Nremt Paramedic Level Quiz: Allergic Reactions Anaphylaxis And Immunologic Emergencies

What this quiz covers

This quiz focuses on Allergic Reactions Anaphylaxis And Immunologic Emergencies, giving you a quick way to practice the rules, question types, and explanations that matter most for Nremt Paramedic Level.

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

Question 1

1. H2 blockers provide synergistic bronchodilation when combined with albuterol.
2. Blocking both H1 and H2 receptors may provide more complete relief of cutaneous symptoms like urticaria. (correct answer)
3. H2 blockers are the primary treatment for the gastrointestinal symptoms of anaphylaxis.
4. Famotidine potentiates the vasopressor effects of epinephrine on the cardiovascular system.

Explanation: Histamine acts on multiple receptor types. While H1 receptors are primarily responsible for urticaria and pruritus, H2 receptors are also present in the skin and contribute to vasodilation and edema. Blocking both receptor types with an H1 and H2 antagonist may be more effective in treating cutaneous manifestations than blocking H1 receptors alone. H2 blockers do not have significant effects on bronchodilation, GI symptoms in the acute phase, or potentiation of epinephrine.

Question 2

1. Delay airway interventions until antihistamines have been administered
2. Provide oxygen, prepare suction, and be ready for advanced airway if worsening (correct answer)
3. Perform immediate endotracheal intubation before giving epinephrine
4. Place the patient flat and apply a nonrebreather without further planning

Explanation: This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on airway management in potential compromise (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, stridor and facial swelling indicate possible airway involvement, necessitating preparedness for deterioration. The correct answer involves providing oxygen, preparing suction, and readiness for advanced airway intervention. A common distractor might involve immediate intubation without preparation, which is incorrect as it skips supportive measures. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and practice airway management drills. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

Question 3

1. Continuous ECG and frequent reassessment of airway, BP, and mental status (correct answer)
2. Stop reassessments once rash improves because recurrence is unlikely
3. Check vital signs only on arrival to avoid stimulating the patient
4. Remove oxygen after epinephrine to prevent hyperoxia-related bronchospasm

Explanation: This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on transport monitoring (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, post-epinephrine care requires vigilance for recurrence or complications. The correct answer involves continuous ECG and frequent reassessment of key parameters. A common distractor might involve stopping monitoring if rash improves, which is incorrect due to biphasic risks. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and maintain monitoring. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

Question 4

1. 0.3 mg IM epinephrine (1 mg/mL) with airway-focused monitoring (correct answer)
2. Diphenhydramine 25–50 mg IV/IM as the sole initial medication
3. Normal saline bolus only, then reassess for rash resolution
4. Nebulized albuterol only, then contact medical control for further orders

Explanation: This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on treatment escalation with worsening symptoms (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, worsening urticaria and hoarseness suggest progression to anaphylaxis with airway involvement. The correct answer involves prompt IM epinephrine administration with airway monitoring. A common distractor might involve antihistamines alone, which is incorrect for systemic symptoms. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and recognize progression cues. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

Question 5

1. It slows the heart rate and reduces airway tone to prevent tachycardia
2. It causes bronchodilation and vasoconstriction to improve ventilation and perfusion (correct answer)
3. It blocks histamine receptors to eliminate rash and itching only
4. It reduces blood pressure to limit capillary leakage and edema

Explanation: This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on pharmacology and epinephrine's mechanism (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, persistent hypotension and bronchospasm highlight epinephrine's role in reversing these effects. The correct answer involves understanding epinephrine's bronchodilation and vasoconstriction to improve ventilation and perfusion. A common distractor might involve histamine blocking as its primary action, which is incorrect as epinephrine targets adrenergic receptors. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and review medication mechanisms. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

Question 6

1. Exact time and dose of the new medication and any prior reactions (correct answer)
2. Whether the patient has eaten spicy foods in the last 24 hours
3. Family history of asthma during childhood
4. Last dental visit and recent fluoride exposure

Explanation: This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on history-taking and assessment (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, the patient’s urticaria and abdominal pain after a new antibiotic suggest a possible allergic reaction, making details about the medication crucial. The correct answer involves gathering information on the timing, dose, and prior reactions to guide treatment decisions. A common distractor might involve unrelated history like diet or family asthma, which is incorrect as it does not directly inform the allergic response. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and practice targeted questioning. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

Question 7

1. Generalized hives appearing within minutes of exposure
2. Wheezing with hypotension or signs of poor perfusion (correct answer)
3. Itching at the sting site only
4. Mild nausea without respiratory complaints

Explanation: This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on symptom differentiation (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, urticaria, wheezing, and cramping are present, but wheezing with hypotension is most indicative. The correct answer involves recognizing combined respiratory and circulatory compromise. A common distractor might involve generalized hives alone, which is incorrect without systemic effects. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and prioritize critical symptoms. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

Question 8

1. Administer diphenhydramine 25–50 mg IV/IM and reassess lung sounds
2. Administer 0.3 mg IM epinephrine (1 mg/mL) and begin high-flow oxygen (correct answer)
3. Place the patient supine with legs elevated and delay medications until IV access
4. Give albuterol nebulization first and monitor blood pressure for improvement

Explanation: This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on rapid assessment and intervention for life-threatening symptoms (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, the patient’s symptoms—such as wheezing and hypotension—indicate anaphylaxis, necessitating immediate epinephrine administration and oxygen therapy. The correct answer involves recognizing these critical symptoms and prioritizing epinephrine as the first-line treatment along with high-flow oxygen. A common distractor might involve suggesting antihistamines or albuterol first, which is incorrect because they do not address the systemic effects as quickly as epinephrine. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and practice rapid epinephrine administration. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

Question 9

1. It is reserved for systemic involvement, improving bronchospasm and hypotension rapidly (correct answer)
2. It is the preferred treatment for isolated hives because it prevents all rashes
3. It replaces the need for airway assessment in allergic reactions
4. It works primarily by blocking histamine receptors to stop itching

Explanation: This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on epinephrine's appropriate use (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, isolated hives with stable vitals do not warrant epinephrine. The correct answer involves reserving it for systemic involvement like bronchospasm or hypotension. A common distractor might involve using it for all rashes, which is incorrect. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and understand medication indications. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

Question 10

1. Keep suction and BVM ready, position for comfort, and prepare advanced airway backup (correct answer)
2. Force the patient supine to maximize venous return regardless of breathing comfort
3. Avoid any airway equipment to reduce agitation and delay reassessment
4. Attempt blind nasotracheal intubation as the first airway intervention

Explanation: This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on airway management during transport (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, anxiety and hoarseness indicate potential airway issues without full obstruction. The correct answer involves preparing equipment and positioning for comfort. A common distractor might involve forcing supine position, which is incorrect if it worsens breathing. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and adapt airway plans. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

Question 11

1. Oral cetirizine and observation for symptom progression at home
2. IV diphenhydramine as the initial medication to reverse bronchospasm
3. IM epinephrine (1 mg/mL) administered promptly, with airway and perfusion support (correct answer)
4. Nebulized albuterol alone to treat the allergic response systemically

Explanation: This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on primary treatment protocols (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, wheezing, hives, and hypotension confirm anaphylaxis. The correct answer involves prompt IM epinephrine with supportive care. A common distractor might involve antihistamines first, which is incorrect for acute reversal. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and administer epinephrine. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

Question 12

1. Encourage oral fluids and ambulation to improve blood pressure naturally
2. Wait for hospital arrival because repeat dosing is never indicated prehospital
3. Administer antihistamine only and discontinue oxygen to reduce tachycardia
4. Reassess airway and perfusion and give repeat IM epinephrine per protocol (correct answer)

Explanation: This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on managing recurrence (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, symptom recurrence after initial dose indicates need for repeat treatment. The correct answer involves reassessing and administering repeat epinephrine per protocol. A common distractor might involve waiting for hospital, which is incorrect for biphasic reactions. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and handle recurrences. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

Question 13

1. Whether the patient has had recent sun exposure
2. Whether the patient prefers tablets versus liquid medications
3. Any throat tightness, voice change, wheezing, or lightheadedness since onset (correct answer)
4. Whether the patient has a history of kidney stones

Explanation: This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on pre-treatment assessment (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, hives and itching with normal vitals require checking for subtle progression. The correct answer involves inquiring about symptoms like throat tightness or wheezing. A common distractor might involve preferences for medication form, which is incorrect for urgency. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and ask key questions. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

Question 14

1. Norepinephrine infusion to provide potent alpha-adrenergic effects.
2. Glucagon 1-2 mg IV to bypass the beta-adrenergic receptor site. (correct answer)
3. Dopamine infusion titrated to maintain a systolic blood pressure of 90 mmHg.
4. Push-dose phenylephrine to rapidly increase systemic vascular resistance.

Explanation: Patients on beta-blockers may have an attenuated or refractory response to epinephrine. Glucagon has positive inotropic and chronotropic effects that are not mediated by beta-adrenergic receptors. It can therefore be effective in treating refractory hypotension in anaphylaxis in this specific patient population. While other vasopressors might be used, glucagon is the classic and most appropriate next choice for a patient on beta-blockers.

Question 15

1. Administer a second dose of epinephrine 0.18 mg IM via syringe. (correct answer)
2. Administer 2.5 mg of albuterol via nebulizer as a primary intervention.
3. Establish IV access and administer 18 mg of diphenhydramine.
4. Contact medical control to request an order for IV corticosteroids.

Explanation: The patient has signs of systemic reaction involving two body systems (skin and respiratory), which constitutes anaphylaxis. The first-line treatment is epinephrine. The initial dose from the auto-injector has not resolved his respiratory symptoms. The correct pediatric dose for epinephrine 1:1,000 is 0.01 mg/kg, which for this 18 kg patient is 0.18 mg. Administering a second, correctly calculated dose is the priority. Albuterol is an important adjunct for wheezing but does not address the systemic inflammatory cascade. Antihistamines and steroids are secondary treatments and should not delay repeat epinephrine administration.

Question 16

1. Administer 1 gram of calcium chloride IV over 60 seconds.
2. Initiate an epinephrine infusion at 2-10 mcg/min, titrated to effect. (correct answer)
3. Administer 2 grams of magnesium sulfate IV over 10 minutes.
4. Give an additional 1.0 mg of epinephrine 1:10,000 via rapid IV push.

Explanation: This patient is in profound, refractory anaphylactic shock. After IM epinephrine and fluids have failed, the next step is intravenous vasopressor support. An epinephrine infusion is the preferred agent, allowing for careful titration to achieve a target blood pressure (e.g., SBP > 90 mmHg). A rapid IV push of 1.0 mg epinephrine (as used in cardiac arrest) would be dangerously excessive and likely cause lethal arrhythmias. Calcium and magnesium do not have a primary role in treating anaphylactic shock.

Question 17

1. To increase the heart rate and improve cardiac contractility.
2. To cause bronchodilation and relieve respiratory distress.
3. To suppress the release of histamine from mast cells and basophils.
4. To cause vasoconstriction, which increases blood pressure and reduces edema. (correct answer)

Explanation: Epinephrine has multiple effects. Its alpha-1 adrenergic effects cause peripheral vasoconstriction, which combats the profound vasodilation seen in anaphylaxis. This action increases systemic vascular resistance, raises blood pressure, and reduces edema formation (including angioedema). Beta-1 effects increase heart rate and contractility. Beta-2 effects cause bronchodilation and suppress further mediator release. While all are beneficial, vasoconstriction is the specific function of the alpha-1 effect.

Question 18

1. The deltoid muscle of the upper arm.
2. The subcutaneous tissue of the abdomen.
3. The vastus lateralis muscle of the anterolateral thigh. (correct answer)
4. The gluteus medius muscle of the buttock.

Explanation: The anterolateral thigh (vastus lateralis muscle) is the recommended site for IM epinephrine administration in anaphylaxis. This large, well-vascularized muscle provides more rapid and reliable drug absorption compared to the deltoid or gluteal muscles. Subcutaneous injection has been shown to result in slower absorption and lower peak plasma concentrations, which is undesirable in a life-threatening emergency.

Question 19

1. Administer a 500 mL bolus of normal saline.
2. Increase the epinephrine infusion rate. (correct answer)
3. Administer 1 mg of glucagon IV push.
4. Administer hydrocortisone 100 mg IV.

Explanation: The patient is on a titratable vasopressor infusion for hemodynamic support post-anaphylaxis. A sudden drop in blood pressure indicates that the current dose is insufficient to overcome the vasodilation. The most direct and immediate action is to titrate the infusion upward to increase the vasopressor effect and restore blood pressure. While a fluid bolus may also be helpful, adjusting the primary vasoactive medication is the priority. Glucagon is for beta-blocker associated resistance, and steroids have no immediate effect on blood pressure.

Question 20

1. Botulism poisoning
2. Ciguatera fish poisoning
3. Norovirus outbreak
4. Scombroid poisoning (correct answer)

Explanation: Scombroid poisoning results from the ingestion of fish (like tuna, mackerel, mahi-mahi) with high levels of histamine, produced by bacteria in improperly stored fish. The symptoms are nearly identical to an IgE-mediated allergic reaction because the underlying chemical mediator (histamine) is the same. The key diagnostic clue is often multiple people becoming ill after eating the same meal. While treatment is similar (antihistamines, supportive care), it's important to differentiate it from a true allergy.