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Dip Allerg(SA)

THE COLLEGES OF MEDICINE OF SOUTH AFRICA


Incorporated Association not for gain
Reg No 1955/000003/08

Examination for the Diploma in Allergology of the


College of Family Physicians of South Africa

12 July 2016
Paper 2

Long Questions/Cases

3 hours)

All questions to be answered. Each question to be answered in a separate book (or books if more than one is required
for the one answer)

Question 1
You are called to the emergency department to review a patient, Emma, presenting with shortness
of breath. The background is of a 10-year-old girl with moderate persistent asthma, previously well
controlled and now presenting with recurrent acute exacerbations. Clinically she is poorly
cooperative, with a respiratory rate of 40 breaths/minute, heart rate of 156 beats/minute and oxygen
saturation of 85% in room air.
a)

Outline the initial management of this patient, including the dosages of the agents used.

(5)

After initiation of therapy, the patient shows some improvement after an hour, but remains hypoxic
on room air.
b)

Describe the ongoing management of this asthma exacerbation.

(5)

Emma has stabilised on the management instituted. You chat to the mom and Emma about her
diagnosis, exploring possible reasons for the recurrent asthma exacerbations.
c)

Name FIVE reasons for Emmas poor asthma control that you would explore.

(5)

The mom explains that she is struggling to manage the asthma and allergic rhinitis after she was
commenced on NSAID (non-steroidal anti-inflammatory) therapy for juvenile idiopathic arthritis.
d)
e)

Name TWO possible causes of Emmas poor asthma control in view of this history.
Describe management strategies for Emmas allergic disease.

(2)
(8)
[25]

PTO/Page 2 Question 2

2
Question 2
Discuss mastocytosis under the following headings
a) Definition.
b) World Health Organisation (WHO) classification.
c)
Clinical features.
d) Treatment / management.

(2)
(5)
(10)
(8)
[25]

Question 3
An 8-month-old boy, Zahid, is brought into your consulting room by his mother, with the complaint
that she is struggling to introduce solids to her baby after he was diagnosed with food allergies to
cows milk, hens egg and peanut. He had been placed on an amino acid formula by the general
practitioner after blood tests were done for recurrent bronchiolitis and phlegm on the chest.
a)

Discuss a rational approach to testing for food allergies in children of this age group.

(15)

You phone the private pathologist whose laboratory performed the blood tests, and the following
results are faxed through to your practice.
Specific IgE (sIgE) to foods
sIgE to cows milk
4.1kU/L
sIgE to hens egg
0.75kU/L
sIgE to peanut
1.6 kU/L
sIgE to casein
0.16kU/L
sIgE to ovomucoid
0.0 kU/L
sIgE to ara h2
0.23kU/L
Interpretation of Specific IgE levels (kU/L)
<0.10
Below reliably detectable limits.
0.10 0.35
Very low levels of antibody.
0.35 0.70
Low levels of antibody.
0.70 3.50
Moderate levels of antibody.
3.50 17.50
High levels of antibody.
15.50 100.00
Very high levels of antibody.
>100.00
Extremely high levels of antibody.

b)

Interpret the results and outline any additional information that is necessary to diagnose or
refute food allergy. What advice would you give Zahids mother?
(10)
[25]

Question 4
Discuss eosinophilic oesophagitis under the following headings
a) Pathophysiology.
b) Clinical presentation.
c)
Diagnosis.
d) Management.

(5)
(6)
(7)
(7)
[25]

Dip Allerg(SA)

THE COLLEGES OF MEDICINE OF SOUTH AFRICA


Incorporated Association not for gain
Reg No 1955/000003/08

Examination for the Diploma in Allergology of the


College of Family Physicians of South Africa
13 July 2016

Paper 3

Short Questions

(3 hours)

All questions to be answered. Each question to be answered in a separate book (or books if more than one is required
for the one answer)

Part A
1

Discuss diagnostic criteria for allergic bronchopulmonary aspergillosis in patients with


asthma.
[10]

Outline the workup of a patient who is possibly penicillin allergic and who requires treatment
with a cephalosporin.
[10]

Compare and contrast persistent allergic conjunctivitis and vernal kerato-conjunctivitis.

[10]

Write short notes on Samters Triad.

[10]

Discuss the follow-up management of a 10-year-old child that presented to casualty a week
previously with a first episode of anaphylaxis thought to be due to a bee sting.
[10]

Discuss vocal cord dysfunction including clinical presentation, diagnosis and management.
[10]

Write short notes on the modified Asthma Predictive Index (mAPI).

[10]

Write short notes on immunotherapy for allergic rhinitis.

[10]