Final exam, Set I

1. Which one of the following statements regarding toxicology is true?

A) Modern toxicology is concerned with the study of the adverse effects of chemicals on ancient forms
of life.
B) Modern toxicology studies embrace principles from such disciplines as biochemistry, botany,
chemistry, physiology, and physics.
C) Modern toxicology has its roots in the knowledge of plant and animal poisons, which predates
recorded history and has been used to promote peace.
D) Modern toxicology studies the mechanisms by which inorganic chemicals produce advantageous as
well as deleterious effects.
E) Modern toxicology is concerned with the study of chemicals in mammalian species.

2. All of the following complications of forced diuresis are except:

A) Pulmonary congestion
B) Organism hyperhydratation
C) Brain congestion.
D) Acute renal failure.
E) Hypokalemia

3. Which of the following vital signs or physical fin ngs is mos useful in thedifferentiation on of
adrenergic xposure from anticholinergic exposure ?
A) Pulse
B) Temperature
C) Mental status
D) Pupil Size
E) Bowel sounds.

4. Which of the following sets of clinical features characterizes a sympathomimetic toxic

syndrome?
A) miosis, decreased bowel sounds, decreased alertness.
B) decreased heart rate, increased temperature, mydriasis.
C) hyperalertness, decreased blood pressure, miosis.
D) increased temperature, increased heart rate, miosis.
E) mydriasis, increased blood pressure, hyperalertness.

5. Which of the following sets of clinical features characterizes an anticholinergic toxic

syndrome?
A) increased blood pressure, decreased heart rate, decreased temperature.
B) decreased blood pressure, increased heart rate, decreased temperature.
C) increased blood pressure, increased heart rate, increased temperature.
D) decreased blood pressure, decreased heart rate, decreased temperature.
E) increased blood pressure, decreased heart rate, increased temperature.
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6. Amphetamine toxicity is not expected to result in mortality from which of the following
events?
A) Intracranial hemorrhage
B) Dysrhythmias
C) Hypothermia
D) Aortic dissection
E) Agitation.

7. Why is acidification of the urine for amphetamine toxicity NOT recommended?

A) Acidification will increase amphetamine elimination in the urine
B) Acidification will decrease oxygen unloading to the tissues
C) Acidification may cause a heatstrokelike syndrome
D) Acidification will worsen hypokalemia
E) Acidification will increase precipitation
F) Myoglobin in the renal tubules

8. Which of the following mechanisms explains cocaine-induced myocardial ischemia?

A) Increased myocardial oxygen demand from hypertension and tachycardia
B) Coronary artery spasm from adrenergic effects
C) Platelet aggregation and impaired thrombolysis
D) Increased atherogenesis
E) All of the above

9. Which of the following symptoms is NOT likely to be observe in a patient with

amphetamine toxicity?
A) Urinary retention
B) Mydriasis
C) Tachycardia
D) Hypertension
E) Hyperthermia

10. Which of the following therapies is contraindicted in a patient with cocaine-induced

myocardial ischemia?
A) Nitroglycerin
B) Phentolamine
C) Metoprolol
D) Aspirin
E) Thrombolysis

11. Which of the following is the best piece of information for prognosticating acute Tylenol
(Acetaminophen) Toxicity?

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A) Total grams of acetaminophen ingested
B) Liver function test
C) Four-hour serum level
D) Serum creatinine and BUN.

12. Activated charcoal would be expected to have significant absorption of which of the
following substances?
A) Lithium
B) Ethanol
C) Organic solvents
D) Aspirin

13. Hemodialysis would be most helpful for a medication overdose with which of the
following properties?
A) Large volume of distribution. High protein avidity.
B) Small volume of distribution. Low protein avidity.
C) Large volume of distribution. Low protein avidity.
D) Small volume of distribution. High protein avidity.

14. What is the most common clinical finding in organic phosphorus poisoning that is not
effectively treated with atropine?
A) Bronchorrea
B) Miosis
C) Muscle weakness
D) Diarrhea
E) Bronchoconstriction

15. Clinical signs of methanol poising are, except:

A) Nausea, vomiting, abdominal pain
B) Pain in shank muscles
C) Dimness of eyesight, diplopia, blindness
D) Mydriasis, depressing reaction of pupils against the light
E) Miosis
F) Confusion of consciousness
G) Short and nois

16. The pharmacokinetic process or property that distinguishes the elimination of ethanol and high
doses of phenytoin and aspirin from the elimination of most other drugs is called:
A) Distribution
B) Excretion
C) First-pass effect
D) First-order elimination
E) Zero-order elimination

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17. Drug metabolism in humans usually results in a product that is:
A) Less lipid soluble than the original drug
B) More likely to distribute intracellularly
C) More likely to be reabsorbed by kidney tubules
D) More lipid soluble than the original drug
E) Less water soluble than the original drug

18. Toxic chemicals are most likely to be biotransformed in which of the following organs?
A) central nervous system.
B) heart.
C) lung.
D) pancreas.
E) liver.

19. Why is is important to know the toxic mechanism of a poson?

A) to know what vital function will be affected
B) to know the potential severity of the case
C) it helps to decide what course of action will be taken
D) all of the above.

20. In general, Which of the following factors is the most important regarding the expected
severity of a case of poisoning?
A) dose of the poison
B) age of the person
C) sex of the person
D) form of the substance
E) route of exposure

21. Absorbtion of the poison is more by:

A) inhalation
B) ingestion
C) skin contact
D) absorbtion is similar all routes.

22. Absorption of the poison means:

A) poison reaches circulation
B) poison leaves blood to tissues
C) effect of the poison on receptors
D) none of the above

23. All of the following factors act on activated charcoal antidote effect, except:
A) Poison exposition in the stomach

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B) Size of charcoal subunits
C) Food full stomach
D) Administered charcoal dose
E) Unconsciousness (of the patient)

24. T e impairment of hepatic function can have numerous negative consequences. Which of the
following is likely NOT caused by impaired hepatic function?
A) jaundice.
B) hypercholesterolemia.
C) hyperammonemia.
D) hyperglycemia.
E) hypoalbuminemia

25. Which of the following vital signs or physical findings is most useful in the differentation
of adrenergic exposure from anticolinergic exposure ?
A) Pulse
B) Temperature
C) Mental status
D) Pupil Size
E) Bowel sounds.

26. Which of the followingis the most important to monitor when using atropine to treat a patient
whith cholinergic poisoning ?
A) Blood preassure
B) Pulse
C) Respiratory rate
D) Temperature
E) Mental status

27. What chemicals often used a pesticide is easily absorbed through dermal contact?
A) Rodenticides
B) Carbamates
C) Organophosphates
D) Hemotoxins.

28. Which of the following neurotransmitters undergoes synaptic enzymatic degradation as the
main mechanism by which its actions are terminated?
A) Serotonin
B) Dopamine
C) Norepinephrine
D) Glutamate
E) Acetylcholine

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29. Which of thefolowing sets of clinical features characterizes a sympathomimetic toxic
syndrome?
A) miosis, decreased bowel sounds, decreased alertness.
B) decreased heart rate, increased temperature, mydriasis.
C) hyperalertness, decreased blood pressure, miosis.
D) increased temperature, increased heart rate, miosis.
E) mydriasis, increased blood pressure, hyperalertness.

30. Which of the following xenobiotics lowers the seizure threshold?

A) Phenytoin
B) Secobarbital
C) Haloperidol
D) Alprazolam
E) Diazepam

31. Which of the following mechanisms explains cocaine-induced myocardial ischemia?

A) Increased myocardial oxygen demand from hypertension an tachycardia
B) Coronary artery spasm from adrenergic effects
C) Platelet aggregation and impaired thrombolysis
D) Increased atherogenesis
E) All of the above

32. Which of the following symptoms is NOT likely to be observed in a patient with
amphetamine toxicity?
A) Urinary retention
B) Mydriasis
C) Tachycardia
D) Hypertension
E) Hyperthermia

33. Ethanol is not known to cause which of the following types of hepatobiliary injury?
A) Fatty liver.
B) hepatocyte death.
C) fibrosis.
D) immune-mediated responses.
E) canalicular cholestasis.

34. You are stuck in traffic in New York City in summer for 3 or4 h and you begin to get a
headache, a feeling of tightness inthe temporal region, and an increased pulse rate. What is the antidote
based on the most likely cause of these effects?
A) Activated charcoal
B) Atropine

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C) Fomepizole
D) Oxygen
E) Pralidoxime

35. Which of the following is used as pharmacologic antagonist during opiate intoxication:
A) Thiamine
B) Lipoic acid
C) Pentenic acid /DTPA/
D) Naloxone (Narcan)
E) Cyancobalamine

36. Which of the following mushrooms would be capable of causing seizures?

A) Amanita gemmata
B) Clitocybe nebularis
C) Gyromitra esculenta
D) Cortinarius orellanus
E) Paxillus involutus

37. What is the most common clinical manifestation of the intermediate syndrome?
A) Proximal limp and cranial nerve weakness.
B) Mydriasis
C) Bronchorrhea
D) Ventricular dysrhythmias
E) Vomiting and diarrhea.

38. Which of the following therapies is contraindicted in a patient with cocaine-induced

myocardial ischemia?
A) Nitroglycerin
B) Phentolamine
C) Metoprolol
D) Aspirin
E) Thrombolysis

39. Which of the following is the best piece of information for prognosticating acute Tylenol
(Acetaminophen) Toxicity?
A) Total grams of acetaminophen ingested
B) Liver function test
C) Four-hour serum level
D) Serum creatinine and BUN.

40. Activated charcoal would be expected to have significant absorption of which of the
following substances?
A) Lithium

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B) Ethanol
C) Organic solvents
D) Aspirin