Q- A child is brought to the emergency room because he accidentally ingested a large amount of rat poison. His vital signs are within normal limits, and his physical examination is unremarkable. His lab tests come back normal except for an elevated prothrombin time.
Which of the following is the most effective treatment?
A- Atropine
B- Flumazenil
C- Protamine
D- Vitamin K
D- Vitamin K- The rat poison most likely contains warfarin or a warfarin-like compound (a common anticoagulant used in rodenticides). Warfarin inhibits vitamin K epoxide reductase, leading to impaired synthesis of vitamin K-dependent clotting factors (II, VII, IX, and X), which results in prolonged prothrombin time (PT) and increased risk of bleeding.
Q- Which of the following medications produces vasodilation by increasing cGMP in the smooth muscle cells of the veins?
A- Atenolol
B- Nifedipine
C- Nitroglycerin
D- Phenylephrine
C- Nitroglycerin- Nitroglycerin is converted to nitric oxide (NO) in the body. NO activates guanylate cyclase in vascular smooth muscle, which increases cyclic GMP (cGMP), leading to smooth muscle relaxation and vasodilation, especially in veins and to some extent, arterioles. It is used in angina and heart failure to reduce preload, which decreases myocardial oxygen demand.
Q- Administration of which one of the following medications may cause tinnitus, blurred vision, delirium, and gastrointestinal upset?
A- Hydralazine
B- Niacin
C- Quinidine
D- Spironolactone
C- Quinidine- Quinidine is a Class Ia antiarrhythmic drug that blocks sodium channels and prolongs the action potential. Its administration may cause cinchonism, which is characterized by tinnitus, blurred vision, delirium, and gastrointestinal upset.
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