Mock Exam Part 2, #16-30 Reviewer

Question 1

vomiting and diarrhea present <2 hours after ingesting this mushroom

Answer 1

Chlorophyllum molybdites

Question 2

hallucinogenic mushrooms (“magic mushrooms”) that contain the chemical _____________, which is rapidly dephosphorylated by alkaline phosphatase to the more psychoactive chemical psilocin.

Answer 2

Psilocybin

Psilocin acts on serotonergic neurons in the CNS, causing effects similar to those of lysergic acid diethylamide

Question 3

What are the toxicities of Gyromitra esculenta and Amanita phalloides?

Answer 3

Initial: GI symptoms nausea, vomiting, diarrhea
Day 2: rise in AST, ALT levels
Day 3: hepatic failure

Onset 6–24 h

Treatment:

• IV hydration, glucose; monitor AST, ALT, bilirubin, BUN, and creatinine levels, prothrombin time, partial thromboplastin time
• Amanita: multiple-dose activated charcoal
• N-acetylcysteine 150 milligrams/kg loading dose (see text)
• Consider penicillin G, 300,000–1,000,000 units/kg/d
• Silymarin, 20–40 milligrams/kg/d, where available
• Cimetidine, 4–10 grams/d
• transfer to a center with active liver transplant

Question 4

What are the toxicities of Inocybe and Clitocybe?

Answer 4

• Muscarinic syndrome
• Onset <30 min
• SLUDGE syndrome (salivation, lacrimation, urination, defecation, GI hypermotility, and emesis)

Question 5

Indications for Hyperbaric Oxygen Therapy

Answer 5

Question 6

Common Indications for Referral for Hyperbaric Oxygen Treatment in CO Poisoning

Answer 6

Question 7

Risk factors for development of Delayed neurologic sequelae in Carbon Monoxide Poisoning

Answer 7

• Risks include prolonged CO exposure (>6 hours)
• Glasgow Coma Scale score <9
• seizures at the time of initial presentation
• leukocytosis

Question 8

the only accurate measurement tool for carboxyhemoglobin measurement

Answer 8

Co-oximetry

measures:
- total hemoglobin
- oxyhemoglobin
- methemoglobin
- COHb saturation

Question 9

Sources of Carbon Monoxide

Answer 9

Question 10

True or false

Long acting Insulin preparations Insulin glargine have NO PEAK

Answer 10

TRUE

Question 11

Hypoglycemia occurs most frequently with which anti-diabetic meds : ________ and _________

Answer 11

Insulin and Sulfonylureas

long-acting sulfonylureas associated more episodes of hypoglycemia:

• chlorpropamide
• glyburide (glibenclamide)
• long-acting glipizide

Question 12

50% dextrose in water is administered IV as a bolus dose of 50 mL, which provides _____ grams of glucose

Answer 12

25

Question 13

euDKA is an adverse side effect in patients taking which anti-diabetic meds?

Answer 13

sodium-glucose cotransporter 2 (SGLT-2) inhibitors

inhibitors of sodium-glucose transport protein 2

(e.g., canagliflozin, dapagliflozin, or empagliflozin)

Question 14

Euglycemic Ketoacidosis Risk Factors

Answer 14

Question 15

HHS is “defined” by severe hyperglycemia with:

• serum glucose _____milligrams/dL
• elevated calculated plasma osmolality of________ mOsm/kg
• serum bicarbonate ________ mEq/L
• an arterial pH ________
• serum ketones ___________

Answer 15

HHS is “defined” by severe hyperglycemia with:

• serum glucose >600 milligrams/dL
• elevated calculated plasma osmolality of >315 mOsm/kg
• serum bicarbonate >15 mEq/L
• an arterial pH >7.3
• serum ketones negative to mildly positive

Question 16

the key to effective recovery in HHS

Answer 16

Improvement of tissue perfusion

Question 17

True or false

Administer activated charcoal to patients presenting with severe vomiting and diarrhea within a few hours of mushroom ingestion.

Answer 17

True