Transcript Med Tox Board Review - American College of Medical Toxicology

Med Tox Board Review:
Buzzwords for the Boards
GP Daubert 2014
1
“Egg-shell” calcifications of hilar lymph
nodes, increase risk of tuberculosis,
upper lung disease
Buzzwords for the Boards
2
Silicosis
Buzzwords for the Boards
3
Pneumoconiosis with hilar adenopathy;
clinically and pathologically identical to
sarcoidosis except no eye involvement;
lymphocyte transformation test
Buzzwords for the Boards
4
Berylliosis
Buzzwords for the Boards
5
Porphyria, pemba yara, spongiform
encephalopathy, outbrake in Turkey in
1956
Buzzwords for the Boards
6
Hexachlorobenzene
Buzzwords for the Boards
7
Isolated thrombocytopenia, “bathtub
refinisher’s lung”, sensitizing agent largest recognized cause of
occupational asthma
Buzzwords for the Boards
8
Toluene di-isocyanate (TDI)
Buzzwords for the Boards
9
Hepatic angiosarcoma
Buzzwords for the Boards
10
Vinyl chloride
Buzzwords for the Boards
11
Pesticide operator with sterility, altered
sex ratio in offspring
Buzzwords for the Boards
12
Dibromochloropropane
(DBCP)
Re: “Da Balls Can’t Produce”
Buzzwords for the Boards
13
Phossy jaw
Buzzwords for the Boards
14
Yellow phosphorus
Buzzwords for the Boards
15
Brown lung, “Monday morning
tightness”, byssanosis
Buzzwords for the Boards
16
Cotton
Buzzwords for the Boards
17
Hypertension, Saturnine gout, renal
failure, microcytic anemia
Buzzwords for the Boards
18
Adult lead poisoning
Buzzwords for the Boards
19
“Silver solderers”, proximal RTA, itaiitai disease in Jintsu River basin, acute
lung injury, renal failure
Buzzwords for the Boards
20
Cadmium
Buzzwords for the Boards
21
Perforated nasal septum, lung cancer,
painless ulcers, “blackjack disease”,
Type IV hypersensitivity dermatitis
Buzzwords for the Boards
22
Chromium
Buzzwords for the Boards
23
Hairdresser with hearing loss, renal
failure, methemoglobinemia
Buzzwords for the Boards
24
Bromate
Buzzwords for the Boards
25
The cholera toxin activates cAMP, which
intern stimulate CFTR causing a
dramatic efflux of ions and water from
infected enterocytes.
What popular ‘pop’ band was associated
with this disease?
Buzzwords for the Boards
26
The Go-Gos
Buzzwords for the Boards
27
Acute psychosis with elevated serum
chloride level
Buzzwords for the Boards
28
Bromide
Buzzwords for the Boards
29
Solvent, epoxide metabolite
(hepatotoxicity), “Degreaser’s flush”,
trigeminal neuralgia
Buzzwords for the Boards
30
Trichloroethylene
Buzzwords for the Boards
31
Viscous rayon, increase rate of
atherosclerosis; disulfiram and metam
sodium metabolites; basal ganglia toxin;
associated with spontaneous abortions;
decreased spermatogenesis, craniofacial
abnormalities; optic nerve and retinal
degeneration
Buzzwords for the Boards
32
Carbon disulfide
Buzzwords for the Boards
33
The percentage of sick people who are
identified as having the condition
or
The likelihood of a test being positive if
the condition is present
Buzzwords for the Boards
34
Sensitivity
Buzzwords for the Boards
35
A result of 100% means that the test
recognizes all healthy people as healthy
or
The likelihood of the unaffected
individuals correctly having a negative
test
Buzzwords for the Boards
36
Specificity
Buzzwords for the Boards
37
Condition
+
+
-
True Positive
False Positive
(Type I error)
→ PPV
Test
outcome
-
False Negative
(Type II error)
↓
Sensitivity
True Negative
→ NPV
↓
Specificity
Buzzwords for the Boards
38
Condition
Yes
No
Yes
A
B
→ Absolute Risk
Exposed (ARE)
A/(A+B)
No
C
D
→ Absolute Risk
Unexposed (ARU)
C/(C+D)
Risk
Factor
Attributable Risk (Risk Difference) = ARE – ARU
Relative Risk = ARE/ARU
Odds Ratio = (A/C)/(B/D)
Solvent, acute CNS depression,
arrhythmias, AML, Hodgkin’s
lymphoma, paroxysmal nocturnal
hemoglobinuria
Buzzwords for the Boards
40
Benzene
Buzzwords for the Boards
41
Wastewater treatment worker with
sensory and motor distal axonal
neuropathy (axonopathy)
Buzzwords for the Boards
42
What singer is associated with
Hymonoptera-induced anaphylaxis?
Buzzwords for the Boards
43
Sting
Buzzwords for the Boards
44
Wastewater treatment worker with sensory
and motor distal axonal neuropathy
(axonopathy), also has blue discoloration
of hands and feet, desquamation, and
pulmonary irritation
Buzzwords for the Boards
45
Acrylamide
Buzzwords for the Boards
46
Ginger Jake, NTE inhibitor, sensorymotor neuropathy, 1960 Morocco
disaster
Buzzwords for the Boards
47
Triorthocresyl phosphate (TOCP)
Buzzwords for the Boards
48
Minamata Bay
Buzzwords for the Boards
49
Methylmercury
Buzzwords for the Boards
50
Bhopal disaster
Buzzwords for the Boards
51
Methyl isocyanate
Buzzwords for the Boards
52
Lung cancer, beer drinker with
cardiomyopathy, classic tetrad: goiter,
cardiomyopathy, metabolic acidosis,
polycythemia, inhibits oxidation of aKG to succinyl CoA and pyruvate to
acetyl CoA
Buzzwords for the Boards
53
Cobalt
Buzzwords for the Boards
54
Pulmonary disease-anemia syndrome,
strong respiratory sensitizer
Buzzwords for the Boards
55
Trimellitic anhydride
Buzzwords for the Boards
56
Uranium mining, lung cancer
Buzzwords for the Boards
57
Radon
Buzzwords for the Boards
58
Firefighter with delayed pulmonary
edema (ARDS) and smell of freshly
mowed hay
Buzzwords for the Boards
59
Phosgene
Buzzwords for the Boards
60
Pest-control operator with fishy odor,
respiratory distress, refractory
hypotension, delayed pulmonary
edema
Buzzwords for the Boards
61
Phosphine
(aka Phosfish)
Buzzwords for the Boards
62
Sewage worker with rapid collapse,
mucous membrane irritation,
blackened jewelry, sodium nitrite
antidote
Buzzwords for the Boards
63
Hydrogen Sulfide
Buzzwords for the Boards
64
Endoscopy technician with mucous
membrane irritation, pulmonary
edema, leukemia, sweet odor,
convulsions, N/V
Buzzwords for the Boards
65
Ethylene Oxide
Buzzwords for the Boards
66
Epping jaundice
Buzzwords for the Boards
67
Buzzwords for the Boards
68
Methylenedianiline
Buzzwords for the Boards
69
Aromatic solvent, acute CNS
depression, basal ganglia toxin,
pneumonitis, hypokalemia,
RTA/renal failure, myopathy,
leukoencephalopathy
Buzzwords for the Boards
70
Toluene
Buzzwords for the Boards
71
Fungicide with pungent odor, skin and
respiratory sensitizer, photoallergic
dermatitis
Buzzwords for the Boards
72
Captafol
Buzzwords for the Boards
73
1937 Sulfanilamide poisoning
Buzzwords for the Boards
74
Diethylene glycol
Buzzwords for the Boards
75
Neonatal gasping syndrome
Buzzwords for the Boards
76
Benzyl alcohol
Buzzwords for the Boards
77
1986 Lake Nyos disaster
Buzzwords for the Boards
78
Carbon dioxide
Buzzwords for the Boards
79
L-Tryptophan
Buzzwords for the Boards
80
Eosinophilia myalgia syndrome
Buzzwords for the Boards
81
Koremlu poisoning
Buzzwords for the Boards
82
Thallium
Buzzwords for the Boards
83
Hopewell epidemic, “Kepone shakes”,
Chesapeake Bay contamination
Buzzwords for the Boards
84
Chlordecone
Buzzwords for the Boards
85
Stalinon poisoning, vomiting, transitory
paralysis, photophobia, white matter
edema
Buzzwords for the Boards
86
Triethyltin
Buzzwords for the Boards
87
Golfer with disulfiram reaction at the
18th hole
Buzzwords for the Boards
88
Thiuram herbicide
Buzzwords for the Boards
89
Welder with early Parkinson’s Disease
Buzzwords for the Boards
90
Manganese
Buzzwords for the Boards
91
Parakeet dies while family is cooking in
the kitchen
Buzzwords for the Boards
92
Polymer fume fever
Buzzwords for the Boards
93
Welder dies after ingesting soldering flux
Buzzwords for the Boards
94
Zinc chloride
Buzzwords for the Boards
95
Black henna, black hair dye, angioedema,
renal failure, and methemoglobinemia,
leukemia/bladder cancer
Buzzwords for the Boards
96
Para-phenylenediamines
(para- and ortho-PD)
Buzzwords for the Boards
97
Fumigant worker, peanut poisoning, fish
odor
Buzzwords for the Boards
98
Zinc phosphide
Buzzwords for the Boards
99
Young male chimney sweeper with early
testicular cancer
Buzzwords for the Boards
100
Polyaromatic hydrocarbons
Buzzwords for the Boards
101
Middle aged male stripping paint that
develops angina from delayed
carbon monoxide poisoning
Buzzwords for the Boards
102
Methylene chloride
Buzzwords for the Boards
103
Galvanized metal welder, “Monday
morning fever”, “brass foundry
workers ague”
Buzzwords for the Boards
104
Zinc Oxide
(Metal fume fever)
Buzzwords for the Boards
105
Mill worker with allergic contact
dermatitis and respiratory sensitization
(occupational asthma)
Buzzwords for the Boards
106
Plicatic acid
(Western red cedar)
Buzzwords for the Boards
107
Farmer’s lung
Buzzwords for the Boards
108
Thermophilic actinomycetes
Buzzwords for the Boards
109
Irritant gas, warning agent in methyl
chloride, component of papite (tear
gas), cyclophosphamide metabolite
Buzzwords for the Boards
110
Acrolein
Buzzwords for the Boards
111
Urine metabolite of acrylamide used for
testing worker exposure
Buzzwords for the Boards
112
Carboxyethyl-cysteine
Buzzwords for the Boards
113
Primary ingredient in bone cement, skin
sensitizer, elevated urine mercapturic
acid, pediatric burns
Buzzwords for the Boards
114
Methyl methacrylate
Buzzwords for the Boards
115
Spain 1981: rapeseed oil contaminated
with denatured aniline. Diffuse
pulmonary infiltrates on x-ray,
methemoglobinemia
Buzzwords for the Boards
116
Aniline
Buzzwords for the Boards
117
Airbag inflation, herbicide, cytochrome
aa3 inhibitor
Buzzwords for the Boards
118
Sodium azide
Buzzwords for the Boards
119
Fumigant, fire extinguisher, lower
extremity axonopathy, intoxication
resembles Wernicke’s
encephalopathy, inferior colliculi
lesions, NAC may worsen syndrome
Buzzwords for the Boards
120
Methyl bromide
Buzzwords for the Boards
121
Irritant gas with gasoline-like odor, may
cause hypotension and bradycardia
with inhalation, associated with
lymphohematopoeitic cancers
Buzzwords for the Boards
122
1,3 Butadiene
Buzzwords for the Boards
123
Current pesticide/herbicide but once in
mouthwash and toothpaste,
methemoglobinemia and GI distress
after 3-6 hour latent period
Buzzwords for the Boards
124
Sodium chlorate
Buzzwords for the Boards
125
Hyperthyroid medication that was linked
to aplastic anemia – now ground
water contaminant
Buzzwords for the Boards
126
Perchlorates
Buzzwords for the Boards
127
Tar smarts; pitch warts and squamous
cell carcinoma; chronic melanosis;
UV phototoxicity; strong carcinogen
of lung, bladder, skin, scrotal, oral,
stomach
Buzzwords for the Boards
128
Coal tar products
Buzzwords for the Boards
129
Ammonia-like odor, rocket fuel and
water treatment agent, toxicity
tetrad: SLE (skin sensitizer),
methemoglobinemia, seizures,
hepatitis
Buzzwords for the Boards
130
Hydrazine (diamines)
Buzzwords for the Boards
131
Paint remover and solvent with fishy or
ammonia smell that causes severe
hepatitis with jaundice and eventual
liver failure
Buzzwords for the Boards
132
Dimethylacetamide (DMAC)
Buzzwords for the Boards
133
Solvent used in pharmaceutical industry,
acrylic fiber production and recovery
of CO2 in gasses that may result in
skin irritation, severe hepatotoxicity,
and disulfiram reactions
Buzzwords for the Boards
134
N,N Dimethylformamide (DMF)
Buzzwords for the Boards
135
Explosive/munitions production, spandex
fibers, causes severe GI distress and
vomitus smells like bitter almonds,
retrobulbar and optic neuropathy, methb,
hepatitis, aplastic anemia; and yellowing
of skin, hair, and eyes
Buzzwords for the Boards
136
1,3 Dinitrobenzene
Buzzwords for the Boards
137
Oily liquid used in explosives and
diisocyanate production, possible
weight loss product, uncoupler,
retrobulbar and optic neuropathy,
methb, turns skin yellow
Buzzwords for the Boards
138
2,4 Dinitrotoluene
Buzzwords for the Boards
139
Sweet smelling irritant gas, insect
fumigant and heat stabilizer for
plastic production, delayed
pulmonary toxicity
Buzzwords for the Boards
140
Epichlorohydrin
Buzzwords for the Boards
141
Textile finishing agent and used in the
synthesis of malathion; vapors result
in corneal edema, photophobia, and
diplopia; chronic use associated with
occupational asthma, hemolytic
anemia, and pulmonary hemorrhage
Buzzwords for the Boards
142
Maleic anhydride
Buzzwords for the Boards
143
Used as an odorant for natural gases,
rotten cabbage odor,
methemoglobin and hemolytic
anemia
Buzzwords for the Boards
144
Mercaptans
Buzzwords for the Boards
145
Abdominal pain, hemolytic anemia, Paris
green, hematuria, bronze skin
Buzzwords for the Boards
146
Arsine
Buzzwords for the Boards
147
Metals that produce non-fibrogenic
benign pneumoconiosis
Buzzwords for the Boards
148
Tin (Stannosis)
Barium (Baritosis)
Iron (siderosis)
Calcium (Chalitosis)
Molybdenum
Buzzwords for the Boards
149
Vineyard sprayer’s lung (interstitial
pulmonary fibrosis, histiocytic
granulomas, adenocarcinoma)
[Portugal]
Buzzwords for the Boards
150
CuSO4
(Bordeaux soln)
Buzzwords for the Boards
151
Hard metal pneumoconiosis, pulmonary
eosinophilia portends poor prognosis
Buzzwords for the Boards
152
Tungsten-carbide
Buzzwords for the Boards
153
Diamond polishers lung
Buzzwords for the Boards
154
Cobalt
Buzzwords for the Boards
155
Patient on dialysis who develops
somnolence, perioral numbness,
abdominal pain, and
hyperamylasemia
Buzzwords for the Boards
156
MnSO4
Buzzwords for the Boards
157
Worker with osteosclerosis with
accompanying nerve root
compression. Plain film xray reveals
ligament calcification and lesions
resembling osteoblastic metastasis
Buzzwords for the Boards
158
Fluorisis
Cryolite (NaAlFl)
Buzzwords for the Boards
159
Acroosteolysis (bone resorption at distal
phalanx)
Buzzwords for the Boards
160
Vinyl chloride
Buzzwords for the Boards
161
Most common medication associated
with hypersensitivity pneumonitis
Buzzwords for the Boards
162
Nitrofurantoin
Buzzwords for the Boards
163
Middle aged adult with chronic seizure
disorder with xray demonstrating
hilar lymphadenopathy. Biopsy
reveals drug-induced lymphoid
hyperplasia
Buzzwords for the Boards
164
Phenytoin
Buzzwords for the Boards
165
Elderly male with hepatic
angiocarcinoma and pneumococcal
sepsis. Abdominal xray reveals
multiple opacities in the liver and
spleen
Buzzwords for the Boards
166
Thorotrast (thorium dioxide)
Buzzwords for the Boards
167
Xenobiotic-induced aplastic anemia is
most commonly associated with
destruction of these progenitor cells
Buzzwords for the Boards
168
CD34+ progenitor cells
Buzzwords for the Boards
169
Lymphoma in a Dutch flower bulb
worker using a nematode fumigant
(also seen in fireman)
Buzzwords for the Boards
170
Dichloropropene (Telon)
Buzzwords for the Boards
171
Cola-colored infant with MRCP,
abnormal skull calcification, and
hypoplastic nails
Buzzwords for the Boards
172
PCBs
(remember Pepsi-Colored Babies)
Buzzwords for the Boards
173
Metabolite of disulfiram and used in the
treatment of nickel carbaryl and
platinoid poisoning
Buzzwords for the Boards
174
Diethyldithiocarbamate (DDC)
Buzzwords for the Boards
175
4-year-old boy on an antineoplastic drug
that develops fever, SIADH,
necrotic myocardial infarction, and
loss of deep tendon reflexes
Buzzwords for the Boards
176
Vincristine
Buzzwords for the Boards
177
Antineoplastic producing hilar
lymphadenopathy
Buzzwords for the Boards
178
Methotrexate
Buzzwords for the Boards
179
Antineoplastic producing nodular
bronchiolitis obliterans
Buzzwords for the Boards
180
Bleomycin
Buzzwords for the Boards
181
Antineoplastic associated with
perforation of the GI tract
Buzzwords for the Boards
182
Time (hrs)
Time (hrs)
Buzzwords for the Boards
183
Natural Log (ln)
Drug Concentration
Drug Concentration
1st Order Elimination
Buzzwords for the Boards
184
Paclitaxol
Buzzwords for the Boards
185
Antineoplastic associated with hemolytic
uremia syndrome
Buzzwords for the Boards
186
Mitomycin
Buzzwords for the Boards
187
Metal that is radiolucent on plain film
xray
Buzzwords for the Boards
188
Copper
Buzzwords for the Boards
189
Metal causing paresthesias (pins and
needles), ataxia, dysarthria,
constricted visual fields, deafness
Buzzwords for the Boards
190
Methyl mercury
Buzzwords for the Boards
191
“Pink disease”: mercury teething
powders such as calomel
Buzzwords for the Boards
192
Mercury
calomel (HgCl)
Buzzwords for the Boards
193
Riboflavin inhibition (i FAD); Painful
peripheral neuropathy; neuropathy
spares CN I, V, VIII; alopecia with
sparing of axilla, facial hair, and
inner 1/3 of eyebrow; reverse sleep
cycle
Buzzwords for the Boards
194
Thallium
Buzzwords for the Boards
195
Biological monitoring
Benzene
Toluene
Styrene
Lead
Methylmercury
Inorganic mercury
Polyaromatic HC
Buzzwords for the Boards
196
Biological monitoring
Benzene
Toluene
Styrene
Lead
Methylmercury
Inorganic mercury
Polyaromatic HC
Total urine phenol
Urine hippuric acid
Urine mandelic and
phenylglyoxylic acid
Blood ZPP/FEP
Blood mercury
Urine mercury
Urine 1-hydroxypyrene
Buzzwords for the Boards
197
Oily liquid used in cold sterilization,
sensitizer and occupational asthma
Buzzwords for the Boards
198
Glutaraldehyde
Buzzwords for the Boards
199
Used in plastics and rubber, dental
fillings and styrofoam. Causes flu-like
symptoms and drunkeness acutely,
peripheral neuropathy and hearing loss
chronically
Buzzwords for the Boards
200
Styrene
Styrene syndrome
Buzzwords for the Boards
201
Chemical associated with highest
incidence of lung cancer in the
world
Buzzwords for the Boards
202
Polyaromatic HC
Buzzwords for the Boards
203
Dentist with vitamin B12-like deficiency,
bone marrow suppression, and
pernicious anemia. Histochemistry
reveals inactive cobalt and inhibition
of methionine synthetase
Buzzwords for the Boards
204
Nitrous oxide
Buzzwords for the Boards
205
Person exposed to a cloud of “red
smoke” with delayed pulmonary
edema and chemical burns with
characteristic yellow discoloration
Buzzwords for the Boards
206
Nitric acid
Buzzwords for the Boards
207
Pyrophoric material causing severe
thermal and chemical burns
(submerge in CuSO4) and exposure
may lead to hepatotoxicity and
hypocalcemia with increased QT
interval
Buzzwords for the Boards
208
White phosphorus
Buzzwords for the Boards
209
“Rush” fire in San Francisco in 1983
leading to a number of firefighters
with methemoglobinemia
Buzzwords for the Boards
210
Isobutyl nitrate
Buzzwords for the Boards
211
1978 Jonestown mass suicide
Buzzwords for the Boards
212
KCN
Buzzwords for the Boards
213
Only organic phosphorus pesticide that
possesses a significant vapor hazard
(high vapor pressure)
Buzzwords for the Boards
214
Dichlorvos
Buzzwords for the Boards
215
Patient presenting after herbicide
ingestion with myotonia, myoclonus,
hematuria/rhabdo, and cardiac
disturbances
Buzzwords for the Boards
216
Chlorphenoxy herbicide
Buzzwords for the Boards
217
Fetal syndrome – 10-30%, 25% risk of
spontaneous abortion,
microcephaly/hydrocephaly,
congenital heart disorders, microtia,
cleft lip/palate
Buzzwords for the Boards
218
Fetal isoretinoin
Buzzwords for the Boards
219
Microcephaly, developmental delay,
telecanthus, short nose and flat nasal
bridge, anteverted nares, long
shallow filtrum, thin upper lip, nail
displasia
Buzzwords for the Boards
220
Fetal hydantoin
Buzzwords for the Boards
221
Microcephaly, small palpebral fissure
length, thin upper lip, smooth
philtrum, flatted cheeks and short
nose. Risk of brain injury increases
as eyes get smaller, philtrum gets
flatter, and lip gets thinner
Buzzwords for the Boards
222
Fetal alcohol
Buzzwords for the Boards
223
Small nose and markedly depressed nasal
bridge; brachydactyl; hypoplasia of all
distal phalanges; severe shortening of
lower extremities; Epiphyseal stippling
of the sacrum, spine, proximal humeri,
and femurs
Buzzwords for the Boards
224
Fetal warfarin
Buzzwords for the Boards
225
(Parrot fish and tidal xanthid crabs)
Inhibits Na/K ATPase, N/V/D,
paresthesias, hypocalcemic tetany, CV
collapse (2nd most potent toxin on
planet earth)
Buzzwords for the Boards
226
Palytoxin
Buzzwords for the Boards
227
(Paralytic shellfish poisoing,
gonyautoxins) Na channel blocker,
oysters/red tides, N/V, paresthesias,
throat pain, descending paralysis
Buzzwords for the Boards
228
Saxitoxin
Buzzwords for the Boards
229
(Neurotoxin shellfish poisoing) Na
channel opener; paresthesias;
temperature reversal; N/V/D
uncommon; tide aerosolized toxin
causes conjunctivitis, rhinitis,
bronchitis
Buzzwords for the Boards
230
Brevetoxin
Buzzwords for the Boards
231
(Diarrhetic shellfish poisoing) Inhibits
protein phosphates disrupting cell
metabolism, benign gastric tumors,
N/V/D predominate
Buzzwords for the Boards
232
Okadaic acid
Buzzwords for the Boards
233
(Amnestic shellfish poisoing) CNS glutamate
receptor stimulation causing Na channel
upregulation and Na/Ca influx g
neuronal cell lysis; toxicity resembles
Alzheimer’s-like dementia, N/V/D,
headaches, ataxia, seizures; assoc. with
eating blue muscles
Buzzwords for the Boards
234
Domoic acid
(think Dumb-oic acid)
Buzzwords for the Boards
235
(Also maitotoxin) Na and Ca channel
openers; metallic taste; paresthesias;
glove and stocking numbness; palmer
pruritis; hot/cold reversal; sensation of
loose teeth; treat with mannitol and
gapapentin; symptoms worsen with
alcohol
Buzzwords for the Boards
236
Ciguatoxin
Buzzwords for the Boards
237
Bacteria-catalyzed decarboxylation of
decomposing finfish muscle,
“sunburn-like” rash, urticaria,
pruritis, bronchospasm
Buzzwords for the Boards
238
Scombroid
(Histamine poisoning)
Buzzwords for the Boards
239
Sodium channel blocker, perioral
paresthesias, numbness, tremor,
ataxia, dysarthria/dysphagia,
respiratory paralysis, death (5th most
potent toxin on planet earth)
Buzzwords for the Boards
240
Tetrodotoxin
Buzzwords for the Boards
241
Japanese vinyl sandal maker with
peripheral sensorimotor neuropathy.
Nerve biopsy reveals axonal swelling.
Buzzwords for the Boards
242
Hexane
Buzzwords for the Boards
243
Cicuta spp. Most fatal plant species in
North America (30-70% fatality
rate).
Buzzwords for the Boards
244
Water Hemlock
Water Gate Candidate Scandal (Water
hemlock, GABA, Cicutoxin, Seizures)
Buzzwords for the Boards
245
The only form of poisoning caused by
bacterial contamination.
Buzzwords for the Boards
246
Scombroid
(Histamine poisoning)
Buzzwords for the Boards
247
St. Anthony’s Fire, ergotism
Buzzwords for the Boards
248
Claviceps purpurea
Buzzwords for the Boards
249
Structural similarity to the herbicide
Endothall, also know as Spanish Fly,
produced by the blister beetle
Buzzwords for the Boards
250
Cantharidin
Buzzwords for the Boards
251
Profound hypoglycemia, hepatitis with
hyperbilrubinemia, acidemia and
aciduria without ketosis
Buzzwords for the Boards
252
Ackee (hypoglycin)
Buzzwords for the Boards
253
The maximum concentration of a
chemical to which workers may be
exposed continuously for up to 15
minutes without danger to health or
work efficiency and safety
Buzzwords for the Boards
254
STEL
(Short-term exposure limit)
Buzzwords for the Boards
255
Sulfonylurea known to cause SIADH
and disulfiram reactions
Buzzwords for the Boards
256
Chlorpropramide
Buzzwords for the Boards
257
Side chain on cephalosporin (ie,
cefazolin) antibiotics linked to
disulfiram reactions
Buzzwords for the Boards
258
n-methyltetrathiol
Buzzwords for the Boards
259
Antidysrhythmic with antimuscarinic
properties and causes hypoglycemia
Buzzwords for the Boards
260
Disopyramide
Buzzwords for the Boards
261
Intoxicants that produce metaphyseal
bands on plain-film x-ray
Buzzwords for the Boards
262
Lead (lead lines)
Yellow phosphorus
Bismuth
Hyervitaminosis D
Buzzwords for the Boards
263
5 most common medications linked to
lupus-like syndrome
Buzzwords for the Boards
264
CHIMP
Chlorpropramide
Hydralazine
INH
Methyldopa
Procainamide
Buzzwords for the Boards
265
Idiopathic intracranial hypertension
(pseudotumor cerebri)
Buzzwords for the Boards
266
Vitamin A
Buzzwords for the Boards
267
Time (hrs)
Time (hrs)
Buzzwords for the Boards
268
Natural Log (ln)
Drug Concentration
Drug Concentration
Zero order elimination
Buzzwords for the Boards
269
Chan Su
Buzzwords for the Boards
270
Chinese herbal remedy with
bufadenalide cardiac steroid
Buzzwords for the Boards
271
Plant that is a CYP3A4 inducer
Buzzwords for the Boards
272
St. John’s Wart
(Hypericum perforatum)
Buzzwords for the Boards
273
P450
Pulegone g methofuran g hepatitis
Buzzwords for the Boards
274
Pennyroyal
(Mentha pelugium)
Buzzwords for the Boards
275
Aspiration pneumonitis, CNS
depression, patient’s urine smells like
violets
Buzzwords for the Boards
276
Turpentine (pine oil)
Buzzwords for the Boards
277
Essential oil, CNS depression, mild
hepatitis, hemorrhagic pulmonary
edema
Buzzwords for the Boards
278
Oil of Cloves (Eugenol)
(Euginia aromatica)
Buzzwords for the Boards
279
Most common cause of medicationinduced contact dermatitis
Buzzwords for the Boards
280
Neomycin
Buzzwords for the Boards
281
Endocardial and mitral valve fibrosis,
pulmonary hypertension
Buzzwords for the Boards
282
Fenfluramine
Buzzwords for the Boards
283
Disinfectant associated with neonatal
vacuolar encephalopathy and cerebral
edema
Buzzwords for the Boards
284
Hexachloraphene
Buzzwords for the Boards
285
Disinfectant ingestion causing metabolic
acidemia due to decreased renal
clearence of H+ (patients have a
normal lactate)
Buzzwords for the Boards
286
Providone iodine
Buzzwords for the Boards
287
Disinfectant, hypopigmented skin,
tardive dyskinesia-like syndrome,
bradycardia, hypotension, PEG
decontamination
Buzzwords for the Boards
288
Phenol
Buzzwords for the Boards
289
“Rose eye” discoloration of eyelids,
conjunctivitis, refractory hypotension,
reddish discoloration of viscera postmortem
Buzzwords for the Boards
290
Acute selenium toxicity
(Selenious acid)
Buzzwords for the Boards
291
Peanut meal worker who develops liver
cancer (hepatoma)
Buzzwords for the Boards
292
Aflatoxin
Buzzwords for the Boards
293
Biomarker for benzene exposure
Buzzwords for the Boards
294
Urine phenol
Buzzwords for the Boards
295
HIV medication associated with severe
(death) hypersensivity reactions
Buzzwords for the Boards
296
Abacavir
Buzzwords for the Boards
297
The two P450 isozymes linked to the
development of cancer
Buzzwords for the Boards
298
CYP1A2
CYP2E1
Buzzwords for the Boards
299
Enzyme linked to aromatic
anticonvulsant hypersensitivity
syndrome
Buzzwords for the Boards
300
Epoxide hydrolase
Buzzwords for the Boards
301
The only medication-induced seizure
that will likely respond to phenytoin
Buzzwords for the Boards
302
Aminopyridine
Buzzwords for the Boards
303
The only local anesthetic that causes
vasoconstriction
Buzzwords for the Boards
304
Cocaine
Buzzwords for the Boards
305
Most cardiotoxic amide local anesthetic
(may cause cardiotoxicity before CNS
toxicity)
Buzzwords for the Boards
306
Bupivacaine
Buzzwords for the Boards
307
Most extensively metabolized anesthetic,
hepatitis, malignant hyperthermia,
acute lung injury from abuse (PO/IV)
Buzzwords for the Boards
308
Halothane
Buzzwords for the Boards
309
The only IARC Group 4 drug
IARC Group 4: Probably not
carcinogenic to humans
Buzzwords for the Boards
310
Caprolactam
Buzzwords for the Boards
311
Patient with ventricular ectopy,
blindness, N/V, diaphoresis, tinnitus,
after drinking tonic water with Cinchona
succirubra extract
Buzzwords for the Boards
312
Quinine
Buzzwords for the Boards
313
Biventricular ventricular tachycardia
Buzzwords for the Boards
314
Cardiac steroids (#1)
Aconitine
Halogenated hydrocarbsons
Buzzwords for the Boards
315
Patient with an aortic dissection and
renal failure that develops altered
mental status, seizures, and no
metabolic acidosis
Buzzwords for the Boards
316
Thiocyanate toxicity
Buzzwords for the Boards
317
Opioid linked to serotonin syndrome,
seizures, MPTP, and may not result in
miosis in overdose
Buzzwords for the Boards
318
Meperidine
Buzzwords for the Boards
319
Grey baby syndrome
Buzzwords for the Boards
320
Chloramphenical
Buzzwords for the Boards
321
NSAID linked to aplastic anemia
Buzzwords for the Boards
322
Phenylbutazone
Buzzwords for the Boards
323
Patient with HIV with sulfa allergy who
develops hemolysis and
methemoglobinemia
Buzzwords for the Boards
324
Dapsone
Buzzwords for the Boards
325
Patient undergoing elective endoscopy
that develops methemoglobinemia
during pre-op
Buzzwords for the Boards
326
Benzocaine
(Hurricane spray)
Buzzwords for the Boards
327
Most frequently reported antineoplastic
overdose
Buzzwords for the Boards
328
Vincristine
Buzzwords for the Boards
329
Free radical induced cardiomyopathy
with irreversible heart failure
Buzzwords for the Boards
330
Doxorubicin
Buzzwords for the Boards
331
Alkylating agent causing hemorrhagic
cystitis and MESNA antidote
Buzzwords for the Boards
332
Cyclophosphamide
Buzzwords for the Boards
333
Alkylating agent causing pulmonary
fibrosis and skin hyperpigmentation
(tan appearance)
Buzzwords for the Boards
334
Busulfan
“Busulfan tan”
Buzzwords for the Boards
335
6 intoxicants for which urine alkalination
(ion trapping) enhances drug
elimination
Buzzwords for the Boards
336
Salicylates
Phenobarbital
Methotrexate
Chlropropramide
Chlrophenoxy herbicides
Fluoride
Buzzwords for the Boards
337
Scleritis and uveitis in a patient being
treated for hypercalcemia
Buzzwords for the Boards
338
Bisphosphanate
(ie, pamidronate)
Buzzwords for the Boards
339
Peliosis hepatis
Buzzwords for the Boards
340
Alkalated anabolic steroids
Buzzwords for the Boards
341
Buzzwords for the Boards
342
Morphine
Buzzwords for the Boards
343
Buzzwords for the Boards
344
Cocaine
Buzzwords for the Boards
345
Buzzwords for the Boards
346
Phosgene
Buzzwords for the Boards
347
Buzzwords for the Boards
348
Sarin
Buzzwords for the Boards
349
Buzzwords for the Boards
350
Digoxin
Buzzwords for the Boards
351
Buzzwords for the Boards
352
Dioxin
(2,3,7,8 TCDD)
Buzzwords for the Boards
353
Buzzwords for the Boards
354
Succimer (DMSA)
Buzzwords for the Boards
355
Buzzwords for the Boards
356
Acetylcysteine
Buzzwords for the Boards
357
Buzzwords for the Boards
358
D-penicillamine
Buzzwords for the Boards
359
Buzzwords for the Boards
360
Methylene blue
Buzzwords for the Boards
361
Buzzwords for the Boards
362
EDTA
Ethylenediaminetetraacetic Acid
Buzzwords for the Boards
363
Buzzwords for the Boards
364
Deferoxamine
Buzzwords for the Boards
365
Buzzwords for the Boards
366
Pralidoxime
Buzzwords for the Boards
367
Buzzwords for the Boards
368
Alpha-amanitin
Buzzwords for the Boards
369
Buzzwords for the Boards
370
Ciguatoxin
Buzzwords for the Boards
371
Buzzwords for the Boards
372
Aspirin
Buzzwords for the Boards
373
Buzzwords for the Boards
374
Acetaminophen
Paracetamol
Buzzwords for the Boards
375
Buzzwords for the Boards
376
Flumazenil
Buzzwords for the Boards
377
Buzzwords for the Boards
378
Tetrodotoxin
Buzzwords for the Boards
379
Buzzwords for the Boards
380
Physostigmine
Buzzwords for the Boards
381
Buzzwords for the Boards
382
Pyridoxine
Buzzwords for the Boards
383
Buzzwords for the Boards
384
DMPS
Buzzwords for the Boards
385
Lactrodectus mactans
Buzzwords for the Boards
386
Black widow
Painful bite
Calcium channel opener
Increase release ACh, NE
Buzzwords for the Boards
387
Loxosceles reclusa
Buzzwords for the Boards
388
Brown recluse
Painless bite
Sphingomyelinase D
Hyoluranidase
Local wound ulcer (red, white, blue)
Buzzwords for the Boards
389
Tegenaria agrestis
Buzzwords for the Boards
390
Hobo spider
Painless bite
Local ulcer
Buzzwords for the Boards
391
Chironex fleckeri
Buzzwords for the Boards
392
Box jellyfish
Most lethal cnidaria
Rapid death in minutes
Acetic acid/Antivenom
Buzzwords for the Boards
393
Carukia barnesi
Buzzwords for the Boards
394
Irukandji jellyfish
Irukandji Syndrome
Hypertension
Buzzwords for the Boards
395
Physalia physallis
Buzzwords for the Boards
396
Portugese man-of-war/Bluebottle
Painful linear welts
Acetic acid
Buzzwords for the Boards
397
Acanthaster planci
Buzzwords for the Boards
398
Crown-of-thorns
Pain, paralysis
Hot water immersion
Buzzwords for the Boards
399
Pterosis spp
Buzzwords for the Boards
400
Lionfish
Pain, possible blisters
Hot water immersion
Buzzwords for the Boards
401
Synanceja verrucosa
Synanceja horrida
Buzzwords for the Boards
402
Stonefish
Cytotoxic, hemolytic, myotoxic
Severe pain, hypotension, hemolysis
Hot water, antivenom
Buzzwords for the Boards
403
Dasyatis spp.
Buzzwords for the Boards
404
Stingray
Local pain
Vibrio infections
Hot water, antibiotics
Buzzwords for the Boards
405
Atrax robustus
Buzzwords for the Boards
406
Funnel web spider
Massive release of ACh, NE, epi
Rabbit IgG antivenom
Death historically in peds < age 4
Buzzwords for the Boards
407
Solenopsis invecta
Buzzwords for the Boards
408
Fire ant
Glucosaminidase, piperidines
Wheals, clear vesicles
Local care
Buzzwords for the Boards
409
Centruroides exilicauda
Buzzwords for the Boards
410
Bark scorpion
Sodium channel opener
Pain, paresthesias, palsies
Buzzwords for the Boards
411
Bufo alvarius
Buzzwords for the Boards
412
Colorado River Toad
Bufadienolide cardiac steroid
Bufotenin tryptamines
Chan Su Herbal
Dig fab fragments
Buzzwords for the Boards
413
Bodybuilder presenting with tachycardia,
wide pulse pressure, hypokalemia
Buzzwords for the Boards
414
Clenbuterol
Buzzwords for the Boards
415
Silo Filler’s Disease
Buzzwords for the Boards
416
Nitric oxides (NO, NO2)
Buzzwords for the Boards
417
Basal ganglia toxins
Buzzwords for the Boards
418
Carbon disulfide
CO
Manganese
Methanol
Buzzwords for the Boards
419
Remediation level for home radon
Buzzwords for the Boards
420
11 pc/L
Buzzwords for the Boards
421
Three agents associated with perinatal
death
Buzzwords for the Boards
422
ACE inhibitors
Cigarette smoking
Lead
Buzzwords for the Boards
423
Most common hydrocarbon used in dry
cleaning
Buzzwords for the Boards
424
PERC
Perchloroethylene
Buzzwords for the Boards
425
Cement worker with contact dermatitis
Buzzwords for the Boards
426
Chromium (CrVI)
Buzzwords for the Boards
427
OSHA PEL for benzene
Buzzwords for the Boards
428
1 ppm
Buzzwords for the Boards
429
OSHA PEL for carbon monoxide
Buzzwords for the Boards
430
50 ppm
Buzzwords for the Boards
431
Azo dye and rubber manufacturing,
HCN lab detection agent,
methemoglobinemia, associated with
bladder cancer (IARC 1)
Buzzwords for the Boards
432
Benzidine
Buzzwords for the Boards
433
Patient etching glass or wheel cleaning
with delayed pain out of proportion to
exam, hypocalcemia, hyperkalemia
Buzzwords for the Boards
434
Hydrofluoric acid
Buzzwords for the Boards
435
Vitamin B6 (pyridoxine) antidote
Buzzwords for the Boards
436
Isoniazid
Gyromitra esculenta
Hydrazines
Ethylene glycol
Buzzwords for the Boards
437
The factor by which exposure is reduced
by use of a respirator
Buzzwords for the Boards
438
Protection factor
Ambient/protection factor = exposure
Buzzwords for the Boards
439
Study design comparing an exposed
group to an unexposed group either
retro- or prospectively with results
expressed as Relative Risk
Buzzwords for the Boards
440
Cohort study
Buzzwords for the Boards
441
Study design comparing an exposed
group to an unexposed group at one
point in time. Provides prevalence
data, results expressed as Relative Risk
Buzzwords for the Boards
442
Study design comparing individuals with
a specific condition to those that do
not have the condition and compare
exposures or risk factors. Results
expressed as Odds Ratio
Buzzwords for the Boards
443
Case-control study
Buzzwords for the Boards
444
Cross-sectional study
Buzzwords for the Boards
445
Federal agency responsible for
conducting research and making
recommendations for the prevention
of work-related injury and illness. Has
no legal authority.
Buzzwords for the Boards
446
NIOSH
Buzzwords for the Boards
447
The main federal agency charged with
the enforcement of safety and health
legislation.
Buzzwords for the Boards
448
OSHA
Buzzwords for the Boards
449
Enacted by Congress in1980 and created a
tax on the chemical and petroleum
industries and provided broad Federal
authority to respond directly to releases or
threatened releases of hazardous
substances that may endanger public health
or the environment
Buzzwords for the Boards
450
CERCLA
Comprehensive Environmental
Response, Compensation, and Liability
Act
(aka Superfund)
Buzzwords for the Boards
451
Federal public health agency charged
with the responsibility of evaluating
the human health effects of exposure
to hazardous substances.
Buzzwords for the Boards
452
ATSDR
Buzzwords for the Boards
453
Characteristics of substances
partitioning into breast milk
Buzzwords for the Boards
454
Low molecular weight
Non-polar (breast milk is high in fats)
Low protein binding
Buzzwords for the Boards
455
What are ther isks for quinoloneinduced tendinopathy?
Buzzwords for the Boards
456
Age > 60 years
Non-obese
Steroid use
Female,
Renal failure
Diabetes
Buzzwords for the Boards
457
What is the normal urinary ratio of
testosterone to epitestosterone
Buzzwords for the Boards
458
Less than 6 to 1
Buzzwords for the Boards
459
Hepatic zone were CYP2E1 is primarily
present and acitve
Buzzwords for the Boards
460
Zone 3
Centrilobular necrosis
Buzzwords for the Boards
461
The primary toxicity associated with
methoxyflurane
Buzzwords for the Boards
462
Nephrotoxicity
Buzzwords for the Boards
463
Describe their mechanisms of action
Tetrodotoxin
Saxitoxin
Brevetoxin
Domoic acid
Okadoic acid
Ciguatoxin
Buzzwords for the Boards
464
Tetrodotoxin: Blocks voltage-gated Na channels
Saxitoxin: Blocks voltage-sensitive Na channel
Brevetoxin: Stimulates voltage-sensitive Na channel
Domoic acid: Glutamate agonist, analog of glutamic and
kainic acids
Okadoic acid: Posphatase a1 and a2 inhibitor
Ciguatoxin: lowers the threshold for opening voltagegated Na channels
Buzzwords for the Boards
465
Fixed amount eliminated per time
Non-linear, no half-life
Elimination saturated, capacity limited
Concentration rises with dose
Curve on semi-log paper
Michaelis-Menten when concentration is high
Buzzwords for the Boards
466
Zero order kinetics
Buzzwords for the Boards
467
Clearance is constant over concentration
Elimination is not saturated
Percentage eliminated per time is constant
Linear on semi-log paper
Half life is time for a 50% reduction
Michaelis-Menten when concentration is low
Buzzwords for the Boards
468
First order kinetics
Buzzwords for the Boards
469
HORDe - Hydrolysis, Oxidation,
Reduction, Dealkylation
Buzzwords for the Boards
470
Phase I Metabolism
Buzzwords for the Boards
471
Conjugation of polar groups
Increase hydrophilicity
GAS MAG - Glucuronidation,
acetylation, sulfation, methylation,
addition of amino acids and
glutathione
Buzzwords for the Boards
472
Phase II Metabolism
Buzzwords for the Boards
473
Intoxicants associated with peripheral
neuropathy
Buzzwords for the Boards
474
Acrylamide
Bromide (Methyl)
Carbon disulfide
Styrene
Trichloroethylene
Buzzwords for the Boards
475
Occupational intoxicants associate with
asthma (pulmonary sensitizers)
Buzzwords for the Boards
476
Maleic Anhydride
Trimellitic Anhydride: “Trimellitic Flu”
Ethylenediamine
Toluene diisocyante/isocyanates: (#1)
Diethylhexyl Phthalate (DEHP)
Buzzwords for the Boards
477
Rodenticide producing nausea, vomiting,
bradycardia, and hyperkalemia
Buzzwords for the Boards
478
Red squill (digoxin-like syndrome)
Buzzwords for the Boards
479
Rodenticide producing CNS excitation,
irritability, seizures, coma,
ventricular dysrhythmias
Buzzwords for the Boards
480
SMFA (Compound 1080)
Tetramine
Buzzwords for the Boards
481
Rodenticide producing oropharyngeal
and skin burns, smoking
vomitus and stools, garlic odor, GI and
hepatic injury
Buzzwords for the Boards
482
Yellow phophorus
Buzzwords for the Boards
483
Rodenticide producing tremors,
myoclonus, depressed mental
status
Buzzwords for the Boards
484
Bromethalin
Buzzwords for the Boards
485
This compound was used in hospital laundry.
Toxicity resulted in 9 neonates ill, 2 deaths.
Presented with: fever, sweating, renal failure
and acidosis. This agent was also used in
various ways including in treating wood to
function as preservative.
It uncouples oxidative phosph.
Buzzwords for the Boards
486
Pentachlorophenol
Disaster occurred in 1967
Buzzwords for the Boards
487
What chemical(s) is associated with
causing choracne?
Buzzwords for the Boards
488
Usually due to chlorinated aromatic
hydrocarbons. Also associated with general
chlorine exposure. Pentachlorophenol is
classically associated with this (Still used as
wood preservative today i.e telephone
poles; formerly as fungicide; not permitted
for home use)
Buzzwords for the Boards
489
Hairdresser hand dermatitis
Buzzwords for the Boards
490
p-phenylenediamine
Permanent hair color dye with pphenylenediamine (PPD)
oxidized by H2O2 → Amines
Fingertips #1 spot
Buzzwords for the Boards
491
International treaty completed in 1987
by 24 nations to control the depletion
of the ozone layer. Targeted to
decrease the use of CFCs and halons
used in fire extinguishers i.e. Halon
1211 and 1301
Buzzwords for the Boards
492
Montreal Protocol
Buzzwords for the Boards
493
Shoemaker’s
Polyneuropathy
Buzzwords for the Boards
494
Shoemaker’s
Polyneuropathy
Due to use of N-hexane. Another term is “Hexacarbon
neuropathy.” Same associated with Methy-N-Butyl
Ketone. All of which → methylethyl ketone; all of
mhich are metabolized to 2,5-butanedione (the actual
problem child). Had a classic mass problem in Italy
with this. Don’t confuse with the other big HC used in
this industry; benzene. These folks also developed the
problems associated with benzene: AML
Buzzwords for the Boards
495
Toluene toxicities (4 major)
Buzzwords for the Boards
496
Toluene toxicities
Distal RTA
Metabolic acidosis (due to Hippuric acid
metabolite and RTA)
Hypokalemia and associated symptoms
Leukoencephalopathy (chronic use)
Buzzwords for the Boards
497
The only hydrocarbon exposure
associate with a change in
cardiovascular mortality
Buzzwords for the Boards
498
Carbon disulfide
Associated with accelerated
atherosclerotic CAD
(Don’t forget the peripheral neuropathy)
Buzzwords for the Boards
499
Cement eczema
Buzzwords for the Boards
500
Refers to the dermatitis associated with
exposure to chromium 6+
Type IV hypersensitivity reaction
Buzzwords for the Boards
501
Wolf-Chaikoff Effect
Buzzwords for the Boards
502
Wolf-Chaikoff Effect
The reaction where chronic iodine exposure
lead to ↓ thyroid hormone production. The
inhibition of organic binding of iodide in
the thyroid gland by excess iodide → ↓
thyroid synthesis. Compare with the
Jodbasedow reaction (The reaction where
chronic iodine exposure causes increased
thyroid hormone production)
Buzzwords for the Boards
503