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Toxicology ITE Review

Total questions: 40

Worksheet time: 21mins

Name
Class
Date
1.

What toxidrome is characterized by confusion, tachycardia, HTN, dry MM, urinary retention and picking behavior

a)

sympathomimetic

b)

serotonin syndrome

c)

withdrawal

d)

anticholinergic

2.

What lab finding would you expect after an envenomation by a Western Diamondback?

a)

elevated fibrinogen

b)

thrombocytopenia

c)

leukopenia

d)

thrombocytosis

3.

What antidote is used for anticholinergic toxicity?

a)

cyproheptadine

b)

lorazepam

c)

physostigmine

d)

dexmedetomidine

4.

What clinical finding requires treatment after envenomation by a coral snake

a)

bulbar palsies

b)

pain

c)

leg swelling

d)

thrombocytopenia

5.

What toxidrome is characterized by rigidity, hyperthermia, dilated pupils, elevated HR and BP

a)

serotonin syndrome

b)

malignant hyperthermia

c)

sympathomimetic

d)

anticholinergic

6.

What is the antidote for malignant hyperthermia?

a)

physostigmine

b)

cyclobenzaprine

c)

deferoxamine

d)

dantrolene

7.

What toxicity is characterized by the following ABG:

pH 7.32, pCO2 20, pO2 125, HCO3 10

a)

ethylene glycol

b)

salicylate

c)

acetaminophen

d)

iron

8.

What is the 4 hour level of acetaminophen that requires treatment in an adult?

a)

150mcg/ml

b)

250mcg/ml

c)

50mcg/ml

d)

any level

9.

What end organ is affected with methanol toxicity?

a)

kidney

b)

liver

c)

eye

d)

lung

10.

What causes an osmolar gap but no anion gap?

a)

ethylene glycol

b)

isopropyl alcohol

c)

methanol

d)

propylene glycol

11.

Getting your patient intoxicated can treat toxic alcohol ingestions

a)

True

b)

False

12.

What EKG changes are seen with TCA overdoses?

a)

RBBB

b)

RAD

c)

Wide QRS

d)

Terminal R wave in AVR

13.

What is the antidote for TCA overdoses?

a)

intralipids

b)

NAC

c)

sodium bicarbonate

d)

fomepizole

14.

Which of the following overdoses is most likely to cause a prolonged QRS?

a)

salicylate

b)

escitalopram

c)

risperdone

d)

bupropion

15.

What overdose is characterized by bradycardia, hypotension, vision changes and hyperkalemia?

a)

clonidine

b)

carbamazepine

c)

digoxin

d)

verapamil

16.

What test can be used to differentiate a calcium channel blocker overdose from other cardio toxins?

a)

blood gas

b)

EKG

c)

Echo

d)

Levels

17.

Which of the following is associated with hepatic failure?

a)

b)

c)

d)

18.

Which of the following share the same antidote?

a)

acetaminophen

b)

amanita muscaria

c)

salicylate

d)

amanita phalloides

19.

Which of the following is associated with refractory seizures?

a)

b)

c)

d)

20.

Which of the following share the same antidote?

a)

true morel

b)

INH

c)

paracetamol

d)

false morel

21.

A 2 y/o F presents to the ED due to AMS, restlessness, drooling and opsoclonus. What is the likely diagnosis?

a)

DKA

b)

salicylate toxicity

c)

envenomation

d)

meningitis

22.

What envenomation is characterized by a red/white/blue lesion and blister formation?

a)

africanized honey bees

b)

bark scorpion

c)

black widow spider

d)

brown recluse spider

23.

What envenomation is characterized by local and systemic reactions, MSOF, and rhabdomyolysis

a)

africanized honey bees

b)

bark scorpion

c)

black widow spider

d)

brown recluse spider

24.

What envenomation is characterized by a target shaped lesion, HTN, tachycardia and muscle cramping

a)

Africanized honey bees

b)

bark scorpion

c)

black widow spider

d)

brown recluse spider

25.

What envenomation can be treated with an antivenin

a)

Portuguese Man of war

b)

box jellyfish

c)

stingray

d)

lionfish

26.

A man presents after eating with personal paresthesias, dysphagia and diplopia. What was his likely exposure/toxin?

a)

Scombroid fish poisoning

b)

ciguatera fish poisoning

c)

thimble jellyfish

d)

pufferfish

27.

What is the ultimate goal of treatment for HBO therapy for the treatment of CO toxicity

a)

improved oxygenation

b)

prevention of delayed toxicity

c)

treatment of neuropathy

d)

rapid removal of CO

28.

A 9 month old presents due to AMS and SOB. An IV is started and Rob notices that the blood looks dark. What antidote is needed?

a)

hydroxycobalamin

b)

HBO

c)

methylene blue

d)

oxygen

29.

Which of the following is characterized by skin changes, hepatic failure and pseudotumor cerebri

a)

vitamin A

b)

vitamin B6

c)

vitamin C

d)

Vitamin D

30.

A 47 y/o M presented with the CC of facial paresthesias that began during dinner followed by v/d. He notes that he feels that "my teeth are going to fall out". What is the diagnosis?

a)

scombroid poisoning

b)

ciguatera poisoning

c)

tetrodotoxin

d)

neurotoxic shellfish poisoning

31.

The spouse of the previous patient had sea food as well. They are now feeling flushed and having a peppery taste in their mouth? What is the likely diagnosis?

a)

Scombroid poisoning

b)

ciguatera toxicity

c)

tetrodotoxin

d)

neurotoxic shellfish poisoning

32.

After eating mussels, a patient presents with dizziness, n/v/d. They feel that the warm blanket feels cold and are feeling SOB. Their exam is notable for bradycardia and miotic pupils. What is the diagnosis?

a)

ciguatera poisoning

b)

scombroid shellfish poisoning

c)

neurotoxic shellfish poisoining

d)

paralytic shellfish poisoning

33.

The last patient's partner presented after eating mussels. They have paresthesias, n/v/d. They feel SOB and their exam shows diffuse weakness, worse in their lower extremities. What is the toxin/dx?

a)

neurotoxic shellfish poisoning

b)

paralytic shellfish poisoning

c)

amnestic shellfish poisoning

d)

tetrodotoxin

34.

The waiter from the restaurant presents with increasingly erratic behavior, confusion. On exam they are externally stimulated, seeing fish and are grimacing and appear to be chewing. They have labile BP/HR with PVCs on the monitor. What is the dx?

a)

paralytic shellfish poisoning

b)

neurotoxic shellfish poisoning

c)

amnestic shellfish poisoning

d)

psychosis

35.

A 2 y/o M presents to the ED due to constipation. An X-ray shows hyperechoic circular structures. Labs show anemia and an AKI. What is the likely exposure?

a)

lead

b)

mercury

c)

arsenic

d)

iron

36.

A 54 y/o F with metastatic breast CA presents due to syncope while at her naturopaths office. She had multiple runs of ventricular tachycardia/TdP en route. She presented confused, hypotensive with a nonfocal neurologic examination. What is the likely exposure?

a)

lead

b)

arsenic

c)

mercury

d)

iron

37.

2 8 y/o brothers present due to "parental concerns". Mom noted they have become more shy, withdrawn and seem to scare easily. They have had diarrhea, decreased appetite and swelling in their arms/legs. Both have a fine motor tremor and pink extremities on exam. What is the exposure?

a)

prenatal vitamins

b)

essential oil exposure

c)

paint chips

d)

thermometers

38.

What stage of iron toxicity is characterized by shock, seizures and coagulopathy?

a)

1

b)

2

c)

3

d)

4

e)

5

39.

A 3y/o presented after an exploratory ingestion of her grandfather's warfarin. She is otherwise healthy, UTD on vaccinations and has a normal exam. What is the next step in management?

a)

admit for 24 hour observation

b)

obtain blood work in the ED and dc if normal

c)

dc home with return precautions and outpatient labs

d)

empiric reversal

40.

A 3y/o presented after an exploratory ingestion of a degreasing agent found in the garage. Pt is otherwise healthy and UTD on vaccinations. What is potential complication of her exposure?

a)

seizures

b)

pulmonary edema

c)

CO toxicity

d)

none, send her home