Dan Pink'sDriveis one of my favourite books. I also really like hisRSA talkon the same subject. Pink argues that people are happy, engaged, productive, and creative when they are intrinsically motivated, as opposed to being motivated extrinsically by money, fear, punishment, or shame. He argues that intrinsic motivation derives from three essential elements: autonomy, mastery, and purpose. Autonomy is our desire to be self-directed; mastery, the urge to improve our skills; and purpose, our desire to contribute to something meaningful.

1 As a third-year medical student in Russia I am researching 'the role of proteolytic enzymes and their inhibitors in lung pathology'. Can you explain how proteolytic enzymes function in the normal lung?

2 Bronchiectasis is given as one of the causes of bronchial breath sounds. This is difficult to comprehend. Could you explain the mechanism of bronchial breath sounds more clearly?

3 I have been taught to examine vocal resonance by asking the patient to say 'ninety-nine' while auscultating. I listen for a louder 'ninety-nine' over an area of consolidation and more quiet sounds with effusion. Is this right?

4 What role does bupropion play in giving up smoking?

5 The clinical signs and symptoms of rhinitis are very similar to those of the common cold (influenza). How do I differentiate between the two?

6 What is the advantage of the drugs des-loratidine and levo-cetirizine over their parent compounds? Are they safe in pregnancy and lactation?

7 What are the differences between acute bronchitis and pneumonia? Are both diseases caused by infection?

8 1. If a patient with chronic bronchitis develops obstructive jaundice and Escherichia coli biliary sepsis, should the routine administration of oral steroids (e.g. prednisolone) be suspended until liver function improves? 2. Are there any adverse reactions that preclude the concurrent use of steroids while the patient is treated with IV ciprofloxacin, gentamicin, metronidazole and cefuroxime?

9 Robbins Basic Pathology mentions that in patients with chronic obstructive pulmonary disease (COPD), the forced ventilation capacity (FVC) is either normal or slightly increased! I just can't justify that. I mean it should decrease. And this is exactly what is mentioned in your book. I couldn't contact the authors of that book so I decided to ask you whether there is actually a situation in which the FVC in COPD patients might increase?

10 Is there any obstructive pulmonary condition in which there might be an increase in FVC? If so by what mechanism?