Snakebite & Envenomation MCQ Quiz | Poisonings & Environmental

Quiz Introduction

Welcome to this specialized quiz on Snakebite and Envenomation, designed for MBBS students. This quiz will test your understanding of the critical aspects of snakebite management, from identifying venomous species and understanding venom pathophysiology to applying correct first aid and advanced clinical interventions. Covering neurotoxic, hemotoxic, and myotoxic syndromes, the questions delve into diagnosis, laboratory findings like the 20WBCT, and the proper administration and management of Anti-Snake Venom (ASV), including its potential adverse reactions. This comprehensive assessment will help you solidify your knowledge for both theoretical exams and practical clinical scenarios. After completing the quiz, you can download all questions with their correct answers in a PDF format for future revision.

1. The 20-minute whole blood clotting time (20WBCT) is a crucial bedside test primarily used to detect which type of envenomation?

Neurotoxic envenomation Haemotoxic (coagulopathic) envenomation Myotoxic envenomation Cytotoxic envenomation without systemic effects

2. Ptosis, dysphagia, and descending respiratory paralysis are classical signs of envenomation by which family of snakes?

Viperidae (Vipers) Colubridae (e.g., Keelback) Elapidae (Cobras and Kraits) Hydrophiinae (Sea snakes)

3. Which of the following is the most appropriate first aid measure for a snakebite victim in a field setting?

Applying a tight arterial tourniquet above the bite Making incisions over the bite marks and sucking the venom Washing the wound with soap and water and applying ice Reassuring the patient and immobilizing the bitten limb

4. The venom of which of the “Big Four” Indian snakes is notorious for causing Acute Kidney Injury (AKI)?

Indian Cobra (Naja naja) Common Krait (Bungarus caeruleus) Russell’s Viper (Daboia russelii) Saw-scaled Viper (Echis carinatus)

5. What is the primary mechanism of action of polyvalent anti-snake venom (ASV)?

Reversing tissue necrosis at the bite site Neutralizing unbound, circulating venom toxins in the blood Blocking the venom’s effect at the neuromuscular junction Inducing a host immune response to degrade the venom

6. The venom of the Common Krait is predominantly neurotoxic. A key clinical feature distinguishing it from a Cobra bite is:

Severe local pain and extensive swelling Minimal or absent local signs at the bite site Rapid onset of coagulopathy Presence of fang marks with oozing blood

7. A patient develops urticaria, bronchospasm, and hypotension 20 minutes after starting an ASV infusion. What is the immediate management step?

Increase the rate of ASV infusion Administer an antihistamine only and continue the infusion Temporarily stop the infusion and administer adrenaline Switch to a different brand of ASV immediately

8. The “syndromic approach” to snakebite management is based on:

Treating based on definitive identification of the snake species Administering ASV to every patient with a history of snakebite Managing the patient based on the clinical syndrome (e.g., neurotoxic, haemotoxic) Using monovalent antivenom specific to the geographical region

9. What is the role of neostigmine and atropine in the management of snakebite envenomation?

They reverse the haemotoxic effects of viper venom They are used to treat anaphylactic reactions to ASV They can reverse postsynaptic neurotoxicity, particularly from cobra bites They prevent acute kidney injury after a viper bite

10. A patient presents with dark brown, “cola-colored” urine and severe muscle pain after being bitten by a snake. This presentation is highly suggestive of:

Disseminated Intravascular Coagulation (DIC) Rhabdomyolysis and myoglobinuria Direct nephrotoxicity from venom Intravascular hemolysis

11. Compartment syndrome, characterized by severe pain, swelling, and neurological deficits in a limb, is a known complication of envenomation by which type of snake?

Common Krait Sea Snake Russell’s Viper Banded Krait

12. Which of the following is NOT part of the “Big Four” venomous snakes responsible for most deaths in India?

Indian Cobra (Naja naja) Russell’s Viper (Daboia russelii) King Cobra (Ophiophagus hannah) Saw-scaled Viper (Echis carinatus)

13. According to National Snakebite Management Protocol, what is the recommended initial dose of polyvalent ASV for an adult with signs of systemic envenomation?

2 vials 5 vials 10 vials 20 vials

14. Which venom component is primarily responsible for the procoagulant effect seen in viper bites, leading to a consumptive coagulopathy?

Phospholipase A2 Hyaluronidase Metalloproteinases Prothrombin activators / Thrombin-like enzymes

15. The Elapidae family of snakes (e.g., Cobras, Kraits) are characterized by which type of fang structure?

Solenoglyphous (long, hollow, retractable fangs) Proteroglyphous (short, fixed fangs at the front) Opisthoglyphous (enlarged fangs at the rear) Aglyphous (no specialized fangs)

16. What is the main reason for avoiding Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) for pain management in snakebite victims?

They can mask the signs of developing compartment syndrome. They can worsen venom-induced coagulopathy and increase bleeding risk. They can precipitate an anaphylactic reaction to ASV. They interfere with the binding of ASV to venom toxins.

17. A bite from a sea snake (Hydrophiinae) typically results in which dominant clinical syndrome?

Severe coagulopathy Rapidly progressive neurotoxicity Extensive local tissue necrosis Myotoxicity with rhabdomyolysis

18. After administering the initial dose of ASV for a viperine bite, what is the best indicator to decide if a repeat dose is needed?

Reduction in limb swelling Patient’s subjective feeling of improvement Persistent or worsening coagulopathy after 6 hours Development of a fever

19. Which snakebite is classically associated with abdominal pain, which can mimic an acute abdomen?

Indian Cobra Common Krait Bamboo Pit Viper Rat Snake

20. The term ‘dry bite’ in the context of snakebites refers to a bite where:

The snake is non-venomous A venomous snake bites but injects no venom The bite does not break the skin The bite only produces local symptoms

21. Tetanus prophylaxis is recommended for all snakebite victims because:

Snake venom contains Clostridium tetani It is a puncture wound and can be contaminated with soil ASV administration increases the risk of tetanus Neurotoxic venom mimics the symptoms of tetanus

22. Serum sickness is a delayed hypersensitivity reaction to ASV that typically occurs:

Within 1 hour of administration 1 to 4 days after administration 5 to 14 days after administration More than 1 month after administration

23. In a patient with cobra envenomation, respiratory failure is primarily due to paralysis of the:

Bronchial smooth muscles Diaphragm and intercostal muscles Laryngeal muscles causing obstruction Central respiratory centers in the brainstem

24. What is the most reliable feature to distinguish a venomous snake from a non-venomous one in India?

Triangular head shape Bright coloration and patterns Presence of a pit between the eye and nostril There is no single reliable external feature; identification is complex

25. A patient with snakebite has a normal 20WBCT, no bleeding manifestations, and no neurological signs. What is the appropriate next step?

Administer a prophylactic dose of 2 vials of ASV Discharge the patient home immediately Observe the patient for at least 24 hours for delayed signs of envenomation Perform a fasciotomy to prevent swelling

Snakebite & Envenomation MCQ Quiz | Poisonings & Environmental

Quiz Introduction

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