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Question 1
Correct
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A 25-year-old woman presents with an anaphylactic reaction after consuming a peanut. What is the MOST suitable initial step in her management?
Your Answer: Administer IM adrenaline
Explanation:When dealing with an anaphylactic reaction, it is important to remove the trigger if it is easily accessible. However, it is not realistic to try and remove a peanut that has already been swallowed, and it is advised against attempting to induce vomiting in the patient.
In cases where an anaphylactic reaction has been confirmed, it is crucial to administer 500 micrograms of adrenaline immediately.
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This question is part of the following fields:
- Allergy
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Question 2
Incorrect
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A 32-year-old male presents to the emergency department with complaints of increasing lip swelling that began 30 minutes ago. Upon reviewing his medical history, it is noted that he has a previous diagnosis of hereditary angioedema (HAE) and that his primary care physician recently prescribed him a new medication. The following vital signs have been documented:
Blood pressure: 122/78 mmHg
Pulse rate: 88 bpm
Respiration rate: 15
Temperature: 37.4 oC
During episodes of acute hereditary angioedema, which systems are most commonly affected?Your Answer: Respiratory, cardiac and muscular systems
Correct Answer: Respiratory, gastrointestinal and integumentary systems
Explanation:Hereditary angioedema (HAE) mainly affects the respiratory, gastrointestinal, and integumentary systems. This condition primarily impacts the respiratory system, gastrointestinal system, and the skin.
Further Reading:
Angioedema and urticaria are related conditions that involve swelling in different layers of tissue. Angioedema refers to swelling in the deeper layers of tissue, such as the lips and eyelids, while urticaria, also known as hives, refers to swelling in the epidermal skin layers, resulting in raised red areas of skin with itching. These conditions often coexist and may have a common underlying cause.Angioedema can be classified into allergic and non-allergic types. Allergic angioedema is the most common type and is usually triggered by an allergic reaction, such as to certain medications like penicillins and NSAIDs. Non-allergic angioedema has multiple subtypes and can be caused by factors such as certain medications, including ACE inhibitors, or underlying conditions like hereditary angioedema (HAE) or acquired angioedema.
HAE is an autosomal dominant disease characterized by a deficiency of C1 esterase inhibitor. It typically presents in childhood and can be inherited or acquired as a result of certain disorders like lymphoma or systemic lupus erythematosus. Acquired angioedema may have similar clinical features to HAE but is caused by acquired deficiencies of C1 esterase inhibitor due to autoimmune or lymphoproliferative disorders.
The management of urticaria and allergic angioedema focuses on ensuring the airway remains open and addressing any identifiable triggers. In mild cases without airway compromise, patients may be advised that symptoms will resolve without treatment. Non-sedating antihistamines can be used for up to 6 weeks to relieve symptoms. Severe cases of urticaria may require systemic corticosteroids in addition to antihistamines. In moderate to severe attacks of allergic angioedema, intramuscular epinephrine may be considered.
The management of HAE involves treating the underlying deficiency of C1 esterase inhibitor. This can be done through the administration of C1 esterase inhibitor, bradykinin receptor antagonists, or fresh frozen plasma transfusion, which contains C1 inhibitor.
In summary, angioedema and urticaria are related conditions involving swelling in different layers of tissue. They can coexist and may have a common underlying cause. Management involves addressing triggers, using antihistamines, and in severe cases, systemic corticosteroids or other specific treatments for HAE.
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This question is part of the following fields:
- Allergy
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Question 3
Correct
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A 32-year-old male presents to the emergency department with complaints of increasing lip swelling that began 30 minutes ago. Upon reviewing his medical history, you discover a previous diagnosis of hereditary angioedema (HAE) and that his primary care physician recently prescribed him a new medication. The following vital signs have been documented:
Blood pressure: 122/78 mmHg
Pulse rate: 88 bpm
Respiration rate: 15
Temperature: 37.4 oC
Which class of drugs is specifically contraindicated in this condition?Your Answer: ACE inhibitors
Explanation:ACE inhibitors should not be used in individuals with HAE because they can enhance the effects of bradykinin. This can lead to drug-induced angioedema, which is a known side effect of ACE inhibitors. In individuals with HAE, ACE inhibitors can trigger attacks of angioedema.
Further Reading:
Angioedema and urticaria are related conditions that involve swelling in different layers of tissue. Angioedema refers to swelling in the deeper layers of tissue, such as the lips and eyelids, while urticaria, also known as hives, refers to swelling in the epidermal skin layers, resulting in raised red areas of skin with itching. These conditions often coexist and may have a common underlying cause.
Angioedema can be classified into allergic and non-allergic types. Allergic angioedema is the most common type and is usually triggered by an allergic reaction, such as to certain medications like penicillins and NSAIDs. Non-allergic angioedema has multiple subtypes and can be caused by factors such as certain medications, including ACE inhibitors, or underlying conditions like hereditary angioedema (HAE) or acquired angioedema.
HAE is an autosomal dominant disease characterized by a deficiency of C1 esterase inhibitor. It typically presents in childhood and can be inherited or acquired as a result of certain disorders like lymphoma or systemic lupus erythematosus. Acquired angioedema may have similar clinical features to HAE but is caused by acquired deficiencies of C1 esterase inhibitor due to autoimmune or lymphoproliferative disorders.
The management of urticaria and allergic angioedema focuses on ensuring the airway remains open and addressing any identifiable triggers. In mild cases without airway compromise, patients may be advised that symptoms will resolve without treatment. Non-sedating antihistamines can be used for up to 6 weeks to relieve symptoms. Severe cases of urticaria may require systemic corticosteroids in addition to antihistamines. In moderate to severe attacks of allergic angioedema, intramuscular epinephrine may be considered.
The management of HAE involves treating the underlying deficiency of C1 esterase inhibitor. This can be done through the administration of C1 esterase inhibitor, bradykinin receptor antagonists, or fresh frozen plasma transfusion, which contains C1 inhibitor.
In summary, angioedema and urticaria are related conditions involving swelling in different layers of tissue. They can coexist and may have a common underlying cause. Management involves addressing triggers, using antihistamines, and in severe cases, systemic corticosteroids or other specific treatments for HAE.
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This question is part of the following fields:
- Allergy
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Question 4
Incorrect
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A 7-year-old boy is brought in to see you by his father following an incident where he developed a rash, wheeze, and abdominal pain after accidentally eating a peanut. He has a known history of peanut allergy and carries an EpiPen junior with him at all times. His father administered the EpiPen junior, and the child now feels fine, but his father would like you to examine him.
What is the total amount of adrenaline administered in a single dose by an EpiPen junior?Your Answer: 0.5 mg
Correct Answer: 0.15 mg
Explanation:An EpiPen is a device that automatically injects adrenaline and is used to treat anaphylaxis. It is often given to individuals who are at risk of experiencing anaphylaxis so that they can administer it themselves if needed.
It is important for healthcare professionals to be familiar with the various auto-injector devices that are commonly available. In the event that an adrenaline auto-injector is the only option for treating anaphylaxis, healthcare professionals should not hesitate to use it.
Each EpiPen auto-injector contains a single dose of 0.3 mg of adrenaline. For children, there is also a version called EpiPen Jr that contains a single dose of 0.15 mg of adrenaline.
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This question is part of the following fields:
- Allergy
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Question 5
Incorrect
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A 35-year-old man comes in with swelling of his face, particularly his upper lip, and his hands. He has a confirmed diagnosis of hereditary angioedema.
Which of the following statements about hereditary angioedema is correct?Your Answer: It is caused by a deficiency of C1 esterase
Correct Answer: Long-term prophylaxis can be achieved with tranexamic acid
Explanation:Hereditary angioedema is a condition caused by a lack of C1 esterase inhibitor, a protein that is part of the complement system. It is typically inherited in an autosomal dominant manner. Symptoms usually start in childhood and continue sporadically into adulthood. Attacks can be triggered by minor surgical procedures, dental work, and stress. The main clinical signs of hereditary angioedema include swelling of the skin and mucous membranes, with the face, tongue, and extremities being the most commonly affected areas. There is often a tingling sensation before an attack, sometimes accompanied by a non-itchy rash.
Angioedema and anaphylaxis resulting from C1 esterase inhibitor deficiency do not respond to adrenaline, steroids, or antihistamines. Treatment requires the use of C1 esterase inhibitor concentrate or fresh frozen plasma, both of which contain C1 esterase inhibitor. In situations that may trigger an attack, short-term prophylaxis can be achieved by administering C1 esterase inhibitor or fresh frozen plasma infusions prior to the event. For long-term prevention, androgenic steroids like stanozolol or antifibrinolytic drugs such as tranexamic acid can be used.
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This question is part of the following fields:
- Allergy
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Question 6
Incorrect
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A 7-year-old child experiences an anaphylactic reaction after being stung by a bee. How much IM adrenaline should be administered in this situation?
Your Answer:
Correct Answer: 300 mcg
Explanation:The management of anaphylaxis involves several important steps. First and foremost, it is crucial to ensure proper airway management. Additionally, early administration of adrenaline is essential, preferably in the anterolateral aspect of the middle third of the thigh. Aggressive fluid resuscitation is also necessary. In severe cases, intubation may be required. However, it is important to note that the administration of chlorpheniramine and hydrocortisone should only be considered after early resuscitation has taken place.
Adrenaline is the most vital medication for treating anaphylactic reactions. It acts as an alpha-adrenergic receptor agonist, which helps reverse peripheral vasodilatation and reduce oedema. Furthermore, its beta-adrenergic effects aid in dilating the bronchial airways, increasing the force of myocardial contraction, and suppressing histamine and leukotriene release. Administering adrenaline as the first drug is crucial, and the intramuscular (IM) route is generally the most effective for most individuals.
The recommended doses of IM adrenaline for different age groups during anaphylaxis are as follows:
– Children under 6 years: 150 mcg (0.15 mL of 1:1000)
– Children aged 6-12 years: 300 mcg (0.3 mL of 1:1000)
– Children older than 12 years: 500 mcg (0.5 mL of 1:1000)
– Adults: 500 mcg (0.5 mL of 1:1000) -
This question is part of the following fields:
- Allergy
-
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Question 7
Incorrect
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A child has arrived at the Emergency Department with facial swelling and difficulty breathing. The child has been given adrenaline, corticosteroids, and chlorpheniramine and subsequently shows improvement. Your attending physician is uncertain if this was an anaphylactic reaction and suspects it may have been angioedema.
What SINGLE test could confirm a diagnosis of anaphylaxis in this situation?Your Answer:
Correct Answer: Mast cell tryptase
Explanation:The mast cell tryptase test, also known as the tryptase test, is a valuable tool for detecting mast cell activation and confirming the diagnosis of anaphylaxis in cases where there is uncertainty. Tryptase is the primary protein found in mast cells. During anaphylaxis, mast cells release their contents, leading to an increase in blood tryptase levels. Typically, these levels start to rise approximately 30 minutes after symptoms begin, reach their peak at 1-2 hours, and return to normal within 6-8 hours.
For optimal results, it is recommended to collect three timed samples. The first sample should be taken as soon as possible after resuscitation efforts have commenced. The second sample should be obtained 1-2 hours after the onset of symptoms. Lastly, a third sample should be collected at the 24-hour mark to establish a baseline level.
While skin allergy tests, like the patch test, and blood tests for specific IgE can help identify the trigger of an allergic reaction, they alone cannot confirm the occurrence of anaphylaxis. The mast cell tryptase test, on the other hand, provides valuable information in confirming the diagnosis.
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This question is part of the following fields:
- Allergy
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Question 8
Incorrect
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A 45-year-old teacher complains of a red and itchy urticarial rash on her hands that appeared 15 minutes after she wore a pair of latex gloves. What is the most probable cause for the development of this rash?
Your Answer:
Correct Answer: Type I hypersensitivity reaction
Explanation:Type I hypersensitivity reactions are allergic reactions that occur when a person is exposed again to a particular antigen, known as an allergen. These reactions are triggered by IgE and typically happen within 15 to 30 minutes after exposure to the allergen.
A rapid onset of an urticarial rash, which occurs shortly after being exposed to an allergen (such as latex), is highly likely to be caused by a type I hypersensitivity reaction.
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This question is part of the following fields:
- Allergy
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Question 9
Incorrect
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A child with a known history of latex allergy arrives at the Emergency Department with a severe allergic reaction caused by accidental exposure.
Which of the following fruits is this child MOST likely to have an allergy to as well?Your Answer:
Correct Answer: Banana
Explanation:The connection between latex sensitivity and food allergy is commonly known as the latex-fruit syndrome. Foods that have been found to be allergenic in relation to latex are categorized into high, moderate, or low risk groups.
High risk foods include banana, avocado, chestnut, and kiwi fruit.
Moderate risk foods include apple, carrot, celery, melon, papaya, potato, and tomato.
Citrus fruits and pears are considered to have a low risk of causing allergic reactions in individuals with latex sensitivity.
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This question is part of the following fields:
- Allergy
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Question 10
Incorrect
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A 6-year-old child experiences an anaphylactic reaction after being stung by a bee.
What dosage of IV hydrocortisone should be administered in this situation?Your Answer:
Correct Answer: 50 mg
Explanation:Corticosteroids can be beneficial in preventing or reducing prolonged reactions. According to the current APLS guidelines, the recommended doses of hydrocortisone for different age groups are as follows:
– Children under 6 months: 25 mg administered slowly via intramuscular (IM) or intravenous (IV) route.
– Children aged 6 months to 6 years: 50 mg administered slowly via IM or IV route.
– Children aged 6 to 12 years: 100 mg administered slowly via IM or IV route.
– Children over 12 years: 200 mg administered slowly via IM or IV route.
– Adults: 200 mg administered slowly via IM or IV route.It is important to note that the most recent ALS guidelines do not recommend the routine use of corticosteroids for treating anaphylaxis in adults. However, the current APLS guidelines still advocate for the use of corticosteroids in children to manage anaphylaxis.
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This question is part of the following fields:
- Allergy
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Question 11
Incorrect
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A 25 year old female is treated for anaphylaxis and responds well to treatment. You inform the patient that she will need to remain under observation. What is the minimum duration an adult patient should be observed following an episode of anaphylaxis?
Your Answer:
Correct Answer: 6-12 hours
Explanation:According to NICE guidelines, it is recommended that adults and young people aged 16 years or older who receive emergency treatment for suspected anaphylaxis should be observed for a minimum of 6-12 hours from the time symptoms first appear. There are certain situations where a longer observation period of 12 hours is advised. These include cases where the allergen is still being absorbed slowly, the patient required more than 2 doses of adrenaline, there is severe asthma or respiratory compromise, or if the presentation occurs at night or there is difficulty in accessing emergency care.
Further Reading:
Anaphylaxis is a severe and life-threatening hypersensitivity reaction that can have sudden onset and progression. It is characterized by skin or mucosal changes and can lead to life-threatening airway, breathing, or circulatory problems. Anaphylaxis can be allergic or non-allergic in nature.
In allergic anaphylaxis, there is an immediate hypersensitivity reaction where an antigen stimulates the production of IgE antibodies. These antibodies bind to mast cells and basophils. Upon re-exposure to the antigen, the IgE-covered cells release histamine and other inflammatory mediators, causing smooth muscle contraction and vasodilation.
Non-allergic anaphylaxis occurs when mast cells degrade due to a non-immune mediator. The clinical outcome is the same as in allergic anaphylaxis.
The management of anaphylaxis is the same regardless of the cause. Adrenaline is the most important drug and should be administered as soon as possible. The recommended doses for adrenaline vary based on age. Other treatments include high flow oxygen and an IV fluid challenge. Corticosteroids and chlorpheniramine are no longer recommended, while non-sedating antihistamines may be considered as third-line treatment after initial stabilization of airway, breathing, and circulation.
Common causes of anaphylaxis include food (such as nuts, which is the most common cause in children), drugs, and venom (such as wasp stings). Sometimes it can be challenging to determine if a patient had a true episode of anaphylaxis. In such cases, serum tryptase levels may be measured, as they remain elevated for up to 12 hours following an acute episode of anaphylaxis.
The Resuscitation Council (UK) provides guidelines for the management of anaphylaxis, including a visual algorithm that outlines the recommended steps for treatment.
https://www.resus.org.uk/sites/default/files/2021-05/Emergency%20Treatment%20of%20Anaphylaxis%20May%202021_0.pdf -
This question is part of the following fields:
- Allergy
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Question 12
Incorrect
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A 40-year-old man experiences anaphylaxis after being stung by a bee. He is rushed to the resuscitation room for immediate treatment.
Which category of hypersensitivity reaction does anaphylaxis exemplify?Your Answer:
Correct Answer: Type I
Explanation:Anaphylaxis is a type I hypersensitivity reaction, where the body’s response is triggered by the attachment of an antigen to a specific antibody. This attachment then leads to the release of histamine and other mediators, such as leukotrienes, tumor necrosis factor, and various cytokines, from mast cells and basophils. These substances are released when these cells are exposed to the antigen.
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This question is part of the following fields:
- Allergy
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Question 13
Incorrect
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A 30-year-old woman who is 15-weeks pregnant presents with bothersome hives after coming into contact with latex. The itching is extremely intense, and she is asking for something to alleviate the symptoms.
Which of the following antihistamines is the most suitable to prescribe to this patient?Your Answer:
Correct Answer:
Explanation:Urticaria is a common condition that causes a red, raised, itchy rash on the skin and mucous membranes. It can be localized or spread out. Approximately 15% of people will experience urticaria at some point in their lives. There are two forms of urticaria: acute and chronic, with acute being more common.
According to the current guidelines from the National Institute for Health and Care Excellence (NICE), individuals seeking treatment for urticaria should be offered a non-sedating antihistamine from the second-generation category. Examples of second-generation antihistamines include cetirizine, loratadine, fexofenadine, desloratadine, and levocetirizine.
It is no longer recommended to use conventional first-generation antihistamines like promethazine and chlorpheniramine for urticaria. These medications have short-lasting effects and can cause sedation and anticholinergic side effects. They may also interfere with sleep, learning, and performance, as well as interact negatively with alcohol and other medications. In some cases, lethal overdoses have been reported. Terfenadine and astemizole should also be avoided as they can be harmful to the heart when combined with certain drugs like erythromycin and ketoconazole.
It is advisable to avoid antihistamines during pregnancy if possible. There is a lack of systematic studies on their safety during pregnancy. However, if an antihistamine is necessary, chlorpheniramine is the recommended choice. For breastfeeding women, loratadine or cetirizine are preferred options.
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This question is part of the following fields:
- Allergy
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Question 14
Incorrect
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A 6-year-old child experiences an anaphylactic reaction after being stung by a bee.
What is the appropriate dose of IM adrenaline to administer in this situation?Your Answer:
Correct Answer: 150 mcg
Explanation:The management of anaphylaxis involves several important steps. First and foremost, it is crucial to ensure proper airway management. Additionally, early administration of adrenaline is essential, preferably in the anterolateral aspect of the middle third of the thigh. Aggressive fluid resuscitation is also necessary. In severe cases, intubation may be required. However, it is important to note that the administration of chlorpheniramine and hydrocortisone should only be considered after early resuscitation has taken place.
Adrenaline is the most vital medication for treating anaphylactic reactions. It acts as an alpha-adrenergic receptor agonist, which helps reverse peripheral vasodilatation and reduce oedema. Furthermore, its beta-adrenergic effects aid in dilating the bronchial airways, increasing the force of myocardial contraction, and suppressing histamine and leukotriene release. Administering adrenaline as the first drug is crucial, and the intramuscular (IM) route is generally the most effective for most individuals.
The recommended doses of IM adrenaline for different age groups during anaphylaxis are as follows:
– Children under 6 years: 150 mcg (0.15 mL of 1:1000)
– Children aged 6-12 years: 300 mcg (0.3 mL of 1:1000)
– Children older than 12 years: 500 mcg (0.5 mL of 1:1000)
– Adults: 500 mcg (0.5 mL of 1:1000) -
This question is part of the following fields:
- Allergy
-
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Question 15
Incorrect
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The triage nurse contacts you to assess a 25-year-old woman experiencing respiratory distress and potential anaphylaxis. Besides cardio-respiratory disturbances, what other signs or symptoms are included in the essential diagnostic criteria for anaphylaxis?
Your Answer:
Correct Answer: Skin and/or mucosal changes
Explanation:In some cases, the signs of skin or mucosal involvement may be difficult to detect or may not be present at all. The Royal College of Emergency Medicine (RCEM) states that anaphylaxis is likely when three specific criteria are met: the illness has a sudden and rapid onset, there are noticeable changes in the skin or mucosal areas such as flushing, hives, or swelling, and there are severe problems with the airway, breathing, or circulation that pose a life-threatening risk.
Further Reading:
Anaphylaxis is a severe and life-threatening hypersensitivity reaction that can have sudden onset and progression. It is characterized by skin or mucosal changes and can lead to life-threatening airway, breathing, or circulatory problems. Anaphylaxis can be allergic or non-allergic in nature.
In allergic anaphylaxis, there is an immediate hypersensitivity reaction where an antigen stimulates the production of IgE antibodies. These antibodies bind to mast cells and basophils. Upon re-exposure to the antigen, the IgE-covered cells release histamine and other inflammatory mediators, causing smooth muscle contraction and vasodilation.
Non-allergic anaphylaxis occurs when mast cells degrade due to a non-immune mediator. The clinical outcome is the same as in allergic anaphylaxis.
The management of anaphylaxis is the same regardless of the cause. Adrenaline is the most important drug and should be administered as soon as possible. The recommended doses for adrenaline vary based on age. Other treatments include high flow oxygen and an IV fluid challenge. Corticosteroids and chlorpheniramine are no longer recommended, while non-sedating antihistamines may be considered as third-line treatment after initial stabilization of airway, breathing, and circulation.
Common causes of anaphylaxis include food (such as nuts, which is the most common cause in children), drugs, and venom (such as wasp stings). Sometimes it can be challenging to determine if a patient had a true episode of anaphylaxis. In such cases, serum tryptase levels may be measured, as they remain elevated for up to 12 hours following an acute episode of anaphylaxis.
The Resuscitation Council (UK) provides guidelines for the management of anaphylaxis, including a visual algorithm that outlines the recommended steps for treatment.
https://www.resus.org.uk/sites/default/files/2021-05/Emergency%20Treatment%20of%20Anaphylaxis%20May%202021_0.pdf -
This question is part of the following fields:
- Allergy
-
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Question 16
Incorrect
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A middle-aged male patient comes in with wheezing, facial swelling, and low blood pressure after being stung by a bee. You suspect that he is experiencing an anaphylactic reaction.
Which immunoglobulins mediate anaphylaxis?Your Answer:
Correct Answer: IgE
Explanation:Anaphylaxis is a prime example of a type I hypersensitivity reaction. It is mediated by IgE antibodies. The complex formed by IgE and the antigen binds to Fc receptors found on the surface of mast cells. This binding triggers the degranulation of mast cells, leading to the release of histamine, proteoglycans, and serum proteases from their granules. It is important to note that anaphylaxis can only occur after prior exposure to the antigen. During the initial exposure, a sensitization reaction takes place, and it is only upon subsequent exposure to the antigen that anaphylaxis is triggered. The degranulation of mast cells is a result of a significant influx of calcium into these cells.
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This question is part of the following fields:
- Allergy
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Question 17
Incorrect
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A 10-year-old boy is experiencing an anaphylactic reaction after consuming a peanut. What is the appropriate dosage of IM adrenaline to administer in this case?
Your Answer:
Correct Answer: 0.3 mL of 1:1000
Explanation:The management of anaphylaxis involves several important steps. First and foremost, it is crucial to ensure proper airway management. Additionally, early administration of adrenaline is essential, preferably in the anterolateral aspect of the middle third of the thigh. Aggressive fluid resuscitation is also necessary. In severe cases, intubation may be required. However, it is important to note that the administration of chlorpheniramine and hydrocortisone should only be considered after early resuscitation has taken place.
Adrenaline is the most vital medication for treating anaphylactic reactions. It acts as an alpha-adrenergic receptor agonist, which helps reverse peripheral vasodilatation and reduce oedema. Furthermore, its beta-adrenergic effects aid in dilating the bronchial airways, increasing the force of myocardial contraction, and suppressing histamine and leukotriene release. Administering adrenaline as the first drug is crucial, and the intramuscular (IM) route is generally the most effective for most individuals.
The recommended doses of IM adrenaline for different age groups during anaphylaxis are as follows:
– Children under 6 years: 150 mcg (0.15 mL of 1:1000)
– Children aged 6-12 years: 300 mcg (0.3 mL of 1:1000)
– Children older than 12 years: 500 mcg (0.5 mL of 1:1000)
– Adults: 500 mcg (0.5 mL of 1:1000) -
This question is part of the following fields:
- Allergy
-
-
Question 18
Incorrect
-
A 40-year-old teacher presents with a red itchy urticarial rash on her arms 20 minutes after wearing a pair of latex gloves.
Which of the following mediates the allergic reaction in this case?Your Answer:
Correct Answer: IgE
Explanation:Type I hypersensitivity reactions are allergic reactions that occur when a person is exposed again to a particular antigen, known as an allergen. These reactions are triggered by IgE and typically happen within 15 to 30 minutes after exposure to the allergen.
A rapid onset of an urticarial rash, which occurs shortly after being exposed to an allergen (such as latex), is highly likely to be caused by a type I hypersensitivity reaction.
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This question is part of the following fields:
- Allergy
-
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Question 19
Incorrect
-
You assess a 50-year-old woman who has a past medical history of hereditary angioedema. What is the ONE option that can be utilized for the chronic prevention of this condition?
Your Answer:
Correct Answer: Tranexamic acid
Explanation:Hereditary angioedema is a condition caused by a lack of C1 esterase inhibitor, a protein that is part of the complement system. It is typically inherited in an autosomal dominant manner. Symptoms usually start in childhood and continue sporadically into adulthood. Attacks can be triggered by minor surgical procedures, dental work, and stress. The main clinical signs of hereditary angioedema include swelling of the skin and mucous membranes, with the face, tongue, and extremities being the most commonly affected areas. There is often a tingling sensation before an attack, sometimes accompanied by a non-itchy rash.
Angioedema and anaphylaxis resulting from C1 esterase inhibitor deficiency do not respond to adrenaline, steroids, or antihistamines. Treatment requires the use of C1 esterase inhibitor concentrate or fresh frozen plasma, both of which contain C1 esterase inhibitor. In situations that may trigger an attack, short-term prophylaxis can be achieved by administering C1 esterase inhibitor or fresh frozen plasma infusions prior to the event. For long-term prevention, androgenic steroids like stanozolol or antifibrinolytic drugs such as tranexamic acid can be used.
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This question is part of the following fields:
- Allergy
-
-
Question 20
Incorrect
-
A 32 year old male is brought into the emergency department with wheezing and swelling of the lips. The patient's friend informs you that he has a nut allergy. Anaphylaxis is suspected. What is the underlying pathophysiology of anaphylaxis?
Your Answer:
Correct Answer: IgE mediated immediate reaction
Explanation:Anaphylaxis is a severe allergic reaction that is caused by the immune system overreaction to a specific allergen. This reaction is classified as a Type I hypersensitivity reaction, which means it is mediated by the IgE antibodies.
Further Reading:
Anaphylaxis is a severe and life-threatening hypersensitivity reaction that can have sudden onset and progression. It is characterized by skin or mucosal changes and can lead to life-threatening airway, breathing, or circulatory problems. Anaphylaxis can be allergic or non-allergic in nature.
In allergic anaphylaxis, there is an immediate hypersensitivity reaction where an antigen stimulates the production of IgE antibodies. These antibodies bind to mast cells and basophils. Upon re-exposure to the antigen, the IgE-covered cells release histamine and other inflammatory mediators, causing smooth muscle contraction and vasodilation.
Non-allergic anaphylaxis occurs when mast cells degrade due to a non-immune mediator. The clinical outcome is the same as in allergic anaphylaxis.
The management of anaphylaxis is the same regardless of the cause. Adrenaline is the most important drug and should be administered as soon as possible. The recommended doses for adrenaline vary based on age. Other treatments include high flow oxygen and an IV fluid challenge. Corticosteroids and chlorpheniramine are no longer recommended, while non-sedating antihistamines may be considered as third-line treatment after initial stabilization of airway, breathing, and circulation.
Common causes of anaphylaxis include food (such as nuts, which is the most common cause in children), drugs, and venom (such as wasp stings). Sometimes it can be challenging to determine if a patient had a true episode of anaphylaxis. In such cases, serum tryptase levels may be measured, as they remain elevated for up to 12 hours following an acute episode of anaphylaxis.
The Resuscitation Council (UK) provides guidelines for the management of anaphylaxis, including a visual algorithm that outlines the recommended steps for treatment.
https://www.resus.org.uk/sites/default/files/2021-05/Emergency%20Treatment%20of%20Anaphylaxis%20May%202021_0.pdf -
This question is part of the following fields:
- Allergy
-
-
Question 21
Incorrect
-
A 6-year-old child is experiencing an anaphylactic reaction after being stung by a bee. What is the appropriate dosage of IM adrenaline to administer?
Your Answer:
Correct Answer: 0.3 mL of 1:1000
Explanation:The management of anaphylaxis involves several important steps. First and foremost, it is crucial to ensure proper airway management. Additionally, early administration of adrenaline is essential, preferably in the anterolateral aspect of the middle third of the thigh. Aggressive fluid resuscitation is also necessary. In severe cases, intubation may be required. However, it is important to note that the administration of chlorpheniramine and hydrocortisone should only be considered after early resuscitation has taken place.
Adrenaline is the most vital medication for treating anaphylactic reactions. It acts as an alpha-adrenergic receptor agonist, which helps reverse peripheral vasodilatation and reduce oedema. Furthermore, its beta-adrenergic effects aid in dilating the bronchial airways, increasing the force of myocardial contraction, and suppressing histamine and leukotriene release. Administering adrenaline as the first drug is crucial, and the intramuscular (IM) route is generally the most effective for most individuals.
The recommended doses of IM adrenaline for different age groups during anaphylaxis are as follows:
– Children under 6 years: 150 mcg (0.15 mL of 1:1000)
– Children aged 6-12 years: 300 mcg (0.3 mL of 1:1000)
– Children older than 12 years: 500 mcg (0.5 mL of 1:1000)
– Adults: 500 mcg (0.5 mL of 1:1000) -
This question is part of the following fields:
- Allergy
-
-
Question 22
Incorrect
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A 45-year-old doctor in the Emergency Department complains of a red and itchy urticarial rash on her hands that appeared 15 minutes after she wore a pair of latex gloves. What is the most probable cause for the development of this rash?
Your Answer:
Correct Answer: Type I hypersensitivity reaction
Explanation:Type I hypersensitivity reactions, also known as allergic reactions, are triggered when a person is exposed again to a particular antigen, which is referred to as the allergen. These reactions are mediated by IgE and typically manifest within 15 to 30 minutes after exposure to the allergen. One common symptom of a type I hypersensitivity reaction is the rapid onset of a urticarial rash, which occurs shortly after coming into contact with the allergen, such as latex.
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This question is part of the following fields:
- Allergy
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Question 23
Incorrect
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A child with a known history of latex allergy arrives at the Emergency Department with a severe allergic reaction caused by accidental exposure.
Which of the following foods is this child MOST likely to have an allergy to as well?Your Answer:
Correct Answer: Avocado
Explanation:The connection between latex sensitivity and food allergy is commonly known as the latex-fruit syndrome. Foods that have been found to be allergenic in relation to latex are categorized into high, moderate, or low risk groups.
High risk foods include banana, avocado, chestnut, and kiwi fruit.
Moderate risk foods include apple, carrot, celery, melon, papaya, potato, and tomato.
Citrus fruits and pears are considered to have a low risk of causing allergic reactions in individuals with latex sensitivity.
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This question is part of the following fields:
- Allergy
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Question 24
Incorrect
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A 30-year-old man comes in with swelling of his face, particularly his upper lip, and his hands. He has a confirmed diagnosis of hereditary angioedema.
What is the pattern of inheritance for this disorder?Your Answer:
Correct Answer: Autosomal dominant
Explanation:Hereditary angioedema is a condition caused by a lack of C1 esterase inhibitor, a protein that is part of the complement system. It is typically inherited in an autosomal dominant manner. Symptoms usually start in childhood and continue sporadically into adulthood. Attacks can be triggered by minor surgical procedures, dental work, and stress. The main clinical signs of hereditary angioedema include swelling of the skin and mucous membranes, with the face, tongue, and extremities being the most commonly affected areas. There is often a tingling sensation before an attack, sometimes accompanied by a non-itchy rash.
Angioedema and anaphylaxis resulting from C1 esterase inhibitor deficiency do not respond to adrenaline, steroids, or antihistamines. Treatment requires the use of C1 esterase inhibitor concentrate or fresh frozen plasma, both of which contain C1 esterase inhibitor. In situations that may trigger an attack, short-term prophylaxis can be achieved by administering C1 esterase inhibitor or fresh frozen plasma infusions prior to the event. For long-term prevention, androgenic steroids like stanozolol or antifibrinolytic drugs such as tranexamic acid can be used.
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This question is part of the following fields:
- Allergy
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Question 25
Incorrect
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A 25-year-old woman develops an irritating rash after a recent viral infection. The rash is characterized by multiple wheals of varying sizes on her skin, surrounded by redness. It is extremely itchy and accompanied by a slight burning sensation. The rash lasts for a few hours but is now nearly gone. She has a history of mild asthma but no other significant medical conditions.
What is the MOST LIKELY diagnosis for this individual?Your Answer:
Correct Answer: Urticaria
Explanation:Urticaria is a condition characterized by a raised, itchy rash on the skin and mucous membranes. It can be localized or widespread and affects about 15% of people at some point in their lives. There are two forms of urticaria: acute and chronic, with the acute form being more common.
In about 50% of cases of acute urticaria, a specific trigger can be identified. Common triggers include allergies (such as foods, bites, stings, and drugs), skin contact with irritants (like chemicals, nettles, and latex), physical stimuli (such as firm rubbing, pressure, and extremes of temperature), and viral infections.
The main skin lesion seen in urticaria is called a wheal or wheel. Wheals typically have three characteristics: a central swelling that can be red or white in color, surrounded by a red area (known as the flare), and they are usually very itchy, sometimes accompanied by a burning sensation. Wheals are temporary and usually disappear within 1 to 24 hours, returning the skin to its normal appearance.
Wheals can vary in size, ranging from a few millimeters to lesions as large as 10 cm in diameter. They can appear as single lesions or multiple ones, and sometimes they merge together to form large patches. In some cases, urticaria can also cause swelling of the soft tissues in the eyelids, lips, and tongue, known as angioedema.
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This question is part of the following fields:
- Allergy
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Question 26
Incorrect
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A 32-year-old woman arrives at the emergency department with lip swelling and wheezing. According to her partner, she has a nut allergy. Anaphylaxis is suspected. What type of hypersensitivity reaction is allergic anaphylaxis?
Your Answer:
Correct Answer: Type I hypersensitivity reaction
Explanation:Anaphylaxis is a severe allergic reaction that is caused by the immune system overreaction to a specific allergen. This reaction is classified as a Type I hypersensitivity reaction, which means it is mediated by the IgE antibodies.
Further Reading:
Anaphylaxis is a severe and life-threatening hypersensitivity reaction that can have sudden onset and progression. It is characterized by skin or mucosal changes and can lead to life-threatening airway, breathing, or circulatory problems. Anaphylaxis can be allergic or non-allergic in nature.
In allergic anaphylaxis, there is an immediate hypersensitivity reaction where an antigen stimulates the production of IgE antibodies. These antibodies bind to mast cells and basophils. Upon re-exposure to the antigen, the IgE-covered cells release histamine and other inflammatory mediators, causing smooth muscle contraction and vasodilation.
Non-allergic anaphylaxis occurs when mast cells degrade due to a non-immune mediator. The clinical outcome is the same as in allergic anaphylaxis.
The management of anaphylaxis is the same regardless of the cause. Adrenaline is the most important drug and should be administered as soon as possible. The recommended doses for adrenaline vary based on age. Other treatments include high flow oxygen and an IV fluid challenge. Corticosteroids and chlorpheniramine are no longer recommended, while non-sedating antihistamines may be considered as third-line treatment after initial stabilization of airway, breathing, and circulation.
Common causes of anaphylaxis include food (such as nuts, which is the most common cause in children), drugs, and venom (such as wasp stings). Sometimes it can be challenging to determine if a patient had a true episode of anaphylaxis. In such cases, serum tryptase levels may be measured, as they remain elevated for up to 12 hours following an acute episode of anaphylaxis.
The Resuscitation Council (UK) provides guidelines for the management of anaphylaxis, including a visual algorithm that outlines the recommended steps for treatment.
https://www.resus.org.uk/sites/default/files/2021-05/Emergency%20Treatment%20of%20Anaphylaxis%20May%202021_0.pdf -
This question is part of the following fields:
- Allergy
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Question 27
Incorrect
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You assess a 48-year-old woman who has experienced an anaphylactic reaction after mistakenly consuming peanuts in a dish at a Thai eatery. She has a history of hypertension, but her blood pressure is effectively managed with a daily dose of atenolol 50 mg and amlodipine 5 mg. You have given her two injections of IM adrenaline, but her condition continues to worsen.
Which of the following interventions is most likely to quickly improve her condition?Your Answer:
Correct Answer: IM glucagon
Explanation:Patients who are on beta-blockers may not respond effectively to adrenaline during anaphylaxis. Research conducted on animals and reported cases have indicated that glucagon can be utilized to counteract the effects of beta-blockade if initial adrenaline doses prove ineffective.
Although prednisolone and hydrocortisone can be beneficial later on, it typically takes 6-8 hours for them to take full effect. Therefore, they are unlikely to have any impact on the patient during the brief period it will take for the ambulance to arrive.
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This question is part of the following fields:
- Allergy
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Question 28
Incorrect
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A 25-year-old individual complains of persistent and bothersome urticaria after being exposed to latex. Despite taking an antihistamine, the itch remains severe and greatly affects their well-being.
What is the most suitable treatment to prescribe alongside the antihistamine for this patient?Your Answer:
Correct Answer: Prednisolone
Explanation:Urticaria is a skin condition characterized by red, raised, and itchy rashes that can appear in specific areas or all over the body. It is a common issue, affecting around 15% of individuals at some point in their lives. Urticaria can be either acute or chronic, with the acute form being more prevalent.
According to the current guidelines from the National Institute for Health and Care Excellence (NICE), individuals seeking treatment for urticaria should be offered a non-sedating antihistamine from the second-generation category. Examples of second-generation antihistamines include cetirizine, loratadine, fexofenadine, desloratadine, and levocetirizine.
It is no longer recommended to use conventional first-generation antihistamines like promethazine and chlorpheniramine for urticaria. These medications have short-lasting effects, can cause sedation and anticholinergic side effects, and may interfere with sleep, learning, and performance. They can also interact negatively with alcohol and other medications. Additionally, there have been reports of lethal overdoses with first-generation antihistamines. Terfenadine and astemizole should also be avoided as they can have harmful effects on the heart when combined with certain drugs like erythromycin and ketoconazole.
In cases where symptoms are severe, a short course of oral corticosteroids such as prednisolone (40 mg for up to seven days) may be prescribed alongside the second-generation antihistamine.
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This question is part of the following fields:
- Allergy
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Question 29
Incorrect
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A 65-year-old patient experiences an anaphylactic reaction after starting a new medication.
Which medication is the MOST likely cause of this drug-induced anaphylactic reaction?Your Answer:
Correct Answer: Ibuprofen
Explanation:Penicillin is frequently responsible for drug-induced anaphylaxis, making it the primary cause. Following closely behind are NSAIDs, which are the second most common cause. Additionally, ACE inhibitors and aspirin are commonly associated with anaphylaxis.
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This question is part of the following fields:
- Allergy
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Question 30
Incorrect
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A 7-year-old child experiences an anaphylactic reaction after being stung by a bee.
What dosage of IV hydrocortisone should be administered in this situation?Your Answer:
Correct Answer: 100 mg
Explanation:Corticosteroids can be beneficial in preventing or reducing prolonged reactions. According to the current APLS guidelines, the recommended doses of hydrocortisone for different age groups are as follows:
– Children under 6 months: 25 mg administered slowly via intramuscular (IM) or intravenous (IV) route.
– Children aged 6 months to 6 years: 50 mg administered slowly via IM or IV route.
– Children aged 6 to 12 years: 100 mg administered slowly via IM or IV route.
– Children over 12 years: 200 mg administered slowly via IM or IV route.
– Adults: 200 mg administered slowly via IM or IV route.It is important to note that the most recent ALS guidelines do not recommend the routine use of corticosteroids for treating anaphylaxis in adults. However, the current APLS guidelines still advocate for the use of corticosteroids in children to manage anaphylaxis.
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This question is part of the following fields:
- Allergy
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