General

Question 1

Poisons investigations work-up (5)

Answer 1

1. ECG - look for QRS widening (anti epileptics) and QT prolongation (abx) - antiarrythmics, antidepressants, antipsychotics will do both
2. Bloods
3. Paracetamol +/- specific levels
4. UDS
5. CXR for aspiration or ingestion

Question 2

What is second-line inotropic support for poisoning?

Answer 2

High-dose insulin euglycaemia therapy (HIET)
- 1 unit/kg slow injection with 50mls of 50% - can continue on with slow infusion
- support glucose and potassium

Question 3

Approach to treatment of QRS widening and QT prolongation in poisons? (not the same)

Answer 3

Serum alkalisation via IV sodium bicarb with concurrent hyperventilation
- e.g. TCA poisoning

Correct magnesium, potassium, calcium - Torsades = magnesium, and if HR <90 then isoprenaline

Question 4

Poisons decontamination (2)

Answer 4

1. Charcoal within 2hrs - NOT for decreased GCS, seizures, vomiting
2. Whole-bowel irrigation (prep) within 4hrs for metals, modified release or drug smuggling

NOT recommended - gastric lavage or induced emesis

Question 5

Anticholinergic and cholinergic toxidrome - how they present, what agents cause them, what is the treatment?

Answer 5

Anticholinergic = delirium + dry
- atropine, benzatropin, oxybutynin, TCAs, antihistamines
- treat with physostigmine

Cholinergic = altered mental status + sludge
- pesticides, donepezil and rivastigmine, nicotine, mushrooms
- treat with atropine

Question 6

A 58 year old gentleman who drinks a bottle of vodka a day presents with ataxia, ophthalmoplegia and confusion. He is treated with thiamine with improvement. What is the most likely long term consequence?
A. Ophthalmoplegia
B. Amnesic memory loss
C. Dementia
D. Visuospatial disturbance

Answer 6

B. Amnesic memory loss

Residual deficits post Wernicke
- 60% horizontal nystagmus (gaze palsy resolved)
- 60% ataxia; remaining deficits ranged from inability to walk at all to a wide‐based, slow, shuffling gait.
- 80% percent had a permanent amnestic memory loss.

Question 7

Live vaccines are contraindicated in all of the following groups of patients EXCEPT:
a. Pregnant women
b. HIV with CD count of 180
c. Asplenic patients
d. Renal transplant recipients on long term immunosuppression
e. Teenager with congenital immunodeficiency

Answer 7

Answer: C

Asplenia - can have live vaccines, NEED to have protection against encapsulated - HiB, Pneumococcal, Meningococcal

The inactivated influenza and dTap vaccines are usually the only vaccine given during pregnancy.

HIV >250

haematological tumours or long-term immunosuppression such as with Prednisone >20mg/day or TNF alpha inhibitors.