COLLEGE OF MEDICINE

Patient Presentation – Based Approach

“Core Knowledge for Practice”

 INTRODUCTION
The MBBS curriculum offered by the College of Medicine is competency based, integrated
curriculum. Its main educational strategy is problem based learning.

The Accreditation Council for Graduate Medical Education competency outcomes frame and the
related curriculum objective identified by the Association of American Medical College
(AAMC), guides the development, educational strategy, curriculum structure and
implementation.

In relation to the domains of competency, “Knowledge of practice” we have developed a patient

presentation based approach (PPB).

This approach leads to the identification of all the core “Knowledge “needed and integrated.
 MEDICAL COLLEGE CURRICULUM OUTCOMES
Competencies and Corresponding Curriculum Objectives

Core curriculum content, in addition to medical knowledge, should reflect prevalent and
important clinical problems/presentation in the community. Epidemiological data, social,
environmental and cultural characteristics of the community should influence priority
identification of the curriculum content “The must, should and nice to know”

A: Patient & Population Care:

COMPETENCIES
1. Communicate effectively with patients, families and groups.

2. Gather essential and accurate information about their patients, for the purposes of
problem identification and characterization.

3. Make informed decisions about diagnostic and therapeutic interventions based on patient
information and preferences, up-to-date scientific evidence, and clinical judgment.

4. Develop and carry out (patient) management plans, with the engagement of patients as
partners.

5. Perform competently medical procedures considered essential for the management of

common health problems.

6. Counsel and educate patients and their families.

7. Use information technology to support patient care decisions and patient education.

8. Provide and advocate for health care services aimed at preventing health problems or
maintaining health.

9. Work with health care professionals, including those from other disciplines and
professions, to provide patient, family and community care.

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CURRICULAR OBJECTIVES
1. The ability to obtain an accurate holistic medical history that covers all essential aspects
of a patient and his/her problem, including issues related to age, gender and socio-
economic status.

2. The ability to reason deductively in solving clinical problems.

3. The ability to perform both a complete and a focused organ system specific examination,
including a mental status examination.

4. The ability to perform routine technical procedures at a level suitable to medical students.

5. The ability to construct appropriate management strategies (both diagnostic and

therapeutic) for patients with common conditions related to different age groups and
genders, both acute and chronic, including medical, psychiatric, and surgical conditions,
and those requiring short- and long-term rehabilitation.

6. Formulate a treatment plan, demonstrating the ability to take action by balancing the
relative risks and benefits of outcomes and treatment options.

7. The ability to recognize patients with immediately life threatening cardiac, pulmonary, or
neurological conditions regardless of etiology, and to institute appropriate initial therapy
applying Basic Life Support and Advanced Life Support principles.

8. The ability to recognize and outline an initial course of management for patients with
serious conditions requiring critical care.

9. The ability to identify factors that place individuals at risk for disease or injury, to select
appropriate tests for detecting patients at risk for specific diseases or in the early stage of
disease, and to determine strategies for responding appropriately (screening).

10. Interpret laboratory tests, demonstrating knowledge of the limitations of standard

laboratory measurements and integrate clinical and laboratory findings in the diagnosis
and management of a patient problem.

11. Document and share patient-specific information, demonstrating the ability to record in
information systems specific findings about a patient and orders directing the further care
of the patient.

12. The ability to define and describe a population, to include its demography, cultural and
socioeconomic constitution, circumstances of living, and health status, and to understand
the relevance of these factors to the health and health care of individuals, families and
administrators.

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B: Knowledge of Practice:
COMPETENCIES
1. Acquire a core of basic and clinical supportive sciences which are appropriate to the care
of a patient and the community.

2. Demonstrate a reasoning and analytic thinking approach to clinical situations and

applying medical knowledge in patient problem solving.

CURRICULAR OBJECTIVES
3. Knowledge of the normal structure and function of the body (as an intact organism) and
of each of its major organ systems.

2 Knowledge of the molecular, biochemical, and cellular mechanisms that are important in
maintaining the body’s homeostasis.

3. Knowledge of the various causes (genetic, developmental, metabolic, toxic,

microbiologic, autoimmune, neoplastic, degenerative, and traumatic) of illness/disease
and the ways in which they operate on the body (pathogenesis).

4. Knowledge of the altered structure and function (pathology and pathophysiology) of the
body and its major organ systems that are seen in various diseases and conditions.
5. Knowledge of the most frequent clinical, laboratory, radiological, and pathologic
manifestations of common maladies.
6. An understanding of the power of the scientific method in establishing the causation of
disease and efficacy of traditional and non-traditional therapies.
7. An understanding of the principles of disease prevention and behavior change appropriate
for specific populations
8. Knowledge of the important non-biological determinants of health and of the economic,
psychological, social, and cultural factors that contribute to the development and/or
continuation of maladies.
9. Knowledge of the epidemiology of common diseases within a defined population, and the
systematic approaches useful in reducing the incidence and prevalence of those diseases.

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C: Evidence-Based Practice and Lifelong Learning
COMPETENCIES
1. Exhibit good “information habits”, making decisions based on evidence, when such is
available, rather than opinion.
2. Locate, appraise, and assimilate evidence from scientific studies related to their patients’
health problems.
3. Apply knowledge of research designs and statistical methods to the appraisal of clinical
studies and other information on diagnostic and therapeutic effectiveness.
4. Demonstrate knowledge of the information resources and tools available to support life-
long learning.

5. Understand information technology’s impact on basic clinical and biomedical research.

CURRICULAR OBJECTIVES
1. Determine what data exist relative to a clinical question or formal hypothesis,
demonstrating knowledge of data sources (including medical records, and online data) at
one’s own institution by identifying how these might be used to address a specific clinical
question.

2. Execute a plan for data collection and organize data for analysis, demonstrating the
ability to properly represent data from a study in a form that is useful and supports
computer-based analysis.

3. Plan, analyze, interpret and report findings, demonstrating the ability to select the
appropriate computer software tool for analysis of data.

4. Demonstrate knowledge of the information resources and tools available to support life-
long learning. Knowledge includes awareness of these resources, their content, and the
information needs that they can address. Relevant resources include MEDLINE and
other bibliographic databases, textbooks and reference sources, diagnostic expert
systems, and medical internet resources.

5. Retrieve information, demonstrating the ability to refine search strategies to improve

relevance and completeness of retrieved items.

6. Filter, evaluate, and reconcile information, demonstrating the ability to discriminate

between types of information sources in terms of their currency, format (for example a
review vs. an original article), authority, relevance and availability.

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D: Interpersonal and Communication Skills:
COMPETENCIES
1. Create and sustain effective, ethically sound, caring and respectful relationships with
patients and families.

2. Work effectively with others as a member or leader of a health care team, or other
professional group.

CURRICULAR OBJECTIVES
1. Use effective communication skills to elicit and provide information using values and
attitudes and effective verbal, nonverbal (explanatory, questioning) writing skills.

2. Use effective writing skills to transmit information, express concerns, help, etc.

3. Listen to and respect the view of patients and their supporters

4. Listen to and respect the view of other members of the team involved in the patient’s care

5. Recognize and respect the varying needs of patients for information and explanation

6. Encourage patients to discuss the proposed treatment with their supporters

7. Fully inform the patient, and their supporters of progress during treatment

8. Explain any complications of treatment as they occur and explain the possible solution

9. Act immediately when patients have suffered harm and apologize when appropriate

10. Work effectively as an individual, in inter-professional groups, and as a member of a

complex health care system, demonstrating knowledge of online resources for legislation,
political advocacy and local health care policy setting.

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E: Ethics & Professionalism:
COMPETENCIES
1. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients
and society that supersedes self-interest; accountability to patients, society, and the
profession; and a commitment to excellence and on-going professional development.

2. Demonstrate a commitment to ethical principles pertaining to provision or withholding of

clinical care, confidentiality of patient information, informed consent, and business
practices.

3. Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and

disabilities.

CURRICULAR OBJECTIVES
1. Knowledge of the theories and principles that govern ethical decision making, and of the
major ethical dilemmas in medicine, particularly those that arise at the beginning and end
of life and those that arise from the rapid expansion of knowledge of genetics.

2. Compassionate treatment of patients, and respect for their privacy and dignity.

3. Honesty and integrity in all interactions with patients’ families, colleagues, and others
with whom physicians must interact in their professional lives.

4. An understanding of, and respect for, the roles of other health care professionals, and of
the need to collaborate with others in caring for individual patients and in promoting the
health of defined populations.

5. A commitment to advocate at all times the interest of one’s patients over one’s own
interests.

6. An understanding of the threats to medical professionalism posed by the conflicts of

interest inherent in various financial and organizational arrangements for the practice of
medicine.

7. The capacity to recognize and accept limitations in one’s knowledge and clinical skills,
and a commitment to continuously improve one’s knowledge and ability.

8. Respect patient (and physician) confidentiality, demonstrating knowledge of the legal,

ethical, and medical issues surrounding patient documentation, including confidentiality
and data security.

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F: Health Care Systems and Cost-Effective
Practice:
COMPETENCIES
1. Advocate for quality patient care and assist patients in dealing with healthcare system
complexities.

2. Practice cost-effective health care and resource allocation that does not compromise
quality of care.

3. Understand how their patient care and other professional practices affect the health care
organization and the larger society and how these elements of the system affect their own
practice.

CURRICULAR OBJECTIVES
1. Formulate and make decisions for individuals and groups, demonstrating knowledge of
cost/benefit issues in health care.

2. Knowledge about how local health care systems deliver patient care to different kinds of
patients.

References

1. Accreditation Council for Graduate Medical Education. Toolbox of assessment

methods.http://www.acgme.org/outcome/assess/toolbox.asp. Accessed February 25,
2003.

2. Leach DC. Evaluation of competency: an ACGME perspective. Am J Phys Med Rehabil

79:489-9, 2000

3. Dreyfus HL, Dreyfus SE, Anthanasiou T. Mind over machine: the power of the human
intuition ad expertise in the era of the computer. NewYork: Simon & Schuster; 2000.

4. ** Allen F Shaughnessy, Jennifer sparks, , Entrustable professional activities in family

medicine, Journal of Graduate Medical Education, March 2013

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 List of Core Clinical Presentations and underlying
Pathologies/Diseases

No. Presentation Disease/Pathology Page

GIT
1. Vomiting Gastroenteritis
2. Blood in vomitus (1) Esophageal varices ( See 9
Cirrhosis)
3. Blood in vomitus (2) Peptic ulcer + Gastritis + Gastric
Neoplasms.
4. Abdominal Pain (Specify site and/or
severity)
5. Pain right iliac Fossa Abdominal pain Appendicitis
(1)
6. Upper Abdominal pain (2) Pancreatitis, peptic ulcer
7. Upper Abdominal pain (3) Cholecystitis
8. Colicky Abdominal pain (4) Ischemic Bowel (Intussusception)
intestinal obstruction, gastroenteritis
9. Lower Abdominal pain (5) Infective colitis
10. Abdominal distension (1) + Vomiting Liver cirrhosis with ascites Chronic
blood liver disease
11. Abdominal distension (2) Hepatosplenomegaly,
12. Generalized Abdominal distension (3) Intestinal obstruction ,Peritonitis,
13. Dysphagia Carcinoma of the esophagus
Stricture
Achalasia

14. Bulky loose stools Chronic pancreatitis ,Malabsorption

(celiac disease)
15. Bulky loose stools Viral Diarrhea, Bacterial Diarrhea.
16. Recurrent Bloody diarrhea (1) Inflammatory bowel disease.
17. Lower Abdominal Pain and Bloody Amoebic colitis
diarrhea (2) Infective colitis

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18. Anal pain (1) Anal fissure, perianal abscess,
Thrombosed hemorrhoid.

19. Anal pain (2) Perianal Abscess and Fistula

20. A mass in the groin Inguinal hernia
21. Rectal Anorectal bleeding Colo-rectal carcinoma, fissure and
hemorrhoid
22. Jaundice (1) Viral hepatitis
23. Jaundice (2) Gall stone disease, cholangitis.
24. Jaundice (3) Carcinoma of the Pancreas
25. Jaundice (4) Cholangiocarcinoma Carcinoma of
the liver
26. Constipation Diverticular disease, colonic
carcinoma, Functional
constipation,Hurshspring disease
Respiratory System
27. Blocked nose Allergic rhinitis
28. Sore throat pharyngitis,
Tonsillitis.(bacterial,viral)
29. Hoarseness of voice Viral croup, vocal cord nodule and
polyp, laryngitis, Laryngeal cancer.
30. Dyspnea with wheeze Acute Bronchial asthma.
breathlessness (1)

31. Fever, cough, yellowish sputum Acute Pneumonia, bronchiectasis

breathlessness (2)
32. Chronic breathlessness (1) Emphysema, interstitial lung
disease (sarcoidosis),COPD
33. Chronic productive cough Chronic bronchitis, bronchiectasis,

34. Chest pain (1) Pulmonary embolism

35. Chest pain (2) Pneumothorax
36. Blood in sputum (1) Bronchogenic carcinoma
37. Blood in sputum (2) Tuberculosis

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38. Respiratory distress Neonatal respiratory distress
syndrome/ ARDS
Cardiovascular System

39. An infant with a murmur Ventricular septal defect

40. Breathlessness & Generalized Edema Congestive heart failure
Painless edema of the lower limbs
41. Chest pain (1) Ischemic Heart disease (Ischemic
and infarction), acute aortic
dissection.
42. Retrosternal Chest pain (3) Acute myocardial infarction
43. Dyspnoea & Fever Chest pain (2) Infective endocarditis, pericarditis,
myocarditis
44. Progressive dyspnea Left sided heart failure
45. Palpitations Atrial fibrillation. Supraventricular
tachycardia.
46. Intermittent claudication Peripheral vascular disease
47. Hypertension Essential hypertension,

Renal System
48. Periorbital edema Nephrotic Syndrome
49. Hematuria (1) Post-streptococcal
glomerulonephritis, Hemolytic
uremic syndrome,
Stones,UTI
50. Hematuria (2) Transitional Cell Carcinoma
51. Loin pain (1) Urinary tract infection,
52. Loin pain (2) Renal stones, Pyelonephritis
53. Progressive deterioration of kidney Advanced diabetic nephropathy
function
54. Retention of urine Carcinoma of the prostate/ Benign
prostatic hyperplasia, stones
55. renal graft Complicated renal transplantation
Metabolism & Endocrine
Systems
56. Gigantism Pituitary adenoma

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57. Secondary hypogonadism in an adult Prolactinoma,Klinfilter syndrome
male
58. Polyuria Diabetes insipidus,DM
59. Hyperventilation Metabolic acidosis (Diabetic
ketoacidosis)
60. Blue toe Diabetic foot ,Gangrene
61. Goiter and Weight loss (1) Graves ,Thyrotoxicosis
62. Thyroid swelling Goiter/Thyroid carcinoma

63. Obesity Weight gain (1) Primary obesity, metabolic

syndrome, Hypothyroidism,
Polycystic ovary.
64. Obesity Weight gain (2) Cushing’s disease, steroid intake

65. Hypoglycemia Insilinoma, Addison’s disease,

congenital adrenal hyperplasia.

66. Headache Phaeochromecytoma

Reproductive System
67. Testicular Scrotal swelling Testicular tumors/hydrocele
,varicocele, epididymitis
68. Amenorrhea (secondary) Normal pregnancy
69. Amenorrhea (primary) pseudo hermaphroditism ,Turner
syndrome, ,(gonadal dysgenesis)
,polycystic ovary functional
hypothalamic
amenorrhea,hyperprolactinoma,
ovarian insufficiency (discussed
earlier)
70. Vaginal bleeding (1) Abortion
71. Vaginal bleeding (2) Carcinoma of the cervix
72. Vaginal bleeding (3) Endometrial hyperplasia
,dysfunctional uterine bleeding
73. Pelvic pain Pelvic inflammatory diseases (PID),
ectopic pregnancy, tortion of ovary
ovarian cyst, salpengitis,
dysmenorrhea. Tubo-ovarian
abscess

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74. Vaginal discharge (1) Bacterial vaginosis ,chlamydia
Trichomonas vaginitis
75. Vaginal discharge – 2 Candidiasis
76. Pelvic mass Ovarian tumors ,ovarian cyst, uterin
masses
77. Hot flushes Menopause

78. Urethral discharge Gonorrhea, chlamydia

79. Breast lump Carcinoma of the breast, Benign

mass.,abscess
80. Perineal tear in the female (Prolonged Vaginal tear
labor)
81. Perineal trauma in the male urethra tear

Hematopoietic & Immune

Systems
82. Tiredness (1) Iron deficiency anemia
83. Tiredness (2) G6PD deficiency
84. Extremity pain Sickle cell disease
85. Fatigue Leukemia
86. Bleeding tendency (1) Hemophilia
87. Bleeding tendency (2) I ,T Thrombocytopenic purpura
88. Bleeding tendency (3) Vitamins K Deficiency
89. Generalized lymphadenopathy lymphoma
90. Cough Pneumocystis carinii pneumonia in
AIDS

Malaria,leukemia,lymphoma
91. Fever of unknown origin bacterial,viral,protozoal infection,
connective tissue disease, FMF.,
leukemia, lymphoma
Integumentary & Musculo-
skeletal Systems
92. Burns Burns(Thermal, electrical,
chemical)
93. Abscess Abscess
94. Chronic skin ulcer Cutaneous leishmaniosis, skin

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 tumor
95. Skin rash Atopic dermatitis
96. Skin hyperpigmentation Skin malignancy
97. Weakness Myasthenia gravis, myositis
98. Multiple painful swollen joints (1) Rheumatoid arthritis,
99. Multiple painful swollen joints (2) Systemic lupus erythematosus
(SLE)
100. Joint pain in adults osteoarthrosis,septic arthritis, gout
101. Joint pain in a child Rheumatic fever, transient
synovitis(reactive arthritis),septic
arthritis,Perthe disease(AVN)
102. Extremity pain (1) Bone tumors
103. Back pain (1) Vertebral compression fracture
secondary to osteoporosis
104. Back pain (2) Disc prolapse,tumer.,Ankylosing
spondylitis
105. Swollen leg and fever Osteomyelitis, cellulitis.
106. Bone fracture Fracture femur
107. Crush injuries Rhabdomyolysis, compartment

Nervous System & Human

Behavior
108. Tingling and numbness Peripheral neuropathy secondary to
type II Diabetes mellitus,B12
deficiency
109. Headache (1) Migraine, cluster and tension
headache
110. Headache (2) Brain Tumor,psuedotumor cerebri,,
Sub- arachnoid hemorrhage
111. Stiff neck Meningitis
112. Memory loss Alzheimer’s disease (Dementia)
113. vertigo Meniere’s disease, benign
paroxysmal positional
vertigo(bppv),labrynthitis
114. Dizziness Cerebellar Tumors,
115. Unsteady gait Cerebellar tumors
116. Hearing loss Cholesteatoma and mastoiditis,
Otosclerosis.otitis media, cerumen

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 impaction
117. Convulsions Epilepsy, head
injury,tumor,infection(meningitis
,encephalitis),electrolyte imbalance
118. Headache (3) Subdural hematoma,
traumatic(brain injury)
119. Loss of consciousness Intracranial hemorrhage, injury,
tumor
120. Paraplegia Spinal cord injury
121. Tremor Parkinsonism, cerebellar pathology
122. Hemiplegia Cerebrovascular accident,
123. Red eye (1) Glaucoma
124. Red eye (2) Conjunctivitis
125. Blurring of vision Cataract,glaucoma,trauma.,third
nerve palsy
126. Visual impairment Retinal detachment,cataract,CVA
127. Crossed eyes Congenital and acquired squint
128. Insomnia Late---Depression
Early--mania
129. Mood disorders Bipolar
Disorder,depression,,hypomania
130. Hallucinations Schizophrenia, ,organic causes
(fever,drugs,alcohol,
Tumor.)
131. Panic and anxiety Phobias
132. Adult abuse Domestic Violence,neglect
133. Violence Cocaine abuse
134. Personality disorders
135. Substance Abuse
136. Mental retardation Down syndrome
137. Behavioral Disorder in a Child Attention Deficit Hyperkinetic
Disorder
138. Para-suicide Paracetamol Poisoning, wrist
cutting
139. Suicide Organophosphate Poisoning,
hanging, firearm
140. Alcoholism Organic Brain Disease (Wernicke
encephalopathy, withdrawal

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 symptoms)
Community-Oriented
Presentations
141. Epidemiologic transition
142. Outbreaks
143. Disasters
144. Marginalized populations
145. Pollution
146. Occupational hazards

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Gastrointestinal Tract

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 Vomiting
Disease/Pathology Gastroenteritis

Anatomy • General histological layout of the GI tract

• General layout of abdominal (GI) organs
• General innervations of the GIT
• General development of the GIT

Biochemistry • Acid-base balance: Definition of pH; arterial blood gases,

• Hypochloremic metabolic alkalosis.
• Investigation of water & electrolyte status: serum Na, K, Cl, Ca,
HCO3, urea/creatinine.
Genetics & Molecular
biology
Microbiology/ • Food borne agents; Staphylococcus aureus, Clostridium perfringens,
Immunology bacillus cereus, Clostridium botulinum. Mechanisms of pathogenicity,
& clinical transmission, clinical manifestations, antibiotic therapy, specimen
selection for microbiology laboratory diagnosis. Principle of available
laboratory techniques.

Physiology • Simple Reflex arc & vomiting reflex

• Body fluid compartments (Extracellular , intracellular, Interstitial).
• Regulation of acid base status (buffers, respiratory and renal control)

Pharmacology • Antiemetics
• IV-fluids/ORS
• Anti-infectious drugs
Community & Family • Prevention and control of Gastroenteritis
Medicine • Modes of Transmission of Gastroenteritis
• Food safety and food hygiene
• Social determinants of health

Pathology • Classification of Gastritis

• Complications of gastritis
• Dehydration
• Shock type definition, classification
• Oligaemic shock, introduction

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 • Approach to the patient with acute vomiting and how to manage it**
Clinical • Causes of gastro-enteritis in adults
• Gastro-enteritis in the immuno-compromised patient
• Gastroenteritis in adults: who should be investigated and who should
be treated
• Prevention and treatment of viral gastroenteritis
• Role of fluroquinolones in treatment of acute diarrheal illnesses

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 Blood in Vomitus (1)
Disease/Pathology Esophageal Varices

Anatomy • Gross structure of the esophagus and its relations .Venous drainage
with special reference to Porta-caval anastomosis.
• Imaging for oesophagus

Physiology • Portal circulation (function & regulation)

Pathology • Pathogenesis of portal hypertension.

Clinical • Portal hypertension: pathogenesis and clinical

• manifestations
• Evaluation of occult GIT bleeding
• Endoscopic diagnosis of upper GIT disease.
• Prinicples of treatment of bleeding oesphageal varices
• Recurrent bleeding from esophageal varices and its prevention

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 Blood in Vomitus (2)
Disease/Pathology Peptic Ulcer + Gastritis + Gastric neoplasm

Anatomy • Parts and relations of the stomach and duodenum

• Histology of stomach
• Blood supply and regional lymphatic drainage (nodes) of the stomach
• Anatomical basis for vagotomies
• Imaging related to the stomach and duodenum
• Surface marking of the stomach and duodenum
• Histology of stomach & duodenum
• Development of the foregut.
Biochemistry • The Pentagastrin test for maximal HCl secretion; Plasma Gastrin
(fasting and secretin-stimulated)
Microbiology/ • Helicobacter pylori Mechanisms of pathogenicity, transmission,
Immunology & clinical clinical manifestations, antibiotic therapy, specimen selection for
microbiology laboratory diagnosis.
• Principle of available laboratory techniques.
Physiology • Mechanism of HCL secretion
• Hormonal and neural control of HCL secretion
• Gastric mucosal barrier
Pharmacology • Proton pump inhibitors
• H2 blockers
• Antacids, Cytoprotective agents
• Anti-H. pylori drugs
• Principles of treatment of peptic ulcer disease
Community & Family • Health, social and economic burden of peptic ulcer disease.
Medicine • Epidemiology of H Pylori
• Risk Factors of peptic ulcer
• Concept of Association causation: Example H Pylori and peptic ulcer

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Pathology • Classification of chronic gastritis
• Microscopic and macroscopic features of H.pylori gastritis.
• Features of autoimmune gastritis
• Acquired mucosa autoimmune gastritis (MALT)
• Gastric lymphoma, pathogenesis, diagnosis, prognosis
• Mechanisms, morphological and diagnostic features of H. pylori
associated and auto-immune gastritis.
• Sites of peptic ulcer
• Mechanisms of peptic ulcer formation
• Complications of peptic ulcer
• Gross and microscopic features of peptic ulcer
• Gastric neoplasm, pathogenesis, diagnosis, prognosis

Clinical • Epidemiology and risk factors of peptic ulcer disease

• Clinical aspects and natural history of peptic ulcer disease
• Diagnosis of peptic ulcer disease
• NSAIDs, COX-2 inhibitors and peptic ulcer
• Refractory peptic ulcer disease
• Treatment of bleeding peptic ulcer
• Surgery

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 Pain right iliac Fossa Abdominal Pain (1)
Disease/Pathology Appendicitis

Anatomy • Gross structure, relations, arterial supply, venous drainage,

lymphatic and innervation of the cecum and appendix
• Histology of the appendix
• Surface marking of the appendix

Microbiology/ • Anaerobic bacteria as members of the normal intestinal

Immunology microbiota.
• The role of normal microbiota in human health.
• The major groups of anaerobic bacteria of medical interest.
Bacteroides, Fusobacterium, Clostridia. Their relevance in
surgical infections.
• Mechanisms of transmission, clinical manifestations, antibiotic
resistance, specimen selection for microbiology laboratory
diagnosis.
• Principle of available laboratory techniques for anaerobic
cultures.
• Intestinal worms. Tenia, Hookworms Enterobius. Their
microbiological properties of clinical relevance, Epidemiology,
prevention.

Physiology • Physiological basis of Visceral pain & referred pain

• Regulation of ileo-cecal valve

Pharmacology • Principles of treatment of mixed infections / empiric

chemotherapy
• Anti-helminthic drugs???

Pathology • Inflammation and its causes.

• Cardinal signs of inflammation
• Local and systemic features of inflammation.
• Inflammatory ocdenar exudates and transudate
• Function and formation of inflammatory exudate.
• Various types of inflammatory mediators and their function
giving examples
• The sequelae of inflammation.
• Types of white cells
• Phagocytosis, mechanisms and functions
• Chemotoxis

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Clinical • Focused history for patients presenting with abdominal pain,and
managing it.**
• Significance of various maneuvers utilized in evaluating acute
abdominal pain
• Keys to successful examination of infants and children with
abdominal pain
• Common non-surgical conditions that can present with
abdominal pain
• Acute appendicitis in young adults, the very young, very old,
and pregnant women
• The approach to patients with common abdominal problems
with emphasis on indications for surgical consultation,
indications / contraindications to surgery, complications of
disease and intervention, and expected outcomes.
• The approach to patients with postoperative abdominal pain
• Clinical manifestations, investigations and treatment of
Appendicitis.
• Presentation with vomiting, abdominal pain and fever
• Rebound tenderness in LLQ
• Condition is acute and needs immediate surgical intervention

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 Upper Abdominal Pain (2)
Disease/Pathology Pancreatitis, peptic ulcer (discussed in blood in vomitus 2)

Anatomy • Parts, relations, of the pancreas

• Histology of the pancreas
• Development of the pancreas.
Biochemistry • Pancreatic enzymes – Proenzymes (zymogens) and their
activation; amylase function and properties; diagnostic tests:
plasma amylase and lipase and urine amylase

Physiology • Pancreatic juice (Phases of secretion, mechanism of secretion,

major enzymes and their functions)
• Regulation of pancreatic secretion (neural and hormonal)
• Digestion of carbohydrates, fats and proteins

Community & Family • Diet related diseases

Medicine • Lifestyle modification

Pathology • Enzymatic fat necrosis

• Complications of acute pancreatitis
• Pathogenesis and pathological features of acute pancreatitis
• Investigations for the diagnosis of acute pancreatitis

Clinical • Pathogenesis of acute pancreatitis

• Diagnosis of acute pancreatitis
• Evaluation of severity of acute pancreatitis
• Complications of acute pancreatitis
• Treatment of acute pancreatitis

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 Upper Abdominal Pain (3)

Disease/Pathology Cholecystitis

Anatomy • Parts of the gall bladder and extra-hepatic biliary tract

• Peritoneal relations of the gall bladder
• Lesser momentum and contents
• Imaging of the Gall Bladder
• Surface marking of the gall bladder.
Biochemistry • Composition of bile and gall stones
• Metabolism of bilirubin.
Physiology • Visceral pain & referred pain
• Functions of gall bladder

Pharmacology • Analgesics (Opiates)

Community & Family • Diet related diseases

Medicine • Lifestyle modification

Pathology • Inflammation and its causes.

• The sequelae of inflammation.
• Pathological features of choleycytotis
• Cholelithiasis
• Bile duct obstruction, causes, pathogenesis
Clinical • Clinical presentation and management of Cholecystitis.
• Exclude : Pancreatitis
Peptic ulcer
G-E-Reflux
Hepatitis – acute
Hepatic Abscess

• Underlying hemolytic diseases and gallstone/ slush formation

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 Colicky Abdominal Pain (4)
Disease/Pathology Ischaemic Bowel (Intussusception, volvulus, &hernia)
Intestinal obstruction, gastroenteritis (discussed in vomiting)
Anatomy • Structure, relations, blood supply, regional lymph nodes and
innervation of the small and large gut
• Gut mesenteries & contents
• Development of the midgut derivatives
• Rotation of the gut
• Imaging of the small gut
• Histology of the small and large gut
Physiology • Regulation of gastrointestinal blood flow

Pharmacology • General anesthetics

• Preanesthetic medications
• Muscle relaxants
Community & Family • Diet related diseases
Medicine • Lifestyle modification

Pathology • Various types of inflammatory mediators and their function giving

examples
• The sequelae of inflammation.(repeated)
Clinical • Focused history for various patients presenting with abdominal pain.
• Significance of various maneuvers utilized in evaluating acute
abdominal pain
• Keys to successful examination of infants and children with
abdominal pain
• The presentation, diagnostic strategy, and initial treatment of
patients presenting with common or catastrophic abdominal
conditions
• Common non-surgical conditions that can present with abdominal
pain
• Acute appendicitis in young adults, the very young, very old, and
pregnant women
• The approach to patients with common abdominal problems with
emphasis on indications for surgical consultation, indications /
contraindications to surgery, complications of disease and
intervention, and expected outcomes.
• The approach to patients with postoperative abdominal pain
• Clinical presentation and management of Ischaemic Bowel
disease.

27
 Lower Abdominal Pain (5)

Disease/Pathology Colitis Infective Colitis

Anatomy • Structure, relations, blood supply, innervation and lymphatic

drainage of the large gut
• Development of the hindgut
• Imaging of the large gut
• Surface marking of the large gut
• Histology – Refer to Ischaemic Bowel

Physiology • Functions of the large intestine (motility, secretory, absorptive).

Pharmacology • Antispasmodics (Anticholinergics)

• Antiinfectives
Community & Family • Diet related diseases
Medicine • Lifestyle modification
Pathology • Inflammation and its causes.(repeated)
• Local and systemic features of inflammation.
• Function and formation of inflammatory exudate.
• Various types of inflammatory mediators and their function giving
examples
• The sequelae of inflammation.

Clinical • Approach to the patient with acute diarrhea

• Acute diarrhea in the immuno-compromised patient
• Psudomembranous entero-coloitis: prevention and management
• Differential diagnosis of acute lower GT bleeding
• Guidelines for management of infectious diarrhea
• Clinical presentation, investigation and treatment.

28
 Abdominal Distension (1) + Vomiting Blood
Disease/Pathology ? Chronic liver disease+ Liver cirrhosis with ascites

Anatomy • Peritoneum – Reflections, Recesses and processes

• Venous drainage with special reference to Porta-caval anastomosis
Biochemistry • Plasma proteins: relative abundance, properties and functions
• Transudate and exudate differentiated by measuring the protein
content of ascitic fluid

Microbiology/ • The role of normal microbiota in human health. The major groups
Immunology of anaerobic bacteria of medical interest. Bacteroides,
Fusobacterium, Clostridia. Their relevance in surgical infections.
Mechanisms of pathogenicity, transmission, clinical
manifestations, antibiotic resistance, specimen selection for
microbiology laboratory diagnosis. Principle of available
laboratory techniques for anaerobic culture.
Physiology • Capillary fluid dynamics
• Portal circulation (function & regulation

Pharmacology • Drug Biotransformation – sites, types and mechanisms.

• Cytochrome P-450 system
• Liver diseases and drug biotransformation.

Pathology • Cirrhosis and its causes

• Cirrhosis Classification
• The microscopic appearances of cirrhosis
• Features of chronic liver failure
• Features of portal hypertension and its causes
• Hepatic neoplasms Classification.
• Etiology and morphological features of hepatocellular carcinoma
• Features of cholangiocarcinoma
• Causes of liver injury
• Fatty infiltration of the liver and list its causes

Clinical • Pathology of chronic hepatitis and liver cirrhosis

• Outcomes of viral hepatitis
• Differential diagnosis of diffuse abdominal distension
• Interferon and anti-viral therapy of chronic viral hepatitis
• Liver biopsy: Indications and limitations
• Treatment strategies**

29
 Abdominal Distension (2)

Disease/Pathology Hepato-splenomegaly

Anatomy • Anatomy of Portal circulation – Refer to viral Hepatitis.

• Structure, relations, blood supply and lymph nodes draining the
spleen
• Surface marking of the spleen
• Histology of the spleen with concept of closed versus open
circulations
• Imaging of portal vein
Biochemistry • Sources of ammonia: amino acid transamination and deamination;
• Disposal of amino nitrogen – Outline the urea cycle
• Hepatic encephalopathy: Ammonia and the decarboxylation products
of tyrosine and phenylalanine
Microbiology/
Immunology
? Kala-azar, malaria
Physiology • Portal circulation
• Function of spleen

Pharmacology • Enzyme induction & inhibition

• Enterohepatic recirculation
• Anti-flatulent / Drugs for paralytic ileus
• Anti-infectives (Rx for mixed infections)

Pathology • Pathogenesis of liver cirrhosis and portal hypertension.

•
Clinical • Differential diagnosis of hepatosplenomegaly
• Lymphoproliferative disorders
• Hepatosplenomegaly in sarcoidosis, shistosomiasis and other
granulomatous diseses
• Hypersplenism: pathogenesis and diagnosis
• Splenectomy: indications and complications
• Clinical findings in hepato-spheurugaly.
• Investigation and treatment

30
 Generalized Abdominal Distension (3)

Disease/Pathology Intestinal obstruction( discussed in colicky abdominal pain 4) ,

Peritonitis
Anatomy • Refer to Abdominal Distension (1).

Pharmacology • Pre-systemic elimination

Pathology(repeated) • Inflammation and its causes.

• Local and systemic features of inflammation.
• Function and formation of inflammatory exudate.
• Various types of inflammatory mediators and their function giving
examples
• The sequelae of inflammation.

Clinical • Clinical features in peritonitis

• Principles of treatment

31
 Dysphagia
Disease/Pathology Carcinoma of the Esophagus
stricture
Achalasia

Anatomy • Oral cavity and salivary glands.

• Refer to sore (throat).
• Histology of the oesophagus (Refer to esophageal varices.)
• Innervation of oesophagus.
• Gross structure of the esophagus and its relations
• Barium swallow imaging for structure and relations
Biochemistry • Phases of the cell cycle and it is regulation
• Oncogenes and their functions
• Metabolism in starvation: glycogenolysis, Gluconeogenesis,
proteolysis and lipolysis.
Physiology • Salivary secretion
• GIT motility (Types, mechanisms & control)
• Neuronal & hormonal control of GIT
• Mechanism of deglutition
• Upper and lower esophageal sphincters (mechanisms of control))
Pharmacology • Prokinetic drugs

Community & Family • Sources of cancer data

Medicine • Global and regional burden of esophageal cancer
• Risk factors of esophageal cancer
• Breaking bad news
• Coping Mechanisms
• Burden of illness on individual and community
• Cultural habits and cancer of esophagus
Pathology • Causes of esophagitis with special reference to reflux
• Macroscopic and microscopic features of reflux esophagitis
• Implications of chronic esophagitis (metaplasia, dysplasia and
carcinoma)
• Features, complications, and pathogenesis of carcinoma of the
esophagus
• Staging of Carcinoma of Oesophagus
• Achalasia, definition, features, complications.
• Peptic ulceration and stricture of oesophagus.
Clinical • Pathogenesis and clinical features of dysphagia
• Clinical diagnosis of oropharyngeal dysphagia
• Radiological & endoscopic diagnosis of esophageal D.

32
• pathogenesis and management of malignant cachexia
• management of dyspepsia**
• Enteral and parenteral nutrition
• Total parenteral nutrition

33
 Bulky Loose Stools (1)
Disease/Pathology
Malabsorption(celiac disease),chronic pancereatitis (discussed in upper
abdominal pain 2)
Anatomy • Histology of small gut,pancreas

Biochemistry • Disaccharidases and absorption of carbohydrates: lactose intolerance

• Tests of exocrine pancreatic function: (fluorescein dilaurate test)
• Tests of intestinal function: Xylose absorption test; Fecal fat; Triolein
breath test; hydrogen breath test; Schilling test for B12 absorption
Physiology • Exocrine function of the pancreas
• Role of Pancreatic enzymes in digestion and absorption of food
nutrients.
• Digestion and absorption of fat, protein and carbohydrates
• Regulation of pancreatic secretion

Pathology • Features of chronic pancreatitis

• Malabsorption and its causes
• Features of celiac disease and IPSID.

Clinical • Mechanisms of nutrient absorption

• Clinical features and diagnosis of malabsorption
• Approach to the patient with chronic diarrhea
• Diabetic autonomic neuropathy
• Cystic fibrosis: clinical manifestations and diagnosis
• Evaluation and management of chronic diarrhea
• Hypocalcemia, hypomagnesemia and hypophosphatemia
• Assessment of dehydration
• Degree of dehydration
• Type of dehydration
• Correcting volume depletion
• Correcting electrolyte and acid-base imbalance
• hyponatremia
• hypokalemia
• acidosis

34
 Bulky Loose Stools (2)
Disease/Pathology Viral Diarrhea, bacterial diarrhea

Anatomy • Histology of small gut

Biochemistry • Digestion and absorption of nutrients

Microbiology/ • Bacterial and viral agents of diarrhea Salmonella, Shigella,

Immunology Campylobacter, Vibrio cholera, Rotavirus, Adenovirus, Norwalk.
Mechanisms of pathogenicity (toxinogenicity, invasiveness, etc), life
cycle, transmission, clinical manifestations, antibiotic therapy.
• Specimen selection for microbiology laboratory diagnosis.
• Principle of available laboratory techniques for diagnosis.
Physiology • Absorption of water & electrolytes in small intestine
• Body fluid compartments (extracellular, intracellular, interstitial)
• Transport mechanisms across membranes
• Osmolality
Pharmacology • Discussed in bulky loose stool (1)

Clinical • Management of diarrhea.

35
 Bulky? Recurrent? Bloody Diarrhea (1)

Disease/Pathology Inflammatory Bowel Disease

Anatomy • Histology of large intestine (Refer to Colitis).

Biochemistry • Tissue glutaminase and gluten sensitivity

Microbiology/ • Mucosal immune responses, Immunopathogenesis of ulcerative

Immunology colitis and HLA association

Physiology • Functions of large intestine

• Gastro-intestinal immunology

Pharmacology • Drugs for inflammatory bowel disease

Community & Family • Diet and inflammatory bowel disease

Medicine

Pathology • Causes of colitis

• Features of amoebic colitis and its complications
• Features of inflammatory bowel disease.
• Chronic inflammation and its types

Clinical • Clinical features, diagnosis and prognosis of

inflammatory bowel disease
• Endoscopic diagnosis of inflammatory bowel disease
• Toxic megacolon
• Surveillance of colorectal cancer
• Treatment strategies for the inflammatory bowel disease
• Treatment strategies for the inflammatory bowel D.
• How to Manage patient with diarrhea**
• How to Manage patient with change bowel habits**

36
 Lower Abdominal Pain and Bloody Diarrhea (2)
Disease/Pathology Amoebic Colitis + Infective colitis

Anatomy • Histology of the large gut (Refer to Infective colitis.)

Microbiology/ • Entameba hystolytica and the major other amoebae of medical
Immunology interest. Giardia lamblia, Cryptosporidium parvum, Isospora belli.
Mechanisms of pathogenicity (toxinogenicity, invasiveness, etc), life
cycle, transmission, clinical manifestations, antibiotic therapy.
Specimen selection for microbiology laboratory diagnosis. Principle
of available laboratory techniques for diagnosis.

Physiology • Functions of large intestine

• Gastro-intestinal immunology

Pharmacology • Antiamebic drugs

Community & Family • Epidemiology and prevention of amebiasis
Medicine • Water and food pollution
• Screening of food handlers
• Food safety and food hygiene
• Role and applications of Public Health
Pathology • Causes of colitis and classification
• Mechanisms of invasion amoebae to tissues
• Macroscopic and microscopic appearances of amoebic colitis
• Differential diagnosis of multiple colonic ulcers
• Amoebiasis of skin, perianal, penis etc.
• Amoebonic with differential diagnosis
• Causes of colitis
• Features of inflammatory bowel disease.(repeated)
• Chronic inflammation and its types(repeated)
• Gross changes in inflamed organs and tissues
Clinical • Dysentery: diagnosis and differential diagnosis
• Colonic pain and colonic masses
• Amoebic liver acess
• Approach to the patient with bloody diarrhea
• Colonoscopy: indications and limitations
• Clinical features of Colitis
• Principles of management

37
 Anal Pain (1)

Disease/Pathology Anal Fissure, perianal abscess, thrombosed hemorrhoid

Anatomy • Structure, relations, blood supply, innervation and lymphatic

• Drainage of the rectum and anal canal
• Development of rectum and anal canal.
• Histology of rectum and anal canal (Refer to Anal Pain 1)

Pharmacology • Local anesthetics (topical)

• Antiinfectives (topical)

Community & Family • Prevention of lifestyle related health problems (diet)

Medicine • Lifestyle modification
• Health Promotion

Pathology Abcess ,fissure and hemorroid description

Clinical • Clinical features in anal fissure

• Investigations
• Treatment
• Association with constipation
• Proper examination
• Association with sexual abuse

38
 Anal Pain (2)

Disease/Pathology Abcess and Fistula

Anatomy • Histology of the rectum and anal canal

• Ischio-anal fossa
• Refer to Anal Pain (1)

Pharmacology • Antiinfectives

Community & Family • Diet and constipation

Medicine

pathology Description of abcess and fistula

Clinical • Clinical features in fistula and Perianal Abscess

• Treatment

39
 A mass in the groin
Disease/Pathology Inguinal hernia

Anatomy • . Gross anatomy of the anterior abdominal wall (including muscle

layers, blood supply, lymphatic drainage and innervation).
• Gross anatomy of the inguinal region.
• Applied anatomy of inguinal hernias.

Pathology • Description of hernia in general

Clinical • Differential diagnosis of inguinal pain, mass or bulge.

• The anatomic differences between indirect and direct hernias.
• The relative frequency of indirect, direct and femoral hernias by age
and gender.
• Clinical conditions that may predispose to development of inguinal
hernia.
• Indications, surgical options, and normal post-operative course for:
• inguinal hernia repair
• Femoral hernia repair
• Clinical significance of incarcerated, strangulated, reducible and
Richter’s hernias.
• Differential diagnosis of an abdominal wall mass.
• The potential sites for abdominal wall hernias.
• Natural history and treatment of umbilical hernia in children and
adults.
• Clinical factors contributing to the development and repair of an
incisional hernia.

40
 Anorectal Bleeding
Disease/Pathology Colorectal Carcinoma,fissure and hemorroid (Refer to Anal Pain 1)

Anatomy • (Refer to Anal Pain 1)

Biochemistry, Genetics & • Carcinogenic agents & carcinogenesis
Molecular biology • p53 tumor-suppressor gene
• Tumor markers

Community & Family • Burden of disease

Medicine • Risk factors of colorectal carcinoma
• Prevention of lifestyle related health problems
• Lifestyle modification
• Health Promotion
• Coping mechanism
• Break bad news
Pathology • Definition and classification of polyps
• Types of neoplastic polyps
• Types of hamartomatous polyps
• Polyposis syndromes
• Adenoma – carcinoma sequence and genes involved
• Macroscopic and microscopic appearances of colorectal carcinoma
• Hereditary nonpolyposis colon cancer (HNPCC
• Staging and prognostic features of colonic cancer
• Macroscopic features of colorectal carcinoma.
• Major histological features of colorectal carcinoma.
• Lesions that predispose to / are precursors of colorectal carcinoma
• Grading and staging of malignant neoplasms.
• Colonic polyposis syndromes
• adenomatous polyps Classification.
• The genes involved in cancer with special reference to colorectal
carcinoma
Clinical • Clinical presentations
• Investigations
• Treatment

41
 Jaundice (1)
Disease/Pathology Acute Viral Hepatitis

Anatomy • Peritoneal relations of the liver

• Lobation of the liver (Anatomical as well as Cantlie’s)
• Histology of the portal lobulation & acinus
• Intrahepatic circulation
• Surface anatomy of liver.

Biochemistry • Liver functions & enzymes

• Bilirubin metabolism
• Classification and investigation of types of jaundice: Prehepatic,
hepatic and posthepatic
•

Microbiology/ • HAV, HBV, HCV, Microbiological properties of the viruses, viral

Immunology structure, replication, pathogenicity, oncogenicity, transmission.
Laboratory diagnosis of acute and chronic infections. Vaccine
prophylaxis. Antiviral agents and their clinical use.
• Autoimmune hepatitis

Physiology • Functions of the liver

• Bilirubin metabolism
Pharmacology • (Liver) diseases and drug biotransformation

Community & Family • Epidemiology and control of hepatitis

Medicine • Population at risk of hepatitis
• Screening for hepatitis
• Counseling Hepatitis Patients
• Evidence-Based Healthcare:Immunization
• Health, social and economic burden of hepatitis
• Safe Sexual Behavior
Pathology • Jaundice definition, classification and its mechanism of causation
• Causes of liver injury
• Apoptosis giving acidophil body as an example
• Causes of acute hepatitis
• Pathological changes of acute viral hepatitis,
• Investigations due to establish the diagnosis of acute viral hepatitis.
• Acute liver failure

42
Clinical • Approach to the patient with jaundice
• Viral markers and the diagnosis of viral hepatitis
• Natural history of viral hepatitis
• Evaluation of chronic hepatitis (activity, chronicity)
• Extra-hepatic manifestations of chronic hepatitis
• Guidelines for Interferon & antiviral therapy in chronic hepatitis
• Clinical features
• Treatment

43
 Jaundice (2) *
Disease/Pathology Gall Stone Disease, cholangitis

Anatomy • Relations, blood supply, innervation and lymphatic drainage of the gall
bladder
• Refer to Abdominal Pain (3)

Biochemistry • Bile salt metabolism

• Gall stones: solubilization of cholesterol in bile

Physiology • Functions of GB
• Pathophysiology of gall stone formation

Community & Family • Epidemiology of gall stone disease

Medicine • Risk factors of gall stone disease
• Prevention of gall stone disease

Pathology Pathological changes in cholangitis

Clinical • Clinical features in cholelithiasis

• Investigation
• Treatment
• Association with chronic hemolytic diseases
• Indications for cholecystectomy

44
 Jaundice (3) *

Disease/Pathology Carcinoma of the Pancreas*

Anatomy • Refer to Abdominal Pain (2)

Biochemistry • (investigation of jaundice and pancreatic function)

• Tumour markers: CEA and CA 19-9

Community & Family • Epidemiology and control pancreatic carcinoma

Medicine • Breaking bad news
• Coping with cancer
Pathology • Carcinoma of the pancreas,type and prognosis.

Clinical • Clinical feature

• Investigation
• Treatment

45
 Jaundice (4)

Disease/Pathology Carcinoma of Liver

Anatomy • Refer to Jaundice (1)

Biochemistry • (Bile salt metabolism; ammonia metabolism)

• Serum α-fetoprotein (tumor marker)
• Epidemiology and control of liver carcinoma

Community & Family • Population at risk

Medicine • Association and Causation
• Research methodology
• Health, social and economic burden of liver

Pathology • Carcinoma of liver, type and prognosis

Clinical • Risk factors and screening for hepatocellular carcinoma

• Clinical features, diagnosis and staging of hepatocellular
carcinoma
• Natural history and prognosis of hepatocellular carcinoma
• Hepatocellular Ca.: non-surgical therapies and liver
transplantation
• Clinical features
• Investigation
• Treatment

46
 Constipation

Disease/Pathology Diverticular Disease, colonic carcinoma (refer to rectal

bleeding),functional carcinoma,Hurshspring disease in newborn
Anatomy • Meckel’s diverticulum
• Refer to Abdominal Pain (4)
• innervation

Physiology • Motility in large intestine

• Mechanism of defecation

Pharmacology • Laxatives / Purgatives

Community & Family • Lifestyle related health problems

Medicine • Healthy lifestyle
• Parent must notice Delayed meconium passage in newborn
Pathology • Causes of intestinal obstruction
• Causes of intestinal ischemia
• Morphological changes in intestinal gangrene
• Colonic carcinoma type and stages.
• Absence of ganglion cells in biopsy
Clinical • Clinical presentation
• Investigation
• Treatment

47
RESPIRATORY SYSTEM

48
 Blocked Nose

Disease/Pathology - Allergic Rhinitis*, Allergic fungal sinusitis

- Allergic bronchopulmonery aspergillosis

Anatomy • Structure of nose & paranasal sinuses

• Structure of nasopharynx
• Imaging of the nose & paranasal sinuses
• Blood supply and innervation of nasal mucosa
• Histology of nasal mucosa

Fungus ,aspergillosis
Microbiology/
Immunology

Physiology • Mechanism of smell

• Sneezing Reflex

Pharmacology • Vasoconstrictors/decongestants
• Leukotriene antagonists

Pathology • Microscopic features of allergic reactions

• Fungal vs inflammatory

Clinical • Clinical features

• Investigation
• Treatment (management**)

49
 Sore Throat*

Disease/Pathology pharyngitis, tonsillitis (bacterial,viral)

Anatomy • Structure of the pharynx (oro and laryngo pharynx).

Microbiology/Immunology • Streptococcus pyogenes. Streptococci. Microbiological properties of

clinical relevance, classification, mechanisms of pathogenesis, the
concept of lysogeny.
• Immunopathological consequences of streptococcal infection,
epidemiology, transmission, antibiotic resistance and
therapy/prophylaxis. Viral agents with special focus on
Paramyxoviruses and adenoviruses. Serological diagnosis of
Viral infections. ELISA, Agglutination, IF, CF test

Physiology • Mechanism of deglutition

Pharmacology • Antiviral drugs

• Antibiotics
Community & Family • Common infectious conditions and their prevention in school
Medicine children
• Prevention of rheumatic fever
Clinical • Clinical presentations
• Treatment and management**
• Clinical presentations
• Proper examination
• Be aware of complications if not treated properly (acute
glomerulonephritis, rheumatic disease)

50
 Hoarseness of Voice

Disease/Pathology Viral Croup , Vocal cord nodules, polyp,laryngitis,laryngeal

cancer
Anatomy • Structure of the larynx
• Muscles of the larynx and their innervations.
• Imaging of the pharynx & larynx

Microbiology/Immunology parainfluenza virus

Physiology • Mechanism of voice production (phonation, resonation and
articulation of sounds).
Pharmacology • Antiviral drugs

pathology
• Description of vocal cord nodule, polyp,
• Laryngeal cancer type ,prognosis

Clinical • Clinical features in epiglottitis,laryngitis,laryngeal cancer

• Treatment,
• Presentation with strider and “croup” cough.
• Differential diagnosis R/O epiglottitis
• Management with cold mist and re-assurance
• Prognosis – good

51
 Dyspnoea with wheeze
Acute Breathlessness (1)
(With Wheezing)

Disease/Pathology Bronchial asthma

Anatomy • Gross anatomy of the tracheo-bronchial tree

• Histology of tracheo-bronchial tree
•

Biochemistry • Blood gases and acid-base balance: Respiratory acidosis

• Biosynthesis of the prostaglandins and leukotrienes
Genetics & •
Molecular biology

Microbiology/ * Immediate hypersensitivity, Role of IgE and Mast cells. Mast

Immunology cell mediators. Immunopathogenesis of atopic asthma, role of
Th2 lymphocytes & their cytokines.

Physiology • Airways resistance and distribution of air way resistance

• Neural and Chemical control of airways resistance
• Pulmonary function tests: assessment of airways resistance
• Dynamic compression of air ways
• Pressure flow curves and flow volume curves
• Lung volumes and capacities
• Spirometry

Pharmacology • Drugs for asthma & anti-inflammatory drugs

• Principles of treatment of bronchial asthma including status
asthmaticus.
• Treatment of anaphylactic shock

Community & • Prevention and control of asthma

Family Medicine • Burden of illness on individual and family
• Family function and effect on childhood asthma
• Medical Compliance

Pathology • Asthma definition.

• Classification of asthma.
• Mechanism of inflammation in asthma.

52
 • Pathology and pathogenesis of bronchial asthma.
• Structure and function of eosinophils.
• Hypersensitivity reactions

Clinical • Differential diagnosis of acute dyspnea

• Pathogenesis and clinical spectrum of Type-1 hypersensitivity
reactions
• Evaluation of severity of Bronchial asthma
• Management of the asthmatic patient

53
 Fever, cough, yellowish sputum
Acute Breathlessness (2)

Disease/Pathology Pneumonia,bronchiectasis

Anatomy • Gross anatomy of the lungs

• Imaging of the lungs
• Histology of the lungs
• Surface anatomy of lungs and pleura

Microbiology/Immunology • Common causes of community acquired pneumonia.

Streptococcus pneumoniae, Mycoplasma, Chlamydiae, Legionella
(Microbiological properties, clinical relevance, mechanisms of
pathogenesis, epidemiology, transmission, antibiotic resistance
and therapy, selection of specimens and tests to be ordered for
microbiological diagnosis).
Physiology • Alveolar ventilation
• Partial pressure of gases in alveolar air, arterial and venous blood
• Diffusion of gases across respiratory membrane
• Bohr equation and the alveolar gas equation
• Alveolar and arterial Oxygen difference
• Measurement of lung diffusion capacity
Pharmacology • Anti-microbial drugs (Pencillins – Classifications, Mechanism of
Action, Kinetics and ADR )
• Macrolides & Azalides
• Principles of treatment of pneumonias.

Community & Family • Prevention of hospital acquired infections

Medicine • Prevention of community acquired infections

Pathology • Morphological features and complications of pneumonia.

• Gross and microscopic features of pneumonia.
• Complications of pneumonia,bronchiactasis
• . Types of pneumonia (diffuse,lobar)
Clinical • The clinical spectrum of lower respiratory infections
• Pneumonia: predisposing factors
• Role of different imaging modalities in diagnosis of chest
disease
• Management of pneumonia

54
 Chronic Breathlessness (1)
Disease/Pathology Emphysema, interstitial lung disease (sarcoidosis),COPD

Anatomy • Joints of the thorax

• General features of ribs, thoracic vertebrae & sternum
• Imaging of the chest wall

Biochemistry and • Neutrophil Elastase: action

• a1-Antitrypsin: The PiMM, PiMZ, PiSZ and PiZZ phenotypes
Genetics & Molecular
biology
Physiology • Generation of spontaneous rhythmicity of breathing
• Medullary and pontine respiratory centers and spinal pathways
• Neural and Chemical Control of Ventilation
• Central and Peripheral chemoreceptors

Pharmacology • Pharmacology of Nicotine

Community & Family • Population at risk of emphysema,sarcoidosis

Medicine
Pathology • Morphological features of various types of emphysema
• a-1 antitrypsin deficiency and smoking in the pathogenesis of
emphysema
• Complications of emphysema – pneumothorax
• Emphysema definition and its classification.
• Pathogenesis of emphysema and chronic bronchitis.
• Microscopic changes of sarcoidosis,COPD,
Clinical • Diagnosis of chronic obstructive airway disease
• Natural history and prognosis of chronic obstructive airway
disease
• Management** of stable chronic obstructive airway disease
• Risk factors for chronic obstructive airway disease
• Preventive aspects of chronic obstructive airway disease
• Clinical features in Emphysema,sarcoidosis
• Imaging in Emphysema, Chronic Bronchitis
• Management of Emphysema,sarcoidosis
• Mechanisms clinical features and management of chronic
respiratory failure

55
 Chronic productive cough
Disease/ Chronic Bronchitis, ,bronchiectasis
Pathology

Anatomy • Histology of airways

• Muscles of the thoracic wall including the diaphragm
• Blood supply of the thoracic wall and the diaphragm
• Innervation & lymphatic drainage of the thoracic wall and the
diaphragm
• Gross anatomy of the thoracic wall and diaphragm.
Microbiology/ • Common causes of reactivation of chronic bronchitis in COPD:
Immunology Haemophilus influenzae, Moraxella catharralis, respiratory viruses
(Orthomyxovirus, paramyxovirus): microbiological properties,
clinical relevance, mechanisms of pathogenesis, epidemiology,
transmission, antibiotic resistance and therapy.

Physiology • Mechanism of cough

• O2, CO2 transport
• Hb-O2 Dissociation Curves
• O2 Capacity of Blood
• Carbon Dioxide dissociation curves
Pharmacology • Inhalation route of drug administration
• Antitussives
Community & Family • Population at risk of chronic bronchitis
Medicine • Prevention and control of chronic bronchitis
• Risk factors of chronic bronchitis
• Patterns of tobacco use (global and regional)
• Health, social and economic burden of
tobacco use
• Smoking Cessation
• Counseling of smokers
• Prevention and control of chronic bronchitis
• Smoking and its impact on health
Pathology • Chronic bronchitis and its morphological features
• Definition of chronic bronchitis,bronchiactesis,
• Microscopic and macroscopic appearances of chronic bronchitis,
Hyperplasia, metaplasia and dysplasia in chronic bronchitis.
Clinical • Definition and diagnosis of obstructive airway disease.
• Cough, sputum and hemoptysis as major features of pulmonary
disease
• Contribution of pulmonary function tests to the diagnosis &
management** of lung disease.

56
 Chest Pain (1)

Disease/Pathology Pulmonary Embolism

Anatomy • General layout of major veins

• Surface marking of major veins

Biochemistry • Vitamin K: types and sources; mechanism of action in

hemostasis
Genetics & Molecular •
biology
Microbiology/Immunology
Physiology • Bronchial circulation
• Pulmonary circulation and pulmonary vascular resistance
• Regional distribution of ventilation and pulmonary blood flow
• Ventilation perfusion ratio
• Mechanism of pulmonary edema
• Mechanisms of haemostasis and clotting
Pharmacology • Antithrombotics
• Thrombolytic drugs
• Anticoagulants
Community & Family
Medicine
Pathology • Deep venous thrombosis
• Types of thrombi
• Predisposing factors to DVT
• Virchow’s triad (coagulopathy, venous stasis,
endothelial injury).

• The predisposing factors for thrombus formation.

• The pathogenesis and morphology of venous, arterial and
cardiac thrombi.
• Deep venous thrombosis
• The formation of the thrombus: its appearance, composition,
propagation, and organization.
• Types of emboli and pathological changes with special
reference to pulmonary emboli.
• List criteria of death.
• Information required in death certificate.
• Procedure of postmortem examination and embalming

57
Clinical • Clinical features in pulmonary embolism
• Investigation and treatment (management**)
• Limitations inherent in diagnosis of P. embolism
• Risk factors and prevention of P. embolism
• Principles of anti-coagulant therapy

58
 Chest Pain (2) *
Disease/Pathology Pneumothorax*

Anatomy • Gross anatomy of the Trachea

• Structures in the posterior mediastinum
• Imaging of mediastinum
• Gross and applied anatomy of the pleurae
• Surface marking of the lungs and pleurae
• Paracentesis thoracis - anatomy
Biochemistry • (Blood gases and Acid-Base balance)

Physiology • Lung mechanics and generation of pressure gradients between

alveoli and atmosphere
• Pressure volume relationships in respiratory system
• Compliance of lungs and chest wall
• Elastic recoil of the lung
• Anatomic dead space and alveolar ventilation

Pharmacology • Oxygen therapy

Clinical • Causes of spontaneous pneumothorax
• Clinical features and diagnosis of tension pneumothorax
• Tube thoracostomy
• Clinical findings in pneumothorax
• Causes of pneumothorax
• Investigation and treatment

59
 Blood in Sputum (1)

Disease/Pathology Bronchogenic Carcinoma

Anatomy • Refer to chest pain (2)

Biochemistry • (DNA mutations: Point (Silent, Missense,– and Non-sense)

Frameshift (insertion or deletion), Suppressor and Constitutive
mutations
• (Eukaryotic cell cycle)
Genetics & Molecular • Phases of cell cycle
biology • Cell cycle regulation
• Cancer development
• Characteristics of cancer cells

Pharmacology • Antineoplastic drugs - Classification

Community & Family • Epidemiology of tuberculosis

Medicine • Screening for tuberculosis (General and specific Populations)
• Prevention and Control and of tuberculosis
• Role of Public Health Directorate in TB control
Pathology • Nerves and structures involved by local infiltration by carcinoma
bronchus
• Para neoplastic syndromes
• Staging of carcinoma of bronchus
• Carcinoids, hamartomas and tumours arising from bronchial
mucinous glands.
• Morphological features, efforts and diagnosis of mesothelioma
• Morphological features of carcinoma of the bronchus.
• Morphological features of mesothelioma.
• Classification of carcinoma of the bronchus.
• Effects of carcinoma of the bronchus including paraneoplastic
syndromes.
• Methods of diagnosis of lower respiratory tract malignancies
• Malignant neoplasm of the bronchus grossly
Clinical • Diversity of presenting features in B. carcinoma
• Risk factors for bronchial carcinoma
• Pathology of B. carcinoma

60
• Diagnostic value of sputum cytology
• Bronchoscopy as a diagnostic tool and as an aid for therapeutic
interventions
• The para-neoplastic syndromes
• Investigations
• Principles of treatment

61
 Blood in Sputum (2)
Disease/Pathology Pulmonary Tuberculosis

Anatomy • Refer to Acute Breathlessness (2)

Microbiology/ • Mycobacterium tuberculosis and related atypical Mycobacteria.

Immunology M. leprae. Microbiological properties of clinical relevance,
mechanisms of pathogenesis, epidemiology, transmission,
antibiotic resistance and therapy, selection of specimens and tests
to be ordered for microbiological diagnosis.
• Mechanism of delayed type hypersensitivity, role of Th1
lymphocytes and their cytokines. Intracellular survival in
macrophages & Macrophage activation, role of Interferon gamma
and Nitric oxide derivatives in intracellular microbial killing
Physiology • Ventilation perfusion ratio

Pharmacology • Anti-tubercular drugs – First-line & alternative drugs

• Mechanism of action and ADR of first-line drugs
• Treatment of tuberculosis
• Chemoprophylaxis
Community & Family • Screening for tuberculosis
Medicine • Control of tuberculosis
• Role of Public Health Directorate in TB

Pathology • Definition and microscopic appearances of granuloma.

• Major granulomatous diseases (introduction).
• Morphological changes of pulmonary tuberculosis (primary and
post-primary).
• Complications of tuberculosis
• Types of granuloma, causes

Clinical • Clinical manifestations of pulmonary tuberculosis

• Diagnosis of tuberculosis: conventional and rapid methods
• Principles of treatment of tuberculosis
• Tuberculosis: infection control issues
• Tuberculosis in immuno-compromised patients
• Extra-pulmonary tuberculosis

62
 Respiratory Distress
Disease/Pathology Neonatal Respiratory Distress Syndrome / ARDS

Anatomy Lung histology

Physiology • Breathing mechanisim

• Surfactant function
Pharmacology • Surfactant

Community & Family • Good prenatal care to avoid premature delivery

Medicine

clinical Symptoms and management

63
CARDIOVASCULAR
SYSTEM

64
 An Infant with a Heart Murmur

Disease/Pathology Ventricular Septal Defect (VSD)

Anatomy • Gross anatomical features of the heart (external and internal)

• Development of the heart and great vessels
• Developmental anomalies of the heart and and great vessels
• Fetal circulation

Physiology • Cardiac cycle

- Functional anatomy of atrioventricular and
semilunar valves
- Timing of pressure, volume, sounds and ECG
changes in the cardiac cycle
- Relationship between pressure and flow during each
phase of the cardiac cycle
• Heart sounds (generation, abnormalities)
- Timing and causes of the 4 heart sounds
• Cardiac murmurs – mechanisms and types

Pharmacology • Teratogenicity
Community & Family • Coping mechanism for families with child having CHD
Medicine • Role of child screening

Clinical • Clinical features in VSD

• Investigations in VSD
• Principles of treatment (management of murmur)**
• Clinical presentation
• Absence of cyanosis
• Predilection to (infective) bacterial endocarditis
• Natural course
• Surgical intervention

65
 Breathlessness and Generalised Oedema
Painless edema of lower limbs
Disease/Pathology Congestive Heart Failure

Anatomy • Relations of the heart

• Imaging of the heart
• Histology of cardiac muscle

Biochemistry •
Genetics & Molecular •
biology
Microbiology/Immunology
Physiology • Functional characteristics of cardiac muscle
- Cardiac muscle as a functional syncytium
- Compare electrical and mechanical properties to
other excitable cells
• Regulation of cardiac muscle contractility
- Cardiac muscle action potential
- Mechanism of cardiac muscle contraction
- Role of extracellular calcium in cardiac muscle
contraction
- Length-tension relationship in cardiac muscle
- Starling’s law of the heart
• Cardiac output, venous return and their regulation
- Concept of preload and afterload
- Ventricular function curves
• Pathophysiology of congestive heart failure
Pharmacology • Drugs for CHF (inotropics, vasodilators, diuretics)
• Principles of treatment of congestive heart failure (acute &
chronic).
Community & Family • Life style modification (Diet)
Medicine
Pathology • Major causes and mechanisms of cardiac failure and the
mechanisms by which cardiac failure is produced by each.
• Cardiac failure classification such as acute, chronic, left sided
and congestive, and outline the features of each.
• Passive venous congestion and edema.
• Effects of congestive cardiac failure on various tissues with
special reference to lung, liver and kidney.
• Cardiomyopathy.

66
Clinical • Causes and pathophysiology of (cor pulmonale) heart failure
• Clinical features and diagnosis of systemic venous congestion
• Clinical & imaging diagnosis of right ventricular hypertrophy
• Treatment of congestive heart failure

67
 Retrosternal Chest Pain (1)
Disease/Pathology Ischaemic Heart Disease ( Myocardial Ischaemia and
Infarction), acute aortic dissection.
Anatomy • Coronary arteries and their branches
• Specific areas of arterial supply to the heart
and correlation with ECG leads
• Angiograms (normal)

Biochemistry • Markers of myocardial damage: CK and LDH isoenzymes,

Troponins I & T, high-sensitivity C-Reactive Protein.
Physiology • Coronary circulation and regulation of coronary blood flow

Pharmacology • Anti-angina drugs

• Drugs for treatment of acute myocardial infarction (……..)
• Anti-platelet drugs
Community & Family • Health, social and economic burden of Ischaemic heart disease
Medicine • Concept of Risk and risk factors : Ischaemic heart disease
• Life style modification
• Prevention and control of Ischaemic heart diseases and
conditions: Approaches, levels and types
• Lifestyle related health problems (diet, smoking, stress..)
• Compliance with management strategies
• Life course approach to NCDs
• Completeness and validity of death certification
• Post myocardial infarction counselling
Pathology • Necrosis definition and causes.
• Microscopic and macroscopic appearances of Coagulative,
liquifactive, caseous necrosis and Gangrene.
• Apoptosis definition and its mechanism.
• Effects and complications of myocardial ischaemia.
• Macroscopic and microscopic features of myocardial infarction.
• Laboratory investigations for the diagnosis of myocardial
ischaemia.
• Various stages in the evolution and healing of myocardial infarct.
• Complications of myocardial infarction.
• Recognition of myocardial infarction in specimen.
• Results interpretation of cardiac enzyme tests.
• defintion of dissection ,types.

68
Clinical • Clinical precaution in ischaemia and infarction
• Electro candiagraphic interpretation of ischemia infarction
and pericarditis.
• Treatment of myocardial ischaemia and
infarcts.(management**) and aortic dissection

69
 Chest Pain (2) *
Disease/Pathology Infective Endocarditis,pericarditis,myocarditis

Anatomy • Fibrous skeleton of the heart

• Relations, innervation and blood supply Gross anatomy of the
pericardium

Microbiology/Immunology • Alpha hemolytic streptococci. Staphylococcus epidermidis and

Central venous catheter related infections (Microbiological
properties of clinical relevance, mechanisms of pathogenesis,
epidemiology, transmission, antibiotic resistance and therapy).
Special focus on Methicillin resistance, its clinical significance,
molecular basis, alternative options.
• Antibiotic policy in hospital.
• Techniques for proper blood culture collection.

Pharmacology • Anti-infectives (Aminoglycosides)

Community & Family • Compliance with medication

Medicine • Preventive strategies during operative procedures
• Risk factors of endocarditis

Pathology • Causes of infective endocarditis, pericarditis, myocarditis

• Pathological changes of infective endocarditis, pericarditis,
myocarditis
• Vegetations and systemic embolism
• Hemodynamic changes in infective endocarditis
Clinical • Risk factors for infective endocarditis
• Presentation and diagnostic criteria of bacterial endocarditis,
pericarditis, myocarditis
• Complications of endocarditis, pericarditis, myocarditis
• Medical treatment of endocarditis, pericarditis, myocarditis
• Endocarditis of a prosthetic valve
• Anti-microbial prophylaxis
• Clinical features in endocarditis and pericarditis, ,
myocarditis

• Investigation and treatment

70
 Progressive dyspnea

Disease/Pathology Left-sided heart failure

Anatomy Histology of cardiac muscle (Refer to " Painless edema of the

lower limbs")
Physiology • Cardiac output and its regulation
• Pulmonary circulation (pressures, regulation)
• Capillary fluid dynamics and pathogenesis of edema

Clinical • Pathophysiology and common causes of L. ventricular failure

(LVF)
• Clinical features of dilated cardiomyopathy
• Bed-side Dx and assessment of severity of LVF
• Drug therapy of LVF
• Drug therapy of LVF
• Imaging in heart failure

71
 Palpitations
Disease/Pathology Mitral valve disease complicated with Atrial Fibrillation
,supraventricular tachycardia.
Anatomy • Organization of the conducting system of the heart
• Applied anatomy of the conducting system
• Histology of cardiac conducting tissue
• Anatomy of cardiac valves
Physiology • Electrophysiologic events in the heart, their origin, conduction
and spread
• Basic principles of ECG
• Regulation of heart rate and abnormal rhythms

Pharmacology • Anti-dysrrhythmic drugs – classification based on electro-

physiological mechanisms.

Pathology • Rheumatic fever definition and criteria for diagnosis..

• Pathogenesis and pathological changes of rheumatic fever.
• Pathological changes of acute rheumatic fever in the heart.
• Morphological and haemodynamic changes of rheumatic heart
disease.
• Pathology of acute rheumatic carditis
• Chronic rheumatic endocarditis and valvular disease
• Haemodynamic changes in valvular incompetence and stenosis
• Pathology of cardiac hypertrophy and stenosis
• Pulmonary congestion and haemorrhage
• Left atrial fibrillation and thrombosis, supraventricular
tachycardia.
• Systemic embolism
Clinical • Main causes and pathology of valvular disease of the heart
• Pathophysiologic mechanisms of cardiac chamber enlargement
• Clinical consequences of cardiac chamber enlargement
• Cardiac murmurs and their interpretation
• Arrhythmia: mechanisms and treatment
• Main causes and pathology of valvular disease of the heart
• Patho-physiologic mechanisms of cardiac chamber enlargement
• Clinical consequences of cardiac chamber enlargement
• Cardiac murmurs and their interpretation
• Arrhythmia: mechanisms and treatment(management**)
• Electrocardiographic diagnosis of dysrhythmias

72
 Intermittent Claudications*
(Peripheral vascular disease)
Disease/Pathology Peripheral vascular disease

Anatomy • Histology of the arterial system

Biochemistry • Cholesterol metabolism: Acetyl-CoA as precursor; the committed

step (HMG-CoA reductase); Functions of cholesterol
• Blood lipids and lipoprotein metabolism: Classification of blood
lipids; Chylomicrons and the exogenous pathway; VLDL and the
endogenous pathway; LDL and HDL; the apolipoproteins
• The LDL receptor: ACAT; regulation of receptor number
• NO metabolism: synthesis from Arginine; subtypes of NOS
• Investigation of blood lipid profile: Triglycerides, Cholesterol (toal,
LDL & HDL); Classification of the dyslipidemias
Physiology • Principles of haemodynamics
• Flow, pressure and resistance

Pharmacology • Antidyslipidemic drugs

• Principles of treatment of dyslipidemias
Community & Family • Hazards of smoking
Medicine • Diet and cholesterol
• Guidelines for cholesterol and triglyceride checkup
Pathology • Pathological features and complications of atherosclerosis.
• Theories of atheroma formation.
• Mechanism, features and predisposing factors of arterial and cardiac
thrombosis.

Clinical • Pathogenesis & pathophysiology of

• Hypercholesterolemia and atherosclerosis
• Clinical outcomes of atheroma of large arteries
• Causes and diagnosis of secondary hypertension
• Atherosclerosis: preventive aspects
• Clinical presentation in peripheral vascular disease
• Treatment of peripheral vascular disease
• Differential diagnosis

73
 Hypertension

Disease/Pathology Essential Hypertension

Anatomy • Refer to "Intermittent claudications"

Physiology • Flow, pressure and resistance
• Regulation of arterial blood pressure (Short term, intermediate and
long-term).
• Pathophysiology of hypertension

Pharmacology • Antihypertensive drugs – classification, mechanism of action &

ADR.
• Principles of treatment of essential hypertension.
• Drug compliance – definition and factors influencing.

Community & Family • Guidelines for blood pressure checkup

Medicine • Health, social and economic burden of hypertension
• Lifestyle modification
• Health consequences of hypertension
• Diet and hypertension
• The Normal distribution (Review)
• Compliance with medication

Pathology • Arterial and arteriolar changes in hypertension.

• Pathological features and complications of atherosclerosis.
• Theories of atheroma formation.
• Mechanism, features and predisposing factors of arterial and cardiac
thrombosis.
• Mechanisms of hemostasis and clotting.
• Thrombus definition.
• List the predisposing factors for thrombus formation.
Pulmonary embolism
• Describe the pathogenesis and morphology of venous, arterial and
cardiac thrombi.
• Describe the formation of the thrombus: its appearance,
composition, propagation, and organization.
• Types of emboli and pathological changes with special reference to
pulmonary emboli.
• List criteria of death.
• Information required in death certificate.

74
 • Procedure of postmortem examination and embalming
Clinical • Definitions of hypertension
• Hypertension as a risk factor for cardio-vascular Diseases.
• Secondary hypertension
• Initial evaluation of the hypertensive patient
• Hypertension: therapeutic strategies & specific anti-hypertensive
drugs(management**)
• Managing patient with hypertensive urgency**
• Retinoscopic evaluation of hypertension
• Electrocardiographic evaluation in hypertension

75
RENAL SYSTEM

76
 Peri-orbital Edema
Disease/ Pathology Nephrotic Syndrome

Anatomy • Structure, relations, blood supply of the kidneys

• Histology of the renal corpuscle and the kidney
• Development of kidneys
• Surface marking of the kidneys

Biochemistry • Creatine metabolism: synthesis of creatine phosphate from

arginine and Glycine in kidney then in liver; non-enzymatic
dephosphorylation to creatinine in muscle
• (The plasma proteins); hypoalbuminemia
• Urine analysis
• Proteinuria investigation: Dip-stick test for proteins, 24 h protein
estimation, electrophoretic separation of urinary proteins
Microbiology/Immunology • Circulating Immune complexes and mechanism of clearance.
• Mechanism of Immune complex disease, complement activation
• Other immunological mechanisms of kidney damage.
Physiology • Composition of glomerular filtrate
• Glomerular filtration rate and Renal blood flow (measurement,
and regulation)
• Clearance and its role in assessing the renal function
• Measurement of GFR using the concept of clearance
Pharmacology • Renal elimination of drugs
• clearance of drugs
• Diuretics – classification according to the site of action and
mechanisms, ADR.
Community & Family • Impact of child sickness on family
Medicine • Nutritional therapy of nephritic syndrome
Pathology • Nephrotic Syndrome and its causes.
• Edema formation.
• Types and causes of localised edema.
• Types and causes of generalized oedema
• Role of renal function tests in assessing the function of diseased
glomeruli.
• Microscopic examination of normal and diseased kidney
• Indications for renal biopsy
• Causes of proteinuria.
• Amyloid, classification, causes and pathological changes

77
Clinical • Indications for renal biopsy
• Causes of proteinuria.
• Features of GN glomerulo-nephritis in adults
• Nephrotic syndrome: definition and differential diagnosis
• Urinalysis
• Immune complex disease

78
 Hematuria (1)

Disease/Pathology Acute Post-streptococcal glomerulonephritis (APSGN)

• UTI (refer to loin pain 1),stone (refer to loin pain 2)
• Hemolytic uremic syndrome

Anatomy • Refer to periorbital edema

Biochemistry • Plasma electrolytes, buffers, and creatinine changes.

• Renal tubular acidosis: types 1-4
Microbiology/ • Mechanism of Immune complex disease, complement activation
Immunology • Immunopathological mechanisms correlated to post streptococcal
events.
• Other immunological mechanisms of kidney damage.

Physiology • The processes of renal tubular reabsorption and secretion

• Renal tubular handling of water, sodium, potassium, bicarbonate,
glucose and amino acids

Pharmacology • Prevention and prophylaxis of streptococcal infection

Pathology • Types of glomerulonephritis.

• Causes, predisposing factors and clinical features of acute
glomerulonephritis.
• Pathogenesis of streptococcal infection inducing
glomerulonephritis.
• Compare and contrast generalized edema secondary to glomerular
disease to edema due to cardiac failure.
• Complications of acute glomerulonephritis.
• Laboratory diagnosis of immune complex disease.
• Mechanism of oliguria, hematuria and proteinuria in glomerular
diseases.
• Hemolytic uremic syndrome

Clinical • Major causes of acute nephritic syndrome

• Sodium homeostasis
• Renal parenchymal hypertension
• Hematuria: differential diagnosis

79
 Hematuria (2)
Disease/Pathology Transitional Cell Carcinoma

Anatomy • Lymphatic drainage of urinary bladder

• Refer to Loin Pain (1)

Physiology • Physiological characteristics of smooth muscles and application to

urinary bladder.
• Micturition reflex
• Neural regulation of urinary bladder

Pharmacology • Antiparasitic drugs

Community & Family • Health, social and economic burden of bladder cancer.
Medicine • Risk factors of bladder cancer
• Prevention of bladder cancer
• Cultural habits and cancer

Pathology • Causes of hematuria. .(painless vs. painful)

• Pathology of renal cell carcinoma.
• Pathology of Nephroblastoma (rare cause of hematuria)
• Pathology and clinical features of renal cell carcinoma.
• Etiology and pathogenesis of the urinary bladder cancer.
• Histological types of bladder carcinoma.
• Pathological staging of the bladder cancer.
• Difference between grade and stage of the bladder cancer.
• Recurrence of the superficial bladder carcinoma.
• Metastatic spread of the bladder carcinoma.

Clinical • Investigations
• Complications
• Treatment

80
 Loin Pain (1)
Disease/Pathology Urinary Tract Infection,

Anatomy • Structure, relations, innervation and blood supply of the ureters

and bladder
• Imaging of the urinary tract
• Development of the ureter and bladder

Microbiology/Immunology • Enterobacteriaceae and their role in urinary tract infections.

Staphylococcus saprophyticus
• Enterococci: Microbiological properties of clinical relevance,
identification protocol, mechanisms of pathogenesis,
epidemiology, transmission, antibiotic resistance and
therapy/prophylaxis.
• Principles of the antibiotic sensitivity testing, MIC MBC,
vancomycin resistance in enterococci.
• Selection of specimens for microbiological diagnosis of UTI and
prostatitis
Physiology • Visceral pain (pathways, referred pain).
• Mechanisms of concentration and dilution of urine
- Counter-current mechanism
• Arginine vasopressin (Antidiuretic) hormone
Pharmacology • Antiinfectives (Fluoroquinolones – mechanism of action, kinetics
and ADR)
• Urinary tract antiseptics
• Principles of treatment of UTI
Community & Family • Advice to UTI patients
Medicine
Pathology • Predisposing factors for urinary tract infection.
• Infections including bacterial and parasitic, involving different
levels of urinary tract.
• Complications of urinary tract infection.
• Radiological and laboratory evaluation of urinary tract infection
and obstruction.
Clinical • Characteristics and differential D. of renal pain
• Renal cysts in adults
• Genetics, clinical aspects and complications of ADPKD
• Complicated UTI and its management**
• Causes of pain-dysuria syndrome

81
 Loin Pain (2)
Disease/Pathology Renal Stones

Anatomy • Structure of the Pelvi-calyceal system

• Refer to Periorbital edema

Biochemistry • Calcitriol, PTH and calcitonin
• Calcium homeostasis
• Uric acid metabolism: Purine catabolism; HPRT and APRT in
Salvage synthesis
• Inhibitors of stone formation: nephrocalcin, citrate and
pyrophosphate
• Types of urinary calculi: calcium, uric acid, struvite, and cystine
Physiology • Hormonal regulation of calcium (Role of parathormone and
calcitonin)

• Renal handling of calcium and phosphate

Pharmacology • Radiocontrast media

Community & Family • Epidemiology of renal calculus disease

Medicine • Advice to renal stone patients
• Nutritional therapy of nephrolithiasis

• Urine analysis and description of chemical and microscopic

pathology findings
• Predisposing factor, formation, type, detection, consequences and
treatment of renal calculi.
• Epidemiology of renal calculus disease.

Clinical • Characteristics and differential D. of renal pain

• Renal stones in adults clinical aspect.
• Treatment strategies in nephrolithiasis

82
 Progressive Deterioration of Kidney
Function (CRF)
Disease/Pathology Advanced diabetic nephropathy?

Anatomy
• Refer to Periorbital edema

Biochemistry • Renal function tests: Electrolytes, creatinine, acid-base status

(metabolic acidosis)
Physiology • Water and electrolyte homeostasis in Chronic Renal Failure
• Acid-base changes in Chronic Renal Failure
• Calcium and phosphate homeostasis in chronic renal failure

Pharmacology • Antiinfectives (Fluroquinolones, urinary tact antiseptics)(delete)

• Drug dosage adjustment in renal failure
• Nephorotoxicity of drugs
Community & Family • Guidelines for nephropathy among diabetic patients
Medicine
Pathology • Causes of chronic renal failure.
• Urinary retention and its causes.
• Pathological changes and complications of enlarged prostate
• Pathological changes in end stage kidney
• Microscopic changes in diabetic nephropathy
Clinical • Magnitude of the problem of Chronic Renal Failure
• Natural history of diabetic nephropathy
• Mechanisms of progression of renal disease
• Interventions to slow down the progression of renal disease
• Clinical aspects of the uremic syndrome
• Renal replacement therapy
• Clinical features

83
 Retention of Urine
Disease/Pathology Benign Prostatic Hyperplasia/Carcinoma of the prostate
Renal stone(refer to loin pain 2).
Anatomy • Structure, relations, lymphatic drainage and blood supply of the
prostate
• Development of the prostate

Biochemistry • Prostate Specific Antigen: nature of this enzyme, free and bound
forms. Sensitivity, Specificity and Predictive value of test
Physiology • Physiology of micturition (Mechanism, control and abnormalities)
• Sacral parasympathetic outflow

Pathology • Causes and complications of urinary tract obstruction

• Benign prostatic hyperplasia
• Carcinoma of the prostate

Pharmacology • Anti-androgens & GnRH antagonist

• 5-a reductase inhibitor and a1-blockers
• Clinical features
• Investigations including imaging
• Treatment options(management**)
Clinical

84
 Renal graft
Disease/Pathology Complicated renal transplantation

Anatomy • Refer to Periorbital edema

Microbiology/Immunology
Immune reaction to graft

Pharmacology • Immunosuppressant drugs – classifications,

mechanism of action and ADR.
Community & Family Medicine • Individual and family counseling of patients
with renal transplantation

Pathology Renal transplant rejection

• -hyper acute
• -acute
• -chronic

Clinical • Organ replacement therapy: indications and

limitations
• Immunology of organ transplantation
• Opportunistic infections
• Ethical considerations of organ Tx

85
METABOLISM,
&
ENDOCRINE
SYSTEMS

86
 Gigantism
Disease/Pathology Pituitary Adenoma

Anatomy Gross and microscopic anatomy of the pituitary

gland
• Contents & relations of the cavernous sinus
• imaging of the middle cranial fossa
• Development of the pituitary gland.

Biochemistry • Pituitary hormone synthesis: processing of

preprohormones
• Growth hormone action: IGF-1, its binding proteins
and receptors
• G-Protein Coupled Receptors and signal transduction
• Evaluation of GH secretion: suppression in response
to an OGTT.
Genetics & Molecular biology • Delayed puberty
• Genetics of puberty & delayed puberty
• Molecular determinants of Puberty (role of
Kisspeptin/GPR54, leptin..)
• Sex determination
- SRY
- X inactivation
• Disorders of sexual differentiation
- True hermaphroditism
- Male pseudohermaphroditism
- Female pseudohermaphroditism
• Disorders of sex chromosomes
- Klinefelter
- Turner WEEK3 YR2
Microbiology/Immunology
Physiology • Anterior pituitary hormones
• Hypothalamic control of pituitary hormones
• Physiological actions of growth hormone
• Regulation of growth hormone secretion
• Abnormalities of growth hormone secretion
- Hypersecretion (before and after adolescence)
- Hyposecretion

Pharmacology • Somatostatin analogs

87
Community & Family Medicine • Body image
• Social stigma

Pathology • Types of pituitary tumor and their effects.

• Pituitary hyperplasia and neoplasia
• Causes of Cushing’s Syndrome.
• Morphological changes in hyperplasia and neoplasia
of the adrenal cortex.
Clinical • Clinical features of acromegaly and gigantism
• Neurologic manifestations of pituitary tumors
• Trans-sphenoidal resection Vs. drug therapy
• Treatment of adenomas
• Imaging

88
 Secondary hypogonadism in an adult male
(pituitary gland)
Disease/Pathology Prolactinoma,,klinfilter syndrome
WEEK3 YR2
Anatomy
• Histology of the pituitary gland Refer to
Gigantism

Biochemistry • Lactose metabolism: Protein A, α-lactalbumin

and role of prolactin
• Plasma prolactin and macroprolactin; response
to TRH
• Laboratory investigation of the hypothalamic-
pituitary-gonadal axis
Genetics & Molecular biology • Gametogenesis & meiosis
• Genetics of male and female infertility
• Y microdeletion
Microbiology/ • Infectious disease as a cause of infertility.
Immunology • Genetic basis for klinfilter syndrome
Physiology • Regulation of prolactin secretion
• Actions of prolactin on mammary gland
(development and lactation)
• Influence of prolactin on other reproductive
hormones in male and female (LH and FSH)
• Abnormalities of prolactin secretion
- Hyperprolactinemia and its effects
- Hypoprolactinemia
Pharmacology • Dopamine agonists

Community & Family Medicine • Ethical issues related to infertility

• Cultural issues related to infertility
• Infertility effect on individual and family
• Coping mechanism: Effect of social factors
• Sexual history taking (Review)
Pathology • Histology of prolactinoma and the
significance of immunoperoxidase in its
diagnosis

89
Clinical • The spectrum of clinical features of pituitary
disease and klinfilter syndrome
• Diagnosis of pituitary hormone deficiencies
• Treatment of hormone deficiencies
• Differential diagnosis of dwarfism
• Imaging in Pituitary disease

90
 Polyuria (posterior pituitary)
Disease/Pathology Diabetes insipidus,DM(refer to CRF and blue toe)

Anatomy Refer to Gigantism

Biochemistry • The Fluid Deprivation and desmopressin tests:

plasma and urine osmolality
Physiology • ECF osmolarity (definition, measurement and
and regulation)
• Antidiuretic hormone and Oxytocin - secretion,
physiological actions, their mechanism and
regulation
• Factors stimulating and inhibiting ADH release
• Renal mechanisms for concentration and
dilution of urine

Pharmacology • Vasopressin and analogs

Clinical • Water homeostasis and free water clearance

• Differential diagnosis of polyuria and
management**
• Diagnosis of diabetes insipidus,DM
• Treatment of diabetes insipidus,DM

91
 Hyperventilation (1)
(Acute metabolic complications of DM.)
Disease/Pathology Diabetic ketoacidosis(METABOLIC ACIDOSIS)

Anatomy Refer to Blue Toe

Biochemistry • (Acid base balance: metabolic acidosis)

• Anion gap: definition and calculation
• Biochemical structure of insulin: preproinsulin,
proinsulin, insulin and C-peptide.
• Metabolic effects of insulin deficiency:
catabolism of carbohydrates, lipids and proteins
• Fatty acid oxidation and ketogenesis
Physiology • Insulin action on glucose and fatty acid
metabolism
• Consequences of insulin deficiency
• Fluid and electrolyte homeostasis secondary to
high plasma glucose levels
• Control of acid base balance
• Disturbances in acid base balance (metabolic
acidosis)
Pharmacology • Insulin preparations
• Principles of management of diabetic ketoacidosis

Clinical 1. Pathogenesis and diagnosis of D. keto-acidosis

2. Evaluation of severity of dehydration
3. Insulin therapy
4. Infections and diabetes
5. Monitoring fluid therapy

92
 Blue toe
(Vascular complications of DM)
Disease/Pathology Diabetic foot ,gangrene

Anatomy • Histology of pancreas (Refer to Abdominal

Pain 2 (GI)
• Histology of a peripheral nerve Refer to
Tingling and Numbness (Nervous System)

Biochemistry • Glycolysis & Gluconeogenesis: Key reactions

• Glycogen metabolism: Key reactions of
Glycogenesis and glycogenolysis
• The insulin receptor and insulin signalling
• Counter-regulatory hormones: Glucagon,
adrenaline, GH, cortisol nature and action
• The Glucose Tolerance Test: description of the
procedure and interpretation of results
• Glycation of proteins: AGE, HbA1c and
fructosamine diagnostic relevance
Microbiology/Immunology • Clinical microbiology of diabetic ulcers. Major
involved bacteria Enterobacteriaceae,
Pseudomonadaceae, Staphylococci.
• Anaerobes: Problems related to antibiotic
resistance. Major mechanisms of antibiotic
resistance.
• Correct procedure for specimen collection.
• Interpretation of microbiological results
Physiology • Glucose Homeostasis: role of Insulin,
Glucagon, Somatostatin, and other non
pancreatic hormones
• Dysregulation of plasma glucose levels:
- Hypoglycemia, hyperglycemia
- Complications of diabetes mellitus, Micro
and macro vascular and metabolic
- Short term and long term effects of diabetes
mellitus
Pharmacology • Insulin preparations
• Oral anti-diabetic drugs – classification, mechanism of
action and ADR including drug interactions

93
 • Principles of treatment of Type 1& type 2
diabetes

Community & Family Medicine • Diabetes Mellitus as a public health problem

• Importance of patient’s and the family’s
education and counseling in complying with
anti-diabetic medication
• Screening for diabetes
• Coping with chronic illness (Diabetes)
• Measurements of Exposure in Epidemiology:
Diabetes
• Concept of prognostic factors
• Nutritional assessment
• Foot care

Pathology • Complications of diabetes

• Gangrene (dry, wet)causes
[DM,atherosclerosis,trauma,reynaud
phenomenon]
• Gangrene of the lower limb and its
pathogenesis
• Features of peripheral neuropathy
• Features of diabetic nephropathy
Clinical • Type 2 DM: prevalence / impact on community
health
• Macrovascular and microvascular
complications of DM
• Oral hypoglycemic drugs
• Prevention of diabetic complications
• Diabetes as a cardio-vascular risk factor
• Clinical features
• Treatment

94
 Ambiguous genitalia
Disease/pathology Congenital adrenal hyperplasia

Anatomy Adrenal histology

Clinical
Biochemistry Steroidogenesis

Genetics & Autosomal recessive

Molecular biology

Physiology the function of adrenal hormones, 21-hydroxylase

clinical features
Investigation
management

95
 Goitre and Weight Loss (1)
Disease/Pathology Thyrotoxicosis,Gravis

Anatomy • Structure, relations, blood supply of the Thyroid

gland
• Orientation of the cervical fasciae
• Histology of thyroid and parathyroid

Biochemistry • Oxidative metabolism: glycerol 3-P

dehydrogenase; uncoupling proteins (UCPs)
• Investigation of the hypothalamic-pituitary-
thyroid axis
Physiology • Regulation of thyroid hormone production and
secretion
- Role of hypothalamus and pituitary in
regulation of thyroid secretion
• Physiological actions of thyroid hormone on:
thermogenesis, growth and development, central
nervous system, cardiovascular system ,and
metabolism of carbohydrate, fat and protein.
Pharmacology • Antithyroid drugs, b-blockers.
• Principles of treatment of hyperthyroidism
including pre-operative management.
• Treatment of thyroid disease: Monitoring
and adverse effects of therapeutic
management.
Pathology • Causes of thyroid enlargement
• Microscopic and macroscopic changes of
thyrotoxicosis.
• Pathogenesis of thyrotoxicosis.
• Causes of hypothyroidism
• Pathological changes of hypothyroidism
Clinical • Pathogenesis and diagnosis of thyroid disease
• Myxedema: Clinical features and differential
diagnosis
• Treatment of thyroid disease: Monitoring and
adverse effects
• Clinical features in thyrotoxicosis &
prognosis.
• Treatment of thyrotoxicosis.(management**)

96
 Thyroid Swelling
Disease/Pathology Goiter/Thyroid carcinoma

Anatomy • Structure, relations and blood supply of thyroid

gland (Refer to Thyrotoxicosis and Weight
Loss 1)
• Development of the thyroid gland
• Refer to Generalized lymphadenopathy in
Blood an Immune systems

Biochemistry • Iodine metabolism: sources of iodine, RDA,

uptake by thyroid follicular cells, oxidation,
organification; coupling; T3 and T4 transport,
peripheral conversion, rT3
• The thyroid hormone receptor
• Thyroid function tests: Total and free T3 and T4,
TSH and TRH
•
Microbiology/Immunology • Mechanisms of tolerance and tolerance bypass.
• Autoimmunity and autoimmune disease. The
spectrum of autoimmune disease.
• Autoimmune thyroiditis.
Physiology • Regulation of thyroid hormone production and
secretion: Role of hypothalamus and pituitary in
regulation of thyroid secretion
• Physiological effects of thyroid hormone on
metabolism of carbohydrate, fat and protein
Pharmacology • Thyroxin replacement Rx

Community & Family Medicine • Nutritional management of Iodine Deficiency

• Screening for Iodine Deficiency
• Prevention of Iodine Deficiency
• Validity of diagnostic tests
• Epidemiology of thyroid cancer

Pathology • Thyroid carcinoma types and morphology

97
Clinical • Causes of thyroid enlargement
• Types of thyroiditis
• Thyroid hyperplasia and adenoma
• Types of morphological features of thyroid
malignant neoplasms
• Clinical features related to thyroid swellings
• Treatment of thyroid &
swellings(management**)

98
 Obesity Weight Gain (1)
Disease/Pathology Primary Obesity,Hypothyrodisim, Polycystic ovary
.
Anatomy Histology of adipose tissue,thyroid gland,ovaries

Biochemistry • Lipogenesis: acetyl-CoA carboxylase and

formation of Malonyl-CoA; esterification of
fatty acids for storage or export
• Metabolism in the well-fed state: Anabolic
reactions: Glycogenesis, lipogenesis and their
regulation
Physiology • Energy balance: metabolic rate, Energy storage,
energy utilization.
• Regulation of body weight (short-term and long-
term)
• Regulation of food intake, hormonal and neural
mechanisms
• Pathophysiology of weight gain
Pharmacology • Appetite suppressants
• Drug treatment of obesity
• Benefits/Risk of drug therapy
Community & Family Medicine • Health, social and economic burden of obesity
• Measurements of overweight and obesity
• Nutritional assessment.
• Life style and diet related health problem
• Food diary and food frequency table
• Body image and culture

Clinical • Etiology and natural history of obesity

• Clinical evaluation of the overweight patient
• Clinical evaluation of hypothyrodisim,PCO
• Health hazards associated with obesity
• The metabolic syndrome
• General principles of therapy of obesity
• Diagnosis
• Treatment (management**)

99
 Obesity, Weight Gain (2)
Disease/Pathology Cushing’s Disease, steroid intake

Anatomy • Anatomy of the adrenal suprarenal gland (gross

and histology)
• Development of suprarenal gland

Biochemistry • Adrenal cortex hormones (synthesis, secretion &

mechanism of action): Key enzymatic steps and major
structural differences
• Biochemical tests for adrenal function: Plasma
electrolytes and glucose, 24 h urinary Cortisol,
dexamethasone suppression test, CRH test, plasma
ACTH; Aldosterone and renin activity
Physiology • Adrenal- cortical hormones (Aldosterne,
glucocorticoids and androgens).
• Physiological actions of glucocorticoids :effects on
intermediary metabolism, maintenance of normal
circulatory functions, adaptation to stress, and
suppression of immune response
• Regulation of glucocorticoid secretion: negative –
feedback mechanism by CRH and
ACTH,(Hypothalamo-pituitary-adrenal axis).,
• Disorders of adrenocortical functions :Hypofunction
and hyperfunction of adrenal cortex
Pharmacology • Gluco & Mineralocorticoids (synth)
• Adverse effects of steroids
• Principles of steroid therapy
• Major adverse effects of glucocorticoids
Community & Family Medicine •

Clinical • Mineralocorticoids and the renin-angiotesin system in

health and disease
• Major adverse effects of glucocorticoids
• Clinical manifestations of Cushing’s disease.
• Withdrawal of corticosteroid drugs
• Hormonal reaction to stress

100
 Hypoglycemia
Disease/Pathology Insilinoma
Addison’s disease, congenital adrenal hyperplasia
Anatomy Adrenal gland histology
Pancreas histology

Physiology • Adrenal hormones (steroid, glucocorticoid and

mineralocorticoid),pancreas hormones

Pharmacology • Corticosteroid, dextrose

Clinical Symptoms (whipple ‘s triad ;glucose less than or

equal 45mg\dl,reversibility of symptoms with
glucose administration ,symptoms and signs of
hypoglycemia)

Investigation( Electrolyte imbalance…..)

MANAGEMENT

101
 Headache
Disease/Pathology Phaeochromecytoma

Anatomy Histology of adrenal gland

physiology Function of catecholamine

Pathology microscopic description

Criteria of malignancy

Clinical Clinical features(elevated blood pressure and

heart rate ,palpitation ,weight loss)
Investigation (blood test, urine test, biopsy,
radiology)
Management

102
REPRODUCTIVE
SYSTEM

103
 Testicular Scrotal Swelling
Disease/Pathology Testicular Tumors/hydrocele/ Epididymo-orchitis
,varicocele.
Anatomy • Structure, relations, blood supply and lymphatic
drainage of the testes
• Structure of spermatic cord
• Histology of the testes, epididymis, ductus
deferens and seminal vesicles
• Tunica vaginalis
• Development of the testis

Biochemistry • Androgen metabolism: Key reactions, DHEA,

DHEAS, testosterone and dihydrotestosterone
• Sex Hormone Binding Globulin; peripheral
conversion of testosterone
• The hGH test and plasma testosterone
•

Physiology • Spermatogenesis
• Physiological effects of testosterone
• Regulation of testosterone secretion:
Hypothalmo-pituitary gonadal axis
• Functions of Sertoli cells

Pharmacology • Antineoplastic drugs

• Blood – testes barrier
Community & Family Medicine • Epidemiology of testicular cancer
• Child Screening

Pathology Testicular tumor types and morphological

changes

•
Clinical Clinical features of scrotal & testicular
swellings.
• Differential diagnosis
• Treatment

104
 Amenorrhea (Secondary)
Disease/Pathology Pregnancy

HSF YR1
Anatomy • Histology of the endometrium (Refer to
vaginal bleeding (2)
….embryology,fertilization,implantaion WEEK1 YR2

Biochemistry • Sex steroid hormone synthesis: Progesterone and

estradiol; the estrogen receptor
• Placental hormones: hCG, progestins, estrogens
and lactogens
• The pregnancy test WEEK1 YR2
Genetics & Molecular biology • Mitotic cell division WEEK 1 YR2
• Spindle molecular structure and function
• Twinning & zygosity determination
• Prenatal diagnosis
WEEK1 YR2 - Techniques used in prenatal
diagnosis

- Indications for prenatal

diagnosis
- Prenatal treatment
• Population screening
- Prenatal screening
§ NTD
§ Down’s syndrome WEEK3 YR2
- Criteria for screening programs
§ The disease
§ The test
§ The program
WEEK2 YR2 - Newborn screening
• Genetic registries

Physiology • The female ovulatory and endometrial cycle.

• The formation of sperm WEEK1 YR2
• Placental hormones
• Maternal changes in pregnancy
• Physiology of parturition
• Fertilization & implantation

105
 WEEK1 YR2

• Placental hormones and pregnancy test

• Hormonal changes in pregnancy
• The physiology of breast feeding and suckling

Pharmacology • Teratogenicity WEEK3 YR2

• Principles of drug use during pregnancy and
lactation
• Antihypertensives in pregnancy (centrally acting
vasodilators/a & b blockers)
• Anticonvulsants in pregnancy
Community & Family Medicine • Marriage and fertility rates
• Reproductive health
• Premarital counseling
• Antenatal careand postmartum
WEEK1 YR2
(management**)
• Culture, marriage and reproduction
• Family as a social institution
WEEK1 YR2
Clinical • Conduct health education on nutrition and
advantages of breast feeding
• Diagnosis of pregnancy
• Clinical features in pregnancy
• Managing the patient who needs options
counceling for pregnancy and cotraception**

106
 Amenorrhea (Primary)
Disease/Pathology pseudo hermaphroditism (pseudo
hermaphrodite).Turner syndrome, (gonadal
dysgenesis) ,polycystic ovary,functional
hypothalamic
amenorrhea,hyperprolactinoma,ovarian
insufficiency (discussed earlier)

Anatomy • Development of male and female reproductive

systems

Biochemistry • Evaluation of the hypothalamic-pituitary-

gonadal axis: GnRH/clomiphene test; measure
FSH, LH, estradiol, testosterone
Genetics & Molecular biology • Genetic basis for pseudohermaphroditism.
• Genetic basis for Turner syndrome
•
Physiology • Oogenesis during fetal development, follicular
development during puberty
• Physiological changes during puberty, secondary
sex characteristics
• Hormonal changes during puberty
• Control of onset of puberty: pulsatile GnRH
release, relationship of leptin and other
hormones in control of puberty
• Ovarian hormones: estrogen and progesterone
• Effect of the ovarian hormones on: female
genitalia, breast, CNS,
• Mechanism of action of ovarian hormones
• Abnormalities of ovarian functions, amenorrhea
Pharmacology • Androgen replacement therapy
Community & Family Medicine • Parent counceling

Clinical Clinical features

Management

107
 Vaginal Bleeding (1)
Disease/Pathology Abortion

Anatomy • Fertilization and implantation

• Imaging of the female genital tract

Genetics & Molecular biology • Genetics of pregnancy loss

- Genetic factors in recurrent abortion
Microbiology/Immunology • Feto-maternal immunology
• Mechanism of Type II hypersensitivity

Physiology • Fertilization & implantation

• Placental hormones and pregnancy test
• Hemorrhagic shock
• Feedback mechanisms in shock
•
Pharmacology • Abortifacients
• Drugs for PPH
• Oxytoxic drugs
Community & Family Medicine • Risk factors of Abortion
• Breaking bad news
• Coping mechanisms for loss
• Unwanted pregnancies
• Unsafe abortion
• Cultural and religious views on abortion
• Fundamentals of Research Methodology: Recall
bias in reproductive history
Clinical • Classification of Abortion
• Investigations
• Treatment options(management**)

108
 Vaginal Bleeding (2)
Disease/Pathology Carcinoma of the Cervix

Anatomy • Structure, relations, blood supply and lymphatic

drainage of the uterus
• Development of the uterus
• Histology of cervix

Microbiology/Immunology • Human papilloma virus Microbiological

properties of clinical relevance, identification
protocol, mechanisms of pathogenesis,
epidemiology, transmission, Molecular
diagnostic, relevance of typing

Pharmacology • Cancer chemotherapy

Community & Family Medicine • Breaking bad news

• Coping mechanisms
• Health, social and economic burden of cancer:
cervix and endometrial
• Screening for cancer of cervix
• Risk factors of cancer of cervix

Pathology Cervical cancer types, grade and stage

Clinical Clinical features

Management

109
 Vaginal Bleeding (3)
Disease/Pathology Endometrial Hyperplasia ,dysfunctional uterine
bleeding
Anatomy • Histology of the endometrium
• Refer to Secondary Amenorrhea

Physiology • Mestrual cycle: ovarian, uterine (endometrial ),

cervical and vaginal changes
• Hormonal changes in menstruation
• Hypothalamo-pituitary-gonadal axis
• Role of gonadotrropic hormones (hypothalmo-
pituitary gonadal axis ) for control of ovarian
functions

Pharmacology • Gonadotropin releasing hormone antagonists

Community & Family Medicine

pathology types ( simplex,complex,atypical)

Clinical management

110
 Pelvic Pain
Disease/ Pelvic Inflammatory Diseases (PID), ectopic
Pathology pregnancy,tortion of ovary ,ovarian
cyst,salpengitis,tubo-ovarian abcess,dysmenorrhea
(management**)

Anatomy • Pelvic walls, pelvic fasciae and pelvic vessels

and nerve

Microbiology/ • Agents causing PID: Neisseria gonorrhoeae,

Immunology Chlamydia, Ureaplasma, Mycoplasma,
Syphilis. Bacterial vaginosis.
• Candida and related yeasts, Trichomonas,
Herpes virus Human papilloma virus. Scabies.
Microbiological properties of clinical relevance,
identification protocol, mechanisms of
pathogenesis, epidemiology, transmission,
antibiotic resistance and therapy/prophylaxis.
• Selection, Collection, Transport and Processing
of specimens for microbiological diagnosis
Pharmacology • Antiinfective drugs

Community & Family Medicine • Epidemiology of STDs

• Health education of patients with STDs
• Sources of Health Data :Notification of STDs
• Prevention of STDs
• Ethical issues in STD’s
• Notification of STD’s
• Sexual history
• Safe sex

Clinical Clinical features of ectopic pregnancy,tortion of

ovary ,ovarian cyst,salpengitis,tubo-ovarian
abcess,dysmenorrhea

Management

111
 Vaginal Discharge (1)
Disease/Pathology Trichomonas Vaginitis,bacterial
vaginosis,chlamydia
Anatomy • Gross anatomy and histology of the vagina
• Refer to Primary Amenorrhea (Development
of reproductive organs)

Pharmacology • Hormonal contraceptives - oral and injectables,

types, mechanism of action, indication and
contraindications, common ADR.
Community & Family Medicine • Family planning methods
• Postnatal services
• Epidemiology of STDs
• Health education of patients with STDs
and(management**)
• Sources of Health Data :Notification of STDs
• Prevention of STDs
• Ethical issues in STD’s
• Notification of STD’s
• Sexual history
• Safe sex
Clinical • Contraception & family planning**
• Management patient with genital rash,complaints
or sexual proplem**

112
 Vaginal Discharge (2)
Disease/Pathology Candidiasis

Anatomy Refer to vaginal discharge (1)

Microbiology/Immunology candida
Pharmacology • Antifungal drug

Clinical Symptoms and management

113
 Pelvic Mass
Disease/Pathology Ovarian Tumors,ovarian cyst,uterine masses

Anatomy • Structure, relations, blood supply and lymphatic

drainage of ovaries,uterus
• Relations and blood supply of adnexa
• Development of uterus and adnexa

Biochemistry • (Metabolism of estrogens & progesterone)

• Tumour markers: CA 125
Physiology • Hormonal regulation of ovarian cycle
• Hypothalmo-pituitary-gonadal axis

Pharmacology • Antineoplastic drugs

Community & Family Medicine • Health, social and economic burden of ovarian
cancer
• Risk factors of ovarian and uterine cancer

Pathology Ovarian and uterine tumer types and stages

Fibroid features.

Clinical Clinical features

management

114
 Hot Flushes
Disease/Pathology Menopause Week6 YR 2

Physiology • Hormonal changes in menstruation

• Hypothalamo-pituitary-gonadal axis
• Physiological changes in menopause
• Role of estrogen in bone metabolism

Pharmacology • Hormonal replacement therapy

Clinical • Clinical features (amenorrhea………….)

• (management**)

115
 Urethral Discharge
Disease/Pathology Gonorrhea, chlamydia

Anatomy Refer to vagina discharge 1

Pharmacology • Refer to vagina discharge 1

Community & Family Medicine • Refer to vagina discharge 1

Clinical Refer to vagina discharge 1

116
 Breast Lump
Disease/Pathology Carcinoma of the Breast,benign mass.,abcess

Anatomy • Structure, lobation, blood supply, lymph nodes

and lymphatic drainage of the breast
• Histology of breast

Biochemistry • Molecular markers of breast cancer: CA 15-3

and MCA
• (The estrogen receptor)
Genetics & Molecular biology • Screening for familial cancers
Microbiology/Immunology

Physiology • Hormonal control of mammogenesis

• Development of the breast
• Physiology of lactation
• Role of oxytocin and prolactin for breast
function
• Lactational amenorrhea
Pharmacology • Antineoplastic drugs
• Antiestrogens
Community & Family Medicine • Health, social and economic burden of
carcinoma of the breast
• Risk factors of breast cancer
• Women at high risk of breast cancer
• Prevention of breast cancer
• Screening and guidelines of breast cancer
• Sensitivity, specificity of tests
• Evidence based health policies on screening
Pathology • Differential diagnosis of breast mass
• Features of cystic diseases of the breast
• Classification of carcinoma of the breast
• Pathological changes of carcinoma of the
breast
• Staging of carcinoma of the breast
• Prognostic features of carcinoma of the breast
including molecular

117
Clinical • Differential diagnosis for breast mass in a 20 –
year old and a 45- year-old patient Consider
benign vs. malignant, vs. abscess.
• Importance of the patient's history: estimated
duration of illness, nipple discharge, breast
cancer risk factor assessment
• Discuss physical findings to look for
• In-office procedures for evaluation and
treatment (FNAC, needle aspiration, incision
& drainage, core needle biopsy) and their
diagnostic/therapeutic implications
• Discuss the diagnosis and management** of
the patient with an abnormal mammogram
(consider microcalcifications)
• Discuss the rationale for management with
specific emphasis on:
• Clinical staging of breast CA
• The various possible malignant, pre-malignant,
and benign pathology results (including
hormonal receptor analysis, tumor DNA
analysis)
• The follow-up for a patient with a benign
lesion (alterations in lifestyle, imaging studies,
cancer risk)
• The role of incision and drainage and
antibiotics in breast abscess treatment
• Current recommendations for screening
mammography
• Therapeutic options for the patient with breast
CA
• role of surgery/when to consult a surgeon for
further diagnosis & treatment
• role of radiotherapy
• role of chemotherapy (adjuvant or neoadjuvant)
• role of hormonal therapy
• surgical options including reconstruction

118
 Perineal tear in the Female
(Prolonged Labor)

Disease/Pathology Vaginal tear

Anatomy • Gross anatomy of the female perineum.

• Gross anatomy of the female external genitalia.
• Development of the female genitalia.
• Applied anatomy of the female perineum & external genitalia.

Physiology • Physiological mechanisms of parturition

Clinical • management

119
 Perineal Trauma in the Male

Disease/Pathology Urethra tear

Anatomy • Gross anatomy of the male perineum.

• Gross anatomy of the male external genitalia.
• Development of the male genitalia.
• Applied anatomy of the male perineum & genitalia.

Clinical • management

120
HEMATOPOEITIC
&
IMMUNE SYSTEMS

121
 Tiredness (1)
Disease/Pathology Iron deficiency anemia

Anatomy • None
Biochemistry • Heme synthesis: intracellular sites, key reactions and control
• Iron metabolism: sources, absorption, transport and storage
Genetics & Molecular • Chromosome breakage syndromes
biology • Fanconi anemia
Microbiology/ • Pernicious Anemia.
Immunology • Immunopathological mechanisms.
• Iron deficiency anemia: Hookworm infestation: Life cycle,
Transmission, Diagnosis and Prevention

Physiology • Erythrocytes: function, production,

maturation, destruction
• Formation of hemoglobin; iron metabolism
• Effect of anemia and polycythemia on the circulatory system
• Functions of spleen
Pharmacology • Iron preparations
• Iron toxicities, overload and poisoning / management.
• Principles of treatment of iron deficiency anemia (including
cost-effectiveness and essential drugs)
Community & Family • Health, social and economic burden of iron deficiency anemia
Medicine • Nutritional assessment and management of iron deficiency
anemia
• Population at risk of iron deficiency anemia
• Nutritional needs of specific populations
• Screening for iron deficiency anemia
• Community based intervention Programs
Pathology • Definition of anemia, causes and classification.
• Causes of iron deficiency anemia.
• Causes and lab diagnosis of iron overload
• Causes, clinical features, lab diagnosis and treatment of iron
overload.
• Pathogenesis and lab diagnosis of megaloblastic anemia.
• Causes of vitamin B12 and folic acid deficiencies. Clinical
features, pathogenesis, lab diagnosis and management of
megaloblastic anemia.

122
 • Identification of the stages of maturation of marrow
erythroblasts.
• Identification of the following types of erythrocytes: (a)
Normocytic and normochromic cells (b) Microcytic and
hypochromic cells (c) Macrocytes (d) Reticulocytes
• Identification of hypersegmented neutrophils.
• Hematocrit measurement of a blood sample.
• Calculation of the red cell indices (MCV, MCH and MCHC).
The hemoglobin value, hematocrit and RBC Count.
• Calculation of corrected reticulocyte count and the
reticulocyte production index

Clinical • Clinical evaluation of the anemic patient

• Laboratory diagnosis of major classes of anemia
• Iron therapy
• Blood transfusion: indications & adverse effects

123
 Tiredness (2)
Disease/Pathology G6PD Deficiency

Anatomy • None

Biochemistry • The Pentose-P Pathway: oxidative reaction and outline

of non-oxidative reactions
• Metabolic consequences of enzyme deficiencies: GSH
and detoxication of Reactive Oxygen Species (ROS);
membrane lipids and protein damage
Physiology • Structure and function of red blood cell
• Red cell cycle and hemoglobin metabolism
• Osmotic fragility

Pharmacology • Folic acid, B12

• Pharmacogenetics : drug-induced hemolysis
Community & Family • Health, social and economic burden G6PD deficiency
Medicine • Population at risk of G6PD deficiency
• Screening for G6PD deficiency
• Premarital counseling
• Health education for G6PD deficiency patients
Clinical • Diagnosis of intravascular and extravascular hemolysis
• Approach to the patient with splenomegaly
• Hemolysis & mechanisms of immune injury
• Sickle cell disease & other hemoglobinopathies
• Genetic counseling of anemic patients

124
 Extremity Pain
Disease/Pathology Sickle Cell Disease

Anatomy • None
Biochemistry • Hemoglobin structure and function: critical residues in
the heme-binding pocket; (cooperativity)
• (Point mutation); properties of HbS – surface charge and
solubility
Genetics & Molecular • Hemoglobin gene cluster
biology - Developmental expression/transitions of Hb gene
cluster
(Review molecular aspects: DNA structure, Genes, The
genetic code, regulation of gene expression,
Transcription, Translation, Posttranslational
modification, gene mutations)
- Haplotypes in Sickle cell anemia
- Mendelian patterns of inheritance
(review)
• Population carrier screening
- Thalassaemia
- Sickle cell disease
• Genetic counseling
- Establishing the diagnosis
- Risk assessment
- Discussing the options
- Communication and support
- Special problems in genetic counseling
Consanguinity
Community & Family • Health, social and economic burden Sickle cell disease
Medicine • Screening for Sickle cell disease
• Premarital counseling of sickle cell
Patients
Pathology • Structure of haemoglobic
• Haemoglobinopathies
• Types of thalasaemias and pathogenesis
• Complication of sickle cell disease
• Blood components, indications of transfusion of packed
red cells and hazards of transfusions.
• Identification of the stages of maturation of marrow
erythroblasts.
• Identification of the following types of erythrocytes: (a)
Normocytic and normochromic cells (b) Microcytic and

125
 hypochromic cells (c) Macrocytes (d) Reticulocytes
• Identification of hypersegmented neutrophils.
• Hematocrit measurement of a blood sample.
• Calculation of the red cell indices (MCV, MCH and
MCHC). The hemoglobin value, hematocrit and RBC
Count.
• Calculation of corrected reticulocyte count and the
reticulocyte production index
• Red cell antigen systems: ABO and Rh.
• Pathogenesis, clinical features, diagnosis and
management of hemolytic disease of newborn due to Rh
incompatibility.
• Clinical associations, manifestations, diagnosis and
management** of autoimmune hemolytic anemia.
• Identification: a) sickle cells, b) nucleated RBC, c)
spherocytes in blood smears.
• Working principle of direct and indirect Coomb’s tests.
• Working principles of blood grouping and typing tests.

Clinical • Diagnosis of intravascular and extravascular hemolysis

• Approach to the patient with splenomegaly
• Hemolysis & mechanisms of immune injury
• Sickle cell disease & other hemoglobinopathies
• Genetic counseling of anemic patients

126
 Fatigue
Disease/Pathology Leukaemia

Anatomy • None

Biochemistry • Purine & pyrimidine metabolism: Key reactions, PRPP

and de novo and salvage synthesis; Thioredoxin and the
regulation of ribonucleotide reductase
• (Degradation of purine nucleotides: uric acid
formation)
Genetics & Molecular • Cellular/molecular biology of neoplastic cells
biology • Transformation, altered cell proliferation & cell
differentiation
• Oncogenes
• Tumor suppressor genes
Microbiology/Immunology • Infection in the immuno-compromised host Hospital
acquired infection antibiotic policy, disinfection and
sterilization Candida and related yeasts, Fungal
classification; infections with special focus on
Aspergillus, Penicillus, Histoplasma, Cryptococcus,
• Major antifungal agents
Physiology • Leukocytes – characteristics, genesis, life span, defense
properties, phagocytosis, reticuloendothelial system,
role in inflammation

Pharmacology • Antineoplastic drugs – mechanism of action and

toxicities
• Principles of treatment of leukemias (actute & chronic)
• Management of secondary hyperurecemia
Community & Family • Health, social and economic burden of HIV and AIDS
Medicine • Role and applications of Public Health:
• Screening for HIV
• Applications of the Iceberg Phenomenon and AIDS
• Ethical and cultural considerations
• Counseling HIV patients

127
Pathology • Myelopoiesis including the maturation sequence of
myeloid cells.
• Classification, epidemiology, cytogenetic and
molecular aspects, clinical features, diagnosis and
treatment principles of acute leukemia.
• Principles and applications of bone marrow
transplantation in acute leukemia.
• To learn the differential WBC count of blood films.
• Identification of blast cells in blood smears.
• Interpretation of blast lineage from results of
cytochemical staining and immunophenotyping.
• Bone marrow transplantation.
• Causes of lymphopenia
• Differentiate between T and B lymphocytes
• Remission criteria for acute leukemia and
consequences of chemotheraphy.
• Phagocytosis.
• Definition of neutropenia and causes.
• Causes and lab diagnosis of DIC.
• Pathogenesis, clinical features and diagnosis of chronic
granulomatous disease.
Clinical • Physiology of hemostasis
• Differential diagnosis of bleeding diathesis
• Laboratory diagnosis of bleeding disorders
• Bone marrow infiltration and aplastic anemia
• Workup of thrombocytopenia
• Acute leukemia: Diagnosis and management**
strategies

128
 Bleeding Tendency (1)
Disease/Pathology Hemophilia

Anatomy • None

Genetics & Molecular • Patterns of inheritance (special reference to X-linked

biology inheritance)
• Chronic thrombocytopenia
• Vitamin deficiency such as Vit. K
Microbiology/Immunolog • Immunopathological mechanisms of ITP.
y
Physiology • Hemostasis: vasoconstriction, platelet plug formation,
blood coagulation (Extrinsic and Intrinsic pathways) and
fibrous tissue formation.
• Intravascular anticoagulants.
• Fibrinolysis
Pharmacology • Vitamin K
Community & Family • Premarital counseling
Medicine
Pathology • Factors that interact to promote normal hemostasis.
• Blood coagulation factors and pathways contributing to
fibrin clot formation.
• Genetics, clinical features, diagnosis and management of
hemophilia and von Willebrand disease.
• Interpretation of laboratory tests for coagulation
disorders.

Clinical • Types
• Incidence and prevalence of hemophilia
• Clinical presentation in comparison to platelet problems
• Replacement therapy
• Quality of life

129
 Bleeding Tendency (2)
Disease/Pathology I,T Thrombocytopenic purpura

Anatomy • None

Microbiology/Immunolog • Structure and function of blood platelets

y • Role of platelets in hemostasis
• Functions of Vitamin K
• Bleeding time
Pharmacology • Principles of Rx of ITP

Community & Family

Medicine
Pathology • Factors that interact to promote normal hemostasis.
• Structure, production and function of platelets.
• Causes, clinical manifestations, diagnosis and
management of acute and chronic thrombocytopenia.
• Identification of platelets in blood smears.
• Identification of megakaryocytes in bone marrow
aspirate smears and biopsies.
• Interpretation of laboratory tests for coagulation
disorders.

Clinical • Approach to the patient with thrombocytopenia

• Clinical manifestations and management of idiopathic
thrombocytopenic purpura
• Drug-induced thrombocytopenia
• Platelet transfusion therapy
• Clinical use of thrombopoietin

130
 Bleeding Tendency (3) covered in several parts
Disease/Pathology Vitamins K Deficiency

Biochemistry • (Vit. K metabolism: Vitamin K types and sources;

mechanism of action in hemostasis)
Physiology • Mechanism of blood coagulation
• Functions of Vitamin K

Pharmacology • Oral anticoagulants

• Heparins, Anticoagulant therapy monitoring

Community Medicine • Health, social and economic burden of

Vitamin K deficiency
• Population at risk of vitamin k deficiency
• Nutritional assessment and management of vitamin k
deficiency
Pathology • Factors that interact to promote normal hemostasis.
• Interpretation of laboratory tests for coagulation
disorders.

Clinical • Relevance in neonatal period

• K-dependant factors and their use in treatment

*Liver cirrhosis

131
 Generalized Lymphadenopathy
Disease/ Lymphoma
Pathology
Anatomy • Development of the thymus and branchial arches.
• Histology of lymph node & thymus
• Lymph nodes of the neck
• General arrangement of the lymph nodes in the body.
• Anatomy of the triangles in the neck.
Physiology • Functions of lymphocytes: resistance of the body to
infection-immunity and allergy
Pharmacology • Antineoplastic drugs
Community & Family • Health, social and economic burden of lymphomas
Medicine
Pathology • Causes of lymph mode enlargement.
• Hematological changes in infectious mononucleosis and
methods of diagnosis.
• Indications of lymph node biopsy.
• Handling and processing of lymph node biopsy.
• Definition of lymphoma.
• Classification of lymphoma.
• Criteria for diagnosis and classification of Hodgkin’s
disease.
• Staging of Hodgkin’s disease.

Clinical • Causes of lymph mode enlargement. Differential dx and

management** --EBV FOR example
• Hematological changes in infectious mononucleosis and
methods of diagnosis.
• Indications of lymph node biopsy.
• Handling and processing of lymph node biopsy.
• Classification of lymphoma.
• Criteria for diagnosis and classification of Hodgkin’s
disease.
• Staging of Hodgkin’s disease.

132
 Cough
Disease/Pathology Pneumocystis Carinii Pneumonia, AIDS

Microbiology/ • HIV and related retroviruses. Biology of retroviruses,

Immunology multiplication cycle. Mechanisms of oncogenesis by RNA
viruses. Microbiological properties of clinical relevance,
identification protocol, mechanisms of pathogenesis,
epidemiology, transmission, antiviral resistance and
therapy/prophylaxis. Selection of specimens for
microbiological diagnosis. Molecular techniques for viral
detection. Viral Load.
• Infections in HIV patients with special focus on fungal
infections (Pneumocystis jiroveci, Aspergillus, Mold
infections) and viral (Cytomegalovirus, and other Herpes
viridae), antiviral agents. Immunological techniques for
antibodies detection. ELISA, WB, Control of the immune
response, cell cooperation in the immune response, the T
cell receptor.
• Immunodeficiencies.
• Role of CD4 and chemokine receptors in HIV infection
• Immunological changes in HIV infection.
Physiology • Innate and acquired immunity
• Humoral and cell mediated immunity
• Functions of T and B lymphocytes: resistance of the body
to infection-immunity and allergy
Pharmacology • Antiretoviraldrugs
• Principles of anti-HIV therapy - HAART
• Drugs for Pneumocystis infection.
Community & Family • Health, social and economic burden of HIV and AIDS
Medicine • Role and applications of Public Health:
• Screening for HIV
• Applications of the Iceberg Phenomenon and AIDS
• Ethical considerations
Clinical • Approach to the immuno-compromised patient with
fever
• Classifcation, clinical aspects and natural history of
of HIV-1 infection
• HIV-1 infection: outlines of diagnois and treatment
• Prophylactic anti-microbial therapy in the immuno-
compromised patient
• Clinical presentation and diagnosis of pneumocystis
carinii infection

133
 Fever of Unknown Origin
Disease/Pathology
Malaria,leukemia,lymphoma
Anatomy bacterial,viral,protozoal infection, connective tissue
disease, FMF., leukemia, lymphoma
Microbiology/Immunology • Plasmodium; Microbiological properties of medical
relevance, pathogenicity, epidemiology, antiparasitic
drugs and mechanism of resistance, malaria prophylaxis.
•
Physiology • Heat gain and heat loss
• Regulation of body temperature
• Pathophysiology of fever

Pharmacology • Ureidopenicillins (delete)

• Antimalarial drugs – classification and ADR.
• Principles of treatment / prophylaxis of malaria
Community & Family • Health hazards during international travel
Medicine • Health related advice for travelers
• Epidemiology, prevention and control of malaria
Pathology • Monocyte phagocytic system
• Causes of splenomegaly
• Pathological changes of malaria
• Pathological features of severe malaria including cerebral
malaria
• Renal complications of malaria
• Pathological changes of malaria with special reference to
the monocyte phagocytic system, the brain, the kidney,
spleen

Clinical • Pathogenesis, clinical features and diagnosis of

Malaria,FMF
• Natural protection against malaria
• Prevention and treatment of malaria
• The anticipated malarial vaccine
• MANAGEMENT**

134
INTEGUMENTARY &
MUSCULO-SKELETAL
SYSTEMS

135
 Burns
Disease/Pathology Burns(Thermal, electrical, chemical)

Anatomy • Histology and development of the skin

• Histology of connective tissue

Biochemistry • Connective tissue proteins: outline synthesis of collagen

and elastin

Microbiology/Immunolog • Agents of infections in burns

y
Physiology • Functions of normal skin e.g. thermoregulation, protection,
sensory, immunological.
• Body fluid compartments
• Plasma proteins
• Somatic pain
Pharmacology • Topical antiinfectives (Silver sulphadiazine, neomycin,
polymyxin, bacitracin, fusidic acid).
Community & Family • Safety in the household and at work
Medicine
Pathology • Classification and types of burns
• Healing of wounds and list its complications
• Complications of burns

Clinical MANAGEMENT

136
 Abscess
Disease/Pathology Abscess

Biochemistry • (Mitochondrial respiration and thermogenesis), futile cycles

Microbiology/Immunol • Agents of sepsis. Sepsis in various ages and in various
ogy clinical setting with a description of major pathogens
involved Focus on Staphylococci and Gram-negative
organisms.
• Proper procedure to collect blood culture.
• Prosthetic devices - associated sepsis.

Physiology • Regulation of body temperature – mechanism of fever

Pharmacology • Monobactams

Pathology • Abcess description

Clinical management

137
 Chronic Skin Ulcer
Disease/Pathology Cutaneous Leishmaniasis,skin tumor (refer to skin
malignancy)
Anatomy • Histology of skin appendages (hair, nails, glands)
• Refer to Burns

Microbiology/ • Bacterial, viral and fungal infection (special focus on

Immunology dermatophytes) of the skin. Skin manifestations in
systemic infection
• Skin rashes in childhood with special focus on scarlet
fever, rubella, measles, parvovirus B19.
• Leishmania, description and classification of the
pathogen, major microbiological properties of medical
interest. . Anti-Leishmania drugs. Microbiological
procedures for laboratory diagnosis of the infection Other
mosquito and vector borne pathogens with special focus
on yellow fever, Rift valley fever, West Nile fever,
CCHF, dengue
• The immune response in parasitic infections. Role of
Th1/Th2 in the immune response against Leishmania.

Pharmacology • Antiinfectives (b-lactamase-

resistant penicillins)
• Drug treatment of Leishmaniasis (cutaneous, visceral &
mucocutaneous)
Community & Family • Epidemiology of Leishmaniasis
Medicine
Pathology • Causes of chronic skin ulcer
• Pathological features of cutaneous leishmaniasis
• Major clinicopathological presentations of leishmaniasis

Clinical Management

138
 Skin Rash
Disease/Pathology Atopic Dermatitis

Anatomy • Refer to Burns

Pharmacology • Antihistamines (H1 blockers) – Classification, kinetics and ADR

• Topical antimicrobials
• Antiseptics / Disinfectants
• Antiprotozoal drugs
• Drugs for UV-protection
and depigmenting agents
Sunscreens
Community & Family • Parental counseling on coping with atopic dermatitis
Medicine
Pathology • description
Clinical • Typical clinical presentation
• Natural course
• Optimal management**
• Association with systemic disease

139
 Skin pigmentation
Disease/Pathology Skin malignancy

Anatomy Refer to Burns

• Development and ultrastructure of melanocytes

Biochemistry • Melanin synthesis and MSH

Pharmacology • Transdermal absorption of drugs

Community & Family • Epidemiology of skin cancer

Medicine • Population at risk of skin cancer

Pathology • Skin cancer types and stages

Clinical Management

140
 Weakness
Disease/Pathology Myasthenia Gravis ,myositis

Anatomy • Histology of skeletal muscle (differences between skeletal,

smooth and cardiac muscles)

Biochemistry • High energy phosphates in muscle contraction: ATP and

Creatine Phosphate turnover

Physiology • Neuromuscular transmission

• Excitation contraction coupling
• Molecular mechanisms of muscle contraction
• Electromyography (EMG): principles, abnormalities in
myopathy and neuropathy
Pharmacology • Parasympathomimetics
• Cholinesterase inhibitors
• Edrophonium test – cholinergic vs. myasthenia crisis.

Clinical • Pathogenesis, clinical features and diagnosis of neuro-

muscular junction disease
• Respiratory considerations in myasthenia gravis
• Treatment of myositis and myasthenia
gravis(management**)

141
 Multiple Painful Swollen Joints (1)
Disease/Pathology Rheumatoid Arthritis

Anatomy • Synovial joints

• Joints of the hand
• Muscles, tendons and joints of the hand
• Imaging of the hands

Biochemistry • Eicosanoid metabolism: Outline synthesis from membrane

polyunsaturated fatty acids; phospholipases,
cyclooxygenases and peroxidase
Genetics & Molecular •
biology
Microbiology/Immuno • Immunopathogenesis of RA. Role of CD4+ T lymphocytes
logy and cytokines in the inflammatory response and bone
erosion. Diagnosis of RA
Physiology • Capillary fluid dynamics
• Exudate and transudate

Pharmacology • Drugs for rheumatoid arthritis

(immunosuppressants), DMARDs
• Principles of treatment of rheumatoid arthritis
Community & Family • Coping and rehabilitation with Rheumatoid arthritis
Medicine • Risk factors of Rheumatoid arthritis
Pathology • Pathological changes of the joint in Rheumatoid arthritis

Clinical • Differential diagnosis of polyarthritis and (management**)

• Diagnosis of rheumatoid arthritis
• Systemic and non-articular manifestations of rheumatoid A.
• Assessment of activity of rheumatoid arthritis
• Disease outcome and functional capacity in rheumatoid
arthritis

142
 Multiple Painful Swollen Joints (2)
Disease/Pathology Systemic Lupus Erythematosis (SLE)

Anatomy • Refer to Burns (connective tissues)

Biochemistry • (Eicosanoid metabolism: Outline synthesis from membrane

polyunsaturated fatty acids; phospholipases,
cyclooxygenases and peroxidase)
Microbiology/Immun • Immunopathological mechanisms in SLE.
ology Immunodiagnosis of SLE (anti dsDNA antibodies and
nuclear staining). Association of autoimmune diseases and
the Role of HLA antigens
Pharmacology • Immunosuppressants
• Principles of long-term corticosteroid therapy.

Community & Family • Coping with SLE on the individual and family
Medicine
Pathology • Pathological changes of SLE

Clinical • Clinical manifestations of SLE in adults

• Mechanisms of auto-immunity
• Anti-nuclear antibodies
• Diagnosis of SLE
• Systemic & non-articular manifestations of SLE
• Pregnancy in patients with SLE
• Treatment strategies of SLE.

143
 Joint Pain in Adults(1)
Disease/Pathology
Osteoarthrois,septic arthritis
Anatomy • Structure of knees joints, hip joints and spine
• Imaging of joints
• Muscles acting at knee, hip and spine
• Movements at knee, hip and spine

Physiology • Biomechanics of joints

Pharmacology • NSAIDs – classification, mechanism of action and ADR

(including issues related to upper GI ADR, prevention and
management; drug withdrawal of COX-2 inhibitors,
pharmacovigilance and ADR).
• Intraacrticular steroid therapy
• Local anaesthetics
Community & Family • Epidemiology of Osteoarthrois
Medicine • Risk factors of Osteoarthrois
• Rehabilitation
• Health consequences on\family and community
• Economic Burden
Pathology • Description

Clinical • Classification of osteoarthritis

• Risk factors and clinical manifestations of osteoarthritis
• Non-pharmacological therapy of osteoarthritis
• Role of physiotherapy in modern medicine
• Management of septic arthritis

144
 Joint Pain in Children
Disease/Pathology Rheumatic Fever, , transient synovitis(reactive
arthritis),septic arthritis,Perthe disease(AVN)
Anatomy
• Structure of the shoulder, elbow and ankle joints
• Muscles, movement and innervations
• Imaging of shoulder, elbow and ankle

Microbiology/Immunology • Group A streptococci

• Immunopathological mechanism in rheumatic fever
Pharmacology • Antiinfectives
• Depot preparations of penicillins (prolongation of
drug effect).
Community & Family • Compliance with medication
Medicine • Burden of child sickness on family
• Risk Factors of Rheumatic Fever
• Prevention of Rheumatic Fever and its complications
Clinical • Joints modified criteria for diagnosis
• A typical presentation
• Association with tonsillopharyngitis
• Response to treatment
• Prevention of recurrence of complications
• Clinical features ,risk factors and management of ,
transient synovitis(reactive arthritis),septic
arthritis,Perthe disease(AVN)

SEE CARDIOVASCULAR SYSTEM

145
 Joint Pain in Adults(2)
Disease/Pathology Gout

Anatomy • Small joints and movement of the foot

• Arches of the foot
• Imaging of the foot

Biochemistry • (Uric acid metabolism: Purine catabolism; HPRT and

APRT in Salvage synthesis)
Genetics & Molecular •
biology
Microbiology/Immunology
Physiology • Renal handling of uric acid

Pharmacology • Drug-induced hyperurecemia

• Uricosuric drugs
• Treatment ofgout- acute / chronic
Community & Family • Risk factors of gout
Medicine • Nutritional management of gout
Pathology • Causes of knee swelling
• Pathological changes of the joint in osteoarthritis:
comparison with rheumatoid arthritis
• Classification of bone tumors
• Pathological features of the major types of bone
tumors
• Pathological changes of acute and chronic gout
• Renal complications of gout

Clinical • Crystal induced arthropathy: differential diagnosis

• Clinical manifestations and diagnosis of gout
• Management of asymptomatic hyperurecemia
• Long term complications of gout, tophaceous gout
• Treatment of gout(management**)

146
 Extremity Pain
Disease/Pathology Bone Tumors

Anatomy • Histology of bone and cartilage

• Ossification

Biochemistry • Alkaline phosphatase isoenzymes: sources functions

and use as tumor markers.
Pharmacology •
Community & Family • Health, social and economic burden of bone cancer
Medicine • Coping with cancer
Pathology • Classification of bone tumors
• Pathological features of the major types of bone
tumors

Clinical • Diagnostic facilities

• Modalities of therapy based on types and
response(management**)

147
 Back Pain (1)
Disease/Pathology Vertebral compression fracture secondary to osteoporosis

Anatomy • Histology of bones

• Refer to Back Pain (disc protrusions)
•

Biochemistry • Calcium metabolism: Vit. D, PTH and calcitonin;

bone remodeling
• Markers of bone resorption and formation
Physiology • Effects of hormones on bone homeostasis (estrogen,
parathormone, calcitonin, vitamin D).

Pharmacology • Drugs for osteoporosis

• Hormone replacement therapy

Community & Family • Life course approach to the epidemiology of

Medicine osteoporosis
• Lifestyle related health problems- Osteoporosis
• Health Promotion
• Lifestyle modification
• Primary and secondary prevention of osteoporosis
Pathology • Complications of fractures
• Pathogenesis and pathophysiology of osteoporosis
• Steps in the healing of bone fracture

Clinical (management**)

148
 Back Pain (2)
Disease/Pathology Disc Protrusion, ,tumer.(refer to bone tumor),Ankylosing
spondylitis.
Anatomy • Structure of vertebral column
• Inter-vertebral joints & disc
• Muscles of the spine
• Spinal curvatures and development
• Imaging of the spine
• Transmission of body weight; posture
• Spinal nerves, plexuses (brachial and lumbo-sacral) and
dermatome
Microbiology/Immunology • Plasma cell malignancy.
• Molecular mechanisms of generation of antibody diversity,
Monoclonal gammopathy
Pharmacology • NSAIDs (ADR)
• Principles of chronic pain management.
Community & Family • Health, social and economic burden of back pain
Medicine • Risk factors of back ache
• Occupational Health: Safety, prevention and Ergonometrics
• Coping with chronic illness
• Measures of physical disability
• Back Hygiene
Clinical • History and physical exam finding that permits a focused
evaluation of back pain.
• Key manifestations of various back pain syndromes.
• Radicular pain symptoms (herniated disc) and correlated
neurologic findings with neuroanatomic level of disease.
• Differential diagnosis, initial evaluation and treatment strategies
for herniated disc, spondylosis / spondylolisthesis and scoliosis
• Primary & metastatic tumors of the spine
• Traumatic (musculoskeletal strain, vertebral
fractures/dislocation ± cord injury)
• Retroperitoneal sources of back pain (aortic aneurysm, GU
sources, pancreatic disease).
• Diagnostic studies available for evaluation of back and leg pain.
Include spine radiographs, CT scan, MRI, bone scan,
myelography, angiography.
• Indications for surgical consultation and treatment in problems
addressed above.
• Potential complication of surgery on the spine as well as unique
concerns for perioperative management and rehabilitation /
recovery.

149
 Swollen leg and fever
Disease/Pathology Osteomyelitis. Cellulitis

Anatomy • Refer to Extremity Pain (2) and Bone Fracture (1)

Microbiology/Immunology • Major infectious causes of osteomyelitis.

• Causes of osteomyelitis in SCD. Staphylococci,
Neisseria, Salmonella.
• Laboratory interpretation of synovial fluid
biochemical features.
• Microbiological properties of clinical relevance,
identification protocol, mechanisms of pathogenesis,
epidemiology, transmission, antibiotic resistance and
therapy/prophylaxis.
• Selection of specimens for microbiological diagnosis
Physiology • Bone turnover in health and in osteolytic tumors
• Pathological changes of osteomyelitis

Pharmacology • Principles of treatment of bone and joint

infections(management**)
Community & Family • Preventive measures in high risk groups eg SCD
Medicine
Pathology • Complications of fractures
• Steps in the healing of bone fracture
• Cellulitis

Clinical management

150
 Bone Fractures
Disease/Pathology Fracture femur

Anatomy • Anatomy of the femur

HSF YR 1
• Ossification in bones
• Blood supply of bones

Physiology • Nerve degeneration and regeneration

Community & Family • Safety measures in high risk groups

Medicine
Pathology • Complications of fractures
• Steps in the healing of bone fracture
• Types of nerve injury
• Various types of nerve regeneration
• The pathology of avascular necrosis

Clinical management

151
 Crush Injuries
Disease/Pathology Rhabdomyolysis ,compartment syndrome

Clinical Clinical features

management

152
NERVOUS SYSTEM
&
HUMAN BEHAVIOR

153
 Tingling and Numbness*
Disease/Pathology Peripheral neuropathy secondary to type II Diabetes,
B12
Anatomy • Histology of a peripheral nerve
• Blood supply of peripheral nerves
• Spinal nerves : plexuses (cervical, brachial,
lumbo-sacral)

Biochemistry • (Insulin signalling)

• (Glycation & HbA1c)
• The Polyol pathway: glucose-sorbitol-fructose
interconversions
Physiology • Central and peripheral nervous system
complications of DM.
• Somatosensory receptors (Types, mechanism of
action, function)
• Somatosensory system (Anterolateral and dorsal
column pathways): tactile and position senses, Pain
and thermal sensations.
• Somatosensory cortex: structure and function
Primary and somatosensory association areas.
• Interpretation of sensory stimulus intensity and
stimulus localization.
Pharmacology • Insulin preparations
• Oral antidiabetic drugs
• Principles of treatment of Type 1& type 2 diabetes
• Drugs for erectile dysfunction
Community & Family • Diabetes as a public health
Medicine problem(management**)
• Importance of patient’s and the family’s education
and counseling in complying with anti-diabetic
medication
• Screening for diabetes and managing patient at risk
of**
• Coping with chronic illness
• Prevention of diabetes complications

Pathology • Complications of diabetes

• Features of peripheral neuropathy
• Features of diabetic nephropathy
Clinical • Sensory map of the body

154
 • Causes and diagnosis of common entrapment
neuropathies(management**)
• Measurement of nerve conduction velocity
• Clinical features of mono-neuropathy Vs.
peripheral neuropathy
• clinical features and management of carpal tunnel
syndrome
• Types of injuries to peripheral nerves and their
healing.

* See diabetes

155
 Headache (1)
Disease/Pathology Migraine , cluster and tension headache

Anatomy • Innervation of face and scalp

• Relations, processes and innervation of drua
• Vth & Xth Cranial nerves; Cervical spinal nerves

Physiology • Physiology of pain (pain receptors, pathways, central

& peripheral mechanisms)
Types of pain: Fast and slow pain.

• Endogenous analgesia system.

• Pain sensitive areas in the head
Headache of Intracranial origin.
Headache of extracranial origin.

Pharmacology • Anti-migraine drugs

• Analgesics

Community & Family • Health, social and economic burden of headache

Medicine • Population at risk and risk factors of headache.
• Diet and migraine
• Stress management
• Family support to migraine sufferers

Clinical (management**)

156
 Headache (2)
Disease/Pathology Brain Tumor, psuedotumor cerebri,,
Sub- arachnoid hemorrhage
Anatomy • Gross anatomy of cerebral hemispheres : (Lobes,
fissures, gyri and sulci)
• white matter and basal nuclei)
• Imaging of the skull and brain (normal)
• Blood supply

Physiology • Functions of brain lobes

• Functions of the temporal, parietal and occipital
lobes.

Pathology • Brain Tumors types and grades

Community & Family • Breaking bad news

Medicine

Clinical
Clinical features
(management**)

157
 Stiff Neck
Disease/ Meningitis
Pathology

Anatomy • Cerebral venous sinuses, arachnoid granulations

• Formation and circulation of CSF : ventricles &
subarachnoid space
• Meninges {Dura, Arachnoid and Pia mater}
• Imaging of the skull and brain
Microbiology/ • Bacterial, viral and fungal agents of meningo-encephalitis.
Immunology Neisseria meningitidis, Haemophilus influenzae, Group B
streptococcus, M. tuberculosis.
• Enteroviruses with special attention to coxsackie and
poliovirus, Post vaccination encephalitis, Rabies encephalitis.
Cryptococcus neoformans, Herpes simplex. Rarer causes of
CNS involvements protozoa and worms.
• Microbiological analysis of CSF. Physicochemical and
cellular features suggestive of infection.
• Microbiological properties of clinical relevance, mechanisms
of pathogenesis, epidemiology, transmission, antibiotic
resistance and therapy/prophylaxis
Physiology • Cerebrospinal fluid :
- Chemical composition of CSF.
- Formation, circulation and drainage of CSF.
- Communicating and non-communicating hydrocephalus
• Intacranial pressure
• Blood Brain Barrier, Blood-CSF and Brain-CSF barriers

Pharmacology • Anti-infectives
• Blood-brain barrier
Community & Family • Health, social and economic burden of meningitis
Medicine • Epidemiology of meningococcal meningitis
• Immunizations and prophylaxis of population at risk
• Role and applications of Public Health
• Public Rights to health information
• Outbreak investigation
Pathology • Pathological classification of meningitis
• Pathological features of acute suppurative (bacterial)
meningitis, viral meningitis, and tuberculous meningitis
• Major infectious causes of non-bacterial, non-viral meningitis
• Interpretation of CSF findings in the various types of
meningitis

158
Clinical • Clinical features of meningial irritation
• CNS infections in adults
• Lumbar puncture: diagnostic value, indications and limitations
• Bacterial meningitis: preventive aspects
• Anti-microbial therapy of bacterial
meningitis(management**)

159
 Memory Loss
Disease/Pathology Alzheimer’s disease (Dementia)

Anatomy • Refer to Headache (2)

• Histology of the cerebral cortex
• Projection, association and commissural fibers
• Components and connections of the limbic system

Biochemistry • Protein misfolding: Amyloid Precursor Protein, Prion disease

Genetics & Molecular • Genetics of Alzheimer’s disease

biology
Microbiology/Immunology • Prions: Microbiological properties of clinical relevance,
mechanisms of pathogenesis, epidemiology, transmission.
Physiology • Higher cortical functions:
- Functions of specific cortical areas.
- Association areas of the cortex.
- Concept of dominant hemisphere.
• Neurochemical basis of learning and memory
- Long synaptic facilitation and inhibition.
- Short term and long term memories.
- Consolidation of memory.
• Synaptic transmission and neurotransmitters.
- Physiology of synapses.
- Types of synapses.
- Excitatory and inhibitory post synaptic potentials.
Pharmacology • Anti-dementia drugs
• Principles of drug use in elderly
Community & Family • Health, social and economic burden of degenerative CNS
Medicine diseases
• Population at risk of Degenerative CNS diseases
• Burden of illness on the care-givers
• Early detection
Pathology • Common causes of dementia
• Pathological features of Alzheimer’s disease
Clinical (management**)
Manage falls in older patient
Manage older patient with medication **

160
 VERTIGO

Disease/Pathology Meniere’s disease, benign paroxysmal positional

vertigo(bppv),labrynthitis

Anatomy • Gross anatomy Structure and relations of the

external, middle and inner ear
• Histology of the Inner Ear
• VII and VIIIth cranial nerves
• Imaging of the ear

Physiology • Function of the vestibular system (Semicircular

canals, utricle and saccule)
• Maintenance of balance and equilibrium
• Medial motor system (Vestibulospinal and
reticulospinal tracts)
Pharmacology • Drugs for Meniere’s disease
•
Community & Family • Coping with Meniere’s disease, benign paroxysmal
Medicine positional vertigo(bppv),labrynthitis
• Safety implications

Clinical (management**)

161
 Dizziness

Disease/Pathology Cerebellar (Tumors).

Anatomy • Gross anatomy of the cerebellum

• Connections of the cerebellum
• Histology of the cerebellar cortex
• Refer to imaging of the brain in Headache (2)
•

Physiology • The role of cerebellum in motor function

• Functional divisions of cerebellum
• Functional unit of the cerebellum

Clinical • Causes and clinical manifestations of cerebellar

disease
• Gait disorders and differential diagnosis of ataxia
• Dysarthria Vs dysphonia
• Ataxic hemiparesis as a manifestation of lacunar
infarcts
• Friedreich ataxia

162
 Unsteady Gait
Disease/Pathology Cerebellar Tumors

Anatomy • Parts and nuclei of the cerebellum

• Connections of the cerebellum
• Histology of the cerebellar cortex

Physiology • Afferents and efferents of the cerebellum

• Functional divisions of cerebellum
- Neuronal circuits of the cerebellum.
- Functional unit of the cerebellum
• The role of cerebellum in motor function
Clinical abnormalities of the cerebellum.

Clinical • Causes and clinical manifestations of cerebellar disease

• Gait disorders and differential diagnosis of ataxia
• Dysarthria Vs dysphonia
• Ataxic hemiparesis as a manifestation of lacunar infarcts
• Friedreich ataxia

163
 Hearing Loss
Disease/Pathology Cholesteatoma and mastoiditis . Otosclerosis.otitis media,
cerumen impaction
Anatomy • Refer to VERTIGO
• Structure and relations of the middle ear

Microbiology/Immunology • Agents of otitis media Haemophilus influenzae,

Moraxella catharralis, adenoviruses, anaerobic bacteria
of the oral cavity Microbiological properties of clinical
relevance, mechanisms of pathogenesis, epidemiology,
transmission, antibiotic resistance and
therapy/prophylaxis
Physiology • Physiology of hearing
- Functions of the external, middle and inner ear
- Determination of sound frequency and intensity,
sound localization
- Cochlear hair cells
- Central auditory pathway
• Deafness and audiometry

Pharmacology • Antiinfectives (penicillins)

• b-lactamase inhibitors)
• Ototoxicity of drugs
• Neomycin / Bacitracin
Community & Family • Antiinfectives (penicillins)
Medicine • b-lactamase inhibitors)
• Ototoxicity of drugs
• Neomycin / Bacitracin

Pathology • Pathogenesis and pathological features of otitis media

• Pathogenesis and histological features of cholesteatoma
Clinical (management**)

164
 Convulsions
Disease/Pathology Epilepsy, head injury,tumor,infection(meningitis ,encephalitis)
,electrolyte imbalance
Anatomy • Refer to Headache (2)
• Functional areas of the cerebrum

Genetics & Molecular • Genetics of epilepsy

biology • Angelman syndrome (genomic imprinting/uniparental disomy)
•
Physiology • Transmission and processing of neuronal signals
• EEG waves and their genesis
- Origin of the brain waves.
- EEG waves in generalized and focal epilepsies.
• Functions of thalamus
- Sensory nuclei and sensory functions
- Motor nuclei and functions
- Non specific nuclei and functions
Pharmacology • Anti-epileptic drugs
• Principles of treatment of seizure disorders
• Therapeutic drug monitoring
Community & Family • Epidemiology of epilepsy
Medicine • Social adjustment: employment of
Epileptics and schooling
• Advise to epileptic patients
• Educate and advise to epileptic patients and families
• Ethical issues: Breaking confidentiality

Clinical • Classification and differential diagnosis of epilepsy

• Evaluation of the first seizure
• Management of epilepsy
• Approach to the patient with status epilepticus

165
 Headache (3) *
Disease/Pathology Subdural hematoma

Anatomy • Dura and extradural blood vessels

• Types of intracranial hemorrhages
• Imaging of the skull & brain
• Parasympathetic functions of the cranial nerves and
correlation with clinical signs
• Refer to "Loss of Consciousness"

Physiology • Function of the meninges

•

Community & Family • Public health approach to injuries

Medicine • Health, social and economic burden of injuries
• Population at risk of injuries
• Prevention and control of injuries.
• Epidemiology of occupational injuries
• Occupational health: Safety at work
Clinical

*Is this the usual way subdural haematoma presents?

166
 Loss of Consciousness
Disease/Pathology Intracranial Hemorrhage, ,injury

Anatomy • Arterial supply to the cerebral hemispheres

• Normal cerebral angiograms
• Normal carotid and vertebral angiograms
• Brainstem : External features and internal organization
• Imaging : Refer to Headache (2)
•

Physiology • Cerebral blood flow regulation.

• Physiology of consciousness
- Role of the thalamus in brain activation.
- Levels of consciousness and causes of coma.
• Function of reticular activating system.
Pharmacology • Osmotic diuretics
• Mannitol and intracranial pressure

Pathology • Different types of intracranial hemorrhage

• Pathogenesis and clinicopathological features of each type
of intracranial hemorrhage
Clinical • Risk factors for intracranial hemorrhage
• Subarachnoid hemorrhage
• Atherosclerosis of cerebral vessels and its consequences
• Stroke: pathogenesis, outcomes and differential diagnosis
• Speech disorders
• Management of stroke

167
 Paraplegia
Disease/Pathology Spinal cord damage

Anatomy • Ext. and int. structure of the spinal cord

• Tracts and connections of the spinal cord
• Blood supply of the spinal cord
• Imaging of the spinal cord
Physiology • Functions of the spinal cord
- Spinal cord nuclei (grey) and tracts (white matter).
• Spinal cord reflexes.
- Neuronal pool and circuits
- Monosynaptic reflexes.
- Flexor reflex and withdrawal reflexes.
• Control of muscle tone
- Receptor functions of the muscle spindles.
- Muscle stretch reflex.
• Control of posture and locomotion
- Role of muscle spindles in voluntary motor activity.
- Reflexes of posture and locomotion

Pharmacology •
Community & Family • Epidemiology of road traffic accidents
Medicine • Health, social and economic burden of road traffic
accidents
• Prevention and control of diseases and conditions resulting
from road traffic injuries
• Burden on caregivers
Pathology •

Clinical • Causes and differential diagnosis of non-traumatic

paraplegia
• Dermatomes and myotomes of the lower limbs
• Arcs of deep and superficial reflexes
• Clinical features of upper Vs lower motor neuron lesions

168
 Tremors
Disease/Pathology Parkinsonism,cerebellar pathology

Anatomy • Gross anatomy of Basal nuclei and extra pyramidal system

•

Genetics & Molecular • Genetics of Parkinson’s disease

biology

Physiology • Neuronal circuitry of the basal nuclei.

• Function of the basal nuclei
• Neurotransmitters in the basal nuclei
• Role of the basal nuclei in motor control
• Clinical syndrome resulting from basal nuclei damage.
• Pyramidal and extra pyramidal motor systems

Pharmacology • Anti-Parkinsonian drugs

Community & Family • Burden on individual and caregivers
Medicine
Pathology • Pathological changes in the basal ganglia and cortex in
Parkinson’s disease
Clinical • Bradykinetic movement disorders
• Differential diagnosis of tremors
• Pathogenesis and diagnosis of Parkinson’s disease
• Pharmacologic and non-pharmacologic treatment of
Parkinson’s disease

169
 Hemiplegia
Disease/Pathology stroke

Anatomy • Anatomy of the cerebral circulation

• Arterial supply to the basal nuclei and internal capsule

Physiology • Cortical and brain stem control of movements

- Brain stem centers for motor control.
- Cranial nerves nuclei in the brain stem.
- Corticospinal tracts
• Mechanisms of speech
- Functions of the corpus callosum.
- Types of Aphasia.
• Cerebral blood flow and its regulation
Pharmacology • Antithrombotic drugs
Community & Family • Health Services and organizations:
Medicine Rehabilitation
• Risk factors of Cerebrovascular Accidents
• Burden of CVA on individual and
Caregivers
Pathology • Risk factors for stroke
• Pathology of cerebral hemorrhage and cerebral
infarction
Clinical • Outcomes of atherosclerosis of cerebral vessels
• Stroke: pathogenesis and differential diagnosis
• Speech disorders
• Management of stroke

170
 Red Eye (1)
Disease/Pathology Glaucoma

Anatomy • Gross anatomy and histology of the eye.

Blood supply of the eye
• Orbit and its content

Physiology • Optics of the eye

- Formation of the image
- Focal length and types of lenses.
- Mechanism of Accommodation.
- Errors of refraction.
• Formation and absorption of the aqueous humor.
• Intra-ocular pressure and Glaucoma
• Autonomic control of pupillary diameter
• Pupillary light reflex

Pharmacology
• Drugs and intra-ocular pressure (IOP)
• Mydriatics & miotics

Community & Family • Epidemiology of glaucoma

Medicine • Screening for glaucoma
• Prevention of complications
Clinical • Causes of red eye
• (management**)

171
 Red Eye (2)
Disease/Pathology Conjunctivitis, ,

Anatomy • Refer to Red Eye (1)

Biochemistry • Vitamin A metabolism: Sources, absorption, transport

and storage; Role in mucus membranes and vision
Microbiology/Immunology • Viral and Bacterial causes of conjunctivitis

Physiology • Optics of the eye, accommodation intra ocular

pressure
• Formation and absorption of the aqueous humor
•

Pharmacology • Antiinfectives (topical including chloramphenicol,

neomycin, sodium fusidate & tetracyclines)
• Antihistamines
• Leukotriene antagonists
• Vasoconstrictors
Community & Family • Eye hygiene
Medicine • Disease Transmission

Clinical (management**)

172
 Blurring of Vision
Disease/Pathology Cataract, glaucoma,trauma.,third nerve palsy

Anatomy • Refer to Red Eye (1)

Cranial nerves

Biochemistry • (Polyol pathway)

• Galactose metabolism and galactosemia
• Vit. E, selenium and free radical metabolism

Physiology • Accommodation reflex

• Visual acuity

Pharmacology • Ocular toxicity of drugs

Community & Family • Epidemiology of cataract
Medicine • Prevention of cataract
• Population at risk of cataract
Clinical (management**)

173
 Visual Impairment
Disease/Pathology Retinal Detachment, cataract,CVA

Anatomy • Histology of the retina

• Development of eye
• Visual pathway and lesions

Physiology • The functional elements of the retina.

• Photochemistry of vision.
• Photochemistry of cones and color vision.
• Retinal sensitivity: Light and dark adaptation.
• Ganglion cells types and function.
• Neural function of the retina.
• Color blindness.
• Visual fields and perimetry.

(management**)
Clinical

174
 Crossed eyes
Disease/Pathology Congenital and Acquired Squint

Anatomy • Actions and innervation of extraocular muscles

• Imaging of the orbit

Physiology • Control of eye movement.

- Fixation movements of the eye.
- Fusion of visual images from the two eyes.
• Binocular vision and perception of depth.
• The vestibule-ocular reflex.
• Central visual pathways
• Cortical analysis of visual information
• Visual pathways lesions and blindness.

Community & Family • Child Screening

Medicine
Clinical Management

175
 Insomnia
Disease/Pathology Late---Depression
Early—mania
Anatomy • Refer to "Memory Loss"
• Reticular formation – Refer to brainstem in "Loss
of Consciousness"

Physiology • EEG waves of wakefulness and sleep.

• Mechanisms of sleep & wakefulness.
• Sleep stages.
• REM sleep and dreams
• Sleep disorders.
Pharmacology • Antidepressant drugs
• Principles of treatment of depression
• Iatrogenic depression
Community & Family • Epidemiology of depression
Medicine • Health, social and economic burden of depression
• Sleep Hygiene
Clinical (management**)

176
 Mood disorders
Disease/Pathology Bipolar Disorder,depression,,hypomania

Anatomy • Refer to "Memory Loss"

Physiology • The role of the limbic system in behavior control.
• Emotions and the role of Amygdala.
• Limbic system lesions.

Pharmacology • Anti-depressant drugs – classification: TCAs, SSRIs,

MAO-inhibitors; mechanism of action and ADR.
• Principles of treatment of affective disorders.
Mood stabilizers (Lithium, Valproate,
Carbamazepine)

Clinical (management**)

177
 Hallucinations
Disease/Pathology Schizophrenia, , organic causes fever,drugs,alcohol,tumor

Anatomy • Refer to "Memory Loss"

Physiology • Dopamine system of the brain.

• Limbic system and human behavior
• Reward and punishment centers.
• Function of the prefrontal lobe
• Neurotransmitters abnormalities in schizophrenia.
Pharmacology • Antipsychotic drugs (typical, atypical- mechanism of
action and ADR)
• Mood stabilizers
Community & Family • Epidemiology of schizophrenia
Medicine • Mental Health Community Services
Clinical Management

178
 Panic and Anxiety
Disease/Pathology Phobias

Anatomy • Refer to "Memory Loss"

Biochemistry • Catecholamine metabolism: synthesis and degradation
Physiology • The autonomic nervous system.
• Neurotrasmitters in sympathetic and parasympathetic
systems.
• The hypothalamic role in control of behavior

Pharmacology • Anti-anxiety drugs

• Anti-depressant drugs
Community & Family • Counseling
Medicine • Relaxation techniques
• Avoidance of drug dependence

Clinical (management**)

179
 Adult abuse
Disease/Pathology Domestic Violence,neglect

Community & Family • Prevention of spouse abuse

Medicine • Human Rights
• Abuse of house help and labourers

Clinical (management**)

Conducting the well adult or well-woman visit**

Conducting the well –chid and newborn visit** Week2 YR 2
Managing child who is victim of abuse**
Managing the dying patient**

180
 Violence Week5 YR 2

Disease/Pathology Cocaine abuse

Physiology • Higher control of the prefrontal lobe on behavior.

• Effects of frontal lobectomy.

Pharmacology • Substance abuse (classification: stimulants and

hallucinogens and depressants)
• Drugs and crime – forensic aspects

Clinical (management**)

181
 Personality disorders
Disease/Pathology

Anatomy • Refer to "Memory Loss"

Physiology • The general interpretative area of the brain.
• The intraneural mechanisms, and second messenger system.
• Neurotransmitters and receptors.

182
 Substance abuse Week5 YR 2

Disease/Pathology

Anatomy • Refer to "Memory Loss"

Physiology • Function of the limbic system (Reward and

Punishment centers)
• The ventral tegmental area and nucleos accumbens
role in drug dependence.
• Dopamine system and addiction.
• Endogenous analgesia system

Pharmacology • Opioid analgesics

• Drug dependence

Community & Family • Prevention

Medicine • Youth health
• Health promotion

Clinical (management**)

183
 Mental Retardation
Disease/Pathology Down syndrome WEEK3 YR2

Anatomy • Development and anomalies of the CNS

Physiology • Development and maturation of the brain.
• Neural degeneration and regeneration.
• Neural and synaptic plasticity.

Community & Family • Role of NGOs

Medicine • Counseling of parents
• Antenatal screening
• Integration in society

Clinical • Clinical features

• Definitive diagnosis
• Maternal age and Down Syndrome
• Optimal care
• Ethical considerations
• Managing child with growth and developmental
problem **

184
 Behavioral Disorder in a Child
Disease/Pathology Attention Deficient Hyperkinetic Disorder

Community & Family Counseling of parents

Medicine
Clinical Managing the child with inattention,hyperactivity or
impulsivity.**

185
 Para-suicide
Disease/Pathology Paracetamol Poisoning, wrist cutting

Community & Family How to deal with

Medicine
Clinical management

186
 Suicide
Disease/Pathology Organophosphate Poisoning, hanging, firearm

Community & Family How to deal with

Medicine
Clinical management

187
 Alcoholism
Disease/Pathology Organic Brain Disease, (Wernicke encephalopathy,
withdrawal symptoms)

Clinical Management**
Manage patient with anaphylaxis**

188
COMMUNITY-ORIENTED
PRESENTATIONS

189
 Epidemiologic Transition

Community & Family • Epidemiology: Uses, Scope and Applications

Medicine • Population Health: Determinants and indices
• Socioeconomic Status indicators
• Ecology of Health and Disease.
• Basic Demography: Population Pyramid,
Population transition, Nuptiality, Fertility,
Mortality and Migration
• Epidemiologic transition
• Family Dynamics (Function)
• Family life cycle
• The family as a social system
• Family dysfunction and assessment
• Impact of life events on family

190
 Outbreaks
Community & Family • Epidemiologic Disease Models : Triad ,Wheel,
Medicine Web of Causation
• Fundamental Concepts in Epidemiology :
Population, Sample, Case definition, Iceberg
Phenomenon, Herd Immunity, Incubation
Period, Carrier, natural History of Disease ,
Disease Spectrum
• Patterns of Disease Occurrence of (person, place
and time)
• Common Measures of Disease Occurrence
• Modes of Disease Transmission
• Food Hygiene and safety.
• Outbreaks: Types, Investigation and Control of
Epidemics.
• “Iterative Loop” approach in Disease Control.
• Role and applications of Public Health: Disease
Surveillance and Monitoring
• Prevention of diseases and conditions:
Approaches, levels and types.
• Disease Notification
• Sources of Health Data
• Fundamentals of Research Methodology
§ Types of variables
§ Graphical presentation of data
§ Tabular presentation of data
§ Measures of central tendency
§ Linear correlation
§ Hypothesis testing

191
 Disasters
Community & Family • Types of disasters
Medicine • Social Determinants of health
• Ecology of Health and Disease (Review)
• Measurements of Exposure in Epidemiology
• Epidemiological Study Designs
• Burden of illness and conditions: Health, social and
economic
• Coping with Death of family member
• Family Oriented Counseling (Individual and Family )
• Support : Family, Community and Organizations
• Hypothesis testing
• Confidence intervals

192
 Marginalized Populations (Migrant workers)
Community & Family • Health Services and organizations: Types, equality
Medicine and equity
• Role and applications of Public Health (Pre-
employment examination, screening, regulations)
• Research Methodology : Migrant studies
• Social impact
• Nutrition
• Domestic violence
• Support : Family, Community and Organizations
• Coping mechanism
• Principles of ethics
• Social Determinants of Health
• Occupational epidemiology
• Occupational history taking
• Occupational hazards and exposures and injuries

193
 Pollution
Pharmacology • Xenobiotic metabolism
• Environmental toxicology
• Acute and chronic toxicities

Community & Family • Concept of Risk and risk factors

Medicine • Association and Causation
• Confounding, Bias, and Effect Modification.
• Environmental epidemiology
• Environmental history taking
• Environmental Health (Principles of environmental
health, types and sources Pollution, environmental
hazards, safety, food hygiene.
• Environmental Tobacco Smoking
• Evidence-Based Healthcare
• Evidence based Decisions
• Critical Appraisal
• Simple linear regression

194
 Occupational Hazards
Pharmacology • Pharmacoepidemiology
Community and Family • Principles of occupational health
Medicine • Occupational epidemiology
• Occupational history taking
• Occupational hazards and exposures and injuries
• Classification of Diseases and Conditions
• Association and Causation
• Confounding, Bias, and Effect Modification.
• Employees health
• Prevention of occupational diseases and
conditions
• Surveillance and Monitoring
• Occupational Safety (Fire ,First aid)
• Health insurance
• Health ,economic and social burden of illness
and disability on individual, family and
community
• Coping Mechanism (Constructive vs destructive;
Social support system; Health support system)
• Screening: (Purpose, Criteria, Validity and
Guidelines, practical applications )

195
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