FACEM Toxicology and Poisoning

Question 1

A 25-year-old presents 4 hours after ingesting 15g of acetaminophen. What is the most appropriate initial management step?

Accepted Answer

Obtain a serum acetaminophen level and plot it on the Rumack-Matthew nomogram

Answer

The Rumack-Matthew nomogram requires a serum acetaminophen level drawn at 4 hours or later post-ingestion to accurately stratify risk and determine whether NAC is indicated.

Question 2

A patient presents with QRS widening to 160ms after tricyclic antidepressant (TCA) overdose. What is the most appropriate immediate treatment?

Accepted Answer

Sodium bicarbonate 1–2 mEq/kg IV bolus

Answer

Sodium bicarbonate alkalinizes the serum and provides a sodium load that reverses TCA-induced fast sodium channel blockade, narrowing the QRS and reducing arrhythmia risk.

Question 3

A farm worker presents with excessive secretions, miosis, bradycardia, urinary incontinence, and muscle fasciculations. Which antidote should be administered first?

Accepted Answer

Atropine 2–4mg IV, titrated until secretions dry

Answer

Atropine is the first-line antidote for organophosphate poisoning, blocking muscarinic receptors to reduce secretions and bradycardia; pralidoxime is given concurrently but atropine takes priority.

Question 4

A patient is found unresponsive with miosis, respiratory rate of 6 breaths/min, and oxygen saturation of 78%. What is the most appropriate antidote?

Accepted Answer

Naloxone 0.4–2mg IV

Answer

The classic opioid toxidrome — miosis, respiratory depression, and decreased consciousness — is rapidly reversed by naloxone, a competitive opioid antagonist.

Question 5

A patient rescued from a house fire presents with headache, confusion, vomiting, and cherry-red skin. What is the most appropriate immediate treatment?

Accepted Answer

Administer 100% oxygen via non-rebreather mask

Answer

High-flow 100% oxygen via non-rebreather mask is the immediate first-line treatment for carbon monoxide poisoning, accelerating the half-life reduction of carboxyhemoglobin from ~5 hours to ~60–90 minutes.

(FACEM) Fellowship of the Australasian College for Emergency Medicine Practice Test

(FACEM) Fellowship of the Australasian College for Emergency Medicine Practice Test

FACEM Toxicology and Poisoning