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Toxic acetaminophen ingestion — USMLE Step 2 CK MCQ

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EasyEmergency MedicineToxic acetaminophen ingestionUSMLE Step 2 CK

A 39-year-old Native American woman comes to the emergency department because of progressive symptoms. History and focused examination are notable for nausea after overdose with elevated acetaminophen level on nomogram. Temperature is 98.6°F (37.0°C), blood pressure is 126/78 mmHg, pulse is 84/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Focused laboratory studies and initial testing support the clinical pattern described in the stem. Which of the following is the most appropriate next step in management?

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Correct answer: B — N-acetylcysteine

The vignette describes Toxic acetaminophen ingestion, supported by nausea after overdose with elevated acetaminophen level on nomogram. N-acetylcysteine is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: American College of Medical Toxicology Guidance