psych/toxicology Flashcards
A 15-year-old adolescent is brought to the emergency department by his friends who became concerned when he complained of nausea, dizziness, and weakness. He had a hard time describing how he was feeling to his friends except to say that he was hearing colors and that time seemed to have slowed down. In the emergency department, the adolescent is euphoric. His vital sign assessment is significant for tachycardia and hypertension.
Of the following, the MOST appropriate statement regarding this boy’s condition is that he
A. is at risk for serotonin toxicity
B. is likely to experience hepatic injury
C. should be treated with naloxone
D. will experience physical dependence
is at risk for serotonin toxicity
Synesthesia, a state of altered perception where one sense is perceived as another (eg, hearing colors), is the most distinctive symptom indicating hallucinogen use.
Hallucinogens act at serotonin receptors and their use carries a risk for serotonin toxicity.
Treatment of acute hallucinogen intoxication is primarily supportive, and morbidity from hallucinogen use is primarily from the person’s behaviors while in the altered state (eg, accidents).
Hallucinogens are drugs that alter sensory perception, thoughts, and mood. They include lysergic acid diethylamide (LSD), mescaline, psilocybin, N,N-dimethyltryptamine (DMT), lysergic acid amide (LSA), Salvia divinorum, and recreational nutmeg.
A 9-month-old infant is seen in the clinic for urgent evaluation. Her parents report that she is sleepy, weak, and listless. She developed a runny nose and increased drooling yesterday. Today, she has had 5 loose stools and decreased oral intake. She has had a normal number of wet diapers. She lives with her parents on a farm. She has no known sick contacts and does not attend daycare. She has a temperature of 37.5°C, heart rate of 80 beats/min, respiratory rate of 50 breaths/min, and blood pressure of 90/50 mm Hg. She has decreased tone and is sleepy, but responds appropriately to painful stimuli. Her pupils are constricted (1-2 mm diameter), and she is tearing and drooling. Her lungs are clear to auscultation. Intermittent intercostal retractions are noted. The heart has a regular rate and rhythm, and her abdomen is soft and nontender without distention or hepatosplenomegaly. Her skin is dry, and she has a capillary refill time of 3 seconds.
Of the following, the MOST likely source of the toxin causing her symptoms is
A. chicken droppings B. goat milk C. parents’ clothing D. unpasteurized honey
parents’ clothing
Exposure to pesticides that contain organophosphates can cause symptoms of cholinergic excess, including bradycardia, miosis, lacrimation, salivation, bronchospasm and bronchorrhea, urination, emesis, and diarrhea.
Organophosphates are well absorbed through the skin, gut, and respiratory tract. Children can be exposed to organophosphate insecticides through accidental ingestion, inhalation of insecticide sprays, ingestion of contaminated food, or transmission on clothing or fabric.
A 2-year-old girl is brought to the emergency department by emergency medical services after being found in the family garage with significantly altered mental status. She was lying in a puddle of her own urine, with emesis around her mouth. Emergency medical technicians suctioned her oropharynx and noted copious oral secretions. She has a temperature of 38.5°C, a heart rate of 75 beats/min, a blood pressure of 95/65 mm Hg, and a respiratory rate of 14 breaths/min with shallow breaths and poor effort. Her pupils are pinpoint bilaterally, and wheezing is heard throughout both lung fields. There are no signs of head trauma. The skin is warm to the touch, and no rashes are noted. The remainder of the physical examination findings are normal.
Of the following, the BEST medication to administer is
A. albuterol B. atropine C. naloxone D. sodium bicarbonate
atropine
Organophosphate poisoning results in overstimulation of the parasympathetic nervous system.
Atropine is the antidote of choice for organophosphate poisoning.
Atropine acts only on muscarinic acetylcholine receptors.
A 16-year-old adolescent girl is seen in the clinic for a pregnancy test. The limits of confidentiality are discussed. She reports that she recently met her older boyfriend on a social media site. She sneaks out of her house to see him every night; her family does not know about him. He frequently takes her to parties at which she participates in sexual activities with his friends when he asks her to. He rewards her with clothes and jewelry. Her last sexual encounter with his friend was 1 week ago and was unprotected. Physical examination findings are unremarkable. The result of her pregnancy test is negative. She reports no abdominal or genitourinary symptoms. Results of testing for sexually transmitted infections are pending. Concerns for her safety are discussed. The patient requests that her parents not be told.
Of the following, the BEST next step in treatment is to contact
A. child protective services
B. the local law enforcement agency
C. a national trafficking organization hotline
D. the patient’s parents
child protective services
Children and adolescents who have experienced sexual exploitation, including sex trafficking, human trafficking, and commercial sexual exploitation, seek medical attention for a variety of reasons but seldom self-identify.
When responding to cases of suspected commercial sexual exploitation, a national trafficking organization (such as the National Human Trafficking Resource Center Hotline at 1-888-373-7888, sponsored by the Polaris Project) should be contacted for assistance.
Providers should also provide anticipatory guidance to pediatric patients about protecting themselves from online exploitation.
A 6-year-old boy is being evaluated for concerns about his behaviors. He has an autism spectrum disorder and is receiving special education services and in-home applied behavioral analysis therapy. Despite using strategies learned during therapy, his mother reports difficulty managing his behaviors. She is concerned about his safety when they are out in public, as he often darts away from her. In stores, he pulls items down from the shelves. At school, he has difficulty staying seated and has left the classroom without permission on several occasions. He is not aggressive toward others and does not engage in self-injurious behaviors. Review of systems is otherwise negative. The boy speaks using short complete sentences and makes some eye contact. With encouragement, he cooperates with the physical examination, findings of which are within normal limits.
Of the following, the BEST next management step for this boy is to
A. make a referral to occupational therapy
B. prescribe an atypical antipsychotic medication
C. request a more restrictive educational environment
D. screen for a coexisting mental health condition
screen for a coexisting mental health condition
Children with autism are at increased risk for seizures (particularly those with intellectual disability), gastrointestinal complaints, feeding disorders, obesity, pica, sleep disturbance, and motor disorders.
Common coexisting mental health conditions in children with autism spectrum disorder (ASD) include attention-deficit/hyperactivity disorder (in ~50% of children with ASD), anxiety (in 40%-66% of school-aged children and adults with ASD), and depressive disorders (in 12%-33% of children and adults with ASD).
When concerning behaviors are present in a child with ASD, the primary care physician should first evaluate for a possible medical problem (eg, dental problem, constipation, otitis media), because pain or discomfort could be the cause of behavioral change.
Behavioral, developmental, and educational interventions are the mainstay of treatment for ASD. These include:
Applied behavior analysis (ABA)
Developmental relationship-focused interventions (DIR) (eg, Developmental Individual-Difference, Relationship (DIR)/Floortime)
Naturalistic developmental behavioral interventions (eg, Early Start Denver Model)
Parent management training
Classroom-based models (eg, Treatment and Education of Autistic and Related Communication Handicapped Children [TEACCH])
A 16-year-old adolescent is brought to the emergency department by ambulance after he was found wandering outside at 2 am. He is accompanied by a friend who reports that the patient ingested an over-the-counter cough and cold medication that night in order to get high. The patient is uncooperative and agitated. He is not oriented to place or situation. He has a heart rate of 140 beats/min, blood pressure of 125/90 mm Hg, respiratory rate of 12 breaths/min, and oxygen saturation of 100% in room air. He is diaphoretic, and his pupils are dilated.
Of the following, the ingredient that is MOST likely responsible for the adolescent’s signs and symptoms is
A. acetaminophen B. chlorpheniramine C. dextromethorphan D. guaifenesin
dextromethorphan
Dextromethorphan is an over-the-counter cough suppressant that, when taken in excess, can cause euphoria, hallucinations, and a feeling of dissociation as well as tachycardia, mydriasis, and diaphoresis.
Chlorpheniramine is an over-the-counter antihistamine. Overdoses cause features of anticholinergic toxicity, including agitation, tachycardia, hypertension, elevated temperature, dry and flushed skin, and decreased pupillary responsiveness.
A 3-year-old girl is brought to the clinic by her foster parents. Child protective services removed the girl from her parents’ custody because of allegations of physical abuse toward her infant brother. The girl’s foster parents are concerned that she will have difficulty forming appropriate emotional connections.
Of the following, the factor MOST likely to be associated with the outcome of concern is a history of
A. physical abuse when she was an infant
B. psychological abuse of the girl by her parents
C. witnessing violence between her parents
D. witnessing physical abuse of her brother
psychological abuse of the girl by her parents
Psychological abuse is defined as caregiver behaviors (verbal or nonverbal, active or passive, with or without intent to harm) that negatively affect a child’s cognitive, social, emotional, and/or physical development. Examples include terrorizing, isolating, belittling, or denying emotional responsiveness.
Children who experience psychological abuse have higher rates of attachment disorders, disruptive behaviors, developmental and educational delays, and mental health problems.
