Exam category: Patient Care → Pharmacology
Why it matters: Contrast media can cause allergic-like reactions and kidney injury, and a patient on metformin whose kidneys are injured can develop lactic acidosis. The registry tests contrast agent types, routes and dose calculation, kidney function and metformin, and how to recognize and respond to a reaction.
Contrast media makes soft tissue and vasculature visible on x-ray, but it's still a drug — it has indications, contraindications, and possible side effects. Your job is to gather the right history, use the right contrast for the right patient, and recognize and respond correctly if something goes wrong.
Before any contrast goes in, you take a history. Ask about any previous reaction to contrast media, about asthma — a recognized risk factor that itself raises the likelihood of an allergic-like reaction, independent of any prior contrast history — and about allergies generally, and confirm what the patient is currently taking. A shellfish or povidone-iodine allergy does not by itself raise the risk of a contrast reaction; a previous reaction to the same class of contrast does, and it is the strongest predictor of another one — a prior allergic-like or unknown-type reaction to a given contrast class raises the risk of a repeat reaction to that same class by roughly 5-fold. Two parts of that history get their own registry questions: the current-medication list, and the order the patient's exams are performed in.
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A patient booked for iodinated contrast, the same class used on a past visit, gives four history items. Which is the strongest predictor of a reaction today?
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