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Internal Medicine > Poision > Flashcards

Poision Flashcards

1
Q

Triad Of Arsenic Poisoning

A

Garlic breath with watery diarrhea

Prolong QTC

Depigmentation with stock glove neuropathy

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2
Q

How to dx and manage Arsenic Poisoning?

A

Dx through urine arsenic levels

Tx::Dimercaprol / DMSA

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3
Q

Classification of Hypothermia

A

Mild (35-32’c)with tachycardia And tachypnea / increased shivering

Moderate ( 32-28’c) bradycardia with decrease shivering

Severe (<28’c) coma / ventricular arrthymia

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4
Q

How to t/m Hypothermia in General?

A

Warm IV fluids for low BP

ETT if comatose patient

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5
Q

How to manage mild Hypothermia?

A

Passive external warming that is remove wet clothing And the patient body is cover with blanket

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6
Q

How to manage moderate Hypothermia?

A

Active external warming that is warm blanket with heating pads and warm bath

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7
Q

How to manage severe Hypothermia?

A

Active internal rewarming that is warm pleural Or peritoneal irrigation

Warm humidified O2

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8
Q

How acidosis occur in Hypothermia?

A

Meta-acidosis due to decrease tissue perfusion

Resp Acidosis due to hypoventilation

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9
Q

How azotemia and hyperkalemia occur in Hypothermia?

A

Azotemia due to decrease renal perfusion

Hyperkalemia due to cell lysis

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10
Q

How hyperglycemia and low wbc/PLTs occur in Hypothermia?

A

High glucose due to loss of insulin effect esp in temp less than 30*c
Low wbc/PLTs due to splenic squestration

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11
Q

How high Hematocrit and coagulopathy occur in Hypothermia?

A

High Hematocrit due to hemoconcentration

Coagulopathy due to impaired coagulation pathway

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12
Q

How lipase level increased in Hypothermia?

A

Cold induced pancreatitis

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13
Q

What to do if patient have persistent Hypothermia despite giving IV warm fluid?

A

IV fluids and rewarming ineffective in restoring normal BP—> inotropic support with dopamine

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14
Q

Triad of Heat Exhaustion

A

Body temp less than 104’F

Not significant CNS dysfunction

Loss of fluid and electrolytes with physical activity leads to Exhaustion

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15
Q

Triad of MARIJUANA

A

Conjunctival injection with Slow reaction time

affecting the ability to operate automobiles and increasing the risk of motor vehicle accidents.

Increased appetite

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16
Q

Triad of methanol ketoacidosis

A

High osmole gap with high anion gap

Visual SxS

Alter mental status

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17
Q

Lab finding of alcohol ketoacidosis

A

High osmole gap with high anion gap

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18
Q

Triad of ETHYLENE GLYCOL POISONING

A

High osmole gap with high anion gap

Renal Sxs with stones

Neuro Sxs like cranial nerve palsy / tetani

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19
Q

Triad of Isopropyl alcohol ingestion

A

High osmole gap without anion gap

CNS depression

Disconjugate gate with absent ciliary reflex

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20
Q

How FLUPHENAZINE cause HYPOTHERMIA?

A

cause hypothermia by inhibiting the body’s shivering mechanism and/or inhibiting autonomic thermoregulation.

For this reason, patients taking antipsychotic medications should be advised to avoid prolonged exposure to extreme temperatures.
Under such conditions, they can develop extreme hypothermia

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21
Q

Triad of PCP

A

Multidirectional nystagmus

Ataxia

Aggressive behavior

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22
Q

Important point of opioid treatment

A

Methadone and buprenorphine—long acting opioid agonists not used in acute intoxication rather used for withdrawal

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23
Q

What are the reliable SxS of Opioid intoxication?

A

Bradycardia with low BP and low RR

Decrease Bowel sound with Hypothermia due to histamine

Miosis but not so reliable

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24
Q

What is treatment of choice for lithium intoxication?

A

Hemodialysis is the treatment choice for severe lithium toxicity because it is the most dialyzable toxin.

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25
Q

How to t/m fits due to TCA?

A

Seizures b/c TCA caused by inhibition of GABA—hence treated with GABA agonist like benzodiazepines instead of Na+-channel blocking agents like phenytoin (as it can cause hypotension and arrhythmia)

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26
Q

Important point of DIPHENHYDRAMINE

A

Antihistamine as well as anticholinergic properties

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27
Q

How to assess caustic ingestion through imaging?

A

Serial chest and abdominal x-ray: look for perforation

suspected perforation: upper GI x-ray with water soluble contrast

Upper GI endoscopy within 12-24 hours in the absence of perforation and severe respiratory distress in hemodynamically stable patient

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28
Q

What ABGs changes occur in iron poisoning?

A

Anion gap metabolic acidosis

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29
Q

How to approach ACETAMINOPHEN toxicity if level is more than 7.5g?

A

If less than 4 hours of ingestion—> add charcoal and then check level
If more than 10 or timing of ingestion unknown give NAC

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30
Q

How to t/m severe lead poisoning?

A

Level more than 70mcg/dl

Give Dimercaprol plus EDTA

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31
Q

How to t/moderate lead poisoning?

A

Level 45-69mcg/dl

Give DMSA

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32
Q

How to t/m mild lead poisoning?

A

Level 4-44mcg/dl
No treatment
Repeat level of lead in a month

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33
Q

Triad of METHEMOGLOBINEMIA

A

cyanosis

bluish discoloration of skin and mucous membranes

Mimics to CO Poisoning

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34
Q

Triad of cyanide poisoning

A

metabolic acidosis

Bitter almond breath is characteristic

Markedly elevated lactate (typically >10 mEq/L)

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35
Q

Name the high potency Anti psychotic medication

Remember (HTF)

A

Haloperidol

TriAuoperazine

Fluphenazine

more neurologic side effects (eg, extrapyramidal symptoms [EPS)).

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36
Q

Name the low potency first generation antipsychotic

A

Chlorpromazine

Thioridazine

(anticholinergic, antihistamine, Alpha-blockade effects)

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37
Q

What are the ophthalmologic complications of first generation antipsychotic?

A

Chlorpromazine-Corneal deposits

Thioridazine-reTinal deposits.

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38
Q

How to t/m acute dystonia due to antipsychotic?

A

benztropine

diphenhydramine.

39
Q

How to t/m Akathisia (restlessness) and Parkinsonism (bradykinesia)?

A

Both with benztropine

In case of Akathisia ——> benzodiazepines

In case of Parkinsonism—-> amantadine

40
Q

How to t/m Tardive dyskinesia?

A

atypical antipsychotics (eg, clozapine)

valbenazine

deutetrabenazine.

41
Q

What are the atypical antipsychotic?

A

Aripiprazole
asenapine

clozapine
olanzapine

quetiapine
iloperidone

paliperidone
risperidone

lurasidone
ziprasidone.

42
Q

Name the atypical antipsychotic causing hyperprolactinemia

A

Risperidone

43
Q

Important point of clozapine

A

Use clozapine for treatment-resistant schizophrenia or schizoaffective disorder and for suicidality in schizophrenia.

44
Q

What is the MOA of Buspirone and use of it?

A

Stimulates serotonin receptors.

Use in GAD

45
Q

Name the d/f SSRI

A

Fluoxetine
fluvoxamine

paroxetine
sertraline

escitalopram
citalopram.

46
Q

What are the clinical uses of SSRI?

ABPD

A

Anxiety disorder
bulimia binge-eating disorder

PTSD /premature ejaculation / premenstrual dysphoric disorder.
Depression

47
Q

What are the specific S.E of SSRI?

A

SIADH

sexual dysfunction

48
Q

Important point

A

If depression patient develop HTN think of SNRI

49
Q

What are the d/f SNRI?

A

Venlafaxine
desvenlafaxine

duloxetine

levomilnacipran
milnacipran.

50
Q

Name the substance causing lithium toxicity

A

In acute case overdose of lithium

Or

In chronic condition causing dehydration / ACEI, NASIDs, Thiazide diuretic

51
Q

Name the medication given for extra pyramidal SxS Occur due to antipsychotic

A

Acute dystonia —>Benztropine / diphenhydramine

Akathasia —->BB / benzo / Benztropine

Parkinsonism—->Benztropine/amantadine

52
Q

Triad of Ectasy (MDMA//Molly)

A

Sxs like Serotonin syndrome with low sodium and Amphetamine

53
Q

Important point::

A

Inhalants are depressive

Bath salts are synetic amphetamine; it also leads to Serotonin syndrome

54
Q

In which condition Succinylcholine avoided?

A

Hyperkalemia condition like GBS, tumor lysis syndrome
Rhabdomyolysis
Burns
*in case of deranged LFT use low dose of drug

55
Q

What are the consequences of high voltage Electrical injuries?

A

Rnhabdomylosis

Heme pigment induced AKI

Acute compartment syndrome from intra compartmental muscle swelling

56
Q

How to Rx high voltage electrical injuries?

A

Potassium sparing IV fluid as muscles injury result hyperkalemia

57
Q

What are the common features of Neuroleptic malignant syndrome and serotonin syndrome?

A

Both show AMS, increase body temperature and autonomic dysregulation

58
Q

Difference between Neuroleptic malignant syndrome and Serotonin syndrome

A

NMS::
Dose independent and take times to occur
Severe diffuse muscle rigidity

Serotonin syndrome::
Dose dependent and quick to occur
Clonus, hyer reflexia and tremor

59
Q

What are the SxS of organophosphate poisoning?

A

Narrow pupil
Excessive lacrimation and salivation

Bronchospasm with low HR

Excessive emesis and diarrhoea
Lots of urine

60
Q

How to manage Organophosphate poisoning?

A

First remove clothes and irrigate skin
Given atropine followed by Pralidoxime

Former only reverse muscarinic SxS and latter both nicotinic and muscarinic

61
Q

How to manage SEROTONIN SYNDROME?

A

1) First withdraw all culprit meds followed by supportive care and sedation with benzo
2) Cyproheptadine if above fail
3) if temp > 106f (41.1c) —> stat sedation, paralysis and tracheal intubation

62
Q

Difference b/w lithium induced physiological tremor and Lithium toxicity tremor

A

Lithium induced physiological tremor::
Symmetric and limited to hand and upper limbs
Rx:: just observe

Lithium toxicity tremor::
Irregular, coarse tremor
Involved multiple part of body with GIT and neurological SxS
Rx:: dialysis

63
Q

How phenytoin toxicity occur?

Drugs which inhibit or CYP 450 or displace this drugs from plasma protein leads to increase level of it

A

Acute toxicity SxS like cerebellar dysfunction

Severe —> like AMS fits death
S’times Rapid IV infusing leads to hypotension and bradyarrhythmia

64
Q

How Tetrahydrocannabinol poisoning present?

A

increase appetite with red reflex and slowed reflex

65
Q

What is the most specific ECG suggest digoxin toxicity?

A

Atrial tachycardia with type 2A AV block

Former due to increase automaticity and latter due to AV node block.

66
Q

Name the Antihistamine and Anti Parkinson meds showing Anti cholinergic properties

A

Anti Histamine::
Diphenhydramine and Cyproheptadine

Anti Parkinson::
Benztropine and Trihexyphenidyl

67
Q

Name the Psychotropics meds showing Anti cholinergic properties

A

1st Generation—-> Chlorpromazine and Haloperidol
2nd Generation—-> Clozapine

TCA like Amitriptyline and Clomipramine

68
Q

Name the plant based which showing Anti cholinergic properties

A

Jimsonweed
Nightshade species
Muscarinic mushroom species

69
Q

What are the CNS, CVS and Pulmonary complications of AMIDARONE?

A

CNS—> Peripheral Neuropathy

CVS—-> sinus brady Or QT prolonged or risk of torsade de pointes

Pulmo—> Chronic interstitial pnemonia

70
Q

What are the Ocular, GIT and derma complications of AMIDARONE?

A

Ocular—> Optic Neuropathy or Corneal microdeposit

GIT—> deranged LFT or hepatitis

Derma—> blue gray skin discoloration

71
Q

How to treat Comedonal acne?
Located at nose, forehead and chin

Remember GAS

A

Topical retinoids like Glycolic acid, Azelaic, Salicylic

72
Q

How to manage mild, mod and severe Inflammatory acne?

It shows inflammatory erythematous papules and pustules

A

If mild give—> Topical retinoids plus benzoyl peroxide

If moderate—> topical ABx like Clindamycin or erythromycin

If severe—> Oral Abx

73
Q

How to manage moderate, severe and unresponsive Nodular (cystic) acne?

A

Moderate—-> topical (ABx + benzoyl peroxide) + topical ABx

Severe —-> add oral Abx
Unresponsive—-> Oral isotretinoin

74
Q

How to manage DELIRIUM non-pharma?

MCPS E

A
  • Mobilise the patient with avoidance of restrain
  • Constant observation by family member or professional sitters
  • Personal interaction via physical touch or just reassurance
  • Sleep facilitation viz Bright day / dim night lighting
  • Environment peaceful viz noise reduction or intervention grouping
75
Q

How to manage DELIRIUM pharma?

A

Reduce pain but use non opioid

Off label use of antipsychotic

If still in delirium then use of benzo

76
Q

How to approach Hyponatremia?

Part 1

A

First check serum Osm

1) If normal or high—>
High glucose, Exogenous osmoles like mannitol, pseudo Hyponatremia (paraproteinmia or hyperlipidemia)

2) If low —>check ECV and urine findings

77
Q

How to approach Low Serum sodium with low serum osmolality in Hypovolemia and hypervolemia?

For hypovolemia cut off urine Na is 40

A

Check ECV and urine findings

1) If Hypervolemic —-> CHF, CLD, nephrotic syndrome

2) If hypovolemia—> check urine Na
If less than 40–>Non renal salt loss

If more than 40–> diuretic or primary adrenal insufficiency

78
Q

How to approach Low Serum sodium with low serum osmolality in Euvolemia?

Cut off urine osm 100

A

Check Urine osm

If less than 100 —->beer potomania Or psychogenic polydipsia

If more than 100–> SIADH

79
Q

What are the causes of post operative Delayed emergence?

In normal situation patient regain conscious within 15 mins after extubation

A

1) Neuro disorder like stroke, fits or Increase ICP
2) Metabolic disorder like alter temperature, blood glucose, low sodium and Liver disease
3) Drug effect like toxin or heavy dose / prolonged used of anesthesia

80
Q

Name the drugs and their MOA causing Rhabdomyolysis

FACE (A= S) :. ONE (N = benzo): CA

A

• Direct Myotoxicity
(Fibrates Statins Colchicine cocaine Ethanol)

• Prolong Immobilisation
( compression ischemia) Opioid Benzo Ethanol

• Vasoconstrictive ischemia
( Ethanol cocaine)

81
Q 
What are the causes of Secondary Priapism? Remember MSN
Primary cause (unknown)
A

Meds like alpha1 blocked or Antidepressants like Trazadone or SSRI,
Sildenafil Or stimulant like Amphetamine or cocaine

Medical issue like SCD, leukemia

S surgery like Perineal or genital trauma

Neurogenic lesion like cauda equina syndrome

82
Q

What are the withdrawal sxs of Opioid?

A

Eye —> lacrimation and pupil dilated
Mouth—> yawing

Bowel—> hyperactive
Penis—> piloerection

83
Q

How BB toxicity present physically and on ECG?

A

AMS with breathing d/f ( bronchospasm)
Low BP, HR and Glucose
Fits

EKG show Increase PR interval and bradycardia

84
Q

How to manage BB toxicity?

A

First secure airway Along with IV fluid infusion

Not response—->.IV atropine
Not response——–> IV glucagon.

85
Q

Triad of Osler weber rendu syndrome

Autosomal dominant

A

Recurrent nasal bleeding and clubbing

Ruby colored papules blanch with pressure (telangiectasia)

AV malformation with reactive polycythemia

86
Q

What are the IMMEDIATE and Delayed cause of Post operative fever?

A

• IMMEDIATE (within 6hours after surgery)
Tissue trauma
Blood product
Malignant hyperthermia

• DELAYED (After 1month)
Viral Infections
SSI (indolent organism)

87
Q

What are the Acute Infective and Non Infective cause of Post operative fever?
After 24 hour but before 1

A

• INFECTIVE::
Nosocomial Infection
SSI (due to Group A strep / C perfringen)
Catheter site Infection

• Non INFECTIVE:
MI
PE and DVT

88
Q

What are the sub Acute Infective and Non Infective cause of Post operative fever
After 1 week but before 1 month

A

• INFECTIVE::
Catheter site Infection
Clostridium difficile

• NON INFECTIVE
DVT / PE
Drug fever

89
Q

What are the typical features of Edward syndrome?

Face—>Hands—>thorax—->Abdomen—->Lower limb

A

Face shows small jaw with prominent occiput and low set Ears

Clenched hands with Overlapping fingers
Heart and Renal defects

Limited hip abduction and Rocker bottom feet

90
Q

What are the typical features of Patau syndrome?

Face—>Hand–>thorax with abdomen—>lower limb

A

Face shows small eye with small head Or holoprosencephaly

Hands shows more than 5 fingers

Cardiac with Renal defects and Umbilical hernia / Omphalocele

Rocker bottom feet

91
Q

Name the drugs which has positive urine drug test even though patient not used amphetamine

A

Bb like atenolol Or propanolol

Bupropion

Nasal decongestant

92
Q

Name the drugs which has positive urine drug test even though patient not used phencyclidine

A

Dextromethorphan
Diphenhydramine
Doxylamine

Ketamine
Tramadol

Venlafaxine

93
Q

Name the drugs which has positive urine drug test even though patient not used cannabis and natural opioids

A

If CANNABIS:
Hemp containing food

If Natural OPIOID:
Poppy seeds

Internal Medicine (14 decks)

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