Respiratory/Renal Course Objectives
Updated 1/24/2008
Respiratory
1. Understand the concept of pressure and partial pressure as it applies to molecules such as
oxygen and carbon dioxide in a gas mixture as well as a liquid. Predict the effects of
increasing altitude on inspired partial pressures of oxygen.
2. Review the Fick equation for diffusion, and show how it is modified to account for diffusion
of uncharged gas molecules such as oxygen and carbon dioxide.
3. Explain why the concept of partial pressure is important for understanding diffusion of
molecules such as oxygen between: the gas spaces (alveoli) of the lungs and alveolar
capillary blood; and between blood and body tissues.
4. Draw the relationship between partial pressure of oxygen in the blood and oxygen content or
the percent saturation of hemoglobin with oxygen (the oxygen dissociation curve). Know
normal values found in arterial blood and typical venous blood from body tissues at sea level.
5. Describe how the oxygen dissociation curve is modified by carbon dioxide, hydrogen ion,
2,3-bisphosphoglycerate, and temperature.
6. Characterize the factors influencing oxygen diffusion to body tissues; comment on the partial
pressure of oxygen in tissue necessary to support oxidative metabolism.
7. List the ways that carbon dioxide is carried in the blood, and describe the relative importance
of each for picking up carbon dioxide in body tissues.
8. Draw the relationship between partial pressure of carbon dioxide in the blood and carbon
dioxide content of the blood. Show and explain how this relationship is modified by the
oxygenation of hemoglobin. Know values found in arterial blood and typical venous blood
from body tissue.
9. Using the Fick equation for diffusion, show how the lungs are able to transfer large volumes
of oxygen across alveolar capillaries.
10. Describe factors that affect the transfer of oxygen and carbon dioxide between alveoli and
blood.
11. Approximate the amount of each tidal volume that normally remains in the dead space, and
tell how much tidal volume and dead space volume can be increased from resting values as
we take bigger breaths.
12. Use a quantitative relationship to describe the effects of alveolar ventilation on partial
pressure of carbon dioxide in the alveoli as well as partial pressure of carbon dioxide in
arterial blood.
13. Define the terms respiratory quotient and respiratory exchange ratio, and explain how they
differ.
14. Describe the changes in alveolar ventilation and blood flow which occur from apices to bases
of the lungs of seated or standing individuals. Describe the effect of these changes on the
ratio between alveolar ventilation and blood flow (V dot / Q dot).
15. Explain why oxygen uptake by each region of the lungs is strongly influenced by the blood
flow it receives and why carbon dioxide elimination is strongly influenced by ventilation it
receives.
16. Define arterial hypoxemia and hypercapnia and their causes.
17. Explain the circumstances under which a higher partial pressure of oxygen would occur in
mixed alveolar gas than in mixed arterial blood (alveolar to arterial PO2 difference).
18. Describe the factors that contribute to alveolar to arterial PO2 differences in normal
individuals.
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19. Discuss the basic properties of elastic tissue and show how these properties are used to
characterize the relationship between lung volume and transmural pressure between the
inside and outside of the lungs (Pel).
20. Explain how surface tension contributes to the transmural pressure across the lungs, and
describe two ways that lung surfactant modifies the effects of surface tension.
21. List the major volumes and capacities of the lungs in the chest, and describe each in
reference to the total lung capacity and residual volume.
22. Describe how a volume-pressure curve can be obtained for the lungs of an intact person, and
explain the relationship between measured intrapleural pressure and the elastic pressure of
the lungs.
23. Be able to show how alveolar and intrapleural pressures, as well as elastic pressure of the
lungs, change during inspiration and expiration.
12. Be able to contrast the source of energy for inspiration as opposed to expiration during quiet
breathing. Describe the relationship between lung volumes and airflows for a vital capacity
expiration performed with increasing muscular effort in a normal person.
13. Describe the relationship between intrapleural pressure and expiratory airflows with different
efforts for a high lung volume and a lower lung volume.
14. Define the terms, effort dependent and effort independent, and show how effort
independence can be characterized using Ohm’s law.
15. Describe the functions of areas in the brainstem that control respiration.
16. List 3 kinds of receptors in the lungs which can modify breathing, and describe stimuli for
these receptors. Discuss the effect of stimulating the above receptors on breathing pattern.
17. Be able to show how sleep modifies breathing, and describe pathologies in breathing which
become apparent during sleep.
18. Give reasons why it appears that we attempt to regulate arterial carbon dioxide but not
oxygen levels around normal values
19. Describe the chemical control of breathing, including the chemoreceptors and CNS sites
involved.
20. Be able to differentiate the acute and chronic respiratory acidosis in terms of effects on
central and peripheral chemoreceptors. Discuss the interaction between central and
peripheral chemoreceptors when producing a ventilatory response to acute and chronic
metabolic acidosis.
21. Define the different spirometric measurements.
22. Describe the relationship between blood pH, serum bicarbonate concentration, and pCO2 and
describe the compensatory mechanisms that are activated in response to an increase or
decrease in each component
23. Discuss the mechanisms of hypoventilation and its implications on therapy.
24. Recognize the characteristics of a normal flow-volume loop and volume-time curve and
compare to those seen with obstructive and restrictive diseases of the lung
25. Describe the defense mechanisms of the lung against inhaled particulate matter.
26. Describe the manner in which the lung responds to epithelial injury.
27. Define the different segments of the tracheobronchial tree and discuss their differences in
terms of gross and microscopic features and function.
28. Define, explain the development of, and discuss the clinical significance of Bronchogenic
cyst, Bronchopulmonary dysplasia, Bronchopulmonary sequestration, Diaphragmatic hernia.
29. Define and discuss the predisposing conditions that may result in pulmonary hypoplasia.
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30. Describe the different forms of neoplasias and squamous cell carcinoma seen in the upper
respiratory tract and compare and contrast their possible etiologies, clinical presentations,
and clinical course.
31. Discuss the clinical and morphologic similarities and differences between chronic bronchitis,
emphysema, asthma, and bronchiectasis.
32. Discuss the mechanisms of air flow obstruction and pulmonary complications in patients
with cystic fibrosis.
33. Compare and contrast primary pulmonary hypertension and secondary pulmonary
hypertension in terms of etiology, clinical signs and symptoms, and clinical course
34. Compare the differences between restrictive and obstructive pulmonary disease on
ventilation, expected spirometric changes, clinical presentation, and pathogenesis.
35. Discuss the effects of interstitial lung disease on gas exchange, blood gases, acid/base
balance, and alterations in flow volume loops.
36. Compare and contrast different forms of atelectasis in term of predisposing factors, etiology,
and clinical significance.
37. Compare and contrast Respiratory Distress Syndrome Type I and Respiratory Distress
Syndrome Type II in terms of predisposing factors, pathogenesis, morphology, clinical
features, and potential complications.
38. Compare and contrast coal workers lung, silicosis, and asbestosis in terms of predisposing
factors, pathogenesis, gross and microscopic morphology, clinical features, and potential
complications.
39. Discuss the basic pathogenesis and natural history of chronic interstitial (non-infectious)
pneumonias
40. Describe the pulmonary complications of sarcoidosis and their pathophysiologic effect.
41. Discuss the features of pulmonary embolism in the terms of associated conditions and
predisposing factors, clinical presentation, effect on pulmonary physiology, and potential
complications.
42. Discuss the clinical features of different types of pneumonias, including pathogenesis, effects
on lung function, clinical expression, and blood gases.
43. Discuss the predisposing factors, etiologic agents, morphologic tissue changes, clinical
expression, natural history, and methods of diagnosis of pulmonary abscess, pneumocystis
pneumonia, pulmonary tuberculosis.
44. Compare and contrast the various types of pulmonary carcinomas.
45. Describe the pharmacologic management of pulmonary diseases.
Renal
46. Describe the anatomy and histology of the normal kidney.
47. Describe the volume of the body fluid compartments and how to calculate them,
concentrations of the major ions in the intracellular and extracellular compartments, and how
water is exchanged between body fluid compartments.
48. Describe the process of glomerular filtration and its regulation.
49. Describe the concept of renal clearance, and the mechanisms by which the glomerular
filtration rate is measured in patients.
50. Describe the general mechanisms by which water reabsorption and solute reabsorption and
secretion occur in the different nephron segments.
51. Describe the relationship between water balance and the regulation of the plasma osmolality,
and the role of tubular countercurrent transport in establishing renal osmolar gradients and its
importance in antidiuresis.
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52. Describe the basic physiology of osmoregulation and antidiuretic hormone release and its
action on tubular water transport.
53. Describe the concept of free-water clearance and how to calculate it.
54. Discuss the relationship between sodium balance and the regulation of the extracellular fluid
volume.
55. Describe the concept of the effective circulating volume.
56. Describe the roles of the renin-angiotensin-aldosterone system, atrial natriuretic peptide, and
antidiuretic hormone in the regulation of sodium excretion and extracellular fluid volume.
57. Discuss the major factors that regulate renal potassium excretion and the mechanisms by
which these factors do so.
58. Discuss the function of the major extracellular and intracellular buffering systems,
particularly the role of the bicarbonate-carbon dioxide buffer system. Discuss how the
kidney maintains acid-base homeostasis by adjusting the rate of net acid excretion to equal
the daily acid load. Describe the characteristics of the four primary acid-base disorders and
the compensatory responses they initiate.
59. Discuss factors that maintain and influence renal blood flow.
60. Given a clinical situation, formulate a differential diagnosis for a patient with hyperkalemia,
hypokalemia, hypernatremia, hyponatremia, metabolic acidosis, metabolic alkalosis.
61. Discuss basic methods of treatment for patients with an acid-base disturbance
62. Discuss the similarities and differences in terms of predisposing factors, pathogenesis,
morphologic features, clinical signs and symptoms, expected laboratory findings, natural
clinical course, clinical significance, and potential complications of cystic renal diseases.
63. On electron microscopy, discuss the nature of and significance of electron dense material
deposited in subepithelial, intramembranous, subendothelial, and mesangial regions of the
glomerulus, and name the renal diseases associated with each.
64. Discuss the similarities and differences between nephritic and nephrotic syndrome in terms
of clinical signs and symptoms, general mechanisms of renal injury, and constituent diseases.
65. Compare and contrast the major glomerular diseases in terms of mechanism of injury,
clinical signs and symptoms, expected laboratory findings, distinguishing morphologic
(gross, light microscopic, electron microscopic, immunofluorescent) features, and clinical
course.
66. Discuss the etiology, predisposing factors, pathogenesis, morphologic change, clinical signs
and symptoms, expected laboratory findings, clinical significance, potential complications,
and basic management of different types of nephritis.
67. Discuss the clinical significance of renal papillary necrosis and list the diseases with which it
is associated.
68. Discuss the causes, morphology, clinical signs and symptoms, expected laboratory findings,
and clinical significance of acute tubular necrosis, fibromuscular dysplasia of the renal artery,
renal artery stenosis, renal calculi, urinary obstruction.
69. Discuss the factors involved in hyperacute, acute, and chronic renal transplant rejection and
the expected morphologic features seen in the kidneys of each.
70. Discuss the effect of the following systemic diseases on the kidney in terms of function and
morphologic changes: amyloidosis, diabetes mellitus, multiple myeloma, systemic lupus
erythematosus.
71. Compare and contrast in terms of etiology, clinical presentation, morphologic appearance,
expected laboratory findings, and clinical course of acute cystitis and acute pyelonephritis,
acute renal failure and chronic renal failure, acute tubular necrosis and acute cortical
necrosis, benign hypertension and malignant hypertension.
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72. Discuss the predisposing factors, precursor lesions, morphologic appearance, clinical signs
and symptoms, diagnostic procedures/lab tests, expected laboratory findings, and clinical
course of angiomyolipoma, renal cell carcinoma, renal cortical adenoma, transitional cell
carcinoma, Wilms tumor.
73. Discuss each of the following entities seen in urinalysis specimens in terms of morphologic
appearance and clinical significance: fatty cast, hyaline cast, oval fat body, red blood cell
cast, waxy cast, white blood cell cast.
74. List the common laboratory tests used to assess renal function and discuss the implications of
an abnormal value.
75. Describe the clinical presentation of drug-induced renal diseases, and how to prevent them.
76. State the mechanisms by which kidney disease can alter the bioavailability and metabolism
of drugs, given patient-specific data and a medication history.
77. Describe the pharmacological management of patients with renal diseases.
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