FISDAP Toxicology and Substance Abuse

Question 1

A patient is found unresponsive with pinpoint pupils, slow respirations (4/min), and cyanosis. Bystanders report heroin use. What is the priority intervention?

Accepted Answer

Support ventilation and administer naloxone

Answer

The classic opioid toxidrome (unresponsive, pinpoint pupils, respiratory depression) is reversed by naloxone (Narcan), an opioid antagonist. However, ventilatory support must begin immediately — airway and breathing take priority, and naloxone is given concurrently or immediately after.

Question 2

A patient presents with salivation, lacrimation, urination, defecation, GI distress, and emesis (SLUDGE). The patient was spraying insecticide. What class of toxin is responsible?

Accepted Answer

Organophosphates (cholinergic agents)

Answer

SLUDGE is the mnemonic for cholinergic toxidrome caused by organophosphate or carbamate insecticides, which inhibit acetylcholinesterase. Treatment includes atropine (to block muscarinic effects) and pralidoxime (2-PAM) to reactivate cholinesterase.

Question 3

An EMT responds to a patient found in a closed garage with a running vehicle. The patient is confused and has a headache. Skin color appears flushed and cherry-red. What is the most appropriate initial treatment?

Accepted Answer

Remove the patient from the environment and administer 100% high-flow oxygen

Answer

These are classic signs of carbon monoxide (CO) poisoning. CO displaces oxygen from hemoglobin. The antidote is high-flow 100% oxygen, which accelerates CO elimination. Standard pulse oximetry is unreliable in CO poisoning — SpO2 will read falsely normal because CO-bound hemoglobin reads as oxyhemoglobin.

Question 4

A patient who takes tricyclic antidepressants (TCAs) is found unresponsive with a wide QRS complex on the monitor. Which treatment is most appropriate for this toxicity?

Accepted Answer

Administer sodium bicarbonate to alkalinize the blood

Answer

TCA overdose causes sodium channel blockade, leading to a wide QRS and dysrhythmias. Sodium bicarbonate alkalinizes the blood and raises sodium levels, partially reversing the channel blockade and narrowing the QRS. Naloxone is ineffective; vomiting is contraindicated with altered mental status.

Question 5

A patient presents with hyperthermia, tachycardia, hypertension, dilated pupils, and agitation after cocaine use. Which toxidrome does this represent?

Accepted Answer

Sympathomimetic toxidrome

Answer

Cocaine and other stimulants produce a sympathomimetic toxidrome: the body is in a hyper-adrenergic state with increased heart rate, blood pressure, temperature, and agitation, along with mydriasis (dilated pupils). Management is supportive — benzodiazepines for agitation, cooling for hyperthermia.

(FISDAP) Field Internship Student Data Acquisition Project Practice Test

(FISDAP) Field Internship Student Data Acquisition Project Practice Test

FISDAP Toxicology and Substance Abuse