Outcome of the undergraduate Curriculum · Web viewLangman's Medical Embryology (T.W. Sadler) Student Notes: . Department: Anatomy: dissecting room Practical 1: Structure of the nose,

RESPIRATORY SYSTEM MODULE

Faculty of Medicine

King Abdulaziz University

Faculty of Medicine Name of the Module

RESPIRATORY SYSTEM MODULE

Study Guide

2

Phase II, MBBS

2009

TABLE OF CONTENTS

Topic PageTHE OUTCOMES OF THE UNDERGRADUATE CURRICULUM 4

CURRICULUM MAP 5

PHASE 2 6

STRUCTURE OF THE MODULE 8

INTRODUCTION 9

AIMS & OBJECTIVES 10

TEACHERS CONTACTS 17

ASSESSMENT 18

ICONS 25

TOPIC OUTLINES 26

NO. LECTURES (NAMES)

1 Overview of structure & function of respiratory system

2 Lung pleura and surface anatomy3 Muscles of respiratory system 4 Mechanics of breathing.5 Respiratory system development6 Pressure- volume relationship in the respiratory tract7 Neural control of breathing. 8 Acid-base balance9 Gas diffusion and blood flow to the lung, regional differences.

10 The transport of oxygen in the blood.11 The transport of carbon dioxide in the blood. 12 Chemical control of breathing. 13 Metabolic function of the respiratory system.

14 Exercise & high altitude, the physiological responses to hypoxia & hypercapnia.

15 Medical Micobiology:16 Medical Micobiology:17 Medical Parasitology: Paragonimyiasis18 Medical Parasitology: Parasitic larva migrates to lungs.19 The pathology of pulmonary microbial infection 20 Treatment of tuberculosis. 21 Chronic obstructive lung diseases and bronchiectasis. 22 Drugs used in treatment of bronchial asthma 23 Principles of treatment of pulmonary infections. 24 Interstitial lung disease 1.

Faculty of Medicine Name of the Module25 Interstitial lung disease 11. 26 Disease of pulmonary vasculature. 27 Pulmonary neoplasia.28 Clinical pharmacology of pulmonary embolism29 Clinical approach to patient with respiratory diseases.30 Pleural effusion

31 Overview definition of epidemiology, pathologic & clinical features of asthma

32 Radiology of the lungs.33 Pneumothorax and haemothorax

NO. TUTORIAL 1 Lung surfactant. 2 Haemoglobin binding & oxygen haemoglobin dissociation curve. 3 Pathology of the lungs. 4 Drugs & the lung. dissociation curve

NO. PRACTICAL(Names)

1 Structure of the nose, paranasal sinuses, trachea & Larynx.

2 Clinical anatomy of the thoracic cage including images

3 The thoracic wall, muscles of breathing.

4 Lung function tests.

5 Effect of drugs on isolated guinea pig trachea.

6 Special lung function tests

7 Pathology of pneumonia: demonstration case, histories & X-ray.

NO. STUDENT DIRECTED LEARNING 70

1 Problem involving blood gases and acid-base status.

NO. Problem-Based Learning (PBL) Sessions 72

1 Case (1) Case studies of asthma in childhood & adulthood

2 Case (2) A case of Pneumonia

3 Case (3) Case studies of chronic obstructive pulmonary diseases.

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Phase I Module Name Faculty of Medicine

OUTCOMES OF THE MEDICAL UNDERGRADUATE CURRICULUM

1) Knowledge

Graduate should have sufficient knowledge and understanding of:a. The normal structure, function and development of the human body and

interaction between body and mindb. The normal pregnancy and child birth, the principles of antenatal and

postnatal carec. The aetiology, pathogenesis, clinical presentation, natural history and

prognosis of common physical and mental disease, particular those which pose acute danger to function, life or the community.

d. Common diagnostic tests and procedures, their uses, limitations and costse. The management of common conditions including pharmacological,

psychological, physical and nutritional therapyf. The principles of health education, disease prevention, rehabilitation and the

care of the suffering and dying.g. The principles and ethics related to health care and the Islamic and legal

responsibilities of the medical profession

2) SkillsGraduate should acquire the skills of

a. Take a tactful, accurate and organised medical history b. Perform a gentle and accurate physical and mental examinationc. Integrate history and physical examination to reach a provisional diagnosis

of differential diagnosisd. Select the most appropriate and cost effective diagnostic procedurese. Formulate a management planf. Counsel patients and families clearly regarding diagnostic and therapeutic

procedures before eliciting consentg. Perform common life-saving proceduresh. Use information resources to obtain further knowledge and interpret medical

evidence critically and scientificallyi. Communicate clearly and considerately with other health professionals

3) AttitudesGraduate should have the attitude of

a. Respect for every human being and abide by relevant Islamic ethicsb. A desire to ease pain and sufferingc. Willingness to work in a team with other health professionalsd. Responsibility to remain a life-long learner and maintain the highest ethical

and professional standardse. Referring patients to other health professional when neededf. A realization that it is not always in the interest of patients to pursue every

diagnostic or therapeutic possibility

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CURRICULUM MAPYOU ARE HERE…

Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Internship

Phase I Phase II Phase III

Phase II of the MBBS program is the second step with objectives specified

in the curriculum. These objectives include knowledge, skills and attitudes,

particularly attitudes toward the self-learning process. The curriculum

philosophy in Phase II is enforcing the development of a mixture of teaching

approaches including “student-directed learning”, self-learning medical

ethics & self-dependence. By the end of Phase II, the student should be

much more involved in the control of the learning process heading for the

phase III & the semi-final years.

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Short Note about the Respiratory S. Module mODULEWrite a paragraph about the module


Second Year Courses

SECOND YEAR

3RD SEMESTER 4TH SEMESTER

Foundation Corse Musculoskeletal System

General Anatomy (1) Immune, Blood lymphatic System

Cells and Tissues Cardiovascular System

Embryology Respiratory Biochemical Basis of Medicine

(1) Renal System

Pathology (1) Basic Emergency Care

Islamic Studies (3) Islamic Studies (4) and Medical Ethics

7


TIMETABLE IN HOURS:

TEACHING DEPARTMENTS:

33 Lectures, 7 Practicals, 4 Tutorials, & 1 SDL

Anatomy, Physiology, Biochemistry, Parasitology Microbiology Pharmacology Pathology, Medicine, Pediatrics, Radiology & Surgery

RESPIRATORY SYSTEM

Module Coordinators:

Dr. Khidir Adam Abdel-Galil (male section)

Dr. Hayat Zakaria Kamfar (female section)

Course No.

Course TitleContact Hours

Credit HoursL T/S P SDL

SYS222 Respiratory System

33 4 7 1 4

AIMS:

The aim of this module is to:1. Study the structure and function of the human Respiratory System and compare it with abnormal structure and

function.2. Study the assessment of the Respiratory System and how its function is altered in common disease states. 3. Acquire skills and working knowledge and understanding of the principles and concepts applicable to the

Respiratory System in general. 4. Provide the basis for the study of common clinical conditions and disorders, and for clinical examination

together with performing simple clinical procedures related to the Respiratory System and its management.

8

STRUCTURE OF THE MODULE


Before the students begin the Respiratory System module, they should demonstrate the ability to:

1. Describe the classification and basic histology of epithelia. Describe the physical chemistry of pH and buffers.

2. Describe the biochemistry of haemoglobin, and basic properties of blood3. Describe the basic pathological processes, such as inflammation, oedema, neoplasm4. Describe the basic structure and function of the autonomic nervous system and drugs which affect it.

5. Describe the structure and function of the cardiovascular system.

OBJECTIVES

By the end of this module, the student should be able to:

1. Describe the internal and external structure, blood supply and innervation of the nose, and the connection between the nose, pharynx and auditory tube, and describe the paranasal sinuses.

2. Describe the structure and function of the pharynx and larynx.

3. Describe the structure of the pleural cavity and lines of j5leural reflection.

4. Describe the structure and arrangement of airways and blood vessels in the lungs.5. Describe the histology of the airways of the lungs.6. Describe the structure of typical thoracic vertebra and rib and the relations and the arrangement of muscles in

the thoracic wall and diaphragm.7. Describe the function and distribution of the intercostal nerves, arteries and veins.8. Describe the mechanism of inspiration and expiration and the measurement of lung volume and capacities.9. Describe the carriage of oxygen in the blood.10. Describe and explain the role of carbon dioxide in blood and its role in acid-base balance.11. Describe the neural and chemical control of breathing, particularly with reference to different types of

respiratory failure.12. Describe common tests of lung function.13. Describe the defenses of the lung against infection and the immunology of the lung.14. Describe the condition of asthma, its presentation, diagnosis, cell biology, epidemiology and treatment with

bronchodilators and other drugs.15. Describe the classification, microbiology and principles of diagnosis and treatment of pneumonias, and

tuberculosis.16. Describe the definition and classification of interstitial lung disease, its relationship to occupational lung

disease, its pathology and the principles of diagnosis and treatment.17. Describe the pathology of lung cancers, their classification, and the principles of their diagnosis and

management.18. Describe the common diseases of the pleura and chest wall.19. Describe the changes in various types of respiratory failure and explain their physiological consequences.

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Transferable Skills:

By the end of this module, students will demonstrate the ability to:

1. Assimilate and integrate information from lectures, practical sessions, tutorials, clinical presentation sessions and independent learning activities.

2. Gain practical skills associated with the dissection of the cadaver and the examination of the living.3. Interpret two-dimensional images of the Respiratory System from radiographic techniques.4. Explain the pathology of Respiratory System and drug action in relation to the underlying processes.

Module structure:

This module is comprised of:

Principles and concepts applicable to the structure and function of the Respiratory System will be studied by dissection and examination of prosected parts or models of the human body.

Lectures on general aspects of the Respiratory System will be given for the purpose of conveying deeper understanding of the general concepts and principles underlying normal and abnormal structure and function during the module.

Practical sessions will be timetabled to enforce theoretical aspects of the subject but will be used for demonstrating skills/procedures and the use of electronic material will be encouraged.

Tutorials and Clinical Presentations :

Small Group Tutorials on special topics will be organized for the purposes of enriching the students’ general knowledge and overall understanding of the Respiratory System. It allows students to apply newly acquired knowledge and it is suitable for higher order cognitive objectives.

The use of Clinical Presentations, a series of multi-disciplinary sessions of small-group teaching led by staff from the appropriate Clinical Departments. These sessions also provide an opportunity for students to see patient-doctor interaction and the personal and social effects of illness. Satisfactory attendance and performance in practical classes and at clinical sessions are part of the final assessment at such level.

Problem-based learning sessions will be encouraged and timetabled to facilitate higher cognitive objectives: problem solving and decision making; and incorporate objectives that cross domains. They will be organized into small groups and facilitated by a staff faculty member.

Directed-Learning sessions will promote self-directed learning and thus, time will be available for further study by the students using all available learning resources including electronic learning materials.

Cross Modular Themes:

Concurrent and previous modules:

1. The work in acid-base balance in health and disease will relate closely to the Renal Urinary System module.

2. In each condition studied, students will call upon their knowledge of core courses, and modules of the second year.

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Assessment:Formative :

This form of assessment is designed to produce feedback to students to identify deficiencies in the understanding of a subject or a topic; and to the teacher, thus to enforce more guidance to students in relation to areas of deficiencies. Thus, it helps the student to improve performance:

a. Identification of areas for improvementb. Specific suggestions for improvement.

This includes a mixture of MCQs, short answer-questions (SAQs), extended- matching questions (EMQs), problems-solving exercises and independent learning activities in all subjects. These will be given during tutorial sessions and practicals. The answers are presented and discussed immediately with the students after the assessment. Results are published to students.

Summative:

This type of assessment is used for judgment or decisions to be made about a student performance, it serves:

a. Verification of achievement for the student satisfying requirementb. Motivation of the student to maintain or improve performancec. Certification of performance for othersd. Gradese. Promotion

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In all subjects covered, examination papers are divided into 4 parts:Quiz 1, Quiz 2, Final exam & OSPE

1-Quiz 1

It contains MCQs; these are designed to test the breadth of knowledge and understanding depending 100 % on horizontal integration. Students are required to attempt all the questions set in the examination.

2-Quiz 2:

These contain MCQs depending on 50 % horizontal integration and 50 % vertical integration. 3- Final Examination: These contain MCQs depending on 50 % horizontal integration and 50 % vertical integration. Students are required to attempt all the questions set, including evidence and points of clinical significance

Practical examinations (OSPE):These are given to students to assess certain transferable skills during the course according to the objectives of the subject.

Course work: Students are required to complete satisfactorily one piece of work during the course. This may involve a variety of activities, from essays to problem-solving papers and short answer-questions to “spotters’ or presentations. The main course work during the module is the PBL case.

Assessment:

Total mark: 100% = (100 Marks)

Part 1Continuous assessment: 20% = (Q1=10, Q2=10)

Part 2 PBL assessment 15% = (Tutor= 7, MCQs= 8)

Part 3Final Examination: 50 % = (50 Marks = 84 MCQs + 16 MCQs, PBL) Part 4:Practical assessment: 15% = (15 Marks, 30 questions)

Textbooks:

Appendix (V): Modules Text Books and References Submitted By The Different Departments and The Crash Course In Respiratory System.

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Respiratory System Module Group 3Final Report

1- Department of Anatomy:

Lecture # 1: Overview of structure & function of respiratory system. Lecture # 2: Pleura and Lungs. Lecture # 3: Medial relations & hila of the lungs. Lecture # 5: Development of the respiratory system.

Practical # 1: Structure of the nose, paranasal air sinuses, pharynx, larynx & trachea.

Practical # 2: Thoracic cavity & pleural cavities. Practical # 3: Important relations of the lungs & structures forming lung root..

2- Department of Physiology:

Lecture # 4: Mechanics of breathing. Lecture # 6: Pressure- volume relationship in the respiratory tract. Lecture # 7: Neural control of breathing. Lecture # 9: Gas diffusion and blood flow to the lung, regional difference. Lecture # 10: The transport of oxygen in the blood. Lecture # 11: The transport of carbon dioxide in the blood. Lecture # 12: Chemical control of breathing. Lecture # 14: Exercise & high altitude, the physiological responses to hypoxia & hypercapnia.

Practical # 4: Lung function tests. Practical # 6: Special lung function test.

13


3- Department of Biochemistry:

Lecture # 8: Acid-base balance. Lecture #13: Metabolic function of the respiratory system.

Tutorial # 1: The biochemistry of lung surfactant.

Tutorial # 2: Biochemistry of haemoglobin & its binding to oxygen

Directed Learning # : Problem involving blood gasses and acid-base status.

4- Department of Medical Parasitology: Lecture # 15: Paragonimyiasis. Lecture # 16: Parasitic larva migrates to lungs.

5- Department of Medical Microbiology:

Lecture # 17: Lecture # 18:

6- Department of Pathology:

Lecture # 19: The pathology of pulmonary microbial infections.

Lecture # 21: Chronic obstructive lung diseases and bronchiectasis. Lecture # 24: Interstitial lung disease 1.Disease of pulmonary vasculature. Lecture # 25: Interstitial lung disease 11. Lecture # 26: Disease of pulmonary vasculature. Lecture # 27: Pulmonary neoplasia.

Tutorial # 3: A case of pneumonia.

Practical # 7: Pathology of pneumonia.

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7- Department of Pharmacology:

Lecture # 20: Treatment of tuberculosis Lecture # 22: Drugs used in treatment of bronchial asthma. Lecture # 23: Principles of treatment of lung infections. Lecture # 28: Clinical pharmacology of pulmonary embolism

Tutorial # 4: Drugs & the lung. Practical # 5: Effect of drugs on isolated guinea pig

trachea.

8- Department of Pediatrics:

Lecture # 29: Clinical approach to patient with respiratory diseases.

9- Department of Medicine:

Lecture # 30: Pleural effusion Lecture # 31: Overview of definition epidemiology, pathogenic & clinical features of asthma.

10- Department of Radiology:

Lecture # 32: Radiology of the lungs.

11- Department of Surgery:

Lecture # 33: Pneumothorax and Haemothorax

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Table of contents

Department Lectures Practical Tutorials Directed learning

Anatomy 4 3 - -Physiology 8 2 - -Biochemistry 2 - 2 1Microbiology 2Parasitology 2Pharmacology 4 1 1 -Pathology 6 1 1 -Medicine 2 - - -Pediatrics 1 - - -Radiology 1 - - -Surgery 1 - - -

Total 33 7 4 1

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Lectures: Teachers Contacts

Lecture # Department Lecture Title Lecturer

Lecture # Department Lecture Title Lecturer

Lecture # Department Lecture Title LecturerMale Female

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18

Male FemaleLec. # 1 Anatomy Overview of structure &

function of respiratory system.

Prof. Said Zaghloul0557567746

Prof. Amira Ali Al-Hagagi

05086092326 Lec. # 2 Anatomy Pleura and Lungs. Prof. Said Zaghloul

0557567746Prof. Amira Ali

Al-Hagagi05086092326

Lec. # 3 Anatomy Medial relations & hila of the lungs..

Prof. Said Zaghloul

0557567746

Prof. Amira Ali Al-Hagagi

05086092326 Lec. # 4 Physiology Mechanics of breathing Dr. Khidir A.

Galil. 0504321459

Prof. Sawsan Roheim 0506638532

Lec. # 5 Anatomy Development of the respiratory system.

Prof. Said Zaghloul0557567746

Prof. Fathia Ahmed.

05086092326 Lec. # 6 Physiology Pressure- volume relationship

in the respiratory tract.Dr. Khidir A.

Galil.0504321459

Prof. Sawsan Roheim 0506638532

Lec. # 7 Physiology Neural control of breathing. Dr. Atef M. Abood

0544431007

Dr Zeinab Al-Refae

0507553272Lec. # 8 Biochemistry Acid-base balance. Prof. Adil A.

Rafae 05018895751

Dr. Huda Jad 0501856638

Lec. # 9 Physiology Gas diffusion & blood flow to the lung, regional differences

Dr. Khidir A.Galil.

0504321459

Prof. Sawsan Rahim 0506638532

Lec. # 10 Physiology The transport of oxygen in the blood.

Prof. A. Rahman Fahmi 0507620596

Dr Zeinab Al-Refae

0507553272

Lec. # 11 Physiology The transport of carbon dioxide in the blood.

Prof. A. Rahman Fahmi 0507620596

Dr Zeinab Al-Refae

0507553272

Lec. # 12 Physiology Chemical control of breathing.

Dr. Atef M. Abood

0544431007

Dr Zienab Al-Refae

0507553272

Male Female

Lec. # 13 Biochemistry Metabolic function of the respiratory system

Prof. Adil A. Rafae

Dr. Huda Jad 0501856638

Lec. # 14 Physiology Exercise & high altitude, physiological responses to

hypoxia & hypercapnia

Prof. A. RahmanFahmi

0507620596

Dr Zienab Al-Refae

0507553272

Lec. # 15 Microbiology Prof. Hassan Al-Bana Yunis

Prof. Mona O. Abass Mukhtar

Lec. # 16 Microbiology Prof. Hassan Al-Bana Yunis

Prof. Mona O. Abass Mukhtar

Lec. # 17 Parasitology Paragonimyiasis Prof. Adnan Amin

Dr. Hala Said Salim

Lec. # 18 Parasitology Parasitic larva migrates to lungs

Prof. Mahmoud Faud

Dr. Mona Abdul Fattah

Lec. # 19 Pathology The pathology of pulmonary microbial infections.

Dr. Osama I. Nasif

0505626775

Dr. Eman Emam0562480316Pager: 3488

Lec. # 20 Pharmacology Treatment of tuberculosis Prof. Osman H.

Osman 0506620311

Prof. Magdah M. S. Hagras 0508702235

Lec. # 21 Pathology Chronic of obstructive airway diseases & bronchiectasis

Prof.. Ahmed Ghanim

0559417955Pager: 1715

Dr. GhadeerMukhtar

0505352367Pager: 1645

Lec. # 22 Pharmacology Drugs used for treatment of bronchial asthma

Prof. Osman H. Osman

0506620311


Lec. # 23 Pharmacology Principles of treatment of pulmonary infections.

Prof. Osman H. Osman

0506620311


Lec. # 24 Pathology Interstitial lung disease 1 Dr. Osama I. Nasif

0505626775


Lec. # 25 Pathology Interstitial lung disease 11 Dr. Osama I.

Nasif 0505626775


Lec. # 26 Pathology Disease of pulmonary

vasculatureDr. Osama I.

Nasif 0505626775


ec. # 27 Pathology Pulmonary neoplasia Dr. Osama I.

Nasif 0505626775


Lec. # 28 Pharmacology Clinical pharmacology of

pulmonary embolismProf. Osman H.

Osman 0506620311


Lec. # 29 Pediatrics Clinical approach to patient with respiratory diseases.

Dr. Saad Al-Saadi

0504661535

Dr. Hayat Kamfar

055580108

Lec. # 30 Medicine Pleural effusion Dr. Serag Wali0505606100

Dr. Nawal Al-Ghamdi

Lec. # 31 Medicine Overview of definition epidemiology, pathogenic

& clinical features of asthma

Dr. Serag Wali0505606100

Dr. Nawal Al-Ghamdi

Lec. # 32 Radiology Radiology of the lungs Dr. Athar Radwi

050567914

Dr. Gala Sindi

Lec. # 33 Surgery Pneumothorax and Haemothorax

Dr. Iskander S. Salim Al-Thaghafi


Icons (standards)

The following icons have been used to help you identify the various experiences you will be exposed to.

Learning objectives

Content of the lecture

Independent learning from textbooks

Independent learning from the CD-ROM.

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Phase I Module Name Faculty of MedicineThe computer cluster is in the 2nd floor of the medical library, building No. 7.

Independent learning from the Internet

Problem-Based Learning

Self- Assessment (the answer to self-assessment exercises will be discussed in tutorial sessions)

The main concepts

20


Topic Outlines

21

Read carefully the following Topics


Department: Anatomy

Lecture # 1 : Overview of Structure & Functions of The Respiratory System .

Tutor: Prof Said Zaghloul (Male section) Tutor: Prof. Amira Hagagi (female section).

At the end of the lecture the student should be able to:

1. Overview of the components of the respiratory system. a. Nose and para-nasal sinuses. b. Pharynx and auditory tube. c. larynx and trachea.2. Functions of the different parts of respiratory system. 3. Lining epithelium of different parts of respiratory system

Contents of the Lecture:

1. Study the parts forming the respiratory system.2. Study the function of each part of the respiratory system 3. Study the lining epithelium of each part in relation to its function

Independent Learning from textbooks.

1. Clinical anatomy for medical students (Richard S. Snell)2. Textbook of histology (Gartner and Hiatt).

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Department: Anatomy

Lecture 2: Pleura and Lungs.

Tutor: Prof Said Zaghloul (Male section) Tutor: Prof. Amira Hagagi (female section)

1. Anatomy of the pleurae (visceral & parietal).2. Surface anatomy of pleura.3. Pleura recesses.4. Surface anatomy of the lungs.5. Blood and nerve supply of pleura and Lung.

1. Surface anatomy of right & left pleura and the pleural recesses.2. Surface anatomy of right & left lungs. 3. Blood supply of the parietal and visceral pleurae. .4. Blood supply of the right and left lungs.5. Bronchopulmonary segments. 6. Lymphatic drainage of the pleura and the lungs.

.

Clinical Anatomy for Medical Students, (Richard S. Snell).

Student Notes: .

23

http://www/


2. Textbook of histology (Gartner and Hiatt).

You have the opportunity to watch the CD-ROM during your spare time.

In the computer cluster also you have the opportunity to see some useful web site following web sites:

Self-assessment

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Phase I Module Name Faculty of MedicineDepartment: Anatomy

Lecture # 3: Medial Relations & Hila of the Lungs.

Tutor: Prof. Said Zaghloul (male section) Tutor: Prof. Amira Hagagi (female section)

1. Contents of the hilum of each lungs.2. Medial relations of the lungs.

1. Study of the structures forming the root of each lung2. Study of the structures related to the medial surface of each lung.3- Study of the important impressions on the medial surface of each lung.4- Mechanism of respiration: anatomical point of view (normal respiration, forced inspiration, forced expiration, mechanism of cough & straining down efforts)..

1. Clinical Anatomy for Medical Students, (Richard S. Snell

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Department: Anatomy

Lecture 5: Development of the respiratory system

Tutor: Prof. Said Zaghloul (Male section) Tutor: Prof. Fathia Ahmed (female section)

1. Development of the respiratory tract2. Congenital anomalies.

1. Development of trachea, and lungs.

2. Stages of lung maturation

3. Congenital anomalies of the respiratory system, including tracheo-esophageal fistula

Langman's Medical Embryology (T.W. Sadler)

26


Department: Anatomy : dissecting room

Practical 1: Structure of the nose, paranasal air sinuses, pharynx , larynx and trachea

Tutor: Members of the staff.

Identification of the different parts of the respiratory system.

1. Identification of the parts forming the nose.2. Identification of the parts of the pharynx.3. Identification of the larynx and trachea.4. Identification of the pharyngeal opening of auditory tube.5. Identification of the sites of tonsils: pharyngeal, tubal, palatine and lingual tonsils

TRANSFERABLE SKILLS:

Identification of clinically important structures, e.g. nasal cavity, paranasal sinuses, pharynx, auditory tube, tonsils, larynx and trachea

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Practical 2: Thoracic cavity & pleural cavities


1. Study of the structures in the thoracic cavity.

2. Study of the visceral & parietal pleurae

3. Study of the surfaces, borders & lobes of the lungs

1. Identification of the parietal and visceral pleurae .

2. Identification of surfaces, borders, apex and base of each lung

3. How to identify the sides, lobes, fissures, base, and apex of the lungs

4. Identify the pleural recesses

5. Identify the differences between right & left lungs


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Phase I Module Name Faculty of MedicineAnatomical differences between right and left lungs


Practical 3: Important relations of the lungs & structures forming lung root


1. Study of the structures forming the root of each lung

2. Study of the structures related to the medial surface of each lung

1. Identification of the structures present in the hilum of each lung2. Identification of the important structures in the mediastinum related to each lung 3. Identification of important impressions & groove on the medial surface of each lung

TRANFERABLE SKILLS:

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Surfactant, and its clinical importance

Department : Physiology

Lecture # 4: The Mechanics of Breathing.

Tutor: Dr. Khidir A. Galil (male section) Tutor: Prof. Sawsan Rohaeim (female section).

1. To understand the mechanical changes of the thorax during normal &deep breathing:

a) Normal inspiration b) Normal expiration. c) Deep inspiration. d) Normal expiration

2. To understand the various pressure changes accompanying the mechanics of normal and deep breathing.3. To be able to comprehend the pathological changes and causation of airways obstruction, restriction of lung expansion and respiratory muscle paralysis. breathing.

1. Guyton, AC and Hall, JE (2005). Textbook of Medical Physiology, 11th ed. (2000). WB Sunders Co.2. Ganong, WF (2007).Review of Medical Physiology, 23th ed. (2001). McGraw Hill) 3.Roddie, IC and Wallace WFM (2004). MCQs in human physiology, 5th ed. (2004).

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Phase I Module Name Faculty of Medicine Oxford Univ. Press.

Department : Physiology

Lecture # 6: Pressure -Volume relationship in the respiratory tract.

Tutor: Dr. Khidir A. Galil (male section) Tutor: Prof. Sawsan Rohaeim (female section)

To study the nature, origin and function of surfactant in minimizing alveolar surface tension.2. To understand the compliance of the lungs & that of lungs & thorax in lung expansion in the healthy person.3. To understand the compliance curves in healthy subject.4. To study the work of breathing during normal and deep respiration.

1. Different effects of alveolar surface tension on smaller and larger alveoli (Laplace Law).2. The nature, origin, and constituents of surfactant molecule, its orientation and effects in smaller and larger alveoli.3. Factors that decrease surfactant.4. Compliance: Expansibility of lungs and thorax. It is a volume change in the lungs per unit change in alveolar pressure.5. Conditions of high compliance and low compliance.6. Working utilized during breathing against elastic recoil, airway resistance and tissue resistance.

1. Guyton, AC and Hall, JE (2005). Textbook of Medical Physiology, 11th ed. (2000). WB Sunders Co.2. Ganong, WF (2007).Review of Medical Physiology, 23th ed. (2001). McGraw Hill) 31

Phase I Module Name Faculty of Medicine3.Roddie, IC and Wallace WFM (2004). MCQs in human physiology, 5th ed. (2004). Oxford Univ. Press.

Department: Physiology

Lecture # 7: Neural Control of Breathing

Tutor: Dr. Atef M. Abood (male section) &Tutor: Dr. Zienab Al-Refae (female section).

1. To understand the involuntary neural control of breathing. a) The medullary respiratory centers (MRC). * The medullary inspiratory neurons (IN). * The medullary expiratory neurons (EC). b) The Botzinger complex at nucleus ambiguous. c) The pontine centres: apneustic & pneumotaxic centres.2. To understand the voluntary neural control via cerebral cortex.3. Feedback inputs on MRC from various sensory receptors to modify breathing

1. To understand the mechanisms of the:

1. Guyton, AC and Hall, JE (2005). Textbook of Medical Physiology, 11th ed. (2000). WB Sunders Co.

a) Dorsal medullary inspiratory neurons (IN) in causing inspiration (IC). b) Ventrolateral medullary expiratory neurons (EN) that cause deep expiration (EN) 2. The botzinger complex rostral to nucleus ambiguous, it inhibits (IN) and excite (EN).3. The pontine centers that modify MRC: a) The apneustic center that discharge to inspiratory neurons. b) The pneumotaxic center discharging to cause deep expiration, & affecting the rate . 4. Voluntary neural control of breathing. 5. The action of the different sensory receptors.

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http://www/

Phase I Module Name Faculty of Medicine2. Ganong, WF (2007).Review of Medical Physiology, 23rd ed. (2001). McGraw Hill

Lecture # 9: Gas Diffusion & Blood flow to the Lungs, Regional Differences.


Tutor: Dr. Khidir A. Galil (male section) &Tutor: Prof. Sawsan Rohaeim (female section).

1. Gas laws & gas diffusion across the respiratory membrane.2. Factors affecting gas diffusion across the respiratory membrane. 3. Overview the pulmonary, bronchial and systemic circulation in terms of blood volume, blood pressure, resistance to flow and the pressure gradient.4. To understand the regional pulmonary blood distribution.5. The ventilation perfusion (V/P) ratio.6. Significance of low capillary blood pressure.7. Regulation of pulmonary blood flow.

1. Guyton, AC and Hall, JE (2005). Textbook of Medical Physiology, 11th ed. (2005). WB Sunders Co.2. Ganong, WF (2007). Review of Medical Physiology, 23rd ed. (2007). McGraw Hill 3. Roddie, IC and Wallace WFM (2004). MCQs in human physiology, 5th ed.

1. The pulmonary vascular system as low resistance and low-pressure system.2. Total blood volume in pulmonary capillaries in relation to total surface are of alveoli. The efficiency of gas transfer.3. Significance of low pulmonary capillary pressure in keeping alveoli always dry 4. Regional pulmonary blood distribution at apices and bases of the lungs & at different positions that affects V/P ratio. 5. Regulation of pulmonary blood flow.

33

Phase I Module Name Faculty of Medicine (2004). Oxford Univ. Press.


Lecture # 10: The transport of oxygen in the blood.

Tutor: Prof. Adul Rahman Fahmi (male section) Tutor: Dr. Zienab Al-Refae (female section).

1. Review of gas laws: Henry's law and Dalton's law in relation to solubility of gases and partial pressure of gas in a mixture of gases.2. Transport of O2 dissolved in physical solution.3. Transport of O2 in chemical combination.4. The oxygen binding and oxyhaemoglobin dissociation curve and its significance.5. Factors affecting the oxygen building and oxyhaemoglobin dissociation curve.6. The myoglobin curve.

1. Oxygen and CO2 exchange between lungs and blood and between the blood and tissue cells in relation to partial pressures.3. Transport of O2 dissolved in blood plasma related to partial pressure of O2.4. Carriage of oxygen combined with haemoglobin depending on PO2.

5. The oxygen binding and oxyhaemoglobin dissociation curve and its significance.6. Factors affecting the shift of the oxyhaemoglobin dissociation curve to the right or to the left and the O2 release. The Bohr's effects. 7. Comparison of oxyhaemoglobin curve with that of myoglobin curve.8. The O2 content, O2 capacity and the coefficient of O2 utilization.

1. Guyton, AC and Hall, JE (2005). Textbook of Medical Physiology, 11th ed. (2005). WB Sunders Co.2. Ganong, WF (2007). Review of Medical Physiology, 23rd ed. (2007). McGraw Hill

34



Lecture # 11: The transport of CO2 in the blood.

Tutor: Prof. Adul Rahman Fahmi (male section) Tutor: Dr. Zienab Al-Refae (female section).

1. Solubility of CO2 in solution.2. Transport of CO2 dissolved in physical solution.3. Transport of CO2 combined as: a) Bicarbonate in RBCs and plasma. b) As Carbaminohaemglobin (CO2-HHb) c) As Carbaminoprotein (CO2-R-NH2)4. Release of CO2 in the lungs and loading of O2.

.1. To understand that solubility of CO2 as 20 times that of O2, & the solubility coefficient of CO2 as compared to O2.2. Transport of CO2 dissolved in blood plasma depending on PCO2 3. Transport of CO2 combined inside the RBCs and plasma. a) As bicarbonates inside the RBCs (KHCO3) and in the plasma (NaHCO3), respectively. The bicarbonate-chloride shift. b) Combined with Hb as Carbaminohaemglobin (CO2-HHb). c) Combined with plasma protein as carbaminoprotein (CO2-R-NH2). d) The buffering effect of Hb (H+ +Hb- HHb).4. Diffusion of CO2 into the lungs and reloading of O2 with Hb depending on the pressure gradient for PCO2 and PO2.

35

Phase I Module Name Faculty of Medicine1. Guyton, AC and Hall, JE (2005). Textbook of Medical Physiology, 11th ed. (2005). WB Sunders Co.2. Ganong, WF (2007). Review of Medical Physiology, 23rd ed. (2007). McGraw Hill .


Lecture # 12: Chemical Control of Breathing.

Tutor: Dr. Atef M. Abood (male section) &Tutor: Dr. Zienab Al-Refae (female section).

1. The chemical control of breathing: a) Effects of increased CO2 (hypercapnia) and increased (H+) acidosis. b) The central chemoreceptors and blood brain barrier and CSF-barrier. c) Effects of O2 lack (hypoxia). The peripheral chemoreceptors.2. A brief mention on acid-base balance.

1. Guyton, AC and Hall, JE (2005). Textbook of Medical Physiology, 11th ed. (2005). WB Sunders Co.2. Ganong, WF (2007). Review of Medical Physiology, 23rd ed. (2007). McGraw Hill 3. Roddie, IC and Wallace WFM (2004). MCQs in human physiology, 5th ed. (2004). Oxford Univ. Press.

1. The chemical control of breathing: a) Effects of increased CO2 (hypercapnia) and increased H+ concentration acidosis b) Effects of central chemoreceptors & the blood-brain barrier. c) The oxygen lack (hypoxia) & the peripheral chemoreceptors. d) A brief mention of acid base regulation

36



Lecture # 14: Exercise and high altitude. Physiological responses to Hypoxia, Hypercapnia.

Tutor: Prof. Adul Rahman Fahmi (male section). Tutor: Dr. Zienab Al-Refae (female section).

1. To understand the responses of the respiratory system to exercise: hypothermia, hypercapnia and acidosis.2. To understand the responses of the respiratory system to high altitude.3. The oxygen lack and various types of hypoxia O2 therapy, O2 toxicity and cyanosis.4. Abnormalities of ventilation:5. Review the methods of artificial breathing; the resuscitators.

1. To understand the mechanism of the respiratory system to exercise: hypothermia, hypercapnia and acidosis.2. Different types of hypoxias: Hypoxic hypoxia, anaemic hypoxia, stagnant hypoxia and cytotoxic hypoxia. * Effects on various body systems. * Effects of cyanosis: effects of O2 therapy and O2 toxicity.5. The abnormalities of ventilation: * Cheyne-stroke respiration & periodic breathing. * Asphyxia: occlusion of air passage or breathing in a confined space. * Dyspnea: Mental anguish related to inability to ventilate enough. * Nitrogen narcosis and decompression sickness. *Effect of cyanide and CO poisoning

37

Phase I Module Name Faculty of Medicine1. Guyton, AC and Hall, JE (2005). Textbook of Medical Physiology, 11th ed. (2005). WB Sunders Co.2. Ganong, WF (2005). Review of Medical Physiology, 222nd ed. (2005). McGraw Hill


Practical # 4: Lung Function Testing. Tutor: Dr. Khidir A. Galil (male section) &Tutor: Dr. Zienab Al-Refae (female section).

1. To understand the definition and values of lung volume: TV, IRV, ERV, RV and lung capacities: IC, EC, FRC, VC and TLC.2. To understand methods of measuring the lung volumes and capacities: the spirometer method & the flow-volume loop method. 3. The minute ventilation and alveolar ventilation per minute.4. To understand the anatomical dead space (ADS) and the physiological dead space (PDS). 5. Special method: the helium dilution method for measurement of FRC, RV, TLC.6. Significance of vital capacity in diagnostic purposes

1. To understand the definition, values and measurements of 4 lung volumes& 4 lung capacities.2. To practice using the spirometer and the computerized apparatus for flow-volume loops method.3. To understand special methods for measuring ADS. Definition and values for ADS and PDS.4. To understand special methods for helium dilution technique and using it to measure FRC, RV, TLC.5. To find out the minute volume and alveolar ventilation per minute.

TRANSFERABLE SKILLS:1. Students understand practical skills associated with lung volumes and capacities.2. Identify values and measurements.

38

Phase I Module Name Faculty of Medicine1. Guyton, AC and Hall, JE (2005). Textbook of Medical Physiology, 11th ed. (2005). WB Sunders Co.2. Ganong, WF (2007). Review of Medical Physiology, 23rd ed. (2005). McGraw Hill


Practical # 6: Special Lung Function Tests. Tutor: Dr. Dr. Khidir A. Galil (male section) &Tutor: Dr. Zienab Al-Refae (female section).

1. To understand definition, values and measurements for maximum voluntary ventilation (MVV) or maximum breathing capacity (MBC). 2. To understand values definitions and measurements of forced vital capacity (FVC) and forced expiratory volume/sec. (FEC/sec).3. Differentiate between obstructive lung and restrictive lung disease.

1. To use the spirometer or the flow-volume loops to measure the maximum voluntary ventilation per minute (MVV/min).2. To use the spirometer or flow-volume loops to measure the FVC and FEV/sec and get the values in percentage (80%-70%).3. To differentiate by diagram between obstructive lung disease and restrictive lung disease.


1. Students understand practical skills concerning: MVV, FEV/sec.2. To utilize these in diagnosis of obstructive and restrictive lung diseases.

39

Phase I Module Name Faculty of Medicine1. Guyton, AC and Hall, JE (2005). Textbook of Medical Physiology, 11th ed. (2005). WB Sunders Co.2. Ganong, WF (2007). Review of Medical Physiology, 23rd ed. (2005). McGraw Hill .

Department: Clinical Biochemistry

Lecture # 8: Acid – base balance

Tutor: Prof. Adil A. Rafae (male section) Tutor: Dr. Huda Jad (female section).

1. Outline the interrelationship of the buffering mechanisms of bicarbonate, Carbonic acid and haemoglobin

2. Explain the clinical significance of the following pH and blood gas parameters pH, PCo2, PO2 , actual bicarbonate, Carbonic acid, base excess , Oxygen saturation , Fractional oxyhaemoglobin, haemoglobin oxygen (binding) capacity, Oxygen content and Total CO2.

1- Definitions: Acid, Base, Buffer2- Acid – Base Balance

a. Maintenance of H+

b. Buffer system: regulation of H+

c. Regulation of Acid – Base Balance: Lungs and Kidneys. 3- Assessment of acid base Homeostasis

a. The bicarbonate buffering system and the Henderson – Hasselbach Equation

b. Acid base Disorders : Acidosis and Alkalosis

40


1- Clinical Chemistry, W J. Marshall, Mosby, London. Last Edition.


Lecture # 13: Metabolic functions of respiratory system Tutor: Prof. Adil A. Rafae (male section) Tutor: Dr. Huda Jad (female section).

1. Outline the Metabolic function of respiratory system .2. Describe the role of respiratory system in maintenance of acid base balance

3. Determine whether data are normal or represent metabolic or respiratory acidosis or alkalosis

1- Role of lung in acid base regulation2- Oxygen and gas exchange

a- Oxygen and carbon Dioxideb- Oxygen Transportc- Quantities associated with assessing patient’s oxygen statusd- Haemoglobin – Oxygen dissociation

41

Phase I Module Name Faculty of Medicine1- Clinical Chemistry, W J. Marshall, Mosby, London. Last Edition.


Tutorial # 1: Lung surfactant Tutor: Prof. Adil A. Rafae (male section) Tutor: Dr. Huda Jad (female section).

1. Identify the source and synthesis of lung surfactant2. Describe the physiologic purpose of lung surfactant

3. Discuss the clinical significance of lung surfactant

1. Definition2. Lung Surface tension3. Composition of lung phospholipids 4. Lung surfactant and respiratory distress syndrome5. Significance of ratio between lecithin and sphingomyelin

1- Clinical Chemistry, W J. Marshall, Mosby London. Last Edition.

42



Tutorial # 2: The Biochemistry of Haemoglobin binding to Oxygen.


1. Describe the significance of the configuration of haemoglobin molecule & its binding to oxygen. The impact of pH , 2,3 diposphoglycerate, temperature, pH and PCO2 on

The release of O2 to the tissues

1. Quaternary structure of haemoglobin2. Cooperative binding of oxygen, effect of hydrogen ion and carbon

dioxide (Bohr effect) functional significance of DPG, fetal haemoglobin, 3. Abnormal haemoglobin

1- Clinical Chemistry, W J. Marshall, Mosby, London. Last Edition

43



Directed Learning # 1: Problem Involved in Blood Gas and Acid – Base Status.


1. Determine whether data are normal or represent metabolic, respiratory, non respiratory (Acidosis, Alkalosis)2. Discuss problems and precautions in collecting and handling samples for pH and blood gas analysis.3. Calculate partial pressures for PCO2 and PO2 for various percentage of carbon dioxide and oxygen

4. Discuss the reasons for possible discrepancies, given oxygen saturation data calculated by the blood gas analyzer

1. Discussion of selected cases with acid – base disturbance

1- Clinical Chemistry, W J. Marshall, Mosby, London. Last Edition.

44


4- Department of Medical Microbiology:

Lecture # 15: Lecture # 16:

5- Department of Medical Parasitology:

Lecture # 17: Paragonimyiasis. Lecture # 18: Parasitic larva migrates to lungs

45


Department: Pathology

Lecture # 19 : The Pathology of pulmonary microbial infection

Tutor: Dr. Osama I. Nassif (male section) Tutor: Dr. Eman Emam (female section)

By the end of this session, the student will be able to:

1. Differentiate between acute and chronic pneumonias.2. Interprete different patterns of pulmonary infiltrate and consolidations types.3. Choose the laboratory methods required in the process of diagnosing pneumonias.4. Correlation of all clinical findings with the pathology of case.5. Antisepatie the possible fate and/complications of such case.6. Conclude by the best therapy for the current care depending or etiology.

1. A brief introduction to immune and non-immune deficiency barriers against microbial infection in the structure of the respiratory passage.

2. The classification of different pneumonias into typical, atypical and chronic localized peneumonias in addition to pneumonias affecting the immune difficient subjects with their etiology, morphology and particular clinical presentations allowing with their complications will be introduced.

3. The pathology and the etiological factors involved in lung abscess will be ginen.4. Detailed clinical and pathological aspects of the different presentations of

pulmonary tuberculosis will be entertaied.5. Detailed presentations of opportunistic lung infections affecting immune

suppressed patients will be discussed.

Robbins pathologic basis of diseases

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Lecture # 21 Chronic Obstructive airways disease & Bronchietasis.

Tutor: Prof. Ahmed Ghanim (male section) &Tutor: Dr. Ghadeer Mukhtar (female section)

By the end of this session the student will be able to :1. Recall the differences between obstructive and restrictive lung diseases.2. Classify the differences types of obstructive lung diseases.3. Understand pathogenesis and complications of bronchial asthma4. Comprehend the scope of chronic obstructive pulmonary diseases namely chronic

bronchitis, emphysema and chronic smell.5. List the causes of necrotizing lung infection and inherited disorders leading to

bronchiectasis.

1. The differentiation between obstructive restrictive lung from the functional and clinical points of view will be recalled.

2. Classification of chronic obstructive airway diseases in to asthma chronic bronchitis, emphysema and bronchoiecatsis will be discussed.

3. Pathogenesis, mediation, presentation and etiological factors and complications of bronchial asthma.

4. Definition of bronshiecatsis, predisposing factors, pathogenesis, evolution and complications.

5. Detailed clinico pathological correlation and composition between emphysema and chronic bronchitis well be discussed.


47



Lecture # 24 : Interstitial lung disease 1, including pneumoconiosis.



1. Comphrehend classify interstitial lung diseases.2. Etiological factors involved in interstitial lung diseases.3. Apprreciate the function and clinico pathological differences between obstructive

and restrictive lungdisease.4. Understand the detailied pathology-physiology, morphology and selected clinical

presentationof acute and chrinic obstructive lungdiseases.5. List the commin types of ecvironmental important pneumonotic lung diseases.

1. The classification of ILD in to acute and chronic with regards to etiological factors and clinical presentations will be discussed.

2. Differential diagnosis of obstructive and restrictive lung diseases as far as functional (RFT) and clinico-pathological aspects.

3. Morphological and clinical aspects of particular examples of ILD including sarcodises and allergic alveolotis.

4. Histopathological and clinical aspects of environmental important pneumocenietic disorders, e.g. silicosis, asbestosis and coal miners diseases


48



Lecture # 25 : Interstitial lung disease 11, including pneumoconiosis.



6. Comphrehend classify interstitial lung diseases.7. Etiological factors involved in interstitial lung diseases.8. Apprreciate the function and clinico pathological differences between obstructive

and restrictive lungdisease.9. Understand the detailied pathology-physiology, morphology and selected clinical

presentationof acute and chrinic obstructive lungdiseases.10. List the commin types of ecvironmental important pneumonotic lung diseases.

5. The classification of ILD in to acute and chronic with regards to etiological factors and clinical presentations will be discussed.

6. Differential diagnosis of obstructive and restrictive lung diseases as far as functional (RFT) and clinico-pathological aspects.

7. Morphological and clinical aspects of particular examples of ILD including sarcodises and allergic alveolotis.

8. Histopathological and clinical aspects of environmental important pneumocenietic disorders, e.g. silicosis, asbestosis and coal miners diseases


49



Lecture # 26 : Diseases of the Pulmonary Vasculature Tutor: Dr. Osama I. Nassif (male section) Tutor: Dr. Eman Emam (female section)

By the end of this session, the student will be able to:1. Haemostasis and lung circulations2. Fate of incoming venous emboli.3. differential diagnosis of haemoptysis4. Differential diagnosis of cor-pulmonale5. Phythophysiology of pulmonary hypertension

1. The natural history of deep vein the deep vein thrombosis and pulmonary are discussed.

2. Pathophysiology and etiological of essential ( primary ) and secondary pulmonary hypertension are elaborated.

3. The different causes and presentations of all haemorrhagic lung diseases.4. Pathophysiology and evaluation of co-pulmonale including pulmonary and extra

pulmonary causes.


50



Lecture # 27: Pulmonary Neoplasia.

Tutor: Prof. Ahmed Ghanim (male section) &Tutor: Dr. Ghadeer Mukhtar (female section)

By the end of this session, the student will be able to know:1. The clasification of lung neoplasm2. Epidemilogy and pathogenesis of lung cancer3. Molecular basis of lung cancer4. Types and morphology of lung cancer5. Pulmonary para neoplastic syndromes6. Investigafion of lung cancer7. Common causes of upper resporatory tract inflammation and tumors

1. Classification of lung tumors into primary and secondary as wll as bening and malignant tumors will be entertained.

2. Epidemiollogy of lung cancer as far as its world distribution and relation to environmantal, racial, sexual,genetic, microbial and nutritional factors. Predisponsing lung conditions in the evaluation of lung cancer ( pathogenesis ) will be thoroughly discussed.

3. The role of the main types of growth controlling genes ( suppressor, oncogenes, apoptosis genes, and DNA repair genes etc.) in the evolution of lung cancer will be explained.

4. The distinction of lung cancer group bsed on ,morphology and behaviours in to two main prognostic groups, (small cell and non-small cell will be evaluated).

5. The different resentations of paraneoplastic syndromes in association with lung cancer and the chemical mediators responsible and their mechanisms will be given.

6. The different investigations of lung cancers will be explained including laboratory radiological investigastations.

7. The inflammatory disoeders of upper airways will be discussed along with the common terms especially nasopharyngeal carcinoma.


51



Tutorial # 3: Case of Pneumonia Tutor: Dr. Osama I. Nassif (male section) Tutor: Dr. Eman Emam (female section)

By the end of this session the student will be able to:

1. Differentiate between acute and chronic pneumonias2. Interpret different patterns of pulmonary infiltrate and consolidations types3. Choose the laboratory methods required in the process of diagnosing pneumonias4. Correlation of all clinical findings with the pathology of the case

5. Conclude by the best therapy for the current care depending or etiology

1. Differentiate between acute and chronic pneumonias2. Interpret different patterns of pulmonary infiltrate and consolidations types3. Choose the laboratory methods required in the process of diagnosing pneumonias

4. Conclude by the best therapy for the current care depending or etiology

Robbins pathologic basis of diseases.

52



Practical # 7: Pathology of pneumonia: demonstrations, case histories & X-Rays..


By the end of this session, the students should be able to:

1. Identify the morphological features and the different presentations of lung infections.

2. Correlate clinical presentations of each pneumonia with the corresponding morphological features (Radiological, macroscopic and microscopic).

3. Discuss the case histories and their correlation with the pathology and etiological microbial agents.

The following will be demonstrated:1. The Radiological prognosis and microscopic features of bacterial

pneumonias( Lobar and Lobular ) will be demonstrated in conjunction with the clinical presentation based on particular pyogenic organism.

2. The radiological microscopic and minoscopic features of atypical pneumonia in correlation with the causative organisms and clinical presentation will be demonstrated

3. Radiological gross and microscopic features of the different clinical presentation of lung abscess in relation to the source of infection and types of organisms.

4. Radiological gross and microscopic features of chronic pneumonia with partical interest microsopic features of chronic pneumonia with particular interest in pulmonary tuberculosis and mimicking granular lesions.


53


Department: Pharmacology

Lecture # 20 : Treatment of tuberculosis. Tutor: Prof. Osman H. Osman (male section) &Tutor: Prof. Magdah M. S. Hagras (female section)

1. Describe the strategies of treatment of T.B.

2. List the major classes of drugs used in treatment of TB.

3. Describe the mechanism of action of these drugs.

4. Describe the pharmacokinetics

5. Describe the pharmacological action of these drugs.

6. List the major adverse effects of these drugs and drug resistance

1. Drugs used to treat TB are discussed as regards their pharmacodynamics,

pharmacokinetics effects.

2. Also, the adverse effects, drug interactions and drug resistance are mentioned.

Combination therapy also discussed.

a. First line treatment: Isoniazide, rifampin, pyrazinamide, ethambutol and streptomycin.

b. Second line treatment: Amikacin, capreomycin, ciprofloxacin, ofloxacin, cycloserine, ethionamide

1. Lippincott’s illustrated review edited by Richard A. Harvey & Pamela C. Champe 3rd edition 2006.2. Basic and clinical pharmacology by Katzung, McGraw &Hill.3. Rang, Dale and Ritter, Churchill & Livingstone.

54



Lecture # 22 : Drugs used in the treatment of bronchial asthma. Tutor: Prof. Osman H. Osman (male section) &Tutor: Prof. Magdah M. S. Hagras (female section)

1. Describe the strategies of drug treatment of bronchial asthma.

2. List the major classes of drugs used in asthma (acute asthma, in between attacks

and status asthmaticus).

3. Describe the mechanisms of action of these drug groups.

4. Describe the pharmacodynamics of these drugs.

5. Describe the pharmacokinetics of these drugs.

6. Describe the pharmacological actions of these drugs.

7. List the major adverse reactions of the most important drug groups.

8. List drug-drug interactions

1. Drugs used to treat bronchial asthma are discussed as regards their pharmacodynamics, pharmacokinetics effects.2. Also, the clinical uses, adverse effects and drug interactions are mentioned. β2- adrenoceptor agonists, theophylline, aminophylline, proxifylline, muscarinic antagonists (e.g ipratropium), sodium cromoglycate, Ketotifen, glucocorticoids, leukotriene antagonists, monoclonal antibodies and new trends in treatment of bronchial asthma.


55



Lecture # 23 : Principles of treatment of lung infections. Tutor: Prof. Osman H. Osman (male section) &Tutor: Prof. Magdah M. S. Hagras (female section)

1. Identify drugs used in treatment of pneumonias.

2. Describe the mechanism of action of these antibiotics.

3. Describe the pharmacokinetics of these antibiotics

4. Describe the spectrum of action of these antibiotics.

5. Identify the adverse effects of these drugs.

6. Identify mechanisms of drug resistance

1. Drugs used for lung infections are discussed as regards their pharmacodynamics, pharmacokinetics effects. 2. Also, the adverse effects and drug resistance are mentioned. Cell wall inhibitors (penicillins and cephalosporins), Protein synthesis inhibitors (streptomycin, chloramphenicol and tetracyclines), Vancomycin in methicillin-resistant cases, antipseudomonal drugs (carbenicillin combined with gentamycin), for klebsiella infections (streptomycin, chloramphenicol and tetracyclines


56



Lecture # 28 : Clinical pharmacology of pulmonary embolism.

Tutor: Prof. Osman H. Osman (male section) &Tutor: Prof. Magdah M. S. Hagras (female section)

1. Describe the strategies of prevention of pulmonary embolism.

2. Describe the strategies of treatment of pulmonary embolism.

3. List the major drugs used for prevention of pulmonary embolism

4. List the major drugs used for treatment of pulmonary embolism.

5. Describe the mechanism of action of these drugs.

6. Describe the pharmacological action of these drugs.

7. List the major adverse effects of these drugs

8. List the major drug interactions of these drugs

1. Drugs used to treat pulmonary embolism are discussed as regards their

pharmacodynamics, pharmacokinetics effects.

2. Also, the clinical uses, adverse effects and drug interactions are mentioned.

3. Anticoagulants (heparin and oral anticoagulants), Antiplatelets and thrombolytics are discussed


57



TUTORIAL # 4: Drugs & the Lungs . Tutor: Prof. Osman H. Osman (male section) &Tutor: Prof. Magdah M. S. Hagras (female section)

1. Drug-induced lung disease.

2. Autonomic control of respiratory system and drugs affecting receptors.

3. Mediators and autacoids released in bronchial asthma and their possible modulation

1. Drugs causing pulmonary fibrosis as a side effect e.g. amiodarone and bleomycin.

2. Drugs causing bronchoconstriction.

3. Sympathetic and parasympathetic receptors in bronchial tree and their modulation for

treatment of bronchial asthma.

4. Autacoids and their modulation in bronchial asthma e.g. leukotriene antagonists


58



Practical # 5: Effect of drugs on isolated guinea pig trachea. Tutor: Prof. Osman H. Osman (male section) &Tutor: Prof. Magdah M. S. Hagras (female section)

1. To demonstrate the effect of muscarinic agonist on isolated trachea

(dose-response curve).

2. To demonstrate the effect of antagonist on tracheal contraction induced by

muscarinic agonist.

3. To demonstrate the effect of histamine agonist on isolated trachea

(dose-response curve).

4. To demonstrate the effect of antagonist on tracheal contraction induced by histamine agonist

1. The effect of drugs (acetylcholine or histamine) that contract tracheal smooth muscles will be presented in a dose response curve.2. To antagonize the contraction induced by acetylcholine or histamine by either competitive antagonists or physiological antagonists


59


Department: Pediatric

Lecture #29: Clinical Approach to Patient with Respiratory Diseases .

Tutor: Dr. Saad Al-Saedi (male section) & Tutor: Dr. Hayat Kamfar (female section)

Students should be able to recognize and describe:

1. The common symptoms of pulmonary diseases and the significant characteristics to identify in the history interview.

2. The characteristics of the 4 – types of normal breath sounds.3. The appropriate terms for describing normal and abnormal lung sounds.4. Appropriate history raking physical examination of the respiratory system and

interpret symptoms with signs.

1. Correct techniques for appropriate physical assessment2. Common causes for abnormal identified during physical examination of the

patient with respiratory diseases.3. The Value of other assessment adjuncts , including chest radiography, PFT, arterial

blood gases.4. The value of other assessment adjuncts e.g.: chest x-ray, PFM & ABG.

60


1. Lung Sounds – A practical Guide ( Roberts Wilkins, john Hodgkin's, Brad Lopez)2. Respiratory System ( Angus Jefferies, Andrew Tuley)

Department: Medicine

Lecture # 30: Pleural Effusion.

Tutor: Dr.Sirag Wali (male section) &Tutor: Dr. Aisha Al-Ghamdi (female section)

To educate students on how to:

1. Overview of pleural effusion. a) pathophysiology. b) clinical presentations. c) and approach to diagnosis)2. Overview of Pneumothorax

Students should be able to understand:

1. Definition and common causes of pleural effusions.2. Types of pleural effusion (Exodate /Trensidate).3. Approach to the diagnosis of pleural effusions

61


Department: Medicine

Lecture # 31: Overview of definition epidemiology, pathogenic & clinical features of asthma

Tutor: Dr.Sirag Wali (male section) &Tutor: Dr. Abeer Kawther (female section)

1. Overview of bronchial asthma.2. Type of asthma.3. Clinical presentation of asthma.4. Overview of medication used for control asthma.

5. Introduction to guidelines of asthma management

1. Definition2. Prevalence3. Mode of presentation4. Classification5. Diagonosis6. Medication used for managemant7. Types pf medications:Bronchodilators/anti-inflammatory.

62


Department: Radiology:

Lecture # 32: Radiology of the lungs.

Tutor: Dr. Athar Radawi (male section) & Tutor: Dr. Asmaa Aldabbagh (female section) Tutor: Dr. Jala Sindi (female section)

1. Various Clinical indications for a chest radiograph.2. How a CXR is obtained; simplified technique and quality assessment.3. Basic radiology anatomy, on a plain chest radiograph.4. Basic pattern based interpretation skills.

1. Brief Disscussion of why the CXR is so commonly requested.2. Emphasis on the importance of knowledge of gross anatomy, and how its correlated with radiology.3. Pattern recognition concept in the process of deriving differential / definitive diagnoses / diagnosis.

Books: Diagnostic imaging, Peter Arstrong. Chest ray made easy, Jontahon Corne.

Websites: www.chest-x-ray.com www.learningradiology.com www.auntminnie.com 63

http://www.auntminnie.com/

http://www.learningradiology.com/

http://www.chest-x-ray.com/


Department: Surgery:

Lecture # 33a: Haemothorax

Tutor: Dr. Iskander S. Salim Al-Thaghafi (male section) Tutor: Dr. (female section)

1. Recognition of the different types and cause of haemothorax.2. Methods of Diagnosis.3. Knowledge of Steps and Management.

1. Definition of Haemothorax.2. Different Cause.3. Pathophysiologic effect of haemothorax.4. Clinical presentation.5. Diagnosis and management.

1. Bailey and Loue's – Short Practice of Surgery 2. Schmertz- Principles of Surgery

64


Department: Surgery:

Lecture # 33b: Pneumothorax

Tutor: Dr. Iskander S. Salim Al-Thaghafi (male section) Tutor: Dr. (female section)

1. Recognition of the different types and cause of haemothorax.2. Methods of Diagnosis.3. Knowledge of Steps and Management.

1. Definition of Haemothorax.2. Different Cause.3. Pathophysiologic effect of haemothorax.4. Clinical presentation.5. Diagnosis and management.

1. Bailey and Loue's – Short Practice of Surgery

65

Phase I Module Name Faculty of Medicine2. Schmertz- Principles of Surgery

PBL assessments:

The total percentages allocated to PBL is 15 %, it is divided as follows:1. 8% will be assigned to the theoretical part of the case and

represented in the end of the module exam.

2. 7% will be assigned to the ability of the students to conduct the PBL process, an assessment sheet (See Appendix B) will be filled by the tutor for each student and submitted at the end of the PBL case.

Appendix A

Helpful tips for the students

A. What are the learning issues? Identify the important issues in the problem.

B. How well do you understand the issues?

Are there any words or terms about which you are unclear? Consider the basic mechanisms that might explain each important aspect of each problem. Assess your current understanding of the basic structural and/or functional mechanisms that may contribute to the presentation of the problem. Use the collective skills and experiences of group members to explore or explain these phenomena. Identify current gaps in knowledge or understanding. As time progresses, you will appreciate the difference between "superficially covering" an issue and "really understanding the basic principles

C. Learn from each other: Share your own knowledge, expertise, or ability to reason and synthesize information. Be receptive and appreciative of the contribution of your small group members.

D. Determine priorities for learning: Consider time, resources and objectives and set priorities regarding the relative importance of each learning issue. Remember that the primary task of each problem is not to make a quick diagnosis and work out a management plan. The problem is a stimulus for discussion, asking questions, and a framework for organizing your knowledge.

E. Monitor group progress:

All members of the group will be expected to take an active role; the group will depend on the contributions of each member. Small group sessions will encourage ongoing evaluation and feedback directed at the process itself.

F. Avoid a series of "mini-lectures": Avoid giving a "mini-lecture" on what you learned since the previous session. All students need to be actively involved in a discussion of the

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Phase I Module Name Faculty of Medicinelearning objectives. Students may want to share photocopies of particularly valuable material or present a framework for integrating a number of concepts.

G. Approaches to learning

Some students benefit from setting up a diagnostic grid: The relevant points in the history, signs, symptoms and clinical tests are written across the top, while possible diagnoses are listed down the left-hand side. Further investigations may be requested, or questions asked, to test the diagnostic hypothesis until the grid is completed and a plausible differential diagnosis is apparent. This approach encourages problem-solving, but has the potential disadvantage of emphasizing diagnosis only.

Another approach which can be used is concept-mapping: Concept maps are constructed by putting down all the words that relate to the case (e.g. fatigue, poor diet, serum iron, transferin, overwork, poverty). The words (usually in boxes or "balloons") are joined by appropriate connecting lines, with relational words (e.g. "is caused by", "suppresses", "leads to", etc). This approach results in wide ranging discussion and has the advantage of bringing all aspects of the case into the discussion, from pathophysiology to psychological factors.

Whatever method is used, the student should make a point of critically appraising the points raised: why is a certain investigation necessary, what is the sensitivity and specificity of a particular test, have treatment options been proven effective, and so on.

H. Asking questions: Questioning is one of the most important means of facilitating learning, not only for the individual asking the question, but for the group as a whole. It can serve to keep the group focused, and help other group members to present information and concepts more precisely.

I. Information sharing sessions: Use the group to develop effective communication skills. It is important that each member become an active participant in the group in order to contribute his or her unique knowledge and ideas to the learning process. Don't start up mini-discussions outside of the group as a whole. Remember that other students may see things differently than you do, or may be less assertive than you are - allow them time and opportunity to express themselves.

J. Most learning occurs between sessions: It is extremely valuable for students to create their own summaries of what they learn between sessions. This gives practice in organizing knowledge and makes it much more likely that students will remember what they have learned. This also makes study and review easier. Remember that the major purpose of the tutorials is to identify learning issues and to provide a forum for students to check out their understanding. At the same time, through this group work, you are learning how to work together and how to evaluate knowledge.

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Appendix B King Abdul Aziz University

Faculty of MedicineMedical Education Department

PBL STUDENT ASSESSMENTS

Please fill ONE assessment sheet for EACH student at the end of the case and submit it to Kristine room # GD/007, the anesthesia department, Basement hospital building

Student’s name:Student’s academic number:Date:Module:

The final grade should be (7) Please take the average of section 11-V) and add it to the grades of section I)

I. Professional behavior during the sessions Grade(out of 2)

1. Attends ALL sessions ( Missed sessions has to have a valid excuse)(1 mark)

2. Follows ground rules (1/2 mark)

4. Provides evidence of preparing for the sessions ( did research all agreed upon learning issues) (1/2 mark)

II. Knowledge and Discussion Grade(out of 5)

Explores knowledge base (Provides evidence of integration of information from lecture, readings, tutorials and practical sessions.). (1 mark)

Seeks clarification and verification of ideas and information from the group, correcting self and peers. (1 mark)

Is able to present both the big picture and details when discussing learning issues. (1 mark)

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Phase I Module Name Faculty of MedicineIs learning to summarize issues and discussions clearly and succinctly and reach closure of discussions. (1 mark)

Demonstrates the ability to recognize the limits of his/her own knowledge. (1 mark)

III. Reasoning skills Grade(out of 5)

Actively is involved in hypothesis generation (1 mark)

Connects hypotheses to patient’s problems/data. (1 mark)

Asks questions that stimulate the group’s learning to clarify concepts and content. (1 mark)

Routinely participates in the development of learning issues that are clearly defined, related to the discussion and the case, and primarily oriented toward mechanisms. (1mark)

Supports statements with reasoning and evidence. (1mark)

IV. Communication Skills Grade(out of 5)

Listens critically to others by entering into and contributing to ongoing discussions. (1 mark)

Interacts with colleagues with respect and consideration , and allows participation of colleagues (Not dominant) (1 mark)

Participates in discussion without being invited (Not passive) (1 mark)

Provides presentations that are logical, ordered, and easy to follow. (1 mark)

Uses board when necessary to graphically demonstrate difficult concepts with little or no prompting. (1 mark)

V. Assessment Skills Grade(out of 5)

Is open to and accepts constructive feedback from others. (1 mark)

Uses specific examples during self assessment. (1 mark)

Includes a plan for improvement. (1 mark)

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Phase I Module Name Faculty of MedicineProvides evidence of incorporating feedback into tutorial behaviors. (1 mark)

Gives constructive feedback to tutor and peers. (1 mark)

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FurtherReading

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GOOD LUCK FOR YOU 72

Documents

Outcome of the undergraduate Curriculum · Web viewLangman's Medical Embryology (T.W. Sadler) Student Notes: . Department: Anatomy: dissecting room Practical 1: Structure of the nose,