Toxicology: organophosphate-induced delayed neuropathy: 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: organophosphate-induced delayed neuropathy

Sample item

Two weeks after recovering from acute organophosphate poisoning, a man develops burning of the feet and then distal limb weakness with foot drop. He has no cholinergic features. What is this condition?

AOrganophosphate-induced delayed polyneuropathyBGuillain-Barre syndrome after infectionCIntermediate syndromeDRecurrent cholinergic crisis

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

The answer and the reasoning

A. Organophosphate-induced delayed polyneuropathy

Some organophosphates inhibit neuropathy target esterase, causing a delayed distal axonal polyneuropathy one to three weeks after exposure. It is not responsive to atropine or oxime, since it is not a cholinergic effect. The intermediate syndrome appears sooner, within one to four days, with proximal and respiratory weakness.

Option by option

A. Organophosphate-induced delayed polyneuropathy (correct)
Correct. A distal sensorimotor neuropathy weeks later is the delayed polyneuropathy.
B. Guillain-Barre syndrome after infection
A post-infectious ascending paralysis is unrelated to a pesticide exposure.
C. Intermediate syndrome
Intermediate syndrome occurs within about four days and affects neck flexors and proximal muscles.
D. Recurrent cholinergic crisis
A cholinergic crisis would show sweating, salivation and miosis, which are absent.

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 A, Organophosphate-induced delayed polyneuropathy. Some organophosphates inhibit neuropathy target esterase, causing a delayed distal axonal polyneuropathy one to three weeks after exposure.

Why is "Guillain-Barre syndrome after infection" not the answer?

A post-infectious ascending paralysis is unrelated to a pesticide exposure.

Why is "Intermediate syndrome" not the answer?

Intermediate syndrome occurs within about four days and affects neck flexors and proximal muscles.

Why is "Recurrent cholinergic crisis" not the answer?

A cholinergic crisis would show sweating, salivation and miosis, which are absent.

What concept does this question test?

It tests Toxicology: organophosphate-induced delayed neuropathy in Forensic Medicine. It is not responsive to atropine or oxime, since it is not a cholinergic effect. The intermediate syndrome appears sooner, within one to four days, with proximal and respiratory weakness.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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: organophosphate-induced delayed neuropathy?

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.