Med Tox Board Review: Buzzwords for the Boards GP Daubert 2014 1 “Egg-shell” calcifications of hilar lymph nodes, increase risk of tuberculosis, upper lung disease Buzzwords for the Boards 2 Silicosis Buzzwords for the Boards 3 Pneumoconiosis with hilar adenopathy; clinically and pathologically identical to sarcoidosis except no eye involvement; lymphocyte transformation test Buzzwords for the Boards 4 Berylliosis Buzzwords for the Boards 5 Porphyria, pemba yara, spongiform encephalopathy, outbrake in Turkey in 1956 Buzzwords for the Boards 6 Hexachlorobenzene Buzzwords for the Boards 7 Isolated thrombocytopenia, “bathtub refinisher’s lung”, sensitizing agent largest recognized cause of occupational asthma Buzzwords for the Boards 8 Toluene di-isocyanate (TDI) Buzzwords for the Boards 9 Hepatic angiosarcoma Buzzwords for the Boards 10 Vinyl chloride Buzzwords for the Boards 11 Pesticide operator with sterility, altered sex ratio in offspring Buzzwords for the Boards 12 Dibromochloropropane (DBCP) Re: “Da Balls Can’t Produce” Buzzwords for the Boards 13 Phossy jaw Buzzwords for the Boards 14 Yellow phosphorus Buzzwords for the Boards 15 Brown lung, “Monday morning tightness”, byssanosis Buzzwords for the Boards 16 Cotton Buzzwords for the Boards 17 Hypertension, Saturnine gout, renal failure, microcytic anemia Buzzwords for the Boards 18 Adult lead poisoning Buzzwords for the Boards 19 “Silver solderers”, proximal RTA, itaiitai disease in Jintsu River basin, acute lung injury, renal failure Buzzwords for the Boards 20 Cadmium Buzzwords for the Boards 21 Perforated nasal septum, lung cancer, painless ulcers, “blackjack disease”, Type IV hypersensitivity dermatitis Buzzwords for the Boards 22 Chromium Buzzwords for the Boards 23 Hairdresser with hearing loss, renal failure, methemoglobinemia Buzzwords for the Boards 24 Bromate Buzzwords for the Boards 25 The cholera toxin activates cAMP, which intern stimulate CFTR causing a dramatic efflux of ions and water from infected enterocytes. What popular ‘pop’ band was associated with this disease? Buzzwords for the Boards 26 The Go-Gos Buzzwords for the Boards 27 Acute psychosis with elevated serum chloride level Buzzwords for the Boards 28 Bromide Buzzwords for the Boards 29 Solvent, epoxide metabolite (hepatotoxicity), “Degreaser’s flush”, trigeminal neuralgia Buzzwords for the Boards 30 Trichloroethylene Buzzwords for the Boards 31 Viscous rayon, increase rate of atherosclerosis; disulfiram and metam sodium metabolites; basal ganglia toxin; associated with spontaneous abortions; decreased spermatogenesis, craniofacial abnormalities; optic nerve and retinal degeneration Buzzwords for the Boards 32 Carbon disulfide Buzzwords for the Boards 33 The percentage of sick people who are identified as having the condition or The likelihood of a test being positive if the condition is present Buzzwords for the Boards 34 Sensitivity Buzzwords for the Boards 35 A result of 100% means that the test recognizes all healthy people as healthy or The likelihood of the unaffected individuals correctly having a negative test Buzzwords for the Boards 36 Specificity Buzzwords for the Boards 37 Condition + + - True Positive False Positive (Type I error) → PPV Test outcome - False Negative (Type II error) ↓ Sensitivity True Negative → NPV ↓ Specificity Buzzwords for the Boards 38 Condition Yes No Yes A B → Absolute Risk Exposed (ARE) A/(A+B) No C D → Absolute Risk Unexposed (ARU) C/(C+D) Risk Factor Attributable Risk (Risk Difference) = ARE – ARU Relative Risk = ARE/ARU Odds Ratio = (A/C)/(B/D) Solvent, acute CNS depression, arrhythmias, AML, Hodgkin’s lymphoma, paroxysmal nocturnal hemoglobinuria Buzzwords for the Boards 40 Benzene Buzzwords for the Boards 41 Wastewater treatment worker with sensory and motor distal axonal neuropathy (axonopathy) Buzzwords for the Boards 42 What singer is associated with Hymonoptera-induced anaphylaxis? Buzzwords for the Boards 43 Sting Buzzwords for the Boards 44 Wastewater treatment worker with sensory and motor distal axonal neuropathy (axonopathy), also has blue discoloration of hands and feet, desquamation, and pulmonary irritation Buzzwords for the Boards 45 Acrylamide Buzzwords for the Boards 46 Ginger Jake, NTE inhibitor, sensorymotor neuropathy, 1960 Morocco disaster Buzzwords for the Boards 47 Triorthocresyl phosphate (TOCP) Buzzwords for the Boards 48 Minamata Bay Buzzwords for the Boards 49 Methylmercury Buzzwords for the Boards 50 Bhopal disaster Buzzwords for the Boards 51 Methyl isocyanate Buzzwords for the Boards 52 Lung cancer, beer drinker with cardiomyopathy, classic tetrad: goiter, cardiomyopathy, metabolic acidosis, polycythemia, inhibits oxidation of aKG to succinyl CoA and pyruvate to acetyl CoA Buzzwords for the Boards 53 Cobalt Buzzwords for the Boards 54 Pulmonary disease-anemia syndrome, strong respiratory sensitizer Buzzwords for the Boards 55 Trimellitic anhydride Buzzwords for the Boards 56 Uranium mining, lung cancer Buzzwords for the Boards 57 Radon Buzzwords for the Boards 58 Firefighter with delayed pulmonary edema (ARDS) and smell of freshly mowed hay Buzzwords for the Boards 59 Phosgene Buzzwords for the Boards 60 Pest-control operator with fishy odor, respiratory distress, refractory hypotension, delayed pulmonary edema Buzzwords for the Boards 61 Phosphine (aka Phosfish) Buzzwords for the Boards 62 Sewage worker with rapid collapse, mucous membrane irritation, blackened jewelry, sodium nitrite antidote Buzzwords for the Boards 63 Hydrogen Sulfide Buzzwords for the Boards 64 Endoscopy technician with mucous membrane irritation, pulmonary edema, leukemia, sweet odor, convulsions, N/V Buzzwords for the Boards 65 Ethylene Oxide Buzzwords for the Boards 66 Epping jaundice Buzzwords for the Boards 67 Buzzwords for the Boards 68 Methylenedianiline Buzzwords for the Boards 69 Aromatic solvent, acute CNS depression, basal ganglia toxin, pneumonitis, hypokalemia, RTA/renal failure, myopathy, leukoencephalopathy Buzzwords for the Boards 70 Toluene Buzzwords for the Boards 71 Fungicide with pungent odor, skin and respiratory sensitizer, photoallergic dermatitis Buzzwords for the Boards 72 Captafol Buzzwords for the Boards 73 1937 Sulfanilamide poisoning Buzzwords for the Boards 74 Diethylene glycol Buzzwords for the Boards 75 Neonatal gasping syndrome Buzzwords for the Boards 76 Benzyl alcohol Buzzwords for the Boards 77 1986 Lake Nyos disaster Buzzwords for the Boards 78 Carbon dioxide Buzzwords for the Boards 79 L-Tryptophan Buzzwords for the Boards 80 Eosinophilia myalgia syndrome Buzzwords for the Boards 81 Koremlu poisoning Buzzwords for the Boards 82 Thallium Buzzwords for the Boards 83 Hopewell epidemic, “Kepone shakes”, Chesapeake Bay contamination Buzzwords for the Boards 84 Chlordecone Buzzwords for the Boards 85 Stalinon poisoning, vomiting, transitory paralysis, photophobia, white matter edema Buzzwords for the Boards 86 Triethyltin Buzzwords for the Boards 87 Golfer with disulfiram reaction at the 18th hole Buzzwords for the Boards 88 Thiuram herbicide Buzzwords for the Boards 89 Welder with early Parkinson’s Disease Buzzwords for the Boards 90 Manganese Buzzwords for the Boards 91 Parakeet dies while family is cooking in the kitchen Buzzwords for the Boards 92 Polymer fume fever Buzzwords for the Boards 93 Welder dies after ingesting soldering flux Buzzwords for the Boards 94 Zinc chloride Buzzwords for the Boards 95 Black henna, black hair dye, angioedema, renal failure, and methemoglobinemia, leukemia/bladder cancer Buzzwords for the Boards 96 Para-phenylenediamines (para- and ortho-PD) Buzzwords for the Boards 97 Fumigant worker, peanut poisoning, fish odor Buzzwords for the Boards 98 Zinc phosphide Buzzwords for the Boards 99 Young male chimney sweeper with early testicular cancer Buzzwords for the Boards 100 Polyaromatic hydrocarbons Buzzwords for the Boards 101 Middle aged male stripping paint that develops angina from delayed carbon monoxide poisoning Buzzwords for the Boards 102 Methylene chloride Buzzwords for the Boards 103 Galvanized metal welder, “Monday morning fever”, “brass foundry workers ague” Buzzwords for the Boards 104 Zinc Oxide (Metal fume fever) Buzzwords for the Boards 105 Mill worker with allergic contact dermatitis and respiratory sensitization (occupational asthma) Buzzwords for the Boards 106 Plicatic acid (Western red cedar) Buzzwords for the Boards 107 Farmer’s lung Buzzwords for the Boards 108 Thermophilic actinomycetes Buzzwords for the Boards 109 Irritant gas, warning agent in methyl chloride, component of papite (tear gas), cyclophosphamide metabolite Buzzwords for the Boards 110 Acrolein Buzzwords for the Boards 111 Urine metabolite of acrylamide used for testing worker exposure Buzzwords for the Boards 112 Carboxyethyl-cysteine Buzzwords for the Boards 113 Primary ingredient in bone cement, skin sensitizer, elevated urine mercapturic acid, pediatric burns Buzzwords for the Boards 114 Methyl methacrylate Buzzwords for the Boards 115 Spain 1981: rapeseed oil contaminated with denatured aniline. Diffuse pulmonary infiltrates on x-ray, methemoglobinemia Buzzwords for the Boards 116 Aniline Buzzwords for the Boards 117 Airbag inflation, herbicide, cytochrome aa3 inhibitor Buzzwords for the Boards 118 Sodium azide Buzzwords for the Boards 119 Fumigant, fire extinguisher, lower extremity axonopathy, intoxication resembles Wernicke’s encephalopathy, inferior colliculi lesions, NAC may worsen syndrome Buzzwords for the Boards 120 Methyl bromide Buzzwords for the Boards 121 Irritant gas with gasoline-like odor, may cause hypotension and bradycardia with inhalation, associated with lymphohematopoeitic cancers Buzzwords for the Boards 122 1,3 Butadiene Buzzwords for the Boards 123 Current pesticide/herbicide but once in mouthwash and toothpaste, methemoglobinemia and GI distress after 3-6 hour latent period Buzzwords for the Boards 124 Sodium chlorate Buzzwords for the Boards 125 Hyperthyroid medication that was linked to aplastic anemia – now ground water contaminant Buzzwords for the Boards 126 Perchlorates Buzzwords for the Boards 127 Tar smarts; pitch warts and squamous cell carcinoma; chronic melanosis; UV phototoxicity; strong carcinogen of lung, bladder, skin, scrotal, oral, stomach Buzzwords for the Boards 128 Coal tar products Buzzwords for the Boards 129 Ammonia-like odor, rocket fuel and water treatment agent, toxicity tetrad: SLE (skin sensitizer), methemoglobinemia, seizures, hepatitis Buzzwords for the Boards 130 Hydrazine (diamines) Buzzwords for the Boards 131 Paint remover and solvent with fishy or ammonia smell that causes severe hepatitis with jaundice and eventual liver failure Buzzwords for the Boards 132 Dimethylacetamide (DMAC) Buzzwords for the Boards 133 Solvent used in pharmaceutical industry, acrylic fiber production and recovery of CO2 in gasses that may result in skin irritation, severe hepatotoxicity, and disulfiram reactions Buzzwords for the Boards 134 N,N Dimethylformamide (DMF) Buzzwords for the Boards 135 Explosive/munitions production, spandex fibers, causes severe GI distress and vomitus smells like bitter almonds, retrobulbar and optic neuropathy, methb, hepatitis, aplastic anemia; and yellowing of skin, hair, and eyes Buzzwords for the Boards 136 1,3 Dinitrobenzene Buzzwords for the Boards 137 Oily liquid used in explosives and diisocyanate production, possible weight loss product, uncoupler, retrobulbar and optic neuropathy, methb, turns skin yellow Buzzwords for the Boards 138 2,4 Dinitrotoluene Buzzwords for the Boards 139 Sweet smelling irritant gas, insect fumigant and heat stabilizer for plastic production, delayed pulmonary toxicity Buzzwords for the Boards 140 Epichlorohydrin Buzzwords for the Boards 141 Textile finishing agent and used in the synthesis of malathion; vapors result in corneal edema, photophobia, and diplopia; chronic use associated with occupational asthma, hemolytic anemia, and pulmonary hemorrhage Buzzwords for the Boards 142 Maleic anhydride Buzzwords for the Boards 143 Used as an odorant for natural gases, rotten cabbage odor, methemoglobin and hemolytic anemia Buzzwords for the Boards 144 Mercaptans Buzzwords for the Boards 145 Abdominal pain, hemolytic anemia, Paris green, hematuria, bronze skin Buzzwords for the Boards 146 Arsine Buzzwords for the Boards 147 Metals that produce non-fibrogenic benign pneumoconiosis Buzzwords for the Boards 148 Tin (Stannosis) Barium (Baritosis) Iron (siderosis) Calcium (Chalitosis) Molybdenum Buzzwords for the Boards 149 Vineyard sprayer’s lung (interstitial pulmonary fibrosis, histiocytic granulomas, adenocarcinoma) [Portugal] Buzzwords for the Boards 150 CuSO4 (Bordeaux soln) Buzzwords for the Boards 151 Hard metal pneumoconiosis, pulmonary eosinophilia portends poor prognosis Buzzwords for the Boards 152 Tungsten-carbide Buzzwords for the Boards 153 Diamond polishers lung Buzzwords for the Boards 154 Cobalt Buzzwords for the Boards 155 Patient on dialysis who develops somnolence, perioral numbness, abdominal pain, and hyperamylasemia Buzzwords for the Boards 156 MnSO4 Buzzwords for the Boards 157 Worker with osteosclerosis with accompanying nerve root compression. Plain film xray reveals ligament calcification and lesions resembling osteoblastic metastasis Buzzwords for the Boards 158 Fluorisis Cryolite (NaAlFl) Buzzwords for the Boards 159 Acroosteolysis (bone resorption at distal phalanx) Buzzwords for the Boards 160 Vinyl chloride Buzzwords for the Boards 161 Most common medication associated with hypersensitivity pneumonitis Buzzwords for the Boards 162 Nitrofurantoin Buzzwords for the Boards 163 Middle aged adult with chronic seizure disorder with xray demonstrating hilar lymphadenopathy. Biopsy reveals drug-induced lymphoid hyperplasia Buzzwords for the Boards 164 Phenytoin Buzzwords for the Boards 165 Elderly male with hepatic angiocarcinoma and pneumococcal sepsis. Abdominal xray reveals multiple opacities in the liver and spleen Buzzwords for the Boards 166 Thorotrast (thorium dioxide) Buzzwords for the Boards 167 Xenobiotic-induced aplastic anemia is most commonly associated with destruction of these progenitor cells Buzzwords for the Boards 168 CD34+ progenitor cells Buzzwords for the Boards 169 Lymphoma in a Dutch flower bulb worker using a nematode fumigant (also seen in fireman) Buzzwords for the Boards 170 Dichloropropene (Telon) Buzzwords for the Boards 171 Cola-colored infant with MRCP, abnormal skull calcification, and hypoplastic nails Buzzwords for the Boards 172 PCBs (remember Pepsi-Colored Babies) Buzzwords for the Boards 173 Metabolite of disulfiram and used in the treatment of nickel carbaryl and platinoid poisoning Buzzwords for the Boards 174 Diethyldithiocarbamate (DDC) Buzzwords for the Boards 175 4-year-old boy on an antineoplastic drug that develops fever, SIADH, necrotic myocardial infarction, and loss of deep tendon reflexes Buzzwords for the Boards 176 Vincristine Buzzwords for the Boards 177 Antineoplastic producing hilar lymphadenopathy Buzzwords for the Boards 178 Methotrexate Buzzwords for the Boards 179 Antineoplastic producing nodular bronchiolitis obliterans Buzzwords for the Boards 180 Bleomycin Buzzwords for the Boards 181 Antineoplastic associated with perforation of the GI tract Buzzwords for the Boards 182 Time (hrs) Time (hrs) Buzzwords for the Boards 183 Natural Log (ln) Drug Concentration Drug Concentration 1st Order Elimination Buzzwords for the Boards 184 Paclitaxol Buzzwords for the Boards 185 Antineoplastic associated with hemolytic uremia syndrome Buzzwords for the Boards 186 Mitomycin Buzzwords for the Boards 187 Metal that is radiolucent on plain film xray Buzzwords for the Boards 188 Copper Buzzwords for the Boards 189 Metal causing paresthesias (pins and needles), ataxia, dysarthria, constricted visual fields, deafness Buzzwords for the Boards 190 Methyl mercury Buzzwords for the Boards 191 “Pink disease”: mercury teething powders such as calomel Buzzwords for the Boards 192 Mercury calomel (HgCl) Buzzwords for the Boards 193 Riboflavin inhibition (i FAD); Painful peripheral neuropathy; neuropathy spares CN I, V, VIII; alopecia with sparing of axilla, facial hair, and inner 1/3 of eyebrow; reverse sleep cycle Buzzwords for the Boards 194 Thallium Buzzwords for the Boards 195 Biological monitoring Benzene Toluene Styrene Lead Methylmercury Inorganic mercury Polyaromatic HC Buzzwords for the Boards 196 Biological monitoring Benzene Toluene Styrene Lead Methylmercury Inorganic mercury Polyaromatic HC Total urine phenol Urine hippuric acid Urine mandelic and phenylglyoxylic acid Blood ZPP/FEP Blood mercury Urine mercury Urine 1-hydroxypyrene Buzzwords for the Boards 197 Oily liquid used in cold sterilization, sensitizer and occupational asthma Buzzwords for the Boards 198 Glutaraldehyde Buzzwords for the Boards 199 Used in plastics and rubber, dental fillings and styrofoam. Causes flu-like symptoms and drunkeness acutely, peripheral neuropathy and hearing loss chronically Buzzwords for the Boards 200 Styrene Styrene syndrome Buzzwords for the Boards 201 Chemical associated with highest incidence of lung cancer in the world Buzzwords for the Boards 202 Polyaromatic HC Buzzwords for the Boards 203 Dentist with vitamin B12-like deficiency, bone marrow suppression, and pernicious anemia. Histochemistry reveals inactive cobalt and inhibition of methionine synthetase Buzzwords for the Boards 204 Nitrous oxide Buzzwords for the Boards 205 Person exposed to a cloud of “red smoke” with delayed pulmonary edema and chemical burns with characteristic yellow discoloration Buzzwords for the Boards 206 Nitric acid Buzzwords for the Boards 207 Pyrophoric material causing severe thermal and chemical burns (submerge in CuSO4) and exposure may lead to hepatotoxicity and hypocalcemia with increased QT interval Buzzwords for the Boards 208 White phosphorus Buzzwords for the Boards 209 “Rush” fire in San Francisco in 1983 leading to a number of firefighters with methemoglobinemia Buzzwords for the Boards 210 Isobutyl nitrate Buzzwords for the Boards 211 1978 Jonestown mass suicide Buzzwords for the Boards 212 KCN Buzzwords for the Boards 213 Only organic phosphorus pesticide that possesses a significant vapor hazard (high vapor pressure) Buzzwords for the Boards 214 Dichlorvos Buzzwords for the Boards 215 Patient presenting after herbicide ingestion with myotonia, myoclonus, hematuria/rhabdo, and cardiac disturbances Buzzwords for the Boards 216 Chlorphenoxy herbicide Buzzwords for the Boards 217 Fetal syndrome – 10-30%, 25% risk of spontaneous abortion, microcephaly/hydrocephaly, congenital heart disorders, microtia, cleft lip/palate Buzzwords for the Boards 218 Fetal isoretinoin Buzzwords for the Boards 219 Microcephaly, developmental delay, telecanthus, short nose and flat nasal bridge, anteverted nares, long shallow filtrum, thin upper lip, nail displasia Buzzwords for the Boards 220 Fetal hydantoin Buzzwords for the Boards 221 Microcephaly, small palpebral fissure length, thin upper lip, smooth philtrum, flatted cheeks and short nose. Risk of brain injury increases as eyes get smaller, philtrum gets flatter, and lip gets thinner Buzzwords for the Boards 222 Fetal alcohol Buzzwords for the Boards 223 Small nose and markedly depressed nasal bridge; brachydactyl; hypoplasia of all distal phalanges; severe shortening of lower extremities; Epiphyseal stippling of the sacrum, spine, proximal humeri, and femurs Buzzwords for the Boards 224 Fetal warfarin Buzzwords for the Boards 225 (Parrot fish and tidal xanthid crabs) Inhibits Na/K ATPase, N/V/D, paresthesias, hypocalcemic tetany, CV collapse (2nd most potent toxin on planet earth) Buzzwords for the Boards 226 Palytoxin Buzzwords for the Boards 227 (Paralytic shellfish poisoing, gonyautoxins) Na channel blocker, oysters/red tides, N/V, paresthesias, throat pain, descending paralysis Buzzwords for the Boards 228 Saxitoxin Buzzwords for the Boards 229 (Neurotoxin shellfish poisoing) Na channel opener; paresthesias; temperature reversal; N/V/D uncommon; tide aerosolized toxin causes conjunctivitis, rhinitis, bronchitis Buzzwords for the Boards 230 Brevetoxin Buzzwords for the Boards 231 (Diarrhetic shellfish poisoing) Inhibits protein phosphates disrupting cell metabolism, benign gastric tumors, N/V/D predominate Buzzwords for the Boards 232 Okadaic acid Buzzwords for the Boards 233 (Amnestic shellfish poisoing) CNS glutamate receptor stimulation causing Na channel upregulation and Na/Ca influx g neuronal cell lysis; toxicity resembles Alzheimer’s-like dementia, N/V/D, headaches, ataxia, seizures; assoc. with eating blue muscles Buzzwords for the Boards 234 Domoic acid (think Dumb-oic acid) Buzzwords for the Boards 235 (Also maitotoxin) Na and Ca channel openers; metallic taste; paresthesias; glove and stocking numbness; palmer pruritis; hot/cold reversal; sensation of loose teeth; treat with mannitol and gapapentin; symptoms worsen with alcohol Buzzwords for the Boards 236 Ciguatoxin Buzzwords for the Boards 237 Bacteria-catalyzed decarboxylation of decomposing finfish muscle, “sunburn-like” rash, urticaria, pruritis, bronchospasm Buzzwords for the Boards 238 Scombroid (Histamine poisoning) Buzzwords for the Boards 239 Sodium channel blocker, perioral paresthesias, numbness, tremor, ataxia, dysarthria/dysphagia, respiratory paralysis, death (5th most potent toxin on planet earth) Buzzwords for the Boards 240 Tetrodotoxin Buzzwords for the Boards 241 Japanese vinyl sandal maker with peripheral sensorimotor neuropathy. Nerve biopsy reveals axonal swelling. Buzzwords for the Boards 242 Hexane Buzzwords for the Boards 243 Cicuta spp. Most fatal plant species in North America (30-70% fatality rate). Buzzwords for the Boards 244 Water Hemlock Water Gate Candidate Scandal (Water hemlock, GABA, Cicutoxin, Seizures) Buzzwords for the Boards 245 The only form of poisoning caused by bacterial contamination. Buzzwords for the Boards 246 Scombroid (Histamine poisoning) Buzzwords for the Boards 247 St. Anthony’s Fire, ergotism Buzzwords for the Boards 248 Claviceps purpurea Buzzwords for the Boards 249 Structural similarity to the herbicide Endothall, also know as Spanish Fly, produced by the blister beetle Buzzwords for the Boards 250 Cantharidin Buzzwords for the Boards 251 Profound hypoglycemia, hepatitis with hyperbilrubinemia, acidemia and aciduria without ketosis Buzzwords for the Boards 252 Ackee (hypoglycin) Buzzwords for the Boards 253 The maximum concentration of a chemical to which workers may be exposed continuously for up to 15 minutes without danger to health or work efficiency and safety Buzzwords for the Boards 254 STEL (Short-term exposure limit) Buzzwords for the Boards 255 Sulfonylurea known to cause SIADH and disulfiram reactions Buzzwords for the Boards 256 Chlorpropramide Buzzwords for the Boards 257 Side chain on cephalosporin (ie, cefazolin) antibiotics linked to disulfiram reactions Buzzwords for the Boards 258 n-methyltetrathiol Buzzwords for the Boards 259 Antidysrhythmic with antimuscarinic properties and causes hypoglycemia Buzzwords for the Boards 260 Disopyramide Buzzwords for the Boards 261 Intoxicants that produce metaphyseal bands on plain-film x-ray Buzzwords for the Boards 262 Lead (lead lines) Yellow phosphorus Bismuth Hyervitaminosis D Buzzwords for the Boards 263 5 most common medications linked to lupus-like syndrome Buzzwords for the Boards 264 CHIMP Chlorpropramide Hydralazine INH Methyldopa Procainamide Buzzwords for the Boards 265 Idiopathic intracranial hypertension (pseudotumor cerebri) Buzzwords for the Boards 266 Vitamin A Buzzwords for the Boards 267 Time (hrs) Time (hrs) Buzzwords for the Boards 268 Natural Log (ln) Drug Concentration Drug Concentration Zero order elimination Buzzwords for the Boards 269 Chan Su Buzzwords for the Boards 270 Chinese herbal remedy with bufadenalide cardiac steroid Buzzwords for the Boards 271 Plant that is a CYP3A4 inducer Buzzwords for the Boards 272 St. John’s Wart (Hypericum perforatum) Buzzwords for the Boards 273 P450 Pulegone g methofuran g hepatitis Buzzwords for the Boards 274 Pennyroyal (Mentha pelugium) Buzzwords for the Boards 275 Aspiration pneumonitis, CNS depression, patient’s urine smells like violets Buzzwords for the Boards 276 Turpentine (pine oil) Buzzwords for the Boards 277 Essential oil, CNS depression, mild hepatitis, hemorrhagic pulmonary edema Buzzwords for the Boards 278 Oil of Cloves (Eugenol) (Euginia aromatica) Buzzwords for the Boards 279 Most common cause of medicationinduced contact dermatitis Buzzwords for the Boards 280 Neomycin Buzzwords for the Boards 281 Endocardial and mitral valve fibrosis, pulmonary hypertension Buzzwords for the Boards 282 Fenfluramine Buzzwords for the Boards 283 Disinfectant associated with neonatal vacuolar encephalopathy and cerebral edema Buzzwords for the Boards 284 Hexachloraphene Buzzwords for the Boards 285 Disinfectant ingestion causing metabolic acidemia due to decreased renal clearence of H+ (patients have a normal lactate) Buzzwords for the Boards 286 Providone iodine Buzzwords for the Boards 287 Disinfectant, hypopigmented skin, tardive dyskinesia-like syndrome, bradycardia, hypotension, PEG decontamination Buzzwords for the Boards 288 Phenol Buzzwords for the Boards 289 “Rose eye” discoloration of eyelids, conjunctivitis, refractory hypotension, reddish discoloration of viscera postmortem Buzzwords for the Boards 290 Acute selenium toxicity (Selenious acid) Buzzwords for the Boards 291 Peanut meal worker who develops liver cancer (hepatoma) Buzzwords for the Boards 292 Aflatoxin Buzzwords for the Boards 293 Biomarker for benzene exposure Buzzwords for the Boards 294 Urine phenol Buzzwords for the Boards 295 HIV medication associated with severe (death) hypersensivity reactions Buzzwords for the Boards 296 Abacavir Buzzwords for the Boards 297 The two P450 isozymes linked to the development of cancer Buzzwords for the Boards 298 CYP1A2 CYP2E1 Buzzwords for the Boards 299 Enzyme linked to aromatic anticonvulsant hypersensitivity syndrome Buzzwords for the Boards 300 Epoxide hydrolase Buzzwords for the Boards 301 The only medication-induced seizure that will likely respond to phenytoin Buzzwords for the Boards 302 Aminopyridine Buzzwords for the Boards 303 The only local anesthetic that causes vasoconstriction Buzzwords for the Boards 304 Cocaine Buzzwords for the Boards 305 Most cardiotoxic amide local anesthetic (may cause cardiotoxicity before CNS toxicity) Buzzwords for the Boards 306 Bupivacaine Buzzwords for the Boards 307 Most extensively metabolized anesthetic, hepatitis, malignant hyperthermia, acute lung injury from abuse (PO/IV) Buzzwords for the Boards 308 Halothane Buzzwords for the Boards 309 The only IARC Group 4 drug IARC Group 4: Probably not carcinogenic to humans Buzzwords for the Boards 310 Caprolactam Buzzwords for the Boards 311 Patient with ventricular ectopy, blindness, N/V, diaphoresis, tinnitus, after drinking tonic water with Cinchona succirubra extract Buzzwords for the Boards 312 Quinine Buzzwords for the Boards 313 Biventricular ventricular tachycardia Buzzwords for the Boards 314 Cardiac steroids (#1) Aconitine Halogenated hydrocarbsons Buzzwords for the Boards 315 Patient with an aortic dissection and renal failure that develops altered mental status, seizures, and no metabolic acidosis Buzzwords for the Boards 316 Thiocyanate toxicity Buzzwords for the Boards 317 Opioid linked to serotonin syndrome, seizures, MPTP, and may not result in miosis in overdose Buzzwords for the Boards 318 Meperidine Buzzwords for the Boards 319 Grey baby syndrome Buzzwords for the Boards 320 Chloramphenical Buzzwords for the Boards 321 NSAID linked to aplastic anemia Buzzwords for the Boards 322 Phenylbutazone Buzzwords for the Boards 323 Patient with HIV with sulfa allergy who develops hemolysis and methemoglobinemia Buzzwords for the Boards 324 Dapsone Buzzwords for the Boards 325 Patient undergoing elective endoscopy that develops methemoglobinemia during pre-op Buzzwords for the Boards 326 Benzocaine (Hurricane spray) Buzzwords for the Boards 327 Most frequently reported antineoplastic overdose Buzzwords for the Boards 328 Vincristine Buzzwords for the Boards 329 Free radical induced cardiomyopathy with irreversible heart failure Buzzwords for the Boards 330 Doxorubicin Buzzwords for the Boards 331 Alkylating agent causing hemorrhagic cystitis and MESNA antidote Buzzwords for the Boards 332 Cyclophosphamide Buzzwords for the Boards 333 Alkylating agent causing pulmonary fibrosis and skin hyperpigmentation (tan appearance) Buzzwords for the Boards 334 Busulfan “Busulfan tan” Buzzwords for the Boards 335 6 intoxicants for which urine alkalination (ion trapping) enhances drug elimination Buzzwords for the Boards 336 Salicylates Phenobarbital Methotrexate Chlropropramide Chlrophenoxy herbicides Fluoride Buzzwords for the Boards 337 Scleritis and uveitis in a patient being treated for hypercalcemia Buzzwords for the Boards 338 Bisphosphanate (ie, pamidronate) Buzzwords for the Boards 339 Peliosis hepatis Buzzwords for the Boards 340 Alkalated anabolic steroids Buzzwords for the Boards 341 Buzzwords for the Boards 342 Morphine Buzzwords for the Boards 343 Buzzwords for the Boards 344 Cocaine Buzzwords for the Boards 345 Buzzwords for the Boards 346 Phosgene Buzzwords for the Boards 347 Buzzwords for the Boards 348 Sarin Buzzwords for the Boards 349 Buzzwords for the Boards 350 Digoxin Buzzwords for the Boards 351 Buzzwords for the Boards 352 Dioxin (2,3,7,8 TCDD) Buzzwords for the Boards 353 Buzzwords for the Boards 354 Succimer (DMSA) Buzzwords for the Boards 355 Buzzwords for the Boards 356 Acetylcysteine Buzzwords for the Boards 357 Buzzwords for the Boards 358 D-penicillamine Buzzwords for the Boards 359 Buzzwords for the Boards 360 Methylene blue Buzzwords for the Boards 361 Buzzwords for the Boards 362 EDTA Ethylenediaminetetraacetic Acid Buzzwords for the Boards 363 Buzzwords for the Boards 364 Deferoxamine Buzzwords for the Boards 365 Buzzwords for the Boards 366 Pralidoxime Buzzwords for the Boards 367 Buzzwords for the Boards 368 Alpha-amanitin Buzzwords for the Boards 369 Buzzwords for the Boards 370 Ciguatoxin Buzzwords for the Boards 371 Buzzwords for the Boards 372 Aspirin Buzzwords for the Boards 373 Buzzwords for the Boards 374 Acetaminophen Paracetamol Buzzwords for the Boards 375 Buzzwords for the Boards 376 Flumazenil Buzzwords for the Boards 377 Buzzwords for the Boards 378 Tetrodotoxin Buzzwords for the Boards 379 Buzzwords for the Boards 380 Physostigmine Buzzwords for the Boards 381 Buzzwords for the Boards 382 Pyridoxine Buzzwords for the Boards 383 Buzzwords for the Boards 384 DMPS Buzzwords for the Boards 385 Lactrodectus mactans Buzzwords for the Boards 386 Black widow Painful bite Calcium channel opener Increase release ACh, NE Buzzwords for the Boards 387 Loxosceles reclusa Buzzwords for the Boards 388 Brown recluse Painless bite Sphingomyelinase D Hyoluranidase Local wound ulcer (red, white, blue) Buzzwords for the Boards 389 Tegenaria agrestis Buzzwords for the Boards 390 Hobo spider Painless bite Local ulcer Buzzwords for the Boards 391 Chironex fleckeri Buzzwords for the Boards 392 Box jellyfish Most lethal cnidaria Rapid death in minutes Acetic acid/Antivenom Buzzwords for the Boards 393 Carukia barnesi Buzzwords for the Boards 394 Irukandji jellyfish Irukandji Syndrome Hypertension Buzzwords for the Boards 395 Physalia physallis Buzzwords for the Boards 396 Portugese man-of-war/Bluebottle Painful linear welts Acetic acid Buzzwords for the Boards 397 Acanthaster planci Buzzwords for the Boards 398 Crown-of-thorns Pain, paralysis Hot water immersion Buzzwords for the Boards 399 Pterosis spp Buzzwords for the Boards 400 Lionfish Pain, possible blisters Hot water immersion Buzzwords for the Boards 401 Synanceja verrucosa Synanceja horrida Buzzwords for the Boards 402 Stonefish Cytotoxic, hemolytic, myotoxic Severe pain, hypotension, hemolysis Hot water, antivenom Buzzwords for the Boards 403 Dasyatis spp. Buzzwords for the Boards 404 Stingray Local pain Vibrio infections Hot water, antibiotics Buzzwords for the Boards 405 Atrax robustus Buzzwords for the Boards 406 Funnel web spider Massive release of ACh, NE, epi Rabbit IgG antivenom Death historically in peds < age 4 Buzzwords for the Boards 407 Solenopsis invecta Buzzwords for the Boards 408 Fire ant Glucosaminidase, piperidines Wheals, clear vesicles Local care Buzzwords for the Boards 409 Centruroides exilicauda Buzzwords for the Boards 410 Bark scorpion Sodium channel opener Pain, paresthesias, palsies Buzzwords for the Boards 411 Bufo alvarius Buzzwords for the Boards 412 Colorado River Toad Bufadienolide cardiac steroid Bufotenin tryptamines Chan Su Herbal Dig fab fragments Buzzwords for the Boards 413 Bodybuilder presenting with tachycardia, wide pulse pressure, hypokalemia Buzzwords for the Boards 414 Clenbuterol Buzzwords for the Boards 415 Silo Filler’s Disease Buzzwords for the Boards 416 Nitric oxides (NO, NO2) Buzzwords for the Boards 417 Basal ganglia toxins Buzzwords for the Boards 418 Carbon disulfide CO Manganese Methanol Buzzwords for the Boards 419 Remediation level for home radon Buzzwords for the Boards 420 11 pc/L Buzzwords for the Boards 421 Three agents associated with perinatal death Buzzwords for the Boards 422 ACE inhibitors Cigarette smoking Lead Buzzwords for the Boards 423 Most common hydrocarbon used in dry cleaning Buzzwords for the Boards 424 PERC Perchloroethylene Buzzwords for the Boards 425 Cement worker with contact dermatitis Buzzwords for the Boards 426 Chromium (CrVI) Buzzwords for the Boards 427 OSHA PEL for benzene Buzzwords for the Boards 428 1 ppm Buzzwords for the Boards 429 OSHA PEL for carbon monoxide Buzzwords for the Boards 430 50 ppm Buzzwords for the Boards 431 Azo dye and rubber manufacturing, HCN lab detection agent, methemoglobinemia, associated with bladder cancer (IARC 1) Buzzwords for the Boards 432 Benzidine Buzzwords for the Boards 433 Patient etching glass or wheel cleaning with delayed pain out of proportion to exam, hypocalcemia, hyperkalemia Buzzwords for the Boards 434 Hydrofluoric acid Buzzwords for the Boards 435 Vitamin B6 (pyridoxine) antidote Buzzwords for the Boards 436 Isoniazid Gyromitra esculenta Hydrazines Ethylene glycol Buzzwords for the Boards 437 The factor by which exposure is reduced by use of a respirator Buzzwords for the Boards 438 Protection factor Ambient/protection factor = exposure Buzzwords for the Boards 439 Study design comparing an exposed group to an unexposed group either retro- or prospectively with results expressed as Relative Risk Buzzwords for the Boards 440 Cohort study Buzzwords for the Boards 441 Study design comparing an exposed group to an unexposed group at one point in time. Provides prevalence data, results expressed as Relative Risk Buzzwords for the Boards 442 Study design comparing individuals with a specific condition to those that do not have the condition and compare exposures or risk factors. Results expressed as Odds Ratio Buzzwords for the Boards 443 Case-control study Buzzwords for the Boards 444 Cross-sectional study Buzzwords for the Boards 445 Federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. Has no legal authority. Buzzwords for the Boards 446 NIOSH Buzzwords for the Boards 447 The main federal agency charged with the enforcement of safety and health legislation. Buzzwords for the Boards 448 OSHA Buzzwords for the Boards 449 Enacted by Congress in1980 and created a tax on the chemical and petroleum industries and provided broad Federal authority to respond directly to releases or threatened releases of hazardous substances that may endanger public health or the environment Buzzwords for the Boards 450 CERCLA Comprehensive Environmental Response, Compensation, and Liability Act (aka Superfund) Buzzwords for the Boards 451 Federal public health agency charged with the responsibility of evaluating the human health effects of exposure to hazardous substances. Buzzwords for the Boards 452 ATSDR Buzzwords for the Boards 453 Characteristics of substances partitioning into breast milk Buzzwords for the Boards 454 Low molecular weight Non-polar (breast milk is high in fats) Low protein binding Buzzwords for the Boards 455 What are ther isks for quinoloneinduced tendinopathy? Buzzwords for the Boards 456 Age > 60 years Non-obese Steroid use Female, Renal failure Diabetes Buzzwords for the Boards 457 What is the normal urinary ratio of testosterone to epitestosterone Buzzwords for the Boards 458 Less than 6 to 1 Buzzwords for the Boards 459 Hepatic zone were CYP2E1 is primarily present and acitve Buzzwords for the Boards 460 Zone 3 Centrilobular necrosis Buzzwords for the Boards 461 The primary toxicity associated with methoxyflurane Buzzwords for the Boards 462 Nephrotoxicity Buzzwords for the Boards 463 Describe their mechanisms of action Tetrodotoxin Saxitoxin Brevetoxin Domoic acid Okadoic acid Ciguatoxin Buzzwords for the Boards 464 Tetrodotoxin: Blocks voltage-gated Na channels Saxitoxin: Blocks voltage-sensitive Na channel Brevetoxin: Stimulates voltage-sensitive Na channel Domoic acid: Glutamate agonist, analog of glutamic and kainic acids Okadoic acid: Posphatase a1 and a2 inhibitor Ciguatoxin: lowers the threshold for opening voltagegated Na channels Buzzwords for the Boards 465 Fixed amount eliminated per time Non-linear, no half-life Elimination saturated, capacity limited Concentration rises with dose Curve on semi-log paper Michaelis-Menten when concentration is high Buzzwords for the Boards 466 Zero order kinetics Buzzwords for the Boards 467 Clearance is constant over concentration Elimination is not saturated Percentage eliminated per time is constant Linear on semi-log paper Half life is time for a 50% reduction Michaelis-Menten when concentration is low Buzzwords for the Boards 468 First order kinetics Buzzwords for the Boards 469 HORDe - Hydrolysis, Oxidation, Reduction, Dealkylation Buzzwords for the Boards 470 Phase I Metabolism Buzzwords for the Boards 471 Conjugation of polar groups Increase hydrophilicity GAS MAG - Glucuronidation, acetylation, sulfation, methylation, addition of amino acids and glutathione Buzzwords for the Boards 472 Phase II Metabolism Buzzwords for the Boards 473 Intoxicants associated with peripheral neuropathy Buzzwords for the Boards 474 Acrylamide Bromide (Methyl) Carbon disulfide Styrene Trichloroethylene Buzzwords for the Boards 475 Occupational intoxicants associate with asthma (pulmonary sensitizers) Buzzwords for the Boards 476 Maleic Anhydride Trimellitic Anhydride: “Trimellitic Flu” Ethylenediamine Toluene diisocyante/isocyanates: (#1) Diethylhexyl Phthalate (DEHP) Buzzwords for the Boards 477 Rodenticide producing nausea, vomiting, bradycardia, and hyperkalemia Buzzwords for the Boards 478 Red squill (digoxin-like syndrome) Buzzwords for the Boards 479 Rodenticide producing CNS excitation, irritability, seizures, coma, ventricular dysrhythmias Buzzwords for the Boards 480 SMFA (Compound 1080) Tetramine Buzzwords for the Boards 481 Rodenticide producing oropharyngeal and skin burns, smoking vomitus and stools, garlic odor, GI and hepatic injury Buzzwords for the Boards 482 Yellow phophorus Buzzwords for the Boards 483 Rodenticide producing tremors, myoclonus, depressed mental status Buzzwords for the Boards 484 Bromethalin Buzzwords for the Boards 485 This compound was used in hospital laundry. Toxicity resulted in 9 neonates ill, 2 deaths. Presented with: fever, sweating, renal failure and acidosis. This agent was also used in various ways including in treating wood to function as preservative. It uncouples oxidative phosph. Buzzwords for the Boards 486 Pentachlorophenol Disaster occurred in 1967 Buzzwords for the Boards 487 What chemical(s) is associated with causing choracne? Buzzwords for the Boards 488 Usually due to chlorinated aromatic hydrocarbons. Also associated with general chlorine exposure. Pentachlorophenol is classically associated with this (Still used as wood preservative today i.e telephone poles; formerly as fungicide; not permitted for home use) Buzzwords for the Boards 489 Hairdresser hand dermatitis Buzzwords for the Boards 490 p-phenylenediamine Permanent hair color dye with pphenylenediamine (PPD) oxidized by H2O2 → Amines Fingertips #1 spot Buzzwords for the Boards 491 International treaty completed in 1987 by 24 nations to control the depletion of the ozone layer. Targeted to decrease the use of CFCs and halons used in fire extinguishers i.e. Halon 1211 and 1301 Buzzwords for the Boards 492 Montreal Protocol Buzzwords for the Boards 493 Shoemaker’s Polyneuropathy Buzzwords for the Boards 494 Shoemaker’s Polyneuropathy Due to use of N-hexane. Another term is “Hexacarbon neuropathy.” Same associated with Methy-N-Butyl Ketone. All of which → methylethyl ketone; all of mhich are metabolized to 2,5-butanedione (the actual problem child). Had a classic mass problem in Italy with this. Don’t confuse with the other big HC used in this industry; benzene. These folks also developed the problems associated with benzene: AML Buzzwords for the Boards 495 Toluene toxicities (4 major) Buzzwords for the Boards 496 Toluene toxicities Distal RTA Metabolic acidosis (due to Hippuric acid metabolite and RTA) Hypokalemia and associated symptoms Leukoencephalopathy (chronic use) Buzzwords for the Boards 497 The only hydrocarbon exposure associate with a change in cardiovascular mortality Buzzwords for the Boards 498 Carbon disulfide Associated with accelerated atherosclerotic CAD (Don’t forget the peripheral neuropathy) Buzzwords for the Boards 499 Cement eczema Buzzwords for the Boards 500 Refers to the dermatitis associated with exposure to chromium 6+ Type IV hypersensitivity reaction Buzzwords for the Boards 501 Wolf-Chaikoff Effect Buzzwords for the Boards 502 Wolf-Chaikoff Effect The reaction where chronic iodine exposure lead to ↓ thyroid hormone production. The inhibition of organic binding of iodide in the thyroid gland by excess iodide → ↓ thyroid synthesis. Compare with the Jodbasedow reaction (The reaction where chronic iodine exposure causes increased thyroid hormone production) Buzzwords for the Boards 503