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PBL 12 Quiz
RICK ALLEN
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.
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
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
drained?


Exudative pleural effusion with >15,000 leukocytes/microlitre
Yes
 The procedure to investigate a pleural effusion is
called a:

thoracentesis
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???
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:
http://www.vectors.cx/med/apps/abg.cgi
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.
2.
3.
4.
5.

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

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
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
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
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.
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
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