RESPIRATORY SYSTEM MODULE - kau · DEPARTMENT OF MEDICAL MICROBIOLOGY 67 ... Before the students...

RESPIRATORY SYSTEM

MODULE

Faculty of Medicine

King Abdulaziz University

Faculty of Medicine Name of the Module

2

RESPIRATORY SYSTEM

MODULE

Study Guide

Phase II, MBBS

2009

TABLE OF CONTENTS

Topic Page

TABLES OF CONTENTS 3

LECTURE NAMES, TUTORIAL, PRACTICALS, SDL &PBL 4-5

THE OUTCOMES OF THE UNDERGRADUATE CURRICULUM 6

CURRICULUM MAP: PHASE II 7

SECOND YEAR COURSES 8

STRUCTURE OF THE MODULE & MODULE COORDINATORS 9

AIMS & OBJECTIVES 9-10

TRANSERABLE SKILLS 11

ASSESSMENTS: FORMATIVE & SUMMATIVE 12

EXAMINATION PAPERS 13

THE DESCRIPTIV REPORT 14

DEPARTMENTS 14-16

SUMMARY OF CONTENTS 17

TEACHERS' CONTACTS LECTURES 18-20

PRACTICALS 21

TUTORIALS 22

SDL 23

PBL 23-34

INDEPENDENT LEARNING 35-36

THE TIMETABLE 37

ASSESSMENT TOOLS 38

ICONS 39-40

TOPIC OUTLINES 41

DEPARTMENT OF ANATOMY 42-49

DEPARTMENT OF PHYSIOLOGY 50-59

DEPARTMENT OF BIOCHEMISTRY 60-64

DEPARTMENT OF MEDICAL PARASITOLOGY 65-66

DEPARTMENT OF MEDICAL MICROBIOLOGY 67-69

DEPARTMENT OF PATHOLOGY 70-77

DEPARTMENT OF PHARMACOLOGY 78-83


4

DEPARTMENT OF PEDIATRICS 84

DEPARTMENT OF MEDICINE 85-86

DEPARTMENT OF RADIOLOGY 87

DEPARTMENT OF SURGERY 88-89

PBL APPENDIX A 90-91

PBL APPENDIX B 92-93

FURTHER READING 94

A WISH OF GOOD LUCK 95

LECTURES (NAMES)

NO.

1 Overview of structure & function of respiratory system

2 Pleura and lungs.

3 Medial relations & hila of the lungs

4 Mechanics of breathing.

5 Development of the respiratory system.

6 Pressure- volume relationship in the respiratory tract

7 Neural control of breathing.

8 Acid-base balance

9 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 Microbiology:

16 Medical Microbiology:

17 Medical Parasitology: Paragonimyiasis

18 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.

25 Interstitial lung disease 11.

26 Disease of pulmonary vasculature.


5

27 Pulmonary neoplasia.

28 Clinical pharmacology of pulmonary embolism

29 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 Binding of haemoglobin to oxygen

3 A case of pneumonia

4 Drugs & the lung

NO. PRACTICAL(Names)

1 Structure of the nose, paranasal air sinuses, pharynx, larynx

and trachea.

2 Thoracic cavity & pleural cavities

3 Important relations of the lungs & structures forming lung root

4 Lung function tests.

5 Effect of drugs on isolated guinea pig trachea.

6 Special lung function tests.

7 Pathology of pneumonia: demonstration.

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.

Phase I Module Name Faculty of Medicine

6

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 mind

b. The normal pregnancy and child birth, the principles of antenatal and

postnatal care

c. 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 costs

e. The management of common conditions including pharmacological,

psychological, physical and nutritional therapy

f. 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) Skills

Graduate should acquire the skills of

a. Take a tactful, accurate and organised medical history

b. Perform a gentle and accurate physical and mental examination

c. Integrate history and physical examination to reach a provisional diagnosis

of differential diagnosis

d. Select the most appropriate and cost effective diagnostic procedures

e. Formulate a management plan

f. Counsel patients and families clearly regarding diagnostic and therapeutic

procedures before eliciting consent

g. Perform common life-saving procedures

h. Use information resources to obtain further knowledge and interpret medical

evidence critically and scientifically

i. Communicate clearly and considerately with other health professionals

3) Attitudes

Graduate should have the attitude of

a. Respect for every human being and abide by relevant Islamic ethics

b. A desire to ease pain and suffering

c. Willingness to work in a team with other health professionals

d. Responsibility to remain a life-long learner and maintain the highest ethical

and professional standards

e. Referring patients to other health professional when needed

f. A realization that it is not always in the interest of patients to pursue every

diagnostic or therapeutic possibility


7

CURRICULUM MAP YOU 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.

Short Note about the Respiratory S. Module

mODULEWrite a paragraph about the module

e.g……………


8

Second Year Courses

SECOND YEAR

3RD SEMESTER 4TH SEMESTER

Foundation Corse Musculoskeletal Module

General Anatomy (1) Immune, Blood lymphatic

Module

Cells and Tissues Cardiovascular Module

Embryology Respiratory Module

Biochemical Basis of Medicine (1)

Renal Module

Pathology (1) Basic Emergency Care Module

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

Ethics


9

TIMETABLE IN HOURS:

TEACHING DEPARTMENTS:

33 Lectures, 7 Practicals, 4 Tutorials, & 1

SDL

Anatomy, Physiology, Biochemistry,

Parasitology Microbiology, Pathology,

Pharmacology Pediatrics, Medicine, Radiology

& Surgery.

RESPIRATORY SYSTEM

Module Coordinators:

Dr. Khidir Adam Abdel-Galil (male section)

Dr. Hayat Zakaria Kamfar (female section)

Course

No.

Course Title Contact Hours

Credit

Hours L 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.

STRUCTURE OF THE MODULE


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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.

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 blood

3. Describe the basic pathological processes, such as inflammation, oedema, neoplasm

4. 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


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second year.

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 improvement

b. 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 requirement

b. Motivation of the student to maintain or improve performance

c. Certification of performance for others

d. Grades

e. 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 1

Continuous assessment: 20% = (Q1=10%, Q2=10%, each is 20 MCQs)

Part 2

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

Part 3

Final Examination: 50 % = (50 Marks = 42 MCQs + 8 MCQs, PBL)

Part 4:

Practical assessment: 15% = (15 Marks, 30 questions)

Textbooks:

Appendix (V):

Modules Text Books and References Submitted By The Different


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Departments and The Crash Course In Respiratory System.

Respiratory System Module Group 3

Final Report

1- Department of Anatomy:

Lecture # 1: Overview of structure & functions of the 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.


15

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 Microbiology:

Lecture # 15: Upper respiratory tract infections

Lecture # 16: Lower respiratory tract infections

5- Department of Medical Parasitology:

Lecture # 17: Parasitic larvae migrate in lungs.

Lecture # 18: Parasites cause cystic lesion in the lung

6- Department of Pathology:

Lecture # 19: Atelactasis & acute lung injury & Obstructive

versus restrictive lung diseases

Lecture # 21: Chronic obstructive lung diseases and bronchiectasis.

Lecture # 24: Interstitial lung disease. Disease of pulmonary vasculature I.

Lecture # 25: The pathology of pulmonary microbial infections.

Lecture # 26: Disease of pulmonary vasculature II.

Lecture # 27: Pulmonary neoplasia.

Tutorial # 3: discussion on all topics in lectures.

Practical # 7: Pathology of lung.


16

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


17

Table of contents

Department Lectures Practical Tutorials Directed learning

Anatomy 4 3 - -

Physiology 8 2 - -

Biochemistry 2 - 2 1

Microbiology 2 - - -

Parasitology 2 - - -

Pharmacology 4 1 1 -

Pathology 6 1 1 -

Medicine 2 - - -

Pediatrics 1 - - -

Radiology 1 - - -

Surgery 1 - - -

Total 33 7 4 1

Lectures: Teachers Contacts


18

Lecture # Department Lecture Title Lecturer

Male Female

Lec. # 1 Anatomy Overview of structure &

function of respiratory

system.

Prof. Said Zaghloul

0557567746

Prof. Amira Ali

Al-Hagagi

05086092326

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

0557567746

Prof. Amira Ali

Al-Hagagi

05086092326

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 Zaghloul

0557567746

Prof. Fathia

Ahmed.

05086092326

Lec. # 6 Physiology Pressure- volume relationship

in the respiratory tract.

Dr. Khidir A.

Galil.

0504321459

Prof. Sawsan

Rohiem

0506638532

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

Abood

0544431007

Dr Zeinab Al-

Refae

0507553272

Lec. # 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

Roheim

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

Lecture # Department Lecture Title

Lecturer

Male Female

Lec. # 13 Biochemistry Metabolic function of the

respiratory system

Prof. Adil A.

Rafae

Dr. Huda Jad

0501856638


19

Lec. # 14 Physiology Exercise & high altitude,

physiological responses to

hypoxia & hypercapnia

Prof. A.

Rahman

Fahmi

0507620596

Dr Zienab Al-

Refae

0507553272

Lec. # 15 Microbiology Upper respiratory tract

infections

Prof. Hassan

Al-Bana Yunis

Prof. Mona O.

Abass Mukhtar

Lec. # 16 Microbiology Lower respiratory tract

infections

Prof. Hassan

Al-Bana Yunis

Prof. Mona O.

Abass Mukhtar

Lec. # 17 Parasitology Paragonimyiasis Prof. Mahmoud

Fouad

Dr. Hala Said

Salem

Lec. # 18 Parasitology Parasitic larva migrates to

lungs

Prof. Mahmoud

Fouad

Dr. Hala Said

Salem

Lec. # 19 Pathology Atelactasis & acute lung

injury & Obstructive

versus restrictive lung

diseases .

Prof.. Ahmed

Ghanim

0559417955

Pager: 1715

Dr. Eman Emam

Pager: 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

0559417955

Pager: 1715

Dr. Eman Emam

Pager: 3488

Lec. # 22 Pharmacology Drugs used for treatment of

bronchial asthma

Prof. Osman H.

Osman

0506620311

Prof. Magdah M.

S. Hagras

0508702235

Lec. # 23 Pharmacology Principles of treatment of

pulmonary infections.

Prof. Osman H.

Osman

0506620311

Prof. Magdah M.

S. Hagras

0508702235


20

Lecture # Department Lecture Title Lecturer

Male Female

Lec. # 24

Pathology Interstitial lung disease.

Disease of pulmonary

vasculature I.

Prof.. Ahmed

Ghanim

0559417955

Pager: 1715

Dr. Eman Emam

Pager: 3488

Lec. # 25

Pathology The pathology of pulmonary

microbial infections.

Dr. Osama I.

Nasif

0505626775

Dr. Ghadir

Mokhtar

Lec. # 26

Pathology Disease of pulmonary

vasculature II.

Dr. Osama I.

Nasif

0505626775

Dr. Ghadir

Mokhtar

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

Nasif

0505626775

Dr. Ghadir

Mokhtar

Lec. # 28 Pharmacology Clinical pharmacology of

pulmonary embolism

Prof. Osman H.

Osman

0506620311

Prof. Magdah M.

S. Hagras

0508702235

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 Wali

0505606100

Dr. Nawal Al-

Ghamdi

Lec. # 31 Medicine Overview of definition

epidemiology, pathogenic

& clinical features of

asthma

Dr. Serag Wali

0505606100

Dr. Nawal Al-

Ghamdi

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

Radwi

050567914

Dr. Asma

Aldabbagh Dr. Gala Sindi

Lec. # 33 Surgery Pneumothorax and

Haemothorax

Dr. Iskander S.

Salim Al-

Thaghafi


21

Practical

Practical # Department Practical Title

Lecturer

Male Female

Practical # 1 Anatomy Structure of the nose,

paranasal air sinuses,

pharynx, larynx and

trachea

Staff Members

0505688864

Staff Members

05086092326

Practical # 2 Anatomy

Thoracic cavity & pleural

cavities

Staff Member

0505688864

Staff Members

05086092326

Practical # 3 Anatomy

Important relations of the

lungs & structures forming

lung root

Staff Member

0505688864

Staff Members

05086092326

Practical # 4 Physiology Lung function tests. Dr. Khidir A.

Galil.

0504321459

Prof. Sawsan

Roheim

0506638532

Practical # 5 Pharmacology Effect of drugs on isolated

guinea pig trachea.

Prof. Osman H.

Osman

0506620311

Prof. Magdah M.

S. Hagras

0508702235

Practical # 6 Physiology Special lung function tests

MVV, FEV1.

Dr. Khidir A

.Galil.

0504321459

Prof. Sawsan

Roheim

0506638532

Practical # 7 Pathology Pathology of lung

diseases:,

Dr. Osama I.

Nasif

0505626775

Dr. Eman Emam

Pager: 3488


22

Tutorials:

Tutorial # Department Tutorial Title Lecturer

Male Female

Tutorial # 1 Biochemistry Lung surfactant. Prof. Adil A.

Rafae

05018895751

Dr. Huda Jad

0501856638

Tutorial # 2 Biochemistry Binding of haemoglobin

to oxygen

Prof. Adil A.

Rafae

05018895751

Dr. Huda Jad

0501856638

Tutorial # 3 Pathology Discussion on lung

diseases & case histories.

Dr. Osama I.

Nasif

0505626775

Dr. Eman

Emam

Pager: 3488

Tutorial # 4 Pharmacology Drugs & the lung. Prof. Osman H.

Osman

0506620311

Prof. Magdah

M.

S. Hagras

0508702235


23

Directed learning

Problem based learning:

DL # Department DL Title Lecturer

Male Female

DL #1 Biochemistry Problem involving blood

gasses and acid-base status.

Prof. Adil A. Rafae

05018895751

Dr. Huda Jad

0501856638

PBL # PBL Title Lecturer

Male Tutors Female Tutors

PBL #1 Case studies of Bronchial Asthma with

Pneumonia in Childhood.

Faculty Staff Faculty Staff


24

PBL

Case (1)… Bronchial asthma with Pneumonia

in Childhood


25

PBL process

The clinical scenario

Key information

Explore the problem

What you know

What you need to know

Identify learning issues

Self/group study

Share the knowledge

Solve the problem

Give feedback & reflect


26

Learning opportunity

Rspiratory System by McGowan, Jefferies & Turley

The Crash Course 2nd

Edition. 2004

Ganong, Review of Medical

Physiology, 20th

edition 2005

Try to access CD-ROM series about the Respiratory System

in the 2nd

floor of the medical library, building No. 1

I would recommend you to use the key words – chest pain & case study –in the search

engine google (www.google.com). The aim is to recognize the rich resources in the web.

o http://www. Google.com

http://www/


27

KING ABDUL AZIZ UNIVERSITY

FACULTY OF MEDICINE

PBL

RESPIRATORY SYSTEM MODULE

STUDENT COPY

DAY I

Hashim a 6 years old child came with his mother, Amal to your clinic. Amal

told you that her son experienced cough throughout last week.

She said that last week Hashim woke up for three nights coughing. The

mother added that the cough seemed dry. She also said that this happened on and off

for about a year and she usually gives him cough syrup for it.

Amal decided to come to the hospital when she noticed that the usual shortness

of breath that accompanied her sons cough is sever and now he is experiencing

difficulty in breathing.


28


FACULTY OF MEDICINE

PBL

RESPIRATORY SYSTEM MODULES

STUDENT COPY

DAY II

Amal also added that she noticed that her son is warm. When you examined Hashim

you noted that his oral temperature is 39 0C.

While examining Hashim, Amal interrupted you and said:

"Doctor Hashims' breathing sounds like whistling, are those noises coming from

his chest related to his fever?' You know doctor I noticed that Hashim’s condition

happened exactly the same time last year, the weather was nice as it is nowadays. You

know what doctor I also think that Hashim gets worse when his dad smokes shisha at

home, is that possible, why do you think this is happening, my husband smokes shisha

and I am ok”

Listening to Amal you immediately you realize that she is talking about the

wheezing Hashim is having.


29


FACULTY OF MEDICINE

PBL

RESPIRATORY SYSTEM MODULES

TUDSENT COPY

DAY III

While examining Hashim you noted that his face is flushed with cirumoral

bluish discoloration. His palms are plethoric & his nails are pale & bluish. Hashim is

also mouth breathing.

You also noted that Hashim is tachypnic. Auscultation of the chest showed a

diminished air entry all over the chest & bronchial breathing in the right lower part.

There were also wheezes all over the chest.

You asked for full investigations.


30

King Abdul Aziz University

Faculty of Medicine

Medical Education Department

Problem Based Learning

I. What is Problem based learning (PBL): Problem based learning (PBL) is a curriculum design and a teaching/learning strategy. It

simultaneously develops higher order thinking and disciplinary knowledge bases and skills. PBL

places students in the active role of problem-solvers and confronts students with a situation that

reflects the real world.

PBL represents a philosophy towards learning rather than a specific method of teaching.

Application of the PBL approach allows the focus to shift from teacher-centered activity to student-

centered learning. The aim is to promote an inquiry based approach that requires students to develop

and refine their problem solving skills. PBL challenges students to learn about a subject by tackling a

real-world problem in a fairly unstructured environment. In essence, it shows students how people

have to make decisions in the real world.

The move towards PBL in the curriculum has the potential to fulfill a number of educational

objectives. One of the prime goals of PBL is to foster critical thinking. In PBL the responsibility for

learning rests with the learner, rather than the teacher. PBL also allows for the integration of many

concepts, which ultimately increases the relevance of what is being learned, and subsequently results

in greater motivation and engagement of students. Other educational objectives of PBL involve the

ability of PBL to encourage cooperation and the development of group work. PBL also encourages

high-level cognitive processes in all students, offering a wide variety of experiences. The latter

allows students to make choices, promoting self-management and self-evaluation.

II. Student’s responsibilities in PBL: Problem-based learning is a student-centered process and it is the responsibility of the

individual student to participate fully, not only for his or her own learning, but also to aid the

learning of others in the group. Although much time is spent alone in the library or at the computer,

the full benefits of PBL cannot be realized in isolation

Guide to Professional Behaviour in Tutorials (Courtesy of McMaster University)

Respect

Listens, and indicates so with appropriate verbal or non-verbal behavior.

Allows others to express opinions and give information without "putting down" anyone.

Acknowledges others' contributions.

Apologizes when late or gives reason for being so.


31

Communication

Speaks directly to group members.

Presents information clearly.

Uses open-ended questions appropriately.

Identifies misunderstanding between self and others or among others.

Attempts to resolve misunderstanding.

Non-verbal behavior (body posture, facial expressions) are consistent with tone and content

of verbal communications

Recognizes and responds to group member's non-verbal communication

Responsibility

Attends all the session

Punctual

Completes assigned tasks

Presents relevant information

Identifies irrelevant or excessive information

Takes initiative or otherwise helps to maintain group dynamics

Advances discussion by responding to or expanding on relevant issues

Self-Awareness/Self-Evaluation

Acknowledges own difficulty in understanding

Acknowledges own lack of appropriate knowledge

Acknowledges own discomfort in discussing or dealing with a particular issue

Identifies own strengths

Identifies own weaknesses

Identifies means of correcting deficiencies or weaknesses

Responds to fair negative evaluative comment without becoming defensive or blaming others

Responds to fair negative evaluative comment with reasonable proposals for behavioural

change


32

III. The PBL process:

The following section describes how to approach steps in "the process of PBL".

The process of problem-based learning is summarized graphically below.

CASE

Identify Problem(s)

Propose Hypotheses

Explore Mechanisms

Identify Needed Information

to Test Hypotheses

•Recall

•Brainstorm

•Ask Questions

Learning

Issues

Go Get New

Information

Apply New Information to Problem

Test Hypotheses and Refine/Revise


33

IV. Explanation of the sessions’ dynamics:

Randomly assigned small groups of ten students will consider a problem together with an assigned

tutor. Tutorial groups will meet for approximately two hours twice a week starting from the second

week in the module. In appendix A, you will find helpful tips that will allow you to excel in PBL

sessions.

Session I: During this session, the student group members are expected to:

a. Identify the patient’s problems

b. Propose hypothesis to explain the problem

c. Reason and explore mechanism that explain the hypothesis

d. Determine the knowledge gaps during the discussion

e. Form learning issues that will address the knowledge gaps

f. Prioritize a number of learning issues/objectives.

g. Verbal self and tutor assessments will be conducted at the end of the session

In between sessions: Students will be expected to spend four to six hours each week on independent

study outside the small group to research and elaborate upon new information and concepts.

Session II: During this session, the student group members are expected to:

a. Bring and discuss new knowledge and information to the group.

b. Identify and discuss important issues and learning objectives.

c. New information built into the original problem (day II of the case) will be introduced by

the tutor.

d. Determine the knowledge gaps during the discussion.

e. Form learning issues that will address the knowledge gaps.


34


g. Verbal self and tutor assessments will be conducted at the end of the session.

In between sessions: Students will be expected to spend four to six hours each week on independent

study outside the small group to research and elaborate upon new information and concepts.

Session III: During this session, the student group members are expected to:


b. Identify and discuss important issues and learning objectives.

c. New information built into the original problem (day II of the case) will be introduced by

the tutor.

d. Determine the knowledge gaps during the discussion.

e. Form learning issues that will address the knowledge gaps.


g. Verbal self and tutor assessments will be conducted at the end of the session.

Session IV: During this session, the student group members are expected to:


b. Wrap up the case and summarize all findings

c. Provide detailed verbal self and tutor assessments

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


35

by the tutor for each student and submitted at the end of the PBL

case.

Independent learning

“Independent learning is a very essential skill for tomorrow’s doctors. We will train

you to gain this important skill by asking you to read independently about specific

topics in cardiovascular system”


36

You may use the following objectives as guidelines:

describe the histological structure of different blood vessels

recognise specific cell types for the different tissues as well as those common to many tissues.

relate the structure to function in all types of blood vessels.

Ganong, Review of Medical Physiology, 20th

edition, page: 556 – 559

Weather's Functional Histology (3rd

ed) pp. 140 - 152

I would recommend you to use the key word – blood vessels & histology–in the

search engine Google (www.google.com).

http://www. Google.com

http://www/


37

Timetable for Respiratory System Module:

Second Year

Will be Submitted Before Teaching.


38

Exams:

Written exams will include multiple choice questions (MCQs). They will cover material presented in lecture,

readings, and discussion. There will be two quizzes (20 marks) and a final paper (50 marks). All exams must

be taken on the date scheduled. In case of an emergency, the coordinator must be notified. No make-up exams

will be provided if you fail to notify and discuss your situation with the coordinator.

Practical Exam will be in an OSPE (Objective Structured Practical Exam) format, where you will pass

through several stations representing all the subjects. The marks for the OSPE will be 15. The total mark is

100

Assignment paper:

The purpose of the work is to provide you with the opportunity to explore an area of basic medical sciences or

medical education in depth. The paper is to be a some pages of literature review of the PBL topic & will

constitute 7 % of your final grade. Policy: Topics must be approved in writing by the coordinator. Directions

for topic submission will be discussed during the first week of class. Topics that have not been approved will

not be accepted.

All papers must reference a minimum of eight references from refereed journals. All papers must be typed,

double-spaced, have 1 inch margins. Another 8 % of your final grade will be included as PBL MCQs in the

final paper exam

Note:

Class attendance and participation are extremely important to your learning and as such are considered in the

evaluation of your course grade. This course is recommended for students that can make the required time and

energy commitment. If there is anything that the coordinator can do to assist you during the course, please feel

free to contact him.

A short description about assessment tools.


39

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


40

Independent learning from textbooks

Independent learning from the CD-ROM. The computer cluster is in the 2

nd 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


41

Topic Outlines

Read carefully the following Topics


42

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).


43

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: .


44

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


45

Department: 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 lung

2. 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


46

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 tract

2. 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)


47

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


48


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


Anatomical differences between right and left lungs


49


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 lung

2. 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:

Surfactant, and its clinical importance


50

Department : Physiology

Lecture # 4: The Mechanics of Breathing.

Tutor: Dr. Khidir A. Galil (male section)

Tutor: Prof. Sawsan Rohaiem (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).

Oxford Univ. Press.


51

Department : Physiology

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

Tutor: Dr. Khidir A. Galil (male section)

Tutor: Prof. Sawsan Rohaiem (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.


ed.


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).

Oxford Univ. Press.


52

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:


ed.


2. Ganong, WF (2007).Review of Medical Physiology, 23rd ed. (2001). McGraw Hill

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.


53

Lecture # 9: Gas Diffusion & Blood flow to

The Lungs, Regional Differences.


Tutor: Dr. Khidir A. Galil (male section) &

Tutor: Prof. Sawsan Rohaiem (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.


ed.


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 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.


54


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

Tutor: Prof. Adul Rahman Fahmi (male 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.


ed.


2. Ganong, WF (2007). Review of Medical Physiology, 23rd ed. (2007). McGraw

Hill


55


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

Tutor: Prof. Adul Rahman Fahmi (male 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.


ed. (2005). WB

Sunders Co.


56

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) &


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.


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


57


Lecture # 14: Exercise and high altitude. Physiological

Responses to Hypoxia and Hypercapnia.

Tutor: Prof. Adul Rahman Fahmi (male 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


ed. (2005). WB

Sunders Co.

2. Ganong, WF (2005). Review of Medical Physiology, 222nd

ed. (2005). McGraw Hill


58


Practical # 4: Lung Function Testing.

Tutor: Dr. Khidir A. Galil (male 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.


1. Students understand practical skills associated with lung volumes and capacities.

2. Identify values and measurements.

1. Guyton, AC and Hall, JE (2005). Textbook of Medical Physiology, 11

th ed. (2005). WB

Sunders Co.



59


Practical # 6: Special Lung Function Tests.

Tutor: Dr. Dr. Khidir A. Galil (male 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.


ed. (2005). WB

Sunders Co.



60

.

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, Buffer

2- 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

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


61


Lecture # 13: Metabolic functions of respiratory system



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 regulation

2- Oxygen and gas exchange

a- Oxygen and carbon Dioxide

b- Oxygen Transport

c- Quantities associated with assessing patient’s oxygen status

d- Haemoglobin – Oxygen dissociation



62


Tutorial # 1: Lung surfactant



1. Identify the source and synthesis of lung surfactant

2. Describe the physiologic purpose of lung surfactant

3. Discuss the clinical significance of lung surfactant

1. Definition

2. Lung Surface tension

3. Composition of lung phospholipids

4. Lung surfactant and respiratory distress syndrome

5. Significance of ratio between lecithin and sphingomyelin

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


63


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 haemoglobin

2. 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


64


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



65

Department: Medical Microbiology:

Lecture # 15: Upper Respiratory Tract Infections Tutor: Prof. Hassan Al-Bana Yunis (male section)

Tutor: Prof. Mona O. Abass Mukhtar (female section).

Upper respiratory tract infections are mild and are usually manifested by:

sore throat, dysphagia, nasal discharge, and nasal obstruction ,etc.....…..

1. Natural immunity of the respiratory tract .

2. Signs and symptoms of upper and lower respiratory tract infections.

3. The main causative microorganisms(pathogens) as bacterial , viral and fungal.

4. Types of infection whether primary or secondary, community or nosocomial

in different ages as in neonates, young children, adults, elderly and in

immunocompromised individuals .

5. Specimen’s collection for laboratory investigations and for selection (choice)

of appropriate antimicrobial therapy.

6. Prophylaxis and treatment.

1. Healthy respiratory system is protected by natural immunity through the mucocilliary

system, the flushing action of saliva, and through other defensive mechanisms leading

to production of:

a) A thin film of mucus to which the organisms are attached and driven upwards

by ciliated cells.

b) Lysozymes present in mucus and act as antimicrobial agents.

c) Local IgA antibodies prevent attachment of microorganisms.

d) Phagocytes act as barriers to prevent spread of microorganisms.

2. Respiratory tract infections could be:

a) Primary when organisms affect healthy respiratory tract.

b) Secondary when organisms affect diseased respiratory tract.


66

1. A Clinical Core Text for Integrated Curricula. with self-assessment T.J. Inglis

Churchill Livingstone 2nd

edit. 2003.

2. Microbiology and Infection Master Medicine Series

Department: Medical Microbiology:

Lecture # 16: Lower Respiratory Tract Infections Tutor: Prof. Hassan Al-Bana Yunis (male section)

Tutor: Prof. Mona O. Abass Mukhtar (female section

Lower respiratory tract infections are severe and are usually manifested by:

Fever, cough either dry or productive, localized chest pain, or pleuritic pain with or without dyspnea,

headache and malaise, etc...

1- Natural immunity of the respiratory tract.

2- Signs and symptoms of upper and lower respiratory tract infections.

3- The main causative microorganisms(pathogens) as bacterial, viral and

fungal.

4- Types of infection whether primary or secondary, community or

nosocomial in different ages as in neonates, young children, adults,

elderly and in immunocompromised individuals.

5- Specimen’s collection for laboratory investigations and for selection

(choice) of appropriate antimicrobial therapy.

6- Prophylaxis and treatment.

1. Fever, cough either dry or productive, localized chest pain or pleuritic pain with or

without dyspnea, headache and malaise,…etc


67

The causative organisms are:

a) Bacteria: Prokaryotic cells that can be seen by ordinary microscope and bacterial

infections can be treated by antibiotics. They are classified into:

Gram +ve bacteria e.g Corynebacterium diphtheria, Strept. Pneumoinae ,etc.....…..

Gram – ve bacteria e.g Hemophilus influenza, Klebsiella pneumoniae ,etc.....…….

Acid fast bacilli. e.g. Mycobacterium tuberculosis.

b- Viruses: A cellular infectious agents contain either DNA or RNA, sub microscopic

lacking machinery system and are obligate intracellular parasites. All viruses are not

affected by antibiotics

They are classified according to their nucleic acid content into :

DNA viruses e.g. Adenoviruses. Herpes viruses ,etc.....…….

RNA viruses e.g. Influenza viruses. Respiratory syncytial viruses ,etc.....…...

c-Fungi: eukaryotic cells. e.g. Candida, Aspergillus ,etc.....…..

Fungal infections are usually accidental as most of them are found as normal flora and

can be treated by antifungal drugs.

Specimens:

Throat swab, nasopharyngeal swab, Sputum, blood and / or serum samples

Laboratory diagnosis:

a) Direct by demonstration of the causative organism.(isolation and identification).

b) Indirect by detection of specific antibodies in patient’s serum.

c) Other laboratory tests

d) In-vivo (hypersensitivity) tests

Prophylaxes:

a-Vaccines.

B-Chemoprophylaxis.

Treatment:

Depends on the causative organism and on their culture/sensitivity result.

Antibacterial, antiviral, antifungal as well as symptomatic and supportive treatment.

1. A Clinical Core Text for Integrated Curricula. with self-assessment T.J. Inglis

Churchill Livingstone 2nd

edit. 2003.

2. Microbiology and Infection Master Medicine Series


68

Department: Medical Parasitology: Lecture # 17: Parasitic larvae migrate in the lung:

Tutor: Prof. Mahmoud Fouad (male section)

Tutor: Dr. Hala Said Salem (female section).

1. Specify the parasites involved in lung tissue migration during its life cycle

( Ascaris lumbricoides, Ancylostoma duodenale, Strongyloides stercoralis,

Schistosma spp.).

2. State the impact of each parasite on lung physical condition.

3. Differentiate between the mentioned parasites.

1- Geographical distribution for each parasite.

2- Life cycle of each include:

* Mode of infection and infective stage.

* Mechanism of lesion development and pathogenic stage.

3- Clinical picture and complications.

4- Diagnostic methods and the diagnostic stages.

5- The recommended treatment.

6- The preventive measures

Basic Clinical Parasitology, Franklin A. Neva and Harold W. Brown, 6

th edition, 2007, Prentice

Hall International Edition.

Medical Parasitology, Edward K. Markellet.al. (2007) publisher W.B.Sauders

Organ Based Parasitology, A.AM. Amin et al (2007), Dar Khawarizim for academic

publishing and distribution.

Internet websites: e.g. CDC.com, emedicine.com,


69

Department: Medical Parasitology:

Lecture # 18: Parasites cause cystic lesion in the lung

Tutor: Prof. Mahmoud Fouad (male section)

Tutor: Dr. Hala Said Salem (female section).

1. Specify the parasites ended up with cyst in the lung tissue (Ecchinococcus

granulosus, Paragonimus westerman, Entamoeba histolyticai).

2. Set the impact of each parasite on lung physical condition.

3. Differentiate between the mentioned parasites.

1. Geographical distribution for each parasite.

2. Life cycle of each include:

* Mode of infection and infective stage.

* Mechanism of lesion development and the pathogenic stage.

3- Clinical picture and complications.

4- Diagnostic methods and the diagnostic stages. 5- The recommended treatment.

6- The preventive measures.

Basic Clinical Parasitology, Franklin A. Neva and Harold W. Brown, 6th edition, 2007, Prentice Hall International Edition.

Medical Parasitology, Edward K. Markellet.al. (2007) publisher W.B.Sauders

Organ Based Parasitology, A.AM. Amin et al (2007), Dar Khawarizim for academic

publishing and distribution.

Internet websites: e.g. CDC.com, emedicine.com, Wikipedia.com


70

Department: Pathology

Lecture # 19: Atelactasis & acute lung injury & Obstructive

versus restrictive lung diseases

Tutor: Prof. Ahmed Ghanim (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


71


Lecture # 21 Chronic obstructive airway diseases & bronchiectasis

Tutor: Prof. Ahmed Ghanim (male 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 asthma

4. 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.



72


Lecture # 24: Interstitial lung disease.

Tutor: Prof. Ahmed Ghanim (male section)



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



73


Lecture # 25: The Pathology of pulmonary microbial infection

Tutor: Dr. Osama I. Nassif (male section)

Tutor: Dr. Ghadeer Mukhtar (female section)


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



74


Lecture # 26: Diseases of the Pulmonary Vasculature




1. Haemostasis and lung circulations

2. Fate of incoming venous emboli.

3. differential diagnosis of haemoptysis

4. Differential diagnosis of cor-pulmonale

5. 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.



75


Lecture # 27: Pulmonary Neoplasia.

Tutor: Prof. Ahmed Ghanim (male section) &


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

1. The clasification of lung neoplasm

2. Epidemilogy and pathogenesis of lung cancer

3. Molecular basis of lung cancer

4. Types and morphology of lung cancer

5. Pulmonary para neoplastic syndromes

6. Investigafion of lung cancer

7. 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.



76


Tutorial # 3: Discussion on lung diseases & case histories:



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

1. Differentiate between acute and chronic pneumonias

2. Interpret 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 the case

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

1. Differentiate between acute and chronic pneumonias

2. Interpret different patterns of pulmonary infiltrate and consolidations types

3. 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.


77


Practical # 7: Pathology of lung diseases:



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.



78

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.


79


Lecture # 22: Drugs used in the treatment of bronchial asthma.



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,


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.


edition 2006.




80


Lecture # 23: Principles of treatment of lung infections.



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,


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


edition 2006.




81


Lecture # 28: Clinical pharmacology of pulmonary embolism.



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


edition 2006.




82


TUTORIAL # 4: Drugs & the Lungs.



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


edition 2006.




83


Practical # 5: Effect of drugs on isolated guinea pig trachea. Tutor: Prof. Osman H. Osman (male 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


edition 2006.




84

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 assessment

2. 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.

1. Lung Sounds – A practical Guide ( Roberts Wilkins, john Hodgkin's, Brad Lopez)

2. Respiratory System ( Angus Jefferies, Andrew Tuley)


85

Department: Medicine

Lecture # 30: Pleural Effusion.

Tutor: Dr.Sirag Wali (male section) &

Tutor: Dr. Nawal 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


86

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. Definition

2. Prevalence

3. Mode of presentation

4. Classification

5. Diagonosis

6. Medication used for managemant

7. Types pf medications:Bronchodilators/anti-inflammatory.


87

Department: Radiology:

Lecture # 32: Radiology of the lungs.

Tutor: Dr. Athar Radawi (male section) &

Tutor: Dr. Asma 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

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

http://www.learningradiology.com/

http://www.auntminnie.com/


88

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


89

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

2. Schmertz- Principles of Surgery


90

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

learning objectives. Students may want to share photocopies of particularly valuable

material or present a framework for integrating a number of concepts.


91

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.


92

Appendix B

King Abdul Aziz University

Faculty of Medicine

Medical 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)

Is 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)


93

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)

Provides evidence of incorporating feedback into tutorial behaviors. (1 mark)

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


94

Further

Reading


95

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RESPIRATORY SYSTEM MODULE - kau · DEPARTMENT OF MEDICAL MICROBIOLOGY 67 ... Before the students...

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