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Angio-oedema from ACE inhibitor — SCE Acute Medicine MCQ

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ModerateAcute Rheumatological and Dermatological EmergenciesAngio-oedema from ACE inhibitorSCE Acute Medicine

A 64-year-old man is assessed on the acute medical unit. He has tongue swelling without urticaria after starting ramipril. He has muffled voice but no wheeze or hypotension. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: B — Assess airway urgently and stop ACE inhibitor

Assess airway urgently and stop ACE inhibitor is the best answer because ACE-inhibitor angio-oedema threatens the airway and is bradykinin-mediated rather than histamine-mediated. Give broad-spectrum intravenous antibiotics within one hour is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Adrenaline may be needed if anaphylaxis is uncertain, but airway assessment is central.

Reference: BNF; Resuscitation Council UK