AMLS Toxicological Emergencies 1 — Questions and Answers
Question 1: Which toxidrome is characterized by miosis, bradycardia, excessive secretions, and bronchospasm?
- Cholinergic toxidrome (organophosphate poisoning) (Correct answer)
- Sympathomimetic toxidrome
- Anticholinergic toxidrome
- Opioid toxidrome
Correct answer: Cholinergic toxidrome (organophosphate poisoning)
The cholinergic toxidrome from organophosphate or nerve agent exposure presents with SLUDGE signs: salivation, lacrimation, urination, defecation, GI distress, emesis.
Question 2: What is the specific antidote for opioid overdose with respiratory depression?
- Naloxone (Narcan) (Correct answer)
- Flumazenil
- N-acetylcysteine
- Physostigmine
Correct answer: Naloxone (Narcan)
Naloxone competitively antagonizes opioid receptors and rapidly reverses respiratory depression, miosis, and altered consciousness in opioid overdose.
Question 3: A patient presents with fever, tachycardia, hypertension, mydriasis, and dry flushed skin. Which toxidrome is most likely?
- Anticholinergic toxidrome (Correct answer)
- Cholinergic toxidrome
- Opioid toxidrome
- Sedative-hypnotic toxidrome
Correct answer: Anticholinergic toxidrome
The anticholinergic toxidrome is described as 'hot as a hare, dry as a bone, blind as a bat, red as a beet, mad as a hatter.'
Question 4: Which laboratory finding is the hallmark of acetaminophen (Tylenol) toxicity in the delayed phase (24-72 hours)?
- Elevated AST/ALT indicating hepatocellular damage (Correct answer)
- Metabolic alkalosis
- Hyperglycemia
- Elevated creatinine only
Correct answer: Elevated AST/ALT indicating hepatocellular damage
Acetaminophen overdose causes hepatic necrosis, leading to markedly elevated liver enzymes (AST/ALT) in the delayed phase 24–72 hours post-ingestion.
Question 5: What is the antidote for acetaminophen overdose?
- N-acetylcysteine (NAC) (Correct answer)
- Activated charcoal alone
- Sodium bicarbonate
- Atropine
Correct answer: N-acetylcysteine (NAC)
N-acetylcysteine replenishes glutathione stores, preventing toxic NAPQI accumulation and hepatic injury from acetaminophen overdose.
Question 6: A patient with beta-blocker overdose presents with bradycardia and hypotension unresponsive to atropine. What is the next treatment?
- High-dose insulin therapy with dextrose (HIE) (Correct answer)
- Digoxin-specific antibodies (Digibind)
- Flumazenil IV
- Naloxone infusion
Correct answer: High-dose insulin therapy with dextrose (HIE)
High-dose insulin euglycemia therapy improves myocardial function in beta-blocker and calcium channel blocker toxicity by enhancing cardiac glucose uptake.
AMLS Toxicological Emergencies 1
Which toxidrome is characterized by miosis, bradycardia, excessive secretions, and bronchospasm?