Review Block III Flashcards
6 y/o in ER after bout of vomits and epigastric pain; abd pain in the past. Findings include: wrist and foot drop, lines in gum, wasting mm of hand with motor weaknes. CBC: hypchromic microcytic anemia with basophilic stippling. Most likely Dx?
Lead poisoning
**wrist drop and foot drop are hallmarks
Which is an antidote for iron overdose?
Deferoxamine
A 73 y/o woman with breast cancer and CHF placed on chemo, including MTX (methotrexate) after a mastectomy. This agent’s activity is related to its ability to do what?
Inhibits DNA and RNA synthesis.
In this question the answer was: indirectly inhibit DNA synthesis
A 56 y/o female w/metastatic breast cancer started on chemo. Initially treated with cyclophosphamide and doxorubicin. Careful attention is required b/c of doxorubcin’s toxicity; what is it?
Cardiomyopathy
Chromosomal studies in 56 y/o male indicate a (9:22) translocation in Philly chromosome; confirms dx of chronic myelocytic leukemia (CML). Which could be used in treatment?
Imatinib
47 y/o with invasive ductal carcinoma…After three rounds of chemo, she complains of shortness of breath at night and fainting spells. Echo reveals mild cardiomyopathy which is most likely associated to which chemotherapy agent?
Doxorubicin
59 y/o with multiple, nontender lymphadenopathies and night sweats. Dx is Burkitt’s lymphoma. Should she be placed on cyclophosphamide, what unique side effect should she be informed of?
Hemorrhagic cystitis
39 y/o Asian man diagnosed with gastric carcinoma, had had surgery to remove tumour and most of his stomach. Has undergone chemo and remains free of malignancy. Which agent was likely administered to him with the intent of inhibiting tumour cell thymidylate synthetase?
5-fluorouracil
53 y/o with changes in bowel frequency and pencil thin stools with occasional bright red blood in them. CT of chest, abdomen and pelvis demonstrates metastatic lesions in the liver. His therapy will likely include which of the following chemotherapeutic agents?
Fluorouracil
42 y/o premenopausal women, partial mastectomy and radiation therapy for breast tumour. No lymph nodes involved and was Estrogen-receptor positive. No chemo but tamoxifen is recommended. Which is a concerning side effect of tamoxifen?
Thromboembolism
Increased risk of endometrial cancer
37 y/o woman who had a large soft tissue sarcoma resected from her retroperitoneum. She is to receive radiation and chemo, with cyclophosphamide as part of her chemo treatment. What agent should be given in conjunction to this drug?
MESNA
Someone being given high doses of Adriamycin and cyclophosphamide for breast cancer; a particularly myelosuppressive treatment. What would you give to prevent neutropenia in this patient?
Filgrastim
Neutropenia develops in a pt undergoing chemo. Administration of which of the following would accelerate recovery of neutrophil counts?
Filgrastim
Man with diffuse b-cell lymphoma (malignant CD20+ B cells found). Which biologic would be given?
Rituxan
Most likely side-effect of paclitaxel?
Numbness and tingling
Pt. treated with topotecan for refractory ovarian cancer that failed to respond to initial therapy. What is dose-limiting toxicity of Topotecan?
Neutropenia
63 y/o with metastatic colon cancer that overexpresses EGFR. You add monoclonal antibody to EGFR to her treatment. What would be added?
Efitimib
Example of a DNA topoisomerase I inhibitor?
Teniposide (professor’s answer, maybe wrong)
2nd best option is Irinotecan
Pt. undergoing chemotherapy has dangerously low platelet count. Which medication, along with a platelet transfusion, will the doctor recommend?
Erythropoeitin
What do you give to prevent a relapse for a Estrogen receptor positive breast cancer?
Anastrozole
Trastuzamab works by:
Preventing phosphorylation of a receptor tyrosine kinase.
Low Hb levels in an alcoholic complaining of lightheadedness and dyspnea on exertion. Peripheral smears show increased number of spherocytes. What agent would be given to treat this anemia?
Vitamin B12
68 y/o with acute myeloid leukemia. Which monoclonal antibodies may be considered after he relapses?
Rituximab
Chronic NSAID use, given methotrexate to help. On which cell cycle phase does methotrexate act upon?
S-phase
What is used to treat acetaminophen overdose?
N-acetylcysteine (NAC)
Child with abdominal pain, diarrhea, difficult to arouse and altered consciousness. Lives in an old home with chipping paint. What is the most likely toxin causing this?
Ojo al difficult to arouse and altered consciousness** indicative of LEAD toxicity
Which correctly pair a toxin and its antidote/treatment?
Benzodiazepines/Flumazenil
Kid who passed out after drinking beers and Valiums. Appropriate treatment (he is unresponsive)?
Flumazenil
Treatment for a migrant farmer worker (pesticide poisoning probably); has fasciculations and pinpoint pupils. Which antidote would you give first?
Atropine
Unresponsive heroin addict, has pinpoint pupils, respiratory depression. Normal glucose. What is the most appropriate agent to administer?
Naloxone
Kid that overdoses on iron supplements should be give what to relieve toxicity?
Deferoxamine
Organophosphate poisoning is treated with:
Amyl nitrate first
Most common result of benzene poisoning? (bone marrow poison)
CNS depression (true for all petroleum-derived products)
What toxin can cause cherry red lips and nail beds?
Carbon monoxide
Which of the following pose a problem with dermal exposure?
Inorganic arsenic (if chronic exposure) Organophosphates in insecticides (if acute)
Respiratory alkalosis and metabolic acidosis are associated strongly with:
aspirin toxicity (he said this won’t be on this exam)
Child with high levels of lead. What do you treat him with?
LMSA
Typical of lead poisoning:
foot and wrist drop
Overdose of propranolol (beta blocker) is treated initially with what?
Glucagon
Atropine can be used as an antidote to poisoning by which toxic agent?
Chlophenothane (DDT)
Chronic alcoholic with methanol poisoning. Tests show severe anion gap and acute renal failure. Which would be an appropriate therapy?
Fomepizole
Increasing doses of a drug is best determined by:
Quantal dose response curve
**there will be a simple one on exam to interpret
Man cleaning metal with an unknown cleaner becomes giddy, has hyperpnea, headache, followed by cyanosis and unconsciousness. What is the appropriate treatment?
Administration of nitrite
**Unknown metal cleaners that cause this usually are indicative of Cyanide poisoning.
Which are contraindications for inducing emesis in a patient?
- altered mental status
2.
Seafood dish that causes ciguatera (first GI then neurologic symptoms). What do you treat it with?
2% mannitol by IV
Which are cholinergic toxidromes?
Didn’t get the answer
EDTA is given with Calcium during lead poisoning in order to:
reduce toxic effects of EDTA as it binds Calcium and Sodium
Therapeutic efficacy of sodium nitrite to treat cyanide poisoning is based on:
formation of methemoglobin
The most significant problem associated with chelating agents is?
They bind to essential ions, causing adverse side-effects.
What is Vitamin D being associated with?
Increased risk of cancer
Oro gastric lavage: when is it indicated? When is it contraindicated?
Requires protected airway
Indicated when:
1. amount of poison ingested is potentially life threatening
2. Within 60 minutes of ingestion (Except anti-cholinergic
Activated charcoal: uses, indications, contraindications?
Large Surface Area (like 2 tennis courts)
Binding property
Interrupts Enterohepatic & Enteroentric Circulation
Most appropriate agent to decontaminate GI tract.
Adsorbs toxin in gut lumen.
Benefits include capability to decontaminate
w/out requiring invasive procedures.
Safety proven in adults and children.
Indicated for:
Digoxin; Amitriptyline; Phenobarbitone; Dozepin; Theophylline; Salicylates;Phenobarbital; dapsone; phyentoin; carbamazepine; Aspirin
Contraindicated:
Ileus
GI perforation
Loss of airway protection
Only works if taken within 2 hours of intoxication. so rarely used in the ER