MDSC 2001 RESPIRATION 2010 September 06 – October 08 (5 weeks)

Contents Course Information ......................................................................................................................... 2 Schedule .......................................................................................................................................... 3 Course Assessment ......................................................................................................................... 4 Course Development Committee and Resource Personnel* .......................................................... 5 Course Objectives ........................................................................................................................... 6 Large Group Activities ................................................................................................................. 11 Problem 1: Krazy Kookie ............................................................................................................. 14 Problem 2: Holy Smokes! ............................................................................................................ 15 Problem 3: Soccer Sorrows ........................................................................................................... 16 Problem 4: Lying Loser: ‘O2’ to the rescue! ................................................................................ 17 Resource Material ......................................................................................................................... 18 Multimedia Resources .................................................................................................................. 20 Websites ........................................................................................................................................ 22 

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Course Information YEAR: Second COURSE CODE: MDSC 2001 SEMESTER: 1 NO. OF CREDITS: 3 PRE- REQUISITES: Preference is for successful completion of the Year 1 Courses (MDSC 1001, 1002, 1101, 1102). DURATION: Five (5) weeks COURSE DESCRIPTION: An integrated basic science course designed to introduce the student to the concepts of respiratory physiology. The course focuses primarily on the preclinical disciplines of Anatomy, Biochemistry and Physiology and encompasses various aspects of Pharmacology, Pathology, Microbiology, and Public Health/Primary Care in so far as they facilitate learning in a holistic manner. The contents of the course include: The anatomy of the respiratory system, the conducting and respiratory airways; lungs as respiratory organs; accessory structures of respiration; physiological mechano-concepts involved in breathing and respiration; control of respiration; biochemistry of gas transport and oxygen and carbon dioxide exchange; biochemistry of the electron transport chain and oxidative phosphorylation; physiological transport of blood gases; basic pulmonary function testing, to include an understanding of the subdivisions of the lung, and the effects of changes on same; defense mechanisms of the respiratory system; immunology, as it relates to respiratory disorders, and the social impact of such conditions. (e.g. HIV-AIDS...); basic physiological principles underlying certain pathological respiratory conditions (e.g. chronic obstructive lung disease [COLD], restrictive disorders...); basic pharmacological intervention in cough and bronchial asthma, the pharmacology of autacoids; occupational and community health aspects of the respiratory system (e.g. domestic and industrial allergens, pneumoconioses, active and passive smoking, pulmonary function testing for the industrial workforce...); focused history taking (respiratory), and physical examination of the respiratory system. The course is delivered through weekly PBL sessions, anatomy and physiology laboratory exercises, video demonstrations, skillstraining sessions and large group exercises.

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Schedule (Students will be notified of any changes which may be necessary) Day Time Activity Venue Mondays 13h00-17h00 Physiology/Biochemistry labs Bldg 34, 1st floor Tuesdays 08h00-10h00 Physiology lectures Amphitheatre A 10h00-12noon Anatomy lectures Amphitheatre A 13h00-14h00 Anatomy video/demos Amphitheatre B 14h00-18h00 Anatomy labs Bldg 34, ground floor Wednesdays 14h00-15h00 Biochemistry lectures Amphitheatre A 15h00-16h00 Chemical Pathology lecture* Amphitheatre A Thursdays 08h00-09h00 Physiology lectures Amphitheatre A 09h00-12noon PBL sessions As assigned Fridays 08h00-12noon Physiology labs Bldg 34, 1st floor >>>>>>>>>>><<<<<<<<<<< SPECIAL NOTES:

1. On Thursday, September 9, PBL will commence at 10h00 in order to facilitate the Tutors’ pre-course meeting, which is scheduled for 09h00-09h45.

2. Friday, September 10 is expected to be celebrated as the EID public holiday. If this is

indeed so it will mean that NO labs will be held on that day. 3. Friday, September 24 is Republic Day in Trinidad & Tobago; as such no laboratory

exercises will be conducted on that day. 4. Students will be assigned to lab groups for Physiology. No changes will be permitted.

There will be a pre-lab on Monday September 06 in the Physiology Lab, and a post-lab on Tuesday October 05 in Amphitheatre A.

5. There will be one Biochemistry laboratory exercise for this course. Student schedules

will be posted during the week of September 06. 6. The date for the Chemical Pathology lecture will be announced.

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Course Assessment Continuous Assessment (25%)

Evaluation of PBL 5 marks May include: Lab evaluation, Anatomy spotter, Quizzes 20 marks Continuous Assessment (End of Course)*: To be announced

Written Examination (75%) Final Phase 1 (End of Semester) Examination 60 Multiple Choice Questions 45 marks

One scenario type multidisciplinary Short Answer Question 30 marks Monday, 13 December 2010, 1.00pm to 3.30pm Venue to be announced

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Course Development Committee and Resource Personnel* Dr EM Davis (Convenor) Physiology 4621* Professor GN Melville Physiology 4621 Dr TA Alleyne Biochemistry 4636* Dr N Ovchinnikov Anatomy 4625* Dr G Davis Pathology/Microbiology 2253* Mrs J Wilson CMSE 5229

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Course Objectives ANATOMY (15) At the end of the course, students will be able to:

1. Describe the anatomy of the nasal cavity including the para-nasal air sinuses (Lecture, Practical and PBL).

2. Describe the anatomy of the naso-pharynx (Lecture, Practical). 3. Describe the anatomy of the larynx (Lecture, Practical, and PBL). 4. Describe the anatomy of the trachea (Lecture, Practical). 5. List the muscles of respiration in quiet and forced breathing (Lecture, Practical). 6. Describe the anatomy of the thoracic wall and cavity with special reference to muscles of

respiration (Lecture, Practical, and PBL). 7. Describe the anatomy of the left and right lungs (Lecture, Practical, and PBL). 8. Describe the anatomy of the bronchial tree (Lecture). 9. Discuss the anatomy of the pleurae and pleural cavities (Lecture, Practical, and PBL). 10. Describe the nerve supply, arterial supply and venous and lymphatic drainage of the

lungs, pleurae, and bronchial tree (Lecture, PBL). 11. Describe the histology of the respiratory system, emphasising the changes in the walls

and epithelial linings of the respiratory tract (Practical and Lecture). 12. Identify the different structures of the respiratory system on prosected anatomical

specimens and histological sections (Practical). 13. Describe the development of the respiratory system (Lecture, PBL). 14. Discuss the important congenital abnormalities in the respiratory system (Lecture). 15. Explain the changes in the respiratory system occurring at birth (Lecture).

BIOCHEMISTRY (12) (Objectives 3, 6, 7, 8, 9, 12 to be covered in lectures) At the end of the course, students will be able to:

1. Discuss and compare the principles of the allosteric models (concerted and sequential) of enzymes/proteins.

2. Discuss the role of allosteric effector molecules. 3. Discuss the importance of allosteric control in the regulation of biological activity (e.g.

regulation of metabolism and oxygen delivery to tissue). 4. Compare the structure, function and oxygen binding properties of haemoglobin and

myoglobin. 5. Discuss the factors which influence oxygen binding by haemoglobin. (e.g. the effect of

H+ and CO2, etc.). 6. Explain how the exchange of gases, i.e. CO2 and O2 is regulated (Bohr-Haldane effects). 7. Explain how oxygen delivery to the foetus is facilitated by:

a. structural differences in hemoglobin and b. metabolic factors.

8. Describe the organisational structure of the electron transport chain. 9. Discuss the relevance of oxidative phosphorylation to the life of cells.

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10. Discuss the significance of the disruption of oxidative phosphorylation by: a. Inhibitors b. Uncouplers c. Physical methods (choking, drowning etc).

11. Discuss the basic concepts of the chemiosmotic theory. 12. Explain the biochemistry of cigarette smoking.

PHYSIOLOGY (37) At the end of the course, students will be able to: OVERVIEW OF RESPIRATORY PHYSIOLOGY

1. Describe the respiratory and metabolic functions and defense mechanisms of the lung (Lecture).

2. Define the following: (Lecture) eupnoea tachypnoea hyperoxia apnoea hypoventilation oxygen debt dyspnoea hyperventilation hypocapnia hypopnoea hypoxia (and its types) hypercapnia hyperpnoea hypoxaemia (and its types) asphyxia

3. Explain the difference between, breathing, ventilation and respiration (Lecture). MECHANICS OF BREATHING

4. Explain, with diagrams, the pressure-volume changes which occur during breathing (PBL and Lecture).

5. Draw a spirogram indicating the lung volumes and capacities and discuss the factors affecting them (Lecture, PBL and Lab).

6. Describe the physiological significance of the residual volume and RV/TLC ratio (PBL and Lecture).

7. Explain flow-volume curves with special reference to the effort-dependent and effort-independent regions and their change with disease states (PBL, Lecture and Practical).

8. Distinguish between obstructive and restrictive lung diseases (PBL and Lecture). 9. Define airway resistance (RAW) and lung compliance (CL) and discuss the components of

each and factors affecting them (PBL and Lecture). 10. Discuss the mechanics and measurement of surface tension (Lecture). 11. Discuss the role of pulmonary surfactant in the optimal functioning of the respiratory

system (Lecture). 12. Explain the concept of dynamic compression of airways (Lecture and self-directed

learning). 13. Explain the “work of breathing” and discuss the effects of resistance, compliance and

surface tension on it (PBL and Lecture). PULMONARY VENTILATION AND GAS EXCHANGE

14. Explain the relevance of the Gas Laws in respiratory physiology (PBL and Lecture). 15. List the normal fractional concentrations and partial pressures (at sea level) for the main

constituents of air (PBL and Lecture).

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16. Calculate the partial pressures of gases in atmospheric and alveolar air (PBL). 17. Define and quantitate alveolar ventilation (VA), physiologic dead space and anatomic

dead space (VD) (PBL and Lecture). 18. Explain the concept of the ventilation/perfusion ratio (Lecture). 19. Discuss the regional differences in normal alveolar ventilation and pulmonary blood flow

(Lecture). 20. Describe the various laboratory methods used to assess ventilatory function (PBL and

Lecture). 21. Explain the measurement and significance of “closing volume” (Lecture). 22. Define diffusion capacity (transfer factor) and discuss its measurement and factors

affecting it (PBL and Lecture). 23. Relate abnormal ventilation/perfusion ratios to PaO2 and PaCO2 values (Lecture). 24. Discuss the various types of hypoxia (PBL and Lecture). 25. Explain the significance of an elevated alveolar to arterial PO2 difference (PBL and

Lecture). 26. Explain the physiological bases for hypoxaemia (PBL and Lecture).

TRANSPORT OF BLOOD GASES 27. Describe the transport of oxygen and the role played by haemoglobin (PBL and

Lecture). 28. Describe the transport of carbon dioxide and discuss the importance of the chloride shift

(PBL and Lecture). 29. Explain the oxyhaemoglobin and carbon dioxide dissociation curves and discuss the

factors which affect them (PBL and Lecture). 30. Define respiratory acidosis and alkalosis and describe the mechanism and function of

respiratory acid base compensations (Self-directed learning). CONTROL OF RESPIRATION

31. Explain, in outline, the chemical control of breathing (including the role of the chemoreceptors (PBL and Lecture).

32. Utilise appropriate diagrams to describe the pathways of the various respiratory centres, feedback loops and peripheral nerve inputs used in the neural control of breathing (PBL and Lecture).

33. Describe abnormal breathing patterns (e.g. Cheyne-Stokes, Kussmaul’s, Biot’s, apneustic, sleep apnoea) (PBL and self-directed learning).

SOME CLINICAL APPLICATIONS AND RELEVANCE OF RESPIRATORY PHYSIOLOGY

34. Discuss the factors involved in the control of bronchomotor tone including the mechanisms for clearance of vasoactive substances from the blood (Lecture).

35. Discuss the effect of domestic allergens (smoke, dust etc.) on the airways and the mechanisms by which they are cleared (PBL).

36. Explain the physiological changes which occur during exercise and at high altitude (PBL and self-directed learning).

37. Explain the physiological bases for coughing, sneezing, sighing, yawning, wheezing, clubbing of the fingers, cyanosis, decompression sickness and shallow water blackout (Self-directed learning).

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PHARMACOLOGY (5) (All objectives are to be covered by self-directed learning) At the end of the course, students will be able to:

1. Discuss the pharmacology of the following drugs that are used in the management of bronchial asthma:

i. sympathomimetics (adrenaline and epinephrine) b2 agonists (salbutamol). ii. phosphodiesterase inhibitors (aminophylline). iii. corticosteroids (beclomethasone). iv. cromolyn sodium v. anticholinergics (ipratropium bromide)

2. List the receptor subtypes of histamine, and name the agonists and antagonists acting at these receptor subtypes.

3. List the drugs, which release histamine. 4. List the receptor subtypes of 5-HT, and name the agonists and antagonists acting at these

receptor subtypes. 5. Briefly discuss the role of acetazolamide with respect to acid-base balance.

ANATOMICAL PATHOLOGY (5) (All objectives are to be covered by self-directed learning) At the end of the course, students will be able to:

1. Define chronic obstructive pulmonary disease (COPD) and list the disorders that comprise chronic obstructive pulmonary diseases (COPD).

2. Discuss the aetio-pathogenesis, pathology and clinical features of asthma. 3. List the causes of pulmonary oedema. 4. Define adult respiratory distress syndrome (ARDS) and list the causes. 5. Define pneumoconioses and their significance in relation to environmental pollution.

CHEMICAL PATHOLOGY (3) At the end of the course, students will be able to:

1. Write the Henderson-Hasselbalch equation, and use it to explain acid-base disturbances such as, non-compensated respiratory acidosis; non-compensated respiratory alkalosis; compensated respiratory acidosis; compensated respiratory alkalosis (Lecture).

2. Define the term Anion Gap and explain its application in patients with mixed acid base disturbance. (Lecture).

3. Explain the control of blood pH. (Lecture). HAEMATOLOGY (5) (All objectives are to be covered by self-directed learning) At the end of the course, students will be able to:

1. Discuss haemopoiesis and its regulation (growth factors with special reference to erythropoeitin).

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2. Review the structure and function of haemoglobin with special reference to the disorders of oxygen carrying capacity.

3. Discuss the role of hypoxaemia and erythropoeitin in respiratory disorders. 4. Explain the role of white blood cells in respiratory disorders: e.g. asthma

a. monocyte - phagocytic system (macrophages) b. eosinophils (hypereosinophilic syndrome) c. mast cells (basophils) d. hereditary haemolytic anaemias

5. Describe anaemia of chronic disease (ACD), with reference to respiratory diseases. IMMUNOLOGY (5) (All objectives are to be covered by self-directed learning) At the end of the course, students will be able to:

1. Outline the major immune defenses in the upper and lower respiratory tract. 2. Discuss the immunopathogenesis, clinical features, diagnosis and treatment of hayfever

(seasonal allergic rhino-conjunctivitis) and perennial rhinitis. 3. Discuss the immunopathogenesis, clinical features, diagnostic investigation and

principles of management of asthma. 4. List the common respiratory infections seen in patients with inherited and acquired forms

of humoral and/or cell-mediated immunodeficiency. 5. Outline the respiratory complications of HIV infection.

MICROBIOLOGY (1) (All objectives are to be covered by self-directed learning) At the end of the course, the student will be able to:

1. Discuss the aetiology of upper respiratory tract infections under the following headings: • Bacteria: Group A Streptococcus, Haemophilius influenzae, Corynebacterium

diptheriae, Mycoplasma pneumoniae, Neisseria gonorrhea • Viruses: Rhino, Corona, Epstein Barr, Herpes simplex, Coxsackie A and B,

Paramyxoviruses and Orthomyxoviruses • Opportunistic fungi: Candida albicans and Aspergillus species.

PUBLIC HEALTH/PRIMARY CARE (5) (All objectives are to be covered by self-directed learning) At the end of the course, students will be able to:

1. Outline the health issues involved in asthma and its prevention. 2. Discuss the effects of active and passive smoke, and issues involved in smoking in the

home and in the work environment. 3. Discuss the disadvantages of a sedentary lifestyle with specific reference to the

respiratory system. 4. Describe the effects of work on health and health on work. 5. Discuss the public health concerns with respect to environmental pollutants.

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Large Group Activities ANATOMY Lectures:

1. Introduction to the respiratory system. Morphological basis of breathing and respiration. Air-blood barrier (respiratory membrane) and types of respiration. Overview of the gross anatomy of the respiratory system.

2. Embryology of the respiratory system. Changes occurring in the respiratory system at birth. Respiratory movements of the chest and structures producing them.

3. Surface markings of the lungs. External structure of the lungs. The pulmonary root and hilum. Pulmonary lobes, bronchopulmonary segments and pulmonary lobules. The nerve and blood supply of the lungs and lymphatic drainage.

4. Overview of the gross anatomy of the lower respiratory tract (airway), its conducting and respiratory portions. The bronchial tree and the respiratory tree. Neural control of respiration.

5. Overview of the histology of the respiratory tract (conducting and respiratory portions), the lungs and the pleura.

Demonstrations:

1. Video demonstration of the gross anatomy structures for the practical session (40 min) Acland’s DVD Atlas: Vol. 4, Part 3 (27 min); Part 4 (13 min).

2. Video demonstration of gross anatomy structures for the practical session (52 min). Acland’s DVD Atlas: Vol. 3, Part 1 (5 min); Part 2 (47 min).

3. Demonstration of the gross anatomy structures for the practical session. Acland’s DVD Atlas: Vol. 6, Part 1 (10 min); Netter’s Atlas of Human Anatomy (50min).

4. Demonstration of the gross anatomy structures for the practical session. Acland’s DVD Atlas: Vol. 4, Part 5 (18 min); Vol. 6, Part 1 (3 min) Netter’s Atlas of Human Anatomy (35 min).

Practicals:

1. Gross anatomy of the upper respiratory tract (airway): the nasal cavity, paranasal air sinuses, nasopharynx, oropharynx and laryngopharynx.

2. Gross anatomy of the thoracic wall (thoracic bones: vertebrae, ribs, sternum & joints between them; intercostal spaces). Muscles of respiration, pleurae and pleural cavities.

3. Gross anatomy of the lungs, their lobes, bronchopulmonary segments and pulmonary lobules. The nerve and blood supply of the lungs and lymphatic drainage.

4. Gross anatomy of the larynx, trachea and bronchi. 5. Histology of the respiratory tract (conducting and respiratory portions), the lung and the

pleural membranes. BIOCHEMISTRY Lectures:

1. Allosteric enzymes/protein models 2. Allosteric enzymes/protein models/oxygen transport and storage proteins. 3. Haemoglobin: Bohr Effect, 2, 3-BPG, sickle cell anaemia.

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Laboratory Exercise: (Building 34, 1st floor) 1. SDS – Polyacrylamide Gel Electrophoresis: (SDS – PAGE) of Proteins

PHYSIOLOGY Lectures will cover six broad areas:

1. OVERVIEW OF RESPIRATORY PHYSIOLOGY • Functions of the respiratory system • Language of respiratory physiology

2. MECHANICS OF BREATHING • Muscles of respiration. • Physiological mechano-concepts in breathing and respiration. • Pressures involved in the movement of air into and out of the lungs. • Elastic recoil of the lungs. • Lung compliance. • Resistance to airflow. • Surface forces and lung recoil. • Work of breathing.

3. PULMONARY VENTILATION AND GAS EXCHANGE

• Relevance of gas laws in pulmonary physiology. • Lung volumes and capacities; measurement and application. • Alveolar ventilation, dead space and uniformity of ventilation. • Concepts of ventilation and perfusion; ventilation/perfusion ratio. • Diffusion of gases. • Oxygen availability (hypoxia, hypoxaemia, hyperoxia). • Assessment of ventilatory function.

4. TRANSPORT OF BLOOD GASES • Transport of oxygen and carbon dioxide. • Oxyhaemoglobin dissociation curve, significance and factors affecting it.

5. CONTROL OF RESPIRATION

• Chemical control of breathing. • Respiratory rhythm (neural). • Reflexes from the lung and chest wall. • Abnormal breathing patterns.

6. CLINICAL APPLICATIONS AND RELEVANCE OF RESPIRATORY

PHYSIOLOGY • Bronchomotor tone

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Laboratory Exercises: (Building 34, 1st floor) Students will work in small groups for the labs. Results obtained are to be recorded and analysed by EACH student.

1. Pulmonary Function I: Volumes and capacities 2. Pulmonary Function II: Forced Expiratory Volume (FEV), Maximum Voluntary

Ventilation (MVV)

CHEMICAL PATHOLOGY Lecture:

1. Introduction to blood gases

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Problem 1: Krazy Kookie Kookie, an obese 38 year old woman desperately wanted to lose weight before getting married the following year. She suffered from bouts of acute sinusitis which often progressed to a cough. At her last check up she was told she had features of bronchial asthma. Kookie took her prescribed medication, and for six months stuck to a sensible diet and walked for 30 minutes five days a week for exercise. She got rid of her sinusitis, her asthmatic symptoms were under control, lost a considerable amount of weight, reduced her body mass index (BMI), and realised that she was no longer short of breath on climbing stairs. At her medical check up Kookie asked her doctor to explain why her breathing was now so much easier. The doctor proceeded to explain the pressure and volume changes which occur during normal breathing, the differences to be expected with overweight and obese persons, and gave her a brief account of bronchial asthma. She was encouraged to lose some more weight and achieve a normal BMI within the next six months. Kookie was doing well, and was no longer considered asthmatic, but became really busy preparing for the wedding. As a result she stopped walking and did not maintain a healthy diet. She was worried that she would not be able to fit into her designer wedding gown, and against her doctor’s advice she started taking 2,4 dinitrophenol (2,4,DNP), a slimming drug that had been around for years. Kookie almost died! Upon recovery from the near fatal consequences of the slimming drug, she learned that the dangerous difference between weight loss and death is only a small change in the concentration of 2,4 DNP!

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Problem 2: Holy Smokes! Harry, a 60 year old retired cement and construction worker, was nicknamed ‘Smokey’ because of his well known 40 year history of smoking 20 cigarettes a day, despite being warned repeatedly at every company medical examination for which he was sent. Always smiling, Smokey would boast that even though he had a chronic cough his lung function tests were always normal, and “something would take him” so it may as well be something he enjoyed! Smokey’s lung function tests, a year ago, showed that he had obstructive lung disease (which he knew about) but with an added mild restrictive component. He told the doctor he would try to cut down his smoking. Over the past three weeks, however, Smokey admitted to his friends that he was experiencing exertional shortness of breath and noticed blood whenever he coughed. He was persuaded to visit the doctor when, for the first time, while playing cards he felt left sided chest pain. On examination the doctor found Smokey’s breath sounds were diminished in the upper lobe of the right lung, and heard fine rales mainly at the left lung base. Smokey’s chest radiograph showed a mass at the hilum of the right lung and fine, diffuse mottling of the left lung. The attending physician immediately requested bronchoscopy and mediastinoscopy, as these changes were suggestive of a tumour. The mass, which was obstructing the origin of the right superior lobe bronchus, was biopsied as were the right tracheobronchial lymph nodes, with the results being positive for a malignancy. A very subdued and no longer smiling Smokey was referred to the pulmonary function laboratory for pre-operative evaluation.

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Problem 3: Soccer Sorrows 27 year old Hal, a senior medical resident, was an avid soccer player in high school. He was well aware of some of the dangers involved in this glorious game, having suffered a fractured ankle during a match some years before. One day while on call at the Accident & Emergency Department of his hospital, a popular professional soccer player (Mali Pes) was brought in complaining of excruciating chest pain. The young player had received injuries to the right side of his chest wall when tackled during a friendly match. After taking an appropriate history from Mali, Hal’s physical examination findings included tachypnoea, cyanosis and a small laceration with flailing of the right anterolateral thoracic wall. He assumed that the pleura had not been breached as he did not hear any breath sounds associated with the wound. Hal placed the player on positive pressure endotracheal respiration, and was pleased that this corrected the Mali’s cyanosis and flailing chest wall. He then requested a chest radiograph before attempting to suture the laceration. Radiograph results showed fractures of the 4th through 8th ribs in the right anterior axillary line, and fractures of the 4th through 6th ribs at the right costochondral junction. Hal asked the radiologist to confirm that there was no evidence of a pneumothorax before suturing the wound and bandaging Mali’s chest. Nurses assigned to Mali called Hal later on that evening explaining that his right side appeared to be more expanded than the left. When Hal arrived he noted additionally that the cyanosis had returned and the right side of Mali’s chest was not moving as much as the left even with the endotracheal ventilation still in effect. Hal thought of what may have happened to Mali’s blood gases had the endotracheal ventilation not been set up. A repeat chest radiograph showed a horizontal fluid level in Mali’s right lung, and a ventilation-perfusion scan showed marked unevenness of ventilation. Right thoracic wall puncture was performed on Mali and a negative pressure drain was inserted into the pleural space.

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Problem 4: Lying Loser: ‘O2’ to the rescue! Twenty five year old Onya Osler, known to her close friends as ‘O2’, was a well known local athlete and an aspiring sports physiologist. She and a small group of friends decided to go on a hiking trip to the island’s highest mountain to prepare for an upcoming sporting event. Prior to their departure Onya and the group had to undergo medical examinations by their local physician. The group of girls, aged 19-25 years were all deemed fit for the trip, given acetazolamide, and advised to take it before the climb to an altitude of 18,000 feet where the barometric pressure was said to be 415 mm Hg. Anandi, one of the younger girls, complained of feeling ill at about 10,000 feet into the climb, and Onya recognised the symptoms as ‘mountain sickness’. Anandi admitted that she had forgotten to take the medication, did not want to be debarred from the climb, and therefore lied to Onya about having taken it. Onya acted quickly, and got her friend to breathe from a tank of 100% oxygen. The remainder of the hike was uneventful, but on their return home Onya took Anandi to the doctor for specific blood tests.

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Resource Material ANATOMY Anatomy, Regional and Applied. Last, R J., Churchill Livingstone. The Developing Human. Moore, K L., Persaud, TVN., W B Saunders Co. A Textbook of Histology. Bloom, W B., and Fawcett, D W. Chapter 22 Clinically Oriented Anatomy. Moore, K L., Williams and Wilkins. BIOCHEMISTRY Harper’s Biochemistry. Granner, Mayes, Murray, Rodwell. Prentice Hall Int’l. (latest edition) Textbook of Biochemistry with Clinical Correlations. Devlin, T M John Wiley & Sons Inc. Biochemistry by Diagrams. Morrison, E. Canoe Press Biochemistry. A Case Oriented Approach. Conway, Montgomery & Spector. (latest edition). C V Mosby. Biochemistry for the Medical Sciences. E A Newsholme & A R Leach (latest edition). John Wiley & Sons Inc. Biochemistry. L Stryer. (Int. Student Ed.) (latest edition) W H Freeman Biochemistry Illustrated. P N Campbell and A L Smith (latest edition). Churchill Livingstone. PHYSIOLOGY Physiology. Berne and Levy. Mosby. (latest edition) Review of Medical Physiology. W F Ganong. Appleton and Lange. Textbook of Medical Physiology. E C Guyton. W B Saunders. Human Physiology. L Sherwood. Pulmonary Physiology. J B West. Williams and Williams. PHARMACOLOGY Basic and Clinical Pharmacology. B G Katzung. Lange Publications (latest edition). Goodman and Gilman’s The Pharmacological Basis of Therapeutics. (latest edition). Hardman, Limbird et al. McGraw Hill PATHOLOGY (Anatomical, Haematological, Chemical and Immunological) Basic Pathology. Robbins, Angell & Kumar. General Pathology. Walter & Israel. (Reference) Lecture Notes in Chemical Pathology. Whitby, Smith and Beckett. Blackwell. Clinical Biochemistry. Gaw, Cowan, O’Reilly, Stewart and Shepherd. Churchill Livingstone. Lecture Notes on Immunology. (latest edition). Gordon Reeves and Ian Todd. Blackwell Science Basic and Clinical Immunology. (latest edition). Stites, Terr and Parslow. Lange PUBLIC HEALTH/PRIMARY CARE Work and Health. An introduction to occupational health care. Bamford, M (ed.) Chapman and Hall, London 1995 MODELS The Respiratory System. Located in Anatomy Lab, building 34, ground floor.

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CHARTS The Respiratory System. Located in Multi-Purpose Lab, building 34, 1st floor.

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Multimedia Resources Available at the Medical Sciences Library CD-ROMS ADAM Interactive Physiology:Respiratory System. Welch Allyn’s Interactive CD-ROM - Eye, Ear, Nose & Throat McMinn’s Interactive Clinical Anatomy - Head & Neck. AUDIOCASSETTES Lung Sounds (21 min.) Heart Sounds, Chest Sounds & Breathing Sounds (1 hr.) Chest Sounds (15 min.) Understanding Lung Sounds (1 hr.) Auscultatory Pneumonia in other Diseases (15 min.) Diseases of the Respiratory System (30 min.) Auscultatory Pneumonia in various Diseases & Review (35 min.) SLIDE SHOWS Chest X-Ray: Pleura, Diaphragm, Lung Allergy & Immunology SLIDE TAPES Respiratory Distress (11 min.) Chest Injuries – Intensive Care (25 min.) Wheezing in Young Children (26 min.) Apnea (14 min.) Chest Radiography of Neonate (21 min.) Respiratory System: History Taking (37 min.) Respiratory System: Physical Examination (35 min.) Asphyxia (12 min.) VIDEOTAPES Respiratory Tract Infection (1 hr.) Asthma: The Continuing Challenge (18 min.) Pharynx and Nasal Cavity (16 min.) Root of the Neck & the Thorax (23 min.) Gross Anatomy: Larynx. (11 min.) Neck & Anterior Triangle (24 min.) Branched Examination of the Thorax (4 min.) Questions & Answers About AIDS (38 Min.) Endoscopic Examination of the Upper Airway (22 min.) Respiratory System. (30 min.) Airway Obstruction in Infants and Children (27 min.) The Right Puff (8 min.) COPD –Differential Diagnosis (22 min.) Management of the Upper & Lower Airway (16 min.)

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Pneumonia & a Review of Pulmonary Intestinal Lung Disease (1hr. 57 min). Pneumonia & Respiratory Failure (1hr. 58 min.) A Review of Smoking Cessation (1hr. 49 min.). Physical Examination for Medical Students Respiratory System (22 min.) Tuberculosis – Prevention & Practices for Health Care Workers (20 min).

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Websites Introductory Anatomy: Respiratory System http://www.leeds.ac.uk/chb/lectures/anatomy7.html Hardin MD: Respiratory system and lung diseases http://www.lib.uiowa.edu/hardin/md/resp.html Lung Diseases http://healthlibrary.stanford.edu/resources/bodysystems/resp_lung.html Martindale’s: Cardiology and Pulmonary Centre http://www.martindalecenter.com/MedicalCardio.html Oxygen Delivery System http://sln.fi.edu//biosci/systems/respiration.html Physiology of the Respiratory System http://www.acbrown.com/lung Pulmonary Pathology Index http://medstat.med.utah.edu/WebPath/LUNGHTML/LUNGIDX.html Respiratory Care Areas of Interest on the Web http://www.rcsw.org/ts_med.htm#RESPIRATORY Smoking and Respiratory Disease http://www.ash.org.uk/html/factsheets/html/fact05.html The Virtual Anaesthesia Textbook http://www.virtual-anaesthesia-textbook.com Search for "respiration" to find Respiration and drugs affecting the respiratory system Useful websites physiology http://www.acofp.org/state/Useful%20Websites-physiology.htm