Organophosphate Poisoning – Board-Style Questions

What this deck covers

Organophosphate 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. Wet, small and slow
2. What to titrate against
3. Why the second drug tonight
4. Two results, one answer
5. The staff feel it too
6. Twitching after the drying
7. What actually kills
8. Third day, cannot sit up
9. Six weeks on, numb feet
10. Drawing up the relaxant
11. The label says something else
12. The next few doses
13. Still shaking at four minutes
14. Coughing after being sick
15. Off the drip for a day
16. Twice in one year
17. Small pupils, two causes
18. Why he is muddled

Diagnoses and management options tested

Across the 18 cases you are asked to choose between options such as: Poisoning by a sedative taken from a relative’s bedside cupboard, Drying of the secretions and a clear chest, rather than the width of the pupils, A steroid, which reduces the inflammation in the airways over some hours, The white cell count, which rises in proportion to the dose absorbed, Undress him outside, wash the skin, and put the team into nitrile gloves, Too much atropine, which causes twitching whenever the dose is excessive, Bleeding into the stomach from the corrosive effect of the liquid, Weakness from lying still in bed, which physiotherapy will correct quickly, A delayed nerve injury, which follows some of these compounds weeks later, A depolarising blocker is the safest possible choice in this poisoning, Atropine is no longer useful, and only the oxime should be given, Change to a slow infusion only, with no further single doses, A benzodiazepine, which controls the fitting better than any other agent, Fluid in the airways from the poisoning, which atropine will soon dry up.

Clinical pearls from this deck

• Wet everywhere with pinpoint pupils: think the sprays.
• Atropine is titrated to the chest, not the pupils.
• The oxime works only before the bond sets hard.
• The red cell enzyme mirrors the nerve ending best.
• Decontaminate outside, and protect the team first.
• Atropine dries the chest but never the muscles.

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.