Modules

• Year 1
  • Introduction to Year 1 and FunMed
  • Fundamentals of Medicine
  • Human Development 1
  • Cardiorespiratory 1
  • Metabolism 1
  • Locomotor 1
  • Brain and Behaviour 1
  • Medicine in Society 1
  • Inter-Professional Education 1
• Year 2
  • Introduction to Year 2 and Year Outcomes
  • Cardiorespiratory 2
  • Metabolism 2
  • Brain and Behaviour 2
  • Human Development 2
  • Human Sciences and Public Health 2
  • Locomotor 2
  • Medicine in Society 2
  • Extended Patient Contact 2
  • Moving and Handling Training
  • Year 2 Lifesaver Programme
• Year 3
  • Clinical Science and Professionalism (Weeks 1-3)
  • Cardiovascular, Respiratory and Haematology (CR3)
  • Gastroenterology and Cancer (MET3A)
  • Endocrinology and Renal Medicine (MET3B)
  • General Practice and Community Care
  • Public Health
• Year 4
  • Obstetrics and Gynaecology
  • Child Health
  • Neuroscience
  • Psychiatry
  • Ophthalmology
  • HIV & Sexual Health
  • Musculoskeletal
  • Health Care of the Elderly
  • Dermatology
  • General Practice and Community Care
  • Ear, Nose and Throat
  • Global Health and Ethics
  • ALL CSP WEEKS
  • B&B Classroom Skills
• Year 5
  • Introduction to Year 5 and Year Outcomes
  • Teaching Week 1
  • Acute Medical Care (AMC)
  • Surgery, Anaesthetics and Perioperative Care (SAPOC)
  • Community Care
• Year GEP 1
  • Movement and Posture
  • Carriage of Oxygen
  • Human Sciences and Public Health
  • Digestion, Growth and Metabolism
  • Infection and Immunity
  • Brain and Behaviour
  • Consolidation and Integration
  • Human Development
  • Medicine in Society (GEP)
  • IPE Programme Week (inc. IP Days within Modules)

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Year 1 CR1: Cardiorespiratory 1

• Dr Julian Millar
• j.miller@qmul.ac.uk

Introduction

 

Welcome to the Cardiorespiratory System introductory course. This course is designed to introduce you to the basic structure and function of the body systems that enable oxygen and metabolic fuel to reach tissues, and carbon dioxide and waste products to be removed. By the end of the course you should be able to:

1. Describe the structure and function of the different types of cells in the blood
2. Explain the mechanisms of haemostasis and blood clotting, and describe the commonest medical conditions where these mechanisms malfunction
3. Explain the method by which oxygen is carried from the lungs to the tissues
4. Describe the basic structure and functions of blood vessels, the heart and lungs
5. Describe how the heart works as a pump, including the pressures of the cardiac cycle and the heart's electrical activity as measured by the ECG; understand what is meant by heart failure and how it may be managed.
6. Explain the role of blood pressure, cardiac output and peripheral resistance in the distribution of blood to the various organs of the body; describe the neuronal and hormonal control of these parameters
7. Describe the role of the sympathetic nervous system in the control of blood pressure at rest and during exercise and injury
8. Describe the mechanisms of gaseous exchange in the lungs, and the mechanisms whereby blood carried gases to and from tissues to the lungs; describe the commonest medical conditions where these mechanisms malfunction
9. Describe the main classes of drugs used to treat the most common pathological conditions in the cardiorespiratory system
10. Carry out basic clinical physical examinations related to the cardiorespiratory system

 

The following books will give you the essential information necessary for the course:

Human Anatomy and Physiology - Elaine N Marieb and Kalja Hoehn

Clinical Medicine - Parveen Kumar and Michael Clark (Eds)

Please see your handbook for the full book list.

 

 

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Index

• General Outcomes for the Cardiovascular System
• General Outcomes for Haematology
• General Outcomes for the Respiratory System
• General Outcomes for Renal and Urinary System
• Asthma (Priority 1*)
• Pneumothorax (Priority 2*)
• Nephrotic Syndrome and Glomerulonephritis

• General Outcomes for the Cardiovascular System
  • Medical knowledge: ANATOMY
    • The Mediastinum
      1. Identify the pleural cavities and the mediastinum
      2. Understand the divisions of the mediastinum and the structures that lie in each
    • The Heart and Coronary Arteries
      1. Describe the mediastinum and its contents
      2. Understand the arrangement of the pericardium and the layers of the heart wall
      3. Identify the pericardium
      4. Trace the flow of blood through the heart, identifying the major blood vessels and the chambers
      5. Note the position of the heart and the great vessels in situ.
      6. Discuss the functional anatomy of the heart valves
      7. On the surface of the heart, identify the four chambers.
      8. Understand the anatomy and perfusion of the coronary circulation
      9. Revise understanding of the cardiac myocyte and the blood supply to the myocardium.
      10. Identify the right and left coronary arteries and their major branches.
      11. Understand the effects of ischaemia on the myocardium.
      12. Examine the coronary sinus and note its main tributaries.
      13. Identify the four valves of the heart; indicate which chambers they lie between and how they differ in their structure.
      14. Identify the nervous supply to the heart
    • Blood Vessels and Circulation of the Thorax
      1. Describe the three layers that typically form the wall of a blood vessel
      2. Distinguish among the types of blood vessels on the basis of their structure and function
      3. Identify the major arteries of the systemic and pulmonary circuits and the areas they serve.
      4. Explain the arterial supply to the thoracic wall and the lungs
      5. Describe the azygos system of venous drainage to the thorax
    • Circulation of the Shoulder, Arm and Hand
      1. Know the arterial supply to the upper limb
      2. Know the venous drainage of the upper limb
    • Blood and the Circulatory System
      1. Revise the understanding of the anatomical characteristics and functions of different types of leukocytes and identify them in blood smears
      2. Be able to differentiate between erythrocytes found in normal blood smears and those indicative of anaemia.
      3. Understand the basic structure and function of bone marrow
      4. Be able to identify arteries and veins and relate the structure of their walls to their physiological function.
    • Circulation of the lower limb and foot
      1. Know the arterial supply to the lower limb
      2. Know the venous drainage of the lower limb
  • Medical knowledge: PHYSIOLOGY
    • General Cardiovascular Physiology
      1. Describe the role of the vascular endothelium .
    • Sympathetic Nervous System and Circulation
      1. Describe the anatomy of the sympathetic nervous system with particular reference to the innervation of blood vessels
      2. Describe the transmitters used by the sympathetic nervous system
      3. Describe the role of the sympathetic nervous system in the control of blood pressure and cardiac output
      4. Describe the changes in the blood flow to muscle during exercise
      5. Describe how the sympathetic nervous system reacts after injury or haemorrhage
    • Smooth and Cardiac Muscle
      1. List the structures where smooth muscle is found
      2. Describe the heterogeneity of smooth muscle and link to function
      3. Describe the excitation - contraction coupling in smooth muscle and briefly contrast with cardiac and skeletal muscle
      4. Explain briefly the electrophysiology of smooth muscle
      5. Describe how external factors may contract or relax smooth muscle
      6. Describe the innervation of smooth muscle
    • Blood Pressure
      1. Describe the physiological sensors and effectors for the control of blood pressure
      2. Explain how blood pressure and blood volume may be independently controlled
      3. Describe the position and innervation of the aortic and carotid sinus baroreceptors, their central connections, and the role of the brainstem in the control of blood pressure
      4. Describe the role of the vagus nerve and the sympathetic nervous system in the control of blood pressure
      5. Describe the renin-angiotensin-aldosterone system and explain its role in blood pressure regulation
    • Microcirculation and Oedema
      1. Draw a labelled diagram showing the anatomy of the microcirculation.
      2. Describe the three types of capillaries, continuous, fenestrated and discontinuous, with reference to their structure, distribution and function.
      3. Describe how the capillary permeability of lipid soluble molecules can be explained in terms of their oil:water partition coefficients.
      4. Describe how lipid insoluble molecules can move across the capillary endothelium.
      5. Draw a labelled diagram showing filtration and reabsorption of fluid along an average capillary.
      6. Explain how capillary pressure, plasma colloid osmotic pressure and interstitial colloid osmotic pressure can affect fluid movements between plasma, interstitium and lymph.
    • Haemodynamics
      1. Define the terms systolic and diastolic blood pressure, pulse pressure and mean blood pressure and state values for these in the normal healthy young adult
      2. Explain the relationships between cardiac output, peripheral resistance and blood pressure
      3. Explain the concept of arterial compliance, and describe the relationship between pulse pressure, stroke volume and compliance
      4. Know the importance of Poiseuille's Law relating vessel radius and resistance to flow, and the relevance of this to changes in pressure in the circulation
      5. Be able to comment on the importance of Laplace's Law relating vessel radius and pressure, and how this relates to aneurysm formation.
    • The Heart as a Pump
      1. Explain how the chambers of the heart and the heart valves cause blood to flow in sequence through the pulmonary and systemic circulations
      2. Define cardiac output and comment on how this is matched to demand
      3. Be able to draw a diagram of the pressure profiles in the left atrium, left ventricle and the aorta for a single cardiac cycle. Indicate the points at which the cardiac valves open and close, and the periods of iso-volumetric contraction and relaxation.
      4. Briefly describe the structure of the heart valves, and state what causes them to open and close
      5. State the reasons for the occurrence of the dichrotic notch of the aortic pressure pulse
      6. Draw the typical pressure / volume diagram for the heart and relate this to the difference phases of the cardiac cycle
  • Medical knowledge: THERAPEUTIC PRINCIPLES
    • General Outcomes for Cardiovascular Pharmacology
      1. Briefly describe how drugs may be used for treatment of hypertension and angina.
  • Clinical skills: DIAGNOSTIC PROCEDURES
    • ECG Monitoring and Interpretation
      1. Describe or demonstrate the recording of a 6 lead ECG using standard and augmented limb leads.
      2. Relate the P-wave, QRS complex and T-wave of the lead II ECG to the sequence of depolarization and repolarization of the atria and ventricles of the heart.
      3. Explain why the shape of the ECG varies between the 6 leads.
      4. Describe the relationship between the heart sounds and the ECG and relate both the mechanical events of the cardiac cycle.
  • Clinical skills: PHARMACOLOGICAL THERAPY
    • Pharmacological Therapy - Cardiovascular Disorders (General)
      1. Define heart failure and describe its treatment.
      2. Explain the benefits of lipid-lowering drugs.
• General Outcomes for Haematology
  • Medical knowledge: PHYSIOLOGY
    • Carriage of Oxygen in the Blood
      1. Describe the structure of haemoglobin and explain why it is uniquely suitable for the carriage of oxygen in the blood
      2. Explain the significance of the subunit structure of haemoglobin and the consequences of mutations in the haemoglobin genes.
      3. Comment on the significance of methaemoglobin in erythrocytes
      4. Explain what is meant by haematocrit and how it is regulated.
      5. Explain the ways in which carbon dioxide is transported by the blood
    • Structure and Function of Blood
      1. List the cellular components of blood cells and outline their roles in the carriage of oxygen and carbon dioxide, immunity / allergy and haemostasis
      2. List the major chemical components of plasma, and comment on the role of these in clotting, immunity, colloid pressure and buffering
      3. Outline the production of blood cells from pluripotent haemopoietic stem cells and the regulation of erythropoiesis and myelopoiesis
      4. Outline the response to anaemia
      5. Define the parameters of a full blood count and give an outline classification of anaemia
    • Haemostasis and Thrombosis
      1. Describe the nature and function of platelets; explain what is meant by thrombocytopenia
      2. Describe the normal coagulation pathway and how it is activated by: tissue damage, contact of blood with tissue collagen or glass.
      3. Describe the roles of Vitamin K, platelets, calcium, serine proteases and modifier proteins in the clotting process
  • Medical knowledge: THERAPEUTIC PRINCIPLES
    • Anticoagulation
      1. Explain the mechanism of action of Heparin, Warfarin, Aspirin and Stroptokinase; indicate under what circumstances it is appropriate to administer them
• General Outcomes for the Respiratory System
  • Medical knowledge: ANATOMY
    • Muscles of the Thoracic Wall and Respiration
      1. Describe the arrangement of an intercostal space
      2. Name the major and accessory muscles involved in inspiration
      3. Trace the flow of air from the nose to the alveoli
    • Pleural Cavity and Lungs
      1. Identify the components of the respiratory mucous membrane.
      2. Describe the structure and innervation of the lungs and bronchi
      3. Describe the structure and function of the pleurae
      4. Identify the lobes of each lung and describe the pattern of division of bronchi entering the lobes.
      5. Examine the extent of the pleural cavity differentiating between visceral and parietal pleura.
    • General Anatomy of the Thorax
      1. Identify, on an articulated skeleton, bones forming the thoracic cage, manubrium and body of the sternum, xiphisternum, costal cartilages and ribs and thoracic vertebrae.
      2. Describe the parts of a typical thoracic vertebra.
      3. Describe the attachments of the diaphragm. Identify the main structures passing through it and note their vertebral levels.
      4. Describe the attachments and neurovascular bundle of a typical intercostal space.
    • Larynx and Trachea
      1. Describe the structure and position of the trachea.
      2. Understand the cartilaginous and bony skeleton of the larynx.
      3. Identify some of the important membranes and intrinsic muscles of the larynx.
    • Nasal Cavity and Sinuses
      1. Identify the important structures within the nasal cavity.
  • Medical knowledge: PHYSIOLOGY
    • Acid Base and the Control of Breathing
      1. Review the definition of gas partial pressure in a mixture of gases and gas partial pressure in a solution.
      2. Briefly describe the brainstem structures involved in the production of breathing, and list the inputs to the brainstem which influence breathing. Describe the types of pathological respiratory patterns that can occur.
      3. State the normal pH of arterial plasma, define the terms acidosis, alkalosis, acidaemia and alkalaemia, and explain the effects on arterial pH of hyper- and hypo-ventilation.
    • Lung Mechanics
      1. Outline the relationships between the lungs, pleura, chest wall and diaphragm.
      2. Explain why a negative pressure exists in the (potential) pleural space
      3. Compare and contrast the structure of conducting components of the respiratory system and relate their structural differences to differing functions.
      4. Identify the respiratory components of the lung and understand their functions.
      5. Explain why alterations to lung recoil (in for example emphysema and pneumonia) may produce alterations to the shape of the chest.
      6. Show, by means of simple diagrams, how the ribs move during breathing.
      7. List the muscles active in a) quiet breathing; and b) vigorous breathing.
    • Gas Exchange and Lung Function Testing
      1. Draw a simple diagram of an alveolus (and its blood supply), annotated to show how the microscopic structure is suited to efficient gas exchange.
      2. Know what pulmonary surfactant is, where is it produced and why is it important.
      3. Be able to tabulate the normal partial pressures of oxygen and carbon dioxide in room air, alveolar air, pulmonary arterial (or ‘mixed venous’) blood, pulmonary venous (or systemic arterial) blood and expired air; comment on why these differ.
      4. Give an equation for Fick’s law of diffusion as applied to gas exchange in the lung the lung, identify the components of the equation, and name one pulmonary disorder affecting each component.
      5. Show, by means of simple graphs, how gas exchange comes to equilibrium along a pulmonary capillary; relate this information to physical exercise and progressive loss of lung function.
      6. Define, and give typical values for, commonly used terms in lung function testing and explain how clinically important measures of lung function are obtained.
    • The Lungs and Pulmonary Circulation
      1. Explain how the pulmonary and systemic circulations differ in terms of pressure and other factors
      2. Explain the changes that occur in the pulmonary circulation at birth
    • General Outcomes for Respiratory Physiology
      1. List the functions of the respiratory system.
      2. Name the main structural features of the lungs.
      3. Distinguish between respiratory and non-respiratory components of the lungs and show how histological features are related to function.
      4. Describe the branching pattern of the respiratory tree, commenting on the significance of the cross-sectional area at different levels.
    • Lung Volumes and the Rates of Air Flow
      1. Describe and demonstrate the use of a spirometer, to measure tidal volume, respiratory rate, inspiratory reserve volume, expiratory reserve volume and vital capacity.
      2. Name those lung volumes which cannot be measured using a spirometer and describe one method for their measurement.
      3. Describe and demonstrate the use of the Vitalograph to measure the FVC and FEV1. Define the terms forced vital capacity (FVC), Forced Expiratory Volume 1 (FEV1) and the ratio FEV1/FVC expressed as a percentage (FEV1 %).
      4. Describe how the Vitalograph may be used to distinguish between restrictive and obstructive types of lung function disorders.
    • Blood Gases, Control of Ventilation and Plasma pH
      1. State normal values of the partial pressures of oxygen and carbon dioxide in arterial blood (PaO2, PaCO2). How are these measured directly and estimated indirectly?
      2. Describe the location and properties of the peripheral and central chemoreceptors and show, by means of simple graphs, how alterations in PaO2 and PaCO2 alter ventilation.
  • Medical knowledge: THERAPEUTIC PRINCIPLES
    • General Outcomes for Respiratory Pharmacology
      1. List and describe the actions of the autonomic nervous system on bronchial smooth muscle and secretory mucosa, relating these actions to the microscopic structure of the airway.
      2. List and give mode of action of agents which induce bronchoconstriction and bronchosecretion.
      3. Outline the consequences of antigen interaction with fixed mast cell antibody and the actions of mediators released from mast cells.
  • Medical knowledge: EPIDEMIOLOGY
    • Respiratory Disease (inc. Tuberculosis)
      1. Outline the causes and social impact (in terms of mortality and morbidity) of a) airways disease; and b) respiratory infection
      2. Comment on the major social, environmental and occupational factors associated with pulmonary disease.
  • Clinical skills: DIAGNOSTIC PROCEDURES
    • Respiratory Function Tests
      1. Describe and demonstrate the use of a spirometer, to measure tidal volume, respiratory rate, inspiratory reserve volume, expiratory reserve volume and vital capacity.
      2. Name those lung volumes which cannot be measured using a spirometer and describe one method for their measurement.
      3. Describe and demonstrate the use of the Vitalograph to measure the FVC and FEV1. Define the terms forced vital capacity (FVC), Forced Expiratory Volume 1 (FEV1) and the ratio FEV1/FVC expressed as a percentage (FEV1 %).
      4. Describe how the Vitalograph may be used to distinguish between restrictive and obstructive types of lung function disorders.
• General Outcomes for Renal and Urinary System
  • Medical knowledge: ANATOMY
    • Renal System and Urinary Tract
      1. Outline the general organisation of the urinary system including the kidney, ureter, bladder and urethra
      2. Describe the vasculature of the kidney, relating its unique features to the physiology of urine production and nourishment of the nephron
      3. Identify the parts of the nephron and describe the role of each component in the physiologic processes involved in urine production
  • Medical knowledge: PHYSIOLOGY
    • Renal Function
      1. Describe the vasculature of the kidney, relating its unique features to the physiology of urine production and nourishment of the nephron
      2. Identify the parts of the nephron and describe the role of each component in the physiologic processes involved in urine production
      3. Identify the components of the juxtaglomerular apparatus and describe its role in regulation of blood and urine volumes and renal homeostasis.
      4. Briefly describe the autoregulation of GFR under normal circumstances and the significance of a reduced GFR.
• Asthma (Priority 1*)
  • General Outcomes for Asthma
    1. Explain, in terms of modes of action, how various agents can be used in the management of asthma, indicating possible side effects.
    2. Describe and demonstrate the use of a Peak Flow Meter to a patient. Be able to interpret the values obtained using charts and tables for normal values with respect to age, gender and height.
• Pneumothorax (Priority 2*)
  • General
    1. Define the terms, pneumothorax, spontaneous pneumothorax and tension pneumothorax and comment briefly on the management of these conditions.
• Nephrotic Syndrome and Glomerulonephritis
  • General Outcomes for Nephrotic Syndrome and Glomerulonephritis
    1. Know the different causes of oedema and explain the pathophysiology of each.

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