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SAEM Tox, Infxn, Optho, Foreign Bodies, SAEM AMS, 2017 CV, 2017 trauma, SAEM MISC, SAEM - Shock and Sepsis, Environment and Endocrine, Pulm Emergencies/ 270+ Questions with Definitive Solutions/ .

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SAEM Tox, Infxn, Optho, Foreign Bodies, SAEM AMS, 2017 CV, 2017 trauma, SAEM MISC, SAEM - Shock and Sepsis, Environment and Endocrine, Pulm Emergencies/ 270+ Questions with Definitive Solutions/ .

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  • 28 september 2024
  • 135
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Voorbeeld van de inhoud

SAEM Tox, Infxn, Optho, Foreign Bodies, SAEM
AMS, 2017 CV, 2017 trauma, SAEM MISC,
SAEM - Shock and Sepsis, Environment and
Endocrine, Pulm Emergencies/ 270+ Questions
with Definitive Solutions/ 2024-2025.
A 45 year-old is brought in 8 hours after a large overdose of his lithium. What is the best
treatment method for this overdose?
Answers:
1.Activated charcoal
2.Gastric lavage
3.Hemodialysis
4.Whole bowel irrigation - Answer: 3. Hemodialysis; Dehydration, over-diuresis, and drug-drug
interaction (particularly NSAIDs) are common precipitants of lithium toxicity in the patient
chronically taking lithium


Page 1 of 135

,A 42 year-old woman presents with an overdose of her Xanax (alprazolam) that her family
indicates she has been taking for years to help with her anxiety. The bottle indicates that the
prescription was filled yesterday with 90 pills and is now empty. The patient is minimally
responsive to painful stimuli and does not react when you suction secretions out of her
posterior pharynx. What is your next management step?
1.Administration of flumazenil
2.Administration of narcan
3.Close observation
4.Intubation for airway support - Answer: 4. Intubation for airway support


A 26 year-old presents with agitation, chest pain and a heart rate of 142 bpm after intranasal
cocaine use. The EKG is normal except for sinus tachycardia. What is the best medication to use
in this situation?
1.Lorazepam
2.Diphenhydramine
3.Esmolol
4.Haloperidol - Answer: 1. Lorazepam; Benzodiazepines are the treatment mainstay for cocaine
toxicity. Lorazepam and diazepam can be titrated to treat the symptoms of agitation and
increased adrenergic tone common to patients with cocaine toxicity. Beta blockers should not
be administered due to a potential for unopposed alpha-adrenergic stimulation and resultant
hypertension. Haloperidol and diphenhydramine can contribute to the hyperthermia common
to patients with cocaine toxicity.


A 19 year old presents with bizarre behavior and a friend admits to use of PCP. What ocular
findings would you expect?
1.Afferent pupillary defect
2.Monocular diplopia
3.Nystagmus


Page 2 of 135

,4.Mydriasis - Answer: Nystagmus


A 72 year-old presents with an intentional overdose of a bottle of aspirin about 3 hours prior to
presentation in the ED. Which of the following arterial blood gas results would you expect to
come from this patient?
1.pH 7.14 pCO2 68 pO2 102 HCO3 23
2.pH 7.33 pCO2 48 pO2 58 HCO3 29
3.pH 7.45 pCO2 21 pO2 124 HCO3 14
4.pH 7.47 pCO2 31 pO2 96 HCO3 25 - Answer: 3. pH 7.45 pCO2 21 pO2 124 HCO3 14; metabolic
acidosis with respiratory alkalosis


A 25 year old presents with an ingestion of acetaminophen 2 hours prior to arrival. Which of the
following statements is TRUE?
1.AST of 32 and ALT of 27 from arrival labs indicate the absence of hepatotoxicity from this
ingestion.
2.An acetaminophen level of 84 mg/dl from arrival labs necessitates use of n-acetylcysteine
3.Activated charcoal is indicated to treat this ingestion
4.Acetaminophen toxicity is predicted to occur at a dose of 20 mg/kg. - Answer: 3. Activated
charcoal is indicated to treat this ingestion; NAPQI -- the prime toxic mediator -- builds up when
glutathione stores deplete and thus causes hepatotoxicity. The first stage of acetaminophen
toxicity is largely asymptomatic. The toxic acetaminophen dose, when a single ingestion of
nonsustained-release preparation is taken, is about 140 mg/kg. Therapy is guided by the
Rumack-Matthew nomogram, provided the ingestion is an acute one involving nonsustained-
release preparations. The antidote, N-acetylcysteine, prevents toxicity by inhibiting the binding
of NAPQI to hepatocytes.


A teenager presents one hour after ingesting a "handful" of acetaminophen tablets. Which of
the following statements is TRUE?
1.An acetaminophen level drawn at hour four dictates need for antidotal therapy.


Page 3 of 135

, 2.Serial liver function tests are indicated in all acetaminophen ingestions.
3.Renal sequelae are expected.
4.The intravenous formulation of N-acetylcysteine is safer than oral N-acetylcysteine - Answer:
1. An acetaminophen level drawn at hour four dictates need for antidotal therapy.


An 84 year-old with a history of congestive heart failure is brought in by his family for vomiting
and diarrhea. He also complains that things "have weird colors". He has been having odd
palpitations but cannot describe them further. His family expresses their concern that he has
not been taking his medications correctly. Given his presenting symptoms, which medication are
you most concerned about?
1.Amiodarone
2.Digoxin
3.Diphenhydramine
4.Metoprolol - Answer: 2. Digoxin; Digoxin toxicity classically presents as weakness,
fatigue,nausea/vomiting/diarrhea, confusion, and a visual disturbance hallmarked
byyellow/green halos around objects.


The clinical presentation of clonidine toxicity most closely mimics toxicity from which of the
following classes of medication?
1.Beta blockers
2.Cholinergics
3.Stimulants
4. Opioids - Answer: 4. Opioids; the hallmark signs and symptoms of clonidine toxicity
include:hypotension, bradycardia, mental status change, respiratory depression, and miosis. The
presentation very closely mimics opioid toxicity.


A patient presents after an unknown ingestion. Her initial electrocardiogram (EKG) is shown in
the image. Based on the EKG, an overdose with which of the following medications would be
most likely? (EKG DEMONSTRATES QRS PROLONGATION; QRS>100)


Page 4 of 135

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