Download MBBS Toxicology Lecture Notes

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1. A 24 y/o patient presents with an unknown ingestion 2 hours prior to arrival. Which of the following statements is true?
   1. Regardless of the method, gastric emptying is always 100% effective
   2. Too much time has elapsed in this case for gastric emptying to have any benefit

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   3. If the patient has a normal mental status at presentation, syrup of ipecac is indicated
   4. Sorbitol should be routinely administered with activated charcoal
   5. Activated charcoal administration may still be indicated and has the fewest adverse side effects
2. A 32 y/o dialysis patient presents to the ED following an overdose. Which of the following agents can be eliminated via hemodialysis?
   1. Secobarbital

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   2. Lithium
   3. Digoxin
   4. Phenytoin
   5. Iron

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3. Regarding whole bowel irrigation, which of the following statements is true?
   1. Should not be utilized in drug packers
   2. Has been shown to be clinically effective in well designed clinical trials
   3. May be utilized for iron ingestions with a positive abdominal radiograph
   4. Is contraindicated in lead ingestions since it may exacerbate encephalopathy
   5. Can be used cautiously in patients with bowel obstructions

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4. Regarding antidotes, which statement is correct?
   1. Warfarin toxicity is treated with protamine
   2. Beta blocker toxicity is treated with glucagon
   3. Cyanide toxicity is responsive to methylene blue
   4. Calcium channel blocker toxicity is not treated with glucagon

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   5. Carbamate toxicity should always be treated with 2-PAM
5. A 17 y/o patient presents following an unknown ingestion. His electrolytes are as follows: Na+ = 145, Cl- = 92, CO2 = 13. What toxin did this patient most likely ingest?
   1. Acetaminophen
   2. Phenobarbital
   3. Salicylates

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   4. Isopropanol
   5. Mercury
6. Which of the following therapies is likely to be most efficacious in the previous patient's management?
   1. N-acetylcysteine
   2. Urinary alkalinization

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   3. Urinary acidification
   4. 4-Methylpyrazole
   5. BAL chelation
7. A 15 y/o patient presents with confusion, agitation, mydriasis and dry, flushed skin. Which is the most likely etiology?
   1. MDMA toxicity

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   2. Amanita phalloides mushroom ingestion
   3. Methadone toxicity
   4. Jimson weed exposure
   5. Cannabis exposure

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8. A 44 y/o patient presents 30 hours after an acute on chronic acetaminophen ingestion. He reports abdominal pain, vomiting and is jaundiced. Which of the following statements is true regarding the proper management?
   1. The acetaminophen nomogram can still be used to plot serum levels to guide therapy
   2. The antidote indicated in this scenario can only be administered orally
   3. The patient's hepatotoxicity unlikely to be due to acetaminophen toxicity
   4. N-acetylcysteine is still indicated and may have clinical benefit in this delayed setting
   5. N-acetylcysteine therapy is contraindicated after 24 hours post ingestion

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9. A 29 y/o female presents to the ED complaining of nausea, vomiting and headache. She is flushed and diaphoretic. She reports being seen & treated 24 hours ago for a vaginal discharge. Which is the most likely cause of her symptoms?
   1. Hypersensitivity reaction to doxycycline
   2. Subarachnoid hemorrhage
   3. Viral meningitis
   4. Jarisch-Herxheimer reaction

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   5. Disulfiram reaction
10. A 25 y/o patient presents with headache, vomiting and somnolence. She reports using 2 gas space heaters for warmth last night. You order a carbon monoxide level which is measured at 25%. Which statement is true?
    1. The patient's pulse ox will be low
    2. CO shifts O2 saturation curve to the right
    3. HBO is always indicated in this case due to CO neurotoxic effects

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    4. If the patient is pregnant, the fetal hemoglobin has a high affinity for CO
    5. Administration of the cyanide antidote kit should also be considered in this case
11. A 39 y/o alcoholic male presents with nausea, vomiting and visual disturbances. His CO2 = 5. His osmolal gap = 40. What is likely to improve this patient's condition?
    1. Intravenous 4-methylpyrazole
    2. Intravenous octreotide

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    3. Intravenous methylene blue
    4. Intravenous N-Acetyl cysteine
    5. Intravenous physostigmine
12. Which of the following entities causes a normal anion gap acidosis?
    1. Isoniazid toxicity

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    2. Salicylates
    3. Renal tubular acidosis
    4. Uremia
    5. Metformin

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13. An 18 year old patient presents to the ED comatose with midrange pupils following a rave party on a Saturday night at 2am. After no response to D50 and naloxone therapy, the patient is orally intubated without complications. At 6am the patient suddenly becomes agitated and extubates himself. What drug of abuse is this scenario most consistent with?
    1. LSD-laced psilocybe mushrooms
    2. Ketamine
    3. Gamma hydroxybutyric acid
    4. Ecstasy MDMA
    5. Fentanyl

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14. A 47 y/o patient presents with an altered mental status following an ingestion of an unknown quantity of clonidine. Which of the following is true?
    1. This patient's symptoms will be similar to an anticholinergic overdose
    2. The patient will experience hypotension, followed by hypertension
    3. The patient will be agitated with dilated pupils
    4. Naloxone may be beneficial

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    5. This overdose does not share any similarities with a opiate toxicity
15. A 23 y/o fire fighter was involved in a extinguishing a large 5 alarm factory fire. He presents to the ED comatose with profound metabolic acidosis despite high flow oxygen therapy. What is the most appropriate intervention?
    1. Sodium thiosulfate and hydroxycobalamine
    2. Methylene blue
    3. Pyridoxine therapy

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    4. Pralidoxime therapy
    5. Emergent hemodialysis
16. A 78 y/o patient is hyperkalemic with a digoxin level = 8.5. Her ECG shows PAT with AV block. Which of the following would be most appropriate?
    1. Administer Digibind
    2. Administer CaCl for this patients hyperkalemia

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    3. Withhold further digoxin awaiting clearance of the patient's toxicity
    4. Cardiovert the patient with 50 Joules
    5. Administer procainamide
17. A 45 y/o patient was working with a liquid while etching glass. He was not wearing his gloves. He is complaining of intense hand pain. Which of the following is indicated?
    1. Copious irrigation with copper sulfate

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    2. Intradermal calcium chloride
    3. Topical calcium gluconate
    4. Intravenous potassium phosphate
    5. An immediate surgical intervention

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18. A 36 y/o migrant worker presents in status epilepticus despite benzodiazepines, phenytoin and phenobarbital administration. His ABG pH is 6.8 on high flow oxygen therapy. What is the next most appropriate therapeutic step?
    1. Vitamin B6 pyridoxine therapy
    2. Vitamin B12 hydroxycobalamine
    3. Vitamin B3 niacin
    4. Vitamin B1 thiamine
    5. Bicarbonate drip

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19. Which of the following agents causes miosis?
    1. Cocaine
    2. Jimson weed
    3. Atropine
    4. Methamphetamine

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    5. Fentanyl
20. A 39 y/o Type II diabetic presents following an overdose. He is unresponsive with a GLC = 25 mg/dl. Which therapy may be indicated if this patient's hypoglycemia persists despite aggressive dextrose administration?
    1. Octreotide
    2. Cyproheptadine
    3. Insulin rescue therapy

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    4. Metformin administration
    5. Emergent pancreatectomy