Poisoning/Toxicology

Question 1

Ingestion with burning sensation in throat, chest, nausea, dysphagia

Answer 1

Corrosives (toilet bowl cleaner sodium hydroxide), drain cleaner, rust remover

Question 2

Respiratory distress, gagging, coughing after ingestion

Answer 2

hydrocarbons

Question 3

How to treat the muscarinic effects (pulmonary) of organophosphate poisoning

Answer 3

Atropine

Question 4

How to treat the nicotinic effects (neuromuscular) of organophosphate poisoning?

Answer 4

Pralidoxime

Question 5

How to treat TCA overdose

Answer 5

Activated charcoal followed by alkalinization of urine

Question 6

What antidepressant renders allergy testing unreliable??

Answer 6

TCAs

Question 7

Suspected carbon monoxide toxicity. First step?

Answer 7

High flow oxygen. Obtain carboxyhemoglobin levels (O2 sats are unreliable)

Question 8

Presents in same fashion as CO toxicity, but failure to respond to 100% oxygen. Tx?

Answer 8

Cyanide poisoning. Hydroxocobalamin, or sodium thiosulfate.

Question 9

What level of elemental iron ingestion is considered toxic?

Answer 9

40mg/kg

Question 10

Iron ingestion. First step?

Answer 10

serum levels 4 hours post ingestion (>350 is significant), abdominal film to identify pills, deferoxamine if level >500

Question 11

Which toxicity causes fixed dilated pupils, visual changes, and blindness?

Answer 11

Methanol

Question 12

What is the cutoff level to treat ethylene glycol/methanol intoxication? How to treat?

Answer 12

Treat with ethanol infusion if >20, hemodialysis if >50

Can also give fomepizole

Question 13

What toxicity is oil of wintergreen associated with?

Answer 13

Salicylate

Question 14

Antidote for phenothiazine ingestion

Answer 14

Diphenhydramine

Question 15

Which acid/base disorder in aspirin toxicity

Answer 15

Mixed respiratory alkalosis (hyperventilation) and metabolic acidosis

Question 16

What is the concern with St. John’s Wort?

Answer 16

It increases elimination of other drugs. Especially think when a girl is on OCP, needs backup

Question 17

When is echinacea contraindicated?

Answer 17

Patients on immunosuppressants.

Question 18

When should valerian root not be used?

Answer 18

In combination with alcohol or other sedating drugs.

Question 19

Isotretinoin and griseofulvin, instructions on how to take

Answer 19

With fatty foods, because they are lipophilic and bioavailability is enhanced

Question 20

What 3 medications should not be taken with dairy products?

Answer 20

Doxycycline, tetracycline, and ciprofloxacin

Question 21

What is the metabolic derangement caused by furosemide? What are some dose dependent side effects?

Answer 21

Hypokalemic, hypochloremic metabolic alkalosis. Dose dependent ototoxicity and renal toxicity

Question 22

Kerosene, furniture polish, mineral spirits, and gasoline. What are these examples of and how to treat the asymptomatic patient?

Answer 22

Hydrocarbons. Observe for 6 hours, obtain CXR at 4-6 hours. May dc home if negative and no sx.

Question 23

At what lead level should chelation therapy be given?

Answer 23

> 45 mcg/dL