Complications and emergencies: hereditary angioedema: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Complications and emergencies: hereditary angioedema

Sample item

A 30-year-old has recurrent non-itchy facial swelling and abdominal pain, a family history of similar episodes and a low C4. He needs dental extraction under general anaesthesia. Which prophylaxis is appropriate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. C1 esterase inhibitor concentrate, or fresh frozen plasma, before the procedure

Hereditary angioedema results from C1 esterase inhibitor deficiency, with bradykinin-mediated swelling. Airway manipulation can trigger life-threatening laryngeal oedema, so short-term prophylaxis with C1 inhibitor concentrate (or plasma if unavailable) is given. Antihistamines, steroids and adrenaline are not effective.

Option by option

  • A. No prophylaxis, since instrumentation cannot cause an attack

    Dental and airway instrumentation are recognised triggers.

  • B. Oral antihistamine and steroid premedication, as for an allergy

    Allergy-type premedication does not help bradykinin-mediated swelling.

  • C. C1 esterase inhibitor concentrate, or fresh frozen plasma, before the procedure (correct)

    Correct. Replacing the deficient inhibitor prevents a trigger-induced attack.

  • D. Subcutaneous adrenaline injection before intubation

    Adrenaline is not reliably effective for bradykinin-mediated angioedema.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is C, C1 esterase inhibitor concentrate, or fresh frozen plasma, before the procedure. Hereditary angioedema results from C1 esterase inhibitor deficiency, with bradykinin-mediated swelling.

Why is "No prophylaxis, since instrumentation cannot cause an attack" not the answer?

Dental and airway instrumentation are recognised triggers.

Why is "Oral antihistamine and steroid premedication, as for an allergy" not the answer?

Allergy-type premedication does not help bradykinin-mediated swelling.

Why is "Subcutaneous adrenaline injection before intubation" not the answer?

Adrenaline is not reliably effective for bradykinin-mediated angioedema.

What concept does this question test?

It tests Complications and emergencies: hereditary angioedema in Anaesthesia. Airway manipulation can trigger life-threatening laryngeal oedema, so short-term prophylaxis with C1 inhibitor concentrate (or plasma if unavailable) is given. Antihistamines, steroids and adrenaline are not effective.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Complications and emergencies: hereditary angioedema?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.