SYLLABUS OF FINAL PROFESSIONAL M.B.B.S.(A). (B). (C). (D). (E). SURGERY MEDICINE OBSTETRICS GYNAECOLOGY PAEDIATRICS (A) Distribution of Subjects: Paper I: SURGERY General Surgery, Surgical Anatomy, Principles of Anaesthesia, Principles of Radiology, Principles of Radiotherapy and Chemotherapy. Paper II: Systematic and Operative Surgery: Musculoskeletal system, GIT, Renal system, Male and female reproductive system, Head and Neck, Thorax, Breast, Nervous system, Cardiovascular System, Orthopaedics and Traumatology. The course outline is as follows : 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. 3. Oral cavity including tongue. 4. Diseases of salivary glands (Inflammation, Calculus, Tumours) 5. Neck lumps including lymph nodes, thyroid and parathyroid Breast 1. Diseases of the breast, nipple and areola 2. Benign and malignant tumours. Chest Wall & Thorax 1. Blunt & penetrating injuries and their complications. 2. Lung abscess and empyema thoracis. 3. Tumors and cysts in the lungs. Gastro Intestinal Tract 1. Diseases causing oesophageal obstruction. 2. Peptic ulcer disease & its complications. 3. Tumours of stomach. 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/ Inguinoscrotal and femoral hernia. 3. Epigastric hernia/umbilical/ para-umblical hernia. 4. Incisional hernia. 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. Tumours Pancreas 1. Acute, relapsing and chronic pancreatitis. 2. Pancreatic masses including cysts 3. Benign and malignant neoplasia. Spleen 1. Trauma 2. Surgical aspects of spleen Urinary Tract 1. 2. 3. 4. 5. 6. 7. Common congenital anomalies. Infection & its sequelae. Calculus disease and its sequelae. Bladder lesions. Enlarged prostate. Urogenital trauma. Neoplasms of kidney and urinary tract. Liver External Genitalia, Male and Female 1. Developmental abnormalities. 2. Common pelvic conditions Scrotal and testicular lesions 1. Scrotal swelling. 2. Testicular swelling. 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. Vascular and Nerve Disorders 1. 2. 3. 4. Vascular afflictions and limb ischaemia. Varicosities Deep venous thrombosis. 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. Principles of pre-operative preparations, sterilization/disinfection techniques. 8. Principles of wound care, skin suturing and suture removal, incision treatment of fracture/ dislocation and methods of general / local anaesthesia. (I) ORTHOPAEDIC SURGERY & TRAUMATOLOGY The course outline is as follows : a. Necessary Applied Basic Sciences With Reference To Orthopaedics: • • • • • • • • Pathophysiology of trauma and shock. Systems and Diseases 1: Congenital & Development Diseases. Principles of physiotherapy Orthotics – orthopaedic appliances to support and correct deformities Prosthesis – artificial substitute for missing body parts. Congenital talipes equino varus (CTEV) and talipes valgus. Healing & repair (bone & soft tissues). hip spica. 9. Mechanical properties of bone & soft tissue. Von Rosen splint. Specific required skills • • 2: 3: Clinical examination and x-ray interpretation of above mentioned diseases Observe the manipulation/application of POP cast for CTEV. 10. • Chronic osteomyelitis. Perth’s disease. needle biopsies. • Osteolysis/bone cyst. pelvic harness. congenital dislocation of hip (CDH). • Tuberculous arthritis/Caries spine. sequestrum. aspiration of localized fluids. Slipped Capital Femoral Epiphysis.Achondroplasia Bone and joint infections • Acute osteomyelitis and septic arthritis. Have observed instillation of chemotherapy and principles of radiotherapy. Healing principles of fracture.tissue lumps. etc. 11. periosteal reaction . Have observed common surgical procedures. b. flat foot. Bone dysplasia (defect intrinsic to bone) • Dwarf. Apply bandage and splint/pop cast to the patient’s limbs. Biomechanics of fracture. Specific required skills • Clinical examination for above mentioned diseases • Interpretation of related x-ray and laboratory reports • Observe or assist in joint aspiration. 4: Metabolic Bone diseases • Rickets. chondrosarcoma. hyperparathyroidism. breast and prostate. Bone Tumours a. lipoma. indications. curettage and sequestrectomy. 5: Neuromuscular disorders • Muscular dystrophies e. lungs. spina bifida. Management suggesting and explaining of orthosis. Principles. walking aids (walking stick. Spinal injury. • Post-polio paralysis (PPP). Specific required skills • Interpretation of related X-rays • Interpretation of laboratory reports of serum Ca.g. neurological damage . strains etc. crutches. phosphatase. giant cell tumour. metastatic bone tumors from thyroid. techniques and orthotics related to amputation. B. muscle power and tone clonus. Specific Required Skills • • Observe biopsy – needle and open. drainage of abscess etc. PO4.) Fractures (stable. Benign Exostosis/multiple hereditary exostosis/enchondroma. Low Back Pain and Sciatica • • • Deformities of scoliosis. Observe amputation/limb salvage surgery – 7: Neck Pain. Duchenne type and Becker’s type. walkers). Alk. multiple myeloma. Ewings sarcoma. fibroma. parathormone. neuroma. osteoporosis. c. cerebral palsy. soft tissue injuries (sprains. unstable). deep tendon jerks. • Management of diabetes with relation to injury /surgical procedure and infections. kyphosis. osteomalacia. neurofibromatosis Specific required skills • • 6: Clinical examination of sensations. osteoid osteoma. wheel chairs. Malignant Osteogenic sarcoma. diabetes. kidney. osteoarthritis.g. x-rays and laboratory. 9: Soft Tissue Injuries • Sprains/ruptures of muscles. • Management. Observe internal fixation of spinal fracture Log rolling. • Mal-united fractures. cervical traction. pulse rate. neurological. blood urea and sugar etc. respiratory rate peripheral pulses and capillary filling. Application of cervical collar.Specific Required Skills • • • • 8: Examination and basic management. Gout. Specific Required Skills • Examination. 10: Fractures • Basic and advanced trauma life support • Triage of injured patients in emergency room. request and interpret urine and blood examination in trauma patient (CBC. record BP. • Principals of fracture fixation • Management of common orthopaedic emergencies. non-unions. vascular compartment syndrome etc. clinical examination of injured patient. de Quervains disease. • Catheterize male and female patients. interpret x-ray of limbs with fractures and dislocations. . • Investigations. nerve injuries. prescription writing for arthritis and painful muscle disorders. • Principles of fracture classification • Principals of fracture treatment in children. tennis elbow. • Arterial injuries clean/contaminated wounds. ankylosing spondylitis. prevention of bed sores. lumbosacral corset. trigger finger. frozen shoulder. Specific Required Skills • Clinical examination of patients with arthritis (differentiate on x-ray) • Interpretation of related investigations. bladder care/catheter care and rehabilitation. tendons. plantar fasciitis. ESR. Vascular. Arthritis and Musculoskeletal Painful Disorders • • Rheumatoid arthritis. recognition of associated injuries/complications e. ligaments. ultrasound. and Tom. Andersen. Alan G. fractures and dislocations (immobilization of body part. nails others). reductions and observation of surgical fixations. Roy Calne. • • • • • • RECOMMENDED BOOKS: Short Practice Of Surgery By Bailey And Love’s Text Book Of Surgery By Ijaz Ahsan General Surgery (Lecture Notes Series) by Harold Ellis. Pass nasogastric tube. Browse. Charles Brunicardi. plasters and other immobilization techniques in fracture patients in emergency. application of traction skin/skeletal. • Apply dressings. Injections I/V and I/M. stool and blood findings with relevance to orthopaedic diseases. Prepare patients for surgeries and post operative care. and David L. resuscitation of injured patient. Dunn 8th edition. Chris Watson An Introduction to the Symptoms and Signs of Surgical Disease by Norman Browse Current Surgical Practice: by Norman L. Vol. Dressing of surgical wounds post operatively. Interpret and explain the urine. Johnson. internal and external fixation of fractures (plates. 6 Schwartz's Principles of Surgery by F. MRI scans • Management. Timothy R. Billiar.Serving patients with bed pan and urine bottle. provide first aid to a person with bone injury like common sprains. use of external fixators in treatment of open fractures. Dana K. 2004 Online Journals and Reading Materials through HEC Digital Library Facility. manipulation and application of plaster of paris cast/back slab. splints. maintain clear airway of patient. CT. • Request and interpret x-rays. . 8. CPR. Pain management and postoperative care. Demonstration of induction of general anaesthesia and tracheal intubation. Demonstration of epidural block. Demonstration of CPR. • Perioperative management. Demonstration of sterilization procedures in O. Demonstration of spinal block. 9. Introduction to the ICU. 10. PROCEDURES Pre-operative assessment of the patient. ENT and General Surgery. I/V cannulation and Intra-operative fluid management. Demonstration of vital sign monitors and their application 1. • Cardiopulmonary Resuscitation. 3. Post-operative care/pain management. 7. signed by Head of in final professional .T and ICU. Demonstration of local blocks in Eye. 5. LOG BOOK The submission of a complete logbook duly Department should be compulsory to appear examination. 4. • Complications of anaesthesia.(II) ANAESTHESIOLOGY The course outline is as follows : • Pre-operative assessment of patients and pre-medication • Local anaesthesia o Local anaesthetic agents (pharmacology) o Regional anaesthesia (spinal and epidural) • Intravenous anaesthetic agents • Muscle relaxants • Inhalational anaesthetic agents • Anaesthesia and associated diseases. 12. Demonstration of anaesthesia machine and other instruments 11. 2. 6. • Recovery from anaesthesia. Short Practice of Anaesthesia by M.RECOMMENDED BOOKS: 1. G. gall stones and other calcifications . Morgan. A Synopsis of Anaesthesia by J. Smith and A.R. Online Journals and Reading Materials through HEC Digital Library Facility. Latest edition 3. Hall. Textbook of Anaesthesia by G.Alfred Lee 4. Aitkenhead 2. (III) RADIOLOGY 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 Skull • • • • • • Normal anatomy and projections Fracture Lytic and sclerotic lesion Calcifications Pituitary fossa Paranasal sinuses Abdomen • Normal anatomy and projections • Renal & urinary tract stones. . and Nakielny R. 2003. (perforation) • Enlarged liver and spleen Spine • Normal anatomy and projections. • Disc space reduction • Vertebral collapse 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 • Malabsorption pattern • Stricture • Any filling defect • Ulcerative colitis • Intravenous Urogram • Hydronephrosis and renal masses • Micturating Cystourethrogram • Reflux • Cholecystogram • Gall bladder diseases and stones • Echocardiogram • Be able to interpret the report • CT Scanning • Be able to interpret the report • MRI • Basic principle RECOMMENDED BOOKS: 1. 2.• Free gas under diaphragm. Elsevier Science Limited. Aids to Radiological Differential Diagnosis by Chapman S. Online Journals and Reading Materials through HEC Digital Library Facility. 4th ed. • Valvular heart diseases. • Mitral valve • Aortic valve • Ischaemic heart disease.Oncology 5. • Cor pulmonale. • Fallot’s tetralogy • Atrial septal defect • Ventricular septal defect • Patent ductus arteriosus • Cardiomyopathies • Pericardial diseases.Metabolic Diseases 3. Genetics 10. Dermatology MEDICINE 7.Genitourinary System 9. • Left ventricular failure.Endocrinology including Diabetes 8. • Heart failure.Psychiatry 1. Acid and Base Balance 6.Immunology 4. • Constrictive pericarditis . CARDIOLOGY The course outline is as follows : • Rheumatic fever and infective endocarditis.Infectious Diseases 2. • Cyanotic/acyanotic heart diseases.(B) Distribution of subjects Paper-I All except Paper-II Paper-II will include: 1. • Congestive cardiac failure. • Angina • Myocardial infarction • Cardiac arrhythmias • Atrial fibrillation • Ventricular tachycardia • Premature atrial and ventricular beats.Water and Electrolyte Balance 11. • Congenital heart diseases (brief). blood pressure. Ischemia. osler’s nodes. Acute MI. Xray chest. Echocardiography.• • • • • Pericardial diseases Pericardial effusion A therosclerosis/arteriosclerosis.e. • Systemic hypertension • Ischaemic heart diseases • Congestive cardiac failure • Valvular diseases and infective endocarditis Understand the Symptomatology to reach the Differential Diagnosis: Palpitation. breathlessness. JVP. Hypertension. auscultation of precordium – mitral. Stress Testing. CLINICAL TRAINING: Important Topics To Be Discussed: Case discussion for diagnosis and management of common cardiovascular diseases. palpation of precordium. complete heart block. VT etc. raised JVP. cyanosis. koilonychia. Thallium Scan. Normal. • Interpretation of related radiological and laboratory investigations • General medication and prescription writing in CVS diseases. chest pain. • GPE in CVS – clubbing. • Percussion. VPC. pulmonary areas. Procedures (Observe/ Assist): • ECG taking and basic reading i. Peripheral vascular disease. jaundice etc. • Inspection. Holter And Angiography Etc. • Symptoms and signs • Arteriosclerosis • Acute & chronic ischaemia of the leg • Aneurysms • Buerger's disease • Raynaud's disease • variocose veins • Venous thrombosis • Investigations. aortic. SVT. splinter haemorrhages. Skills To Be Learnt: • History taking in CVS. APC. tricuspid. . • Electrocardiography. • Pulse. • Bronchiectasis. • Type-I and type-II respiratory failure • Pleural effusion. • Asbestosis • Silicosis • Bagassosis • Pneumoconiosis • Byssinosis • Farmer’s lung • Pneumonia • Community acquired • Nosocomial • Lobar and bronchopneumonia • Adult respiratory distress syndrome • Acute respiratory failure • Mechanical ventilation. antiplatelet therapy. treatment of acute pulmonary edema. heparinisation/anticoagulation therapy and control. • Observe Echo and should recognize chambers and valves on echo print. • Cardiac monitoring. • Pneumothorax. complications etc. • Environmental lung diseases/occupational. 2. • Pulmonary thromboembolism • Acute corpulmonale. learn and even may assist electroversion therapy (DC shock) with indications. • Chronic obstructive airway diseases. digitalization. • Tuberculosis • Tumors of the lung • Disorders of chest wall and pleura • Chest trauma • Deformities of the rib cage . • Chronic bronchitis • Emphysema • Interstitial lung diseases.• X-ray chest interpretation – (Cardiology). • Basics of ETT. • Should observe. PULMONOLOGY COURSE OUTLINES: • Asthma. • Observe pericardial effusion aspiration. • Should learn thrombolytic therapy. nitrates infusion. o2 therapy. • General medication and prescription writing in pulmonology • Any deficient program.• Dry pleurisy. palpation. • Bronchial asthma • Pleural effusion • Pneumonia • Hemoptysis • Pulmonary tuberculosis • Chronic obstructive airway disease • Type-I and type-II respiratory failure • Bronchogenic carcinoma Understand the Symptomatology to reach the Differential Diagnosis: • Breathlessness • Wheezing • Haemoptysis • Orthopnoea • Paroxysmal nocturnal dyspnoea (PND) • Pain in calf on walking • Undue coldness. • Learn pleural aspiration and assist • Endotracheal suction. auscultation front of chest. cough. percussion. • Basics of pulmonary function tests. wheezing. Procedures (Observe/ Assist): • How to start O2 therapy. • Interpretation of pulmonary function tests. haemoptysis. pleural effusion. • Interpretation of related radiological and laboratory investigations. palpation. auscultation back of chest. • Inspection. • Chest pain. expectoration. pneumothorax. complications. • Imaging in pulmonary diseases/investigations CLINICAL TRAINING: Important Topics To Be Discussed: Case discussion for diagnosis and management of common pulmonary diseases. percussion. empyema. assist . indications. • Inspection. redness or blueness of extremities • Chest pain • Cough/expectoration/sputum Skills To Be Learnt: • History taking in respiratory system – dyspnoea. observe/assist Management of respiratory failure Observe bronchoscopy 3.• • • • • Pleural biopsy. Pigmentary disorders Disorders of nails. observe FNA biopsy. inguinale. Sexually transmitted diseases. CLINICAL TRAINING: Important Topics To Be Discussed: Case discussion for diagnosis and management of common dermatological diseases. Disorders of hairs. Psoriasis Lichen planus Bullous disorders. skin) • Scabies • Lice • Mosquito bite • Acute & chronic eczema • Lesions of small pox. herpes simplex. pediculosis. Bacterial and mycobacterial infections Fungal and viral diseases. Acne vulgaris Eczemas. DERMATOLOGY COURSE OUTLINES: • • • • • • • • • • • • • Anatomy. herpes zoster • SLE. unguam) • Candida (oral. chicken pox. Should recognize lesions of: • Leprosy • Syphilitic lesions (chancre. secondary syphilis. observe Under water seas aspiration. • Psoriasis • Lichen planus • Impetigo contagiosum • Moluscum contagiosum • Acne vulgaris . physiology of skin related to clinical dermatology Infestations: scabies. capitis. gumma) • Tinea (corporis. Neurology and Central Nervous System COURSE OUTLINES: o Infections and inflammatory lesions Meningitis Bacterial. cellulitis • Drug eruption Understand the Symptomatology to reach the Differential Diagnosis: • Alopecia • Eruption and rashes • Itching • Pigmentation and depigmentation Skills To Be Learnt: • History taking in Dermatology • Clinical examination of various skin lesions • Interpretation of related radiological and laboratory investigations • General medication and prescription writing in Dermatology Procedures (Observe/ Assist): • • • • Scraping for fungus Use of magnifying glass Observe skin biopsy Use of Wood’s lamp 4. Viral etc. • Ischemic • Embolism • Infarction • • • . basal cell carcinoma and melanoma • Leukoderma • Pityriasis versicolor • Alopecia and hirsutism • Sexually transmitted diseases • Furnculosis. Brain abscess Encephalitis Hydrocephalus o Epilepsy and other convulsive disorders o Cerebrovascular diseases (stroke).• Seborhoea • Exfoliative dermatitis • Skin neoplasm like squamous cell cacinoma. Tuberculous. • Vertigo. • Trigeminal neuralgia. • Spinal cord compression • Hemiplegia. • Syringomyelia and syringobulbia. Peripheral nerve disorders. nystagmus Spinal cord disorders.Q Speech disturbances Important Topics To Be Discussed: . quadriplegia • Myelitis. • Transient mono-ocular blindness (amaurosis fugax). Motor neuron disease. Space occupying lesions of brain and spinal cord. myasthenia gravis • CLINICAL TRAINING: Case discussion for diagnosis and management of common CNS disorders: • Cerebrovascular accident • Paraplegia • Polyneuropathy • Muscular dystrophies and Motor neuron disease • Parkinsonism • Meningitis • Tetanus • Hemiplegia • Facial Palsy Understand the Symptomatology to reach the Differential Diagnosis: • • • Behaviour I.o o o o o o o o o o Haemorrhage • Intra-cerebral • Subarachnoid Dementia and Alzheimer’s disease. Multiple sclerosis. Cranial nerve disorders. • Peripheral polyneuropathy • Gullian Barry syndrome • Mononeuritis multiplex. Parkinson’s disease and other movement disorders. • Spondylosis. paraplegia. • Facial palsy (Bell’s). Muscular dystrophies Myopathies. two point discrimination. vibration. sensory loss Rigidity / paralysis. memory. • Fine touch. joint position. • Cortical sensations • Two point localization. behaviour. • Examination of sensory system – crude touch. • Higher mental functions – level of consciousness. temperature. • Examination of cranial nerves. Movement disorders Skills To Be Learnt: • History taking in CNS. • Examination of motor system. • Reflexes • Examination of cerebellar system • Examination of nystagmus • Examination of rigidity • Assessment of movement disorders • Interpretation of related radiological and laboratory investigations • General medication and prescription writing in Neurology Procedures (Observe/ Assist): Observe and learn lumbar puncture . speech. pressure. pain. tingling.• • • • • • • • • • • • • • • • • Memory Confusional states Dementia Tremor Fasciculations Athetosis Chorea Gait abnormalities Convulsions/fits Coma Syncope/dizziness Vertigo Deafness Blindness Numbness. lower GI bleeding o Drugs contraindicated in liver diseases . o Carcinoma liver and transplant. Peptic ulcer o Intestines o Malabsorption syndromes. o Hepatic encephalopathy.5. o Acute and chronic pancreatitis. acute and chronic o Toxic o Drugs o Auto immune hepatitis. o Liver o Ascites. Dysphagia with special reference to Ca oesophagus GERD Achalasia Candiasis of oral cavity and oesophagus o Stomach Gastritis. ALIMENTARY SYSTEM COURSE OUTLINES: o Oral cavity Infections and inflammatory disorders Benign and malignant diseases o Esophagus. o Tropical sprue o Coeliac disease o Inflammatory bowel diseases. o Jaundice. o Upper GI bleeding. o Cirrhosis of liver. • Ulcerative colitis Crohn’s disease o Irritable bowel syndrome (IBS). o Congenital hyperbilirubinaemia o Gilbert syndrome o Dubin Johnson syndrome o Rotor syndromes o Haemolytic o Obstructive o Hepatitis o Viral. • Percussion. • Interpretation of related radiological and laboratory investigations • General medication and prescription writing in GIT diseases. bleeding per rectum • Jaundice • Hepatomegaly • Abdominal distension/ascites Skills To Be Learnt: • History taking in GIT – vomiting. Procedures (Observe/ Assist): • • • • Learn N/G tube passing and feeding Learn and observe aspiration of peritoneal fluids Learn and observe endoscopies. melena.CLINICAL TRAINING: Important Topics To Be Discussed: Case discussion for diagnosis and management of common gastrointestinal and hepatobiliary diseases. constipation. pain abdomen. distension. Abdominal Koch’s infection Understand the Symptomatology to reach the Differential Diagnosis: • Oral ulceration • Dysphagia • Heart burn • Nausea/vomiting • Indigestion/flatulence • Diarrhoea and constipation • Melena. diarrhoea. • Examination of GIT – • Inspection. upper and lower GIT Preparing a patient for GI endoscopies . palpation. • • • • • • • • Acid peptic disease Tender hepatomegaly Hepatosplenomegaly Jaundice Chronic liver disease Acute and chronic diarrhoea Variceal bleeding and peptic ulcer bleeding. hematemesis. • Any deficient programme. haematemesis. dyspepsia. auscultation. • Polycystic kidneys. • Prostatic diseases CLINICAL TRAINING: Important Topics To Be Discussed: Case discussion for diagnosis and management of common Renal & Urinary system diseases • • • • Nephrotic syndrome Nephritic syndrome Acute renal failure Chronic renal failure Understand the Symptomatology to reach the Differential Diagnosis: • • • • • Lumbar /pelvic pain Anuria. hypercalcemia. oliguria Hematuria Dysuria. • Nephritic syndrome. • Urinary tract infections Infections of the kidneys Infections of the lower urinary tract • Inflammatory lesions of the kidneys • Introduction to dialysis & renal transplant • Drugs causing renal disease (brief). Analgesic nephropathy. Lead. uric acid. radiation & hypersensitivity Nephropathy. • Chronic renal failure • Nephrotic syndrome. Drugs contra indicated in renal insufficiency Drugs to be used with caution in renal disease. pyuria Urgency / frequency of micturation . KIDNEYS AND URINARY SYSTEM COURSE OUTLINES: • Acute renal failure. • Renal vascular disorders Renal artery stenosis Renal vein thrombosis Tumours • Hemolytic uremic syndrome.6. pyuria. o Short stature Infertility o Diseases of hypothalamus and posterior pituitary. dysuria. Hyperthyroidism (thyrotoxicosis) Hypothyroidism (myxedema. Addison’s disease Acute Addisonian crisis . • Interpretation of related radiological and laboratory investigations • General medication and prescription writing in upper & lower urinary tract diseases. pelvic pain. Growth hormone disorders o Acromegaly o Gigantism. ENDOCRINOLOGY COURSE OUTLINES: o Anterior pituitary. Cushing Syndrome Aldosteronism Primary/Secondary. Hirsutism.• • • Urinary retention Urinary incontinence Nocturia Skills To Be Learnt: • History taking – lumbar pain. cretinism) Inflammatory lesions Benign and malignant tumors o Adrenal Gland. o Thyroid gland. anuria. nocturia. percussion. auscultation. Empty sella syndrome Diabetes insipidus Syndrome of inappropriate ADH secretion (SIADH). oliguria. • Examination of abdominopelvic and lumbar area • Inspection. urinary retention. palpation. hematuria. urgency/frequency of micturition. urinary incontinence. Procedures (Observe/ Assist): • Observe and assist insertion of Foley’s catheter/Red rubber • Learn and observe peritoneal and hemodialysis • Indications and outcomes of renal transplant • Observe I/V urograms catheter 7. Multiple myeloma Multi-System Immunological Diseases Systemic lupus erythematosis (SLE) Serum sickness . male and female genital organs etc. Examination of thyroid gland. Interpretation of related radiological and laboratory investigations General medication and prescription writing in endocrinology 8. RHEUMATOLOGY COURSE o o o o o o o o o OUTLINES: Osteoarthritis Osteoporosis Rheumatoid arthiritis and related arthropathies Paget’s disease of the bone.Inflammatory lesions Adrenocortical tumors including Pheochromocytoma o Endocrine Pancreas Diabetes mellitus and hypoglycaemic states Other associated endocrine disorders o Testes Sexual precocity Heterosexual precocity Gynaecomastia Inflammations Tumours o Multiple endocrine neoplasia Type I Type II CLINICAL TRAINING: Important Topics To Be Discussed: Case discussion for diagnosis and management of common endocrine disorders • Diabetes mellitus • Thyroid diseases • Cushing’s disease • Infertility and common reproductive disorders Skills To Be Learnt: • • • • History taking and correlate with a specific diagnosis. Osteopetrosis (marble bone disease). joints. Vasculitis syndromes (brief). Ankylosing spondylitis. Procedures (Observe/ Assist): • Observe aspiration of fluids from joints (knee) • Observe bone marrow aspiration/terphine . skin and other organs • Interpretation of related radiological and laboratory investigations • General medication and prescription writing in rheumatology. Bechet’s syndrome (brief). CLINICAL TRAINING: Important Topics To Be Discussed: Case discussion for diagnosis and management of common rheumatological diseases.o o o o o o o o o o o o o o Systemic sclerosis (scleroderma). Sjogren’s syndrome (brief). • Examination and assessment of the pattern of involvement of bones. Mixed connective tissue diseases (brief). • Rheumatoid arthritis • Osteoarthritis • Multiple Myeloma • SLE etc. Anaphylactoid purpura Polyarteritis nodosa Hpersensitivity vasculitis Wegner’s granulomatosis Temporal arteritis Takayasu’s arteritis Thromboangitis obliterans (Burger’s disease) Sarcoidosis (brief). Understand the Symptomatology to reach the Differential Diagnosis: • Joint pain and joint swelling • Joint deformities • Muscle cramps • Muscle weakness • Muscular wasting • Other related systemic signs and symptoms Skills To Be Learnt: • History taking and correlate with a specific diagnosis. INFECTIOUS DISEASES COURSE OUTLINES: o Clinical syndromes. Ehler’s danlos syndrome. meningococcaemia Acute infectious diarrhoeal diseases and bacterial food poisoning. • Gaucher’s disease. Hemophilis influenzae. Streptococci. Renal glycosuria 10. Disorders of amino acid metabolism and storage Homocystinuria. Pneumococci Staphylococci. Gonococci. Lipid. Alkaptonuria. METABOLIC DISORDERS COURSE OUTLINES: Hyperlipidemia Hemochromatosis Porphyrias Wilson’s disease Gout and hypercalcemia Storage diseases.9. Hereditary connective tissue disorders Osteogenesis imperfecta. Chondrodysplasias. Shigella. Hospital acquired infections. o Common disease syndromes caused by the following bacteria and their drug therapy. • Fabry’s disease. . Glycogen. Hartnup disease. Sepsis and septic shock. • Leukodystrophies • Niemann pick disease. Marfan syndrome. Alport syndrome. Pseudomonas. Cholera. o Following diseases in detail. Tuberculosis. Tetanus. Leprosy. o Helminthic infestations Ascariasis Hookworm Whipworm (trichuriasis) Threadworm (entrobiasis) Taenia (tapeworm) Hydatid diseases CLINICAL TRAINING: Important Topics To Be Discussed: Case discussion for diagnosis and management of common infectious diseases in Pakistan • Malaria • Typhoid fever • Acute diarrhoeal diseases • Acute / chronic respiratory tract infections • Generalized septicemia etc. Malaria. Enteric fever/salmonellosis. Amoebiasis/giardiasis/trichomoniasis. hematemesis Jaundice/hepatomegaly Eruption and rashes Itching Joint pain and joint swelling etc. Rabies. pyuria Diarrhoea / vomiting Melena. AIDS. . Infectious mononucleosis. pain Anorexia/ weight loss Haemoptysis/ chest pain/ epigastric Cough/expectoration/sputum Dysuria. Understand the Symptomatology to reach the Differential Diagnosis: o o o o o o o o o o o o Fever Headache. • Examination and assessment of the pattern of fever. • Classification • Iron deficiency • Megaloblastic o B-12 deficiency o Folic acid deficiency • Anaemia of chronic disorder • Haemolytic anaemia o Hereditary o Acquired o Intra-corpuscular o Extra-corpuscular • Aplastic anemia Haemoglobinopathies. branula. Knee) • Lumbar Puncture • O2 therapy • Nebulisation etc. direct. Pericardial. Observe: 11. CVP • N/G tube passing and feeding • Foley’s catheter/Red rubber catheter • IOP record maintenance • Aspiration of fluids (Pleural. • Interpretation of related radiological and laboratory investigations • Symptomatic treatment and prescription writing in infectious diseases. S/C. Peritoneal.Skills to Be Learnt: • History taking and correlate with a specific diagnosis. • Sickle cell syndromes . cutdown. Procedures: Perform: • Injection I/V. I/M. involvement of organ systems and any positive findings. intradermal • Oxygen therapy • Urinary catheterisation – collection of samples • Collection of blood samples/ blood film preparation • Observe I/V lines/Fluids/Blood/Blood products. HAEMATOLOGY COURSE OUTLINES: Anaemias. • Haemophilia • Vitamin K deficiency. • Disorders of coagulation. • Disseminated intravascular coagulation (DIC). Anticoagulants Therapy • Heparin • Oral (warfarin etc. • Vessel wall disorders. • Acute • Chronic • Lymphomos • Non-Hodgkin’s • Hodgkin’s Blood groups and blood transfusion. • Thrombocytopenia • Idiopathic thrombocytopenic purpura (ITP) • Von Willebrand’s disease. • Chronic myeloid leukemia (CML) • Polycythemia vera • Myelofibrosis • Essential thrombocytosis • Leukemias. K infusion • Antiplatelet drugs CLINICAL TRAINING: Important Topics To Be Discussed: Case discussion for diagnosis and management of common haematological disorders • Anaemias • Bleeding disorders • Myeloproliferative or lymphoproliferative diseases Understand the Symptomatology to reach the Differential Diagnosis: • • • • • Lassitude Dyspnoea Infections Edema Gum hypertrophy .) • Vit. Disorders of haemostasis. Bone marrow transplantation.• Thalassaemias Myeloproliferative diseases. intradermal • Collection of samples of blood/blood film preparation • Perform I/V lines/fluids/blood/blood products. weight loss. • Major depressive episodes • Unipolar • Bipolar • Dysthymic • Atypical • Maniac episodes • Anxiety disorders. CVP etc. pulse. clubbing. I/M. • Acute anxiety states • Panic disorders • Generalized anxiety disorders • Psychic Traumatic disorders • Obsessive-compulsive disorders • Phobic disorders . Skills To Be Learnt: • History taking in general • General physical examination.• • • • • • • • • Bleeding tendency Bruising purpura Lymph node enlargement Weight loss Facial swelling Bone pain Jaundice Hepatosplenomegaly Hypersensitivity/ allergic reactions etc. anorexia. pallor. koilonychia. Procedures (Observe/ Assist): • Injection I/V. lymph nodes. PSYCHIATRY COURSE OUTLINES: • Mood disorders. fever. cutdown. edema. cyanosis. pain. • Examination and assessment of the extent of the disease • Interpretation of related radiological and laboratory investigations • General medication and prescription writing in Haematology. headache. cyanosis. direct branula. • Observe bone marrow aspiration/ trephine 12. S/C. jaundice. facial swelling etc. intradermal • Oxygen therapy • Urinary catheterisation – collection and samples of blood . • Interpretation of related radiological and laboratory investigations • General medication and prescription writing in psychiatry • Psychotherapy • Electroconvulsive Therapy (ECT) • Electroencephalogram (EEG) Procedures: 13. Alcoholism. Procedures To Be Performed/Observed/Assisted: Perform: • Injection I/V. Psychosexual disorders in men and women. Addiction. MISCELLANEOUS AND EMERGENCIES • • • • Heat stroke Snake bite Electric shock Poisoning etc.• • • • Schizophrenia. S/C. I/M. CLINICAL TRAINING: Important Topics To Be Discussed: Case discussion for diagnosis and management of common Psychiatric disorders like• Anxiety • Depression • Schizophrenia • Manic depressive psychosis • Phobias • Eating disorders Understand the Symptomatology to reach the Differential Diagnosis: Skills To Be Learnt: • History taking in psychiatry • Clinical examination of patients • Counseling and psychoanalysis especially in patients with suicidal and homicidal attitude. branula.Observe: • Observe I/V lines/fluids/blood/blood products. The log book shall also contain a record of the procedures which student would have performed in 3rd. Pericardial. 4th & 5th year. cutdown. collapse vertebra. it is a reflective record of achievements. multiple myeloma. Knee) • Lumbar puncture • O2 therapy • Nebulisation • ECG taking/reading • X-ray chest reading • Barium series • I/V urograms • Bone and joint X-ray reading for medical problems (Rheumatoid arthritis. CVP • N/G tube passing and feeding • Foley’s catheter/Red rubber catheter. osteoarthritis. caries spine. IOP record maintenance • Endotracheal tube placement • Endotracheal suction/maintenance of airway/nursing on side etc. • Aspiration of fluids (Pleural. cervical rib etc. The log book is a collection of evidence that learning has taken place. direct. .) • Preparing a patient for endoscopies. Peritoneal. upper and lower GIT THE LOG BOOK/CLINICAL CARD RECORD The student is expected to make a record of his/her achievements in the log book. Smith's General Urology by Emil A. 21st edition 4. e. Gordon 5. Basic psychiatry by Myre Sim. Hutchison's Clinical Methods by Michael Swash. Latest Edition. Clinical Medicine by Parveen J Kumar & Michaell. 2. Practice of Medicine by Davidson. Oxford Text Book of Psychiatry 6. 2007 8. B. 7.RECOMMENDED BOOKS: 1. Tanagho and Jack W. Online Journals and Reading Materials through HEC Digital Library Facility . McAninch 15th edition. Clark 3. ABC of Dermatology. g. Operation delivery. 12. Ante-partum haemorrhage. 10. 26. 20. 8. Diagnosis of pregnancy. . 14. 6. Ante-natal care. implantation and development of placenta. Vacuum delivery. Pregnancy with anaemia Pregnancy with heart disease Pregnancy with diabetes Pregnancy with jaundice/hepatitis Renal problems during pregnancy Pyrexia in pregnancy Hypertensive disorders of pregnancy e. 16. Obstetric history taking and examination. Complications of 3rd stage of labour. Caesarean section. 21. 5. Induction of labour. Hyperemisis gravidarum. 19. PET Eclampsia Essential hypertension Obstetric shock. 22. Physiological changes associated with pregnancy.g. Medical Disorder associated with pregnancy e. Fetal distress and its management. 2. 28. Hydramnios. Forceps delivery. Pre-maturity. Intra uterine growth retardation and its management. Abnormal labour e. 23. 29.(C) 1. Conception. 3. 13.g. Foetal skull and bony pelvis. abnormalities of placenta. 27. 30. Conduction of normal delivery. Early pregnancy loss and its management (Abortions) Physiology of labour. 15. Mechanism of labour. 4. 25. Management of labour. 24. 9. 7. 11. 17. Prolonged labour/obstructed labour. 18. fetal circulation. Pre-term labour. OBSTETRICS The course outline is as follows : Introduction. Post-maturity. Fetal presentations. Puerperium (normal and abnormal). Practical: Log Book of 20 assisted deliveries. 33.31. 5th Ed. 40. RECOMMENDED BOOKS: 1. 17th Ed 2000 2. Face presentation. Vital statistics. 34. Breech presentation. Minor problems of the new-born. Cord prolapse/compound presentation. Fetal Monitoring. Draycott. Essentials of Obstetrics and Gynecology by Neville F. 4. 37. Stirrat. 41. Breast feeding and its importance. Notes on Obstetrics & Gynecology. 45. Examination of the new-born baby. 36. 42. Mills. Obstetric injuries/ruptured uterus. 47. Obstetrics and Gynecology by Arshad Chauhan 6. 46. 44. Multiple pregnancy. Occipito posterior position. Haematological disorder of pregnancy e. 43. Hacker. Resuscitation of new-born. 2004 3. Obstetrics by Ten Teachers by Stuart Campbell and Christoph Lees. Transvese lie/unstable lie. J. 49. Text book of Obstetrics and Gynecology by Rashid Lateef 5. 35.g. Brow presentation. 39. 38. Online Journals and Reading Materials through HEC Digital Library Facility. . and Joseph C. 4th ed. 32. 2003. George Moore. 48. Foetal congenital abnormalities. Rh incompatibility Thalassemia major/minor Role of Ultrasound in obstetric. Gambone. 9. Gynaecological history taking and examination 8. Ovulation and its clinical importance. Genital prolapse. 28. . 17. Minor gynaecological operative procedures. Tumours of uterus. 22. Contraception. 20. Infections of lower genital tract 27. Anatomy of female i. Infections of upper genital tract ii. 19. Role of USG in gynaecology Practical: Log Book of 20 patients of Gynaecology.(D) GYNAECOLOGY The course outline is as follows : 1. Post-operative complications and its management. Menopause. Tumours of cervix. 23. Infections of female genital tract i. 18. Genital organs ii. Development of female genital organs 3. Tumours of vagina. Infertility. Hormone replacement therapy. Amenorrhoea 10. Menstrual abnormalities. 13. Introduction. 7. Ectopic pregnancy. 2. Vulval lesions 15. Tumours of fallopian tubes. 6. Tumours of ovaries. 25. 14. 21. 5. Problems of marriage and sex. 29. Pelvic floor injuries. Vaginal discharges. Pre-operative preparations. Urogynaecology. Puberty and adolescence. Normal menstruation. 26. 16. 4. 24. 11. 12. Trophoblastic tumours. 2003. 4. Clayton and Ash Monga 2006. Notes on Obstetrics & Gynecology by Stirrat. Essentials of Obstetrics and Gynecology by Neville F. 5th Ed. and Joseph C. 2. George Moore. Online Journals and Reading Materials through HEC Digital Library Facility. Text book of Obstetrics and Gynecology by Rashid Lateef 5.RECOMMENDED BOOKS: 1. J. Draycott. . 4th ed. 2004 3. Mills. Hacker. Gambone. Gynaecology by Ten Teachers by Stanley G. Obstetrics and Gynecology by Arshad Chauhan 6. cerebral palsy. • Haematology: anaemias. hepatitis. enteric fever. • Neurology: meningitis. rickets. iodine deficiency.(E) PAEDIATRICS The course outline is as follows : List of suggested topics for teaching the undergraduates is given below. urinary tract infections. acute glomeulonephritis • Endocrinology: hypothyroidism. . myelomeningocele. short stature. premature and low birth weight babies. • Common pediatric infections: measles. birth asphyxia. tuberculosis. Down’s syndrome. cerebral malaria. bleeding disorders. tetanus. thalassemia. • Neonatology: resuscitation of new born. respiratory distress of new born. hydrocephalus. neonatal fits. iron deficiency ) • Growth and development. aids • Malaria. giardia. febrile. • Genetics: patterns of inheritance. vitamin A deficiency. asthma. polio. infant feeding . TOF. rectal polyp. pleural effusions. amoebiasis. • Nephrology: nephrotic syndrome. acute liver failure • Diarrhea[acut/echronic] dysentery. clinical assessment of a cyanotic neonate/infant. ASD]. • Acute respiratory infections (ARI). weaning) and nutritional disorders:(PEM. Congestive cardiac failure. encephalitis • Cardiology: congenital heart diseases [VSD. • Gastroenterology: abdominal pain. PDA. epilepsy. pyloric stenosis. pneumonias . 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. convulsions. diabetes • Pulmonology: croup. care of normal new born. common skin conditions of neonates. whooping cough. rheumatic fever. leukemias. cirrhosis. diphtheria. neonatal sepsis.newer vaccines • Diarrheal diseases. • IMCI (integrated management of childhood illness). worm infestations. neonatal jaundice. common congenital abnormalities and birth trauma. malabsorption. mental handicap. tuberculosis. chicken pox. common skin infections • Expanded program of immunization (EPI) . encoparesis. Student will recognize the danger signs of disease in children and be able to appropriately refer children with severe disease to appropriate specialists/hospitals. 2. attention deficit disorder • Miscellaneous: poisoning. Students will demonstrate his ability to obtain a relevant clinical history from a parent or an older child. Student will be able to counsel the parents on health promotive and disease preventive strategies for the child e. hyperactivity • Dyslexia. enuresis. 7. congenital dislocation of hip. SKILLS: 1.g. prevention of home accidents. intestinal obstruction. Resuscitation of newborn. Student will demonstrate his ability to perform essential clinical procedures relevant to children e. proper weaning) 5. avoidance of bottle. hand washing) 6. immunization procedures.g.• Social pediatrics: right of child. Student will be able to recognize and manage common health problems of children. vesico ureteral reflux. Basic cardio-pulmonary resuscitation. • Pediatric surgery: hernia. 4. tallipes. 8. Student will be able to interpret clinical and laboratory data to arrive at a diagnosis. 3. behavioral disorders. Student will be able to advise appropriate nutritional measures for healthy and sick children (Breast feeding. Measuring blood pressure Starting intravenous lines/ draw blood sample Administration of oxygen therapy Giving nebulizer therapy [bronchodilator] Use of growth chart . Anthropometric measurements. intussusceptions. Student will demonstrate his ability to perform adequate clinical examination of a child of any age (including newborn). child abuse. Observe passing of catheter 10. Online Journals and Reading Materials through HEC Digital Library Facility . Renal biopsy 9. Essentials of Paediatrics by Nelson. Text book of paediatrics by Pervaiz Akbar 2. Observe pericardial tap RECOMMENDED BOOKS: 1. 3. Liver biopsy 8. Thoracentesis 6. Supra pubic puncture 4. Lumbar puncture 2. Bone marrow aspiration 3.OBSERVE THE FOLLOWING SKILLS: 1. Pericardiocentesis 7. Latest Edition. Subdural tap 5.