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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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Listening Part B

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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Listening Part B

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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Listening Part B

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 100200 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

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Listening Part B

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

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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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