Anaphylaxis — CCFP MCQ
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Correct answer: A — Give intramuscular epinephrine into the lateral thigh immediately
**Answer: E – Give intramuscular epinephrine into the lateral thigh immediately.** This 4-year-old meets anaphylaxis criteria (multisystem involvement: cutaneous, respiratory, GI, mucosal). Epinephrine is the cornerstone of management and must be given immediately; delays increase mortality. The dose for children is 0.01 mL/kg up to 0.3 mL of 1:1000 dilution, administered intramuscularly into the anterolateral thigh—not subcutaneously—for rapid, reliable effect. **Distractor analysis:** Option E (antihistamine first) is a common error in practice but delays definitive therapy; antihistamines are adjunctive. Option B (salbutamol alone) treats only bronchospasm but does not reverse the underlying anaphylactic cascade. Option C (wait for hypotension) is dangerous—delayed epinephrine is associated with increased mortality and biphasic reactions. Option D (antibiotics) is irrelevant; anaphylaxis is not infection-driven. Immediate epinephrine is both life-saving and safe even if diagnosis is uncertain.
Reference: CMAJ. 'Diagnosis and management of anaphylaxis.' Canadian Medical Association Journal, 169(4): 307–311. https://www.cmaj.ca/content/169/4/307