Part 8- FUNGAL / ANIMAL TOXINS and AIR POLLUTANTS

Aflatoxin is produced by:

a. Clostridium botulinum
b. Penicillium notatum
c. Claviceps purpurea
d. Aspergillus flavus

d. Aspergillus flavus

Aflatoxin contamination is commonly associated with:

a. Fresh fruits
b. Dairy products
c. Improperly dried peanuts and grains
d. Seafood

c. Improperly dried peanuts and grains

Compared with children, adults exposed to aflatoxin are more likely to be:

a. Immediately symptomatic
b. More severely affected
c. Relatively tolerant and asymptomatic
d. Unable to metabolize the toxin

c. Relatively tolerant and asymptomatic

• ↑ Tolerance – asymptomatic

A child exposed to significant amounts of aflatoxin is at greatest risk of developing:

a. Acute hepatic necrosis
b. Pulmonary fibrosis
c. Renal stones
d. Myocardial infarction

a. Acute hepatic necrosis

• Acute hepatic necrosis → liver cirrhosis → liver cancer

The treatment of aflatoxin poisoning is primarily:

a. Chelation therapy
b. Naloxone
c. Supportive care
d. Hemodialysis

c. Supportive care (IV fluids and electrolyte replacement)

Saxitoxin is produced by:

a. Aspergillus flavus
b. Dinoflagellates
c. Claviceps purpurea
d. Clostridium botulinum

b. Dinoflagellates

Saxitoxin is responsible for:

a. Minamata disease
b. Red tide poisoning
c. Itai-itai disease
d. Mad Hatter disease

b. Red tide poisoning

Another name for saxitoxin poisoning is:

a. Ciguatera poisoning
b. PSP
c. Ergotism
d. Scombroid poisoning

b. Paralytic shellfish poisoning (PSP)

The mechanism of action of saxitoxin is:

a. Acetylcholinesterase inhibition
b. Na⁺ channel blockade
c. K⁺ channel blockade
d. Calcium channel activation

b. Na⁺ channel blockade

• Na+ channel blocker (important for muscle depolarization → contraction) → flaccid paralysis

The characteristic type of paralysis seen in saxitoxin poisoning is:

a. Spastic paralysis
b. Flaccid paralysis
c. Rigid paralysis
d. Hemiplegia

b. Flaccid paralysis

• Na+ channel blocker (important for muscle depolarization → contraction) → flaccid paralysis

The most serious complication of saxitoxin poisoning is:

a. Liver failure
b. Renal failure
c. Respiratory depression
d. GI hemorrhage

c. Respiratory depression

Amatoxin is found in which mushroom?

a. Psilocybe cubensis
b. Amanita muscaria
c. Amanita phalloides
d. Agaricus bisporus

c. Amanita phalloides

Amanita phalloides is commonly known as:

a. Angel Dust
b. Destroying Angel
c. Death Cap
d. Mad Hatter

b. Destroying Angel

The primary mechanism of amatoxin toxicity is:

a. Inhibition of acetylcholinesterase
b. Blockade of Na⁺ channels
c. Inhibition of RNA polymerase II
d. Activation of opioid receptors

c. Inhibition of RNA polymerase II

• inhibits RNA polymerase II in the liver → ↓ protein synthesis → hepatotoxicity

The hepatotoxicity of amatoxin is primarily due to:

a. Free radical formation only
b. Decreased protein synthesis in hepatocytes
c. Vasoconstriction
d. Hemolysis

b. Decreased protein synthesis in hepatocytes

• inhibits RNA polymerase II in the liver → ↓ protein synthesis → hepatotoxicity

A patient develops severe liver injury after ingesting wild mushrooms. The most likely toxin is:

a. Saxitoxin
b. Aflatoxin
c. Amatoxin
d. Ergotamine

c. Amatoxin

The cornerstone of treatment for amatoxin poisoning is:

a. Naloxone
b. Supportive care
c. Flumazenil
d. Vitamin K

b. Supportive care (IV fluids, electrolytes)

Which drug has been proposed to competitively inhibit amatoxin at hepatic receptors?

a. Penicillin G
b. Pyridoxine
c. Atropine
d. Benzylpenicillin

a. Penicillin G &
d. Benzylpenicillin

• Pen G is aka Benzylpenicillin

Benzylpenicillin is used in amatoxin poisoning because it:

a. Enhances RNA synthesis
b. Stimulates RNA polymerase II in the liver
c. Competitively inhibits amatoxin uptake in the liver (theoretical)
d. Neutralizes mushroom toxins directly

c. Competitively inhibits amatoxin uptake in the liver (theoretical)

Latrotoxin is the venom of:

a. Brown recluse spider
b. Black widow spider
c. Scorpion
d. Cobra

b. Black widow spider

Latrotoxin is produced by:

a. Loxosceles reclusa
b. Latrodectus mactans
c. Amanita phalloides
d. Claviceps purpurea

b. Latrodectus mactans

The mechanism of action of latrotoxin is:

a. Inhibits acetylcholinesterase
b. Blocks Na⁺ channels
c. Causes presynaptic release of acetylcholine
d. Inhibits RNA polymerase II

c. Causes presynaptic release of acetylcholine

LATROTOXIN Clinical Presentation:

Parasympathomimetic or Sympathetic?

Xanthopsia or Conjunctivitis?

Restlessness or Coma?

Hypertension or Hypotension?

Parasympathomimetic

Conjunctivitis

Restlessness

Hypertension

The specific treatment for severe latrotoxin poisoning is:

a. Naloxone
b. Flumazenil
c. Antivenom
d. Deferoxamine

c. Antivenom

Tetrodotoxin is commonly associated with:

a. Black widow spider
b. Pufferfish
c. Amanita mushroom
d. Dinoflagellates

b. Pufferfish

Tetrodotoxin may be found in all EXCEPT:

a. Amphibians
b. Mollusks (snails, octopus)
c. Shellfish
d. Pufferfish

c. Shellfish

Which country is classically associated with pufferfish poisoning?

a. China
b. India
c. Japan
d. Brazil

c. Japan

The mechanism of action of tetrodotoxin is:

a. Acetylcholinesterase inhibition
b. Presynaptic ACh release
c. Na⁺ channel blockade
d. RNA polymerase II inhibition

c. Na⁺ channel blockade

• same with saxitoxin

The earliest symptom of tetrodotoxin poisoning is often:

a. Jaundice
b. Perioral numbness
c. Hematuria
d. Blindness

b. Perioral numbness

The characteristic type of paralysis in tetrodotoxin poisoning is:

a. Spastic paralysis
b. Flaccid paralysis
c. Hemiplegia
d. Rigidity

b. Flaccid paralysis

• same with saxitoxin

The most important treatment for severe tetrodotoxin poisoning is:

a. Naloxone
b. Flumazenil
c. Airway support and intubation
d. IV fluids and supplements

c. Airway support and intubation

TETRODOTOXIN Toxicity:

Bufotoxin

Clupeotoxin

Gemblid

Venerupin

Saurine

Choices:

a. Mackerel

b. Bullfrogs

c. Oysters

d. Tuna

e. Sardines

Which of the following is a common air pollutant?

a. Lead
b. Carbon Monoxide (CO)
c. Mercury
d. Arsenic

b. Carbon Monoxide (CO)

Which gas is NOT typically included among the major air pollutants?

a. Nitric Oxide (NO)
b. Sulfur Dioxide (SO₂)
c. Ozone (O₃)
d. Nitrous Oxide (N₂O)

d. Nitrous Oxide (N₂O)

Which of the following is a common acute effect of air pollutant exposure?

a. Airway irritation
b. Hepatic necrosis
c. Renal failure
d. Bone fractures

a. Airway irritation

Severe exposure to air pollutants may result in:

a. Pulmonary edema
b. Hemophilia
c. Osteomalacia
d. Hyperthyroidism

a. Pulmonary edema

Chronic exposure to air pollutants primarily causes:

a. Acute liver failure
b. Chronic cardiopulmonary disease
c. Bone marrow suppression
d. Peripheral neuropathy

b. Chronic cardiopulmonary disease

Which statement regarding air pollutant toxicity is TRUE?

a. Effects always immediately damage the lungs
b. Chronic exposure may gradually damage the lungs
c. Air pollutants only affect the skin
d. Pulmonary edema never occurs

b. Chronic exposure may gradually damage the lungs