TOXYCOLOGY EXAM

1- Antidote of mercury may include: a) Dimercaprol b) EDTA c) Deferoximine d) Succimer e) Naloxone

2- Which of the following is a benzodiazepinics antagonist: a) Naloxone b) Physostigmine c) Flumazenil d) Naltrexone e) Penicillamine

3- What would be the best treatment for cyanide poisoning? a) Antivenin b) Sodium thiosulfite c) Acetylcystein d) Oxygen therapy e) Sodium bicarbonate

4- Carbon monoxide can be highly toxic because it easily binds to: I- Hemoglobin II- Myoglobin III- Cytochrome oxidase a) I only

b) III only c) I and II only d) II and III only e) All are correct

5- Acetaminophen toxicity most well know complication is: a) Cardiovascular failure b) Pulmonary edema c) CNS lethargy d) Liver necrosis e) Sedation

6- Salicylate toxicity treatment include which of the following? I- Alkalinization of urine with sodium bicarbonate II- Decontamination with syrup of IPECAC until 30 minutes of overdose III- CHARCOAL every 6 hours a) I only b) III only c) I and II only d) II and III only e) All are correct

7- Hyperphosphatemia is best treated by: a) Magnesium hydroxide b) Calcium carbonate c) Aluminium hydroxide d) Sodium Bicarbonate

e) Sodium phosphate

8- Correct statements regarding IPECAC may include: I- It has an emetic effect when large doses are administrated II- It has a expectorant effect when small doses (1 to 2mls) is administrated III- Used in decontamination procedures during toxic treatments a) I only b) III only c) I and II only d) II and III only e) All are correct

9- The organophosphates commonly found in insecticides are thought to act by witch of the following mechanisms? a) Combining with acetylcholine b) Potentiating the action of acetylcholinesterase c) Forming a very stable complex with acetylcholinesterase d) Reacting at the cholinergic receptor e) Preventing the release of acetylcholine from the nerve ending

10- all of the following can be recognized as atropine poisoning, EXCEPT: a) Dry skin b) Mydriasis c) Flushed appearance d) Diarrhea e) Delirium

11- Antidote for atropine poisoning may include:

a) Physostigmine b) Aminophillim c) Pralidoxine d) Flumazenil e) Dimercaprol

12- Poison Ivy can be treated by which of the following agents? I- Topical antipruritic II- Antihistaminics III- Systemic corticosteroids a) I only b) III only c) I and II only d) II and III only e) All are correct

13- A patient is stabilized on heparin as anticoagulant. After one hour of administration of the drug, he exercised bleeding from his gums, while he was brushing his teeth. The pharmacist can advise him to take: a) Ascorbic acid b) Vitamin K c) Protamine sulfate d) Warfarin e) Quinolone

14- N-acetyl-cysteine may be the antidote of choice for which of the following agents? a) Aspirin b) Warfarin

c) Digoxin d) Lead e) Acetaminophen

15- Dimercaprol (BAL) + mercury (Hg) combination characteristics include: I- Dimercaprol is the best antidote for elemental mercury inhalation poisoning II- They form a stable complex excreted renally III- Penicillamine is an alternative when mercury suffer GIT absorption a) I only b) III only c) I and II only d) II and III only e) All are correct

16- Naloxone is the best antidote for which of the following overdose agents? a) Opioid overdose b) Heavy metal overdose c) Benzodiazepinics overdose d) Organophosphate overdose e) Digitalis overdose

17- Management and characteristics of Digoxin toxicity may include: I- May cause heart failure, cardiac dysrrhythmias, nausea, anorexia, vomiting, and confusion II- Treated by decontamination and supportive therapy III- Treated with a digoxin specific antidote known as FAB antibodies a) I only b) III only

c) I and II only d) II and III only e) All are correct

18- Death due to cyanide poisoning is due to: a) Cyanide-RBCs complex formation b) Cyanide-hemoglobin complex formation c) Cyanide inhibiting of cytochrome oxidase d) Cyanide increasing hemoglobin levels e) Coronary vessel oclusion

19- The toxicity of methyl alcohol is due to formation of: a) Ketones b) Formaldehyde c) Free alcohol radicals d) Ethylene e) Aldehyde

20- Acetaminophen toxicity is due to: a) Oxidation stress b) Active metabolite c) Free radical chain d) Reactive metabolite e) Reduction of metabolite

21- Salicylate toxicity excessive respiration is due to: I- Excess production of CO2

II- Pulmonary irritation III- Central stimulation in the brain a) I only b) III only c) I and II only d) II and III only e) All are correct

22- Grayish mouth and loose of teeth are toxic symptoms of: I- Fe salts poisoning II- Cu poisoning III- Lead poisoning a) I only b) III only c) I and II only d) II and III only e) All are correct

23- Vomiting is contra indicated if poisoning is due to: I- Bleaching II- Gasoline III- Light petroleum a) I only b) III only c) I and II only d) II and III only e) All are correct

24- Universal antidote is a mixture of: I- Activated charcoal II- Magnesium oxide III- Tannic acid a) I only b) III only c) I and II only d) II and III only e) All are correct

25- Amphetamines overdose is best treated with administration of: a) Salicylates b) Benzodiazepinics c) Barbiturates d) Naloxone e) B and C are right.

26- True statements regarding the treatment of hyperkalemia: I- If change in ECG is detected give Ca to counteract the excess of K on the heart II- Bicarbonate and insulin administration can shift K from extra to intracellular III- Enema of kafexolate (exchange resin) or dialysis helps to remove excess of K from the body a) I only b) III only c) I and II only d) II and III only e) All are correct

27- Cardiovascular drug that overdose can cause cyanide intoxication include: a) Nitrates b) Nitroglycerin c) Nitroprusside d) Isosorbide e) Isosorbide dinitrate

28- Lead poisoning can be treated by: I- BAL-Dimercaprol II- EDTA-Edentate III- Penicillamine a) I only b) III only c) I and II only d) II and III only e) All are correct

29- Specific antidote for iron preparations overdose include: a) Dimercaprol b) Deferoxamine c) Penicillamine d) Naloxone e) Sucimmer

30- Atropine, an anticholinergic drug is used as antidote in the poisoning treatment of: a) Organophosphates

b) Heavy metal c) Salicylates d) Tricyclic antidepressants e) Iron

31- Treatment of tricyclic antidepressants overdose is done by all the following procedures, EXCEPT: a) Control the seizures and cardiotoxicity b) Administration of benzodiazepinics or phenytoin to control seizures c) Activated charcoal can be used d) MAO antidepressants can helps to overcome the patients seizure e) Control acidosis with administration of sodium bicarbonate

32- Specific antidote used for poisoning caused by snake and black spider bits a) Deferoxamine b) Ancrod c) Antivenin d) Psysostigmine e) Naloxone

33- Best treatment for carbon monoxide intoxication: a) Alkalinization of urine b) Oxygen therapy c) Supportive therapy d) Acidification of urine e) Gastric lavage

34- Which of the following is the isoniazide antidote?

a) Vitamin A b) Bitamin B6 c) Vitamin B12 d) Folic acid e) Vitamin E

35- Which of the following is considered the warfarin antidote? a) Vitamin K b) Heparin c) Protamine d) Filgrastin e) Vitamin E

36- The major first step in the initial management of ANY intoxication and poisoning is the supportive care treatment that involve: a) Detoxification b) Decontamination c) Hydration d) Evaluation and support of vital function (Airway, Breath and Circulation-ABC) e) Toxicology laboratory tests

37- General management in treating patients with depressed mental status include: I- Treat hypoglycemia with 50mls of dextrose 50% II- Administration of thiamine 100mg IV push III- Administration of naloxone a) I only b) III only c) I and II only

d) II and III only e) All are correct

38- Decontamination procedures may include: a) Gastric lavage b) Emesis c) Administration of activated charcoal d) Administration of adsorbent agents e) All are correct

39- Intravenous calcium administration is used in which of the following situations? a) Verapamil overdoses b) Cocaine overdose c) Verapamil overdose and hyperkalemia d) Hyperkalemia e) Nifedipeno overdose

40- What is the mechanism of action of the mercury antidote? a. Binds mercury in the GIT to prevent absorption. b. Reduces mercury to a non toxic form & stored in the liver. c. Rapidly excreted by kidneys.* i. (a) Only. ii. (c) Only. iii. (a), (b) Only. iv. (b), (c) Only. v. (a), (b), and (c).

41. Which one is true about IPECA: a. 15 30ml/day (one dose) will give an emetic action.* b. 1ml 2ml tid (for adults) will work as expectorant.* c. 0.25ml 0.5ml tid is not recommended for ages less than six.* i. (a) Only. ii. (c) Only. iii. (a), (b) Only. iv. (b), (c) Only. v. (a), (b), and (c).

42. The organophosphate commonly found in insecticides are thought to act by: a. Combining with acetylcholine. b. Potentiating the action of acetylcholinesterase. c. Forming a very stable complex with acetylcholinesterase. d. Reacting at the cholinergic receptor. e. Preventing the release of acetylcholine from the nerve ending.

43. Which of the following is considered CNS poison that is selectively toxic to retina? a. Warfarin. b. Methyl Alcohol. c. Arsenic. d. Carbon tetrachloride. e. Ethyl alcohol.

45. The antidote used in treating Heparin over dose is: a. Vitamin K. b. Warfarin.

c. Protamine Sulphate. d. Pralidoxime. e. EDTA.

46.Which of the following is true about Chronic Hemochromatosis? a. Excessive deposition of iron in tissues leading to bronze skin. b. Causes hepatic necrosis. c. Causes diabetes mellitus. i. (a) Only. ii. (c) Only. iii. (a), (b) Only. iv. (b), (c) Only. v. (a), (b), and (c).

47. Propantheline is a synthetic anti-cholinergic anti-muscarenic competitive acetyl Choline blocker at cholinergic neuroeffector sites. It is also used as antacid. Its side effects include: a. Constipation. b. Dry mouth. c. Dry skin. i. (a) Only. ii. (c) Only. iii. (a), (b) Only. iv. (b), (c) Only. v. (a), (b), and (c).

48. In all of the following kinds of poisoning, there should be NO EMESIS (vomiting), because emesis will lead to

Aspiration Pneumonia, except in case of: a. Bleaches. b. Gasoline. c. Iron salts. d. Organic acids. e. Liquid petrolatum.

49. Which is NOT true about Naloxone? a. It blocks all the pharmacological actions of morphine. b. It is used in respiratory failure caused by barbiturates. c. It has analgesic activity. d. It is a pure antagonist. e. None of the above.

50. Digoxin toxicity is treated by: a. Digoxin immune tablets. b. Potassium Chloride. c. Amiodarone. d. Digibind. e. Digitoxin.

51. The use of Dimercaprol (BAL) in the treatment of mercury poisoning due to: a. Forming a complex that is easily excreted in urine. b. Reactivation the enzyme which contains sulphadryl group. c. Chelating mercury molecules. i. (a) Only. ii. (c) Only.

iii. (a), (b) Only. iv. (b), (c) Only. v. (a), (b), and (c).

52. Which drug is used in organo-phosphate poisoning? a. Pralidoxime. b. EDTA c. Methyl cellulose. d. Sorbitol. e. Pancuronium.

53. Which of the following can be given in base poisoning? a. HCL. b. Vinegar. c. Lemon juice. d. Weak acid. e. Strong acid.

54. The anti-dote for Iron poisoning is: a. Deferoxamine. b. Penicillamine. c. EDTA. d. Folic acid. e. NH3cl

55. Death due to Cyanide poisoning results from: a. Cyanide-Hemoglobin complex formation.

b. Cyanide combining with red blood cells. c. Cyanide inactivating Cytochrome oxidase. i. (a) Only. ii. (c) Only. iii. (a), (b) Only. iv. (b), (c) Only. v. (a), (b), and (c).

56. The anti-dote for Cyanide poisoning could be: a. Sodium Nitrite and/or Amyl Nitrite. b. Sodium Thiosulfate and/or Sodium bicarbonate. c. Oxygen and/or Hyperbaric oxygen. i. (a) Only. ii. (c) Only. iii. (a), (b) Only. iv. (b), (c) Only. v. (a), (b), and (c).

57. Cyanide toxicity symptoms include the following: a. Headache & Dyspnea. b. Nausea & vomiting. c. Ataxia, coma, seizure and death. i. (a) Only. ii. (c) Only. iii. (a), (b) Only. iv. (b), (c) Only. v. (a), (b), and (c).

58. The anti-dote for Copper poisoning is: a. Penicillamine (used also in Rheumatoid Arthritis). b. EDTA. c. Sodium bisulphite. d. Ammonium Chloride. e. Sodium Stearate.

59. Drugs containing hydroxyl or carboxyl groups are detoxified (metabolized) by: a. Acetylation. b. Reduction. c. Glucuronic acid. d. Hydrolysis. e. Oxidation.

60. In the toxicity of Carbon Monoxide (CO): a. It forms methoxy hemoglobin (HB) b. Carbon Monoxide poisoning is characterized by lack of oxygen in erythrocytes. c. Carbon Monoxide combines chemically with hemoglobin and reduces its capacity to carry oxygen (O2) i. (a) Only. ii. (c) Only. iii. (a), (b) Only. iv. (b), (c) Only. v. (a), (b), and (c).