Rosh 24

Question 1

anticholinergic toxidrome mnemonic

Answer 1

blind as a bat (mydriasis)
red as a beet (vasodilation leading to flushing)
hot as a hare (hyperthermia)
dry as a bone (dry skin and mucosa)
mad as a hatter
bloated as a toad (ileus and urinary retention)
heart runs alone (tachycardia).

Question 2

anticholinergic toxidrome rx

Answer 2

IVF
Charcol
Benzos
NaBicarb if wide QRS

Physostigmine: risk of profound bradycardia, seizures, and even asystole in patients with widened QRS complexes. Therefore, physostigmine should only be used with the assistance of a medical toxicologist.

Question 3

Cholinergic agents toxidrome mnemonic

Answer 3

SLUDGE and the killer B’s 
salivation
lacrimation
urination
diarrhe
diaphoresis
emesis 

bronchorrhea, bradycardia, and bronchospasm

Question 4

What is the endpoint of atropine treatment for cholinergic toxicity?

Answer 4

Resolution of bronchorrhea.

Question 5

digoxin toxicity

Answer 5

blurred vision, bradycardia, hyperkalemia, vision changes (yellow halos)

ECG will show PVCs, PAT with AV block, bidirectional ventricular tachycardia, hyperk peaked t waves

Question 6

If digoxin toxicity is suspected in a patient, ____________ administration is contraindicated due to theoretical risk of cardiac tetany.

Answer 6

calcium

Question 7

What is the indicated treatment for digoxin toxicity with a serum level > 15 ng/mL or serum potassium of >5 mEq/L in a suspected ingestion?

Answer 7

Digoxin immune Fab fragments.

Question 8

What is the dosing of alteplase for massive pulmonary embolism?

Answer 8

100 mg over 2 hours intravenously.

Question 9

Bladder Injury rx

Answer 9

Intraperitoneal - nonemergent surgical repair

Extraperitoneal - nonsurgical

Question 10

Fracture-dislocation of the foot tarsometatarsal joints is commonly called

Answer 10

a Lisfranc injury

Pain is located on the dorsum of the midfoot

Question 11

Tracheo-innominate artery fistula timeframe

Answer 11

usually within the first 3 weeks, with the peak incidence between the first and second week

Question 12

Lithium dialysis

Answer 12

lithium levels > 4 mEq/L (acutely) and > 2.5 mEq/L (chronically)

This level is considered to be an indication for hemodialysis regardless of clinical status

Question 13

What 2 co-factor adjuncts should be given in acute ethylene glycol overdose?

Answer 13

Thiamine and pyridoxine.

Question 14

What antibiotic can be given in toxic shock syndrome that also reduces toxin production?

Answer 14

Clindamycin.

Question 15

The antidote for magnesium sulfate toxicity is ____________

Answer 15

calcium gluconate

Question 16

What is the upper limit of normal for the diameter of the appendix?

Answer 16

6 mm

Question 17

appe on US

Answer 17

Direct signs of acute appendicitis on ultrasound include diameter > 6 mm, wall thickness > 3 mm, target sign, appendicolith, and noncompressible appendix (perforated appendicitis may be compressible)