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PEM Board Review > Toxicology > Flashcards

Toxicology Flashcards

Toxicology from these resources: AAP PREP:EM course

1
Q

If you see metabolic acidosis + respiratory alkalosis, you should think of this poisoning

A

salicylate poisoning

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2
Q

classic blood gas abnml with salicylate poisoning

A

metabolic acidosis + respiratory alkalosis

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3
Q

key difference in presentation between ethylene glycol and methanol poisonings

A

ethylene glycol: results in oxalic crystals in the urine and hurts the kidneys
methanol: results in formic acid and causes blindness

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4
Q

toxic alcohol resulting in blindness

A

methanol

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5
Q

toxic alcohol resulting in renal failure

A

ethylene glycol

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6
Q

radiopaque toxins (5)

A

COINS
1. chloral hydrate
2. opiate packets
3. iron and Hg, As, Li, Ca
4. neuroleptics
5. SR/enteric coated meds
also solvents like CCl4

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7
Q

poisonings that activated charcoal won’t work for (3)

A

ions/metals
acids/bases
alcohols

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8
Q

this common household object can be 17% EtOH

A

mouthwash

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9
Q

toxin that smells like rotten eggs

A

hydrogen sulfide

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10
Q

toxin that smells like almonds

A

cyanide

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11
Q

toxin that smells like garlic

A

arsenic

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12
Q

Morning Glory poisoning symptoms

A

hallucinations, mydriasis, perspiration, bronchorrhea, salivation, hyper or hypothermia, diarrhea

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13
Q

Treatment to reduce thyroid uptake of radioactive iodine?

A

Potassium iodine

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14
Q

Fish associated with scombroid poisoning?

A

tuna, mackerel, bonito, mahi-mahi, bluefish, sardines, anchovies

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15
Q

Fish associated with cigautera poisoning?

A

barracuda, snapper, grouper, amberjack, moray eels, triggerfish, parrotfish

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16
Q

bidirectional v tach is pathognomic for what toxicity?

A

digoxin toxicity

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17
Q

digoxin toxicity causes what characteristic, unique EKG abnormality?

A

bidirectional v tach

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18
Q

what is unique about digoxin toxicity related hyperkalemia?

A

do NOT give calcium - it can cause a “stone heart” from excessive intracellular calcium and cardiac tetany

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19
Q

what is the treatment for digoxin toxicity?

A

atropine
digiFab
mag, potassium
consider PHYT, lidocaine

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20
Q

first lab abnml in radiation poisoning

A

leukopenia

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21
Q

treatment for cesium radiation poisoning

A

prussian blue

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22
Q

EKG findings in TCA OD

A

sinus tach, prolonged PR, QRS, and QT intervals

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23
Q

Symptoms of scorpion sting

A

local pain, restlessness, hyperactivity, roving eye movements, and respiratory distress. More severe signs include seizures, drooling, wheezing, hyperthermia, cyanosis, GI hemorrhage, respiratory distress and death from shock or respiratory paralysis

24
Q

envenomation associated with metallic taste

A

rattlesnake

25
Q

systemic symptoms of brown recluse spider bite

A

fever, chills, malaise, weakness, nausea, vomiting, joint pain, petechial morbilliform rash, intravascular hemolysis, hematuria, and renal failure

26
Q

fish that cause scombroid

A

tuna, mackerel, and bonito

27
Q

fish that cause ciguatera

A

barracuda, grouper, and snapper

28
Q

what do you need to avoid when treating a patient with ciguatera poisoning?

A

opioids - may interact with toxin and cause hypotension

29
Q

toxic dose of acetaminophen?

A

150mg/kg in adults

200-250mg/kg in kids

30
Q

toxicity of ethelyne glycol vs methanol?

A

ethylene glycol: metabolized into oxalic acid, will crystals in urine and possible ARF
methanol: metabolized into formic acid, injures the eyes

31
Q

normal serum osmolality

A

285-295

32
Q

treatment of organophosphate poisoning

A

atropine if wet/killer Bs

pralidoxime for for weakness (works at nicotinic skeletal muscle receptors)

33
Q

Coral snake vs king snake?

A

red on black, venom lack;

red on yellow, kill a fellow.

34
Q

ricin poisoning

A

inhalational: sudden onset of fever, chest tightness, cough, dyspnea, nausea, and arthralgias, progressing to cyanosis, pulmonary edema and respiratory failure

35
Q

Tularemia: symptoms and treatment

A

fever, malaise, pneumonia

tx: streptomycin, doxy, cipro

36
Q

aerosolized toxin that smells of “newly mown hay”? symptoms?

A

phosgene - ocular and nasal irritation, resp symptoms, pulmonary edema

37
Q

inhalational anthrax - presentation

A

initial mild symptoms followed by abrupt onset resp distress, cyanosis, diaphoresis 1-6 days later. may see widened mediastinum on CXR.

38
Q

inhalational anthrax ppx

A

cipro or doxy

39
Q

staph enterotoxin b symptoms

A

sudden onset of fever, chills, headache, myalgias and nonproductive cough

40
Q

pneumonic plague symptoms

A

The initial presentation includes respiratory symptoms, fever, cough and myalgia. The clinical course is rapidly progressive with bloody sputum, dyspnea, cyanosis, circulatory collapse and a bleeding diathesis.

41
Q

The initial presentation includes respiratory symptoms, fever, cough and myalgia. The clinical course is rapidly progressive with bloody sputum, dyspnea, cyanosis, circulatory collapse and a bleeding diathesis.

A

pneumonic plague

42
Q

toxin with sudden onset of fever, chills, headache, myalgias and nonproductive cough

A

staph enterotoxin b

43
Q

initial mild symptoms followed by abrupt onset resp distress, cyanosis, diaphoresis 1-6 days later. may see widened mediastinum on CXR.

A

inhalational anthrax

44
Q

treatment of plague

ppx?

A

tx: doxy or streptomycin or cipro
ppx: doxycycline or cipro

45
Q

what is hydrogen sulfide

A

mustard gas

causes superficial skin burns, eye irritation, and resp tract irritation

46
Q

ingestions where multidose activated charcoal may be helpful?

A

phenobarbital, carbamazepine, theophylline, and dapsone

47
Q

carbamezepine toxicity

A

can cause resp compromise, altered mental status, vomiting, drowsiness, slurred speech, nystagmus, hallucinations, hypotension, coma, dystonic reactions, seizures
has some anticholinergic properties
false positive for TCAs on UDS

48
Q

symptoms and management of hydrofluoric acid burns?

A

used in glass etching, metal cleaning, and electronics manufacturing
hypocalcemia, hypomag, and hyperkalemia
treat with topical, intra-arterial, IV calcium gluconate

49
Q

Symptoms of lithium toxicity

A

coarse tremor, ataxia, dysarthria, vomiting, diarrhea, cardiovascular changes and renal dysfunction.
Later signs: impaired consciousness, muscle fasciculations, myoclonus, seizures, coma and death.

50
Q

Amanita phalloides ingestion

A

white mushroom that can kill. classically:
stage I: 6-24hrs of no sxs
II: V/D 12-24hrs
III: seeming recovery
IV: 2-4d later with liver and renal failure

51
Q

ectasy/MDMA intoxication

A

hyponatremia, concentrated urine, altered mental status

may see serotonin syndrome

52
Q

toxic alcohol resulting in large ketosis

A

isopropyl alcohol

53
Q

toxins causing miosis

A 
COPS
cholinergics/clonidine
opiates
phenothiazines
sedatives
54
Q

toxins causing mydriasis

A 
AAAs
antihistamines
anticholinergics
atropine
sympathomimetics
55
Q

toxins causing hypoglycemia

A 
HOBBIES
hypoglycemics
oral hypoglycemics
beta blockers
insulin
ethanol
salicylates
56
Q

nerve agents

A

sarin and venom x (VX)

act as organophosphates

PEM Board Review (8 decks)

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