Master the Boards Step 3

Question 1

When can gastric emptying be used in the setting of toxic ingestion

Answer 1

Only in the first 1 hr after ingestion. Rarely the right answer, because you can rarely guarantee that it has been 1 hr or less.
-50% of pills can be removed in this time

**NEVER use w/ caustic ingestion

Question 2

When is intubation and lavage used in the setting of toxic ingestion

Answer 2

Rarely
In first 1-2 hrs post ingestion, if patient does not respond to naloxone, thiamine, and dextrose and substance is not caustic

Question 3

What is the antidote for acetaminophen toxicity

Answer 3

N-acetylcysteine
Also give charcoal

Question 4

What is the antidote for aspirin toxicity

Answer 4

Bicarbonate to alkalinize the urine

Question 5

What is the antidote for carbon monoxide toxicity

Answer 5

100% oxygen, hyperbaric if needed

Question 6

What is the antidote for digoxin toxicity

Answer 6

digoxin binding antibodies

Question 7

What is the antidote for ethylene glycol toxicity

Answer 7

Fomepizole or ethanol

Question 8

What is the antidote for methanol toxicity

Answer 8

Fomepizole or ethanol

Question 9

What is the antidote for Methemoglobinemia

Answer 9

methylene blue

Question 10

What is the antidote for neuroleptic malignant syndrome

Answer 10

Bromocriptine or dantrolene

Question 11

What is the antidote for opiates

Answer 11

Naloxone

Question 12

What is the antidote for Organophosphate toxicity

Answer 12

atropine, pralidoxime

Question 13

What is given in triclycic antidepressant (TCA) toxicity

Answer 13

Bicarbonate to protect the heart

Question 14

What is the general presentation of acetaminophen toxicity

Answer 14

First 24 hr: nausea and vomiting
48-72 hrs: hepatic failure
with history of ingestion

Question 15

When to give N-acetylcysteine for acetaminophen toxicity

Answer 15

Within first 24 hrs, after 24 hrs there is no specific treatment for toxicity

Question 16

What are the findings associated with aspirin (salicylate) toxicity

Answer 16

-HYPERVENTILATION
-ARDS
-tinnitus
-AG Metabolic acidosis
-Respiratory alkalosis
-Renal insufficiency
-Elevated PT
-Altered mental status
-Fever

Question 17

What diagnositic tests should be ordered in suspected aspirin (salicylate) toxicity

Answer 17

-CBC
-Chem panel
-ABG
-PT/PTT/INR
-Salicylate (ASA) level

Question 18

What is the initial treatment for aspirin toxicity

Answer 18

-D5W + 3 amps Bicarbonate to alkalinize the urine & increase excretion
-Charcoal to block absorption (1st hr only)
-Dialysis in severe cases

Question 19

Alkalinization of the urine with Bicarbonate faciliates excretion of which toxins

Answer 19

ASA (salicylates)
TCAs (tricyclic antidrepressants)
Phenobarbital
Chlorpropamide

Question 20

What is the acute managment for benzodiazepine overdose

Answer 20

Monitor and test for co-ingestion with ASA, acetaminphen, and ETOH
Toxic effect often self-resolves

Question 21

What is the most common cause of death associated with fires

Answer 21

Carbon monoxide poisoning (60% of deaths in first 24 hrs)

Question 22

What are the symptoms of carbon monoxide poisoning

Answer 22

-SOB
-lightheadedness/Headaches
-Disorientation
-metabolic acidosis in severe cases from tissue hypoxia

Question 23

What is the best initial test for diagnosing pulmonary hypertension

Answer 23

Echocardiography (noninvasive)

Question 24

Cough, coryza, conjunctivitis, and Koplik spots are most commonly associated with ________

Answer 24

Measles

Question 25

Of the MMR infections, _____ can cause orchitis and subsequent infertility

Answer 25

Mumps

Question 26

Of the MMR infections, _______ is most commonly associated with parotitis

Answer 26

Mumps

Question 27

What is the mechanism of SGLT2 inhibitors

Answer 27

Blocking renal uptake of glucose resulting in urinary excretion of glucose

Question 28

Sulfonylureas are associated with weight ______ (gain/loss)

Answer 28

Gain

Question 29

How many oz of formula does a baby need to take to not need vitamin D supplementation

Answer 29

34 oz or 1 liter of formula probably has 400 IU of vitamin D. Anything less and baby needs supplementation. *all babies in Alaska need supplementation (800 IU daily total goal)
Should be started within first 2 months of life