Core Adult Internal Medicine Disciplines

Thoracic and Sleep Medicine

Topics

• Understanding of basic respiratory and sleep physiology.
• Assessment of respiratory symptoms and signs including:
  • Distinction and assessment of nonrespiratory causes for dyspnoea, cough and chest pain.
  • Investigation of haemoptysis.
  • Aetiology, investigation and management of chronic cough.
• Essential respiratory investigations including :
  • Chest X-ray, basic lung function, interpretation or arterial blood gases and understanding of indications for bronchoscopy. thoracoscopy and needle biopsy.
• Respiratory emergencies:
  • Severe pneumonia, pneumothorax, acute severe asthma, acute respiratory failure, pulmonary thrombo-embolism, acute upper respiratory obstruction/foreign body.
• Respiratory and nonrespiratory sleep disorders:
  • Obstructive and central sleep apnoea, neuromuscular diseases and ventilatory failure.
• Thoracic malignancy:
  • Primary and secondary lung cancers including extra-thoracic manifestations, staging and assessment for treatment.
  • Mesothelioma and secondary pleural malignancy including management differences.
  • Mediastinal malignancy and benign mediastinal masses.
• Smoking-related chronic lung disease:
  • Clinical manifestations and pathophysiology.
  • Management of stable and unstable disease including chronic, acute on chronic and acute respiratory failure.
• Asthma:
  • Pathophysiology.
  • Assessment and clinical management including pharmacological and nonpharmacological treatment.
  • Occupational factors.
• Interstitial lung disease:
  • Aetiologies and pathophysiology.
  • Diagnosis, investigations and management.
  • Understanding of hypersensitivity and other occupational factors.
  • Associations with extra-pulmonary disease.
• Infections:
  • Acute and chronic parenchymal infection including bronchitis, bronchiectasis and pneumonia (including complications and empyema and parapneumonic effusions).
  • Cystic fibrosis: investigation and management of pulmonary and extra-pulmonary disease.
  • Opportunistic infections in the immunocompromised.
  • Tuberculosis, nontuberculosis mycobacterial infections and fungal disease in the immunocompetent patient.
• HIV-related pulmonary disease:
  • Diagnosis, investigation and management of the spectrum of infections and noninfectious manifestations.
• Pulmonary vascular disease:
  • Spectrum of pathologies causing pulmonary hypertension; investigation and management.
  • Pulmonary thromboembolism including investigation and management of thrombophilias.
• Pleural disease:
  • Distinction between and causes of exudates and transudates.
  • Benign and malignant disease processes - investigation and management.
• Pulmonary involvement in systemic diseases:
  • Sarcoid and other granulomatous conditions.
  • Systemic connective tissue diseases and vasculitis.
  • HIV infection.
• Adult Respiratory Distress Syndrome:
  Pathophysiology and management.
• Lung transplantation:
  • Potential recipients and selection.
  • Post-transplant problems and survival.
• Occupational lung disease:
  • Including occupational asthma, asbestos-related pleural and parenchymal disease (benign and malignant).
  • Interstitial lung disease from exposure to organic and inorganic dusts.

Practical Skills for all Trainees

• Aspiration of pleural effusion and pleural biopsy.
  
• Insertion of intercostal drain/catheter and subsequent management of drain.
• Establishment and maintenance of oropharyngeal airway.
  
• Endotracheal intubation.
• Spirometry.

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