Toxic ingestions and overdoses — MCQs

A 3-year-old boy is brought to the emergency department by his mother for the evaluation of abdominal pain for one hour after drinking a bottle of toilet bowl cleaner. The mother reports that he vomited once on the way to the hospital and his vomit was non-bloody. The patient has pain with swallowing. He appears uncomfortable. Pulse oximetry shows an oxygen saturation of 82%. Examination shows heavy salivation. Oral examination shows mild oral erythema in the area of the epiglottis, but no burns. An x-ray of the chest shows no abnormalities. The patient is admitted to the intensive care unit. He is intubated and oxygenation and intravenous fluid resuscitation are begun. All contaminated clothes are removed. Which of the following is the most appropriate next step in the management of this patient?

A 16-year-old woman is brought to the emergency department by her family for not being responsive. The patient had locked herself in her room for several hours after breaking up with her boyfriend. When her family found her, they were unable to arouse her and immediately took her to the hospital. The patient has a past medical history of anorexia nervosa, which is being treated, chronic pain, and depression. She is not currently taking any medications. The patient has a family history of depression in her mother and grandmother. IV fluids are started, and the patient seems to be less somnolent. Her temperature is 101°F (38.3°C), pulse is 112/min, blood pressure is 90/60 mmHg, respirations are 18/min, and oxygen saturation is 95% on room air. On physical exam, the patient is somnolent and has dilated pupils and demonstrates clonus. She has dry skin and an ultrasound of her bladder reveals 650 mL of urine. The patient is appropriately treated with sodium bicarbonate. Which of the following is the best indicator of the extent of this patient's toxicity?

A 36-year-old man is brought to the emergency department by a neighbor with signs of altered mental status. He was found 6 hours ago stumbling through his neighbor's bushes and yelling obscenities. The neighbor helped him home, but found him again 1 hour later slumped over on his driveway in a puddle of vomit. He is oriented to self, but not to place or time. His vitals are as follows: temperature, 36.9°C (98.5°F); pulse, 82/min; respirations, 28/min; and blood pressure, 122/80 mm Hg. Cardiopulmonary examination indicates no abnormalities. He is unable to cooperate for a neurological examination. Physical examination reveals muscle spasms involving his arms and jaw. Laboratory studies show: Na+ 140 mEq/L K+ 5.5 mEq/L CI- 101 mEq/L HCO3- 9 mEq/L Urea nitrogen 28 mg/dL Creatinine 2.3 mg/dL Glucose 75 mg/dL Calcium 7.2 mg/dL Osmolality 320 mOsm/kg The calculated serum osmolality is 294 mOsm/kg. The arterial blood gas shows a pH of 7.25 and a lactate level of 3.2 mmol/L. Urine examination shows oxalate crystals and the absence of ketones. What is the most appropriate treatment indicated for this patient experiencing apparent substance toxicity?

A 34-year-old woman with a history of depression is brought to the emergency department by her husband 45 minutes after ingesting an unknown amount of a termite poison in a suicide attempt. She has abdominal pain, nausea, and vomiting. Her husband reports that she has had two episodes of watery diarrhea on the way to the emergency department. A distinct, garlic-like odor on the breath is noted on examination. An ECG shows sinus tachycardia and QTc prolongation. Administration of which of the following is most appropriate?

A 6-year-old boy is brought to the emergency department 12 hours after ingesting multiple pills. The patient complains of noise in both his ears for the past 10 hours. The patient’s vital signs are as follows: pulse rate, 136/min; respirations, 39/min; and blood pressure, 108/72 mm Hg. The physical examination reveals diaphoresis. The serum laboratory parameters are as follows: Na+ 136 mEq/L Cl- 99 mEq/L Arterial blood gas analysis under room air indicates the following results: pH 7.39 PaCO2 25 mm HG HCO3- 15 mEq/L Which of the following is the most appropriate first step in the management of this patient?

A 3-year-old boy is brought in by his parents to the emergency department for lethargy and vomiting. The patient was fine until this afternoon, when his parents found him in the garage with an unlabeled open bottle containing an odorless liquid. On exam, the patient is not alert or oriented, but is responsive to touch and pain. The patient is afebrile and pulse is 90/min, blood pressure is 100/60 mmHg, and respirations are 20/min. Which of the following is an antidote for the most likely cause of this patient’s presentation?

A 64-year-old man is brought to the emergency department by his wife with a 2-hour history of diarrhea and vomiting. He says that he felt fine in the morning, but noticed that he was salivating, sweating, and feeling nauseated on the way home from his work as a landscaper. The diarrhea and vomiting then started about 10 minutes after he got home. His past medical history is significant for depression and drug abuse. His wife says that he has also been more confused lately and is afraid he may have ingested something unusual. Physical exam reveals miosis, rhinorrhea, wheezing, and tongue fasciculations. Which of the following treatments would most likely be effective for this patient?

A 67-year-old man presents to the emergency department acutely confused. The patient's wife found him mumbling incoherently in the kitchen this morning as they were preparing for a hike. The patient was previously healthy and only had a history of mild forgetfulness, depression, asthma, and seasonal allergies. His temperature is 98.5°F (36.9°C), blood pressure is 122/62 mmHg, pulse is 119/min, and oxygen saturation is 98% on room air. The patient is answering questions inappropriately and seems confused. Physical exam is notable for warm, flushed, and dry skin. The patient's pupils are dilated. Which of the following is also likely to be found in this patient?

A 25-year-old woman is brought to the emergency department 12 hours after ingesting 30 tablets of an unknown drug in a suicide attempt. The tablets belonged to her father, who has a chronic heart condition. She has had nausea and vomiting. She also reports blurring and yellowing of her vision. Her temperature is 36.7°C (98°F), pulse is 51/min, and blood pressure is 108/71 mm Hg. Abdominal examination shows diffuse tenderness with no guarding or rebound. Bowel sounds are normal. An ECG shows prolonged PR-intervals and flattened T-waves. Further evaluation is most likely to show which of the following electrolyte abnormalities?

For evaluating the functioning of a health center, which is the most important determinant for assessing clinical management?