20-ACUTE POISONING

1.
The following statements about drug metabolism are true
A Apparent volume of distribution = volume of total body water
B First order elimination = rate of renal clearance of a drug
C Drug clearance = amount of the drug removed from plasma per hour
D First-pass elimination = degree of drug excretion in the first hour
E Bioavailability = amount of the drug bound to specific receptors

2.
The following statements about
pharmacokinetics are true
A 50% of steady state concentration is achieved in one half-life
B The drug half-life = time taken to eliminate half the dose given
C Steady state is achieved after approximately five half-lives
D Drug bioavailability is enhanced by intravenous administration
E Drug absorption and excretion are increased when drugs are in a nonionised
state

3.
The following statements about drug
absorption are true
A Oral drug absorption is reduced if nausea or pain are present
B Only 10% of drugs given by pressurised aerosols reach the lungs
C Buccal and transdermal routes avoid first pass hepatic metabolism
D Rectal administration avoids pre-systemic hepatic elimination
E Drug absorption within the stomach is enhanced by food or alcohol

4.
The following examples of pharmacolkinetic variability are true
A Lipid-soluble drug bioavailability is enhanced by food
B Chronic liver disease reduces the bioavailability of propranolol
C Hypoalbuminaemia decreases drug concentrations in the free form
D Impaired neonatal glucuronidation increases chloramphenicol toxicity
E Ampicillin increases plasma concentrations of oral contraceptives
5.
Examples of pharmacolkinetic interactions include
A allopurinol inhibits the metabolism of azathioprine
B amitriptyline delays gastric emptying and the absorption of drugs
C digoxin and verapamil compete for renal tubular secretion
D effect of methotrexate is inhibited by NSAID therapy
E antibiotics alter gut flora disrupting enterohepatic drug cycling

6.
The following drugs inhibit drug metabolism by reducing hepatic enzyme
activities
A carbamazepine
B ciprofloxacin
C metronidazole
D allopurinol
E erythromycin

7.
The following statements about self- poisoning are true
A The majority of patients are middle-aged and/or suicidal
B 50% of episodes are associated with alcohol intoxication
C 66% of patients ingest drugs prescribed for family members
D 50% of patients have a previous history of self-poisoning
E 75% of patients repeat self-poisoning within 12 months

8.
Clinical features suggestive of self-poisoning include
A coma in patients under the age of 40 years
B strabismus and nystagmus in young patients
C evidence of self-injury e.g. scars on the forearms
D evidence of needle tracks suggesting drug abuse
E circumoral acneiform rash suggesting solvent abuse

9.
Immediate measures in the management of self-poisoning include
A identification of the ingested poison
B use of specific antidotes and antagonists
C maintenance of the airway and respiratory function
D maintenance of blood pressure and circulatory function
E induction of vomiting by salt water
10.
The following statements about gastric lavage are true
A Lavage is preferable to the use of ipecacuanha in children
B The position of the tube should be checked under X-ray confro)
C In comatose patients, endotracheal intubation must precede lavaqe
D Patients should lie on their left side in a feet-down tilt
E Activated charcoal should be given following completion of lavage

11.
The use of gastric lavage or lpecacuanha following self-poisoning
A should be avoided if petroleum distillates have been ingested
B with aspirin is unlikely to be helpful 8 hours after ingestion
C with tricyclic antidepressants is indicated 8 hours post-ingestion
D should always be undertaken if paraquat has been ingested
E should never be undertaken in hypothermic patients

12.
The following treatments are effective in poisoning with the following
drugs
A Forced alkaline diuresis - salicylates
B Dimercaprol - arsenic
C Flumazenil - opiates and analogues
D N-acetylcysteine - paracetamol
E haemoperfusion - medium acting barbiturates

13.
Typical features 12 hours after paracetamol poisoning include
A nausea and vomiting
B coma and internuclear ophthalmoplegia
C prolongation of the prothrombin time
D metabolic acidosis and hypoglycaemia
E prevention of liver damage with methionine

14.
Typical features 8 hours after salicylate
poisoning in an adult include
A coma and dilated pupils
B deafness, tinnitus and blurred vision
C hypokalaemia and respiratory alkalosis
D hyperventilation, sweating and restlessness
E an empty stomach before gastric lavage
15.
Typical features following benzodiazepine
poisoning include
A ataxia, clysarthria, nystagmus and drowsiness
B severe systemic hypotension and respiratory depression
C nausea, vomiting and diarrhoea
D convulsions, muscle spasms and papilloederna
E resolution of symptoms in < 12 hours in lorazepam poisoning

16.
Typical features following barbiturate poisoning include
A hypotension and hypothermia
B coma and respiratory depression
C skin blisters on dependent areas
D sweating, restlessness and hallucinations
E nausea, vomiting and abdominal pain

17.
Typical features following amitriptyline
poisoning include
A coma, hyperreflexia and extensor plantar responses
B warm, dry skin and dry mouth
C pinpoint pupils
D hallucinations and urinary retention
E convulsions and cardiac tachyarrhythmias

18.
Poisoning with drugs containing
dextropropoxyphene produces
A hyperventilation and agitation
B coma with pinpoint pupils and hypotonia
C hypotension and hypothermia
D high plasma paracetamol concentration
E absence of a response to naloxone therapy

19.
Typical features of morphine poisoning include
A nausea, vomiting and pallor
B coma, miotic pupils and hyporeflexia
C hypoventilation and hypothermia
D hypotension and respiratory arrest
E non-cardiac pulmonary oedema
20.
Typical features of elemental iron poisoning include
A nausea, vomiting and abdominal pain
B tachypnoea and tachycardia
C acute gastrointestinal haemorrhage
D encephalopathy and circulatory failure
E pyloric stricture presenting 6 weeks later

21.
Typical features of lithium carbonate
poisoning include
A response to forced diuresis
B thirst and polyuria
C management by haernodialysis if plasma level > 5 mmol/L
D hypernatraemia and hypokalaemia
E prolongation of the QRS and QT intervals and AV block on ECG

22.
Findings consistent with ethanol poisoning include
A drowsiness, dysarthria, ataxia and nystagmus
B hyponatraernia and hypoglycaemia
C hypothermia
D metabolic acidosis
E aspiration pneumonia

23.
Methanol poisoning characteristically
produces
A the features of ethanol intoxication
B abdominal pain, vomiting and convulsions
C fixed, dilated pupils and papilloedema
D severe metabolic acidosis due to lactic acid
E severe toxicity only in volumes > 100 ml

24.
In ethylene glycol poisoning
A toxicity is primarily due to ethylene glycol itself
B papilloedema and ophthalmoplegia are typical features
C lactic acidosis and renal failure frequently develop
D hypokalaemia and hypercalcaernia are typical
E treatment with alcohol may be valuable
25. Organophosphate poisoning is characteristically associated with
A sewage workers
B vomiting, abdominal pain and diarrhoea
C sweating, hypersalivation and bronchorrhoea
D coma, convulsions and muscle twitching
E clinical response to obidoxime therapy