Medical Terminology Quiz
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Questions and Answers

What does AACT stand for?

  • American Academy of Clinical Toxicology (correct)
  • American Association of Clinical Toxicologists
  • American Academy of Chemistry
  • American Association of Chemical Technicians

    • What does ABG refer to in medical terms?

    Arterial blood gas extraction and analysis

    Which enzyme is referred to as ALT?

  • Angiotensin-converting enzyme
  • Aspartate aminotransferase
  • Alanine aminotransferase (correct)
  • Alkaline phosphatase

    • ARDS stands for ___.

    <p>Acute respiratory distress syndrome</p> Signup and view all the answers

    What does AAPC stand for?

    <p>European Association of Poisons Centres and Clinical Toxicologists</p> Signup and view all the answers

    PO means by mouth.

    <p>True</p> Signup and view all the answers

    Which of the following is a common cause of poisoning managed at the NPMCC?

    <p>Alcohol</p> Signup and view all the answers

    The acronym for Intensive Care Unit is ___.

    <p>ICU</p> Signup and view all the answers

    What does the acronym NSAIDs stand for?

    <p>Non-steroidal anti-inflammatory drugs</p> Signup and view all the answers

    Define toxicity.

    <p>Inherent ability of a substance to cause injury to biologic material</p> Signup and view all the answers

    What is self-poisoning?

    <p>Deliberate ingestion of more than the therapeutic dose of a drug or substance not intended for consumption</p> Signup and view all the answers

    Accidental poisoning is always intentional.

    <p>False</p> Signup and view all the answers

    What is a symptom of substance withdrawal?

    <p>Characteristic withdrawal syndrome</p> Signup and view all the answers

    What management step should be prioritized in poisoning cases?

    <p>Life-saving measures</p> Signup and view all the answers

    Substance dependence excludes acute drug intoxication if there is no history of dependence or abuse.

    <p>True</p> Signup and view all the answers

    What is the first step in the general approach to managing a patient with poisoning?

    <p>Emergency stabilization</p> Signup and view all the answers

    What does the airway management in poisoning cases involve?

    <p>All of the above</p> Signup and view all the answers

    Match the symptoms of acute poisoning with their corresponding manifestations:

    <p>GI disturbances = Anorexia, Nausea, Vomiting Cardiovascular symptoms = Arrhythmias CNS manifestations = Headache, Convulsions, Visual disturbances Chronic poisoning = Weakness, Bradycardia</p> Signup and view all the answers

    The symptoms of substance intoxication include ______ changes due to the effect of the substance on the central nervous system.

    <p>psychological</p> Signup and view all the answers

    What is paracetamol primarily used for?

    <p>Analgesic-antipyretic</p> Signup and view all the answers

    Paracetamol is safe in all doses.

    <p>False</p> Signup and view all the answers

    What is the recommended dose computation for digoxin-specific antibody?

    <p>Total body load = (Serum digoxin conc.)(Vd)(weight in kg) / 1000</p> Signup and view all the answers

    The toxic dose of paracetamol in adults is _____ g.

    <p>7.5</p> Signup and view all the answers

    A dose of 20-30 mg/kg of elemental iron can cause abdominal pain, vomiting, and diarrhea.

    <p>True</p> Signup and view all the answers

    Activated charcoal effectively binds iron.

    <p>False</p> Signup and view all the answers

    What antidote is most effective for paracetamol overdose?

    <p>N-acetylcysteine (NAC)</p> Signup and view all the answers

    Iron is absorbed in the small intestines in the ______ state.

    <p>ferrous (+2)</p> Signup and view all the answers

    What are the stages of clinical features in paracetamol poisoning?

    <p>Stage I (0-24 hrs): Asymptomatic; Stage II (24-72 hrs): Asymptomatic with RUQ pain; Stage III (72-96 hrs): Hepatic and renal failure; Stage IV (days 7-10): Resolution of symptoms.</p> Signup and view all the answers

    What should be done if a patient ingests a dose of Elemental Iron greater than 60 mg/kg?

    <p>This is potentially fatal and requires immediate medical attention.</p> Signup and view all the answers

    Which age group generally considers doses of 150 mg/kg to produce significant toxicity from paracetamol?

    <p>Children</p> Signup and view all the answers

    What is the normal concentration range of iron in serum?

    <p>50-150 mcg/dL</p> Signup and view all the answers

    What is the recommended initial course of NAC for adults?

    <p>150 mg/kg in 200 mL D5W over 1 hour</p> Signup and view all the answers

    Match the following indications for deferoxamine treatment with appropriate criteria:

    <p>Peak serum iron concentration &gt;500 mcg/dL = Indication for deferoxamine treatment Serum iron concentration below 150 mcg/dL = Indication for deferoxamine treatment termination 32 hours after ingestion with persistent symptoms = Indication for deferoxamine treatment Return of normal urine color = Indication for treatment cessation</p> Signup and view all the answers

    What laboratory tests should be monitored in paracetamol overdose?

    <p>AST, ALT, protime</p> Signup and view all the answers

    Intravenous NAC is not recommended for patients with asthma.

    <p>True</p> Signup and view all the answers

    What are potential clinical manifestations of iron toxicity?

    <p>Gastrointestinal perforation</p> Signup and view all the answers

    Ingestion of ferric chloride is treated using the ______ protocol.

    <p>acid</p> Signup and view all the answers

    What is the recommended gastric decontamination method in paracetamol poisoning?

    <p>Activated charcoal</p> Signup and view all the answers

    What is the volume of distribution (Vd) used for calculating digoxin-specific antibody dose?

    <p>5.6 L/kg</p> Signup and view all the answers

    What distinguishes rectal administration of NAC from intravenous NAC?

    <p>IV NAC has a faster effect but is risky for patients with certain histories.</p> Signup and view all the answers

    The Rumack-Matthew nomogram applies to patients presenting within 72 hours of ingestion.

    <p>False</p> Signup and view all the answers

    Liquid iron preparations and chewable tablets are less toxic than the tablet form.

    <p>False</p> Signup and view all the answers

    What is the maximum dose of Lorazepam for adults per dose?

    <p>4 mg</p> Signup and view all the answers

    What condition is treated with sodium bicarbonate in cases of metabolic acidosis?

    <p>Metabolic acidosis</p> Signup and view all the answers

    Theophylline is a methylxanthine derivative that has a quick absorption in the gastrointestinal tract.

    <p>True</p> Signup and view all the answers

    What is the recommended dose of IV Pyridoxine in cases of seizures due to theophylline toxicity?

    <p>IV Pyridoxine</p> Signup and view all the answers

    Ingesting more than ______ mg/kg of Theophylline is considered potentially toxic in acute overdose.

    <p>10</p> Signup and view all the answers

    Match the following electrolyte disturbances with their corresponding treatments:

    <p>Hypoglycemia = Adult: 50 to 100 mL D50-50 IV Hypokalemia = Correlate with ABG and correct appropriately Low Protime = Fresh frozen plasma Metabolic Acidosis = Sodium bicarbonate 1 mEq/kg</p> Signup and view all the answers

    What are some factors that affect the metabolism of Theophylline?

    <p>All of the above</p> Signup and view all the answers

    What is the target pH level to maintain in patients with metabolic acidosis?

    <p>pH &gt; 7.4</p> Signup and view all the answers

    What is the main focus of the book 'Algorithms of Common Poisonings'?

    <p>Management of poisoning cases and treatment algorithms for specific poisons.</p> Signup and view all the answers

    Who is the publisher of the book?

    <p>National Poison Management and Control Center.</p> Signup and view all the answers

    In what year was the first edition of the book published?

    <p>1991</p> Signup and view all the answers

    Which of the following is not a contributor to the book?

    <p>Jane Doe</p> Signup and view all the answers

    The book is only intended for physicians in the emergency room.

    <p>False</p> Signup and view all the answers

    What is emphasized in the preface about the management of poisoned patients?

    <p>Individualized treatment interventions should be considered.</p> Signup and view all the answers

    Which section addresses household and workplace chemicals?

    <p>Household and Workplace Chemicals</p> Signup and view all the answers

    What does the acronym NPMCC stand for?

    <p>National Poison Management and Control Center.</p> Signup and view all the answers

    Study Notes

    Publication Information

    • Algorithms of Common Poisonings, Third Edition, published by the National Poison Management and Control Center.
    • First edition released in 1991, followed by second edition in 1998, with the third edition published in 2011.
    • Proceeds from the book support future editions and related manuals.

    Editorial Team

    • Editors include Nelia P. Cortes-Maramba, MD, Lynn Crisanta R. Panganiban, MD, Joselito C. Pascual, MD, and Carissa Paz C. Dioquino, MD.
    • Contributors represent various departments at the University of the Philippines College of Medicine.

    Content Overview

    • Prefaces outline the historical context and evolution of the book, highlighting the importance of rapid diagnosis and management of poisoning.
    • Book includes algorithms for treatment of specific poisons, organized by categories such as pharmaceuticals, household chemicals, and substance abuse.

    Management Principles

    • Emphasizes individualized treatment approaches, considering unique patient circumstances.
    • Includes general measures pertinent to all cases of poisoning before detailing specific treatment algorithms.

    Key Sections

    • Definitions: Establishes terminology in toxicology.
    • General Measures: Overview of initial management steps for poisoning cases.
    • Antidotes: Readily available agents listed for quick reference.
    • Common Pharmaceuticals: Detailed algorithms for overdoses of frequently encountered drugs like antidepressants, benzodiazepines, and paracetamol.

    Chemicals and Toxins

    • Examination of household and workplace chemicals, including caustics and corrosives.
    • Includes information on pesticides and garden chemicals frequently associated with poisoning.

    Substance Abuse and Toxic Buds

    • Reviews common substances of abuse, including amphetamines and alcohol.
    • Discussion of animal and plant toxins, detailing specific examples like cobra bites and battery plant toxins.

    Annexes and Additional Resources

    • Comprehensive annexes provide critical data like the properties of common drugs involved in poisoning, detectability durations in urine, and common antidote formulations.
    • Important contact numbers and resources for poison management accessible at the end.

    Disclaimer

    • Notes the importance of cross-verifying treatment information due to the potential for errors or changing clinical practices.
    • Encourages the use of other reliable sources alongside this handbook for the most effective patient management.### Poison Management and Control in the Philippines
    • The National Poison Management and Control Center (NPMCC) was formed by merging the NPCIS and PGH Poison Control and Information Unit in January 2005.
    • The development of toxicology in the Philippines began in 1975 at the Philippine General Hospital (PGH) due to rising poisoning cases from pesticides.
    • From 1984 to 1989, PGH recorded an average of 190 poisoning cases per year, with the 1987 Department of Health statistics showing 279 cases at an incidence of 0.5 per 100,000 population.
    • Underreporting and misdiagnosis hindered comprehensive data collection on poisoning incidents.
    • In 1991, the Poisons Control and Information Service Network (PCISN) was established with support from the International Development Research Centre (IDRC) and GTZ to improve poison management.
    • The NPCIS was recognized as a focal point for a nationwide network managing poisoning cases and increasing public awareness of chemical hazards.
    • Common toxicants managed at NPMCC include alcohol, kerosene, methamphetamine, sodium hypochlorite, and various pesticides.
    • Alcohol remains among the top five toxicants, influenced by aggressive marketing and social norms.
    • The prevalence of poisoning from methamphetamine has decreased, while newer stimulants like MDMA have seen a rise.
    • Two high-risk groups for poisoning incidents are young adults aged 20-35 and children under 6 years, primarily due to accessibility and curiosity.

    Poisoning Case Statistics

    • Approximately 35% of cases handled by NPMCC involve accidental poisoning in children, with many incidents arising from unlabelled household chemicals.
    • Non-accidental poisoning, including suicide attempts, constitutes 60% of cases, with socio-relational conflicts as common triggers.
    • Historical data from the 1980s indicate that mortality rates for poisoning range from 2% to 9%, with significantly higher rates in males.

    Strategies for Poison Management

    • The NPMCC focuses on training healthcare workers in poison recognition and management, along with creating public information campaigns.
    • Health advisories are released during surges in specific poisoning incidents, highlighting the center's role in chemical safety and community awareness.
    • Partnerships and networking among health professionals and policymakers are essential for effective poison prevention and control.

    Definitions

    • Toxicity: Ability of a substance to cause biological injury.
    • Risk: Likelihood of injury occurring in specific situations.
    • Exposure: Contact with a chemical, potentially entering the body.
    • Poison: Agents that harm biological systems or cause death.
    • Accidental Poisoning: Non-intentional exposure to harmful substances.
    • Substance Abuse and Dependence: Patterns of drug use leading to impairment or distress, defined by specific DSM-IV-TR criteria.

    Management of Poisoning

    • Key approaches include emergency stabilization, clinical evaluation, minimizing poison absorption, enhancing elimination, administering antidotes, and supportive therapy.
    • Emergency Stabilization focuses on maintaining airway, breathing, and circulation (the ABCs of life support) tailored to poison exposure severity.
    • Assess airway patency and address potential obstructions by positioning the patient correctly and performing necessary interventions for compromised airways.

    Oxygenation and Mechanical Ventilation

    • Inadequate oxygen delivery may stem from ventilatory failure, hypoxia, or bronchospasm.
    • Assess ventilation accurately by checking arterial blood gases (ABGs).
    • Oxygen should be administered if clinical signs of poor oxygenation appear or if pO2 is under 80 mmHg.
    • Delivery methods include nasal cannula, face mask, or mechanical ventilator depending on equipment availability and required FiO2.
    • Bronchospasm requires evaluation for bronchodilator administration.

    Common Toxicants Causing Hypoxia

    • Alcohol
    • Opiates
    • Quinine
    • Carbon monoxide
    • Organophosphates

    Oxygen Delivery Modes and FiO2 Levels

    • Nasal cannula provides approximately 44% FiO2.
    • Plastic mask supplies about 60% FiO2.
    • Rebreathing mask delivers between 60 to 80% FiO2.
    • Mechanical ventilator can offer 100% FiO2.

    Contraindications for Oxygen

    • Initial management of watusi poisoning requires caution; oxygen may cause explosions due to flammability.
    • In paraquat poisoning, oxygen increases pulmonary fibrosis risk.

    Maintaining Adequate Circulation

    • Establish intravenous (IV) access and begin infusion of appropriate fluids.
    • Hypotension can be treated with IV fluids when systolic blood pressure is low.

    Digitalis Toxicity

    • Digoxin toxicity can arise from chronic drug intake without dosage adjustments under certain conditions.
    • Acute toxicity is influenced by thyroid dysfunction, renal issues, electrolyte imbalances, and myocardial disease.

    Drug Interactions Increasing Digoxin Levels

    • Amiodarone, macrolide antibiotics, carvedilol, quinidine, diltiazem, spironolactone, indomethacin, and verapamil enhance toxicity.

    Metabolic Imbalances Affecting Toxicity

    • Hypokalemia, hypernatremia, hyperkalemia, alkalosis, hypomagnesemia, and hypoxemia can increase the risk of digoxin toxicity.

    Management of Digitalis Poisoning

    • Supportive treatment is generally effective.
    • Charcoal and cholestyramine can aid in drug removal.
    • Cardioversion is not advisable due to arrhythmia risks.

    Symptoms of Digitalis Toxicity

    • Acute: GI disturbances, cardiovascular symptoms, CNS effects like convulsions or visual disturbances (yellow halos).
    • Chronic: weakness, similar CNS manifestations, bradyarrhythmias, and atrial fibrillation.

    Toxicologic Examination

    • Monitor serum digoxin levels 6 hours after ingestion and monitor ECG for abnormalities.
    • Serum chemistry, CBC, and electrolytes are essential in assessing the extent of toxicity.

    Supportive Measures for Life Support

    • Maintain airway, breathing, and circulation (ABCs).
    • Initiate IV fluids, monitor cardiac status, and consider nasogastric tube insertion.
    • Gastric lavage may be necessary in acute poisoning cases to reduce toxin absorption.

    Seizure Management

    • Diazepam (for adults) and lorazepam (for pediatric patients) may be given for seizure control.

    Deferoxamine for Iron Toxicity

    • Indicated when serum iron levels exceed 500 mcg/dL, indicate clinical symptoms, or present on radiographs.
    • Treatment cessation is appropriate when serum iron drops below 150 mcg/dL and signs of poisoning are resolved.

    Clinical Signs of Iron Toxicity

    • Early symptoms include severe hemorrhagic gastritis, diarrhea, and lethargy.
    • Delayed onset may lead to serious consequences such as gastrointestinal perforation, liver failure, and metabolic acidosis.

    Laboratory Tests for Iron Poisoning

    • Total serum iron tests must be conducted 3 to 5 hours post-ingestion.
    • Monitor for signs of iron overload with regular blood tests to adjust treatment as necessary.

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