Archive Of Standardized Exam Questions: Acetaminophen Poisoning


This page is dedicated to organizing various examples of standardized exam questions whose answer is acetaminophen poisoning. While this may seem a odd practice, it is useful to see multiple examples of how acetaminophen poisoning will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a traditional question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a topic is quite valuable.


When it comes to standardized exams, each topic has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for acetaminophen poisoning

  • History of acetaminophen usage: especially in excess.
  • Elevated liver enzymes: sometimes can be VERY high. Anyone with any LFTs > 1000 very likely could have acetaminophen poisoning.

Question # 1

A 50 year old male with a 8 year history of alcoholism comes to the clinic because he has noticed a change in his skin color. He has had a been taking 4-6 tablets every day of over the counter pain medication for a severe headache during this past week. A physical exam reveals jaundice. Lab analysis demonstrate an AST over 1000. What is the likely diagnosis in this patient?

Explanation # 1

Excessive acetaminophen usage + AST > 1000 =  acetaminophen poisoning

Question # 2


Explanation # 2



Many questions on standardized exams go beyond simply recognizing the underlying topic. Often there are specific testable facts regarding some aspect of the topic’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:

  • Consequence of toxicity: depletes glutathione and forms toxic tissue byproducts in the liver (leading to hepatic necrosis)
  • What does glutathione do: glutathione peroxidase important scavenging enzyme to help protect tissues gains free radical injury (coverts H202 to H20)
  • Treatment: N-acetylcysteine (replenishes glutathione)



Page Updated: 04.19.2017