Society and Health A Examination Questions

2004 Examination

Question 1

A 49 year old woman presents to her general practitioner complaining of shortness of breath and cough with blood-stained sputum for a period of 2 months. You arrange a number of procedures including a bronchoscopy on the patient for investigation of haemoptysis (coughing up blood).

Describe the features you would expect to see in a normal respiratory tract as the fibre-optic bronchoscope passes down from the oropharynx. Your answer should include some indication of the location of the features that you describe relative to the patient’s surface anatomy.

Question 2

This question refers to the third scenario in the Society and Health course about Rebecca, the Australian aid worker who went to PNG and contracted tuberculosis.

Part A
List reasons for the greater prevalence of tuberculosis in PNG than in Australia.

Part B
Why was a combination of antimicrobial drugs prescribed for Rebecca, rather than a single drug?

Part C
Rebecca did not receive a BCG vaccination before leaving for PNG. Was this decision justifiable at that time? Give reasons for your answer.

Part D
List features of the organism Mycobacterium tuberculosis that contribute to its capacity to cause disease.

Question 3

Nora Goldsmith is a 75 year old pensioner who lives alone. She has felt generally unwell for 3 to 4 days, with a high fever and headache. She has also had increasing left-sided pleuritic chest pain, shortness of breath and a dry cough for the last day. Her 40 year old daughter takes the day off work to accompany her mum to the GP. The GP finds that Nora is markedly short of breath and blue around the lips. One examination, there is dullness to percussion over the base of the left lung. On auscultation, there are diminished breath sounds and inspiratory crackles at the left lung base. The GP makes a provisional diagnosis of pneumonia as a complication of influenza.

Part A
Briefly outline the sequence of events involved in a cough.

Part B
Indicate the normal blood gas values (PO2, PCO2 and oxygen saturation) for arterial blood. How are these values likely to be altered in Nora Goldsmith?

Part C
Nora is short of breath. Describe the receptors in the body responsible for detecting changes in blood gas status. What do they detect and how do they alter respiration?

Question 4

Part A
Nora’s daughter was in a dilemma as to whether she should take her mother to the general practitioner or to an Accident and Emergency Department at a major teaching hospital. In general, what factors influence consumers’ choices about where to seek medical attention?

Part B
Nora has never received vaccination against influenza. Explain whether Nora fits within the inclusion criteria for receiving influenza vaccination. Assuming she recovers, explain whether or not Nora should have an influenza vaccine next year. In Australia, who administers these vaccines, and who pays for them?