KU Syllabus

KATHMANDU UNIVERSITY
SCHOOL OF MEDICAL SCIENCES
BACHELOR OF MEDICINE & BACHELOR OF SURGERY

(MBBS) CURRICULUM
Revised Version 2011
1
CURRICULUM
FOR
BACHELOR OF MEDICINE & BACHELOR OF SURGERY
(MBBS)
KATHMANDU UNIVERSITY
DHULIKHEL, KAVREPLANCHOWK
NEPAL
2011
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FOREWORD
Kathmandu University was established in November 1991 by an act of Parliament. Kathmandu University
started functioning from December 11, 1991. The University operates through the School of Sciences,
Engineering, Management, Arts, Education and Medical Sciences.
The University first granted affiliation to a private medical college, Manipal Colleges of Medical Sciences,
at Pokhara to start MBBS program since December 1994. Since then six other medical colleges have been
granted affiliation college of Medical Sciences, Bharatpur, Chitwan, in August 1996; Nepalgunj Medical
College, Chisapani, Banke, in December 1997; Kathmandu Medical College, Kathmandu, in December
1997; Nepal Medical College, Kathmandu, in December 1997; Nobel Medical College, Biratnagar, in
February 2007 and Lumbini Medical College, Palpa, in February 2009.
Kathmandu University School of Medical Sciences started its own Medical College in collaboration
between Kathmandu University and Dhulikhel Hospital. KUSMS launched its own constituent MBBS
program in August 2001.
The first MBBS curriculum in now called Pre-Clinical Science was developed in association with the
Manipal Academy of Higher Education, Manipal, India. In Keeping with developments in modern medical
education, the first review of the Pre-Clinical Science curriculum was carried out in 1996 along with the
participation of the Institute of Medicine, Tribhuvan University and Manipal Academy of Education,
Manipal, India. The outcome was the second version of Pre-Clinical Science curricumum in December
1996.
The University is in touch with the changing scenario in Medical education. The emphasis is now on
problem-based learning. With this concept in mind, another review of the Pre-Clinical Sciences curriculum
was carried out in March 2001. The new version emphasizes teaching Pre-Clinical Science subjects
system-wise and in an integrated way. Appropriate common clinical problems related to each organ system
was revised in consonance with the existing health situation; and practical activities were identified in each
subject. A chapter on medical ethics was added. Also during that phase the student were introduced to
clinical knowledge and skills utilizing a problem solving approach. Medical informatics was added in
newly to enhance computer literacy relevant to medical education. These changes fostered in students the
ability to learn through self-directed and independent study.The Third Version was introduced in august
2001 academic session; there was rearrangement of the Community Medicine curriculum.
The present edition of the Fourth version which begins from August 2011 academic session contains
rearrangement of semesters (instead of Unit) and evaluation scheme. Extensile information gathering from
all concerned was done. Workshops were conducted inviting all representatives from all affiliated colleges
of KU; TU-IOM and Nepal Medical Council necessary changes in the curriculum were done. Common
curriculum and evaluation scheme for both constituent and affiliated colleges is adapted. PBL (Problem
Based Learning) teaching methodology and Introduction to Clinical Medicine (ICM) are introduced in
both constituent as well as affiliated colleges. The University is aware of the fact that there is no best
way but always a better way and is always commited to improve the curriculum, as necessity demands.
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Table of Contents
Pre-Clinical Sciences
Contents Page
Kathmandu University Mission ................................................................................................... 1

Overall Goals of the School of Medical Sciences ........................................................................ 2
General Description of the Curriculum ........................................................................................ 3
Features of the Curriculum .......................................................................................................... 4

The Curriculum Outline .............................................................................................................. 5
Objectives of the MBBS Program ............................................................................................... 6
Guidelines to Medical College and Faculty ............................................................................... 10
First Year
Semesters I & II Objectives & Contents..11
Semester - I ........................................................................................................................ 12-40
Basic Concepts .............................................................................................................. 12
Genetics ........................................................................................................................ 22
Immune system and immunology .................................................................................. 25
Autonomic Nervous system ........................................................................................... 32
Integumentary System ................................................................................................... 35
Musculo-Skeletal System...36
Community Medicine.40
Introduction to Clinical Medicine (ICM) ....................................................................... 39
Medical Informatics....................................................................................................... 40
Semester - II ................................................................................................................... (41-59)

Haemopoetic System39
Respiratory System ........................................................................................................ 41
Cardiovascular System .................................................................................................. 48
Community Medicine .................................................................................................... 55
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Second Year
Semesters III & IV Objectives & Contents..11
Semester - III ................................................................................................................... (60-98)
Gastrointestinal System ................................................................................................. 61
Hepatobiliary System .................................................................................................... 69
Renal-Electrolyte System .............................................................................................. 73
Metabolism and Endocrine System ................................................................................ 79
Community Medicine .................................................................................................... 95
Semester - IV ................................................................................................................. (99-121)

Reproductive System ..................................................................................................... 99
Central Nervous System and Special Senses ................................................................ 105
Community Medicine .................................................................................................. 118
Introduction to Clinical Medicine (ICM) ..................................................................... 121
List of Practical Classes.......................................................................................................... 122
List of Formate of ICM..222
ANNEXES:
Annex I Subject wise break down of Semester hours: Semesters I- IV ..................... 217-218
Annex II Calendar of Operation for an Academic Year...219
Annex III Scheme for Semester Examinations ...................................................... .220
Annex IV Flow Chart of Modules in Community Medicine...221
Annex VIII List of Reference Books ....................................................................... ...234
Annex IX List of Participants .................................................................................... 238
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KATHMANDU UNIVERSITY MISSION
The Kathmandu University has the mission to:
a) promote all-round development of students abilities and personalities.
b) develop an awareness of the role of sciences and its application in the understanding of problems of
contemporary society.
c) extend and disseminate knowledge and encourage its application.
d) develop a community of scholars, students and staff in which understanding and wisdom can grow
and flourish.
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OVERALL GOALS OF THE SCHOOL OF MEDICAL SCIENCES
The School of Medical Sciences of Kathmandu University is headed by the Dean and has the following
overall goals:
1. conduct and give permission to conduct academic programs of certificate, bachelor, masters and
doctoral levels in medical sciences including other branches of health sciences.
2. collaborate and coordinate with medical schools of other universities for the growth and
development of academic programs, research undertakings and health care services.
3. promote and conduct research for the growth of new scientific knowledge.
4. participate and provide health care to the people.
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GENERAL DESCRIPTION OF THE CURRICULUM
This curriculum, which has been designed embracing modern Educational Science Technology as
applied to Medical Education, provides for acquisition of
a core knowledge, the basic medical doctor must possess.

clinical skills to diagnose and manage disease.
desirable characteristics and attitudes ingrained in the profession.
competency to determine and resolve health problems of the community.
proficiency to function in diverse health care settings.
interest in continuing medical education.
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FEATURES OF THE CURRICULUM
The curriculum is
Student centered (rather than teacher centered)

Problem based (rather than subject based)
Integrated (rather than discipline based)
Community oriented (rather than hospital centered)
Electives embodied (rather than standard program oriented)
Systematic (rather than apprentice based)
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THE CURRICULUM OUTLINE
The aim of this curriculum for the MBBS degree is to produce a well-rounded medical graduate, who as a
result of the five and half years of undergraduate education program in medical sciences will be competent
to carry out preventive, promotive and curative functions expected of a basic doctor. The accent of the
curricular approach is community orientation, integrated teaching-learning and problem-based learning.
The curriculum synthesized initially (in 1994) consulting the curricula of medical institutions in Nepal is
aptly revised and presented here.
The four-and-half year span of the MBBS course of study is divided into nine semesters, each of six
months duration. The first four semesters are devoted to the Pre-Clinical Sciences. The next five semesters
are devoted to Clinical Sciences. After successful completion of the course of study of four-and-half years,
and having passed the final MBBS examination, the student will have to complete one year of compulsory
Rotating Residential Internship to become eligible for being conferred with the degree of MBBS of the
Kathmandu University.
The MBBS curriculum is divided into two Parts. Pre-Clinical sciences include the curriculum of the first
and the second year. Whilst, the Clinical Sciences include the curriculum of the remaining two and a half
years.
Pre-Clinical Sciences (first year and second year):
The First year and the Second year instruction cover Integrated Pre-Clinical Sciences, Community
Medicine and Introduction to Clinical Medicine.
Pre-Clinical Sciences include Anatomy, Biochemistry, Microbiology, Pathology, Pharmacology and

Physiology. These subjects will be taught in an integrated manner and would be threaded into Community
Medicine and Introduction to Clinical Medicine, as appropriate. Also, during this phase the student will be
introduced to clinical knowledge and skills utilizing a problem solving approach. Medical Informatics will
provide computer literacy relevant to medical education.
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OBJECTIVES OF THE MBBS PROGRAM
On completion of the five and a half year of MBBS program, the Medical Graduate should be able
to:
a) Demonstrate the understanding of principles and practice of modern medicine with an in-depth
knowledge of structure and functions of human body.
b) Develop a holistic approach to the practice of modern medicine.
c) Advance ones own knowledge and skills through higher education via continuing medical education
programs and research.
d) Demonstrate an understanding of contemporary knowledge and skills.
e) Possess qualities of a compassionate and socially accountable human being.
f) Discharge job responsibilities with concern and care.
g) Provide immediate management care to life threatening situations by self.
h) Identify common health problems, manage them initially, ask opinion from seniors or refer to
appropriate health institutions when required.
i) Provide education to people on health and health related matters.
j) Participate in immunization programs and in health camps.
k) Communicate well with patient and patients relatives by explaining matters known and refer them to
appropriate persons when matters are not clear to self.
l) Provide all information on matters of management of patients to the patient and the relatives.
m) Identify medico legal cases and function as required.
n) Develop a health care team-approach and give respect to all the other members of the team.
o) Give due care to children, elder citizens and women.
p) Provide health care by becoming aware of the ethos of medical ethics.
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CURRICULUM FLOWCHART
PRE - CLINICAL SCIENCES
11st year SEMESTER I
Basic concepts
Genetics
Immune System and Immunology
Autonomic Nervous System
Integumentary System
Musculo-skeletal System
Community Medicine
Introduction to Clinical Medicine (ICM)
Medical Informatics
SEMESTER II
Haemopoietic System
Respiratory System
Cardiovascular System
Community Medicine
2nd year SEMESTER III

Gastrointestinal System
Hepatobiliary System
Renal - Electrolyte System
Metabolism and Endocrine System
Community Medicine
SEMESTER IV
Reproductive System (including breast)
Central Nervous System and Special Senses
Community Medicine
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COURSE REGULATIONS
(Eligibility; Attendance; Examinations)
1. The candidate must complete Intermediate Science or 10+2 years of education or equivalent with
English, Biology, Physics and Chemistry as main subjects and having secured not less than 50% of
marks in the subjects mentioned above put together and an aggregate of 50% overall. The candidate
should have completed 17 years of age on or before the date of admission, or
completed B.Sc. Degree recognized by the university with one of the following subjects viz. Physics,
Chemistry or Biology and at least one other prescribed science subject of study up to the ancillary level
and should have scored not less than aggregate of 50% marks and provided that such candidate shall
have passed the earlier qualifying examination (I. Sc. or equivalent) with the subjects English, Biology,
Physics and Chemistry.
2. In order to derive maximum benefit from integrated teaching the student is expected to have 100%
attendance in all the subjects; however to meet unavoidable contingencies the student should have not
less than 80% of the attendance separately in theory and practical / clinical to be eligible for the
university examination.
5. A student should clear all the subjects of Pre-Clinical Sciences, before he/she is allowed into Semester
V.
6. A student must complete the different subjects of the Pre-Clinical Sciences - I MBBS Examination
within three years from the date of admission. Similarly, a student must complete the different subjects
of the Pre-Clinical Sciences - II MBBS Examination within four and half years from the date of
admission.
7. Internal assessment: At the end of every system, formative evaluation may be conducted to enable the
students to learn and to get a feed back of the progress in all subjects. Average of these marks should
constitute 50% of an individuals internal assessment for theory component. The average of marks
obtained in the semester examinations (two in a year) in that subject should account for the remaining
50%. The average of the sessional marks in practical shall constitute the internal assessment for
practical. To qualify for the University examination a student is required to obtain a minimum of 50%
internal assessment in both theory and practical separately in each subject.
9. The mandatory minimum mark for passing the theory examination in any subject is 50% of the marks
in the theory segment (i.e. written, viva-voce and internal assessment components put together),
including not less than 50% of the maximum marks in the written component. Both written and viva-
voce are compulsory components of university theory examination.
The mandatory minimum mark for passing the practical examination in any subject likewise is 50% of
the maximum marks in the practical segment (i.e. practical plus internal assessment).
10. The evaluation scheme for Kathmandu University School of Medical Sciences will be according to
the KUSMS Evaluation Scheme.
General Recommendations
Each semester consists of 20 weeks of 6 working days per week, 7 hours/ day. The time frame may not
be relevant for hospital postings.
Curriculum should be approached in a manner so that not more than one third of the time allotted for
each subject is spent as didactic teaching.
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The examinations in theory and practical will be as objective and structured as possible.
The University will maintain Question Bank for every system subject wise, consisting of different
types of questions.
The University will conduct workshops for faculty development (teaching-learning and student
evaluation) as necessary.
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GUIDELINES TO MEDICAL COLLEGE AND THE FACULTY
The Medical College should follow the curriculum guidelines in imparting knowledge to the
undergraduate student.
Emphasis should be laid to ensure that the undergraduate student grasps the basic concepts
throughout the course.
When time-tabling the semester schedules, the concerned academic departments should get
together and identify in an integrated manner, the instructional objectives to be covered.
As a rule, the departments concerned should ensure integration of related subject matter of a
particular System / Topic by carrying out teaching synchronously.
In instruction, common clinical problems should form the prologue to establish relevance of basic
sciences to clinical medicine.
In correlation seminars, the student should be guided to address common problems / common
clinical problems serving as themes, around which discipline-wise subject is threaded coherently.
Pre-Clinical sciences should be revisited as a rule whilst implementing Clinical Sciences of the
curriculum of clinical disciplines.
Clinical symptoms and clinical signs must be emphasised upon and should be explained, referring
to Pre-Clinical sciences, wherever possible.
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11st year SEMESTER I
Basic concepts
Genetics
Immune System and Immunology
Community Medicine
Medical Informatics
SEMESTER II
Haemopoietic System
Respiratory System
Community Medicine
2nd year SEMESTER III

Renal - Electrolyte System
Community Medicine
SEMESTER IV
Reproductive System (including breast)
Community Medicine
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FIRST YEAR
SEMESTERS I & II
OBJECTIVES:
SEMESTER I
Facilitates acquisition of fundamental knowledge in pre-clinical sciences, required to understand
the human body systems to follow.
Provides learning inputs in structural-functional aspects on the immune system and immunology,
integumentary and musculo-skeletal to understand diseases process affecting these systems.
SEMESTER II
Provides learning inputs in respiratory, cardiovascular, function-dysfunction with a basis for
understanding, common clinical disorders, affecting respiratory and cardiovascular systems.
CONTENTS:
Basic Concepts
Genetics
Immune System and immunology

Haemopoietic System
Respiratory System
Community Medicine
Medical Informatics
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SEMESTER - I
BASIC CONCEPTS
COMMON CLINICAL PROBLEMS:

Understanding the Human Body and Its Functions
Maintaining Normal Health
Understanding Disease
Human Values and Value-Systems
Medical Profession and Professional Ethics
ANATOMY
General Anatomy
General Histology
General Embryology
BIOCHEMISTRY
Importance of Biochemistry in Medicine
Introduction to cells
Carbohydrates
Amino acids
Proteins
Lipids
Nucleic acids-Gene Expression
Enzymes
Metabolism
Vitamins
MICROBIOLOGY
Historical perspectives and contributions of Microbiology to medical sciences.
Differences between Prokaryotic and Eukaryotic cells, Fungi, Bacteria, Viruses and Parasites.
Introduction, classification and nomenclature of microbes.
Bacteria - Introduction
Anaerobiosis
Sterilization, Disinfections, Decontamination:
Normal Flora
Infection
Bacteria - Introduction
Fungi - Introduction
Viruses - Introduction
Parasites - Introduction
Antimicrobial Agents
Microbial genectics
Laboratory diagnosis of Viral, Bacterail, fungal and parasitic infections.
Biomedical waste management.
Hospitalacquired infection and HICC.
PATHOLOGY
Cellular adaptations, cell injury and cell death
Inflammation and Repair
Hemodynamic disorders
Neoplasia
PHARMACOLOGY
Introduction
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Sources and Routes of Drug Administration
Pharmacokinetics
Pharmacodynamics
Adverse Drug Reactions
Essential Drugs Concept and Rational Drug Therapy
P-drug concept
PHYSIOLOGY
Introduction
Homeostasis
Bioelectricity
COMMUNITY MEDICINE
Human and Medicine
Concepts of Health
Nutrition
Environmental Sciences
Biostatistics
INTRODUCTION TO CLINICAL MEDICINE

Medical Ethics
Art of History Taking
Clinical Examination
MEDICAL INFORMATICS
Fundamentals of Computer
Windows 98/2000 Applications
Word Processing (Microsoft Word)
Working With Worksheets (Microsoft Excel)
Graphic Presentation (MS-Power Point and Multimedia)
Statistical Treatment of Data (Using Epi Info WHO
Epidemiological Software)
Retrieving Information (Internet WEB)
CONTENTS
ANATOMY
General Anatomy:
Introduction to anatomy - anatomical positions, planes and terms.
Cell divisions
Skin and fasciae - introduction.
Locomotor system.
Bones - classification, functions, development, growth.
Long bones - parts and blood supply.
Cartilage - classification, sites of occurrence, nutrition and growth.
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Joints - classification, examples of each variety.
Muscles - classification, examples of each type.
Nervous tissue- introduction to nervous system, subdivisions and their functions, neurons- types,
structure, nerve fibres, synapses
General Histology:
Cell and sub-cellular organelles - electron microscopic structure.

Structure and function of nucleus, mitochondrion, endoplasmic reticulum, Golgi Apparatus, lysosome.
Epithelial tissues - definition, classification, functions.
Connective tissues classification, functions structural components.
Skin & Fascia- structure
Exocrine glands classification with examples.
Muscles types with example.
Bone- TS & LS
Blood vessels: artery large & medium size and vein.
Nervous tissue- nerve, spinal ganglia, sympathetic ganglia, neurons & neuroglia.
Microanatomy of adrenal medulla
General Embryology:
Menstrual cycle
Gametogenesis
Graafian follicle, spermatozoon - structure
Corpus luteum formation, fate
Ovulation, fertilisation, implantation
Morula and blastocyst formation
Bilaminar embryonic disc
Neurulation
Formation and fate of notochord
Intraembryonic mesoderm and its subdivisions (somites)
Ectoderm, mesoderm, endoderm derivatives
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Folding of embryo
Embryonic period
Placenta: Structure, formation, types, function and twinning
Foetal membranes: chorion, decidua, umbilical cord amnion, yolk sac and allantois brief account
Foetal period
Teratogens and teratology
BIOCHEMISTRY
Importance of Biochemistry in Medicine:

Molecular basis of disease, role of biochemistry in diagnosis
Introduction to cells:
Prokaryotic and Eukaryotic cells, cell structure, biochemical functions of organelles
Carbohydrates:
Biomedical importance, functions, classification, isomerism
Monosaccharides, disaccharides, polysaccharides: starch, glycogen, cellulose - structure and properties,
glycosaminoglycans, proteoglycans and glycoproteins
Amino acids:
Classification, special structural features, functions, optical activity, iso-electric pH, acid-base
properties and characteristics of peptide bond
Proteins:
Classification and structural organisation, functions
Lipids:
Classifications, Fatty acids and its classifications, poly unsatuarated fatty acids, triacylglycerols,
phospholipids, prostaglandins, steroids and lipoproteins
Nucleic acids - Gene Expression:

Purine - pyrimidine bases, purine pyrimidine derivatives, DNA and RNA structure and functions,
concept of exons, introns, gene expression.
Enzymes:
Definition, International Union of Biochemistry (IUB), classification, enzyme kinetics, factors
affecting activity, regulation of activity, inhibition of activity, measurement of enzyme activity
isoenzymes, enzymology in medicine.
Metabolism:
Essentials of metabolism, metabolic pathways, regulation, integration
Vitamins:
Definition, classification, vitamin cofactors - biochemical functions, deficiency symptoms
MICROBIOLOGY`
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Historical perspectives and contributions of Microbiology to medical sciences
Differences between Prokaryotic and Eukaryotic cells, Fungi, Bacteria, Viruses and Parasites
Introduction, classification and nomenclature of microbes
Bacteria - Introduction:
a. Morphology of bacteria and Bacterial spore
b. Bacterial growth requirements, bacterial growth curve and its relationship with infection and disease,
growth media and types of culture.
c. Anaerobiosis: Definition, classification and method of anaerobiosis and anaerobic culture.
Sterilization, Disinfections, Decontamination:

Definitions, Principles, methods and their applications
Normal flora:
Preliminary concepts, anatomical distributions, factors influencing normal flora, bacteriocin, role of
normal flora in nosocomial infections and opportunistic infections
Fungi:
Introduction, general characteristics and classification of fungal infections
Viruses Introduction:
a. Introduction, general characteristics and classification of viruses and bacteriophage
b. Replication, pathogenesis of viral diseases
Parasites Introduction:
Classifications of parasites (by morphology, infection sites/disease)
Host parasite relationship
Infections:
Types of infections (local and systemic), source of infections (including Zoonotic diseases), Mode of
transmission of microorganisms, Virulence factors and Mechanism of pathogenesis
Host parasite relationship of medically important bacteria, viruses, fungi and parasites
Complement system:
Role of complement, different pathways
Laboratory diagnosis of Viral, Bacterial, fungal and parasitic infections:

Principles, specimen collection, storage and transport, methods of diagnosis
Antimicrobial agents:
Antibiotic susceptibility test, reliability of tests, factors influencing susceptibility tests.
Infectious waste management

Hospital acquired infection and HICC
PATHOLOGY
Cellular Adaptations:
Atrophy, hypertrophy, hyperplasia, metaplasia - definitions, examples and mechanism
Cell Injury:
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Reversible and irreversible - mechanism and changes produced in different types of degeneration
including fatty change in liver and heart.
Necrosis - definition, types, examples and morphology.
Differences between necrosis and apoptosis
Mechanism of apoptosis
Pathologic Calcification:
Definition, types, mechanism, examples
Inflammation and Repair:

Definition, acute and chronic inflammation - morphological types, vascular and cellular response,
chemical mediators and their role in inflammation,
Granuloma - definition, description, diseases.
Wound healing - mechanisms, factors affecting healing.
Shock, Oedema, Thrombosis, Embolism, Infarction and Chronic Venous Congestion:

Shock -definition, morphological changes in target organs and aetiopathogenesis.
Oedema - pathogenesis.
Thrombosis - types, pathogenesis, morphology, fate of thrombus.
Embolism - definition, types, sequelae.
Infarction - sites, types, consequences.
Chronic venous congestion - gross and microscopic changes in lungs, liver, spleen.
Neoplasia:
Definitions of neoplasia - tumour - dysplasia, carcinoma in situ and allied definitions
Benign - malignant neoplasia - differences
Mode of spread of malignant tumours with suitable examples
Histogenetic classification - epithelial, mesenchymal, totipotent
Aetiopathogenesis, oncogenesis and clinical presentation of tumors - benign-malignant
Paraneoplastic syndromes - brief discussion
Laboratory diagnosis
PHARMACOLOGY
Introduction to General Pharmacology:

Explanation of terms
Pharmacology, drug, pharmacokinetics, pharmacodynamics, therapeutics, chemotherapy, pharmacy,
Clinical pharmacology, orphan drug
Terminology of allied branches, sources of information, drug nomenclature
Definition of terms:
Alkaloid, glycoside, oil, tannin
Sources and Routes of Drug Administration:

Sources and nature of drugs: common sources e.g., natural (plant, animal) & synthetic
Routes of drug administration: common routes, advantages - disadvantages, new drug delivery systems
Pharmacokinetics:
Absorption and bioavailability of a drug
Methods of absorption, factors affecting drug absorption and bioavailability
Bioavailability, Bioequivalence: definition - significance
Distribution of drugs: concept of apparent volume of distribution,protein-binding of drugs and its
clinical importance
Blood brain barrier, placental barrier
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Biotransformation: definition, types of reactions, consequences, factors affecting biotransformation,
clinical significance.
Excretion: routes, factors affecting.
Kinetics: first order, zero order, biological half-life.
Optimization of dosage regimen: loading dose, maintenance dose and steady state plasma
concentration.
Therapeutic drug monitoring: importance.
Methods of prolonging the duration of action of a drug
Pharmacodynamics:
Principles of drug action, drug - receptor interactions.
Dose response relationships, types of DRC different components like ED50, LD50.
Therapeutic index.
Factors affecting drug response: Drug factor , Factors related to patient: age, body weight, sex,
Pharmacogenetics, Drug Tolerance, Drug Dependence.Drug antagonism, synergism, cumulation.
Adverse Drug Reactions:

Adverse drug reactions - definition, types, clinical significance.
Drug toxicity - organ toxicity, hypersensitivity, teratogenicity, carcinogenicity, dependence.
Heavy metals - antagonists (brief), chelators - dimercaprol, d-Penicillamine, EDTA.
Essential Drug Concept and Rational Drug Therapy:

Essential drug concept: principles, importance, model list preparation.
Rational drug therapy: concept, examples: p-drug concept
PHYSIOLOGY
Introduction
General functional organization of human body.
Body fluid compartments- Functions of electrolytes: Dehydration and over hydration.
Define and explain terminology: Isotonic, hypertonic, hypotonic fluids
Osmotic pressure crystalloid and oncotic. Osmosis
Cell membrane transport.
Cell to cell and local commutation.
Intracellular mechanism of signal transduction
Homeostasis:
Definition, maintenance, control of internal environment, different regulatory systems in homeostasis.
Principles of control systems general characteristics and components of biological control systems,
concept of negative and positive feedback correction, error, gain.
Hormonal control mechanisms definition of hormones, receptors and target cell, role of hormones in
homeostasis.
Neural control mechanism role in homeostasis.
Bioelectricity: Terminology Excitable cells, neurons and muscles and their excitable properties.
Functional anatomy of neurons.
Resting membrane potential, Nernst equation.
Action potential - ionic basis of its genesis and propagation Its refractory period
Receptor Classification and functions.
Cutaneous receptors - classification and function, generator potential, properties and transduction.
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SEMESTER - I
GENETICS

Cerebral Palsy
Downs Syndrome
Intra-Uterine Growth Retardation
Lactose Intolerance
Prematurity
ANATOMY
Genetic Terms, Symbols Used in Pedigree Chart
Mendelian Inheritance
Structure of Chromosomes, Chromosomal Aberrations
Sex Determination and Hermaphrodites
BIOCHEMISTRY
Nucleic acids and Genetics
Biochemistry of Tumor Metabolism
Trace Element Metabolism
MICROBILOGY
Microbial genectics
PHARMACOLOGY
Pharmacogenetics
PHYSIOLOGY
Growth and Development
Disorders of Normal Growth
Physiology of Aging
CONTENTS
ANATOMY
Genetic Terms, Symbols Used in Pedigree Chart
Mendelian inheritance (single gene and multifactorial patterns)
Chromatin and Chromosomes (morphology and classification)
Karyotyping
Chromosomal aberrations (numerical and structural)
Autosomal disorders of chromosomes (Pataus, Edwards, and Downs syndromes)
Sex-chromosomal disorders (Turners, Klinefelters, and fragile-X syndromes, metafemales)
27
BIOCHEMISTRY
Nucleic Acids DNA and RNA:

Chemistry, Structure of DNA, types of RNAs.
Watson - Crick Model of DNA
Genes:
Definition, base sequence determination, types of mutation, mutagens.
Replication:
Cell cycle, semi-conservative replication, mechanism
Protein Synthesis:
Transcription, translation, fundamental differences between prokaryote-eukaryote protein synthesis.
Regulation of gene expression:

Control of gene expression in prokaryotes (Lac operon) and eukaryotes
Recombinant DNA Technology:

Knowledge of: Recombinant DNA, vector, cloning, restriction enzyme, blot techniques application in
medicine.
Purine and Pyrimidine Metabolism:

Synthesis and degradation salvage pathway, uric acid, gout.
Genetic Disorders:
Mutation and repair, biochemical disorders of carbohydrate, lipid, amino, purine and pyrimidine, seen
in the local hospital.
Enzyme Deficiency Disorders
Cytogenetic Disorders
Biochemistry of Tumor Metabolism:

Biochemical basis of cancer,comparison with normal cell metabolism, tumor suppressor gene, proto
onco gene, loss of metabolic regulation, tumor markers.
Trace Element Metabolism:

Zinc, Copper, Chromium, Selenium, Molybdenum, Iodine, Fluoride. Iron, cobalt & manganese
.
MICROBIOLOGY
Microbial genetics:
Introduction, genetic materials, mutation and repair mechanism, gene transfer, genetic basis of
pathogenicity, antibiotic resistant and toxogenic gene, molecular diagnostic techniques
PHARMACOLOGY
Pharmacogenetics: general concept
PHYSIOLOGY
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Growth and Development:
Definition
Physical growth: prenatal period, birth to puberty, pubertal growth.
Skeletal age and physical maturity
Organ growth: differential growth of specific organs and tissues i.e. brain, head, lymphoid tissue,
visceral, reproductive organs at various ages.
Growth spurts in human life: infancy, late puberty.
Growth rates in boys and girls, mental growth and IQ.
Factors influencing growth: genetic, nutritional, hormonal
Disorders of Normal Growth:

Abnormalities of foetal and postnatal growth
Hereditary short stature
Physiology of Aging:
Changes in various systems and mechanisms involved.
Factors affecting aging
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SEMESTER - I
IMMUNE SYSTEM AND IMMUNOLOGY

ANATOMY
Lymphoid organs
MICROBIOLOGY
Immunity
Antigens
Antibody
Immune response
Complement system
Hypersensitivity
Autoimmune diseases
Primary and secondary immune deficiency diseases
AIDS
Immuno-prophylaxis
PATHOLOGY
Amyloidosis
Organ transplant rejection
PHARMACOLOGY
Immunosuppresant and Immunostimulants
PHYSIOLOGY
Spleen and Lymph Nodes
Lymph and Tissue Fluids
Immunology- Plasma Cells and Immune Scenario
Immunoglobulins
Innate and acquired immunity
Plasma Cells and Immune Scenario
CONTENTS
ANATOMY
Gross features and development of Spleen, Tonsil and Thymus
Microanatomy of Lymph node, Spleen, Tonsil and Thymus
MICROBIOLOGY
Immunity:
Introduction, basic concepts role of immunity in health and diseases
Mechanism of innate, acquired, active, passive immunity
Antigens:
Hapten, carrier, epitope, heterophilic antigens
Antibody:
Classes, structure and functions of immunoglobulins
Immune response:
30
Humoral and cellular immunity
Complement system:
Role of complement, different pathways
Common immunological and serological tests used for diagnosis
Hypersensitivity:
Types and mechanisms
Immunological disorders:
Primary, Secondary immune deficiency diseases
A.I.D.S.
Auto immune disorders
Immuno-prophylaxis:
Introduction, basic concepts; active and passive, vaccines monovalent, polyvalent, live, killed, subunit,
synthetic and KBMA vaccines (killed but metabolically active)
Common immunological and serological tests used for diagnosis
PATHOLOGY
Amyloidosis - definition, classification, morphology, special stains.
Organ transplant rejection
Types, mechanism, and morphology
PHARMACOLOGY
Immunosuppresant and Immunostimulants
List the drugs and therapeutic uses
PHYSIOLOGY
Spleen and Lymph Nodes:
Functions of reticuloendothelial system
Lymph and Tissue Fluids:

Formation and functions
Immunology: Introduction.
Role of B & T lymphocytes and macrophages in immunity
Concepts of function of interleukins and complement system
Immunoglobulins:
Types, plasma concentration, functions, special features
Plasma Cells and Immune Scenario:

Development, morphology, functions, antibody production
31
SEMESTER - I
AUTONOMIC NERVOUS SYSTEM

Shock
Colic
Organophosphorous Poisoning
Mushroom Poisoning
Myasthenia Gravis
ANATOMY
Adrenal Medulla
BIOCHEMISTRY
Neurotransmitters
PHARMACOLOGY
Introduction
Cholinergic Receptor Agonists
Muscarinic Receptor Antagonists
Adrenergic Receptor Agonists
Adrenergic Receptor Antagonists
Antimicrobials
PHYSIOLOGY
Organisation of Nervous System
Physiological Role of Autonomic Nervous System
CONTENTS
ANATOMY
Autonomic Nervous System:

Sympathetic nervous system
Parasympathetic nervous system
Adrenal Medulla
Gross anatomy, microanatomy
BIOCHEMISTRY
Neurotransmitters:
Definition
Synaptic transmission, Nuromuscular transmission, Neuro transmitter receptors
Acetylcholine, dopamine, nor-epinephrine, epinephrine, GABA, Serotonin, Nitric oxide
Biosynthesis and metabolism of Polyamines and their medical importance
Biochemical basis of Myasthenia gravis Parkinsons disease, organophospherous poisoning.
Neuropsyciatric disorders
32
PHARMACOLOGY
Introduction to Autonomic Pharmacology:

Review briefly physiology of autonomic nervous system.
Define the terms cholinergic receptors, adrenergic receptors.
Outline of actions.
Cholinergic Receptor Agonists / cholinomimetics:

Definition, Classification, Mechanism of action, uses, adverse effects and contraindications of : Esters
of choline acetylcholine , Bethanechol etc.
Alkaloids pilocarpine, Mucarine.
Anti cholinesterases neostigmine, physostigmine etc
Explain the principles of management of glaucoma, myasthenia gravis, organophosphorous poisoning.
Cholinergic Receptor Antagonists:

Definition
List the drugs belladonna alkaloids and atropine substitutes
Discussion atropine (prototype)
Advantages and disadvantages of clinically used atropine substitutes
Adrenergic Receptor Agonists/ Sympathomimetic agents:

Adrenergic Receptor: types, distribution and function
Endogenous catecholamines epinephrine, nor-epinephrine, dopamine
Review biosynthesis, storage and release
Adrenergic drugs classification
Discussion epinephrine (prototype)
-adrenergic receptor agonists selective and non-selective
List the drugs, pharmacological actions, advantages, uses and adverse effects
-adrenergic receptor agonists
List the drugs, enumerate the actions, uses and adverse effects
Adrenergic Receptor Antagonists:

Definition, types.
- Blockers
Classification (selective and non-selective), Mechanism of action, Adverse effects, Contraindications,
Therapeutic Uses and Drug interactions
.
-blockers
Classification (selective and non-selective), Mechanism of action, Adverse effects, Contraindications,
Therapeutic Uses and Drug interaction, Propanolol (prototype)
Antimicrobials:
Introduction
General principles
Classification, Mechanism of action, adverse effects, Contraindications, Therapeutic Uses & Drug
interactions of
Cotrimoxazole, sulphonamides
Fluoroquinolons.
33
-lactam antibiotics: penicillins, cephalosporins etc.
-lactamase inhibitors: examples.
Rationale of combining with -lactams.
Aminoglycosides: list of important drugs - Streptomycin, gentamicin, amikacin, netilmicin,
tobramicin, neomycin: general features, mechanisms, kinetics, adverse effects, comparison of clinically
most useful preparations.
Tetracyclines, chloramphenicol.
Macrolides:Erythromycin: prototype.
Miscellaneous groups of antibiotics: very brief discussion, e.g. bacitracin, vancomycin, clindamycin,
polymyxin-B, spectinomycin.
Antifungal Agents:
Introduction
General principles- Classification, Mechanism of action, Adverse effects, Contraindications,
PHYSIOLOGY
Organisation of the Nervous System

Functional organisation of nervous system review.
Inter neuronal communication synapse structure, synaptic transmission, neurotransmitters and
modulators.
Site and mechanism of generation of an action potential in a neuron
Functional organisation of Autonomic Nervous System: divisions, distribution, .

Transmitters and receptors in ANS
Higher control of autonomic nervous system
Physiological role of autonomic nervous system in the control of various body functions
34
SEMESTER - I
INTEGUMENTARY SYSTEM

Burn
Scabies
Dermatitis
Leprosy
Malignancies
ANATOMY
Skin Thick and Thin with Appendages
BIOCHEMISTRY
Melanin Synthesis
MICROBIOLOGY
Introduction to skin infections
Bacillus anthracis
Mycobacterium Leprae
Atypical Mycobacteria
Gas gangrene
Superficial mycosis
Dermatophytosis
Subcutaneous Mycoses
Viral infections
Parasite infection
PATHOLOGY
Tumours
Leprosy
PHARMACOLOGY
Antileprotic Drugs
PHYSIOLOGY
Skin Functions
Sweat Glands
Thermoregulation
CONTENTS
ANATOMY
Skin (microscopic structure of thin, thick, and pigmented skin)
Appendages of Skin (hair, nail, pilosebaceous unit)
BIOCHEMISTRY
35
Melanin:
Synthesis - cells involved, abbreviated pathway.
Albinism: The molecular defect, implications.
MICROBIOLOGY
Introduction to skin infections: Types of infections, common etiological agents, Staph aureus, Strept
pyogenes and its complication (PSGN= post streptococcal glomerular nephritis).
Bacillus anthracis: Morphology, culture, pathogenicity, laboratory diagnosis.
Mycobacterium leprae: Morphology, pathogenicity, clinical classifications, laboratory diagnosis,

lepromin test.
Atypical Mycobacteria: Swimming pool granuloma, Buruli ulcer.
Gas gangrene: Cl perfringens etc
Superficial mycosis: P. versicolor, T. nigra etc. clinical features and laboratory diagnosis.
Dermatophytosis: classification, clinical features and laboratory diagnosis.
Subcutaneous Mycoses: Mycetoma, chromomycosis, Sporothrix schenkii- Sources, types of infection,

clinical features, laboratory diagnosis.
Viral infection: Varicella zoster clinical features, laboratory diagnosis; viral exanthematic diseases.
Parasite infection: T spiralis, Larva migrans
PATHOLOGY
Leprosy:
Classification.
Tuberculoid and Lepromatous leprosy: Pathogenesis, immunology, complications, microscopic
features and diagnosis.
Tumours:
Squamous papilloma.
Aetiology, morphology, mode of spread of squamous cell carcinoma.
Nevus: definition, types (intradermal Junctional and compound), morphology.
Malignant melanoma.
PHARMACOLOGY
Antileprosy Drugs:
Introduction, aetiopathogenesis
Classification of antileprosy drugs, multiple drug therapy.
Discussion of individual drugs.
PHYSIOLOGY
Skin:
36
Functions.
Sweat Glands:
Types, control of secretion, functions.
Thermoregulation:
Mechanism, receptors, hypothalamic thermostat.
Physiological responses on acute exposure to hot and cold environment.
Acclimatisation, disorders of thermoregulation - hypothermia, hyperthermia, fever.
37
SEMESTER - I
MUSCULO-SKELETAL SYSTEM

Tetanus
Hemiplegia
Osteomyelitis
Varicose Veins
Arthritis
Injuries
ANATOMY
Upper Limb Gross Anatomy
Bones- clavicle, scapula, humerus, radius, ulna and carpals bones
Joints
Axillary Lymph nodes
Flexor extensor compartments
Muscles
Nerves
Brachial plexus
Arteries
Veins
Surface anatomy
Radiological anatomy
Lower Limb Gross Anatomy

Bones: Hip bones, femur, tibia, fibula, patella and bones of foot
Thigh and leg
Hip joint, knee joint, ankle joint
Gluteal region, sole, dorsum of foot
Arches of foot
Lymph nodes
Muscles
Nerves
Arteries
Veins
Surface anatomy
BIOCHEMISTRY
Muscle Metabolism
Creatine Creatine Phosphate
Markers of Muscle Damage
Calcium homeostasis
MICROBIOLOGY
Infectious Arthritis
Osteomyelitis
PATHOLOGY
Congenital disorders
Fracture
Osteomyelitis
Osteoporosis
38
Osteomalacia and rickets
Paget disease of bone
Bone Tumors
Rheumatoid Arthritis, Gout, Osteoarthritis
Soft Tissue Tumors
Muscular Dystrophies
PHARMACOLOGY
NSAIDS
Drugs for RA and Gout
Skeletal muscle relaxant
PHYSIOLOGY
Functional organization of striated muscles
Neuromuscular transmission
Excitation contraction coupling (ECC)
Mechanical events during muscle contraction
Denervated muscle
Types of muscle fibers
Physiology of smooth muscle
CONTENTS
Upper Limb:
(cross section at the level of insertion of deltoid and middle of forearm)
Boundaries, contents, applied aspects of: axilla, cubital fossa, anatomical snuff box, carpal tunnel.
Joints:
Types, subtypes, ligaments, movements of sterno-clavicular, acromio-clavicular joints.
Type and subtypes: capsular attachments, ligaments, movements, muscles involved, blood supply,
nerve supply and applied aspects of : shoulder joint, elbow joint, radio-ulnar joints, first carpo-
metacarpal joint, wrist joint, carpo-metacarpal joint.
Palm: fascial spaces in the palm and Palmer aponeroses and their applied aspects. Actions and nerve
supply of interossei and lumbricals.
Bones: clavicle, scapula, humerus, radius, ulna, carpals and metacarpals

Side determination: parts, immediate relations; capsular attachments and blood supply of bones.
Identification of bones in an articulated hand.
Axillary lymph nodes:

Subgroups, relations, applied aspects.
Flexor extensor compartments:

Contents of arm and forearm.
Muscles:
Origin, insertion, nerve supply and actions of Trapezius, Latissimus dorsi, pectoralis major, pectoralis
minor, deltoid, biceps brachii, pronator teres, supinator, adductor pollicis.
Nerves:
Origin, root value, course, branches, distribution and applied anatomy of axillary, radial, median,
ulnar nerves.
Brachial plexus:
39
Formation, parts, branches and applied aspects.
Arteries:
Origin, course, termination and branches of axillary, brachial, radial,
ulnar arteries, palmar arches.
Veins:
Formation, tributaries, termination, position, applied anatomy of - basilic, cephalic, median cubital
veins.
Radiological Anatomy
X-rays of shoulder, elbow, and wrist
Surface Anatomy
Acromion process of scapula, medial and lateral humeral epicondyles, olecranon process of ulna, head
of radius bone, and styloid processes of radius and ulna bones.
Brachial, radial, and ulnar arteries, and superficial and deep palmar arches
Cephalic, basilic, and median cubital vein
Development of the limb bud
Lower Limb Gross Anatomy:

(cross section at the level of apex of femoral triangle and middle one-third of the leg)
Bones:
Hip bone, femur, tibia, fibula, patella, tarsals and metatarsals
Side determination, parts, immediate relations, capsular attachments, blood supply.
Identification of bones in an articulated foot.
Boundaries, Contents, applied aspects of: femoral triangle, adductor canal, popliteal fossa.
Thigh and leg:

Compartments and contents.
Identification of structures in gluteal region, sole, dorsum of foot.
Hip joint, knee joint, ankle joint:

Type, subtype, capsular attachments, ligaments, movements-muscles involved, nerve supply, blood
supply and applied aspects.
Arches of foot:
Formation, supports, applied anatomy.
Inversion Eversion
Lymph nodes:
Inguinal group, popliteal groups subgroups, afferents, efferents and applied aspects.
Muscles:
Origin, insertion, nerve supply, actions of: gluteus maximus, gluteus medius, triceps surae, biceps
femoris, semimembranosus, rectus femoris, adductor magnus, popliteus, tibialis anterior and tibialis
posterior, and peroneus longus.
Nerves:
40
Origin, root value, course, branches, applied aspects of : sciatic, common peroneal, tibial, femoral and
obturator.
Arteries:
Origin, course, branches of: femoral, popliteal, arteria dorsalis pedis, peroneal, anterior and posterior
tibial, plantar arch.
Veins:
Origin, termination, tributaries, applied aspects: long and short saphenous veins, popliteal, femoral.
X-rays of hip, knee, and ankle
Surface Anatomy
Anterior superior iliac spine, pubic tubercle, greater trochanter of femur, adductor tubercle, patella,
medial and lateral malleoli, femoral, popliteal, anterial and posterior tibial, and dorsalis pedis arteries,
long and short saphenous, and femoral veins,
Development of limb bud and axis artery
BIOCHEMISTRY
Muscle Metabolism:
Glycogen metabolism.
Energy metabolism switch over in conditions: from resting to contracting, adequate O2 to hypoxic, fed
to fasting, Cori Cycle, powre stroke of contraction, role of calcium, tetany and rigor mortis.
Creatine and Creatine Phosphate:

Synthesis from precursors, catabolism, creatine phosphate function.
Markers of Muscle Damage:

Myoglobin, troponins, enzymes.
Calcium homeostasis:
Role of parathyroid hormone (PTH), calcitriol, calcitonin in regulation of Plasma calcium level.
MICROBIOLOGY
Infectious Arthritis:
Causative organisms.
Pathogenesis, laboratory diagnosis.
Osteomyelitis:
Acute and chronic, agents, pathogenesis, laboratory diagnosis.
PATHOLOGY
Congenital Disorders:
Achondroplasia, Osteogenesis imperfecta, Osteopetrosis
Fracture:
Types, morphology of healing, factors delaying the healing.
41
Osteomyelitis:
Aetiology, pathogenesis, clinical features and complications.
Osteoporosis:
Classification, pathogenesis, morphology, clinical features
Osteomalacia, rikets:
Classification, pathogenesis, morphology, clinical features
Paget disease of bone
Bone Tumours:
Classification, gross and microscopic features, clinical features and X-ray findings of: Ewings
Sarcoma, Giant cell tumor (Osteoclastoma), Osteosarcoma, chondrio sarcoma.
Rheumatoid Arthritis, Osteoarthritis, Gout:

Aetiopathogenesis, morphological features and complications.
Soft Tissue Tumors:

Gross and microscopic features of lipoma , fibrosarcoma, rhabdomyosarcoma,
Muscular Dystrophies:
Definition.
Mode of inheritance, clinical features, morphology, investigations of Duchennes muscular dystrophy,
Beckers muscular dystrophy.
Polymyositis.
Myasthenia gravis: Investigations.
PHARMACOLOGY
Nonsteroidal Antiinflammatory Drugs (NSAID)

(Analgesic antipyretic and antiinflammatory drugs)
Classification, salient features of various groups.
Prostaglandins, kinins and mediators of inflammation.
Drug therapy for gout

Acute and chronic drug treatment and prophylaxis.
Drug therapy for Rheumatoid Arthritis

Drugs, actions, limitations, adverse effects.
Skeletal Muscle Relaxants

Classification, mechanisms of action, uses and cautions. Comparison of salient features of various
groups.
PHYSIOLOGY
Functional organization of striated muscles:

Muscle cell, sarcomere and organization of contractile proteins and sarcoplasmic reticulum
Neuromuscular transmission:
42
Structure, mechanism of transmission, mechanism of generation of end plate potential (EPP) and
muscle action potential; myasthenia gravis
Excitation contraction coupling (ECC):

Role of T tubules and SR in the release of calcium; cross bridge cycle, mechanism of contraction and
relaxation, rigor mortis
Mechanical events during muscle contraction:

Isotonic and isometric contraction, effect of two or more stimuli on muscle contrction- titanic
contraction, preload and after load, effect of load on velocity of contraction, effect of length on tension
developed.
Denervated muscle:
Neurotropic factor/s and their role in maintenance of structure and function of the striated muscle
(fibrillation and paralysis), reinnervation, cross innervations, EMG and streangth duration curve,
chronaxie and rheobase
Types of muscle fibers:

Structural and functional differences between slow and fast twitch muscle fibers
Effect of exercise and training on skeletal muscle structure and function. Physiological basis of
fatigue.
Physiology of smooth muscle:

Structure, types, mechanism of contraction and relaxation, properties of smooth muscle and effect of
neural, humoral and local factors on it.
43
SEMESTER I
COMMUNITY MEDICINE
HUMAN AND MEDICINE

Themes and Topics:
Medicine in antiquity (Primitive Medicine, Indian Medicine, Chinese Medicine, Egyptian Medicine,
Greek Medicine, Roman Medicine)
Dawn of Scientific Medicine
Modern Medicine
Medical Revolution
Health Care Revolution
Socio-Cultural aspects of Health in Nepal
Eugenics
Alternative medicine
Medical Ethics
Objectives:
Appreciate that knowledge of past prevents repetition.
Describe medical and health in various time, place and person.
Acquaintance of past health and medical practice in Nepal.
Principal Teaching Learning Methods to be used:

Group discussion
Seminar presentation
CONCEPTS OF HEALTH & DISEASE
Themes and Topics:

Definition of health and well-being
Dimensions and determinants of health
Indicators of health
Epidemiological triad
Theories of disease causation
Natural history of disease
Risk factor concept
Concept of control of disease
Levels of prevention
Modes of intervention
Primary Health Care
Goals / targets set to achieve Health for All
Critical review of HFA 2000
Revitalizing Primary Health Care
MDGs in the context of Nepal
Objectives:
Orientation to the basic concepts of health and its determinants.
Orientation to the concept of epidemiological triad and theories of disease occurrence.
Describe the levels of prevention and modes of intervention.
Describe the principles of Primary Health Care and other related concepts.
44
List the goals / targets set to achieve Health for All.
Describe the socio-cultural structure of the community.
Identify the environmental problems.
Describe the existing health facilities.
Make a simple presentation regarding the above.
Suggest and conduct a simple intervention for an identified problem
State the National Health Policy and planning.
Principal teaching-learning methods to be used:

Lecture discussion
Small group discussion
Practical exercises
NUTRITION -I
Themes and Topics:
Common problems:
Protein-energy malnutrition
Iron deficiency
Vitamin A deficiency
Determinants of nutritional status of individual / community

Nutritional sources and requirements
Balanced diet
Nutritional deficiency disorders e.g. PEM, Iron deficiency, Vitamin A deficiency.
Nutritional problems in Nepal.
Practical exercise: Nutritional status assessment in a community and presentation of data collected.
Objectives:
Describe the determinates of nutritional status of individual / community.
Describe the nutritional sources and requirements at different ages and for males and females.
Describe the nutritional deficiency disorders especially protein energy malnutrition (PEM), iron
deficiency anaemia, vitamin A deficiency.
Assess the nutritional status of a community.
Describe and prioritise the nutritional problems in Nepal.
Prescribe a balanced diet within the socio-economic-cultural milieu for normal adult male / female,
pregnant / lactating / postpartum woman, under-five child.

Lecture discussion
Demonstration
Simulated practical exercises in class room
Student action: problem based learning (malnutrition): group activity - students as a group will conduct
a nutritional survey in 10 houses each to collect information about nutrition for an under 5 year child;
pregnant, lactating woman and analyze and present the data.
Follow up intervention by the students regarding nutritional education.
NUTRITION -II
Themes and Topics:

Iodine Deficiency Disorders (IDD)
Magnitude of the Problem in Nepal
45
Community Assessment of IDD
Zinc deficiency
Salt Fortification
Objectives:
State the magnitude of the problems on IDD in Nepal.
Describe the steps in the community assessment of IDD.
Describe the importance of salt fortification (iodisation).

Lecture discussion.
Demonstration: use of field testing kits for iodine levels in salt.
Small group discussion.
Student action: The students as a group will conduct a survey in 10 houses to collect information about
IDD, level of Iodine in salt at the household level and analyze and present the data. Follow up
intervention by the students regarding nutrition education. Problem based learning: integrated seminar,
presentation with other departments.
ENVIRONMENTAL SCIENCES
Themes and Topics:
Environment: physical environment inside and outside the home

Water: safe water, Potable water, purification of water at the household and community levels
Waste disposal - necessity of waste disposal
General principles of waste disposal
Excreta disposal - necessity of excreta disposal
General principles of excreta disposal
Family environment and principles of good housing
(In all of the above topics the general principles are to be taught avoiding engineering details)
Objectives:
Describe the physical environment: both inside and outside the home.
Describe the family environment and principles of good housing.
Define and analyze the importance of water and sanitation in human health.
Define safe water obtained from tap, hand-pump, well.
Describe appropriate methods for making water safe at the household level.
Understand the methods of waste and excreta disposal.
Suggest feasible methods of environmental control.

Lecture discussion
Demonstration
Practical exercises
Student action - during the family health exercise students will identify environmental problems and
suggest feasible and appropriate remedial measures
BIOSTATISTICS
Themes and Topics:

46
Need of biostatistics in medicine
Statistical methods
Frequency distribution
Measure of central tendency
Proportions
Presentation of statistical data
Tables: simple and frequency distribution tables
Charts and diagrams: bar, histogram, frequency polygon, line diagram,
pie-chart, pictogram
Objectives:
Define, calculate and interpret commonly used statistical treatment.
Select and use appropriate diagrammatic representation of statistical data.
Principal Teaching-Learning Methods To Be Used:
Lecture discussion
Simulated practical exercises in the classroom: calculate various statistical values using data from
hospital or community
47
SEMESTER - I
Themes and Topics:
Medical Ethics
Art of History Taking
Clinical Examination
At the end of Semester-I the learner should be able to:

1. realise the roles and responsibilities of a basic medical doctor.
2. familiarise with the societal expectations of medical profession.
3. understand the functions of Nepal Medical Council.
4. perceive medical ethics as an essential of medical profession and;
4.1 cultivate and exhibit an attitude of compassion and respect to patient as a fellow-human being.
4.2 develop preparedness and readiness to provide medical care with dedication, acting in the best
interest of the patient.
4.3 uphold confidentiality of patient related information.
4.4 be truthful and honest with colleagues and others in the medical profession.
4.5 refrain from causing any form of harm to the patient.
4.6 be well aware of the Law of the Land and strive to uphold the Law of the Land.
4.7 know the professional norms and imbibe - exhibit the behavior expected of a doctor.
5. appraise with the components of communications skills.
6. state the importance and the need for history taking.
7. develop skill of taking history
8. comprehend the socio-cultural habits of ethnic groups.
9. recognise the geographical variations in the prevalence of different types of diseases.
10. demonstrate on peers the techniques of systematic general physical examination procedures.
11. make observation of: first aid, dressings, injection procedures, venesection, blood transfusion in
emergency room / hospital wards.
1. appraise the common problems related to Musculo-skeletal System.

2. take relevant history on Musculo-Skeletal System.
3. correlate anatomical structures and Pathophysiology involved in giving rise to different clinical
signs in relation to Musculo-Skeletal System.
4. identify laboratory and radiological investigations required in making diagnosis.
5. list steps of testing patients clinically in relation to motor, reflexes, , sensory, gait and
coordination.
Instructional Method:
Lectures in class-room, practical demonstrations, practice on peers and on patients, supplementary
video.
48
SEMESTER - I
MEDICAL INFORMATICS
Fundamentals of Computer
Windows 98/2000 Applications
Word Processing (Microsoft Word)
Working with Worksheets (Microsoft Excel)
Graphic presentation (MS-PowerPoint and Multimedia)
Statistical Treatment of Data (Epi Info WHO Epidemiological software)
Retrieving Information (Internet Web)
Aim :
To provide hand-on-practice in order to increase and improve students ability to use computers to an
extent that he / she will utilise computers effectively to improve learning.
Objectives:
On completion of the course in Medical Informatics, the student will be able to
1. write reports using word and excel software.
2. use MS-Powerpoint with multimedia facility when presenting to audiences, presenting correlation
seminars and project findings.
3. obtain subject matter from CD ROMs, computerised tutorials, computerised patient-records and
from patient simulations.
4. download subject matter from the Internet and Websites of other medical schools and journal
publications.
5. carry out statistical analysis using Epi Info package.
Demonstration, practice under supervision, independent practice to achieve mastery.
49
SEMESTER - II
HAEMOPOIETIC SYSTEM

Haemorrhage
Anaemia
Leishmaniasis
Filariasis
Malaria
BIOCHEMISTRY
Haemoglobin
Iron Metabolism
Vitamin B12 Metabolism
Folic Acid Metabolism
Blood pH Regulation
Glycolysis
HMP Shunt
Glutathione (Redox) System
Plasma Proteins
MICROBIOLOGY
Introduction to blood borne infections
Blood borne parasites
PATHOLOGY
Anaemias
Haemorrhagic Diathesis
Idiopathic Thrombocytopenic Purpura
Disseminated Intravascular Coagulation
Blood Groups
Blood Banking Blood Transfusion
Lymphadenitis
Leukaemia
Lymphomas
Hodgkins Lymphoma and Non-Hodgkins Lymphoma
Splenomegaly
PHARMACOLOGY
Haemostatics
Therapy of Thromboembolic Disorders
Therapy of Iron Deficiency Anaemia
Therapy of Megaloblastic Anaemia, Pernicious Anaemia
Therapy of Parasitic Infections
Anti cancer agents
PHYSIOLOGY
Blood as a Body Fluid
Plasma
Blood Cells
Blood Groups
Haemostasis
50
CONTENTS
BIOCHEMISTRY
Haemoglobin:
Structure, functions, structure-function relation, comparison with myoglobin. role of 2,3-BPG
Biosynthesis: Chromosomes globin genes, chronology of gene expression.
Haem Biosynthesis: Building materials, reaction at commencement/ termination, general overview of
pathway, key intermediates, significance of fetal Hb
Haemoglobinopathy: Definition, genetic basis.
Abnormal haemoglobin: HbS as an example - genetic basis, molecular disease concept, laboratory
identification of HbS.
Thalassaemias: Molecular basis of -thalassaemia, -thalassaemia.
Porphyrias: Definition, acquired - one example, congenital - one example.
Iron Metabolism:
Functions, absorption, transport, storage, release, utilisation,
requirement for haemopoiesis, elimination, menstrual losses, Fe-cost per pregnancy.
Iron deficiency anaemia: Biochemical indicators, laboratory diagnosis.
Vitamin B12 Metabolism:

General metabolism, biochemical functions, biochemical impairments in deficiency.
Folic acid Metabolism:

General metabolism, RDA, biochemical functions as 1-C carriage, biochemical impairments in
deficiency.
Blood pH Regulation:
Blood hydrogen ion concentration, buffers - [H+] buffering, clinical relevance of [H+] measurement,
respiratory acidosis/ alkalosis, clinical intervention in respiratory acidosis / alkalosis, arterial blood gas
analysis.
Glycolysis:
Importance, definition, overview of pathway, committed step, regulated steps, irreversible steps,
mechanisms of regulation, hormonal regulation in fed / fasted conditions, net energy yield,
intermediates at metabolic junctions, glycolysis in RBC, hepatocyte, in adipocyte, entry of fructose /
galactose into glycolysis.
HMP Shunt:
Importance, NADPH generating steps, ribose generating step, transketolase, interconnection with
glycolytic pathway, G6PD deficiency - haemolysis.
Glutathione (redox) System:

Composition, functions, biochemical mode of action, glutathione-reductase, GSH-peroxidase,
selenium.
Plasma Proteins:
Introduction, classification, diagnostic importance.
MICROBIOLOGY
Introduction to blood borne infections:
51
Bacteraemia, septicemia, pyaemia, viremia, fungemia, parasitemia: Definitions, differentiations, list of
common organisms and diseases caused by them. Brucellosis, Leptospirosis, Borreliosis
Blood borne parasites:

Leishmanisis, Toxoplasmosis, Malaria, Filariasis: Morphology, life cycles, pathogenesis, clinical
features, laboratory diagnosis.
PATHOLOGY
Anaemias:
Definition, classification based on aetiology and morphology.
Iron deficiency anaemia: Aetiology, laboratory diagnosis.
Megaloblastic anaemia: Aetiology, laboratory diagnosis.
Aplastic anaemia: Aetiology, laboratory diagnosis.
Hereditary spherocytosis: Aetiopathogenesis, laboratory diagnosis.
Thalassaemia: Aetiopathogenesis, laboratory diagnosis, complications.
Sickle cell anaemia: Aetiopathogenesis, laboratory diagnosis.
Haemorrhagic Diathesis:
Basic screening tests, significance of the tests.
Coagulation disorders: Haemophilia, Christmas disease.
Idiopathic Thrombocytopenic Purpura:

Aetiopathogenesis, laboratory diagnosis.
Disseminated Intravascular Coagulation:

Definition, aetiopathogenesis.
Blood Groups:
ABO blood group and Rh blood group.
Blood Banking, Blood Transfusion:

Blood Grouping and cross matching
Blood transfusion reactions.
Lymphadenitis:
Definition and causes, reactive and tuberculous gross and microscopic features.
Sarcoidosis.
Leukaemias:
FAB classification of acute leukaemias, differences between myeloblast and lymphoblast, peripheral
blood smear, bone marrow findings, clinical presentations in AML, ALL, CML and CLL.
Multiple Myeloma: Clinical manifestations, aetiopathogenesis, morphology, laboratory diagnosis.
Lymphomas:
Classification with special reference to Working International Formulation for Non Hodgkins
lymphoma.
Hodgkins Lymphoma and Non-Hodgkins Lymphoma:

Gross and microscopic features.
52
Splenomegaly:
Causes, Morphology; Hyperspleenism.
PHARMACOLOGY
Haemostatics Agents:
Classification, their actions and uses.
Therapy of Thromboembolic Disorders:
Anticoagulants :
Introduction
Therapeutic Uses and Drug interactions.
Thrombolytics:
preparations, pharmacological basis for their actions and related usefulness.
Antiplatelet agents:
Classification, Mechanism of action, Adverse effects, Contraindications, Therapeutic Uses.
Therapy of Iron Deficiency Anaemia:

Introduction
Iron Preparations, indications, adverse effects, treatment of overdose.
Therapy of Megaloblastic Anaemia With / Without Neurological Involvement, Pernicious

Anaemia:
Folic acid and vitamin B12:
Preparations, actions, uses, inter-relationship between folic acid and vitamin B12 .
Therapy of Parasitic Infections:

Anti Malarial Drugs:-
Introduction
Drug therapy for Leishmaniasis:
classification of drugs, uses of Stibogluconate and pentamidine.
Drug therapy for Filariasis:
classification of drugs, uses of diethylcarbamazine citrate and Ivermectin.
Anticancer Drugs:
Introduction
General adverse effects of anti-cancer drugs.
PHYSIOLOGY
53
Blood as a Body Fluid:
Composition, physical characteristics and functions of blood.
Plasma:
Normal constituents. Plasma proteins: types, concentrations, properties, functions.
Red Blood Cells:

Types, distribution, overview of haematopoiesis.
Erythrocytes: morphology, functions, fate, normal count, PCV, ESR, MCV, MCH, MCHC, fragility,
haemolysis.
Erythropoiesis: definition, stages, regulating factors, RBC indices and clinical usefulness.
Anaemia : Physiological basis of causes and treatment
White Blood Cells: classification, morphology, development, normal counts and functions,.
Platelets: morphology, functions.
Blood Groups:
Agglutinogens, agglutinins, Landsteiners law, ABO group, Rh group.
Blood transfusion: relation to blood groups, indications, hazards.
Inheritance, erythroblastosis foetalis, hemolytic disease of the new-born.
Hemostasis:
Physiology of coagulation intrinsic and extrinsic mechanism, clot retraction, fibrinolysis, tests for
clotting. Natural and other anticoagulants.
54
SEMESTER - II
RESPIRATORY SYSTEM
COMMON CLINICAL PROBLEMS

Acute Respiratory Infections
Tuberculosis
Bronchial Asthma
Chronic Obstructive Pulmonary Disease
Bronchogenic Carcinoma
ANATOMY
Nasal Cavity
Paranasal Air Sinuses
Larynx, Trachea
Bronchial Tree, Pleura and Lung
Applied anatomy
Surface anatomy
BIOCHEMISTRY
Cellular Respiration
Biological Oxidation
Oxidative Stress Antioxidant Systems
Vitamin E
MICROBIOLOGY
Introduction to respiratory system infections
Approach to diagnosis of respiratory pathogens
Bacteria as respiratory pathogens
Fungi as respiratory pathogens
Viruses as respiratory pathogens
Parasites as respiratory pathogens
PATHOLOGY
Lesions of Upper Respiratory Tract
Bronchial Asthma
Bronchiectasis
Atelectasis
Hyaline Membrane Disease and Adult Respiratory Distress Syndrome
Chronic Obstructive Pulmonary Disease and Cor-Pulmonale
Pneumonia
Lung Abscess
Tuberculosis
Pneumoconiosis
Bronchogenic Carcinoma
Pleural Lesions
PHARMACOLOGY
Therapy of Bronchial Asthma - Bronchodilators
Therapy of Allergic Rhinitis - Antihistaminics
Therapy of Cough - Antitussives and Mucolytics
Therapy of Tuberculosis - Antitubercular Drugs
55
PHYSIOLOGY
Functional Anatomy
Mechanics of Breathing
Spirometry
Pulmonary Circulation
Pulmonary Gas Exchange
Gas Transport
Regulation of Respiration
Respiration in Unusual Environments
Abnormal Breathing
Respiratory Failure and Principles of Artificial Respiration
Lung Function Tests
Cyanosis and Asphyxia
CONTENTS
ANATOMY
Nasal Cavity:
Lateral wall of nasal cavity: boundaries, gross features, blood supply, nerve supply lymphatic drainage,
applied anatomy.
Nasal septum : formation, blood supply, nerve supply, applied anatomy.
Paranasal Air Sinuses:

Names, sites of opening of various air sinuses and functions.
Maxillary air sinus: Boundaries, blood supply, nerve supply, lymphatic drainage, applied anatomy.
Larynx, Trachea:
Names of cartilages.
Names of intrinsic muscles, innervations, actions.
Parts and features of cavity of larynx with blood supply, nerve supply, lymphatic drainage, applied
anatomy.
Rima glottidis.
Trachea: gross features, relations, blood supply, nerve supply, applied anatomy.
Bronchial Tree, Pleura, Lung:

Names of parts of bronchial tree.
Bronchial tree and bronchopulmonary segments and their applied anatomy.
Bronchi: right & left.
Root and hilum of lung.
Pleura and lung: parts, relation, blood supply, nerve supply, applied anatomy. Pleural recesses.
Microanatomy of epiglottis, trachea, lungs. Relations and lymphatic drainage of lungs.
Development of pleura, lung and bronchial tree.
Thoracic Cage
Skeletal framework Components (thoracic vertebrae, ribs or costae, and sternum), and congenital and
acquired anomalies
Intercostals space: boundaries, contents and applied aspects
Intercostal muscles Nerve-supply and actions
Intercostal nerves
Superior thoracic aperture ( thoracic inlet)
56
Inferior thoracic aperture (thoracic outlet)
Diaphragm: Development, attachments, relations, blood-supply, nerve-supply, applied aspects, and

structures passing through its major openings.
Respiratory movements
Azygous vein- formation, course, termination & tributaries
Thoracic duct- origin, course, termination, tributaries & area of drainage
Surface Anatomy
Sternal angle, xiphoid process, counting of ribs
Pleura and lungs
Chest X-rays A.P, P.A & lateral views, X-rays of skull showing paranasal air sinuses
BIOCHEMISTRY
Cellular Respiration / Biological Oxidation:

Biological oxido-reduction: mechanism, examples.
Citric acid cycle: feeder pathways, pathways leading from, overview of reactions, regulation,
energetics of citric acid cycle, amphibolism and clinical application.
Electron transport chain: cellular location, channeling of reducing equivalents, mechanism of ATP
synthesis.
Oxidative phosphorylation: chemiosmotic theory, clinical application of inhibitors / uncouplers.
Brown adipose tissue energy metabolism, thermogenin.
Oxidative Stress and Antioxidant Systems:

Free radicals, sources of free radicals, antioxidant systems, other biological anti-oxidants, failure of
antioxidant systems clinical implications.
Vitamin E:
Dietary sources, metabolism and antioxidant function.
MICROBIOLOGY
Introduction to respiratory system infections: Normal flora- list the normal flora; classification of
respiratory diseases, Pathogen of RTI - List common pathogens Causative organisms of various
respiratory diseases (Rhinitis, pharyngitis, laryngitis, sinusitis, community acquired pneumonia,
hospital acquired pneumonia, ventilator associated pneumonia etc.
Approach to diagnosis of respiratory pathogens: procedure of sample collection, storage, transport,
processing and laboratory diagnosis of common respiratory pathogen.
Bacteria as respiratory pathogens: Streptococcus pyogenes (Streptococcal sore throat and
consequences), Streptococcus pneumoniae and other Streptococci, Staphylococcus, Haemophilus
influenzae, Corynebacterium diphtheria, Bordetella pertusis, Organisms causing Hospital Associated
Pneumonia including Ventilator Associated Pneumonia (e.g. Klebsiella, Pseudomonas etc), Atypical
57
pneumonia (Legionella, Chlamydia, Mycoplasma, Uearaplasma), Mycobacterium tuberculosis and
MOTT
Fungi as respiratory pathogens: Histopalsma capsulatum; Candida albicans, Aspergilus fumigatus;
Cryptococcus neoformans -morphology, pathogenesis and diagnosis.
Viruses as respiratory pathogens: Orthomyxo and paramyxo viruses, Adenovirus, Rhinovirus,
SARS.
Parasites as respiratory pathogens: Pneumocystis jerovicii, Paragonimus westermani. Morphology,
life cycle, pathogenesis, laboratory diagnosis.
PATHOLOGY
Lesions of Upper Respiratory Tract:

Tumours of larynx.
Bronchial Asthma:
Mechanism and pathogenesis.
Bronchiectasis:
Pathogenesis, gross and microscopic features, complications.
Atelectasis:
Definition, types, morphology pathogenesis and complications.
Hyaline Membrane Disease and Adult Respiratory Distress Syndrome:

Definition, pathogenesis.
Chronic Obstructive Pulmonary Disease and Cor Pulmonale:

Chronic Bronchitis: Aetiology, gross and microscopic features.
Emphysema: Definition, types, pathogenesis.
Pneumonia:
Types, aetiopathogenesis, stages, complications.
Lung Abscess:
Aetiopathogenesis, morphology.
Tuberculosis:
Aetiopathogenesis, primary complex - definition, Ghons focus morphology.
Secondary tuberculosis - types of lesion.
Fibrocaseous, cavitary and miliary tuberculosis.
Gross and microscopic features, complications.
Pneumoconiosis:
Definition, pathogenesis.
Anthracosis, asbestosis, silicosis.
Bronchogenic Carcinoma:
Aetiology, gross and microscopic features of:
58
Squamous cell carcinoma, adenocarcinoma, small and large cell carcinomas, bronchioloalveolar
carcinoma.
Pleural Lesions:
Mesothelioma, pleural effusion, pneumothorax.
Investigations: examination of sputum and pleural fluid.
Sex hormones: preparation and antagonists.
PHARMACOLOGY
Therapy of Bronchial Asthma - Bronchodilators:

Types of bronchial asthma
acute, chronic, Severe acute asthma (status asthmaticus)
Classification of drugs, mechanism of action/pharmacological basis for the use, advantages and
disadvantages of each group, adverse effects, drugs interactions, contraindications and special features.
Therapy of COPD.
Antihistaminics:
Classification, comparison of various groups, mechanism of action, therapeutic uses and adverse effects.
Therapy of Cough:
Antitussives and mucolytic agents - examples for each group.
Mechanism of action, usefulness and limitations.
Adverse reactions and cautions.
Therapy of Tuberculosis:
Classification according to antibacterial effect.
Comparison between primary and secondary antitubercular drugs.
Regimens and prophylaxis.
Discussion of individuals drugs under mechanism of actions, adverse effects, contraindications and drug
interaction.
List drugs for resistant tuberculosis, their limitations.
PHYSIOLOGY
Functional Anatomy of Respiratory System.

Functional anatomy, composition of air in atmosphere and alveoli, gas laws
Mechanism and Mechanics of Breathing:

Movements of thoracic cage during respiration.
Muscles involved and their nerve supply.
Intrapleural, intrapulmonary pressures and volume changes during inspiration & expiration.
Pressure-volume inter-relationships.
Lung compliance, surfactant, airway resistance.
Work of breathing.
Spirometry:
Lung volumes capacities: definitions, normal values, significance.
59
Pulmonary Circulation:
Functional anatomy, distribution, special features & factors influencing.
Pulmonary Gas Exchange:

Alveolocapillary membranes, diffusion capacities, partial pressure gradients, factors influencing
diffusion of gases.
Measurement of diffusion capacity using carbon monoxide.
Applied physiology shunt and alveolocapillary block.
Ventilation perfusion ratio and its importance in respiratory diseases.
Gas Transport:
Oxygen transport: factors influencing the combination of haemoglobin with oxygen.
Oxygen dissociation curve: plot, features, physiological advantage of its shape, factors affecting the
shift of curve, Bohr effect.
Carbon dioxide transport: tissue production, carriage in blood and release at the lungs.
Role of red blood cell, chloride shift, role in acid-base balance, Haldane effect.
Carbon monoxide transport and its effects
Regulation of Respiration:
Neural control: medulla, pons, vagus.
Chemo-receptors: peripheral, central, chemical, non-chemical.
Influences on respiration, integrated responses.
Respiration in Unusual Environments:

Ttypes of hypoxia
High altitude hypoxia, space flight.
Deep sea diving nitrogen narcosis.
Hyperbaric oxygen and oxygen toxicity.
Abnormal Breathing:
Apnoea, hyperpnoea, tachypnoea, dysponea: definition, features, physiolological basis.
Principles of Artificial Respiration:

Definition, types, principles, indications, advantage and disadvantages, Oxygen therapy; respiratory
failure.
Principles of Lung Function Tests and non respiratory functions of the respiratory system
Applied respiratory physiology

Cyanosis and Asphyxia. Pneumothorax, Emphysema, Restrictive and Obstructive Pulmonary Diseases
60
SEMESTER - II
CARDIOVASCULAR SYSTEM

Hypertension
Ischaemic Heart Diseases
Rheumatic Fever
Rheumatic Heart Diseases
ANATOMY
Mediastinum
Heart and Blood Vessels
Applied anatomy
Surface anatomy
BIOCHEMISTRY
Cholesterol TAG Metabolism
Fatty Acid Metabolism
Ketone Body Metabolism
Lipoprotein Metabolism
Eicosanoids
Cardiac Muscle Metabolism
MICROBIOLOGY
Acute Rheumatic Fever
Rheumatic Heart Disease
Infective Endocarditis
PATHOLOGY
Atherosclerosis
Hypertension
Inflammatory Disease of Blood Vessels
Rheumatic Heart Disease
Infective Endocarditis
Myocardial Infarction
Cardiomyopathies
Myocarditis
Congestive Cardiac Failure
Congenital Heart Disease
Diseases of the Pericardium
PHARMACOLOGY
Therapy of Myocardial Ischaemia and angina
Therapy of Hypertension
Therapy of Congestive heart failure
Therapy of Arrhythmia - Antiarrythmic Drugs
Therapy of Hyperlipoproteinaemias
PHYSIOLOGY
Heart a Mechanical Pump
Properties of Myocardiac Cells
Cardiac Cycle
61
Electrocardiography
Cardiac Output
Haemodynamics of Circulation
Arterial Blood Pressure and Its Regulation
Microcirculation, formation & absorption of tissue fluid & lymph
Regional Circulation
Cardiovascular Changes During Exercise
Heart Sounds and murmurs
Arterial Pulse
Hypovolemic Shock
CONTENTS
ANATOMY
Divisions of Mediastinum and Their Contents:
Pericardium:
Parts, sinuses, blood supply, nerve supply, lymphatic drainage, development, applied anatomy.
Heart
Surfaces, borders, positions, relations.
Internal structures: right atrium, right ventricle, left atrium, left ventricle, interatrial septum -
development and anomalies, interventricular septum - development and anomalies.
Conducting system of heart.
Arch of aorta; superior vena cava.
Microscopic structure of heart and blood vessels.
Development of various chambers of the heart.
Development of major arteries and veins.
Congenital anomalies of heart and major vessels.
Foetal circulation and changes at birth.
Blood supply of heart.
Surface Anatomy
Heart, arch of aorta, pulmonary trunk, superior and inferior vena cavae, innominate veins
X-ray chest A.P. view, coronary angiogram
BIOCHEMISTRY
Cholesterol Metabolism:
Absorption, transport, functions.
62
Synthesis, regulation of synthesis - factors - mechanism, conversion to bile acids and excretion- blood
plasma cholesterol lowering agents biochemical basis of action, hypercholesterolaemia-implications.
Fatty acid - TAG Metabolism:

Aspects on fatty acid synthesis tissues, precursors, overview of conversion of Acetylcoenzyme-A
fatty acid (e.g. palmitic acid), regulatory step mechanism.
Mechanism of conversion of e.g. palmitic acid to the next higher saturated / unsaturated fatty acid,
biochemical basis of nutritionally essential fatty acid.
Triacylglycerol formation and storage.
Aspects on oxidation () of a fatty acid - e.g. palmitic acid Acetylcoenzyme-A, tissues, energy
yield.
The feed - fast cycle and hormonal intervention in reciprocal regulation of lipogenesis-lipolysis.
Ketone Body Metabolism:

Formation - degradation: tissues, overview of mechanism of formation - degradation,
Conditions favoring synthesis physiological pathological, oxidation, advantages,
Ketonaemia undesirable aspects.
Lipoprotein Metabolism:
Chylomicron, VLDL, LDL, HDL: aspects on formation - maturation - discharge of cargo, lipoprotein
disorders
Lipid profile - Interpretation of - normal - marginally high - undesirable profiles, variations
predisposing to common clinical disorders, biochemical basis of clinical intervention to normalise the
profile.
Eicosanoids:
Formation, biochemical functions of selected eicosanoids, mechanisms inclined to pharmacological
intervention.
Metabolism in the Cardiac Muscle:

Fuel molecules, energy metabolism, metabolic alterations if tissue is made anoxic, biochemical aspects
of MI, cardiac markers. Reperfusion-injury due to free radicals.
MICROBIOLOGY
Acute Rheumatic fever/ RHD: Aetiopathogenesis, clinical features, laboratory diagnosis.

Infective endocarditis: types of endocarditis, predisposing factors, Causative agents (Streptococcus
viridians, Staphylococci, Gram Negative bacilli, HACEK group ( heamophilus, actinobacillus,
cardiobacterium, eikenella, kingella). Collection of appropriate specimen, Laboratory diagnosis.
.
PATHOLOGY
Atherosclerosis:
Risk factors, aetiopathogenesis.
Gross and microscopic features of atheromatous plaques, complications, aneurysms.
Hypertension:
Definition, classification, aetiopathogenesis, morphological changes, complications.
Inflammatory Diseases of Blood Vessels:

63
Thromboangitis obliterans; types of vasculitis.
Rheumatic Heart Disease:

Aetiopathogenesis, gross and microscopic features, complications.
Infective Endocarditis:
Myocardial Infarction:
Cardiomyopathies:
Types.
Myocarditis:
Aetiology, pathology.
Congestive Cardiac Failure:

Pathophysiology.
Congenital Heart Disease:

Examples, Fallots tetralogy.
Diseases of Pericardium:
Acute pericarditis aetiology, pathology.
PHARMACOLOGY
(Mechanism of action, Indications, Adverse Effects and Contraindication of following therapeutic
agents)
Therapy of Myocardial Ischaemia and Angina:

Antianginal drugs: Classification, Mechanism of action, Adverse effects, Contraindications,
Therapy of Hypertension:
Introduction and grading.
Antihypertensive drugs: Classification, rationale for use, mechanism of action, indications, adverse effects,
contraindication and drug interaction.
Management principles: non-pharmacological, pharmacological, combination therapy.
Therapy of Congestive heart failure:
Types, review, pathogenesis.
Drugs: Classification, mechanism of action, adverse effects, therapeutic uses and drug interactions.
Therapy of arrythmics:
Antiarrythmic drugs: Classification, Mechanism of action, Adverse effects, Contraindications,
Therapy of hyperlipoproteinaemias:
Classification, Mechanism of action, Adverse effects, Contraindications, Therapeutic Uses and Drug
interactions
64
PHYSIOLOGY
Heart - a Mechanical Pump:

Design of systemic and pulmonary circulation.
Introduction of the terms: pressure, flow, resistance.
Types of blood vessels, their functions.
Properties of Myocardiac Cells:

Site of generation of cardiac impulse: pacemaker tissue, mechanisms of spontaneous generation of
impulses, specialized conducting system, its importance, electrical properties of working myocardial
cells, molecular basis of contraction and excitation, contraction coupling.
All - or - none phenomenon, length-tension relationships.
Frank-Stralings Law, neural influences, effect of Ca2+ ions and chemicals on myocardial contractility.
Cardiac Cycle:
Mechanical and electrical events, pressure-volume relationship.
Electrocardiography:
Definition, uses, principle, waves and their genesis, ECG recording techniques.
Cardiac Output:
Definition, normal values and variations, major determinants of cardiac output and regulation.
Regulation of heart rate and stroke volume.
Ficks principle and its application.
Haemodynamics of Circulation:
Definition of terms pressure, flow, resistance, velocity.
Laminar flow, turbulent flow, Reynolds number, Poiseuille law, factors affecting blood flow and
resistance, critical closing pressure.
Local regulation of blood flow to tissues - Neural, humoral and autoregulation. (role of vasoconstrictors
and vasodilators),
Arterial Blood Pressure and Its Regulation:

Definition, normal value, variations, measurement, mean arterial pressure, determinants.
Cardio-vasomotor centers, higher influences
Regulation of BP
Short term reflex control - baroreceptors, their significance.
Mechanism of reflex control, its limitations.
Role of chemoreceptors, CNS ischemic response
Long term control - Regulation of blood volume and pressure-
Role of kidneys , RAAS, , ANP ADH,
Reabsorption of tissue fluid
.
Microcirculation
Functional anatomy, mechanism of formation and absorption of tissue fluid (Starlings forces) mechanism
and routes of absorption of tissue fluid, Origin of lymphatics, Formation, circulation and functions of
lymph. Edema.
Regional Circulation:
Coronary, cerebral, cutaneous, splanchnic, foetal.
Normal values, special features, regulation.
65
Cardiovascular Changes During Exercise:
Cardiovascular changes during exercise, Beneficial effect of tracing an HR, SV, BP and blood flow in
muscle.
Effect of G on cardiovascular functions.
Heart Sounds:
Normal, Murmurs - origin of systolic and diastolic murmurs in relation to cardiac cycle and their
hemodynamic effects
Arterial Pulse:
Normal, abnormal, types, characteristics.
Hypovolemic Shock - Pathophysiology

Definition and causes, compensatory mechanisms short term and long term.
Decompensation in shock
66
SEMESTER II
COMMUNITY MEDICINE
EPIDEMIOLOGY-I
Themes and Topics:

Definition of Epidemiology.
Uses of Epidemiology in hospital, community and health planning.
Basic measures in Epidemiology e.g. rate, ratio and proportion.
Mortality: concepts of crude, specific and standardized death rates.
Morbidity: concept of incidence and prevalence of disease.
Significance of time, place and person distribution in Epidemiology.
Sources of epidemiological data.
Objectives:
Understand and describe the basic epidemiological measures.
Use basic epidemiological tools to make rational decisions relevant at the individual and
community level.
List and describe sources of epidemiological data.
Principal Teaching-Learning Methods to Be Used:

Practical exercises in field situations: to calculate the various indices using
data from hospital or community
Lecture discussion
INFORMATION EDUCATION COMMUNICATION (IEC)
Themes and Topics:

Health educational methods including A-V aids for individual, group and mass: significance,
advantages and disadvantages of the methods.
Planning a health education programme
Information Education Communication strategies
Evaluation of health education activities.
Practical exercise: Preparing and conducting a health education session on an issue like:
Personal hygiene.
Clean water.
Domestic environment.
Preventive dentistry.
The art of communication.
The skills of communication.
Methods of overcoming resistance in the individual.
Objectives:
Describe health education methods.
Design different health education aids e.g. posters, scripts for role play etc.
Plan and conduct health education sessions for an individual and community using different health
educational aids.
Evaluate a health education programme.
Communicate effectively with the individual, family and community.
67
Lecture discussion
Demonstration
Simulated practical exercises in class room: Role-play-students to be encouraged to role-play based on
different themes provided by the preceptors e.g. talking to a couple about family planning, asking a
woman about nutritional habits and beliefs etc. debriefing at the end of the session.
Students action: Each student will prepare a health education session plan, have it discussed with
preceptor, and deliver using simple A-V aids.
Use of Video films to demonstrate simple methods of health education and uses of simple A-V aids:
films covering the following topics may be used- Steps in communication:
Overcoming difficulties and resistance to communication in the individual Wrong methods of
communication / interviewing.
ENVIRONMENTAL HEALTH II
(including Entomology)
Themes and Topics:

Air Pollution : source, effects, control, green house effect, ozone layer.
Energy Conservation: alternate sources of energy
Noise Pollution: source, effects and control
Ventilation
Lighting
Radiation Hazards
Hospital Waste Management
Urban Health
Global warming
Meteorology of Medical Relevance
Mosquito
Housefly
Lice
Ticks
Fleas
Sandfly
Reduviid Bugs
Rodents and Their Control
(General principles only to be covered, avoiding engineering details.)
Objectives:
Define air pollution, cause of air pollution and describe appropriate measure Prevention.
List the hazards of smoking.
Describe the long-term effects of smoke inhaled by the housewife while preparing meals for the
family.
Describe the sources of environmental pollution and its impact on health.
Describe measures to control and mitigate effects of such pollution.
Describe and identify the arthropods of medical importance.
Describe and apply measures to control such arthropods.
Principles and importance of rodent control.

Lecture discussion
Demonstration
68
Practical exercises
Student action: During the family health exercise students will identify environmental Problems and
suggest appropriate remedial measures.
DEMOGRAPHY
Themes and Topics:

Importance of Demography
Demography Cycle
World population trends: regional differences, birth and death rates,
Growth Rates.
Transmigration.
Demographic trends of the country: age and sex composition, age pyramids,
sex ratio, density of population, family size, urbanisation, literacy,
life expectancy.
Fertility - determinants of fertility: biological and behavioral determinants
Fertility related statistics.
Effect on population of changes in birth, death and growth rates.
Vital statistics and methods of collection: census, registration of vital events,
Hospital records, population surveys.
(Family welfare programme, population policy will be covered in the 6th semester)
Objectives:
Describe the basic demographic pattern of the country.
Define vital statistics, describe their methods of collection.

Lecture discussion
69
SEMESTER - II
THEMES AND TOPICS
Examination of Respiratory System

Examination of Cardiovascular System
At the end of Semester II, the undergraduate medical students should be able to:
1. recall the structures of respiratory and cardiovascular systems.
2. correlate anatomical locations of organs and describe steps of clinical examinations.
3. demonstrate locations of important structures related to respiratory and cardiovascular over the
chest, neck and limbs.
4. integrate basic sciences with clinical problems related to respiratory system and cardiovascular
system.
5. take good history related to respiratory and cardiovascular system.
6. practice on peers the method of clinical examination of respiratory system and cardiovascular
system, as appropriate.
7. familiarise with X-ray chest, ECG, sputum, blood and other investigations in relation to respiratory
system and cardiovascular system.
8. identify normal structures in diagrams, angiograms, echocardiograms.
9. mention the steps followed in performing cardiopulmonary resuscitation.
Instructional Methods:
Lectures in class room, practical demonstrations, practice on Peers, and on patients and supplementary
video.
70
SECOND YEAR
SEMESTERS - III & IV
OBJECTIVES:
SEMESTER III
provides learning inputs in digestive-absorptive, excretory, metabolic and homeostatic functions
and their functional impairments encountered in common clinical conditions.
SEMESTER IV
provides learning inputs in structural-functional aspects on the nervous system, special senses and
reproductive system to understand diseases process affecting these systems.
CONTENTS:
Renal-Electrolyte System
Reproductive System
Community Medicine
71
SEMESTER - III
GASTROINTESTINAL SYSTEM

Worm infestation
Acid-peptic disease
Diarrhoea
Dysentery
Constipation
Colitis
ANATOMY
Oral Cavity
Pharynx
Oesophagus
Stomach
Intestines
Appendix
Pancreas
Rectum
Anal Canal
Pancreas
Anterior Abdominal Wall
Posterior abdominal wall
Lumbar vertebrae
Surface anatomy
Applied anatomy
BIOCHEMISTRY
Biochemical Principles to Nutrition
Digestion and absorption
Carbohydrates-Digestion & Absorption.
Proteins-Digestion & Absorption.
Lipids-Digestion & Absorption.
Starvation, Obesity
MICROBIOLOGY
Normal Flora
Gastrointestinal Infections
Pathogens: Bacteria, Virus, Parasites
Food Poisoning
PATHOLOGY
Oral pathology Premalignant Lesions
Squamous Cell Carcinoma
Pleomorphic Adenoma
Barrets Oesophagus
Carcinoma of the Oesophagus
Peptic Ulcer (acid-peptic disease)
Carcinoma of the Stomach
Tuberculosis of Intestine
Typhoid-Intestine
72
Appendicitis
Amoebic Colitis
Necrotising Enterocolitis
Ulcerative Colitis and Crohns Disease
Polyps of Large Intestine
Carcinoma of the Colon
Acute Pancreatitis
Carcinoma of the Pancreas
PHARMACOLOGY
Drug therapy for peptic ulcer
Emetics and Anti-emetic agents
Drugs for diarrhea and constipation
Anthelminthics
Antiprotozoals
Hepatotoxic drugs
PHYSIOLOGY
Introduction
Oral cavity
Deglutition
Secretions
Motility of Gut
Functions of Colon
Gastrointestinal Hormones
Vomiting
Defecation
CONTENTS
ANATOMY
Gross Anatomy:
Regions and quadrants of abdomen
Umbilicus: normal position, umbilical hernia
Lumbar vertebrae, sacrum and coccyx, XII rib, and hip bone
Oral cavity:
Teeth: dental formulae, microscopic structure of adult tooth
Palate: development and gross features
Tongue: development, gross features, blood-supply, microscopic structure
Salivary glands: development, gross features, microscopic structure
Pharynx:
Gross features, parts, relations, innervation.
Gastrointestinal tract: development and congenital anomalies
Peritoneum and Subdiaphragmatic spaces
Oesophagus:
Extent, normal constrictions, blood supply, nerve supply, lymphatic drainage, microscopic structures
Stomach:
73
gross features, relations, blood-supply, nerve-supply, lymphatic drainage, microscopic structure,
applied aspects
Small Intestine:
Duodenum:
gross features, relations of different parts, blood-supply, nerve-supply, lymphatic drainage,
microscopic structure, applied aspects
Jejunum and Ileum:

gross features, regional differences between jejunum and ileum, blood-supply, microscopic structure
Large Intestine:
Parts, cardinal features
Differences between small and large intestines
Blood supply and nerve supply
Caecum and Appendix: position, gross features, applied aspect, microscopic structure of appendix
Colon: parts, gross features, nerve supply, blood supply, and lymphatic drainage
Rectum and anal canal:

parts, gross features, nerve supply, blood supply, and lymphatic drainage
Pancreas:
Parts, position, relations, blood supply, lymphatic drainage, development, applied
anatomy,microscopic structures.
Anterior abdominal wall:

Flat muscles,
Rectus sheath:
Formation, boundaries and contents, Rectus abdominis
Inguinal canal: boundaries, contents in males and females, inguinal hernias
Posterior abdominal wall:

Muscles and fasciae- Thoracolumbar fascia
Abdominal aorta:
Extent and branches
Infereior vena cava: formation and tributaries
Lumbar plexus:
Formation and branches
Abdominal parts of the sympathetic and parasympathetic subdivisions of the autonomic nervous
system
Cisterna chyli
Surface anatomy
Anterior superior iliac spine, iliac crest, and posterior superior iliac spine
Stomach, duodenum, pancreas, ileo-caecal junction, caecum
Base of appendix, and McBurneys point
74
Plain X-ray of abdomen
Contrast X-rays of barium swallow, barium meal and barium enema
BIOCHEMISTRY
Biochemical Principles to Nutrition:

BMR: factors affecting, energy expenditure related to BMR, specific dynamic action and respiratory
quotient.
Caloric value (Atwater Factors) of carbohydrate, fat, protein, ethanol.
Proximate principles of diet, RDA.
Energy requirement: with age, for physical activity.
Nutritional importance of protein, protein requirement, protein energy under-nutrition.
Digestion and absorption:

Digestive enzymes, secretagogues,NaCl absorption and secretion, cystic fibrosis, diarrhoea, NaHCO3
secretion by pancreas, composition of pancreatic , gastric and bile secretion
Carbohydrate Digestion:
Dietary carbohydrates.
Enzymatic digestion of carbohydrates: salivary, pancreatic, intestinal enzymes.
Intestinal absorption of monosaccharides: glucose, galactose, fructose.
Mechanism of absorption of glucose.
Lactose intolerance.
Dietary fiber: types, requirement, advantages, disadvantages.
Proteins Digestion:
Enzymatic digestion of proteins - gastric, pancreatic , intestinal enzymes.
Intestinal absorption of amino acids - carrier systems for absorption of amino acids.
Protein intolerance.
Lipids Digestion:
Dietary lipids.
Enzymatic digestion of lipids :- pancreatic, role of bile.
Intestinal absorption of lipids.
Maldigestion, malabsorption, steatorrhoea.
Starvation and Obesity:

Biochemistry of starvation and obesity.
MICROBIOLOGY
Normal flora; GI Infections: Terminology, causative agents of gastroenterititis, diarrheoea,

dysentery, pseudomembraneous colitis (enterocolitis), Acquisition and transmission of infections, host
defenses, laboratory diagnosis.
Pathogens:
a. Bacteria: E coli, Salmonella typhi and paratyphi, b. Shigella, Vibrio cholera, H pylori, Clostridium
difficile
b. Virus: Viral diarrhea (Rotavirus, Norwalk virus, adenovirus etc).
c. Parasite
75
Protozoa - Giardia lamblia, Entameba histolytica, Balanitidium coli. Morphology, life cycle,
pathogenicity, laboratory diagnosis, complication of Entameba histolytica infection
Worms Ascaris lumbricoides, Ancylostoma duodenale, Necator americans, Strongyloides

stercoralis, Tenia solium, Tenia saginata, Diphylobothrum latum, Enterobias vermicularis, Trichuris
trichiura
Food poisoning: Bacterial and mycotic poisoning
PATHOLOGY
Oral Pathology Premalignant Lesions:

List, morphology.
Squamous Cell Carcinoma:

Aetiopathology, morphology.
Pleomorphic Adenoma:
Classification, gross and morphology of pleomorphic adenoma.
Barrets Oesophagus:
Carcinoma of the Oesophagus:

Aetiopathogenesis, gross and microscopic features.
Peptic Ulcer:
Definition and sites of occurrences, pathogenesis, gross and microscopic features and complications.
Carcinoma of the Stomach: Benign and malignant; Classification;

aetiopathogenesis, gross and microscopic features.
Tuberculosis of Intestine:
Typhoid of Intestine:
Appendicitis:
Amoebic Colitis:
Aetiology, gross and microscopic features, complications.
Necrotising Enterocolitis:
Pathogenesis and morphology.
Ulcerative Colitis and Crohns Disease:

Polyps of Large Intestine:

Classification, Comparison of morphology of tubular and villous adenomas.
Carcinoma of the Colon:
76
Pathogenesis, gross and microscopic features.
Acute Pancreatitis:
Aetiopathogenesis, morphology and complications.
Carcinoma of the Pancreas:

Morphology and complications.
PHARMACOLOGY
Therapy of peptic ulcer

Introduction, pathogenesis
list of durgs - Classification, mechanism of action, uses, adverse effects and drug interactions
non-drug measures.
Therapy of nausea and vomitimg

Classification, mechanism of action, uses, adverse effects and drug interactions.
Therapy of diarrohea
Oral rehydration solution - constituents, indications.
Non- specific antidiarrhoeals and antispasmodics - list.
Non-drug treatment.
Therapy of constipation
Commonly used drugs in constipation, clinical importance, adverse actions.
Non-drug treatment.
Therapy of worm infestation

Anthelminthics
List the drugs; its mechanism of action, uses, adverse effects, drug interactions and contraindications
Therapy of amoebiasis and giardiasis

Antiprotozoals
Classification, mechanism of action, uses, adverse effects and drug interactions.
Hepatoxicity of drugs
Brief discussion
PHYSIOLOGY
Introduction to Gastrointestinal Physiology:

Functions of gastrointestinal system, individual parts, enteric nervous system,
innervation of the gut, regulation of GI function, general overview.
Oral Cavity:
Salivary secretion mechanism of formation, composition,regulation, functions, mastication, digestion in
the mouth.
Physiology of Deglutition:
Definition, stages, neural control.
Stomach:
77
Overview of functions.
Physiology of gastric secretion - mechanism, composition, functions, control.
Experimental procedures to elucidate phases of gastric secretion.
Gastric motility - characteristics, control, gastric emptying, antral pump mechanism. Gastric mucosal
barrier
Digestion & absorption in stomach.
Pancreatic Secretions (exocrine)

Composition, Functions, control.
Small Intestine:
Exocrine and endocrine secretions, their regulation and functions, movements, functions and their control.
Large Intestine:
Movements, functions and control
Gastrointestinal Hormones:
Role in secretomotor functions of the gut.
Physiology of Vomiting:
Reflex mechanism involved
Defecation:
Mechanism, control.
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SEMESTER - III
HEPATOBILIARY SYSTEM

Infective Hepatitis
Jaundice
Amoebic Hepatitis, Amoebic Liver Abscess
Cirrhosis of Liver
ANATOMY
Liver, Gall Bladder, Bile Duct, Hepato-portal System
Hepatobiliary Apparatus.
Applied anatomy
Surface anatomy
BIOCHEMISTRY
Carbohydrate Metabolism
Bile Acids
Bilirubin Metabolism
Jaundice
Liver Functions and tests
Urea Cycle and blood urea
Vitamin K
MICROBIOLOGY
Hepatobiliary Parasitism
Hepatitis A, B, C, D, E
PATHOLOGY
Jaundice
Cirrhosis of Liver
Viral Hepatitis
Portal Hypertension
Hepatocellular Failure
Liver Abscess Amoebic and Pyogenic
Tumours of Liver
Chronic Cholecystitis
Cholelithiasis
Carcinoma of the Gall Bladder
PHYSIOLOGY
Liver Functions
Mechanism of Formation of Bile
Regulation of Bile Synthesis and Secretion
Gall Bladder
Liver Function Tests
CONTENTS
ANATOMY
79
Liver, Gall bladder, Bile duct and Hepato-portal System:
Gross features, applied anatomy,
Microscopic structure - liver and gall bladder.
Hepatobiliary Apparatus
Parts, gross anatomy.
Development, congenital anomalies of hepatobiliary system.
Surface anatomy:
Inferior border of liver, fundus of gall bladder
Radiological anatomy:
cholangiogram
BIOCHEMISTRY
Carbohydrate Metabolism:
Gluconeogenesis: importance, organ / tissues, intracellular site/s, precursors, overview of pathways,
regulated enzymes, effect of hormones.
Glycogen metabolism: purpose, organ / tissues, glycogenesis, glycogenolysis, hormonal influence
hormonal mechanism of action, reciprocal regulation of glycogenesis and glycogenolysis.
Uronic acid pathway: purpose, organ, properties of the end product.
Bile Acids:
Synthesis and role in digestion of lipids.
Bilirubin Metabolism:
Tissue cells involved, pathway overview, hepatocyte involvement, further metabolism of bilirubin
diglucuronide in the gut, enterohepatic circulation of urobilinogen, genetic disorder of bilirubin
metabolism.
Jaundice:
Types, biochemical differentiation.
Liver Functions:
Functions from a biochemical angle: synthetic, detoxication, excretory, secretory, metabolic.
Liver Function tests:

Tests based on: synthetic, detoxication, excretory, secretory, metabolic functions, plasma enzyme
elevations.
Urea cycle and blood urea:

Tissue location
Generation of ammonia
Flow of nitrogen into ornithine-urea cycle, enzymes and intermediates relation of urea cycle and TCA
cycle, regulation.
Physical-chemical properties of urea.
Urea cycle disorders and ammonia toxicity,
Blood and urine levels, physiological-pathological conditions causing alterations.
Vitamin K:
Metabolism.
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Mechanism of activation of clotting factors II, VII, IX, X.
MICROBIOLOGY
Hepatobilliary parasitism: C sinensis, Fasciola hepatica, Echinococcus granulosus- morphology, life

cycle, pathogenesis, laboratory diagnosis.
Infective hepatitis, A, B, C, D, E, G: virus structure, properties, modes of transmission, clinical

picture, laboratory diagnosis; immunomarkers, interpretation of immunomarkers
PATHOLOGY
Jaundice:
Types and pathogenesis.
Cirrhosis of the Liver:

Definition, aetiologic and morphologic types.
Morphology with special reference to alcoholic cirrhosis.
Viral Hepatitis:
Aetiology, gross and microscopic features, sequelae of acute viral hepatitis.
Portal Hypertension:
Definition, types, major clinical consequences.
Hepatocellular Failure:
Pathophysiology.
Liver abscess Amoebic and Pyogenic:

Gross and microscopic features, complications.
Tumors of Liver:
Classification, hepatocellular carcinoma, hepatoblastoma: gross and microscopic features.
Chronic Cholecystitis:
Cholelithiasis:
Pathogenesis, morphology, complications.
Carcinoma of Gall Bladder:

PHYSIOLOGY
Liver Functions:
Carbohydrate, fat & protein metablosim, synthesis of proteins, and clotting factors, formation of urea,
storage. Detoxification of drugs, hepatic macrophage- defense mechanism, hemolysis of R.B.C.,
endocrine (release of Erythropoietin & thrombopoietin).
Mechanism of Formation of Bile.
81
Bile formation, secretion, regulation & enterohepatic circulation.
Gall Bladder:
Functions.
Regulation of gall bladder contraction - mechanism.
Liver Function Tests:

Physiological basis.
82
SEMESTER - III
RENAL AND ELECTROLYTE SYSTEM

Urinary Tract Infection
Glomerulonephritis
Nephrotic Syndrome
Urinary Calculi
Haematuria
Albuminuria
Renal Failure
ANATOMY
Kidney
Ureter
Urinary Bladder
Urethra
Applied anatomy
Surface anatomy
BIOCHEMISTRY
Role of Kidney in Acid-Base Regulation
Metabolic Acidosis - Alkalosis
Water and electrolyte balance
Renal Function Tests
Amino acid Metabolism
MICROBIOLOGY
Urinary Tract Infection
Renal Tuberculosis
PATHOLOGY
Polycystic Kidney
Glomerular Diseases
Glomerulonephritis
Nephrotic Syndrome
Acute Tubular Necrosis
Renal Failure
Pyelonephritis
Nephrosclerosis
Hydronephrosis
Renal Calculi
Tumours of Kidney
Urinary Bladder Cystitis, Calculi, Tumors
Systemic Lupus Erythematosus
Examination of Urine
PHARMACOLOGY
Diuretics
Antidiuretics, treatment of Diabetes insipidus
Nephrotoxic drugs
Drugs in urinary tract infection
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PHYSIOLOGY
Over view of functions of the kidney
Functional Unit of Kidney
Glomerular Filtration
Tubular Functions
Micturition
Renal Function Tests
Cystometrogram
CONTENTS
ANATOMY
Kidneys: development, anterior and posterior relations of right and left kidneys, vascular segments,
and microscopic structure
Ureters: development, extent, course in males and females, gross features, and microscopic structure
Urinary bladder: retropubic space (of Retzius), development, gross features, relations (in males and
females), blood supply, nerve supply, lymphatic drainage, and microscopic structure
Urethra: development, gross features and relations (in males and females), applied aspects, and
microscopic structure
Surface anatomy:
Parallelogram, kidneys and ureters
plain X-rays of KUB region, contrast X-rays of Intravenous urography
BIOCHEMISTRY
Role of Kidney in Acid-Base Regulation:
Metabolic Acidosis - Metabolic Alkalosis and compensation:
Water and electrolyte balance:

Sodium and Potassium homeostasis, water balance, disorders.
Renal Function Tests:

Tests, principle, method, interpretation of findings.
Amino Acid Metabolism:

Amino acid pool, proteinamino acid turnover, general overview, essentialnon-essential amino acid
concept, glucogenic amino acid concept.
Metabolism of individual amino acids: alanine, asparatic acid, glutamic acid.
Key steps of metabolism of: phenyl alanine, tyrosine, tryptophan, methionine.
Commonly clinically encountered aminoacidopathies (viz., phenylketonuria, alkaptonuria, cystinuria,
homocystinuria, mapple syrup disease, methylmalonic aciduria, Tyrosinosis, Hartnup disease.)
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MICROBIOLOGY
UTI: types of Urinary Tract Infection, organisms, laboratory diagnosis
Renal tuberculosis and Schistosomiasis: Pathogenesis, laboratory diagnosis, Modern techniques of

diagnosis
PATHOLOGY
Polycystic Kidney:
Adult and childhood - morphology, complications.
Glomerular Diseases (in general):

Clinical presentation, morphology, aetiopathogenesis.
Glomerulonephritis:
Classification.
Acute post-streptococcal glomerulonephritis - aetiopathogenesis, morphology.
Rapidly progressive glomerulonephritis: type, aetiopathogenesis, morphology.
Chronic glomerulonephritis.
Nephrotic Syndrome:
Definition, pathophysiology, causes minimal change disease (lipoid nephrosis),
Membranous glomerulonephritis, membranoproliferative glomerulonephritis and focal segmental
glomerulosclerosis.
Differences between Nephritic syndrome and Nephrotic syndrome.
Diabetic nephropathy.
Acute Tubular Necrosis:

Definition, aetiophathogenesis, morphology.
Renal Failure:
Concept, types, causes, stages.
Pyelonephritis:
Definition.
Acute pyelonephritis: aetiopathogenesis, morphology.
Chronic pyelonephritis: aetiopathogenesis, morphology, sequelae.
Nephrosclerosis:
Benign and malignant: definition, pathogenesis, morphology.
Hydronephrosis:
Definition, causes, morphology.
Renal Calculi:
Aetiopathogenesis, morphology.
Tumours of Kidney:
Wilms tumour, renal cell carcinoma.
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Urinary Bladder:
Cystitis: types, morphology.
Calculi: types, morphology, complications.
Tumour: transitional cell carcinoma; aetiopathogenesis, gross and microscopic features.
Systemic Lupus Erythematosus:

Lesions in kidney.
Examination of Urine:
Urine Examination in UTI.
PHARMACOLOGY
Diuretics:
Classification; Mechanism of Action, Indications, Adverse Effects and Contraindications
Antidiuretics:
Vasopressin analogues; Mechanism of Action, Indications, Adverse Effects and Contraindications
Treatment of Diabetes insipidus

Vasopressin antagonists
Nephrotoxic Drugs: Drugs, precautions.
Urinary Tract Infection:

Common organisms.
Define and list urinary antiseptics, analgesics.
Review antimicrobials of choice for common infections
PHYSIOLOGY
Overview of functional anatomy of kidney:

Nephron divisions of nephron, functions.
Processes involved in urine formation.
Role of kidney in homeostasis.
Renal circulation: pressure profile, peculiarities, functional significance.
Glomerular Filtration:
Structure of glomerulus and filtering membranes, , mechanism of formation and composition of
glomerular filtrate, factors influencing and regulation of GFR, methods of measurement, its
physiological importance, variations.
Tubular Functions:
Mechanisms of reabsorption, secretion of electrolytes and other substances in various segments of
nephrons.
Role of hormones in their absorption & secretion.
Countercurrent mechanism; generation of medullary osmotic gradient.
Mechanism of formation of acidic & alkaline urine.
Water excretion mechanisms of concentration, dilution, water diuresis.
Micturition:
Definition.
86
Nerve supply of urinary bladder and its control. Micturition reflex and its higher neural control
Renal Function Tests:

Physiological basis.
Cystometrogram:
Principle.
87
SEMESTER - III
METABOLISM AND ENDOCRINE SYSTEM

Diabetes Mellitus
Goiter
Thyrotoxicosis
Osteoporosis
ANATOMY
Pituitary Gland
Pineal Gland
Thyroid Gland
Parathyroid Gland
Adrenal Gland
BIOCHEMISTRY
Hormones
Pituitary
Thyroid
Calcium Homeostasis Regulation
Endocrine Pancreas
Adrenal Cortex
PATHOLOGY
Pituitary Gland
Thyroid Gland
Parathyroid Gland
Metabolic Bone Diseases
Adrenal Gland
Endocrine Pancreas
PHARMACOLOGY
Anterior pituitary Hormones & Analogues.
Thyroid and Antithyroid Drugs
Drugs affecting calcium balance and bone turnover
Adrenocorticosteroids and Synthetic Analogues
Drug therapy for Diabetes Mellitus
PHYSIOLOGY
Introduction to Endocrinology
Hypothalamus
Pituitary Gland
Thyroid Gland
Calcium and Phosphorus Metabolism
Adrenal Cortex
Adrenal Medulla
Stress
Endocrine Pancreas
Pineal Gland
88
CONTENTS
ANATOMY
Pituitary gland: development, location, relations, blood supply, and microscopic structure
Pineal gland: development, location, blood supply, and microscopic structure
Thyroid gland: development, location, gross features, blood supply, venous drainage, lymphatic
drainage, surface marking, and microscopic structure
Parathyroid glands: development, location, blood supply, and microscopic structure
Adrenal gland: development, location, gross features, blood supply, and microscopic structure of
adrenal cortex
Applied anatomy
BIOCHEMISTRY
Classification of Hormones:
Polypeptide, steroid.
Mechanism of Hormone Action:

Polypeptide, steroid, second messenger.
Pituitary Hormones:
Classification of anterior Pituitary, physiologic and biochemical action, pathophysiology
Classification of posterior Pituitary, physiologic and biochemical action, pathophysiology
Thyroid Hormones:
Chemistry, biosynthesis, transport, functions, metabolism.
Iodine metabolism and thyroid function tests.
Calcium Homeostasis Regulation:

Integrated role of parathormone, vitamin-D, calcitonin.
Vitamin D: source, chemistry, functions, deficiency symptoms.
Parathyroid hormone: physiological effects and mechanism of action.
regulation of release, consequences of hypo and hyper parathyroidism.
Calcitonin source, physiological effects, regulation of.
Ca2+ as an intracellular messenger.
Endocrine Pancreas:
Insulin: synthesis, transport, metabolism. mechanism of action, biochemical effects Glucagon:
biochemical effects.
Homeostasis of blood glucose: Normoglycaemia maintenance in fed fasted conditions, biochemical
pathways in operation, hormonal play.
Diabetes mellitus: definition, classification, biochemical basis of clinical complications, diagnostic and
prognostic tests, metabolic syndrome, Hypoglycemia, renal glycosuria.
Adrenal Cortex:
Hormones of adrenal cortex, biosynthesis, regulation, transport, degredation and metabolic effects.
Cushing syndrome, Addisons disease, Conns disease, biochemical investigations.
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PATHOLOGY
Pituitary Gland:
Hypopituitarism: causes and brief discussion on Sheehans syndrome, Empty SellaTurcicas syndrome.
Hyperpituitarism: causes and brief discussion of pituitary adenoma - somatotropic adenoma,
corticotropic adenoma.
Prolactinoma.
Diabetes insipidus.
Craniopharyngioma.
Thyroid Gland:
Hyperthyroidism causes, thyrotoxicosis, Graves disease aetiology, morphology.
Hypothyroidism cretinism, myxoedema.
Goiter types, pathogenesis, morphology.
Thyroiditis Hashimotos, Granulomatous aetiology, pathogenesis, morphology.
Tumours classification, gross and microscopic features of Thyroid adenoma, follicular carcinoma,
papillary carcinoma, medullary carcinoma, anaplastic carcinoma.
Parathyroid Gland:
Primary and secondary hyperparathyroidism, Brown tumour of Hyperparathyroidism
Hypoparathyroidism.
Tumours : Parathyroid adenoma causes, gross and microscopic features.
Metabolic Bone Diseases:

Rickets and osteomalacia clinical features, aetiology, pathogenesis, morphology.
Adrenal Gland:
Cushings syndrome- Causes, aetiopathgenesis, morphology, clinical features.
Adrenogenital syndrome.
Addisons disease.
Tumours adrenal adenoma, cortical carcinoma - gross and microscopic features.
Multiple endocrine neoplasia.
Neuroblastoma.
Pheochromocytoma.
Diabetes Mellitus:
Aetiopathogenesis of IDDM and NIDDM.
Morphological changes, complications.
Zollinger Ellison syndrome.
PHARMACOLOGY
Anterior pitutary hormone

GH and its analogues, uses and adverse effects
Growth hormone inhibitors
Prolactin analogues and inhibitors uses, adverse effects
Gonadotropin preparations, uses, adverse effects
GnRH agonist and antagonist preparations, uses, adverse effects
Thyroid and Antithyroid Drugs:

90
Review biosynthesis and physiology of thyroid hormones.
Consequences of excess and deficiency of thyroid hormones.
Drugs for treating hypo and hyperthyroidism. (discuss the common drugs as per format)
List drugs that can cause hyper or hypothyroidism.
Drugs affecting calcium balance and Bone Turnover :

Integrated physiological role, therapeutic implications of parathormone, calcitonin and vitamin-D.
Bisphosphonates classification, mechanism of action, uses and adverse effects
Adrenocorticosteroids and Synthetic Analogues:
Review the synthesis, regulation and physiological actions, enumerate the preparations and compare
the salient features. Mechanism of action, Indications, Adverse effects, Contraindications.
Drug therapy for Diabetes Mellitus:

Diabetes - review, pathogenesis.
Principles of management, role of insulin, oral hypoglycaemics.
List the various preparations and compare the salient features.
Discuss the commonly used preparations under Mechanism of action, Indications, Adverse effects,
Contraindications.
Glucagon - explain the uses and the rationale.
Enumerate other drugs that may alter the blood sugar level.
PHYSIOLOGY
Introduction to Endocrinology:
Definition of hormones, classification, general mechanisms of action, concept of second messenger.
Hypothalamus:
Role of hypothalamus in the regulation of secretion of hormones of anterior and posterior pituitary.
Concept of hypothalamo-hypophyseal portal sysetm.
Anterior Pituitary:
List the hormones.
Growth hormone release, functions and regulation of secretion and disorders.
Posterior pituitary:
Hormones.
Vasopressin -, regulation of release, physiological actions, mechanism of action hyperactivity,
hypoactivity - clinical symptoms.
Oxytocin.
Thyroid Gland:
Review biosynthesis of T3 and T4.
Physiological effects, mechanism of action, regulation of release, consequences of hypothyroidism,
hyperthyroidism.
Parathyroid Gland:
Calcium and phosphorus metabolism.
Adrenal Cortex:
Glucocorticoids - names of hormones, physiological effects, mechanism of action, regulation of
secretion, consequences of hyper and hypo secretion.
91
Mineralocorticoids - names of hormones, physiological effects, mechanism of action, regulation of
secretion, consequences of hyper and hypo secretion.
Sex corticoids - names of hormones, physiological effects, effects of excessive secretion.
Summary of the effects of adrenocortical hyper and hypo functions.
Adrenal Medulla:
Review the physiological actions of epinephrine.
Stress:
Definition, Physiological mechanisms (hormonal and neural) for coping up with stress. Beneficial and
harmful effects of stress.
Endocrine Pancreas:
Hormones.
Insulin: sites of synthesis, secretion, transport, metablolism, regulation of release, mechanism of action,
physiological effects, consequences of deficiency and excess.
Glucagon - review secretion, transport, metabolism, physiological effects, mechanism of action,
regulation of secretion.
Insulin-glucagon molar ratio and implications in alternation.
Glucose homeostasis
Pineal Gland:
Hormone secreted, actions, clinical importance.
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93
SEMESTER - III
COMMUNITY MEDICINE
SOCIOLOGY
Medical Sociology, Psychology and Social Anthropology
Themes and Topics

Types of family
Functions of family
Role of family in health and disease
Cultural factors influencing health and disease
Social organisation and community participation
Measurement of the socio-economic status of a family and its importance in health and disease
Objectives
describe the role of family / community in health maintenance and disease prevention.
determine the socio-economic status of a family and describe its importance in health maintenance
and disease prevention.

Lecture discussion
Simulated practical exercises in class room e.g. role play
Field exercises
COMMUNITY DIAGNOSIS ORIENTATION
Themes and Topics

Collect demographic data and study:
The Community 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 (Male) Preference
Child Rearing Practices
Acute Morbidity in the Family
Follow Up A Pregnant Woman, A Neonate, Under Five-Year Child to Record Growth and
Development,
Diet Pattern of a Pregnant, Lactating and Postpartum Woman
Follow Up an Adolescent
Follow Up Elderly / Disabled Persons
Follow Up Eligible Couples and Provide Family Planning Advice
Objectives
Describe the principles and importance of making a community diagnosis.

Acquire the necessary skills for making a community diagnosis.
94
Diagnose and manage the common morbidity in an individual / family / community within the
resources available.
Plan, conduct, analyze, interpret and present an epidemiological field exercise.
Plan, conduct and evaluate an intervention programme with community participation.
Describe the role of health services in the National Health Programs.
Plan and conduct an immunization camp.

Lecture discussion.
Demonstration.
Student action: feasible community intervention to be done at regular intervals.
Student will follow up and record the results of community intervention.
Problem-based learning.
FAMILY MEDICINE
Themes and Topics

Identify and diagnose illness in the family
Follow up and study response(s) of the individual / family / community to the specific illness
Identify and diagnose and manage illness in the family as a family physician to acquire familiarity with
the common illnesses: e.g.
Acute respiratory
infections, Rubella.
Mumps , Diptheria,
Pertusis, Chickenpox,
Pneumonia,
Tuberculosis,
Measles
Diarrhea
Fever
HIVand AIDS
Bronchial asthma /
COPD
Objectives
Function as a family physician.
Learn to manage the patient / family within the available health resources, socio-cultural milieu and
economic resources of the
family / community.

Lecture discussion
Demonstration
Student action: feasible community intervention involvement at regular intervals.
Students will follow up and record the results of community intervention Problem based learning:
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 family to determine the psycho-social aspects of the disease and the effects on the patient
and family.
Each student should present the allotted case individually.
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96
SEMESTER - III
THEMES AND TOPICS
Renal System
At the end of the Semester- III, the undergraduate medical students should be able to;
1. list common problems related to Gastrointestinal, Hepatobiliary, Renal, Metabolism and Endocrine
Systems.
2. perform on peers clinical examination procedures related to Gastrointestinal, Hepatobiliary and Renal
System.
3. correlate anatomical structures of different systems while performing clinical examinations on peers.
4. familiarise with routine blood, urine, stool examination and with upper and lower endoscopic
examination and other examinations in relation to Gastrointestinal, Hepatobiliary, Renal and Endocrine
Systems.
5. demonstrate Heimlich maneuver.
Instructional Methods:
Lectures in class-room, practical demonstrations, practice on peers and on patients, supplementary
video.
97
SEMESTER - IV
REPRODUCTIVE SYSTEM

Pregnancy normal and abnormal
Sexually Transmitted Diseases (STD)
Acquired Immune Deficiency Syndrome (AIDS)
Cancer cervix
Pelvic inflammatory diseases
ANATOMY
Male Reproductive System
Female Reproductive System Including Breast
Pelvis
Pelvic Diaphragm
Applied anatomy
BIOCHEMISTRY
Sex hormones
Synthesis and Regulation.
Biochemical test for infertility
MICROBIOLOGY
Introduction to STD& STI
Syphillis
Gonorrohoea & Non gonococcal urethritis
LGV & GI
Herpes simplex
HIV/ AIDS
Genital warts
Vaginitis and vaginosis
Vertically transmitted infections
PATHOLOGY
Male Genital Tract
Benign Prostatic Hyperplasia
Carcinoma Prostate
Tumours of Testes
Premalignant and Malignant Lesions of Penis
Female Genital Tract Including Breast
Cervicitis
Carcinoma Cervix
Endometrium
Carcinoma Endometrium
Leiomyoma
Tumours of Ovary
Trophoblastic Tumours
Breast Abscess
Fibrocystic Disease of Breast
Tumours of Breast
Pagets Disease of Breast
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Gynaecomastia
Acquired Immune Deficiency Syndrome
PHARMACOLOGY
Gonadal hormones and antagonists.
Anabolic Steroids
Hormonal Contraceptives
Oxytocics and Tocolytics
Medication during pregnancy and lactation
Sexually Transmitted Diseases
Antiviral agents
Drugs,
PHYSIOLOGY
Male Reproductive System
Female Reproductive System
Physiology of Fertilisation and Implantation
Physiology of Pregnancy
Physiology of Parturition
Physiology of Lactation
Physiological Basis of Contraceptive Methods
CONTENTS
ANATOMY
Male Reproductive System:

Blood supply and lymphatic drainage of:
Scrotum, epididymis, seminal vesicle, spermatic cord, penis.
Gross and microscopic features of testes, vas deferens, prostate.
Male genital system :- development, developmental anomalies.
Female Reproductive System:
Uterus, broad ligament, supports of uterus and other features.
Gross features - ovary, fallopian tube, external genitalia.
Breast - morphology, structure, lymphatic drainage, blood supply, development and age changes.
Microscopic structure - ovary, oviduct, uterus, cervix, vagina, breast.
Development - female genital system, congenital anomalies.
Skeletal Plevis:
Types, features, difference in sexes, various diameters.
Parts, sexual dimorphism.
Pelvic Diaphragm:
Levator ani and connection with defecation, micturition and pregnancy.
Perineum:
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Spaces, contents, applied, anatomy; Perineal Body and urogenital
diaphragm.
Applied Anatomy
Salphingograph
BIOCHEMISTRY
FSH, LH, Estrogen, Progesterone and Androgens: Synthesis, metabolism and functions.
Biochemical test for infertility
MICROBIOLOGY
Introduction to STD & STI
Syphillis: agents, pathogenicity, clinical presentations, laboratory diagnosis, complications
Gonorrohoea & Non gonococcal urethritis: agents, pathogenicity, clinical presentations, laboratory
diagnosis, complications
LGV & GI: agents, pathogenicity, clinical presentations, laboratory diagnosis, complications
Herpes simplex: agents, pathogenicity, clinical presentations, laboratory diagnosis, complications
HIV/ AIDS: agents, pathogenicity, clinical presentations, laboratory diagnosis, complications,

opportunistic infections
Genital warts: papiloma virus and Molluscum contagiosum- agents, pathogenicity, clinical
presentations, laboratory diagnosis, complications.
Vaginitis and vaginosis: Trichomonas vaginalis, Candidiasis, bacterial vaginosis- agents,

pathogenicity, clinical presentations, laboratory diagnosis, complications.
Vertically transmitted infections: TORCH; Toxoplasma, Rubella, CMV, HSV, etc
PATHOLOGY
Male Genital Tract

Benign prostatic hyperplasia
Carcinoma prostate
Tumours of testes
Premalignant and malignant lesions of penis

Cervicitis
Carcinoma cervix
Endometrium
Carcinoma endometrium
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Leiomyoma
Tumours of ovary
Trophoblastic tumours
Breast abscess
Fibrocystic disease of breast
Tumours of breast
Pagets disease of breast
Gynaecomastia
Male Genital Tract

Prostatic Benign Hyperplasia: aetiology, pathogenesis, gross and microscopic features.
Carcinoma: aetiology, pathogenesis, gross and microscopic features.
Tumours of Testes:
Classification, examples.
Gross and microscopic features of Seminoma, Embryonal carcinoma, Teratoma.
Premalignant and Malignant Lesions of Penis:

Carcinoma penis, aetiology, gross and microscopic features.

Cervicitis:
Aetiology and morphology.
Carcinoma Cervix:
Aetiology, risk factors and pathogenesis.
Cervical intra-epithelial neoplasia.
Squamous cell carcinoma gross and microscopic features and staging.
Endometrium:
Simple and complex (cytoglandular and adenomatous) hyperplasia
aetiology and morphology.
Endometriosis: Definition, sites and pathogenesis.
Adenomyosis and its complications, Chocolate Cyst.
Carcinoma Endometrium:
Aetiopathogenesis, gross and microscopic features.
Leiomyoma:
Tumours of Ovary:
Classification with examples.
Aetiopathogenesis, gross and microscopic features mucinous cystadenoma, serous cystadenoma,
teratoma, dysgerminoma.
Trophoblastic Tumours:
Hydatidiform mole and choriocarcinoma - gross and microscopic features.
Breast Abscess:
Aetiology, gross and microscopic features.
Fibrocystic Disease of Breast:

Pathogenesis, gross and microscopic features.
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Tumours of Breast:
Classification.
Gross and microscopic features of fibroadenoma.
Carcinoma breast pathogenesis, gross and microscopic features of ductal (invasive) carcinoma,
medullary carcinoma.
Differential diagnosis of lump in the breast.
Pagets Disease of Breast:

Definition, gross and microscopic features.
Gynaecomastia:
Definition and causes.
PHARMACOLOGY
Gonadal hormones and antagonists:
Anabolic Steroids:
Preparations, basis for use, misuse.
Hormonal Contraceptives:
Types, mechanism of action, pharmacological actions, uses, choice of preparation, adverse effects,
contraindications.
Oxytocics and Tocolytics:

Mechanism of actions, uses, adverse effects.
Medication during pregnancy and lactation
Examples of safe drugs

Drugs causing teratogencity and its categories
Types of damage to foetus and its prevention
Sexually Transmitted Diseases:

Preparations of choice.
Antiviral Agents:
Introduction
General principles- Classification, Mechanism of action Indications, Adverse effects,
Contraindications, Therapeutic Uses and Drug interactions
PHYSIOLOGY
Introduction:
Sexual differentiation, development of sex organs
Physiology of puberty.
Male Reproductive System:

Primary and accessory organs, their functions.
Spermatogenesis, its regulation. Role of Sertoli cells
Testosterone: transport, metabolism, mechanism, physiological actions.
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Control of testicular function - feedback mechanism, abnormalities.
Female Reproductive System:

Physiology of menstrual cycle: ovarian cycle, uterine cycle, vaginal, cervical cycle. Role of hormones
Physiology of ovulation and its detection.
Ovarian hormones: estrogen and progesterone; physiological actions, mechanism of action.
Control of ovarian function feedback mechanism, menopause, abnormalities.
Physiology of Fertilization and Implantation.

Transport of sperms in female genital tract, capacitation, acrosomal reaction, species specificity,
fertilization, prevention of polyspermia. Transport of fertilized ovum-zygote-blastocyst. Day of
implantation, formation and functions of fetoplacental unit
Physiology of Pregnancy:
Endocrine changes, functions of placenta, changes in mother during pregnancy, tests for pregnancy.
Physiology of Parturition: Factors which determine onset of parturition, Mechanism of uterine

contractions - Role of oxytocin.
Physiology of Lactation: Hormones involved in growth and development of breast during pregnancy
and their actions. Onset of lactation, and factors involved in its maintenance. Role of oxytocin,
prolactin. Mechanism of lactation amenorrhorea
Physiological Basis of Contraceptive Methods: Physiological basis of various methods of

contraceptives and emergency pill.
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SEMESTER - IV
CENTRAL NERVOUS SYSTEM AND SPECIAL SENSES

Sinusitis
Meningitis
Epilepsy
Cerebrovascular Accidents
Encephalitis
Poliomyelitis
Cataract
Deafness
Migraine
ANATOMY
HEAD AND NECK

Development
Cranial bones
Triangles of neck
Joints
Infratemporal fossa
Pterygopalatine fossa
Parotid and submandibular regions
Scalp
Orbit
Ear
Nose
Surface anatomy
Applied anatomy
CENTRAL NERVOUS SYSTEM AND SPECIAL SENSES

Brain
Cranial Nerves
Spinal Cord
Meninges
Eye
Ear
Nose
Surface anatomy
Applied anatomy
BIOCHEMISTRY
Cell Membrane
Neurotransmitters
Vitamin A
MICROBIOLOGY
Meningitis
Tetanus
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Botulism
Encephalitis
Trachoma
Conjunctivitis
Acute/Chronic Suppurative Otitis Media
PATHOLOGY
Meningitis
Brain Abscess
Hydrocephalus
Viral Encephalitis
Cerebrovascular Accident
Degenerative Diseases
Demyelinating Diseases
Tumours
Retinoblastoma
PHARMACOLOGY
Indroduction
Aliphatic Alcohols
General Anaesthetics
Local Anaesthetics
Therapy of Epilepsies
Therapy of Parkinsonism
Opioid Analgesics and Antagonists
Sedatives and Hypnotics
CNS Stimulants
Drug Abuse
Psychopharmacology
Antipsychotic and antianxiety drugs
Antidepressants and antimanic drugs
PHYSIOLOGY
Nervous System
Visual System
Auditory System
Vestibular System
Olfactory System
Gustatory System
CONTENTS
ANATOMY
HEAD AND NECK:
Pharyngeal arches
Development of: face & eye
Bones: Gross and Special Features of Bones

Maxilla, zygomatic bone
Cranial bones- frontal, parietal, temporal, sphenoid
Foetal skull
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Names of skull bones in adult
Cranial fossae with structures passing through major foramina
Cervical vertebrae: general and special features
Mandible: attachments of muscles and ligaments, differences in mandible at different ages
Face: muscles of facial expression, nerves & vessels
Scalp: layers, blood-supply, and nerve-supply
Joints:
Atlanto-occipital & Atlanto-axial
type, subtype, ligaments, movements, applied aspects
Temporomandibular type, movements and applied aspects, including the muscles involved in
producing movements
Deep fascia of neck- distribution & clinical important
Triangles of neck: Boundaries, contents and applied aspects
Infratemporal fossa: boundaries, contents and applied aspects
Pterygopalatine fossa: boundaries, contents and applied aspects
Parotid and submandibular regions
Muscles:
Names and nerve-supply of muscles of facial expressions
Attachments, nerve-supply, and actions of following muscles:
Sternocleidomastoid
Muscles of mastication
Orbicularis oculi
Buccinator
Scalenus anterior (including Scalenus anterior syndrome)
Blood vessels:
origin, course, termination, and branches/tributaries of:
Common carotid artery
External carotid artery
Internal carotid artery
Subclavian arteries (right and left)
Maxillary artery
Internal jugular vein
Cervical lymph nodes:

subgroups, drainage areas, applied aspects
X-rays of skull A.P & lateral views
Angiogram of external & internal carotid arteries.
Surface anatomy:
External carotid artery,Internal carotid artery,Subclavian arteries (right and left) & Internal jugular vein
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CENTRAL NERVOUS SYSTEM
Development of nervous system
Brain and its meninges

Parts of Brain
Cerebral Hemispheres- Sulci and Gyri, Functional areas, Fibres (white matter), Blood supply,
Microscopic structure of cerebral cortex,
Iinternal capsule: parts, fibres, blood supply and applied aspects
Diencephalon:
Thalamus and Hypothalamus- Parts, Connections, Blood supply,
Epithalamus and Metathalamus- Parts and their functions
Basal Nuclei- Parts, Blood supply

Major connections of corpus striatum
Limbic system: parts, connections & functions
Dural venous sinuses

Base of brain: surface attachment of cranial nerves, arterial circle (of Willis)
Ventricular System and Cerebrospinal Fluid (CSF)

Ventricles and the boundaries of their parts
Circulation of CSF
Cerebellum- Gross Features, Connections, Blood supply, Microscopic structure of cerebellar cortex
Brainstem (Midbrain, Pons, and Medulla oblongata)- External features, Blood supply,
Cross-sections at different labels of each brainstem
Red nucleus position, connections and applied aspects
Olivary nucleus position, connections and applied aspects
Clinical conditions associated with vascular/neurological deficits
Cranial nerves: origins, course, distributions & applied aspects
Spinal Cord
Vertebral canal
Extent, gross features, meninges, and blood supply
Transverse sections at cervical, thoracic, lumbar & sacral regions showing positions of major tracts
Origin, course termination, modalities, and applied aspects of the following tracts:
Corticospinal
Spinothalamic
Spinocerebellar, and
Posterior column tracts
SPECIAL SENSES
Vision
Eye ball (Development, and associated anomalies)
Tunics of eyeball and their blood supply
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Microscopic structure of cornea and retina
Chambers of the eyeball, and circulation of aqueous humor
Extraocular muscles (attachments, nerve supply and actions)
Hearing
Ear and its parts
External ear (gross features, blood supply, and nerve supply)
Middle ear (tympanic cavity): parts, boundaries, and contents; pharyngo-tympanic (Eustachian) tube
Internal ear: names of its parts only
Smell
External nose, parts of the nasal cavity with particular reference to olfactory epithelium
Taste
Taste buds: location and microscopic structure
Surface anatomy:
Middle meningeal aertery
Angiogram of cerebral arteries
BIOCHEMISTRY
Cell Membrane:
Components, transport systems, impulse propagation.
Vitamin A:
Sources, Synthesis, transport, functions, deficiency symptoms.
Biochemical analysis of CSF:

Content of CSF, Biochemical aspect of normal and abnormal CSF (Pyogenic , tubercular and viral
menengitis)
MICROBIOLOGY
Introduction to CNS infections: Definitions, etiological agents, principles of laboratory diagnosis
Meningitis: Pyogenic, Aseptic, and Chronic: agents, pathogenicity, clinical presentations, laboratory
diagnosis, complications.
Tetanus: agents, pathogenicity, clinical presentations, laboratory diagnosis, complications, vaccines.
Botulism: agents, pathogenicity, clinical presentations, laboratory diagnosis, complications.
Encephalitis: Rabies, Arbovirus, Poliomyelitis: agents, pathogenicity, clinical presentations,

laboratory diagnosis, complications.
Trachoma: agents, pathogenicity, clinical presentations, laboratory diagnosis, complications
Conjunctivitis: agents, pathogenicity, clinical presentations, laboratory diagnosis, complications
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Acute/ Chronic Suppurative Otitis Media: agents, pathogenicity, clinical presentations, laboratory
diagnosis, complications.
Slow Viruses, Prion diseases etc (introductory).
PATHOLOGY
Meningitis:
Aetiopathogenesis, gross and microscopic features of: Bacterial meningitis, viral meningitis, tubercular
meningitis.
CSF examination as a tool in its differential diagnosis.
Brain Abscess:
Aetiopathogenesis, morphology, diagnosis.
Hydrocephalus:
Definition, types, morphology, clinical features, complications.
Viral encephalitis:
Aetiology, pathogenesis, morphology.
Cerebrovascular Accidents:
Intracranial haemorrhage.
Degenerative Diseases:
Classification with examples, aetiopathogenesis, gross and microscopic features of Alzheimer's
disease, Parkinsons disease.
Demyelinating diseases:
Classification with examples.
Gross and microscopic features of multiple sclerosis.
Tumours:
Classification.
Gross and microscopic features of: astrocytoma, meningioma, basal cell carcinoma.
Retinoblastoma:
PHARMACOLOGY
Introduction
Aliphatic Alcohols:
Ethanol and methanol - effects on different organ systems, acute and chronic alcoholism, methyl
alcohol poisoning - management
General Anaesthetics:
Principles, classification.
Commonly used general anaesthetics.
Dissociative anesthesia, neuroleptanalgesia.
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Preanaesthetic medication- rationale and examples.
Local Anaesthetics:
Types of local anesthesia, classification, mechanism, uses and adverse effects.
Antiepileptic drugs:
Classification; mechanism of action, indications, adverse effects, drug interactions and
contraindication.
Types of epilepsies and drugs for each.
Therapy of Parkinsonism:
Types, causes.
Classification of antiparkinsonian drugs; mechanism of action, adverse effects and the rationale of
therapy.
Opioid Analgesics and Antagonists:

Classification, mechanism, pharmacological actions, uses, adverse effects, acute poisoning,
management, drug dependence - management.
Sedative and Hypnotics

Classification, mechanism, pharmacological actions, uses, adverse effects, acute poisoning,
management, drug dependence - management.
Therapy of insomnia.
Drug Abuse: Types and management.
Psychopharmacology:
Anti-psychotics, antidepressants and mood stabilizers.
Classification, mechanism, pharmacological actions, uses, adverse effects and drug interactions.
Antianxiety drugs: brief discussion
PHYSIOLOGY
Introduction to Nervous System:

Organization of the nervous system.
The structural and functional unit of nervous system.
Neurons: types, morphology, functions, functional components, morphology, types, classification of
nerves.
Signal transmission :
Review.
Graded potential: definition, characteristic, physiological significance.
Resting membrane potential ionic basis.
Action potential definition.
Ionic basis for electrical, chemical, excitability changes.
Propagation: mechanism, factors influencing.
Response of neurons and nerve fibers to injury:

Types of injuries.
Types of changes: Wallerian degeneration, regeneration, factors influencing regeneration.
110
Microenvironment of the neuron:
Blood brain barrier, importance.
Synapses
Ultra structure, properties, synaptic plasticity, neurotransmitters and mode of transmission.
Definition, types, structure and mechanism of transmission.
Neurotransmitters and neuromodulators and their properties.
Sensory receptors:
Definition, classification, properties.
Reflexes:
Definition, classificationReflex arc and stretch reflex.
Properties of reflexes, their clinical significance.
Somato-sensory system:
Classification and characteristics of different sensations.
Sensory pathways and regulation at the higher level.
Physiology of pain including endogenous pain relief system and referred pain.
Control of posture and movement:

General principles of organisation of motor control.
Effects of complete transection and hemisection of spinal cord.
Descending pathways involved in motor control.

Pyramidal (corticospinal) and extrapyramidal system (vestibulospinal, reticulospinal, tectospinal
and rubrospinal).
Motor cortical areas, , basal ganglia,cerebellum and vestibular apparatus in control of -motor
movements, and their disorders.
Reticular formation:
Definition, connections, functions.
Physiological basis of consciousness and sleep.
EEG: Evoked potentials, their clinical significance.
Hypothalamus: Components, connections, functions.
Thalamus: Components, connections, functions. Thalamic syndrome.
Limbic system: Components, connections, functions.
Prefrontal lobe: Components, connections, functions. Effects of lesions.
Higher cortical functions: Learning, memory, judgement, language, speech.
Visual System:
Structure of eye, overview of functions.
Structure and function of cornea.
Aqueous humor: formation, circulation, drainage.
Intraocular pressure, functions.
Optics of vision-image forming mechanism.
Pupil, its functions.
111
Light reflex, accommodation.
Binocular and monocular vision.
Common errors of refraction.
Visual acuity and visual fields-clinical importance.
Ophthalmoscopy, and perimetry.
Photo receptors - distribution, visual pigments mechanism of excitation and their functions.
Light and dark adaptation, photopic and scotopic vision.
Visual pathway-transduction, transmission.
Synaptic modulation and visual cortex.
Effects of transection of visual pathway at various levels.
Eye movements.
Neurophysiological basis of fixation of gaze and conjugate movements, squint.
Physiology of colour vision- theories and electrophysiological aspects.
Colour blindness: classification, tests.
Auditory Systems:
Functional anatomy of ear and general properties of sound.
External ear: functions.
Middle ear: functions of tympanic membrane and ossicles,
mechanism of sound transmission, impedance matching, function of eustachian tube.
Internal ear: structure and function of cochlea, pitch and intensity discrimination.
Auditory pathway: receptive fields and tonotopic maps, binaural interactions, nerve pathway from the
cochlea to the auditory cortex.
Organisation of auditory cortex, functions, sound localisation.
Deafness: Types. Tests to diagnose deafness. Audiometry, its clinical applications.
Vestibular System:
Structure of labyrinth.
Vestibular transduction - response to rotational and linear acceleration.
Central vestibular pathway.
Vestibulo-ocular reflex, its clinical importance.
Clinical tests for vestibular integrity, disorders of labyrinth
Olfactory System:
Location of receptors, mechanism of stimulation and pathways.
Disorders of olfactory sensation.
Gustatory System:
Location of receptors, mechanism of stimulation and pathways.
,Disorders of gustatory sensation.
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SEMESTER IV
COMMUNITY MEDICINE
EPIDEMIOLOGY II
Themes and Topics

Epidemiological studies: descriptive, analytical and experimental
Basic concepts about transmission of infectious agents
Principles of control of communicable diseases
Principles of control of non-communicable diseases
Investigation and control of an epidemic
Epidemiological principles underlying screening
Distinction between screening and diagnostic test
Calculate: sensitivity, specificity, positive predictive value etc. for screening tests
Collect and interpret clinical, psycho-social information from patient / family to understand natural
history of a disease
Objectives
Apply epidemiological methods to different health problems.
Describe the various types of epidemiological study designs, their applications, biases involved and
relative merits and demerits.
Describe Bradford Hills criteria for causation of disease.
Describe and illustrate with suitable examples the natural history of a disease (communicable and
non-communicable).
Collect relevant clinical, psycho-social information from a patient and family, analyse and present
the same to illustrate natural history of a common disorder.
Advise relevant (psycho-social, cultural and economic context) promotive, preventive, curative and
rehabilitative measures.
Describe the need and uses of screening tests.
Differentiate between screening and diagnostic tests.
Define the terms used in measurement.
Calculate the sensitivity, specificity and positive predictive value of tests from the given data.

Practical exercises in field situations: Students will be encouraged to select an area that they would like
to investigate. They will plan the investigation under the guidance of preceptor (Community Medicine
and Clinician if needed). They will collect the data, analyze (using a computer to encouraged), interpret
and present. Based on their findings, they will
plan an intervention programme, execute and evaluate it. A final presentation will be made. Lecture
discussion.
BEHAVIOURAL SCIENCES
(Integrated teaching with Psychology)
Themes and topics

Factors affecting behavior attitude
Attitudes, nature, development
Cognitive development
Puberty and adolescence
113
Behavior problems
Sexual behavior
Normal and abnormal behaviors
Implications of behavior in illness
Methods to change attitude, behavior
Measurement of attitudes
Questionnaire / pre-testing and validation of a questionnaire / interview schedule
The need for counseling in various situations (e.g. HIV / AIDS affected person)
Proper approach and attitude of counselor
Communication skills required of a counselor
Objectives
Define attitudes.
Describe the process of attitudinal development and methods to change attitudes.
Construct, pre-test and validate a questionnaire / interview schedule to test attitudes of individual /
community.
Acquire basic skill in individual and group counseling.

Lecture discussion
Demonstration
Simulated practical exercises in class room e.g. role play
Student action: In groups of 2-3, students will construct an interview schedule on any topic of their
choice. They will interview about 20 people and analyse the results to validate the questionnaire. Use
of computers is encouraged. Presentations will be made.
Problem-based learning
COMMUNITY BASED INTEGRATED MANAGEMENT OF CHILDHOOD

ILLNESSES (CB-IMCI)
Topics
a. Introduction to IMCI and orientation to the Global program.
b. Importance of IMCI in family medicine.
Practicals:
Video cassette show.
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SEMESTER - IV
THEMES AND TOPICS
Reproductive system
At the end of the semester IV the undergraduate medical students should be able to:
1. appraise the common problems related to Reproductive system, Central Nervous System and
Special Senses..
2. take relevant history on Reproductive system, Central Nervous System and Special Senses.
3. correlate anatomical structures and Pathophysiology involved in giving rise to different clinical
signs in relation to Reproductive system, Central Nervous System and Special Senses.
4. identify laboratory and radiological investigations required in making diagnosis.
5. list steps of testing patients clinically in relation to higher functions, motor, reflexes, cranial nerves,
sensory, gait and coordination.
Lectures in classroom, practical demonstrations, practice on peers and on patients, supplementary
video displays.
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PRACTICAL CLASSES
ANATOMY
SEMESTER - I
Gross Anatomy Practicals
Basic concepts and Autonomic Nervous System:

1. Study of body parts and regions.
2. Study of parts of nervous system - brain, spinal cord and nerves and autonomic system.
3. Study of models of spermatozoa, ova, spermatogenesis, oogenesis.
4. Study of models of fertilisation, implantation, blastocyst, early development of embryo.
5. Study of models of placenta, umbilical cord.
Lymphoid organs:
1. Gross anatomy of spleen, lymph nodes.
2. Gross anatomy of tonsil, thymus.
Integumentary System:
1. Study of different parts of skin.
2. Dissection & Demonstration of mammary gland.
Musculo-skeletal System:
Upper Limbs:
1. Dissection & Demonstration of pectoral region, breast.
2 Dissection & Demonstration of axilla, axillary artery, brachial plexus.
3. Dissection & Demonstration of shoulder region, deltoid, axillary artery.
4. Dissection & Demonstration of scapular muscles, muscles of back.
5. Dissection & Demonstration of upper arm front and back.
6. Dissection & Demonstration of shoulder joint, sterno-clavicular joint, acromio-clavicular joint,
movements of scapula.
7. Dissection & Demonstration of cubital fossa, front of forearm.
8. Dissection & Demonstration of back of forearm.
9. Dissection & Demonstration of palm, back of hand, carpal tunnel.
10. Dissection & Demonstration of elbow joint, radio-carpal joint.
11. Radiological anatomy of upper limb.
12. Surface anatomy of upper limb
Lower Limbs:
1 Dissection & Demonstration of femoral triangle, front of thigh, femoral vessels and nerve.
2 Dissection & Demonstration of muscles of anterior and medial compartments of thigh and
obturator nerve.
3 Dissection & Demonstration of adductor canal, hip joint.
4 Dissection & Demonstration of gluteal region, gluteus maximus.
5 Dissection & Demonstration of muscles of back of thigh and sciatic nerve.
6 Dissection & Demonstration of popliteal fossa.
7 Dissection & Demonstration of knee joint.
8 Dissection & Demonstration of anterior and lateral compartments of leg.
9 Dissection & Demonstration of posterior compartment of leg and ankle joint.
116
10 Dissection & Demonstration of sole and arches of foot.
11 Radiological anatomy of lower limb.
12 Surface anatomy of lower limb.
Histology Practicals
Basic Concepts:
1. Study of microscope, histological techniques, histological structure of an animal cell.
2. Histological structure of simple epithelium.
3. Histological structure of compound epithelium.
4. Histological structure of fibrous tissue, adipose tissue.
5. Histological structure of bone (T.S & L.S.).
6. Histological structure of different types of cartilages.
7. Histological structure of skeletal muscle.
8. Histological structure of smooth muscle, cardiac muscle.
9. Histological structure of nerve.
10. Histological structure of ganglion - spinal and sympathetic.
Lymphoid organs:
1 Histological structure of lymph node, spleen.
2 Histological structure of tonsil, thymus.
Integumentary System:
1. Histological structure of skin thick and thin skin.
2. Histological structure of mammary gland active and resting phase.
ANATOMY
SEMESTER - II
Gross Anatomy Practicals:
Respiratory System:
1. Dissection & Demonstration of thoracic wall inter costal muscles.
2. Dissection & Demonstration of thoracic wall- inter costal nerves, vessels, internal thoracic vessels.
3. Dissection & Demonstration of structures of inlet of thorax.
4. Dissection & Demonstration of outlet of thorax, thoracic diaphragm.
5. Dissection & Demonstration of pleura, different parts of pleura, pleural recesses & para-nasal
sinuses.
6. Gross anatomy of right lung, relations of mediastinal surface.
7. Gross anatomy of left lung, relations of mediastinal surface.
8. Dissection & Demonstration of structures of root of lung right and left.
9. Dissection & Demonstration of structures in superior mediastinum- arch of aorta.
10. Dissection & Demonstration of structures in superior mediastinum trachea, oesophagus
brachiocephalic veins, superior vena cava.
11. Dissection & Demonstration of structures in posterior mediastinum descending aorta.
12. Dissection & Demonstration of structures in posterior mediastinum- oesophagus, thoracic duct
azygos and hemiazygos veins.
13. Radiological anatomy of respiratory system.
14. Surface anatomy of respiratory system
Cardio-Vascular System:
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1 Dissection & Demonstration of pericardium fibrous and serous pericardium, sinuses of
pericardium.
2 Study of external features of heart and its surface markings.
3 Dissection & Demonstration of arteries supplying heart.
4 Dissection & Demonstration of veins draining venous blood from heart.
5 Dissection & Demonstration of right atrium features in the interior.
6 Dissection & Demonstration of right ventricle features in the interior.
7 Dissection & Demonstration of left atrium features in the interior.
8 Dissection & Demonstration of left ventricle features in the interior.
9 Dissection & Demonstration and study of interatrial and interventricular septa, neuromyocardium.
10 Dissection & Demonstration of ascending aorta, cardiac plexuses.
11 Dissection & Demonstration of pulmonary trunk and pulmonary veins.
12 Dissection & Demonstration of superior vena cava and inferior vena cava.
13 Radiological anatomy of cardiovascular system.
14 Surface anatomy of cardiovascular system.
Histology Practicals:
Respiratory System:
1. Histological structure of epiglottis.
2. Histological structure of trachea.
3. Histological structure of lung.
4. Histological structure of bronchi and bronchioles.
Cardio-Vascular System:
1 Histological structure of cardiac muscle and neuromyocardium.
2 Histological structure of aorto-elastic artery.
3 Histological structure of inferior vena cava large vein.
4 Histological structure of medium size artery and vein.
ANATOMY
SEMESTER - III
Gross Anatomy Practicals:
Gastro-intestinal System:
1. Dissection & Demonstration of anterior abdominal wall rectus sheath.
2. Dissection & Demonstration of anterior abdominal wall inguinal canal.
3. Dissection & Demonstration of stomach.
4. Dissection & Demonstration of coelic axis artery.
5. Dissection & Demonstration of duodenum, pancreas.
6. Dissection & Demonstration of superior mesenteric artery jejenum, ileum, mesentery.
7. Dissection & Demonstration of inferior mesenteric artery, caecum, appendix.
8. Dissection & Demonstration of colon- ascending, transverse, descending, sigmoid, marginal artery.
9. Dissection & Demonstration of omental bursa, subdiaphragmatic space.
10. Dissection & Demonstration of portal vein
11. Radiological anatomy.
12. Surface anatomy.
Hepatobiliary System:
118
1. Gross anatomy of liver borders, surfaces, relations.
2. Gross anatomy of lesser omentum, peritoneal ligaments of liver.
3. Gross anatomy of hepatic ducts, gall bladder, cystic duct.
4. Gross anatomy of common bile duct, termination of bile duct.
5. Surface anatomy
Renal and Electrolyte System:

1. Gross anatomy of kidneys surfaces, relations, hilum, blood vessels.
2. Dissection and gross structure of kidney.
3. Gross anatomy of ureter.
4. Gross anatomy of urinary bladder.
5. Radiological anatomy
6. Surface anatomy
Endocrine System:
1. Gross anatomy of thyroid gland and parathyroid gland.
2. Gross anatomy of suprarenal gland relations, blood supply.
Gastro-intestinal System:
1. Histological Structure of oesophagus, stomach, fundic and pyloric parts.
2. Histological Structure of duodenum.
3. Histological Structure of pancreas.
4. Histological Structure of jejunum, ileum.
5. Histological Structure of large intestine, vermiform appendix.
Hepatobiliary System:
1. Histological Structure of liver.
2. Histological Structure of gall bladder.
Renal Electrolyte System:

1. Histological Structure of kidney cortex and medulla.
2. Histological Structure of kidney, parts of nephron, juxta-medullary apparatus.

3. Histological Structure of ureter.
4. Histological Structure of urinary bladder.
Endocrine system:
1. Histological Structure of pituitary gland.
2. Histological Structure of thyroid gland and parathyroid gland.
3. Histological Structure of suprarenal gland.
ANATOMY
SEMESTER - IV
Gross Anatomy Practicals
Reproductive System:
Male:
119
1. Gross anatomy of testis, scrotum and spermatic cord.
2. Gross anatomy of penis.
3. Gross anatomy of vas deferens and seminal vesicle.
4. Gross anatomy of prostate gland.
Female:
1. Gross anatomy of ovary, relations, blood supply.
2. Gross anatomy of fallopian tube.
3. Gross anatomy of uterus, broad ligament, supports of uterus.
4. Gross anatomy of vagina and levator ani.
Central nervous system and special senses
Head and neck:

1. Dissection & Demonstration of scalp.
2. Dissection & Demonstration of face.
3. Dissection & Demonstration of posterior triangle of neck.
4. Dissection & Demonstration of anterior triangle of neck.
5. Dissection & Demonstration of temporomandibular joint, and atlanto-axial joint.
6. Dissection & Demonstration of muscles of neck.
7. Dissection & Demonstration of common carotid, external carotid and internal carotid arteries.
8. Dissection & Demonstration of internal jugular vein and cranial nerves in neck.
10. Surface anatomy
Central Nervous System:

1. Dissection & Demonstration of meninges of brain and folds of duramater.
2. Dissection & Demonstration of arteries of brain, circle of Willis.
3. Dissection & Demonstration of veins of brain and venous sinuses of skull.
4. Dissection & Demonstration and study of attachment of cranial nerves on base of brain.
5. Dissection & Demonstration and study of external features of medulla oblongata.
6. Dissection & Demonstration and study of external features of pons and mid-brain.
7. Dissection & Demonstration of cerebellum its parts and important fissures.
8. Dissection & Demonstration of fourth ventricle of brain.
9. Dissection & Demonstration of parts of diencephalon and structures the floor of third ventricle.
10. Study of external features of cerebrum sulci, gyri and lobes, cortical areas.
Special Senses:
1. Dissection & Demonstration of tongue and study of papillae of tongue.
2. Dissection & Demonstration of nasal cavity septum of nose, lateral wall of nose- opening in
lateral wall of nose.
3. Dissection & Demonstration of extraocular muscles of eyeball, their nerve supply.
4. Dissection & Demonstration of arteries and veins of eyeball.
5. Dissection & Demonstration of eyeball its internal structure.
6. Dissection & Demonstration of ear- external, middle and internal ear.
Reproductive System:
Male:
120
1. Histological Structure of testis.
2. Histological Structure of epididymis.
3. Histological Structure of vas deferens and seminal vesicle.
4. Histological Structure of prostate gland.
Female:
1. Histological Structure of ovary.
2. Histological Structure of uterine tube.
3. Histological Structure of uterus, vagina.
4. Histological Structure of mammary gland active phase, resting phase.
Central Nervous System:

1. Transverse Section of spinal cord in cervical region.
2. Transverse Section of medulla oblongata - Motor decussation, - Sensory decussation.
3. Transverse Section of pons.
4. Transverse Section of midbrain at the level of superior colliculus - at the level of inferior
colliculus.
5. Histological structure of cerebrum.
6. Histological structure of cerebellum.
7. Median section of brain third ventricle and thalamus.
8. Horizontal section of brain study of internal capsule and basal nuclei.
Special Senses:
1. Histological structure of papillae of tongue-taste buds.
2. Histological structure of internal ear Organ of Corti.
3. Histological structure of cornea.
4. Histological structure of retina and interior of eyeball.
121
BIOCHEMISTRY
SEMESTERS - I & II
Practicals:
1. Introduction and uses of Laboratory Instruments.
2. Estimation of: (a) serum protein and A/G ratio. (b) serum cholesterol.
3. DNA extractions
4. Estimation of blood glucose.
5. Protein and lipoprotein electrophoretic pattern in normal and abnormal condition.
Practicals:
1. Instruments: spectrophotometer, colorimeter, flame-photometer, electrophoresis apparatus, paper/
thin layer chromatography.
2. Salivary amylase action on starch.
3. Alkaline phosphatase, AST and ALT. Students should be able to interpret the liver function test
findings.
4. Interpretation of cerebrospinal fluid (CSF) finding.
5. Urine analysis-normal and pathological.
6. Estimation of blood glucose: glucose oxidase method/ O-Toluidine method).
7. Oral glucose tolerance test. Student should be able to interpret OGTT findings and know the
criteria for diagnosing diabetes mellitus.
8. Estimation of serum, bilirubin (conjugated and un-conjugated)
9. Estimation of serum- urea, creatinine, uric acid and calcium and phosphate.
10. Knowledge of NPN, calculation of BUN, importance of GFR-its calculation.
11. Qualitative analysis of gastric juice estimation of free and total acidity, interpretation of result.
122
MICROBIOLOGY
SEMESTER - I
Practicals:
1. Introduction to Microbiology laboratory and Biosafety
2. Microscopy
3. Application of different sterilization methods
4. Application of different disinfection methods
5. Visit to CSSD, Hosp Waste management, Visit to Clinical Microbiology Laboratory at Hospital
6. Study of colony characteristics of bacteria on NA, BA, MacConkeys agar, Chocolate Agar, CLED,
Smear preparation and Gram staining
7. Study of morphology and classification of microorganisms by Grams stain, Motility by Hanging
Drop Preparation and agar inoculation
8. Approach to laboratory diagnosis (specimen collection, containers etc, transport, handling)
9. Study of biochemical tests and identification of Gram positive and Gram negative bacteria.
10. Study of antibiotic sensitivity tests by Stokes method and Kirbey Baur Method.
11. Demonstration of lepra bacilli
12. Visit to Leprosy hospital
13. Clinical cases Cellulitis: Staph and Strept
14. Medical Mycology: Lab diagnosis of fungal infection: Skin scraping: KOH mount.
15. LPCB mount, Growth of fungi on SDA
16. Candia: Germ tube tests, Growth on BA, SDA
17. Spotters
MICROBIOLOGY
SEMESTER - II
Practicals:
1. Collection and processing of clinical specimen for respiratory tract infections (throat swab, sputum)
2. Laboratory Diagnosis of Gram Positive bcteria: Staph, S. pyogens, Str. Pneumonia, Coryne
diphtheriae
3. Diagnosis of pulmonary TB: Staining for Acid-fast bacilli (Ziehl-Neelsen stain), demonstration of
LJ media, biochemical reactions (catalase, Niacinproduction etc)
4. Demonstration of capsule by India ink, serum eosin preparation, Quellung reaction.
5. Blood culture for bacterial isolation.
6. Demonstration of blood parasites: Malaria, Leishmania, Filaria and their laboratory diagnosis.
7. Spotters
123
MICROBIOLOGY
SEMESTER - III
Practicals:
1. Lab diagnosis of enteric pathogenic bacteria: IMViC, oxidase, TSI, Urea, and other tests.
2. Diagnosis of enteric fever. Specimen collection, Demonstration of Salmonella on selective media,
enrichment media, biochemical reactions, Widal test
3. Presumptive coliform count of drinking water
4. Demonstration of Ova/cyst/adult parasites of gastrointestinal system
5.Laboratory Diagnosis of UTI: Sample collection significant bacteriurea (1) (Clinical case of UTI
with E coli, Kleb, Proteus etc)
6. Spotters
MICROBIOLOGY
SEMESTER - IV
Practicals:
6. Spore staining using malachite green staining
7. Microbiological examination of vaginal swab
8. Laboratory diagnosis of Sexually Transmitted Diseases (Gram staining for GNC, RPR, TPHA,
HBsAg, HCV)
9. Laboratory diagnosis of HIV: Serological tests HIV1 & 2, ELISA, Western Blot Demonstration
10. Demonstration of RPR test.
11. Laboratory diagnosis of meningitis: CSF Gram staining and ZN staining
12. Spotters
124
PATHOLOGY
SEMESTERS - I & II
1. Orientation to the Pathology Laboratories, knowing equipment and instruments.

2. Haematology:
Collection of blood, anticoagulants, preparation staining of peripheral blood smears;
Identification of cells in Leishman-stain stained blood film; RBC, haemoglobin, PCV, ESR
determinations and absolute values; Study of morphology of RBC; Total leukocyte count (TLC)
determination; Differential leukocyte count (DLC) determination; BT, CT, platelet count; Blood
grouping ABO and Rh; Cross-matching; Demonstration of peripheral blood smears and bone
marrow smear in different diseases.
3. Gross and microscopic changes in diseases. (On materials available, specimens, slides and
photographs).
Tuberculous lymph node
Squamous papilloma
Squamous cell carcinoma
Basal cell carcinoma
Chronic venous congestion - spleen
Infarction of spleen
Hodgkins lymphoma
Amyloidosis of spleen
Myocardial infarction
Medial calcification of artery
Thromboangitis obliterans
Haemangioma
Lobar pneumonia
Bronchopneumonia
Bronchiectasis of lung
Chronic venous congestion lung
Fibrocasseous tuberculosis lung
Bronchogenic carcinoma
PATHOLOGY
SEMESTER - III & IV
1. Urine examination: physical, chemical, microscopic.

2. Indications of different laboratory tests and interpretations of reports.
3. Gross and microscopic changes in diseases (on materials available, specimens, photographs):
Acute appendicitis Adenoma of

Pleomorphic adenoma thyroid
Chronic gastritis Papillary
Gastric ulcer carcinoma thyroid
Intestinal tuberculosis Lepromatous
Acute appendicitis leprosy
Juvenile polyp Tuberculoid
Adenocarcinoma of colon leprosy
Fatty liver Squamous cell
Cirrhosis of liver papilloma
125
Chronic venous Squamous cell
congestion - Liver carcinoma
Infective hepatitis Basal cell
Heaptocellular carcinoma carcinoma
Chronic cholecystitis Melanoma
Adenocarcinoma of Meningitis
gallbladder Meningioma
Chronic pyelonephritis Astrocytoma
Renal cell carcinoma Glioblastoma
Wilms tumour multiforme
Amyloidosis of kidney Osteogenic
Benign prostatic sarcoma
hyperplasia Osteoclastoma
Carcinoma of prostate Lipoma
Carcinoma of penis Fibroma
Endometrium Neurofibroma
proliferative phase Fibrosarcoma
Endometrium secretory Liposarcoma
phase Rhabdomyosarcoma
Adenocarcinoma of
endometrium
Leiomyoma
Mucinous cystadenoma
ovary
Dysgerminoma
Teratoma
Fibroadenoma breast
Adenocarcinoma breast
Pagets disease of breast
Primary hyperplasia
thyroid
126
PHARMACOLOGY
GENERAL PHARMACOLOGY
1. Introduction
2. Commonly used abbreviations in prescriptions
3. Study of different dosage forms
4. Study of different drug delivery devices
5. To compare Disintegration time, Dissolution time of Aspirin, soluble Aspirin and enteric coated
Aspirin.
6. Rational drug therapy
7. To study Drug Use Indicators (Prescription audit)
8. Prescription writing
9. Effect of autonomic drugs on eye
10. Local anesthetics
11. Prescription writings and clinical problems for each system
OBJECTIVE:
To compare Disintegration time, Dissolution time of Aspirin, soluble Aspirin and enteric coated
Aspirin.
METHOD:
Take One Beaker and fill it with 50 ml of distilled water. In first beaker place Soluble Aspirin one
tablet and start the stopwatch simultaneously. Occasionally stir the contents with stirrer. Note the time
of its complete disintegration. Repeat the same procedure with Enteric coated Aspirin and Aspirin
similarly. Note the time of disintegration of each tablet.
OBSERVATIONS:
TABLE 1
DRUG: Disintegration Time Dissolution Time

Aspirin
Soluble Aspirin
Enteric coated aspirin
_____________________________________________________________
REMARKS:
_____________________________________________________________
TABLE 2
Enteric coated aspirin

Double distilled water OBSERVATIONS
1. HCl (Dil)
2. Soda bicarb.
__________________________________________________________
CONCLUSIONS:
127
RATIONAL PRESCRIBING
Process of Rational Prescribing: The practical sessions in Pharmacology to provide systematic

approach to prescribing are designed with an objective that students will be able to write an appropriate
and correct prescription for a patient. For achieving this objective, students will be given scenario that
should focus on therapy but not the diagnosis.
At the end of the session, the student should be able :
to specify the therapeutic objective.

to choose between drug and / or non-drug.
to select a drug on the basis of comparative efficacy, safety, cost and suitability.
to write a correct prescription.
to counsel the patient.
to make appropriate arrangements for follow-up.
The guide to Good Prescribing (WHO) should serve as source of clinical scenarios and discussions.
Drug Use Indicators Study

(Prescription Audit)
In all the health care delivery systems, drugs are prescribed to treat the illness of patients. Drug Use
involves not only the actual prescribing of drugs but also wide range of behaviors that occur during the
drug use encounter, the interaction between the prescriber (provider) and the patient. These behaviors
include the processes of making a dispensing, and use of drugs by patient. Here lies the concept of
rational use of drugs; whether or not a prescriber has prescribed the drugs keeping in mind the concept
of rational use of drugs and essential drug. Rational Use of Drugs requires that patients receive
medications appropriate to their clinical needs, in doses that meet their own requirements for an
adequate period of time, and the lowest cost to them and their community. Essential Drugs are the
drugs that satisfy the health care needs of majority of the population; they should therefore be available
at all times in adequate amounts and in appropriate dosage form. The different aspects of drug use can
be assessed by some of the indicators, called drug use indicators, put forth by WHO namely,
prescribing indicators, patient care indicators and facility indicators.
Prescribing indicators assess the drug prescribing behavior of a prescriber. It entails:
(i) Average number of drugs per encounter,
(ii) Percentage of drugs prescribed by generic name,
(iii)Percentage of encounters with an antibiotic prescribed,
(iv) Percentage of encounters with an injection prescribed,
(v) Percentage of drugs prescribed from essential drug list or formulary.
(i) Average number of drugs per encounter:

Calculated by dividing the total number of different drug products prescribed, by the number of
encounters surveyed.
(ii) Percentage of drugs prescribed by generic name:

Calculated by dividing the number of drugs prescribed by generic name by the total number of drugs
prescribed, multiplied by hundred.
(iii)Percentage of encounters with an antibiotic prescribed:

Calculated by dividing the number of patient encounters during which an antibiotic is prescribed, by
the total number of encounters surveyed 100.
(iv) Percentage of encounters with an injection prescribed:

128
Calculated by dividing the number of patient encounters during which an injection is prescribed, by the
total of number of encounters surveyed, multiplied by hundred.
(v) Percentage of drugs prescribed from essential drug list: Calculated by dividing the number of
products prescribed which are listed on essential drug list, by the total number of products prescribed,
multiplied by hundred.
INDICATORS ENCOUNTER FORM

TEACHING HOSPITAL
Enumerator: . Date:
#
A I #
D n n D
A D #
a t j # r
g r G
t i e u
e u e
e b c o g
DEPAR g n
. . n D
TMEN ( e
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T y P r
f ( ( E s
r r i
0 0 D p
s e c
R / / L e
) s s
x 1 1 n
c
) ) .
.
129
Encounters
(#)
Sum
Average
o
o f o
f f
t t t
O O
o o o
f f
t t t
a a a
Percentage e e
l l l
n n
d d
c c
r d r
e e
u r u
g u g
s g s
s
130
Objectives:
To make the student analyse the prescription on the basis of prescribing indicators independently.
Procedure:
1. Ten simulated prescriptions are given to each student.

2. National list of essential drugs (alphabetical order) is provided to the student.
3. Indicator Encounter form is also provided to the student.
4. Each prescription is to be thoroughly scrutinized by the students and the proforma.
5. to be completed as required.
6. After completing the form, the data is analyzed and submitted for scrutiny to the concerned teacher.
Conclusion:
Assessing Promotional Materials
The Practical sessions on promotional materials has been developed with following objectives:
to critically analyze the promotional materials against WHO Ethical Criteria for Drug Marketing and
Promotion.
to sensitize about existence of misleading information.
to keep up to date with appropriate objective information.
to achieve the objectives, students are divided into small groups and each group is asked to review the
printed material against WHO Ethical Criteria for Drug Marketing and Promotion.
The groups are asked to present their findings and is followed by discussions.
COMMUNICATIONS SKILL
OSCE Score list
Examinee: . Total: .. /38

Scorer .
Par W
N
tial el
o
ly l
Define the problem 0 1 2
Check the suitability of your P-
drug for this patient
0 1 2
ontra indications
0 1 2
nteractions
0 1 2
onvenience
Non-drug measures
0 1 2
escribes rationale
0 1 2
ives instructions
0 1 2
ives warnings
131
Write the full prescription (if
necessary)
ame and address of prescriber, date,

0 1 2
signature, name and address of
patient
eneric name, concentration /

0 1 2
strength, dosage, form
administered, total amount
0 1 2
nstructions, warnings
Information, Instructions,
warnings
rug effect (effect, onset and 0 1 2

duration of action)
0 1 2
ide-effect (describes, what to do)
nstructions (when to take, dosage,

0 1 2
dosage interval, duration of
therapy, points of care)
arnings (maximum dose, 0 1 2

interactions, stop the drug)
Monitoring
0 1 2
ext appointment
0 1 2
hen earlier
Communication style
lear, understandable, logical 0 1 2

structure
0 1 2
llow, patient to ask questions
nsure patient understands, asks to 0 1 2

repeat instructions
132
PHYSIOLOGY
SEMESTERS - I & II
Growth & development practicals:

1. To show the prepared charts and diagrams, figures to explain applied aspects of growth and
development.
Musculo-skeletal system practicals:

1. Determination of work done and fatigue by ergograph.
2. Study of apparatus used in experimental physiology;
i.e.: kymograph, myograph, and stimulator.
3. To show important recorded graphs of nerve-muscle preparation;
i.e.: Simple muscle curve, fatigue curve.
Blood practicals:
1. Study of the compound microscope.
2. Blood film drawing, staining and identification of cells.
3. Differential leukocyte count.
4. Total Count (RBC, WBC).
5. Estimation of hemoglobin percentage.
6. Bleeding time, Clotting Time.
7. Blood groups.
Demonstrations:
1. ESR.
2. PCV (Haemogram).
3. Osmotic fragility test.
4. Haemin crystal.
5. Reticulocytes and platelets
Respiratory System Practicals:

1. Clinical examination of respiratory system.
2. Spirometry.
3. Stethograph for respiratory movements and breatholding time..
4. Peak flow meter.
5. Vitalograph.
Cardiovascular System Practicals:

1. Clinical Examination of CVS.
2. Measurement of blood pressure.
3. Effect of exercise on respiration and CVS.
4. Cardiopulmonary resuscitation.
Demonstrations:
1. Electrocardiogram.
2. Methods of artificial respiration.
133
PHYSIOLOGY
Renal and electrolyte system/ endocrine, & reproductive system practicals:

2. To show the prepared charts and diagrams, figures to explain applied aspects of renal and
electrolyte system/ endocrine and reproduction.
CNS & special senses practicals:

1. Physiological examination of sensory system.
2. Physiological examination of motor system.
3. Physiological examination of reflexes.
4. Examination of cranial nerves.
5. Visual activity, field of vision, colour vision.
6. Tests for hearing: Rinnes test, Webers test.
7. Tests for taste and smell.
8. Examination of cerebellar functions
134
HISTORY TAKING: SKILL DEVELOPMENT
FORMAT
Name: Age: Gender: Marital status:

Religion: Address: Occupation:
Date of admission:
Date of examination:
Source of history (patient/relative):
History of cheif complaint/s and duration of each in chronological order:

1..
2..
3..
Present illness: Onset and progress in chronological order
Previous health: Illness/operation/accidents
Travel abroad
Prophylactic medications
Immunizations
History of birth in case of infants and children:
Family history:
Parents/siblings/spouse age; status of health; cause of death (if relevant)
Social and personal history:
Details of occupation, housing, family /school/workplace relationships
Habits recreation, physical exercise, alcohol/tobacco/others
Level of self-dependence in case of elderly
135
PHYSICAL EXAMINATION
FORMAT
General assessment:
Demeanour and general conditions- physique, nutrition, state of hydration,
Posture, gait, personality and mental state:
Record height and weight:

Regional examination:
Skull deformity, asymmetry Facies

Exophthalmos, endophthalmos Thyroid swelling
Scoliosis, kyphosis, lordosis Abdominal swelling
Abdominal asymmetry Abnormal posture of limbs
Deformity of limbs Scrotal swelling
Cardinal signs:
Anaemia Clubbing Venous engorgement
Cyanosis Oedema legs/sacrum Temperature - oral
Jaundice Peripheral pulse Respiration
Blood pressure Lymph nodes
Skin: Abnormal pigmentation/texture/swelling/rashes
Nails: Roughness/pitting/brittleness/spooning/ridging
As the Pre-clinical Sciences progress to organ systems, history taking and physical examination should
also match the same.
Eliciting additional information according to system.
136
ITRODUCTION TO CLINICAL MEDICINE
SUGGESTED STANDRAD QUESTIONS
Locomotor system:
Joint pain or stiffness
Muscle pain or weakness
Cardiovascular system:
Ankle swelling, palpitations, chest pain or pain in legs on exertion,
Breathlessness when lying flat (orthopnoea), waking up with breathlessness
(paroxysmal nocturnal dyspnoea)
Respiratory system:
Shortness of breath exercise tolerance, wheezing, coughing
Sputum colour, amount, presence of blood (haemoptysis)
Chest pain in relation to respiration or coughing
Gastrointestinal system:
Condition of mouth oral and dental hygiene, ulcers, bleeding gums
Difficulty with swallowing (dysphagia), indigestion, heartburn, abdominal Pain, Change in bowel
habits, colour of stool normal, pale, dark, black; fresh blood, Weight loss, Vomiting : Character and
Quantity.
Genito-urinary system:
Pain on passing urine (dysuria)
Frequency of passing urine during day and night
Abnormal color of urine e.g. blood
Male If, of appropriate age, ask for prostatic symptoms such as difficulty in initiating micturition,
poor stream, terminal dribbling
If, of appropriate age, ask for mental attitude to sex (libido),
Frequency of intercourse, ability to maintain erections, ejaculations,
Urethral discharge, number of sexual partners
Female age at menarche, duration of the menstrual cycle, dysmenorrhoea, duration and severity of
menstruation, the date of last menstruation. The relation between duration of menstrual flow and cycle
can be conveniently recorded as 5/28,6/30 etc.
Type of contraception, if relevant, presence or absence of vaginal discharge,
Post-menopausal bleeding, stress and/or urge incontinence,
Pain during intercourse (dyspareunia), and the number of sexual partners if relevant
Obstetric history:
The number of pregnancies and the outcome i.e. spontaneous, miscarriage or induced abortions,
complications during pregnancy, labor or the puerperium children born and year of each
Endocrine system :
Heat/cold intolerance
Prominence of eyes
Swelling in neck
Obesity
Tremor of fingers
137
Nervous system:
Headache, fits or faints, sleep patterns, visual symptoms e.g. double vision,
Loss of acquity or visual field. Tingling, numbness, muscle weakness
Hearing symptoms e.g. deafness, tinnitus
Excessive thirst
138
SYSTEMIC EXAMINATION
FORMAT
Cardiovascular system:
Skin temperature and colour
Venous abnormal vessels, signs of inflammation
Arterial pulse and pressure, jugular venous pulse and pressure
Heart: Inspection pulsations and deformities of anterior chest wall
Palpation apex beat
Auscultation first and second heart sounds
Respiratory system:
Upper respiratory tract nose, tonsils, pharynx
Chest inspection shape and lesions of chest wall,
Respiration rate and depth; chest expansion and mode of breathing
Palpation position of trachea and range of movement
Percussion anterior lateral and posterior chest wall; hepatic dullness
Auscultation breath sounds; vocal resonance and added sounds
Gastrointestinal:
Mouth: lips, tongue, teeth gums and other mucosae
Abdomen: Inspection: scars; abdominal wall shape dilated veins,

general and local changes,
palpation: tenderness, guarding, individual organs and abnormal masses,
hernial orifices and inguinal lymph nodes
percussion: fluid, gas and individual organs
auscultation: frequency and character of bowel sounds
Genito-urinary system
Genitalia:
Male Inspection: swellings and skin changes
Palpation: penis, testis, epididymis, vas deferens
Female Breast examination
Inspection of external genitalia
Pelvic examination by speculum and then digitally as bimanual vagino-abdominal examination
Rectal examination in certain instances.
Nervous System:
Higher functions (place, person, time) motors, reflexes,, carnial nerves, sensory, gait and coordination.
139
ANNEXES
ANNEX Ia
Subject-wise break down of Semester hours:

Pre-Clinical Sciences: Semesters I IV
SUBJECTS Semester- I Semester- II Semester- III Semester- IV TOTAL

TH PR TH PR TH PR TH PR
Anatomy 49 71 25 57 48 88 65 69 472
Biochemistry 63 25 30 25 70 25 37 25 300
Microbiology 32 20 15 20 49 20 32 20 208
Pathology 60 26 32 20 83 20 39 20 300
Pharmacology 51 26 40 24 41 30 29 26 267
Physiology 31 30 37 30 56 30 62 30 306
Community Medicine 48 45 35 40 35 30* 24 30 287
Introduction to Clinical 20 20 20 20 80
Medicine
Medical Informatics 30 30
Total Instructional Hours 627 446 653 524 2250
Self Study 326 196 522
Theory (TH) - Practical (PR)
* Plus 1 week for field visits / practice.
Note: Theory and Practical hours given in the table are approximate hours of instruction.
Theory includes admixture of lectures, seminars, tutorials and problem-based learning.
Practicals include laboratory work, hands on skill development, etc.
140
ANNEX II
CALENDAR OF OPERATION FOR AN ACADEMIC YEAR
Medical college is required to prepare its own calendar of operations for an academic year at the beginning
of an academic year which may be in the month of August or the month of February.
Medical college may also prepare its own holidays list, by taking note of HMG, Kathmandu University
and the local practices. Medical college will make decisions on matters related to vacations and holidays as
per its rules and practices.
Tentative allocated days for different purposes during a calendar year:
1. Summer and Winter Vacations 45 days maximum
2. Dasai and Tihar Vacations 18 days maximum
3. Other Holidays (local and national) 10 days maximum
4. Days required for holding 2 Sessional Examinations
(Theory + Practicals) 30 days
5. Annual University Examinations-Period
for preparatory leave 30 days
Total 133
141
ANNEX IV
FLOW CHART OF MODULES IN COMMUNITY MEDICINE
SEMESTER I THEORY
Theory/ Practical 1. Human & Medicine 2.Concept of Health 3. Nutrition I 4. Nutrition II 5 Environmental Science
48 hours/45 hours - 8 hours - 10 hours - 10 hours - 5 hours - 10 hours
SEMESTER II
Theory/ Practical 6. Epidemiology 7.Information, 8. Environmental Health II 9. Demography

35 hours/40 hours I Education & - 5 hours
- 10 hours Communication
- 5 hours
SEMESTER III
Theory/ Practical 11.Medical Sociology, Psychology 12.Community Diagnosis 13. Family Medicine
35 hours/30 hours & Social Anthropology Orientation - 15 hours
- 10 hours - 10 hours
SEMESTER IV
Theory/ Practical 14. Epidemiology II 15.Behivioral Science 16. Community Based Integrated
24 hours/30 hours -10 hours - 10 hours Management of Childhood illnesses
(IMCI)
- 4 hours
SEMESTER VI
Theory/ Practical 17.Communicable Diseases 18. National plan of communicable 19.Occupational Health
40 hours/45 hours - 20 hours diseases -10 hours - 5 hours
Theory/ Practical 20.Mental health- 5 hrs 21. Non-Communicable 22. National plan for Non-
40 hours/40 hours + 3 weeks Diseases communicable
- 12 hours diseases
- 8 hours
SEMESTER VII
Theory/ Practical 23. Reproductive 24.National 25. EPI 26. Health 27. Health Delivery
30 hours/40 hours Health -10 hours Health Info Planning & System
Program for - 5 hours Management in Nepal
reproductive - 6 hours - 3 hours
health and
specific age
group -5
hrs
28. Inferential 29. Disaster 31. Research

Statistics-12 Management 30.internatio Methodology
hours 5 Hours nal Health - 2 hours
- 2 Hours
142
ANNEX VIII
LIST OF REFERENCE BOOKS
PRE-CLINICAL SCIENCES
ANATOMY
1. Grays Anatomy by Drake
2. Human Anatomy Volume- I, II & III by BD chaurasia, 5th edition, Editor: Krishna Garg
3. Text book of Histology K Garg, I Bahl, M Kaul 4th edition
4. Text book of Neuroanatomy K garg M kaul I Bahl 4th edition
5. BD Chaurasia Hand book of General Anatomy Editor Krishna Garg 4th edition
6. Cunninghams Manual of Practical Anatomy Vol. I, II & III by G. J. Romanes
7. Text book of Anatomy by AK Datta, volume- I & II
8. Langman Medical Embryology by T W Sandler
9. Human Embryology by Inderbir Singh
10. Wheaters Functional Histology by Young
11. Text Book of Histology by Inderbir Singh
12. Clinical Anatomy by Keith and Moore
13. Clinical Neuroanatomy by Snell
14. Netters Atlas of Anatomy by Netter
15. Mcminns Atlas of Anatomy by Abrahams
16. A Method of Anatomy by Grant
17. DiFiores Atlas of Histology with Functional Correlation
BIOCHEMISTRY
1. Harpers Biochemistry by Murray, Granner, Mayes & Rodwell
2. Lippincotts Biochemistry - Pamella C. Champ, Richard A. Harvey
3. Text book of Biochemistry by U. Satyanayarana
4. Text book of Biochemistry by Vasudevan M D et al, 6th edition Jaypee Brothers Medical Publishers (P)
Ltd 2006.
5. Marks Basic Medical Biochemistry: A Clinical Approach, 2nd edition, Lippincott Williams & Wilkins,
2005.
6. John W. Baynes, Marek H. Dominiczak Medical Biochemistry, Mosby; 3rd edition, 2009.
7. Burtis and Ashwood (Eds). Tietz Textbook Of Clinical Chemistry. 6th edition. Elsevier, 2009.
8. Micheal L. Bishop Clinical Chemistry: Principles, Procedures, Correlations. 6th edition. Lippincott
Williams & Wilkins, 2009.
COMMUNITY MEDICINE
1. Parks Textbook of Preventive and Social Medicine by Park
2. Control of Communicable Diseases in Man by Benson
3. Methods in Biostatistics for Medical Students by Mahajan
4. Foundation of Epidemiology by Lilienfield, David & Pauld
5. Essential Preventive Medicine Shai & Gupta
6. The Quest for Health by Dr. Hemang Dixit
7. Clinical Epidemiology The essentials by Robert H. Fletcher
MICROBIOLOGY
1. Jawetz, Melnick & Adelbergs Medical microbiology, Appleton & Lenge
143
2. Microbiology human prospective, Nester, Anderson, Robert & pearsall, Mc Graw Hill
3. Medical microbiology and immunology, Lenge Medical books/ McGraw- Hill by Warren Levison &
Ernest Jawetz.
4. Microbiology by Willian A. Strohl, Hariet Rouses & Bruce D. Fisher, Lippincott William & Wilkins
5. Janeways Immunobiology by Kenneth Murphy, Paul Trevers & Mark Walport
6. Diagnostic Microbilogy, by Koneman, Allen, Janda, Schreckenberger, Winn, Lippincort co.
PATHOLOGY
1. Robbins Basic Pathology
2. Robbins Pathologic Basis of Diseases
3. Questions and answers in Pathology - Ashraf Mohammad
4. Concise Pathology by Chandrasoma & Taylor
5. Practical Examination Manual of Pathology - Ashraf Mohammad
6. Pathology Practical Book for Undergraduates by Harsh Mohan
PHARMACOLOGY
1. Pharmacology and Pharmacotherapeutics by Satoskar, Bhandarakar & Ainapure
2. Clinical Pharmacology by Laurence & Bennett.
3. WHO Guide to good prescribing
4. WHO How to investigate drug use in health facilities
PHYSIOLOGY
1. Textbook of Medical Physiology by Guyton & Hall
2. Review of Medical Physiology by W. F. Ganong
3. Physiology by Robert M. Berne, Mathew N. Levy, BM Koeppen & BA Stanton
4. Physiology by Linda S. Costanzo
5. Human Physiology by Andrew Davies, A Blakeley & Cecil Kidd
6. Text book of Medical Physiology by Indu Khurana
7. Essential of Medical Physiology by K. Sembulingam & Prema Sembulingam
8. Practical Physiology by Pinaki Chattopadhyay
144
ANNEX IX
LIST OF PARTICIPANTS IN CURRICULUM REVIEW
MBBS Subject Committee
1. Dr. Ram Kantha Makaju Shrestha

Professor of Surgery, Kathmandu University School of Medical Sciences,
Dhulikhel
Chairman
2. Dr. Arpana Neopane
Associate Professor of Medicine, Kathmanu Medical College, Kathmandu Member
3. Dr. Heera Tuladhar

Associate Professor of OBGY, Nepal Medical College, Kathmandu Member
4. Dr. O. K. Malla
Professor of Opthalmology, Kathmandu Medical College, Kathmandu Member
5. Dr. Veena Gupta

Professor of Paediatrics, Nepalganj Medical College, Nepalgunj Member
6. Dr. Ranjit Guha

Associate of Anatomy, College of medical Sciences, Bharatpur Member
7. Dr. Shiva Kumar Rai

Professor of Microbiology, Nepal Medical College, Kathmandu Member
8. Dr. Ashraf Mohammad

Professor of Pathology, KUSMS Member
9. Dr. Archana Saha

Professor of Pharmacology, Manipal College of Medical Sciences, Pokhara Member
10. Dr. Sashi L. Malik

Professor of Physiology, KUSMS Member
Attendees
1. Prof. Dr. N. B. Rana
Dean, KUSMS
1. Prof. Dr. P. R. Adhikari
Controller of Examinations, KU
2. Prof. Dr. B. P. Nepal
Associate Dean, KUSMS
3. Prof. Dr. N. R. Tuladhar
Associate Dean, KUSMS
4. Dr. Rajendra Koju
CAO, KUSMS
5. Mr. B. Lakhey
Assistant Controller of Examinations, KU
6. Dr. Anjana Singh Dongol
Assistant Professor of OBGY, KUSMS
7. Dr. Dil Islam Mansur
145
Lecturer of Anatomy, KUSMS
8. Mr. Prakash Aryal
Office assistant, KUSMS
Kathmandu University School of Medical Sciences

Prof. Dr. N.B. Rana, Dean
Prof. Dr. Ram Kantha Makaju Shrestha, Associate Dean
Prof. Dr. Marcus Ritter, Paracelsus Medical University Salzburg, Austria
Prof. Dr. Puspa Raj Adhikari, Controller of Examinations
Mr. Birendra Lakhe, Assistant Controller of Examinations
List of Core Members

Prof. Dr. Marcus Ritter
Prof. Dr. B. P. Nepal
Prof. Dr. N. R. Tuladhar
Prof. Dr. C. D. Chawla
Prof. Dr. N. P. Sinha
Dr. Rajendra Koju
Dr. Anjana Dongol Singh
Dr. Dil Islam Mansur
Logistics Members
Mr. Dipak Dahal
Mr. Pashupati Adhikari
Institute of Medicine, Tribhuvan University, Kathmandu

Prof. Dr. J. P. Agrawal
Manipal College of Medical Sciences, Pokhara

Prof. Dr. B. M. Nagpal
Prof. Dr. S. Gokhale
Prof. Dr. Archana Saha
College of Medical Sciences, Bharatpur

Prof. Dr. A. K. Dutta
Dr. N. S. Reddy
Prof. Dr. J. N. Sinha
Dr. Ranjit Guha
Nepalgunj Medical College, Nepalgunj

Prof. Dr. S. M. Mishra
Prof. Dr. D. R. Singh
Prof. Dr. N. K. Mishra
Dr. B. R. Joshi
Kathmandu Medical College, Kathmandu

Prof. Dr. Hemang Dixit
Prof. Dr. Shambhu Nath
Dr. Arti S. Pandey
Dr. Abhinav Vaidya
Dr. Arpana Neupane
Mr. K. D. Sharma
146
Nepal Medical College, Jorpati
Prof. Dr. S.B. Rizyal
Prof. Dr. Ramesh P. Singh
Mr. Gynendra Ghimire
Nobel Medical College, Biratnagar

Dr. Sita Pokhrel
Dr. Ajit Agrawal
Mr. Kamal Parajuli
Lumbini Medical College, Lumbini

Dr. Y. G. Tambey
Dr. Sushila Jain
Kathmandu University School of Medical Sciences, Dhulikhel

Prof. Dr. B. P. Nepal
Prof. Dr. N. R. Tuladhar
Prof. Dr. N. P. Sinha
Prof. Dr. Shashi L. Mallik
Prof. Dr. B. K. Kapoor
Prof. Dr. Ashraf Mohammad
Prof. Dr. T. R. S. Bedi
Prof. Dr. C. D. Chawla
Dr. Rajendra Koju
Dr. Raj Kumar Chhetri
Dr. Puspa Raj Sharma
Dr. Anjana Singh Dongol
Dr. D. I. Mansur
Dr. M. K. Haque
Dr. R. P. B. Shrestha
Dr. R. C. M. Amatya
Dr. Jagdish Chataut
Dr. Nirajan Parajuli
Dr. Sangina Ranjitkar
Dr. Raj Kumar Karki
Dr. Dharmendra Karn
Dr. Chandan Upadhayay
Dr. Jyoti Tara Manandhar
147
CLINICAL SYLLABUS
V SEMESTER VI SEMESTER
Community Medicine Community Medicine
Medicine Forensic Medicine
Surgery Ophthalmology
Obstetrics & Gynecology Oto-rhinolaryngology
Pediatrics Medicine
Surgery
Obstetrics & Gynecology
Pediatrics
VII SEMESTER VIII SEMESTER
Community Medicine Medicine,
Forensic Medicine Psychiatry,
Ophthalmology Dermatology,
Oto-rhinolaryngology Surgery,
Medicine Orthopedics
Orthopedics Radiology,
Obstetrics & Gynecology Dental,
Pediatrics Anesthesia,
Obstetrics & Gynecology,
Pediatrics
IX SEMESTER INTERNSHIP
Medicine One year rotating
Surgery
Orthopedics
Obstetrics & Gynecology
Pediatrics
Community Medicine
SEMESTER III Theory
Module 11 Sociology
Module 12 Community Medicine
Module 13 Family Medicine
SEMESTER IV Theory
Module 14 Epidemiology II
Module 15 Behavioral Sciences
Module 16 Integrated Management of Childhood illnesses
SEMESTER V Theory
Module 17 Communicable Diseases, IMCI, Neonatal Health Strategy
Module 18 National Plans for Communicable Diseases
Module 19 Occupational Health
Module 20 Mental Health
SEMESTER VI Theory
Module 21 Non-communicable Diseases
Module 22 National Plans for Non-communicable Diseases
Module 23 Reproductive Health, IMCI
Module 24 National Health programs for Reproductive Health and specific age group
Module 25 EPI- Info 2002
SEMESTER VII Theory
Module 26 Health Planning and Management
Module 27 Health delivery system in Nepal
Module 28 Inferential Statistics
Module 29 Disaster Management
Module 30 International Health
Module 31 Research Methodology
Community Medicine Course Content
SEMESTER V
Modules 17: COMMUNICABLE DISESASES, IMCI AND NEONATAL HEALTH STRATERGY MODULE
Themes and Topics:
Malaria
STD/AIDS
Pulmonary Tuberculosis
Leprosy
Vaccine preventable disease (VPDs) included in the Expanded Program on Immunization
Diarrhoeal diseases
Hepatitis - A, B, C, D, E
Kala-azar
Arboviral diseases - J. E., Dengue,,Yellow fever
Filaria
Zoonoses - Rabies, Plague
Enteric Fever
Chicken pox, German measles
Re-emerging infectious measles
Hospital acquired infections
IMCI and Neonatal Health-Strategy
Introduction to IMCI and orientation to the global program.
Importance of IMCI in family medicine
Neonatal health strategy of Nepal
Module 18: National Plans for Communicable Diseases

Themes and Topics
National plans for
Malaria
STD/AIDS
Pulmonary Tuberculosis
Leprosy
Vaccine preventable diseases (YPDs) included in the Expanded Program of Immunization:
cold chain and surveillance of VPDs
Diarrhoeal diseases etc.
Module 19: OCCUPATIONAL HEALTH MODULE
Themes and Topics:
Working environment: health hazards of industrial and agricultural workers
Common occupational diseases
Industrial toxic substance, health hazards & international safety limits
Principles of control of Occupational diseases
Legal aspects
Practical exercise: visit to a factory
Module 20: MENTAL HEALTH
Themes & Topics
Problems of mental health
Assessment of mental health
Causes of mental ill health
Types of mental illness
Mental development in children
Alcoholism & drug abuse/addiction
Suicide a deliberate self-harm
Problem of sexuality and gender disorders
Prevention of mental ill health
Mental health services in Nepal
SEMESTER VI
Module 21: Non-communicable diseases
Themes and Topics:
Epidemiology of non-communicable diseases
Nutrition disorders
Rheumatic health diseases
Hypertension
Cancers
Blindness
Diabetes
Obesity
Accidents
Module 22: National plans for non-communicable diseases
Themes and Topics:
Program for control of Iodine Deficiency Disorders
Blindness Control Programs
Program for control of other Nutritional Disorders e.g.
Nutritional anemia
Night Blindness etc.
Impairment / Disability / Handicap: Definitions and concepts
Assessment of Impairment / Disability / Handicap: e.g. Post-Polio residual paralysis
Programs for rehabilitation at the individual and community levels
Community based rehabilitation
Module 23: REPRODUCTIVE HEALTH & IMCI

Themes and Topics:
Maternal and child health
Safe motherhood
Magnitude of the problem
Maternal morbidity and mortality
Under 5 year child morbidity and motility ,
Breast feeding and weaning
Family planning methods
Practical exercises
Insertion of IUD
Use of injectable contraceptives
Tubal ligation
Vasectomy
Perform - IUD insertion, tubectomy / vasectomy. Administer injectable contraceptives.
Module 24: NATIONAL HEALTH AND PROGRAMS For REPRODOCTIVE HEALTH and SPECIFICAGE
GROUPS
Themes and topics:
Mother and child health (MCH) program
School health program
Problems for the elderly
Social organizations to assist the elderly
Module 25: EPI info 2002

Themes and Topics:
How to design a computer compatible questionnaire in "EPED"
How to "ENTER" data in the questionnaire
Simple forms of "CHECK" programes while entering date e.g. range checks, legal values etc.
"ANALYSIS" of data set.
Cleaning of data set
Frequencies and other tables
Graphical output
Cross-tabulation
SEMESTER VII
Module 26: Health planning and management
Themes and Topics:
Primary Health Care
Management of health resources
Planning and organization of health services in Nepal
Health team at district hospital, health post etc.
Voluntary agencies in health care
Evaluation of a health program: epidemiology and management principles
Need of health economics.
Concepts of cost benefit and cost effectiveness
Practical exercise: Game to demonstrate management
Module 27: HEALTH DELIVERY SYSTEM IN NEPAL
Themes & Topics:
Evolution of health services
Organization of health delivery system in Nepal from center (MOH) Jo sub Health Post
functions of different category health personnel
Module 28: INFERENTIAL BIOSTATISTIC
Themes and Topics:
Probability
Normal distribution, Poison distribution, Binomial distribution
Estimation of standard error
Confidence interval
Tests of significance
Concepts of alpha and beta error
Bias and random error
Sample, size calculation
Sampling
Practical exercise in: random sampling, cluster sampling (UIP)
Correlation and regression
Module 29: DISASTER MANAGEMENT

Themes and Topic:
Definitions of Calamity, Disaster - natural and man-made
Concepts of Hazard and Vulnerability
Disaster Cycle
Planning for Disaster management
Disaster management committee: constituents, line of command etc.
Relief measures: when and what to ask for?
Concept of Triage
Practical play in a disaster situation
Simulated exercise on patient triage
Module 30: INTERNATIONAL HEALTH

Themes and Topics:
Need of International Health Organization.
Structure and functions of WHO
Other UN agencies and their role in Health care.
Bilateral Health Agencies
Non-government International Health Agencies
Module 31: RESEARCH SKILLS

Themes and Topics:
Research: Aptitude or Attitude?
Avenues of medical research: Clinical/Laboratory/Epidemiological
Critical analysis of a published paper:
A.B. Hill's question.
"Why did you begin?"-------------------Introduction/Objective (s)
"What did you do?"----------------------Methods
"What did you find?"--------------------Results / Analysis
"So, what does it all mean?" ---------Discussion
Difference between meta-analysis and review
Research project protocol write up
Community activity project proposal write-up
Forensic Medicine
COURSE CONTENT
Introduction
Definitions synonyms of Forensic Medicine
Text books recommended
Historical aspect-evolution and development
Modem forensic medicine-sub-divisions
Medical Law and Ethics:
Definitions, Nepal Medical Council Act
Nepal Medical "Council-formation and functions
Registered Medical Practitioner - duties and privileges
Professional misconduct (Infamous Conduct), Punishments, Appeal, COPRA, -
Malpractice, Medical Indemnity Insurance
Consent-its relevance in medical practice '
Euthanasia
AIDS and its legal implication, confidentiality in testing blood banks.
Basics of human experimentation and clinical trials in general, practices.
Brief introduction with medico-legal aspect of genetic engineering and cloning.'
Legal Procedure: ,
AIDS and its legal implication, confidentiality in testing, blood banks, aids and
autopsy.
Basics of human experimentation and clinical trials in general practices.
Brief introduction with medico legal aspect of genetic engineering and closing.
Identity:
Definition, types, corpus delecti
Factors establishing, identity - age and its medico legal importance
Sex - its medico legal importance
Other - race-, stature, dactylographic, poroscopy, foot prints, hairs, scars. Tattoo,
superimposition etc,
Thanatology
Definition, types of death, moment of death, suspended animation, modes of death
Causes of death, manner of death, sudden death
Medico-legal importance of death, issuing death certificate
Postmortem changes-immediate, early, late
Adipocere, mummification, time since death
Somatic and molecular death. ' ,
Brain death and organ transplantation.
Organ transplantation act.
Medico-legal autopsy and artifacts:
Objectives and rules
Routing procedures of medico-legal autopsy examination in Nepal.
Preservation of viscera in poisoning, skeletal remains examination, exhumation, negative
and obscure autopsy, artifacts
AIDS and autopsy
Asphyxial deaths:
Classification, pathophysiology, signs and symptoms of asphyxia.
Hanging - definitions, types, autopsy findings and medico legal aspects.
Strangulation, suffocation, etc. definitions, types autopsy findings and medico-legal aspects.
Drowning definitions, types mechanisms, autopsy findings, medico-egal aspects,
Traumatic asphyxia, sexual asphyxia.
Forensic Psychiatry:
Definition, restraint of the insane in Nepal, feigned insaniy.
Civil and criminal responsibilities of an insane person.
Mental health act.
Restraint of insane in Nepal.
Forensic Science:
FSL, biological stains of medico-legal importance.
Blood, saliva and semen, DNA - profiling.
Trauma-mechanical injuries:
Definitions, classification - abrasions, contusion, lacerations, incised wounds, stab wounds,
chop wounds & their medico legal significance.
Fire arm wounds-basics, rifle fire arm & smooth bore fire arm wounds and their medico-legal
aspects.
Regional injuries - head injuiy: mechanisms, injury to scalp, skull and brain, intra-cranial
hemorrhages, injury to spine, neck, chest, abdomen, bones, joints etc.
Complications and causes of death by trauma
Medico legal aspects of trauma-homicide, dowry death, suicide, hurt, grievous hurt, wound
certificate
Other types:
Thermal injuries due to heat, burns, scals
Thermal injuries due to cold (hypothermia)
Injury due to electricity, lightning, x-rays, radio-active substances, CT-scans, MRI,
ultrasonography, and bone densitometry
Injury sustained in road traffic accidents, railway accidents, plane crash, explosion
and mass disasters
Self-inflicted injuries and defense injuries
Torture: definition, methods and consequences. Examination and reporting of
victim of torture
Sexual jurisprudence:
Virginity, pregnancy, delivery - definitions, signs and medico-legal importance
Paternity, impotency, sterility - definitions and medico-legal importance.
Abortion, medical termination of pregnancy, criminal abortion and its complications
Sexual Offence:
Classification,
Definitions- rape, incest, sodomy, lesbianism, buccal coitus, bestiality
Definition, examining a case of infanticide, viability, still birth, dead birth, live birth, battered
baby syndrome, sudden infant death syndrome.
Toxicology:
General consideration, corrosives, irritants: metallic, non-metallic
Organic vegetable and animal insecticides, somniferous poisons, inebriant poisons, dellriant
poison, cardiac poisons, spinal poisons, food poisoning, asphyxiants, drug dependence.
Epidemiology of poisoning in Nepal
Laws involving poisoning in Nepal
Deciding on management of poisoning cases
Occupational and environmental toxicology.
Chemical and biological warfare agents: advantage, disadvantages, selectivity, dissemination
and delivery.
PRACTICALS
Forensic Osteology:
Giving expert opinion on age, sex, structure, cause of death, time since death, etc. on examining the
skeletal remains (skull, mandible, femur, hipbone etc.)
Forensic Radiology:
Expert opinion on age by examining the radiographs (Pelvis, knee, : ankle, shoulder, elbow and wrist
joints)
Forensic Odontology:
Age determination by teeth examinatipn.
Study of Museum Specimens:
Soft specimens, histopathology slides, photographs, weapons, common, vegetable poisons, chemical
poison, poisonous animal & insects, appliances & instruments of medico - legal significance (
Including autopsy instruments)
Drafting Certificates during Routine Medical Practice:
a) Birth certificate b) Physical fitness certificate
c) Leave certificate d) wound certificate
e) Age certificate f) Drunkenness Certificate
g) Death certificate h) Postmortem report
Drafting police intimation letters in medico- legal cases of accident, assault, discharge on
treatment, brought dead, etc. cases.
Witnessing and drafting report of medico- legal autopsy.
Taking students to courts to witness recording of evidence.
Otorhinolaryngology
COURSE CONTENT
Nose, paranasal sinuses and Nasopharynx
Surgical anatomy of the nose, paranasal sinuses and nasopharynx
Applied physiology of the nose.
Examination of nasal passages, nasopharynx and. paranasal sinuses.
Diseases of the nose: congenital malformations - stenosis of anterior nares,-, posterior
chaoanal atresia, dermoid cyst, injuries, oro-antral fistula, nasal furunculosis, vestibulitis.
Diseases of nasal septum: - haematoma, abscess, ulceration, .perforation, deviation and
spurs.
Diseases of the nasal cavity: foreign bodies, rhinoliths, acute rhinitis- nonspecific common
cold - specific - nasal diphtheria. Chronic - non - specific - chronic simple; hypertrophic and
atrophic rhinitis. Specific diphtheria, lupus, tuberculosis, syphilitic, leprosy,
rhinospoddiosis, rhinoscleroma, malignant, granuloma. Nasal allergy, nasal allergy, nasal
polypi, epistaxis.
Sinusitis: general considerations of acute and chronic sinusitis, diagnosis: - frontal sinusitis,
ethmoditis, sphenoiditis. Acute and chronic maxillary sinusitis.
Complications of suppurative sinusitis - frontal ostemyelitis. Osteomyelitis of maxilla-orbital
complications, intracranial complications, secondary effects of sinusitis.
New growths and cysts of the nose and sinuses: papilloma, angioma, carcinoma and
sarcoma and simple cysts.
Diseases of the nasopharynx - congenital dermoid, polyp of the nasopharynx,
nasopharyngitis-acute and chronic, adenoids.
New growths: Benign- juvenile angiofibromas, malignant-carcinoma.
Pharynx/ Oral cavity
Anatomy and applied physiology. (Pharynx, oropharynx)
Examination of the pharynx.
Foreign bodies, trauma, inflammations - acute - non-specific and specific, Vincent's angina,
acute diphtheritic pharyngitis. Moniliasis. Chronic non-specific pharyngitis. Specific-
tuberculosis, syphilis, leprosy, scleroma.
Acute tonsillitis & chronic tonsillitis, indications for tonsillectomy.
Abscesses of the pharynx: peritonsillar abscess, para- pharyngeal-abscess, acute and chronic
retropharyngeal abscess, lingual tonsil abscess.
New growth-benign and malignant.
Oral ulcers
Sub mucous fibrosis
Lesions of tongue - geographical tongue,
Rhomboid ulcers
Ulcers caused by other causes e.g. neoplasia
Fungal infection of the oral cavity
Larynx, trachea and bronchi:
Surgical Anatomy and applied physiology.
Examination of the larynx and lower respiratory tract.
Endoscopy - method, indications,
Diseases, of the larynx-congenital. malformations of larynx. Foreign bodies in the air
passages.
Inflammations: acute non-specific - simple laryngitis, laryngo- tracheo-
Bronchitis, specific-diphtheria. -
Chronic non-specific - simple laryngitis, leukoplakia, pachydermia.
Vocal nodules-tuberculosis, lupus, syphilis, scleroma, leprosy.
Function: laryngeal paralysis, organic laryngeal paralysis, laryngismus stridulus
New-growths of the larynx.
Tracheostomy: indications, technique, after treatment, complications.
Ear
Surgical anatomy and applied physiology
Examination of the ear: clinical examination of the ear, functional examinations tests for
hearing, test for vestibular function, test for Eustachian tube function.
Diseases of external ear: congenital malformations, affections of the auricle, perichondritis,
dermatitis, lupus, syphilis.
Affection of the external auditory canal - furuncles, otitis external, herpes, myringitis bullosa,
otomycosis, leprosy, wax, foreign bodies, new growth, injuries of external ear and tympanic
membrane.
Acute inflammations of middle car cleft, Eustachian sampingitis, acute and chronic, acute
catarrhal otitis medial acute suppurative otitis media acute mastoiditis.
Chronic suppurative otitis media- simple and dangerous.
Other types (non-suppurative): - chronic, catarrhal otitis media, secretory otitis media, otitis
media, acute suppurative otitis media acute mastoiditis. ,
Chronic suppurative otitis media-sample and dangerous.
Other types (non suppurative): - chronic catarrhal otitis media, , secretory otitis media, otitis
barotraumas, tuberculous otitis media, syplilitic otitis media.
Complication of suppurative otitis media. Extracranial: - Mastoiditis, Mastoid abscest,.
petrositis, facial nerve paralysis, labyrinthitis. Internal: - meningitis, extradural abscess,
subdural abscess. Thrombosis, brain abscess.
Otosclerosis: etiology, pathology, clinical features, treatment.
Prevention of S. O. M. and prevention; of complications of otitis media.
Diseases of inner ear: congenital disorders, traumatic disorders, otogenic labyrinthitis,
mumps, herpes Zoster, otitis, rubella, meningitis, deafness.
Noise trauma, drug toxicity, presbyacusis, Menier's disease, auditory nerve tumor.
Newgrowth: middle ear and mastoid: - carcinoma, glomus jugular tumor.
Rehabilitation of deaf'and dumb.
Ototoxicity
Head and Neck:
Mid line and lateral swellings of the neck and their management
Parotid swelling
Ophthalmology
A. Optics, Refration, conjunctiva and Cornea Optics
Optics
Elementary Optics and Physiological Optics
Measurement of Visual acuity
Refractive Errors
a. Types of refractive errors (etiology, classification, clinical features and treatment)
Myopia
Hypermetropia
Astigmatism
b. Presbyopia & accommodation
Conjunctiva
a. Applied anatomy
b. Conjunctivitis
Types: infective, allergic
Symptoms and signs
Treatment
c. Degenerative changes in the conjunctiva:
Pinguecula
Pterygium
Cornea / Sclera
a. Applied anatomy and physiology implications
b. Episcleritis / scleritis
B. Uvea and Liens
Uvea
a. Applied anatomy.
b. Uveitis
Types
Causes
Clinical features
Investigations
Treatment
c. Complications
d. Endophthalmitis
e. Panophthalmitis
Lens
a. Applied anatomy and physiology
b. Cataract: Causes, symptoms, stages development. Diagnosis, management and
complications
C. Glaucoma, Retina and Vitreous
Glaucoma
a. Applied anatomy, and physiology.
b. Classification of glaucoma:
Primary open angle glaucoma (POAG)
Clinical features
Diagnosis
Management
Primary angle closure glaucoma (PACG)
Stages of ACG
Clinical features
Management
Congenital glaucoma
Etiology
Clinical features
Treatment
Secondary glaucoma
Causes
Retina
a. Applied anatomy and physiology
b. Diabetic retinopathy
Non-proliferative diabetic retinopathy
Proliferative diabetic retinopathy , ,
Treatment
c. Hypertensive retinopathy
Clinical features
Grading of hypertensive retinopathy
d. Retinal vein occlusion (CRVO/BRVO)
e. Retinal artery occlusion (CRAO/BRAO)
f. Retinal detachment
Clinical features and management
g. Age related macular degeneration (ARMD)
h. Retinopathy of blood dyscrasia
i. Leukocoria
Causes / differential diagnosis
j. Toxemia of pregnancy
Vitreous
a. Anatomy
b. Vitreous degeneration (in general)
c. Vitreous hemporrhage
Causes
D. Pupil, optic nerve and orbit
Pupil
a. Pulillary pathways and reflexes
b. Variations of pupil
Physiological: mydriasis and miosis
Pharmacological variations: mydriatiocs and miotics
Optic Nerve
a. Visual pathway
b. Papillitis: etiology and clinical features
c. Papilledema: etiology and clinical features
d. Optic atrophy: causes
Orbit
a. Applied anatomy
b. Orbital cellulites: causes, investigation and treatment
c. Proptosis: causes and management
E. Squint/Diploma
Squint
a. Applied anatomy of extraocular muscles
b. Types
c. Causes
d. Clinical features
e. Treatment
Amblyopia
a. Types
b. Diagnosis
c. Management
F. Eye.
a. Applied anatomy
b. Inflammation of lids ; blepharitis
c. Inflammation of the glands of the lids
Stye
Chalazion
d. abnormalities in the position of eye lids, lid margin and eye lashes.
Trichiasis
Ectropion
Causes
Clinical features
Management
Entropion
Causes
Clinical features
Management
Ptosis/lagophthalmos
o Causes
o Clinical features
o Management
Tumors of eye lids
basal cell Carcinoma
squamous cell carcinoma
G. Lacrimal apparatus
a. Applied anatomy /
b. Inflammation of the lacrimal passage (
Acute dacryocystitis
Etiology
Clinical features
Management
Chronic dacryocystitis
Clinical presentation
Investigation
Treatment
c. Dry eye: causes, clinical features and treatment
H. Eye injuries and community Ophthalmology
Eye injuries:
a. Types:
Mechanical (extraocular foreign bodies, blunt injury) Penetrating /perforating injury,
sympathetic ophthalmitis
Non-mechamcal (chemical, thermal, electrical, radiational)
b. Primary management
c. Referral criteria
Community ophthalmology
a. Blindness:
Definition
Major causes (cataract, trachoma, xerophthalmia, eye infections and Injuries, glaucoma)
Epidemiology: global and national perspectives blindness
b. Ocular manifestations of tuberculosis leprosy
Medicine and Allied Subjects
Diseases of Cardiovascular System
Take appropriate history pertaining to cardiovascular system.
Perform thorough physical examination of cardiovascular system.
Diagnose and learn the management of following common conditions: Congestive heart
failure, acute coronary syndromes, disorders of cardiac rhythm, pericarditis, myocarditis,
infective endocarditis, congenital heart disease, aortic aneurysm and coarctation of aorta,
peripheral vascular disease, hypertension, pericardial effusion.
Diagnose and manage the following cardiac emergencies i.e acute pulmonary edema,
myocardial, infarction, shock, Thromboembolism, cardiac arrest.
Learning the normal EGG and interpretation of abnormal findings.
Diseases of Gastrointestinal System
Take detail history of patient suffering from gastrointestinal disease. ,
Perform thorough physical examination of gastrointestinal system including rectal
examination and examination of hernial orifices.
Diagnose and manage following problems: gastro esophageal reflux disease (GERD),
gastritis, peptic ulcers, gastroesphageal disease due to parasitic infestations (round worms,
giardiasis, hook worm, tape worms, hydatid), dysentery, amoebiasis (hepatic and intestinal),
hepatitis jaundice, cirrhosis of liver.
Diagnose, give initial treatment and refer: hiatus hernia, achlasia, malabsorption syndrome,
irritable bowel syndrome, tropical sprue, ulcerative colitis, carcinoma GI tract, Chrons
disease, pancreatitis.
Diagnose and manage following emergencies: he'metemesls & malena, as a complication of
peptic ulcer, esophageal varices, due to toxic substances, hepatic coma, acute pancreatitis.
Learning of normal plain X-ray abdomen and recognition of significance of air under
diaphragm and other findings.
Diseases of Respiratory System
Learning and taking the history of a patient suffering from respiratory diseases.
Learning and performing the clinical examination of respiratory system.
Diagnose and manage the following respiratory illnesses: acute and chronic bronchitis,
chronic, obstructive airway disease (COAD) and emphysema, bronchial asthma, pneumonia
(broncho, lobar, Aspiration), pleural effusion, empyema (including amoebic empyema),
occupational lung disease, allergic alveolitis, pulmonary tuberculosis.
Recognize and refer pneumothorax, lung absecess, bronchiectasis, carcinoma lung.
Diagnose and, manage following emergencies: status asthmaticus, hemoptysis,
pneumothorax, pulmonary embolism, high altitude sickness, acute and chronic respiratory
failure.
Recognizing normal X-ray chest and common abnormalities, sputum examination for AFB.
Infectious and Tropical diseases
Learning and taking the history of patients suffering from infective and tropical diseases
Learning and performing the relevant physical examination
Diagnosis and treatment of common infective and Tropical diseases (amoebiasis, giardiasis,
malaria, filariasis and tropical eosinophilia, kalazar, leprosy, enteric fever, plague, small pox,
chicken pox, mumps, measles, rabies, poliomyelitis, brucellosis)
Learning appropriate investigations for diagnosis of infective and Tropical disorders (fr.e
bone marrow examination for parasitic fever and investigations of viral disorders).
Diagnosis and management of following emergencies: cerebral malaria and its
complications, cholera, heat stroke and exhaustion.
Learning stool examination, recognition of hemoparasites (i.e malarial parasites and LD
bodies) and blood smear examination.
Disease of Blood and lymph reticular system
Outline the normal coagulation process and the abnormal coagulation.
Describe the pathogenesis of various hematological disorders. Take proper history
pertaining to lymph reticular system and hematological disorders.
Do a physical examination of lymphoreticular system.
Learn the principles of blood transfusion and indications, techniques, and complication.,
Diagnose and treat following common disease anemia (iron deficiency, megaloblastic,
hypoplastic anemia, agranulocytosis bleeding disorders.
Recognise; give initial treatment and refer acute leukemia, polycythemia, hemolytic anemia
bleeding disorders due to disorders of coagulation, reticulosis, hodgkins diseases and non-
hodgkins lymphoma.
Manage the emergency of acute blood loss.
Learning the normal values of examination of blood CBC, bleeding time, coagulation time,
platelet count blood and blood groups and their interpretation,
Diseases of Endocrinal systems and Disorders of Metabolism
Learning taking the appropriate history.
Performing physical examination relevant to dysfunctions of endocrine glands.
Diagnosis and management of following common endocrinal disorders i.e Diabetes mellitus,
goitre with stress on endemic goiter as one of the four major health problems in the hills
and other thyroid disorders including hyperthyroidism and hypothyroidism.
Recognize, give initial treatment and refer: growth -disorders. Sheehan's syndrome,
pheochro raocytoma, hyperthyroidism, hypoparathyroidism, hypogonadism, impotency,
infertility.
Diagnosis and manage the following emergencies: diabetic coma, addisonian crisis,
thyrotoxic crisis.
Diseases of Bone and Joints and Immunological disorders
Take history pertaining to joints and immunological disorders.
Perform physical examination of musculoskeletal system and relevant physical examination
Diagnosis, pathogenesis and management of gout, rheumatoid arthritis, systemic lupus
erythematosus, ankylosing spondylitis and scleroderma, osteomelacia, rickets in adult.
Learning the basics of immunosuppressive therapy.
Learning the normal radiology of joints and other bones and the recognition and
interpretation of abnormal findings.
Learning the diagnostic procedures i.e. joints aspiration.
Diseases of Urinary systems and electrolyte disorders
Taking of appropriate history related to renal diseases.
Examination of disorders of urinary systems and relevant physical examination.
Diagnose and manage following common conditions: urinary tract infection, acute
glomerulonephritis, nephrotic syndrome, renal & vesical calculus.
Recognize give initial treatment and refer e.g. chronic renal failure, genitourinary
tuberculosis, neoplastic diseases of kidney, polycystic kidney disease chronic recurrent
urinary tract infections.
Diagnosis and management of renal emergencies: hematuria acute renal failure,
hyperkalemia, hypokalemia, acidosis & alkalosis.
Learn examination of urine:
Learn to recognize abnormal shadows in relation to ureter and bladder in x-ray.
Diseases of Central Nervous System
Take appropriate history in relation to central nervous system.
Learn to perform thorough neurological examination
Diagnose and treat following common conditions: meningitis, Encephalitis, neurosyphilis,
epilepsy, headaches including migraine, involuntary movement disorders (i.e. choreas,
tremors etc. ), peripheral neuropathies, Parkinsonism.
Recognize, give initial treatment and refer brain abscess, brain tumor, carnial nerve palsies,
multiple sclerosis, Motor neuron disease, muscular differentiate the causes and manage an
unconscious patient), status epilepticus, cerebrovascular accidents, sub arachnoid
hemorrhage.
Learn to do CSF examination and interpretation of abnormal ' findings interpret normal X-ray
skull, principles of CT scanning.
Poisoning and Toxicology
Learn to give first aid management in poisoning cases including gastric lavage.
Diagnose and treat following poisoning: organophosphorous compounds, paracetamol.
Barbiturates, morphine and other sedatives poisoning, food poisoning (i.e staphylococcal
food poisoning, botulinism, mushroom poisoning, poisoning), corrosive poisoning and Heavy
metals (i .e lead, mercury, arsenic) poisoning.
Diagnosis and treatment of snake bites, scorpion and spider bites.
Clinical pharmacology
Antibiotic therapy
Immunosuppressive therapy
Antihypertensive agents
Diuretics
Anti anginal drugs
Anticonvulsant drugs
Anticoagulant therapy
Common Geriatric problems and their management
Psychiatry
SPECIFIC OBJECTIVES
General psychiatry, Basic concept of psychiatry, Differentiate between normal and abnormal
behavior, classify psychiatric disorders
Clinical evaluation, perform psychiatric interview, Take detail psychiatric case history and
conduct mental state examination, Refer for relevant investigations including psychological
testing, Describe psychopathology, Diagnose psychiatric disorders in a rationale and
systemic manner.
Community psychiatry, Diagnose and manage common psychiatric disorders in the
community, Refer difficult cases to secondary or tertiary care centers.
Clinical Psychiatry, Psychiatric disorders: describe etiology, epidemiology, clinical
manifestations and the principles of following psychiatric disorders, Organic mental
disorders, Schizophrenia and related disorders, Mood disorders, Anxiety disorder:
generalized anxiety, panic & phobic disorders, Dissociative and somatoform disorders,
Obsessive compulsive disorders, Reaction on -severe stress and adjustment disorders,
Neurasthenia and depersonalization- derealisation syndrome, Non organic sexual functions,
Psycho-physiological disorders: in systemic organic disease, personality' disorders, Drug
abuse, Psychiatric disorders in childhood and adolescences, Psychiatric disorders in
geriatrics. ,
Emergency psychiatry: Refer to emergency medicine
Management: Describe pharmacology of commonly psychotropic medicine, Describe
indications, contraindications and procedures of electro convulsive therapy, Apply
counseling skills, Describe non pharmacological methods of treatment in psychiatry
Forensic psychiatry, Describe legal and ethical issues in psychiatry.
Consultation liaison psychiatry
Rehabilitation, Plan- rehabilitation for patients with chronic mental illness, mental
retardation and substance abuse.
Dermatology
BASIC CONCEPTS (INTRODUCTION)
Outline the role and importance of dermatology in modern medicine.
Define terms commonly used in dermatological practice.
Explain the structure and function of the skin as an organ.
Elicit a complete clinical history from the patients, perform clinical examination, requisition
of relevant investigation and outline the principles of management.
Perform skin scrapings and do a KOH preparation for fungus infections.
Nutritional and Metabolic disorders
Diagnose, and manage pellagra, and phrynoderma. Diagnose and refer hyperlipidemia and
acrodermatitis.
Infective disorders
Diagnose, manage and outline the preventive measures against the most common infective
skin diseases in the community.
Viral-herpes zoster, herpes simplex, common warts
Fungal-superficial - dermatophytosis, pityrasis versicolor, candidiasis.
Bacterial-skin tuberculosis, leprosy, pyogenic infections.
Parasitic-scabies and pediculosis.
Dermatitis and Eczema
Identify and manage common eczemas.
Endogenous atopic, seborrhoeic and nummular dermatitis simplex chronicus.
Refer chronic recurrent cases of eczema.
Papulo-squamous diseases
Idenfity and treat psoriasis, pityriasis and lichen planus
Refer complicated cases of psoriasis
Vesiculobulbous diseases
Diagnose pemphigus
Institute primary care with steroids
Refer complicated cases
Drug reactions and eruptions
Diagnose and manage acute drug eruptions: erythema multiforme, fixed drug eruption,
Stevens-Johnson syndrome.
Refer complicated cases
Disorders of pigmentation
Diagnose and treat acne, miliaria and alopecia
Diagnose and outline principles of management of vitiligo, albinism, and hypopigmentation.
Leprosy
Diagnose various types of leprosy Manage and treat patients of leprosy Recognize and treat
leprosy reactions Refer cases requiring surgery
Describe preventive and rehabilitative aspects of leprosy
Acquired Immuno-deficiency Syndrome
Describe dermatological manifestations of AIDS.
Diagnose case of HIV and AIDS
Provide health education regarding, its prevention '
Refer cases of AIDS
* Will be taught under medicine
Sexually transmitted diseases
Diagnose and treat gonococcal urethritis, syphilis, non-gonococcal urethritis, chancroid,
lympho granuloma venereum, genital herpes, granuloma inguinale.
Immunological diseases
Identify and refer patients having SLE, PSS
Dermatological manifestations of systemic diseases
List common causes
Outline principles of management
Tumors of the skin
Describe diagnose and outline of the principles of management and refer common
precancerous and cancerous conditions of the skin.
Pediatrics
Semester V
Theory
Introduction/overview/ of pediatrics
Normal child/ newborn nomenclature
Growth & development
Immunizations
Nutritional assessment
Nutritional deficiency
Behavior pediatrics
National Health programs related to children in Nepal
School Health
Breastfeeding
Infant feeding
Child Health situation, Vital Statistics
IMCI practice (orientation global program, present status)
Clinicals
History taking in pediatrics
Anthropometric measurements
Developmental assessment
Physical examination of the child
Code of conduct during clinical examination
Normal development of child
Integrated
School Health
National Health Program
Immunization
Nutritional assessment
Behavior pediatrics
Semester VI
Theory
Infectious diseases
Diseases of respiratory system
Neonatolosis
Tuberculosis
Fluid and electrolyte-therapy
Diarrhoeal disease and their management
Clinical
History taking
Developmental assessment in a child
General physical examination
Systemic examination-CVS, Respiratory, GI & CNS
Approach to IMCI in clinical practice
Examination of newborn
Semester VII
Theory
Cardiovascular diseases
Renal disease
Hepatobiliary system diseases
INTEGRATED - self learning
Embryology, physiology of the above'
Semester VIII
Theory
Hematology
Oncology
CNS & neuromuscular disorders
Diseases of endocrines
Genetics & chromosomal disorders
Childhood disabilities
Congenital malformation
Clinical
Examination of a newborn (Normal and abnormal)
Gestational assessment of newborn
Low birth weight babies
Resuscitation of newborn
Breast feeding & BFHI
Identification & management of common neonatal problems.
IMCL training (documentation, danger sign, follow up, video show)
Semester IX
Theory
Pediatric surgical problems
Emergencies in pediatrics
Collagen vascular diseases
Inborn errors of metabolism-General aspect
AIDS in children
Rational drug therapy
Poisoning, snake bite & drowning
IMCI- documentation, medication, follow up & referral
Clinical
Emergency room posting
Instruments
X-rays study
Immunization training
Procedure training
Diarrhea unit training
Surgery and allied subjects
Theoretical Knowledge:
General Surgery
Describe the causes of bleeding the type and source; assess the blood loss in relation to the
clinical condition of the patient.
Outline the principles of control of bleeding (bearing in mind condition such as
haemorrhagic diathesis); administer first aid treatment to a patient with active bleeding;
make reasonable judgment concerning' active surgical investigation in such patient.
Describe the principles of blood transfusion, blood grouping cross matching, blood
transfusion, its indication and hazards.
List the causes the path physiology of shock, and correlate the clinical features with the
degree of shock, and describe the natural compensatory mechanisms involved preventing
shock.
Initiate treatment of shock and correct fluid, electrolyte and pH imbalance; describe the role
of drugs like steroids, antibiotics, anticoagulants and analgesics.
Management of mass disaster.
Multiple Trauma, ABC of trauma & resuscitation
Describe anatomy of respiratory passage and. mechanism of respiration.
List tile causes of respiratory failure and describe the emergency management of. such cases
including assisted respiration (its advantages the .disadvantages), the indications for
tracheotomy, details of its technique and post-operative care of a tracheotomised patient.
Describe the types of wound, nature of wound, e.g. clean, infected or contaminated;
understand the importance of time elapsed since sustaining such wounds; actively
participate in treating such a patient.
Describe the mechanism of wound healing and list the indications for primary closure,
secondary closure, debridement wound excision and skin grafting
Describe the types, degree and percentage of burns.
Outline the path physiology, specially the fluid and electrolytes imbalance.
Correlate the requirement of particular painted instruct treatment e.g crystalloids plasma,
blood substitute, antibiotic analgesics.
Describe the complication and their treatment including skin grating
Cardiothoracic Surgery:
This is a specialized branch of surgery and 'students are expected to have brief knowledge of
the following common conditions, their investigations, diagnosis and management.
Describe investigation, chest X-ray, bronchoscopy and bronchography
Outline the surgery of chest injuries, fracture ribs, surgical emphysema, penumothorax,
hydrothorax, haemothorax, pyothoax, chylothorax, including stove in chest, flail chest.
Outline the surgery of diseases of lung, tuberculosis, atelectasis, collapse, consolidation,
pulmonary Oedema, bronchopneumonia, embolism infarction, bronchiectasis,, lung abscess,
tumors, bronchial adenoma, hydatid cyst, bronchogenic carcinomas.
Outline the surgery of heart, special methods of investigations, radiology,
angiocardiography, cardiac catheterisation, cardiopulmonary resuscitation, pericardial
effusion, cardiac tamponade, pericarditis, and their treatment, congenital and acquired
heart diseases and their surgical management.
Surgery of Genito-urinary system:
Describe the anatomy arid physiology of the related organs.
Describe the following common diseases, their clinical features, examination, diagnosis and
treatment,
Congenital abnormalities, polycystic kidney, solitary cyst of the kidney, horseshoe kidney,
double ureter, post-caval ureter, hypospadius, epispadius, phimosis, crypto-orchidism,
posterior urethral valve, ectopia vesicae.
Rupture of kidney, bladder, utethra and trauma to testes.
Obstructive nephropathy and calculus diseases (hydronephrosis, pyonephrosis, urinary
stones, chyluria, haematuria).
Genito-urinary tumours (Wilm's tumor, Renal cell carcinoma, carcinoma of ureter and
urethra, papilloma of bladder, carcinoma bladder, and prostate.
Calculous obstructive diseases of Kidneys, ureters urinary bladder urethra (stone urinary
bladder, nephritis, pyelitis, cystitis and urethretis).
Retention of urine (acute and chronic) and obstructive uropathy.
Prostatitis, benign .enlargement of prostate, prostatic carcinoma stricture urethra, phimosis.
Testes, vas, epidydimitis, scrotum and penis, crypto orchism, maldescended testes,
hydrocoele, haenatocele, seminoma, teratoma.
Vasectomy, infertility and subfertility in man, impotency.
Epidydimitis and orchitis, pin hole meaturs, paraphimosis, stricture urethra, carcinoma
penis. ,
Central Nervous System
Examine the central nervous system.
Diagnose and manage the different types of head injuries, hydrocephalus; space occupying
lesion of brain and spinal cord.
Musculoskeletal System:
(To be covered in curriculum of orthopaedics)
Endocrine System:
Describe the anatomy, physiology and the hormone secretion of the endocrine glands and
its surgical aspect.
Describe the hypothyrodism, goitre, tumors
Hypo and hyper function of adrenal gland, tumors of adrenal
Hyperparathyrodism and tetany
Diseases of pituitary gland that are encountered in surgical practice, e.g. gigantism,
acromegaly
Common conditions of thyroids, testes pancreas and ovaries
Lympho-reticular System:
Describe different conditions that are encountered in surgical practice of require surgical
management including lymphomas, Hodgkin's and non-Hodgkins' lymphoma, rupture- of
spleen and splenomegaly, e.g tropical, idiopathic, thrombocytopenic purpura, congenital
spherocytosis.
Miscellaneous
Describe physiology and different condition involving breast abscess, benign and malignant
tumors and their management.
Know the anatomy and physiology of vessels, effects of occlusion of a vessel and tile
common diseases; diabetic gangrene, deep vein thrombosis, varicose veins.
Describe the anatomy and physiology of the lymph node and lymph vessels, their function
and different condition such as lymphangitis, lymph adenitis, lymph oedema and their
management.
Surgical Oncology
Minimal invasive surgery
Principles of organ transplant, rejection and immune-suppression.
Upper & Lower Endoscopy
Orthopedics
SPECIAL OBJECTIVES
VII Semester:
THEORY
Traumatology:
Introduction to Orthopaedics, classification of fractures and fracture
General management of acutely injured and polytrauma.
Specific management of acutely injured.
Acute management of acutely injured
Splinting in Orthopaedics
V Tractions: Principle of skin traction.
Tractions: Principles of skeletal traction
Plaster- techniques - principles of application. Types of casts and complications
Imaging in the acutely injured: Techniques and interpretation.
INTRODUCTION CLINICS
General introduction to orthopedic examination
- Examination of the hip
- Examination of the knee
- Examination of the ankle
- Examination of the fool.
- Examination of the spine
- Examination of the shoulder
- Examination of the elbow
- Examination of the wrist
- Examination of the hand
- General format of examination of a paralyzed limb.
- Examination of the child with polio
- Examination of peripheral nerve lesion
- Examination of diseased bone
- Examination of a bone tumor
CLINICAL ASSIGNMENT
Case discussion and observation of surgical procedures
VII Semester
THEORY
Cold Orthopaedics
Congenital anomalies I-CTEV
Congenital anomalies H- CDH
Neuromuscular I - Cerebral palsy
Neuromuscular H- polio, spina bifida, M CC, Hansen's
Osteochondroses: e.g Perthes disease
Metabolic bone disease: Rickets, Scurvy, Osteomalacia.
Tumors H - Malignant bone tumors.
Infection I-Osteomyelitis acute/chronic.
Infection II - Septic arthritis
Infection W -Tuberculosis of the spine
Arthritis III - Rheumatoid arthritis
Arthritis IB - Seronegative arthritis, ankylosing spondylitis, Haemophilia & Gout.
Deformities I - Axial skeleton: Torticollis scoliosis, Kyphosis
Deformities H-Upper Limb: Cubitus Varus, valgus and wrist deformities and hand
deformities.
Deformities W-Lower limb: Coxa vara, genuvaigum, genuvarum, flat foot, Torsinal
deformities.
Soft tissue lesions- periathritis, supraspinats, tendinitis, tennis elbow, carpal tunnel
syndrome, trigger finger, Dequervain's Dupuytren's, plantar fascitis.
Back ache, disc prolapse, spondylolisthesis.
DEMONSTRATION CLASSES
Instrument used in Orthopaedic Surgery.
Trethoyan's bone lever
Bristow's bone lever
Lane's bone lever
Sewestrectomy forceps
Osteotome
Bone gauge
Lanes bone holding forceps
Mallet
Periosteal elevator
Chisel
Curette
Bone hook
Implants used in Orthopaedics
Austin Moore pin
Knowles pin
Austin Moore prosthesis
Thompson's prosthesis
Smith Petersen nail
Jewett nail
Dynamic hip screw
Kuntscher's nail
Kirchner's wire
Square nails for radius & ulna
Rush nail
Steinamnn's pin
Bone plates
Bone screws
Bone screws
X-rays (Trauma)
Aust Shoulder dislocation
Fracture clavicle
Fracture humerus
Supracondylar fractures
Elbow dislocation
Monteggia fracture
Olecranon fracture
Radial head fracture
Galleazzi fracture
Fracture both bones of Forearm- green stick & adult
Colle's fracture
Scaphoid fracture
Pelvis fracture (anterior and posterior)
Dislocation hip
Fracture shaft of femur adult/child
Fracture neck femur
Trochanteric fracture
Condylar fracture femur & tibia
Patella fracture
Ankle fracture
Calcaneal fracture
fracture spine- cervical and thoracic
Nonunion of fracture
Tibia & fibula fracture
X-rays (Cold orthopaedics)
Chronic osteomyelitis
Giant Cell tumor
Multiple exostosis
Osteochondroma
Osteosarcoma
Ewing's tumor
T.B spine
Secondaries in spine
Pathological fracture
Rickets
Osteoarthritis
Genu valgum & varum
Cubitus varus and valgus
Perthes disease
CDH
Spondylolisthesis
Ankylosing spondylitis
Kyphosis
Scoliosis
T.B hip
Radiology
THEORY
Kidney
Congenital anomalies: Renal agenesis/ dysplasisa/ ectopic/ duplication malrotation fusion/
ureterocele
Benign lesions: Simple cyst/ cystic diseases- polycystic diseases
Renal calculi: Nephrocalcinosis
Renal parenchymal diseases: Pyelonephritis/ tuberculosis
Renal vascular disease & renal hypertension
Tumors: Adenocarcinoma and Wilm's
Bladder and Prostate
Extrophy/ urachal anomalies
Bladder calculi/ diverticula
Bladder tumor
B.E.P
Urethra
Stricture
Urethral valve .
Trauma
Posterior urethral valves
Ortho
Denis splint
Denis browne shoe
AFO
KAFO
Soft cervical collar
Hard cervical collar
Arch support
Thomas heel
MCR Chappals
Heel wedges
Heel and sole correction for shortening
Prosthesis
Syme's prosthesis
PTB prosthesis
Orthopaedic shoe
A.K prosthesis
Hip disarticulation
Below elbow prosthesis
Prosthesis with fillers
Above elbow prosthesis
Walking & Mobility Aids
Walking stick
Axillar crutch
Elbow crutch
Walker
Rollator
Tripod & Quadripod
Wheelchair
Anesthesiology
THEORY
Introduction to anesthesia
Preoperative evaluation, premedication and preoperative preparation
General anesthesia inhalation agents
General anesthesia inhalation agents
Neuromuscular blocking agents
Pharmacology of local anesthetics
Spinal, epidural and regional nerve blocks
Endotracheal intubation
Post anesthetic complications and care
Fluid and electrolyte balance
Acid, Base arid Blood Gases - how to read and analyze
Monitoring during anesthesia
Basics of Cardiopulmonary resuscitation (CPR), Basic life support (BLS), Advanced life support
(ALS)
Post CPR management
Dental Surgery
SPECIFIC OBJECTIVES
General Dentistry:
Recall anatomy of teeth, mandible and maxilla. Recognize the difference between deciduous
and permanent teeth and distinguish between healthy and diseased oral structure.
Recall physiology of mastication and describe causes and pathways of pain arising in the oral
cavity
Demonstrate methods of examining patients with dental problems.
Practical Dentistry:
Examine the hard and soft structure of the oral - cavity, recognize gross abnormalities and
pathology and development defects.
Administer local anesthesia required for extraction of teeth
Extract loose teeth and drain simple dental abscess perform biopsies
Render primary dental care for dental and gingival conditions management initially and refer
unmanageable cases of gingivitis, pulpitis, pericoronitis, epulis, dentigenous cysts,
leukoplakia, sub-mucosal fibrosis, carcinoma of gums, and oral mucosa, fractures of
mandible and maxilla, sarcoma of bones of oral cavity
Perform reduction and immobilization of simple fractures of jaws.
Advise the patients on simple preventive dental care.
Preventive Dentistry:
Plan and implement school health programs in oral hygiene conjunction with their similar
activities in Community Medicine.
Gynecology and Obstetrics
Semester V
OBSTETRICS
1. Anatomy of female reproductive organs
2. Fundamentals of reproduction- Fertilization, Embryogenesis
3. Physiological changes in pregnancy
4. Diagnosis of Pregnancy and minor problem of pregnancy
5. Antenatal care
6. Placenta, Amniotic fluid, Amniocentesis
7. Umbilical cord and anomalies
8. Fetomaternal circulation
9. Female pelvis and Fetal skull
10. Normal labor and Mechanisms of Labor
11. Intrapartum fetal monitoring, Partogram
12. Active management of 1st, 2nd, 3rd stages of labor.
13. Complications of 3rd stages of labor:
PPH, Retained Placenta, postpartum collapse
14. Normal puerperium
15. Abnormal Puerperium
Puerperal sepsis, Puerperal pyrexia, Breast complications, Subinvolution, Thromboembolism
16. Postnatal psychiatric disorders
GYNECOLOGY
1. Gynecological history and physical examination
2. Physiology of Menstruation.
3. Puberty and pubertal abnormalities
4. Gynecological diagnosis, menstrual disorders and premenstrual syndrome
5. Development and malformations of female genital tract
6. Paedratic gynecology
7. Diseases of vagina and vaginal discharge
8. Infections of lower genital tract including genital tuberculosis
9. PID
10. Sexually transmitted infections, HIV, AIDS
Semester VI
OBSTETRICS
1. Structure and function of cervix in pregnancy and labour
2. Active management of labour
3. Methods to evaluate fetal health & maturity during period
4. Abnormal labour
Prolonged labour
Obstructed labour
CPD
5. Antepartum haemorrhage
6. Anaemia in pregnancy
7. Pregnancy induced hypertension
8. Diabetes mellitus in pregnancy
9. Rhesus Isoimmunization
GYANECOLOGY
1. Primary amenorrhoea and secondary anenorrhoea
2. Adolescent gynecology & precocious puberty
3. Dysfunctional uterine bleeding
4. Subfertility/ Infertility including genital tuberculosis
5. Male infertility
6. Assisted reproductive technology
7. Ovulation failure and induction of ovulation
8. Polycystic ovarian disease
9. Fibroid ,
10. Utero-vaginal prolapse
11. Endometriosis/adenomyosis
Semester VII
OBSTRETICS
1. Pregnancy spontaneous, Induced, Recurrent
2. Molar pregnancy
3. Ectopic pregnancy
4. Hyperemesis gravidarum
5. UTI
6. Twins & Multifetal pregnancy
7. Transverse lie
8. Unstable lie
9. Cord prolapse
10. Instrumental delivery: Forceps, Ventouse
11. Operative delivery: Caesarian delivery; vaginal birth after 1 caesarean section 1
12. Ultrasound in obstetrics
13. Maternal mortality and safe motherhood
14. Perinatal mortality
15. Prenatal diagnosis and genetic counseling
16. Adolescent pregnancy
17. Uncertain gestational period
18. Maternal injuries form birth
GYNAECOLOGY
1. Contraception I: Natural method, Barrier method, Emergency,; IUCD, Male contraception,
Hormonal control, Therapeutic termination of Pregnancy and complications.
2. Sexual disorder
3. Intersexuality
4. Use of hormones in gynaecology
5. Ultrasound in gynaecology
Semester VIII
OBSTRETICS
1. Ante-partum fetal surveillance
2. Intra-partum fetal surveillance
3. Heart diseases in pregnancy
4. Cardiovascular changes in pregnancy
5. Hepatitis and Jaundice in pregnancy
6. TORCH infection in pregnancy
7. Tuberculosis in pregnancy
8. Epilepsy in pregnancy
9. Thyroid dysfunction in pregnancy
10. Malaria in pregnancy
11. Post-dated pregnancy
12. Post-Caesarean pregnancy
13. Intra uterine growth restriction
14. Elderly primigravida and grand multipara
15. Intra-uterine death and Bad obstetric history
16. Obstructed labor and uterine rupture
17. Obstetric shock
18. Premature rupture of membranes
19. Preterm labour
20. Postmaturity/Prolonged pregnancy
21. Induction of labour
22. Gyanaecological diseases in pregnancy: Ca cervix, Ovarian tumor, Fibroid uterus, Genital
prolapse, retroversion
23. Surgical diseases in pregnancy: Acute abdomen in pregnancy
24. Drugs in pregnancy
25. Forceps and Ventouse
26. Caesarean Section
27. Destructive operations in obstetrics
28. Neonatal resuscitation
29. Contracted pelvis and Cephalo-pelvic disproportion
30. Occito-posterior position ,
31. Breech
32. Brow and Face presentation
33. Abnormal uterin action
34. Shoulder dystocia
35. Critical care in obstetrics
36. Analgesia in labour
GYNECOLOGY
1. Screening of gynecological cancer
2. Cervical intraepithelial neoplasia
3. Ca cervix
4. Ca endometrium
5. Ovarian tumor
6. Gestational trophoblastic disease
7. VIN
8. Vulvular cancer
9. Pruritus vulvi
10. Chemotherapy
11. Radiotherapy
12. Care of the terminally ill patients
13. HRT and related controversies
14. Post-menopausal bleeding
15. Dyspareunia
Semester IX
GYNECOLOGY
1. Urogynaecology
Anatomy of continence
Urodynamic studies
Stress urinary incontinence
Detrussor hyper- reflexia
Genito- urinary fistula
2. Menopause
Pathophsiology of menopause
Short and long term effect of menopause
HRT and Controversy related to its use
Osteoporosis
3. Recurrent pregnancy loss
Anti-phospholipid syndrome
Cervical incompetence
Uterine anomalies
4. Chrome pelvic pain
5. Operative gynaecology
Preoperative preparation and postoperative care
D&C
Bartholin's cyst
Hysterosalpingography
Hysteroscopy
Laparoscopy
Manchester Operation/Abdominal sling operation
Staging laparotomy for ovarian cancer
Hysterectomy
Complete perineal tear
Surgical conditions encountered during gynaecological procedures
OBSTRETICS
1. Rupture of the uterus
2. Inversion of uterus
3. Cs
4. Broad ligament hematoma
5. USG
6. Antenatal fetal surveillance
Bio- physical profile
Non stress test

KU Syllabus

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KATHMANDU UNIVERSITY

SCHOOL OF MEDICAL SCIENCES

BACHELOR OF MEDICINE & BACHELOR OF SURGERY

Kathmandu University Mission ................................................................................................... 1

General Description of the Curriculum ........................................................................................ 3

Features of the Curriculum .......................................................................................................... 4

Semester - II ................................................................................................................... (41-59)

Semester - IV ................................................................................................................. (99-121)

List of Practical Classes.......................................................................................................... 122

List of Formate of ICM..222

The Kathmandu University has the mission to:

a) promote all-round development of students abilities and personalities.

c) extend and disseminate knowledge and encourage its application.

4. participate and provide health care to the people.

a core knowledge, the basic medical doctor must possess.

Student centered (rather than teacher centered)

Pre-Clinical Sciences (first year and second year):

Pre-Clinical Sciences include Anatomy, Biochemistry, Microbiology, Pathology, Pharmacology and

2nd year SEMESTER III

2nd year SEMESTER III

Immune System and immunology

COMMON CLINICAL PROBLEMS:

INTRODUCTION TO CLINICAL MEDICINE

Introduction to anatomy - anatomical positions, planes and terms.

Skin and fasciae - introduction.

Bones - classification, functions, development, growth.

Long bones - parts and blood supply.

Cartilage - classification, sites of occurrence, nutrition and growth.

Muscles - classification, examples of each type.

Cell and sub-cellular organelles - electron microscopic structure.

Epithelial tissues - definition, classification, functions.

Connective tissues classification, functions structural components.

Skin & Fascia- structure

Exocrine glands classification with examples.

Muscles types with example.

Blood vessels: artery large & medium size and vein.

Microanatomy of adrenal medulla

Graafian follicle, spermatozoon - structure

Corpus luteum formation, fate

Ovulation, fertilisation, implantation

Morula and blastocyst formation

Bilaminar embryonic disc

Formation and fate of notochord

Intraembryonic mesoderm and its subdivisions (somites)

Ectoderm, mesoderm, endoderm derivatives

Placenta: Structure, formation, types, function and twinning

Teratogens and teratology

Importance of Biochemistry in Medicine:

Nucleic acids - Gene Expression:

Sterilization, Disinfections, Decontamination:

Laboratory diagnosis of Viral, Bacterial, fungal and parasitic infections:

Infectious waste management

Inflammation and Repair:

Shock, Oedema, Thrombosis, Embolism, Infarction and Chronic Venous Congestion:

Introduction to General Pharmacology:

Sources and Routes of Drug Administration:

Adverse Drug Reactions:

Essential Drug Concept and Rational Drug Therapy:

COMMON CLINICAL PROBLEMS:

Genetic Terms, Symbols Used in Pedigree Chart

Mendelian inheritance (single gene and multifactorial patterns)

Chromatin and Chromosomes (morphology and classification)

Chromosomal aberrations (numerical and structural)