1. BOOK REVIEW
Chapters:

2. Which of the following is true regarding anticholinergic crises?
A) Seizures are seen more commonly in adults than
in children.
B) Hyperthermia is a significant cause of death in
patients who receive adequate supportive care.
C) Reduced gastric motility is the earliest sign.
D) Sympathomimetic and Anticholinergic crises are
clinically indistinguishable.
E) Nicotinic antagonism exceeds muscarinic
antagonism.

3. Answer: B

4. What is the most common plant associated with Anticholinergic Toxicity?
Deadly Nightshade
Henbane
Mandrake
Jimsonweed

5. Answer: D

6. Please recite the Judy T. mnemonic for Anticholinergic Toxicity!

7. Dry as a Bone
Red as a Beet
Hot as Hades
Blind as a Bat
Mad as a Hatter
Stuffed as a Pipe

8. What is the most common EKG finding associated with Anticholinergic Toxicity?
AV Dissociation
Bundle Branch Blocks
Sinus Tachycardia
QRS prolongation

9. Answer: C

10. Should a patient that displays clear evidence of anticholinergic toxicity receive the antidote, Physostigmine?

11. NO It may worsen dysrhythmias or seizures
In people who use TCA, it may cause bradycardia or asystole.

12. The most recent National Report Card on Emergency Medicine assigned what grade to Michigan?

13. D+ Ranking Michigan 43rd in the Nation Bravo! Michigan
Remember to contribute to the PAC

14. In what city did Miracle on 34th Street take place?

15. New York

16. What is the most common cause of chronic metal poisoning?
Arsenic
Lead
Mercury
Sagnastium

17. Answer: Lead
890,000 children between 1 and 5 years old have a blood level of at least 10 mcg/dL.

18. Which of the following is true regarding treatment of acute lead toxicity?
Acute lead encephalopathy is self limited and requires no specific therapy
Dimercaprol should be given before EDTA
Activated charcoal is the mainstay of GI Decontamination
Penicillamine is more effective than succimer in chelation of lead.

19. Answer: B
EDTA, if given first, it will cause the chelated lead to cross the BBB.

20. The combination of abdominal or neurologic dysfunction with a _____ anemia should raise the suspicion of lead toxicity.
Aplastic Anemia
Chronic Diseas Anemia
Hemolytic Anemia
Hemorrhagic Anemia

21. Answer: C

22. What is the last ghost called in A Christmas Carol?

23. The Ghost of Christmas Yet to Come

24. What popular Christmas toy is based on a 1903 political caricature?

25. The Teddy Bear
Theodore Roosevelt

26. Which of the following is the most effective therapy for acute arsenic poisoning?
Activated Charcoal
Ipecac
Dimercaprol
Penicillamine
Deferoxime

27. Answer: C

28. Match the odors Cyanide Isopropanol Salicylate Arsenic Fruity Almonds
Garlic
Wintergreen

29. Match the odors Cyanide Isopropanol Salicylate Arsenic Fruity Almonds
Garlic
Wintergreen

30. In A Charlie Brown Christmas, how many cents does Lucy charge for her psychiatric services?

31. 5 cents

32. Nerve agents cause what type of toxidrome?
Anticholinergic
Cholinergic
Sympathomimetic
Sedative Hypnotic

33. Answer: B Salivation Lacrimation Urination Defecation
GI distress (diarrhea)
Emesis
Bronchorrhea, Bradycardia

34. What two agents are administer to patients who have been exposed to Nerve Agents?

35. Atropine
2-PAM

36. HSC, a division of DOW, releases a ‘Chlorine Cloud’ and patients start arriving at your ED c/o of resp. difficulties. What is the appropiate treatment?

37. Supportive care with use of humidified oxygen and bronchodilators
Supportive care with use of humidified oxygen and bronchodilators. Use of aerosolized bicarb is controversial.

38. ‘A Christmas Story’ takes place in Hammond, Indiana
‘A Christmas Story’ takes place in Hammond, Indiana. However, it was not filmed there. Where was the movie filmed and in what year was it released?

39. Cleveland, Ohio. (one of the few good things to actually come out of Ohio)
1983

40. A frat guy shows up in the ED stating that he is taking high doses of a vitamin in order to increase his ability to pick up sorority ladies. However, he complains of the follow:
Blurred vision
Appetite loss
Abnormal skin pigmentation
Hair loss
Long bone pain
Pruritus

41. What vitamin is he taking in high doses?B

42. Answer: Vitamin A

43. What class of medications can be administered to help abate Niacin Flush?

44. Antihistamines

45. High doses of this vitamin can precipitate gout and nephrolithiasis in some patients?

46. Answer: Vitamin C

47. An overdose patient presents complaining of nausea, vomiting and AMS
An overdose patient presents complaining of nausea, vomiting and AMS. She then starts seizing. You suspect she overdosed on an antimicrobial. In addition to standard therapy, what medication should also be given that is specific to this overdose?

48. Answer: Pyridoxine (B6)

49. You are treating a patient with a suspected cyanide poisoning
You are treating a patient with a suspected cyanide poisoning. In what order do you administer the three drugs from the cyanide antidote kit?

50. Amyl Nitrite
Sodium Nitrite
Sodium Thiosulfate
*** Nitrites cause hypotension and the development of methemoglobinemia
*** Hydroxocobalamin (Vit B12a) is an alternative if available

51. Ativan Dextromethorphan Amyl Nitrate Ketamine
A 22 yo female presents with cyanosis. C/O DIB, HA, slurred speech. Friends states she was using some medication to “get high.” Pulse ox is 85% despite aggressive high flow Oxygen. Her blood draw looks like chocolate. What medication did she OD on?
Ativan
Dextromethorphan
Amyl Nitrate
Ketamine

52. Answer: C
Amyl Nitrate

53. What is the treatment for Methemoglobinemia?

54. Methylene Blue