Paramedics Exam Toxicology and Poisoning 1 — Questions and Answers
Question 1: A patient presents with miosis, excessive salivation, bronchospasm, and bradycardia after exposure to pesticides. What is the most appropriate initial treatment?
- Atropine and pralidoxime (Correct answer)
- Naloxone 0.4 mg IV
- Activated charcoal and gastric lavage
- Sodium bicarbonate 1 mEq/kg IV
Correct answer: Atropine and pralidoxime
Atropine blocks muscarinic effects and pralidoxime reactivates acetylcholinesterase, making them the combined antidote for organophosphate poisoning.
Question 2: A 25-year-old is unresponsive with pinpoint pupils and a respiratory rate of 4 breaths/min. What is the priority intervention?
- Administer flumazenil 0.2 mg IV
- Administer naloxone and support ventilation (Correct answer)
- Administer activated charcoal via NG tube
- Apply supplemental oxygen via nasal cannula only
Correct answer: Administer naloxone and support ventilation
Naloxone reverses opioid-induced respiratory depression, and assisted ventilation immediately addresses the life-threatening hypoxia.
Question 3: Which of the following is a contraindication to administering activated charcoal?
- Aspirin ingestion within 2 hours
- Ingestion of a caustic acid or alkali (Correct answer)
- Acetaminophen ingestion within 1 hour
- Tricyclic antidepressant overdose
Correct answer: Ingestion of a caustic acid or alkali
Activated charcoal does not bind caustic substances and can obscure endoscopic evaluation of mucosal injury, making it contraindicated with caustic ingestions.
Question 4: A worker found unconscious in an enclosed space with a running generator has cherry-red skin. What is the most likely diagnosis?
- Cyanide poisoning
- Carbon monoxide poisoning (Correct answer)
- Methemoglobinemia
- Organophosphate toxicity
Correct answer: Carbon monoxide poisoning
Carbon monoxide binds hemoglobin with high affinity causing carboxyhemoglobin, which produces cherry-red skin discoloration, and is classically associated with combustion in enclosed spaces.
Question 5: A depressed patient presents with wide complex tachycardia, seizures, and hypotension. Her ECG shows a prolonged QRS. Which treatment is indicated?
- Lidocaine 1 mg/kg IV
- Sodium bicarbonate 1–2 mEq/kg IV (Correct answer)
- Amiodarone 150 mg IV
- Magnesium sulfate 2 g IV
Correct answer: Sodium bicarbonate 1–2 mEq/kg IV
Sodium bicarbonate alkalinizes the blood and provides excess sodium to overcome tricyclic antidepressant-induced sodium channel blockade, reversing cardiac toxicity.
Question 6: A 35-year-old female ingested an entire bottle of acetaminophen 8 hours ago and now has nausea, vomiting, and right upper quadrant pain. What is the treatment of choice?
- Activated charcoal 1 g/kg orally
- N-acetylcysteine (NAC) (Correct answer)
- Naloxone 2 mg IV
- Flumazenil 0.2 mg IV
Correct answer: N-acetylcysteine (NAC)
N-acetylcysteine replenishes hepatic glutathione stores, preventing toxic metabolite accumulation and hepatotoxicity from acetaminophen overdose.
Question 7: Which finding would you NOT expect in a patient with cyanide poisoning?
- Altered mental status and agitation
- Severe metabolic acidosis with high anion gap
- Bradycardia and pinpoint pupils (Correct answer)
- Bitter almond odor on the breath
Correct answer: Bradycardia and pinpoint pupils
Bradycardia and miosis are signs of opioid or cholinergic toxidrome; cyanide poisoning typically causes tachycardia and does not produce miosis.
Paramedics Exam Toxicology and Poisoning 1
A patient presents with miosis, excessive salivation, bronchospasm, and bradycardia after exposure to pesticides.
What is the most appropriate initial treatment?