The COSECSA Basic Science Course Manual

December 2013

Abebe Bekele, Akoko Larry, Ally Mwanga, Amazene Tadesse, António Luís Assis da Costa,
Brian Sonkwe, David Muchuweti, Dominique Mugenzi, Patson Makobore, Kondwani Chalulu,
George Mugenya, Fred Bisso, Georges Nyakiyiruta, Hamisi Shabani, Helder de Miranda,
Israel Dube, Kenneth Mbati, Kevin Lakati, Leonard Banza, Linda Chokotho, Dr Martin
Nyundo, Mwila Lupasha, Nelson Alema, Onesai Chihaka, Engida Abebe, Prem Yohannan.

It is to be noted that the below are to be considered as recommendations rather than final decisions.
The COSECSA Council, and its relevant committees, will have final say on all aspects relating to
COSECSA, and the RCSI/COSECSA steering committee will have final say on aspects relating to
RCSI/COSECSA.

About COSECSA Basic Science Courses................................................................................3

Physiology Short Course Syllabus.......................................................................................5

Pathology Short Course Syllabus........................................................................................8

Anatomy Short Course Syllabus........................................................................................10

Produced with the support of:

About COSECSA Basic Science Courses

The COSECSA Basic Science Faculty are:

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Anatomy

António Luís Assis da Costa (Mozambique)

Patson Makobore (Uganda)
Hamisi Shabani (Tanzania)
Abebe Bekele (Ethiopia)
Kondwani Chalulu (Malawi)
Martin Nyundo (Rwanda) Anatomy Representative
Israel Dube (Zimbabwe) Anatomy Representative
Kenneth Mbati (Kenya)
Michael Mbambiko (Zambia)

Pathology

Dominique Mugenzi (Rwanda)

Mwila Lupasha (Zambia) Pathology Representative
Nelson Alema (Uganda)
George Mugenya (Kenya)
Helder de Miranda (Mozambique)
Leonard Banza (Malawi)
Akoko Larry (Tanzania) Pathology Representative
Engida Abebe (Ethiopia)
David Muchuweti (Zimbabwe)

Physiology

Ally Mwanga (Tanzania)

Amazene Tadesse (Ethiopia)
Brian Sonkwe (Zambia)
Fred Bisso (Uganda) Physiology Representative
Georges Nyakiyiruta (Rwanda)
Kevin Lakati (Kenya)
Linda Chokotho (Malawi) Physiology Representative
Onesai Chihaka (Zimbabwe)
Prem Yohannan (Mozambique)

Due to circumstances beyond their control, or because they replaced another faculty member
who had to leave the programme, Drs da Costa, Banza and Lakati attended two out of the three
courses, while Dr Mbambiko and Dr Yohannan attended one. All others attended all three
courses.

1. Timing and Frequency of Courses

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Each course is to last 3-4 days. Courses should be held a minimum of 4 times in each two year
period. Some countries plan to devote equal amount of time to all 3 disciplines, others to
devote extra time to physiology.

2. Material needed for Basic Science Course

a) Flash disks
b) Anatomy DVDs
c) Access to School for Surgeons for all COSECSA trainers and trainees
d) Projector
e) Printing costs

3. Fees and Costs

It is recommended that trainee fees be incorporated in registration fees (it should be noted that
the size of this fee presents a greater challenge in some countries).
The standard COSECSA per diem for trainers of US$50 per day shall be adhered to.
Travel allowance for trainees will differ from country to country.

4. Input of Basic Science Faculty into Exams

It was noted that candidates learn what is examined, and that it is vital that the trainings given
and examinations are aligned. For this reason it is recommended that basic sciences play a
greater role in both the written and clinical/VIVA exam processes.

5. Communication among and on behalf of group members

This will take place through the selected representatives of each discipline as previously
indicated.

6. Academic Support
RCSI will provide:
 Help, advice and guidelines on MCQ question writing
 1 External examiner per year
 RCSI faculty will also be available to COSECSA Basic Science Faculty though email for
advice etc.

COSECSA Physiology Short Course Syllabus

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 A draft outline of physiology topics relevant to safe and effective practice of surgery.

1. Cell Physiology
a) Cell structure and composition.
b) The Cell Membrane.
c) Transport across Cell Membranes.
d) Passive exchange of water and solutes.
e) Energy dependent transport across plasma membranes.
f) Cell volume regulation.
g) The Physiology of Excitable Cells (Nerve and Muscle)
h) Resting membrane potential (RMP)
i) Cellular communication

2. Body Fluids and Acid-Base Balance

a) The Body Fluid Compartments.
b) The Composition of Body Fluids.
c) Regulation of fluid and solute exchange between Compartments.
d) Clinical abnormalities of body fluids; causes and treatment.
e) Intravenous Fluids & Blood Products.
f) Acid-Base Regulation.
g) Abnormalities of Acid-Base Balance.

3. Blood
a) The Composition of Blood & Function of Blood Components.
b) Blood formation and its abnormalities.
c) Blood Groups & Blood Transfusion.
d) Hb/O2 Dissociation Curve.
e) Haemoglobinopathies.
f) Coagulation Cascade/ Haemostasis & clinical abnormalities.

4. Renal Phsyiology
a) Physiologic Anatomy of the Kidneys; the Nephrone.
b) Glomerular Structure and function.
c) Renal blood flow.
d) Tubular Function: Urine Formation by the Kidneys.
e) Regulatory Functions of the Kidneys; Solute regulation, water regulation, PH regulation.
f) Clearance.
g) Micturition
h) Renal Failure & Dialysis.

5. Circulatory System
a) Overview of the circulation.

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 b) The Medical Physics of Pressure, Flow and Resistance.
c) Cardiac output, Stroke volume and heart rate.
d) Regulation of Blood Pressure and Peripheral blood flow.
e) The Microcirculation, Lymph and their abnormalities.
f) Circulation through special areas: Coronary; Cerebral; Renal; Skin; Muscle; GIT.
g) Shock
h) Oedema
i) Hypertension and Surgery.
j) Cardiac Failure and Surgery.
k) Cardiac Arrest.

6. Respiratory Physiology
a) Overview of Respiratory Anatomy.
b) Lung Volumes, Capacities and their Clinical Relevance.
c) The Mechanics of Breathing.
d) The Physics of Gas Exchange in the Lungs and Tissues.
e) Oxygen & Carbon Dioxide Transport in the blood.
f) Pulmonary Circulation & Pulmonary Oedema
g) Ventilation / Perfusion relationships and their abnormalities.
h) Regulation of Respiration
i) Respiratory insufficiency.
7. Gastro-Intestinal Physiology
a) Overview of the Structure and innervation of the Gastrointestinal Tract.
b) Regulation of the digestive system.
c) Defensive mechanisms in the digestive tract.
d) GIT Hormones.
e) GIT Motility & its Disorders.
f) GIT Secretions and their Disorders.
g) Digestion, Absorption and their abnormalities.
h) The Exocrine pancreas.

8. Endocrine Physiology and Body Metabolism

a) Overview of Hormones.
b) Mechanism of Action of Hormones.
c) Pituitary Hormones.
d) Thyroid Hormones.
e) Adrenal Hormones.
f) The Endocrine Pancreas.
g) Hormonal Regulation of Calcium & Phosphate Metabolism.
h) Gonadal Hormones and their abnormalities.
i) Overview of the Metabolism of Carbohydrates, Lipids and Proteins.
j) Metabolic Functions of the Liver.
k) Dietary Balances and Nutritional deficiencies.

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9. Neurophysiology
a) General Design of the Nervous System.
b) Neurotransmission (Electrical signals: graded and action potentials; synapses and
neuronal integration).
c) Sensory Receptors and Neuronal Circuits; Somatic and Special Sensory Systems.
d) The Autonomic Nervous System.
e) The Control of Motor Function.
f) Higher Functions of the Cerebral Cortex.
g) Nervous Reflexes: The Stretch Reflex, Micturition, Defecation, Vomiting.
h) Cerebral Blood Flow, the Blood-brain Barrier, Cerebrospinal Fluid.
i) Intracranial pressure
j) Brain Metabolism.
k) Temperature regulation.
l) Pain.

10. Physiologic Response to Trauma

a) SIRS
b) CARS
c) MODS

Suggested Reading
1. Linda S.Constanzo: Physiology. 4th Edition.
2. Guyton & Hall: Textbook of Medical Physiology. 12 th Edition.
3. William F. Ganong; Review of Medical Physiology. 22 nd Edition.
4. Bray J., Cragg PA., et.al. Lecture Notes on Human Physiology. 3rd Edition
5. Sherwood L. Human Physiology from cells to systems. 4th Edition

COSECSA Pathology Short Course Syllabus

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1. The Cell
a) Cell injury – causes, mechanisms, sequelae,
b) Cell death – apoptosis, necrosis and types
c) Cell aging- bearing on immunity
d) Adaptation – metaplasia, dysplasia, hypertrophy, hyperplasia

2. Inflammation
a) Acute- define, causes, phases, mediators, outcome, examples
b) Chronic – define, causes, examples(TB), complications
c) Oedema

3. Wound healing
a) Types, stages, factors affecting, complications

4. Thrombosis , embolism, infarction

a) Thrombosis, definition, Causes, virchow’s triad, sequelae
b) Embolism- definition, types, predisposing factors, systemic effects
c) Infarction –definition, causes including atheroma, types, effects

5. Anaemia
a) Define, classify, causes, interpretation of laboratory reports

6. Coagulation
a) Hemostasis, definition, phases, mechanisms
b) Fibrinolysis, definition, factors affecting, mechanisms
c) Bleeding disorders- classification, Tests -INR, APTT, PT, Bleeding time, coagulation time
d) Complications of blood transfusion

7. Neoplasms
a) Definitions
b) Classification
c) Benign/ malignant- features
d) Anaplasia and differentiation
e) Morphological changes- pleomorphism, nuclear atypia, mitotic index, loss of polarity
f) Invasion and metastasis- types and mechanisms, reason for mets at preferred sites
g) Clinical effects
h) Diagnosis – histology, cytology, tumour marker, IHC, Cell flowmetry
i) Prognosis
j) Principles of treatment- surgery, chemotherapy, radiotherapy, immunotherapy,
hormonal
k) Examples

8. Immunology
a) Define

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 b) Classify - innate( NK cells, MQs, etc)
- adaptive( cell mediated, humoral) mechanisms
c) MHC, APCs
d) Hypersensitivity reactions
e) Defects in immunity system and clinical effects

9. Surgical infections
a) Microbiology- classifications, bacteria, parasites, fungal and viruses
b) Bacteria mechanisms of infections, toxins, resistance, antimicrobial therapy
c) Viruses- mechanism, types, classification, viral disease
d) Parasites – types, associated diseases
e) Infection control
f) Antibiotic policy

10. Surgical Nutrition

11. Fluids and Electrolytes

12. Systemic Pathology

Practicalities

Time Allocation
1. Three blocks per year- Each block running for 5 days. Each day running from 9 am - 3pm
2. First block- March
3. Second block- June
4. Third block- September

Method of delivery
1. Candidates will be given topics to present
2. Trainers role is to guide and moderate
3. Each faculty to arrange the venue
4. Periodic assessments will be done at the local institution

Invitation of other moderators

1. Specialists from other disciplines to be invited
2. Tea and stipend to be provided by the college

COSECSA Anatomy Short Course Syllabus

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1. Head & Neck
a) Scalp
b) Face, eye lid and the lacrimal apparatus
c) Parotid gland
d) Neck- posterior triangle, back of neck and suboccipital triangle
e) Cranial cavity&meninges
f) Orbit and its contents
g) Anterior triangle& cervical fascia
h) Thyroid and parathyroid glands
i) Temporal and infratemporal regions
j) Temporo-mandibular joint
k) Pterygo-palatine fossa
l) Submandibular Region
m) Prevertebral region and root of neck
n) Lymph nodes of head & neck& blood vessels of neck
o) Last four cranial nerves and sympathetic trunk
p) Oral cavity and tongue
q) Pharynx, tonsil and Palate
r) Nasal cavity
s) Larynx
t) Ear
u) Seventh and eighth cranial nerves
v) Eye ball
w) Joints of head & neck
x) Bones-Skull bones, mandible, cervical vertebrae, hyoid

2. Upper limb
a) Introduction and pectoral region
b) Mammary gland
c) Axilla: boundaries, contents, brachial plexus, axillary vessels & lymph nodes
d) Back
e) Shoulder region
f) Shoulder joint, acromioclavicular and sternoclavicular joint
g) Flexor and extensor compartment of arm
h) Cubital fossa
i) Flexor compartment of forearm and palm
j) Extensor compartment of forearm
k) Elbow and radioulnar joints
l) Lymphatic and Venous drainage of upper limb
m) Dermatomes and nerve injuries
n) Bones-clavicle, scapula, humerus, radius, ulna, skeleton of hand

3. Thorax
a) Thoracic wall, Intercostal spaces

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b) Blood supply of thoracic wall
c) Pleura and lungs
d) Mediastinum: subdivisions
e) Pericardium and heart
f) Coronary circulation
g) Superior mediastinum, its contents, arch of aorta
h) Posterior Mediastinum, its contents
i) Thoracic part of oesophagus, thoracic duct, vena azygus
j) Autonomic nervous system
k) Joints of thorax
l) Mechanism of respiration
m) Bones-sternum, ribs, thoracic vertebrae

4. Lower limb
a) Introduction & front of thigh, femoral triangle, boundaries & its contents, femoral hernia
b) Medial side of thigh and adductor canal
c) Gluteal region, muscles, nerves and vessels
d) Popliteal fossa, boundaries and contents
e) Back of the thigh, hamstring muscles
f) Hip joint
g) Front of leg & dorsum of foot
h) Lateral & medial side of leg
i) Back of leg
j) Sole
k) Knee joint
l) Ankle joint
m) Tibio-fibular joint and small joints of foot
n) Venous drainage & lymphatic drainage.
o) Nerve injuries
p) Arches of foot
q) Bones-Hip bone, femur, patella, tibia, fibula and bones of foot

5. Abdomen and Pelvis

a) Anterior abdominal wall
b) Rectus sheath
c) Inguinal canal& hernia
d) Male genital organs
e) Peritoneum
f) Stomach
g) Spleen and coeliac trunk
h) Small and large intestines
i) Mesentric vessels
j) Duodenum

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k) Pancreas
l) Liver and extra-hepatic biliary apparatus
m) Portal vein
n) Kidney, ureter and suprarenal
o) Posterior abdominal wall
p) Perineum-superficial and deep perineal pouches
q) Ishiorectal fossa
r) Pelvis-Urinary bladder
s) Female genital organs: ovary, fallopian tube, uterus and vagina
t) Rectum and anal canal
u) Prostate, vas deferens, seminal vesicles
v) Male urethra
w) Blood vessels, nerves and muscles of pelvis
x) Bones-Lumbar vertebrae, sacrum, male and female pelvis

6. Neuroanatomy
a) Introduction, subdivisions of nervous system and meninges

b) Spinal cord: external and internal features, nuclei, ascending and descending tracts, blood
supply, lesions and their effects.

c) Medulla oblongata: external and internal features, motor and sensory decussation, nuclei of
cranial nerves, floor of the fourth ventricle, inferior cerebellar peduncle, blood supply and
lesions Pons: external and internal features, sections through upper and lower pons, nuclei
of cranial nerves; middle cerebellar peduncle; blood supply and lesions.

d) Midbrain: external and internal features, sections through superior and inferior colliculus,
nuclei of cranial nerves, superior cerebellar peduncle, blood supply and lesions.

e) Cerebellum: subdivisions, connections, white matter and nuclear masses, blood supply
functions and effect of lesions Thalamic complex: dorsal thalamus, metathalamus,
epithalamus, subthalamus, connections, functions, blood supply and lesions.

f) Hypothalamus: nuclei, connections, functions, blood supply, third ventricle and applied
anatomy.

g) Cerebral hemispheres: functional areas, basal ganglion, white matter, internal capsule, blood
supply, lesions and lateral ventricle. Visual and auditary pathways.

h) Limbic system: parts and functions.

i) Reticular system: parts and functions.
j) Cerebrospinal fluid: production, circulation, absorption, functions and applied anatomy.
k) Autonomic nervous system: Sympathetic, Parasympathetic.
l) Ascending and descending pathways.
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 7. Surface Anatomy
Important bony landmarks of the body, important vessels and nerves and projection of the outline
of heart, its borders, surfaces and valves, lungs, their borders, fissures and hila, pleura, and various
abdominal and pelvic organs.

8. Radiological anatomy
Identification of normal anatomical features in commonly used imaging (plain
&contrast), CT scans and MRI.

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