tox

Question 1

what toxins can vs can’t cross placenta

Answer 1

cadmium can’t

lead, mercury, PCBs, insecticides all can

Question 2

what shouldn’t you use activated charcoal for

Answer 2

CALM
cyanide
alcohol/alkaline/kerosene
lithium
heavy metals

also antidotes, except for NAC

Question 3

activated charcoal dosing

Answer 3

0.5-1 g/kg

adult range: 25-100 g

Question 4

how much acetaminophen = overdose

Answer 4

140 mg/kg

if known to have ingested more than this, can give NAC right away

Question 5

when to take acetaminophen level

Answer 5

4-10 hrs post ingestion

most important predictor of outcome

Question 6

wintergreen odor

Answer 6

salicylates

Question 7

can salicylate toxicity cause fever

Answer 7

yes

Question 8

management of ibuprofen ingestion

Answer 8

supportive

Question 9

cutoffs for BAC in ethanol toxicity

Answer 9

0. 1% = mild
1. 2% = moderate (slurred speech, ataxia)
2. 3% = severe (stupor, confusion)
3. 4% - coma, resp depression

Question 10

what to monitor for in ethanol toxicity

Answer 10

hypoglycemia
electrolyte abnormalities
other toxidromes

Question 11

metabolic acidosis, abdominal pain, high AG, vision issues

Answer 11

methanol ingestion

Question 12

management of methanol ingestion

Answer 12

ethanol?
4-MP?
sodium bicarb

Question 13

drunk with no odor of alcohol and large anion gap

Answer 13

ethylene glycol toxicity

Question 14

calcium oxalate crystals in urine 2/2 ingestion

Answer 14

ethylene glycol

Question 15

muscarinic effects

Answer 15

salivation, lacrimation, diarrhea, wheezing, bradycardia

give atropine

Question 16

nicotinic effects

Answer 16

neuromuscular - weakness, paralysis, fasciculations

give pralidoxime

Question 17

management of TCA toxicity

Answer 17

activated charcoal
EKG monitoring
sodium bicarb if widening QRS

Question 18

TCA and allergy testing

Answer 18

interfere with histamine response - results not valid

Question 19

GI irritation, choking, resp symptoms, infiltrates on CXR

Answer 19

hydrocarbon (gasoline, kerosene, lighter fluid) ingestion

can cause ARDS

Question 20

mgmt of hydrocarbon ingestion

Answer 20

obs for 6 hrs if asymptomatic

resp support if symptomatic

Question 21

sudden flu like symptoms, afebrile, other family members affected

Answer 21

carbon monoxide poisoning

Question 22

CO poisoning management

Answer 22

100% oxygen (O2 sat reading inaccurate)

carboxyhemoglobin levels

Question 23

smell of almonds, flu like symptoms and respiratory distress without responding to O2

Answer 23

cyanide poisoning

Question 24

management of cyanide poisoning

Answer 24

hydroxocobalamin

sodium thiosulfate, nitrate

Question 25

coughing, crying, drooling, chest pain, trouble swallowing

Answer 25

caustic substance ingestion | DO NOT DO GASTRIC LAVAGE

Question 26

what part of GI tract do alkali substances injure

Answer 26

esophagus

Question 27

what part of GI tract do acidic substances injure

Answer 27

stomach

Question 28

mechanism of alkali toxicity

Answer 28

direct contact with skin and mucosa cuasing necrosis

Question 29

min lead level to cause cognitive deficit

Answer 29

10 mcg/dL

Question 30

what to do for lead 5-14 mcg/dL

Answer 30

report and confirm in 3 months, screen for iron, development

Question 31

what to do for lead 15-44 mcg/dL

Answer 31

report and confirm in 4 weeks, consider XR for pt with pica

Question 32

what to do for lead 45-70

Answer 32

confirm in 48 hours, chelation with succimer as outpt, admit if GI or CNS sx

Question 33

what to do for lead 70+

Answer 33

confirm immediately, admit, dimercaprol and edetate calcium disodium

Question 34

how much iron is toxic ingestion

Answer 34

40 mg/kg elemental iron

Question 35

multisystem effects of iron ingestino

Answer 35

metabolic acidosis coagulopathy cardiovascular collapse

Question 36

when to check iron level

Answer 36

4 hrs post ingestion

Question 37

indications for iron chelation

Answer 37

severe symptoms AG acidosis iron > 500 mcg/dL many pills seen on AXR

Question 38

activated charcoal for iron?

Answer 38

not indicated (poor absorption)

Question 39

when is deferoxamine therapy done?

Answer 39

urine no longer pink

Question 40

early teeth eruption, dark pigmentation of skin, acneiform rash, low birthweight

Answer 40

prenatal PCB exposure | Pigmentation Cutting teeth Birthweight low

Question 41

vesicles starting in face and extremities in same stage of dvlpmt, leaves scars

Answer 41

small pox

Question 42

pruritic papule --> central black painless eschar

Answer 42

cutaneous anthrax

Question 43

coin in esophagus on CXR

Answer 43

face forward on PA film

Question 44

coin in trachea on CXR

Answer 44

face forward on lateral film

Question 45

how long for coin to pass through GI tract

Answer 45

4-6 days

Question 46

coin in prox esophagus -->

Answer 46

endoscopy

Question 47

coin in mid-lower esphagus -->

Answer 47

observe if asymptomatic