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CARDIORESPIRATORY: Respiratory System

Index

• General Outcomes for the Respiratory System
• Asthma (Priority 1*)
• Chronic Obstructive Pulmonary Disease (COPD) (Priority 1*)
• Respiratory Failure (Priority 1*)
• Pneumonia (Priority 1)
• Pulmonary Embolism (Priority 1*)
• Deep Vein Thrombosis (Priority 1)
• Oxygen Therapy (Priority 1*)
• Carcinoma of the Bronchus (Priority 2)
• Pulmonary Tuberculosis (Priority 2)
• Pleural Effusion and Pleural Disease (Priority 2)
• Pneumothorax (Priority 2*)
• Chest Trauma and Haemothorax (Priority 3*)
• Bronchiectasis and Cystic Fibrosis (Priority 3)
• Sarcoidosis (Priority 3)
• Interstitial Lung Disease (Priority 3)
• Obstructive Sleep Apnoea (Priority 3)
• Pulmonary Hypertension (Priority 3)
• Occupational Lung Disease (Priority 3)

• General Outcomes for the Respiratory System
  • Medical knowledge: ANATOMY
    • Pleural Cavity and Lungs
      1. Identify the components of the respiratory mucous membrane. (CR1, GEP/CO2)
      2. Describe the surface anatomy of the lungs and relate this to auscultation and percussion (CR2)
      3. You should know the surface markings of the normal lungs. (CR2)
      4. Describe the positions of the lobes of the lungs. (CR2)
      5. Explain the functional anatomy of the pleura (CR2)
      6. Describe the structure and innervation of the lungs and bronchi (CR1)
      7. Describe the structure and function of the pleurae (CR1)
      8. Identify the lobes of each lung and describe the pattern of division of bronchi entering the lobes. (CR1)
      9. Examine the extent of the pleural cavity differentiating between visceral and parietal pleura. (CR1)
    • 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. (CR1)
      2. Revise the bony thorax, the lungs, and the neuronal control of breathing. (CR2)
      3. Revise the gross anatomy of the chest wall, the pleura, the lungs and bronchial tree (CR2)
      4. Describe the parts of a typical thoracic vertebra. (CR1)
      5. Describe the attachments of the diaphragm. Identify the main structures passing through it and note their vertebral levels. (CR1)
      6. Describe the attachments and neurovascular bundle of a typical intercostal space. (CR1)
    • Muscles of the Thoracic Wall and Respiration
      1. Describe the arrangement of an intercostal space (CR1)
      2. Name the major and accessory muscles involved in inspiration (CR1)
      3. Trace the flow of air from the nose to the alveoli (CR1)
    • Larynx and Trachea
      1. Describe the structure and position of the trachea. (CR1)
      2. Understand the cartilaginous and bony skeleton of the larynx. (CR1)
      3. Identify some of the important membranes and intrinsic muscles of the larynx. (CR1)
    • Nasal Cavity and Sinuses
      1. Identify the important structures within the nasal cavity. (CR1)
  • Medical knowledge: PHYSIOLOGY
    • Lung Mechanics
      1. List the components of the total work of breathing (CR2, GEP/CO2)
      2. Outline the relationships between the lungs, pleura, chest wall and diaphragm. (CR1, GEP/CO2)
      3. Define the term compliance, as applied to the lungs (or chest wall). Comment on the significance of surface tension forces and the role of pulmonary surfactant. (CR2, GEP/CO2)
      4. Compare and contrast the structure of conducting components of the respiratory system and relate their structural differences to differing functions. (CR1, GEP/CO2)
      5. Explain why a negative pressure exists in the (potential) pleural space (CR1, GEP/CO2)
      6. Identify the respiratory components of the lung and understand their functions. (CR1, GEP/CO2)
      7. Explain the relationship between airflow, airway calibre and airway resistance at different levels in the respiratory tree and name two conditions which may significantly affect the work of breathing. (CR2, GEP/CO2)
      8. Show, by means of graphs how the main components of the work of breathing contribute to the total work done in normal, tidal ventilation. (CR2, GEP/CO2)
      9. Explain why alterations to lung recoil (in for example emphysema and pneumonia) may produce alterations to the shape of the chest. (CR1, GEP/CO2)
      10. Show, by means of simple diagrams, how the ribs move during breathing. (CR1, GEP/CO2)
      11. List the muscles active in a) quiet breathing; and b) vigorous breathing. (CR1, GEP/CO2)
    • 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. (CR1, CR2, GEP/CO2)
      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. (CR1, CR2, GEP/BB, GEP/CO2)
      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. (CR1, CR2, GEP/CO2)
    • Physiological Adaptation to Altitude
      1. Explain the changes in the atmospheric and alveolar partial pressures during accent to high altitude. (11/12 Arch)
      2. Describe the chemical/physical changes to blood expected in high altitude acclimation. (11/12 Arch)
      3. Explain the acid base disturbance common in rapid accent to high altitude. (11/12 Arch)
      4. Outline the changes in the control of respiration at altitude. (11/12 Arch)
      5. Outline the pharmacological approach to altitude sickness (11/12 Arch)
    • Ventilation and Perfusion
      1. Outline the responses of bronchiolar and arteriolar smooth muscle which maintain a balance between ventilation of the alveoli and blood flow (perfusion) to the alveoli in normal conditions. (CR2, GEP/CO2)
      2. Define the term ventilation to perfusion ratio (Va/Q); give values for the whole lung, the base, and apex in a normal subject in the upright position, explaining why these differ. (CR2, GEP/CO2)
      3. Illustrate, by means of diagrams, how the perfusion of the lung may be considered as a ‘three zone model’. (CR2)
      4. Comment briefly on the effects, on blood passing through the lungs, of a high or a low Va/Q. (CR2, GEP/CO2)
    • 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. (CR1, GEP/CO2)
      2. Name those lung volumes which cannot be measured using a spirometer and describe one method for their measurement. (CR1, GEP/CO2)
      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 %). (CR1, GEP/CO2)
      4. Describe how the Vitalograph may be used to distinguish between restrictive and obstructive types of lung function disorders. (CR1, GEP/CO2)
    • The Lungs and Pulmonary Circulation
      1. Explain how the pulmonary and systemic circulations differ in terms of pressure and other factors (CR1, GEP/CO2)
      2. Explain the changes that occur in the pulmonary circulation at birth (CR1, GEP/CO2)
    • General Outcomes for Respiratory Physiology
      1. List the functions of the respiratory system. (CR1)
      2. Name the main structural features of the lungs. (CR1)
      3. Distinguish between respiratory and non-respiratory components of the lungs and show how histological features are related to function. (CR1)
      4. Describe the branching pattern of the respiratory tree, commenting on the significance of the cross-sectional area at different levels. (CR1)
    • Carriage of Gases
      1. Describe the unique features of haemoglobin that make it able to transfer oxygen from lungs to tissues. (GEP/CO2)
      2. By means of an annotated diagram, show how red blood cells are involved in the transport of carbon dioxide. (GEP/CO2)
      3. Show, by means of graphs, the contributions of dissolved carbon dioxide, bicarbonate ion and carbamino-Hb to carbon dioxide transport in arterial and venous blood. (GEP/CO2)
      4. Explain how the allosteric properties of haemoglobin may affect oxygen binding (the Bohr effect) and carbon dioxide transport (the Haldane effect). (GEP/CO2)
    • 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. (CR1, GEP/CO2)
      2. Know what pulmonary surfactant is, where is it produced and why is it important. (CR1, GEP/CO2)
      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. (CR1, GEP/CO2)
      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. (CR1)
      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. (CR1, GEP/CO2)
      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. (CR1, GEP/CO2)
    • 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? (CR1, CR2, GEP/CO2)
      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. (CR1, CR2, GEP/CO2)
      3. Name the FOUR simple classes of acid-base disturbance, stating the primary disturbance and the form of compensation for each class. Comment on the time scale for renal as compared with respiratory compensation and give ONE clinical cause for each class. (GEP/CO2, GEP/DGM, MET2)
    • Renal Function
      1. Outline the role of hydrogen carbonate, phosphate and ammonium ions in the renal excretion of acid, noting the relationship between tubular pCO2, hydrogen carbonate reabsorption and proton excretion (GEP/CO2, GEP/DGM, MET2)
      2. Name the FOUR simple classes of acid-base disturbance, stating the primary disturbance and the form of compensation for each class. Comment on the time scale for renal as compared with respiratory compensation and give ONE clinical cause for each class. (GEP/CO2, GEP/DGM, MET2)
  • Medical knowledge: BIOCHEMISTRY (inc. Metabolism)
    • Acid-Base Balance
      1. Define 'pH' and state the normal range for arterial pH and the range compatible with life. Comment on the differences between normal arterial and mixed venous pH values. (GEP/CO2, GEP/DGM, MET2)
      2. List the sources of bodily acid and comment on the ways in which acid is removed from the body, noting the relative importance of lungs and kidneys (GEP/CO2, GEP/DGM, MET2)
      3. List the principal buffer systems in plasma, extra- and intra-cellular fluid and bone (GEP/CO2, GEP/DGM, MET2)
      4. State the Henderson-Hasselbalch equation for the hydrogen carbonate/carbonic acid buffer system and give normal values for each component. Explain why the hydrogen carbonate/carbonic acid buffer system is important (GEP/CO2, GEP/DGM, MET2)
      5. In terms of the ratio of base to acid and of absolute values of base and acid, explain the processes of buffering, compensation and correction in acid-base disturbance (GEP/CO2, GEP/DGM, MET2)
      6. Define the terms 'acidosis', 'alkalosis', 'acidaemia' and 'alkalaemia'. Outline how a sample of arterial blood may be used to determine the acid-base status of a patient (GEP/CO2, GEP/DGM, MET2)
      7. Outline the role of hydrogen carbonate, phosphate and ammonium ions in the renal excretion of acid, noting the relationship between tubular pCO2, hydrogen carbonate reabsorption and proton excretion (GEP/CO2, GEP/DGM, MET2)
      8. Name the FOUR simple classes of acid-base disturbance, stating the primary disturbance and the form of compensation for each class. Comment on the time scale for renal as compared with respiratory compensation and give ONE clinical cause for each class. (GEP/CO2, GEP/DGM, MET2)
  • Medical knowledge: PATHOLOGY
    • General Outcomes for Respiratory Disorders
      1. Recognise and describe specific disease processes that affect the lung, relating pathological features to radiological changes. (CR2)
      2. Describe the neurological pathways involved in the sensation of breathlessness (CR2)
      3. Discuss the differentiation between obstructive and restrictive lung disease. (CR2)
      4. Discuss the natural history and prognosis of obstructive and restrictive lung conditions (CR2)
      5. Explain the basic anatomical changes in some common lung pathologies and how they are identified in a chest X-ray. (CR2)
  • Medical knowledge: CLINICAL FEATURES of DISEASE
    • General Outcomes for Respiratory Disorders
      1. Describe examples and causes of the common obstructive and restrictive lung diseases (CR2)
      2. Describe clinical symptoms and signs that are associated with the obstructive and restrictive lung diseases (CR2)
  • 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. (CR1, GEP/CO2)
      2. List and give mode of action of agents which induce bronchoconstriction and bronchosecretion. (CR1, GEP/CO2)
      3. Outline the consequences of antigen interaction with fixed mast cell antibody and the actions of mediators released from mast cells. (CR1, GEP/CO2)
  • 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 (CR1)
      2. Comment on the major social, environmental and occupational factors associated with pulmonary disease. (CR1)
  • Clinical skills: HISTORY and EXAMINATION
    • Examination of the Respiratory System
      1. You should be able to auscultate the lungs and recognise normal breath sounds. (CR2)
      2. You should be putting together examination of the hands, pulse, JVP and lungs to conduct a systematic examination of the normal respiratory system. (CR2)
  • Clinical skills: INVESTIGATION
    • Lung Function Testing
      1. Explain the importance of lung function testing, especially spirometry, in the diagnosis of lung disease. (CR2)
      2. Discuss the limitations of current tests and how the technique of performing the tests may affect the results, with understanding of how individuals are compared to equivalent populations. (CR2)
      3. Discuss the abnormalities seen in asthma and COPD where there is an obstructive defect, and the patterns of obstruction and restriction and their causes. (CR2)
      4. Discuss other tests of respiratory function, including exercise testing and their use in assessing operative risk. (CR2)
  • Clinical skills: IMAGING
    • Respiratory Imaging
      1. Describe the basic features of a normal chest X-ray. (CR2)
      2. Explain the basic anatomical changes in some common lung pathologies and how they are identified in a chest X-ray. (CR2)
      3. Describe a normal chest x-ray, and compare this with chest x-rays from patients with lung cancer, tuberculosis, Chronic Obstructive Pulmonary Disease and pneumothorax (CR2)
  • Clinical skills: DIAGNOSIS and REASONING
    • General Outcomes for Respiratory Diagnosis
      1. Identify the anatomical features of COPD, pneumonia, carcinoma and tuberculosis on pathological specimens and on radiographs (CR2)
  • 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. (CR1, GEP/CO2)
      2. Name those lung volumes which cannot be measured using a spirometer and describe one method for their measurement. (CR1, GEP/CO2)
      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 %). (CR1, GEP/CO2)
      4. Describe how the Vitalograph may be used to distinguish between restrictive and obstructive types of lung function disorders. (CR1, GEP/CO2)
  • Clinical skills: PATIENT MANAGEMENT
    • General Outcomes for Respiratory Disorders
      1. Discuss how variable the symptom of breathlessness may be, and how it may or may not correlate with other tests of lung function. (CR2)
      2. Describe the effects of airway resistance, chest wall loading and chest wall stiffness on breathlessness; describe the ways in which we may treat this sensation (CR2)
• Asthma (Priority 1*)
  • General Outcomes for Asthma
    1. List the clinical features of bronchial asthma (CSP3)
    2. Describe the underlying pathology in asthma and its effect on airway function. (CR2)
    3. Describe the aetiology, pathophysiology, morphology and pathological consequences of asthma (CR3)
    4. Discuss how asthma is defined, diagnosed and the measurements used in its management and diagnosis. (CR2)
    5. Give a differential diagnosis for a wheeze (CR3)
    6. Describe symptoms and signs of poorly controlled asthma (CR3)
    7. List the types and triggers of bronchial asthma (CSP3)
    8. Discuss the various triggers that can affect an asthmatic and the effect on their airways and lung function. (CR2)
    9. Explain the two phases of asthma and how bronchial hyper-responsiveness is documented (CSP3)
    10. Describe the changes that occur in severe asthma and its danger to the patient. (CR2)
    11. Describe investigations that can be used to confirm the diagnosis of asthma including the diagnosis of allergy (CR3)
    12. Explain the role of mast cells, eosinophils, dendritic cells, B lymphocytes and CD4 Th1 and CD4 Th2 T-lymphocytes in asthma (CSP3)
    13. Explain, in terms of modes of action, how various agents can be used in the management of asthma, indicating possible side effects. (CR1, GEP/CO2)
    14. Describe the mechanism of action, place in therapy and major side effects of asthma treatments including: long / short acting beta2 agonists, corticosteroids, leukotriene antagonists and anti-IgE. (CR3)
    15. Explain the role of IgE, Fcel1, FceRII, IL2, IL3, IL4, IL5, IL13, GMCSF gamma interferon, histamine, leukotrienes, cytokines, adhesion molecules and the Th1/Th2 paradigm (CSP3)
    16. Explain the rationale behind the stepwise approach used in asthma management and demonstrate use of the British Thoracic Society (BTS) guidelines and Scottish Intercollegiate Guidelines Network (SIGN) guidelines to choose treatments for asthma (CR3)
    17. List environmental and genetic factors predisposing to or protecting from asthma (CSP3)
    18. Explain the role of the specialist nurse practitioners and self management plans in the management of asthma (CR3)
    19. Explain to a patient the difference between a reliever and preventer inhaler and the use of each in asthma management (CR3)
    20. Demonstrate the use of a metered dose inhaler with and without a spacer to a patient (CR3)
    21. 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. (CH4, CR1, CR2, CR3, GEP/CO2)
    22. Explain how clinical features can be used to determine if an attack is an acute severe asthma attack, a life-threatening asthma attack, brittle asthma or near fatal asthma (CR3)
    23. Be able to recognise differences and similarities in the management of asthma and COPD (CR3)
  • Acute Asthma
    1. List precipitating factors for an asthma attack (CR3)
    2. Describe the emergency management of asthma in a person presenting to the accident and emergency department and indications for admission (CR3)
    3. Discuss the role of intensive care in managing an acute asthma attack (CR3)
    4. Describe how a patient with acute asthma should be monitored following admission to hospital (CR3)
    5. Describe measures that should be taken prior to hospital discharge to prevent asthma recurrence (CR3)
• Chronic Obstructive Pulmonary Disease (COPD) (Priority 1*)
  • General Outcomes for COPD
    1. List symptoms experienced by people with COPD (CR3)
    2. Describe the clinical signs found in people with COPD (CR3)
    3. Give a differential diagnosis for exertional breathlessness (CR3)
    4. Review normal lung function tests, and compare them with abnormal lung function tests from a patient with obstructive lung disease and restrictive lung disease (CR2)
    5. Give five most common causes of cough (CR3)
    6. Describe the pathology of COPD (CR3)
    7. List causes of COPD (CR3)
    8. Describe how a patient's 'pack years' are calculated (CR3)
    9. Describe the role of spirometry in diagnosing and measuring the severity of COPD (CR3)
    10. Describe the purpose and expected findings of other investigations including chest X-Ray, full blood count and arterial blood gases in a patient with COPD (CR3)
    11. Explain the rationale behind the stepwise approach to COPD management and demonstrate use of the British Thoracic Society guidelines and NICE guidelines on COPD and the BNF to choose drugs for COPD (CR3)
    12. List drugs that can be used to aid smoking cessation and give evidence for their effectiveness (CR3)
    13. Give smoking cessation advice to a patient (CR3)
    14. Explain the mechanism of action and major side effects of bronchodilators, corticosteroids, theophylline in the management of COPD. Use BRAINS&AIMS when choosing, giving and monitoring the drugs. (CR3)
    15. Describe the roles of specialist nursing, physiotherapy and pulmonary rehabilitation in the management of COPD (CR3)
    16. Describe the role of long term oxygenation therapy in COPD (CR3)
    17. List complications of COPD and describe their investigation and management (CR3)
  • Acute Exacerbations of COPD
    1. Describe the clinical features (symptoms and signs) of an acute exacerbation of COPD (CR3)
    2. Give a differential diagnosis for increased breathlessness in a patient with COPD (CR3)
    3. Describe the investigation of a patient presenting with an acute exacerbation of COPD (CR3)
    4. Describe the emergency management of a patient with an acute exacerbation of COPD (CR3)
    5. Describe how you would determine what concentration of oxygen to administer to a patient with COPD (CR3)
    6. List organisms that may cause pulmonary infection in patients with COPD (CR3)
    7. Discuss the choice of antibiotics for treatment of an acute exacerbation of COPD (CR3)
• Respiratory Failure (Priority 1*)
  • General Outcomes for Respiratory Failure
    1. Describe the clinical feature of hypoxia and hypercapnia, and the difference between patients who are pink and puffing and blue and bloated. (CR2)
    2. Describe the pathological consequences of hypoxia and hypercapnoea (CR3)
    3. Define Type 1 and Type 2 respiratory failure (CR3)
    4. Discuss the benefits of supplemental oxygen therapy in patients with acute and acute on chronic respiratory failure, and describe any precautions necessary in administering therapy. (CR2)
    5. Describe findings on arterial blood gas analysis in Type 1 and 2 respiratory failure (CR3)
    6. Explain the importance of correcting hypoxia in respiratory failure (CR3)
    7. Describe the different devices uses to enrich the oxygen content of inspired air, including nasal prongs, ventimasks and reservoir masks (CR3)
    8. Discuss the choice of inspired oxygen concentration in respiratory failure (CR3)
    9. Explain why oxygen replacement can cause deterioration or improvement in a patient with respiratory failure (CR3)
    10. Describe treatment options for patients with ventilatory failure including: non-invasive ventilation; continuous positive airways pressure (CPAP); bi-phasic positive airways pressure (biPAP); invasive ventilation (CR3)
    11. Discuss situations in which treatment may not be appropriate for ventilatory failure and describe palliative measures that could be used to relieve symptoms in these patients (CR3)
  • Type 1 Respiratory Failure
    1. Explain how matching of ventilation and perfusion is achieved in the normal lung (CR3)
    2. Describe the pathogenesis of Type 1 respiratory failure (CR3)
    3. List causes of Type 1 respiratory failure (CR3)
    4. Describe symptoms and signs of Type 1 respiratory failure (CR3)
  • Type 2 Respiratory Failure
    1. Describe the normal mechanical process of ventilation (CR3)
    2. Describe the normal process of control of breathing (CR3)
    3. Describe the pathogenesis of Type 2 respiratory failure (CR3)
    4. List causes of Type 2 respiratory failure (CR3)
    5. Describe symptoms and signs of Type 2 respiratory failure (CR3)
• Pneumonia (Priority 1)
  • General Outcomes for Respiratory Tract Infections
    1. Describe the nature of viruses and the main therapeutic interventions against viral disease. (CR2)
    2. Discuss the importance of lower respiratory tract infections as a cause of morbidity and mortality, both in the hospital and community setting. (CR2)
    3. Describe the main causes of lower respiratory tract infections. (CR2)
    4. Discuss the effect of viruses on pre-existing respiratory conditions. (CR2)
    5. Explain how to diagnose and treat lower respiratory tract infections. (CR2)
    6. Explain why emerging viruses are such a threat. (CR2)
  • Pneumonia - General
    1. Describe symptoms and signs of pneumonia (CR3)
    2. Compare and contrast lobar pneumonia and bronchopneumonia with particular reference to clinical features, pathogenesis, macroscopic appearance and complications (CR3)
    3. Describe the physiological processes important for normal lung defence from infection (CR3)
    4. Pneumonia: severity (CURB-65 score), guidelines, choice of antimicrobials (CSP3)
    5. List pulmonary, immunological or other conditions which predispose patients to pulmonary infection (CR3)
    6. Name the principal organisms that cause pneumonia in a) immuno-competent people b) immuno-compromised people, and c) people in hospitals and institutions (CR3)
    7. Describe what is meant by atypical pneumonia. Name the principle organisms that cause "atypical" lower respiratory tract infections and describe the associated morphological changes (CR3)
    8. Describe the clinical features (signs and symptoms) that suggest an atypical organism is responsible for lower respiratory tract infections (CR3)
    9. Describe the investigation of a patient with pneumonia (CR3)
    10. Explain how organisms causing lower respiratory tract infections are differentiated and identified by culture and microscopy (CR3)
    11. Name antibiotics likely to be effective against each of the major respiratory pathogens (CR3)
    12. Explain how the correct drug is chosen for lower respiratory tract infections (CR3)
    13. Describe routes of administration by which antibiotics can be given and state when each route should be used (CR3)
    14. Describe the major adverse consequences of antibiotics used in the treatment of LRTI a) for the individual, and b) for society (CR3)
    15. Know the indications for vaccination against the following: a) influenza b) pneumococcus and c) mycobacterium tuberculosis (CR3)
    16. Describe the typical X-ray features of lobar pneumonia, bronchopneumonia and atypical pneumonia (CR3)
  • Pneumonia - Emergency Management
    1. Describe clinical features that differentiate mild, moderate and severe pneumonia; know about the use of CURB 65 (CR3)
    2. Explain how and why management differs in those with mild, moderate and severe pneumonia (CR3)
    3. Give reasons for hospital admission with pneumonia (CR3)
• Pulmonary Embolism (Priority 1*)
  • General Outcomes for Pulmonary Embolism
    1. Describe symptoms and signs of pulmonary embolus (CR3)
    2. Give a differential diagnosis for pleuritic chest pain (CR3)
    3. Discuss the causes and predisposing factors of DVT and pulmonary embolism. (CR2)
    4. Explain how clinical history and examination can be used to distinguish between causes of pleuritic chest pain (CR3)
    5. Describe the presentation and diagnosis of DVT and pulmonary embolism (CR2)
    6. Describe the differential diagnosis of those conditions which present with similar symptoms (other than pleuritic chest pain) to PE (CR3)
    7. Discuss the treatment of DVT and pulmonary embolism and the prognosis in both conditions. (CR2)
    8. Describe the role of D-Dimer, CXR, ECG, V/Q Scanning, Spiral CT Scanning and Pulmonary Angiogram in the diagnosis of pulmonary embolus (CR3)
    9. Describe the newer anti-thrombotic agents, e.g. fondaparinux, direct thrombin inhibitors, antiplatelet drugs and thrombolytic agents (CR2)
    10. Describe the clinical features of massive pulmonary embolism (CR3)
    11. Describe the relationship between DVT and pulmonary embolism. (CR2)
  • Acute Emergency
    1. Describe the investigation of a patient with suspected massive pulmonary embolism (CR3)
    2. Outline the management of a patient with a suspected massive pulmonary embolism (CR3)
    3. Discuss the advantages and disadvantages of thrombolysis and surgery in a patient with a massive pulmonary embolus (CR3)
• Deep Vein Thrombosis (Priority 1)
  • General Outcomes for Deep Vein Thrombosis
    1. Describe the anatomy of the lower limb venous system (CR3)
    2. Describe the pathological and physiological mechanisms leading to DVT and pulmonary embolism. (CR2)
    3. Describe the symptoms and signs of deep venous thrombosis (DVT) (CR3)
    4. Describe the presentation and diagnosis of DVT and pulmonary embolism (CR2)
    5. Give the differential diagnosis for calf swelling / tenderness (CR3)
    6. List risk factors for deep venous thrombosis and pulmonary embolus (CR3)
    7. Discuss the treatment of DVT and pulmonary embolism and the prognosis in both conditions. (CR2)
    8. Describe how investigations are used to confirm or refute the diagnosis of a deep vein thrombosis (CR3)
    9. Describe the newer anti-thrombotic agents, e.g. fondaparinux, direct thrombin inhibitors, antiplatelet drugs and thrombolytic agents (CR2)
    10. Describe the mechanism of action, place in therapy and major side effects of heparin and warfarin in the treatment of DVT and pulmonary embolus (CR3)
    11. Counsel a patient regarding avoidance of drugs, foods and alcohol whilst taking Warfarin (CR3)
    12. Describe the physiological and pathological processes that occur in a post-thrombotic limb; explain how these may lead to venous insufficiency and ulceration (CR3)
    13. Describe the management of a post-thrombotic limb and of venous ulceration (CR3)
    14. Explain when hospital in-patients shoud receive prophylaxis against DVT and describe how this is done (CR3)
    15. Advise a patient on DVT / PE prophylaxis during travel e.g. a long haul flight (CR3)
    16. Describe the relationship between DVT and pulmonary embolism. (CR2)
• Oxygen Therapy (Priority 1*)
  1. Learn about oxygen transport and the oxygen dissociation curve (CR3)
  2. Describe methods of oxygen delivery for patients both in hospital and in the community (CR3)
  3. Describe how to decide how much oxygen to prescribe (CR3)
  4. Describe the role of controlled versus high flow oxygen in patients with COPD and asthma (CR3)
• Carcinoma of the Bronchus (Priority 2)
  • General Outcome for Lung Cancer
    1. List the factors that cause lung cancer and explain how lung cancer can be prevented (CR3)
    2. Describe the mortality associated with lung cancer and how this has changed over time. (CR2)
    3. Discuss the important causes of lung cancer, and recognise preventative strategies. (CR2)
    4. Describe the epidemiology of lung cancer (CR3)
    5. Describe the different histological types of lung cancer, spread of lung cancer and prognostic features. (CR2)
    6. Provide a histological classification of lung cancer (CR3)
    7. Describe the common presenting features of lung cancer and some of the difficulties of diagnosis. (CR2)
    8. List causes of haemoptysis (CR3)
    9. Explain why it is important to differentiate between small call and non-small cell forms of lung cancer (CR3)
    10. Discuss in outline the various treatments available for lung cancer. (CR2)
    11. Describe clinical presentations of lung cancer (CR3)
    12. Describe non-metastatic manifestations of lung cancer (CR3)
    13. Describe investigations used in the diagnosis of lung cancer (CR3)
    14. Learn about bronchoscopy in general and its usefulness in the diagnosis of lung cancer and other conditions (CR3)
    15. Explain how you would break the news that the patient has lung cancer (CR3)
    16. Discuss the role of the multi-disciplinary team in the treatment and support of a patient diagnosed with lung cancer (CR3)
    17. Describe the histological types of bronchial carcinoma in relation to mode of presentation including secretion of ACTH and ADH by small cell carcinoma and PTHrp by squamous carcinoma (CR3)
    18. Understand the role of surgery, chemotherapy, radiotherapy and palliative care in the management of bronchial carcinoma (CR3)
  • Carcinoma of the Bronchus
  • Non-small Cell Lung Cancer
    1. Describe specific clinical features and likelihood and common sites of metastasis of non-small cell cancer (CR3)
    2. Describe the clinical course and prognosis of patients with non-small cell lung cancer (CR3)
    3. Describe the management of non-small cell lung cancer if: a) operable; b) locally advanced; c) metastatic (CR3)
    4. Define adjuvant, neo-adjuvant and palliative treatment and list measures of each type (CR3)
    5. Discuss the side effects and expected benefits of each treatment for non-small cell lung cancer (CR3)
  • Small Cell Lung Cancer
    1. Describe specific clinical features and likelihood and common sites of metastasis of small cell lung cancer (CR3)
    2. Describe the clinical course and prognosis of patients with small cell lung cancer (CR3)
    3. Describe the management of small cell lung cancer if: a) locally advanced; b) metastatic (CR3)
    4. Discuss the side effects and expected benefits of each treatment for small cell lung cancer (CR3)
  • Palliative Care of Lung Cancer
    1. Explain how treatment may result in either improvement or deterioration in quality of life and discuss how treatment decisions are made (CR3)
    2. List symptoms experienced by patients dying of lung cancer and describe palliative measures which may be used to relieve each one (CR3)
    3. Describe the role of the palliative care home team in supporting patients dying at home and their families (CR3)
    4. Describe the role of the primary care team in the palliative care of terminal respiratory disease. (CR3)
• Pulmonary Tuberculosis (Priority 2)
  • Notification and contact tracing
  • General Outcomes for Pulmonary Tuberculosis
    1. Describe the nature of Mycobacterium tuberculosis and of other types of atypical mycobacterium. (CR2)
    2. Describe the symptoms of pulmonary tuberculosis (CR3)
    3. Describe how tuberculosis affecting organs other than the lung may present (CR3)
    4. Discuss epidemiological factors associated with tuberculosis, and differentiate between primary and post-primary disease. (CR2)
    5. Give a differential diagnosis for haemoptysis (CR3)
    6. Describe the presentation of tuberculosis, especially potential difficulties in diagnosis. (CR2)
    7. Describe the microbiology and pathogenesis of tuberculosis (CR3)
    8. Discuss changes in tuberculosis worldwide and in the UK over the past 100 years (CR3)
    9. Describe the tests required for a diagnosis of tuberculosis. (CR2)
    10. Discuss the management of tuberculosis, to include chemotherapy, contact tracing and BCG vaccination. (CR2)
    11. List conditions that predispose to tuberculosis and groups of people in whom tuberculosis should be strongly suspected (CR3)
    12. State features of diagnosis and treatment of infections with mycobacteria other than mycobacterium tuberculosis. (CR2)
    13. State features of diagnosis and treatment of infections with other mycobacteria. (CR2)
    14. Discuss the investigation and diagnosis of pulmonary and non-pulmonary tuberculosis (CR3)
    15. List key members of the multi-disciplinary team for the management of tuberculosis and describe their roles (CR3)
    16. Explain why patients with tuberculosis require treatment with multiple drugs and describe a typical treatment regime (CR3)
    17. List drugs used to treat tuberculosis and give major side effects for each; in addition understand the usefulness of using both bactericidal and bacteriostatic antibiotics (CR3)
    18. Describe measures which can be used to reduce or avoid drug side effects (CR3)
    19. Define adherence to treatment (CR3)
    20. List the consequences and discuss ethical and legal implications of non-adherence to anti-TB therapy (CR3)
    21. Describe the process of directly observed therapy (CR3)
    22. Be able to describe the elementary classification of mycobacteria (CR3)
    23. Be able to understand the difference between primary and post-primary tuberculosis (CR3)
    24. Discuss the purpose of TB notification and describe the processes whereby this is done (CR3)
    25. Recognise the radiological features of pulmonary tuberculosis (CR3)
    26. List the people in contact with a person with TB who should be traced (CR3)
    27. Describe the importance of tracing and investigating contacts in the control of TB and explain how this is done (CR3)
    28. List the indications for immunisation against TB and describe the vaccine used and its effectiveness (CR3)
• Pleural Effusion and Pleural Disease (Priority 2)
  • General
    1. Describe symptoms and signs of a pleural effusion (CR3)
    2. Differentiate clinical signs of a pleural effusion from those of pulmonary consolidation or collapse (CR3)
    3. Describe how pleural aspiration is done and list analyses that should be performed on the fluid obtained (CR3)
    4. Describe how pleural aspiration distinguishes between an exudate and a transudate and explain why this is important (learn Light's criteria) (CR3)
    5. List causes of an exudate and a transudate (CR3)
    6. Describe how investigations including chest X-Ray, pleural tap, pleural biopsy and CT chest can help to differentiate between causes of effusion (CR3)
    7. Describe how pleural effusions are managed medically and surgically (CR3)
    8. Learn about video assisted thoracoscopic biopsy (VATS) (CR3)
• Pneumothorax (Priority 2*)
  • General
    1. Describe symptoms and signs in those patients presenting with a pneumothorax (CR3)
    2. List causes and describe the pathogenesis of pneumothorax (CR3)
    3. Define the terms, pneumothorax, spontaneous pneumothorax and tension pneumothorax and comment briefly on the management of these conditions. (CR1, GEP/CO2)
    4. Describe investigations used to confirm the diagnosis of pneumotharax (CR3)
    5. Describe conservative, medical and surgical management of pneumothorax (CR3)
    6. Describe how an underwater chest drain is managed on a day to day basis on the ward (CR3)
    7. Describe the criteria used in order to remove a chest drain in a patient (CR3)
    8. Explain the chances of pneumothorax recurrence and activities to avoid to a young patient with a simple pneumothorax (CR3)
    9. Describe the role of smoking cessation in patients with pneumothorax (CR3)
  • Acute Tension Pneumothorax
    1. Describe the clinical features of a tension pneumotherax (CR3)
    2. Explain why a tension pneumothorax is life threatening (CR3)
    3. Describe the emergency management of a tension pneumothorax (CR3)
• Chest Trauma and Haemothorax (Priority 3*)
  • General
    1. List pulmonary and pleural complications of blunt, sharp and explosion related chest trauma (CR3)
    2. Describe how chest trauma is assessed as part of the Advanced Trauma Life Support (ATLS) protocol (CR3)
    3. Describe the extent of the pleural cavity and the consequences of pleural injuries (CR2)
    4. Describe the diagnosis of a haemothorax (CR3)
    5. Describe the management of a haemothorax (CR3)
• Bronchiectasis and Cystic Fibrosis (Priority 3)
  • General
    1. Describe the symptoms and signs of bronchiectasis (CR3)
    2. Cystic Fibrosis, Pseudomonas Aeruginosa, Staphylococcus Aureus, Physiotherapy, Ciproflaxacin, Flucloxacilin, DNAase, CFTR (FM1)
    3. Give a differential diagnosis for cough productive of sputum (CR3)
    4. Describe the pathology of bronchiectasis (CR3)
    5. List the causes of bronchiectasis including cystic fibrosis (CR3)
    6. List the signs and symptoms of cystic fibrosis (CR3)
    7. Describe the genetic mutation of cystic fibrosis and explain current theories as to how this leads to lung disease (CR3)
    8. Describe the pathological effect and clinical consequences of cystic fibrosis in non-pulmonary organs (CR3)
    9. Describe the investigations that can be used to confirm diagnosis of bronchiectasis and cystic fibrosis (CR3)
    10. List organisms that exacerbate bronchiectasis and cystic fibrosis and explain how you would choose an antibiotic for patients with exacerbations (CR3)
    11. Describe the role of physiotherapy in the management of cystic fibrosis (CR3)
    12. Describe nutritional problems in cystic fibrosis and discuss the management of these (CR3)
    13. Describe the impact of cystic fibrosis on the education of young people (CR3)
• Sarcoidosis (Priority 3)
  • General
    1. Describe symptoms and signs of sarcoidosis (CR3)
    2. Describe the pathological features of sarcoidosis (CR3)
    3. Describe how sarcoidosis affects a) the lungs and b) other tissues and organs (CR3)
    4. Describe clinical conditions which closely resemble sarcoidosis (CR3)
    5. Describe investigations that can be used to confirm the diagnosis of a) pulmonary and b) extra-pulmonary sarcoidosis (CR3)
    6. Describe treatment options for patients with sarcoidosis (CR3)
    7. Estimate the prognosis for patients with different presentations of sarcoidosis (CR3)
• Interstitial Lung Disease (Priority 3)
  • General
    1. Describe the symptoms and signs of interstitial lung disease (CR3)
    2. Give a differential diagnosis for finger clubbing (CR3, CR3, CR3)
    3. Describe investigations that can be used to confirm the diagnosis of interstitial lung disease (CR3)
    4. Describe the tests for gas transfer and their limitations and value, especially in interstitial lung disease. (CR2)
    5. Summarise the other causes of lung fibrosis including occupational dusts, sarcoidosis, extrinsic alveolitis, TB, connective tissue diseases and drugs (CR3)
    6. Describe which patients with interstitial lung disease should be referred for specialist management (CR3)
    7. Describe the role of steroids and immune-modulating drugs in the therapy of interstitial lung disease (CR3)
    8. Describe the symptoms and signs characteristic of a restrictive lung defect including the changes in lung function (CR3)
    9. Discuss the indications for a single lung or heart-lung transplant (CR3)
    10. Describe the linkages between medication and interstitial lung disease (CR3)
• Obstructive Sleep Apnoea (Priority 3)
  • General
    1. Describe symptoms experienced by a patient suspected of having sleep apnoea (CR3)
    2. Identify patients who may be suitable for referral to a sleep service (CR3)
    3. Discuss the difference between obstructive and central sleep apnoea (CR3)
    4. Explain to a patient what they can expect when undergoing a sleep study (CR3)
    5. Describe the treatments available for obstructive sleep apnoea including conservative measures, non-invasive ventilation and surgery (CR3)
    6. Discuss the complications of untreated sleep apnoea and describe how you would advise a patient with this condition regarding driving (CR3, CR3)
    7. Outline the causes of sleep apnoea in children and adults (CR3)
    8. Describe the clinical features of sleep apnoea in a child (CR3)
• Pulmonary Hypertension (Priority 3)
  • General
    1. Describe the differences, including pressure differences, between the systemic and pulmonary circulation, and left and right sides of the heart (CR3, CR3, CR3, CR3, CR3, CR3)
    2. List causes of pulmonary hypertension, particularly other systemic conditions (CR3)
    3. Outline investigations that can be used to confirm the diagnosis of pulmonary hypertension (CR3)
    4. Describe which patients with pulmonary hypertension should be referred for specialist management (CR3)
• Occupational Lung Disease (Priority 3)
  • General Outcomes for Occupational Lung Disease
    1. Describe measures that can be taken to prevent occupational lung disease (CR3)
    2. Give examples of occupational exposures that cause a) asthma, b) extrinsic allergic alveolitis, c) fibrosis, d) pulmonary malignancy (CR3, CR3, CR3, CR3)
  • Asbestos Related Lung Disease
    1. List occupations that have a high chance of asbestos exposure (CR3)
    2. Describe the pulmonary consequences of asbestos exposure (CR3)
    3. Describe investigations that can be used to confirm the diagnosis of asbestos-related lung disease (CR3)
    4. Learn about the patient categories with asbestos-related lung disease who are entitled to compensation (CR3)
  • Mesothelioma
    1. Learn about the clinical symptoms and signs of mesothelioma (CR3)
    2. Learn about how mesothelioma is diagnosed (CR3)
    3. Describe the role of the primary care team in the palliative care of terminal respiratory disease (CR3, CR3, CR3, CR3)

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