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Paracetamol toxicity is caused by excessive use or overdose of the analgesic drug paracetamol (called acetaminophen in North America). Mainly causing liver injury, paracetamol toxicity is one of the most common causes of poisoning worldwide. In the United States and the United Kingdom it is the most common cause of acute liver failure. Many individuals with paracetamol toxicity may have no symptoms at all in the first 24 hours following overdose. Others may initially have nonspecific complaints such as vague abdominal pain and nausea. With progressive disease, signs of liver failure may develop; these include low blood sugar, low blood pH, easy bleeding, and hepatic encephalopathy. Some will spontaneously resolve, although untreated cases may result in death.

Damage to the liver, or hepatotoxicity, results not from paracetamol itself, but from one of its metabolites, N-acetyl-p-benzoquinoneimine (NAPQI)(also known as N-acetylimidoquinone).

The correct answer is: Tolerance developing requiring larger doses

The correct answer is: This is so that the clinician can monitor for anaemia

The correct answer is: CaEDTA

The correct answer is: lethargy

The correct answer is: Chrons disease and Rhematioid arthritis

This would be the best course of action as the dosage could be considered hepatotoxic. The correct answer is: Refer him to the emergency department

The correct answer is: person to person transmission

The main toxic side effect of opioids is respiratory depression.

The correct answer is: Cefuroxime Axetil

Well done. Often students will jump at answering dehydration, however these are all potential side effects. Laxatives very rarely cause serious side-effects. Common side-effects include wind (flatulence), cramps, diarrhoea, feeling sick, and bloating. Most of the side-effects can be avoided or reduced by starting off on a low dose and increasing the dose of oral laxatives gradually.

Bulk-forming laxatives - patients may notice an increase in flatulence and abdominal bloating. This is normal and tends to settle down after a few weeks as the gut becomes used to the increase in fibre (or bulk-forming laxative). Occasionally, bulk-forming laxatives can make symptoms worse if the patient has very severe constipation. This is because they may cause abdominal bloating and discomfort without doing much to clear a lot of stools (faeces) which are stuck further down the gut.

After tolerance to asthma-inducing effects of aspirin has been increased following repetitive dosing (desensitization), other cross-reactive drugs are not as likely to cause asthma either. This effect is cross-tolerance. Another example of cross-tolerance is seen among sedative hypnotics. He an increased tolerance to diazepam, for example, may also be seen for other sedative hypnotics.

The correct answer is: benztropine

The correct answer is: Chloramphenicol

The correct answer is: Sulfasalazine

The correct answer is: Miosis

The correct answer is: You may feel drowsy with this medication and if affected you should avoid driving or using machinery.

The correct answer is: Phenytoin

The correct answer is: physostigmine