Diagnosis of Diagnosis of PoisoningPoisoning QUIZ QUIZ

Diagnosis of Diagnosis of PoisoningPoisoning QUIZ QUIZ

Kent R. Olson, MDKent R. Olson, MDCalifornia Poison Control SystemCalifornia Poison Control System

1. Which of the following sources of information is useful for Dx of OD?

A. The patientB. Family and friendsC. ParamedicsD. The pharmacyE. All of the above

2. Which one of the following can cause a NARROW anion gap?

A. Methylated spiritsB. Lithium carbonateC. ParacetamolD. HypokalemiaE. Brompheniramine

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

P________________

4. Ingestion of which of these will make the breath smell like nail polish remover (acetone)?

A. Methylated spiritsB. Eucalyptus oilC. Oil of wintergreenD. Rubbing alcoholE. Cyanide

Electrocardiogram for next case:

5. Given the ECG findings, which intoxication is most likely?

A. VerapamilB. Beta blockerC. DigoxinD. AmitriptylineE. Lithium

6. Six hours after drinking a cupful of antifreeze chased with vodka:

A. Osm gap 45 mmol/L; Anion gap 32 mEq/L; EtOH 0.10 gm%

B. Osm gap not detectable; Anion gap 32 mEq/L; EtOH 0.10 gm%

C. Osm gap 45 mmol/L; Anion gap 10 mEq/L; EtOH 0.10 gm%

7. A patient with poisoning by an organophosphate insecticide has HR 120/min. This is explained by:

A. Depolarization blockade of muscarinic receptors

B. Activation of sympathetic ganglia

C. Blockade of nicotinic receptorsD. Activation of the enteric nervous

system

8. The neurotransmitter for thermoregulatory sweat glands is:

A. SerotoninB. NorepinephrineC. EpinephrineD. AcetylcholineE. GABA

9. What is the expected pupil size in a patient who has overdosed on clonidine?

A. NonreactiveB. ConstrictedC. Dilated

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

A. NormalB. ElevatedC. Low

11. Which one is NOT likely to give a positive test on a routine drug screen?

A. HeroinB. CodeineC. OxycodoneD. CocaineE. Diazepam

12. All can cause metabolic acidosis early after overdose EXCEPT one:

A. AspirinB. IbuprofenC. AcetaminophenD. DiazepamE. Isoniazid

13. Patient has dyspnea and appears cyanotic after ingestion of Pyridium

A. pO2 low; pulse Ox lowB. pO2 normal; pulse Ox 89%C. pO2 and pCO2 lowD. pO2 normal, pulse Ox normal

14. Which one causes pink venous blood with an elevated venous pO2?

A. Carbon monoxideB. CyanideC. Carbon tetrachlorideD. Arsine gas

15. Which finding is most likely to help differentiate amphetamine from anticholinergic poisoning?

A. Pupil sizeB. Heart rateC. PeristalsisD. SweatingE. Mental status

16. Which of the following causes fever, hyperventilation and metabolic acidosis after excessive skin application?

A. Oil of rosesB. Oil of wintergreenC. Motor oilD. Gentian violetE. Myristica fragrans

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

A. TrueB. False

ANSWERS

1. Which of the following sources of information is useful for Dx of OD?

A. The patientB. Family and friendsC. ParamedicsD. The pharmacyE. All of the above

2. Which one of the following can cause a NARROW anion gap?

A. Methylated spiritsB. Lithium carbonateC. ParacetamolD. HypokalemiaE. Brompheniramine

Na+

Cl-

HCO3-

Anion Gap(10 mmol/L)

Normal anion gap

Anion gap with Lithium carbonate

Na+

Cl-

HCO3-

Anion Gap(4 mmol/L)

Li+

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

P________________ParaldehydePhenforminor . . . Paracetamol?

4. Ingestion of which of these will make the breath smell like nail polish remover (acetone)?

A. Methylated spiritsB. Eucalyptus oilC. Oil of wintergreenD. Rubbing alcoholE. Cyanide

Electrocardiogram for the next case:

5. Given the ECG findings, which intoxication is most likely?

A. VerapamilB. Beta blockerC. DigoxinD. AmitriptylineE. Lithium

6. Six hours after drinking a cupful of antifreeze chased with vodka:

A. Osm gap 45 mmol/L; Anion gap 32 mEq/L; EtOH 0.10 gm%

B. Osm gap not detectable; Anion gap 32 mEq/L; EtOH 0.10 gm%

C. Osm gap 45 mmol/L; Anion gap 10 mEq/L; EtOH 0.10 gm%

7. A patient with poisoning by an organophosphate insecticide has HR 120/min. This is explained by:

A. Depolarization blockade of muscarinic receptors

B. Activation of sympathetic ganglia

C. Blockade of nicotinic receptorsD. Activation of the enteric nervous

system

8. The neurotransmitter for thermoregulatory sweat glands is:

A. SerotoninB. NorepinephrineC. EpinephrineD. AcetylcholineE. GABA

9. What is the expected pupil size in a patient who has overdosed on clonidine?

A. NonreactiveB. ConstrictedC. Dilated

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

A. NormalB. ElevatedC. Low

Digoxin inhibits the Na-K-ATPase pump,

leading to extracellular K+ accumulation

11. Which one is NOT likely to give a positive test on a routine drug screen?

A. HeroinB. CodeineC. OxycodoneD. CocaineE. Diazepam

12. All can cause metabolic acidosis early after overdose EXCEPT one:

A. AspirinB. IbuprofenC. AcetaminophenD. DiazepamE. Isoniazid

13. Patient has dyspnea and appears cyanotic after ingestion of Pyridium®

A. pO2 low; pulse Ox lowB. pO2 normal; pulse Ox 89%C. pO2 and pCO2 lowD. pO2 normal, pulse Ox normal

14. Which one causes pink venous blood with an elevated venous pO2?

A. Carbon monoxideB. CyanideC. Carbon tetrachlorideD. Arsine gas

15. Which finding is most likely to help differentiate amphetamine from anticholinergic poisoning?

A. Pupil sizeB. Heart rateC. PeristalsisD. SweatingE. Mental status

16. Which of the following causes fever, hyperventilation and metabolic acidosis after excessive skin application?

A. Oil of rosesB. Oil of wintergreen (methyl

salicylate)C. Motor oilD. Gentian violetE. Myristica fragrans

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

A. TrueB. 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

Tie-breaker question: which of the following can cause miosis, bradycardia, drowsiness and hypertension?

A. AmlodipineB. ChlorpromazineC. TetrahydrozolineD. ZolpidemE. Tolterodine

Tie-breaker question: which of the following can cause miosis, bradycardia, drowsiness and hypertension?

A. AmlodipineB. ChlorpromazineC. TetrahydrozolineD. ZolpidemE. Tolterodine