1. RICK ALLEN PBL 12 Quiz

2. Ethics List the 6 elements of competence:  Comprehend the details  They have the capacity to make a rational decision  They reflect on their decision  They can communicate this decision to an HCP  They can account for and justify their decision  They persist with their decision A pt. has a history of changing their mind regarding risky treatment at least once a day. Is this person competent and can you proceed with the treatment regardless?  Yes. No.

3. Wrist Anatomy Which vessel of the hand can be absent in some people?  The deep plamar arch Does blood taken from the radial artery fill under its own pressure?  Yes

4. Lung Anatomy Which lobe is the ‘lingula’ a part of?  Right superior From a lateral perspective, what vertebrae levels approximate the borders of the left inferior lobe?  T2 and T 11 At what spinal level does bronchi bifurcation occur?  T4-5 (sternal angle) Describe the relationship of the trachea to the aorta, superior vena cava and the oesophagus:  Aortic arch – loops over left bronchi at T3-4  SVC is ant., oesophagus is post.

5. Pleural effusion What is a pleural effusion, and what are the two general mechanisms for their development?  Accumulation of fluid in the pleural space (>15mL)  ↑ entry rate or ↓ exit rate of fluid What constitutes a stage 1 empyema? Can it be drained?  Exudative pleural effusion with >15,000 leukocytes/microlitre  Yes The procedure to investigate a pleural effusion is called a:  thoracentesis

6. Defences of the respiratory tract List four defences of the URT and how they may become impaired:  Waldeyer’s ring: immunodeficiency disorder, lymphoma, CLL, myeloma  Mucociliary apparatus: ↑ mucous thickness or viscosity (CF, asthma, chronic bronchitis), mucociliary dyskinesia (smoking, anaesthesia)  IgA secretion: selective IgA defeciency (1:400)  Saliva: aging, dehydration  Sneeze/cough reflex: CVA, ventilator, anaesthetics, elderly, neonate, lung transplant, neuromuscular disorder, smoking, paralysis, opiates, alcohol If the mucociliary apparatus in the LRT dysfunctions, interstitial macrophages will still perform their role as antigen presenters.  What is wrong with this question?  No MA in the LRT  List two other defence mechanism in the LRT:  Alveolar lining fluid, alveolar and intravascular macrophages, dendritic cells, BALT???

7. Lung physiology Describe the V/Q for the apical and basal lung  Apical > 1, basal <1 Why is pressure in the pleural space always ~4mmHg < the lungs?  Chest wall ‘spring’ and lung recoil. List three factors which increase efficiency of diffusion across the basal membrane  ↑ SA, ↑ gas gradient, ↑ time, ↑ diffusion coefficient, ↓ distance

8. Blood ABG Explain the scenario: http://www.vectors.cx/med/apps/abg.cgi

9. Respiratory failure A decrease in the work done by a pt.s resp muscles would lead to which type of respiratory failure?  Type II List the 5 general causes of hypoxia 1. Inadequate oxygenation of blood in lungs 2. Pulmonary disease 3. Venous  arterial shunt 4. Inadequate O2 transport 5. Inadequate O2 use by tissues Which of these can be rectified with O2 therapy?  1 and 2 (and 4?) List three factors causing a decrease in FEV1.  ↓ lung recoil, ↓ muscle force or airway obstruction

10. Micro shiznap List three microorganisms which are natural flora of the LRT  None What AB would you use to combat acute bacterial rhinosinusitis if allergic to penicillin?  Cefuroxime, cefaclor, doxycycline Why might a throat swab be unnecessary when investigating a throat infection?  Viral causes most common When performing the throat swab, where should you sample and what must be done to reduce the likelihood of sample contamination?  Swab tonsils, post. pharynx and inflamed areas  Depress the tongue

11. Pneumonia What are the development differences between lobar pneumonia and bronchopneumonia?  Lobar – inhalation of infectious agent into alveoli  BP – bronchitis spread or viral complication List the four stages of lobar pneumonia and describe its likely presentation macroscopically vs. BP:  Congestion, red – grey hepatisation, resolution  Entire lobe, vs. focal spots. What is the most common symptom of pneumonia  Productive cough List three common causes of community-acquired acute pneumonia  Strept. Pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staph aureus, Legionella pneumophilia

12. Pneumonia List three complications of pneumonia  Abcess, empyema, metastatic infection, resp. failure, ARDS, CCF, MI, PE Is there an available vaccine for pneumonia?  Yes What is the treatment for a class III pneumonia?  Iv benzyl penicillin/ amoxycillin + roxithromycin/doxycyclin/azithromycin

13. TB Explain the potential fates of primary and secondary TB infection  Kill/heal, latent, progressive, miliary Explain the effect of steroids on a pt. suffering from TB  Make them feel better due to anti-inflam. effects, however immunosuppression would assist TB spread Explain the elements of a Gohn complex  Gohn focus (Langhan giant cells – granulomatous inflam, casseous necrosis, potential calcification) with involvement of the hilar/mediastinal lymph nodes What is the location and name of the focus where secondary TB is commonly observed?  Apex of the lung. Assman’s focus.

14. Thyroid What effect does T3/T4 have on the CVS?  Positive inotropic & chronotropic effects  (  HR and force of contraction   CO) What investigations would you perform on a pt. you suspect is suffering from hypothyroidism?  TSH, T3/4, iodine levels, thyroid Ab, scintillation imaging? What is a “thyroid storm” and why is it a medical emergency?  Acute hyperthyroidism, can cause arrhythmias  death

15. Diabetic Immunosuppression Did anyone look at the well-regarded chairman’s FQ?  Trick question – chairman is not well regarded Was Angus appropriately dressed to the SWIM cocktail night?  Woefully no What is the theorised cause for immunosuppression in diabetics?  Hyperglycaemia and vascular insufficiency