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Which of the following community emergency response agencies should be involved in planning for disasters such as those involving mass exposures to cholinesterase inhibitors? (Choose ALL correct answers)
Emergency management/disaster offices
All area hospitals
The poison center
Fire departments
EMS providers
The Local Emergency Planning Committee (LEPC)
None of the above
Which of the following should be assumed to happen with incidents involving patients acutely exposed to cholinesterase inhibitors (Choose ALL correct answers)
Patients will be transported to the hospital without having been decontaminated
Chemically exposed patients will be sent to a single hospital in the community designated for chemical casualties
Contaminated patients will arrive unannounced
None of the above
Cholinesterase inhibitor toxicity leads to (Choose ALL correct answers)
Excessive cholinesterase activity
Depression of cholinesterase activity
Excessive amounts of acetylcholine
Occupation of cholinesterase binding sites by the cholinesterase inhibitor
None of the above
Which of the following are among the 4 major types of pathology caused by cholinesterase inhibitors? (Choose ALL correct answers)
The cholinergic toxidrome
The acute polyneuropathic syndrome
The intermediate syndrome
Organophosphate-induced delayed neuropathy
None of the above
The key function of nicotinic receptors is to (Choose ALL correct answers)
Trigger excretion of exocrine glands
Trigger rapid neural and neuromuscular transmission
Suppress rapid neural and neuromuscular transmission
Modulate intrinsic rhythmic electrical and mechanical activity
None of the above
Which of the following effects of acute cholinesterase toxicity involve nicotinic receptors? (Choose ALL correct answers)
Sweating
Miosis (pupillary constriction)
Hyperglycemia
Fasciculations
None of the above
In which of the following anatomical locations are nicotinic receptors found? (Choose ALL correct answers)
Neuromuscular junctions
Sympathetic nervous system
Autonomic ganglia
Central nervous system
None of the above
Muscarinic receptors (Choose ALL correct answers)
Are faster to respond than nicotinic receptors
Are not found in the central nervous system
Trigger bronchodilation
Trigger mostly sympathetic nervous system effects
None of the above
Which of the following are true about the cholinergic toxidrome? (Choose ALL correct answers)
CNS effects are mediated by both nicotinic and muscarinic receptors
CNS effects can mimic mental illness
Uncontrolled seizures can lead to long-term CNS effects
Seizures are more common in adults than children
None of the above
Acute cholinesterase inhibitor toxicity has been known to result in the following laboratory abnormalities (Choose ALL correct answers)
Leukocytosis
Peaked T-waves on EKG
Elevated serum glucose
Hyperkalemia or hypokalemia
None of the above
Which of the following medical conditions can be mimicked by cholinesterase inhibitor toxicity? (Choose ALL correct answers)
Mental illness
Food poisoning
Opiate overdose
Influenza
None of the above
Pediatric cholinesterase inhibitor poisoning differs from that in adults in the following ways (Choose ALL correct answers)
Seizures are less likely
Nicotinic effects are more likely
Fasciculations are more common
Bradycardia is less common
None of the above
Potential sources of exposure to cholinesterase inhibitors include which of the following (Choose ALL correct answers)
Insecticides
Antiparkinson drugs
Snake venom
Malaysian Bean sprouts
None of the above
Which of the following questions should be included in history for suspected cholinesterase inhibitor exposure? (Choose ALL correct answers)
Typical work activities
Medications
Hobbies
Use of traditional or ethnic remedies
None of the above
Which of the following are true about laboratory tests for cholinesterase inhibitor toxicity? (Choose ALL correct answers)
The rapid availability of RBC cholinesterase levels, compared to serum cholinesterase levels makes them a useful tool for the emergency management of acutely toxic patients
Reduction in RBC cholinesterase levels to normal is a good end point for titration for initial doses of 2-PAM
Normal ranges of serum cholinesterase vary widely among individuals, but RBC cholinesterase level normals vary little among individuals
Since the imposition of federal laboratory standards, the normal ranges for serum and RBC cholinesterase levels are the same for each laboratory
None of the above
Supportive care is an important aspect of treatment for the cholinergic toxidrome and should be focused primarily on maintaining and improving (Choose the ONE BEST answer)
Renal function
Hepatic function
Respiratory function
CNS function
None of the above
Atropine counteracts cholinesterase inhibitor toxicity by (Choose the ONE BEST answer)
Competitively occupying muscarinic receptor sites
Competitively occupying nicotinic receptor sites
Competitively occupying nicotinic and muscarinic receptor sites
Neutralizing acetylcholine
None of the above
Which of the following is/are the best end-points against which to titrate the dose of atropine in acute cholinesterase poisoning? (Choose the ONEBEST answer)
Pupillary dilation
Pupillary constriction
Clinically significant reduction of bronchorrhea and bronchoconstriction, (as reflected by level of oxygenation and ease of ventilation)
Development of heart rate of between 100-150/min
Return of consciousness
Return of muscle strength
all of the above
None of the above
In order of preference, the best routes of atropine administration are: (Choose the ONE BEST answer)
Intramuscular is better than Intravenous which is better than Autoinjector
Intravenous is better than Autoinjector which is better than Intramuscular
Autoinjector is better than Intravenous which is better than Intramuscular
Intravenous is better than Intramuscular which is better than Autoinjector
Intravenous is best; Intramuscular and Autoinjector are equally good
None of the above
Which type of cholinesterase toxicity can require the highest doses of atropine? (Choose the ONE BEST answer)
Inhalation of nerve agent
Dermal exposure to organophosphorus agents
Suicidal ingestion of organophosphorus agents
Ingestion of carbamates
Which of the following are true about 2-PAM? (Choose ALL correct answers)
It should never be used in carbamate poisoning
It works by attaching to the cholinesterase inhibitor bound to cholinesterase, attaching to and removing the inhibitor
It reduces the effectiveness of atropine
It is ineffective after aging occurs
None of the above
Which of the following are reasons for treatment failure with 2-PAM? (Choose ALL correct answers)
Inadequate dose
Co-administration of atropine
Redistribution of cholinesterase inhibitor from fat tissue
Aging has already occurred
None of the above
Which of the following lead to delayed aging, and therefore prolongation of the time course when 2-PAM is still effective? (Choose ALL correct answers)
Co-administration of atropine
Poisoning from fat-soluble organophosphorus compounds
Dermal exposure
Poisoning with chemicals that must be metabolically converted before they possess cholinesterase inhibiting properties
None of the above
Which of the following is true about seizures resulting from cholinesterase inhibitors? (Choose ALL correct answers)
They are more common in adults than in children
Although diazepam is effective in controlling seizures, it has not been shown to improve clinical outcome
Diazepam should not be used unless seizures occur
CNS damage from cholinesterase inhibitors is due to a direct toxic effect, not seizure activity
None of the above
Which of the following are currently recommended in the routine treatment of poisoning?
Syrup of ipecac
Gastric lavage
Cathartics
Activated charcoal
None of the above
Which of the following is true regarding the intermediate syndrome? (Choose ALL correct answers)
It most commonly occurs after nerve agent poisoning
If good supportive care has been given and there is no hypoxic damage, the condition usually resolves spontaneously
Atropine is indicated if muscarinic signs are present
Delayed, but sudden-onset of respiratory weakness or paralysis may occur, leading to respiratory failure
None of the above
Which of the following are true about Organophosphate-induced delayed neuropathy (OPIDN)? (Choose ALL correct answers)
It is caused by a molecular alteration of nicotinic receptors at the neuromuscular junction of distal skeletal muscle groups
Pain is not a characteristic symptom
If there has not been any hypoxic damage, and good supportive care has been given, full recovery is the rule
Early and adequate doses of 2-PAM and atropine have been shown to prevent this condition
None of the above
Which of the following are true about Organophosphorus ester-induced neurotoxity (OPICN) (Choose ALL correct answers)
It is a set of long-term, persistent neuropsychiatric signs and symptoms
No specific treatment has been identified
Studies carried out to assess whether the condition can occur after asymptomatic exposures to cholinesterase inhibitors have suffered from methodological problems
It occurs when cholinesterase inhibitors trigger a permanent defect in neurotarget esterase
None of the above
Which of the following are true about cholinesterase inhibitors? (Choose ALL correct answers)
Chronic, asymptomatic exposure to cholinesterase inhibitors is associated with an increased risk of chronic lymphocytic leukemia
Neural tube defects have been associated with symptomatic exposures during the first trimester of pregnancy
The available evidence does not explain the myriad of symptoms of Gulf War Illness on the basis of exposure to cholinesterase inhibitors
The Wenger-Herzold study demonstrated clinically significant long-term decrements in immunity in those with long-term exposure to organophosphorus compounds, but not carbamates
None of the above
The most characteristic early finding in intermediate syndrome is: (Choose the ONE BESTanswer)
Loss of sensation in distal extremities
Inability of the patient to lift his/her head off the pillow
Muscle fasciculations
Profound salivation (liters per day)
None of the above
Muscarinic receptors are found in: (Choose ALL correct answers)
Skeletal muscle
Smooth muscle
Exocrine glands
Sweat glands
None of the above
Which of the following are true about the central nervous system effects of cholinesterase inhibitors (Choose the ONE BEST answer)
The pathology can be explained on the basis of increased muscarinic, as opposed to nicotinic, receptor activity
The pathology can be explained on the basis of increased nicotinic, as opposed to muscarinic, receptor activity
The pathology is poorly understood but involves both nicotinic and muscarinic receptors
None of the above
Which of the following central nervous system signs and symptoms have been reported in cases of cholinesterase inhibitor poisoning? (Choose ALL correct answers)
Anxiety
Emotional lability
Convulsions
Excess dreaming
None of the above
Which of the following questions on an exposure history are appropriate for the physician to ask in a patient suffering from signs and symptoms suggestive of cholinesterase inhibitor poisoning? Choose ALL correct answers
What are your hobbies?
Do you cook with wild mushrooms?
Does anyone at home have similar signs or symptoms?
Do you handle venomous snakes?
None of the above
Cholinesterase inhibitors block the ability of acetylcholinesterase to break down acetylcholine by? (choose the ONE best answer)
Occupying the binding site on cholinesterase to which the acetylcholine would attach
Preventing the release of acetylcholine from its attachment on cholinesterase
Attaching to acetylcholine which prevents its attachment to cholinesterase
None of the above
What causes the cholinergic toxidrome? (Choose the ONE best answer)
An excess of acetylcholine
A deficiency of acetylcholine
An excess of acetylcholinesterase
None of the above
Where are cholinergic receptors are found? (Choose ALL correct answers)
At the neuromuscular junction
In the central nervous system
In the sympathetic, peripheral nervous system
In the parasympathetic, peripheral nervous system
None of the above
Nicotinic and muscarinic receptors differ in which the following ways (Choose ALL correct answers)
They have different functions
They have different mechanism by which they trigger signal transmission
They may exist at different anatomical locations
None of the above
Why do excessive levels of acetylcholine (“The cholinergic toxidrome”) cause different signs and symptoms, depending on whether the nicotinic or muscarinic receptors are involved? (Choose ALL correct answers)
Because some nicotinic and muscarinic receptors are located in and affect different anatomic structures
Because nicotinic and muscarinic receptors are triggered by different neurotransmitters
Because nicotinic and muscarinic receptors have different mechanisms of action
None of the above
Factors that account for variation in the clinical presentation of cholinesterase toxicity include: (Choose ALL correct answers)
Route of exposure
The balance of nicotinic and muscarinic effects on the sympathetic and parasympathetic nervous system
Age of the patient
The specific cholinesterase-inhibiting chemical
None of the above
Which of the following are major factors leading to respiratory failure in cases of cholinesterase inhibitor poisoning? (Choose ALL correct answers)
Bronchodilation
Central respiratory depression
Weakness or paralysis of the respiratory muscles
Excessive respiratory tract secretions
None of the above
Which of the following statements are true regarding serum or red blood cell cholinesterase levels? (Choose ALL correct answers)
The use of these tests helps to avoid serious errors in emergency treatment
With current technology, interindividual variation in results, is no longer a significant problem
While percentage of inhibition in the same person may be different in different laboratories, the absolute cholinesterase values are usually the same
None of the above
Which of the following statements are true about the laboratory measurement of cholinesterase inhibitors themselves or their metabolites? (Choose ALL correct answers)
Each test can measure only one chemical, so it is only useful if you know the specific chemical to which the patient was exposed
The results are not usually available in time to guide emergency treatment
The test results are usually very accurate
None of the above
Which of the following statements is true about the patient with exposure to cholinesterase inhibitors? (Choose ALL correct answers)
If the patient has only been exposed to cholinesterase inhibitor vapor, there is no risk of secondary exposure
If the patient has ingested a cholinesterase inhibitor, others can be exposed if the patient vomits
More important than which decontamination fluid is used is how rapidly decontamination is initiated
Water and soapy water are very effective decontamination fluids
None of the above
If a hospital receives a patient with cholinesterase inhibitor toxicity and there is the potential that others were also exposed at the scene, which of the following should be notified (Choose ALL correct answers)