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					                                                                                  Authors: 5-15-05
                                                                                  S. Lorin, MD
                                                                                  D. Fischler, MD

                 Mount Sinai Pulmonary Medicine

                      Core Curriculum Objectives
                                 and
                         Relevant Literature

 Guide for Students, Residents, and Fellows During
            Their Pulmonary Rotations
______________________________________________

A. Asthma:
   1. Objectives:
            a. To understand the epidemiology of asthma and the contributions of genetic
                predisposition and environmental factors
            b. To learn the pathology and pathophysiology of asthma and importance of
                inflammatory mechanisms of this disease
            c. To appreciate the risk factors for asthma and the causes of exacerbation of
                symptoms
            d. To be able to objectively and accurately diagnose this disease
            e. To learn the strategies of treating asthma based on the NIH guidelines
   2. Relevant Literature:
            a. NAEEP Expert Panel Report: Guidelines for the Diagnosis and Management
                of Asthma. July 2002; NIH Publication #02-5075
            b. Advances in Immunology: Asthma. NEJM 2001; 344(5):350-362
            c. Clinical Practice: Mild Asthma. NEJM 2001; 345(17):1257-1262
            d. Measuring Efficacy and Safety of Different Inhaled Corticosteroid
                Preparations. J Allergy Clin Immunol 1999: 104;S132-137
            e. The Anti-inflammatory Effects of Leukotriene Modifying Drugs and their Use
                in Asthma. Chest 2001; 119(5):1533-1546
            f. Low-dose Inhaled Corticosteroids and the Prevention of Death from Asthma.
                NEJM 2000; 343(5):332-336
            g. Long-acting ß2-Agonist Monotherapy vs Continued therapy with Inhaled
                Corticosteroids in Patients with Persistent asthma: a Randomized Trial. JAMA
                2001; 285:2583–2593
            h. Omalizumab, anti-IgE Recombinant Humanized Monoclonal Antibody, for
                the treatment of Severe Allergic Asthma. J Allergy Clin Immunol 2001;
                108:184–190
            i. Management of Refractory Asthma. Am J Respir Crit Care Med 2000;
                162:2341-2351
            j. Alternate Treatments in Asthma. Chest 2003; 123:1254-1265
             k. Use of Exhaled Nitric Oxide Measurements to Guide Treatment in Chronic
                Asthma. NEJM 2005; Volume 352:2163-2173
             l. Daily versus As-Needed Corticosteroids for Mild Persistent Asthma. NEJM
                2005; Volume 352:1519-1528.
             m. Acute Asthma in Adults: A Review. Chest 2004 125: 1081-1102.


B. Occupational Asthma:
   1. Objectives:
         a. To provide a clinical definition of occupational asthma
         b. To outline the various mechanisms by which asthma develops from exposures
            encountered in the work setting
         c. To highlight specific examples of occupational asthma
         d. To discuss the evaluation of a patient with possible occupational asthma
         e. To review the management of a patient with confirmed occupational
   2. Relevant Literature:
         a. Occupational Respiratory Diseases. NEJM 2000: 342;406-413
         b. A Guide to the Diagnosis and Treatment of Occupational Asthma. Mayo Clin
            Proc 2001; 76:633-640
         c. ACCP Consensus Statement: Assessment of Asthma in the Workplace. Chest
            1995; 108:1084-1117
         d. Reactive Airways Dysfunction Syndrome. Chest 1996: 109:1618-1626

C. Lung Cancer:
   1. Objectives:
         a. To outline the various causes of lung cancer, and the types of clinical and
            radiologic presentations peculiar to each cell type
         b. To review the paraneoplastic syndromes associated with lung cancer
         c. To place in perspective the appropriate use of laboratory studies, imaging
            techniques, and diagnostic approaches to patients with lung cancer
         d. To review the results of various treatment modalities for both small-cell and non-
            small cell lung cancers
   2. Relevant Literature:
         a. Diagnosis and Management of Lung Cancer: ACCP Evidence Based Guidelines
            Chest 2003; 123(1): 1S-337S an entire volume dedicated to this topic
         b. Molecular and Genetic Aspects of Lung Cancer. Am J Respir Crit Care Med
            2000; 161:1355-1367
         c. Screening for Lung Cancer. NEJM 2000; 343(22):1627-1633
         d. The Solitary Pulmonary Nodule. NEJM 2003; 348(25):2535-2542
         e. Evaluation of the Solitary Pulmonary Nodule. Am J Respir Crit Care Med 2000;
            162:782-787
         f. Lung Cancer: Where are we today? Am J Respir Crit Care Med 2002; 166:1166-1196
         g. Current Role of PET in Thoracic Oncology. Thorax 1998; 53:703-712
         h. Revisions in the International System for Staging Lung Cancer. Chest 1997;
            111:1710-1717
         i. Regional Lymph Node Classification for Lung Cancer Staging. Chest 1997;
            111:1718-1723
          j. Superior Pulmonary Sulcus Tumors and Pancoast Syndrome. NEJM 1997;
             337(19): 1370-1376
          k. Non-small Cell Lung Cancer with Chest Wall Invasion. Chest 2003; 123: 1341-1347



D. Chronic Obstructive Pulmonary Disease:
   1. Objectives:
         a. To review the current definition of COPD and describe how this definition may
            be inadequate based on our current understanding of the disease
         b. To explore the impact of COPD including morbidity and mortality
         c. To review the risk factors for COPD
         d. To explore the natural history of COPD from its earlier asymptomatic stages to
            the late stages associated with morbidity and mortality
         e. To explore the current understanding of the pathophysiology of COPD through an
            understanding of the pathologic changes that occur
         f. To review the current state of therapy for COPD including preventative measures
            such as smoking cessation
   2. Relevant Literature:
         a. Global Strategy for the diagnosis, management and prevention of chronic
            obstructive pulmonary disease. NHLBI/WHO global initiative for chronic
            obstructive lung disease (GOLD) workshop summary. Am J Respir Crit Care
            Med 2001; 163:1256–1276
         b. Chronic Obstructive Pulmonary Disease. NEJM 2000; 343(4):269-280
         c. Clinical Practice: Acute Exacerbations of Chronic Obstructive Pulmonary
            Disease. NEJM 2002; 346(13):988-994
         d. Antibiotics are Associated with Lower Relapse Rates in Outpatients with Acute
            Exacerbation of COPD. Chest 2000; 117:1345–1352
         e. Multicentre randomized placebo-controlled trial of inhaled fluticasone in patients
            with COPD. Lancet 1998; 351:773-780
         f. Effect of Systemic Glucocorticoids on Exacerbations of COPD. NEJM 1999;
            340:1941-1947
         g. State of the Art: Noninvasive Ventilation. Am J Respir Crit Care Med 2001;
            163:540-577
         h. A Randomized Trial Comparing Lung Volume Reduction Surgery with Medical
            Therapy for Severe Emphysema. NEJM 2003; 348(21):2059-2073
         i. Clinical Practice: Treatment of Tobacco Use and Dependence. NEJM 2002;
            346(7):506-512
         j. ACCP/AACVPR Pulmonary Rehabilitation Guidelines Panel: Pulmonary
            Rehabilitation. Chest 1997; 112:1363-1396
         k. Alpha1 antitrypsin deficiency. Thorax 1998; 53:501-505
         l. ATS/ERS Statement: Standards for the diagnosis and management of individuals
            with Alpha1 Antitrypsin Deficiency. Am J Respir Crit Care Med 2003; 168:818-
            900
         m. Management of COPD. NEJM 2004; Volume 350:2689-2697.
          n. Innovative Approaches to Lung Volume Reduction for Emphysema. Chest 2004
             126: 238-248.


E. Pulmonary Vascular Diseases:
   1. Objectives:
         a. To review the management of Venous Thromboembolic (VTE) disease
         b. To describe the risk factors and epidemiology of VTE
         c. To provide alternative approaches to the diagnosis of VTE
         d. To describe the causes of secondary pulmonary hypertension
         e. To review the steps in the diagnosis of primary pulmonary hypertension
         f. To review the therapy for primary and secondary pulmonary hypertension
         g. To review the diagnosis and management of hereditary hemorrhagic
            telangiectasia and pulmonary arteriovenous malformations
   2. Relevant Literature:
         a. State of the Art: Venous Thromboembolism. Am J Respir Crit Care Med 1999;
            159:1-14
         b. Clinical Practice Guidelines: The Diagnostic Approach to Venous
            Thromboembolism. Am J Respir Crit Care Med 1999; 160:1043-1066
         c. Antithrombotic Therapy for Venous Thromboembolic Disease. Chest 1998;
            114:561S-578S
         d. Medical Progress: Pulmonary Embolism. NEJM; 1998; 339(2):93-104
         e. A Clinical Trial of Vena Caval Filters in the Prevention of Pulmonary Embolism
            in Patients with Proximal Deep-Vein Thrombosis. NEJM 1998; 338:409-415
         f. Thrombolytic Therapy for Pulmonary Embolism: A Comprehensive Review of
            Current Evidence. Chest 1999; 115(6):1695-1707
         g. Thrombolytic Therapy in Patients with Submassive Pulmonary Embolism. NEJM
            2003; 348:357-359
         h. Chronic Thromboembolic Pulmonary Hypertension. NEJM 2001; 345(20): 1465-1472
         i. Primary Pulmonary Hypertension. NEJM 1997; 336:111-117
         j. New Treatments for Pulmonary Arterial Hypertension. Am J Respir Crit Care
            Med 2002; 165:1209-1216
         k. Treatment of Pulmonary Hypertension Secondary to Connective Tissue Diseases.
            Thorax 1999; 54:273-277
         l. Reduction in Pulmonary Vascular Resistance with Long-Term Epoprostenol
            Therapy in Primary Pulmonary Hypertension. NEJM 1998; 338:273-277
         m. Bosentan Therapy for Pulmonary Arterial Hypertension. NEJM 2002; 346(12):896-903
         n. Portopulmonary Hypertension: A tale of two circulations. Chest 2003; 123:562-576
         o. Hepatopulmonary Syndrome. Gut 2000; 46:1-4
         p. State of the Art: Pulmonary Veno-Occlusive Disease. Am J Respir Crit Care Med
            2000; 162:1964-1973
         q. Care of Patients Receiving Long-Term Anticoagulant Therapy. NEJM 2003;
            349(7):675-682
         r. Clinical Use of the Low Molecular Weight Heparins. Chest 1999; 115:1418-1423
         s. State of the Art: Pulmonary Arteriovenous Malformations. Am J Respir Crit Care
            Med 1998; 158:643-661
           t. Hereditary hemorrhagic telangiectasia and pulmonary arteriovenous
              malformations: clinical management and review of pathogenic mechanisms.
              Thorax 1999; 54:714-729
           u. Pulmonary arterial hypertension. NEJM 2004; Volume 351:1655-1665.
           v. Treatment of Pulmonary arterial hypertension. NEJM 2004; Volume 351:1425-
              1436.
           w. Treatment of deep vein thrombosis. NEJM 2004; Volume 351:268-277.

F. Bronchiectasis/Cystic Fibrosis
   1. Objectives:
         a. To address the causes of bronchiectasis
         b. To discuss the therapeutic options for the treatment of bronchiectasis
         c. To review the genetic aspects of cystic fibrosis
         d. To consider the newer therapeutic approaches to the treatment of cystic fibrosis
   2. Relevant Literature:
         a. Bronchiectasis. NEJM 2002; 346(18):1383-1393
         b. Bronchiectasis in Systemic Diseases. Chest 1999; 116:1063-1074
         c. Diagnosis of Cystic Fibrosis. NEJM 1997; 336:487-491
         d. Management of Pulmonary Disease in Patients with Cystic Fibrosis. NEJM 1996;
            335:179-188
         e. Effects of aerosolized recombinant human DNase on exacerbations of respiratory
            symptoms and on pulmonary function in patients with Cystic Fibrosis. NEJM
            1994; 331:637-642
         f. Intermittent administration of inhaled tobramycin in patients with cystic fibrosis.
            NEJM 1999; 340:23-30
         g. Lung Transplantation in Cystic Fibrosis: Consensus Conference Statement. Chest
            1998; 113:217-226
         h. Cystic Fibrosis. NEJM 2005; Volume 352:1992-2001.
         i. Tracheomalacia and Tracheobronchomalacia in Children and Adults: An In-depth
            Review. Carden et al. Chest 2005 127: 984-1005.


G. Hypersensitivity Pneumonitis:
   1. Objectives:
         a. To discuss the features of dusts and particulate matter that dictate possible clinical
            manifestations
         b. To identify the most common causes and the usual clinical presentations of
            hypersensitivity pneumonitis
         c. To describe those clinical situations that are similar to hypersensitivity
            pneumonitis but are clinically distinct entities
         d. To review the most likely pathogenetic mechanisms and the continuing gaps in
            our understanding
         e. To outline an approach to the diagnosis of the disease
   2. Relevant Literature:
         a. Hypersensitivity pneumonitis: Current Concepts. Eur Respir J 2001; 32:81s-92s
         b. Hypersensitivity pneumonitis: Current Concepts and Future Questions. J Allergy
            Clin Immunol 2001; 108(5):661-670
          c. The Diagnosis of Hypersensitivity Pneumonitis. Chest 1997; 111:534-536
          d. A Case of Hypersensitivity Pneumonitis. Chest 2000; 117:1500-1504

H. Pulmonary Infections:
   1. Objectives:
        a. To define the epidemiology of community-acquired-pneumonia (CAP) and risk
            factors for mortality
        b. Discuss the common etiologic pathogens of CAP
        c. Review current treatment strategies for CAP
        d. Discuss the clinical relevance of atypical pathogens and penicillin-resistant
            pneumococci
        e. Review the benefits of pneumococcal and influenza vaccine
        f. To discuss the diagnosis and treatment of influenza
        g. To discuss the diagnosis and treatment of Nocardia infection in the lung
        h. To discuss the diagnosis and treatment of Actinomycosis of the lung
        i. To review tick-borne pulmonary diseases
        j. To describe the epidemiology of the endemic mycosis
        k. To describe the clinical syndrome of endemic mycosis
        l. To familiarize physicians with the various diagnostic tests pertaining to
            pulmonary fungal infections
        m. To detail different therapeutic strategies for fungal diseases

   2. Relevant Literature:
         a. ATS guidelines for the Management of Adults with Community-acquired
            Pneumonia. Am J Respir Crit Care Med 2001; 163:1730-1754
         b. Community Acquired Pneumonia in Adults: Guidelines for Management. Clin
            Infect Dis 1998; 26:811-838
         c. Community Acquired Lower Respiratory Tract Infections. Chest 2001; 120:2021-2034
         d. Management of Community Acquired Pneumonia. NEJM 2002; 347(25):2039-2045
         e. Legionellosis. NEJM 1997; 337(10):682-687
         f. Aspiration Pneumonitis and Aspiration Pneumonia. NEJM 2001; 344(9):665-671
         g. Prevention and Treatment of Influenza. NEJM 2000; 343(24):1778-1787
         h. Viral Pneumonias in Adults. Radiology 2002; 22:S137-S149
         i. Pulmonary infection with Nocardia species. Eur Respir J 1997; 10(7):1542-1546
         j. A case of pulmonary Nocardia. NEJM 2000; 870-877
         k. Pulmonary Actinomycosis. Eur Respir J 2003; 21(3):545-51
         l. Tick Borne Pulmonary Disease. Chest 1999; 116:222-230
         m. State of the Art: Review of Pulmonary Fungal Infections. Semin Respir Infect
            2002; 17(2):158-81
         n. The Clinical Spectrum of Pulmonary Aspergillosis. Chest 2002; 121:1998-1999
         o. Coccidioidomycosis. NEJM 1995; 332(16): 1977-1082
         p. Practice Guidelines for the Treatment of Coccidioidomycosis. Clin Infect Dis
            2000; 30:658-661
         q. Practice Guidelines for the Management of Patients with Blastomycosis. Clin
            Infect Dis 2000; 30:679-683
         r. Histoplasmosis. Semin Respir Infect 2001 Jun;16(2):109-148
         s. Pneumocystis pneumonia. NEJM 2004; Volume 350:2487-2498.
I. Eosinophilic Lung Diseases:
    1. Objectives:
          a. To highlight the heterogeneous nature of these disorders and suggest a usable
              classification system
          b. To discuss important aspects of the eosinophil
          c. To review diseases that involve the eosinophil and the airways
          d. To discuss known parenchymal lung disorders that are associated with peripheral
              and/or tissue eosinophilia
          e. To highlight the idiopathic eosinophilic lung diseases
    2. Relevant Literature:
          a. State of the Art: Eosinophilic lung diseases. Am J Respir Crit Care Med 1994;
              150: 1423-1438
          b. Idiopathic acute eosinophilic pneumonia: a study of 22 patients. Am J Respir Crit
              Care Med 2002; 166:1235-1239
          c. A Case of chronic eosinophilic pneumonia. Chest 2000; 118:230-234
          d. A Case of bronchocentric granulomatosis. Chest 1999; 115:1184-1187
          e. Diagnosis and Treatment of Allergic Bronchopulmonary Aspergillosis. Mayo Clin
              Proc 2001; 76:930-938
          f. Churg-Strauss Syndrome. Thorax 2000; 55:870-877
          g. Tropical Pulmonary Eosinophilia. Chest 1998; 113:1673-1679

J. Pneumoconioses:
   1. Objectives:
        a. To review the pathology, pathophysiology and radiographic similarities and
            differences between coal worker’s pneumoconiosis and silicosis
        b. To explain asbestos-induced lung and pleural diseases, with emphasis on the
            functional abnormalities and the ILO system for classifying the pneumoconiosis
        c. To discuss malignancies related to asbestos
        d. To review briefly a variety of other nonorganic pneumonconioses

   2. Relevant Literature:
         a. State of the Art: Mechanisms in the Pathogenesis of Asbestosis and Silicosis. Am
            J Respir Crit Care Med 1998; 157:1666-1680
         b. Asbestos and the Pleura. Chest 2004; 125: 1103-1117
         c. Asbestosis and Silicosis. Lancet 1997; 349:1311-1315
         d. Heavy Metal Toxicity. J Emergency Med 1998; 16:171-177
         e. Chronic Beryllium Disease: uncommon disease, less common diagnosis.
            Environmental Health Perspectives 1998;106:765-767
         f. Diagnosis and Initial Management of Nonmalignant Diseases Related to
            Asbestos. Am. J. Respir. Crit. Care Med. 2004; 170: 691-715.

K. Pleural Diseases:
   1. Objectives:
         a. To understand the pathogenesis of pleural fluid formation in health and disease
         b. To appreciate the clinical presentation, radiographic features and course
             associated with common causes of pleural effusions
         c. To appreciate the value of pleural fluid analysis in determining the cause of a
            pleural effusion
         d. To understand the management of patients with pleural effusions, especially
            malignant and parapneumonic effusions
         e. To understand the pathogenesis, causes, clinical features and management of
            patients with spontaneous pneumothorax
         f. To understand the pathophysiology, diagnosis and management of patients with
            trapped lung
         g. To understand the pathophysiology, diagnosis and management of patients with
            yellow nail syndrome
   2. Relevant Literature:
         a. Pleural Effusion. NEJM 2002; 346:1971-1977
         b. BTS Guidelines for the Management of Pleural Disease. Thorax 2003; 58(Supp II)
         c. State of the Art: The Pleura. Am J Respir Crit Care Med 1988; 138:184-234
         d. Resolution of Pleural Effusions. Chest 2001; 119:1547-1562
         e. Medical and Surgical Treatment of Parapneumonic Effusions: an Evidence Based
            Guideline. Chest 2000; 118:1158-1171
         f. Tuberculous Pleural Effusion and Tuberculous Empyema. Semin Resp Crit Care
            Med 2001; 22(6):637-646
         g. Hepatic Hydrothorax. Am J Med 1999; 107:262-267
         h. Pleural Effusions in Hematologic Malignancies. Chest 2004; 125: 1546-1555
         i. Management of Malignant Pleural Effusions. Am J Respir Crit Care Med 2000;
            162: 1987-2001
         j. Pleurodesis: State of the Art. Eur Respir J 1997; 10:1648-1654
         k. Spontaneous Pneumothorax. NEJM 2000; 342:868-874
         l. Management of Spontaneous Pneumothorax: an ACCP Delphi Consensus
            Statement. Chest 2001; 119:590-602
         m. Trapped lung. Semin Resp Crit Care 2001; 22(6):631-635
         n. Yellow Nail Syndrome. Postgrad Med J 1997; 74:466-468
         o. Asbestos and the Pleura: A Review. Chest 2004 125: 1103-1117.


L. Mediastinum
   1. Objectives:
          a. Discuss compartments of the mediastinum
          b. Discuss diagnostic evaluation of mediastinal lesions
          c. Describe common mediastinal disorders
          d. To understand the pathogenesis, clinical presentation, diagnosis and management
             of patients with fibrosing mediastinitis and mediastinal lipomatosis
   2. Relevant Literature:
          a. Primary Mediastinal Tumors Part 1. Chest 1997; 12:511-522
          b. Primary Mediastinal Tumors Part 2. Chest 1997; 112:1344-1357
          c. Thymoma: Update for the New Millenium. The Oncologist 2001; 6:239-246
          d. Clinical Spectrum of Mediastinal Cysts. Chest 2003; 124:125-132
          e. Mediastinal Lipomatosis. South Med J 1998; 91(12):1169-72
          f. Fibrosing Mediastinits. Radiographics 2001; 21:737-757
M. Other Intrathoracic Tumors
    1. Objectives:
         a. Discuss the tumors that can affect the mediastinum
         b. Describe carcinoid, cylindroma, hamartoma, etc.
         c. Discuss metastatic malignancy in the thorax
         d. Discuss tracheobronchial amyloidosis
   2. Relevant Literature:
         a. Carcinoid tumors. NEJM 1999; 340:858-868
         b. Pulmonary Hamartomas. Mayo Clin Proc 1996; 71:14-20
         c. A Case of Tracheopathia osteoplastica. NEJM 1999; 341:1292-1299
         d. Malignant Tracheal Tumors. Mayo Clin Proc 1993; 68:680-684
         e. Primary Pulmonary Lymphoma. Eur Resp J 2002; 20(3):750-62
         f. Non-neoplastic Pulmonary Lymphoid Lesions. Thorax 2001; 56:964-971
         g. Lymphoid Interstitial Pneumonia. Chest 2002; 122:2150-2164
         h. Pulmonary Complications of Leukemia. Chest 1990; 98: 1233-1239
         i. Myelomatous pleural effusion. South Med J 1997 Jan; 90(1):65-8.
         j. Primary Pulmonary Plasmacytoma. Chest 2001; 120:1405-1407
         k. A Case of Pulmonary Artery Sarcoma. NEJM 2000; 343(7):493-500
         l. Advancement in Treatment of Malignant Pleural Mesothelioma. Chest 1999;
             116:504-520
         m. Resection of Pulmonary Metastases. Am J Respir Crit Care Med 1993; 148:1691-1696
         n. Malignant Pleural Mesothelioma: Update, Current Management, and Newer Therapeutic
             Strategies. Chest 2004 126: 1318-1329.


N. Parenchymal Lung Disease (non IIP):
   1. Objectives:
         a. To discuss several uncommon diffuse lung diseases
         b. Describe the pulmonary manifestations of these uncommon pulmonary disorders
         c. Discuss treatment options for these uncommon entities
         d. Discuss the pathogenesis, clinical features and treatment of pulmonary disorders
            that occur in patients with sickle cell hemoglobinopathies
         e. To discuss pulmonary injury caused by radiation therapy of malignancy
         f. To describe the salient epidemiologic, clinical, physiologic and radiographic
            features of Langerhans cell histiocytosis, lymphangioleiomyomatosis and
            crytogenic organizing pneumonia
         g. To compare and contrast the salient features on high-resolution CT scans seen in
            these disorders
         h. To review the characteristic histopathologic immunohistochemical techniques or
            markers
         i. To review the differing therapeutic strategies among these disorders
   2. Relevant Literature:
         a. State of the Art: Pulmonary Alveolar Proteinosis. Am J Respir Crit Care Med
            2002; 166:215-235
         b. Pulmonary alveolar proteinosis. Thorax 2000; 55: 67-77
         c. Pulmonary Alveolar Microlithiasis. Semin Respir Crit Care Med 2002; 23:103-113
         d. Pulmonary Alveolar Microlithiasis (image). NEJM 2003; 348(16):1555
          e. State of the Art: Calcium Deposition with or without Bone Formation in the Lung
             Am J Respir Crit Care Med 2002; 165:1654-1669
          f. Pulmonary Complications of Sickle Cell Anemia. Am J Respir Crit Care Med
             2001; 164: 2016-2019
          g. Pathogenesis of Lung Disease in Sickle Hemoglobinopathies. Am J Respir Crit
             Care Med 1993; 148:249-256
          h. Causes and Outcomes of the Acute Chest Syndrome in Sickle Cell Disease.
             NEJM 2000; 342:1855-1865
          i. Pulmonary radiation injury. Chest 1997; 111:1061-1076
          j. Pulmonary Langerhans’ cell Histiocytosis. NEJM 2000; 342:1969-1978
          k. Pulmonary Langerhans’ cell Histiocytosis. Chest 2003; 123:1673-1683
          l. Lymphangioleiomyomatosis. Chest 1998; 114:1689-1703
          m. Lymphangioleiomyomatosis. Thorax 1999; 54:254-264
          n. Organizing Pneumonia. Thorax 2000; 55:318-328
          o. Pulmonary Infiltrates in the Non-HIV-Infected Immunocompromised Patient:
             Etiologies, Diagnostic Strategies, and Outcomes. Chest 2004 125: 260-271.
          p. Pulmonary Complications of Solid Organ and Hematopoietic Stem Cell
             Transplantation. Am. J. Respir. Crit. Care Med. 2004; 170: 22-48.


O. Pulmonary Vasculitis and Alveolar Hemorrhage Syndromes:
   1. Objectives:
         a. Discuss the spectrum of respiratory vasculitides
         b. Describe clinical features of Wegener’s Granulomatosis
         c. Consider other respiratory vascultides
         d. Review the therapy of respiratory vasculitides
         e. Discuss alveolar hemorrhage syndromes
   2. Relevant Literature:
         a. Small vessel vasculitis of the lung. Thorax 2000; 55:502-510
         b. Small vessel vasculitis. NEJM 1997; 337(21):1512-1523
         c. Wegener’s Granulomatosis. Thorax 1999; 54: 629-637
         d. Pulmonary Manifestations of Behcet’s disease. Thorax 2001; 56(7):572-8
         e. Pulmonary Capillaritis and Alveolar Hemorrhage. Chest 1996; 110:1305-1316

P. Pulmonary Function Testing:
   1. Objectives:
         a. To understand the importance of test performance quality; normal range of values
            and clinical context on interpretation of pulmonary function tests
         b. To recognize the distinct role of lung mechanics tests and gas exchange tests in
            the evaluation of pulmonary impairment
         c. To develop a fuller understanding of the significance of the shape and pattern of
            the flow-volume loop and volume-time curves.
         d. To recognize the pulmonary function test result patterns of abnormality found in
            various diseases
         e. To recognize the role of bronchoprovocation testing in excluding the diagnosis of
            asthma
   2. Relevant Literature:
          a. Pulmonary Function Testing. NEJM 1994; 331:25-30
          b. ATS guidelines: Standardization of spirometry. Am J Respir Crit Care Med
             1995; 152:1107-1136
          c. ATS guidelines: Selection of references values and interpretive strategies. Am
             Rev Respir Dis 1991; 144:1202-1218
          d. ATS guidelines: Single-breath carbon monoxide diffusing capacity:
             recommendations for a standard technique. Am J Respir Crit Care Med 1995;
             152:2185-2198
          e. ETS/ATS guidelines: Measurement of lung volumes by plehtysmography. Eur
             Respir J 1997; 10: 1415-1427
          f. ATS/ERS Statement on Respiratory Muscle Testing. Am J Respir Crit Care Med
             2002; 166:520-619
          g. ATS Guidelines for methacholine and exercise challenge testing. Am J Respir Crit
             Care Med 2000; 161:309-329

Q. Symptoms of Respiratory Disease:
   1. Objectives:
         a. To address the symptoms of respiratory disease commonly encountered by the
            pulmonologist
         b. To review the physiology, pathophysiology, complications, differential diagnosis,
            pathogenesis, diagnosis and treatment of cough
         c. To review the physiology, pathophysiology, complications, differential diagnosis,
            pathogenesis, diagnosis and treatment of wheeze
         d. To review the physiology, pathophysiology, complications, differential diagnosis,
            pathogenesis, diagnosis and treatment of hemoptysis
         e. To review the physiology, pathophysiology, complications, differential diagnosis,
            pathogenesis, diagnosis and treatment of dyspnea
   2. Relevant Literature:
         a. The diagnosis and treatment of cough. NEJM 2000; 343(23):1715-1721
         b. ACCP Consensus panel Report: Managing Cough. Chest 1998; 114(2): 133S-181S
         c. The Persistently Troublesome Cough. Am J Respir Crit Care Med 2002; 165:1469-1474
         d. The role of GERD in cough and asthma. Chest 1997; 111:1389-1402
         e. Pathophysiology of Dyspnea. NEJM 1995; 333(23):1547-1533
         f. Respiratory Sounds: Advances beyond the Stethoscope. Am J Respir Crit Care Med
            1997; 156: 974-987

R. Tuberculosis and Nontuberculous Mycobacterium:
   1. Objectives:
         a. To become familiar with the epidemiology of tuberculosis
         b. To review the pathogenesis and clinical presentation of tuberculosis
         c. To address issues concerning the prevention of tuberculosis, including the
            diagnosis and treatment of tuberculosis infection
         d. To review issues concerning the diagnosis and treatment of tuberculosis disease
         e. To outline pertinent topics in of Mycobacterium other than tuberculosis
         f. To review the pathogenesis, diagnosis and treatment of HIV patients with
            tuberculosis
   2. Relevant Literature:
           a. ATS/CDC/IDSA Guidelines: Treatment of Tuberculosis. Am J Rev Respir Crit
              Care Med 2003; 167:603-622
           b. ATS/CDC Guidelines: Targeted Tuberculin Testing and Treatment of Latent
              Tuberculosis Infection. Am J Respir Crit Care Med 2000; 161:S221-S247
           c. Clinical Practice: Latent Tuberculosis Infection. NEJM 2002; 347(23):1860-1866
           d. ATS/CDC Guidelines: Diagnostic Standards and Classifcation of Tuberculosis in
              Adults and Children. Am J Respir Crit Care Med 2000; 161:1376-1395
           e. ATS Guidelines: Diagnosis and Treatment of Disease caused by Nontuberculous
              Mycobacteria. Am J Respir Crit Care Med 1997; 156:S1-S25
           f. Tuberculosis in Patients with HIV infection. NEJM 1999; 340(5):367-373
           g. Priorities for the Treatment of Latent Tuberculosis Infection in the United States.
              NEJM 2004; Volume 350:2060-2067.
           h. Mycobacterium avium complex Pulmonary Disease in Patients Without HIV
              Infection. Chest 2004 126: 566-581.


S. Idiopathic Interstitial Pneumonias (IIP) and Sarcoidosis:
    1. Objectives
          a. To describe the salient epidemiologic, clinical, physiologic, and radiographic
              features of idiopathic pulmonary fibrosis, non-specific interstitial pneumonia,
              desquamative interstitial pneumonia and acute interstitial pneumonia
          b. To discuss the salient features on high-resolution CT scans and their impact on
              prognosis
          c. To review the characteristic histopathologic features of each of these disorders
              and the role of transbronchial or surgical lung biopsies
          d. To discuss the clinical role of ancillary studies such as radionuclide scanning or
              BAL to stage or follow up these disorders
          e. To review therapeutic strategies


   2. Relevant Literature
         a. ATS/ERS Classification of the Idiopathic Interstitial Pneumonias. Am J Respir
            Crit Care Med 2002; 165:277-304
         b. ATS/ERS Consensus Statement: Idiopathic pulmonary fibrosis: diagnosis and
            treatment. Am J Respir Crit Care Med 2000; 161:646–664
         c. State of the Art: Idiopathic Pulmonary Fibrosis- Clinical Relevance of Pathologic
            Classification. Am J Respir Crit Care Med 1998; 157:1301-1315
         d. Idiopathic Pulmonary Fibrosis. NEJM 2001; 345(7):517-525
         e. A Placebo Controlled Trial of Interferon Gamma 1b in Patients with Idiopathic
            Pulmonary Fibrosis. NEJM 2004; 350:125-133
         f. Pharmacologic Therapy for IPF. Am J Respir Crit Care Med 1999; 160:1771-1777
         g. The Elusive Goal of Therapy for Usual Interstitial Pneumonia. NEJM 2004; 350:
            181-183
         h. American Thoracic Society Statement on Sarcoidosis. Am J Respir Crit Care
            Med 1999; 160: 736-755
         i. What is Sarcoidosis? Chest 2003; 124:367–371
         j. Sarcoidosis. NEJM 1997; 336(17): 1224-1234
          k. Sarcoidosis. JAMA 2003; 289(24): 3300-3303
          l. The Diagnostic Pathway to Sarcoidosis. Chest 2003;123:406-412
          m. Idiopathic Pulmonary Fibrosis: Challenges and Opportunities for the Clinician
             and Investigator. Swigris et al. Chest 2005 127: 275-283.


T. Lung Transplantation
   1. Objectives
         a. To define indications for lung transplantation
         b. To review guidelines for recipient selection for lung transplantation
         c. To describe relative and absolute contraindications to lung transplantation
         d. To describe outcomes following transplantation including survival and
            physiologic results
         e. To review complications following lung transplantation
         f. To give an overview of the immunosuppressive medications used in lung
            transplantation
   2. Relevant Literature
         a. Lung Transplantation. NEJM 1999; 340(14):1081-1091
         b. Lung Transplantation. Am J Respir Crit Care Med 1997; 155:789-818
         c. ATS International Guidelines for the Selection of Lung Transplant Candidates.
            Am J Respir Crit Care Med 1998; 158:335-339
         d. Bronchiolitis Obliterans after Lung Transplantation. Am J Respir Crit Care Med
            2002; 166; 440-444
         e. Spectrum of Aspergillus Infection in Lung Transplant Recipients. Chest 2001;
            119:169-175
         f. Spectrum of Mycobacterial Infection after Lung Transplantation. Am J Respir
            Crit Care Med 1999; 160:1611-1616
         g. New Immunosuppressive Regimens in Lung Transplantation. Eur Respir J 1997;
            10:2630-2634




U. Women’s Issues in Pulmonary Medicine
   1. Objectives
         a. To review the normal respiratory and cardiovascular physiology of pregnancy
         b. To review the management of asthma in pregnancy
         c. To review the management of venous thromboembolism in pregnancy
         d. To review the management of tuberculosis in pregnancy
         e. To review the causes and management of acute respiratory failure in pregnancy
         f. To discuss the statistics regarding smoking and the epidemiology of lung cancer
            in women
   2. Relevant Literature
         a. Critical Care in the Pregnant Patient. Am J Respir Crit Care Med 1995; 152; 427-455
         b. Asthma in Pregnancy. Thorax 2001; 56(4):325-328
         c. Tuberculosis in Pregnancy. Thorax 2001; 56(4):494-499
         d. Thrombosis in Pregnancy: Maternal and Fetal Issues. Lancet 1999; 353:1258-1265
          e. Management of Venous Thromboembolism during Pregnancy. J Thromb
             Haemost; 2003:1435-1442.
          f. Use of Antithrombotic Agents during Pregnancy. Chest 2001; 199:122S-131S
          g. Pneumonia in Pregnancy. Thorax 2001; 56: 398-405

V. Drug-Induced Lung Diseases
   1. Objectives
         a. To appreciate the diverse clinical syndromes of drug-induced pulmonary diseases
         b. To understand the general approach to the patient with suspected drug toxicity
         c. To review the common abnormalities associated with specific chemotherapeutic
            agents
         d. To comprehend the typical manifestations of pulmonary toxicity due to non-
            chemotherapeutic agents
   2. Relevant Literature
         a. Bleomycin Induced Pneumonitis. Chest 2001; 120:617-624
         b. Drugs and the Pleura. Chest 1999; 116:212-221
         c. Methotrexate Pneumonitis. Eur Respir J 2000; 15(2):373-81
         d. Amiodarone Pulmonary Toxicity. BMJ 1997; 314:619-620
         e. Gold-induced Pulmonary Disease. Am J Respir Crit Care Med 1997; 155:1011-1020
         f. Pulmonary Complications of Crack Cocaine. Chest 1995; 107:233-240
         g. Heroin-related Noncardiogenic Pulmonary Edema. Chest 2001; 120:1628-1632

U. Pulmonary Manifestations of Systemic Diseases
   1. Objectives
         a. To review the pulmonary manifestations of SLE
         b. To review the pulmonary manifestations of RA
         c. To review the pulmonary manifestations of Scleroderma
         d. To review the pulmonary manifestations of Sjogren’s Syndrome
         e. To review the pulmonary manifestations of Ankylosing Spondylitis and Relapsing
            Polychrondritis
         f. To review the pulmonary manifestations of Polymyositis and Dermatomyositis
         g. To review the pulmonary manifestations of Amyloidosis
         h. To review the pulmonary complications of HIV infection
         i. To review the pulmonary complications of Bone Marrow Transplantation
   2. Relevant Literature
         a. Interstitial Lung Diseases in Collagen Vascular Diseases. Eur Respir J 2001;
            32:69s-80s
         b. Pleuropulmonary Manifestations of Systemic Lupus Erythematosus. Thorax
            2000; 55:159-166
         c. Pulmonary Manifestations of Rheumatoid Arthritis. Hospital Physician 2001;
            37(7):23-27
         d. Evaluation and Management of Alveolitis and Interstitial Lung Disease in
            Scleroderma. Curr Opin Rheumatol 2003; 15(6):748-55
         e. Pulmonary Manifestations of Sjogren’s Syndrome. Clin Chest Med 1998;
            19(4):687-99
         f. Pulmonary Manifestations of Ankylosing Spondylitis and Relapsing
            Polychondritis. Clin Chest Med 1998; 19(4):747-57
           g. Interstitial Lung Disease, a Common Manifestation of Newly Diagnosed
              Polymyositis and Dermatomyositis. Ann Rheum Dis 2004; 63(3):297-301
           h. Amyloidosis and the Respiratory Tract. Thorax 1999; 54:444-45
           i. Pulmonary Complications of HIV Infection. Am J Respir Crit Care Med 2001;
              164:2120-2126
           j. Pulmonary Complications of Bone Marrow Transplantation. Chest 1996;
              109(4):1066-1077

V. Preoperative and Perioperative Management
   1. Objectives
         a. To review the preoperative evaluation of patients undergoing lung resection as
             well as patients undergoing non-pulmonary surgery
         b. To apply physiologic parameters preoperatively to predict postoperative
             pulmonary complications following thoracic resection or cardiac surgery
         c. To explain the pathophysiology of hypoxemia in patients following cardiac
             surgery
         d. To recognize and treat the most common causes of post cardiac surgery
             respiratory failure
   2. Relevant Literature
         a. Preoperative Pulmonary Evaluation. NEJM 1999; 340(12):937-944
         b. Preoperative Evaluation of Patients Undergoing Lung Resection Surgery. Chest
             2003; 123:2096-2103
         c. Evidence-Based Preoperative Evaluation of Candidates for Thoracotomy. Chest
             1999; 116:474S-476S
         d. Pulmonary Dysfunction after Cardiac Surgery. Chest 2002; 121: 1269-1277
         e. The Postpneumonectomy State. Chest 1998; 114:1158-1184

W. Radiology:
         a. Seeking a Home for a PET, Part 1: Defining the Appropriate Place for Positron
            Emission Tomography Imaging in the Diagnosis of Pulmonary Nodules or
            Masses. Chest 2004 125: 2294-2299.
         b. Seeking a Home for a PET, Part 2: Defining the Appropriate Place for Positron
            Emission Tomography Imaging in the Staging of Patients With Suspected Lung
            Cancer. Chest 2004 125: 2300-2308.
         c. Seeking a Home for a PET, Part 3: Emerging Applications of Positron Emission
            Tomography Imaging in the Management of Patients With Lung Cancer. Chest
            2004 126: 1656-1666.


X. High-Altitude/Diving/Near Drowning
   1. Objectives
         a. To explain the pathophysiology of diving-related and high altitude pulmonary
              related complications by using the ideal gas law and the alveolar gas equation
         b. To contrast the differences in thoracic volume and pressure that occur in breath-
              hold diving, scuba diving, and descent in a submarine
         c. To predict which patients with pulmonary disease will require supplemental
              oxygen when flying in commercial aircraft
      d. To discuss preventative methods to avoid acute mountain sickness and high
         altitude pulmonary edema.
      e. To recognize that noncardiogenic edema occurs in freshwater and saltwater near-
         drowning victims and that most immersion accidents are preventable
2. Relevant Literature
      a. Medical Problems Associated with Underwater Diving. NEJM 1992; 326(1):30-34
      b. Medical Problems Associated with Underwater Diving. Clin Pulm Med 2001;
         8:242-247
      c. Managing Patients with Respiratory Disease Planning Air Travel: BTS
         recommendations. Thorax 2002; 57:289-304
      d. High Altitude Illness. NEJM 2001; 345(2):107-114
      e. Pathogenesis of High Altitude Pulmonary Edema. JAMA 2002; 287:2228-2235
      f. Pneumonia Associated with Near Drowning. Clin Infect Dis 1997; 25:906-907
      g. Drowning. NEJM 1993; 328:253-256

				
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