Medstudy Q&a

Front 1

Formula for osmolal gap

Back 1

Measured minus calculated osmolality (2xNa + glu/18 + BUN/2.8)

Front 2

Significance of osmolal gap

Back 2

Implies presence of LMW substance in the serum

Front 3

Causes of increased osmolar gap (7)

Back 3

Mannitol, sorbitol, glycerol; ethylene glycol, alcohols – methanol, ethanol and isopropyl alcohol

Front 4

Comatose patient with osmolar gap and an anion gap; etiology?

Back 4

Ethylene glycol or methanol

Front 5

Patient more intoxicated-appearing than is consistent with the blood level of ethanol, diagnosis?

Back 5

Ethylene glycol (same molecular weight but toxic at much lower doses)

Front 6

Probable overdose patient, general management

Back 6

Cardiac monitoring, IV naloxone; fingerstick glucose, D50 PRN; pulse ox with O2, thiamine 100mg IM IV

Front 7

Activated charcoal is not effective with overdose with these substances

Back 7

Metals lithium and iron

Front 8

Reason for alkalinizing or acidifying serum and urine in drug overdose

Back 8

Compounds in their ionized form are less tissue-permeable and more easily eliminated by kidneys; weakly acidic substances ionize in alkaline environment and vv

Front 9

Alkalinzation of urine increases excretion of these substances

Back 9

ASA, TCAD, Phenobarbital

Front 10

Acidification of urine increases excretion of these substances

Back 10

Amphetamine and phencyclidine )PCP)

Front 11

Hemodialysis is effective in eliminating these substances

Back 11

Substances that have LMW, are not lipid soluble, protein-bound or tissue-bound, i.e. lithium, chloral hydrate, salicylates and alcohols (methanol, ethylene glycol and ethanol)

Front 12

Charcoal hemoperfusion is useful for eliminating these substances

Back 12

Drugs that are lipid-soluble and protein bound; digoxin, theophylline, salicylate

Front 13

Main metabolite of alcohol

Back 13

Acetone

Front 14

Signs and symptoms of isopropyl alcohol intoxication

Back 14

CNS depression, cardiac depression, abd pain and vomiting

Front 15

Toxic metabolites of methanol

Back 15

Formaldehyde and formic acid

Front 16

Signs of methanol intoxication

Back 16

Inebriation, toxicity delayed >24 hours; visual impairment (blurring to blindness)

Front 17

Treatment of methanol

Back 17

Alcohol infusion, folic acid and immediate dialysis

Front 18

MOA of folic acid in methanol overdose

Back 18

Increases metabolism of formic acid

Front 19

Toxic metabolites of ethylene glycol

Back 19

Oxalate

Front 20

Indicates the presence of oxalate

Back 20

Calcium oxalate crystals in urine and hypocalcemia

Front 21

Treatment for ethylene glycol intoxication

Back 21

Alcohol infusion which has 100x stronger affinity for alcohol dehydrogenase; bicarbonate, calcium PRN and immediate dialysis

Front 22

So toxic they may cause signs of toxicity at normal osmolality levels

Back 22

Methanol and ethylene glycol

Front 23

Effects of salicylate overdose on respiratory system

Back 23

Causes hyperventilation through a central effect

Front 24

Treatment of salicylate overdose

Back 24

Lavage, activated charcoal with cathartic, serum / urine alkalinization, HD and charcoal hemoperfusion

Front 25

Metabolite of acetaminophen

Back 25

NAPQI or N-acetyl-p-benzoquinoneimine

Front 26

How is NAPQI cleared

Back 26

Reacts with sulfhydryl group of glutathione forming nontoxic mercapturic acid

Front 27

Treatment of lithium toxicity

Back 27

Activated charcoal not effective; gastric alvage, restore fluid and electrolyte balance, HD in severe overdose

Front 28

Why can’t TCADs be removed by dialysis?

Back 28

Lipophilic and protein bound, large Vd

Front 29

EKG changes of TCAD overdose

Back 29

Prolonged PR, QRS, QT

Front 30

EKG change that correlates most closely with degree of intoxication

Back 30

QRS prolongation

Front 31

Treatment of TCAD overdose

Back 31

Cardiac problems respond to alkalemic state (hyperventil;ation or IV bicarb) so keep serum pH 7.5 to 7.55; lidocaine or phenytoin as needed

Front 32

Antidote for nitrates

Back 32

Methylene blue

Front 33

Antidote for ethylene glycol

Back 33

ETOH

Front 34

Antidote for methanol

Back 34

ETOH

Front 35

Antidote for organophosphates

Back 35

Atropine and pralidoxime

Front 36

Antidote for cyanide

Back 36

Nitrates, Na-thiosulfate

Front 37

Antidote for iron

Back 37

Deferoxamine

Front 38

Miosis or small pupils, increased bowel sounds, diarrhea, increased salivation, muscle weakness, agitation and seizurs

Back 38

Cholinergics

Front 39

Dilated pupils, warm dry skin, tachycardia, HTN, inc temperature, dec bowel sounds,urinary retention, agitation, hallucination

Back 39

Anticholinergics

Front 40

Dilated pupils, warm wet skin, tachycardia, HTN, increased temperature, agitation, psychosis

Back 40

Stimulants

Front 41

Young patient presenting with MI

Back 41

Cocaine

Front 42

Acute psychotic agitation, seizures, dystonia (rhabdo), HTNive crisis

Back 42

PCP

Front 43

Treatment of PCP

Back 43

Acidify urine with ammonium chloride, treat HTN with diazoxide

Front 44

When to suspect CO poisoning

Back 44

Working around cars, or gas/oil heating units

Front 45

Winter time, patient calls saying family bedridden with bad flu, headache and lightheadedness

Back 45

CO poisoning; get out of the house and send EMS unit

Front 46

Wintertime, complains of headache and lightheadedness whichimproves when he goes outside

Back 46

CO poisoning; get out of the house and send EMS unit