BCEN Toxicology 3 — Questions and Answers
Question 1: A patient presents with altered mental status, miosis, bradycardia, and excessive salivation after pesticide exposure. Which intervention is the highest priority?
- Administer pralidoxime only
- Administer atropine to dry secretions and protect airway (Correct answer)
- Perform gastric lavage immediately
- Administer activated charcoal
Correct answer: Administer atropine to dry secretions and protect airway
In organophosphate poisoning, atropine is the priority to reverse muscarinic effects, especially secretions that threaten airway patency.
Question 2: Which urine color change is associated with significant rhabdomyolysis from drug toxicity?
- Orange urine
- Tea-colored or brown urine (Correct answer)
- Bright red urine
- Milky white urine
Correct answer: Tea-colored or brown urine
Tea-colored or brown urine indicates myoglobinuria from rhabdomyolysis, a serious complication requiring aggressive IV fluid resuscitation.
Question 3: A patient on warfarin presents with supratherapeutic INR of 9.5 and active major bleeding. What is the MOST appropriate treatment?
- Hold warfarin and recheck INR in 24 hours
- Administer vitamin K 10 mg IV only
- Administer 4-factor prothrombin complex concentrate and vitamin K (Correct answer)
- Administer fresh frozen plasma alone
Correct answer: Administer 4-factor prothrombin complex concentrate and vitamin K
4-factor PCC provides immediate reversal of warfarin effect for life-threatening bleeding, while IV vitamin K ensures sustained reversal.
Question 4: A patient presents with hypotension, bradycardia, and hyperglycemia after suspected calcium channel blocker overdose. Which treatment is appropriate for refractory shock?
- High-dose insulin euglycemic therapy (Correct answer)
- Sodium bicarbonate infusion
- Flumazenil administration
- Activated charcoal only
Correct answer: High-dose insulin euglycemic therapy
High-dose insulin euglycemic therapy improves myocardial function in calcium channel blocker toxicity by enhancing carbohydrate metabolism in cardiac cells.
Question 5: Which symptom cluster correctly describes the anticholinergic toxidrome?
- Miosis, bradycardia, diaphoresis, urinary retention
- Mydriasis, tachycardia, dry skin, urinary retention (Correct answer)
- Miosis, bradycardia, bronchospasm, lacrimation
- Mydriasis, bradycardia, flushing, diaphoresis
Correct answer: Mydriasis, tachycardia, dry skin, urinary retention
The anticholinergic toxidrome is remembered as 'hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter' — mydriasis, tachycardia, dry skin, urinary retention.
Question 6: A patient presents with severe salicylate toxicity and an arterial blood gas showing respiratory alkalosis with metabolic acidosis. Which treatment should be initiated?
- Hemodialysis only for pH less than 7.0
- Sodium bicarbonate IV drip to alkalinize urine (Correct answer)
- Activated charcoal regardless of time since ingestion
- Calcium gluconate infusion
Correct answer: Sodium bicarbonate IV drip to alkalinize urine
Urinary alkalinization with sodium bicarbonate traps ionized salicylate in the renal tubules, enhancing elimination and reducing CNS penetration.
Question 7: Which toxic ingestion classically causes a 'toxidrome gap' — meaning a wide anion gap metabolic acidosis with an elevated osmol gap?
- Salicylate overdose
- Isoniazid toxicity
- Ethylene glycol ingestion (Correct answer)
- Lithium toxicity
Correct answer: Ethylene glycol ingestion
Ethylene glycol is metabolized to glycolic and oxalic acids, causing both an elevated osmol gap (unmeasured osmoles) and anion gap acidosis.
BCEN Toxicology 3
A patient presents with altered mental status, miosis, bradycardia, and excessive salivation after pesticide exposure.
Which intervention is the highest priority?