Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

USMLE Step 3 > Emergency Medicine/Toxicology > Flashcards

Emergency Medicine/Toxicology Flashcards

1
Q

What is the most important step for an acute change in mental status of unclear etiology (e.g. after suicide attempt)?

A
  • antidotes (e.g. naloxone, dextrose, thiamine)

- On a CCS case, also give O2 and saline while checking tox screen (all at same time)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When do I answer “gastric emptying?”

A

the answer is almost ALWAYS wrong, only useful in 1st hour after OD (removes ~50% of pills); you can NEVER do this when caustics (acids and alkalis) have been ingested

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Is ipecac ever the right answer?

A

It seems like likely not (and especially not in pt w/ AMS and kids)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When can intubation and lavage be performed?

A

rarely; only done if pt has ingested the substance w/i last 1-2 hours and there is NO response to naloxone, thiamine, and dextrose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When do I give charcoal?

A

just give it, no harm; will help in most OD cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the “overdose case menu” in CCS OD cases?

A
  • specific antidote if etiology clear
  • tox screen
  • charcoal
  • CBC, BMP, U/A
  • psych consult if OD result of suicide attempt
  • O2 for CO poisoning or any dyspneic patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the antidote for acetaminophen?

A

N-acetyl cysteine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the antidote for ASA?

A

bicarbonate to alkalinize the urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the antidote for benzodiazepines?

A

do NOT give flumazenil; may precipitate a SZ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the antidote for carbon monoxide?

A

100% O2; hyperbaric in some cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the antidote for digoxin?

A

digoxin-binding antibodies (in severe disease i.e. CNS and cardiac abnormalities)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the antidote for ethylene glycol?

A

fomepizole or ethanol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the antidote for methanol?

A

fomepizole or ethanol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the antidote for methemoglobinemia?

A

methylene blue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the antidote for neuroleptic malignant syndrome?

A

bromocriptine, dantrolene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the antidote for opiates?

A

naloxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the antidote for organophosphates?

A

atropine, pralidoxime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the antidote for tricyclic antidepressants?

A

bicarbonate protects the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the clinical course of acetaminophen OD?

A
  • 1st 24 hours: N/V, which resolve

- 48-72 hrs: hepatic failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

For how long is N-acetyl cystine useful to prevent liver toxicity from acetaminophen OD?

A

24 hours; after that, it is useless and there is no specific tx to prevent/reverse toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How can you give NAC in acetaminophen OD pt who is vomiting?

A

NAC IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What blood level of acetaminophen is toxic? Fatal?

A

10 g; 15 g (lower if underlying liver disease or alcohol abuse)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What physical exam findings are present in ASA/salicylate overdose?

A

hyperventilation but NO DYSPNEA (stimulant to brainstem), tinnitus, +/- confusion, fever, seizures, coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What lab findings do you see in ASA/salicylate OD?

A

metabolic acidosis w/ elevated anion gap, respiratory alkalosis (precedes metabolic acidosis), renal insufficiency (ASA directly toxic to kidneys), elevated PT (ASA interferes with Vit K-dependent clotting factors)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What do you order in ASA/salicylate OD pt?
- CBC - BMP - ABG - PT/INR/PTT - salicylate (ASA) level
26
Tx for ASA/salicylate OD?
- alkalinize the urine with D5W w/ 3 amps of bicarbonate - charcoal - dialysis in severe cases
27
What substances does alkalinization of the urine help facilitate excretion of?
- salicylates (ASA) - TCAs - phenobarbital - chlorpropamide (sulfonylurea used to treat T2DM)
28
Tx for benzodiazepine OD?
Let the patient sleep! Benzos by themselves are not fatal. The OD will pass. Do not administer flumazenil in the ED - you do not know who has chronic dependency and you do not want to precipiate a withdrawal and SZs.
29
What are the presenting sxs of CO poisoning?
SOB, lightheadedness/HA, disorientation, metabolic acidosis from tissue hypoxia
30
How does digoxin poisoning most commonly present?
GI disturbance (N/V, diarrhea, pain), +/- pt seeing "yellow halos" around objects, blurred vision, arrhythmias, encephalopathy
31
What lab abnormality is seen in digoxin poisoning?
hyperkalemia (poisoning of Na+/K+ ATPase)
32
What lab abnormality is common to both ethylene glycol and methanol OD?
metabolic acidosis with increased anion gap
33
What organ system does ethylene glycol OD particularly affect?
kidney (renal insufficiency from direct toxicity, hypocalcemia from precipitation of oxalic acid w/ Ca2+, kidney stones) Also causes rapid and deep breathing (Kussmaul's respirations), N/V, slurred speech, ataxia, nystagmus, lethargy
34
What organ system does methanol OD particularly affect?
eyes (visual disturbance, retinal hyperemia from toxicity of formic acid)
35
How are ethylene glycol and methanol OD treated?
- fomepizole (antidote of choice; inhibitor of ADH) | - dialysis to remove them from the body before they are metabolized into the toxic metabolite
36
Physiologically, what happens in methemoglobinemia?
hemoglobin is locked in an oxidized state that will not allow it to pick up oxygen
37
How does methemoglobinemia present?
cyanosis, SOB, dizziness, HA, confusion, SZs
38
What drugs can precipitate methemoglobinemia?
nitrates, anesthetics, dapsone, other oxidants, any of the drugs ending in -caine (lidocaine, benzocaine, bupivacaine), nitroglycerin
39
Dx of methemoglobinemia?
- normal pO2 on ABG with chocolate-brownish blood (oxidized blood) - methemoglobin level
40
Tx of methemoglobinemia?
100% O2, methylene blue restores the hemoglobin to its normal state
41
What will usually be in the history of a patient with neuroleptic malignant syndrome?
ingestion of neuroleptic meds (e.g phenothiazines)
42
Lab abnormalities in NMS?
CPK and K+ can be elevated
43
Physical exam findings in NMS?
muscle rigidity
44
What is usually in history of pt with malignant hyperthermia?
h/o anesthetic use
45
Tx of malignant hyperthermia?
dantrolene
46
Tx of heat stroke?
physical removal of heat from body (spray patient with water and fan patient in air conditioned room or use ice baths/packs); do NOT infuse iced saline into body - this can stop the heart
47
Why do people die in opiate OD?
death from respiratory depression
48
Mechanism in organophosphate poisoning?
inhibition of acetylcholinesterase
49
What should you look for in hx with organophosphate poisoning?
- crop duster exposed to insecticides | - nerve-gas attack
50
What are presenting sxs in organophosphate poisoning?
salivation, lacrimation, urination, diarrhea, wheezing from bronchospasm, bradycardia, skin flushing, miosis, garlic-like odor on clothes
51
Tx of organophosphate poisoning?
- best initial tx: atropine - most effective tx: pralidoxime - remove the clothes and wash the rest off the patient
52
Death from TCA overdose occurs from what?
seizures, arrhythmias
53
If you suspect TCA OD in a patient, what is the first step?
EKG --> if widened QRS, give bicarbonate (otherwise, don't)
54
What are the physical exam findings in TCA OD?
dilated pupils, dry mouth, dry skin, constipation, urinary retention (anticholinergic effects)
55
Presenting sxs of black widow spider bite?
abdominal pain, rigidity, hypocalcemia, pain WITHOUT tenderness
56
Tx of black widow spider bite?
antivenin
57
Presenting sxs of brown recluse spider?
local necrosis, bullae, dark lesions
58
Tx of brown recluse spider bite?
debride the wound
59
What is the 1st step in a burn patient?
100% O2! (most common cause of death is CO poisoning)
60
After 100% O2 administration, what do you do next for a burn pt?
look for hoarseness, wheezing, stridor, burns inside the nose or mouth - if none, give fluids (4 mL LR or NS for each % w/ a 2nd or 3rd degree burn for each kilogram)
61
What is the most common cause of death later on for a burn patient?
infection
62
How does hypothermia kill?
arrhythmias (J waves of Osborn, look like ST elevation, on EKG)
63
How does acute angle closure glaucoma present?
red eye, fixed midpoint pupil
64
Tx of acute angle closure glaucoma?
``` pilocarpine drops (to constrict pupil) -other therapies = acetazolimide (decreases production of aqueous humor), prostaglandin analogues (latanoprost, travoprost), beta blockers topically (timolol), alpha agonists (apraclonidine) ```
65
How does retinal detachment present?
sudden loss of vision "like a curtain coming down"
66
Tx of retinal detachment?
- consult ophthalmology, perform dilated retinal exam | - reattach by: tilting head back, reattach w/ surgery, cryotherapy, by injecting expansile gas into eye
67
Presentation of conjunctivitis?
- viral: bilateral watery discharge, itchy eyes | - bacterial: unilateral purulent discharge, eyelids stuck together
68
Dx of conjunctivitis?
clinical
69
Tx of conjunctivitis?
topical Abx (if bacterial) - Erythromycin ointment
70
Presentation of uveitis?
photophobia
71
Dx of uveitis?
slit lamp exam (leukocytes in anterior chamber)
72
Tx of uveitis?
antimicrobial for viral or bacterial; steroids for non-infectious
73
Presentation of corneal abration?
h/o trauma, most commonly from contact lenses
74
Dx of corneal abrasion?
fluorescein stain picks up on damaged cornea
75
Tx of corneal abrasion?
NO specific tx; do NOT patch abrasions caused by contact lenses
76
How do calculate an anion gap?
Na - [HCO3 + Cl-] (normal = 12, range 8-16)
77
Dx of CO poisoning?
CO-oximetry
78
Dx of organophosphate poisoning?
RBC cholinesterase (but hard to perform)
79
Sxs of PCP intoxication?
disorientation, restlessness, tachycardia, hypertension, b/l vertical nystagmus
80
Tx of PCP intoxication?
- low-stim environment, metabolic and hemodynamic control - if agitation or SZ --> benzos - if aggression --> Haloperidol
81
Sxs of lead poisoning?
anorexia, decreased activity, irritability, vague abd pain, insomnia, neurocognitive defects
82
Dx of lead poisoning?
CBC, serum iron and ferritin, retic ct, blood lead level
83
Tx of dry chemical burns with powder?
Brush off first, then rinse with low-pressure water x 15-30 min
84
Tx of hypothermia?
- if hypoventilation --> intubation - if hypotension --> fluids - then, active rewarming with warm IV fluids
85
Cause of scombroid?
improperly stored seafood (histidine --> histamine!)
86
Sxs of scombroid?
flushing, throbbing HA, palpitations, abd cramps, diarrhea, skin erythema, oral burning

USMLE Step 3 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions