct Answer: Hydrated copper(II) ions absorbing visible light

Q17. Which test helps assess renal involvement after copper sulphate poisoning?

• Serum amylase
• Serum creatinine and urine output monitoring
• Thyroid function tests
• Serum cholesterol level

Correct Answer: Serum creatinine and urine output monitoring

Q18. Why is emesis not recommended in corrosive ingestions such as copper sulphate?

• It neutralizes the corrosive agent
• It may retraumatize the esophagus and increase aspiration risk
• It guarantees complete removal of the poison
• It enhances chelation therapy

Correct Answer: It may retraumatize the esophagus and increase aspiration risk

Q19. Which of the following routes of exposure to copper sulphate is most likely to cause systemic toxicity rapidly?

• Dermal contact with intact skin
• Inhalation of dust or fumes
• Ingestion
• Topical ocular application

Correct Answer: Ingestion

Q20. Which clinical feature indicates methemoglobinemia in a patient with copper sulphate poisoning?

• Chocolate-brown colored blood and low pulse oximetry readings unresponsive to oxygen
• Bright red arterial blood and hypertension
• Excessive salivation and bradycardia
• High oxygen saturation and cyanosis that improves with oxygen

Correct Answer: Chocolate-brown colored blood and low pulse oximetry readings unresponsive to oxygen

Q21. Which biochemical mechanism primarily explains copper-induced hemolysis?

• Inhibition of acetylcholinesterase
• Oxidative damage to erythrocyte membranes and proteins
• Formation of immune complexes against RBCs
• Direct blockade of hemoglobin synthesis

Correct Answer: Oxidative damage to erythrocyte membranes and proteins

Q22. Which laboratory marker directly reflects recent copper exposure?

• Serum ceruloplasmin only
• Serum copper concentration
• Serum ferritin
• Blood lead level

Correct Answer: Serum copper concentration

Q23. In the context of copper sulphate poisoning, which statement about ceruloplasmin is correct?

• Ceruloplasmin is an acute-phase protein that binds copper; levels can be misleading in acute poisoning
• Ceruloplasmin rapidly decreases in acute copper ingestion
• Ceruloplasmin measurement is the best indicator of acute toxicity severity
• Ceruloplasmin is the antidote for copper poisoning

Correct Answer: Ceruloplasmin is an acute-phase protein that binds copper; levels can be misleading in acute poisoning

Q24. What is the recommended management for severe hemolysis due to copper sulphate?

• Immediate platelet transfusion
• Supportive care, blood transfusions as needed and management of renal failure
• High-dose corticosteroids as first-line
• Bone marrow transplant

Correct Answer: Supportive care, blood transfusions as needed and management of renal failure

Q25. Which statement best describes the gastrointestinal effects of copper sulphate?

• It is a gastric irritant causing corrosive injury, hemorrhage, and perforation
• It causes constipation and intestinal obstruction
• It selectively affects the colon without gastric symptoms
• It acts as a systemic laxative

Correct Answer: It is a gastric irritant causing corrosive injury, hemorrhage, and perforation

Q26. Which imaging or endoscopic investigation may be needed after significant copper sulphate ingestion?

• Upper GI endoscopy to assess corrosive injury
• Chest X-ray to detect pulmonary edema only
• ECG to detect bone lesions
• Mammography

Correct Answer: Upper GI endoscopy to assess corrosive injury

Q27. Which of the following is a public health use of copper sulphate rather than a therapeutic use?

• Algicide in agriculture
• Oral emetic in modern clinical practice
• Long-term antihypertensive agent
• Vitamin supplement

Correct Answer: Algicide in agriculture

Q28. Which electrolyte disturbance may occur secondary to hemolysis and renal failure in copper sulphate poisoning?

• Hyperkalemia
• Hypokalemia only
• Severe hypernatremia exclusively
• Hypocalcemia only

Correct Answer: Hyperkalemia

Q29. What is the recommended action regarding charcoal administration in acute copper sulphate ingestion?

• Activated charcoal is universally effective and always indicated
• Activated charcoal may be considered if airway is protected and presentation is early
• Charcoal neutralizes copper and is the antidote of choice
• Charcoal should be given even if patient is vomiting and unprotected

Correct Answer: Activated charcoal may be considered if airway is protected and presentation is early

Q30. Which patient population has increased susceptibility to oxidative hemolysis from copper exposure?

• Patients with G6PD deficiency
• Patients with hypertension
• Patients with hypothyroidism
• Patients taking beta-blockers

Correct Answer: Patients with G6PD deficiency

Q31. Which of the following best describes the disposition of copper after absorption?

• Rapid renal excretion without hepatic involvement
• Distribution to liver and red blood cells with biliary excretion
• Storage in adipose tissue primarily
• Complete excretion unchanged in feces

Correct Answer: Distribution to liver and red blood cells with biliary excretion

Q32. Which cardiovascular effect can be seen in severe copper sulphate poisoning?

• Severe hypotension and shock
• Marked hypertension only
• Bradyarrhythmias exclusively without hypotension
• No cardiovascular effects occur

Correct Answer: Severe hypotension and shock

Q33. In occupational exposure, which preventive measure reduces inhalational risk of copper sulphate?

• Using appropriate respiratory protection and dust control
• Wearing short-sleeved clothing only
• Avoiding handwashing after work
• Increasing workplace temperature

Correct Answer: Using appropriate respiratory protection and dust control

Q34. Which of the following is TRUE about the use of emetics historically in poisoning?

• Emetics like copper sulphate were safe and remain first-line today
• Emetics were used historically but are now limited due to safety concerns
• Emesis guarantees prevention of systemic toxicity in all cases
• Emetics are recommended for corrosive ingestions

Correct Answer: Emetics were used historically but are now limited due to safety concerns

Q35. Which laboratory test is most useful to detect hemolysis after copper ingestion?

• Serum albumin
• Lactate dehydrogenase (LDH) and peripheral smear
• Fasting blood glucose
• Serum triglycerides

Correct Answer: Lactate dehydrogenase (LDH) and peripheral smear

Q36. Which statement about chronic copper overexposure differs from acute poisoning?

• Chronic exposure mainly causes neurodegeneration identical to Wilson’s disease
• Chronic exposure can cause liver cirrhosis and neuropsychiatric symptoms over time
• Chronic exposure causes immediate hemolysis like acute ingestion
• Chronic exposure is always asymptomatic

Correct Answer: Chronic exposure can cause liver cirrhosis and neuropsychiatric symptoms over time

Q37. In an ED, what is the role of hemodialysis in severe copper sulphate poisoning?

• Hemodialysis is the primary method to remove copper from tissues
• Hemodialysis is used to manage renal failure and electrolyte disturbances; copper removal is limited
• Hemodialysis has no role in management
• Hemodialysis is contraindicated

Correct Answer: Hemodialysis is used to manage renal failure and electrolyte disturbances; copper removal is limited

Q38. Which sign would prompt consideration of exchange transfusion in copper sulphate poisoning?

• Mild nausea without anemia
• Severe hemolysis with refractory hypoxia despite supportive care
• Asymptomatic elevated serum copper alone
• Stable vital signs with normal hemoglobin

Correct Answer: Severe hemolysis with refractory hypoxia despite supportive care

Q39. Which of these measures is important when administering dimercaprol (BAL)?

• Administer by intramuscular injection and monitor for hypertension and pain at injection site
• Give orally mixed with food
• Administer it only if renal function is normal and never otherwise
• It can be given without monitoring due to its safety

Correct Answer: Administer by intramuscular injection and monitor for hypertension and pain at injection site

Q40. Which of the following best describes why copper sulphate is a poor choice as an emetic today?

• It is ineffective at inducing vomiting
• It causes severe corrosive injury, systemic toxicity and unpredictable effects
• It is too expensive compared to other emetics
• It has pleasant taste and is easy to administer

Correct Answer: It causes severe corrosive injury, systemic toxicity and unpredictable effects

Q41. Which clinical test can help detect methemoglobinemia reliably?

• Pulse oximetry always accurate for methemoglobin
• Co-oximetry to measure methemoglobin fraction
• Blood culture
• Serum lipase

Correct Answer: Co-oximetry to measure methemoglobin fraction

Q42. A pharmacy student studying copper sulphate should recognize its classification as:

• An essential vitamin
• An inorganic salt and corrosive compound
• A beta-lactam antibiotic
• A steroidal anti-inflammatory

Correct Answer: An inorganic salt and corrosive compound

Q43. Which of the following is a red flag indicating need for ICU care after copper sulphate ingestion?

• Mild abdominal discomfort only
• Progressive hemolysis, hypotension, oliguria and metabolic acidosis
• Absence of vomiting at presentation
• Stable vitals and normal labs

Correct Answer: Progressive hemolysis, hypotension, oliguria and metabolic acidosis

Q44. For teaching purposes, which statement accurately reflects historical use of copper sulphate as an emetic?

• It was commonly used historically but fell out of favor due to toxicity
• It has always been banned and never used as an emetic
• It is still the recommended emetic in modern poison protocols
• It was only used as a topical ointment historically

Correct Answer: It was commonly used historically but fell out of favor due to toxicity

Q45. Which symptom is NOT typically associated with acute copper sulphate poisoning?

• Severe gastrointestinal pain and vomiting
• Hemolysis and jaundice
• Methemoglobinemia and cyanosis
• Gradual onset polyneuropathy without systemic signs

Correct Answer: Gradual onset polyneuropathy without systemic signs

Q46. Which environmental precaution is important when disposing of copper sulphate in a laboratory?

• Dispose down the sink without treatment
• Collect as hazardous waste and follow institutional protocols to avoid water contamination
• Burn in open air to neutralize
• Mix with organic solvents before disposal

Correct Answer: Collect as hazardous waste and follow institutional protocols to avoid water contamination

Q47. Which of the following is the least appropriate action after a small, asymptomatic dermal exposure to dilute copper sulphate?

• Wash the area with soap and water
• Remove contaminated clothing
• Ignore and do nothing further
• Seek medical advice if irritation persists

Correct Answer: Ignore and do nothing further

Q48. Which pharmacokinetic property influences the limited effectiveness of dialysis in removing copper?

• Copper is solely present as volatile gas in blood
• Copper is largely protein-bound and distributed to tissues, reducing free plasma fraction
• Copper is only intracellular and cannot be measured
• Copper is rapidly excreted unmetabolized in breath

Correct Answer: Copper is largely protein-bound and distributed to tissues, reducing free plasma fraction

Q49. In teaching MCQs, which preventive counseling point should pharmacy students provide regarding household copper sulphate?

• Store it in clearly labeled, child-resistant containers away from food and children
• Keep it in beverage bottles for convenience
• Store next to household spices
• Recommend it as a home emetic for children

Correct Answer: Store it in clearly labeled, child-resistant containers away from food and children

Q50. Which statement about the use of methylene blue in methemoglobinemia is correct?

• Methylene blue is contraindicated in all cases of methemoglobinemia
• Methylene blue is effective except in patients with severe G6PD deficiency where it may worsen hemolysis
• Methylene blue cures hemolysis by chelating copper
• Methylene blue is administered orally as first-line therapy

Correct Answer: Methylene blue is effective except in patients with severe G6PD deficiency where it may worsen hemolysis

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

Mail- Sachin@pharmacyfreak.com