You have just given a 10-year-old boy an injection of pollen extract as prescribed by his allergist. You are about to move on to the next patient when the boy starts to complain about nausea and a funny feeling in his chest. You note that his face is flushed and his voice sounds muffled and strained. Which of the following is the first priority in managing this episode of anaphylaxis?
a. Endotracheal intubation
b. Intramuscular injection of diphenhydramine
c. Administration of oxygen
d. Subcutaneous injection of 1:1000 epinephrine
e. Administration of corticosteroids
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is a; Endotracheal intubation.
Anaphylaxis is a medical emergency that must be recognized and managed promptly. The onset of symptoms is usually dramatic. In the case presented, the change in voice suggests impending airway compromise, making airway stabilization your top priority. The other choices are all important in managing anaphylaxis and, in reality, may be occurring concurrently; of those listed, subcutaneous epinephrine would be the first medication used. Additional treatment can include plasma expanders, diphenhydramine, and cimetidine, as indicated by the clinical course of the patient. Additional treatment such as administration of corticosteroids should be started early, but the effect will be delayed.