Poisoning Flashcards
(45 cards)
A 2-year-old child presents with vomiting, abdominal pain, and lethargy after accidentally ingesting an unknown number of iron tablets. Which of the following is the best initial investigation to assess the severity of poisoning?
A. Serum electrolytes
B. Abdominal X-ray
C. Liver function tests
D. ECG
Correct Answer: B
Explanation: Iron tablets are radiopaque, so an abdominal X-ray can help visualize the number and location of tablets in the GI tract. This is important for risk stratification and treatment decisions. Serum iron levels are helpful too but take time and are not the first-line.
A child ingests a large amount of paracetamol. After 12 hours, she remains asymptomatic. What is the most appropriate next step?
A. Gastric lavage
B. Serum paracetamol level
C. Start N-acetylcysteine immediately
D. Reassure the parents
Correct Answer: B
Explanation: After 4 hours post-ingestion, the serum paracetamol level should be measured and plotted on the Rumack-Matthew nomogram to guide antidote therapy. Asymptomatic status does not rule out hepatotoxicity.
Which of the following is a hallmark sign of organophosphate poisoning in children?
A. Dry skin and mydriasis
B. Bradycardia and salivation
C. Hyperactivity and mydriasis
D. Ataxia and tremors
Correct Answer: B
Explanation: Organophosphate poisoning causes cholinergic excess – DUMBELS (Diarrhea, Urination, Miosis, Bradycardia, Emesis, Lacrimation, Salivation). Antidote includes atropine and pralidoxime.
A 3-year-old presents after accidental kerosene ingestion. He is coughing but otherwise alert. What is the best next step?
A. Induce emesis
B. Give activated charcoal
C. Observe without inducing vomiting
D. Start antibiotics immediately
Correct Answer: C
Explanation: Hydrocarbon (kerosene) ingestion can lead to aspiration pneumonitis. Gastric decontamination is contraindicated due to aspiration risk. Observation and supportive care are mainstays unless respiratory symptoms worsen.
What is the most common electrolyte abnormality in salicylate poisoning?
A. Hypokalemia
B. Hyponatremia
C. Hyperkalemia
D. Metabolic alkalosis
Correct Answer: A
Explanation: Salicylate poisoning leads to a mixed acid-base disorder: respiratory alkalosis (early) and metabolic acidosis (late). Hypokalemia often occurs due to renal compensation and vomiting.
A 4-year-old child is brought with vomiting, lethargy, and garlic odor on breath. Pupils are constricted, and there is excessive salivation. What is the most likely toxin?
A. Lead
B. Organophosphates
C. Iron
D. Paracetamol
Correct Answer: B
Explanation: Organophosphate poisoning causes cholinergic symptoms including miosis, bradycardia, salivation, lacrimation, and a garlic odor. It requires immediate treatment with atropine and pralidoxime.
A 5-year-old child presents with headache, cherry red skin, and confusion. Which poisoning is most likely?
A. Cyanide
B. Lead
C. Carbon monoxide
D. Methanol
Correct Answer: C
Explanation: Carbon monoxide poisoning presents with headache, cherry-red skin (classic but rare), and CNS symptoms. Treatment is 100% oxygen or hyperbaric oxygen if severe.
A child with a history of pica presents with irritability, abdominal pain, and anemia. What is the most likely diagnosis?
A. Iron poisoning
B. Lead poisoning
C. Zinc deficiency
D. Mercury toxicity
Correct Answer: B
Explanation: Lead poisoning classically presents with microcytic anemia, abdominal pain (lead colic), and neurocognitive issues. Pica is a risk factor due to ingestion of lead-containing materials.
Which of the following is a common complication of methanol poisoning?
A. Pulmonary edema
B. Optic neuropathy and blindness
C. Renal failure
D. Hyperkalemia
Correct Answer: B
Explanation: Methanol poisoning primarily affects the optic nerve leading to visual disturbances and possible blindness. It also causes metabolic acidosis. Treatment includes fomepizole or ethanol and bicarbonate.
A child with iron overdose enters the second stage of toxicity. What is the expected clinical picture?
A. Gastrointestinal bleeding
B. Seizures and coma
C. Transient improvement
D. Hepatic failure
Correct Answer: C
Explanation: Iron poisoning has 5 stages. The second stage is deceptively benign with transient clinical improvement before systemic toxicity sets in (shock, acidosis, hepatic failure).
A child is brought with pinpoint pupils, respiratory depression, and unconsciousness. Which of the following is the most likely cause?
A. Organophosphate poisoning
B. Opioid overdose
C. Benzodiazepine toxicity
D. Atropine toxicity
Correct Answer: B
Explanation: Opioid toxicity classically presents with the triad of miosis (pinpoint pupils), respiratory depression, and CNS depression. Naloxone is the antidote.
A toddler ingested his father’s phenytoin tablets. He now presents with ataxia, horizontal nystagmus, and slurred speech. What is the most likely cause?
A. Valproate toxicity
B. Iron poisoning
C. Phenytoin toxicity
D. Lead poisoning
Correct Answer: C
Explanation: Phenytoin toxicity presents with cerebellar signs like ataxia, nystagmus, and slurred speech. Severe cases may lead to coma and require supportive care.
Which of the following poisonings is associated with an anion gap metabolic acidosis and visual disturbances?
A. Carbon monoxide
B. Methanol
C. Salicylates
D. Lead
Correct Answer: B
Explanation: Methanol poisoning causes an anion gap metabolic acidosis and is classically associated with blurred vision and optic nerve toxicity.
A 3-year-old child develops seizures after ingesting an unknown substance. Which poisoning should be suspected if there is also metabolic acidosis and a characteristic odor of bitter almonds?
A. Organophosphate
B. Iron
C. Cyanide
D. Paracetamol
Correct Answer: C
Explanation: Cyanide poisoning presents with seizures, cardiovascular collapse, metabolic acidosis, and a bitter almond odor. It inhibits cellular respiration by blocking cytochrome oxidase.
Which of the following treatments is most appropriate for benzodiazepine overdose with respiratory depression?
A. Naloxone
B. Flumazenil
C. Activated charcoal
D. Gastric lavage
Correct Answer: B
Explanation: Flumazenil is a specific antagonist of benzodiazepine receptors and can reverse CNS depression. Use with caution as it may precipitate seizures, especially in mixed overdose.
A child presents with muscle twitching, hypertension, and excessive salivation after a scorpion sting. What is the most appropriate initial treatment?
A. IV steroids
B. Antibiotics
C. Prazosin
D. Atropine
Correct Answer: C
Explanation: Scorpion venom causes an autonomic storm (parasympathetic then sympathetic). Prazosin, an alpha-blocker, is the drug of choice to counteract the sympathetic overdrive.
Which of the following is a characteristic finding of snakebite envenomation by a viper in children?
A. Neurotoxicity and ptosis
B. Hemorrhagic manifestations and DIC
C. Paralysis and respiratory failure
D. No systemic effects
Correct Answer: B
Explanation: Viper bites commonly cause local tissue damage, coagulopathy, hematuria, and disseminated intravascular coagulation (DIC). Antivenom and supportive care are critical.
A child with a history of exposure to an old house has developmental delay, anemia, and wrist drop. What is the most likely diagnosis?
A. Zinc deficiency
B. Lead poisoning
C. Iron deficiency
D. Copper toxicity
Correct Answer: B
Explanation: Lead poisoning can cause CNS symptoms, microcytic anemia, and peripheral neuropathy such as wrist drop. Exposure from old paints or pipes is a common cause.
A toddler is brought with drooling, refusal to eat, and severe oropharyngeal burns. What is the most likely ingested agent?
A. Kerosene
B. Paracetamol
C. Caustic alkali (e.g., drain cleaner)
D. Iron tablets
Correct Answer: C
Explanation: Caustic alkali ingestion causes liquefactive necrosis leading to oropharyngeal burns and drooling. Endoscopy is needed within 24 hours to assess esophageal damage.
A child with suspected mercury poisoning presents with tremor, emotional lability, and gingivitis. Which of the following is the best confirmatory test?
A. Serum mercury level
B. Urinary mercury level
C. Hair mercury level
D. MRI brain
Correct Answer: B
Explanation: Urinary mercury levels are the best test to confirm chronic mercury exposure. Mercury toxicity can affect the nervous system and mucous membranes.
A 6-year-old child is brought after ingesting several of his grandfather’s amitriptyline tablets. He is drowsy, has a wide QRS on ECG, and has had a seizure. What is the most appropriate treatment?
A. Sodium bicarbonate
B. Activated charcoal
C. Flumazenil
D. Naloxone
Correct Answer: A
Explanation: Tricyclic antidepressant (TCA) overdose causes anticholinergic effects, seizures, and cardiac arrhythmias. Sodium bicarbonate is used to narrow the QRS and prevent ventricular arrhythmias.
A toddler is found with an open bottle of bleach. He has oropharyngeal burns and is drooling. What is the most appropriate next step?
A. Induce emesis
B. Give activated charcoal
C. Immediate endoscopy
D. Reassurance and discharge
Correct Answer: C
Explanation: Caustic ingestion from bleach or drain cleaners requires early endoscopy (within 24 hours) to assess the extent of esophageal damage. Inducing emesis is contraindicated.
A child presents with CNS depression, high anion gap metabolic acidosis, and calcium oxalate crystals in urine. Which of the following substances was likely ingested?
A. Methanol
B. Ethylene glycol
C. Iron
D. Salicylates
Correct Answer: B
Explanation: Ethylene glycol (antifreeze) poisoning presents with CNS depression, anion gap acidosis, and renal toxicity marked by calcium oxalate crystals in urine. Treated with fomepizole or ethanol.
Which of the following clinical features is most typical of anticholinergic poisoning (e.g., diphenhydramine overdose)?
A. Bradycardia and pinpoint pupils
B. Hyperthermia, dry skin, dilated pupils
C. Profuse salivation and diarrhea
D. Constriction of pupils and sweating
Correct Answer: B
Explanation: Anticholinergic toxidrome includes hyperthermia, flushed skin, dry mouth, urinary retention, and mydriasis (dilated pupils). Classic mnemonic: “Dry as a bone, red as a beet, blind as a bat, mad as a hatter.”
