MBBS Curriculum - 2nd Edition

THE MBBS CURRICULUM
OF
B. P. KOIRALA INSTITUTE OF HEALTH SCIENCES
DHARAN
NEPAL
2nd Edition 2014
1
Curriculum Review Committee
1. Prof Bishnu Hari Paudel Chairperson

2. Dr Siddhartha Koirala Member
3. Dr Sudeep Khaniya Member
4. Dr Manoj Shrivastava Member
5. Dr Anju Pradhan Member
6. Mr Akshaya Pd Gautam Member-Secretary
7. Student Representatives
a. Mr Mukesh Sah MBBS Intern (2007 Batch)
b. Mr Subash Ghimire MBBS Intern (2007 Batch)
[Constitution date: 31st January 2013]
First Edition 1994

Second Edition 2014
© B.P. Koirala Institute of Health Sciences
2
CONTENTS
Page
Preface to the First Edition 1
Preface to the Second Edition 2
Introduction 4
Vision and Mission 5
Institutional goals 6
Program goals 7
Conceptual Framework of the MBBS Program 8
Guidelines for Implementation 9
Additional guidelines for implementation 10
Teaching Learning Environments 11
Phase I 13
Academic Calendar 15
Orientation Program 16
Unit 0 General Concepts 19
(Anatomy, Physiology, Pathology, Biochemistry,
Microbiology, Pharmacology, Community Medicine
& Behavioral Sciences, and Forensic Medicine)
Community Diagnosis Program
Unit 1 33
Growth, Development and Genetics
Blood and Immunology
Unit 2 47
Respiratory & Environment including Autonomic Nervous System
Cardiovascular System
Unit 3 61
Gastrointestinal System
Hepatobiliary System
Nutrition
Unit 4 75
Endocrinal and Reproductive Systems
Kidneys and Fluid Balance
Integumentary System
Unit 5 93
Musculoskeletal System
Nervous System and Special Senses
Unit 6 Multi-system Seminars 109
Clinical Posting 111
Assessment and Evaluation 117
3
Phase II 123
Academic Calendar 126

Anaesthesiology 129
Community Medicine 130
Family health exercise
Applied behavioral sciences
Applied health education
Counseling
Geriatrics
Epidemiology
Biostatistics
Epidemiological methods
Applied epidemiology
Occupational health
Health administration
National health strategies
Health economics and health financing
Rural posting
Dermatology 143
Emergency Care 146
Medical emergencies
Surgical emergencies
Paediatric emergencies
Orthopaedic emergencies
Obstetric and gynaecological emergencies
Emergencies in otorhinolaryngology and head & neck surgery
Ophthalmological emergencies
Psychiatric emergency
Forensic Medicine 153

Medical Ethics and Professionalism 158
Research 158
Laboratory Medicine 159
Medicine 163
Respiratory system
Cardiovascular system
Gastrointestinal tract
Hepato-billary system and pancreas
Nutrition
Metabolic, endocrine and reproductive disorders
Haemopoietic and reticuloendothelial systems
Fluid-electrolyte and renal disorders
Central nervous system
Musculo-skeletal system and collagen vascular disorders
4
Infectious and tropical diseases
Poisoning, environmental and occupational disorders
Obstetrics & Gynaecology 180

Introduction to obstetrics and gynaecology
Management of Normal Pregnancy
Management during labour
Menstrual function and dysfunction
Common Gynaecological Symptoms
Complications in Pregnancy
Abnormal Labour
Puerperium
Infertility
Genital Infections
Gynaecological Malignancies
Fertility Regulation
Emergency Obstetrics & Gynaecology
Miscellaneous
Ophthalmology 194
Oral Health 199
Orthopaedics 201
Otorhinolaryngology 208
Paediatrics 212
General paediatrics
Infectious diseases
Neonatology
Hematology
Gastrointestinal system
Hepato-biliary system
Cardiovascular system
Central nervous system
Genito urinary system
Respiratory system
Endocrine system
Chromosomal and genetic disorders
Oncologic disorders
Musculoskeletal disorders
Behavioral paediatrics
Adolescence medicine
Psychiatry 221
Radiodiagnosis 224
Surgery 229
General surgery
Diseases of lymphatic system, arteries and veins
5
Breast and thyroid
Chest
Neuro-surgery
Face, oral cavity and salivary glands
Gastrointestinal system
Hepato-biliary system and pancreas
Abdominal wall and hernias
Genito-urinary system
Assessment & Evaluation 243

Internship 249
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PREFACE TO THE FIRST EDITION
It gives me great pleasure to write a preface for the "BPKIHS, MBBS Curriculum 1996 Version". It
may legitimately be asked: Why a new curriculum for BPKIHS when it could have easily adopted
or adapted from any of the many excellent curricula in operation in medical schools all over the
world? It is not only the newness of our institute which has prompted us to draw up a new
curriculum but many other valid reasons - temporal and spatial. Just as advances in medical science
have led to change in practice patterns, it is natural that advances in medical education should
influence our philosophy and concepts of education. Just as it would be unwise to continue to treat
our patients with discarded treatment models of previous decade, so would it be unwise to teach our
students with models developed in the previous centuries ignoring the changes that have taken place
already and changes that are taking place now. Since our graduates would be ready to assume
service responsibilities only in the next century, many of us here at BPKIHS feel responsible to
ensure a futuristic curriculum still appropriate through much of the next century. In pursuance of
these objectives we organized a conference on "Medical Education for Twenty-first Century" in
December 1993. This conference provided us with the guidelines for the proposed curriculum.
Equipped with these, we then organized in April 1994 a more goal-directed workshop on
curriculum development which went into the nitty-gritty of the curriculum, especially that of Phase
one. We implemented the curriculum in October 1994 when our first batch of students was
admitted. Not only the students and teachers are generally satisfied with the curriculum, it has been
flattering to know that we are being watched with interest and appreciation by several other
institutions. However, implementation of the Phase I curriculum has given us some insight and
feedback which has been incorporated in the present version of the curriculum.
In anticipation of our first batch entering Phase II of the course in August 1996, we
organized a workshop in October 1995 to develop a curriculum for them. In all our endeavours at
curriculum development we have had the benefit of the expertise of the faculty of All India Institute
of Medical Sciences, New Delhi, Dr P.T. Jayawickramrajah, Medical Educationist and W.H.O.
consultant, faculty of the Institute of Medicine, Kathmandu, and above all our own faculty at
BPKIHS. The result of this combined effort is the: BPKIHS Curriculum, 1996 version.
It is a product conceived as a result of rapid changes taking place in medical education

system as perceived by BPKIHS faculty. Although this curriculum, like its ancestors, may only be a
small variation on its own ancestors, we would like to think of it as an elegant variation. This is in
keeping with the general philosophy and that is to move ahead and have a forward looking
curriculum. We have avoided radicalism and tried to build on the strength of the old by adding
forceful and validated new thoughts. Finally, a curriculum is only a means and not an end in itself.
In a dynamic process such as curriculum development, the last word cannot be written and we have
tried not to do that. Hence, only the "1996 version of the BPKIHS MBBS curriculum”.
Prof Madan P. Upadhyay, FRCS

Director
7
PREFACE TO THE SECOND EDITION
It is our privilege to write this preface to the second edition of the MBBS Curriculum 2013. The
first edition of the curriculum for Phase I comprising primarily the basic medical sciences of
anatomy, biochemistry, microbiology, pathology, pharmacology and physiology was prepared in
1994 after extensive background work that included the assessment of local need, national
context, international practice and advancement in medicine and education. Similarly, the Phase
II part of the curriculum comprising clinical sciences was prepared in 1996.
After almost two decades, the philosophy of the university and the purpose of its medical
curriculum went through time testing. Though there is no proven evidence that our curriculum
served the initially conceived purpose, our graduates - the product of the first version of the
curriculum - are distinct and visible well-above the surface in the country and abroad. They have
uncovered their competency both in service and academics. The administrators, faculty,
graduates, and all who were the pioneer of the BPKIHS are pleased with and proud of their
performance. There is today a strong perception at the institute that the institutional philosophy
and the medical curriculum served their purpose very well. Likewise, outside BPKIHS, our
curriculum and its products are well appreciated and acknowledged in the entire country and
abroad.
However, a curriculum is only a means and not an end in itself. And means evolve as they are
dynamic processes. There has been concern over the past few years among the major
stakeholders of the BPKIHS that the time has come to revise the curriculum (1994/1996
version). There have been advancements in medicine. Some new diseases like SARS, swine flu
and bird flu emerged. Some new national regulations have come into action like abortion law and
free primary healthcare with political change in the country. And the number of student
enrolment has increased. Similarly, educational science has validated new developments. Ethical
issues and professionalism have received more attention.
To address these new developments, a revision of the curriculum is long due. Consequently, we
organized two Curriculum Review Workshops in Apr 2011 and Feb 2013. Between the
workshops, we took feedback from the major stakeholders. All of them contributed with great
interest. All their reflections were compiled, analyzed and synthesized. Equipped with these, and
keeping in mind the institute’s philosophy and the curricular rigid timeframe (4½+1 years), we
prepared this version, incorporating the reflections of the stakeholders. We carefully weighed the
sensitivity and desire of the stakeholders so that the revised curriculum is not skewed in its
content and delivery process. Any new addition rationally necessitates deletion of the irrelevant
content of the curriculum and merger of the less relevant ones. Similarly, we have tried to
balance the curricular content so that the weight and relevance of each section are preserved.
Valuing the MBBS program goals, the revised version has allotted proportionate space for all the
disciplines.
All the existing practices, about which the first version was silent, have been substantiated by
documenting them in appropriate places. New developments in each discipline, as suggested by
the departments, have been incorporated. In Phase II, an attempt has been made to calculate the
number of hours in the curricular sections, disciplines and semesters. The tentative hours are
8
expressed in weeks. More attention has been paid to research, medical ethics and
professionalism. An outline of the internship program has also been incorporated.
This version of the MBBS curriculum 2013 is an amalgamation of the strength of old and of the
new advancements. Being futuristic, it has ample room for the implementing authorities to
absorb new developments in medicine and education.
Members, Curriculum Review Committee; 2013
9
INTRODUCTION
The Bachelor of Medicine and Bachelor of Surgery (MBBS) curriculum of B.P. Koirala
Institute of Health Sciences (BPKIHS) is essentially the product of a Seminar on "Medical
Education for the Twenty-first Century" held in December 1993, the Workshop on MBBS
Curriculum Development held in April-May 1994, and the Workshop on MBBS (Phase II)
Curriculum Development held in October-November 1995. In the course of brain storming during
these meetings, many alternative models of curricular design were discussed - ranging from the
most conservative to thoroughly revolutionary and innovative. Finally, a blend of idealism and
realism, the old and the new has been arrived at, by a consensus, and seems the most appropriate
one for the MBBS curriculum of BPKIHS.
The MBBS curriculum of BPKIHS is thoroughly integrated and community-oriented and

partially problem based incorporating the organ-system and need-based approach. During the first
two years, the emphasis has been laid on the pre and para-clinical sciences along with community
medicine and professional skills; and in the next two and a half years the emphasis is on clinical
sciences with a high degree of probability for integration between clinical disciplines and
community medicine while the foundation of pre and para clinical sciences continues to be
strengthened. The curriculum incorporates early patient contact and emphasizes the importance of
study of community medicine and behavioral sciences from the beginning. Teaching through
lectures has been restricted to a bare minimum while problem-based learning and other
unconventional learning experiences (UNCLE) are encouraged.
The curriculum has taken into consideration the health statistics and national health policy of
Nepal, and recommendations of the Nepal Medical Council (NMC) and Medical Council of India
(MCI), including the recent recommendations of MCI on a need-based curriculum for
undergraduate medical education. It is felt that the BPKIHS curriculum has successfully been able
to avoid the usual pitfall of overloading the student with "nice to know" information.
It is hoped that this thoroughly contemporary curriculum with a futuristic outlook will stand
the test of time and serve as a model for medical schools of the future to adopt or adapt.
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VISION AND MISSION OF BPKIHS
VISION
BPKIHS has been visualized as

 A self-governing, self-reliant International Health Sciences University attracting students
and teachers from all over the world to its constantly innovative educational programs.
 A national center for providing quality health services both, tertiary as well as primary,
and developing replicable and sustainable models of integrated health systems sensitive
to the needs of both, individuals and the community living in urban as well as rural areas.
 A prestigious center for biomedical and health system research, and as a center of
excellence for tropical and infectious diseases.
 A complete health development project through its teaching districts which will catalyze
an environment-friendly human development initiative resulting in enhancement in the
quality of life of the people of Nepal and, those working in BPKIHS to ensure a high
level of commitment to excellence and dedication to service.
MISSION
The main mission of BPKIHS is to improve the health status of the people of Nepal by providing
holistic health care through training of compassionate, caring, communicative and socially
accountable health workforce acting as agents of change and through advancement in research
and innovation in service as well as education to ensure healthy individuals and families by
collaborating with all stakeholders.
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INSTITUTIONAL GOALS
The B.P. Koirala Institute of Health Sciences aims for the attainment of its Institutional Goals that
are designed to:
1. Develop Human Resources for Health by:
1.1 Educating a competent and caring health professional who will provide service of the
highest quality with the resources available in the community with concern,
compassion and commitment for the improvement of the health of the people of
Nepal.
1.2 Developing in students an inquiring mind and appropriate science base for further
education and research.
2. Provide Quality Health Services by:
2.1 Providing highest quality service to the people by utilizing appropriate technology.
2.2 Creating socio-cultural organizations for promoting low cost technology for solving
health problems of the general population.
2.3 Collaborating with local and national health authorities to propagate education to ensure
preventive, promotional and rehabilitative care.
3. Conduct Scientific, Bio-Medical and Bio-Social Research:
3.1 For generating new knowledge in Health Sciences through scientific research.
3.2 By utilizing research results to the solution of health problems.
3.3 By disseminating research findings for the growth of scientific knowledge.
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PROGRAM GOALS OF THE MBBS COURSE AT BPKIHS
At the end of the course the student should be able to:

1. Describe the structure and function of the body in health and disease.
2. Determine the socio-economic, psychosocial, cultural and environmental factors influencing
health and disease.
3. Diagnose and manage common health problems of the individual and the community
appropriate to his/her position as a member of the health team at primary, secondary and
tertiary levels.
4. Apply appropriate technology for clinical diagnosis and develop habits of rational use of
drugs.
5. Practice curative, preventive, promotional and rehabilitative medicine applying the concept of
Primary Health Care.
6. Realize his/her limitations and refer patients to the next level of care as and when appropriate
and to the advantage of the patient.
7. Identify and initiate appropriate treatment for life threatening emergencies and refer when
necessary.
8. Estimate the importance of and participate in, implementing the National Health Programs in
the context of National Health and Development Priorities.
9. Develop ability for continued self learning with a scientific attitude of mind and acquire
further expertise in any chosen area.
10. Plan, implement and evaluate health programs.
11. Develop skills necessary for providing information, education and communication to
individual, family and community on one hand and with peers and members of the health
team on the other.
12. Treat patients with respect and dignity maintaining highest standards of ethical practice of
medicine.
13. Provide information on different kinds of treatment to the patient and help patient make up
his/her own mind for choice of treatment.
14. Manage medico-legal problems.
15. Demonstrate leadership qualities and be able to work in a team.
16. Develop humane attitude and become sensitive to the needs of the people, especially women,
children and the elderly.
17. Demonstrate an open attitude to the alternative systems of medicine.
18. Develop familiarity with the existing socio-economic norms in order to learn from them and
also act as an agent of change as and when appropriate.
19. Promote reproductive health programs.
20. Play a meaningful role in disaster preparedness and response.
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CONCEPTURAL FRAMEWORK OF THE MBBS PROGRAM
14
GUIDELINES FOR IMPLEMENTATION
The curriculum is only a statement of intent. Hence it cannot go into details to the extent a teaching
program does. Translating a curriculum into the teaching program requires commitment to the
philosophy of the curriculum and at the same time flexibility to:
a. overcome the inevitable shortcomings in the curriculum,

b. improve upon the curriculum,
c. take into account ground realities, and
d. allow freedom of thought to the teachers who have to implement the program so that they
can put in their best efforts.
These are some of the reasons why the taught curriculum resembles, but is not identical to the
planned curriculum. The differences are not only acceptable but desirable provided they are the
result of conscious decisions by teachers in the overall interest of the quality of education.
Teaching Program Implementation Committee (TPIC) meets regularly every week under the
chairmanship of the MBBS Program phase I and II coordinators. As a result a remarkable degree of
integration of all basic medical sciences and community medicine is achieved along the organ-
system approach in the teaching program as well as assessment. The program is based on
approximately 40 h/wk of structured instruction, which includes 2-3 lectures, one laboratory
exercise, and one unconventional learning experience per day, 2-4 h of clinical posting per week
and one field trip every week or fortnight. Every organ-system opens with a problem-based
learning exercise. The two-year experience in implementation has shown that the best pace of
learning is achieved by having 2 rather 3 lectures per day. Therefore all efforts should be made to
eliminate redundant and superfluous details and try and fit the course into a program comprising of
only 2 lectures per day.
Phase two of the curriculum has been presented discipline-wise because it was felt that the organ-
system approach may not be feasible. But while implementing the program, all efforts should be
made to integrate the disciplines. Some suggestions for integration have been made in the Programs
of individual disciplines. The key to integration is sequence: with a little effort it would not be
difficult to bring related learning experiences from different disciplines close together. Since
didactic teaching is likely to need less time and clinical clerkship more time in Phase II, the
structured instruction time may be divided into 2 lectures, and 3 hrs of clinical posting per day, with
some additional time for unconventional learning experiences and a field trip every week or
fortnight. Problem based learning exercises should also continue in Phase II.
15
Additional guidelines for implementation
All the guidelines of the first edition remain as such.
The curriculum is primarily a guideline for the teaching-learning and student assessment. This
document seems different for different people. But its intent is one, that is, to produce complete
medical graduates. For the international viewers it is the document of what attributes a BPKIHS
medical graduate would have; and whether international standards met or not. For the medical
educationist, it is the document of sustaining change and further advancement. For national
policymakers it is the document mirroring the faces of the graduates it would produce. For the
local administrators it is the document for ensuring its implementation in terms of words and
spirit. For the individual departments and the faculty members it is the document to study,
implement, and improve upon; and identify, delimit, and be accommodative in executing their
roles. For the students, it is the document to learn what is expected of them and reflect
accordingly.
While implementing the curriculum, all the efforts should be made to eliminate unnecessary
details and try to teach general rules. For better outcome of the curriculum, both the teachers and
students need regular training. Teachers training should focus on the teaching-learning methods
and student evaluation with the purpose of developing scholarship in them; making them enjoy
teaching and feel proud of being academician or medical teacher/faculty. There should be
refresher courses for all faculty members on regular basis. Teaching job can be spread over
different levels of faculty members and teaching staff. The senior teachers should teach general
rules, difficult topics and concepts. And less difficult areas should be shared by other faculty
members and the senior residents. Some of the simple topics, concepts and competencies can be
entrusted to the residents and even the exit-level interns, after ensuring their competency to
teach. Brief teaching-learning sessions should also be organized in the individual departments
independently or with the involvement of experienced teachers or educationist(s).
The first version of the curriculum has gone through several cycles of implementation. Over the
years, the cycles have been evaluated by Teaching Program Implementation Committees (TPIC).
It should be the most crucial body in implementing the curriculum. The Committees are
mandated to adjust content and process of curriculum implementation. It needs to meet regularly
with all the heads of the departments at least once a month under the chairmanship of the
respective MBBS Program Coordinator(s) separately for Phase I and Phase II. Both the
Committees should also meet together under the chairmanship of the Dean (academics) in
presence of the Rector at the end of each unit or semester. Every organ-system in first Phase is
desirable to open with at least two blocks of problem-based learning exercise. Integrated nature
of the curriculum should further be strengthened for better student learning.
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TEACHING LEARNING ENVIRONMENTS
1. Structured interactive session (SIS)

2. Laboratory exercises (LABEX)
3. Case-based learning (CBL)
4. Continuing medical education (CME)
5. Clinical grand round (CGR)
6. Continuing professional development (CPD)
7. Community diagnosis program (CDP)
8. Clinical postings (CLIP)
9. Elective posting (EP)
10. Family health exercises (FHE)
11. Library (LIB)
12. Small group discussions (SGD)
13. Learning in field (LIF)
14. Problem-based exercise (PBL)
15. Sharpening your clinical skills (SYCS)
16. Unconventional learning exercises (UNCLE)
17. Theater exercises (THEATREX )
18. Seminar (SEM)
19. Self study (SS)
20. Tutorial (TUT)
21. Ward posting (WP)
22. Examinations (EXAM)
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18
PHASE I
19
20
ACADEMIC CALENDAR
1st Year Week
Orientation Program 1 wk
Unit O Basic Concepts 15 wk

Community Diagnosis Program 2 wk
Unit 1 Genetics, Growth & Development, 15 wk

Blood & Immunology
Unit 2 Respiratory & Environment including 11 wk

Autonomic Nervous System and
Cardiovascular System
Annual Examination 4 wk
2nd Year
Unit 3 Gastrointestinal System, 12 wk

Hepatobiliary System, Nutrition
& Metabolism
Unit 4 Endocrines and Reproductive Systems 13 wk

Kidney, Fluid Balance &
Unit 5 Musculoskeletal System, Special Senses 13 wk

& Central Nervous System
Unit 6 Multisystem Seminars 6 wk
Annual Examination 4 wk
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ORIENTATION PROGRAM
Day 1
The philosophy of BPKIHS and
the MBBS Course Vice-Chancellor
Bird's-eye view of the MBBS

program Rector
Introduction of the faculty

to students Rector
Introduction of students
to faculty Dean Academics
The BPKIHS organogram with

special emphasis on national
investment for producing a
medical graduate Registrar
Welcome tea
Bird's-eye view of the

Phase I MBBS Program Dean/Asst. Dean (Academics)
Tour of the BPKIHS Complex

with special emphasis on
facilities such as library,
post office, telecommunications,
shopping complex, sports,
police etc. Deputy Manager (Academics)
Tour of Dharan town Deputy Manager (Academics)
Day 2
Approach to learning and
learning skills; innovations in learning
tools & technology Dept of Health Professions Education
History of Medicine School of Public Health and CM
Socio-economic and cultural

aspects of Sunsari District
with special reference to Dharan School of Public Health & CM
22
Day 3
Communication skills Dept of Psychiatry &
Role plays
Development of personality School of Public Health & CM
profile with scales
Introduction to community Medicine School of Public Health & CM
Visit to the community (Batch A) Field Program Coordinator
Visit to the Hospital (Batch B) Deputy Manager (Hospital Admin)
Preparation for presentations

on community visit Field Program Coordinator
Day 4
Doctor-patient relationship
Questionnaire on career-choice
Visit to the Community (Batch B) Field Program Coordinator
Visit to the Hospital (Batch A) Deputy Manager (Hospital Admin)
Preparation for presentations

on community visit Field Program Coordinator
Day 5
The tools of the trade Dept of Health Professions Education
(Introduction to learning resources
in basic medical sciences)
Introduction to Problem-based
learning (PBL) PBL Coordinator
Resource session on PBL (1)

PBL Tutorial (1) PBL Coordinator
Day 6
Day 7
Day 8
Assessment System Dean (Examinations)
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Organization of the Community Visit
Students going to the community will be given guidelines to make observations on:
a. Social structure of the community
b. Family living conditions
c. Environmental problems, sanitary condition, water supply, health facilities (Distance from the
nearest Health Post/District Hospital/Dispensary)
In the end of the visit students will be assigned 5 households to each group (2 students in one group)
for Family Health Exercises (FHE) which will continue till the end of the Internship Program.
Objectives of the Community Visit
At the end of the orientation course, the student should be able to:
1. Describe the socio-cultural structure of the community.
2. Identify the environmental problems.
3. Describe the existing health facilities.
4. Make a simple presentation regarding the above.
5. Suggest and conduct a simple intervention for an identified problem.
Organization of the Hospital Visit
1. Introduction of the student to the BPKIHS Hospital Director and other administrative staff.
2. Students will be divided into 2 groups and will visit the departments of Medicine, Surgery,
Gynaecology and Paediatrics by rotation, spending 30 minutes in each department.
Objectives of the course on behavioral sciences
At the end of the course, the students should be able to:

1. List components of communication, verbal and non-verbal.
2. Listen actively and formulate a patient's problem.
3. State the importance of using appropriate dialect which is easily understood by the patient.
4. Identify barriers to effective communication and measures to overcome them.
5. State the importance of establishing congenital doctor-patient relationship.
6. Identify measures to develop empathetic relationship with patients.
7. Define meaning and significance of confidentiality.
8. State reasons for maintaining positive attitudes towards different types of patients, especially
elderly, children and women.
9. Maintain adequate physical proximity and emotional distance while examining patients of
opposite sex.
10. Appreciate communication skills in FHE.
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Unit 0
General Concepts
Anatomy
Physiology
Pathology
Biochemistry
Microbiology
Pharmacology
Community Medicine & Behavioral Sciences, and
Forensic Medicine
25
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GENERAL CONCEPTS
GOAL: To familiarize the students with general concepts of health and disease which are
relevant to all organ systems and are essential for understanding any organ system.
ANATOMY
GENERAL ANATOMY
Themes and Topics
1. Introduction to anatomy, anatomical positions, planes and terms.

2. Mechanism of locomotion.
Objectives
At the end of the course, the student will be able to:

1. Explain the various positions, planes and terms in relation to body and various organs.
2. Describe the mechanism of locomotion and functional anatomy of the various structures used
in the process.
GENERAL MICROANATOMY
Themes and Topics
1. Introduction to microscopy and principles of histological techniques.

2. Introduction to microanatomy.
3. The cell
4. Epithelial tissue
5. Connective tissue
6. Exocrine glands
7. Muscle tissue
8. Nervous tissue
Objectives

1. Identify the various parts of the microscope and explain the function of each.
2. Identify the various parts of a cell as seen under the light and electron microscopes.
3. Explain the various staining techniques used in the microanatomy laboratory.
4. Identify the various types of epithelial tissues, their locations and functions.
5. Identify the various types of connective tissues, their location and functions.
6. Describe the classic features of glandular, muscular and nervous tissues.
27
EXTREMITIES
Themes and Topics
1. Breast and axilla

2. Nerve supply of upper limb, Branchial plexus.
3. Synovial joints in the upper limb
4. Palmar spaces
5. Femoral hernia
6. Locomotion in lower limb
7. Hip joint
8. Knee joint
9. Arches of foot
Objectives

1. Describe the major features of bones, muscles, blood vessels, nerve supply and lymphatic
drainage of upper and lower limbs.
2. Explain the anatomical basis of common lesions, injuries and surgical practices with respect to
upper and lower limbs.
GENERAL EMBRYOLOGY
Themes and Topics
1. Fertilization
2. Clearage
3. Formation of germ layers
4. Implantation
5. Intrauterine growth
Objectives
At the end of the course, the student should be able to:

1. Describe the process of fertilization
2. Describe the initial steps in development of the employees.
3. Describe the formation of germ layers
4. Narrate the tissues arising from the three germ layers.
5. Describe the basic features of implantation.
6. Describe the basic features of intrauterine growth and differentiation.
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NERVOUS SYSTEM
Themes and Topics
1. Introduction to nervous system

2. Introduction to autonomic nervous system.
Objectives

1. Describe the general organization of nervous system.
2. Describe the structural differences between the sympathetic and parasympathetic nervous
systems.
PHYSOLOGY
GENERAL PHYSIOLOGY
Themes and Topics
1. Introduction of Physiology.
2. Homeostasis
3. Biological transport
Objectives

1. Define physiology
2. List general functional organization of the human body.
3. State principles of control systems.
4. Define homeostasis or maintenance of the internal environment.
5. Describe basic types of principles of active and passive transport.
PHYSIOLOGICAL BASIS OF OTHER CONCURRENT COURSES
Themes and Topics
1. Physiological basis of inflammation.

2. Introduction to immunology.
3. Introduction to nervous system.
4. Introduction to autonomic nervous system.
29
Objectives

1. Describe the morphology of leucocytes.
2. Outline the basic functions of leucocytes.
3. Describe the physiological basic of edema with special reference to inflammatory edema.
4. Describe the components and mechanisms underlying cutaneous reactions to injury, viz. white
line, red line, flare and wheal.
5. Outline the functions of T and B lymphcytes.
6. Describe the differentiation of T and B lymphocytes.
7. Outline the induction and expression of cellular and humoral immunity.
8. Explain why secondary immune response is better than primary immune response.
9. Outline the functional organization of the nervous system.
10. Describe the structure and function of the reflex arc.
11. Explain the functional differences between sympathetic and parasympathetic nervous system.
12. Recall the neurotransmitters employed at different levels of synapses in the autonomic
nervous system.
13. Narrate the rationale of the effects of sympathetic and parasympathetic activation on various
organs.
BIOCHEMISTRY
GENERAL BIOCHEMISTRY
Themes and Topics
1. Introduction to biochemistry in Medicine

2. Introduction to pH and buffer
3. Cellular transport
4. Basic Concepts of Carbohydrates, Lipids, Amino acids, Proteins, Nucleic acids & Enzymes
5. Bioenergetics and biological oxidation
6. Concepts of free radicals and antioxidants.
Objectives

1. Recall structure and ultra-structure of a cell, list the function of each, and correlate its
structure.
2. State the structure, function and role in signal transduction of cell membrane.
3. Recall the structure of a plasma membrane.
4. Describe hydrophilicity and hydrophobicity and its importance in the transport of different
molecules.
5. Correlate the role of specific proteins in cell membranes with their function especially with
regards to receptor and transport proteins.
6. Describe the phenomenon of signal transduction and the role of different types of second
messengers.
30
7. Describe basic concept of thermodynamics so as to appreciate the directionality of a reaction.
8. Compare and contrast the similarities and dissimilarities between inorganic catalyst and
enzymes at structural and functional levels with concepts of apoenzyme and prosthetic group.
9. Recall the characteristics of an enzyme catalyzed by reaction and simple interpretation
regarding values of Km, Vma.
10. Describe key features of active sites including the features of prosthetic groups within the
same.
11. Describe various forms of inhibition and the concepts of activators inhibitors and allostery.
12. Describe the components of a humoral and cellular immune response.
13. Define the terms antigen, heptene, carrier, primary and secondary response.
14. Describe the structure of a) Antibody molecule b) T-cell receptor, its relationship to the
generation of diversity of the immune response.
15. Describe the processes of antigen presentation, antigen recognition and cellular cooperation in
the immune system and correlate these with the regulation of the immune response.
16. Rationalize the process of self-non self recognition.
17. Describe various mechanisms of hypersensitivity and autoimmunity and identify the
breakdowns in cellular controls.
18. Describe the various values and rationalize on the requirement (or otherwise) of a cold chain.
PRACTICAL SKILLS
Objectives
At the end of the course the student should be able to acquire knowledge and skills related to:
1. Introduction to Laboratory Chemistry
2. Introduction to Buffers and pH
3. Reaction of Carbohydrates
4. Reaction of Amino acids and Peptides
5. Reaction of Unknown protein and Isoelectric Point
6. Reaction of Lipids
7. Chromatography (separation of amino acids)
8. Salivary Amylase: Determination of achromatic point and effect of pH and temperature.
PATHOLOGY
Themes and Topics
1. Introduction to Pathology.
2. Cellular response to injury.
3. Necrosis and Apoptosis.
4. Calcification and intracellular accumulations.
5. Inflammation and Healing.
6. Edema and Chronic venous congestion.
7. Thrombosis and Embolism.
8. Infarction and Shock.
31
9. Infection.
10. Cellular growth and differentiation
11. Neoplasia.
Objectives

1. List the causes of reversible and irreversible cell injury.
2. Explain the mechanism involved in reversible and irreversible cell injury.
3. Describe the morphology of reversible and irreversible cell injury.
4. Define necrosis. Enlists its types with an example of each.
5. Define apoptosis. Describe the mechanism of it.
6. Mention differences between necrosis and apoptosis.
7. Discuss types of calcification.
8. Discuss about different types of intracellular accumulations.
9. Define inflammation.
10. Describe different types of inflammation.
11. Discuss the vascular and cellular responses to inflammation.
12. Enlist cell derived and plasma derived chemical mediators of inflammation and their role in
inflammation.
13. Describe the causes and types of nonspecific and granulomatous inflammation.
14. Describe the mechanism underlying wound healing by primary and secondary union.
Mention the factors promoting and delaying the process.
15. Discuss in brief about cell cycle and types of cells.
16. Mention the pathologic aspects of repair.
17. Define edema.
18. Explain the pathogenesis of edema. Enlist different types of edema.
19. Identify the gross and microscopic changes seen in lung, liver and spleen in chronic venous
congestion.
20. Define thrombus.
21. Explain the mechanism of thrombus formation. Discuss the fate of the thrombus.
22. Define embolism. Enlist its types.
23. Enumerate the type of infarcts and their common sites.
24. Define shock. Describe the pathogenesis of shock.
25. Enlist the types of shock. Mention stages of shock.
26. Describe the morphological changes seen in cells and tissues caused by shock.
27. Discuss pathogenesis of infections.
28. Describe cellular adaptations of growth and cellular differentiation.
29. Classify neoplasia.
30. Differentiate between benign and malignant epithelial and mesenchymal tumors.
31. Discuss grades and stages in malignant neoplasm.
32. Enumerate the routes of metastasis in malignant neoplasm.
33. Discuss systemic effects of tumor and host interaction as in Paraneoplastic syndrome.
34. Define carcinogenesis and list important carcinogens.
35. List the common modalities used for laboratory diagnosis of tumors.
32
MICROBIOLOGY
Themes and Topics
1. Taxonomy and nomenclature of bacteria, fungi, viruses and animal parasites.

2. Structure of bacteria.
3. Structure of viruses.
4. General properties and replication of viruses.
5. Structure of parasites and fungi.
6. Metabolism, growth and multiplication of bacteria.
7. Growth and multiplication of parasites and fungi.
8. Pathogenesis of infections: host factors.
9. Pathogenesis of infections: agent factors.
10. Bacteriophage.
11. Bacterial genetics.
12. Fundamentals of immunology.
13. Principles of vaccines.
14. Antibiotics and lab control of antibiotic therapy.
15. General features of gram positive cocci.
16. General features of bacterial zoonoses.
17. Anaerobes and methods of anaerobiosis.
18. General features of aerobic gram negative bacilli.
19. General features of gram negative non-sporing anaerobes.
20. General features of nosocomial infections.
21. Bacteriology of water and milk.
22. Arbo viruses.
23. Oncogenic viruses.
24. Fungi causing apportunistic infection.
25. Lab diagnosis of fungal infection.
Objectives

1. Cite examples of contributions that microbiology has made to mankind.
2. Describe the unique properties of unicellular prokaryotic organisms in contrast to those of the
eukarytes.
3. State the rationale of classification of microbes.
4. List the growth requirements of microbes.
5. Describe the variety of interactions between microbes and human hosts from commensalism
to pathogenesis.
6. Cite some examples of specific pathogenic mechanisms of bacterial, viral, parasitic and fungal
illness.
7. Define sterilization and disinfection.
8. Explain the mode of action of antimicrobial drugs.
9. Describe the tests necessary to determine drug susceptibility.
10. Outline the principles of isolation and identification of bacteria, fungi and viruses.
33
11. Describe non-culture methods for establishing etiological diagnosis of microbial diseases.
12. Define the terms - reservoir, source of infection, exposure, colonization, infection, vector,
fomites, epidemic, endemic, pandemic, zoonosis, incidence, prevalence, risk of infection,
attack rate.
13. Enumerate various sources of exposure to microbes.
14. Explain passive and active immunity.
15. List live as well as killed vaccines.
16. Define nosocomial infections.
17. Enumerate the general features of common and important bacteria, viruses, fungi and
parasites.
18. Explain the basic principles of identifying microbes.
19. Describe the role of physician in initiating microbiological investigations.
PRACTICAL SKILLS
Objectives

1. Demonstrate his familiarity with different parts of a microscope, media and wire loops.
2. Perform simple staining such as Gram, Ziehl Nielsen, Capsule, Albert and Spore Staining.
3. Demonstrate, using simple techniques, virulence factors of microbes (capsule, toxin,
coagulase).
4. Identify and interpret the following tests:
a. Slide agglutination test.
b. Tube agglutination test.
c. ELISA test.
5. Interpret the results of:
a. Disc diffusion test.
b. MIC/MBC value.
6. Prepare saline and iodine preparation for ova and cyst and identify common pathogens.
7. Prepare, stain and examine peripheral blood films for parasites.
8. Prepare and examine Cap slides for fungus.
9. Collect and transport appropriate samples for isolation/demonstration of the pathogen.
PHARMACOLOGY
GOAL:To familiarize the students with general concepts of health and disease which are relevant to
all organ systems and are essential for understanding any organ system.
Themes and Topics
1. Sources and routes of drug administration.

2. Absorption, distribution, biotransformation and elimination of drugs.
3. Principles of drug action.
4. Drug-drug and drug-food interactions.
34
5. Adverse drug reactions and their monitoring.
7. Therapeutic drug monitoring.
8. Pharmacogenetics.
9. Special considerations for use of drugs during childhood, old age and pregnancy.
10. Antimicrobial therapy.
Objectives

1. State sources of drugs and routes of drug administration.
2. Describes factors affecting absorption of drugs.
3. Describe concept of distribution, biotransformation and elimination of drugs.
4. State principles of drug action, drugs receptor interaction.
5. Describe factors affecting drug response.
6. State principles of drug-drug interaction and drug-food interaction.
7. Comprehend concepts of bio-availability and bio-equivalence.
8. State adverse drug reactions and monitoring.
9. Enumerate principles of prescription writing.
10. State broad principles of use of drugs in children, geriatric population and pregnancy.
11. State principles of therapeutic drug monitoring.
12. Describe general principles of antimicrobial therapy including combination chemotherapy,
bacterial resistance, cost effectiveness of antimicrobial therapy and newer antibiotics.
COMMUNITY MEDICINE & BEHAVIORAL SCIENCES

Themes and Topics
1. Concept of health
2. Determinants of health
3. Indicators of health
4. Concept of disease
5. Concept of prevention
6. Communication skills
a. the art of communication
b. skills of communication
c. methods of overcoming resistance in individual, family and community.
7. Behavioral Sciences
a. Culture, Society and Health
b. Role of Family in health and disease
c. Social Organization and Community Participation
d. Measurement of socioeconomic status and its importance in relation to health and
disease.
e. Questionnaire/Interview schedule designing.
f. Construction/pretesting of questionnaire/interview schedule.
35
8. Health Education
a. Health Education methods.
b. Audiovisual aids.
c. Planning a health educational program.
d. Practical exercise: making and delivering a health educational talk on simple issues:
* Personal hygiene.
* Clean water
* Clean domestic environment
* Clean external environment
* Dental hygiene
* Any other topic
9. Environment
a. Environment:Physical environment inside and outside the home, family environment.
b. Water
c. Waste
d. Air pollution, green house effect, ozone layer
e. Energy conservation/alternate sources of energy
10. Application of the above-mentioned concepts through the FHE by visiting allocated families.
Objectives

1. Describe in broad and enlightened terms what we mean by health, disease and prevention.
2. Describe the role of a doctor in promotion of health and other levels of prevention.
3. Communicate effectively with the individual, family and community.
4. Describe the role of the family/community in health and disease.
5. Measure the socio-economic status of a family and describe its importance in health and
disease.
6. Construct, pre-test and validate a questionnaire/interview schedule.
7. Describe health educational methods.
8. Plan and conduct health educational session for an individual/community.
9. Describe the physical environment inside and outside the home.
10. Describe the family environment.
11. Suggest appropriate methods for improving the internal/external environment.
12. Define safe water as obtained from a tap, hand pump, well.
13. Describe appropriate methods for making water safe at the domiciliary level.
14. Describe methods of waste control.
15. Define air pollution, causes of air pollution and describe appropriate measures of prevention.
16. List hazards of smoking.
17. Describe the long term effects of smoke inhaled by the housewife while preparing meals for
family.
36
FORENSIC MEDICINE
Themes and Topics
1. Legal procedure
2. Medical law and ethics
Objectives

1. Explain legal procedures and list medico-legal responsibilities of a general physician.
2. Discuss physician's responsibilities in criminal matters.
3. Demonstrate familiarity with concepts of medical ethics and need for ethical practice of
Medicine.
37
LEARNING RESOURCES (Time, hours)
No of SIS No of LABEX CLIP

(1 hour) (3 hours) (3 hours)
Anatomy 34 18
Physiology 8 0
Biochemistry 21 11
Pathology 20 9
Microbiology 20 5
Pharmacology 29 6
Community Medicine & 5 0

Behavioral Sciences
Forensic Medicine
5 0
Clinical Postings (CLIP)
in groups & by rotation in:
Medicine
5
Surgery
Paediatrics
Obst/Gynaecology
TOTAL 142 hours 49 x 3 hours = 147 Hrs 5 x 3 = 15 Hrs
Time Required (approx)
Theory + Practical : 14 weeks

Community Diagnosis Program : 2 weeks + 2 visits in FHE
Assessment : 1 week
Total : 17 weeks
38
Unit 1
1. Growth, Development and Genetics
2. Blood and Immunology
39
40
GROWTH, DEVELOPMENT AND GENETICS
Common Problems
1. Developmental anomalies
2. Down's syndrome
3. Phenylketonuria
4. Lactose intolerance
5. Intra-uterine Growth Retardation
6. Prematurity
7. Cerebral Palsy and Mental retardation
8. Learning disabilities
Themes and Topics
Anatomy
1. Gametogenesis.
2. Menstrual Cycle.
3. First Three weeks of human development.
4. Determination, differentiation and morphogenesis
5. Twining.
6. Formation, structure and functions of placenta.
7. Teratogen and teratogenicity.
8. Acquisition of external body form and growth.
9. Common genetic terms and symbols used in pedigree charts.
10. Mendelian and multifactorial pattern of inheritance.
11. Chromosomes, morphology, banding patterns and classification.
12. Numerical and structural abnormalities of chromosomes.
13. Common chromosome abnormality syndromes - Down's syndrome, Trisomy, Turner's
Syndrome, Klinefelter's syndrome.
14. Sex determination, differentiation and hermaphrodites
Physiology
1. Growth and Development

2. Aging
Biochemistry
1. Cell cycle
2. Nucleic acids: DNA and RNA
3. DNA replication
4. Transcription
5. Translation
6. Regulation of gene expression
41
7. Epigenetics, mi RNA, si RNA
8. Genetic engineering
9. Mutations and prototypes of inherited metabolic disease
10. Biochemical and genetic basis of disease
11. Human genome project
12. Concept of bioinformatics
13. Gene therapy and molecular medicine
Pathology
1. Important terminologies
2. Mendelian disorders
3. Cytogenetic disorders
Pharmacology
1. Teratogenicity and Medication during pregnancy

2. Dosage in malnutrition
Paediatrics
1. Developmental milestones
2. Anthropometry
3. Physiological changes in adolescence
Behavioral Sciences
1. Genetic counseling
2. Cognitive Development
3. Puberty and Adolescence
4. Behavior Problems
Objectives
Anatomy
At the end of the course, the student should be able to :

1. Demonstrate knowledge of the basic principle and sequential development of the body form.
2. Recognize critical stages of development and the effects of common teratogen, genetic
mutations and environmental hazards.
3. Identify the basis and types of twining.
4. Identify the fetal membranes. Explain the functions, variations and congenital anomalies of
placenta.
5. Explain the morphology, banding pattern, classification and abnormalities of chromosomes
6. Demonstrate methods of sex determination
7. Identify different types of hermaphroditism
42
Physiology

1. Define growth, development, pattern of growth and development in various organ systems.
2. List factors affecting growth and development.
3. Describe important theories of aging, physiological changes in organ systems associated with
aging and factors affecting aging.
Biochemistry

1. Describe the phenomenon of cell division and the intracellular changes occurring during
this process.
2. Describe the phenomena and analyze the relevance of mitosis and meiosis.
3. Describe the cell cycle and its regulation.
4. Describe the structure and function of nucleic acids.
5. Describe the Watson Crick model of DNA and analyze the functional implications of the
same.
6. Describe the steps involved in DNA replication and analyze how these ensure the faithful
replication of genetic material.
7. Describe the structure and role of RNA as an adapter molecule and the phenomena of
transcription.
8. Analyze the structure-function relationships of tRNA and ribosomes. Describe how RNA is
translated into protein.
9. Describe the mechanism of translocation of proteins, post-translation modification in
eukaryotes.
10. Analyze the need for regulation of gene expression. Describe the lac operon and analyze it
as a paradigm for regulation of prokaryotic gene expression. Analyze the mechanism of
action of steroid hormone as way of eukaryotic gene regulation.
11. Describe the meaning of epigenetics and the mechanism involved in genetics.
12. Describe the role of mi RNA and si RNA in regulation of gene expression.
13. Describe the meaning of genetic engineering, and recombinant DNA technology, plasmid
and restriction enzyme. Outline how recombinant DNA technology can be used to
a. make a medically relevant product e.g. insulin and
b. disease diagnosis taking any one example
14. Comprehend the concepts of mutation to:
a. Describe the nature of metabolic block in phenyl ketonuria (PKU).
b. Correlate the same with clinical features and preventive strategies in PKU.
c. Consider the experience of PKU to conceptualize genetic screening program.
d. Use knowledge of PKU to generalize on concepts of inherited disorders of
metabolism.
15. Lactose intolerance
a. Describe the biochemical defects in both genetic and acquired lactose tolerance.
b. Correlate above with the phenomenon of mal-absorption and methods of managing
the same.
16. Demonstrate the screening of inherited disorders of metabolism and to interpret the results.
43
17. Describe the process involved in gene therapy and its contribution to development of
molecular medicine.
18. Describe the goals, currents status and future major implications of Human genome
projects in health and disease.
19. Describe the process of carcinogenesis, role of oncogenes and proto-oncogenes in
carcinogenesis, mechanism of action of oncogenes.
20. Describe the role of growth factors on cell cycle and mitosis.
21. Correlate the action of growth factors, oncogenes and tumor suppression genes in cancer.
22. Describe the biochemical laboratory test (tumor markers) in the management of patients
with cancer.
Pathology
1. Mention important terminologies in genetics.
2. Enlist Autosomal Dominant, Autosomal Recessive and X-Linked disorders.
3. Mention disorders associated with defects in Enzyme as in Gauchers and Niemmenpick
disease.
4. List cytogenetic disorders with special reference to Down’s syndrome.
Pharmacology
1. List drugs that have established teratogenic effect and
potential teratogenic effect.
2. Analyze the risk involved in using such drugs during pregnancy.
3. Suggest modification in the dosage schedule of drugs in malnourished conditions.
Paediatrics
1. Describe milestones of normal development in child from birth to two years.
2. Describe methods of assessing gross and fine motor development, language development.
3. Illustrate Physiological changes in normal adolescence.
4. Compare Physiological changes in boys and girls (Exercises).
5. Describe methods of anthropometric measurements of newborns and order children.
Behavioral Sciences
1. Define counseling and state its importance in medical practice.
2. Describe methods of genetic counseling (group work).
3. Outline a plan of genetic counseling for parent of a child with Down's syndrome (exercise).
4. Define cognitive development.
5. State the stages of cognitive development from birth to fourteen years.
6. Differentiate normal and subnormal cognitive development.
7. Illustrate classification of intelligence.
8. Examine role of heredity and environment in development of cognition.
44
9. Demonstrate clinical assessment of intelligence.
10. Chart language development, list psycho-motor development.
11. Describe social development from birth to adolescence.
12. Illustrate Psychological changes in formal adolescence.
13. Compare the psychological changes in boys and girls.
BLOOD AND IMMUNOLOGY

Common Problems
1. Anemia*
2. Purpura
3. Leukemia
4. Thalassemia
5. Lymphadenopathy
6. AIDS
* A prototypic disease, best suited for teaching basic mechanisms.
Themes and Topics
Anatomy
Lymphatic Organs and system (Gross & Microscopic structure)

1. Spleen
2. Lymph node
3. Lymphoid tissue
4. Tonsil &
5. Thymus
Physiology
1. Functions of plasma proteins

2. Hemopoiesis
3. Normal Structure and Function of Red Blood Corpuscles, White blood corpuscles and
Platelets
4. Innate immunity
5. Specific acquired immunity : cellular and humoral blood groups.
6. Coagulation
Biochemistry
1. Plasma proteins
2. Immune mechanisms: biochemical aspects
3. Hybridoma technique
4. Tumor markers
5. Biochemistry of AIDS
6. Iron metabolism
45
7. Heme synthesis and porphyria.
8. Hemoglobinopathies
 Iron metabolism
 Heme synthesis
 Immune mechanisms: biochemical aspects.
Pathology
1. Anemia of different etiology.

2. Quantitative disorders of white blood cells.
3. Leukemia.
4. Bleeding disorders.
5. Coagulation disorders.
6. Lymphadenopathy and splenomegaly.
7. Neoplastic lesions of Lymph node.
8. Immunodeficiency Syndromes.
9. Hypersensitivity.
10. Autoimmunity.
11. Transplant rejection.
12. Amyloidosis.
Microbiology
1. Parasites
 Hook worm
 Malarial parasite
 Leishmania donovani
 Filarial parasite
2. Bacteria: Septicemia, Brucella
3. HIV virus
4. Oncogenic Virus
5. Systemic fungal infections
6. Immune mechanisms, vaccines
Pharmacology
1. Treatment of anemia
2. Immunostimulants and immuno suppressants
3. Treatment of malignancies of blood and lymphoid tissues
4. Drug-induced blood disorders
5. Anticoagulants
6. Thrombolytic and antiplatelet drugs
Community Medicine
1. Iron and folic acid deficiency anemia
2. AIDS: Community aspects
3. Vaccination
46
Forensic Medicine
1. AIDS: Medicolegal aspects
Objectives
Anatomy

1. Locate the normal position of thymus, liver, spleen and various groups of lymph nodes
2. Identify the microscopic structure of thymus, spleen and lymph nodes and correlate structure
with functions
3. Explain development of thymus, spleen and lymph nodes and analyze the functions of the
organs at different age groups.
Physiology

1. Describe composition of plasma.
2. List functions of plasma proteins.
3. State erythropoiesis and its regulation.
4. List functions of red blood cells.
5. Mention destruction of red blood cells and bilirubin metabolism.
6. Describe hemostatic mechanisms,functions,formation and destruction of platelets.
7. Describe physiological basis of transfusion medicine: Blood groups, Rh incompatibility.
8. List functions of leukocytes. Leucopoiesis and its regulation.
9. Describe mechanism of innate immunity
10. Describe induction and expression of cellular and humoral immunity.
At the end of the course, the student should be able to perform/determine and interpret:
A peripheral blood smear. Differential leucocyte count. Erythrocyte count. Leucocyte
count. Eosinophil count. Reticulocyte count. Erythrocyte fragility. Erythrocyte
sedimentation rate. Packed cell volume. Blood groups. Blood haemoglobin level.
Bleeding and clotting time.
Biochemistry

1. Describe the components of a humoral and cellular immune response.
2. Define the terms antigen, hapten, carrier, primary and secondary response.
3. Describe the structure of (a) Antibody molecule (b) T-cell receptor, its relationship to the
generation of diversity of the immune response.
4. Describe the processes of antigen presentation, antigen recognition and cellular cooperation
in the immune system and correlate these with the regulation of the immune response.
5. Rationalize the process of self-non self recognition.
47
6. Describe various mechanisms of hypersensitivity and autoimmunity and identify the
breakdowns in cellular controls.
7. Describe the process involved in hybridoma technique for production of monoclonal
antibodies.
8. Mention sources of iron in diet.
9. Describe the mechanism of iron absorption and correlate these with iron availability in
different food stuffs and preparations of iron.
10. Analyze the role of absorption in iron homeostasis.
11. Interpret the different indicators of iron metabolism to arrive at a diagnosis of the nature of
anaemia.
12. Correlate the pathophysiology of haemochromatosis with the unique regulation of iron
metabolism.
13. Describe the heme synthesis and porphyria.
14. Describe the molecular basis of hemoglobinopathy.
15. List different types of plasma proteins.
16. Describe their properties and functions.
17. Describe the mechanism by which albumin affects blood volume.
18. Explain the principle and application of immunoassay.(ELISA, RIA)
19. Interpret normal and abnormal serum electrophoretogram.
Practical Skills
Objectives
At the end of the course, the student should be able to develop knowledge and skills related to :
1. Introduction to Colorimetry and Spectrophotometry.
2. Isolation and characterization of DNA.
3. Electrophoresis of serum and hemoglobin and interpret the same.
Pathology

1. Classify Anemia.
2. List the etiology and describe the morphological features of microcytic hypochromic
anemia as in iron deficiency anemia.
3. List the etiology and describe the morphological features as in Vitamin B12 and Folic acid
deficiency anemia.
4. Define hemolysis. Enlist its types.
5. Mention the mechanism of extravascular and intravascular hemolysis.
6. Classify Hemolytic anemia.
7. Describe the etiology, morphology and complications of Hereditary hemolytic anemia.
(Beta Thalassemia Hereditary Spherocytosis, G6PD Deficiency anemia and Sickle cell
anemia).
8. Discuss Acquired hemolytic anemia.
9. List the etiology of bleeding disorders.
10. Discuss platelet disorders with special reference to idiopathic thrombocytopenic purpura.
48
11. Discuss the etiology and pathogenesis of common inherited coagulation disorders namely
von Willebrand disease, Hemophilia A and Hemophilia B.
12. Enlist causes of acquired coagulation disorder.
13. Discuss the etiology and pathogenesis of Disseminated Intravascular Coagulopathy.
14. Enumerate common causes of leucocytosis, leucopenia and pancytopenia.
15. Define and classify acute and chronic leukemia.
16. Differentiate leukemia and leukemoid reactions.
17. Discuss the types and pathophysiology of blood transfusion reaction.
18. Discuss different types of blood components and its uses.
19. List the causes of lymphadenopathy.
20. Describe gross and microscopic features of reactive lymphadenitis.
21. Describe gross and microscopic features of tuberculous lymphadenitis.
22. Classify lymphomas.
23. Describe morphology of Hodgkin's and Non-Hodgkin's lymphoma.
24. Differentiate between Hodgkin's and Non-Hodgkin's lymphoma.
25. List causes of splenomegaly.
26. Describe the types and mechanism of hypersensitivity reactions.
27. Define Autoimmunity and immunologic tolerance.
28. Describe mechanisms of autoimmune diseases.
29. Mention the names of Primary immunodeficiency diseases.
30. Describe etiopathogenesis of AIDS.
31. Define Amyloid and mention its physical and chemical nature.
32. Classify and state the pathogenesis of Amyloidosis.
33. Discuss mechanism involved in transplant rejection.
34. Describe gross and microscopy of different types of rejections in kidney.
Microbiology

1. List parasites that can be demonstrated in the blood and lymphoid tissues.
2. Demonstrate the presence of Leishmania donovani bodies in bone marrow aspirate by
appropriate staining.
3. Perform leishman stain to differentiate malarial and filarial parasite.
4. Explain the precautions to be taken while collecting blood for culture.
5. Enumerate bacteria commonly associated with septicemia.
6. Plan investigations and interpret results in suspected enteric fever.
7. List fungi causing systemic infection.
8. List viruses causing immunodeficiency
9. List oncogenic viruses.
10. Describe antigen-antibody reactions.
11. Describe the immunologic basis of common vaccines.
Pharmacology

1. Describe the Pharmacological effects, side effects, importance of drug interactions of oral
anticoagulants and heparin.
49
2. Describe the hematinics and state their use in different types of anemia.
3. List drugs that can cause hematological disorders.
4. Describe mechanisms of action and use of immunostimulants and immunosuppressant.
5. Describe drugs used for treatment of hematological malignancies.
6. Describe the pharmacology of thrombolytic and anti-platelet drugs.
Community Medicine

1. Describe socio-economic causes of iron deficiency and folic acid deficiency anemia.
2. Enumerate cost-effective interventions for prevention and treatment of anemia.
3. Describe present and future social implications of AIDS.
4. Describe schedule and route of administration of common vaccines.
Forensic Medicine

1. Medico-legal aspects of AIDS, Future medico-legal complication.
2. Describe future medico-legal implications of AIDS.
50
LEARNING RESOURCES (TIME, HOURS)
Genetics Growth & Immunology Blood CLIP

Development (3
hrs)
SIS LABEX SIS LABEX SIS LABEX SIS LABEX
Anatomy 8 1 0 0 2 1 0 0 0
Physiology 0 0 2 0 3 0 6 10 0
Biochemistry 12 0 0 0 6 0 4 1 0
Pathology 1 0 0 0 4 1 15 7 0
Microbiology 0 0 0 0 8 1 13 5 0
Pharmacology 0 0 0 0 2 0 14 3 0
Community 0 0 1 0 2 0 0
Medicine
Forensic 0 0 0 0 1 0 0
Medicine
Paediatrics 0 2 0 0 0 0 0
Psychiatry 0 5 0 0 0 0 0
Clinical 8
Postings
(CLIP)
in groups & by
rotation in:
Medicine
Surgery
Paediatrics
Obst/Gynae
TOTAL 21 1 x 3hrs 9 0 26 3 x 3hrs 55 26 x 8x3
hrs = 3 hrs hrs hrs hrs = 9 hrs hrs 3hrs = = 24
78 hrs
hrs
TIME REQUIRED (approx)

PBL : 2 weeks
Assessment : 1 week
Total : 15 weeks
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52
UNIT 2
1. Respiratory & Environment including Autonomic Nervous System
2. Cardiovascular System
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54
RESPIRATORY SYSTEM
GOALS: Provides learning inputs in respiratory, cardiovascular, function-dysfunction with a
basis for understanding, common clinical disorders, affecting respiratory and
cardiovascular systems.
Common Problems
1. Tuberculosis
2. Acute respiratory infections
3. Chronic obstructive pulmonary disease*
4. Nasobronchinal allergies
5. Suppurative lung disease
6. Carcinoma of the lung
7. Acute respiratory distress syndrome
*A prototypic disease best suited for teaching basic mechanisms.
Themes and Topics
Anatomy
1. Pleura and Lung

2. Trachea, bronchial tree and bronchopulmonary segments
3. Mediastinum
4. Microanatomy of lung and tracheobronchial tree
5. Development of pleura, lung and tracheobronchial tree
6. Congenital anomalies of lower respiratory tract
Radiology
Radiological structure of lungs.
Physiology
Introduction to respiratory physiology, lung volumes and capacities, gas laws, composition of
respired air.
1. Oxygen transport
2. Carbon dioxide transport
3. Mechanics of respiration
4. Regulation of respiration
5. Pulmonary function tests
Biochemistry
1. Role of haemoglobin in gas transport.

2. Plasma buffer, acid base disorder and role of lungs.
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Pathology
1. Inflammatory diseases of bronchi.

2. Pneumonia.
3. Lung abscess.
4. Bronchial asthma.
5. Emphysema.
6. Tuberculosis.
7. Tumors of lungs.
8. Tumors of nasopharynx and larynx.
9. Hyaline membrane disease.
10. Occupational lung diseases.
11. Disease of pleura and pleural effusion.
Microbiology
Micro-organisms in the respiratory tract (including anthrax, mycoplasma and chlomydiae)

Examination of respiratory secretions for diagnosis of respiratory disease.
Pharmacology
1. Antitubercular drugs
2. Anti-asthmatic drugs
3. Treatments of cough
Community Medicine
1. Occupational lung disease

2. Tuberculosis
3. Environmental pollution and health
4. Hazards and socio-economic aspects of smoking.
Forensic Medicine
1. Compensation for occupational diseases
Objectives
Anatomy

1. Identify the normal disposition and interrelationships of pleura and lung.
2. Identify microscopic structure of lung and tracheobronchial tree for understanding the effect
of various disease processes.
3. Explain the sequential development of lung and tracheobronchial tree and their anomalies.
56
Physiology

1. State functional anatomy of the respiratory system.
2. Describe mechanisms of normal respiration.
3. Define lung compliance.
4. Describe pulmonary function tests.
5. Describe alveolar ventilation.
6. Describe ventilation/perfusion ratio.
7. Describe oxygen and carbon dioxide transport.
8. Describe diffusion capacity.
9. Describe regulation of respiration.
10. Describe adjustments during muscular exercise.
1. Spirometry
2. Dead Space
3. Stethography
Biochemistry

1. Describe the nature of oxygen binding to a porphyrin ring.
2. Describe the structure of the globin molecule, and explain its influence in oxygen binding.
3. Correlate the above with the oxygen and carbon monoxide binding properties of myoglobin
and hemoglobin.
4. Describe the concept of allostery and analyze how subunit interactions influence oxygen
binding.
5. Correlate the above knowledge with oxygen loading in lungs and unloading in the tissues.
6. Correlate the oxygen binding of fetal haemoglobin with its structure.
7. Explain the molecular and genetic basis of sickle cell anaemia and correlate the same with
the physicochemical basis of sickling.
8. Discuss the roles of plasma buffer in acid base homeostasis.
9. State the role of lungs in maintenance of acid base disorder.
Pathology

1. Explain the concept of obstructive and restrictive lung disorders.
2. Describe the etiopathogenesis, gross and microscopic features of chronic bronchitis.
3. Define bronchiectasis.
4. Explain the pathogenesis of bronchiectasis.
5. Describe the gross and microscopic features of bronchiectasis.
6. List three important complications of bronchiectasis.
7. Define pneumonia and classify pneumonia syndrome.
8. Describe the gross and microscopic features of broncho and lobar pneumonia.
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9. Write important causes of lung abscess.
10. Describe the gross and microscopic characteristics of lung abscess.
11. List complication of lung abscess.
12. Define bronchial asthma.
13. Explain the mechanism involved in the pathogenesis of bronchial asthma.
14. Describe the morphology of bronchial asthma.
15. Enumerate various types of emphysema.
16. Describe the gross and microscopic features of emphysema.
17. Describe the etiopathogenesis of primary and secondary tuberculosis.
18. State the gross and microscopic features of primary and secondary tuberculosis.
19. Differentiate Ghon's focus and Ghon's complex.
20. State the gross and microscopic features of miliary tuberculosis.
21. Enumerate common tumors of the lung/bronchi.
22. Mention common factors implicated in the etiology of bronchogenic carcinoma.
23. Identify the gross and microscopic features of bronchogenic carcinoma.
24. List tumors of nasopharynx and larynx.
25. Discuss etiopathogenesis and morphology of nasopharyngeal carcinoma.
26. Describe etiopathogenesis of Hyaline membrane disease.
27. Describe gross and microscopic features of Hyaline membrane disease.
28. Define pneumoconiosis. List diseases causing pneumoconiosis.
29. Describe the pathogenesis, gross and microscopic features of silicosis, asbestosis and coal
worker pneumoconiosis.
30. List types of pleural effusion and mention its causes.
31. List pleural tumors.
32. Mention etiology and its effects on mesothelioma.
33. Describe morphology of mesothelioma.
Microbiology

1. List common bacteria found in upper respiratory tract.
2. Enumerate various pathogenic bacteria and the sites which they most commonly infect.
3. Suggest appropriate samples which could be collected to demonstrate the pathogens.
4. Perform simple tests to determine the presence of corynebacterium diphtheriae and
Mycobacterium tuberculosis.
5. Evaluate the diagnostic yield of different tests.
6. Analyze the consequence of group A streptococcal sore throat.
Pharmacology
At the end of the course, the student should able to:

1. Classify antitubercular drugs.
2. Describe the mechanism of action, side effects, doses and different schedules of antitubercular
drugs.
3. Classify drugs used in bronchial asthma, describe their mechanism of action, important side
effects and drug interactions.
4. Enumerate anti-tussives and expectorants and their rational use .
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Community Medicine

1. List the social aspects of occupational lung disease.
2. Describe the nutritional and environmental factors in causation and treatment of tuberculosis.
3. List environmental hazards to respiratory health.
4. Describe socio-economic aspects of smoking.
Forensic Medicine

1. Describe the legal aspects of compensation for occupational lung disease.
CARDIOVASCULAR SYSTEM
Common Problems
1. Rheumatic fever and rheumatic heart disease.

2. Hypertension
3. Ichemic heart disease
4. *Heart failure
5. Peripheral vascular disease
6. Congenital heart disease
7. Cardiomyopathies
*A prototypic disease, best suited for teaching mechanisms.
Themes and Topics
Anatomy
1. Pericardium
2. Internal structure of the heart
3. Conducting system of the heart
4. Blood supply of the heart
5. Nerve supply of the heart
6. Microanatomy of the heart and blood vessels
7. Development of various chambers & major vessels of the heart.
8. Congenital anomalies of the heart
9. Fetal circulation and changes at birth
10. Development of major arteries and veins
11. Congenital variations and anomalies of vessels
Radiology
1. Radiological structure of the heart, coronary angiogram, echocardiography.

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Physiology
1. Properties of cardiac muscle

2. Electrophysiology of the heart
3. Cardiac Cycle
4. Electrocardiography
5. Cardiac output
6. Hemodynamics
7. Regulation of cardiovascular function
8. Blood pressure
9. Pathophysiology of hypertension
10. Pulmonary circulation
11. Coronary circulation
12. Cerebral circulation
13. Splanchnic circulation
14. Pathophysiology of edema
15. Pathophysiology of circulatory shock
16. Physiology of temperature regulation
17. Human responses to hot environment
18. Human responses to cold environment
19. Human responses to high attitude
20. Under-water physiology
21. Aviation and space physiology
Biochemistry
1. Lipoprotein, Triglyceride and cholesterol metabolism.

2. Metabolism in cardiac muscles.
3. Atherosclerosis, hypertension and ischemic heart disease and myocardial infarction (MI).
Pathology
1. Rheumatic heart disease.

2. Ischemic heart disease.
3. Hypertension and hypertensive heart disease.
4. Congenital heart disease.
5. Atherosclerosis.
6. Cardiomyopathy.
7. Infective endocarditis.
8. Myocarditis and Pericarditis.
9. Heart failure.
10. Non-atherosclerotic diseases of blood vessels.
11. Tumors of blood vessels.
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Pharmacology
1. Anti-hypertensive
2. Vasodilators
3. Calcium channel blockers
4. Cardiac glycosides
5. Anti-arrhythmic drugs
6. Anticoagulants
7. Thrombolytic agents
Community medicine
1. Socio-economic causes of rheumatic fever
Forensic Medicine
1. Sudden death
Anaesthesiology
1. Cardiopulmonary resuscitation
Integrated Seminar
1. Circulatory shock
Objectives
Anatomy

1. Identify the normal disposition and structure of the heart.
2. Trace the course and distribution of the coronary arteries.
3. Identify the microscopic structure of the myocardium.
4. Explain the development of the heart and give the embryological basis of various congenital
anomalies.
Physiology

1. Describe functional anatomy of the heart.
2. Mention properties of cardiac muscle.
3. Describe electrical and mechanical changes in cardiac cycle.
4. Interpret normal ECG
5. Describe cardiac output
6. Mention regulatory mechanisms of CVS
7. Describe regional circulations: coronary, cerebral, splanchnic, cutaneous; their normal values
and special features of regulation.
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8. Describe circulatory adjustments during exercise.
9. Describe the mechanism of temperature regulation.
10. Describe acute and long-term responses to hot environment, cold environment and high
altitude, including the process of occlimatization to these extreme environments.
11. Describe physiological responses of divers.
12. Describe the effects of rapid ascent and descent on the human body.
13. Describe how man has tried to solve physiological problems encountered in air and space
travel.
Practical Skills
1. Blood pressure in human being.
2. Properties of cardiac muscle
3. Plethysmography
4. Electrocardiography
5. Physical fitness tests
6. Exercise stress tests
7. Mechanical efficiency tests
Pathology

1. Describe the etiopathogenesis of rheumatic heart disease (RHD).
2. Describe the microscopic features (Aschoff nodule) of RHD.
3. Explain the complications of rheumatic valvular heart disease.
4. Describe the pathology and pathogenesis of myocardial infarction.
5. Describe the microscopic features of acute and healed myocardial infarct.
6. Enumerate the complications of acute myocardial infarction.
7. List investigations for diagnosis of myocardial infarction.
8. Define and classify Hypertension.
9. Explain the mechanisms of hypertension.
10. List causes of hypertension.
11. Recognize the target organs involved in hypertension and describe the changes seen.
12. Identify gross and microscopic features of benign and accelerated phases of hypertensions.
13. Classify congenital heart disease. Discuss in brief about common types of congenital heart
disease (ASD, VSD, Fallot’s Bicuspid aortic valve, PDA).
14. Enumerate predisposing factors of atherosclerosis.
15. Mention mechanism involved in the formation of atheromatous plaque.
16. Describe the gross and microscopic features of an atheromatous plaque.
17. Enumerate the complications of atherosclerosis.
18. Enlist the causes and types of cardiomyopathies.
19. Describe morphology of different types of cardiomyopathies.
20. List causes of endocarditis.
21. Define infective endocarditis.
22. Explain the pathogenesis of infective endocarditis.
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23. Describe gross and microscopic features of infective endocarditis.
24. Enumerate important complications of infective endocarditis.
25. Mention the causes and types of pericarditis and myocarditis.
26. Explain mechanism of cardiac failure.
27. List the types of cardiac failure and explain their pathophysiology.
28. Explain the pathological changes in target organs in heart failure.
29. Define aneurysm. Enlist its types and causes.
30. Define aortic dissection. Enlist its predisposing factor.
31. Classify vasculitis based on pathogenesis.
32. Classify vascular tumors. Describe gross and microscopic features of hemangioma.
Microbiology
At the end of the Course, the student should be able to:

1. Analyze the consequence of group A streptococcal infection causing sore throat.
2. Plan laboratory investigations to establish the diagnosis of acute rheumatic fever (ARF) and
rheumatic heart disease (RHD).
3. Interpret the results of serological tests for ARF/RHD.
4. Collect appropriate samples for establishing the diagnosis of infective endocarditis.
Pharmacology

1. Classify antihypertensive drugs and rationalizing use in different types of hypertension.
2. Describe the mechanism of action, side effects and important drug interactions of
antihypertensive agents.
3. Analyze the cost effectiveness and compliance of different antihypertensive regimens.
4. Describe arteriodilator, venodilator drugs and those of mixed type and be able to describe their
use in congestive cardiac failure.
5. Describe the basic mechanism of action, rationale of use and side effects, and toxicology and
ways to manage toxicity of cardiotonic and anti-arrhythmic drugs.
6. Outline the drug treatment of angina pectoris.
7. Describe the drugs used in management of acute myocardial infarction including thrombolytic
and anticoagulant agents.
Community Medicine

1. List the Socio-economic causes of rheumatic fever
Forensic Medicine

1. Describe the legal aspects of sudden unnatural death.
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Anaesthesiology

1. Describe the methods of cardiopulmonary resuscitation (CPR).
2. Describe the scientific basis of CPR.
3. Perform CPR
4. Describe methods of relieving respiratory obstruction.
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Cardiovascular Respiratory & CLIP

system Environment (3 hrs)
including ANS
System
SIS LABEX SIS LABEX
Anatomy 9 5 7 3
Physiology 12 4 18 3
Biochemistry 4 2 1 0
Pathology 9 1 8 3
Microbiology 2 1 9 3
Pharmacology 10 1 19 3
Community Med 1 1
Behav. Sci. 1
Forensic Medicine 1 1
Anaesthesia 2
Clinical Postings
(CLIP)
in groups & by 6
rotation in:
Medicine
Surgery
Paediatrics
Obst/Gynaecology
TOTAL 49 hrs 14 x 66 hrs 9 x 3hrs 6x3=
3hrs = = 27 hrs 18 hrs
42hrs
TIME REQUIRED (approx)

PBL : 1 week
Assessment : 1 week
Total : 11 weeks
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66
Unit 3
1. Gastrointestinal System
2. Hepatobiliary System
3. Nutrition
4. Metabolism
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68
GASTROINTESTINAL SYSTEM
GOALS: Provides learning inputs in digestive-absorptive, hepatobiliary, nutrition, metabolic
functions and impairments encountered in common clinical conditions.
Common Problems
1. Diarrhea
2. Malabsorption syndrome*
3. Acid-peptic disease
4. Ascites
5. Acute abdomen
Themes and Topics
Anatomy
1. Stomach: features, vasculature, innervation and lymphatic drainage

2. Peritonium & Coeliac trunk
3. Regional differences between small and large intestine, blood supply of small and large
intestine, Rectum and anal canal, Microscopic structure of esophagus, stomach, duodenum,
jejunum, ileum and large intestine
4. Development of G.I.T. congenital anomalies of G.I.T.
Radiology
1. Barium meal
2. Barium enema
3. Cyclic and mesenteric angiography
Physiology
1. Regulation of salivary secretion

2. Regulation of gastric secretion
3. Regulation of pancreatic and biliary secretions.
4. Functions of the colon
5. Motility of the gut
Biochemistry
1. Digestion in the mouth

2. Digestion in the stomach
3. Role of pancreas in digestion
4. Role of liver in digestion
5. Digestion and absorption in the small intestine
6. Gastrointestinal Function Tests
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Pathology
1. Oral pathology.
2. Salivary gland tumors.
3. Oesophagitis and Barrets esophagus.
4. Carcinoma of esophagus.
5. Gastritis.
6. Peptic ulcer disease.
7. Tumors of stomach.
8. Infectious and parasitic enterocolitis.
9. Malabsorption syndromes.
10. Idiopathic Inflammatory Bowel Disease.
11. Ischemic bowel disease.
12. Tumors and tumor like conditions of small and large intestine.
13. Appendicitis.
Microbiology
1. Parasitology: hookworm, roundworm, tapeworm, pinworm, amoebiasis and other intestinal

protozoa.
2. Microorganisms of the gut, including Family Enterobacteriaceal, Salmonella, Listeriosis,
Campylobacter, Schistosomes, Diphyllobothrium, Hymenolepis, Trictrenella, Dracunculus.
3. Food Poisoning.
Pharmacology
1. Drugs used in peptic ulcer

2. Antispasmodics
3. Anti-diarrheal
4. Emetics and antiemetic
5. Purgatives
6. Anthelminthics
Community Medicine
1. Diarrhea
2. Oral Rehydration Therapy
Integrated seminars
1. Diarrhea
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Objectives
Anatomy

1. Comprehend the normal disposition and interrelationships of various parts of gastrointestinal
tract.
2. Identify the microscopic structure of various parts of gastrointestinal tract to understand
various disease processes.
3. Explain the development of gastrointestinal tract and give the basis of its various anomalies
Physiology

1. State functions and regulation of the secretory activity of salivary glands, stomach, pancreas
and gall bladder.
2. Describe regulation of motility of the gut
At the end of the course, the student will be able to perform/determine and interpret:
1. Movement of isolated segment of intestine and effect of temperature and chemicals on it.
Biochemistry

1. Describe the various constituents of diets.
2. Describe digestion of nutrients.
3. Describe absorption of nutrients.
4. Describe the genetic and biochemical basis of lactose intolerance.
5. State sites of production and action of gut hormones.
6. Describe biochemical basis of tests for gastrointestinal function.
7. Explain biochemistry of starvation and obesity.
Pathology

1. Discuss precancerous lesions and common tumors of the oral cavity.
2. Classify odontogenic tumors. Discuss in brief about Ameloblastoma.
3. Classify salivary gland tumors. Discuss in brief about Pleomorphic adenoma.
4. Describe the morphology of Oesophagitis and Barrets esophagus.
5. Enumerate factors associated with carcinoma of esophagus.
6. Describe the morphology of carcinoma esophagus.
7. Enumerate major etiologic associations of acute and chronic gastritis.
8. Mention diseases associated with H.pylori infection.
9. Differentiate gross features of benign and malignant gastric ulcer.
10. Define peptic ulcer. Enumerate its site of occurrence.
11. Discuss pathogenesis of peptic ulcer disease.
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12. Describe the morphology of peptic ulcer disease. Enlist its complication.
13. Classify gastric carcinoma according to WHO.
14. Enumerate factors associated with gastric carcinoma.
15. Describe different gross appearances and microscopy of gastric carcinoma.
16. Describe the pathogenesis and morphology of typhoid, tuberculosis and amoebiasis.
17. Name the important complications of typhoid and amoebiasis of intestine.
18. Discuss in brief about important Malabsorption syndromes: Celiac disease and Tropical sprue.
19. Name the idiopathic inflammatory bowel diseases.
20. Describe etiopathogenesis of inflammatory bowel disease.
21. Describe gross and microscopic features of Crohn’s Disease and ulcerative colitis.
22. Differentiate between ulcerative colitis and Crohn’s Disease.
23. List complications of ulcerative colitis.
24. Name the predisposing conditions and describe the microscopic features of Ischemic bowel
disease.
25. Classify tumors of small intestine and colon.
26. Discuss tumor like conditions of small and large intestines.
27. Discuss in brief non neoplastic and neoplastic polyps of the colon and rectum.
28. Identify the gross and microscopic features of colorectal carcinoma.
29. Describe gross and microscopic features of acute appendicitis.
30. List complications of acute appendicitis.
Microbiology

1. Discuss the role of Helicobacter pylori in peptic ulcer disease.
2. Enumerate normal flora of the intestine.
3. List at least five common pathogens responsible for acute gastroenteritis.
4. Tabulate the differences between amoebic and bacillary dysentery.
5. Prepare saline and iodine preparations of stool and identify common pathogenic ova and cysts.
6. Enumerate common pathogens associated with food poisoning and indicate their incubation
period as well as common modes of exposure.
Pharmacology

1. Classify drugs used in peptic ulcer disease.
2. Describe the mechanism of action, side effects, and limitations of drugs used in treatment
of peptic ulcer.
3. Justify the relation of drug dose and duration of drug action in management of peptic ulcer.
4. Describe the mechanism of control of vomiting observed in disease or as side effects of
drugs, and in physiological conditions as motion sickness or pregnancy, using appropriate
antiemetic agents.
5. Enumerate agents to treat constipation and describe their mechanism of action.
6. Classify antispasmodic drugs and drugs used for non-specific Diarrhea .
7. Describe composition and the role of Oral Rehydration Solution (ORS) in acute Diarrhea .
8. Classify drugs used for the treatment of worm infestations .
9. Enumerate drugs used in protozoal infections.
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Community Medicine
At the end of the course, the student be able to:

1. List socio-economic causes of diarrhea
2. Acquire knowledge of rehydration therapy
HEPATOBILIARY SYSTEM
Common Problems
1. Jaundice
2. Infective hepatitis
3. Cirrhosis
4. Portal hypertension
5. Amoebic liver abscess
6. *Hepatic failure
7. Alcoholic liver disease
8. Cholelithiasis
9. Pancreatitis
*A rototypical disease, best suited for teaching basic mechanisms.
Themes and Topics
Anatomy
2. Liver, gall bladder and hepatobiliary apparatus

3. Hepatic portal system
4. Pancreas: disposition, relations, duct system and blood supply
5. Microanatomy of liver, gall bladder and common bile duct
6. Microanatomy of pancreas
7. Development of Hepatobiliary system and pancreas, their variations and anomalies
Radiology
1. Ultrasound of liver and gall bladder

2. ERCP
Physiology
1. Functions of the liver
Biochemistry
1. Hepatobiliary function tests

2. Differential diagnosis of jaundice
73
Pathology
1. Hepatitis and liver abscess.

2. Alcoholic Liver Disease.
3. Cirrhosis.
4. Hepatic failure.
5. Portal hypertension.
6. Tumors of liver and gall bladder.
7. Gall stone disease.
8. Pancreatitis and tumors of non endocrine pancreas.
Microbiology
1 Amoebic liver disease

2. Hydatid cyst
Pharmacology
1. Hepatotoxic drugs
2. Drug metabolism in liver
3. Drugs used in obstructive jaundice
4. Drug treatment of gall stone disease
Community Medicine
1. Effect of alcohol on health and society

2. Role of safe drinking water and hygienic food for control of infective and amebic hepatitis.
Objectives
Anatomy

1. Locate the normal disposition and inter-relationships of liver, gall bladder, bile duct and
pancreas.
2. Identify the microscopic structure of extrahepatic biliary apparatus and Pancreas.
3. Explain the development of extrahepatic biliary apparatus, pancreas and developmental basis
of its various anomalies.
Physiology

1. State the digestive functions of the liver.
2. List other functions of the liver.
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3. Describe mechanism of formation of bile.
4. List constituents of bile.
Biochemistry

1. Explain the steps of heme metabolism, formation of bilirubin, its conjugation, excretion
and secondary metabolism.
2. Correlate the above knowledge with the states of pre-hepatic, hepatic and post-hepatic
jaundice.
3. Describe the changes in clinical chemistry (including serum enzymes) in different types of
liver diseases.
4. Describe the biochemical basis of fatty liver.
5. Describe the metabolisms of xenobiotics.
Pathology

1. Enumerate the causes of viral hepatitis.
2. Describe etiopathogenesis of Hepatitis B and Hepatitis C viruses.
3. Describe the morphologic features of acute and chronic hepatitis.
4. List common causes of liver abscess.
5. Describe gross and microscopic features of liver abscess.
6. Describe pathogenesis and morphologic features of alcoholic liver disease.
7. Define cirrhosis of liver.
8. List etiologic factors of cirrhosis of liver and describe its pathogenesis and morphology.
9. List common tumors of liver.
10. List etiologic factors of Hepatocellular carcinoma. Mention its pathogenesis.
11. Describe gross and microscopic features of hepatocellular carcinoma.
12. Discuss the concept of hepatic failure.
13. List the types of portal hypertension.
14. Identify gross and microscopic features of chronic cholecystitis.
15. Discuss in brief about different types of gall stones and their associated risk factors.
16. Describe the etiopathogenesis, microscopic features and complications of acute and chronic
pancreatitis.
17. List sequel of acute and chronic pancreatitis.
18. List exocrine neoplasm of pancreas.
19. List etiology; describe pathogenesis and morphology of pancreatic carcinoma.
Microbiology

1. List the common etiologic agents of acute hepatitis.
2. Plan the laboratory diagnosis of amoebic liver disease.
3. Perform and interpret Casoni's test.
4. Interpret the serological diagnosis of hepatitis.
75
Pharmacology

1. Enumerate drugs that can cause significant hepatotoxicity.
2. Describe general concepts of metabolism of drugs in the liver.
Community Medicine

1. Describe the health effects of alcohol
2. Describe the socio-economic impact of alcoholism.
3. Describe the methods of making water potable.
4. Describe the methods of prevention of injective and amebic hepatitis.
NUTRITION
Common Problems
1. Protein-energy malnutrition (PEM)*

2. Iron deficiency.
3. Iodine deficiency.
4. Vitamin A deficiency
Themes and Topics
Physiology
1. Energy metabolism.
2. Carbohydrates.
3. Fats.
4. Proteins.
5. Recommended dietary allowances.
6. Nutrition during pregnancy and lactation.
7. Nutrition during infancy and childhood.
Biochemistry
1. Vitamins
2. Minerals
3. Dietary Fibers
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Community Medicine
1. Nutritional problems in Nepal.

2. Nutritional requirements and sources
3. Balanced Diet.
4. Deficiency Disorders.
5. PEM
6. Assessment of Nutritional Status of a Community
7. Practical exercise: Nutritional Status Assessment of a family (FHE)
Objectives
Physiology

1. Describe energy metabolism.
2. Describe dietary sources, significance and metabolism of carbohydrates, fats and proteins.
3. Describe basis of recommended dietary allowances.
4. Describe basis for diet recommended during pregnancy, lactation, infancy and childhood.
5. Determine resting metabolic rate.
6. Calculate the composition of a given diet.
7. Frame a diet according to given specifications.
8. Improve a poor diet.
Biochemistry

1. Describe the dietary sources and metabolism of vitamins and minerals.
2. Name the manifestations of common vitamin and mineral deficiencies.
3. Describe the biochemical basis of common tests for assessment of vitamin and mineral
nutritional status.
4. Discuss the roles of dietary fibers in health and disease.
Community Medicine

1. Describe and prioritize the nutritional problems in Nepal.
2. Describe the nutritional sources and requirements at different ages and for males and females.
3. Describe deficiency disorders.
4. Describe features of PEM.
5. Assess nutritional status of the community.
6. Prescribe a balanced diet within the socio-cultural, economic milieu for:
a. a normal adult male/female
b. a pregnant/lactating/postpartum woman
c. an under-five child
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In addition, field trips/family health exercises will be conducted by the department of Community
Medicine once a week/once in 2 weeks starting with Unit 0 and continuing throughout Phase one.
Students will be allotted 1-2 families in a nearby urban area and will visit them once a
week/once in 2 weeks.
Topics: Collect demographic data

Study:  the environment
 family environment
 family support system
 water collection/storage
 refuse/waste disposal
 customs/beliefs during pregnancy, lactation, postpartum.
 customs/practices towards elderly, disabled.
 illness behavior.
 food practices/customs/beliefs.
 beliefs about family size, son preference.
 child rearing practices.
 acute morbidity in the family.
 follow up a pregnant women.
 follow up a new born child to record growth and development.
 follow up an under five child.
 dietary history for a pregnant, lactating, postpartum woman.
 dietary history for an under five child.
 follow up elderly/disabled persons.
 follow up an adolescent.
 follow up an eligible couple and provide family planning advice.
Community intervention to be done at regular intervals. This intervention will depend ont he
problems identified.
Students will follow up and record the results of community intervention.
Objectives
1. Perform as a family physician.
Metabolism
Themes and Topics
1. Metabolism of Carbohydrates
2. Metabolism of Lipids
3. Metabolism of Amino acids
4. Metabolism of Proteins
5. Metabolism of Vitamins
6. Metabolism of Minerals
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Objectives
1. State the overall concept of metabolism and the thermodynamic reasons for the use of ATP.
Describe the process of glycolysis, glycogenolysis and gluconeogenesis and their
interaction in the regulation of blood sugar.
2. Describe the pentosephosphate pathway and the formation of reducing intermediates.
3. Recall the examples of only a few inherited disorders of carbohydrate metabolism e.g.
glycogen storage disease and glucose 6 phosphate dehydrogenase (G6PD).
4. Describe TCA cycle and biological oxidation and generation of energy.
5. Describe Lipogenesis and its control.
6. Describe Lipolysis and energy economics of fat breakdown.
7. Describe Ketogenesis and its regulation.
8. Describe the importance of catabolism of amino-nitrogen.
9. Describe the process of Transamination and the urea cycle.
10. Correlate the above information with a view to inter-relating the metabolic pathways.
Practical Skills
At the end of the course, the student should be able to perform and interpret:
1. Serum Bilirubin Estimation
2. Serum Protein Estimation
3. Serum Amylase Estimation
4. Gastric Function Test
5. Serum Alkaline Phosphatase
6. Serum AST and ALT
79
GIT, HBS, Nutrition, CLIP

Metabolism (3 hrs)
SIS LABEX
Anatomy 17 6
Physiology 11 3
Biochemistry 26 4
Pathology 16 5
Microbiology 15 3
Pharmacology 10 2
Community 2 0
Medicine &
Behavioral Sciences
Clinical Postings
(CLIP)
in groups & by
rotation in:
14
Medicine
Surgery
Paediatrics
Obst/Gynaecology
Total 97 hrs 23 x 3hrs = 69 14 x 3 = 42
hrs hrs
TIME REQUIRED (approx.)

PBL : 1 week
FHE visit : 1 visit
Assessment : 1 week
Total : 13 weeks
80
Unit - 4
1. Endocrine and Reproductive Systems
2. Kidney and Fluid Balance
3. Integumentary System
81
82
ENDOCRINOLOGY
Common Problems
1. Iodine Deficiency Disorders (Thyroid)*

2. Diabetes Mellitus*
3. Hypogonadism
*Prototypic diseases, best suited for Teaching Basic Mechanisms.
THEMES AND TOPICS
Anatomy
1. Suprarenal: Features and Vasculature

2. Thyroid and parathyroid: Location, features, relations and vasculature.
3. Pituitary and pineal: Location and vasculature.
4. Structure of Suprarenal, Thyroid, Parathyroid, Pituitary glands and analyze their integrative
and regulative functions.
5. Development of Suprarenal glands.
6. Development of thyroid, parathyroid and their congenital anomalies.
7. Development of pituitary gland.
8. Pancreas: Features, vasculature and location.
Physiology
1. Regulation and functions of endocrine glands.

2. Stress
Biochemistry
1. General mechanism of hormone action

2. Neuroendocrinal axis and feedback mechanisms
3. Thyroid
4. Parathyroid
5. Adrenal
6. Pancreas and GIT
7. Gonadal hormones
8. Metabolic Interrelationships
Pathology
1. Tumors of Pituitary gland.

2. Tumors of Adrenal gland.
3. Goiter and Thyroiditis.
4. Graves disease.
83
5. Tumors of thyroid gland.
6. MEN Syndrome.
7. Diabetes Mellitus.
Pharmacology
1. Diabetes Mellitus
2. Thyroid
3. Pituitary
4. Adrenal
Community Medicine
1. Iodine Deficiency Disorders
OBJECTIVES
Anatomy

1. Comprehend the normal disposition and interrelationships of suprarenal, thyroid, parathyroid,
pituitary and pineal glands.
2. Identify the microscopic structure of suprarenal, thyroid, parathyroid and pituitary glands and
analyze their integrative functions.
3. Understand the development of all the endocrine glands and explain the embryological basis
of congenital abnormalities.
Physiology

1. State general principles of regulation of hormone secretion.
2. List functions and regulation of secretion of hormones of the hypothalamus, pituitary, thyroid,
parathyroid, adrenal cortex, adrenal medulla and pancreas in normal and hypo and
hypersecretory states.
3. Describe physiological mechanisms for coping with stress.
Biochemistry

1. Describe the actions of hormone using a prototype protein and steroid hormone, relate them
to concepts of target organ specificity, and analyze these actions in terms of signal
transduction and cellular response.
2. (a) Describe the secretions of hypothalamus and pituitary (anterior and posterior), and
state their target glands and analyze the concept of feedback regulation.
(b) Describe the effects of the above hormones in terms of mechanism of action, sites and
effects on target tissue and analyze the effects of their hyper and hyposecretion.
84
3. Describe the steps leading to the formation of thyroid hormones and their regulation.
4. Describe the role of iodine, its nutritional requirements and its metabolism by the thyroid
gland.
5. Describe the effects of thyroid hormones on target tissue and analyze their types and
hypofunction (& hyperfunction).
6. Analyze the regulation and effects of thyroid hormones in terms of action of drugs used for
managing thyroid disorders.
7. Describe the effects of parathyroid secretions.
8. Describe (as an overview) the metabolism of cholesterol, leading to the formation of
different steroid hormones.
9. Describe the actions of glucocorticoid and mineralocorticoid.
10. Describe (as an overview) the process of synthesis and breakdown of hormones of the
adrenal medulla.
11. Describe their actions and analyze the effects of altered secretion.
12. Rationalize the use of their agonist and antagonists in therapy.
13. List pancreatic hormones and describe their actions.
14. Correlate the actions of various hormones (pancreatic or otherwise), with the regulation of
carbohydrate metabolism.
15. Analyze the effect of decreased and increased levels of the same on metabolism of
carbohydrate, lipids and proteins.
16. List the endocrine secretions of the GIT and state their action.
17. Analyze the basis of the view that the GIT has neuroendocrine components.
PRACTICAL SKILLS
1. Perform and Interpret Blood glucose estimation.
2. Perform and Interpret Oral Glucose Tolerance Test (OGTT).
3. Measure and Interpret Glycated Hemoglobin.
Pathology
1. Classify pituitary adenoma. Describe its morphology.
2. Classify adrenal tumors.
3. Describe morphology of adrenocortical tumors.
4. Mention important associated syndromes of pheochromocytoma.
5. Describe morphology of pheochromocytoma.
6. Describe etiopathogenesis and morphology of goiter and Graves disease.
7. Enlist types of throiditis.
8. Describe pathogenesis and morphology of Hashimotos thyroiditis.
9. Describe morphology of subacute granulomatous and subacute lymphocytic thyroiditis.
10. Classify tumors of thyroid: adenoma and carcinoma- follicular, papillary and medullary.
11. Describe morphology of thyroid tumors.
12. Define Diabetes Mellitus.
13. Enumerate diagnostic criteria and classify Diabetes Mellitus.
14. Describe etiopathogenesis of Type 1 and Type 2 Diabetes Mellitus.
15. Describe pathogenesis of complications of Diabetes Mellitus.
85
Pharmacology

a. Classify oral hypoglycemic agents and different preparations of insulin.
b. Categorize patients who need treatment with oral hypoglycemic agents and those who
need insulin.
c. Describe the important side effects, contraindications and drug interactions of oral
hypoglycemic agents and insulin.
d. Describe the mechanism of action of oral hypoglycemic agents and insulin and their
effect on other metabolism.
e. Recognize drugs which may affect the blood glucose level and agents that may give
false positive test for Diabetes Mellitus.
2. Thyroid
a. Classify drugs used to treat hyperthyroid and hypothyroid conditions.
b. Describe important side effects, contraindications and drug interactions in thyroid
disorders.
c. Describe the basic mechanism of action of anti-thyroid drugs and radioactive iodine.
d. Recognize drugs causing hyperthyroid or hypothyroid conditions as their side effects.
3. Pituitary
a. Describe the Pharmacological effects and indications of pituitary hormones.
5. Adrenal
a. Describe the pharmacological effects, indications, precautions and contraindications of
Adrenocorticoids.
Community Medicine

1. Describe the magnitude of problem of IDD in Nepal.
2. Describe the steps involved in Community assessment of Iodine Deficiency Disorder (IDD).
3. Describe measures to control IDD and the importance of Salt fortification and iodine
ingestion.
86
REPRODUCTIVE SYSTEM
Common Problems
Female:
1. Pregnancy, Normal and Abnormal
2. Lactation
3. Postpartum Haemorrhage (PPH)
4. Pelvic inflammatory Diseases (PID)
5. Sexually Transmitted Diseases (STD)
6. Acquired Immuno Deficiency Syndrome (AIDS)
7. Dysfunctional Uterine Bleeding
8. Cancer Cervix*
9. Breast Lump*
10. Infertility
Male:
1. Infertility
2. STD. AIDS
3. Hydrocele
4. Hypogonadism*
*Prototypic diseases, best suited for teaching basic mechanisms.
Anatomy
1. Skeletal pelvis: features, sex differences, various diameters and types of pelvis.
2. Female reproductive organs: Uterus, Perinium, Oviduct and Ovary.
3. Male reproductive organs: Testes, Vas deferens and Prostate.
4. Male and female external genitalia.
5. Breast: Morphology, structure, lymphatic drainage and age changes.
6. Microanatomy of ovary, oviduct, uterus, vagina and breast.
7. Microanatomy of Testes, Vas deferens and prostate.
8. Development of female genital system and its abnormalities.
9. Development of male genital system and its anomalies.
10. Development of breast.
Physiology
1. Physiology of male reproductive System

2. Reproductive Physiology of the non-pregnant female
3. Reproductive physiology of the pregnant female
Biochemistry
1. Role of Hypothalamic Pituitary axis in the reproductive cycle

2. Sex steroids, their regulation and functions
87
3. Biochemical changes in pregnancy
4. Endocrinological basis of contraception
5. Prenatal and antenatal diagnosis
Pathology
1. Breast
2. Female reproductive tract
3. Male reproductive tract
Microbiology
1. Intra-uterine infections
2. Infertility
3. Vaginal Discharge
4. STD and AIDS
Pharmacology
1. Hormonal contraceptives
2. Drugs affecting uterine musculature
3. Drugs in breast milk
4. Impotence and infertility
5. Sexually transmitted diseases
Community Medicine
1. Maternal and Child Health: Magnitude of the Problem

2. Maternal morbidity, mortality, under five morbidity and mortality.
3. Breast feeding/weaning
4. Family Planning Methods
Behavioral Sciences
1. Sexual Behavior
Objectives
Anatomy

1. Identify the types of pelvis and their significance in labor.
2. Comprehend the normal disposition, interrelationships and functional anatomy of male and
female reproductive organs.
3. Identify the microscopic structure of male and female reproductive organs and note the age
changes.
88
4. Explain the development of male and female reproductive organs and comprehend the
developmental basis of the various congenital abnormalities.
Physiology

1. Mention functions of testes and their regulation.
2. List functions of seminal vesicles and prostate.
3. Mention constituents of semen.
4. Describe physiology of ejaculation.
5. List changes in Ovary, Uterus and Hypothalamic, Pituitary and Ovarian hormones during
menstrual cycle.
6. List regulation of ovarian function, physiology and detection of ovulation, physiology of
coitus, physiology of fertilization, and physiology of implantation. Physiological changes
during pregnancy, physiology of menopause.
7. Describe physiological basis of contraception in males and females.
At the end of the course, the student should be able to perform/determine/interpret:

2. Vaginal smears.
3. Pregnancy tests.
4. Semen examination.
Biochemistry

1. Describe the regulation and actions of FSH and LH in male and female.
2. Describe the pathways involved in the synthesis of sex steroids (M & F) and analyze their
regulation.
3. Describe the endocrinological alterations during the menstrual cycle and analyze its
regulation.
4. Describe the endocrinological changes in pregnancy and correlate them with the progress
of pregnancy.
5. Rationalize the endocrinological interventions during pregnancy and contraception.
Pathology

1. Enumerate causes of breast lump.
2. Describe gross and microscopic features of mastitis and breast abscess.
3. Describe gross and microscopic features of fibrocystic changes and fibroadenoma of breast.
4. Classify carcinoma of breast.
5. Describe gross and microscopic features of carcinoma breast.
6. Enlist causes and describe pathological changes in endometrium namely endometritis and
endometrial carcinoma.
7. Define endometriosis and discuss the mechanism of theories underlying it.
8. Describe gross and microscopic features of leiomyoma uterus.
89
9. Describe gross and microscopic features of chronic cervicitis.
10. Discuss precancerous lesions of cervix.
11. Describe etiopathogenesis, gross, microscopic features and cytological diagnosis of
carcinoma cervix.
12. Enlist gestational trophoblastic diseases.
13. Enlist types of Hydatidiform Mole. Mention its pathogenesis and describe the morphology.
14. Discuss the morphology of Choriocarcinoma.
15. Classify ovarian tumors.
16. Describe gross and microscopic features of important benign and malignant tumors of the
ovary namely serous and mucinous tumors, teratoma, dysgerminoma and Krukenberg
tumor.
17. Enumerate the inflammatory lesions of testis and epididymis.
18. Discuss the causes and morphology of torsion of testis.
19. Enlist the causes of testicular atrophy and describe its morphology.
20. Classify testicular tumors.
21. Discuss etiopathogenesis of Germ cell tumor of testis.
22. Describe morphology of seminoma.
23. Discuss the pathogenesis of nodular hyperplasia of prostate.
24. Describe morphology of nodular hyperplasia and adenocarcinoma of prostate.
25. Mention clinical course of adenocarcinoma of prostate.
26. Discuss gross and microscopic features of precancerous lesions and carcinoma of penis.
Microbiology

1. List the organisms causing intrauterine infections including leading to Intrauterine Growth
Retardation (IUGR).
2. Enumerate the pathogenic bacteria that can contribute to development of infertility in women.
3. Explain why mumps may be followed by infertility in male.
4. Plan investigations for infertility and interpret the results obtained.
5. List the pathogenic organisms implicated in pelvic-Inflammatory Diseases (PID).
6. Prepare and examine smears for Candida albicans, Trichomonas and Gonococcus.
7. Define Sexually Transmitted Diseases (STD)
8. List common pathogenic organisms.
9. Plan investigation of a patient with genital ulcer.
10. Plan investigations of a patient with discharge.
11. Interpret serological tests for HIV infection.
12. Discuss Universal Precautions.
13. Explain the reasons for increased susceptibility of AIDS patients to opportunistic infections.
Pharmacology

1. Describe actions of male and female sex hormones.
2. Describe mechanism of action of oral contraceptive agents.
3. Enumerate the drugs that can cause uterine muscle relaxation or contraction.
90
4. Describe their use for termination of pregnancy or in threatened abortion.
5. Enumerate drugs that are secreted significantly in the breast milk.
6. Enumerate drugs that may cause impotence and infertility.
7. Describe drugs used in sexually transmitted diseases.
Community Medicine

1. State the magnitude of the problems associated with maternal and child health in Nepal.
2. Advise a mother on the importance of breast feeding & weaning at appropriate time and
addition of weaning foods.
3. Advise a couple on spacing & family planning methods.
Behavioral Sciences

1. State abnormal sexual behavior and its causes.
KIDNEYS AND FLUID BALANCE

Common Problems
1. Nephrotic syndrome*
2. Glomerulonephritis*
3. Renal failure*
4. Urinary tract infections
5. Urinary tract calculi
6. Hematuria
*Prototypic diseases, best suited for teaching basic mechanisms.
Themes and Topics
Anatomy
Gross and microscopic structure and development of:

1. Kidney (Gross and Microscopic Structure)
2. Ureter (Gross and Microscopic Structure)
3. Bladder (Gross and Microscopic Structure)
4. urethra (Gross and Microscopic Structure)
Radiology
1. Radiological anatomy of kidneys, ureters and urinary bladder.
91
Physiology
2. Functions of kidney, ureter, bladder & urethra.

3. Formation and composition of urine.
4. Physiology of micturation
5. Water, Electrolyte and Acid base Balance.
Biochemistry
1. Renal Function Tests

2. Fluid, electrolyte and acid-base balance
Pathology
1. Glomerulonephritis.
2. Glomerular syndrome.
3. Tubulo-interstitial diseases.
4. Nephrosclerosis.
5. Nephrolithiasis and obstructive uropathy.
6. Tumors of kidney and urinary bladder.
Microbiology
1. Renal tuberculosis
2. Urinary tract infections
3. Urinary examination
Pharmacology
1. Diuretics and anti-diuretics

2. Drug treatment of urinary tract infections
3. Nephrotoxic drugs
Forensic Medicine
1. Medico-legal aspect of renal transplantation
Objectives
Anatomy

1. Comprehend the normal disposition, relation and blood supply of the Kidney, ureter and
urinary bladder.
2. Identify the microscopic structure of the kidney, ureter and urinary bladder and correlate
structure with functions.
92
3. Explain the sequential development of the kidney, ureter and urinary bladder and give the
developmental basis of the major variations and abnormalities.
Physiology

1. State functions of different parts of the nephron, acidification of urine, concentration/dilution
of urine, role of kidney in fluid and electrolyte balance and physiology of micturition.
2. Describe renin-angiotensin system.

1. Clearance tests. Dilution/concentration tests.
Biochemistry
Renal Function Tests
1. Describe the components of normal urine.

2. Correlate the alterations in renal function with abnormal composition of urine.
3. Describe the basis of alteration in blood chemistry with impaired renal function.
4. Describe the concept of clearance and correlate clearance of different substances with
different functions of the kidney.
5. Perform urine analysis for normal and abnormal constituents.
6. Interpret alterations in composition of urine, blood and creatinine clearance tests to obtain
an indication of renal function.
7. Describe the composition of renal stone.
Electrolytes
1. Explain the concept of buffers.

2. List different blood buffers.
3. Explain the role of Lungs and Kidney in monitoring blood pH.
4. Interpret blood picture to obtain the nature and extent of acidosis and alkalosis.
Practical Skills
At the end of the course the student should be able to perform and interpret
1. Estimation of Blood Urea
2. Serum Bicarbonate Estimation
3. Abnormal Constituent of Urine
4. Serum Creatinine Estimation and Clearance
5. Analysis of Sodium / Potassium (Demonstration)
93
Pathology

1. Mention common terminologies used in glomerulonephritis.
2. Enlist glomerular syndrome. Describe diagnostic features and morphologic correlate of
glomerular syndrome.
3. Explain the etiopathogenesis and describe morphology of acute post streptococcal
glomerulonephritis.
4. Describe the microscopic features of acute and chronic glomerulonephritis.
5. Describe morphology of cresentic and membranous glomerulonephritis.
6. List systemic diseases causing glomerulonephritis.
7. Discuss the pathogenesis and morphology of tubulointerstitial diseases.
8. Discuss in detail about chronic pyelonephritis.
9. Mention the types of renal calculus. Describe morphology of various types of renal
calculus.
10. Enumerate common causes of obstructive uropathy and describe its morphology.
11. Describe gross and microscopic features of benign and malignant nephrosclerosis.
12. Enumerate common kidney tumors.
13. Discuss epidemiology of renal cell carcinoma.
14. Identify gross and microscopic features of renal cell carcinoma.
15. Classify urothelial tumors.
16. Describe etiopathogenesis and morphology of papillary urothelial carcinoma.
Microbiology

1. List the commensals of external urethra.
2. Enumerate the common causative agents of Urinary Tract Infection.
3. Explain the significance of concepts of bacteriuria in the community as well as hospital
acquired infections.
4. Discuss the consequence of group A streptococcus infection on the kidney.
5. Plan investigations of a patient suspected to have renal tuberculosis
Pharmacology

1. Classify diuretic agents according to their mechanism of action, and efficacy.
2. Describe indications, side effects of important drugs acting on the kidney.
3. Enumerate nephrotoxic drugs.
4. Describe therapeutic principles of drugs used in urinary tract infection.
Forensic Medicine

1. Describe the medico-legal aspects of organ transplantation.
94
INTEGUMENTARY SYSTEM
Common Problems
1. Scabies
2. Leprosy
3. Burns
4. Dermatitis
5. Skin malignancy
Themes and Topics
Anatomy
1. Structure of skin and appendages.
Physiology
1. Function of skin. Sweat and its composition.
Biochemistry
1. Electrolyte balance in relation to burns.
Pathology
1. Leprosy.
2. Tumors of skin.
Microbiology
1. Bacterial, Fungal, and Parasitic infections of skin staphylococci
Pharmacology
1. Anti-leprosy drugs
2. Drug treatment of scabies
3. Coetaneous drug reactions
Community medicine
1. Water related skin problems in Nepal (Scabies, pediculosis and other ecto-parasites)
Forensic Medicine
1. Medico-legal aspects of burns

95
Objectives
Anatomy

1. Identify the microscopic structure of the skin and its appendages.
2. Explain the development of various appendages of the skin.
Physiology

1. State the role of skin in temperature regulation as well as other functions of skin.
Biochemistry
1. Describe the changes in electrolytes in relation to burn.
Pathology

1. Classify Leprosy.
2. Describe microscopic features of tuberculoid and lepromatous leprosy.
3. Discuss the concept of tuberculoid and lepromatous leprosy.
4. Classify skin tumors.
5. Describe the morphology of benign and malignant skin tumors.
Microbiology

1. List pyogenic bacteria.
2. Enumerate the difference between staphylococcus and streptococcus infections.
3. Collect appropriate sample, stain and examine skin scrapping for presence of myco-bacterium
Lepra.
4. Collect skin scrapping, prepare KoH slides and examine for presence of fungal elements.
Forensic medicine

1. Differentiate between ante-mortem and post-mortem burns.
2. Medico-legal aspect of burns scalds.
Pharmacology

1. Enumerate the anti-leprosy drugs.
2. Describe their mechanism of action and side effects.
3. Enumerate drugs used to treat scabies.
96
Community Medicine

1. List socioeconomic causes of transmission and perpetuation of scabies.
2. Describe community treatment of scabies.
Forensic Medicine

1. Differentiate between antemortem and postmortem burns.
2. Describe medico-legal aspects of burns and scalds.
97
Endocrinology & Kidney and Fluid Integumentary CLIP

Reproductive System Balance (3 Hrs)
SIS LABEX SIS LABEX SIS LABEX
Anatomy 14 5 4 2 1 1
Physiology 20 1 9 0 0 0
Biochemistry 11 2 2 4 0 0
Pathology 13 6 9 4 2 0
Microbiology 4 1 2 1 5 2
Pharmacology 14 3 3 1 2 1
Forensic Medicine 0 0 2
Community 1 0 1
Medicine &
Behavioral
Sciences
Psychiatry 1
Clinical Postings
(CLIP)
in groups & by
rotation in:
Medicine 4
Surgery
Paediatrics
Obst/Gynaecology
TOTAL 77 hrs 18 x 3 hrs 29 hrs 12 x 3 hrs 14 4 x 3 hrs 4 x 3=
= 54 hrs = hrs = 12 hrs 12 hrs
36 hrs
TIME REQUIRED (APPROX.)

PBL : 2 weeks
Assessment : 1 week
Total : 13 weeks
98
Unit 5
1. Musculoskeletal System
2. Nervous System and Special Senses
99
100
MUSCULOSKELETAL SYSTEM
Common Problems
1. Injuries
2. Arthritis
3. Osteomyelitis*
4. Tetanus
5. Myasthenia Gravis*
6. Gout
7. Parathyroid
* Prototypic diseases, best suited for teaching basic mechanisms.
Themes and Topics
Anatomy
1. Ossification
2. Scalp
3. Intervertebral joints
4. Muscles of the back
5. Muscles of facial expression
6. Skull
7. Structure of skeletal muscle and neuromuscular junction
8. Cervical fascia, triangles of the neck and muscles of the neck
Physiology
1. Neuromuscular transmission, muscle contraction,

2. Physiology of smooth muscle
3. Degeneration and regeneration of nerves
4. Work physiology
Biochemistry
1. Calcium, Phosphorus and Vitamin D metabolism in relation with the skeleton.

2. Uric acid formation and excretion.
Pathology
1. Infections and Degenerative disorders of bone and joints.

2. Metabolic disorders of bone.
3. Fracture healing.
4. Tumors and tumor-like lesions of bone.
5. Neuromuscular and motor unit disorders
101
Microbiology
1. Micro-organisms affecting bones, joints and nerves.

2. Tetanus and other clostridia
3. Strongyloides
Pharmacology
1. Analgesic, Anti-inflammatory agents

2. Antibiotics in reference to bones
3. Cholinergic drugs for Myasthenia gravis
4. Treatment of tetanus
5. Muscle relaxants
6. Gout
Forensic Medicine
1. Medico-legal aspects of injury and workman compensation act.
Community Medicine
1. Need for Rehabilitation, Types of impairment, Disability/ Handicap

2. Assessment of Post-polio residual paralysis(PPRP), Rehabilitation at individual level,
Community based rehabilitation
3. Practical exercise: PPRP assessment, Presentation
Objectives
Anatomy
1. Identify the bones and their disposition in the body.
2. Identify various muscle groups and demonstrate their actions.
3. Differentiate between structure of a bone and cartilage.
4. Identify the structure and connections of the Spinal Cord.
Physiology

1. List types of muscle tissue.
2. Identify mechanical properties of skeletal muscle.
3. Describe electrophysiology of skeletal muscle and molecular basis of muscle contraction.
4. Describe neuromuscular transmission, oxygen debt and mechanical efficiency.
5. Describe mechanical and electrical properties of smooth muscle and mechanism of
contraction of smooth muscle.
6. Describe response of nerve and muscle to injury.
7. List elements of kinesiology.
8. Describe physiology of bone.
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At the end of the course, the student should be able to perform/determine/interpret.
Simple muscle twitch. Stimulus - Response relationship in skeletal muscle. Effect of
temperature on muscle contraction. Fatigue in skeletal muscle. Effect of two successive
stimuli. Genesis of tetanus. Effect of after load and freeload on muscle contraction.
Velocity of conduction in motor nerve. Experiments on human fatigue. Mechanical
efficiency.
Biochemistry
At the end of the course, the student should be able to

1. Describe the structure of collagen and correlate it with its functional properties.
2. Correlate the structure - function relationship of muscle proteins with muscle contraction.
3. Describe the biochemical basis of gout.
Pathology

1. Explain the etiopathogenesis and complications of pyogenic and tuberculous osteomyelitis.
2. List the common arthritic disorders.
3. State the types along with gross and microscopic features of Osteoarthritis.
4. Define rheumatoid arthritis. Describe its pathogenesis, gross and microscopic features.
5. Mention types of infectious arthritis.
6. Classify gout. State the pathogenesis, gross and microscopic features of gouty arthritis.
7. List the common metabolic bone disorders.
8. Discuss pathophysiology and morphology of osteoporosis.
9. Discuss in brief rickets, osteomalacia, hyperparathyroidism and renal osteodystrophhy.
10. Describe the sequence of events in fracture healing.
11. List complications of fracture healing.
12. Classify bone tumors.
13. Discuss in brief about important benign and malignant bone tumors namely osteoid
osteoma, osteoblastoma, enchondrom, osteosarcoma, chondrosarcoma, giant cell tumor and
Ewings sarcoma.
14. List types of muscular dystrophy.
15. Explain the etiopathogenesis and morphology of Duchenne Muscular Dystrophy.
16. List neuromuscular junction disorders.
17. Explain the pathogenesis, morphology and clinical course of Myasthenia Gravis.
Microbiology

Acute osteomyelitis:
1. List common pathogens associated with acute osteomyelitis.
2. Plan microbiological investigations to isolate and identify the pathogen.
Chronic osteomyelitis:
1. List common pathogens associated with chronic osteomyelitis.
2. Plan microbiological investigations to isolate and identify the pathogen.
103
Arthritis:
1. List common pathogens associated with arthritis.
2. Plan microbiological investigations to isolate and identify pathogens.
Pharmacology
At the end of the study the student should be able to:

1. Classify narcotic and non-narcotic analgesic drugs.
2. Classify non steroidal anti-inflammatory agents.
3. Classify steroidal agents.
4. Enumerate side effects of NSAIDs and steroids.
5. List different cholinergic drugs and describe their mechanism of action in myasthenia gravis.
6. Name antibiotics useful in bone and joint infections.
a. Describe uricosuric drugs used in gout.
b. Enumerate important drugs that may precipitate gout.
7. Parathyroid
State the role of parathyroid hormone, calcitonin and vitamin D in the Calcium homeostasis.
Forensic Medicine
1. Define injury and its types based on severity of injury.

2. Apply the workmen compensation act in relation to damages claimed in injuries.
Community Medicine
1. Define and describe different grades of disability, handicap and impairment.

2. Conduct a community assessment of post polio residual paralysis.
3. Advise rehabilitation at individual and community levels.
NERVOUS SYSTEM
Common Problems
1. Headache
2. Addiction
3. Meningoencephalitis
4. Epilepsy
5. Poliomyelitis
6. Parkinson's Disease*
7. Cerebro Vascular accidents
8. Anxiety/Depression disorder
*A prototypic disease, best suited for teaching basic mechanisms.
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Themes and Topics
Anatomy
1. Spinal Nerves/Spinal cord, brain stem

Meninges
CSF
Brain - Cerebellum/Thalamus/hypothalamus
2. Cerebrum/Ventricles, Basal nuclei, Internal capsule, extra pyramidal system, reticular
formation/Blood Supply
Cranial Nerves
Motor and Sensory Tracts
Autonomic Nervous System
Physiology
1. Neural organization
2. Motor and Sensory System
3. CSF (Cerebrospinal Fluid)
4. Autonomic Nervous System
5. Reflexes
6. Synaptic Transmission
7. Sleep & EEG
8. Higher Neural Functions
Biochemistry
1. CSF Chemistry
2. Synthesis and breakdown of neurotransmitters
3. Biochemical basis of neurological diseases
Pathology
1. Inflammatory diseases.
2. Cerebrovascular accident.
3. Cerebrovascular diseases.
4. Intracranial hemorrhage.
5. Demyelinating and degenerative disorders.
6. Malignancies.
Microbiology
1. Microorganisms responsible for meningitis

2. Poliomyelitis, Encephalitis. Slow virus.
105
Pharmacology
Drugs for a. Convulsive disorders

b. Narcotics and non narcotics
c. Movement disorders including Parkinson's Disease
Anti-anxiety and anti-depressant drugs

General and Local Anaesthetic agents
Forensic Medicine
1. Brain death
Community Medicine
1. Epidemiology of virus related CNS diseases (Poliomyelitis, Rabies)
Behavioral Sciences
1. Normal and abnormal behaviors

2. Cognition
3. Learning & memory
4. Intelligence
5. Emotions
6. Motivation
7. Psychosocial changes from birth to adolescence
8. Implication of behavior in illness
Radiology
1. CT scan of the head

2. MRI of the spine
Objectives
Anatomy

1. Comprehend the basic structure and connections of the central nervous system.
2. Trace the course and distribution of cranial and spinal nerves.
3. Locate the site of gross lesions according to the neurological deficit encountered.
Physiology

1. Mention the functional organization of the nervous system.
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2. Describe mechanism of synaptic transmission.
3. Describe formation, absorption and functions of CSF.
4. Describe blood brain barrier.
5. Describe physiology of receptors. Mechanism of sensory perception.
6. Describe motor mechanisms at the periphery and in CNS.
7. Describe physiology of sleep.
8. Describe basis of EEG.
9. Describe physiology of limbic system.
10. Describe physiology of speech and other higher functions.
11. Describe autonomic nervous system and its functions.

1. perform/determine/interpret:
2. EEG. Reflex and Reaction time.
Biochemistry
At the end of the course, the student should ba able to:

1. Enumerate the basic steps in the synthesis and breakdown of various neurotransmitters.
2. Describe the process of neurotransmitter receptor interaction and signal transduction.
3. Describe the composition of CSF (Biochemical and cellular and interpret its alterations in
disease.
Practical Skills
At the end of the unit the students should be able to perform and interpret
1. CSF analysis with respect to sugar and protein.
Pathology

1. Describe the etiopathogenesis and microscopic features of acute meningitis (Bacterial,
Viral, Tubercular)
2. Interpret the biochemical and cellular changes in CSF with special reference to meningitis.
3. Enlist predisposing factors leading to brain abscess. Describe morphology of brain abscess.
4. List the etiology and consequences of cerebrovascular accident.
5. Describe morphology of epidural and subdural hematoma.
6. Describe morphology of global cerebral ischemia.
7. Describe pathogenesis and morphology of subarachnoid hemorrhage and ruptured saccular
aneurysm.
8. Enlist demyelinating and degenerative diseases of central nervous system.
9. Discuss pathogenesis and morphology of Multiple sclerosis, Alzheimer disease and
Parkinson disease.
10. Classify brain tumors.
11. Describe morphology of astrocytoma, medulloblastoma, meningioma and and benign nerve
sheath tumor.
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Microbiology

Encephalitis
1. Identify types of mosquitoes and list the viruses that they transmit.
2. Plan diagnostic tests.
3. Discuss the usefulness and availability of vaccines.
Acute Meningitis
1. Enumerate at least three bacteria responsible for causing acute pyogenic meningitis.
2. Prepare, stain and examine relevant smears for presence of pathogenic organisms.
3. Transport the sample and explain the reason for refrigeration, Evaluate the diagnostic efficacy
of rapid tests.
Chronic Meningitis
1. Enumerate at least two pathogenic organisms responsible for chronic meningitis and select
appropriate diagnostic tests for determining the etiology.
Poliomyelitis
1. Prepare a plan for diagnosis of the condition in the acute phase, List the susceptibility of the
virus to different chemical disinfectants.
2. Tabulate the differences between wild and vaccine strain of the virus.
Rabies
1. Recall the structure and susceptibility of the virus to various chemicals, Explain the natural
history, Evaluate the protective efficacy and types of vaccines available.
Gas gangrene
1. Plan investigations of a suspected case of gas gangrene.
2. Collect appropriate sample, prepare smear, stain and examine aspirate for the pathogen,
Suggest methods to limit the spread of infection in the ward/operation theater.
Tetanus
1. Plan investigations; suggest methods to limit the spread of infection in the ward/operation theater.
2. Evaluate the protection role of ATS and tetanus toxoid.
Pharmacology
At the end of the unit study, the student should be able to:
1. Classify drugs used to differentiate different types of convulsive disorders.
2. Describe the mechanism of action, side effects and important drug interactions of antiepileptic drugs.
3. Choose appropriate antiepileptic drugs for children and pregnant mothers.
4. Classify, and list, on the basis of mechanism of actions, the drugs used in Parkinson's disease
and other movement disorders.
5. Describe the side effects, rationale of drug combination of anti-Parkinson's drugs.
6. Enumerate the anxiolytic drugs and describe their side effects.
7. Suggest appropriate anxiolytic agent for different anxiety and anxiety disorders.
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8. Classify, according to the mechanism of action and effectiveness, the drugs used in
depression.
9. Describe drugs that have abuse potential and addiction abilities.
Forensic Medicine

1. State the criteria of brain death.
2. Discuss medico-legal aspects of brain death.
3. Explain the importance of brain death in organ transplantation.
Community Medicine

1. Understand the importance of neuro-epidemiology and role of virus in disease causation
Behavioral Sciences

1. Analyze the relationship between brain and human behavior.
2. Define cognition and differentiate between cognitive processes - sensation, attention,
perception, thinking concept formation and problems solving.
3. State factors that facilitate attention and concentration.
4. Identify the effects of sickness on attention and concentration.
5. Demonstrate perception of pain.
6. Illustrate the process of short term memory (STM) and long term memory (LTM)
7. Identify memory functioning during sickness.
8. List causes of forgetting.
9. Suggest methods to improve memory
10. State nature of intelligence.
11. Define learning and differentiate it from performance and maturation.
12. Describe types of learning.
13. Examine the role of conditioning in adaptive and maladaptive behaviors.
14. Indicate importance of cognitive learning methods.
15. Suggest methods to improve studying skills.
16. Define motivation, need and drive.
17. Discriminate between biological and social motives.
18. Suggest methods to increase self-motivation.
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SPECIAL SENSORY SYSTEM
Common Problems
a. Deafness*
b. Eye infection - Trachoma
c. Cataract
d. Blindness (Incurable)
e. Sinusitis
g. Cavernous sinus Thrombosis
*A prototypic disease, best suited for teaching basic mechanisms.
Themes and Topics
Anatomy
1. Ear
2. Vestibulocochlear apparatus
3. Eye ball, muscles and movements
4. Orbit and Lacrimal apparatus
5. II, III, IV and VI Cranial Nerves
6. Paranasal Sinuses
7. Visual Pathways
Physiology
1. Optics of vision
2. Aqueous humor
3. Retinal function
4. Color vision
5. Optic pathways
6. Central Mechanisms of vision
7. External and Middle ear
8. Inner ear Mechanisms
9. Auditory pathways
10. Central Mechanisms of hearing
11. Vestibular apparatus
12. Taste
13. Smell
Biochemistry
1. Ocular biochemistry
2. Biochemical basis of cataract
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Pathology
1. Inflammatory conditions of ears

2. Tumors of eye and orbit
Microbiology
1. Trachoma
2. Conjunctivitis and other
Pharmacology
1. Miotic and Mydriatic drugs

2. Drugs affecting Intraocular Pressure
Objectives
Anatomy

a. Identify the structure of middle and internal ear.
b. Identify the structure of eye ball.
c. Trace the course and distribution of cranial nerves in the orbit.
d. Comprehend the normal disposition and functions of para-nasal sinuses.
Physiology

1. State optics of vision.
2. Describe retinal mechanisms.
3. Describe formation and absorption of aqueous humor.
4. Describe mechanisms of accommodation, dark adaptation and color vision.
5. Describe optic pathway and central mechanisms of vision.
6. List functions of external, middle and inner ear.
7. State auditory pathway and central mechanisms of hearing.
8. List functions of vestibular system.
9. Describe mechanism of detection and perception of taste and smell.

1. Acuity of vision.
2. Perimetry.
3. Color vision.
4. Size of blind spot.
5. Tuning fork tests.
6. Audiometry.
7. Tests on taste and smell.
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Biochemistry

1. Describe the biochemical changes associated with the visual process.
2. Describe the biochemical changes in the lens associated with cataract.
Pathology

1. Describe the morphology of acute and chronic otitis media.
2. List common tumors of the eye and orbit.
3. List the causes and describe morphology of sebaceous carcinoma, malignant melanoma and
retinoblastoma.
Microbiology
At the end of course, the student should be able to:

1. Enumerate the causative agents of infectious red eye.
2. Plan investigations of a case of trachoma.
3. Plan investigations of a case of corneal ulcer.
4. List the causative agents of Acute and Chronic Suppurative Otitis Media.
5. Enumerate the causative agents of sinusitis.
6. Plan investigations of a case of Otitis media.
Pharmacology
1. Enumerate important miotic and mydriatic agents and explain their mechanism of action,
indications, side effects and contraindications.
2. Describe the drugs that are used to reduce intraocular pressure and their mechanism.
3. Enumerate the drugs that have ocular side effects.
4. Enumerate the drugs that have Ototoxicity.
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Musculoskeletal Central Nervous Special Sensory CLIP

System System System (3 hrs)
SIS LABEX SIS LABEX SIS LABEX
Anatomy 12 11 15 9 16 3
Physiology 5 3 22 2 10 3
Biochemistry 2 0 4 0 2 0
Pathology 5 1 4 2 1 0
Microbiology 5 1 5 1 2 0
Pharmacology 9 2 16 7 2 1
Forensic Medicine 0 1 0 0
Community Medicine 1 0 0 1
& Behavioral
Sciences
Psychiatry 7 1
Clinical Postings
(CLIP)
in groups & by
rotation in:
Medicine 20
Surgery
Paediatrics
Obst/Gynae
TOTAL 39 18 x 74 hrs 22 x 34 hrs 7 hrs x 3 20 x 3
hrs 3hrs = 3hrs = = 21hrs = 60
54 hrs 66 hrs hrs
TIME REQUIRED (APPROX.)

PBL : 2 weeks
Assessment : 1 week
Total : 13 weeks
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Unit 6
MULTI SYSTEM SEMINARS

There are many conditions in Medicine which involve multiple organ systems.
The students, for this part of the course, would demonstrate their ability to organize, synthesize and
integrate information acquired during the organ system units by delivering seminars on some topics
which cut across organ systems and disciplines. A few examples of such topics are given below:
1. Fluid & Electrolyte balance 2. Oedema

3. Shock 4. Autoimmune diseases,
5. Transplantation 6. Inflammation & cell injury
7. Cytokines 8. Prostaglandins
9. Neoplasia 10. Connective tissue diseases
11. Tuberculosis 12. Kala-a-zar
13. STD 14. Atherosclerosis
15. Diabetes 16. Inflammatory Bowel Diseases
17. Immuno compromised Host 18. HIV/AIDS
19. Malaria 20. Enteric Fever
21. RHD 22. Renal Failure
23. Hepatic Failure 24. Mode of action of drugs
25. Hypertension 26. Exercise Physiology
27. Sports medicine 28. High attitude medicine
29. Diarrhea 30. Substance abuse
31. Acute respiratory infections 32. Amoebiasis
33. Leprosy 34. Nosocomial infections
As an example, the objectives of the seminar on Atherosclerosis are given below:
During this seminar the student will be able to:

1. Define Atherosclerosis
2. Describe normal structure of artery and aorta
3. Explain the role of lipids in the development of Atherosclerosis
4. Explain the pathogenesis
5. Enumerate atheromatous lesions and complications that might result
6. Describe the effects on brain, heart, kidney, peripheral and, large arteries.
7. Describe the role of psychophysiological factors that contribute to its development.
8. Describe aneurysms of aorta and list differential diagnosis of aneurysm.
9. Explain its epidemiology.
10. Suggest strategies for its prevention.
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Organization of Seminars
The following guidelines may be useful in organizing the seminar:

1. Divide each seminar into three sub-topics.
2. Allot each subtopic to one student.
3. The student should be asked to prepare a 15-20 minute presentation on the allotted subtopic.
4. One seminar may be held every day at 8am.
5. In a batch of 30 students, all students would have spoken by the time ten seminars are over.
Then they can start all over again by rotation.
6. The allotment of topic for the first seminar may be done by draw of lots. The subsequent
seminar allotted to a student would depend on the first topic so that an appropriate gap can be
maintained for each student.
7. For each seminar there will be a coordinating department from which one member would
moderate the seminar. However, faculty members of all other departments would be available
to guide the speakers, if required.
8. At the end of the unit, a written assessment would be held, which would contribute to the
internal assessment.
9. The students may be asked to submit an essay or at least one of the topics on which they
speak. The essays should be assessed and some prize/recognition may be given for a few
commendable efforts.
LEARNING RESOURCES (Time)
Seminars : 5 weeks
Assessment : 1 week
TOTAL : 6 weeks (approx.)
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CLINICAL POSTING
The students will be posted to the clinical departments most relevant to the on-going system during
phase one. The posting will be for one or two days per week, and will be of two hours duration on
each day. The broad goals of the posting will be as follows:
a. During Unit 0 : to familiarize the students with case taking.

b. During Units 1-4 : to continue the process initiated in Unit 0 and to provide some clinical
experience relevant to the on-going system in order to facilitate the understanding of basic
mechanisms.
Objectives
At the end of the first phase of the MBBS course, students should be able to:
1. State the importance and need for history taking.
2. Develop elementary skill in history taking.
3. Demonstrate the techniques of a systematic physical examination.
4. Correlate structure and function of organ-systems with clinical manifestations.
5. Integrate clinical and community medicine.
6. Perform cardiopulmonary resuscitation.
7. Draw blood (venous sample & capillary blood) from one another.
8. Perform routine blood examination.
9. Perform routine urine examination.
10. Identify normal structures in x-ray chest, coronary angiogram, ultrasound of liver and gall
bladder, mesenteric and coeliac angiogram, barium meal and barium enema, kidney and
urinary bladder, CT scan of Head and MRI of spines.
11. Interpret major biochemical tests on blood, urine and CSF.
Themes and Topics
General History of Present Illness
a. Age, address and occupation

b. Presenting symptoms in chronological order
c. History of present illness from the starting, duration, mode of onset, aggravating or
relieving factors, association with other symptoms and with drugs if already taken.
d. History of past illness.
e. Family history including diabetes mellitus, hypertension, heart diseases and tuberculosis.
f. Details of marriage, family structure, diet, smoking habit, alcohol intake, substance abuse,
housing and environmental surroundings.
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General Examination
Complexion, nutritional state, state of hydration, temperature, pulse, blood pressure, respiration,
shape of head, face, hair, eyes, eyelids, xanthelasma, conjunctivae, pallor, icterus, gums, tongue,
pigmentation; swelling at different places, neck, jugular venous pressure, lymph nodes, hand,
fingers, nails, feet.
History taking for Respiratory System
1. Cough: nature, dry or productive, relation with chest pain

2. Sputum: amount, color, containing blood and relation with posture
3. Shortness of breath: duration, mode of presentation, with rest or exertion, associated
symptoms (like chest pain, palpitations) and relieving factors
4. Wheezing: sometime, all the time, relation to weather
5. Chest pain: site, relation with deep inspiration, coughing and rest
6. Coughing of blood: duration, quantity, episode in the past.
Systemic Examination of the Respiratory System
1. Inspection: chest shape, size, symmetry, flaring of ribs, types of breathing, intercostal
indrawing, superficial veins, paradoxical respiration
2. Palpation: trachea, lymphnodes, apex beat, vocal fremitus, chest expansion
3. Precussion: cardiac outline and liver dullness and areas of resonance and dullness.
4. Auscultation: vesicular and bronchial breath sounds, crackles & wheeze,pleural rub,
whispering pectorilique, vocal resonance
History Taking for Cardiovascular System
1. shortness of breath: relevant factors like rest or exertion.

2. chest pain: site and factors which aggravate or relieve
3. palpitation: mode of onset; onset at rest or on exertion, duration and nature of heart beats,
regular or irregular
4. swelling
Systemic Examination of Cardiovascular System
1. Inspection: jugular venous pressure, apical impulse, swelling of neck, and upper extremities
2. Palpation: pulse rate, rhythm, volume and character, compare radial with femoral pulse, sacral
and ankle oedema, apex beat, sternal heave, thrill, femoral, popliteal, posterior tibial dorsalis
paedis arteries and assess their nature on both sides
3. Percussion: cardiac outline
4. Auscultation: first and second heart sound, systolic and diastolic murmur, bruit over carotid,
renal and femoral arteries
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History taking for Gastrointestinal/Hepatobiliary System
1. abdominal pain: site, type, duration, severity, mode of onset, aggravating and relieving factors
2. appetite: increased or decreased
3. weight: increased or decreased
4. vomiting: type, color, amount, containing blood
5. difficulty in swallowing: relation to solid/liquid
6. bowel habits: loose motion, constipation, color, containing blood or mucus, flatulence,
borborygmi
7. acidity: relation with different food items
8. yellow discoloration of conjunctiae and skin
Systemic Examination of Gastrointestinal and Hepatobiliary system
1. Inspection: abdomen and note size, contour, pulsations, superficial veins, herneal sites, visible
peristalsis, pulsation and also inspect oral cavity and note relevant findings.
2. Palpation: superficially to identify abnormalities and deeply for liver, spleen, kidneys and
other abdominal masses, detect tenderness, rigidity, rebound tenderness at different sites
3. Percussion: to detect lower border of the hepatic dullness, and free fluid in the abdomen
4. At Auscultation: normal, abnormal bowel sounds and bruit.
Rectal Examination
Growth and Development System
At the end of the course, students should be able to

1. Record complete medical history on the history form designed for teaching/noting complaints,
previous history, birth history, mother's health during pregnancy, details of delivery, infancy,
development, past illness, operations, family history, geographical history; enquiring about
travel and contact with one who has travelled
2. Indicate what additional information is needed and explain why it is important, list the series
of questions used to explore each chief complaint: reconstruct from memory the standard
immunization routine; indicate which are important neonatal milestones, (sitting up, crawling,
standing, walking, falling); estimate appropriate age for achieving each of the milestones,
identify health of parents and others in contact with the person suffering, detect weight and
height of parents (eg. dwarfism); construct a medical family tree; compile a social history; list
common complaints involving each of the general organ systems
Endocrine System
At the end of the course, student should be able to ask as well as try to correlate the importance of:
1. taking history of passing large volume of urine and frequent urination.
2. increased appetite and thirst, loss of weight, diminished vision, tingling sensation.
3. history of intolerance to heat and cold, tremor, palpitation, change of voice, weakness,
asymmetrical body distribution of fat, increase in size of hands and feet.
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Reproductive System

1. inquire about the reasons for which a woman has come to the clinic or hospital and record it
properly
2. inquire about the menstrual pattern of the women in the following order: the age of onset of
menstruation, duration of menstrual period, interval between (from the first day of bleeding of
one period to the first day of bleeding of the next period), the last bleeding and its duration,
pain in relation to the menstrual period, its location, duration and radiation
3. inquire about bleeding from the nose or rectum during the menstrual period in addition to
vaginal bleeding and whether there is pain or bleeding during defecation or micturation
4. inquire about pregnancies and record in the following order: the number of pregnancies, the
number of pregnancies which had terminated before 28th week of pregnancy, the number of
pregnancies which had terminated after 28th week of pregnancy (i.e. viable foetus), number of
live births or stillbirths (if a stillbirth, whether it was intact or macerated, and whether she felt
movement of the foetus at or near the time of delivery or not), the sex of the babies born and
their ages (if some of the children are dead, the age at which they died, and if possible the
reasons).
5. inquire about any deformities or abnormalities in the children
6. inquire about previous deliveries (spontaneous, operative or assisted delivery) if delivery was
assisted, by what means or why (forceps, vacuum or caesarian section - sometimes mothers
carry a piece of paper or discharge slip from the hospital which will help the students to record
the reason).
7. inquire whether the mother had excessive bleeding after delivery and received blood
transfusion for this or any other reason
8. inquire whether she had to be helped for the delivery of the placenta
History Taking from a Pregnant Woman
Student should be able to:

a. determine the date of last menstrual period and calculate the expected date of delivery
(which falls on the completion of the 40th week from date of last menstrual period)
b. record the presence of pain during present pregnancy, and note the type, duration and
location of the pain.
c. record the presence of any bleeding per vaginum during the course of pregnancy, its
color, amount, duration and association with pain.
d. in the second trimester, inquire whether the mother feels movement of the foetus.
History Taking Regarding Vaginal Discharge
Students should be able to:

a. ask how does the vaginal discharge affect her, whether it is just a botheration that she
has to change clothes very often or there is any other associated condition like irritation
and foul smell
b. record choice of contraceptive that is being used
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History Taking Regarding Other General Health Problems
Students should be able to record age, number of siblings and family history of
hypertension, diabetes mellitus, tuberculosis multiple births, physical deformities, or blindness
Clinical Examination of Reproductive System
At the end of the course, students should be able to:

a. assess height and proportionate growth of the women
b. detect pallor and assess anaemia
c. note excessive hair growth on the face and limbs.
d. examine the breast by inspection (the shape and size of whole breast including nipple,
areola; see if there is any difference between two breasts, discharge from nipple and
redness over breasts including color of areola) and palpation (using whole of the palm of
the hand, feel the smooth contour of breast: feel for any mass or tenderness in one or
both breasts)
e. examine the abdomen by inspection (shape and size of abdomen, any localized mass
specially in suprapubic region, any scar in abdomen), palpation (for any mass or
tenderness, is it localized or generalized, test for rebound tenderness; if there is mass,
demonstrate shape, size, mobility, consistency of the mass and tenderness over it
f. demonstrate in pregnancy the height of the uterus, fundus, and feel the foetal parts, the
lie, presentation and position of the presenting part) and auscultation (listen to the foetal
heart sound)
History taking in Blood, Lymphoreticular and Immune system
Weakness, fever, bleeding tendency, rashes, blue patches, nodal enlargements, drug abuse,
sexual contacts.
History taking in Urinary System
1. Burning micturition: pain in loins, frequency of micturition, amount, color of urine,

association with blood
2. pus per urethra
Examination of Urinary system
1. Inspection: puffiness of face, oedema, anaemia, anasarca, abdominal scars, suprapubic

swelling and abdominal lumps
2. Percussion: fullness of bladder, colonic resonance over kidneys
3. Auscultation: bruit over renal artery stenosis
4. Examination of external genitalia and identification of different parts.

1. ask about itching, rashes, deformed fingers, contact with leprosy, sexual contacts.
2. examine ulcers and rashes
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Locomotor System
At the end of the course, student should be able to:

1. assess gait and posture
2. assess joints by inspection (identify swelling, redness, nodules around joints)
3. palpate for tenderness, fluid and fluctuation, note nodes, (rheumatoid as well as Heberden's);
test range of movement of different joints; and palpate muscles around individual joints to
assess abnormalities
Nervous System
1. headache: its duration, mode of onset, site, type, association with vomiting, fever, giddiness
and medications
2. dizziness, tinnitus and vertigo
3. sleep: interrupted or sound
4. worries: whether more than other people or more than usual
5. fits or fainting spells
6. sensation: bowel and bladder control, pain and touch
7. weakness of limbs: duration, mode of onset, nature
8. measure levels of consciousness, fully conscious, semi-conscious or unconscious; assess
higher mental state and speech
9. note facial appearance for ptosis, mask-like face, anxious, depressed, twitching and tremors;
and observe posture and gait
10. examine cranial nerves from I-XII
11. examine motor system and note muscular development, the presence of muscular wasting,
twitching and fasciculation
12. measure tone and movements
13. test reflexes: biceps, triceps, supinator, knee, ankle & plantar and ankle clonus
14. examine sensory, (a) test for temperature, hot and cold, (b) touch superficial cotton wool, deep
pressure, (c) joint and vibration, proprioception, stereognosis and two point discrimination
15. examine cerebellar functions; observe for nystagmus, gait; test for dysarthria and for rapid
alternating movement of the upper and lower limbs, finger to nose test, heel to shin test
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ASSESSMENT & EVALUATION PLAN
(Phase I)
1. Attendance: In order to be eligible to appear in the annual examination the students should
have at least 80% attendance in each of theory, practical, clinical posting & field postings
separately during the academic year.
2. Assessment will be both formative and summative. The formative (internal) assessment will
contribute 30% to the summative (final) assessment. Students must secure 50% marks in
theory & practical examinations in each subject/paper separately to pass the final
assessment (30% of Internal Assessments + 70% of Annual Examination = Final
Assessment).
3. The contribution of internal assessment & annual examination to the final assessment will
be 30% & 70% respectively. Separate re-internal assessment for failures in the final
assessment will not be taken, and in their case the 30% marks to be considered for internal
assessment will be derived from the marks secured in the concerned subject/paper in the
regular annual examination. This mark will be added to the marks obtained in the
supplementary examination.
4. Internal assessment will be conducted at the end of every unit/module of study.
5. Final assessment will be conducted annually, i.e. at the end of the first year (second semester)
and at the end of the second year (fourth semester) of study.
6. The syllabus for the first year annual examination will be the topics taught during the first
year. The syllabus for the second year annual examination will be the topics taught during the
second year only.
7. A supplementary examination will be held about 5-6 weeks after the publication of result of
regular annual examination to provide a second chance to students who fail at the regular
examination provided they achieve a defined minimum level of performance at the regular
examination.
8. Any student who fails in the supplementary examination will have to reappear in the next final
assessment in the subject(s)/paper(s) in which he/she has failed & rules governing the
attendance, internal assessment and payment of fees will be applicable as per rules of BPKIHS.
9. Certificate of merit will be awarded to those students scoring a minimum aggregate of 75%
on total marks in the annual examinations in the first attempt & being on the 90th
percentile & above.
10. A student declared unsuccessful at the first year examination will be allowed a maximum of
three more attempts. Any student who fails to clear the first year examination in up to four
attempts (including the first one) will be required to leave the course.
11. A student must pass in all the papers of the second annual examination in order to be eligible
to study in the third year. Any student who fails to clear the second year examination in up to
four attempts (including the first one) will be required to leave the course.
12. The instruments of assessment will be a judicious mixture of the traditional and relatively new
objective instruments.
13. The students will evaluate the course at the end of every unit/module in order to provide
feedback to the teachers.
14. The examinations will be integrated to the extent feasible.
15. Each final examination will have a paper on Problem Solving Exercises.
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16. The registration of the candidate failing to complete the course within 10 years from the
academic year of admission will be cancelled.
INTERNAL ASSESSMENT
THEORY
There will be three Units in first year, Unit 0, I, and II. In each unit there will one internal
assessment comprising of theory and practical examination. Theory consists of two papers each
consisting of 200 marks and practical (OSCE/Viva) of 400 marks.
Unit Paper Name

Unit 0 Paper IA Basic Concept (Anatomy, Physiology, Biochemistry)
Paper IB Basic Concept (Pathology, Microbiology, Pharmacology)
Unit I Paper IIA Growth, Development, Genetics and Immunology
Paper IIB Blood
Unit II Paper IIIA Cardiovascular System
Paper IIIB Respiratory & Environment including ANS
The marks distribution of each paper is as follow.

Time Maximum marks
Multiple Choice Questions 1 hour 75
Short Answer Questions 2 hour 125
THEORY
Total of 6 papers : 1200 marks

Contribution to final assessment (30%) : 360 marks
PRACTICALS & ORALS
A total of three practical and oral examinations will be held during the year.
Total of 3 practical exams : 900 marks
Total of 3 oral exams : 300 marks
Total : 1200 marks
Contribution to final assessment : 360 marks
Note: A purely formative assessment will be held about one month after the beginning of Unit 0
to familiarize the students with the pattern of assessment of BPKIHS.
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Theory
Q FIRST YEAR ANNUAL EXAMINATION
The examination will consist of 6 papers as follows:
-------------------------------------------------------------------
Marks
-----------------
MCQs SAQs
-------------------------------------------------------------------
Paper I A Basic Concept 50 90
(Anatomy, Physiology, Biochemistry)
Paper I B Basic Concept 50 90

(Pathology, Microbiology, Pharmacology)
Paper IIA Growth, Development, Genetics 50 90

and Immunology
Paper IIB Blood 50 90
Paper IIIA Cardiovascular System, 50 90
Paper IIIB Respiratory & Environment including ANS 50 90

Total 300 540
-------------------------------------------------------------------
Note: Each paper will be of 3 hours duration.

In the MCQ papers, no negative marks will be allotted for incorrect responses.
PRACTICALS
1. The practical examination may not be system-wise

2. The practical examination will consist of OSPE.
3. The minimum pass level will be an overall score of 50 in practical exams and orals put
together.
4. At the supplementary examination, the student will have to appear and pass both components
of the paper:
5. The examination will consist of 75 OSPE stations which will be set up in groups of 25 each on
three different days.
6. The OSPE section will carry 10 marks for each stations (75 stations X 10 marks each =750
marks) and 30 marks viva in each paper (3 X 30= 90 marks). Thus the Practical exam will
carry 840 marks (750+90).
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ORALS
1. The oral examination will be integrated.

2. The orals will carry 90 marks. Each paper 30 marks. For convenience for each paper each
department will take viva of 10 marks (total 60 marks which later converted to 30).
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FIRST YEAR FINAL ASSESSMENT
MARKS
Theory Practical & Oral
Internal Assessment 360 360
Annual Examination 840 840

Total 1200 1200
2ND YEAR ANNUAL EXAMINATION

There will be III, IV, V, &VI units in second year. The pattern and detail of mark distribution is
similar to first year. Except there will be one theory paper in Unit III and Unit VI and two papers
in IV and V. There will be no practical/oral exam at the end of Unit VI. The name of paper in
different unit will be as follow:
Unit Paper Name
Unit III Paper IB GIT, HBS, Nutrition and metabolism
Unit IV Paper IIA Endocrine and Reproductive system
Paper IIB Kidney, Fluid Balance & Integumentary
Unit V Paper IIIA MSK & Special Senses
Paper III B Central Nervous system
Unit VI Paper IA Multisystem topics
During the second year, the practical and oral examination at the end of Unit 3, Unit 4 and 5 will
carry 400 marks each. There will be no practical and oral examination at the end of Unit 6.
The pattern and details would be similar to those for the first year Annual Examination. The break-
up of the 6 theory papers will be as follows:
-------------------------------------------------------------------
Marks
-----------------
MCQs SAQs
-------------------------------------------------------------------
Paper IA Multisystem topics 50 90
Paper IB GIT, HBS, Nutrition & Metabolism 50 90
Paper IIA Endocrines & Reproductive system 50 90
Paper IIB Kidney, Fluid Balance & Integumentary 50 90
Paper IIIA MSK & Special Senses 50 90
Paper IIIB CNS 50 90
Total = 300 540
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The breakup of the scores in the practical examination will be as follows.
-------------------------------------------------------------------
Marks
-----------------
PRACTICAL OSPE ORAL
-------------------------------------------------------------------
OSPE I GIT, HBS, Nutrition & metabolism 250 30
OSPE II Endocrine & reproduction

Kidney, Fluid Balance & Integumentary 250 30
OSPE III Musculoskeletal system, Special Senses, Nervous System 250 30
Total = 750 90
*For convenience each paper viva is taken of 60 marks (10 marks x 6 dept.) later converted to 30
marks.
2ND YEAR FINAL ASSESSMENT

MARKS
Theory Practical & Oral
Internal Assessment 360 360
Annual Examination 840 840

Total 1200 1200
128
PHASE II
129
130
ACADEMIC CALENDAR
(Learning Resources)
5th Semester CBL (Wk) LIF (Wk) SIS (Hr) LABEX (x3 hrs)
Medicine 4.75 3.8 37 -

Surgery 4.75 3.8 29 -
Obst/Gynae 4.75 3.8 13 -
Paediatrics 4.75 3.8 25 -
Community Medicine - 3.8 25
Forensic Medicine - - 40 10
TB Module 1 - - -
FHE (Family Health exercise) 1
Note:
Seminar and SGD of 3 hours each take place in every week
6th Semester CBL (Wk) LIF (Wk) SIS (Hr) LABEX (x 3 hrs)
Medicine 2.5 3.4 34 -

Surgery 2.5 3.4 34 -
Obst/Gynae 2.5 3.4 13 -
Paediatrics 2.5 3.4 23 -
Community Medicine - 3.4 18 -
Forensic Medicine - - 32 10
Note:
Research 4 weeks (includes SIS & exercises)
Community Medicine (Residential Posting: Epidemiological Exercises) 2 weeks
Elective posting 4 weeks (2 subjects x 2 weeks)
Final Examination (includes Forensic Medicine only)
7th Semester CBL (Wk) LIF (Wk) SIS (Hr) SYCS (Wk)
Anaesthesia 2 - 14 -
Community Medicine - 3.2 - -
Emergency 4 - - -
Dermatology 2 3.2 20 -
General Practice 4 - 33 -
Lab Med 2 - 18 -
Psychiatry 2 3.3 14 -
Oral Health 2 - 22 -
Orthopaedics - 3.2 - -
Ophthalmology - 3.2 - -
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ENT - 3.3 - -
Radiodiagnosis 2 - 14 -
Medicine - - - 5
Surgery - - - 5
Obst/Gynae - - - 5
Paediatrics - - - 5
Note:
Internal Assessment (includes all subjects students have been taught in 7th Semesters).
8th Semester CBL (Wk) LIF (Wk) SIS (Hr) SYCS (Wk)
Emergency Medicine 4 - 32 -
Ophthalmology 4 2.8 26 -
Orthopaedics 4 2.8 31 -
ENT 4 2.8 38 -
Community Medicine - 2.8 - -
Dermatology - 2.8 - -
Psychiatry - 2.8 - -
Oral Health - 2.8 - 4.5
Surgery - - - 4.5
Paediatrics - - - 4.5
Obst/Gynae - - - 4.5
Note:
Community Medicine (Residential Posting: Health Management) for 2 weeks
Elective Posting (1 subject x 2 weeks)
Internal Assessment (includes all subjects students have been taught in 8th Semesters).
Final Examination (includes all subjects students have been taught in 7th and 8th Semesters).
9th Semester CBL (Wk) LIF (Wk) SIS (Hr)
Medicine 5 4 35
Surgery 5 4 21
Obst/Gynae 5 4 29
Paediatrics 5 4 23
Community Medicine - 4 15
Note:
1. Seminar and SGD of 3 hours each take place in every week
2. Final Examination (includes all subjects students have been taught in 5th, 6th and 9th
Semesters)
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Important
1. Seminar and SGD of 3 hours each will take place every week. Topics will be selected
corresponding to the CBL by rotation.
2. CBL refers to the clinical posting of about 3 hr per day only.
3. CBL, SYCS and SGD postings take place in OPD or wards.
4. SIS (about 2 h/d) will continue from 5th through 9th semesters, and will correspond to the
subjects of clinical posting as far as feasible.
5. LIF corresponds to the subjects in CBL/SIS and lasts 3 hours in the field (teaching district
hospitals assigned by the Institute). Students shall be divided into groups and each group shall
be posted in different disciplines (corresponding to the semester subjects) in the teaching
hospital under faculty supervision by rotation.
6. Classes in Forensic Medicine will be held in 5th and 6th Semester.
7. Classes in Community Medicine will be held from 5th through 9th Semester.
8. Time allocation is based on the availability of 20 wks per semester. Some adjustments might
be necessary in order to hold examinations or allow vacations at the most appropriate time.
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ANAESTHESIOLOGY
Broad Objectives
At the end of the course, the students should be able to:

1. perform cardiopulmonary resuscitation with available resources and transfer the victim to a
nearby better equipped hospital/institution for advanced life support.
2. clear and maintain a patent airway in an unconscious patient.
3. administer oxygen judiciously.
4. set-up intravenous lines.
5. describe simple nerve blocks and infiltration anaesthesia.
6. enumerate the principles of administration and monitoring of patients under general and
regional anaesthesia.
Prerequisites
1. Anatomy and physiology of respiratory, cardiovascular and nervous systems.

2. Pharmacology, including drug interaction, of anaesthetic and allied drugs.
3. Fluid, electrolyte and acid-base balance.
4. At least one semester posting in all major clinical disciplines.
5. Mental preparedness to face/observe life-threatening conditions.
Themes and Topics
1. Introduction to principles of critical care

2. Cardiopulmonary cerebral resuscitation.
3. Assessment and management of upper airway obstruction.
4. Management of unconscious patient.
5. Oxygen therapy.
6. Clinical pharmacology of anaesthetic agents, muscle relaxants and its antagonists.
7. Preanesthetic management of surgical patients.
8. Principles of administration of general, spinal, epidural, caudal anaesthesia and brachial
plexus blocks.
9. Infiltration anaesthesia and digital, wrist and ankle.
10. Principles of recovery room management.
11. Concept of pain clinic and pre-anaesthesia clinic.
Learning experiences
1. Operation theatre/table teaching.

2. Bedside clinical discussion either in recovery room and emergency care areas.
3. Practical demonstration over simulator.
4. Preoperative patients’ evaluation.
5. Video tape demonstrations.
6. Lecture/integrated seminars.
7. Patient management problems.
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Learning Resources
1. Simulator
2. Videotape
3. Tape-slide program
4. Patients in the hospital and preanaesthesia clinic.
Recommended Reading
1. Synopsis of Anaesthesia by Lee and Atkinson.

2. Principles and Practice of Anaesthesia by Wylie and Churchill Davidson.
3. Text book of Anaesthesia by R.D. Miller.
4. Cardiopulmonary Cerebral Resuscitation by Peter Safar.
5. British Journal of Anaesthesia.
6. Anaesthesia
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COMMUNITY MEDICINE
Broad Objectives

1. Work as an active partner of a multidisciplinary team(s) in managing health care activities in
Districts and Primary Health Centre (PHC) areas.
2. Manage information to make rapid appraisal of health and related problems in Districts and
PHC areas.
3. Prioritize the health problems and plan appropriate action to deal with them.
Specific Objectives
1. Describe the epidemiological methods.
2. Apply epidemiological methods to communicable and non-communicable diseases in the
hospital and community situations.
3. Use epidemiological tools to make rational decisions relevant at the individual and community
levels.
4. Select, use and interpret biostatistical methods to make inferences from hospital / community
data.
5. Plan, collect, analyze, interpret and present data from a hospital/community survey.
6. Plan and implement an intervention program with community participation.
7. Describe and analyze the roles of the individuals, family, community and socio-cultural milieu
in health and disease.
8. Diagnose and manage common health problems and emergencies at the individual, family and
community levels keeping in mind the existing health care resources, prevailing socio-cultural
beliefs and family resources.
9. Describe common occupational hazards in industries, agriculture.
10. Describe feasible methods of control of occupational hazards.
11. Describe the important/common health problems in Nepal.
12. Describe the School Health Program
13. Describe the health information system in Nepal with reference to the Management
Information System, census, and vital statistics.
14. Describe and evaluate the National Health Strategies.
15. Describe the health care delivery system in Nepal.
16. Describe the organization and functions of the health care team at health posts, Primary
Health Centres and District levels.
17. Interact with other members of the health care team and participate in the organization of
health care services and implementation of National Health Strategies.
18. Plan and implement measures for disaster management.
19. Describe the principles and components of Primary Health Care.
20. List the goals/targets set to achieve according to the current Millennium Development Goals.
21. Diagnose and manage maternal and child health problems and advise a couple and the
community on the family planning methods available.
22. Diagnose and manage common nutritional problems at the individual and community levels.
23. Plan, implement and evaluate, using simple audiovisual aids, a health educational program.
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24. Interact with other members of the health care team and participate in the organization of
health care services and implementation of National Health Programs.
Unit I
1. Family Health Exercise

[This exercise is a continuation of the exercise initiated in Phase I]
Family Health Exercise (FHE) is a learning program for the students during their undergraduate
training course. The objective of this exercise is to help them understand that family is a basic
unit of health care, obtain practical experience in early diagnosis and treatment of disease in the
family as well as community health promotion, specific protection, disability limitation and
rehabilitation. The aim of this exercise is to prepare the future family physician, primary health
care provider and to bring positive changes in the community.
Specific Objectives
At the end of the FHE the student should be able to:

1. Prepare and maintain complete profile of the family
2. Identify socioeconomic, psychological, cultural and environmental factors that influence
the health of the family and identify diseases associated with these factors
3. Analyze social, cultural and health related variable in the family and community
4. Recognize the effect of illness of an individual on other members of the family and the
community
5. Identify most common diseases, epidemic, outbreak, emergence or re-emergence of
diseases in the community and propose management of those diseases
6. Assess the attitude of the community towards health and describe the role of the
family/community in health and diseases
7. Develop skills on effective communication with the individual and the community
8. Identify cultural and social norms, values and practices of the community
9. Plan health education package, conduct health education session for an
individual/community and evaluate the health education program conducted
10. Develop effective counseling skills to promote good health and create healthy environment
in the community
11. Manage family health problems with available resources, plan and execute appropriate
intervention
12. Timely referral to the nearby hospital to those who are in real need of hospital care.
Program outline
Students will follow up the allotted family beginning from 1st year to internship in the following
way:
1. FHE should be organized in such a way that before completion of the Internship a graduate
of the BPKIHS should have completed a minimum of 12 interactive family visits under
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FHE. The FHE will be evaluated through a logbook, feedback from families and positive
health impact made in the allocated families.
2. Students will be allowed to spend entire day with the family during the official visits.
(Provision of breakfast, lunch should be done by student themselves.)
3. Students should fill up the log book and signed up with the concerned supervisor within a
week.
4. Presentation on the respective families by the student at the end of each year
Responsibilities of Students
Each student will be allotted three families. Students will play a role of a health advisor to the
family during the entire period of training. Students will always keep the Hippocratic Oath in
mind. They will follow the code of conduct and medical ethics. They are expected to have a
holistic and humane approach toward each individual of the family. Welfare of the family should
be the priority of students. Confidentiality and individuality of every individual in the family has
to be maintained by the students.
1. Maintain a logbook which should reflect details of all the works done
2. Maintain an electronic record of the family profile
3. Define household as a unit which includes members of 1 or more generations who share the
same kitchen. Such a unit may contain one or more nuclear families
4. Record the measurements and draw the sketch of the house
5. Record the nutritional status of the family and index cases
6. Calculate overcrowding
7. Obtain personal information on economic status
8. Assess the health knowledge of the family especially with regards to common
communicable diseases, nutrition pregnancy and antenatal care, infant feeding and rearing
practices, family planning etc
9. Assess the sanitary practices and hygiene of the family
10. Take a thorough and detailed history of the index case or any other infectious disease in the
family
11. Perform a detailed general and systemic examination relevant to the case and manage them
under the supervision of the supervisors
12. Record the details regarding any disabilities and death during the study period
13. Report the family details in every 8 weeks in electronic format to the respective supervisor
14. Presentation on the family and the progress report at end of each year to respective
supervisor
15. Present the final report of the Family Health Exercise in an electronic format at the end of
internship
Evaluation
The evaluation in Family Health Exercises includes continuous evaluation from the first exercise
in “Orientation Program” till the completion of the “Internship Program”.
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1. Field visits (2 visits in year; total 12 visits spread from Orientation to the end of Internship)
2. Interactive sessions
3. Logbook evaluation
4. Presentation
2. Applied Behavioral Sciences
Objectives
At the end of the session a student will be able to:

1. Define attitudes
2. Describe the process of attitudinal development and methods to change
3. Assess the attitude of the community towards health by using a questionnaire or interview
schedule.
Themes and Topics
1. Attitudes, nature, development, methods to change.

2. Measurement of attitudes
3. Questionnaire design, interview technique, pretesting and validation.
Learning Experiences
1. Integrated seminars with Psychiatry

2. Practical exercise
3. Applied Health Education
Objectives

1. Design health education packages including A.V. aids and role plays.
2. Use the designed packages to educate and motivate the community
3. Evaluate the health education program undertaken.
Themes and Topics
1. Information, Education & Communication strategy and materials
2. Interactive session
3. IEC program development
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4. Counseling
Objectives:

1. Explain the concepts of client counseling
2. Enumerate the steps of counseling
3. Enumerate the procedure for counseling
4. Use appropriate methods and media for counseling
5. Evaluate the effectiveness of the counseling
1. Interactive sessions with Psychiatry
5. Geriatrics
Themes and Topics
2. Problems of the elderly

3. social organizations to assist the elderly
Unit II
1. Epidemiology
Objectives

1. Define the measures of morbidity and mortality.
2. List and describe the sources of epidemiological data.
3. Describe criteria of causation of disease
4. Describe and illustrate natural history of communicable and non communicable diseases
5. Relate agent, host and environment factors in development of health problems.
6. Advise on relevant promotive, preventive, curative and rehabilitative measures for a disorder.
7. Describe the need and uses of screening and diagnostic tests.
8. Describe and calculate sensitivity, specificity, positive and negative predictive values of a test.
Themes and Topics
1. Definitions, scope in hospital, community, planning.

2. Measures of Morbidity/Mortality
3. Rates: Incidence, Prevalence
Death rate
Crude rates/standardized rates
Fertility Rates
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Person Years
Ratio
Proportions
4. Sources of epidemiological data
5. Causation
Natural history of disease
Clinico-psycho-social case review
General control of communicable and non- communicable diseases
6. Screening and diagnostic tests
Learning experience:
Interactive sessions
Practical exercises
For the clinico-psycho-social case review, each student will be allotted a case from the hospital to
take history and do a complete physical examination and reach a diagnosis. This will be followed
by a visit to the patient's family to determine the psycho-social aspects of the disease and the effects
on the patient and family. Individual presentation.
2. Health Statistics & Research Methodology
Objectives

1. Define, calculate and interpret commonly used statistical methods.
2. Select and use appropriate diagrammatic representations of statistical data.
3. Describe the demographic pattern of the country.
4. Define vital statistics, describe their method of collection.
5. Define
Normal distribution
Probability
Bias including confounding
Random error
6. Describe methods of sampling and calculate sample size
7. Carry out simple random, systematic and cluster sampling
8. Apply appropriate tests of significance.
Themes and Topics
1. Need of Biostatistics in Medicine

2. Statistical Methods:
 Frequency Distribution
 Measures of Central Tendency
 Proportions
3. Tabular & diagrammatic presentation of data
141
4. Vital Statistics
5. Demography
Normal distribution, probability standard error, tests of significance.

1. alpha and beta errors, confidence interval,
2. Biases
3. Sample size
2. Practical exercises
3. Epidemiological Methods
Specific Objectives

1. Describe various types of epidemiological methods
Themes and Topics
1. Cross sectional and case studies

2. Longitudinal studies
3. Case control studies
4. Randomized control studies
5. Experimental studies
Learning Experience:
1. Interactive Sessions
4. Applied Epidemiology
Objectives

1. Describe the epidemiology of communicable and non- communicable diseases
2. Enumerate the objectives and the strategies involved in the various national strategies for
prevention and control of diseases.
3. Enumerate the steps in epidemiological investigation of communicable & non-communicable
diseases including development of program for management, control and follow up.
142
Themes and Topics
Malaria, Leishmaniasis, JE, Dengue, Filaria, STDs/ AIDS, Hepatitis B infection, Pulmonary
Tuberculosis, Leprosy, Vaccine preventable disease, Diarrheal diseases, Infective hepatitis,
Nutritional disorders, RHD/CHD/ hypertension, cancers, COPD, blindness, alcoholism,
drug addiction including smoking.
2. Interactive sessions.
3. Practical exercises
4. Problem Solving
5. Field visits
5. Occupational Health
Objectives:

1. Enumerate the common industrial and occupational diseases.
2. Describe the common patho- physiological mechanisms of development of such diseases (to
be integrated into medicine and forensic medicine).
3. Describe the feasible methods of control of industrial and occupational diseases.
4. Describe the important features of the consumer protection act and work place protection act.
Themes and Topics
1. Safe working environment, health hazards of industrial and agricultural workers.

2. Occupational diseases.
3. Legal aspect of occupational health.
4. Principles of prevention and management of occupational diseases.
Learning Experiences:
1. Interactive sessions to be integrated with Medicine and Forensic Medicine.

2. Field visits.
Unit III
1. Health Administration
Objectives:

1. Describe the national health services including long term health plan.
2. Describe the basic principles of health management.
143
3. Describe the concept, components, and principles of Primary Health Care and school health
care.
Themes and Topics
1. New health plan and existing health structure.

2. Methods of planning, direction, implementation, coordination, supervision and monitoring/
evaluation.
3. Inventory management
4. Primary health care, Alma Ata Declaration
5. School health care
6. Government Organizations, Non- Governmental Organizations, International organizations in
health care
2. Field posting
3. Development of reports on planning and management.
2. National Health Strategies
Objectives

1. Describe important national health programs and their implementation modes at district and
primary health center levels.
2. Identify and apply the steps of monitoring and evaluation of such programs.
Themes and Topics
1. Family health programs:

2. Reproductive health program
3. Family Planning, MCH including Immunization Programs, STD/AIDS, Nutrition program,
care of elderly and disabled.
4. Iodine Deficiency Disorders prevention program
5. Cancer relief program
6. ARI control program
7. Diarrheal disease control program
8. TB control program
9. Leprosy control program
10. Malaria control program
11. Drug prevention and rehabilitation programs
12. Monitoring and evaluation mechanism
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2. Site visits
3. Field visits
3. Health Economics and Health Financing
Objectives

1. List the principles of health financing at individual and at public health levels.
Themes and Topics
1. Equity and Demand

2. Health outcomes
3. Measuring socio-economic status
4. Measuring inequalities in health
5. Demand for health services
6. Supply of health services
7. National Health Accounts
8. Health financing
9. Macroeconomics and health
10. Health care provision
11. Universal Health Coverage
Interactive sessions involving economists and health administrators.
145
Learning Resources
Reference books for MBBS in Community Medicine
1) Parks Textbook of Preventive & Social Medicine. – K. Park

2) Survey Methods in Community Medicine – J.H. Abramson, Z.H.
Abramson
3) Epidemiology – Leon Gordis
4) Public Health and Preventive Medicine – Maxcy, Rosenau, Last
5) Communicating Health- an action guide to Health
Education & Health Promotion – John Hubley
6) Epidemiology, Biostatistics and Preventive Medicine – James Jekel, DavidKatz,
Joann Elmore
7) Basic and Clinical Biostatistics – Dawson, Trapp
8) Principles of Medical Statistics – Bradford Hills
9) Epidemiology & Management for Health Care for all – P.V. Sathve, A.P. Sathve
10) Oxford Textbook of Public Health – Detels, McEwen,
Beaglehole
11) Basic Epidemiology – R. Beaglehole, R. Bonita
12) Principles and Practice of Community Medicine – Asma Rahim
13) Interpretation and Uses of Medical Statistics – Leslie Daly, Geoffery
Bourke
14) Hunters Diseases of Occupation – Raffle, Adams, Baxter & Lee
15) Understanding Environmental Health – Nancy Irwin Maxwell
16) Medical Sociology – William C. Cockerham
17) Mansons Tropical Diseases – Gordon Cook
18) Vector Control (Methods for use by individuals and
community) – Jan A. Rozendaal
19) Principles and practices of Infectious Diseases – Gerald Mandell, John
Bennet, R. Dolin
20) Serious Mental Health Problems in Community – Charlie Brooker, Julie
Repper
21) Principles of Population Studies – AshaBhende, Tara
Kanitkar
22) Medical Anthropology – M. Johnson, Carolyn
Sargent
23) Macro-Economic Theory – M.L. Jhingam
24) Tribal Ethnography of Nepal – Rajesh Gautam
25) Infectious Disease Epidemiology – Kenard Nelson, Carolyn
Williams
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Time
Unit I Family health exercise [minimum 12 visits by the end of the internship]
Applied Behavioral Sciences 20 h
Applied Health Education 10 h
Counseling 1h
Geriatrics 2h
Unit II Epidemiology 36 h
Biostatistics 33 h
Epidemiological methods 9h
Occupational Health 7h
Unit III Health Administration 9h

National Health Strategies 5h
Health Economics and
Health Financing 2h
Unit IV Inter professional Community diagnosis 2 wks
VIth Semester Epidemiological Exercises 2 wks
VIIIth Semester Health Management 2 wks
147
DERMATOLOGY
(Including venereology and leprosy)
Skin diseases are quite prevalent in the community and a large number of patients attending to any
hospital OPD come with the complaints related to skin diseases. The aim of the training is to train
the undergraduate students so that they will be able to diagnose and manage common skin diseases,
sexually transmitted diseases and leprosy, able to diagnose and manage common medical
emergencies related to skin diseases, leprosy and sexually transmitted diseases, to know the
preventive measures at individual and community levels against communicable skin diseases
including sexually transmitted diseases and leprosy and also able to refer the patients to the
dermatologists in time. They should develop a compassionate attitude towards the patients and their
attendants.
Objectives
Knowledge
1. Basic concepts (Introduction)

a. outline the role and importance of dermatology in modern medicine.
b. define terms commonly used in dermatological practice.
c. explain the structure and function of the skin as an organ.
2. Nutritional and Metabolic disorders

a. diagnose and manage pellagra, acrodermatitis enteropathica, phrynoderma
b. refer complicated cases
3. Infective disorders
diagnose, manage and outline the preventive measures against the most common infective
skin diseases in the community.
Viral - Varicella, Herpes Zoster, Herpes simplex, common warts, Molluscum contagiosum
Fungal - Superficial dermatophytosis, pityriasis versicolor, candidiasis.
Bacterial - pyogenic infections, Skin Tuberculosis, leprosy
Parasitic - Scabies and pediculosis
4. Dermatitis and Eczema

 Identify and manage common eczemas.
a. Endogenous: atopic, seborrhoeic, and nummular dermatitis and lichen simplex
chronicus.
b. Exogenous: Contact and irritant dermatitis, urticaria
 Refer chronic recurrent cases of eczema.
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5. Papulo squamous diseases
a. identify and treat psoriasis, pityriasis rosea and lichen planus.
b. refer complicated cases of psoriasis, lichen planus
6. Vesiculobullous diseases
a. diagnose pemphigus, Pemphigoid
b. institute primary care with steroids.
c. refer complicated cases.
7. Drug reactions and eruptions

a. diagnose and manage acute drug eruptions: erythema multiforme, fixed drug eruption,
Stevens Johnson Syndrome: toxic epidermal necrolysis
8. Disorders of sebaceous glands, sweat glands and hair follicles

a. diagnose and treat acne, miliaria and alopecia.
9. Disorders of pigmentation
a. diagnose and outline principles of management of:
b. vitiligo, Melasma
c. refer cases with proper counseling
10. Leprosy
a. diagnose various types of leprosy.
b. manage patients of leprosy.
c. recognize and treat leprosy reactions.
d. refer cases requiring surgery.
e. describe preventive and rehabilitative aspects of leprosy.
11. HIV/AIDS
a. describe dermatological manifestations of AIDS.
b. diagnose cases of HIV and AIDS.
c. provide health education regarding its prevention.
d. refer cases of AIDS.
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12. STD
a. diagnose and treat gonococcal urethritis, syphilis, non-gonococcal urethritis, chancroid,
LGV, genital warts, genital Herpes, granuloma inguinale.
b. Syndromic approach to the diagnosis and management of sexually transmitted diseases
13. Immunological Diseases

a. identify, and refer patients having SLE, systemic sclerosis, Morphea and refer.
14. Dermatological Manifestations of Systemic diseases

a. list common causes
b. outline principles of management
15. Tumors of the skin

a. describe and diagnose, outline of the principles of management, and refer common
precancerous and cancerous conditions of the skin.
Skills
Elicit a complete clinical history from the patients, perform clinical examination, requisition
relevant investigations and outline the principles of management of common dermatological
conditions, sexually transmitted diseases and leprosy.
At the end of the course, the student should be able to perform and interpret the following
tests/diagnostic procedures:
 KOH smear examination
 Tzanck test
 Gram’s staining
 Giemsa staining
 Zeil-Neilson staining for acid fast bacilli (AFB)
 Dark ground illumination (DGI) microscopy for treponemes
 Wood’s lamp examination
Recommended Text Books
1. Illustrated Synopsis of Dermatology STD – Neena Khanna

2. Atlas of Dermatology – L.K. Bhutani
3. Atlas of Sexually Transmitted Disease - L.K. Bhutani
4. Leprosy- WH Jopling, AC McDougall
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EMERGENCY CARE
Broad Objective
The general objective of the course care is to train medical students in as much real life situations as
possible with well planned learning experiences.
Specific Objectives

1. Elicit a complete clinical history from the patient, relative or attendant, perform a thorough
general physical and systemic examination and interpret findings in a patient presenting as an
emergency both in the hospital as well as community settings.
2. Diagnose and initiate appropriate measures for common life threatening and non-life
threatening medical emergencies.
3. Requisition, justify and interpret relevant laboratory investigations that are cost effective,
keeping in mind the hospital resources, patient's socio-economic circumstances and
compliance.
4. Identify, provide first aid and refer complicated medical problems to secondary and tertiary
care centers at appropriate time.
5. Grade the severity or specify the type of emergency (wherever applicable) with the help of
clinical findings and supportive investigations.
6. Recognize complications arising as a result of the association of the emergency situation with
conditions like pregnancy, preexisting illness or disease and manage the complications.
7. Outline the role of the treatment initiated and monitor the recovery and recognize signs that
indicate deterioration of the case.
8. Maintain relevant data and notify concerned authorities (wherever necessary) regarding the
problem.
9. Manage medico-legal problems and discharge statutory obligations of a registered medical
practitioner.
10. Demonstrate leadership qualities, work in a team and play a meaningful role in disaster
preparedness and management.
11. Counsel and provide information to the individual, relative or attendant regarding the type,
severity, prognosis and medico-legal implications of emergency.
Orientation Program
This program will introduce the students to the emergency care component of their training.
The students will be familiarized with the emergency care areas of the hospital. They will be
provided with the names and phone numbers of the resource persons whom they can contact when
they face problems during the course.
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BASIC CONCEPTS
At the end of the course students should be able to:

1. outline principles of management of cases of drowning including the medico-legal
implications.
2. suspect poisoning by history and clinical features, institute immediate remedial measures and
fulfill medico-legal obligations in a case of common poisoning.
3. ascertain the nature of snake/animal/insect bite, institute immediate remedial measures and
administer specific therapy if the situation warrants.
4. examine and prepare report/certificates in medico-legal cases/situations according to the law
of Nepal.
5. write reports of ;
a. Injury case
b. Age estimation
c. Examination of accused in sexual offence
d. Examination of victim in sexual offence
e. Post mortem examination
6. write:
a. Death certificate
b. Illness certificate
7. obtain informed consent
8. record dying declaration
9. describe medico-legal implications in cases like
a. brought dead
b. death on arrival
10. Collect, label, preserve and dispatch specimens/samples to appropriate government authorities
for necessary examination.
11. outline the management of a battered baby.
MEDICAL EMERGENCIES
At the end of the course, students should be able to:

1. Obtain a brief and relevant history; perform rapid clinical evaluation to arrive at a logical
working diagnosis, request relevant investigations and institute immediate remedial measures
for following medical emergencies:
 Hepatic coma
 Hypertensive crisis
 Cardiac arrest
 Diabetic ketoacidosis and hypoglycemia
 Ischaeomic heart disease including myocardial infections
 Convulsive disorders including status epilepticus
 Hemoptysis
 Acute severe asthma
 Cerebral malaria
 Encephalitis and meningitis
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 Pneumothorax
 Heart failure and pulmonary oedema
 Acute gastroenteritis and cholera
 Adverse drug reaction and drug interactions.
 Shock and anaphylaxis
 Respiratory distress
 Comatose patient
 Anuria
 Hyperpyrexia
2. Interpret:
 EKG findings of myocardial infarction, cardiac arrest and arrythmia.
 skiagram of left ventricular failure, pneumothorax, pleural effusion.
3. Perform following procedures competently:

 Lumbar puncture
 Pleural and ascitic fluid tapping
 Naso-gastric tube insertion
SURGICAL EMERGENCIES

1. classify wounds
2. describe the principles of debridement and closure of wounds under local anaesthesia.
3. define
4. enumerate the causes of acute abdomen.
5. start initial management of common thoracoabdominal emergencies and head injuries.
6. start resuscitative measures for hypovolemic states.
7. enumerate the causes of haematuria and urethral rupture.
8. catheterize both male and female urethra.
9. institute primary immunization against tetanus.
PAEDIATRIC EMERGENCIES

1. diagnose by history and clinical examination and institute immediate life saving measures in
paediatric cases suffering from :
 Seizures
 Coma
 Peripheral circulatory failure
 Dehydration
 Cyanotic spell
 Congestive cardiac failure
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 Respiratory distress
 Acute renal failure
 Hyperpyrexia
 Hypothermia
 Asphyxia and cardiorespiratory arrest
ORTHOPAEDIC EMERGENCIES

1. Diagnose fractures clinically, identify associated neuro-vascular complications, splint the
affected part and advise specific X-rays.
2. Apply figure of "8" bandage, splints, PoP, slabs and skin traction and release tight plaster and
constricting structures.
3. Perform wound toileting and splintage of open fractures.
4. Evaluate and preserve safely fresh and clean amputated parts.
5. Suspect spinal injuries, recognize the associated complications, organize safe handling,
transport and supervise during radiological procedures.
6. Recognize, initiate resuscitation measures, apply splints and plan radiological evaluation of
fractures of pelvis and poly-trauma patient.
7. Outline the principles of organization and management of mass casualty according to the
specified protocol.
OBSTETRIC AND GYNAECOLOGICAL EMERGENCIES

1. Come to a provisional diagnosis by clinical examinations, request specific relevant
investigations, initiate immediate remedial measure to stabilize the patient and refer
appropriately in following emergencies:
 Bleeding P/V
 Convulsions during pregnancy.
 Coma during pregnancy.
 Acute abdomen during pregnancy.
2. Enumerate the causes of the above problems.
3. Recognize injuries of female genital tract, its medico-legal implications and take care of the
injuries promptly.
EMERGENCIES IN OTORHINOLARYNGOLOGY AND HEAD & NECK SURGERY

1. Diagnose, institute primary care management and refer appropriately in the following
emergency conditions:
Ear
b. Acute vertigo, acute otitis media and its related complications, sudden hearing loss and
foreign bodies.
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Nose and Para-nasal Sinuses
1. Epistaxis, foreign bodies, fractures of nasal bone and maxilla.
Oral cavity, pharynx, esophagus, larynx and tracheobronchial tree
1. Foreign bodies and peritonsillar abscess, stridor.
Neck
1. Blunt penetrating and short weapon injuries of the neck including cut throat.
2. Remove foreign bodies from oropharynx, nose and ear
3. Do anterior nasal packing
4. Syringe the ear
5. Do tracheostomy
OPHTHALMOLOGICAL EMERGENCIES

1. evaluate a patient with ocular injury and differentiate between surface injury (corneal abrasion
and ulcer), blunt injury and penetrating injury of the eye ball.
2. initiate primary treatment for ocular injury and refer them when required.
3. determine the medico-legal implications of ocular injuries and explain these to the patients/
attendants.
4. list the causes for unilateral and bilateral sudden loss of vision.
5. evaluate a patient with sudden loss of vision, requisition appropriate investigations, interpret
the clinical and investigative findings, institute remedial measures and refer appropriately.
6. List the causes for acute red eyes.
7. Treat infective and allergic conjunctivitis.
8. Diagnose, initiate appropriate remedial measures and refer following sight threatening causes
of the red eyes:
 Acute narrow angle glaucoma
 Acute iridocyclitis
 Corneal abrasion and ulcers
PSYCHIATRIC EMERGENCY

1. Conduct a comprehensive psychiatric evaluation, reach a provisional psychiatric diagnosis,
institute immediate remedial measures, request relevant investigations and refer to the
psychiatrist at appropriate time.
2. Recognize stupor and monitor input/output chart and general condition of the patient.
3. Make a provisional diagnosis after taking a brief history and physical examination, control
excitement of the patient and consult the psychiatrist as early as possible.
4. Recognize, asses and manage psychiatric cases posing danger to themselves and/or to others.
5. Recognize, asses and manage cases of drug overdose.
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Skills to be learnt during Postings in Emergency
 Catheterization
 Venesection
 Nasogastric, stomach, and flatus tube insertion.
 Pleural tapping
 Lumbar puncture
 Four quadrant abdominal tapping
 Collection of samples for medico-legal purposes
 Ophthalmoscopy
 P/V examination
 Communication with patient and relatives
 Cardiopulmonary resuscitation
 Airway insertion
 Positioning and alignment of patient
Prerequisites
a. Should have completed posting in major clinical subjects, related clinical disciplines and
forensic medicine.
b. Basic knowledge of:
 Fluid & electrolyte imbalance
 Cardio-pulmonary resuscitation.
 Emergency laboratory investigation.
 Imaging techniques
 Oxygen therapy
 Normal ECG reading.
c. Should know following procedures:
 Setting up IV lines & blood collection.
 Airway insertion
 Positioning & alignment
d. Blood grouping and cross matching.
a. Real life practical demonstration in emergency care area.

b. Case discussions
c. Integrated student seminars
d. Structured lectures
e. Simulator training
f. Role play
Learning Resources
 Study guide provided by the institution

 Simulator
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 Video tape demonstration
 Emergency patients
 Tape-slide programs
 Emergency kits
Text Books
1. Cardiopulmonary cerebral resuscitation by Peter Safar.

2. Short practice of clinical surgery - Bailey & Love
3. Hamilton Bailey's Clinical methods in surgery.
4. S. Das - Clinical surgery.
5. Pye's surgical handicraft
6. Ferquarhson's operative surgery
7. Parson's diseases of the eye.
8. Essential Orthopaedics - J. Maheswari
9. Apley's system of Orthopaedics & fractures - Apley & Solomon.
10. Diseases of Nose Throat and Ear by Simson I. Hall and Bernard H. Colman.
11. Medical emergencies in Paediatrics - Dr Meharban Singh. Sagar publications.
12. Modi's textbook of medical jurisprudence and toxicology.
13. Essentials of forensic medicine by Narayan Reddy.
14. Emergency psychiatry by Kaplan HI & Sadock BJ.
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FORENSIC MEDICINE
Broad Objectives

1. Describe the ethical and legal responsibilities of the physician towards the patient, profession,
society, state and humanity at large.
2. Enumerate relevant legal/court procedures applicable to medicolegal/medical practice.
3. Examine and prepare reports or certificates in medicolegal cases/ situations in accordance with
the law of Nepal.
4. Perform under supervision medicolegal postmortem and interpret autopsy findings and results
of the other relevant investigations to logically conclude the cause, manner and time since
death.
5. Preserve and dispatch specimens in medicolegal/ postmortem cases and other concerned
materials to the appropriate Government agencies for necessary examination.
6. Diagnose, outline the principles of therapy of common poisons and their medicolegal
importance.
7. Outline the general principles of analytical, environmental, occupational and preventive
aspects of toxicology.
Unit I
Forensic Medicine
Themes and Topics
1. Medical law and ethics

2. Identification
3. Medicolegal autopsy
4. Death and its medicolegal aspects
5. Mechanical injuries and wounds
6. Regional injuries
7. Traffic injuries
8. Death from heat, cold, electricity, starvation and lightning
9. Anaesthetic and operative deaths.
10. Mechanical asphyxia.
11. Virginity, pregnancy and delivery.
12. Abortion
13. Sexual offences.
14. Infanticide.
15. Forensic psychiatry.
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Objectives

a. Medical law and ethics:
 Describe code and law of medical ethics, unethical practices, dichotomy, consumer
protection act.
 Describe duties of a medical practitioner towards his patient and the society.
 Define consent, vicarious liability, malpractice; civil criminal and ethical, the doctrine of
res epsa loquitur, contributory negligence.
b. Identification:
 Define personal identity corpus delicti.
 Enlist medicolegal responsibilities related to age.
 Outline the principles involved in the methods of identification of a living person and a
dead body by race, age, sex, religion, complexion, stature, hair, teeth, anthropometry,
dactylography, foot prints, hairs, tatoos and poroscopy.
 Develop skills in examination of mutilated human remains, skeletal remains and in
exhumation.
c. Medicolegal autopsy
 Outline the principles involved in postmortem examination - objectives, procedures and
formalities of medicolegal autopsies.
 Enlist methods of preservation of viscera.
 Identify preserved specimens.
d. Death and its medicolegal aspects:

 Define and classify death; brain death
 Enumerate causes of sudden death and correlate with postmortem findings.
 Define presumption of death and survivorship
 Identify signs of death
 Estimate time of death
 Explain early and late changes after death
 Define suspended animation and conditions associated with it.
e. Mechanical injuries and wounds:

 Define, classify and differentiate abrasion contusion and laceration.
 Differentiate simple from grevious injuries
 Describe stab wound, incised wound, defence cut, hesitation cuts, self inflicted injuries,
fabricated wounds.
 Differentiate between accidental, suicidal and homicidal injuries.
 Determine the age of injury
 Classify firearms, and intepret the findings of firearm wounds.
 Explain the medicolegal aspects of wounds
f. Regional injuries.
 Enumerate types of skull fracture.
 Explain coup and counter coup injuries, intracranial haemorrhage and injury to brain.
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 Outline the injuries to: spinal cord, eye, thoracic, abdominal and pelvic viscera, bones and
joints and their medico legal importance.
g. Traffic injuries.
 State the importance of primary and secondary impact, crush syndrome, reconstruction of
railway accidents spine in relation to medico legal practice.
h. Death from heat, cold, electricity, starvation and lightening.
 Explain death occurring due to heat, cold, electricity, starvation, lightening and their
medico-legal importance.
i. Anaesthetic and operative deaths
 Describe the medico legal implications of anaesthetic and operative deaths.
j. Mechanical asphyxia
 Define and classify asphyxia.
 Outline causes, signs, postmortem appearances and medicolegal significance of hanging,
strangulation, throttling, smothering, choking, traumatic asphyxia and sexual asphyxias.
 Differentiate hanging from strangulation.
 Define and classify drowning. Describe postmortem findings and its medico-legal
importance.
k. Virginity, Pregnancy and delivery
 Explain medico legal aspects of virginity, pregnancy and delivery.
l. Abortion
 Define and classify abortion.
 Enumerate complications of criminal abortion.
 Outline investigative procedure in deaths due to criminal abortion.
m. Sexual offences
 Explain medico legal aspects of sexual offences/perversions.
 Outline principles in conduct of physical examination of victim and accused in case of
sexual offence.
n. Infanticide
 Define still birth and death birth and list the signs of live birth.
 Determine the age of foetus.
 Define cot death, battered baby and precipitate labour.
o. Forensic psychiatry
 Classify mental disorders.
 Define and classify delusions, hallucinations illusion, lucid interval and obsessions.
 State the mental health act.
 Differentiate true insanity from false insanity.
 Explain testamentary capacity, restraint of the insane.
 Describe insanity with reference to civil and criminal responsibilities, doctrine of
diminished responsibility and MC Naughten's rule.
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Unit II
Toxicology
Themes and Topics

1. General consideration of poisons.
2. Corrosive poisons.
3. Non metallic poisons.
4. Metallic poisons.
5. Vegetable poisons.
6. Animal poisons.
7. Somniferous poisons.
8. Inebriant poisons.
9. Deliriant poisons.
10. Sedative poisons.
11. Drug dependence.
12. Spinal poisons.
13. Cardiac poisons.
14. Asphyxial poisons.
15. War-gases.
16. Food poisoning and food adulteration.
17. Common household poisons.
18. Toxic hazards of occupation and industry.
Objectives

a. General Consideration of poisons:
 Describe general aspects of poisoning, laws relating to poison, duties of a doctor in case
of poisoning, & general principles of treatment in case of poisoning.
 Outline the conduct of medico-legal autopsy in poisoning; preservation, dispatch of
viscera for chemical analysis, role of forensic science laboratory.
b. Describe types of poison, fatal dose, fatal period, symptoms, signs, management and medico-
legal aspects of:
 Corrosive poisons: Sulfuric acid, nitric acid, hydrochloric acid, oxalic acid and carbolic
acid
 Non metallic poisons: Phosphorous, insecticides and pesticides & allied compounds.
 Metallic poisons: Arsenic, lead, mercury and copper.
 Vegetable poisons: Abrus, croton, risinus, semicarpus, capsicum, calotropis & ergot.
 Animal poisons: Snake bite, scorpion bite, bees bite.
 Somniferous poisons: Opium, pethidine & heroin.
 Inebriant poisons: Ethyl alcohol, methyl alcohol and barbiturates.
 Deliriant poisons: Dhatura, cannabis and cocaine.
 Sedatives: Chloral hydrate and bromides.
 Spinal poisons: Strychnine and brucine.
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 Cardiac poisons: Like-cyanide, aconite, digitalis, tobacco.
 Asphyxiant poisons: Carbon monoxide.
 Wargases
 Common household poisons: Kerosene, detergents.
 Food poisoning and food adulteration.
c. Enlist toxic hazards of occupation and industry.
a. Demonstration of museum specimens: Identification and description of medico-legal

importance of objectives.
b. Demonstration of ten postmortem examination of different types:
c. Preparation of reports.
 Injury case
 Age estimation
 Examination of accused in sexual offence.
 Examination of victim in sexual offense.
 Post mortem examination.
 Certificate writing of: Birth, illness and death
 Recording dying declaration.
 Obtaining informed consent in clinical practice.
d. Log book of practical experiences.
e. Lectures.
f. Problem solving exercise.
g. Role play.
h. Video cassettes.
Text Books
1. C.A. Franklin: Modis text book of medical Jurisprudence and Toxicology: N.M. Tripathi
private limited Bombay.
2. Narayan Reddy: The essentials of Forensic Medicine and toxicology: Suguna devi Hyderabad.
3. C.K. Parikh: Parikhs text book of Medical Jurisprudence and toxicology: CBS Publisher, New
Delhi.
4. Gresham and Turner: Post-mortem procedures: Walfe publications London.
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MEDICAL ETHICS AND PROFESSIONALISM
The general objective of the course is to provide an overview of many ethical issues that arise in the
practice of medicine and research.
More specifically the course introduces students to the core elements of ethical reasoning around
issues such as
 truth telling/breaking bad news
 confidentiality
 interpersonal & communication skills
 rationing
 professional boundaries
 conflicts of interest
 informed consent for treatment and research, and
 end-of-life care
 Euthanasia
The course also deals with inter-professional behavior and culture-sensitive behavior.
 Interactive sessions
 Seminars
 Case-based learning
References
 WHO guidelines of medical ethics and research

 Helsinki Declaration
 Nepal Health Research (NHRC) Guidelines
RESEARCH
The general objective of the course is to provide an overview of research methods.
More specifically the course introduces students about data collection methods, primary and
secondary data, measures of central tendency, data analyses, and result interpretations.
 Interactive sessions
 Exercises (Students in a group of 3-4 carry out simple research in any discipline applying
common standard tools).
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LABORATORY MEDICINE
Biochemistry
Themes and Topics

1. Jaundice
2. Renal function test
3. Myocardial Infarction
5. Thyroid function test
6. Pint of care testing (POCT)
7. Quality control
8. Reference range
Objectives
At the end of the course the students should be able to:

1. Differentiate various types of jaundice biochemically.
2. Describe the various tests involved in Renal function test, cardiac function test, thyroid
function test, diabetes mellitus and its clinical correlation.
3. Describe the various point of care testing used in the health care services.
4. State the importance of quality control in laboratory services and the role of reference
range in diagnosis making and patient management.
Microbiology
Themes and topics
1. Hospital-acquired infection and preventive measures

2. Hospital waste management
3. Diagnostic tests in infections
Objectives

1. Describe the principles of sterilization, disinfection and standard precautions and
understand their role in the prevention and control of the hospital acquired infection.
2. Describe the various methods of segregation and disposal of wastes generated in hospital.
3. Describe the significance of proper collection and transport of specimens for the diagnosis
of various infectious diseases.
4. Define and classify pyrexia of unknown origin (PUO), outline the approach to its lab diagnosis.
5. List the microbial agents causing intrauterine infection and explain its pathogenesis.
Describe the principle of diagnostic tests and their application.
6. Outline the principle, application and interpretation of commonly performed serological
tests for the diagnosis of infectious diseases.
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Pathology
Themes and topics

1. Laboratory Approach to Bleeding disorder
2. Laboratory Approach to Anemia
3. Laboratory Approach to Leukemia
4. Role of cytology and histology in diagnosis and patient management
Objectives
1. State the laboratory approach to a case of anemia.
 Enlist causes of anemia – etiologic classification
 Hemoglobin estimation, reference value according to WHO
 Importance of Red blood cell indices
 Interpretation of common investigations performed to arrive at a diagnosis.
2. State the laboratory approach to a case of Leukemia.
 Different types of Leukemic cells.
 Importance of cytochemical stains.
 Common CD markers (immunomarkers) used for the diagnosis and typing of
Leukemia.
3. State the laboratory approach to a case of bleeding disorder.
 Enlist causes of bleeding disorder.
 Principles and interpretation of platelet count, BT, CT, PT, APTT, D- dimer
estimation, factor assay.
4. Mention the role of cytology in early diagnosis of cancer.
 Have knowledge of relevance of various cytologic specimens and of test.
 Have basic concept of cytology as a tool in clinical investigation.
 Have knowledge of sample sources and their types.
 Know the advantages and limitations of cytology.
5. Mention the role of histopathology in diagnosis and patient management.
 Have basic concept of Histopathology as a tool in clinical investigation.
 Know about the types of histopathology specimens.
Objectives of Lab Postings (CBL)
Biochemistry
At the end of the laboratory posting the students should be able to:
1. Practice universal precaution.
2. Describe the steps of quality control in clinical biochemistry.
3. Identify the common errors involved with pre-analytical, analytical and post analytical phase
of lab test.
4. Collect samples in proper vials with suitable preservatives.
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5. Explain the concept of reference value in laboratory test.
6. Enumerate the test parameters involved with liver function, renal function, cardiac function
diabetes, fluid electrolyte balance, acid base disorders, thyroid function, reproduction, cancer.
7. State the methods/ techniques involved in the above tests.
8. Interpret the above test.
9. Differentiate emergency and specialized test parameters from that of routine test.
10. State the importance of Point of Care Testing (POCT) in laboratory care services.
Microbiology
1. Collect and store various specimens for laboratory tests in microbiology.
2. Perform and interpret blood smears for parasites.
3. Interpret the bone marrow/splenic aspirates smear for Leishmania donovani (LD) bodies.
4. Perform and interpret other diagnostic test for Kala-azar.
5. Perform the stool examination for ova and cysts and hanging drop for Vibrio-cholerae.
6. Perform and examine a wet film for vaginal smear for Trichomonas and Candida.
7. Perform and interpret Gram’s stain, Albert’s stain and Ziehl Neilsen stain of relevant
clinical specimens.
8. Interpret Mantoux test.
9. Interpret common serological tests such as Widal test, VDRL test, HIV ELISA and other
serological tests for diagnosis of various infection.
10. Interpret culture and sensitivity tests performed for the clinical bacterial isolates.
Pathology
I) Histopathology
1. Identify the fixative used for Histopathology specimen.
2. Know how to submit a specimen for Histopathologic evaluation –ie, amount of
fixative required, type of container preferred.
3. Know the fixative used for routine and frozen section
4. Have knowledge of the relevance of biopsy specimen.
5. Grossing: Observation of grossing technique and identify different types of biopsy
specimens.
6. Have knowledge about processing, ie, time required.
7. Stain: Observe H&E, AFB (T.B).
II) Cytopathology
1. Different fixatives used for cytologic Specimens.
2. Submit Specimens for Cytology, ie, Pap smear, serous fluids, urine for cytology and
sputum.
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3. Know the relevance of various cytologic specimens.
4. Observation of performance of FNAC.
5. Observation of processing of any sample in the cyto-laboratory
(FNAC smears, cytocentrifuge, cytospin).
III) Hematology (observe and interpret the results)

1. Observe blood collection for various hematologic lists.
2. Identify the anticoagulants and vials used for specific hematologic tests like CBC,
ESR, PT, aPTT.
3. Know the uses and reference values of the common tests performed like HB,TC, DC,
ESR, B, CT, PT, aPTT.
4. Collection and preparation of urine sample for RE/ME and its interpretation.
5. Observe peripheral smears for blood cell morphology: anemia and Leukemia.
6. Observe reticulocyte Stain.
7. Observe and perform ESR, PT, aPTT
8. Perform Total and Differential leukocyte count (Automated Analyser and Neubers
chamber), Hb estimation (methods) ESR.
9. Observe slides of urine and interpret the results.
1. Structured interactive session.

2. Posting in the clinical laboratory service (CBL).
3. Small group discussions.
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MEDICINE
Broad Objectives

1. identify the nature and extent of various health problems and medical diseases/disorders in
Nepal.
2. demonstrate a holistic approach towards a patient and evaluate each patient as a person and
not merely a collection of symptoms and signs.
3. develop the art of medicine involving communication with patients and their relatives,
demonstrate empathy, humane attitude and understand the importance of doctor-patient
relationship in providing medical care at all levels.
4. elicit a complete clinical history from the patient and/or attendant, perform a thorough general
physical and systemic examination and interpret findings and outline the principles of
management.
5. requisition, justify and interpret relevant laboratory investigations and perform common side-
lab procedures.
6. diagnose and outline the principles of management and also manage common medical
conditions of the individual and the community.
7. diagnose and provide appropriate measures for common life threatening medical emergencies.
8. identify, provide first aid and refer complicated medical problems appropriately to the
advantage of the patient.
9. practise rational use of drugs.
10. diagnose and institute appropriate measures for adverse drug reactions and notify the
authorities concerned.
11. enumerate complications resulting from the diseases in pregnancy, old age and in the presence
of pre-existing disease(s), and the principles of management of the same.
12. plan, implement and evaluate health programs and describe the mortality and morbidity data
pertaining to the major health problems of Nepal.
13. outline the principles of management of medico-legal problems and discharge statutory
obligations of a registered medical practitioner.
14. learn to adapt to new ideas and situations where patient, community or hospital resources may
be limited.
15. demonstrate an understanding of ethical and legal implications of his medical decisions.
16. demonstrate a spirit of enquiry and an understanding of basic research methodology.
Basic Concepts
Prerequisites
 Temperature regulation
 Physiology of respiration
 Normal and abnormal heart sounds.
 Pathophysiology of anemia
 Pathophysiology of shock.
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 Formation of urine.
 Physiology of micturition.
 Fluid and electrolyte balance.
 Regulation of gut motility.
 Liver function tests.
 Surface anatomy of liver and spleen.
 Anatomical distribution of Lymph nodes.
 Nutrition and metabolism.
 Cerebral circulation.
 Electrophysiology of brain and EEG.
 Physiology of cerebral, cerebellar and vestibular systems.
 Concept of upper and lower motor neurone lesions.
 Locomotor system.
 Acid Base Balance.
Themes and Topics
A. Common symptoms and Signs of Disease

1. Pain
2. Fever
3. Cough, expectoration and haemoptysis.
4. Dyspnoea, tachypnoea and orthopnoea.
5. Cardiac murmurs: functional and organic.
6. Pallor and Cyanosis.
7. Haemorrhage, shock and cardiovascular collapse.
8. Common urinary symptoms including dysuria, oliguria, nocturia, polyuria, incontinence
and enuresis.
9. Oedema and anasarca.
10. Anorexia, nausea and vomiting.
11. Constipation, Diarrhea and dehydration.
12. Haematemesis, melaena and haematochezia.
13. Jaundice and hepatomegaly.
14. Enlargement of lymph nodes and spleen.
15. Abdominal swelling and ascites.
16. Obesity, weight loss and weight gain.
17. Fainting, syncope and seizures.
18. Headache, dizziness and vertigo.
19. Disorders of movement and gait.
20. Paresis and paralysis.
21. Coma and disturbances of consciousness.
22. Joint pain, backache and pain in the extremities.
B. General Topics
1. Fluid and electrolyte disturbances.
2. Acid-base disturbances.
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Objectives
At the end of the unit the student should be able to:

1. demonstrate a rational clinical approach to the patient with regard to the art of medicine,
doctor-patient relationship and communication skills.
2. elicit relevant signs on physical examination based on symptomatology.
3. deduce diagnostic possibilities based on the interpretation of clinical history, physical
findings, laboratory investigations and outline principles of management.
4. maintain a comprehensive case record of the patient's complaints, all relevant findings,
investigations and the line of management.
RESPIRATORY SYSTEM
Prerequisites
1. Pulmonary Function Tests.

2. Sputum examination.
3. Common micro-organisms of the respiratory tract.
4. Gram staining and ZN staining.
5. Pharmacology of antitubercular drugs, bronchodilators, antitussives, antihistaminics.
6. Hazards of smoking.
7. Pathology of pulmonary neoplasms.
Themes and Topics
1. Tuberculosis
2. Acute upper and lower respiratory infections
3. COPD and cor pulmonale
4. Acute respiratory distress.
5. Naso-bronchial allergies.
6. Suppurative lung disease
7. Pleural diseases - pleural effusion, empyema and pneumothorax.
8. Neoplasms of the lung.
9. Common occupational lung diseases.
Specific Objectives
At the end of the unit, the student should be able to:

1. describe the clinical features, correlate them with pathophysiology, arrive at a logical
diagnosis and outline principles of management of the following common respiratory diseases
- URI, pneumonias, pulmonary tuberculosis, bronchial asthma, acute and chronic bronchitis,
pleural effusion, cor pulmonale, bronchiectasis, bronchogenic carcinoma, lung abscess and
respiratory failure.
2. diagnose and initiate treatment for the following respiratory emergencies: Haemoptysis,
pneumothorax and acute severe asthma and acute respiratory distress due to other causes.
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3. diagnose, provide initial treatment and refer uncommon and complicated cases of lung
collapse, neoplasms of lung, interstitial lung diseases and common occupational lung diseases.
4. interpret x-ray chest and sputum reports with reference to common respiratory diseases.
Prerequisites
1. Anatomy and physiology of cardiovascular system.

2. Pathophysiology of cardiovascular diseases.
3. Pharmacology of drugs acting on cardiovascular system
4. Microorganisms involved in rheumatic fever, rheumatic heart disease and infective
endocarditis.
Themes and Topics
1. Rheumatic fever and rheumatic heart disease.

2. Infective endocarditis.
3. Hypertension and hypertensive heart disease.
4. Coronary artery disease.
5. Acute and chronic heart failure.
6. Common congenital heart diseases in adolescents and adults: ASD, VSD, PDA, TOF and
coarctation of aorta.
7. Common cardiac arrhythmias.
8. Acute and chronic pericarditis, pericardial effusion and cardiac tamponade.
9. Cardiomyopathies.
10. Common aortic diseases, peripheral vascular disease: arterial and venous.
Objectives

diagnosis and outline principles of management of the following common diseases:
Rheumatic fever and RHD, Infective endocarditis, common congenital heart diseases (ASD,
VSD, PDA, TOF, Coarctation of aorta), coronary artery disease, congestive cardiac failure,
hypertension, pericarditis, pericardial effusion and common cardiac arrhythmias
2. diagnose and initiate treatment for the following life threatening cardiac emergencies: Acute
pulmonary oedema, acute MI, Cardiogenic shock, Thromboembolism, Cardiac arrest and
cardiac tamponade.
3. diagnose, provide initial treatment and refer cardiomyopathies, myocarditis, uncommon
congenital heart diseases, aortic aneurysms, syphilitic cardiac complications and peripheral
vascular diseases appropriately.
4. interpret ECG, x-ray chest and echocardiographic findings with reference to common cardio-
vascular diseases.
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GASTROINTESTINAL TRACT
Prerequisites
1. Anatomy of the GIT.

2. Physiology of GI secretions and motility.
3. Physiology of digestion and absorption.
4. Pathology of inflammatory and neoplastic disorders of GIT.
5. Pharmacology of drugs acting on the GIT.
6. Microbial pathogens of GIT.
Themes and Topics
1. Diarrhea and dysentery.

2. Helminthiasis.
3. Food poisoning.
4. Constipation.
5. Malabsorption syndromes.
6. Acid peptic disease.
7. Tuberculosis of the GI tract.
8. Enteric fevers.
9. Upper and Lower GI bleeding.
10. Acute abdomen.
11. Intestinal obstruction.
12. GI malignancies.
13. Ulcerative colitis.
Objectives

diagnosis and outline principles of management of the following common GI diseases: Acute
appendicitis, Diarrhea , helminthiasis, abdominal tuberculosis, Enteric fever, ulcerative colitis,
upper and lower GI malignancies, acute intestinal obstruction, upper and lower GI
haemorrhage.
2. diagnose and provide primary care and refer them for special investigations - ulcerative colitis,
malabsorption syndrome, peptic ulcer, upper and lower gastrointestinal malignancies.
3. counsel the individual, family and the community about prophylaxis measures.
4. Interpret the results of stool examination, endoscopy and common radiological procedures
with reference to common gastrointestinal diseases.
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HEPATO-BILLARY SYSTEM AND PANCREAS
Prerequisites
1. Anatomy of hepato-biliary system and pancreas.

2. Functions of the liver.
3. Liver function tests.
4. Aetiopathogenesis of hepatitis, cirrhosis, cholecystitis and tumors of the liver and pancreas.
5. Microbes causing hepatitis.
6. Metabolism of drugs in the liver.
7. Hepatotoxic drugs.
8. Exocrine-pancreatic function tests.
Themes and Topics
1. Hepatitis.
2. Jaundice.
3. Cholecystitis.
4. Cholelithiasis.
5. Pancreatitis.
6. Cirrhosis.
7. Liver abscess.
8. Portal hypertension.
9. Liver failure.
10. Ascites.
11. Hepato-bilary and pancreatic malignancies.
12. Alcoholic liver disease.
Objectives

diagnosis and outline the principles of management of the following common hepatobiliary
and pancreatic diseases: Acute hepatitis (Viral, alcoholic and drug-induced); liver abscess-
pyogenic and amoebic, chronic liver disease, cirrhosis of liver, portal hypertension, and
pancreatitis.
2. diagnose and initiate primary care management for life-threatening emergencies: variceal
bleeding, Acute pancreatitis, Acute hepatic encephalopathy and Acute cholecystitis.
3. diagnose, provide initial treatment and refer cases of malabsorption syndrome, cholecystitis,
cholelithiasis, hepatobiliary, and pancreatic malignancies, and hydatid disease of liver.
4. Counsel the individual, family and community on prophylactic measures.
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NUTRITION
Prerequisites
1. Energy and nutrient metabolism

2. Nutritional requirements and sources.
3. Balanced diet
Themes and Topics
1. PEM
2. Nutritional Anemia
3. Iodine deficiency.
4. Hypo-and hyper-vitaminoses
5. Deficiencies of mineral and trace elements.
6. Obesity.
7. Hyperlipidemias.
8. Special diets.
Objectives

1. plan and advise on nutritional requirements in adults in different states of health and disease.
2. diagnose common nutritional disorders in adults with special reference to PEM, nutritional
anemia, Iodine deficiency disorders, vitamin deficiency and excess, osteomalacia and obesity.
3. counsel the individual, family and community regarding prevention of nutritional disorder.
METABOLIC, ENDOCRINE AND REPRODUCTIVE DISORDERS
Prerequisites
1. Structure and functions of endocrine glands and reproductive system.

2. Regulation of hormone synthesis and secretion.
3. Aetiopathogenesis of endocrine disorders.
4. Pharmacology of drugs used in endocrine disorders.
Themes and Topics
1. Diabetes mellitus.
2. Thyroid disorders.
3. Disorders of Pituitary.
4. Disorders of sex organs.
5. Adrenal gland disorders (Cushing's & Addison's).
6. Pheochromocytoma.
7. Metabolic Bone disease.
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Objectives

1. Describe the clinical features, correlate them with pathophysiology, requisition investigations,
interpret and arrive at a logical diagnosis and outline principles of management of diabetes
mellitus, hypo-and hyperthyroidism, IDD, Cushing's syndrome, Addison's disease,
Acromegaly, Gout and metabolic bone disease.
2. Diagnose and initiate primary care management of hypoglycemic and hyperglycemic coma.
3. Diagnose and initiate primary care management and refer cases of Addisonian crisis,
thyrotoxic crisis and myxedema coma.
4. Describe the clinical features, diagnose and refer appropriately the cases of
phaeochromocytoma, dwarfism, gigantism, hypopituitarism, including Sheehan's syndrome,
hypogonadism, impotence and loss of libido.
5. Interpret lab reports of glucose tolerance test and other common tests performed for
assessment of endocrine function.
HAEMOPOIETIC AND RETICULOENDOTHELIAL SYSTEMS
Prerequisites
1. Anatomical distribution of haemopoietic, reticuloendothelial and lymphoid tissues.
2. Haemopoiesis.
3. Haemostasis.
4. Iron, folic acid and B12 metabolism.
5. Etiology, classification and morphological features of anemia, Leukemia and Lymphomas.
6. Performance of basic haematological procedures.
7. Parasitic diseases associated with anemia.
8. Heme metabolism.
9. Drugs related to or causing haematologic disturbances.
10. Pharmacology of haematinics
11. Pharmacology of cytotoxic drugs.
12. Principles of blood grouping and cross matching.
Themes and Topics
1. Anemia
2. Leukemia
3. Platelet disorders.
4. Polycythemia.
5. Lymphomas - Hodgkin's and Non Hodgkin's
6. Bleeding disorders.
7. Lymphoreticular malignancies.
8. Disorders of the Immune system.
9. Blood transfusion and component therapy
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Objectives
At the end of the unit the students should be able to:

1. describe the clinical features, relate them to pathophysiology diagnose, treat and advise
prophylatic measures for prevention of deficiency anemia, specially Iron deficiency, fobic
acid and vitamin B12 deficiency anemia.
2. describe the clinical features, correlate them with pathophysiology, investigate, arrive at a
logical diagnosis and outline the principles of management of common haemolytic anemia
(Thalassemia, Sickle cell anemia, acquired haemolytic anemia), hypoplastic and aplastic
anemia, agranulocytosis, bleeding and coagulation disorders, polycythemia, Leukemia,
lymphomas and porphyrias.
3. describe the clinical features, investigate and diagnose immunocompromised states including
that due to HIV infection.
4. diagnose, institute primary care management and refer the following emergencies: acute
intermittent porphyria, acute hemolytic crisis, acute presentation of bleeding and coagulation
disorders.
5. plan and undertake safe blood transfusion; outline concepts of transfusion and component
therapy, indications for transfusion therapy, precautions to be taken, hazards of transfusion
and safe handling of blood and blood products.
6. perform and interpret common hamatological investigations.
FLUID-ELECTROLYTE AND RENAL DISORDERS
Prerequisites
1. Structure and functions of the urinary system.

2. Fluid and electrolyte balance.
3. Acid base balance.
4. Renal function tests.
5. Pathogens of the urinary system.
6. Immunopathology of renal diseases.
7. Pharmacology of drugs used in urinary disorders.
8. Nephrotoxic drugs.
9. Urinalysis.
Themes and Topics
1. Acute and chronic glomerulonephritis.

2. Acute and chronic pyelonephritis.
3. Renal Failure.
4. Nephrotic syndrome.
5. Urinary tract infections.
6. Fluid and Electrolyte disturbances.
7. Acid-base balance.
8. Haematuria.
9. Renal calculi.
10. Renal malignancies.
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Objectives

diagnosis and outline the principles of management of acute and chronic glomerulonephritis,
nephrotic syndrome, UTI, Acute pyelonephritis, acute renal failure and chronic renal failure.
2. identify the common causes, arrive at a logical diagnosis institute primary care treatment and
refer patients presenting with haematuria, acute renal failure, dehydration, acidosis and
alkalosis and renal colic.
3. outline the principles involved in peritoneal and haemo dialysis. Enumerate the indications
and possible complications of dialysis.
4. perform and interpret routine urinalysis.
5. interpret common lab reports on urine examination, blood gas estimations and serum
electrolyte estimations.
CENTRAL NERVOUS SYSTEM
Prerequisites
1. Cerebral circulation.
2. Basic structures and connections of the central nervous system.
3. Motor and sensory tracts and concept of upper motor neurons and lower motor neurons.
4. Blood Brain Barrier and physiology of CSF.
5. CSF analysis.
6. EEG.
7. Bacteria and viruses causing meningitis and encephalitis.
8. Pathogenesis of common CNS disorders.
9. Pharmacology of drugs used in CNS disorders.
Themes and Topics
1. Migraine.
2. Meningitis.
3. Encephalitis
4. Poliomyelitis.
5. Cerebro-vascular accidents.
6. Seizure disorders.
7. Parkinsonism and movement disorders.
8. Guillain-Barre syndrome.
9. Peripheral neuropathies.
10. Paresis, paraplegia, hemiplegia and quadriplegia.
11. Myasthenia Gravis.
12. Common muscular dystrophies.
13. Degenerative and demyelinating diseases.
14. Cord compression.
15. Intra-cranial SOL including brain abscess.
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Objectives

1. take a complete history pertaining to the CNS, assess the mental functional status, speech and
level of consciousness in a fully conscious, semiconscious or unconscious patient and initiate
primary care for patients with different levels of consciousness.
2. describe the clinical features relate them to patho-physiology, requisition relevant
investigation, arrive at a logical diagnosis and outline the principles of management of:
migraine meningitis, seizure disorders, cerebro-vascular accidents, polyneuropathy,
parkinsonism and movement disorders.
3. diagnose and institute primary care management for emergencies - cerebrovascular accidents,
status epilepticus, coma, traumatic cord compression and acute neuropathies.
4. diagnose, provide initial treatment and refer the following: poliomyelitis, cord compression,
intra-cranial SOL including brain abscess, encephalitis, myasthenia gravis, muscular
dystrophies, motor-neuron disease, other degenerative and demyelinating cerebral and
cerebellar diseases.
5. interpret lab reports on CSF.
6. interpret radiological and other common investigations related to the nervous system.
MUSCULO-SKELETAL SYSTEM AND COLLAGEN VASCULAR DISORDERS
Prerequisites
1. Anatomy of locomotor system.

2. Mechanical and electrical properties of skeletal muscle.
3. Immuno pathogenesis of collagen-vascular diseases.
4. Non steroidal anti-inflammatory drugs.
5. Corticosteroids and other immunosuppressant drugs.
Themes and Topics
1. Rheumatoid arthritis.
2. SLE
3. PSS
4. Dermato-and polymyositis.
5. Osteoarthritis.
6. Tetanus
Objectives

1. Describe the clinical features, correlate with pathophysiology, arrive at a logical diagnosis and
outline the principles of management of rheumatoid arthritis osteoarthritis and SLE.
2. Diagnose and initiate supportive measures and refer cases of dermato and poly-myositis and
acute presenations of vasculitides.
3. Interpret common lab reports related to immune function.
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INFECTIOUS AND TROPICAL DISEASES
Pre-requisites
1. Epidemiology of communicable diseases.

2. National Health Programs.
3. Life cycles of Protozoa and parasites
4. Anti-microbial drugs.
5. Anthelmenthics.
6. Basic concepts of immunization.
Themes and Topics
1. Malaria
2. Kala-azar
3. Filariasis
4. Tuberculosis
5. Enteric fever
6. Amoebiasis and Giardiasis
8. PUO
9. Viral fevers including dengue fever
10. Diphtheria
11. Tetanus
12. Leprosy
13. Plague
14. HIV and AIDS
15. Rabies
16. Snake and insect bites
17. Brucellosis.
18. Helminthiasis.
19. Cysticercosis.
20. Hydatid disease.
21. Toxoplasmosis.
22. Pneumocystis carinii infection
23. Immunization in adults.
Objectives

1. Describe the clinical features, relate with pathophysiology, arrive at a logical diagnosis and
outline the principles of management of the following: Malaria, Kala-azar, Filariasis,
Tuberculosis, enteric fever, Inf. hepatitis, PUO, Viral fever including Dengue fever,
Diphtheria, Tetanus, Leprosy, Plague, HIV and AIDS, Snake and insect bites, Amoebiasis and
Giardiasis, Brucellosis, Rabies.
2. Diagnose, and initiate primary care management for the following emergencies: Cerebral
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malaria, Tetanus, enteric encephalopathy, TBM, Snake bites, Diphtheria.
3. Describe the clinical features, diagnose and refer cases of toxoplasmosis, PCP, Hydatid
disease, cysticercosis, Rabies, Tetanus, Plague and Leprosy.
4. Counsel the individual, family and community regarding prophylactic and rehabilitative
measures.
5. Interpret common investigations related to infectious diseases.
POISONING, ENVIRONMENTAL AND OCCUPATIONAL DISORDERS
Prerequisites
1. Common Poisons
2. High-risk occupations.
Themes and Topics
1. Occupational lung diseases.

2. High altitude sickness
3. Motion sickness
4. Allergic disorders
5. Heat injuries
6. Cold injuries
7. Drowning
8. Radiation hazards.
9. Common poisonings:
Acute - rodenticide, pesticides, insecticides, corrosives
Chronic - Lead, Arsenic, Mercury
10. Smoking, alcohol and Drug abuse.
Objectives

1. describe the clinical features, correlate with pathophysiology, arrive at a logical diagnosis and
outline the principles of management of common poisoning, Heat and cold injuries and
motion sickness.
2. Diagnose and initiate primary care for the following emergencies: Heat stroke, Hyperpyrexia,
cold exposure, acute altitude sickness and severe allergic conditions.
3. Diagnose, provide first-aid and refer complicated cases.
1. Didactic Lectures
2. Integrated Seminars*
3. Group discussions
4. Outpatient postings
5. Ward postings
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6. Bed side case demonstration and/or discussion
7. Case presentation
8. Clinico-pathological exercises
9. Medical case studies
10. Demonstration of procedures and/or performance of procedures under supervision.
11. Learning in field (LIF)
* Suggested Integrated Seminars:
Management of TB +-- Medicine

+-- Pharmacology
+-- Community Medicine
+-- Microbiology
Rheumatic heart +-- Paediatrics

disease +-- Medicine
+-- Obst/Gynae.
+-- Surgery
Hypertension +-- Medicine

+-- Obst. & Gynae
+-- Pharmacology
+-- Physiology
Atherosclerosis +-- Biochemistry

+-- Pathology
+-- Medicine
Acid-Peptic disease +-- Medicine

+-- Surgery
+-- Pharmacology
+-- Physiology
Management of
Upper and Lower +-- Medicine
GI Bleeding +-- Surgery
Acute abdomen +-- Medicine

+-- Surgery
+-- Obst. & Gynae
Management of +-- Medicine

Jaundice +-- Surgery
+-- Pathology
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Management of +-- Medicine
Diabetes Mellitus +-- Obst. & Gynae.
+-- Pathology
Immuno compromised +-- Medicine

state +-- Surgery
+-- Microbiology
Management of fluid, +-- Medicine

and electrolyte, +-- Biochem/Physio.
disturbances +-- Surgery
+-- Anaesthesia
Management of acid +-- Medicine

base disorders +-- Biochem/Physio.
+-- Surgery
+-- Anaesthesia
Management of pain +-- Medicine

+-- Anaesthesia
+-- Pharmacology
+-- Physiology
Nosocomial +-- Medicine

infections +-- Microbiology
+-- Surgery
+-- Pharmacology
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List of Skills for the MBBS Students
At the end of an undergraduate training program the student should be able to:
1. Obtain a proper relevant history, perform a humane and thorough clinical examination
including internal examination (per/rectal, per-vaginal) and examination of all organs/systems
in adults, children and neonates.
2. Use stethoscope, B.P. Apparatus, Thermometer, weighing scales, Percussion Hammer,
Measuring Tape and Tuning Fork.
3. Interpret biochemical laboratory values of common diseases.
4. Interpret skiagrams of chest and abdomen.
5. Identify irrational prescriptions and explain their irrationality.
6. Interpret serological tests such as VDRL, ASLO, Widal, HIV, Rheumatoid factor, Hepatitis
and TORCH infections.
7. Interpret antimicrobial sensitivity reports.
8. Interpret peripheral blood smear for common diseases.
9. Write a complete case record with all necessary details.
10. Adopt universal precautions for self protection against HIV and hepatitis and counsel patients.
11. Organize and carry out investigation of an epidemic and institute corrective/preventive
measure.
12. Record visual acuity.
13. Perform lumbar puncture.
14. Catheterize bladder in both males and females.
15. Prepare ORS.
16. Advise dietetic management in different diseases.
17. Provide first aid to patients with peripheral vascular failure and shock.
18. Manage acute anaphylactic shock.
19. Manage Diarrhea /dysenteries; Assess dehydration; Prepare and administer oral rehydration
therapy (ORT).
20. Manage emergencies of drowning.
21. Manage common poisonings.
22. Do complete urine examination including microscopy.
23. Perform and interpret Hb assay, TLC, DLC, ESR, PCV, BT, CT and blood smear for parasites
and red cell morphology.
24. Perform stool exam for ova, cysts, and occult blood; and hanging-drop for Vibrio cholerae.
25. Perform and interpret Gram's stain, Albert's stain, Ziehl - Nielsen or modified Ziehl Nielsen's
stain.
26. Record and interpret an ECG and be able to identify common abnormalities such as
myocardial infarction and common arrhythmias.
27. Start i.v. line and infusion in adults.
28. Give intradermal/SC/IM/IV injection.
29. Perform CPR (Cardiopulmonary resuscitation).
30. Manage acute severe bronchial asthma.
31. Institute primary care for epilepsy and status epilepticus.
32. Institute primary care for comatose patients regarding airway, positioning, prevention of
aspiration and injuries.
33. Manage hyperpyrexia.
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Learning Resources
Textbooks
1. "Davidson's Principles and Practice of Medicine" Ed. CRW Edwards, IAD Bouchier, ELBS,
Livingstone.
2. "Clinical Medicine" by Kumar PJ & Clark ML, ELBS.
Clinical Methods in Medicine
1. Hutchison's "Clinical Methods", Revised, latest edition– Ed. Swash M, ELBS Publications.
2. Macleod's Clinical Examination, Eds, Munro J. and Edwards C., ELBS.
3. Chamberlain's "Symptoms and Signs in Clinical Medicine", An Introduction to Medical
Diagnosis". Eds. Ogilivie C, Evans CC, ELBS Publications.
4. Neurological examination in clinical practice. Backerstaff.
Emergency Medicine
1. Manual of Medical Emergencies. Washington Manual.
Reference books in Medicine
1. Harrison's "Principles of Internal Medicine", Eds. Wilson JD, Braunwald E, Isselbacher KJ,
Perdorf RG, Martin JB, Fauci AS, Root RK, McGraw Hill Publications.
2. Cecil's "Textbook of medicine" Ed. Wyngaarden JB, Smith LH, Bennett JC. WB Saunders.
3. "Oxford Textbook of Medicine" Vol I and II, by Weatherall DJ, Ledhingham JGG, Warrell
DA, ELBS Publication.
Tropical Medicine
1. Textbook of Tropical Medicine by Manson and Barr.
Problem-based approach to clinical medicine
1. Problem oriented Diagnosis, Ed. H. Harold Freidman, Little Brown Publications.
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OBSTETRICS & GYNAECOLOGY
Broad Objectives
1. Participate in all national health programs and policies related to reproductive health and safe
motherhood.
2. Define terms commonly used in obstetrics and gynecology.
3. Demonstrate skills of history taking and performing obstetric and gynecological examination
in order to arrive at a logical diagnosis.
4. Recognize clinical features of common obstetric and gynecological disorders correlate these
with etio-pathology and institute primary management.
5. Diagnose pregnancy and provide antenatal, natal, post-natal and essential newborn care.
6. Identify high risk pregnancy, provide primary care and refer to appropriate medical centres.
7. Prescribe drugs judiciously during pregnancy and lactation.
8. Screen women for genital and breast cancer for early diagnosis and prevention.
9. Counsel and guide patients and family regarding illness, care, possible complications and
prognosis.
10. Counsel couples and provide fertility regulation.
11. Acquire and practise communication skills required for taking informed consent and
providing reproductive health care to women.
12. Handle medico-legal and ethical issues related to obstetrics and gynecology.
13. Diagnose and provide primary care of common obstetric and gynecological emergencies.
Themes and Topics
1. Introduction to obstetrics and gynaecology

 Terms used in obstetrics, gynaecology and fertility regulation.
 Demography
 National health policy for reproductive health care and safe motherhood.
Pre-requisites
 Definition of maternal, perinatal, neonatal and inant morality.

 Birth rate, death rate, growth rate, net reproduction rate.
 Available health care infrastructure.
Objectives
1. Define obstetrics, gynaecology, safe motherhood and reproductive health.
2. List components and goals of National Health Policy with reference to reproductive health and
safe motherhood and productive health and safe motherhood.
3. Identify socio-cultural, economic and demographic factors influencing reproductive health of
women.
4. List causes of maternal and perinatal mortality in order of relative importance.
5. Describe current mortality and morbidity status of the nation.
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 Clinical posting in the department and community posting.
 Integrated seminar with the department of community medicine.
 Case Assignment and follow up.
 Handouts
 Reading assignment
 RC
 Case presentation
 Family study, diagnosis and management, and referral.
2. Management of Normal Pregnancy

 Development of placenta and development and growth of foetus.
 Maternal adaptation to pregnancy.
 Diagnosis of pregnancy.
 Screening for high risk pregnancy.
 Fetal surveillance for growth and well being.
Pre-requisites
 Physiology of ovulation, menstruation, fertilization and conception.

 Early development of fetus and placenta.
 Nutrition requirements during pregnancy and lactation.
Objectives

1. Explain the process of conception.
2. Describe placental and foetal development and growth.
3. Enumerate abnormal development of placenta and foetus.
4. List the metabolic, endocrinal, cardiovascular, haemotological, respiratory, uro-genital and
breast changes during pregnancy and lactation.
5. Diagnose pregnancy by history, clinical examination, laboratory investigations and
ultrasonography.
6. Identify the high risk factors in pregnant women and make appropriate referrals.
7. Provide periodic antenatal care and immunization.
8. Define commonly used terminology in pregnancy.
9. Enumerate drugs which are safe during pregnancy, adverse effects of commonly used drugs
and drugs to be avoided during pregnancy and lactation.
10. Monitor fetal growth and well being and identify deviations from normal.
 Clinical posting in outdoor and indoor, minor operation theatre and labour room.
 Laboratory diagnosis of pregnancy (gravindex).
 Problem based learning.
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 Integrated seminar with radiology department.
 Use of Gravidogram.
 History taking, examination, and follow up of normal pregnancy.
 Lectures.
3. Management during labour

 Mechanism of normal labour.
 Intrapartum monitoring and use of partogram.
 Pain relief during labour.
 Management of normal delivery.
 Management of third stage.
Pre-requisites
 Anatomy of pelvis including different types of pelvis.
Objectives

1. Describe various fetal presentations. Positions and diametes of fetal skull in relation to
maternal pelvis.
2. Describe physiology of initiation of labour.
3. Describe mechanism of labour in vertex presentation.
4. Diagnose true labour and monitor progress of labour using partogram.
5. Identify deviations from normal.
6. Conduct pelvic examination during labour.
7. Identify different stages of labour.
8. Describe measures for pain relief during labour.
9. Conduct normal delivery with or without episiotomy.
10. Manage third stage of labour.
 Perform and stitch episiotomies. Plot of partogram for 5 normal labour and 5 abnormal
labour cases. Conduct 10 normal deliveries and assist in 5 abnormal deliveries. Pelvic
examination under supervision.
 Labour room posting.
 Log book recording.
 Seminar and group discussion.
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4. Menstrual function and dysfunction
 Menstrual disorders
 Dysmenorrhoea
 Abnormalities of menarche and menopause.
Pre-requisites
 Developmental anatomy of genital tract.
 Physiology of ovulation, menstruation, menarche and menopause.
 Endocrinology of menstrual cycle and menopause.
Objectives
1. Define primary and secondary amenorrhoea, menorrhagia, polymenorrhoea, metrorrhagia.
Oligomenorrhea and dysmenorrhoea.
2. List causes of primary and secondary amenorrhoea and other menstrual dysfunctions.
3. Diagnose and manage a patient with menstrual dysfunction.
4. List indications of and assist in endometrial biopsy, cervical dilatation and curettage, cervical
biopsy and endometrial aspiration.
5. Describe abnormalities of puberty and menopause.
6. Prepare a slide for assessment of hormonal status for vaginal cytology.
 Outpatient, minor operation theatre, gynaecology ward posting.
 Integrated seminar.
 To perform, endometrial biopsy and endometrial aspiration under supervision.
 lectures, handouts, reading assignments.
 Group discussion.
 PBL (Menstrual dysfunction)
5. Common Gynaecological Symptoms
 Vaginal discharge
 Pain abdomen.
 Abdominal mass.
 Utero-vaginal prolapse.
Pre-requisites
 Anatomy of abdominal and pelvic organs.
 Microbiology of normal vaginal flora.
 Common pathogens of the female urogenital tract.
 Supports of the uterus and vagina.
 Antibacterial, antifungal and antiviral drugs.
Objectives
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1. List the causes for vaginal discharge, pain abdomen, abdominal mass and utero-vaginal
prolapse.
2. Correlate clinical findings and investigation results with symptomatology.
3. Initiate primary management and identify conditions needing referral.
 Clinical posting in gynaecology ward and outdoor.

 Preparation of wet smear for Trichomonas, Monilial and Gonococcal infection.
 Integrated seminar with other disciplines like microbiology, pharmacology and anatomy.
 Case presentation.
6. Complications in Pregnancy
Complications of early Pregnancy

 Abortions
 Ectopic pregnancy
 Gestational trophoblastic tumors
 Hyperemesis gravidarum
 Retention of urine
Obstetric Complications
 Multiple pregnancy
 Malpresentations
 Antepartum Haemorrhage
 Pregnancy induced hypertension and eclampsia
 Preterm labour and premature rupture of membranes.
 Intracuterine growth retardation.
 Rh Isoimmunisation.
 Intrauterine fetal death
 Repeated pregnancy loss
Medical Complications
 Anemia
 Hypertensive disorders
 Renal disorders
 Cardio vascular disorders
 Diabetes mellitus
 Jaundice
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Surgical Complications
 Appendicitis
 Intestinal obstruction
 Acute abdomen
 Twisted ovarian cyst
Infections During Pregnancy

 Malaria
 Tuberculosis
 Syphilis
 TORCH infections
 AIDS
Pre-requisites
 Normal physiology of pregnancy

 Nutrition during pregnancy
 Intra-uterine development and growth of foetus
 Blood groups and isoimmunization
 Bacterial, parasitic and viral infections.
 Initiation of labour.
 Pharmacology of commonly used drugs.
Objectives
Complications of early pregnancy

1. List causes of bleeding during early pregnancy.
2. Define, diagnose and describe management of ectopic pregnancy.
3. diagnose and outline the principles of management of different types of abortions including
septic abortions.
4. Diagnose and outline the principles of management of patients with gestational trophoblastic
neoplasms.
5. List causes of hyperemesis.
6. Assess state of hydration and replace fluid and electrolytes as required.
7. Maintain an intake and output chart.
8. List causes of urinary retention in early pregnancy.
Obstetric complications
List the causes, diagnose and institute primary management in patients of:
1. Multiple pregnancy
2. Malpresentations
3. Antepartum haemorrhage
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4. Pregnancy induced hypertension
5. Eclampsia
6. Preterm labour
7. premature rupture of membranes
8. Intra uterine growth retardation
9. Rh isoimmunization
10. Intra uterine foetal death
11. Repeated pregnancy loss
Medical complications

1. Diagnose and classify anemia, hypertension, cardiovascular diseases, diabetes and jaundice in
pregnancy.
2. Indicate primary care management of a patient with medical disorders in pregnancy and refer
appropriately.
Surgical Complications

1. list causes of acute abdomen during pregnancy.
2. diagnose acute surgical problems such as: intestinal obstruction, acute appendicitis and twisted
ovarian cyst during pregnancy.
3. Institute primary management and refer appropriately
Infections during Pregnancy

1. Diagnose and manage patients suffering from malaria and, tuberculosis during pregnancy.
2. Screen for and diagnose and manage syphilis during pregnancy.
3. List components of TORCH infections.
4. List perinatal infections and their effect on pregnancy and fetal out-come.
5. Screen and manage HIV positive patients and patients with AIDS during pregnancy, labour
and puerperium.
Complications of early pregnancy
 Clinical posting in outdoor, indoor, maternity wards and emergency ward.

 Insertion of catheter with aseptic precautions under supervision.
 Demonstration of use of various urinary catheters.
 Integrated seminar with radiology and pathology department.
 Problem based learning in cases of hydatid form mole, all types of abortion, e.g. septic
abortion and missed abortion.
Obstetric complications
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 Clinical posting in outpatient department, maternity ward, labour room, obstetrics
operation theater.
 Group discussion.
 Clinical bed side grand round.
 Lectures.
Medical complications
 Clinical posting.
 Integrated seminar with medicine department.
 Problem based learning in case of heart disease with pregnancy, PIH, diabetes and
jaundice.
 Lectures
Surgical complications
 Posting in emergency ward OPD and gynaecology ward.

 Integrated seminar with surgical department.
 Case discussion.
 Problem based learning in twisted ovarian cyst and appendicitis with pregnancy.
 Lectures.
Infections during pregnancy
 Clinical posting
 Problem based learning in case of syphilis and tuberculosis with pregnancy.
 Integrated seminar with microbiology department.
7. Abnormal Labour
 Prolonged labour
 Obstructed labour
 Assisted delivery
 Breech delivery
 Forceps delivery
 Ventouse delivery
 Caesarean section
 Version (I.P.V.)
 Destructive operations
 Post partum haemorrhage
 Manual removal of placenta
 Birth canal injuries
Pre-requisites
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 Stages of normal labour
 Mechanism of normal labour
 Anatomy of genital organs
 Placental separation
Objectives

1. Define prolonged and obstructed labour.
2. Assist in operative deliveries (breech, forceps and ventouse delivery).
3. List indications, contraindications and steps of caesarean section.
4. Assist in versions and destructive operations.
5. Define primary and secondary post partum haemorrhage, identify clinically causes of PPH
and manage appropriately.
6. Assist in manual removal of placenta.
7. Identify and manage perineal and cervical injuries after delivery.
 Clinical posting in labour room.

 Assistance in operation in elective and emergency surgery.
 Problem based learning in labour, post partum haemorrhage.
8. Puerperium
 Normal peurperium
 Puerperal sepsis
 Lactation and Breast feeding
 Puerperal contraception and sterilization
 Psychological disturbances
 Neonatal care
Pre-requisites
 Physiology of puerperium
 Physiology of lactation
 Microbiology
 Basic drug therapy
Objectives

1. Define puerperium and puerperal sepsis and list their causes.
2. Diagnose and institute primary management in a case of puerperal sepsis.
3. Describe the process of lactation and importance of breast feeding and lactation management.
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4. List the psychiatric disorders during puerperium.
5. Advise for puerperal contraception.
 Clinical posting in OPD and maternity ward.

 Practical demonstration on breast care and breast feeding.
 Demonstration of contraception on mannequins, Assist in puerperal sterilization,
Vasectomy, norplant insertion and removal, and injectable contraceptives.
 Lecture.
9. Infertility
 Causes, investigations and management of infertile couples.
Pre-requisites
 Anatomy of female and male genital tract and their developmental disorders.
 Physiology of ovulation, menstrual cycle, fertilization and conception.
 Spermatogenesis.
Objectives

1. List causes of infertility in females and males.
2. Obtain history from a couple suffering from infertility including psychosexual history and do
detailed clinical evaluation.
3. Outline plan of investigation and management.
4. List indications, contra indications and describe procedures for cervical mucus scoring, post-
coital test, endometrial biopsy, tubal insufflation test and hysterosalpingogram.
5. Interpret results of investigations in female and male.
6. Counsel regarding fertile period, basal body temperature recording and adoption.
 Problem based learning in secondary infertility.

 Clinical posting in gynae outdoor.
 Perform cervical mucus scoring and ost coital test.
 Lectures.
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10. Genital Infections
 Upper genital tract infection

 Lower genital tract infection
 Urinary tract infection
 Post-operative infection
Pre-requisites
 Common microbial pathogens of uro-genital tract.

 Physiology of wound healing.
 Physiology of micturition.
 Changes in vagina during different phases of menstrual cycle and pregnancy.
Objectives

1. List common organisms responsible for lower and upper genital tract, urinary tract and post
operative infections.
2. Diagnose clinically common types of vaginitis.
3. Define and outline clinical features and management of pelvic inflammatory disease.
4. Describe clinical features and management of genital tuberculosis.
5. List cause of adnexal masses.
6. Describe causes, clinical features and treatment of urinary tract infection.
7. Explain diagnosis, management and principles of prevention of postoperative infection.
 Clinical posting in gynae ward and OPD.
 Integrated seminar with department of microbiology.
 Lectures.
11. Gynaecological Malignancies
 High risk factors

 Screening & early diagnosis
 Staging
 Principles of management
Pre-requisites
 Pathogenesis of genital precancer.

 Pathogy of neoplasia.
 Classification of different genital cancers.
 Pharmacology of anticancer drugs.
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 Principles of radiotherapy.
 Tumor markers in gynaecological malignancies.
Objectives

1. List high risk factors for cervical, uterine, endometrial, ovarian and breast cancer.
2. Screen a woman for presence of high risk factors.
3. Prepare a slide for pap-smear and interpret result of cytological diagnosis.
4. Carry out breast examination.
5. Diagnose genital cancer and stage according to FIGO classification.
6. Outline principles of management based on cancer type and stage including chemotherapy
and radiotherapy.
 Problem based learning in case of carcinoma of cervix, and ovary.
 Integrated seminar with pathology, radiotherapy, and oncology department.
 Lectures.
12. Fertility Regulation
 MTP
 Contraception (Banier methods, Normal Contraception).
 Sterilization, Vasectomy Permanent methods.
 Emergency Contraception.
Pre-requisites
 Anatomy of genital tract

 Physiology of ovulation and conception
 Pharmacology of hormonal contraception.
 Mechanism of action of contraceptives.
Objectives

1. List the temporary and permanent method of male and female contraception.
2. List merits and demerits of different methods.
3. Counsel eligible couple regarding appropriate fertility regulation methods.
4. Assist in intra-uterine device insertion, suction evacuation, tubal ligation, vasectomy, norplant
insertion and removal.
5. Know the legal issues related to abortion, contraception and sterilization.
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 Clinical posting in gynae ward and family planning centre.
 Practical experience of various contraceptives on mannequin.
 Lectures.
13. Emergency Obstetrics & Gynaecology
 Excessive vaginal bleeding

 Acute abdomen
 Convulsions
 Coma
 Obstetric shock
 Injuries & accidents of genital tract
Pre-requisites
 Physiology of menstruation
 Anatomy of abdominal and pelvic organs
 Etiopathogenesis and primary management of convulsions, coma and shock.
 Principles of haemostasis.
Objectives

1. List the causes of excessive vaginal bleeding in different ages.
2. Correlate clinical findings with specific clinical conditions.
3. Resuscitate the patient and initiate primary treatment.
4. Refer emergency cases appropriately.
5. List causes of genital injuries, describe clinical features and institute primary management.
 Integrated seminar with anaesthesia, surgery and medicine department.
 Learning in Field (LIF)
14. Miscellaneous
 Drugs and substance abuse.

 Preoperative and post operative care.
 Medico-legal and ethical issues.
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Pre-requisites
 Pharmacology of substance abuse.

 Medicolegal and ethical issues.
Objectives

1. Recognize cases for medicolegal registration, counsel and practice medical ethics as related to
obstetircs and gynaecology.
2. Recognize, counsel and manage patients with substance abuse.
Learning Experience:
 Clinical posting in gynae OPD and casualty.

 Integrated seminar with forensic medicine department.
Assessment
Formative assessment
 Students will be assessed on a day to day basis.

 Maintenance of a well designed log book (during the period of posting in the labour
room)
Summative assessment
 Assessment of theory and practical as per institutional policy.

 Objective structured clinical examination (OSCE) would include:
 Interpretation of test items e.g. temperature chart, instruments, X-rays, anatomical parts,
pathological specimens (macroscopic and microscopic).
Text Books
1. Shaw's text book of gynaecology.

2. Manual of Obstetrics by Holland and Brews. BI Churchill Livingston.
3. Principle of Gynaecology. V.R. Tindal, Butterworth- Heineman. International Edition.
4. Practical Obstetrics by Ian Donald.
5. Illustrated Obstetrics by Garry and Hovens.
6. Illustrated Gynaecology by Garry and Hovens.
7. Manual on Normal Labour.
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OPHTHALMOLOGY
Broad Objectives

1. diagnose, manage and prevent common ophthalmic diseases.
2. diagnose systemic diseases through ophthalmic manifestations of those conditions.
3. participate actively in National Program for Prevention of Blindness.
4. enumerate services available for rehabilitation of the blind in Nepal so that he may be able to
refer them for appropriate services.
5. develop attitude for continuous self directed learning.
Specific Objectives
After completion of this unit the students should be able to

a. define commonly used terms in ophthalmology.
b. enumerate common symptoms/presentation of ophthalmic diseases.
c. elicit relevant history in ophthalmological practice to reach a working diagnosis.
d. perform examination of the external eye and anterior segment to reach a more definitive
diagnosis.
e. perform direct ophthalmoscopy.
f. outline broad objective and targets of National Health Programs for prevention and control of
blindness.
Unit I
Diminution of Vision
At the end of this unit, the students should be able to:

a. list the causes of sudden/gradual and unilateral/bilateral loss or diminution of vision.
b. accurately measure visual acuity with and without the use of pin hole.
c. list the refractive errors, outline their management and enumerate possible complications of
refractive errors.
Sub-unit: Cataract
After completion of this sub-unit the students should be able to:

a. enumerate the causes of cataract
b. state the global and national distribution as well as population characteristics of cataract.
c. diagnose cataract, distinguish between mature, hypermature and immature cataract and
differentiate cataract from chronic simple glaucoma and refer appropriately.
d. outline the methods of surgical management of cataract.
e. outline visual rehabilitation of aphakic patients.
f. outline management of cataract in young age.
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Sub-unit: Glaucoma
After completion of this sub-unit, the students should be able to:

a. describe the etiology of primary open angle glaucoma.
b. enumerate diagnostic triad of glaucoma.
c. detect chronic simple glaucoma by optic disc examination.
Unit II
Red Eye/Watery Eye

a. list the causes of red eye
b. diagnose, institute primary care and appropriately refer following sight threatening causes of
red eyes:
Narrow angle glaucoma
Acute iridocyclitis
Corneal abrasion and ulcer
c. diagnose and treat infective and allergic conjunctivitis.
Sub unit: Trachoma
After completion of this sub-unit, the students should be able to:

a. describe the national distribution and population characteristics of trachoma.
b. enumerate the diagnostic criteria of trachoma.
c. diagnose and treat trachoma.
d. initiate/participate in programs for control of trachoma in the community.
Sub-unit: Watery eye
After completion of this subunit, the students should be able to:

a. list the causes of watery eye.
b. diagnose, administer initial treatment of acute dacryocystitis and refer them for more
definitive treatment.
c. detect and refer patients suffering from chronic dacryocystitis.
Unit III
Ocular Trauma
At the end of completion of this unit, the students should be able to:
a. diagnose and institute primary care management for following ocular injuries and conditions:
b. Blunt injuries of the eye.
c. Penetrating injuries of the eye.
d. Corneal abrasion and ulcer.
e. Chemical injury of the eye.
f. Lacerated injury of the lids.
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g. Extra-ocular foreign bodies.
h. Sympathetic ophthalmitis.
i. Endophthalmitis.
Unit IV
Eye as a Mirror of Systemic Disease
At the end of this unit the students should be able to:

1. Recognize and describe ocular manifestations of following systemic diseases:
a. Hypertension.
b. Diabetes mellitus.
c. Intracranial space occupying lesions.
d. Toxaemias of pregnancy.
e. Thyroid dysfunction.
f. Demyelinating diseases.
g. Head injury.
Unit V
Ocular Neoplasms

a. list the causes of Leucocoria.
b. detect and refer children with retinoblastoma.
Unit VI
Extraocular Muscles and Amblyopia
At the end of this unit, the students should be able to

a. detect and refer children with amblyopia.
b. enlist the causes for diplopia.
c. detect and refer patients suffering from diplopia.
Unit VII
Nutritional Diseases
At the end of this unit, the students should be able to

a. describe the social and economical factors involved in the occurrence of xerophthalmia.
b. recognize the signs of xerophthalmia and be able to grade them on the basis of severity.
c. give prophylactic and therapeutic treatment depending upon the severity of the disease.
d. identify the cases who will need referral for better management.
e. identify children at risk of developing xerophthalmia.
Pre-Requisites
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Unit I
1. Anatomy of the eye and orbit, physiology of vision and intra-ocular pressure.
2. Pharmacological basis and routes of administration of ocular drugs.
3. National Health Statistics.
Unit II
1. Optics of normal eye, and refractive errors.

2. Anatomy of lens and anterior chamber.
3. Physiology of intraocular pressure.
4. Pharmacology of ocular hypotensive agents.
Unit III
1. Anatomy and blood supply of conjunctiva, anterior chamber angle, uveal tract, cornea and
lacrimal system.
2. Physiology of aqueous circulation.
3. Common microbial pathogens of the eye and adnexa.
4. Pharmacological basis of antibiotics, steroids and ocular hypotensive agents.
Unit IV
1. Anatomy of eye and ocular adnexa.

2. Common pathogens of eye/adnexa, pharmacological basis of antibiotics, steroidal and non
steroidal anti inflammatory agents.
3. Immunological basis of delayed hypersensitivity reactions.
4. Medicolegal implications of simple and grievous injuries.
5. Measurement of visual acuity.
6. Training in surgical first aid.
Unit V
1. Basic Principles of clinical practice.
Unit VI
1. Genetic basis for inheritance of diseases.
Unit VII
1. Anatomy and nerve supply of extraocular muscles.

2. Refractive errors.
3. Manifestations of intracranial space occupying lesions.
Unit VIII
1. Metabolism of Vitamin A.
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2. Physiology of vision and night vision.
3. Nutritional deficiencies and their assessment.
--------------------------------------------------------
Areas that can be integrated with other specialties
1. Unit IV: Medicine, Surgery, Gynae/Obst.

2. Unit VII: Paediatrics.
--------------------------------------------------------
1. Structured lectures.
2. Case presentations.
3. Structured Ward/OPD/Emergency dept. postings.
4. Student seminars.
5. PBL sessions.
6. Participation in the community oriented activities of the ophthalmology department such as:
a. School screening programs.
b. Community screening programs.
c. Eye Camps.
Learning Resources
1. Parson's disease of the eye.

2. Ophthalmology. Practice and Principles, - Frank B. Newell.
3. May and Worth's Diseases of the eye.
4. Epidemiology of blindness in Nepal. Report of Nepal Blindness Survey, 1981.
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ORAL HEALTH
Broad Objectives

1. identify, diagnose and manage common dental problems in Nepal.
2. impart health education to the individual and community, and in schools regarding oral
hygiene.
Themes and Specific Objectives

1. Recognize clinical features, relate with pathophysiology, arrive at a logical diagnosis and
institute primary care management for the following:
 Dental plaque and its control
 periodontal diseases (gingivitis, periodontitis and its systemic disease risks)
 dental caries and its sequelae (pulpitis and pulp abscess)
 fluorosis
 white lesions of oral cavity
 fractures of maxilla and mandible
 common cysts and oral tumors
 Oral and fascial spaces infection
2. List indications and contraindications of extraction of teeth and explain the post extraction
instructions;
3. List common dental /maxillofacial injuries and explain their management;
4. Administer common local anesthesia in dentistry
5. Explain and educate the individual and community about the importance of oral hygiene,
dental care and brushing techniques in children and adults;
6. Plan and implement school health program in oral hygiene.
7. List the oral manifestations of systemic diseases and medical emergencies in dental practice
8. identify the intra- and extraoral maxillofacial prosthesis and their use
9. Describe the temporomandibular joint and list the common diseases and their principle of
management
10. List the craniofacial syndromes and their systemic effects
Prerequisites
a. Anatomy and histology of oral cavity

b. Nerve supply, blood supply of upper and lower jaws, and teeth.
 Didactic Lectures
 Integrated Seminars*
 Group discussions
 Clinical postings
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 Ward postings
 Bed side case demonstration and/or discussion
 Procedural demonstrations and/or performance under preceptor supervision.
Assessment
For formative assessments:

a. Students will be assessed on a day to day basis.
b. Maintenance of a well designed log book (during the period of posting in the discipline)
For summative assessments:
 Objective structured clinical examination (OSCE).
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ORTHOPAEDICS
Broad Objectives
1. identify the common orthopaedic injuries and ailments in the community.
2. obtain a proper relevant history, and perform a humane and thorough clinical examination.
3. plan and interpret relevant investigations including x-rays.
4. arrive at a logical working diagnosis after examination and review of investigations.
5. plan and institute treatment.
6. recognize situations which call for urgent or early treatment at specialized centers and
make a prompt referral.
INJURIES
Objectives
1. diagnose injuries of the tendons, muscles, ligaments, nerves, bones and joints.
2. diagnose closed and open fractures, dislocations and associated neurological and vascular
complications.
3. request for and interpret relevant x-rays for confirmation of diagnosis.
4. apply splints, P.O.P. slabs and skin traction.
5. recognize situations warranting immediate referral and arrange for safe transport.
6. recognize vascular injury, compartment syndrome and impending gangrene.
7. perform release of tight plaster and constricting structures.
Pre-requisites
 Gross anatomy of musculo-skeletal system.
 Patho-physiology of inflammation, wound healing, and fractures.
Themes & Topics

1. Fractures: Definition, types, clinical and radiological diagnosis, fracture healing and
complications of fractures (immediate, early and late).
2. Principles of treatment of closed and open fractures;
3. Dislocations and subluxations: definition, diagnosis and management of common
dislocations-shoulder, hip, elbow and knee.
4. Common injuries of the lower limbs I: fractures of foot, ankle and tibia.
5. Common injuries of the lower limbs II: fractures of shaft of femur, trochanter and neck of femur.
6. Common injuries of upper limbs I: fractures around shoulder, arm and elbow.
7. Common injuries of upper limbs II: fractures of forearm, wrist and hand.
8. Injury of spine
9. Injury of pelvis
10. Peripheral nerve injuries: diagnosis and principles of management of radial, ulnar, median
and sciatic nerves
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 SIS/Lecture/Handouts
 Seminars
 Tutorials/Clinical case Discussions
 Seminar: Common injuries and diseases of peripheral nerves in association with:
o Anatomy
o Physiology (Nerve conduction studies)
o Dermatology (Leprosy)
o Orthopaedics (Principles of management)
INFECTIONS
Objectives

1. diagnose, outline the principles of treatment and recognize the complications of
a. Acute osteomyelitis.
b. Chronic osteomyelitis.
c. Septic arthritis of Hip and Knee.
d. Tuberculosis of bones and joints.
2. aspirate and drain superficial abscess.
3. refer complicated cases to a specialized centre with antibiotics and splintage.
Pre-requisites
 Micro-vasculature of bones
 Inflammation
 Microbiology of common pathogens
 Pharmacology of NSAID
 Antibiotics
Themes & Topics
1. Acute and chronic osteomyelitis

2. Septic arthritis of hip and knee
3. Tuberculosis of spine
4. Tuberculosis of bones and joints (hip, knee and other joints)
 SIS/Lectures/Handouts
 Clinical case discussion (Abscess, sinus, chronic ulcer, knee joint swelling).
 Seminar: Tuberculosis of Bones & joints, spine and paraplegia in association with:
o Anatomy
o Microbiology
o Pathology
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o Paediatrics/Medicine
o Orthopaedics
INFLAMMATORY & DEGENERATIVE CONDITIONS OF BONES JOINTS AND

SPINE
Objectives
1. diagnose and outline the principles of the management of:
 Rheumatoid arthropathy
 Ankylosing spondylitis
 Osteoarthritis and
 Degenerative spondylosis
Pre-requisites
 Gross anatomy of the spine, bones and joints.
 Pathophysiology of inflammation of a joint
 Pharmacology of NSAIDS:
 Indications, limitations and complications of systemic steroid therapy.
Themes & Topics

1. Degenerative arthritis (knee, hip) and spondylosis(cervical, lumbar)
2. Inflammatory arthritis I: Rheumatoid arthritis
3. Inflammatory arthritis II: Ankylosing spondylitis and other seronegative spondarthritides
4. Nontraumatic soft tissue disorders of the upper limb: frozen shoulder, painful arc
syndrome,tennis elbow, De Quervain’s disease.
5. Nontraumatic soft tissues disorders of the lower limbs: pre patellar bursitis, infrapatellar
bursitis, Achilles tendinitis, retrocalcaneal bursitis, plantar fasciitis.
 Bedside discussions
 Seminar : Low back pain
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METABOLIC DISORDERS
Objectives

1. diagnose and outline the principles of management of rickets, osteomalacia, osteoporosis,
gout.
Pre-requisites
 Calcium metabolism
 Phosphorus metabolism
 Vitamin D metabolism
 Regulation and Function of Endocrine glands.
Themes & Topics
1. Osteoporosis
2. Rickets and osteomalacia
3. Gout/pseudogout
 Bedside case discussion
 Seminar: Metabolic bone diseases: osteoporosis, osteomalacia and rickets.
CONGENITAL AND DEVELOPMENTAL DISORDERS
Objectives

1. screen a neonate for congenital musculoskeletal abnormalities and birth injuries with
special reference to clubfoot and hip dysplasia.
2. outline the principles of management of club foot.
Pre-requisites
 Development of Bones and joints
Themes & Topics
1. Congenital disorders I: club foot

2. Congenital disorders II: DDH
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 Lectures/Handouts
 Clinical case discussion
 Club foot (Case demonstration)
NEOPLASTIC CONDITIONS
Objectives

1. diagnose and outline the principles of management of:
 benign tumors
 malignant tumors
Pre-requisites
 Histopathology of bone tumors.
 Chemotherapy (Pharmacology).
Themes & Topics

1. Neoplasms of bone: General principles
2. Neoplasms of bone: Benign (osteochondroma, enchondroma, simple bone cyst & osteoid
osteoma)
3. Neoplasms of bone: Malignant (osteosarcoma, Ewing's sarcoma, chondrosarcoma, giant
cell tumor and secondary deposits)
 Clinical case discussion
PHYSIOTHERAPY AND REHABILITATION
Objectives

1. describe the principles of:
 Physiotherapy in common disorders like backache, spondylosis.
 Osteoarthrosis, post traumatic stiffness of joints.
 Orthotics and Prosthetics in disabilities, amputations and anaesthetic limb.
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Pre-requisites
 Degenerative & Inflammatory disorders.

 Complications of fractures
 Neuro-muscular disorders.
Themes & Topics
1. Principles of physiotherapy.
2. Principles of Orthotics/prosthetics
Learning Experience
 SIS/ Lecture/Handout
 Visit to Physiotherapy/Rehabilitation Units.
List of topics for students’ seminar
1. Common injuries and diseases of peripheral nerves (Orthopaedics, Anatomy, Physiology

and Dermatology )
2. Low back pain (Orthopaedics and Radiology)
3. Management of Multisystem trauma (Orthopaedics, General Practice and Emergency
Medicine, General Surgery)
4. Osteoarticular tuberculosis (Orthopaedics, Radiology, Anatomy, Microbiology, Pathology
and Medicine)
5. Metabolic bone disease (Orthopaedics, Physiology and Medicine)
List of topics for CBL (5 days posting in a week for 4 weeks from 10AM to 1PM =total 20
postings)
1. Clinical examination of hip

2. TB Hip
3. Fracture neck of femur and trochanter
4. Clinical examination of knee
5. TB Knee
6. Paraplegia/quadriplegia
7. Spinal injuries
8. TB Spine
9. Acute and chronic osteomyelitis
10. Non union
11. Mal-union
12. Peripheral nerve injuries
13. Benign and malignant bone tumors
14. Miscellaneous
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List of topics for Small Group Discussion (SGD)
1. X rays in orthopaedics
2. Implants and instruments
3. Traction, splints and walking aids
4. Plaster, plaster techniques and complications
5. Physiotherapy
6. Orthotics/prosthetics
Assessment
1. Internal assessment and final examinations at the end of 8th semester.
2. OSCE and Viva voce including X-rays, common orthopaedic implants and instruments and
splints.
3. Theory
 MCQ
 Structured SAQ
Text Books
1. A Manual on Clinical Surgery - S. Das
2. Clinical Orthopaedic Examination - Ronald Mc Rae
3. Apley’s System of Orthopaedics and Fractures - Apley & Solomon.
4. Outline of Fractures - J. Crawford Adams.
5. Outline of Orthopaedics - J. Crawford Adams.
6. Essential Orthopaedics - J. Maheshwari
7. Pye's Surgical Handicraft.
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OTORHINOLARYNGOLOGY AND HEAD & NECK SURGERY
Broad Objectives

1. Identify the common Otorhinolaryngology (ORL) and Head and Neck diseases particularly
those prevalent in the community.
2. Institute basic preventive measures for hearing impairment and other common ORL and Head
and Neck problems in the community.
3. Identify common ORL and Head and Neck emergencies, institute primary care and refer when
necessary.
4. Identify ORL and Head and Neck diseases that need surgery perform certain surgical
procedures and refer the rest.
5. Participate in community programs on prevention of hearing impairment.
Specific Objectives

1. Elicit history, identify instruments and equipment used for ORL and Head and Neck
examination and examine patients using the head mirror.
2. Recognize clinical features, correlate them with pathophysiology, diagnose and institute
primary care management and prophylactic measures and refer when necessary in the
following conditions:
a. Ear
External Ear: infections like furunculosis, otitis externa including otomycosis, dermatological
conditions like eczematous lesions* and contact dermatitis*, wax, foreign body, congenital
anomalies like preauricular sinus, microtia*, anotia *and atresia* of the external auditory
canal.
Middle Ear : infections like acute suppurative otitis media and chronic suppurative otitis
media, otitis media with effusion and its sequalae, complications of infections of middle ear
cleft, barotrauma, otospongiosis, neoplasms* and tympanosclerosis.
Inner Ear: infections like acute labyrynthitis and vestibular neuronitis, ototoxicity,
presbyacusis, Meniere's disease, benign paroxysmal positional vertigo* and acoustic
neuroma.
Others: hearing impaired child, delayed speech, syndromic congenital anomalies of the ear*
and lower motor neuron facial nerve palsy.
b. Nose and Paranasal Sinuses

Infections like vestibulitis, furunculosis and acute and recurrent sinusitis including its
complications; allergic rhinitis, nasal polyposis, deviated nasal septum, chronic infective
diseases like rhinosporidiosis, atrophic rhinitis, respiratory scleroma*, leprosy*,
tuberculosis*, neoplasms of maxilla and foreign bodies.
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c. Oral cavity, pharynx, oesophagus, larynx and tracheobronchial tree
Infections like acute and recurrent tonsillitis, peritonsillar abscess, adenoids, acute and chronic
pharyngitis, acute epiglottitis, acute and chronic laryngitis, laryngotracheobronchitis;
submucosal fibrosis of oral cavity, neoplasia of oral cavity*, nasopharynx*, oropharynx*,
hypopharynx* and larynx; foreign bodies, laryngomalacia, vocal cord nodules, respiratory
papillomatosis*, vocal cord paralysis*, globus pharyngeus and keratosis pharyngis*.
d. Neck
Submandilular sialadenitis and sialolithiasis, neoplasms of the submandibular salivary gland*,
acute parotitis, parotid abscess and neoplasms of the parotid salivary gland*, thyroiditis*,
goitre *and neoplasms of the thyroid*.
3. Enumerate the common causes of, reach a logical diagnosis and institute primary care
management for the following conditions:
a. Ear
Otalgia, congenital and acquired sensory-neural and conductive hearing loss and vertigo.
b. Nose and Paranasal sinuses:

Epistaxis, unilateral nasal obstruction, bilateral nasal obstruction, septal perforation, maxillary
swelling and proptosis.

Unilateral enlargement of tonsil, membrane on the tonsils, dysphagia, hoarseness and stridor.
d. Neck
Cervical lymphadenopathy with emphasis on metastatic lymph node, swellings of the neck
including midline swellings.
N.B. * mark topics should be given less emphasis.
4. Diagnose, institute primary care management and refer appropriately in the following
emergency conditions:
a. Ear
Acute vertigo, acute otitis media, otitis media related complications, sudden hearing loss,
foreign bodies and acute lower motor neuron facial nerve palsy.
b. Nose and Paranasal Sinuses

Epistaxis, fractures of nasal bone and maxilla and foreign bodies.

Foreign bodies and peritonsillar abscess.
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d. Neck
Stridor, blunt/penetrating and sharp weapon injuries of the neck including cut throat.
5. Recognize and interpret the following:

Pure tone audiograms, plain X-rays of the mastoids, plain X-rays of the paranasal sinus and
nasal sinuses, plain X-rays of the soft tissue of the neck and plain X-rays to rule out foreign
bodies.
6. Outline the principles and enumerate the indications and steps of the following procedures:
Syringing of the ear, nasogastric tube insertion, lymph node biopsy, punch biopsy from oral
cavity and oropharynx, nasal packing, removal of foreign body from ear, nose and orpharynx,
trachaeostomy, cricothyrotomy, minitrachaeostomy, drainage of peritonsillar abscess and
other superficial abscesses.
N.B. The student, after the completion of the internship, should be able to perform the above
skills independently.
7. Outline the principles and enumerate the indications of common ORL and Head and Neck
surgical procedures not listed above.
Pre-requisites
a. Anatomy of external ear, middle ear and inner ear - neural connections and sensory nerve
supply of external and middle ear.
b. Anatomy of nose and paranasal sinuses, blood supply of nasal cavity.
c. Anatomy of larynx and nerve supply of larynx.
d. Development of external ear and branchial arches.
e. Physiology of hearing and balance.
f. Speech and hearing centers in the brain*.
g. Microbial pathogens and normal bacterial flora of external auditory canal, nose and oral
cavity.
h. Pharmacology of ototoxic drugs and commonly used drugs like antibiotics, anti-inflammatory
and anti-histamines.
a. Demonstration of the use of head mirror, tuning forks and other instruments used for clinical
examination and out-patient procedure.
b. Demonstration and practice of clinical examination methods during clinical postings.
c. Demonstration of anatomical models of larynx and ear.
d. Lectures.
e. Small group discussions.
f. Integrated seminars*.
g. Problem-solving exercises.
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* Integrated seminars:
a. Dysphagia : ORL & General Surgery.
b. Stridor in children : ORL & Paediatrics
c. Maxillofacial trauma : ORL & Dental Surgery
d. Vertigo : ORL & Internal Medicine
e. Headache : ORL, Internal Medicine and Ophthalmology.
Text Books
1. Diseases of Nose Throat and Ear by I.Simson Hall and Bernard H. Colman.
2. Logan Turner's Diseases of the Nose Throat and Ear, edited by A.G.D. Maran.
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PAEDIATRICS
Broad Objectives

1. Diagnose and manage common neonatal and childhood diseases/problems that require
primary care.
2. Identify neonatal and childhood illness problems that require referral and refer them.
3. Diagnose and provide primary care in acute pediatrics and neonatal emergencies.
4. Provide emergency cardio-pulmonary resuscitation to newborns and children.
5. Counsel and guide patients, parents and relatives regarding the illness, care, possible
complications and prognosis.
6. Participate in the National Programs related to child health.
GENERAL PAEDIATRICS
Pre-requisites
 Physiology and biochemistry of Nutrients.
 Nutritive value of common food items.
 Nutritional requirements at different ages.
 Ability to use the growth charts.
 Anthropometry.
 Developmental milestones.
 Immunization schedule.
 Definition of terms: IMR, NMR, PNMR, U5MR, MMR
Objectives

1. History taking and physical examination
a. elicit and record relevant history with special reference to antenatal, natal and
postnatal periods, nutrition, immunization & growth & development.
b. conduct physical examination and elicit relevant signs.
c. correlate the complaints and physical signs to arrive at a logical diagnosis with
justification.
2. Nutritional disorders
a. Assess nutritional status of children at different age groups.
b. Recognize nutritional disorders with special reference to PEM, Vitamin A
deficiency, nutritional anemia, iodine deficiency disorders and rickets.
c. Plan and advise on nutritional requirements of infants and children.
3. Growth and development
a. Record and assess growth patterns in terms of weight, height, head circumference,
dentition, body proportions and identify deviations from normal using growth charts.
b. Recognize disorders of growth with special reference to short stature and failure to
thrive; and institute appropriate management.
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c. Assess the developmental status of a child with special reference to milestones in
gross, fine motor, social emotional and language skills and identify deviations from
normal.
d. Recognize the disorders of development with special reference to mental retardation
and cerebral palsy, and institute appropriate management.
e. Counsel parents about childhood symptoms that cause undue anxiety.
4. National Child Health Programs
a. Describe national immunization schedule and administer the same in the
community and hospital setting.
b. List the national programs of maternal and child health.
5. Child Health Situation: Vital Statistics
a. State the current IMR, NMR, PNMR, UFMR and MMR in Nepal.
b. Enumerate the common causes of perinatal, neonatal, infant and under five mortality
and morbidity in Nepal.
c. List the preventive measures necessary for the reduction of childhood morbidity and
mortality.
6. Childhood disabilities
a. Recognize the childhood disabilities and counsel parents for the rehabilitation of
disabled.
7. Paediatric emergencies
The students should be able to diagnose and institute primary care management and
possible preventive measures of the following emergencies:
a. Breathlessness
b. Convulsions
c. Respiratory distress
d. Shock
e. Dehydration
f. Hypertensive crises
g. Haemorrhages
h. Cyanotic spells
i. Congestive cardiac failure
j. Poisonings with kerosene, insecticides, paracetamol, iron OPIODS etc.
k. Scorpion stings and
l. Snake bite.
INFECTIOUS DISEASES
Pre-requisites
 Microbiology of infective agents.
 Pathologic changes in respective infections.
Objectives
The students should be able to recognize the clinical features, relate them to patho-physiology,
diagnose and institute primary care management and prophylactic measures in the following
common infective disorders:
Viral: Mumps, Measles, Rubella, Poliomyelitis, Chickenpox, Hepatitis and HIV
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Bacterial: Tuberculosis, Leprosy, Pertussis, Diphtheria, Typhoid, Pyoderma and
Furunculosis, LEPTOSPIROSIS
Parasitic: Malaria, Kala-a-zar, Giardiasis, Amebiasis, Filariasis, Intestinal Helminthiasis,
Taeniasis, Scabies,
Fungal: Common cutaneous and systemic infections like Candidiasis and teniasis
Objectives
diagnose, institute primary care management and prophylactic measures in the following
conditions:
 Rheumatic fever
 Juvenile Rheumatoid Arthritis
 Henoch Schonlein Purpura
NEONATOLOGY
Pre-requisite
 Physiology of fetal circulation.
 Changes in circulation at birth.
 Mechanisms of thermo-regulation.
Objectives

1. examine the neonates, elicit & interpret neonatal reflexes & provide care for a normal
newborn.
2. detect birth trauma and birth asphyxia; and provide emergency cardio-pulmonary resuscitation.
3. identify neonates with congenital malformations, institute primary care management and
refer appropriately.
4. assess the gestational age of a neonate and identify the preterm and neonates and with
IUGR, manage them with special reference to maintenance of body emperature, feeding,
prevention of complications and appropriate method of transfer to a facility with higher
level of care.
5. recognize and manage high risk infant, neonates with hypoglycemia, hypocalcaemia,
hypothermia, anemia, jaundice, respiratory distress, septicaemia, haematologic diseases of
newborn, feeding difficulties and infants of diabetic mothers.
HEMATOLOGY
Pre-requisites
 Haemopoiesis, normal hematological values in children.

 Morphologial features of different anemia.
 Porto Hepatic circulation.
Objectives
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disorders:
 Nutritional, haemolytic, hypoplastic and aplastic anemia.
 Bleeding and coagulation disorders.
 Leukaemia
 Plan and undertake safe blood transfusion and recognize hazards of transfusion.
Pre-requisites
 Structure of the gastrointestinal tract

 Physiology of digestion and absorption
 Pathophysiology of dirrahoea
 Microorganisms causing Diarrhea and dysentery
 Physiology of gut mobility
 Pathophysiology of oedema
Objectives
The students should be able to identify the common causes and arrive at a logical diagnosis and
institute primary care of the following:
 Acute Diarrhea
 Chronic and persistent Diarrhea
 Dysentery
 Acute abdomen
 Paralytic ileus
 Chronic constipation
 Recurrent vomiting
 Ascites
 G.I. Bleeding
HEPATO-BILIARY SYSTEM
Pre-requisites
 Liver function tests

 Pathology of hepatitis and cirrhosis
 Microbiology of hepatitis viruses
 Drug metabolism in liver and hepatotoxic drugs
Objectives
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diagnose, institute primary care management and prophylactic measures of the following:
 viral hepatitis
 cirrhosis of liver
 portal hypertension
 liver abscess
 hepatic failure
Pre-requisites
 Hemodynamics
 Electrocardiography
 Measurement of BP
 Fetal circulation
 Pulmonary circulation
 Pathology of rheumatic heart diseases
 Pharmacology of decongestives and antibiotics
Objectives
The student should be able to recognize the clinical features, relate them to patho-physiology,
diagnose, institute primary care management and prophylactic measures in the
following:
 Rheumatic heart disease
 Congenital acyanotic heart diseases like ASD, VSD, PDA.
 Congenital cyanotic heart diseases e.g. TOF.
 Cyanotic spells.
 Infective endocarditis.
 Congestive cardiac failure
 Hypertension
CENTRAL NERVOUS SYSTEM
Pre-requisites
 Microbiology of poliovirus and other common CNS pathogens.

 Physiology of CSF circulation
 Biochemistry of CSF
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Objectives
1. The students should be able to recognize the clinical features, relate them to patho-
physiology, diagnose, institute primary care management and prophylactic measures of the
following:
a. meningitis, Encephalitis and Meningoencephalitis
b. intracranial space occupying lesions.
c. hydrocephalus
2. Identify the common causes of arrive at a logical diagnosis and institute primary care of the
following:
a. comatose child,
b. seizure disorders
c. raised intracranial tension
GENITO URINARY SYSTEM
Pre-requisites
 Functions of kidney and renal function test

 Formation of urine
 Fluid, electrolyte and acid base balance
 Microbiology of common urinary pathogens
 Drug metabolism in renal failure
Objectives
1. The students should be able to recognize the clinical features, relate them to patho-
physiology, diagnose, institute primary care management and prophylactic measures in the
following:
 urinary tract infection
 acute glomerulonephritis
 nephrotic syndrome
 acute renal failure
2. Identify the common causes, arrive at a logical diagnosis and institute primary care of
hematuria.
RESPIRATORY SYSTEM
Pre-requisites
 Microbiology of common respiratory pathogens.

 Respiratory physiology.
 Pulmonary function test.
 Pathology of common ARI.
 Pharmacology of common antibiotics and bronchodilators.
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Objectives
following:
 ARI/Pneumonia
 Bronchial asthma
 Foreign body aspiration
ENDOCRINE SYSTEM
Pre-requisites
 Physiology and biochemistry of thyroid and islet cells of pancreas.

 Pharmacology of insulin and thyroxine.
Objectives
The students should be able to recognize the clinical features, relate them to patho-physioloyg,
following:
 Hypothyroidism and goiter.
 Diabetes mellitus.
 Ambiguous genitalia.
CHROMOSOMAL AND GENETIC DISORDERS
Pre-requisites
 Normal karyotype
 Morphology of chromosomes
 Patterns of inheritance
Objectives
At the end of the course the student should be able to suspect, investigate and refer appropriately:
 Down's syndrome
 Turner's syndrome
ONCOLOGIC DISORDERS
Pre-requisites
 Basic concept of neoplasia.

 Pharmacology of chemotherapeutic agents. At the end of the course the student should be
able to suspect, investigate and refer appropriately:
 Lymphomas
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 Wilms' tumor
MUSCULOSKELETAL DISORDERS
Objectives
At the end of the course the student should be able to suspect, investigate and refer appropriately:
 Floppy infant
 Muscular dystrophy
BEHAVIORAL PAEDIATRICS
Objectives
The student should be able to recognize the clinical features, relate them to patho-physiology,
common childhood behavioral disorders:
 Attention deficit disorders
 Somatoform disorders
 Conduct disorders
 Dyslexia
 Infantile autism
ADOLESCENCE MEDICINE
Objectives
The students should be able to identify the common problems, institute primary care
management and counsel the adolescents and their parents on:
 Problems of puberty
 Sexuality in adolescence
 Adjustments during adolescence
LEARNING EXPERIENCE
a. Orientation of the students to the hospital services.

b. Allocation of beds for clinical work and follow up.
c. Case presentation by students (including history, physical findings and progress of the
patients).
d. Seminars: student/faculty seminar on clinical problems.
e. Problem solving discussions based on:
 a specific patient in the wards, ORT centre, OPD, etc.
 a given case report consisting of history, physical findings and investigation reports.
f. Record of 20 case studies: 15 in general pediatrics patients and 5 neonatal patients.
g. Lecture discussion sessions.
h. Field visits to MCH clinics:
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 Demonstration of administration of vaccines.
 Practise administering vaccines.
 Counseling of mothers for vaccination in future.
LEARNING RESOURCES
Text Books
1. O.P. Ghai: Essentials of Paediatrics.

2. R.K. Adhikari/Iriam Krantz: Child Nutrition and Health.
3. R.L. Bijlani: Nutrition - A Practical Approach Jaypee Brothers, New Delhi.
4. P.R. Sharma: Pocketbook of Paediatric Problems.
5. General pediatrics – P. Gupta
Reference Books
1. Nelson's Textbook of Paediatrics.

2. Illingworth: Common Symptoms in Childhood.
3. M.B. Singh: Care of the Newborn.
225
PSYCHIATRY
Broad Objectives

1. Outline the scope of Psychiatry.
2. Recognize differences between normal and abnormal behaviour.
3. Develop positive attitude towards mentally ill patients.
4. Recognize clinical manifestations of and diagnose common psychiatric disorders.
5. Plan the management of common psychiatric disorders.
6. Practise rational use of different modes of therapy in psychiatric disorders.
7. Diagnose acute psychiatric emergencies and institute immediate remedial measures.
8. Assess psychosocial determinants of medical disorders.
9. Contribute to promotion of positive mental health and prevention of psychiatric disorders.
10. Provide mental health care to the community.
11. Participate in community mental health programs.
12. Request and interpret relevant investigations related to Psychiatry.
13. Counsel, guide and explain the prognosis of the psychiatric disorders to the patient and the
attendants.
14. Decide when to refer a case to a secondary or tertiary care centre/psychiatrist.
15. Discharge medico-legal and ethical responsibilities related to Psychiatry.
16. Update his professional knowledge and skills on an ongoing basis.
Specific Objectives
Unit I
GENERAL PSYCHIATRY
a. Basic concepts/Introduction to Psychiatry
1. Differentiate between normal and abnormal behaviour.

2. Classify psychiatric disorders
b. Clinical Evaluation
1. Perform a Psychiatric interview.

2. Take detailed psychiatric case history and conduct mental status examination.
3. Refer for relevant investigations including psychological testing.
4. Describe psychopathology.
5. Diagnose psychiatric disorders in a rational and systematic manner.
c. Community Psychiatry
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1. Diagnose and manage common psychiatric disorders in the community.
2. Refer difficult cases to secondary or tertiary care centre.
Unit II
CLINICAL PSYCHIATRY
a. Psychiatric Disorders
Describe etiology, epidemiology, clinical manifestations and outline the principles of management
of the following psychiatric disorders:
1. Organic mental disorders
2. Schizophrenia and related disorders.
3. Mood disorders
4. Anxiety disorders (Generalized anxiety disorder, Panic disorder, Phobic disorder).
5. Dissociative and somatoform disorders.
6. Obsessive compulsive disorder
7. Reaction to severe stress and adjustment disorders.
8. Neurasthenia and Depersonalization-derealization syndrome.
9. Non-organic sexual dysfunction.
10. Psycho-physiological disorders (Gastro-intestinal disorders, obesity, anorexia nervosa, cardio-
vascular disorders, respiratory disorders, endocrine disorders, skin disorders, rheumatoid
arthritis, headache, immune disorders, chronic pain).
11. Personality disorders.
12. Drug abuse.
13. Alcohol abuse.
14. Psychiatric disorders in childhood and adolescence.
15. Psychiatric disorders in geriatrics.
b. Emergency Psychiatry
(Refer to Emergency Medicine)
c. Management
The student should be able to:

1. Describe pharmacology of commonly used psychotropic medicines.
2. Describe indications, contraindications and procedure of Electro-convulsive therapy.
3. Apply counseling skills.
4. Describe non-pharmacological methods of treatment in Psychiatry and in medical disorders.
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Unit III
PSYCHIATRY AND OTHERS SPECIALITIES
a. Forensic Psychiatry
The student should be able to describe legal and ethical issues in Psychiatry.
b. Consultation-liaison Psychiatry
The student should be able to utilize consultation-liaison Psychiatry.
c. Rehabilitation
The student should be able to plan rehabilitation for patients with chronic mental illness,
mental retardation and substance abuse.
a. Clinical case presentations.

b. Small group case discussions.
c. Structured interaction sessions (Lectures)
d. Demonstration of skills
i. Psychiatric interview skills
ii. Skills to elicit psychopathology
iii. Counseling skills
e. Role play
f. Integrated Seminars
Resource Materials
a. Gelder M, Gath D & Mayou R. Oxford Textbook of Psychiatry. University Press, Oxford.
b. Kaplan HI & Sadock BJ.Pocket Handbook of Emergency Psychiatric Medicine, B.I.
Publications Private Limited, New Delhi.
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RADIODIAGNOSIS
Broad Objectives

1. Enumerate various imaging modalities and enunciate basic principles of imaging.
2. Identify and interpret the radiographs of common diseases and come to a logical diagnosis.
3. Justify indications for various radiological investigations.
4. Elicit relevant history and perform clinical and systemic examination suitable for the desired
radiological investigation.
5. Requisition and justify relevant radiological investigations that are cost effective keeping in
mind the hospital resources, patient's socio-economic circumstances and compliance to the
best advantage of the patient.
6. Enumerate complications and adverse reactions arising out of radiological procedures and
outline the principles underlying their management.
7. Identify the need of radiation protection for the patient as well as the hospital staff.
8. Identify the limitations of existing imaging modalities.
9. Develop good communication skills to deal with the patient, relatives, community and
colleagues of concerned departments.
10. Identify medicolegal problems and statutory obligations of a registered medical practitioner.
11. Identify the legal and ethical implications of radiological procedures.
12. Participate in national health programs.
Specific Objectives
Unit I
1. Basic Concepts in Radiodiagnosis
The student should be able to outline the basic concepts of radiation, radiation hazards, various
imaging techniques and the principles involved in them.
Unit II
1. Respiratory System
At the end of the unit, the student should be able to:

a. Identify following films:
 Normal chest X-ray
 CT Scan of chest
 Bronchography
 MRI of chest
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b. List the Indications for requisitioning of
 Chest X-Ray
 CT/MRI of chest
 Bronchography
c. Interpret the skiagrams of

 Tuberculosis
 Pneumonia
 COPD
 Pleural effusion
 Pneumothorax/Hydropneumothorax
 Lung abscess
 Collapse/Consolidation
 Bronchiectasis
 Mediastinal and hilar masses
 Bronchogenic carcinoma
2. Cardiovascular system
The students should be able to identify in skiagrams

a. Normal topography of heart and deviations from normal
b. Cardiomegaly
c. Rheumatic heart disease
d. Pericardial effusion
3. Gastrointestinal Tract (GIT)
The students should be able to identify in the films of relevant imaging modalities:
a. Acute intestinal obstruction
b. Perforation (gas under diaphragm)
c. Calculi/Calcification
d. Worms
e. Gastric ulcers
f. Carcinoma esophagus, stomach and large bowel
g. Ileocecal tuberculosis
h. Inflammatory bowel disease
4. Hepatobiliary System
The students should be able to enumerate the indications of:

a. Ultrasonography (USG)
b. Oral cholecystogram (OCG)
c. Computerized Tomography (CT)
d. Percutaneous transhepatic Cholangiogram (PTC)
e. Endoscopic retrograde cholangio pancreaticography (ERCP)
f. T-Tube cholangiogram (TTC)
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g. Splenoportovenography (SPV)
h. Angiography
i. Radioisotope Scan
The student should be able to identify using suitable radiological modalities/ radiographs
 Gall-bladder calculi
 Liver abscess
 Liver masses
 Acute pancreatitis/ pancreatic masses
Unit III
1. Endocrine
The students should be able to point out:

a. Evidences of metabolic bone diseases using plain radiographs.
b. Lesions of Pituitary/ Adrenal/ Thyroid and parathyroid using CT/MRI/USG.
2. Reproductive System (female)
The student should be able to

 Explain usefulness of USG and CT/ MRI in the diagnosis of pelvic masses.
 Enumerate
 Indications of plain x-ray/ USG/ MRI during pregnancy and gynecological disorders.
 Radiation hazards during pregnancy
 Indications for hysterosalpingography (HSG)
Unit IV
1. Genito-urinary System
The student should be able to enumerate indications for:

 Plain x-ray, (KUB)
 USG, CT, angiography
 IVP
 Uretherography
 Radioisotope scan
The student should be able to interpret:

 Renal, ureteric and vesical calculus on plain x-ray (KUB) and USG
 Hydronephrosis on USG
 Renal and bladder tumors on US/CT/ MRI
The student should be able to list adverse effects of contrast media used in IVU and CT
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Unit V
1. Musculoskeletal System
The student should able to identify radiological features of

 Common fractures/ Dislocations
 Osteomyelitis
 Tubercular Spondylitis
 Bone and soft tissues tumors
 Disease of Joints
 Rickets, Osteoporosis and Osteomalacia
 Congenital dislocation of hip (CDH)
2. Central nervous system
The student should be able to identify using various imaging modalities

 Features of raised intracranial tension .
 Intracranial bleeding
Unit VI
1. Miscellaneous
The student should be able to

 list the indication of Mammography
 List the indications of plain x-ray ORBIT/ CT/ MRI/Dacryocystography
 Identify foreign body in orbit
The student should be able to identify Radiological features of:

 Radiopaque foreign bodies in Ear, Nose and throat
 Opaque sinuses/mastoid air cells
 Tumors of ear, nose and throat
The student should be able to enumerate Indications and identify films of:
 Sialography
 Sinogram
 Fistulogram
 Dental x-rays
2. Interventional Radiology
The student should be able to list the indications of:

a. Drainage procedures under:
- Fluoroscopy
- USG
- CT
b. FNAC/ Biopsy:
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c. PCN
d. Angiographic embolization
e. Angioplasty
The student should be able to practice protection measures against AIDS and hepatitis during
radiological practice.
Prerequisites
 Anatomy of the related organs

 Basic Principles of imaging modalities
Learning Resources
 Film viewing sessions

 Observation of radiological procedures
 Attending reporting sessions
 Small group discussions
 Lecture/ Demonstration
 Integrated seminars
 Problem solving exercises
Assessment
Integrated with all Clinical disciplines
Learning Resources
Text book
Radiology for medical students by K.T. EVANS et al.
Reference Book
Text book of Radiology by DAVID SUTTON
233
SURGERY
Broad Objectives
(Including MBBS course and Internship)

1. identify common surgical problems
2. obtain proper and relevant history in details
3. perform general, systemic and local examinations
4. able to generate the differential diagnoses
5. arrive at a logical working diagnosis
6. request relevant cost effective investigations in order to establish the diagnosis and plan
treatment
7. interpret laboratory investigation results, skiagram of common surgical diseases
8. obtain informed consent for any examination / procedure
9. plan and institute treatment under supervision
10. employ life saving measures in life threatening conditions
11. develop habit of rational use of drugs including antibiotics
12. provide first aid and consult senior about complicated surgical problems
13. develop cordial attitude towards patients, colleagues and other staff
14. act in a manner befitting a doctor and communicate sympathetically while dealing with an
incurable disease /dying patient and counsel patients
15. adopt universal precautions for self protection against HIV and hepatitis
16. able to recognize surgical complications
17. able to implement sterilization and antiseptic measures
18. demonstrate leadership qualities, promote team spirit, and be able to play a meaningful role in
disaster preparedness and management
19. able to declare death sensitively
Procedural Skills
At the end of course (MBBS including internship), the student should be able to:
1. maintain airway, conduct cardio-pulmonary resuscitation and provide first aid
2. protect and immobilize spine in patients with head and neck injuries
3. administer oxygen by mask or catheter
4. start intravenous line and infusion in adults and children
5. control external haemorrhage
6. give subcutaneous/intramuscular and intravenous injections
7. pass a nasogastric tube
8. catheterize bladder in both males and females
9. perform proctoscopy and rectal examination and describe the state of prostate
10. do different types of dressings
11. administer enemas and insert flatus tube
12. interpret skiagrams of abdomen, chest, interpret USG and CT of common surgical conditions
13. relieve tension pneumothorax
14. perform wound excision, wound toilet, and suturing of wound
GENERAL SURGERY
234
Pre-requisites
1. Pathophysiology of inflammation, tissue repair and shock
2. Physiology of acid-base and fluid electrolyte balance
3. Pathology of neoplasia
4. Common microbial pathogens and rational use of drugs
5. Etiopathogenesis of surgical infections
6. Medico-legal aspects of burns, scalds and trauma
Themes and Topics
1. Shock
2. Fluid and electrolyte therapy
3. Blood transfusion
4. Nutrition
5. Wound healing
6. Swelling (congenital, traumatic, neoplastic, inflammatory), lymphadenopathy
7. Ulcer, sinus and fistula
8. Burns
9. Cellulitis, abscess, erysipelas, carbuncle
10. Surgical site infection (SSI)
11. Tetanus
12. Gas gangrene
13. AIDS and hepatitis in surgical practice
14. Principles of organ transplantation
Objectives

1. define shock and enumerate its different types
2. Identify different types of shock based on their pathophysiology
3. diagnose different types of shock and initiate their primary management
4. monitor progression of shock with treatment and modify treatment accordingly
5. outline the principles of fluid and electrolyte balance/imbalance in paeditric as well as adult
surgical cases
6. enumerate the indications and complications of blood and its component transfusion in adults
and pediatrics patients
7. enumerate the indications, route, components and complication of nutritional supplementation
in surgical patients
8. enumerate with its characteristics and timeline of stages of wound healing
9. take relevant history, conduct physical examination, formulate differential diagnostic
hypotheses in patients with swelling, ulcer, gangrene, sinus, fistula and lymphadenopathy
10. diagnose and outline the principles of management of swelling, ulcer, gangrene, sinus, fistula
and lymphadenopathy
11. define burns and classify according to etiology and depth of involvement
12. identify degrees of burns
13. institute resuscitative measures and primary care of burns
235
14. prevent complications of burns
15. able to plan and initiate different types of dressing under supervision for burn
16. outline the principles of wound coverage (primary closure, secondary closure, graft, flap and
skin substitutes)
17. able to diagnose and manage cellulites, abscess, erysipelas, carbuncle and SSI
18. diagnose and outline the principles of management and take preventive measures for tetanus
and gas gangrene
19. enumerate and describe the implications of HIV and hepatitis viral infection in surgical
patients and precautions to be taken when dealing with these patients
20. outline the principles of universal precaution
21. outline the principles of organ transplantation
DISEASES OF LYMPHATIC SYSTEM, ARTERIES AND VEINS
Pre-requisites
1. Gross anatomy and micro-anatomy of blood vessels and lymphatics

2. Concept of inflammation.
3. Physiology of blood coagulation.
4. Etiopathogenesis of atherosclerosis, thrombosis, embolism, edema and collagen vascular
diseases
Themes and Topics
1. Lymphadenitis
2. Lymphomas
3. Lymphangitis
4. Lymphoedema
5. Arterial injury
6. Buerger's disease
7. Arterial occlusion, Gangrene
8. Thoracic outlet obstruction
9. Aneurysm
10. Varicose veins and ulcer
11. Deep vein thrombosis, superficial thrombophlebitis.
Objectives

1. take relevant history, conduct physical examination and elicit relevant physical sign in above
conditions
2. correlate the complaints and physical signs to arrive at a logical diagnosis with justification
3. consider the differential diagnoses
4. request relevant investigation
5. outline the principles of management
6. enumerate the complications and outline principles of their management in all the above
conditions where applicable
236
BREAST AND THYROID
Pre-requisites
1. Anatomy of breast and thyroid, their relations, blood supplies and lymphatic drainages.
2. Physiology of lactation.
3. Thyroid function, synthesis of thyroxin and their control mechanism.
4. Etiopathogenesis of benign and malignant breast diseases
5. Etiopathogenesis of colloid goiter, multinodular goiter, autoimmune thyroid diseases and
thyroid cancer
Themes and Topics

1. Developmental anomalies of breast.
2. Benign breast disease
3. Breast abscess, mastalgia and nipple discharge.
4. Malignant breast diseases
5. Developmental anomalies of thyroid.
6. Other thyroid disorders such as thyroglossal cyst, goiter, thyrotoxicosis, thyroid cancer,
thyroiditis and hyperthyroidism
Objectives
1. take relevant history, conduct physical examination and elicit relevant physical sign in breast
swellings
2. correlate the complaints and physical signs to arrive at a logical diagnosis with justification in
breast diseases
3. classify benign breast diseases and describe the risk factors for carcinoma of breast, consider
the differential diagnoses and request relevant investigations in breast diseases
4. outline the principles of management for breast diseases
5. enumerate the complications and outline principles of their management in all the breast
6. take relevant history, conduct physical examination and elicit relevant physical sign in thyroid
swellings
7. correlate the clinical features with pathophysiology and arrive at a logical diagnosis of thyroid
disorders
8. request specific investigations relevant for thyroid diseases
9. outline the principles of management of disorders of thyroid
10. describe epidemiology, pathogenesis and prevention of goiter
11. identify and enumerate possible complications of thyroid swelling including those following
surgery
12. prescribe antithyroid drugs, identify their toxic and side effects
CHEST
Pre-requisites
237
1. Anatomy of chest wall, tracheo-bronchial tree and pleura
2. Physiology of respiration, blood circulation and blood gas exchange
Themes and Topics
1. Ribs fracture, flail chest, pneumothorax, hemothorax, open pneumothorax, lung contusion
2. Empyemathoracis
3. Cardiac contusion
Objectives:

1. diagnose and request relevant investigation, consider differential diagnoses and outline the
principles of management in cases of ribs fracture, flail chest, pneumothorax, hemothorax,
open pneumothorax, lung contusion, empyema thoracis and cardiac contusion
2. outline the steps of chest tube insertion
NEURO-SURGERY
Pre-requisites
1. Anatomical layers of scalp, gross anatomy of brain and its coverings

2. Embryology of brain and spinal cord
3. Blood supply of brain
4. Circulation of CSF
5. Etiopathogenesis of neural tube defects and hydrocephalus
Themes and Topics
1. Head injury
2. Meningocele, Meningomyelocele, Encephalocele
3. Hydrocephalus
Objectives

1. take relevant history, conduct physical and neurological examination and elicit relevant
physical sign in head injury, meningocele, meningomyelocele, encephalocele, hydrocephalus
2. describe the patho-physiology of head injury
3. describe the clinical features of acute extra dural, sub-dural and intra-cerebral haematomas
7. outline the principles of management for above conditions
8. enumerate the complications and outline the principles of their management in all the above
238
FACE, ORAL CAVITY AND SALIVARY GLANDS
Pre-requisites
1. Anatomy of parotid, submandibular salivary glands and their relations.

2. Gross embryology of development of face.
3. Muscles of face, their nerve and blood supply and venous drainage.
4. Etiopathogenesis of oral cancers, salivary glands tumors
Themes and Topics
1. Leukoplakia, submucous fibrosis

2. Ranula, plunging ranula
3. Oral cancers (cheek, tongue, floor of mouth)
4. Cleft lip and cleft palate
5. Cysts and superficial tumors (sebaceous cyst, dermoid, lipoma, haemangioma), a-v fistula of
face and scalp.
6. Basal and squamous cell carcinoma of face
7. Preauricular sinus
8. Inflammation, abscess, tumor, calculus and fistula of salivary glands.
Objectives

1. take relevant history, perform local examination and elicit relevant physical findings in all the
above conditions
Pre-requisites
1. Embryological development, gross anatomy, blood supply, lymphatic drainage, nerve supply,
congenital anomalies and functions of the esophagus, stomach, duodenum, intestines,
appendix, rectum, anal-canal, hepato-biliary organs, portal venous system, pancreas and
spleen
2. Peritoneal reflexion in relation to the various abdominal viscera
3. Etiopathogenesis of inflammatory bowel diseases, carcinoma of esophagus, colon and rectum,
liver, pancreas, bile duct and gall bladder
4. Bilirubin metabolism and hepatobiliary function tests
5. Pathology of liver abscess, portal hypertension, gall stone, tumors of liver
6. Drugs used in gall stone disease
7. Drug metabolism in liver and hepatotoxic drugs
239
Esophagus
Themes and Topics
1. Trachea-esophageal fistula
2. Dysphagia, corrosive burns
3. Hiatal hernia
4. Achalasia cardia and other motility disorders of esophagus
5. Carcinoma esophagus
Objectives

conditions
Stomach and Duodenum
Themes and Topics
1. Congenital hypertrophic pyloric stenosis

2. Upper gastrointestinal bleeding
3. Acid-peptic diseases
4. Gastric-outlet obstruction
5. Carcinoma stomach
Objectives

conditions
Intestines
240
Themes and Topics
1. Intestinal obstruction in adults and newborn

2. Intussusceptions
3. Congenital megacolon
4. Meckel's diverticulum
5. Diverticular diseases and polyposis
6. Intestinal amoebiasis
7. Typhoid and tuberculous ulcers
8. Ulcerative colitis/crohn's disease
9. Colostomy and ileostomy
10. Malignant tumors of colon
Objectives

conditions
Appendix
Themes and Topics
1. Acute appendicitis
2. Carcinoid tumor
Objectives
conditions
Rectum
Themes and Topics
241
1. Polyp
2. Prolapse
3. Proctitis
4. Carcinoma
Objectives

conditions
Anus and anal canal
Themes and Topics
1. Imperforated anus
2. Fissure
3. Haemorrhoid
4. Perianal abscesses
5. Fistula in ano
6. Pilonidal sinus
7. Anal wart
8. Anal canal cancer
Objectives

conditions
Peritoneum, mesentery, retroperitoneum and abdominal wall
Themes and Topics
1. Acute abdomen and peritonitis

242
2. Subphrenic abscess, pelvic abscess
3. Mesenteric adenitis and cysts
4. Retroperitoneal masses
5. Malignant ascites
Objectives

conditions
3. able to identify acute abdomen and surgical emergency in abdominal diseases
4. consider the differential diagnoses of above conditions
HEPATO-BILIARY SYSTEM, AND PANCREAS
Themes and Topics
1. Obstructive jaundice
2. Liver abscess, hydatid cyst
3. Cholelithiasis, choledocholithiasis acute cholecystitis, chronic cholecystitis
4. Portal hypertension
5. Liver tumors, secondaries in the liver
6. Acute and chronic pancreatitis
7. Carcinoma of gall bladder, bile duct and pancreas.
8. Principles of laparoscopic surgery
Objectives
conditions
7. outline the principles of laparoscopic surgery in general and laproscopic cholecystectomy
Spleen
Themes and Topics
243
1. Splenic trauma
2. Splenomegaly
Objectives
conditions
ABDOMINAL WALL AND HERNIAS
Pre-requisites
1. Layers of abdominal wall and their blood and nerve supply

2. Boundaries of inguinal canal, femoral canal
3. Pathway of testicular descent
4. Embryology of umbilicus, vitello-intestinal duct and allantois
Themes and Topics

1. Ventral hernia
2. Umbilical sepsis and discharge
3. Inguinal herina
4. Femoral hernia
5. Umbilical and paraumbilical hernia
Objectives

1. take relevant history in patients of hernia and perform clinical examination
2. diagnose different types of hernia, elicit relevant history in patients of hernia, define clinical exam
3. enumerate the underlying predisposing conditions
4. diagnose, outline the principles of managements and complication of inguinal, femoral,
umbilical, para-umbilical and ventral hernias
5. enumerate different causes of umbilical discharge and outline their principle of management
GENITO-URINARY SYSTEM
Pre-requisites
244
1. Development of kidney, ureter, bladder and external genitalia
2. Anatomy of kidney, ureter, bladder and external genitalia
3. Physiology of micturition
4. Metabolism of uric acid and calcium
5. The normal values of bun, creatinine and creatinine clearance
6. Physiology of urine formation
7. Pathology of renal malignancy
8. Pathophysiology of hydronephrosis
Themes and Topics
1. Haematuria
2. Acute and chronic retention of urine
3. Congenital anomalies
4. Urinary tract injury
5. Hydronephrosis
6. Renal stones
7. Polycystic kidney
8. Renal malignancy
9. Urinary tract infection
8. Diseases of prostate
9. Bladder tumors
10. Obstructive uropathy
11. Testicular torsion and undescended testes
12. Urethral stricture
13. Scrotal and testicular swellings (epididymo-orchitis, testicular tumors)
14. Phimosis and paraphimosis
15. Carcinoma penis
16. Minimally invasive surgery in urology
Objectives

1. take relevant history in patients of hernia and perform clinical examination
2. diagnose different types of hernia, elicit relevant history in patients of hernia, define clinical exam
3. enumerate the underlying predisposing conditions
4. diagnose, outline the principles of managements and complication of inguinal, femoral,
umbilical, para-umbilical and ventral hernias
5. enumerate different causes of umbilical discharge and outline their principle of management
7. enumerate the causes of haematuria, acute retention of urine and hydronephrosis and outline
their principles of management
8. describe the steps of circumcision, suprapubiccystostomy, hydrocoelectomy and vasectomy
9. outline the principles of minimally invasive surgery in urology
245
1. Structured interactive sessions

2. Multidisciplinary integrated seminars
3. Small group discussions
4. Outpatient postings
5. Ward postings / case based learning (CBL)
6. Bed side case demonstrations and/or discussions
7. Case presentations
8. Clinico-pathological exercises
9. Surgical case studies
10. Procedural demonstrations and/or performance under supervision.
Integrated Seminars
1. Wounds, fissure repair and scars (Surgery, Dermatology, Microbiology, Pathology)

2. Wound infection (Surgery, Dermatology, Pathology, Microbiology)
3. AIDS and Hepatitis – universal precautions surgical practice (Surgery, Dermatology,
Medicine, Microbiology)
4. Haemorrhage, blood transfusion, nutrition in surgery (Surgery, Biochemistry, Medicine,
Anaesthesia, Paediatrics)
5. Fluid, electrolyte and acid-base balance (Surgery, Biochemistry, Anaesthesia, Paediatrics)
6. Intestinal Obstruction (Surgery, Medicine, Paediratric, Radiology)
7. Principles of management of peptic ulcer (Surgery, Medicine, Radiology)
8. Acute Appenditicitis (Surgery, Medicine, Paediatrics, Radiology)
9. Urinary tract infection (Surgery, Microbiology, Medicine, OG, Family Medicine)
10. Polytrauma (surgery, Anesthesia, Radiology, Orthopaedics, Emergency Medicine)
Learning in Field (LIF)
Students shall be posted in a teaching district hospital (defined by the Institute) in groups under
faculty supervision.
Learning objectives
At the end of the course, the student shall be:

1. Able to apply the clinical skills to recognize and prioritize the common surgical diseases
including the surgical emergencies in the community.
2. Able to develop the ability to diagnose with help of limited investigations, formulate the
management plan and be able to function as first contact surgeon as well as physician.
3. Aware of the physical, social, psychological, economic, and environmental determinants of
health and their impact upon surgical diseases.
Assessment
Formative Assessment
246
1. Students will be assessed on a day to day basis
2. Maintenance of a well designed log book (during the period of posting in the discipline)
Summative assessment
1. Theory examination.
2. Case presentation.
a. Long case – one
b. Short case – two
c. Viva
3. Objective structured clinical examination (OSCE), including.
 interpretation of test items e.g. Temperature chart, instruments, photographs, x-rays,
USG, ct-scan of common surgical conditions, anatomical parts, pathological specimens
(macroscopic and microscopic), patient counseling session
Text Books and References Books of Latest Edition
1. Bailey &Love. Short Practice of Surgery: Norman S. Williams et al. Hodder Arnold,
3. Concepts and Practices of Rural Surgery: Benerjee B.I. Publications,
4. Principles and practices of Surgery: Forrest et al.
5. An Introduction to the symptoms and signs of surgical diseases: Browse.
6. A manual on clinical Surgery: S. Das. SD, Calcutta,
7. Pye's Surgical handicraft: Kyle, Smith et al. KM Verghese Company, Bombay,
8. Oxford Textbook of Surgery: Morris PJ, Malt RA. Oxford Medical Publications
9. Textbook of Surgery: Sabiston D.C.W.B. Saunders Company
10. AlfredCuschieri's textbook of Surgery
11. Greenfield's text book of Surgery
12. Hamilton Bailey's Demonstration of Physical Signs in Clinical Surgery
247
ASSESSMENT & EVALUATION
MBBS Phase II
1. Attendance: In order to be eligible to appear in the annual examination the students should
have at least 80% attendance in each of theory, practical, clinical posting & field postings
separately during the academic year.
2. Final assessment will be conducted at the end of the
a. third year (sixth semester)
b. fourth year (eight semester)
c. final year (ninth semester)
3. Final examinations held at the end of the sixth, eighth and ninth semesters will constitute
barriers for going to the next section of the curriculum. The examinations will be integrated to
the extent feasible.
4. Each final examination will have a paper on Problem Solving Exercises.
5. Students must secure 50% marks in theory & practical examinations in each subject/paper
separately to pass the final assessment.
6. A supplementary examination will be held between 5- 6 weeks from the date of completion
of the regular annual examination for 3rd & 4th year & between5- 6 months for final year.
7. No student will be allowed to appear in the supplementary examination if he/she has not
appeared in the regular annual examination except where there is exceptional condition
either due to illness of the candidate or bereavement in the family or any other such
compelling circumstance. The final decision pertaining to this matter will rest on the
decision of Rector’s office.
8. Any student who fails in the supplementary examination will have to reappear in the next
final assessment in the subject(s)/paper(s) in which he/she has failed & rules governing the
attendance, internal assessment and payment of fees will be applicable as per rules of
BPKIHS.
9. The registration of the candidate failing to complete the course within 10 years from the
academic year of admission will be cancelled.
12. The contribution of internal assessment & annual examination to the final assessment will
be 30% & 70% respectively. Separate re-internal assessment for failures in the final
assessment will not be taken, and in their case the 30% marks to be considered for internal
assessment will be derived from the marks secured in the concerned subject/paper in the
regular annual examination. This mark will be added to the marks obtained in the
supplementary examination.
13. Certificate of merit will be awarded to those students scoring a minimum aggregate of 75%
on total marks in the annual examinations in the first attempt & being on the 90th
percentile & above.
248
Semester V: Internal Assessment
Theory Practical Total Total
Department MCQ SAQ MEQ OSCE/ Long Short Case VIVA Theory Pract
OSPE Cases Cases Records ical
Community 15 25 20 15 15 0 10 20 60 60
Medicine
Internal 45 50 45 40 40 20 20 20 140 140
Medicine
Obst/Gynae 45 50 45 40 40 20 20 20 140 140
Paediatrics 45 50 45 40 40 20 20 20 140 140
Surgery 45 50 45 40 40 20 20 20 140 140
Forensic 45 115 40 160 0 0 0 40 200 200
Medicine
Semester VI: Internal Assessment

Theory Practical Theory Practical
Department MCQ SAQ MEQ OSCE/ Long Short Case VIV Total Total
OSPE Cases Cases Records A
Community 60 50 30 40 30 30(Res 20 20 140 140
Medicine posting)
Internal 15 25 20 15 20 10 5 10 60 60
Medicine
Obst/Gynae 15 25 20 15 20 10 5 10 60 60
Paediatrics 15 25 20 15 20 10 5 10 60 60
Surgery 15 25 20 15 20 10 5 10 60 60
Forensic 45 115 40 160 0 0 0 40 200 200
Medicine
3rd Year Annual Examination

(Forensic Medicine only)
Forensic MCQ SAQ MEQ OSPE VIVA Theory Practical
Medicines
Paper I 30 60 50 225 55 140 280
Paper II 30 60 50 0 0 140 0
30% of Internal 120 120
Assessment
(carrying from V
& VI semesters)
Total 400 400
249
Semester VII: Internal Assessment
Paper I
Theory Practical Practical
Department Theory
MCQ SAQ MEQ OSCE VIVA Total
Dematology 13 24 30 67 53 14 67
Psychiatry 13 24 30 67 53 14 67
Lab Medicine 13 24 30 67 53 14 67
Total 39 72 90 201 159 42 201
Paper II
Department Theory
Anaesthesiology 20 23 24 67 53 14 67
Oral Health 20 23 24 67 53 14 67
Radiology 13 24 30 67 53 14 67
Total 53 70 78 201 159 42 201
Paper III
Department Theory
General
23 29 80 132 108 24 132
Practice
Emergency 20 23 23 66 54 12 66
Total 43 52 103 198 162 36 198
Note: Each paper will be for 3 (three) hours
Semester VIII: Internal Assessment

Papers Theory Theory Practical Practical
MCQ SAQ MEQ Total OSCE VIVA Total
Paper I 33 50 50 133 108 25 133
Ophthalmology
Paper II 33 50 50 133 108 25 133
ENT
Paper III 33 50 50 133 108 25 133
Orthopaedics
Paper IV 38 67 96 201 161 40 201
(Emergency
Medicine)
Total 600 600
Note: Each paper will be for 3 (three) hours
250
4th Year Annual Examination
Paper I
Department Theory Theory Practical Practical
Dermatology 10 16 20 46 36 9 45
GP 20 36 40 96 80 20 100
Lab Med 10 16 20 46 36 9 45
Psychiatry 10 16 20 46 36 9 45
Radiology 10 16 20 46 36 9 45
Sub-Total 280 280
Assessment
(carrying from
VII & VIII
semesters)
Total 400 400
Paper II
Anaesthesia 10 18 20 48 40 9 49
Oral Health 10 18 20 48 40 9 49
Ophthalmology 20 32 40 92 72 19 91
ENT 20 32 40 92 72 19 91
Sub-Total 280 280
Assessment
(carrying from
VII & VIII
semesters)
Total 400 400
Paper III
Emergency 36 60 72 168 144 34 178
Orthopaedics 24 40 48 112 80 22 102
Sub-Total 280 280
30% of 120 120
Internal
Assessment
(carrying from
VII & VIII
semesters)
Total 400 400
251
Semester IX: Internal Assessment
MCQ SAQ MEQ Total OSCE Long Short Case VIVA Total
Cases Cases Records
Community 45 50 45 140 30 50 25 15 20 140
Medicine
Internal 45 50 45 140 30 50 25 15 20 140
Medicine
Obst/Gynae 45 50 45 140 30 50 25 15 20 140
Paediatrics 45 50 45 140 30 50 25 15 20 140
Surgery 45 50 45 140 30 50 25 15 20 140
Total 700 700
5th Year Annual Examination

MCQ SAQ MEQ Total OSCE Long Short Case VIVA Total
Cases Cases Records
Community 60 120 100 280 54 90 80 - 56 280
Medicine
Internal 60 120 100 280 54 90 80 - 56 280
Medicine
Obst/Gynae 60 120 100 280 54 90 80 - 56 280
Paediatrics 60 120 100 280 54 90 80 - 56 280
Surgery 60 120 100 280 54 90 80 - 56 280
Sub Total 1400 1400
30% of 600 600
Internal
Assessment
(carrying
from V, VI
& IX
semesters)
Total 2000 2000
252
The internal assessment of 5th year of MBBS final assessment will include internal assessment held
in the relevant subjects during 1st semester through 9th semester as per detail given in table below.
Marks Distribution in internal assessment

Subjects I Year II Year V Semester VI Semester IX Semester Seminar Total
Community Th 60 140 140 60 400
Medicine Pr 30(10+20) 30(10+20) 60(15+15+10+20) 140(40+30+30+20+20) 140(50+25+15+20+30) 400
Th 140 60 140 60 400
Medicine
Pr 30(10+20) 30(10+20) 140(40+40+20+20+20) 60(15+20+10+5+10) 140(50+25+15+20+30) 400
Obstetrics & Th 140 60 140 60 400
Gynaecology Pr 30(10+20) 30(10+20) 140(40+40+20+20+20) 60(15+20+10+5+10) 140(50+25+15+20+30) 400
Th 140 60 140 60 400
Paediatrics
Pr 30(10+20) 30(10+20) 140(40+40+20+20+20) 60(15+20+10+5+10) 140(50+25+15+20+30) 400
Th 140 60 140 60 400
Surgery
Pr 30(10+20) 30(10+20) 140(40+40+20+20+20) 60(15+20+10+5+10) 140(50+25+15+20+30) 400
1. Internal assessment Total theory= 400x5subjects=2000marks.

2. Carryover marks for final exam = 30% of 2000 (120 of each subject) =600.
3. Internal assessment Total Practical= 400x5subjects=2000marks.
4. Carryover marks for final exam = 30% of 2000 (120 of each subject) =600.
5. I & II year practical 30 (20 CLIP practical exam + 10 log book).
6. 5th Semester practical 140 (40 OSCE+40 Long case+20Short cases+20 Logbook +20Viva)
7. 6th Semester practical 60 (15 OSCE+20 Long case+10Short cases+5Logbook+10 Viva).
8. 9th Semester practical 140 (50 long case+25 short cases+20 Viva+15 Logbook+ 10 OSCE)
253
INTERNSHIIP PROGRAM
Students, who have passed the Fifth Year Final Assessment, have to undergo one year
Community Oriented Compulsory Residential Rotatory Internship Program (COCRRIP) at
BPKIHS and its Teaching District Hospitals. This is mandatory. The degree will not be awarded
in case of failure to comply with this rule.
The Internship Program consists of six months posting at BPKIHS teaching hospital and
remaining six months at teaching district hospitals with adequate facilities under supervision.
While posted at district level hospitals, the interns will be given ample opportunities to work in
the community.
The Internship Program will begin with an orientation program. Several important aspects of
medical ethics & professionalism, communication skills, techniques of sample collection for
investigations, rational drug prescription, operation theater protocol, medico-legal aspects, health
research methodology etc. will be covered during the orientation program.
The progress of the intern throughout the program will be monitored through a structured log
book. The interns are required to maintain and update the log-book daily, and get the entries
verified by the supervisor. The log-book will be used to evaluate the overall performance of the
intern. A certificate of completion will be awarded to those who have successfully completed all
rotations and duly verified the log-book by the concerned supervisors
For successful completion of the one year Community Oriented Compulsory Residential
Rotatory Internship student must have been posted in the following hospitals and disciplines.
Teaching Hospital, BPKIHS Teaching District Hospitals designated by the

BPKIHS
Medicine 1½ months Comprehensive training 6 months
(Community Medicine, Dermatology,
Emergency Medicine*, Medicine,
Obstetrics & Gynaecology,
Ophthalmology, Oral Health,
Orthopaedics, Otorhinolaryngology,
Paediatrics, Surgery).
Surgery 1½ months
Obstetrics & Gynaecology ¾ month [*15 days posting in the Emergency
of BPKIHS]
Paediatrics ¾ month
Elective Posting:
(Any 3 disciplines)
Discipline A ½ month
Discipline B ½ month
Discipline C ½ month
254

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MBBS Curriculum - 2nd Edition

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THE MBBS CURRICULUM

B. P. KOIRALA INSTITUTE OF HEALTH SCIENCES

2nd Edition 2014

1. Prof Bishnu Hari Paudel Chairperson

[Constitution date: 31st January 2013]

First Edition 1994

© B.P. Koirala Institute of Health Sciences

Clinical Posting 111

Assessment and Evaluation 117

Academic Calendar 126

Forensic Medicine 153

Obstetrics & Gynaecology 180

Assessment & Evaluation 243

It is a product conceived as a result of rapid changes taking place in medical education

Prof Madan P. Upadhyay, FRCS

Members, Curriculum Review Committee; 2013

The MBBS curriculum of BPKIHS is thoroughly integrated and community-oriented and

BPKIHS has been visualized as

1. Develop Human Resources for Health by:

2. Provide Quality Health Services by:

3. Conduct Scientific, Bio-Medical and Bio-Social Research:

At the end of the course the student should be able to:

a. overcome the inevitable shortcomings in the curriculum,

1. Structured interactive session (SIS)

1st Year Week

Unit O Basic Concepts 15 wk

Unit 1 Genetics, Growth & Development, 15 wk

Unit 2 Respiratory & Environment including 11 wk

Unit 3 Gastrointestinal System, 12 wk

Unit 4 Endocrines and Reproductive Systems 13 wk

Unit 5 Musculoskeletal System, Special Senses 13 wk

Unit 6 Multisystem Seminars 6 wk

Bird's-eye view of the MBBS

Introduction of the faculty

The BPKIHS organogram with

Bird's-eye view of the

Tour of the BPKIHS Complex

Tour of Dharan town Deputy Manager (Academics)

History of Medicine School of Public Health and CM

Socio-economic and cultural

Introduction to community Medicine School of Public Health & CM

Visit to the community (Batch A) Field Program Coordinator

Visit to the Hospital (Batch B) Deputy Manager (Hospital Admin)

Preparation for presentations

Visit to the Community (Batch B) Field Program Coordinator

Visit to the Hospital (Batch A) Deputy Manager (Hospital Admin)

Preparation for presentations

Resource session on PBL (1)

Objectives of the Community Visit

Organization of the Hospital Visit

Objectives of the course on behavioral sciences

At the end of the course, the students should be able to:

Community Medicine & Behavioral Sciences, and

Themes and Topics

1. Introduction to anatomy, anatomical positions, planes and terms.

At the end of the course, the student will be able to:

Themes and Topics

1. Introduction to microscopy and principles of histological techniques.

At the end of the course, the student will be able to:

Themes and Topics

1. Breast and axilla

At the end of the course the student should be able to:

Themes and Topics