FACEM Toxicology and Poisoning

Question 1

A 25-year-old presents 4 hours after ingesting 15g of acetaminophen. What is the most appropriate initial management step?

Accepted Answer

Obtain a serum acetaminophen level and plot it on the Rumack-Matthew nomogram

Answer

Administer N-acetylcysteine (NAC) immediately without further workup

Answer

Give activated charcoal and observe

Answer

Initiate hemodialysis

Question 2

A patient presents with QRS widening to 160ms after tricyclic antidepressant (TCA) overdose. What is the most appropriate immediate treatment?

Accepted Answer

Sodium bicarbonate 1–2 mEq/kg IV bolus

Answer

Lidocaine 1mg/kg IV push

Answer

Magnesium sulfate 2g IV over 10 minutes

Answer

Amiodarone 300mg IV

Question 3

A farm worker presents with excessive secretions, miosis, bradycardia, urinary incontinence, and muscle fasciculations. Which antidote should be administered first?

Accepted Answer

Atropine 2–4mg IV, titrated until secretions dry

Answer

Pralidoxime (2-PAM) 1–2g IV

Answer

Physostigmine 2mg IV

Answer

Diazepam 5mg IV for fasciculations

Question 4

A patient is found unresponsive with miosis, respiratory rate of 6 breaths/min, and oxygen saturation of 78%. What is the most appropriate antidote?

Accepted Answer

Naloxone 0.4–2mg IV

Answer

Flumazenil 0.2mg IV

Answer

Physostigmine 1mg IV

Answer

N-acetylcysteine IV infusion

Question 5

A patient rescued from a house fire presents with headache, confusion, vomiting, and cherry-red skin. What is the most appropriate immediate treatment?

Accepted Answer

Administer 100% oxygen via non-rebreather mask

Answer

Arrange urgent hyperbaric oxygen therapy

Answer

Give the cyanide antidote kit

Answer

Administer sodium thiosulfate 12.5g IV

Question 6

A patient on digoxin develops nausea, yellow-green visual halos, and a ventricular rate of 38 bpm with complete heart block on ECG. What is the definitive treatment?

Accepted Answer

Digoxin-specific antibody fragments (DigiFab)

Answer

Calcium gluconate 1g IV

Answer

Magnesium sulfate 2g IV

Answer

Transvenous temporary pacing alone

Question 7

A patient presents with tinnitus, diaphoresis, hyperventilation, and arterial blood gas showing pH 7.50, PaCO2 25 mmHg, and HCO3 18 mEq/L after aspirin ingestion. Which finding would most strongly indicate a need for hemodialysis?

Accepted Answer

Serum salicylate level > 100 mg/dL or end-organ dysfunction

Answer

Serum salicylate level > 40 mg/dL

Answer

Any respiratory alkalosis on blood gas

Answer

Presence of tinnitus and hyperventilation alone