Toxicology

Question 1

What 3 toxic substances can smell like Garlic?

Answer 1

• Dimethy sulfoxide (DMSO)
• Arsenic
• Organophosphates

Question 2

What toxic substance smells like bitter almonds?

Answer 2

Cyanide

Question 3

What 2 toxic substances smell like rotten eggs?

Answer 3

1. Hydrogen sulfide
2. Sewer gas

(“SH it smells like rotten eggs”)

Question 4

What 2 toxic substances smell like acetone?

Answer 4

1. Isopropyl alcohol
2. Ethanol

Question 5

What toxic substance smell like shoe polish?

Answer 5

Nitrobenzene

(“I get my shoes polished at Night”)

Question 6

What toxic substance smells like violates?

Answer 6

Turpentine

Question 7

What toxic substance smells like pears?

Answer 7

Chloral Hydrate

Question 8

What toxic substance smells like peanuts?

Answer 8

Vacor (rat poison)

Question 9

What toxic substance smells like carrots?

Answer 9

Cicutoxin (water hemlock)

Question 10

What toxic substance smells fruity?

Answer 10

DKA

Isopropanol

Question 11

What 2 toxic substances smell like mothballs?

Answer 11

• Naphthalene
• Paradichlorbenzene

(“I Partied too hard so I took a Nap in some mothballs”)

Question 12

What toxic substance smells like rotten wintergreen?

Answer 12

Methylsalicylate

(“He did Meth in Winter”)

Question 13

How do you calculate an anion gap?

Answer 13

Na - (Cl+ HCO3)

(normal= 12 +/- 4)

Question 14

What can cause an anion gap to be high?

Answer 14

MUDPILES:

• Methanol
• Uremia
• DKA
• Paraldehyde/ Propylene glycol
• Iron/Isoniazid
• Lactate
• Ethylene glycol
• Salicylates

(Could also be CUTER DIMPLES A= cyanide, toluene, ethanol, rhabdomyolysis, renal tubular acidosis, DKA, Isoniazid, Iron, Methanol, Propylene glycol, Lactic acidosis, Ethylene glycol, Salicylates)

Question 15

What 4 things could cause an anion gap to be decreased?

Answer 15

• Lithium
• Bromide
• Hypoalbuminemia
• Multiple Myeloma

(“Multiple Bros got Hyped after getting Lit”)

Question 16

If your osmolar gap is normal (<10), what can you exclude form your Ddx?

Answer 16

Can exclude toxic alcohol

Question 17

When is your osmolar gap increased? (“ME DIE”)

Answer 17

• Methanol
• Ethylene Glycol
• Diuretics (mannitol)/DKA (acetone)
• Isopropyl alcohol
• Ethanol

**A normal osmolar gap can exclude toxic alcohol from ddx*

Question 18

What foreign bodies show up on imaging (radioopaque substances)?

(“CHIPES”)

Answer 18

• Chloral hydrate, calcium, crack cocaine
• Heavy metals
• Iodine, iron
• Phenothiazines, TCA, packets, Play-Doh
• Enteric coated
• Solvents, salicylates, sustained release

Question 19

What things can cause bradycardia? (“PACED”)

Answer 19

• Propanolol, poppies, propoxyphene, physiostigmine
• Anticholiesterase drugs, antiarrhythmic
• Clonidine, CCBs
• Ethanol (or other alcohols)
• Digoxin, Digitalis

Question 20

What can cause Tachycardia (FAST)

Answer 20

• Free base, freon
• Anticholinergics, antihistamines, anti-pyschotics, amphetamines, alcohol withdrawal
• Sympathomimetics, solvents, strychnine
• Theophylline, TCA’s, thyroid hormones

Question 21

Toxicology vital signs- what can cause hypothermia? (“COOLS”)

Answer 21

• Carbon monoxide
• Opiates
• Oral hypoglycemics, insulin
• Liquor (alcohols)
• Sedative hypnotics

Question 22

Toxicology vital signs- what can cause hyperthermia? (“NASA”)

Answer 22

• Neurologic malignant syndrome, nicotine
• Antihistamines, alcohol withdrawal
• Salicylates, sympathomimetics, serotonin syndrome
• Anticholinergics, antidepressants, anti-psychotics

Question 23

Toxicology vital signs- What can cause Hypotension (“CRASH”)

Answer 23

• Clonidine, calcium channel blockers
• Rodenticides (containing arsenic, cyanide)
• Antidepressants, aminophylline, anti-hypertensives
• Sedative hypnotics
• Heroin (other opiates)

Question 24

Toxicology vital signs- What can cause Hypertension? (“CT SCAN”)

Answer 24

• Cocaine
• Thyroid supplement
• Sympathomimetics
• Caffeine
• Anticholinergic, amphetamines
• Nicotine

Question 25

Toxicology vital signs- What causes rapid breathing? ("PANT")

Answer 25

* **PCP**, paraquat, pneumonitis, phosgene * **ASA** * Noncardiogenic pulmonary edema, nerve agents * noxin-induced metabolic acidosis

Question 26

Toxicology Vital signs- What causes slow breathing? ("SLOW")

Answer 26

* Sedative hypnotics (barbiturates, benzo) * Liquor (alcohols) * Opioids * Weed (marijuana)

Question 27

Toxicology Vital signs- What can cause Coma? ("LETHARGIC")

Answer 27

* **Lead, lithium** * **Ethanol**, **ethylene glycol** * TCAs, thallium, toluene * **Heroin**, hemlock, heavy metals, hepatic encephalopathy, hydrogen sulfide, hypoglycemics * Arsenic, antidepressants, antipsychotics, anticonvulsants, antihistamines * Rohypnol (sedative hypnotics), **risperidone** * GHB * **Isoniazid, insulin** * **Carbon monoxide, cyanide,** clonidine

Question 28

Toxicology vital signs- Seizure inducing agents ("OTIS CAMPBELL")

Answer 28

* Organophosphates, oral hypoglycemics * Tricyclic antidepressants * Isoniazid, insulin * Sympathomimetics, strychnine, salicylates * Camphor, cocaine, CO, cyanide, chlorinated hydrocarbons * **Amphetamines**, anticholinergics * Methylxanthines, methanol * **PCP**, propranolol * **Benzodiazepine withdrawal,** botanicals (water hemlock, nicotine), bupropion, ghB * **Ethanol withdrawa**l, ethylene glycol * **Lithium, lidocaine** * **Lead, lindane**

Question 29

What causes Miosis? ("COPS")

Answer 29

oCholinergics, Clonidine, Carbamates o**Opiates,** Organophosphate oPhenothiazine, Pilocarpine, Pontine hemorrhage oSedative hypnotics

Question 30

What causes Mydriasis? ("SAW")

Answer 30

o**Sympathomimetic** (cocaine, amphetamines) o**Antihistamines**, Antidepressants, Anticholinergics (atropine) **oWithdrawal**

Question 31

What toxins are accessible to hemodialysis? ("UNSTABLE")

Answer 31

* Uremia * No response to conventional therapy * **Salicylates** * Theophylline * **Alcohols** * Boric acid, barbiturates * **Lithium** * **Ethylene glycol**

Question 32

What are diaphoretic skin causes? ("SOAP")

Answer 32

* **Sympathomimetics** * Organophosphates * **Aspirin** * PCP

Question 33

What are 2 things that cause **red skin**? | (on exam)

Answer 33

**CO** Boric acid

Question 34

What causes **blue skin**? | (on exam)

Answer 34

Methemoglobinemia