ENPC Toxicological Emergencies 1 — Questions and Answers
Question 1: Which antidote is indicated for acetaminophen toxicity in pediatric patients?
- Naloxone
- N-acetylcysteine (NAC) (Correct answer)
- Flumazenil
- Atropine
Correct answer: N-acetylcysteine (NAC)
N-acetylcysteine replenishes glutathione stores and prevents hepatotoxicity from acetaminophen overdose.
Question 2: A 4-year-old presents with miosis, bradycardia, excessive secretions, and bronchospasm after pesticide exposure. Which toxidrome does this represent?
- Sympathomimetic
- Anticholinergic
- Cholinergic (Correct answer)
- Opioid
Correct answer: Cholinergic
Organophosphate and carbamate pesticides inhibit acetylcholinesterase, producing the cholinergic toxidrome (SLUDGE/DUMBELS).
Question 3: What is the first-line antidote for opioid-induced respiratory depression in a pediatric patient?
- Atropine
- Flumazenil
- Naloxone (Correct answer)
- Activated charcoal
Correct answer: Naloxone
Naloxone is a competitive opioid receptor antagonist that rapidly reverses opioid-induced respiratory depression and sedation.
Question 4: Which GI decontamination method is MOST appropriate for an alert 2-year-old who ingested an unknown substance 30 minutes ago?
- Ipecac syrup
- Gastric lavage
- Activated charcoal (Correct answer)
- Whole bowel irrigation
Correct answer: Activated charcoal
Activated charcoal is most effective when given within 1 hour of ingestion in alert patients who can protect their airway.
Question 5: A teenager presents with hyperthermia, tachycardia, hypertension, agitation, and dilated pupils. Which toxidrome is most likely?
- Opioid toxidrome
- Cholinergic toxidrome
- Sedative-hypnotic toxidrome
- Sympathomimetic toxidrome (Correct answer)
Correct answer: Sympathomimetic toxidrome
Sympathomimetic toxidrome from cocaine or amphetamines presents with hyperthermia, tachycardia, hypertension, agitation, and mydriasis.
Question 6: Which clinical finding best indicates severe acetaminophen hepatotoxicity rather than early ingestion effects?
- Nausea and vomiting
- Right upper quadrant pain
- Markedly elevated transaminases with coagulopathy (Correct answer)
- Mild tachycardia
Correct answer: Markedly elevated transaminases with coagulopathy
Markedly elevated transaminases combined with coagulopathy signal hepatic injury from acetaminophen-induced NAPQI accumulation.
Question 7: What is the appropriate dose of activated charcoal for a pediatric patient weighing 20 kg?
- 5 grams
- 10 grams
- 20 grams (Correct answer)
- 50 grams
Correct answer: 20 grams
The recommended dose of activated charcoal is 1 g/kg body weight, so a 20 kg child receives 20 grams.
ENPC Toxicological Emergencies 1
Which antidote is indicated for acetaminophen toxicity in pediatric patients?