Pediatric Poisonings Quiz (Tox Quiz #2) 6/04

American College of Emergency Physicians
Section of Pediatric Emergency Medicine
Pediatric Poisonings Quiz (Tox quiz #2) 6/04

Nazeema Khan-Assad, MD
Pediatric Emergency Medicine Fellow
University of Florida-Jacksonville
Thomas Kunisaki, MD, FACEP, ACMT

Associate Professor, University of Florida-Jacksonville
Medical Director, Poison Control Center, Jacksonville
1. A 2-year-old presents to the emergency department (ED) with a history of vomiting and diarrhea that
started abruptly on the morning of presentation. You note that the mother is pregnant during your
physical exam of the child. The vital signs include: T 37° C, HR 110, BP 80/P, and SaO2 95% on room
air. What is the mostly likely ingestion in this patient?
a. Salicylic acid
b. Acetaminophen
c. Iron
d. Lead
2. A 16-year-old male with a history of bipolar disorder presents via EMS with confusion, nausea,
vomiting, and ataxia noted this morning by his mother. His vital signs include: T 36.9° C, HR 100, BP
110/70, and SaO2 96% on room air. On physical exam, you note the patient to have a resting tremor with
myoclonus. Which drug do you suspect is causing his condition?
a. Clonazapam (Klonopin)
b. Lithium
c. Cocaine
d. Fluoxetine (Prozac)
3. An 18-month-old boy was playing in the garage and 20 minutes later was found by his parents vomiting
and gagging. They bring him to the ED 30 minutes after the incident. Vital signs include: HR 130, BP
90/50, SaO2 93% on RA, RR 50. He is tachypneic and coughing on physical exam. What is the next most
appropriate step in treatment before getting a CXR?
a. Give activated charcoal
b. Give supplemental O2
c. Intubate immediately
d. Albuterol nebulizer treatment
4. A 16-month-old presents to (ED) with grandmother after she notes seeing the child sitting with her
opened bottle of Glyburide. The patient is currently active and alert. Grandmother states that 2 of her
pills are missing. The patient presents 2 hours post possible ingestion. What is your next plan of action?
a. Serial accuchecks of the blood glucose
b. Ipecac
c. Start whole bowel irrigation (WBI)
d. Activated charcoal
5. Match the toxin with the antidote

Iron A. Physostigmine
Neuroleptics (dystonic rxn) B. Deferoxamine
Anticholinergics C. Pyridoxine (Vitamin B6)
Isoniazid D. Benzotropin (Cogentin)
Warfarin E. Vitamin K
6. Multiple dose charcoal would be beneficial in enhancing elimination of the following drugs (choose all
the correct answers).
a. Theophylline
b. Phenobarbital
c. Iron
d. Carbamezapine
e. Digoxin
7. A 15-month-old presents to the ED because the mother noted whitish discoloration of the lips and
distinct mothball smell. She remembered she had placed mothballs in her closet a few days ago and the
closet door was open this morning while she was getting dressed. Mom also states that her child has
G6PD deficiency. What is the most significant complication in a patient with the above history?
a. Severe hemolytic anemia
b. Acute renal failure
c. Non-cardiogenic pulmonary edema
d. Status epilepticus
8. A 20-month-old is brought to the ED after ingesting 4 of her grandfather’s Digitalis 0.25 mg pills. Which
of the following is true about digoxin toxicity and the use of digoxin-specific antibody (Fab) fragments?
a. Digoxin intoxication in pediatric patients differs from that in adults because children with healthy
hearts seem more resistant to digoxin’s toxic effects.
b. Potassium concentration > 5.5 mEq/L in the setting of digoxin overdose is one indication for Fab
c. After the administration of Fab, the serum digoxin concentration cannot be used to judge continuing
tissue-level exposure to the drug, since digoxin that has been bound by Fab contributes to the level.
d. Digoxin-specific antibody fragments (Fab) will cause a significant decrease in potassium
concentration.
e. A and C
f. All of the above are correct.
9. A 15-year-old male presents to ED in a coma with CPR in progress. A friend found him in the
schoolyard. His friend confesses that the patient has been depressed over the past several days. His initial
labs reveal hypocalcemia and a severe metabolic acidosis. The urine shows calcium oxalate crystals.
What was the toxic ingestion?
a. Methanol
b. Ethylene Glycol
c. Organophosphates
d. Ethanol
10. Which of the following plants causes systemic toxicity? (May be more than one answer)
a. African violet
b. Gardenia
c. Oleander
d. Jimsonweed
e. Dieffenbachia (Dumbcane)
Copyright 2004 American College of Emergency Physicians. Pediatric Emergency Medicine Section quizzes may be
reproduced for educational purposes only. To obtain permission to reprint for any other purpose, please submit your
written request to: Deputy Executive Director, American College of Emergency Physicians, PO Box 619911, Dallas, TX
75261.

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American College of Emergency Physicians

Section of Pediatric Emergency Medicine

Pediatric Poisonings Quiz (Tox quiz #2) 6/04

Thomas Kunisaki, MD, FACEP, ACMT

5. Match the toxin with the antidote

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