تفاصيل المقرر

المقدمة


The primary function of the cardiorespiratory system is the transport and exchange of gases O2 between blood and inspired air, a process which is vital for cellular metabolism and the survival of the living organism
In the human being this exchange takes place in about 250 million alveoli with a surface area of approximately 80 sq. meter, more than 50 times the skin surface area of an adult. Furthermore the entire cardiac output has to pass through the lungs. Thus one can imagine the vulnerability of the lung to insults from potentially harmful agents in the atmosphere; i.e. physical – chemical – biological, and also from noxious material carried by the blood, i.e. bacteria, thrombi, Antigen, Antibody complexes, etc. It is also of importance to mention that the respiratory tract is the portal of entery for an uncountable numbers of both harmless and pathogenic micro-organisms. Thus it is no wonder that respiratory diseases are among the commonest seen by doctors everywhere in the world and the study of the functions of this system and its diseases and their management is indispensable to the practicing doctor
The ease with which organisms get access to the respiratory system created an enormous epidemic potential for such virulent organisms i.e. influenza, measles cerebrospinal meningitis and whooping cough. This also facilitated the endemicity of chronic infections like Tuberculosis which in this country is a great problem and a challenge for the health services. In dealing with respiratory tract problems awareness of socio-economic factors such as overcrowding, occupational hazards and nutrition is of paramount importance in implementing preventive and curative measures
Heart failure is a common medical problem that affects patients of all age groups. It results from various aetiological and pathological processes. Rheumatic heart disease stands out as one of the commonest causes in this country, it affects young patients and it is preventable. Anaemia, another common problem in this country, might be complicated by heart failure. However, we are seeing more cases of ischaemic heart disease, manifesting as angina pectoris, left ventricular failure or acutely as acute myocardial infarction with all possible serious complications
Hypertension is another common cardiovascular problem with far reaching complications involving the heart, kidneys and central nervous system (CNS); it is a major risk factor of ischaemic heart disease. Good control and management of hypertension, based on sound understanding helps to reduce its complications particularly on the kidneys and CNS
A mention should be made of congenital problems involving this system (congenital heart disease), which is a common problem in paediatric practice, however one should not forget that some of these congenital problems might be seen in adults (atrial septal defect, coarctation, of the aorta)
Most patients with cardio-respiratory disease present with similar symptoms, e.g. cough, shortness of breath, chest pain and oftenly this thus difficult to make a final diagnosis without taking a good history, conducting thorough clinical examination and performing various investigations. For this reason it is thought that it would be more practical if this block is introduced as one unit
Some of the basic sciences will continue here, e.g. application of use of lung functions in respiratory diseases, e.g. forced vital capacity, in relation to vital capacity, analysis of blood gases. This block also include the pathology and microbiology of the common diseases. The plan in this block is to integrate most of the basic sciences with the basic skills in relation to the clinical problems. In this block the student is going to be introduced to the common medical problems e.g. Bronchial asthma, hypertension, heart failure in a quite different approach



المحتويات


1 Introduction to Problem V (chest pain)
2 Blood buffers
3 Physiology (Revision)
4 Electric Activity of the Heart and ECG
5 Tumors of Bronchus
6 Circulation through special Organs
7 Ward round
8 Pathology of Blood Vessels
9 Practical Bacteriology Z-N stain
10 Epidemiology of hypertension
11 Tutorial on Upper Airway Obstruction

12 Risk Factors in Ischaemic Heart Disease
13 Ischaemic Heart Disease (clinical)
14 Practical Session on ECG
15 X-ray
16 Respiratory Distress in the Newborn
17 Bronchial Asthma
18 Chronic Obstructive Airway Disease
19 Resuscitation of Cardiac & Respiratory Arest
20 Resuscitation of the Newborn
21 Pneumothorax
22 Pleural Effusion

23 Tutorial:Common cardiac arrhythmias
24 Survey on Hypertnsion
25 Chest injuries
26 Ca nasopharynx
27 Heart Failure
28 Haemoptysis
29 Hypertension (clinical picture)
30 Therapeutics of Hypertension
31 Tutorial on Pastoperative
32 Respiratory complications
33 Occupational Lung Disease

34 Interstitial lung disease
35 Myocardial Disease
36 Drugs used in Cardiac Arrythmias
37 Deep VEin Thrombosis (Lecture)
38 Discussion:pulmonary Embolism & Pulmonary Infarction
39 Infective Endocarditis
40 Pericardial Disease
41 Congenital Heart Disease I (Acyanotic)
42 X-ray Session on Cardio-pulmonary Disease

43 Epidemiology of Cardiac
44 Drugs Heart Failure
45 Hypertension & Heart Failure in Pregnancy
46 Tutorial on Heart Failure in Neonate and Infants
47 Hazards of smoking (seminar)
48 Cardiac Surgery
49 Shock
50 Tutorial on: Drug Therapy in T.B.
51 X-ray session on C-P Disease
52 Anatomy (Revision)



المنسقون



المطلوبات


(CARDIO - RESPIRATORY SYSTEM (Part I


الأهداف


I GENERAL OBJECTIVES:
There are the same previous objectives but they will be integrated. A new objective is added in part one. (At the end of the course the student should be able to discuss the pathophysiology of the common symptoms and signs e.g. cough, breathlessness, haemoptysis, chest pain, wheezes, crepitations, added sounds, murmurs)

II SPECIFIC OBJECTIVES:
At the end of the course the student should be able to :
1 )Using a diagram, describe the normal electrocardiogram (ECG) discausing the underling electrical activity in the heart with some reference to changes in ECG in common cardiovascular problem e.g. atrial fibrillation, ischaemic heart disease, hypertension
2)Describe CO2 exchange, its transport in RBCs and plasma the chloride shift phenomena. Define blood Bufferes the Hondreson-Hasselbalch equation, the lung role in pH regulation and changes during resp, Acidosis and resp. alkalosis
3)Describe different mechanisms that regulate the circulation in health (e.g. change in posture and exercise) and disease (e.g. haemorrhagic shock)

4)Describe circulation through special organs and factors regulating it :
1 Cerebral circulation
2 Renal circulation
3 Coronary circulation
4 Pulmonary circulation
5 Splanchnic circulation
6 Foetal circulation


5) Given a vialograph he should be able to use it, describe the normal and abnormal values

6) Resucitate a patient with :
1 Cardiac arrest
2 Respiratory arrest
3 Newborn


7) Disease of Arteries of Degnerative, Inflammatory or vaso-pastic nature:
1 aetiological and predisposing factors
2 pathology
3 different way of presentation
4 diagnosis
5 treatment medical and surgical


8) Describe characteristics of the pulmonary circulation and changes in pulmonary hypertension
9) Describe postoperative respiratory complications
10) Read and describe a normal chest X-Ray
11) Diagnosis X-Ray appearances of mediastinal shift, consolidation, pleural effusion and pneumothorax
12) Describe the role of sputum tests in diagnosis of respiratory diseases with special reference to Z-N statining

13) Describe the epidemiology, pathophysiology ``including microbiology``, clinical presentation, investigations, diagnosis, management and control of the following respiratory problems :
1 Bronchial Asthma
2 Respiratory distress syndrome
3 Ch. Obstructive airway disease ``emphysema & Ch. Bronchitis``
4 Cannasopharynx Bronchus
5 Pleurisy pleural effusion
6 Pneumothorax
7 Influenza
8 Occupational lung disease
9 Chest injuries
10 Upper respiratory obstruction


14) Problems related to therapeutic measure in respiratory diseases, paricularly in pulmonary T.B., Bronchial asthma and oxygen therapy
15) Describe epidemiologyical factors favouring prevelance of pulmonary T.B. in Sudan, measures for prevention and role of the BCG and mantoux testing
16) Infective endocarditis :

1 Bacteriology
2 Pathology
3 Clinical
4 Investigations
5 Diagnosis
6 Treatment & PREVENTION


17) Hypertention :
1 Epidemiology
2 Physiology
3 Methods of measurement
4 Aetiology
5 Pathology
6 Clinical presentation
7 Relevant investigation
(Including, urine analysis, CXR, ECG, blood urea electrolytes)
8 Complications
9 Drug treatment

18) Ischaemic heart disease :
1 Aetiology
2 Risk factors
3 Pathology
4 Clinical features
5 Investigations
6 Diagnosis
7 Complications
8 Treatment, medical surgical and PREVENTION

19) Heart Failure:
1 Symptoms and signs and their underlying pathophysiology
2 Aetiology
3 Precipitating factors
4 Investigations
5 Management

20) Deep Vein Thrombosisn:
1 Aetiological factors
2 Clinical presentation
3 Investigations
4 Complications
5 Treatment and PREVENTION

21) Pulmonary Embolism and/or Infarction :
1 Aetiology
2 Predisposing factors
3 Clinical features
4 Investigations
5 Diagnosis
6 Treatment

22) Pericardial Disease (Acute pericarditis):
1 Pericardial effusion
2 Constrictive pericarditis
3 Aetiology
4 Clinical presentation
5 Diagnosis
6 Treatment


23) Myocardial Diseases (Acute myocarditis, and cardiomyopathy): Aetiology
Clinical picture
Diagnosis and Treatment

24) Congenital Heart Disease (Ventricular septal, defect, atrial, septal defect, tetralogy of fallot, coarctation of the aorta, patent ductus arteriosus)
1 Underlying embroyological defect
2 Predisposing factors
3 Clinical signs
4 Complications
5 Diagnosis
6 Treatment both medical and surgical


25) Evaluate role of smoking as a health hazard with special reference to epidemiology of Ca broncgus

26) Heart Disease during Pregnancy :
1 Physiological changes in pregnancy
2 Effects of those on heart disease
3 Management of heart disease
4 Management of labour and post-partum period



طرق التدريس


1 Practicals including practicals in physiology e.g. lung functions, action of different drugs on the cardiac muscle
2 Lectures
3 Surveys e.g. hypertension, smoking, lung diseases
4 Seminars in common problems e.g. T.B., heart failure
5 Problem solving a trial of a small group system
6 Demonstrations: heart sounds Lung sounds
7 Reading Assignments



المصادر


1) HUMAN RESOURCES:
1 Anatomist
2 Physiologist
3 Physicians
4 Paediatrician
5 Surgeon
6 Epidemiologist
6 Pathologist
7 Radiologist
8 Cardiologist
9 ENTspecialist

2 ) PHYSICAL RESOURCES:
1 Tape slide projector
2 Laboratory (basic skill and physiology)
3 Stethoscopes
4 ECG Machine
5 Sphygmomanometers
6 Vitilograph
7 Tape record player
8 Computer, multimedia and screen
9 Black and white boards
10 Dissection room and cadavers



وسائل التقويم


1- MCQs --- %40
2- Written papter: two problems, short questions ---%20
3- Clinical examination (PACES) --- %30
4- A& P --- %10



المراجع


( Medical Library ) ( Audio-visual Aids)
1 Anatomy (611)
- Cunningham Manual of Anatomy
- Last Anatomy
- Gray’s Anatomy
2 Physiology (612)
- Medical physiology (Large)
- Introduction to Human Physiology (Green)
- Review of medical pbhysiology (Ganong)
3 General Medicine
- Davidson`s Principles and Practice of Medicine
- Hutchison`s Clinical Methods
- Harrison`s Principles of Internal Medicine
4 Human Anatomy (Atlas)
5 B.D.S. Textbook for Biochemistry and physiology
6 Respiratory Medicine M. Schonell
7 Miure`s Textbook of Pathology
8 Last's Anatomy Regional and Applied – Edited by R.M.H McMINN.
9 Functional HUMAN ANATOMY – Prof. QURASHI M.ALI & Prof. TAHER OSMAN ALI.
10 Clinical Anatomy – RICHARD S.SNELL
11 SADLER – MEDICAL EMBRYOLOGY
12 Cunninghams - Manual of practical Anatomy
13 BASIC HISTOLOGY
14 Lecture note in ear, nose and throat
15 Diseases of the Ear, Nose, Throat and Head and Neck. An illustrated colored textboo



الجدول الزمني

Coordinators
Introduction

Sunday:22/1/2017
8: 8.30
Nahid Ahmead Mohammed
ECG
11:00 - 9:00
Dr.Ahmed Awad Elkarim
(1) ECG
2:00 – 11:30
Dr .Hind Osman Taha
Pathology of Tuberculosis

MONDAY:23/1/2017
8 – 9:30
Dr . Sosan Mohmmed Omer
Obstructive lung disease
2:00 - 10:30
Dr .Ahmed Awad Elkarim
(2) ECG

TUESDAY:24/1/2017
9:30 – 8:00
Dr . Musea Mostafa Saad
ِAcute Resp. Tract Infection in children
11:30 – 10:30
Dr AbdAlla AbdelKarim
(1)Valvular disease
3:00 - 12:00

longitudinal

WEANSDAY:25/1/2017
Dr. Hosham Mostafa
History & Exam. of cardio pulmonary system

THURSDAY:26/1/2017
8:00 - 9:00
Dr.Ahmed Awad Elkarim
Histary & Exam of cardio pulmonary system in adults
12: 30 – 10:30
Dr AbdAlla AbdelKarim
Introduction of Smoking Seminar
2:00 - 12:30
Md . Ehsaan Ishag
ECG Skill lab

Sunday:29/1/2017
8 – 10:30
Dr.Ahmed Awad Elkarim
Ischemic Heart Disease(1)
3:00-11:00
Dr . Ahmed Awad Elkarim
Ischemic Heart Disease(2)

MONDAY:30/1/2017
8:00 – 9:30
Dr . Marym Omer Gurashi
Circulation in different systems(1)
12:30 – 10:30
Dr . Al Fadil Eisa
(RDS( problem introduction Respiratory distress syndarome
3:00- 1:00
Prof . Ali Haboor
Childhood Asthma

TUESDAY:31/1/2017
8 – 10
Md . Ehsaan Ishag
EGG
2:00-11:00

longitudinal

WEANSDAY:1/2/2017

Clinical Round

THURSDAY:2/2/2017
8 -1
Dr. AbdAlla AbdelKarim
(Valvular disease(1
3:00-1:00
Mr AbdAlla El Elshiekh
Pneumothorax

Sunday:5/2/2017
8 -10
Dr Muatafa Ibrahim
Introduction chest pain (Problem )
12:00 – 11:00
Dr.Ahmed Awad Elkarim
Heart Sound
3:00- 1:00
Dr.Mohamed Alamin
A cyanotic congenital heart disease

MONDAY:6/2/2017
8 – 9:30
Dr.Mohamed EL MOGTAR
Dr AbdAlla AbdelKarim

Discussion of smoking simenar
1:00 – 11:00
Prof. Ahmed El Amin Elshiekh Mr AbdAlla Elmin Elshiekh
respiratory complication after surgery
3:00 – 1:00
Dr.Mohamed Alamin
Cyanotic congenital heart disease

TUESDAY:7/2/2017
8:00 – 9:30
Dr. Marym Omer Gurashi
Circulation in different systems(2)
11:30 – 10:30
Dr .Mahmud Hussein
(2)Cardiac Arrhythmia
3:00- 12:00

longitudinal

WEANSDAY:8/2/2017

clinical round

THURSDAY:9/2/2017
12:00 - 9:00
Dr AbdAlla AbdelKarim
problem introduction - Haemoptysis
3:00- 1:00
Dr . Faroog Al Ameer
CXR of heart and chest

Sunday:12/2/2017
8:00- 10:00
Dr .Mahmud Hussein
Treatment of Cardiac Arrhythmia
1:00 - 11:00
Dr.Mohamed Alamin
visit to wad madani cardiac centre
3:00 – 1:00
Dr . faroog al ameer
CXR of heart and chest

MONDAY:13/2/2017
8:00 – 9:30
Dr. Sayed Muatafa Elbushra
Hypertension
12:30 – 10:30
Dr.Mohamed Alamin
Infective endocarditis

TUESDAY:14/2/2017
8:00 – 9:30
Dr.Ahmed Awad Elkarim
Dr AbdAlla AbdelKarim

(problem discussion) Haemoptysis
11:30 – 10:30

longitudinal

WEANSDAY:15/2/2017

Clinical round

THURSDAY:16/2/2017
9:00 - 12:00
Dr.Ahmed Awad Elkarim Dr AbdAlla AbdelKarim
seminar (introduction) Heart failure
1:00 - 12:00
Dr . Al Fadil Eisa
Respiratory distress syndrome of newborn

Sunday:19/2/2017
8 – 10
Dr. Sayed Muatafa Elbushra
Hypertension management
12:00 - 2:00
Dr . Omema Salah
Cardiac muscles diseases

MONDAY:20/2/2017
8 – 9:30
Dr.Ahmed Ali
industrial lung diseases
12:00-10:00
Mr AbdAlla Elmin Elshiekh
CHEST Trauma
3:00- 1:00
Prof . Ali haboor
Childhood T.B.

TUESDAY:21/1/2017
8:00 – 9:30
prof. Mawia Elbalal
interstitial lung diseases
12:30 – 10:30

longitudinal

WEANSDAY:22/2/2017
Dr AbdAlla AbdelKarim
clinical round

THURSDAY:23/2/2017
9:00 - 12:00
Dr Muatafa Ibrahim Dr. Nasr ElDeen Yousif
seminar Heart failure
3:00 –1:00
Dr.Mohamed Alamin
Heart failure in children

Sunday:26/2/2017
8 – 10
Porf. Osman Khalafallah
Pulmonary embolism & infarction
1:00 - 11:00
Porf. Osman Khalafallah
Pulmonary embolism & infarction
1:00 - 11:00
Dr . EL Waleed Abd El lGabbar
Pleural effusion

MONDAY:27/2/2017
8 – 9:30
Dr . Muatafa Ibrahim
Discassion of chest pain problem
2:00 - 10:30
Porf. Osman Khalafallah
Bronchial Asthma

TUESDAY:28/2/2017
8:00 – 9:30
Mr AbdAlla Elmin Elshiekh
Principls of heart Surgry
11:30 – 10:30
Mr AbdAlla Elmin Elshiekh
Principls of heart Surgry
11:30 – 10:30

longitudinal

WEANSDAY:1/3/2017

clinical round

THURSDAY:2/3/2017
9:00 - 12:00
Prof . Mohamadani
Cardiac Tuomar
3 :00- 1:00
Dr . Ahmed Awad Elkarim
CARDIOPULMONARY REVIOW

TUESDAY:7/3/2017
8 - 9:30
Porf. Osman Khalafallah
Cardiopulmonary Resuscitation
11:30 - 10:30

longitudinal

WEANSDAY:8/3/2017

clinical round

THURSDAY:9/3/2017
9:30 - 12:00
Dr.Mohamed ELBushra
Pericardial Diseases
3:00 –1:00
Dr.Ahmed Awad Elkarim
Coordinators

Cardiopulmonary Resuscitation

Sunday:12/3/2017

ELECTIVE

MONDAY:13/3/2017

MCQS +ASSAY

TUESDAY:14/3/2017

CLINICAL EXAM

WEANSDAY:15/3/2017

CLINICAL EXAM

THURSDAY:16/3/2017

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