Poisoining med + surg

Question 1

A drug withdrawal syndrome should be considered in a patient with acute agitation in an otherwise uncomplicated hospital stay.

hallucinations, tremulousness/restlessness, delirium, siezures, in a patient with history of anxiety is concerning for?

Answer 1

benzodiazepine withdrawal

Question 2

snake bite treatment?

Answer 2

mild localized swelling = observation

pronounced swelling, echymosis, abnormal coagulation eg oozing, hypotension = crotalidae polyvalent immune fab!!!!!! (antivenom)

Question 3

Other incorrects filed under female and male repro accidentally

Question 4

67 yo man. multiple myeloma. Altered mental status. takes morphine sulfate. labs show raised creatinine and BUN (renal insufficiency in keeping with MM). and low sodium. most likely explantation for AMS?

Answer 4

Accumulation of drug metabolite!!! = morphine

hyponatremia was not severe enough and MM causes psuedohyponatremia

Question 5

IV drug user with infective endocarditis in hospital. AMS. becomes somnolent. pupils are 1mm bilaterally. patient can move all extremities and reflexes normal. next step in management?

Answer 5

administer naloxone!! -> opiod intoxication!!!

NOT stroke as you would expect paralysis and typically normal pupils

Question 6

left arm cellulitis and needle marks. on iv antibiotics. now experiencing nasal congestions, nausea, abdominal cramps, multiple episodes of vomiting and loose stools. aching muscles and joints

next best step in management?

Answer 6

subcutaneous buprenorphine!!! OR methadone!!

opioid withdrawal!!

Question 7

sudden collapse after exercise without LOC =?

Answer 7

exercise associated postural htn

Question 8

beta blocker overdose signs?

Answer 8

hypotension, bradycardia, hypoglycemia!!!!

also AMS, bronchospasm, siezures may occur

Question 9

74 YO
confused
ringing in ears
signs of salicilate posisoning
AKI
lung auscultation reveals bilateral crackles

next step in management?

Answer 9

Hemodialysis!!!

indicated if there is:
-> renal failure/ESRD!!
-> salicylate induced pulmonary edema !!
-> AMS!!!
-> Refractory acidosis

if all this is not present, the first line treatment. = IV sodium bicarb!!! NOT acetazolamide

activated charcoal only given within first 2 hours, and for acute ingestion not chronic eg from using a topical salicilate. dont used in confused or obtunded people