Verily, along with every - Yusra Medical and Dental …ymdc.edu.pk/wp-content/uploads/2017/09/Study-Guide-Book-6th.pdf · Verily, along with every hardship is relief STUDY GUIDE RESPIRATORY

YUSRA MEDICAL & DENTAL COLLEGE, ISLAMABAD

Al-Quran: 94; 5

Verily, along with everyhardship is relief

RESPIRATORY MODULESTUDY GUIDE

Index

S.No Topic Page

1 Team members

1

2 Introduction

2

3 Curriculum framework

4

4 Main content areas

5

5 Teaching / learning methods

6

6 Recommended reading material

7

7 Organization of module 9

8 Anatomy

10

9 Physiology

19

10

Biochemistry

31

11 Vertical integration 40

12 Timetable 47

1

Team Members

Name Commi�ee Department

Dr. Idrees Farooq Bu�

Professor Chief Coordinator Physiology

Dr. Aysha Baber

Associate Professor Coordinator Physiology

Dr. Muhammad Aziz

Professor Member Anatomy

Dr. Shabbir Rana

Professor Member Surgery

Dr. Shahid Aziz

Professor Member Pediatrics

Dr. Muhammad Luqman

Professor Member Medical Educa�on (DME)

Dr. Hamid Akram

Professor Member Radiology

Dr. Amina Rasul

Assistant Professor Member Physiology

Dr. Farah Rashid

Professor Member Community Medicine / DME

Dr. Shumaila Najeeb Piracha

Associate Professor Member Pathology

Dr. Saima Manzoor

Assistant Professor Member Biochemistry

Dr. Zarafshan Badar

Assistant Professor Member Pharmacology

2

INTRODUCTION

Assalam – u – alaikum and a very warm welcome to medical students in the

Respiratory Module. This module has been developed as a part of introducing the integrated,

modular, contextualiz ed curriculum in Yusra Medical and Dental College, Islamabad. It will be

covered in 5 weeks. The Respiratory Module has been designed to facilitate the learning of

normal structure and func�on in context of clinical problems, which the pa�ents can encounter in

life.

Respira�on is a vital process which occurs throughout life. Respiratory system not only

facilitates breathing process but also contributes in many other physiologic processes including

maintenance of acid base balance. A good knowledge of structure, func�on and understanding of

biochemical processes of respira�on will help medical students to grasp the pathologic basis of

pulmonary diseases in a much be�er way.

The module will extensively cover the anatomy, both gross and microscopic, of up per and

lower respiratory tract along with the development and congenital anomalies which may occur.

The physiology of respira�on will elaborate the func�onal part of breathing and the mechanisms

controlling it. The study of biochemistry will elaborate the role of vitamins and nutri�onal

elements in the body. The horizontal integra�on of basic medical science subjects will be carried

out with ver�cal integra�on of paraclinical sciences like pathology, pharmacology and community

medicine, radiology and clinical specialties such as medicine, surgery and pediatrics.

The medical students are advised to use this Study Guide for the management of their

learning. The support of faculty members in this learning process will stay with them all the way.

Good luck to all of the medical students in their future endeavors for learning!

3

General Learning Objec�ves:

By the end of this module, the students will be able to:

ANATOMY

Describe the developmental anatomy and histology of respiratory system.

Explain the various parts and movements of respiratory system.

Relate the developmental anatomy of diaphragm and embryological basis of

diaphragma�c hernias.

PHYSIOLOGY

Explain mechanical events, volume and pressure changes during respira�on

Explain the physiological basis of ven�la�on perfusion ra�o and its applica�on.

Discuss the various modes of transport of oxygen and carbon dioxide from

lungs/atmosphere to �ssues and vice versa.

Explain the various neurological and chemical control mechanisms involved in regula�on

of respira�on both at rest and under stressful circumstances.

Describe the basis of various abnormal breathing pa�erns and relate with the associated

clinical condi�ons.

BIOCHEMISTRY

Describe sources, nutri�onal importance and deficiency effects of various vitamins.

Explain balanced diet ,its importance and hazards of over-nutri�on and under-nutri�on

4

5

MAIN CONTENT AREAS ANATOMY

Histology:

Trachea

Bronchi

Lungs

Pleura

Embryology:

Development of body cavi�es

Development of lower respiratory system and diaphragm

Gross Anatomy

Thorax

Lower respiratory tract

Lungs

Pleura

diaphragm

PHYSIOLOGY

Pulmonary ven�la�on

Pulmonary circula�on ,edema and pleural fluid

Principles and mechanism of gases exchange

Regula�on of respira�on

Hypoxia, physiology of deep sea diving and hyperbaric condi�on

BIOCHEMISTRY

Vitamins

Nutri�on

6

Teaching / Learning Methods

The teaching and learning sessions of this module will be of diverse types:

a. Large group interac�ve sessions (LGIS)

b. Small group teaching will include interac�ve tutorials (SGIS)

c. Problem – based learning sessions (PBL) or Case based learning sessions (CBL).

d. Prac�cal sessions will comprise sessions on early exposure to clinical methods and

prac�cal laboratory demonstra�ons.

e. Seminars on different topics, in which students will give oral presenta�ons on different

aspects of the allocated topics.

f. Directed self learning (DSL): Students are pre advised the topics and they study them

under supervision.

g. Self-directed learning sessions (SDL): This is the �me during which students are expected

to revise what they have learnt in the class, clear their concepts by consul�ng different

text books, reference material and prepare their assignments and projects.

h. Skill laboratory: Students learn medical skills in lab e.g. CPR (cardiopulmonary

resuscita�on)

7

Recommended Reading Material

LEARNING RESOURCES

Gross Anatomy

i. Clinical Anatomy by Regions, Richard S. Snell- 9th edi�on, 2012

Reference Books

ii. Gray’s Anatomy 40th edi�on, 2008

General Anatomy

iii. General Anatomy by Dr. Laiq Hussain, 3rd edi�on 2011

iv. Understanding General Anatomy by Professor Ta sadduq Hussain-14th edi�on, 2014

Embryology

v. Langman’s Medical Embryology, 12th edi�on, 2012

Histology

vi. Medical Histology by Dr. Laiq Hussain, 5th edi�on, 2015

vii. Difiore’s Atlas of Histology - 12th edi�on, 2013

Physiology

viii. Guyton and Hall Text book of Medical Physiology. 13 th edi�on, 2016.

ix. Human Physiology: From Cells to Systems. Lauralee Sherwood, 9 th edi�on, 2014.

x. Lab Manual Physiology, part 1st, 3rd edi�on 2017.

Biochemistry

i. Lippinco�’s illustrated Reviews: Biochemistry 6 th edi�on, 2014.

ii. Harper’s illustrated Biochemistry. 30 th edi�on, 2012.

iii. Essen�als of Medical Biochemistry. Mushtaq Ahmed, Vol I and II, 8 th edi�on, 2011.

8

Pathology

i. Robbins Basic Pathology (9th EDITION)

Medicine

i. Davidsons Principle and prac�ce of Medicine, 22nd Ed, Part 2

Pharmacology

i. Bertram G. Katzung, 13th edi�on, chapter 35

ii. Bertram G. Katzung, 13th edi�on, chapter 11

Community Medicine

i. Parks’ Textbook of Preven�ve and Social Medicine. 21 st edi�on, 2012. ii. Public Health and Community Medicine. Ilyas and Ansari, 7th edi�on, 2008.

iii. Epidemiology. Leon Gordis, 5th edi�on, 2014.

9

Organiza�on

Time distribu�on

Horizontal Integra�on Basic Medical Sciences

Anatomy 75 Hours

Physiology 79 Hours

Biochemistry 63.5 Hours

PBL 8 Hours

Ver�cal Integra�on

Pathology 1 Hour

Pharmacology 1 Hour

Medicine 2 Hours

Surgery 2 Hours

Pediatrics 1 Hour

Radiology 1 Hour

Longitudinal Integra�on

Community Medicine 11.5 Hours

Islamiat and Pak studies 2.5 Hours

_____________________________________

Total = 247.5 Hours

_____________________________________

ANATOMY

10

Embryology Lectures

S # Learning Objec�ves

By the end of the session, students will be able to:

Content Areas Teaching Ac�vity

(Dura�on) Assessment

1. Development of respiratory system

Describe the development

of respiratory system. (K)

Forma�on of respiratory

diver�culum from foregut

Forma�on of tracheoesophageal

septum

Development of larynx and

trachea

Forma�on of bronchi,

bronchioles, alveolar ducts and

sacs

Different phases of matura�on

of lungs and factors responsible

for matura�on of lungs

Forma�on of blood-air barrier

LGIS 1 hour

MCQs SEQs SAQs

2. Birth defects

Describe the developmental anomalies of respiratory system. (K)

Esophageal artesia and

tracheoesophageal fistulas,

respiratory distress syndrome

LGIS

1 hour

MCQs SEQs SAQs

11

HISTOLOGY LECTURES

S #

Learning Objec�ves

By the end of the session,

students will be able to:

Content Areas

Teaching

Ac�vity

(Dura�on)

Assessment

1. Respiratory system

Differen�ate between

conduc�ng and

respiratory por�ons of

respiratory system &

microscopic details of

larynx. (K)

Respiratory epithelium

Role of nasal cavity in

condi�oning of air and

conduc�ng it to lungs

Olfactory epithelium and

its microscopic details

Microscopic details of

larynx

LGIS

1 hour

MCQs

SEQs

SAQs

2. Trachea

Describe the


trachea. (K)

Microscopic details of

trachea

Components of blood-air

barrier

Role of surfactant in

preven�on of respiratory

distress syndrome

LGIS

1 hour

MCQs

SEQs

SAQs

3 Bronchial tree and lungs

Describe the

microscopic structure

of bronchi and

differen�ate primary,

secondary and ter�ary

bronchi. (K)

Microscopic details

bronchial tree

Differences between

terminal and respiratory

bronchioles

LGIS 1 hour

MCQs

SEQs

SAQs

12

HISTOLOGY PRATICALS

S

NO




Content Areas

Teaching

Ac�vity

(Dura�on)

Assessment

1. Microscopic study of larynx

and

olfactory epithelium

Iden�fy and draw

respiratory and olfactory

epithelium and


larynx. (S)

Slide of larynx

showing

microscopic details.

Slide of olfactory

epithelium showing

microscopic details.

Demonstra�on

2 hours

MCQs

SEQs

SAQs

2.. Microscopic study of trachea

and lungs

Iden�fy and draw


trachea, bronchi and lungs.

(S)

Slide of trachea.

Slide of lungs.

Demonstra�on

2 hours

MCQs

SEQs

SAQs

13

ANATOMY PRATICALS

S #




Content Areas

Teaching

Ac�vity

(Dura�on)

Assessment

1.

Thoracic wall and cavity

Describe the structure of

thoracic wall and rela�ons

of thoracic viscera. (S)

Muscles, fascia, bones

and thoracic wall

Muscles which a�ach

limb to the trunk

Bony cage of thorax

Rela�ons of heart , lung

and medias�num, nerves

and vessels

Medias�num and its

subdivisions

Prac�cal 2 hours

OSPE

2

Thoracic vertebra

Iden�fy parts of a typical

vertebra and differen�ate

different thoracic vertebrae.

(S)

Parts and shape of

thoracic Vertebrae

Inter vertebral foramina

and emergence of spinal

nerves

Prac�cal

2 hours

OSPE

3. Ribs and sternum

Iden�fy parts of a typical rib

and differen�ate typical

from atypical ribs. (S)

Demonstrate different parts

of sternum and its muscle

a�achments. (S)

Demonstrate ar�cula�ons

of ribs and sternum. (S)

Typical and atypical ribs

True, false and floa�ng

ribs

Ar�cula�ons of ribs

Ar�cula�ons of sternum

Parts of sternum

Muscle a�achments of

sternum

Ossifica�on of sternum

Prac�cal

2 hours OSPE

14

4. Intercostal spaces

Iden�fy thoracic outlet,

intercostal space and

demonstrate intercostal

muscles, their ac�ons and

arrangement of intercostal

vessels and nerves in

intercostal space. (S)

A�achments, direc�on

and parts of intercostal

muscles.

Course of intercostal

nerves and vessels

(Neurovascular plane)

Distribu�on of intercostal

nerves and vessels.

Anastomosis between

intercostal arteries and

veins.

Prac�cal

2 hours

OSPE

5. Pleura, endothoracic fascia,

medias�num

Iden�fy pleura and its

reflec�ons, pleural cavity

and medias�num. (S)

Pleura, pulmonary

Ligaments.

Parietal pleura, visceral

pleura and their nerve

supply.

Anterior and Posterior

intercostal arteries.

Costo-cervical trunk.

Typical and atypical

Intercostal nerves.

Endo thoracic fascia and

its modifica�ons.

Prac�cal

2 hours

OSPE

6 Lungs

Demonstrate fissures and

lobes of lungs, arrangement

of bronchi and vessels in the

hili of lungs and differen�ate

right and le� lungs. (S)

Parts and surfaces of

lungs.

Lobes and impressions of

lungs.

Lymph nodes and vessels

of lungs.

Blood vessels of lungs.

Prac�cal

2 hours

OSPE

15

7. Bronchopulmonary segments

Iden�fy broncho pulmonary

segments and demonstrate

their clinical significance. (S)

Loca�on of

bronchopulmonary segments

in each lung.

Shape, neurovasculature of

segments

Clinical significance of

bronchopulmonary segments

Prac�cal

2 hours OSPE

8. Diaphragm

Iden�fy a�achments,

different parts of diaphragm

and demonstrate nerve

supply, blood supply and

role of diaphragm in

inspira�on and expira�on.

(S)

Concept of origin and

inser�on of diaphragm.

Vertebral levels of domes of

diaphragm in respira�on.

Course and distribu�on of

phrenic nerves and their

lesions.

Diaphragma�c pleura and

peritoneum.

Structures passing through

diaphragm.

Prac�cal

2 hours

OSPE

9. Respiratory movements

Demonstrate different

diameters of thorax and

how these diameters

change during quiet and

forced inspira�on and

expira�on. (S)

Joints between vertebrae.

Costo-vertebral and sterno-

chondral joints.

Inter costal joints.

Role of scalene and

abdominal muscles,

sternocledomastoid and

muscles of thoracic wall.

� Various (respiratory)

movements at the

Prac�cal

2 hours

OSPE

16

costovertebral joints.

10. Surface anatomy

Demonstrate the different

visceral loca�ons in rela�on

to body points and

intercostals spaces. (S)

Iden�fy intercoastal spaces

boney points

Surface marking of heart,

lungs, vessels and nerves

Prac�cal 2 hours

OSPE

17

ANATOMY SEMINARS

S #

Topic Content Areas

Teaching

Ac�vity

(Dura�on)

Assessment

1. Body cavities. (S) Forma�on of

intraembryonic cavi�es

Division of thoracic cavity

into pleural and pericardial

cavi�es

Appearance of lung buds

Serous membranes (pleural,

pericardial and peritoneal

membranes)

Body wall defects and

clinical correlates

Student Presenta�on

7 mins

Marking / Evalua�on Marks 10

2. Development of respiratory system. (S)

Forma�on of respiratory

diver�culum from foregut

Forma�on of

tracheoesophageal septum

Development of larynx and

trachea

Forma�on of bronchi,

bronchioles, alveolar ducts

and sacs

Different phases of

matura�on of lungs and

factors responsible for

matura�on of lungs

Forma�on of blood-air barrier

Esophageal Artesia and

tracheoesophageal fistulas,

respiratory distress syndrome

Student

Presenta�on

7 mins

Marking /

Evalua�on

Marks 10

18

3. Trachea, bronchial tree and lungs. (S)

Microscopic details of trachea,

bronchial tree & lungs

Differences between terminal

& respiratory bronchioles

Components of blood-air

barrier

Role of surfactant

Student

Presenta�on

7 mins

Marking /

Evalua�on

Marks 10

4. Intercostal spaces, pleura,

endothoracic fascia,

medias�num. (S)

A�achments, direc�on and

parts of intercostal muscles.

Course of intercostal nerves

and vessels (Neurovascular

plane)

Distribu�on of intercostal

nerves and vessels.

Anastomosis between

intercostal arteries

Pleura, pulmonary ligaments.

Parietal pleura, visceral pleura

and their nerve supply.

� Anterior and Posterior

intercostal arteries.

Costo-cervical trunk.

Typical and atypical

Intercostal nerves.

Endo thoracic fascia and its

modifica�ons.

Student

Presenta�on

7 mins

Marking /

Evalua�on

Marks 10

PHYSIOLOGY

19

Physiology Lectures

S. No

.

Learning Objec�ves By the end of the session, students will be able to:



1 Introduc�on to respira�on

Outline the organiza�on

and general func�ons of

respiratory system (K)

Physiological anatomy of

respiratory system

Func�ons of respiratory system

Non-respiratory func�ons of

respiratory system

LGIS 1 hour

MCQs SEQs SAQs Viva

2 Pulmonary mechanics

Enlist the muscles

involved during quiet

and forceful respira�on.

(K)

Explain pressure and

volume changes in lungs

during pulmonary

ven�la�on. (K)

Muscles of inspira�on during

quiet respira�on and

forceful respira�on.

Muscles of expira�on during

quiet and forceful breathing.

Intrapulmonary, intrapleural and

transpulmonary pressures

Physiological basis of nega�vity

of intrapleural space

LGIS 1 hour

MCQs SEQs SAQs Viva

3 Compliance

Define compliance.

Explain the role of

elas�c force of lung

�ssue and surface

tension in affec�ng

compliance in healthy

state. (K)

List the chemical

composi�on of

surfactant and explain

its role in reducing

Compliance of lungs and

thoracic cage

Factors effec�ng lung

compliance

Elas�c forces of lung �ssue

Elas�c forces of surface tension

Alveolar interdependence

Role of surfactant

Respiratory distress syndrome

Work of breathing

LGIS 1 hour

MCQs SEQs SAQs Viva

20

surface tension. (K)

4 Lung volumes and capaci�es

Explain the pulmonary

volumes and capaci�es

and outline their

method of

measurement. (K)

Differen�ate between

anatomical and

physiologic dead space

with emphasis on

significance of each. (K)

Pulmonary volumes and

capaci�es

Alveolar ven�la�on

Alveolar, anatomic and

physiologic dead space

Helium-dilu�on method for

determina�on of func�onal

residual capacity, residual volume

and

Total lung capacity

Nitrogen meter method for

determina�on of dead space

LGIS 1 hour

MCQs SEQs SAQs Viva

5 Pulmonary circula�on

Compare pulmonary

and systemic

circula�ons. (K)

Illustrate zone 1, 2 and

3 of pulmonary blood

flow with the help of a

diagram. (K,S)

Features of pulmonary

circula�on

Comparison with systemic

circula�on

Blood flow through lungs and

its distribu�on

Effect of hydrosta�c pressure

gradients in lungs on regional

pulmonary blood flow

LGIS 1 hour

MCQs SEQs SAQs Viva

6 Pulmonary capillary dynamics

Explain the

interrela�onships

between inters��al

fluid pressure and other

Dynamics of fluid exchange

across the lung capillary

Pulmonary edema safety factor

Significance of nega�ve

pulmonary inters��al pressure

LGIS 1 hour

MCQs SEQs SAQs Viva

21

pressures of lung

Outline the

pathophysiology of

pulmonary edema. (K)

7. Principles of gases exchange

Explain the par�al

pressures of respiratory

gases as they enter and

leave the lungs (at sea

level). (K)

Physics of gases exchange

Vapor pressure of water

Comparison of par�al pressure

of respiratory gases in

atmosphere and alveoli

LGIS 1 hour

MCQs SEQs SAQs Viva

8 Respiratory membrane

Calculate the par�al

pressure of oxygen and

carbon dioxide in

atmosphere and body at

different level. (K)

Define diffusing capacity

and explain the factors

that effects rate of

gases diffusion across

respiratory

membrane.(K)

Physiological basis of different

par�al pressures in different

areas

Composi�on of alveolar and

atmospheric air

Alveolar gas equa�on

Structure and func�on of

respiratory membrane

LGIS 1 hour

MCQs SEQs SAQs Viva

9 Ven�la�on perfusion ra�o

VA/Q - I

Explain the physiological

basis of ven�la�on

perfusion ra�o and its

applica�on. (K)

Zones of lung.

Physiological basis of

ven�la�on and perfusion ra�o

Diagram of ven�la�on and

perfusion ra�o.

Effect of ven�la�on - perfusion

ra�o on alveolar gas

LGIS 1 hour

MCQs SEQs SAQs Viva

22

concentra�on.

10 Ven�la�on perfusion ra�o

VA/Q - II


basis of abnormali�es in

VA/Q ra�o. (K)

Concept of physiologic shunt

and physiologic dead space

Abnormali�es of ven�la�on-

perfusion ra�o

LGIS 1 hour

MCQs SEQs SAQs Viva

11 Oxygen transport – I

Discuss the various

modes of transport of

oxygen from

lungs/atmosphere to

�ssues (K)

Transport of oxygen from lungs

to �ssues via blood

Role of hemoglobin in oxygen

transport

LGIS 1 hour

MCQs SEQs SAQs Viva

12 Oxygen transport - II

Explain oxy hemoglobin

dissocia�on curve with

the help of diagram. (K)

(S)

Discuss its significance.

(K)

Transport of oxygen from lungs

to �ssues via blood

Oxy hemoglobin dissocia�on

curve

Factors causing right and le�

shi� of oxy hemoglobin

dissocia�on curve

Bohr’s effect

LGIS 1 hour

MCQs SEQs SAQs Viva

13 Transport of CO2 in blood and

�ssue fluids I

Discuss the various

modes of transport of

carbon dioxide from

�ssues to lungs and

atmosphere. (K)

Draw and explain CO2

Transport of carbon dioxide

from lungs to �ssues via blood

Diagram of CO2 dissocia�on

curve

LGIS 1 hour

MCQs SEQs SAQs Viva

23

dissocia�on curve for

arterial and venous

blood. (K,S)

14 Transport of CO2 in blood and

�ssue fluids II

Discuss haldene effect

and explain the

phenomenon of

Chloride shi�. (K)

Haldane’s effect

Chloride shi�

LGIS 1 hour

MCQs SEQs SAQs Viva

15 Nervous control of respira�on

� Enlist the components

of respiratory center

and discuss the role of

each in regula�on of

respira�on at rest and

during exercise.

Explain the significance

of Herring Breuer’s

infla�on reflex. (K)

Components and loca�on of

respiratory center

Medullary and pon�ne groups

of regulatory neurons

Genera�on of respiratory

rhythm

Role of ventral group of

respiratory neurons in forceful

breathing

Herring Breuer’s infla�on reflex

LGIS 1 hour

MCQs SEQs SAQs Viva

16 Chemical control of respira�on

Explain the role of

peripheral and central

chemoreceptors in

control of respira�on


basis of Cheyne Stokes

breathing (periodic

breathing) and sleep

apnea. (K)

• Loca�on of peripheral and

central chemoreceptor

• Effect of raised H+ ions in CSF

and raised pCO2 levels of

arterial blood on central

chemoreceptors

• Effect of decreased pO2, pH and

increased pCO2 on peripheral

chemoreceptors to regulate

respira�on.

LGIS 1 hour

MCQs SEQs SAQs

24

17 Respiratory insufficiency-

pathophysiology, diagnosis

and O2 therapy

Define and classify

hypoxia. (K)

Explain the

pathophysiology and

treatment of each type.

(k)

Describe the causes,

clinical features and

pathophysiology of

cyanosis, asphyxia,

hypocapnia and

hypercapnia (K)

Types of hypoxia

Causes, Pathophysiology and

treatment of different types

Pathophysiology of cyanosis

asphyxia hypocapnia and

hypercapnia

LGIS 1 hour

MCQs SEQs SAQs Viva

18 High al�tude physiology

Discuss the

physiological processes

employed for

acclima�za�on to low

PO2. (K)

Describe the

pathophysiology of

acute and chronic

mountain sickenss. (K)

Alveolar pO2 and satura�on of

hemoglobin with oxygen at

different al�tudes.

Effect of breathing pure oxygen

on alveolar pO2 at different

al�tudes

The acute effects of hypoxia.

Acclima�za�on to low PO2

parachute jumping

HAPE and HACE

LGIS 1 hour

MCQs SEQs SAQs Viva

19 Space physiology

Define centrifugal

acceleratory forces i.e

posi�ve and nega�ve G

and zero G. (K)

Measurement of G

Posi�ve and nega�ve loops

during avia�on

Ar�ficial climate in space cra�

LGIS 1 hour

MCQs SEQs SAQs Viva

25

Describe the effects of

posi�ve and nega�ve G

on the body along with

the management of

these effects. (K)

Weightlessness in space and its

effects on body systems

20 Deep sea physiology

Describe the

pathophysiology and

clinical features in

Nitrogen narcosis and

Decompression

sickness. (K)

Nitrogen narcosis

Decompression sickness

Hyperbaric oxygen therapy

SCUBA and submarine

physiology

LGIS 1 hour

MCQs SEQs SAQs Viva

26

Physiology Prac�cals

S. No.


Content Areas

Teaching Ac�vity (Dura�o

n)

Assessment

1 Demonstra�on of simple spirometry

Iden�fy different

components of the

spirometer and explain

their func�ons. (S)

Assemble different

components of the

spirometer and connect

it with a kymograph. (S)

Components of the spirometer

Func�ons of each component of

spirometer

Prac�cal 2 hours

Viva voce

OSPE

2 Recording of lung volumes and

capaci�es by spirometry

Demonstrate the

procedure of recording

the spirogram. (S)

Draw the scale of the

graph and interpret the

readings accordingly. (S)

Calculate the observed

VC, TV, ERV and IRV and

convert ATPS values to

BTPS values. (S)

Scale of the spirogram

Lung volumes and capaci�es

Interpreta�on of the readings

Calcula�on of the observed VC,

TV, ERV and IRV

ATPS and BTPS values Prac�cal 2 hours

Viva voce

OSPE

3 Recording of forced expiratory

volumes by spirometer

Demonstrate the


the forced spirogram.

Recording the forced spirogram.

Calcula�on of FEV1/FVC ra�o

Interpreta�on of the ra�o

Significance of recoding FEV1/FVC

ra�o in diagnosis of obstruc�ve

Prac�cal 2 hours

Viva voce

OSPE

27

(S)

Calculate FEV1/FVC

ra�o from the graph

and interpret their

results by comparing

with normal FEV1/FVC

ra�o. (S)

and restric�ve respiratory

diseases

4. Peak expiratory flow rate

(PEFR) with wright’s peak flow

meter and Stethography

Iden�fy and explain the

func�ons of different

components of Wright’s

peak flow meter and

demonstrate the


the PEFR.(S)

Iden�fy different

components of

stethograph and explain

their uses. (S)

Record normal and

modified respiratory

movements. (S)

Iden�fy and calculate

the breath holding �me

and breaking point from

obtained graph. (S)

Func�ons of different components

of Wright’s peak flow meter

Recording the PEFR with the help

of Wright’s peak flow meter

Condi�ons in which PEFR is

decreased

Breath holding �me and breaking

point

Prac�cal 2 hours

Viva voce

OSPE

5 Examina�on of respiratory

system

Examine the front and

Protocol while examining

respiratory system

Steps of examina�on of chest

Prac�cal 2 hours

Viva voce

OSPE

28

back of chest of a given

subject (S)

Organize the

examina�on in a

manner which is

comfortable for the

pa�ent.(A)

- Inspec�on

- Palpa�on

- Percussion

- Ausculta�on

29

Physiology SEMINARS

S NO

Learning Objec�ve By the end of the session, students will be able to:

Content Areas

Teaching Ac�vity

(Dura�on)

Assessment

1 Respiratory mechanics and

Compliance.

Describe the mechanics

of breathing and explain

lung compliance. (S)

Mechanism of inspira�on at

rest and exercise

Mechanism of Expira�on at

rest and exercise

Transpulmonary pressure

Factors affec�ng compliance

Role of surfactant



2 Lung volume and capaci�es

and V/Q ra�o

Explain different lung

volumes and capaci�es

and describe V/Q ra�o. (S)

Lung volumes, their values and significance

Lung capaci�es , their values and significance

V/Q ra�o in different lung zone and its significance

Physiological and anatomical dead space

Significance of V/Q ra�o



3 Oxygen and carbon dioxide transport

Explain the transport of

oxygen and carbon dioxide

from lungs to �ssues via

blood. (S)

Transport of oxygen from

lungs to �ssues via blood

Oxy-hemoglobin dissocia�on

curve

Transport of carbon dioxide

from lungs to �ssues via blood

Diagram of CO2 dissocia�on

curve

Bohr effect Haldane effect,

chloride shi�



30

4 Nervous and chemical control

of respira�on

Describe the nervous

and chemical control of

respira�on. (S)

Medullary and pon�ne groups

of regulatory neurons and

Genera�on of respiratory

rhythm

Role of ventral group of

respirator neurons in forceful

breathing

Herring Breuer’s infla�on

reflex

Role of central

chemoreceptor in control of

respira�on

Role of peripheral

chemoreceptor in control of

respira�on



5 High al�tude and deep sea

diving

Explain the

acclima�za�on at high

al�tude. (S)

Describe the

pathophysiology, sign

and symptoms of

decompression

sickness and nitrogen

narcosis. (S)

Acclima�za�on to low PO2

The acute effects of hypoxia

Nitrogen narcosis

Decompression sickness

HAPE and HACE



BIOCHEMISTRY

31

Biochemistry Lectures

S

NO



Content Areas

Teaching Ac�vity

(Dura�on)

Assessment

1. Introduc�on to vitamins

Define and classify vitamins Explain general aspects of all vitamins. (K)

• Defini�on and classifica�on of vitamins

• Bio-medical importance of vitamins

LGIS 1 hour

MCQs SEQs SAQs Viva

2. Vitamin A

Explain vitamin A in detail. (K)

• Sources of vitamin A • Daily requirement • Absorp�on • Chemical structure • Biochemical func�ons and visual

cycle • Effect of vitamin A deficiency • Hypervitaminosis A

LGIS 1 hour

MCQs SEQs SAQs Viva

3. Vitamin D Discuss role of vitamin D in the body. (K)

• Sources of vitamin D • Daily requirement • Absorp�on • Synthesisand ac�va�on of

vitamin D • Biochemical func�ons • Effect of vitamin D deficiency • Hypervitaminosis D

LGIS 1 hour

MCQs SEQs SAQs Viva

4 Vitamin E Discuss vitamin E and its role as

an�oxident. (K)

• Sources of vitamin E • Daily requirement • Absorp�on • Chemical structure and vitamin

E as an�oxidant • Biochemical func�ons • Effect of vitamin E deficiency • Hypervitaminosis E

LGIS 1 hour

MCQs SEQs SAQs Viva

5 Vitamin K and C Explain different features of

vitamin K and C. (K)

• Sources of vitamin K and C • Daily requirement • Absorp�on • Chemical structure of both

LGIS 1 hour

MCQs SEQs SAQs Viva

32

vitamins • Biochemical func�ons • Synthesis of vitamin K and role

of vitamin K in blood clo�ng • Effect of vitamin K and C

deficiency • Hyper vitaminos is of vitamin K.

6 Thiamine and riboflavin Outline characteris�cs of

thiamine and riboflavin in the body. (K)

• Sources of thiamine and riboflavin

• Daily requirement • Absorp�on • Chemical structure of both

vitamins • Biochemical func�ons of

riboflavin and thiamine • Thiamine deficiency in alcoholics • Effect of riboflavin and thiamine

deficiency • Hypervitaminosis of both

vitamins

LGIS 1 hour

MCQs SEQs SAQs Viva

7 Nico�nic acid and pantothenic acid

Explain role of nico�nic acid and

pantothenic acid in humans. (K)

• Sources of nico�nic acid and pantothenic acid


vitamins • Biochemical func�ons of

nico�nic acid and pantothenic acid

• Nico�nic acid role in DNA repair mechanism

• Effect of deficiency of nico�nic acid and pantothenic acid

• Hypervitaminosis of both vitamins

LGIS 1 hour

MCQs SEQs SAQs Viva

8 Pyridoxine and bio�n

Describe proper�es of pyridoxine

and bio�n. (K)

• Sources of pyridoxine and bio�n • Daily requirement • Absorp�on Chemical structure

of both vitamins • Biochemical func�ons • Pyridoxine role in mechanism of

ac�on of steroid hormone � Effect of deficiency of pyridoxine

LGIS 1 hour

MCQs SEQs SAQs Viva

33

and bio�n • Hypervitaminosis of both vitamins

9 Folic acid and cobalamin

Discuss role of folic acid and

cobalamin in the body. (K)

Explain role of vitamin as coenzymes and hemopoe�c vitamin.(K)

• Sources of folic acid and cobalamin


vitamins • Biochemical func�on of folic

acid and cobalamin • Folate trap hypothesis • Neural tube defect • Metabolite in urine in case of

vitamin B12 and folic acid • Effect of deficiency of folic

acid and cobalamin • Hypervitaminosis of both

vitamins

LGIS 1 hour

MCQs SEQs SAQs Viva

10 Nutri�on

Outline various aspects of nutri�on.(K)

Defini�on of nutri�on Bio-medical importance of

nutri�on Classes of nutrients Caloric value of food

LGIS 1 hour

MCQs SEQs SAQs Viva

11 Nutri�onal importance of nutrients

� Explain nutri�onal importance of each dietary nutrient.(K)

Nutri�onal importance of lipid carbohydrates protein vitamin minerals Water

LGIS 1 hour

MCQs SEQs SAQs Viva

12 Caloric requirement of body Describe various factors to

determine the daily caloric requirement of a person. (K)

Basal metabolic rate. (BMR ) Specific dynamic ac�on of

food (SDA) Effect of physical ac�vity

LGIS 1 hour

MCQs SEQs SAQs Viva

13 Balanced diet Discuss balanced diet in detail.

(K)

Defini�on of balanced diet Components of balanced diet

and it’s biomedical importance

Hazard of imbalanced diet

LGIS 1 hour

MCQs SEQs SAQs Viva

34

14 Protein energy malnutri�on Explain protein energy

malnutri�on. (K)

Protein energy malnutri�on Marasmus Kwashiorkor Marasmic-kwsahiorkor

LGIS 1 hour

MCQs SEQs SAQs Viva

15 Nutri�onal requirements Discuss nutri�onal requirements

in different phases of life.(K)

Nutri�onal requirement in Pregnancy

Lacta�on and new born Nutri�onal disorder

LGIS 1 hour

MCQs SEQs SAQs Viva

35

Biochemistry Prac�cals

S. NO

Learning Objec�ves By the end of this session students will be able to:

Content Areas

Teaching ac�vity

(Dura�on)

Assessment

1. Introducton to carbohydrate, Molisch’s test, Seliwanoff’s test

Define and classify carbohydrates. (K)

Perform Molisch’s, Seliwanoff’s and iodine tests. (S)

Detec�on of presence of carbohydrates in the given solu�on

Detec�on of presence of ketose sugar Ac�on of strong acids (Furfural Forma�on) Condensa�on of furfural with phenols to

form colored products Qualita�ve detec�on of polysaccharides Detec�on and dis�nc�on between starch,

dextrin, glycogen and cellulose Interpreta�on of results and biomedical

importance of test

Prac�cal 2 hours

Viva Voce

OSPE

2. Detec�on of reducing carbohydrates Perform Fehling’s, Benedict’s and

Barfoed’s tests. (S)

Qualita�ve detec�on of reducing carbohydrates

Qualita�ve and semi quan�ta�ve detec�on of reducing carbohydrates

Reduc�on of cupric hydroxide to cuprous oxide

Detec�on of reducing monosaccharides and disaccharides

Interpreta�on of results and biomedical importance of test

Prac�cal 2 hours

Viva Voce

OSPE

3. Ac�on of phenylhydrazine: Osazone forma�on. Perform osazone test. (S) Handle the microscope carefully.

(A) Urine analysis Perform bio-chemical examina�on of inorganic cons�tuent of urine. (S)

Qualita�ve detec�on of reducing carbohydrates

Reac�ons of reducing sugars with phenylhydrazine to form osazone crystals

Iden�fica�on and characteriza�on of

different sugars having closely similar

proper�es (like maltose and lactose).

Detec�on and dis�nc�on between monosaccharides (glucose, fructose, mannose), maltose, lactose and galactose


Chemical proper�es of urine Bio-chemical examina�on of inorganic

cons�tuents Chlorides Calcium Phosphates

Prac�cal 2 hours

Viva Voce

OSPE

4. Hydrolysis of sucrose Perform hydrolysis of sucrose. (S) Handle the apparatus carefully.

(A) Tonicity

• demonstrate the effect of

solu�ons of different tonicity on

RBCs. (S)

Understanding structure of sucrose Understanding of hydrolysis of sucrose in

given solu�on Hydrolysis of sucrose in the presence of

concentrated HCL into its reducing monosaccharide cons�tuents, glucose and fructose.

Glucose and fructose give posi�ve results for tests of reducing sugars (Benedict’s and Fehling’s)

Also give posi�ve results for other tests such as the Osazone and Selivanoff‟s test

Prac�cal 2 hours

Viva Voce

OSPE

36

for monosaccharides Interpreta�on of results and biomedical

importance of test Effect of solu�ons of different tonicity on

RBCs osmo�c pressure Clinically used isotonic, hypotonic and

hypertonic solu�on explain osmo�c pressure (K)

enlist clinically used isotonic, hypotonic and hypertonic solu�on (K)

5. Hydrolysis of starch Perform hydrolysis of starch. (S) Beware of personal and lab

safety. (A)

Understanding structure of starch Understanding of hydrolysis of starch in

given solu�on Hydrolysis of starch in the presence of

concentrated HCL into glucose Glucose gives posi�ve results for tests of

reducing sugars (Benedict’s and Fehling’s) Also gives posi�ve results for other tests

such as the Osazone and Selivanoff‟s test for monosaccharides


Prac�cal 2 hours

Viva Voce OSPE

37

Biochemistry Seminars

S NO

Learning Objec�ves By the end of the session, students

will be able to describe: Content Areas

Teaching Ac�vity


1. Defini�on and classifica�on of vitamins. Fat soluble vitamins

Define and classify vitamins. Explain fat soluble vitamins.

(S)

Defini�on and classifica�on of vitamins

Sources of vitamin A,D,E,K Daily requirement Absorp�on Chemical structure Biochemical func�ons Effect of vitamins deficiency Hypervitaminosis Visual cycle, Synthesis and

ac�va�on of vitamin D, vitamin E as an�oxidant Synthesis of vitamin K and role of vitamin K in blood clo�ng


7 minutes


2. Thiamine, riboflavin, niacin and vitamin C

Outline characteris�cs of thiamine, riboflavin, niacin and vitamin C in the body.

(S)

• Sources of thiamine , riboflavin, nico�nic acid and vitamin C

• Daily requirement • Absorp�on • Chemical structure of all vitamins • Biochemical func�ons • Thiamine deficiency in alcoholics • Effect of deficiency • Hypervitaminosis • Nico�nic acid role in DNA repair

mechanism


7 minutes


3. Folic acid ,vitamin B12 ,pantothenic acid ,bio�n and pyridoxine

Outline characteris�cs of Folic acid, vitamin B12, pantothenic acid, bio�n and

pyridoxine in the body. (S)

• Sources of folic acid ,vitamin B12, pantothenic acid ,bio�n and pyridoxine

• Daily requirement • Absorp�on • Chemical structure of all vitamins • Biochemical func�ons • Effect of deficiency • Hypervitaminosis • Pyridoxine role in mechanism of

ac�on of steroid hormone • Folate trap hypothesis • Neural tube defect • Metabolite in urine in case of

vitamin B12 and folic acid


7 minutes


4.

Nutri�on Outline various aspects of

nutri�on. (S)

Defini�on of nutri�on Bio-medical importance of nutri�on Classes of nutrients Caloric value of food Defini�on of respiratory quo�ent Methods to determine respiratory

quo�ent


7 minutes


38

Various factor affec�ng respiratory quo�ent

Specific dynamic ac�on of food Nutri�onal importance of fat

soluble and water soluble vitamin Calcula�on of caloric requirement

of a medical student

5. Balanced diet Define and explain balanced

diet. Outline hazard of

imbalanced diet. (S)

Defini�on Role of water, protein,

carbohydrate, fat and fiber Bio-medical importance of balanced

diet Hazard of imbalanced diet Protein energy malnutri�on

including kwashiorkor and marasmus


7 minutes


39

PROBLEM BASED LEARNING (PBL)

2 PBLs will be introduced in this module.

Each will be introduced in one week and will be discussed in the next one taking four weeks

in total

Learning Tool Theme PBL trigger Subjects integrated in PBL

PBL 1

Difficulty in breathing

A known asthma�c pa�ent comes with shortness of breath

and fracture and

Learning objec�ves will be from Anatomy,

Physiology, Biochemistry, Medicine and Community

Medicine

PBL 2

Diving dilemma

A�er a deep sea dive the pa�ent comes with

severe pain in joints and dyspnea

Learning objec�ves will be from Anatomy,

Physiology, Biochemistry and Pathology

Learning Resources:

The students will be guided to look for the relevant study material from the books guided by each

discipline in this study guide in their relevant sec�on in addi�on to the other reference books

from the college library.

VERTICALINTEGRATION

40

MEDICINE LECTURES

S No


Content Areas

Teaching Ac�vity (Dura�on)

Assessment

1 Asthma

Iden�fy clinical

features and list

inves�ga�ons of

asthma. (K)

Defini�on of asthma

Clinical features of asthma

Inves�ga�on of asthma

LGIS 1 hour

MCQs/SEQs /SAQs

2 Pneumonia

Iden�fy clinical

features and

enumerate

inves�ga�ons of

pneumonia. (K)

Defini�on of pneumonia

Classifica�on and Clinical

features of pneumonia

Inves�ga�on in diagnosing

pneumonia

LGIS 1 hour

MCQs/SEQs /SAQs

41

PHARMACOLOGY LECTURE





1. Introduc�on to drugs used to

manage bronchial asthma:

Iden�fy different groups of

drugs used in the

treatment of bronchial

asthma. (K)

Outline the role of various

groups of drugs used in

bronchial asthma. (K)

List the steps in the

treatment and prophylaxis

of acute severe asthma. (K)

Major group of drugs used

in bronchial asthma

Pharmacokine�cs,

mechanism of ac�on,

pharmacological ac�ons,

therapeu�c uses and

adverse effects

Management of acute

severe asthma

Prophylaxis of bronchial

asthma

LGIS 1 hour

MCQs/ SEQS/SAQS

42

SURGERY LECTURES

S#


Content Areas

Teaching Ac�vity

(Dura�on)

Assessment

1. 2.

Tumors of lung and pleura Iden�fy various tumors

of lung, pleura and

chest cage. (K)

Injuries of lungs and

pleura

Iden�fy various lung,

pleura and chest wall

injuries. (K)

Tumors of lungs

Tumors of pleura

Tumors of ribs

Injuries of lungs

Injuries of pleura

Fracture of ribs and

thoracic cage

LGIS 1 hour

LGIS 1 hour

MCQS/ SEQS/SAQS

MCQS/ SEQS/SAQS

43

COMMUNITY MEDICINE LECTURES





1 Iden�fy the epidemiologic determinants of acute respiratory infec�ons. (K)

Discuss the preven�ve measures of acute respiratory infec�ons. (K)

Causes of respiratory diseases

WHO model of acute respiratory infec�ons

Preven�ve measures

(LGIS)

1 hour

MCQs/

SEQ/SAQS

2 Describe the epidemiology and preven�ve measures of influenza and its subtypes. (K)

Basic defini�ons Dynamics of disease

transmission Epidemiologic triad preven�ve measures of

influenza and its subtypes

LGIS

1 hour

MCQs/

SEQ/SAQS

3. Explain the epidemiology and prevention of meningococcal meningi�s. (K)

Epidemiological determinants

Mode of transmission of meningococcal meningi�s

Preven�on and control

(LGIS)

1 hour

MCQs/

SEQ/SAQS

4 Enlist the hazards of smoking. (K)

Discuss the preven�ve measures of smoking. (K)

Causes of smoking Chemical composi�on of

cigare�e Health Hazards of

smoking Preven�on

(LGIS)

1 hour

MCQs/

SEQ/SAQS

44

PATHOLOGY LECTURE





1. Give an overview of respiratory tract infec�ons. (K)

Upper respiratory tract infec�ons (Phyrangi�s, laryngi�s)

Lower respiratory tract infec�ons (pneumonia, tuberculosis)

LGIS 1 hour

MCQs/SAQS SEQs

45

GENERAL PEDRIATICS LECTURE





1. Describe the

pathophysiology of

respiratory distress

syndrome. (K)

Enlist the risk factors and

causes for RDS, ARI and

pneumonia. (K)

Enlist the clinical sign and

symptoms (K)

Interpret lab inves�ga�ons

and radiological findings of

these diseases.(K)

Causes,

pathophysiology

predisposing factors,

clinical presenta�on

and lab inves�ga�on

Radiological findings

LGIS 1 hour

MCQs SEQs/SAQs

46

RADIOLOGY LECTURE

S #




1. Iden�fy normal anatomical structures of respiratory system on an X-ray Chest. (K)

Trachea Carina Hilar structures Lymph nodes

(Paratracheal, carinal, hilar)

Major bronchi Difference in

angula�on of right and le� main bronchi

Fissures (Horizontal. Oblique. Azygos)

Pleural layers Lung vasculature End-on blood

vessels, end -on bronchi.

Rela�onship between arteries and air channels.

Normal shape and levels of domes of diaphragm.

Lung bases. Costo-phrenic angles Lung compliance

LGIS 1 hour

MCQs SEQs

TIMETABLE

47

48

49

50

51

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