Opioid Poisoning – Board-Style Questions

What this deck covers

Opioid poisoning in 18 board-style clinical cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong, with the guideline or textbook it follows named on the answer.

Board-style teaching questions for paediatricians and trainees preparing for paediatric board, MRCPCH and licensing examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 18 cases, in order

1. Green syrup in the fridge
2. Blue lips, no cannula
3. How far to push it
4. Awake, then flat again
5. Why the breathing stops
6. Pink at the lips
7. Awake and furious
8. The dose that is not enough
9. A fit after the tablets
10. Something in the bin
11. The screen came back clear
12. Jittery at two days old
13. Going back to that house
14. Small pupils, no response
15. Still no bowel sounds
16. Watching the clock on the ward
17. Twice the marks on the chart
18. What is missing from the plan

Diagnoses and management options tested

Across the 18 cases you are asked to choose between options such as: Poisoning by a sedative bought over the counter for travel sickness, Open the airway and ventilate with a bag before any drug is drawn up, Give the full remaining dose at once, so that he wakes and can be assessed, Observation only, since a second fall in the rate is entirely to be expected, Suppression of the drive to breathe at the brainstem, through the mu receptor, Aspiration of stomach contents, which is the only cause of this picture, A second drug taken at the same time, which is now becoming apparent, A second drug that blocks the antidote and prevents it working at all, Tramadol, which brings on fitting in a way the others do not, A tablet from the same prescription, which the child has found and swallowed today, The sample was taken too early, and a repeat in the morning will be positive, Ongoing poisoning by the drug that crossed to him before delivery, A supply kept at home, with the family taught when and how to use it, A second opioid taken at the same time, which would need much larger doses again.

Clinical pearls from this deck

• Slow breathing and tiny pupils: think the syrup.
• Breathe for the child before you reach for a drug.
• Titrate to the breathing, not to the eyelids.
• The antidote fades hours before the drug does.
• It switches off the drive, so the child looks asleep.
• Pink froth can follow the drug and the reversal.

Work through the deck once for recognition, then again a week later to test yourself — each question gives the answer and explains why every other option fails.

More from this system: all emergency and critical care case decks · pediatric reference values.