Inservice deck 7 - metabolic and tox

Question 1

patient presents with tachy, HTN,and new onset CHF. Tx? diagnosis?

Answer 1

propranolol. Thyrotoxicosis

Question 2

medication blocks release of thyroid hormone

Answer 2

PTU blocks synthesis, iodine blocks release

Question 3

50 year old male with calcium 15, phosphate < 1. Most common cause?

Answer 3

hyperparathyroid

Question 4

overdose of which vitamin associated with peudotumor cerebri? tx?

Answer 4

vitamin A

tx = LP

Question 5

tx for patient with swollen lip on ACE inhibitor?

Answer 5

observe

Question 6

tx for patient with swollen lips not on ACEI. Family history of same. Dx, genetic deficiency, and specific medication that can replace the missing inhibitor protein

Answer 6

hereditary angioedema

c1 esterase inhibitor
tx = FFP

Question 7

pt arrives post-ictal with continued AMS and sugar that reads high. Tx?

Answer 7

normal saline - prior to insulin, need to check K

Question 8

patient on PCN or sulfa drug and develops fever, LAD, arthralgias? tem for reaction?

Answer 8

serum sickness

type 3 sensitivity

Question 9

tx of alcoholic patient presents vomiting with acidosis and elevated anion gap?

Answer 9

alcoholic ketoacidosis

dextrose containing solution

Question 10

30 year old with diarrhea and weightloss for months. Now AMS, Na 125, K 5.7, glucose 55, metabolic acidosis. Dx and tx?

Answer 10

adrenal crisis

tx = corticosteroids

Question 11

60 year old presents with AMS and Na 125, K 5.7 glucose 800. Diagnosis?

Answer 11

HHS

Question 12

60 year old with AMS and Na of 125, urine significant for osmolal of 300, urinary Na 35 but euvolemic wiht normal adrenal, renal, cardiac functions. Dx?

Answer 12

SIADH

tx - water restriction

Question 13

12 year old with DKA develops headache, then confusion with agitation while being treated with NS and insulin?

Answer 13

IV mannitol for cerebral edema

Question 14

tx for symptomatic patient with Ca > 15?

Answer 14

saline diuresis

Question 15

tx for hypernatremia dehydration

Answer 15

nl saline

Question 16

antidote for beta blocker?

Answer 16

glucagon

Question 17

elected official with flu=like illness, CXR shows wideden mediastinum. Suspect?

Answer 17

inhalational anthrax, hilar adenopathy causes widened mediastinum

Question 18

intoxicated patient with increased osmolar gap and urine that fluoresces has what intoxication? antidote?

Answer 18

ethylene glycol

tx - fomepizole

Question 19

patient with inhalational injury from house fire, as well as CO, what other toxin should be suspected?

Answer 19

hydrogen cyanide

Question 20

tx of patient who has been poisoned with almond smelling substance?

Answer 20

amyl/sodium nitrite, sodium thiosulfate or hydroxycobalamin

Question 21

tx for amyl nitrite tox?

Answer 21

methylene blue

Question 22

product to decontaminate sarin intox?

Answer 22

bleach

Question 23

tx for iron overdose. activated charcoal?

Answer 23

deferoxamine feels so good

deferoxamine
fumarate
sulfate
gluconate

AC not useful

Question 24

distinguishing feature of sympathomimetic as opposed to anticholinergic toxidrome?

Answer 24

sweating with sympathomimetic

Question 25

agent that causes 1 year old to become cyanotic, not in respiratory distress. Topical analgesic.

Answer 25

benzocaine

Question 26

Unknown ingestion with EKG findings of frequent PVCs or bidirectional v tach, junctional rhythm or afib with slow ventricular response requires what treatment?

Answer 26

digibind PVCs most common, bidirectional vtach most specific

Question 27

tx for seizures in patient who presents after unknown ingestion with EKG with widened QRS and terminal right axis deviation in lead aVR?

Answer 27

TCA overdose tx - benzos, sodium bicarb for cardio

Question 28

tx for and complication of phosgene inhalation?

Answer 28

supportive | admit - ARDS late complication

Question 29

clinical picture of patient with clonidine tox

Answer 29

hypotension, pinpoint pupils, AMS

Question 30

toxin that used to be in rat poison, causes patient to have seizure like activity in all limbs but alert?

Answer 30

strychnine - may mimic tentanus tox

Question 31

3 year old with possible medication ingestionw ith brady and glucose 40. Etiology and treatment?

Answer 31

beta blocker | tx - IV glucagon

Question 32

3 year old with possible medication ingestion with brady and glucose 200. Etiology and treatment?

Answer 32

ca channel blocker | - CaCl

Question 33

med should not b e given to patient who has ingested toluene or other halogenated or aromatic hydrocarbon

Answer 33

catecholamines

Question 34

tox ingestion presenting with hyperventilation and tinnitus

Answer 34

salicylate

Question 35

acid base abnl in salicylate poisoning

Answer 35

resp alkalosis and metabolic acidosis

Question 36

tx for rust remover who presents with hand pain

Answer 36

calcium gluconate

Question 37

tx for possible iron overdose 1 hour PTA

Answer 37

whole bowel irrigation

Question 38

tx for patient with severe tachy, HTn, fever, and agitation while on antipsych, once fluids have been started?

Answer 38

benzo

Question 39

tx for seizures in TB patient hwo may have overdosed on his medications

Answer 39

pyridoxine | - INH poisoning

Question 40

end point of tx for a patient that presents with salivation, lacrimation, urinationk, nausea, and diarrhea

Answer 40

think cholinergic | drying of secretions is endpoint for treatment

Question 41

ED treatment for bipolar patient that presents with nausea, vomiting, lethargy, and tremors

Answer 41

NS hydration for lithium tox, hemodialysis for severe tox