Toxicology MCQs

1
Which of the following drugs does NOT cause a prolonged QRS?
A

Thioridazine

Propanolol

Quinine

Metoprolol

Answer
2
Which of the following antidotes is NOT used in cyanide poisoning?
A

Dicobalt EDTA

Hydroxycobalamin

Sodium nitrite

Dimercaprol

Answer
3
Regarding Tests for Drugs in Toxicology, which statement is FALSE?
A

Bedside ECG and serum-Paracetamol are regarded as routine Toxicology

screening tests

Fluorescence polarization immunoassay on urine or blood samples is used

for Drug Screening

Gas chromatography/mass spectrometry is performed as Confirmatory test

on blood or urine samples

Thin layer/paper chromatography, used on urine and blood samples assists

in Drug Screening

Answer

4
Extracorporeal elimination of drugs may be of use in all of the following
EXCEPT:
A

Ethylene glycol

Salicylates

Atenolol

Organophosphates

Answer
5
The following statements about Digibind are true EXCEPT:
A

Indicated when there is a hx of ingestion of > 10 mg

40 mg binds approximately 0.6 mg digoxin

Serum digoxin levels increase following its administration

Indicated for use if serum digoxin level is > 10nmol/L in acute overdose

Answer
6
The following is contra-indicated to treat theophylline seizures
A

Diazepam

Phenobarbitone

Chloral Hydrate

Phenytoin

Answer

Following Aspirin overdose the initial acid base derangement is usually

Respiratory acidosis

Metabolic acidosis

Respiratory alkalosis

Metabolic alkalosis

Answer

Which of the following pairs is FALSE regarding Drugs and their appropriate
antidotes?

Beta blockers -Glucagon

Chloroquine - Diazepam

Isoniazid - Pralidoxime

Methanol-Ethanol

Answer

With regard to sympathomimetic toxicity, which of the follow is TRUE?

Co-ingestion of cocaine and alcohol results in greater neurological toxicity

than cocaine alone.

There is no difference between intravenous or oral amphetamine use and

the incidence of rhabdomyolysis.

Patients with psychomotor acceleration and psychosis should initially

reviewed by the psychiatric team

Auditory hallucinations are uncommon

Answer

10

The maximum safe dose for paracetamol every 24 hours is

90 mg/kg in children

150 mg/kg in children

200mg/kg in children

In an adult up to 5 grams

Answer

be

11

Theophylline toxicity

Often presents with abdominal pain, haematemesis and drowsiness

Causes its effects by blockade of voltage sensitive calcium channels in

cardiac muscle and CNS

Is rarely fatal with good supportive care

May cause refractory seizures

Answer

12

Which statement is FALSE regarding Anti-Histamine toxicity?

Doxylamine overdose may result in non-traumatic rhabdomyolysis

The 1 generation anti-histamines is a common cause for patients

presenting with anti-cholinergic toxicity in ED

Phenytoin is indicated for managing seizures

Diphenhydramine and Dimenhydrinate may cause cardiac conduction

delays similar to Tri-cyclic anti-depressant overdose

st

Answer

13

Which statement is FALSE regarding Colchicine poisoning?

Colchicine is rapidly absorbed following oral administration

The multiorgan failure phase typically occurs 24 hours after ingestion

A rebound leucocytosis occurs 3 weeks after poisoning in survivors,

signalling recovery of bone marrow function.

Charcoal is indicated for gut decontamination

Answer

14

Which statement is TRUE regarding anticonvulsant drug poisoning?

Chronic toxicity with therapeutic dosing is uncommon with Phenytoin

A poisoning with Sodium Valproate at 100 mg/kg is likely to result in coma

Cardiac monitoring is not required where Phenytoin is the only agent

ingested.

Carbamazepine levels are not useful in the management of carbamazepine

poisoning

Answer

15

Regarding antimicrobial toxicity, the following are often fatal EXCEPT

Isoniazid

Neomycin

Chloroquine

Quinine

Answer

16

Regarding Isoniazid toxicity, all of the following are true EXCEPT

Metabolic acidosis common

Treatment of seizures is best treated with high dose BDZ

Acidosis is thought to be secondary to seizures

Toxicity seen early post ingestion (within 1-2hrs)

Answer

17

Which is FALSE regarding Quinine poisoning

Deliberate overdose is often fatal

Significant overdose may result in cardiovascular collapse

Deliberate overdose may result in permanent blindness

PR interval prolongation is major ECG change seen

Answer

18

In overdose the following are true EXCEPT

Penicillins and cephalosporins are associated with seizures.

Seizures in isoniazid toxicity are due to pyridoxine disruption.

A farmer presenting with hallucinations, dementia, and exquisitely painful

legs may well have ergot poisoning.

A patient presenting after ingestion of colchicine presenting with minimal

symptoms can be safely discharged after a short period of observation.

Answer

19

In a patient with a history of unknown psychiatric medication, which of the

following is TRUE?

Hyperreflexia, rigidity and hyperthermia would likely represent a doserelated effect of olanzapine.

Extrapyramidal effects make it more likely to be a typical than atypical

antipsychotic.

Positive ECG changes in TCA toxicity are highly predictive of likely

arrhythmias.

If you suspect serotonin syndrome in an intubated patient then midazolam

and fentanyl sedation would be a good choice due to its short duration of
action.

Answer

20

Which of the following is LEAST likely to be helpful in a Calcium Channel

Blocker overdose?

Atropine

Intra-aortic balloon counterpulsation

Insulin

Resonium

Answer

21

Which is FALSE regarding Paraquat poisoning?

Supplemental oxygen should be avoided

It is associated with Paraquat tongue

A raised creatinine carries a poor prognosis

Paraquat has an effect on the neuromuscular junction

Answer

22

Which of the following drug: antidote pairs is least appropriate in the ED

Hydrofluoric acid burn: Calcium chloride

Cyanide poisoning: Thiosulphate

Clonidine overdose: Naloxone

Benzodiazepine overdose: Flumazenil

Answer
23
Which statement is FALSE?
A

In Anticholinergic Syndrome death may result from hyperthermia and

dysrhythmias

Oil of wintergreen ingestion is associated with altered mental state,

respiratory alkalosis, metabolic acidosis and tinnitus

Serotonin Syndrome is associated with ocular myoclonus and hyperreflexia

Cyproheptadine may be of benefit in Neuroleptic Malignant Syndrome

Answer

24

Which statement is FALSE in regard to Lithium poisoning?

Peak serum levels occur within 2-4 hours of oral ingestion

Significant ECG changes only occur at very high serum levels

Clinical features of Lithium toxicity can be observed even when serum levels
are in the normal range.

Neurological features dominate the clinical presentation

Answer

25

Which statement is FALSE in regard to Theophylline poisoning?

The precise mechanism of toxicity is unknown.

Serum levels will confirm poisoning and are invaluable in ongoing

management

Seizures refractory to benzodiazepines should be treated with second line

agents including phenytoin and phenobarbitone.

Poisoning associated with chronic use is more common than acute

ingestions.

Answer

26

Which of the following is NOT a feature of pure fast sodium channel

blockade

QRS widening

Tachycardia

VT

VF

Answer

27

In regards to B blockers, which is FALSE?

Poisoning with most B blockers is usually benign

Insulin:dextrose therapy may have a role

NaHCO3 has an occasional role

Most symptomatic overdoses exhibit bradycardia

Answer

28

Regarding activated charcoal, which is INCORRECT:

The enormous surface area provided by these particles of charcoal

irreversibly absorbs most ingested toxins preventing further absorption from
the GI tract

The major risk is charcoal pulmonary aspiration due to loss of airway

reflexes associated with impaired consciousness or seizures.

Ileus is not a contraindication to single dose activated charcoal.

Multiple dose activated charcoal has the potential to enhance drug

elimination by interruption to enterohepatic circulation and gastrointestinal
dialysis.

There is no data to support the use of activated charcoal in sorbitol or other

cathartic agent over activated charcoal in water.

Answer

29

Regarding urinary alkalinisation which is INCORRECT:

Production of alkaline urine prevents reabsorption across the renal tubular

epithelium thus promoting excretion in the urine.

In salicylate overdose metabolism is saturated and the elimination half life

greatly prolonged.

Severe established salicylate toxicity warrants a trial of urinary alkalinisation

rather than immediate haemodialysis.

In Phenobarbitone coma, multi dose activated charcoal is superior to urinary

alkalinisation as first line.

Answer

30

Which of the following statements is FALSE with regards the toxicokinetics

of phenytoin?

HONK is a recognised complication

Is a Na Channel blocker

Causes QRS widening

Shares the same order of elimination kinetics as salicylate

Answer

31

Digoxin immune Fab therapy is NOT indicated in which of the following

natural teas / broths

Oleander

Lily of the valley

Cane toad

Sea Horse

Answer

32

With respect to Theophylline toxicity, which is FALSE

Anxiety, vomiting and tremor are early manifestations

It can precipitate supraventricular tachycardia

Hypoglycemia, hypophosphataemia and hypomagnesaemia are

complications

Beta blockers are contraindicated

Answer

33

Which of the following paired agents or syndrome/interventions is FALSE

Anticholinergic agents: Physostigmine

Neuroleptic Malignant syndrome: Bromocryptine

Serotonin syndrome: Cyproheptadine

Organophosphates: atropine, pyridoxine

Answer

34

Regarding clozapine overdose, which is TRUE:

Ingestion of a single tablet in a child needs assessment in hospital

Acute poisoning is associated with agranulocytosis

Patients typically become comatose and require endotracheal intubation

with significant overdose

Overdose is not associated with anticholinergic effects

Answer

35

All of the following is true regarding iron overdose, EXCEPT:

A serum iron level should be done 12 hours following ingestion

An anion-gap metabolic acidosis is typical

Activated charcoal is not indicated as it does not adsorb iron

Abdominal X-ray may be useful

Answer

36

With regard to Iron overdose which statement is FALSE?

Accidental childhood ingestion is usually not serious

Desferrioxamine is indicated if there are signs of systemic toxicity or a 4-6

hour level of greater than 90 micromol/L

Whole Bowel Irrigation is recommended for ingestions of greater than

60mg/kg confirmed on X-ray

Significant toxicity causes a normal anion-gap acidosis

Answer

37

Which of the following significant toxic ingestions would NOT require early
activated charcoal to ensure a good outcome?

Paraquat > 50mg/kg

Sodium Valproate > 1g/kg

Colchicine > 0.8mg/kg

Bupropion > 9g

Answer

38

Common causes of toxic seizures in Australia include all EXCEPT

Alcohol

Tramadol

Venlafaxine

Bupropion

Answer

39

A drug that can mimic brain death when taken in overdose is?

Thiopentone

Propanolol

Quetiapine

Baclofen

Answer

40

Which of the following statements regarding clozapine overdose is TRUE:

A child that ingested a single tablet needs to be assessed and observed in

hospital

Acute poisoning is associated with agranulocytosis

Patients typically become comatose and require endotracheal intubation

with significant overdose

Patients need to be observed in hospital for at least 24 hours

Answer

41

All of the following is true regarding iron overdose, EXCEPT:

A serum iron level should be done 12 hours following ingestion

An anion-gap metabolic acidosis is typical

Activated charcoal is not indicated as it does not adsorb iron

Hypoglycaemia is a rare feature of severe iron poisoning

Answer

42

Which of the following is NOT a benign presentation?

A child with a normal GIT who bites a mercury thermometer and swallows
some mercury

A child who ingests 30mg/kg of elemental iron

A child who ingests one of her brothers Respiridone tablets

A child who ingests 1g metformin

Answer

43

Which pairing is INCORRECT?

Lead encephalopathy sodium calcium edetate

Isoniazid overdose - pyridoxine

Methaemoglobinaemia methylene blue

Methotrexate overdose - cyproheptadine

Answer

44

Amisulpride overdose commonly results in

Abrupt cardiovascular collapse up to 12 hours post ingestion with large

overdoses

Torsades at doses of 2-4 grams

Serotonin syndrome if co-ingested with a serotinergic compound

Seizures with massive overdose

Answer

45

Which of the following statements regarding sympathomimetic toxicity is

INCORRECT

MDMA may cause SIADH

Cocaine is a sodium channel blocker

Lignocaine is used as a second line agent to control ventricular

dysrhythmias in cocaine overdose

Beta blockers are used as a first line agent to control hypertension and
tachycardia in methamphetamine overdose

Answer

46

Which of the following is TRUE regarding b-Blocker toxicity

Propranolol facilitates sodium entry into cells resulting in QT prolongation on

ECG

Significant toxicity is usually apparent within 6 hours

Sotalol is the only b-Blocker which causes QT prolongation

B-blocker overdose causes decreased intracellular cAMP concentrations

Answer

47

Regarding calcium channel blockers (CCB)

Nifedipine produces more cardiotoxic effects than verapamil

Activated charcoal therapy is not indicated in CCB overdose

Calcium and glucagon form the mainstay of treatment in CCB overdose

Standard CCB preparations are rapidly abdorbed from the GI tract with
onset of action within 30mins

Answer

48

Regarding Warfarin, which is FALSE

Activated charcoal may be useful for decontamination

A normal INR at 48hr excludes an acute warfarin ingestion

Prothrombinex contains factors II, IX and X

Superwarfarin ingestion is rarely fatal

Answer

49

Regarding Beta-blocker toxicity, which is FALSE

Activated charcoal may be useful for decontamination

Sotalol is associated with prolonged QRS

Seizures are seen in propranolol poisoning

PR prolongation is an early sign of toxicity

Answer

50

Which is NOT associated with potentially lethal toxicity when ingested by a

10kg toddler?

2 capsules Diltiazem 180mg SR

2 tabs Chloroquine

2 tabs Digoxin 250mcg

Marijuana

Answer

51

Which medication is NOT implicated in serotonin syndrome?

Fentanyl

Ondansetron

Valproic acid

Mirtazapine

Answer

Answers
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.

D
D
D
D
D
D
C
C
D
A
D
C
C
C
B
B
D
D
B
D
D
D

23.
24.
25.
26.

D
B
C
B

27. D
28. A
29. C
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.

C
D
D
D
A
A
D
B
A
D
A
A
C
D
A
B
D
B
C
B
C
D

It is a herbicide and acts on NADH to create superoxides

Flumazenil can cause seizures in chronic BDZ users, multiple ingestions, and
Those patients with an underlying seizure disorder
Cyproheptadine is of theoretical benefit in Serotonin Syndrome
Never see significant ECG changes occasionally benign only
Phenytoin is contraindicated.
B-pure Na blockade results in bradycardia. In practice a tachycardia is
commonly seen due to other factors (eg anticholinergic effects) Toxicology
handbook
A True, toxicology handbook, exception Sotalol and propranolol B True propranolol OD C True-propranolol OD can behave like TCA D False- Ann
Emerg Med 2002:40(6) 603-610 E True-Tox handbook
Should read reversibly absorbs.... Toxicology handbook Ed 1, pages 20, 21,
25, 26
Haemodialysis preferred to urinary alkalinisation. Toxicology Handbook Ed 1
Page 27, 28
Cardiac side effects are not seen - Toxicology handbook Murray et al.
how could a sea horse be nasty
D: atropine, Pralidoxime
Tox handbook p 176
Tox handbook p 213
D High anion gap acidosis Toxicology Handbook pg 213-216, pg 325-325
B Haemodialysis alone will ensure a good outcome, Toxicology Crew
A - Alcohol Tox Handbook p 41
Tox Handbook, multiple pages
Tox handbook p 176
Tox handbook, p 213
Toxicology handbook p 285
cyproheptadine for serotonin syndrome Toxicology Handbook
Tox handbook p 128
Tox handbook
rd
Cameron 3 ed p 900-905
rd
Cameron 3 ed p 900-905
long QT, Tox handbook Ch. 3.14
Tox Handbook, p 106
Tox Handbook p. 50