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Toxicology as a Discipline and Clinical Diagnostic Tool

Total questions: 98

Worksheet time: 49mins

Name
Class
Date
1.

A 2-year-old child is found with an open bottle of acetaminophen, and the parents are unsure how many tablets were ingested. They call 911, and EMS arrives shortly. What is the most important phone number that healthcare professionals and the public should call immediately for guidance on suspected poisonings?

a)

911

b)

1-800-273-8255

c)

1-800-222-1222

d)

1-800-555-1212

2.

Which of the following best defines toxicology as a clinical discipline?

a)

The study of drug interactions in healthy individuals

b)

The use of medications to treat infections

c)

The study of adverse effects of chemicals on living organisms

d)

The process of measuring blood levels of prescribed medications

3.

Which of the following is NOT a typical system affected by toxic exposure?

a)

A. Respiratory system

b)

B. Musculoskeletal system

c)

C. Nervous system

d)

D. Hepatic system

4.

A poison is best defined as any substance that:

a)

Is ingested intentionally

b)

Enhances organ function

c)

Disrupts normal physiological function when introduced to the body

d)

Has a strong odor

5.

Which of the following is most accurate regarding the concept of poisoning?

a)

All poisonings are intentional

b)

Most poisonings occur in occupational settings

c)

Most poisonings are accidental but preventable

d)

Poisoning only occurs with synthetic substances

6.

Which mechanism is NOT commonly involved in toxicologic injury?

a)

Alteration of cellular function

b)

Enhancement of oxygen uptake

c)

Inhibition of organ function

d)

Disruption of essential substrate transport

7.

Which of the following examples demonstrates toxicology being used as a diagnostic tool?

a)

Using a thermometer to assess for fever

b)

Measuring acetaminophen levels to assess for overdose

c)

Ordering a CBC for anemia

d)

Starting empiric antibiotics in a septic patient

8.

The clinical application of toxicology can include all of the following EXCEPT:

a)

Interpretation of tox screens

b)

Use of antidotes

c)

Choosing a radiologic imaging modality

d)

Monitoring serum drug concentrations

9.

Which of the following substances is considered toxic only in high doses?

a)

Oxygen

b)

Table salt

c)

Acetaminophen

d)

All of the above

10.

What is the primary goal of clinical toxicology?

a)

To invent new medications

b)

To identify microbial pathogens

c)

To assess and manage toxic exposures

d)

To prevent surgical complications

11.

Which of the following is the most common route by which toxic substances enter the body?

a)

Intramuscular injection

b)

Inhalation

c)

Ingestion

d)

Ocular absorption

12.

A patient working in an enclosed garage with a running car is at greatest risk for toxic exposure via:

a)

Ingestion

b)

Injection

c)

Inhalation

d)

Transplacental transmission

13.

A landscaper presents with bradycardia, salivation, and muscle fasciculations after spraying insecticide. What is the most likely route of toxic entry?

a)

Inhalation

b)

Dermal absorption

c)

Oral ingestion

d)

Injection

14.

Which of the following exposure routes has the fastest onset of toxic symptoms?

a)

Inhalation

b)

Ingestion

c)

Dermal absorption

d)

Rectal administration

15.

A child presents after eating colorful plant berries. Which route of exposure is most likely?

a)

Inhalation

b)

Injection

c)

Dermal

d)

Oral

16.

Which of the following is LEAST likely to be a significant toxic route of exposure?

a)

Intravenous injection

b)

Sublingual absorption

c)

Ocular exposure

d)

Transdermal through intact nails

17.

Which route of exposure bypasses first-pass metabolism, potentially leading to more rapid toxicity?

a)

Oral ingestion

b)

Rectal administration

c)

Dermal absorption

d)

Inhalation

18.

Which route of toxin entry is most likely in a heroin overdose involving intravenous drug use?

a)

Inhalation

b)

Oral

c)

Injection

d)

Dermal

19.

An organophosphate pesticide sprayed outdoors is likely to cause systemic symptoms through which route?

a)

Intramuscular absorption

b)

Rectal absorption

c)

Ocular exposure

d)

Inhalation and dermal absorption

20.

A factory worker presents with symptoms of lead poisoning. Which exposure route is most likely?

a)

IV exposure from contaminated needles

b)

Inhalation of lead dust

c)

Dermal contact with clean surfaces

d)

Sexual transmission

21.

Which of the following factors MOST influences the severity of a toxic substance's effect?

a)

Color of the substance

b)

Route and dose of exposure

c)

Storage container shape

d)

Whether the substance has a pleasant smell

22.

Lipophilic (fat-soluble) toxins have which of the following characteristics?

a)

Poor penetration into the CNS

b)

Rapid excretion by the kidneys

c)

Prolonged duration due to tissue storage

d)

Immediate breakdown in the stomach

23.

Which of the following describes a characteristic of a volatile toxic substance?

a)

Easily dissolves in water

b)

Forms crystals at room temperature

c)

Converts to gas and is readily inhaled

d)

Remains stable in UV light

24.

Which of the following increases the toxicity of acetaminophen?

a)

Alkaline urine

b)

Chronic alcohol use

c)

Iron deficiency

d)

Elevated calcium levels

25.

The biotransformation of toxic substances most commonly occurs in which organ?

a)

Kidneys

b)

Liver

c)

Spleen

d)

Pancreas

26.

A toxin with a narrow therapeutic index means:

a)

It is only available by prescription

b)

It causes symptoms in pregnant patients

c)

Small differences between therapeutic and toxic dose

d)

It has minimal side effects

27.

The half-life of a toxin refers to:

a)

The amount of toxin stored in fat

b)

Time it takes for the liver to absorb the toxin

c)

Time for serum levels to decrease by 50%

d)

The lethal dose in 50% of test subjects

28.

A highly protein-bound toxin is expected to:

a)

Have a very short duration of action

b)

Distribute quickly to the CNS

c)

Be eliminated rapidly in urine

d)

Have reduced free (active) serum levels

29.

The LD50 of a toxin refers to:

a)

The dose that is lethal to 50% of a population

b)

The dose that causes 50% recovery in a population

c)

The dose that is safe for 50% of a population

d)

The dose that causes mild symptoms in 50% of a population

30.

Which factor is least likely to affect how a toxic substance behaves in the body?

a)

A. Age of the patient

b)

B. Time of day of exposure

c)

C. Pre-existing liver or kidney disease

d)

D. Genetic metabolic variation

31.

What is the first step in emergency management of a patient with suspected toxic exposure?

a)

Administer the antidote

b)

Begin decontamination

c)

Establish ABCs (Airway, Breathing, Circulation)

d)

Draw toxicology labs

32.

When managing a toxic exposure scene, what is the priority for healthcare personnel?

a)

Ensuring decontamination supplies are available

b)

Avoiding self-exposure

c)

Administering oxygen

d)

Giving naloxone

33.

The dose that is lethal in 50% of the population is called:

a)

The level of drug that causes drowsiness in 50%

b)

The lowest dose that causes toxicity

c)

The dose that is lethal in 50% of the population

d)

The dose that causes GI symptoms in most patients

34.

Which of the following patients should receive naloxone empirically?

a)

A drowsy patient with pinpoint pupils and bradypnea

b)

An alert patient with acetaminophen ingestion

c)

A seizing patient with high fever and mydriasis

d)

A vomiting child with iron ingestion

35.

What is the recommended empiric treatment "cocktail" in an unknown toxicologic emergency?

a)

Atropine, Naloxone, Dextrose

b)

Thiamine, Naloxone, Dextrose

c)

Flumazenil, Atropine, Activated charcoal

d)

N-acetylcysteine, Epinephrine, Sodium bicarbonate

36.

Which decontamination method is appropriate for a patient with dermal pesticide exposure?

a)

Irrigate eyes with saline

b)

Induce vomiting with ipecac

c)

Remove clothes and wash skin thoroughly

d)

Administer activated charcoal

37.

When should activated charcoal be considered in a poisoned patient?

a)

Any time after ingestion

b)

Only if patient is symptomatic

c)

Within 1 hour of a known ingestion

d)

Only if antidote is unavailable

38.

The most important consideration before initiating gastric lavage is:

a)

Airway protection

b)

Patient age

c)

Type of poison ingested

d)

Time since ingestion

39.

Which of the following is TRUE about whole bowel irrigation?

a)

Not effective for sustained-release drug ingestion

b)

Safe for patients with vomiting

c)

Contraindicated in iron poisoning

d)

Indicated for radiopaque substances visible on KUB

40.

What should be done immediately when a patient arrives with altered mental status and unknown toxic ingestion?

a)

CT head and lumbar puncture

b)

Begin empiric naloxone, thiamine, and dextrose

c)

Wait for tox screen

d)

Perform endoscopy

41.

A patient with inhaled chemical exposure is brought to the ED. Which action is most appropriate first?

a)

Start IV fluids

b)

Apply high-flow oxygen

c)

Administer atropine

d)

Intubate immediately

42.

A patient presents with miosis, bradycardia, salivation, and diarrhea. Which toxidrome is most likely?

a)

Anticholinergic

b)

Opioid

c)

Cholinergic

d)

Sympathomimetic

43.

A young adult is agitated, tachycardic, diaphoretic, and has dilated pupils. What toxidrome is this consistent with?

a)

Opioid

b)

Sedative-hypnotic

c)

Cholinergic

d)

Sympathomimetic

44.

A patient with opioid overdose would most likely present with which of the following?

a)

Mydriasis, dry skin, tachycardia

b)

Miosis, respiratory depression, altered mental status

c)

Diarrhea, fever, lacrimation

d)

Delirium, hypertension, muscle rigidity

45.

Which finding is most characteristic of anticholinergic toxicity?

a)

Bradycardia

b)

Miosis

c)

Diaphoresis

d)

Dry mucous membranes

46.

A pediatric patient presents with high anion gap metabolic acidosis, visual disturbances, and confusion. What is the likely toxin?

a)

Methanol

b)

Iron

c)

Opioids

d)

Lead

47.

What physical exam finding is most suggestive of carbon monoxide poisoning?

a)

Cyanosis

b)

Bitter almond breath

c)

Cherry-red lips and skin (late finding)

d)

Vomiting with bloody diarrhea

48.

A teenager is found with vomiting, tinnitus, hyperpnea, and confusion. Which ingestion is most likely?

a)

Acetaminophen

b)

Aspirin (salicylate)

c)

Benzodiazepines

d)

MDMA

49.

A patient presents with hypotension, bradycardia, and AV block. Which toxin should be suspected?

a)

Beta-blocker

b)

Cocaine

c)

Amphetamine

d)

Hallucinogen

50.

Which set of symptoms is most consistent with lead poisoning in a child?

a)

Acute liver failure, jaundice, RUQ pain

b)

Hyperactivity, constipation, abdominal pain

c)

Vomiting, tinnitus, lethargy

d)

Tremors, mydriasis, insomnia

51.

Which is a hallmark symptom of anticholinergic toxicity?

a)

Sweating

b)

Diarrhea

c)

Hallucinations

d)

Bradycardia

52.

When managing a contaminated patient in the emergency department, what is the most critical first step?

a)

Administer activated charcoal

b)

Secure the airway

c)

Ensure staff wear proper PPE to prevent secondary exposure

d)

Move patient directly to radiology

53.

A patient exposed to a chemical spill is brought in with contaminated clothing. What is the next best step?

a)

Perform gastric lavage

b)

Remove clothing and perform dermal decontamination

c)

Intubate the patient

d)

Begin IV antibiotics

54.

Which of the following is true regarding decontamination?

a)

Vomiting is an effective method

b)

Dermal exposure is rarely dangerous

c)

Patient clothing should be removed and bagged immediately

d)

Gastric lavage is always the first step

55.

Why is it critical to handle a contaminated patient in a designated decontamination area?

a)

To reduce documentation errors

b)

To allow faster imaging

c)

To prevent cross-contamination and protect healthcare personnel

d)

To access lab testing more quickly

56.

Which of the following materials requires dry decontamination (no water)?

a)

Organophosphates

b)

Hydrofluoric acid

c)

Elemental metals like sodium

d)

Acetaminophen tablets

57.

What is the main danger of using water to decontaminate certain chemicals like alkali metals?

a)

It dilutes the toxin

b)

It enhances toxin absorption

c)

It causes an exothermic reaction and fire risk

d)

It creates toxic gas

58.

After dermal decontamination, the next step for a symptomatic patient is:

a)

Administer antidotes if indicated

b)

Discharge the patient

c)

Begin physical therapy

d)

Start nutritional support

59.

In suspected inhalation exposure, which of the following is appropriate?

a)

Remove clothes and wash with soap

b)

Induce emesis

c)

Administer activated charcoal

d)

Move to fresh air and administer supplemental oxygen

60.

What PPE should healthcare workers wear when handling a patient exposed to an unknown powder?

a)

None until the powder is identified

b)

Standard gloves and gown only

c)

Full body protection including mask, gloves, and eye shield

d)

N95 mask only

61.

Which of the following is inappropriate when handling a contaminated patient?

a)

Using protective gear

b)

Transporting the patient directly to imaging before decontamination

c)

Placing the patient in a decontamination area

d)

Removing all visible contaminants

62.

What is the mechanism of action of N-acetylcysteine (NAC) in acetaminophen toxicity?

a)

Enhances renal excretion of APAP

b)

Blocks opioid receptors

c)

Replenishes glutathione and detoxifies NAPQI

d)

Inhibits COX-1 and COX-2

63.

Which antidote is used in benzodiazepine overdose, and what is a major caution?

a)

Naloxone; risk of pulmonary edema

b)

Flumazenil; risk of seizures in chronic users

c)

Atropine; may cause bradycardia

d)

Physostigmine; can worsen sedation

64.

What antidote is used in iron toxicity?

a)

EDTA

b)

Deferoxamine

c)

Flumazenil

d)

Atropine

65.

Which of the following is the antidote for organophosphate poisoning?

a)

Atropine and pralidoxime (2-PAM)

b)

Flumazenil

c)

Digoxin immune Fab

d)

Sodium bicarbonate

66.

In digoxin toxicity with life-threatening arrhythmias, what is the most appropriate antidote?

a)

Naloxone

b)

Glucagon

c)

Digibind (Digoxin immune Fab)

d)

Beta blockers

67.

Which antidote reduces methemoglobin levels?

a)

N-acetylcysteine

b)

Methylene blue

c)

Deferoxamine

d)

Fomepizole

68.

A patient presents with signs of clonidine overdose. Which antidote may be considered?

a)

Flumazenil

b)

Physostigmine

c)

Tolazoline

d)

Pralidoxime

69.

Which of the following antidotes is used in ethylene glycol or methanol poisoning?

a)

Methylene blue

b)

Naloxone

c)

Fomepizole

d)

Atropine

70.

The role of sodium bicarbonate in tricyclic antidepressant (TCA) overdose is:

a)

To enhance TCA absorption

b)

To alkalinize the blood and reverse cardiac toxicity

c)

To induce vomiting

d)

To increase TCA metabolism

71.

 What is the role of sodium bicarbonate in tricyclic antidepressant (TCA) overdose?

a)

Enhances renal clearance

b)

Binds the toxin in the GI tract

c)

Narrows the QRS complex and stabilizes the myocardium

d)

Acts as an antidote to serotonin syndrome

72.

What is the antidote for opioid toxicity, and what is its onset of action?

a)

Atropine; onset in 5–10 minutes

b)

Naloxone; onset in 1–2 minutes

c)

Physostigmine; onset in 30 minutes

d)

Flumazenil; onset in 10 minutes

73.

A 25-year-old male is found unresponsive with pinpoint pupils and respiratory depression. What is the first step in management?

a)

Give naloxone

b)

Start activated charcoal

c)

Obtain urine tox screen

d)

Order a head CT

74.

A patient presents with dry skin, mydriasis, hallucinations, and urinary retention. What toxidrome is most likely, and what should be considered in treatment?

a)

Opioid; administer naloxone

b)

Sympathomimetic; give propranolol

c)

Anticholinergic; consider physostigmine

d)

Cholinergic; give atropine

75.

In acetaminophen overdose, when should N-acetylcysteine ideally be initiated?

a)

Within 1 hour

b)

Immediately after ingestion

c)

4 hours post ingestion if APAP level is above the treatment line

d)

After liver enzymes are elevated

76.

What is the most appropriate treatment for TCA overdose with wide QRS on EKG?

a)

Atropine

b)

Glucagon

c)

Sodium bicarbonate

d)

Physostigmine

77.

A patient with beta-blocker overdose is bradycardic and hypotensive. What is the most appropriate pharmacologic intervention?

a)

Calcium chloride

b)

Flumazenil

c)

Glucagon

d)

Naloxone

78.

A 6-year-old has taken an unknown number of iron tablets. He has had multiple episodes of vomiting and bloody diarrhea. What is the best next step?

a)

Activated charcoal

b)

Flumazenil

c)

Whole-bowel irrigation and start deferoxamine

d)

Atropine and 2-PAM

79.

A patient presents with slurred speech, ataxia, and respiratory depression. He takes diazepam. What treatment is potentially indicated?

a)

Flumazenil (if no chronic use)

b)

Naloxone

c)

Physostigmine

d)

Thiamine

80.

A patient with altered mental status has a high anion gap metabolic acidosis. Osmolal gap is also elevated. What exposure should you suspect?

a)

Acetaminophen

b)

Iron

c)

Ethylene glycol

d)

Benzodiazepine

81.

A child presents with SLUDGE symptoms (salivation, lacrimation, urination, diarrhea, GI upset, emesis) and miosis. Which treatment is most appropriate?

a)

Naloxone

b)

Atropine and pralidoxime

c)

Diazepam

d)

Glucagon

82.

A patient has suspected carbon monoxide poisoning. What is the definitive treatment?

a)

Flumazenil

b)

Sodium bicarbonate

c)

100% oxygen or hyperbaric oxygen

d)

N-acetylcysteine

83.

 A patient presents 4 hours after ingesting 10g of acetaminophen. She feels fine but is worried. What stage of toxicity is she likely in?

a)

stage 1

b)

stage 2

c)

stage 3

d)

stage 4

84.

Which of the following laboratory changes is most likely to begin during Stage I of acetaminophen toxicity?


a)

elevated bilirubin

b)

Elevated transaminases (AST/ALT)

c)

Hypoglycemia

d)

Increased INR

85.

A patient with recent APAP overdose presents with RUQ tenderness, elevated LFTs, and mild hypotension. Which stage is this?

a)

stage I

b)

stage 2

c)

stage 3

d)

stage 4

86.

 What is a hallmark clinical finding of Stage III acetaminophen toxicity?


a)

RUQ pain and nausea

b)

Jaundice, coagulopathy, encephalopathy

c)

Vomiting and diaphoresis

d)

Normal physical exam

87.

A patient presents 72 hours after ingesting acetaminophen. Labs show AST >3000, INR elevated, creatinine 2.1, and they are confused. What is the likely stage?

a)

stage 1

b)

stage 2

c)

stage 3

d)

stage 4

88.

. A patient ingested a large dose of acetaminophen but presents to the ED 5 days later with normal LFTs. What stage are they most likely in?

a)

stage 1

b)

stage 2

c)

stage 3

d)

stage 4

89.

What happens in Stage IV of acetaminophen toxicity?

a)

Permanent liver damage

b)

 Complete hepatic failure

c)

. Resolution of liver function or death

d)

Delayed coagulopathy

90.

A 78-year-old woman with a history of atrial fibrillation presents with nausea, confusion, and visual disturbances. She describes her vision as “seeing everything with a yellow tint.” Her medications include digoxin and furosemide. Which of the following findings is most consistent with the suspected diagnosis?

a)

Miosis and bradycardia

b)

Tinnitus and metabolic acidosis

c)

. Yellow vision and ventricular ectopy

d)

Mydriasis and hyperthermia

91.

A 22-year-old male is brought to the ED after being found confused and hallucinating. He has flushed skin, dilated pupils, dry mucous membranes, and a temperature of 101.9°F. Vitals show HR 116, BP 132/84. He recently ingested an unknown quantity of diphenhydramine. Which of the following is the most appropriate antidote?

a)

Atropine

b)

Naloxone

c)

Physostigmine

d)

Flumazenil

92.

Which of the following signs indicates progression from Stage II to Stage III?


a)

Normalization of LFTs

b)

Onset of encephalopathy

c)

Disappearance of RUQ tenderness

d)

Return of appetite

93.

What is the time frame for Stage III of acetaminophen toxicity?


a)

0-12hrs

b)

12-24 hrs

c)

24-48 hrs

d)

72-96 hrs

94.

9. Which of the following symptoms is most specific to Stage III toxicity?


a)

nausea

b)

diaphoresis

c)

hepatic encephalopathy

d)

mydriasis

95.

A 28-year-old man presents to the ED agitated, hypertensive, and tachycardic after using cocaine. On exam, he is diaphoretic with dilated pupils and has chest pain. Which of the following medications should be avoided in this patient due to risk of worsening vasoconstriction?

a)

benzos

b)

nitroglycerin

c)

beta blockers

d)

aspirin

96.

A 34-year-old woman is brought to the ED in January after being found in her garage with the car engine running. She is alert but complains of a pounding headache, dizziness, and nausea. Pulse oximetry reads 99%. What is the most likely cause of her symptoms, and what is the most common presenting symptom of this condition?

a)

Carbon monoxide poisoning; headache

b)

Migraine; photophobia

c)

Ethylene glycol ingestion; visual changes

d)

Heat exhaustion; syncope

97.

A farmer presents to the emergency department after collapsing in his field. He was recently spraying insecticides. On exam, he is bradycardic, drooling, sweating profusely, and has pinpoint pupils. Which of the following best describes the SLUDGE mnemonic associated with this type of poisoning?

a)

Sweating, Lethargy, Urination, Drowsiness, Gagging, Edema

b)

Salivation, Lacrimation, Urination, Diaphoresis, Gastritis, Emesis

c)

Seizures, Lethargy, Urination, Dizziness, GI upset, Edema

d)

Salivation, Lacrimation, Urination, Diarrhea, GI cramps, Emesis

98.

A 70-year-old man receiving an intravenous heparin infusion for a pulmonary embolism develops sudden hypotension and active bleeding at the IV site. His aPTT is significantly elevated. What is the most appropriate antidote to reverse the effects of heparin?

a)

Vitamin K

b)

Desmopressin

c)

Protamine sulfate

d)

Fresh frozen plasma

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