FACEM Toxicology and Poisoning 2

Question 1

A hiker in Australia is bitten by an unknown snake and develops local pain and systemic symptoms. Which first aid measure is MOST important?

Accepted Answer

Apply pressure immobilization bandaging to the entire bitten limb

Answer

Apply a tourniquet proximal to the bite site

Answer

Incise the bite site and suction out venom

Answer

Wash the bite site thoroughly with soap and water

Question 2

A patient with respiratory depression after benzodiazepine overdose is considered for flumazenil. What is the most important contraindication to its use?

Accepted Answer

Physical dependence on benzodiazepines

Answer

History of asthma

Answer

Suspected co-ingestion of opioids

Answer

Advanced age with renal impairment

Question 3

A patient presents with visual disturbances, high anion gap metabolic acidosis, and osmolar gap after suspected methanol ingestion. What is the mechanism of methanol toxicity?

Accepted Answer

Accumulation of formaldehyde and formic acid via alcohol dehydrogenase metabolism

Answer

Direct methanol-induced retinal ischemia

Answer

Competitive inhibition of cytochrome P450 3A4

Answer

Methemoglobin formation impairing oxygen delivery

Question 4

A patient with beta-blocker overdose has a heart rate of 32 bpm and BP of 70/40 mmHg, refractory to atropine 3mg IV. What is the next most appropriate treatment?

Accepted Answer

Glucagon 3–5mg IV bolus

Answer

High-dose insulin euglycemic therapy (HIET)

Answer

Calcium gluconate 1g IV

Answer

Norepinephrine infusion at 0.1 mcg/kg/min

Question 5

A patient develops hyperthermia (39.8°C), clonus, hyperreflexia, mydriasis, and diaphoresis after starting tramadol and sertraline concurrently. What is the most likely diagnosis?

Accepted Answer

Serotonin syndrome

Answer

Neuroleptic malignant syndrome

Answer

Malignant hyperthermia

Answer

Anticholinergic toxidrome

Question 6

A patient with severe calcium channel blocker overdose develops cardiogenic shock unresponsive to calcium, vasopressors, and atropine. Which treatment has the most evidence for this scenario?

Accepted Answer

High-dose insulin euglycemic therapy (HIET) with dextrose

Answer

Sodium bicarbonate 2 mEq/kg IV bolus

Answer

Magnesium sulfate 4g IV infusion

Answer

Phenylephrine infusion at 2 mcg/kg/min

Question 7

A firefighter is removed from a structure fire with severe lactic acidosis, refractory cardiovascular collapse, and a bitter almond odor. Which antidote is the current preferred treatment for suspected cyanide poisoning?

Accepted Answer

Hydroxocobalamin 5g IV

Answer

Sodium thiosulfate 12.5g IV alone

Answer

Dicobalt edetate 300mg IV

Answer

Amyl nitrite inhalation followed by sodium nitrite IV