Emergency and Toxicology – Set 5

What this deck covers

Emergency and Toxicology – Set 5 in 50 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 50 cases, in order

1. Drowsy beside grandmother’s tablets
2. Mixed tablets from a kitchen drawer
3. Timing the first blood sample
4. How the antidote shields the liver
5. Where the UK treatment line starts
6. Fast breathing after grandad’s pills
7. Alkalotic now, but what follows?
8. A mother asks for a stomach washout
9. Blood in the vomit at 18 months
10. Counting the tablets per kilogram
11. Sleepy with a dry mouth
12. How long on the monitor?
13. Shouting and pacing after party pills
14. Could it be the strong painkiller?
15. Frightened girl pulling at her drip
16. Result delayed past 8 hours
17. Drip or drink for the antidote?
18. Flushed and itchy on treatment
19. Planning the blood sampling
20. A buzzing noise and a level of 520
21. Tablets scattered across the film
22. The days after a deceptive calm
23. Playing again after early vomiting
24. Watching the nappies on treatment
25. Walked in 45 minutes after the pills
26. The ominous sign after amitriptyline
27. Head pulling back after aunt’s pills
28. Telling two hot toxidromes apart
29. Fits at an all-night dance event
30. When a cholinesterase inhibitor helps
31. Handfuls bought from several shops
32. Timing of the worst liver tests
33. How fulminant liver failure kills
34. Tender liver on the second day
35. Teenage self-poisoning by the numbers
36. Ringing ears, then confusion
37. The infusion’s goal and its helper
38. A meter reading that understates
39. White powder around her mouth
40. Hidden sources at home
41. Flushed and hypotensive on the drip
42. Why the sampling time matters
43. Seemed better, then would not wake
44. Reversal agents best left alone
45. Airway plan in severe poisoning
46. Danger to a small child at home
47. Told nobody for a day and a half
48. After the party, who gets to know?
49. Half-empty bottle in a handbag
50. Vomiting again five weeks on

Diagnoses and management options tested

Across the fifty cases you are asked to choose between options such as: An opioid, It speeds the kidneys’ excretion of paracetamol, A high anion gap metabolic acidosis, About 20 mg/kg: no toxicity expected, Cholinergic toxidrome, Give activated charcoal and wait for the level, A single level at 6 hours after ingestion, Complete recovery with no further risk, Activated charcoal 1 g/kg by mouth, up to 50 g, A high temperature, Repeat it in 4 hours and treat only if it has risen, Paracetamol hepatotoxicity from NAPQI, A blood pH above 7.60, with sodium intake restricted, Oil of wintergreen.

Clinical pearls from this deck

• Small pupils plus dystonia: think of a dopamine blocker, not an opioid.
• Unknown pills: always check paracetamol.
• No paracetamol level before 4 hours.
• NAPQI is the poison; glutathione is the shield; acetylcysteine refills it.
• UK line: 100 at 4.
• Aspirin first drives the breathing, then poisons the cells.

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 toxicology case decks · pediatric reference values.