Overdose/withdrawal Flashcards
1
Q
- A 45-year-old male presents 48 hours after ingesting a toxic dose of acetaminophen. Labs reveal elevated bilirubin, prolonged PT, and confusion. Which phase of toxicity is he likely in?
A) Phase 1
B) Phase 2
C) Phase 3
D) Phase 4
A
Answer: C) Phase 3
2
Q
- A 50-year-old female in alcohol withdrawal is experiencing hypertension and tachycardia. Which medication is most appropriate to manage these symptoms?
A) Clonidine
B) Lorazepam
C) Propofol
D) Esmolol
A
Answer: B) Lorazepam
3
Q
- A 60-year-old patient with alcohol use disorder presents with confusion, nystagmus, and ataxia. Which complication should you suspect?
A) Delirium tremens
B) Wernicke encephalopathy
C) Hepatic encephalopathy
D) Alcoholic ketoacidosis
A
Answer: B) Wernicke encephalopathy
4
Q
- A 32-year-old male is brought to the ER after ingesting a large quantity of amphetamines. He is agitated and hyperthermic. What is the initial treatment?
A) Gastric lavage
B) Administer benzodiazepines
C) Start cooling measures
D) Alkalization of urine
A
Answer: C) Start cooling measures
5
Q
- A 25-year-old male with benzodiazepine overdose is unresponsive. What should be considered before administering flumazenil?
A) Presence of seizures
B) The patient’s heart rate
C) Blood alcohol level
D) Glucose level
A
Answer: A) Presence of seizures
6
Q
- A 58-year-old male presents with severe bradycardia, hypotension, and respiratory depression after ingesting a large dose of barbiturates. What treatment is most appropriate?
A) Administer flumazenil
B) Gastric lavage and supportive care
C) Administer naloxone
D) Start IV benzodiazepines
A
Answer: B) Gastric lavage and supportive care
7
Q
- A 70-year-old patient with chronic alcohol use is admitted for delirium tremens. Which symptom would be least expected?
A) Hallucinations
B) Hyperthermia
C) Profound sedation
D) Tachycardia
A
Answer: C) Profound sedation
8
Q
- A 30-year-old male presents with slurred speech, lethargy, and a respiratory rate of 8 breaths/min after taking an unknown substance. Which finding supports a diagnosis of benzodiazepine overdose?
A) Mydriasis
B) Tachycardia
C) Normal blood pressure
D) Pinpoint pupils
A
Answer: C) Normal blood pressure
9
Q
- A 40-year-old female is admitted for alcohol withdrawal and develops seizures 24 hours after her last drink. What is the most appropriate intervention?
A) Administer phenytoin
B) Start lorazepam
C) Initiate dexmedetomidine infusion
D) Administer flumazenil
A
Answer: B) Start lorazepam
10
Q
- A patient with suspected acetaminophen overdose has a serum APAP level of 8 µg/mL at 10 hours post-ingestion. There is no evidence of hepatotoxicity. What is the next step?
A) Administer activated charcoal
B) Start IV NAC therapy
C) Provide supportive care and monitor
D) Perform gastric lavage
A
Answer: C) Provide supportive care and monitor
11
Q
- A 30-year-old male presents 4 hours after ingesting a large dose of acetaminophen. Labs reveal a serum acetaminophen level of 6 µg/mL. What is the most appropriate management?
A) Provide supportive care only
B) Administer activated charcoal
C) Begin NAC therapy
D) Obtain an MRI
A
Answer: C) Begin NAC therapy
12
Q
- A 45-year-old female with alcohol use disorder presents with tremors, tachycardia, and anxiety 6 hours after her last drink. What stage of alcohol withdrawal is she in?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
A
Answer: A) Stage 1
13
Q
- A 45-year-old female with alcohol use disorder presents with tremors, tachycardia, and anxiety 6 hours after her last drink. What stage of alcohol withdrawal is she in?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
A
Answer: A) Stage 1
14
Q
- A patient is experiencing delirium tremens 3 days after cessation of alcohol. Which symptom is most concerning?
A) Hypertension
B) Visual hallucinations
C) Tachycardia
D) Hyperthermia
A
Answer: D) Hyperthermia
15
Q
- A 29-year-old male presents with agitation, tachycardia, and mydriasis after using amphetamines. He complains of severe muscle pain. What complication should be ruled out?
A) Acute kidney injury
B) Myocardial infarction
C) Rhabdomyolysis
D) Serotonin syndrome
A
Answer: C) Rhabdomyolysis
16
Q
- A 60-year-old male presents with a history of prolonged barbiturate use. He is now lethargic and hypotensive. Which intervention is appropriate?
A) Administer naloxone
B) Start flumazenil
C) Perform gastric lavage
D) Initiate benzodiazepines
A
Answer: C) Perform gastric lavage
17
Q
- A 38-year-old female with a benzodiazepine overdose presents with slurred speech and a respiratory rate of 6 breaths/min. What is the initial step in management?
A) Administer flumazenil
B) Perform endotracheal intubation
C) Administer naloxone
D) Begin IV fluids
A
Answer: B) Perform endotracheal intubation
18
Q
- A patient with suspected acetaminophen overdose develops RUQ pain and elevated LFTs 36 hours post-ingestion. Which phase of toxicity is this?
A) Phase 1
B) Phase 2
C) Phase 3
D) Phase 4
A
Answer: B) Phase 2
19
Q
- A 55-year-old male presents with confusion, hallucinations, and tachycardia 36 hours after his last drink. What is the most appropriate intervention?
A) Begin IV lorazepam
B) Administer thiamine and glucose
C) Monitor for seizures
D) All of the above
A
Answer: D) All of the above
20
Q
- A 45-year-old patient overdosed on amphetamines and presents with hyperthermia and agitation. After initial cooling measures, what is the next step?
A) Start IV benzodiazepines
B) Administer propranolol
C) Provide gastric lavage
D) Begin hemodialysis
A
Answer: A) Start IV benzodiazepines
21
Q
- A 50-year-old male is admitted with severe alcohol withdrawal and a CIWA-Ar score of 25. What is the preferred treatment?
A) IV dexmedetomidine
B) Oral lorazepam
C) Intramuscular haloperidol
D) IV lorazepam
A
Answer: D) IV lorazepam
22
Q
- Scenario:
A 45-year-old male presents to the emergency department 8 hours after ingesting an unknown quantity of acetaminophen. He is asymptomatic. Initial labs show an acetaminophen level of 7 µg/mL, and liver function tests are within normal limits. What is the next step in management?
o A) Discharge with no further treatment
o B) Administer activated charcoal
o C) Start N-acetylcysteine (NAC) therapy
o D) Perform a liver biopsy
A
Answer: C) Start N-acetylcysteine (NAC) therapy
23
Q
- Scenario:
A 38-year-old woman is brought to the ED by her family after she started experiencing confusion, hallucinations, and tremors 48 hours after abruptly stopping alcohol consumption. Her vital signs show tachycardia, hypertension, and a temperature of 101.2°F. What is the most likely diagnosis?
o A) Alcohol intoxication
o B) Delirium tremens
o C) Wernicke encephalopathy
o D) Amphetamine withdrawal
A
Answer: B) Delirium tremens
24
Q
A 25-year-old male presents with agitation, hyperthermia, and mydriasis after reportedly using “Molly” at a concert. He is tachycardic and diaphoretic. Labs show elevated creatinine kinase levels and metabolic acidosis. What is the most appropriate next step in management?
o A) Administer dantrolene
o B) Start aggressive IV hydration and cooling
o C) Give naloxone
o D) Administer flumazenil
A
Answer: B) Start aggressive IV hydration and cooling
25
A 60-year-old female presents with lethargy, slurred speech, and ataxia after an overdose of phenobarbital. Her blood pressure is 90/60 mmHg, and her respiratory rate is 8 breaths/min. What is the priority in her management?
o A) Administer flumazenil
o B) Start IV fluids
o C) Perform endotracheal intubation
o D) Initiate hemodialysis
Answer: C) Perform endotracheal intubation
26
A 48-year-old male with a history of alcohol use disorder presents 6 hours after his last drink. He complains of nausea, anxiety, and tremors. Which of the following would be the best initial treatment?
o A) IV lorazepam
o B) Oral thiamine
o C) Haloperidol
o D) Propofol
Answer: A) IV lorazepam
27
A 22-year-old male is brought in after ingesting a large quantity of benzodiazepines. He is lethargic with a respiratory rate of 10 breaths/min but maintains an adequate oxygen saturation on room air. What is the next best step in management?
o A) Administer flumazenil
o B) Provide supportive care and monitor
o C) Start naloxone
o D) Perform gastric lavage
Answer: B) Provide supportive care and monitor
28
A 34-year-old male presents with RUQ pain, jaundice, and elevated liver enzymes 72 hours after a reported acetaminophen overdose. What is the most appropriate next step?
o A) Start N-acetylcysteine therapy
o B) Monitor liver enzymes and wait
o C) Prepare for a liver transplant evaluation
o D) Administer activated charcoal
Answer: A) Start N-acetylcysteine therapy
29
A 40-year-old male presents with a history of chronic alcohol use and is now agitated, diaphoretic, and complaining of visual hallucinations. His CIWA-Ar score is 20. What is the best next step in management?
o A) Start dexmedetomidine
o B) Administer IV lorazepam
o C) Provide propofol sedation
o D) Monitor CIWA-Ar without intervention
Answer: B) Administer IV lorazepam
30
A 50-year-old male presents with agitation, confusion, and tachycardia. His family states he has been using amphetamines for several weeks. He is found to have a temperature of 103°F. What is the most important initial intervention?
o A) Administer esmolol
o B) Provide aggressive cooling measures
o C) Start IV haloperidol
o D) Monitor for serotonin syndrome
Answer: B) Provide aggressive cooling measures
31
10. Scenario:
A 29-year-old female presents to the emergency room after a seizure. She admits to heavy alcohol use and recently stopped drinking abruptly. Labs reveal hypomagnesemia and hypokalemia. What is the next best step in her management?
* A) Administer IV lorazepam and correct electrolyte abnormalities
* B) Start IV thiamine and oral magnesium
* C) Administer phenobarbital
* D) Monitor in the ED without intervention
Answer: A) Administer IV lorazepam and correct electrolyte abnormalities
32
A 35-year-old male presents to the emergency department after ingesting a large dose of acetaminophen 6 hours ago. His labs show an acetaminophen level of 12 µg/mL, normal liver enzymes, and no symptoms. What is the appropriate management?
o A) Discharge the patient with no treatment
o B) Administer activated charcoal and discharge
o C) Start N-acetylcysteine (NAC) therapy
o D) Wait and repeat acetaminophen levels in 4 hours
Answer: C) Start N-acetylcysteine (NAC) therapy
33
A 55-year-old female presents with confusion, visual hallucinations, and tremors. She reports she stopped drinking alcohol abruptly 2 days ago. Her heart rate is 120 bpm, and blood pressure is 160/100 mmHg. What is the most likely diagnosis?
o A) Alcohol intoxication
o B) Delirium tremens
o C) Wernicke encephalopathy
o D) Alcohol withdrawal seizure
Answer: B) Delirium tremens
34
A 25-year-old male presents to the emergency department with tachycardia, agitation, and a temperature of 104°F after taking “Molly” at a music festival. Labs reveal rhabdomyolysis and acute kidney injury. What is the most critical intervention?
o A) Administer naloxone
o B) Start aggressive IV hydration and cooling
o C) Administer benzodiazepines for agitation
o D) Perform gastric lavage
Answer: B) Start aggressive IV hydration and cooling
35
A 60-year-old male presents to the emergency department with slurred speech, ataxia, and lethargy after ingesting an unknown number of benzodiazepine tablets. His oxygen saturation is 95% on room air, and vital signs are stable. What is the next best step?
o A) Administer flumazenil
o B) Provide supportive care and observation
o C) Perform gastric lavage
o D) Start IV naloxone
Answer: B) Provide supportive care and observation
36
A 40-year-old female with a history of chronic alcohol use presents with seizures and confusion. She is tachycardic and hypertensive. Her labs reveal hypomagnesemia and elevated liver enzymes. What is the most appropriate immediate treatment?
o A) Start IV lorazepam and correct electrolyte abnormalities
o B) Administer IV thiamine and oral magnesium
o C) Provide IV fluids and monitor
o D) Start IV phenobarbital
Answer: A) Start IV lorazepam and correct electrolyte abnormalities
37
A 45-year-old male presents with bradycardia, hypotension, and confusion 3 hours after ingesting an unknown quantity of propranolol. What is the next best step in management?
o A) Administer naloxone
o B) Initiate glucagon therapy
o C) Administer atropine only
o D) Perform gastric lavage immediately
Answer: B) Initiate glucagon therapy
38
2. Question: A 60-year-old female presents with hypotension and bradycardia 8 hours after ingesting a sustained-release calcium channel blocker. Which of the following treatments is appropriate?
o A) Administer calcium chloride bolus
o B) Perform gastric lavage
o C) Start high-dose insulin infusion
o D) All of the above
Answer: D) All of the above
39
3. Question: A patient presents with agitation, tachycardia, and chest pain after suspected cocaine use. Which intervention is most appropriate?
o A) Administer benzodiazepines for agitation
o B) Start IV fluids and nitroglycerin
o C) Avoid beta-blockers and manage blood pressure with phentolamine
o D) All of the above
Answer: D) All of the above
40
4. Question: A 35-year-old male presents with mydriasis, tachycardia, dry skin, and confusion after ingesting an unknown medication. The mnemonic “Blind as a bat, hot as a hare, dry as a bone, red as a beet, mad as a hatter” is most consistent with which toxicity?
o A) Beta-blocker toxicity
o B) Tricyclic antidepressant toxicity
o C) Opioid overdose
o D) SSRI toxicity
Answer: B) Tricyclic antidepressant toxicity
41
5. Question: A 70-year-old male presents with lethargy, blurred vision, and hyperkalemia. He has a history of heart failure and takes digoxin. His digoxin level is 3.2 ng/mL. What is the next best step in management?
o A) Administer digoxin-specific antibody fragments (Digibind)
o B) Initiate high-dose insulin therapy
o C) Perform immediate hemodialysis
o D) Treat with activated charcoal only
Answer: A) Administer digoxin-specific antibody fragments (Digibind)
42
6. A patient on chronic lithium therapy presents with confusion, ataxia, and coarse tremors. His serum lithium level is 3.6 mEq/L. Which intervention is most appropriate?
o A) Administer sodium bicarbonate
o B) Perform hemodialysis
o C) Administer activated charcoal
o D) Start high-dose insulin therapy
Answer: B) Perform hemodialysis
43
A patient presents with pinpoint pupils, respiratory depression, and hypotension after opioid ingestion. Which is the most appropriate initial treatment?
o A) Administer naloxone 0.4 mg IV
o B) Perform gastric lavage immediately
o C) Start an infusion of norepinephrine
o D) Administer benzodiazepines
Answer: A) Administer naloxone 0.4 mg IV
44
8. Question: A 45-year-old male presents with tinnitus, nausea, vomiting, and respiratory alkalosis progressing to metabolic acidosis. Which drug toxicity is most likely?
o A) Salicylates
o B) Beta-blockers
o C) Calcium channel blockers
o D) Tricyclic antidepressants
Answer: A) Salicylates
45
9. Question: A patient presents with agitation, hyperreflexia, tachycardia, and diaphoresis after taking a high dose of an SSRI. Which of the following is the most likely diagnosis?
o A) Serotonin syndrome
o B) Neuroleptic malignant syndrome
o C) Malignant hyperthermia
o D) Anticholinergic toxicity
Answer: A) Serotonin syndrome
46
1. Question: A 45-year-old male presents with bradycardia, hypotension, and confusion 3 hours after ingesting an unknown quantity of propranolol. What is the next best step in management?
o A) Administer naloxone
o B) Initiate glucagon therapy
o C) Administer atropine only
o D) Perform gastric lavage immediately
Answer: B) Initiate glucagon therapy
47
A 60-year-old female presents with hypotension and bradycardia 8 hours after ingesting a sustained-release calcium channel blocker. Which of the following treatments is appropriate?
o A) Administer calcium chloride bolus
o B) Perform gastric lavage
o C) Start high-dose insulin infusion
o D) All of the above
Answer: D) All of the above
48
3. Question: A patient presents with agitation, tachycardia, and chest pain after suspected cocaine use. Which intervention is most appropriate?
o A) Administer benzodiazepines for agitation
o B) Start IV fluids and nitroglycerin
o C) Avoid beta-blockers and manage blood pressure with phentolamine
o D) All of the above
Answer: D) All of the above
49
4. Question: A 35-year-old male presents with mydriasis, tachycardia, dry skin, and confusion after ingesting an unknown medication. The mnemonic “Blind as a bat, hot as a hare, dry as a bone, red as a beet, mad as a hatter” is most consistent with which toxicity?
o A) Beta-blocker toxicity
o B) Tricyclic antidepressant toxicity
o C) Opioid overdose
o D) SSRI toxicity
Answer: B) Tricyclic antidepressant toxicity
50
A 70-year-old male presents with lethargy, blurred vision, and hyperkalemia. He has a history of heart failure and takes digoxin. His digoxin level is 3.2 ng/mL. What is the next best step in management?
o A) Administer digoxin-specific antibody fragments (Digibind)
o B) Initiate high-dose insulin therapy
o C) Perform immediate hemodialysis
o D) Treat with activated charcoal only
Answer: A) Administer digoxin-specific antibody fragments (Digibind)
51
A patient on chronic lithium therapy presents with confusion, ataxia, and coarse tremors. His serum lithium level is 3.6 mEq/L. Which intervention is most appropriate?
o A) Administer sodium bicarbonate
o B) Perform hemodialysis
o C) Administer activated charcoal
o D) Start high-dose insulin therapy
Answer: B) Perform hemodialysis
52
: A patient presents with pinpoint pupils, respiratory depression, and hypotension after opioid ingestion. Which is the most appropriate initial treatment?
o A) Administer naloxone 0.4 mg IV
o B) Perform gastric lavage immediately
o C) Start an infusion of norepinephrine
o D) Administer benzodiazepines
Answer: A) Administer naloxone 0.4 mg IV
53
: A 45-year-old male presents with tinnitus, nausea, vomiting, and respiratory alkalosis progressing to metabolic acidosis. Which drug toxicity is most likely?
o A) Salicylates
o B) Beta-blockers
o C) Calcium channel blockers
o D) Tricyclic antidepressants
Answer: A) Salicylates
54
A patient presents with agitation, hyperreflexia, tachycardia, and diaphoresis after taking a high dose of an SSRI. Which of the following is the most likely diagnosis?
o A) Serotonin syndrome
o B) Neuroleptic malignant syndrome
o C) Malignant hyperthermia
o D) Anticholinergic toxicity
Answer: A) Serotonin syndrome
55
Which electrolyte abnormality is commonly associated with beta-blocker toxicity?
o A) Hypoglycemia
o B) Hyperkalemia
o C) Hyponatremia
o D) Hypocalcemia
Answer: B) Hyperkalemia
56
A patient presents with bradycardia and hypotension following beta-blocker ingestion. What is the first-line pharmacologic intervention?
o A) Atropine
o B) Glucagon
o C) Calcium gluconate
o D) High-dose insulin
Answer: A) Atropine
57
In beta-blocker toxicity, glucagon is administered because it:
o A) Directly binds beta-receptors
o B) Enhances calcium influx into myocardial cells
o C) Activates adenylate cyclase independent of beta-receptors
o D) Inhibits adrenergic effects
Activates adenylate cyclase independent of beta-receptors
58
4. Question: A patient ingested a massive dose of sustained-release beta-blockers. What is the maximum time window for considering gastric lavage?
o A) 1 hour
o B) 2 hours
o C) 4 hours
o D) 8 hours
Answer: B) 2 hours
59
5. Question: In calcium channel blocker toxicity, which treatment is used to manage refractory hypotension?
o A) High-dose insulin
o B) Naloxone
o C) Vasopressin
o D) Magnesium sulfate
Answer: A) High-dose insulin
60
A patient presents with hyperglycemia, confusion, and lethargy 6 hours after ingesting a calcium channel blocker. What is the most appropriate diagnostic test?
o A) Serum potassium level
o B) Blood glucose level
o C) Serum calcium level
o D) ECG
Answer: D) ECG
61
What electrolyte abnormality is typically seen in severe calcium channel blocker toxicity?
o A) Hyperglycemia
o B) Hypernatremia
o C) Hypoglycemia
o D) Hyponatremia
Answer: A) Hyperglycemia
62
A 30-year-old presents with euphoria, tachycardia, and agitation after cocaine use. Which complication is most life-threatening?
o A) Delirium
o B) Myocardial infarction
o C) Anxiety
o D) Hyperthermia
Answer: B) Myocardial infarction
63
10. Question: Which is the most appropriate initial treatment for cocaine-induced agitation?
* A) Haloperidol
* B) Benzodiazepines
* C) Beta-blockers
* D) NSAIDs
Answer: B) Benzodiazepines
64
Which pharmacologic treatment is specifically indicated for calcium channel blocker overdose to improve cardiac contractility?
o A) Glucagon
o B) Calcium chloride
o C) Dextrose
o D) Atropine
Answer: B) Calcium chloride
65
11. Question: Beta-blockers are contraindicated in cocaine-induced chest pain because they:
* A) Worsen hypotension
* B) Cause unopposed alpha-adrenergic stimulation
* C) Increase heart rate
* D) Cause bradycardia
Answer: B) Cause unopposed alpha-adrenergic stimulation
66
What is the most common cardiovascular complication of cocaine toxicity?
* A) Pulmonary embolism
* B) Hypertension
* C) Atrial fibrillation
* D) Ventricular tachycardia
Answer: D) Ventricular tachycardia
67
A patient presents with mydriasis, tachycardia, dry skin, and confusion after a TCA overdose. Which ECG finding is commonly seen?
* A) Prolonged QT interval
* B) Widened QRS complex
* C) ST-segment elevation
* D) Atrial fibrillation
Answer: B) Widened QRS complex
68
What is the first-line treatment for arrhythmias associated with TCA toxicity?
* A) Amiodarone
* B) Sodium bicarbonate
* C) Lidocaine
* D) Magnesium sulfate
Answer: B) Sodium bicarbonate
69
A mnemonic for symptoms of TCA toxicity includes "Blind as a bat, mad as a hatter, red as a beet." What does “red as a beet” signify?
* A) Seizures
* B) Vasodilation
* C) Fever
* D) Hypertension
Answer: B) Vasodilation
70
17. Question: Which electrolyte abnormality potentiates digoxin toxicity?
* A) Hypokalemia
* B) Hypernatremia
* C) Hypomagnesemia
* D) Hypercalcemia
Answer: A) Hypokalemia
71
18. Question: What is the threshold lithium level indicating severe toxicity?
* A) >1.5 mEq/L
* B) >2.0 mEq/L
* C) >2.5 mEq/L
* D) >3.5 mEq/L
Answer: D) >3.5 mEq/L
72
19. Question: What is the treatment of choice for lithium toxicity in a patient with severe neurotoxicity?
* A) Hemodialysis
* B) Sodium bicarbonate
* C) High-dose insulin
* D) Gastric lavage
Answer: A) Hemodialysis
73
20. Question: Which route of naloxone administration is associated with the fastest onset?
* A) Intranasal
* B) Subcutaneous
* C) Intramuscular
* D) Intravenous
Answer: D) Intravenous
74
1. Question: What is the typical clinical onset time for beta-blocker toxicity symptoms following ingestion?
o A) 30 minutes
o B) 1 hour
o C) 4 hours
o D) 12 hours
Answer: C) 4 hours
75
2. Question: Which of the following beta-blockers is associated with seizures in toxicity cases?
o A) Atenolol
o B) Propranolol
o C) Metoprolol
o D) Bisoprolol
Answer: B) Propranolol
76
3. Question: Which therapy is considered the best option for refractory beta-blocker toxicity unresponsive to fluids and glucagon?
o A) Epinephrine infusion
o B) Calcium gluconate
o C) Hyperinsulinemia-euglycemia therapy
o D) Vasopressin
Answer: C) Hyperinsulinemia-euglycemia therapy
77
4. Question: Which is a hallmark sign of calcium channel blocker overdose?
o A) Hyperkalemia
o B) Hyperglycemia
o C) Hypocalcemia
o D) Hypoglycemia
Answer: B) Hyperglycemia
78
A patient with calcium channel blocker overdose is hypotensive despite initial fluid boluses. What is the next pharmacologic treatment?
o A) Glucagon
o B) Norepinephrine
o C) Calcium chloride
o D) Sodium bicarbonate
Answer: C) Calcium chloride
79
What is the most effective initial intervention for a patient presenting 7 hours after ingesting sustained-release calcium channel blockers?
o A) Gastric lavage
o B) Activated charcoal
o C) Hemodialysis
o D) Intravenous insulin
Answer: A) gastric lavage upt to 8 hours
80
7. Question: What is the preferred medication for refractory hypertension in cocaine toxicity?
o A) Labetalol
o B) Nitroglycerin
o C) Phentolamine
o D) Hydralazine
Answer: C) Phentolamine
81
A 25-year-old patient presents with chest pain and hyperthermia after using cocaine. What is the first-line treatment for hyperthermia?
o A) Benzodiazepines and cooling measures
o B) Dantrolene and cooling measures
o C) Antipyretics and muscle relaxants
o D) Beta-blockers and sedatives
Answer: A) Benzodiazepines and cooling measures
82
9. Question: What is the first-line treatment for a widened QRS complex in TCA toxicity?
o A) Sodium bicarbonate
o B) Magnesium sulfate
o C) Calcium gluconate
o D) Atropine
Answer: A) Sodium bicarbonate
83
: In TCA toxicity, which finding indicates the need for immediate intervention?
* A) Prolonged QT interval
* B) Tachycardia
* C) Seizures
* D) Dry mucous membranes
Answer: C) Seizures
84
: Which of the following indicates digoxin toxicity?
* A) Bradycardia with hyperkalemia
* B) Tachycardia with hyperglycemia
* C) Hypertension with hypokalemia
* D) Respiratory alkalosis
Answer: A) Bradycardia with hyperkalemia
85
What is the primary indication for administering Digibind in digoxin toxicity?
* A) Hypercalcemia
* B) AV block
* C) Serum potassium >5.0 mmol/L
* D) Seizures
Answer: C) Serum potassium >5.0 mmol/L
86
: A 45-year-old patient presents with confusion, tremors, and nystagmus. Lithium level is 2.7 mEq/L. What is the most appropriate intervention?
* A) IV fluids
* B) Hemodialysis
* C) Sodium bicarbonate
* D) Activated charcoal
Answer: B) Hemodialysis
87
: Which condition increases the risk of lithium toxicity?
* A) Hyperkalemia
* B) Hypothyroidism
* C) Hyponatremia
* D) Hypercalcemia
Answer: C) Hyponatremia
88
Which symptom is the most life-threatening in opioid toxicity?
* A) Bradycardia
* B) Respiratory depression
* C) Miosis
* D) Hypotension
Answer: B) Respiratory depression
89
What is the correct intranasal dose of naloxone for opioid reversal?
* A) 2 mg every 2-3 minutes
* B) 0.4 mg every 5 minutes
* C) 4 mg every 2-3 minutes
* D) 1 mg every 10 minutes
Answer: C) 4 mg every 2-3 minutes
90
Which symptom indicates severe salicylate toxicity?
* A) Tinnitus
* B) Hyperglycemia
* C) Respiratory alkalosis with metabolic acidosis
* D) Peripheral neuropathy
Answer: C) Respiratory alkalosis with metabolic acidosis
91
18. Question: What is the threshold serum salicylate level for initiating hemodialysis?
* A) >60 mg/dL
* B) >80 mg/dL
* C) >100 mg/dL after 6 hours
* D) >120 mg/dL acutely
Answer: C) >100 mg/dL after 6 hours
92
19. Question: Which is a hallmark symptom of serotonin syndrome?
* A) Miosis
* B) Myoclonus
* C) Hypotension
* D) Bradycardia
Answer: B) Myoclonus
93
20. Question: Which medication is contraindicated in serotonin syndrome?
* A) Cyproheptadine
* B) Benzodiazepines
* C) Tramadol
* D) Beta-blockers
Answer: C) Tramadol
94
A patient overdoses on beta-blockers and develops bradycardia and hypotension. What is the first-line pharmacologic treatment?
o A) Epinephrine
o B) Glucagon
o C) Atropine
o D) Calcium gluconate
Answer: C) Atropine
95
Hyperinsulinemia-euglycemia therapy for beta-blocker overdose includes which of the following?
o A) 1 unit/kg bolus followed by 0.5 units/kg/hr infusion
o B) 10 units bolus followed by 0.1 units/kg/hr infusion
o C) 1 unit/kg bolus followed by 1 unit/kg/hr infusion
o D) 5 units bolus followed by 0.5 units/kg/hr infusion
Answer: C) 1 unit/kg bolus followed by 1 unit/kg/hr infusion
96
Which laboratory value is typically elevated in calcium channel blocker toxicity?
o A) Serum calcium
o B) Blood glucose
o C) Serum potassium
o D) Hematocrit
Answer: B) Blood glucose
97
4. Question: A patient with calcium channel blocker overdose is unresponsive to fluids and vasopressors. What is the next best step?
o A) Administer calcium chloride
o B) Administer glucagon
o C) Start a lipid emulsion infusion
o D) Initiate high-dose insulin therapy
Answer: D) Initiate high-dose insulin therapy
98
What is the first-line treatment for agitation in cocaine toxicity?
o A) Haloperidol
o B) Lorazepam
o C) Phentolamine
o D) Metoprolol
Answer: B) Lorazepam
99
6. Question: A patient with cocaine toxicity develops ventricular tachycardia. What is the recommended treatment?
o A) Amiodarone
o B) Lidocaine and sodium bicarbonate
o C) Beta-blockers and atropine
o D) Magnesium sulfate
Answer: B) Lidocaine and sodium bicarbonate
100
: Which ECG finding is characteristic of TCA toxicity?
o A) Widened QRS complex
o B) ST elevation
o C) Prolonged PR interval
o D) Flattened T waves
Answer: A) Widened QRS complex
101
: What is the maximum time window for administering activated charcoal in TCA overdose?
o A) 1 hour
o B) 2 hours
o C) 4 hours
o D) 6 hours
Answer: A) 1 hour
102
Which symptom is a common sign of chronic digoxin toxicity?
o A) Blurred vision with yellow halos
o B) Severe hypotension
o C) Generalized edema
o D) Elevated white blood cell count
Answer: A) Blurred vision with yellow halos
103
Digoxin toxicity treatment with Digibind is indicated for which condition?
* A) Serum potassium >6.5 mmol/L
* B) QT prolongation >500 ms
* C) Creatinine clearance <30 mL/min
* D) Heart rate >140 bpm
Answer: A) Serum potassium >6.5 mmol/L
104
At what lithium level is hemodialysis recommended?
* A) >1.5 mEq/L
* B) >2.5 mEq/L with severe symptoms
* C) >3.5 mEq/L regardless of symptoms
* D) >5.0 mEq/L
Answer: B) >2.5 mEq/L with severe symptoms
105
Which electrolyte imbalance increases the risk of lithium toxicity?
* A) Hyperkalemia
* B) Hyponatremia
* C) Hypercalcemia
* D) Hypomagnesemia
Answer: B) Hyponatremia
106
What is the typical dose for naloxone to reverse respiratory depression in opioid toxicity?
* A) 0.1 mg IV every 2-3 minutes
* B) 0.4 mg IV every 2-3 minutes, up to 10 mg total
* C) 1 mg IV every 5 minutes, up to 5 mg total
* D) 4 mg IV every 10 minutes
Answer: B) 0.4 mg IV every 2-3 minutes, up to 10 mg total
107
14. Question: What is a common respiratory complication after administering naloxone?
* A) Pulmonary embolism
* B) Aspiration pneumonitis
* C) Pulmonary fibrosis
* D) Pleural effusion
Answer: B) Aspiration pneumonitis
108
A patient presents with salicylate toxicity and metabolic acidosis. What is the first-line treatment?
* A) Sodium bicarbonate infusion
* B) Hemodialysis
* C) IV calcium gluconate
* D) High-dose insulin therapy
Answer: A) Sodium bicarbonate infusion
109
What is a key symptom of salicylate toxicity?
* A) Mydriasis
* B) Tinnitus
* C) Hypothermia
* D) Jaundice
Answer: B) Tinnitus
110
Which symptom differentiates serotonin syndrome from neuroleptic malignant syndrome?
* A) Hyperthermia
* B) Rigidity
* C) Hyperreflexia and clonus
* D) Diaphoresis
Answer: C) Hyperreflexia and clonus
110
Which drug is used to manage serotonin syndrome?
* A) Cyproheptadine
* B) Dantrolene
* C) Haloperidol
* D) Lorazepam
Answer: A) Cyproheptadine
111
A patient is admitted for acute alcohol withdrawal and high liver enzymes. Which medication would you recommend to treat delirium in this patient?
Group of answer choices:
* Fluoxetine
* Haloperidol
* Lorazepam
*Chlordiazepoxide
Answer: Lorazepam
112
When assessing a patient with acute opioid withdrawal, which of the following would you expect to find?
Group of answer choices:
* Constipation
* Hypothermia
* Hypertension
* Somnolence
Answer: Hypertension
113
What symptoms would make you highly suspicious of early alcohol withdrawal?
Group of answer choices:
* Drowsiness and bradycardia
* Visual hallucinations and vomiting
* Delirium and violent behavior
* Hand tremors and nausea
Answer: Hand tremors and nausea
114
A patient presents to the emergency department with her sister. Her sister tells the staff she thinks she took something, but the patient does not know what it was. The patient is experiencing nausea, vomiting, and abdominal pain. Labs show an elevated INR and an elevated AST on the liver function panel. Given this information, what antidote would you consider?
Group of answer choices:
* Glucagon
* N-acetylcysteine
* Calcium gluconate
* Flumazenil
Answer: N-acetylcysteine
114
A patient presents with barbiturate overdose. Gastric lavage is not performed because:
Group of answer choices:
* The patient has normal ABG results.
* The time of ingestion is unknown.
* It is contraindicated in all overdoses.
* The patient is already intubated.
Answer: The time of ingestion is unknown.
115
A patient with beta blocker overdose presents with severe bradycardia and hypotension. Which treatment should be administered after atropine fails to improve heart rate?
Group of answer choices:
* Naloxone
* Glucagon
* N-acetylcysteine
* Digoxin
Answer: Glucagon
116
Which lab test is most critical to monitor in a patient with beta blocker overdose receiving hyperinsulinemia-euglycemia therapy?
Group of answer choices:
* Serum potassium
* Hemoglobin levels
* Thyroid-stimulating hormone
* Liver function tests
Answer: Serum potassium
117
What is the role of intravenous lipid emulsion in the treatment of beta blocker overdose?
Group of answer choices:
* Reduces drug absorption in the stomach
* Enhances drug excretion via the kidneys
* Sequesters lipid-soluble drugs to reduce toxicity
* Corrects metabolic acidosis
Answer: Sequesters lipid-soluble drugs to reduce toxicity
117
In a barbiturate overdose, which neurological complication would warrant immediate consultation with neurology?
Group of answer choices:
* Severe headache
* Seizure activity
* Peripheral neuropathy
* Insomnia
Answer: Seizure activity
118
For a patient presenting with beta blocker overdose, what is the most reliable indicator of hypoperfusion?
Group of answer choices:
* Elevated lactate levels
* Hypokalemia
* Respiratory alkalosis
* Increased hematocrit
Answer: Elevated lactate levels
119
A patient with beta blocker overdose is undergoing initial stabilization. Which diagnostic tool is critical to assess cardiac function?
Group of answer choices:
* ECG
* Echocardiogram
* Chest X-ray
* MRI
Answer: ECG
120
After initiating treatment for beta blocker overdose, the patient remains hypotensive. Which additional intervention should be considered?
Group of answer choices:
* Vasopressors
* Magnesium sulfate infusion
* Activated charcoal
* Vitamin B12 supplementation
Answer: Vasopressors
121
A patient with barbiturate overdose requires hemodialysis. What is the most likely indication for this intervention?
Group of answer choices:
* Severe respiratory acidosis
* Elevated intracranial pressure
* Prolonged drug half-life and persistent toxicity
* Development of peripheral neuropathy
Answer: Prolonged drug half-life and persistent toxicity
122
Which specialty service would be most appropriate for long-term management of a patient recovering from beta blocker overdose?
Group of answer choices:
* Cardiology
* Nephrology
* Psychiatry
* Pulmonology
Answer: Psychiatry
123
A patient presents to the ED with suspected barbiturate overdose. Which of the following initial interventions is most appropriate?
Group of answer choices:
* Administer activated charcoal (AC)
* Perform gastric lavage
* Provide oxygen and prepare for intubation
* Administer flumazenil
Answer: Provide oxygen and prepare for intubation
124
Which diagnostic tests would be prioritized in a patient with suspected barbiturate overdose?
Group of answer choices:
* MRI, blood cultures, and glucose
* Tox screen, electrolytes, and ABG
* Echocardiogram and lipid panel
* D-dimer and thyroid function tests
Answer: Tox screen, electrolytes, and ABG
125
A patient presents after a beta blocker overdose with traumatic arm lacerations and hypovolemic shock. Which fluid resuscitation strategy is recommended?
Group of answer choices:
* Administer 2L of warmed normal saline or lactated Ringer's
* Administer 500 mL of D5W over 1 hour
* Administer 1L of half-normal saline with glucose
* Start total parenteral nutrition immediately
Answer: Administer 2L of warmed normal saline or lactated Ringer's
126
For a patient with beta blocker overdose and bradycardia, which medication should be administered initially?
Group of answer choices:
* Glucagon 5-10 mg bolus
* Epinephrine infusion
* Atropine
* Calcium gluconate
Answer: Atropine
127
In a beta blocker overdose case, which advanced treatment can help improve hemodynamic stability if initial interventions are insufficient?
Group of answer choices:
* Lipid emulsion therapy
* Naloxone infusion
* Vitamin K administration
* Methadone maintenance
Answer: Lipid emulsion therapy
128
A patient with barbiturate overdose is admitted. What specialty services are likely to be involved in this patient’s care?
Group of answer choices:
* Cardiology and endocrinology
* Neurology, psychiatry, and nephrology
* Dermatology and hematology
* Gastroenterology and infectious disease
Answer: Neurology, psychiatry, and nephrology
129
What toxicology screen findings would you expect in a patient with barbiturate overdose?
Group of answer choices:
* Elevated lactate and low bicarbonate
* Respiratory acidosis and positive barbiturate levels
* Elevated calcium and hyperglycemia
* Hyperkalemia and elevated digoxin levels
Answer: Respiratory acidosis and positive barbiturate levels
130
A patient with beta blocker overdose is experiencing refractory bradycardia and hypotension despite initial treatments. Which additional therapy should be considered?
Group of answer choices:
* Hyperinsulinemia-euglycemia therapy
* Thiamine supplementation
* Flumazenil administration
* Sodium bicarbonate infusion
Answer: Hyperinsulinemia-euglycemia therapy
131
What is the primary goal of calcium administration in a beta blocker overdose?
Group of answer choices:
* To reverse hypocalcemia
* To stabilize blood pressure and support cardiac contractility
* To reduce serum potassium levels
* To treat metabolic acidosis
Answer: To stabilize blood pressure and support cardiac contractility
132
Which of the following imaging studies is indicated for both barbiturate and beta blocker overdoses?
Group of answer choices:
* Abdominal ultrasound
* CT scan of the brain
* Chest X-ray
* MRI of the spine
Answer: Chest X-ray
133
19. Which finding is most concerning in acetaminophen overdose?
A) Mydriasis
B) Elevated liver enzymes
C) Respiratory acidosis
D) Hypercalcemia
Answer: B) Elevated liver enzymes
134
20. What is the best initial treatment for benzodiazepine overdose?
A) Gastric lavage
B) Flumazenil
C) Hemodialysis
D) Naloxone
Answer: B) Flumazenil
135
21. A patient with suspected opioid overdose presents with respiratory depression and pinpoint pupils. What is the first-line treatment?
A) Intravenous naloxone
B) Activated charcoal
C) Intravenous fluids
D) Lorazepam
Answer: A) Intravenous naloxone
136
22. Which of the following substances commonly causes serotonin syndrome?
A) Beta-blockers
B) Tricyclic antidepressants
C) Acetaminophen
D) Opioids
Answer: B) Tricyclic antidepressants
137
23. The antidote for acetaminophen toxicity is:
A) Flumazenil
B) Naloxone
C) N-acetylcysteine (NAC)
D) Sodium bicarbonate
Answer: C) N-acetylcysteine (NAC)
138
24. Which symptom is most indicative of alcohol withdrawal?
A) Bradycardia
B) Tremors
C) Pinpoint pupils
D) Respiratory depression
Answer: B) Tremors
139
25. Which intervention is used to prevent Wernicke encephalopathy in alcohol withdrawal?
A) Vitamin B12 supplementation
B) Thiamine supplementation
C) Iron infusion
D) Folic acid supplementation
B) Thiamine supplementation
140
26. What is a key diagnostic test for salicylate toxicity?
A) Serum glucose
B) Serum salicylate levels
C) Liver function tests
D) EKG
Answer: B) Serum salicylate levels
141
27. Beta-blocker overdose can cause all of the following EXCEPT:
A) Bradycardia
B) Hypertension
C) Hypoglycemia
D) Bronchospasm
Answer: B) Hypertension
142
29. The most common cause of unintentional poisoning in adults is:
A) Household cleaners
B) Pain medications
C) Alcohol
D) Pesticides
Answer: B) Pain medications
143
30. Which complication is associated with tricyclic antidepressant overdose?
A) Hyperkalemia
B) Prolonged QT interval
C) Respiratory alkalosis
D) Hyperglycemia
Answer: B) Prolonged QT interval
144
13. Which of the following is a key diagnostic marker for salicylate toxicity?
A) Hypokalemia
B) Respiratory alkalosis with metabolic acidosis
C) Hypernatremia
D) Elevated creatinine kinase
Answer: B) Respiratory alkalosis with metabolic acidosis
145
14. What is the hallmark symptom of benzodiazepine withdrawal?
A) Mydriasis
B) Tachycardia
C) Seizures
D) Miosis
Answer: C) Seizures
146
15. Alcohol withdrawal can lead to which life-threatening condition if untreated?
A) Wernicke encephalopathy
B) Delirium tremens
C) Hepatic encephalopathy
D) Cardiomyopathy
Answer: B) Delirium tremens
147
16. Which treatment strategy is most appropriate for benzodiazepine overdose?
A) Flumazenil administration
B) Gastric lavage only
C) Dialysis to remove excess drugs
D) Activated charcoal within 4 hours of ingestion
Answer: A) Flumazenil administration
148
18. Which laboratory gap is useful for identifying toxic ingestion?
A) Anion gap
B) Calcium gap
C) Potassium gap
D) Phosphate gap
Answer: A) Anion gap
149
19. Treatment for opioid overdose involves:
A) Activated charcoal and glucagon
B) Flumazenil and gastric lavage
C) Naloxone and supportive care
D) Hemodialysis and insulin
Answer: C) Naloxone and supportive care
150
20. Which of the following substances causes centrilobular hepatic necrosis in overdose?
A) Acetaminophen
B) Aspirin
C) Cocaine
D) Lithium
Answer: A) Acetaminophen
151
8. Which of the following is a nonpharmacologic intervention to promote sleep in hospitalized patients?
A) Administering Ambien nightly
B) Using massage therapy
C) Increasing light exposure at night
D) Frequent interruptions for monitoring
Answer: B) Using massage therapy
152
9. Which medications are most likely to disrupt sleep?
A) Melatonin and glucocorticoids
B) Benzodiazepines and beta-blockers
C) Acetaminophen and antacids
D) Insulin and antihistamines
Answer: B) Benzodiazepines and beta-blockers
153
10. Melatonin use in critically ill patients is currently under research for its role in:
A) Promoting muscle relaxation
B) Preventing respiratory complications
C) Reducing delirium risk
D) Enhancing medication efficacy
Answer: C) Reducing delirium risk
154
11. What is a key consequence of sleep deprivation in mechanically ventilated patients?
A) Decreased need for oxygenation
B) Impaired ventilator weaning
C) Increased tolerance to noninvasive ventilation
D) Improved immune response
Answer: B) Impaired ventilator weaning
155
1. A 30-year-old male is found unconscious after ingesting an unknown quantity of acetaminophen 8 hours ago. He reports nausea and abdominal discomfort. What is the next best step in management?
A) Administer activated charcoal
B) Administer N-acetylcysteine (NAC)
C) Perform gastric lavage
D) Obtain serum acetaminophen levels
B) Administer N-acetylcysteine (NAC)
156
2. A 45-year-old female presents with agitation, tachycardia, and mydriasis after taking a large dose of amphetamines. What is the priority intervention?
A) Administer benzodiazepines for agitation
B) Perform gastric lavage
C) Administer flumazenil
D) Administer naloxone
Answer: A) Administer benzodiazepines for agitation
157
3. A 22-year-old male is brought to the ED after ingesting a large amount of an unknown substance. He has slurred speech, bradycardia, and hypothermia. The toxicology screen is positive for barbiturates. What is the most appropriate treatment?
A) Alkalinization of urine with sodium bicarbonate
B) Perform hemodialysis
C) Administer naloxone
D) Supportive care with monitoring
Answer: D) Supportive care with monitoring
158
A 16-year-old female presents with severe salicylate toxicity. She has tinnitus, tachypnea, and an anion gap metabolic acidosis. What is the next step in management?
A) Administer sodium bicarbonate
B) Provide intravenous glucagon
C) Administer flumazenil
D) Perform gastric lavage
Answer: A) Administer sodium bicarbonate
159
5. A 40-year-old patient with a history of depression is brought in after a suspected tricyclic antidepressant overdose. He is confused, has dilated pupils, and his ECG shows a widened QRS complex. What is the most appropriate next step?
A) Administer benzodiazepines
B) Administer sodium bicarbonate
C) Initiate gastric lavage
D) Perform immediate dialysis
Answer: B) Administer sodium bicarbonate
160
6. A 25-year-old female ingested an unknown amount of lithium tablets. She presents with confusion, tremors, and ataxia. Her serum lithium level is elevated. What is the most appropriate intervention?
A) Administer activated charcoal
B) Start hemodialysis
C) Administer flumazenil
D) Provide intravenous glucose and fluids
Answer: B) Start hemodialysis
161
7. A 50-year-old male presents to the ED after overdosing on beta-blockers. He has bradycardia, hypotension, and hypoglycemia. What is the initial treatment?
A) Administer atropine
B) Administer glucagon
C) Perform gastric lavage
D) Administer naloxone
Answer: B) Administer fluids, atropine glucagon, insuline, calcium,
162
8. A patient with a history of chronic pain overdoses on opioids and presents with respiratory depression and pinpoint pupils. What is the most appropriate next step?
A) Administer naloxone
B) Initiate activated charcoal therapy
C) Perform a CT scan of the head
D) Begin intravenous fluids
Answer: A) Administer naloxone
163
9. A 35-year-old male ingests a large quantity of cocaine and presents with severe agitation, hyperthermia, and hypertension. What is the priority in his management?
A) Provide benzodiazepines for sedation
B) Administer activated charcoal
C) Initiate cooling measures
D) Administer naloxone
Answer: A) Provide benzodiazepines for sedation
164
1. A 48-year-old male with a history of chronic alcohol use presents with restlessness, tremors, and sweating 12 hours after his last drink. What is the most appropriate treatment?
A) Administer lorazepam
B) Administer flumazenil
C) Start intravenous fluids only
D) Perform gastric lavage
Answer: A) Administer lorazepam
165
2. A 30-year-old patient on long-term opioids presents with withdrawal symptoms, including nausea, muscle aches, and anxiety. What is the best management strategy?
A) Start methadone or buprenorphine
B) Administer naloxone
C) Provide flumazenil
D) Restrict fluids and monitor
Answer: A) Start methadone or buprenorphine
166
3. A 40-year-old male with benzodiazepine dependence stops taking his medication abruptly and presents with seizures. What is the most appropriate management?
A) Administer a benzodiazepine like lorazepam
B) Start flumazenil
C) Perform gastric lavage
D) Begin opioid substitution therapy
Answer: A) Administer a benzodiazepine like lorazepam
167
4. A 50-year-old female undergoing alcohol withdrawal develops confusion, agitation, and hallucinations. Vital signs show tachycardia and hypertension. What is the next step in her management?
A) Administer haloperidol
B) Start benzodiazepine therapy
C) Provide naloxone
D) Initiate mechanical ventilation
Answer: B) Start benzodiazepine therapy
168
5. A patient with chronic opioid use stops cold turkey and reports diarrhea, abdominal cramping, and lacrimation. What supportive care measure is most appropriate?
A) Administer loperamide for diarrhea
B) Provide naloxone
C) Begin methadone therapy
D) Administer flumazenil
Answer: A) Administer loperamide for diarrhea
169
6. A 28-year-old female with a history of substance use presents with diaphoresis, dilated pupils, and tremors after stopping cocaine. What is the initial management?
A) Provide benzodiazepines for agitation
B) Administer naloxone
C) Begin methadone therapy
D) Initiate sodium bicarbonate infusion
Answer: A) Provide benzodiazepines for agitation
170
7. A 35-year-old patient abruptly stops their high-dose clonazepam and reports restlessness and insomnia. What is the best approach?
A) Gradually taper the benzodiazepine dose
B) Start a high-dose benzodiazepine
C) Provide naloxone
D) Monitor without intervention
Answer: A) Gradually taper the benzodiazepine dose
171
8. A patient in alcohol withdrawal presents with disorientation and ataxia. You suspect Wernicke's encephalopathy. What is the next step in treatment?
A) Administer intravenous thiamine
B) Start benzodiazepines immediately
C) Provide IV glucose before thiamine
D) Perform a CT scan
Answer: A) Administer intravenous thiamine
172
9. A 22-year-old patient with heroin use disorder is experiencing withdrawal symptoms, including irritability, yawning, and sweating. Which medication is most appropriate?
A) Methadone or buprenorphine
B) Naloxone
C) Flumazenil
D) Haloperidol
Answer: A) Methadone or buprenorphine
173
10. A 55-year-old male abruptly discontinues long-term gabapentin use and presents with agitation, confusion, and sweating. What is the best next step?
A) Restart gabapentin and taper slowly
B) Administer naloxone
C) Begin benzodiazepine therapy
D) Provide flumazenil
Answer: A) Restart gabapentin and taper slowly
174
8. A patient with suspected opioid overdose is unresponsive and has pinpoint pupils. What test confirms the diagnosis?
A) Serum opioid level
B) Urine toxicology screen
C) Pulse oximetry
D) Arterial blood gas
Answer: B) Urine toxicology screen
175
11. Which intervention is most appropriate to manage a patient with acute amphetamine toxicity and agitation?
A) Provide benzodiazepines
B) Administer naloxone
C) Perform gastric lavage
D) Initiate therapeutic cooling measures
Answer: A) Provide benzodiazepines
176
12. For a patient experiencing withdrawal symptoms from long-term benzodiazepine use, what is the first step?
A) Administer flumazenil
B) Gradually taper the benzodiazepine
C) Provide methadone
D) Administer lorazepam
Answer: B) Gradually taper the benzodiazepine
177
20. A patient experiencing alcohol withdrawal develops agitation, visual hallucinations, and tachycardia. What is the most concerning complication?
A) Delirium tremens
B) Wernicke’s encephalopathy
C) Seizures
D) Alcoholic ketoacidosis
Answer: A) Delirium tremens
178
1. What is the primary pathophysiologic cause of acetaminophen toxicity?
A) Hepatocellular apoptosis due to mitochondrial dysfunction
B) Glutathione depletion leading to centrilobular hepatic necrosis
C) Direct enzymatic destruction of hepatocytes by acetaminophen
D) Overstimulation of NMDA receptors in the liver
Answer: B) Glutathione depletion leading to centrilobular hepatic necrosis
179
2. Which neurotransmitter is most implicated in alcohol withdrawal?
A) Dopamine
B) Serotonin
C) GABA
D) Acetylcholine
Answer: C) GABA
180
4. Which receptor is antagonized by naloxone during opioid overdose?
A) NMDA receptor
B) GABA receptor
C) Mu-opioid receptor
D) Nicotinic receptor
Answer: C) Mu-opioid receptor
181
5. What causes serotonin syndrome in patients taking serotonergic drugs?
A) Increased dopamine reuptake
B) Excessive serotonin release or reuptake inhibition
C) Downregulation of adrenergic receptors
D) Overstimulation of GABA receptors
Answer: B) Excessive serotonin release or reuptake inhibition
182
6. What is the primary diagnostic test for acetaminophen overdose?
A) Serum acetaminophen level
B) Complete blood count
C) Arterial blood gas
D) Serum osmolality
Answer: A) Serum acetaminophen level
183
8. A patient with suspected aspirin overdose presents with metabolic acidosis and respiratory alkalosis. What diagnostic test confirms the diagnosis?
A) Serum salicylate level
B) Complete blood count
C) Coagulation profile
D) EKG
Answer: A) Serum salicylate level
184
9. What is the first step in diagnosing an unknown toxic exposure?
A) Obtain a detailed patient history
B) Administer activated charcoal
C) Perform a lumbar puncture
D) Start broad-spectrum antibiotics
Answer: A) Obtain a detailed patient history
185
10. Which lab value is most indicative of hepatic injury in acetaminophen toxicity?
A) Elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
B) Increased white blood cell count
C) Reduced hemoglobin levels
D) Elevated creatinine
Answer: A) Elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
186
13. Which intervention is the priority for a patient with hypothermia from barbiturate toxicity?
A) Alkalinize urine
B) Provide active rewarming
C) Administer benzodiazepines
D) Perform hemodialysis
Answer: B) Provide active rewarming
187
14. In a patient with serotonin syndrome, what is the first-line pharmacologic treatment for agitation?
A) Lorazepam
B) Flumazenil
C) Haloperidol
D) Morphine
Answer: A) Lorazepam
188
15. How should decontamination be performed for a patient who ingested a toxic substance within one hour?
A) Whole bowel irrigation
B) Activated charcoal
C) Intravenous fluids
D) Gastric lavage
Answer: D) Gastric lavage
189
16. What is the preferred treatment for severe alcohol withdrawal with delirium tremens (DTs)?
A) Dexmedetomidine
B) Lorazepam
C) Methadone
D) Clonidine
Answer: B) Lorazepam
190
17. Which drug is used to alkalinize urine in aspirin overdose?
A) Sodium bicarbonate
B) Calcium gluconate
C) Glucagon
D) N-acetylcysteine
Answer: A) Sodium bicarbonate
191
18. What is the first-line treatment for opioid withdrawal symptoms?
A) Naloxone
B) Methadone or buprenorphine
C) Clonidine
D) Flumazenil
Answer: B) Methadone or buprenorphine
192
19. What is the main treatment for hypoglycemia caused by beta-blocker overdose?
A) Glucagon
B) Insulin
C) Calcium
D) Activated charcoal
Answer: A) Glucagon
193
22. Which condition is a potential complication of salicylate toxicity?
A) Pulmonary edema
B) Hyperglycemia
C) Cardiac tamponade
D) Pneumothorax
Answer: A) Pulmonary edema
194
23. What complication is most likely after naloxone administration in opioid overdose?
A) Seizures
B) Aspiration pneumonia
C) Pulmonary edema
D) Hyperglycemia
Answer: C) Pulmonary edema
195
25. Which complication is associated with serotonin syndrome?
A) Lactic acidosis
B) Hypotension
C) Chronic kidney disease
D) Cardiomyopathy
Answer: A) Lactic acidosis
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27. What is the most common cause of death in alcohol withdrawal?
A) Seizures
B) Hypertension
C) Aspiration pneumonia
D) Arrhythmias
Answer: D) Arrhythmias
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28. Which is a “toxic time bomb” ingestion?
A) Immediate-release acetaminophen overdose
B) Extended-release beta blockers
C) Single-dose lithium toxicity
D) Methamphetamine overdose
Answer: B) Extended-release beta blockers
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29. What is the priority intervention for a patient with suspected TCA overdose and wide QRS complex on EKG?
A) Administer sodium bicarbonate
B) Provide intravenous lipid emulsions
C) Perform immediate gastric lavage
D) Start atropine for bradycardia
Answer: A) Administer sodium bicarbonate
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1. What is the primary pathophysiological mechanism of acetaminophen toxicity?
A) Hepatotoxicity from NAPQI accumulation
B) Renal failure due to nephrotoxicity
C) Central nervous system depression
D) Pancreatitis from enzyme activation
Answer: A) Hepatotoxicity from NAPQI accumulation
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2. Which diagnostic test confirms acetaminophen toxicity?
A) Serum acetaminophen level at 4 hours post-ingestion
B) Complete blood count
C) Chest X-ray
D) CT scan of the abdomen
Answer: A) Serum acetaminophen level at 4 hours post-ingestion
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3. What is the first-line pharmacologic intervention for this patient?
A) Activated charcoal
B) N-acetylcysteine (NAC)
C) Hemodialysis
D) IV fluids only
Answer: B) N-acetylcysteine (NAC)
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26. Which drug overdose is associated with a high risk of sudden death from arrhythmias?
A) Cocaine
B) Lithium
C) Salicylates
D) Acetaminophen
Answer: A) Cocaine
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2. How does naloxone work in opioid overdose?
A) Blocks opioid receptors and reverses CNS depression
B) Increases dopamine levels in the brain
C) Enhances metabolism of opioids in the liver
D) Stimulates respiratory drive directly
Answer: A) Blocks opioid receptors and reverses CNS depression
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3. What complication might arise after administering naloxone?
A) Hyperthermia
B) Severe withdrawal symptoms
C) Acute kidney injury
D) Hyperkalemia
Answer: B) Severe withdrawal symptoms
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4. What are common signs of opioid withdrawal?
A) Diarrhea, tachycardia, agitation
B) Hypotension, bradycardia, drowsiness
C) Hyperthermia, hypertension, delirium
D) Cyanosis, respiratory depression, miosis
Answer: A) Diarrhea, tachycardia, agitation
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1. What pathophysiological change occurs during alcohol withdrawal?
A) Increased GABA activity
B) Unopposed NMDA receptor activity
C) Decreased dopamine levels
D) Increased acetylcholine release
Answer: B) Unopposed NMDA receptor activity
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4. What complication is most likely if alcohol withdrawal is untreated?
A) Wernicke's encephalopathy
B) Sepsis
C) Liver failure
D) Hypoglycemia
Answer: A) Wernicke's encephalopathy
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1. What is the pathophysiological mechanism of salicylate toxicity?
A) Respiratory depression and CNS hypoxia
B) Disruption of oxidative phosphorylation leading to acidosis
C) Peripheral vasoconstriction and cardiac ischemia
D) Increased GABA activity causing sedation
Answer: B) Disruption of oxidative phosphorylation leading to acidosis
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2. Which lab finding is most consistent with aspirin toxicity?
A) Respiratory alkalosis with metabolic acidosis
B) Hyperkalemia and hypocalcemia
C) Elevated liver enzymes
D) Increased anion gap with hypoglycemia
Answer: A) Respiratory alkalosis with metabolic acidosis
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4. What complication should you monitor for in aspirin toxicity?
A) Pulmonary edema
B) Hepatic failure
C) Myocardial infarction
D) Chronic renal insufficiency
Answer: A) Pulmonary edema
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3. What is the most appropriate initial intervention for salicylates toxicity?
A) Hemodialysis
B) Sodium bicarbonate infusion
C) Gastric lavage and activated charcoal
D) Immediate endotracheal intubation
Answer: C) Gastric lavage and activated charcoal
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1. What cardiovascular complication is most likely in cocaine overdose?
A) Coronary vasospasm leading to myocardial infarction
B) Bradycardia causing decreased cardiac output
C) Prolonged QT syndrome with syncope
D) Hypertrophic cardiomyopathy
Answer: A) Coronary vasospasm leading to myocardial infarction
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2. Which diagnostic test should be ordered immediately in cocaine overdose?
A) EKG and cardiac enzymes
B) Brain MRI
C) Complete blood count
D) Spirometry
Answer: A) EKG and cardiac enzymes
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3. How should tachycardia and hypertension be managed in the patient with cocaine overdose?
A) Beta-blockers like propranolol
B) Benzodiazepines and alpha-blockers
C) ACE inhibitors and nitrates
D) Calcium channel blockers
Answer: B) Benzodiazepines and alpha-blockers
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4. What is the role of benzodiazepines in the case of patient with cocaine overdose?
A) Prevents seizures and controls agitation
B) Decreases heart rate directly
C) Enhances catecholamine reuptake
D) Reverses cocaine toxicity at receptor sites
Answer: A) Prevents seizures and controls agitation
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2. What complication should you monitor for in this patient with digoxin toxicity?
A) Ventricular arrhythmias
B) Stroke
C) Hypoglycemia
D) Acute liver failure
Answer: A) Ventricular arrhythmias
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A 42-year-old woman on fluoxetine and tramadol presents with agitation, fever, tremors, and hyperreflexia. She is hypertensive and has clonus on physical exam.
1. What is the primary cause of serotonin syndrome in this patient?
A) Combination of serotonergic medications
B) Long-term fluoxetine therapy
C) Acute alcohol withdrawal
D) Excessive caffeine intake
Answer: A) Combination of serotonergic medications
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2. What is the next step in management of serotonin syndrome?
A) Administer dantrolene
B) Discontinue serotonergic drugs and provide benzodiazepines
C) Start hemodialysis
D) Begin IV antibiotics
Answer: B) Discontinue serotonergic drugs and provide benzodiazepines
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1. What is the most effective antidote for beta-blocker overdose?
A) Flumazenil
B) Glucagon
C) Naloxone
D) Atropine
Answer: B) Glucagon
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2. What is the pathophysiological mechanism of beta-blocker overdose?
A) Decreased sympathetic activity
B) Increased GABA receptor stimulation
C) Hyperpolarization of neuronal membranes
D) Increased norepinephrine reuptake
Answer: A) Decreased sympathetic activity
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A 25-year-old female presents with nausea, vomiting, tinnitus, and dizziness after ingesting 25 aspirin tablets 6 hours ago. ABG shows respiratory alkalosis with metabolic acidosis.
1. What is the primary treatment to enhance salicylate elimination?
A) Activated charcoal
B) Sodium bicarbonate infusion
C) Gastric lavage
D) Hemodialysis
Answer: B) gastric lavage and activated charcoal acutely; NaHCO3, dextrose, hemodialysis,
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2. What complication must be closely monitored in this patient with aspirin toxicity?
A) Pulmonary edema
B) Stroke
C) Hypoglycemia
D) Liver failure
Answer: A) Pulmonary edema
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A 48-year-old male started on tramadol and sertraline presents with confusion, fever, and tremors. Physical exam reveals hyperreflexia and clonus.
1. Which pharmacologic agent may be used for severe serotonin syndrome?
A) Flumazenil
B) Cyproheptadine
C) Sodium bicarbonate
D) Naloxone
Answer: B) Cyproheptadine
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2. How should the hyperthermia in this patient with serotonin syndrome be managed?
A) External cooling and benzodiazepines
B) Dantrolene
C) Ice water immersion
D) Antipyretics
Answer: A) External cooling and benzodiazepines
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A 45-year-old male is found unconscious in his apartment with a respiratory rate of 6/min and pinpoint pupils. A syringe is found nearby.
1. What is the appropriate initial dose of naloxone?
A) 0.1 mg IV
B) 0.4 mg IV
C) 2 mg IV
D) 10 mg IV
Answer: B) 0.4 mg IV
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1. What is the primary pathophysiological mechanism behind refeeding syndrome?
A) Hyperinsulinemia leading to cellular uptake of electrolytes
B) Dehydration from increased metabolic demands
C) Increased gluconeogenesis causing hypoglycemia
D) Hyperkalemia due to tissue breakdown
Answer: A) Hyperinsulinemia leading to cellular uptake of electrolytes
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2. Which factor increases the risk of lithium toxicity?
A) Hypokalemia
B) Dehydration
C) Low magnesium levels
D) Liver dysfunction
Answer: B) Dehydration
