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This is a 25 point quiz on the assessment of poisoning, mostly comprised of single choice MCQs. We suggest reviewing the Epidemiology of poisoning, Risk assessment in poisoning, Toxidromes, Poisoning by unknown substances and Analytical toxicology pages before taking this quiz.
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Question 1 of 21
1. Question
The percentage of poisonings in adults that involve more than one substance is approximately
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Question 2 of 21
2. Question
The percentage of poisonings in adults that involve more than 3 substances is approximately
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Question 3 of 21
3. Question
The cumulative suicide risk at one year following an episode of non fatal poisoning in Australia is approximately
Correct
The cumulative suicide risk at one year has been reported to be less than 1%, rising to approximately 7% by 10 years.
Incorrect
The cumulative suicide risk at one year has been reported to be less than 1%, rising to approximately 7% by 10 years.
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Question 4 of 21
4. Question
Which one of the following is least likely to give a sweet, apple like smell on the breath
Correct
Sodium valproate ingestion is associated with an ammonia like odour.
Incorrect
Sodium valproate ingestion is associated with an ammonia like odour.
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Question 5 of 21
5. Question
Ingestion of which one of the following is least likely to give a garlic like smell on the breath following toxic ingestion
Correct
Chloroform ingestion is usually associated with a sweet, ketotic odour.
Incorrect
Chloroform ingestion is usually associated with a sweet, ketotic odour.
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Question 6 of 21
6. Question
Match the poisoning and the usually diagnostic odour that it causes.
Sort elements
- Violets
- Garlic
- Pear
- Almond
- Rotten eggs
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Turpentine
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Thallium
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Chloral hydrate
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Cyanide
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Disulfiram
Correct 5 / 5PointsThe correct matching poisonings and odours are: Turpentine – violets; thallium – garlic; chloral hydrate – pear; cyanide – almond; disulfiram – rotten eggs.
Incorrect / 5 PointsThe correct matching poisonings and odours are: Turpentine – violets; thallium – garlic; chloral hydrate – pear; cyanide – almond; disulfiram – rotten eggs.
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Question 7 of 21
7. Question
A 33 year old man is brought to your ED with vomiting and diarrhoea. On examination he has small pupils, a heart rate of 32 beats/min, blood pressure of 115/70 mmHg, has copious tears, is swallowing frequently and has a moist cough. Which of the following is the most likely cause for his symptoms.
Correct
The presentation is typical of a cholinergic toxidrome, the only cause of which that is listed is that of ingestion of inocybe or clitocybe mushrooms.(link)
Incorrect
The presentation is typical of a cholinergic toxidrome, the only cause of which that is listed is that of ingestion of inocybe or clitocybe mushrooms.(link)
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Question 8 of 21
8. Question
You are attending a 42 year old woman who was brought to your ED semiconscious. She has a heart rate of 48 beats/min, blood pressure of 90/60 mmHg, a GCS of 8, and small pupils. Examination of the oral cavity and skin is unremarkable. Poisoning from which of the following agents is most likely.
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Question 9 of 21
9. Question
An 18 month old boy is brought to your ED by his distraught parents. He has a heart rate of 150bpm, a BP of 120/60 mmHg, is floppy and has frequent fasiculations in his right forearm and arm. Which of the following is the most likely cause.
Correct
The focality of the fasiculations suggests a funnel web like spider bite, instead of nicotine replacement therapy, which would be expected to cause more generalised fasiculations. (link)
Incorrect
The focality of the fasiculations suggests a funnel web like spider bite, instead of nicotine replacement therapy, which would be expected to cause more generalised fasiculations. (link)
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Question 10 of 21
10. Question
A 16 year old girl is bought to your ED having been found agitated in a park. She is alert, with pressure of speech, has a heart rate of 120 bpm, a BP of 140/70 mmHg, warm sweaty skin and a resting tremor. Her pupils are dliated and examination of the abdomen reveals few bowel sounds and a palpable suprapubic mass that extends midway to the umbilicus. The most likely cause is:
Correct
The pressure of speech and sweaty skin suggests stimulant poisoning, otherwise the features could be of an antimuscarinic toxidrome. The suprapubic mass could be due to urinary retention or a pregnant uterrus. (link)
Incorrect
The pressure of speech and sweaty skin suggests stimulant poisoning, otherwise the features could be of an antimuscarinic toxidrome. The suprapubic mass could be due to urinary retention or a pregnant uterrus. (link)
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Question 11 of 21
11. Question
Which of the following is not a feature of drug withdrawal syndromes
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Question 12 of 21
12. Question
Following chronic use, which one of the following agents is least likely to cause a withdrawal syndrome following sudden cessation of use.
Incorrect
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Question 13 of 21
13. Question
Which one of the following is not normally a feature of heavy metal poisoning
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Question 14 of 21
14. Question
Which one of the following is least likely to cause severe toxicity following poisoning
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Question 15 of 21
15. Question
Which one of the following substances would be most likely to cause blindness with normal pupillary reflexes following poisoning
Correct
Blindness with preserved pupillary reflexes indicates a cortical cause – hydrogen sulphide is the only one of the substances listed that does not cause retinal toxicity, although cocaine could cause both. Phencyclidine has no direct retinal toxicity, however “sun gazers retinopathy” is a recognised complication of PCP use.(link)
Incorrect
Blindness with preserved pupillary reflexes indicates a cortical cause – hydrogen sulphide is the only one of the substances listed that does not cause retinal toxicity, although cocaine could cause both. Phencyclidine has no direct retinal toxicity, however “sun gazers retinopathy” is a recognised complication of PCP use.(link)
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Question 16 of 21
16. Question
Which of the following would be least likely to contribute to the onset of toxicity being delayed following ingestion of a toxic amount of a substance.
Correct
Connective tissue diseases often reduce gastric motility as can shock and diabetes, bezoar formation can cause delayed release of active substance.(link)
Incorrect
Connective tissue diseases often reduce gastric motility as can shock and diabetes, bezoar formation can cause delayed release of active substance.(link)
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Question 17 of 21
17. Question
Which one of the following agents would be least likely to cause delayed onset of toxicity following oral ingestion
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Question 18 of 21
18. Question
Which one of the following investigations is the most useful in stratifying risk of early adverse outcome in patients who present following a toxic ingestion of unknown substances
Correct
The 12 lead ECG is the cornerstone of risk statification for early (cardiovascular) complications of poisoning. Serum paracetamol and osmolar gap may have prognostic significance, but mostly for delayed complications (if untreated). (link)
Incorrect
The 12 lead ECG is the cornerstone of risk statification for early (cardiovascular) complications of poisoning. Serum paracetamol and osmolar gap may have prognostic significance, but mostly for delayed complications (if untreated). (link)
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Question 19 of 21
19. Question
The agents involved in significant toxicity following poisoning can be determined by history, examination and basic laboratory investigations in approximately what percentage of drug ingestions
Correct
Incorrect
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Question 20 of 21
20. Question
The yield of screening for detectable paracetamol concentrations following overdose in patients without a history of paracetamol ingestion is approximately.
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Question 21 of 21
21. Question
The yield of screening for paracetamol concentrations requiring the use of NAC following overdose in patients without a history of paracetamol ingestion is approximately