Study Guide Respiratory Semester VI tayang 22 Pebruari 2016
Study Guide The Respiratory System and Disorders
TABLE OF CONTENTS
Page
Table of Contens
1
Introduction
2
Curriculum
3
Planner team & Lecturers
4
Facilitators
6
General Time Table
7
Important Informations
8
Meeting of the students’ representative
8
Self Assessment
8
Assessment Method
8
Time Table (Regular Class)
9
Time Table (English Class)
14
Learning Programs
19
Faculty of Medicine Udayana University,DME
1
Study Guide The Respiratory System and Disorders
INTRODUCTION
The medical curriculum has become increasingly vertically integrated, with stronger
basic concept and support by clinical examples and cases to help in the understanding of
the relevance of the underlying basic science. Basic science concepts may help in the
understanding of the pathophysiology and treatment of diseases. Respiratory system and
disorders block has been written to take account of this trend, and to integrate core aspects
of basic science, pathophysiology and treatment into a single, easy to use revision aid.
The respiratory system consists of a pair of lungs within the thoracic cage. Its main
function is gas exchange, but other roles include speech, filtration of microthrombin arriving
from systemic veins and metabolic activities such as conversion of angiotensin I to
angiotensin II and removal or deactivation of serotonin, bradykinin, norepinephrine,
acetylcholine and drugs such as propranolol and chlorpromazine. So this block will discuss
about anatomy, histology, symptom and signs of lung disease and its pathophysiology,
major upper respiratory diseases, major lung diseases, major pediatric lung disease, and
basic principle concept to education, prevention, treatment and rehabilitation in respiratory
system disorder in patient, family and community.
The learning process will be carried out for 6 weeks (27 working days) starts from 22 nd of
February 2016 as shown in the time table. The final examination will be conducted on 4 th of
April 2016 in the form of MCQ. The learning situation include lecture, individual learning,
small group discussion, plenary session, practice, and clinical skill.
Most of the learning material should be learned independently and discuss in SGD by the
students with the help of facilitator. Lecture is given to emphasize the most important thing
of the material. In small group discussion, the students gave learning task to lead their
discussion.
This simple study guide need more revision in the future, so that the planners kindly invite
readers to give any comments and critics for its completion. Thank you.
Planners
Faculty of Medicine Udayana University,DME
2
Study Guide The Respiratory System and Disorders
CURRICULUM
RESPIRATORY SYSTEM AND DISORDER
Aims :
Comprehend the structure, physiologic, and pathologic of the respiratory system.
Interpret the laboratory and imaging examination of the respiratory system
disorders
Diagnose and treat the patient with common respiratory system disorders
Plan education, prevention, management and rehabilitation of respiratory system
disorders to patient, family and community.
Learning outcomes:
Concern about the size of problem and diversity of respiratory disease in the
community
Able to describe the structure and function of the respiratory system
Able to interpret the result of examination (physical, laboratory, function test,
blood gas analysis and chest imaging)
Able to explore patients with respiratory problem (runny nose, cough, dyspnea,
non cardiac chest pain, hemoptysis)
Able to manage major upper respiratory diseases (tonsillitis, rhinitis, sinusitis)
Able to manage major lung diseases (TBC, asthma, COPD, lung cancer,
pneumonia, occupational lung disease, pleural disease) on patient, family and
community
Able to manage major pediatric lung disease (bronchiolitis, TB, asthma)
Able to implement DOTS program against TB
Able to implement the strategy of smoking cessation, especially in patient with
respiratory disease
Curriculum contents:
Structural and function of the respiratory system
Physiology of lung in related with oxygen consumption and acid base balance
Symptoms and signs of lung disease
Pathophysiology of respiratory system disorders
Basic physical, laboratory and imaging examination
Interpretation of examination results.
Drugs that commonly used in respiratory system disorders (decongestant, antiasthma & bronchodilators, antitussive, expectorant
Basic principle concept to education, prevention, treatment and rehabilitation in
respiratory system disorders in patient, family and community.
Faculty of Medicine Udayana University,DME
3
Study Guide The Respiratory System and Disorders
PLANNER TEAM
LECTURERS
No
Department
Phone
1
Prof. Dr.dr.IB Ngr Rai Sp.P (K)
Name
Pulmonology
08123804579
2
dr.I GN Sri Wiryawan,M.Repro
Histology
08123925104
3
dr.Gede Wardana, M.Biomed
Anatomy
0361-7864957
4
Biochemistry
081338776244
5
Dr.dr.Dsk Made Wihandani,
M.Kes
dr.Ida Bagus Subanada, Sp.A
Paediatric Dept.
0812399533
6
dr.Dewa Artika, Sp.P
Pulmonology
08123875075
7
dr.Ida Bagus Suta, Sp.P
Pulmonology
08123990362
8
dr. Made Bagiada, Sp.PD-KP
Pulmonology
9
Prof.dr I Gst.Md.Aman,Sp.FK
Pharmacology
08123607874
8543948
081338770650
10
Dr. dr.Muliarta, M.Kes
Physiology
081338505350
11
dr. IGN Bagus Artana, Sp.PD
Pulmonology
08123994203
12
dr.Ketut Putu Yasa, Sp.BTKV
Thorax surgery
08123843260
13
dr.Elysanti Martadiani,Sp.Rad
Radiology
08123807313
14
dr. Wayan Winarti, Sp.PA
Pathology Anatomy
087860990701
15
Prof.Dr.dr. M.Wiryana,Sp.AnKIC
Anaesthesiology
0811392171
16
dr.Putu Siadi Purniti,Sp.A
Paediatric
08123812106
17
dr.DGA Eka Putra,Sp.THT
Otorhinolaryngology
0813387826317
Faculty of Medicine Udayana University,DME
4
Study Guide The Respiratory System and Disorders
18
18
19
20
dr. Luh Made Ratnawati,
Sp.THT(KL)
dr. Putu Andrika, Sp.PD-KIC
Otorhinolaryngology
08123806108
Pulmonology
08123989192
dr. Gede Ketut Sajinadiyasa,
Sp.PD
Prof. Suardana, Sp.THT
Pulmonology
085237068670
Otorhinolaryngology
0811385299
Faculty of Medicine Udayana University,DME
5
Study Guide The Respiratory System and Disorders
~ FACILITATORS ~
Regular Class (Class A)
No
1
2
Name
dr. Gde Somayana, Sp.PD
dr. Ida Bagus Wirakusuma,
MOH
Group
Departement
Phone
A1
Interna
081345136913
Venue
(2&3 rd floor)
2nd floor:
R.2.09
A2
Public Health
08124696647
2nd floor:
R.2.10
A3
Andrology
081338605087
2nd floor:
R.2.11
A4
Anasthesi
081337711220
2nd floor:
R.2.12
4
dr. I Gusti Ngurah
Pramesemara , M.Biomed,
Repro
Dr.dr. Tjok G A Senapathi,
Sp.An. KAR
5
Dr. dr. I Dewa Made Sukrama,
MSi, Sp.MK(K)
A5
Microbiology
081338291965
2nd floor:
R.2.13
6
Dr.dr. Ketut Sudartana, Sp.BKBD
A6
Surgery
0811398996
2nd floor:
R.2.14
A7
Parasitologi
08124649002
2nd floor:
R.2.15
A8
Radiologi
081916442626
2nd floor:
R.2.16
A9
Surgery
08123811106
2nd floor:
R.2.23
A10
Andrology
085935054964
3nd floor:
R.3.21
3
7
8
9
10
dr. I Kadek Swastika , M Kes
dr. Made Widhi Asih, Sp.Rad (K)
dr. Ketut Sudiasa, Sp.B (K)
Trauma
dr. I Made Oka Negara, FIAS
11
dr. Ida Ayu Sri Wijayanti,
M.Biomed, Sp.S
A11
Neurology
081337667939
3nd floor:
R.3.22
12
dr. I Gusti Ayu Agung Elis
Indira , Sp.KK
A12
Dermatology
081338718384
3nd floor:
R.3.23
English Class (Class B)
No
Name
Group
1
Dr. dr. Desak Made Wihandani,
M.Kes
B1
2
dr. I Gusti Ayu Sri Darmayani,
Sp.OG
B2
3
Dr. dr. Made Ratna Saraswati,
Sp.PD-KEMD-FINASIM
B3
dr. I Gusti Ayu Artini, M.Sc
B4
dr. Ni Ketut Sri Diniari, Sp.KJ
B5
Dr.dr. I Wayan Sudarsa, Sp.B
(K) Onk
B6
4
5
6
Faculty of Medicine Udayana University,DME
Departement
Phone
Biochemistry
081338776244
Venue
(2&3rd floor)
2nd floor:
R.2.09
DME
081338644411
2nd floor:
R.2.10
Interna
08123814688
2nd floor:
R.2.11
Pharmacology
08123650481
2nd floor:
R.2.12
Psychiatry
081338748051
2nd floor:
R.2.13
Surgery
0811398971
2nd floor:
R.2.14
6
Study Guide The Respiratory System and Disorders
7
8
9
10
11
12
Dr. dr. Anak Agung Wiradewi
Lestari , Sp.PK
B7
Dr.dr. Susy Purnawati, MKK
B8
Dr.dr. Ni Made Linawati, M.Si
B9
Dr.dr. Elysanti Dwi Martadiani,
Sp.Rad
B10
dr.Kumara Tini, Sp.S
B11
dr. Nyoman Suryawati , M.Kes,
Sp.KK
B12
Clinical
Pathology
08155237937
2nd floor:
R.2.15
Fisiology
08123989891
2nd floor:
R.2.16
Histology
081337222567
2nd floor:
R.2.23
Radiology
081805673099
3nd floor:
R.3.21
Neurology
081238701081
3nd floor:
R.3.22
Dermatology
0817447279
3nd floor:
R.3.23
GENERAL TIME TABLE
FOR A AND B CLESSES
CLASS A
ACTIVITIES
TIME
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Lecture
Independent learning
SGD
Break
Student project
Plenary session
TIME
CLASS B
ACTIVITIES
09.00-10.00
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Lecture
Student project
Break
Independent learning
SGD
Plenary session
There are several types of learning activity:
Lecture
independent learning based on the lecture’s topic
Small group discussion to solve the learning task
Practice
Student project
Clinical skill and demonstration
Self assessment at the end of every topic
Plenary session
Lecture will be held at room 401, while discussion rooms available at 2 nd and
3rd floor (room A209-A216, A223, A321, A322, A323)
IMPORTANT INFORMATIONS
Faculty of Medicine Udayana University,DME
7
Study Guide The Respiratory System and Disorders
Meeting of the students’ representative
In the middle of block schedule, a meeting is designed among the student
representatives of every small group discussions, facilitators, and resource persons. The
meeting will discuss the ongoing teaching learning process, quality of lecturers and
facilitators as a feedback to improve the next process. The meeting will be taken based on
schedule from Medical Education Unit.
SELF ASSESSMENT
Self assessment of each lecture will be given after each lecture session, and will be
marked. This mark can determine whether the student pass this block or not. Any final mark
between 65 to 69 will be reconsidered with self assessment’s mark to see the student’s
status. Any student with self assessment’s mark more than 70 will pass this block. And for
the lower one will have to attend the remedial examination. It is important to do this self
assessment cautiously, because this activity may be your ticket to pass this block.
ASSESSMENT METHOD
Assessment in this theme consists of:
SGD
: 5%
Final Exam
: 80%
Student Project
: 15%
Final mark more than 70 considered to pass this block. Certain conditions applied for those
with final mark between 65 – 69. These students will be analyzed using their self
assessment’s mark. Students with final mark 65 – 69 and self assessment’s mark equal or
more than 70 will also considered pass this block.
TIME TABLE
REGULAR CLASS
DAY/DATE
TIME
Faculty of Medicine Udayana University,DME
ACTIVITY
VENUE
PIC
8
Study Guide The Respiratory System and Disorders
08.00-08.15
08.15-09.00
1
Monday
Feb 22,
2016
2
3
Wednesday
Feb 24,
2016
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
Class room
dr.Wardana
dr. Sri Wiryawan
Lecture2
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
dr. Sri Wiryawan
Lecture 3
Class room
dr. Muliarta
Physiology of
Respiratory System:
Ventilation
Independent learning
SGD
Break
Student project
Plenary session
Lecture 4
Disc room
Facilitator
Class room
Class room
dr. Muliarta
dr. Muliarta
Anatomy: 1st
floor
Histology: 4th
floor
Class room
dr. Wardana
Physiology of
Respiratory System:
Gas Exchange,
diving, altitude
Independent learning
09.00-15.00
08.00-09.00
Practice : Anatomy,
Histology
Lecture 5
Carriage of oxygen
and Carbon dioxide
5
Friday
Feb 26,
2016
Prof.I.B. Rai
dr.Wardana
Histology of
Respiratory System
4
Thursday
Feb 25,
2016
Lecture 1
Class room
Class room
Anatomy of
Respiratory System
REGULAR
CLASS
Tuesday
Feb 23,
2016
Introduction
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Faculty of Medicine Udayana University,DME
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Class room
dr. Sri Wiryawan
dr. Desak
Wihandani
Facilitator
dr. Desak
Wihandani
9
Study Guide The Respiratory System and Disorders
08.00-09.00
Class room
dr. Desak
Wihandani
Disc room
Facilitator
Class room
Class room
dr. Desak
Wihandani
Prof. Wiryana
Disc room
Facilitator
Class room
Class room
Prof. Wiryana
dr. Winarti
Disc room
Facilitator
Hospital Visit
Class room
Class room
dr. Winarti
dr. Winarti
Control of acid base
balance, Arterial Gas
Analysis (AGA)
6
Monday
Feb 29, 2016
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Independent learning
SGD
Break
Student project
Plenary session
08.00-09.00
Lecture 7
Control of
Respiratory Function
and Blood Gas
Analyzes
7
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
REGULAR
CLASS
Tuesday
March 1,
2016
8
Lecture 6
Wednesday
March 2,
2016
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
9
Thursday
March 3,
2016
10
Independent learning
SGD
Break
Student project
Plenary session
Lecture 8
Pathology of
Respiratory Tract
Independent learning
SGD
Break
Student project
Plenary session
Lecture 9
Lung Defense
Mechanism
Independent learning
09.00-15.00
Practice : Physiology,
Pathology Anatomy (PA)
Physiology:
2nd floor
PA: Joint Lab
(4th floor)
dr. Muliarta
Class room
Prof. Aman
Disc room
Facilitator
dr. Winarti
BKFK
Friday
March 4,
2016
11
08.00-09.00
Lecture 10
Pharmacological and
non pharmacological
interventions
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
Independent learning
SGD
Break
Student project
Faculty of Medicine Udayana University,DME
10
Study Guide The Respiratory System and Disorders
Monday
March 7,
2016
14.00-15.00
Plenary session
Class room
Prof. Aman
08.00-09.00
Lecture 11
Pharmacological and
non pharmacological
interventions
Class room
Prof. Aman
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Hospital Visit
Class room
Class room
Prof. Aman
dr. Elysanti
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
dr. Elysanti
08.00-09.00
Lecture 13
Bronchiolitis, asthma
in children,
Pneumonia
Class room
dr. IB Subanada
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Hospital Visit
Class room
Class room
dr. IB Subanada
dr. Siadi Purniti
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
Class room
dr. Siadi Purniti
dr. Sutha,
12
13
REGULAR
CLASS
Friday
March 11,
2016
Monday
March 14,
2016
14
Tuesday
March 15,
2016
15
Wednesday
March 16,
2016
16
Thursday
March 17,
2016
17
Lecture 12
Respiratory Imaging
Lecture 14
TB in children, Difteri,
Pertusis
Lecture 15
Pulmonary TB and
Extrapulmonary TB,
TB in the
Immunocompromised
Host, Abses TB
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Independent learning
SGD
Break
Student project
Plenary session
08.00-09.00
Lecture 16
Asthma,
COPD
Faculty of Medicine Udayana University,DME
dr. Bagiada
Disc room
Hospital Visit
Class room
Facilitator
dr. Sutha,
dr. Bagiada
Class room
Prof. IB Rai,
dr. Artana
11
Study Guide The Respiratory System and Disorders
18
Independent learning
SGD
Break
Student project
Plenary session
08.00-09.00
Lecture 17
Pleural effusion,
Pneumothorax,
Hematothorax
REGULAR
CLASS
Friday
March 18,
2016
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Monday
March 21,
2016
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Independent learning
SGD
Break
Student project
Plenary session
08.00-09.00
Lecture 18
Bronchitis and
Bronchiectasis,
Lung Ca and
Smoking Cessation
19
Tuesday
March 22,
2016
20
Wednesday
March 23,
2016
21
Independent learning
SGD
Break
Student project
Plenary session
08.00-08.30
08.30-09.00
Lecture 19
Disorder of nose,
sinus
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Independent learning
SGD
Break
Student project
Plenary session
08.00-09.00
Lecture 20
Disorder of larynx,
Disorder of Pharynx
09.00-10.30
Independent learning
10.30-12.00
SGD
12.00-12.30
Break
12.30-14.00
Student project
14.00-15.00
Plenary session
REGULAR
CLASS
Thursday
March 24,
2016
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Faculty of Medicine Udayana University,DME
Disc room
Facilitator
Class room
Prof. IB Rai,
dr. Artana
Class room
dr. Andrika,
dr, Yasa
Disc room
Hospital Visit
Class room
Facilitator
dr. Andrika,
dr, Yasa
Class room
dr.Dewa Artika,
dr. Saji
Disc room
Facilitator
Class room
dr.Dewa Artika,
dr. Saji
Class room
dr. Ratna,
Sp.THT
Disc room
Facilitator
Hospital Visit
Class room
dr. Ratna,
Sp.THT
Class room
Prof. Suardana,
dr. Dewa Artha
Eka Putra,
Sp.THT
Disc room
Facilitator
Class room
Prof. Suardana,
dr. Dewa Artha
Eka Putra,
Sp.THT
12
Study Guide The Respiratory System and Disorders
22
Monday
March 28,
2016
08.00-15.00
BCS: Spirometry
BCS: WSD, Radio Imaging
(Pre-test, lecture, demo
Practice, discussion)
08.00-15.00
BCS: Physical Diagnostic of
Thorax
BCS: Bronchoscopy
BCS: THT
(Pre-test, Lecture, practice,
demo)
08.00-15.00
BCS: Spirometry
BCS: Physical Diagnostic of
Thorax
(Pre-test, lecture, practice,
demo)
23
Tuesday
March 29,
2016
24
Wednesday
March 30,
2016
25
Monday
March 31,
2016
08.00-15.00
26
Friday
April 1,
08.00-15.00
2016
27
Monday
April 5,
2016
Faculty of Medicine Udayana University,DME
BCS: Physical Diagnostic of
Thorax
BCS: Provocation test
BCS: THT
(Pre-test, lecture, demo)
BCS: Physical Diagnostic of
Thorax, Provocation test,
Spirometry, WSD,
Bronchoscopy, Radio
Imaging, THT
(Practice, post-test)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
dr. Muliarta
dr. Yasa
Elysanti
dr. Saji
dr. Sutha
dr. Lely
dr. Muliarta
dr. Saji
dr. Saji
dr Artana
dr. Lely
dr. Saji
dr Artana
dr. Sutha
dr. Muliarta
dr. Yasa
dr. Elysanti
dr. Lely
Examination
13
dr.
Study Guide The Respiratory System and Disorders
TIME TABLE
ENGLISH CLASS
DAY/DATE
09.00-09.15
09.15-10.00
1
Monday
Feb 22,
2016
2
Wednesday
Feb 24,
2016
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-10.00
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-10.00
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-10.00
Lecture 1
Class room
Class room
Prof.I.B. Rai
dr.Wardana
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
Class room
dr.Wardana
dr. Sri Wiryawan
Lecture2
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
dr. Sri Wiryawan
Lecture 3
Class room
dr. Muliarta
Disc room
Facilitator
Class room
Class room
dr. Muliarta
dr. Muliarta
Anatomy: 1st
floor
Histology: 4th
floor
Class room
dr. Wardana
Disc room
Facilitator
Class room
dr. Desak
Wihandani
Physiology of
Respiratory System:
Ventilation
Independent learning
SGD
Break
Student project
Plenary session
Lecture 4
Physiology of
Respiratory System:
Gas Exchange,
diving, altitude
Independent learning
10.00-16.00
09.00-10.00
Practice : Anatomy,
Histology
Lecture 5
Carriage of oxygen
and Carbon dioxide
5
Friday
Feb 26,
2016
Introduction
PIC
Histology of
Respiratory System
4
Thursday
Feb 25,
2016
VENUE
Anatomy of
Respiratory System
ENGLISH
CLASS
Tuesday
Feb 23,
2016
3
TIME
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
Faculty of Medicine Udayana University,DME
Independent learning
SGD
Break
Student project
Plenary session
dr. Sri Wiryawan
dr. Desak
Wihandani
14
Study Guide The Respiratory System and Disorders
09.00-10.00
Class room
dr. Desak
Wihandani
Disc room
Facilitator
Class room
Class room
dr. Desak
Wihandani
Prof. Wiryana
Disc room
Facilitator
Class room
Class room
Prof. Wiryana
dr. Winarti
Disc room
Facilitator
Hospital Visit
Class room
dr. Winarti
Class room
dr. Winarti
Physiology:
2nd floor
PA: Joint Lab
(4th floor)
dr. Muliarta
Class room
Prof. Aman
Disc room
Facilitator
Class room
Prof. Aman
Control of acid base
balance, Arterial Gas
Analysis (AGA)
6
Monday
Feb 29, 2016
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
Independent learning
SGD
Break
Student project
Plenary session
09.00-10.00
Lecture 7
Control of
Respiratory Function
and Blood Gas
Analyzes
7
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-10.00
ENGLISH
CLASS
Tuesday
March 1,
2016
8
Lecture 6
Wednesday
March 2,
2016
9
Thursday
March 3,
2016
10
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-10.00
10.00-16.00
Independent learning
SGD
Break
Student project
Plenary session
Lecture 8
Pathology of
Respiratory Tract
Independent learning
SGD
Break
Student project
Plenary session
Lecture 9
Lung Defense
Mechanism
Independent learning
Practice : Physiology,
Pathology Anatomy (PA)
dr. Winarti
BKFK
Friday
March 4,
2016
09.00-10.00
11
Monday
March 7,
2016
Lecture 10
Pharmacological and
non pharmacological
interventions
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
Faculty of Medicine Udayana University,DME
Independent learning
SGD
Break
Student project
Plenary session
15
Study Guide The Respiratory System and Disorders
09.00-10.00
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-10.00
ENGLISH
CLASS
13
Monday
March 14,
2016
15
Wednesday
March 16,
2016
16
Thursday
March 17,
2016
Independent learning
SGD
Break
Student project
Plenary session
Lecture 12
Prof. Aman
Disc room
Facilitator
Hospital Visit
Class room
Class room
Prof. Aman
dr. Elysanti
Respiratory Imaging
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
Independent learning
SGD
Break
Student project
Plenary session
09.00-10.00
Lecture 13
Disc room
Facilitator
Class room
dr. Elysanti
Class room
dr. IB Subanada
Disc room
Facilitator
Bronchiolitis, asthma
in children,
Pneumonia
14
Tuesday
March 15,
2016
Class room
Pharmacological and
non pharmacological
interventions
12
Friday
March 11,
2016
Lecture 11
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
Independent learning
SGD
Break
Student project
Plenary session
09.00-10.00
Lecture 14
Hospital Visit
Class room
dr. IB Subanada
Class room
dr. Siadi Purniti
Disc room
Facilitator
Class room
Class room
dr. Siadi Purniti
dr. Sutha,
TB in children, Difteri,
Pertusis
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-10.00
Independent learning
SGD
Break
Student project
Plenary session
Lecture 15
Pulmonary TB and
Extrapulmonary TB,
TB in the
Immunocompromised
Host, Abses TB
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
Independent learning
SGD
Break
Student project
Plenary session
09.00-10.00
Lecture 16
Asthma,
COPD
Faculty of Medicine Udayana University,DME
dr. Bagiada
Disc room
Hospital Visit
Class room
Facilitator
dr. Sutha,
dr. Bagiada
Class room
Prof. IB Rai,
dr. Artana
16
Study Guide The Respiratory System and Disorders
17
Independent learning
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
Prof. IB Rai,
dr. Artana
Lecture 17
Class room
ENGLISH
CLASS
Friday
March 18,
2016
12.00-13.30
09.00-09.00
18
Monday
March 21,
2016
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
Independent learning
SGD
Break
Student project
Plenary session
08.00-09.00
Lecture 18
20
Wednesday
March 23,
2016
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-09.30
09.30-10.00
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
22
Monday
March 28,
2016
Independent learning
SGD
Break
Student project
Plenary session
Lecture 19
Disorder of nose, sinus
Independent learning
SGD
Break
Student project
Plenary session
08.00-15.00
BCS: Spirometry
BCS: WSD, Radio Imaging
(Pre-test, lecture, demo
Practice, discussion)
08.00-15.00
BCS: Physical Diagnostic of
Thorax
BCS: Bronchoscopy
BCS: THT
(Pre-test, Lecture, practice,
demo)
23
Tuesday
March 29,
2016
Disc room
Hospital Visit
Class room
Faculty of Medicine Udayana University,DME
Facilitator
dr. Andrika,
dr, Yasa
Class room
Bronchitis and
Bronchiectasis,
Lung Ca and
Smoking Cessation
19
Tuesday
March 22,
2016
dr. Andrika,
dr, Yasa
Pleural effusion,
Pneumothorax,
Hematothorax
dr.Dewa Artika,
dr. Saji
Disc room
Facilitator
Class room
dr.Dewa Artika,
dr. Saji
Class room
dr. Ratna,
Sp.THT
Disc room
Facilitator
Hospital Visit
Class room
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
dr. Ratna,
Sp.THT
dr. Muliarta
dr. Yasa
Elysanti
dr. Saji
dr. Sutha
dr. Lely
17
dr.
Study Guide The Respiratory System and Disorders
24
Wednesday
March 30,
2016
08.00-15.00
25
Monday
March 31,
2016
08.00-15.00
26
Friday
April 1,
08.00-15.00
2016
27
Monday
April 5,
2016
Faculty of Medicine Udayana University,DME
BCS: Spirometry
BCS: Physical Diagnostic of
Thorax
(Pre-test, lecture, practice,
demo)
BCS: Physical Diagnostic of
Thorax
BCS: Provocation test
BCS: THT
(Pre-test, lecture, demo)
BCS: Physical Diagnostic of
Thorax, Provocation test,
Spirometry, WSD,
Bronchoscopy, Radio
Imaging, THT
(Practice, post-test)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
dr. Muliarta
dr. Saji
dr. Saji
dr Artana
dr. Lely
dr. Saji
dr Artana
dr. Sutha
dr. Muliarta
dr. Yasa
dr. Elysanti
dr. Lely
Examination
18
Study Guide The Respiratory System and Disorders
LEARNING PROGRAMS
LECTURE 1
ANATOMY OF RESPIRATORY TRACT
Abstract
dr. I Nyoman Gede Wardana, M.Biomed
The respiratory system consists of conducting zone and respiratory zone.
Conducting zone, whose walls are too thick to permit exchange of gases between the air in
the tube and the blood stream. The nostrils (nares), nasal cavity, pharynx, larynx, trachea,
bronchi, and terminal bronchioles are included in this zone. Respiratory zone, whose walls
are thin enough to permit exchange of gases between tube and blood capillaries
surrounding them. Air travels to the lungs through that zone. The right lung divided into
three lobes: superior, middle, and inferior. The left lung divided into two lobes: superior and
inferior. Each lung cover by a membrane that called pleura. Both lungs are inside the
thoracic cage. The thoracic cage is formed by the vertebral column behind, the ribs, and
intercostal spaces on other side and the sternum and costal cartilages in front. Below it
separated from the abdominal cavity by diaphragm
Learning Task
Vignette 1:
Kesawa, 32 years old, was seen in the clinic ten days ago, was diagnosed with rhinitis and
sent home with instructions for increased fluids, decongestants, and rest. Kesawa presents
today with worsened symptoms of malaise, low-grade temperature, nasal discharge, night
time coughing, mouth breathing, early morning pain over sinuses, and congestion. The
doctor diagnose he is suffering sinusitis.
1. Describe the boundaries of the nasal cavity and its blood supply
2. Describe the paranasal sinuses and its opening at nasal cavity
Vignette 2:
Gotawa, a singer-18 years old came to clinic with complain a hoarse voice for 3 days. She
also suffers sore throat, nose block, and fever. She was diagnosed laryngitis
1. Describe the structure of larynx and location of vocal cord
2. Describe the intrinsic and extrinsic muscle of larynx
Vignette 3:
Mande, 30 years old male came to clinic with chief complaint difficulty to breath start from
this morning. He also suffers cough, runny nose and fever. He has history bronchial asthma
when he was 2 years old. The doctor diagnose he is suffering bronchial asthma.
1. Describe the structure of trachea
2. Describe the different between right and left main bronchus
3. Describe the principal different between trachea, bronchi, and bronchioles
Vignette 4:
A 57-year-old male is admitted to the hospital with a chief complaint of shortness of breath
for 2 weeks. The radiology examination shows a large left-side pleural effusion.
1. Describe the different between right lung and left lung
2. Describe the structure of pleura
3. Describe the structure of thoracic wall
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Study Guide The Respiratory System and Disorders
LECTURE 2
HISTOLOGY OF RESPIRATORY TRACT
dr. Sri Wiryawan, MRepro
Abstract
The lower respiratory tract consists of : the lower part of the trachea, the two main
bronchi, lobar, segmental, and smaller bronchi, bronchioles and terminal bronchioles, and
last but not least is the end respiratory unit. These structure make up the tracheobronchial
tree. As for the structure distal to the main bronchi along with a tissue known as the lung
parenchyma.
There are several structure we should also understand, when talking about lower
respiratory tract. Several structures such as thorax, mediastinum, pleurae and pleural cavity,
and lung. Thorax especially thoracic cavity and thoracic wall protect our lung and
mediastinum and also play an important role in respiratory process. The mediastinum,
which has a role in protecting our heart , located between the two lungs, and contains the
heart and great vessels, trachea and esophagus, phrenic and vagus nerves, and lymph
nodes.
The pleurae covers the external surface of the lung, and is then reflected to cover
the inner surface of thoracic cavity. Pleurae divided into the visceral (lines the surface of the
lung) and parietal (lines the thoracic wall and diaphragm) one. The space between these
two pleurae called as pleural cavity which contains a thin film fluid to allow the pleurae to
slip over each other during breathing.
The lungs are placed within the thoracic cavity. The lungs contain airways structure,
vessels, lymphatic and lymph nodes, nerves, and supportive connective tissue. The trachea
divides and form the left and right primary bronchi, which in turn divide to form lobar bronchi.
Each lobar bronchi divide again to give segmental bronchi to supply air to
bronchopulmonary segments. The tracheobronchial tree can also be classified into two
functional zones: the conducting zone (proximal to the respiratory bronchioles) which
involved in air movement, and the respiratory zone (distal to the terminal bronchioles) which
involved in gaseous exchange.
The other term to show functional structure of the lower respiratory tract is the
acinus. The acinus defined as the part of the airway that is involved in gaseous exchange.
The acinus consist of respiratory bronchioles, alveolar ducts, and alveoli as the smallest
functional structure of the lung. The areas of lung containing groups of between three to five
acini surrounded by parenchimal tissue are called lung lobules.
The alveolus is an blind-ending terminal sac of respiratory tract. Most gaseous
exchange occurs in the alveoli. The alveoli are lined with type I (structural) and type II
(produce surfactant) of pneumocytes cell. The understanding about histological pattern of
these functional structures of the lung is important in pathophysiology of lung problems.
Learning Tasks
I.
Structure of The Upper Respiratory tract
Krishna, a man, 25 years old came to doctor Arjuna clinic with fever, sore throat,
sneezing, runny nose and sometimes blocked nose. He also cannot smell well. The
doctor diagnoses Krishna with acut Rhinopharingitis.
1. Describe the histological structure of the upper respiratory tracts
are involved ?
2. Describe the histological structure and function of epiglottis !
3. Compare the histological structure and function between vestibular fold and
vocal fold !
II. Structure of The Lower Respiratory tract
Radha, a 17 years old beautiful girl, came to doctor Laksmi clinic with shortness of
breath, wheezing and cough with phlegm. The doctor diagnoses Radha with Asthma.
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Study Guide The Respiratory System and Disorders
1.Describe the histological structure of the lower respiratory tracts are involved ?
2.Compare the histological structure and function between terminal bronchioles and
respiratory bronchioles !
3.Describe the histological structure of the interalveolar septum !
4.Describe the histological structure of blood-air barrier ?
5.Describe about the pulmonary surfactant ?
LECTURE 3
PHYSIOLOGY OF RESPIRATORY SYSTEM: VENTILATION
dr. I Made Muliarta, MKes
Abstract
In living cells aerobic metabolism consumes oxygen and produces carbon dioxide. Gas
exchange requires a large , thin, moist exchange surface, a pump to move air circulatory
system to transport gases to cells. The primary function system are:
Exchange the gases between atmosphere and the blood.
Homeostatic regulation of body pH .
Protection from inhaled pathogens and irritation substance
Vocalization.
In addition to serving these function, the respiratory system also source of significant
losses of water and heat from the lung.
A single respiratory cycle consists of an inspiration and expiration. Relation with
ventilation had to know about compliance, surfactant, lung volume and capacities
Respiratory control resides in a central pattern generator, a net work of neurons in the
pons and medulla oblongata.
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Study Guide The Respiratory System and Disorders
LEARNING TASK
dr. Muliarta, MKes
1.
What is the sequence of event during quiet inspiration (muscle involvement,
pressure changes (intrapulmonary and intrapleura), volume changes)
2.
What is pulmonary ventilation and alveolar ventilation means?
3.
Andi, male, 30 years old, has a puncture wound due to car accident in his right chest
and penetrate his pleural cavity. The patient has complained shortness of breathing and
doctor determine that his lung is collapsed.
a. What is this condition called?
b. Describe the mechanism of the lung collapse!
c. What kind respiratory system compensation to anticipate this condition (lung
collapse)
d. How can he still be alive in this condition?
4.
Describe the Boyle’s Law!
LECTURE 4
PHYSIOLOGY OF RESPIRATORY SYSTEM: GAS EXCHANGE, DIVING,
ALTITUDE
dr. I Made Muliarta, MKes
Abstract
Gas exchange during external respiration occurs in respiratory membrane. Several
factors may influence gas exchange. Dalton’s law and Henry’s law may apply during gas
exchange.
Some physiologic responses on respiratory system at high altitude and during diving.
Some illnesses/injuries related pressure change may occurs at high altitude and during
diving.
LEARNING TASK
dr. Muliarta, MKes
1.
2.
3.
Describe the Dalton’s Law!
Describe the factors that influence oxygen diffusion from alveoli into the blood!
Predict the response of the pulmonary arterioles and bronchioles when PO2 increase
and PCO2 decrease!
4.
Describe some illnesses/injuries due to high altitude
5.
Describe some illnesses/injuries due to diving
LECTURE 5
CARRIAGE OF OXYGEN AND CARBON DIOXIDE
dr. Desak Wihandani
Abstract
Gas Transport
The supply of oxygen to the tissues is our most immediate physical need. We take in about
250 ml of oxygen gas per minute and this is our most pressing physical need. If our oxygen
supply is interrupted for more than a few minutes, irreversible damage is done to some
tissues, notably the brain. Oxygen is abundantly available in the air around us but cannot
diffuse into our tissues at sufficient rate to meet our needs. It must be transported from the
lung, the specialized organ for gas exchange, by the blood to all the other tissue.
While oxygen has to be transported from lungs to tissues, carbon dioxide must be
transported from the tissues for excretion by the lungs. Carbon dioxide has physicochemical
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Study Guide The Respiratory System and Disorders
properties that make its transport less difficult then transport of oxygen. Carbon dioxide can
be transported in the blood in three ways: in simple solution, by reversible conversion to
bicarbonate and by reversible combination with haemoglobin to form carbamino
haemoglobin.
LEARNING TASK:
1. Describe the structure and function of hemoglobin
2. Describe the mechanism of oxygen binding to hemoglobin
3. Describe the differences between hemoglobin and myoglobin
4. Describe the mechanism of oxygen binding to myoglobin
5. Describe conformational differences between deoxygenated and oxygenated Hb!
6. Summarize the processes by which carbondioxide is transported from peripheral
tissues to the lungs
LECTURE 6
CONTROL OF ACID BASE BALANCE, ARTERIAL GAS ANALYSIS (AGA)
dr. Desak Wihandani
Abstract
Acid-Base Balance
There is large daily flux of oxygen, carbon dioxide and hydrogen ion through the human
body. Carbon dioxide generated in tissues dissolves in H2O to form carbonic acid, which in
turn dissociates releasing hydrogen ion. The blood concentration of hydrogen ion is
constant, it remains between 36 and 46 nmol/L (pH 7,36-7,46). Changes in pH will affect
the activity of many enzyme and tissue oxygenation. Problems with gas exchange and acidbase balance underlie many diseases of respiratory system.
Blood Gases
Blood gas measurement is an important first-line investigation performed whenever there is
a suspicion of respiratory failure or acid-base disorders. In respiratory failure, the results of
such measurements are also an essential guide to oxygen therapy and assisted ventilation.
The key clinically used parameters are pH, pCO 2 and pO2, the bicarbonate concentration is
calculated from pH and pCO2 values.
Learning Task:
1. Describe organs in our body involved in acid-base balance, and how they work
2. Describe acid-base balance disorders! What is mean by : a. Respiratory
alkalosis, b. metabolic alkalosis, c.respiratory acidosis, and d. metabolic
acidosis
3. In which condition respiratory acidosis and respiratory alkalosis occurs ?
4. What is the importance of blood gas measurement. To perform measurement
where are the blood sample taken from? What kind of measurement are done?
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Study Guide The Respiratory System and Disorders
LECTURE 7
CONTROL OF RESPIRATORY FUNCTION
Prof. Dr. dr. Wiryana, SpAn
Abstract
When considering contol of breathing, the main control variable is P aCO2 (we try to
control this value near to 40 mmHg). This can be carried out by adjusting the respiratory
rate, the tidal volume, or both. By controlling PaCO2 we are effectively controlling alveolar
ventilation (see Ch.3) and thus PACO2. Although PaCO2 is the main control variable, PaO2 is
also controlled, but normally to a much lesser extent than P aCO2. However, the PaO2
control system can take over and become the main controlling system when the P aO2 drops
below 50 mmHg.
Control can seem to be brought about by :
1. Metabolic demands of the body (metabolic control)-tissue oxygen demand and acidbase balance.
2. Behavioural demands of the body (behavioral control) – singing, coughing, laughing
(i.e.control is voluntary).
These are essentially feedback and feed-forward control systems, respectively. The
behavioural control of breathing overalys the metabolic control.
Its control is derived from higher centres of the brain. The axons of neurons whose cell
bodies are situated in the cerebral cortex bypass the respiratory centres in the brainstem
and synapse directly with lower motor neurons that control respiratory muscles. This system
will not be dealt with in this next;we shall deal only with the the metabolic control of
respiration.
Learning Tasks
1. Discuss the central control of breathing with reference to the pontine respiratory
group and the dorsal-ventral respiratory groups of medulla spinalis
2. List the different types of receptors involved in controlling the respiratory system
3. Describe factors that stimulate central and peripheral chemoreceptor
4. outline the response of the respiratory system to change in carbon dioxide
concentration, oxygen concentration and pH.
5. discuss the mechanism thought to influence the control of ventilation in exercise
6. discuss the changes that occur in response to high altitude
LECTURE 8
PATHOLOGY OF UPPER AND LOWER URINARY TRACT
dr. Ni Wayan Winarti, SpPA
ABSTRACT
The term upper airways is used here to include the nose, pharynx, and larynx and their
related parts. Disorders of these structures are among the most common afflictions of
humans, but fortunately the overwhelming majority are more nuisances than threats.
Inflammatory diseases are the most common disorders of the upper respiratory tract, i.e.
rhinitis, sinusitis, pharyngitis, tonsillitis and laryngitis. It may occur as the sole manifestation
of allergic, viral, bacterial or chemical insult. Although most infections are self-limited, they
may at times be serious, especially laryngitis in infancy or childhood, when mucosal
congestion, exudation, or edema may cause laryngeal obstruction. Tumors in these
locations are infrequent but include the entire category of mesenchymal and epithelial
neoplasms. Some distinctive types are nasopharyngeal angiofibroma, Sinonasal
(Schneiderian) Papilloma, Olfactory Neuroblastoma and Nasopharyngeal Carcinoma.
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Study Guide The Respiratory System and Disorders
Classification of lower respiratory tract (lung) diseases can be made based on the result of
lung function test, although some authors prefer etiology and pathogenesis background.
Some important diseases are obstructive lung disease (asthma, COPD, bronchiectasis) and
restrictive lung disease (ARDS), and also infections, diseases of vascular origin and tumors.
Pleura as protective structure of the lungs, are sometimes involved as secondary
complication of some underlying disease, but in rare case, can be primary.
Because of the complexity of respiratory disease, it is important to understand their
pathogenesis, supported by recognizing their morphologic changes.
LEARNING TASK
Case 1
A male patient, 16 year old, came to a doctor with chief complaint difficulties in breathing. It
has occurred since 1 month ago. This patient suffers from rhinitis alergica since he was 3
year old. On physical examination, a pedunculated nodule in right nasal cavity was found. It
was whitish in color, 1.5 cm in diameter occluding the nasal cavity.
1. Based on clinical finding, what is the most possible diagnosis?
2. What are the DDs?
3. Describe the morphological appearance (macroscopy and microscopy) that
supposed to be found to confirm your diagnosis!
4. Explain the pathogenesis of this diasease!
Case 2
A male patient, 65 year old, has suffered from dyspnea and productive cough since 1 year
ago. Lung function test showed increased of FEV1 with normal FVC (confirm an obstructive
lung disease). He is a heavy smoker since he was 25 year old. No history of atopy. No
evidence of cardiac disorders.
A. Mention 4 diseases including in the spectrum of obstructive lung disease!
B. Explain their pathogenesis!
C. Distinguish their morphology!
Case 3
A female patient, 50 year old, has suffered from tumor of right lung with pleural effusion. As
the first step to confirm the diagnosis, doctor asked the patient to do cytology test.
A. Mention some cytology test can be choose for this patient!
B. Among the test mention above (A), which one is the most simple and non-invasive?
And, discuss how to collect the specimen
LECTURE 9
LUNG DEFENCE MECHANISM
dr. Ni Wayan Winarti, SpPA
Abstract
Respiratory tract is an organ that constantly exposed by contaminated air. It is there
fore a small miracle that the normal lung parenchyma remains sterile. Fortunately, a
plethora of immune and non immune defense mechanisms exist in the respiratory system,
extending from the nasopharynx all the way into alveolar airspaces.
The major categories of defense mechanisms to be discussed include : (1)physical
or anatomic factors related to deposition and clearance of inhaled materials, (2)antimicrobial
peptides, (3) phagocytic and inflammatory cells that interact with inhaled materials,
(4)adaptive immune response, which depends on prior exposure to recognize the foreign
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Study Guide The Respiratory System and Disorders
materials. Each components appears to have a distinct role, but a tremendous degree of
redundancy and interaction exists among different components.
Any condition breaks down the lung defense mechanism may result in lung injury
and respiratory tract infections
Learning Tasks
1.
Defense mechanism of the lung and respiratory tract ca be divided into four
major categories. Mention them, their components and explain how each of them
acts against foreign materials.
2.
Explain about diseases or conditions that break the lung defense mechanism
down which result in increase susceptibility to respiratory tract infections
LECTURE 10
PHARMACOLOGICAL AND NON PHARMACOLOGICAL INTERVENSION I
Prof. dr. GM Aman
Abstract
Drugs for cough, rhinitis, asthma bronchiale
Cough is a protective reflex mechanism that removes foreign material and secretions
from the bronchi and bronchioles. It can be inappropriately stimulated by inflammation in the
respiratory system or by neoplasia. In these cases, antitussive (cough suppressant) drugs
are sometimes used. It should be understood that these drugs merely suppress the
symptom without influencing the underlying condition. In cough associated with
bronchiectasis or chronic bronchitis, antitussive drugs can cause harmful sputum thickening
and retention. They should not be for the cough associated with asthma.
Most drugs used in rhinitis are effectively relief the symptom of rhinitis, not affect the
underlying disease. No drug can relief symptom completely. Drugs are more effective for
allergic rhinitis than non allergic rhinitis, and acute form of allergy respond more favorable
than chronic form of allergy. The most common drugs used for rhinitis are antihistamine,
nasal disodium cromoglycate, nasal decongestant, anticholinergic, intranasal corticosteroid.
Bronchial Asthma is a disease characterized by airway inflammation, edema and
reversible bronchospasm. Bronchodilator and anti-inflammatory are the most useful drugs
used in asthma. B2 selective agonists, muscarinic antagonists, aminophylline and
leucotriene receptor blockers are the most effective bronchodilator. Anti-inflamatory drugs
such as corticosteroid, mast cell stabilizers, leucotriene antagonists, and an anti IgE
antibody are widely used. Short acting B2 agonist are the most widely used for acute
asthma attack, by relaxing airway smooth muscle. Theophylline, aminophylline and
antimuscarinic agent are also used for acute asthma attack. Long term control can be
achieved with an anti-inflammatory agent such as corticosteroid (systemic or inhaled), with
leucotriene antagonist, mast cell stabilizers (cromolyn or nedocromil). Long acting B2
agonists such as Salmeterol and Formeterol, are effectively in improving asthma control,
when taken regularly.
Learning Tasks Day 10
The patient complained about a sore throat and a nasty cough. It started two weeks ago
with a cold. The cold was over within a week, but he continued coughing, especially at night.
He is a heavy smoker. After physical examination you diagnosed a dry, tickling cough.
Faculty of Medicine Udayana University,DME
26
Study Guide The Respiratory System and Disorders
Task 1
1. Differentiate between Antitussive, Expectorant, Mucolytic
2. Differentiate the effects of Codeine, Dextromethorphan and Diphenhydramine
3. List the side effects of Codeine
4. In this patient, what kind of anti cough you give best.
Task 2
If the patient also has sneezing, rhinorrhea and congested nose and then you diagnosed as
rhinitis.
1. List the group of drugs used for Rhinitis
2. List the drugs used as oral nasal decongestant, and describe the important side effects.
3. List the side effects of intranasal decongestant
4. what is the drug of choice for patient suffer from Rhinitis Medicamentosa
LECTURE 11
PHARMACOLOGICAL AND NON PHARMACOLOGICAL INTERVENSION II
Prof. dr. GM Aman
Task Day 11
If the patient come with cough, breathless, and in your examination, you found wheezing.
After physical examination you diagnosed Acute attack of bronchial asthma.
1. Chose the drug of first choice for this patient
2. List the side effects of this drug
3. Compare the effect of this drug with Salmeterol
4. Theophyllin is a bronchodilator, but has a narrow safety margin. List the side effects &
toxic effect of Theophyllin.
5. Ipratropium not as effectiv
TABLE OF CONTENTS
Page
Table of Contens
1
Introduction
2
Curriculum
3
Planner team & Lecturers
4
Facilitators
6
General Time Table
7
Important Informations
8
Meeting of the students’ representative
8
Self Assessment
8
Assessment Method
8
Time Table (Regular Class)
9
Time Table (English Class)
14
Learning Programs
19
Faculty of Medicine Udayana University,DME
1
Study Guide The Respiratory System and Disorders
INTRODUCTION
The medical curriculum has become increasingly vertically integrated, with stronger
basic concept and support by clinical examples and cases to help in the understanding of
the relevance of the underlying basic science. Basic science concepts may help in the
understanding of the pathophysiology and treatment of diseases. Respiratory system and
disorders block has been written to take account of this trend, and to integrate core aspects
of basic science, pathophysiology and treatment into a single, easy to use revision aid.
The respiratory system consists of a pair of lungs within the thoracic cage. Its main
function is gas exchange, but other roles include speech, filtration of microthrombin arriving
from systemic veins and metabolic activities such as conversion of angiotensin I to
angiotensin II and removal or deactivation of serotonin, bradykinin, norepinephrine,
acetylcholine and drugs such as propranolol and chlorpromazine. So this block will discuss
about anatomy, histology, symptom and signs of lung disease and its pathophysiology,
major upper respiratory diseases, major lung diseases, major pediatric lung disease, and
basic principle concept to education, prevention, treatment and rehabilitation in respiratory
system disorder in patient, family and community.
The learning process will be carried out for 6 weeks (27 working days) starts from 22 nd of
February 2016 as shown in the time table. The final examination will be conducted on 4 th of
April 2016 in the form of MCQ. The learning situation include lecture, individual learning,
small group discussion, plenary session, practice, and clinical skill.
Most of the learning material should be learned independently and discuss in SGD by the
students with the help of facilitator. Lecture is given to emphasize the most important thing
of the material. In small group discussion, the students gave learning task to lead their
discussion.
This simple study guide need more revision in the future, so that the planners kindly invite
readers to give any comments and critics for its completion. Thank you.
Planners
Faculty of Medicine Udayana University,DME
2
Study Guide The Respiratory System and Disorders
CURRICULUM
RESPIRATORY SYSTEM AND DISORDER
Aims :
Comprehend the structure, physiologic, and pathologic of the respiratory system.
Interpret the laboratory and imaging examination of the respiratory system
disorders
Diagnose and treat the patient with common respiratory system disorders
Plan education, prevention, management and rehabilitation of respiratory system
disorders to patient, family and community.
Learning outcomes:
Concern about the size of problem and diversity of respiratory disease in the
community
Able to describe the structure and function of the respiratory system
Able to interpret the result of examination (physical, laboratory, function test,
blood gas analysis and chest imaging)
Able to explore patients with respiratory problem (runny nose, cough, dyspnea,
non cardiac chest pain, hemoptysis)
Able to manage major upper respiratory diseases (tonsillitis, rhinitis, sinusitis)
Able to manage major lung diseases (TBC, asthma, COPD, lung cancer,
pneumonia, occupational lung disease, pleural disease) on patient, family and
community
Able to manage major pediatric lung disease (bronchiolitis, TB, asthma)
Able to implement DOTS program against TB
Able to implement the strategy of smoking cessation, especially in patient with
respiratory disease
Curriculum contents:
Structural and function of the respiratory system
Physiology of lung in related with oxygen consumption and acid base balance
Symptoms and signs of lung disease
Pathophysiology of respiratory system disorders
Basic physical, laboratory and imaging examination
Interpretation of examination results.
Drugs that commonly used in respiratory system disorders (decongestant, antiasthma & bronchodilators, antitussive, expectorant
Basic principle concept to education, prevention, treatment and rehabilitation in
respiratory system disorders in patient, family and community.
Faculty of Medicine Udayana University,DME
3
Study Guide The Respiratory System and Disorders
PLANNER TEAM
LECTURERS
No
Department
Phone
1
Prof. Dr.dr.IB Ngr Rai Sp.P (K)
Name
Pulmonology
08123804579
2
dr.I GN Sri Wiryawan,M.Repro
Histology
08123925104
3
dr.Gede Wardana, M.Biomed
Anatomy
0361-7864957
4
Biochemistry
081338776244
5
Dr.dr.Dsk Made Wihandani,
M.Kes
dr.Ida Bagus Subanada, Sp.A
Paediatric Dept.
0812399533
6
dr.Dewa Artika, Sp.P
Pulmonology
08123875075
7
dr.Ida Bagus Suta, Sp.P
Pulmonology
08123990362
8
dr. Made Bagiada, Sp.PD-KP
Pulmonology
9
Prof.dr I Gst.Md.Aman,Sp.FK
Pharmacology
08123607874
8543948
081338770650
10
Dr. dr.Muliarta, M.Kes
Physiology
081338505350
11
dr. IGN Bagus Artana, Sp.PD
Pulmonology
08123994203
12
dr.Ketut Putu Yasa, Sp.BTKV
Thorax surgery
08123843260
13
dr.Elysanti Martadiani,Sp.Rad
Radiology
08123807313
14
dr. Wayan Winarti, Sp.PA
Pathology Anatomy
087860990701
15
Prof.Dr.dr. M.Wiryana,Sp.AnKIC
Anaesthesiology
0811392171
16
dr.Putu Siadi Purniti,Sp.A
Paediatric
08123812106
17
dr.DGA Eka Putra,Sp.THT
Otorhinolaryngology
0813387826317
Faculty of Medicine Udayana University,DME
4
Study Guide The Respiratory System and Disorders
18
18
19
20
dr. Luh Made Ratnawati,
Sp.THT(KL)
dr. Putu Andrika, Sp.PD-KIC
Otorhinolaryngology
08123806108
Pulmonology
08123989192
dr. Gede Ketut Sajinadiyasa,
Sp.PD
Prof. Suardana, Sp.THT
Pulmonology
085237068670
Otorhinolaryngology
0811385299
Faculty of Medicine Udayana University,DME
5
Study Guide The Respiratory System and Disorders
~ FACILITATORS ~
Regular Class (Class A)
No
1
2
Name
dr. Gde Somayana, Sp.PD
dr. Ida Bagus Wirakusuma,
MOH
Group
Departement
Phone
A1
Interna
081345136913
Venue
(2&3 rd floor)
2nd floor:
R.2.09
A2
Public Health
08124696647
2nd floor:
R.2.10
A3
Andrology
081338605087
2nd floor:
R.2.11
A4
Anasthesi
081337711220
2nd floor:
R.2.12
4
dr. I Gusti Ngurah
Pramesemara , M.Biomed,
Repro
Dr.dr. Tjok G A Senapathi,
Sp.An. KAR
5
Dr. dr. I Dewa Made Sukrama,
MSi, Sp.MK(K)
A5
Microbiology
081338291965
2nd floor:
R.2.13
6
Dr.dr. Ketut Sudartana, Sp.BKBD
A6
Surgery
0811398996
2nd floor:
R.2.14
A7
Parasitologi
08124649002
2nd floor:
R.2.15
A8
Radiologi
081916442626
2nd floor:
R.2.16
A9
Surgery
08123811106
2nd floor:
R.2.23
A10
Andrology
085935054964
3nd floor:
R.3.21
3
7
8
9
10
dr. I Kadek Swastika , M Kes
dr. Made Widhi Asih, Sp.Rad (K)
dr. Ketut Sudiasa, Sp.B (K)
Trauma
dr. I Made Oka Negara, FIAS
11
dr. Ida Ayu Sri Wijayanti,
M.Biomed, Sp.S
A11
Neurology
081337667939
3nd floor:
R.3.22
12
dr. I Gusti Ayu Agung Elis
Indira , Sp.KK
A12
Dermatology
081338718384
3nd floor:
R.3.23
English Class (Class B)
No
Name
Group
1
Dr. dr. Desak Made Wihandani,
M.Kes
B1
2
dr. I Gusti Ayu Sri Darmayani,
Sp.OG
B2
3
Dr. dr. Made Ratna Saraswati,
Sp.PD-KEMD-FINASIM
B3
dr. I Gusti Ayu Artini, M.Sc
B4
dr. Ni Ketut Sri Diniari, Sp.KJ
B5
Dr.dr. I Wayan Sudarsa, Sp.B
(K) Onk
B6
4
5
6
Faculty of Medicine Udayana University,DME
Departement
Phone
Biochemistry
081338776244
Venue
(2&3rd floor)
2nd floor:
R.2.09
DME
081338644411
2nd floor:
R.2.10
Interna
08123814688
2nd floor:
R.2.11
Pharmacology
08123650481
2nd floor:
R.2.12
Psychiatry
081338748051
2nd floor:
R.2.13
Surgery
0811398971
2nd floor:
R.2.14
6
Study Guide The Respiratory System and Disorders
7
8
9
10
11
12
Dr. dr. Anak Agung Wiradewi
Lestari , Sp.PK
B7
Dr.dr. Susy Purnawati, MKK
B8
Dr.dr. Ni Made Linawati, M.Si
B9
Dr.dr. Elysanti Dwi Martadiani,
Sp.Rad
B10
dr.Kumara Tini, Sp.S
B11
dr. Nyoman Suryawati , M.Kes,
Sp.KK
B12
Clinical
Pathology
08155237937
2nd floor:
R.2.15
Fisiology
08123989891
2nd floor:
R.2.16
Histology
081337222567
2nd floor:
R.2.23
Radiology
081805673099
3nd floor:
R.3.21
Neurology
081238701081
3nd floor:
R.3.22
Dermatology
0817447279
3nd floor:
R.3.23
GENERAL TIME TABLE
FOR A AND B CLESSES
CLASS A
ACTIVITIES
TIME
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Lecture
Independent learning
SGD
Break
Student project
Plenary session
TIME
CLASS B
ACTIVITIES
09.00-10.00
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Lecture
Student project
Break
Independent learning
SGD
Plenary session
There are several types of learning activity:
Lecture
independent learning based on the lecture’s topic
Small group discussion to solve the learning task
Practice
Student project
Clinical skill and demonstration
Self assessment at the end of every topic
Plenary session
Lecture will be held at room 401, while discussion rooms available at 2 nd and
3rd floor (room A209-A216, A223, A321, A322, A323)
IMPORTANT INFORMATIONS
Faculty of Medicine Udayana University,DME
7
Study Guide The Respiratory System and Disorders
Meeting of the students’ representative
In the middle of block schedule, a meeting is designed among the student
representatives of every small group discussions, facilitators, and resource persons. The
meeting will discuss the ongoing teaching learning process, quality of lecturers and
facilitators as a feedback to improve the next process. The meeting will be taken based on
schedule from Medical Education Unit.
SELF ASSESSMENT
Self assessment of each lecture will be given after each lecture session, and will be
marked. This mark can determine whether the student pass this block or not. Any final mark
between 65 to 69 will be reconsidered with self assessment’s mark to see the student’s
status. Any student with self assessment’s mark more than 70 will pass this block. And for
the lower one will have to attend the remedial examination. It is important to do this self
assessment cautiously, because this activity may be your ticket to pass this block.
ASSESSMENT METHOD
Assessment in this theme consists of:
SGD
: 5%
Final Exam
: 80%
Student Project
: 15%
Final mark more than 70 considered to pass this block. Certain conditions applied for those
with final mark between 65 – 69. These students will be analyzed using their self
assessment’s mark. Students with final mark 65 – 69 and self assessment’s mark equal or
more than 70 will also considered pass this block.
TIME TABLE
REGULAR CLASS
DAY/DATE
TIME
Faculty of Medicine Udayana University,DME
ACTIVITY
VENUE
PIC
8
Study Guide The Respiratory System and Disorders
08.00-08.15
08.15-09.00
1
Monday
Feb 22,
2016
2
3
Wednesday
Feb 24,
2016
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
Class room
dr.Wardana
dr. Sri Wiryawan
Lecture2
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
dr. Sri Wiryawan
Lecture 3
Class room
dr. Muliarta
Physiology of
Respiratory System:
Ventilation
Independent learning
SGD
Break
Student project
Plenary session
Lecture 4
Disc room
Facilitator
Class room
Class room
dr. Muliarta
dr. Muliarta
Anatomy: 1st
floor
Histology: 4th
floor
Class room
dr. Wardana
Physiology of
Respiratory System:
Gas Exchange,
diving, altitude
Independent learning
09.00-15.00
08.00-09.00
Practice : Anatomy,
Histology
Lecture 5
Carriage of oxygen
and Carbon dioxide
5
Friday
Feb 26,
2016
Prof.I.B. Rai
dr.Wardana
Histology of
Respiratory System
4
Thursday
Feb 25,
2016
Lecture 1
Class room
Class room
Anatomy of
Respiratory System
REGULAR
CLASS
Tuesday
Feb 23,
2016
Introduction
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Faculty of Medicine Udayana University,DME
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Class room
dr. Sri Wiryawan
dr. Desak
Wihandani
Facilitator
dr. Desak
Wihandani
9
Study Guide The Respiratory System and Disorders
08.00-09.00
Class room
dr. Desak
Wihandani
Disc room
Facilitator
Class room
Class room
dr. Desak
Wihandani
Prof. Wiryana
Disc room
Facilitator
Class room
Class room
Prof. Wiryana
dr. Winarti
Disc room
Facilitator
Hospital Visit
Class room
Class room
dr. Winarti
dr. Winarti
Control of acid base
balance, Arterial Gas
Analysis (AGA)
6
Monday
Feb 29, 2016
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Independent learning
SGD
Break
Student project
Plenary session
08.00-09.00
Lecture 7
Control of
Respiratory Function
and Blood Gas
Analyzes
7
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
REGULAR
CLASS
Tuesday
March 1,
2016
8
Lecture 6
Wednesday
March 2,
2016
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
9
Thursday
March 3,
2016
10
Independent learning
SGD
Break
Student project
Plenary session
Lecture 8
Pathology of
Respiratory Tract
Independent learning
SGD
Break
Student project
Plenary session
Lecture 9
Lung Defense
Mechanism
Independent learning
09.00-15.00
Practice : Physiology,
Pathology Anatomy (PA)
Physiology:
2nd floor
PA: Joint Lab
(4th floor)
dr. Muliarta
Class room
Prof. Aman
Disc room
Facilitator
dr. Winarti
BKFK
Friday
March 4,
2016
11
08.00-09.00
Lecture 10
Pharmacological and
non pharmacological
interventions
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
Independent learning
SGD
Break
Student project
Faculty of Medicine Udayana University,DME
10
Study Guide The Respiratory System and Disorders
Monday
March 7,
2016
14.00-15.00
Plenary session
Class room
Prof. Aman
08.00-09.00
Lecture 11
Pharmacological and
non pharmacological
interventions
Class room
Prof. Aman
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Hospital Visit
Class room
Class room
Prof. Aman
dr. Elysanti
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
dr. Elysanti
08.00-09.00
Lecture 13
Bronchiolitis, asthma
in children,
Pneumonia
Class room
dr. IB Subanada
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Hospital Visit
Class room
Class room
dr. IB Subanada
dr. Siadi Purniti
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
Class room
dr. Siadi Purniti
dr. Sutha,
12
13
REGULAR
CLASS
Friday
March 11,
2016
Monday
March 14,
2016
14
Tuesday
March 15,
2016
15
Wednesday
March 16,
2016
16
Thursday
March 17,
2016
17
Lecture 12
Respiratory Imaging
Lecture 14
TB in children, Difteri,
Pertusis
Lecture 15
Pulmonary TB and
Extrapulmonary TB,
TB in the
Immunocompromised
Host, Abses TB
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Independent learning
SGD
Break
Student project
Plenary session
08.00-09.00
Lecture 16
Asthma,
COPD
Faculty of Medicine Udayana University,DME
dr. Bagiada
Disc room
Hospital Visit
Class room
Facilitator
dr. Sutha,
dr. Bagiada
Class room
Prof. IB Rai,
dr. Artana
11
Study Guide The Respiratory System and Disorders
18
Independent learning
SGD
Break
Student project
Plenary session
08.00-09.00
Lecture 17
Pleural effusion,
Pneumothorax,
Hematothorax
REGULAR
CLASS
Friday
March 18,
2016
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Monday
March 21,
2016
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Independent learning
SGD
Break
Student project
Plenary session
08.00-09.00
Lecture 18
Bronchitis and
Bronchiectasis,
Lung Ca and
Smoking Cessation
19
Tuesday
March 22,
2016
20
Wednesday
March 23,
2016
21
Independent learning
SGD
Break
Student project
Plenary session
08.00-08.30
08.30-09.00
Lecture 19
Disorder of nose,
sinus
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Independent learning
SGD
Break
Student project
Plenary session
08.00-09.00
Lecture 20
Disorder of larynx,
Disorder of Pharynx
09.00-10.30
Independent learning
10.30-12.00
SGD
12.00-12.30
Break
12.30-14.00
Student project
14.00-15.00
Plenary session
REGULAR
CLASS
Thursday
March 24,
2016
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Faculty of Medicine Udayana University,DME
Disc room
Facilitator
Class room
Prof. IB Rai,
dr. Artana
Class room
dr. Andrika,
dr, Yasa
Disc room
Hospital Visit
Class room
Facilitator
dr. Andrika,
dr, Yasa
Class room
dr.Dewa Artika,
dr. Saji
Disc room
Facilitator
Class room
dr.Dewa Artika,
dr. Saji
Class room
dr. Ratna,
Sp.THT
Disc room
Facilitator
Hospital Visit
Class room
dr. Ratna,
Sp.THT
Class room
Prof. Suardana,
dr. Dewa Artha
Eka Putra,
Sp.THT
Disc room
Facilitator
Class room
Prof. Suardana,
dr. Dewa Artha
Eka Putra,
Sp.THT
12
Study Guide The Respiratory System and Disorders
22
Monday
March 28,
2016
08.00-15.00
BCS: Spirometry
BCS: WSD, Radio Imaging
(Pre-test, lecture, demo
Practice, discussion)
08.00-15.00
BCS: Physical Diagnostic of
Thorax
BCS: Bronchoscopy
BCS: THT
(Pre-test, Lecture, practice,
demo)
08.00-15.00
BCS: Spirometry
BCS: Physical Diagnostic of
Thorax
(Pre-test, lecture, practice,
demo)
23
Tuesday
March 29,
2016
24
Wednesday
March 30,
2016
25
Monday
March 31,
2016
08.00-15.00
26
Friday
April 1,
08.00-15.00
2016
27
Monday
April 5,
2016
Faculty of Medicine Udayana University,DME
BCS: Physical Diagnostic of
Thorax
BCS: Provocation test
BCS: THT
(Pre-test, lecture, demo)
BCS: Physical Diagnostic of
Thorax, Provocation test,
Spirometry, WSD,
Bronchoscopy, Radio
Imaging, THT
(Practice, post-test)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
dr. Muliarta
dr. Yasa
Elysanti
dr. Saji
dr. Sutha
dr. Lely
dr. Muliarta
dr. Saji
dr. Saji
dr Artana
dr. Lely
dr. Saji
dr Artana
dr. Sutha
dr. Muliarta
dr. Yasa
dr. Elysanti
dr. Lely
Examination
13
dr.
Study Guide The Respiratory System and Disorders
TIME TABLE
ENGLISH CLASS
DAY/DATE
09.00-09.15
09.15-10.00
1
Monday
Feb 22,
2016
2
Wednesday
Feb 24,
2016
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-10.00
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-10.00
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-10.00
Lecture 1
Class room
Class room
Prof.I.B. Rai
dr.Wardana
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
Class room
dr.Wardana
dr. Sri Wiryawan
Lecture2
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
dr. Sri Wiryawan
Lecture 3
Class room
dr. Muliarta
Disc room
Facilitator
Class room
Class room
dr. Muliarta
dr. Muliarta
Anatomy: 1st
floor
Histology: 4th
floor
Class room
dr. Wardana
Disc room
Facilitator
Class room
dr. Desak
Wihandani
Physiology of
Respiratory System:
Ventilation
Independent learning
SGD
Break
Student project
Plenary session
Lecture 4
Physiology of
Respiratory System:
Gas Exchange,
diving, altitude
Independent learning
10.00-16.00
09.00-10.00
Practice : Anatomy,
Histology
Lecture 5
Carriage of oxygen
and Carbon dioxide
5
Friday
Feb 26,
2016
Introduction
PIC
Histology of
Respiratory System
4
Thursday
Feb 25,
2016
VENUE
Anatomy of
Respiratory System
ENGLISH
CLASS
Tuesday
Feb 23,
2016
3
TIME
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
Faculty of Medicine Udayana University,DME
Independent learning
SGD
Break
Student project
Plenary session
dr. Sri Wiryawan
dr. Desak
Wihandani
14
Study Guide The Respiratory System and Disorders
09.00-10.00
Class room
dr. Desak
Wihandani
Disc room
Facilitator
Class room
Class room
dr. Desak
Wihandani
Prof. Wiryana
Disc room
Facilitator
Class room
Class room
Prof. Wiryana
dr. Winarti
Disc room
Facilitator
Hospital Visit
Class room
dr. Winarti
Class room
dr. Winarti
Physiology:
2nd floor
PA: Joint Lab
(4th floor)
dr. Muliarta
Class room
Prof. Aman
Disc room
Facilitator
Class room
Prof. Aman
Control of acid base
balance, Arterial Gas
Analysis (AGA)
6
Monday
Feb 29, 2016
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
Independent learning
SGD
Break
Student project
Plenary session
09.00-10.00
Lecture 7
Control of
Respiratory Function
and Blood Gas
Analyzes
7
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-10.00
ENGLISH
CLASS
Tuesday
March 1,
2016
8
Lecture 6
Wednesday
March 2,
2016
9
Thursday
March 3,
2016
10
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-10.00
10.00-16.00
Independent learning
SGD
Break
Student project
Plenary session
Lecture 8
Pathology of
Respiratory Tract
Independent learning
SGD
Break
Student project
Plenary session
Lecture 9
Lung Defense
Mechanism
Independent learning
Practice : Physiology,
Pathology Anatomy (PA)
dr. Winarti
BKFK
Friday
March 4,
2016
09.00-10.00
11
Monday
March 7,
2016
Lecture 10
Pharmacological and
non pharmacological
interventions
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
Faculty of Medicine Udayana University,DME
Independent learning
SGD
Break
Student project
Plenary session
15
Study Guide The Respiratory System and Disorders
09.00-10.00
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-10.00
ENGLISH
CLASS
13
Monday
March 14,
2016
15
Wednesday
March 16,
2016
16
Thursday
March 17,
2016
Independent learning
SGD
Break
Student project
Plenary session
Lecture 12
Prof. Aman
Disc room
Facilitator
Hospital Visit
Class room
Class room
Prof. Aman
dr. Elysanti
Respiratory Imaging
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
Independent learning
SGD
Break
Student project
Plenary session
09.00-10.00
Lecture 13
Disc room
Facilitator
Class room
dr. Elysanti
Class room
dr. IB Subanada
Disc room
Facilitator
Bronchiolitis, asthma
in children,
Pneumonia
14
Tuesday
March 15,
2016
Class room
Pharmacological and
non pharmacological
interventions
12
Friday
March 11,
2016
Lecture 11
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
Independent learning
SGD
Break
Student project
Plenary session
09.00-10.00
Lecture 14
Hospital Visit
Class room
dr. IB Subanada
Class room
dr. Siadi Purniti
Disc room
Facilitator
Class room
Class room
dr. Siadi Purniti
dr. Sutha,
TB in children, Difteri,
Pertusis
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-10.00
Independent learning
SGD
Break
Student project
Plenary session
Lecture 15
Pulmonary TB and
Extrapulmonary TB,
TB in the
Immunocompromised
Host, Abses TB
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
Independent learning
SGD
Break
Student project
Plenary session
09.00-10.00
Lecture 16
Asthma,
COPD
Faculty of Medicine Udayana University,DME
dr. Bagiada
Disc room
Hospital Visit
Class room
Facilitator
dr. Sutha,
dr. Bagiada
Class room
Prof. IB Rai,
dr. Artana
16
Study Guide The Respiratory System and Disorders
17
Independent learning
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
Prof. IB Rai,
dr. Artana
Lecture 17
Class room
ENGLISH
CLASS
Friday
March 18,
2016
12.00-13.30
09.00-09.00
18
Monday
March 21,
2016
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
Independent learning
SGD
Break
Student project
Plenary session
08.00-09.00
Lecture 18
20
Wednesday
March 23,
2016
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-09.30
09.30-10.00
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
22
Monday
March 28,
2016
Independent learning
SGD
Break
Student project
Plenary session
Lecture 19
Disorder of nose, sinus
Independent learning
SGD
Break
Student project
Plenary session
08.00-15.00
BCS: Spirometry
BCS: WSD, Radio Imaging
(Pre-test, lecture, demo
Practice, discussion)
08.00-15.00
BCS: Physical Diagnostic of
Thorax
BCS: Bronchoscopy
BCS: THT
(Pre-test, Lecture, practice,
demo)
23
Tuesday
March 29,
2016
Disc room
Hospital Visit
Class room
Faculty of Medicine Udayana University,DME
Facilitator
dr. Andrika,
dr, Yasa
Class room
Bronchitis and
Bronchiectasis,
Lung Ca and
Smoking Cessation
19
Tuesday
March 22,
2016
dr. Andrika,
dr, Yasa
Pleural effusion,
Pneumothorax,
Hematothorax
dr.Dewa Artika,
dr. Saji
Disc room
Facilitator
Class room
dr.Dewa Artika,
dr. Saji
Class room
dr. Ratna,
Sp.THT
Disc room
Facilitator
Hospital Visit
Class room
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
dr. Ratna,
Sp.THT
dr. Muliarta
dr. Yasa
Elysanti
dr. Saji
dr. Sutha
dr. Lely
17
dr.
Study Guide The Respiratory System and Disorders
24
Wednesday
March 30,
2016
08.00-15.00
25
Monday
March 31,
2016
08.00-15.00
26
Friday
April 1,
08.00-15.00
2016
27
Monday
April 5,
2016
Faculty of Medicine Udayana University,DME
BCS: Spirometry
BCS: Physical Diagnostic of
Thorax
(Pre-test, lecture, practice,
demo)
BCS: Physical Diagnostic of
Thorax
BCS: Provocation test
BCS: THT
(Pre-test, lecture, demo)
BCS: Physical Diagnostic of
Thorax, Provocation test,
Spirometry, WSD,
Bronchoscopy, Radio
Imaging, THT
(Practice, post-test)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
dr. Muliarta
dr. Saji
dr. Saji
dr Artana
dr. Lely
dr. Saji
dr Artana
dr. Sutha
dr. Muliarta
dr. Yasa
dr. Elysanti
dr. Lely
Examination
18
Study Guide The Respiratory System and Disorders
LEARNING PROGRAMS
LECTURE 1
ANATOMY OF RESPIRATORY TRACT
Abstract
dr. I Nyoman Gede Wardana, M.Biomed
The respiratory system consists of conducting zone and respiratory zone.
Conducting zone, whose walls are too thick to permit exchange of gases between the air in
the tube and the blood stream. The nostrils (nares), nasal cavity, pharynx, larynx, trachea,
bronchi, and terminal bronchioles are included in this zone. Respiratory zone, whose walls
are thin enough to permit exchange of gases between tube and blood capillaries
surrounding them. Air travels to the lungs through that zone. The right lung divided into
three lobes: superior, middle, and inferior. The left lung divided into two lobes: superior and
inferior. Each lung cover by a membrane that called pleura. Both lungs are inside the
thoracic cage. The thoracic cage is formed by the vertebral column behind, the ribs, and
intercostal spaces on other side and the sternum and costal cartilages in front. Below it
separated from the abdominal cavity by diaphragm
Learning Task
Vignette 1:
Kesawa, 32 years old, was seen in the clinic ten days ago, was diagnosed with rhinitis and
sent home with instructions for increased fluids, decongestants, and rest. Kesawa presents
today with worsened symptoms of malaise, low-grade temperature, nasal discharge, night
time coughing, mouth breathing, early morning pain over sinuses, and congestion. The
doctor diagnose he is suffering sinusitis.
1. Describe the boundaries of the nasal cavity and its blood supply
2. Describe the paranasal sinuses and its opening at nasal cavity
Vignette 2:
Gotawa, a singer-18 years old came to clinic with complain a hoarse voice for 3 days. She
also suffers sore throat, nose block, and fever. She was diagnosed laryngitis
1. Describe the structure of larynx and location of vocal cord
2. Describe the intrinsic and extrinsic muscle of larynx
Vignette 3:
Mande, 30 years old male came to clinic with chief complaint difficulty to breath start from
this morning. He also suffers cough, runny nose and fever. He has history bronchial asthma
when he was 2 years old. The doctor diagnose he is suffering bronchial asthma.
1. Describe the structure of trachea
2. Describe the different between right and left main bronchus
3. Describe the principal different between trachea, bronchi, and bronchioles
Vignette 4:
A 57-year-old male is admitted to the hospital with a chief complaint of shortness of breath
for 2 weeks. The radiology examination shows a large left-side pleural effusion.
1. Describe the different between right lung and left lung
2. Describe the structure of pleura
3. Describe the structure of thoracic wall
Faculty of Medicine Udayana University,DME
19
Study Guide The Respiratory System and Disorders
LECTURE 2
HISTOLOGY OF RESPIRATORY TRACT
dr. Sri Wiryawan, MRepro
Abstract
The lower respiratory tract consists of : the lower part of the trachea, the two main
bronchi, lobar, segmental, and smaller bronchi, bronchioles and terminal bronchioles, and
last but not least is the end respiratory unit. These structure make up the tracheobronchial
tree. As for the structure distal to the main bronchi along with a tissue known as the lung
parenchyma.
There are several structure we should also understand, when talking about lower
respiratory tract. Several structures such as thorax, mediastinum, pleurae and pleural cavity,
and lung. Thorax especially thoracic cavity and thoracic wall protect our lung and
mediastinum and also play an important role in respiratory process. The mediastinum,
which has a role in protecting our heart , located between the two lungs, and contains the
heart and great vessels, trachea and esophagus, phrenic and vagus nerves, and lymph
nodes.
The pleurae covers the external surface of the lung, and is then reflected to cover
the inner surface of thoracic cavity. Pleurae divided into the visceral (lines the surface of the
lung) and parietal (lines the thoracic wall and diaphragm) one. The space between these
two pleurae called as pleural cavity which contains a thin film fluid to allow the pleurae to
slip over each other during breathing.
The lungs are placed within the thoracic cavity. The lungs contain airways structure,
vessels, lymphatic and lymph nodes, nerves, and supportive connective tissue. The trachea
divides and form the left and right primary bronchi, which in turn divide to form lobar bronchi.
Each lobar bronchi divide again to give segmental bronchi to supply air to
bronchopulmonary segments. The tracheobronchial tree can also be classified into two
functional zones: the conducting zone (proximal to the respiratory bronchioles) which
involved in air movement, and the respiratory zone (distal to the terminal bronchioles) which
involved in gaseous exchange.
The other term to show functional structure of the lower respiratory tract is the
acinus. The acinus defined as the part of the airway that is involved in gaseous exchange.
The acinus consist of respiratory bronchioles, alveolar ducts, and alveoli as the smallest
functional structure of the lung. The areas of lung containing groups of between three to five
acini surrounded by parenchimal tissue are called lung lobules.
The alveolus is an blind-ending terminal sac of respiratory tract. Most gaseous
exchange occurs in the alveoli. The alveoli are lined with type I (structural) and type II
(produce surfactant) of pneumocytes cell. The understanding about histological pattern of
these functional structures of the lung is important in pathophysiology of lung problems.
Learning Tasks
I.
Structure of The Upper Respiratory tract
Krishna, a man, 25 years old came to doctor Arjuna clinic with fever, sore throat,
sneezing, runny nose and sometimes blocked nose. He also cannot smell well. The
doctor diagnoses Krishna with acut Rhinopharingitis.
1. Describe the histological structure of the upper respiratory tracts
are involved ?
2. Describe the histological structure and function of epiglottis !
3. Compare the histological structure and function between vestibular fold and
vocal fold !
II. Structure of The Lower Respiratory tract
Radha, a 17 years old beautiful girl, came to doctor Laksmi clinic with shortness of
breath, wheezing and cough with phlegm. The doctor diagnoses Radha with Asthma.
Faculty of Medicine Udayana University,DME
20
Study Guide The Respiratory System and Disorders
1.Describe the histological structure of the lower respiratory tracts are involved ?
2.Compare the histological structure and function between terminal bronchioles and
respiratory bronchioles !
3.Describe the histological structure of the interalveolar septum !
4.Describe the histological structure of blood-air barrier ?
5.Describe about the pulmonary surfactant ?
LECTURE 3
PHYSIOLOGY OF RESPIRATORY SYSTEM: VENTILATION
dr. I Made Muliarta, MKes
Abstract
In living cells aerobic metabolism consumes oxygen and produces carbon dioxide. Gas
exchange requires a large , thin, moist exchange surface, a pump to move air circulatory
system to transport gases to cells. The primary function system are:
Exchange the gases between atmosphere and the blood.
Homeostatic regulation of body pH .
Protection from inhaled pathogens and irritation substance
Vocalization.
In addition to serving these function, the respiratory system also source of significant
losses of water and heat from the lung.
A single respiratory cycle consists of an inspiration and expiration. Relation with
ventilation had to know about compliance, surfactant, lung volume and capacities
Respiratory control resides in a central pattern generator, a net work of neurons in the
pons and medulla oblongata.
Faculty of Medicine Udayana University,DME
21
Study Guide The Respiratory System and Disorders
LEARNING TASK
dr. Muliarta, MKes
1.
What is the sequence of event during quiet inspiration (muscle involvement,
pressure changes (intrapulmonary and intrapleura), volume changes)
2.
What is pulmonary ventilation and alveolar ventilation means?
3.
Andi, male, 30 years old, has a puncture wound due to car accident in his right chest
and penetrate his pleural cavity. The patient has complained shortness of breathing and
doctor determine that his lung is collapsed.
a. What is this condition called?
b. Describe the mechanism of the lung collapse!
c. What kind respiratory system compensation to anticipate this condition (lung
collapse)
d. How can he still be alive in this condition?
4.
Describe the Boyle’s Law!
LECTURE 4
PHYSIOLOGY OF RESPIRATORY SYSTEM: GAS EXCHANGE, DIVING,
ALTITUDE
dr. I Made Muliarta, MKes
Abstract
Gas exchange during external respiration occurs in respiratory membrane. Several
factors may influence gas exchange. Dalton’s law and Henry’s law may apply during gas
exchange.
Some physiologic responses on respiratory system at high altitude and during diving.
Some illnesses/injuries related pressure change may occurs at high altitude and during
diving.
LEARNING TASK
dr. Muliarta, MKes
1.
2.
3.
Describe the Dalton’s Law!
Describe the factors that influence oxygen diffusion from alveoli into the blood!
Predict the response of the pulmonary arterioles and bronchioles when PO2 increase
and PCO2 decrease!
4.
Describe some illnesses/injuries due to high altitude
5.
Describe some illnesses/injuries due to diving
LECTURE 5
CARRIAGE OF OXYGEN AND CARBON DIOXIDE
dr. Desak Wihandani
Abstract
Gas Transport
The supply of oxygen to the tissues is our most immediate physical need. We take in about
250 ml of oxygen gas per minute and this is our most pressing physical need. If our oxygen
supply is interrupted for more than a few minutes, irreversible damage is done to some
tissues, notably the brain. Oxygen is abundantly available in the air around us but cannot
diffuse into our tissues at sufficient rate to meet our needs. It must be transported from the
lung, the specialized organ for gas exchange, by the blood to all the other tissue.
While oxygen has to be transported from lungs to tissues, carbon dioxide must be
transported from the tissues for excretion by the lungs. Carbon dioxide has physicochemical
Faculty of Medicine Udayana University,DME
22
Study Guide The Respiratory System and Disorders
properties that make its transport less difficult then transport of oxygen. Carbon dioxide can
be transported in the blood in three ways: in simple solution, by reversible conversion to
bicarbonate and by reversible combination with haemoglobin to form carbamino
haemoglobin.
LEARNING TASK:
1. Describe the structure and function of hemoglobin
2. Describe the mechanism of oxygen binding to hemoglobin
3. Describe the differences between hemoglobin and myoglobin
4. Describe the mechanism of oxygen binding to myoglobin
5. Describe conformational differences between deoxygenated and oxygenated Hb!
6. Summarize the processes by which carbondioxide is transported from peripheral
tissues to the lungs
LECTURE 6
CONTROL OF ACID BASE BALANCE, ARTERIAL GAS ANALYSIS (AGA)
dr. Desak Wihandani
Abstract
Acid-Base Balance
There is large daily flux of oxygen, carbon dioxide and hydrogen ion through the human
body. Carbon dioxide generated in tissues dissolves in H2O to form carbonic acid, which in
turn dissociates releasing hydrogen ion. The blood concentration of hydrogen ion is
constant, it remains between 36 and 46 nmol/L (pH 7,36-7,46). Changes in pH will affect
the activity of many enzyme and tissue oxygenation. Problems with gas exchange and acidbase balance underlie many diseases of respiratory system.
Blood Gases
Blood gas measurement is an important first-line investigation performed whenever there is
a suspicion of respiratory failure or acid-base disorders. In respiratory failure, the results of
such measurements are also an essential guide to oxygen therapy and assisted ventilation.
The key clinically used parameters are pH, pCO 2 and pO2, the bicarbonate concentration is
calculated from pH and pCO2 values.
Learning Task:
1. Describe organs in our body involved in acid-base balance, and how they work
2. Describe acid-base balance disorders! What is mean by : a. Respiratory
alkalosis, b. metabolic alkalosis, c.respiratory acidosis, and d. metabolic
acidosis
3. In which condition respiratory acidosis and respiratory alkalosis occurs ?
4. What is the importance of blood gas measurement. To perform measurement
where are the blood sample taken from? What kind of measurement are done?
Faculty of Medicine Udayana University,DME
23
Study Guide The Respiratory System and Disorders
LECTURE 7
CONTROL OF RESPIRATORY FUNCTION
Prof. Dr. dr. Wiryana, SpAn
Abstract
When considering contol of breathing, the main control variable is P aCO2 (we try to
control this value near to 40 mmHg). This can be carried out by adjusting the respiratory
rate, the tidal volume, or both. By controlling PaCO2 we are effectively controlling alveolar
ventilation (see Ch.3) and thus PACO2. Although PaCO2 is the main control variable, PaO2 is
also controlled, but normally to a much lesser extent than P aCO2. However, the PaO2
control system can take over and become the main controlling system when the P aO2 drops
below 50 mmHg.
Control can seem to be brought about by :
1. Metabolic demands of the body (metabolic control)-tissue oxygen demand and acidbase balance.
2. Behavioural demands of the body (behavioral control) – singing, coughing, laughing
(i.e.control is voluntary).
These are essentially feedback and feed-forward control systems, respectively. The
behavioural control of breathing overalys the metabolic control.
Its control is derived from higher centres of the brain. The axons of neurons whose cell
bodies are situated in the cerebral cortex bypass the respiratory centres in the brainstem
and synapse directly with lower motor neurons that control respiratory muscles. This system
will not be dealt with in this next;we shall deal only with the the metabolic control of
respiration.
Learning Tasks
1. Discuss the central control of breathing with reference to the pontine respiratory
group and the dorsal-ventral respiratory groups of medulla spinalis
2. List the different types of receptors involved in controlling the respiratory system
3. Describe factors that stimulate central and peripheral chemoreceptor
4. outline the response of the respiratory system to change in carbon dioxide
concentration, oxygen concentration and pH.
5. discuss the mechanism thought to influence the control of ventilation in exercise
6. discuss the changes that occur in response to high altitude
LECTURE 8
PATHOLOGY OF UPPER AND LOWER URINARY TRACT
dr. Ni Wayan Winarti, SpPA
ABSTRACT
The term upper airways is used here to include the nose, pharynx, and larynx and their
related parts. Disorders of these structures are among the most common afflictions of
humans, but fortunately the overwhelming majority are more nuisances than threats.
Inflammatory diseases are the most common disorders of the upper respiratory tract, i.e.
rhinitis, sinusitis, pharyngitis, tonsillitis and laryngitis. It may occur as the sole manifestation
of allergic, viral, bacterial or chemical insult. Although most infections are self-limited, they
may at times be serious, especially laryngitis in infancy or childhood, when mucosal
congestion, exudation, or edema may cause laryngeal obstruction. Tumors in these
locations are infrequent but include the entire category of mesenchymal and epithelial
neoplasms. Some distinctive types are nasopharyngeal angiofibroma, Sinonasal
(Schneiderian) Papilloma, Olfactory Neuroblastoma and Nasopharyngeal Carcinoma.
Faculty of Medicine Udayana University,DME
24
Study Guide The Respiratory System and Disorders
Classification of lower respiratory tract (lung) diseases can be made based on the result of
lung function test, although some authors prefer etiology and pathogenesis background.
Some important diseases are obstructive lung disease (asthma, COPD, bronchiectasis) and
restrictive lung disease (ARDS), and also infections, diseases of vascular origin and tumors.
Pleura as protective structure of the lungs, are sometimes involved as secondary
complication of some underlying disease, but in rare case, can be primary.
Because of the complexity of respiratory disease, it is important to understand their
pathogenesis, supported by recognizing their morphologic changes.
LEARNING TASK
Case 1
A male patient, 16 year old, came to a doctor with chief complaint difficulties in breathing. It
has occurred since 1 month ago. This patient suffers from rhinitis alergica since he was 3
year old. On physical examination, a pedunculated nodule in right nasal cavity was found. It
was whitish in color, 1.5 cm in diameter occluding the nasal cavity.
1. Based on clinical finding, what is the most possible diagnosis?
2. What are the DDs?
3. Describe the morphological appearance (macroscopy and microscopy) that
supposed to be found to confirm your diagnosis!
4. Explain the pathogenesis of this diasease!
Case 2
A male patient, 65 year old, has suffered from dyspnea and productive cough since 1 year
ago. Lung function test showed increased of FEV1 with normal FVC (confirm an obstructive
lung disease). He is a heavy smoker since he was 25 year old. No history of atopy. No
evidence of cardiac disorders.
A. Mention 4 diseases including in the spectrum of obstructive lung disease!
B. Explain their pathogenesis!
C. Distinguish their morphology!
Case 3
A female patient, 50 year old, has suffered from tumor of right lung with pleural effusion. As
the first step to confirm the diagnosis, doctor asked the patient to do cytology test.
A. Mention some cytology test can be choose for this patient!
B. Among the test mention above (A), which one is the most simple and non-invasive?
And, discuss how to collect the specimen
LECTURE 9
LUNG DEFENCE MECHANISM
dr. Ni Wayan Winarti, SpPA
Abstract
Respiratory tract is an organ that constantly exposed by contaminated air. It is there
fore a small miracle that the normal lung parenchyma remains sterile. Fortunately, a
plethora of immune and non immune defense mechanisms exist in the respiratory system,
extending from the nasopharynx all the way into alveolar airspaces.
The major categories of defense mechanisms to be discussed include : (1)physical
or anatomic factors related to deposition and clearance of inhaled materials, (2)antimicrobial
peptides, (3) phagocytic and inflammatory cells that interact with inhaled materials,
(4)adaptive immune response, which depends on prior exposure to recognize the foreign
Faculty of Medicine Udayana University,DME
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Study Guide The Respiratory System and Disorders
materials. Each components appears to have a distinct role, but a tremendous degree of
redundancy and interaction exists among different components.
Any condition breaks down the lung defense mechanism may result in lung injury
and respiratory tract infections
Learning Tasks
1.
Defense mechanism of the lung and respiratory tract ca be divided into four
major categories. Mention them, their components and explain how each of them
acts against foreign materials.
2.
Explain about diseases or conditions that break the lung defense mechanism
down which result in increase susceptibility to respiratory tract infections
LECTURE 10
PHARMACOLOGICAL AND NON PHARMACOLOGICAL INTERVENSION I
Prof. dr. GM Aman
Abstract
Drugs for cough, rhinitis, asthma bronchiale
Cough is a protective reflex mechanism that removes foreign material and secretions
from the bronchi and bronchioles. It can be inappropriately stimulated by inflammation in the
respiratory system or by neoplasia. In these cases, antitussive (cough suppressant) drugs
are sometimes used. It should be understood that these drugs merely suppress the
symptom without influencing the underlying condition. In cough associated with
bronchiectasis or chronic bronchitis, antitussive drugs can cause harmful sputum thickening
and retention. They should not be for the cough associated with asthma.
Most drugs used in rhinitis are effectively relief the symptom of rhinitis, not affect the
underlying disease. No drug can relief symptom completely. Drugs are more effective for
allergic rhinitis than non allergic rhinitis, and acute form of allergy respond more favorable
than chronic form of allergy. The most common drugs used for rhinitis are antihistamine,
nasal disodium cromoglycate, nasal decongestant, anticholinergic, intranasal corticosteroid.
Bronchial Asthma is a disease characterized by airway inflammation, edema and
reversible bronchospasm. Bronchodilator and anti-inflammatory are the most useful drugs
used in asthma. B2 selective agonists, muscarinic antagonists, aminophylline and
leucotriene receptor blockers are the most effective bronchodilator. Anti-inflamatory drugs
such as corticosteroid, mast cell stabilizers, leucotriene antagonists, and an anti IgE
antibody are widely used. Short acting B2 agonist are the most widely used for acute
asthma attack, by relaxing airway smooth muscle. Theophylline, aminophylline and
antimuscarinic agent are also used for acute asthma attack. Long term control can be
achieved with an anti-inflammatory agent such as corticosteroid (systemic or inhaled), with
leucotriene antagonist, mast cell stabilizers (cromolyn or nedocromil). Long acting B2
agonists such as Salmeterol and Formeterol, are effectively in improving asthma control,
when taken regularly.
Learning Tasks Day 10
The patient complained about a sore throat and a nasty cough. It started two weeks ago
with a cold. The cold was over within a week, but he continued coughing, especially at night.
He is a heavy smoker. After physical examination you diagnosed a dry, tickling cough.
Faculty of Medicine Udayana University,DME
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Study Guide The Respiratory System and Disorders
Task 1
1. Differentiate between Antitussive, Expectorant, Mucolytic
2. Differentiate the effects of Codeine, Dextromethorphan and Diphenhydramine
3. List the side effects of Codeine
4. In this patient, what kind of anti cough you give best.
Task 2
If the patient also has sneezing, rhinorrhea and congested nose and then you diagnosed as
rhinitis.
1. List the group of drugs used for Rhinitis
2. List the drugs used as oral nasal decongestant, and describe the important side effects.
3. List the side effects of intranasal decongestant
4. what is the drug of choice for patient suffer from Rhinitis Medicamentosa
LECTURE 11
PHARMACOLOGICAL AND NON PHARMACOLOGICAL INTERVENSION II
Prof. dr. GM Aman
Task Day 11
If the patient come with cough, breathless, and in your examination, you found wheezing.
After physical examination you diagnosed Acute attack of bronchial asthma.
1. Chose the drug of first choice for this patient
2. List the side effects of this drug
3. Compare the effect of this drug with Salmeterol
4. Theophyllin is a bronchodilator, but has a narrow safety margin. List the side effects &
toxic effect of Theophyllin.
5. Ipratropium not as effectiv