Professional Documents
Culture Documents
CHILD HEALTH
I. PREAMBLE
A PG student after undergoing the required training
should be able to deal effectively with a need of the
community and should be competent to handle all the
problems related to his specialty.
II. PROGRAMME OBJECTIVES
The goal of Diploma Course in Pediatrics is to
produce a competent Pediatrician who:
1. Recognizes the health needs of infants, children and
adolescents and carries out professional obligations in
keeping with principles of National Health Policy and
professional ethics.
2. Has acquired the competencies pertaining to
pediatrics that are required to be practiced in the
community.
3. Has acquired skills in effectively communicating with
the child, family and the community.
III. COURSE CONTENTS
COURSEI : BASIC SCIENCES
Chromosomal disorders, single gene disorders,
multifactorial disorders / polygenic, genetic diagnosis, and
prenatal diagnosis. Embryogenesis of different organ
systems
especially
heart,
genitourinary
system,
gastrointestinal tract, applied anatomy of different organs,
functions of kidney, liver, lungs, heart and endocrinal
glands. Physiology of micturition and defecation, placental
physiology, fetal and neonatal circulation, regulation of
temperature (esp. newborn), blood pressure, acid base
balance, fluid electrolyte balance, calcium metabolism,
vitamins and their functions, hematopoiesis, bilirubin
metabolism, growth and development at different ages,
puberty and its regulation, nutrition, normal requirements
of various nutrients, basic immunology, bio-statistics,
clinical epidemiology, ethical and medico-legal issues,
teaching
methodology
and
managerial
skills.
2
Pharmocokinetics of community used drugs, microbial
agents and their epidemiology.
COURSEII : GENERAL PEDIATRICS INCLUDING
COMMUNITY PEDIATRICS
(i) Nutrition
Protein energy malnutrition (underweight, wasting,
stunting) vitamin and mineral deficiencies, trace elements
and micro nutrient deficiencies obesity. Adolescent
nutrition, nutritional management in diarrhea, nutritional
management of systemic illnesses (celiac disease,
hepatobiliary disorders, nephrotic syndrome), parenteral
and enteral nutrition in neonates and children.
(ii) Growth and development
Principles of growth and development, normal growth
and development in childhood and adolescence, deviations
in growth and development, sexual maturation and its
disturbances. Short stature, obesity, precocious and
delayed puberty, developmental delay, impaired learning.
(iii) Infections
Bacterial, viral, fungal, parasitic, rickettssial,
mycoplasma, Pneumocystis carnii infections, Chlamydia,
protozoal and parasitic, tuberculosis, HIV, nosocomial
infections. Control of epidemics and infection prevention.
(iv) Immunization and Infections diseases
Bacterial, viral, fungal, parasitic, rickettssial,
mycoplasma, Pneumocystis carnii infections, Chlamydia,
protozoal and parasitic, tuberculosis, HIV, nosocomial
infections. Control of epidemics and infection prevention.
(v) Community Paediatrics
National health programs related to child health,
nutrition screening of community, prevention of blindness,
school
health
programs,
prevention
of
sexually
transmitted diseases, contraception, health legislation,
child labor, adoption, disability and rehabilitation, rights
of the child, national policy of child health and population,
juvenile delinquency, government and non government
3
support services for children, investigation of adverse
events of following immunization in a community, general
principles of prevention and control of infections including
food borne, water soil borne and vector borne disease and
investigation of an epidemic in a community.
COURSEIII : GENERAL PEDIATRICS
(i) Behavioural and Psychological Disorders
Rumination, pica, enuresis, encopresis, sleep
disorders, habit disorders, breath holding spells, anxiety
disorders, mood disorders, temper tantrums, attention
deficit hyperactivity disorder, infantile autism.
(ii) Skin Diseases
Exanthematous illnesses vascular lesions, pigment
disorders, vesicobullous disorders, infections: Pyogenic
and fungal and parasitic, Steven Johnson Syndrome,
eczema, seborrheic dermatitis, drug rash, urticaria,
alopecia, icthyosis.
(iii) Eye Problems
Refraction and accommodation, Partial/total loss of
vision,
cataract,
night
blindness,
chorioretinitis,
strabismus, conjunctival and corneal disorders, ROP.
Retinoblastoma, optic atrophy, papilloedema.
(iv) ENT
Acute and chronic otitis media, conductive /
sensorineural hearing loss, diphtheria - tonsillar, nasal,
post-diphtheritic palatal palsy, acute / chronic tonsillitis /
adenoids, allergic rhinitis / sinusitis.
(v) Emergency and Critical Care
Emergency care of shock, cardiorespiratory arrest,
respiratory failure, therapy, cardiac failure, acute renal
failure,
status
epilepticus,
fluid
and
electrolyte
disturbances and its therapy, acid-base disturbances,
poisoning, accidents, scorpion and snake bites.
(vi) Accidents and Common Poisoning
4
(vii) Neurology
Limping child, convulsions, abnormality of gait,
intracranial
space
occupying
lesion,
paraplegia,
quadriplegia, large head, small head, floppy infant, acute
paralysis cerebral palsy and other neuromotor disability,
headache.
(viii) Hematology and Oncology
Deficiency anemia, hemolytic anemia, aplastic
anemia / pancytopenia, disorders of homeostasis,
thrombocytopenia, blood component therapy, transfusion
related infections, bone marrow transplant / stem cell
transplant, acute and chronic leukemia, myelodysplastic
syndrome, Hodgkin disease, non-Hodgkins lymphoma,
neuroblastoma, Wilms tumor, hypercoagulable states.
(ix) GIT and Liver
Acute, persistent and chronic diarrhea. Abdominal
pain and distension, ascitis, vomiting, constipation,
gastrointestinal bleeding, jaundice, hepato-splenomegaly
and chronic liver disease, hepatic failure and
encephalopathy.
(x) Endocrinology
Hypopituitarism
/
hyperpituitarism,
Diabetes
insipidus, pubertal disorders, hypo-and hyperthyroidism,
hypo-and hyperparathyroidism, adrenal insufficiency,
Cushings syndrome, adrenogenital syndromes, diabetes
mellitus, short stature, failure to thrive, gonadal
dysfunction and intersexuality, Pubertal changes and
gynecological disorders.
(xi) Gastrointestinal and Liver Diseases
Diseases of mouth, oral cavity and tongue, Disorders
of deglutition and esophagus, peptic ulcer disease.
H.pylori infection, foreign body, congenital pyloric
stenosis, intestinal obstruction, malabsorption syndrome,
acute and chronic diarrhea, Irritable bowel syndrome,
ulcerative colitis, Hirschsprung disease, anorectal
malformations. Liver disorders hepatitis, hepatic failure,
5
chronic failure, chronic liver disease. Wilsons disease,
Budd Chiari syndrome, metabolic disease of liver,
cirrhosis, and portal hypertension.
(xii) Cardio-vascular
Murmur, cyanosis, congestive heart failure, systemic
hypertension, arrhythmia, shock.
(xiii) Respiratory
Cough/chronic cough, noisy breathing, wheezy child,
respiratory distress, haemoptysis.
(xiv) Miscellaneous
Habit disorders, hyperactivity and attention deficit
syndrome, arthralgia, arthritis, multiple congenital
anomalies.
IV. SCHEME OF TRAINING
1. Paediatrics
2. Neonatology
3. Intensive Care/Emergency
Optional Specialties
Internal Periphery
4. Paediatric Surgery
5. ENT
6. Ophthalmology
7. PMR
8. Dermatology
9. Community / Rural
10. External Periphery
11. Newborn
12. Nephrology
13. Neurology
V. SCHEME OF EXAMINATION
16 Months
4 Months
1 Months
3 Months
2 Months
1 Month
Theory
CourseI : Basic Sciences
CourseII : General Paediatrics including
Advances in Paediatrics
CourseIII : General Paediatrics
- 300 Marks
- 100 Marks
- 100 Marks
- 100 Marks
6
150 Marks
Clinical Examination No. of Days - 1
Long Case : (Forenoon Section)
- 80 Marks
Short Case : (Forenoon Section)
- 70 Marks
Viva : (Afternoon Section)
- 50 Marks
500 Marks
Total
VI. RECOMMENDED BOOKS & JOURNALS
Textbooks
1. Nelsons Textbook of Pediatrics, Harcourt Asia
Saunders
2. Clohertys Manual of Neonatal Care
3. Meharban Singhs Care of the Newborn
4. O.P.Ghais Textbook of Pediatrics
5. Forfar and Arneils Textbook of Pediatrics,ELBS
6. Averys Disease of the Newborn
7. Robertons Textbook of Neonatology
8. IAP Textbook of Pediatrics
Journals
1. Indian Pediatrics
2. Indian Journal of Pediatrics
3. Pediatric Clinics of North America
4. New England Journal of Medicine
5. Lancet
6. British Medical Journal
7. Journal of Pediatrics
8
plexuses and innervations, autonomic nervous system.
Anatomy of spinal and epidural space, lumbar epidural
space, caudal epidural space, circulation of CSF.
Physiology
Respiratory physiology control of breathing
mechanism and mechanism of breathing, compliance and
resistance, pulmonary function testing, gas exchange, O2
carriage and CO2 elimination, cardiovascular physiology
maintenance of circulation and cardiac output, blood
pressure, fluid, electrolytes and acid base balance,
physiology of neuro muscular transmission, central nervous
system formation of CSF, maintenance of intracranial
pressure, perception of pain and pain modulation, neuro
transmitters hepatic and renal physiology.
Pharmacology
Pharmacokintics and pharmacodynamics of drugs
related to anaesthetic practice and their mode of actioninhaled anaesthetics, intravenous, anaesthetics, narcotics,
muscle relaxants, local anaesthetics premedicant drugs,
drugs acting on CNS, RS, CVS, autonomic nervous
system, kidney and endocrines.
Microbiology
Disinfection and sterilization related to anaesthetic
practices.
Physical Measurements and Applied Physics
Measurement of blood gases-oxygen, corbondioxide,
PH measurement of physiological pressures arterial and
venous blood pressures - measurement of flows and
volumes and pressures flow of gases, flow of liquids, gas
laws, density and viscosity, pressure gauges oxygen,
carbon di oxide, nitrogen nitrous oxide, inhaled
anaesthetics vapours vaporization, humidity
humidification, measurement of temperature.
Equipment
Anesthesia machine and safety factors incorporated
in anaesthesia delivery system breathing systems CO2
9
absorbers endrotrachlal tubes, endobronchial double
lumen tubes non-rebreathing valves vaporizers
explosion hazards sterilization of equipments.
COURSEII : CLINICAL ANAESTHESIOLOGY
1. History of anaesthesia
2. Pre-anaesthetic evaluation and preparation
3. Anaesthesia for patients with co-existing systemic
diseases cardiovascular, respiratory, endocrine,
hepatic, renal and gastro-intestinal.
4. Anaesthesia in Obstetrics and Gynaecological
procedures.
5. Regional anaesthesia and pain relief.
6. Anaesthesia for ENT / Ophthalmology procedures
7. Anaesthesia for Orthopaedic procedures
8. Anaesthesia for Radiological investigations
9. Anaesthesia for thoracic abdominal surgery
10. Anaesthesia for Cardiac surgery
11. Paediatric anaesthesia
12. Neuro anaesthesia
COURSEIII : ANAESTHESIOLOGY INCLUDING
RESUSCITATION, CRITICAL CARE AND RECENT
ADVANCES
1. Complications of anaesthesia (General and regional)
and their management
2. Cardio pulmonary resuscitation and prolonged life
support.
3. Neonatal resuscitation
4. Oxygen therapy
5. Management of pain post operative and chronic pain
6. airway management
7. Recent advances in the field of anaesthesia including
mechanical ventilation of lungs theories of
anaesthesia
and
analgesia
intravenous
10
8. Management
of
common
poisoning,
medical
conditions requiring intensive care management.
9. Current concepts regarding organization of pain
clinics out patient anaesthesia services mass
casualties.
IV. SCHEME OF TRAINING
First Year Objectives
The first year resident should be taught expertise in
the management of ASA I and II cases, to start with they
will observe and slowly become independent in giving
general anaesthesia and spinal anaesthesia to ASA I & II
cases for minor and major surgery, under graded
supervision. They should be posted to the following
specialities during the first year: Gynaecology, General
Surgery, Orthopaedic, ENT, Recovery Room and Urology.
Second Year Objectives
The student should be taught to give general
anaesthesia and regional anaesthesia to ASA I, II, III & IV
under supervision. They should be able to give extradural
block (EDB) spinal block, and peripheral Nerve Blocks
under supervision, should learn peadiatric and trauma life
supports and maintain skills for basic and advanced
cardiac life support. It is suggested that they may be
posted in the following specialities: Obstetrics, Dental
surgery, Eye, ICU, pain clinic and peripheral theatres.
The student should be able to plan and administer to
all patients under graded prevision including patients for
cardiac, neurosurgery, peadiatric surgery and for all major
surgeries. The aim at the end is to be competent and
independent soon after the third year of junior residency
in providing anaesthesia to elective and emergency cases.
The junior resident should be able to manage critically ill
patient and treat intractable pain they should also know
how to organize resources in case of mass casualty. The
curriculum should be able to provide 1 month of elective
postings.
11
V. SCHEME OF EXAMINATION
Title
Max. Marks
CourseI
Theory
100
CourseII
Clinical Anaesthesiology
100
CourseIII
100
Total
300
Practical
150 Marks
50
12
17. Drugs for Anaesthetists Wood and wood
18. Intravenous Anaesthesia Dounde J.W.
19. Principles of anesthesiology Vincent Collins
20. General Anaesthesia Nunn, Uting & Brown. Vol. I&II
21. Anaesthesia for neurosurgical procedure 1 attani
22. Anaesthesia Morgan.
Journals
1. Indian Journal of Anaesthesia
2. British Journal of Anaesthesia
3. Anaesthesia and Analgisia
4. Journal of Pain.
13
14
14. Properly maintain medical records and know the
Medico-legal aspects and acts in respect of Obstetrical
and Gynaecological practice.
15. Keep abreast with advances in the field of Obstetrics
and Gynaecology.
16. Involve in educational progrmame in Obstetrics and
Gynaecology (with seniors) for medical and
paramedical staff and also for the society.
17. Be familiar with modern methods of teaching.
18. Develop communication skills and demonstrate
compassionate attitude towards the patients.
III. COURSE CONTENTS
It is stressed that the topics listed can only be
regarded
as
guidelines
because
Obstetrics
and
Gynaecology are not static subjects and as developments
occur in other clinical and preclinical areas.
The syllabus includes Obstetrics and Gynaecology
and those aspects of medicine, surgery and paediatrics
relevant to the practice of both. It is only intended as a
guide to the topics on which candidates may be examined
and it is not intended to be comprehensive. As new
developments occur and become part of accepted practice
they will become eligible for inclusion. For this candidates
are advised to familiarize themselves with the current
contents of the scientific journals and up-to-date reviews
of major topics. Candidates are expected to be able to
make a critical appraisal of scientific articles and
demonstrate that they can interpret the data they contain.
COURSEI : APPLIED BASIC SCIENCES RELATED TO
OBSTETRICS & GYNAECOLOGY
A. Embryology
Development of fetus and placenta various congenital
anomalies
B. Anatomy
Anatomy of hypothalamus and pituitary and
relationship with menstrual or ovarian cycles Pelvic
innervations Anatomy of abdominal wall. Bony pelvis
15
and pelvic floor Development and anatomy female genital
organs Development and anatomy of urinary tract and
variations Lymphatic drainage general and pelvic
lymph nodes with special reference to cancer of the female
genital tract Anatomy of lower alimentary tract Breast
anatomy, blood supply, innervations and lymphatic
drainage.
C. Physiology
Fluid balance Body water and external internal fluid
exchange Renal Function Causes of Oedema fluid
Blood Haematology. Erythropoiesis, Iron Metabolism, Rh
factor, blood groups and coagulation of blood Heart
Cardiac output blood pressure, reaction of body to
hemorrhage Fetal circulation and respiration Liver
function, Hepatic failure Physiology of pregnancy,
pregnancy diagnosis tests Mammary glands & Lactation
Uterus: Growth & Contractility of Uterus Endocrinology:
Hypothalamic Hormones - Pituitary, Adrenal, Thyroid,
Ovary, Pancreas and placenta Nutrition Normal diet,
nutritional requirements of special groups
D. Biochemistry
Haemoglobin Metabolism of Iron, Anaemia,
Abnormal Haemoglobin Bile Pigments Circulation of bile
pigments & laboratory investigations for jaundice
Carbohydrate metabolism Maternal and fetal, Diabetes,
G.T.T, Glycogan storage diseases. Fat metabolism
Disorders of fat metabolism & obesity. Protein metabolism
Maternal and fetal value of plasma proteins & amino
acids. Normal and disorders of hormone metabolism,
ovarian tumours, steroid hormones, insulin, thyroxine,
paratharmone and posterior pituitary hormones, placental
hormones. Fluid and Electrolyte balance.
E. Pathology
Menstruation Normal histology of ovary and
endometrium, endometrial pathology Pathology of
abortions Genetic factors hormonal factors & placental
pathology Amniocentesis Significance of alfa-feto
16
proteins Chorion villous sampling Placenta Placental
adhesions in PPH. Diseases of placenta, abnormalities of
implantation and new growths Trophoblast Vasicular
mole, chorio-adenoma destruens, and chorio carcinoma
Cervix Histology, Benign, pre cancerous and malignant
lesions of cervix, effects of radiotherapy Vaginal cytology
In Obstetrics and Gynaecology Hormonal pattern &
cancer screening Endometrium Hyper-plasia &
carcinoma Vagina Inflammations, benign & malignant
lesions. Vulva Inflammations, benign & malignant
lesions. Pelvic endometriosis Pelvic inflammatory
disease. Ovary Benign & Malignant tumours Genetic
& Sex anamolies in abortions, primary amenorrhoea &
congenital anomalies.
F. Microbiology
Disinfection and sterilization Immunology
Antigen-antibody reaction immunity and hyper sensitivity,
Antibiotic sensitivity, - Bacteria : Classification,
Microscopic examination, culture Infections in
Obstetrics and Gynaecology Gram Negative infections,
STD, Genital Tuberculosis Vaginal Infections
Trichomonas vaginalis, moniliasis. Uterus : Specific to
Hepatitis, AIDS & HIV infection, Torch infection
G. Pharmacology
Cardiac glycosides and vaso dilators and vaso
constrictors Haematinics Adjuvants to Iron therapy,
Role of cyanocobalamins Diuretics Hormones : Ovarian
& Placental Hormones, Male and female sex hormones
Antihypertensives Antibiotics Oral Pills Other
Hormones Thyroid, Iodine, Parathyroid calcium, Insulin
and oral anti-diabetic drugs, Adrenal cortical hormones
Oxytocics Ergot and oxytocin Prostoglandins Use in
induction of abortion and labour Emetics, Antacids,
Digestives, Vitamins and Laxatives Cytotoxic drugs.
Heparin and oral Anticoagulants Teratogenic drugs,
Drugs acting on automomic nervous system and muscle
relaxants
17
COURSEII : OBSTETRICS AND GYNAECOLOGY
INCLUDING NEONATOLOGY
Physiology of Labour
1. Spontaneous Labour and Delivery: Parturition : Bio
molecular and physiologic processes, Mechanism of
Normal labour, in occiput presentation, Intrapartum
care, Maternal and fetal monitoring, puerperium
2. Management of Normal Pregnancy: Prental care
Technics to evaluate high risk mother and neonatal
Conduct of normal labour and delivery Analgesia
and Anaesthesia
3. Abnormalities of Labour and Delivery: Dystocia due
to abnormalities of the expulsive forces Precipitate
labour Dystocia due to abnormalities in
presentation position and development of fetus.
Dystocia due to pelvic contraction Dystocia due to
soft tissue abnormalities of the reproductive tract.Techniques for breech delivery injuries to the birth
canal. Abnormalities of the third stage of labour.
4. Operative Obstetrics: Forceps delivery and related
techniques Caesarean section and caesarean
hysterectomy.
5. Abnormalities of the Puerperium: Puerperal
infection Other disorders of the puerperium.
6. Complications of Pregnancy: Abortion Ectopic
pregnancy Diseases and abnormalities of the
placenta and fetal membranes Multiple pregnancy
Hypertensive disorders in pregnancy Obstetric
Haemmorhage Abnormalities of the Reproductive
tract Preterm and Post-term pregnancy Intra
uterine growth retardation Isoimmunization due to
Rh and other Blood group incompatibilities 0
Obstetric Shock Mal-presentations.
7. Medical Genetics in Obstetrics: Pattern of
inheritance of genetic disorders Genetic factors in
recurrent abortions Genetic counseling and
preconceptional
counseling
Congenital
malformations and inherited disorders Prenatal
diagnosis of genetic defects Sex determination and
sex selection ethical issues Puberty testing
18
8.
9.
10.
11.
12.
conservative
management of tubal pregnancy
5. Trophoblastic
Tumors:
vesicular
mole
19
6. Injuries to Genital Tract: Foreign bodies in genital
tract Direct trauma Burns Complete perineal
tear Lacerations of cervix Rupture and
performation of uterus Haematomas : Vulva,
Vagina, Broad ligament General tract fistulas
Acquired atreias and stenosis of genital tract.
7. Uterine Displacements: Utero vaginal prolapse
Other displacements Retroverted gravid uterus
Chronic inversion
8. Torsion of Pelvic Organs: Uterus Myoma
Hydrosalpinx Torsion ovarian cyst.
9. Infections of Genital Tract: Individual organs
Pelvic inflammatory disease Sexually transmitted
diseases genital tuberculosis
10. Epithelial Abnormalities of Genital Tract: Vulva
dystrophies Vagine Basal cell hyperplasia and
Neoplasia Cervix Erosion Basal Cell hyperplasia
Squemous metaplasia Dysplasias Cervical
Neoplasia Uterine Corpus Endometerial
Hyperplasias Squamous cell mataplasia
11. Endometriosis ad Adnomyosis :
12. Vulva: Developmental abnormalities Injury
Vascular changes Infections Retention cysts
Innocent Neoplasm Malignant Neoplasts
Enlargement of Bartholins Gland
13. Vagina: Infections Vaginal cysts Benign and
Malignant Neoplasmas
14. Cervix: Infections Innocent Neoplasms Carcinoma
cervix.
15. Body of Uterus: Dysmennorhoea Innocent ; Fibroid
uterus and others ; Malignant Neoplasms
Carcinoma of Endometrium Sarcoma etc.
16. Fallopian Tube: Innocent neoplasms and malignant
Neoplasms
17. Ovary: Cysts Benign ovarian tumors Malignant
ovarian tumors
18. Clinical Endocrinology: Ovary from conception to
senescence Menopause Amnnorhoea An
ovulation Hirsutism Dysfunctioanl uterine
20
bleeding Prostaglandins abnormal puberty and
growth problems Obesity Steriod contraception.
19. Infertility: Sperm and egg transport fertilization and
implantation Investigation of the infertile couple
Endometriosis and Infertility Induction of ovulation
Assisted reproductive technology.
20. Medical
Genetics
in
Gynaecology:
Sex
determination, sexuality and intersex
21. Contraception: Temporary methods Permanent
methods Latest trends in contraception
Reconstructive surgeries tuboplasty, vaso vasostomy
22. Hormone Therapy
23. Current concepts in Obstetrics and Gynaecology
IV. SCHEME OF TRAINING
1. Schedule of Training
First Year
Labour Ward
3 Months
3 Months
3 Months
Neonatology Ward
15 Days
Infertility
15 Days
Family Welfare
1 Months
Community Obstetrics
Total
15 Days
12 Months
Final Year
Labour Ward
3 Months
3 Months
3 Months
Anaesthesia
15 Days
Department of Oncology
15 Days
Postnatal Ward
1 Month
Sonar
15 Days
Gynac endoscopy
15 Days
Total
V. SCHEME OF EXAMINATION
12 Months
21
Theory
Duration Max.
in Hrs
Marks
Title
CourseI
CourseII
to
100
100
100
Total
300
Clinical Examination
Long Case One x 80 = 80 marks
Short Case Two x 35 = 70 marks
Total
Viva / Practicals
A. Spotting
150
10 Marks
Slides/
Specimen /
Chart /
X-ray, Scan /
Instrument
B. Viva
40 Marks
50 Marks
Total
VI. RECOMMENDED BOOKS AND JOURNALS
A. Books
1. Fernando Arias High risk pregnancy and delivery
2. Ian Donald Practical obstetric problems, Williame
Obstetrics
3. Dawhurst Text Book of obstetrics and Gynaecology
4. Munro Kerrs Operative obstetrics, year book in
Obstetrics and Gynaecology
5. Pro. Dr. Ratnam, Dr. Bhasker Rao, and Dr. Arul
Kumaran Obstetrics and Gynaecology for
postgraduates
6. Kistners Gynaecology Principles and Gynaecology
7. Bonnar Recent Advances in Obstetrics and
Gynaecology
8. Studd Progress in Obstetrics and Gynaecology
9. Ruby.E.Subbagha Diagonostic Ultra sound applied
to Obstetrics and Gynaecology
10. Jeffoates Principels of Gynaecology
22
11. Novok Text Book of Gynaecology
12. Shaw Operative Gynaecology
13. Bonney Telinde and C.S.Dawns Obstetrics and
Neonatolog Gynaecology and Contraception
14. Sper Off Clinical Gyaecologic endocrinology and
infertility
15. Meharbanu singh Care of Nee Born
16. Harrisons Text Book of Medicine.
Journals (Periodicals)
1. American Journal of Obstetrics and Gynaecology
2. British Journal of Obstetrics and Gynaecology
3. Obstetrics and Gynaecology (Green Journal)
4. Fertility and Sterile
5. International Journal of Gynaecology
6. Gynaecology oncology
7. Obstetrics and Gynaecology survey
8. The Australian and New Zealand Journal of
Obstetrics and Gynaecology
9. The Lancet
10. Journal of Obstetrics and Gynaecology India (FOGSI)
11. Obstetrics and Gynaecology today India
12. Acta Obstetrics and Gynaecology Scandinovia
13. Obstetrics and Gynaecology clinics of North America
14. Journal of clinical ultrasound
15. Journal of Clinical Obstetrics and Gynaecology.
23
24
Electro Physiology Action Potential, Nerve Conduction
Chronaxy, Rheobases, Electro Myography, SD curve.
Pathology: Bone Tumours Orthopaedic related
genetic disorders Blood dyscrasias Embolism Fat
embolism, Thrombo embolism.
Microbiology: Gas
gangrene,
Tetanus
Antibiotics
25
COURSEIII : GENERAL ORTHOPAEDICS AND
PHYSICAL MEDICINE REHABILITATION
The study of general Orthopaedics shall include all
the diseases that affect the locomotor system including:
1. Deformities
Congenital
and
acquired
incidence
Bacteriology Patho-Physiology cerebral palsy
incidence etiology Patho-physiology various
clinical types Physiotherapy splinting and bracing
surgical management rehabilitation Obstetrical
paralysis incidence Pathomechanics Clinical
electro
diagnosis
splinting
and
bracing
Physiotherapy and management.
7. Metabolic Disorders : Involving the skeletal system.
The course requires the candidates to attend the
Orthopaedic wards and outpatient department and
shall have performed the common Orthopaedic
Operations independently and assisted all major
Operations during the period of study and learn the
principles of all traction procedures.
26
Physical Medicine & Rehabilitation
1. Principles of physical therapy including exercise
therapy and electrotherapy, examination and
prescription for splints and braces.
2. Principles of Occupational therapy and
3. Principles of electrodiagnosis
IV. SCHEME OF TRAINING
First year
First Semester 6 Months
4. Introductory programme - 15 days
5. Orientation in Orthopaedics with regard to outpatient,
inpatient, OT
- 1 month
6. Casualty postings :
On admission days, the students will attend
emergency
Orthopaedic
postgraduates
patients
along
with
senior
examination,
27
Second Year
First semester
1. Attend emergency casualty duty on admission days.
2. Preoperative preparation of inpatients.
3. See patients in OPD, application of corrective POP
casts, do closed reductions of fractures and
disclocations
4. Assist for major surgeries
5. Postoperative care.
Second Semester
1. Casualty, OPD and inpatient care as before
2. Start doing minor surgical procedures individually
3. Present papers in conferences
4. Discuss articles in Journal club 03.00 p.m. to 04.00
p.m. once in a fortnight.
5. Attend combined classes 03.00 p.m. to 04.00 p.m.
once in a fortnight.
6. 2 months training of postgraduate in allied
specialities
V. SCHEME OF EXAMINATION
The D.Ortho postgraduate examination shall be in
two parts
Theory
Title
Max. Marks
CourseI
100
CourseII
Traumatology
100
CourseIII
100
300
Practical
a. Long Case One - 80
b. Short Case Two x 35 70
c. Viva-Voce
(Operative surgery and instruments,
Osteology, Orthopaedic, Pathology,
Radiology)
Max. Marks
150
50
28
VI. RECOMMENDED BOOKS AND JOURNALS
Text Books
1. System of Orthopaedics and Fracture G. Apley
2. Outline of Orthopaedics C.Adms
3. Text Book of Orthopaedics and Traumtology
M. Natarajan
4. Fractures and Joint Injuries Watson Jones Wilson
5. Merces Orthopaedic Surgery Duthie Bentley
6. Orthopaedics S. Turek Vol. I & II
7. Operative Orthopaedics Campbell Vol. I to IV
8. Orthopaedic Diseases Aegerter and Kirkpartrick
9. Kusculo Skeletal Tumors Vol. I & II by Enneking
10. Spine James Cyciax
11. Fracture in Children and Adults Vol. I to III by
Rockwood & Green
12. Skeletal Tuberculosis SM. Tuli
13. Clinical Examination McRae
14. Orthopaedic Appliances Stewart
15. Sports Injuries Fu & Stone
16. Paediatric Orthopaedics Tachdjian
17. Clinical Orthopaedics Kulkarni Vol. I to VI
18. A manual of Internal Fixation, latest edition Springer
Verlogg Author: Mullter Rudie - Allgower
Journals
1. Indian Journal of Orthopaedics
2. Journal of Bone and Joint Surgery American &
British Edition
3. Orthopaedic Clinics of North America
4. ACTA Orthopaedics Scandinavia
5. Trauma
6. Clinical Orthopaedics & Related Research
29
30
COURSEI : THE BASIC SCIENCES (APPLIED)
1. Orbital and Ocular anatomy
a. Gross anatomy
b. Histology
2. Ocular Physiology
3. Pathology
a. General Pathology
b. Ocular pathology: Gross pathology, Histopathology
4. Biochemistry: General biochemistry,
applicable to ocular function
5. Microbiology
a. 7General Microbiology
Biochemistry
2. Disorders of Refraction
a) Retinoscopy
b) Streak retinoscopy
c) Use of trial set
d) Use of Jackson cross cylinder
e) Subjective and objective refraction
f) Various errors of refraction
COURSEIII : OPHTHALMIC MEDICINE AND SURGERY
Candidate should be trained in such a way that he or
she is able to manage
1. Various Anaesthesia during cataract surgeries like
a) Retrobulbar anaesthesia
b) Peribulbar anaesthesia
31
c) Parabulbar anaesthesia and
d) Facial blocks
e) Frontal blocks
f) Intra orbital blocks
g) Blocks for sac surgery
2. Magnification
a) Operating microscope Familiarity with use is
Essential
b) Operating loupe
3. Lid surgery
a) Tarsorrhaphy
b) Ectropion and entropion procedures
c) Prosis surgery
d) Lid repair following trauma and surgical excision
of lid for tumours etc.
e) Epilation, electrolysis, cryotherapy etc.
4. Destructive procedures
a) Evisceration with or without implant
b) Enucleation with or without implant
c) Modified enucleation procedures for intraocular
Tumours.
5. Sac surgery
a) Dacrocystectomy
b) Dacryocystorhinostomy
c) Probing for congenital obstruction of nasolacrimal
duct
6. Extraocular muscle surgery
a) Recession and resection procedures on the
horizontal recti.
7. Cataract surgery
a) Standard ECCE with or without IOl implantation.
b) Small incision ECCE with or without IOL
implantation.
c) Membranectomy.
d) Intra capsular cataract extraction.
32
8. Retinal surgery
a) Needs to know how to assist in external
procedures such as buckling
b) Prophylactic cryotherapy
9. Vitrectomy Procedures
a) Intra vitreal and intra cameral (anterior chamber)
injection techniques and dosages, particularly for
endophthalmitis management.
b) Needs to know the basics of open sky vitrectomy
(anterior segment) as management of cataract
surgery complication.
c) Assist vitrectomy surgeon if facility exists.
10. Keratoplasty
a) Assisting or doing penetrating keratoplasty
(therapeutic, optical)
11. Glaucoma surgery:
a) Trabeculectomy
b) Pharmacological modifications of trabeculectomy
c) Cyclocryotherapy and other cyclodestructive
procedures.
12. Surface Ocular procedures:
a) Pterygium excision with modifications
b) Conjunctival grafting
c) Biopsy of cornea and conjunctiva
13. Pterygium excision
14. Tarsorrhaphy
15. Retrobulbar, parabulbar anaesthesia.
Outpatient
Manual diagnostic procedures such as syringing,
corneal
scraping,
conjunctival
swab
collection,
conjunctival scraping etc.
Conjunctival and corneal foreign body removal on the
slit lamp
1. Chalazion incision and curettage
33
2. Biopsy of small lid tumours
3. Suture removal skin, conjunctival,
corneoscleral
4. Subconjunctival injection
5. Posterior Sub-Tenons injections
6. Artificial eye fitting
The candidate is trained to perform
corneal
1. Tonometry
i.
Applanation
ii. Indentation (commonly Schiotz)
2. Assessment of epiphora
i.
Jones dye test
ii. Syringing-performance & interpretation
3. Dry eye evaluation
i.
Schirmer test
ii. Rose Bengal staining
iii. Tear film breakup time
iv. Tear meniscus evaluation
4. Corneal ulceration
i.
Taking a corneal scraping
ii. Inoculation into media
iii. Evaluation of Grams stain
iv. Evaluation of KOH preparation
v. Corneal wedge biopsy
5. Direct ophthalmology
i.
Distant direct
ii. Media assessment
iii. Use of filters provided
6. Indirect ophthalmoscopy
i.
Scleral depression
ii. Fundus drawing capability
iii. Use of filter provided
7. Slit Lamp Examiantion
i.
Diffuse examination
and
34
ii. Focal examination
iii. Retroillumination direct and indirect
iv. Sclerotic scatter
v. Specular reflection
vi. Staining modalities and interpretation
8. Slit Lamp Accessories:
i.
Applanation Tonometry
Goldmans applanation
ii. Gonioscopy
Single mirror gonioscope
Gonioprism
Grading of the angle
Testing for occludability
Indentation gonioscopy
iii. 3-mirror examination of the fundus
iv. 78-D/90-D/60-D examination
v. Hruby lens examination
vi. Optical pachymetry
vii. Slit lamp photography
9. Colour vision evaluation
i.
Ishihara pseudoisochromatic plates
10. Use of Amslers charting
i.
Instructing in the use of and interpreting the chart.
11. Keratometry
i.
Performance and interpretation of keratometry
ii. Diagnosis of situations such as keratoconus
iii. Keratoscope
12. Refraction
i.
Retinoscopy
ii. Streak Retinoscopy
iii. Use of trial set
iv. Use of Jacksons cross-cylinder
v. Subjective and objective refraction.
35
13. Diagnosis and assessment of Squint
i.
Ocular position and motility examination
ii. Versions, ductions and vergeneces
iii. Convergence facility estimation
iv. Cover/Uncover/Alternate cover test
v. Use of prism bars or free prisms in assessment of
squint
vi. Use of synaptophore/major amblyoscope
vii. Use
of
Bagolinis
striated
glasses/red
filters/Maddox rod
viii. Use of Worths four dot test
ix. Use of minor amblyoscope
x. Use and interpretation of the Hess chart/Lees
screen
xi. Performance and interpretation of diplopia charting
xii. Diagnosis of amblyopia.
14. Exophthalmometry
i.
Use of Hertels exopthalmometer
ii. Use of Luedds exopthalmometer
iii. Use of other exopthalmometers
iv. Measurement of proptosis or exophthalmos
15. Use and evaluation of ophthalmic ultrasound
i.
A-Scan ultrasound with biometry
ii. B-Scan
ultrasound:
Performance
and
interpretation
16. Interpretation of perimetry
i.
Tangent screening
ii. Static computerized perimetry
Interpretation of commonly managed problems
17. Radiology
i.
Interpretation of plain skull films
PA-20 (Caldwells view)
PNS (Waters vioew)
Lateral
Submentovertical
36
Optic canal views
Localisation of intra ocular and intra orbital FBs
ii.
venograms
Interpretation of carotid angiograms
iii. Interpretation of CT-Scans & MRI Scans
Orbital CT interpretation and orbital
evaluation
Brain CT interpretation
The candidate is trained to acquire
MRI
37
4. Community ophthalmology
i.
Ability to organize institutional screening
ii. Ability to organize peripheral eye screening camps
iii. Knowledge and ability to execute guidelines of
National Program for Prevention of Blidness.
5. Presentation
i.
Ability to present ones work effectively at various
scientific forum particularly free papers in
scientific conferences within allotted framework of
time.
6. Organisation
i.
Ability to organize meetings, seminars and
symposia
ii. Ability to get along with colleagues and work as a
team with the other members of the department
iii. Ability to interact with and work as a team with
other disciplines that may exist in the same
hospital.
7. Communication skills
i.
With patients
ii. With colleagues
8. Record keeping
i.
The ability to maintain records as scientifically as
possible
ii. Knowledge of computer software is helpful
9. Teaching
i.
The ability to pass on skills acquired to ones
juniors, theoretical, procedural and surgical
IV. SCHEME OF TRAINING
First Year
Outpatient and Casualty
3 months
6 months
Refraction
3 months
12 months
38
Second Year
Cataract & IOL
2 months
Glaucoma Clinic
2 months
2 months
Neuro Ophthalmology
1 month
Community Ophthalmology
2 months
Refraction room
3 months
V. SCHEME OF EXAMINATION
Theory (Written)
There shall be three question papers, each of three
hours duration, carrying 100 marks. Each Course shall
consist of two long essay questions each carrying
20 marks and six short essays type of questions each
carrying 10 marks.
Distribution of Marks
a) Theory 3 Courses (3 x 100)
1.
2.
3.
CourseI
CourseII
CourseIII
b) Clinical
Long case- one
Short case- Two
Retinoscopy- One
Fundus Two
300 Marks
Duration
45 min
40 min
15 min
30 min
c) Viva Voce
150 Marks
Marks
80
40
15
15
50 Marks
10
40
500 Marks
39
Books
1. Arnold sorsby Modern Ophthalmology
2. Principles and practice of Ophthalmology by Peyman
3. Parsons diseases of the eye
4. Clinical Ophthalmology Kanski
5. Becker Shaeffers diagnosis of therapy of the
glaucoma
6. Clinical methods of neuro-ophthalmologic exam A.
Kestenbaum
7. Diseases of the eye May and worths
8. Cataract surgery & its complications by Jaffee
9. Stallards eye surgery
10. Practical orthopedics in the treatment of squint-Kieth
lyle.
Journals
1. British Journal of Ophthalmology
2. American Journal of Ophthalmology
3. Archives of Ophthalmology
4. Cornea
5. Glaucoma
6. Indian Journal of Ophthalmology
7. Highlights of Ophthalmology.
40
POSTGRADUATE DIPLOMA IN
OTOLARYNGOLOGY (D.L.O.)
I. PREAMBLE
A postgraduate specialist having undergone the
required training should be able to recognize the health
needs of the community should be competent to handle
effectively medical problems and should be aware of the
recent advances pertaining to his speciality. The PG
student should acquire the basic skills in teaching of
medical / para-medical students. He/she is also expected
to know the principle of research methodology and modes
of consulting library.
II. PROGRAMME OBJECTIVES
At the end of postgraduate training the student
should be able to:
Practice his speciality ethically
Demonstrate sufficient understanding of basic
41
ii.
42
Applied anatomy of the skull bones, accessory
sinuses, external, middle and inner ears, nose, PNS,
nasopharynx, meninges, brain, pharynx, larynx, trachea
and bronchi, lungs, pleurao oesophagus and the
mediastinum. Anatomy of all cranial nerves with their
function.
COURSEII : PRINCIPLES AND PRACTICE OF
OTOLARYNGOLOGY
1. Clinical Methodology as applied to ORL diseases in
adult & children and the accessory sinuses, diagnosis
and surgical treatment of diseases of nose, throat and
car in adult and children. Prevention and treatment,
infectious diseases of Otolaryngology and Head Neck
region. Circulatory and nervous disturbances of the
nose, throat and car and their effects on other organs
of the body. Deformities, injuries sinus infections.
Polyps and the tumors of the nose, and paranasal
sinuses.
2. Examination of the ear, deafness and allied diseases,
complications of diseases of the ear. Injuries, tumors,
nervous and circulatory neurological disturbances of
the ear. Diagnosis and treatment of tinnitus and
vertigo. Diagnosis and rehabilitation of the Hearing
handicapped including, dispensing of hearing aid
other vibrotatile aids
3. Surgical pathology of Otolaryngology and Head Neck
region.
4. Basic knowledge of anaesthesia as related to ENT
5. Examination of diseases of children (paediatric ORL)
in connection with throat and larynx.
6. Neurological and vascular disturbances. Congenital
and neonatal stridor
7. Pathology of various diseases of the larynx and throat,
tracheo bronchial tree and their causative organisms.
8. Indications and various techniques of direct
laryngoscopy nasal endoscopy. Bronchoscopy and
oesophagoscopy,
including
microlaryngoscopic
procedures
43
9. Reading
of
radiograms,
scans,
audiograms,
nystagmograms and tympanograms in connection
with ENT diseases/disorders.
10. Special apparatus for the diagnosis and treatment of
the diseases of ear, nose and throat including
audiometer, BERA, ENG, speech analyzer etc.
COURSEIII : RECENT ADVANCES IN OTOLARYNGOLOGY
AND HEAD AND NECK SURGERY
1. The
recent
developments
in
the
diagnosis
pathogenesis treatments of the END diseases.
2. The knowledge of the frontiers of the oto.-.laryngology
and lateral skull base surgery.
3. Rhinoplasty, endoscopic sinus surgery, and anterior
cranial fossa surgery.
4. Knowledge of LASERS and fibre optics.
5. Other methods of managing Hearing loss
6. Implantable hearing aids cochlear implants.
7. Phonosurgery
Etiology and Managements of sleep apncea / snoring,
Hypophysectomy and optic nerve decompressions.
Immunotherapy and modalities of the gene therapy Newer
techniques for Radiotherapy including, use of gamma
knife for treatment of Intracranial tumors and other
malignancy. Chemotherapy of cancer
IV. SCHEME OF TRAINING
Didactic lectures are of least importance, seminars,
journal clubs, symposia, reviews and guest lectures
should get priority for theoretical knowledge. Bedside
teaching, grand rounds, interactive group discussions and
clinical demonstrations should be the hallmark of
clinical/practical learning. Student should have hand-on
training
in
performing
various
procedures
(medical/surgical concerning his subject) and ability to
interpret various tests/investigations. Exposure to never
specialized diagnostic/therapeutic procedures concerning
his subject should be given.
44
Clinical Postings
First Year
Spends 5 months in orientation programme
including exposure to Speech and Audiology Section and
Vestibular Laboratory.
Learn bedside history taking in ward, CT exposures,
casualty, ICU requirement and their visit to related Care of
indoor (Medical; preoperative and postoperative) patients
for a minimum period of 6 months.
Attends operation theatre and emergency operations
for acclimatization, Assists ward rounds and visit other
wards with senior colleagues to attend call consultations
from other department. Participate in the teaching
sessions in ward for bedside clinical aspect in the weekly
afternoon Seminar/Journal Club.
Radiology and radiotherapy
1 Month
2 Months
1 Month
ENT
7 Months
Total
12 Months
Second Year
ENT including upper gastrointestinal and upper
respiratory tract and common ENT emergencies such as
epistaxis, F.B infections of mucosal origin etc. their
posting will be mostly in OPD, ward and in the emergency
situation. Less posting in the Main OT as the thrust may
not be on training them in the entire operative procedures.
Cadaveric training may be given to them similarly and as
per their requirement.
Discusses
problematic
cases
with
the
consultant(s) in OPD/ward
Attends Operation Room/theatre
Attends morning rounds
Looks after minor OT by relation in the OPD and
the minor procedures
45
Care of the indoor patients on beds allotted to
him/her
Attend
46
Preparation of a report on a project
Humanity/Ethics:
Lectures on humanity including
personality
development, team spirit and ethical issues in
patients care and human relationship including,
public relations, by Psychologist and public
relation officers are to be arranged by the
dept./college.
Teaching Methods
The following learning methods are to be used for the
teaching of the postgraduate students:
1. Journal club
2. Paper presentation/discussion
3. Seminar: Lecture/discussion: Lecture on newer topics
by faculty in place of seminar/ as per need.
4. Case presentation in the ward
5. Afternoon special clinics (such as vertigo/otology
Tumour clinics)
6. Surgicopathological conference: Special emphasis is
made on the surgical pathology and the radiological
aspect of the case in the pathology dept. Such
exercises
help
the
ENT/Pathology/Radiology
Residents.
7. Combined Round/Grand Round; These exercises are
to be done for the hospital once/wk or twice/month
involving presentation of unusual of difficult patients.
Presentations of cases in clinical combined Round
and a clinical series/research data on clinical
materials for benefit of all clinicians/ Pathologists/
other related disciplines once in a week or fortnightly
in the grand round.
8. Community camps: For rural exposure and also for
experience in preventive aspect in rural situation/
Hospital/School, Patient care camps are to be
arranged 2-3 / year, involving Residents/junior
faculty.
9. Emergency situation: casualty duty to be arranged by
rotation among the PGs with a faculty cover daily by
rotation.
47
10. AFTERNOON Clinics;
i.
Vertigo Clinic (Friday): all the patients of vertigo
attending ENT OPD/ referred cases are worked up
in details by the junior residents and are discussed
with one/two faculty and treatment decided upon.
ii. Tumour clinic/Head & neck cancer clinic
(Tuesday): in collaboration with the Radiotherapy
Department the patient with head and keep in the
file of ENT and Head and Neck are worked up by
the junior resident and discussed about the then
management by the ENT as well as Radiotherapy
Consultants and treatment decision made.
iii. Rhinology clinic: for patients with sinus diseases
and nasal deformity for rhinoplasty-presented and
are discussed. Decision for FESS/ Rhinoplasty are
made.
iv. Otology clinic: the ear cases are thoroughly
investigated and are discussed by the junior
residents
with
the
faculty
for
their
management/discussions are made after each case
is presented. Audiologist also participates in this
clinic.
11. Bedside clinical training for patient care management and for
bedside manners:
Daily for half to one hour's duration during ward
round with faculty and 1-2 hours in the evening by senior
resident/Faculty on emergency duty, bedside patient care
discussions are to be made.
Teaching Rounds by Rotation
1. Death cases: the records of such cases are presented
by the senior residents. The junior Residents are
encouraged to participate actively in the discussion in
the presence of Faculty of ENT and hospital
administration. This programme helps to take
corrective measures as well as to maintain account
ability in patient management.
2. Clinical Teaching: In OPD, Ward rounds. Emergency,
ICU and the Operation Theatres: Residents/Senior
Residents and Faculty on duty in Respective placesmake discussion on clinical diagnosis/surgical
48
procedures/treatment modalities, including post
operative care and preparation discharge slip.
3. Clinical
interaction
with
audiologists/speech
therapist: Clinical interaction with audiologist/
speech therapist pertaining to management of the
patients with audiological/ speech problems is to be
made/discussion arranged. Audiologic methods and
therapy strategies are to be made known to Resident
doctors.
V. SCHEME OF EXAMINATION
Theory Exams:
(3 Courses 100) 300 Marks
Practical Exams:
Identification
of
instruments
&
discussion,
interpretation as audio vestibular investigations such as
audiogram, ABR, ENG etc. Simulated surgical situation /
steps of operative procedures, required instruments /
discussion.
2. Viva Examination
50 Marks
i.
One long case: The long case will be structured,
comprising history taking, clinical examination,
investigations,
decision
making,
proposed
treatment modalities, ethical justification and
personal attributes.
80 Marks
ii. Two short cases: The short cases will also be
structured in which only one particular system
49
may be considered and therapy decision /
discussion, made.
70 Marks
Note: Modifications may be made in the method of
practical examination to bring about objectivity in
the exam and an attempt may be made to eliminate
individual bias in the conduction of the exam.
VI. RECOMMENDED BOOKS & JOURNALS
Books
1. Scott Brown Otolaryngology-VoI-1 to Vol-6 :6th
edition
2. Ballenger's diseases of the nose,throat,ear,head,neck
3. Glamassock and Shambaugh-surgery of the ear
4. Rob smith-operative surgery
5. Radiology of head and neck-Vaivossor
6. Mawson's diseases of the ear
7. Micro surgery of skull base by Ugo fish
8. Textbook of operative surgery by Lee
9. Essentials of medical pharmacology-Tripathi
10. Gray's Anatomy-38~ edition
11. Gyton textbook of medical Physiology-Xth edition
Journals
1. Indian Journal of otolaryngology
2. British journal of otolaryngology
3. Laryngoscope
4. North American clinics of otolaryngology
5. ACTA oto laryngoligica
6. Archives of otolaryngology, head and neck surgery
50
POSTGRADUATE DIPLOMA IN
MEDICAL RADIO DIAGNOSIS (D.M.R.D.)
I. PREAMBLE
The aim of this course is to make the students
seeking the Diploma in Medical Radio Diagnosis to
acquire knowledge about the various investigative
modalities that are available at present and their utilities
in various medical Diagnostic problems. They should be
able to arrive at a possible clinical, Radiological and
Pathological diagnosis based on their basic knowledge
they possess in the Undergraduate course.
This postgraduate training course would be to train an
undergraduate medical degree holder, who would be able:
1. To do independent practice in Radiology and Imaging,
with support of his knowledge and practical skill.
2. To show a humanitarian approach to any sick or
suffering person approaching for some medical
problem.
3. To show his interest in updating his knowledge now
and then by attending the various Continuous
Medical Education programmes.
4. To show his interest in sharing his knowledge with his
colleagues, as a senior person or as a teacher or as a
consultant.
II. PROGRAMME OBJECTIVES
The main aim of training a candidate is based on the
following objectives. These objectives are to be gained
during the course of their training and before they
complete the courses. The objectives are:
1. Theoretical knowledge.
2. Practical skill.
3. To follow the medical ethics and to be aware of
consumer problems.
Theoretical Knowledge
To describe the aetiology, patho-physiology,
principles of diagnosis and management of
common problems including emergencies both in
adults and children.
51
To know the indications and methods for fluid and
52
Medical Ethics and Consumer Problems
To adopt ethical principles in all aspects of ones
practice. Professional honesty and integrity are to
be fostered. Care is to be delivered irrespective of
the social status, caste, creed or religion of the
patient.
To develop communication skills, in particular the
skill to explain various options available in
management and to obtain a true informed
consent from the patient.
To develop leadership and to get the best out of
his aim in a congenial working atmosphere.
To apply high moral and ethical standards during
the work on human or animal research.
To be humble and accept the limitations in his
knowledge and the skill and to ask for help from
colleagues when needed.
To respect others feelings, rights and privileges
including patients right to ask for the information
and to seek for second opinion.
III. COURSE CONTENTS
Part I
COURSEI : MEDICAL RADIATION PHYSICS AS APPLIED
TO RADIO DIAGNOSIS
1. Ionising Radiation
Structure of atom
Radioactivity and radionuclides: basic definition of
alphs, beta and gamma radiation, principles of
exponential decay, specific activity and units of
activity, simple calculations using exponential
decay
Electromagnetic spectrum
General properties of x- and gamma rays:
wavelength , energy , inverse square law
2. Production of X- rays
Basic priciples of a rotating anode x-ray tube
Basic factors that influence x-ray output from
different types of x-ray machinery: anode material,
kV, mA , focal spot size, tube rating, filtration
53
3. Physical Interaction of Ionising Radiation with Matter
Interation of x- and gamma rays with matter:
coherent, Compton and photoelectric interactions,
concepts of attenuation, absorption and scatter
and their practical consequences
4. Clinical effects of Ionising Radiation on Living Tissue and
Radiation Protection
Statutory responsibilities : an appreciation of
relevant legislation and codes of practice
The contents as specified by the International
Council of Radiation Protection regulations
Genetic and somatic effects of ionising radiation
Relative risks of ionising radiation
Principles of dose limitation, including the various
practical means of dose reduction to staff and
patient with special consideration of females and
children
Staff
and patient doses: magnitude and
measurement
5. The Radiological Image
Geometric factors and magnification, effect of focal
spot size, geometric movement and unsharpness.
Conventional
filem/screen
systems:
basic
structure, characteristic curve, latitude, density,
speed, contrast and how to influence or
manipulate it.
Basic principles and effects of film processing
Basic principles of image intensification. Operatorcontrolled variables
Basic principles of digital imaging, picture
archiving and communications systems (PACS)
6. Computed Tomography
Principles of tomography
Basic principles and components of the system,
helical scanning , detector types
54
Operator-controlled variables, eg. Slice thichness,
55
Single photon emission computed tomography
Part II
COURSEI : RADIO DIAGNOSIS INCLUDING NUCLEAR
MEDICINE
General Radiology, contrast investigations, including
Radiological Anatomy, Physiology and pathology of
different systems of the body in normal and diseased
conditions and Radiographic Techniques applied to the
appropriate situations. Nuclear Medicine as applicable to
Radio Diagnosis.
COURSEII : RADIO DIAGNOSIS, IMAGING INCLUDING
INSTRUMENTATION
General Radiology, Computed Tomography, Magnetic
Resonance Imaging, Ultrasound Imaging, Doppler
applications,
Instrumentations
and
Interventional
procedures, and Recent advances system wise in
normal and disease conditions.
System Wise Details
a) Respiratory System
Includes the following methods of investigations and
interpretation of chest x-rays, chest wall, Diaphragm,
pleural disease and air way disease, pulmonary infections,
pulmonary neoplasms, diffuse lung disease, Mediastinal
disease, Chest trauma, post operative lung and intensive
care.
b) Alimentary and Hepatobiliary System
Congenital anomalies of GI tract, disease and
disorders of mouth, pharynx, esophagus, stomach, small
intestine, large intestine, disease of omentum and
mesentery,
acute
abdomen,
abdominal
trauma,
application of newer imaging modalities and Isotope study.
CT, MRI, in hepato biliary system, diseases and disorders,
Isotope study applicable to hepato biliary system, spleen
and portal system.
56
c) Head and Neck and Spinal Column
Includes Radiological armamentarium of diagnostic
modalities and their application in various neurological
and neuro-surgical disorders.
Investigative procedures of congenital lesions,
vascular lesions, infective lesions, metabolic lesions,
traumatic lesions and neoplasia of the central nervous
system and interventional procedures under the guidance
of various diagnostic instruments.
Diseases and disorders of spinal column and spinal
cord, including the interventional and diagnostic
procedures applicable to it.
d) Cardiovascular System
Role of Radiological imaging by different techniques
including DSA and interventional procedures.
Disease and disorders of Cardiovascular system
including Congenital conditions and the role of imaging by
conventional x-ray investigations, Ultrasound, Doppler,
CT, MRI, Angio including Digital Subtraction angiography
in peripheral vascular study and Radio Isotope studies.
e) Endocrine System
Imaging of disorders, disease and congenital
conditions of endocrinal glands, pituitary, thyroid, para
thyroids, adrenals, pancreas, ovarian and testes.
Newer methods of imaging techniques including
interventional procedures applicable to each organ.
f) Genito Urinary System
Uses of conventional radiographic procedures,
Ultrasound, Radio isotope techniques, CT, MRI, in various
disease and disorders of Genito urinary system, including
the interventional procedures.
g) Musculo Skeletal System
Role of conventional, Ultrasound, Radio nuclide
studies, CT, MRI investigations of disease and congenital
conditions that involve the muscles, soft tissues, bones
and joints.
57
h) Soft Tissue Radiology
Various disease status of soft tissues like breast,
extremities and the role of radiological and imaging
techniques.
i) Interventional Radiology
Includes all procedures like interventional diagnostic
and therapeutic procedures to arrive at a positive
diagnosis or to alleviate the patients agony.
j) Recent Trends and Advances
That includes information and imaging information
that are published in National and International Journals,
News Bulletins, PACS, Digital radiography, CT, MRI, and
Nuclear medicine.
IV. SCHEME OF TRAINING
Teaching / Learning Activities
A candidate undergoing this course should work in
the institution as a full time student. No candidate shall
be permitted to attend any clinic/laboratory/nursing
home while undergoing the course. Each year will be
taken as a unit for the purposes of calculating the
attendance. Every student should attend all teaching and
learning activities during each as prescribed by the
department and not to absent himself / herself from work
without valid reasons.
A list of teaching and learning activities shall be
designed to facilitate students to acquire essential
knowledge and skills outlined is as follows:
1. Lectures: Lectures are to be kept to a minimum.
They may, however, be employed for teaching certain
topics. Lectures may be didactic or integrated.
a)
b)
58
2. Journal club: Planned to have once in a week. All
the PG students are expected to attend and to actively
participate in discussion and in presentation. Such
activities should be entered in the LOG book with relevant
details. Every student will be expected to present an
article from the latest journals and to discuss about it,
atleast 3 times in a year. This would be evaluated and
suitable weightage will be given for satisfactory completion
of the course.
3. Student symposium: Recommended for optional
multi disciplinary programme. The evaluation may be
similar to that described for other activities.
4. Seminars: Recommended to be held once a week.
All the PG students are expected to attend and actively
participate in discussion and enter in the Log Book with
relevant details. Further every candidate must present on
selected topics at least three times a year. Such activities
will carry a weightage for the satisfactory completion of the
course.
5. Clinicopathological conference: Recommended
once a month for all post graduate students. Presentation
is by rotation. Active participation in the discussion is
expected. If there are no cases available, published
CPCs may be taken for discussion.
6. Clinical case presentation: Candidates should
periodically present cases, which also will be assessed.
7.
Inter
departmental
meetings:
Strongly
recommended particularly with departments of Medicine,
Surgery, Orthopaedics, Paediatrics etc. Such meetings
should be attended by all post graduate students of
concerned specialities. Proper entries should be made in
the Log Book.
8. Ward rounds: Post graduate students should
make ward rounds during their posting in clinical
departments and should attend to the patients care,
should take care about working out the newly admitted
patients, should discuss about the case with the teachers,
59
seniors and other colleagues. So also should attend all
clinics by their Professors, and other teaching faculties.
9. Continuing Medical Education Programmes
(CME): Recommended to attend at least 2 or 3 state level
CME programme in the duration of 3 years.
10. Conferences: All postgraduate students are
encouraged to attend state level and National level
conferences in this speciality at least once, during the
course of 2 years.
The post graduate students are expected to maintain
Diary (Log Book) with relevant entries of day to day work
done, in addition to the entries made as mentioned above.
Rotation Postings: (during Second Year)
1.
3 months
2.
Medicine
1 month
3.
Surgery
1 month
4.
Obstetrics
15 days
5.
Paediatric department
15 days
60
Trust worthiness and reliability
To understand and communicate intelligibly with
61
Such records/diary/Log Book maintained by each
postgraduate student and supervised and attested by
teaching faculties in the department.
The duration of the Training Programme is two years.
The Contents of the Course shall be covered as follows:
First Year
Medical Radiation Physics.
General Radiology, Ultrasound and
Tomography shall be taught concurrently.
Computed
Second Year
General Medicine, General Surgery, Obstetrics and
Gynaecology, Paediatrics and Orthopaedics as Rotation
Postings.
Postings to Apollo Hospital for learning Magnetic
Resonance Imaging, Interventional aspects of Radiology
and Radio active isotope imaging.
General Radiology, Applied Radiological Anatomy,
Physiology and Pathology, Ultrasound imaging, Doppler
and Computed Tomographic imaging.
V. SCHEME OF EXAMINATION
a) Theory: There shall be Three question papers,
altogether, are to be answered in the examination.
These papers shall be considered under Part I and Part II.
PartI
a) Theory: One Course shall be at the end of First
Year. The subject for this Course shall consist of Medical
Radiation Physics as applied to Radio Diagnosis.
There will be 2 sections to be answered.
Section A: shall consist of 20 MCQ model
questions, each question carrying 01 - mark.
The time given for answering this paper is 20
minutes. (Total marks 20)
Section B: shall consist of 2 long questions, each
carrying 20 marks. And there will be 4 short
questions, each carrying 10 marks. The time given
62
for answering this section is 2 hours and 40 minutes.
(Total marks - 80)
The maximum marks for the whole Course
(section A & B) is 100.
The total time for the above Course is 3 hours.
b) Practical: 50 marks
Shall consist of practical examination concerned with
Medical Radiation Physics as applicable to Radio
Diagnosis.
c) Viva Voce: 50 marks
All examiners will conduct the viva voce conjointly,
on the various aspects of Medical Radiation Physics as
applicable
to
Radio-diagnosis,
concerned
with
conventional x-rays, computed tomography, ultrasound,
Doppler and Magnetic Resonance Imaging and Radionuclide imaging.
PartI:
a) Theory: The examination for Part II shall be at the
end of second year. There will be Two Course, each with
the maximum marks of 100 each and with a time duration
of three hours.
COURSEI : RADIO DIAGNOSIS INCLUDING
NUCLEAR MEDICINE
Consists of questions from General
contrast investigations and Nuclear Medicine.
Radiology,
63
There will be 2 long questions of essay type, each
carrying 25 marks, and 5 short essay questions, each
carrying 10 marks.
Total Marks is 100.
Time: 3 hours.
b) Clinical: 150 marks
a) Long Case - 1 80 marks
b) Short cases - 2
70 marks
Theory
Part I
D.M.R.D.
Practical Viva
Section A
20
Section B
80
Grand
Total
100
50
50
200
200
150
50
400
CourseI : 100
Part II
CourseII : 100
- Sutton
- Grainger
- Rumack
- Sheldin Baur
-Dr.SubbaRao
- Osborn
64
7. Fundamentals in Radiology Physics - Meredith &
Massey
8. Christensens Physics of Diagnostic Radiology Thomas S. Curry
9. Radiographic Anatomy - Isodore Meschan
10. Clerks Positioning in Radiography
Reference Books
1. Diagnostic Radiology, CT and MRI whole body - John
Haaga
2. Paediatric X-ray Diagnosis - John Caffey
3. Roentgen Signs in Diagnostic Imaging - Isodore
Meschan
4. Felson Chest Roentgenology
5. Alimentary tract Radiology and Imaging - Margulis
6. Aids to differential Diagnosis - Chapman
Journals
1. Indian Journal of Radiology and Imaging
2. American Journal of Radiology
3. Clinical Radiology
4. Radiologic Clinics of North America
5. Journal of Diagnostic Medical Sonography
6. Journal of Computed Assisted Tomography
7. Clinical Nuclear Medicine.
65
66
b) Clinical / Practical skills:
A student should be
an expert in good history taking, physical examination,
providing basic life support and advanced cardiac life
support, common procedures like FNAC, Biopsy,
aspiration from serous cavities, lumber puncture etc.
He/she should be able to choose the required
investigations.
c) Research:
He/she should know the basic
concepts of research methodology, and should know how
to consult library. Basic knowledge of statistics is also
required.
d) Teaching: He/she should learn the basic
methodology of teaching and develop competence in
teaching medical / paramedical students.
III. COURSE CONTENTS
COURSEI : APPLIED BASIC SCIENCES RELATION TO
DERMATOLOGY, VENEREOLOGY AND LEPROSY
The
67
Metabolism of carbohydrates, proteins, fats and
68
Ichthyoses and ichthyosiform dermatoses.
Vesiculo Bullous Disorders
Kyrles disease and other perforating disorders.
Erythema
multiforme,
Stevens-Johnson
syndrome, Toxic epidermal necrolysis
Bullous pemphigoid, Pemphigus
Chronic bullous disease of childhood.
Herpes gestationis (pemphigoid gestationis)
Hereditary epidermolysis bullosa
Epidermolysis bullosa acquisita
Dermatitis herpetiformis
Familial benign pemphigus
Subcorneal pustular dermatoses
Pustular eruptions of palms and soles
Disorders of Epidermal Appendages and Related Disorders
Disorders of hair and nails
Disorders of sebaceous glands
Rosacea, Perioral dermatitis, Acne
Disorders of eccrine and apocrine sweat glands
Follicular syndromes with inflammation and
atrophy
Epidermal and Appendageal Tumours
Precancerous lesions, squamous cellcarcinoma
and Basal cell carcinoma
Keratoacanthoma, Benign epithelial tumours,
Appendageal tumours
Merkel cell carcinoma, Pagets disease
Disorders of Melanocytes
Disorders of pigmentation, Albinism, Benign
neoplasia and hyperplasias of melanocytes,
Dysplastic melanocytic nevi, cutaneous malignant
melanoma.
Inflammatory and Neoplastic Disorders of the Dermis
Acute Febrile Neutrophilic dermatosis(Sweets
syndrome)
Erythema Elevatum Diutinum
Cutaneous Eosinophilic Diseases
Granuloma Faciale
69
Pyoderma Grangrenosum
Erythema Annulare Centrifugum
and other
Figurate Erythemas
Granuloma Annulare
Malignant Atrophic Papulosis (Degos Disease)
Neoplasms, Pseudo neoplasms and Hyperplasias
of the Dermis.
Vascular Anomalies
Kaposis Sarcoma
Anetoderma and other Atrophic Disorders of the
skin
Ainhum and pseudoainhum
Neoplasias and hyperplasias of Neural and
Muscular origin
Elastosis Perforans Serpiginosa and Reactive
Perforating Collagenosis
Lmphomas, Pseudolymphomas and Related Conditions
Disorders of Subcutaneous Tissue
Panniculitis
Lipodystrophy
Neoplasms of the subcutanceous Fat
Disorders of the Mucocutaneous Integument
Biology and Disorders of the oral Mucosa
Disorders of the Anogenitalia of Males
Females
and
Complement
Abnormalities
Graft-versus-Host Disease
Muco-cutaneous
Manifestations
in
immunosuppressed host other than HIV-infection.
Contact Dermatitis
Auto Sensitization Dermatitis
Atopic Dermatitis (Atopic Eczema)
Nummular Eczematous Dermatitis
Seborrhoeic Dermatitis
Vesicular, Palmoplantar Eczema
70
Skin Changes due to Mechanical and Physical Factors
Occupational skin disease
Radiobiology of the skin
Skin problems in Amputee
Sports Dermatology
Skin problems in War field
Decubitus Ulcers
Photomedicine, Photo Biology and Photo Immunology in Relation
to Skin
Acute and chronic Effects of Ultraviolet Radiation
Therapy
zinc
deficiency disorders
Cutaneous changes in Errors of Amino Acid
Metabolism : Tyrosinemia II, Phenylketonuria,
Argininesuccinic Aciduria, and Alkaptonuria,
Amyloidosis of the skin.
The porphyrias
Xanthomatosis and Lipoprotein Disorders
Fobrys Disease ; Galactosidase A deficiency
(Angiokeratoma Corporis Diffusum Universale)
Lipoid Proteinosis
Cutaneous mineralisation and Ossification
Heritable Disorders of Connective Tissue with skin
changes
Heritable Disease with increased Sensitivity to
Cellular injury
71
Basal Cell Naevus Syndrome
Skin Manifestations of Hematologic Disorders
Skin changes in hematological Disease
Langerhans
Cell
and
other
cutaneous
histiocytoses
cardiovascular,
pulmonary
disorders
and
endocrinal disorders
Skin changes and diseases in pregnancy
Skin changes in the Flushing Disorders and the
Carcinoid syndrome
72
Skin Manifestations of Rheumatologic Disease
Lupus Erythematous
Dermatomyositis
Scleroderma
Systemic Necrotizing Arteritis
Cutaneous Necrotising venulitis
Cryoglobulinemia and Cryofibrinogenemia
Relapsing Polychondritis
Rheumatoid Arthritis, Rheumatic Fever and Gout
Sjogrens syndrome
Raynauds phenomenon
Reiters syndrome
Multicentric Reticulohisticytosis
Cutaneous Manifestations of Disease in other Organ Systems
Sarcoidosis of the skin
Cutaneous Manifestations of Internal Malignancy
Acanthosis Nigricans
Scleredema
Papular Mucinosis
Neurocutaneous Disease
Tuberous Sclerosis Complex
The Neurofibromatosis
Ataxia Telangiectasia
Behcets Disease
Bacterial Diseases with Cutaneous Involvement
General Considerations of Bacterial Diseases
Pyodermas
:
Staphylococcus
aureus,
Gangrenous Cellulitis
Gram. Negative Coccal and Bacillary Infections
Bartonellosis
Miscellaneous Bacterial Infections with Cutaneous
Manifestations
Tuberculosis and other mycobacterial infections
Actinomycosis, Nocardiosis, and Actinomycetoma
Lyme Borreliosis
Kawasaki Disease
73
Fungal Diseases with Cutaneous Involvement
Superficial Fungal Infection : Dermatophytosis,
Versicolor
Deep Fungal Infections
74
Therapy of STDs inclusive of HIV & opportunistic
Leprosy
Approach to the patient with leprosy
Epidemiological Aspects
Structure,
biochemistry,
microbiology
of
Mycobacterium leprae
Structure of Nerve
Animal models
Pathogenesis
Classification
Immunology and molecular biological aspects
Histopathology and diagnosis including laboratory
aids
Clinical features
Reactions
Systemic involvement (Ocular, bone, mucosa,
testes and endocrine etc.)
Pregnancy and leprosy
HIV infection and leprosy
Therapeutic aspects including newer drugs
Immunotherapy
Disabilities, deformities and Rehabilitation
Prevention, education and counselling
National
Leprosy Control and Elimination
Programme
IV. SCHEME OF TRAINING
A. Theory: Training in theory is given as per the following:
i.
75
implication of such results in the present set up.
National and International journals will be
reviewed.
iv. Symposium: He/she is required to present at least
one symposium per year. The topics will be chosen
by the faculty members.
v. Guest Lectures: Guest Lectures will be arranged by
the department. Eminent speakers will deliver
lectures.
vi. Test: Regular tests will be conducted once in three
months and the marks are taken into
consideration for internal assessment.
vii. Integrated Lectures: Integrated seminars involving
more than one department is arranged once a
week. Postgraduate student is trained to
participate in this.
viii. Conference: He/she is required to present at least
one Course during the course in national / Zonal /
state level conference.
ix. CME: He/she is required to attend one CME
programme during course which is conducted
along with conference or separately in other places
or on the institution.
B. Clinical
1st Year: First month after joining he/she is posted in
the ward for orientation programme. During this period
he/she is taught to elicit a detailed history, use
dermatological
terminologies
basics
of
various
investigations ordered and to interpret the normal values.
Next ten months they will work in the ward, write the
case sheet and administer treatment.
During the end of first year he/she is posted in
pathology to interpret the basic dermtopathology slides
and in microbiology to learn procedures take fungal
culture, bacterial culture, VDRL, ELISA, etc.,
2nd Year: Candidate is posted in the ward every day
after OP hours. He/she is expected to make a diagnosis
76
and manage patients on their own and able to discuss the
differential diagnosis.
Time of Posting
He/she must work in OPD on all days from 08.00 am
to 11.30 am and expected to learn diagnosis and
management of out patients. After the OPD hours he/she
is posted in the ward.
Training is Venereology is given for three months in
the OPD. Leprosy training is given on all leprosy clinic
days ie. Tuesday between 02.00 03.00 pm.
Training Programme
Days
Monday
Tuesday
Wednesday
08.00 to 11.30
OPD
OPD
OPD
11.30 to 01.00
Ward
Ward
Ward
Thursday
OPD
Ward
Friday
Saturday
OPD
OPD
Ward
Ward
02.00 to 04.00
Journal Club
Leprosy Clinic
Integrated
Lectures
Dermatology
Seminars
STD Seminars
-
V. SCHEME OF EXAMINATION
Examination will be conducted at the end of two year
period.
A. Theory
CourseI
CourseII
: Principles of
Therapeutics
CourseIII
Dermatologic
Diagnosis
B. Clinical Examination
Long Case: 1 (Dermatology)
Short Cases: 2 (One in Venereology and
one in Leprosy)
Spotters (Ten) (Dermatology, Venereology
and Leprosy)
C. Viva Voce
150 Marks
Time
45 Mins.
Marks
75 Marks
40 Mins.
50 Marks
4 Mins.
25 Marks
Max. Marks: 50
77
In the afternoon viva voce is conducted to test the
knowledge in dermatology, Venereology and Leprosy. This
includes X-rays, charts, topical agents, instruments, etc.
VI. RECOMMENDED BOOKS AND JOURNALS
Books
1. Rook et al Text Book of Dermatology 4 Volumes (Ed. 6)
2. Fitzpatric TB et al Dermatology General Medicine
2 Volumes (Ed. 4).
3. IADVL, Text Book of Dermatology (Ed.2).
4. Demis DJ: Clinical Dermatology: Five Volumes
(Ed. 12).
5. Lever WF & Lever GS: Histopathology of the Skin
(Ed. 8).
6. Shelly WB & Shelley ED: Advances in Dermatologic
Thereapy.
7. King & Nicol Text Book of Venereology.
8. King & K.Homes, Text Book of Sexually Transmitted
Diseases (Ed.3).
9. Jopling EH: Hand Book of Leprosy ELBS.
10. Bryceson et al: Leprosy (Ed. 3).
Journals
1. Achieves of Dermatology.
2. British Journal of Dermatology.
3. Journal of American Academy of Dermatology.
4. International Journal of Dermatology.
5. Indian Journal of Dermatology, Venereology &
Leprosy.
6. International Journal of Sexuality Transmitted
Diseases.
7. Dermatology Clinics.
8. Indian Journal of STD.
9. Indian Journal of Leprosy.
78
79
b) Systemic pathology
c) Haematology
d) Blood Banking including Transfusion Medicine
e) Cytopathology
f) Laboratory Organization including quality control
Microbiology
a) General Microbiology
b) Serology
c) Basic systemic microbiology
Biochemistry
Metabolic disorders and the related investigations.
Postings
Histopathology
4 months
Cytopathology
4 months
Haematology & Blood Bank 8 months
Biochemistry
4 months
Microbiology
4 months
Pathology
1. Regular postings in various sections, Histopathology,
Autopsy, Cytology, Hematology, Blood Bank &
Museum Techniques.
2. Regular Seminars in Various subjects (Please see
Chapter IV also)
Specimen discussion
Slide seminars
Various techniques short subjects
Cytology including FNAC
Hematology various methods
WHO Transparencies review
Journal Club
Clinic pathological conference (C.P.C)
To attend conferences and present papers
To attend C.M.E.
Biochemistry
Basic Biochemistry applied to biochemical investigations
Handling of Photocolorimeter
Spectrophotometer
80
PH meter
Flame photometer
Semi Autoanalyser
Autoanalyser
Electrophoresis
Microbiology
1. Hands or experience in techniques, its interpretation
and reporting
a) Simple staining
b) Grams
c) Alberts
d) Z.N.
e) Hanging drop
f) KoH/ Lactophenol preparation
2. Staining and reporting of Peripheral blood smear for
MP/Microfilaria
3. Sterilization
techniques,
culture
identification and reporting Training only
methods,
Diagnostic
V. SCHEME OF EXAMINATION
A. THEORY (Written)
There shall be three question papers, each of three
hours duration. Each Course shall consist of two long
essay questions each question carrying 20 marks and
6 short essay questions each carrying 10 marks. Total
marks for each Course will be 100.
Questions on recent advances may be asked in any
or all the Courses.
81
Theory Examination: (3 x 100)
300 Marks
CourseI
100 Marks
CourseII
Systemic pathology
100 Marks
B. PRACTICAL
Day 1
100 Marks
1. Microbiology Exercise
2. Clinical case/ Data of examination/
Discussion
Haematology Exercise
Biochemistry Exercise
Urine Analysis
Afternoon 3. Hisopathology Techniques
Section Cutting
Hematoxylin Eosin Stain
Cytology Stain
Forenoon
25 marks
50 marks
25 marks
Day 2
1. Reporting on Microbiology exercise
2. Histopathology slides - 6
Afternoon 3. Cytology slides - 6
Haematology slides 8
Forenoon
50 marks
Afternoon
C. VIVA-VOCE
Viva-Voce Examination: (50 Marks)
Students will be examined by all the examiners
together about students comprehension, analytical
approach, expression and interpretation of data. Student
shall also be given case reports, charts for interpretation.
Maximum marks for
D.C.P.
Theory
Practical
Viva
Grand Total
300
150
50
500
82
3. Mc. Gee, Isaacson and Wright Edited, Oxford Text
Book of Pathology Vol. 1, 2a, 2b, Published by Oxford
University Press.
4. J.B. Walter, M.S. Israel, General Pathology, Published
by Churchill Livingstone
5. Wf Lever Gs Lever, Histopathology of the skin,
Published: J.B. Lippin Cott Company
6. Maxwell M Wintrobe, Clinical Haematology, Published
by K.M. Varghese & Company
7. De Gruchys Edited by Firkin, Chesterman,
Penington, & Rush, Clinical Haematology In Medical
Practice, Published by Oxford University Press.
Journals
1. British Journal of Haematology Published by
Blackwell Science
2. CANCER, International journal of the America cancer
society, published by John Wiley and sons, Inc.
3. Journal of Clinical Pathology, Publishing Group BMJ
4. Hematology/Oncology Clinics of North America,
Published by W.B. Saunders and Company
5. Histopathology, Journal of the British Division of the
international academy of pathology Published by
Blackwell Science
6. The American journal of Surgical Pathology,
Published by Lippincott Raven
7. ACTA Cytologica, The journal of clinical cytology and
Cytopathology
8. Archives of pathology and Laboratory medicine,
Published by the American Medical Association.
9. The Indian Journal of Pathology & Microbiology,
Published by IAPM
10. The Indian Journal of Cancer, Published by Indian
Cancer Society
11. Human Pathology, Published by W.B. Saunders
Company
12. Indian Journal of Cytology Published by Indian
Academy of cytology.
83
84
(ii) Clinical Knowledge: He/She should attain
understanding of and develop competence in executing
common general laboratory procedures employed in
diagnosis and research in rehabilitation medicine. He/She
should be able to practice and handle independently most
day-to-day problems as encountered in Rehabilitation
Medicine. He/She should also be able to recognize the
need to seek further help, when required.
(iii) Clinical Rehabilitation Medicine: Given
adequate opportunity to work on the basis of graded
responsibilities in out-patients, in-patient and operation
theatre on a rotational basis in the Division from the day
of entry to the completion of the training programme the
students should be able to: Acquire
85
common diseases in the field of rehabilitation medicine.
He/she should be able to integrate the preventive and
promotive methods with the curative and rehabilitative
measures in the treatment of diseases.
2.2.3 Community Rehabilitation Medicine
He/she should be able to practice rehabilitation
medicine at the community. He should be familiar with
the common problems occurring in rural areas and deal
with them effectively. Given an opportunity to participate
in surveys and camps, the candidate should be able to: Organize and conduct surveys in rural, urban and
the
current
86
certain changes are effected at the implementation level.
They are:
The number of Practice Task a candidate has to
87
5.2 Performance Audit
The following parameters are chosen for assessment
by faculty.
Sl
No
1
Item
Attendance
Scoring Method
Score/mark
s
81 to 85% - 1 mark
86 to 90% - 2 marks
91 to 95% - 3 marks
Over 96% - 5 marks
05
Assignments
2 per month
20
Publication,
Conference
National journal
Regional/National
05
Logbook
Workup of cases,
Procedures done
Report by Faculty on
Quality of work done
20
Total
50
88
The Part II Examination will take place at the end of
course. This part contains two papers for three hours and
carrying 100 marks each. The papers will be called as
Papers I, and II. A score of 50% of the aggregate, i.e., 100
out of 200 is essential for pass.
CourseI : Evaluation, CBR and Medical Applications
CourseII : Access, Prosthetics & Orthotics and Surgical
Applications
89
Sl.
No
Item
Maximum
Marks
15
ii.
05
Iii.
15
iv.
05
v.
10
vi.
Bedside procedure/investigation
Discussion (including recent advances)
Differential Diagnosis
Investigations/interpretation
Management
Community approaches
i.
vii.
05
15
15
10
05
Total
100
Nature Subjects
PartI
Basic
Sciences
Total
No. of Maximum
Course
Marks
1
Minimum
needed
for Pass
100
50
100
50
Remarks
Pass in Part I
needed to
appear in Part II
PARTII
:THEORY
300
Physical
2 papers @ 100
Medicine &
marks and int.
Rehabilitation Assessment
150
PARTII :
CLINICAL
PARTII : PMR
VIVA
Grand Total for Final Year
Subjects
200
Remarks
Nature
No of Course &
Marks
Sl No
Maximum Marks
90
Minimum
for pass in
PART II is
100 300 out of
600.
100
50
600
300
7.9 Results
A candidate who has secured 50% marks or more as
provided above at the Part II Final Examination will be
declared to have passed the Examination of DPMR in
PMR. Sub-classification of candidates who score more
than 60% at the Final Examination will be as per
University rules governing other medical Post-Graduate
courses.
A candidate who fails at the Final Examination can
appear again at the supplementary examinations
conducted by the University, subject to rules in force.
There is no limitation on the number of attempts made for
a pass
8. PROGRAMME CONTENT FOR D.P.M.R.
The course content would include the following:
8.1 Basic Science
The Basic science course will include Basic Medical
sciences like Anatomy, Physiology and Biochemistry, Paraclinical sciences like Pathology, Microbiology and
Pharmacology, Behavioural Sciences like Psychology and
Sociology, Statistics and Research Methodology, Medical
Electronics and Computers.
8.1.1 Basic Medical Sciences
91
Histology, Osteology, Arthrology, Myology, Neurology,
Genetics as applied to PMR., Introduction, Branches of
Physiology, Individual Difference, Emotion, Sensation and
perception, Muscle, Nerve, The Afferent Nervous System,
The Regulation of Posture, The Cerebellum, The Cerebral
Cortex, The Autonomic Nervous System, The Endocrine.
The Blood, Basic Biochemistry, Metabolism of Protein,
Carbohydrates,
Fats,
Fatty
acids,
Intermediary
Metabolism, Bone & Mineral Metabolism
8.1.2 Para-clinical Sciences
General & Special, Infection and Disease, Disease of
Cardiovascular system, Disease of Respiratory system,
Nutritional disorders, Disorder of Blood and forming
Organs, Transfusion Medicine, Disease f Endocrine
system, Disease of the kidney and Urinary system.
Disease of the Digestive System, Laboratory Procedures in
Pathology and Microbiology Pharmarokinetics and
Pharmacodynamics of Analgesics, NSAIDS, Muscle
relaxants, Antibone resorption agents, Anticoagulants,
Antihrombotics, Corticosteroids, Antispastics, Antibiotics
8.1.3 Behavioural Sciences
Learning, Memory and Forgetting, Motivation and
Emotion, Cognition: Thinking, Cognition: Intelligence and
Creativity, Personality, Attitudes, Social Identity, Prejudice
and Discrimination, Interpersonal Attraction, Close
Relationships, Social Influence, Pro-Social Behaviour,
Aggression, Application of Social Psychology, Sociology &
Health, Socialization, Social Groups, Family, Community,
Social
Problems,
Social
Welfare,
Understanding
Counselling in Organizations, Assessing various types of
Counselling provisions, Conflicts between values of
organization
and
Counselling,
the
roles
and
responsibilities of counselors, Vocation, Aptitudes, Skills,
Assessments, Rehabilitation.
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8.1.4 Statistics & Research Methodology
Definition and Scope of Statistics, Uses of Statistical
Methods, Data Collection Primary and Secondary Methods
in Experimental Data, Attributive Data, Contingency
Tables, Representation of Data, Measurement of Central
Value, Percentiles, Averages, Dispersion, Deviation,
Coefficient of Variation, Correlation and Regression,
Probability, Random Variable and Distribution, Sampling,
Nonsampling Errors and Control.
8.1.5 Physics, Medical Electronics & Computers
Elements of physics, Physical principles in
musculoskeletal function, Application of Physics in
Pathomechanics, Fundamentals of electricity and
Electronics; Their application in PMR, Heating effect of
current, Use of temperature and electricity in management
of diseases, Basis of Computer Applications, Computers in
Office, Office Automation, Internet, Search Engines, Use of
Internet as Educative, Therapeutic Research and
Administrative tool, Use and Access to Internet, Internet in
Academics, Research and Practice.
8.2 PMR Subjects
The Physical Medicine & Rehabilitation subjects will
include the following areas listed into 59 subtopics. They
are then divided into courses in PMR. All these courses
are compulsory for DPMR Programme.
8.2.1 Course I
1. Philosophy, history, scope and need of Rehabilitation
Medicine.
2. Disability process and epidemiology of Disability,
Levels of Prevention.
3. Evaluation
Process:
History
taking,
Clinical
evaluation, Muscle Charting, Joint range of Motion,
Goniometry, and outcome measures, Investigations,
Electro diagnosis in detail, Gait analysis.
4. Principles of disability evaluation, Basic Principles,
Various
methods-Outcome
measures
for
93
rehabilitation: QOL assessment, different scales for
evaluation
5. Recent Advances in
Physical Medicine and
Rehabilitation
6. Legislation in relation to disability, Rehabilitation and
Health
7. Schemes and Benefits extended to the Disabled
persons by the Government.
8. Architectural barriers, Ergonomics and accessibility
issues for the disabled persons.
9. Joint and Soft tissue injection techniques.
10. Ethics related to Medical Rehabilitation, Medicine and
Health
8.2.2 CourseII
1. Rehabilitation of patients with spinal cord injury,
Anatomy and physiology of the spine and spinal cord,
Mechanism of injury and fractures of spine, Clinical
presentation and acute management. Rehabilitation
of
paraplegia.
Rehabilitation
of
quadriplegia,
Management of bladder and bowel, Management of
complications of spinal cord injury
2. Rehabilitation of patients with neurologic disorders,
e.g. neuropathies, Bell's Palsy, LGB syndrome etc.
3. Rehabilitation of patients with diseases of muscles:
Muscular dystrophy, Introduction, types, inheritance,
presentation,
diagnosis,
Management
and
Rehabilitation
4. Rehabilitation of patients with neurogenic bladder,
incontinence, and principles of urodynamic studies.
5. Rehabilitation of patients with diseases of metabolic
disorders:
osteoporosis,
Osteomalacia,
rickets,
Diabetes Mellitus, gout Inborn errors of Metabolism
6. Rehabilitation of patients with diseases of back pain,
Introduction, causes, presentation, management and
Rehabilitation.
7. Rehabilitation of patients with diseases of neck pain.
8. Rehabilitation of patients with Cerebral Palsy
94
8.2.3 CourseIII
1. Rehabilitation with patients with diseases of
pulmonary
diseases
Introduction,
diagnosis,
investigations, Rehabilitation of C.O.P.D. and other
pulmonary conditions
2. Rehabilitation of patients with cardiovascular
diseases Anatomy and physiology of heart, Coronary
artery disease, Myocardial infarction, Hypertension,
Arrythmia, Principles of cardiac rehabilitation,
Rehabilitation of post Myocardial Infarction patient
and post coronary artery bypass surgery patient
3. Rehabilitation of patients with Stroke, Introduction
causes,
presentation,
investigation,
Initial
management and prevention of complications,
Rehabilitation of a hemiplegic patient
4. Rehabilitation of patients with head injury.
Introduction, causes, mechanism presentation,
Rehabilitation of a head injured patient
5. Rehabilitation
of
patients
with
poliomyelitis,
Introduction, pathogenesis, Clinical presentation,
acute management, Rehabilitation of polio patient,
Prevention of polio, Post Polio Syndrome
6. Rehabilitation of patients with Spina bifida and
Meningomyelocele, Neuro-degenerative conditions,
multiple sclerosis, dementia and related syndromes
7. Rehabilitation of patients with peripheral Nerve
Injury, Plexopathies.
8.2.4 CourseIV
1. Rehabilitation of patients with Orthopaedic problems,
Plaster applications, Management of Volkmann's
Ischaemic
Contracture,
Hand
Rehabilitation,
Fractures and complications. Spinal deformities,
Congenital deformities, C.T.E.V., Common foot
disorders, Osteoarthritis, Post-surgical patient, Hip
and knee contractures, Correction of Equinus
deformity, Principles of tendon transfers of foot and
ankle, knee and hip. Foot stabilization operations,
basic principles, various techniques, Neurectomy,
tendon lengthening, tenotomy, Neurolysis, Correction
95
of congenital and acquired deformities, Rehabilitation
after joint replacements (TKR and THR etc.)
2. Rehabilitation
of
patients
with
amputations,
Indications, levels and surgical techniques, Immediate
fitting of prosthesis, Rehabilitation of upper and lower
limb amputees
3. Rehabilitation of patients with Haemophilia
4. Rehabilitation of patients with Arthritis
5. Rehabilitation of patients with Leprosy
6. Rehabilitation of patients with Burns
7. Rehabilitation of patients with Rheumatoid arthritis,
Ankylosing Spondylitis and other rheumatic diseases.
8.2.5 CourseV
1. Rehabilitation of patients with chronic pain,
Principles of Palliative Medicine
2. Rehabilitation of patients with sports injuries, Medical
and Biomechanical principles
3. Geriatric Rehabilitation, Introduction, Senescence,
problems of aging, Rehabilitation of a geriatric patient
4. Rehabilitation of patients with cancer related
disability; introduction, relative incidence, cancer
pain,
Colostomy,
mastectomy,
Laryngectomy
management
5. Principles of rehabilitation medicine as applied to
Paediatrics and Obstetrics & Gynaecology.
6. Rehabilitation
of
patients
with
Vestibular
system/balance problems
8.2.6 CourseVI
1. Computers in Rehabilitation Medicine
2. Organization and administration of Rehabilitation
Medicine Services.
3. Principles and Prescription of Physical Modalities
4. Rationale and Prescription of Physical Therapy
5. Rationale and Prescription of Occupational Therapy
6. Rationale of A.D.L. (Activities of Daily Living)
7. Rationale and Prescription of Wheel Chairs, Assistive
devices
8. Human Walking. Gait analysis and training
96
8.2.7 CourseVII
1. Orthotics; Introduction, definitions, indications,
Biomechanics, Materials used, Prescription Writing,
Check out; Different types of orthoses for lower limbs,
upper limbs and spine, Recent advances in Orthotics
2. Prosthetics: Introduction, definitions, indications,
mechanics, Materials used, prescription writing,
Assessment of patient, check out of prosthesis, Upper
and lower limb prostheses, Recent advances in
prosthetics
3. Principles of rehabilitation of visually handicapped.
4. Principles of rehabilitation of mentally retarded.
5. Principles of management of hearing and speech
impaired.
6. Principles of management of psychological problems.
7. Principles of management of social problems.
8. Principles of management of vocational problems
8.2.8 CourseVIII
1. Medicine and allied specialties as applied to PMR
2. Surgery and allied specialties as applied to PMR
3. Medical Emergencies in Rehabilitation Medicine
4. Sexuality in Disabled; Rehabilitation and sexuality
5. Emerging Areas in PMR
9. LIST OF RECOMMENDED BOOKS
The recommended books are the same as for the
MD course in PMR.
(Acknowledgement: Generous inputs from Dr.S.
Bhattacharjee, Vellore, and Dr. U. Singh, New Delhi,
the reports by the MCIs PG Committee on syllabus and
the syllabi from Kerala University and the TN Dr. MGR
Medical University are hereby gratefully acknowledged
Dr. U. N. Nair).