SAQ-Toxicology

  TOXICOLOGY WEEK 1

2001/2/SAQ8: An 18 y.o. female is brought be ambulance following an ingestion of an unknown quantity of diltiazem slow release and 50mg atenolol tablets with an unknown quantity of alcohol 45 minutes prior to her arrival. On arrival she is drowsy but responsive, pulse rate 55/min, BP 85/30, RR 12/min and SaO2 99% on oxygen. She is triaged to resuscitation. Describe your management of this patient. (100%)

2003/1/SAQ5: A middle aged man is brought into your emergency department by ambulance. He was found unconscious in his apartment with a suicide note next to him. There was no evidence of trauma and no empty medication packages were found. He was intubated at the scene. Naloxone given had no effect on his level of consciousness. On arrival his observations were heart rate 50 beats/minute, BP 110/70, spontaneous respiratory rate 6/minute achieving an oxygen saturation of 92% on 6L oxygen per minute. His initial ECG revealed a slow atrial flutter with variable block. His Na+ 128mmol/L, K+ 7.5mmol/L, Cl 110 mmol/L, Urea 17mmol/L and Creatinine 0.08mmol/L. Outline your assessment of this patient. (50%) Outline your management of this patient. (50%)

2004/1/SAQ7:A 38 year olda man is brought in by ambulance. He was found unconscious in a house by the fire brigade. He is now conscious with spontaneous respirations and has O2 being delivered by Hudson mask at 6L/min. He has a black sooty faceand head. Both his hair and nasal hair are singed. He has carbonaceous spots in his tongure and pharynx. There is circumferenctial blistering to his left leg. Outline your manangement of this patient (70%). Discuss the use of hyperbaric in this case. (30%)

2006/2/SAQ1: a. What are the symptoms and signs of lithium toxicity? (30%) b. Describe the specific treatments for lithium toxicity including their indications. (70%)

worked answers

TOXICOLOGY WEEK 2

2002/1/SAQ6: A 42 year old female factory worker is brought to hospital with protracted vomiting following a chemical spill at a local petrochemical plant. Hazchem information provided by her employer identifies the substance involved as an organophosphate. Describe the management of this patient on arrival at your department. (80%). Briefly discuss the investigations indicated. (20%).

2004/2/ SAQ6: A 3 year old child is brought into the emergency department having ingested “at least 20” of her mother’s iron tablets. Describe your assessment of this patient. (50%) Describe your management of this patient (50%)

2000/2/SAQ8: A mother presents with her very disressed 18 month old child. The mother thinks the child has been eating the powder detergent from the dishwasher. Discuss your assessment and management (100%).

1996/2/SAQ4: Outline your treatment strategy for a 30 year old female brought to the emergency department with a fluctuating level of consciousness and intermittent vomiting. Initially her rectal temperature is noted to be 38.7oC, the pulse rate is 120bpm and the blood pressure is 90/60mmHg. Muscular rigidity is clinically apparent. Empty bottles of fluoxetine, paracetamol, phenelzine and amitriptyline have been found beside her (100%).

worked answers

TOXICOLOGY WEEK 3

A 45 year old man who has drunk a bottle of bourbon and a bottle of antifreeze, is brought to the emergency department by his wife. He is agressive and angry and stumbling about the department. He smells strongly of alcohol and wants to leave your department. Describe your management of this man (100%).

A 26 year old female is brought in by ambulance with a history of having 10 generalised tonic clonic seizures in the last hour. On arrival to the ED she is beginning to fit again. The ambulance service report a history of tuberculosis and had informed her mother that she had overdosed on her medications 4 hours ago (she does not know what the medications were and the container is unlabelled and empty). The patient has already received 10mg IM midazolam en route. Outline your management (100%)

2009/1/SAQ3: A 47 year old man with a history of hypertension and depression has presented to your emergency department following deliberate self poisoning approximately 3hrs ago with 20 x 240mg slow release verapamil tablets. His initial vital signs are: GCS 15, HR 50 /min, BP 115/70, RR 16 /min, SpO2 99% room air. Describe your management of this patient (100%).

2009/2/SAQ6: A 25 year old man presents to your emergency department following an accidental exposure of the whole of his right hand to a 35% solution of hydrofluoric acid. He has no other injuries. Describe your management (100%)

worked answers

2011/1/3: Describe the indications for initiating and terminating antidotal therapy with N-acetylcysteine in the treatment of suspected or actual overdoses of paracetamol. (100%)

examiner's comments

2010/2/SAQ8: A 45 year old orchard worker presents following an accidental exposure to organophosphate spray.  He looks anxious and complains of abdominal pain, vomiting and weakness.  On exam you note muscle fasciculations, lacrimation, salivation, and widespread wheeze on chest auscultation. Describe your management (100%).

examiner's comments

2007/2/SAQ7: a. Outline the spectrum of possible emergency department presentations resulting from metamphetamine use (30%). b. Outline your approach to the treatment of acute behavioural disturbance caused by methamphetamine toxicity (70%).

examiner's comments

2005/2/SAQ2: a. How would you distinguish between neuroleptic malignant syndrome and serotonin syndrome?(50%) b. Outline your management of neuroleptic malignant syndrome. (25%) c. Outline your management of serotonin syndrome. (25%)

examiner's comments

2004/1/SAQ2: A 23 year old overseas student presents to your emergency department complaining that he has difficulty with his eyesight. Examination shows he can only recognise hand movements. He admits to work stresses and that he had taken an overdose of quinine tablets. Describe the clinical features and complications of a quinine overdose. (50%) Describe the management of this patient. (50%)

examiner's comments

2002/2/SAQ7: A 38 year old woman, recently discharged following admission for depression, presents having ingested a large amount of paracetamol. She says that she ingested twenty (20) 500mg tablets the previous day and has ingested a further twenty (20) paracetamol tablets 2 hours prior to presentation. Describe your assessment and discuss management of this patient. (100%)

examiner's comments

2001/1/SAQ5: A 2 year old child is brought to your Emergency Department after several episodes of haematemesis. The mother is concerned that the child may have taken some of her iron tablets. Discuss your assessment and management (100%).

examiner's comments