Verily, along with every Al-Quran: 94; 5 STUDY...

STUDY GUIDE

& D l ea nci tade l CM oa llr es gu eY

Al-Quran: 94; 5

Verily, along with everyhardship is relief

YUSRA MEDICAL &

DENTAL COLLEGE, ISLAMABAD

st1 Year MBBS

2018

Respiratory Module

Al-Quran: 94; 5


STUDY GUIDE Respiratory Module

YUSRA MEDICAL & DENTAL COLLEGE, ISLAMABAD


Index

S.No Topic Page

1 Team members 1

2 Introduc�on 2

3 Curriculum framework 3

4 Main content areas 4

5 General learning objec�ves 5

6 Teaching / learning methods 6

7 Student assessment 7

8 Recommended reading material 9

9 Organiza�on of module 11

10 Anatomy 12

11 Physiology 18

12 Biochemistry 26

13 Ver�cal integra�on 36

14 Timetable 42


1

Team Members

Name Commi�ee Department

Dr. Idrees Farooq Bu�

Professor Chief Coordinator Physiology

Dr. Aysha Baber

Associate Professor Coordinator Physiology

Dr. Arslan Mughal

Assistant Professor Member Anatomy

Dr. Shabbir Rana

Professor Member Surgery

Dr. Shahid Aziz

Professor Member Pediatrics

Dr. Muhammad Luqman

Professor Member Medical Educa�on

Dr. Hamid Akram

Professor Member Radiology

Dr. Farah Rashid

Professor Member Community Medicine

Dr. Shumaila Najeeb Piracha

Associate Professor Member Pathology

Dr. Romana

Assistant Professor Member Biochemistry

Dr. Fa�ma Qasim Malik

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 4 weeks. The respiratory module has been designed to facilitate the learning of normal

structure and func�on, in context with 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 upper 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 discuss 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

SHAHEED ZULFIQAR ALI BHUTTO MEDICAL UNIVERSITY

CURRICULUM FRAMEWORK: MBBS 1-5 YEARS

Block I Block II Block III

Block IV Block V Block VI

Module 1 Module 2 Module 3 Module 4 Module 5 Module 6

Module 7 Module 8 Module 9 Module 10 Module 11 Module 12

Sen

d u

p &

Fin

al E

xam

s

Ex

am B

lock

I

Ex

am B

lock

IV

Ex

am B

lock

V

Ex

am B

lock

II

Ex

am B

lock

III

E

xam

Blo

ck V

I

Foundation6 Weeks

Renal6 Weeks

Reproductive6 Weeks

Neuroscience8 Weeks

SpecialSenses

6 Weeks

1

3

4

5

MusculoskeletalI

6 Weeks

Cardiovascular7 Weeks

Respiratory5 Weeks

Gastrointestinal6 Weeks

2Endocrine4 Weeks

MusculoskeletalII

6 Weeks

Hematology&

Immunology6 Weeks



4

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


5

General Learning Objectives:

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 effect s of various vitamins.

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

i. Integrated seminars on different topics, in which student give oral presenta�ons on

different aspects of the allocated topics.


7

1. During the 1st academic year of MBBS, there will be 3 end-of-block exams. The results of

these block exams will carry 30% weightage as the internal assessment for the final

professional examinations of the 1st MBBS year.

2. End-of-block-exams

Each end-of-block exams will have following pattern:

a) There will be two theory papers, one for Module I, and II for each block.

b) These integrated theory papers will have components of following subjects:

i. Three horizontally integrated subjects i.e. anatomy, physiology and

biochemistry

ii. Questions from other vertically integrated specialties.

c) The pattern of integrated theory papers will be as following:

i. 60 MCQs – 1 mark each (Most of the MCQs will be one best type,

scenario – based)

ii. 10 SEQs – 4 marks each (Most of SEQs will be scenario – based)

d) The pattern of the OSPE will be as following:

i. 10 OSPE stations based on contents of Module – I 10 marks each

ii. 10 OSPE stations based on contents of Module – II 10 marks each

END OF BLOCK EXAMINATIONS

Shaheed Zulfiqar Ali Bhutto Medical University Internal Assessment Framework: MBBS 1st year


8

Summary of marks for each end-of-block exam

Two Theory Papers: MCQs: 60 (1X60) = 60 Marks SEQs: 10 (4X10) = 40 Marks ____________________________

100 X 2 = 200 Marks ____________________________

OSPE:

- 10 stations of module I: 10X10 = 100 Marks - 10 stations of module II: 10X10 = 100 Marks ____________________________________________

20X10 = 200 Marks _____________________________________________

· Internal assessment will be carried out by the respective colleges.

· The end of the year, 1st professional university exams (Part I and II) will

carry 70 percent weightage.

· The end of the block exams and continuous assessment will carry 30

percent weightage.

· It is the prerogative of the colleges to include whatever they want in the

continuous assessment; class tests, attitude, conduct etc.

Mandatory Criteria

· All those students securing less than 50 percent marks and who are absent

from the test due to any reason in their block examination will appear in the

resit exam.

· Student will appear only in the component failed (theory or OSPE).

· Maximum marks awarded to the passing students will not be more than 50

%.

· Time of the resit examination will be at the end of the academic year.

INTERNAL ASSESSMENT

RESIT POLICY


9

Recommended Reading Material

LEARNING RESOURCES

Gross Anatomy

Recommended Books

i. Cunningham’s Manual of Practical Anatomy vol. I- 15th edition, 1986.

ii. Clinical Anatomy by Regions. Richard S. Snell, 9th edition, 2012.

iii. Netter Atlas of Human Anatomy, 5th edition 2011.

Reference Books

i. Clinically Oriented Anatomy. Keith L Moore, 6th edition, 2010.

ii. Gray’s Anatomy, 40th edition, 2008.

General Anatomy

Recommended Books

i. Cunningham’s Manual of Practical Anatomy vol. I- 15th edition, 1986.

ii. Clinical Anatomy by Regions. Richard S. Snell, 9th edition, 2012.

Reference Books

i. General Anatomy.Dr. Laiq Hussain, 3rd edition, 2011.

ii. Understanding General Anatomy. Professor Tassaduq Hussain, 14th edition, 2014.

Embryology

Recommended Book

i. Langman’s Medical Embryology. 12th edition, 2012.

Reference Books

i. The Developing Human: Clinically Oriented Embryology, 10th edition. 2015.

Histology

Recommended Book

i. Basic Histology.Junqueira, 13th edition, 2013.

ii. DiFiore’s Atlas of Histology. 12th edition, 2013.

Reference Books

i. Medical Histology. Dr. Laiq Hussain, 5th edition, 2015.


10

Physiology

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

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

iii. Lab Manual Physiology, part 1 st, 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.

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, Basic and Clinical Pharmacology. 13th edi�on, chapter 35

ii. Bertram G. Katzung, Basic and Clinical Pharmacology.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.


11

Organization

Horizontal Integra�on

Basic Medical Sciences Time distribu�on

· Anatomy 39 Hours

· Physiology 39 Hours

· Biochemistry 32 Hours

· PBL 4 Hours

· Integrated seminar 1 Hour

Ver�cal Integra�on

· Pathology 1 Hour

· Pharmacology 1 Hour

· Medicine 2 Hours

· Surgery 2 Hours

· Pediatrics 1 Hour

· Radiology 1 Hour

· Community Medicine 4 Hours

Longitudinal Integra�on

· Islamiat and Pak studies 5 Hours

__________________________________________

Total = 132 Hours

__________________________________________

Anatomy


12

Embryology Lectures

S. NO

Learning Objectives By the end of the session, students

will be able to Content Areas

Teaching Activity

(Duration) Assessment

1. Development of respiratory system

· Describe the development of

respiratory system. (K)

· Formation of respiratory diverticulum

from foregut

· Formation of tracheoesophageal septum

· Development of larynx and trachea

· Formation of bronchi, bronchioles,

alveolar ducts and sacs

· Different phases of maturation of lungs

and factors responsible for maturation

of lungs

· Formation of blood-air barrier

LGIS 1 hour

MCQs SEQs

2. Congenital anomalies of respiratory

System

· Describe the developmental

anomalies of respiratory system.

(K)

· Esophageal artesia and

tracheoesophageal fistulas, respiratory

distress syndrome

LGIS

1 hour

MCQs SEQs


13

HISTOLOGY LECTURES

S. NO



Teaching Activity


1. Histology of Upper respiratory tract

· Differentiate between conducting

and respiratory portions of

respiratory system and microscopic

structure of larynx. (K)

· Respiratory epithelium

· Role of nasal cavity in conditioning of air

and conducting it to lungs

· Olfactory epithelium and its microscopic

details

· Microscopic structure of larynx

LGIS 1 hour

MCQs SEQs

2. Histology of upper respiratory tract

· Describe the microscopic structure

of trachea. (K)

· Microscopic structure of trachea

· Components of blood-air barrier

· Role of surfactant in prevention of

respiratory distress syndrome

LGIS 1 hour

MCQs SEQs

3 Histology of lower respiratory tract

· Describe the microscopic structure

of bronchi and differentiate primary,

secondary and tertiary bronchi. (K)

· Microscopic structure of bronchial tree

· Differences between terminal and

respiratory bronchioles

LGIS 1 hour

MCQs SEQs

HISTOLOGY PRATICALS

S. NO



Teaching Activity


1. Microscopic study of trachea

· Identify and draw microscopic

structure of trachea. (S)

· Slide of trachea

Demonstration 2 hours

OSPE

2.. Microscopic study of trachea and

lungs

· Identify and draw microscopic

structure of lungs. (S)

· Slide of lungs

Demonstration

2 hours OSPE


14

ANATOMY PRATICALS

S. NO



Teaching Activity


1 Thoracic wall and cavity

· Identify the structure of thoracic

wall and relations of thoracic

viscera. (S)

· Muscles, fascia, bones and

thoracic wall

· Muscles which attach limb to

the trunk

· Bone cage of thorax

· Relations of heart , lung and

mediastinum, nerves and

vessels

· Mediastinum and its

subdivisions

Practical 2 hours

OSPE

2

Thoracic vertebra

· Identify parts of a typical vertebra

and differentiate different thoracic

vertebrae. (S)

· Parts and shape of thoracic

vertebrae

· Inter-vertebral foramina and

emergence of spinal nerves

Practical 2 hours

OSPE

3 Ribs and sternum

· Identify parts of a typical rib and

differentiate typical from atypical

ribs. (S)

· Demonstrate different parts of

sternum and its muscle

attachments. (S)

· Demonstrate articulations of ribs

and sternum. (S)

· Typical and atypical ribs

· True, false and floating ribs

· Articulations of ribs

· Articulations of sternum

· Parts of sternum

· Muscle attachments of sternum

· Ossification of sternum

Practical 2 hours

OSPE

4. Intercostal spaces

· Identify thoracic outlet, intercostal

space and demonstrate intercostal

muscles, their actions and

arrangement of intercostal vessels

and nerves in intercostal space. (S)

· Attachments, direction and

parts of intercostal muscles.

· Course of intercostal nerves

and vessels (neurovascular

plane)

· Distribution of intercostal nerves

and vessels.

· Anastomosis between

intercostal arteries and veins.

Practical 2 hours

OSPE

5. Pleura, endothoracic fascia,

mediastinum

· Identify pleura and its reflections,

pleural cavity and mediastinum. (S)

· Pleura, pulmonary ligaments.

· Parietal pleura, visceral pleura

and their nerve supply.

· Anterior and posterior

intercostal arteries.

· Costo-cervical trunk.

Practical 2 hours

OSPE


15

· Typical and atypical Intercostal

nerves.

· Endo thoracic fascia and its

modifications

6 Lungs and bronchopulmonary

segments

· Demonstrate fissures and lobes of

lungs, arrangement of bronchi and

vessels in the hilium of lungs and

differentiate right and left lungs. (S)

· Identify broncho-pulmonary

segments and demonstrate their

clinical significance. (S)

· Location of bronchopulmonary

segments in each lung

· Shape, neurovasculature of

segments

· Clinical significance of

bronchopulmonary segments

Practical 2 hours

OSPE

7. Diaphragm

· Identify attachments, different

parts of diaphragm and

demonstrate nerve supply, blood

supply and role of diaphragm in

inspiration and expiration. (S)

· Concept of origin and insertion of

diaphragm

· Vertebral levels of domes of

diaphragm in respiration

· Course and distribution of phrenic

nerves and their lesions

· Diaphragmatic pleura and

peritoneum

· Structures passing through

diaphragm

Practical 2 hours

OSPE

8. Respiratory movements

· Demonstrate different diameters of

thorax and how these diameters

change during quiet and forced

inspiration and expiration. (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 costovertebral joints

Practical 2 hours

OSPE

9. Surface anatomy and adiology

· Demonstrate the different visceral

locations in relation to body points

and intercostal spaces. (S)

· Interpret a normal chest x-ray. (S)

· Identify intercoastal spaces bone

points

· Surface marking of heart, lungs,

vessels and nerves

Practical 2 hours

OSPE


16

ANATOMY SEMINARS

S. NO

Topics Content Areas Teaching Activity


1. Body cavities · Formation of intraembryonic

cavities

· Division of thoracic cavity into

pleural and pericardial cavities

· Appearance of lung buds

· Serous membranes (pleural,

pericardial and peritoneal

membranes)

· Body wall defects and clinical

correlates

Student Presentation

7 minutes

Marking / Evaluation Marks 10

2. Development of respiratory system · Formation of respiratory diverticulum

from foregut

· Formation of tracheoesophageal

septum

· Development of larynx and trachea

· Formation of bronchi, bronchioles,

alveolar ducts and sacs

· Different phases of maturation of

lungs and factors responsible for

maturation of lungs

· Formation of blood-air barrier

· Esophageal artesia and

tracheoesophageal fistulas,

respiratory distress syndrome


7 minutes


3. Trachea, bronchial tree and lungs · Microscopic structure of trachea,

bronchial tree & lungs

· Differences between terminal and

respiratory bronchioles

· Components of blood-air barrier

· Role of surfactant


7 minutes


4. Intercostal spaces, pleura,

endothoracic fascia, mediastinum

· Attachments, direction and parts of

intercostal muscles.

· Course of intercostal nerves and

vessels (neurovascular plane)

· Distribution of intercostal nerves and

vessels.


7 minutes



17

· 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

modifications

Physiology


18

Physiology Lectures

S. NO



Teaching Activity


1 Introduction to respiration

· Outline the organization and

general functions of respiratory

system. (K)

· Physiological anatomy of

respiratory system

· Functions of respiratory system

· Non-respiratory functions of

respiratory system

LGIS 1 hour

MCQs SEQs

2 Pulmonary mechanics

· Explain pressure and volume

changes in lungs during quiet

respiration and forceful

respiration. (K)

· Muscles of inspiration during

quiet respiration and forceful

respiration.

· Muscles of expiration during

quiet and forceful breathing.

· Intrapulmonary, intrapleural and

transpulmonary pressures

· Physiological basis of negativity

of intrapleural space

LGIS 1 hour

MCQs SEQs

3 Compliance

· Define compliance and

explain factors affecting

compliance in healthy state.

(K)

· Compliance of lungs and thoracic

cage

· Factors effecting lung

compliance

· Elastic forces of lung tissue

· Elastic forces of surface tension

· Alveolar interdependence


· Chemical composition of

surfactant

· Respiratory distress syndrome

· Work of breathing

LGIS 1 hour

MCQs SEQs

4 Lung volumes and capacities

· Explain the pulmonary

volumes and capacities and

outline their methods of

measurement and

significance. (K)

· Pulmonary volumes and

capacities

· Alveolar ventilation

· Alveolar, anatomic and

physiologic dead spaces

· Helium-dilution method for

determination of functional

residual capacity, residual volume

and total lung capacity

· Nitrogen meter method for

determination of dead space

LGIS 1 hour

MCQs SEQs


19

5 Pulmonary circulation

· Describe zone 1, 2 and 3 of

pulmonary blood flow with the

help of a diagram. (K)

· Features of pulmonary

circulation

· Comparison with systemic

circulation

· Blood flow through lungs and its

distribution

· Effect of hydrostatic pressure

gradients in lungs on regional

pulmonary blood flow

LGIS 1 hour

MCQs SEQs

6 Pulmonary capillary dynamics

· Explain the interrelationships

between interstitial fluid

pressure and other pressures

of lung. (K)

· Dynamics of fluid exchange

across the lung capillary

· Pulmonary edema safety factor

· Significance of negative

pulmonary interstitial pressure

· Pathophysiology of pulmonary

edema.

LGIS 1 hour

MCQs SEQs

7. Principles of gases exchange

· Explain the partial 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 partial pressure

of respiratory gases in

atmosphere and alveoli

LGIS 1 hour

MCQs SEQs

8 Respiratory membrane

· Calculate the partial 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

partial pressures in different

areas

· Composition of alveolar and

atmospheric air

· Alveolar gas equation

· Structure and function of

respiratory membrane

LGIS 1 hour

MCQs SEQs

9 Ventilation perfusion ratio VA/Q - I

· Explain the physiological

basis of ventilation perfusion

ratio and its application. (K)

· Zones of lung

· Physiological basis of

ventilation and perfusion ratio

· Diagram of ventilation and

perfusion ratio.

· Effect of ventilation - perfusion

ratio on alveolar gas

concentration

LGIS 1 hour

MCQs SEQs

10 Ventilation perfusion ratio VA/Q - II


basis of abnormalities in

VA/Q ratio. (K)

· Concept of physiologic shunt and

physiologic dead space

· Abnormalities of ventilation-

perfusion ratio

LGIS 1 hour

MCQs SEQs


20

11 Oxygen transport – I

· Discuss the various modes of

transport of oxygen from

lungs/atmosphere to tissues.

(K)

· Transport of oxygen from lungs

to tissues via blood

· Role of hemoglobin in oxygen

transport

LGIS 1 hour

MCQs SEQs

12 Oxygen transport - II

· Explain oxygen hemoglobin

dissociation curve with the

help of diagram. (K) (S)

· Transport of oxygen from lungs

to tissues via blood

· Oxygen hemoglobin

dissociation curve

· Factors causing right and left

shift of oxygen hemoglobin

dissociation curve

· Bohr’s effect

LGIS 1 hour

MCQs SEQs

13 Transport of CO2 in blood and

tissue fluids I

· Discuss the various modes of

transport of carbon dioxide

from tissues to lungs and

atmosphere. (K)

· Transport of carbon dioxide

from lungs to tissues via blood

· Diagram of CO2 dissociation

curve

LGIS

1 hour MCQs SEQs

14 Transport of CO2 in blood and

tissue fluids II

· Discuss haldene effect and

explain the phenomenon of

chloride shift. (K)

· Haldane’s effect

· Chloride shift

LGIS 1 hour

MCQs SEQs

15 Nervous control of respiration

· Enlist the components of

respiratory center and

discuss the role of each in

regulation of respiration at

rest and during exercise. (K)

· Components and location of

respiratory center

· Medullary and pontine groups of

regulatory neurons

· Generation of respiratory

rhythm

· Role of ventral group of

respiratory neurons in forceful

breathing

· Herring Breuer’s inflation reflex

LGIS 1 hour

MCQs SEQs

16 Chemical control of respiration

· Explain the role of peripheral

and central chemoreceptors

in control of respiration. (K)


• Location of peripheral and

central chemoreceptor

• Effect of raised H+ ions in CSF

and raised pCO2 levels of

arterial blood on central

LGIS 1 hour

MCQs SEQs


21

basis of Cheyne Stokes

breathing (periodic breathing)

and sleep apnea. (K)

chemoreceptors

• Effect of decreased pO2, pH

and increased pCO2 on

peripheral chemoreceptors to

regulate respiration.

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

18 High altitude physiology

· Discuss the physiological

processes employed for

acclimatization to low PO2..

(K)

Describe the pathophysiology

of acute and chronic

mountain sickness. (K)

· Alveolar pO2 and saturation of

hemoglobin with oxygen at

different altitudes

· Effect of breathing pure oxygen

on alveolar pO2 at different

altitudes

· The acute effects of hypoxia

· Acclimatization to low PO2

· Parachute jumping

· HAPE and HACE

LGIS 1 hour

MCQs SEQs

19 Space physiology

· Define centrifugal

acceleratory forces i.e

positive and negative G and

zero G. (K)

· Describe the effects of

positive and negative G on

the body along with the

management of these effects.

(K)

· Measurement of G

· Positive and negative loops

during aviation

· Artificial climate in space craft

· Weightlessness in space and its

effects on body systems

LGIS 1 hour

MCQs SEQs


22

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

Physiology Practicals

S. NO



Teaching Activity


1 Demonstration and recording of lung

volumes and capacities by

spirometry

· Identify different components of

the spirometer and explain their

functions. (S)

· Record different lung volumes

and capacities using

spirometer. (S)

· Components of the spirometer

· Functions of each component

of spirometer

· Scale of the spirogram

· Lung volumes and capacities

· Interpretation of the readings

· Calculation of the observed

VC, TV, ERV and IRV

· ATPS and BTPS values

Practical 2 hours

OSPE

2. Recording of forced expiratory

volumes by spirometer

· Demonstrate the procedure of

recording the forced spirogram.

(S)

· Calculate FEV1/FVC ratio from

the graph and interpret their

results by comparing with

normal FEV1/FVC ratio. (S)

· Recording the forced

spirogram

· Calculation of FEV1/FVC

ratio

· Interpretation of the ratio

· Significance of recoding

FEV1/FVC ratio in diagnosis

of obstructive and restrictive

respiratory diseases

Practical 2 hours

OSPE

3. Peak expiratory flow rate (PEFR) with

wright’s peak flow meter and

stethography

· Identify and explain the

functions of different

components of Wright’s peak

flow meter and demonstrate the

procedure of recording the

PEFR. (S)

· Identify different components of

stethograph and explain their

· Functions of different

components of Wright’s peak

flow meter

· Recording the PEFR with the

help of Wright’s peak flow

meter

· Conditions in which PEFR is

decreased

· Breath holding time and

breaking point

Practical 2 hours

OSPE


23

uses. (S)

· Record normal and modified

respiratory movements. (S)

4. Examination of respiratory system

· Examine the front and back of

chest of a given subject. (S)

· Conduct the examination in a

manner which is comfortable

for the patient. (A)

· Protocol while examining

respiratory system

· Steps of examination of chest

Ø Inspection

Ø Palpation

Ø Percussion

Ø Auscultation

Practical 2 hours

OSPE

Physiology Tutorials

S. NO



Teaching Activity


1 Pulmonary mechanics

· Draw a diagram to explain

pressure and volume changes in

lungs during quiet respiration

and forceful respiration. (K,S)

· Functions of respiratory

system

· Non-respiratory functions of

respiratory system

· Muscles of inspiration during

quiet respiration and

forceful respiration.

· Muscles of expiration during

quiet and forceful breathing.

· Intrapulmonary, intrapleural

and transpulmonary pressures


negativity of intrapleural space

SGIS 2 hours

MCQs SEQs

2. Ventilation perfusion ratio VA/Q - I

· Draw a diagram to explain the

physiological basis of ventilation

perfusion ratio and its

application in health and

diseased state. (K,S)

· Zones of lung


ventilation and perfusion ratio

· Diagram of ventilation and

perfusion ratio

· Effect of ventilation -

perfusion ratio on alveolar

gas concentration

· Concept of physiologic shunt

and physiologic dead space

· Abnormalities of ventilation-

perfusion ratio

SGIS 2 hours

MCQs SEQs


24

3. Oxygen transport - II

· Draw and explain

oxygenhemoglobin and

carbondioxide dissociation

curve. (K,S)

· Transport of oxygen from

lungs to tissues via blood

· Oxy hemoglobin dissociation

curve

· Factors causing right and left

shift of oxy hemoglobin

dissociation curve

· Bohr’s effect

· Transport of carbon dioxide

from lungs to tissues via

blood

· Diagram of CO2 dissociation

curve

LGIS 1 hour

MCQs SEQs

4. Regulation of respiration

· Draw a diagram to explain the

nervous and chemical

regulation of respiration. (K,S)

· Medullary and pontine groups

of regulatory neurons and

generation of respiratory

rhythm


respirator neurons in forceful

breathing

· Herring Breuer’s inflation

reflex

· Role of central

chemoreceptor in control of

respiration

· Role of peripheral


respiration

LGIS 1 hour

MCQs SEQs


25

Physiology Seminars

S. NO



Teaching Activity


1 Comprehend Respiratory mechanics ,

Compliance and V/Q ratio

· Describe the mechanics of

breathing and explain lung

compliance. (K)

· Explain different lung volumes and

capacities and describe V/Q

ratio.(K)

· Mechanism of inspiration at

rest and exercise

· Mechanism of expiration at

rest and exercise

· Transpulmonary pressure

· Factors affecting compliance


· Lung volumes, their values

and significance

· Lung capacities , their values

and significance

· V/Q ratio in different lung

zone and its significance

· Physiological and anatomical

dead space

· Significance of V/Q ratio

Student Presenta�ons

7 minutes

Marking / Evalua�on Marks 10

2. Nervous and chemical control of

respiration

· Describe the nervous and

chemical control of respiration.

(K)

· Medullary and pontine

groups of regulatory neurons

and generation of respiratory

rhythm


respirator neurons in forceful

breathing

· Herring Breuer’s inflation

reflex

· Role of central


respiration

· Role of peripheral


respiration

Student Presenta�ons

7 minutes

Marking / Evalua�on Marks 10

Biochemistry


26

Biochemistry Lectures

S. NO



Teaching Activity


1.

Introduction to vitamins

• Define and classify vitamins.

(K)

• Explain general aspects of all

vitamins. (K)

• Definition and classification of

vitamins

• Bio-medical importance of

vitamins

LGIS 1 hour

MCQs SEQs

2. Vitamin A

• Explain vitamin A in detail. (K)

• Sources of vitamin A

• Daily requirement

• Absorption

• Chemical structure

• Biochemical functions and visual

cycle

• Effect of vitamin A deficiency

LGIS 1 hour

MCQs SEQs

3. Vitamin D

• Discuss role of vitamin D in the

body. (K)

• Sources of vitamin D


• Absorption

• Synthesis and activation of

vitamin D

• Biochemical functions

• Effect of vitamin D deficiency

LGIS 1 hour

MCQs SEQs

4 Vitamin E

• Discuss vitamin E and its role

as antioxidant. (K)

• Sources of vitamin E


• Absorption

• Chemical structure and vitamin E

as antioxidant


• Effect of vitamin E deficiency

LGIS 1 hour

MCQs SEQs


27

5 Vitamin K and C

• Explain different features of

vitamin K and C. (K)

• Sources of vitamin K and C


• Absorption

• Chemical structure of both

vitamins


• Synthesis of vitamin K and role of

vitamin K in blood clotting

• Effect of vitamin K and C

deficiency

LGIS 1 hour

MCQs SEQs

6 Thiamine and riboflavin

• Discuss characteristics of

thiamine and riboflavin in the

body. (K)

• Sources of thiamine and

riboflavin


• Absorption


vitamins

• Biochemical functions of

riboflavin and thiamine

• Thiamine deficiency in alcoholics

• Effect of riboflavin and thiamine

deficiency

LGIS 1 hour

MCQs SEQs

7 Nicotinic acid and Pantothenic acid

• Explain role of nicotinic acid and

pantothenic acid in humans. (K)

• Sources of nicotinic acid and

pantothenic acid


• Absorption


vitamins

• Biochemical functions of nicotinic

acid and pantothenic acid

• Nicotinic acid role in DNA repair

mechanism

• Effect of deficiency of nicotinic

acid and pantothenic acid

LGIS 1 hour

MCQs SEQs

8 Pyridoxine and Biotin

• Describe properties of

pyridoxine and biotin. (K)

• Sources of pyridoxine and biotin


• Absorption


LGIS 1 hour

MCQs SEQs


28

vitamins


• Pyridoxine role in mechanism of

action of steroid hormones

• Effect of deficiency of pyridoxine

and biotin

9 Folic acid and cobalamin

• Discuss role of folic acid and

cobalamin in the body. (K)

• Explain role of vitamin as

coenzymes and hemopoetic

vitamin. (K)

• Sources of folic acid and

cobalamin


• Absorption


vitamins

• Biochemical functions 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

LGIS 1 hour

MCQs SEQs

10 Nutrition

• Discuss various aspects of

nutrition.(K)

• Definition of nutrition


nutrition

• Classes of nutrients

• Caloric value of food

LGIS 1 hour

MCQs SEQs

11 Nutritional importance of nutrients

• Explain nutritional importance of

each dietary nutrient. (K)

Nutritional importance of

Ø Lipids

Ø Carbohydrates

Ø Proteins

Ø Vitamins

Ø Minerals

Ø Water

LGIS 1 hour

MCQs SEQs

12 Caloric requirement of body

• Describe various factors to

determine the daily caloric

requirement of a person. (K)

• Basal metabolic rate. (BMR )

• Specific dynamic action of food

(SDA)

• Effect of physical activity

LGIS 1 hour

MCQs SEQs

13 Balanced diet

• Discuss balanced diet in detail.

• Definition of balanced diet

Components of balanced diet and

LGIS 1 hour

MCQs SEQs


29

(K) its biomedical importance

Hazard of imbalanced diet

14 Nutritional requirements

• Discuss nutritional requirements

in different phases of life. (K)

• Nutritional requirement in

Pregnancy Lactation and

Newborn

• Nutritional disorder

LGIS 1 hour

MCQs SEQs

15 Obesity

• Discuss obesity and health. (K)

• Assessment of obesity

• BMR

• Body weight regulation

• Metabolic changes in obesity

LGIS 1 hour

MCQs SEQs


30

Biochemistry SGIS

S.

NO

Learning Objectives

By the end of the session, students

will be able to

Content Areas

Teaching

Activity

(Duration)

Assessment

1. Hypervitaminosis

• Explain hypervitaminosis. (K)

• Hypervitaminosis vitamin A, D, K

and E.

• Clinical manifestations of

hypervitaminosis

SGIS 2 hours

MCQs SEQs

2. B-complex factor vitamins as co-

enzymes.

• Discuss co-enzymes of B-

complex vitamins. (K)

• Thiamine pyrophosphate [TPP]

• Flavin mononucleotide [FMN]

• Flavin adenine dinucleotide [FAD]

• Nicotinamide adenine

dinucleotide.[NAD]

• Nicotinamide adenine dinucleotide

phosphate.[NADP]

• Tetrahydrofolate.[TH4F]

• Pyridoxal phosphate

• Co-enzyme A

SGIS 2 hours

MCQs SEQs

3. Protein energy malnutrition

• Explain protein energy

malnutrition. (K)

• Protein energy malnutrition

• Marasmus

• Kwashiorkor

• Marasmic-kwsahiorkor

SGIS 2 hours

MCQs SEQs

4. Glycemic Index

• Discuss post- prandial blood

glucose concentration. (K)

• Dietary carbohydrate and blood

glucose

• Low glycaemic index food

• High glycaemic index food

SGIS 2 hours

MCQs SEQs


31

Biochemistry Practicals

S.

NO

Learning Objectives

By the end of the session, students

will be able to

Content Areas

Teaching

Activity

(Duration)

Assessment

1. Hydrolysis of sucrose

• Perform hydrolysis of sucrose.

(S)

• Handle the apparatus carefully.

(A)

• Understanding structure of

sucrose

• Understanding of hydrolysis of

sucrose in given solution

• Hydrolysis of sucrose in the

presence of concentrated HCL

into its reducing monosaccharide

constituents, glucose and fructose.

• Interpretation of results and

biomedical importance of test

Practical 2 hours

OSPE

2. 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 solution

• Hydrolysis of starch in the

presence of concentrated HCL

into glucose

• Interpretation of results and

biomedical importance of test

Practical 2 hours

OSPE

3. Millons and Aldehyde test

• Perform Millons and Aldehyde

test. (S)

• Aromatic amino acids and their

identification.

• Importance of nitration of benzene

ring

• Biomedical importance of aromatic

amino acids

Practical 2 hours

OSPE

4. Heat coagulation test

• Perform heat coagulation test.

(S)

• Define iso-electric pH,

coagulation, denaturation of

proteins

• Differentiate between coagulation

and denaturation of proteins

Practical 2 hours

OSPE


32

Biochemistry Seminars

S. NO



Teaching Activity


1. Definition and classification of

vitamins. Fat soluble vitamins

• Define and classify vitamins. (K)

• Explain fat soluble vitamins. (K)

• Definition and classification of

vitamins

• Sources of vitamin A, D, E, K


• Absorption

• Chemical structure


• Effect of vitamins deficiency

• Visual cycle, Synthesis and

activation of vitamin D, vitamin E

as antioxidant Synthesis of vitamin

K and role of vitamin K in blood

clotting


7 minutes


2. Thiamine, riboflavin, niacin and

vitamin C

• Discuss characteristics of

thiamine, riboflavin, niacin and

vitamin C in the body. (S)

• Sources of thiamine , riboflavin,

nicotinic acid and vitamin C


• Absorption

• Chemical structure of all vitamins


• Thiamine deficiency in alcoholics

• Effect of deficiency

• Nicotinic acid role in DNA repair

mechanism


7 minutes


3. Folic acid ,vitamin B12, pantothenic

acid , biotin and pyridoxine

• Explain characteristics of folic

acid, vitamin B12, pantothenic

acid, biotin and pyridoxine in the

body. (S)

• Sources of folic acid ,vitamin B12,

pantothenic acid ,biotin and

pyridoxine


• Absorption

• Chemical structure of all vitamins


• Effect of deficiency

• Pyridoxine role in mechanism of

action of steroid hormone


7 minutes



33

• Folate trap hypothesis

• Neural tube defect

• Metabolite in urine in case of

vitamin B12 and folic acid

4. Nutrition and Balanced diet

• Describe various aspects of

nutrition. (K)

• Define and explain balance diet

and discuss hazard of

imbalanced diet. (K)

• Definition of nutrition

• Bio-medical importance of nutrition

• Classes of nutrients

• Caloric value of food

• Respiratory quotient

• Specific dynamic action of food


balanced diet

• Hazards of imbalance diet


7 minutes



34

PROBLEM BASED LEARNING (PBL)

· 2 PBLs will be conducted in this module.

· Each will be introduced in one week and will be discussed the next week.

Learning Tool

Theme

PBL trigger

Subjects integrated in PBL

PBL 1 Difficulty in breathing

A known asthmatic patient

comes with shortness of

breath and fracture

Learning objectives will be from

Anatomy, Physiology, Biochemistry,

Medicine and Community Medicine

PBL 2 Diving dilemma

After a deep sea dive the

patient comes with severe

pain in joints and dyspnea

Learning objectives 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 section in addition to the other reference books from the college library.


35

INTEGRATED SEMINAR



Teaching Activity


Restrictive lung disorders

· Explain the pathophysiology of the

clinical features, diagnosis and

treatment of restrictive lung

disorders. (K)

· Gross anatomy and histology of the

bronchial tree

· Gross anatomy and histology of

lungs

· Pathohysiology of restrictive and

obstructive disorders

· Management of restrictive disorders

· Functions of vitamin D

· Effects of deficiency of vitamin D

Student Presentations

7 minutes

Marking / Evaluation* Marks 10

VerticalIntegration


36

Medicine Lectures

S. NO

Learning Objectives By the end of the session, students will be

able to Content Areas

Teaching Activity


1 Asthma

· Identify clinical features and list

investigations of asthma. (K)

· Definition of asthma

· Clinical features of

asthma

· Investigations of asthma

LGIS 1 hour

MCQs SEQs

2 Pneumonia

· Identify clinical features and enumerate

investigations of pneumonia. (K)

· Definition of pneumonia

Classification and

Clinical features of

pneumonia

· Investigation in

diagnosing pneumonia

LGIS 1 hour

MCQs SEQs

Learning resource: Davidsons Principles and Practice of Medicine. 22nd Edition.


37

Pharmacology Lecture

S. NO



Teaching Activity


1. Introduction to drugs used to manage

bronchial asthma:

· Identify 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

· Pharmacokinetics,

mechanism of action,

pharmacological actions,

therapeutic uses and

adverse effects

· Management of acute

severe asthma

· Prophylaxis of bronchial

asthma

LGIS 1 hour

MCQs SEQS

Learning resource: Basic and Clinical Pharmacology. Bertram G. Katzung, 13thedition, 2015.


38

Surgery Lectures

S. NO

Learning Objectives By the end of the session, students will

be able to Content Areas

Teaching Activity


1.

Tumors of lung and pleura

· Identify various tumors of lung, pleura

and chest cage. (K)

· Tumors of lungs

· Tumors of pleura

· Tumors of ribs

LGIS 1 hour

MCQs SEQs

2. Injuries of lungs and pleura

· Identify various lung, pleura and chest

wall injuries. (K)

· Injuries of lungs

· Injuries of pleura

· Fracture of ribs and

thoracic cage

LGIS 1 hour

MCQs SEQs

Learning resource: Clinical Anatomy by Regions. Richard S. Snell, 9th edition, 2012.

Bailey and Love Short Practice of Surgery. Norman S. Willams, 26 th edition, 2013.


39

Community Medicine Lectures

S.

NO

Learning Objectives

By the end of the session, students will be

able to

Content Areas

Teaching

Activity

(Duration)

Assessment

1 Acute respiratory infections

· Identify the epidemiologic determinants

of acute respiratory infections. (K)

· Discuss the preventive measures of

acute respiratory infections. (K)

· Causes of respiratory

diseases

· WHO model of acute

respiratory infections

· Preventive measures

LGIS 1 hour

MCQs SEQs

2 Influenza and meningococcal meningitis.

· Describe the epidemiology and

preventive measures of influenza and its

subtypes. (K)

· Explain the epidemiology and prevention

of meningococcal meningitis. (K)

· Basic definitions

· Dynamics of disease

transmission

· Epidemiologic triad

· Preventive measures

of influenza and its

subtypes

· Epidemiological

determinants

· Mode of transmission

of meningococcal

meningitis

· Prevention and control

·

LGIS 1 hour

MCQs SEQs

3 Hazards of smoking

· Enlist the hazards of smoking. (K)

· Discuss the preventive measures of

smoking. (K)

· Causes of smoking

· Chemical composition

of cigarette

· Health Hazards of

smoking

· Prevention

LGIS 1 hour

MCQs SEQs

Learning resource: Park’s Textbook of Preventive and Social Medicine, 23rd edition, January 2015


40

Pathology Lecture

S. NO



Teaching Activity


1. Respiratory tract infections.

· Give an overview of respiratory

tract infections. (K)

· Upper respiratory tract infections

(Phyrangitis, laryngitis)

· Lower respiratory tract infections

(pneumonia, tuberculosis)

LGIS 1 hour

MCQs SAQS

Learning resource: Robins Basic Pathology. B. Kumar.10 th edition, 2018.


41

General Pedriatics Lecture

S. NO



Teaching Activity


1. Respiratory distress syndrome

· 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 investigations and

radiological findings of these

diseases.(K)

· Causes,

pathophysiology

predisposing factors,

clinical presentation

and lab investigation

· Radiological findings

LGIS 1 hour

MCQs SEQs

Learning resource: Parvez Akbar, Kundi Pediatrics. Chapter 18


42

Radiology Lecture

S. NO



Teaching Activity


1. · Identify 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 angulation of

right and left main bronchi

· Fissures (Horizontal.

Oblique. Azygos)

· Pleural layers

· Lung vasculature

· End-on blood vessels, end -

on bronchi.

· Relationship 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


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00

1300

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me

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try

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to R

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00

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ee

p s

ea

ph

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logy

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lty

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grat

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se

min

ar

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lun

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iso

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s

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liday

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day

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olid

ay


T

IME

TA

BL

E

RE

SP

IRA

TO

RY

SY

ST

EM

MO

DU

LE

W

EE

K 5

End

of

Blo

ck e

xam


YUSRA MEDICAL & DENTAL COLLEGE, ISLAMABADZaraj Housing Scheme, Opp DHA Phase II, Gate 3

Main GT Road, Islamabad.Phone: 5709443-5 Fax: 5709428

& D l ea nci tade l CM oa llr es gu eY

Al-Quran: 94; 5


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