Common toxidromes, antidotes, and environmental emergencies as tested on USMLE Step 3.
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- What enzyme does organophosphate poisoning inhibit?
- Acetylcholinesterase
- What is the first-line antidote for organophosphate poisoning?
- Atropine
- What is the role of pralidoxime (2-PAM) in organophosphate poisoning?
- It reactivates acetylcholinesterase by removing the organophosphate from the enzyme
- What are the 'killer B's' of cholinergic toxicity?
- Bradycardia, bronchorrhea, and bronchospasm
- What are the classic exam findings of anticholinergic toxicity?
- Hot, dry, flushed skin, dilated pupils, urinary retention, and delirium
- What is the antidote for severe anticholinergic toxicity?
- Physostigmine
- What is the classic triad of opioid overdose?
- Respiratory depression, pinpoint pupils, and CNS depression
- What is the antidote for opioid overdose?
- Naloxone
- What are the key findings of sympathomimetic toxidrome?
- Hypertension, tachycardia, hyperthermia, diaphoresis, and agitation with dilated pupils
- What are the key findings of sedative-hypnotic toxidrome?
- CNS depression, slurred speech, and ataxia with normal pupil size
- What toxic metabolite accumulates in acetaminophen overdose?
- NAPQI (N-acetyl-p-benzoquinone imine)
- What is the antidote for acetaminophen overdose?
- N-acetylcysteine
- What tool determines the need for treatment after a single acute acetaminophen ingestion?
- The Rumack-Matthew nomogram
- What acid-base disturbance is classically seen in salicylate toxicity?
- A mixed respiratory alkalosis and metabolic acidosis
- What is a key treatment for salicylate toxicity?
- Urinary alkalinization with sodium bicarbonate