Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Mike > Section 4: Biologicals > Flashcards

Section 4: Biologicals Flashcards

1
Q

4.1 Plants

A

4.1 Given an exposure, identify which plant is responsible. Identify the toxicity and symptoms of plant exposure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  1. Anticholinergic
A

a. Examples: Nightshade, mandrake, henbane, jimson weed, moonflowers (angel’s trumpet)
i. Atropa belladonna (deadly nightshade) s/s consistent with atropine/anticholinergic ingestion.
ii. Solanum nigrum (black nightshade) symptoms are anticholinergic; plant also contains solanine. May see hallucinations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
  1. Cardiac glycosides
A

a. Examples: Oleander, foxglove, lily of the valley, red squill, rhododendron, toad venom, dogbane
b. Concern for: hyperkalemia, bradycardia, heart blocks. May see initial GI symptoms. Systemic toxicity may be delayed several hours while toxins are distributed to body tissues.

c. Obtain digoxin level (levels will not necessarily correspond to toxicity)
* start with 10 vials of digifab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q
  1. Cicutoxin
A

a. Example: Cicuta maculata (water hemlock)

b. High concern for seizures and cholinergic symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
  1. Conine
A

a. Example: Conium maculatum (poison hemlock)
b. Expect clinical course similar to nicotine. Initial stimulation (GI upset) followed by CNS depression and ascending muscle/respiratory paralysis. May see seizures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
  1. Cyanogenic glycosides
A

a. Examples: Bitter almonds, fruit pits, cassava, bahia, hydrangea, English laurel, pampas grass.

b. Concern for: SOB, cyanosis, weakness, sz, coma, CV collapse.
- - Of note, s/s may be delayed 3-4 + hrs as glycoside is hydrolyzed to cyanide in the gut.

c. Obtain cyanide level, lactic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
  1. Dermatitis
A

a. Examples: Daisy, dogwood, elm, fleabane, geranium, ginko

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
  1. Gastrointestinal irritants
A

a. Examples: Amaryllis, eucalyptus, holly, mistletoe, yarrow, pokeberry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
  1. Hallucinogenic
A

a. Examples: Cannabis, marijuana, nutmeg, salvia
i. Of note: Morning glory seed ingestion produces symptoms similar to LSD. Symptoms vary from diarrhea to hallucinations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
  1. Oxalate
A

a. Soluble oxylates produce hypocalcemia, renal injury, end organ damage, mild gastroenteritis
- Examples: Rhubarb leaves, starfruit, shamrock (sorrel)

b. Insoluble oxylates produce burning and swelling of mucous membranes
- Examples: Diffenbachia, Calla lily, arrowhead, dumbcane, peace lily, philodendron, pothos, umbrella plant, elephant’s ear, Chinese evergreen, schefflera, arum lily, skunk cabbage, flamingo plant, jack-in-the pulpit, philodendron, ivy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  1. Solanine
A

a. Examples: Nightshade, Green parts of: eggplant, potato, tomato
b. Concern for: Salivation, gastroenteritis, coma, hypotension, bradycardia, paresthesias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  1. Stimulants
A

a. Examples: Ephedra, khat, guarana, blackbrush, tobacco, cassine, coffee, tea, mate, cocoa, kola

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  1. Toxalbumins
A

Inhibits Protein Synthesis

Examples:
False acacia (Robinia pseudoacacia)
Black locust (Bark, foliage, seeds contain phasin, robin, and robitin [Toxalbumins] -flowers are not poisonous), Castor bean (ricin)
Abrus precatorius (rosary pea, jequirity bean, prayer bean)
Indian licorice seed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

4.2 Mushrooms

A

4.2 Given an exposure, identify which mushroom class is responsible.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  1. Coprine (mushrooms)

Ex: inky cap mushrooms (Coprinus atramentaria)

A

a. May see an Antabuse-like reaction up to 5d post-ingestion
* When ethanol is ingested within a few hours of ingesting these mushrooms, nausea, vomiting, metallic taste, paresthesias, weakness, vertigo, confusion, and tachycardia may develop; occasionally the effects have been noted as long as 5 days after a mushroom meal, suggesting a dose-related effect. It is not otherwise toxic.

b. Treatment
i. Beta blocker (propranolol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
  1. Cyclopeptide (Amanitins)

mushrooms

A

a. Watch for delayed GI upset: abd pain, N/V/D (6-24 hrs s/p ingestion)
b. This is followed by a latent period (LFT elevation, renal damage)
c. Lastly will see return of initial GI s/s

d. Treatment
i. Supportive care
ii. Consider charcoal
iii. D-penacillamine and silibinin (milk thistle)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q
  1. Gastrointestinal irritants (mushrooms)
A

a. Watch for GI s/s (0-2 hrs post ingestion)

b. Treatment
i. hydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q
  1. Ibotenic Acid/Mucimol (mushrooms)
A

a. Ibotinic acid is hallucinogeic/mucimol causes CNS depression
b. Watch for hallucinations on awakening from sedation

c. Treatment
i. Physostigmine for severe anticholinergic effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q
  1. Monomethylhydrazine (Gyromitra mushrooms)
A

a. Neuro symptoms, GI symptoms, SEIZURES (2-12 hrs)
b. Inhalation of vapors can cause s/s
c. Liver and kidney injury, methemoglobinemia

d. Treatment
i. Pyridoxine for seizures
ii. Methylene Blue for methemoglobinemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q
  1. Muscarine (mushrooms)
A

a. Expect cholinergic SLUDGE s/s

b. Treatment
i. Atropine

21
Q
  1. Psilocybin (mushrooms)
A

a. Is hallucinogenic, watch for fever, seizures, other CNS s/s

b. Treatment
i. Benzos and cooling

22
Q
  1. Orellanine (mushrooms)
A

a. Causes delayed renal failure (36 h – 14 days)

b. Treatment
i. Dialysis, kidney transplant

23
Q

4.3 Food-Borne Illness

A

4.3 Given an exposure, identify which food-borne illness is responsible. Identify the toxicity and
symptoms of food poisoning.

24
Q
  1. Bacterial
A

a. Shigella & Ecoli 0157:H7 causes hemorrhagic colitis and hemolytic-uremic syndrome, renal failure, and death in children and immunocompromised adults
b. Listeriosis causes sepsis and meningitis. Severe fetal sequela.
c. Campylobacter can sometimes be followed by Guillain-Barre or reactive arthritis
d. Salmonella causes GI s/s, fever, bloody diarrhea

25
Q
  1. Botulism
A

a. Anaerobic, spore-forming, gram-positive bacillus, Clostridium botulinum

i. Blocks ACh release and causes muscle paralysis
ii. Anticholinergic toxidrome findings also d/t muscarinic receptor blockade
iii. Inactivated by heat for 5 min at 85 degrees C

26
Q

b. Botulism Types

A

i. Infant
1. Frequently ingested via honey or dust-containing spores

ii. Food borne
1. Under-processed canned food, poorly-preserved meat, some fresh
foods

iii. Wound
iv. Adult intestinal
v. Inhalational

vi. Parenteral/injection

27
Q

c. Botulism S/S

A

i. S/s onset may occur 2 hrs after ingestion, but have been delayed for up to 8 days

ii. does not cross blood-brain barrier and only affects PNS
iii. mental status normal unless affected by another cause (hypoxia)

  1. Cranial nerve dysfunction (dysphagia, diplopia, dysarthria)
  2. Ptosis, gaze paralysis, facial palsy
  3. Dry mouth, mydriasis, constipation
  4. Descending paralysis upper limbs then lower limbs
  5. Severe case affects diaphragm
  6. Food borne botulism also includes n/v/constipation/diarrhea preceding
    neuro s/s
28
Q

d. Botulism Tx

A

i. Supportive care

ii. Botulinum antitoxin available from CDC and army
1. Horse derived

iii. Infant botulism treated with baby-BIG
1. Human derived immune globulin

29
Q

e. Botulism Labs

A

i. Diagnosis not immediate. Must send out labs (to CDC or HD) for serum, stool or wound drainage

30
Q
  1. Ciguatera
A

a. Neurotoxin from predatory reef seafood (warm water).

i. It is the most common fish toxin.
ii. Dinoflagulates (red tide) are eaten by small fish and move up the food chain
with toxin accumulation .
iii. Found in red snapper, grouper, barracuda, amberjack, moray eel, parrot fish, tiger fish, and farmed salmon
iv. Note fish in US are often mislabeled
v. Toxin is not killed by any form of cooking or preserving

31
Q

b. Ciguatera S/S

A

i. s/s may occur within minutes to 24 hrs after ingestion
ii. s/s can last years and can recur with ingestion of ethanol

iii. Toxin binds to and holds sodium channels open
1. Mimics MS
2. Severe GI distress (N/V/D)
3. Headache, dizziness, ataxia, myalgias, itching, paresthesias, vertigo, reverse temperature sensation, “loose teeth” feeling
4. Hypotension, bradycardia

32
Q

c. Ciguatera Treatment

A

i. Supportive care
ii. Atropine for symptomatic bradycardia
iii. Antihistamines for pruritus
iv. Mannitol for acute neuro s/s
v. Amitriptyline and gabapentin for neuro s/s

33
Q
  1. Scombroid
A

a. Histamine poisoning from consumption of poorly preserved or refrigerated dark or red-muscled fish

i. Ex tuna, mackerel, mahi-mahi, herring, sardine, anchovies
ii. 2nd most common fish poisoning
iii. Cooking and freezing do not neutralize toxins

34
Q

b. Scombroid S/S

A

i. occur within minutes of ingestion (5-90 min)
ii. Flushing of face/neck
iii. Sensation of warmth; no fever
iv. Metallic/peppery taste in mouth
v. Burning of mouth/throat
vi. N/V/D/abd pain
vii. Bronchospasm/hypotension possible

35
Q

c. Scombroid Treatment

A

i. Antihistamines (Benadryl and Cimetidine / H1 and 2)
ii. Bronchodilators (albuterol) for spasm
iii. IVF, airway control and epi for severe cases with hypotension and resp distress

36
Q
  1. Tetrodotoxin (TTX)
A

a. Sodium channel blockade from puffer fish intestines, liver, and ovaries (fugo sushi); also from globe fish, balloon fish, blow fish, toad fish, newts, salamanders, and blue ringed octopus

i. 10,000x more potent than cyanide. No antidote
ii. Binds voltage-gated Na channels; inhibits Na influx creating poor nerve and muscle function

37
Q

b. Tetrodotoxin S/S

A

i. “Zombie” potion
ii. Na channel blocker
iii. Paresthesias begin within an hour post ingestion
iv. Fixed dilated pupils, headache, diaphoresis, salivation, drooling, dysarthria, mouth paralysis, facial numbness
v. ascending paralysis (onset 4-12 hrs), resp depression, cardiac collapse

38
Q

c. Tetrodotoxin Treatment

A

i. Supportive care

  1. Activated charcoal and lavage with alkaline solution may be considered early post-ingestion
  2. IVF, vasopressors, ventilation, pacing for heart block
  3. Neostigmine has been used anecdotally
39
Q

4.4 Arthropods

A

4.4 Identify the toxicity and symptoms of a bite or sting from an insect or arthropod species indigenous to North America.

40
Q

Hymenoptera Stings (indigenous to North America)

A

i. Ex: honeybees, bumblebees, wasps, hornets, yellow jackets and ants

  1. Honeybees leave stingers in victim and can sting only once
  2. Other bees are able to inflict multiple stings as they retain their stingers
    ii. Labs:
  3. CK, troponin, renal function with severe cases

iii. Treatment
1. Scrape retained stingers out
2. Treat anaphylaxis
3. Topical ice, meat tenderizer, steroids or antihistimines

41
Q

Scorpion stings (indigenous to North America)

A

a. Most US scorpion stings (Western and SW US) cause local pain and inflammation

b. Centruroides scorpion (bark scorpion) is neurotoxic
i. Venom causes stimulation of peripheral Na channels
ii. Tapping on sting site produces severe pain (tap test)
iii. Worst outcomes/systemic toxicity children <10 yrs
iv. Four grades for poisoning. Grades 3 and 4 may use antivenin
v. Ensure identification of scorpion if by handler
1. **Foreign scorpions can be systemically toxic

c. Treatment
i. Generally supportive
ii. Tetanus update
iii. Cool compresses/intermittent ice packs
iv. Discontinued antibody derived antivenins (controversial for Centuroides)

42
Q

Spider bites (indigenous to North America)

A

a. Brown Recluse (Loxesceles reclusa)
b. Black Widow (Latrodectus)
c. Tarantula

43
Q

a. Brown Recluse (Loxesceles reclusa)

A

i. Habitat: Native to southern US, may extend up into IL and IA
1. Live in dry, secluded, warm areas (woodpiles, basements and attics)

ii. ID: They are brown to gray in color; medium size; brown violin-shaped marking
on dorsal side

iii. Bite
1. Initial bite may or may not be painful; followed by central blanching and
surrounding erythema (bulls eye)
2. Vesicle or bulla (1-12 hr) with bulls eye develops in central area
followed by progressive ulceration and necrosis (necrotic ulceration 24-
72 hrs)
3. Bites tend to be more severe over areas of adipose tissue
4. Venom has poorly defined systemic effects
a. n/v/fever weakness, rhabdo, ? DIC

iv. Labs
1. CBC, BUN, Cr
2. Urine dipstick for occult blood

v. Treatment
1. Symptomatic
2. Wound care
3. T=Tetanus

44
Q

b. Black Widow (Latrodectus)

A

i. Habitat: Ubiquitous in the continental US
1. Prefer dark places: garages, wood piles, outdoor toilets, patio furniture

ii. ID: Shiny black with red/orange hourglass to ventral abdomen; there is also a
brown widow spider to west coast region

iii. Bite
1. Initially painful but may go unnoticed; becomes very painful within 30-
120 minutes
2. May have bulls eye erythema around bite site
3. Common s/s: regional diaphoresis, n/v, tachycardia/HTN, restlessness
4. Painful cramping and muscle fasciculations progressing toward core
may create board-like rigidity
5. May see weakness, dyspnea, headache, and paresthesias
6. Sympathomimetic toxidrome (Ca uptake into presynaptic neurons
causes ACh, dopamine & norepi release into synapses)
7. Envenomation can mimic MI, dissection, acute abdomen

iv. Labs
1. CMP, Ca, Glucose, CK, ECG/trop as needed for chest pain

v. Treatment
1. Symptomatic
2. Tetanus
3. Monitor 6-8 hrs
a. Treat with pain meds (opioids and benzos)
b. Antivenin (horse derived). New antivenin pending.

45
Q

c. Tarantula

A

i. Painful bite and urticating hairs

46
Q

Snake (Indigenous to North America)

A

4.5 Identify the toxicity and symptoms of a bite from a snake indigenous to North America. Given a
bite from a snake indigenous to North America, determine the appropriate treatment.

47
Q
  1. Elapidae
A

a. Ex: Coral snakes [exotic snakes such as cobras, mambas, kraits in same classification]
i. Neurotoxic venom
ii. Bite with a chewing motion (small teeth)

b. ID
i. Red-on-yellow stripes (applies only to US Coral snakes)
ii. Round black head
iii. Round eyes

c. S/S
i. Minimal edema/pain at site
ii. General malaise, weakness, paresthesias, slurred speech, diplopia, dysphagia, stridor, resp arrest, total body paralysis (3-5d).

d. Treatment
i. Supportive care
ii. Pressure dressing for transport
iii. Maintain airway
iv. Any legitimate bite receives antivenin
v. Monitor 12-24 hrs

48
Q
  1. Viperidae
A

a. Ex: Rattlesnakes, copperheads and cottonmouths
i. Pit vipers (crotalinae) and vipers without pits (viperinae).
ii. Hemotoxic venom (exception baby rattlesnakes and Mojave rattlesnakes are predominately neurotoxic)
iii. Puncture with fangs

b. ID
i. Triangular head
ii. Elliptical pupils
iii. Paired hollow fangs
iv. Pits between eye and nostril
v. Single row of subcaudal scales
vi. Copperheads have red-brown heads with hourglass pattern to body
vii. Cottonmouths have white buccal mucosa

c. S/S
i. Localized edema and ecchymosis (begins 15-30 min after bite); tissue necrosis; coagulopathy; hemorrhagic blistering

ii. Systemic toxicity
Metallic taste in mouth, generalized weakness, confusion, edema, abd
pain, n/v, dyspnea, tachycardia, hypotension

iii. Rattlesnake bites (NEUROTOXIC/hemotoxic)
Paresthesias, fasciculations, cranial nerve palsy, respiratory arrest
*Mojave rattlesnake require special observation. Often have delayed and significant neurotoxic effects (monitor 12-24 hrs)

d. Labs
i. Watch for thrombocytopenia and elevated INR

e. Treatment
i. Immobilization
ii. Supportive care
iii. Hourly limb measurements
iv. No fasciotomy
v. CroFab 4-6 vials (monitor for allergic rx)
vi. FFP/Platelets for significant bleeding
vii. Wound care
viii. Observation minimum 4 hrs for dry bite

49
Q

4.6 General review of marine envenomations:

A
  1. Use heat on most stings
  2. For most jellyfish stings use vinegar or salt water
  3. Remove foreign bodies
  4. Clean wounds/abx
  5. Tetanus prophylaxis
  6. Supportive care

Mike (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions