-
Question 1
Correct
-
A 10-year-old severely atopic boy is brought to the practice by his father. The father produces drugs from his bag and wants to ‘sort them out and get a repeat prescription’. He says the child is currently reasonably well. Among the items are:
an empty packet of prednisolone 5 mg tablets (30 tablets) dated 10 months ago, take six tablets daily for five days
budesonide dry powder inhaler 200 µg, use two puffs twice a day
hydrocortisone cream 1%, apply twice a day to inflamed skin (30 g tube)
loratadine syrup (5 mg/5 ml), take one 5 ml dose daily
sodium cromoglicate eye drops use in both eyes four times a day.
Which item seems the MOST SIGNIFICANT in importance in the first instance to discuss with the father?Your Answer: Budesonide
Explanation:Medication Review for an Atopic Child with Asthma
When reviewing the medication of an atopic child with asthma, it is important to consider the dosage of inhaled corticosteroids, the potency of topical corticosteroids, and the effectiveness of antihistamines and rescue courses of prednisolone. In this case, the child is using a medium dose of budesonide, which suggests the need for specialist care. The use of mild hydrocortisone for atopic eczema may not be sufficient, and a larger tube may be needed. Loratadine is an effective non-sedating antihistamine for allergic rhinitis and conjunctivitis, and repeat prescriptions are appropriate. Short courses of prednisolone may be necessary for acute exacerbations, and sodium cromoglicate can be used intermittently for allergic conjunctivitis. Overall, careful consideration of medication is crucial for managing the symptoms of an atopic child with asthma.
-
This question is part of the following fields:
- Allergy And Immunology
-
-
Question 2
Correct
-
A 26-year-old woman comes for follow-up after experiencing a systemic reaction to a wasp sting during a picnic at the park. She reports swelling and redness at the site of the sting that had begun to spread to her face.
What is the best course of action for long-term management?Your Answer: Refer for venom immunotherapy and dispense an adrenaline auto-injector (AAI, e.g. EpiPen®)
Explanation:Venom allergy can cause local or systemic reactions, including anaphylaxis. Acute management is supportive, with anaphylaxis treated with adrenaline, steroids, and antihistamines. Referral to an allergy specialist is recommended for those with systemic reactions or suspected venom allergy. Venom immunotherapy may be recommended for those with a history of systemic reactions and raised levels of venom-specific IgE, but should not be performed in those without demonstrable venom-specific IgE or recent anaphylaxis. VIT has a high success rate in preventing systemic reactions and improving quality of life.
-
This question is part of the following fields:
- Allergy And Immunology
-
-
Question 3
Incorrect
-
A 26-year-old woman is 18 weeks pregnant. She works as a kindergarten teacher, and two children in the kindergarten have developed Chickenpox. Her own mother is certain that she had Chickenpox as a child.
What is the most appropriate piece of advice to give in order to reassure this woman that her baby is not at risk from this Chickenpox contact?
Your Answer: Positive IgG and negative IgM
Correct Answer: The patient is at low risk of developing an infection as she is sure she had a previous Chickenpox infection
Explanation:Understanding Chickenpox Serology Results in Pregnancy
Chickenpox infection during pregnancy can have serious consequences for both the mother and the fetus. Therefore, it is important to determine a woman’s immunity status before she is exposed to the virus. Serology testing can help determine if a woman has been previously infected or vaccinated against Chickenpox. Here are the possible results and their implications:
– Negative IgG and negative IgM serology: This indicates that the woman has not been previously exposed to the virus and is not immune. She should avoid exposure and receive immunoglobulin if she has significant exposure. She should also be vaccinated postpartum.
– Positive IgG and negative IgM serology: This indicates that the woman has been previously infected or vaccinated and has protective immunity against re-infection. This is the desired result if the woman has no history of Chickenpox.
– Positive IgG and positive IgM serology: This suggests recent infection, but should not be used alone to diagnose infection. Clinical presentation should also be considered. If the woman develops Chickenpox, she should receive acyclovir.
– No serology testing needed: If the woman has a definite history of Chickenpox, she is considered immune and doesn’t need serology testing.It is important to note that a history of Chickenpox may not be a reliable predictor of immunity in women from overseas, and serology testing may be necessary. The NICE guidance on Chickenpox infection in pregnancy provides further recommendations.
-
This question is part of the following fields:
- Allergy And Immunology
-
-
Question 4
Incorrect
-
A 27-year-old female complains of mild mouth swelling and itching after consuming raw spinach, apple, and strawberries, which subsides within 15 minutes. She has a history of birch pollen allergy but no other medical conditions.
What is the probable diagnosis?Your Answer: Lip-licking dermatitis
Correct Answer: Oral allergy syndrome
Explanation:Urticarial reactions can be caused by various factors, including drug-induced angioedema or C1-esterase inhibitor deficiency. Contact irritant dermatitis is usually the result of prolonged exposure to a mild irritant, but it doesn’t typically produce a rapid and predictable response that resolves quickly. Lip licking dermatitis is a form of skin inflammation that occurs when saliva from repeated lip licking causes redness, scaling, and dryness of the lips.
Understanding Oral Allergy Syndrome
Oral allergy syndrome, also known as pollen-food allergy, is a type of hypersensitivity reaction that occurs when a person with a pollen allergy eats certain raw, plant-based foods. This reaction is caused by cross-reaction with a non-food allergen, most commonly birch pollen, where the protein in the food is similar but not identical in structure to the original allergen. As a result, OAS is strongly linked with pollen allergies and presents with seasonal variation. Symptoms of OAS typically include mild tingling or itching of the lips, tongue, and mouth.
It is important to note that OAS is different from food allergies, which are caused by direct sensitivity to a protein present in food. Non-plant foods do not cause OAS because there are no cross-reactive allergens in pollen that would be structurally similar to meat. Food allergies may be caused by plant or non-plant foods and can lead to systemic symptoms such as vomiting and diarrhea, and even anaphylaxis.
OAS is a clinical diagnosis, but further tests can be used to rule out other diagnoses and confirm the diagnosis when the history is unclear. Treatment for OAS involves avoiding the culprit foods and taking oral antihistamines if symptoms develop. In severe cases, an ambulance should be called, and intramuscular adrenaline may be required.
In conclusion, understanding oral allergy syndrome is important for individuals with pollen allergies who may experience symptoms after eating certain raw, plant-based foods. By avoiding the culprit foods and seeking appropriate medical care when necessary, individuals with OAS can manage their symptoms effectively.
-
This question is part of the following fields:
- Allergy And Immunology
-
-
Question 5
Incorrect
-
A 25-year-old man has had recurrent chest and sinus infections. He was originally thought to be asthmatic, but his response to treatment has been poor. He does respond to antibiotics, but the courses he has had in the previous 12 months have totalled 2 months. Primary immunodeficiency is suspected.
Which of the following is the most appropriate test?Your Answer: Antinuclear antibody
Correct Answer: Immunoglobulin assay
Explanation:Understanding Common Variable Immunodeficiency: Prevalence, Diagnosis, and Delayed Treatment
Common variable immunodeficiency (CVID) is the most prevalent primary antibody deficiency, affecting approximately 1 in 25,000 individuals. However, due to its rarity, only a small fraction of healthcare professionals will encounter a patient with CVID during their career. This, coupled with a delay in diagnosis, increases the risk of irreversible lung damage and bronchiectasis.
Defects in humoral immunity account for 50% of primary immunodeficiencies, with combined humoral and cellular deficiencies making up 20-30% of cases. Inherited single-gene disorders are the most common cause of primary immune deficiencies. While many of these defects present in infancy and childhood, CVID typically presents after the age of five, with a peak in the second or third decade of life.
A diagnosis of CVID is based on defective functional antibody formation, accompanied by decreased serum immunoglobulin levels (IgG and IgA), generally decreased serum IgM, and exclusion of other known causes of antibody deficiency. Identifying defective functional antibody formation may involve measuring the response to a vaccine such as the pneumococcal vaccine.
Overall, understanding the prevalence, diagnosis, and delayed treatment of CVID is crucial in providing appropriate care for individuals with this rare but potentially debilitating condition.
-
This question is part of the following fields:
- Allergy And Immunology
-
-
Question 6
Correct
-
What is the appropriate advice to give to a patient with a confirmed food allergy?
Your Answer: Food allergens may be encountered by routes other than ingestion e.g. skin contact, inhalation
Explanation:Managing Food Allergies and Intolerances
Food allergies and intolerances can be managed through food avoidance. Elimination diets should only exclude foods that have been confirmed to cause allergic reactions, and the advice of a dietician may be necessary. It is important to read food labels carefully, although not all potential allergens are included. Cross contact of allergens during meal preparation should be avoided, and high-risk situations such as buffets and picnics should be avoided as well. It is also important to note that there is a possibility of food allergen cross-reactivity, such as between cows’ milk and goats’ milk or between different types of fish. Additionally, there is a risk of exposure to allergens through routes other than ingestion, such as skin contact or inhalation during cooking.
-
This question is part of the following fields:
- Allergy And Immunology
-
-
Question 7
Correct
-
A 42-year-old man has difficulty swallowing and speaking that worsens after physical activity. The physician suspects he may have myasthenia gravis.
What is the most likely target of the autoimmune antibodies that cause this disease?Your Answer: Acetylcholine receptors
Explanation:Understanding Myasthenia Gravis: Targets and Associations
Myasthenia gravis is an autoimmune disorder that affects the neuromuscular junction of skeletal muscles, leading to muscle weakness that worsens with exercise and improves with rest. In up to 90% of generalized cases, antibodies form against acetylcholine receptors (anti-AChR). However, other muscle antigens may also be targeted.
One such antigen is low-density lipoprotein receptor-related protein 4 (anti-LRP4), which is found in subsets of myasthenia gravis patients. Another target is muscle-specific receptor tyrosine kinase (anti-MuSK), which is detected in about half of generalized myasthenia gravis patients who are seronegative for anti-AChR antibodies. These patients may not respond to anticholinesterase drugs but do respond to steroid immunosuppression.
An association has also been observed between myasthenia gravis and human leukocyte antigen (HLA), although it is not the most likely target. Additionally, one-half of thymoma patients develop myasthenia gravis, while 15% of myasthenia gravis patients have thymomas. Non-AChR muscle autoantibodies reacting with striated muscle titin and RyR antigens are found in up to 95% of myasthenia gravis patients with a thymoma and in 50% of late-onset myasthenia gravis patients (onset at age of 50 years or later). These antibodies are usually associated with more severe myasthenia gravis.
Understanding the various targets and associations of myasthenia gravis can aid in diagnosis and treatment of this autoimmune disorder.
-
This question is part of the following fields:
- Allergy And Immunology
-
-
Question 8
Correct
-
Individuals with primary antibody deficiencies often experience repeated infections. What is the most common symptom observed in these individuals?
Your Answer: Respiratory infection
Explanation:Understanding Primary Antibody Deficiencies: Causes, Symptoms, and Diagnosis
Primary antibody deficiencies refer to a group of rare disorders that affect the body’s ability to produce effective antibodies against pathogens. These disorders may be caused by a mutation in a single gene or by multiple genetic factors, similar to diabetes. While primary antibody deficiencies are the most common forms of primary immune deficiency, other primary immune deficiencies involve defects in cellular immunity, phagocyte defects, and complement defects. It is important to distinguish primary antibody deficiencies from secondary immune deficiencies caused by factors such as malignancy, malnutrition, or immunosuppressive therapy.
Clinical history is crucial in identifying primary antibody deficiencies. Patients of any age who experience recurrent infections, particularly in the respiratory tract, should be investigated if the frequency or severity of infection is unusual or out of context. While most patients are under 20 years old, common variable immunodeficiency typically peaks in the second or third decade of life. A systematic review has found that respiratory and sinus infections are the most common presenting symptoms, followed by gastrointestinal and cutaneous infections. Meningitis, septic arthritis/osteomyelitis, and ophthalmic infections are much less common.
In summary, understanding primary antibody deficiencies is essential in diagnosing and managing patients with recurrent infections. Clinical history plays a crucial role in identifying these disorders, which can be caused by genetic factors and affect the body’s ability to produce effective antibodies against pathogens.
-
This question is part of the following fields:
- Allergy And Immunology
-
-
Question 9
Correct
-
A 30-year-old patient presents to your GP clinic with a spider bite that occurred 7 days ago. The patient reports experiencing pruritus, urticarial rash, erythema, lip swelling, abdominal pain, and vomiting shortly after being bitten. The patient has been taking cetirizine daily from a home supply for the past week, which has resolved all symptoms.
What is the recommended follow-up plan for this patient?Your Answer: Referral to an allergy specialist
Explanation:If someone experiences a systemic reaction to an insect bite, it is important to refer them to an allergy specialist. In this case, the patient’s moderate reaction suggests the need for further evaluation by a specialist who can determine if an adrenaline auto-injector and medical identification bracelet are necessary. However, since the bite occurred 7 days ago and the patient is currently stable, there is no need to refer them to the emergency department or medical team at this time. Additionally, late-onset reactions typically occur within a few hours of the bite, so a follow-up appointment at the 2-week mark is not necessary.
Venom allergy can cause local or systemic reactions, including anaphylaxis. Acute management is supportive, with anaphylaxis treated with adrenaline, steroids, and antihistamines. Referral to an allergy specialist is recommended for those with systemic reactions or suspected venom allergy. Venom immunotherapy may be recommended for those with a history of systemic reactions and raised levels of venom-specific IgE, but should not be performed in those without demonstrable venom-specific IgE or recent anaphylaxis. VIT has a high success rate in preventing systemic reactions and improving quality of life.
-
This question is part of the following fields:
- Allergy And Immunology
-
-
Question 10
Correct
-
A 47-year-old woman with rheumatoid arthritis is being evaluated in the clinic as she has not responded well to methotrexate. The possibility of starting sulfasalazine is being considered. However, if she has an allergy to which of the following drugs, it may not be advisable to prescribe sulfasalazine?
Your Answer: Aspirin
Explanation:Sulfasalazine may cause a reaction in patients who are allergic to aspirin.
Sulfasalazine: A DMARD for Inflammatory Arthritis and Bowel Disease
Sulfasalazine is a type of disease modifying anti-rheumatic drug (DMARD) that is commonly used to manage inflammatory arthritis, particularly rheumatoid arthritis, as well as inflammatory bowel disease. This medication is a prodrug for 5-ASA, which works by reducing neutrophil chemotaxis and suppressing the proliferation of lymphocytes and pro-inflammatory cytokines.
However, caution should be taken when using sulfasalazine in patients with G6PD deficiency or those who are allergic to aspirin or sulphonamides due to the risk of cross-sensitivity. Adverse effects of sulfasalazine may include oligospermia, Stevens-Johnson syndrome, pneumonitis/lung fibrosis, myelosuppression, Heinz body anaemia, megaloblastic anaemia, and the potential to color tears and stain contact lenses.
Despite these potential side effects, sulfasalazine is considered safe to use during pregnancy and breastfeeding, making it a viable option for women who require treatment for inflammatory arthritis or bowel disease.
-
This question is part of the following fields:
- Allergy And Immunology
-
-
Question 11
Incorrect
-
A 25-year-old woman presents to the General Practice Surgery where she has recently registered. She is experiencing sneezing, an itchy nose, and itchy, watery eyes. She suspects that her symptoms are due to allergies and would like to undergo comprehensive allergy testing to inform her workplace and make necessary adjustments. She also wonders if she should carry an EpiPen.
What is the most probable cause of this patient's allergy?Your Answer: Chronic urticaria
Correct Answer: Seasonal rhinitis
Explanation:Common Allergic and Non-Allergic Conditions: Causes and Differences
Seasonal rhinitis, atopic eczema, chronic urticaria, lactose intolerance, and coeliac disease are common conditions that can cause discomfort and distress. Understanding their causes and differences is important for proper diagnosis and treatment.
Seasonal rhinitis, also known as hay fever, is caused by allergens such as tree pollen, grass, mould spores, and weeds. It is an IgE-mediated reaction that occurs at certain times of the year.
Atopic eczema can be aggravated by dietary factors in some children, but less frequently in adults. Food allergy should be suspected in children who have immediate reactions to food or infants with moderate or severe eczema that is not well-controlled.
Chronic urticaria may have an immunological or autoimmune cause, but can also be idiopathic or caused by physical factors, drugs, or dietary pseudo allergens. It presents with a rash.
Lactose intolerance is due to an enzyme deficiency and is different from milk allergy, which is IgE-mediated. It can occur following gastroenteritis.
Coeliac disease is an autoimmune condition that affects the small intestine in response to gluten exposure. It is not a gluten allergy.
-
This question is part of the following fields:
- Allergy And Immunology
-
-
Question 12
Correct
-
A couple brings their 2-year-old son to see the family General Practitioner, as they are concerned about his development. He was born at term. He was a little slow to crawl but started walking at around 18 months. He has never had much speech. In the last few weeks, he has stopped walking and stopped feeding himself. He has started clapping his hands every few minutes and at times seems very distressed and screams. He has not been unwell with a fever or recent illness. The is no family history of note.
What is the most likely diagnosis?Your Answer: Rett syndrome
Explanation:The child in the video exhibits symptoms of a rare neurological genetic disorder called Rett syndrome. This condition is caused by a random mutation of the MECP2 gene on the X chromosome and typically affects girls between six and 18 months of age. Symptoms include delayed speech, muscle weakness, and jerky hand movements, which can be distressing for the individual. Other possible symptoms include microcephaly, seizures, and scoliosis. Sturge-Weber syndrome, Angelman syndrome, phenylketonuria, and encephalitis are unlikely diagnoses based on the absence of specific symptoms and history.
-
This question is part of the following fields:
- Allergy And Immunology
-
-
Question 13
Correct
-
Antihistamine drugs are commonly prescribed for skin disorders. Which of the following conditions are they most likely to be effective in treating?
Your Answer: Acute urticaria
Explanation:Understanding Skin Conditions: Causes and Mechanisms
Skin conditions can have various causes and mechanisms. Urticaria, for instance, is triggered by the release of histamine and other mediators from mast cells in the skin. While IgE-mediated type I hypersensitivity reactions are a common cause of urticaria, other immunological and non-immunological factors can also play a role.
In atopic eczema, antihistamines are not recommended as a routine treatment. However, a non-sedating antihistamine may be prescribed for a month to children with severe atopic eczema or those with mild or moderate eczema who experience severe itching or urticaria. It’s worth noting that allergies to food or environmental allergens may not be responsible for the symptoms of atopic eczema.
Contact allergic dermatitis and erythema multiforme are examples of cell-mediated immunity, and their symptoms are not caused by histamine release. On the other hand, bullous pemphigoid is an autoimmune disorder that occurs when the immune system attacks a protein that forms the junction between the epidermis and the basement membrane of the dermis.
Understanding the causes and mechanisms of different skin conditions can help in their diagnosis and treatment.
-
This question is part of the following fields:
- Allergy And Immunology
-
-
Question 14
Correct
-
A 50-year-old man comes to the emergency department with facial swelling that he has had for 2 hours. He started taking a new medication yesterday. During the examination, his lips are found to be swollen. His blood pressure is 128/76 mmHg and his pulse is 70 beats per minute. He reports no breathing difficulties or stridor.
What medication could be responsible for this reaction?Your Answer: Valsartan
Explanation:Angioedema, a condition characterized by swelling under the skin, can be caused by various allergens as well as certain medications such as ACE inhibitors and NSAIDs. antihistamines are a common treatment option depending on the underlying cause. However, the medications listed other than ACE inhibitors and NSAIDs are not known to cause angioedema.
Understanding Angioedema: Causes and Treatment
Angioedema is a condition characterized by swelling beneath the skin, which can be caused by different allergens. The treatment for this condition varies depending on the underlying cause, but it often involves the use of antihistamines. Angioedema can be triggered by a variety of factors, including food allergies, insect bites, medication reactions, and genetic factors. The swelling can occur in different parts of the body, such as the face, lips, tongue, throat, and hands. In some cases, angioedema can be life-threatening, especially if it affects the airways and causes difficulty breathing.
-
This question is part of the following fields:
- Allergy And Immunology
-
-
Question 15
Correct
-
A 36-year-old woman comes to the clinic with facial swelling that started 6 hours ago. She is a busy lawyer and has important court cases this week. During the examination, her lips are found to be swollen. Her blood pressure is 118/72 mmHg and her pulse rate is 80 beats per minute. She reports no breathing difficulties or stridor.
What is the most suitable course of treatment for this patient?Your Answer: Loratadine
Explanation:The symptoms and signs exhibited by this woman suggest the presence of angioedema, which is a condition characterized by swelling of the connective tissue beneath the skin in response to a trigger. Unlike anaphylaxis, angioedema doesn’t affect breathing or vital signs. antihistamines are effective in treating this condition, while adrenaline is not necessary as it is primarily used to treat anaphylaxis. Hydrocortisone is also used to treat anaphylaxis, but it is not recommended for angioedema. Furosemide is typically prescribed for leg swelling caused by heart failure and is not suitable for treating angioedema. Chlorphenamine and loratadine are both effective in reducing swelling caused by angioedema, but since the woman has an important job that requires full concentration, loratadine would be the better option as it is a non-sedating antihistamine.
Understanding Angioedema: Causes and Treatment
Angioedema is a condition characterized by swelling beneath the skin, which can be caused by different allergens. The treatment for this condition varies depending on the underlying cause, but it often involves the use of antihistamines. Angioedema can be triggered by a variety of factors, including food allergies, insect bites, medication reactions, and genetic factors. The swelling can occur in different parts of the body, such as the face, lips, tongue, throat, and hands. In some cases, angioedema can be life-threatening, especially if it affects the airways and causes difficulty breathing.
-
This question is part of the following fields:
- Allergy And Immunology
-
-
Question 16
Correct
-
A 35-year-old teacher with a history of eczema, seasonal allergies and high blood pressure visits her doctor complaining of itchy hives on her arms after wearing latex gloves for 30 minutes. She reports no difficulty breathing or facial swelling. Her vital signs are within normal range.
What is the probable mechanism involved in this case?Your Answer: Immunoglobulin E (IgE)-mediated hypersensitivity
Explanation:Types of Hypersensitivity Reactions and Their Characteristics
Hypersensitivity reactions are immune responses that can cause damage to the body. There are different types of hypersensitivity reactions, each with their own characteristics.
Immunoglobulin E (IgE)-mediated hypersensitivity is a type of reaction that involves the release of antibodies against an antigen, resulting in mast cell degranulation and the release of inflammatory mediators. This type of reaction is characterized by the presence of weals and occurs within one hour of contact with the allergen. Atopic individuals, such as those with asthma and hay fever, are more susceptible to this type of reaction.
Delayed-type hypersensitivity reactions produce symptoms 48-72 hours after contact with an allergen. Allergic contact dermatitis is an example of this type of reaction, which causes redness, itching, swelling, blistering, or bumps on the skin.
Antibody-mediated cytotoxic reactions occur when antibodies bind to antigens on the cell surface, interfering with cell function and marking the cells for destruction. This type of reaction is the basis for autoimmune diseases and haemolytic diseases in newborns.
Contact irritant dermatitis occurs when irritants remove oils and natural moisturizing factors from the skin, allowing chemical irritants to penetrate the skin barrier and trigger inflammation. This type of reaction presents acutely with redness, papules, swelling, and blistering, and progresses to redness, dryness, and cracking in the chronic stage.
Immune complex-mediated hypersensitivity occurs when antibodies bind to free-floating antigens, forming antigen-antibody complexes that can deposit in susceptible tissue and cause inflammation and damage. Henoch-Schönlein purpura is an example of a disease caused by this mechanism.
Understanding the Different Types of Hypersensitivity Reactions
-
This question is part of the following fields:
- Allergy And Immunology
-
-
Question 17
Correct
-
A 12-year-old boy, who has a known severe allergy to peanuts, comes to the emergency room after accidentally eating a peanut butter sandwich. He reports feeling itchy all over and his lips are starting to swell. He is having difficulty breathing and feels like he might pass out. His mother is in a panic, saying that she remembers a similar incident when he was younger.
What is the initial treatment option that should be considered in this case?Your Answer: Administer 0.5 ml of 1 in 1000 adrenaline by IM injection
Explanation:Anaphylaxis in General Practice: Importance of Emergency Knowledge
There are few life-threatening situations that GPs encounter in their daily practice, but anaphylaxis is one of them. The RCGP emphasizes the need for examination candidates to be proficient in their knowledge of life-threatening emergencies such as this. An example of anaphylaxis could be a bee sting, medicine, or immunization reaction.
Prompt injection of adrenaline is of paramount importance, and the preferred route of administration should be intramuscular. Other treatments may be supplemented, but adrenaline is the preferred first-line treatment. Chlorphenamine could be given by slow intravenous injection as an adjunctive treatment, as would be inhaled bronchodilators. Intravenous hydrocortisone is of secondary value because the onset of action is too slow compared to adrenaline.
To issue a prescription for anything would be wholly inappropriate. This patient needs immediate treatment. Oral treatments are too slow in their action. Although we have not tested your wider knowledge of her management in this question, it is important to remember your basic resuscitation skills.
It is crucial to carry emergency drugs in your doctor’s bag and know the correct dose of adrenaline to administer. Most vials of adrenaline come as 1 in 1000, but a 1 in 10,000 ampoule is available and this could lead to errors. It is essential to check the drug bag and ensure that all medications are within date. In case of an anaphylactic reaction to an immunization in a baby, the correct dose of adrenaline should be known.
In conclusion, anaphylaxis is a life-threatening emergency that requires prompt and appropriate treatment. GPs should be proficient in their knowledge of emergency management and carry emergency drugs in their doctor’s bag.
-
This question is part of the following fields:
- Allergy And Immunology
-
-
Question 18
Correct
-
You are instructing a woman on the proper use of an EpiPen. What is the most suitable guidance regarding the injection site?
Your Answer: Anterolateral aspect of the middle third of the thigh
Explanation:The anterolateral aspect of the middle third of the thigh is the recommended site for injecting IM adrenaline.
Anaphylaxis is a severe and potentially life-threatening allergic reaction that affects the entire body. It can be caused by various triggers, including food, drugs, and insect venom. The symptoms of anaphylaxis typically develop suddenly and progress rapidly, affecting the airway, breathing, and circulation. Swelling of the throat and tongue, hoarse voice, and stridor are common airway problems, while respiratory wheeze and dyspnea are common breathing problems. Hypotension and tachycardia are common circulation problems. Skin and mucosal changes, such as generalized pruritus and widespread erythematous or urticarial rash, are also present in around 80-90% of patients.
The most important drug in the management of anaphylaxis is intramuscular adrenaline, which should be administered as soon as possible. The recommended doses of adrenaline vary depending on the patient’s age, with the highest dose being 500 micrograms for adults and children over 12 years old. Adrenaline can be repeated every 5 minutes if necessary. If the patient’s respiratory and/or cardiovascular problems persist despite two doses of IM adrenaline, IV fluids should be given for shock, and expert help should be sought for consideration of an IV adrenaline infusion.
Following stabilisation, non-sedating oral antihistamines may be given to patients with persisting skin symptoms. Patients with a new diagnosis of anaphylaxis should be referred to a specialist allergy clinic, and an adrenaline injector should be given as an interim measure before the specialist allergy assessment. Patients should be prescribed two adrenaline auto-injectors, and training should be provided on how to use them. A risk-stratified approach to discharge should be taken, as biphasic reactions can occur in up to 20% of patients. The Resus Council UK recommends a fast-track discharge for patients who have had a good response to a single dose of adrenaline and have been given an adrenaline auto-injector and trained how to use it. Patients who require two doses of IM adrenaline or have had a previous biphasic reaction should be observed for a minimum of 6 hours after symptom resolution, while those who have had a severe reaction requiring more than two doses of IM adrenaline or have severe asthma should be observed for a minimum of 12 hours after symptom resolution. Patients who present late at night or in areas where access to emergency care may be difficult should also be observed for a minimum of 12
-
This question is part of the following fields:
- Allergy And Immunology
-
-
Question 19
Correct
-
A 25-year-old healthcare worker presents to her General Practitioner with an itchy rash on her hands. She reports that the rash develops quickly while she is wearing gloves at work and is diagnosed with a latex allergy. She also mentions experiencing similar symptoms related to food. Which of the following foods is she most likely allergic to?
Your Answer: Banana
Explanation:Latex-Fruit Syndrome: Allergies to Certain Fruits and Vegetables
Latex allergies are immediate hypersensitivity reactions that can cause itching, urticaria, angioedema, anaphylaxis, and other symptoms. Latex-fruit syndrome occurs when there is a co-existing allergy to latex and certain fruits or vegetables due to cross-reactivity. The most common fruits associated with this syndrome are bananas, chestnuts, kiwi fruit, avocado, and tomato. Melon, apple, papaya, and potato are less commonly associated with this syndrome. It is believed that the resemblance of these fruits and vegetables to a latex protein component is responsible for the cross-reactivity. If you have a latex allergy, it is important to be aware of the potential for cross-reactivity with certain fruits and vegetables.
-
This question is part of the following fields:
- Allergy And Immunology
-
-
Question 20
Correct
-
A 42-year-old female presents to rheumatology with complaints of fatigue and joint pain in her fingers. She has a history of mild asthma, which is managed with a salbutamol inhaler, and a known allergy to co-trimoxazole. Her blood tests reveal a positive rheumatoid factor and an anti-CCP antibody level of 150u/ml (normal range < 20u/ml). Which medication could potentially trigger an allergic reaction in this patient?
Your Answer: Sulfasalazine
Explanation:If a patient has a known allergy to a sulfa drug like co-trimoxazole, they should avoid taking sulfasalazine. However, hydroxychloroquine, leflunomide, and methotrexate are all viable options for first-line disease-modifying anti-rheumatic drugs for rheumatoid arthritis in this patient. Sarilumab may also be considered, but only if the patient has not responded well to other medications and has a disease activity score of over 5.1.
Sulfasalazine: A DMARD for Inflammatory Arthritis and Bowel Disease
Sulfasalazine is a type of disease modifying anti-rheumatic drug (DMARD) that is commonly used to manage inflammatory arthritis, particularly rheumatoid arthritis, as well as inflammatory bowel disease. This medication is a prodrug for 5-ASA, which works by reducing neutrophil chemotaxis and suppressing the proliferation of lymphocytes and pro-inflammatory cytokines.
However, caution should be taken when using sulfasalazine in patients with G6PD deficiency or those who are allergic to aspirin or sulphonamides due to the risk of cross-sensitivity. Adverse effects of sulfasalazine may include oligospermia, Stevens-Johnson syndrome, pneumonitis/lung fibrosis, myelosuppression, Heinz body anaemia, megaloblastic anaemia, and the potential to color tears and stain contact lenses.
Despite these potential side effects, sulfasalazine is considered safe to use during pregnancy and breastfeeding, making it a viable option for women who require treatment for inflammatory arthritis or bowel disease.
-
This question is part of the following fields:
- Allergy And Immunology
-
00
Correct
00
Incorrect
00
:
00
:
00
Session Time
00
:
00
Average Question Time (
Secs)