Anaphylaxis — RACGP Fellowship MCQ

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HardEmergency presentations in general practiceAnaphylaxisRACGP Fellowship

A 40-year-old man becomes acutely wheezy after a bee sting. He has lip swelling, urticaria, BP 86/52 mmHg and oxygen saturation 92%. He has no asthma history. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Give intramuscular adrenaline immediately and call an ambulance

Explanation lettering: D = shown as A · A = shown as B · E = shown as D · B = shown as E

This patient has anaphylaxis: acute onset following known trigger (bee sting), multi-system involvement (urticaria, angioedema of lips, bronchospasm), and haemodynamic compromise (hypotension, hypoxia). Intramuscular adrenaline is the only first-line treatment. Give 0.5 mL of 1:1000 adrenaline IM into the anterolateral thigh immediately without delay; call ambulance for transfer to hospital and observation for biphasic reaction. Keep patient supine during transfer. Option A is incorrect: antihistamines do not treat respiratory or cardiovascular manifestations and delay definitive treatment. Option C fails because beta-2 agonists alone do not address the underlying anaphylactic pathophysiology or hypotension. Options D and E are inappropriate: topical treatment is ineffective and driving home is dangerous in a haemodynamically unstable, hypoxic patient at risk of rapid deterioration.

Reference: RACGP CHECK (2013) Emergency – Anaphylaxis; Australian Prescriber (ASCIA-endorsed) Anaphylaxis – emergency management for health professionals. https://gplearning.racgp.org.au/Content/check/2013/PDF/Sept.pdf and https://australianprescriber.tg.org.au/articles/anaphylaxis-emergency-management-for-health-professionals.html