Course overview

The Victorian Regional Committee have partnered with hospitals in Victoria to bring weekly First Part Teaching via Teams. These sessions are a great opportunity for Victorian trainees to have access to more teaching from different hospital and benefit from a range of educators and knowledge and resource sharing. Please use the Microsoft Teams link to enter the session, running every Tuesday 11:00am – 12:00pm. Please see below the upcoming sessions, topics and questions to study on prior to the upcoming session you're attending. Tuesday 18th February: Topic: Anatomy of the respiratory system, Pulmonary circulation, Pulmonary gas volumes , Pulmonary function tests Facilitator: Neil Glassford Contact email: neil.glassford2@monashhealth.org Questions: 1. Describe the anatomical course and relations of the trachea and bronchial tree (to the level of the segmental bronchi).Define functional residual capacity (10% marks). 2. Describe the anatomical (20% marks) and physiological (80% marks) features of the pulmonary circulation 3. Compare and contrast the systemic circulation with the pulmonary circulation. 4. Define closing capacity (10% of marks). Describe the factors that alter it (30% of marks), its clinical significance (30% of marks) and one method of measuring it (30% of marks). 5. Draw and explain a normal respiratory flow-volume loop (25% of marks) and compare these with the loops for patients with severe obstructive (25% of marks) and restrictive (25% of marks) lung disease. Explain how the diffusive capacity of the respiratory system is measured and what may cause high or low values (25% of marks). 6. What is functional residual capacity and describe how it is measured. 7. Describe the cough reflex. Tuesday 25th February: Topic: Control of ventilation, Mechanics of breathing Facilitator: Neil Glassford Contact email: neil.glassford2@monashhealth.org Questions: 1. Define respiratory compliance, include its components and their normal values (25% marks). Explain the factors that affect respiratory compliance (75% marks). 2. What is lung compliance and how is it measured? 3. Explain the concept of time constants and relate these to "fast" and "slow" alveoli. 4. What factors affect airway resistance? (80% of marks). Briefly outline how it may be measured and/or changes in flow are detected. (20% of marks) 5. Explain the significance of the vertical gradient of pleural pressure (50%) and the effect of positioning on respiratory mechanics (50%) 6. Describe the work of breathing and its components. 7. Describe the production, properties, and role of surfactant. 8. Explain the control of breathing. 9. Explain the detection and response to hypoxaemia. Tuesday 4th March: NO SESSION Tuesday 11th March: Topic: Gas transport in the blood, Respiratory pharmacology Facilitator: Neil Glassford Contact email: neil.glassford2@monashhealth.org Questions: 1. Describe the oxygen cascade in a person breathing room air at sea level. 2. Describe the movement of carbon dioxide from the cell to the atmosphere 3. Describe the carriage of oxygen in the blood, including total oxygen delivery per minute. 4. Explain the oxyhaemoglobin dissociation curve and the factors that may alter it. 5. Describe how carbon dioxide (CO2) is carried in the blood. 6. Explain the carbon dioxide dissociation curve and the factors that may alter it. 7. Describe the pharmacology of oxygen 8. Describe the mechanism of action, and adverse effects, of pulmonary vasodilators that are administered via the inhalational route. 9. Categorise the drugs used in the treatment of asthma, give examples and outline their mechanisms of action. Tuesday 18th March: Topic: Ventilation-perfusion relationship, Diffusive transfer of respiratory gas, Applied physiology Facilitator: Neil Glassford Contact email: neil.glassford2@monashhealth.org Questions: 1. Describe the effects of Ventilation/Perfusion (V/Q) inequality on the partial pressure of oxygen (PaO2) in arterial blood. 2. Describe the ventilation / perfusion (V/Q) relationships in the upright lung according to West’s zones (40%). Explain the physiological mechanisms responsible for these relationships (60%). 3. Outline the physiological factors that affect the diffusion of oxygen and carbon dioxide within the lung. 4. Describe the cardiovascular and respiratory effects of positive pressure ventilation. 5. Explain the causes of the differences between measured end tidal and arterial partial pressures of carbon dioxide (CO2). 6. Define dead space and its components (30% of marks). Explain how these may be measured (35% of marks) and describe the physiological impact of increased dead space (35% of marks). 7. Define venous admixture and list its causes. (50% of marks) How is it diagnosed and how is it quantified? (50% of marks) 8. Explain the concept of shunt, and the physiological effects of increasing shunt fraction. Tuesday 25th March: Topic: Structure and function of the heart, Electrical properties of the heart, CVS Pharmacology Facilitator: Neil Glassford Contact email: neil.glassford2@monashhealth.org Questions: 1. Compare the structure, function and coronary circulation of the right and left ventricles. 2. Briefly describe the cardiac events that occur during ventricular diastole 3. Outline the structure of fast cardiac sodium channels and describe in detail how they work. 4. Describe and compare the action potentials from cardiac ventricular muscle and the sinoatrial node. 5. Describe the ionic events associated with a ventricular cardiac action potential (80% of marks). Outline how the action potential relates with the mechanical events of the cardiac cycle (20 % marks). 6. Compare and contrast the mechanisms of action and toxicity of sodium nitroprusside and glyceryl trinitrate (GTN). 7. Classify commonly used inotropic agents. (40% of marks) Outline four different mechanisms of action for inotropic agents. (60% of marks) 8. Classify the anti-arrhythmic drugs using the Vaughan-Williams classification (30% of marks). Compare and contrast the electrophysiological effects of Class 1 anti-arrhythmic drugs (70% of marks). 9. Using metaraminol, adrenaline and noradrenaline, illustrate the structure-function relationships of sympathomimetic drugs. Tuesday 1st April: VICEN / NO SESSION Tuesday 8th April: NO SESSION Tuesday 15th April: Topic: Determinants and control of cardiac output Facilitator: Neil Glassford Contact email: neil.glassford2@monashhealth.org Questions: 1. Define cardiac output. (10% of marks) Outline the factors that affect cardiac output. (60% of marks) Briefly describe the thermo dilution method of measuring cardiac output. (30% of marks) 2 Describe the factors that determine right and left ventricular afterload. 3. Define cardiac preload and describe its determinants. 4. Define myocardial contractility and briefly describe dP/dT, the end systolic pressure volume (ESPV) relationship and the ejection fraction (EF) 5. Discuss the regulation of cardiac output. Illustrate your answer by using a graph to describe the important physiological relationships. 6. Discuss the determinants of venous return to the heart 7. Draw and label a left ventricular pressure volume loop in a normal adult (40% of marks). List the information that can be obtained from this loop (60% of marks). 8. Compare and contrast the supply and demand of oxygen for the right and left ventricle. 9. Describe the physiological control of systemic vascular resistance (SVR) Tuesday 22nd April: NO SESSION Tuesday 29th April: Topic: The peripheral circulation, Control of circulation Facilitator: Neil Glassford Contact email: neil.glassford2@monashhealth.org Questions: 1. Describe the cardiovascular changes that occur following the loss of 1000mL of blood in an adult. 2. Describe the baroreceptors and their role in the control of blood pressure. 3. Describe how Starling forces determine fluid flux within the pulmonary capillary bed. 4 Describe how interstitial fluid recirculates to the vascular system. 5. Describe the regulation of the coronary circulation 6. Outline the various cardiac reflexes and the mechanisms by which they maintain physiological homeostasis 7. Describe the physiology of the Renin and Angiotensin system.