Sydney Medical Program GDMP2013
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Sydney Medical Program GDMP2013 STAGE 1 ESSENTIAL READINGS BLOCK 3: RESPIRATORY SCIENCES Copyright © 2008 Sydney Medical Program, University of Sydney Complied by T. M. Melhuish for SUMS LEARNING TOPIC S - BLOCK 3 RESPIRATORY SCIENCES 3.01 - Not At Fault // Chest Trauma & Pneumothorax pg 1 1. The Thoracic Wall And Lower Respiratory Tract 2. Thoracic Trauma 3. Pleural Structure And Function 4. Communication With Patients, Police, Family In 3.05 - Sleeping On The Job // Sleep Aponea & Respiratory Emergencies Failure pg 36 5. Posttraumatic Stress Syndrome 1. Neurobiological Consequences Of Sleep Loss 6. Autonomic Nervous System In The Thorax 2. Human Chronobiology 7. Pneumothorax 3. Autonomic Nervous System (Ans) 3.02 - Wheezing And Breathless // Asthma pg 9 4. Movement Disorders In Sleep 1. Mechanisms Of Wheezing 5. Pulmonary Circulation & Adaptation To Chronic Hypoxia 2. Atopy 6. Sedatives And Stimulants - New In 2012 3. Respiratory Infections In Infants 3.06 - A Different Cause Of Cough // Cystic Fibrosis pg 43 4. Clinical Features Of Asthma 1. Mechanisms Of Cough 5. Asthma - A National Health Priority 2. Molecular Genetics Of Cystic Fibrosis 6. Management Of Asthma 3. Bronchiectasis 7. Atopic Eczema 4. Prognosis In Cystic Fibrosis 8. Pathology Of Asthma 5. Management Of Cystic Fibrosis 3.03 - A Nasty Cough // Acute Exacerbation Of COPD pg 19 6. Dna Mutation Analysis 1. Tobacco Addiction 7. Antibiotics In Respiratory Disease 2. Pharmacology Of Nicotine 8. Recurrent Illness And Psychosocial Development 3. Public Health Policy In Tobacco Control 3.07 - Difficult Circumstances // Pneumonia & Otitis 4. Risk Reduction Following Cessation Of Smoking Media pg 53 5. Ethical Dilemmas In Tobacco Control Policy 1. Ear Infections 6. Chronic Obstructive Pulmonary Disease 2. Function Of The Ear 7. Pulmonary Rehabilitation With Focus On Copd 3. Growth And Nutrition In Indigenous Children 3.04 - Ex-Navy // Interstitial Lung Disease pg 27 4. Acute Respiratory Infection In Indigenous Children 1. Mechanisms Of The Sense Of Breathlessness 5. Management Of Pneumonia 2. The Gas Exchange Unit: Structure 6. Epidemiology Of Respiratory Infection 3. Interstitial Lung Disease 7. Causes Of Deafness 4. Mechanisms Of Lung Inflammation 5. Occupational Disability And Impairment 6. Compliance Of The Chest Wall And Lungs 7. Transport Of Oxygen And Carbon Dioxide 8. Blood Gas Analysis I 3.01 - NOT AT FAULT // CHEST TRAUMA & PNEUMOTHORAX LEARNING OBJECTIVES Description Disciplines Revise practical notes on upper limb, lower limb and back Identify gaps in knowledge, revise and self-test Anatomy Attempt self-test questions in class (with answers) The organisation of the neural innervations of the pleurae and lungs Anatomy To develop understanding of the structural organisation of the thoracic wall, breast and thoracic cavity; to understand structure-function Anatomy relationship of the thoracic wall and structures within the thorax and to relate the structure of the thoracic cavity to clinical context. Detailed anatomical organisation of the trachea and bronchi, lungs and pleura Anatomy Behavioural Science, The doctor-patient-relatives communication in emergency settings, and the principles of communication when breaking bad news Psychiatry Describe the role of the Emergency Department to stabilise, evaluate, treat and arrange disposition for all patients presenting. The wide range of severity of illness and patient complexity mandates the Emergency Department triage patients needs and priorities. to the most potent life threats of airway, breathing and circulation. When stability is secure then a more thorough evaluation with history Emergency Medicine andLife threateningexamination, processes which can must identify be anticipated processes requiringand dealt treatmentwith in an orimmediate, formal investigations. ordered initial Emergency assessment. Department This assessment organisation attends and first procedures are essential to deal with both the urgency and breadth of its role from management of medical and surgical emergencies to the management of trauma, assault, toxicological problems and pre-hospital care. The mechanism of injury, assessment and management of thoracic trauma, and the range of chest injuries (for example pneumothorax Emergency Medicine, and haemothorax) Surgery By the end of this session students should be able to: The contribution of road traffic crashes to injury related death and disability in Australia and internationally, and prevention strategies. describe the trends in injury related death and disability that has occurred globally over the last three decades General Practice describeunderstand the extent the to respectivewhich road roles traffic of crasheshuman andcontribute vehicle tofactors injury-related along with death physical and disabilityand social in environmental Australia and factorsinternationally in the causal • pathways for motor vehicle crash and injury • use the Haddon Matrix to identify strategies for prevention of motor vehicle crash and injury identify and discuss the evidence for the effectiveness of these strategies • •1. Differentiate between olfactory and respiratory epithelium when viewed with the light microscope 2. Recognize and describe the wall of the trachea, bronchus, bronchiole, alveolar duct and alveoli when viewed with the light microscope Histology 3. Describe the ultrastructure of the alveolar septum when viewed with the electron microscope 4. Apply your knowledge of epithelia to the changes seen in the epithelia lining the conducting versus respiratory airways · Interpretation of normal values · Clinical indications for peak flow Medicine · Describe other common tests of respiratory function · Perform peak flow · Be familiar with inhalational devices for the delivery of medications · Understand the limitations and pitfalls in interpretation of peak flow in children Parasympathetic and sympathetic divisions of the autonomic nervous system: physiological role in the maintenance of homeostasis Transmitters - acetylcholine and noradrenaline • synthesis and storage in nerve terminals actions at cholinergic and adrenergic postsynaptic receptors Pharmacology • inactivation of transmitters to limit duration of action • • muscarinic receptor antagonists eg. atropine Pharmacologicalsympathomimetics mechanisms eg. phenylephrine, - predicting the isoprenaline, action of drugs dobutamine, which influence salbutamol normal transmitter function: • adrenoceptor antagonists eg. propranolol, atenolol, prazosin • •A range of possible psychological effects in patients that suffer traumatic injury with special reference to post traumatic stress disorder Psychiatry A patient who suffers a traumatic injury may suffer a multitude of psychological effects by a number of avenues. This lecture illuminates Psychiatry, Behavioural a variety of possible psychological effects with special reference to post-traumatic stress disorder which is described in the Learning Science Topics. Structured clinical exercises Block 3 Respiratory Medicine Respiratory Medicine DemonstrateStudents should ability demonstrate: to carry out a respiratory system examination and report on the findings. · The ability to elicit a history of a respiratory problem Respiratory Medicine · The ability to communicate with a breathless patient · Awareness of the possible emotional reactions of patients with recurrent or severe breathlessness The concept, mechanisms, causes and treatments of pneumothorax Respiratory Medicine Respiratory Medicine TheDescribe significance the anatomy and function of the respiratory of the gas exchangesystem and unit its mechanical properties that allow it to function as a gas exchanging organ. The of the lungs and for exchanging oxygen and carbon dioxide. The generation of a more negative pleural pressure by the contraction of Respiratory Medicine therespiratory inspiratory system muscles is a complex (mainly elasticthe diaphragm) structure draws which airhas through been arranged the conducting to function airways efficiently to the with respiratory respect zone. to moving Relaxation air in ofand the out inspiratory muscles allows the elastic system to passively return to its pre-inspiratory state, thus achieving exhalation. The anatomy and mechanical properties of the respiratory system dictate how breathing and gas exchange occurs. Because of the Respiratory Medicine concepts of how disease affects the normal functioning of the lung provides a sound basis of clinical assessment of respiratory disease. apical to basal gradient of ventilation, blood flow must also match this gradient to allow efficient gas exchange. Understanding the basic The organisation and function of the visceral and parietal pleura. The precise mechanisms that give rise to pleural pressure gradients Respiratory Medicine, across the lung Anatomy 1 3.01 - NOT AT FAULT // CHEST TRAUMA & PNEUMOTHORAX 1. THE THORACIC WALL AND LOWER RESPIRATORY TRACT Thoracic Cage lobes. The two layers of pleura are held together by surface tension due to a small amount of fluid in the pleural space (cavity). The The thoracic cage is comprised of the thoracic vertebrae, twelve pleural fluid allows the visceral and parietal pleura to slide over pairs of ribs and the sternum. It functions to house and protect one another but resists separation of the pleural layers. Conse- the internal organs. The thoracic cavity is limited superiorly by quently, the pleura counteracts the tendency for the thoracic cage the first ribs (thoracic inlet) and inferiorly by the muscular