100+ Free ABP Med Toxicology Practice Questions

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A 17-year-old presents with hyperthermia (40.1°C), dry mucous membranes, dilated pupils, urinary retention, flushed skin, and confusion after a suspected ingestion. Which toxidrome is MOST consistent with this presentation?

Sympathomimetic

Anticholinergic

Cholinergic

Serotonin syndrome

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Key Facts: ABP Med Toxicology Exam

1992

Tri-Board Subspecialty Established

Co-sponsored by ABEM, ABPM, ABP since 1992

8 hr

1-Day CBT Length

Approximate testing time at Pearson VUE

2 yr

Required Fellowship

ACGME-accredited Medical Toxicology fellowship

~$2,200

Registration Fee

ABP subspecialty fee schedule (annual updates)

10 yr

MOC Cycle

Plus annual MOCA-Peds for ABP diplomates

≥3.5

Pediatric BLL Reference (mcg/dL)

CDC reference value, lowered October 2021

ABP Medical Toxicology is the pediatric path to the tri-board (ABP/ABEM/ABPM) Medical Toxicology subspecialty established in 1992. The 1-day, ~8-hour CBT covers General Toxicology Approach 15%, Acetaminophen/Salicylates/Iron 15%, CV Toxins 10%, CNS Toxins 15%, Toxic Alcohols 10%, Heavy Metals 10%, Envenomations 10%, Environmental & Industrial 10%, and Pediatric-Specific 5%. Eligibility requires ABP Pediatrics + 2 years of ACGME Medical Toxicology fellowship. The fee is approximately $2,200 and certification is maintained on a 10-year MOC cycle with MOCA-Peds.

Sample ABP Med Toxicology Practice Questions

Try these sample questions to test your ABP Med Toxicology exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 17-year-old presents with hyperthermia (40.1°C), dry mucous membranes, dilated pupils, urinary retention, flushed skin, and confusion after a suspected ingestion. Which toxidrome is MOST consistent with this presentation?

A.Sympathomimetic

B.Anticholinergic

C.Cholinergic

D.Serotonin syndrome

Explanation: The classic anticholinergic toxidrome is summarized by 'hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter, full as a flask.' Hyperthermia, dry mucous membranes, mydriasis, flushed skin, urinary retention, and altered mental status describe muscarinic blockade. Common agents include diphenhydramine, TCAs, jimson weed (Datura), and atropine.

2A farm worker presents with miosis, profuse salivation, lacrimation, urinary incontinence, diarrhea, vomiting, bronchospasm, bronchorrhea, and bradycardia. After airway management, which combination is FIRST-line therapy?

A.Physostigmine and benzodiazepines

B.Atropine and pralidoxime (2-PAM)

C.Naloxone and supportive care

D.Hydroxocobalamin and sodium thiosulfate

Explanation: This is the cholinergic (SLUDGE/DUMBELS plus killer Bs) toxidrome from organophosphate poisoning. Atropine is titrated to dry pulmonary secretions (the kill marker, not pupil size or heart rate), and pralidoxime (2-PAM) regenerates acetylcholinesterase before aging. Aging time is agent-specific: ~2 minutes (soman), ~5 hours (sarin), ~48 hours (VX).

3Which feature BEST distinguishes serotonin syndrome from neuroleptic malignant syndrome (NMS)?

A.Hyperthermia

B.Altered mental status

C.Lower-extremity clonus and hyperreflexia greater than upper extremity

D.Autonomic instability

Explanation: Both syndromes feature hyperthermia, altered mental status, and autonomic instability, but only serotonin syndrome characteristically shows clonus (especially inducible/spontaneous in the lower extremities) and hyperreflexia LE > UE. NMS is defined by lead-pipe rigidity from D2 antagonism, evolves over days, and lacks clonus.

4A 4-year-old ingested an unknown amount of an unknown substance approximately 30 minutes ago. He is awake and alert with normal vitals and a protected airway. Which decontamination intervention is CONTRAINDICATED if the substance turns out to be a hydrocarbon?

A.Activated charcoal

B.Whole bowel irrigation with PEG

C.Observation

D.Skin decontamination

Explanation: Activated charcoal does not bind hydrocarbons, caustics, alcohols, lithium, iron, or potassium. Worse, hydrocarbon ingestion increases aspiration risk; inducing emesis or administering charcoal raises pneumonitis risk substantially. Supportive care and observation are preferred.

5Which mnemonic best captures the indications for hemodialysis in poisonings?

A.MUDPILES

B.STUMBLED (Salicylates, Theophylline, Uremia, Methanol, Barbiturates, Lithium, Ethylene Glycol, Dabigatran/others)

C.DUMBELS

D.SLUDGE

Explanation: STUMBLED is a useful memory aid for dialyzable toxins: Salicylates, Theophylline, Uremia, Methanol, Barbiturates, Lithium, Ethylene Glycol, and Dabigatran/other newer indications. All are small-molecular-weight, low-protein-bound, water-soluble agents amenable to extracorporeal removal.

6Per the AAP 2003 policy statement, syrup of ipecac is:

A.First-line for any acute pediatric ingestion within 30 minutes

B.Recommended only when activated charcoal is contraindicated

C.Not recommended for routine home or hospital use

D.Recommended for caustic ingestions

Explanation: The American Academy of Pediatrics formally recommended against routine ipecac use in 2003. Evidence demonstrated no improvement in clinical outcomes and substantial risks (delay to charcoal, prolonged emesis, aspiration). Most pediatric ingestions are managed by Poison Control consultation, observation, and selective decontamination.

7A 16-year-old is brought in confused, with bilateral pupillary constriction and a respiratory rate of 6/min. He responds only to sternal rub. Which intervention is the appropriate empiric antidote?

A.Flumazenil 0.2 mg IV

B.Naloxone 0.04-0.1 mg/kg IV/IN

C.Physostigmine 0.02 mg/kg IV

D.Activated charcoal 1 g/kg PO

Explanation: Pinpoint pupils, depressed level of consciousness, and respiratory depression define the opioid toxidrome. Naloxone is the antidote, titrated to restore adequate respirations — not full arousal — to avoid acute withdrawal. Pediatric dose is 0.04-0.1 mg/kg IV, IN, or IM (typical max 2 mg per dose); repeat as needed because half-life is shorter than most opioids.

8A toddler ingested an unknown substance 45 minutes ago. He is awake with stable vitals. Which ingestion would NOT benefit from activated charcoal?

A.Carbamazepine sustained-release

B.Diphenhydramine

C.Iron pediatric multivitamin

D.Theophylline

Explanation: Activated charcoal does not bind iron salts, alcohols, caustics, hydrocarbons, lithium, or potassium. For iron ingestion, whole bowel irrigation with polyethylene glycol is preferred for radiopaque tablets seen on KUB, and deferoxamine chelation is used for systemic toxicity (>500 mcg/dL or symptomatic).

9A teenager presents with HR 165, BP 188/110, dilated pupils, diaphoresis, and severe agitation. She admits to insufflating cocaine. Beta-blocker monotherapy is contraindicated because of which mechanism?

A.It causes hyperkalemia in this setting

B.Unopposed alpha-adrenergic vasoconstriction worsening hypertension and coronary spasm

C.It precipitates acute pulmonary edema

D.It causes paradoxical bradycardia and asystole

Explanation: In sympathomimetic toxicity (cocaine, amphetamines), beta-blocker monotherapy blocks beta-2 vasodilation, leaving alpha-1 vasoconstriction unopposed. This worsens hypertension and can precipitate coronary vasospasm and end-organ ischemia. Benzodiazepines are first-line for tachycardia, agitation, and hypertension; mixed alpha/beta blockade (labetalol, phentolamine) may be considered.

10Whole bowel irrigation with polyethylene glycol (PEG) is MOST appropriate for which scenario?

A.Symptomatic acetaminophen ingestion 2 hours prior

B.Body packer with intact cocaine packets in the GI tract

C.Aspiration risk with caustic ingestion

D.Unconscious patient with unprotected airway

Explanation: WBI is indicated for substances poorly bound by charcoal (iron, lithium, body packers, sustained-release tablets). It mechanically flushes the GI tract using high-volume PEG-electrolyte solution (15-25 mL/kg/hr in children). Endpoints are clear rectal effluent or radiographic clearance.

About the ABP Med Toxicology Exam

Medical Toxicology has been co-sponsored by ABEM, ABPM, and ABP since 1992 and is issued by the candidate's primary board. For pediatric diplomates, the American Board of Pediatrics issues the Medical Toxicology subspecialty certificate. The exam is a 1-day computer-based test of approximately 8 hours and assesses expert-level knowledge of poisoning, envenomation, drug overdose, environmental and occupational toxins, and pediatric-specific exposures. Eligibility requires ABP General Pediatrics certification followed by completion of a 2-year ACGME-accredited Medical Toxicology fellowship. Maintenance involves a 10-year MOC cycle plus annual MOCA-Peds activity.

Questions

100 scored questions

Time Limit

8 hours (CBT)

Passing Score

Scaled by ABP

Exam Fee

~$2,200 (American Board of Pediatrics (ABP))

ABP Med Toxicology Exam Content Outline

15%

General Toxicology Approach

Initial assessment (ABCs, history, exam, labs), toxidromes (sympathomimetic, anticholinergic, cholinergic SLUDGE/DUMBELS, opioid, sedative-hypnotic, serotonin syndrome, NMS), decontamination (activated charcoal within 1-2 h; not for caustics, hydrocarbons, alcohols, lithium, iron, K), whole bowel irrigation (PEG for body packers, sustained-release, iron, lithium), gastric lavage (rare), AAP 2003 against syrup of ipecac, hemodialysis indications (STUMBLED), antidote pharmacology.

15%

Acetaminophen, Salicylates, and Iron

Acetaminophen: NAPQI mechanism, Rumack-Matthew nomogram (4-h ≥150 mcg/mL), 21-h IV NAC (150-50-100 mg/kg) or 72-h PO, late presentation criteria (>7.5 g, unknown timing, repeated supratherapeutic), King's College criteria, INH/alcohol risk modifiers. Salicylates: tinnitus, mixed respiratory alkalosis + AGMA, urinary alkalinization with bicarbonate (pH 7.5-8), hemodialysis if >100 mg/dL acute, intubation hazards. Iron: ≥40 mg/kg elemental significant, vin-rosé urine, deferoxamine, 5-stage clinical course, WBI for radiopaque tablets.

10%

Cardiovascular Toxins

Beta-blocker overdose (bradycardia + hypoglycemia + CNS depression — glucagon, HIET, ILE, pacing, ECMO). Calcium-channel blocker overdose (verapamil/diltiazem with hyperglycemia — calcium, HIET, vasopressors, ILE, ECMO). Digoxin (hyperkalemia in acute, Fab fragments / DigiFab; calcium controversial). TCA (anticholinergic + alpha-block + Na-channel block — sodium bicarbonate for QRS >100 ms, R wave in aVR). Clonidine (opioid-mimic, atropine, naloxone partial), antiarrhythmics, sympathomimetic-related ischemia.

15%

CNS Toxins

Anticholinergics (diphenhydramine, TCAs, jimson weed, atropine — physostigmine selectively). Sedative-hypnotics (benzodiazepines, barbiturates — flumazenil cautions). Opioids (heroin, fentanyl analogs — naloxone titration to ventilation; pediatric infusions). Stimulants (cocaine, amphetamines, MDMA, bath salts) — benzodiazepines first; avoid beta-blocker monotherapy. Hallucinogens (LSD, psilocybin, PCP). Cannabis edibles. Antidepressants (serotonin syndrome — cyproheptadine). INH-induced refractory seizures (pyridoxine).

10%

Toxic Alcohols

Methanol (windshield washer fluid → formate → blindness, putamen necrosis). Ethylene glycol (antifreeze → glycolic/oxalic acid → AKI with calcium oxalate crystalluria; fluorescein under Wood's lamp). Isopropanol (rubbing alcohol → ketosis without anion gap acidosis, fruity breath). Antidotes: fomepizole (4-MP) blocks ADH, ethanol alternative. Adjuncts: folate/folinic acid (methanol), pyridoxine + thiamine (ethylene glycol). Hemodialysis for severe acidosis, end-organ injury, high level. Osmolal gap utility.

10%

Heavy Metals

Lead — succimer (DMSA, oral) for pediatric BLL ≥45 mcg/dL; CaNa2EDTA + dimercaprol (BAL) for severe encephalopathy or BLL >70-100 mcg/dL; CDC reference value lowered to ≥3.5 mcg/dL (2021); microcytic anemia with basophilic stippling, ZPP. Mercury — DMSA for inorganic; supportive for elemental vapor (acrodynia, erethism); methylmercury fish-chain neurodevelopmental injury (Minamata). Arsenic — BAL or DMSA, Mees lines, peripheral neuropathy. Cadmium, manganese.

10%

Envenomations

Crotalidae (rattlesnakes, copperheads, water moccasins) → CroFab/Anavip (4-6 vials initial; 2 vials q6h x 3 maintenance; pediatric=adult dose). Coral snake (Micrurus, 'red on yellow') → North American Coral Snake Antivenom (limited supply) or Coralmyn; descending paralysis. Black widow (Latrodectus) → opioids + benzodiazepines, antivenom for severe. Brown recluse (Loxosceles) — supportive, dapsone controversial. Scorpion (Centruroides) → Anascorp (FDA 2011). Marine: stingray (hot water 113°F, Vibrio antibiotics), jellyfish (vinegar for box jellyfish).

10%

Environmental & Industrial

Carbon monoxide (cherry red late, falsely normal pulse oximetry, co-oximetry; 100% O2; HBO if COHb >25%, LOC, neuro symptoms, ECG ischemia, pregnancy >15%). Cyanide (house fires, bitter almond) — hydroxocobalamin (Cyanokit) preferred over nitrite-based kit when concurrent CO. Methemoglobinemia (cyanosis refractory to O2, chocolate blood — methylene blue). Hydrogen sulfide ('rotten egg', knock-down). Organophosphates/carbamates (SLUDGE/DUMBELS — atropine + pralidoxime; aging time by agent). Caustics (NaOH, HCl). Hydrocarbons (no charcoal, no ipecac).

Pediatric-Specific Exposures

Single-use detergent pods (Tide Pods — caustic, prolonged emesis, CNS/respiratory injury). Button batteries (esophageal lodgement = emergent endoscopy <2 h; honey 10 mL q10 min en route in children >12 mo; observe past pylorus if asymptomatic and <20 mm). Rare-earth (Buckyball) magnets — surgical removal if multiple. Hand sanitizer (FDA 2020 recall — methanol contamination). Cannabis edibles. Pediatric fentanyl exposures (secondary contamination, counterfeit pills) — naloxone with anticipated repeat dosing/infusion.

How to Pass the ABP Med Toxicology Exam

What You Need to Know

Passing score: Scaled by ABP
Exam length: 100 questions
Time limit: 8 hours (CBT)
Exam fee: ~$2,200

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABP Med Toxicology Study Tips from Top Performers

1Master the toxidromes cold: Sympathomimetic (HTN, tachycardia, mydriasis, DIAPHORETIC, agitated — cocaine/amphetamines/MDMA), Anticholinergic ('hot, dry, red, blind, mad, full' — diphenhydramine/TCAs/jimson weed/atropine), Cholinergic (SLUDGE/DUMBELS — organophosphates/carbamates), Opioid (CNS depression + miosis + respiratory depression), Sedative-hypnotic (CNS depression with NORMAL pupils and vitals), Serotonin syndrome (HARM — clonus LE>UE; SSRI + MAOI/tramadol/triptan/linezolid), and NMS (lead-pipe rigidity + hyperthermia + autonomic instability from D2 antagonism). The skin (wet vs dry) is the highest-yield discriminator between sympathomimetic and anticholinergic.

2Memorize the decontamination decision rules: activated charcoal 1 g/kg within 1-2 h works for MOST agents but NOT caustics, hydrocarbons, alcohols, lithium, iron, or potassium. Whole bowel irrigation (PEG-electrolyte) is for body packers, sustained-release, iron, and lithium. Gastric lavage is reserved for life-threatening ingestion within 1 h with no alternative. Syrup of ipecac is NOT recommended (AAP 2003). Hemodialysis indications follow STUMBLED: Salicylates, Theophylline, Uremia, Methanol, Barbiturates, Lithium, Ethylene glycol, Dabigatran/others.

3Acetaminophen exam pearls: Rumack-Matthew nomogram applies ONLY to single acute ingestions; the 4-h treatment line is 150 mcg/mL. NAC works best within 8-10 hours but is given even late if hepatotoxicity is present. The 21-h IV NAC protocol is 150-50-100 mg/kg. Predisposing factors include chronic alcohol use, INH therapy, malnutrition (depleted glutathione). Salicylates: alkalinize urine to pH 7.5-8 (maintain K+ >4); intubation is HAZARDOUS because hyperventilation is protective. Iron: ≥40 mg/kg elemental is significant; deferoxamine produces vin-rosé urine.

4Toxic alcohols: think osmolal gap early, anion gap late. Methanol → blindness, putamen necrosis (formate); add folate/folinic acid. Ethylene glycol → calcium oxalate crystals + AKI; add pyridoxine + thiamine. Isopropanol → ketosis WITHOUT anion gap acidosis. Fomepizole (4-MP) is preferred over ethanol as ADH inhibitor. Hemodialysis indicated for severe acidosis (pH <7.25), end-organ injury, hemodynamic instability, high level. Lead: CDC reference value ≥3.5 mcg/dL (2021); chelate at ≥45 with succimer (DMSA); BAL+EDTA for encephalopathy or BLL >70-100.

5Pediatric-specific exposures: button battery in esophagus = emergent endoscopy within 2 hours (honey 10 mL q10 min in children >12 mo en route per 2018 NASPGHAN); past pylorus and asymptomatic <20 mm batteries can be observed. Multiple rare-earth magnets = surgical/endoscopic removal. Detergent pods = aggressive supportive care; can require intubation. Hand sanitizer recall (FDA 2020) — suspect methanol with anion gap acidosis. Pediatric fentanyl exposures from counterfeit pills/secondary contamination are rising — anticipate repeat naloxone dosing or infusion (start at 2/3 of effective bolus per hour).

Frequently Asked Questions

What is the ABP Medical Toxicology subspecialty?

Medical Toxicology has been co-sponsored by the American Board of Emergency Medicine (ABEM), American Board of Preventive Medicine (ABPM), and American Board of Pediatrics (ABP) since 1992. Pediatric diplomates earn the credential through the ABP after completing General Pediatrics certification and a 2-year ACGME-accredited Medical Toxicology fellowship. The subspecialty addresses poisoning, envenomation, drug overdose, environmental and occupational toxins, drug-induced illness, and chemical/biological warfare agents.

Who is eligible for the ABP Medical Toxicology examination?

Candidates must hold current ABP certification in General Pediatrics (in good standing) and complete 2 years of full-time ACGME-accredited Medical Toxicology fellowship. Program directors attest to satisfactory completion. A valid unrestricted medical license is required. Equivalent international training pathways may be considered case-by-case by the ABP Credentials Committee.

What is the format of the ABP Medical Toxicology exam?

The Medical Toxicology subspecialty examination is a 1-day computer-based test of approximately 8 hours, delivered at Pearson VUE testing centers. Items are single-best-answer multiple-choice, predominantly case-based, drawn from a tri-board content outline that emphasizes general approach, principal toxin classes (analgesics, cardiovascular, CNS, alcohols, metals), envenomations, environmental/industrial agents, and pediatric exposures.

How much does the ABP Medical Toxicology exam cost?

The current registration fee is approximately $2,200 for the standard window (the ABP publishes updated subspecialty fees annually; late registration adds a fee). Withdrawal and refund policies follow ABP subspecialty rules. Continuous Certification (MOC) requires an annual fee after initial certification.

How is the exam scored and how are results released?

ABP uses criterion-referenced scaled scoring set by content-expert standard-setting panels. Tri-board scoring uses a common item bank but each board issues its own certificate. Results are typically posted to the ABP candidate portal within 10-12 weeks of test administration. First-time pass rates are reported periodically by each board.

How is ABP Medical Toxicology certification maintained?

Pediatric diplomates maintain certification through ABP MOC: a 10-year recertification cycle PLUS annual MOCA-Peds (formative knowledge assessment) and Part 4 quality improvement activities. Annual fees apply. Continuous Certification has largely replaced the secure 10-year recertification examination for many ABP credentials.