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In-Training Exam High Yield Topics Toxicology

In-Training Exam High Yield Topics Toxicology. Emergency Medicine Foundations Curriculum. In-training Exam (ITE) Content:. Written to level of EM3 Predicts performance on EM Boards 225 MC questions Given 4.5 hrs to take +/- 25 are visual stimuli – pictures/ ekg/xrays

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In-Training Exam High Yield Topics Toxicology

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  1. In-Training ExamHigh Yield Topics Toxicology Emergency Medicine Foundations Curriculum

  2. In-training Exam (ITE) Content: • Written to level of EM3 • Predicts performance on EM Boards • 225 MC questions • Given 4.5 hrs to take • +/- 25 are visual stimuli – pictures/ekg/xrays • Highest yield topics • Cardiovascular ~ 10% • Trauma ~ 10% • Abd/GI ~ 8% • Thoracic/Respiratory ~ 8% • Procedures/Skills ~8% • Note that Geriatrics makes up at least 6% of these and Pediatrics at least 8%

  3. Foundations Challenge Overview • Rapid Review of High-Yield Test Topics • Visual Diagnosis • Clinical Concepts • Rapid Fire • Work in 2-4 different teams • Answer challenge questions for points • Point value per challenge varies by difficulty • Win test prep and pride

  4. Foundations Challenge Rules • Create a Team Name • Best Team Name starts the Challenge (as arbitrarily determined by your Instructor) • Your team must answer the entire question correctly to win points • If you team answers incorrectly, the Challenge Question points can be stolen by the next team • If they answer correctly, they get your points AND a chance to answer the next question • If they answer incorrectly, the turn passes again to the next team in line

  5. toxicology

  6. 27 yo f non-responsive, barely breathing Foundations Challenge Visual Diagnosis 1pt Dx and Tx?

  7. 27 yo f non-responsive, barely breathing Foundations Challenge Visual Diagnosis 1pt Dx: Opioid Overdose Tx: Naloxone

  8. HIV+ pt on Dapsone with fatigue, O2 sat 85% 2 pts Foundations Challenge Visual Diagnosis Dx and Tx?

  9. HIV+ pt on Dapsone with fatigue, o2 sat 85% 2 pts Foundations Challenge Visual Diagnosis Dx: Methemoglobinemia Tx: Methylene blue

  10. methemoglobinemia Foundations Challenge Knowledge Bomb

  11. 2 pts 23 yo m with depression, brought in after suicide attempt Foundations Challenge Visual Diagnosis Dx and Tx?

  12. 2 pts 23 yo m with depression, brought in after suicide attempt Foundations Challenge Visual Diagnosis Dx: TCA overdose Tx: sodium bicarb

  13. TCA overdose Foundations Challenge Knowledge Bomb

  14. How can you differentiate these toxidromes? Foundations Challenge Clinical Concepts 2 pts Serotonin syndrome Neuroleptic malignant syndrome

  15. How can you differentiate these toxidromes? 2 pts Foundations Challenge Clinical Concepts Serotonin syndrome Neuroleptic malignant syndrome Clonus/hyperreflexia Muscle rigidity

  16. 2 pts Foundations Challenge Clinical Concepts How can you differentiate these toxidromes? Anticholinergic Sympathomimetic

  17. 2 pts Foundations Challenge Clinical Concepts How can you differentiate these toxidromes? Anticholinergic Sympathomimetic Dry (“as a bone”) Sweaty

  18. toxidromes Foundations Challenge Knowledge Bomb

  19. When is activated charcoal contraindicated? 2 pts Foundations Challenge Clinical Concepts Name 1 When is activated charcoal ineffective? Name 1

  20. When is activated charcoal contraindicated? 2 pts Foundations Challenge Clinical Concepts AMS/obtunded, Ileus, Vomiting, Risk of Seizure When is activated charcoal ineffective? Metals, Alcohols, Hydrocarbons, Caustics

  21. What is the classic metabolic disorder with salicylate toxicity?When do you dialyze for salicylate toxicity? Foundations Challenge Clinical Concepts 2 pts

  22. What is the classic metabolic disorder with salicylate toxicity?When do you dialyze for salicylate toxicity? 2 pts Foundations Challenge Clinical Concepts Concurrent metabolic acidosis and respiratory alkalosis Acute: ASA>100mg/dL Chronic: ASA>60mg/dL OR Presence of renal failure, severe acidemia, cerebral/pulmonary edema

  23. Associations 3 pts Foundations Challenge RAPID FIRE Garlic smell, multi-organ failure Rotten eggs smell, unconscious pt On meds for TB, p/w seizure ??? ??? ???

  24. Associations 3 pts Foundations Challenge RAPID FIRE Garlic smell, multi-organ failure Rotten eggs smell, unconscious pt On meds for TB, p/w seizure Arsenic Hydrogen sulfide Isoniazid

  25. Antidote time! Foundations Challenge RAPID FIRE 2 pts Cyanide Methemoglobinemia ??? ???

  26. Antidote time! Foundations Challenge RAPID FIRE 2 pts Cyanide Methemoglobinemia Hydroxycobalamin OR Na thiosulfate+Amylnitrate+Na nitrate Methylene blue

  27. Antidote time! 3 pts Foundations Challenge RAPID FIRE Acetaminophen Benzodiazepines Methanol/Ethylene Glycol ??? ??? ???

  28. Antidote time! 3 pts Foundations Challenge RAPID FIRE Acetaminophen Benzodiazepines Methanol/Ethylene Glycol N-acetylcysteine (NAC) Flumazenil (NB: may cause seizure) EtOH or fomepizole

  29. Antidote time: toxidromes 5 pts Foundations Challenge RAPID FIRE Sympathomimetic Anticholinergic Serotonin syndrome Neuroleptic malignant syndrome Malignant hyperthermia ??? ??? ??? ??? ???

  30. Antidote time: toxidromes 5 pts Foundations Challenge RAPID FIRE Sympathomimetic Anticholinergic Serotonin syndrome Neuroleptic malignant syndrome Malignant hyperthermia Benzos Benzos, consider physostigmine Benzos, consider cyproheptadine Benzos, consider bromocriptine Dantrolene

  31. Antidote time: Metals 5 pts Foundations Challenge RAPID FIRE ??? ??? ??? ??? ??? Iron Lead Mercury Arsenic Lithium

  32. 5 pts Foundations Challenge RAPID FIRE Antidote time: Metals Iron Lead Mercury Arsenic Lithium Deferoxamine Dimercaprol or EDTA Dimercaprol Dimercaprol Hemodialysis

  33. Good Luck!!! www.emergencymedicinefoundations.com

  34. References Foundations Teaching Content: Dr. Andrew Ketterer, MD, MA Medical Education Fellow, Beth Israel Deaconess Dr. Kristen Grabow Moore, MD, MEd Assistant Professor, Emory University References: • Life in the Fast Lane • HippoEM Board Review • Rivers Written Board Review • Medscapeemedicine • Northwestern EM Chief Residents

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