Toxicology

Question 1

o Inherent ability of a substance to cause harm, injury,
or death to a biologic material

Answer 1

TOXICITY

Question 2

Any agent that is capable of producing deleterious or
harmful effects in biological system, seriously injuring
function or producing death

Answer 2

POISON

Question 3

Bradycardic
Hypothermic
Bradypneic

Answer 3

Alcohol

Question 4

Tachypneic
Hyperthermic

Answer 4

Salicylates

Question 5

Hyperthermic
Hypertensive

Answer 5

Nicotine

Question 6

BITTER ALMOND

Answer 6

Cyanide

Question 7

PEARS

Answer 7

Chloral hydrate

Question 8

Garlic smell

Answer 8

Organophosphate, arsenic

Question 9

Oil of wintergreen

Answer 9

Methylsalicylate

Question 10

Fruity

Answer 10

DKA, isopropanolol

Question 11

in seizure that can’t be medicated
by the usual anticonvulsants

Answer 11

Isoniazid overdose INTRACTABLE SEIZURES

Question 12

HEMATEMESIS

Answer 12

Iron ingestions

Question 13

PROTRACTED COUGHING o

Answer 13

Hydrocarbon

Question 14

INABILITY TO SWALLOW
or drooling

Answer 14

Caustic

Question 15

Meclizine, Promethazine

Answer 15

ANTIEMETICS/ANTIDIZINESS

Question 16

ANTIDEPRESSANTS

Answer 16

Imipramine, Nortryptyline

Question 17

ANTIARRHYTHMICS

Answer 17

Quinidine, Procainamide

Question 18

ANTIPSYCHOTICS

Answer 18

Chlorpromazine, Clozapine

Question 19

ANTIHISTAMINE

Answer 19

Diphenhydramine, Hydroxyzine

Question 20

Very evident in young adults who presents with hypertension and
tachycardia and looks agitated

Answer 20

DRUGS WITH SYMPATHOMIMETIC EFFECTS DRUGS

Question 21

Consciousness: depressed
Pupils: pinpoint
Respiration: depressed

And hypotension, bradycardia

Answer 21

OPIOID SYNDROME (CPR – TRIAD)

Question 22

SIGNS AND SYMPTOMS of DRUGS WITH SYMPATHOMIMETIC EFFECTS

Answer 22

Goosebumps
• Delusions/Paranoia • Pupil dilation
Temperature • Seizures • Sweating • Hypertension
Tachycardia

Question 23

o For Phenothiazine overdose(+) Blue/deep purple – when sulfuric acid and
ferric chloride to 2ml of patient’s acidified urine

Answer 23

FORREST TEST

Question 24

Brown urine

Answer 24

Chloroquine

Question 25

ORANGE TO RED ORANGE

Answer 25

o Rifampin, Mercury, Chronic lead poisoning

Question 26

Copper sulfate or Methylene blue, what urine color?

Answer 26

Greenish blue

Question 27

Pink urine

Answer 27

Ampicillin or Cephalosporin

Question 28

Agents potentially visible on abdominal radiographs (COINS):

Answer 28

Chloral hydrate, cocaine packets, calcium o Opium packets o Iron, other heavy metals such as lead, arsenic, mercury o Neuroleptic agents o Sustained-release or enteric-coated agents (salicylate)

Question 29

METABOLIC ACIDOSIS, elevated anion gap

Answer 29

Methanol, metformin • Cyanide, carbon monoxide Ethylene glycol • Isoniazid, iron • Toluene • Diabetic ketoacidosis • Alcoholic ketoacidosis • Generalized seizure-producing • Lactic acidosis toxins • Aminoglycosides, other uremic • ASA or other salicylates agents • Paraldehyde, phenformin

Question 30

initial dose of 400mcg IV every 3mins or 10-100 mcg/kg/dose IV, IM, SC every 3 minutes for 3 doses

Answer 30

Naloxone

Question 31

100mg IV followed by D50-50 50-100ml o For possible alcohol intoxication to prevent Wernicke’s encephalopathy

Answer 31

Thiamine: (Vitamin B complex if pure thiamine not available)

Question 32

In organophosphate poisoning, presence of muscle weakness/fasciculations requires which antidote?

Answer 32

Pralidoxime As atropine has no effect on the neuromuscular junction and muscle weakness, oximes are used clinically to reverse neuromuscular blockade by reactivating the inhibited acetylcholinesterase before aging. Benzodiazepines for patients with agitation and seizures

Question 33

You have a 23 years old male coming in at the ED with complaints of difficulty of breathing after ingestion of an unknown substance. What will be your first step in the management of this patient? a. Get Adequate History b. Secure Venous access and initiate hydration C. Give Antidote D. Maintain Adequate Airway

Answer 33

Resuscitation is the first priority in any poison patient

Question 34

Miosis

Answer 34

opioids, organophosphates, phenothiazines, clonidine intoxication)

Question 35

Nystagmus/ataxia

Answer 35

anticonvulsant and ethanol toxicity

Question 36

Bronchorrhea/crepitations/hypoxia

Answer 36

organophosphate toxicity

Question 37

Hypersalivation

Answer 37

cholinergic toxidrome

Question 38

Tremor/fasciculations

Answer 38

lithium toxicity

Question 39

Lead pipe” rigidity

Answer 39

neuromuscular malignant syndrome)

Question 40

Flushing/warm, dry skin

Answer 40

anticholinergic toxicity

Question 41

Warm, moist skin

Answer 41

sympathomimetic toxicity

Question 42

Activated charcoal dose

Answer 42

Adults 50 grams orally, children 1 gram/kg orally

Question 43

Multidose activated charcoal

Answer 43

Initial dose: 50 grams (1 gram/kg children), repeat dose of 25 grams (0.5 gram/kg children) every 2 hours

Question 44

Causes bradypnea

Answer 44

Sedative-hypnotics (barbiturates, BZD) Liquor -alcohol Opioids Marijuana

Question 45

Hypotension Brdypnea Hypothermia

Answer 45

Sedative-hypnotics

Question 46

Hypertensive toxins/drugs

Answer 46

Cocaine Thyroid supplements Sympathomimetics Caffeine Anticholinergics, amphetamines, Nicotine (also causes tachycardia except nicotine which causes hyperthermia)

Question 47

Tachypneic Tachycardia

Answer 47

PCP

Question 48

Hyperthermic but hypotensive

Answer 48

Antidepressants

Question 49

Hypothermics

Answer 49

CO2 Oral hypoglycemics, insulin Liquor (all low except BP) Sedative-hypnotics (all low except HR) Also bradypneic, bradycardic (propoxyphene, physostigmine), hypotensive(heroin): Opioids

Question 50

Rodenticides containing arsenic, cyanide causes

Answer 50

Hypotension

Question 51

Cholinergic effects Organophosphate/carbamate pesticides

Answer 51

D - diarrhea U - urination M - miosis, muscle fasc B - bradycardia, bronchoconst, bronchorrhea E - emesis L - lacrimation L - lethargy S - salivation

Question 52

Commonly used pesticides

Answer 52

Malathion Parathion Diazinon Trichlorfon