Return to Scenario ListShow Learning Points most relevant to Phase 1:

Facial swelling and itchy rash

Clinical Discipline(s)/Organ System(s)
Dermatology, Immunology
Progress Test Topic(s)
A 30 year old NZ European man comes in to the Emergency Department with a widespread itchy rash that has been present for several days. This morning he also woke up with swollen eyelids and lips.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Physiology of mast cells
   - Explain the mechanism of histamine release due to allergic and non-allergic pathways and explain the role of IgE in type I hypersensitivity responses
   - Principles of adverse drug reactions
   - Pharmacology of antihistamines
Clinical and Communication Skills 
   - Take a history focusing on presence or absence of other symptoms of anaphylaxis, possible triggers for urticaria and previous episodes of urticaria or angioedema
   - Examine the patient's skin, evaluate general status and look for signs of underlying infection or disease
   - Describe the cutaneous findings using dermatological terminology
   - Make a rapid assessment as to presence or absence of airway compromise
   - Institute emergency management if there are features of anaphylaxis or airway compromise; a medium term therapy with avoidance of precipitants (where needed) and antihistamines
   - Common causes of acute urticaria (including food allergy, medications, insect stings and latex allergy) and chronic urticaria (idiopathic; physical causes such as dermographism and cholinergic urticaria; medications; autoimmune disease)
   - Explain the effect of antihistamines
   - Provide the patient with verbal and written information about urticaria and angioedema
Personal and Professional Skills 
   - Be able to counsel a patient about the likely disease course (short-lived in acute urticaria/angioedema, longer in chronic urticaria/angioedema)
   - Deal with patient anxiety and causal uncertainty
   - Recognise that it is sometimes appropriate to shift focus to management of symptoms
   - Understand the ways in which pruritus can affect an individual's sleep, function and relationships
Hauora Māori 
   - Ability to cater for differential health literacy needs of Māori patients and whānau
Population Health 
   - Community reporting of adverse drug reactions: Centre for Adverse Reactions Monitoring (CARM)
Conditions to be considered relating to this scenario
infection-induced urticaria/angioedema, idiopathic urticarial, insect bites
Less common but 'important not to miss'
anaphylaxis, angioedema, erythema multiforme, vasculitis
autoimmune disease e.g. SLE, urticarial vasculitis, hereditary angioedema (in cases of isolated angioedema)
Related Scenarios
[Compromised airway]