Environmental, Anaphylactic, and Temperature Emergencies — WACS Viva & Clinical Scenarios (Acute Medical Care and Intensive Care Medicine)

Exam-style environmental, anaphylactic, and temperature emergencies viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 28-year-old teacher presents to the emergency unit 15 minutes after receiving an intramuscular injection of an antibiotic at a primary care clinic. He is restless, sweating profusely, and struggling to breathe, with audible stridor and diffuse wheeze. Blood pressure is 70/40 mmHg, pulse rate is 138 beats per minute, respiratory rate is 34 breaths per minute, and SpO₂ is 84% on ambient air. Widespread urticarial plaques and facial angioedema are noted. Detail your step-by-step immediate resuscitation, pharmacotherapy (including doses, routes, and concentrations), secondary management, and pos
• SCENARIO 2: A 34-year-old farmer is brought from a rural farming community in the Guinea Savannah zone four hours after sustaining a snakebite to the right ankle. He presents with severe local swelling extending above the knee, active bleeding from the puncture wounds, epistaxis, and microscopic haematuria. Outline the diagnostic approach including the performance and interpretation of the bedside 20-minute whole blood clotting test (20WBCT), your protocol for antivenom administration and adverse reaction management, and complications to monitor.
• SCENARIO 3: A 24-year-old military recruit collapses during rigorous outdoor physical training in an ambient temperature of 39°C. On arrival, he is deeply comatose (Glasgow Coma Scale 6/15). Axillary temperature is not recordable on standard clinical thermometers; rectal temperature is 41.2°C. Blood pressure is 85/50 mmHg, pulse rate is 144 beats per minute. Describe the diagnostic differentiation between heat exhaustion and heat stroke, outline the rapid cooling methods and target endpoints, and detail the prevention and management of secondary rhabdomyolysis and acute kidney injury.
• SCENARIO 4: A 62-year-old destitute man with severe alcohol use disorder and protein-energy malnutrition is found unresponsive on a concrete floor during the Harmattan season. Core body temperature measured via low-reading rectal probe is 27.5°C. The electrocardiogram demonstrates marked sinus bradycardia at 32 beats per minute, prolonged PR and QTc intervals, and characteristic J (Osborn) waves at the J point. Discuss the classification of hypothermia, the physiological hazards of rapid peripheral rewarming, active internal rewarming techniques, and modifications required for cardiopulmonary resuscitatio
• SCENARIO 5: A 30-year-old patient with psychiatric illness presents with acute hyperthermia (temperature 40.5°C), lead-pipe rigidity, autonomic instability, and elevated serum creatine kinase of 28,000 U/L. Contrast the clinical features, pathophysiology, and specific pharmacotherapy of Neuroleptic Malignant Syndrome versus Serotonin Syndrome, and state the principles of supportive intensive care management.