€¦ · web viewcomplete the table below, by stating one (1) expected dose-dependent clinical...

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Fellowship course Week 2 – Toxicology 1

WRITTEN EXAMINATIONSHORT ANSWER QUESTIONS

EXAMINATION TIME: 66 Minutes

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Question 1 (13 marks) 6 minutes

i) State the three (3) cardinal clinical features of serotonin syndrome. (3 marks)

1. ______________________________________________________________________

2. ____________________________________________________________________

3. ___________________________________________________________________

ii) List four (4) different agents that may lead to serotonin syndrome (each to be from a different class of medication). (4 marks)

1. ______________________________________________________________________

2. ____________________________________________________________________

3. _____________________________________________________________________

4. ____________________________________________________________________

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Question 1 (continued)

iii) List three (3) key steps in the management of a patient with suspected serotonin syndrome. State one (1) justification for your choice of each step. (6 marks)

Management step(3 marks)

Justification(3 marks)

1.

2.

3.

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Question 2 (16 marks) 6 minutesA 22-year-old male presents four hours following an overdose.

i) List four (4) specific indications for charcoal use in paracetamol poisoning. (4 marks)

1. ___________________________________________________________________

2. ___________________________________________________________________

3. ___________________________________________________________________

4. ___________________________________________________________________

ii) List four (4) drugs for which multiple dose charcoal may be of benefit. (4 marks)

1. ___________________________________________________________________

2. ___________________________________________________________________

3. ___________________________________________________________________

4. ___________________________________________________________________

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iii) List four (4) drugs for which charcoal is not indicated, independent of the time of ingestion. (4 marks)

1. ______________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

4. _____________________________________________________________________

iv) List four (4) drugs for which haemodialysis is the elimination method of choice in the management of severe toxicity from overdose. (4 marks)

1. ___________________________________________________________________

2. ___________________________________________________________________

3. ___________________________________________________________________

4. ___________________________________________________________________

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You are standing at the Triage desk of your Emergency Department. A distressed man presents to the Triage desk carrying his 5-year-old son. He states that he witnessed his son being bitten on the right thigh by a snake, about 30 minutes earlier.

The child is conscious and alert.You note a small bruised area on the child’s right thigh.The child is placed in a resuscitation cubicle with full external monitoring applied.

a. State three (3) key, immediate steps in your management of this child. (3 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

b. List two (2) symptoms and two (2) signs that would be consistent with envenomation in this child. (4 marks)

Symptoms:

1. _______________________________________________________________________

2. _______________________________________________________________________

Signs:

1. ________________________________________________________________________

2. _______________________________________________________________________

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Question 3 (continued)c. List your preferred technique (i.e. bite site or urine or blood) to collect a sample for

Venom detection. State two (2) points of justification for choice. (3 marks)Preferred site:

________________________________________________________________________

Justifications:

1. _______________________________________________________________________

2. _______________________________________________________________________

An FBE and U+E are taken.

d. List four (4) other key blood tests that you would perform for this patient. (4 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

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Question 3 (continued)You suspect envenomation. Antivenom is indicated.

e. Complete the table below. State one (1) justification for each choice. (6 marks)

Management step

Variable(3 marks)


Antivenom type

(2 marks)

Antivenom dose

(2 marks)

Likelihood of serum sickness

(2 marks)

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i) List three (3) cardinal features of a patient with Neuroleptic Malignant syndrome. (3 marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

ii) List four (4) risk factors for the development of Neuroleptic Malignant syndrome. (4 marks)

1. ______________________________________________________________________

2. ______________________________________________________________________

3. ______________________________________________________________________

4. ______________________________________________________________________

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Question 4 (Continued)

iii) List three (3) treatment that may be beneficial for a patient with Neuroleptic Malignant Syndrome. (3 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

iv) Other than antidote use, list four (4) key components to the management of a patient with Neuroleptic Malignant syndrome. (4 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

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A 25-year-old female presents following a deliberate quetiapine overdose.

a. Complete the table below to demonstrate your dose related risk assessment. (6 marks)

Dose (1 mark)

Clinical effects(5 marks)

b. What is the most common ECG abnormality in significant overdose and what is the significance of this change (2 marks)?

ECG change:______________________________________________________________

Significance:______________________________________________________________

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c. Complete the table below by stating the role of decontamination and elimination in this poisoning. (2 marks)

Management task Role

(2 marks)

Decontamination

(1 mark)

Enhanced elimination

(1 mark)

d. List four (4) specific circumstances that must be met to safely discharge a patient from the Emergency department following a rapid release Quetiapine overdose. (4 marks)

1. ________________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

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i) Complete the table below (continued on the next page), listing the clinical and biochemical features of the phases of acute paracetamol poisoning. (22 marks)

Phase of poisoning

Time frame(2 marks)

Clinical features(3 marks)

Biochemical features(6 marks)

Phase 1(5 marks)

1. 1.

2.

3.

Phase 2(6 marks)

1. 1.

2. 2.

3.

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Phase of poisoning

Time frame(2 marks)

Clinical features(3 marks)

Biochemical features(6 marks)

Phase 3(6 marks)

1. 1.

2. 2.

3.

Phase 4(5 marks)

1. 1.

2.

3.

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A 32-year woman is brought to your emergency department by her friend who believes her to have taken a deliberate overdose earlier that morning. The patient denies taking any tablets.

His observations are:BP 130/60 mmHg

RR 16 /min

O2 saturation 100% 10 L/min O2 via Hudson mask

GCS 15

Her ECG is shown.

i) What is the major abnormality shown in this ECG. (1 mark)

________________________________________________________________________

ii) List four (4) drugs that may account for this abnormality in overdose. (Each drug to be from a different drug class). (4 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

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iii) List six (6) non-medication causes that may account for these changes. (6 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

5. _______________________________________________________________________

6. _______________________________________________________________________

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A 45-year-old male presents unwell after eating mushrooms.

i) What is/ are the usual initial symptoms of toxic mushroom ingestion? ( 1mark)

___________________________________________________________________________

ii) Other than accurate species identification, which feature on history most accurately predicts a serious from a benign ingestion. (1 mark)

___________________________________________________________________________

iii) Which mushroom is associated with the most number of fatal ingestions? (1 mark)

___________________________________________________________________________

iv) List the two (2) most common life-threatening effects of mushroom ingestion. (2 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

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v) List four (4) key management steps in suspected serious mushroom toxicity. (4 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

vi) List three (3) antidotes that may be used in toxic mushroom ingestions. (3 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

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A 35-year-old presents following a stated overdose.

An ECG taken on arrival:

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i) State five (5) abnormalities shown in this ECG. (5 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

5. _______________________________________________________________________

ii) List four (4) possible causative drugs (each must be from a different drug type). (4 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

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The patient experiences a ventricular fibrillation arrest prior to the initiation of any care.

iii) State three (3) modifications for this patient to your standard management of a ventricular fibrillation arrest. State one (1) justification for each modification. (6 marks)

Modification(3 marks)


1.

2.

3.

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Question 10 (13 marks) 6 minutesa. Complete the table below, by stating one (1) expected dose-dependent clinical effect

for each dose range of Venlafaxine overdose. State also one (1) point of management of venlafaxine overdose for each dose range up until > 7 grams- for this dose range state three (3) management steps. (10 marks)

Dose range Clinical effect(4 marks)

Management indicated(6 marks)

< 1.5 g

1. 1.

> 3 - 4.5g

1. 1.

> 4.5 -7 g

1. 1.

> 7 g

1. 1.

2.

3.

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b. List three (3) criteria that must be met in a patient with a venlafaxine overdose for the use of activated charcoal. (3 marks)

1. ________________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

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