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ORIGINAL CONTRIBUTION AND CLINICAL INVESTIGATION27. Richmond R, Zwar N, TaylorR, Hunnisett J, Hyslop F. Teachingabout tobacco in medical schools: aworldwide study. Drug Alcohol Rev.2009;28:484-97.28. Polanska K, Hanke W, RonchettiR, Van den Hazel P, Zuurbier M,Koppe J, Bartonova A. Environmentaltobacco smoke exposure andchildren’s health. Acta Paediatrsuppl. 2006 ;95:86-92.29. Difranza J, Andrew aligne C,Weitzman M. Prenatal and postnatalenvironmental tobacco smokeexposure and children’s health.Pediatrics, 2004 ;113:1007- 1530. Richmond E , Cehoe I. Smokingbehaviour and attitudes amongAustralian medical students. MedicalEducation 1997; 31, 169-17631. Mostafa S, Shokeir N. Smokingrelatedbehaviour and attitudesamong medical students inAlexandria. J Egypt Public HealthAssoc. 2002;77:1-2832. lam A, Tse A , Yu C, GriffithsS. Prevalence of smoking andenvironmental tobacco smokeexposure, and attitudes and beliefstowards tobacco control among HongKong medical students. Public Health2009;123:42-433. Roddy E, Rubin P, Britton J.A study of smoking and smokingcessation on the curricula of UKmedical schools. Tobacco Control2004;13:74-7.CME QuizA 45 year old farmer, is brought to emergency by his wife afterexperiencing a sudden onset of profuse sweating, vomiting and feelingthat ‘his legs would not hold him up’.Ramesh’s wife informs you that during the journey he developedslurred speech and abdominal pains and the urgent desire to defecate.On examination the patient has constricted pupils and is salivating. Hispulse rate is regular at 65 beats per minute. There were generalisedrhonchi on chest auscultation.The wife brought a tin of pesticide that they were using. The label onthe tin was “Metacid” (an organophosphorous compound) and thepatient had wiped up some liquid that the farmhand had spilt earlier,without wearing gloves or overalls.QuestionIn relation to this presentation which of the following are True or False?1. “Metacid” is an organophosphorous compound with anti-cholinesteraseaction2. Anti-cholinesterase pesticides are an uncommon cause of acute poisoning3. Organophosphorous compounds readily penetrate the skin4. Clinical features vary depending on the relative effects on parasympatheticnerves, sympathetic ganglia and neuro-muscular junctions.5. Initial effects are due to parasympathetic activity6. Weakness of skeletal muscle is due to enzyme suppression at neuromuscularjunctions7. Atropine blocks parasympathetic overactivityAnswers and feedback are on page 18MIDDLE MIDDLE EAST EAST JOURNAL JOURNAL OF OF FAMILY FAMILY MEDICINE VOLUME • VOLUME 10 ISSUE 7, ISSUE 7 10 11