Paramedics Exam Toxicology and Poisoning 2 — Questions and Answers
Question 1: Which presentation best describes the sympathomimetic toxidrome?
- Bradycardia, miosis, bronchospasm, and excessive secretions
- Tachycardia, hypertension, hyperthermia, and mydriasis (Correct answer)
- Sedation, bradycardia, and hypothermia
- Altered mental status, diaphoresis, and muscle rigidity only
Correct answer: Tachycardia, hypertension, hyperthermia, and mydriasis
Cocaine, amphetamines, and similar drugs cause excess adrenergic stimulation, producing tachycardia, hypertension, hyperthermia, and pupil dilation.
Question 2: The SLUDGE mnemonic (Salivation, Lacrimation, Urination, Defecation, GI distress, Emesis) describes which toxidrome?
- Opioid toxidrome
- Anticholinergic toxidrome
- Cholinergic toxidrome (Correct answer)
- Sedative-hypnotic toxidrome
Correct answer: Cholinergic toxidrome
SLUDGE describes excess acetylcholine at muscarinic receptors, seen with organophosphate pesticides, nerve agents, and certain mushroom species.
Question 3: A patient overdosed on metoprolol and presents with symptomatic bradycardia and hypotension. Which treatment combination is most appropriate?
- Atropine and high-dose glucagon IV (Correct answer)
- Naloxone 2 mg IV
- Calcium gluconate 3 g IV
- Sodium bicarbonate 1 mEq/kg IV
Correct answer: Atropine and high-dose glucagon IV
Atropine treats vagally mediated bradycardia and glucagon bypasses beta-receptor blockade to directly stimulate adenylate cyclase and increase cardiac output.
Question 4: A chronic alcohol user presents with confusion, ataxia, and horizontal nystagmus with a blood glucose of 38 mg/dL. What must be administered BEFORE dextrose?
- Naloxone 0.4 mg IV
- Thiamine 100 mg IV/IM (Correct answer)
- Flumazenil 0.2 mg IV
- Sodium bicarbonate 50 mEq IV
Correct answer: Thiamine 100 mg IV/IM
Giving glucose before thiamine to a thiamine-deficient alcoholic patient can precipitate Wernicke's encephalopathy by consuming the last remaining thiamine stores.
Question 5: Which finding best distinguishes methanol poisoning from ethanol intoxication?
- Visual disturbances and high anion gap metabolic acidosis (Correct answer)
- Slurred speech and ataxia
- Sedation and respiratory depression
- Tachycardia and hypertension
Correct answer: Visual disturbances and high anion gap metabolic acidosis
Methanol is metabolized to formic acid, causing high anion gap metabolic acidosis and optic nerve toxicity with visual changes not seen with ethanol.
Question 6: You administer flumazenil to a benzodiazepine overdose patient. Which complication must you most closely monitor for?
- Hypertensive crisis
- Precipitation of opioid withdrawal
- Seizures in a chronic benzodiazepine user (Correct answer)
- Ventricular fibrillation
Correct answer: Seizures in a chronic benzodiazepine user
Flumazenil can precipitate acute benzodiazepine withdrawal causing refractory seizures, especially dangerous in patients with chronic use or polysubstance ingestion.
Question 7: Which acid-base pattern is most characteristic of salicylate (aspirin) poisoning in adults?
- Respiratory alkalosis followed by metabolic acidosis (Correct answer)
- Metabolic alkalosis followed by respiratory acidosis
- Pure respiratory alkalosis throughout the course
- Pure metabolic acidosis from the onset
Correct answer: Respiratory alkalosis followed by metabolic acidosis
Salicylates directly stimulate the respiratory center causing initial respiratory alkalosis, then impair oxidative phosphorylation producing high anion gap metabolic acidosis.
Paramedics Exam Toxicology and Poisoning 2
Which presentation best describes the sympathomimetic toxidrome?