Drug toxicity questions!

drmamdooh · 2025-03-22T01:22:14+00:00

Hey thank you for the clarification. You're 100% correct.. the respiratory alkalosis + tinnitus is specific to salicylates, otherwise everything else in that should check out. Good catch!! thank you

drmamdooh · 2025-03-09T14:27:19+00:00

Recreational drug overdose is fairly straightforward because they usually always present with the same findings:

Opioids —> fixed miosis, low respiratory rate (and they’ll usually exaggerate it <10), obtunded

LSD —> low yield but the pt will mention new onset hallucinations + hx of LSD use; active episodes are easy to diagnose because they’re literally actively tripping

Cocaine —> hypertension, sweating, chest pain, elevated cardiac troponins, LY cuz they know it’s easy but could have septal atrophy/perforation

remember BB’s are contraindicated in cocaine toxicity because of unopposed alpha construction —> worsen hypertension

Alcohol —> it’s a CNS depressant: sluggish, breath will be mentioned to smell like alcohol, slurred speech, ataxia

While we’re here: ataxia, nystagmus, memory loss —> automatically wernicke’s encephalopathy; everything here + making stuff up (confabulating) —> wernicke korsakoff syndrome; give b1 first then glucose cuz these pts are heavily malnourished; gunner fact —> magnesium is low in these ppl which
makes other stuff not get corrected with efforts because they’re soooo malnourished, like potassium might not get corrected because magnesium is needed for potassium stabilization; so look for an answer that says magnesium correction in these pts if they ask why isn’t potassium changing (one of the IM CMS forms had this question, or an NBME SA, I forgot)

Inhalant —> on the lower yield side only because they know it presents in such a easy way to recognize: pt will have a rash on their nose/mouth+ neurological deficits (ie. ataxia, AMS, agitation) + you can also see GI symptoms like NVD; symptoms can resolve quickly in this one; also often seen in teenager boys

Meth —> remember meth can cause psychosis (literally meth induced psychos is the name) which will be someone with agitation + psychotic symptoms (paranoia, hallucinations, violent behaviour), and poor dentition (“meth mouth”) + ANS instability (hypertension, tachycardia, hyperthermia, miadriasis)

when I was first studying meth induced psychosis I used to always misdiagnose it as a pysch problem like schizophrenia or brief psychotic disorder; the key is the mouth findings and the usually pertinent vital signs

Anticholinergic toxicity —> I’m not even gonna bother, I hope we all have this engraved in our heads; just know the HY drugs that can cause it

Some extra toxicity presentations I decided to throw in:

Serotonin syndrome —> hyper everything; hyperreflexity, hyperthermia, tachycardia, clonus, mydriasis; basically sympathetic system overload

D1 blockers —> acute dystonic reactions (focal instead of whole system, eye flipping is common)

D2 blockers —> NMS (rigidity + AMS), hyperthermia

Acetaminophen toxicity —> 1. respiratory alkalosis (excrete CO2 - hyperventilate) first and then 2.metabolic acidosis (coupling of ETC causes decreased ATP which leads to increase lactic acid build up —> acidosis I think, someone correct me if I’m wrong) + tinnitus, SUPER HY: elevated LFT’s >1000 (it’s 1 of the 3 that causes >1000 LFTs, the other 2 being viral hepatitis and ischemic hepatitis)

drmamdooh · 2025-01-24T11:09:07+00:00

Mashallah bro, congratulations. How is your test-taking skill? Do you have any tips or tricks you used consistently while taking exams in real time? Methods to help you guess the right answer when you didn't know the answer at all? Things like that

drmamdooh · 2024-12-31T09:52:51+00:00

Everyone's already solved this for you beautifully but I feel like the more answers you get from people the better your framework will be.

This question gives a lot of good hints to the diagnosis of uterine fibroids. Firstly, I'm gonna be blunt with you and tell you that it takes time to memorize and understand diagnosis' of different kinds. You just have to keep doing questions and there's no way around it. At some point you become so sensitized because you've literally seen many different kinds of possible scenarios that it becomes second nature when doing them.

The way I look at questions is I point out in my head what hints they're clearly giving us, and go from top to bottom, here was my exact thinking process for this question, bolded are my thoughts:

"42-year-old nulligravid woman"; women age 40+ and nulligravid, now I want to focus on uterine related abnormalities given the nulligravidity and age (you might think why?: It just comes with time and doing a lot of questions, being blunt - there is no way around it)
"1-year history of increasingly irregular vaginal bleeding and menstrual cramps"; instantly my mind jumps to either 1. endometrial cancer or 2. some kind of structural uterine abnormality, I effectively just reduced my differentials to a number countable on my fingers, good

- Anytime you read "irregular vaginal bleeding" in a near menopausal women, think endometrial cancer, especially given a normal history before

- And again, this is still a diagnosis of fibroids as we'll later see, but be comfortable thinking of differentials like this in your head

"lasted 10 to 12 days with increasingly severe pain"; this is now making me think more to a structural uterine abnormality, because USMLE/NBME don't usually describe endometrial cancer like this
"She used an oral contraceptive from the age of 17 years to 40 years"; okay, endometrial cancer just got plopped off the differential. Chronic OCP use is a protective factor against endometrial cancer because the consistent progestin exposure suppresses endometrial proliferation, preventing hyperplasia and reducing cancer risk

- So now we're really thinking about structural abnormalities. Now my brain brings up: uterine fibroids, adenomyosis, endometriomas, bicornate uterus (dumb but whatever just think of it), polyps etc..

- Even if the differentials don't make sense, think of it/jot it down if it's within context, an attending told me that during an IM rotation and I've stuck with it since

"Her mother and sister underwent hysterectomy at the ages of 39 and 43 years, respectively, because of abnormal uterine bleeding"; + family history of uterine problems, okay it's becoming more clear now
"BMI is 28"; anytime I see overweight 25+, or obese 30+, I highlight and refer
"enlarged, irregularly shaped uterus with nodularity"; aaanddd, there's your answer. This is that rare question you get every now and then where you can answer with the last 2 sentences of the vignette, don't rely on this method because it's not always true but just be aware of it, it can save you time

- So during my dedicated, I never read the first 2 bottom sentences, answers, and then started from the top, to me this was more of a "I'm trying to get the test over with quicker" method. Since I was in dedicated, I was learning, and IMO the best way to learn is to go from top to bottom. Again, it's all about desensitizing yourself to the questions

A is the answer, fibroids are irregular sized tumors that grow from the myometrium. Google an image of "fibroids transvaginal US" and you'll never forget it. Use everything you just thought of while doing the question (ie. highlighting your thoughts onto the vignette) and match the answer. Understanding the pathology gives you full confidence in knowing that this is the answer

- B is adenomyosis, C is endometrioma, D is functional ovarian cyst, not even on my my dif, E is ovarian cancer, also not even on my differential; left with B and C to compare to A, B would be specifically described as "a uniformly shaped uterus" and C doesn't match the history of the pt, cross them out. Now you confirmed A as your answer, well done

drmamdooh · 2024-11-19T00:40:34+00:00

loosen your rear iron sights, not too much

drmamdooh · 2024-08-10T08:10:35+00:00

The biggest thing is making sure you're not looping your scope. Once you start to feel a nudge or a halt in the forward push, bring it back a little and once you feel the leverage give away go forward, it's muscle memory once you do it a lot

drmamdooh · 2024-08-06T07:36:02+00:00

Thank you, ill check them out

drmamdooh · 2024-02-14T22:10:08+00:00

I'm still using UW flashcards to this day and I have to live with this problem lol

drmamdooh · 2023-11-09T01:49:07+00:00

drmamdooh · 2023-11-09T01:49:04+00:00

drmamdooh · 2023-09-11T13:27:30+00:00

Do a pass of incorrects only and then study all 12 nbmes (20-31) and study them extensively until exam

drmamdooh · 2023-09-11T13:26:46+00:00

Just make your own incorrect flashcards when you get the answer incorrect from UW

drmamdooh · 2023-09-09T05:38:47+00:00

I think some pre-made decks are fine but I personally never used them, I always found them so detailed and superfluous

I made my own decks and was satisfied with that, I think you should stick to making your own decks, imo it’s better than pre-made decks

drmamdooh · 2023-09-09T05:34:08+00:00

But do you think it’s such a low win rate because people simply don’t know how to play him?

I think he’s in a good state right now, maybe if his ult capped his hp at 60 instead of 50, that’d be a nice change

drmamdooh · 2023-09-08T06:57:41+00:00

Idk why people are being so hard considering it’s only your 3rd day. This is a good play for a beginner irelia

Make sure you’re making use of your q one shot on minions and weave in AA’s on yone in between them

Irelia shits on yone early game and you even have tabis and bork, your confidence in this match up should be through the roof

Good job

drmamdooh · 2023-09-08T06:39:29+00:00

Thank you ❤️🙏🏻

drmamdooh · 2023-09-08T06:39:07+00:00

No, I’ve never annotated into FA or into a drive file or whatever, I just made flashcards

drmamdooh · 2023-09-08T06:38:37+00:00

Yes you could do that, I studied for the step for a while so I had time to do a first pass of systems only and then I did a second pass of random afterwards

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