Master the board step 3

Master the Boards: USMLE Step 3
Angioedema
Angioedema is a sudden swelling of the face, palate, tongue, and airway in
association with minor trauma to the face or hands or the ingestion of ACE
inhibitors. The question may describe a person hit in the face with a pillow
or wood chips hitting the arm. The hereditary form occurs from deficiency
of C1 esterase inhibitor. Other symptoms include:
Consider placing people
with angioedema in the
ICU.
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Stridor
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Abdominal pain
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A lack of response to steroids
Angioedema Face
Diagnostic Testing
The diagnosis of angioedema is based on finding low levels of C2 and C4 in
the complement pathway. They are chronically depleted because of the deficiency
of the C1 esterase inhibitor. An elevated white cell count is not specific.
Ecallantide, an inhibitor of
kallikrein, is the best initial
therapy for angioedema.
Ecallantide blocks
bradykinin production.
Treatment
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Infusion of fresh frozen plasma (acute episodes)
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Chronic episodes: Ecallantide is the drug of choice for hereditary angioedema.
Androgens are also used for chronic therapy. Androgens, for unknown
reasons, raise the levels of C1 esterase inhibitor. The most frequently used
androgens are danazol and stanazol.
A patient comes to the emergency department with shortness of breath, facial
swelling, and lip swelling 30 minutes after a bee sting. There was no response to
epi-pen injection in the field. Six hours after a bolus of steroid and diphenhydramine,
the patient is still short of breath and still has lip swelling.
Where should the patient be placed?
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