Institute of Education in Healthcare and Medical Sciences

School of Medicine, Medical Sciences and Nutrition

YEAR 1 MBChB
ME2512 Medicine 1
Learning Guide for the Respiratory System

2023 / 2024
Contents

General Introduction to the Medicine 1 Course.......................................................3

Who is the Guide for, and How Should I Use It?.......................................................... 3
Case Based Learning.......................................................................................... 4
How are the Medicine Courses Structured?............................................................... 5
General Structure of Teaching.............................................................................. 5
GP Visits........................................................................................................ 6
Assessments.................................................................................................... 6

The Respiratory System....................................................................................7

Introduction................................................................................................... 7
Aims............................................................................................................. 7
Course Delivery............................................................................................... 8
Topics Covered Elsewhere................................................................................... 9
Resources.................................................................................................... 10
Lecture Summaries and Keywords........................................................................ 12
Standard Symbols and Abbreviations.................................................................... 38

2
General Introduction to the Medicine 1 Course

Having completed the Foundations of Medicine course in Term 1, you are now going to embark
on a tour of the many different systems in the human body over the next year and a half. The
length of each system block varies, between 2 and 6 weeks. In general, each system begins
with teaching with the normal structure and function, and goes on to cover relevant diseases,
clinical presentations, investigations and treatment options.

Each system will have a learning guide to provide some structure to your studies. Learning
guides are not substitutes for textbooks or other learning resources, but can direct you to
what material is relevant.

It is important to recognise that while you are being taught about each of the various systems
separately, the normal mode of working for the body is the result of the integrated action of
many systems working together. There are many activities which involve all bodily systems
simultaneously, so try not to regard each system as a separate entity. It is a convenient
way of teaching and currently, owing to specialisation in medicine, the actual practise of
medicine is largely systems based (e.g, someone with chest pain is often more likely to be
referred by their GP to a cardiologist rather than a general physician). In the senior years of
the curriculum you will learn more about integration of systems and specialist collaboration
following a recent shift in focus towards doctors as generalists. This will equip you with the
skills required to deal with today’s increasingly aged population with multi-system diseases
and complex health needs.

Who is the Guide for, and How Should I Use It?

It is intended for Year 1 undergraduate medical students but will remain relevant for your
revision purposes throughout the remainder of the programme.

Look briefly through the guide to see what it contains. There is a glossary of terms at the end
which you may find helpful to refer to when listening to the lectures. Learning outcomes may
be covered in lectures, smaller group activities or in your own study time.

We know from past experience that students who use the learning guides to hep focus their
studying and do some preparatory work before live teaching do better than those who do not.
Please note that although most lectures will be recorded and available on Moodle as they were
in Term 1, now that you are moving into more clinically focused teaching, with more patient
centred content, live teaching may not always be recorded for patient confidentiality purposes.

3
Case Based Learning

To help you integrate form, function and disease, each system will have a number of clinical
cases associated with it. There will be both self-directed and tutor-led cases. The self-
directed cases will be accessed via links in Moodle that will be released at relevant points in
the curriculum. The tutor-led cases will be delivered live by a specialty clinician and these
will be detailed on your timetable.

The cases aim to supplement the formal components of the planned curriculum with a “real-
life” dimension. Each case will be adapted from actual patients and integrate both basic
science and clinical medicine. The cases will therefore reflect realistic issues that clinicians
deal with and encourage an integration of traditional pre-clinical and clinical material,
thereby encouraging you to develop skills, attitudes and knowledge relevant to the practice
of medicine. Some cases may involve real patients who have volunteered to come along
and speak to you. Please treat these patients with the respect and gratitude they deserve
by listening attentively to their stories, and if prompted, by asking appropriate and kind
questions.

Engagement with both the tutor-led and self-directed cases will be monitored. You are
expected to engage with all self-directed cases in a timely manner and attend all live, tutor-
led sessions.

The Respiratory block is also associated with the Lung Function: Testing and Clinical Examples
self-learning package, which can be found on the MyMBChB site under Learning Guides.

4
How are the Medicine Courses Structured?

There are three Medicine Courses (Medicine I, 2 and 3). Each course culminates in a degree
examination. The content of each Systems course is as follows:

Course When taught Content

Medicine 1 Spring Term Year 1 Respiratory
Cardiovascular
Medicine 2 Autumn Term Year 2 Alimentary
Spring Term Year 2 Head & Neck/Dermatology
Nervous
Diabetes/Endocrine
Urinary
Musculoskeletal
Medicine 3 Summer Term Year 2 Infection
Autumn Term Year 3 Medical Ethics/Law
Spring Term Year 3 Psychiatry
Reproductive
Haematology/Immunology
Specialty Teaching

The Medicine 3 Course finishes at Easter Year 3, after which you will continue into the next
part of the course which focuses on ward-based teaching.

General Structure of Teaching

This course, “Medicine I” is your first exposure to the systems of the body. It covers the
respiratory system and the cardiovascular system and will be followed by Medicine 2 from the
start of Year 2 and then Medicine 3 at the end of Year 2 and start of year 3. By the time you
have completed Medicine 3 you will have toured all the major systems of the human body!

Principles of General Practice continues as part of Medicine 1. Please continue to refer to the
General Practice 1 Learning Guide (Term 2) for specific details with regards to lectures and
tutorials. It is in this handbook you will find the learning outcomes and GP tutor details.

5
GP Visits

You will already have had two sessions with your GP tutor. Further sessions will take place
with your GP tutor in the Medicine 1 course. Sessions with your GP tutor will continue to
occur face to face in your GP surgery on Tuesday mornings.

Assessments

The Medicine 1 course will be assessed in the summative Degree examinations in May.
Assessment will cover the respiratory and cardiovascular systems as well as General Practice
content. The assessment will consist of a written exam (1 hour 45 mins) made up of 85
SBA questions split equally between the respiratory and cardiovascular systems as well as a
number of general practice SBA’s. There will also be short formative assessments at the end
of the respiratory and cardiovascular blocks. While formative assessments do not contribute
to your final mark, they will provide essential feedback and help you to check and focus your
learning.

Further details about assessment and evaluation can be found in the Year 1 MBChB Student
Handbook.

6
The Respiratory System

Introduction

The Respiratory System is a five-week teaching block. It begins by introducing you to the
normal structure and function of the human respiratory system, moving on later to the many
diseases, investigations and treatment options that are available. Clinical and communication
skills are a vital part of assessment of patients with respiratory diseases and will be taught in
tandem with the rest of the course.

Aims

The overarching aims of the Respiratory System block within Medicine 1 are as follows:
• To understand the form and function of the human respiratory system in health and
disease.
• To understand the principles and application of clinical examination and communication
skills in generic terms and as applied to the respiratory system.

Detailed learning objectives are included with each lecture synopsis.

7
Course Delivery

Teaching in this block will be a mixture of pre-recorded lectures, on campus lectures, , small
group problem solving and both self-directed and tutor-led case studies with opportunities for
Q&A’s.

Lectures

We strongly recommended that you engage with all lectures and that you review and
supplement your notes by reading the appropriate sections in one or more textbooks. All of
the material presented in the course is available in textbooks, though it may not be in the
same sequence, nor with the precise emphasis.

An important component to understanding and learning any topic is to read and think about
similar material derived from several different sources. Use the learning outcomes in this
document as questions to test your knowledge and understanding. Try to answer the learning
outcomes in as much detail as you have been taught.

Online

• There will be an online quiz at the end of each week, similar to term 1.
• There is a self-learning package “Lung Function: Testing and Clinical Examples” – the
content of which is examinable. This and other resources are available via the MyMBChB
site.

Small Group Activities

As in term 1, throughout term 2 there will be a number of small group teaching sessions which
include problem solving, case based discussions, Clinical Skills and Anatomy. Since these
sessions are taught in small groups, it is very important that you check your timetable to
ensure you are in the right place at the right time! Attendance is recorded at all small group
sessions.

8
Topics Covered Elsewhere

• Structure and function of the upper airways – this will be covered in further detail in
Medicine 2 (Head and Neck)
• Control of acid/base – this will be covered in some detail in the respiratory block and again,
in more detail, during the urinary system course in Medicine 2.

How to Learn

The amount of material to be learnt is daunting, but achievable if you study effectively.
You should draw on the techniques covered in the “Learning to Learn” sessions delivered in
Term 1. Different students will find different approaches effective. Examples of approaches
include:
• Prepare for small group teaching in advance by reading around the topic beforehand. The
excel weekly schedule of events, located on Moodle, has been created to guide you with
the order in which to approach the material each week.
• Review lecture notes soon after making them, relating them to the material in the
textbooks
• Actively participate in small group sessions where appropriate
• Create a study plan, including time for relaxation

9
Resources

Staff

All questions about specific lectures or other learning activity should be directed to the
lecturer or tutor concerned.

Information on course administration, sickness and requests for absence should be directed to
the Year I Administrator, Katie Bouchet, katie.bouchet@abdn.ac.uk

Other questions on content may be directed to the respiratory system course leaders:

Dr Alison Jack
Year 1 Lead, Co-ordinator of Medicine 1
a.jack@abdn.ac.uk

Dr Fiona Thomson
Respiratory Physician, Co-ordinator of Medicine 1
fiona.thomson@abdn.ac.uk

Dr Jenny Sinclair
GP, Co-ordinator of Medicine 1
jenny.sinclair1@abdn.ac.uk

Other support mechanisms are detailed in the Year 1 handbook.

10
Textbooks

You should read broadly around the content of lectures and other activities. The following are
recommended and available in the Foresterhill library:

Silverthorn, Human Physiology, an Integrated Approach (8th Edition) 2018

Agur & Dalley, Moores’ Essential Clinical Anatomy (7th Edition) 2023
Kumar & Clark, Clinical Medicine (10th Edition) 2020
Underwood’s, Pathology: A Clinical Approach (7th Edition) 2018
Bourke, Lecture Notes on Respiratory Medicine (9th Edition) 2015
Partridge, Understanding Respiratory Medicine (1st Edition) 2006
West and Luks, Pulmonary Pathophysiology: The Essentials (10th Edition) 2021
Spratt, Salkowski, Loukas et al., Imaging Atlas of Human Anatomy (5th Edition) 2016

11
Lecture Summaries and Keywords

Week 1 - Respiratory Physiology

Case Based Learning

Self-directed on-line cases will be released on a regular basis which discuss some of the
issues and common conditions encountered in the practice of respiratory medicine. A
series of on-line questions will be asked and answers will subsequently be disclosed in an
“immediate feedback” manner. You will be expected to complete all cases.
Self-directed cases will be released at appropriate points during the block and links to the
cases will be found within the course work for the relevant week in Moodle.
Tutor-led cases will also be presented to students via live sessions. These sessions are
shown in your timetable and will be delivered by specialist clinicians. These will be an
opportunity for you to engage with clinical staff and ask questions.

Overview of the Respiratory System

Dr A Jack

This is a short recording outlining the five respiratory physiology lectures, demonstrating
how all the different concepts covered in the lectures fit together in order to maintain
optimum blood gas composition. You may find it useful to keep referring back to this
overview slide to orientate yourself and appreciate the role each physiological process
plays in maintaining homeostatic control of blood gas composition.

12
Week 1 - Physiology and Anatomy

Introduction and Anatomy of Lungs, Airways and Blood Supply

Dr Alison Jack

Lecture Summary:
Structure of airways and lungs, functions of upper and lower respiratory tracts, role of
type I and type II alveolar cells, pulmonary vs systemic circulation, bronchial circulation.

Learning Outcomes:
• Describe the main anatomical features of the airways and gross anatomical features of
the lung
• Identify the different classes of airways and the two types of alveolar cells
• List the functions of the respiratory system
• Know the difference between pulmonary and systemic circulation
• Identify points of gas exchange between the respiratory and cardiovascular systems
• Understand why, and how, resistance to air flow varies across the respiratory tree

Keywords: Trachea, bronchi, bronchioles, pneumocytes, alveolar cells (type I and type II),
pulmonary circulation, resistance to air flow

13
Anatomy of pleural cavity, mechanics of breathing, surfactant and
compliance
Dr Alison Jack

Lecture Summary:
Structure and function of pleural cavity and importance of relationship between pleural
membranes. Role of skeletal muscle in expansion and relaxation of thoracic cavity; intra-
thoracic pressure changes during breathing cycle. Role of surfactant in reducing the work
of breathing and how this relates to the concept of lung compliance.

Learning Outcomes:
• Name and explain the key terms used to describe the different lung volumes
• Describe the anatomy of the pleural cavity
• Describe the relationship between the parietal and visceral pleura and why this is
important for inflation and deflation of the lung
• Describe how the muscles of respiration act to increase and decrease thoracic volume
• Relate Boyle’s law to the mechanics of breathing, inspiration and expiration
• State the mechanical factors that affect respiratory minute volume.
• Explain why intrapleural pressure is always less than alveolar pressure
• State the role of pulmonary surfactant and the Law of Laplace
• Define the term compliance the factors that affect this

Keywords: Pleural cavity, pleural fluid, parietal pleura, visceral pleura, pneumothorax,
intercostal muscles, diaphragm, abdominal muscles, accessory muscles of respiration,
mechanics of breathing, intra-pleural pressure, alveolar pressure, surfactant, compliance

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Ventilation, Diffusion, Common Lung Pathologies & Lung Function Tests
Dr Alison Jack

Lecture Summary:
Definition of lung volumes and capacities, alveolar vs pulmonary ventilation, alveolar and
arterial gas partial pressures, diffusion of gas across cell membranes in health and disease,
brief review of lung function tests.

Learning Outcomes:
• Define the various lung volumes and capacities and provide approximate normal values
for them.
• Understand the functional difference between pulmonary and alveolar ventilation
• Be able to describe the impact dead space has on alveolar ventilation
• Know the normal values for alveolar and arterial gas partial pressures in different units
• Be able to describe the blood supply to the lungs
• Be able to describe the factors that influence diffusion of gases across the alveoli
• Know the abbreviations used to describe the partial pressure of gases in the alveoli,
systemic arteries and veins
• Understand how certain lung pathologies impact on gas exchange
• Outline the basic characteristics of obstructive and restrictive lung diseases.
• Outline how spirometry can be used to identify abnormal lung function.
• Describe and explain the characteristic results you would observe following lung
function tests in patients with obstructive lung diseases
• Describe and explain the characteristic results you would observe following lung
function tests in patients with restrictive lung diseases

Keywords: lung volumes and capacities, anatomical dead space, alveolar ventilation,
partial pressure, diffusion, obstructive lung disease, restrictive lung disease, spirometry.

15
The Ventilation - Perfusion Relationship and Gas Transport
Dr Alison Jack

Lecture Summary:
Factors determining distribution of blood flow and ventilation across the lung, composition
of alveolar gas and pulmonary blood. Oxygen transport in blood; oxygen vs carbon
dioxide solubility, oxygen-haemoglobin dissociation curve, effects of CO2, pH, DPG
and temperature. Oxygen loading in lung and unloading at tissues. Myoglobin, foetal
haemoglobin. Brief description of hypoxia. Ventilation-perfusion relationships across
normal lung. Ventilation- perfusion mismatch. Carbon dioxide transport; role of oxygen
and ‘chloride shift’.

Learning Outcomes:
• State the differences between partial pressure and gas content.
• Describe the role of haemoglobin in the transport of O2 in the blood.
• Explain why the shape of the oxyhaemoglobin dissociation curve is important to O2
loading in the lungs and unloading in the tissues.
• Describe the factors that affect the oxyhaemoglobin dissociation curve.
• Compare oxyhaemoglobin dissociation for adult haemoglobin with that of foetal
haemoglobin and myoglobin in relation to their physiological roles.
• Identify the forms in which CO2 is carried in the blood.
• Explain the action of carbonic anhydrase in CO2 transport.
• Identify the factors which favour CO2 unloading to the alveoli at the lungs.
• Describe the relationship between ventilation and perfusion and its significance in
health
• Describe the conditions under which there may be an imbalance in the ventilation-
perfusion ratio of regions of the ratio of regions of the lung and describe how this
affects the O2 and CO2 content of alveolar gas and arterial blood.
• Define the terms shunt, alveolar dead space, physiologic dead space and anatomical
dead space.
• Define the five different types of hypoxia

Keywords: Hypoxic pulmonary vasoconstriction, Ventilation- perfusion relationship, Gas

exchange, Alveolar gas, Oxygen transport, Haemoglobin, Dissociation curve, CO2, pH,
Myoglobin, Foetal haemoglobin, Hypoxia, CO2 transport, shunt, alveolar dead space,
physiologic dead space.

16
Control of Ventilation
Dr Alison Jack

Lecture Summary:
Rhythm of breathing: central nervous control via medulla pons and cortex; respiratory
rhythm generator. Peripheral and central chemoreceptors. Actions of changed partial
pressures of carbon dioxide, oxygen and pH. Integrated responses to alterations in
respiratory gas and hydrogen ion stimuli. Role of stretch receptors, irritant and other
receptors. Breath-holding. Voluntary control of breathing. Respiratory origin of, versus
compensation of, acidosis and alkalosis. Effect of sedative/ anaesthetic agents on
ventilation.

Learning Outcomes:
• Explain how respiratory motor movements are affected by the central nervous system.
• Describe the location of the two classes of chemoreceptors and identify the stimuli
which activate them.
• List the factors involved in changing ‘respiratory drive’, rate and depth of breathing.
• Explain how the central chemoreceptors serve to regulate the arterial PCO2 by
monitoring the pH of CSF.
• Explain how the peripheral chemoreceptors become important during hypoxia and
acid-base imbalance.
• Outline the role of the respiratory system in acid-base disturbances.
• Explain how CO2 affects acid-base balance
• Outline how the respiratory system can both create, and compensate for, acid-base
disturbances.

Keywords: Central nervous system control of respiration, vagus, chemoreceptors, partial

pressures, stretch receptors, breath-holding, voluntary control of breathing, acid-base
balance.

17
Clinical Respiratory Medicine

Week 2 – Obstructive Lung Disease:

Obstructive Lung Diseases: Pathology, Clinical Features and Management

(7 Lecture Sessions)
Prof K Kerr, Dr F Thomson, Dr M Chetty/Dr C Kuo, Dr S Turner, Dr D Miller, Dr K Scott

Keywords: Obstructive lung disease, asthma, chronic bronchitis, emphysema, cor

pulmonale, atopy, smoking, allergens, dietary and environmental factors, bronchodilators,
anticholinergics, corticosteroids, theophyllines, British Thoracic Society Guidelines,
nebuliser therapy.

Pathology of Obstructive Lung Diseases

Prof K Kerr

Lecture Summary:
• Pathological features of common obstructive lung diseases, particularly chronic
bronchitis and emphysema.

Learning Outcomes:
• Describe the major pathological feature of the common obstructive lung diseases,
asthma, chronic bronchitis and emphysema and their complications (including hypoxic
cor pulmonale).
• Describe the symptoms and clinical patterns of asthma, and show how this affects the
O2 alveolar gas.
• Describe the term ‘shunt’.
• Know the difference between anatomical, alveolar and physiologic dead space.

18
Clinical Features of COPD
Dr F Thomson

Lecture Summary:
Clinical features and epidemiology of chronic obstructive pulmonary disease (COPD).
Clinical presentations of COPD. Investigation of COPD.

Learning Outcomes:
• Describe the defining features and epidemiology of COPD and its aetiological factors.
• Describe the major pathological features of the common obstructive lung diseases,
asthma, chronic bronchitis and emphysema and their complications (including hypoxic
cor pulmonale).
• Differentiate the main causes of wheezing illness.
• Describe the symptoms, signs and clinical patterns of COPD.
• Define the specific features to be included in the clinical history of COPD.
• Define the investigations used to diagnose COPD.
• Explain how to assess the severity of acute and chronic COPD.
• Describe similarities and differences between asthma and COPD.
• Describe the natural history of COPD and how this relates to realistic medicine.

19
Management of COPD
Dr M Chetty/Dr C Kuo

Lecture Summary:
Management of COPD, contrasting with management of asthma.

Learning Outcomes:
• Define the aims of COPD management strategies.
• Explain how to assess the severity of acute and chronic COPD.
• Define the investigations used in the assessment of a COPD exacerbation.
• Describe the classes of drugs and modes of delivery available in the management of
obstructive lung diseases, both asthma and COPD.
• Describe non-pharmacological aspects of COPD management.
• Define the role of patient education in the management of COPD.
• Contrast the management of asthma with strategies for management of COPD.
• Describe other treatment strategies which are important in the palliation of COPD.

20
Asthma Clinical Features (Children and Adults)
Dr S Turner, Dr. D Miller

Lecture Summary:
Epidemiology of asthma, its proven and putative aetiological factors.
Clinical presentation of asthma. Assessment of severity of asthma. Investigation of asthma.

Learning Outcomes:
• Describe the defining features and epidemiology of asthma, its proven and putative
aetiological factors.
• Describe the major pathological features of asthma.
• Differentiate the main causes of wheezing illness.
• Discuss possible reasons for the changing prevalence and severity of respiratory disease
with child’s age and possible links with respiratory disease in adult life.
• Describe the symptoms and clinical patterns of asthma.
• Define the specific features to be included in the clinical history of asthma.
• Define the investigations used to diagnose asthma.
• Explain how to assess the severity of acute, severe asthma.

21
Asthma Management (Children and Adults)
Dr. S Turner, Dr. K Scott

Lecture Summary:
Assessment of severity of asthma. Investigation of asthma. Approaches to management of
asthma, including drugs and their delivery, patient education, and management of life-
threatening asthma.

Learning Outcomes:
• Contrast the management of asthma with strategies for management of COPD.
• Explain how to assess the severity of acute asthma.
• Describe the clinical management of acute asthma.
• Outline the stepwise approach to management of asthma based on the Scottish
Intercollegiate Guidelines Network and British Thoracic Society Guidelines.
• Describe the classes of drugs and modes of delivery available in the management of
obstructive lung diseases, both asthma and COPD.

22
Week 3 - Infection

Respiratory Infection (7 Lecture Sessions)

Prof K Kerr, Dr S Turner, Dr F Mosgrove, Dr F Thomson, Dr R. Brittain-Long, Dr A Nicolson

Lecture Summary:
Clinical presentation and organisms causing upper respiratory tract infections. Clinical
features of acute bronchitis and pneumonia. Organisms causing lower respiratory tract
infections. Clinical management of lower respiratory infections.

Keywords: Upper respiratory tract infections, tonsillitis/pharyngitis, common cold,

glandular fevered, otitis media, sinusitis, Streptococcus pyogenes, rhinovirus, adenovirus,
parainfluenza, influenza, EB virus, lower respiratory tract infections, bronchitis,
pneumonia, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis,
Staphylococcus aureus, Mycoplasma, Chlamydia, Coxiella, Legionella. TB, COVID-19

Pathology of Respiratory Tract Infections

Prof K Kerr

Learning Outcomes:
• Define the common organisms causing upper respiratory infection including bacteria,
such as Strep. pyogenes and common viruses, including rhinoviruses, adenoviruses,
parainfluenza, influenza and EB virus.
• Define the mechanisms of defence in the respiratory system.
• Describe the pathogenesis of bronchopneumonia and lobar pneumonia and the
complications and consequences of lower respiratory tract infection.
• Describe the clinical features of acute bronchitis, pneumonia, and be aware of
bronchiectasis, lung abscess and empyema.
• Be aware of causes of recurrent pneumonia.
• Understand the physiological changes to pulmonary gas exchange in respiratory tract
infections.

23
Upper Respiratory Tract Infections in Children
Dr S Turner

Learning Outcomes:
• Describe the clinical presentations of common upper respiratory infections including
tonsillitis/pharyngitis, the common cold, EB virus glandular fever, otitis media and
sinusitis
• Define the common organisms causing upper respiratory infection including bacteria,
such as Strep. pyogenes and common viruses, including rhinoviruses, adenoviruses,
parainfluenza, influenza and EB virus.
• Define the role of supportive therapy in addition to specific antimicrobial therapy.

Lower Respiratory Tract Infections in Children

Dr S Turner

Learning Outcomes:
• Describe the clinical presentations of common lower respiratory tract infections
including bronchitis, pneumonia and bronchiolitis
• Define the common organisms causing lower respiratory infection including bacteria,
and common viruses.
• Define the role of supportive therapy in addition to specific antimicrobial therapy.

24
Lower Respiratory Tract Infections in Adults
Dr F Thomson

Lecture Summary:
Clinical presentation and organisms causing lower respiratory tract infections. Clinical
features of acute bronchitis and pneumonia. Clinical management of lower respiratory
infections.

Learning Outcomes:
• Describe the clinical features of acute bronchitis, pneumonia, and be aware of
bronchiectasis, lung abscess and empyema.
• Describe the pathogenesis of bronchopneumonia and lobar pneumonia and the
complications and consequences of lower respiratory tract infection.
• Describe the common organisms leading to lower respiratory tract infections.
• Be aware of causes of recurrent pneumonia.
• Be aware of the different spectrum of hospital acquired (nosocomial) pneumonia
compared with community acquired pneumonia.
• Describe the clinical management of lower respiratory infection, particularly with
regard to pneumonia.
• Define the role of supportive therapy in addition to specific antimicrobial therapy.
• Be aware of the general approach to management of rarer lung infections including
bronchiectasis, lung abscess and empyema.
• Be aware of the different approaches of primary care and secondary care management
of respiratory infections, including the practice of realistic medicine and strategies for
dealing with uncertainty.

Respiratory Medicine – a GP Perspective

Dr F Mosgrove

Learning Outcomes:
• State the common respiratory presentations seen in primary care
• Understand how each of these present
• Understand the role of primary care in managing these conditions

25
Tuberculosis
Dr R Brittain-Long

Lecture Summary:
Pathogenesis of tuberculosis (primary, post-primary). Miliary tuberculosis. Histopathology
of tuberculous tissues. Common clinical presentations of tuberculosis. Management of
tuberculosis, historical and current including antituberculous drugs and general supportive
measures.

Learning Outcomes:
• Describe the global distribution of tuberculosis and its impact on tuberculosis in the
UK.
• Describe the pathogenesis of tuberculosis in its primary, post- primary and fibrocaseous
forms in the lung.
• Describe the histopathology of tuberculosis.
• Describe the common clinical presentations of tuberculosis.
• Define the major groups of antituberculous drugs, their pharmacological profiles and
side effects, and their practical application in the management of tuberculosis.
• Describe the public health duties of doctors managing cases of Tuberculosis.

Keywords: Primary tuberculosis, post-primary tuberculosis, fibrocaseous tuberculosis,

miliary tuberculosis, caseating granuloma, antituberculous drug therapy.

COVID-19 - The Pandemic so Far

Dr A Nicolson

Learning Outcomes:
• Describe the pathogenesis and transmission of SARS-CoV-2.
• Define the terms epidemic, pandemic, endemic and outbreak.
• Describe the common clinical presentations of COVID-19 disease.
• Define the clinical management of COVID-19 including general supportive measures.
• Describe the role of infection control practitioners in the management of COVID-19.
• Understand the concept of herd immunity in relation to population vaccination.

26
Week 4 - Neoplasia

Neoplasia: Clinical Features, Pathology, Staging and Management

(5 Lecture Sessions)
Prof K Kerr, Dr S Dubois-Marshall, Dr M Chetty, Dr A Duncan, Mr M Khalil

Lecture Summary:
Common presentation of lung tumours, including local and extrathoracic symptoms and
signs. Causes of localised opacity on the chest x-ray. Typing of lung cancer. Investigation
and staging processes for lung cancer. Surgical treatment for lung cancer and its outcome.
Management of small cell lung cancer. Principles of management of inoperable non-small
cell lung cancer with radiotherapy and/or chemotherapy. Palliative therapy in lung cancer.

Keywords: Finger clubbing, superior vena cava obstruction, hypertrophic pulmonary

osteoarthropathy, Horner’s syndrome, coin lesion, haemoptysis, chest pain, dyspnoea,
small-cell lung cancer, non-small cell lung cancer, fibreoptic bronchoscopy,
mediastinoscopy, thoracoscopy, thoracotomy, lobectomy, pneumonectomy, radiotherapy,
chemotherapy, palliative therapy.

Pathology of Lung Cancers

Prof K Kerr

Learning Outcomes:
• Describe the common clinical presentations of lung tumours, including local and
extrathoracic symptoms and signs.
• Define the types of lung carcinoma.
• Describe the epidemiology and pathogenesis of primary lung cancer.
• Describe how lung cancer spreads both within and outwith the thorax.

27
Radiology of Lung Cancer and Staging
Dr S Dubois-Marshall

Learning Outcomes:
• Describe the investigation and staging process used to plan management of lung
cancer.
• Describe the causes of a localised opacity (coin lesion) on the chest xray.

Surgical Management of Lung Cancer

Mr M Khalil

Learning Outcomes:
• Describe the principles of surgical treatment for lung cancer and its outcome.

Clinical Features and Investigation of Lung Cancer

Dr M Chetty

Learning Outcomes:
• Describe the common clinical presentations of lung tumours, including local and
extrathoracic symptoms and signs.
• Describe the causes of a localised opacity (coin lesion) on the chest xray.
• Define the types of lung carcinoma.
• Describe the epidemiology and pathogenesis of primary lung cancer.
• Describe how lung cancer spreads both within and outwith the thorax.
• Describe the investigation and staging process used to plan management of lung
cancer.
• Define the role of the multidisciplinary team involved in the diagnosis and
management of lung cancer.

28
Non-operative Management of Lung Cancer
Dr A Duncan

Learning Outcomes:
• Describe the principles of management of inoperable, non- small cell lung cancer with
radiotherapy and/or chemotherapy, the side effects of these treatments and their
likely outcomes.
• Describe the principles of management of small cell lung cancer.
• Describe the other treatment strategies which are important in the palliation of lung
cancer.

Smoking Cessation
Dr O Dempsey

Lecture Summary:
Prevalence of smoker’s diseases. Passive smoking, Smoking prevalence. Tobacco addiction.
Identifying smokers. How to help cessation. Economics and politics of smoking. What
medical students and doctors can do about the tobacco issue.

Learning Outcomes:
• Describe epidemology of smoking.
• Describe economics and politics of smoking.
• Describe individual and population strategies to reduce smoking.

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Pleural Disease
Dr R Alluri

Lecture Summary:
Causes and clinical features of pleural effusion. Differential diagnosis of pleural effusion.
Investigation of a pleural effusion. Management of pleural effusion, including pleural
plaques, and malignant pleural mesothelioma.

Learning Outcomes:
• Describe the causes and clinical features of pleural effusion.
• Define the problems in differential diagnosis of pleural effusion.
• Describe the pathology of malignant mesothelioma.
• Define the approach to investigation of a pleural effusion.
• Describe the management of common causes of pleural effusion.
• Be aware of other pleural conditions including pleural plaques, empyema and
malignant pleural mesothelioma.

Keywords: Pleural effusion, malignant mesothelioma, pleural fibrosis, pleural plaques.

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Week 5 - Restrictive lung disease and other miscellaneous conditions:

Developmental aspects of lung disease

Dr J Stewart

Lecture Summary:
Embryology of the respiratory tract, common congenital anomalies. Relationship between
respiratory illness in childhood and adulthood. Tracking of pulmonary function from early
life into adulthood and factors which influence tracking. Remodelling.

Learning Outcomes:
• Understand the embryology of the respiratory tract
• Be aware of the common congenital anomalies affecting the respiratory tract
• Understand the relationship between respiratory illness in childhood and adulthood
• Understand the “tracking” of pulmonary function from early life into adulthood and
factors which influence tracking
• Be aware of the term remodelling

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Sleep Apnoea and Neuromuscular Respiratory Failure
Dr P Fitch

Lecture Summary:
Prevalence, physiology and consequences of sleep apnoea, respiratory muscle disorders.
Assessment, investigation and treatment of sleep apnoea and neuromuscular respiratory
failure.

Learning Outcomes:
• Sleep apnoea presentation. Conditions associated with sleep apnoea. Consequences
of untreated sleep apnoea. Management options. Other conditions causing excessive
daytime sleepiness.
• Neurological conditions associated with respiratory muscle weakness. Presenting
symptoms and signs of respiratory muscle weakness. Investigations and management of
respiratory muscle weakness.

Keywords: Obstructive sleep apnoea, Epworth score, CPAP, narcolepsy, muscular

dystrophy, motor neurone disease, orthopnoea, paradoxical abdominal wall motion,
ventilatory failure, non-invasive ventilation.

Restrictive Lung Disease (2 Lecture Sessions)

Prof K Kerr, Dr O Dempsey

Lecture Summary:
Lung function abnormality in restrictive lung disease. Major classes of restrictive lung
disease, including occupational disease, granulomatous disease, idiopathic pulmonary
fibrosis. Clinical symptoms associated with restrictive lung disease. Natural history
of restrictive lung disease. Pathological features of common restrictive lung disease.
Investigation of restrictive lung disease. Approach to management of common restrictive
lung disease.

Keywords: Restrictive lung disease, occupational lung disease, sarcoidosis, idiopathic

pulmonary fibrosis, diffuse alveolar damage syndrome, hypersensitivity pneumonitis,
honeycomb lung, lung biop sy, corticosteroid therapy, prevention of occupational lung
disease.

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Pathology of Restrictive Lung Diseases
Prof K Kerr

Learning Outcomes:
• Describe the clinical symptoms associated with restrictive lung disease.
• Define the major classes of restrictive lung disease, including occupational,
granulomatous lung disease (sarcoidosis), idiopathic pulmonary fibrosis.
• Define the natural history of restrictive lung disease.
• Identify the lung interstitium and describe the functional effects of interstitial lung
disease.
• Describe the aetiology and pathogenesis of diffuse alveolar damage syndrome,
sarcoidosis, hypersensitivity pneumonitis and idiopathic pulmonary fibrosis.
• Recall the causes and effects of endstage lung fibrosis/honeycomb lung.

Clinical Features and Management of Restrictive Lung diseases

Dr O Dempsey

Learning Outcomes:
• Describe the investigation of restrictive lung disease and the approach to management
of the common diseases (sarcoidosis, occupational lung disease, hypersensitivity
pneumonitis, and idiopathic pulmonary fibrosis).

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Pulmonary Vascular Disease
Dr P Fitch

Lecture Summary:
Pathogenesis of deep venous thrombosis, pulmonary embolism and pulmonary infarction.
Definition and causes of pulmonary hypertension. Diagnostic procedures in pulmonary
vascular disease. Principles of management of pulmonary vascular disease.

Learning Outcomes:
• Describe the pathogenesis of deep vein thrombosis, pulmonary embolism, and
pulmonary infarction.
• Define pulmonary hypertension and outline the major causes.
• Describe the diagnostic investigative procedures used in pulmonary vascular disease.
• Define the principles of management of pulmonary vascular diseases.

Keywords: Deep vein thrombosis, pulmonary embolism, pulmonary infarction,

pulmonary hypertension, cor pulmonale, venography, ultrasound, ventilation perfusion
scanning, pulmonary angiography, anticoagulant therapy, pulmonary vasodilators, lung
transplantation.

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Cystic Fibrosis
Dr P Srivastava

Lecture Summary:
Genetics of cystic fibrosis. Presenting features of cystic fibrosis. Complications of cystic
fibrosis. Screening for cystic fibrosis. Transplantation. End of life issues. CF related
diabetes. Osteoporosis. Infertility.

Learning Outcomes:
• Describe the genetics and presenting features of cystic fibrosis.
• Define the possible complications of cystic fibrosis.
• Outline the management of pancreatic insufficiency and chest infection.
• Explain the options available for antenatal and post natal screening for cystic fibrosis
• Appreciate the differing issues associated with the management of adult and
paediatric patients with Cystic Fibrosis
• Appreciate the social, educational and economic impact of cystic fibrosis on the child
and the family
• Understand the role of transplantation
• End of life issues
• Have an awareness of emerging CFTR modulator therapies

Keywords: CFTR, dF508, pseudomonas, burkholderia, physiotherapy, multidisciplinary

approach, malabsorption, intestinal obstruction, enzymes, diabetes, infertility,
osteoporosis, transplantation, liver disease.

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Cardiothoracic Surgery in Non Malignant Situations
Mr M Khalil

Lecture Summary:
Overview of common thoracic surgical interventions for non-malignant lung disease
including lung abscess, empyema, thymic tumours, pneumothorax, bullous lung disease.
Outline lung transplantation.

Learning Outcomes:
• Appreciate the role of surgery in non-malignant lung disease

Keywords: abscess, empysema, thymus, neurofibroma, cyst, pneumothorax, bulla, bullous

lung disease, emphysema, cystic fibrosis, lung transplant

Problem Solving 1: Respiratory Physiology

Dr Alison Jack

Session Summary:
During this interactive session you will apply knowledge gained during the basic science
lectures to further your understanding of the processes that underpin health and disease.

Problem Solving 2: Clinical Pharmacology Problem Solving Session

Dr F Thomson, Dr J Whitfield

Session Summary:
This interactive session will involve case discussions of common respiratory clinical
problems and their management. A useful revision session drawing together many aspects
of respiratory medicine. Dr Thomson will be willing to answer any questions on the
Respiratory System.

This session will take place in the CVS block in 2023 and include CVS medicine.

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Respiratory Tutorial in General Practice
GP Tutors

Learning Outcomes:
• Formulation of the differential diagnoses of key presenting complaints in general
practice including Wheeze, Shortness of Breath, Cough and Haemoptysis
• Describe common clinical patterns and presenting features of key respiratory
conditions encountered in day to day general practice including Asthma, COPD, URTI,
LRTI, Pneumonia, Lung cancer
• Describe the clinical management of the above key respiratory conditions, in the
community setting including the use of clinical prediction and severity scoring tools
• Describe commonly used therapeutic strategies; non-pharmacological and
pharmacological approaches
• Define commonly used classes of drugs and the most common side-effects and
contra-indications including bronchodilators, corticosteroids, leukotriene receptor
antagonists, antihistamines, decongestants and over the counter preparations
• Be aware of the different approaches of primary care vs secondary care management
of respiratory conditions, including the practice of holistic medicine (treating the
patient as a whole), person-centred care and strategies for dealing with uncertainty

Interactive lessons and patient Q+A:

You will also have a series of interactive lessons on the following themes:
- COPD and asthma
- Respiratory infections
- Lung cancer
- Cystic fibrosis
- Interstitial lung disease

These will either be run online or live in a lecture theatre with a tutor +/- a patient to give
you opportunity to ask questions and gain an insight into how they live with their condition

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Standard Symbols and Abbreviations Used in Respiration
Physiology and Medicine

Throughout Respiratory Physiology and Medicine a common set of symbols is used to describe
the variables. You should understand how they are derived and be able to make use of them.

Main symbols indicate the nature of the variable and are usually large capital letters. A
symbol may be modified by a character over it, such as a bar (-) for a mean value or a single
dot (.) for the rate (ie, a quantity per minute eg, L/min).

Modifiers: The main symbols are modified by the addition of small capitals for gas phase,
standard symbols for chemicals species, or lowercase letters for liquids.

The respiratory symbols are used in three groups: alveolar gas exchange and pulmonary
circulation, respiratory mechanics, and control of breathing. A few have more than one
meaning and must be interpreted in context (usage).

Part 1: Aveolar Gas Exchange and Pulmonary Circulation

Main Symbols
C Concentration in a liquid
f Breathing frequency
P Pressure, total or partial F Fraction
Q Volume of liquid
Q Flow of blood, perfusion
R Gas-exchange ratio
S Saturation
V Gas volume
V Ventilation

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Modifiers
a Arterial
aw Airway
A Alveolar
c Capillary
E Expired
I Inspired
pl Pleural
s Shunt
t Time
v venous

Examples
PaO2 Partial pressure of 0 in arterial blood
Q Cardiac output
SaO2 Saturation of haemoglobin with O in arterial blood
V/Q Ventilation/perfusion ratio
Ve Expired minute ventilation
PA Alveolar pressure

Part 2: Respiratory Mechanics

Main Symbols
C Compliance
f Frequency
P Pressure
R Resistance
V Volume
w Work

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