DNB Respiratory Medicine: Admissions, Medical Colleges, Fees, Eligibility Criteria Details Here

Milestones in the history of Pulmonary Medicine:

Structure & Functions of Respiratory System and mediastinum.

1. Anatomy

2. Development & aging of respiratory system

3. Physiology

 Respiratory Mechanics

 Physiology of Respiration & Ventilation

 Molecular Regulation of Lung development

 Pulmonary Surfactant and disorders of Surfactant Homeostasis

 Mucociliary clearance

 Physiological basis of pulmonary function testing & arterial blood gases.

 Acid base disturbances

 Physiology aspects related to mechanical ventilation

 Physiology related to endocrine aspects of lung

 Sleep physiology

4. Patho-Physiology of all disorders pertaining to pulmonary medicine.

5. Microbiology

6. Genetics

7. Pharmacology

8. Pathology

9. Immunology & defense mechanisms

10. Molecular biology

11. Biochemistry

Symptoms and Signs

1. Dyspnoea

2. Wheeze

3. Stridor

4. Hoarseness

5. Cough

6. Sputum production

7. Chest Pain

8. Haemptysis

9. Snoring

10. General symptoms of disease including fever, weight loss, oedema, Nocturia and

11. Day time somnolence

12. Abnormal findings on general examination including cyanosis, clubbing, superior vena cava syndrome and Horners syndrome.

13. Abnormal findings on inspection should include abnormal breathing patterns, chest wall deformities.

14. Abnormal findings on palpation and percussion

15. Abnormal findings on auscultation

Diseases of Airways

1. Asthma

2. Acute Bronchitis

3. Chronic bronchitis/ COPD

4. Bronchiolitis

5. Bronchiectasis

6. Airway Stenosis, megaly & malacia

7. Tracheooesophageal Fistula

8. Upper airway disease

9. Vocal cord Dysfunction

10. Foreign body aspiration

11. GERD

Neoplasms of the Lung and Thorax

1. Pathogenesis

2. Approach to the patient with Pulmonary nodules

3. Pathology of Bronchogenic Carcinoma

4. Clinical evaluation and diagnosis

5. Natural history

6. Genetic and Molecular changes

7. Prospects for a Personalized Pharmacological Approach to treatment

8. Epidemiology of the lung cancer

9. Clinical evaluation, diagnosis & staging of lung cancer

10. Treatment of non-small cell lung cancer: Surgery

11. Treatment of Non-Small cell lung cancer: Chemotherapy

12. Small Cell Lung Cancer: Diagnosis, Treatment, and natural history.

13. Primary lung tumors other than Bronchogenic Carcinoma: Benign and Malignant.

14. Extra pulmonary Syndromes associated with Lung Tumors

15. Metastatic Pulmonary tumours: The role of Surgical Resection

16. Mesothelioma

17. Metastatic & Other pleural tumours

18. Benign intrathoracic tumours

19. Mediastinal tumours

20. Chest wall tumours

21. Sarcoma

Lymphoproliferative and Hematologic Diseases Involving the lung and Pleura Lung Immunology

1. Innate and Adaptive Immunity in the lung

2. Lymphocyte- and Macrophage-Mediated Inflammation in the lung

3. Mast cells and Eosinophils

4. Leukocyte Accumulation in Pulmonary Disease

5. Antibody- Mediated Lung Defenses and Humoral Immunodeficiency

Lung Injury and Repair

1. T Lymphocytes in the lung

2. Chemokines, Adipokines, and growth factors in the lung

3. Redox Signaling and Oxidative Stress in Lung Diseases

4. Fibroblasts in Lung Homeostasis and Diseases

Non Tubercular Infectious Diseases of the Lungs

1. Pulmonary clearance of Infectious agents

2. Approach to the patient with Pulmonary Infection

3. Pulmonary Infection in Immunocompromised hosts

4. Microbial Virulence factors in Pulmonary Infections

5. Principles of Antibiotic Use and the Selection of Empiric therapy for Pneumonia

6. HIV, AIDS and pulmonary disorders

7. Upper Respiratory Infections

8. Lower respiratory infections

9. Community acquired pneumonia

10. Nosocomial pneumonia

11. Pneumonia in the immunocompromised host

12. Other pneumonias

13. Parapneumonic effusion & Empyema

14. Lung abscess

15. Fungal infections

16. Parasitic infections

17. Epidemic Viral infections

18. Others infections

Tuberculosis

1. Pulmonary TB

2. Extrapulmonary TB

3. TB in the immunocompromised host

4. Latent TB infections

5. Non tuberculous mycobacterial diseases

6. Drug resistant Tuberculosis

7. Tuberculosis control programme, including Programmatic management of drug

resistant Tuberculosis (PMDT).

Pulmonary Vascular diseases

1. Pulmonary Embolism

2. Pulmonary edema

3. Primary Pulmonary Hypertension

4. Secondary Pulmonary Hypertension, Cor Pulmonale

5. Vasculitis and Diffuse pulmonary hemorrhage

6. Abnormal A-V communication

7. Hepatopulmonary Syndrome

Community and Social Pulmonary Medicine

1. Prevention and cure of tuberculosis under RNTCP including Programmatic management of drug resistant Tuberculosis (PMDT).

2. Implementation of DOTS

3. Prevention of HIV (VCTC) as it increases prevalence of tuberculosis.

4. Investigation of adverse events following anti tubercular therapy

5. General principles of prevention and control of tuberculosis and nosocominal infection (pneumonia).

6. Prevention of drop let infection.

Occupational and Environmental Diseases

1. Occupational Asthma

2. Reactive airway dysfunction syndrome

3. Pneumoconiosis and Asbestos related Disease

4. Hypersensitivity pneumonitis

5. Dust and Toxic gas inhalation disease

6. Air pollution (indoor and outdoor) and it's impact on health

7. Smoking related diseases

8. Health effects of Climate change, including those due to Heat Waves

9. High altitude Disease

10. Diving related disease, Aviation and sports related pulmonary disorders.

11. Disability evaluation and compensation.

Diffuse Parenchymal (interstitial) Lung Diseases

1. Sarcoidosis

2. Idiopathic Interstitial pneumonias including Idiopathic Pulmonary Fibrosis (IPF)

3. NSIP, COP, AIP, RB-ILD, DIP, LIP

4. Interstitial lung diseases specific to Infancy

Iatrogenic diseases

1. Drug induced lung diseases

2. Complications of invasive procedures

3. Radiation induced Disease

Acute Injury

1. Inhalation Lung Injury

2. Traumatic thoracic injury

Respiratory Failure

3. Acute Lung Injury and Acute Respiratory Distress Syndrome

4. Obstructive Lung disease

5. Neuromuscular Disease

6. Chest Wall Diseases

7. Other restrictive lung Disease

Pleural Diseases

1. Pleurisy

2. Pleural Effusion

3. Chylothorax

4. Haemothorax

5. Fibrothorax

6. Pneumothorax/Hydropneumothorax/Pyopneumothorax

7. Empyema

Diseases of the chest wall and respiratory muscles including the diaphragm

1. Chest wall deformities

2. Neuromuscular disorders

3. Phrenic Nerve Palsy

4. Diaphragmatic hernia

5. Chest wall and diaphragmatic tumours

Mediastinal Diseases excluding tumours

1. Mediastinitis

2. Medistinal Fibrosis

3. Pneumomedistinum

Pleuropulmonary manifestations of systemic/ Extrapulmonary disorders

1. Collagen vascular disease

2. Cardiac disease

3. Abdominal disease

4. Haematological disease

5. Obesity

6. Hyperventilation syndrome

Genetic and Developmental Disorders

1. Cystic Fibrosis

2. Primary Ciliary Dyskinesia

3. Alpha-1 antitrypsin deficiency

4. Agenesis, Aplasia and Hypoplasia

5. Sequestration

6. Anomalies of Tracheo-bronchial tree and Fissures

7. Others

Respiratory Diseases and Pregnancy

1. Asthma

2. Bronchiectasis/ Cystic fibrosis etc.

3. Tuberculosis

4. Sarcoidosis

5. Restrictive Lung diseases

6. Pregnancy induced respiratory diseases

7. Others

Pulmonary changes in autoimmune disorder Allergic Diseases

1. Upper airway diseases

2. Asthma

3. Allergic Bronchopulmonary aspergillosis

4. Anaphylaxis

5. Others

Eosinophilic Diseases

1. Tropical pulmonary Eosinophilia

2. Non-asthmatic eosinophilic bronchitis

3. Acute and chronic eosinophilic pneumonia

4. Hypereosinophilic syndrome

5. Churg-strauss syndrome

6. Polyarteritis Nodosa

7. Others

Sleep related disorders

1. Obstructive sleep apnoea

2. Central sleep apnoea

3. Upper airway resistance syndrome

4. Obesity hypoventilation syndrome

5. Others

Immunodeficiency disorders

1. Congenital immunodeficiency syndrome

2. Acquired immunodeficiency syndrome

3. HIV related diseases

4. Graft versus host diseases

5. Post-transplantation immunodeficiency

6. Others

Pulmonary Rehabilitation

Lung Transplantation

Bioterrorism

Pediatric Pulmonology

Respiratory response to exercise in health

Aging of the respiratory system

Pulmonary diseases in Geriatrics population

Infection control practices in healthcare settings

Other Areas

1. Acute Responses to Toxic Exposures

2. Trauma and Blast Injuries

3. High Altitude

4. Diving Medicine

5. Pulmonary Complications of HIV Infection

6. Pulmonary Complications of stem cell and solid organ transplantation

7. Pulmonary Complications of primary Immunodeficiencies

8. Pulmonary Complications of Abdominal Diseases

9. Pulmonary Complications of Hematologic Diseases

10. Pulmonary Complications of Endocrine Diseases

11. The lungs in Obstetric and Gynecologic Diseases

12. The respiratory System and Neuromuscular Disease

13. Acute Ventilatory failure

14. Acute Hypoxemic Respiratory failure and ARDS

15. End-of-Life Care in Respiratory Failure

Biostatistics and Research methods

Public Health & Epidemiology

1. Epidemiological aspects of major respiratory and public health problems like Asthama, COPD, Interstitial lung disease

2. Occupational & Environmental disorders

3. Smoking related disorders

4. Infective diseases of lung

5. Tuberculosis and Pneumonias.

Surgical Aspects

Surgical interventions in various pulmonary disorders including trauma, tuberculosis and other infections & lung transplantation & minimally invasive interventions.

Medico-Legal Aspects

1. Compensation (occupational lung disorders) Fitness & disability evaluation.

2. Personal Protective measures for occupational health, biosafety guidelines for medical equipment & waste disposal.

3. Human Rights, ethical aspects, consent for procedures/newer drug development.

4. Aspects related to medical procedures & interventions performed in various pulmonary disorders.

Orphan Lung diseases

1. Langerhans cell histiocytosis

2. Lymphangioleiomyomatosis

3. Pulmonary alveolar proteinosis

4. Amyloidosis

Pulmonary Function Testing

1. Spirometry performance and interpretation

2. Static and Dynamic Lung Volumes- Interpretation and Performance

3. Body Plethysmography – Interpretation

4. Gas transfer- Interpretation

5. Blood gas assessment and Oximetry-Interpretation and Performance

6. Bronchial provocation testing- Interpretation and performance

7. Cardiopulmonary exercise testing- Interpretation and performance

8. Assessment of respiratory mechanics- Interpretation

9. Compliance measurements - Interpretation

10. Respiratory muscle assessment – Interpretation

11. Ventilation perfusion measurement – Interpretation

12. Shunt measurement – Interpretation

13. Sleep studies- Interpretation and performance

14. Measurement of regulation of ventilation- Interpretation

Imaging in Chest Medicine

1. Chest X-ray

2. Ultrasound

3. CT Scan

4. MRI

5. PET Scan

6. Others

Nutrition in Respiratory medicine

Medical Emergency Management

1. Management of acute asthma, Pneumothorax/Hydropneumothorax, hemothorax, acute exacerbation of COPD, hemoptysis

2. Cardiopulmonary resuscitation

3. Endotracheal intubation

4. Management of acute respiratory failure and ARDS

5. Pulmonary thromboembolism

Critical care in Pulmonary Medicine

1. Hemodynamic and respiratory monitoring

2. Principles of mechanical ventilation

3. Nutrition in critically ill patients

4. Management of pain and sedation in critical care medicine

5. Ethics and palliative care in ICU settings

6. Organization of intensive care setting

Recent Advances:

1. Recent diagnostic techniques for Tuberculosis

2. Drug development in respiratory medicine.

3. Sleep Medicine

4. Invasive diagnostic techniques

5. Lung in extreme conditions.

6. Role of mechanical Ventilator and setting up of I.R.C.U.

7. Major indications of Surgery in Lung Diseases.

8. Modern concepts of Heart Lung Transplantation.

9. Promotion of Lung functions through exercise and Oxygen supplementation.

10. Recent diagnostics and therapeutic interventions in Lung cancer.

Miscellaneous

1. Approach to Important Clinical Problems

2. Oncology. Lung cancer, benign and malignant with pleural metastasis with

primary pleural malignancy

3. Connective tissue disorder, drug induced pulmonary diseases, HIV related pulmonary disease and tuberculosis.

Topics to be included in all subjects:

 Biostatistics, Research Methodology and Clinical Epidemiology

 Ethics

 Medico legal aspects relevant to the discipline

 Health Policy issues as may be applicable to the discipline

Training and Practicals

A. Training in Pulmonary Function Testing

Understanding of performing and interpretation of Spirometry, lung volume and diffusion test. A clear understanding of the indications and potential pitfalls in the performance and the limitations of interpretation of pulmonary function testing including reversibility test of airway obstruction and bronchialprovocation test.

B. Training in Critical Care Medicine

Trainees will be expected to master the cognitive skills and develop knowledge and understanding of the following:

1. Pathophysiology of Respiratory Failure.

2. Indications and Interpretation of Arterial Blood gas and Electrolytes analysis.

3. Indications and management of invasive and non-invasive mechanical ventilation.

4. Thorough knowledge about Ventilator associated complications.

5. The pharmacology, adverse reactions, efficacy and appropriate use of drugs used in Pulmonology. These include Oxygen, Nebulisations, Bronchodilators, Antibiotics, anti‐Tuberculosis drugs, antifungal agents and various cytotoxic drugs.

6. Bronchoscopic procedures in critically ill patients.

C. Training in Asthma & COPD

Clinical Training

1. To identify patients suffering from asthma & COPD.

2. Common diagnostic tests for diagnosis of asthma and COPD

3. To acquire clinical skills in managing exacerbations of asthma and COPD.

4. Training on primary and secondary prevention of asthma.

5. Training of patient education program.

6. Indication and delivery of long term oxygen therapy.

Training Procedure

Use and maintenance of nebulisers, spacers, peakflow meter, Meter Dose Inhalers, CPAP, BIPAP, Humidifier and other appliances.

D. Training in Respiratory Infections

Trainees must master in basic knowledge regarding respiratory infections, including:

1. The mechanisms of inflammation.

2. Elements of the Respiratory defense system (including the mucosal immuno system and the components of mucosal barrier function).

3. The prevalence, clinical presentation of respiratory pathogens (viral, bacterial, fungal, and protozoal).

4. The Pathophysiology of pneumonia, Tuberculosis & other infectious diseases.

5. The indications and contraindications of antimicrobial therapy, mechanisms of microbial drug resistance, and risk of infections from enteric organism.

6. Clinical exposure of respiratory infections should include the diagnosis and management of patients with common infectious presentations such as Pneumonias (bacterial, viral, fungal); Tuberculosis & its various presentations (including appropriate antitubercular chemotherapies; in relation to emergence of drug Resistant cases); infections in immunocompromised hosts (e.g., transplantation patients, patients with AIDS).

E. Training in Respiratory Malignancy

Throughout the entire period of training, trainees should participate in the outpatient screening for and diagnosis of all types respiratory malignancy and the outpatient and inpatient management of patient with respiratory cancers. Endoscopic training in the diagnosis and management of respiratory malignancy.

F. Training in Respiratory Endoscopy (Bronchoscopy)

At the completion of training, the trainee should have achieved the following:

1. The ability to recommend bronchoscopic procedures based on findings of a personal consultation and in consideration of specific indications, contraindications, and diagnostic / therapeutic alternatives.

2. The ability to perform a specific procedure safely, completely, and expeditiously.

3. The ability to interperet most bronchoscopic finding correctly.

4. The ability to integrate bronchoscopic findings or therapy into the patient management plan.

5. The ability to understand the risk factors attendant to bronchoscopic procedures and to be able to recognize and manage complications.

6. The ability to recognize personal and procedural limits and to know when to request help.

Guidelines for Bronchoscopic Training in Routine Procedures

The P.G. Students should able to perform Fiberoptic bronchoscopy Including endobronchial biopsy, bronchoalveolar lavage, therapeutic bronchial toileting, transbronchial biopsy, Needle aspiration, Pulmonary rehabilitation and Physiotherapy, RNTCP-OP, Operational Research, Clinical Research & Epidemiology.

The trainee must be exposed to a sufficient number of new and follow‐up inpatients and outpatients of varied age (Pediatric, adult and geriatric) and of both sexes and with a variety of common and uncommon Respiratory disorders to permit a broad endoscopic experience. All trainees should have a clear understanding of the indications, limitations, complications, and medical and surgical implications of the findings of respiratory Endoscopy. Essential components of patient safety during endoscopic procedures must be mastered, including the intravenous administration of medications that produce conscious sedation and the application and interpretation of noninvasive patient monitoring devices. Trainees should be familiar with the care, cleaning, and proper maintenance of respiratory equipment. After suitable supervision, the trainee should be capable of independently performing routine respiratory procedures.

Postings:

It is recommended that postings should be undertaken in the following departments:

Intensive Care : 2 Months

Emergency : 1 Month

PFT Lab : 15 Days

Bronchoscopy Lab : 1 Month

Radiology : 1 Month

Pathology : 15 Days

Microbiology & Mycobacteriology : 15 Days

Sleep Lab : 15 Days

RNTCP and PMDT : 1 Month

Career Options

After completing a DNB in Respiratory Medicine, candidates will get employment opportunities in Government as well as in the Private sector.

In the Government sector, candidates have various options to choose from, including Registrar, Senior Resident, Demonstrator, Tutor, etc.

While in the Private sector the options include Resident Doctor, Consultant, Visiting Consultant (Respiratory Medicine), Junior Consultant, Senior Consultant (Respiratory Medicine), Consultant Respiratory Medicine Specialist, etc.

Courses After DNB in Respiratory Medicine Course

DNB in Respiratory Medicine is a specialization course that can be pursued after finishing MBBS. After pursuing a specialization in DNB (Respiratory Medicine), a candidate could also pursue super specialization courses recognized by NMC, where DNB (Respiratory Medicine) is a feeder qualification.

DM Cardiology, DM Infectious Disease and DM Critical Care Medicine are the courses that require DNB (Respiratory Medicine) as a feeder qualification.

Frequently Asked Questions (FAQs) – DNB in Respiratory Medicine Course

Question: What is a DNB in Respiratory Medicine?

Answer: DNB Respiratory Medicine or Diplomate of National Board in Respiratory Medicine also known as DNB in Respiratory Medicine is a Postgraduate level course for doctors in India that is done by them after completion of their MBBS.

Question: Is DNB in Respiratory Medicine equivalent to MD in Respiratory Medicine?

Answer: DNB in Respiratory Medicine is equivalent to MD in Respiratory Medicine, the list of recognized qualifications awarded by NBE in various broad and super specialties as approved by the Government of India are included in the first schedule of the Indian Medical Council Act, 1956.

Question: What is the duration of a DNB in Respiratory Medicine?

Answer: DNB in Respiratory Medicine is a postgraduate programme of three years.

Question: What is the eligibility of a DNB in Respiratory Medicine?

Answer: Candidates must be in possession of an undergraduate MBBS degree from any college/university recognized by the Medical Council of India (now NMC).

Question: What is the scope of a DNB in Respiratory Medicine?

Answer: DNB in Respiratory Medicine offers candidates various employment opportunities and career prospects.

Question: What is the average salary for an DNB in Respiratory Medicine postgraduate candidate?

Answer: The DNB in Respiratory Medicine candidate's average salary is between Rs. 4,00,000 - 30,00,000 per year. depending on the experience.

Question: Are DNB Respiratory Medicine and MD Respiratory Medicine equivalent for pursuing teaching jobs?

Answer: The Diplomate of National Board in broad-speciality qualifications and super speciality qualifications when granted in a medical institution with attached hospital or in a hospital with the strength of five hundred or more beds, by the National Board of Examinations, shall be equivalent in all respects to the corresponding postgraduate qualification and the super-speciality qualification granted under the Act, but in all other cases, senior residency in a medical college for an additional period of one year shall be required for such qualification to be equivalent for the purposes of teaching also.