Anaphylaxis and allergic emergencies — MCQs

A 23-year-old man presents to the emergency department with shortness of breath. The patient was at a lunch hosted by his employer. He started to feel his symptoms begin when he started playing football outside with a few of the other employees. The patient has a past medical history of atopic dermatitis and asthma. His temperature is 98.3°F (36.8°C), blood pressure is 87/58 mmHg, pulse is 150/min, respirations are 22/min, and oxygen saturation is 85% on room air. Which of the following is the best next step in management?

A 45-year-old woman, suspected of having colon cancer, is advised to undergo a contrast-CT scan of the abdomen. She has no comorbidities and no significant past medical history. There is also no history of drug allergy. However, she reports that she is allergic to certain kinds of seafood. After tests confirm normal renal function, she is taken to the CT scan room where radiocontrast dye is injected intravenously and a CT scan of her abdomen is conducted. While being transferred to her ward, she develops generalized itching and urticarial rashes, with facial angioedema. She becomes dyspneic. Her pulse is 110/min, the blood pressure is 80/50 mm Hg, and the respirations are 30/min. Her upper and lower extremities are pink and warm. What is the most appropriate management of this patient?

A 6-year-old boy is brought to the emergency room by ambulance, accompanied by his kindergarten teacher. Emergency department staff attempt to call his parents, but they cannot be reached. The boy’s medical history is unknown. According to his teacher, the boy was eating in the cafeteria with friends when he suddenly complained of itching and developed a widespread rash. Physical exam is notable for diffuse hives and tongue edema. His pulse is 100/min and blood pressure is 90/60 mmHg. The boy appears frightened and tells you that he does not want any treatment until his parents arrive. Which of the following is the next best step in the management of this patient?

A 23-year-old woman is brought to the emergency department by her friends because she thinks that she is having an allergic reaction. The patient is visibly distressed and insists on immediate attention as she feels like she is going to die. Her friends say they were discussing future plans while dining at a new seafood restaurant when her symptoms started. The patient has no history of allergies. She takes no medications and has no significant medical history. Her vitals include: pulse 98/min, respiratory rate 30/min, and blood pressure 120/80 mm Hg. On physical examination, she is tachypneic and in distress. Cardiopulmonary examination is unremarkable. No rash is seen on the body and examination of the lips and tongue reveals no findings. Which of the following would most likely present in this patient?

A 29-year-old man is outside his home doing yard work when a bee stings him in the right arm. Within 10 minutes, he reports breathlessness and multiple, circular, pruritic rashes over his right arm. He drives to his family physician’s office for evaluation. His past medical history is significant for hypertension and he takes lisinopril. Known allergies include latex, Hymenoptera, and aspirin. His blood pressure is 118/68 mm Hg; heart rate is 104/min and regular; respiratory rate is 22/min; temperature is 37.7°C (99.8°F). There is non-pitting edema but erythema with raised wheels are present in the region of the right arm. Auscultation of the lungs reveals mild wheezing at the lung bases. Which of the following is the best course of action in the management of this patient?

You are working in the emergency room of a children's hospital when a 4-year-old girl is brought in by ambulance due to "difficulty breathing." The patient had been eating lunch on a school field trip when she suddenly complained of abdominal pain. Shortly thereafter, she was noted to have swelling of the lips, a rapidly developing red rash and difficulty breathing. In the ambulance her blood pressure was persistently 80/50 mmHg despite intramuscular epinephrine. In the course of stabilization and work up of the patient, you note an elevated tryptase level. What is the mechanism behind this elevated tryptase level?

For evaluating the functioning of a health center, which is the most important determinant for assessing clinical management?

A 56-year-old woman is brought to the emergency department after falling on her outstretched hand. Her wrist is clearly deformed by fracture and is painful to palpation. Her wrist and finger motion is limited due to pain. After treatment and discharge, her final total cost is $25,000. Her health insurance plan has a $3,000 copayment for emergency medical visits after the annual deductible of $20,000 is met and before 20% co-insurance applies. Previously this year, she had 2 visits to the emergency department for asthma attacks, which cost her $3,500 and $4,500 respectively. She has had no other medical costs during this period. Given that she has no previous balance due, which of the following must she pay out of pocket for her current visit to the emergency department?

An orthopaedic surgeon at a local community hospital has noticed that turnover times in the operating room have been unnecessarily long. She believes that the long wait times may be due to inefficient communication between the surgical nursing staff, the staff in the pre-operative area, and the staff in the post-operative receiving area. She believes a secure communication mobile phone app would help to streamline communication between providers and improve efficiency in turnover times. Which of the following methods is most appropriate to evaluate the impact of this intervention in the clinical setting?

A 29-year-old woman with hypothyroidism comes to her primary care physician for advice on a health insurance plan. She works as a baker and owns a small bakery. The patient explains that she would like to have affordable monthly premiums. She would be willing to make additional payments to be able to see providers outside her network and to get specialist care if referred by her primary care physician. Which of the following health insurance plans would be most appropriate?