Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Pharmacology and Toxicology--->Toxins and Poisoning
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Question 1# Print Question

A 24-year-old male caterer is admitted to the ICU approximately 24 hours after ingesting what he described as a “sweet-tasting” liquid from the canned fuel used to heat the food. Fomepizole therapy was started promptly in the emergency department and toxic alcohol levels are sent to the lab and pending. On arrival to the ICU, he complains of being “in a snowstorm.”

What is the etiology for his visual changes? 

A. Focal (partial) seizure in the occipital lobe
B. Direct damage to the retina and optic nerve
C. Basal ganglia hemorrhage
D. Vitamin B12 (cobalamin) deficiency–induced neuron demyelination
E. Substance-induced delirium

Question 2# Print Question

A 32-year-old male auto mechanic is transferred to your ICU from a small local hospital for consideration of dialysis. Two days prior, the patient ingested an entire jug of antifreeze at work on a dare. He was admitted to the local hospital for supportive care but developed progressive oliguric renal failure. On arrival to your hospital, a small amount of dark urine is present in the Foley catheter, which is sent to the lab for analysis. The lab calls you to tell you that there are crystals present in the urine.

What is the likely composition of these crystals?

A. Uric acid
B. Calcium pyrophosphate
C. Magnesium ammonium phosphate (struvite)
D. Calcium oxalate
E. Cysteine

Question 3# Print Question

A 28-year-old male is admitted from the emergency department after he was found unconscious at a party. The patient was given two doses of intranasal naloxone empirically with minimal improvement in his mental status. After he began to vomit, he was intubated for airway protection and placed on an infusion of propofol for sedation. His friends told the ED physicians that he ingested several tablets of crushed oxycodone, a “large number” of shots of liquor, and some of his friend’s newly distilled moonshine. His ethanol level in the ED was 453 mg/dL and a toxicology screen was positive for oxycodone. On arrival to the unit, your intern suggests treating empirically with fomepizole given the moonshine ingestion.

You reply that fomepizole therapy can be deferred at present because of the presence of: 

A. Oxycodone
B. Propofol
C. Ethanol
D. Naloxone
E. Moonshine

Question 4# Print Question

A 36-year-old female is admitted to the ICU for altered mental status after ingestion of an unknown substance in a suicide attempt. Laboratory studies in the emergency department were as follows:

  • Sodium 140 mEq/L
  • Potassium 4.0 mEq/L
  • Chloride 100 mEq/L
  • Bicarbonate 24 mEq/L
  • Blood urea nitrogen (BUN) 10 mg/dL
  • Glucose 100 mg/dL
  • Ethanol level 100 mg/dL
  • Measured serum osmolality 340 mOsm/kg

Which of the following calculated values most strongly supports the diagnosis of a toxic alcohol ingestion?

A. Osmolal gap >25 mOsm
B. Osmolal gap <10 mOsm
C. Anion gap >20 mEq
D. Anion gap <10 mEq

Question 5# Print Question

A 41-year-old male was admitted from the emergency department for altered mental status after drinking a bottle of an unknown liquid. A venous blood gas and measures of the serum electrolytes, renal function, and anion gap were all normal and ethanol level was 100 mg/dL. On arrival to the floor, repeat labs demonstrate a measured serum osmolality that is 40 mOsm above the calculated value. The patient is found to be hypotensive and has a pH of 7.05 and an anion gap of 30 mEq. The next osmolal gap is nearly normal.

Which of the following alcohols is NOT likely to be the ingested agent? 

A. Methanol
B. Ethylene glycol
C. Ethanol
D. Propylene glycol
E. Isopropyl alcohol

Category: Critical Care Medicine-Pharmacology and Toxicology--->Toxins and Poisoning
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