Toxicological
Jeopardy
Toxic
Tidbits
Antidotes
And
Anecdotes
Picture
That
Street
Drugs And
Salicylates
Name That
Toxidrome
100
100
100
100
100
200
200
200
200
200
300
300
300
300
300
400
400
400
400
400
500
500
500
500
500
750
750
750
750
750
Final Jeopardy
Toxic Tidbits
Acute Lithium toxicity is characterized
by which of the following?
A) Seizures, hypotension, arrhythmias
B) Rotary nystagmus, Agitation,
hypertension
C) GI symptoms, tremor, hyprerreflexia
D) Hypoglycemia, tremor, AMS
Toxic Tidbits $100 (1 of 1)
Toxic Tidbits
Overdose of which of the following is
most likely to result in a metabolic
acidosis?
A) Captopril
B) Furosemide
C) Acetaminophen
D) Metformin
Toxic Tidbits $200 (1 of 1)
Toxic Tidbits
Alkaline diuresis enhances the excretion
of all of the following substances
Except?
A) Phenobarbital
B) Chlorpropamide
C) Salicylate
D) Pentobarbital
Toxic Tidbits $300 (1 of 2)
Pentobarbital


All the other substances except
pentobarbital can be enhanced by
urinary alkalinization
Increasing the ionized form of weak
acids increases their water solubility,
therefore, more eliminated in urine
rather than distributing to tissues
HA
Toxic Tidbits $300 (2 of 2)
H++A-
Toxic Tidbits
After an overdose of captopril, which of
the following electrolyte disturbances
Is most likely to occur?
A) Hypokalemia
B) Hypocalcemia
C) Hypercalcemia
D) Hyperkalemia
Toxic Tidbits $300 (1 of 2)
Angiotensinogen
Substance P
Renin
Bradykinin
Angiotensin I
X
NE release
ACE I
Angiotensin II
Aldosterone
Na+ Resorption
Na+
K+ Excretion
Resorption
H2O Resorption
Blood Pressure
Toxic Tidbits $300 (2 of 2)
X
PG
synthesis
Inactive Vasodilation
Peptide
ADH
H2O Resorption
Vasoconstriction
Peripheral
Vascular
Resistance
Blood Pressure
Toxic Tidbits
Serotonin Syndrome is most likely to
occur with combination of which of
the following?
A) Prozac and Ambien
B) Lexapro and Demerol
C) Linezolid and Etomidate
D) Lithium and Valproic Acid
Toxic Tidbits $400 (1 of 1)
Toxic Tidbits
A 3 y/o female presents with a BG level
of 14mg/dl. Labs show an elevated
prolactin, GH, insulin and C peptide,
UDS (-) What was the child exposed to?
A) Rosiglitazone
B) Metformin
C) Glyburide
D) insulin
Toxic Tidbits $500 (1 of 2)
Sulfonylurea
Mechanism
sulfonylurea
Ca
KATP
I
I
I
K+
I
insulin
Toxic Tidbits $500 (2 of 2)
Pancreatic  cell
Sulfonylurea
receptor
Toxic Tidbits
(+) anion gap, (-) osmol gap, (+)
ketones is seen with which of the
Following?
A) Alcoholic Ketoacidosis
B) Ethylene Glycol
C) Isopropanol
D) Methanol
Toxic Tidbits $750 (1 of 1)
Antidotes And Anecdotes
A 48 year old male develops chest pain,
dyspnea and cyanosis shortly after the
administration of Benzocaine. Which of the
following should be administered?
A) Nitroglycerin
B) Methylene Blue
C) Physiostygmine
D) Narcan
Antidotes And Anecdotes $100 (1 of 2)
Antidotes And Anecdotes

Medications
–
–
–
–
–
–
–
–
–
–
–
Amyl nitrite
Benzocaine
Dapsone
Lidocaine
NTG
Nitroprusside
Phenacetin
Phenazopyridine
Prilocaine
Quinones
Sulfonamides
Antidotes And Anecdotes $100 (2 of 2)

Chemical Agents
–
–
–
–
–
–
–
–
–
–
–
Anline dyes
Butyl nitrite
Chlorobenzene
Fires
Nitrates
Isobutyl nitrite
Napthalene
Nitrophenol
Nitrous gases
Silver nitrate
Trinitrotoluene
Antidotes And Anecdotes
A 16 year old male ingested 20 (200mg)
INH tablets prior to ED arrival. He is
actively seizing, what course of action
should be taken?
A) Administer IV valium 5mg
B) Administer IV pyridoxine 2 grams
C) Administer IV PHB 20mg/kg IV
D) Administer IV pyrodoxine 4 grams
Antidotes And Anecdotes $200 (1 of 2)
MECHANISM OF INH
TOXICITY
GLUTAMIC ACID DECARBOXYLASE
GLUTAMIC ACID
PYRIDOXAL 5` PHOSPHATE
GABA
INH INHIBITS
INH INACTIVATES
PYRIDOXINE
PHOSPHOKINASE
INH
ENHANCES
PYRIDOXINE
Antidotes And Anecdotes $200 (2 of 2)
URINARY
ELIMINATION
Antidotes And Anecdotes
Which of the following is NOT a
mechanism by which N-acetylcysteine
works to prevent APAP induced
hepatotoxicity?
A) Precursor for Glutathione synthesis
B) A substrate for sulfonation
C) Directly Binds NAPQUI
D) Increase CYP2E1 activity
Antidotes And Anecdotes $300 (1 of 2)
Antidotes And Anecdotes $300 (2 of 2)
Antidotes And Anecdotes
Which of the following is not a
component of the cyanide antidote kit?
A) Amyl nitrate
B) Amyl nitrite
C) Sodium nitrite
D) Sodium thiosulfate
Antidotes And Anecdotes $400 (1 of 2)
Antidotes And Anecdotes $400 (2 of 2)
Antidotes And Anecdotes
Side effects of administration of
Deferoxamine include which of the
Following?
A) Hypotension
B) ARDS
C) Increased risk or Yersinia Infections
D All of the above
Antidotes And Anecdotes $500 (1 of 2)
Deferoxamine Challenge
Dose Administered
Antidotes And Anecdotes $500 (2 of 2)
Antidotes And Anecdotes
How many vials of Digibind should be
given to a 70kg male with acute digoxin
Toxicity and a level of 7ng/mL?
A) 4 vials
B) 5 vials
C) 6 vials
D) 10 vials
Antidotes And Anecdotes $750 (1 of 2)
Inhibition of Na-K-ATPase
heart
skeletal muscle
rise in Nai+
and Cai++
[Nai+]
automoticity
[Cai++]
baroceptors
rise in Nai+
and Cai++
[Ko+]
firing
premature beats
escape rhythms
V-tach, V-fib
contractility
hyperkalemia
vagal
tone
bradycardia, AV blocks, asystole
Picture That
Name the
toxin
Picture That $100 (1 of 4)
Picture That
Name the
toxin
Picture That $100 (2 of 4)
Picture That
Name the
toxin
Picture That $100 (3 of 4)
Jimson Weed
(datura stramonium)

Anticholinergic Plants
–
–
–
–
–
–
–
–
–
–
–
Atropa belladonna (deadly nightshade)
Cestrum nocturnum (night blooming jessamine)
Datura suaveolens (angel’s trumpet)
Datura stramonium (jimson weed)
Hyoscyamus niger (black henbane)
Lantana camara (red sage)
Solanum carolinensis (wild tomato)
Solanum dulcamara (bittersweet)
Solanum pseudocapsicum (Jerusalem cherry)
Solanum tuberosum (potato)
Arctium lappa (burdock root)
Picture That $100 (4 of 4)
Picture That
Name the
toxin
Picture That $200 (1 of 5)
Picture That
Name the
toxin
Picture That $200 (2 of 5)
Picture That
Name the
toxin
Picture That $200 (3 of 5)
Picture That
Name the
toxin
Picture That $200 (4 of 5)
Picture That
Name the
toxin
Picture That $200 (5 of 5)
Picture That
Picture That $300 (1 of 3)
Picture That
Ingestion/exposure to the previously
pictured plant is most likely to result in?
A) Hyponatremia
B) Contact Dermatitis
C) Arrhythmias
D) Flatulence
Picture That $300 (2 of 3)
Picture That
Picture That $400 (1 of 2)
Picture That
Which of the following should be
administered to the patient after an
unknown overdose with the previous
EKG?
A) Physiostigmine
B) Calcium Salts
C) Glucagon
D) Sodium Bicarbonate
Picture That $400 (2 of 2)
Picture That
Picture That $500 (1 of 2)
Picture That
Which toxin is found in the pictured
mushroom?
A) Ibotenic acid
B) Psilocybin
C) Gyromitrin
D) muscarine
Picture That $500 (2 of 2)
Picture That
Picture That $750 (1 of 2)
Picture That
What is the name of the toxin found in
the pictured fish?
A) Cigutoxin
B) Domoic acid
C) Tetrodotoxin
D) Scrombroid
Picture That $750 (2 of 2)
Salicylates
The minimal toxic dose (mg/kg) of
salicylates is?
A) 100
B) 50
C) 25
D) 150
Salicylates $100 (1 of 2)
Salicylates: Toxic Dose




Therapeutic Range: 10–15 mg/kg
Mild Toxicity: 150 mg/kg
Moderate Toxicity: 150-300 mg/kg
Severe Toxicity: > 300 mg/kg
Salicylates $100 (2 of 2)
Street Drugs
An 18 year old female presents to the
Emergency Department obtunded. She is
intubated but self extubates shortly after. She
is now awake, alert and appropriate. Which of
the following may be responsible?
A) GHB
B) Gamma-butyrolactone
C) 1,4-butanediol
D) All of the above may be responsible
Street Drugs $200 (1of 3)
GHB dehydrogenase
GABA transaminase
GABA transaminase
Succinic semialdehyde reductase
Tissue
lactonases
Nonenzymatic
hydrolysis
B-oxidation
GABAB
Receptor
Trans-4-hydroxycrotonic acid
Street Drugs $200 (2of 3)
GHB-receptor
Alcohol
Dehydrogenase
HO
NAD
NADH
NAD
Aldehyde
dehydrogenase
NADH
Trans-4-hydroxycrotonic acid
B-oxidation
GHB-receptor
Street Drugs $200 (3of 3)
GABAB Receptor
Salicylates
As a salicylate poisoned patient becomes
more acidotic, more salicylate will exist in
the ____ form and the volume of
distribtuion ____.
A) Ionized, decreases
B) Unionized, increases
C) Unionized, decreases
D) Ionized, increases
Salicylates $300 (1 of 3)
Salicylates $300 (2 of 3)

Volume of distribution (Vd)
– Apparent volume the drug is dissolved in
– Measured in Liters or Liters/Kg
 not a real volume
Salicylates $300 (3 of 3)
Salicylates
Hyperthermia, occuring in salicylate
toxicity, is secondary to?
A) Inhibition of the krebs cycle
B) Uncoupling of oxidative
phosphorylation
C) Stimulation of lipid metabolism
D) Increasing capillary permeability
Salicylates $500 (1 of 1)
Street Drugs
A patient presents to the Emergency
Department with agitation, a sense of
persecution and rotary nystagmus. Exposure
to which of the following can cause theses
symptoms.
A) A preparation containing Camphor
B) A preparation containing Pseudophed
C) A preparation containing DXM
D) A preparation containing Ethanol
Street Drugs $400 (1of 2)
Street Drugs $400 (2of 2)
Salicylates
Which of the following is more likely to
be seen in acute vs chronic salicylate
toxicity?
A) Neurological symptoms
B) Gastrointestinal Symptoms
C) Renal insufficiency
D) Elevated LFT’s
Salicylates $500 (1 of 2)
ACUTE
CHRONIC
85%
15%
AGE
YOUNG
OLD
INTENTION OD
OFTEN
RARE
COINGESTION
OFTEN
RARE
COMMON
UNCOMMON
COMORBIDITY
RARE
COMMON
TIME TO DX
EARLY
LATE
YES
YES
RENAL FXN
NORMAL
OFTEN ABNORMAL
HEPATIC FXN
NORMAL
OFTEN ABNORMAL
NEUROLOGIC SYMPTOMS
OCCASSIONALLY
COMMON
PULMONARY SYMPTOMS
RARE
COMMON (50%)
VERY COMMON
RARE
MORBIDITY
16%
30%
MORTALITY
2%
25%
INCIDENCE
PSYCH. HX
ABNORMAL PROTIME
GI SYMPTOMS
Salicylates $500 (2 of 2)
Street Drugs
A patient presents to the Emergency
Department with profound hyponatremia and
seizures after attending a RAVE party. Which
of the following is the most likely cause
A) GHB
B) Cocaine
C) MDMA (Ectascy)
D) Rohypnol
Street Drugs $750 (1 of 1)
Name That Toxidrome
An increased heart rate, dry flushed
skin, dilated pupils agitation and urinary
retention are seen in which of the following?
A) Cholinergic Toxidrome
B) Anticholinergic Toxidrome
C) Sympathomimetic Toxidrome
D) Sedative Hypnotic Toxidrome
Name That Toxidrome $100 (1 of 1)
Name That Toxidrome
Ingestion of which of the following is
most likely to cause dilated pupils?
A) Risperdal
B) Meperidine
C) Amytriptylline
D) Lexapro
Name That Toxidrome $200 (1 of 1)
Name That Toxidrome
The most reliable way to differentiate
the difference between anticholinergic
and sympathomimetic toxidrome are:
A) Dilated pupils, agitation
B) Diaphoresis, urinary retention
C) Flushed skin, hyperthermia
D) Visual hallucinations, pressured speech
Name That Toxidrome $300 (1 of 1)
Name That Toxidrome
Which of the following is capable of
producing a toxdrome similar to the
opioid toxidrome?
A) Geodon
B) Clonidine
C) Reglan
D) Propofol
Name That Toxidrome $400 (1 of 1)
Name That Toxidrome
The odor described in a patient exposed
to Organophosphate insecticides is?
 Bitter Almonds
 Burnt Rope
 Garlic
 Sulfur
Name That Toxidrome $500 (1 of 1)
Name That Toxidrome
Exposure to which of the following
is capable of producing muscle
fasiculations, weakness and respiratory
distress?
A) China-Berry Tree
B) Germanium
C) Nicotine containing plants
D) Grayanotoxin containing plants
Name That Toxidrome $750 (1 of 1)
Final Jeopardy
In the course of treatment of a patient with
Ethylene Glycol Toxicity, which of the
following may be used as an adjunct to
decrease the production of Oxalic Acid?
A) Thiamine
B) Folic Acid
C) Niacin
D) Magnseium
(CH2OH)2
Ethylene glycol
ADH
CH2OHCHO
Glycoaldehyde
ADH
CH2OHCOOH
Glycolic Acid
ADH
CHOCOOH
thiamine
Mg++
Alpha-hydroxy-betaketoadipic acid
Glyoxylic Acid
B6
Oxalic Acid
Glycine +
Benzoic Acid
Hippuric Acid