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Metabolic dysfunction-associated steatotic liver disease — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareMetabolic dysfunction-associated steatotic liver diseaseUSMLE Step 3

A farm worker is brought in after pesticide exposure with diaphoresis, vomiting, pinpoint pupils, wheezing, copious bronchial secretions, bradycardia, and fasciculations. Clothing is removed and decontamination begins. Which medication strategy is most appropriate?

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Correct answer: B — Titrate atropine to clear bronchial secretions and administer pralidoxime early

The best answer is “Titrate atropine to clear bronchial secretions and administer pralidoxime early”. Atropine is rapidly repeated and escalated to the clinical endpoint of drying bronchial secretions and improving oxygenation and ventilation, not normalization of pupils or heart rate. Pralidoxime is added early to reactivate acetylcholinesterase before aging and helps nicotinic weakness. Physostigmine intensifies toxicity, and epinephrine does not reverse the cholinergic syndrome.

Reference: ATSDR Medical Management Guideline: Parathion: https://wwwn.cdc.gov/TSP/MMG/MMGDetails.aspx?mmgid=1140&toxid=246