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Retired NBME 25 Answers

nbme25/Block 2/Question#17 (reveal difficulty score)
A 45-year-old man who works in a government ...
Anticholinesterase poisoning ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—shak360(19)
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I saw the government building/employees being affected and I instantly picked Anthrax because of that incident where people sent Anthrax-laced letters to people in the US through the mail as a form of bioterrorism. If I had read the question more clearly, the symptoms of organophosphate (or anticholinesterase) poisoning were evident (DUMBBELSS).

  • Diarrhea
  • Urination
  • Miosis
  • Bronchospasm
  • Bradycardia
  • Emesis
  • Lacrimation
  • Sweating
  • Salivation

The easiest way to remember these is just know that acetylcholine or cholinergic tone in general is usually parasympathetic or "rest-and-digest". So you can urinate and defecate, you can keep your pupils closed, slow your heart rate down, and salivate to eat. Though organophosphate poisoning through something like parathion or malathion is commonly seen in insecticides (where the poisoned victim is usually a farmworker or someone in an agricultural setting), I guess it can also happen as a form of bio-terrorism.

You can reverse this poisoning through Atropine, a muscarinic antagonist, a competitive inhibitor that can cross the BBB. Pralidoxime is also given to regenerate AChE.

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