CIR Contrast Media Administration & Adverse Reaction Management 2

Question 1

According to ACR classification, which clinical presentation defines a SEVERE anaphylactoid contrast reaction?

Accepted Answer

Bronchospasm, laryngeal edema, or cardiovascular collapse

Answer

Urticaria covering less than 50% of body surface area

Answer

Nausea and vomiting lasting more than 30 minutes

Answer

Isolated systolic blood pressure drop of 10 mmHg

Question 2

What is the FIRST-LINE treatment for a severe anaphylactic reaction occurring during cardiac catheterization?

Accepted Answer

IM epinephrine 0.3–0.5 mg (1:1000)

Answer

IV diphenhydramine 50 mg

Answer

IV hydrocortisone 200 mg

Answer

IV atropine 1 mg

Question 3

A patient develops diffuse urticaria and mild itching 5 minutes after contrast injection with no respiratory or hemodynamic changes. How is this classified?

Accepted Answer

Mild anaphylactoid reaction

Answer

Severe anaphylactoid reaction

Answer

Delayed T-cell-mediated hypersensitivity

Answer

Vasovagal reaction

Question 4

During contrast injection, a patient develops bradycardia to 38 bpm, diaphoresis, and hypotension without urticaria or bronchospasm. What is the MOST likely reaction type?

Accepted Answer

Vasovagal reaction

Answer

Severe anaphylaxis

Answer

Moderate anaphylactoid reaction

Answer

Contrast-induced cardiomyopathy

Question 5

What is the appropriate treatment for a vasovagal reaction with persistent bradycardia and hypotension during a catheterization procedure?

Accepted Answer

Atropine IV and IV fluid bolus

Answer

Epinephrine IV push and antihistamine

Answer

Diphenhydramine IV alone

Answer

Methylprednisolone IV infusion

Question 6

Which patient factor is the STRONGEST predictor of a repeat adverse contrast reaction?

Accepted Answer

History of a prior moderate or severe contrast reaction

Answer

Age over 70 years

Answer

Documented seafood allergy

Answer

Asthma without prior contrast exposure

Question 7

Which ACR-recommended premedication regimen is used for ELECTIVE contrast studies in patients with a prior contrast reaction?

Accepted Answer

Prednisone 50 mg PO at 13, 7, and 1 hour before contrast plus diphenhydramine 50 mg PO 1 hour before

Answer

Single-dose IV methylprednisolone 1 hour before contrast

Answer

Diphenhydramine 25 mg PO only, 1 hour before

Answer

Ranitidine 150 mg PO the night before only