Psych, Substance Abuse, Poisoning Flashcards Preview

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Flashcards in Psych, Substance Abuse, Poisoning Deck (35)
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1
Q

Antidotes for cyanide poisoning include […] (preferred) or […]; alternatively nitrites may be used to induce methemoglobinemia.

A

Antidotes for cyanide poisoning include hydroxycobalamin (preferred) or sodium thiosulphate; alternatively nitrites may be used to induce methemoglobinemia.

2
Q

Antidotes for cyanide poisoning include hydroxycobalamin (preferred) or sodium thiosulphate; alternatively […] may be used to induce methemoglobinemia.

A

Antidotes for cyanide poisoning include hydroxycobalamin (preferred) or sodium thiosulphate; alternatively nitrites may be used to induce methemoglobinemia.

3
Q

Exertional heat stroke occurs in healthy individuals undergoing conditioning in extreme heat/humidity due to […].

A

Exertional heat stroke occurs in healthy individuals undergoing conditioning in extreme heat/humidity due to thermoregulation failure.

vs heat exhaustion, which is due to inadequate fluid and salt replacement

4
Q

Sodium bicarbonate alleviates the cardiotoxicity associated with TCA overdose by decreasing the drugs affinity for […].

A

Sodium bicarbonate alleviates the cardiotoxicity associated with TCA overdose by decreasing the drugs affinity for fast-acting Na+ channels.

NaHCO3 increases serum pH and extracellular sodium, which alleviates the cardio-depressant action of TCAs on sodium channels

5
Q

Treatment of salicylate intoxication includes alkalinization of the urine with […].

A

Treatment of salicylate intoxication includes alkalinization of the urine with sodium bicarbonate.

improves renal excretion

6
Q

What acid-base disturbance is associated with cyanide poisoning?

A

Metabolic acidosis

cyanide blocks cytochrome oxidase a3 in the mitochondrial ETC, thus promoting anaerobic metabolism and causing lactic acidosis

7
Q

What anti-emetic agents may cause extraparkinsonian symptoms (e.g. acute dystonia) as a possible side effect?

A

metoclopramide and prochlorperazine

other EPS include akathisia and parkinsonism; due to dopamine receptor blockade

8
Q

What antidote is frequently used to treat methanol and/or ethylene glycol poisoning?

A

Fomepizole

inhibits alcohol dehydrogenase; ethanol may be used as well

9
Q

What is the likely diagnosis in a farmer that presents to the hospital with agitation, vomiting, and watery eyes? Physical exam reveals 1 mm pupils bilaterally and increased bowel sounds.

A

Organophosphate (acetylcholinesterase inhibitor) poisoning

10
Q

What is the likely diagnosis in a group of individuals that present with headache, nausea/vomiting, and confusion after eating at an indoor barbecue? Physical examination of one patient reveals tachycardia, tachypnea, and pinkish-skin hue.

A

Carbon monoxide poisoning

diagnosis is confirmed by measuring carboxyhemoglobin levels (> 3% in non-smokers; > 10% in smokers)

11
Q

What is the likely diagnosis in a homeless patient that presents with confusion, epigastric pain, and blurred vision? Laboratory studies reveal anion gap metabolic acidosis.

A

Methanol poisoning

methanol intoxication effects the eyes (vs ethylene glycol, which effects the kidneys)

12
Q

What is the likely diagnosis in a homeless patient that presents with confusion, flank pain, and hematuria? Laboratory studies show anion gap metabolic acidosis and urine microscopy reveals calcium oxalate crystals.

A

Ethylene glycol poisoning

ethylene glycol doesn’t typically affect the eyes (vs methanol)

13
Q

What is the likely diagnosis in a middle-aged man with a history of poorly controlled HIV that presents with changes in personality and bizarre behavior? The patient also appears to have impaired attention and calculation. Brain MRI reveals a diffuse increase in intensity in the white matter.

A

HIV-associated neurocognitive dysfunction

14
Q

What is the likely diagnosis in a military recruit that collapses during training exercises on a hot, humid day? The patient is disoriented and has a fever of 105.8 F.

A

Exertional heat stroke

vs heat exhaustion, which typically presents with lower-grade fever (< 104 F) and no altered mental status

15
Q

What is the likely diagnosis in a patient brought to the ED with severe agitation and combativeness? Urine toxicology is negative. The patient is admitted and remained psychotic for one week before symptoms subsided.

A

Bath salts intoxication

PCP and cocaine intoxication may present similarly but with shorter durations of effect; additionally, PCP and cocaine are typically included in hospital urine toxicology screens

16
Q

What is the likely diagnosis in a patient that develops confusion, agitation, diaphoresis, and tremors three days after being admitted to the hospital following a motor vehicle accident? Physical exam reveals tachycardia, tachypnea, and hypertension.

A

Delirium tremens

defined by autonomic excitation, agitation, tremor, and altered sensorium 48 - 96 hours after the last drink

17
Q

What is the likely diagnosis in a patient that experiences sleep difficulties with “normal” bed times? The patient has no difficulty going to bed and waking up late (e.g. sleeping from 4 am to 12 pm).

A

Delayed sleep phase syndrome

circadian rhythm disorder characterized by inability to fall asleep at “normal” bedtimes (“night owls”);

vs.

advanced sleep phase syndrome, where patients cannot stay up late and have early morning insomnia (“early birds”)

18
Q

What is the likely diagnosis in a patient that presents with confusion and blurry vision after overdosing on an unknown medication? Physical examination reveals dry mucous membranes, decreased bowel sounds, and 8 mm pupils bilaterally.

A

Anticholinergic toxicity

“mad as a hatter, blind as a bat, dry as a bone, full as a flask, red as a beet”; may be reversed with physostigmine (cholinesterase inhibitor)

19
Q

What is the likely diagnosis in a patient that presents with heavy drooling, dysphagia, and a white tongue after being found next to an empty bottle of an unknown substance?

A

Caustic ingestion

in severe cases, perforation of the esophagus or stomach can occur, resulting in mediastinitis or peritonitis

20
Q

What is the likely diagnosis in a patient that presents with progressive worsening peripheral neuropathy? Physical exam reveals areas of hyper- and hypopigmentation, as well as hyperkeratosis. The patient restores antique furniture as a hobby.

A

Arsenic poisoning (chronic)

arsenic may be found in pressure-treated wood and insecticides; diagnosis is confirmed with elevated urine arsenic levels. Mees lines are a characteristic finding

21
Q

What is the likely diagnosis in an automobile mechanic that presents with constipation, increased forgetfulness, and peripheral neuropathy? Laboratory studies reveal microcytic anemia.

A

Lead poisoning

triad of GI, neurologic, and hematologic symptoms is classic for lead poisoning; peripheraly blood smear may reveal basophilic stippling, though this finding is not specific for lead poisoning

22
Q

What is the likely drug intoxication in a patient that presents with slurred speech, lethargy, and difficulty walking? Pupils are 5 mm and respiratory rate is 8/min.

A

benzodiazepine or alcohol overdose

lack of pupillary constriction and severe respiratory depression distinguishes benzodiazepine overdose from opioid overdose

23
Q

What is the most common cause of death in patients with TCA overdose?

A

Cardiac toxicity (e.g. ventricular arrhythmias)

24
Q

What is the next step in management for a patient that presents after ingesting twenty acetaminophen tablets two hours ago? Physical exam and laboratory studies, including LFTs, are normal.

A

administer activated charcoal and measure serum acetaminophen levels

if a single dose of > 7.5g of acetaminophen is ingested and it’s been < 4hrs since ingestion, activated charcoal should be administered

25
Q

What is the next step in management for a patient that presents with drooling and retrosternal/epigastric pain after ingesting sodium hydroxide (lye)? The patient has been decontaminated and is hemodynamically stable with a normal CXR.

A

Endoscopy

endoscopy is recommended within the first 12-24 hours to assess the severity of damage and guide further therapy

26
Q

What is the next step in management for an unresponsive patient that presents with respiratory depression and decreased bowel sounds? The patient smells of alcohol. Physical examination reveals 3 mm pupils bilaterally and a respiratory rate of 5/minute.

A

Naloxone

this patient likely has opioid intoxication (decreased respiratory rate is the most reliable and predictive sign of OI); miosis may be absent!

27
Q

What is the recommended initial management of frostbite?

A

Rapid rewarming with warm water

however, rewarming should not be attempted if there is a possibility of refreezing before definitive care can be provided

28
Q

What is the recommended treatment for anticholinergic poisoning?

A

physostigmine (cholinesterase inhibitor)

29
Q

What is the recommended treatment for carbon monoxide poisoning?

A

100% O2 or hyperbaric O2

30
Q

What is the recommended treatment for organophosphate or acetylcholinesterase inhibitor poisoning?

A

atropine +/- pralidoxime

equally important is the removal of any clothes, which may be contaminated with pesticides, and washing of skin to prevent further cutaneous absorption

31
Q

What is the treatment for arsenic toxicity?

A

Chelating agents, such as dimercaprol or DMSA

32
Q

What is the treatment of choice for acute opioid withdrawal?

A

low-dose methadone + adjunctive medications for symptoms

e.g. loperamide for diarrhea, ibuprofen for myalgias, etc…

33
Q

What is the treatment of choice for patients with alcohol withdrawal?

A

Benzodiazepines (e.g. lorazepam)

34
Q

What medication is administered to patients with suspected TCA toxicity to improve the effects of cardiac toxicity (e.g. hypotension, prolonged QRS interval, arrhythmia)?

A

Sodium bicarbonate

indicated if QRS > 100 ms or presence of arrhythmia

35
Q

What medication is administered to treat seizures in patients with suspected TCA toxicity?

A

Benzodiazepines