Etc

Question 1

No Pee, No See, No Spit, No Shit + Tachycardia

Toxicity?

Answer 1

Anticholinergic Toxicity

• +Cutaneous vasodilation (red as a beet)
• +mad as a hatter (delirium)
• e.g. Diphenhydramine poisoning
• Tx: Physostigmine (cholinesterase inhibitor)

Question 2

Tinnitus, N/V, Fever

Toxicity?

Answer 2

Salicylate Intoxication

• +AMS
• +Metabolic acidosis & Respiratory Alkalosis
• Tx: Sodium bicarbonate (alkalinization of urine)

Question 3

House fire victim has this toxicity concern from combustion in closed spaces

Answer 3

Hydrogen Cyanide and Carbon Monoxide (CO)

• Cyanide poisoning Tx: Sodium Thiosulfate or hydroxocobalamin (B12) or Nitrites
• CO Poisoning Tx: 100% O₂ or hyperbaric O₂

Question 4

Cyanide Poisoning. Tx?

Answer 4

• Sodium Thiosulfate
• Hydroxocobalamin (B12)
• Nitrites (to induce methemoglobinemia thru Fe3+ conversion, causing left shift)

Question 5

Causes methemoglobinemia

Answer 5

Dapsone, Nitrates, Topical/local anesthetics

Question 6

Lacrimation, bradycardia, miosis (constriction), salivation, diarrhea. Dx & Tx?

Answer 6

Organophosphate Poisoning

Tx: Atropine

Question 7

Horizontal nystagmus, cerebellar ataxia, confusion. Toxicity?

Answer 7

Phenytoin toxicity

Tx: Supportive care

Question 8

Acidosis + vision loss/blindness. Toxicity?

Answer 8

Methanol Poisoning

• Vision loss 2/2 optic disc hyperemia
• AGMA
• Tx: Supportive care

Question 9

Pinkish-red skin hue or cherry lips

Answer 9

CO poisoning

Question 10

Acetaminophen OD

Answer 10

• Activated charcoal (if <4 hrs)
• N-acetylcysteine

Question 11

Caustic poisoning

Answer 11

• Necrosis, edema, scarring, and severe pain of GI tract
• Severe esophageal & stomach ulcerations
• Peritonitis, mediastinitis (if severe)

Question 12

Garlic breath

Answer 12

Arsenic poisoning

• +Vomiting
• +Watery diarrhea
• +QTc prolongation
• +Hypo/hyperpigmentation
• +Hyperkeratosis
• +Stocking glove neuropathy

Question 13

MJ intoxication effect on HR, RR, BP

Answer 13

Increased

(Tachycardia, Tachypnea, Hypertension)

• +Dry mouth
• +Conjunctival injection
• +Increased appetite

Question 14

Opiate abuse/withdrawal Tx:

Answer 14

MSNBC

• Methadone
• Suboxone/Subutex
• Naloxone/Naltrexone: partial agonist & antagonist respectively
• Buprenorphine (partial agonist)
• Clonidine

Question 15

Alcohol Abuse Tx:

Answer 15

NAAT:

• Naltrexone (antagonist)
• Acamprosate
• Antabuse (disulfiram)
• Topiramate (anticonvulsant)

Question 16

Ethylene Glycol poisoning Tx

Answer 16

Fomepizole or Ethanol

(to inhibit alcohol dehydrogenase)

• Presentation: Hypocalcemia, Calcium oxalate deposition

Question 17

Hypotension + Dilated pupils + QRS Prolongation. Toxicity?

Answer 17

TCA Overdose

Tx: Sodium bicarbonate

(treats cardiotoxicity affecting myocyte sodium channels)

Question 18

Aspirin + asthma

Answer 18

ASA-exacerbated respiratory disease (AERD)

ASA and ß-blockers can trigger bronchoconstriction in asthmatics, especially those with chronic rhinositis and/or nasal polyps

Question 19

Systolic-diastolic abdominal bruit

Answer 19

Renal Artery Stenosis

(RAS)

Bruit is 2/2 renovascular HTN

• +Resistant HTN (_>_3 drugs)
• +Severe HTN (>180/120)
• +Malignant HTN (end-organ damage)
• +Diffuse atherosclerosis

Question 20

Whenever we want to treat HTN in conjunction with DM, ____ are the best Rx option because they are ____.

Answer 20

ACE-I; rebal protective

Question 21

Type of IVF preferred for volume resuscitation of burn victims

Answer 21

Lactated Ringer solution (LR)

• Isotonic crystalloid solution that is a balanced fluid w/ near-physiologic levels of chloride, potassium, and calcium, including sodium lactate, a buffer that is hepatically metabolized to bicarbonate, which helps correct acidosis and maintain normal blood pH
• Normal Saline (0.9% Saline) is considered an unbalanced fluid bc its chloride concentration is supraphysiologic (154 vs 103 mmol/L) and can cause a hyperchloremic metabolic acidosis; has also been a/w hypocoagulability
• Half-Normal Saline (0.45% Saline) is used as a maintenance fluid and should be infused slowly because it is hypotonic (lower osmolality than blood).

Question 22

Type of IVF preferred for volume resuscitation of burn victims

Answer 22

Lactated Ringer solution (LR)

• Isotonic crystalloid solution that is a balanced fluid w/ near-physiologic levels of chloride, potassium, and calcium, including sodium lactate, a buffer that is hepatically metabolized to bicarbonate, which helps correct acidosis and maintain normal blood pH
• Normal Saline (0.9% Saline) is considered an unbalanced fluid bc its chloride concentration is supraphysiologic (154 vs 103 mmol/L) and can cause a hyperchloremic metabolic acidosis; has also been a/w hypocoagulability
• Half-Normal Saline (0.45% Saline) is used as a maintenance fluid and should be infused slowly because it is hypotonic (lower osmolality than blood).