Brainscape's Knowledge GenomeTM

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


See full index

FRCEM SBA > Toxiciology > Flashcards

Toxiciology Flashcards

1
Q

How do you calculate anion gap?

A

Na+ - (Cl- + HCO3-)

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

What is a normal anion gap?

A

4-12

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

What are the causes of normal anion gap acidosis?

A

A - ddisons
B -icarbonate loss (GI/renal)
C -hloride excess
D - iuretics (acetezolamide)

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

When should activate charcoal be given within?

A

1 hour

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

What does not bind to activated charcoal? (10)

A
  1. Iron
  2. Lithium
  3. Borid acid
  4. Cyanide
  5. Ethanol
  6. Ethylene glycol
  7. Methanol
  8. Organophosphates
  9. Petroleum distillates
  10. Strong acids and alkalis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the adult dose of activate charcoal?

A

50g

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

What are the features of salicylate poisoning? (6)

A
  1. Increased RR
  2. Tinnitus
  3. Deafness
  4. Sweating
  5. Vasodilation
  6. Acid base disturbance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What metabolic disturbance do adults presenting with salicylate poisoning predominates?

A

Reps alkalosis > metabolic acidoses

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

What metabolic disturbance do children presenting with salicylate poisoning predominates?

A

Metabolic acidosis > resp alkalosis

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

When should salicylate levels be taken? (2)

A
  1. At least 2 hours if symptomatic
  2. At least 4 hours if asymptomatic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is mild salicylate poisoning and how should it be managed?

A
  1. < 300mg/L
  2. Asymp and normal VBG then home at 6 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is moderate salicylate poisoning and how should it be managed?

A
  1. 300-700mg/L
  2. Urinary alkalization - PH 7.5-8.5 using sodium bicarbonate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is severe salicylate poisoning?

A

1, CNS features, acidosis or > 700mg/L
2. Consider HD and I+V

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

What is the pathophysiology of paracetamol poisoning?

A

Metabolite of paracetamol (NAPQI) binds glutathione in the liver and causes hepatic necrosis when glutathione stores are depleted.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the features of TCA OD in conscious patients? (7)

A

Anti-cholinergic toxidrome

  1. Tachycardia
  2. Dry skin
  3. Dry mouth
  4. Dilated pupils
  5. Urinary retention
  6. Ataxia
  7. Jerky limb movements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What signs to unconscious patients developed following TCA OD? (7)

A
  1. Divergent squint
  2. Hypertonia
  3. Hyper-reflexia
  4. Myoclonus
  5. Upgoing plantars

If comatose - areflexia and muscle facciditiy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What ECG changes will be seen in TCA OD and which is the most sensitive?

A
  1. Increased QRS (most sensitive)
  2. Increased PR
  3. Tachy
  4. P waves can be lost in T - looks like VT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the tx for TCA overdose?

A
  1. If under 1 hour activated charcoal
  2. 50-100ml 8.4% bicarbonate
  3. Aim PH 7.5-7.55 (excessive is fatal) and normal QRS
  4. Avoid routine use anti-arrhythmics
  5. Severe consider glucagon or intralipid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the antidote to benzo OD?

A

Flumazenil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How long does flumezanil last?

A

1 hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the risks of using flumazenil and when is it particularly high risk?

A

Can lead to convulsions and arrhythmias

With concurrent TCA OD - can lead to arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What signs/symptoms feature in haloperidol + chlorpromazine (and related drugs)?

A

Oculogyric crisis
Muscle spasms - torticollis/opisthonus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What ECG changes will you see in haloeridol/chlorpromazine/similar drugs in OD? (2)

A
  1. Increased QRS
  2. Arrhythmias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the treatment for haloperiol/chlorpromazine OD? (3)

A
  1. Proycylidine
  2. Diazepam
  3. Bicarbonate if QRS >120ms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the features of lithium toxicity? (6)

A
  1. n/v
  2. diarrhoea
  3. ataxia
  4. confusion
  5. increased tone
  6. clonus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the treatment for lithium toxicity?

A

Supportive
Dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the effects of sulfanylurea overdose?

A
  1. Low glucose
  2. Low potassium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the treatment for sulfanylurea overdose?

A

Octreotide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the features of unique to propanolol OD? (2)

A
  1. Bronchospasm in asthmatics
  2. Hypoglycaemia in children
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What does sotalol OD cause in particular?

A

Torsades des pointes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the treatments of beta blocker OD?

A
  1. Consider activated charcoal
  2. Atropine may work (pacing probably not)
  3. Glucagon 5-10mg IV (anticipate vomiting)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

In severe beta-blocker OD with low BP what are 3 treatment options?

A
  1. High dose Insulin Euglycaemic Therapy (HIET)
  2. Intralipid
  3. Ionotropes/vasopressors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the features of CCB OD? (6)

A
  1. Bradycardia
  2. AV block
  3. Profound vasolidation
  4. Metabolic acidosis
  5. Hyperkalaemia
  6. Hyperglycaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the treatment for CCB OD? (3)

A
  1. Consider activated charcoal
  2. Atropine +/- pacing
  3. Calcium chloride 10% over 10 mins and consider repeating up to x 4
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the treatment options for severe CCB OD? (3)

A
  1. Glucagon
  2. Intralipid
  3. HIET
  4. Vasopressors/ionotropes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the features of digoxin toxicity? (4)

A
  1. Xanthopisa- yellow flashes/discolouration
  2. Hyperkalaemia
  3. Brady, increased PR/QRS
  4. Arrhythmias
37
Q

When should digoxin levels be taken?

A

6 hours - poor correlation to clinical features

38
Q

What is the treatment for digoxin toxicity? (3)

A
  1. Digiblind/Digifab
  2. Insulin/dex for increased K+ (rapid decrease with Digibind)
  3. Atropine/pacing
39
Q

What are the mild features of iron poisoning? (4)

A
  1. N/v
  2. Diarrhoea
  3. Hyperglycaemia
  4. GI bleed
40
Q

What are the severe features of iron poisoning? (4)

A
  1. Haemetemesis
  2. Metabolic acidosis
  3. Coma
  4. Seizures
41
Q

What is the clinical course of iron poisoning? (7)

A

Initial d/v / abdopain/ GI bleed

Symptoms settle 6-12 hours but then at 24-48hours can present with:
- shock
- hypoglycaemia
- jaundice
- metabolic acidosis
- hepatic failure
- renal failure
- bowel infarction

42
Q

What is not indicated in Fe poisoining?

A

Activated charcoal

43
Q

What investigations maybe useful in Fe poisoning?

A
  1. XR as tablets radio-opaque
    Can consider bowel irrigation
44
Q

What is the treatment for iron poisoning?

A

Desferrioxamine

45
Q

What can desferrioxamine cause?

A

Anapx
hypotension
ARDS

46
Q

If giving desferrioxamine before Fe level back what confirms it was appropriate?

A

Iron-desferrioxamine complex causes orange/red urine

47
Q

What are the biochemical changes in acute methanol poisoning? (3)

A
  1. Acidosis
  2. Hypergylcaemia
  3. Raised amylase
48
Q

What are survivors of methanol poisoning at risk of? (2)

A
  1. Blindness
  2. Parkinsonian features
49
Q

What is the treatment for methanol poisoning? (4)

A

Ethanol
Fomepizole
Folinic acid
Bicarbonate if acidotic

50
Q

What are the early (<12 hours) features of ethylene glycol poisoning?

A

Appear drunk, no smell alcohol

51
Q

What are the late features of ethylene glycol poisoning? (6)

A
  1. CCF
  2. Acidosis
  3. Tachy/arrhythmias
  4. Hypocalcaemia (can be profound)
  5. Acute tubular necrosis
  6. CN palsies`
52
Q

What are the treatment options for ethylene glycol poisoning? (5)

A
  1. Fomepizole
  2. Ethanol
  3. Sodium bicarbonate for acidosis
  4. Calcium chloride only if seizures or QTc >500 as can lead to calcium oxolate stones
  5. HD + I+V
53
Q

What can occur in petrol ingestion?

A

Can be fine but aspiration lead to severe pneumonitis requiring steroids + resp support

54
Q

What is the pathophysiology of organophosphate poisoning?

A

Inhibit cholinesterases which leads to build up of acetylcholine at nerve endings

55
Q

What are the features of organophosphate poisoning? (8)

A

S- alivation
L - acrimation
U - rination
D - efecation
G - I upset
E - mesis
M - iosis
M - muscle twitching

Bradycardia, paralysis and resp failure

56
Q

What is the treatment for organophosphate poisoning and what is its mechanism

A

Atropine - blocks affect of acetylcholine at muscarinic receptors
Eases smooth muscle constriction and dries up secretions

57
Q

What is the atropine dose in organophosphate poisoning?

A

2mg IV adult
0.02mg/kg children
Every 5 mins double dose until atropinisation

58
Q

What is the mechanism of pralidoxime?

A

Reactivate acetylcholinesterase inhibited by organophosphates allowing metabolisation of acetylcholine.

59
Q

What can lead to cyanide poisoning? (3)

A
  1. Polyurethane burning
  2. Fruit kernels
  3. Finger polish remover
60
Q

What are the features of cyanide poisoning? (4)

A
  1. Metabolic acidosis
  2. Seizures
  3. Pulmonary oedema
  4. Arrhythmias
61
Q

What is the initial management of cyanide poisoning? (2)

A
  1. Remove clothes
  2. Wash exposed skinW
62
Q

What is the antidote for severe cyanide poisoning and what is the risk of giving it?

A
  1. Dicobalt edetate - Kelocyanor
  2. If no cyanide can be fatal
63
Q

What are the treatments for mild cyanide poisoning? (2)

A
  1. Sodium thiosulphate
  2. Sodium nitrate
64
Q

What is the best treatment for inhaled cyanide poisoning?

A

5g hyroxycobalamin IV (Cyanokit)

65
Q

What is the max dose of lidocaine?

A

3mg/kg
max 200mg

66
Q

What is the maximum dose of lidocaine with adrenaline?

A

7mg/kg
max 500mg

67
Q

What is the maximum dose of bupivicaine?

A

2mg/kg
150mg

68
Q

What is the management of LA toxicity including dose?

A

Intralipid

1.1.5mg/kg bolus and 15mg/kg/hr infusion
5 mins no response:
2. 2nd bolus and increase infusion to 30mg/kg/hr
3.Continue to 3rd and 4th bolus which is maximum

In arrest may need 1 hour for intralipid to take effect

69
Q

How are hydrofluric burns managed? (4)

A
  1. Irrigate normal saline ++
  2. Calcium gluconate gel
  3. Tx low Ca2+
  4. In arrest - 60ml x 10% calcium chloride
70
Q

What drugs can cause methaemoglobinaemia?(7)

A

benzene derivatives
chloroquine
dapsone
prilocaine
metoclopramide
nitrites (nitroglycerin, NO, sodium nitroprusside)
sulphonamides

71
Q

What are the features of methaemoglobinaemia?

A

1.cyanosis
2. symptoms and signs of decreased oxygen delivery e.g. chest pain, dyspnea, altered metal state, end organ damage
3. SpO2 reading 85-90%
4. blood samples typically have a chocolate brown hue
5. Normal PaO2

72
Q

What is the treatment for methaemoglobinaemia?

A

Methylene blue

73
Q

What is are the signs/symptoms of Scromboid?

A
  1. Tachy
    2.Headache
  2. N/v
  3. ‘Peppery’ taste in mouth
  4. Diarrhoea
  5. Rash and wheeze sometimes
74
Q

What is the mechanism of Schombroid poisoning?

A

Histamine

75
Q

How is Schombroid treated?

A

Anti-histamines
Adrenaline if severe

76
Q

What is the triad of symptoms in serotonin syndrome?

A
  1. Change in mental staus
  2. Autonomic hyperactivity
  3. Neuromuscular manifestations
77
Q

What are the 3 major and 5 minor symptoms suggestive of neuroleptic malignant syndrome?

A

Major
1. Fever
2. Rigidity
3. Elevated CK

Minor
1. Tachycardia
2. Abnormal arterial pressure
3. Altered consciousness
4. Diaphoresis
5. Leucocytosis

78
Q

Describe an anticholinergic toxidrome (8)

A
  1. Altered mental status, confusion, restlessness, seizures, coma

Symptoms resulting from peripheral muscarinic receptor blockade:
2. Impaired sweat gland function
3. Dry mouth
4. Dry axillae
5. Mydriasis
6. Tachycardia
7. Flushing
8. Urinary retention

79
Q

In cases of serotonin syndrome where other management options have failed, what is the treatment?

A

Cryoheptadine

80
Q

What are the tx options for NMS? (2)

A
  1. Bromocriptine (first line)
  2. Dantrolene
81
Q

What are the commonly used drugs in ED that might cause methaemaglobinaemia?

A
  1. Metoclopramide
  2. Nitrites (including ‘poppers’ and GTN)
  3. Local anaesthetics
  4. Abx including dapsone
82
Q

What level of methaemagobinaemia should be treated? (2)

A
  1. > 30% methaemaglobin
  2. Any evidence of tissue hypoxia
83
Q

When should serum Iron levels be taken in OD?

A

Immediately and then at 4 hours.

84
Q

What are the Kings Liver Unit Criteria for transplant in paracetamol OD?

A

PH < 7.3 or all 3 of:
1. INR over 6.5
2. Creatinine >300
3. Grade III / IV hepatic encephalopathy

85
Q

If initial management of beta blocker OD with low BP doesn’t success (i.e. glucagon) what does toxbase suggest as second line?

A

HIET

86
Q

How do we calculate osmolar gap?

A

Measured osmolality - calculate osmolality

calculated osmolality (2 x Na+) + gluc + urea

87
Q

What is a high osmolar gap and what does this represent?

A

Above 10

That there is an unmeasured solute

88
Q

What are common causes of a high osmolar gap? (4)

A
  1. mannitol
  2. methanol
  3. ethylene glycol
  4. IV benzos

There are more

FRCEM SBA (12 decks)

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