VOLUME 3 CHAPTER 5 IMMUNOLOGY
Your patient is a 46-year-old male who is unconscious on his front lawn after being stung by a bee. You note angioneurotic edema. HR = 132, BP = 76/40, RR = 24 and shallow. You should first: A. Administer high-concentration oxygen with a nonbreather mask or similar device. B. Start an IV of NS wide open and administer epinephrine 1:10,000 IV C. Administer epinephrine 1:1000 SC D. Intubate the patient
A. Administer high-concentration oxygen with a nonbreather mask or similar device.
How is a therapeutic level of epinephrine normally maintained in the pediatric patient? A. By repeating the calculated boluses every 3-5 minutes as required B. By initiating an epinephrine continuous infusion C. By supplementing the epinephrine with other vasopressors D. By initiating a dopamine drip
A. By repeating the calculated boluses every 3-5 minutes as required
Immunity resulting from a direct attack on a foreign substance by specialized cells in the immune system is: A. Cellular immunity B. Secondary response C. Humoral immunity D. Primary immunity
A. Cellular immunity
Which of the following statements about corticosteroid use in anaphylaxis treatment is TRUE? A. Corticosteroids can reduce the inflammation associated with anaphylaxis. B. Corticosteroids can help reverse bronchospasm associated with anaphylaxis. C. Administration of high-dose corticosteroids results in peripheral vasoconstriction. D. Corticosteroids stabilize mast cell and basophil membranes, preventing degranulation and histamine release.
A. Corticosteroids can reduce the inflammation associated with anaphylaxis.
Your patient is experiencing dyspnea and urticaria after ingesting penicillin. Auscultation of his lungs reveals diffuse expiratory wheezes. Which of the following medications will best help correct your patient's bronchospasm? A. Epinephrine 1:1000 SC B. 100 percent oxygen via nonrebreather mask 15 lpm C. Solu-Medrol 125 mg IV D. Ranitidine 50 mg IV
A. Epinephrine 1:1000 SC
In an allergic reaction, what substance released by mast cells and basophils causes bronchoconstriction, increased intestinal motility, vasodilation, and increased vascular permeability? A. Histamine B. Acetylcholine C. Toxins D. Epinephrine
A. Histamine
Upon identifying an antigen in the bloodstream, B cells launch a chemical attack by producing antigens specific to the antibody. This is an example of ________ immunity. A. Humoral B. Secondary C. Antibody D. Cellular
A. Humoral
Epinephrine administration results in all of the following EXCEPT: A. Hypotension B. Increased cardiac contractile force C. Tachycardia D. Increased peripheral vasoconstriction
A. Hypotension
Which of the following is the best route for administering epinephrine to patients in severe anaphylactic shock refractory to initial interventions? A. IV B. SC C. ET D. IM
A. IV
Your patient is exhibiting signs and symptoms of an allergic reaction with dyspnea and wheezing. The blood pressure is still acceptable, but the pulse oximeter is dropping despite high-flow oxygen. What should the paramedic consider administering next? A. Intramuscular epinephrine B. Intramuscular diphenhydramine C. IV epinephrine D. IV diphenhydramine
A. Intramuscular epinephrine
After administering epinephrine and a 1000 ml bolus of 0.9 percent saline, you are ordered to administer 300 mg of Tagamet slow IV push to your patient that is experiencing an anaphylactic reaction. What is the benefit of Tagamet in this scenario? A. In theory, it can block the H2 receptors in the peripheral blood vessels and reverse some vasodilation. B. It will help to reverse the bronchospasm and laryngeal edema associated with anaphylaxis. C. It will enhance the inflammatory response associated with the anaphylactic reaction. D. It is used in conjunction with epinephrine to support cardiac output and reverse vasoconstriction.
A. In theory, it can block the H2 receptors in the peripheral blood vessels and reverse some vasodilation.
Your patient tells you he was cutting down brush in the woods behind his house today and when he finished, he noticed a large rash developing on his arms and legs. He is in no outward respiratory or cardiovascular distress, but the majority of his anterior arms and legs are covered with urticaria. He lets you assess his vital signs, and they are all within normal limits. What is the best treatment option for this patient? A. Observe the patient and consider an IM injection of Benadryl or Tagamet B. Start an IV and administer a 1000 ml fluid challenge, then observe the patient C. Place him on high-flow oxygen and give 0.5 mg of 1:1000 epinephrine IM D. Immediately place him on high-flow oxygen and give 0.1 mg of 1:10,000 epinephrine IV
A. Observe the patient and consider an IM injection of Benadryl or Tagamet
How many days are needed following exposure to a new antigen so that the cellular and humoral components of the immune systems will respond to a response-inducing antigen? A. Several days B. None, response is immediate C. A few hours D. A few months
A. Several days
Which of the following is the desired physiologic reaction that occurs after the administration of a vaccine that contains live, attenuated viruses? A. The immune system will create specific antibodies to the viruses in the vaccine. B. The viruses in the vaccine act as an antigen, resulting in a nonspecific immune response. C. The immune system will create specific antigens to the viruses in the vaccine. D. The antibodies in the vaccine multiply in the body.
A. The immune system will create specific antibodies to the viruses in the vaccine.
Which of the following best describes why the secondary response to an antigen is faster than the primary response? A. The secondary response uses memory cells, which immediately release antibodies specific to the antigen. B. The secondary response uses memory cells, which immediately release antigens specific to the antibodies. C. The secondary response has fewer steps than the primary response, allowing it to progress faster. D. The primary response uses B and T cells specific to the antigens.
A. The secondary response uses memory cells, which immediately release antibodies specific to the antigen.
A male patient presents with a puncture wound to his heel from stepping on a nail. He informs you that he is visiting from El Salvador and has never received a tetanus vaccination. At the emergency room he is administered tetanus immune globulin, as well as a tetanus vaccination. Which of the following best describes the rationale for this treatment? A. The tetanus immune globulin provides passive immunity, while the tetanus vaccination provides active immunity. B. The tetanus immune globulin provides immediate protection, while the tetanus vaccination provides passive immunity by producing tetanus-specific antibodies. C. The tetanus immune globulin provides IgG and IgM antibodies for immediate protection, while the tetanus vaccination provides passive immunity by producing tetanus-specific antibodies. D. The tetanus immune globulin provides IgE antibodies for immediate protection, while the tetanus vaccination provides natural immunity by producing tetanus-specific antibodies.
A. The tetanus immune globulin provides passive immunity, while the tetanus vaccination provides active immunity.
Which sign associated with an allergic reaction should concern a caregiver the most? A. Wheezing B. Urticaria C. Warm, flushed skin D. GI distress
A. Wheezing
The principal chemical agents of the humoral immunity attack are: A. antibodies. B. red blood cells. C. neurotransmitters. D. antigens.
A. antibodies.
Following exposure to an allergen in which IgE antibodies are released, mast cells degranulate, releasing: A. histamine. B. insulin. C. epinephrine. D. T cells.
A. histamine
The chemical attack of an invading substance is: A. humoral immunity. B. an allergic reaction. C. natural immunity. D. cellular immunity.
A. humoral immunity.
Histamine causes the all of the following EXCEPT: A. increased intracranial pressure. B. bronchoconstriction. C. increased permeability. D. vasodilation.
A. increased intracranial pressure.
Your patient is a 19-year-old female who called EMS because she awoke with "itchy red patches" on her chest, back, and arms that "seem to come and go." As you obtain the history, you learn that she started taking Keflex, an antibiotic, two days ago to prevent infection in a laceration to her hand. In explaining to your patient what is going on, which of the following statements would be the most accurate? A. "These look like hives. They occur during an allergic reaction. You may have developed an allergy to the antibiotic you are taking." B. "This is a typical side effect of Keflex. It happens in most patients who take it." C. "It looks like the infection in your hand has spread to the bloodstream. The toxins from the bacteria are causing a rash." D. "I cannot say what this is, but it is not an allergic reaction. Hives do not come and go as you have described."
A. "These look like hives. They occur during an allergic reaction. You may have developed an allergy to the antibiotic you are taking."
Which of the following treatment regimens for anaphylaxis lists the medications in the correct order of administration following oxygen? A. Epinephrine, diphenhydramine, dexamethasone B. Dexamethasone, diphenhydramine, epinephrine C. Epinephrine, dexamethasone, diphenhydramine D. Diphenhydramine, epinephrine, dexamethasone
A. Epinephrine, diphenhydramine, dexamethasone
What is the name of the particular substance released from mast cells and basophils that causes bronchoconstriction? A. SRS-A B. Allergen C. Toxin D. Heparin
A. SRS-A
The standard dose of diphenhydramine for anaphylaxis is: A. 30dash40 mg. B. 50dash100 mg. C. 25dash50 mg. D. 10dash20 mg.
B. 50dash100 mg.
Which medication would be the best choice for reducing the bronchospasm and laryngeal edema associated with anaphylaxis? A. Solu-Medrol B. Albuterol C. Oxygen D. Dexamethasone
B. Albuterol
Your patient presents to you pale, diaphoretic, dyspneic, hypotensive, and complains of severe abdominal cramping. Inspiratory and expiratory wheezing is auscultated throughout all lung fields, and angioedema is also noted. What do you suspect is this patient's ailment? A. Acute anxiety B. Anaphylaxis C. Asthma attack D. Allergic reaction
B. Anaphylaxis
Which of the following is a potentially life-threatening condition involving the head, neck, face, and upper airway? A. Wheals B. Angioedema C. Hives D. Urticaria
B. Angioedema
Which medication is best for improving hypotension secondary to anaphylactic shock? A. Diphenhydramine B. Epinephrine C. Hydrocortisone D. Oxygen
B. Epinephrine
What is the term for the chemical attack staged by the immune system in response to invading substances by immunoglobulins? A. Acquired immunity B. Humoral immunity C. Cellular immunity D. Natural immunity
B. Humoral immunity
The two most common causes of fatal anaphylaxis are ________ and ________. A. Hymenoptera stings, tree nuts B. Hymenoptera stings, injected penicillin C. Shellfish, tree nuts D. Shellfish, sulfa drugs
B. Hymenoptera stings, injected penicillin
Your patient is a conscious and alert 22-year-old female who was stung by a hornet. She states that she has "allergies to bee stings" and has been told that she could die if stung. Your physical examination reveals a 1-cm-diameter, red, edematous area where she was stung on the left forearm. Her skin is warm and dry, and her lung sounds are clear and equal bilaterally. HR = 112 and regular, BP = 122/82, RR = 12 and regular, SaO2 = 98%. The most appropriate treatment for this patient would include: A. 100 percent oxygen via nonrebreather mask 15 lpm, IV of NS 1-2 L, epinephrine 1:1000 0.3 mg SC, diphenhydramine 25 mg IV B. IV of NS KVO C. 15 lpm oxygen by nonrebreather, epinephrine 1:1000 0.3 mg SC, diphenhydramine 25 mg IV, transport D. Transport only
B. IV of NS KVO
Your patient is a 43-year-old female with a history of peanut allergy. She is complaining of dizziness after eating a casserole that she later discovered contained peanuts. Your physical examination reveals warm, diaphoretic skin; a blotchy, red rash covering her chest and arms; and lung sounds that are clear and equal bilaterally. HR = 122, BP = 124/76, RR = 15 and regular, SaO2 = 97%. In addition to providing oxygen, appropriate treatment for this patient includes: A. IV of NS wide open, epinephrine 1:1000 SC, diphenhydramine IV. B. IV with crystalloid solution such as lactated Ringer's or normal saline, epinephrine 1:1000 SC, diphenhydramine IV. C. IV with crystalloid solution such as lactated Ringer's or normal saline, epinephrine 1:1000 SC, diphenhydramine IV, nebulized albuterol. D. IV with crystalloid solution such as lactated Ringer's or normal saline.
B. IV with crystalloid solution such as lactated Ringer's or normal saline, epinephrine 1:1000 SC, diphenhydramine IV.
The ___________ system is a complicated body system responsible for combating infection. A. Respiratory B. Immune C. Cardiovascular D. Nervous
B. Immune
Which of the following types of immunity provides protection from exposure to an antigen by getting a vaccination? A. Passive B. Induced active C. Humoral D. Naturally acquired
B. Induced active
Anaphylaxis most rapidly develops during what type of antigen exposure? A. Inhalation B. Injection C. Absorption D. Ingestion
B. Injection
Your patient is complaining of difficulty breathing and dizziness. You can hear audible stridor and wheezing. Which of the following will be least beneficial? A. 0.3-0.5 mg of 1:1,000 epinephrine IM B. Methylprednisolone (Solu-Medrol) C. Oxygen by nonrebreather mask D. 50 mg of diphenhydramine IV
B. Methylprednisolone (Solu-Medrol)
Your patient is a 36-year-old female, conscious and alert, sitting at her desk and complaining of a rash and itchiness after taking a sulfa antibiotic. Physical examination reveals warm and dry skin, urticaria on her chest and back, that reveal mild expiratory wheezing. HR = 100, BP = 132/78, RR = 18, SaO2 = 93%. Which of the following is the most appropriate treatment for this patient? A. Oxygen via nasal cannula, IV crystalloid solution, 5 mg epinephrine IV, 25 mg diphenhydramine IV B. Oxygen via nonrebreather mask, IV crystalloid solution, 0.3 mg epinephrine IM, and consider 25 mg diphenhydramine IV and albuterol 2.5 mg via nebulizer C. Oxygen via nasal cannula and transport only D. Oxygen via nonrebreather mask, IV crystalloid solution, 25 mg diphenhydramine IV push
B. Oxygen via nonrebreather mask, IV crystalloid solution, 0.3 mg epinephrine IM, and consider 25 mg diphenhydramine IV and albuterol 2.5 mg via nebulizer
Which sign associated with an allergic reaction should concern a caregiver the most? A. Urticaria B. Wheezing C. GI distress D. Warm, flushed skin
B. Wheezing
You are called for a female patient in respiratory distress. The patient reports an allergy to cats and bees; however, she is not aware of recent exposure to either. She states her current complaint is similar to previous episodes but the symptoms are much worse this time and developed much quicker than usual. Your primary concern would be: A. pulmonary disease since exposure was delayed. B. an anaphylactic reaction despite the inability to identify the antigen. C. allergic reaction since the patient has had them before. D. hyperventilation syndrome since there is no antigen.
B. an anaphylactic reaction despite the inability to identify the antigen.
You respond to a report of a patient with shortness of breath. Upon arrival, you find a patient who has been stung by a bee. The patient is displaying urticaria and wheezing. You suspect: A. ARDS. B. anaphylaxis. C. asthma. D. meningitis.
B. anaphylaxis.
The immune response is a cascade that reacts to a: A. bacteria. B. pathogen. C. toxin. D. virus.
B. pathogen.
Initial exposure to an antigen is referred to as: A. allergy. B. sensitization. C. anaphylaxis. D. desensitization.
B. sensitization.
The first medication administered to a patient experiencing an anaphylactic reaction should be: A. Glucagon B. High-concentration oxygen C. Diphenhydramine D. Epinephrine
B. High-concentration oxygen
Your patient is a 48-year-old female who is supine on the floor of a neighborhood health clinic. She became unconscious after receiving 250 mg of IM doxycycline. Clinic staff reports that the patient "broke out in hives and lost consciousness." The patient is being ventilated by bag-valve mask and has an IV of normal saline running wide open. A nurse practitioner on the scene informs you that, before your arrival, he administered 2 doses of 0.5 mg of epinephrine SC, 50 mg of diphenhydramine IV, and 1 L of NS. HR = 138; BP = 84/60; RR = 12/min, assisted with BVM; SaO2 = 94%. Of the following, which is the most appropriate continued treatment of this patient? A. Continue administering fluids and transport to the nearest facility B. Intubate, administration of dopamine IV infusion, rapid transport C. Initiate a second IV of NS wide open, intubate and hyperventilate, transport D. Intubate, Solu-Medrol IV, 250 cc NS fluid challenge, transport
B. Intubate, administration of dopamine IV infusion, rapid transport
How is the children's dosage of epinephrine calculated for anaphylactic shock? A. 0.01 mg/kg given over 3-5 minutes IVP B. 0.1 mg/kg given over 3-5 minutes IVP C. 0.01 mg/kg IVP D. 0.1 mg/kg IVP
C. 0.01 mg/kg IVP
The administration of a vaccine results in ________ immunity. A. Natural induced B. Passive induced C. Active induced D. Natural passive
C. Active induced
You are dispatched to a soccer field for a referee complaining of shortness of breath. After determining that the scene is safe, you proceed to the sidelines where your patient is in obvious respiratory distress with some significant perioral cyanosis, red splotches on his face and chest, and swelling in his left leg. You note as you approach that you hear wheezing and stridor, and he has a respiratory rate of 34. When you ask the patient if he can speak, he slowly responds to shake his head "no." You ask him if he is choking, and you again get a "no." While your partner starts the patient on high-flow oxygen via a nonrebreather mask, you get a weak, regular radial pulse of 122 bpm. At that time your patient goes unresponsive. What is your next action? A. Initiate an IV B. Draw up benedryl and Tagamet C. Administer epinephrine D. Prepare an epinephrine infusion
C. Administer epinephrine
Which of the following is a potentially life-threatening condition involving the head, neck, face, and upper airway? A. Urticaria B. Hives C. Angioedema D. Wheals
C. Angioedema
Which of the following is a substance that enters the human body and induces an immune response? A. Basophil B. Antibody C. Antigen D. Neutrophil
C. Antigen
Which of the following medications is NOT used as a first-line drug to counter the physiologic effects of the release of slow-reacting substance of anaphylaxis (SRS-A)? A. Diphenhydramine B. Albuterol C. Dopamine D. Epinephrine 1:10,000
C. Dopamine
The two most common causes of fatal anaphylaxis are ________ and ________. A. Hymenoptera stings, tree nuts B. Shellfish, sulfa drugs C. Hymenoptera stings, injected penicillin D. Shellfish, tree nuts
C. Hymenoptera stings, injected penicillin
Your patient is experiencing profuse hives, itching, dyspnea, coughing, tachycardia, and dizziness after eating seafood 5 minutes ago. You might also expect to see all of the following additional signs EXCEPT: A. Bronchospasm B. Laryngeal edema C. Hypertension D. Cyanosis
C. Hypertension
You respond to a patient with shortness of breath after he took a dose of an antibiotic. You find your patient with audible stridor and uticaria. You should administer: A. SQ epinephrine 1:1000 0.3dash0.5 mg. B. albuterol 5 mg. C. IM epinephrine 1:1000 0.3dash0.5 mg. D. diphenhydramine 75 mg.
C. IM epinephrine 1:1000 0.3dash0.5 mg.
Your patient is a conscious and alert 22-year-old female who was stung by a hornet. She states that she has "allergies to bee stings" and has been told that she could die if stung. Your physical examination reveals a 1-cm-diameter, red, edematous area where she was stung on the left forearm. Her skin is warm and dry, and her lung sounds are clear and equal bilaterally. HR = 112 and regular, BP = 122/82, RR = 12 and regular, SaO2 = 98%. The most appropriate treatment for this patient would include: A. 15 lpm oxygen by nonrebreather, epinephrine 1:1000 0.3 mg SC, diphenhydramine 25 mg IV, transport B. 100 percent oxygen via nonrebreather mask 15 lpm, IV of NS 1-2 L, epinephrine 1:1000 0.3 mg SC, diphenhydramine 25 mg IV C. IV of NS KVO D. Transport only
C. IV of NS KVO
Your patient is a 31-year-old female complaining of dizziness and difficulty breathing after being stung by a bee. You note that she is extremely anxious, and your physical examination reveals a rapidly developing urticaria to her shoulders, neck, and face. Your partner has administered oxygen via a nonrebreather, initiated IV access, placed the patient on the cardiac monitor, and administered epinephrine SC and diphenhydramine IV. Despite this, you also note that her voice is quickly becoming more hoarse and she has developed expiratory wheezes in all lung fields. HR = 128, BP = 100/70, RR = 20, SaO2 = 99%. What should be your major concern at this point, and what is the most appropriate treatment? A. Hypotension leading to cardiovascular collapse; administer fluids wide open and initiate a dopamine infusion B. Increased bronchospasm leading to respiratory arrest; administer albuterol via nebulizer C. Laryngeal edema leading to total airway occlusion; intubate D. Increased bronchospasm leading to respiratory arrest; administer epinephrine IV
C. Laryngeal edema leading to total airway occlusion; intubate
Your patient is a 31-year-old female complaining of dizziness and difficulty breathing after being stung by a bee. You note that she is extremely anxious, and your physical examination reveals a rapidly developing urticaria to her shoulders, neck, and face. Your partner has administered oxygen via a nonrebreather, initiated IV access, placed the patient on the cardiac monitor, and administered epinephrine SC and diphenhydramine IV. Despite this, you also note that her voice is quickly becoming more hoarse and she has developed expiratory wheezes in all lung fields. HR = 128, BP = 100/70, RR = 20, SaO2 = 99%. What should be your major concern at this point, and what is the most appropriate treatment? A. Increased bronchospasm leading to respiratory arrest; administer epinephrine IV B. Hypotension leading to cardiovascular collapse; administer fluids wide open and initiate a dopamine infusion C. Laryngeal edema leading to total airway occlusion; intubate D. Increased bronchospasm leading to respiratory arrest; administer albuterol via nebulizer
C. Laryngeal edema leading to total airway occlusion; intubate
The initial exposure of an individual to an antigen is referred to as what? A. Allergy B. Hypersensitivity C. Sensitization D. Active immunity
C. Sensitization
Which of the following is true regarding the vital signs of a patient experiencing the onset severe allergic and anaphylactic reactions? A. The patient will not experience any symptoms for a few hours after exposure. B. The patient will often be unconscious. C. The patient will experience an increase in heart rate. D. The patient will temporarily lose vision.
C. The patient will experience an increase in heart rate.
Which of the following statements about the use of vasopressors in the treatment of anaphylaxis is TRUE? A. A norepinephrine infusion can correct the peripheral vasodilation that occurs secondary to SRS-A release by basophils and mast cells. B. An epinephrine infusion can correct the peripheral vasodilation that occurs secondary to SRS-A release by basophils and mast cells. C. A norepinephrine infusion encourages a net movement of plasma from the intravascular space to the vascular space, raising blood pressure. D. A dopamine infusion can correct the peripheral vasodilation that occurs secondary to histamine release by basophils and mast cells.
D. A dopamine infusion can correct the peripheral vasodilation that occurs secondary to histamine release by basophils and mast cells.
You are called to the home of a 28-year-old male who is complaining of hoarseness, a scratchy sensation in the back of his throat, and palpitations. The symptoms began about 30 minutes ago and have grown steadily worse ever since the patient ingested prescribed penicillin 1 hour ago. Patient management should include all of the following EXCEPT: A. Supplemental oxygen via nonrebreather mask B. Epinephrine 1:1000 0.3 mg SC C. IV of NS KVO D. Administration of an IV beta-blocker
D. Administration of an IV beta-blocker
A 19-year-old female is complaining of itching on her upper extremities, across her chest, and on her neck. She states that she started taking a new antibiotic for a urinary tract infection about 30 minutes ago, as prescribed. She states she has no allergies but upon physical exam, you do see some diffuse urticaria on her right arm and anterior neck. No wheezing or dypnea is noted. Lung sounds are clear. Pulse is 90 and regular and blood pressure is 130/80. What would you consider as the field diagnosis? A. Delayed hypersensitivity reaction B. Activation of the SRS-A complex C. Anaphylactic reaction to the medication D. Allergic reaction to the medication
D. Allergic reaction to the medication
Which of the following statements about using antihistamines in the treatment of anaphylaxis is TRUE? A. Antihistamines displace histamine, then block histamine receptors. B. Antihistamines block H1 and H2 receptors and prevent further release of histamine from B and T cells. C. Blocking of H1 receptors results in mild vasoconstriction, while the blocking of H2 receptors results in bronchodilation. D. Antihistamines block histamine receptors and reduce histamine release from mast cells and basophils.
D. Antihistamines block histamine receptors and reduce histamine release from mast cells and basophils.
Which monitoring devices are used by the paramedic for a patient anaphylaxis? A. Monitoring devices are not necessary B. Cardiac monitor, RAD-57, pulse oximetry C. Mechanical chest compression device, end-tidal carbon dioxide detector, tourniquets D. Cardiac monitoring, pulse oximetry, end-tidal carbon dioxide detector
D. Cardiac monitoring, pulse oximetry, end-tidal carbon dioxide detector
Your partner experiences an itchy, red rash on her hands that stops at the wrists after using a new brand of glove your service purchased. Her skin is warm, dry, and nondiaphoretic; the rash is isolated to her hands; and her lung sounds are clear bilaterally. She has no other complaints. HR = 88, RR = 12, BP = 122/80. Of the following treatments, which is most appropriate? A. Advise the dispatcher you will be going out of service B. Oxygen via nasal cannula 4 lpm, cardiac monitor, IV of NS KVO, epinephrine IV, diphenhydramine IM C. Oxygen via nonrebreather mask 15 lpm, cardiac monitor, IV of NS KVO, epinephrine SC, diphenhydramine IM D. Diphenhydramine IM
D. Diphenhydramine IM
Which treatment would best halt the urticaria associated with an allergic reaction? A. Oxygen B. Dopamine and albuterol C. Solu-Medrol D. Epinephrine and diphenhydramine
D. Epinephrine and diphenhydramine
Which one of the following histamine receptor types is located in the central nervous system? A. H4 B. H1 C. H2 D. H3
D. H3
Which of the following best explains the cause of the histamine and heparin release in response to exposure to an antigen? A. IgG and IgM antibodies have activated basophils and mast cells, resulting in degranulation. B. Humoral cells have initiated a chemical attack on the antigens. C. IgE antibodies have activated the membranes of B and T cells, resulting in release of histamine and heparin. D. IgE antibodies have attached themselves to the membranes of basophils and mast cells, resulting in degranulation.
D. IgE antibodies have attached themselves to the membranes of basophils and mast cells, resulting in degranulation.
An allergen's most common route of entry in an anaphylactic reaction is: A. Absorption B. Inhalation C. Injection D. Ingestion
D. Ingestion
Diphenhydramine is administered in anaphylaxis because it: A. Reduces histamine release from mast cells and basophils B. Blocks histamine receptors C. Possibly reduces peripheral vasodilation D. Produces all of the above
D. Produces all of the above
You respond to a report of a patient with shortness of breath. Upon arrival, you find a patient who has been stung by a bee. The patient is displaying urticaria and wheezing. You suspect: A. asthma. B. ARDS. C. meningitis. D. anaphylaxis.
D. anaphylaxis.
As anaphylaxis progresses for an unresponsive and intubated patient, you would expect end tidal dioxide levels may: A. lower with the administration of fluid boluses. B. stabilize with the administration of diphenhydramine. C. increase due to swelling of the glottis opening and more carbon dioxide retained. D. climb due to the development of both respiratory and metabolic acidosis.
D. climb due to the development of both respiratory and metabolic acidosis.
The effect of histamine on the gastrointestinal system includes A. stridor. B. hypomotility. C. constipation. D. diarrhea.
D. diarrhea.
Following exposure to an allergen in which IgE antibodies are released, mast cells degranulate, releasing: A. epinephrine. B. insulin. C. T cells. D. histamine.
D. histamine.
Histamine causes the all of the following EXCEPT: A. increased permeability. B. vasodilation. C. bronchoconstriction. D. increased intracranial pressure
D. increased intracranial pressure
Your patient is a 19-year-old female who called EMS because she awoke with "itchy red patches" on her chest, back, and arms that "seem to come and go." As you obtain the history, you learn that she started taking Keflex, an antibiotic, two days ago to prevent infection in a laceration to her hand. In explaining to your patient what is going on, which of the following statements would be the most accurate? A. "It looks like the infection in your hand has spread to the bloodstream. The toxins from the bacteria are causing a rash." B. "I cannot say what this is, but it is not an allergic reaction. Hives do not come and go as you have described." C. "This is a typical side effect of Keflex. It happens in most patients who take it." D. "These look like hives. They occur during an allergic reaction. You may have developed an allergy to the antibiotic you are taking."
D. "These look like hives. They occur during an allergic reaction. You may have developed an allergy to the antibiotic you are taking."
Your patient is a 48-year-old female who is supine on the floor of a neighborhood health clinic. She became unconscious after receiving 250 mg of IM doxycycline. Clinic staff reports that the patient "broke out in hives and lost consciousness." The patient is being ventilated by bag-valve mask and has an IV of normal saline running wide open. A nurse practitioner on the scene informs you that, before your arrival, he administered 2 doses of 0.5 mg of epinephrine SC, 50 mg of diphenhydramine IV, and 1 L of NS. HR = 138; BP = 84/60; RR = 12/min, assisted with BVM; SaO2 = 94%. Of the following, which is the most appropriate continued treatment of this patient? A. Intubate, Solu-Medrol IV, 250 cc NS fluid challenge, transport B. Continue administering fluids and transport to the nearest facility C. Initiate a second IV of NS wide open, intubate and hyperventilate, transport D. Intubate, administration of dopamine IV infusion, rapid transport
D. Intubate, administration of dopamine IV infusion, rapid transport
