Professional Documents
Culture Documents
MBBS program
Of
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Table of Contents
1. PAHS Overview
2. Mission and Goals
3. PAHS Graduate Attributes
4. PAHS Student Code of Conduct
5. PAHS Faculty Code of Conduct
6. Introductory Course
7. Basic Sciences
8. List of Books and Resources for Basic Sciences
9. Clinical Sciences Curriculum
10. Elective Posting
11. Community Health Sciences
12. Community Based Learning and Education
13. Internship
14. Student Assessment
15. Annexes
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PAHS OVERVIEW
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Patan Academy of Health Science
We will give our students the practical skills and knowledge that they need to
practice good medicine, but we also hope to inculcate an attitude of social
responsibility and compassion so that they have a heart felt desire and drive to meet
the needs of the Nepali people.
For each of these strategies we will set out a detailed description in this document.
In this introduction, we will give a brief overview to demonstrate how the individual
strategies interrelate and complement one another to achieve our ultimate goal.
Our strategy begins with the selection of our medical students. It is well
documented in the literature that selection of students from rural areas is the most
important factor in whether students will eventually return to those areas to work.
Our selection process will therefore include rural recruitment, bias to those coming
from disadvantaged people groups and careful interviews and psychometric testing
to find those most suited to fulfill PAHS attributes and goals. We are also keen to
include those who come from a health assistant background, as experience in Nepal
suggests that these people are also more likely to be willing to serve in rural areas.
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Since we are recruiting students from a wide range of backgrounds, some of whom
have studied in more disadvantaged schools, we are providing a six month
premedical block to ensure that all students are brought up to the same level of
science knowledge prior to starting the course proper. This will also be an
opportunity to upgrade the students English language skills, as our educational
strategy of Problem based learning in small groups requires good language skills.
The basic science curriculum will be taught using Problem based learning. This
educational strategy has been extensively tested and used internationally and has
been shown to encourage deep, independent learning amongst students. Students
are introduced to basic science concepts according to systems of the body rather
than medical subspeciality, to give an integrated approach which can be applied to
real patient problems. Students develop skills of independent enquiry as well as
learning to identify gaps in knowledge, which are vital lifelong learning skills for all
doctors, but particularly those working in remote rural areas.
A parallel course running throughout the basic science and premedical block is the
Introduction to Clinical Medicine (ICM). This course introduces students to the
concepts of professionalism, ethics and communication skills in addition to teaching
the basics of history taking and examination skills. In PAHS we believe that the
students’ attitudes and professional behaviour should be nurtured right from the
beginning of the course, so that we can inculcate the values expressed in our mission
statement.
Community health is a core part of the PAHS curriculum, and forms 25% of the
teaching time. It runs parallel throughout the course. PAHS believes that in order to
make a significant impact on the health of Nepali citizens, doctors need to have a
firm grasp of concepts of preventive health and social determinants of health as well
as having skills in management, epidemiology and research. It is not enough to
focus purely on the sick patient that comes to the hospital, providing technically
competent secondary or tertiary level care.
A significant part of the community health course will take place in urban slums or
rural community postings. These will allow students to keep their feet grounded in
the reality of life for the majority of their patients, as well as encouraging an attitude
of compassion and desire to contribute to their society. Students will learn about the
health care system in Nepal, what their role in that system should be and will have
the opportunity to think about how they might improve that system.
In the same way, Primary Care is internationally recognized to be a key area that
must be implemented to make a nations’ health care system effective and efficient.
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PAHS is including a longitudinal primary care course during the clinical years, and
the six month rural posting in a District general hospital during the final year will be
supervised by a primary care physician (the MDGP). This rural posting will allow
students to integrate all the knowledge and skills they have acquired whilst working
in Patan hospital, and apply it to the rural context. They will experience the
practical difficulties of working in rural areas and hopefully be challenged and
stimulated to make a difference to those who live in these places.
Our summative exams will use Multiple Choice Questions and Modified Essay
Questions to assess knowledge. Traditional long and short cases are widely agreed
to be inadequate for the valid and reliable assessment of students’ clinical skills.
Instead we are planning to use the OSCE method – Objective Structured Clinical
Examination, which is described in more detail in the Assessment section.
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MISSION AND GOALS
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PATAN ACADEMY OF HEALTH SCIENCES (PAHS)
Mission Statement:
Goals:
· Train technically competent, caring and socially responsible physicians and other
health care professionals who:
o Believe in compassion, love, respect, fairness and excellence.
o Communicate well with patients, family and colleagues.
o Are committed to life long learning and
o Have the willingness and ability to become inspiring leaders in their
respective fields and deal with the existing and emerging health care
challenges in Nepal
· Sustain and upgrade the quality of the current health services of PAHS related
hospitals preserving the tradition of giving special consideration to needs of the
poor and disadvantaged.
· Work in collaboration with the National Health System (NHS) to contribute to the
improvement of the health status of the people in Nepal and proactively encourage
the national government in the development of appropriate health policies,
programs and systems to uplift the health of the rural poor.
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PAHS ATTRIBUTES
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Attributes:
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CODES OF CONDUCT
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PAHS STUDENT CODE OF CONDUCT:
PURPOSE:
The Patan Academy of Health Sciences (PAHS) is committed to produce the doctors who
are socially responsible, compassionate, service orientated and believe in equity. In order
to be retained in the institution, a student must demonstrate the personal traits of honesty,
integrity and regard for others. Both the students and faculty are responsible for
monitoring each others professional conduct. Any violations of the Honor Code will be
dealt with by the Student Affairs Committee.
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14. I promise to recognize the confidentiality of medical records and their importance
as legal documents. Under no circumstances will I knowingly record false
information or statistics.
15. I will respect the confidentiality of patients whom I meet. I will not discuss cases
except under appropriate professional or academic circumstances.
16. I will not participate in patient care under circumstances in which I am under the
influence of any substance (including alcohol) or other conditions that impair my
ability to function. If I recognize that one of my colleagues is impaired (substance
abuse or emotional instability) I will try to help them and if necessary, take an
active role in preventing them from being involved in patient care.
17. I will not take any drugs of abuse whilst I am a student at PAHS
18. I will clearly identify myself as a medical student to each patient. I will not
undertake any clinical procedure unless I am supervised by a qualified instructor. I
will not attempt to advise a patient or prescribe treatment for them without
consulting an appropriate senior.
19. I recognize that I am an important member of the health care team and I will abide
by the rules and regulations and Code of Honor in all settings in which I train or
work. I will work respectfully with my fellow colleagues in the health care system,
regardless of their qualifications or medical background.
20. When given some responsibility for patient care, I will do so to the best of my
abilities. If for some reason I am unable to fulfill my obligation, I will promptly
notify the physician in charge of the patient and make sure that someone else
assumes their care.
21. I will be punctual, reliable, conscientious and truthful in carrying out my clinical
responsibilities, never deliberately falsifying information or misrepresenting a
situation.
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PAHS FACULTY CODE OF CONDUCT:
PURPOSE:
The Patan Academy of Health Sciences (PAHS) is committed to produce doctors who are
socially responsible, compassionate, service orientated and believe in equity. We
recognize that unless such exemplary behavior is also modeled by the faculty, students
will not take the code of conduct seriously. Students emulate what we do rather than what
we say. In order to be retained in the institution, a faculty member must demonstrate the
personal traits of honesty, integrity and regard for others. Both the students and faculty
are responsible for monitoring each others professional conduct. Any violations of the
Faculty Honor Code will be dealt with by the dean in consultation with Faculty
Development Committee
1. I pledge that as a member of the Patan Academy of Health Sciences I will serve
the people of Nepal, both rural and urban, as a competent, caring doctor.
2. I pledge to show compassion and empathy to my patients and colleagues at all
times. I will, both in my behavior and speech, show respect for all patients, their
families, students and colleagues, regardless of their age, gender, race, caste,
religion, socio-economic status, state of health or handicap, sexual orientation,
personal habits and cleanliness.
3. In particular, when teaching students in the clinical setting I will ensure that the
patient has given full informed consent. I will ensure that I and the students
respect the patient’s dignity and privacy.
4. I will work respectfully with my fellow colleagues (including students) in the
health care system, regardless of their qualifications or medical background. As
part of showing respect for patients I will maintain a professional appearance,
hygiene and clothing suitable for the patient care setting. I pledge to listen to
patients carefully and explain their problem to them clearly
5. I am committed to help PAHS achieve its objectives of serving the disadvantaged,
particularly those in remote, rural areas of Nepal
6. I promise to demonstrate respect for patient’s cultural and religious beliefs
7. I promise to use cost effective approaches in investigation and management
decisions, taking into account the patients financial and social issues
8. I will keep up to date with recent advances in my specialty and apply that
knowledge to my daily practice as well as my teaching of students.
9. I pledge to act professionally at all times.
10. When participating in medical research I promise to pursue original knowledge
addressing the health care needs of Nepal, and record truthfully the data that I
collect. I promise not to participate in any form of academic dishonesty.
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11. I promise to recognize the confidentiality of medical records and their importance
as legal documents. Under no circumstances will I knowingly record false
information or statistics.
12. I will respect the confidentiality of patients under my care. I will not discuss cases
except under appropriate professional or academic circumstances.
13. I will not participate in patient care or training of students during academic
activities under circumstances in which I am under the influence of any substance
(including alcohol) or other conditions that impair my ability to function.
14. If I recognize that one of my colleagues is impaired (substance abuse or emotional
instability) I will try to help them and if necessary, take an active role in
preventing them from being involved in patient care.
15. I will not take any drugs of abuse.
16. I will be punctual, reliable, conscientious and truthful in carrying out my clinical
and teaching responsibilities.
17. I will be loyal to the institution of PAHS and will not participate in any activities
that harm the reputation or bring disgrace to the institution’s good name
18. When taking a teaching session with a student I will prepare carefully and do my
best to enhance their learning experience.
19. When assessing a student, I will do so honestly, without bias. I will not allow a
student to cheat and I will not divulge any examination materials to students or
others except within the examination itself.
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INTRODUCTORY BLOCK
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INTRODUCTORY BLOCK
Introduction
Six months introductory block has been introduced in order to provide common
educational backgrounds for the students from two different streams so that their
performance would be matching and effective in the subsequent medical course.
· To familiarize students with the specific PAHS mission, goals and attributes.
· To review relevant applied sciences in order to better prepare the students for
subsequent courses.
· To familiarize students with the basics of medical ethics, communication, first aid
and patient safety.
· To enable students to acquire basic knowledge in mathematics and statistics
including medical informatics and apply them appropriately.
· To introduce students to scientific writing and communication
· To train students to become sensitive about health science issues.
· To train students to be active self directed-learners.
· Biology
· Chemistry
· Physics
· Mathematics, statistics and medical informatics
· Scientific writing and communication skills
· Community Health Science
· Introduction to Clinical Medicine
The details of the curricular goals have been elaborated in the respective discipline as
follow:
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BIOLOGY
General Objectives:
1. Cell
Specific Objectives:
· Identify the general functions for each of the following: cell wall, plasma
membrane, cytoplasm, ribosomes, DNA, endoplasmic reticulum, lysosome,
Golgi apparatus, mitochondria, nucleus and cell inclusion.
· Compare the structure of prokaryotic and eukaryotic cell.
· Describe the differences between plant and animal cells.
· Discuss the structure and function of cell membranes.
· List the types and functions of membrane proteins.(e.g. receptors, ion channels
etc).
· Discuss the process of cellular respiration.
· Outline the different stages of cell cycle.
· Outline the stages and events of mitosis and meiosis and correlate them with
clinically important events (e.g. tumor, non dysjunction, etc).
· Describe the types and differentiate animal tissues.
Contents:
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2. Biomolecules
Specific Objectives:
Contents:
Specific Objectives:
· Describe structure and morphology of bacteria and their roles in health and
diseases.
· Describe the general structure and properties of virus and their roles in the
living system.
Contents:
4. Genetics
Specific Objectives:
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· Describe the pattern of inheritance with examples.
· Explain the different types of mutation and its significance.
Contents:
Specific Objectives:
Contents:
· Overview of Evolution
· Ecosystem
· Environmental Conservation
Specific Objectives:
Contents:
· Classification of fungi
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· Medicinal uses of fungi
· Common fungi that cause disease in human.
· Classification of parasites
· Common parasitic diseases in Nepal
· Pathogenic significance and preventions of various helminthes
Specific Objectives:
Contents:
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CHEMISTRY
General Objectives:
Specific Objectives:
Contents:
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2. Chemical Bonding
Specific Objectives:
· Define ionization
· Define valency and discuss valence bond theory and molecular orbital theory
· Describe the formation of ionic bond, covalent, co-ordinate covalent bond.
· Discuss hydrogen bonding
Contents:
· Ionic bond
· Covalent bond
· Co-ordinate covalent bond
· Hydrogen bonding
Specific Objectives:
Contents:
· Gas Law
o Boyle's Law
o Charle's Law
o Avogadro's Law
o Dalton's Law of partial pressure
o Graham's Law of diffusion
4. Solution
Specific Objectives:
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Contents:
Specific Objectives:
Contents:
6. Chemical Energetics
Specific Objectives:
Contents:
· Laws of thermodynamics
· Enthalpy, exothermic and endothermic reactions
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· Entropy of reaction
· Free energy
7. Electrochemistry
Specific Objectives:
Contents:
· Oxidation-reduction
· Electromotive force, electrode potential and electrochemical cells.
· Electrolysis and its mechanism
Specific Objectives:
Contents:
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9. Organic Chemistry
Specific Objectives:
Contents:
· Hydrocarbons
o Aliphatic
o Aromatic
· Nomenclature
· Isomerism (structural and optical)
· Organic Compound containing heteroatoms
o Ethers
o Aldehydes
o Ketones
o Alcohols
o Nitro compounds
o Amino compounds
o Carboxylic acid
· Biomolecules
o Carbohydrates
o Amino acids and protein
o Lipids
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PHYSICS
General Objectives:
· Measure basic physical quantities, in terms of magnitude and units and use
techniques for the measurement and recording of length, mass, time, temperature,
current, amount of substance.
· Describe the action of forces on mass, acceleration and rotation of an object.
· Categorize types of motions in a daily life.
· Define the viscosity of liquids and use it to discuss the flow of blood in vessels.
· Draw ray diagrams and apply its principles in explaining the major defects of
vision of eye.
· Draw ray diagrams of microscope.
· Explain the basic principle of hearing and their use in health and disease.
· Explain the basic behaviors of wave and sound and their uses in medicine.
· Discuss the principles of electricity and magnetism and their applications to the
understanding of living system.
· Describe the properties of radioactive substances and explain their uses and
hazards in medicine and the surrounding.
1. Mechanics
Specific Objectives:
Contents:
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2. Dynamics
Specific Objectives:
Contents:
3. Forces
Specific Objectives:
· Describe the gravitational force, electrostatic force, up thrust, frictional force and
viscous force.
· Use triangle law and parallelogram laws for forces in equilibrium.
· Define center of mass and center of gravity and define weight of a body in terms of
its center of gravity.
· Show an understanding that a couple is a pair of forces which tends to produce
rotation on a body.
· State and apply principle of moments.
Contents:
· Types of forces
· Equilibrium of forces
· Center of gravity
· Turning effects of forces.
4. Hydrostatic
Specific Objectives:
· Define the term pressure and use the equation p= ρhg to solve liquid pressure.
· Define viscosity as liquid friction.
· Differentiate between steady flow and turbulent flow with examples.
· Illustrate the flow of blood in human body and compute blood pressure.
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· Explain capillary action and adhesive and cohesive force in liquid
Contents:
· Pressure in a fluid
· Viscosity of liquids, coefficient of viscosity
· Laminar and turbulent flow.
· Flow of blood and blood pressure in a human body
· Molecular theory of surface tension.
· Capillary action.
Specific Objectives:
Contents:
· Nature of waves
· Transverse and longitudinal waves
· Speed, frequency and wavelength of waves.
· Physics of hearing.
6. Optics
Specific Objectives:
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polarized light.
Contents:
Specific Objectives:
Contents:
8. Modern Physics
Specific Objectives:
· Describe the nature and properties of these charged particles and their
applications in medicine.
· Describe and analyze qualitatively the deflection of charged particles by uniform
electric and magnetic fields.
· State that all electromagnetic waves travel with the same speed and recall the
orders of magnitude of the wavelengths from radio waves to γ-rays.
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Contents:
· Charged particles
· Radioactivity
· Electromagnetic wave
9. Nuclear physics.
Specific Objectives:
· Describe a simple model for the nuclear atom to include protons, neutrons and
orbital electrons.
· Show an understanding that an element can exist in various isotopic forms each
with a different number of neutrons.
· Show an understanding of the use of isotopes and radio isotopes in medical
diagnostic.
· Explain the biological effects of radiation in terms of absorbed dose, dose
equivalent rate and quality factor (Q).
· Describe the radiation hazard by natural and man-made sources and disposal of
radioactive wastes.
· Describe the applications of nuclear physics in medicine.
Contents:
· The nucleus
· Isotopes
· Effects of radiation
· Radioactive substances
· Introduction to nuclear medicine
Specific Objectives:
· Explain the principles of the production, interaction with matter and the use of x-
rays.
· Describe the basic principle and the use of CT scan and Mammography in
medicine.
· Explain the basic principles behind the use of ultrasound to obtain diagnostic
information about internal structures.
· Explain the basic principles behind the use of magnetic resonance to obtain
diagnostic information about internal structures.
· Explain the principle of the production of laser.
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· Describe the use of ultra fast laser in surgical procedures (e.g. eye surgery and
tumor ablation).
· Describe general principle of radio protection.
Contents:
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MATHEMATICS, STATISTICS AND MEDICAL INFORMATICS
1. Mathematics
General Objectives:
The main objective of this course is to provide the applied aspect of pure mathematics in
statistics and other health sciences.
Specific Objectives:
Contents:
General Objectives:
The main objectives of this course are to apply mathematical concepts in statistics. It also
aims to discuss the use of bio-statistical methods in health sciences focusing on the
descriptive application of biostatistics in medicine.
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Specific Objectives:
Contents:
Refer to Community Health Science Curriculum and especially the Biostatistics I syllabus
for details.
3. Medical Informatics
General Objectives:
The main aim of this course is to enable students to retrieve (from electronic databases
and other resources), manage, and utilize biomedical information for solving problems
and making decisions that are relevant to the care of individuals and populations.
Specific Objectives:
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· Discuss the underlying reasons to maintain a healthy skepticism about the quality
and validity of all information.
· Demonstrate the effective use of security procedures (for example, choosing
“good” passwords, not sharing them, and changing them often).
· Discuss how to protect confidentiality of private information obtained from the
community, patients, colleagues, and others.
· Discuss the Database and Database Management System.
· Describe the principles and tools of communication and networking.
Contents:
· Fundamentals of Computer
· Types of computer
· Demonstration and explanation of computer system
· Operating Systems
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SCIENTIFIC WRITING AND COMMUNICATION
General Objective:
To prepare the students to extract data from journals, synthesize information and present
it to others in a clear coherent fashion.
Specific Objectives:
Contents:
· Feedback
· PowerPoint presentation skills
· Extracting data and summarizing it
· Synthesis of data
· Presentation of synthesis of data
· Database searching
· Presentation of research
· Alternative forms of delivering information
· Introduction to critical thinking
· Use of diagrams/charts to convey information
· Use of graphs and spread sheets
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COMMUNITY HEALTH SCIENCE
Description:
During the course, students will be provided with the opportunities to collect information
and data that are necessary to prepare a health plan. The student should know that such
data are not necessarily confined to health matters only but also include physical, social,
economical and cultural conditions.
Contents:
A. Induction Part
· Institutional mission, vision, goals and MBBS program objectives
· Health and Social Development
- Community Health as a Tool for Social Development
- Good Health is a Precondition for Social Development
- Social and Physical Determinants of Health and Disease
B. Discipline Based Courses
- Basic Mathematics, Statistics and Medical Informatics
- Society, Culture and Health
- Health Education and Behavioral Change
- Basic Epidemiology
Teaching-Learning Methods:
· Classroom learning- lecture, small group session, workshop and seminar
· Public health laboratory related works
· Applied computer skill sessions
· Experiential practical learning during community rotations
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A. Induction Part
Objectives:
· Describe the PAHS mission, goals and attributes and give examples of how
these values and attributes can be expressed and applied in community health
practice.
· Give examples of skills required for effective team work.
· Give examples of skills required for immersion process to work in the
community
Contents:
Objectives:
· Describe the international indicators for social development.
· Describe the statistics for the indicators of social development in Nepal.
· Identify the possible areas of interventions that a PAHS medical graduate
could do to influence the status of such indicators in Nepal.
Contents:
Human Development Indicators of Nepal in relation to Regional and Global context
Objectives:
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· Describe techniques for analyzing the relationship between health conditions and
physical, social, economic and cultural factors.
· Describe the importance of sharing their findings with the community.
Contents:
Objectives:
· Identify the physical, social, economic and cultural factors that can influence
people’s health conditions.
· Discuss factors that have a negative impact on population health.
Contents:
Annual report of Department of Health Services and other important national level
studies like Demographic and Health Survey, etc
Discipline based courses starts as continuation of induction part. The specific contents of
these courses to be covered during Introductory Block are enlisted in Community Health
Sciences Curriculum. In addition to these courses, students will be provided with
opportunities of field works during the period.
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INTRODUCTION TO CLINICAL MEDICINE
1. Medical Ethics:
Specific Objectives:
2. Communication skills
Specific Objectives:
3. First Aid:
Specific Objectives:
At the end of the course the students should demonstrate the ability to:
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4. Patient Safety
Specific Objectives:
Contents:
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BASIC SCIENCE
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Basic Science Curriculum
Introduction:
Basic Science at PAHS is two years duration starting after the six months of introductory
block. Curriculum integration module that has been developed in Basic Science
curriculum moves in the context of organ system block with the emphasis on clinical case
scenarios. Interdisciplinary integration in the context of clinical cases gives the platform
for the horizontal integration which helps to learn the curricular content effectively. Also,
the spiral movement of curriculum within Basic Science and throughout the entire
curriculum renders vertical integration which reinforces the progressive and explicit
learning.
· To build the understanding of the structure and function of the human body and
mind in both healthy and disease states; understanding of the causes and
mechanism of diseases.
· To build the strong foundation of Basic Sciences that is essential for understanding
the underlying principle for clinical cases that will be applied in the clinical years.
Two years of Basic Science curriculum is delivered in the organ system basis. It starts
with the Principle of Human Biology where basics of all the disciplines are covered. This
will facilitate the students learning efficiently when the organ system block starts.
Community health science curriculum runs parallel throughout the basic science courses.
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Arrangement of different blocks in Basic Science:
Basic Science
First year blocks Second year blocks
Principle of Human Biology I Gastrointestinal and Hepatobiliary System
Principle of Human Biology II Renal System and Electrolytes
Hemopoetic System Endocrine, Metabolism and Reproductive System
Respiratory System Musculoskeletal System and Skin
Cardiovascular System Nervous System and Special Senses
The details of the curricular goals have been elaborated in the respective organ system
block as follow:
1. Block: Principle of Human Biology I
2. Block: Principle of Human Biology II
3. Hemopoietic System
4. Respiratory System
5. Cardiovascular System
6. Gastrointestinal and Hepatobiliary System
7. Renal and Electrolytes
8. Endocrine, Metabolism and Reproductive System
9. Musculoskeletal System and Integumentary System
10. Nervous System and Special Sense
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1. BLOCK: PRINCIPLE OF HUMAN BIOLOGY I
Course Description:
Anatomy
Objectives:
· Discuss various positions, planes and terms in relation to body and various organs.
· Describe types, different parts and ossification of bone.
· Discuss the subdivision of nervous system and the functional significance.
· Explain the various joints.
· Discuss the principles of routine histological technique.
· Relate the histological features of different types of general tissue with their functions.
· Describe the anatomy of upper and lower limb and explain the common clinical
conditions related to it.
· Relate the radiological features of upper limb & lower limb to the different parts,
types and ossification of the bone.
· Demonstrate the surface landmarks and the surface markings of nerve and vessels of
upper limb and lower limb.
Contents:
· Introduction to Anatomy
· Introduction to Osteology
· Introduction to Nervous System
· Introduction to Arthrology
· Introduction to Histology
· Epithelial tissue
· Connective tissue
· Bone and Cartilage
· Muscular tissue
· Nervous Tissue
· Upper Limb
· Lower Limb
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Physiology
Objectives:
Content:
Biochemistry
Objectives:
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· Perform the test for the biochemical reactions of carbohydrates, lipids, amino acids
and proteins.
· Perform the test for the total protein estimation in blood and interpret the result.
Contents:
Microbiology
Objective:
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Contents
· Bacteriology:
o Bacterial structure
o Classification of bacteria
o Growth and Nutrition
o Bacterial Genetics
o Anaerobes and methods of anaerobiasis.
o Isolation and Identification of Bacteria
· Virology:
o Bacteriophage
o General properties, Classification, Replication and laboratory diagnosis of
viruses
· Parasitology:
o Medically Important Parasitic infections
· Mycology:
o Fungi of medical importance
o Types of fungal infections
o Sample collection and fungal isolation and identification methods
· Infection Control:
o Basic concept of infection control and prevention measures
o Methods of sterilization and disinfection
o Biohazard waste and disposal methods
Pathology
Objectives:
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· Discuss vascular and cellular responses, role of chemical mediators and
inflammatory cells in inflammation.
· Discuss the mechanism of wound healing and factors affecting it.
Contents:
· Introduction to Pathology
· Cellular responses to injury
o Cellular adaptation
o Cell injury and cell death
o Cellular accumulation
o Pathologic calcification
· Inflammation and Repair
Pharmacology
Objectives:
· Define drug and explain different routes of drug administration and the concepts of
Pharmacokinetics: absorption, distribution, biotransformation and elimination of
drugs.
· Differentiate the concept of Bioavailability and Bioequivalence.
· Explain the significance of therapeutic drug monitoring, and optimization of dosage
regimen.
· Explain the concepts of Pharmacodynamics: Principles of drug action, Drug receptor
interaction, factors affecting drug response, principles of drug-drug and drug-food
interactions.
· Explain different types of Adverse Drug Reactions and their clinical significance
during drug therapy.
· Discuss the principle of management of different types of poisoning and drug
overdose.
· Summarize the basics of essential drug concept, rational drug therapy and
Pharmacoeconomics.
· Apply the concepts of posology in compounding simple formulations.
Contents:
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o Drug disposition
o Kinetics of drug elimination.
o Optimization of dosage regimen
o Therapeutic Drug Monitoring (TDM)
· Pharmacodynamics
o Introduction
o Principles of drug action, drug- receptor interactions.
o Dose response relationship
o Factors affecting drug response
· Adverse Drug Reactions
· Poisoning and Overdose.
· Essential Drug Concept, Rational drug therapy and Pharmacoeconomics
Objectives
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BLOCK: PRINCIPLE OF HUMAN BIOLOGY II
Course description:
Anatomy
Objectives:
Contents:
· Host-defense/Immunology
o Thymus
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o Spleen
o Tonsil
o Lymph node
o Mucosa associated lymphoid tissue (MALT)
· General Embryology
o Gametogenesis
o First two weeks of development: Ovulation to implantation
o Second week of development
o Embryonic period: Third to eighth week of development
o Fetal period
o Placenta and fetal membranes
o Twinning
o Birth defects and teratogen
· Medical Genetics
o Introduction to Medical Genetics
o Mode of Inheritance of Single Gene Disorder
o Introduction to Cytogenetic
o Chromosomal Abnormalities
o Autosomal and the Sex Chromosomal Disorders
o Pedigree Analysis
o Prenatal Diagnosis
o Genetic Counseling
o Ethics in medical genetics
Physiology
Objectives:
· Classify the hormones according to their nature, properties and mechanism of action
and discuss their methods of regulation of secretion.
· Define ligand, receptor and second messenger and the mechanism of signal
transduction.
· Describe different types of synapses and their proqperties.
· Describe the components of the neuromuscular junction and transmission through it.
· Discuss the physiological organization and function of the autonomic nervous system.
Contents:
- 52 -
Biochemistry
Objectives:
Contents:
Immunology
· Immunoglobulins:
o Structure of immunoglobin
o Antibody diversity
· Molecular Biology:
o Cell cycle and Cell division
o DNA Replication, Mutation and Repair
- 53 -
o Transcription and it’s Regulation
o Translation and regulation of gene expression
o Stem Cell and differentiation
o Apoptosis
o Oncogenetics
o Recombinant DNA technology
o Recent molecular techniques
· Medical Genetics
o Introduction to Medical Genetics
o Inheritance Pattern
o Chromosome and Cytogenetics
o Inborn error of metabolism
o Population genetics
o Genetic Counseling
· Neurotransmitters
Microbiology
Objectives:
Host Defense/Immunology
Contents:
· Introduction to Immunity
· Types of immunity
· Cells of the immune system and their roles
· First and second line of defense
- 54 -
· Antigens, Antibodies and Antigen- Antibody reactions
· Major Histocompatibility Complex
· Hypersensitivity reactions
· Immune tolerance
· Autoimmunity
· Immunology of transplantation
· Immunity to infections
· Antimicrobial agents.
Pathology
Objectives:
Contents:
· Lymphadenitis
· Lymphomas
· Splenomegaly
· Haemodynamic disorders
· Thromboembolism
· Shock
· Neoplasia
· Amyloidosis
- 55 -
Pharmacology
Objectives:
Contents:
· Antimicrobial Agents
· Anticancer Agents
· Immunomodulators
· Pharmacogenetics
· Autonomic Nervous System
o Adrenergic receptor agonists
o Adrenergic receptor antagonists
o Cholinergic receptor agonists
o Cholinergic receptor antagonists
Objectives:
- 56 -
2. BLOCK: HEMOPOIETIC SYSTEM
Course Description:
Physiology
Objectives:
Contents:
Biochemistry
Objective:
- 57 -
· Discuss different component of RBC membrane and their role in its structural
stability.
· Discuss different metabolic pathways in RBC and their significance in its functioning.
Contents:
· Haemoglobin
o Haem Biosynthesis
o Haemoglobinopathy
o Molecular Basis of Thalassemias
o Porphyrias
· Iron Metabolism
· Folic acid and Vitamin B12 Metabolism
· Red Blood Cell Structure and Metabolism
o Components of RBC membrane
o Glycolysis Pathway
o HMP Shunt Pathway
o Glutathione (Redox) System
Microbiology
Objectives
Contents:
· Bloodstream infections
· Bacteremia
· Blood/tissue parasitic infections
- 58 -
· Systemic fungal infections
· Viral hemorrhagic fever
Pathology
Objectives:
Contents:
· Anemia
o Iron deficiency anemia
o Thalassemia
o Megaloblastic anemia
o Aplastic anemia
o Hereditary spherocytosis
o Sickle cell disease
· Leukemia
· Multiple myeloma
· Haemorrhagic Diathesis
o Hemophilia (A & B)
- 59 -
o von Willebrand disease
o Idiopathic Thrombocytopenic Purpura (ITP)
o Disseminated Intravascular Coagulation (DIC)
· Myelodysplastic syndrome
· Chronic myeloproliferative disorders
Pharmacology
Objectives
Contents:
· Anticoagulants
· Thrombolytic and antifibrinolytic agents
· Antiplatelet agents
· Hematinics
· Therapy of Parasitic Infections
o Malaria
o Leishmaniasis
o Filariasis
Objectives:
- 60 -
3. BLOCK: RESPIRATORY SYSTEM
Course Description:
Anatomy
Objectives:
Contents:
· Pharyngeal apparatus
· Nose and nasal cavity
· Paranasal sinuses
· Larynx
· Trachea
· Bronchus
· Lungs and pleura
· Thoracic cage
· Diaphragm
- 61 -
Physiology
Objectives:
Contents:
· Mechanics of Breathing
· Spirometry
· Diffusion capacities and factors influencing diffusion of gases
· Pulmonary circulation
· Respiratory shunt
· Oxygen transport
· Carbon dioxide transport
· Regulation of Respiration
· Respiration in high altitude
Biochemistry
Objectives:
· Compare the structural difference in hemoglobin and myoglobin and its importance in
their function as oxygen carrier and oxygen storage.
· Explain the role of biological oxidation in various body functions.
· Discuss electron transport chain (ETC) and oxidative phosphorylation and relate
their role in ATP synthesis.
· Compare inhibitors and uncouplers of ETC and its clinical application.
· Describe generation of reactive oxygen species in the body and discuss the role of
antioxidant in neutralizing reactive oxygen species to prevent oxidative stress.
· Discus the importance of blood buffers in maintaining Acid base homeostatis.
· Describe the role of respiratory system in pH regulation; its imbalance leading to
respiratory acidosis/alkalosis and biochemical basis of the clinical intervention in
respiratory acidosis/alkalosis.
· Discuss the method of arterial blood gas analysis and its interpretation.
- 62 -
Contents:
· Oxygen transport
· Bioenergetics, biological oxidation and oxidative phosphorylation
· Oxidative stress – Antioxidant systems
· Blood buffers
· Blood pH regulation
Microbiology
Objectives:
Contents:
Pathology
Objectives:
- 63 -
· Explain the pathogenesis of hyaline membrane disease and adult respiratory distress
syndrome.
· Explain the aetiopathogenesis of pneumonia. Enlist its types, stages and
complications.
· Explain the aetiopathogenesis of lung abscess and enlist its complications.
· Classify and explain the aetiopathogenesis,, gross and microscopic features of
bronchogenic carcinoma.
· Describe the aetiopathogenesis and microscopic features of tuberculosis. Explain
primary and re-infection tuberculosis.
· Explain Ghon’s focus and primary complex.
· Discuss pleural lesions (Infective, benign and malignant).
· Differentiate between transudative and exudative pleural effusions.
· Describe aetiology and types of pneumothorax.
· List the investigations required to diagnose diseases of the respiratory tract.
· Define pneumoconiosis and explain its pathogenesis with special reference to
anthracosis, asbestosis and silicosis.
Contents:
· Chronic bronchitis
· Bronchial asthma
· Bronchiectasis
· Emphysema
· Atelectasis
· Hyaline membrane disease and adult respiratory distress syndrome
· Pneumonia
· Lung abscess
· Tuberculosis of lung
· Bronchogenic carcinoma
· Pleural lesions
· Pneumoconiosis
Pharmacology
Objectives:
- 64 -
o H1 antihistamines
o Antitussive and Expectorants.
· Discuss pharmacotherapeutic approaches to common forms of respiratory tract
infections
Contents:
Objectives:
- 65 -
4. BLOCK: CARDIOVASCULAR SYSTEM
Course Description:
Anatomy
Objectives:
Contents:
· Heart
· Pericardium
· Mediastinum
· Aorta
· Superior venacava
· Azygous system of vein
· Thoracic duct
· Sympathetic trunk
Physiology
Objectives:
· Describe the properties of the cardiac muscles and the conducting system of the heart.
· Describe the events in the cardiac cycle.
- 66 -
· Interpret the normal electrocardiogram and explain its genesis.
· Describe cardiac output and factors affecting it.
· Describe the haemodynamics of circulation.
· Describe the regulation of the arterial blood pressure.
· Discuss lymph circulation, its functions and factors affecting it.
· Discuss coronary circulation during different phases of cardiac cycle and factors
affecting it.
· Comprehend the cardiovascular changes during exercise.
· Describe the genesis of normal heart sounds.
· Describe the basis of hypovolemic shock.
Contents:
Biochemistry
Objectives:
Contents:
- 67 -
Microbiology
Objectives:
· Describe cause and pathogenesis of acute rheumatic fever and rheumatic heart
disease
· Plan the tests necessary for establishing the diagnosis of acute rheumatic fever and
rheumatic heart disease.
· List the agents causing infective endocarditis.
· Plan the laboratory diagnosis of endocarditis.
Contents:
Pathology
Objectives:
Contents:
· Atherosclerosis
· Rheumatic fever and rheumatic heart disease
· Infective endocarditis
- 68 -
· Ischaemic heart diseases
· Cardiomyopathies
· Myocarditis,
· Pericarditis
· Hypertension
· Aneurysm
· Congenital heart diseases
Pharmacology
Objectives:
Contents:
· Therapy of Hypertension
· Therapy of Myocardial Ischemia
· Therapy of Cardiac failure
· Therapy of Cardiac arrhythmias
· Hypolipidemic Agents
· Therapy of Shock
· Therapy and prophylaxis of rheumatic heart disease and endocarditis
- 69 -
Introduction to Clinical Medicine
Objectives:
- 70 -
5. BLOCK: GASTROINTESTINAL AND HEPATOBILIARY SYSTEM
Course Description:
Anatomy
Objectives:
Contents:
- 71 -
Physiology
Objectives:
Contents:
Biochemistry
Objectives:
Contents:
- 72 -
Microbiology
Objectives:
Contents:
Pathology
Objectives:
· Enlist the common inflammatory, premalignant and malignant lesions of the oral
cavity.
· Enlist the inflammatory and common tumors of the salivary glands.
· Enlist the gross and microscopic features of a pleomorphic adenoma.
· Define and explain the aetiopathogenesis and consequences of Barrett’s esophagus.
· Enlist the common tumors of the oesophagus.
- 73 -
· Explain the aetiopathogenesis of acute and chronic gastritis. Discuss the morphology
of chronic gastritis.
· Explain the aetiopathogenesis, gross and microscopic features and complications of
peptic ulcer.
· Differentiate the gross features of a benign and malignant gastric ulcer.
· Classify gastric tumours. Discuss the aetiopathogenesis, clinical features,
complications, gross and microscopic feature of a gastric carcinoma.
· Enlist the important inflammatory diseases of small and large intestine.
· Discuss the aetiopathogenesis, clinical features and complications of intestinal
tuberculosis, ulcerative colitis, Crohn’s disease, amoebic colitis and typhoid ulcer.
· Enumerate the differentiating features of an ulcerative colitis and Crohn’s disease.
· Enlist the gross and microscopic features of an acute appendicitis and its
complications.
· Classify the tumours of the small and large intestine.
· Enumerate the gross and microscopic features of colorectal carcinoma.
· Enlist the common causes of liver abscess.
· Enlist the causes of jaundice.
· Discuss the aetiopathogenesis and sequelae of viral hepatitis.
· Discuss portal hypertension and its consequences.
· Discuss the aetiopathogenesis and complications of cirrhosis. Enlist its gross and
microscopic features.
· Discuss the aetiopathogenesis of hepatocellular carcinoma and enlist its gross and
microscopic features. .
· Explain the aetiopathogenesis, morphology and complications of acute and chronic
pancreatitis.
· Discuss the aetiopathogenesis, and complications of chronic cholecystitis.
· Identify gross and microscopic features of chronic cholecystitis and carcinoma of the
gall bladder.
Contents:
· Oral Pathology
· Salivary gland lesions
· Barrett’s esophagus
· Carcinoma of esophagus
· Gastritis
· Peptic ulcer
· Carcinoma of stomach
· Tuberculosis of intestine
· Typhoid of intestine
· Appendicitis
· Amoebic colitis
· Ulcerative colitis and Crohn’s disease
· Tumours of the small and large intestine
· Jaundice
· Cirrhosis of liver
· Viral hepatitis
· Portal hypertension
- 74 -
· Liver abscess – amoebic and pyogenic
· Hepatocellular carcinoma
· Chronic cholecystitis
· Carcinoma of gall bladder
· Acute and chronic pancreatitis
Pharmacology
Objectives:
Contents:
Objectives:
- 75 -
6. BLOCK: RENAL AND ELECTROLYTES
Course Description:
Anatomy
Objectives:
· Discuss the normal development of urinary system and relate it with common
developmental anomalies.
· Describe the anatomy of different parts of urinary system and relate it with clinical
conditions.
· Identify and describe histological features of different parts of urinary system.
· Demonstrate the different parts of the urinary system on standard diagnostic images.
· Demonstrate of the surface marking of kidney.
Contents:
· Kidney
· Ureter
· Urinary Bladder
· Urethra
Physiology
Objectives:
- 76 -
Contents:
Biochemistry
Objectives:
Contents:
Microbiology
Objectives:
Contents:
- 77 -
Pathology
Objectives:
· Describe adult and childhood polycystic kidney. Enlist its gross features.
· Classify glomerular diseases and discuss the aetiopathogenesis, morphology and
clinical presentations of acute post-streptococcal glomerulonephritis, rapidly
progressive glomerulonephritis and chronic glomerulonephritis.
· Explain the pathophysiology of nephrotic syndrome and differentiate nephrotic and
nephritic syndromes.
· Describe the aetiopathogenesis of benign and malignant nephrosclerosis.
· Explain the aetiopathogenesis, morphology, clinical features and consequences of
acute tubular necrosis.
· Discuss the aetiopathogenesis and sequelae of acute and chronic pyelonephritis.
Enlist the gross and microscopic features of chronic pyelonephritis.
· Enlist the types, morphology and consequences of renal calculi.
· Define hydronephrosis. Discuss its causes and morphology.
· Enlist common kidney tumors. Identify gross and microscopic features of renal cell
carcinoma and Wilm’s tumour.
· Discuss the aetiopathogenesis of cystitis.
· Enlist the tumours of the urinary bladder. Describe the aetiopathogenesis, and
microscopic features of transitional cell carcinoma.
Contents:
· Polycystic kidney
· Glomerulonephritis
· Nephrosclerosis
· Nephrotic Syndrome
· Acute Tubular Necrosis (ATN)
· Pyelonephritis
· Hydronephrosis
· Urolithiasis
· Tumors of kidney
· Inflammation and tumours of urinary bladder
- 78 -
Pharmacology
Objectives:
· Classify the diuretic and antidiuretic agents and describe their use in different
situations, their mechanisms of action, adverse effects and contraindications
· Discuss nephrotoxic drugs with their mechanism of nephrotoxicity.
· Discuss common antibiotics used in treating urinary tract infections (UTIs).
Contents:
Objectives:
- 79 -
7. BLOCK: ENDOCRINE, METABOLISM & REPRODUCTIVE
Course Description:
Anatomy
Objectives:
· Discuss the normal development of the endocrine glands and relate it with
common developmental anomalies.
· Describe the anatomy of endocrine glands and relate it with clinical conditions.
· Identify and describe the histological feature of endocrine glands.
· Discuss the normal development of male and female reproductive and associated
organs and relate it with common developmental anomalies
· Describe the gross features of pelvis and perineum.
· Describe the anatomy of male and female reproductive and associated organ and
relate it with common clinical conditions.
· Identify and describe the histological feature of various parts of male and female
reproductive organs and associated organs.
· Demonstrate the various parts of male and female reproductive and associated
organs on standard diagnostic images.
· Describe the features and sex differences of bony pelvis and discuss their clinical
importance.
Contents:
· Endocrine glands
· Male reproductive organs
· Female reproductive organs
· Pelvis and Pelvic diaphragm
· Perineum and External Genitalia
· Breast
- 80 -
Physiology
Objectives:
Contents:
Biochemistry
Objectives:
- 81 -
· Describe the nature, synthesis, secretion and mechanism of action of pituitary
hormones.
· Describe the nature, synthesis, secretion and mechanism of action of thyroid
hormones.
· Describe the nature, synthesis, secretion and mechanism of action of
corticosteroid hormones.
· Describe the nature, synthesis, secretion and mechanism of action of testicular
hormones.
· Describe the nature, synthesis, secretion and mechanism of action of ovarian
hormones.
· Describe the nature, synthesis, secretion and mechanism of action of pancreatic
hormones.
· Describe different types of diabetes mellitus, metabolic changes that occurs in
diabetes and biochemical basis of diabetic complication.
· Describe the role of hormones in the control of body weight.
· Perform glucose estimation test and interpret the result.
· Interpret the result of oral glucose tolerance test (OGTT) and HbA1c.
· Interpretation of thyroid function test.
Contents:
Microbiology
Objective:
At the end of the course, the students should be able to:
· List the normal flora of genital tract.
· Explain the aetiology, pathogenesis and laboratory diagnosis of sexually
transmitted and genital tract infections.
· Plan lab investigation for Sexually Transmitted Infections and interpret lab
results.
· Describe the structure, pathogenesis and laboratory diagnosis of HIV.
· Interpret the tests for HIV diagnosis.
· Describe etiologic agents of intrauterine growth retardation and its consequences.
· Plan for lab diagnosis of TORCH Infection and interpret the result.
Content:
- 82 -
· Genital tract infections
· TORCH
Pathology
Objectives:
Content:
- 83 -
· Diseases of pituitary gland
· Diseases of thyroid
· Diseases of Parathyroid gland
· Diseases of Adrenal gland
· Diabetes mellitus
· Benign prostatic hyperplasia (BPH)
· Prostatic carcinoma
· Tumors of testis
· Carcinoma of penis
· Cervicitis
· Carcinoma of cervix
· Endometrial carcinoma
· Leiomyoma and adenomyosis
· Ovarian tumours
· Trophoblastic diseases
· Breast diseases- male and female
Pharmacology
Objectives:
Contents:
- 84 -
· Selective estrogen receptor modulators
· Synthetic analogues and antagonists of adenocorticosteroids
· Insulin and oral hypoglycemic agents
· Analogues and antagonists of sex hormones
· Oxytocics and tocolytics
· Parathormone, calcitonin and Vitamin D
· Hormonal contraceptives
· Drugs used in Sexually transmitted diseases
· Use of drugs in Pregnancy
Objectives:
- 85 -
BLOCK: MUSCULOSKELETAL SYSTEM AND INTEGUMENTARY SYSTEM
Course Description:
Anatomy
Objectives:
· Discuss the normal development of face and relate it with common birth defects.
· Describe the organization of spinal column, the developmental changes, principle
group of muscles acting upon it; intervertebral articulations and intervertebral discs
and relate it with common back problems.
· Describe the layers, innervation, blood supply and applied anatomy of scalp.
· Describe the muscle of facial expression, innervation, blood supply and lymphatic
drainage and relate it with common clinical conditions.
· Describe the disposition of cervical fascia and its clinical significance.
· Describe the boundaries and contents of the different regions or fossa in head and
neck.
· Discuss the cranial duramater and dural venous sinuses.
· Describe the temporo-mandibular joint (TMJ), atlantooccipital joint and
atlantoaxial joint and clinical condition related to these joints.
· Identify individual bones of the skull and cervical vertebra and discuss the gross
features of the skull and the bones of skull, joints of the skull, gross feature of the
cervical vertebra.
· Demonstrate the radiological feature of head on standard diagnostic images.
· Demonstrate the surface landmarks and surface marking of head and neck.
· Discuss the normal development of the skin and its appendages and relate it with
common developmental anomalies.
· Identify and describe the histological features of skin and its appendages.
Contents:
· Spinal Column
· Triangles of Neck
· Cervical fascia
· Atlanto-occipital and atlantoaxial Joints
· Face
- 86 -
· Scalp
· Parotid Region
· Temporal and infratemporal Fossa
· Temporomandibular Joint
· Submandibular Region
· Cranial Duramater, Dural folds and Dural Venous Sinuses
· Bony orbit
· Skin and its appendages
Physiology
Objectives:
· Describe the functional organization of skeletal muscles and compare with other
types.
· Describe the structural organization of neuro-muscular junction and the sequence
of neuro-muscular transmission.
· Describe the mechanism of excitation – contraction coupling in skeletal muscle.
· Define and compare isotonic and isometric muscle contraction and its
physiological significances in exercise.
· Compare different types of muscle fibers and discuss the factors that influence
their force of contraction.
· Describe muscle tone, its common abnormalities and responses of muscle after
nerve injury.
· Discuss different functions of skin.
Contents:
Biochemistry
Objectives:
- 87 -
· Discuss the integrated role of parathyroid hormone, calcitonin and vitamin D in
bone mineralization and correlate it with common clinical conditions.
· Discuss the nucleic acid metabolism and its regulations.
· Describe significance of muscle marker in diagnosing muscle injury.
· Describe the melanin biosynthesis along with the associated disorders.
Contents:
· Muscle metabolism
· Bone Metabolism and calcium homeostasis
· Nucleic acid metabolism
· Muscle Markers
· Melanin Synthesis
Microbiology
Objectives:
Contents:
- 88 -
o Poliomyelitis
o Tetanus
· Wound infections
· Bone and joint infections
o Infectious arthritis
o Osteomyelitis
Pathology
Objectives:
· Describe the sequence of events in fracture healing and factors delaying healing.
· Explain the aetiopathogenesis, clinical features and complications of
osteomyelitis.
· List the metabolic diseases and explain rickets, osteomalacia, osteopenia and
osteoporosis on the basis of clinical features, aetiology, and pathogenesis.
· Classify bone tumours. Enumerate the gross and microscopic features of an
osteosarcoma and giant cell tumour.
· Discuss the aetiopathogenesis of osteoarthritis, rheumatoid arthritis and gouty
arthritis.
· Classify different types of soft tissue tumors. Enlist the gross and microscopic
features of lipoma and a sarcoma.
· Explain the aetiopathogenesis and clinical features of Duchenne muscular
dystrophy and Becker muscular dystrophy.
· Enlist the common benign and malignant lesions of the skin. Enlist the types and
the microscopic features of common benign naevi.
· Discuss the aetiopathogenesis and morphology of a melanoma, squamous cell
carcinoma and a basal cell carcinoma.
Contents:
· Fracture
· Osteomyelitis
· Metabolic bone diseases
· Bone tumors
· Diseases of joints
· Soft tissue tumors
· Muscular dystrophies
· Naevus
· Common tumours of skin
Pharmacology
- 89 -
Objectives:
Contents:
Objectives:
· Perform examination of
o Skin
o Neck
o Joints including shoulder, hip and lower back
· Discuss ethical issues surrounding
o Allocation of resources
- 90 -
BLOCK: NERVOUS SYSTEM AND SPECIAL SENSES
Course Description:
Anatomy
Objectives:
· Discuss the normal developmental process of the different parts of CNS and relate
it with developmental anomalies
· Discuss the normal developmental process of the special senses and relate it with
developmental anomalies
· Describe the gross features of different parts of the CNS and the neuronal
circuitry in brain and spinal cord and relate it with clinical conditions.
· Describe the gross features of Special senses and related cranial nerves in terms
of origin, functional component, course and termination in respective part of brain
and relate it with common clinical conditions.
· Describe the blood supply of the brain and spinal cord and apply the knowledge to
explain the functional deficit resulting from ischemic injuries.
· Describe the functional component, nuclei of origin, course, distribution and
functional significance of cranial nerves and relate it with clinical conditions.
· Identify and describe the histological features of spinal cord, cerebrum and
cerebellum and cytoarchitecture of cerebrum and cerebellum.
· Identify and describe the histological features of special senses
· Identify the radiological features of different parts of CNS on standard diagnostic
images.
Contents:
· Cerebrum
· Thalamus and Hypothalamus
· Brainstem
· Cerebellum
· Basal ganglia,
· Ventricles
· Meninges and Cerebrospinal Fluid
· Spinal Cord
· Blood supply
· Cranial Nerves
- 91 -
· Eye
· Ear
Physiology
Objectives:
Contents:
· Neural organization
· Synaptic transmission and plasticity
· Response of neurons and nerve fibers to injury
· Cerebrospinal fluid system.
· Sensory system
· Spinal cord reflexes
· Motor system
· Higher cortical function
- 92 -
· Mechanism of maintenance of equilibrium and posture
· Cerebellum and basal ganglia
· Physiological basis of sleep and consciousness
· Limbic system and hypothalamus
· Visual System
· Auditory System
· Olfactory system
· Gustatory system
Biochemistry
Objectives:
Contents:
· Nerve Cell
· Neurotransmitters
· Vitamin A
· Cerebrospinal fluid (CSF) Analysis
Microbiology
Objectives:
- 93 -
Contents:
· Meningitis
· Encephalitis
· Botulism
· Rabies
· Infections of eye
· Infections of ear
Pathology
Objectives:
Contents:
· Meningitis
· Viral encephalitis
· Brain abscess
· Hydrocephalus
· Cerebrovascular accidents
· Degenerative diseases
· Demyelinating diseases
· Brain tumors
· Retinoblastoma
Pharmacology
Objectives:
· Explain the treatment of chronic and acute alcoholism ,clinical consequences and
management of methanol poisoning
- 94 -
· Explain the different stages of anesthesia. Classify general and local anesthetics
and describe their mechanism of action, rational for use, adverse drug reactions,
contraindication and drug interaction.
· Describe the mechanism of action, side effects, important drug interactions and
contraindications of antiepileptic agents; identify the drug of choice in different types
of epilepsies and epilepsy in special situations.
· Classify the drugs used in Parkinsonism and describe the mechanism of action,
side effects and rationale of drug combination of Antiparkinsonian agents.
· Classify opioid analgesics. Explain their mechanism of action, pharmacological
effects, indications, adverse effects, contraindications, management of overdose and
treatment of dependence.
· Classify the sedative and hypnotic agents. Describe the mechanism of action,
indications, adverse effects, limitations, drug interactions and contraindication of
sedating and non sedating anxiolytic agents.
· Classify antipsychotic and antidepressant agents; describe their mechanism of
action, indications, adverse effects, limitations and contraindications.
· Explain why certain drugs have abuse potential and addiction capability and
enumerate important drugs which fall under this category.
Contents:
Objectives:
- 95 -
RESOURCES LIST FOR BASIC SCIENCE
Anatomy
Textbooks
· Langman’s Medical Embryology: 10th Edition, Sadler TW; Lippincott Williams &
Wilkins.
· Wheater’s Functional Histology: A Text and Colour Atlas: 5th Edition,Young B,
Heath JW; Churchill Livingstone.
· Basic Histology: 11th Edition, Junqueira LC, Carneiro J; McGraw-Hill Medical.
· Clinically Oriented Anatomy: 5th Edition, Moore KL, Dalley AF; Lippincott
Williams & Wilkins
· Gray’s Anatomy for Students: 1st Edition, Richard Drake, Wayne Vogl, Adam
Mitchell; Churchill Livingstone
· Clinical Anatomy by Region: 8th Edition, Richard S Snell; Lippincott Williams
and Wilkins.
· Thompson & Thompson Genetics in Medicine:7th Edition, Nussbaum RL,
McInnes RR, Willard HF; Saunders
· Clinical Neuroanatomy for Medical Students: 6th Edition, Richard S Snell;
Lippincott Williams & Wilkins
Reference books
· Larsen’s Human Embryology: 4th Edition, Gary C Schoewolf, Steven B Bleyl,
Philip R Brauer, Philippa H Francis-West; Churchill Livingstone.
· Gray’s Anatomy: The Anatomical Basis of Clinical Practice: 39th Edition, Susan
Standring; Elsevier.
· Emery's Element of Medical Genetics: 13th Edition, Peter Turnpenny, Sian Ellard;
Churchill Livingstone.
· Carpenter's Human Neuroanatomy: 9th Edition, Andre P; Williams & Wilkins
Physiology
Textbooks
· Textbook of Medical Physiology: 11th Edition, Guyton and Hall; WB Saunders
publication.
Reference books
· Review of Medical Physiology: 22nd Edition, William F Ganong; McGraw-Hill.
· Berne and Levy Physiology: 6th Edition, Bruce M Koeppen, Bruce A Stanton;
Mosby.
· Vander, Sherman, Luciano's Human Physiology: The Mechanisms of Body
Function; C Edition, Eric P. Widmaier, Hershel Raff, Kevin T Strang; McGraw-Hill
Ryerson.
· Essentials Medical Physiology: 3rd Edition, Leonard R Johnson; Academic Press.
· Medical Physiology: 4th Edition, Rodney A Rhoades, George A Tanner; Academic
Press.
- 96 -
Biochemistry
Textbooks
· Lehninger Principle of Biochemistry: 4 th Edition. David L. Nelson, Michael M.
Cox; W. H. Freeman.
Reference books
· Biochemistry 6th Edition Jeremy Mark Berg, John L. Tymoczko, Lubert Stryer; W.
H. Freeman
· Harper’s Biochemistry: 27th Edition, Robert K. Murray, Daryl K Grammer, Peter
A. Mayes, Victor W Rodwell; McGraw-Hill Medical.
· Lippincott's Illustrated Reviews: Biochemistry: 2 nd Edition. Pamela C Champe,
Richard A Harvey; Lippincott Williams & Wilkins.
· Textbook of Biochemistry with clinical correlations: 6th Edition, Thomas M.
Devlin; Wiley-Liss.
· Marks' Basic Medical Biochemistry; A Clinical Approach: 3 rd Edition, Colleen M
Smith, Allan D Marks, Michael A; Lieberman Lippincott Williams & Wilkins.
· Clinical Chemistry: 6th Edition, Marshall W J and Bangert S K; Mosby.
· Clinical Chemistry: Principles, procedures and correlations: 5 th Edition, Bishop M
L, Duben-Engelkirk J L & Fody E P; Lippincott Williams & Wilkins.
· Fundamentals of Clinical Chemistry: 6th Edition, Burtis CA & Ashwood; ER
Saunders.
· Clinical Chemistry: Theory, analysis, correlation: 4th Edition Kaplan L A, Pesce A
J, Kazmierczak; S C Mosby.
· Student Companion for Stryer's Biochemistry: 4th Edition, Richard I Gumport,
Lubert Stryer; WH Freeman & Company.
· Modern Experimental Biochemistry: 3rd Edition Rodney F. Boyer Prentice Hall.
· The Cell: A Molecular Approach: 4th Edition, Geoffrey M Cooper, Robert E
Hausman; Sinauer Associates, Inc.
· Molecular Cell Biology: 6th Edition, Harvey Lodish; WH Freeman.
· Emerys’s elements of Medical genetics: 11 th Edition, Robeert F Muller, Ian D
Young; Churchill Livingstone.
Microbiology
Textbooks
· Jawetz, Melnick & Adelberg's Medical Microbiology: 24th Edition, Geo Brooks,
Karen C Caroll, Janet Butel, Stephen Morse; Mc Graw-Hill Medical.
· Sherris Medical Microbiology; An Introduction to Infectious Diseases: 4th
Edition, Kenneth J. Ryan , C. George Ray; Mc Graw-Hill Medical.
· Text Book of Medical Mycology: 1st Edition, Jagdish Chander; Interprint / Mehta
Publisher.
· Text book of Medical Parasitology: 1st Edition, Chakraborty P; New Central Book
Agency (P) Ltd.
Reference books
· Practical Medical Microbiology (Mackie & Mc Cartney's Medical Microbiology):
13th Edition, Collee; Churchill Livingstone.
- 97 -
· Bailey & Scotts Diagnostics Microbiology: 11th Editon, Betty A Forbes, Daniel F
Sahm, Alice S Weissfeld; Mosby.
· Koneman's color Atlas and Text book of Diagnostic Microbiology: 6th Edition,
Elmer W. Koneman; Lippincott Williams & Wilkins.
· Roitt's Essential Immunolgy: 11th Edition, Peter J Delves, Ivan M Roitt, Seamus J
Martin; Blackwell Publishers
· Fields Virology 2 Volume Set: 5th Edition, David M Knipe; Lippincott Williams &
Wilkins.
· Diagnostic Medical Parasitology: 5th Edition, Lynne Shore Garcia; ASM Press.
Pathology
Textbooks
· Pathologic basis of disease: 7th Edition, Robbins and Cotran; Elsevier.
Reference books
· Sternberg's Diagnostic Surgical Pathology: 5th Edition, Lippincott Williams and
Wilkins
· Rosai and Ackerman's Surgical Pathology: 9th Edition, Rosai, Juan; Elsevier
Health Sciences
· Wintrobe's Clinical Hematology: 12th Edition; Lippincott Williams and Wilkins
· Enzinger and Weiss's Soft Tissue Tumors: 5th Edition, Weiss Sharon W,
Goldblum JR; Elsevier Health Sciences
· Lever's Histopathology of the Skin: 10th Edition, Elder, David E; Lippincott
Williams and Wilkins
· Atlas of Clinical Hematology: 2nd Edition, Hoffbrand, A.V.; Pettit, J.E; Elsevier
Health Sciences
Pharmacology
Textbooks
· Basic and Clinical Pharmacology: 10th Edition, Bertram G Katzung; McGraw Hill.
Reference books
· Clinical Pharmacy and Therapeutics: 4 th Edition, Roger Walker; Churchill
Livingstone.
· Clinical Pharmacology (with student consult access): 10th Edition, Benette Brown;
Churchill Livingstone.
- 98 -
· Pharmacology (with student access consult online): Rang, Dale, Ritter, Moore;
Churchill Livingstone.
· Text Book of Pharmacology (Hardcover): S D Seth; Elsevier.
· Pharmacology: Lippincott’s Illustrated Reviews; Lippincott Williams and Wilkins
· Pharmacotherapy: A pathophysiological approach (Hardcover): 7th Edition,
Dipiro; McGraw Hill.
- 99 -
CLINICAL SCIENCE
- 100 -
CLINICAL SCIENCE
Introduction
The clinical years will consist of clinical specialties, community health and a six month
district health postings.
General Objectives:
At the end of the clinical rotation, the student should be able to:
· Identify the major health problems in Nepal.
· Demonstrate good communication skills with patients, their relatives, colleagues
and other stakeholders.
· Demonstrate a holistic approach in patient care (taking into account physical,
psychological, socioeconomic and cultural factors).
· Elicit and record a relevant history and perform a complete physical examination.
· Correlate the history and examination findings to arrive at a logical diagnosis and
to be able to list a few common differentials.
· Identify relevant investigations to order and interpret their results.
· Explain the natural history, management options, rehabilitation, prognosis and
complications of clinical conditions.
· Perform counseling on prevention and health promotion issues.
· Describe and participate in the various national health programs of Nepal
· Demonstrate good medical record keeping.
· Apply the principles of critical thinking and Evidence based practice
· Discuss the ethical and legal implications of medical decisions.
· Identify medico legal problems and describe statutory obligations of a registered
medical practitioner
· Perform Primary care for common conditions. Identify conditions that need
referral, and refer appropriately
· Identify life threatening conditions and perform emergency management including
basic life support.
· Demonstrate leadership and management skills
· Demonstrate an ability to work with locally available resources
· Demonstrate skill in breaking bad news
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CLINICAL PRESENTATION CURRICULUM
Introduction
Clinical presentations are the common symptoms, signs or laboratory abnormalities with
which a patient or population can present to a doctor. The underlying principle or
philosophy of Clinical Presentation Curriculum (CPC) is that: "The reaction of human
body to infinite number of insults is always finite and stable over time". For example, any
insult to the respiratory system whether infectious, inflammatory, immunological,
traumatic or iatrogenic, respiratory system responds either as cough, cyanosis, chest pain,
difficulty breathing, noisy breathing or hemoptysis.
Medical education is vast and is expanding very fast while the duration of medical school
is short and limited. It is virtually impossible to teach or make the student learn everything
during their medical school years. So our aim during MBBS years is to teach the students
the basic 'must know areas' of medicine. To achieve this, CPC will be very helpful as we
will be able to cover most of the conditions that we need to cover while focusing the
teaching learning activities around the defined clinical presentations. In this method, the
focus is always on the patient. Additional attention will be given to the conditions where
students are required to attain competency level 3 and 4.
CP curriculum will help the graduates to scientifically approach each clinical presentation,
categorize them into different groups with the help of their basic science knowledge,
clinical examination findings and some investigations and finally come to the closest
possible diagnosis or diagnoses by excluding other conditions. They will learn to follow
the schema for each CP with practice. This is a forward reasoning process with inductive
reasoning.
The list of Clinical Presentations (CPs) is outlined. Schemas for all the CPs have been
developed. Commonly seen conditions in different specialties e.g.. Medicine/ Surgery/
Obstetrics-Gynecology etc. will be taught during the respective clinical postings.
Repetition and further refinement will continue to occur in subsequent postings.
Repetition of a systematic approach to key clinical presentations is an important method
for reinforcing learning of the essential clinical knowledge, skills and attitudes that a
medical student needs to acquire.
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Some important conditions or diseases which are not covered by the defined CPs, will be
covered through lectures. We have outlined list of common lectures for that purpose.
(Please see Annex 1 Page no 174). See Annex 2 Page No175 for full list of clinical
presentations according to organ system and Annex 3 Page No. 176 for distribution of
clinical presentations in different clinical postings. One sample Case Presentation is
written in detail in Annex 4 Page No. 177
1. Competency level 1
Based on familiarity with the literature, the graduating doctor will be able to recognise the
clinical picture of the disease. Correspondingly, he/she knows the clinical picture and knows
how to get more information. This is the overview level. The doctor will refer a patient with
this clinical picture.
2. Competency level 2
Be able to make a clinical diagnosis by means of physical examination, simple tests, and
additional investigations requested by the doctor him/herself (such as simple laboratory
investigations or x-rays). The doctor is able to refer the patient immediately to the relevant
specialists to take over subsequent treatment.
3. Competency level 3
Be able to make a clinical diagnosis by means of physical examination, simple tests, and
additional investigations requested by the doctor him/herself (such as simple laboratory
investigations or x-rays). The doctor is able to make the judgment which initial treatment is
needed and is able to carry out that treatment, and to refer the patient to the relevant
specialist/s.
Competency level 4
Be able to make a clinical diagnosis by means of physical examination, simple tests and
additional investigation requested by the doctor him/herself (such as simple laboratory
investigations or X-rays). The doctor is able to make a decision and manage independently.
(See Annex5, Page No. 201 for detail list in each speciality)
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General Medicine
Specific Objectives:
At the end of each clinical rotation, the student should demonstrate the ability to:
Skills
· The art of history taking, communication skills and the method of disclosing
facts or bad news.
· General and physical examinations of various systems which include
cardiovascular, respiratory, hepato-biliary and renal, locomotor and joints,
and nervous system.
· Students will be able to perform independently the following procedures:
o Opening IV line, blood drawing from various sites including femoral
puncture
o ECG recording and basic interpretation
o Catheterize bladder in both males and females
o Naso-gastric tube insertion and stomach wash
o Lumber puncture
o Pleural fluid aspiration, both diagnostic and therapeutic
o Ascetic fluid aspiration, both diagnostic and therapeutic
o Bone marrow aspiration and biopsy
o Bag mask ventilation
o Emergency thoracostomy for pneumothorax
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· Students should observe the following procedures and have knowledge of
o Pericardiocentesis
o Central line placement
o Chest tube insertion and pleurodesis
o Endotracheal intubation
o Attain ACLS training
Contents
· Clinical Presentations
o Chest pain
o Shortness of breath
o Palpitation
o Oedema
o Haemoptysis
o Hypertension
o Syncope
o Jaundice
o Dyspepsia/indigestion
o Oliguria/anuria
o Polyuria
o Weakness of extremities
o Movement disorder
o Abnormal sensation (parasthesia/hypoasthesia)
o Ataxia
o Vertigo
o Fever/sepsis
o Infection in immunocompromised host
o Abnormal clotting (thromboembolic)
o Bites and stings
- 105 -
General Surgery
Specific Objectives:
Skills
Contents
· Clinical Presentations
o Abdominal pain
o Abdominal swelling/distension
o Nausea/vomiting
o Constipation
o Haematemesis
o Blood in stool/malaena
o Dysphagia
o Haematuria
o Urinary retention
o Scrotal pain/swelling
o Lymphadenopathy
o Neck mass (thyroid)
o Erectile dysfunction/impotence
o Breast lumps/nipple discharge
o Lumps and bumps
o Burn
o Dying patient
- 106 -
Paediatrics
Specific Objectives:
· Diagnose and perform primary care for the common neonatal and childhood
diseases/ conditions.
· Identify and perform primary care for neonatal and paediatric emergencies.
· Identify neonatal and paediatric conditions/ diseases that require referral and
refer them appropriately.
· Elicit and record relevant history with special reference to antenatal, natal & post
natal periods, growth, development, nutrition and immunization and conduct
relevant physical exam.
· Interpret the growth charts, (weight, height, head circumference, body
proportions).
· Conduct developmental milestone assessment (gross motor, fine motor, social,
emotional and language skills) and identify deviations from normal.
· Identify children with cerebral palsy and mental retardation, and be able to
provide primary care, parental counseling, appropriate referral and
rehabilitation.
· Conduct nutritional status assessment, plan and advice on nutritional
requirements of children at different ages, identify specific nutritional deficiencies
(e.g. Vitamins and micronutrients) and address the underlying cause.
· Describe how to counsel parents of children with special needs, chronic diseases
and acute life threatening condition.
· Discuss the national programs related to child health and describe the national
immunization schedule.
· Describe and explain NMR, IMR, PMR, UFMR, MMR and enumerate the common
causes of NMR, IMR, PMR and UFMR in Nepal.
Skills
· Intravenous cannula insertion
· ECG recording and basic interpretation
· Lumbar Puncture
· Nasogastric tube insertion
· Foley’s catheter insertion
· Emergency needle thoracostomy for pneumothorax
· Pleural fluid aspiration
· Ascitic fluid aspiration
· Bag mask ventilation
· Intubation
· Cardiopulmonary resuscitation of infant and child
· Newborn resuscitation
· Breast feeding counseling
· Umbilical vein cannulation
· Introsseous needle insertion
· Bone marrow aspiration
- 107 -
Contents
· Clinical Presentations
o Cough
o Cyanosis
o Noisy breathing
o Diarrhoea
o Dysuria
o Proteinuria/Chyluria
o Electrolyte imbalance
o Preterm/low birth weight/IUGR
o Depressed newborn
o Respiratory distress
o Neonatal seizure
o Paediatric Fever/sepsis
o Hepatosplenomegally
o Abnormal bleeding
o Growth disorder (short stature/tall stature)
o Obesity
o Dysmorphic child
o Developmental delay
o Failure to thrive & malnutrition
o Eneuresis
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Gynecology Obstetrics
Specific Objectives:
Skills
· Obstetrics Skills:
o Perform under supervision:
§ Examination of a pregnant lady including internal examination.
§ Conduct Normal delivery
§ Episiotomy and repair
§ Vacuum delivery
§ Manual removal of placenta
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§ Observe caesarean delivery
· Gyne Skills:
o Under supervision:
§ Examination of Gyne patient (Per speculum and PV examination)
§ Insertion of ring pessary
§ Insertion of Cu T
§ Evacuation of retained product of conception (ERPC)
§ Taking pap smear
§ Perform endometrial and cervical biopsy
Contents
· Clinical Presentations
o PV bleeding
o Amenorrhoea
o Abnormal vaginal discharge
o Mass in female genital tract
o Subfertility
o Complicated pregnancy
o Labour pain
o Puerperium
o Contraception
o Pubertal disorder
o Virilisation/hirsuitism
o Incontinence
- 110 -
General Practice
Specific Objectives:
At the end of their undergraduate training in General practice students should be able
to:
· Describe the scientific concept of General practice.
· Discuss the place of General Practice within the health care system of Nepal,
both rural and urban.
· Describe how the General Practitioner works as part of a primary health care
team, particularly in a community setting, providing an integrated approach to
patient management with appropriate referral and feedback mechanisms.
· Describe what is meant by a holistic patient-centered approach.
· Describe how a patient’s socio-cultural background and economic
circumstances influence the way they present with a medical problem and how
they should be managed.
· Discuss the importance of continuity of care, particularly in the context of
chronic disease management.
· Demonstrate familiarity with the key health problems met in the context of
Nepal.
· Describe the role of health promotion and disease prevention (including
screening) both within a consultation and at a population level.
· Discuss the particular role of the General Practitioner in the management of
the elderly and dying.
· Understand clinical examination, elicit relevant clinical signs and arrive at
possible differential diagnosis for each clinical presentation in General
Practice.
Skills
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· Perform initial assessment and stabilization of a trauma patient
· Perform bag and mask ventilation
· Discuss the indications for intubation and perform intubation
· Perform basic screening techniques (e.g. smear)
· Demonstrate leadership and management skills
· Demonstrate an ability to work with limited resources
· Conduct health education in an effective, patient-centered manner
· Demonstrates skill in breaking bad news
Contents
· Clinical Presentations
o Loss of appetite
o Headache
o Pallor/fatigue
o Unexplained physical symptoms
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Psychiatry
Specific Objectives:
· Demonstrate the ability to diagnose and provide primary care for the common
mental disorders
· Demonstrate the ability to identify and provide immediate care for psychiatric
emergencies
· Discuss mental disorders that require referral and refer them appropriately
· Demonstrate the ability to elicit and record relevant history with special reference
to personal history and pre-morbid personality and conduct relevant mental state
examination
· Identify and provide emergency management / primary care for alcohol and
substance use disorders
· Use the Mini Mental State Examination and identify deviations from normal
· Identify children with mental retardation, and be able to provide parental
counseling and appropriate referral.
· Identify common psychiatric disorders / behavioral problems in children and be
able to provide parental counseling and appropriate referral
· Demonstrate the basic counseling skills and apply them to counsel family
members of patients with chronic mental disorders / substance use disorders
· Discuss about the legal implications of mental disorders
· Discuss the national mental health act and policy along with Community Mental
Health Program / Services
· Outline the relevance of diagnostic investigations in Psychiatry including
Psychological tests, EEG, CT Scan (Head), Thyroid function test, CSF
Examination and Serum Lithium estimation
Skills
· Under supervision
o Approach to a violent patient
o Approach to a suicidal patient
o Conducting Psychiatric Interview
o Mini mental state examination
o Counseling
Contents
· Clinical Presentations
o Abnormal mood
o Suicide & intentional harm
o Substance abuse
o Violent behaviour
o Abnormal thought
o Reaction to stress and adjustment disorder
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Dermatology, Genito-urinary medicine and Leprosy
Specific Objectives:
· Discuss the history and the role of dermatology and venereology in modern
medicine.
· Define commonly used terminologies in these subjects.
· Discuss the structure and function of skin.
· Demonstrate the ability to take history and perform physical examination and
order investigations.
· Demonstrate the ability to manage the common diseases in Dermatology and
venereology.
Skills
· After proper history taking and examinations they should be able to diagnose most
of the skin diseases. Many skin diseases that are prevalent in our country fall
under competency level 4.
· Perform simple tests like taking skin scrapping and nail clippings to demonstrate
the type of fungus whether it is dermatophyte or yeasts
· Take skin biopsies.
· Perform simple procedures like electrocautery, chemical cautery and cryotherapy
like liquid nitrogen or carbon dioxide snow.
· Demonstrate sarcoptes scabie by using needles.
· Perform skin smear for AFB under Zeihl-Neelsen’s staining and determine BI and
MI
· Perform endourethral smear for gonococci and pus cells.
· Perform endourethral smear test for haemophilus ducreyi.
· Demonstrate spirochetes under dark ground illumination microscope.
· Interpret laboratory tests like VDRL (screening test) and TPHA & TPI
(confirmatory tests), HIV Screening and confirmatory tests.
· Proper counseling for STD patients and contact tracings.
Contents
· Clinical Presentations
o Rash and pruritis
o Abnormal pigmentation
o Hair & nail problems
o Skin manifestation of systemic disease
o Urethral discharge
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Anaesthesia
Specific Objectives:
Skills
· Under supervision
o Set up I.V. canulation and intravenous line.
o Clear and maintain patent airway with basic technique with airways
(nasopharyngeal, oropharyngeal and laryngeal mask)
o Oxygen therapy
o Observe a patient during process of recovery from general anaesthesia.
· The students should observe and have the knowledge of the following procedures:
o Endotracheal intubation
o Local, regional and central nerve blocks
o Basic and advance life support technique.
o Monitoring anaesthetised and critically ill patients.
o Central venous and arterial cannulation
Contents
· Clinical Presentations
o Shock
o Acid base balance
- 115 -
Forensic medicine
Specific Objectives:
At the end of each clinical rotation, the student should demonstrate the ability to:
· Describe the ethical and legal responsibilities of the physician towards the patient,
profession, society and humanity at large.
· Enumerate relevant legal/court procedures applicable to medico legal and
medical practice.
· Examine and prepare reports or certificates in medico legal cases in accordance
to Law of Nepal.
Skills
· Perform medicolegal postmortem
· Interpret autopsy findings and conclude the cause of death and time since death.
Contents
· Clinical Presentations
o Sexual assault
o Physical assault
o Hanging
o Near drowning
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Emergency
Specific Objectives:
Skills
- 117 -
· Management of Physical assaults
· Breaking bad news.
· Examine and prepare reports/certificates in medico legal cases/situations
according to the law of government of Nepal
Contents
· Clinical Presentations
o Shock
o Diminished level of consciousness
o Seizure
o Poisoning/Drug overdose
o Mass Casualty incident (Chemical/Bio/Nuclear/Earthquake/Flood)
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Orthopedics
Specific Objectives:
Skills
Contents
· Clinical Presentations
o Joint pain/swelling
o Limb pain/swelling
o Limb deformity
o Limping
o Fracture
o Dislocation
o Backache
o Soft tissue infection
o Head and spinal injury
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Ophthalmology
Specific Objectives:
At the end of each clinical rotation, the student should demonstrate the ability to:
Skills
Contents
· Clinical Presentations
o Red eye/Eye discharge
o Squint/Diplopia
o Pain in eye
o Visual abnormality/night blindness
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Otorhinolaryngology
Specific Objectives:
At the end of each clinical rotation, the student should demonstrate the ability to:
· Understand the clinical implication, patho-physiology and arrive at possible
diagnosis of each clinical presentation in Otorhinolaryngology.
· Correlate the various presentations compile and create common possible
differential diagnosis.
· Discuss the common and preventable diseases of the ear, nose and throat.
· Identify the communicable and infectious diseases of ears, nose and throat and
perform proper precautionary measures for self, patient, attendant and to the
community, with proper counseling.
· Describe different forms of appropriate therapy for a given diagnosis and an
understanding of the mode of action of frequently prescribed drugs and their
known side effects, including toxicity, indications, contraindications, and
interactions and the knowledge about relieving pain and ameliorating the
suffering of patients.
· Formulate effective management plans including therapeutic drug plan, treatment,
and prevention strategies for common ENT diseases.
· Identify the forthcoming complication, assess the severity, and manage/refer the
emergency conditions.
· Assess the disability likely to result from a given diagnosis.
Skills
Clinical skills
· Syringing
· Removal of simple foreign bodies from ear, nose and throat
· Anterior nasal packing
Contents
· Clinical Presentations
o Abnormal hearing/tinnitus
o Earache/ear discharge
o Sore throat/hoarseness
- 121 -
Dentistry
Specific Objectives:
Skills:
Contents
· Clinical Presentations
o Orofacial swelling/pain
o Mouth sores/oral ulcers
- 122 -
Laboratory Medicine
Specific Objectives:
- 123 -
Electives Posting
Elective system is a system whereby students have a choice of subject, teacher or method
of study which leads to more broadly educated students. It also helps students to develop
good organizational and planning skills.
PAHS envisions sending medical doctors to rural Nepal. Therefore, in order to broaden
the knowledge of the students and understand the meaning of life in a greater dimension,
the elective options that PAHS opens to the students have non-school and within-school
options.
There is the provision of 2 weeks electives during the junior clerkship. It is entirely
student initiated and organized. Student should decide where he wants to do his elective.
1. Students should submit learning goals of the elective of their choice to Dean’s
office for the approval.
2. Dean’s committee approves the elective choice the students make.
3. Approval needs to be obtained two months before starting electives.
4. After approval:
a. Dean’s committee will issue letter of recognition to the students to
facilitate them during electives.
b. Students themselves need to arrange the elective.
5. At the end of the electives, students will write a short reflective report and
submit to Dean’s committee including:
a. Supervisor report from where elective was done.
b. Student report on his/her elective including:
i. Whether the clerkship met their learning objectives.
ii. A personalized account of a unique experience gained from the
electives.
- 124 -
COMMUNITY HEALTH SCIENCES
- 125 -
COMMUNITY HEALTH SCIENCES
Introduction
There is a dire national need of training and enthuse medical students to work together
with other health workers for the benefit of people in both the remote rural areas and the
fast-growing urban towns in Nepal.
The course introduces and explores the principles of public health sciences including
sociology, anthropology, management sciences for doctors and other health care
professionals, health communication as well as emphasizing the importance of
management of population health problems by working with and learning from the
community. The course also reviews several major health issues and current
developments in the organization, financing, regulating and delivery of health services in
Nepal.
The course combines classroom presentations with opportunity for student participation,
individual and group exercises, integrated learning and real world learning in community.
Objectives:
At the end of the course the students are expected to be able to:
· Apply the principles and methods of public health sciences, behavioral and social
sciences, biostatistics and epidemiology.
· Assess, define and understand the health status of a population, dynamics and
determinants of health and illness, and factors contributing to health promotion
and disease prevention.
· Design appropriate interventional programs by mobilizing all the available
resources.
· Work as a team with other members of the health care team and community.
- 126 -
· Demonstrate attitudes of helping people and acknowledging responsibility and
accountability of their own profession and to the people.
The community health course will comprise around 25% of the total duration of the
MBBS course. From the beginning of the course, students will be exposed to communities
with different population characteristics. They are encouraged to explore what they need
to learn in order to understand and manage that problem. After each community posting,
students will present the results of their findings, readings, discussions and group work.
Each case or situation is carefully designed with key community objectives enumerated,
the range of skills to be acquired and a list of requested and suggested readings. Faculties
and other experts in the field of community health will be available for consultation. We
believe that this programme will have long term effect on improving and promoting
health of people in Nepal.
2. Epidemiology
o Basic
o General
o Applied
4. Family Health
- 127 -
6. Biostatistics
7. Demography
- 128 -
Overview of Community Health Sciences Courses Deliveries
Subject Year 1 Year 2 Year 3 Year 4 Year 5
Introductory Basic Sciences Clinical Sciences
Health, Culture and Society
Health Education and Behavior Change
Health, Culture and Society
Epidemiology I
Biostatics I
Management Science for Health I
Ecologic Health
Family Health I
Demography
Public Health Laboratory
Epidemiology II
Family Health II
Biostatics II
Epidemiology III
Management Science for Health II
Food and Nutrition
Integrated Workshops / Field Orientations
1 Community Health + Basic Sciences (individual/ household) 5 Community Health + Basic Sciences (CPD/VDC)
- 127 -
Management Science for Healthcare Professional (Part 1)
General description:
This course provides a core foundation on health care management.
It is intended to provide the student with a very basic understanding of components of public
health services, inventory management, time management, hospital production, health
services accessibility and affordability.
General Objectives:
General description:
This second part of the management course aims at preparing graduates to take a crucial role
in managing public health services and optimum utilization of scarce resources. It presents a
systematic coverage of management theory and practice.
The course is intended to provide the student with an understanding of components of public
health services, inventory management, resource mobilization (state/local), total quality
management, time management, conflict management, communication skills, hospital
production, outcomes assessment, globalization and its impact on health services accessibility
and affordability.
Students are expected to learn and apply health care management theories at different levels
- 128 -
(district, village development committee, wards) of health institutions during each CBLE
posting. This will enable students to understand the type of work they are expected to
perform once they are posted in district heath system after their graduation.
In addition to programme management, students are expected to acquire knowledge and skill
about project management, health care institutions and hospitals administration.
Specific objectives
At the end of the course students should be able to:
· Describe the fundamental principles of healthcare institution and hospital
management.
· Describe the concept of management and its application in health care including
hospital.
· Discuss and compare the health care management system in Nepal and other parts of
the world
· Describe introduction of preventive, curative, promotive, rehabilitative health
services
· Describe organizational development issues in the health system
· Describe and discuss the philosophies behind investing in health
· Describe effective hospital management principles
· Describe book-keeping
· Discuss the purpose of medical and non-medical data and records
· Discuss planning and budgeting
· Describe the rules and regulations of Ministry of Health and Population, Nepal
· Discuss the ethics and responsibility of management
References:
1. Managing Health Services Organizations, Fifth Edition, Jonnathon S. Rakich, Beaufort B.
Longest, Jr. Kurt Darr, Health Professions Press
4. Principles of Management, Agrawal, GR, M. K. Publishers
& Distributors, Kathmandu
5. The Yale Management Guide for Physicians, Stephen Rimar, John Wiley & Sons, Inc.
2. The Well-Managed Healthcare Organization, John R. Griffith and Kenneth R. White, 6th
Edition, Health Administration Press, Chicago, Illinois, AUPHA Press, Washington, DC,
AUPHA/HAP
3. Nepal’s Quest for Health, Hemang Dixit, Educational Publishing House, Jamal,
Kathmandu, 2005.
6. Annual Report, Department of Health Services (current publication), MOHP, Kathmandu,
Nepal
7. Better Management 100 Tips, Managers Guide, Jack Reynolds, Maria Franscisco, Susan
Gearon, Aga Khan Health Services/ ISBN 1-882839-17-X.
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Basic Epidemiology (Epidemiology I)
The basic epidemiology course is designed to equip the undergraduate students with a basic
knowledge on the need, philosophy, concepts, methods, strategy and use of epidemiology. This
course enables students to develop competency skills and attitude to apply epidemiological
principles and logic in the community and individual diagnosis, and also health care practices.
General Objectives:
At the end of this course students should be able to:
· Identify and differentiate the health and non-health factors affecting the population
exposed, the environment and ecosystem including social in which they live in and the
specific agents which influence or determine health and disease, as a basis for the health
care of communities
· Use epidemiology principles and approaches in understanding and analyzing health
problems and developing community health care for population
· Design and organize control and prevention programs
· Manage diseases and other health problems appropriate to the existing physical, eco-
biological and socio-cultural conditions through integrated application of knowledge and
skills from other disciplines
Specific Objectives:
Students will be able to:
· Describe and differentiate descriptive, comparative, analytical, interventional
and experimental epidemiology
· Review, apprise, present, and apply (commonly use) various epidemiological
studies
· Apply basic knowledge of epidemiology in the community:
· Understand and explain cause and effect relationship, types of associations and
their use
· Use epidemiological concepts for prevention and management of health problem
· Discuss hypothesis regarding the cause or determinants and the distribution of
disease and problem in the population or area
· Formulate a hypothesis and test it scientifically
·
· Explain the need and underlying principles of classifying diseases
Discuss and apply measurement of disease frequency
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General Epidemiology (Epidemiology II)
The General epidemiology course is designed to enable students to develop competency skills
for different levels of prevention program. In addition students will be able to use acquired
knowledge for health promotion at communities during Community Based Learning Education
processes.
General Objectives:
Specific Objectives:
Students will be able to:
References:
· Barker, D.J.P, Rose, G., Epidemiology in Medical Practice, Churchill Livingstone
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Applied Epidemiology (Epidemiology III)
In this final section of the epidemiology course students will become familiarized with the
broader thematic areas of applied epidemiology and will use these concepts in the day to day
management of clinical cases and program management at a population level. The course
consists of three thematic parts:
(1) Epidemiology of infectious diseases
(2) Epidemiology of non infectious diseases
(3) Health services for communicable and non communicable diseases.
Specific Objectives:
Group 3: Health service for communicable and non communicable diseases in Nepal:
Students will visit a numbers of programs and describe their operation. Programs include a
leprosy hospital, TB hospital and program, infectious disease hospital, Heart centers, cancer
hospital and different divisions, centers and sections of Department of Health services.
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Community Health Sciences Laboratory and Public Health Program Appraisal
This course is designed to help students apply knowledge of basic community health sciences
(including epidemiology, bio-statistics, demography, medical sociology and anthropology,
environment health, and family health) in both clinical and public health in an integrated and
balanced way.
Specific Objectives:
Students will be able to:
· Assess the quality and quality assurance mechanism of physical facilities, such as
latrines and water supplies, designed and installed for public health reasons
· Perform simple laboratory procedures in health program and public health research
Appraise the activities of water supply and sewerage system; solid waste disposal
system, Food Research Laboratory, Control of Diarrhea Diseases.
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Family Health I
This course is designed to enable the students to understand the social, psychological, and
economical dimensions of illnesses.
General Objectives:
Student will develop knowledge and insight on what will happen when a person falls sick in a
family. They will be able to identity the roles and responsibilities of family, community and
health institution to help the sick person to recover
Specific Objectives:
Teaching strategies
Two students will be assigned a village and they will have to maintain a diary for that assigned
village for 4 years. They have to submit their village diary and have to make a presentation at
PAHS.
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Family Health II
The course is designed to help students appreciate the importance of family size and
environment. The course includes Family Planning and Maternal and Child Health Service,
essential health care package and rehabilitation.
General Objectives:
Students will be able to apply and evaluate family health principles in terms of:
· Family Planning
· Maternal and child health
· Nutrition: integrate with Food and Nutrition
· Primary Health Care and Essential Health Care
· Care of elderly and disabled
· Rehabilitation
Specific Objectives:
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Food and Nutrition
The course is designed to help students develop basic knowledge and competency in the areas of
food and nutrition with the emphasis of problems encountered in Nepal.
General Objective
To understand, apply, evaluate and manage nutrition and food related problem at individual and
population level using integrated knowledge and skills of basic, community and clinical science
disciplines.
Specific Objectives
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Biostatistics I – Basic Biostatistics (Descriptive Statistics)
This part of the biostatistics course is designed to provide the undergraduates students with a
basic knowledge on the need, concepts, methods, and use of descriptive statistics in health
sciences.
General Objectives:
Specific Objectives:
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· Belle GV, Fisher LD, Heagerty, PJ, Lumley T. (2004). Biostatistics: A Methodology
for Health Sciences. Wiley Series in Prabability and Mathematical Statistics.
· Campbell MJ, Machin D and Walters SJ (2007). Medical Statistics: A Textbook for
the Health Sciences, 4th Edition, Wiley, United Kingdom.
· Greasley P (2007). Quantitative Data Analysis using SPSS: An Introduction for
Health and Social Science. Open University Press.
· Hills M and Stavola BLD (2007). A Short Introduction to Stata for Biostatistics.
Stata Press: Timberlake Consultants Ltd.
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Biostatistics II – Advanced Biostatistics (Inferential Statistics)
This part of the biostatistics course is designed to provide the undergraduates students with basic
knowledge, competency skills and attitude in applied biostatistics for the practice of evidence
based medicine, health care management and research as well as CBLE processes.
General Objectives:
At the end of this course students should be able to:
· Discuss the use and misuse of the inference statistics
· Identify and apply the appropriate statistical methods
· Integrate statistical methods with other disciplines
Specific Objectives
Reference Books:
· Swinscow TDV (2002). Statistics at Square One (Revised by M J Campbell). 10th
Edition, BMJ Books, United Kingdom.
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· Campbell M J (2006). Statistics at Square Two: Understanding Modern Statistical
Applications in Medicine. 2nd Edition, BMJ Books, United Kingdom.
· Campbell MJ, Machin D and Walters SJ (2007). Medical Statistics: A Textbook for
the Health Sciences, 4th Edition, Wiley, United Kingdom.
· Belle GV, Fisher LD, Heagerty, PJ, Lumley T. (2004). Biostatistics: A Methodology
for Health Sciences. Wiley Series in Prabability and Mathematical Statistics.
· Juul S (2008). An Introduction to Stata for Health Researchers. 2nd Edition. Stata
Press.
· Gaur AS and Gaur SS (2009). Statistical Methods for Practice and Research: A
Guide to Data Analysis using SPSS (Respose Books). 2nd Edition. Sage Publication
Pvt. Ltd.
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Demography
Demography is divided into two parts: formal and social demography. Formal demography deals
with measurement of the population size, distribution, structure and change in population
whereas social demography analyzes the relationships between economic, social, cultural and
biological processes influencing a population. Medical demography concentrates on the
application of formal and social demography in health. Demographic methods and tools are
important to assess and devise health plans and policies at local, national and international
levels.
General Objectives:
Specific Objectives:
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· Ministry of Health and Population (2008). Population Report of Nepal 2007.
(http://www.moh.gov.np/population/publications.asp)
Reference Materials:
· Central Bureau of Statistics/UNICEF/New ERA (1995 – 98). Nepal Multiple
Indicator Survey: Cycle I – VI. (http://www.cbs.gov.np/nmis_contents.php)
· Central Bureau of Statistics/UNICEF (2000). Between Census Household
Information, Monitoring and Evaluation System (BCHIMES).
(http://www.cbs.gov.np/BCHIMES.php)
· Gurung, H (2001). Nepal: Social Demography and Expressions, New ERA, Himal
Books, Second Edition.
· Central Bureau of Statistics/UNFPA (2002). National Report 2001. Kathmandu,
Nepal. (http://www.cbs.gov.np/national_report_2001.php)
· Central Bureau of Statistics/UNFPA (2003). Population Monographs of Nepal: 2001.
Nepal. (http://www.cbs.gov.np/population_1_contents.php and
http://www.cbs.gov.np/population_2_contents.php)
· New ERA, Ministry of Health, MACRO International. Nepal Demographic and
Health Survey: 1996, 2001 and 2006 Final Reports.
· (http://www.measuredhs.com/pubs/pub_details.cfm?ID=669)
· Central Bureau of Statistics/World Bank (. Nepal Living Standard Survey:
2003/2004. (http://www.cbs.gov.np/Surveys/NLSSII/NLSSIIReportVol1.pdf and
http://www.cbs.gov.np/Surveys/NLSSII/NLSSIIReportVol2.pdf)
· Department of Education (2005). School Level Educational Statistics of Nepal:
Consolidated Report. Sanothimi, Bhaktapur, Nepal.
· Central Bureau of Statistics. Nepal Labour Force Survey Reports, Kathmandu,
Nepal. (http://www.cbs.gov.np/nlfs_report_contents.php)
· Singh ML. Introduction to Mathematical Demography, Koseli Prakashan.
· Graziella Caselli, Jacques Vallin, and Guillaume Wunsch (eds) (2006). Demography:
Analysis and Synthesis. ELSEVIER Academic Press, Vol I – IV.
· Institute for Social and Environment Research/University of Michigan (2001 – till
date). Chitwan Valley Family Study.
(http://perl.psc.isr.umich.edu/researchprojects.htm)
· Park K (2009). Park’s Textbook of Preventive and Social Medicine. Banarasida
Bhanot Publishers (20th Edition).
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Culture, Society, Health and Illness
This course aims to provide students training in society, culture and social development and the
contribution which behavioral science can make to the prevention and control of health
problems
Objectives:
· Discuss the concept of medical sociology, medical anthropology, nature and subject
matter of medical sociology and anthropology, in determining health and health related
needs of the family and the community.
· Describe cross-cultural understanding of health, illness, and disease.
· Describe various perspectives on health and illness.
· Explore and analyze the social determinants of health and disease.
· Compare the differentials in health status of people in the community and identify their
causes.
· Explore and describe the health care pluralism in the family and the community.
· Compare the communication patterns among various service providers and service
receivers.
· Describe how health and disease distributed is influenced by different social classes,
ethnic groups and ecological regions within countries.
· Define the social problems, describe various social problems, and compare the social
problems in urban and rural areas.
· Describe various components of health system, health care philosophy and health care
expenditure.
· Describe and compare various level of health planning.
· Describe the rights of patients and professionals.
· Compare the theory versus practice of the health rights in the community.
· Describe the health care ethics and explore the dilemma of health care ethics in the
community.
· Describe qualitative and quantitative research methods, apply various tools to collect
qualitative and quantitative information, summarize and compare the findings.
· Formulate and propose the culturally competent program to promote the health in rural
community.
Text Books
· Helman, Cecil G. (2001). Culture, Health and Illness (Fourth Edition). London: Arnold.
· Scambler, Graham (ed.) (2003). Sociology as Applied to Medicine (Fifth Edition).
Edinburgh: Saunders.
References
· Annandale, Ellen (1998). The Sociology of Health and Medicine: A Critical
Introduction. UK: Polity Press.
· Beine, David K. (2003). Ensnared by AIDS: Cultural Contexts of HIV/AIDS in Nepal.
Kathmandu: Mandala Book Point.
· Davey, Basiro, Alastair Gray and Clive Seale (eds.) (2001). Health and Disease: A
Reader. Buckingham: Open University Press.
· Hahn, Robert A. (ed.) (1999). Anthropology in Public Health: Bridging Differences in
Culture and Society. New York: Oxford University Press.
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· McElroy Ann and Patricia K. Townsend (1996). Medical Anthropology in Ecological
Perspectives (Third Edition). Westview Press.
· Nichter, Mark and Mini Nichter (1996). Anthropology and International Health: Asian
Case Studies. Gordon and Breach Publishers.
· Piotrow, Phyllis Tilson; D. Lawrence Kincaid; Jose G. Rimon II and Ward Rinehart
(eds) (1997). Health Communication: Lessons from Family Planning and Reproductive
Health. USA: Praeger Publishers.
· Schwartz, Howard D (ed). (1994). Dominant Issues in Medical Sociology (Third
Edition). New York: McGraw-Hill, Inc.
· Subedi, Madhusudan Sharma (2001). Medical Anthropology of Nepal. Kathmandu:
Udaya Books.
· White, Kevin (2002). An Introduction to the Sociology of Health and Illness. London:
Sage Publication.
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Health Education and Behavioral Change
Specific objectives:
1. Introduction
4. Method and media of health education and counseling in a medical care setting.
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Students will be able to:
· Explain effective interpersonal and group communication with patient and patient
parties
· Define communication and its elements
· Describe interpersonal and group communication barriers and the ways to overcome
these barriers
Students will be provided with an opportunity to visit the National Information, Education and
Communication center during course delivery.
During the rural rotation, students will apply BEHAV or similar Framework for health
promotion as part of a teaching-learning exercise.
Evaluation:
Periodic assessments of the teaching learning activities of students will be done during the
period of the course, including class tests, project report, presentation and interaction.
Community health will be included in the integrated examinations that take place at the end of
each academic year.
Text Books:
Reference Books:
· Egger, G.;Spark, R., Health promotion strategies and methods, Mcgraw-Hill Publication
· Shreehari Sharma, Swastha Pariwaar Saral Upaya, Premier Printing Industry, Chitwan,
2008
· J. Kishore, A Dictionary of Public Health, Century Publications, New Delhi, 2002
· Steve Sussman, Hand Book of Program Development for Health (Behavior Research &
Practice), Sage Publications Inc., 2000
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Ecologic Health
The course aims to provide basic theoretical and practical knowledge and skills on
environmental health. The course is thematically divided into:
1. Environmental sanitation
2. Eco-health
3.Climate change and health.
Students will learn and understand management of environmental sanitation and understand
effects of environment, ecology and climate change on human health and development.
General Objectives:
· Identify problems related to environmental sanitation and health, and be able to develop
programs to solve or mitigate the effects on human health and environment.
· Evaluate and assess environmental and health status and to conduct research in
environmental health.
Specific Objectives:
1. Ecology:
2. Water
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3. Air
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8. Housing
1. Climate Change and Human Health-Risks and Responses, WHO, WMO and UNEP
Reference books:
1. Ecosystem and Human Health: Some findings from Millennium Ecosystem Assessment
2. United States Environmental Protection Agency, Climate Change and Public Health,
EPA 236-F-97-005 October 1997
5. Ministry of Health, Nepal, Health Care Waste Management in Nepal, June 2003
6. Rijal, H.B., H. Yoshida, T. Miyazaki and I Uchiyama, Indoor air pollution from firewood
combustion in traditional houses in Nepal.
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COMMUNITY BASED LEARNING AND EDUCATION
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Community Based Learning and Education
Community Based Learning and Education (CBLE) is an important part of Patan Academy of
Health Sciences strategy to achieve its stated goals. The Academy will have a long-term
commitment with the community, where students and faculty learn in the real life situation..
PAHS will develop the necessary infrastructure and skills to establish linkage with the
communities and the national health system. PAHS will initially work in several communities
and gradually cover a whole district over time. In the teaching district, PAHS engagement and
commitment will be long-term and will not be considered as merely for posting students. The
broader aim of CBLE is to provide benefits to the communities, the students and the faculty and
eventually to the national health system.
PAHS has a philosophical commitment for community based learning and education, therefore,
there will be on going development of institutional support mechanisms and infrastructure. This
will be reflected primarily through the curriculum and the job responsibilities of faculty. The
implementation strategies will be designed in such a way that PAHS educational and service
objectives and activities will be coherently linked and bridged together.
B. Basic minimum necessary infrastructure: In the context of CBLE the most important
infrastructure is well informed and supported communities. The Department of Community
Health Sciences will arrange local family support for students when they are posted at
village level. This is important for motivation and fulfillment of daily basic needs.in order to
provide an optimal learning opportunity and environment.
C. Link with the National Health System: There will be formal and informal linkage with the
national health system from the Ministry of Health to the village health system.
D. Link with the communities: PAHS will develop and establish teaching districts and
communities. PAHS and the teaching communities will jointly develop long-term
engagement plans from the very beginning of the program.
F. Shared benefits with communities: PAHS will invest its knowledge and skills to build the
capacity of local health facilities. Local health facilities workers will be our local supervisors
also. In addition we will organize periodic service outlets which will be used for three
purposes:
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a. training students
b. training local health facilities staff
c. providing services to local communities.
G. Community will serve as community based research area: Teaching communities and
district will be developed with the necessary community based infrastructure and
information database for community based research. GIS technology will be used in addition
to basic demographic information and all health related events will be recorded. A separate
plan will be developed for the implementation of research activities.
The Government of Nepal has committed to achieve the Millennium Development Goals
(MDG) by the year 2015 and Ministry of Health has been putting resources and efforts to realize
goals 4, 5 and 6 within this time frame. Furthermore, Primary Health Care (PHC) approach has
been the strategy to achieve these goals. Significant efforts have been made to train health
personnel to work at various levels, in the community and at primary, secondary and tertiary
levels health facilities.
The inception and establishment of Patan Academy of Health Sciences is to provide support to
MOH for the realization of its objectives through training of a health workforce with adequate
competency to work in the most under served areas. There are clear roles and responsibilities:
PAHS programs have a broad aim to train a health workforce with adequate competency skills
to deliver services especially in rural area of Nepal; MOH will provide an enabling structural
frame for this health workforce to work at peripheral levels in rural areas. Therefore, the role of
MOH and concerned other ministry is important not only by serving as client-consumer of the
products of an academic institution but also to provide input to the process of implementation,
overall program design, and most importantly to create an enabling environment.
PAHS students will have different opportunities to equip them to be effective and efficient for
their job later. Their training will take place in a real life setting, with the specific aim of
developing the student's understanding of community problems, and their ability to work with
the community in tackling such problems. Thus, the PAHS students and future ‘health leaders’
will be prepared to work toward fulfilling the Millennium Development Goals.
The particular educational strategy chosen to meet the goal is field-based, responsive, problem-
solving methods. These encourage students to become responsive to their future responsibilities
while they learn, and develop clinical, management and communication competencies under
supervision in the community.
It will be necessary for PAHS to periodically review the relevance of its educational and training
programs in the light of overall context and policy changes, and to consider the wisdom of
making curriculum revisions.
For the last several decades it was believed that health problems could be solved through the
advancement of medical technology. It is true that 100 years ago, people died prematurely due to
lack of technology and knowledge of proper diagnosis and proper treatment. Much emphasis
was given to explore the secret of diseases and their remedy. The goal of the medical school was
to produce doctors who were smart in identifying diseases and treating them. Although many of
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the secrets of diseases are known today, many people on this planet still lose their lives
unnecessarily because of many other factors. These factors include social contexts where the
poor do not have access to the technology. Therefore, the doctors of the present generation, if
they wish to save human lives, cannot do so just by mastering knowledge and skills of medical
sciences. They have to play a new role, as a community-oriented health professional.
Considering Nepal’s specific needs in health and dealing with Nepal’s specific problems in the
context of its socio-economic development, PAHS should put a lot of emphasis on CBLE.
"If the student in public health is to become familiar with the educational approach to health
problems, training methods must become adjusted to this objective and --- needs to work WITH
and IN the community as a part of -- training. Thus, in advanced training for public health - and
in training for public health education of the public - the community should be used as the
laboratory of the school."
Source: WHO Expert Committee on Public Health Education 1995. Series No. 156-25.
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Fundamentals of Community Based Learning and Education (CBLE)
· CBLE is not merely community oriented learning or learning to serve the community.
Rather, it is a process of learning from the community and with the community. CBLE
encourages engagement in community and socio-political processes.
· CBLE helps to understand about health, disease, their interrelationship and their
determinants in real life contexts (ecology).
· CBLE helps to understand health and disease in longitudinal ways rather than in cross
section, as is typical in the setting of a clinic or hospital.
· CBLE helps to internalize the suffering and pain related to the diseases.
· CBLE helps to inform and empower the population about their health risks and
behaviors, and in whatever context they chose to live.
Strategies of CBLE
Department of Community Health Sciences will be the focal point for the implementation of
the CBLE program.
Specific functions:
· To co-ordinate with Department of Medical Education and its activities
· To assess the needs of the CBLE support, identify areas and resources available for field
and maintain up-to-date records of these activities.
· To enlist and maintain the co-operation and participation of local administration and the
community.
· To assess new facilities and develop their role as sites for CBLE.
· To provide support for staff & students in field teaching sites.
· To assist the program co-coordinators with the evaluation of the effect of field education
activities, on the performance of their students, and through this means, to monitor the
CBLE component's contribution to the student's education
· To prepare and distribute periodic reports on CBLE activities.
The following section illustrates the platforms, educational resources and the expected function
of students in the particular levels of rotations. In the subsequent sections objectives, procedure
and expected outcome of each posting is further discussed to provide scope and guideline for
implementation.
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Scheme of Community Based Learning and Education
Urban slum
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Scheme of Community Based Learning and Education
Ward
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Scheme of Community Based Learning and Education
Village
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Scheme of Community Based Learning and Education
Ilaka
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Scheme of Community Based Learning and Education
Figure: 5: Four weeks duration at Village Development Committee (VDC) Area for Community Diagnosis
Village
Educational resources: Around 1000 · Tools development, pre-testing and application of data
households and 5000 population, a collection tools (questionnaire)
local health facility, promotive, · Questionnaire to have geographical location, Support system:
demographic, socio-economic, cultural and health Day to day by
preventive and curative care services
related information
through national health system, local supervisor,
· Prepare data entry tool and analysis plan
village, functioning of village health Periodic by field
Field Posting: 5 · House to house visit and administer questionnaires
system, recording and reporting, faculty,
· Identify the households with GPS device
supportive supervision and · Compilation, tabulation and presentation of data at:
At least once by
monitoring, organization and function a. Community Central faculty
of outreach activities, support and b. PAHS
supply to Female Community Health · Preparation of village health status popularly known as
Volunteers ‘Community Diagnosis’
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Scheme of Community Based Learning and Education
Sub-district
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Scheme of Community Based Learning and Education
District
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The Community Based Learning and Education offers a unique opportunity for students
to understand and internalize the community and health institution in which they are
supposed to manage program and provider services in their later career.. The CBLE
process yields useful data and information to help health care program planning locally
and at national level. In addition, students have close contact with people in families
and communities who, in the future, will be their patients and comprise their target
population in management of district public health services.
This course outline has been prepared to assist students and faculty in the various
departments in particular for Department of Community Health Sciences for the
implementation of CBLE program.
It should be pointed out that Lesson Plans for different level will be prepared and this
will be the responsibility of assigned faculty. Relevant and useful materials will be
incorporated as they are available and agreed upon by the DCHS. In addition to
cognitive inputs, suggestions will be collected from different academics to enable
students to develop needed skills and appropriate attitudes for successful teaching
learning work. There will a standard detailed teaching material available for faculty and
reading materials and handouts for students.
Step: One
The first rotation will be non-residential and in one of the growing slum areas in
Kathmandu valley.
Goal:
To describe current population movement in Nepal and ascertain the opportunities and
challenges faced by migrants in relation to health and other basic social services in
Nepal.
Specific objectives:
Student will be able to:
· Observe the settlement through ‘rapid walk in’ technique
· Assess in general: total population and density
· Assess housing condition
· Provision of drinking water system
· Assess and availability of health services and other social services
· Food availability
· Health service coverage / waste disposal
· Identify major determinants of health (literature review and findings)
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· Total duration: 16 hours in the field
Assessment:
· Students will be able to discuss growing slum settlement and challenges faced
by slum dwellers
· Report presentation at PAHS
· Report preparation and submission to the Department
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Step: Two (Ward)
The second posting will be residential and in one of the identified ward of PAHS
program Village Development Area in the rural part outside Kathmandu valley.
Goal:
To understand overall village ecology (physical and socio-cultural) and its relation to
health
Specific objectives
Student will be able to:
· Assess in general: total population and density
· Identify population composition and characteristic through group informants
· Identify major source of income, occupation of different age and sex
· Identify major type of economic system
· Identify socio-cultural practices and their relation to health
· Identify village institutions and organizations and their role and responsibilities
in the village health and development process
· Identify role and responsibilities of Female Community Health Volunteer
· Participate in FCHV work process including assessment of sick child
· Assess FCHV and outreach health service coverage
· Participate with FCHV in her counseling process to mother
· Identify and understand importance of IEC and job aid materials being used by
FCHV
· Participate in mothers’ group meeting
· Assess housing condition
· Assess drinking water system
· Assess food security situation
· To identify major determinants of health (literature review and findings)
· Identify opportunity and constraints existing in the village for health and
development process
· Identify other existing multi-sectoral development extension work (eg. JTA,
Vetenary, Community forestry initiative, Cooperative, etc.)
Assessment:
1. Report presentation at PAHS
2. Report preparation and submission to the DCHS
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Step: Three
Goal:
To assess overall health status and determinants including existing health services
Specific objectives:
Student will be able to:
· Identify population composition and characteristics
· Identify source of income, occupation of different age and sex
· Identify major type of economic system
· Identify socio-cultural practices and their relation to health
· Identify village institutions and organizations and their role and responsibilities
in the village health and development process
· Identify role and responsibilities of local health facility
· Identify opportunity and constraints existing in the village for health and
development process
· Identify others existing development extension work
· Participate in day to day activity of local health facility
· Participate and understand management of local health facility i.e. personnel,
logistics, services
· Participate in the organization of outreach activities with Village Health
Worker and Maternal and Child Health Worker
· Participate in the immunization program
· Participate in the family planning and child health outreach program
· Participate in the daily activity of health facility
· Produce a Case study of a sick child and socio-economic status of the
concerned family.
· Organize Focus Group Discussions to explore community perspectives of
maternal and child health.
Assessment:
1. Report presentation at PAHS
2. Report submission to the Department
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Step: Four
Goal:
To assess overall health status of Ilaka and understand priority health programs and
management plan of the facility
Specific objectives:
Student will be able to:
· Identify population composition and characteristics
· Identify characteristics of catchment area
· Identify and briefly discuss economic system
· Identify socio-cultural practices and their relation to health
· Identify role and responsibilities of Health Post
· Participate in day to day activity of Ilaka health facility
· Participate and understand management of Ilaka health facility i.e. personnel,
logistics, services
· Collect and analyze available data and information
· Demonstrate management and follow up of a sick child (Integrated
Management of Childhood Illness)
· Assess pregnant mother and participate in education process (Birth
Preparedness Package)
· Demonstrate management of adult patients with chronic shortness of breath
· Perform Family planning counseling and dispense commodity of client’s choice
· Assess infection prevention situation in the facility and develop plan of action
including follow up plan
Assessment:
1. Report presentation at PAHS
2. Report submission to the Department
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Step: Five
Goal:
To assess overall population health status and its determinants using household census
at family, household, ward and village level
Specific objectives:
Student will be able to:
· Construct, pre-test and finalize the household survey instrument (questionnaire)
· Design a questionnaire to assess sanitation and health related information
· Plan the household survey
· Prepare data entry tool and analysis plan
· Conduct the household survey
· Compute survey data and interpret it.
· Present the key findings in the community during the visit
· Perform data entry, validation and finalization at PAHS
DCHS and Basic Science departments will engage in the supportive supervision and
monitoring. Statistician/demographer will be the in charge.
Assessment:
1. Detail presentation at PAHS
2. Prepare a detailed Community Diagnosis Report and submit it to the DCHS
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Step: Six
Goal:
To assess overall health status of Sub-District (Ilakas) and develop one year priority 1
and 2 interventions management plan
Specific objectives:
Student will be able to:
· Identify population composition and characteristics
· Identify characteristics of catchment area
· Identify and briefly discuss economic system
· Identify socio-cultural practices and their relation to health
· Identify village institutions and organizations and their role and responsibilities
in the village health and development process
· Identify role and responsibilities of PHCC
· Assist and participate in a normal delivery
· Appraise institutional harmony and conflict in the Ilaka
· Participate in day to day activity of PHCC
· Participate and understand management of PHCC i.e. personnel, logistics,
services
· Collect and analyze available data and information
· Demonstrate management and follow up of the sick child (Integrated
Management of Childhood Illness)
· Assess pregnant mother and participate in education process (Birth
Preparedness Package)
· Perform simple abscess management process
· Demonstrate management of adult patients with chronic shortness of breath
· Assist and participate in Family planning counseling and dispense commodity
of client’s choice
Assessment:
1. Report presentation at PAHS and submit to DCHS
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Step: Seven
Goal:
To familiarize students with the District Health System and help them acquire all the
basic skills on management and basic clinical competency which will be expected by
MOHP for a district public health and medical officer to manage district health
programs.
Specific objectives
Student will be able to:
· Identify population composition and characteristics
· Identify characteristics’ different catchment area
· Identify and briefly discuss economic system
· Identify socio-cultural practices and their relation to health
· Identify institutions and organizations and their role and responsibilities in the
district health and development process
· Identify role and responsibilities of district health system
· Identify opportunity and constraints existed in the district
· Participate and assist in managing all health services in the district health
office i.e. district hospital, district public health office, laboratory, etc
· Participate and assist in logistics management activities
· Participate and assist in infection prevention activities
· Participate and assist in personnel management activities
· Participate and assist financial and accounting activities
· Participate and assist performance appraisal activities
· Appraise one management issue in-depth
· Conduct an epidemiological study of a selected disease
· Acquaint with medico-legal problem
· Perform Quick assessment of private sector service providers.
· Organize district level stakeholders workshop and incorporate inputs for next
Five Year Strategic Planning
Platform: A district and district hospital and district public health office
1. There will be five students in a district.
2. Total duration: six month
Assessment:
1. Report presentation at PAHS
2. Report preparation on Five Year Strategic Plan based on situation assessment
and submission to the Department of Community Health Sciences
3. Epidemiological report of selected disease
4. Critical appraisal paper of a management issue
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Internship
One year rotating compulsory rotating internship will be 6th year of the curriculum.
Scheme V from National Guidelines for Medical Internship Training 2007, NMC will
be followed.
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Student Assessment plan
The PAHS medical curriculum is divided into three main phases for the purposes of
assessment– the introductory block, the basic sciences and the clinical phase.
In each phase, there is internal assessment of the process of learning as well as content
evaluation. The assessment of whether PAHS attributes have been achieved will be integrated
into these.
During the introductory and basic science phases, learning process assessment is via Problem
based learning assessment. In the clinical phase, it will be via Clinical Presentation assessment.
Introductory phase
Content evaluation will be both formative and summative in each phase. Formative assessment
occurs in the middle of the introductory block with Multiple choice questions (MCQ) and
Problem based questions (PBQ), followed by a practical exam using Objective Structured
Practical Exams (OSPE). The same style of examination will be used for summative purposes
at the end of the introductory block.
Clinical phase
In the clinical phase, content evaluation will be undertaken using a similar format of formative
and summative assessments. A formative theory exam, employing MCQ and PBQ will occur at
the end of each rotation. Formative assessment of practical skills will take place during the
clinical rotations, using the Mini-CEX (mini-Clinical Examination) and DOPS (Directly
observed procedural skills) and a logbook.
There will be a formative practical exam (i. e. OSCE) at the middle of the junior clerkship
(after the end of two clinical rotations). There will be one internal summative examination,
using MCQ, PBQ and OSCE at the end of the first major clerkship.
From each of the formative exams, in each of the phases of the curriculum, 10% of the marks
will be added to the next summative examination score. There will also be self-assessment
MCQs available for students in each of the phases of the curriculum.
There will be three comprehensive final summative examinations during the MBBS program:
· Comprehensive Basic Science Examination (CBS - at the end of basic science)
· Comprehensive Clinical Science Examination I (CCSE I) - at the end of one and half
years of clinical sciences. This is the final examination for all the minor specialties
· Comprehensive Clinical Science Examination II (CCSE II) - at the end of five years of
curriculum.
The external examinations will continue to employ the same format of MCQ, PBQ and OSCE
examinations with structured vivas.
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Summary table of content examination schedule
Type Method
Formative Peer, Self and Tutor Feedback
Summative Tutor Feedback
· Students must meet expectation (pass) in the process evaluation to appear in summative
(final) exam.
Type Method
Formative Feedback from Local facilitator, PAHS facilitator, community
presentation, presentation at PAHS (each Community Field Visits)
Summative Presentation at PAHS
· Students must meet expectation (pass) in the process evaluation to appear in summative
(final) exam.
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ANNEXES
- 173 -
Annex 1: List of Common Lectures
1. Shock
2. Acute abdomen
3. Food & Nutrition
4. Fluid & electrolyte balance
5. Wound pathopthysiology & management
6. Fracture & dislocation
7. Skin manifestation of systemic diseases
8. blood count abnormalities
9. Sepsis
10. Autoimmune disorder & collagen vascular disorders
11. Infection in immunocompromised host
12. Allergy & anaphylaxixs
13. Mentally & physically challenged people
14. Breast feeding counseling
15. Genetic counseling
16. Adolescent health
17. Behavioral problem in children
18. Congenital anomalies
19. Immunization
20. Diabetes Mellitus
21. Menstrual cycle
22. Post traumatic stress disorder
23. Psychosexual disorder
24. Sleep hygiene
25. Alcohol
26. Poisoning – general management
27. Disaster management
28. Polytrauma
29. Sexual assault
30. Ethics
31. Medico legal problems
32. Principles of CPR, brain death
33. Palliative & terminal care
34. Tuberculosis
35. HIV
36. Parasitic infestation
37. Geriatric patient care
38. Acute encephalitic syndrome
39. Principles of GP & it,’s role in Nepal
40. Principles of holistic patient centered care
41. Principles of chronic care
42. Patients with multiple somatic complaints
43. Evidence based practice
44. Rational prescribing
45. Breaking bad news
46. Tumors & neoplasm
47. Research methodology
48. Ocular manifestations of systemic diseases
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Annex 2: Clinical Presentation by Organ System
· Cardiovascular / Respiratory
o Chest pain
o Shortness of breath
o Palpitation
o Oedema
o Shock
o Cough
o Haemoptysis
o Hypertension
o Cyanosis
o Arterial blood gas abnormalities
o Syncope
o Wheezing and respiratory difficulty
· Hematological
o Pallor
o Fatigue (GP)
o Abnormal bleeding
o Abnormal clotting
o Lymphadenopathy
· Gastrointestinal / Nutritional
o Mouth sores/ oral ulcers
o Abdominal pain
o Abdominal swelling / distension / mass
o Nausea / Vomiting
o Diarrhea
o Constipation
o Jaundice
o Haematemesis
o Blood in stool / Melena
o Dyspepsia / Indigestion
o Dysphagia
o Loss of appetite
o Weight loss / Malnutrition
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Annex 3: Distribution of clinical presentations in different clinical
postings
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Annex 4: Sample Clinical Presentation: Musculoskeletal pain
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Figure: High energy injuries
A. Clinical clues
· Ask about:
o Mechanism of injury (driver or passenger, with/without seatbelt on;
motorcycle rider w/wo helmet; hit as pedestrian, fall from higher
than standing height etc.)
o Timing of injury. Six hours is in general turning moment up to when:
§ open wounds have to be surgically treated (cleaned, debrided
- excised and closed or covered) in order to prevent
infections
§ vascular injuries have to be repaired / reconstructed in order
to avoid amputations
§ tight compartments with increased pressures have to be
released in order to avoid irreversible damages, tissues
necrosis and amputations
§ dislocated joints have to be reduced (in order to preserve
cartilage and avoid avascular necrosis – bone death; diminish
pressure on neurovascular bundle)
o Ability to ambulate, pre-injury functional level (w/wo assistive
devices like walker, cane; house or community ambulatory)
· Look for:
o Deformities (swelling, “funny” – unusual extremity positions
o Presence of skin breakage – wound and bleeding (arterial – pulsatile
bright red blood, or venous: dark – bluish, oozing blood) and
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whether are in vicinity of joint or broken bone (open joint or bone
injury - high risk of infection, which is an orthopedic emergency)
§ Visible bone fragments, ruptured tendons and muscles, foreign
material – grass, pieces of clothing, car paint, glass, sand
particles, dirt and alike in the wound
o Spontaneous motion (or absence) of digits and toes, extremities
distal to the injury level (nerve damage, muscles damage)
B. Investigations
· History:
o Cooperative patient:
§ chief complaint, symptoms
§ pertinent medical and surgical history, allergies
o Non-cooperative patient (child, intubated, comatose, intoxicated) –
get report from paramedics, bystanders, family
o Physical exam
§ Vital signs
§ Presence of arterial pulse and capillary refill distal to the injury;
color and temperature of the skin (diminished or absent in main
vessel arterial injuries)
§ Ability to move and feel extremity distal to the injury level
(spontaneously if comatose; on request if cooperative)
§ Tightness on palpation of compartments at/or distal to the level
of injury; presence of pain out of proportion (if cooperative) and
increased by passive stretch of muscles going through
compartment in question (plantar flexion of toes for antero-
lateral leg compartment)
o Align and immobilize extremity and obtain
§ X-ray in two plains of injured area and neighboring joints
(orthogonal, 90°-90°)
§ CT – for complex joint injuries and most spine injuries
§ MRI – for better evaluation of soft tissue injuries, spine and
occult fractures
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§ Bone scans – when looking for isolated (scaphoid, femoral neck
fracture; they are strongly positive after three days) or more often
when looking for multiple occult fractures (spine, sacrum… in
multiple injured and non-cooperative patients; pathological
fractures – looking for other lesions) or infection.
C. Comments
· Patients with high energy trauma could have multiple injuries (brain, chest,
intra-abdominal, extremities), and such severely injured patients are at risk for
permanent disability or even death (polytrauma). In order to get optimal care
and maximize the possibility of improvement and recovery, they require an
organized, trained team approach utilizing established and validated trauma
protocols. This type of approach will be considered in the clinical presentation
or lecture “trauma”. In the current clinical presentation, only isolated
musculoskeletal injuries will be considered.
· Isolated injuries still could be severe and grave, but they require less
involvement of other specialists besides orthopedic surgeon (as plastic surgeon,
vascular surgeon) in delivering care for their damages.
· It is important to evaluate whether the patient is able to cooperate (level of
consciousness) and move and feel her/his extremities. Moreover, the patient
need to be completely exposed (all clothing is removed) and all parts of the
body is visually inspected and palpated to ensure the absence of any other injury
and confirm that the injury identified is indeed isolated. If possible, obtaining
and storing digital photos on presentation and during the course of treatment,
might be extremely helpful:
o medically (for other members of the team to be able to evaluate
covered wounds and non-aligned, original presentation of the
injuries) and
o legally (family, patient, jury and lawyers will appreciate more the
severity of injuries and eventual less than perfect outcome if they
had chance to see the original damages).
· Secondary and tertiary surveys (each part of the body is examined, visually and
palpated) have to be repeated later (hours and days; when situation is less urgent
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and/or patient is able to be more cooperative), preferably by different members
of the team, in order to avoid the risks of missing other injuries. One severe
injury could be distracting and masking other, less severe injuries. It is
important to notify relatives that up to 20% of injuries (mostly minor, like foot,
spine, ribs etc) might be missed in non-cooperative (intubated, comatose,
intoxicated, brain injured and so on) patients, and that family members’
cooperation could help us in finding out what is bothering the patient
(occasionally they spend more time with their loved ones). From a medico-legal
point of view, it is important to record the patient’s neurological status (if
attainable) prior to any diagnostic or therapeutic interventions.
· The age of the injured patient is very important. It is expected that most children
who are victims of injury are healthy. Their body is “elastic”, light, and mobile.
If even light skeletal injury is sustained, it is indicative of high impact injury. If
the cause of injury is low energy mechanism, be aware that child could have
bone abnormalities, fragile bones like in osteogenesis imperfecta or some
underlying bone tumor. Children do have good healing potential and excellent
chance for fast and full recovery. It is very important to involve
parents/caregivers in their care from the beginning. When dealing with minors,
consent, for medico-legal reasons, must be obtained from parents. Finally, their
musculoskeletal condition could be changing until growth ceases, meaning that
there is need for long term follow-up.
· In the adult population, the use of nicotine could hinder recovery (slow
wound/bone healing, increased risk of pulmonary problems). In addition, drugs
and alcohol will significantly influence pain treatment (need for more narcotics)
and cooperation as well as general medical condition (liver and nerve problems
in alcoholics, immune status and possibility of HIV and hepatitis in drug
abusers).
· Elderly patients have multiple medical problems, less healing potential and
lower activity capacities and needs than younger patients. They tend to sustain
severe, potentially life threatening injuries after low energy trauma (e.g., hip
after fall from standing height) or even without trauma (e.g., osteoporosis of the
spine or bones invaded by tumors). Their medical/ surgical care is complex.
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· The occupation of the patient might also affect treatment (violin player will
need a different approach to the treatment of a small finger injury than security
guard). Patients who are hurt at work may require special attention and
documentation since Workmen’s Compensation Fund may be involved.
· Women in childbearing age require pregnancy testing. The fetus could sustain
injury as a result of the trauma or diagnostic and therapeutic interventions
(anesthesia, irradiation, medications etc).
· The mode of injury is very important, not only for determining the high or low
energy trauma, but also for proper documentation. The patients who have
sustained Motor Vehicle Accident, or who have sustained injury as a result of
fall from height might need proper documentation as regards to the mode of
injury for medicolegal purposes.
D. Diagnoses to consider
· High energy
o Polytrauma. Patients have injuries of two or more organ systems
(like cranio-cerebral, cardio-vascular, respiratory, gastrointestinal,
urogenital, musculoskeletal) and are in serious medical condition
(like hemorrhagic shock, respiratory insufficiency, renal
insufficiency…) with potentially endangered life.
o Multiple trauma – usually there are two or more severe injuries
within one organ system (e.g. musculoskeletal: broken femur and
tibia, humerus and so on).
o Isolated severe injuries, fractures and fracture-dislocations (closed or
open femoral or tibial fractures, dislocated hip or knee joint, ankle or
wrist fracture dislocation, amputation etc).
o Morbidly obese patients with dislocated knee after fall from height
(their weight - mass makes it high energy with potentially severe
consequences like neurovascular injuries, amputations).
o Major wounds or burns (depth and area).
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Figure: Low energy injuries
A. Clinical clues
· Ask about
o Mechanism of injury (standing height fall, minimal activity vs.
repetitive stress activities – marching or running, overuse injuries)
o Timing of injury (very important in dislocations and extremities with
neuro-vascular compromise)
o Functional capabilities before injury (walking)
· Look for
o Deformities (swelling, “funny” – unusual extremity positions)
o Presence of skin breakage – wound and bleeding
o Extent of disability
§ Mental status: patient could be fully cooperative or obtunded
to comatose (no contact or response possible).
§ If non-cooperative (intoxicated, agitated, somnolent,
comatose), identify others who could provide information
about the injury.
§ If patient is able to cooperate, determine movement and
sensation in the upper and lower extremities (neurological
exam to determine whether spinal cord and main peripheral
nerves are intact). Also, look for spontaneous motion (or
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absence) of digits and toes, extremities distal to the injury
level (nerve damage, muscles damage) in non-cooperative
patients.
o Visually inspect and palpate all parts of the body from head to toe in
order to establish the extent of injuries.
§ Examine chest for respiratory motion
§ Eyes, size of pupils and reaction
§ Contusion marks, bruises, wounds, swelling, gross
deformities, instability of extremities and pelvis, skin color
and temperature, blood in orifices (mouth, urethra, rectum).
B. Investigations
· Vital signs
· Clinical exam
· X-rays, CT, MRI, Bone Scans
· Labs
C. Diagnoses to consider
· Low energy
o Bruises, sprains (stretched or ruptured ligaments of different joints)
or strains (stretched or ruptured tendons or muscles).
o Minor wounds or burns.
o Broken pathologically changed bones (in elderly population: distal
radius, hip, proximal humerus, spine).
o Nondisplaced or minimally displaced fractures (adults with normal
bone structure and pediatric fractures like: distal radius, radial head,
forearm, elbow etc).
o Stress fractures (foot fractures in soldiers, dancers, players; femoral
neck fractures in runners).
o Overuse injuries (elbow pain in tennis or golf players; shoulder pain
in pitchers and gymnasts).
A. Clinical clues
· Ask about
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o Pain
o Diminished or limited function, suggestive of fracture and/or
dislocation.
· Look for
o Swelling
o Contusions
o Deformity
o Discoloration
o Superficial skin damage
o Wounds in communication with bone fragments (draining
hematoma, open fractures)
o Crepitations by trial of active or passive motion at fracture level
(audible or palpable rubbing of bone pieces against each other,
always painful).
B. Investigations
· Definitive sign of fracture is provided by diagnostic imaging
o Radiography (x-ray)
o Computer tomography (CT)
o Magnetic resonance imaging (MRI)
o Radionuclide (bone) scans.
· After studying diagnostic imaging results, determine whether there is a non-
displaced or minimally displaced fracture present. Even without some or all
symptoms and signs discussed above.
· Fractures can be outside of the joint (shaft and metaphyseal area), inside of the
joint (epiphyseal fractures) or a combination thereof.
C. Comments
· About 75% of patients who sustain trauma have injured extremities.
· The bones give mechanical strength and support to the extremities. The bones
are connected via joints (bone ends encapsulated in joint capsule and ligaments)
that allow controlled motion. Muscles are attached to the bones via tendons and
some cross joints in different directions allowing for motion through contraction
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or shortening of the muscle bellies. Muscle contractions are controlled by
nerves as is sensation of all parts of the extremities. All tissues are nourished by
vessels (arterial, venous and lymphatic), and all of them work in harmony in
order to have a normal, functional extremity. Trauma could damage all these
tissues and it is necessary to evaluate each one separately.
D. Diagnoses to consider
· Contusion or sprain
· Fracture
· Dislocation
Figure: Fractures
Fractures are breaks in the continuity of bone caused by trauma which exceeds bone
resistance to mechanical load. If a patient presents soon after injury, then any bone
break sustained is an acute fracture; if the bone break is presented to the physician late
(weeks and months), than it is termed a chronic or old fracture.
A. Clinical clues
· Ask about:
o Mechanism of injury
o Timing
o Function (motion and sensitivity)
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· Look for
o Damaged soft tissue protective envelop (complete skin breakage,
open wounds). Such breaks provide openings for contamination of
fracture or hematoma which could result in acute or chronic
infection. Such complications can significantly affect bone healing
and final outcomes.
o Distal pulses for presence and quality in every injured extremity
(absence of pulse in patient who is not in shock will need further
evaluation by ultrasound, angiography, or exploration) in order to
prevent ischemia and eventual loss of extremity.
o Tightness of osteo-fascial extremity compartments; evaluate in order
to rule out increased intra-compartmental pressure which could
destroy all tissues within compartments (nerves, muscles and
vessels).
o Damaged nerves (ability to move and feel) have to be evaluated in
order to avoid further harm (to remove the cause – pressure caused
by fragment(s), displacement, or increased soft tissue intra-
compartmental pressure).
B. Investigations
· X-rays, two orthogonal (90°-90°) planes, consider special views for hand foot,
shoulder, calcaneum
· Intra-compartmental pressure monitoring
· CT (intra-articular fractures)
· MRI (occult fractures, soft tissues)
· Bone scan
C. Comments
· Acute fractures are result of relatively recent injury. Pain, swelling, deformity,
limited function is present as well as instability (motion) at level of injury (for
unstable, displaced fractures).
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· If fracture presents late (weeks or even months), all symptoms will be
diminished and there is possibility that motion is abolished (fracture in healing
or healed). In cases where reduction is needed (better alignment, rotation and
length), it would be impossible to mobilize fragments without surgery.
· Late presentation might be in form of united cresidual pain and limited range of
motion or non-united fracture (no bone bridging formed, gaps visible on x-rays
nonunion).
D. Diagnoses to consider
· Contusions, sprains or strains
· Dislocations
· Fractures (acute or chronic)
o Upper limb fracture
o Lower limb fracture
o Pelvic fracture
o Spinal fracture
A. Clinical clues
· Ask about
o Time of injury
o Treatments before (reduction attempts, immobilization, surgery)
o History of osteopenia (osteoporosis)
o History of hormonal problems (parathyroid, suprarenal)
o History of cancer (metastases)
· Look for
o Deformity, scars, signs of drainage (infection)
o Function (inability to bear weight, pain at fracture level)
o Signs of muscles atrophy, joint contractures (stiffness)
B. Investigations
· Clinical exam
o pain at fracture level - spontaneous, on touch and/or at weight
bearing
o Instability at chronic fracture level (on stress)
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· Diagnostic
o X-ray, multiple views, non-weight bearing and weight bearing
(difference – instability)
o CT – bone bridging (healing), yes or no
o Bone scans
o Labs (exclusion of infection, hormonal status of the patient)
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C. Comments
· All fractures will heal in favorable circumstances (adequate stability, preserved
blood supply and innervations, absence of bone destroying infection, normal
hormonal and nutritional status) in certain, expected time. Usual timing to bone
healing is historically known and dependant on the age of the patient,
localization and fracture type:
o Younger patient will have faster healing (weeks) than older (months
needed).
o Epiphyseal and metaphyseal fracture (joint and close to the joint)
with a lot of cancellous, well vascularized bone will heal faster than
diaphyseal, mostly cortical bone with less abundant blood supply.
o Simple, long spiral fracture (with two main fragments and broad
fracture - contact surfaces) will heal faster than transverse fracture
(small contact area) or complex, multifragmentary fracture.
· Non-union is defined as
o absence of healing in expected time for respectful localization, type
of fracture and age of the patient,
o lack of three bridging cortices on two orthogonal x-rays views,
o pain at non-union (chronic fracture) site on weight bearing there is
no progress of healing (radiological and clinical) in the last three
months of follow up.
D. Diagnoses to consider
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Figure: Dislocations
A. Clinical clues
· Ask about
o Mechanism of injury
o Timing of injury, pain and swelling
o Ability to bear weight after injury
o About similar problems in the past
· Look for
o Appearance of joint
o Presence of wounds, draining hematoma or synovial - joint fluid
o Ability to move and feel extremity at level of injury and distal to it
o Color and temperature of the skin distal to the injury
B. Investigations
· Clinical exam
o Ability to actively move the joint
o Pulse, sensation and active motion distal to the joint
o Presence of fluid into the joint
o X-rays, two orthogonal (90° - 90°) views
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o CT
§ in uncertain diagnosis just with x-rays
§ when intra-articular fractures present
o Aspiration of joint fluid and instillation of local anesthetic
o Joint stability testing (if pain control obtained)
C. Comments
· Joint injury can present acutely soon after trauma (immediately, hours or
days), as an old injury (after weeks), or as result of chronic repetitive
injuries (months or years).
· Bone ends of two neighboring bones are covered by cartilage, held together
by their symmetrical shape, secured by capsule, ligaments, and muscle
tonus, and innervated by local nerves. If trauma exceeds joint resistance, it
could result in:
o Sprain (stretching or tearing of ligaments and capsule), with some
pain, swelling and difficulties to bear weight. On stress x-rays
(weight bearing or under specific load), joint surfaces are still
aligned well, parallel. On clinical exam joint appears to be stable
although testing the stability could be painful in acute setting (pain
control necessary).
o Subluxation – on x-ray exam (weight bearing or stress view) joint
surfaces are apart (still in some contact, but not parallel any more).
On clinical stress exam joint is “opening” more than opposite,
uninjured joint. Underlying problem is partial or full tear of some or
all supporting structures (ligaments and capsule) or their chronic
elongation (old or repetitive injuries and healing).
o Dislocation - when there is complete separation of adjacent joint
surfaces as result of major disruptions, avulsions and tears of
supporting structures. There could be additional neuro-circulatory
damage as well.
o Fracture dislocation, besides joint asymmetry has additional intra-
articular bony fragments.
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· For joints to function properly (stable, without pain and with full range of
motion, long lasting), it is necessary to reestablish stability, alignment ,
congruity and motion:
o Non-operatively (by immobilization using static or dynamic splints,
muscles strengthening, anti-inflammatory and pain medications) or
o Surgically (repair and reconstructions).
o In cases of fracture-dislocation, all bone pieces have to be put
together and articular surfaces have to be restored back to anatomical
shape as much as possible (to allow early smooth range of motion
and avoid cartilage damage). Also, the rest of the fractured extremity
needs to have good alignment in order to distribute weight evenly on
the articular surface and prevent posttraumatic arthritis.
D. Diagnoses to consider
· Sprains
· Subluxation
· Dislocation
· Fracture/Dislocation
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If minimal trauma such as falling at the same level or activity of daily living (like
lifting or pushing) causes bone discontinuity, consider both the level of energy as well
as whether pathological changes may be producing excessively fragile bones
(osteopenia, bone tumors).
A. Clinical clues
· Ask about
o Pain, variable in quality, sharp or dull, in the absence of preceding
trauma or exercise.
o Acute pain, if any, resolving after 4 – 6 weeks.
o Diminished or limited function, suggestive of fracture.
o On occasion, history of minor trauma such as going over speed
bumps.
· Look for
o Kyphosis
B. Investigations
· X-rays
· CT
· MRI
· Bone scans
C. Comments
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fractures include those that occur at sites of bone tumors (primary or
metastatic), bone cysts, and infections.
D. Diagnoses to consider
· Insufficiency fractures
· Pathological fractures
A. Clinical clues
· Ask about
o Mechanism of injury
o History of malignancy
o Age
o Recent weight loss
o Medications
· Look for
o Patient nutritional status (undernourished?)
B. Investigations
· X-rays (orthogonal)
· Chest x-rays (metastases?)
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· Bone scan (metastases)
· CT (cortical involvement)
· MRI (soft tissue involvement, skipped intramedullary lesions)
· Labs (ESR, CRP, metabolic panel)
C. Comments
· There should be high suspicion of pathological fracture if trauma is
minimal, pain is mild, fracture edges on x-rays are not sharp and
surrounding bone does not appear normal (like the rest of neighboring bone
tissue).
· Age is significant factor in making diagnosis (in elderly population we are
expecting more malignant tumors and mostly metastases) and in younger
population benign tumors (like benign bone cysts) or occasionally
malignancy (Ewing, osteosarcoma)
· Staging of the disease (local versus generalized disease – metastases) and
early involvement of oncologists, internal medicine or pediatric and
orthopaedic, is crucial in taking care of these rare but severe pathology.
Surgeries are much more difficult, specific and eventually life saving.
D. Diagnoses to consider
· Tumors
o Benign
o Malignant
§ Primary
§ Secondary
· Osteomyelitis
Stress fractures are due to loads that stress (either compress or stretch) a bone, but
which would not individually be expected to cause it to break. Stress fractures may be
the result of a small number of repetitions with a relatively large load (e.g., a military
recruit marching for several miles with a heavy backpack), a large number of
repetitions with a usual load (e.g., an athlete training for a long distance race), or some
intermediate combination of increased load and number of repetitions. If a fracture is
- 196 -
caused by repetitive minor stress, like femoral neck fractures in runners or metatarsal
fracture in marching solders, then the injury is termed a stress fracture. Underlying
cause might be unrecognized bone metabolism deficiency (nutritional, hormonal etc.).
A. Clinical clues
· Ask about
o Insidious onset of localized pain that is initially activity related and
increases in severity with increased activity. Eventually the pain is
present during less strenuous activity and ultimately during rest.
Occasionally, the patient experiences an abrupt increase in pain at
the site of milder chronic symptoms indicating that a repeatedly
stressed area of bone has finally fractured.
o Any repeated tensile or compressive stresses in a person who is not
known to have an underlying disease that would be expected to
cause abnormal bone fragility.
o Occupation or type/frequency/extent of exercise
o Any abrupt increase in the duration, intensity, or frequency of
physical activity without adequate periods of rest.
o Risk factors
§ White race
§ Alcohol, cola, and/or tobacco use
§ Less weight-bearing exercise prior to exercise
§ Lower adult weight (lowest adult weight)
§ Glucocorticoid use
§ Use of depo-medroxyprogesterone acetate (DMPA) for
contraception (DMPA increased the risk for stress fracture in
white women)
o Dietary history (vitamin D deficiency)
o Past history: general health, past medical history, current
medications, occupation, and previous injuries.
o Sites of possible fracture in order to assess risk of complications.
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§ Second through fourth metatarsal shafts, posteromedial tibial
shaft, proximal humerus or humeral shaft, ribs, sacrum, and
pubic rami are considered low risk.
§ Stress fractures of the superior side of the femoral neck (i.e.,
tension side), patella, anterior cortex of the tibia (i.e., tension
side), medial malleolus, talus, tarsal navicular, proximal fifth
metatarsal, great toe sesamoids, and the base of the second
metatarsal bone are considered to be at high risk for
complications.
· Look for
o Muscle strains, joint sprains, nerve entrapment syndromes and
compartment syndrome that share some features with stress
fractures.
o Among runners, the shin splint syndrome is most common.
o The most worrisome competing diagnoses are neoplasm and
infection. (see clinical presentations “localized pain” and “lumps,
MSK”
B. Investigations
· Radiography (x-ray)
· Computer tomography (CT)
· Magnetic resonance imaging (MRI).
· Bone scan
C. Comments
· Fracture refers to the breaking of a bone. Complete fractures divide the
affected bone into two or more pieces, while partial (incomplete) fractures
do not extend contiguously through the cortex. An example of an
incomplete fracture is the "greenstick" fracture, in which the convex side of
a long bone is disrupted, while the concave surface remains intact; or
femoral neck stress fracture – just one side has broken cortex.
· Stress fracture occurs when a bone breaks after being subjected to repeated
tensile or compressive stresses, none of which, individually, would be large
- 198 -
enough to cause the bone to fail, in a person who is not known to have an
underlying disease that would be expected to cause abnormal bone fragility.
D. Diagnoses to consider
· Stress fracture
· Insufficiency fracture
· Pathological fracture
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Annex 5: Level of ability expected at the end of basic medical
education
Competency Level for
1. General Medicine:
Essential hypertension 1 2 3A 3B 4
Secondary hypertension 1 2 3A 3B 4
Pulmonary hypertension 1 2 3A 3B 4
Raynaud's disease 1 2 3A 3B 4
Coarctation of the aorta 1 2 3A 3B 4
Buerger's disease 1 2 3A 3B 4
Arterial embolism 1 2 3A 3B 4
Atherosclerosis 1 2 3A 3B 4
Aortic aneurysm 1 2 3A 3B 4
Dissecting aneurysm 1 2 3A 3B 4
Cardiogenic shock 1 2 3A 3B 4
Septic shock 1 2 3A 3B 4
Hypovolaemic shock 1 2 3A 3B 4
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Veins
Deep vein thrombosis 1 2 3A 3B 4
Thrombophlebitis 1 2 3A 3B 4
Lymph vessels
Lymphangitis 1 2 3A 3B 4
Lymphadenitis 1 2 3A 3B 4
Lymphoedema, primary and secondary 1 2 3A 3B 4
Respiratory
Uncomplicated pulmonary tuberculosis 1 2 3A 3B 4
Tuberculosis with HIV 1 2 3A 3B 4
Acute bronchitis 1 2 3A 3B 4
Bronchial asthma 1 2 3A 3B 4
Status asthmaticus 1 2 3A 3B 4
Lung emphysema 1 2 3A 3B 4
Atelectasis 1 2 3A 3B 4
Bronchiectasis 1 2 3A 3B 4
Chronic obstructive pulmonary disease (COPD) 1 2 3A 3B 4
Severe acute respiratory syndrome (SARS) 1 2 3A 3B 4
Pneumonia 1 2 3A 3B 4
Avian influenza 1 2 3A 3B 4
Lung abscess 1 2 3A 3B 4
Pulmonary embolism 1 2 3A 3B 4
Lung infarction 1 2 3A 3B 4
Pleurisy (tuberculous) 1 2 3A 3B 4
Pleurisy (malignant) 1 2 3A 3B 4
Pleurisy (lupus) 1 2 3A 3B 4
Pneumothorax 1 2 3A 3B 4
Cystic fibrosis 1 2 3A 3B 4
Aspiration pneumonia 1 2 3A 3B 4
Gastrointestinal
Mouth
Leukoplakia 1 2 3A 3B 4
Candidiasis 1 2 3A 3B 4
Mouth ulcers (aphthous, herpes) 1 2 3A 3B 4
Glossitis 1 2 3A 3B 4
Oesophagus
- 201 -
Oesophageal varices 1 2 3A 3B 4
Oesophageal rupture 1 2 3A 3B 4
Gastro-oesophageal reflux 1 2 3A 3B 4
Stomach and duodenum
Gastritis 1 2 3A 3B 4
Gastric/duodenal ulcer 1 2 3A 3B 4
Gastrointestinal bleeding 1 2 3A 3B 4
Zollinger-Ellison syndrome 1 2 3A 3B 4
Mallory-Weiss syndrome 1 2 3A 3B 4
Gastroenteritis 1 2 3A 3B 4
Liver
Fatty liver 1 2 3A 3B 4
Hepatitis A 1 2 3A 3B 4
Uncomplicated hepatitis B 1 2 3A 3B 4
Active hepatitis C 1 2 3A 3B 4
Hepatic cirrhosis 1 2 3A 3B 4
Amoebic liver abscess 1 2 3A 3B 4
Liver failure 1 2 3A 3B 4
Pancreas
Pancreatitis (acute and chronic) 1 2 3A 3B 4
Jejunum, ileum
Enteritis 1 2 3A 3B 4
Colon
Irritable bowel syndrome 1 2 3A 3B 4
Necrotizing enterocolitis 1 2 3A 3B 4
Diverticulosis/diverticulitis 1 2 3A 3B 4
Colitis 1 2 3A 3B 4
Crohn's disease 1 2 3A 3B 4
Ulcerative colitis 1 2 3A 3B 4
Nephrourology
Acute renal failure 1 2 3A 3B 4
Chronic renal failure 1 2 3A 3B 4
Nephrotic syndrome 1 2 3A 3B 4
Acute glomerulonephritis 1 2 3A 3B 4
Chronic glomerulonephritis 1 2 3A 3B 4
Interstitial nephritis 1 2 3A 3B 4
Polycystic kidneys (ADPKD) 1 2 3A 3B 4
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Urinary tract infection 1 2 3A 3B 4
Acute tubular necrosis 1 2 3A 3B 4
Uncomplicated pyelonephritis 1 2 3A 3B 4
Urinary incontinence 1 2 3A 3B 4
Male genitalia
Infertility 1 2 3A 3B 4
Erection disorders 1 2 3A 3B 4
Ejaculation disorders 1 2 3A 3B 4
Haematology
Aplastic/hypoplastic anaemia 1 2 3A 3B 4
Iron deficiency anaemia 1 2 3A 3B 4
Macrocytic anaemia 1 2 3A 3B 4
Haemolytic anaemia 1 2 3A 3B 4
Haemoglobinopathy 1 2 3A 3B 4
Anaemia associated with chronic diseases 1 2 3A 3B 4
Polycythaemia 1 2 3A 3B 4
Thrombocytopenia 1 2 3A 3B 4
Thrombocytosis 1 2 3A 3B 4
Haemophilia 1 2 3A 3B 4
Von Willebrand's disease 1 2 3A 3B 4
Disseminated intravascular coagulation (DIC) 1 2 3A 3B 4
Agranulocytosis 1 2 3A 3B 4
Haemorrhagic disorders 1 2 3A 3B 4
Antiphospholipid syndrome 1 2 3A 3B 4
Immunology
Autoimmune rheumatological and
autoimmune disorders
Uncomplicated systemic lupus erythematosus
(SLE) 1 2 3A 3B 4
Complicated systemic lupus erythematosus
(SLE) 1 2 3A 3B 4
Scleroderma 1 2 3A 3B 4
Polyarteritis nodosa 1 2 3A 3B 4
Lupus vasculitis 1 2 3A 3B 4
Polymyalgia rheumatica 1 2 3A 3B 4
Rheumatoid arthritis 1 2 3A 3B 4
Immunological/allergic reactions
Anaphylactic reaction 1 2 3A 3B 4
Rheumatic fever 1 2 3A 3B 4
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Henoch-Schönlein purpura 1 2 3A 3B 4
Erythema multiforme 1 2 3A 3B 4
Stevens-Johnson syndrome 1 2 3A 3B 4
Transplantation immunology 1 2 3A 3B 4
Immunodeficiency – HIV 1 2 3A 3B 4
Genetics/newborn/chromosomal disorder
Genetics/congenital disorders
Down syndrome 1 2 3A 3B 4
Turner's syndrome 1 2 3A 3B 4
Klinefelter's syndrome 1 2 3A 3B 4
Marfan's syndrome 1 2 3A 3B 4
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Addison's disease 1 2 3A 3B 4
Multiple endocrinological neoplasia (MEN
syndrome) 1 2 3A 3B 4
Tumour with ectopic production of hormone 1 2 3A 3B 4
Errors of metabolism
Hyperlipoproteinaemia 1 2 3A 3B 4
Porphyria 1 2 3A 3B 4
Gout 1 2 3A 3B 4
Obesity 1 2 3A 3B 4
- 205 -
Vascular dementia 1 2 3A 3B 4
Alzheimer's disease 1 2 3A 3B 4
Pick's disease 1 2 3A 3B 4
Movement Disorders
Parkinson's disease 1 2 3A 3B 4
Tremor 1 2 3A 3B 4
Secondary parkinsonism 1 2 3A 3B 4
Huntington’s disease 1 2 3A 3B 4
Sydenham’s chorea 1 2 3A 3B 4
Dystonia
2
Hemifacial spasm
2
Epilepsy and other seizures
Focal epilepsy 1 2 3A 3B 4
Generalized epilepsy 1 2 3A 3B 4
Absence seizure 1 2 3A 3B 4
Status epilepticus 1 2 3A 3B 4
Narcolepsy 1 2 3A 3B 4
Sleep apnoea syndrome 1 2 3A 3B 4
Demyelination diseases
Multiple sclerosis 1 2 3A 3B 4
Optic neuromyelitis (Devic's disease) 1 2 3A 3B 4
Diseases of spine and spinal cord
Amyotrophic lateral sclerosis (ALS) 1 2 3A 3B 4
Complete spinal transaction 1 2 3A 3B 4
Brown-Sequard syndrome 1 2 3A 3B 4
Cauda equina syndrome 1 2 3A 3B 4
Neurogenic bladder 1 2 3A 3B 4
Syringomyelia 1 2 3A 3B 4
Myelopathy 1 2 3A 3B 4
Dorsal root syndrome 1 2 3A 3B 4
Acute medullary compression 1 2 3A 3B 4
Radicular syndrome/HNP 1 2 3A 3B 4
Tuberculous spondylitis
1 2 3A 3B
Neuromuscular diseases and neuropathy
Horner’s syndrome 1 2 3A 3B 4
Carpal tunnel syndrome 1 2 3A 3B 4
Tarsal tunnel syndrome 1 2 3A 3B 4
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Neuropathy 1 2 3A 3B 4
Guillain-Barré syndrome 1 2 3A 3B 4
Myasthenia gravis 1 2 3A 3B 4
Polymyositis 1 2 3A 3B 4
Duchenne muscular dystrophy 1 2 3A 3B 4
Neurofibromatosis (von Recklinghausen’s disease) 1 2 3A 3B 4
Infectious diseases
Meningitis 1 2 3A 3B 4
Encephalitis 1 2 3A 3B 4
Cerebral malaria 1 2 3A 3B 4
Tetanus 1 2 3A 3B 4
Cerebral toxoplasmosis 1 2 3A 3B 4
Tuberculoma 1 2 3A 3B 4
Brain abscess 1 2 3A 3B 4
HIV AIDS 1 2 3A 3B
Neurobehavioural Disorders
Post-traumatic amnesia 1 2 3A 3B 4
Aphasia 2 2 3A 3B 4
Mild cognitive impairment (MCI) 1 2 3A 3B 4
Vascular cognitive impairment) (VCI) 2
CNS Tumors
Primary tumour 1 2 3A 3B 4
Secondary tumor 1 2 3A 3B 4
Pain
Nociceptive pain 1 2 3A 3B 4
Neuropathic pain 1 2 3A 3B 4
Visual disturbances
Sudden blindness 1 2 3A 3B 4
Visual field disorders 1 2 3A 3B 4
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Infectious and tropical diseases
Gram-positive cocci
Staphylococcal and streptococcal infections
Staphylococcal pneumonia 1 2 3A 3B 4
Staphylococcal bacteraemia 1 2 3A 3B 4
Streptococcal infection
Rheumatic fever 1 2 3A 3B 4
Rheumatic heart disease 1 2 3A 3B 4
Meningococcal infection
Meningitis 1 2 3A 3B 4
Gonococcal infections
Gonorrhoea 1 2 3A 3B 4
Gram-negative bacilli
Urinary tract infection (UTI) 1 2 3A 3B 4
Typhoid fever 1 2 3A 3B 4
Bacillary dysentery 1 2 3A 3B 4
Cholera 1 2 3A 3B 4
Pertussis 1 2 3A 3B 4
Plague 1 2 3A 3B 4
Chancroid 1 2 3A 3B 4
Toxin producing bacteria
Tetanus 1 2 3A 3B 4
Mycobacterial diseases
Cuticular tuberculosis 1 2 3A 3B 4
Leprosy 1 2 3A 3B 4
Lepra reaction 1 2 3A 3B 4
Spirochaetal diseases
Syphilis 1 2 3A 3B 4
Yaws 1 2 3A 3B 4
Leptospirosis 1 2 3A 3B 4
Deep fungal infections
Actinomycosis 1 2 3A 3B 4
Chromoblastomycosis 1 2 3A 3B 4
Maduromycosis 1 2 3A 3B 4
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Viral infections
Influenza 1 2 3A 3B 4
Poliomyelitis 1 2 3A 3B 4
Rabies 1 2 3A 3B 4
Measles 1 2 3A 3B 4
Varicella 1 2 3A 3B 4
Herpes zoster 1 2 3A 3B 4
Herpes simplex 1 2 3A 3B 4
Mumps 1 2 3A 3B 4
Cytomegalovirus (CMV) infections 1 2 3A 3B 4
Dengue hemorrhagic fever (DHF) 1 2 3A 3B 4
HIV-AIDS 1 2 3A 3B 4
Protozoal infections
Amoebiasis 1 2 3A 3B 4
Malaria 1 2 3A 3B 4
Leishmaniasis and tripanosomiasis 1 2 3A 3B 4
Toxoplasmosis 1 2 3A 3B 4
Giardiasis 1 2 3A 3B 4
Trichomoniasis 1 2 3A 3B 4
Worm infestations
Hookworm diseases 1 2 3A 3B 4
Strongyloidiasis 1 2 3A 3B 4
Ascariasis 1 2 3A 3B 4
Filariasis 1 2 3A 3B 4
Schistosomiasis 1 2 3A 3B 4
Cutaneous larva migrans 1 2 3A 3B 4
Taeniasis 1 2 3A 3B 4
Neoplasms
Blood and lymph nodes
Non-hodgkin's lymphoma 1 2 3A 3B 4
Hodgkin's lymphoma 1 2 3A 3B 4
Acute leukaemia 1 2 3A 3B 4
Chronic leukaemia 1 2 3A 3B 4
Myelodysplastic syndromes 1 2 3A 3B 4
Multiple myeloma 1 2 3A 3B 4
Langerhans' cell histiocytosis 1 2 3A 3B 4
Lung
Bronchogenic carcinoma 1 2 3A 3B 4
Bronchoalveolar carcinoma 1 2 3A 3B 4
Neuroendocrine tumor (carcinoid tumor) 1 2 3A 3B 4
Mesothelioma 1 2 3A 3B 4
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Gatrointestinal
Benign polyps 1 2 3A 3B 4
Squamous cell carcinoma 1 2 3A 3B 4
Adenocarcinoma 1 2 3A 3B 4
Carcinoid tumor 1 2 3A 3B 4
Lymphoma 1 2 3A 3B 4
Liver
Liver cell adenoma 1 2 3A 3B 4
Hepatocellular carcinoma 1 2 3A 3B 4
Pancreas
Carcinoma of the pancreas 1 2 3A 3B 4
Kidney
Cortical adenoma 1 2 3A 3B 4
Renal cell carcinoma 1 2 3A 3B 4
Wilm's tumor 1 2 3A 3B 4
Male genitals
Squamous cell carcinoma 1 2 3A 3B 4
Seminoma 1 2 3A 3B 4
Teratoma of the testis 1 2 3A 3B 4
Benign prostatic hyperplasia 1 2 3A 3B 4
Carcinoma of the prostate 1 2 3A 3B 4
Breast
Gynaecomastia 1 2 3A 3B 4
Endocrine glands
Thyroid adenoma 1 2 3A 3B 4
Thyroid carcinoma 1 2 3A 3B 4
Thymus
Thymoma 1 2 3A 3B 4
Central and peripheral nervous system
Astrocytoma 1 2 3A 3B 4
Oligodendroglioma 1 2 3A 3B 4
Ependymoma 1 2 3A 3B 4
Medulloblastoma 1 2 3A 3B 4
Retinoblastoma 1 2 3A 3B 4
Meningioma 1 2 3A 3B 4
Neurofibroma 1 2 3A 3B 4
- 210 -
Schwannoma 1 2 3A 3B 4
Psych-organic syndromes and disorders due to drugs
Intoxication 1 2 3A 3B 4
Withdrawal syndrome 1 2 3A 3B 4
Delirium 1 2 3A 3B 4
Dementia 1 2 3A 3B 4
Amnesic syndrome 1 2 3A 3B 4
Other organic disorders 1 2 3A 3B 4
miscellaneous
Drowning 1 2 3A 3B 4
4
Poisoning
1 2 3A 3B
Suffocation 1 2 3A 3B 4
- 211 -
2. Surgery:
Cardiovascular
Arterial thrombosis 1 2 3A 3B 4
Buerger's disease 1 2 3A 3B 4
Arterial embolism 1 2 3A 3B 4
Aortic aneurysm 1 2 3A 3B 4
Dissecting aneurysm 1 2 3A 3B 4
Septic shock 1 2 3A 3B 4
Hypovolaemic shock 1 2 3A 3B 4
Veins
Respiratory
Gastrointestinal
Leukoplakia 1 2 3A 3B 4
Candidiasis 1 2 3A 3B 4
Mouth ulcers (aphthous, herpes) 1 2 3A 3B 4
Glossitis 1 2 3A 3B 4
Mucus cyst 3A
Oesophagus
Oesophageal atresia 1 2 3A 3B 4
Achalasia 1 2 3A 3B 4
Corrosive lesions of oesophagus 1 2 3A 3B 4
Oesophageal varices 1 2 3A 3B 4
Oesophageal rupture 1 2 3A 3B 4
Reflux oesophagitis 1 2 3A 3B 4
CORrOSIVE OESOPHAGITIS 1 2 3A 3B 4
OESOPHAGEAL CA 1 2 3A 3B 4
PRIMARY MEDIASTINAL TUMORS 1 2 3A 3B 4
- 212 -
Diaphragm
Diaphragmatic hernia 1 2 3A 3B 4
Hiatus hernia 1 2 3A 3B 4
Acute abdomen
Intestinal Obstruction 1 2 3A 3B 4
Stomach and duodenum
Gastritis 1 2 3A 3B 4
Gastric/duodenal ulcer 1 2 3A 3B 4
Gastrointestinal bleeding 1 2 3A 3B 4
Zollinger-Ellison syndrome 1 2 3A 3B 4
Mallory-Weiss syndrome 1 2 3A 3B 4
Liver
Jejunum, ileum
Intestinal atresia 1 2 3A 3B 4
Meckel's diverticulum 1 2 3A 3B 4
Umbilical fistula, omphalocoele-gastroschisis 1 2 3A 3B 4
Malrotation 1 2 3A 3B 4
Intestinal TB
- 213 -
Irritable bowel syndrome 1 2 3A 3B 4
Necrotizing enterocolitis 1 2 3A 4
Diverticulosis/diverticulitis 1 2 3A 4
Colitis, ULCERATIVE ~ 1 2 3A 3B 4
Rectal, anal prolapse 1 2 3A 3B 4
Proctitis 1 2 3A 3B 4
Haemorrhoids 1 2 3A 3B 4
THROMBOSED PILES 1 2 3A 3B 4
Perianal fistula 1 2 3A 3B 4
Rectal polyps 2
Rectal cancer 2
Anal fissure 1 2 3A 3B 4
INTESTINAL OBST- INTUSSUSCEPTION, VOLVULOUS, OBST HERNIA 2
Pediatrics Surgery
Oesophageal atresia 1 2 3A 3B 4
Intestinal atresia 1 2 3A 3B 4
Anal atresia/IMPPERFORATED ANUS 1 2 3A 3B 4
Diaphragmatic hernia (congenital) 1 2 3A 3B 4
Pyloric stenosis/HYPERTROPHIC ~ 1 2 3A 3B 4
Gastro-oesophageal reflux 1 2 3A 3B 4
Intestinal obstruction-worms 1 2 3A 3B 4
Acute abdomen 1 2 3A 3B 4
Ileus 1 2 3A 3B 4
Tuberculous peritonitis 1 2 3A 3B 4
Peritonitis due to pancreatitis 1 2 3A 3B 4
Intussusception 1 2 3A 3B 4
Malrotation 1 2 3A 3B 4
Umbilical hernia 1 2 3A 3B 4
Meckel's diverticulum 1 2 3A 3B 4
Ulcerative colitis 1 2 3A 3B 4
Hirschsprung's disease 1 2 3A 3B 4
Biliary atresia 1 2 3A 3B 4
- 214 -
Urinary incontinence 1 2 3A 3B 4
Nocturnal and diurnal enuresis 1 2 3A 3B 4
Prostatitis 1 2 3A 3B 4
Pyonephrosis, perinephric abscess, cystitis, orchitis 1 2 3A 3B 4
Single kidney, ectopic kidney, partial/complete duplication of
collecting system, ureterocele 1 2 3A 3B 4
Renal/bladder/epididymal tb 1 2 3A 3B 4
Obst uropathy/bph, post urethral valv 1 2 3A 3B 4
Male genitalia
Hypospadias 1 2 3A 3B 4
Epispadias 1 2 3A 3B 4
Undescended testes/cryptorchidism 1 2 3A 3B 4
Retractile testes 1 2 3A 3B 4
Torsion of testis 1 2 3A 3B 4
Epididymitis 1 2 3A 3B 4
Spermatocoele 1 2 3A 3B 4
Varicocoele 1 2 3A 3B
Hydrocoele 1 2 3A 3B 4
Phimosis 1 2 3A 3B 4
Paraphimosis 1 2 3A 3B 4
Ruptured urethra 1 2 3A 3B 4
Ruptured bladder 4
1 2 3A 3B
Ruptured kidney 4
1 2 3A 3B
Urethral stricture 3A 4
1 2 3B
Priapism 3A 4
1 2 3B
Peyronie’s disease 3A 4
1 2 3B
Extrophy of the bladder 3A 4
1 2 3B
Infertility 1 2 3A 3B 4
Erection disorders 1 2 3A 3B 4
Ejaculation disorders 1 2 3A 3B 4
Gynaecological Surgery
Haematology
Immunology
Immunological/allergic reactions
- 215 -
Anaphylactic reaction 1 2 3A 3B 4
Henoch-Schönlein purpura 1 2 3A 3B 4
Transplantation immunology 1 2 3A 3B 4
Genetics/newborn/chromosomal disorder
Disorders of newborns
Infection of umbilicus 1 2 3A 3B 4
Loss of consciousness
Coma 1 2 3A 3B 4
Brain death 1 2 3A 3B 4
Cardio Vascular Diseases
Subarachnoid haemorhage 1 2 3A 3B 4
HEAD INJURY 1 2 3A 3B 4
SUBDURAL HAEMATOMA 1 2 3A 3B 4
Infectious diseases
Brain abscess 1 2 3A 3B 4
HIV AIDS 1 2 3A 3B
Congenital disorders
Hydrocephalus 1 2 3A 3B 4
Spina bifida 1 2 3A 3B 4
Pediatric neurological disorders
Cerebral abscess 1 2 3A 3B 4
Neurobehavioural Disorders
- 216 -
CNS Trauma
Epidural haematoma 1 2 3A 3B 4
Subdural haematoma 1 2 3A 3B 4
Subarachnoid haemorrhage 1 2 3A 3B 4
Spinal and medullary trauma 1 2 3A 3B 4
CNS Tumors
Primary tumour 1 2 3A 3B 4
Secondary tumor 1 2 3A 3B 4
Ears, hearing and equilibrium
Cyst 1 2 3A 3B 4
Goitre 1 2 3A 3B 4
Hyperthyroidism 1 2 3A 3B 4
Trachea
Aspiration 1 2 3A 3B 4
Foreign body/ies 1 2 3A 3B 4
Paronychia 1 2 3A 3B 4
Suppurative tenosynovitis 1 2 3A 3B 4
Human bite 1 2 3A 3B 4
Corn 1 2 3A 3B 4
Ingrown toenail 1 2 3A 3B 4
Infections of the head and neck
Suppurative parotitis 1 2 3A 3B 4
Suppurative cervical adenitis 1 2 3A 3B 4
Peritonsilar abscess 1 2 3A 3B 4
Ludwig's angina 1 2 3A 3B 4
Neoplasms
Non-hodgkin's lymphoma 1 2 3A 3B 4
Hodgkin's lymphoma 1 2 3A 3B 4
Lung
- 217 -
Bronchogenic carcinoma 1 2 3A 3B 4
Bronchoalveolar carcinoma 1 2 3A 3B 4
Neuroendocrine tumor (carcinoid tumor) 1 2 3A 3B 4
Mesothelioma 1 2 3A 3B 4
Leukoplakia 1 2 3A 3B 4
Polyps 1 2 3A 3B 4
Nasopharynx carcinoma 1 2 3A 3B 4
Pleomophic adenoma 1 2 3A 3B 4
Warthin’s tumor 1 2 3A 3B 4
Gatrointestinal
Benign polyps 1 2 3A 3B 4
Squamous cell carcinoma 1 2 3A 3B 4
Adenocarcinoma 1 2 3A 3B 4
Carcinoid tumor 1 2 3A 3B 4
Lymphoma 1 2 3A 3B 4
Liver - Hepatoma
Liver cell adenoma 1 2 3A 3B 4
Hepatocellular carcinoma 1 2 3A 3B 4
Cholangiocarcinoma 1 2 3A 3B 4
Pancreas
Carcinoma of the pancreas 1 2 3A 3B 4
Kidney
Cortical adenoma 1 2 3A 3B 4
Renal cell carcinoma 1 2 3A 3B 4
Wilm's tumor 1 2 3A 3B 4
Male genitals
Squamous cell carcinoma 1 2 3A 3B 4
Seminoma 1 2 3A 3B 4
Teratoma of the testis 1 2 3A 3B 4
Benign prostatic hyperplasia 1 2 3A 3B 4
Carcinoma of the prostate 1 2 3A 3B 4
Female genitals
Breast
Fibrocystic change 1 2 3A 3B 4
Fibroadenoma mammae 1 2 3A 3B 4
Phyllodes tumor 1 2 3A 3B 4
Breast carcinoma 1 2 3A 3B 4
Paget's disease of the breast 1 2 3A 3B 4
Gynaecomastia 1 2 3A 3B 4
- 218 -
Bloody Nipple discharge 3A
Endocrine glands
Somatotrophic adenoma 1 2 3A 3B 4
Prolactinoma 1 2 3A 3B 4
Thyroid adenoma 1 2 3A 3B 4
Thyroid carcinoma 1 2 3A 3B 4
Thymus
Thymoma 1 2 3A 3B 4
Skin
Benign epithelial tumors 1
Seborrheic keratosis 1 2 3A 3B 4
Epithelial cyst 1 2 3A 3B 4
Premalignant and malignant epithelial tumors
Actinic keratosis 1 2 3A 3B 4
Bowen's disease 1 2 3A 3B 4
Squamous cell carcinoma 1 2 3A 3B 4
Basal cell carcinoma 1 2 3A 3B 4
Tumors of the dermis
Xanthoma 1 2 3A 3B 4
Haemangioma 1 2 3A 3B 4
Lymphangioma 1 2 3A 3B 4
Angiosarcoma 1 2 3A 3B 4
Tumors of immigrant cells to the skin
Mycosis fungoides 1 2 3A 3B 4
Mastocytosis 1 2 3A 3B 4
Langerhans' cell histiocytosis 1 2 3A 3B 4
Tumors of melanocytic cells
Lentigo 1 2 3A 3B 4
Naevus pigmentosus 1 2 3A 3B 4
Malignant melanoma 1 2 3A 3B 4
Bone and soft tissue
Ganglion cyst 1 2 3A 3B 4
Lipoma 1 2 3A 3B 4
Desmoid tumor 1 2 3A 3B 4
Fibroma 1 2 3A 3B 4
Fribrosarcoma 1 2 3A 3B 4
Benign fibrous histiocytoma 1 2 3A 3B 4
Malignant fibrous histiocytoma (MFH) 1 2 3A 3B 4
Rhabdomyosarcoma 1 2 3A 3B 4
Leiomyoma 1 2 3A 3B 4
Leiomyosarcoma 1 2 3A 3B 4
Central and peripheral nervous system
Astrocytoma 1 2 3A 3B 4
- 219 -
Oligodendroglioma 1 2 3A 3B 4
Ependymoma 1 2 3A 3B 4
Medulloblastoma 1 2 3A 3B 4
Retinoblastoma 1 2 3A 3B 4
Meningioma 1 2 3A 3B 4
Neurofibroma 1 2 3A 3B 4
Schwannoma 1 2 3A 3B 4
Musculoskeletal system
Traumatology
Burning 1 2 3A 3B 4
Bleeding 1 2 3A 3B 4
Hypovolaemic shock 1 2 3A 3B 4
Rib fractures/contusion 1 2 3A 3B 4
Injury caused by rib fractures 1 2 3A 3B 4
Pneumothorax 1 2 3A 3B 4
Haemothorax 1 2 3A 3B 4
Injury to specific internal organs, such as liver, kidney, lung, etc 1 2 3A 3B 4
PNEURMOPERITONEUM 1 2 3A 3B 4
HAEMOPERITONEUM 1 2 3A 3B 4
FROST BITE 1 2 3A 3B 4
Accident and emergency neurology
Head injuries 1 2 3A 3B 4
Diffuse brain damage 1 2 3A 3B 4
Cerebral concussion and contusion 1 2 3A 3B 4
Brain death 1 2 3A 3B 4
Extradural haemorrhage 1 2 3A 3B 4
Subdural haemorrhage 1 2 3A 3B 4
Fracture of base of skull 1 2 3A 3B 4
Acute traumatic spinal transaction 1 2 3A 3B 4
Reproductive system
Puerperium
Mastitis 1 2 3A 3B 4
Cracked nipple 1 2 3A 3B 4
Inverted nipple 1 2 3A 3B 4
Incontinence of urine 1 2 3A 3B 4
Incontinence of faeces 1 2 3A 3B 4
Deep venous thrombosis 1 2 3A 3B 4
Thrombophlebitis 1 2 3A 3B 4
Embolism 1 2 3A 3B 4
- 220 -
Principle of surgery/history/evolution/ recent advances/future
development/surgical ethics/communication 1 2 3A 3B 4
Aseptic technique/ot
Methods of sterilization, antiseptics, preparation for surgeon,
1 2 3A 3B 4
patient, operative field, gowning, gloving, painting, draping
Anaesthesia/pain management
1 2 3A 3B 4
Introduction, pre anaesthetic prepartion/checkup, types of
anaesthesia- ga/reginal/la, recovery from anaesthesia
War surgery
- 221 -
3. PAEDIATRIC CONDITIONS
Cardiovascular
Heart failure 1 2 3A 3B 4
Cardiorespiratory arrest 1 2 3A 3B 4
Mitral stenosis 1 2 3A 3B 4
Mitral regurgitation 1 2 3A 3B 4
Aortic stenosis 1 2 3A 3B 4
Aortic regurgitation 1 2 3A 3B 4
Other valvular heart diseases 1 2 3A 3B 4
Ventricular septal defect 1 2 3A 3B 4
Atrial septal defect 1 2 3A 3B 4
Patenent ductus arteriosus 2
Tetralogy of Fallot 2
Sinus tachycardia 1 2 3A 3B 4
Supraventricular tachycardia 1 2 3A 3B 4
Bundle branch block 1 2 3A 3B 4
Other arrhythmias 1 2 3A 3B 4
Endocarditis 1 2 3A 3B 4
Pericarditis 1 2 3A 3B 4
Myocarditis 1 2 3A 3B 4
Cardiomyopathy 1 2 3A 3B 4
Systemic hypertension 1 2 3A 3B 4
Pulmonary hypertension 1 2 3A 3B 4
Raynaud's disease 1 2 3A 3B 4
Coarctation of the aorta 1 2 3A 3B 4
Arterial embolism 1 2 3A 3B 4
Cardiogenic shock 1 2 3A 3B 4
Septic shock 1 2 3A 3B 4
Hypovolaemic shock 1 2 3A 3B 4
Veins
Deep vein thrombosis 1 2 3A 3B 4
Thrombophlebitis 1 2 3A 3B 4
Lymph vessels
Lymphangitis 1 2 3A 3B 4
Lymphadenitis 1 2 3A 3B 4
Lymphoedema, primary and secondary 1 2 3A 3B 4
- 222 -
Respiratory
Tonsillitis 1 2 3A 3B 4
Pharyngitis 1 2 3A 3B 4
Croup 1 2 3A 3B 4
Tracheitis 1 2 3A 3B 4
Epiglottitis 3B
Bronchiolitis 1 2 3A 3B 4
Bronchitis 4
Bronchial asthma 1 2 3A 3B 4
Status asthmaticus 1 2 3A 3B 4
Pleural effusion 1 2 3A 3B 4
Empyema 1 2 3A 3B 4
Bronchiectasis 1 2 3A 3B 4
Acute otits media 1 2 3A 3B 4
Tubeculosis of lungs / Pleura 4
Severe acute respiratory syndrome (SARS) 1 2 3A 3B 4
Pneumonia 1 2 3A 3B 4
Avian influenza 1 2 3A 3B 4
Lung abscess 1 2 3A 3B 4
Pulmonary embolism 1 2 3A 3B 4
Pleuritis 1 2 3A 3B 4
Pneumothorax 1 2 3A 3B 4
Respiratory failure 1 2 3A 3B 4
Aspiration / Choking 3B
Aspiration pneumonia 1 2 3A 3B 4
Congenital abnormalities of upper airway 2
Gastrointestinal
- 223 -
Gastroenteritis
Dysentry 4
Cholera
1 2 3 4 4
Uncomplicated Infective hepatitis 1 2 3A 3B 4
Worms 1 2 3A 3B 4
Chronic diarrhea 1 2 3A 3B 4
Malabsorption 1 2 3A 3B 4
Food intolerance 1 2 3A 3B 4
Acute abdomen 1 2 3A 3B 4
Ileus 1 2 3A 3B 4
Tuberculosis abdomen 1 2 3A 3B 4
Intussusception 1 2 3A 3B 4
Crohn's disease 1 2 3A 3B 4
Ulcerative colitis 1 2 3A 3B 4
Hirschsprung's disease 1 2 3A 3B 4
Biliary atresia 1 2 3A 3B 4
Reye's syndrome 1 2 3A 3B 4
Nephrourology
Acute renal failure 1 2 3A 3B 4
Chronic renal failure 1 2 3A 3B 4
Uncomplicated Nephrotic syndrome 1 2 3A 3B 4
Acute post streptococcal glomerulonephritis 1 2 3A 3B 4
Chronic glomerulonephritis 1 2 3A 3B 4
Interstitial nephritis 1 2 3A 3B 4
Polycystic kidneys 1 2 3A 3B 4
Other congenital abnormalities of urinary
system 1
Urinary tract infection 1 2 3A 3B 4
Acute tubular necrosis 1 2 3A 3B 4
- 224 -
Horseshoe kidney 1 2 3A 3B 4
Uncomplicated pyelonephritis 1 2 3A 3B 4
Urinary incontinence 1 2 3A 3B 4
Nocturnal and diurnal enuresis 1 2 3A 3B 4
Haematology
Aplastic / Hypoplastic anaemia 1 2 3A 3B 4
Iron deficiency anaemia 1 2 3A 3B 4
Macrocytic anaemia 1 2 3A 3B 4
Haemolytic anaemia 1 2 3A 3B 4
Haemoglobinopathy 1 2 3A 3B 4
Anaemia associated with chronic diseases 1 2 3A 3B 4
Polycythaemia 1 2 3A 3B 4
Idiopathic thrombocytopenic purpura 1 2 3A 3B 4
Chronic Idiopathic thrombocytopenic purpura 1 2 3A 3B 4
Haemophilia 1 2 3A 3B 4
Von Willebrand's disease 1 2 3A 3B 4
Disseminated intravascular coagulation (DIC) 1 2 3A 3B 4
Agranulocytosis 1 2 3A 3B 4
Non-hodgkin's lymphoma 1 2 3A 3B 4
Hodgkin's lymphoma 1 2 3A 3B 4
Acute leukaemia 1 2 3A 3B 4
Chronic leukaemia 1 2 3A 3B 4
Myelodysplastic syndromes 1 2 3A 3B 4
Immunology
Autoimmune / Immunological / allergic
disorders
Uncomplicated systemic lupus erythematosus
(SLE) 1 2 3A 3B 4
Complicated systemic lupus erythematosus
(SLE) 1 2 3A 3B 4
Uncomplicated Juvenile Rheumatoid arthritis 1 2 3A 3B 4
Rheumatic fever
1 2 3 3B 4
Rheumatic heart disease
1 2 3A 3B 4
Anaphylactic reaction 1 2 3A 3B 4
Juvenile chronic arthritis 1 2 3A 3B 4
Henoch-Schönlein purpura 1 2 3A 3B 4
Dermatomyositis
2
Atopy 1 2 3A 3B 4
Drug reactions 3A
Stevens-Johnson syndrome 1 2 3A 3B 4
- 225 -
Genetics/newborn/chromosomal disorder
Genetics/congenital disorders
Down syndrome 1 2 3A 3B 4
Turner's syndrome 1 2 3A 3B 4
Klinefelter's syndrome 1 2 3A 3B 4
Gonadal XY-dysgenesis 1 2 3A 3B 4
Testicular feminization 1 2 3A 3B 4
Fragile X syndrome 1 2 3A 3B 4
Phenylketonuria (PKU) 1 2 3A 3B 4
Galactosaemia 1 2 3A 3B 4
Glycogen storage disease 1 2 3A 3B 4
Other storage diseases 1 2 3A 3B 4
Spina bifida 1 2 3A 3B 4
Anencephaly 1 2 3A 3B 4
Hydrocephalus 1 2 3A 3B 4
Marfan's syndrome 1 2 3A 3B 4
Disorders of newborns
Hypothermia 1 2 3A 3B 4
Bacteraemia and septicaemia 1 2 3A 3B 4
Respiratory distress syndrome 1 2 3A 3B 4
Bronchopulmonary dysplasia 1 2 3A 3B 4
Aspiration pneumonia 1 2 3A 3B 4
Pneumothorax
1 2 3A 3B 4
Apnoeic attacks 1 2 3A 3B 4
Jaundice of newborn 1 2 3A 3B 4
Severe neonatal jaundice (kernicterus) 1 2 3A 3B 4
Hypoglycaemia 1 2 3A 3B 4
Child of diabetic mother 1 2 3A 3B 4
Neonatal convulsion 1 2 3A 3B 4
Necrotizing enterocolitis 1 2 3A 3B 4
Retinopathy of prematurity 1 2 3A 3B 4
Anaemia 1 2 3A 3B 4
Polycythaemia
2
Rhesus incompatibility 1 2 3A 3B 4
Other Blood group incompatibility 1 2 3A 3B 4
Haemorrhagic disease of newborn 1 2 3A 3B 4
Cerebral haemorrhage 1 2 3A 3B 4
Infection of umbilicus 1 2 3A 3B 4
Common neonatal skin conditions 1 2 3A 3B 4
- 226 -
Opthalmia neonatarum 1 2 3A 3B 4
Birth asphyxia 1 2 3A 3B 4
Birth trauma 1 2 3A 3B 4
Near sudden infant death syndrome (SIDS) 1 2 3A 3B 4
Endocrine, metabolic disorders and nutrition
Endocrinological disorders
Insulin-dependent diabetes mellitus (IDDM) 1 2 3A 3B 4
Non insulin-dependent diabetes mellitus
(NIDDM) 1 2 3A 3B 4
Diabetic ketoacidosis 1 2 3A 3B 4
Other complication of diabetes mellitus (acute
and chronic) 1 2 3A 3B 4
Hypoglycaemia 1 2 3A 3B 4
Diabetes insipidus 1 2 3A 3B 4
Acromegaly, gigantism 1 2 3A 3B 4
Growth hormone deficiency 1 2 3A 3B 4
Hyperparathyroidism 1 2 3A 3B 4
Hypoparathyroidism 1 2 3A 3B 4
1
Hyperthyroidism
2 3A 3B 4
Hypothyroidism 1 2 3A 3B 4
Thyroiditis 1 2 3A 3B 4
Cushing's disease 1 2 3A 3B 4
Adrenal cortex failure 1 2 3A 3B 4
Primary hyperaldosteronism 1 2 3A 3B 4
Phaeochromocytoma 1 2 3A 3B 4
Precocious puberty 1 2 3A 3B 4
Delayed puberty 1 2 3A 3B 4
Testicular feminization syndrome 1 2 3A 3B 4
Hypogonadism 1 2 3A 3B 4
Adrenogenital syndrome 1 2 3A 3B 4
Addison's disease 1 2 3A 3B 4
Multiple endocrinological neoplasia (MEN
syndrome) 1 2 3A 3B 4
Tumour with ectopic production of hormone 1 2 3A 3B 4
- 227 -
Central and peripheral nervous system
Loss of consciousness
Metabolic encephalopathy 1 2 3A 3B 4
Coma 1 2 3A 3B 4
Brain death 1 2 3A 3B 4
Tension headache 1 2 3A 3B 4
Migraine 1 2 3A 3B 4
Hypertensive encephalopathy 1 2 3A 3B 4
Cerebral palsy /
1 2 3A 3B 4
Mental retardation 1 2 3A 3B 4
Kernicterus 1 2 3A 3B 4
Bell’s palsy 1 2 3A 3B 4
Brainstem lesions 1 2 3A 3B 4
Movement Disorders
Tremor 1 2 3A 3B 4
Ataxia 2
Sydenham’s chorea 1 2 3A 3B 4
Dystonia 1 2 3A 3B 4
Seizure disorders
Focal seizure 1 2 3A 3B 4
Generalized seizure 1 2 3A 3B 4
Absence seizure 1 2 3A 3B 4
Infantile spasms 3A
Febrile seizure 4
Status epilepticus 1 2 3A 3B 4
Neuromuscular diseases and neuropathy
Guillain-Barré syndrome 1 2 3A 3B 4
Myasthenia gravis 1 2 3A 3B 4
Polymyositis 1 2 3A 3B 4
Duchenne muscular dystrophy 1 2 3A 3B 4
Neurofibromatosis (von Recklinghausen’s disease) 1 2 3A 3B 4
Acute flaccid paralysis
1 2 3A 3B 4
Hemiperesis / paraperesis / Monoperesis
1 2 3A 3B 4
Hypotonia
1 2 3A 3B 4
Hydrocephalus 3B 4
- 228 -
1 2 3A
Spina bifida
1 2 3A 3B 4
Infections
Uncomplicated Meningitis 1 2 3A 3B 4
Encephalitis 1 2 3A 3B 4
Cerebral malaria 1 2 3A 3B 4
Tetanus 1 2 3A 3B 4
Tuberculoma 1 2 3A 3B 4
Tuberculosis of spine
1 2 3A 3B 4
Neurocysticercosis
1 2 3A 3B 4
Brain abscess 1 2 3A 3B 4
Poliomyelitis 1 2 3A 3B 4
Autism 1 2 3A 3B 4
Attention-deficit hyperactivity disorder (ADHD) 1 2 3A 3B 4
CNS tumors (Primary) 1 2 3A 3B 4
CNS tumor (secondary) 1 2 3A 3B 4
Mycobacterial diseases
Cuticular tuberculosis 1 2 3A 3B 4
Leprosy 1 2 3A 3B 4
Lepra reaction 1 2 3A 3B 4
- 229 -
Spirochaetal diseases
Cogenital Syphilis 1 2 3A 3B 4
Leptospirosis 1 2 3A 3B 4
Fungal infections
Actinomycosis 1 2 3A 3B 4
Oral Candidiasis 4
Mucocutaneous candidiasis 1 2 3A 3B 4
Viral infections
Influenza 1 2 3A 3B 4
Viral gastroenteritis 1 2 3A 3B 4
Rabies 1 2 3A 3B 4
Measles 1 2 3A 3B 4
Varicella 1 2 3A 3B 4
Herpes zoster 1 2 3A 3B 4
Herpes simplex 1 2 3A 3B 4
Mumps 1 2 3A 3B 4
Cytomegalovirus (CMV) infections 1 2 3A 3B 4
Dengue hemorrhagic fever (DHF) 1 2 3A 3B 4
HIV-AIDS 1 2 3A 3B 4
Protozoal infections
Amoebiasis 1 2 3A 3B 4
Malaria 1 2 3A 3B 4
Leishmaniasis 1 2 3A 3B 4
Toxoplasmosis 1 2 3A 3B 4
Giardiasis 1 2 3A 3B 4
Trichomoniasis 1 2 3A 3B 4
Worm infestations
Hookworm diseases 1 2 3A 3B 4
Strongyloidiasis 1 2 3A 3B 4
Ascariasis 1 2 3A 3B 4
Filariasis 1 2 3A 3B 4
Schistosomiasis 1 2 3A 3B 4
Cutaneous larva migrans 1 2 3A 3B 4
Taeniasis 1 2 3A 3B 4
Neoplasms
Blood and lymph nodes
Non-hodgkin's lymphoma 1 2 3A 3B 4
Hodgkin's lymphoma 1 2 3A 3B 4
Acute leukaemia 1 2 3A 3B 4
- 230 -
Chronic leukaemia 1 2 3A 3B 4
Myelodysplastic syndromes 1 2 3A 3B 4
Multiple myeloma 1 2 3A 3B 4
Langerhans' cell histiocytosis 1 2 3A 3B 4
Neuroblastoma 1 2 3A 3B 4
Nephroblastoma 1 2 3A 3B 4
Wilms tumor
1
Retinoblastoma
1
Hepatoblastoma
1
Rhabdomyosarcoma 1 2 3A 3B 4
Thymoma 1 2 3A 3B 4
Skin
1
Seborrheic dermatitis 1 2 3A 3B 4
Infantile Eczema 3A
Haemangioma 1 2 3A 3B 4
Central and peripheral nervous system
Astrocytoma 1 2 3A 3B 4
Oligodendroglioma 1 2 3A 3B 4
Ependymoma 1 2 3A 3B 4
Medulloblastoma 1 2 3A 3B 4
Retinoblastoma 1 2 3A 3B 4
Meningioma 1 2 3A 3B 4
Neurofibroma 1 2 3A 3B 4
Schwannoma 1 2 3A 3B 4
Psychiatry and mental health
Developmental and behavioral disorders
Mental deficiency 1 2 3A 3B 4
Autistic disorder 1 2 3A 3B 4
Disorder of motor development 1 2 3A 3B 4
Disorder of coodination 1 2 3A 3B 4
Attention deficit hyperactive disorder 1
Sleep disorders
Nightmares 1 2 3A 3B 4
Night terrors 1 2 3A 3B 4
Sleep disorders 3A
Eating disorders
- 231 -
Anorexia nervosa 1 2 3A 3B 4
Bulimia 1 2 3A 3B 4
Pica 1 2 3A 3B 4
Rumination in infancy 1 2 3A 3B 4
Tics
Gilles de la Tourette syndrome 1 2 3A 3B 4
Chronic focal tic disorders 1 2 3A 3B 4
Transient tic disorders 1 2 3A 3B 4
Disorders of excretion
Functional encopresis 1 2 3A 3B 4
Functional enuresis 1 2 3A 3B 4
Speech disorders
Uncoordinated speech 1 2 3A 3B 4
Stammer 1 2 3A 3B 4
Psych-organic syndromes and disorders due to
drugs
Intoxication 1 2 3A 3B 4
Withdrawal syndrome 1 2 3A 3B 4
Musculoskeletal system
Bone and joints
Congenital dislocation of the hips 1 2 3A 3B 4
Genu varum (bow legs) 1 2 3A 3B 4
3A
Genu valgum (knock knee)
1 2 3B 4
Achondroplasia 1 2 3A 3B 4
Club foot 1 2 3A 3B 4
Congenital scoliosis
1 2 3A 3B 4
Limb length discrepancy
1
Arthrogryposis
1
Sternomastoid tumor
1
Hypophosphataemic rickets/ Vitamin D depentant rickets
1
Renal oesteodystrophy
2
- 232 -
4. Gyne/obst department
Vulva/Vagina
Vulvovaginitis
1 2 3A 3B 4
Vulval dystrophy
1 2 3A 3B 4
Condylomata accuminata
1 2 3A 3B 4
Vulval Ca 2
Congenital malformations
1 2 3A 3B 4
Gärtner duct/Cyst
1 2 A 3B 4
Foreign body
1 2 3A 3B 4
Cervix
Cervicitis
1 2 3A 3B 4
Polyps
1 2 3A 3B 4
Nabothian cyst
1 2 3A 3B 4
- 233 -
Congenital malformations
1 2 3A 3B 4
Haematocolpos, Hematometra
1 2 3A 3B 4
Fibroid
1 2 3A 3B 4
DUB 1 2 3A 3B 4
Adnexae
Ovarian tumor
1 2 3A 3B 4
Ovarian tumor
1 2 3A 3B 4
Carcinoma of ovary
1 2 3A 3B 4
Ectopic pregnancy
1 2 3A 3B 4
Adnexal Torsion
1 2 3A 3B 4
Ovulatory pain
1 2 3A 3B 4
- 234 -
Reproductive system
Infection during pregnancy/delivery
Syphilis 1 2 3A 3B 4
Toxoplasmosis, Rubella, Cytomegalo virus, Herpes
infection 1 2 3A 3B 4
HIV infection 1 2 3A 3B 4
Gonorrhoea 1 2 3A 3B 4
Herpes virus infection type 2 1 2 3A 3B 4
Drugs and harmful substance during pregnancy
Mother taking tobacco 1 2 3A 3B 4
Mother with substance abuse 1 2 3A 3B 4
Pregnancy disorders
Threatened Miscarriage 1 2 3A 3B 4
Incomplete spontaneous Miscarriage 1 2 3A 3B 4
Completed spontaneous miscarriage 1 2 3A 3B 4
Inevitable miscarriage 1 2 3a 3b 4
Induced septic abortion 1 2 3A 3B 4
Hyperemesis gravidarum 1 2 3A 3B 4
1 2 3A
Hydatidiform mole
3B 4
Rh incompatibility 1 2 3A 3B 4
Gestational hypertension/ Pre-eclampsia 1 2 3A 3B 4
Pregnancy induced diabetes mellitus 1 2 3A 3B 4
Fetal growth disorder 1 2 3A 3B 4
Antepartum hemorrhage 1 2 3A 3B 4
Cervical incompetence 1 2 3A 3B 4
Polyhydramnios/ Oligohydramnios 1 2 3A 3B 4
Jaundice in pregnancy 1 2 3A 3B 4
Urinary tract infection 1 2 3A 3B 4
Pyelonephritis in pregnancy 1 2 3A 3B 4
Anemia during pregnancy 1 2 3A 3B 4
Intra-uterine fetal demise 1 2 3A 3B 4
1 2 3A
Inverted nipple
3B 4
Delivery
Preterm contractions 1 2 3A 3B 4
Preterm delivery 1 2 3A 3B 4
Uterine rupture 1 2 3A 3B 4
Post-term pregnancy 1 2 3A 3B 4
Pre-labor rupture of membranes (PPROM) 1 2 3A 3B 4
Unstable lie / malposition after 36 weeks 1 2 3A 3B 4
- 235 -
Dystocia/ Prolonged labor 1 2 3A 3B 4
Cord presentation / cord prolapse 1 2 3A 3B 4
Suspected fetal jeopardy 1 2 3A 3B 4
Normal labor 1 2 3A 3B 4
Failure to rotate / incorrect rotation 1 2 3A 3B 4
Cervical tear 1 2 3A 3B 4
Episiotomy & repair 1 2 3A 3B 4
Shoulder dystocia 1 2 3A 3B 4
4th degree perineal tear 1 2 3A 3B 4
Retained placenta & Manual removal of placenta 1 2 3A 3B 4
Partograph
1 2 3A 3B 4
Vacuum delivery
1 2 3A 3B 4
Postpartum
Retained placental tissue 1 2 3A 3B 4
Uterine inversion 1 2 3A 3B 4
Postpartum haemorrhage 1 2 3A 3B 4
Puerperium
Cracked nipple 1 2 3A 3B 4
Puerperal sepsis 1 2 3A 3B 4
Deep venous thrombosis Embolism 1 2 3A 3B 4
Post-natal psychosis / Depression 1 2 3A 3B 4
Secondary PPH 1 2 3A 3B 4
Contraception
Temporary 1 2 3A 3B 4
Permanent 1 2 3A 3B 4
- 236 -
5. PSYCHIATRY ROTATION
Affective disorders
Bipolar disorders
Bipolar disorder, manic episode 1 2 3A 3B 4
Bipolar disorder, depressive episode 1 2 3A 3B 4
Unipolar disorders
Depressive Disorder, single episode and recurrent 1 2 3A 3B 4
Dysthymic disorder 1 2 3A 3B 4
Anxiety disorders
Panic disorder 1 2 3A 3B 4
1 2 3A 3B 4
Social phobia 1 2 3A 3B 4
Specific phobia 1 2 3A 3B 4
Obsessive compulsive disorder 1 2 3A 3B 4
Generalised anxiety disorder 1 2 3A 3B 4
- 237 -
Reactions to Stress
Adjustment Disorder 1 2 3A 3B 4
Acute Stress Reaction 1 2 3A 3B 4
Post traumatic stress disorder 1 2 3A 3B 4
Somatoform disorders
Conversion disorder 1 2 3A 3B 4
Hypochondriasis 1 2 3A 3B 4
Somatisation disorder 1 2 3A 3B 4
Somatoform pain disorder 1 2 3A 3B 4
1 2 3A 3B 4
Dissociative disorders
Mass Hysteria 1 2 3A 3B 4
Trance and possession disorder
1 2 3A 3B 4
1 2 3A 3B 4
Sexual Perversions
Paraphilia 1 2 3A 3B 4
Sexual dysfunctions
Disorder of sexual desire 1 2 3A 3B 4
Disorder of sexual excitement 1 2 3A 3B 4
Disorder of orgasm 1 2 3A 3B 4
Sexual pain disorders 1 2 3A 3B 4
Parasomnia
Nightmares 1 2 3A 3B 4
Night terrors 1 2 3A 3B 4
Sleep walking 1 2 3A 3B 4
1 2 3A 3B 4
- 238 -
Psychological factors affecting physical
condition 1 2 3A 3B 4
Personality disorders
Paranoid personality 1 2 3A 3B 4
Schizoid personality 1 2 3A 3B 4
Schizotypal personality 1 2 3A 3B 4
Antisocial personality 1 2 3A 3B 4
Borderline personality 1 2 3A 3B 4
Histrionic personality 1 2 3A 3B 4
Narcisistic personality 1 2 3A 3B 4
Avoidant personality 1 2 3A 3B 4
Dependent personality 1 2 3A 3B 4
Obsessive-compulsive personality 1 2 3A 3B 4
Passive-aggressive personality 1 2 3A 3B 4
Mental Disorders with Childhood Onset
Mental retardation 1 2 3A 3B 4
Specific Learning Disorders 1 2 3A 3B 4
Attention Deficit Hyperactive Disorder 1 2 3A 3B 4
Conduct Disorder 1 2 3A 3B 4
Tic disorders 1 2 3A 3B 4
Functional encopresis 1 2 3A 3B 4
Functional enuresis 1 2 3A 3B 4
Stammering 1 2 3A 3B 4
Neurotic disorders of childhood 1 2 3A 3B 4
Breath holding spells 1 2 3A 3B 4
Extrapyramidal side effects (eg. Acute dystonia,
tardive dyskinesia, parkinsonism) 1 2 3A 3B 4
Anticholinergic side effects 1 2 3A 3B 4
1 2 3A 3B 4
Neuroleptic malignant syndrome 1 2 3A 3B 4
1 2 3A 3B 4
Other items of knowledge
Knowledge of forensic psychiatry 1 2 3A 3B 4
Knowledge of National Mental Health act / Policy 1 2 3A 3B 4
- 239 -
6. Orthopedics
Buerger's disease 1 2 3A 3B 4
Septic shock 1 2 3A 3B 4
Hypovolaemic shock 1 2 3A 3B 4
Immunology
Polymyalgia rheumatica 1 2 3A 3B 4
Rheumatoid arthritis 1 2 3A 3B 4
Juvenile chronic arthritis 1 2 3A 3B 4
Genetics/newborn/chromosomal disorder
Spina bifida 1 2 3A 3B 4
Endocrine, metabolic disorders and nutrition
Errors of metabolism
Gout 1 2 3A 3B 4
Central and peripheral nervous system
Diseases of spine and spinal cord
Amyotrophic lateral sclerosis (ALS) 1 2 3A 3B 4
Complete spinal transaction 1 2 3A 3B 4
Brown-Sequard syndrome 1 2 3A 3B 4
Cauda equina syndrome 1 2 3A 3B 4
Neurogenic bladder 1 2 3A 3B 4
Syringomyelia 1 2 3A 3B 4
Myelopathy 1 2 3A 3B 4
Dorsal root syndrome 1 2 3A 3B 4
Acute medullary compression 1 2 3A 3B 4
Radicular syndrome/HNP 1 2 3A 3B 4
Tuberculous spondylitis
1 2 3A 3B 4
- 240 -
Myasthenia gravis 1 2 3A 3B 4
Polymyositis 1 2 3A 3B 4
Duchenne muscular dystrophy 1 2 3A 3B 4
Neurofibromatosis (von Recklinghausen’s disease) 1 2 3A 3B 4
Neck
Torticollis 1 2 3A 3B
Gram-positive cocci
Staphylococcal and streptococcal infections
Chronic Osteomyelitis 1 2 3A 3B 4
Acute Osteomyelitis 1 2 3A 3B 4
Neoplasms
Multiple myeloma 1 2 3A 3B 4
- 241 -
Ganglion cyst 1 2 3A 3B 4
Lipoma 1 2 3A 3B 4
Liposarcoma 1 2 3A 3B 4
Fibromatosis 1 2 3A 3B 4
Desmoid tumor 1 2 3A 3B 4
Fibroma 1 2 3A 3B 4
Fribrosarcoma 1 2 3A 3B 4
Benign fibrous histiocytoma 1 2 3A 3B 4
Malignant fibrous histiocytoma (MFH) 1 2 3A 3B 4
Rhabdomyosarcoma 1 2 3A 3B 4
Leiomyoma 1 2 3A 3B 4
Leiomyosarcoma 1 2 3A 3B 4
Synovial sarcoma 1 2 3A 3B 4
Musculoskeletal system
Bone and joints (pediatrics)
Club foot 1 2 3A 3B 4
Congenital dislocation of the hip 1 2 3A 3B 4
Marfan's disease 1 2 3A 3B 4
Inflammatory Arthritis 1 2 3A 3B 4
Septic Arthritis 1 2 3A 3B 4
Genu varum (bow legs) 1 2 3A 3B 4
Genu valgum (knock knee) 1 2 3A 3B 4
Pes planus 1 2 3A 3B 4
Scoliosis 1 2 3A 3B 4
Kyphosis 1 2 3A 3B 4
Lordosis 1 2 3A 3B 4
Perthes disease 1 2 3A 3B 4
Slipped epiphysis 1 2 3A 3B 4
Osgood-Schlatter disease 1 2 3A 3B 4
Chondromalacia patellae 1 2 3A 3B 4
Osteogenesis imperfecta 1 2 3A 3B 4
Bone cyst 1 2 3A 3B 4
Achondroplasia 1 2 3A 3B 4
- 242 -
Localized disorders of the musculoskeletal system
Physical overload 1 2 3A 3B 4
Aseptic necrosis of bone 1 2 3A 3B 4
Osteomyelitis, acute 1 2 3A 3B 4
Arthritis 1 2 3A 3B 4
Trauma of joint cartilage 1 2 3A 3B 4
Trauma of joint capsule 1 2 3A 3B 4
Simple ganglion 1 2 3A 3B 4
Compound Ganglion 1 2 3A 3B 4
Primary bone tumors 1 2 3A 3B 4
Bone metastasis 1 2 3A 3B 4
Pathological fracture 1 2 3A 3B 4
Spine
Spina bifida 1 2 3A 3B 4
Sacrococcygeal teratoma 1 2 3A 3B 4
Scoliosis 1 2 3A 3B 4
Kyphosis 1 2 3A 3B 4
Lordosis 1 2 3A 3B 4
Spondylarthrosis, spondylosis 1 2 3A 3B 4
Spondylitis, spondylodiscitis 1 2 3A 3B 4
Hernia of nucleus pulposus 1 2 3A 3B 4
Spondylolisthesis 1 2 3A 3B 4
Spondylolysis 1 2 3A 3B 4
Metastases from elsewhere 1 2 3A 3B 4
Pathological fractures 1 2 3A 3B 4
Fractures and dislocations of spine 1 2 3A 3B 4
Spinal transection 1 2 3A 3B 4
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Fractures of pelvis 1 2 3A 3B 4
Fractures of hip 1 2 3A 3B 4
Dislocation of hip 1 2 3A 3B 4
Ligamentous lesions of hip 1 2 3A 3B 4
Arthritis of hip 1 2 3A 3B 4
Fractures of femur 1 2 3A 3B 4
Fractures, capsule, tendon and ligament lesions of knee 1 2 3A 3B 4
Lesion of meniscus, medial and lateral 1 2 3A 3B 4
Abnormal patellar cartilage 1 2 3A 3B 4
Genu varum, genu valgum 1 2 3A 3B 4
Osteochondritis dissecans 1 2 3A 3B 4
Arthritis of the knee 1 2 3A 3B 4
Achilles tendonitis 1 2 3A 3B 4
Rupture of achilles tendon 1 ∆2 3A 3B 4
Tarsal tunnel syndrome 1 2 3A 3B 4
Instability of ankle 1 2 3A 3B 4
Ingrowing toe nail 1 2 3A 3B 4
Pes planus 1 2 3A 3B 4
Club foot 1 2 3A 3B 4
Claw foot 1 2 3A 3B 4
Hallux valgus 1 2 3A 3B 4
Hammer toe 1 2 3A 3B 4
Metatarsalgia 1 2 3A 3B 4
Onychogryphosis 1 2 3A 3B 4
Anisomelia 1 2 3A 3B 4
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Traumatology
Birth trauma
Caput succedaneum 1 2 3A 3B 4
Brachial plexus injury 1 2 3A 3B 4
Fracture (clavicle, humerus, rib) 1 2 3A 3B 4
Peripheral nerves
Injury of peripheral nerves 1 2 3A 3B 4
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Lateral epicondylitis (tennis elbow) 1 2 3A 3B 4
Dislocation of distal radius 1 2 3A 3B 4
Dislocation of wrist 1 2 3A 3B 4
Progressive inflammation of finger following injury 1 2 3A 3B 4
Olecranon bursitis 1 2 3A 3B 4
Carpal tunnel syndrome 1 2 3A 3B 4
Injury to finger tendon, e.g. Boutonniere-deformity 1 2 3A 3B 4
Mallet finger 1 2 3A 3B 4
Dupuytren's contracture 1 2 3A 3B 4
Nail loss 1 2 3A 3B 4
Subungual haematoma 1 2 3A 3B 4
Traumatic vessel injury 1 2 3A 3B 4
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Annex 6: Basic Procedural skills
KW – knows what
KH – knows how
SH – shows how
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