Deck 8: Toxicology and Substance Abuse

Question 1

Which of the following is the therapeutic effect of a cathartic?

A) Vomiting
B) Increased protein binding of drugs
C) Alkalinization of the urine
D) Diarrhea

Answer 1

Diarrhea

Question 2

Your patient is a 40-year-old male who ingested 30 tablets of Lexapro and 24 tablets of Tylenol PM. Which of the following is the most important question you should ask?

A) "Why did you take these medications?"
B) "Have you ever done this before?"
C) "Do you have a history of depression?"
D) "How long ago did you take these medications?"

Answer 2

"How long ago did you take these medications?"

Question 3

Your patient is a 45-year-old female who became hypertensive after eating some cheese and drinking wine. Which type of medication would most likely account for this reaction?

A) Phenothiazines
B) Tricyclic antidepressants
C) Selective serotonin reuptake inhibitors
D) Monoamine oxidase inhibitors

Answer 3

Monoamine oxidase inhibitors

Question 4

Your patient is a 56-year-old female who is sitting on a park bench. She is conscious, though lethargic, and complaining of faintness. She states she has had a "chest cold" for the past week so had decided to stop taking her "blood pressure pills" until she felt better. She states that this morning she ingested five tablets instead of her normal one tablet dose to "catch up" after the days off. You note cool, slightly diaphoretic skin; lungs clear bilaterally; PEARL; and no motor deficits. HR = 48, BP = 76/30, RR = 12, SaO₂ = 97%. Which of the following is least likely to be the medication she overdosed on?

A) Metoprolol
B) Procardia
C) Cardizem
D) Verapamil

Question 5

Lithium is used to treat:

A) bipolar disorder.
B) schizophrenia.
C) depression.
D) personality disorders.

Question 6

When a substance enters the body through the gastrointestinal tract, it has accessed the body by:

A) inhalation.
B) surface absorption.
C) injection.
D) ingestion.

Question 7

Which of the following medication combinations is beneficial for a lithium overdose?

A) Narcan and sodium bicarbonate
B) Mannitol and sodium bicarbonate
C) Flumazenil and naloxone
D) Haloperidol and furosemide

Question 8

A patient has accidentally ingested about 4 ounces of drain cleaner. Your primary concern should be:

A) metabolic alkalosis.
B) internal bleeding.
C) potential airway compromise.
D) decreased level of consciousness.

Question 9

You have been called to a residence by the parents of a 14-year-old boy, whom they found sniffing paint fumes in an effort to get high. The patient is agitated, coughing, and complaining of dizziness and shortness of breath. His airway is patent, respirations adequate, and radial pulse easily palpable. Closer assessment of the patient reveals paint around his mouth and breath sounds that are clear and equal. Heart rate = 96, respirations = 20, blood pressure = 116/78, and SaO₂ = 96%. Oxygen via a nonrebreather has been applied and an IV established. Which of the following is the most important in the assessment and care of this patient?

A) Benzodiazepines
B) Antipyretics
C) Cardiac monitoring
D) Albuterol administration

Question 10

Your patient is a 22-year-old female who has increased her daily dose of lithium without her physician's knowledge. She is complaining of generalized weakness, vomiting, and diarrhea. You notice that her speech is slurred. Heart rate = 68 and irregular, respirations = 16, blood pressure = 104/70, SaO₂ = 97% on room air, and the monitor shows a sinus rhythm with PACs and PJCs. Which of the following would be most beneficial to this patient?

A) Oxygen
B) Magnesium sulfate
C) Calcium chloride
D) Sodium bicarbonate

Question 11

Restoril and Ativan are examples of:

A) benzodiazepines.
B) barbiturates.
C) opiates.
D) narcotics.

Question 12

Your patient is a 29-year-old male who is conscious, alert, and extremely hyperactive after using cocaine. HR = 134, BP = 148/102, RR = 20. Physical examination reveals warm, diaphoretic skin and dilated pupils bilaterally. Which of the following medications should be considered to manage this patient?

A) Metoprolol
B) Naloxone
C) Propranolol
D) Diazepam

Question 13

Which of the following classes of drugs is commonly abused to produce hyperactivity and exhilaration?

A) Amphetamines
B) Barbiturates
C) Alcohol
D) Benzodiazepines

Question 14

Which of the following statements would make you suspicious that your patient has been exposed to cyanide?

A) "I think I smoked some bad weed."
B) "I inhaled some fumes when I was fueling my truck."
C) "I think my car has an exhaust leak."
D) "I have been burning carpets and old furniture all day."

Question 15

Your patient has ingested cyanide in a suicide attempt. Which of the following is the primary threat to life you should anticipate?

A) Hypotension
B) Pulmonary edema
C) Cellular asphyxia
D) Liver failure

Question 16

A 54-year-old female is conscious and alert and in significant pain after a coral snake bite to her hand. You note two small puncture wounds surrounded by a swollen, red area. She states that she is nauseous and has chills. Your management of this patient should include immobilization of the affected arm and:

A) placing it at the level of the heart.
B) placing it below the level of the heart with a constricting band proximal to the wound.
C) elevating it above the level of the heart.
D) placing it at the level of the heart with ice packs to the affected area.

Question 17

Two 15-year-old boys have been hiking and camping and using a guide to native plants to determine which plants are edible. They drank a tea made from some plants that they picked. They are now complaining of abdominal cramping, watering eyes, vomiting, diarrhea, and sweating. Which of the following have they most likely ingested?

A) Amanita
B) Jimson weed
C) Holly berries
D) Poison sumac

Question 18

A patient is experiencing severe abdominal cramping, vomiting, diarrhea, and facial flushing after eating undercooked chicken. Management of this patient should include all of the following EXCEPT:

A) activated charcoal.
B) IV of normal saline.
C) oxygen.
D) transport.

Question 19

Your patient is a 27-year-old male who has possibly overdosed on heroin. He is unresponsive and bradypneic. Which of the following is appropriate?

A) 25 mg diphenhydramine
B) 2 mg of naloxone
C) 1 mg of flumazenil
D) 100 mg of thiamine

Question 20

Using a pharmaceutical agent for something other than its intended use is called:

A) overdose.
B) addiction.
C) habituation.
D) substance abuse.

Question 21

A 32-year-old female is conscious and alert at a group home for recovering alcoholics and states, "I'm having rum fits." Counselors from the home tell you that she is a chronic alcoholic who entered their program three days ago and has not had a drink since. Physical examination reveals cool, diaphoretic skin; dilated pupils bilaterally that are responsive to light; and obvious anxiety. HR = 122, BP = 156/104, RR = 20, SaO₂ = 99%, blood glucose = 62 mg/dL. Based on the clinical exam findings, all of the following should be part of your patient management EXCEPT:

A) 25 g of D50W IV.
B) metoprolol IV.
C) IV of normal saline.
D) thiamine 100 mg IM.

Question 22

A 19-year-old male has ingested fifty 325 mg aspirin tablets 20 minutes before your arrival. He is alert and complaining of burning abdominal pain. Which of the following is appropriate in the prehospital management of this patient?

A) Syrup of ipecac
B) Activated charcoal
C) Sodium bicarbonate
D) N-acetylcysteine

Question 23

Your patient is a 20-year-old female who is conscious and alert, though obviously hallucinating after ingesting LSD. Her friends state that she is having a "bad trip," and you note that she is vigorously scratching her arms to the point of drawing blood. Physical examination reveals warm, slightly diaphoretic skin and dilated pupils bilaterally. Which of the following medications should be considered to manage this patient?

A) Haloperidol
B) Thiamine
C) Narcan
D) Avapro

Question 24

Which of the following is NOT associated with chronic alcohol ingestion?

A) Decreased sensation in hands and feet
B) Thiamine deficiency
C) Hyperactivity
D) Esophageal varices

Question 25

Your patient was in the building when a fire started at a factory that manufactures plastics. He is complaining of a headache, palpitations, and a burning sensation in his throat. His airway, breathing, and circulation are intact. Heart rate = 128, respirations = 22, blood pressure = 148/84, SaO₂ = 93%. You should immediately:

A) administer amyl and sodium nitrate.
B) initiate supportive measures.
C) apply the cardiac monitor.
D) prepare to intubate.

Question 26

All of the following are examples of one of the three "principles of decontamination" that are specific to toxicological emergencies EXCEPT:

A) administration of N-acetylcysteine.
B) administration of an NS fluid challenge.
C) administration of sorbitol.
D) removing a patient from a structure that is filled with carbon monoxide.

Question 27

"Rock" and "crack" are street names for:

A) cocaine.
B) marijuana.
C) heroin.
D) morphine.

Question 28

Which of the following statements concerning Africanized honeybees is accurate?

A) Envenomation by Africanized honeybees requires treatment with specific antivenin.
B) The venom of Africanized honeybees causes acute renal failure.
C) The venom of Africanized honeybees is more toxic than that of other types of bees.
D) Patients stung by Africanized honeybees tend to have more stings than patients stung by other types of bees.

Question 29

Your patient is a 24-year-old, 176-pound male who is alert and oriented 12 hours after ingesting thirty 500 mg tablets of Tylenol. Which of the following are the most likely complaints or findings?

A) Confusion, lethargy, and hyperthermia
B) Nausea, vomiting, weakness, and fatigue
C) Abdominal pain and oliguria
D) Signs and symptoms of liver failure

Question 30

Your patient is a 56-year-old female who is alert and sitting in a chair. She states that she accidentally took too many of her Cardizem tablets. Which of the following signs or symptoms would you least expect to find?

A) Cool, dry skin and mild hypotension
B) Warm, dry skin and tachycardia
C) Cool, diaphoretic skin and profound hypotension
D) Bradycardia and altered mental status

Question 31

LSD and PCP are examples of:

A) amphetamines.
B) hallucinogens.
C) sedatives.
D) narcotics.

Question 32

Alcohol is classified as a(n):

A) stimulant.
B) anxiolytic.
C) depressant.
D) hallucinogen.

Question 33

Your patient is a 19-year-old male who ingested thirty 500 mg tablets of Tylenol 25 minutes ago. Police officers on the scene are requesting that you "check him out" before they transport him for psychiatric evaluation. The patient denies ingesting other drugs or alcohol and has no complaints. HR = 94, BP = 116/74, RR = 12, SaO₂ = 98%. Which of the following would be most appropriate?

A) Release the patient to law enforcement custody
B) Transport to the emergency department and administer activated charcoal
C) Transport to the emergency department and administer sodium bicarbonate
D) Transport to the emergency department and start an IV of normal saline

Question 34

The primary goal in the prehospital care of a patient who has been bitten by a pit viper is to:

A) induce diuresis.
B) slow absorption of the venom.
C) alkalinize the urine.
D) remove the venom from the surrounding tissue.

Question 35

The order Hymenoptera includes:

A) wasps.
B) jellyfish.
C) spiders.
D) scorpions.

Question 36

Mushrooms from the class ________ are responsible for over 90 percent of deaths from mushroom toxicity.

A) Button
B) Amanita
C) Shiitake
D) Galerina

Question 37

A 38-year-old male is conscious and alert after a black widow spider bite to his right hand. You note pain and swelling to the hand, and the patient states that he is dizzy and nauseous. HR = 117, BP = 128/78, RR = 20. During your physical examination, you note that he begins to experience severe, painful muscle spasms in his right arm. Which of the following is NOT appropriate?

A) Sodium bicarbonate
B) Calcium gluconate
C) Diazepam
D) Midazolam

Question 38

A couple has been experimenting with Ecstasy. They are both complaining of anxiety, nausea, and palpitations. You would also expect:

A) dyspnea.
B) seizures.
C) elevated blood pressure.
D) bradycardia.

Question 39

The need to progressively increase the dose of a drug to reproduce the effect originally achieved at smaller doses is:

A) addiction.
B) tolerance.
C) substance abuse.
D) habituation.

Question 40

Which of the following cause(s) injury by inducing liquefaction necrosis?

A) Caustics
B) Alkalis
C) Emulsifiers
D) Acids

Question 41

Your patient is a 16-year-old female who has taken an overdose of phenobarbital. She is unresponsive. Her skin is cool and pale, BP = 92/60, HR = 60, RR = 6. You have intubated the patient and started an IV. Which of the following is appropriate?

A) Contact poison control-may order bicarbonate.
B) Sodium bicarbonate 100 mEq
C) Naloxone 2 mg, 25 gm dextrose, transport
D) 50 gm activated charcoal through an NG tube en route to the hospital

Question 42

Which of the following does NOT typically enter the body through injection?

A) Medication overdose
B) Organophosphate
C) Envenomation
D) Illicit drug overdose

Question 43

Your patient is a two-year-old male who is alert and crying after ingesting bathroom cleaner. Physical examination reveals no obvious burns or irritation to his oropharynx, and his skin is cool and dry. HR = 112, BP = 108/60, RR = 24, SaO₂ = 99%. Which of the following is most appropriate?

A) Having the patient drink a glass of milk
B) Administration of ipecac
C) Transport
D) Administration of activated charcoal

Question 44

Your patient is an 18-year-old female college student who is supine in bed and responsive only to painful stimuli. Her roommate states that they went to a party last night. She says the patient only drank soda, but now she thinks a guy who had been following them around might have put something in the patient's drink. Physical examination reveals cool, dry skin and pupils sluggish to light bilaterally. HR = 72, BP = 112/64, RR = 10, SaO₂ = 98%. Which of the following drugs was most likely slipped into her drink?

A) Flunitrazepam
B) LSD
C) Amphetamines
D) Opium

Question 45

Which of the following is commonly indicated in the management of cocaine overdose?

A) Thiamine
B) Flumazenil
C) Diazepam
D) Narcan

Question 46

A 32-year-old is conscious and in mild distress, complaining of nausea and sweating. He states that his symptoms started two days ago when he stopped drinking "cold turkey." Physical examination reveals cool, diaphoretic skin; slightly dilated pupils bilaterally; and a general weakness to all extremities. Which of the following findings would also be likely?

A) Delirium tremens, hallucinations, and anxiety
B) Insomnia, hyperglycemia, and difficulty breathing
C) Hypertension, bradycardia, and hyperglycemia
D) Depression, hypotension, and polyuria

Question 47

Which of the following best describes the mechanism of action of activated charcoal?

A) It absorbs toxins in the stomach.
B) It neutralizes both acidic and alkaline substances in the stomach.
C) It adsorbs toxins in the stomach.
D) It prevents substances from ionizing in the small intestine.

Question 48

Which of the following correctly pairs a toxin with its antidote?

A) Benzodiazepine: naloxone
B) Acetaminophen: N-acetylcysteine
C) Carbon monoxide: amyl nitrite
D) Aspirin: magnesium citrate

Question 49

Prozac, Paxil, and Zoloft are all examples of:

A) phenothiazines.
B) monoamine oxidase inhibitors.
C) selective serotonin reuptake inhibitors.
D) tricyclic antidepressants.

Question 50

You are presented with a 25-year-old male complaining of mouth and stomach pain after accidentally ingesting approximately 8 ounces of benzene. Physical examination reveals irritation to the oral mucosa, skin warm and slightly diaphoretic, and lungs clear and equal bilaterally. HR = 100, BP = 118/66, RR = 14, SaO₂ = 99%. Based on the clinical exam findings, treatment would consist of all of the following EXCEPT:

A) O₂ via nasal cannula 2 lpm.
B) rapid transportation to an ED for gastric decontamination.
C) administration of activated charcoal.
D) IV of NS KVO.

Question 51

Naproxen, ibuprofen, and ketorolac are all examples of:

A) MAOIs.
B) SSRIs.
C) NSAIDs.
D) TCAs.

Question 52

Which of the following accounts for more than 90 percent of hospital admissions for toxic substance exposure?

A) Pediatric overdoses
B) Intentional poisoning by another person
C) Pediatric accidental poisonings
D) Adult poisonings and overdoses

Question 53

Your patient is a 60-year-old male complaining of chills, fever, joint pain, and vomiting. He states he was bitten by a spider yesterday morning, and now he thinks the bite might be infected. The patient has an ulcerated wound on his left leg. The best treatment for this patient would include:

A) diazepam 2.5 mg.
B) magnesium sulfate, 2 g.
C) calcium gluconate 0.1 mg/kg.
D) supportive management.

Question 54

Which of the following is NOT a possible source of cyanide poisoning?

A) Fume inhalation from burning plastic, synthetic carpeting, or silk
B) Ingestion of apricot, pear, and cherry pits
C) Long-term sodium nitroprusside therapy
D) Improperly vented heating systems

Question 55

All of the following are roles of a poison control center EXCEPT:

A) identifying the toxin or poison.
B) determining the potential toxicity of the agent.
C) providing information on the most current definitive treatment.
D) notifying the receiving hospital and recommending treatment.

Question 56

You are presented with a 42-year-old male who is unconscious with snoring respirations after a heroin overdose. HR = 64, BP = 98/50, RR = 6 and shallow, SaO₂ = 91%. Which of the following is the most appropriate initial treatment?

A) Intubate, ventilate with supplemental oxygen
B) IV access, administer a 250 cc fluid bolus
C) BLS airway management and ventilation with supplemental oxygen
D) IV access, administer naloxone

Question 57

Your patient is an alcoholic who stopped drinking three days ago. Which of the following should concern you the most in the care of this patient?

A) Abdominal cramps
B) Command hallucinations
C) Hypothermia
D) Potential for seizures

Question 58

Narcan acts as an antagonist to all of the following medications EXCEPT:

A) midazolam.
B) methadone.
C) codeine.
D) heroin.

Question 59

Which of the following is a highly toxic, odorless, tasteless gas that is a by-product of incomplete combustion?

A) Carbon dioxide
B) Carbon monoxide
C) Cyanide
D) Methane

Question 60

The pathophysiology of toxic inhalation involves:

A) bronchodilation and destruction of cilia.
B) irritation, edema, and destruction of alveolar tissue.
C) pulmonary hypertension, alveolar atelectasis, and destruction of cilia.
D) bronchoconstriction and dispersal of surfactant.

Question 61

You respond to an ill male patient. Upon arrival, you note a farmer who is complaining of not feeling well. The patient presents in a tripod position with copious secretions, lacrimation, vomiting, and evidence of urination and defecation. You suspect:

A) anticholinergic exposure.
B) cholinergic exposure.
C) sympathomimetic exposure.
D) extrapyramidal syndrome.

Question 62

Fifty percent of accidental poisonings occur in:

A) adults.
B) geriatric patients.
C) pediatric patients.
D) dementia patients.

Question 63

The half-life of carboxyhemoglobin is reduced to approximately 22 minutes by using:

A) 100% oxygen.
B) 44% oxygen.
C) hypobaric oxygen therapy.
D) hyperbaric oxygen therapy.

Question 64

Inhalation of a poison causes:

A) absorption by the trachea.
B) absorption through the alveolar-capillary membrane.
C) increase in secretions.
D) aspiration.

Question 65

Inhaled toxins:

A) cause damage and edema in the lungs.
B) are immediately absorbed into the bloodstream.
C) are eliminated by first-round metabolism.
D) permeate the blood-brain barrier more quickly.

Question 66

Your patient is a 24-year-old male complaining of a headache for the past two days. He states he has taken aspirin but cannot get rid of the headache. The patient lives in a basement apartment, which you observe is very chilly. The patient states his furnace hasn't been working and he had to use the oven to help heat the apartment. Which other findings and complaints are most likely?

A) Nausea, vomiting, decreased hemoglobin saturation
B) Rash, nausea, a metallic taste in the mouth
C) Pale skin, sluggish pupils, tachycardia
D) Nausea, vomiting, confusion, tachypnea

Question 67

The continued use of the drug despite the fact that it may be harmful and serves no medical purpose is:

A) substance abuse.
B) withdrawal.
C) addiction.
D) habituation.

Question 68

Which of the following is a narcotic?

A) Mescaline
B) Crack
C) Cocaine
D) Heroin

Question 69

In addition to determining potential toxicity based on the type of agent, poison control centers are able to:

A) refer the patient to a specialist.
B) determine whether transport is needed.
C) guide the paramedic in starting definitive treatment in the field.
D) give the paramedic documentation advice.

Question 70

You respond to an ill patient experiencing flu-like symptoms. Upon your arrival, the patient states that she woke up not feeling well. The patient states that she has been heating her home with wood due to the electric bill being too high. You should suspect:

A) carbon dioxide poisoning.
B) carbon monoxide poisoning.
C) hypercarbia.
D) hypothermia.

Question 71

An antidote:

A) neutralizes a specific toxin.
B) enhances the toxin.
C) is not indicated in the field.
D) is universally oxygen.

Question 72

Your patient is a 48-year-old female who is unconscious with snoring respirations after ingesting an unknown substance. You note cold, peripherally cyanotic skin and a weak, rapid pulse. Her pupils are equal and reactive but constricted. She has no unusual odors, and her blood glucose level is 80 mg/dl. HR = 74, BP = 100/68, RR = 4, SaO₂ = 91%. Which of the following is appropriate?

A) Intubate, ventilate using supplemental oxygen, IV, 1 mEq/kg sodium bicarbonate
B) Intubate, ventilate using supplemental oxygen, IV, 2 mg naloxone, 100 mg thiamine, 25 gm dextrose
C) Assist ventilations using supplemental oxygen, IV, 2 mg naloxone
D) Assist ventilations using supplemental oxygen, IV, 2 mg naloxone, 100 mg thiamine, 25 gm dextrose

Question 73

Your first priority in the treatment of an inhaled toxin is to:

A) decontaminate the patient.
B) remove the patient from the source.
C) flood with oxygen.
D) deluge with water.

Question 74

The three steps of decontamination are:

A) reduce absorption, reduce metabolism, increase absorption by the kidney.
B) water, elimination in urine, atropine.
C) elimination in urine, water, oxygen.
D) reduce intake of the toxin, reduce absorption, enhance elimination.

Question 75

Some of the most immediate effects from ingesting a poison include:

A) oral burns.
B) localized skin reaction.
C) absorption by the lower intestine.
D) clotting disorders.