Anaphylaxis management — 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 10-year-old boy is brought to the emergency room after a fall from a horse. He has severe pain in his right forearm. He has a history of asthma and atopic dermatitis. His current medications include an albuterol inhaler and hydrocortisone cream. Examination shows an open fracture of the right forearm and no other injuries. The patient is given a parenteral infusion of 1 L normal saline, cefazolin, morphine, and ondansetron. The right forearm is covered with a splint. Informed consent for surgery is obtained. Fifteen minutes later, the patient complains of shortness of breath. He has audible wheezing. His temperature is 37.0°C (98.6°F), heart rate is 130/min, respiratory rate is 33/min, and blood pressure is 80/54 mm Hg. Examination shows generalized urticaria and lip swelling. There is no conjunctival edema. Scattered wheezing is heard throughout both lung fields. Which of the following is the most appropriate next step in management?

A 23-year-old woman comes to the emergency department because of a diffuse, itchy rash and swollen face for 6 hours. That morning, she was diagnosed with an abscess of the lower leg. She underwent treatment with incision and drainage as well as oral antibiotics. She has no history of serious illness. She is not in acute distress. Her temperature is 37.2°C (99°F), pulse is 78/min, and blood pressure is 128/84 mm Hg. Physical examination shows mild swelling of the eyelids and lips. There are multiple erythematous patches and wheals over her upper extremities, back, and abdomen. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. After discontinuing all recently administered drugs and beginning continuous vital sign monitoring, which of the following is the most appropriate next step in management?

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?

A 12-year-old girl is brought to the emergency department by her parents due to severe shortness of breath that started 20 minutes ago. She has a history of asthma and her current treatment regime includes a beta-agonist inhaler as well as a medium-dose corticosteroid inhaler. Her mother tells the physician that her daughter was playing outside with her friends when she suddenly started experiencing difficulty breathing and used her inhaler without improvement. On examination, she is struggling to breathe and with subcostal and intercostal retractions. She is leaning forward, and gasping for air and refuses to lie down on the examination table. Her blood pressure is 130/92 mm Hg, the respirations are 27/min, the pulse is 110/min and O2 saturation is 87%. There is prominent expiratory wheezes in all lung fields. The patient is put on a nonrebreather mask with 100% oxygen. An arterial blood gas is collected and sent for analysis. Which of the following is the most appropriate next step in the management of this patient?

An 8-year-old girl is brought to the emergency department by her parents with severe difficulty in breathing for an hour. She is struggling to breathe. She was playing outside with her friends, when she suddenly fell to the ground, out of breath. She was diagnosed with asthma one year before and has since been on treatment for it. At present, she is sitting leaning forward with severe retractions of the intercostal muscles. She is unable to lie down. Her parents mentioned that she has already taken several puffs of her inhaler since this episode began but without response. On physical examination, her lungs are hyperresonant to percussion and there is decreased air entry in both of her lungs. Her vital signs show: blood pressure 110/60 mm Hg, pulse 110/min, respirations 22/min, and a peak expiratory flow rate (PEFR) of 50%. She is having difficulty in communicating with the physician. Her blood is sent for evaluation and a chest X-ray is ordered. Her arterial blood gas reports are as follows: PaO2 50 mm Hg pH 7.38 PaCO2 47 mm Hg HCO3 27 mEq/L Which of the following is the most appropriate next step in management?

A 12-month-old boy presents for a routine checkup. The patient immigrated from the Philippines with his parents a few months ago. No prior immunization records are available. The patient’s mother claims that he had a series of shots at 6 months of age which gave him a severe allergic reaction with swelling of the tongue and the face. She also remembers that he had the same reaction when she introduced solid foods to his diet, including carrots, eggs, and bananas. Which of the following vaccinations are not recommended for this patient?

A 16-month-old male patient, with no significant past medical history, is brought into the emergency department for the second time in 5 days with tachypnea, expiratory wheezes and hypoxia. The patient presented to the emergency department initially due to rhinorrhea, fever and cough. He was treated with nasal suctioning and discharged home. The mother states that, over the past 5 days, the patient has started breathing faster with chest retractions. His vital signs are significant for a temperature of 100.7 F, respiratory rate of 45 and oxygen saturation of 90%. What is the most appropriate treatment for this patient?

A 4-year-old girl is brought to the emergency department by her parents with a sudden onset of breathlessness. She has been having similar episodes over the past few months with a progressive increase in frequency over the past week. They have noticed that the difficulty in breathing is more prominent during the day when she plays in the garden with her siblings. She gets better once she comes indoors. During the episodes, she complains of an inability to breathe and her parents say that she is gasping for breath. Sometimes they hear a noisy wheeze while she breathes. The breathlessness does not disrupt her sleep. On examination, she seems to be in distress with noticeable intercostal retractions. Auscultation reveals a slight expiratory wheeze. According to her history and physical findings, which of the following mechanisms is most likely responsible for this child’s difficulty in breathing?