Diagnosis of Poisoning QUIZ

1
Diagnosis of Poisoning QUIZ

• Kent R. Olson, MD
• California Poison Control System

2
1. Which of the following sources of information
is useful for Dx of OD?

• The patient
• Family and friends
• Paramedics
• The pharmacy
• All of the above

3
2. Which one of the following can cause a NARROW
anion gap?

• Methylated spirits
• Lithium carbonate
• Paracetamol
• Hypokalemia
• Brompheniramine

4
3. What does the P in the MUDPILES mnemonic
stand for?

• P________________

5
4. Ingestion of which of these will make the
breath smell like nail polish remover (acetone)?

• Methylated spirits
• Eucalyptus oil
• Oil of wintergreen
• Rubbing alcohol
• Cyanide

6
Electrocardiogram for next case
7
5. Given the ECG findings, which intoxication is
most likely?

• Verapamil
• Beta blocker
• Digoxin
• Amitriptyline
• Lithium

8
6. Six hours after drinking a cupful of
antifreeze chased with vodka

• Osm gap 45 mmol/L Anion gap 32 mEq/L EtOH 0.10
  gm
• Osm gap not detectable Anion gap 32 mEq/L EtOH
  0.10 gm
• Osm gap 45 mmol/L Anion gap 10 mEq/L EtOH 0.10
  gm

9
7. A patient with poisoning by an organophosphate
insecticide has HR 120/min. This is explained by

• Depolarization blockade of muscarinic receptors
• Activation of sympathetic ganglia
• Blockade of nicotinic receptors
• Activation of the enteric nervous system

10
8. The neurotransmitter for thermoregulatory
sweat glands is

• Serotonin
• Norepinephrine
• Epinephrine
• Acetylcholine
• GABA

11
9. What is the expected pupil size in a patient
who has overdosed on clonidine?

• Nonreactive
• Constricted
• Dilated

12
10. After an acute overdose of digoxin in an
otherwise healthy person on no meds, what is the
expected serum K?

• Normal
• Elevated
• Low

13
11. Which one is NOT likely to give a positive
test on a routine drug screen?

• Heroin
• Codeine
• Oxycodone
• Cocaine
• Diazepam

14
12. All can cause metabolic acidosis early after
overdose EXCEPT one

• Aspirin
• Ibuprofen
• Acetaminophen
• Diazepam
• Isoniazid

15
13. Patient has dyspnea and appears cyanotic
after ingestion of Pyridium

• pO2 low pulse Ox low
• pO2 normal pulse Ox 89
• pO2 and pCO2 low
• pO2 normal, pulse Ox normal

16
14. Which one causes pink venous blood with an
elevated venous pO2?

• Carbon monoxide
• Cyanide
• Carbon tetrachloride
• Arsine gas

17
15. Which finding is most likely to help
differentiate amphetamine from anticholinergic
poisoning?

• Pupil size
• Heart rate
• Peristalsis
• Sweating
• Mental status

18
16. Which of the following causes fever,
hyperventilation and metabolic acidosis after
excessive skin application?

• Oil of roses
• Oil of wintergreen
• Motor oil
• Gentian violet
• Myristica fragrans

19
17. A distinctly blue fluorescence on Woods lamp
testing of urine strongly suggests poisoning by
antifreeze.

• True
• False

20
ANSWERS
21
1. Which of the following sources of information
is useful for Dx of OD?

• The patient
• Family and friends
• Paramedics
• The pharmacy
• All of the above

22
2. Which one of the following can cause a NARROW
anion gap?

• Methylated spirits
• Lithium carbonate
• Paracetamol
• Hypokalemia
• Brompheniramine

23
Normal anion gap
Anion Gap (10 mmol/L)
Na
HCO3-
Cl-
24
Anion gap with Lithium carbonate
Li
Anion Gap (4 mmol/L)
Na
HCO3-
Cl-
25
3. What does the P in the MUDPILES mnemonic
stand for?

• P________________
• Paraldehyde Phenformin or . . . Paracetamol?

26
4. Ingestion of which of these will make the
breath smell like nail polish remover (acetone)?

• Methylated spirits
• Eucalyptus oil
• Oil of wintergreen
• Rubbing alcohol
• Cyanide

27
Electrocardiogram for the next case
28
5. Given the ECG findings, which intoxication is
most likely?

• Verapamil
• Beta blocker
• Digoxin
• Amitriptyline
• Lithium

29
6. Six hours after drinking a cupful of
antifreeze chased with vodka

• Osm gap 45 mmol/L Anion gap 32 mEq/L EtOH 0.10
  gm
• Osm gap not detectable Anion gap 32 mEq/L EtOH
  0.10 gm
• Osm gap 45 mmol/L Anion gap 10 mEq/L EtOH 0.10
  gm

30
7. A patient with poisoning by an organophosphate
insecticide has HR 120/min. This is explained by

• Depolarization blockade of muscarinic receptors
• Activation of sympathetic ganglia
• Blockade of nicotinic receptors
• Activation of the enteric nervous system

31
8. The neurotransmitter for thermoregulatory
sweat glands is

• Serotonin
• Norepinephrine
• Epinephrine
• Acetylcholine
• GABA

32
9. What is the expected pupil size in a patient
who has overdosed on clonidine?

• Nonreactive
• Constricted
• Dilated

33
10. After an acute overdose of digoxin in an
otherwise healthy person on no meds, what is the
expected serum K?

• Normal
• Elevated
• Low

Digoxin inhibits the Na-K-ATPase pump, leading
to extracellular K accumulation
34
11. Which one is NOT likely to give a positive
test on a routine drug screen?

• Heroin
• Codeine
• Oxycodone
• Cocaine
• Diazepam

35
12. All can cause metabolic acidosis early after
overdose EXCEPT one

• Aspirin
• Ibuprofen
• Acetaminophen
• Diazepam
• Isoniazid

36
13. Patient has dyspnea and appears cyanotic
after ingestion of Pyridium

• pO2 low pulse Ox low
• pO2 normal pulse Ox 89
• pO2 and pCO2 low
• pO2 normal, pulse Ox normal

37
14. Which one causes pink venous blood with an
elevated venous pO2?

• Carbon monoxide
• Cyanide
• Carbon tetrachloride
• Arsine gas

38
15. Which finding is most likely to help
differentiate amphetamine from anticholinergic
poisoning?

• Pupil size
• Heart rate
• Peristalsis
• Sweating
• Mental status

39
16. Which of the following causes fever,
hyperventilation and metabolic acidosis after
excessive skin application?

• Oil of roses
• Oil of wintergreen (methyl salicylate)
• Motor oil
• Gentian violet
• Myristica fragrans

40
17. A distinctly blue fluorescence on Woods lamp
testing of urine strongly suggests poisoning by
antifreeze.

• True
• False

Mean examiner sensitivity, specificity, and
accuracy for detecting the presence of
fluorescein in urine were 35, 75, and 48 Ann
Emerg Med 2001 3849
41
Tie-breaker question which of the following can
cause miosis, bradycardia, drowsiness and
hypertension?

• Amlodipine
• Chlorpromazine
• Tetrahydrozoline
• Zolpidem
• Tolterodine

42
Tie-breaker question which of the following can
cause miosis, bradycardia, drowsiness and
hypertension?

• Amlodipine
• Chlorpromazine
• Tetrahydrozoline
• Zolpidem
• Tolterodine