1 / 42

Diagnosis of Poisoning QUIZ

Diagnosis of Poisoning QUIZ. Kent R. Olson, MD California Poison Control System. 1. Which of the following sources of information is useful for Dx of OD?. The patient Family and friends Paramedics The pharmacy All of the above.

rianna
Download Presentation

Diagnosis of Poisoning QUIZ

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Diagnosis of Poisoning QUIZ Kent R. Olson, MD California Poison Control System

  2. 1. Which of the following sources of information is useful for Dx of OD? • The patient • Family and friends • Paramedics • The pharmacy • All of the above

  3. 2. Which one of the following can cause a NARROW anion gap? • Methylated spirits • Lithium carbonate • Paracetamol • Hypokalemia • Brompheniramine

  4. 3. What does the “P” in the MUDPILES mnemonic stand for? P________________

  5. 4. Ingestion of which of these will make the breath smell like nail polish remover (acetone)? • Methylated spirits • Eucalyptus oil • Oil of wintergreen • Rubbing alcohol • Cyanide

  6. Electrocardiogram for next case:

  7. 5. Given the ECG findings, which intoxication is most likely? • Verapamil • Beta blocker • Digoxin • Amitriptyline • Lithium

  8. 6. Six hours after drinking a cupful of antifreeze chased with vodka: • Osm gap 45 mmol/L; Anion gap 32 mEq/L; EtOH 0.10 gm% • Osm gap not detectable; Anion gap 32 mEq/L; EtOH 0.10 gm% • Osm gap 45 mmol/L; Anion gap 10 mEq/L; EtOH 0.10 gm%

  9. 7. A patient with poisoning by an organophosphate insecticide has HR 120/min. This is explained by: • Depolarization blockade of muscarinic receptors • Activation of sympathetic ganglia • Blockade of nicotinic receptors • Activation of the enteric nervous system

  10. 8. The neurotransmitter for thermoregulatory sweat glands is: • Serotonin • Norepinephrine • Epinephrine • Acetylcholine • GABA

  11. 9. What is the expected pupil size in a patient who has overdosed on clonidine? • Nonreactive • Constricted • Dilated

  12. 10. After an acute overdose of digoxin in an otherwise healthy person on no meds, what is the expected serum K+? • Normal • Elevated • Low

  13. 11. Which one is NOT likely to give a positive test on a routine drug screen? • Heroin • Codeine • Oxycodone • Cocaine • Diazepam

  14. 12. All can cause metabolic acidosis early after overdose EXCEPT one: • Aspirin • Ibuprofen • Acetaminophen • Diazepam • Isoniazid

  15. 13. Patient has dyspnea and appears cyanotic after ingestion of Pyridium • pO2 low; pulse Ox low • pO2 normal; pulse Ox 89% • pO2 and pCO2 low • pO2 normal, pulse Ox normal

  16. 14. Which one causes pink venous blood with an elevatedvenous pO2? • Carbon monoxide • Cyanide • Carbon tetrachloride • Arsine gas

  17. 15. Which finding is most likely to help differentiate amphetamine from anticholinergic poisoning? • Pupil size • Heart rate • Peristalsis • Sweating • Mental status

  18. 16. Which of the following causes fever, hyperventilation and metabolic acidosis after excessive skin application? • Oil of roses • Oil of wintergreen • Motor oil • Gentian violet • Myristica fragrans

  19. 17. A distinctly blue fluorescence on Wood’s lamp testing of urine strongly suggests poisoning by antifreeze. • True • False

  20. ANSWERS

  21. 1. Which of the following sources of information is useful for Dx of OD? • The patient • Family and friends • Paramedics • The pharmacy • All of the above

  22. 2. Which one of the following can cause a NARROW anion gap? • Methylated spirits • Lithium carbonate • Paracetamol • Hypokalemia • Brompheniramine

  23. Normal anion gap Anion Gap (10 mmol/L) Na+ HCO3- Cl-

  24. Anion gap with Lithium carbonate Li+ Anion Gap (4 mmol/L) Na+ HCO3- Cl-

  25. 3. What does the “P” in the MUDPILES mnemonic stand for? P________________ Paraldehyde Phenformin or . . . Paracetamol?

  26. 4. Ingestion of which of these will make the breath smell like nail polish remover (acetone)? • Methylated spirits • Eucalyptus oil • Oil of wintergreen • Rubbing alcohol • Cyanide

  27. Electrocardiogram for the next case:

  28. 5. Given the ECG findings, which intoxication is most likely? • Verapamil • Beta blocker • Digoxin • Amitriptyline • Lithium

  29. 6. Six hours after drinking a cupful of antifreeze chased with vodka: • Osm gap 45 mmol/L; Anion gap 32 mEq/L; EtOH 0.10 gm% • Osm gap not detectable; Anion gap 32 mEq/L; EtOH 0.10 gm% • Osm gap 45 mmol/L; Anion gap 10 mEq/L; EtOH 0.10 gm%

  30. 7. A patient with poisoning by an organophosphate insecticide has HR 120/min. This is explained by: • Depolarization blockade of muscarinic receptors • Activation of sympathetic ganglia • Blockade of nicotinic receptors • Activation of the enteric nervous system

  31. 8. The neurotransmitter for thermoregulatory sweat glands is: • Serotonin • Norepinephrine • Epinephrine • Acetylcholine • GABA

  32. 9. What is the expected pupil size in a patient who has overdosed on clonidine? • Nonreactive • Constricted • Dilated

  33. 10. After an acute overdose of digoxin in an otherwise healthy person on no meds, what is the expected serum K+? • Normal • Elevated • Low Digoxin inhibits the Na-K-ATPase pump, leading to extracellular K+ accumulation

  34. 11. Which one is NOT likely to give a positive test on a routine drug screen? • Heroin • Codeine • Oxycodone • Cocaine • Diazepam

  35. 12. All can cause metabolic acidosis early after overdose EXCEPT one: • Aspirin • Ibuprofen • Acetaminophen • Diazepam • Isoniazid

  36. 13. Patient has dyspnea and appears cyanotic after ingestion of Pyridium® • pO2 low; pulse Ox low • pO2 normal; pulse Ox 89% • pO2 and pCO2 low • pO2 normal, pulse Ox normal

  37. 14. Which one causes pink venous blood with an elevatedvenous pO2? • Carbon monoxide • Cyanide • Carbon tetrachloride • Arsine gas

  38. 15. Which finding is most likely to help differentiate amphetamine from anticholinergic poisoning? • Pupil size • Heart rate • Peristalsis • Sweating • Mental status

  39. 16. Which of the following causes fever, hyperventilation and metabolic acidosis after excessive skin application? • Oil of roses • Oil of wintergreen (methyl salicylate) • Motor oil • Gentian violet • Myristica fragrans

  40. 17. A distinctly blue fluorescence on Wood’s lamp testing of urine strongly suggests poisoning by antifreeze. • True • False Mean examiner sensitivity, specificity, and accuracy for detecting the presence of fluorescein in urine were 35%, 75%, and 48% Ann Emerg Med 2001; 38:49

  41. Tie-breaker question: which of the following can cause miosis, bradycardia, drowsiness and hypertension? • Amlodipine • Chlorpromazine • Tetrahydrozoline • Zolpidem • Tolterodine

  42. Tie-breaker question: which of the following can cause miosis, bradycardia, drowsiness and hypertension? • Amlodipine • Chlorpromazine • Tetrahydrozoline • Zolpidem • Tolterodine

More Related