BCEN Toxicology 2 — Questions and Answers
Question 1: A patient presents with bradycardia, hypotension, and bronchospasm after ingesting a medication. Which antidote is most appropriate?
- Naloxone
- Atropine and glucagon (Correct answer)
- Flumazenil
- N-acetylcysteine
Correct answer: Atropine and glucagon
Beta-blocker toxicity causes bradycardia, hypotension, and bronchospasm; atropine addresses bradycardia and glucagon reverses cardiac effects.
Question 2: Which finding is MOST consistent with serotonin syndrome rather than neuroleptic malignant syndrome?
- Lead-pipe rigidity
- Hyperthermia over 41°C
- Clonus and hyperreflexia (Correct answer)
- Diaphoresis with normal reflexes
Correct answer: Clonus and hyperreflexia
Clonus and hyperreflexia are hallmark features of serotonin syndrome, distinguishing it from NMS which presents with lead-pipe rigidity.
Question 3: A patient with acetaminophen overdose presents 20 hours post-ingestion. The Rumack-Matthew nomogram indicates toxic levels. What is the priority intervention?
- Activated charcoal administration
- Initiate N-acetylcysteine immediately (Correct answer)
- Gastric lavage
- Hemodialysis
Correct answer: Initiate N-acetylcysteine immediately
N-acetylcysteine is effective and should be started even at 20 hours post-ingestion when serum levels indicate toxicity.
Question 4: Which ECG change is the MOST sensitive indicator of tricyclic antidepressant toxicity?
- Prolonged PR interval
- ST elevation in V1-V3
- QRS duration greater than 100 ms (Correct answer)
- T-wave inversions in lateral leads
Correct answer: QRS duration greater than 100 ms
QRS widening greater than 100 ms is the most sensitive ECG marker for TCA toxicity and predicts risk of seizures and dysrhythmias.
Question 5: A child ingests iron tablets. Which laboratory finding indicates severe iron toxicity?
- Serum iron level of 150 mcg/dL
- Serum iron level greater than 500 mcg/dL (Correct answer)
- Elevated serum ferritin only
- White blood cell count of 12,000
Correct answer: Serum iron level greater than 500 mcg/dL
Serum iron greater than 500 mcg/dL indicates severe toxicity and typically warrants deferoxamine chelation therapy.
Question 6: A patient presents after methanol ingestion. Which finding indicates the most serious complication?
- Mild nausea and vomiting
- Visual disturbances and blurred vision (Correct answer)
- Headache and dizziness
- Mild metabolic acidosis
Correct answer: Visual disturbances and blurred vision
Visual disturbances from methanol toxicity indicate formic acid accumulation causing optic nerve damage, which can lead to permanent blindness.
Question 7: When treating cocaine-induced chest pain, which medication is CONTRAINDICATED?
- Benzodiazepines
- Aspirin
- Nitroglycerin
- Propranolol (Correct answer)
Correct answer: Propranolol
Beta-blockers like propranolol are contraindicated in cocaine toxicity because unopposed alpha-adrenergic stimulation can worsen coronary vasospasm and hypertension.
BCEN Toxicology 2
A patient presents with bradycardia, hypotension, and bronchospasm after ingesting a medication.
Which antidote is most appropriate?