Archive Of Standardized Exam Questions: Anticholinergic Toxicity


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


Question # 1

A 48 year old man is brought to the emergency department with in a confused state. He is disoriented, somnolent, difficult to rouse, and also has a fever. A friend who is with the patient explains that he has a long psychiatric history and has attempted to overdose on prescribed medications in the past. On physical exam his skin is markedly flushed, oral mucosa is dry, and both pupils are dilated and poorly reactive to light. Bowel sounds are diminished. Which of the following types of drug intoxication likely explains this patient’s symptoms?

Question # 2

A homeless 25 year old man who is being treated with antipsychotics and anitparkinsonian drugs comes to the emergency room because he feels very anxious and is having trouble urinating. He is very active, and does not know where he is or what time it is. He has difficulty on focusing during the interview. Physical exam reveals a dry mouth, flushed skin, and tachycardia when the patient is siting at rest. There is no evidence of increased muscle tone or rigidity. What is the most likely diagnosis?

Question # 3

A 45-year-old man is diagnosed with a psychotic depression and is treated with both imipramine and perphenazine. When he develops acute dystonia as a result of his new antipsychotic medication, he is treated with benztropine. One week later, his son reports that the patient has become very forgetful and seems disoriented at nighttime. Physical exam shows  flushed dry, skin, and he is tachycardic. He knows his name and where he is, but is not oriented to the date. All of these symptoms are new compared to his previous appointment. Which of the following is the most likely diagnosis?

Explanation: Imipramine (TCA) and Benztropine both have anticholinergic activity


Page Updated: 09.14.2016