UNDF - Respiratory

Question 1

Answer 1

= D.

Question 2

A patient has a genetically determined selective deficiency of Immunoglobulin A (IgA). Although many of those affected appear symptomatic, what is the major reason for an increased susceptibility to respiratory infections in some of these patients?

• a. Reduced ability for T-cell maturation, resulting in poor cytotoxic killing of infected cells
• b. Reduced ability of macrophages to phagocytose bacteria
• c. Reduced ability to activate complement via the classical pathway
• d. Reduced ability to bind and present microbial peptides in the MHC-II molecule
• e. Reduced ability to neutralise pathogens and toxins on the mucosal surface

Answer 2

= e. Reduced ability to neutralise pathogens and toxins on the mucosal surface

Question 3

Answer 3

= c. Interstitial pneumonia

Question 4

Examine the photmicrograph shown. What is the name given to this disease and what effect, if any, is it likely to have on airway resistance?

• a. Bleb - no effect, but may progress to pneumothorax
• b. Bulla - increased airway resistance on inspiration
• c. Centrilobular emphysema - increased airway resistance on expiration
• d. Interstitial fibrosis - no change in airway resistance
• e. Pneumothorax - symptoms will depend on size of the lesion

Answer 4

= c. Centrilobular emphysema - increased airway resistance on expiration

Question 5

Examine the flow-voliume loop (shown) obtained by spirometry, and indicate whether the patient has obstructive or restrictive disease and which phase of breathing is affected. The dotted line is a reference trace from predicted normal values. The solid thick line is the trace obtained from the patient.

• a. Obstructive disease on expiration
• b. Obstructive disease on inspiration
• c. Restrictive and obstructive disease, during both inspiration and expiration
• d. Restrictive disease on expiration
• e. Restrictive disease on inspiration

Answer 5

= a. Obstructive disease on expiration

Question 6

Answer 6

= e. Terminal bronchioles

Question 7

Answer 7

= C. Respiratory bronchioles

Question 8

• A. Acute suppurative inflammation
• B. Chronic inflammation
• C. Fat necrosis
• D. Fibrinoid necrosis
• E. Granulomatous inflammation

Answer 8

= E. Granulomatous inflammation

Question 9

Answer 9

= B. Mycoplasma pneumoniae

Question 10

A 65 year old pressents to the EFD with a two day history of fevers, cough productive of a brownish-red coloured sputum and pleuritic chest pain.

Which organism is most likely to be responsible for this presentation?

Answer 10

= D. Streptococcus pneumoniae

Question 11

A nine month old presents with cough, wheeze and breathlessness. On examination she is found to have widespread fine inspiratory crackles and expiratory wheeze.

What is the most likely diagnosis?

• A. Asthma
• B. Bronchiolitis
• C. Bronchitis
• D. Croup
• E. Pneumonia

Answer 11

= B. Bronchiolitis

Question 12

A patient presents with shortness of breath. On examination she has decreased air entry on the left, associated with decreased percussion note and decreased vocal resonance.

What is the most likely diagnosis?

• A. COPD
• B. Interstitial lung disease
• C. Pneumonia
• D. Pneumothorax
• E. Pleural effusion

Answer 12

= E. Pleural effusion

Question 13

Answer 13

= D. Muscarinic antagonists

Question 14

What is the most important measure in continued control of tuberculosis (TB) in Australia?

• A. Case management to ensure completion of treatment
• B. Contact tracing
• C. Early diagnosis of cases
• D. Isolation of infectious cases
• E. Migrant screening

Answer 14

= A. Case management to ensure completion of treatment

Question 15

What would be a suitable primary prevention method that could be implemented by a small kitchen renovation business to prevent artificial stone-associated silicosis?

• A. An employee vaccination program
• B. Development of industry guidelines
• C. Provision of appropriate personal-protective equipment to eliminate inhalation of dust
• D. Research into different treatment options
• E. Routine screening of workers for signs of disease

Answer 15

= C. Provision of appropriate personal-protective equipment to eliminate inhalation of dust

Question 16

• A. 20%
• B. 25%
• C. 30%
• D. 35%
• E. 40%

Answer 16

= B. 25%

Question 17

A medical student has just learnt that aspirin in a pharmacy medicine, and sees the packet (shown) being offered for sale at a petrol station. How can this occur?

• A. Aspirin at this dose and pack size is unscheduled
• B. Petrol stations with a person trained in simple dispensing rules may sell aspirin
• C. Pharmacy medicines are not restricted in their sale
• D. The effervescent formulation lowers the absorption rate nad makes it unscheduled
• E. This is technically illegal, but rarely prosecuted

Answer 17

= A. Aspirin at this dose and pack size is unscheduled

Question 18

Answer 18

= C. 12 months

Question 19

Define the terms Gjon focus, Ghon complex, and Ranke complex.

Answer 19

Question 20

Explain how emphysema affects airway resistance, including the mechanism by which airway resistance is affected.

Answer 20

Question 21

What is meant by a ventilation-perfusion mismatch? Support your explanation with an example which would cause lowered partial pressure of oxygen in blood leaving the lung.

Answer 21

Question 22

Your patient is a 71-year-old female with pulmonary TB who is visiting from the Philippines. She will require at least 6 months of treatment.

What interpersonal/ethical issues should you consider when giving information to this patient?

Answer 22

Alternatively, any answer addressing the following points:

1. Language barrier
2. Communication difficulties
3. Meaningful information provision
4. Informed consent (history, examination, investigation, treatment except in emergency and before involving patients in teaching and research)
5. Informed consent and ethical dilemmas of TB
6. Ethical dimensions of contact tracing
7. Patient isolation and lack of support network
8. Handling patient’s reactions as cultures differ in expressing fear and worries
9. The public health ethical grounds for Australia’s policies for all patients with infectious TB to be treated for free including visitors
10. Clarity in passing this message so compliance rates increase

(1 mark for each point up to 4 marks and 2 marks for quality of writing)

Question 23

What psychosocial factors contribute to patients’ adherence to long-term treatment of pulmonary TB?

Answer 23

Question 24

Give three reasons why a doctor may want to refer a patient for a second opinion.

Answer 24

1. Outside scope of practice
2. Difficult case/Difficult patient
3. To reassure patient (when diagnosis or treatment is serious)
4. To reassure doctor
5. To get rid of patient
6. To move the matter along quickly
7. Lack of confidence in medical skill

(1 mark each to a max of 3 marks)

Question 25

Supporting a patient's right to seek a second opinion is part of good medical care as outlined by Good Medical Practice. What are four common reasons patients may seek a second opinion?

Answer 25

1. Seeking certainty/confirmation 2. Lack of trust 3. Dissatisfaction with communication 4. Need for more/personlised information 5. Influence of close ones 6. Need for decisional guidance (1 mark each to max of 4 marks)

Question 26

Answer 26

Formulate the clinical question, include community-acquired pneumonia AND Australia AND therapy in your search terms (0.5 marks), outline which journals/databases you want to search and/or suggest as evidence-based clinical guidelines available for this condition that is relevant to this clinical context. In this situation you would probably refer to the latest version of Australian Therapeutic Guidelines.

Question 27

Read the abstract and answer the following few questions: 1. What type of clinical question/s (frequency/ differential diagnosis, Diagnostic accuracy, treatment/intervention or prognosis/natural history) does this paper address? 2. What type of quantitative study is this? 3. What was the aim of the study? 4. Were bacterial species positively associated with CAP? Justify your answer using information from the abstract. 5. Why would an RCT not have been suitable to address the stated aim of the study? 6. If your reading of the full text paper indicates that the study is internally valid, to which practice settings would the results be generalizable (ie. in which practice settings would the results be externally valid)?

Answer 27

1. **Clinical Q** = Frequency/ Differential diagnosis 2. **Study Type** = Case-control 3. **Aim** = To determine the contribution of common pathogens to community-acquired pneumonia (CAP) in children. 4. **Result** = No, these were found more frequently in controls (80%) than cases (72%). The aOR (0.7) demonstrates a negative association. This was not significant and could be due to chance (95%CI 0.4-1.2) 5. **RCT**? = Exposing children to respiratory pathogens and calculating incidence of CAP would not be an ethical study. 6. **External validity** = These results should be generalisabve to similar urban settings in developed countries (populations with similar characteristics) including Australia. These may not be generalisable to countries or regions with different circulating diseases and with differing social determinants (poverty, over-crowding, access to healthcare) - eg. rural/remote Aboriginal populations

Question 28

What are the 5 principles of motivational interviewing? (EDARS)

Answer 28

**Principles of Motivational Interviewing** 1. Express empathy 2. Develop discrepancy 3. Avoid argument 4. Roll with resistance 5. Support self-efficacy