Respiratory

1. Anatomy of the Respiratory System

• Identify the various areas of the respiratory system and their function
• Be aware of the neuromuscular (nerves and muscles) and neurovascular (nerves and blood vessels) anatomy of the respiratory system and its surrounding area

2. Development of the Respiratory System

• Be aware of a basic outline of the embryological (before-birth) development of the respiratory system and how this can lead to birth defects and other developmental problems
• Understand the basic neonatal (newborn) complications of embryological development

• Understand and define lung ventilation
• Be aware of surfactant, compliance (how easily the lungs stretch), surface tension (the force that pulls the fluid lining the alveoli together and tends to make them collapse) and their impact on lung inflation pressures
• Be aware of how certain lung pathologies can affect lung ventilation mechanics

• Understand the principles of Boyle's Law (at a constant temperature, gas pressure falls as its volume rises)
• Understand the principles of partial pressure (the pressure that one gas in a mixture contributes) in gas exchange
• Understand what determines the partial pressure of oxygen within the alveoli
• Be aware of the factors that can affect diffusion of oxygen into and CO2 out of the alveoli
• Understand the factors that affect the carrying capacity of haemoglobin
• Be aware of how to measure the current oxygen saturation of a patient's blood
• Understand the basics of continuous oxygen delivery to a sick patient

• Understand the role of carbon dioxide within the respiratory system, particularly in regards to its entry into the blood through the lungs and how it is transported around the body
• Understand the role of haemoglobin and carbon dioxide in pH control within the blood 

• Understand how the levels of the partial pressure of oxygen (pO2) and of carbon dioxide (pCO2) can influence breathing rate
• Be aware of the buffering mechanisms and systems in place within the body
• Be aware of the role of chemoreceptors (sensors that detect chemical changes) in detecting changes in the plasma concentrations of oxygen, carbon dioxide and hydrogen ions
• Be able to interpret an Arterial Blood Gas (ABG) 

• Understand how lung function can be assessed quantitatively
• Be able to read and understand spirometry tracing (the graph from a breathing test that measures how much air you blow out, and how fast), including the meaning of key terms that correspond to lung function
• Be able to read and interpret flow-volume curves (graphs of airflow against lung volume during a forced breath)
• Be aware of specialised tests and how they are performed on a basic level

• Define the terms ‘embolus’ and ‘pulmonary embolus’
• Recall the risk factors for a pulmonary embolus
• Understand the pathophysiology (how the disease disrupts normal body function) behind a pulmonary embolus
• Recall the signs and symptoms of a pulmonary embolus
• State the common investigations and treatment for a pulmonary embolus

• Understand the pathophysiology of asthma
• Be able to identify the symptoms of asthma
• Be able to recall the definition of the various types of asthma exacerbation (a sudden worsening, or flare-up)
• Be able to recall the guidelines for long-term asthma management

• Understand how COPD is diagnosed and the components of that diagnosis
• Understand the progression of the disease, diagnosis and potential treatments
• Be aware of the management of an acute COPD exacerbation

• Be aware of and understand the basic pathology of a host of Lower Respiratory Tract Infections (LRTIs)
• Have a good understanding of the pathophysiology, diagnosis, management and severity scoring of Pneumonia

• Understand the definition, pathophysiology, presentation, investigations, management and complications of Bronchiectasis (permanent widening and damage of the airways)
• Understand the definition, pathophysiology, presentation, investigations, management and complications of Cystic Fibrosis

• Be aware of the pathophysiology of Tuberculosis (TB) and its transmission
• Be able to pick up on the red flags (warning features that suggest a serious cause) for a potential TB infection
• Be able to identify a lesion (an area of abnormal tissue) with a risk of TB on a chest X-ray
• Be aware of the tests carried out for identifying latent (dormant, no symptoms) and active (causing disease) TB infections
• Know and recite the management of TB and the side-effects of the potent drugs used in this treatment

• Define and identify a pneumothorax (air in the space between the lung and chest wall), with basic management
• Be able to identify a pneumothorax from signs
• Define a pleural effusion (fluid in the space between the lung and chest wall) and be able to identify its cardinal (main) signs on an X-ray

• Recall the statistics regarding Lung Cancer in the UK, such as incidence (new cases), deaths and survival
• Understand the symptoms, signs and red flags of Lung Cancer
• Be aware of the types of lung cancer and how these can influence outcome
• Understand the basic principle of a paraneoplastic syndrome (an effect of a cancer on the body caused by hormones or immune responses, not by the tumour spreading) and common Lung Cancer-related syndromes
• Be aware of the basics of Lung Cancer staging (working out how far the cancer has spread) and management

• Be able to define type 1 vs type 2 respiratory failure and interpret ABG patterns
• Be able to explain common mechanisms and causes (ventilation/perfusion (V/Q) mismatch, where airflow and blood flow are not matched; diffusion; and hypoventilation, which means breathing too little to clear carbon dioxide)
• Be able to outline initial management and escalation, including oxygen targets and ventilatory support (machines that help breathing, such as non-invasive or invasive ventilation)