Question 1.
A 25 year old veterinary nurse complains of itchy eyes and nose, sneezing, nasal discharge and wheezing when handling domestic pets. After work in the evenings, she experiences a further period of chest tightness and wheezing.
(a) Describe the pathophysiological basis for the above symptoms. Include in your answer an outline of“immediate” and “late phase” responses.
(10 minutes)
(b) Briefly describe investigations which would clarify the nurse’s sensitivities in the work place.
(5 minutes)

Question 1:
A 23 year old man, while riding a motorbike is stung on the face by a bee. He calls for an ambulance using his mobile phone, complaining of difficulty breathing and dizziness. The ambulance crew find him collapsed on the ground, not breathing and pulseless. The man is noted to have a very swollen face and blotchy raised welts over his torso. Resuscitation attempt fail.
• What is the clinical condition described above?
• Outline the physiological changes leading to breathing difficulty and dizziness and ultimately death.
• What self-administered emergency treatment might have prevented this tragedy? Explain briefly.


A 14 year old girl presents to her GP in November complaining of itchy red eyes, sneezing and nasal itch, copious amounts of watery discharge from her nose and eyes and nasal obstructions. Symptoms occur when she is outdoors and begin in September of each year. On particularly hot days with a north wind, she finds she is wheezy by the end of the day.
Question 3:
• What is the diagnosis? (1minute)
• What were the intial immunological events leading to development of this condition? (6minutes)
• Describe the pathophysiology of the symptoms and signs which now occur every spring. (8minutes)

Question 2.

A young woman dining in an Asian restaurant develops facial and lip swelling, generalized itchy welts and expiratory wheeze. She complains of feeling faint, then collapses to the floor. In the horizontal position she rouses sufficiently to ask her partner to remove her emergency pack from her handbag. Her partner provides emergency treatment and she rapidly recovers.

a) Using a well labelled flow diagram, show the underlying pathophysiological mechanism for the above symptoms and provide a unifying diagnosis for this symptom complex. (12 marks)
b) What medication is likely to have produced the rapid recovery, how was it administered, and what is the rationale for using this drug?(3 marks)
c) What food substance might have caused this unexpected reaction? Briefly describe tests which could confirm which food is responsible.

Question 2.

A young woman finds that she is sneezing and wheezing within minutes of entering a friend’s house. Her eyes and nose are itchy and red. She has a watery nasal discharge and blocked nose. In between sneezes, she states “there must be a cat somewhere in the house”.
(a) What is the diagnosis?
(1 mark)
(b) What were the initial immunological events leading to development of this condition?
(6 marks)
(c) Describe the pathophysiology of the symptoms and signs which now occur when she enters an environment shared by cats.
(8 marks)

Question 5.
A 14 year old boy presents to his GP complaining of a constant cold with copious watery nasal
discharge and itching of nose and palate. He has the symptoms all year round. When he cleans
and dusts his room (infrequently!) he has paroxysms of sneezing, develops a blocked nose and
sometimes wheezes.

He is otherwise well and denies sore throat, cough or fever. He had eczema in early childhood.
His home environment is carpeted and has numerous indoor pets.

On examination – adolescent male, speaks in nasal voice. Dark rings under eyes. Partial nasal
obstruction due to glistening swollen nasal lining. Chest clear – no wheeze.
a) What is the most likely diagnosis?
(1 mark)
b) Suggest two environmental factors which could be causing his symptoms?
(2 marks)
c) Describe briefly the initial immunological events leading to the development of this condition. Dot points are sufficient.
(5 marks)
d) Correlate this boy’s current symptoms with underlying immunological processes.
(6 marks)