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UNIVERSITY OF BAGHDAD
COLLEGE OF MEDICINE
RESPIRATORY MODULE
Phase 1 Handbook
FEBRUARY 2014
2
INTRODUCTION:
This handbook contains much of the information needed for the course,
as well as important information about the examination, therefore it
should be red carefully.
This module is concerned with the structure and function of respiratory
system. The module will use a variety of approaches to teach normal
structure and function.
The lecture content is broadly divided into several themes theses being:
anatomy, histology, physiology, embryology, biochemistry,
pharmacology, and medicine. There is also a clinical demonstration on
some respiratory clinical problems.
We will make every effort to be available to answer problems throughout
the module.
Module Moderator:
Asst. Prof. Dr. Khitam R. Al-Khafaji
Department of pathology and forensic medicine.
Moderator Assistant and Assessment officer:
Lect. Dr. Sazan A. Al-Atooshi
Department of pathology and forensic medicine.
Contact e mail:
3
Structure of the Module:
The Teaching Staff:
1. Dr. Abullah Al- Farttoosi.
2. Dr. Adnan Al-Jouboree
3. Dr. Affan Ezat Hassan.
4. Dr. Ahmed Al-Zuhaire.
5. Dr. Firdous Mohammed
6. Dr. Kassim M. Sultan
7. Dr. Maan al-khalisy
8. Dr. Manaf Salih.
9. Dr.Mustafa Al-Nema.
10. Dr. Najeeb Al-Mosuly.
11. Dr. Nawfal K.Al-Hadithi .
12. Dr.Ziad Al-Madfaee
The core content:
All of the core information that are essential to know to pass the module
is covered in the lectures, practical classes, small group teaching, and the
recommended reading that is associated with them. The vast majority of
the information covered in the lectures can be found in recommended
textbooks.
The following two tables show the distributions of lectures (large group
teaching), practical classes, and small group teaching in details, regarding
number of hours, and teaching staff per subject.
4
Table 1: Respiratory module core content I
Faculty Members Hours/Grou
p
Type Of
Teaching
Subject
Prof Dr. Nofal Al-Hadethe 6 LGT Anatomy Prof. Dr.Qay
Prof. Dr.Maan Al-Khalese
Ass.Lec.Dr.Ahmed AbdulWahab
Ass.Lec. Dr.mahmood meshaal
Ass.Lec. Dr.Isam Tareq
10 Practical
0 SGT
Dr.Firdous Mohammed
3 LGT Histology
Department staff 2 Practical
0 SGT
Prof.Dr.Zaid Al-Madfaee
Prof.Dr.Najeeb Al-Mosuly.
Ass.Prof.Dr.Affan Izat
8 LGT physiology
Ass.Prof.Dr.Ghassan Thabet
Ass.Prof.Dr.Affan Izat
Lec.Dr.Hanan Luay
Inst.Dr.Dawood Salman
Inst.Dr.Zainab Muthana
2 Practical
0 SGT
Dr.maan al-khalisee 1 LGT Embryology Dr.Munaf Salih 1 LGT Biochemistry Dr.Ahmed Al-Zuhairee 1 LGT Pharmacology Dr.Adnan Al-jouboree
Dr. Abdulla Al-fartosse
Dr.Mustafa Al-Nema
Dr.Kasim M.Sultan
2 LGT Medicine
2 SGT
4 Review
5
Table 2: Respiratory module core content II
Lecturers Hrs SCT Hrs Practical (Labs) Hrs Theory (LGT) Subject
وفل الحذث . د.أ
هعي . د.م.أ
الخالص
قص.د.أ
احوذ عثذ . د.م.
الوهاب
هحوود هشعل .د.م.م
0 10 1-Bones of the
thorax.
2-Muscle of the
chest wall& Sup.
Mediastinum.
3- Sup. &
Post.Mediastium.
4- The lungs.
5- workshop in
radiology of
thorax.
6 1- Thoracic wall, bone and
joint.
2-Muscle of chest wall,
diaphragm and respiratory
movement.
3- Superior mediastinum.
4- Posterior mediastinum.
5- Organs of respiration.
6- sectional Anatomy
Anatomy
فردوش هحوذ .د.
جعفر
0 2 Nasal epithelium,
trachea,bronchial
tree, and lung
3 1-Respiratory epithelium.
2-Trachea and bronchial
tree
3-Lung
Histology
غطاى ثاتت .د.أ
عفاى عست .د.أ
حاى لؤي .د.م
صذق
داود ضلواى . د
زة هثى. د
2 Spirometry 8 1-Pressure change in
respiration
2-Expansion in lungs and
compliance
3-Alveolar ventilation, and
perfusion
4-Lung volume, lung
capacity, and pulmonary
Physiology
6
function test
5-Exchange of gases, and
diffusion capacity
6-Cellular
respiration(transport of
gases by blood)
7-Control of breathing
8-normal and abnormal
patterns
هعي . د,م.أ
الخالص
1 Lung buds, trachea, and
bronchial tree Embryology
هاف صالح.د.أ
1 Respiratory acidosis and
alkalosis. Acid-base
respiratory component.
Biochemistry
احوذ .د.م.ا
السهري
1 Bronchodilators, and
cough suppressants and
expectorants
Pharmacology
عذاى . د.أ
الجثوري
عثذ هللا .د.م
الفرطوض
قاضن ضلطاى .د.م.أ
هصطفى . د.م.أ
العوه
2 2 1. Introduction to resp.
system and
classification of
resp.disease
2. Bronchial asthma.
Medicine
4 Review
2 14 26 Total
7
Respiratory Module: Learning Objectives
Summary of Content: This module is an introduction to the anatomy, basic histology,
physiology, and biochemistry of respiratory system. There are practical
classes and workshops which complement the lecture course.
Aims: The respiratory system module will build the knowledge of the normal
anatomy, histology and function of the respiratory tract and lung.
In addition to know the most important diseased of the respiratory
epithelium
Objectives:
1- Describe the gross anatomy and histology of respiratory system:
2- State the development of lung buds, trachea, and bronchial tree.
3- Describe the anatomical structure of thoracic wall, and lungs.
4- Explain the physiology of respiratory system:
a- Define alveolar ventilation.
b- Define lung compliance, and pressure change in respiration.
c- Discuss lung function test.
d- Describe the transport of oxygen and carbon dioxide by blood.
e- Define hypoxia, cyanosis, and the mechanism of respiratory
failure.
5- Outline the chemical control of ventilation, and acid- base
balance.
6- Describe the clinical presentation of asthma, and its treatment.
7- Identify the effect of some drugs used in the treatment of lung
diseases.
8
8- Classify Respiratory diseases.
9- Define asthma and Describe the clinical presentation of asthmatic
patients.
10- Manage straight cases of asthma.
Learning Objectives:
Define the thorax & its parts
Describe various bones in its wall
Describe joints in the thoracic wall
Identify muscles in the thoracic wall
Define the neurovascular plane
Discuss the diaphragm
Describe thoracic movements
Define the superior mediastinum
List its contents
Memorize structures & events at the level of the sternal angle
Relate with some clinical points
Describe the posterior mediastinum
List structures in this region
Discuss their main anatomical characters
Relate to some clinical conditions
Define the upper respiratory tract & describe its part
Describe the trachea & bronchial tree
Demonstrate the pleural membranes & cavity
Conclude why pleural integrity is essential for normal respiration
Define the surface landmarks of lungs & pleural cavities
Demonstrate the lung anatomy
Determine the sites of lung auscultation
Identify the effect of ANS on the bronchial tree
Describe the thorax in some sections
Define respiratory epithelium, and describe its histological
structure.
Enumerate the organs that are lined by respiratory epithelium.
Enumerate the types of cells present in respiratory epithelium.
Recognize olfactory epithelium (modified resp. epith).
Identify some clinical problems related to respiratory epith.
Draw and label some diagrams.
9
Describe the histological structure of trachea.
Describe the histological structure of bronchial tree:
o Bronchus.
o Bronchioles.
Draw and label some diagrams.
Describe the histological structure of lung.
Describe the histological structure of alveolar duct, sac, and
alveolus.
Enumerate the components of blood-air barrier.
Enumerate the types of cells present in alveolar wall.
Define pleura, and describe its structure.
Describe the anatomy of the respiratory system and its relation to
function.
Explain the structure of the chest wall and diaphragm and to relate
these to respiratory mechanics.
Describe the inspiratory and expiratory process involving the chest
wall, diaphragm, pleura and lung parenchyma.
Describe the elastic properties of the chest wall and to plot pressure-
volume relationships of the lung, chest wall and the total respiratory
system.
Define compliance and relate this to the elastic properties of the
lung.
Describe the properties of surfactant and relate these to its role in
influencing respiratory mechanics.
Describe the work of breathing and its components.
Evaluate the measurement of lung volumes and capacities, and to
indicate the normal values .
Evaluate dead space and describe its effects on pulmonary
ventilation.
Describe the cough and sneezing reflexes.
Explain normal ventilation-perfusion matching, including the
mechanisms for these as well as the normal values.
10
Relate the vertical lung distance effect on blood capillary pressure
changes.
Explain the factors affecting the diffusion of fluids across the
alveolar membrane.
Describe the carriage of O2 in blood.
Explain the oxyhemoglobin dissociation curve and factors that may
alter it such as temperature, carbon dioxide and hydrogen ion
concentration and 2,3 diphosphoglycerate.
Define Bohr effect.
Describe the carbon dioxide carriage in blood.
Relate the effect of CO2 on O2 transport (Haldane effect).
Define chloride shift.
Discuss the medullary and pontine respiratory control centers and
explain how the ventilatory pattern is generated and controlled.
Describe the chemical control of breathing via central and
peripheral chemoreceptors, and indicate how this is altered in
abnormal clinical states.
Evaluate the effects of different body organs on respiration.
Explain the ventilatory changes accompanying the process of
ageing.
Describe the ventilatory changes accompanying the process of
exercise.
Demonstrate the ventilatory changes accompanying the process of
sleep apnea.
Distinguish between obstructive and restrictive lung disorders using
the family of curves measuring forced expiratory volume, peak
expiratory flow rate and vital capacity.
Evaluate the different types hypoxia.
Describe how respiratory system is formed embryologically.
Discuss how lung buds form.
Describe how the larynx,trachea,bronchi &lungs are formed.
Demonstrate how maturation of the lungs occurred.
11
Define Respiratory Acidosis & Alkalosis.
Describe the control of CO2 by the lungs & the bicarbonate /carbonic
acid buffer system.
State the blood biochemical findings in both conditions.
List some of the causes of such acid-base disorders.
Describe the strategies of treatment of asthma.
List the major classes of drugs used in asthma.
Describe the mechanisms of action of theses drug groups.
List the major adverse effects of the prototype asthma drugs.
o Describe the main parts and function of the resp. system.
o Mention how patient with resp. disease present to the doctor.
o Enumerate the main tests used for diagnosing a resp. disease.
Classify resp. disease.
Define asthma
Identify its aggravating factors
Describe its clinical features
Illustrate ways of diagnosis
Manage a straight case of asthma
Small group teaching: Clinical
Aim:
Early exposure of student to the common symptoms of respiratory
diseases and principles of examination of respiratory system
Evaluation of asthma cases.
12
References and Textbook(s) for the students:
The recommended references are listed in the table below.
SUBJECT REFRENCE
Anatomy Moore Anatomy and Histology.
Histology Junqueira's Basic Histology.
De Fiore'S Atlas Of Histology.
Physiology Guyton & Hall-Textbook of Medical Physiology.
Embryology Langman's Medical Embryology
Developmental Embryology
Human Embryology
Biochemistry Clinical Chemistry and Metabolic Medicine by Martin A. Crook
Pharmacology Basic and clinical pharmacology by Bertram G.katzung
Lippincott's illustrated reviews by Richard A.Harvey and Pamela
C. Champe.
Medicine Davidson-Principles & Practice of Medicine.
Oxford-Handbook of Clinical Medicine.
Note: All the above references are available in the college library free to
students.
13
Lecture Outlines:
Anatomy: Professor Nawfa K. Al-Hadithi
Lec. No. Title Objectives
1 Thoracic bones & joints
o Define the thorax & its parts
o Describe various bones in its wall
o Describe joints in the thoracic wall
2
o Muscles of chest wall
o Diaphragm
o Respiratory movements
o Identify muscles in the thoracic wall
o Define the neurovascular plane
o Discuss the diaphragm
o Describe thoracic movements
3 The superior mediastinum
o Define the superior mediastinum
o List its contents
o Memorize structures & events at the
level of the sternal angle
o Relate with some clinical points
4 The posterior mediastinum
o Describe the posterior mediastinum
o List structures in this region
o Discuss their main anatomical
characters
o Relate to some clinical conditions
5
o The upper RT
o The bronchial tree
o The pleura & P. space
o Define the upper respiratory tract &
describe its part
o Describe the trachea & bronchial tree
o Demonstrate the pleural membranes
& cavity
o Conclude why pleural integrity is
essential for normal respiration
6
o Surface landmarks of lungs &
pleura
o The lungs
o The thorax in sections
o Define the surface landmarks of
lungs & pleural cavities
o Demonstrate the lung anatomy
o Determine the sites of lung
auscultation
14
o Identify the effect of ANS on the
bronchial tree
o Describe the thorax in some sections
Physiology: Dr. Ziad Al-Madfaee
Dr. Najeeb Al-Mosuly
Dr. Affan Ezat Hassan
Lec. No. Title Objectives
1
o General definitions
o Functional anatomy
o Muscles of respiration
o Describe the anatomy of the
respiratory system and its relation
to function.
o Explain the structure of the chest
wall and diaphragm and to relate
these to respiratory mechanics.
o Describe the inspiratory and
expiratory process involving the
chest wall, diaphragm, pleura and
lung parenchyma.
2
o Pleura and its relation to
thoracic pressure.
o Intrapleural, alveolar and
transpulmonary pressure.
o Opposing forces and
compliance.
o Describe the elastic properties of
the chest wall and to plot
pressure-volume relationships of
the lung, chest wall and the total
respiratory system.
o Define compliance and relate this
to the elastic properties of the
lung.
o Describe the properties of
surfactant and relate these to its
role in influencing respiratory
mechanics.
3
o Work of breathing.
o Lung volumes and
capacities.
o Ventilation volume and
dead space.
o Describe the work of breathing
and its components.
o Explain the measurement of lung
volumes and capacities, and to
indicate the normal values .
o Define dead space and describe its
effects on pulmonary ventilation.
15
4
o Nerve supply.
o Blood supply.
o Lung zones.
o Perfusion across the
alveolar wall.
o Explain the cough and sneezing
reflexes.
o Explain normal ventilation-
perfusion matching, including the
mechanisms for these as well as
the normal values.
o Relate the vertical lung distance
effect on blood capillary pressure
changes.
o Explain the factors affecting the
diffusion of fluids across the
alveolar membrane.
5
o Partial pressure and the
composition of gasses in
air.
o Factors affecting diffusion
of gases.
o Ventilation – perfusion
ratio effect on alveolar gas
concentration.
o To explain the factors affecting
O2 and CO2 diffusion across the
lung.
o To relate the clinical significance
of changes in anatomical and
physiological dead space.
o To explain venous admixture and
its relationship to shunt.
o To describe the partial pressure
changes of O2 and CO2 in the
circulation.
o Describe the effect of ventilation-
perfusion on partial O2, CO2
partial pressures.
6
o Oxygen transport in blood.
o Carbon dioxide in blood.
o Describe the carriage of O2 in
blood.
o Explain the oxyhemoglobin
dissociation curve and factors that
may alter it such as temperature,
carbon dioxide and hydrogen ion
concentration and 2,3
diphosphoglycerate.
o Define Bohr effect.
o Describe the carbon dioxide
carriage in blood.
o Relate the effect of CO2 on O2
transport (Haldane effect.)
o Define chloride shift.
o Describe the medullary and
pontine respiratory control centers
and explain how the ventilatory
16
7
Control of Respiration
o Central control.
o Chemical control.
pattern is generated and
controlled.
o Describe the chemical control of
breathing via central and
peripheral chemoreceptors, and
indicate how this is altered in
abnormal clinical states.
o Describe the effects of different
body organs on respiration.
8
o Effect of exercise, age,
sleep apnea on respiration.
o Respiratory investigations.
o Hypoxia.
o Explain the ventilatory changes
accompanying the process of
ageing.
o Explain the ventilatory changes
accompanying the process of
exercise.
o Explain the ventilatory changes
accompanying the process of
sleep apnea.
o Distinguish between obstructive
and restrictive lung disorders
using the family of curves
measuring forced expiratory
volume, peak expiratory flow rate
and vital capacity.
o Evaluate the different types
hypoxia.
17
Histology: Dr. Firdous M. Jaafar
Lec. No. Title Objectives
1
Respiratory epithelium
o Define respiratory epithelium, and
describe its histological structure.
o Enumerate the organs that are
lined by respiratory epithelium.
o Enumerate the types of cells
present in respiratory epithelium.
o Recognize olfactory
epithelium(modified resp. epith).
o Identify some clinical problems
related to respiratory epith.
o Draw and label some diagrams.
2
Trachea & bronchial tree
o Describe the histological structure
of trachea.
o Describe the histological structure
of bronchial tree: o Bronchus.
o Bronchioles.
o Draw and label some diagrams.
3
lung
o Describe the histological structure
of lung.
o Describe the histological structure
of alveolar duct, sac, and alveolus .
Enumerate the components of
blood-air barrier.
o Enumerate the types of cells
present in alveolar wall.
o Define pleura, and describe its
structure.
18
Medicine: Dr. Adnan Al-Joboree
Dr. Kassim M. sultan.
Dr. Abdulla Al-Farttoosi
Dr. Mustafa Nema
Lec. No. Title Objectives
1
Introduction to resp. system and
classification of major resp.
disease
o Describe the main parts and
function of the resp. system.
o Mention How patient with resp.
disease present to the doctor.
o Enumerate the main tests used for
diagnosing a resp. disease.
o Classify resp. disease.
2
Asthma
o Define asthma
o Identify its aggravating factors
o Describe its clinical features
o Illustrate ways of diagnosis
o Manage a straight case of asthma
Embryology: Dr. Maan Al-Khalisy
Lec. No. Title Objectives
o Describe how respiratory system
is formed embryologically
19
1
Respiratory system formation
o Discuss how lung buds are formed
o Describe how the
larynx,trachea,bronchi &lungs are
formed
o Demonstrate how maturation of
the lungs occured
Biochemistry: Dr. Munaf Salih Daoud
Lec. No. Title Objectivers
Acid – Base Balance
(Respiratory Component )
o Define Respitatory Acidosis &
Alkalosis
o Describe the control of CO2 by
the lungs & the bicarbonate
/carbonic acid buffer system
o State the blood biochemical
findings in both conditions
o List some of the causes of such
acid-base disorders
Pharmacology: Dr. Ahmad Al-Zohayri
Lec. No. Title Objectives
1
Drugs acting on respiratory
system
o Describe the strategies of
treatment of asthma.
o List the major classes of drugs
used in asthma.
o Describe the mechanisms of
action of theses drug groups
o List the major adverse effects of
the prototype asthma drugs.
20
Practical Sessions:
1-Anatomy:
P. No. Title Objectives
1 Bones of the thorax o Describe various bones of thorax
o Identify atypical members
2 o Muscles of chest wall
o Superior mediastinum
o Identify muscles in the thoracic wall
o Explore the neurovascular plane
o Explore the structures of superior M
3 o Superior mediastinum
o Posterior mediastinum
o Explore the structures of superior M
o Explore the structures of posterior M
4 The lungs
o Describe lungs, lobes, fissures, levels
o Define visceral impressions
o Define costal impressions
5 Workshop in radiology of
the thorax
o Identify chest radiology in plane films
o Describe the cardiac shadow
o Study some abnormal films
o Study some sections
2- Histology:
P. No. Title Objectives
1
Nasal epithelium
Trachea, bronchial tree &
lungs.
o Examine the resp. epithelium in
different parts of the resp. system
o Examine the olfactory epithelium.
o Examine the trachea layers.
o Examine the lung.
3- Physiology:
21
P. No. Title Objectives
1 Spirometry o Measure forced exp.vol.at the end of 1st
sec.
o Measured forced vital capacity.
o Calculate the ration FEV1/FVC.
Assessment:
Three types of measurement will be performed for learners
●Continuous Progress.
●Formative Assessment.
●Summative Assessment.
Continuous Progress: the progress of student is measured on
predetermined check list in each module. It includes many parameters
such as attendance, preparation, interaction, engagement, and
presentation.
►Check list must be filled by all faculty members in the module.
Formative Assessment: multiple tests similar in their format to
summative assessment are conducted without marks .It involves tests for
knowledge and skills. Formative assessments detect the strength and
weakness in the learner and learning process.
The moderators and faculty members have to adjust continuously the
learning process to achieve improvement.
Summative Assessment: At the end of any module there is a summative
examination which includes knowledge and skills measurement. Marking
proportion of each part will be determined by the module.
Final mark is calculated by adding continuous progress mark and the
summative examination mark.
Assessment policy:
●Formative assessment there is no marks and formats are similar to
summative examination.
●Continuous progress assessment: 20 marks.
●Summative assessment: 80 marks.
■Written and ■OSPE (objective structured practical examination)
●Formative assessment:
►Formal: ■Written and ■OSPE
22
►Informal.
●Summative examination has of two components:
►Written: 50 marks. It is a key feature problem case scenario of two
papers:
*SBA format (SBA; best of five options).
*MEQ format (MEQ).
►OSPE or OSCE: 30 marks. 8-12 stations: five minutes each.
Formats of Assessment
In summative assessments, Exam papers include the following:
■Single best answer.
■Extended matching questions (EMQ).
■Modified essay questions.
■OSCE and OSPE for assessing clinical skills in simulation and practical
skills test.
Duties: Lecturers
●Write objectives of their lectures that align with the aims of the module
in the curriculum.
●Prepare questions in advance to measure the objectives.
●Teach a content that serve the objectives achievement.
●Daily student assessment record for continuous assessment in learning
activities.
Duties: Module Assessment Officer
●Collect assessment materials with the moderator from faculty members
●Design a Blue printing to cover the content.
●Ensure reliability ,validity ,feasibility and education impact.
●Verbal or email feedback to student after formal formative assessment.
●Fill the SAS form and send to assessment coordinator for discussion and
advisement.
Duties: Module Moderator
●Design Module assessment plan, assessment dates and marking in the
guide of general assessment policy.
●Discuss with tutors alignment of questions with the module objectives.
●Keep the bank of questions and blueprint map.
23
Continuous Progress Assessment: Check List
Fail
0
Pass
1
Good
2
●Attitude
Attendance
Receiving
Responding
Valuing
Engagement
Team work
●Cognitive
Prepared for the task
Understanding
Discussion
Critical thinking and reasoning
Skills
Presentation
Procedure
