The child with recurrent facial swelling and a family airway history — structured encounter

Setting and candidate instructions

You are the paediatric registrar in the outpatient clinic. A ten-year-old boy is referred by his general practitioner for three episodes of painless facial and lip swelling over the past year. Each episode lasted two to three days, occurred without any wheals or itch, and resolved spontaneously. Between attacks he is entirely well. His father, who accompanies him, describes similar episodes in his own childhood and one emergency intubation for throat swelling at the age of twenty. The boy is currently well, with no swelling, no airway symptoms and normal observations. The examiner will ask you to build the differential, choose the pivotal investigation, explain the mechanism, and construct a treatment and disposition plan that protects the airway and addresses the family. ^[9]