Modules

• Year 1
  • Introduction to Year 1 and Year Outcomes
  • Fundamentals of Medicine
  • Cardiorespiratory 1
  • Metabolism 1
  • Locomotor 1
  • Brain and Behaviour 1
  • Human Development 1
  • Medicine in Society 1
  • Clinical Communication Skills
  • Student Selected Component (SSC)
• 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
  • Cancer Week
  • Moving and Handling Training
  • Year 2 Lifesaver Programme
  • Clinical Communication Skills
  • Medicine in Society 2
  • Extended Patient Contact
  • Student Selected Component (SSC)
• Year 3
  • Introduction to Year 3 and Year Outcomes
  • Clinical Science and Professionalism (Weeks 1-3)
  • Cardiovascular, Respiratory and Haematology (CR3)
  • Gastroenterology and Cancer (MET3A)
  • Public Health
  • Endocrinology and Renal Medicine (MET3B)
  • General Practice and Community Care
  • Student Selected Component (SSC)
  • Clinical and Communication Skills
• Year 4
  • Introduction and Year 4 Outcomes
  • Obstetrics and Gynaecology
  • Child Health
  • HIV & Sexual Health
  • Musculoskeletal
  • Health Care of the Elderly
  • Neuroscience
  • Dermatology
  • General Practice and Community Care
  • Psychiatry
  • Ear, Nose and Throat
  • Global Health and Ethics
  • Ophthalmology
  • Clinical & Communication Skills
  • Student Selected Component (SSC)
• Year 5
  • Introduction to Year 5 and Year Outcomes
  • Teaching Week 1
  • Teaching Week 2
  • Anaesthesia & ITU (AN & ITU)
  • Breaking Bad News
  • Clinical Pharmacology & Therapeutics
  • Community Care
  • Doctors as Teachers and Educators (DATE)
  • Emergency Medicine (EMERG MED)
  • General (Internal) Medicine (G(I)M)
  • Immediate Life Support (ILS)
  • Student Assistantship
  • Simulation
  • Surgery
  • Student Selected Component (SSC)
• Year GEP 1
  • Cancer Week
  • Movement and Posture
  • Carriage of Oxygen
  • Human Sciences and Public Health
  • Digestion, Growth and Metabolism
  • Infection and Immunity
  • Ethics
  • Brain and Behaviour
  • Human Development
  • Clinical Communication Skills
  • Medicine in Society (GEP)

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Year 2 CR2: Cardiorespiratory 2

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

Teaching Material for this Module

Introduction

By the end of the course the student should understand

1) The structure and function of the heart in terms of how it relates to generating and maintaining cardiac output. The causes and major consequences of valvular heart disease. How electrical activity in the heart is initiated, how it is transmitted, and how it acts to produce efficient synchronised pumping. How to interpret a 12 lead ECG and do a rhythm analysis and a simple conduction analysis.

2) The anatomy and physiology of blood vessels, in particular the role of the endothelium of blood vessels.

3) The physiological mechanisms involved in the homeostasis of blood pressure and blood volume. The effects of hypertension, hypotension & haemorrhage.

4) The condition of clinical shock and how it may be managed

5) The common signs and causes of myocardial infarction.

6) Standard drug treatments for cardiovascular illness.

7) The anatomy and physiology of normal lungs and lung function. How lung function may be investigated; The nature of restrictive and obstructive lung diseases, and the consequences of each of these conditions.

8) Respiratory homeostasis of blood gases and pH and how these functions may be compromised in disease.

9) The signs and symptoms of lung cancer & tuberculosis, and the management of these conditions.

10) The common disorders of blood function including the anaemias and leukaemias

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Index

• General Outcomes for the Cardiovascular System
• General Outcomes for the Respiratory System
• General Outcomes for Haematology
• Acute Coronary Syndrome and Myocardial Infarction (Priority 1*)
• Valvular Heart Disease (Priority 2)
• Atherosclerosis and Arteriosclerosis / Lipid Disorders (Priority 2)
• Myocardial Disease / Cardiomyopathy (Priority 3)
• Asthma (Priority 1*)
• Chronic Obstructive Pulmonary Disease (COPD) (Priority 1*)
• Respiratory Failure (Priority 1*)
• Pulmonary Embolism (Priority 1*)
• Deep Vein Thrombosis (Priority 1)
• Chest Trauma and Haemothorax (Priority 3*)
• Anaemia (Priority 1)

• General Outcomes for the Cardiovascular System
  • Medical knowledge: ANATOMY (TD 8.1)
    • The Heart and Coronary Arteries
      1. Revise the gross anatomy of the heart and the great vessels.
      2. Relate myocardial infarction to the anatomy of the coronary circulation
      3. Know the surface markings of the heart (including apex and valves) and main vessels.
    • Blood and the Circulatory System
      1. Describe the anatomy of blood and lymphatic vessels.
    • Lymphatic System
      1. Describe the anatomy of blood and lymphatic vessels.
      2. Explain how lymph is formed and returned to the bloodstream.
      3. Describe the form and function of the lymph nodes, tonsils, thymus and spleen.
      4. Discuss the lymphatic drainage of the body and the anatomy of the major lymphatic ducts.
  • Medical knowledge: PHYSIOLOGY (TD 8.2)
    • General Cardiovascular Physiology
      1. Discuss the changes that occur in the cardiorespiratory system during exercise, and how these may be compromised in cases of cardiorespiratory disease
  • Medical knowledge: PATHOLOGY (TD 8.7)
    • Pathology of the Cardiovascular System - General
      1. Discuss and understand the pathological basis for atherosclerosis, myocardial infarction, mitral valve disease and aneurysm
  • Clinical skills: HISTORY (TD 13 a-b)
    • Examination of the Cardiovascular System
      1. Be confident in locating (via anatomical landmarks) and commenting on the strength of the following pulses: radial, brachial, carotid, popliteal, dorsalis pedis; posterior tibial
      2. Be able to describe the rate and rhythm of the radial and carotid pulses
      3. You should be able to take blood pressure competently on a normal person by first estimating the systolic pressure by palpation and then accurately measuring by auscultation.
      4. You should be able to recognise the pulsation of the normal JVP and assess its vertical height above the manubrio-sternal angle.
      5. You should be able to accurately locate the normal apex beat, and report on its location by standard anatomical landmarks.
      6. You should be able to auscultate the normal heart, and time the heart sounds with the pulse in your assessment of the cardiac cycle.
      7. You should be aware of the four main areas to auscultate, and the use of the bell and diaphragm of the stethoscope.
      8. You should be confident in recognising the first and second heart sounds, the systolic and diastolic spaces, by timing the cardiac cycle against a central pulse.
      9. You should be starting to put together your assessment of the pulse, peripheral pulses, blood pressure and cardiac examination to form an examination of the cardiovascular system.
  • Clinical skills: PLANNING AND INTERPRETING INVESTIGATIONS (TD 14 c-d)
    • Cardiovascular Imaging
      1. Understand the efficacy of cardiac imaging techniques, e.g. echocardiography, coronary angiography.
      2. Identify the basic features of a normal mediastinal silhouette and the basic features of cardiac pathologies in chest X-rays
    • Cardiovascular Investigations - General
      1. You should have an understanding of the 12-lead ECG, including lead placement and general principles behind what it assesses.
  • Clinical skills: DIAGNOSTIC PROCEDURES (TD 18 a)
    • Pulse and Respiration Measurements
      1. Be able to describe the rate and rhythm of the radial and carotid pulses
      2. You should be able to accurately locate the normal apex beat, and report on its location by standard anatomical landmarks.
      3. You should be able to auscultate the normal heart, and time the heart sounds with the pulse in your assessment of the cardiac cycle.
      4. You should be aware of the four main areas to auscultate, and the use of the bell and diaphragm of the stethoscope.
    • Blood Pressure
      1. You should be able to take blood pressure competently on a normal person by first estimating the systolic pressure by palpation and then accurately measuring by auscultation.
      2. You should be able to recognise the pulsation of the normal JVP and assess its vertical height above the manubrio-sternal angle.
• General Outcomes for the Respiratory System
  • Medical knowledge: ANATOMY (TD 8.1)
    • General Anatomy of the Thorax
      1. Revise the gross anatomy of the chest wall, the pleura, the lungs and bronchial tree
    • Pleural Cavity and Lungs
      1. You should know the surface markings of the normal lungs.
      2. Describe the surface anatomy of the lungs and relate this to auscultation and percussion
  • Medical knowledge: PATHOLOGY (TD 8.7)
    • General Outcomes for Respiratory Disorders
      1. Recognise and describe specific disease processes that affect the lung, relating pathological features to radiological changes.
  • Clinical skills: HISTORY (TD 13 a-b)
    • Examination of the Respiratory System
      1. You should be able to auscultate the lungs and recognise normal breath sounds.
      2. You should be putting together examination of the hands, pulse, JVP and lungs to conduct a systematic examination of the normal respiratory system.
  • Clinical skills: PLANNING AND INTERPRETING INVESTIGATIONS (TD 14 c-d)
    • Respiratory Imaging
      1. 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
  • Clinical skills: MAKING A DIAGNOSIS and CLINICAL JUDGEMENT (TD 14 e-f)
    • General Outcomes for Respiratory Diagnosis
      1. Identify the anatomical features of COPD, pneumonia, carcinoma and tuberculosis on pathological specimens and on radiographs
• General Outcomes for Haematology
  • Medical knowledge: PATHOLOGY (TD 8.7)
    • General Outcomes for Haematological Pathology
      1. Recognise abnormal features in blood films characteristic of white blood cell disorders.
  • Clinical skills: MAKING A DIAGNOSIS and CLINICAL JUDGEMENT (TD 14 e-f)
    • General Outcomes for Haematological Diagnosis
      1. Understand how the patient’s presentation, examination findings and other investigations including blood counts, complement microscopic analyses of blood films. Begin to interpret such information to form likely diagnoses in common conditions
• Acute Coronary Syndrome and Myocardial Infarction (Priority 1*)
  • Coronary Syndrome & Myocardial Infarction - General
    1. List the causes of myocardial ischaemia and infarction.
    2. Describe the changes in the coronary arteries that lead to myocardial ischaemia and infarction.
    3. Describe the pathological changes that occur in a heart undergoing infarction
  • Coronary Syndrome & Myocardial Infarction - Acute Management
    1. List the complications of myocardial infarction
• Valvular Heart Disease (Priority 2)
  • General Outcomes for Valvular Heart Disease
    1. Describe the structure of heart valves
    2. Discuss the structural changes that occur in valvular heart disease and how function is affected.
• Atherosclerosis and Arteriosclerosis / Lipid Disorders (Priority 2)
  • Atherosclerosis and Arteriosclerosis - General
    1. Describe the development of atherosclerosis
    2. Recognise the complications of atherosclerosis
    3. Describe the clinical symptoms and signs of coronary artery disease and their association with underlying pathology.
    4. Describe the prevention and treatment strategies for coronary artery disease, with particular attention paid to the mechanism of action of drugs.
    5. Identify common locations for atherosclerotic lesions and the consequences of these.
• Myocardial Disease / Cardiomyopathy (Priority 3)
  • Cardiomyopathy
    1. Define cardiomyopathy and know the types of cardiomyopathy
    2. Know the constraints that different cardiomyopathies pose on haemodynamics
    3. Know the current criteria that govern the classification of cardiomyopathies
• Asthma (Priority 1*)
  • General Outcomes for Asthma
    1. 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.
• Chronic Obstructive Pulmonary Disease (COPD) (Priority 1*)
  • General Outcomes for COPD
    1. Review normal lung function tests, and compare them with abnormal lung function tests from a patient with obstructive lung disease and restrictive lung disease
• 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.
• Pulmonary Embolism (Priority 1*)
  • General Outcomes for Pulmonary Embolism
    1. Describe the presentation and diagnosis of DVT and pulmonary embolism
    2. Discuss the treatment of DVT and pulmonary embolism and the prognosis in both conditions.
    3. Describe the newer anti-thrombotic agents, e.g. fondaparinux, direct thrombin inhibitors, antiplatelet drugs and thrombolytic agents
• Deep Vein Thrombosis (Priority 1)
  • General Outcomes for Deep Vein Thrombosis
    1. Describe the presentation and diagnosis of DVT and pulmonary embolism
    2. Discuss the treatment of DVT and pulmonary embolism and the prognosis in both conditions.
    3. Describe the newer anti-thrombotic agents, e.g. fondaparinux, direct thrombin inhibitors, antiplatelet drugs and thrombolytic agents
• Chest Trauma and Haemothorax (Priority 3*)
  • General
    1. Understand the extent of the pleural cavity and the consequences of pleural injuries
• Anaemia (Priority 1)
  • General Outcomes for Anaemia
    1. Revise abnormal features in blood films characteristic of anaemias.

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