Angioedema Practice Questions

25 multiple-choice questions on Angioedema for paramedic and EMT students, from Chapter 26 (Immunologic Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. During a transfer, a stroke patient who takes lisinopril and is receiving alteplase develops swelling of one side of the tongue. This is most likely:

   1. A. Bleeding into the tongue from the drug
   2. B. Angioedema linked to the alteplase
   3. C. A new stroke affecting the tongue
   4. D. A bite injury from an unseen seizure
   Show answer

   Answer: B. Angioedema linked to the alteplase

   Orolingual angioedema occurs in a small percentage of patients given alteplase, more often in those taking ACE inhibitors, and it is often one-sided. Watch the airway closely and notify the receiving team, which may stop the infusion and give medications. Bleeding into the tongue and new strokes do not cause sudden tongue swelling.

2. The main danger of angioedema is:

   1. A. Airway obstruction
   2. B. Bowel wall swelling and pain
   3. C. Permanent facial scarring
   4. D. Kidney failure
   Show answer

   Answer: A. Airway obstruction

   Swelling of the tongue or larynx can rapidly obstruct the airway. Bowel wall swelling in hereditary angioedema is painful but rarely fatal, and the facial swelling resolves without scarring.

3. A patient with massive tongue swelling is breathing poorly but can still move air through the nose. Which adjunct may help while you prepare?

   1. A. A nasopharyngeal airway
   2. B. An oropharyngeal airway
   3. C. A tongue blade and suction
   4. D. A bite block
   Show answer

   Answer: A. A nasopharyngeal airway

   An oral airway cannot fit past a massively swollen tongue and may worsen the obstruction, but a nasopharyngeal airway can bypass the tongue through the nose. Keep the patient upright and be ready for a surgical airway if needed.

4. Common ACE inhibitors include:

   1. A. Metoprolol and atenolol
   2. B. Lisinopril and enalapril
   3. C. Amlodipine and diltiazem
   4. D. Furosemide and HCTZ
   Show answer

   Answer: B. Lisinopril and enalapril

   Drugs ending in -pril are ACE inhibitors.

5. ACE inhibitor angioedema can occur:

   1. A. On the first dose and not after
   2. B. After the drug is stopped
   3. C. Mainly in young children
   4. D. At any time during therapy
   Show answer

   Answer: D. At any time during therapy

   It can appear even after years of use.

6. Which group has a higher risk of ACE inhibitor angioedema?

   1. A. Children
   2. B. Men under 40
   3. C. Black patients
   4. D. Patients on statins
   Show answer

   Answer: C. Black patients

   Black patients have a several-fold higher risk. Risk is higher in women and older adults than in younger men, and statins do not raise it. ACE inhibitors are rarely used in children.

7. Hereditary angioedema is caused by a deficiency of:

   1. A. Factor VIII clotting protein
   2. B. C1 esterase inhibitor
   3. C. Immunoglobulin E
   4. D. Histamine receptors
   Show answer

   Answer: B. C1 esterase inhibitor

   This inherited disorder causes recurrent attacks of swelling without hives.

8. Hereditary angioedema attacks typically lack:

   1. A. Facial or lip swelling
   2. B. Abdominal pain
   3. C. Hives and itching
   4. D. Throat swelling
   Show answer

   Answer: C. Hives and itching

   The absence of urticaria helps distinguish bradykinin-mediated swelling from allergic reactions.

9. Abdominal attacks of hereditary angioedema cause:

   1. A. Fever and bloody diarrhea
   2. B. Painless jaundice
   3. C. Itchy hives on the abdomen
   4. D. Severe pain and vomiting
   Show answer

   Answer: D. Severe pain and vomiting

   Bowel wall swelling can mimic a surgical abdomen. Hereditary angioedema attacks do not cause fever, bloody stool, or hives.

10. Hereditary angioedema attacks are commonly triggered by:

    1. A. Dental work or minor trauma
    2. B. Peanuts or shellfish
    3. C. Pollen, mold, or animal dander
    4. D. Bright or flashing lights
    Show answer

    Answer: A. Dental work or minor trauma

    Stress, infection, and estrogen can also trigger attacks. Foods and airborne allergens trigger IgE allergy, not hereditary angioedema, which is bradykinin-mediated.

11. Specific treatments for hereditary angioedema include:

    1. A. High-dose IV diphenhydramine
    2. B. A course of oral prednisone
    3. C. C1 inhibitor or icatibant
    4. D. Nebulized albuterol
    Show answer

    Answer: C. C1 inhibitor or icatibant

    Many patients carry their own medication and know how to use it.

12. Which finding best suggests facial cellulitis rather than angioedema in a patient with facial swelling?

    1. A. Fever with warm, tender red skin
    2. B. Swelling that developed within an hour
    3. C. Swelling of the lips and tongue
    4. D. Recent start of an ACE inhibitor
    Show answer

    Answer: A. Fever with warm, tender red skin

    Cellulitis is an infection, so it brings fever and warm, tender, red skin and develops over a day or more. Angioedema appears over minutes to hours, often involves the lips and tongue, and is usually not warm or tender. A new ACE inhibitor points toward angioedema.

13. A patient on lisinopril has a swollen tongue and no hives. Your priority is:

    1. A. Giving oral fluids for comfort
    2. B. Applying ice packs to the neck
    3. C. Obtaining a full medication list
    4. D. Airway assessment and management
    Show answer

    Answer: D. Airway assessment and management

    Prepare for a difficult airway and transport promptly.

14. Which finding in angioedema suggests impending airway obstruction?

    1. A. Mild swelling of the upper lip
    2. B. Drooling and voice change
    3. C. Itchy skin over the arms
    4. D. Watery eyes
    Show answer

    Answer: B. Drooling and voice change

    Inability to swallow saliva and a muffled voice suggest pharyngeal or laryngeal swelling.

15. The best airway approach in a patient with severe tongue swelling may be:

    1. A. Blind oral intubation
    2. B. Awake nasal fiberoptic intubation
    3. C. Bag-mask only
    4. D. Waiting for the swelling to resolve
    Show answer

    Answer: B. Awake nasal fiberoptic intubation

    In the field, prepare for a surgical airway if intubation fails.

16. Angioedema associated with hives is usually:

    1. A. Bradykinin-mediated
    2. B. Infectious
    3. C. Hereditary
    4. D. Histamine-mediated
    Show answer

    Answer: D. Histamine-mediated

    Allergic angioedema responds to epinephrine, antihistamines, and steroids.

17. Swelling in angioedema is typically:

    1. A. Nonpitting and asymmetric
    2. B. Pitting, firm, and symmetric
    3. C. Red, itchy, and raised
    4. D. Limited to the legs
    Show answer

    Answer: A. Nonpitting and asymmetric

    It often involves one side of the lips or face.

18. After an episode of ACE inhibitor angioedema, the patient should:

    1. A. Double the dose
    2. B. Switch to a different ACE inhibitor
    3. C. Stop ACE inhibitors permanently
    4. D. Take it only at night
    Show answer

    Answer: C. Stop ACE inhibitors permanently

    All ACE inhibitors carry the risk.

19. Angioedema of the uvula is sometimes called:

    1. A. Quincke's uvula
    2. B. Ludwig angina
    3. C. Bell palsy variant
    4. D. Acute epiglottitis
    Show answer

    Answer: A. Quincke's uvula

    Isolated angioedema of the uvula is called Quincke's uvula, after Heinrich Quincke, who described angioedema (also called Quincke's edema); the swollen uvula can cause gagging, a muffled voice, and airway compromise. Ludwig angina is a spreading infection of the floor of the mouth and submandibular spaces. Bell palsy is a facial nerve weakness and does not swell the uvula. Acute epiglottitis is infectious swelling of the epiglottis, not the uvula.

20. Fresh frozen plasma may be used in hereditary angioedema because it contains:

    1. A. Excess histamine
    2. B. Epinephrine
    3. C. C1 inhibitor
    4. D. Bradykinin
    Show answer

    Answer: C. C1 inhibitor

    FFP is an option when specific drugs are not available.

21. Which other drug class can cause angioedema?

    1. A. Statins such as atorvastatin
    2. B. ARBs such as losartan
    3. C. Beta blockers like metoprolol
    4. D. Loop diuretics like furosemide
    Show answer

    Answer: B. ARBs such as losartan

    ARB angioedema is less common than with ACE inhibitors.

22. How quickly can angioedema progress?

    1. A. Over several weeks
    2. B. Over several months
    3. C. After a second dose is taken
    4. D. Over minutes to hours
    Show answer

    Answer: D. Over minutes to hours

    Swelling may worsen quickly. Reassess the airway often.

23. Which position helps a conscious angioedema patient with drooling?

    1. A. Supine and flat on the cot
    2. B. Sitting up and leaning forward
    3. C. Trendelenburg with the head down
    4. D. Prone with the face turned
    Show answer

    Answer: B. Sitting up and leaning forward

    Sitting upright helps the patient manage secretions and breathe.

24. You are transporting a patient whose tongue swelling keeps worsening despite treatment. Notifying the hospital early mainly allows it to:

    1. A. Pull the patient's old records
    2. B. Prepare allergy skin testing
    3. C. Register the patient early
    4. D. Ready a difficult-airway team
    Show answer

    Answer: D. Ready a difficult-airway team

    Patients with progressive angioedema may need awake fiberoptic intubation or a surgical airway. Early notification lets the hospital gather airway experts and equipment before you arrive. Allergy testing and registration can wait; airway preparation cannot.

25. A patient stopped lisinopril 2 weeks ago after an episode of angioedema and now has new lip swelling. Which statement is correct?

    1. A. Stopping the drug ends the risk right away
    2. B. This must be a new food allergy
    3. C. Risk can persist for weeks after stopping
    4. D. Restarting lisinopril will stop it
    Show answer

    Answer: C. Risk can persist for weeks after stopping

    The tendency to angioedema can persist for weeks to months after an ACE inhibitor is stopped, so a recurrence does not prove a new cause. Manage the airway as before, and the patient must not restart any ACE inhibitor.