Listening Part B
Listening Sub-Test: Part B
Anaphylaxis Questions 1. Complete and answer the following statements and questions. a) Complete the list of characteristics associated with anaphylaxis Upper airway obstruction ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Hypotension b) In children food is a common trigger factor, what other trigger factors are mentioned? ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ c)How is an anaphylactoid reaction different to an anaphylactic reaction? ______________________________________________________________ ________________________________________________________________________________ d) What example is given of an anaphylactoid reaction? ___________________________________________________________
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Listening Part B
2. Complete the gaps in the summary. Anaphylaxis is ________________________ and can occur at any time. Milder forms of anaphylaxis occur much more frequently than __________________ anaphylaxis. An Australian survey found that _____________________school children had suffered from anaphylaxis before. In areas where native Myrmecia ant species are common, _____________________ adults have experienced anaphylaxis after __________________. However, deaths from anaphylaxis are ________________________, and estimated to occur at a rate of _________________________ population per year. Hospital-‐based _____________________ in an emergency department suggest a death rate of 1 per 100 to 200 ___________________ of anaphylaxis treated. Some evidence suggests the incidence of ____________________________ and anaphylaxis, like that of allergic rhinitis and atopic _________________ may be increasing. 3. Multiple Choice: Circle the best answer. According to the speaker, which of the following does not influence the
possibility of anaphylaxis? a) genetic history b) previous allergic response c) seasons & environment True or False: Circle the best answer.
Inhalation of a substance can lead to anaphylaxis. True/False
Mosquito bites can trigger an anaphylactic response. True/False
Skin contact with food is a relatively common cause of anaphylaxis.
True/False
Multiple Choice: Circle the best answer
According to the speaker, which of the following is not commonly associated with severe allergic reaction? a) grains b) eggs c) fish
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Which of the following statements is correct? a) 80% of children have some kind of food allergy b) Anaphylactic reaction to food is rare in adults c) Most anaphylaxis cases in children result from food allergy
4. Complete the following table regarding clinical features of anaphylaxis Category
Symptoms rhinitis
Mucocutaneous Zones
a) _____________________ b) _____________________ c) _____________________ d) _____________________
e) ___________________
stomach pain f) _____________________ vomiting h) _____________________
g) ___________________
dizziness confusion i)
_____________________
j)
_____________________ Throat and chest tightness
k) ______________________ Respiratory
coughing and wheezing l)
______________________
m) ______________________ n) ______________________ Cardiovascular
o) ______________________ cardiac arrest
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5. Answer the following questions. a) In children, what is the main risk factor for childhood death due to food allergy?
_________________________________________________
b) What do the symptoms of dyspnoea, sweating & nausea indicate?
_________________________________________________
6. Complete the following information card on anaphylaxis treatment
Immediate assessment of_________________________breathing and _____________________ required.
Adrenalin should be injected________________________________________.
________________________________________should be administered if necessary.
Individuals should carry an _________________________________________.
Emergency surgery includes placing a tube directly into _________________.
One treatment for shock includes is giving fluids___________________________.
_______________________________& ___________________________ may help to reduce symptoms.
The ________________________ is poor without immediate treatment
No _____________________________ apart from repeat anaphylactic attacks
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Listening Part B
7. Complete the following lists Long term management of anaphylaxis includes
o Specialist assessment o Avoid common trigger factors such as certain kinds of
__________________________________________
__________________________________________
__________________________________________
o Avoid cofactors such as
__________________________________________
__________________________________________
__________________________________________
o Educating patients to identify ______________________________ o Wearing a ___________________________________________________ 8. Answer the following questions. a) How can anaphlyactic reaction to insect stings be prevented?
________________________________________________
b) What potential benefit is associated with vaccine development?
_________________________________________________
c) What pre-treatment medications can be given to people with a history of drug allergies?
_______________________________________________
_______________________________________________
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End of Part B You now have 2 minutes to check your answers. Now check your results and add up your score with on the answer sheet. Your Score________ Total Marks 42 To pass the listening test you need to get at least 65%, so for this exam you need to get at least Answer Sheet Total Marks: 65 One mark for each correct answer. Underlined words essential. Variations in vocabulary and grammar are acceptable Slash / indicates alternative answers Brackets (_______) indicate optional details which do not need to be included Question 1 breathing difficulties rash oedema hayfever eczema asthma can occur with no previous exposure to the allergen radiographic contrast material/dye injected into arteries Question 2 life-‐threatening fatal 1 in 170 1/170 1 in 50 1/50 stings uncommon 1 per 3 million ,1/3million studies episodes food allergy dermatitis Question 3 c true false false a c Question 4 a) hives b) (intense) itchiness c) oedema/swelling d) watery eyes e) abdominal f) nausea g) neurological h) (throbbing)headache i) loss of consciousness/collapse j) incontinence k) dysphagia l) dyspnoea m) cyanosis/ bluish ski discolouration n) palpitations o) rapid heart rate Question 5 a) poorly controlled asthma
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Listening Part B b) low blood pressure Question 6 airway circulation without delay CPR Epipen trachea intraveneously antihistamines steroids prognosis long term effects Question 7 food stringing insects medication exercise alcohol (consumption) (taking) NSAIDS early warning symptoms medical alert bracelet Question 8 (with) venom immunotherapy (sufferers can) build up a tolerance to allergy causing foods corticosteroids antihistamines
Transcript Now read question 1 Pause 10 seconds Now answer question 1 What is Anaphylaxis? Anaphylaxis is a serious, rapid-onset, allergic reaction that can result in death. Severe anaphylaxis affects the whole body and is characterised by life-threatening upper airway obstruction, breathing difficulties, rash, oedema and in some cases hypotension leading to shock . Anaphylaxis in children is most often caused by food and breathing difficulties is a common symptom. Importantly, there is usually a background of hypersensitivity reactions, such as hay fever, eczema or asthma. Anaphylaxis is a medical emergency where immediate treatment is needed to prevent potential death. When exposed to a foreign substance, some people suffer reactions identical to anaphylaxis, but in which no allergy is involved. These reactions are called anaphylactoid, which means anaphylaxis-like reactions. In anaphylaxis, the immune system must be "primed" by previous allergen exposure. On the other hand, anaphylactoid reactions can occur with no previous allergen exposure at all. An example of something that can bring on an anaphylactoid type of severe reaction is radiographic contrast material:the dye injected into arteries and veins to make them show up on an x-ray. Although the mechanism of an anaphylactoid reaction is different, the allergy treatment is the same. Pause: 15 seconds Now read question 2 Pause 15 seconds Now answer question 2 I will now introduce some statistics on anaphylaxis. Anaphylaxis occurs infrequently. However, it is life-threatening and can occur at any time. Milder forms of anaphylaxis occur much more frequently than fatal anaphylaxis. An Australian survey of parent-reported allergy and anaphylaxis found that 1 in 170 school children had suffered at least one episode of anaphylaxis. Another Australian study showed that, in areas where native Myrmecia ant species are prevalent, 1 in 50 adults have experienced anaphylaxis after stings from native Myrmecia species or honeybees. However, deaths from anaphylaxis are uncommon, and estimated to occur at a rate of 1 per 3 million population per year. In areas where sting allergy is common, the death rate may be higher than this. Hospital-based studies suggest a death rate in the order of 1 per 100–200 episodes of anaphylaxis treated in an emergency department. There is some evidence that the incidence of food allergy and anaphylaxis — like that of allergic rhinitis and atopic dermatitis — may be increasing. Pause: 15 seconds Now read question 3 Pause 15 seconds Now answer question 3 This resource was developed by OET Online and is subject to copyright © Website: http://oetonline.com.au
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Risk Factors for Anaphylaxis The likelihood of an individual having anaphylaxis is influenced by the following points: • age • gender • atopy: the genetic tendency to develop classic allergic diseases • source of exposure • prior history of any type of allergic reaction After an initial exposure to a substance like bee sting toxin, the person's immune system becomes sensitized to that allergen. On a subsequent exposure, an allergic reaction occurs. Severe allergic reactions are usually triggered by a limited number of allergic exposures. These include injection, swallowing, inhaling or skin contact with an allergen by a severely allergic individual. Examples of injected allergens are bee, hornet, wasp and yellow jacket stings and certain vaccines which have been prepared on an egg medium and allergen extracts used for diagnosis and treatment of allergic conditions. Antibiotics such as penicillin can trigger a reaction by injection or swallowing. Typically, a severe reaction caused by a food allergy occurs after eating that particular food, even a small bite. Allergy to peanuts is an example here. Skin contact with the food rarely causes anaphylaxis. Foods most commonly associated with anaphylaxis are peanuts, seafood, nuts and, in children particularly, eggs and cow's milk. A severe allergic reaction from an inhaled allergen is rare. An increasingly recognizable example is when an allergic individual inhales particles from rubber gloves or other latex products. In emergency department studies, food allergy is the commonest cause in children — responsible for about 80% of anaphylactic reactions in which the cause has been identified— whereas, in adults, foods are implicated in only 20%–30% of cases. Pause: 15 seconds Now read question 4 Pause 15 seconds Now answer question 4 The signs and symptoms of anaphylaxis may occur almost immediately after exposure or within the first 20 minutes after exposure. Rapid onset and development of potentially life threatening symptoms are characteristic markers of anaphylaxis. Clinical Features The clinical features of anaphylaxis can be classified into the following categories. The mucocutaneous zones which includes lips, nostrils, eyes and anus and vagina in females Common symptoms are Rhinitis hives intense itchiness oedema including swelling of the face, lips, tongue and eyes watery eyes Abdominal features include stomach pain nausea vomiting The neurological symptoms commonly displayed include throbbing headache dizziness confusion loss of consciousness or collapse incontinence Respiratory symptoms include throat and or chest tightness dysphagia coughing and or wheezing dyspnea cyanosis, a bluish skin discolouration associated with a lack of oxygen Cardiovascular features are palpitations rapid heart rate cardiac arrest Pause: 15 seconds Now read question 5 Pause 15 seconds Now answer question 5 Respiratory symptoms are more common in children, whereas cardiovascular and cutaneous symptoms dominate in adults. In part, this may be related to the higher frequency of atopy, asthma and food allergy in children. Pre-existing lung disease is associated with an increased frequency of respiratory difficulties from any cause and poorly controlled asthma appears to be the This resource was developed by OET Online and is subject to copyright © Website: http://oetonline.com.au
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Listening Part B main risk factor for childhood death due to food allergy. Confusion, collapse, unconsciousness and incontinence are strongly associated with the presence of hypotension and hypoxia. In adults, the occurrence of dyspnoea, profuse sweating, nausea, vomiting and abdominal pain are also significant, as they correlate with the presence of low blood pressure. Pause: 10 seconds Now read question 6 Pause 10 seconds Now answer question 6 Anaphylaxis is an emergency condition requiring immediate professional medical attention. Assessment of the ABC's as in the Airway, the Breathing, and the Circulation should be done in all suspected anaphylactic reactions. Adrenalin is a drug that should be given by injection without delay. This opens the airways and raises the blood pressure by constricting the blood vessels. Adrenaline comes in multiple formats, one of them called Epipen that might be carried by individuals. CPR (cardiopulmonary resuscitation) should be initiated if needed. People with known severe allergic reactions may carry an Epi-Pen or other allergy kit, and should be assisted if necessary. Emergency interventions by paramedics or physicians may include placing a tube through the nose or mouth into the airway or emergency surgery to place a tube directly into the trachea. Treatment for shock includes administering fluids intravenously through the veins as well as medications that support the actions of the heart and circulatory system. Antihistamines and steroids may be given to further reduce symptoms after lifesaving measures and adrenaline are administered. Anaphylaxis is a severe disorder which has a poor prognosis without prompt treatment. Symptoms, however, usually resolve with appropriate treatment, therefore highlighting the importance of immediate action. There are no long-term effects of anaphylaxis other than the possibility of recurrence of this disease. Pause: 15 seconds Now read question 7 Pause 15 seconds Now answer question 7 Long-term management For most patients, anaphylaxis is a disorder for which the risk of relapse is chronic but the event itself is unpredictable. The mainstays of long-term management of anaphylaxis include: • Specialist assessment. • Identification and avoidance of triggers if possible. Common triggers of anaphylaxis include certain food, stinging insects and medication. • It is also necessary to avoid common cofactors including exercise, alcohol consumption and taking NSAIDS • Training patients to recognise early warning symptoms and to carry self-injectable adrenaline (EpiPen) (after being trained in its use). • Provision of a written anaphylaxis action plan. • Encouragement of at-risk patients to wear a Medical Alert bracelet and entry of an allergy alert into hospital or health care network clinical information systems. Pause: 15 seconds Now read question 8 Pause 15 seconds Now answer question 8 Anaphylaxis Prevention Anaphylaxis to insect stings can be prevented by administering venom immunotherapy which reduces the risk of anaphylaxis from repeated stings and is associated with an improved quality of life compared with carrying an EpiPen alone. Attempts to modify the severity of food allergy using similar techniques have not succeeded so far however there is promise that further research will lead to the development of vaccines which would enable sufferers to build up a tolerance to allergy causing foods. Prevention involves avoidance of known allergens. Any person experiencing an allergic reaction should be monitored, although monitoring may be done at home in mild cases. Occasionally, people who have a history of drug allergies may safely be given the required medication after pre-treatment with corticosteroids and antihistamines That is the end of Listening Part B You now have 2 minutes to check your answers
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