SECTION 1

COURSE SYLLABUS

CLINICAL DIAGNOSIS III (CARDIORESPIRATORY)

COURSE #CL06706

FALL TRIMESTER 1999

75 CLOCK HOURS/5 CREDITS

INSTRUCTOR(S): Donald Christy, B.A.,B.S.,M.S., D.C., Ed.D.

Office: 258 Phone Ext.: 266

DIVISION OF CLINICAL SCIENCE

CATALOGUE DESCRIPTION: This course presents the diagnostic criteria for the study of normal and pathological conditions affecting the cardiorespiratory system.

REQUIRED TEXT(S):

WF/140/D459c/1995/ Clinical Manifestations & Assessment of Respiratory

3rd Edition Disease, Des Jardins and Burton, Mosby Publishing,

1995, 3rd ed.

RECOMMENDED TEXT(S): None

REFERENCE TEXTS:

WB/905.9/G262c/1990 Chiropractic Management of Spine Related

Disorders. Gatterman, Williams & Wilkins, 1990

QT/104/G992t/1996/ Textbook of Medical Physiology, Guyton, Saunders,

9th ed. 1996, 9th ed.

WG/18.2/D814r/1996/ Rapid Integration of EKGS, Dale Dubin, 5th

5th ed. edition, 1996, Cover Publishing Company

COURSE MATERIALS: Diagnostic equipment relative to the physical examination of the cardiovascular and respiratory systems.

COURSE DESCRIPTION: This course will address the following:

1. Review relevant pathophysiology of the cardiovascular/respiratory systems.

2. Review the procedures for history taking and physical examination of the cardiopulmonary patient.

3. Essentials of diagnosis and treatment of the cardiopulmonary patient.

COURSE RELATIONSHIP

TO COLLEGE MISSION: The course seeks to teach principles of differential diagnosis applicable to the cardiorespiratory system, and assist in the education of the Doctor of Chiropractic as a primary health care provider.

PREREQUISITE COURSES: BS03503

BS04504

BS03602

BS04604

KNOWLEDGE ASSUMED: Basic understanding of those pathological processes affecting the heart, lungs and peripheral vascular system. General principles of history taking and physical examination procedures are essential.

RELATIONSHIP TO CLINICAL The following clinical competencies,as listed in

COMPETENCIES: the Logan College Catalog, are addressed in this course:

#1,2, 5, 6, 7, 9, 10, 11

SECTION II

LECTURE SERIES OUTLINE:

WEEK	LECTURE	PAGES
1	The Normal EGG, Wave Complexes Reference to cardiac function, NSR	75-91
2	Electrodes and Leads, understanding intervals Rate and Rhythm, neurological implications Axis deviation, chamber enlargement
3	Conduction disturbances, SA and AV block Blocks (continued)
4	Bundle Branch Block ECG demonstration Blocks (continued), W-P-W syndrome
5	Ischemic Heart Disease Exam #1
6	Explanation of obstructive/restrictive disease Compliance/Recoil, Pulmonary Reflexes	3-75, 91-118
7	Blood gases Primary lung volumes and capacities
8	Ventilatory Pattern Control of respiration
9	Ventilation/Perfusion Imbalance Pulmonary function tests
10	Types of pneumocytes/defense mechanisms Acidosis/Alkalosis Exam #2
11	Intro. to obstructive disease; bronchitis Bronchitis, emphysema	153-163 165-176

WEEK	LECTURE	PAGES
12	Asthma Intro. to restrictive disease Diffuse Interstitial Pulmonary Fibrosis	195-207 415-433
13	Pulmonary Edema Pneumonia	289-299 231-244
14	Pleural disease₁pneumothorax Pneumothorax Exam #3	327-352
15	Neoplastic disease Neoplastic disease	279-307

FINAL EXAMINATION AS SCHEDULED

You must drop one examination; the final examination may be dropped if you are satisfied with the grade earned on the first three examinations.

PLEASE - IF YOU ARE ABSENT THE ONE DROPPED! EXAMINATION OR A FROM AN EXAMINATION, THAT WILL BE PLEASE DO NOT REQUEST A MAKE-UP GRADE OF "I" FOR THE COURSE.

Each exam is worth 35 points. There are 105 possible points for the course. A 10% scale will be followed, with an "A" being 90-105, “B^” 80-89, etc. . .

Exam questions will be derived from course lecture AND THE TEXTBOOK!

SECTION III

COLLEGE POLICIES

This course will follow the institutional policies and procedures as delineated in the current College Catalog and Student Handbook, i.e. grading scale, attendance, cheating, professional behavior, mid-term and final exams, etc.

It is understood that no adjusting or manipulative procedure shall be performed except under the present and direct supervision of a duly licensed and qualified instructor. Unauthorized adjusting procedures performed either on or off campus shall subject the individual(s) so charged to a hearing before the Professional Committee and possible dismissal from Logan College.

COURSE REGULATIONS:

1. Four tests will be given in this course; each exam is worth 35 points. There are 105 maximum possible points. The lowest score will be dropped and the grade will be calculated on the three highest exam scores. You may drop the final exam.

2. Students are expected to perform any assigned reading, as questions on the examination may be derived from this material even if not covered in class.

3. All problems regarding an examination must be resolved within 10 school days after the grade is posted. Any student wishing to see and discuss their examination is directed to make an appointment with the instructor within 10 school days after posting. After that period, the matter is closed, papers destroyed, and the score remains as is. Exam papers will not be returned to the student.

4. Missed examinations:

A. Any student not present for any of the exams will drop that exam, and the final grade will be calculated from the remaining exams.

5. Tutoring: Request for tutoring should be directed through the Dean of Student's Office.

OFFICE HOURS:

Will be posted and updated on office door (Room 253)

SECTION IV

COURSE EDUCATIONAL OBJECTIVES

CLINICAL DIAGNOSIS III (CARDIORESPIRATORY)

COURSE #CL06706

COURSE DESCRIPTION: This course will address the following:

1. Review relevant pathophysiology of the cardiovascular/respiratory systems.

2. Review the procedures for history taking and physical examination of the cardiopulmonary patient.

3. Essentials of diagnosis and treatment of the cardiopulmonary patient.

GENERAL AND SPECIFIC OBJECTIVES:

This course is designed to be an introduction to the clinical diagnosis of the cardiopulmonary system.

Upon satisfactory completion of the course, the student will:

I. Understand the neurobiologic mechanism of manipulative therapy in the treatment of cardiovascular and respiratory disorders.

A. Understanding will be demonstrated by the ability to perform the following:

(1) Define:

(a) Segmental Facilitation

(b) Somatic Dysfunction

(d) Spinal levels associated with cardiovascular and pulmonary disorders

(e) Subluxation Complex

II. Master the terminology specific to the cardiopulmonary system.

A. Knowledge of terminology will be demonstrated by the following:

(1) The ability to correctly select or define terms on objective tests.

(2) Proper use of terms relative to class discussions.

- Specifically; e.g.₁myocardial infarction

III. Demonstrate knowledge and judgement sufficient to interpret clinically relevant information from the patient history and physical examination.

A. Knowledge and judgement will be demonstrated by the following:

(1) The ability to identify clinically relevant signs and symptoms from case histories and assess the significance of these findings in terms of the underlying pathophysiology.

(2) The satisfactory selection of evaluative procedures to further investigate the patient's clinical status based upon the historical data.

IV. Demonstrate a knowledge base sufficient to differentially diagnose cardiovascular-respiratory disorders, with emphasis applied to those conditions most likely encountered in the chiropractic practice.

A. Knowledge will be demonstrated through class participation and examinations by the following:

(1) Accurate recognition of the signs and symptoms of common cardiopulmonary diseases.

(2) Ability to identify and discuss the determining points of differentiation in the diagnosis of cardiopulmonary disease.

(3) Ability to identify and diagnose prevalent cardiopulmonary disorders.

V. Gain knowledge of the accepted conservative and medical treatment of the prevalent cardiopulmonary disorders, and an understanding of the indications and limitations of each approach.

A. Knowledge of conservative and medical treatment procedures will be demonstrated by the ability to identify or devise appropriate management for given disorders.

B. Knowledge and understanding of indications and limitations of conservative and medical treatment will be demonstrated by the ability to identify or describe a rationale for the following:

(1) Acceptance of full responsibility for patient care for appropriate disorders.

(2) Participation in concurrent care with other health care providers for the appropriate disorders.

(3) Complete referral of patients to the proper health care providers for the appropriate disorders.

LOGAN COLLEGE OF CHIROPRACTIC

CLINICAL SCIENCE DIVISION

POSITION STATEMENT

INDEPENDENT STUDY

The Faculty of the Clinical Science Division of Logan College strongly supports the individual faculty members right to refuse an independent study option of their courses. The reasons for this position are enumerated below:

1. Independent study is most often requested by a student who has a schedule conflict due to previous poor academic performance in another area. Of all students, this student is often least equipped for the initiative and discipline required of the independent study experience.

2. In a curriculum as highly structured and specific as the curriculum at Logan College, independent study significantly dilutes the programmed nature of the educational experience in a given course. It is difficult to supervise an independent study student sufficiently to insure that all essential information needed from a course is passed on at a comparable quality level. This is compounded if the student is already academically deficient.

3. It is a faculty members primary responsibility to provide comprehensive exposure of a high quality to the subject matter that he or she is required to teach. A students desire to reduce expenditure or graduate with a specific class, while understandable, should never take precedence over this primary objective. Such items, while quite capable of causing uncomfortable situations for a student, do not fall under the responsibility of any faculty member--rather they belong to the student.

The above statements shall not be construed as a denial of the right of any faculty member to make individual arrangements on a case-specific basis at their discretion. They shall also not be construed as affecting the possibility of a student placing out of a course based upon previous proficiency which has been duly demonstrated to the instructor's satisfaction.

GLOSSARY

CLINICAL DIAGNOSIS III (CARDIORESPIRATORY)

Eupnea

Tachypnea

Periodic Resp.

Ataxic Resp.

Dyspnea

Hyperpnea

Stertorous Resp.

Stridor

Bradypnea

Hyperventilation

Sighing Resp.

Cardiogenic Dyspnea

Mediate Percussion

Immediate Percussion

Bronchial b.s.

Pathognomonic

Sibilant Rhonchus

Fine RaPes

Vocal Resonance

Whispered Pectoriloquy

Pleximeter

Fremitus

Tussive Fremitus

Sonorous Rhonchus

Medium Rales

Bronchophony

Plexor

Bronchovesicular b.s.

Vocal Fremitus

Rhonchus/Wheeze

Rales-Crackles

Coarse Rales

Egophony

Hemothorax

Hydrothorax

Hematopericardium

Atelectasis

Cardiac Tamponade

Pulmonary Congestion

Pleurodynia

Obstructive ds

FEVI

Ventilation

Restrictive ds

FEV%

Diffusion

FVC

Compliance

Perfusion

Etiology

Tactile Fremitus

Incidence/Prevalence

Pathogenesis

Epidemiology

Pathophysiology

Prognosis

Vesicular b.s.

Postprandial

Chief Complaint/Present Illness

Decubitus

La Belle Indifference

PPQRST Factors

Mean Arterial Pressure (MAP)

Diastolic Gap

Pulsus Alternans

Corrigan's Pulse

Bisferiens Pulse

Anacrotic Notch

Cannon A Wave

Thrill

Insufficiency

Presystole

Cor Pulmonale

Angor Animi

Empyema

Effusion

Pneumomediastinum

Pneumoconiosis

Pleuritic

Pyothorax

Pansystole

Systolic Gap

Pulse Deficit

Pulsus Magnus

Waterhammer Pulse

Dicrotic Notch

Sinus Arrhythmia

Incompetence

Holosystole

Mediastinal Crunch

Angioplasty

Thoracocentesis

Telangiectasis

Ischemia/Infaction

Thoracoplasty

CT Ratio

Paroxysmal Atrial Tachycardia (PAT)

Pulse Pressure

Pulsus Parvus

Collapsing Pulse

Paradoxical Pulse

Extrasystole

Giant A Wave

Regurgitation

Angioplasty

Thoracocentesis

Telangiectasis

Ischemia/Infaction

Thoracoplasty

CT Ratio

Visceral/Parietal

Atherosclerosis/Arteriosclerosis

Pneumocentesis

Thrombus/Embolus

Protodiastole

Thrombus/Embolus

Pneumocentesis

Atherosclerosis/Arteriosclerosis

Visceral/Parietal