Q fever symptom diagnosis and treatment

what is q fever

Q fever is a disease caused by infection with Coxiella burnetii, a bacterium that affects humans and other animals. This organism is uncommon, but may be found in cattle, sheep, goats, and other domestic mammals, including cats and dogs. The infection results from inhalation of a spore-like small-cell variant, and from contact with the milk, urine, feces, vaginal mucus, or semen of infected animals. Rarely, the disease is tick-borne.The incubation period is 9–40 days. Humans are vulnerable to Q fever, and infection can result from even a few organisms.The bacterium is an obligate intracellular pathogenic parasite

signs and symptom 

The most common manifestation is flu-like symptoms with abrupt onset of fever, malaise, profuse perspiration, severe headache, muscle pain, joint pain, loss of appetite, upper respiratory problems, dry cough, pleuritic pain, chills, confusion, and gastrointestinal symptoms, such as nausea, vomiting, and diarrhea. About half of infected individuals exhibit no symptoms

Treatment

Treatment of acute Q fever with antibiotics is very effective and should be given in consultation with an infectious diseases specialist.

Commonly used antibiotics 

include doxycycline, tetracycline, chloramphenicol, ciprofloxacin, ofloxacin, and hydroxychloroquine. Chronic Q fever is more difficult to treat and can require up to four years of treatment with doxycycline and quinolones or doxycycline with hydroxychloroquine.

MBBS Tips and Tricks for pakistani students

A-O-A
dear friends every in pakistan need better and best job for happy life many among you was struggle to become a doctor and enjoy higher rank in society but failed to achieve your target .because of may  reasons include proper study .reminder the mbbs is taste is not a rocket science is need more deep study then you think here we are provide some basic tips and  Tricks for pakistani students which may helpful to you

note; 

there are 200 mcqs each one is 4 marks for right answer and -2 for for wrong answer
total marks is 800

according to pmdc rules

he must have obtained minimum sixty percent marks in higher
secondary school certificate (HSSC) or F.Sc (Pre-medical) or
equivalent examination having minimum twelve years of education

marks formula 

(a) SSC (10%);
(b) F.Sc. (40%); and
(c) admission test (50%).

eligibility

 for test minimum marks is 60% according to pmdc rules
Q;how to prepare for eata or mact
A;read your books as much you can because most of mcqs are come from the books vary little are on the base of knowledge so please take your books vary seriously.
Q2;Recommended books;
A;1 your F.S.C books
    2 previous paper of eata or macat
    3 mcqs book generally related to your fsc books
Q3;general method of study
A; Read a chapter thoroughly from your textbooks every word of it solve the mcqs given in its exercise

what about matric books 10th

there is no need of them

best mcqs books for preparation of mcat or eata  

there many mcqs books for mact and eata in kpk many students use ICA (islamia coaching academy)
and ipa ((islamia professor  academy) in punjab many student use mact written by doger bother.

best time of study 

in the morning try to do work in busese it that time you were fresh and can do more study than night
avoid from night study don't waste your time by sleeping.

how to study biology 

study biology on topic wise  not as you study for fsc exams highlight important point
as you think is this important  solve mcqs at the end of each chapter

in physics learn all formulas  learn physics by conceptual method

same as chemistry



if you have any question please comment the post

Down syndrome symptoms causes Diagnosis and treatment

what are Down syndrome

Down syndrome or trisomy 21, is a genetic disorder caused by the presence of all or part of a third copy of chromosome 21. It is typically associated with physical growth delays, characteristic facial features and mild to moderate intellectual disability. The average IQ of a young adult with Down syndrome is 50, equivalent to the mental ability of an 8- or 9-year-old child, but this can vary widely
There is no cure for Down syndrome. Education and proper care have been shown to improve quality of life. Some children with Down syndrome are educated in typical school classes, while others require more specialized education.Some individuals with Down syndrome graduate from high school and a few attend post-secondary education.In adulthood, about 20% in the United States do paid work in some capacity with many requiring a sheltered work environment. Support in financial and legal matters is often needed.Life expectancy is around 50 to 60 years in the developed world with proper health care

Signs and symptoms

Those with Down syndrome nearly always have physical and intellectual disabilities.As adults, their mental abilities are typically similar to those of an 8- or 9-year-old. They also typically have poor immune function and generally reach developmental milestones at a later age.They have an increased risk of a number of other health problems, including congenital heart defect, epilepsy, leukemia, thyroid diseases, and mental disorders, among others

Physical

Feet of a boy with Down syndrome
People with Down syndrome may have some or all of these physical characteristics: a small chin, slanted eyes, poor muscle tone, a flat nasal bridge, a single crease of the palm, and a protruding tongue due to a small mouth and relatively large tongue.These airway changes lead to obstructive sleep apnea in around half of those with Down syndrome. Other common features include: a flat and wide face. a short neck, excessive joint flexibility, extra space between big toe and second toe, abnormal patterns on the fingertips and short fingers.Instability of the atlantoaxial joint occurs in about 20% and may lead to spinal cord injury in 1–2%. Hip dislocations may occur without trauma in up to a third of people with Down syndrome

Neurological

Most individuals with Down syndrome have mild (IQ: 50–69) or moderate (IQ: 35–50) intellectual disability with some cases having severe (IQ: 20–35) difficulties.[1][30] Those with mosaic Down syndrome typically have IQ scores 10–30 points higher. As they age, people with Down syndrome typically perform less well than their same-age peers. Some after 30 years of age may lose their ability to speak. This syndrome causes about a third of cases of intellectual disability.Many developmental milestones are delayed with the ability to crawl typically occurring around 8 months rather than 5 months and the ability to walk independently typically occurring around 21 months rather than 14 month
Down syndrome is caused by having three copies of the genes on chromosome 21, rather than the usual two.The parents of the affected individual are typically genetically normal.Those who have one child with Down syndrome have about a 1% risk of having a second child with the syndrome, if both parents are found to have normal karyotypes.

Genetics

The extra chromosome content can arise through several different ways. The most common cause (about 92–95% of cases) is a complete extra copy of chromosome 21, resulting in trisomy 21. In 1.0 to 2.5% of cases, some of the cells in the body are normal and others have trisomy 21, known as mosaic Down syndrome.The other common mechanisms that can give rise to Down syndrome include: a Robertsonian translocation, isochromosome, or ring chromosome. These contain additional material from chromosome 21 and occur in about 2.5% of cases. An isochromosome results when the two long arms of a chromosome separate together rather than the long and short arm separating together during egg or sperm development

Diagnosis

After birth

The diagnosis can often be suspected based on the child's physical appearance at birth.An analysis of the child's chromosomes is needed to confirm the diagnosis, and to determine if a translocation is present, as this may help determine the risk of the child's parents having further children with Down syndrome.Parents generally wish to know the possible diagnosis once it is suspected and do not wish pity.

Management

Efforts such as early childhood intervention, screening for common problems, medical treatment where indicated, a good family environment, and work-related training can improve the development of children with Down syndrome. Education and proper care can improve quality of life.Raising a child with Down syndrome is more work for parents than raising an unaffected child.Typical childhood vaccinations are recommended

What are common treatments for Down syndrome?

There is no single, standard treatment for Down syndrome. Treatments are based on each individual's physical and intellectual needs as well as his or her personal strengths and limitations.1 People with Down syndrome can receive proper care while living at home and in the community
Early Intervention and Educational Therapy

Treatment Therapies

Physical therapy includes activities and exercises that help build motor skills, increase muscle strength, and improve posture and balance.
Speech-language therapy can help children with Down syndrome improve their communication skills and use language more effectively
Occupational therapy helps find ways to adjust everyday tasks and conditions to match a person's needs and abilities
Emotional and behavioral therapies work to find useful responses to both desirable and undesirable behaviors.

Drugs and Supplements

Some people with Down syndrome take amino acid supplements or drugs that affect their brain activity. However, many of the recent clinical trials of these treatments were poorly controlled and revealed adverse effects from these treatments. Since then, newer psychoactive drugs that are much more specific have been developed. No controlled clinical studies of these medications for Down syndrome have demonstrated their safety and efficacy, however
Treatment for Down syndrome can include:

Regular checkups and screening
Medications
Surgery
Counseling and support.

People with Down syndrome are at increased risk for certain medical problems, such as:

Congenital heart disease
Leukemia and other cancers
Immune system problems
Thyroid problems
Bone, muscle, nerve, or joint problems
Hearing problems
Eye problems
Seizure disorders
Developmental delay
Mental retardation
Premature aging
Alzheimer's disease

Hair Loss and Balding Causes Symptoms prevention and Treatments

Hair Loss and Balding

by general definition are

Hair loss is typically considered the domain of aging men,
but this equal-opportunity condition — which has many
causes — can affect virtually anyone.
hair loss may occur at any age of adult
because of many  verses factor are affected by hair
loss like ageing tension and many other hormonal and
metabolic factor
Everyone sheds about 100 hairs each day as part of the
normal hair growth cycle, but excess loss is usually a
distressing .

Symptoms & causes

Most people’s hair grows about a half-inch per month, and
about 90 percent of your hair is actively growing at any
given time, with the other 10 percent in dormant phase.
After two or three months, this dormant hair falls out and
its follicles begin growing new hair as other follicles begin a
dormant phase.
Shedding hair is different from hair loss, when a hair falls
out and doesn't grow back. People often shed hair during
stressful events, such as childbirth, a breakup or divorce or
during times of grief.
"It still doesn’t feel good, and it takes the hair to reach a
certain length where you perceive its presence,"
 "So it feels like a hair loss, but it's not a hair loss."
Alopecia is the medical term for hair loss, and it doesn’t
only happen on the scalp. Some illnesses and medications
can trigger balding over the entire body, though genetics
account for most cases on the head, according to
the Cleveland Clinic.
Aside from heredity, noticeable hair loss can be caused by
wide variety of factors, including:

Harsh hairstyles or treatments: 

Hairstyles that consistently
use rubber bands, rollers or barrettes, or pull hair into tight
styles such as cornrows, can inflame and scar hair
follicles. So can incorrectly used chemical products such
as dyes, bleaches, straighteners or permanent wave
solutions. Depending on the degree of damage, resulting
hair loss can be permanent.
Hormone imbalances: In women, hormonal shifts from
birth control pills, pregnancy, childbirth, menopause or
hysterectomy can induce more hair follicles than normal to
enter the dormant phase.

Illness or surgery: 

The stress from sickness or surgery
may prompt the body to temporarily cease nonessential
tasks such as hair production. Specific conditions can also
trigger it, including thyroid disorders, syphilis, iron
deficiency, lupus or severe infection. An autoimmune
condition called alopecia areata, which has no cure,
causes rapid body-wide hair loss.

Medications and vitamins: 

Cancer chemotherapy, which
attacks hair follicles in its attempt to kill all fast-growing
cells around the body, is a well-known reason for hair loss.
Other medications’ side effects include hair shedding as
well, such as some that treat high blood pressure and gout
(a painful joint condition caused by a buildup of uric acid).
Excessive levels of vitamin A also contribute.
Nutritional deficits: Heavy dieting or eating disorders such
as bulimia and anorexia can temporarily stun hair follicles
to cease growth. This can also occur from insufficient
protein, vitamin or mineral intake.

Aging: 

A natural effect of growing older is slowed hair
growth.
Women usually don't go completely bald, but loss hair on
the top of the head or the temples. Men tend to lose hair
on their temples, and are more likely than women to go
completely bald, Day said.

Diagnosis

doctor  will examine the person's scalp and take a
history of medical or stressful events "to see what's been
going on in their life and their world
The physician may take a biopsy — a small patch of
skin that includes the hair follicle — and send it to a
pathologist to determine if an autoimmune disease, such
as lupus, is the cause of the hair loss.
Examining the hair and follicle can also determine whether
someone has a bacterial or fungal infection, Day said.

Treatment & medication

Hair loss remedies range from the mild to the extreme and
the inexpensive to the costly. Much depends on how much
hair is gone and how high a priority it is to mask its
absence or replace it.
 treatments include:
Hair weaves or wigs: Typically expensive, wigs and hair
weaves either completely cover the head or add to existing
hair, restoring the appearance of a full head of hair. They
are especially practical for cancer patients and those
whose hair loss is temporary.
Topical creams and lotions: Over-the-counter minoxidil can restore
some hair growth, especially in those with hereditary hair
loss. It is applied directly to the scalp. Prescription-strength
finasteride (Propecia) comes in pill form and is only for
men. it may take up to six months to tell if
these medications are working.
Anti-inflammatory medications: Prescription steroid-based
creams or injections can calm follicles damaged or
inflamed by harsh chemicals or excessive pulling.

Surgery:

 Men tend to be better candidates for surgical hair replacement
techniques because their hair loss is often
limited to one or two areas of the scalp. Procedures
include grafting, which transplants from one to 15 hairs per
disc-shaped graft to other locations. Scalp reduction
removes bald skin from the scalp so hair-covered scalp
can be stretched to fill in the bald areas. Side effects
include swelling, bruising and headaches.
Hair-growth laser treatment can also help stimulate hair
follicles and improve growth,

Natural and alternative therapies

alternative
therapies may not help hair regrow and many are not
supported by medical research. However, other treatments
that reportedly improve alopecia areata include Chinese
herbs, acupuncture, zinc and vitamin supplements,
evening primrose oil and aroma therapy.
Viviscal, a natural supplement, has also shown more hair
growth in men compared to those who took fish extract in
clinical trials

Diabetes mellitus types cause diagnosis and treatment

what is Diabetes mellitus

Diabetes mellitus is the most common of the endocrine disorders.
It is a chronic condition, characterised by hyperglycaemia
and due to impaired insulin secretion with or without
insulin resistance

types 

Type 1 (β-cell destruction, usually leading to absolute insulin
deficiency)
Type 2 (may range from predominantly insulin with relative insulin
deficiency to a predominantly secretory defect with or without
insulin resistance)

Definition of type 1

Type 1 diabetes mellitus is a chronic disorder of carbohydrate,
fat and protein metabolism with hyperglycaemia
resulting in most cases from autoimmune destruction of
pancreatic β cells.

Definition of type 2

Type 2 diabetes mellitus is a chronic disorder of carbohydrate,
fat and protein metabolism with hyperglycaemia
as its principal feature. It is characterised by impaired
insulin secretion and insulin resistance.

Pathophysiology of 2

Insulin resistance in the liver, skeletalmuscle and adipose
tissue secondary to a decrease
in the number of insulin receptors, decreased receptor
tyrosine kinase activity and post-receptor defects
causing impaired glucose transport.
Defective insulin secretion due to islet cell dysfunction
with increased secretion of proinsulin and cleavage
products. Amylin, an amyloid protein, is found in
increased amounts in the islets cells. It may disrupt
the normal insulin secretion.
Reduced effective insulin causes increased gluconeogenesis
by the liver and reduced peripheral uptake,
leading to hyperglycaemia.However, there is sufficient
insulin to suppress lipolysis and ketogenesis, so that
ketosis and ketoacidosis do not occur.

Clinical features

Patients may present with a history of polyuria, polydipsia
and weight loss often despite increased appetite.
Young patient often present acutely in diabetic ketoacidosis
Pathophysiology of type 1
In type 1 diabetes, there is hyperglycaemia due to failure
of glucose uptake and uncontrolled gluconeogenesis,
glycogenolysis, lipolysis and proteolysis:
Osmotic diuresis – there is a renal threshold for glucose
reabsorption, once the levels in the blood rise
above 10 mmol/L the kidney is no longer able to completely
reabsorb it from the proximal tubule resulting
in glycosuria and an osmotic diuresis.

Diagnosis

1. Diabetes symptoms (i.e. polyuria, polydipsia and
unexplained weight loss) plus:
• a fasting serum glucose concentration ≥7.0 mmol/L
• or serum glucose concentration ≥11.1 mmol/L 2 h after
75 g anhydrous glucose in an oral glucose tolerance test
(see later).
2. With no symptoms, diagnosis should not be based on a
single glucose determination but requires confirmatory
serum venous determination. At least one additional
glucose test result, on another day with the value in the
diabetic range, is essential, either fasting or from the 2-h
post-glucose load. If the fasting value is not diagnostic,
the 2-h value should be used.
Current recommendations are that the diagnosis is confirmed
by a glucose measurement performed in an accredited
laboratory on a venous serum sample. A diagnosis
should never be made on the basis of glycosuria or a stick
reading of a finger prick blood glucose alone, although such
tests are being examined for screening purposes. Glycated
haemoglobin (HbA1c) is also not currently recommended
for diagnostic purposes, although this is currently being
considered.

Treatment

the following medicines are helpful  in  Diabetes mellitus types 1 AND 2
Metformin (Glucophage, Glumetza, others). Generally, metformin is the first medication prescribed for type 2 diabetes. ...
Sulfonylureas. ...
Meglitinides. ...
Thiazolidinediones. ...
DPP-4 inhibitors. ...
GLP-1 receptor agonists. ...
SGLT2 inhibitors. ...
Insulin therapy.
Treatment for people with diabetes includes advice on nutrition,
physical activity, weight loss and smoking cessation if
appropriate. Drug therapy is prescribed where necessary
Fats
Since obesity is a major problem in type 2 diabetes and fats
contain more than twice the energy content per unit mass than
either carbohydrate or protein, consumption of fats should
be limited. Monounsaturated fats have a lower atherogenic
potential and are therefore recommended as the main source
of dietary fat. Intake of fat should be less than 35% of total
energy consumption, with saturated and trans-unsaturated
fats accounting for less than 10% of energy intake and monounsaturated
fats providing 10–20%.
Insulin therapy in type 1 diabetes
All patients with type 1 diabetes require treatment with insulin
in order to survive. Exogenous insulin is used to mimic the
normal physiological pattern of insulin secretion as closely
as possible for each individual patient. However, a balance is
required between tight glycaemic control and hypoglycaemia
risk. If the risk of hypoglycaemia is high, then it may be necessary
to aim for less tight glycaemic control. There is a wide
variety of insulin preparations available which differ in species
of origin, onset of action, time to peak effect and duration
of action
Protein
For adults without nephropathy, protein intake is recommended
as less than 1 g/kg of body weight, equivalent to
about 10–20% of total energy intake. For those with nephropathy,
protein intake may need to be further restricted, but this
requires expert dietetic advice and supervision
Fibre
There is no quantitative dietary recommendation for fibre
intake. Dietary fibre has useful properties in that it is physically
bulky, and it delays the digestion and absorption of
complex carbohydrates, thereby minimising hyperglycaemia.
For the average person with type 2 diabetes, 15 g of soluble
fibre from fruit, vegetables or pulses is likely to produce a 10%
improvement in fasting blood glucose, glycated haemoglobin
and low-density lipoprotein cholesterol (LDL-C). Insoluble
fibre from cereals, wholemeal bread, rice and pasta has no
direct effect on glycaemia or dyslipidemia, but it has an overall
benefit on gastrointestinal health and may help in weight
loss by promoting satiety
Salt
Sodium chloride should be limited to a maximum of 6 g/day.
A reduction in salt intake from 12 to 6 g/day has been shown
to produce a reduction in systolic blood pressure of 5 mmHg
and a reduction of 2–3 mmHg in diastolic pressure.

Alternative medicine

No treatments — alternative or conventional — can cure diabetes. So it's critical that people who are using insulin therapy for diabetes don't stop using insulin unless

DETAILED CURRICULUM SYLLABUS OF M.B.B.S OF PAKISTAN

 CURRICULUM
OF
M.B.B.S
Prepared by:
PAKISTAN MEDICAL & DENTAL COUNCIL
&
HIGHER EDUCATION COMMISSION
ISLAMABAD 2
CONTENTS
1. Preface 3
2. Guiding Principles 4
3. Scheme of Studies 7
4. Detail of Courses for MBBS
i) 1st Professional
(Part-I & Part-II)
ii) 2nd Professional 30
iii) 3rd Professional 48
iv) 4th/Final Professional
PREFACE
Curriculum of a subject is said to be the throbbing pulse of a nation. By looking at the curriculum of a subject, one can judge the state of intellectual development and the state of progress of a nation. The world has turned into a global village, new ideas and information are pouring in a constant stream. It is, therefore, imperative to update our curricula by introducing the recent developments in the relevant fields of knowledge.
The Pakistan Medical & Dental Council is a statutory body constituted by the Federal Government under the Pakistan Medical & Dental Council Ordinance, 1962, presently controlled by the Council. One of the main functions of the Council is to lay down the minimum standard of basic and higher qualifications in Medicine & Dentistry. The Council has been empowered to:
- Prescribe a uniform minimum standard of courses of training for obtaining graduate and post-graduate dental qualification.
- Prescribe minimum requirements for the content and duration of courses of studies for the degree of MBBS.
- Prescribe condition for admission to courses of training for the degree of MBBS.
- Prescribe the standards of examinations method of conducting the examination.

Curriculum Development, Review and Revision at Graduate and Post-graduate level is one of the major on-going activities of Higher Education Commission as provided under Section (10) Sub-Section (V) of its Ordinance No.LIII of 2002 and Ministry of Education, Government of Pakistan Notification No.D.733/76-JEA(Curr) dated December 4, 1976 appointed Higher Education Commission as the Competent Authority to look after the Curriculum Revision Work beyond Class XII at Bachelor level and onwards to all Degrees, Certificates and Diplomas awarded by Degree Colleges, Universities and other Institutions of higher education.
For this purpose senior teachers of all specialities in M.B.B.S. were invited to review/revise the existing curriculum. A draft curriculum was finalized after due consideration of the comments and suggestions received from the Universities and Colleges where the subject under consideration is taught.
The curriculum prepared by the National Curriculum Revision committee (NCRC) of Higher Education commission and Pakistan medical & Dental Council was approved by PM&DC which is being circulated for implementation by the concerned institutions.
This Curriculum is to be followed by all Medical Colleges and Universities in Pakistan to get registration of the Council for Medical practitioners.
(PROF.DR.ALTAF ALI G. SHAIKH) (DR.M. SOHAIL KARIM HASHMI)
ADVISER (Academics/R&D) SECRETARY 4
GUIDING PRINCIPLES
Pakistan Medical & Dental Council realized the situation to revise the MBBS curriculum in accordance with need, time and recent progress in the medical field. It is one of the main functions of PM&DC to lay down the minimum standard of basic and higher qualification in Medicine & Dentistry. The sub-section(2) of section 33 of PM&DC ordinance states the powers/function of the Council as:
- To prescribe minimum standard of courses of training for obtaining graduate and post graduate medical & dental qualifications.
- To prescribe minimum requirements for the content and duration of courses of studies for the degree of MBBS.

Medical education is a life long process and revision of MBBS curriculum is a part of education starting from pre-medical education, MBBS, and proceeding to house job, post-graduation, professional development and CME/CPD. Many areas of content extend into more than one discipline for e.g. genetics, bio-statistics, infectious diseases, diabetes mellitus, ethics. It is, therefore appropriate that no important aspect is left out and there should be no duplication. For this reason teachers from all disciplines have been involved in MBBS curriculum formulation. This document lays down general principles and guidelines in a flexible framework which allows universities and institutions to determine ways of teaching and student assessment within the bound of a uniform national curriculum. The Higher Education Commission (HEC) will monitor and ensure that the curriculum is being implemented by public as well as private universities and will also assist universities to implement curriculum. PM&DC through its monitoring process will make sure that the medical institutions are following the curriculum. It is important to build an indiginous curriculum which builds a competent and confident graduate who serves the society’s needs.
The curriculum should aim at application of knowledge and problem solving rather than only recall of factual knowledge and to define the psychomotor skills that the students should be able to perform themselves and differentiate them from those that should be observed. The overall curriculum document should emphasise on areas that the student must know, incorporate new fields of knowledge, and yet ensure that the student is not over burdened and hence eliminate details of uncommon conditions.
Additional compulsory courses should be balanced by the reduction of information overload by deleting obsolete material or those more relevant to postgraduate studies. Taking into consideration the rapid changes occurring in the field of Bio-medical Sciences, institutions wishing to add topics may do so. Advanced courses may be placed as elective opportunities. 5
Repetitive teaching of the same contents by different disciplines should be eliminated. It is not necessary to expect the student to know every thing, because of the ready availability of knowledge; therefore, the curriculum will be continuously refined to state principles and concepts; and clearly define what the student must know. Additional subjects such as English, Information Technology, Ethics, may be added by the universities as optional subject.
Instructional Strategy for implementing this curriculum and assessment is the responsibility of the concerned universities. Multiple methods of instruction should be encouraged. There should be flexibility in implementation, allowing implementation according to staff, faculty and resources.
The curriculum should be student oriented utilizing active processes for learning and should not make the student a passive recipient.
The curriculum should be attractive (and therefore should have early clinical involvement). Integration in education would reflect graduate function in real-world practice settings. It is recommended that the curriculum should move towards concurrent teaching of basic sciences in an organ based system; like introduction of a case-of-the-course, involving a clinical presentation which requires students to integrate knowledge from multiple disciplines/subjects; Integration of clinical and preventive sciences, where students are provided experiences to manage undifferentiated health problems. The university faculty should decide the order in which to teach subjects and the grouping of subjects specified in each examination. The desired humanistic attributes of a caring doctor with effective communication skills should be defined, methods that build these attributes should be included and tested, including trust-building in a professional patient-doctor relationship. In order to facilitate the learning process the students should be given more free time for self-study. This document represents the first phase in an ongoing effort to improve medical education across the country. At this stage, curricular content and general guiding principles have been enunciated and general terminal competencies are listed after the General Education Objectives, the preamble to the proposed curriculum. In the next phases of curriculum development detailed definition of the depth of study will be refined. With time, the Universities and institutions should move towards a uniform system of assessment.
1) Methodology*

1. Problem-based Learning
2. Tutorials/Practical sessions/Essential Skills and Lab practice
3. Clinical rotations and ward visits
6

4. Lectures/Seminars/CPC’s – using modern audio-visual techniques, distant learning using electronic devices and current Information Technology facilities.
5. Journal Club
6. Community -based learning
7. Acquisition of Competencies through any other sources

* It is mandatory for the institute to provide necessary teaching aids and training facilities to implement the methodology 7
SCHEME OF STUDIES
PROFESSIONAL MBBS EXAMINATIONS
1. First Professional MBBS Part-I Examination:

To be held at the end of the 1st year in the following subjects in course work completed in the first year:

PART-I
(a) Anatomy and Histology 

One Paper: 90 Marks
Internal Evaluation 10 Marks
Oral & Practical 90 Marks
Internal Evaluation 10 Marks
Total 200 Marks
(b) Physiology
One Paper: 90 Marks
Internal Evaluation 10 Marks
Practical & Oral Exam: 90 Marks
Internal Evaluation 10 Marks
Total 200 Marks
(c) Biochemistry
One Paper: 45 Marks
Internal Evaluation 5 Marks
Oral & Practical 45 Marks
Internal Evaluation 5 Marks
Total 100 Marks

PART-II
(a) Anatomy and Histology 

One Paper: 90 Marks
Internal Evaluation 10 Marks
Oral & Practical 90 Marks
Internal Evaluation 10 Marks
Total 200 Marks
(b) Physiology
One Paper: 90 Marks
Internal Evaluation 10 Marks
Practical & Oral Exam: 90 Marks
Internal Evaluation 10 Marks
Total 200 Marks 8

(c) Biochemistry 

One Paper: 45 Marks
Internal Evaluation 5 Marks
Oral & Practical 45 Marks
Internal Evaluation 5 Marks
Total 100 Marks
*Note: Any students who fails to clear the first Professional MBBS Part-I & Part-II examination separately in three chances availed or un-availed after becoming eligible for each examination shall cease to become eligible for further medical education in Pakistan.
2. 2nd Professional MBBS Examination:

To be held at the end of the 3rd year in the following subjects:
(a) Pharmacology & Therapeutics

Theory 135 Marks
Internal Evaluation 15 Marks
Oral & Practical 100 Marks
Animal experiment 35 Marks
Internal evaluation 15 Marks
Total 300 Marks

(b) Pathology General & Microbiology 

Theory 135 Marks
Internal Evaluation 15 Marks
Practical & Oral Exam 135 Marks
Internal Evaluation 15 Marks
Total 300 Marks
(c) Forensic Medicine

Theory 90 Marks
Internal Evaluation 10 Marks
Viva Voce 90 Marks
Internal Evaluation 10 Marks
Total 200 Marks
3. 3rd Professional Examination:

To be held at the end of the 4th year in the following subjects:

(a) Community Medicine 

Theory 135 Marks
Internal Evaluation 15 Marks
Oral & Practical 110 Marks
Internal Evaluation 15 Marks
Project 25 Marks
Total 300 Marks 9

(b) Special Pathology 

Theory 135 Marks
Internal Evaluation 15 Marks
Practical & Oral Exam: 135 Marks
Internal Evaluation 15 Marks
Total 300 Marks

(c) Otorhinolaryngology (ENT) 

Theory 90 Marks
Internal Evaluation 10 Marks
Oral & Practical 90 Marks
Internal Evaluation 10 Marks
Total 200 Marks

(d) Ophthalmology 

Theory 90 Marks
Internal Evaluation 10 Marks
Oral & Practical 90 Marks
Internal Evaluation 10 Marks
Total 200 Marks
4. Final Professional MBBS Examination:

To be held at the end of the 5th year in the following subjects:
(a) Medicine including Psychiatry & Dermatology

Theory
- Paper I 135 Marks
- Internal Evaluation 15 Marks
- Paper II 135 Marks
- Internal Evaluation 15 Marks
- Total 300 Marks
Clinical/Practical exam
- Clinical 240 Marks
- OSCE 30 Marks
- Internal Evaluation 30 Marks
- Total 300 Marks

(b) Surgery including Orthopaedic & Anaesthesia   

Theory
- Paper-I 135 Marks
- Internal Evaluation 15 Marks
- Paper II 135 Marks
- Internal Evaluation 15 Marks
- Total 300 Marks 10
Clinical/Practical exam
- Clinical 240 Marks
- OSCE 30 Marks
- Internal Evaluation 30 Marks
- Total: 300 Marks

(c) Obstetrics and Gynaecology 

Paper I 90 Marks
Internal Evaluation 10 Marks
Paper II 90 Marks
Internal Evaluation 10 Marks
Oral & Practical 180 Marks
Internal Evaluation 20 Marks
Total 400 Marks

(d) Paediatrics 

Theory 90 Marks
Internal Evaluation 10 Marks
Oral & Practical 90 Marks
Internal Evaluation 10 Marks
Total 200 Marks 11
DETAILS OF COURSES FOR MBBS ALL DISCIPLINES
SYLLABUS FOR 1ST PROFESSIONAL PART-I&II

PART-I
A. ANATOMY
GENERAL ANATOMY 

1. Brief history of Anatomy. Different disciplines of the subject
2. Anatomical nomenclature-descriptive terms
3. Skeletal system-bones

• Axial skeleton
• Appendicular skeleton
• Functions of bone
• Classification on the basis of shape, development, region

and structure
• General concepts of development & ossification of

bones
• Parts of young bone
• Blood supply
• Properties of bones and cartilages
• Applied aspects

4. Joints
• Structural classification
• Regional classification
• Functional classification
• Characteristics and classification of Synovial joints
• Movements of Synovial joints
• Anatomy of joints with reference to dislocation, sprain

and inflammation
5. Muscle
• Parts of a muscle
• Classification
• Blood supply and nerve supply of muscle
• Neuromuscular junction
• Applied anatomy of muscle with reference to spasm,

paralysis, atrophy and regeneration
6. Cardiovascular system
• Heart & Blood vessels
• Types of circulation
• Anastomoses
12
7. Lymphatic system
• Introduction
• Lymph capillaries
• Lymph Vessels
• Lymph nodes
• Main channels

8. Somatic Nervous system
• Introduction
• Different parts of Central Nervous System (CNS) with

their brief functions
• Peripheral nervous system (cranial and spinal nerves) —

introduction
9. Autonomic nervous system
• Introduction to parasympathetic and sympathetic nervous system

10. Skin and fasciae
• Parts of skin
• Appendages of skin
• Types of fasciae

11. Embalming & museum keeping

GROSS ANATOMY 

1. Upper limb
2. Lower limb
3. Thorax

GENERAL HISTOLOGY 

• Histology will be taught concurrently with Anatomy throughout the course. Underlying principles of histological techniques and staining should be given due consideration. Most of teaching will be done on stained and mounted sections and every type of normal tissue will be covered.
1. Cell
• Cell as a whole
• Cell Membrane
• Interior of cell
• Nucleus

2. Microscopy
3. Epithelial tissues
4. Connective tissue proper
5. Cartilage 13

6. Bone
7. Muscular tissue
8. Nervous System
• Nervous tissue
• Cerebral cortex
• Cerebellar cortex
• Spinal cord

9. Lymphoid organs
10. Circulatory system
11. Integumentary system
12. Routine histological techniques

GENERAL EMBRYOLOGY 

Embryology should be taught with the object of making students understand and grasp those fundamental principles, which result in better comprehension of the structural organization in the body. Stress should be laid on those developmental processes such as growth and differentiation, which have a direct bearing on clinical subjects. The genesis of congenital malformations should be one of the chief aims. All details should be kept on the essential outlines.
1. Male & female reproductive systems
2. Cell Division and Gametogenesis
3. Fertilization, cleavage, blastocyst formation and implantation
4. Development during second week
5. Development during third week
6. Embryonic period
7. Foetal period
8. Foetal membranes and Placenta
9. Introduction to genetics.

10.Teratogenesis
PART-II
ANATOMY
SPECIAL EMBRYOLOGY
1. Head and Neck
• Pharyngeal apparatus

(including pharyngeal arches, pharyngeal pouches & pharyngeal clefts)
• Tongue
• Thyroid
• Parathyroid
14

• Thymus
• Pituitary
• Upper respiratory system
• Face and palate

2. Body cavities
• Development of body cavities
• Formation of diaphragm

3. The respiratory system
4. The cardiovascular system
• Heart
• Great vessels
• Foetal circulation and changes at birth

5. The urinary system
• Development of Kidney
• Urinary bladder
• Urethra
• Development of adrenal glands

6. The male reproductive system
• Testis
• Genital ducts
• External genitalia

7. The female reproductive system
• Ovaries
• Oviducts
• Uterus
• Vagina
• External genitalia

8. The Musclo-skeletal system
• Development of skeleton
• Development of muscles

9. Development of Limbs
10. Development of Integumentary System(consisting of development of skin and its appendages and development of mammary glands)

11. Special Senses (eye and ear)
12. Nervous system
13. Digestive system
• Division of Gut tube
• Mesenteries
• Liver, Gall bladder, Pancreas, Spleen

GROSS ANATOMY 

1. Head & neck
2. Brain and spinal cord
3. Abdomen and pelvis 15
SPECIAL HISTOLOGY
• Digestive System
• Respiratory System
• Urinary System
• Male Reproductive System
• Female Reproductive System
• Endocrine Glands
• Organs of Special Senses

NEURO-ANATOMY 

• Spinal Cord
• Medulla Oblongata
• Pons
• Mid Brain
• Cerebellum
• Thallamus
• Hypothalamus
• Basal Ganglia
• Cerebral Cortex
• Autonomic Nervous System

During study of Gross Anatomy, emphasis should be given on applied aspect, radiological anatomy, surface anatomy and cross-sectional anatomy. 16
PART-I

B. BIOCHEMISTRY 

1. Introduction of Biochemistry:
Biochemistry of the Cell:
a) Introduction to cell (Biochemical point of view)
b) Scientific methods to study the cell biochemistry
c) Biochemical composition of the cell

2. Biochemistry of the Cell and Body Fluids:
a) Ionization of water & weak acids, bases
b) Concept of pH, and pH scale
c) Dissociation constant & titration curve of weak acids, the concept of pK values
d) Buffers, their mechanism of action
e) Henderson-Hesselbalch Equation (No derivation)
f) Types of particles, solution
g) Importance of selectively permeable membranes, osmosis, osmotic pressure, surface tension, viscosity & their importance related to body fluids

Carbohydrates:
a) Definition, biochemical function and classification
b) Structure and functions of Monosaccharides, and their derivatives
c) Disaccharides, their important examples
d) Oligosaccharides, their combination with other macromolecules
e) Polysaccharides, their important examples and biochemical role
f) The biomedical importance of carbohydrates

Proteins:
a) Definitions, Biomedical importance and classification of proteins based on

- Physiochemical properties
- Functional
- Nutritional
- Structural

b) Amino acids, their structure, properties & functions
c) Classification and nutritional significance of amino acids
d) Dissociation, titration and importance of amino acid in pH maintenance
e) Structure of proteins and their significance
f) Separation of proteins e.g. salting out, Electrophoresis, Chromatography, Centrifugation
g) Immunoglobulins and its biomedical significance
h) Plasma Proteins & their clinical significance
17
Nucleotide & Nucleic Acid:
a) Chemistry and structure of nucleosides and their biochemical role
b) Nucleotides, structure, their derivatives and their biochemical role
c) Synthetic derivatives of purine and pyrimidines, their role in health and disease
d) Nucleic acids, their types, structure and functions

Lipids:
a) Definition, biomedical function
b) Classification of lipids
c) Phospholipids, Glycolipids, Sphingolipids and their Biochemical Significance
d) Fatty acids, chemistry, classification and biochemical function
e) Essential fatty acids
f) Eicosanoids, their classification and functions in health and disease
g) Steroids, Sterol e.g. Cholesterol, their chemistry, functions and clinical significance
h) lipid peroxidation and its significance

Biological Membrane:
a) Biochemical composition
b) Biochemistry of cell membrane, chemical composition, importance of lipid and proteins in membranes, chemistry of signals and receptors
c) Biochemistry of membrane transport mechanism, active transport, passive transport, simple and facilitated diffusion

Enzymes:
a) Introduction, definition, mechanism of catalysis

b) Coenymes, co-factors
c) Isoenzymes, their clinical importance
d) Factors affecting enzymes activity, Michaelis-Menten Equation, Lineweaverburk equation and their application in enzyme kinetics (no derivation of equations)
e) Enzyme inhibitors and their classification & biomedical importance
f) Application of enzyme in clinical diagnosis and therapeutic use 18
Prophyrins & Hemoglobin:
a) Chemistry and biosynthesis of porphyrins and its disorders (Porphyrias)
b) Structures, functions and types of haemoglobin
c) Oxygen binding capacity of haemoglobin, factors affecting and regulating the oxygen binding capacity of haemoglobin
d) Degradation of heme, formation of Bile pigments, its types, transport and excetion
e) Hyperbilirubinimea, their biochemical causes and differentiation, jaundice and its types
f) Haemoglobinopathies (Hb-S, thalassaemia etc.) and their biochemical causes.

Vitamins:
a) Introduction, classification
b) Chemistry, Biochemical Functions, Deficiency manifestations, daily allowances and source of water soluble and fat-soluble vitamins
c) Hypervitaminosis

Biochemistry of Digestive Tract:
a) Introduction of digestion and absorption
b) Introduction, composition, functions, daily secretion, stimulants and depressants of

- Saliva
- Gastric Juice & HCL
- Pancreatic Juice
- Bile Juice
- Succus Entericus

c) Digestion and absorption of carbohydrates, proteins, nucleic acid and lipids
d) Biochemical disorders of GIT, e.g. achlorhydria, peptic ulcers, lactose intolerance, cholelithiasis and related disorders

Mineral & Trace Elements:
a) Classification and Biochemical role of:

- Macro minerals (Na, K, Ca, Cl, PO4)
- Micro minerals (Fe, Zn, Mg, Se, I, Cu, Cr, Cd, Mn)
19

PART-II
B. BIOCHEMISTRY 

1. Bioenergetics and Biological Oxidation:
a) Endergonic and exergonic reactions, their coupling through ATP
b) Biologic oxidation and reduction, methods of electron transferring, redox potential, enzymes and coenzymes of biologic oxidation and reduction
c) Respiratory chain and oxidative phosphorylation, components of respiratory chain, electron carriers
d) ATP synthesis coupled with electron flow, phosphorylation of ADP coupled to electron transfer
e) The ATP-synthase, their relation to proton pump, PMF, and active transport
f) Uncouplers and inhibitors of oxidative phosphorylation
2. Introduction to Metabolism:

Metabolism of Carbohydrates
a) Glycolysis

- Phases and reactions of Glycolysis
- Energetics of Aerobic and Anaerobic gylcolysis and their importance
- Regulation of Glycolysis
- Cori’s cycle
- The fate of Pyruvate

b) The Citric Acid Cycle
c) Reactions, energetics and regulation and importance of Citric acid cycle

- Amphibolic nature of citric acid cycle. The anpoleratic reactions and regulations of TCA cycle

d) Gluconeogenesis

- Important three by-pass reaction of gluconeogenesis
- Entrance of amino acids and intermediates of TCA cycle and other nutrients as gluconeogenic substrates
- Significance of gluconeogenesis

e) Glycogen Metabolism

- Reactions of Glycogenesis and gylocogenolysis
- Importance of UDP-Glucose
- Regulation of Glycogen Synthase and Glycogen Phosphorylase
- Glycogen phosphorylase ‘a’ and the blood glucose sensor
- Disorders of Glycogen metabolism (Glycogen Storage Diseases)
20

f) Secondary pathways of carbohydrate (Hexose) metabolism

- Hexose Mono Phosphate Shunt, its reactions and importance
- Glucuronic acid pathway, its reactions and importance

g) Metabolism of Fructose, Galactose and Lactose
h) Regulation of Blood Glucose Level

- Hyperglycemia, hypoglycemia and their regulating factors
- Biochemistry of Diabetes Mellitus, its Laboratory findings and Diagnosis

3. Metabolism of Lipids:
a) Mobilization and transport of fatty acids, tricylglycerol, and sterols
b) Oxidation of fatty acids

- Activation and transport of fatty acid in the mitochondria
- B-oxidation, fate of Acetyl CoA, regulation of B-oxidation
- Other types of oxidation, i.e. alpha-oxidation, w-oxidation, peroxisome oxidation, oxidaton of odd number carbon containing fatty acids and Unsaturated fatty acids etc.

c) Ketogenesis

- Mechanism and utilization of Ketone bodies and significance
- Ketosis and its mechanism

d) Biosynthesis of fatty acids
e) Eicosanoids, synthesis from Arahidonic acid, their mechanism and biochemical functions
f) Triacylgycerol synthesis and regulation
g) Synthesis and degradation of phospholipids and their metabolic disorders
h) Cholesterol synthesis, regulation, functions, fate of intermediates of Cholesterol synthesis, Hypercholesterolemia, Atherosclerosis
i) Plasma Lipoproteins, VLDL, LDL, HDL, and Chylomicrons, their transport, functions and importance in health and disease
j) Glycolipid metabolism and abnormalities
4. Metabolism of Proteins and Amino Acids:
a) Amino acid oxidation, metabolic fates of amino acid, transamination, deamination decarboxylation, deamidation and transamination
b) Transport of amino group, role of Pyridoxal phosphate, Glutamate, Glutamine, Alanine
c) Ammonia intoxication, Nitrogen excretion and Urea formation, Urea cycle and its regulation, genetic defects of Urea cycle
21

d) Functions, pathways of amino acid degradation and genetic disorders of individual amino acids
5. Integration and regulation of Metabolic Pathways in Different Tissues:
6. Metabolism of Nucleotide:
a) De Novo Purine synthesis
b) Synthesis of Pyrimidine
c) Recycling of purine and pyrimidine bases (The salavage pathway)
d) Degradation of purine, formation of Uric acid
e) Disorders of purine nucleotide metabolism
7. Biochemical Genetics (Informational Flow in the Cell):
a) The structural basis of the cellular information
b) DNA, Chromosomes, Discovery and organization of DNA in Genomes
c) Super coiling of DNA
d) The replication of DNA (DNA dependant DNA synthesis)

- DNA polymerase, its components and functions
- Initiation, elongation and termination of Replication
- DNA Repair, Mutation and Cancers

e) The Transcription (DNA dependant RNA synthesis)

- RNA polymerase, its components and functions
- Initiation, elongation and termination of transcription
- RNA processing
- RNA dependant synthesis of RNA and DNA
- Reverse transcription — DNA synthesis from Viral RNA
- Retroviruses in relation to Cancer and AIDS

f) The Translation (Protein Synthesis)

- The genetic codes and their characteristics
- Initiation, elongation and termination of protein synthesis
- Post-translational modification
- Regulation of Gene Expression

g) Molecular biology technology

- DNA isolation
- DNA-recombinant technology
- Hybridization, blotting techniques

h) Genetic disorders 

8. Biochemistry of Endocrine System:
a) Chemistry, Secretion, Mechanism of action, regulation and effect on Carbohydrates, Lipids, Proteins, Mineral and water metabolism and disorders of various endocrine glands
9. Biochemistry of water & Electrolyte imbalance and Acid Base Balance:
10. Nutrition:
a) Caloric requirements of the body
b) Balanced Diet
c) Protein Energy Malnutrition

- Marasmus
- Kwashiorkor
- Marsmic-Kwashiorkor

d) Nutritional requirements in:

- Pregnancy
- Lactation
- New born
- In nutritional disorders

Laboratory Practicals
Introduction to use of laboratory facilities / equipments
Basic techniques and fundamental information
Preparation of solutions-Normal solution and Normal saline
Experiments on Carbohydrates qualitative analysis
Experiments on proteins-qualitative analysis
Experiments on Fats-qualitative analysis
Chemical analysis of Urine-Normal and abnormal specimens
8. The techniques and instrumentation of clinical biochemistry
a) Spectrophotometry
b) Flame photometry
c) UV Spectrophotometry
d) PH metery

e) Collection and preservation of clinical specimens
9. Estimation and clinical interpretation of:
a) Blood Glucose
b) Glucose Tolerance Test (Demonstration)

10. Determination of Amino acids in Urine by Paper Chromatography (Demonstration)
11. Estimation of various biochemical parameters in blood (urea,uric acid, creatinine, billirubin ,Protein, cholesterol and electrolytes)
12. Measurements of plasma enzymes (ALT, AST, LDH, CK, ALP and amylase 23
PART-I

C. PHYSIOLOGY 

Basic Concepts Clinical/Applied Concepts  
General Physiology/Cell  
Functional organization of human body Abnormalities of the cell and its organelles  
Homeostasis  
Control systems in the body  
Cell membrane and its functions  
Intercellular Connections  
Cell organelles  
Transport through cell membrane  
Genetics  
Blood  
Composition and General Functions  
Plasma Proteins  
Red Blood Cell (Erythropoiesis) Anaemia  
Haemoglobin & Blood Indices, Iron metabolism, Fate of Hb. Blood indices in various disorders  
White Blood Cells,
Leucopoiesis,functions Leucopaenia, Leucocytosis  
Platelets Thrombocytopaenia  
Haemostasis Clotting disorders (Haemophilia etc.)  
Blood Groups,
Blood Transfusion & complications
Reticuloendothelial System – Spleen Blood grouping/cross matching & significance
Immunity  
Nerve and muscle  
The neuron-structure & functions  
Properties of Nerve Fibres Nerve conduction studies  
Physiology of action Potential including compound action potentials EMG  
Conduction of Nerve Impulse, Nerve
Degeneration and regeneration
Synapses Nerve Injury  
Structure of the Muscle  
Skeletal muscle contraction Rigor Mortis & Contractures  
Isometric and isotonic contraction  
Smooth muscle contraction  
Neuromuscular Transmission Myasthenia Gravis  
Excitation — contraction coupling Myopathies/Neuropathies  
Motor Unit

PART-II

D. PHYSIOLOGY

Body fluids and Kidneys

Compartments of body fluids & measurement

Renal function tests

Tissue and lymph fluids

Fluid Excess/depletion

Structure of Kidney/Nephron

General functions of kidney

GFR-factors regulating

Formation of urine, filtration, reabsorption, secretion

Plasma Clearance

26

Concentration & Dilution of urine

Renal failure/uraemia

Electrolyte Balance

Water Balance

Regulation of blood pressure by kidneys

Nephrotic syndrome

Hormones of kidneys

Acidification of urine

Artificial kidney/Hemodialysis

Acid Base balance

Metabolic acidosis/alkalosis

Micturition

Abnormalities of micturition including incontinence

Nervous system

Organization of Nervous system

Significance of Dermatomes

Classification of nerve fibres

Properties of Synaptic transmission

Neurotransmitters and neuropeptides

Types and function of sensory receptors

Receptors & Neurotransmitters (applied aspect)

Functions of spinal cord, ascending tracts

Reflex action/ reflexes

Interpretation of Reflexes

Muscle spindle / muscle tone

UMN/LMN Lesion-features and localisation

Tactile, temperature and pain sensations Structure of cerebral cortex

Injuries and diseases of spinal cord, Analgesia system

Sensory Cortex

Disorders of cranial nerves

Motor Cortex

Motor pathways, (Pyramidal & extra pyramidal)

Hemiplegia/Paraplegia

Basal Ganglia, connections and functions

Parkinsonism & other lesions of basal ganglia

Cerebellum, connections and functions

Cerebellar Disorders

Vestibular Apparatus/Regulation of Posture & Equilibrium

Sleep Disorders

Reticular formation

Physiology of sleep/EEG

Physiology of memory

Higher mental function assessment

Physiology of speech

Abnormalities of speech

Thalamus-Nuclei & functions

Thalamic syndrome

Hypothalamus & limbic System

Lesion of Hypothalamus

Cerebrospinal fluid

Regulation of body temperature

Functions of skin

Hydrocephalus

Autonomic Nervous System

Physiology of aging

27

Special senses

Structure & functions of eye-ball

Intraocular pressure & Glaucoma

Optical Principles

Accommodation of eye

Errors of refraction

Visual acuity

Photochemistry of vision

Colour vision/night blindness

Colour blindness, fundoscopy

Dark and light adaptation

Neural function of Retina

Visual pathway, light reflex and pathway

Visual cortex

Field of vision and lesions of visual pathway

Intraocular fluids

Eye movements and control

Visual evoked potentials and electroretinogram

Physiological anatomy of cochlea

Functions of external & middle Ear

Functions of inner Ear-Organ of Corti

Auditory pathway

Hearing test audiometry

Physiology of smell- receptors and pathway

Types of deafness

Physiology of taste

Auditory evoked potentials

Olfaction/taste abnormalities

Endocrinology

General principles(classification, mechanism of action, feed back control)

Acromegaly, Giantism

Biosynthesis, transport, metabolism, actions and control of secretion of hormones of:

Hormonal assay

Hypthalamus

Anterior Pituitary

Dwarfism

Posterior Pituitary

Panhypopituitarism

Thyroid gland

Sheehan’s syndrome

Parathyroid, calcitonin

Diabetes insipidus

Adrenal Medulla

Syndrome of inappropriate ADH secretion

Andrenal Cortex

Myxoedema, Cretinism, thyrotoxicosis

Pancreas

GIT

Pheochromocytoma

Pineal gland

Cushing’s syndrome, Conn’s syndrome

Thymus

Addision’s disease, Adrenogenital syndrome

Kidney

Diabetes Mellitus &Hypoglycemia

Physiology of growth

Zollinger Ellison’s syndrome

28

Reproduction

Functional anatomy of Male reproductive system

Chromosomal abnormalities

Spermatogenesis

Semen analysis

Male infertility

Erection and ejaculation

Testosterone

Male puberty

Oogenesis and functional anatomy of female gonads

Oestrogen & Progesterone

Female infertility

Menstrual cycle

Contraception

Puberty and Menopause

Pregnancy Tests

Pregnancy — Physiological changes in mother during pregnancy

Placenta

Parturition

Lactation

Neonatal Physiology

EXPERIMENTAL PHYSIOLOGY

Haematology

Study of the microscope

Determination of:

Haemoglobin (Hb%)

Erythrocyte sedimentation Rate (ESR)

Packed cell volume (PCV)/Haematocrit

Bleeding Time (BT)

Clotting Time (CT)

Blood Groups

Study of Neubauer chamber

RBCs Count

Red cell indices

WBCs Count

Differential leucocyte Count (DLC)

Osmotic fragility of RBCs

Demontration of prothrombin time and thrombin time

Respiratory System

Clinical examination of chest

Measurement of Pulmonary volumes and capacities (Spirometry)

Stethography

29

Nervous System

Examination of superficial reflexes

Examination of deep reflexes

Examination of sensory, motor system

Clinical examination of cranial nerves

Cardiovascular System

Frog’s Heart

Recording of normal cardiogram and affect of temperature

Effect of drugs on cardiac contractility

Effect of Ions on cardiac contractility

Properties of cardiac muscle in frog’s heart (Demonstration)

Study of sheep’s heart

Cardiopulmonary resuscitation

Cold pressor test

Triple response

Examination of arterial pulse

ECG recording/interpretation

Measurement of arterial blood pressure

Effect of exercise & posture on BP

Examination of Apex Beat

Heart Sounds- auscultation of normal sounds/murmurs

Special Senses

Field of vision by confrontation method

Field of vision by Perimetry

Light reflex

Ophthalmoscopy

Visual acuity

Colour Vision

Hearing tests

Audiometry

Taste Sensation

Olfaction sensation

30

Frog’s Nerve & Muscle

Simple muscle twitch (SMT) in frog and effect of temperature

Effect of fatigue on muscle contraction

Tatanization in frog’s muscle (Demonstration)

Effect of two successive stimuli on SMT (Demonstration)

Effect of preload and after load on SMT (Demonstration)

Determination of velocity of conduction in

sciatic nerve (Demonstration)

Use of Physiograph (polygraph)

Elicit fatigue in human index finger

Miscellaneous

Recording of body temperature

Pregnancy tests

Introduction to biostatistics e.g. data collection and analysis

- Vitalograph

- Nerve conduction studies

- Muscle conduction studies

- Evoke Potential

SYLLABUS FOR SECOND PROFESSIONAL

PATHOLOGY AND MICROBIOLOGY

(A) GENERAL PATHOLOGY

A. CELL INJURY:

1. Definition of necrosis, ischemia, hypoxia, infarction and gangrene.

2. Sequence of the structural and biochemical changes which occur in the cell in response to the following:

• Ischemia

• Immunological injury – e.g. Asthma/SLE/Anaphylactic reaction

• Physical agents: e.g. Radiation

• Genetic defects — e.g. Thalassaemia/haemophilia

• Nutritional deficiency — e.g. Kwashiorkor

• Infectious agents

• Viruses: e.g. Hepatitis

• Bacteria: e.g. Staphylococcus aureus

• Fungi: e.g. Candida

• Parasites: e.g. Malaria

3. Irreversible and reversible injury.

4. Apoptosis and its significance.

5. The necrosis and its types.

6. Exogenous and endogenous pigment deposition.

7. Dystrophic and metastatic calcification along with clinical significance.

31

8. Metabolic disorders

• lipid disorders, steatosis of liver, hyperlipidemia

• protein disorders

• carbohydrate disorders

9. Adaptation to cell injury, atrophy, hypertrophy, hyperplasia, metaplasia.

B. INFLAMMATION, MEDIATORS OF INFLAMMATION

The role of inflammation in the defence mechanisms of the body.

The vascular changes of acute inflammation and their relation to the

morphological and tissue effects.

The process of chemotaxis, opsonization and phagocytosis.

The role of cellular components in inflammatory exudate.

Exudate and trasudate.

Important chemical mediators of inflammation.

The pathway of Arachidonic Acid metabolism.

The role of products of Archidonic acid metabolism in inflammation.

The mechanism for development of fever, with reference to exogenous and

endogenous pyrogens.

Chronic inflammations/Granulomatous diseases.

The systemic effects of acute and chronic inflammation and their possible

outcomes.

Significance of ESR.

Examples of induced hypothermia in medicine.

Pathogenesis, clinical features and lab. Diagnosis of Gout.

Management of acute and chronic Gout.

C. WOUND HEALING:

1. Differences between repair and regeneration.

2. Wound healing by first and second intention.

3. Factors that influence the inflammatory reparative response.

4. Wound contraction with cicatrization.

5. Formation of granulation tissue.

6. Complications of wound healing.

D. DISORDERS OF CIRCULATION

a. THROMBO-EMBOLIC DISORDERS AND THEIR MODALITIES:

1. Pathogenesis of thrombosis.

2. Possible consequences of thrombosis

3. Define and classify emboli according to their composition.

b. DISORDERS OF THE CIRCULATION AND SHOCK:

1. Definition of edema, ascites, hydrothorax and anasarca.

2. Pathophysiology of edema with special emphasis on CHF.

3. Pathogenesis of four major types of shock (Hypovolemic, cardiogenic, vasovagal & septic) and their causes.

4. Compensatory mechanisms involved in shock.

32

E. MICROBIOLOGY

1. Defence mechanisms of the body.

2. Microbial mechanisms of invasion and virulence.

3. Differentiation between sterilization and disinfection.

4. Methods of disinfection and sterilization of the following:

a). Facility where he practices, b) Examination table c) Any spillage e.g. sputum, vomitus, stool, urine, blood, d) Examination tools e.g. thermometer, nasal and ear specula and spatula.

5. Principles of aseptic techniques such as: Venepuncture, urinary catheterisation, bandaging, suturing and lumber puncture.

6. Universal precautions for infection control.

7. General principles of the following serological tests:

• ELISA — Hepatitis (A, B, C, D, E, G) Rubella, CMV and HIV

• Haemagglutination — TPHA

• Western blot - HIV

• ICT — Malaria.

8. Interpretation: a) Culture reports, b) Serological reports and c) microscopic reports of gram stain and AFB stain.

9. Principles of proper collection and submission of specimens for laboratory investigations with due precautions.

10. General characteristics and taxonomy of Bacteria, Rickettsia, Chlamydia Viruses and Fungi.

11. Definition of communicable endemic epidemic and pandemic diseases, carriers, pathogens, opportunists, commensals and colonizers.

12. Micro-organisms responsible for infection of the following organ systems:

• Central nervous system

• Respiratory system

• Gastrointestinal system

• Genital infections

• Urinary system

• Infections of bone and joints

• Zoonosis

• Infection of the skin

• Hepatic infections

13. Pathogenesis, treatment, epidemiology, prevention and control of the following organisms.

Bacteria: Staphylococcus aureus, streptococcus pneumoniae, Beta hemolytic streptococcus group A & B, Diphtheria sp. Bordetella sp. Bacillus anthracis, clostridium perfringens, clostridium botulinum, clostridium difficile, clostridium tetani, Actinomycies israelli, Nocardia asteroides, Neisseria meningitis, Neisseria gonorrhoeae, Gardenella vaginalis, Haemophilus influenzae, Mycobacterium tuberculosis,

33

Mycobacterium leprae, E.Coli, Klebsiella, Proteus, Salmonella, Shigella, Yersinia pestis, Pseudomonas, Vibrio cholera, Vibrio parahemolyticus, Campylobacter jejuni, Helicobacter pylori, legionella, Mycoplasma pneumoniae, Chlamydia, Traponema pallidium, Leptospira, Rickettsia sp.

Viruses: Entero, Mumps, Herpes, Adeno, Measles, Influenza, Parainfluenza, Rhino RSV, Hepatitis A, B, C, D, E, Rota, Astro, CMV, EBV, Rubella, Chicken pox, Arbo, HIV Rabies.

Fungus: Cryptococcus neoformis, Candida albicans, Tinea species, Immunity: Types of Immune Cells, Structure & Function of Immunity , Hypertensitivity Reactions, Autoimmune diseases\

PRINCIPLES OF ANTI-MICROBIAL ACTION

1. Definitions: antibiotics, selective toxicity, bacteriostatic and bactericidal.

2. Host determinants in relation to selection of an antimicrobial drug for therapy.

3. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC)

4. Bacterial resistance and the mechanisms involved in acquiring bacterial resistance.

5. Mechanisms involved in transfer of drug resistance to bacterial resistance.

6. Mode of action of various antimicrobial drug groups.

7. Super infection and cross sensitivity.

34

LIST OF COMMON ORGANISMS CAUSING ORGAN SYSTEM EFFECTS

Common organisms causing CNS Infections

Bacteria: Steptococcus pneumoniae, Neiseria meningitidis, Haemophilis influenza, Beta hemolytic streptococcus group B, E.Coli, Listeria monocytogenes and Mycobacterium tuberculosis.

Viruses: Entero, Mumps, Herpes, Adeno.

Fungus: Cryptococcus neoformis

Protozoa: Malaria

Common organisms causing Respiratory Tract Infection

Bacteria: Steptococcus pneumoniae, Haemophilis, influenza, Beta hemolytic streptococcus group B, Klebsella, Legionella, Mycoplasma pneumonae and Mycobacterium tuberculosis, Chlamydia, Staph aureus, Diptheria sp. Bordetella sp.

Viruses: Measles, Herpes, Adeno, Influenza, Parainfluenza, Rhino, RSV.

Protozoa: Pneumocyctic carinii.

Common organisms causing gastrointestinal infection/infestation

Bacteria: Salmonella, Schigella, Vibrio cholerae, Mycobacterium tuberculosis, Campylobacter jejuni, Helicobacter pylori, Clostridium perfringens, Staph. aurius, Bacillus cereus, Vibrio parahemolyticus, Clostridium botulinum, Clostridium difficle.

Viruses: Hepatitis A, Rota, Astro.

Fungus: Cryptococcus neoformis.

Protozoa: Giardia lamblia, E. histolytica, Cryptosporidium.

Common organisms causing hepatic infections

Bacteria: Streptococcus species, Coliforms and Anaerobes.

Viruses: Hepatitis A, B, C, D, E, G, CMV, EBV, HERPES Simplex.

Protozoa: E.histolytica.

Common organisms causing skin infection

Bacteria: Staph aurius, Strep pyogenes, Actinomyces israilli, Nocardia asteroides, Cornybacterium diptheria, Mycobacterium tuberculosis, Mycobacterium leprae.

Viruses: Small pox, Moluscum contagiosum, Herpes, Measles, Rubella, Chicken pox,

Fungus: Candida albicans, Tinea species.

Arthropodes: Sarcoptes scabiei, Pediculus species, Cinex lectularius.

Helminths: Filaria species, Strongoloides stercoralis, Schistosomia sp.

Protozoa: Leishmenia species.

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Common organisms causing bone and joint infection

Bacteria: Staph aureus, Streptococcus pyogenes, Haemophilus influenzae, Neisseria gonorrhoeae, Brucella melitenesis Salmonella typhi, Strep. pneumonae, Pseudomonas sp. and Mycobacterium tuberculosis.

Viruses: Rubella, Arbo, Entero and mumps.

Fungi: Madurella mycetoma.

Common organisms causing urinary tract infection

Bacteria: E.Coli, Klebsella, Enterococcus, Proteus, Staph, Saprophyticus, Mycobacterium tuberculosis.

Common organisms causing genital infection

Bacteria: Mycoplasma urealyticum.

Viruses: Pox, Herpes, Hepatitis B, HIV.

Fungus: Candida albicans.

Arthropodes: Sarcoptes scabiei.

Protozoa: Tricomonas vaginalis.

Common organisms causing Zoonosis

Viruses: Rabies.

Protozoa: Toxoplasma gondii, leishmania sp.

Helmenthics: Echinococcus sp.

F. GENETICS

1. Common sex linked, autosomal recessive and autosomal dominant disorders.

2. Common genetic mutations.

3. Diseases associated with consanguineous marriages.

G. NEOPLASIA

1. Classification systems of tumours.

2. Characteristics of benign and malignant tumours.

3. Grading and staging system of tumours.

4. Biology of tumour growth

5. Process of carcinogenesis

6. Host defence against tumours.

7. Mechanism of local and distant spread.

8. Local and systemic effects of tumours.

9. Tumour markers used in the diagnosis and management of cancers.

10. Common Chemical, Physical agents and Viruses related to human cancer.

11. Epidemiology of common cancers in Pakistan.

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H. IMMUNOLOGY

Definition antigen, antibody, epitope, hapten and adhesion molecules.

Differentiate between innate and acquired immunity.

The structure and function of Major Histocompatibility Complex (MHC).

Cytokines.

The mechanism of humoural and cell medicated immunity.

Type I, type II, type III and type IV hypersensitivity reactions giving relevant

examples.

Definition autograft, homograft, allograft and xenograft.

Immunotolerance and immunoparalysis.

Discuss the mechanism involved in allograft rejection and steps that can be

taken to combat rejection.

Classification of immunodeficiency disorders.

The basis of autoimmunity.

Amyloidosis-Pathogenesis, classification.

I. PARASITOLOGY

Protozoa: Plasmodium species, Giardia lamblia, Entamoeba histolytica, Leishmania species, Tricomonas vaginalis, Toxoplasma gondii, Pneumocyctis carinii, Trypanosoma, Balantidium Coli.

Helminths:

A. Cestodes Taenia(Solium, Saginata), Echinococcus species,

Hymenolepis nana. Diphyllobothrium latium.

B. Nematodes

Filaria species, Ascaris lumbricoides, Ancylostoma duodenale, Enterobius vermicularis, Trichuris trichiuria, Trichinella spiralis, Strongoloides stercoralis, Loa Loa.

C. Trematodes Schistosomia (Haematobium, Mansoni, Japanicum),

Fasciola Hepatica, Clonorchis Sinensis

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PHARMACOLOGY

The details of the syllabus are as under:

Theory

1. General Pharmacology:

• Definition of Pharmacology, Objectives of learning Pharmacology, definition of drug and drug nomenclature.

• Standard sources of drug information, pharmacopoeias, formularies.

• Branches/Divisions of Pharmacology.

• Sources of drugs.

• Active principles of drugs and Pharmacopoeias.

• Dosage forms and doses of drugs.

• Drug administration.

• Absorption of drugs and processes involved in drug absorption ( transport of drugs across cell-membrane)

• Factors modifying absorption of drugs.

• Bioavailability, its clinical significance and factors affecting bioavailability.

• Drugs reservoirs, distribution and redistribution of drugs, plasma protein binding.

• Pro-drug, Biotransformation of drugs, enzyme induction, enzyme inhibition and entero-hepatic circulation.

• Plasma half-life of drugs, steady state concentration, its clinical importance and factors affecting it.

• Excretion of drugs.

• Mechanism of drug action.

• Dose response curves, structure-activity relationship.

• Factors modifying action and doses of drugs.

• Drug-drug interactions.

2. Locally Acting Drugs

• Demulcents, Emollients, Irritants, Counter irritants, Astringents, anti-seborrhoeics, Locally acting enzymes.

• Antiseptics and Disinfectants

• Ectoparasiticides

3. Drugs Acting on Gastrointestinal Tract

• Anti Emetics

• Drugs affecting motility of GIT

• Ulcer Healing drugs

• Purgatives/Laxatives

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4. Cardiovascular Drugs

• Anti-arrhythmic Drugs

• Inotropic Drugs/Drugs used in cardiac failure.

• Anti-hypertensive Drugs

• Anti-anginal Drugs

• Thrombolytics/Anti-coagulants/Anti-platelets

• Anti-hyperlipidemic Drugs

5. Diuretics

6. Autocoids

7. Drugs Acting on Autonomic Nervous System

Cholinergic Drugs

• Choline Esters.

• Anticholine-esterases,.

• Cholinomimetic Alkaloids

Anti-cholinergic Drugs

• Anti-Muscarinic

• Anti-Nicotinic

Sympathomimetics/Adrenergic Drugs

• Catecholamine

• Non-Catecholamine

Sympatholytics/Antiadrenergics

• Alpha Adrenergic receptor Blockers.

• Beta Adrenergic receptor Blockers

Adrenergic Neurone Blockers

Autonomic Ganglionic Blockers

Skeletal Muscle Relaxants

a) Neuromuscular Blocking Agents.

b) Central Muscle Relaxants.

c) Directly acting skeletal muscle and relaxants.

8. Central Nervous System

a. Sedative-Hypnotics

b. Antiepileptics

c. General Anaesthetics

d. Local Anaesthetics

e. Drugs For Movement Disorders/ Anti Parkinsonism Drugs

f. Alcohol

g. Drugs For Migraine

h. Psychopharmacology

• Anti-psychotics —

• Anxiolytics —

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• Anti-Depressants/Anti-mania

9. Analgesics

a) Opioids

b) Non-Steroidal Anti-Inflamatory Drugs (NSAID)

c) Anti-gout Drugs

d) DMARDs

10. Drugs Acting on Respiratory System

a. Drugs used in treatment of Bronchial Asthma

b. Expectorants

c. Mucolytics

d. Anti-tussives

11. Drugs Acting on Endocrine System:

a. Pituitary-Hypothalamic Drugs

b. Adrenocorticoids

c. Sex Hormones/Hormonal contraception

d. Thyroid/ Parathyroid Drugs

e. Pancreatic Hormones and Oral Antidiabetic Agents

f. Drugs used in infertility

12. Drugs Acting on Uterus

Ergometrine, Terbutaline, Dinoprostone, Carboprost, Ritodrine, Oxytocin.

Antimicrobial Drugs

a) Sulfonamides

b) Penicillins

c) Cephalosporins

d) Aminoglycosides

e) Tetracyclines

f) Macrolides

g) Quinolones

h) Anti-tuberculous drugs

i) Antileprotic drugs

j) Anti-fungal drugs

k) Anti-viral drugs

l) Anti-protozoal drugs

• Anti-malarial drugs

• Anti-amoebic drugs

m) Urinary tract anti-septics

n) Anti cancer drugs

o) Immunosuppressive agents

p) Miscellaneous

q) Antihelmintics

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CLINICAL PHARMACOLOGY/THERAPEUTICS

The teaching of clinical Pharmacology should be designed to meet the daily needs of medical graduates. It should consist of lectures and demonstrations.

• Drug treatment of peptic ulcer

• Drug treatment of bronchial asthma

• Drug treatment of epilepsy

• Treatment of Parkinsonism syndrome

• Drug treatment of rheumatic diseases

• Drug treatment of ischaemic heart disease.

• Drug treatment of hypertension

• Treatment of congestive heart failure

• Drug treatment of hyperlipidemia

• Drug treatment of heavy metal poisoning

• Drug treatment of oedema

• Drug treatment of different types of shock

PRACTICALS P R A C T I C A L S

A. EXPERIMENTAL PHARMACOLOGY

Experiments designed to observe the action of drugs on animals and isolated tissue.

Experiments on the actions of selected drugs to be demonstrated to students on suitable animal/tissue models.

1. Effects of drugs on reflex time.

2. Effects of drugs on CNS.

3. Effects of drugs on heart.

4. Effects of drugs on blood vessels.

5. Effects of drugs on eye.

6. Effects of acetylcholine and atropine on isolated ileum.

7. Effects of histamine and antihistamines on isolated ileum.

8. Schemes to find out unknown drug having stimulatory or inhibitory effect on isolated ileum

B. PRESCRIPTION WRITING

General principles

• Guideline for rationale use of drugs

• Prescription writing for common ailments:

• drug concept

• Acute watery diarrhoea

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• Bacillary dysentery

• Amoebic dysentery

• Ascariasis

• Tape-worm infestation

• Acute streptococcal pharyngitis

• Iron deficiency anaemia

• Allergic rhinitis

• Scabies

• Acute malarial fever

• Cerebral malaria

• Typhoid fever

• Bronchial asthma

• Hypertension

• Migraine

• Cardiac failure

• Shock

Clinicopharmacological Seminars on Rational Drug Therapy and Drug Interaction should be conducted

Antibiotics, vitamins, analgesics etc.

Antibiotics

1) Frequency, distribution of antibiotic prescribed in different clinical settings/units.

2) Rational prescribing pattern of antibiotics

Parameters:

Provisional Diagnosis, Investigation, Empirical Therapy, prescribing after culture and sensitivity.

Vitamins

Parameters:

a) Groups of vitamins prescribed.

b) Vitamins prescribed on basis of therapeutic indication or empirical.

c) Single/multiple vitamins prescribing.

d) Frequency of prescribing and rational use of vitamins/otherwise.

Analgesics

Parameters:

a) Frequency distribution of various groups of analgesics prescribed.

b) Single/multiple adverse drug prescription.

c) Non specific indications of analgesics prescribed.

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Adverse Drug Reactions

a) Anti-microbials, Cytotoxic drugs, Steroids etc.

General Objectives:

It is expected that at the end of medical training, the students will be able to:

1. Prescribe drugs rationally

2. Monitor the drug therapy.

3. Observe drug interactions and adverse drug reactions (ADR).

4. Manage drug over dosage and poisoning.

FORENSIC MEDICINE & TOXICOLOGY

COURSES OF STUDY

1. FORENSIC MEDICINE

a) PAKISTAN’S LEGAL SYSTEM

Students should be able to:

Describe the powers and jurisdiction of courts, procedures for inquest, and legal Procedures.

Define important Legal terms.

Debate the application of relevant Legal sections of the penal code.

Define the role of a medical doctor in the medico-legal system.

Give medical evidence in courts.

Document information to be prepared by a medical doctor for legal procedures.

Describe Procedure of Court attendance and recording of evidence.

b) FORENSIC SCIENCES

The student will:

Describe the role of Forensic Sciences in Crime detection.

c) LAW IN RELATION TO MEDICAL MEN

The student will:

Understand and act according to and within the framework of Privileges and obligations of Registered medical practitioner.

Maintain a Doctor-patient relationship in the context of he highest ethical standards.

Understand and refrain from any temptations to professional misconduct.

Guard Professional secrets and privileged communication.

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Maintain highest ethical principles in medical examination and when obtaining consent.

Define what constitutes medical negligence.

Debate the pros and cons of organ transplantation in each individual case.

Develop and defend a personal moral view on Artificial insemination, Therapeutic abortions, Euthanasia, Biomedical research etc. in keeping with the norms of society and highest ethical principles.

d) PERSONAL IDENTITY

Students should be able to describe:

- Parameters of personal identity, methods of identifying living, dead, decomposed, mutilated and burnt bodies, and skeletal and fragmentary remains, using special techniques (Dentistry: Radiology, Neutron Activation Analysis etc.), and objective methods of identification (Osteomtery, Dactylo-scopy, DNA Technique, Super imposition photography etc.).

- Methods of determination of age, sex and race by various methods with their medico-legal aspects.

- Methods to trace evidence, Locard’s Principle of exchange and its medico-legal significance.

e) THANATOLOGY

The student should be able:

To describe:

- Scientific concepts regarding death, medico-legal aspect of Brain death, Indicators of Death, medico-legal aspects of Sudden and unexpected deaths, causes, manner, mode and mechanisms of death.

- Physicochemical changes subsequent to death occurring in various body tissues and organs under various environmental conditions.

To write:

- A Certification of death according to WHO guidelines.

f) TRAUMATOLOGY

i) MECHANICAL INJURIES:

The student should be able to describe mechanisms of wound production, classification of wounds, wounds produced by conventional weapons and their medico-legal aspects. Firearms, Ammunition, Classification, Nomenclature, wound Ballistics and medico-legal aspects.

ii) MECHANICAL INJURIES — MEDICO-LEGAL CONSIDERATIONS:

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The student should be able to:

- List and debate laws in relation to causing Bodily harm, Wounding and Homicide.

- Examine an injured person, certify nature, manner of cause, causative agent and dating of wounds.

- Link Sequelae of trauma to its original cause; and search for the relationship of sequelae to pre-existing disease.

- Identify the causes of death from wounds.

- Distinguish between ante-mortem and post-mortem wounds.

- Diagnose whether death is suicidal, homicidal and accidental.

iii) The student should also have a knowledge of and be able to describe methods of treatment and possible etiologies of REGIONAL INJURIES, and should be able to suture simple superficial wounds of:

Head (Scalp, Skull, Brain ) and Face. Vertebral column and its contents, Neck, Chest, Abdomen, Limbs, Bones and Joints.

And

Special truma such as: Transportation injuries, Police torture, and Deaths in Custody. And

Should be able to determine the medicolegal aspects of Heat, Cold, Electrical injuries.

g) VIOLENT DEATHS DUE TO ASPHYXIA.

Students should be able to:

Define, Classify, causes of; and detect the Anatomical, Physiological, Biochemical and Pathological signs of violent death; and of

Mechanical, chemical and environmental asphyxial death and their medicolegal implications.

h) AUTOPSY

Students should be able to list:

- Types, objectives, rules, and techniques and describe procedure for post-mortem;

Describe:

- Methods for Assessment of Fatal period and post-mortem interval. Post-mortem artefacts. Risks and Hazards of autopsy, and Autopsy Protocol.

- Procedure for selection and reservation, labelling and despatch of Biological and non-Biological materials for laboratory examination; and should be able to collect relevant samples.

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- Exhumation procedures, and debate its value and limitations.

i) FORENSIC SEXOLOGY

Students should be able to:

Describe the approach to Impotence, determination of Virginity, Pregnancy and criminal processes during delivery, their medico-legal aspects, examination procedure and reporting.

j) SEXUAL OFFENCES AND RELEVANT SECTIONS OF LAW

(ZINA AND HUDOOD ORDINANCE)

Students should be able to:

Differentiate between Natural and unnatural sexual offences and know how to perform a Medical examination of victim and assailant, collect specific specimens and write a required certification.

Students should be able to list:

Common sexual perversions and address their cause.

k) MISCARRIAGE

Students should be able to:

- Determine the relevant sections of law, Medico-legal aspects applicable to miscarriage; and

Be able to:

- Examine mother and aborted material; and send aborted material in proper preservative for examination.

l) CRIME AGAINST NEW-BORN, INFANTS AND CHILD

Students should be able to identify infanticide, and criminal and non-accidental violence or abuse to a newborn, infant or child.

m) FORSENIC PSYCHIATRY

Students should be able to:

- Diagnose mental illness.

- Distinguish between true and feigned insanity.

- Advise on procedure of restraint of the mentally ill.

- List limitations to civil and criminal responsibilities of mentally ill.

n) EXAMINATION OF BIOLOGICAL SPECIMENS

Students should be able to describe:

- Forensic importance of Biological specimens (Blood, Semen, Salvia, Vomitus, Breath, Urine, Hair).

- The method of their collection, preservation, despatch and the common laboratory tests performed.

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2. TOXICOLOGY

a) GENERAL PRINCIPLES OF TOXICOLOGY

The student should be able to describe:

- The scope of toxicology.

- Where to access the laws regulating drugs and noxious products.

- Describe common Toxicants in our environments and their abuse.

- Describe to cause of drug dependence, the fate and detoxification of poisons in the biological tissues,

Be able to:

- Diagnose toxicological cases in acute and chronic exposure in living and dead.

- Utilize general principles of treatment with anti-dotal therapy and management.

- Handle specimens.

- Work within the framework of duties of Doctor in cases of poisoning.

- Prepare and interpret chemical examiners reports.

b) THE STUDENT WILL BE ABLE TO DESCRIBE

- Autopsy techniques with collection, preservation and despatch of Biological material to analytical laboratory.

c) SPECIFIC POISONS

Study of Poisons/drugs of abuse prevailing in our society along with medico-legal aspects is recommended. Emphasis must be given to the following poisons/drugs:

i) Alcohol

ii) Opiates, Opioids and other narcotics

iii) Salicylates and paracetamol

iv) Hypnotics and Sedatives

v) Stimulants (Cocaine), cannabis

vi) Poisonous Plants (Aconite, Belladonna, Hyoscyamus, Stramonium, Digitalis, Ergot, Mushrooms, Nux Vomica, Oleander, Tobacco)

vii) Venomous insects (Snakes)

viii) Inorganic elements, Antimony, Arsenic, lead, Mercury, Phosphorus

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ix) Volatile Poisons and corrosives (Carbon monoxide, Hydro carbons, Cyanides, Sulphuric Acid, Oxalic Acid, Carbolic Acid and Alkalis)

x) Pesticides, Herbicides and Insecticides

Practical work will include:

1. In FORENSIC MEDICINE

􀂉 Autopsies — 10 with log book.

􀂉 Medico-legal Examination of injured.

􀂉 Estimation of age and Forensic Radiology.

􀂉 Sexual assaults and sex related cases

(impotence, pregnancy etc.)

• Procedure of preservation, dispatch of Biological and other evidentiary material.

􀂉 Practical in Biological Laboratory

(Identification of Blood, Semen, Saliva, etc.).

• Procedure of Consent taking and Medical certification.

2. IN TOXICOLOGY, students should have an understanding of and be able to describe:

􀂉 Diagnostic and management process.

(Alcohol, Narcotics and Insecticide poisons).

􀂉 Collection, preservation and despatch

of biological materials.

􀂉 Visual, olfactory and tactile identification

of common poisons found in communities and country.

3. VISITS

For proper orientation and practical demonstration, visits are also suggested to a:

􀂉 Court.

􀂉 Forensic Science Laboratory.

􀂉 Psychiatric unit or Jail.

􀂉 Site during conduction of exhumation.

*Note: All autopsies and Medico-legal work has to be done by forensic medicine department.

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SYLLABUS FOR THIRD PROFESSIONAL

COMMUNITY MEDICINE

CONTENTS OF CURRICULUM

1. Concept of Health & Disease

Concept of health, Definition of health (Dimensions, physical, mental, social and spiritual). Spectrum of health, Determinants of health. Responsibility for health. Indicators of health.

Concept of disease. Concept of causation (all theories including ecological triad, (agent, host & environmental factors). Spectrum of disease. Iceberg phenomenon. Natural history of disease. Levels of prevention. Disease elimination and eradication. Disease surveillance.

2. Introduction to Public Health and Health Systems in Pakistan

Background and Concepts: Definitions and concepts in Public Health. Development of Public Health in Pakistan. Economics and Health. Health Policy and planning in Pakistan. “Health for all”, background, concepts and progress. “Primary Health Care”: Concepts and progress. The National Disease Control programmes; policies, strategies and operations.

Health System in Pakistan: The role of Federal and Provincial Governments in Health Care. The District Health System, in the context of devolution. The Physician as a manager: Functions of manager, management of material, human and financial resources. Leadership and motivation.

Partners in Health: The public and private sector. Non-governmental Organizations and International Agencies. Resources for health. Community Mobilization.

3. Epidemiology and disease control

General Epidemiology and Research methodology.

Background and concepts, uses, Basic measurements in epidemiology (morbidity, Mortality, disability and fatality). Epidemiological methods (descriptive, analytic and experimental). Epidemiological transition. Association and causation. Investigation of an outbreak or an epidemic. Screening for disease. Community diagnosis. Research and survey methodology.

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Introduction to Qualitative research methodology.

Prevention and control of Infectious diseases:

Definitions to differentiate between

• Infection, contamination, pollution, infestation

• Infectious disease, communicable disease, contagious disease

• Host, Immune and susceptible persons

• Sporadic, Endemic, Epidemic, Pandemic

• Epizootic, Exotic, Zoonosis

• Contact, fomites, Carriers, Insect Vectors, Reservoir of infection

• Incubation period, Infective period, Generation time

• Cross infection, Nosocomial infection, Opportunistic infections, Iatrogenic (Physician induced) disorders

• Surveillance control, Eradication, Elimination

Dynamics of infections disease Transmission:

Reservoir and source of infection, Escape of organism, Mode of transmission, Entry into the body, Susceptible host, Immunity (different types of immunity and immunization)

Control of infection:

Controlling the reservoir-notification, early diagnosis treatment, isolation, quarantine, disinfections.

Interruption of transmission.

The susceptible host (active & passive immunization, Combined. Chemoprophylaxis, Non-specific measures).

Health advice to travellers.

National case management guide lines.

i. Epidemiology, control and prevention of infectious diseases of Public Health importance.

1. Diseases transmitted through inhalation.

2. Diseases transmitted through Faeco-oral route.

3. Arthropod borne diseases.

4. Diseases of animals conveyed to man.

5. Diseases due to direct contact.

ii Epidemiology, control and prevention of non-infectious diseases of Public Health importance.

1. Hypertension.

2. Coronary heart disease.

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3. Cancers.

4. Injuries.

5. Diabetes mellitus.

6. Obesity.

7. Acute Rheumatic fever and heart disease.

4. Biostatistics

A. Concepts and uses

B. Data and its types

C. Rates, ratios and proportions

D. Crude, specific and standardized rates.

E. Collection and registration of vital events in Pakistan

F. Sources of health related statistics

G. Measures of central tendency, (Mean, Median, Mode),

H. Measures of dispersion (Range, Standard deviation, Standard error)

I. Normal curve,

J. Methods of data presentation (tables, graphs & diagrams)

K. Interpretation of data (t-test and Chi-square test)

L. Sampling and its various techniques.

M. Health Management Information System

5. Demography and Population dynamics

A. Concept, demographic principles and demographic processes

B. Census, definition, methodology, types

C. Determinants of fertility, mortality

D. Population Pyramid, and its interpretation

E. Demographic Transition, Demographic Trap and its public health importance

F. Demographic and social implication of high population growth

G. Social Mobilization

H. Urbanization

6. Food and Nutrition

A. Concepts (Nutrition, Nutrient, Food, Diet). Food groups and their functions. Role of fibre in diet. Balanced Diet

B. Malnutrition at all stages of life its types causes and prevention. Common nutritional problems of public health importance and their prevention and control

C. Dietary requirements of normal human being at different stages of life

D. Food hygiene, Pasteurization, fortification, additives & adulteration and preservation

E. Food Poisoning

F. Assessment of nutritional status of a Community

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7. Reproductive and Child Health

A. Safe motherhood, and its components. (Ante-natal, Post-natal, Family Planning & Emergency Obstetric Care)

B. Maternal mortality, causes and prevention

C. Infant care: Growth and development. Breast feeding, common causes of morbidity and mortality, their prevention and control

D. Child Care: Health promotion strategies. Common ailments, home accidents, child mortality prevention. Strategic approaches of Integrated Management of Childhood Illness (IMCI)

E. Adolescent health

F. Reproductive tract infections: guidelines for management of STD’s

8. Health of school age children

A. Role of teachers and role of doctor in maintenance of health

B. Procedures for determining health status of school age children

C. Common health problems of school children

9. Environmental Health Sciences

A. Air: Composition of air. Causes of Air pollution. Purification of Air. Diseases caused by impurities in air and their prevention

B. Water: Sources of Water. Daily water requirement. Water pollution its causes and prevention. Purification of Water. Water quality Standards. Diseases due to polluted water

C. Waste disposal: Contents, hazards and safety measures for solid and liquid; Domestic, Industrial and Hospital waste

D. Climate: Climate and weather. Global environmental concerns (Green house effect, depletion of ozone layer, Acid rains). Effect of extremes of temperature, humidity, atmospheric pressure on human health and their prevention

E. Radiation: Sources, types, causes, hazards and prevention

F. Healthful housing. Urban and rural slums. Refugee camps and hostels

G. Noise: Definition, causes, acceptance level, hazards and control

10. Occupational Health

A. Concepts, of occupational health, occupational medicine and occupational hygiene. Ergonomics and its importance

B. Occupational hazards. Principles of control

C. General principles of occupational disease prevention

D. Organization of occupational health services

E. Health Insurance and Social Security Schemes

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11. Arthropods and their public health importance

A. Common arthropod borne diseases

B. Control of arthropods of medical importance

C. Insecticides and their public health importance

12. Prevention and control of Parasitic diseases of public health importance

13. Snake Bites: Personal protection and management

14. Mental Health

A. Concept. Common mental health problems, their causes, prevention and control

B. Juvenile delinquency

15. Behavioural Sciences and lifestyle

A. Concept, attitudes, health and illness behaviour

B. Drug abuse, addiction and smoking

C. Child abuse and child labour

D. Role of physical exercise in health and disease

16. Information, Education and Communication (IEC)

A. Concept. Aims and objectives

B. Approaches used in public health

C. Contents, principles and stages of health education

D. Communication methods, barriers and Skills in health education

E. Planning, organizing and evaluating a health education programme

F. Social Marketing

17. Disaster

Definition, Classification, (Natural disasters like earthquake, floods. Epidemic of communicable diseases, Man Made Disasters. Accidents, Thermo nuclear warfare, causes and prevention).

Magnitude and effects of disaster and Public Health consequences.

Disaster: preparedness and management.

18. Medical Ethics:

A. Background Concepts and components

B. National recommended guidelines

C. Code of Medical Ethics

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PRACTICAL AND COMMUNITY BASED TRAINING

I. Student should have practical experience in questionnaire development, data collection, compilation, presentation, analysis and report writing

II. Field visits

a) Visit to BHU and RHC

b) Visit to an NGO

c) Visit to a primary school to asses the nutritional status of school children

d) Visit to MCH/Reproductive Health Centre to observe the organization, and function of the centre and to demonstrate counselling skills in one of the following

• Nutritional counselling for children, pregnant and lactating women

• Antenatal Care

• Family planning services

• Immunization, others

e) Visit to a hospital to see the hospital waste disposal

f) Visit to an industry

g) Visit to a physical/mental/social rehabilitation centre

III. Skills development lab

a. Water purification at domestic level

b. Contraceptives

c. Vaccination including the cold chain

d. Oral Rehydration solution

SPECIAL PATHOLOGY

1. BLOOD VESSELS & HEART

• Differentiate among atherosclerosis, Monkeberg's medial calcific sclerosis and arteriolosclerosis.

• Describe atherosclerosis with respect to the following factors

• Etiology and pathogenesis

• Early lesion

• Late and complicated lesion

• Vessels affected

• Complications

• Classify hypertension.

• List the causes of secondary hypertension

• Describe the vascular changes in hypertension.

• Discuss the common pathogenetic mechanisms of vasculitis.

• .Classify aneurysm according to the etiology.

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• Describe atherosclerotic aneurysm with respect to

• Pathogenesis.

• Type of vessel involved.

• Morphological & clinical features.

• Describe varicose veins with respect to

• Common sites

• Predisposing factors

• Clinical features.

• List the benign and malignant tumours of blood vessels.

• Describe the pathogenesis of ischemic heart disease.

• Describe myocardial infarction with respect to the following

• Sequence of changes in myocardial infarction (MI)

• Pattern of elevation of biochemical markers used in the evaluation of M.I

• Complications

• List the causes of sudden cardiac death

• Describe cor-pulmonale and list the predisposing disorders

• Describe rheumatic fever with respect to

• Etiology

• Pathogenesis

• Morphological & clinical features

• List the causes of myocarditis

• Describe morphological and clinical features of myocarditis

• Describe the three major clinico-pathological groups of cardiomyopathy (dilated, hypertrophic and restrictive)

• List the causes of pericarditis

• Describe the clinical and morphological feature of pericarditis

• List the primary & secondary cardiac tumours

• Describe the main features of Fallot's tetralogy and coarctation of aorta

2. HAEMATOPOIETIC AND LYMPHOID SYSTEMS

• Outline the stages in the formation of red blood cell and white blood cells.

• List the normal values of red cell count, haemoglobin level, packed cell volume, MCH, MCV, MCHC, WBC count and platelet count.

• Classify anaemia on the basis of mechanism of RBC production.

• Describe the causes of iron deficiency.

• Describe the morphological and clinical features of iron deficiency anaemia.

• List the types of megaloblastic anaemia.

• List the conditions which predispose to folate deficiency.

• Describe vit. B12 deficiency with respect to

• The conditions which produce it

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• Blood picture and clinical features

• Differentiate between anaemia of chronic disease and nutritional deficiency anaemia.

• Describe hereditary spherocytosis with respect to

• The incidence

• Etiology

• Pathogenesis

• Morphological and clinical features

• Discuss the pathogenesis of thalassaemia.

• Classify thalassaemia on the basis of clinical and genetic features.

• Differentiate between the blood picture and clinical feature of Beta-thalassaemia minor and major.

• Discuss the mechanism of haemolytic anaemia due to glucose-6-phosphate dehyrogenase deficiency.

• Classify immunohemolytic anaemia.

• Differentiate between warm and cold antibodies immunohemolytic anaemia.

• Describe aplastic anaemia with respect to the

• Etiology and pathogenesis

• Clinical features and Lab. Diagnosis

• Describe the mechanisms which can cause neutropenia/ agranulocytosis.

• Describe the causes of leukocytosis.

• Describe the epidemiological, morphological and clinical features of infectious mononucleosis.

• Differentiate between acute and chronic non-specific lymphadenitis.

• Describe the different classifications (REAL and working formulations) of non-Hodgkin's lymphoma.

• Describe Hodgkin's disease with respect to

• The classification

• The clinical stages

• Etiology and pathogenesis

• Classify leukemia

• Discuss the prognostic factors of acute lymphoblastic and acute myeloblastic leukemias.

• Describe the pathophysiology of chronic myeloid and chronic lymphocytic leukemias

• Describe multiple myeloma with respect to

• Etiology

• Pathogenesis

• Morphology

• Clinical features

• Describe disseminated intravascular coagulation with respect to

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• Etiology and pathogenesis

• Clinical features and laboratory diagnosis

• List the causes of decreased production and decreased survival of platelets.

• Describe the pathogenesis of idiopathic & thrombotic thrombocytopenic purpura

• Indicate the value of following tests in the assessment of bleeding disorders

• Bleeding time

• Clothing time

• Platelets count

• Platelet function test

• Partial thromboplastin time

• Prothrombin time

• Mixing test studies

• Describe polycythemia with respect to

• Etiology

• Pathogenesis

• Clinical significance

• Lab. Diagnosis

• Describe the ABO and Rhesus blood groups and outline the way in which a sample of blood is typed.

• List the hazards of blood transfusion and how these can be prevented.

3. RESPIRATORY SYSTEM

• List micro-organisms causing upper respiratory tract infection.

• Describe the etiology and clinical features of rhinitis and nasal polyps.

• List malignant & benign tumours of nasopharynx and larynx.

• Discuss pleural effusion, hemothorax, hydrothorax, pleuretis, pneumothorax and chylothorax.

• Discuss acute pharyngitis, acute bacterial epiglottis and acute laryngitis.

• Classification of atelactasis on the basis of underlying mechanism.

• Differentiate between restrictive & obstructive lung disease on the basis of pulmonary function tests.

• Describe the etiology pathogenesis, morphology & clinical features of asthma.

• Describe various types of emphysema, its pathogenesis, morphology and clinical features.

• Describe pathogenesis and clinical features of chronic bronchitis.

• Describe the predisposing factors, pathogenesis, morphology & clinical features of bronchiectasis.

• List the clinical conditions associated with restrictive lung diseases.

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• Describe the pathogenesis, morphology & clinical features of adult respiratory distress syndrome.

• Describe the pathogenesis, morphology & clinical features of sarcoidosis and hypersensitivity pneumonitis.

• Describe the pathogenesis, morphology and clinical features of idiopathic pulmonary fibrosis.

• Describe clinical features of Goodpasture's syndrome.

• List the pathogenesis, morphology & clinical features of thromboemboli.

• Describe the morphology & clinical features of pulmonary infarction.

• List the causes of pulmonary hypertension and vascular sclerosis.

• Describe the etiology, pathogenesis, morphology & clinical features of acute bacterial pneumonia.

• List the micro-organisms causing atypical pneumonia.

• Discuss the etiology, pathogenesis & clinical features of tuberculosis of the lung.

• List the Fungi (candida, pneumocystis carinii) causing lung infections.

• Describe the classification, etiology, pathogenesis and clinical features of bronchogenic carcinoma.

• Describe etiology & pathogenesis of mesothelioma.

• Describe pneumoconioses with respect to etiology, pathogenesis and clinical features.

4. THE ORAL CAVITY AND GASTROINTESTINAL TRACT

4.1 Oral cavity

• Define the term leukoplakia.

• List the possible predisposing factors (pipe smoking, ill-fitting denture, alcohol abuse, irritant foods) of leukoplakia.

• Discuss the risk factors of oral cancer.

• Describe the clinical and morphological feature of oral cancer.

• List the benign and malignant tumours of salivary glands.

• Describe the clinical and morphological features of pleomorphic adenoma.

4.2 Esophagus

• Describe the predisposing factors of esophagitis.

• Carcinoma of the esophagus.

4.3 Stomach

• List the predisposing factors associated with acute gastritis.

• Describe the pathogenesis and clinical features of acute gastritis.

• Describe the pathogenesis, morphological and clinical features of chronic gastritis.

• Describe the pathogenesis, morphological and clinical features of peptic ulcer.

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• Describe the gastric carcinoma with respect to

• Risk factors

• Pathogenesis

• Clinical and morphological features

• Prognosis

4.4 Intestine

• Describe the clinical and morphological features of Hirschsprung's disease.

• Describe the pathogenesis, morphological and clinical features of

• Celiac sprue

• Tropical sprue

• Describe the predisposing conditions for ischemic bowel disease.

• Describe the clinical and morphological features of ischemic bowel disease.

• Differentiate between Crohn's disease and ulcerative colitis.

• List the major causes of intestinal obstruction.

• Describe the clinico-pathological features of following diseases of intestine

• Amebiasis

• Tuberculosis

• Typhoid

• List the non-neoplastic polyps of intestine.

• Classify adenomas on the basis of epithelial architecture.

• Describe the clinical and morphological features of adenomas.

• Discuss the pathogenesis of colorectal carcinoma.

• Describe the morphological and clinical features of colorectal carcinoma.

• Describe the Aster-Collar classifications of carcinoma of the colon and rectum.

• Describe carcinoid tumour with respect to the

• Peak incidence

• Most prevalent sites in the gut

• Morphological features.

• Describe the clinical features of carcinoid syndrome.

• Describe the etiology, pathogenesis, morphological and clinical features of acute appendicitis.

• List the tumours of appendix.

5. LIVER & BILIARY TRACT

5.1 Liver

• Describe the pathway of bilirubin metabolism and its elimination from the body.

• Describe the types of jaundice with respect to the following:

• Causes

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• Clinical features

• Lab diagnosis

• Differentiate between intrahepatic and extrahepatic biliary obstruction.

• List the causes of hepatic failure.

• Describe the morphological and clinical features of hepatic failure.

• Describe the important complication of liver failure (hepatic encephalopathy, hepatorenal syndrome).

• List the common causes of cirrhosis (viral hepatitis, cryptogenic, alcohol, biliary disease, genetic hemochromatosis, Wilson's disease, alpha-1 anti-trypsin deficiency).

• Discuss the pathogenesis of cirrhosis.

• Describe the complications of cirrhosis (progressive liver failure, portal hypertension, hepatocellular carcinoma).

• Differentiate among viral hepatitis A, B, C, D and E with respect to

• Route of transmission

• Incubation period

• Clinical features.

• Potential outcome of acute infection.

• Define carrier state and differentiate between acute and chronic hepatitis.

• List the common causes of liver abscess (amebic, echinococcal, bacterial, fungal).

• Describe clinical and morphological features of liver abscess.

• List the drugs and toxins which cause hepatic injury along with their specific effects.

• Discuss the pathogenesis of alcohol liver disease.

• Describe the morphological and clinical features of alcoholic hepatitis and cirrhosis.

• List the causes of secondary hemochromatosis.

• Describe the pathogenesis, morphological and clinical features of hemochromatosis.

• Discuss the clinico-morphological features of Wilson's disease.

• Describe the clinico-morphological features of alpha-1 anti-trypsin deficiency.

• List the causes of neonatal hepatitis.

• Differentiate between primary and secondary biliary cirrhosis.

• Discuss the epidemiology, pathogenesis, morphological and clinical features of hepatocellular carcinoma.

5.2 Biliary tract

• Describe the pathogenesis and risk factors of cholelithiasis.

• Describe the morphological and clinical features of acute and chronic cholecystitis.

• Describe clinical and morphological features of gall bladder cancer.

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5.3 Pancreas

• Describe acute pancreatitis with respect to

• Etiology and pathogenesis

• Clinical and morphological features.

• Describe the clinical and morphological features of chronic pancreatitis.

• Describe the clinical and morphological features of carcinoma of pancreas.

6. THE URINARY SYSTEM

• Define the terms:

• Azotemia

• Uremia

• Acute renal failure

• Chronic renal failure

• Discuss the types, genesis, basis, clinical features and complications of polycystic kidney disease.

• Describe different types and pathogenesis mechanisms of glomerulonephritis.

• Differentiate between nephrotic and nephritic syndrome. List the diseases included in these categories, their etiology and pathogenesis mechanisms (membranous, minimal change, membranoproliferative & acute poststreptococcal glomeruloneph-ritis).

• Discuss the etiology, clinical course, pathogenesis and complications of acute pyelonephritis.

• Discuss pathogenesis mechanism, morphology clinical features and complications of chronic pyelonephritis.

• Define acute tubular necrosis, its pathogenesis and clinical course.

• Differentiate between benign and malignant nephrosclerosis. (on the basis of clinical date). Discuss the pathogenetic mechanism, morphology and clinical course (Gross & microscope picture).

• Discuss the pathogenesis, clinical features and lab diagnosis of nephrolithiasis. List the various types of renal stones.

• Define hydronephrosis, what are its causes, clinical features and complications.

• Discuss the epidemiology, morphology and clinical features (paraneoplastic syndrome) of renal cell carcinoma.

• Describe the clinical features, morphology and prognosis of Wilm's tumour.

• Describe the etiology, morphology & clinical features of cyctitis.

• Describe the clinical features, etiology and morphology of transitional cell carcinoma of the urinary bladder.

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7. MALE GENITAL SYSTEM

• Discuss the following congenital conditions

• Hypospadias

• Undescended testis

• Describe the etiology, route of infection, pathogenesis and methods of diagnosing urethritis.

• Gonococcal

• Non gonococcal

• Discuss the etiology, pathogenesis and natural history of

• Prostatitis

• Prostatic hyperplasia

• Prostatic carcinoma

• Discuss the causes, pathogenesis and clinical features of scrotal swelling.

• Testicular adnexae

• Varicocele

• Hydrocele

• Spermatocele

• Testis and epididymis

• Inflammation (Orchitis)

• Epididymitis

• Tumour

• Discuss the causes, pathogenesis and relevant investigations of male infertility.

• Classify the tumours of the male genital tract.

• Prostate

• Testis

8. FEMALE GENITAL SYSTEM

• List the causes, routes of infection & methods of diagnosis of sexually transmitted diseases. List the micro-organisms involved, route of infection, pathogenesis and methods of diagnosing the following:

• Gonorrhea, syphilis, chlamydia, HPV, herpes simplex and trichomonas vaginalis.

• Classify the neoplasms of cervix with special reference to cervical intraepithelial neoplasia.

• Describe the clinical features and pathogenesis of adenomyosis and endometriosis.

• Describe the causes, pathogenesis and clinical features of dysfuctional uterine bleeding with special reference to endometrial hyperplasia, endometrial polyp and carcinoma.

• Classify tumours of the uterus.

• Classify tumours of the ovary.

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• Describe the etiology, clinical features and pathogenesis of ectopic pregnancy and toxemia of pregnancy.

• Classify gestational trophoblastic tumours with special reference to their clinical features.

9. BREAST

• List the causes of lump in the breast and discuss etiology, pathogenesis, morphology, clinical features and natural history of

• Mastitis

• Fibrocystic disease of the breast

• Benign tumours of the breast (Fibroadenoma and Phyllodes tumour)

• Carcinomas of the breast (Ductal and Lobular)

• List the causes of nipple discharge with special reference to intraductal papilloma.

• Describe gynaecomastia, and list its causes.

10. MUSCULOSKELETAL SYSTEM

• Describe the pathogenesis and clinical features of each of the following

• Achondroplasia.

• Osteogenesis imperfecta.

• List the causes of osteoporosis.

• Describe the pathogenesis, morphological and clinical features of osteoporosis.

• Describe osteomyelitis with respect to

• Common causative micro-organism (Staphylococcus aureus, Pseudomonas, Escherichia coli, group-B Streptococci, Salmonella, Mycobacterium tuberculosis).

• Common routes of spread (hematogenous, direct extension from the focus of infection, traumatic implantation).

• Complications.

• Differentiate between acute and chronic osteomyelitis.

• List the common sites involved in tuberculosis osteomyelitis (vertebral bodies, long bones).

• Describe the pathogenesis, morphological and clinical features of Paget's disease (osteitis deformans).

• List the benign and malignant bone forming tumours.

• List the common sites (lower end of femur, upper end of tibia, upper end of humerus) of osteogenic sarcoma.

• Describe the morphological and clinical features of osteogenic sarcoma.

• List the benign and malignant cartilaginous tumours.

• Describe chondrosarcoma with respect to

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• Peak incidence (sixth decade)

• Common sites of origin (shoulder, pelvis, proximal femur, and ribs)

• Morphological and clinical features.

• List the most frequent sites (distal femur, proximal tibia, proximal humerus and distal radius) of giant cell tumours of bone.

• Describe the clinical and morphological features of giant cell tumours of bone.

• Describe the Ewing's sarcoma with respect to

• Peak incidence (second decade)

• Common sites of origin (femur, tibia, pelvis)

• Chromosomal abnormality t(11:22) (q24; q12).

• Morphological and clinical features.

• Describe the pathogenesis, morphological and clinical features of osteoarthritis

• Describe rheumatoid arthritis with respect to

• Pathogenesis

• Morphological and clinical features

• Classify gout.

• Describe the pathogenesis, morphological and clinical features of gout.

• Describe the pathogenesis, morphological and clinical features of

• Duchenne muscular dystrophy

• Myotonic dystrophy

• List congenital myopathies (central core disease, nemaline myopathy and centronuclear myopathy).

• List inflammatory myopathies (dermatomyositis, polymyositis and inclusion body myositis).

• Describe the clino-pathological features of myasthenia gravis.

• Differentiate between lipoma and lipasarcoma.

• Describe rhabdomyosarcoma with respect to

• Peak incidence (1st decade of life).

• Histological variants (embryonal, alveolar, sarcoma botryiodes, pleomorphic).

• Frequent sites (head & neck region, genitourinary, retroperitonium).

11. ENDOCRINE SYSTEM

Pituitary

• List the causes of hyperpituitarism.

• Describe the morphology and clinical features of pituitary adenomas.

• Describe the clinical features of acromegaly and giantism.

• List the causes of hypopituitarism.

• Describe the etiology, pathogenesis and clinical features of

• Sheehan’s syndrome

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• Dwarfism

• Describe the etiology factors, clinical features, pathogenesis and lab findings in inappropriate secretion of ADH.

11.1 Adrenal Cortex and Medulla

• List the causes of adrenal cortical hyperfunction.

• Describe the etiology, pathogenesis clinical features and lab diagnosis of

• Conn’s syndrome

• Adrenogenital syndrome.

• List the causes of hypofunction of adrenal cortex.

• Describe the etiology, pathogenesis, and clinical features of Addison’s disease.

• List the tumours of adrenal medulla and cortex.

• Describe the clinical features and diagnosis of pheochromocytoma.

11.2 Thyroid

• List the etiology and clinical features of hyperthroidism.

• List the etiology and clinical features of hypothyroidism including

• Cretinism

• Myxedema.

• Discuss the investigation/lab tests for diagnosis of thyroid dysfunction.

• Define goiter and list its types (diffuse and multinodular).

• Describe the etiology, pathogenesis and clinical features of diffuse and multinodular goiter.

• List the causes of solitary thyroid nodule and discuss the diagnostic approach.

• Describe the types, with pathogenesis, morphology and clinical features of thyroiditis with special reference to auto-immune thyroiditis (Hashimoto’s thyroiditis and Grave’s disease).

• Classify the etiology, pathogenesis, morphology and clinical features of

• Follicular adenoma

• Papillary carcinoma

• Follicular carcinoma

• Medullary carcinoma.

• List the types of MEN syndromes.

11.3 Paratyroid

• List the etiologic factors and clinical features of hyperparathyroidism.

• List the etiologic factors and clinical features of hypoparathyroidism

• Differentiate between primary, secondary and tertiary hyperpara-thyroidism.

• Discuss calcium haemostasis and causes of hyper and hypocalcemia.

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12. SKIN

• Define the following macroscopic and microscope terms:

Macule, papule, nodule, plaque, vesicle, bulla, blister, putsule, scale, lichenification, excoriation, hyperkeratosis, parakeratosis, acanthosis, dyskeratosis, acantholysis, papillomatosis, lentiginous spongiosis.

• Describe the morphological and clinical features of urticaria.

• Classify eczematous dermatitis.

• Describe the etiology and pathogenesis of

• Contact dermatitis

• Atopic dermatitis

• Drug related eczematous dermatitis

• Photoeczematus eruptions

• Primary irritant dermatitis

• Describe the morphological and clinical features of acute eczematous dermatitis.

• List the conditions which are associated with erythema multiforme.

• Describe the clinical features of erythema multiforme.

• Describe the pathogenesis, morphological and clinical features of psoriasis.

• Describe the variants of pemphigus with respect to frequent site of involvement and clinical features.

• Discuss the pathogenesis of pemphigus.

• Describe the clinical and morphological features of bullous pemphigoid.

• List the pre-malignant epithelial lesions.

• List the types of warts and their most frequent locations.

• List the predisposing factors of squamous cell carcinoma of skin.

• Describe the clinical and morphological features of basal cell carcinoma.

• List the types of Nevocellular Nevi (congenital nevus, blue nevus, spitz’s nevus, halo nevus, dysplastic nevus) along with their clinical significance.

• Describe the clinical and morphological features of dysplastic nevi.

• Describe malignant melanoma with respect to frequent site of origin, clinical and morphological features.

13. NERVOUS SYSTEM

• Describe clinico-pathological features of hydrocephalus.

• Describe the categories of cerebral edema (vasogenic & cytotoxic).

• List the types of herniation of brain alongwith clinical significance.

• Describe the clinical and morphological features of intra-cranial haemorrhage.

• Differentiate between acute purulent meningitis and acute lymphocytic meningitis.

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• List the etiologic agents of chronic meningitis (mycobacterium tuberculosis, Cryptococcus neoformas, Treponema pallidum).

• Describe clinical and morphological features of chronic meningitis.

• List the route of infecting agents causing brains abscess

• Describe the clinical and morphological features of brain abscess.

• Describe the clinical and morphological features of tuberculosis meningitis.

• List the causative organisms of viral encephalitis (herpes simples virus, cytomegalovirus, HIV, JC virus, arbovirus).

• Describe clinico-pathological features of Guillain Barre syndrome.

• List the infectious agents associated with polyneuropathies (leprosy, C. diphtheria, Varicella-zoster virus).

• List the organic and inorganic compounds which can produce toxic neuropathy (organophosphorous esters, vincristine, acrylamide, hexame, ethanol, arsenic and lead).

• List the important types of intracranial tumours (astrocytoma, oligodendrogliomas, ependymoma, medulloblastoma and meningioma) along with clinical significance of glial tumours.

• List the frequent metastatic tumours to the brain (carcinoma of the lung, breast, malignant melanoma, leukemia and lymphoma).

• List common primary peripheral nerve sheath neoplasms along with

14. CHEMICAL PATHOLOGY

1. Introduction to chemical pathology, reference/ranges conventional and SI units.

2. Renal functions.

3. Causes of proteinuria and its lab diagnosis.

4. Lab diagnosis of acid base disorders.

5. Lab diagnosis of diabetese mellitus.

6. Liver function tests.

7. Lab diagnosis of hyperlipidaemia and its clinical interpretation.

8. Role of enzymes in diagnosis of pancreatitis.

9. Lab diagnosis of inborn errors of metabolism.

10.Lab diagnosis/investigations of endocrinic disorders:-

i. Thyroid function tests.

ii. Adrenal function test.

iii. Lab diagnosis of hyper and hypoparathyroidism.

iv. Role of hormone estimation in diagnosis of infertility.

v. Role of hormone estimation in diagnosis of growth disorder.

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OPHTHALMOLOGY

COURSE CONTENT

Basics Anatomy and the functions of the Eyeball/Adenexa and Orbit.

Orbit: Orbital Cellulitis, Proptosis.

Lids: Blepharitis, Stye, Chalazion, Trichiasis, Entropion, Ectropion, Ptosis, and Common Tumours.

Conjunctiva: Infective and Allergic Conjunctivitis, Pterygium.

Cornea: Keratits, Corneal Ulcers, risk factors, complications and its management.

Sclera: Episcleritis and Scleritis.

Pupil: Pupillary reflexes and their common abnormalities.

Lacrimal Apparatus: Composition and function of Tear film, Dry Eye, Excessive watering (Epiphora), Dacryocystitis (Acute & chronic).

Therapeutics: Drugs used in common ophthalmic conditions.

Vitamin A Ocular manifestations of vitamin A Deficiency and its management.

Uveal Tract: Uveitis, and its differential Diagnosis from other causes of the Red Eye.

Lens: Classification of cataract,

Congenital Cataract (lamellar, Signs and Symptoms and Management), Rubella syndrome, Acquired Cataract (Senile, Traumatic, Drug induced), Cataract due to systemic diseases (Clinical Picture and Management including Visual Rehabilitation).

Glaucoma: Physiology of Aqueous humour formation and its circulation. Measurement of IOP, Definition and Classification of Glaucoma, Primary Open angle and closed angle Glaucoma, Secondary Glaucoma due to hyper-mature Cataract and Uveitis. Principles of Medical and Surgical Management of Glaucoma.

Vitreo-Retina: Posterior Vitreous/Haemorrhage, detachment, Pri-mary Retinal Detachment (Common Presentation and Principles of Management),

Diabetic Retinopathy, Hypertensive Retinopathy,

Retinitis Pigmentonsa, Retinoblastoma.

Optic Nerve: Papilloedema, Optic Neuritis (Papillitis and Retrobulbar Neuritis), Optic Atrophy.

Visual Pathway: Introduction to Visual Field defects in the lesions of Chiasma and visual Pathway.

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Injuries: Extraocular Foreign Bodies, Closed globe injuries, Open globe injuries with or without retained Intra ocular foreign bodies, Burns and Chemical Injuries, Sympathetic Ophthalmitis.

Squint and Amblyopia: Definition, Classification and Principle of Management.

Errors of Refraction: Introduction to Optical System of Normal Eye, Emetropia, Myopia, Hypermetropia, Astigmatism, Presbyopia, Aphakia, Pseudophakia, Anisometro-pia, and Amblyopia.

Systemics Disease: Diabetes, Thyroid Diseases, vitamin deficiencies

Common causes of Definition and standards of vision/Blindness.

Blindness:

Details of Clinical and Practical Competence:

Level of Learning

Level-1 Observer status

Level-2 Assistant status

Level-3 Perform under supervision

Level-4 Perform Independently

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LEVEL

(a) History Taking 4

1. Defects in Vision

2. Pain in and around the Eye

3. Discharging Eye

4. Abnormal appearance of the Eye and Orbit

5. Colour vision, Diplopia

(b) Examination 4

Visual Acuity, for distance and near

Use of a pinhole

Examination of Adnexa and anterior segment

of the eye.

Eversion of the upper Eye Lid and Lacrimal

regurgitation Test

Detection of the Deviated Eye

Ocular Movement

Pupillary Reflexes (Afferant Pupillary defects)

Measurement of Intra-ocular pressure.

- Palpation Assessment

- Schiotz Tonometer 1

Distant Direct Ophthalmoscopy for Identification

of defects in the Ocular Media

Direct Ophthalmoscopy with emphasis on disc

and its abnormalities Swollen disc, cup disc

and pale disc/retinal lesion.

Confrontation test for field of vision 1

(c) Familiarization with Retinoscopy, Indirect

Ophthalmoscopy, Slit Lamp and its Uses, Visual

Fields and Use of Laser in Ophthalmology 1

(d) Procedure 4

- Irrigation of Eye

- Instillation of Eye drops

- Staining for Corneal Ulcer

- Removal of Superficial Foreign Bodies

- Rational use of Topical Anaesthesia

(e) Preparation for operation and post Operative Management

(f) Understand Medical Ethics and maintain the Confidentiality of the Patient

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Assessment of Level of Competence:

I. To Diagnose, treat and prevent certain common eye conditions e.g.

Blepharitis

Stye and Chalazion

Dacryocystitis

Conjunctivitis

Trachoma

Ocular Trauma (Corneal Foreign Body/Abrasion)

Ocular Allergies

II. To diagnose certain eye diseases, initiate first aid treatment and refer them in time e.g.

Corneal Ulcer

Uveitis

Acute Congestive Glaucoma

Open or closed globe injuries

Red Eye

III. To enable them to diagnose other eye conditions and refer them to secondary or tertiary eye care centres for further management

(Medical/Surgical) e.g.

Cataract

Squint and Amblyopia

Refractive Errors

Tumours (white Pupil)

Serious Ocular Trauma

Painful or painless loss of vision

IV. To understand the importance of prevention in Ocular Diseases

Deficiency Diseases resulting in ocular Problems

Early Detection of Glaucoma

Diabetic Retinopathy

By the end of the training student should be a caring and compassionate, general purpose, doctor who is competent to deal with the common health problems related to Eye diseases.

V. Understand the relationship between Eye and Systemic Diseases

VI. To visit community for Eye Health Care problems including Eye Camps

GENERAL OBJECTIVES

To equip them with essential knowledge, skill and attitude In order to enable them:

1. Identify Ophthalmic diseases including emergencies, provide primary Eye care, refer to appropriate centre and provide follow-up to the patients.

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2. Perform essential minor surgical procedures.

3. Communicate effectively with the patient, the family and the community regarding Eye diseases and its related issues.

4. Understand medical ethics and its application pertaining to Ophthalmology and maintain the confidentiality of the patient.

5. To understand the prevalence and prevention of the common Public Health Problem related to Ophthalmology in the community.

6. Understand the principles of medical research including fundamentals of Information Technology.

E.N.T

COURSE CONTENT

1. NOSE:

Anatomy and Physiology

History taking and examination

Diseases of External Nose

Congenital lesions, choanal atresia, meningiocoele, encephalocoele,

Trauma, Cut Nose, Fractures,

External Deformities

Diseases of Septum

Epistaxis

DNS

Haematoma

Septal Abscess

Perforation

Rhinitis

Allergic

Atrophic

Hyper-Trophic

Foreign bodies

VMR

Polyps

Mucous Ethmoidal

Antrochoanal

Bleeding Polypus

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Foreign Body Nose

Rhinoliyth

Maggots

Sinusits

Acute Sinusitis

Chronic Sinusitis, complications

Fungal Infection of nose and paranasal sinuses

CSF Rhinorrhoea

Tumours

Basal Cell Carcinoma

Squamous Cell Carcinoma

Papilloma

Osteoma

Headache and its ENT causes

2. BUCCAL CAVITY, ORAL CAVITY, OROPHARYNX

Anatomy and physiology

History and examination

ORAL CAVITY ULCERS

Traumatic

Aphthus,

Vincents Angina

Agranulocytic

Tuberculous

Malignant Uclers

Thrush

Leukoplakia

Behcet’s Disease

Ulcerative lesions of Oral Cavity

OROPHARYNX

Acute tonsillitis,

Chronic tonsillitis

Peri tonsillitis and abscess

Diphtheria

Differential diagnosis of white patch on the tonsil

Tonsil/oral cavity

Tumours of tonsils

Retro-pharyngeal abscess

Pharyngeal abscess acute/chronic

Sleep aponea syndrome

AIDS

Ludwig’s angina

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3. LARYNX

Anatomy

Physiology

History Taking

Examination

Glottic stenosis/Larynogocoele

Laryngomalacia

Trauma Larynx/Foreign Body Larynx Infections

Supraglottitis

Acute Laryngitis

Laryngotracheobronchitis

Diphtheria

Chronic Laryngitis

- Tuberculosis

- Syphilis

- Leprosy

Non-specific chronic laryngitis

Vocal Nodules

Vocal cord paralysis

Functional Aphonia

Tumuors.

- Papilloma Laryrnx

- Polyp

- Carcinoma Larynx

TNM classification

Tracheostomy

Indications

Contra indications

Complication

Operation steps

Post-Operation care

4. Oesophagus

Causes of dysphagia

P.V.Syndrome

Foreign body oesophagus

CA oesophagus

Indications and contraindications and complication of Oesophagoscopy.

5. EAR

Anatomy

Physiology

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History and examination tuning fork tests. pure tone audio- metery/impedance audio-metery

Pre-auricular sinus

Deafness

Pain in the ear

External ear

- Perichondritis

- Trauma to pinna/haematoma

- Wax ear

- Foreign body ear

- Hyper ostosis

- Neoplasia

- Boil ear

- Fungus

- Acute diffuse otitis externa

- Malignant otitis externa

- Myringitis bullosa

- Traumatic rupture

Middle ear

- Acute otitis media

- Acute necrotising otitis media

- Serous otitis media

- Chronic otitis media

i. Tubo tympanic

ii. Mucosal disease

iii. Attico antral

Complications of otitis media/mastoiditis

- Oto toxicity

- Traumatic perforation of tympanic membrane

- Deaf child

- Speech therapy

- Oto sclerosis

- Vertigo

- Meniere’s disease

- Facial nerveparalysis

- Eustachian tube dysfunction

6. HEAD & NECK

- Cleft palate

- Hare lip

- Thyroglossal cyst/sinus

- Pre-auricular cyst/sinus

- D/D of mass neck

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- Lesions of salivary glands

SKILLS

By the end of the clerkship in the Department of ENT, the student should be able to:

Obtain an appropriate history.

Perform a complete regional examination.

Identify common ENT, Head & Neck problems for a given patient and outline appropriate management plans.

Identify problems needing referral to an ENT specialist.

GENERAL SKILLS

The students should be able to:

- Demonstrate the use of the head mirror for adequate illumination of the nasal cavity.

- Examine the oropharynx and the neck.

- Examine Larynx by indirect laryngoscopy & examination of post nasal space by posterior Rhinoscopy.

SPECIAL SKILLS

1. Use the tongue blade to aid inspection of the buccal cavity.

2. Use the finger palpation examination of the oral cavity and tongue.

3. Palpate the neck to assess the lymph-nodes and salivary glands in the neck.

4. Examination of Cranial nerves.

5. Identify structures (of the neck, sinuses and ear) on X-ray, MRI, CT SCAN.

6. Demonstrate the appropriate use of nasal speculum.

7. Demonstrate the use of otoscope to aid in examination of the external auditory canal and the tympanic membrane.

8. Learn pneumatic otoscopy. (Use of Seigle’s speculum).

9. Demonstrate the use of tuning forks and interpret the findings.

10. Syringing of ear.

11. Anterior Nasal Packing

Observe the following operations and the use of the listed instruments:

1. Abscess incision drainage/Haematoma

2. Reduction of fracture nose

3. Septal correction Surgery

4. Antral Wash Out

5. Cald Well Luc’s operation

6. Tonsillectomy

7. Nasal packing

8. Tracheostomy

9. Management of obstructed airway

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10. Foreign body in Tracheo-Bronchial tree and Larynx

11. Ear operations

12. Ear instruments like myringotome and ear speculum

Instruments

1. Walsham’s Forceps

2. Ashe’s Forceps

3. Trocar and Cannula

4. Nasal Speculum

5. Freer elevator

6. Suction, Tube

7. Luc’s forceps

8. Tilly’s Nasal Dressing Forceps

9. Nasal Forces

10. Nasal Snare

11. Balenger Swivel Knife

12. Eustachian Catheter

13. Sinus forceps

14. Endotracheal Tube, Cuffed, Non-Cuffed

15. Sucker Pharyngeal

16. Laryngoscope Macintosh

17. McGill Forceps

18. Tracheostomy Tubes

19. Tracheal Dilator

20. Retractors

21. Endoscopes

Laryngoscopes

Bronchoscopes

Oesophagoscopes

Nasopharyngoscope

(Rigid/flexible)

22. Adenoid curette

23. Boyle Davis mouth gag

24. Tonsil holding forceps

25. Tonsilar artety forceps

26. Tonsil snare

27. Knot pusher

GENERAL OBJECTIVES

To equip them with essential knowledge, skills and attitude to enable them:

1. Identify ENT diseases including emergencies, provide primary health care, refer to appropriate centre and provide follow-up to the patients.

2. Perform essential minor ENT procedures.

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3. Communicate effectively with the patient, the family and the community regarding disease and its relevant issues.

4. Understand medical ethics and its application pertaining to ENT and maintain the confidentiality of the patient.

5. To understand the prevalence and prevention of the common Public Health Problem related to ENT in the community

Understand the principles of medical research including fundamentals of Information Technology

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SYLLABUS FOR FINAL (FOURTH) PROFESSIONAL

SURGERY

1. Course Contents (Syllabus)

Following basic syllabus is recommended:-

To Attain Core Knowledge of & Apply Principles of Surgery as listed below:

1. Physiological response to Surgical Trauma and homeostasis.

2. Wound and its Repair.

3. Pathophysiology and Management of Shock including fluid and electrolyte imbalance.

4. Investigation and treatment of Infections and Parasitic Infestations of Surgical Importance.

5. Haemorrhage, Blood Transfusion and their implications.

6. Management of Acutely Injured & critically ill patients including aspiration pneumonia and embolic phenomenon.

7. Principles in the Management of common Skin and Soft Tissue Problems: Ulcers, Abscesses, Sinus & Fistulae, Swellings, Embedded Foreign Bodies and Minor Injuries.

8. Principles of Anaesthesia.

9. Nutrition of surgical patients.

10. Principles of organ Transplantation and its implications.

To deal with Critical Situations:

1. Cardiac Arrest.

2. Polytrauma with airway difficulty and circulatory instability.

3. Uncontrolled External Haemorrhage.

4. Sudden Upper Repiratory Tract Obstruction.

5. Patient in Hypovolaemic or Septicaemic Shock.

6. Tension Pneumothorax.

7. Cardiac Tamponade.

8. Unconscious patient due to Head Injury.

9. Fracture Cervical Spine.

10. Patient with Gas Gangrene and Tetanus.

11. Burns

To acquire knowledge of Systems and the Diseases

• Head, Face and Neck

1. Developmental abnormalities of face, palate, lips.

2. Principles of management of Head Injuries and its Complications.

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1. Oral region including tongue.

2. Diseases of Salivary glands (Inflammation, Calculus, Tumours)

3. Neck lumps including Lymphatic Thyroid and parathyroid

• Breast

1. Breast diseases including lumps benign and malignant tumours.

• Chest Wall & Thorax

1. Blunt & Penetrating Injuries and their Complications.

2. Lung abscess and Empyema Thoracis.

3. Growth of cysts in the lungs.

• Gastro Intestinal Tract

1. Diseases causing Oesophageal Obstruction.

2. Peptic Ulcer disease & its complications.

3. Tumours of Stomach.

4. Conditions Causing Acute Abdomen.

5. Conditions causing Chronic Abdomen including Malignant lesions of small and large bowel

6. Ano-Rectal and peri-anal conditions requiring Surgery.

• Abdominal, Pelvic and Genital Trauma and Hernia.

1. Principles in management of abdominal pelvic and Urogenital Trauma.

2. Inguinal/ Femoral Hernia.

3. Epigastric Hernia/Umbilical/ Para-umblical Hernia.

4. Incisional Hernia.

• Liver

1. Trauma.

2. Obstructive Jaundice.

3. Liver Abscess.

4. Hydatid cyst.

5. Malignancy (Hepatoma & Secondaries).

• Gall Bladder

1. Acute and chronic Cholecystitis.

2. Cholelithiasis and its Complications.

3. Malignancies.

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• Pancreas

1. Acute, Relapsing and Chronic pancreatitis.

2. Pancreatic masses including (benign, malignant) Neoplasia.

• Spleen

1. Trauma

2. Introduction to Surgical aspects of spleen

• Urinary Tract

1. Common congenital anomalies.

2. Infection & its sequelae.

3. Calculus Disease and its sequelae.

4. Bladder pathologies.

5. Enlarged prostate.

6. Urogenital Trauma.

7. Neoplasms of Urinary Tract.

• External Genitalia, Scrotal and testicular pathologies

1. Developmental abnormalities.

2. Scrotal swelling.

3. Testicular swelling.

4. Common Pelvic conditions.

• Skin & Soft Tissues

1. Common benign and malignant Skin lesions.

2. Wounds/Ulcers/abscesses/Sinuses/Fistulae.

3. Soft Tissue Lumps.

• Orthopaedics and Trauma

1. Common Congenital Malformations of Locomotive System.

2. Bone Fractures & their Complications.

3. Sports injuries and afflictions of Tendons and Bursae.

4. Bone and Joint Infections.

5. Arthritis.

6. Bone and Cartilage Tumours.

7. Spinal Trauma.

8. Spinal Tumours.

9. Common spinal Deformities and other surgically correctable lesions.

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• Vascular and Nerve Disorders

1. Vascular afflictions and Limb Ischaemia.

2. Varicosities

3. Deep venous thrombosis.

4. Peripheral nerve Injuries

Essential Skills to be acquired

1. Provide First Aid: Resuscitation (ABC) of Polytrauma, CPR.

2. Collect samples of blood, urine, stool, sputum, pus swab etc.

3. Insert Naso-gastric tube, have observed chest intubation and paracentesis.

4. Do IV cannulation, have Observed CV-line insertion and cut-down of veins.

5. Catheterize male and female patients.

6. Prepare the patient for and know the procedure of doing X-Ray Chest, Abdomen, KUB, Bones, IVU, barium studies, ultrasound and other imaging investigations.

7. Understands the principles of pre-operative preparations, Sterilization/Disinfection techniques.

8. Understand principles of wound care, Skin Suturing and Suture Removal, Incision and Drainage of Superficial Abscesses, Excision of Small Soft Tissue Lumps, Needle Biopsies, Aspiration of localized fluids, etc.

9. Have Observed common surgical procedures, treatment of Fracture/ Dislocation and Methods of General / Local Anaesthesia.

10. Apply Bandage and Splint/POP cast to the patient’s limbs.

11. Have Observed instillation of Chemotherapy and principles of Radiotherapy.

Attitude/Affect/Values to be Inculcated

1. Demonstrate polite and gentle patient handling.

2. Observes Aseptic Techniques.

3. Keeps confidentiality of the patient.

4. Uphold medical ethics.

General Objectives:

To equip them with essential knowledge, skill and attitude to enable them:

1. Identify surgical diseases including emergencies, provide primary health care, refer to appropriate centre and provide follow-up to the patients.

2. Perform essential minor surgical procedures.

3. Communicate effectively with the patient, the family and the community regarding disease and its relevant issues.

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4. Understand medical ethics and its application pertaining to surgery and maintain the confidentiality of the patient.

5. To understand the prevalence and prevention of the common Public Health Problem related to his field in the community.

6. Understand the principles of medical research including fundamentals of Information Technology.

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ORTHOPAEDIC SURGERY & TRAUMATOLOGY

Objectives

1. General Objectives

After successful completion of the course, the students are expected to demonstrate knowledge and exhibit skills regarding preservation, investigations and treatment of common affections of the upper and lower limb and the spine. The students should be able to give emergency care to patients with limb injury, all kinds of injuries to the limbs and spine and demonstrate holistic approach in managing patients inclusive of safe transportation of patients to tertiary care centres.

1.1 Cognitive domain

a. explain principles of recognition of injuries to the bones, joints and soft tissue of limbs and spine.

b. detect and manage related musculoskeletal infections.

c. identify congenital malformations and deformities for referral with management.

d. recognize metabolic bone diseases.

e. explain pathology with diagnosis of neoplasm for appropriate referral and treatment.

f. explain associated pathology of common painful disorders.

1.2 Psychomotor domain

a. deliver first aid measures for common sprains fractures and dislocations.

b. identify problems of patients severely injured in any kind of accidents inclusive of road traffic, explosions, falls, fights, etc.

c. apply dressings, splints, plasters and other immobilization techniques.

d. assist in drainage, debridment, sequestration, orthopaedics surgeries related to the problems listed below and amputations.

2. Specific Objectives

The following levels of competence in domains of cognition, psychomotor skills and attitudes should be kept in mind by the tutors and the students while looking at the objectives of the clerkship.

1. Cognition; C1-Recognition, C2-Interpretation, C3-Problem-solving

2. Psychomotor Skills; P1-Observation, P2-Assist in the procedure, P3-Perform under supervision, P4-Perform independently.

3. Attitudes (Affects).

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2.1 With respect to the diseases and problems listed below, by the end of rotation the students will be cognizant (Cognitive domain) of and able to:

• identify, diagnose and treat common orthopaedic emergencies (C3 P3).

• define common orthopaedic problems in a scientific manner and with logical reasoning with clear understanding of their effect on body systems inclusive of congenital and acquired problems (C1).

• request relevant investigations (C2).

• exhibit holistic approach to an injured patient and identify haemodynamically unstable patient.

• identify the conditions/diseases effecting musculoskeletal system through their signs and symptoms (C1).

• identify the drugs needed for a person with orthopaedic and related problems (C3).

• explain the differential diagnosis with logical reasoning (C3).

• interpret, explain and advise needs of rehabilitation for PPP, CP, Amputations.

• prescribe treatment for common painful conditions.

• understand medical ethics and its application to surgical procedures related to orthopaedics like amputations, hip replacements, etc.

• identify the surgical procedures needed for a person with orthopaedic and related problems (C3).

• communicate effectively with the patients.

• counsel and help patients and his/her family independently for making informed choices regarding relevant surgical procedures (P3).

2.2 Necessary Applied Basic Sciences with reference to Orthopaedics (Cognitive Domain)

• pathophysiology of trauma and shock.

• mechanical properties of bone & Soft & tissue.

• biomechanics of Fracture.

• healing & Repair (Bone & soft tissues).

• healing principles of fracture.

• principles of physiotherapy, (orthotis & prosthesis).

• (Orthotics – Orthopaedic appliances to support and correct deformities).

• (Prosthesis – artificial substitute for missing body parts).

2.3 Required skills (psychomotor domain)

• provide first aid (ABC of management) to a person with bone injury like: common sprains , fractures and dislocations (P4);

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• manage bone infections and discuss indications of drainage, sequestration, (debridement ) and amputation (P2).

• catheterize male and female patients (P4).

• shifting of patient from bed to trolley (P4).

• serving patients with bed pan and urine bottle (P4).

• prepare patients for surgeries and post operative care (P3).

• dressing of surgical wounds post operatively (P3).

• pass nasogastric tube (P3).

• injections I/V and I/M (P4).

• interpret and explain the urine, stool and blood findings with relevance to orthopaedic diseases (C2 P3).

• recognize gross abnormalities on ultrasound and MRI (C2 P2).

3. Systems and the diseases

3.1 Congenital & Development Diseases (C2); Congenital Talipes equino varus (CTEV) and Talipes valgus; Congenital dislocation of hip (CDH); Flat foot; Perth’s Disease; Slipped Capital Femoral Epiphysis.

Specific required skills

• clinical Examination for CTEV (severity of deformity) (P2).

• clinical Examination for CDH (Ortoloni and Barlow test) (P2).

• X-ray interpretation of Perth’s disease and slipped capital femoral epiphysis (C2P2).

• manipulation/application of POP cast for CTEV (P1).

• management – Pelvic Harness, Von Rosen Splint, Hip Spica (P1).

3.2 Bone dysphasia (defect intrinsic to bone)

Dwarf- Achondroplasia

3.3 Bone and joint infections

• Acute osteomyelitis and septic arthritis.

• Chronic osteomyelitis.

• Tuberculosis, arthritis/Carries spines.

Specific required skills

• clinical examination of red hot swollen joint (P2).

• discharging sinus abscess, X-ray interpretations (C2 P1).

• Osteolysis/bone cyst, Sequestrum, Periosteal reaction

• Interpretation of laboratory reports (C2).

• urine blood and bacteriology, Management joint aspiration (P1).

• curettage and sequestrectomy (P1), drainage of abscess (P1).

3. 4 Metabolic Bone diseases

Rickets; Osteomalacia; Osteoporosis; Hyperparathyroidism; diabetes.

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Specific required skills

• Interpretation of X-rays( C2 P1) of Rickets/Osteomalacia, Osteoporosis/osteopetrosis.

• Hyperparathyroidism.

• Interpretation of laboratory reports (C2 P1) of serum Ca, PO4, Alk. Phosphatase, parathormone.

• Management of diabetes with relation to injury /surgical procedure and infections (P2).

3.5 Neuromuscular disorders

• Muscular Dystrophies e.g. Duchenne type and Becker’s type; Spina Bifida; Cerebral Palsy (CP).

• Post-Polio Paralysis (PPP); Neurofibromatosis;

Specific required skills

• Clinical examination of (P3) of sensations, deep tendon jerks, muscle power and tone colonus.

• Management suggesting and explaining (P2) of Orthosis, Walking aids (walking stick, crutches, walkers), Wheal chairs.

3.6 Bone Tumours

a. Benign (C2)

Exostosis/Multiple Hereditary Exostosis/Enchondroma, Fibroma, lipoma, neuroma, Osteoid osteoma, Giant Cell Tumour.

b. Malignant (C2)

Osteogenic Sarcoma, Ewings, Chondrosarcoma, Multiple Myeloma, Metastatic Bone disease from thyroid, lungs, kidney, breast and prostate.

Specific Required Skills

• Biopsy – Needle and open (P1).

• Amputation/Limb salvage surgery – principles, indications, techniques (P1), Orthotics.

3.7 Neck Pain, Low Back Pain and Sciatica

• Deformities (C3) of Scoliosis, Kyphosis.

• Spinal Injury (C3), Soft tissue injuries (Sprains, Strains etc.)

• Fractures (stable, unstable), Neurological Damage (partial, complete) Paraplegia (C3).

Specific Required Skills

• Examination of patient with: low back pain/sciatica (P3), neck pain (P3).

• Management.

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• Application of Cervical Collar (P2), cervical Traction (P1).

• Application of Lumbosacral corset (P2).

• Internal fixation of spinal fracture (P1), log rolling, prevention of Bed sores, bladder Care/Catheter Care and rehabilitation.

3.8 Arthritis and Musculoskeletal Painful Disorders

• Rheumatoid Arthritis (RA) (C3); Ankylosing Spondylitis (AS) (C3); Osteo Arthrosis (OA) (C3).

• Gout (C3); Frozen Shoulder (C3); Tennis Elbow, Plantar Fasciitis, Trigger Finger, De quervains Disease. (C3).

Specific Required Skills

• Examination of painful shoulder (P2); Investigations; X-rays (differentiate on X-ray).

• RA/AS/OA and Gout (P2).

• Management; prescription writing for arthritis and painful muscle disorders (P1).

3.9 Soft Tissue Injuries

• Sprains/ruptures of Muscles, Ligaments, tendons (C3); Nerve Injuries (C3).

• Arterial Injuries (C3) Clean/contaminated wounds (C3).

Specific Required Skills

• Management; application of cold and compression dressings on sprains of ligaments and tendons (P3); repair procedures for Nerve and Vessel Injuries (P1); dressing of Surgical Wounds post-operatively (P3); debridment (P2); wound cleaning/washing (P2); application and removal of wound stitches (P2); aseptic Dressing (P2).

3.10 Fractures

• Basic and advanced trauma life support (C3); Triage of injured patients in emergency room (C3),

• Principles of fracture classification (C3); Principals of fracture treatment in children (C3).

• Principals of fracture fixation (C3); Management of common orthopaedic emergencies (C3).

• Mal-united fractures (C3); Non-unions (C3).

Specific Required Skills

• Examination; Clinical Examination of injured patient (P2); Record BP, pulse rate, respiratory rate peripheral pulses and capillary filling; Recognition of associated injuries/complications e.g. Vascular, neurological, vascular compartment syndrome etc.

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• Investigations; Request and interpret urine and blood examination in trauma patient (CBC, ESR, Blood Urea and Sugar etc. (P2); interpret X-ray of limbs with fractures and dislocations (C2);

• Request and interpret X-rays, ultrasound, CT, MRI scans (P2)

• Management; provide first aid to a person with bone injury like common sprains, fractures and dislocations (Immobilization of body part, resuscitation of injured patient.

• Apply dressings, splints, plasters and other immobilization techniques in fracture patients in emergency (P4); maintain clear airway of patient (P3); reductions and observation of surgical fixations (P1); internal and external fixation of fractures (Plates, nails others) (P1); manipulation and application of plaster of Paris cast/back slab (P2); use of external fixators in treatment of open fractures (P2); application of traction skin/skeletal (P2).

4. List of drugs

Antibiotics; Cephalosporins, Aminoglycosides, Fusidic Acid, Vancomycin, NSAID (non-steroidal anti-inflammatory agents); Diclofenac sodium/Diclofenac Potassium, Naproxen, Prioxicam, Analgesics, Mefenamic Acid, Pracetamol, Tramadol, Sosegon Calcium, Calcitonin, VID3, HRT (Premarin), Bi-phosphonates, Anticoagulant, Heparin, Low molecular weight heparin, Warfarin, Anti-tubercular drugs, Multivitamins (B6, B12), Morphine derivates, Muscle relaxants, Norflex, Ternelin, Zyloric, Anti-depressants, Local Anaesthetic, Xylocaine, Abocaine, Steroids.

5. Instructional strategy

The methods that will be used for teaching learning for the students are given below:

• Lectures.

• Seminars.

• Emergency assignments.

• Community surgeries (observations, assistance and performance of some tasks under supervision).

• Ward rounds and bed-side teachings case-based learning in the tutorials and small group discussions.

• Teaching in the surgical theatres and minor operation theatres task-based learning (in TBL the trainee learns abut the task, develops an understanding of the education related to the task, looks at the applications of knowledge and skills in another context and acquires general competencies as exemplified in the task). Following themes are considered to identify as task in TBL:

• Clinical methods, investigations procedures.

• Normal and abnormal structure and function.

• Biomechanics and Biomaterials.

• Health promotion and disease prevention.

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• Ethics, self-audit.

• Information handling, computers.

ANAESTHESIOLOGY

COURSE CONTENT

• Pre-operative assessment of patients and pre-medication

• Local Anaesthesia

􀂉 Local Anaesthetic agents (Pharmacology)

􀂉 Regional Anaesthesia (Spinal and Epidural)

• Intravenous Anaesthetic agents

• Muscle Relaxants

• Inhalational Anaesthetic agents

• Anaesthesia and Associated Diseases.

• Complications of Anaesthesia.

• Perioperative Management.

• CPR.

• Recovery from Anaesthesia. Pain Management and postoperative care.

GENERAL OBJECTIVES

To equip them with essential knowledge, skill and attitude In order to enable them:

1. Identify condition requiring Anaesthesia including emergencies, provide primary life support, refer to appropriate centre and provide follow-up to the patients.

2. Perform essential minor Anaesthesiological procedures.

3. Communicate effectively with the patient, the family and the community regarding Anaesthesia care and its related issues.

4. Understand medical ethics and its application pertaining to Anaesthesiology and maintain the confidentiality of the patient.

5. Understand the principles of medical research including fundamentals of Information Technology.

DISTRIBUTION OF CURRICULUM

4th Year MBBS

Clinical Rotation = 2 weeks

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EVALUATION

Internal Evaluation (Log book) = 10 marks

Total: 10 marks

The Committee feels that the old system of one Question of Anaesthesia in surgery paper is not serving the practical purpose of learning. A log book consisting of 12 pages should be introduced for awareness and improved performance of Under-Graduate Student staying in the Department for 12 days and this log book should replace this conventional examination system of one question of Anaesthesia (in Surgery).

The submission of a complete logbook duly signed by Head of Department should be compulsory to appear in final professional examination.

LOG BOOK

PROCEDURES

1. Pre-Operative assessment of the patient.

2. I/V Cannulation and Intra-operative fluid Management.

3. Induction of General Anaesthesia and Tracheal Intubation.

4. Demonstration of Spinal Block.

5. Demonstration of Epidural Block.

6. Demonstration of Local Blocks in Eye, ENT and General Surgery.

7. Demonstration of CPR.

8. Post-Operative Care/Pain Management.

9. Introduction to the ICU.

10. Demonstration of Anaesthesia Machine and other instruments

11. Demonstration of Sterilization procedures in O.T and ICU.

12. Demonstration of Vital Sign Monitors and their application.

OBSTETRICS AND GYANECOLOGY

COURSE CONTENT

SUGGESTED SYLLABUS IN OBSTETRICS:

1. Introduction.

2. Obstetric History Taking and examination.

3. Conception, implantation and development of placenta, Fetal circulation, Abnormalities of placenta.

4. Foetal skull and Bony pelvis.

5. Diagnosis of pregnancy.

6. Physiological changes associated with pregnancy.

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7. Ante-natal care.

8. Early pregnancy loss and its management (Abortions)

Labour.

9. Physiology of labour.

10. Mechanism of labour.

11. Management of labour.

12. Complications of 3rd stage of labour.

13. Abnormal labour e.g. prolonged labour/obstructed labour.

14. Pre-term labour.

15. Induction of labour.

16. Pre-maturity.

17. Post-maturity.

18. Conduction of normal delivery.

19. Operation delivery.

20. Forceps delivery.

21. Vacuum delivery.

22. Caesarean section.

23. Ante-partum Haemorrhage.

24. Hydramnios.

25. Hyperemisis Gravidarum.

26. Medical Disorder associated with pregnancy e.g.

- Pregnancy with anaemia

- Pregnancy with Heart Disease

- Pregnancy with diabetes

- Pregnancy with jaundice/Hepatitis

- Renal problems during pregnancy

- Pyrexia in pregnancy

27. Hypertensive disorders of pregnancy e.g.

- PET

- Eclampsia

- Essential hypertension

28. Obstetric shock.

29. IUGR and its management.

30. Fetal distress and its management.

31. Fetal Monitoring.

32. Fetal presentations.

33. Breech presentation.

34. Occipito posterior position.

35. Brow presentation.

36. Face presentation.

37. Cord prolapse/compound presentation.

38. Transvese lie/unstable lie.

39. Multiple pregnancy.

40. Puerperium (normal and abnormal).

41. Examination of the new-born baby.

42. Resuscitation of new-born.

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43. Minor problems of the new-born.

44. Breast feeding and its importance.

45. Obstetric injuries/Ruptured Uterus.

46. Haematological disorder of pregnancy e.g.

- Rh incompatibility

- Thalassemia major/minor

47. Role of Ultrasound in Obstetric.

48. Foetal congenital abnormalities.

49. Vital statistics.

50. Log Book of 20 assisted deliveries.

SUGGESTED SYLLABUS IN GYNAECOLOGY:

1. Introduction.

2. Anatomy of female

- Genital organs

- Development of female genital organs

3. Gynaecological History taking and examination. Minor gynaecological operative procedures.

4. Puberty and adolescence.

5. Ovulation and its clinical importance.

6. Normal Menstruation.

7. Menstrual abnormalities.

8. Amenorrhoea.

9. Infertility.

10. Contraception.

11. Ectopic pregnancy.

12. Trophoblastic Tumours.

13. Vulval lesions

14. Tumours of vagina.

15. Tumours of cervix.

16. Tumours of uterus.

17. Tumours of ovaries.

18. Tumours of Fallopian Tubes.

19. Menopause, HRT.

20. Genital Prolapse.

21. Pelvic Floor injuries.

22. Urogynaecology.

23. Problems of marriage and sex.

24. Vaginal Discharges.

25. Infections of female genital Tract

- Infections of upper genital Tract

- Infections of lower genital Tract

26. Pre-Operative preparations.

27. Post-Operative complications and its management.

28. Role of USG in Gynaecology.

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GENERAL OBJECTIVES

To equip them with essential knowledge, skill and attitude in order to enable them:

1. Identify Gynaecology/Obstetric diseases including emergen-cies, provide primary Reproductive Health Care, refer to appropriate centre and provide follow-up to the patients.

2. Perform essential minor Gynaecology/Obstetric procedures.

3. Communicate effectively with the patient, the family and the community regarding Gynaecology/Obstetric diseases and its related issues.

4. Understand medical ethics and its application pertaining to Gynaecology/Obstetric and maintain the confidentiality of the patient.

5. To understand the prevalence and prevention of the common Public Health Problem related to Gynaecology/Obstetric in the community.

6. Understand the principles of medical research including fundamentals of Information Technology.

MEDICINE

(Including Psychiatry, Dermatology)

CORE CURRICULA

Suggested List of Topics

Instead of starting with the traditional systemic approach a symptomatic approach in Medicine is the theme of these topics. The students are given definition, how to look for these signs, causes, their basic anatomy, physiology and patho-physiology etc as per requirement. The ‘dynamic’ list of topics is:

1. GENERAL

i. Oedema

ii. Cyanosis

iii. Fever

iv. Headache

v. Anorexia, Weight loss

2. ALIMENTARY SYSTEM

vi. Melena, Hematemesis, Bleeding per rectum.

vii. Abdominal Distension/Ascites

viii. Jaundice.

ix. Heart burn.

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x. Diarrhoea and Constipation

3. GENITOURINARY SYSTEM

xi. All signs related to examination by the hands

xii. Lumbar pain, Anuria, Oliguria, Hematuria

xiii. Dysuria, Frequency of Micturation, Urgency, Pyuria

4. RESPIRATORY SYSTEM

xiv. Chest pain

xv. Cough/Expectoration/Sputum

5. CARDIOVASCULAR SYSTEM

xvi. Palpitation, Breathlessness, chest pain

6. CENTRAL NERVOUS SYSTEM

xvii. I.Q.

xviii. Paralysis.

xix. Speech disturbances

xx. Movement disorders

7. MUSCULOSKELETAL SYSTEM

xxi. Joint pain and Joint swelling

8. SKIN

xxii. Eruption and rashes

xxiii Itching, pigmentation and dyspigmentation

9. BLOOD

xxiv. Bleeding tendency, bruising purpura

xxv. Lymph Node, enlargement

Any other topic given below may also be included:-

1. GENERAL

• Pain

• Weight gain/Obesity

• Insomnia

• Facial swelling

2. ALIMENTARY SYSTEM

• Oral ulceration

• Dysphagia

• Nausea/Vomiting

• Indigestion/Flatulence

• Constipation

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3. GENITOURINARY SYSTEM

• Urinary retention

• Nocturia

• Urinary incontinence

• Pelvic pain

• Menorrhagia

• Oligomenorrhia

• Genital ulceration

• Impotence

• Infertility

4. RESPIRATORY SYSTEM

• Breathlessness

• Wheezing

• Haemoptysis

• Orthopnoea

Paroxysmal nocturnal dyspnoea (PND)

• Pain in calf on walking

• Undue coldness, redness or blueness of extremities

5. CENTRAL NERVOUS SYSTEM

• Behaviour

• Memory

• Confusional states

• Dementia

• Tremor

• Fasciculations

• Athetosis

• Chorea

• Gait abnormalities

• Convulsions/Fits

• Coma

• Syncope/Dizziness

• Vertigo

• Deafness

• Blindness

• Nystagmus examination

• Numbness, Tingling, Sensory loss

• Rigidity examination

6. MUSCULOSKELETAL SYSTEM

• Muscle cramps

• Muscle weakness

7. SKIN

• Alopecia

8. BLOOD

• Lassitude

• Dyspnoea

• Infections

• Gum hypertrophy

Lectures, Seminars, Tutorials, etc.

The respective teachers in the specialty will be responsible for teaching the suggested list of topics as under:

1. Cardiology

i. Rheumatic fever and infective endocarditis.

ii. Valvular heart diseases.

• Mitral valve

• Aortic valve

iii. Cyanotic/Acyanotic heart diseases.

• Fallot’s tetralogy

• Name of other diseases

iv. Ischaemic heart disease.

• Angina

• Myocardial infarction

v. Heart failure.

• Left Ventricular Failure.

• Congestive Cardiac Failure.

• Corpulmonale.

vi. Congenital heart diseases (brief).

• Atrial Septal Defect

• Ventricular Septal Defect

• Patent Ductus Arteriosus

vii. Cardiomyopathies (brief).

viii.Pericardial diseases (brief).

• Constrictive pericarditis

• Pericardial effusion

ix. Atherosclerosis/Arteriosclerosis.

x. Hypertension.

xi. Peripheral vascular disease (brief).

xii. Symptoms and signs.

xiii.Investigations.

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• Electrocardiography, X-Ray chest, Echocardiography, Thallium scan, Stress testing, Holter and Angiography etc.

2. Pulmonology

i. Pulmonary function tests.

ii. Imaging in pulmonary diseases/investigations.

iii. Asthma.

iv. Environmental lung diseases/Occupational (brief introduction).

• Asbestosis

• Silicosis

• Bagasosis

• Pneumoconiosis

• Byssinosis

• Farmer’s lung

v. Pneumonia.

• Community acquired

• Nosocomial

• Lobar/Broncho

vi. Adult respiratory distress syndrome/Acute respiratory failure/ Mechanical ventilation.

vii. Bronchiectasis.

viii.Chronic obstructive airway diseases.

• Chronic bronchitis

• Emphysema

ix. Interstitial lung diseases.

x. Pulmonary thromboembolism/Acute corpulmonale.

xi. Pleural effusion.

xii. Pneumothorax.

xiii.Carcinoma lung.

xiv.Tuberculosis.

3. Dermatology

i. Anatomy, Physiology, of Skin related to Clinical Dermatology.

ii. Infestations: Scabies, Pediculosis.

iii. Bacterial and Mycobacterial infections.

iv. Fungal and Viral diseases.

v. Acne vulgaris.

vi. Eczemas.

vii. Psoriasis and Lichen planus.

viii. Bullous disorders.

ix. Pigmentary disorders.

x. Disorders of nails.

xi. Disorders of hairs.

xii. Sexually transmitted diseases.

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4. Psychiatry

i. Mood disorders.

• Major depressive episodes

• Unipolar

• Bipolar

• Dysthymic

• Atypical

• Manic episodes

ii. Anxiety disorders.

• Acute anxiety states

• Panic disorders

• Generalized anxiety disorders

• Psychic Traumatic disorders

• Obsessive-compulsive disorders

• Phobic disorders

iii. Schizophrenia.

iv. Alcoholism.

v. Addiction.

vi. Psychosexual disorders in Men and Women.

CLINICAL TEACHING (4TH YEAR)

The clinical methods of related systems are revised, repeated with case discussion on various common disease presentations and their management. The candidates will also observe/assist in various procedures in the ward.

1. Cardiology

Suggested list of topics for Clinical Training:-

• Systemic hypertension.

• Valvular heart diseases.

• Congestive cardiac failure.

• Rheumatic fever and infective endocarditis.

• Pericardial diseases

• Angina pectoris, Mycardial Infarction

• Atrial Fibrillation

• Ventricular tachycardia

• Premature atrial and ventricular beats.

Procedures:

• ECG taking and basic reading i.e. Normal, Acute MI, Ischemia, complete heart block, APC, VPC, SVT, VT etc.

• X-ray chest reading – (Cardiology).

• Should observe, learn and even may assist electroversion therapy (DC shock) with indications, complications etc.

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• Observe Echo and should recognize chambers and valves on echo print.

• Observe Pericardial effusion aspiration.

• Should learn Thrombolytic Therapy, Heparinisation/Anticoagulation therapy and control, Anti-platelet Therapy, Nitrates Infusion, Digitalization, Treatment of Acute Pulmonary Edema, O2 therapy.

• Cardiac monitoring.

• Basics of ETT.

2. Pulmonology

i. Suggested list of topics for Clinical Training:

• Bronchial asthma

• Pleural effusion

• Pneumonia

• Pulmonary tuberculosis

• Chronic obstructive airway disease

• Type-I and type-II respiratory failure

ii. Procedures:

A. Perform

• Start O2 therapy, indications, complications, intermittent etc.

B. Observe

• Learn pleural aspiration and assist

• Endotracheal suction, assist

• Pleural biopsy, observe

• FNA biopsy, observe

• Under water seas aspiration, observe/assist

• Management of Respiratory Failure

• Observe Bronchoscopy

• Chest X-ray reading of common Pulmononary diseases.

Students should know how to start Oxygen Therapy

3. Dermatology

i. Should recognize lesions of:

• Leprosy

• Syphilitic lesions (Chancre, Secondary Syphilis, Gumma)

• Tinea (Corporis, Capitis, Inguinale, Unguam)

• Candida (Oral, Skin)

• Scabies

• Lice

• Mosquito bite

• Acute & Chronic Eczema

• Lesions of Small Pox, Chicken Pox, Herpes Simplex, Herpes Zoster

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• SLE.

• Psoriasis

• Lichen Planus

• Impetigo Contagiosum

• Moluscum Contagiosum

• Acne Vulgaris

• Seborhoea

• Exfoliative Dermatitis

• Skin Neoplasm like Squamous cell cacinoma, basal cell carcinoma and melanoma

• Leukoderma

• Pityriasis versicolor

• Alopecia and Hirsutism

• Sexually transmitted diseases

• Furnculosis, cellulitis

• Drug eruption

ii. Procedures:

• Scraping for fungus

• Use of Magnifying glass

• Observe skin biopsy

• Use of Wood’s Lamp

4. Psychiatry

i. Procedures:

Observe

• Psychotherapy

• ECT

• EEG

ii. Case discussion for diagnosis and management of common

Psychiatric disorders like-

1. Anxiety

2. Depression

iii. Diagnose and refer:

1. Schizophrenia

2. Manic Depressive Psychosis

3. Phobias

ALIMENTARY SYSTEM

1. Esophagus.

• Dysphagia with special reference to

a) CA Oesophagus

b) GERD

c) Achalasia

d) Candiasis of Oral Cavity and Oesophagus

2. Peptic ulcer and Gastritis.

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3. Malabsorption syndromes.

• Sprue

Tropical

• Coeliac Disease

4. Inflammatory bowel diseases.

• Ulcerative colitis

• Crohn’s disease

5. Irritable bowel syndrome (IBS).

6. Ascites.

6. Jaundice.

• Congenital hyperbilirubinaemia

Gilbert Syndrome

Dubin Johnson Syndrome

Rotor Syndromes

• Haemolytic

• Obstructive

• Hepatitis

Viral, acute and chronic

Toxic

Drugs

7. Auto Immune Hepatitis.

8. Cirrhosis of Liver.

9. Hepatic Encephalopathy.

10. Carcinoma liver and transplant.

11. Acute and chronic pancreatitis.

12. Upper GI Bleeding, Lower GI bleeding

13. Drugs Contraindicated in Liver Diseses

KIDNEYS AND URINARY SYSTEM

1. Acute renal failure. (Introduction

2. Chronic renal failure. to dialysis &

3. Nephrotic syndrome. Renal Transplant)

4. Nephritic syndrome.

5. Urinary tract infections.

6. Dialysis (detail).

7. Drugs and kidney (brief).

a) Causing Renal disease.

• Analgesic nephropathy.

• Lead, Uric acid, Hypercalcemia, Radiation & Hypersensitivity nephropathy.

b) Drugs contra indicated in Renal insufficiency and Drugs to be used with caution in Renal Disease.

8. Polycystic kidneys (brief).

9. Renal artery stenosis (brief).

10. Renal vein thrombosis (brief).

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11. Hemolytic uremic syndrome (brief).

NEUROLOGY AND CNS

1. Investigations .

2. Epilepsy.

3. Cerebrovascular diseases (stroke).

• Ischemic –

Embolism/

Infarction.

• Haemorrhage –

Intra-cerebral/

Subarachnoid

4. Dementia and Alzheimer’s disease.

5. Parkinson’s disease and other movement disorders.

6. Motor neuron disease.

7. Multiple sclerosis.

8. Meningitis.

• Bacterial.

• Tuberculous.

• Brain abscess.

• Viral meningitis and encephalitis.

9. Cranial nerve disorders.

• Transient mono-ocular blindness (Amaurosis fugax).

• Trigeminal neuralgia.

• Facial palsy (Bell’s).

• Vertigo, nystagmus

10. Spinal cord disorders.

• Spinal cord compression, paraplegia, quadriplegia

• Myelitis.

• Spondylosis.

• Syringomyelia and Syringobulbia.

11. Peripheral nerve disorders.

• Peripheral polyneuropathy G.B.Syndrome

• Mononeuritis multiplex.

12. Space Occupying Lesions of brain and spinal cord.

13. Myopathies, Myasthenia Gravis.

METABOLIC DISORDERS

(Definition, causes and some basic information).

1. Hyperlipidemia (brief).

2. Hemochromatosis (brief).

3. Porphyrias (brief).

4. Wilson’s disease (brief).

5. Gout and Hypercalcemia

6. Storage diseases.

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• Lipid.

Leukodystrophies

Niemann Pick disease.

Gaucher’s disease.

• Glycogen.

Fabry’s disease.

7. Hereditary Connective tissue disorders (Brief)

• Osteogenesis imperfecta.

• Ehler’s Danlos syndrome.

• Chondrodysplasias.

• Marfan syndrome.

• Alport syndrome.

8. Disorders of amino acid metabolism and storage (Brief)

• Homocystinuria.

• Alkaptonuria.

• Hartnup disease.

• Renal glycosuria.

DISEASES OF BONES AND JOINTS

1. Osteoarthritis

2. Osteoporosis

3. Rheumatoid Arthiritis and related Arthropathies

4. Paget’s disease of the bone.

5. Osteopetrosis (Marble bone disease).

INFECTIOUS DISEASES

A. Clinical syndromes.

1. Sepsis and Septic shock, Meningococcaemia

2. Acute infectious diarrhoeal diseases and Bacterial food poisoning.

3. Hospital acquired infections.

B. Common disease syndromes caused by the following bacteria and their drug therapy.

1. Pneumococci (Streptococcus Pneumoniae).

2. Staphylococci.

3. Streptococci.

4. Hemophilis influenzae.

5. Shigella.

6. Gonococci.

7. Pseudomonas.

C. Following diseases in detail.

1. Tetanus.

2. Enteric fever/Salmonellosis.

3. Cholera.

4. Tuberculosis.

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5. Leprosy.

6. Amoebiasis/Giardiasis/Trichomoniasis.

7. Malaria.

8. AIDS.

9. Rabies.

10. Infectious mononucleosis.

D. Helminthic infestations

• Ascariasis

• Hookworm

• Whipworm (Trichuriasis)

• Threadworm (Entrobiasis)

• Taenia (tapeworm)

MULTI-SYSTEM IMMUNOLOGICAL DISEASES

• Systemic lupus erythematosis (SLE)

• Serum sickness

• Rheumatoid arthritis

1. Systemic sclerosis (scleroderma).

2. Mixed connective tissue diseases (brief).

3. Sjogren’s syndrome (brief).

4. Ankylosing spondylitis.

5. Bechet’s syndrome (brief).

6. Vasculitis syndromes (brief).

• Anaphylactoid Purpura

• Polyarteritis nodosa

• Hpersensitivity vasculitis

• Wegner’s granulomatosis

• Temporal arteritis

• Takayasu’s arteritis

• Thromboangitis obliterans (Burger’s disease)

7. Sarcoidosis (brief).

HAEMATOLOGY

1. Anaemias.

• Classification

• Iron deficiency

• Megaloblastic

B-12 deficiency

Folic acid deficiency

• Anaemia of chronic disorder

• Haemolytic anaemia

Hereditary

Acquired

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Intra-corpuscular

Extra-corpuscular

• Aplastic anemia

2. Haemoglobinopathies.

• Sickle cell syndromes

• Thalassaemias

3. Myeloproliferative diseases.

• Chronic myeloid leukemia (CML)

• Polycythemia vera

• Myelofibrosis

• Essential thrombocytosis

4. Leukemia’s.

• Acute

• Chronic

5. Lymphomos

• Non-Hodgkin’s

• Hodgkin’s

6. Blood groups and blood transfusion.

7. Bone marrow transplantation.

8. Clotting disorders.

• Thrombocytopenia

Decreased production.

Increased destruction.

Idiopathic thrombocytopenic purpura (ITP)

• Von Willebrand’s disease.

• Vessel wall disorders.

• Disorders of coagulation.

Haemophilia

Vitamin K deficiency.

Disseminated intravascular coagulation (DIC).

9. Anticoagulants Therapy

• Heparin

• Oral (warfarin etc.)

• Antiplatelet drugs

ENDOCRINOLOGY

1. Anterior pituitary.

• Growth hormone disorders

• Acromegaly

• Gigantism.

• Short stature

• Infertility

2. Diseases of hypothalamus and pituitary.

• Empty sella syndrome

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• Diabetes insipidus

• Syndrome of inappropriate ADH secretion (SIADH).

3. Thyroid gland.

• Hyperthyroidism (thyrotoxicosis)

• Hypothyroidism (myxedema, cretinism)

• Interpretation of thyroid functions tests

4. Adrenal Gland.

• Cushing Syndrome

• Aldosteronism Primary/Secondary.

• Hirsutism.

• Addison’s disease, Acute Addisonian crisis

• Pheochromocytoma

5. Diabetes mellitus (detail) and Hypoglycaemic states

6. Testes (brief).

• Sexual precocity

• Heterosexual precocity

7. Gynaecomastia

8. Multiple endocrine neoplasia (brief).

• Type I

• Type II

CLINICAL TEACHING

Students come to wards for about 8 weeks for 4.5 hours for 6 times a week. They present and discuss cases; their clinical methods are checked and corrected. They write histories (10 in each ward), maintain clinical card of daily activity and perform day, night and casualty duties.

They observe, assist and perform various procedures in the ward. The students come to the wards in the evening as well for self-learning, writing histories, preparing case presentations etc. Once a week a CPC is held where various units/departments present cases in turn. Case presentation is by students and discussion covered by consultants of the same unit.Topic/Subjects/Systems are distributed to the wards to stream line training.

Topics to be discussed in clinical teaching are:

1. CENTRAL NERVOUS SYSTEM

• Cerebrovascular accident

• Paraplegia

• Polyneuropathy

• Muscular dystrophies or Motor neurone disease

• Parkinsonism

• Meningitis

• Tetanus

• Hemiplegia

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• Facial Palsy

2. ALIMENTARY SYSTEM

• Acid peptic disease

• Tender Hepatomegaly, Hepatosplenomegaly, Jaundice

• Chronic liver disease

• Acute and Chronic diarrhoea

• Variceal bleeding and peptic ulcer bleeding.

• Abdominal Koch’s infection

3. RHEUMATOLOGY

• Rheumatoid arthritis, Osteoarthritis

• Systemic Lupus Erythematosis

4. CARDIOVASCULAR SYSTEM

• Systemic hypertension

• Ischaemic Heart diseases

• Congestive cardiac failure

• Valvular diseases and Infective Endocarditis

5. RESPIRATORY SYSTEM

• Bronchial asthma

• Pleural effusion

• Pneumonia

• Haemoptysis

• Pulmonary tuberculosis

• Chronic obstructive airway disease

• Bronchogenic Carcinoma

6. FEVERS

• Malaria

• Typhoid fever

7. ENDOCRINOLOGY

• Diabetes mellitus

• Thyroid diseases

• Cushing’s disease

8. BLOOD

• Anaemia

• Bleeding disorders

• Myeloproliferative or lymphoproliferative diseases

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9. KIDNEY

• Nephrotic syndrome, Nephritic Syndrome

• Acute renal failure

• Chronic renal failure

10. MISCELLANEOUS AND EMERGENCIES

• Heat stroke

• Snake bite

• Electric shock

• Poisoning

PROCEDURES TO BE PERFORMED/OBSERVED/ASSISTED:

Perform:

• Injection I/V, I/M, S/C, intradermal

• Oxygen therapy

• Urinary catheterisation – collection and samples of blood

Observe:

• Observe I/V lines/Fluids/Blood/Blood products, direct, branula, cutdown, CVP

• N/G passing and feeding

• Foley’s catheter/Red rubber catheter, IOP record maintenance

• Endotracheal tube placement

• Endotracheal suction/maintenance of airway/nursing on side etc.

• Aspiration of fluids (Pleural, Pericardial, Peritoneal, Knee)

• Lumbar puncture

• O2 therapy

• Nebulisation

• ECG taking/reading basics

• X-ray chest reading

• Barium series

• I/V urograms

• Bone and joint X-ray reading for medical problems (Rheumatoid arthritis, Osteoarthritis, Collapse vertebra, Caries spine, Multiple myeloma, Cervical rib etc.)

• Preparing a patient for endoscopies, upper and lower GIT

• Bone marrow aspiration/Terphine

DESIGN OBJECTIVES

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A fresh medical graduate should have following professional and human qualities.

A. Knowledge and understanding of

1. Mechanism of body in health and disease.

2. Knowledge of relevant behaviour he has to display with patients, families and society.

B. Professional and communication skills

1. To diagnose and manage diseases.

2. To develop excellent communication skills with colleagues doctors, nurses, paramedical staff and public.

3. To have developed conditioned sympathetic attitude towards ailing humanity.

C. Clinical Skills

He/She should have acquired a desired theoretical and practical level of competence according to the goals set up by the medical college.

Note: (Each medical college should have mission statement that the medical graduate passing out from the medical college has actually acquired those theoretical and practical competence including human qualities and that he can play the role of a community leader in practical life as a doctor.

TEACHING HOSPITAL AND COMMUNITY BASED ATTACHMENTS

Students shall spend allocated days a week on hospital attachment AS MENTIONED ABOVE. The community attachment gives the student an opportunity to experience community based clinical medicine and study determinants of health other than those normally considered within the scope of the high-tech Hospital Health Services. Students shall work in a variety of settings including Rural, Tehsil, District Health Facilities and Community Health Trusts, Statutory and Voluntary organizations in small or larger groups. Teacher one from Medicine, Surgery, ENT, Eye, Paediatrics, Obstetrics and Gynaecology shall accompany along with the teachers from Community Medicine.

CLINICAL TEACHING

A brief sample of distribution of the clinical duty is given below to be modified by the respective units as per their requirements and feasibility.

Students are taught to elicit symptoms and signs in clinical medicine and to interpret them with possible aetiology, Pathophysiology, significance

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etc where indicated. They have to appear in a comprehensive end-ward test.

The students have ‘bed allotment’ and write 10 histories and present cases during their stay in the ward. They will perform day duties in the evening hours in turn and observe various activities going on in ward. They are supposed to see and observe various procedures performed in the medical wards (list is given in final year teaching). They will also maintain a clinical card, which show their daily activity and is signed by tutor. The list of teaching schedule is:-

- History taking in general.

- GPE, Pallor, Cyanosis, Jaundice, Clubbing, and Koilonychia.

- Thyroid, Lymph nodes, Dehydration, Nutrition, Decubitus,

Edema.

- Pulse.

- Examination of Blood Pressure and JVP.

- History taking in GIT – Vomiting, Diarrhoea, Pain Abdomen,

Constipation.

- Haematemesis, Melena, Dyspepsia, Distension.

- Examination of GIT – Inspection, Palpation.

- Percussion, Auscultation.

- Any deficient programme.

- History taking in Respiratory system – Dyspnoea, Cough,

Expectoration, Haemoptysis.

- Chest pain, Wheezing.

- Inspection, Palpation, Percussion, Auscultation front of chest.

- Inspection, Palpation, Percussion, Auscultation back of chest.

- Any deficient program.

- History taking in CVS.

- GPE in CVS – Clubbing, Koilonychia, Osler’s nodes, Splinter

Haemorrhages, Cyanosis.

- Pulse, JVP, Blood pressure.

- Inspection, Palpation of precordium.

- Percussion, Auscultation of precordium – Mitral, Tricuspid,

Aortic, Pulmonary areas.

- History taking in CNS.

- Higher Mental Functions – Level of consciousness, Behaviour,

Speech, Memory.

- Examination of cranial nerves.

- Examination of Motor system.

- Examination of Sensory system – Crude touch, Pain,

Temperature.

- Fine touch, Pressure, Vibration, Joint position.

- Cortical sensations

- Two point localization, Two point discrimination.

- Reflexes

- Examination of Cerebellar system

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POST-WARD TEST (Internal assessment)

LECTURES/TUTORIAL/SEMINARS/CLINICO-PATHOLOGICAL CONFERENCES AND OTHER TEACHING METHODOLOGY

There are 03/4 lectures per week to be taken by respective teachers of various medical units. The topic/hours are allocated to each teacher to complete his task. The list of topics is ‘dynamic’ i.e. the teacher can make changes in consultation with head of department but cannot overshoot the time allocated.

THE LOG BOOK/CLINICAL CARD RECORD

The student is expected to make a reflective record of his/her achievements in the log book. The log book is a collection of evidence that learning has taken place, it is a reflective record of achievements. The log book shall also contain a record of the procedures which student would have performed in 3rd, 4th & 5th year.

Distribution of subjects

Paper-I All except Paper-II

Paper-II will include

Infectious Diseases Endocrinology including Diabetes

Metabolic Diseases Genitourinary System

Immunology Genetics

Oncology Water and Electrolyte

Acid and Base Psychiatry/Behavioural Sciences

Dermatology

PAEDIATRICS

PERFORMANCE OBJECTIVES:

COURSE CONTENT

List of suggested topics for teaching the undergraduates is given below, however the individual faculties can alter/add topics as per their discretion in respective institution:

- Common Problems of children in Pakistan and statistics of Pakistani Children.

- Clinical Methods in Paediatrics.

- Nutrition (Breast feeding, infant feeding, Weaning) and Nutritional Disorders: (PCM, Rickets, Vitamin A Deficiency, iodine deficiency, Iron Deficiency).

- Growth and Development.

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- Common Paediatric infections: Measles, tetanus, polio, diphtheria, whooping cough, AIDS, Malaria, Enteric Fever, Tuberculosis, Chicken pox, Common Skin infections.

- Expanded Programme of Immunization (EPI). Newer vaccines.

- Diarrhoeal diseases.

- Acute Respiratory Infections (ARI).

- IMCI (Integrated Management of Childhood Illness).

- Neonatology: Resuscitation of new born, care of normal new-born, birth asphyxia, premature and low birth weight babies, Neonatal Jaundice, Neonatal sepsis, Neonatal fits, Respiratory distress of new born, Common skin conditions of neonates;Pyloric stenosis, Myelo-meningocele, Hydrocephalus, common congenital abnormalities and Birth trauma.

- Neurology: Meningitis, febrile, convulsions, epilepsy, Cerebral Palsy, mental handicap, Cerebral Malaria, Encephalitis.

- Cardiology: Congenital heart diseases [VSD, PDA, TOF, ASD], Rheumatic fever. Congestive cardiac failure, Clinical assessment of a cyanotic neonate/infant.

- Haematology: Anaemias, Thalassemia, Leukemias, Bleeding disorders.

- Nephrology: Nephrotic syndrome, Urinary tract infections, Acute Glomeulonephritis.

- Endocrinology: Hypothyroidism, short stature, Diabetes.

- Pulmonology: Croup, Asthma, Tuberculosis, Pneumonias, Pleural effusions.

- Gastroenterology: Abdominal pain, Malabsorption, Hepatitis, cirrhosis, Acute liver failure, Diarrhoea [acut/echronic] Dysentery, Worm infestations, Giardia, amoebiasis Rectal Polyp.

- Genetics: Patterns of inheritance, Down’s syndrome.

- Social Paediatrics: Right of child, child abuse, Enuresis, encoparesis, Hyperactivity, Dyslexia, Attention Deficit disorder.

- Miscellaneous: Poisoning, prevention of home accidents, behavioural disorders.

- Paediatric Surgery: Hernia, Intussusseption, Intestinal obstruction, Tallipes, congenital Dislocation of Hip, Vesico ureteral reflux.

A. KNOWLEDGE AND UNDERSTANDING

1. Student will be able to give description of common paediatric problems and diseases, in children at different ages.

2. Student will show an understanding of national programmes working for health promotion and disease prevention in children e.g. EPI, ARI etc.

3. Student will show an understanding of processes of growth and development in childhood and will be able to describe growth parameters and developmental milestones at different ages.

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4. Student will demonstrate understanding of the importance of nutrition in children and be able to describe diets suitable for different ages and in different diseases.

5. Student will show an understanding of the interaction between heredity and environment in the genesis of disease in children.

6. Student will be able to describe care of new-born baby, in health and when suffering from common problems, along with importance of perinatal factors impacting on the well being of the new-born.

7. The Student will show understanding and knowledge about common accidents and poisoning in children and their management.

B. SKILLS:

1. Students will demonstrate his ability to obtain a relevant clinical history from a parent or an older child.

2. Student will demonstrate his ability to perform adequate clinical examination of a child of any age (including new-born).

3. Student will be able to interpret clinical and laboratory data arriving at a diagnosis.

4. Student will be able to advise appropriate nutritional measures for healthy and sick children (Breast feeding, avoidance of bottle, proper weaning).

5. Student will be able to counsel the parents on health promotive and disease preventive strategies for the child e.g. immunisation procedures; hand washing)

6. Student will be able to recognize and manage common health problems of children.

7. Student will recognize the danger signs of disease in children and be able to appropriately refer children with severe disease to appropriate specialists/hospitals.

8. Student will demonstrate his ability to perform essential clinical procedures relevant to children, e.g.

Resuscitation of new-born.

Basic cardio-pulmonary resuscitation.

Anthropometric measurements.

Measuring blood pressure.

Starting Intravenous lines/draw blood sample.

Administration of Oxygen therapy

Giving Nebulizer therapy [Bronchodilator]

Use of Growth chart.

OBSERVE THE FOLLOWING SKILLS:

Lumbar Puncture

Bone marrow aspiration

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Supra pubic puncture

Subdural tap

Thoracocentesis

Pericardiocentesis

Liver Biopsy

Renal biopsy

Observe passing of catheter

Observe pericardial tap

9. The Student will show ability to provide general care of sick Paediatric patients and be able to carry out simple diagnostic tests in the side lab.

A curriculum of Paediatrics should be designed based on common problem of Pakistani children which a medical student should at least know.

OBJECTIVES

1. Students acquire the knowledge of health promotion, disease prevention and management of common diseases in children (including new-borns).

2. Students become proficient in basic clinical skills of history taking, physical examination, data interpretation and basic technical procedures as applied to children of different ages.

3. Students develop an attitude of sympathetic care for the child patient and his parents.

4. Students develop a desire for self-learning.

5. Students are able to visualize the impact of the disease on the community as a whole and be able to study the genesis of epidemics and be able to plan prevention of those.

6. The students are equipped with the knowledge and confidence to play the role of a teacher, supervisor and organizer in a primary health care setup.

RADIOLOGY

• The medical graduate should have enough knowledge and exposure to various radiological techniques and be able to interpret radiological findings with accuracy and confidence.

• Different pathologies have characteristics radiological features which are strong basis for diagnosis of different diseases.

• Modern imaging i.e.; Intravenous urography, Ultrasonography, CT and MRI have made diagnosis easy and accurate.

• Interventional Radiology has emerged as rapidly developing sub-specialty and contributes a lot in diagnosis and therapeutic aspect.

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OBJECTIVES

The student will be:

• Able to select/advice the required radiological examination correctly

• Identify gross abnormalities in the films

• List indications and advantages of modern techniques

• Recognize major abdominal viscera and their imaging characters

Required Radiological Examinations and

Abnormalities

• Plain Radiography

- Chest

􀂃 Normal anatomy and projections

􀂃 Pneumothorax

􀂃 Pneumonia

􀂃 Effusion

􀂃 Cardiomegaly

􀂃 Plumonary oedema

􀂃 Fractures 􀂃 Surgical emphysema 􀂃 Neoplastic Diseases

􀂃 Chronic inflammatory disease (TB)

• Plain Radiograph

- Skull

􀂃 Normal Anatomy and Projections

􀂃 Fracture

􀂃 Lytic and scerotic lesion

􀂃 Calcifications

􀂃 Pituitary fossa

􀂃 Paranasal sinuses - Abdomen 􀂃 Normal Anatomy and projections

􀂃 Renal & Urinary tract stones, gall stones and other calcifications

􀂃 Fluid levels (intestinal obstruction) 􀂃 Free gas under Diaphragm, (perforation) 􀂃 Enlarged liver and spleen

• Plain Radiograph

- Spine

􀂃 Normal anatomy and various projections.

􀂃 Disc space reduction

􀂃 Vertebral Collapse

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- Barium Meal and with double contrast (where applicable)

􀂃 Normal anatomy and various projections

􀂃 Gastric outlet obstruction

􀂃 Stomach mass/filling defect

􀂃 Oesophageal outline/varices/strictures

􀂃 Intussusception

􀂃 Colonic defects

􀂃 Malabsoption pattern

􀂃 Stricture

􀂃 Any filling defect

􀂃 Ulcerative colitis

• Intravenous Urogram

- Hydronephrosis and renal masses

• Micturating Cystourethrogram

- Reflux

• Echocardiogram

Be able to interpret the report

• CT Scanning

Be able to interpret the report

• MRI

- Basic principles.

There may be 10 to 12 lectures. The best student will learn during the clinical rotations.

OUTLINE OF SYLLABUS CONTENTS

BEHAVIOURAL SCIENCE

1. Introduction to Behavioural Sciences

SOCIAL INFLUENCES ON BEHAVIOUR

2. Communication: Verbal & Non-verbal

3. Stigma; reactions to Illness

4. Death, Dying & Bereavement

5. Social Support

6. Roles

7. The Family

8. Illness behaviour

9. Culture, Race and Ethnicity

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INDIVIDUAL INFLUENCES ON BEHAVIOUR

10. Learning & Behaviour Change

11. Memory

12. Emotion

13. Stress & Coping

14. Intelligence

15. Cognition, Thinking & Beliefs

16. Personality

17. Child development: including cognitive, emotional and psychosexual

development

18. Adolescence

19. Aging

BIOLOGICAL INFLUENCES ON BEHAVIOUR

20. Sensation & Perception

21. Pain

22. Motivation

23. Sleep

24. Genetics

PSYCHO-SOCIAL ASPECTS OF PHYSICAL ILLNESS

25. Illness and Hospitalization

26. Common medical and surgical conditions

27. Coronary Care Unit

28. Renal/Dialysis Unit

29. Intensive Care Unit

30. Oncology service

31. Paediatric unit

32. Women’s Health

PSYCHIATRY AND MEDICAL PRACTICE

33. Psychopathology

34. Prevention of mental illnesses

35. Suicide and Parasuicide

36. Smoking

37. Non Pharmacological interventions

38. Improving compliance

39. Informational care

40. Ethical aspects including rights of the patients

Academic Councils should decide when the above topics will be addressed and by which department in their institutions. The Council will also ensure implementation. This aspect of the curriculum should be related to the teaching of Islam.

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TABLE OF SPACING AND HOURS OF SUBJECTS IN MBBS COURSE

_________________________________________________________________

SUBJECT 1st year 2nd year 3rd year 4th year 5th year Total Hours

____________________________________________________________________________________

BEHAVIOURAL 5 Hrs. 5 Hrs. 5 Hrs. 5 Hrs. 5 Hrs. 25 Hrs.

SCIENCES____________________________________________________________________________

ISLAMIC & 15 Hrs. 15 Hrs. 10 Hrs. 10 Hrs. - 50 Hrs.

PAKISTAN

STUDIES______________________________________________________________________________

ANATOMY 250 Hrs. 250 Hrs. - - - 500 Hrs.

_____________________________________________________________________________________

PHYSIOLOGY 250 Hrs. 250 Hrs. - - - 500 Hrs.

_____________________________________________________________________________________

BIOCHEMISTRY 100 Hrs. 100 Hrs. - - - 200 Hrs.

_____________________________________________________________________________________

PHARMACOLOGY - - 300 Hrs. - - 300 Hrs.

_____________________________________________________________________________________

PATHOLOGY 15 Hrs. 25Hrs. 260 Hrs 200 Hrs - 500 Hrs.

_____________________________________________________________________________________

* FORENSIC - - 100 Hrs - - 100 Hrs.

MEDICINE___________________________________________________________________________

** COMMUNITY 25 Hrs 25 Hrs 50 Hrs 150 Hrs - 250 Hrs.

MEDICINE____________________________________________________________________________

MEDICINE & Allied 25 Hrs. 30 Hrs. 120 Hrs 265 Hrs. 360Hrs 800 Hrs.

NUCLEAR MEDICINE - 10 Hrs. - 10 Hrs - 20 Hrs.

EMERGENCY MEDICINE,

MEDICINE ELECTIVE,

*** PSYCHIATRY,

DERMATOLOGY AND

GENERAL PRACTICE

- - - - - -

____________________________________________________________________________________

PAEDIATRIC 5 Hrs. 10 Hrs. 15 Hrs 50 Hrs 70 Hrs 150 Hrs.

MEDICINE____________________________________________________________________________

SURGERY & ALLIED 25 Hrs. 30 Hrs. 120 Hrs 265 Hrs 360 Hrs 800 Hrs.

**** RADIOLOGY 5 Hrs. 10 Hrs. - 10 Hrs 15 Hrs 40 Hrs.

ORTHOPAEDICS,

PAED.SURGERY,

NEUROSURGERY,

SURGERY ELECTIVE,

EMERGENCY SURGERY

& ANAESTHESIA______________________________________________________________________

OBSTETRICS & 10 Hrs. 10 Hrs. 50 Hrs 100 Hrs 130 Hrs. 300 Hrs.

GYNAECOLOGY_______________________________________________________________________

OPHTHALMOLOGY 5 Hrs. 10 Hrs. 15 Hrs 70 Hrs - 100 Hrs.

_____________________________________________________________________________________

OTORHINOLARYN- 5 Hrs. 10 Hrs. 15 Hrs 70 Hrs - 100 Hrs.

GOLOGY(E.N.T.)_______________________________________________________________________

CLINICO- - - - 60 Hrs - 60 Hrs.

PATHOLOGICAL

CONFERENCE_________________________________________________________________________

Total 740 Hrs 790 Hrs 1060 Hrs 1265Hrs 940Hrs 4795Hrs

* Bioethics will be taught in the Forensic Medicine.

** Biostatistics will be taught in Community Medicine.

*** Behavioral Sciences will be taught in Psychiatry.

**** Biophysics will be taught in Radiology.

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Distribution of subjects Instructional contents into Theory and Practical learning.

Type of subject

Theory Content

Practical Skills Content

All Basic Sciences

50%

50%

Pre-Clinical Sciences

(Pharmacology and Therapeutics, Forensic Medicine, Community Medicine, Pathology)

40%

60%

Clinical Sciences

30%

70%

Internship/House Job

0%

100%

Time Allocation To Curriculum Content= 7493 hours

Subject specified competencies

General competencies

80%

5994

20%

1499

Time Allocation To the Study Design(5184)

Instructions

Self Study

80%

4795

20%

1198

Time Allocation to Site of Study(4147)

Institution Based

Community Oriented

80%

3836

20%

959

Distribution of Marks in Evaluation

University Examination

Internal Assessments

90%

10%

Examination of Subject Based MBBS Curriculum

Total 100%

Internal Assessment 20%

University Examination 80%

Internal Assessment Theory

Internal Assessment Practical

University Assessment Theory

University Assessment Practical

Total

10%

10%

40%

40%

100%

Generic Competencies

Total Hours = 1499

Compulsory

• Pakistan Studies

• Islamiyat

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Optional

• Excursion Trips

• Field Visits

• Sports

• Philosophy

• Literature

• Culture

• History

• Computer Skills and Information Technologies

• Languages

all of following information come from pmdc  syllabus