Toxicology

Question 1

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

Answer 1

salicylate poisoning

Question 2

classic blood gas abnml with salicylate poisoning

Answer 2

metabolic acidosis + respiratory alkalosis

Question 3

key difference in presentation between ethylene glycol and methanol poisonings

Answer 3

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

Question 4

toxic alcohol resulting in blindness

Answer 4

methanol

Question 5

toxic alcohol resulting in renal failure

Answer 5

ethylene glycol

Question 6

radiopaque toxins (5)

Answer 6

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

Question 7

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

Answer 7

ions/metals
acids/bases
alcohols

Question 8

this common household object can be 17% EtOH

Answer 8

mouthwash

Question 9

toxin that smells like rotten eggs

Answer 9

hydrogen sulfide

Question 10

toxin that smells like almonds

Answer 10

cyanide

Question 11

toxin that smells like garlic

Answer 11

arsenic

Question 12

Morning Glory poisoning symptoms

Answer 12

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

Question 13

Treatment to reduce thyroid uptake of radioactive iodine?

Answer 13

Potassium iodine

Question 14

Fish associated with scombroid poisoning?

Answer 14

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

Question 15

Fish associated with cigautera poisoning?

Answer 15

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

Question 16

bidirectional v tach is pathognomic for what toxicity?

Answer 16

digoxin toxicity

Question 17

digoxin toxicity causes what characteristic, unique EKG abnormality?

Answer 17

bidirectional v tach

Question 18

what is unique about digoxin toxicity related hyperkalemia?

Answer 18

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

Question 19

what is the treatment for digoxin toxicity?

Answer 19

atropine
digiFab
mag, potassium
consider PHYT, lidocaine

Question 20

first lab abnml in radiation poisoning

Answer 20

leukopenia

Question 21

treatment for cesium radiation poisoning

Answer 21

prussian blue

Question 22

EKG findings in TCA OD

Answer 22

sinus tach, prolonged PR, QRS, and QT intervals

Question 23

Symptoms of scorpion sting

Answer 23

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

Question 24

envenomation associated with metallic taste

Answer 24

rattlesnake

Question 25

systemic symptoms of brown recluse spider bite

Answer 25

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

Question 26

fish that cause scombroid

Answer 26

tuna, mackerel, and bonito

Question 27

fish that cause ciguatera

Answer 27

barracuda, grouper, and snapper

Question 28

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

Answer 28

opioids - may interact with toxin and cause hypotension

Question 29

toxic dose of acetaminophen?

Answer 29

150mg/kg in adults | 200-250mg/kg in kids

Question 30

toxicity of ethelyne glycol vs methanol?

Answer 30

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

Question 31

normal serum osmolality

Answer 31

285-295

Question 32

treatment of organophosphate poisoning

Answer 32

atropine if wet/killer Bs | pralidoxime for for weakness (works at nicotinic skeletal muscle receptors)

Question 33

Coral snake vs king snake?

Answer 33

red on black, venom lack; | red on yellow, kill a fellow.

Question 34

ricin poisoning

Answer 34

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

Question 35

Tularemia: symptoms and treatment

Answer 35

fever, malaise, pneumonia | tx: streptomycin, doxy, cipro

Question 36

aerosolized toxin that smells of "newly mown hay"? symptoms?

Answer 36

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

Question 37

inhalational anthrax - presentation

Answer 37

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

Question 38

inhalational anthrax ppx

Answer 38

cipro or doxy

Question 39

staph enterotoxin b symptoms

Answer 39

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

Question 40

pneumonic plague symptoms

Answer 40

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.

Question 41

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.

Answer 41

pneumonic plague

Question 42

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

Answer 42

staph enterotoxin b

Question 43

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

Answer 43

inhalational anthrax

Question 44

treatment of plague | ppx?

Answer 44

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

Question 45

what is hydrogen sulfide

Answer 45

mustard gas | causes superficial skin burns, eye irritation, and resp tract irritation

Question 46

ingestions where multidose activated charcoal may be helpful?

Answer 46

phenobarbital, carbamazepine, theophylline, and dapsone

Question 47

carbamezepine toxicity

Answer 47

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

Question 48

symptoms and management of hydrofluoric acid burns?

Answer 48

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

Question 49

Symptoms of lithium toxicity

Answer 49

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

Question 50

Amanita phalloides ingestion

Answer 50

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

Question 51

ectasy/MDMA intoxication

Answer 51

hyponatremia, concentrated urine, altered mental status | may see serotonin syndrome

Question 52

toxic alcohol resulting in large ketosis

Answer 52

isopropyl alcohol

Question 53

toxins causing miosis

Answer 53

``` COPS cholinergics/clonidine opiates phenothiazines sedatives ```

Question 54

toxins causing mydriasis

Answer 54

``` AAAs antihistamines anticholinergics atropine sympathomimetics ```

Question 55

toxins causing hypoglycemia

Answer 55

``` HOBBIES hypoglycemics oral hypoglycemics beta blockers insulin ethanol salicylates ```

Question 56

nerve agents

Answer 56

sarin and venom x (VX) | act as organophosphates