Urticaria Angioneurotic Edema

Chapter 158 Urticaria Angioneurotic Edema




Clinical Case Problem 1: “Doctor, I have a fat lip.”


A 37-year-old woman has been taking an angiotensin receptor blocker medication for the treatment of hypertension for 2   weeks. She has taken the medication as prescribed, and she reports during a follow-up visit that her home blood pressure readings have been 110 to 130   mm Hg systolic and 60 to 70   mm Hg diastolic, a marked improvement from her readings before beginning therapy. She also reports two episodes of transient lip swelling (both lasting 2 hours), and during the second episode, her eyelids also swelled.



Clinical Case Problem 2: Extremity Swelling and Gastrointestinal Symptoms


An 18-year-old woman recently diagnosed with systemic lupus erythematosus is in the office for follow-up after an emergency department visit for face, hand, and foot swelling along with abdominal pain and diarrhea. She reports that her symptoms improved after treatment with epinephrine and prednisone, and she notes that the emergency department physician recommended that she talk with you about danazol therapy.



Select the best answer to the following questions




1. Angioedema has been reported to be associated with which of the following medications?


a. angiotensin-converting enzyme (ACE) inhibitors

b. angiotensin receptor blockers (ARBs)

c. cyclooxygenase-2 (COX-2) inhibitors

d. clozapine

e. all of the above

2. Which of the following pairs of etiology and mechanism of initiation of angioedema is (are) correct?


a. ARB medication: stimulation of angiotensin II AT2 receptors, which leads to an increase in tissue bradykinin

b. COX-2 inhibitors: release of stored tissue bradykinin

c. systemic lupus erythematosus: consumption of complement C4

d. a and c

e. all of the above

3. How long after an ACE inhibitor is begun should a clinician be concerned about the development of angioedema?


a. 1   week

b. 1   month

c. 1   year

d. 10   years

4. Hereditary angioedema (HAE) differs from acquired angioedema due to collagen vascular diseases or medications in which of the following ways?


a. patients with HAE have a defect on chromosome 11

b. patients with HAE have high complement C1 inhibitor levels

c. patients with acquired angioedema due to collagen vascular diseases do not have involvement of bradykinin in the production of angioedema

d. angioedema is in the epidermal layer in HAE, but it is in the subdermal and deep dermal layers when it is associated with medications

e. a and d

5. Regarding treatment of acute episodes of HAE, which of the following statements is false?


a. epinephrine is of no help and should not be used

b. antihistamines and steroids do not work as well as they do for allergic urticaria but are still of some help

c. fresh frozen plasma (FFP) is thought to supply complement inhibitor proteins and can shorten attack duration

d. some patients worsen with FFP, possibly because of an increase in substrate for inflammatory mediators; as a result, FFP is not recommended when laryngeal edema is life-threatening

e. medications may be needed for a 1- or 2-day period during an acute episode

6. Danazol is commonly used to reduce frequency and severity of angioedema episodes. Which of the following is (are) a common side effect(s) of danazol?


a. virilization

b. hepatitis

c. anovulation

d. acne

e. all of the above

7. Which of the following is (are) the most common site(s) for angioedema?


a. face and lips

b. larynx

c. gastrointestinal tract (leading to diarrhea and abdominal cramps)

d. genitals

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Urticaria Angioneurotic Edema

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