Paracetamol Poisoning – Board-Style Questions

What this deck covers

Paracetamol 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. The blood test too soon
2. How much is too much
3. Forty minutes at the door
4. What runs out
5. Two or three at a time
6. Six times a day for four days
7. Two bags or three
8. A rash during the bag
9. Well and wanting to go home
10. Sore under the ribs
11. Which number matters most
12. The clotting keeps drifting
13. A rising creatinine
14. Three days and well
15. Nobody saw the clock
16. Asking to go home
17. When the bag empties
18. The kitchen drawer spoon

Diagnoses and management options tested

Across the 18 cases you are asked to choose between options such as: Send a second sample at once and compare the two figures obtained, A single amount above 150 milligrams for every kilogram he weighs, A drink of milk, which coats the stomach and limits what is taken up, The liver is starved of blood while the drug is being cleared away, Treat on the history, because doses spread over hours cannot be plotted, A single large swallow, which the family have not noticed happening, A single bag given quickly, then a second bag over four hours, Continue at the same rate, since a rash alone needs no change of plan, A quiet first day, in which the child looks well while damage begins, A pulled muscle from the vomiting she had on the first evening, A paracetamol concentration that is still detectable in his blood today, A single raised enzyme result taken on the day of admission, Kidney injury from tubular damage, appearing as the liver recovers, A full course of the intravenous antidote, whatever the results show.

Clinical pearls from this deck

• Before four hours, a concentration cannot be read.
• One hundred and fifty milligrams a kilogram is the line.
• Charcoal is worth giving inside the first hour.
• The antidote replaces the glutathione that ran out.
• Spread over hours, the graph no longer applies.
• Too much, too often, for too long still poisons.

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.