41. Tom is a 19-year-old man who presents with sudden onset of edema of the lips and
face and a sensation of "throat tightness and shortness of breath" after a bee sting. Physical
examination reveals inspiratory and expiratory wheezing as well as pruritic wheals on his face Correct: C. anaphylaxis.
and arms. Blood pressure is 78/44 mm Hg, heart rate is 102 bpm, and respiratory rate is Though the presentation of anaphylaxis can be highly variable, the most common symptoms
24/min. His clinical presentation is most consistent with the diagnosis of: include urticaria, angioedema, upper airway angioedema, hypotension, and wheeze that
A. vasculitis. develops over a relatively short period of time. The overall physical findings of this patient
B. angioedema. are most consistent with anaphylaxis.
C. anaphylaxis.
D. reactive airway disease.
42. Your priority in caring for Tom, the aforementioned patient, is to:
Correct: B. administer parenteral epinephrine.
A. administer a rapidly acting oral antihistamine.
When anaphylaxis is suspected, first-line treatment is parenteral epinephrine, preferably
B. administer parenteral epinephrine.
given IM in the lateral thigh. There is no contraindication to epinephrine in anaphylaxis, and
C. initiate vasopressor therapy.
a failure or delay in administration is associated with greater risk of fatality.
D. administer a parenteral systemic corticosteroid.
43. Which of the following food-based allergies is likely to be found in adults and children?
Correct: D. peanut
A. milk
Food allergies are more common in children than adults, though persistence of some food
B. egg
allergies can extend into adulthood. Of the most common food allergies, peanut (D), tree nut,
C. soy
fish, and shellfish are most likely to persist in adults.
D. peanut
44. A person with latex allergy also often has a cross-allergy to all of the following except:
Correct: D. romaine lettuce.
A. banana.
Individuals with an allergic reaction to natural rubber latex protein can experience cross-re-
B. avocado.
activity to certain
C. kiwi.
fruit proteins. However, romaine lettuce does not contain these proteins for cross-reactivity (D)
D. romaine lettuce.
45. The most common clinical manifestation of systemic anaphylaxis typically is:
Correct: C. urticaria.
A. dizziness.
The clinical presentation of anaphylaxis can be unpredictable, and an initial mild reaction can
B. airway obstruction.
rapidly progress to a life-threatening condition. The most common findings in anaphylaxis
C. urticaria.
are urticaria (i.e., hives) and angioedema, found in approximately 85% to 90% of cases.
D. GI upset.
46. Second-line drug intervention in the presence of anaphylaxis should be:
Correct: A. oral diphenhydramine.
A. oral diphenhydramine.
When anaphylaxis is suspected, first-line treatment is parenteral epinephrine. Parenteral or
B. nebulized pentamidine.
oral antihistamine, such as diphenhydramine (A), is considered a second-line treatment for
C. nebulized epinephrine.
anaphylaxis but should not replace epinephrine.
D. oral prednisone.
47. Which of the following is the best answer regarding anaphylaxis? Correct: D. Trace amounts of an allergen in a food can cause a severe anaphylactic reaction.
A. Adults usually do not develop new anaphylaxis triggers such as food allergies. For individuals with food allergies, small amounts of the allergen present in food can elicit
B. Peanuts are the only primary food that can cause a severe allergic reaction. a severe IgE-mediated immune reaction that causes anaphylaxis. Following anaphylaxis,
C. Future anaphylactic reactions will become increasingly more severe. individuals should be referred to an allergist or immunologist to confirm the cause of the
D. Trace amounts of an allergen in a food can cause a severe anaphylactic reaction. allergic reaction and reduce risk factors for future episodes.
48. Increased risks for fatal reactions from anaphylaxis include all of the following except: Correct: D. delay in administering antihistamines.
A. personal history of asthma. Severe anaphylaxis can be a life-threatening event and should be treated with parenteral
B. delay in administering epinephrine. epinephrine to reduce mortality risk. Antihistamines are considered second-line treatment
C. age in the teen years. but should not replace the use of epinephrine. A delay in the use of antihistamines is not
D. delay in administering antihistamines. associated with improved mortality (D).
49. Which of the following plays an essential role in type 1 hypersensitivity?
Correct: A. immunoglobulin E
A. immunoglobulin E
Anaphylaxis is a manifestation of a type I hypersensitivity reaction resulting from an IgE-me-
B. immunoglobulin A
1/2
face and a sensation of "throat tightness and shortness of breath" after a bee sting. Physical
examination reveals inspiratory and expiratory wheezing as well as pruritic wheals on his face Correct: C. anaphylaxis.
and arms. Blood pressure is 78/44 mm Hg, heart rate is 102 bpm, and respiratory rate is Though the presentation of anaphylaxis can be highly variable, the most common symptoms
24/min. His clinical presentation is most consistent with the diagnosis of: include urticaria, angioedema, upper airway angioedema, hypotension, and wheeze that
A. vasculitis. develops over a relatively short period of time. The overall physical findings of this patient
B. angioedema. are most consistent with anaphylaxis.
C. anaphylaxis.
D. reactive airway disease.
42. Your priority in caring for Tom, the aforementioned patient, is to:
Correct: B. administer parenteral epinephrine.
A. administer a rapidly acting oral antihistamine.
When anaphylaxis is suspected, first-line treatment is parenteral epinephrine, preferably
B. administer parenteral epinephrine.
given IM in the lateral thigh. There is no contraindication to epinephrine in anaphylaxis, and
C. initiate vasopressor therapy.
a failure or delay in administration is associated with greater risk of fatality.
D. administer a parenteral systemic corticosteroid.
43. Which of the following food-based allergies is likely to be found in adults and children?
Correct: D. peanut
A. milk
Food allergies are more common in children than adults, though persistence of some food
B. egg
allergies can extend into adulthood. Of the most common food allergies, peanut (D), tree nut,
C. soy
fish, and shellfish are most likely to persist in adults.
D. peanut
44. A person with latex allergy also often has a cross-allergy to all of the following except:
Correct: D. romaine lettuce.
A. banana.
Individuals with an allergic reaction to natural rubber latex protein can experience cross-re-
B. avocado.
activity to certain
C. kiwi.
fruit proteins. However, romaine lettuce does not contain these proteins for cross-reactivity (D)
D. romaine lettuce.
45. The most common clinical manifestation of systemic anaphylaxis typically is:
Correct: C. urticaria.
A. dizziness.
The clinical presentation of anaphylaxis can be unpredictable, and an initial mild reaction can
B. airway obstruction.
rapidly progress to a life-threatening condition. The most common findings in anaphylaxis
C. urticaria.
are urticaria (i.e., hives) and angioedema, found in approximately 85% to 90% of cases.
D. GI upset.
46. Second-line drug intervention in the presence of anaphylaxis should be:
Correct: A. oral diphenhydramine.
A. oral diphenhydramine.
When anaphylaxis is suspected, first-line treatment is parenteral epinephrine. Parenteral or
B. nebulized pentamidine.
oral antihistamine, such as diphenhydramine (A), is considered a second-line treatment for
C. nebulized epinephrine.
anaphylaxis but should not replace epinephrine.
D. oral prednisone.
47. Which of the following is the best answer regarding anaphylaxis? Correct: D. Trace amounts of an allergen in a food can cause a severe anaphylactic reaction.
A. Adults usually do not develop new anaphylaxis triggers such as food allergies. For individuals with food allergies, small amounts of the allergen present in food can elicit
B. Peanuts are the only primary food that can cause a severe allergic reaction. a severe IgE-mediated immune reaction that causes anaphylaxis. Following anaphylaxis,
C. Future anaphylactic reactions will become increasingly more severe. individuals should be referred to an allergist or immunologist to confirm the cause of the
D. Trace amounts of an allergen in a food can cause a severe anaphylactic reaction. allergic reaction and reduce risk factors for future episodes.
48. Increased risks for fatal reactions from anaphylaxis include all of the following except: Correct: D. delay in administering antihistamines.
A. personal history of asthma. Severe anaphylaxis can be a life-threatening event and should be treated with parenteral
B. delay in administering epinephrine. epinephrine to reduce mortality risk. Antihistamines are considered second-line treatment
C. age in the teen years. but should not replace the use of epinephrine. A delay in the use of antihistamines is not
D. delay in administering antihistamines. associated with improved mortality (D).
49. Which of the following plays an essential role in type 1 hypersensitivity?
Correct: A. immunoglobulin E
A. immunoglobulin E
Anaphylaxis is a manifestation of a type I hypersensitivity reaction resulting from an IgE-me-
B. immunoglobulin A
1/2
