PUID: 52 || PLAB 2 Mock :: Counseling Medication: Angioedema induced by ACEI:: 2nd Attempt

Practice a case with the AI patient 🤖

Summary:

This scenario involves a patient presenting with swelling likely due to ACE inhibitor-induced angioedema, a potentially life-threatening condition due to the risk of airway obstruction. The candidate must demonstrate effective history-taking, identification of red flags, appropriate diagnosis, clear communication, and urgent management planning.

Key Points:

Presenting Complaint and History Taking

• Use open-ended questions to elicit patient concerns.

• Utilize SOCRATES to explore the nature of swelling.

• Specifically assess:

  • Onset, duration, and progression

  • Impact on daily activities

  • Associated symptoms (e.g., hoarseness, dysphagia, dyspnea, dizziness, rash)

  • Previous similar episodes

Red Flags

• Swelling involving the tongue, throat, or face

• Airway compromise symptoms: breathing difficulty, hoarseness, drooling

• Inability to swallow or sensation of choking

Allergies and Drug History

• Ask about drug and food allergies

• Confirm ACE inhibitor use (e.g., Ramipril)

Past Medical and Lifestyle History

• Conditions: hypertension, asthma, immune disorders

• Smoking and alcohol history

• Previous hospital admissions for similar issues

Important Considerations:

• Angioedema due to ACE inhibitors is not an allergic reaction, hence traditional antiallergic medications may have limited effect.

• This is a medical emergency that may require intubation.

• Use clear layman’s terms to explain the condition.

• Avoid medical jargon and stock phrases.

• Regularly pause to check patient understanding.

Diagnostic Approach:

1. Identify ACE inhibitor usage (likely Ramipril).

2. Rule out allergic causes and consider non-allergic etiology.

3. Assess for airway risk using symptoms like dysphonia, stridor, and respiratory distress.

4. Examine for other potential causes of facial/tongue swelling if history is ambiguous.

Management:

• Immediate cessation of ACE inhibitor.

• Admission for emergency monitoring.

  • Monitor airway

  • Administer oxygen if needed

  • Establish IV access

• Medications:

  • Antihistamines and steroids (limited efficacy but often administered)

• ENT or anaesthetic consult if airway risk increases.

• Switch to an alternative antihypertensive (e.g., calcium channel blockers or cautiously ARBs if necessary).

• Safety netting advice:

  • When to seek immediate help (worsening symptoms, difficulty breathing)

• Schedule follow-up within 1–2 weeks to review medication change and ensure no recurrence.

Communication Skills:

• Begin with open questions to understand the patient’s perspective.

• Explain the diagnosis using simple language:

  • “Angioedema means deep swelling under the skin.”

• Clarify the difference from allergies.

• Discuss next steps clearly.

• Involve the patient in decision-making.

• Check understanding after every key point.

• Reassure while remaining realistic.

• Avoid dominating the conversation; allow patient space to speak.

Ethical Considerations:

• Maintain patient autonomy in decisions.

• Uphold confidentiality and informed consent.

• Provide honest, non-alarming information.

• Adhere to GMC guidelines on safe, compassionate care.

Additional Resources:

• GMC Good Medical Practice Guidelines

• NICE Guidelines on Hypertension

• UK Resuscitation Council protocols

• PLAB 2 Examiner Top Tips: Focus on patient interaction, clear explanation, time management.