ABEM Medical Tox study guide
ABEM Medical Tox · Work through your exam, one topic at a time.
Medical Toxicology is an ABMS-recognized subspecialty concerned with the diagnosis and management of human poisoning and envenomation, adverse drug effects, and exposure to occupational and environmental hazards. ABEM administers subspecialty certification in Medical Toxicology for physicians who already hold primary certification, and ABEM's own navigation lists Medical Toxicology continuing certification as the MyToxCert module. The ABEM Medical Tox study guide has 5 sections and about 1,834 words.
01General Principles of Toxicology: Toxicokinetics, Risk Assessment, Decontamination, and Supportive Care
Volume of distribution (Vd) predicts whether extracorporeal removal can work. Large-Vd, highly protein-bound toxins (digoxin, tricyclics, verapamil, chloroquine) are not meaningfully removed by hemodialysis, whereas small-Vd, poorly bound toxins (lithium, methanol, ethylene glycol, salicylate, theophylline) are.
300 words, about 2 min02Pharmaceutical Agents: Antidotes, Toxidromes, and Overdose Management
Acetaminophen: NAPQI accumulates when glutathione is depleted; N-acetylcysteine replenishes precursors. Apply the Rumack–Matthew nomogram only to single acute ingestions timed at 4 hours or later; for repeated supratherapeutic ingestion or unknown timing, treat empirically using level plus transaminases.
314 words, about 2 min03Drugs of Abuse and Alcohols
Cocaine and amphetamines cause hypertension, tachycardia, diaphoresis, mydriasis, agitation, hyperthermia, seizures, and acute coronary syndrome. Give benzodiazepines first; for cocaine-associated ACS use nitroglycerin, calcium-channel blockers, and phentolamine, and avoid unopposed beta-blockade.
297 words, about 1 min04Environmental, Occupational, and Industrial Toxicology
Lead inhibits ALA dehydratase and ferrochelatase, producing microcytic anemia with basophilic stippling, abdominal colic, and encephalopathy; diagnose with a blood lead level, not hair or urine. Chelate with oral succimer (DMSA) for moderate pediatric levels, or CaNa2EDTA plus dimercaprol for severe or encephalopathic cases - after ending exposure.
297 words, about 1 min05Chemical and Biological Agents, Toxic Terrorism, and Hazardous Materials
Nerve agents (sarin, soman, VX) are organophosphates: cholinergic crisis with miosis, secretions, sweating, fasciculations, and seizures. Treat with atropine titrated to secretions, an oxime, and benzodiazepines for seizures; protect rescuers with Level A or B PPE and SCBA.
626 words, about 3 min