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Q1: Definition & Recognition (2 min)
- Define anaphylaxis (WAO / NIAID-FAAN). Distinguish it from a "simple" allergic reaction.
- Recite the three NIAID/FAAN (2006) diagnostic criteria verbatim. Which is met by acute-onset urticaria with wheeze and hypotension after a bee sting?
- Can anaphylaxis occur WITHOUT skin signs? (Yes — in 10 to 20 percent, especially drug-induced, perioperative, mastocytosis.) When do you treat?
- Anaphylactic (IgE) vs anaphylactoid (non-immunologic) — does the distinction still matter clinically? (No — call both anaphylaxis; treatment is identical.)
Q2: Immediate Management (3 min)
- What is the SINGLE most important first-line drug, and its route, site, and adult dose? (IM adrenaline 0.5 mg, anterolateral thigh.)
- Why IM and not IV initially? Why not subcutaneous?
- How do you POSITION the patient, and why? (Supine with legs elevated; empty vena cava syndrome causes fatal arrest if the symptomatic patient sits/stands.)
- When do you repeat adrenaline? (Every 5 minutes, up to 5 doses.)
- What is the role of antihistamines and corticosteroids? (Adjuncts only — they do NOT save lives.)
- What IV fluid and what volume in an adult? (Crystalloid 500 to 1000 mL bolus, repeat.)
Q3: Refractory & Special Situations (2 min)
- Define refractory anaphylaxis. What is the escalation? (Two IM doses failed — IV adrenaline infusion; consider vasopressin, methylene blue, ECMO.)
- A patient on a beta-blocker is refractory to adrenaline — what drug, what dose? (Glucagon 1 to 5 mg IV, then infusion 5 to 15 micrograms/min.)
- ACE-inhibitor angioedema — why is adrenaline ineffective, and what works? (Bradykinin-mediated; icatibant / C1-inhibitor concentrate.)
- The perioperative patient collapses 5 minutes after induction — most likely culprit? (Neuromuscular blocking agent, e.g. rocuronium.)
Q4: Investigations, Observation & Disposition (2 min)
- Which laboratory test supports the diagnosis, and what is its timing? (Serum tryptase — peaks 1 to 2 h, baseline by 6 to 8 h; sample immediately, at 1 to 2 h, and a baseline at 24 h.)
- A persistently elevated baseline tryptase after recovery — what does it suggest, and what is the next step? (Systemic mastocytosis / clonal mast-cell disorder — KIT D816V mutation, bone-marrow biopsy, allergist + haematologist.)
- What is the biphasic reaction — incidence, timing, predictors? (Up to 15 percent, within 1 to 72 h typically 10 h; severe initial reaction, two or more adrenaline doses, delayed adrenaline, high tryptase.)
- Minimum observation period? (At least 6 h UK; longer/overnight if risk factors.)
- What must the patient leave hospital with? (TWO adrenaline autoinjectors, written action plan, allergen-avoidance advice, oral antihistamine and a short steroid course, MedicAlert, urgent allergy clinic referral — and venom immunotherapy referral for insect-venom anaphylaxis.)