Respiratory

Total Contact Hours:

44 hours

Course Director:

Michel J. Markus, M.D., Assistant Professor of Internal Medicine

Course Description:

Part of the triad of cardiovascular and renal systems courses, the respiratory course focuses on acute and chronic diseases of the respiratory system and how they interface with the other two organ systems. Building upon the physiologic principles of breathing and gas exchange, the course introduces disease states, diagnostic procedures, and therapeutic approaches.

Course Objectives & Integration with the Educational Objectives:

By the conclusion of this course, the student will demonstrate the ability to:

K1 Describe and compare pathophysiologic basis, clinical presentation, treatment, and diagnostic criteria for the respiratory system, including:

• Etiology (if known) and pathogenesis
• Genetic phenotypes (if known), lifestyle influences, and mechanisms
• Characteristic clinical features
• Anatomic distribution of pathologic changes
• Typical gross and histopathologic features
• Natural history and prognosis

K2 Take appropriate action given the following conditions:

• Influenza: In a patient with fever, cough and myalgias in the appropriate seasonal setting, recognize influenza, its treatment sequelae, and preventative measures, as well as age-specific implications
• Pneumonia: Given a patient with cough, fever, dyspnea, and constitutional symptoms, base a treatment plan and prognosis on the likely bacterial, viral, or fungal cause. Support diagnosis with radiologic and laboratory findings.
• Fungal infections (nocardia/ actinomyces): Given a patient with chronic cough and specific environmental exposures or immunologic predisposition, take appropriate diagnostic steps to uncover chronic fungal infections
• In a patient with recent or recurrent pneumonia and persistent fever, cough, or radiologic abnormalities, recognize and suggest treatment for the common complications of pneumonia (bronchiectasis, abscess, empyema)
• Cancers of the lung, head, and neck: Presented with dyspnea, weight loss, abnormal weakness, or neurologic symptoms coupled with abnormal mass, adenopathy, percussion, or lung sounds, differentiate between neoplastic tumors and other disease. Recognize the unique risks, including smoking and environmental factors, in the various types of tumor, as well as paraneoplastic syndromes and staging.
• COPD: Given a patient with productive cough, wheezing, dyspnea, and abnormal spirometry, recognize COPD, differentiate between its acquired and genetic enzyme deficiency-based forms, and understand its prognosis and appropriate treatment
• Asthma: In a patient with wheezing, dyspnea, cough, and abnormal spirometry, recognize asthma, differentiate between it and other causes of wheezing, and understand its prognosis and appropriate treatment
• Tuberculosis: In a patient with a positive PPD test, abnormal sputum findings, suggestive radiologic findings, or high risk because of immunosuppression or environmental exposure, suggest appropriate management. This includes interpretation of the PPD test based on size, occupation, immune status, and likely exposure risk. Apply proper drug regimen for exposure and active disease considering immune status and comorbidities
• Interstitial lung diseases: Presented with a patient giving a history of progressive dyspnea, abnormal radiologic findings, and restrictive deficit on spirometry, identify the causative environmental, genetic, and /or disease exposures and understand their prognosis and appropriate treatment
• Acute and chronic lung injury: Given a patient with dyspnea, hypoxemia, and possible toxic, infectious, or traumatic exposure, recognize classic patterns of presentation for ARDS, chlorine gas, or smoke inhalation. Appreciate clinical and pathologic changes in the early and later stages of illness, as well as differences in therapeutic approach
• Pulmonary vascular disorders: Given a patient with leg swelling, immobility, and acute or chronic dyspnea, differentiate between pulmonary edema, pulmonary hypertension, pleural effusion, and pulmonary embolism, and understand their prognosis and appropriate treatment. Thoroughly understand the risk factors (environmental, genetic, and disease- or injury-related) for deep venous thrombosis, along with appropriate prophylactic measures
• URI and other infectious diseases of the respiratory tract: In a patient with sore throat, otalgia, rhinitis, and/or cough, differentiate between common benign conditions and serious illnesses. and understand their prognosis, causative agent(s), and appropriate therapies
• Childhood and developmental disorders: Presented with an infant in respiratory distress, recognize classic signs and symptoms of Infant Respiratory Distress Syndrome, SIDS, and Bronchopulmonary Dysplasia. Apply appropriate therapies and understand risk factors or genetic predisposition.
• Cystic Fibrosis: In a pediatric patient with cough, recurrent pulmonary infection, dyspnea, and failure to thrive, formulate appropriate management plans based on likely infectious agents, and recognize the genetic basis and molecular changes in this disease. Understand the mechanism and significance of the sweat chloride test, and appreciate family and lifestyle impact issues, as well as community support systems

K3 Describe the normal structure and function of the lung, pleura, nasopharynx, and sinuses, including their embryology and development, with particular attention to alveolar structure and surfactant formation

K4 Identify how normal and diseased lungs are affected by physiologic changes in the following categories:

• Mechanics of breathing
• Lung volumes and capacities
• Neural control of breathing
• Gas exchange and transport
• Ventilation/perfusion relationships
• Trauma and mechanical disorders
• Systemic disorders affecting the respiratory tract
• Cell/tissue repair and life stage changes
• Pulmonary defense mechanisms and normal flora
• Effects of altitude on respiration
• Respiratory failure
• Right heart failure

K5 Apply diagnostic tools to support a diagnosis, including:

• Spirometry
• Radiologic imaging
• Arterial blood gas measurement

K6 Recognize the appropriate usage, including indications and contraindication, of non-pharmacologic therapeutic modalities. including:

• Oxygen therapy
• Nasal CPCP
• Mechanical ventilation
• Physical therapy
• Surgery
• Hyperbaric oxygen therapy

K7 Understand the mechanisms of action, common side effects, potentially catastrophic side effects, indications, and contraindications for the following classes of medication:

• Anticholinergics
• Specific anti-inflammatory agents
• Beta-2 agonists
• Sympathomimetics
• Steroids
• Specific chemotherapy agents
• Specific antibiotics
• Xanthine derivatives
• Cough Suppressants
• Mucolytics
• Drugs with known adverse effects on the respiratory system

C1 Work effectively in teams, through the team-based learning and case-based learning modules, as well as pathology labs

C2 Write, present, and interpret a clinical scenario in respiratory tract illness, including the following:

• General appearance and activity
• Levels of consciousness
• Speech characteristics
• Vital signs
• Use of accessory muscles
• Breathing pattern
• State of tissue oxygenation
• Clinical signs of hypoxia
• Normal and abnormal lung sounds

P1 Convey professionalism by:

• Being punctual and attending required events
• Completing assignments in a timely fashion
• Being truthful
• Being courteous to patients, patients' families, staff, colleagues, and other health professionals
• Maintaining confidentiality regarding patient care
• Demonstrating respect, empathy, responsiveness, and concern regardless of the patient's problems, personal characteristics, or cultural background
• Demonstrating scholarship in the form of contributing to a positive learning environment, collaborating with colleagues, and performing self-assessment and self-directed learning
• Facilitating coping strategies for the patient with special emotional/behavioral needs (e.g., smoking, substance abuse, pets/allergies)
• Providing support and appropriate referral to community systems and assets for the influence of respiratory disease on the patient, family, and society (e.g., TB asthma, COPD, school issues, protective parents, family smoking)
• Eliciting and taking steps to mitigate occupational/environmental risk factors
• Being aware of gender/ethnic factors in the development of and susceptibility to respiratory disease (e.g., sarcoidosis, CA lung)

Learning Activities:

Presentations, Team-Based Learning, SIM center exercise.

Assessment:

One MCQ exam.