Review questions Flashcards by Sheila Gasparek

THE STINGER SHOULD BE REMOVED IMMEDIATELY BY WHATEVER MEANS IS AVAILABLE. T/F

FALSE

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WHICH OF THE FOLLOWING TYPES OF MUSHROOMS WOULD CAUSE A DISULFRAM LIKE RXN?
•	AMANTIA PHALLOIDES
•	AMANITA MUSCARINAE
•	CORTINARIUS SP.
•	COPRINUS SP.

COPRINUS SP.

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APPLY ICE PACKS AS NEEDED. T/F

TRUE

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IF ANAPHYLAXIS OCCURS, IT WILLB E WITHIN 30 MIN. T/F

TRUE

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HOW LONG SHOULD YOU OBS A PATIENT WITH 50 BEE STINGS OR MORE?
•	YOU DON’T. YOU FOLLOW IT AT HOME. 
•	2 HOURS AND HAVE NORMAL LABS
•	4 HOURS AND HAVE NORMAL LABS
•	6-8 HOURS AND HAVE NORMAL LABS

6-8 HOURS AND HAVE NORMAL LABS

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WHICH THERAPY MAY BE HELPFUL TREATING AN INGESTION OF MUSHROOMS CONTAINING MONOMETHYLHYDRAZINE?
•	N-ACETYLCYSETEINE
•	PRUSSION BLUE 
•	PYRIDOXINE
•	THIAMINE

PYRIDOXINE

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WHICH LABS ARE MOST PREDICTIVE OF SEVERE OUTCOME IN A AGKISTRODON (COTTONMOUTH) ENVENOMATION?
•	PT/INR
•	D DIMER
•	CK AND MYOGLOBIN
•	PLATELETS AND FIBRINOGEN

PLATELETS AND FIBRINOGEN

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CALLER ASKS ABOUT USING TOBACCO ON A BEE STING. YOUR RESPONSE SHOULD INCLUDE:
•APPLY TOBACCO FOR INCREASED BLOOD FLOW TO THE AREA
•DO NOT USE TOBACCO, INSTEAD WASH THE AREA THOROUGHLY
•TOBACCO MAY DECREASE THE LOCAL REACTION
•WE DO NOT REC TOBACCO AS NOT EVERYONE HAS ACCESS TO IT

DO NOT USE TOBACCO, INSTEAD WASH THE AREA THOROUGHLY

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WHICH OF THE FOLLOWING ABOUT LOXOCELES SPIDER (BROWN RECLUSE) ENVENOMATIONS IS TRUE?
•CAUSES INTENSE PAIN AT THE BITE SITE IMMEDIATELY
•PROPHYLACTIC ANTIBIOTICS SHOULD NOT BE USED FOR ALL BITES
•THE VENOM CONTAINS POTENT ANTICOAGULANTS AND NEUROTOXINS
•THE BITE LESION WILL HEAL RAPIDLY AND RARELY LEAVE ANY SCARS

PROPHYLACTIC ANTIBIOTICS SHOULD NOT BE USED FOR ALL BITES

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MAN IS BITTEN BY AN INSECT. HE FEELS A PINPRICK SENSATION FOLLOWED BY STOMACH PAIN. WHAT BIT HIM?
•	SCORPION STING
•	CENTEPEDE STING
•	MOSQUITO WITH WEST NILE
•	BLACK WIDOW SPIDER BITE

BLACK WIDOW SPIDER BITE

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WHICH IS THE BEST DESCRIPTION OF A BLACK WIDOW SPIDER?
•BLACK, HAIRY WITH ORANGE HOURGLASS MARKINGS ON STOMACH
•BLACK, HAIRLESS WITH HOURGLASS MARKINGS ON ABDOMEN
•BLACK, HAIRLESS WITH ORANGE HOURGLASS MARKINGS ON THE BACK
•BLACK, HAIRY WITH WHITE SPOTS ON THE BACK AND JUMPS

BLACK, HAIRLESS WITH HOURGLASS MARKINGS ON ABDOMEN

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ER 1 HOUR POST SNAKE BITE. 2 PUNCTURE ON ANKLE. EDEMA TO MID-CALF/EXTENSIVE ECCHYMOSIS.
•ICE TO AREA FOR 5 MIN INTERVALS UNTIL EDEMA SUBSIDES
•BEGIN ADMIN OF CROFAB W/ 4-6 VIALS
•CONT TO OBS. CROFAB IF IT CROSSES A 2ND JOINT
•OBS MIN 8 HOURS, DC HOME IF NO WORSENING SYM

BEGIN ADMIN OF CROFAB W/ 4-6 VIALS

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PT VOMITING AFTER EATING FISH/RICE. BLURRED VISION, DROOPING EYELIDS, DIFFICULTY SWALLOWING.
•	DOMOIC ACID
•	SCOMBROTOXIN
•	BOTULININ TOXIN
•	SHIGA TOXIN

BOTULININ TOXIN

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RASH ON FACE C/O N/V. DURING ASSESSMENT, DISCOVER LUNCH AT A SEAFOOD RESTAURANT.
•	BREVETOXIN
•	DOMOIC ACID
•	CIGUATOXIN
•	SCOMBROTOXIN

SCOMBROTOXIN

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PT HAS BEEN HAVING ITCHY RED EYES, AND DIFFICULTY GETTING A DEEP BREATH SINCE THEIR ARRIVAL. 
•	BREVETOXIN
•	TETRODOTOXIN
•	CIGUATOXIN
•	SAXITOXIN

BREVETOXIN

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WHAT WOULD YOUR RECOMMENDATIONS BE?
•SEEK MD ATTENTION AND NOTIFY THE FLORIDA PCC
•CREATE A STEAM ROOM IN BATHROOM AND INHALE WATER VAPORS
•TAKE AN ANTIHISTAMINE
•LEAVE THE AREA IMMEDIATELY

TAKE AN ANTIHISTAMINE

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WHICH MUSHROOM IS ASSOCIATED WITH CHOLINERGIC SYM?
•	CHILTOCYBE DEALBATA
•	AMANITA MUSCRIA
•	PSILOCYBE CUBENSIS
•	GYROMITRA ESCULENTA

CHILTOCYBE DEALBATA

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WHAT SUBSTANCE WHEN INGESTED WITH MUSHROOMS IN THE COPRINE CATEGORY WILL CAUSE SYM?
•	FISH
•	ALCOHOL
•	MAOIS
•	SSRI

ALCOHOL

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RUQ PAIN, VOMITING STARTED 24HOURS AFTER INGESTING MUSHROOMS TO HALLUCINATE
•	AMATOXIN
•	ORELLANINE
•	PSILOCYBE
•	LYCOPERDON

AMATOXIN

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PT BITTEN BY AN IDENTIFIED RACER SNAKE 20 MIN AGO. BITE SITE: LITTLE ERYTHEMA, NO BLEEDING
•OBTAIN CBC, COAGS, PLTS AND BEGIN ANTIVENOM
•PROVIDE WOUND CARE, TETANUS, AND DC HOME
•OBSERVE THE PT IN THE ED FOR 8-12 HOURS
•OBAIN LABS, OBS 8-12 HOURS, GIVE WOUND CARE AND TETANUS

PROVIDE WOUND CARE, TETANUS, AND DC HOME

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ISOPROPYL ALCOHOL IS METABOLIZED TO: 
•	ACETONE
•	ETHANOL
•	FORMALDEHYDE
•	METHANOL

ACETONE

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THE CORROSIVE EFFECTS SEEN WITH INGESTION OF AN IODINE TINCTURE, MAY BE MINIMIZED BY?
•	LAVAGE WITH POTASSIUM PERMANGANATE
•	ADMINISTER MAALOX
•	INGESTING COLD FLUIDS
•	HAVING THE PATIENT EAT STARCHY FOODS

HAVING THE PATIENT EAT STARCHY FOODS

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THE COMBINATION OF HH SODIUM HYPOCHLORITE AND HH AMMONIA WILL PRODUCE?
•	CARBON DIOXIDE
•	CHLORAMINE GAS
•	HYDROGEN CHLORIDE
•	CHLORINE GAS

CHLORAMINE GAS

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2YO 2HRS AFTER INGESTING A MUSHROOM MOM DID NOT BRING IN. THE CHILD IS VOMITING
• CHECK CK
• GIVE ANTI-EMETICS
• TREND LFTS TO DETERMINE IF TREATMENT IS NEEDED
• START NAC

GIVE ANTI-EMETICS

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PT WAS BIT BY A CORAL SNAKE 2 HRS AGO. LABS AND P.E. ARE BENIGN. WHAT IS YOUR RECOMMENDATION? •ADMIT TO ICU FOR 24 HOURS AS SYM CAN BE DELAYED •MONITOR IN THE ER FOR 6HRS D/C IF PT ASX •D/C HOME SINCE SYM SHOULD BE IMMEDIATE •DISCHARGE, CORAL SNAKES NEVER REQUIRE HOSPITALIZATION

ADMIT TO ICU FOR 24 HOURS AS SYM CAN BE DELAYED

``` A CHILD INGESTED 1 TAB OF AZO. WHAT DO YOU INSTRUCT THE PARENTS TO WATCH FOR? • BRIGHT RED CHEEKS • CONFUSION • CYANOSIS • TREMORS ```

CYANOSIS

``` 2 Y/O INGESTED BUBBLE LIGHTS 30 MIN AGO. YOUR RECOMMENDATION TO HCF SHOULD INCLUDE: • CARBOXYHEMOGLOBIN • NO LABS NEEDED, JUST AN IRRITANT • EKG • GI CONSULT ```

CARBOXYHEMOGLOBIN

``` CALLER STATES PT WAS BITTEN BY MULTPLE FIRE ANTS. C/O GENERALIZED URTICARTIA, SOB. YOU RECOMMEND: • CALLING 911 • APPLY DPH TO BITES • TAKE AN ANTIHISTAMINE • APPLY ICE TO THE BITES ```

CALLING 911

``` THROAT PAIN, DIFFICULTY SWALLOWING, HYPERSALIVATION AFTER INGESTING LIQUID IN GUN BLUING. WHAT SUBSTANCE? • SELENIOUS ACID • CLEANING OIL • ACETONE • METHANOL ```

SELENIOUS ACID

``` ALL OF THE FOLLOWING MEDICATIONS CAN CAUSE HYPERGLYCEMIA IN AN OD EXCEPT: • APAP • CA CHANNEL BLOCKERS • BETA BLOCKERS • IRON ```

BETA BLOCKERS

``` AC WILL ABSORB ALL OF THE FOLLOWING MEDS EXCEPT: • APAP • THEOPHYLINE • PROPRANOLOL • FERROUS SULFATE ```

FERROUS SULFATE

``` IN AN APAP OD, WHICH OF THE FOLLOWING LABS IS MOST HELPFUL TO MONITOR THE PATIENT’S PROGRESS? • CREATININE • ALKALINE PHOPHATASE • PROTHROMBIN TIME • BILIRUBIN ```

PROTHROMBIN TIME

``` THE MOST COMMON SYM OCCURING IN THE FIRST 6 HOURS AFTER APAP OD ARE: • N/V • HYPERGLYCEMIA • TACHPNEA • TINNITIS ```

N/V

``` 3YO INGESTED 3OZ OF APAP ELIXIR (160MG/5CC) APPROX 30 MIN AGO. PT WEIGHS 33LBS. • 192MG/KG • 98MG/KG • 90MG/KG • 36MG/KG ```

192MG/KG

``` WHICH OF THE FOLLOWING ANTIHISTAMINES IS LEAST LIKELY TO CAUSE CNS DEP WHEN TAKEN IN OD? • HYDROXYZINE • DPH • PROMETHAZINE • LORATADINE ```

LORATADINE

AN ED CALLS 3YO/15KG ATE 15X81MG W.IN HR. PT IS ASX. MD IS SURE OF #. YOUR ADVISE? •GIVE AC, THEN OBS THE CHILD FOR SEVERAL HOURS •GIVE AC, GET 4HR APAP/ASA IF WNL, DC PT. •THIS IS SUBTOXIC DOSE AND NO TX IS REQUIRED •GIVE AC, THEN DC HOME

THIS IS SUBTOXIC DOSE AND NO TX IS REQUIRED

``` WHICH OF THE FOLLOWING IS AN INDICATION FOR DIALYSIS IN AN ASA OD? • COAGULOPATHIES • ACUTE SALICYLATE LEVEL OF 60MG/DL • HYPOGLYCEMIA • PERSISTENT CNS DISTURBANCE ```

PERSISTENT CNS DISTURBANCE

WHICH OF THE FOLLOWING STATEMENTS ABOUT ASA OD IS FALSE? •IN AN OD, PEAK LEVELS MAY BE DELAYED AT LEAST 6 HRS •AMS IS CONSIDERED A SIGN OF SEVERE TOXIN ACUTE OD •SX OF RESP ALKALOSIS THEN META ACID IN ACUTE OD •IN CHRONIC OD, HIGHER BLOOD CORRELATE WELL WITH SX

IN CHRONIC OD, HIGHER BLOOD CORRELATE WELL WITH SX

WHICH OF THE FOLLOWING STATEMENTS IS TRUE REGARDING THE NORMOGRAM? •APAP LEVELS >150 NO NEED FOR NORMAGRAM REGARDLESS OF TIME •CHRONIC ING PLOTTED WHEN LEVEL IS DRAWN 4HRS POST LAST DOSE •APAP LEVELS AFTR CHRONIC INGESTION CANNOT BE PLOTTED •CANT PLOT AN APAP LEVEL IF APAP PM WAS TAKEN

APAP LEVELS AFTR CHRONIC INGESTION CANNOT BE PLOTTED

``` WHICH OF THE FOLLOWING ESSENTIAL OILS CAN CAUSE ASA TOX? • CAMPHOR • OIL OF WINTERGREEN • EUCALPTUS OIL • TEA TREA OIL ```

OIL OF WINTERGREEN

``` WHEN SHOULD ASA LEVELS BE OBTAINED? •2 HOURS POST INGESTION •Q2HR UNTIL PEAK AND DECLINE IN ANHY POT TOXIC PT •4 HRS POST INGESION •UPON ARRIVAL AND 4 HOURS ```

Q2HR UNTIL PEAK AND DECLINE IN ANHY POT TOXIC PT

WHICH OF THE FOLLOWING SX CAN BE SEEN IN A DPH OD? •AGITATION, HALLUCINATIONS, MYDRIASIS, WARM SKIN, TACHY •MIOSIS, AGITATION, NYSTAGMUS, HTN, DELUSIONS •]DROWSINESS, ATAXIA, SLURRED SPEECH, TACHY, COMA •ATAXIA, PROTRUDING TONGUE, HTON

AGITATION, HALLUCINATIONS, MYDRIASIS, WARM SKIN, TACHY

WHICH OF THE FOLLOWING SX CAN BE SEEN IN DEXTROMETHORPHAN OD? •MIOSIS, DYSTONIA, NYSTAGMUS, HTN, DELUSIONS •AGITATION, HALLUCINATIONS, MYDRIASIS, WARM SKIN, HTN •DROWSINESS, ATAXIA, SLURRED SPEECH, TACHY •ATAXIA, PROTRUDING TONGUE, HTON

MIOSIS, DYSTONIA, NYSTAGMUS, HTN, DELUSIONS

``` CALLER STATES 5YO, 50 LBS INGESTED 4X30MG PSEUDOPHEDRINE TABS. PT IS DROWSY, DOES HE NEED ED? • SUBTOXIC AMT, OBS AT HOME • OBS AT HOME WITH A FU • HAVE PARENTS CALL 911 • REFER TO ED FOR EKG/LABS/AC ```

HAVE PARENTS CALL 911

ER 3YO DROWSY, MIOSIS, 1 SEIZ AFTER UNKNOWN INGESTION. UDS + PCP. SHOULD CPS BE CALLED? •YES. SCHEDULE 1 DRUG WAS INGESTED •NO. PARENTS ARE ALLOWED ONE INCIDENT BEFORE CALLING CPS •DEXTROMETHORPHAN MAY CAUSE FALSE POSITIVE FOR PCP •ADVISE TO FOLLOW THEIR PROTOCOL

DEXTROMETHORPHAN MAY CAUSE FALSE POSITIVE FOR PCP

``` ER 22KG KID INGESTED 10ML OF A 98%MS. (ACF=1.4). HOW MUCH ASA WAS INGESTED? • 220MG/KG • 623.6MG/KG • 445MG • 13720MG ```

623.6MG/KG

``` 11KG M FOUND WITH AN OPEN AND EMPTY BOTTLE OF ASA 81MG. HOW MANY TABS WOULD BE TOXIC? • 16 • 56 • 88 • 21 ```

``` 15YO F FOUND RESP TO PAINFUL STIMULATION. 1 SEIZ. DILATED/NONREACTIVE PUPILS. 100.1 80/55 140 14. • PHENLEPHRINE • TRIAZOLAM • DPH • SPICE ```

DPH

``` THE MYDRIASIS CAUSED BY A SYMPATHOMIMMETIC AGENT SUCH AS COCAINE IS • REEACTIVE TO LIGHT • IS PERMANENT • NOT REACTIVE TO LIGHT • SUBSIDES 1-2 DAYS POST EXPOSURE ```

REEACTIVE TO LIGHT

``` A UDS + FOR TCA MAY BE A FALSE POS WHEN WHICH OF TH FOLLOWING MEDS IN INGESTED? • +TCA MEANS A TCA WAS TAKEN • LOMOTIL • DEXTROMETHORPHAN • DPH ```

DPH

WHAT ARE THE SIGNS AND SYM OF PSEDUOPHEDRINE AND PHENYLEPHRINE TOXICITY? •ATAXIA, HYPOREFLEXIA, AND SENSORY NEUROPATHIES •BRADYCARDIA, SA AND AV BLOCK, ASYSTOLE •SALIVATION, LACRIMATION, URINATION, DEFECATION, EMESIS •MYDRIASIS, AGITATION, VISUAL/AUDIT, HALLUCINATIONS, SEIZ

MYDRIASIS, AGITATION, VISUAL/AUDIT, HALLUCINATIONS, SEIZ

``` AN NSAID THAT HAS A PREDOMINANT FINDING OF SEIZ AND MUSCLE TWICHING IS: • IBUPROFEN (MOTRIN) • INDOMETHACIN (INDOCIN) • MEFENAMIC ACID (PONSTEL) • KETOROLAC (ACULAR PF SOLUTION) ```

MEFENAMIC ACID (PONSTEL)

``` FLUSHED, MYDRIASIS, DRY, 140/90 140 18 101F. LITTLE URINE OUTPUT. WHICH WOULD NOT CAUSE THESE SX? • PSEUDOPHEDRINE • DPH • AMITRIPTYLINE • CHLORPROMAZINE ```

PSEUDOPHEDRINE

A PATIENT IS FOUND UNRESPONSIVE/INTUBATED, APAP LEVEL IS 16. WHAT IS YOUR NEXT REC? •REPEAT THE APAP LEVEL IN 2 HRS TO SEE IF IT IS CLIMBING •THE LEVEL IS TOO LOW TO BE CLINICALLY SIGNIFICANT •START NAC •TREND THE LFTS

START NAC

``` THE FOLLOWING LABS ARE USEFUL IN PTS WHO PRESENT EARLY FOLLOWING AN ACUTE APAP INGESTION? • APAP LEVEL • APAP, LFT, ELECTROLYTES, INR • LFT, APAP, COAGS • APAP, ASA, LYTES, EKG, UDS\ ```

APAP LEVEL

``` PATIENTS WHO PRESENT WITH AN UNKNOWN TOI OR >8HRS POST APAP INGESTION REQUIRE WHICH LABS? • APAP LEVEL • APAP, LYTES, RFT, LFT, INR • APAP, LFT, COAGS • LFT, INR, RFT ```

APAP, LYTES, RFT, LFT, INR

ALL OF THE FOLLOWING ARE TRUE ABOUT NAPTHALENE EXCEPT? •NO LONGER USED IN MOTHBALLS THEREFORE NOT A RISK •FOUND IN MOTHBALLS, COAL TAR, DYES, RESINS, FUELS, SOLVENTS •MAY CAUSE HEMOLYTIC ANEMIA, METHEMOGLOBINEMIA, RENAL FAIL •MAY CAUSE DELAYED HEMOLYSIS

NO LONGER USED IN MOTHBALLS THEREFORE NOT A RISK

``` HOW WOULD YOU TX METHEMOGLOBINEMIA DUE TO A MOTHBALL INGESTION? • LIPIDS • TRANSFUSION • METHYLENE BLUE • WBI ```

METHYLENE BLUE

``` RAPID ONSET OF COMA, BRADYCARDIA, MYOCLONIC JERKING ARE EFFECTS WITH WHICH OF THE FOLLOWING? • GAMMA-HYDROXYBUTYRATE (GHB) • MDMA • HEROIN • MARIJUANA ```

GAMMA-HYDROXYBUTYRATE (GHB)

1ST DEGREE HEART BLOCK, HTON, BRADYCARDIA ARE MOST COMMON WITH WHICH OF THE FOLLOWING? • NITRATES • ANGIOTENSION-CONVERTING-ENZYME INHIBITORS • THIAZIDE DIURETICS • BETA-ADRENGIC BLOCKERS

BETA-ADRENGIC BLOCKERS

``` 67YO F WITH BRUISING, NOSEBLEEDS. MEDS: WARFARIN/LEVOTHYROXINE/DIGOXIN. PT’S SYM D/T: • ANTACIDS • OTC HEAD MEDICINE • BULK FORMING LAXATIVES • COUGH SUPPRESSANTS ```

OTC HEAD MEDICINE

``` M LETHARGIC/VOMITING. EMPTY BOTTLE ULTRA-RAPID ACTING INSULIN WAS FOUND. BSI 102/LACTIC ACID • ROSGLITAZONE (AVANDIA) • SITAGLIPTIN (JANUVIA) • METFORMIN (GLUCOPHAGE) • GLYBURIDE (DIABETA) ```

METFORMIN (GLUCOPHAGE)

``` UNRESPONSIVE CHILD/4X GLIPIZIDE 10MG. SUGAR 37. D5W/PT AWAKE/THEN CONFUSED/SUGAR 45/REC? • OCTREOTIDE (SANDOSTATIN) • NALOXONE (NARCAN) • PHYTONADIONE (AQUAMEPHYTON) • GLUCAGON (GLUCAGON) ```

OCTREOTIDE (SANDOSTATIN)

``` WHICH OF THE FOLLOWING HERBAL PRODUCTS IS ASSOCIATED WITH HEPATIC INJURY? • KAVA • MILK THISTLE • ST JOHNS WORT • GINSENG ```

KAVA

``` FLUPHENAZINE DECONOATE AND ORAL HALPERIDOL FOR 5 DAYS. MUSCLE RIGIDITY/108F/DYSPHAGIA • MALIGNANT SYNDROME • NEUROLYPTIC MALIGNANT SYNDROME • COCAINE ABUSE • SEROTONIN SYNDROME ```

NEUROLYPTIC MALIGNANT SYNDROME

``` AGITATED/HALLUCINATING/TACHY/HTN/NORMAL BOWEL SOUNDS/DIAPHORETIC • MARIJUANA • JIMSON WEED • HYDROCODONE • MDMA ```

MDMA

``` WHICH DELAYED CLINICAL EFFECT IS MOST CONSISTENT WITH SIGNIFICANT INHALATION OF CHLORAMINE GAS? • PULMONARY EDEMA • RENAL FAILURE • METHHEMOGLOBINEMIA • HEMOLYSIS ```

PULMONARY EDEMA

``` MOM CALLS: 1 HR AGO KID TOOK UNK AMT OF COUGH/COLD SYRUP. WHAT IS THE FIRST QUESTION YOU ASK? • THE AGE OF PATIENT • ARE THERE ANY SYM? • THE WEIGHT OF PT • HOW MUCH MEDICATION IS MISSING? ```

ARE THERE ANY SYM?

``` CYANOTIC LIPS/ON ANTIBIOTIC. TAKING MED FOR URINARY BURNING. WHAT IS OUR CONCERN? • CO POISONING • HYDROGEN SULFICE POISONING • METHEMOGLOBINEMIA • METAL FUME FEVER ```

METHEMOGLOBINEMIA

``` PERSISTENT N/V. SEIZ. GLUCOSE OF 34 MG/DL. WHICH PLANT CAN CAUSE THESE TOXIC EFFECTS? • POKEWEED (PHYTOLACCA AMERICANA) • CASSAVA (MANIHOT ESCULENTA) • CASTOR BEAN (RICINUS COMMUNI) • ACKEE FRUIT (BLIGHIA SAPIDA) ```

ACKEE FRUIT

WHAT EFFECTS ARE COMMONLY ASSOCIATED WITH 3,4 METHYLENEDIOXYMETHAPHETAMINE (MDMA) TOX? • HTON, TACHY, HYPOTHERMIA, HYPERNATREMIA • HTON, BRADY, HYPOTHERMIA, HYPERNATREMIA • HTN, TACHY, HYPONATREMIA, HYPERTHERMIA • HTN, BRADY, HYPERTHERMIA, HYPERNATREMIA

HTN, TACHY, HYPONATREMIA, HYPERTHERMIA

``` WHICH OF THE FOLLOWING HEAVY METALS IS ASSOCIATED WITH MEE’S LINES? • ARSENIC • LEAD • MERCURY • IRON ```

ARSENIC

``` WHICH OF THE FOLLOWING WILL CAUSE BLUE VOMIT? • BORIC ACID • BLUE LISTERINE • ANTIFREEZE • IODINE ```

BORIC ACID

``` WHICH OF THE FOLLOWING DRUGS IS ASSOICIATED WITH JAW CLENCHING, HYPONATREMIA, EUPHORIA? • KETAMINE • COCAINE • MDMA • METHAMPHETAMINE ```

MDMA

``` WHICH OF THE FOLLOWING IS MOST ASSOCIATED WITH METAL FUME FEVER? • ZINC, COPPER • CADMIUM, ALUMINUM • STEEL, CADMIUM • IRON, COBALT ```

ZINC, COPPER

``` 2YO IRRITABLE, HTN, THIRSTY, VOMITING. WHICH IS MOST LIKELY RESPONSIBLE FOR THE SYM? • SALT • GINGER • PARSLEY • CINNAMON ```

SALT

ALL OF THE FOLLOWING ARE TRUE REGARDING COCAINE EXCEPT? •SYM INCLUDE EUPHORIA, AGITATION, HYPERTHERMIA, HTN •BETA BLOCKERS ARE USED TO TREAT THE TACHYCARDIA •MAIN CONCERNS INCLUDE DYSTHYTHMIAS, RHABDOMYLYSIS •NITRATES, CCB, ALPHA BLOCKERS ARE USED FOR HTN IF NEEDED

BETA BLOCKERS ARE USED TO TREAT THE TACHYCARDIA

UNRESP GIVEN NARCAN WITH REPONSE. MD ASKS HOW MUCH NARCAN IS NEEDED FOR THE DRIP. YOUR ANSWER •RATE IS 2/3 DOSE EFFECTIVE FOR INITIAL REVERSAL; TITRATE •RATE IS 1/3 OF DOSE EFFECTIVE FOR INITIAL REVERSAL, TITRATE •WE NEVER REC A NARCAN DRIP •OBS FOR NOW/START AGAIN WITH 0.2MG NARCAN IF RESP DEP

RATE IS 2/3 DOSE EFFECTIVE FOR INITIAL REVERSAL; TITRATE

``` WHICH OF THE FOLLOWING IS ASSOCIATED WITH HTON, BRADY, SEIZ? • PROPANOLOL • METOPROLOL • NALDOLOL • SOTALOL ```

PROPANOLOL

``` ALL OF THE FOLLOWING B BLOCKERS CAN BE DIALYZED EXCEPT • LABETOLOL • ATENOLOL • SOTALOL • ACEBUTALOL ```

LABETOLOL

``` B BLOCKER TOXICITY IS NOT ASSOCIATED WITH WHICH ONE OF THE FOLLOWING? • BRADYCARDIA • HYPERGLYCEMIA • AV BLOCK • HTON ```

HYPERGLYCEMIA

``` WHICH CALCIUM SALT IS THE PREFERRED DRUG FOR IV THERAPY DURING A CCB OD? • CA CHLORIDE • CA GLUCONATE • CA CARBONATE • CALCIUM PHOSPHATE ```

CA GLUCONATE

``` WHICH OF THE FOLLOWING TX IS NOT USEFUL IN TREATING A CCB OD? • GLUCAGON • DIALYSIS • INSULIN • INTRA-AORTIC BALLOON PUMP ```

DIALYSIS

``` WHICH OF THE FOLLOWING WOULD BE EXPECTED TO RESULT IN THE MOST NEGATIVE EFFECTS AFTER OD? • AMLODIPINE • DILTIAZEM • VERAPAMIL • NEFEDIPINE ```

VERAPAMIL

WHICH OF THE FOLLOWING IS THE ANTIDOTE FOR DIGITALIS OD?

DIGIBIND

B BLOCKERS CAN INCREASE BRONCHIOLAR SMOOTH MUSCLE TONE RESULTING IN BRONCOSPAM. T/F

PROPANOLOL MAY CAUSE QRS WIDENING DUE TO SODIUM CHANNEL BLOCKADE. T/F

B BLOCKERS SX USUALLY OCCUR W/IN 6HRS BUT CAN BE SEEN AS EARLY AS 20 MIN. T/F

``` SCOOPED ST SEGMENTS ARE ASSOCIATED WITH WHICH OD? • B BLOCKER OD • DIGITALIS OD • CA CHANNEL BLOCKER OD • TRICYCLIC ANTIDEPRESSANT OD ```

DIGITALIS OD

``` ANY DYSRHYTHMIAS IS POSS WITH A DIGOXIN OD EXCEPT? • PVCS • BIDIRECTIONAL VENTRICULAR TACHYCARDIA • SVT • AV BLOCK ```

SVT

``` WHICH CA SALT IS CONTRAINDICATED IN KIDS DUE TO CAUSING SCLEROSIS OF THE VESSELS? • CA CHLORIDE • CA CARBONATE • CA GLUCONATE • CA PHOSPHATE ```

CA CHLORIDE

``` 1YO OLD INGESTED 1/3 OF A 10Z 2% DPH. PT WEIGHS 18 POUNDS HOW MUCH DID THE PT EAT? • 25MG/KG • 13.8MG/KG • 37.8MG/KG • 7.5MG/KG ```

25MG/KG

``` 6YOF WAS GIVEN HALDOL FOR IMAGING AND IS NOW AGITATED, NECK IS STIFF. WHAT DO YOU RECOMMEND? • ATIVAN • DIPHENHYDRAMINE • PROPOFOL • VALIUM ```

DPH

``` DEFEROXAMINE IS THE CHELATOR OF CHOICE FOR AN OD OF WHICH OF THE FOLLOWING AGENTS? • ARSENIC • IRON • LEAD • MERCURY ```

IRON

``` CAFFEINE IS PHARMACOLOGICALLY AND TOXICOLOGICALLY SIMILAR TO WHAT MEDICATION? • AMITRIPTYLLINE • CARBAMAZEPINE • PHENCYCLIDINE • THEOPHYLLINE ```

THEOPHYLLINE

WHICH TOXIN GENERATES CARBON MONOXIDE ENDOGENOUSLY? • CARBON MONOXIDE RELEASED FROM CAR EXHAUST • METHYLENE CHLORIDE • METHANE • PROPANE

METHYLENE CHLORIDE

``` WHICH OF THE FOLLOWING SYMPTOMS IS MOST LIKELY TO OCCUR IN CHRONIC MERCURY INHALATION? • CNS MANIFESTATIONS • AMS • SOB • NO SYMPTOMS ```

CNS

``` PATIENT ARRIVES TO ER WITH HR145, 145/91, FLUSHED, HALLUCINATING. WHAT DID MOST LIKELY INGEST? • WATER HEMLOCK • POINSETTA • JIMSON WEED • FOX GLOVE ```

JIMSON WEED

``` WHICH OF THE FOLLOWING IS RELATED WITH OTOTOXICITY? • GENTAMYCIN • PENICILLIN • LEVAQUIN • CIPRODEX ```

GENTAMYCIN

``` WHICH OF THE FOLLOWING IS REALTED TO NEPHROTOXICITY? • AMINOGLYCOSIDES • CEPHALOSPORINS • MACROLIDES • PENICILLINS ```

AMINOGLYCOSIDES

``` 4YO CHILD, UNKNOWN DRUG. HE IS OBS FOR 4HRS IS ASX, 10HRS LATER HE DEVS CNS DEP • DIPHENOXYLATE • WELLBUTRIN XR • DOXEPIN • FLEXERIL ```

DIPHENOXYLATE

``` WHICH OF THE FOLLOWING IS RELATED WITH ANION GAP ACIDOSIS, OSMOLAR GAP, SNOWFIELD VISION. • ISOPROPYL ALCOHOL INGESTION • METHANOL INGESTION • ETHYLENE GLYCOL INGESTION • ETHANOL ```

METHANOL INGESTION

WHICH SYM CAN YOU EXPECT TO SEE IN A TRAMADOL OD? • BRADYCARDIA, HTON, SEIZ • CYCLICAL COMA, BRADYCARDIA, SEIZ • N/V/D, CNS DEPRESSION, REFLEX TACHYCARDIA • QRS WIDENING, TACHYCARDIA, SEIZ

BRADYCARDIA, HTON, SEIZ

ALL OF THE FOLLOWING ARE TRUE REGARDING PRODUCTS WITH A PH<7 EXCEPT: • CAUSE COAGULATION NECROSIS • LIFE THREATENING UPPER AIRWAY EDEMA • CAUSE LIQUEFACTIVE NECROSIS • PT MAY BE DC IF ASX 12 HOURS/GRADE 1 BURN AND TOLERATING PO

CAUSE LIQUEFACTIVE NECROSIS

NERVE AGENTS SUCH AS SARIN ARE ORGANOPHOSPHATE CHEMICAL COMPOUNDS. T/F

ALL OF THE FOLLOWING STATEMENTS REGARDING PHOSGENE ARE TRUE EXPECT? • CAUSES A CORROSIVE TYPE OF SKIN AND TISSUE LESION • SKIN LESIONS ARE PAINLESS • RESP EFFECTS INCLUDE PULM EDEMA/DEATH DUE TO RESP ARREST • CAN CAUSE BLINDNESS IN HIGH CONCENTRATIONS

SKIN LESIONS ARE PAINLESS

``` WHICH OF THE FOLLOWING ANTIDOTES IS CONTRADICTED IN A PATIENT WITH A PEANUT ALLERGY? • DEFEROXAMINE • CYANOKIT • METHYLENE BLUE • BAL ```

BAL

``` BAL OR DMSA ARE THE ANTIDOTES USED TO TREAT WHICH OF THE FOLLOWING? • MUSTARD GAS • LEWISITE • CHLORPHENOXY COMPOUNDS • VX ```

LEWISITE

``` CALL STATING 69YO F ACCIDENTALLY INGESTED 2-3 MOUTHFULS OF PEROXIDE 10%. YOUR ADVICE? • DILUTE. NO SX SHOULD DEVELOP • REFER TO ED • OBS AT HOME. .ER IF SEVERE SX. • DILUTE. N/V ARE POSSIBLE ```

``` HCF CALL STATING 7YO F ARRIVED SEIZING, WITH BACK ARCHED, UNKNOWN INGESTION. WHICH? • ALDICARB • DEET • BROMETHALIN • STRYCHNINE ```

STRYCHNINE

``` WHICH OF THE FOLLOWING RODENTICIDES IS ASSOCIATED WITH ALOPECIA, AND PAINFUL NEUROPATHIES? • THALLIUM • NORBORMIDE • WARFARIN • RED SQUILL ```

THALLIUM

ALL OF THE FOLLOWING ARE TRUE ABOUT ARSENIC EXCEPT: •HAS A GARLIC LIKE ODOR •CAUSES HTON THAT MAY BE RESISTANT TO FLUIDS •CAN BE CHEALATED WITH BAL/DMSA •DIAGNOSIS IS CONFIRMED VIA SPOT URINE TESTING

DIAGNOSIS IS CONFIRMED VIA SPOT URINE TESTING

``` WHICH OF THE FOLLOWING IS ASSOCIATED WITH BASOPHILIC STIPPLING • LEAD • THALLIUM • ARSENIC • MERCURY ```

LEAD

``` WHICH OF THE FOLLOWING WOULD WE MOST LIKELY SEE IN A PT WITH ACUTE MERCURY VAPOR INHALATION? • HEMOLYSIS • NEUROLOGICAL SYMPTOMS • AIRWAY IRRITATION • NO SYM. WE DO NOT WORRY ABOUT THIS ```

AIRWAY IRRITATION

WHAT IS OUR CONCERN WITH NITRATES AND NITRITES? • PATIENT DEVELOPING AMS • HTON, SEIZ • PT DEVEVLOPING RESP SYM • PT DEVELOPING METHEMOGLOBINEMIA AND HEMOLYSIS

PT DEVELOPING METHEMOGLOBINEMIA AND HEMOLYSIS

``` WHICH OF THE FOLLOWING MUSCLE RELAXERS CAN CAUSE ANTICHOLINGERGIC EFFECTS? • CARISOPRODOL (SOMA) • CYCLOBENZAPRINE (FLEXERIL) • METHOCARBAMOL (ROBAXIN) • ALL OF THE ABOVE ```

ALL

``` ALL OF THE FOLLOWING REGARDING SOMA ARE TRUE EXCEPT? • MAY CAUSE TRANSIENT QUADRIPLEGIA • CAN CAUSE SEROTONIN SYNDROME • MAY CAUSE TRANSIENT VISION LOSS • MOST PATIENTS DEVELOP RESP DEPRESSION ```

MOST PATIENTS DEVELOP RESP DEPRESSION

ALL ANTICHOLINGERIC DRUGS CAUSE QRS WIDENING? T/F

``` 7YO IN ER WITH SEVERE BLEEDING/NOT RESP TO K/ING RAT POISON 1 WEEK AGO. WHAT DO YOU REC? • INCREASE VIT K • START PT ON RIVAROBAXIN • PCC • ECCMO ```

PCC

``` HOW DO YOU TREAT SEIZ CAUSED BY AN ISONIAZID OD? • BARBITUATES • PYRIDOXINE (B6) • BACLOFEN • BENZODIAZEPINES ```

``` WHICH OF THE FOLLOWING CAN CAUSE VIT D DEFIIENCY, OSTEAMALACIA, AND SLE (LUPUS)? • GABAPENTIN (NEURONTIN) • LEVETIRACETAM (KEPPRA) • DILANTIN (PHENYTOIN) • VALPROIC ACID (DEPAKOTE) ```

DILANTIN (PHENYTOIN)

``` WHICH OF THE FOLLOWING MAY CAUSE BONE MARROW SUPPRESSION 3-5 DAYS POST MASSIVE OD? • VALPROIC ACID (DEPAKOTE) • AMITRIPTYLINE (ELAVIL) • TOPIRAMATE (TOPAMAX) • METHOTREXATE ```

VPA

TOXICITY DUE TO THYROID MEDICATIONS MAY BE DELAYED UP TO 1 WK POST INGESTION. T/F

``` HYPEREMESIS HAS BEEN ASSOCIATED WITH WHICH OF THE FOLLOWING? • PCP • LSD • MARIJUANA • BATH SALTS ```

HYPEREMESIS

``` WHICH OF THE FOLLOWING CAN BE SEEN IN PT ABUSING OF PCP? • VERTICAL NYSTAGMUS • HORIZONTAL NYSTAGMUS • ROTARY NYSTAGMUS • NO NYSTAGMUS ```

ROTARY NYSTAGMUS

``` BULLOUS SKIN LESIONS CAN BE SEEN IN WHICH OF THE FOLLOWING OD? • SOMA • PHENOBARBITAL • METHADONE • TEGRETOL ```

PHENOBARBITAL

``` CALL FROM EMS/PT FROM FIRE. AWAKE AND ALERT. WHAT DO YOU ADVISE? • HYDROXOCOBALAMIN • PYRIDOXINE • CYANOKIT • HIGH FLOW O2 ```

HIGH FLOW O2

``` ACETONITRILE IS METABOLIZED TO WHAT ENDOGENOUSLY? • CARBON MONOXIDE • CYANIDE • NITRATE • ACETONE ```

CYANIDE

HCF CALLS: 2YO INGESTEED SODIUM LAURETH SULFATE WITHIN THE HOUR. PT IS ASX. YOUR RECS: a. ADMIT FOR POSS BURNS b. PT MUST BE SCOPED WITHIN 12 HOURS c. DC HOME, GI SX EXPTECTED d. OBS FOR 6 HOURS, PO CHALLENGE

DC HOME, GI SX EXPTECTED

WHAT IS OUR MAIN CONCERN WITH HAIR RELAXERS? a. INTOXICATION b. GI SX c. BURNS d. NONE, THEY HAVE MIN TOX

BURNS

FORMIC ACID CAUSES A METABOLIC ACIDOSIS AND CAUSES BLINDNESS THROUGH DIRECT RETINAL TOX. T/F

WHICH IS METABOLIZED TO FORMALDEHYDE AND FORMIC ACID? a. ETHANOL b. ISOPROPYL ETOH c. ETHYLENE GLYCOL d. METHANOL

METHANOL

WHICH OF THE FOLLOWING IS USED AS A HALLUCINOGEN AND LIKELY TO HAVE AMPHETAMINE LIKE EFFECTS? a. THYMOL b. NUTMEG c. CLOVE OIL d. ARNICA

NUTMEG

WHICH OF THE FOLLOWING IS FOUND IN ABSINTHE? a. PENNYROYAL OIL b. PEPPERMINT OIL c. NUTMEG d. WORMWOOD OIL

WORMWOOD

H2S MAY BE RELEASED BY MIXING SULFURIC ACID WITH A STRONG BASE SUCH AS SODIUM HYDROXIDE? T/F

WHICH OF THE FOLLOWING IS A CNS STIMULANT THAT CAUSES SEIZURES SOON AFTER INGESTION? a. CAMPHOR b. PHENOL c. MENTHOL d. EUCALYPTUS OIL

CAMPHOR

ATROPINE WILL REVERSE MUSCARINIC AND NICOTINIC EFFECTS? T/F

PULMONARY FIBROSIS OFTEN DEVELOPS AFTER SIGNIFICANT EXPOSURE TO WHICH OF THE FOLLOWING TOXINS? a. DIQUAT b. GLYPHOSATE c. CARBAMATE HERBICIDES d. PARAQUAT

PARAQUAT

THE DIFFERENCE BETWEEN DIQUAT AND PARAQUAT IS? a. NO DIFFERENCE b. DIQUAT DOES NOT CAUSE PULM FIBROSIS c. DIQUAT MAY CAUSE BURNS d. PARAQUAT MAY CAUSE CNS HEMORRHAGIC INFARCTIONS

DIQUAT DOES NOT CAUSE PULM FIBROSIS

WHICH OF THE FOLLOWING ARE MOST LIKELY FOLLOWING LINDANE EXPOSURE? a. SEIZURE b. BRONCHOSPASM c. HYPOGLYCEMIA d. CHOLINERGIC EFFECTS

SEIZ

A RODENTICIDE THAT PRODUCES EXTENSIVE DESTRUCTION OF PANCREATIC BETA CELLS IS: a. SODIUM MONOFLUOROACETATE b. VACOR c. RED SQUILL d. STRYCHNINE

VACOR

WHICH OF THE FOLOWING IS ASSOCIATED WITH A ROTTEN FISH ODOR? a. THALIUM b. CYANIDE c. VACOR d. ZINC PHOSPHATE

ZINC PHOSPHATE

WHICH OF THE FOLLOWING CAN BE SEEN IN LABS IN A PT WITH HF INJURY? a. HYPERCALCEMIA, HYPERKALEMIA, ACIDOSIS b. HYPONATREMIA, HYPOKALEMIA c. HYPOKALEMIA, ACIDOSIS d. HYPOCALCEMIA, HYPERKALEMIA, HYPOMAGNESMIA

HYPOCALCEMIA, HYPERKALEMIA, HYPOMAGNESMIA

16. PHYSOSTIGMINE SHOULD BE AVOIDED IN WHICH OF THE FOLLOWING? a. DIPHENHYDRAMINE b. AMPHETAMINES c. NORTRIPTYLINE d. DEXTROMETHORPHAN

NORTRIPTYLINE

35LB CHILD INGESTED MAX 60ML TUBE OF BENGAY. (CONTAINS 4% CAMPHOR, 30%METHYL SALICYLATE). a. 137MG/KG CAMPHOR b. 15MG/KG CAMPHOR c. 97MG/KG CAMPHOR d. 150MG/KG CAMPHOR

150MG/KG CAMPHOR

HOW MANY BABY ASPIRIN WOULD A CHILD WEIGHING 24 LBS NEED TO EAT TO BE IN A TOXIC RANGE? a. 10 b. 24 c. 17 d. 20

19. WHEN A CAUSTIC SUBSTANCE IS SPLASHED INTO THE EYE, THE CORRECT FIRST AID MEASURE IS: a. IRRIGATION WITH A MILD SOLUTION OF EPSOM SALTS b. IRRIGATION WITH A 10% ACETIC ACID SOLUTION c. NEUTRALIZATION WITH SODIUM BICARBONATE d. NONE OF THE ABOVE

NONE OF THE ABOVE

WHICH OF THE FOLLOWING IS THE MOST IMPORTANT PREDISPOSING FACTOR IN A HYDROCARBON ASPIRATION? a. THE QUANTITY OF INGESTION b. SPONTANEOUS EMESIS c. VISCOSITY d. AGE OF THE PATIENT

VISCOSITY

METHEMOGLOBINEMIA IS ASSOCIATED WITH ALL OF THE FOLLOWING EXPECT? a. CHOCOLATE COLORED BLOOD b. PHENAZOPYRIDINE c. BRIGHT RED BLOOD d. BENZOCAINE

BRIGHT RED BLOOD

THE INGESTION OF A CERAMIC GLAZE WOULD MOST LIKELY RESULT IN TOXICITY DUE TO? a. CADMIUM b. LEAD c. ANTIMONY d. COPPER

LEAD

CALLER STATES A WASP HAS JUST STUNG HER 3YO. THE BITE SITE IS PAINFUL, RED, BEGINNING TO SWELL. • THE STINGER SHOULD BE REMOVED IMMEDIATELY • THE STINGER SHOULNDT BE REMOVED IMMEDIATELY

THE STINGER SHOULNDT BE REMOVED IMMEDIATELY

``` PT ARRIVES TO HCF WITH RECURRENT SEIZ, HR 148 DESPITE BENZOS. EMPTY BOTTLE OF ANTIDEP WERE FOUND AT THE SCENE. RECS? • MORE BENZOS • PHEBNOBARBITAL • PRECEDEX • PYRIDOXINE ```

PHEBNOBARBITAL

WHICH OF THE FOLLOWING IS ASSOCIATED WITH INCREASED INTRACRANIAL PRESSURE? • VITAMIN A • VITAMIN B • VITAMIN C • VITAMINS DO NOT CAUSE INTRACRANIAL PRESSURE

vit a

``` PT ARRIVES TO ER WITH RECURRENT SEIZ AFTER INGESTING A MUSHROOM. RECS INCLUDE: • BENZOS • PYRIDOXINE • PROPOFOL • PHENOBARB ```

PYRIDOXINE

``` PT JUST RELEASED FROM REHAB COMES TO THE ER AFTER A BINGE. HE IS FLUSHED, TACHY, HTN. WHICH MEDICINE WAS HE TAKING? • DISULFURAM • METHADONE • MAOI • BUPRENORPHINE ```

DISULFRAM

VALPORIC ACID DOES NOT CAUSE BONE MARROW SUPPRESSION T/F?

AMANITA MUSHROOMS CAUSE SEIZ T/F?

COPRINE MUSHROOOM CAN CAUSE DISULFRAM LIKE REACTION WITH ALCOHOL T/F?

``` HOT COLD REVERSAL IS ASSOCIATED WITH ? • BREVETOXIN • SCROMBROID • CIGUATERA • TETRODOTOXIN ```

CIGUATERA

WE MUST OBSERVE A RACER SNAKE BITE FOR 8-12 HRS T/F?

LITHIUM LEVELS CORRELATE WELL WITH CHRONICITY T/F?

DIGOXIN CAN CAUSE SNOWFIELD BLINDNESS T/F?

``` A PATIENT WHO ABUSES POPPERS PRESENTS TO ED WITH FLUSHING, PALPITATIONS, BLUE TINGED LIPS, WHAT LABS REC? • CARBOXYHEMOGLOBIN • HEMOGLOBIN • METHEMOGLOBIN • CPR ```

METHEMOGLOBIN

``` PATIENT PRESENTS WITH ROTARY NYSTAGMUS AFTER UNKNOWN DRUG EXPOSURE. WHAT WAS MOST LIKELY EXPOSED? • COCAINE • DEXTROMETHORPHAN • METHAMPHETAMINE • PCP ```

PCP

``` WHICH CLINICAL SYMPTOM COULD BE EXPECTED IMMEDIATELY AFTER EXPOSURE TO A FLUORINATED HYDROCARBON? • PULM EDEMA • HEART BLOCKS • VFIB • SEIZURE ```

VFIB

``` CALLER STATES HER 3YR OLD ATE A PRODUCT 30 MIN AGO. HAS NAUSEA, VOMITING, AND CNS DEP. WHAT DID HE TAKE? • IODINE BASED CLEANER • PINE OIL FLOOR CLEANER • ENZYMATIC CLEANER • SINGLE USE DETERGENT PACKET ```

SINGLE USE DETERGENT

``` FARMER EXPOSED TO PARAQUAT WHILE SPRAYING FIELDS. PRESENTS TO ED 1 WEEK LATER WITH SOB. RECS? • CHECK RENAL FUNC • CHECK LFTS • DO NOT USE O2 • GET AN EKG ```

DO NOT USE O2

``` PT HAS THROAT PAIN, DIFFICULTY SWALLOWING, HYPERSALIVATION AFTER ING LIQUID GUN BLUING. WHAT DID HE INGEST? • SELENIOUS ACID • CLEANING OIL • ACETONE • METHANOL ```

SELENIOUS ACID

``` AT A CONCERT, EVERYONE SUDDENTLY COLLAPSES AND DIES. THERE IS A DRUM THAT CONTAINS AN UNKNOWN CHEMICAL AND AN ACID. WHICH? • MUSTARD GAS • HYDROGEN CYANIDE • RICIN • ARSENIC ```

HYDROGEN CYANIDE

``` PT IN ER EXPOSED TO ORGANOPHOSPHATE AND VERY CHOLINERGIC. 2PAM IS STARTED. WHEN DO WE STOP IT? • UNTIL PULM EXCRETIONS RESOLVE • UNTI DIARRHEA STOPS • UNTIL BRADY IMPROVES • UNTIL SALIVATION STOPS ```

UNTIL PULM EXCRETIONS STOP

CHLORAMINE EXPOSURE CAN RESULT IN PULM EDEMA T/F?

``` PT HAVING DIFFICULTY URINATING AND RINGING IN THE EARS AFTER TAKING UNKNOWN ANTIBIOTIC. WHAT WAS TAKEN? • PENICILLIN • STREPTOMYCIN • BACTRIM • CEPHALOSPORIN ```

STREPTOMYCIN

WE ARE MOST CONCERNED WITH SODIUM IN DIG OD T/F?

MYRISTICA OIL IS USED AS A HALLUCINOGEN T/F?

``` WHAT IS ASSOCIATED WITH CNS STIM AND CNS DEP? • GINSENG • KRATOM • GUARINACA • FENUGREEK ```

KRATOM

``` HCF CALLS WITH 24YO M THAT ARRIVES C/O EXTREME MUSCLE SORENESS. HE IS WORKING WITH A TRAINER. LABS SHOW ARF. • PROTEIN ISOLATES • CREATINE • PRE WORKOUT • GUARANICA ```

CREATINE

``` PT IS HTN AND TACHY AND PICKING AT AIR. WHAT WAS TAKEN? • WATER HEMLOCK • FOX GLOVE • JIMSON WEED • POTHOS ```

JIMSON WEED

``` WHICH IS MOST AT RISK IN CARBON MONOXIDE CASE? • 65 YO WITH PREVIOUS BYPASS • 34 YO SMOKER • 2 MONTH NEW BORN • ATHLETE WITH RESTING HR OF 40 ```

2 MONTH NEW BORN (IF NEW BORN OUT, THEN IT BECOMES CARDIO TOX SO BYPASS PT NEXT)

* SEEK MD ATTENTION * OBS AT HOME FOR SIGNS OF BURNS * FOLLOW UP WITH PEDI * GIVE FLUIDS

SEEK MD ATTENTION

DPH CAUSES FALSE POS FOR ____.

TCA

DEXTROMETHORPHAN CAUSES FALSE POS FOR ____

PCP

``` A FARMER PRESENTS WITH SEVERE BURNS AFTER USING AN HERBICIDE. WHICH? • DIQUAT • PARAQUAT • AGENT ORANGE • GLYPHOSATE ```

GLYOPHOSATE

COCAINE SYM ARE SIMILAR TO _____. BUT COCAINE PUPILS WILL BE REACTIVE/NOT REACTIVE.

ANTICHOL; REACTIVE

ANTICHOLINERGIC PUPILS WILL BE REACTIVE/NOT REACTIVE?

NOT REACTIVE

Patient arrived in the Emergency Department ( ED ) after taking an overdose of Zolpidem (Ambien) and Alcohol. Pt takes Valproic acid ( Depakote) for seizures. Valproic Acid (VPA) level was 55 mcg.ml. ( normal 50 -100 mcg/ml). Pt was transferred to a medical floor from the ED and 6 hours later patient became increasingly somnolent and drowsy. Based upon the information provided what drug is the most likely cause? A. Zolpidem (Ambien) B. Valproic Acid (Depakote) C. Ethanol (Alcohol) D. Ammonia

valporic acid bc delayed!

``` Pt has a history of a seizure disorder and was placed on oral Phenytoin ( Dilantin). The phenytoin level is (32mcg/ml). Which of these symptoms is not related to the elevated phenytoin level? A. Ataxia B. Nystagmus C. Hyperreflexia D. Cardiac arrhythmias ```

d. cardiac arrhythmias

Irritants like hydrogen chloride, acrolein, phosgene, nitrogen oxides: A. Displace oxygen from the airways B. May cause direct corrosive effects, free radical production, and immune-mediated effects. C. Interfere with systemic oxygen utilization D. Cause GI distress

Chemical asphyxiants like carbon monoxide, hydrogen cyanide, hydrogen sulfide: A. Displace oxygen from the airways B. May cause direct corrosive effects, free radical production, and immune- mediated effects. C. Interfere with systemic oxygen utilization D. Cause GI distress

Simple asphyxiants like carbon dioxide: A. Displace oxygen from the airways B. May cause direct corrosive effects, free radical production, and immune-mediated effects. C. Interfere with systemic oxygen utilization D. Cause GI distress

Which general class of medications is primarily used as decongestants? A. Antitussives B. Sympathomimetics C. Sedatives D. Opiates

A worker in a paint plant got aluminum coating spray on his hands. A supervisor called and stated that the patient wasn’t wearing his gloves. The exposure occurred 5 minutes ago. The patient has his hands soaking in a bucket of water and complains of intense pain. He’s having trouble getting the paint off. The ph is 1.0 and the ingredients are: water 40%, chromic acid 10%, phosphoric acid 30%, hydrofluoric acid 20%. What should the SPI advise? A. To decontaminate hands, use running water for 30 minutes and see a physician if irritation persists. B. Soak hands in milk enroute to the closest urgent care clinic for assessment by a physician. C. Remove paint with baby oil and see a physician if irritation persists. D. Rinse with running water and get patient to the closest ED for evaluation and treatment.

An autistic 6-year-old, 20 kg boy ingested an unknown number of nicotine gum pieces, which the package says contains 2 mg nicotine per piece. The maximum available were 10 pieces. The ingestion just occurred and the child is asymptomatic. The mother says the boy doesn’t chew the gum, he typically just swallows it. The SPI should recommend: A. No treatment is needed since the gum isn’t well absorbed from the GI tract. B. Observe at home for vomiting. If vomiting persists, take child to a hospital for evaluation. C. Administer Syrup of Ipecac since the ingestion just occurred. D. Call 911 since the child could develop vomiting and seizures from 1mg/kg.

``` A 70 –year-old man was brought to the ER by his wife. He is febrile, confused and complains of dizziness. His meds include labetalol (Normodyne®), omega-3-acid ethyl esters 1 Gm (Lovaza®), OTC analgesics and vitamins. VS 132/62-119-28-100.9. O2 sat 94%. WBC 14,000. Na 144, K 2.8, Cl 101, BUN 25, Cr 1.2, HCO3 20, glucose 144. Head CT is negative. ABGs show pH 7.44, pCO2 27, pO2 57. Blood ethanol negative. What is the most likely causative agent? A. Ethylene glycol B. Aspirin C. Methanol D. MDMA ```

Which of the following pesticides/herbicides could produce vomiting, diarrhea, miosis, salivation, and bradycardia after ingestion? A. Diazinon B. Glyphosate C. Paraquat D. Pyrethrum

``` All except one of these are typical nicotinic effects that can be seen in an exposure to organophosphates in late toxicity. A. Muscle weakness B. Paralysis C. Tachycardia D. Miosis ```

A 48-year-old female caller is complaining of pain on inspiration and intermittent coughing after mixing 2 cleaning products, one containing bleach and the other containing a strong acid. You advise her to: A. Seek fresh air immediately. If symptoms persist, seek medical attention. B. Immediately call 911, as it is imperative that she be transferred to an emergency room facility for evaluation due to her symptoms C. Immediately scrub the surfaces that the cleaning products came in contact with, to decrease the amount of her inhalation exposure D. Return to the room to open the windows

Most common symptoms of hydrocarbon ingestion include all of the following EXCEPT: A. Rash and itching, sometimes up to 8 – 10 hours post-exposure B. GI upset, especially diarrhea C. An increase in INR/coagulation tests. D. Coughing, wheezing and SOB

An 18 month-old toddler ingested up to 10 levothyroxine (Synthroid®) tabs, 75 mcg each. The child is normally healthy and weighs 24 lb. What is the best course of action? A. Bring the child into the closest ED as this is a potentially toxic ingestion B. Rinse out the child’s mouth, dilute and although symptoms are not expected, review symptoms to watch out for briefly with the parents and have them call back with any concerns C. Call 911 because this ingestion can cause tachycardia and seizures D. Follow up in 7-10 days observe for agitation, fever and tachycardia

2YO BOY IN ED AFTER INGESTING UNKNOWN SUBSTANCE. CBG 35. WHAT WOULD NOT CAUSE HYPOGLYCEMIA? ETHANOL, CHLORPROPAMIDE, GLYBURIDE, NPH INSULIN

NPH INSULIN

WHICH SUBSTANCES WILL NOT APPEAR RADIOPAQUE IF THEY REMAIN UNDISSOLVED IN GI TRACT? THORAZINE, APAP, CHLORAL HYDRATE, IRON, ENTERIC COATED ASA

APAP

WHICH IS AN INDICATION FOR HEMODIALYSIS? A. ASA OF 25 MG/DL WITH TINNITUS B. LITHIUM LEVEL OF 1.4 AFTER ACUTE INGESTION C. THEOPHYLLINE LEVEL OF 38 MCG/ML D. METHANOL LEVEL OF 150MG/DL IN ASX PATIENT E. ALL OF ABOVE

T/F DO CYCLIC ANTIDEPRESSANTS HAVE A DELAYED EFFECT?

``` ELECTROLYTE AND METABOLIC ABNORMALITIES ASSOCIATED WITH SIGNIFICANT HYDROFLUORIC ACID EXPOSURES INCLUDES ALL EXCEPT: A. ACIDEMIA B. HYPOCALCEMIA C. HYPERKALEMIA D. HYPOMAGNESEMIA E. HYPONATREMIA ```

NEUTRALIZATION THERAPY IS CONTRADICTED IN CAUSTIC EXPOSURE BECAUSE: A. THE REACTION IS EXOTHERMIC AND MAY RESULT IN THERMAL BURNS B. NEUTRALIZATION AGENTS ARE EXPENSIVE AND LARGE DOSES ARE REQUIRED C. MUST BE DONE WITHIN SECONDS AFTER THE EXPOSURE TO BE EFFECTIVE D. MAY CAUSE VOMITING, THEREBY INCREASING THE EXTENT OF BURNS

``` DENTAL STUDENT PUT CASTING INTO UNMARKED BEAKER CONTAINING CLEAR SOLUTION HE THOUGHT WAS WATER. 1.5 HRS LATER DEVELOPED PAINFUL TINGLING SENSATION IN FINGERS AND UNDER NAILS. 8 HRS LATER PRESENTS WITH EDEMATOUS, ERTHYMATOUS, PAINFUL RED FINGERS. MOST LIKELY CAUSE? A. SODIUM HYDROXIDE B. HYDROFLUORIC ACID C. ACETONE D. HYDROCHLORIC ACID E. PHOSPHORIC ACID ```

WHICH OF THE FOLLOWING IS NOT A METHOD OF INCREASING NEUROTRANSMISSION? A. INCREASING REUPTAKE OF NEUROTRANSMITTER B. INCREASING RELEASE OF NEUROTRANSMITTER C. AGONISM OF NEUROTRANSMITTER RECEPTOR D. DECREASED BREAKDOWN OF NEUROTRANSMITTER E. NONE OF THE ABOVE

``` WHAT IS THE MAJOR PREGANGLIONIC NEUROTRANSMITER? A. GLUTAMATE B. GABA C. ACETHLCHOLINE D. SEROTONIN E. NOREPINEPHRINE ```

``` SYMPATHOMIMETIC DRUGS MIMIC THE ACTIONS OF WHICH NEUROTRANSMITTER? A. GLUTAMINE B. GABA C. ACETHYLCHOLINE D. SEROTONIN E. NOREPHINEPHRINE ```

``` ATROPINE BLOCKS WHICH IF THE FOLLOWING RECEPTORS? A. ALPHA B. BETA C. NICOTINIC D. MUSCARINIC E. SEROTONERGIC ```

``` WHICH OF THE FOLLOWING SUBSTANCES WOULD NOT HAVE ANTICHOL EFFECTS? A. CHLORPHENIRAMINE B. BENZTROPINE C. PHYSOSTIGMINE D. PRMETHAZINE E. TRAZODONE ```

HOW DO ORGANOPHSOPHATES CAUSE CHOLINERGIC EXCESS? A. INCREASE THE RELEASE OF ACETYLCHOLINE B. ACTS AS A MUSCARINIC AND NICOTINIC AGONIST C. INHIBITS THE BREAKDOWN OF ACETYLCHOLINE D. ACTS AS AN ECETYLCHOLINE REUPTAKE INHIBITOR E. INCREASES THE SYNTHESIS OF ACETYLCHOLINE

``` WHICH GROUP OF ORGANISMS RESULTS IN MOST FATALITIES ANNUALLY? A. ELAPIDS B. LOXOCELLES SP C. HYMENOPTERA D. CROTALIDS E. LATRODECTUS SP ```

C (BEES, WASPS, ETC)

WHICH OF THE FOLLOWING STATEMENTS ABOUT WEYTH POLYVENT CROTALID ANTIVENIN IS TRUE? A. ANAPHYLAXIS ONLY OCCURS IN PTS WITH PRIOR ANTIVENIN THERAPY B. SERUM SICKNESS OCCURS IN >50% OF TREATED PTS C. SKIN TESTS SHOULD BE PERFORMED FOR ALL SNAKE BITES D. A POSITIVE SKIN TEST IS A CONTRADICTION TO THERAPY E. POLYVENT IS DERIVED FROM PIG SERUM

WHICH OF THE FOLLOWING STATEEMENTS ABOUT PLANTS IS FALSE? A. SMALL AMOUNTS OF PLANT MATERIAL USUALLY HAVE LOW TOX B. ALL PARTS OF A POISONOUS PLANT ARE NOT EQUALLY TOXIC C. ACTIVATED CHARCOAL BINDS MOST PLANT TOXINS D. ATROPINE MAY BE BENEFICIAL FOR SEVERE JIMSON WEED POISONING E. DIGIBIND MAY BE USEFUL FOR SEVERE OLEANDER POISONING

WHAT DOES WATER HEMLOCK SMELL LIKE?

CARROTS

WHAT DOES WATER HEMLOCK CUASE?

SEIZ

WHICH THERAPY IS HELPFUL TO TX INGESTIONS OF MONOMEHTTYLHYDRAZINE MUSHROOMS?

PYRIDOXINE

T/F LATRODECTUS (BLACK WIDOW) SPIDERS DO YOU DILUTE ANTIVENIN IN 50-100ML OF NS OR D5W AND INFUSE OVER 30 MIN?

MASSUGA IS WHAT TYPE OF SNAKE?

RATTLESNAKE

FOR A PATIENT TO HAVE A METABOLIC ACIDOSIS, THE MUST: A. HAVE A PH BELOW 7.4 B. PCO2 LESS THAN 35 C. HC03 LESS THAN 24 D. LACTIC LEVEL GREATER THAN 4 E. HAVE AN EXCESS OF UNACCOUNTED FOR CATIONS

A PATIENT WITH 20% COHB LEVEL AND NO OTHER PULM OR TOX PROBLEMS WILL HAVE WHAT % OXYHEMOGLOBIN BY PULSE OX?

90-100%

``` WHICH OF THE FOLLOWING IS A RESP IRRITANT? NITROGEN OXIDE METHANE HYDROGEN ARGON CARBON DIOXIDE ```

NITROGEN OXIDE

``` WHICH IS MOST LIKELY TO CAUSE HEMOLYSIS? CHLORAMINE ARSINE GAS METHANE NITROGEN OXIDE CARBON DIOXIDE ```

ARSINE GAS

``` WHICH IS A SIMPLE ASPHYXIANT? CARBON MONOXIDE NITROGEN DIOXIDE METHANE CHLORINE ALL OF THE ABOVE ```

METHANE

HALF LIFE OF CARBOXYHEMOGLOBIN IS IN ROOM AIR? SO IF GETTING 200% O2, HALF LIFE IS?

5-6 HOURS ROOM AIR, 60 MIN 100%

PROPER SEQUENCE OF THERAPY FOR CYANIDE POISONING USING CYANIDE ANTIDOTE KIT IS?

OXYGEN, AMTYL NITRITE AMPULE, SODIUM NITRITE, SODIUM THIOSULFATE

WHICH OF THE FOLLOWING STATEMENTS ABOUT COBALT IS CORRECT? A. COMPONENT OF JET FUEL B. COMPONENT OF FLUORESCENT LIGHT BULBS C. TOXIC AMTS CAUSE HYPERTHYROIDISM D. INHALATION CAN CAUSE METHEMOGLOBINEMIA E. RENAL FAILURE OCCURRED WHEN IT WAS USED AS A STABILIZER IN BEER

NONE! COBALT CAUSES HYPOTHYROIDISM AND CAN CAUSE CARDIAC FAILURE WHEN IT WAS USED AS A STABILIZER IN BEER

DEFOROXAMINE WORKKS BY: A. CHELATING IRON FROM HEMOGLOBIN B. BINDING FREE FE3+ AT THE THREE N-OH SITES C. BINDING THE FREE FE2+ AT THE THREE N-OH SITES D. CHELATING IRON FROM FERRITIN E. CHELATING IRON FROM HEMOSIDERIN

WHICH IS TRUE ABOUT SUCCIMER (DMSA)? A. DMSA IS FDA APPROVED FOR USE IN ADULTS B. DMSA IS A SELECTIVE CHELATOR C. DMSA CAN CAUSE HEMOLYSIS IN PATIENTS WITH G6PD D. DMSA IS WATER INSOLUBLE E. DMSA IS ORALLY ACTIVE

``` ALL OF THE FOLLOWING CAN BE UTILIZED TO MANAGE LEAD POISONING BY ENCHANCING ELIMINATION EXCEPT: A. CANA2 EDTA B. DIMERCAPROL (BAL) C. D-PENICILLAMINE D. SUCCIMER (DMSA) E. NAC ```

``` ALL OF THE FOLLOWING METALS ARE KNOWN TO CAUSE A PROXIMAL TUBULAR NECROSIS EXCEPT: A. CADMIUM B. LEAD C. CHROMIUM D. MERCURY E. LITHIUM ```

E – This question is very tricky. All of these metals cause renal injury of some sort. I was only able to confirm actual proximal tubular necrosis associated with mercury and chromium. I searched Olson’s, Poisindex, and Goldfranks. I did not see the word “necrosis” when reading about cadmium, lead, or lithium; however, all that I read regarding the nephrotoxic effects of lithium occurred in the distal tubules.

``` ALL OF THE FOLLOWING MERCURY COMPOUNDS ARE POOR ABSORBED FROM GI TRACT EXCEPT: THIOMERSAL ELEMENTAL MERCURY ETHYL MERCURY MERCRESIN MERCUROCHROME ```

Both C & E are organic mercury compounds, which are absorbed via all routes. I have no idea what Mercresin is – it’s not in Poisindex

AN APAP LEVEL OF 180MCG/ML DRAWN 4 HOURS POST INGESTION INDICATES: - NAC STARTED UNTIL APAP LEVEL IS NON TOXIC - NAC DOES NOT NEED TO BE STARTED - A LOADING DOSE OF NAC GIVEN WITH NO FURTHER TX UNTIL A FU APAP LEVEL DRAWN AT 8 HOURS - A LOADING DOSE OF NAC GIVEN FOLLOWED BY 17 MAINTENANCE DOSES

- A LOADING DOSE OF NAC GIVEN FOLLOWED BY 17 MAINTENANCE DOSES

``` WHICH DRUG WILL CAUSE A POSITIVE FERRIC CHLORIDE TEST? INDOMETHACIN APAP ASA IBUPRROFEN ```

ASA

THE END POINT OF DEFEROXAMINE IN AN IRON POISONING IS WHEN: URINE CHANGES TO VINE ROSE COLOR PT HAS METABOLIC ACIDOSIS 24 HRS AFTER STARTING RADIOPAQUE DENSITIES ARE NO LONGER VISIBLE ON AB RADIOGRAPHS.

None of these answers are correct; The end point of deferoxamine therapy is when the urine changes from vin rose back to normal color and when serum iron levels are <500

``` WHAT IS FALSE ABOUT COLCHICINE TOX? GI SYM PRESENT WITHIN 30 MIN OF SEVERELY POISONED PT. RESP FAIL CONTRIBUTES TO DEATH. GLORY LILY CONTAINS COLCHICINE. SHOCK AND BLOODY DIARRHEA ARE SYM. ```

GI SYM PRESENT WITHIN 30 MIN OF SEVERELY POISONED PT.

``` WHICH IS MOST HELPFUL FOLLOWING PT PROGRESS AFTER APAP INGESTION? CREATININE ALKALINE PHOSPHATASE SODIUM PROTHROMBIN TIME BILIRUBIN ```

PROTHROMBIN TIME (ALK PHOS IS ALP!)

WHICH IS TRUE REGARDING ACUTE ASA INTOXICATION? A. TINNITUS IS NOT A COMMON OCCURRENCE B. SALICYLATE BLOOD LEVELS DRAWN 6 HOURS POST INGESTION DO NOT CORRELATE WELL WITH THE EXTENT OF TOX C. ACID BASE DISTURBANCES RARELY DEV D. CHARCOAL INEFFECTIVELY ABSORBS ASA E. NAC IS INDICATED WHEN 4 HR ASA LEVELS ARE >150 MCG/DL

``` S/SX OF SEVERE IRON POISONING INCLUDE ALL OF THE FOLLOWING EXCEPT: VOMITING RIGORS AB PAIN HTON ACIDOSIS ```

RIGORS

WHAT IS PO APAP DOSING?

LOAD: 140MG/KG. MAINTAINENCE: 70MG/KG Q4HR X 1 7DOSES. LABS Q24HR.

CONVERSION FACTOR FOR FERROUS FURARMATE?

CONVERSION FACTOR FOR FERROUS SULFATE?

CONVERSION FACTOR FOR FERROUS GLUCONATE?

ED STARTS NAC IN PT THAT HAS APAP LEVLE OF 200MG/DL 5 HOURS AFTER INGESTION. WHICH ABOUT NAC IS FALSE? - NAC'S PROPOSED MECHANISM OF ACTION IS TO PROVIDE SUBSTRATE TO REPLENISH GLUTATHIONE STORES, WHICH WERE DEPLETED BY AN APAP REACTIVE METABOLITE. - MAINTAINENCE DOSE OF NAC IS 100MG/KG IV Q4 HOURS FOR 17 DOSES. - NAC IS INDICATED WHEN 4HR POST INGESTION LEVEL EQUALS OR EXCEEDS 150MCG/ML - FOR BEST RESULTS, THERAPY SHOULD BE LIMITED WITHIN THE FIRST 16 HOURS POST INGESTION - ALL ARE TRUE

MAINTAINENCE DOSE OF NAC IS 100MG/KG IV Q4 HOURS FOR 17 DOSES.

WHAT IS IV NAC DOSING?

1: 150MG/KG IN 200 CC D5W OVER 1 HR 2: 50MG/KG IN 500 CC D5W OVER 4 HOURS 3: 100MG/KG IN 1 L D5W OVER 16 HRS

``` TODDLERS MOST OFTEN EXPOSED TO? MULTIVITAMINS PERSONAL CARE AND COSMETICS SILICA GEL CLEANING PRODUCTS ```

PERSONAL CARE AND COSMETICS

``` AN ED CALLS ABOUT 2 YO MALE BROUGHT IN AFTER BECOMING LETHARGIC THE PAST 30 MIN. VS: 78/52, HR78, RR22, AFEB, PUPILS ARE MOBILE. 2 DOSES OF NALOXONE GIVEN WITH MINIMAL RESPONSE (0..4MG AND 1 MG). WHICH DRUG? DEXTROMETHORPHAN MEPERIDINE TETRAHYDRAZOLINE CODEINE ```

TETRAHYAZOLINE

HOW SOON ARE SEIZ EXPECTED AFTER TOXIC DOSE OF CAMPHOR?

15 TO 20 MIN

CHRONIC EXPOSURE TO CHAMPHOR RESULTS IN ALL OF THE FOLLOWING EXCEPT: TOLERANCE SOON DEVELOPS DUE TO ENZYME ACTIVATION REYES SYNDROME HEPATOMOLOGY HYPOGLYCEMIA

B? I don’t know what answer they’re looking for. I can’t find any information on camphor related to glucose in PI, Olsen’s, or even Goldfranks, but google says it can cause hypoglycemia. Chronic use can mimic Reye syndrome. It doesn’t cause hepatomegaly, but it can cause elevated transaminases and granulomatous hepatitis. I have no idea about tolerance.

TO IDENTIFY IF A MOTHBALL IS PARADICHOLORBENZENE OR NAPHTHALENE WHICH IS CORRECT?

NAPTHANLENE FLOATS IN SATURATED SALT SOLUTION WHILE PARADICHLOROBENZENE SINKS

WHICH OF THESE IS GREATEST RISK TO TODDLERS? EYE SHADOW, LIPSTICK, PERFUME, ROUGE?

PERFUME

CONCERNING BUTTON BATTERIES, WHICH IS CORRECT? - IPECAC IS RECOMMENDED IF IT CAN BE GIVEN EARLY - LARGER BATTERIES GENERALLY PASS EASILY DUE TO THEIR WEIGHT - GREATER THAN 80% OF BATTERIES PASS UNEVENTFULLY WITHIN 4 DAYS - LEAKAGE OF BATTERY CONTENTS IS COMMON

B or C – I’m not sure if B is referring to larger button batteries or like AA or AAA batteries.

FOR ACCIDENTAL INGESTION OF 180MG OF PSEDUOPHEDRINE IN HEALTHY ADULTS: - MONITOR IN HCF FOR 8HRS MIN - IPECAC IF IT CAN BE GIVEN EARLY - NO TX NEEDED - TREATMENT WITH AC AND MONITORING FOR 8 HRS IN HCF

NO TX NEEDED

HCF REFERRAL FOR PSEDUOPHEDRINE?

11MG/KG

HCF REFERRAL FOR PHENLYEPHRINE?

2-6YRS: >45MG; 6-12YRS: >90MG

``` ORAL EXPOSURE OF CYANOACRYLATS MOST OFTEN REQUIRE? IMMEDIATE DILUTION WITH 6-8 OZ WATER CYANIDE ANTIDOTE KIT SYRUP OF IPECAC IF IT CAN BE GIVEN EARLY SWISHING AND EXPECTORATING ACETONE ```

IMMEDIATE DILUTION WITH 6-8 OZ WATER

HOW LONG WOULD IT TAKE FOR SUPER GLUE ON LOWER CONJUCTIVA AND PART OF CORNEA TO LOOSEN SO THAT OPTH EXAM MAY BE PERFORMED?

OFTEN WITHIN 4 TO 6 HOURS

WHAT SHOULD YOU ADVISE IF CALLER HAS A SOLUTION OF SODIUM HYDROXIDE SPLASH IN EYES WHILE CLEANING POOL?

RINSE WITH A LOT OF WATER FOR 30 MIN AND PROCEED TO ED FOR EYE EXAM

``` WHICH SKELETAL MUSCLE RELAXANT HAS A TRICYCLIC STRUCTURE? METHOCARBAMOL BACLOFEN CYCLOBENZAPRINE CARISOPRODOL ```

CYCLOBENZAPRINE

PT PRESENTS WITH VIOLENT AGITATION, VERTICAL, HORIZONTAL AND ROTARY NYSTAGMUS, AND VISUAL HALLUCINATIONS. WHAT IS MOST PROBABLE DRUG OF ABUSE?

PHENCYCLIDINE

4YO MALE PRESENTS TO ED WITH EPS EFFECTS AFTER SINGLE DOSE OF PROMETHAZINE 12.5MG PER RECTUM. TX FOR THIS ADVERSE DRUG REACTION IS?

DPH

WHICH ANTIARRHYTHMIC DRUG IS APPROPRIATE FOR TX OF VENTRICULAR DYSRHYTHAMIAS ASSOCIATED WITH TRICYCLIC ANTIDEPRSSANT OD?

LIDOCAINE

T/F: PLAMSA DIPHENOXYLATE LEVELS ARE CLINICALLY USEFUL IN ASSESSING THE DEGREE OF TOX IN A PT FOLLOWING LOMOTIL OD?

FALSE

THE ANTIARRHYTHMIC AGENT OF CHOICE TO USE IN TX OF PT WITH MULTIFOCAL PVC'S 2NDARY TO TCA OD IS?

LIDOCAINE

WHICH ABOUT DIG TOX IS FALSE? A. DIG IS PRIMARILY METAZOLIZED BY THE LIVER TO INACTIVE COMPOUNDS B. MDAC HAS SHOWN TO BIND DIGITALIS GLYCOSIDES QUITE EFFECTIVELY AND MAY BE ADMINISTERED AFTER GASTRIC DECONTAMINATION IS COMPLETED C. HYPOKALEMIA LOWERS THE THRESHOLD FOR DIGITALIS INDUCED CARDIAC ARRHYTHMIAS D. FAB FRAGMENTS OFFER AN EFFECTIVE AND RAPID METHOD FOR REVERSING DIGITALIS INDUCED CARDAIC ARRHYTHMIAS E. EKG MAY EXHIBIT ALMOST EVERY KNOWN CARDIAC DYSTHYTHMIA

A. DIG IS PRIMARILY METAZOLIZED BY THE LIVER TO INACTIVE COMPOUNDS

``` ALL OF THE FOLLOWING EFFECTS MAY BE OBS IN A TCA OD EXCEPT: TACHYCARDIA URINARY RETENTION MIOSIS DELAYED GASTRIC EMPTYING HTON ```

MIOSIS

SYM OF DIGITALIS TOX MOST COMMONLY INCLUDE ALL EXCEPT: HYPOGLYCEMIA BRADYCARDIA N/V/AB PAIN COLOR DISTURBANCES CARDIAC CONDUCTION DISTURBANCES LEADING TO HEART BLOCK

HYPOGLYCEMIA

``` S/SX OF TOXIC THYROID INGESTIONS INCLUDE ALL EXCEPT: TACHYCARDIA SWEATING AGITATION HEADACHE ALL ARE TRUE ```

ALL ARE TRUE

ALL OF THE FOLLOWING ARE TRUE REGARDING ACUTE BARBITUATE INGESTIONS EXCEPT: - RESP DEP IS MAJOR TOXIC EVENT AND IS USUAL CAUSE OF EARLY DEATH - MDAC IS EFFECT IN DECREASING THE HALF LIFE OF PHENOBARBITAL - PRIMADONE OD IS TXED DIFFERENTLY FROM PHENOBARBITAL OD - HTON RESULTS FROM DEPRESSION OF CENTRAL SYMPATHETIC TONE - ALKALINAZATION OF URINE INCREASES URINARY EXCRETION OF PHENOBARBITAL

PRIMADONE OD IS TXED DIFFERENTLY FROM PHENOBARBITAL OD All of these answers are true

``` WHAT IS NOT TYPICALLY ASSOCIATED WITH THEOPHYLLINE TOX? HEPATOTOXICITY N/V/D TACHYARRHYTHMIAS SEIZ HYPOKALEMIA AND HYPERGLYCEMIA ```

HEPATOTOXICITY

ALL OF THE FOLLOWING ARE TRUE ABOUT THEOPHYLLINE TOX ARE TRUE EXCEPT: -ITS PROPENSITY TO CAUSE TOXICITY IS GREAT SINCE IT HAS A LOW THERAPEUTIC INDEX - TACHYCARDIA, HTON AND SEIZ ARE HALLMARK OF SEVERE TOX - CHILDREN 1-9 USUALLY CLEAR THEOPHYLLINE FASTER THAN ADULTS - TOX CAN BE DOSE RELATED BUT IT IS NOT NECESSARILY PROPORTIONAL TO THE SEREM THEOPHYLLINE CONCENTRATION E. FORMATION OF A BEZOR MAY RESULT IN DECREASED ABSORPTION OF THEOPHYLLINE LEADING TO INCREASED TOX

FORMATION OF A BEZOR MAY RESULT IN DECREASED ABSORPTION OF THEOPHYLLINE LEADING TO INCREASED TOX

TX OF THEOPHYLLINE OD INCLUDE ALL OF THE FOLLOWING EXCEPT: A. MDAC UNTIL SERUM CONCENTRATIONS ARE WITHIN THERAPEUTIC RANGE B. DIAZEPAM OR PHENYTOIN FOR SEIZ C. GASTRIC EMPTYING WITH GASTRIC LAVAGE IN AN OBTUNDED PATIENT D . IMIPRAMINE FOR SEVERE DIARRHEA E. HTON AND BRADY ARE BEST TREATED WITH BETA ADRENERGIC AGENTS

FAB FRAGMENTS SHOULD BE USED: A. IN ALL DIGOXIN OD B. IN DIGITOXIN OD ONLY C. IN CASES OF LIFE THREATENING DYSRHYTHMIAS OR HYPERKALEMIA (>5) D. WHEN SEREM DIG CONCENTRATION EXCEEDS 3 TIMES THE NORM THERAPEUTIC RANGE (0.5-2) E. CONCOMITANTLY WITH CONVENTIONAL THERAPIES IN ALL DIG AND DIGITOXIN OD

C. IN CASES OF LIFE THREATENING DYSRHYTHMIAS OR HYPERKALEMIA (>5)

WHICH OF THE FOLLOWING STATEMENTS IS TRUE WITH REGARD TO CALCIUM AND CALCIUM ANTAGONISTS? - PATIENTS INGESTING SUSTAINED RELEASE CALCIUM ANTAGONISTS (IE CALAN SR, CARDIZEM CD) MUST BE CAREFULLY MONITORED BC THE PEAK EFFECTS MAY BE DELAYED AND DURATION PROGLONGED - CALCIUM SALTS (CHLORIDE OR GLUCONATE) ARE CONSIDERED TO BE THE FIRST LINE ANTIDOTES OF CHOICE FOR PATIENTS WITH HTON OR BRADY - BRADYCARDIA AND HTON ARE ASSOCIATED WITH INGESTIONS OF DILTIAZEM AND VERAPAMIL - TACHYCARDIA AND HTON ARE ASSOCIATED WITH NIFEDIPINE - ALL ARE CORRECT

A TOXIC DOSE OF AMPHETAMINE WOULD BE EXPECTED TO PRODUCE WHICH OF THE FOLLOWING SYM? - TACHYPNEA, TACHYCARDIA, MYDRIASIS - HTN, HYPOTHERMIA, URINARY RETENTION - HYPERACTIVITY, DIAPHORESIS, SEIZ - MUSCLE RIGIDITY, RHABDOMYOYSIS, PULM EDEM - MYOCARDIAL ISCHEMIA, VASOSPASM, INTRACEREBRAL BLEED

A & C, but C is more concerning

WHICH OF THESE IS FALSE REGARDING COCAINE? - SEZI ARE LIKELY - HTN MAY DEV - MYOCARDIAL INFARCTION OCCURS FROM CORONARY VASOCONSTRICTION - PHYSOSTIGMINE IS CONTRADICTED IN COCAINE INDUCED ARRHYTHMIAS - COCAINE IS HYDROLYZED BY GASTRIC ENZYMES AND THUS DOES NOT CAUSE TOX IF INGESTED

WHAT LYTE DOES DIGIBIND DECREASE?

K (HYPOKALMEIA AS IT MOVES INTO CELL OUT OF BLOOD)

WHAT MEDS CONTRADICTED WITH TCAS? WHY

PHYSOSTIGMINE (ASYSTOLE) AND PHENYTOIN (WORENS CARDIO TOX)

WHAT SMELLS LIKE ROTTEN FISH?

ZINC PHOSPHIDE

WHICH OF THE FOLLOWING STATEMENTS ABOUT ALCOHOLS IS FALSE? - DUE TO THEIR LARGE VD AND SMALL MOLECULAR WEIGHT ALCOHOLS CAN BE EFFECTIVELY DIALYZED - ALCOHOLS ARE EXTENSIVELY METABOLIZED AND METABOLITES ARE EXCRETED MAINLY IN THE URINE - ELEVATED ETHANOL LEVELS WILL INCREASE SERUM OSMOL - ELEVATED AG AND MA ARE HALLMARKS OF EG AND METHANOL POISONING - LEVELS REPORTED IN MG/DL OR MG%

- DUE TO THEIR LARGE VD AND SMALL MOLECULAR WEIGHT ALCOHOLS CAN BE EFFECTIVELY DIALYZED

WHICH OF THE FOLLOWING IS TRUE ABOUT ISOP EOTH? - RELATIVE TO ETOH, HAS ABOUT 1/2 POTENCY AS A CNS DEPRESSANT - METABOLIZED TO ACETONTRITRILE - ALL RUBBING ALCOHOLS CONTAIN ONLY ISOP ETOH - ISO ETOH IS EXTREMELY IRRITATING TO GI TRACT - A SEREM CONCENTRATION OF 50MG/DL IS USUALLY LETHAL

- ISO ETOH IS EXTREMELY IRRITATING TO GI TRACT

DUDE HAS HA, N/V, TACHYCARDIA, HTN AFTER DRINKING. WHAT MED IS HE TAKING?

MAOI + TYRAMINE

WHICH IS FALSE ABOUT METHANOL? - AS LITTLE AS 10ML OF 5% METHANOL MAY CAUSE MORBIDITY IN ADULTS - OCULAR TOX WILL NOT USUALLY OCCUR BEFORE 10 HOURS POST EXPOSURE - CNS DEP IS NOT A COMMON FINDING - SIGNIFICANT METHANOL ABSORPTION CAN OCCUR VIA THE SKIN AND LUNGS - FORMIC ACID IS THE MAJOR TOXIC METABOLITE

- AS LITTLE AS 10ML OF 5% METHANOL MAY CAUSE MORBIDITY IN ADULTS

WHICH ANTICONVULSANT CAUSES HYPERAMMONIA?

VPA

WHICH ANTICONVULSANT IS GIVEN FOR REFRACTORY SEIZ? NOT RESPONDING TO BENZOS

PHENOBARBITAL

WHICH ANTICONVULSANT IS GIVEN FOR MIGRAINES?

TOPIRAMATE (TOPAMAX)

T/F: INGESTING > 100ML OF EG IS LIKELY TO BE FATAL IF UNTREATED

T/F: PROPYLENE GLYCOL IS ESSENTIALLY NON TOXIC WHEN INGESTED

18 MO FOUND WITH RUBBING ETOH AND SMELL OF IT AROUND MOUTH. BROUGH TO ED ASX. PROPER TX?

WHEN DID EXPOSURE OCCUR?

T/F: RETINOL TOX MAY OCCUR WHEN BLOOD METHANOL CONCENTRATIONS EXCEED 100 MG/DL

ALL ARE TRUE ABOUT ETOH TOX EXCEPT: - RESP DEP IS MOST SERIOUS SEQUELAE - LETHAL CONCENTRATION IN CHILDREN IS HIGHER THAN IN ADULTS BC KIDS HAVE A MORE ACTIVE METABOLIZING ENZYME SYSTEM - GASTRITIS IS LIKELY DUE TO INCREASE SECRETIN AND HISTAMINE RELEASE - ETOH MAY BE USED AS ANTIDOTE - SEIZ AND RENAL INSUFFICIENCY MAY DEV AS A RESULT OF RHABDO

- LETHAL CONCENTRATION IN CHILDREN IS HIGHER THAN IN ADULTS BC KIDS HAVE A MORE ACTIVE METABOLIZING ENZYME SYSTEM

MOST MUSCLE RELAXERS CAUSE ANTICHOL SX. BUT THIS ONE CAUSES HTON AND BRADY.

TIZANDINE (ZANAFLEX)

WHICH TWO MUSCLE RELAXERS CAUSE ANTICHOL EFFECTS?

CYCLOBENZPRINE AND CARISOPRODOL

TX OF SYMPTOMATIC ORGANOPHOSPHATE POISONINGS INCLUDES ALL EXCEPT: A. FOR MOD TO SEVERE EXPOSURES, ATROPINE AT DOSE 1-2MG IV SHOULD BE GIVEN AS NEEDED, USUALLY EVERY HOUR UP TO 25-150MG/DAY OR MORE B. CONTAMINATED CLOTHING AND CONTACT LESES SHOULD BE REMOVED QUICKLY TO PREVENT FURTHER ABSORPTION C. SKIN SHOULD BE WASHED WITH SOAP AS THIS HELPS REMOVE TOXIN D. 2PAM IS SPECIFIC ANTIDOTE TO REVERSE SYM CAUSED BY NICOTINIC RECEPTOR STIMULATION E. ALL ARE TRUE

HOW TO CALC METHYL ASA?

- % AND MOVE 1 PLACE TO RIGHT (0.06% BECOMES 0.6 MG/ML - (X MG/ML)(ML'S INGESTED)(CONVERSION FACTOR)/KG - CONVERSION FACTOR IS 1.4

HOW TO CALC ANION GAP? WHAT IS NORM?

AG = NA - (CL + BICARB); 8-16

HOW TO CALC OG? WHAT IS NORM?

CALC OS = 2NA + (BUN/2.8) + (GLUCOSE/18) + (ETOH/4.6) OG = SEREM OS - CALC OS NORM = =14-10

HOW TO CALC FLUORIDE?

(CONCENTRATION IN %) (OZ INGESTED) (CONSTANT)/KG

FLUORIDE CONSTANT?

218

SODIUM FLUORIDE CONSTANT?

128

SODIUM MONOFLUORPHOSPHATE CONSTANT?

STANNOUS FLUORIDE CONSTANT?