Mehl. bullets: intox 03-28 (1)

Question 1

M. 16F + injected conjunctivae + has paranoia; Dx + Tx?

Answer 1

marijuana intoxication; observation.

Question 2

M. 22M + sluggish patient + has angiogram performed (for some reason) that shows decreased cerebral blood flow; drug that was taken?

Answer 2

nswer = cocaine; this question is on USMLE. Cocaine is known to cause vasoconstriction, i.e., placental abruption, coronary vasospasm; apparently that extends to
cerebral blood flow on the exam.

Question 3

M. 26F in Australia picking peaches + pinpoint pupils; Q is “how could this have been prevented?”

Answer 3

wearing gloves,” not “use of facemask.” Apparently organophosphate poisoning is acquired through skin, not droplets.

Question 4

M. Tx for organophosphate poisoning?

Answer 4

atropine before pralidoxime. Retired NBME 15 or 16 for Step 1 has both as answers, and atropine is correct.

Question 5

M. 22M + 1mm pupils + RR of 8 + stuporous; Dx + Tx?

Answer 5

Dx = Opioid/heroin overdose; Tx = naloxone.

Question 6

M. 22M takes a drug + gets mutism + has constricted pupils, Dx?

Answer 6

answer = PCP. Fucking weird but it’s on the psych NBME for 2CK. If you don’t believe me, you can Google “pcp mutism constricted pupils.”

Question 7

M. 22M takes a drug + gets nystagmus + bellicosity (wants to fight). Dx?

Answer 7

answer = PCP

Question 8

M. 16M + found on floor in school bathroom + brought into hospital + sluggish + pupils and vitals normal; which drug/substance did he do?

Answer 8

butane (inhalant toxicity); this is HY!

Question 9

M. 33M + ingested substance + high RR + now has calcium oxalate urolithiasis; Dx?

Answer 9

Ethylene glycol toxicity -> causes calcium oxalate nephrolithiasis; high RR is due to respiratory compensation for high-anion gap metabolic acidosis (MUDPILES).

Question 10

M. 14M + cognitive decline over a few months + ataxia; which drug/substance did he do?

Answer 10

glue, not alcohol -> 14 is too young to get alcohol-induced cerebellar ataxia.

Question 11

M. 23M + used synthetic heroin + diffuse stiffness + drooling; Dx?

Answer 11

MPTP-induced Parkinsonian syndrome –> affects substantia nigra; MPTP-containing powder is sometimes sold as “synthetic heroin.”

Question 12

What is mutism?

Answer 12

muteness or mutism is defined as an absence of speech, with or without an ability to hear the speech of others.