Respiratory System

COURSE OBJECTIVES

Students will be able to

  • identify and explain the nature of abnormalities seen in common respiratory diseases in relation to normal structure and functions.
  • Outline the principles of therapeutic and behavioural management of patient and families.
  • correlate the normal structure and functions of respiratory system to the signs, symptoms patho-physiological states, diagnosis and management of the following common conditions:
  • dyspnoea; haemoptysis; cough with or without sputum; chest pain; tuberculosis; cyanosis; acute respiratory tract infection (upper and lower); bronchial asthma; COPD; pneumonia; sinusitis; SARS; avian influenza; carcinoma lung; acclimatization/ high altitude sickness.

ANATOMY

Students will be able to

  • list different parts of the respiratory system, their location, broad concept of functional anatomy of the parts, division of thoracic cavity and mediastinum.
  • identify on given models or specimens from cadavers, parts of respiratory system and mark them on the surface of the living.
  • describe thoracic cage, thoracic inlet and outlet; list the structures passing through them; define Sibson’s fascia; define and differentiate typical and atypical intercostals space; intercostals muscles, nerves and vessels; explain different mechanisms of respiratory movements.
  • list the muscles taking part in respiration and explain the role of accessory muscles in relation to disorder of breathing; outline the mechanism of pain originating from the chest wall in relation to these structures.
  • explain the development of respiratory system and correlate with developmental anomalies.
  • define the parts of external nose; the extent of the nasal cavity; list the structural components forming lateral and medial nasa! wall, blood supply, nerve supply and lymphatic drainage and the nature of mucous membrane; list the various openings and location of those openings at the lateral wall of nasal cavity.
  • define paranasal sinuses; their locations; explain the normal anatomy of maxillary sinus, its mucosal lining and clinical correlation with maxillary sinusitis; list its nerve supply, blood supply and lymphatic drainage of paranasal air sinuses; list the possible routes of infections, spread of infection in relation to paranasal air sinuses.
  • describe pharynx; explain the walls of the pharyngeal cavity and communication with the middle ear cavity; emphasize its importance in otitis media; explain the role of soft palate in closing the pharyngeal cavity and the lymphatic collection in its wall; outline the mechanism of food regurgitation in paralysis and defect of soft palate; explain the movements of soft palate in a fellow student.
  • describe the subdivisions of the larynx, vestibules and vocal folds and their movements; define the location, structure, innervations, blood supply and lymphatic drainage of larynx; explain the roles of larynx in mechanisms of respiration, phonation and deglutition.
  • Mention the intrinsic and extrinsic muscles of larynx and their role in movement of vocal cords; explain the mechanism of hoarseness of voice; explain the course of recurrent laryngeal nerve in the neck and its relations.
  • Define the structure, innervations and vascular supply and lymphatic drainage of trachea in the neck and thorax; explain the role of cilia and mucous membrane in the mechanism of expectoration; locate the point of bifurcation of trachea.
  • Define bronchopulmonary segments; correlate different parts of the bronchopulmonary segments in relation to pneumonia.
  • describe pleura, its parts, parietal and visceral, its extent, pleural recesses and their clinical importance;
  • Define the gross anatomy of lungs with blood, lymph and nerve supply.
  • Outline the possible anatomical sites of bleeding in haemoptysis.
  • Explain the development, attachment and function of diaphragm; list the different openings in it; list the different congenital deformities associated with diaphragm.

CLINICAL PHYSIOLOGY

Students will be able to

  • Describe functional Anatomy of respiratory system
  • Describe mechanics of Breathing
  • Describe regulation of Respiration
  • Describe pulmonary Circulation
  • describe pulmonary Gas Exchange
  • describe transport of 02 and C0 2 by the blood and their exchange at the tissue level
  • describe pulmonary Function Tests
  • describe applied Respiratory Physiology e.g.
  • Hypoxia
  • High Altitude Sickness
  • Respiratory failure
  • COPD
  • Bronchial Asthma
  • Describe Lung Defense Mechanism.

CLINICAL BIOCHEMISTRY

Students will be able to

  • Describe metabolism of glucose in the lungs and other sources of energy.
  • Explain synthesis of surfactant system in lungs.
  • Explain neonatal hyaline membrane disease and alveolar proteinaceous.
  • Recall Henderson and Hasselbach equation.
  • define: plasma bicarbonate, standard bicarbonate, base excess, partial pressure, normal values of p02, PCO2 pH, respiratory acidosis, respiratory alkalosis, metabolic acidosis, metabolic alkalosis, acid, base, buffer, oxygen content, oxygen saturation, pKa, acidaemia, alkalaemia, compensated and noncompensated;
  • describe the function of haemoglobin and properties of dissociation curve of oxyhaemoglobin (effect of pH, PCO2, temp, and 2–3DPG); correlate with cyanosis.
  • state different forms in which carbon dioxide exists in blood and mechanisms of transport.
  • explain interrelationship among Hb, O2, CO2, H+ and 2–3DPG.
  • describe the anion gap and explain its significance.

Biological Oxidation

Students will be able to

  • define redox potential, free energy, high energy bonds.
  • list the components of electron transport chain and draw the figure of electron transport chain.
  • draw the diagram of detailed structure of mitochondria (with sub mitochondrial structures).
  • describe oxidative phosphorylation and respiratory control.
  • list the important inhibitors of oxidative phosphorylation.
  • explain different theories of oxidative phosphorylation.
  • explain mitochondrial myopathies; explain the action of cyanide on electron transport chain members and the function of nitrites and thiosulphate during cyanide poisoning.

PATHOLOGY

Students will be able to

  • list common investigations done in the diagnosis of diseases of respiratory system.
  • Describe the concept of inflammation to the different parts of respiratory tract.
  • Define atelectasis and describe its types.
  • Describe the etiopathogenesis, gross and microscopic features of pulmonary tuberculosis and its complications.
  • define COPD.
  • define and describe the etiology, pathologic features and complications of chronic bronchitis, bronchial asthma, bronchiectasis, emphysema.
  • define ARDS and list the causes and microscopic features of ARDS.
  • define pneumonia.
  • classify pneumonia.
  • describe the etiology, gross and microscopic features and complications of lobar pneumonia, bronchopneumonia and viral pneumonia.
  • define pneumoconiosis.
  • list different types of pneumoconiosis.
  • describe the etiopathogenesis, gross and microscopic features of different types of pneumoconiosis (anthracosis, simple coal-worker’s pneumoconiosis, progressive massive fibrosis, silicosis, and asbestosis) and their complications.
  • list different types of precancerous lesions of lung.
  • list different types of tumors in the lungs.
  • describe the etiology, gross and microscopic features of bronchogenic carcinoma.
  • describe paraneoplastic syndromes associated with lung cancers.
  • describe the etiology, gross and microscopic features of pleurisy.
  • describe the etiology and morphology of mesothelioma.

CLINICAL MICROBIOLOGY

Student will be able to

  • list and describe the important pathogens affecting Respiratory system;
  • describe the morphology, pathogenesis, laboratory diagnosis, transmission & prevention of the following organisms:

Bacteria

  1. Mycobacterium tuberculosis
  2. Corynebacterium diphtheriae
  3. Streptococcus pneumoniae
  4. Haemophilus influenzae
  5. Bordetella pertusis
  6. Steptococcus pyogenes
  7. Pseudomonas

Viruses

  1. Adenovirus
  2. Myxoviruses
  3. Rhinoviruses
  4. Karl’s Urbani virus (SARS)
  5. Avian influenza

Fungi

  1. Aspergilus fumigatus
  2. Histoplasm capsulatum
  3. Cryptococcus neoformans
  4. Pneumocystic carinii

Parasites

  1. Paragonimus westermani

CLINICAL PHARMACOLOGY

Drugs used in bronchial asthma

Students will be able to

  • define the objectives of treatment of bronchial asthma.
  • name the bronchodilators.
  • describe their indications and explain the advantages and disadvantages of one over the other.
  • name the drugs used in acute and chronic bronchial asthma.
  • describe the mechanism of action, adverse reactions and contraindications of each drug.

Antitussive, expectorants and mucolytics

Students will be able to

  • describe antitussives and their mechanisms of action.
  • describe expectorants, their uses and limitations.
  • explain the difference between expectorants and mucolytics.
  • name the mucolytics.
  • describe mucolytics.
  • explain the mechanism of action, usefulness, adverse reactions and contraindications of mucolytics.

Nasal decongestants and cold remedies

Students will be able to

  • explain the mechanism of action of nasal decongestants.
  • describe nasal decongestants.
  • name the drugs used in common cold.

Chemotherapy of tuberculosis

Students will be able to

  • describe the primary and secondary line of chemotherapy in tuberculosis with possible side effects of anti-TB drugs.
  • describe short term chemotherapy of tuberculosis according to classification of the disease.
  • describe the DOTS strategy in tuberculosis.
  • discuss the role of corticosteroids in the treatment of tuberculosis.
  • outline the treatment of multi-drug resistant (MDRT) tuberculosis.

Common Respiratory Problems

Students will be able to

  • use drug and non-drug treatment for common respiratory problems: acute bronchitis, COPD and acute respiratory infections.
  • describe the drugs to treat pneumocytis carnii pneumonia