Now we really need to focus our attention on strategic issues. The market for our main product, laboratory accreditation, is quickly shrinking so we need to increase our efforts towards further diversification. To guide those efforts we have started working on developing a Balanced Scorecard (BSC) for performance management. We expect the BSC to help us monitor our current performance and make informed decisions about which opportunities are worth pursuing in the near future. While I'm happy with the work we've done so far in thinking strategically, we still have a long way to go. I'd like to use the BSC as a tool to encourage our management team to spend more time on strategic issues and less on operating, day-to-day issues. In our fast-changing healthcare environment, we like to say that the C in COLA stands for change. We are a unique organization with a track record of quality improvement results. We need to take advantage of this unique position to grow our business and focus our resources on value-added products. Increases in sales and continued diversification are clearly important business objectives

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?