Study Guide The Respiratory System and Disorders 2017

2018

Study Guide Respiratory System and Disorders

Department of Medical Education - Faculty of Medicine - Universitas Udayana, 2017
2

Study Guide Respiratory System and Disorders

STUDY GUIDE THE RESPIRATORY SYSTEM AND DISORDERS
Planners
Prof. Dr. dr. Ida Bagus Ngurah Rai, SpP

dr. Winarti, Sp.PA

Dr. dr. I Made Muliarta, M.Kes

Dr. dr. Desak Made Wihandani, M.Kes

Prof. Dr. dr. Wiryana, Sp.An., KIC

dr. Ayu Setyorini, Sp.A

Prof. Dr. dr. I Gusti Made Aman, Sp.FK

dr. Putu Gede Sudira, Sp.S

Contributors
Prof. Dr. dr. Ida Bagus Ngurah Rai, SpP

Dr. dr. Ketut Putu Yasa, Sp.BTKV

dr. IGN Sri Wiryawan, M.Repro

Dr. dr. Elysanti Martadiani, Sp.Rad

dr. Gede Wardana, M.Biomed

dr. Putu Ekawati, M.Repro, Sp.PA

Dr. dr. Desak Made Wihandani, M.Kes

dr. Aryabiantara, Sp.An KIC

Dr. dr. Ida Bagus Subanada, Sp.A

dr.Putu Siadi Purniti, Sp.A

dr. Dewa Artika, Sp.P

dr. Ayu Setyorini, Sp.A

dr. Ida Bagus Suta, Sp.P

dr. DGA Eka Putra, Sp.THT

dr. Made Bagiada, Sp.PD-KP

dr. Luh Made Ratnawati, Sp.THT(KL)

Prof. dr I Gst. Md. Aman, Sp.FK

dr. Putu Andrika, Sp.PD-KIC

Dr. dr. Muliarta, M.Kes

dr. Gede Ketut Sajinadiyasa, Sp.PD

dr. IGN Bagus Artana, Sp.PD

Prof. Dr. dr. Suardana, Sp.THT

Editors
dr. Putu Gede Sudira, Sp.S
Dr. dr. I Made Muliarta, M.Kes
Layout
Anak Agung Istri Sarastriyani Dewi

Department of Medical Education - Faculty of Medicine - Universitas Udayana, 2017
3

Second Edition

October 2017

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,
or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or
otherwise without prior written permission of the publisher.
Published by Department of Medical Education Medicine Programme, Faculty of Medicine,
Universitas Udayana.

CONTENTS

STUDY GUIDE THE RESPIRATORY SYSTEM AND DISORDERS.......................................2
CONTENTS.................................................................................................................. 3
PREFACE.................................................................................................................... 5
GENERAL CURRICULUM RESPIRATORY SYSTEM AND DISORDERS...............................6
PLANNERS AND LECTURERS..................................................................................... 10
FACILITATORS........................................................................................................... 11
LEARNING ACTIVITY.................................................................................................. 12
IMPORTANT INFORMATIONS...................................................................................... 12

STUDENT PROJECT................................................................................................... 13
ARTICLE REVIEW ASSESSMENT FORM FOR FACILITATOR..........................................15
ARTICLE REVIEW ASSESSMENT FORM FOR EVALUATOR...........................................16
SELF ASSESSMENT................................................................................................... 17
ASSESSMENT METHOD............................................................................................. 17
GENERAL TIME TABLE FOR A AND B CLASSES............................................................17
TIME TABLE OF CLASSES.......................................................................................... 18
LEARNING PROGRAMS.............................................................................................. 24
LECTURE 1................................................................................................................ 24
LECTURE 2................................................................................................................ 25
LECTURE 3................................................................................................................ 27
LECTURE 4................................................................................................................ 29
LECTURE 5................................................................................................................ 30
LECTURE 6................................................................................................................ 31
LECTURE 7................................................................................................................ 32

LECTURE 8................................................................................................................ 33
LECTURE 9................................................................................................................ 34
LECTURE 10.............................................................................................................. 35
LECTURE 11.............................................................................................................. 36

LECTURE 12.............................................................................................................. 37
LECTURE 13.............................................................................................................. 38
LECTURE 16-17.......................................................................................................... 39
LECTURE 18.............................................................................................................. 40
LECTURE 19.............................................................................................................. 42
LECTURE 20.1........................................................................................................... 44
LECTURE 20.2........................................................................................................... 45
LECTURE 21.............................................................................................................. 46
LECTURE 22.............................................................................................................. 47
LECTURE 23.............................................................................................................. 48
LECTURE 24.............................................................................................................. 49
LECTURE 25.............................................................................................................. 50
LECTURE 26.............................................................................................................. 51
BASIC CLINICAL SKILLS............................................................................................. 54
REFERENCES............................................................................................................ 57

PREFACE
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 5 weeks starts from 27 th of October 2017 as
shown in the time table. The final examination will be conducted on 11 th of December 2017 in
the form of MCQ. The learning situation include lecture, individual learning, small group
discussion, plenary session, practice, and clinical skills.
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

GENERAL CURRICULUM RESPIRATORY SYSTEM AND DISORDERS
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, anti-asthma &

bronchodilators, antitussive, expectorant.
 Basic principle concept to education, prevention, treatment and rehabilitation in
respiratory system disorders in patient, family and community.
Curriculum structure:
Structure of curriculum mainly is derive from general competences of Indonesian general
practioner. Those competences in diagnosing diseases and doing clinical skills should be
mastered by all the general practioners here. Local values of our institutions are also considered
as added values in this curriculum.

No
1
2
3
4
5
6
7
8
9
10

11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
N

Daftar Penyakit sesuai SKDI 2012
Influenza
Pertusis
Acute Respiratory distress syndrome (ARDS)
SARS
Flu burung
Laring dan Faring
Faringitis
Tonsilitis
Laringitis
Hipertrofi adenoid
Abses peritonsilar
Pseudo-croop acute epiglotitis
Difteria (THT)
Karsinoma laring
Karsinoma nasofaring
Trakea
Trakeitis
Aspirasi
Benda asing
ParuParu
Asma bronkial
Status asmatikus (asma akut berat)
Bronkitis akut
Bronkiolitis akut
Bronkiektasis
Displasia bronkopulmonar
Karsinoma paru
Pneumonia, bronkopneumonia
Pneumonia aspirasi
Tuberkulosis paru tanpa komplikasi
Tuberkulosis dengan HIV
Multi Drug Resistance (MDR) TB
Pneumothorax ventil
Pneumothorax
Efusi pleura
Efusi pleura masif
Emfisema paru
Atelektasis
Penyakit Paru Obstruksi Kronik (PPOK) eksaserbasi akut
Edema paru
Infark paru
Abses paru
Emboli paru
Kistik fibrosis
Haematothorax
Tumor mediastinum
Pnemokoniasis
Penyakit paru intersisial
Obstructive Sleep Apnea (OSA)
Keterampilan Klinis sesuai SKDI 2012

Tingkat Kemampuan
4A
4A
3B
3B
3B
4A
4A
4A
2
3A
3A
3B
2
2
2
3B
2
4A
3B
4A
3B
3A
1
2
4A
3B
4A
3A
2
3A
3A
2
3B
3A
2
3B
3B
1
3A
1
1
3B
2
2
1
1
Tingkat Keterampilan

o
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

PEMERIKSAAN FISIK
Inspeksi leher
Palpasi kelenjar ludah (submandibular, parotid)
Palpasi nodus limfatikus brakialis
Palpasi kelenjar tiroid
Rhinoskopi posterior
Laringoskopi, indirek
Laringoskopi, direk
Usap tenggorokan (throat swab)
Oesophagoscopy
Penilaian respirasi
Inspeksi dada
Palpasi dada
Perkusi dada
Auskultasi dada
PEMERIKSAAN DIAGNOSTIK
Persiapan, pemeriksaan sputum, dan interpretasinya
(Gram dan Ziehl Nielsen [BTA])
Pengambilan cairan pleura (pleural tap)
Uji fungsi paru/spirometri dasar
Tes provokasi bronkial
Interpretasi Rontgen/foto toraks
Ventilation Perfusion Lung Scanning
Bronkoskopi
FNAB superfisial
Trans thoracal needle aspiration (TINA)
TERAPEUTIK
Dekompresi jarum
Pemasangan WSD
Ventilasi tekanan positif pada bayi baru lahir
Perawatan WSD
Pungsi pleura
Terapi inhalasi/nebulisasi
Terapi oksigen
Edukasi berhenti merokok

4A
4A
4A
4A
3
2
2
4A
2
4A
4A
4A
4A
4A
4A
3
4A
2
4A
1
2
2
2
4A
3
3
4A
3
4A
4A
4A

~ CURRICULUM MAP ~
Program or curriculum blocks
Senior Clerkship

1
0
9
8
7

Health Systembased Practice
(3 weeks)

Communitybased practice
(4 weeks)

BCS (1 weeks)

6

5

The
Cardiovascular
System and
Disorders
(3 weeks)
BCS (1 weeks)
Neuroscience
and
neurological
disorders
(3 weeks)

Medical
Emergency
(3 weeks)
BCS (1 weeks)
The Respiratory
System and
Disorders
(3 weeks)

Senior Clerkship
Senior Clerkship
EvidenceSpecial topics :
based Medical
Health Ergonomy &
Practice
Health
Environment
(2 weeks)
(2 weeks)
The Urinary
System and
Disorders
(3 weeks)
BCS (1 weeks)
The skin &
hearing
system
& disorders
(3 weeks)

BCS (1 weeks)
4

3

2

1

BCS (1 weeks)
Musculoskeletal
system &
connective
tissue disorders
(3 weeks)
BCS (1 weeks)
Behavior
Change
and disorders
(3 weeks)
BCS (1 weeks)
BIOMEDIK III
(4 weeks)

Studium
Generale and
Humaniora
(2 weeks)

Alimentary
& hepatobiliary
systems &
disorders
(3 Weeks)
BCS (1 weeks)
Basic Infection
& infectious
diseases
(3 weeks)
BCS (1 weeks)
Growth
&
development
(2 weeks)
BCS: (1 weeks)
BIOMEDIK I
(8 weeks)

The Reproductive
System and
Disorders
(3 weeks)
BCS (1 weeks)
Special Topic :
- Palliative med
- Complemnt &
Alternative Med.

Elective Study
IV (evaluation)
(2 weeks)

Compre
Clinic
Orientation
(Clerkship)
+ medical
ethic
(4 weeks)

Elective Study
III

18

19

(3 weeks)
Forensic
Medicine and
Medicolegal
(2 weeks)

Elective
Study II
(2 weeks)

18

(2 weeks)
BCS (1 weeks)
The Endocrine
System,
Metabolism
and Disorders
(3 weeks)
BCS (1 weeks)
Immune
system &
disorders
(2 weeks)
BCS (1 weeks)

Clinical Nutrition
and Disorders
(2 weeks)

The Visual
system &
disorders
(2 weeks)

BCS (1 weeks)
Hematologic
system & disorder
& clinical oncology
(3 weeks)
BCS (1 weeks)

BCS (1weeks)
Special Topic
- Andro & aging
- Geriatri
- Travel
medicine
(4 weeks)
Basic
Pharmaceutical
medicine &
drug etics
(2 weeks)

Medical
Medical
communicatio
Professionalism
n
(2 weeks)
(2 weeks)
BCS (1 weeks)
BCS (1 weeks)
The cell
BIOMEDIK II
as
(6 weeks)
biochemical
machinery
(2 weeks)
BCS(1 weeks)
Pendidikan Pancasila & Kewarganegaraan ( 3 weeks )

18

19

Elective
Study I
(2 weeks)

17

19

PLANNERS AND LECTURERS

No
1

Name
Prof. Dr. dr. Ida Bagus Ngurah Rai, Sp.P

2
3
4
5
6
7
8
9
10

(Coordinator)
Dr. dr. I Made Muliarta, M.Kes (Secretary)
Prof. dr. Wiryana, Sp.An KIC (member)
Prof. dr I Gst. Md. Aman, SpFK (member)
dr. Winarti, Sp.PA (member)
Dr. dr. Desak Wihandani, M.Kes (member)
dr. Putu Gede Sudira, Sp.S (member)
dr. I GN Sri Wiryawan, M.Repro
dr. Gede Wardana, M.Biomed
Dr. dr. Ida Bagus Subanada, Sp.A

11

dr. Dewa Artika, Sp.P

12
13
14
15
16
17
18
19
20
21
22
23
24
25

dr. Ida Bagus Suta, Sp.P
dr. Made Bagiada, Sp.PD-KP
dr. IGN Bagus Artana, Sp.PD
Dr. dr. Ketut Putu Yasa, Sp.BTKV
Dr. dr. Elysanti Martadiani, Sp.Rad
dr. Putu Ekawati, M.Repro, Sp.PA
dr. Aryabiantara, Sp.An KIC
dr. Putu Siadi Purniti, Sp.A
dr. Ayu Setyorini, Sp.A
dr. DGA Eka Putra, Sp.THT
dr. Luh Made Ratnawati, Sp.THT(KL)
dr. Putu Andrika, Sp.PD-KIC
dr. Gede Ketut Sajinadiyasa, Sp.PD
Prof. Dr. dr. Suardana, Sp.THT

Department

Phone

Pulmonology

08123804579

Physiology
Anaesthesiology
Pharmacology
Pathology Anatomy
Biochemistry
DME
Histology
Anatomy
Paediatric Dept.

081338505350
0811392171
081338770650
08123997328
081338776244
081805633997
08123925104
0361-7864957
0812399533

Pulmonology

08123875075

Pulmonology
Pulmonology
Pulmonology
Thorax surgery
Radiology
Pathology Anatomy
Anaesthesiology
Paediatric
Paediatric
Otorhinolaryngology
Otorhinolaryngology
Pulmonology
Pulmonology
Otorhinolaryngology

08123990362
08123607874
08123994203
08123843260
08123807313
08123958158
08123822009
08123812106
081353286780
0813387826317
08123806108
08123989192
085237068670
0811385299

FACILITATORS
Regular Class (Class A)
No
1
2
3
4
5
6
7
8
9
10

Name
dr Ni Putu Wardani
M.Biomed Sp.An
Dr.dr. Luh Made Mas
Rusyati, SpKK, FINSDV
dr. Dudut Rustyadi, Sp.F.,
S.H.
Prof. dr. I D P Sutjana, M.Erg
Dr. dr. Desak Made
Wihandani, M.Kes
Dr. dr. BK. Satriyasa,
M.Repro
dr. I Nyoman Gede Wardana,
S.Ked., M.Biomed
Dr. dr. Ni Nyoman Sri
Budayanti, Sp.MK (K)
dr. IGN Sri Wiryawan,
M.Repro
Dr. rer nat dr. Ni Nyoman Ayu
Dewi M.Kes

Group

Departement

Phone

A1

DME

08113992784

A2

Dermatovener
ology

081337338738

A3

Forensic

08123994234

A4

Physiology

08123924477

A5

Biochemistry

081338776244

A6

Pharmacology

087777790064

A7

Anatomy

087860405625

A8

Microbiology

08553711398

A9

Histology

082341768888

A10

Biochemistry

081337141506

Group

Departement

Phone

Venue
(2ndfloor)
2nd floor:
R.2.01
2nd floor:
R.2.02
2nd floor:
R.2.03
2nd floor:
R.2.04
2nd floor:
R.2.05
2nd floor:
R.2.06
2nd floor:
R.2.07
2nd floor:
R.2.08
2nd floor:
R.2.21
2nd floor:
R.2.22

English Class (Class B)
No

Name

1

Prof. Dr. I Nyoman Adiputra,
M.O.H. PFK

B1

Physiology

0811397971

2

dr. Kunthi Yulianti, Sp.KF

B2

Forensic

081338472005

B3

Physiology

08123623422

B4

Radiology

081916442626

B5

Parasitology

081239539945

B6

Anatomy
Pathology

082237407778

3
4
5
6

Prof. dr. Ketut Tirtayasa, MS,
AIF, AIFO, Sp.Erg
dr. Made Widhi Asih,
Sp.Rad(K)
Dr. dr. I Made Sudarmaja,
M.Kes
dr. I Wayan Juli Sumadi,
Sp.PA

7

Dr.dr. I Made Jawi, M.Kes

B7

Pharmacology

08179787972

8

dr Putu Gede Sudira Sp.S

B8

DME

081805633997

B9

Histology

081237395050

B10

Public Health

081337005360

9
10

dr. I Gusti Ngurah Mayun,
Sp.H.K
Dr. dr. I Wayan Weta, MS,
SpGK

Venue
(2ndfloor)
2nd floor:
R.2.01
2nd floor:
R.2.02
2nd floor:
R.2.03
2nd floor:
R.2.04
2nd floor:
R.2.05
2nd floor:
R.2.06
2nd floor:
R.2.07
2nd floor:
R.2.08
2nd floor:
R.2.21
2nd floor:
R.2.22

LEARNING ACTIVITY

There are several types of learning activity:


Lecture



Plenary session



Independent learning based on the lecture’s topic



Small group discussion to solve the learning task



Practicing



Student project



Clinical skill and demonstration



Self assessment at the end of every topic

Lecture will be held at room 4.02 (2 nd floor), while discussion rooms available at 2 nd floor
(room 2.01-08, 2.21 and 2.22).

IMPORTANT INFORMATIONS
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.

STUDENT PROJECT

Title of student project
Group discussion
A1
A2
A3
A4
A5
A6
A7
A8
A9
A10
B1
B2
B3
B4
B5
B6
B7
B8
B9
B10

Topic

NOTE:
About Topic, Presentation’s place and schedules, Task rules, Assessment, and Evaluator will be
discussed at lecture of block introduction 27th October 2017.

TITLE
(subject/ topic: choose from compentency list)

Name
NIM

Faculty of Medicine, Udayana University
2017

______________

1.
2.
3.
4.

Introduction (Pendahuluan)
Content (Isi, sesuai topik yang dibahas)
Summary (Ringkasan)
Refferences: (Daftar Pustaka) Van Couver style
Example:
Journal
Sheetz MJ, King GL. Molecular understanding of hyperglycemia’s adverse effect for
diabetic complications. JAMA. 2002;288:2579-86.
Textbook
Libby P. The Pathogenesis of atherosclerosis. In: Braunwald E, Fauci A, Kasper D,
Hoster S, Longo D, Jamason S (eds). Harrison’s principles of internal medicine. 15 th ed.
New York: McGraw Hill; 2001. p. 1977-82.
Internet
WHO. Obesity: preventing and managing the global epidemic. Geneva: WHO 1998.
[cited
2005
July].
Available
from:
http://www.who.int/dietphysicalactivity/publications/facts/ obesity/en.

6 – 10 pages, 1.5 space, Times new romance 12

ARTICLE REVIEW ASSESSMENT FORM FOR FACILITATOR
Faculty of Medicine, Udayana University
___________________________________________________________________________
Block

: Respiratory System and Disorders

Name

: ________________________________________

Student No. (NIM)

: ________________________________________

Facilitator

: ________________________________________

Title

:
__________________________________________________
__________________________________________________

Time table of consultation
Point of discussion
1. Title
2. Refferences
3. Outline of paper
4. Content
5. Final discussion
Assessment
A. Paper structure
B. Content
C. Discussion

Total point

Week

Date

Tutor sign

1
1
2
3
4
:
:
:

7
7
7

8
8
8

9
9
9

10
10
10

: ( A + B + C ) : 3 = _____________

Denpasar, ______________________

Facilitator

ARTICLE REVIEW ASSESSMENT FORM FOR EVALUATOR
Faculty of Medicine, Udayana University
___________________________________________________________________________
Block

: Respiratory System and Disorders

Name

: ________________________________________

Student No. (NIM)

: ________________________________________

Evaluator

: ________________________________________

Title

:
__________________________________________________
__________________________________________________

Assessment
A. Paper structure
B. Content
C. Discussion

Total point

:
:
:

8
8
8

9
9
9

: ( A + B + C ) : 3 = _____________

Denpasar, ______________________

Evaluator

7
7
7

10
10
10

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 62-64 will be reconsidered with self assessment’s mark to see the student’s status. Any
student with self assessment’s mark 70 or more 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 just at First examination.

ASSESSMENT METHOD

Assessment in this theme consists of:


SGD

: 5%



Final Exam

: 80%



Student Project

: 15%

Final mark 65 or more considered to pass this block. Certain conditions applied for those
with final mark between 62 – 64. These students will be analyzed using their self assessment’s
mark. Students with final mark 62 – 64 and self assessment’s mark equal or more than 65 will
also considered pass this block. The value of marking:


A

≥ 80



B+

>70-79



B

65-70

GENERAL TIME TABLE FOR A AND B CLASSES
CLASS B
TIME

ACTIVITIES

CLASS A
TIME

ACTIVITIES

08.00-09.00

Lecture

09.00-10.00

Lecture

09.00-10.30

Independent learning

10.00-11.30

Student project

10.30-12.00

SGD

11.30-12.00

Break

12.00-12.30

Break

12.00-13.30

Independent learning

12.30-14.00

Student project

13.30-15.00

SGD

14.00-15.00

Plenary session

15.00-16.00

Plenary session

TIME TABLE OF CLASSES
DAY/DATE

1
Friday
Oct 27,
2017

Class B

Class A

ACTIVITY

08.00-08.15

09.00-09.15

08.15-09.00

09.15-10.00

Anatomy of
Respiratory System

09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00

12.00-13.30
13.30-15.00
11.30-12.00
10.30-11.30
15.00-16.00

Independent learning
SGD
Break
Student project
Plenary session

08.00-09.00

09.00-10.00

Histology of
Respiratory System

09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00

12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30

Independent learning
SGD
Break
Student project

14.00-15.00

15.00-16.00

Plenary session

Block Introduction

VENUE
Class room

Prof IB Rai

Class room

dr.Wardana

Disc room

Facilitator

Class room

dr.Wardana

Class room

dr. Sri
Wiryawan

Disc room

Facilitator

Class room

dr. Sri
Wiryawan

Class room

dr. Muliarta

Disc room

Facilitator

Class room

dr. Muliarta

Class room

dr. Muliarta

Anatomy:
1st floor

dr. Wardana

Histology:
4th floor

dr. Sri
Wiryawan

Lecture 1

Lecture 2
2
Monday
Oct 30,
2017

PIC

Lecture 3
3
Friday
Nov 3,
2017

08.00-09.00

09.00-10.00

Physiology of
Respiratory System:
Ventilation

09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00

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

Lecture 4
08.00-09.00

09.00-10.00

4
Monday
Nov 6,
2017

Physiology of
Respiratory System:
Gas Exchange, diving,
altitude
Independent learning

09.00-15.00

10.00-16.00
Practice:
Anatomy, Histology

Lecture 5
5
Tuesday
Nov 7,
2017

08.00-09.00

09.00-10.00

Carriage of oxygen and
Carbon dioxide

09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00

12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30

Independent learning
SGD
Break
Student project

14.00-15.00

15.00-16.00

Plenary session

Class room

dr. Desak
Wihandani

Disc room

Facilitator

Class room

dr. Desak
Wihandani

Class room

dr. Desak
Wihandani

Disc room

Facilitator

Class room

dr. Desak
Wihandani

Class room

dr. Arya
Biantara

Disc room

Facilitator

Class room

Prof. Wiryana

Class room

dr. Ekawati

Disc room

Facilitator

Hospital Visit
Class room

dr. Ekawati

Class room

dr. Ekawati

Lecture 6
6
Wed
Nov 8,
2017

08.00-09.00

09.00-10.00

Control of acid base
balance, Arterial Gas
Analysis (AGA)

09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00

12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30

Independent learning
SGD
Break
Student project

14.00-15.00

15.00-16.00

Plenary session

Lecture 7
7
Thursday
Nov 9,
2017

08.00-09.00

09.00-10.00

Control of Respiratory
Function and Blood
Gas Analyzes

09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00

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

09.00-10.00

Pathology of
Respiratory Tract

09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00

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

Lecture 8
8
Monday
Nov 13,
2017

Lecture 9
9
Tuesday
Nov 14,
2017
10
Wed
Nov 15,
2017

08.00-09.00

09.00-10.00

Lung Defense
Mechanism
Independent learning

09.00-15.00

10.00-16.00

Practice : Physiology,
Pathology Anatomy (PA)

Physiology:
2nd floor
PA: Joint Lab
(4th floor)
Class room

08.00-09.00

09.00-10.00

Lecture 10
Pharmacological and
non pharmacological
interventions

09.00-10.30

12.00-13.30

Independent learning

dr. Muliarta
dr. Ekawati

Prof. Aman

10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00

11
Thursday
Nov 16,
2017

12
Friday
Nov 17,
2017

13
Monday
Nov 20,
2017

14
Tuesday
Nov 21,
2017
14
Tuesday
Nov 21,
2017

15
Wed,

13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00

SGD
Break
Student project
Plenary session

08.00-09.00

09.00-10.00

Lecture 11
Pharmacological and
non pharmacological
interventions

09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00

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

09.00-10.00

09.00-10.00

Lecture 12
Respiratory Imaging
Lecture 13
TB in children

10.00-11.30
11.30-13.00
13.00-13.30
13.30-14.00

12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30

Independent learning
SGD
Break
Student project

14.00-15.00

15.00-16.00

Plenary session

08.00-09.00

09.00-10.00

09.00-10.00

10.00-11.00

10.00-11.30
11.30-13.00
13.00-13.30
13.30-14.00

12.00-13.30
13.30-15.00
11.30-12.00
11.00-11.30

Independent learning
SGD
Break
Student project

14.00-15.00

15.00-16.00

Plenary session

08.00-09.00

09.00-10.00

09.00-10.00

10.00-11.00

10.00-11.30
11.30-13.00
13.00-13.30
13.30-14.00

Lecture 14
Pneumonia, Pneumonia
Aspirasi
Lecture 15
Difteri dan Pertusis

Lecture 16
Bronkhiolitis

Disc room

Facilitator

Class room

Prof. Aman

Class room

Prof. Aman

Disc room

Facilitator

Hospital Visit
Class room

Prof. Aman

Class room

dr. Elysanti

Class room

dr. S Purniti

Disc room

Facilitator

Class room

dr. Elysanti
dr. S Purniti

Class room

dr. Ayu
Setyorini

Class room

dr. Ayu
Setyorini

Disc room

Facilitator

Hospital Visit
Class room
Class room

Lecture 17

dr. Ayu
Setyorini
dr. IB
Subanada

Class room

dr. IB
Subanada

12.00-13.30
13.30-15.00
11.30-12.00
11.00-11.30

Child Asma and Status
Asmaticus
Independent learning
SGD
Break
Student project

Disc room

Facilitator

14.00-15.00

15.00-16.00

Plenary session

Class room

dr. IB
Subanada

08.00-09.00

09.00-10.00

Class room

dr. Sutha

09.00-10.00

10.00-11.00

Class room

dr. Bagiada

Lecture 18
Pulmonary TB and
Extrapulmonary TB,
Lecture 19
TB in the

Immunocompromised
Host, Abses TB

Nov 22
2017

16
Thursday,
Nov 23
2017

17
Friday,
Nov 24
2017

18
Monday
Nov 27
2017
18
Monday
Nov 27
2017

19
Tuesday
Nov 28,
2017

10.00-11.30
11.30-13.00
13.00-13.30
13.30-14.00

12.00-13.30
13.30-15.00
11.30-12.00
11.00-11.30

Independent learning
SGD
Break
Student project

14.00-15.00

15.00-16.00

Plenary session

Class room

08.00-09.00

09.00-10.00

Lecture 20
Asthma and COPD

Class room

09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00

12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30

Independent learning
SGD
Break
Student project

14.00-15.00

15.00-16.00

Plenary session

08.00-09.00

09.00-10.00

09.00-10.00

10.00-11.00

10.00-11.30
11.30-13.00
13.00-13.30
13.30-14.00

12.00-13.30
13.30-15.00
11.30-12.00
11.00-11.30

Independent learning
SGD
Break
Student project

14.00-15.00

15.00-16.00

Plenary session

Lecture 21
Pleural effusion,
Emfisema, edema paru
Lecture 22
Pneumothorax and
Hematothorax

Lecture 23
Bronchitis and
Bronchiectasis
Lecture 24
Lung Ca and Education
of Smoking Cessation

Disc room

Facilitator

Hospital Visit
dr. Sutha,
dr. Bagiada
Prof. IB Rai,
dr. Artana

Disc room

Facilitator

Class room

Prof. IB Rai,
dr. Artana

Class room

dr. Andrika,

Class room

dr. Yasa

Disc room

Facilitator

Hospital Visit
Class room

dr. Andrika,
dr, Yasa

Class room

dr.IB Suta

Class room

dr. Saji

Disc room

Facilitator

08.00-09.00

08.00-09.00

09.00-10.00

09.00-10.00

10.00-11.30
11.30-13.00
13.00-13.30
13.30-14.00

12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30

Independent learning
SGD
Break
Student project

14.00-15.00

15.00-16.00

Plenary session

Class room

dr.IB Suta,
dr. Saji

08.00-08.30
08.30-09.00

09.00-09.30
09.30-10.00

Lecture 25
Disorder of nose,
Disorder of sinus, and
Nose foreign Bodies

Class room

dr. Ratna

09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00

12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30

Independent learning
SGD
Break
Student project

Disc room

Facilitator

14.00-15.00

15.00-16.00

Plenary session

Hospital Visit
Class room

dr. Ratna,
Sp.THT

20
Wed
Nov 29,
2017

08.00-09.00

08.00-09.00

Lecture 26
Disorder of larynx,
Disorder of Pharynx,
Throat foreign bodies

09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00

09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00

Independent learning
SGD
Break
Student project

14.00-15.00

21
Thursday,
Nov 30
2017

22
Monday,
Dec 4
2017

23
Tuesday
Dec 5,
2017

24
Wed,
Dec 6
2017

08.00-15.00

08.00-15.00

08.00-15.00

08.00-15.00

14.00-15.00

08.00-15.00

08.00-15.00

08.00-16.00

08.00-16.00

Class room

Prof.
Suardana,
dr. Dewa Artha
Eka Putra,

Disc room

Facilitator
Prof.
Suardana,
dr. Dewa Artha
Eka Putra
Dr. Saji

Plenary session

Class room

BCS: Physical diagnostic
examination of Thorax’s in
adult patients

Physiology
Dept. (2nd
floor

BCS: Radio Imaging

Joint Lab

dr. Elysanti

BCS: Pemasangan dan
Perawatan WSD
(Pre-test, lecture, demo
Practice, discussion)
BCS: Spirometri

Anatomy (1st
floor)

dr. Yasa

Physiology
Dept.

dr. Muliarta

BCS: Pengambilan cairan
Pleura, Punksi, Dekompresi
jarum

Joint Lab (4th
Floor)

dr. Yasa

BCS: Nebulisasi dan terapi
oksigen
(Pre-test, Lecture, practice,
demo)
BCS: Radio imaging

Anatomy (1st
floor)

dr. Arya
Biantara

Physiology
Dept.

dr. Elysanti

BCS: Physical diagnostic
examination of Thorax’s in
baby-children patients

Joint Lab (4th
Floor)

dr. Ayu
Setyorini

BCS: Physical diagnostic
examination of Thorax’s in
adult patients
(Pre-test, lecture, practice,
demo)
BCS: Bronchoscopy,
Provocation test, Radio
Imaging

Anatomy (1st
floor)

dr. Saji

Physiology
Dept. (2nd
floor

dr Artana
dr. Elysanti

BCS: CPEP pada Bayi

Joint Lab

dr. Arya
Biantara

25
Thursday,
Dec 7
2017

08.00-15.00

08.00-16.00

BCS: Physical diagnostic
examination of Thorax’s in
adult patients
(Pre-test, lecture, demo)

Anatomy (1st
floor)

dr. Saji

BCS: Physical diagnostic
examination of Thorax’s in
baby-children patients

Physiology
Dept. (2nd
floor

dr. Ayu
Setyorini

BCS: Perawatan WSD,
Decompresi Jarum

Joint Lab (4th
Floor)

dr. Yasa

BCS: Rhinoskopi Posterior
(Practice, post-test)

Anatomy (1st
floor)

THT staff

26
Friday
Dec 8,
2017

Pre-Evaluation Break

27
Monday,
Dec 11
2017

Examination

LEARNING PROGRAMS
LECTURE 1
ANATOMY OF RESPIRATORY TRACT
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!

LECTURE 2
HISTOLOGY OF RESPIRATORY TRACT
dr. Sri Wiryawan, M.Repro
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
A. 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!
B. 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.
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
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.

Learning Task
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
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
1.
Describe the Dalton’s Law!
2.
Describe the factors that influence oxygen diffusion from alveoli into the blood!
3.
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
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
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
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 acid-base 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, pCO2 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 measurements are done?

LECTURE 7
CONTROL OF RESPIRATORY FUNCTION
Prof. Dr. dr. Wiryana, Sp.An, KIC
When considering contol of breathing, the main control variable is PaCO2 (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 PaO2 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
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.
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 ca