(M.D., TUBERCULOSIS & RESPIRATORY DISEASES/PULMONARY MEDICINE/ RESPIRATORY MEDICINE)

1. GOAL

The aim of teaching the postgraduate student in Tuberculosis and Respiratory Diseases is to impart such knowledge and skills that will enable him/her to diagnose and manage common as well as uncommon ailments affecting the chest with the special emphasis on management and prevention of Tuberculosis and specifically National tuberculosis control programme.

2. OBJECTIVE: -

2.1 Knowledge: -

At the end of the course of Tuberculosis and Respiratory diseases, the student shall be able to:
2.1.1 Demonstrate sound knowledge of common chest diseases, their clinical manifestations, including emergent situations and of investigative procedures to confirm their diagnosis

2.1.2 Demonstrate comprehensive knowledge of various modes of therapy used in treatment of respiratory diseases; and be acquainted with the most current guidelines for expert management of the respiratory illnesses.

2.1.3 Demonstrate detailed knowledge of pulmonary as well as extra pulmonary tuberculosis and to offer a comprehensive plan of management (Including National TB control programme and DOTS)

2.1.4 Describe the mode of action of commonly used drugs, their doses, side-effect/toxicity, indications and contra-indications and interactions.

2.1.5 Describe commonly used modes of management including medical and surgical procedures available for treatment of various diseases and to offer a comprehensive plan of management.

2.2 Skill

The Student shall be able to:

2.2.1 Interview the patients, elicit relevant and correct information and describe the history in chronological order

2.2.2 Conduct clinical examination, elicit and interpret clinical findings and diagnose common respiratory disorders and emergencies;

2.2.3 Perform simple, routine investigative and office procedures required for making the bed side diagnosis, especially sputum collection and examination for etiologic organisms especially Acid Fast Bacilli (AFB), Interpretation of the chest x-ray respiratory function tests; CT scan & MRI scan of thorax.

2.2.4 Interpret and manage various blood gases and PH abnormalities in various respiratory diseases;

2.2.5 Manage common recognizing need for referral for specialized care, of inappropriateness of therapeutic response;

2.2.6 Perform common procedure, like laryngoscopic examination, pleural aspiration, respiratory physiotherapy, laryngeal intubations and thoracic drainage/aspiration.

2.2.7 Perform special diagnosis/ therapeutic procedures such bronchoscopy, lung biopsy, pleural biopsy, thoracoscopy etc.

2.2.8 Deliver the intensive respiratory care effectively by means of expertise in mechanical ventilation and related procedures, respiratory & metabolized functional assessment.

2.3 Integration of teaching

The broad goal of effective teaching can be obtained through integration with department of Medicine, Surgery, Microbiology, Pathology, Radiology, Pharmacology and PSM. This shall enable the student to be acquainted with diagnosis and management of common/uncommon systemic diseases that may affect the lung or may affect the management of various chest diseases. 

3. Training Schedule:-

3.1. - 1^st & 2^nd post (of 6 month each)

     In Dept of TB & Chest (Proposed: Respiratory Medicine)

3.2. - 3rd Post – Allied post

                 In Department of General Medicine

3.3. - 4^th Post – Allied post

In ICU / IRCU / Cardiology

 3.4. - 5th, 6^th post

In Department of TB & Chest Proposed: Respiratory Medicine)

4. SPECIAL ACTIVITIES (COMPULSORY)

4.1 Journal club – Once a week  

4.2 PG Discussions – on management protocol for common diseases at least once a week + as required.

4.3 Active participation in at least one research activity of the department, other than the dissertation.

4.4 Case presentation & Discussion – at least once a week in addition to routine ward activities.

4.5 Integrated teaching: - Participation is case discussions.

4.6 Multimedia presentations: at least once a week

5. DETAILED SYLLABUS   

5.1 RESPIRATORY INFECTIONS:

     5.1.1 PENUMONIA

      5.1.2 VIRAL

5.1.3 FUNGAL

5.1.4 PARASITIC

5.1.5 HIV & LUNG DISEASES

5.2 TUBERCULOSIS

5.2.1 ETIO-PATHOGENESIS

5.2.2 PATHOLOGY

5.2.3 DIAGNOSIS

5.2.4 CLINICAL FEATURES

5.2.5 TREATMENT

5.2.6 PROGRAMME: NTCP, RNTCP

5.2.7 BCG VACCINATION

5.2.7 EXTRA PULMONARY TB

5.2.8 SPECIAL EMPHASIS

a)      NEWER DIAGNOSTIC TESTS

b)      MDR – TB

c)      HIV & TB

d)     TUBERCULIN TEST

e)      SPECIAL SITUATIONS: - PREGNANCY, LIVER & RENAL DISEASES & OTHER SPECIAL SITUATIONS

5.3       SUPPURATIVE LUNG DISEASES

5.3.1.      LUNG ABSCESS

5.3.2.      BRONCHIECTASIS

5.3.3.      EMPYEMA

         5.3.4. SPECIAL EMPHASIS: - POSTURAL DRAINAGE.

5.4.      OBSTRUCTIVE AIRWAY DIESEASES

5.4.1.      ASTHMA

5.4.2.      COPD

5.4.3.      ACUTE BRONCHITIS

5.4.4.      SPECIAL EMPHASIS

5.4.5.      PFT

5.4.6.      OCCUPATIONAL ASTHMA

5.4.7.      SLEEP APNEA SYNDROMES

5.4.8. PHARMACOLOGY

5.5.      RESTRICTIVE LUNG DISEASES

5.5.1.      INTERSTITIAL LUNG DISEASES

5.5.2.      FIRBROSING ALVEOLITIES

5.5.3.      SARCOIDOSIS

5.5.4.      PNEUMOCONIOSIS

5.5.5.      SPECIAL EMPHASIS ON: -

(a)    LATEST DIAGNOSTIC CLASSIFICATION

(B)TREATMENT & MONITORING

5.6.      MALIGNANCIES – LUNG & PLEURAL

5.6.1.      SPECIAL EMPHASIS

STAGING & CHEMOTHERAPY

5.7. PLEURAL DISORDERS

5.7.1.      PLEURITIS

5.7.2.      PLEURAL EFFUSIONS

5.7.3.      PNEUMOTHORAX

5.7.4.      CHYLOTHORAX

5.7.5.      HAEMOTHORAX

5.7.6.      SPECIAL EMPHASIS: ICD MANAGEMENT

5.8. INTENSIVE RESPIRATORY CARE

5.8.1.  VENTILATORY MANAGEMENT

5.8.2.  AIRWAYS CARE

5.8.3.   PULMONARY FUNCTION MONITORING

5.8.4.  HAEMODYNAMIC MONITORING

5.8.5. SPECIAL EMPHASIS: NON INVASIVE VENTILATION
VENTILATION RELATED PROCEDURES
VENTILATION ASSOCIATED PNEUMONIA

5.9. LUNG INVOLVMENT IN SYSTEMIC DISEASES

5.9.1.  COLLAGEN DISORDERS

5.9.2.  NEUROLOGICAL DISORDERS

5.9.3.  RENAL & CARDIAC DISEASES

5.9.4.  AUTO-IMMUNE DISORDERS

5.9.5.  CONGENITAL DISORDERS

5.10 MEDIASTINAL DISORDERS

5.10.1. GENERALIZED & LOCALIZED DISEASES INVOLVING
            MEDIASTINUM: TUMORS, CYSTS, INFECTIONS,
            DIAPHRAGM

5.10.2. SPECIAL EMPHASIS: DIAGNOSTIC APPROACH

5.11. APPLIED ANATOMY & PHYSIOLOGY

5.11.1. LUNGS & PLEURA

5.11.2. VENTILATION, PERFUSION OF LUNG

5.11.3. GAS TRANSFER

5.11.4. OXYGEN TRANSPORT

5.11.5. RESPIRATORY MUSCLES

5.11.6. SPECIAL EMPHASIS: EXERCISE TESTING, PFT

5.12. CARDIOLOGY

5.12.1. MYOCARDIAL DISORDERS

5.12.2. ARRHYTHMIA

5.12.3. IHD

5.12.4. VALVULAR HEART DISEASES

5.12.5. CONGENITAL HEART DISEASES

5.13. DIAGNOSTIC & THERAPEUTIC PROCEDURES

5.13.1. SPUTUM EXAMINATIONS

5.13.2. BRONCHOSCOPY & RELATED PROCEDURES

5.13.3. TRANSCUTANEOUS BIOPSIES

5.13.4. PLEURAL PROCEDURES: - 

(a)     PLEUROCENTESIS, BIOPSY, PLEURODESIS, ICD

(B) THORACOSCOPY

(C) SLEEP STUDIES

(D) PFT & EXERCISE TESTING

5.14. COUNSELING OF RESPIRATORY PATIENTS

5.14.1. ASTHMA

5.14.2. COPD

5.14.3. TB

5.14.4. HIV

5.14.5. CHRONIC RESP. FAILURE

5.14.6. PULMONARY REHABILITATION

5.15. RESEARCH METHODOLOGY

5.15.1. PROTOCOL PLANNING

5.15.2. INCLUSION / EXCLUSION CRITERIA

5.15.3. ETHICAL ISSUES

5.15.4. RESPONSIBILITIES OF INVESTIGATION & INSTITUTE

5.15.5. FUNDING AGENCIES & SUPERVISING AGENCIES

5.15.6. GOOD CLINICAL PRACTICE & ICMR GUIDELINES

5.15.7. ICH/GCP GUIDELINES
5.15.8. STATISTICAL METHODS.

5.16. GENERAL MEDICINE

5.16.1. HYPERTENSION

5.16.2. DIABETES

5.16.3. ELECTROLYTE & FLUID BALANCE

5.16.4. APPROACH TO VARIOUS SYSTEMS

5.16.5. COMMON INFECTIONS

5.16.6. ENT DISORDERS (ALLERGIC RHINITIS / POLYPS)

5.16.7. LIVER DISEASES

5.16.8. CNS DISORDERS

5.16.9. POISONING

6.  THEORY PAPERS                                 

Theory papers will be of 100 marks each.

All papers will be for 3 hours each and paper IV will be for 3 hours.

All papers will consist of following pattern as approved by the University:
Section A:  2 LAQs of 25 marks each
Section B: 5 SAQs of 10 marks each
Papere IV will consist of 50 MCQs with 1 mark each & 2 SAQ of 25 marks each.

6.1.            1^st Paper – Applied – Anatomy

Physiology                    Respiratory system

Pathology

                          And Non-Tubercular Respiratory Diseases

6.2.            2^nd Paper – TB & Related Topics

6.3.            3^rd Paper – General Medicine

6.4.            4^th Paper – Recent Advances

7.  PRACTICALS
The practical examination will be of total 400 marks with distribution as follows based on University guidelines:                             

7.1.            1 Long Case for 150 marks

7.2.            2 Short Cases for 65 marks each

7.3.            Table 1: Grand viva for 30 marks

7.4.            Table 2: X-ray, CT Scan, MRI: for 30 marks

7.5.            Table 3: ECG, PFT, ABG Reports: for 30 marks

7.6.            Table IV: Drugs, Instruments, specimens: for 30 marks

8.  DISSERTATION

8.1. Aim: -

To actively involve the PG student in the research field for the better understanding and new advances in the respiratory medicine.

8.2. Objectives: -

By doing a dissertation, the PG student shall develop/acquire

8.2.1.      Active interest in the research field

8.2.2.      Through knowledge of the research methodology including protocol preparation, setting aims, ethical considerations & statistical analysis.

8.2.3.      Acquaintance with ICMR & GCP guideline on Scientific research 

8.3. Guidelines: -

8.3.1.      The dissertation topic should preferably be an attempt to approval disprove clinical concept, which are important for the management of common illness of National important.

8.3.2.      The ICMR / GCP guidelines should be followed during the dissertation study.

8.3.3.      The study should be prospective study as far as possible.

8.3.4.      The study should be carried out in the institute with utilization of the available research.

8.3.5.      An epidemiological/ lab study will have a second preference over a clinical study.

8.3.6.      Prior approval of the study by the PG Guide is necessary.

9. METHOD OF EVALUATION.

Common scheme of evaluation of student, as approved by the board of Studies.

The internal assessment of the PG students will be done based upon following points:

a. Participation in teaching activities such as seminar, case
    presentations etc.

b. Clinical acumen shown during the ward work
c. Attendance record
d. Internal assessment examination: theory and practical’s.

A 6 monthly report based on these points would be generated.

9.         SUGGESTED READING

a) Recognized textbooks

• Pulmonary Diseases and Disorders - A. Fishman
• Respiratory Diseases (I & II) - Crofton & Douglas
• Tuberculosis – S.K. Sharma.
• Text Book of Pulmonary & critical care medicine-SK Jindal
• Diseases of Chest (I, II, III &IV) - Fraser & Pare

·         Murray and Nadel's Textbook of Respiratory Medicine

·         Pleural Diseases - Richard W. Light

b) Reference books:

• Principles of Critical Care - Farokh E. Udwadia
• Pulmonary Function Testing - Gregg L. Ruppel
• Bronchoscopy -Udaya B. S.Prakash
• Principles & Practices of Sleep Medicine - Kryger & Roth
• Clinical application of Blood Gases - Barry A.Shapiro

• Occupational Lung Disorders - Park & Park
• Paediatric Respiratory Illnesses- Ravindran Chetambath
• High Resolution CT of the Lung - W. Richard Webb
• Surgical Aspects of Tuberculosis - Gibbons
• Tuberculosis – Toman

c) Journals:

• Thorax
• American Review of Critical Care & Respiratory Diseases.
• Indian Journal of Chest Diseases
• European Journal of Respiratory Diseases.
• Clinics in Chest Medicine.
• Recent Advances in Respiratory Medicine.
• Lung India
• Indian J Tuberculosis
• Chest
• JAPI

10) MODEL QUESTION PAPERS

PAPER 1

APPLIED ASPECTS OF ANATOMY, PHYSIOLOGY, BIOCHEMISTRY, PATHOLOGY,

PATHOPHYSIOLOGY, MICROBIOLOGY& RADIOLOGY OF TB & CHEST DISEASES.

Time: Three hours Maximum: 100 marks

1. Discuss defense mechanism of lung

(20 marks)

2. Write short notes on:

a) Lung compliance

b) Newer diagnostic tools for tuberculosis

c) O2 dissociation curve

d) Hyperluscent lung on chest_X-ray

e) Role of sputum examination in lung disorders

f) Role of Eosinophyl in lung disease

g) Mechanism of granuloma formation in TB

h) Equal pressure point

(8x10 = 80 marks

PAPER 2

 Pulmonary Tuberculosis & Extrapulmonary tuberculosis including

Epidemiology and Control Programme.

Time: Three hours Maximum: 100 marks

1. Discuss the evolution and diagnosis of MDR-TB. Describe DOTD plus in the context of

XDR-TB

(20 marks)

2. Write short notes on:

a) Clinical manifestation of abdominal TB

b) Non tubercular mycobacteriosis

c) Broncho-pleural fistula

d) Hepatotoxic anti TB drugs

e) Lag period

f) Lymphnode TB

g) Appriasal of RNTCP

h) Post TB sq\equelae

(8x10 = 80 marks)

PAPER 3

Non Tuberculous Respiratory diseases.

Time: Three hours Maximum: 100 marks

1. Discuss the management of chronic persistent asthma

(20 marks)

2. Write short notes on:

a) Pathogenesis and diagnosis of silicosis

b) Preoperative pulmonary evaluation

c) Thoracoscopic lung volume reduction

d) Non specific interstitial pneumonia

e) Pulmonary infectons in HIV patient

f) Newer antifungal agents

g) Wegeners granulomatosis

h) obstructive sleep apnoea

(8x10 = 80 marks)

PAPER 4

Recent advances in Respiratory Diseases including clinical immunology &

air pollution.

Time: Three hours Maximum: 100 marks

1. Discuss the impact of air pollution on lung health

(20 marks)

2. Write short notes on:

a) Management of ventilator associated pneumonia

b) Assessing cost-effectiveness in medicine

c) Non-invasive ventilation

d) Newer phosphodiesterase inhibitors

e) Natural calamity and lung health

f) Assessing quality of life in COPD

g) Diagnosis of acute lung injury

(8x10 = 80 marks

11) LOG BOOK FORMAT

DEPARTMENT OF ……………………………................................

LOG BOOK OF

THE DEGREE OF ……………………………….

NAME……………………………………………..

1. BIODATA OF THE CANDIDATE

2. EXPERIENCE BEFORE JOINING P.G. COURSE

3. DETAILS OF POSTING:

• FIRST YEAR

• SECOND YEAR

• THIRD YEAR

4. THESIS RESEARCH WORK

5. PARTICIPATION CONFERENCES – CME PROGRAMMES

6. DETAILS OF LEAVE AVAILED

7. DETAILS OF PARTICIPATION IN ACADEMIC PROGRAMME

8. SEMINARS /SYMPOSIA PRESENTED

9. STATISTICAL MEETINGS / DEPARTMENTAL MORTALITY MEETINGS

10. JOURNAL CLUBS

11. TEACHING ASSIGNMENTS – UNDERGRADUATES / NURSES/PARAMEDICAL.

12. SPECIAL DUTIES (IF ANY)

13. INTERNAL ASSESSMENT

14. MISCELLANEOUS

15. DAILY ACTIVITIES RECORD (BLANK PAGES) ONE PAGE FOR EACH MONTH X 36 PAGES

16. SUMMARY