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?

1. The patient
2. Family and friends
3. Paramedics
4. The pharmacy
5. All of the above

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

1. Methylated spirits
2. Lithium carbonate
3. Paracetamol
4. Hypokalemia
5. 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)?

1. Methylated spirits
2. Eucalyptus oil
3. Oil of wintergreen
4. Rubbing alcohol
5. Cyanide

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

1. Verapamil
2. Beta blocker
3. Digoxin
4. Amitriptyline
5. Lithium

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

1. Osm gap 45 mmol/L Anion gap 32 mEq/L EtOH 0.10
   gm
2. Osm gap not detectable Anion gap 32 mEq/L EtOH
   0.10 gm
3. 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

1. Depolarization blockade of muscarinic receptors
2. Activation of sympathetic ganglia
3. Blockade of nicotinic receptors
4. Activation of the enteric nervous system

10
8. The neurotransmitter for thermoregulatory
sweat glands is

1. Serotonin
2. Norepinephrine
3. Epinephrine
4. Acetylcholine
5. GABA

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

1. Nonreactive
2. Constricted
3. Dilated

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

1. Normal
2. Elevated
3. Low

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

1. Heroin
2. Codeine
3. Oxycodone
4. Cocaine
5. Diazepam

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

1. Aspirin
2. Ibuprofen
3. Acetaminophen
4. Diazepam
5. Isoniazid

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

1. pO2 low pulse Ox low
2. pO2 normal pulse Ox 89
3. pO2 and pCO2 low
4. pO2 normal, pulse Ox normal

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

1. Carbon monoxide
2. Cyanide
3. Carbon tetrachloride
4. Arsine gas

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

1. Pupil size
2. Heart rate
3. Peristalsis
4. Sweating
5. Mental status

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

1. Oil of roses
2. Oil of wintergreen
3. Motor oil
4. Gentian violet
5. Myristica fragrans

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

1. True
2. False

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

1. The patient
2. Family and friends
3. Paramedics
4. The pharmacy
5. All of the above

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

1. Methylated spirits
2. Lithium carbonate
3. Paracetamol
4. Hypokalemia
5. 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)?

1. Methylated spirits
2. Eucalyptus oil
3. Oil of wintergreen
4. Rubbing alcohol
5. Cyanide

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

1. Verapamil
2. Beta blocker
3. Digoxin
4. Amitriptyline
5. Lithium

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

1. Osm gap 45 mmol/L Anion gap 32 mEq/L EtOH 0.10
   gm
2. Osm gap not detectable Anion gap 32 mEq/L EtOH
   0.10 gm
3. 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

1. Depolarization blockade of muscarinic receptors
2. Activation of sympathetic ganglia
3. Blockade of nicotinic receptors
4. Activation of the enteric nervous system

31
8. The neurotransmitter for thermoregulatory
sweat glands is

1. Serotonin
2. Norepinephrine
3. Epinephrine
4. Acetylcholine
5. GABA

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

1. Nonreactive
2. Constricted
3. Dilated

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

1. Normal
2. Elevated
3. 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?

1. Heroin
2. Codeine
3. Oxycodone
4. Cocaine
5. Diazepam

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

1. Aspirin
2. Ibuprofen
3. Acetaminophen
4. Diazepam
5. Isoniazid

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

1. pO2 low pulse Ox low
2. pO2 normal pulse Ox 89
3. pO2 and pCO2 low
4. pO2 normal, pulse Ox normal

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

1. Carbon monoxide
2. Cyanide
3. Carbon tetrachloride
4. Arsine gas

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

1. Pupil size
2. Heart rate
3. Peristalsis
4. Sweating
5. Mental status

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

1. Oil of roses
2. Oil of wintergreen (methyl salicylate)
3. Motor oil
4. Gentian violet
5. Myristica fragrans

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

1. True
2. 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?

1. Amlodipine
2. Chlorpromazine
3. Tetrahydrozoline
4. Zolpidem
5. Tolterodine

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

1. Amlodipine
2. Chlorpromazine
3. Tetrahydrozoline
4. Zolpidem
5. Tolterodine