00
Correct
00
Incorrect
00 : 00 : 0 00
Session Time
00 : 00
Average Question Time ( Mins)
  • Question 1 - A 42-year-old woman with a lengthy background of depression arrives at the hospital...

    Incorrect

    • A 42-year-old woman with a lengthy background of depression arrives at the hospital after intentionally overdosing on the medication she takes for her heart condition. She informs you that the medication she takes for this condition is verapamil immediate-release 240 mg. She ingested the tablets approximately half an hour ago but was promptly discovered by her husband, who quickly brought her to the Emergency Department.

      What is one of the effects of verapamil?

      Your Answer: Positive inotropy

      Correct Answer: Negative dromotropy

      Explanation:

      Calcium-channel blocker overdose is a serious matter and should always be treated as potentially life-threatening. The two most dangerous types of calcium channel blockers in overdose are verapamil and diltiazem. These medications work by binding to the alpha-1 subunit of L-type calcium channels, which prevents the entry of calcium into cells. These channels play a crucial role in the functioning of cardiac myocytes, vascular smooth muscle cells, and islet beta-cells.

      The toxic effects of calcium-channel blockers can be summarized as follows:

      Cardiac effects:
      – Excessive negative inotropy: causing myocardial depression
      – Negative chronotropy: leading to sinus bradycardia
      – Negative dromotropy: resulting in atrioventricular node blockade

      Vascular smooth muscle tone effects:
      – Decreased afterload: causing systemic hypotension
      – Coronary vasodilation: leading to widened blood vessels in the heart

      Metabolic effects:
      – Hypoinsulinaemia: insulin release depends on calcium influx through L-type calcium channels in islet beta-cells
      – Calcium channel blocker-induced insulin resistance: causing reduced responsiveness to insulin.

      It is important to be aware of these effects and take appropriate action in cases of calcium-channel blocker overdose.

    • This question is part of the following fields:

      • Pharmacology & Poisoning
      19.1
      Seconds
  • Question 2 - You are summoned to the resuscitation room to provide assistance in the management...

    Correct

    • You are summoned to the resuscitation room to provide assistance in the management of a 48-year-old woman who was saved from a residential fire. The initial evaluation reveals signs and symptoms consistent with a diagnosis of cyanide poisoning. Which of the following antidotes would be suitable for administering to this patient?

      Your Answer: Hydroxocobalamin

      Explanation:

      The Royal College of Emergency Medicine (RCEM) recognizes four antidotes that can be used to treat cyanide poisoning: Hydroxycobalamin, Sodium thiosulphate, Sodium nitrite, and Dicobalt edetate. When managing cyanide toxicity, it is important to provide supportive treatment using the ABCDE approach. This includes administering supplemental high flow oxygen, providing hemodynamic support (including the use of inotropes if necessary), and administering the appropriate antidotes. In the UK, these four antidotes should be readily available in Emergency Departments according to the RCEM/NPIS guideline on antidote availability. Hydroxocobalamin followed by sodium thiosulphate is generally the preferred treatment if both options are available. Healthcare workers should be aware that patients with cyanide poisoning may expel HCN through vomit and skin, so it is crucial to use appropriate personal protective equipment when caring for these patients.

      Further Reading:

      Burn injuries can be classified based on their type (degree, partial thickness or full thickness), extent as a percentage of total body surface area (TBSA), and severity (minor, moderate, major/severe). Severe burns are defined as a >10% TBSA in a child and >15% TBSA in an adult.

      When assessing a burn, it is important to consider airway injury, carbon monoxide poisoning, type of burn, extent of burn, special considerations, and fluid status. Special considerations may include head and neck burns, circumferential burns, thorax burns, electrical burns, hand burns, and burns to the genitalia.

      Airway management is a priority in burn injuries. Inhalation of hot particles can cause damage to the respiratory epithelium and lead to airway compromise. Signs of inhalation injury include visible burns or erythema to the face, soot around the nostrils and mouth, burnt/singed nasal hairs, hoarse voice, wheeze or stridor, swollen tissues in the mouth or nostrils, and tachypnea and tachycardia. Supplemental oxygen should be provided, and endotracheal intubation may be necessary if there is airway obstruction or impending obstruction.

      The initial management of a patient with burn injuries involves conserving body heat, covering burns with clean or sterile coverings, establishing IV access, providing pain relief, initiating fluid resuscitation, measuring urinary output with a catheter, maintaining nil by mouth status, closely monitoring vital signs and urine output, monitoring the airway, preparing for surgery if necessary, and administering medications.

      Burns can be classified based on the depth of injury, ranging from simple erythema to full thickness burns that penetrate into subcutaneous tissue. The extent of a burn can be estimated using methods such as the rule of nines or the Lund and Browder chart, which takes into account age-specific body proportions.

      Fluid management is crucial in burn injuries due to significant fluid losses. Evaporative fluid loss from burnt skin and increased permeability of blood vessels can lead to reduced intravascular volume and tissue perfusion. Fluid resuscitation should be aggressive in severe burns, while burns <15% in adults and <10% in children may not require immediate fluid resuscitation. The Parkland formula can be used to calculate the intravenous fluid requirements for someone with a significant burn injury.

    • This question is part of the following fields:

      • Pharmacology & Poisoning
      48
      Seconds
  • Question 3 - A 70-year-old woman experiences a sudden rupture of her Achilles tendon after completing...

    Incorrect

    • A 70-year-old woman experiences a sudden rupture of her Achilles tendon after completing a round of antibiotics.
      Which of the following antibiotics is MOST likely to have caused this rupture?

      Your Answer: Co-amoxiclav

      Correct Answer: Ciprofloxacin

      Explanation:

      Fluoroquinolones are a rare but acknowledged cause of tendinopathy and spontaneous tendon rupture. It is estimated that tendon disorders related to fluoroquinolones occur in approximately 15 to 20 out of every 100,000 patients. These issues are most commonly observed in individuals who are over the age of 60.

      The Achilles tendon is the most frequently affected, although cases involving other tendons such as the quadriceps, peroneus brevis, extensor pollicis longus, the long head of biceps brachii, and rotator cuff tendons have also been reported. The exact underlying mechanism is not fully understood, but it is believed that fluoroquinolone drugs may hinder collagen function and/or disrupt blood supply to the tendon.

      There are other risk factors associated with spontaneous tendon rupture, including corticosteroid therapy, hypercholesterolemia, gout, rheumatoid arthritis, long-term dialysis, and renal transplantation.

    • This question is part of the following fields:

      • Pharmacology & Poisoning
      19.8
      Seconds
  • Question 4 - You evaluate a 72-year-old woman who has recently been prescribed amiodarone.
    Which ONE statement...

    Incorrect

    • You evaluate a 72-year-old woman who has recently been prescribed amiodarone.
      Which ONE statement about the adverse effects of amiodarone is accurate?

      Your Answer: It causes shortening of the QT interval

      Correct Answer: It can cause jaundice

      Explanation:

      Amiodarone is a medication that can have numerous harmful side effects, making it crucial to conduct a comprehensive clinical assessment before starting treatment with it. Some of the side effects associated with amiodarone include corneal microdeposits, photosensitivity, nausea, sleep disturbance, hyperthyroidism, hypothyroidism, acute hepatitis and jaundice, peripheral neuropathy, lung fibrosis, QT prolongation, and optic neuritis (although this is very rare). If optic neuritis occurs, immediate discontinuation of amiodarone is necessary to prevent the risk of blindness.

      The majority of patients taking amiodarone experience corneal microdeposits, but these typically resolve after treatment is stopped and rarely affect vision. Amiodarone has a chemical structure similar to thyroxine and can bind to the nuclear thyroid receptor, leading to both hypothyroidism and hyperthyroidism. However, hypothyroidism is more commonly observed, affecting around 5-10% of patients.

    • This question is part of the following fields:

      • Pharmacology & Poisoning
      97.7
      Seconds
  • Question 5 - You assess a 20-year-old woman who has ingested a combination of drugs 30...

    Incorrect

    • You assess a 20-year-old woman who has ingested a combination of drugs 30 minutes prior to her arrival at the emergency department. You contemplate the use of activated charcoal to minimize the absorption of the ingested substances. Which of the following is not susceptible to the effects of activated charcoal?

      Your Answer: Calcium channel blockers

      Correct Answer: Lithium

      Explanation:

      Activated charcoal is a useful treatment for many drug poisonings, but it is not effective against certain types of poisonings. To remember these exceptions, you can use the mnemonic PHAILS. This stands for Pesticides (specifically organophosphates), Hydrocarbons, Acids (strong), alkalis (strong), alcohols (such as ethanol, methanol, and ethylene glycol), Iron, Lithium, and Solvents.

      Further Reading:

      Poisoning in the emergency department is often caused by accidental or intentional overdose of prescribed drugs. Supportive treatment is the primary approach for managing most poisonings. This includes ensuring a clear airway, proper ventilation, maintaining normal fluid levels, temperature, and blood sugar levels, correcting any abnormal blood chemistry, controlling seizures, and assessing and treating any injuries.

      In addition to supportive treatment, clinicians may need to consider strategies for decontamination, elimination, and administration of antidotes. Decontamination involves removing poisons from the skin or gastrointestinal tract. This can be done through rinsing the skin or using methods such as activated charcoal, gastric lavage, induced emesis, or whole bowel irrigation. However, induced emesis is no longer commonly used, while gastric lavage and whole bowel irrigation are rarely used.

      Elimination methods include urinary alkalinization, hemodialysis, and hemoperfusion. These techniques help remove toxins from the body.

      Activated charcoal is a commonly used method for decontamination. It works by binding toxins in the gastrointestinal tract, preventing their absorption. It is most effective if given within one hour of ingestion. However, it is contraindicated in patients with an insecure airway due to the risk of aspiration. Activated charcoal can be used for many drugs, but it is ineffective for certain poisonings, including pesticides (organophosphates), hydrocarbons, strong acids and alkalis, alcohols (ethanol, methanol, ethylene glycol), iron, lithium, and solvents.

      Antidotes are specific treatments for poisoning caused by certain drugs or toxins. For example, cyanide poisoning can be treated with dicobalt edetate, hydroxocobalamin, or sodium nitrite and sodium thiosulphate. Benzodiazepine poisoning can be treated with flumazanil, while opiate poisoning can be treated with naloxone. Other examples include protamine for heparin poisoning, vitamin K or fresh frozen plasma for warfarin poisoning, fomepizole or ethanol for methanol poisoning, and methylene blue for methemoglobinemia caused by benzocaine or nitrates.

      There are many other antidotes available for different types of poisoning, and resources such as TOXBASE and the National Poisons Information Service (NPIS) can provide valuable advice on managing poisonings.

    • This question is part of the following fields:

      • Pharmacology & Poisoning
      63.7
      Seconds
  • Question 6 - A 45-year-old man with a history of bipolar affective disorder presents having ingested...

    Incorrect

    • A 45-year-old man with a history of bipolar affective disorder presents having ingested an excessive amount of his lithium medication. You measure his lithium level.
      At what level are toxic effects typically observed?

      Your Answer:

      Correct Answer: 1.5 mmol/l

      Explanation:

      The therapeutic range for lithium typically falls between 0.4-0.8 mmol/l, although this range may differ depending on the laboratory. In general, the lower end of the range is the desired level for maintenance therapy and treatment in older individuals. Toxic effects are typically observed when levels exceed 1.5 mmol/l.

    • This question is part of the following fields:

      • Pharmacology & Poisoning
      0
      Seconds
  • Question 7 - A 45-year-old woman with a history of chronic heart failure presents to the...

    Incorrect

    • A 45-year-old woman with a history of chronic heart failure presents to the Emergency Department with an infection. Upon reviewing her medications, you discover that she is taking furosemide as part of her management.

      Which ONE of the following antibiotics should be avoided?

      Your Answer:

      Correct Answer: Gentamicin

      Explanation:

      When furosemide and gentamicin are prescribed together, there is a higher chance of experiencing ototoxicity and deafness. It is recommended to avoid co-prescribing these medications. For more information, you can refer to the BNF section on furosemide interactions.

    • This question is part of the following fields:

      • Pharmacology & Poisoning
      0
      Seconds
  • Question 8 - A 35-year-old man with a history of anxiety and panic disorder has ingested...

    Incorrect

    • A 35-year-old man with a history of anxiety and panic disorder has ingested an excessive amount of diazepam.
      Which of the following antidotes is appropriate for cases of benzodiazepine poisoning?

      Your Answer:

      Correct Answer: Flumazenil

      Explanation:

      There are various specific remedies available for different types of poisons and overdoses. The following list provides an outline of some of these antidotes:

      Poison: Benzodiazepines
      Antidote: Flumazenil

      Poison: Beta-blockers
      Antidotes: Atropine, Glucagon, Insulin

      Poison: Carbon monoxide
      Antidote: Oxygen

      Poison: Cyanide
      Antidotes: Hydroxocobalamin, Sodium nitrite, Sodium thiosulphate

      Poison: Ethylene glycol
      Antidotes: Ethanol, Fomepizole

      Poison: Heparin
      Antidote: Protamine sulphate

      Poison: Iron salts
      Antidote: Desferrioxamine

      Poison: Isoniazid
      Antidote: Pyridoxine

      Poison: Methanol
      Antidotes: Ethanol, Fomepizole

      Poison: Opioids
      Antidote: Naloxone

      Poison: Organophosphates
      Antidotes: Atropine, Pralidoxime

      Poison: Paracetamol
      Antidotes: Acetylcysteine, Methionine

      Poison: Sulphonylureas
      Antidotes: Glucose, Octreotide

      Poison: Thallium
      Antidote: Prussian blue

      Poison: Warfarin
      Antidote: Vitamin K, Fresh frozen plasma (FFP)

      By utilizing these specific antidotes, medical professionals can effectively counteract the harmful effects of various poisons and overdoses.

    • This question is part of the following fields:

      • Pharmacology & Poisoning
      0
      Seconds
  • Question 9 - A 35-year-old patient with a history of schizophrenia comes in with side effects...

    Incorrect

    • A 35-year-old patient with a history of schizophrenia comes in with side effects from haloperidol, which they were recently prescribed. Upon examination, you observe that they have significant muscle stiffness, a decreased level of consciousness, and a body temperature of 40ÂșC.
      What side effect has manifested?

      Your Answer:

      Correct Answer: Neuroleptic malignant syndrome

      Explanation:

      First-generation antipsychotics, also known as conventional or typical antipsychotics, are powerful blockers of the dopamine D2 receptor. However, each drug in this category has different effects on other receptors, such as serotonin type 2 (5-HT2), alpha1, histaminic, and muscarinic receptors.

      These first-generation antipsychotics are known to have a high incidence of extrapyramidal side effects, which include rigidity, bradykinesia, dystonias, tremor, akathisia, tardive dyskinesia, and neuroleptic malignant syndrome (NMS). NMS is a rare and life-threatening reaction to neuroleptic medications, characterized by fever, muscle stiffness, changes in mental state, and dysfunction of the autonomic nervous system. NMS typically occurs shortly after starting or increasing the dose of neuroleptic treatment.

      On the other hand, second-generation antipsychotics, also referred to as novel or atypical antipsychotics, are dopamine D2 antagonists, except for aripiprazole. These medications are associated with lower rates of extrapyramidal side effects and NMS compared to the first-generation antipsychotics. However, they have higher rates of metabolic side effects and weight gain.

      It is important to note that serotonin syndrome shares similar features with NMS but can be distinguished by the causative agent, most commonly the serotonin-specific reuptake inhibitors.

    • This question is part of the following fields:

      • Pharmacology & Poisoning
      0
      Seconds
  • Question 10 - You are informed that a 45-year-old individual is en route to the emergency...

    Incorrect

    • You are informed that a 45-year-old individual is en route to the emergency department after inhaling an unidentified gas that was intentionally released on a commuter train. Authorities suspect a potential terrorist attack and recommend checking the patient for signs of organophosphate poisoning. What clinical feature would be anticipated in a case of organophosphate poisoning?

      Your Answer:

      Correct Answer: Drooling saliva

      Explanation:

      Organophosphate poisoning is characterized by a set of symptoms known as SLUDGE (Salivation, Lacrimation, Urination, Defecation, Gastric cramps, Emesis). Additionally, individuals affected may experience pinpoint pupils, profuse sweating, tremors, and confusion. Organophosphates serve as the foundation for various weaponized nerve agents like Sarin and VX, which were infamously employed by the terrorist group Aum Shinrikyo during multiple attacks in Tokyo in the mid-1990s. While SLUDGE is a commonly used acronym to recall the clinical features, it is important to note that other symptoms such as pinpoint pupils, profuse sweating, tremors, and confusion are not included in the acronym.

      Further Reading:

      Chemical incidents can occur as a result of leaks, spills, explosions, fires, terrorism, or the use of chemicals during wars. Industrial sites that use chemicals are required to conduct risk assessments and have accident plans in place for such incidents. Health services are responsible for decontamination, unless mass casualties are involved, and all acute health trusts must have major incident plans in place.

      When responding to a chemical incident, hospitals prioritize containment of the incident and prevention of secondary contamination, triage with basic first aid, decontamination if not done at the scene, recognition and management of toxidromes (symptoms caused by exposure to specific toxins), appropriate supportive or antidotal treatment, transfer to definitive treatment, a safe end to the hospital response, and continuation of business after the event.

      To obtain advice when dealing with chemical incidents, the two main bodies are Toxbase and the National Poisons Information Service. Signage on containers carrying chemicals and material safety data sheets (MSDS) accompanying chemicals also provide information on the chemical contents and their hazards.

      Contamination in chemical incidents can occur in three phases: primary contamination from the initial incident, secondary contamination spread via contaminated people leaving the initial scene, and tertiary contamination spread to the environment, including becoming airborne and waterborne. The ideal personal protective equipment (PPE) for chemical incidents is an all-in-one chemical-resistant overall with integral head/visor and hands/feet worn with a mask, gloves, and boots.

      Decontamination of contaminated individuals involves the removal and disposal of contaminated clothing, followed by either dry or wet decontamination. Dry decontamination is suitable for patients contaminated with non-caustic chemicals and involves blotting and rubbing exposed skin gently with dry absorbent material. Wet decontamination is suitable for patients contaminated with caustic chemicals and involves a warm water shower while cleaning the body with simple detergent.

      After decontamination, the focus shifts to assessing the extent of any possible poisoning and managing it. The patient’s history should establish the chemical the patient was exposed to, the volume and concentration of the chemical, the route of exposure, any protective measures in place, and any treatment given. Most chemical poisonings require supportive care using standard resuscitation principles, while some chemicals have specific antidotes. Identifying toxidromes can be useful in guiding treatment, and specific antidotes may be administered accordingly.

    • This question is part of the following fields:

      • Pharmacology & Poisoning
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Pharmacology & Poisoning (1/5) 20%
Passmed