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EM Licensing Exam > Toxicology > Flashcards

Toxicology Flashcards

1
Q

Venomous snakes in Viperidae family

A

Crotalinae (pit vipers): rattlers, cottonmouths, copperheads & western diamondbacks

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2
Q

Crotalinae characteristics (5)

A
  1. Heat-sensing nostril pit
  2. Triangular-shaped head
  3. Elliptical pupils
  4. Green tail tip
  5. Long, folding fangs
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3
Q

Venomous Elapidae snakes

A

Coral snakes

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4
Q

Elapidae characteristics (2)

A
  1. Red stripes adjacent to yellow

2. Short, fixed fangs

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5
Q

Viperidae bite clinical presentation

A
  • Local reaction (pain, edema, erythema, bullae) —> systemic toxicity (metallic taste, rhabdo, compartment syndrome, coagulopathy)
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6
Q

Elapidae bite clinical presentation

A
  • Minimal local reaction —> marked systemic neurotoxicity (ptosis, vertigo, paresthesias, slurred speech, drowsiness, dysphagia, restlessness, increased salivation & proximal muscle weakness)
  • May lead to respiratory paralysis
  • Envenomation always warrants admission
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7
Q

Types of snake antivenin

A
  1. Polyvalent immune Fab (CroFab): sheep product; minimal allergic reactions
  2. Antivenin polyvalent (Crotalidae): horse serum; only for moderate/severe envenomations

Antivenin for Elapidae scarce; only give if symptomatic

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8
Q

Indications for HD in lithium toxicity

A
  1. Lithium >4.0 + impaired kidney function
  2. Lithium >5.0
  3. Seizure, dangerous dysrhythmia or AMS
  4. Symptomatic + contraindication for aggressive fluid repletion
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9
Q

Amiodarone adverse effects

A

Thyroid disease, pulmonary fibrosis & hepatotoxicity

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10
Q

Carbon monoxide hyperbaric indications

A
  1. CO level >25% (15% if pregnant)
  2. Loss of consciousness
  3. Severe metabolic acidosis (pH <7.1)
  4. Concern for end-organ ischemia
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11
Q

Arsine gas poisoning presentation & management

A

Presentation: Abdominal pain, hematuria & jaundice (massive RBC hemolysis)

Treatment: IVF’s, urine alkalinization, plasma/RBC exchange transfusions

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12
Q

Explain the toxicokinetics of acetaminophen

A

Normally metabolized through sulfation and glucuronide conjugation; in setting of overdose, process overwhelmed and APAP shunted to CYP450 (2E1) pathway, generating toxic metabolite NAPQI. Glutathione binds and detoxifies NAPQI, but hepatotoxicity occurs once glutathione stores are depleted by 70%.

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13
Q

Malignant hyperthermia pathophysiology

A

Mutation in RYR1 gene —> unregulated accumulation of calcium from sarcoplasmic reticulum to intracellular space —> sustained muscle contraction, hyperthermia, rhabdomyolysis, hyperkalemia & cardiac dysrhythmia

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14
Q

Plants containing anticholinergic alkaloids

A
  • Belladonna
  • Nightshade
  • Jimson weed
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15
Q

Plants containing cardiac glycosides

A

(can cause digoxin toxicity)

  • Foxglove
  • Oleander
  • Lilly of the Valley
  • Squill
  • Ouabain
  • Dogbane
  • Wallflower

(also cane toad venom)

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16
Q

Half-life of carboxyhemoglobin on AA vs 100% NRB

A

AA: 3 hours

100% NRB: 75 minutes

17
Q

Beta-blocker toxicity management

A
  • calcium: promotes intracellular calcium flux –> improved myocardial contraction
  • glucagon: bypasses beta-receptors and activates adenyl cyclase –> improved myocardial contraction
  • high-dose insulin (1 u/kg bolus then 1-10 u/kg/hr drip): powerful inotrope
  • lipid emulsion therapy?
18
Q

How to distinguish BB from CCB toxicity

A

Patients with CCB have relatively preserved neurological function and moderate hyperglycemia

19
Q

Scorpion envenomation

A
  • usually 2/2 Centruroides species
  • neurotoxin leads to local cholinergic & adrenergic manifestations (systemic rare)
  • opsoclonus (rotary nystagmus)
  • can treat with atropine & antivenom
20
Q

Silo Filler’s disease pathophysiology, presentation & management

A
  • path: inhalation of nitrogen oxides produced from plant material
  • pres: farmer enters silo within 1-2 days of it being filled; cough, chest tightness, vascular collapse, shock, ARDS
  • mgmt: supportive; ?high-dose corticosteroids
21
Q

Ethylene glycol toxicity

A
  • Antifreeze
  • Flank pain, hematuria & oliguria
  • Labs with AGMA, increased osmol gap, low Ca, AKI, UA w/ Maltese crosses & fluorescent urine
  • Toxic metabolite is oxalic acid
  • Treat with fomepizole

EM Licensing Exam (19 decks)

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