VOLUME 3 CHAPTER 5 IMMUNOLOGY

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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


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