ENPC Toxicological Emergencies 3

Question 1

Whole bowel irrigation (WBI) is MOST indicated for which pediatric ingestion scenario?

Accepted Answer

Iron tablets, sustained-release medications, or drug body packing

Answer

Any unknown ingestion within 60 minutes

Answer

Liquid ingestions presenting within 30 minutes

Answer

All intentional overdoses regardless of substance

Question 2

A 16-year-old with tricyclic antidepressant (TCA) overdose presents with QRS widening on ECG. What is the PRIORITY treatment?

Accepted Answer

Sodium bicarbonate bolus

Answer

Lidocaine infusion

Answer

Magnesium sulfate infusion

Answer

Amiodarone

Question 3

Which laboratory test is MOST important to guide treatment in a child with suspected acetaminophen overdose?

Accepted Answer

Serum acetaminophen level at 4 hours post-ingestion plotted on the Rumack-Matthew nomogram

Answer

Complete blood count

Answer

Urine drug screen

Answer

Serum transaminases only

Question 4

Which clinical finding in a toddler indicates systemic iron toxicity requiring chelation therapy?

Accepted Answer

Metabolic acidosis with serum iron level >500 mcg/dL

Answer

Nausea and vomiting within 1 hour of ingestion

Answer

Mild diarrhea with normal vital signs

Answer

Slight tachycardia with normal pH

Question 5

What is the mechanism of action of deferoxamine in iron toxicity?

Accepted Answer

Chelates free iron and promotes its excretion as ferrioxamine in urine

Answer

Blocks intestinal iron absorption by competitive inhibition

Answer

Inhibits iron uptake by red blood cells

Answer

Alkalinizes the GI tract to reduce iron solubility

Question 6

A 14-year-old with moderate-severe salicylate toxicity presents with tachypnea and altered mental status. Which acid-base disturbance is expected?

Accepted Answer

Mixed respiratory alkalosis and high anion gap metabolic acidosis

Answer

Respiratory acidosis only

Answer

Pure high anion gap metabolic acidosis

Answer

Metabolic alkalosis with compensatory hypoventilation

Question 7

Which child is at HIGHEST risk for lead toxicity?

Accepted Answer

2-year-old living in a pre-1978 home with deteriorating paint

Answer

12-year-old who frequently eats at fast food restaurants

Answer

8-year-old who drinks tap water from modern plumbing

Answer

6-year-old who plays outdoors frequently in a suburban park