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PBL 12 Quiz
 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
Yes. No.
Wrist Anatomy
 Which vessel of the hand can be absent in some
The deep plamar arch
 Does blood taken from the radial artery fill under its
own pressure?
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.
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
Exudative pleural effusion with >15,000 leukocytes/microlitre
 The procedure to investigate a pleural effusion is
called a:
Defences of the respiratory tract
 List four defences of the URT and how they may become
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,
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
Blood ABG
 Explain the scenario:
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
Which of these can be rectified with O2 therapy?
Inadequate oxygenation of blood in lungs
Pulmonary disease
Venous  arterial shunt
Inadequate O2 transport
Inadequate O2 use by tissues
1 and 2 (and 4?)
List three factors causing a decrease in FEV1.
↓ lung recoil, ↓ muscle force or airway obstruction
Micro shiznap
 List three microorganisms which are natural flora of
the LRT
 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
 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
 List three complications of pneumonia
 Abcess, empyema, metastatic infection, resp. failure, ARDS,
 Is there an available vaccine for pneumonia?
 Yes
 What is the treatment for a class III pneumonia?
 Iv benzyl penicillin/ amoxycillin +
 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.
 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
Acute hyperthyroidism, can cause arrhythmias  death
Diabetic Immunosuppression
 Did anyone look at the well-regarded chairman’s
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
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