motto of department of medicine
TRANSCRIPT
MEDICINECLERKSHIP BOOKStudent's Identity
Faisalabad Medical Univeristy
Medicine Clerkship Book
Name
Father's Name
Residence
Roll #
Session
Photograph
This gives a great pleasure in writing these few lines for an excellent workbook for students of Medicine in Final year of MBBS. It covers all expects of clinical knowledge and skills required by the medical students in their formative years. The students at this stage of their career require some direction and guidance which if properly provided can go a long way in building their clinical sense and acumen. I must congratulate all those involved in the compilation of this book and especially the faculty of Medicine department for conceiving this idea and bringing it into reality. These are the footprints that we leave on the sand of time for many to follow and in turn serve the humanity in real sense of the word. What are we in this world there for? It is only to illuminate our surroundings with knowledge, wisdom and hope. I would expect all the departments catering for education at undergraduate level must produce such clinical record books which provide a format to the students to follow and learn the clinical clerkship which is the most essential armamentarium of a doctor in active practice.
In the end, I wish all the best to the teachers and students for successful completion of their academic pursuits which in fact are never ending. Keep doing good by trusting your abilities and with strong faith in our Creator Allah the Almighty.
Message fromVice Chancellor
PROFESSOR DR. ZAFAR ALI CHAUDARYFCPS, FRCS Ed (Surgery)Faisalabad Medical University
Faisalabad Medical Univeristy
Medicine Clerkship Book
Dear students We all know that medicine is a noble profession and every noble profession has some privileges and obligations. The ultimate goal of medical education is the delivery of quality health care services for the society. In the present educational system, you are introduced with basic knowledge of medicine till 2nd year MBBS. 3rd year is a transformation year, where you integrate the knowledge with real life patients. Being a good physician is not only confined to knowledge, it demands skills and attitude training. Designing and implementation of a program which integrates knowledge with skills and attitude is not an easy task. Department of Medicine has recognized it and have tried to make a guidebook for our students to facilitate your learning experience on Medical floor. It has been prepared according to basic educational principles. I hope you will like this structured training guide. Your feedback will help us to improve it. I wish you a very pleasant learning experience
Message fromPrincipal
PROF. DR. SAJID HAMEEDMBBS, FCPS (Peads Surgery)Principal Punjab Medical College, Faisalabad
Faisalabad Medical Univeristy
Medicine Clerkship Book
My dear StudentsI congratulate you all on passing your professional exams and welcome you to the final year of your professional degree program. It is an exciting and at the same time very challenging task for the students as well as for the faculty to get prepared for future and help you to complete this basic degree . The department of Medicine has always tried to help the students learn the basic principles of a good medical practice. Disease pattern is changing with every passing day and preparing the new doctors to meet the future needs is an untiring effort.
This academic effort becomes interesting if things are structured in a proper way. To accomplish this task, Department of Medicine has prepared a detailed curriculum document and a study guide. This will guide the teachers and students towards their desired goals. You have a road map in your hands now. It will be a log book and remind you for your achievements. It is a learning log and help you to improve your skills through reflection. I thank all my colleagues and team who have put a great effort in designing this guide.
Best Wishes
Message fromDean
PROF. DR. AHMED BILALMBBS, FCPS (Medicine)Dean/Head of Medicine PMC/FMU, Faisalabad.
Faisalabad Medical Univeristy
Medicine Clerkship Book
Faisalabad Medical Univeristy
Medicine Clerkship Book
PROFESSOR DR AHMED BILALHead of Department of MedicineDean of Medicine & Allied
Faculty of Medicine
PROFESSOR DR AAMIR SHAUKATHead of Medical Unit IIDean of Post Graduate Medical Sciences
PROFESSOR DR AMIR HUSSAINHead of Medical Unit III
DR HANIF NAGRAAssociate ProfessorHead of Medical Unit IV
DR MAQSOOD AHMADAssociate ProfessorHead of Medical Unit V
Faisalabad Medical Univeristy
Medicine Clerkship Book
Authors
PROF. DR. AHMED BILAL
PROF. DR. AAMIR SHAUKAT
PROF. DR. AAMIR HUSSEIN
DR. UMAIR AHMAD
DR. MUHAMMAD USMAN MUSHARRAF
DR. SUMERA EHSAN
DR. MUHAMMAD OWAIS FAZAL
Faisalabad Medical Univeristy
Medicine Clerkship Book
Co-Authors
DR. MUHAMMAD HANIF NAGRA
DR. DILSHAD MUHAMMAD
DR. YASIR YAQOOB
DR AHMAD ZEESHAN CHAGHUTAI
Faisalabad Medical Univeristy
Medicine Clerkship Book
Special thanksFor help
DR. MEMOONA JAHANGIR
DR. MEMOONA FAKHAR
DR. HABIB UR REHMAN
MR. MUHAMMAD ASAD MEHBOOB
MR. MUHAMMAD ASIF
Faisalabad Medical Univeristy
Medicine Clerkship Book
Faculty of Medicine
MEDICAL UNIT-I1. Prof. Dr. Ahmed Bilal (Professor/HOD)2. Dr. Fraz Saeed Qureshi (Assistant Professor)3. Dr. M. Owais Fazal (Assistant Professor)4. Dr. Ahmed Zeeshan (Assistant Professor)5. Dr. Yasir Yaqoob (Assistant Professor)6. Dr. Ghulam Abbas Tahir (Assistant Professor)7. Dr. Muhammad Usman Musharraf (Assistant Professor)8. Dr. Adnan Sarwar (Assistant Professor)9. Dr. Atta-ur-Rehman (Assistant Professor)
MEDICAL UNIT-II1. Prof. Dr. Aamir Shaukat (Professor)2. Dr. Muhammad Arif (Assistant Professor)3. Dr. Umair Ahmad (Assistant Professor)4. Dr. Muhammad Irfan (Assistant Professor))5. Dr. M. Shahzad Khan (Assistant Professor)6. Dr. Israr Hussain (Senior Registrar)7. Dr. M. Yousaf Ayub (Senior Registrar)
MEDICAL UNIT-III1. Prof. Dr. Amir Hussain (Professor)2. Dr. M. Adrees Shani (Assistant Professor)3. Dr. M. Aamir (Assistant Professor)4. Dr. Rai Masood Arif (Senior Registrar)5. Dr. Salman Shakoor (Senior Registrar)6. Dr. Maroof Vaince (Senior Registrar)7. Dr. Zikriya Anwar (Senior Registrar)
MEDICAL UNIT-IV1. Dr. M. Hanif Nagra (Associate Professor)2. Dr. Tahir Habib Rizvi (Associate Professor)3. Dr. Amin Anjum (Assistant Professor)4. Dr. Hafiz Amjed (Assistant Professor)5. Dr. Shahid Maqbool (Senior Registrar)6. Dr. Huma Muzaffar (Senior Registrar)7. Dr. Talha Zahid (Senior Registrar)
Faisalabad Medical Univeristy
Medicine Clerkship Book
Faculty of Medicine
MEDICAL UNIT-V1. Dr. Maqsood Ahmad (Associate Professor)2. Dr. Seher Rasool (Senior Registrar)3. Dr. M. Kashif (Senior Registrar)4. Dr. Muzammal (Senior Registrar)5. Dr. Ahmad Zameer (Senior Registrar)6. Dr. Mehwish (Senior Registrar)7. Dr. Owais Khalid (Senior Registrar)
MEDICAL UNIT-VI1. Dr. Dilshad Muhammad (Associate Professor)2. Dr. Nazir Ahmad (Assistant Professor)3. Dr. Ahmed Ayaz Sabri (Consultant Physician)4. Dr. M. Shoaib (Senior Registrar)
GASTROENTEROLOGY 1. Dr. Dr. Mughees Ather (Associate Professor)2. Dr. Muhammad Arfan (Assistant Professor
NEUROLOGY1. Dr. Javed Iqbal (Assistant Professor)2. Dr. Naveed Alam (Senior Registrar)3. Dr. Nouman Akram (Senior Registrar)
NEPHROLOGY1. Dr. Bilal Javed (Assistant Professor)2. Dr. Ejaz Nabi Kisana (Senior Registrar)3. Dr. Muhammad USman (Senior Registrar)
RADIOLOGY1. Prof.Dr. Asim Shaukat (Professor)2. Dr. Anjum Mehdi (Associate Professor)3. Dr. Nosheen Ahmad (Assistant Professor)4. Dr. Amna Rehan (Assistant Professor)5. Dr. Abdul Rauf (Assistant Professor)6. Dr. Hassan Bokhari (Assistant Professor)7. Dr. Khalid Mahmood (APMO)8. Dr. Azhar Nasim Gill (Senior Consultant)
Faisalabad Medical Univeristy
Medicine Clerkship Book
ContentsSection-1
Guideline and University Rules for Medicine Examination
Section-2Medicine ClerkshipCardiologyGastroenterologyHepatologyHematologyRheumatologyPulmonologyNeurology
Module-IIInfectious DiseasesEndocrinology & metabolism (including Diabetes)Nephrology PsychiatryDermatology
Section-3Clinical rotation guidelines for history taking and examination
Section-4
Section-5
Section-6
Short casesLong cases
Attendance and performance EvaluationPerforma for extracurricular activitiesClassroom activities
Academic Year CalendarPrescription WritingClinical Scenarios
13
Table of Specification By The University Of Health Sciences
This table shows number of questions that are to be asked in the written examination of Final Year
MBBS in the subject of Medicine.
NAME OF UNIT NUMBER OF QUESTIONS
1. GIT 2
2. LIVER 1
3. CVS 2
4. INFECTIOUS DISEASES 2
5. ENDOCRINOLOGY AND DIABETES 2
6. RENAL AND ACID BASE BALANCE 2
7. PSYCHIATRY 2
8. HEMATOLOGY 1
9. CNS 1
10. RESPIRATION 1
11. RHEUMATOLOGY 1
12. DERMATOLOGY 1
14
Paper Scheme as per University of Health Sciences Guidelines
● Medicine Paper-1
o CVS (02 SEQs + 07 MCQs)
o Pulmonology (01 SEQs + 07 MCQs)
o CNS (01 SEQs + 07 MCQs)
o GIT (02 SEQs + 07 MCQs)
o Liver (01 SEQs + 06 MCQs)
o Blood (01 SEQs + 05 MCQs)
o Rheumatology (01 SEQs + 06 MCQs)
● Medicine Paper-2
o KIDNEY(02 SEQs + 10 MCQs)
o Endocrinology(02 SEQs + 07 MCQs)
o Psychiatry(02 SEQs + 10 MCQs)
o Dermatology(01 SEQs + 06 MCQs)
o Infectious diseases(02 SEQs + 07 MCQs)
15
Assessment as per University of Health Sciences Guidelines
At the end of final year MBBS, university examination (final professional MBBS) will include
theory paper of Medicine Paper-1 of 90 marks (45 MCQs and 9 SEQs), Medicine Paper-2 of 85
marks(40 MCQs, 9 SEQs) and viva voice / clinical/practical examination of 275 marks(210
clinical, 65 OSPE). Internal assessment of 50 Marks (25 theories, 25 practical) will be calculated
from 3rd year, 4th year and final year.
S.N
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Theory Su
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Clin
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ss
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SEQs MCQs Int.
Assessment
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45
Marks
9
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5
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45
Marks
45
MECQS
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25
200
210
65
25
300
500
2 Hours 2 Hours
2
Me
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ine-II
45
Marks
9
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45
Marks
45
MECQS
1
Marks Each
2 Hours 2 Hours
16
Section 02
Medicine Clerkship
● Must know topics
● Good to know topics
● Case Discussion
● Clinical skills and Procedure
18
Must know Topics
At the end of clinical rotation, students must be able to define, describe the clinical features,
enlist the important investigations and outline the brief management steps of following:
● Rheumatic Fever
● Infective Endocarditis
● Hypertension
● Ischemic heart disease
o Stable angina
o Unstable angina
o Prinzmetal angina
o Myocardial infarction
o Cardiomyopathies esp. HOCM
● Heart failure
o Right heart failure
o Left heart failure
o High output cardiac failure
o Congestive cardiac failure
● Valvular heart disease
o Mitral valve
o Aortic valve
o Tricuspid Valve
o Pulmonary Valve
● Cardiac arrhythmias
o Atrial fibrillation
o Ventricular fibrillation
o Premature atrial and ventricular beats
● Pericardial diseases
19
Good to know topics
At the end of clinical rotation, it would be better for students to define, describe the clinical
features, enlist important and relevant investigations and outline brief management steps of
following:
● Congenital heart diseases
o Cyanotic heart diseases
o Acyanotic heart diseases
● Peripheral vascular diseases
o Venous thromboembolism
o Acute limb ischemia
o Chronic limb ischemia
Investigations.
At the end of clinical rotation, it would be better for students if they are able to describe
indications/complications of following investigations:
● Echocardiography
● Thallium scan
● Angiography
20
CLINICAL TRAINING
Case Discussion
At the end of ward rotations students must be able to define, describe the clinical features, enlist
the causes, differential diagnosis, and investigations and outline the brief management steps of
following.
● Systemic hypertension
● Chest pain and its causes
● Shortness of breath and its differentials
● Pedal edema and its causes
● Cardiogenic shock
● Palpitations
● Syncope and Presyncope
Mandatory Clinical Methods
At the end of clinical rotation, students must be able to perform following:
History
A comprehensive history of symptomatology of patients coming with cardiovascular disorder to
reach the diagnosis.
● Chest pain
● Shortness of breath/ breathlessness/dyspnea
● Orthopnea
● Paroxysmal nocturnal dyspnea
● Palpitation
● Leg swelling
● Discoloration of limbs
Examination
At the end of clinical rotation, students must be able to perform following clinical methods in a
patient coming with cardiovascular symptomatology.
● General physical examination: cyanosis, clubbing, splinter hemorrhages, Osler nodes,
Janeway lesions, delay in pulses, JVP, blood pressure, etc.
21
● Examination of precordium: inspection, palpation, percussion and auscultation of
precordium.
o Mitral area
o Tricuspid area
o Aortic area
o Pulmonary area
Investigations
At the end of clinical rotation, students must be able to describe the indications, important
positive findings of following investigations regarding cardiovascular disorders.
● ECG
o Normal ECG, acute MI, ischemic changes and heart blocks
● Chest X ray
o Normal anatomy, blunting CP angles, pulmonary edema, cardiomegaly
Clinical skills
At the end of clinical rotation, it would be good for students to know the importance of following
procedures, observe and assist the doctors in the wards during these procedures.
● Cardioversion/defibrillation (Indications & Complications)
● Thrombolysis/ anticoagulation (Indications & Complications)
● Cardiac monitoring
23
Must know topics
At the end of clinical rotation, students must be able to define, describe the clinical features,
enlist the Differential diagnosis/Causes, important investigations and outline the brief
management steps of following:
● Obstructive pulmonary diseases
o Bronchial asthma
o Bronchiectasis
o Chronic obstructive pulmonary disease
Emphysema
Chronic bronchitis
● Infections of respiratory tract
o Pneumonia
Community acquired pneumonia
Hospital acquired pneumonia
Pneumonia in immunocompromised
o Tuberculosis
o Aspergilloma
● Pleural effusion
● Pneumothorax
● Interstitial and infiltrative pulmonary diseases
o Diffuse parenchymal lung disease
o Lung diseases due to systemic inflammatory disease
o Pulmonary eosinophilia and vasculitides
● Pulmonary vascular disease
o Pulmonary embolism
o Pulmonary hypertension
● Adult respiratory distress syndrome
24
Good to know topics
At the end of clinical rotation, it would be better for students to define, describe the clinical
features, enlist investigations and outline brief management steps of following:
● Tumors of lung
● Tumors of the mediastinum
● Lung diseases due to radiation and drugs
● Rare Interstitial lung diseases
● Occupational and environmental lung disease
o Occupational airway disease
o Pneumoconiosis
o Lung diseases due to organic dusts
o Asbestos-related lung and pleural diseases
o Occupational lung cancer
o Occupational pneumonia
● Diseases of the upper airway
o Diseases of the nasopharynx
o Sleep-disordered breathing
o Laryngeal disorders
o Tracheal disorders
Investigations
At the end of clinical rotation, it would be better for students if they are able to interpret and
explain the following investigations:
● Pulmonary function test
● Chest X-ray PA view
● CT chest
25
CLINICAL TRAINING
Case Discussion
At the end of clinical rotations students must be able to define, describe the clinical features,
enlist the causes, differential diagnosis, and investigations and outline the brief management
steps of following.
● Shortness of breath and its causes
● Chest pain
● Cough
● Hemoptysis
● Pleural Effusion
Mandatory clinical methods
At the end of clinical rotation, final year MBBS students must be able to perform following:
History
A comprehensive history of symptomatology of patients with respiratory disorders to reach the
diagnosis.
● Cough, sputum/expectoration/hemoptysis
● Breathlessness/dyspnea/ SOB
● Chest pain
● Discoloration of extremities
Examination
At the end of clinical rotation, students should be able to perform following examination in a
patient coming with respiratory symptomatology.
● General physical examination: clubbing, cyanosis, pulse, blood pressure, lymph
nodes, etc.
● Front of chest: inspection, palpation, percussion and auscultation.
● Back of chest: inspection, palpation, percussion and auscultation.
Clinical skills
26
At the end of clinical rotation, it would be good for students to know the importance of following
procedures, observe and assist the doctors in the wards during these procedures.
● How to start O2 therapy, indications and complications
● Airway insertion, indications and complications
● Endotracheal tube insertion, indications and complications
● Endotracheal suctioning
● Pleural aspiration, Indications and complications
28
Must know topics
At the end of clinical rotation, students must be able to define, describe the clinical features,
enlist the Differential diagnosis/causes, important investigations and outline the brief
management steps of following:
● Esophagus.
o GERD
o Achalasia
● Stomach.
o Peptic ulcer disease
Intestines
● Malabsorption syndromesesp. Coeliac disease
● Inflammatory bowel diseases.
● Ulcerative colitis
● Crohn’s disease
● Irritable bowel syndrome (IBS)
Acute and chronic pancreatitis
Good to know topics
At the end of clinical rotation, it would be better for students to define, describe the clinical
features, enlist investigations and outline the brief management steps of following:
● Candidiasis
● Plummer-Vinsonsyndrome
● Ischemic Gut Injury
● Constipation, Anal fissure, hemorrhoids.
● Perforation of the esophagus
● Tumors
o Esophagus
o Stomach
o Colon
o Pancreas
29
Investigations
At the end of clinical rotation, it would be better for students if they are able to describe the
investigations, their indications/complications:
● Barium swallow
● Abdominal X-ray
● CT abdomen
● Upper and lower endoscopies
30
CLINICAL TRAINING
CASE DISCUSSION
At the end of clinical rotations students must be able to define, describe the clinical features,
enlist the causes, differential diagnosis, and investigations and outline the brief management
steps of following.
● Upper and lower GI bleed
● Abdominal distension/ascites
● Dysphagia
● Dyspepsia
● Heartburn and regurgitation
● Vomiting
● Diarrhea
● Malabsorption
● Weight loss
● Constipation
● Abdominal pain
Mandatory Clinical Methods.
History
A comprehensive history of symptomatology of patients with GIT disorders to reach the
diagnosis.
● Melena, Hematemesis.
● Abdominal Distension/Ascites
● Heart burn
● Diarrhea
● Constipation
● Oral ulceration
● Dysphagia
● Nausea/Vomiting
● Indigestion/Flatulence
Examination
31
At the end of clinical rotation, students must be able to perform following examination in a
patient coming with clinical features of GIT diseases.
● General physical examination: all vitals including BP, pulse, R/R and temperature,
clubbing, jaundice, etc.
● Examination of front of abdomen: inspection, palpation, percussion and auscultation.
● Examination of back of abdomen; bulging in renal area, deformity e.g. scoliosis,
Murphy’s renal punch, any tenderness of spine.
● Digital rectal examination; sphincter tone, tenderness, mucosa , mass, tags , fecal
impaction.
Clinical skills
At the end of clinical rotation, it would be good for students to know the importance of
following procedures (Indications/contraindications, complications), observe and assist
the doctors in the wards during these procedures.
● N/G tube passing and feeding
● Aspiration of peritoneal fluids
● Endoscopies, upper and lower GIT
● Preparation of a patient for GI endoscopies
33
Must know topics
At the end of clinical rotation, students must be able to define, describe the clinical features,
enlist investigations, possible differential diagnosis and outline the brief management steps of
following:
● Jaundice
o Pre hepatic
o Hepatic
o Post hepatic
● Upper and lower GI bleed
● Cirrhosis of liver and portal Hypertension
o Complications
● variceal bleed
● Congestive gastropathy
● Hypersplenism
● Ascites
● Hepatic encephalopathy
● Renal failure ( Hepatorenal syndrome)
● Hepatopulmonary syndrome
Infections of liver
● Viral hepatitis
o Hepatitis A/B/C/D/E
● Liver abscess
Autoimmune diseases of liver and billiary system
● Autoimmune hepatitis
● Primary billiary cirrhosis
● Primary sclerosing cholangitis
Inherited liver diseases
● Haemochromatosis
● Alpha 1 antitrypsin deficiency
34
● Wilson disease
Vascular liver diseases
● Bud Chiari syndrome
Congenital hyperbillirubinemia
● Unconjugatedhyperbillirubinemia
o Gilbert syndrome
o Criglarnajjarsyndrome
● Conjugated hyperbillirubinemia
o DubinJohnson syndrome
o Rotor syndrome
Good to know topic
At the end of clinical rotation, it would be better for students to define, describe the clinical
features, enlist investigations and outline the brief management steps of following :
● Hepatocellular carcinoma
● Cholestatic and biliarydiseses
o extrahepaticbiliary diseases
o Intrahepatic biliary diseases
● Liver transplantation
o indications
o Contraindications
o Complications
o Prognosis
Investigations
At the end of clinical rotation, it would be better for students to know the basics and interpret the
following investigations in a patient coming with clinical features of hepatobiliary disease
● Liver blood biochemistry
35
● Hematological tests
● Immunological tests
● Ultrasound abdomen
● CT abdomen
● Non-invasive markers of hepatic fibrosis
Case Discussion
At the end of clinical rotation, students must be able to define, describe the clinical features,
enlist possible causes, investigations, possible differentials and outline the brief management
steps of following:
● Jaundice
● Acute liver failure
● Ascites
● Hepatomegaly
● Variceal bleed
Mandatory clinical methods
History
A comprehensive history of symptomatology of patients with liver and billiary system disease.
● Yellowish eye discoloration
● Hematemesis
● Melena
● Abdominal distension
● Itching
Examination
● General physical examination : all vitals including BP, pulse, temperature and R/R,
clubbing, flapping tremors, Duputyren's contracture, palmer erythema, jaundice,
edema, etc.
● Abdominal examination : Front and back of abdomen including inspection, palpation,
percussion and auscultation
● Examination of genitalia and DRE
36
Clinical skills
At the end of clinical rotation, it would be better for students to know the importance, observe
and assist doctors in ward during following procedures.
● Diagnostic ascitic tap, it's indications and complications
● Therapeutic ascitic tap, it's indications and complications
38
Must know topics
At the end of clinical rotation, students must be able to define, describe the clinical features,
enlist investigations, possible differentials and outline the brief management steps of following:
● Anemia
o Non Hemolytic anemia
Microcytic (iron deficiency anemia / Thalassemia / Sideroblastic anemia)
Macrocytic ( folate and B12 deficiency anemia)
Normocytic ( anemia of chronic disease / Aplastic anemia)
o Hemolytic anemia
Autoimmune Hemolytic Anemia
o Cold autoimmune Hemolytic anemia
o Warm autoimmune hemolytic anemia
Hereditary spherocytosis
G6PD deficiency
Hereditary elliptocytosis
Bleeding disorders
● Primary disturbance in homeostasis
o ITP
● Disorders of coagulation
o Hemophilia (A/B)
o Von Willibrand disease
o Disseminated intravascular coagulation (DIC)
Leukemia /Lymphoma
● Acute myeloblastic leukemia / Acute lymphocytic leukemia
● Chronic myeloid leukemia / Chronic lymphocytic leukemia
● Multiple myeloma
● Hodgkin /non Hodgkin Lymphoma
39
Good to know topics
At the end of clinical rotation, it would be better for students to define, describe the clinical
features, enlist investigations and outline the brief management steps of following :
● Thrombotic thrombocytopenic purpura (TTP)
● Paroxysmal nocturnal hemoglobinuria (PNH)
● Blood transfusion, it's indications and complications
● Bone marrow transplant, it's indications and complications
Investigations
At the end of clinical rotation, students must be able to know the basics, interpret and describe
following investigations to reach appropriate hematological abnormality.
● Complete blood count and reticulocyte count
● Peripheral blood film
● PT/APTT /D-dimer /FDP /INR
● MCV/MCH/MCHC
● Hematocrit
Case Discussion
At the end of clinical rotation, students must be able to define, describe the clinical features,
enlist possible causes, investigations, important differentials and outline the brief management
steps of following :
● Anemia
● Leukopenia
● Pancytopenia
● Lymphadenopathy
● Bleeding
● Thrombocytosis
Mandatory clinical methods
History
A comprehensive history of symptomatology of patients with hematological disorders to reach a
diagnosis.
● Lassitude
40
● Dyspnea
● Infections
● Edema
● Gum hypertrophy
● Bleeding tendency
● Bruising / pupura
Examination
General physical examination and examination of relevant system to reach a diagnosis in
hematological disorders.
Clinical skills
At the end of clinical rotation, it would be better for students to know the importance, observe
and assist doctors in ward during following procedures.
● Injections ( IM, IV, S/C, intradermal) indications and complications
● Maintain IV line (fluid, blood products) indications and complications
● Bone marrow biopsy, it's indications and complications
42
Must know topics
At the end of clinical rotation, students must be able to define, describe the clinical features,
enlist investigations and outline the brief management steps of following:
● RA(Rheumatoid arthritis)
● Osteoarthritis
● Crystal-induced arthritis
o Gout
o pseudogout
● Bone and joint infections
o Septic arthritis
o osteomyelitis
● Seronegative Spondyloarthropathies
o Ankylosing spondylitis
o Reactive arthritis
o Psoriatic arthritis
o Enteropathic arthritis
● Autoimmune connective tissue diseases
o SLE
o Systemic Sclerosis
o Mixed connective tissue disease
o Polymyositis
o Sjogren’s Syndrome
● Vasculitis
o Takayasu disease
o ANCA associated vasculitis
o Kawasaki disease
● Diseases of bone
● Osteoporosis
● Osteomalacia, rickets and vitamin D deficiency
● Paget's disease of bone
43
Good to know topics
At the end of clinical rotation, it would be better for students to define, describe the clinical
features, enlist investigations and outline the brief management steps of following :
● Fibromyalgia
● Juvenile Rheumatoid Arthritis
● Wegner’s &PollyarteritisNodusa
● Other vasculitis
● Polymyalgia Rheumatica
● Bone and joint tumors
o Osteosarcoma
o Metastatic bone disease
● . Rheumatological involvement in other diseases
Mandatory clinical methods.
History
A comprehensive history of symptomatology of patients with rheumtological disorders to reach
the diagnosis.
● • Joint pain and joint swelling
● • Joint deformities
● • Muscle cramps
● • Muscle weakness
● • Muscular wasting
● • Other related systemic symptoms
Examination
At the end of clinical rotation, students should be able to perform following examination in a
patient coming with rheumatological disorders.
● General physical examination: vitals, clubbing, cyanosis, lymph nodes examination of
hands, etc.
● Examination of joints
o Wrist
o Elbow
44
o Shoulder
o Hip
o Knee
o Ankle
o Spine
● Brief systemic examination to reach differential diagnosis.
Clinical skills
At the end of clinical rotation, it would be better for students to know the importance, observe
and assist doctors in ward during following procedures.
● Aspiration of fluids from joints (knee)
● Bone marrow aspiration/trephine Biopsy.
46
Must know topics
At the end of clinical rotation, students must be able to define, describe the clinical features,
enlist the differential diagnosis, the important investigations and outline the brief management
steps of following:
● Infections of the nervous system
o Meningitis
o Parenchymal viral infections
o Parenchymal bacterial infections
o Diseases caused by bacterial toxins
● Intracranial mass lesions and raised intracranial pressure
o Raised intracranial pressure
o Idiopathic intracranial hypertension
o Head injury
● Disorders of cerebellar function
● Disorders of the Spine and Spinal cord
o Cervical spondylosis
o Spinal cord compression
● Diseases of peripheral nerves
o Guillian-Barre syndrome
● CVA (infarctive, embolic, hemorrhagic)
● Epilepsy
● Diseases of the neuromuscular junction
o Myasthenia gravis
o Lambert-Eaton myasthenic syndrome
● Movement disorders
o Parkinson’s disease
● Multiple sclerosis
● Headache syndromes (especially migraine)
● Motor neuron disease
● Diseases of muscle
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o Muscular dystrophies
o Inherited metabolic myopathies
o Acquired myopathies
Good to know topics
At the end of clinical rotation, it would be better for students to define, describe the clinical
features, enlist investigations and outline the brief management steps of following :
● Transverse myelitis
● Cerebral venous thrombosis
● Trigeminal neuralgia
● Intracranial Mass Lesions
o Brain tumors
o Paraneoplastic neurological disease
o Hydrocephalus
● Entrapment neuropathy
● Polyneuropathy
● Chronic polyneuropathy
● Brachial plexopathy
● Spinal root lesions
Case Discussion
At the end of clinical rotation, students must be able to define, describe the clinical features,
enlist possible causes, investigations, important differentials and outline brief management steps
of following:
● Headache and facial pain
● Status epilepticus
● Coma /Delirium
● Weakness/Sensory disturbance
● Abnormal movements
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Mandatory clinical methods.
Following clinical methods are mandatory.
History
A comprehensive history of symptomatology of patient’s withCNS disorders to reach the
diagnosis.
● Behavior
● I.Q
● Speech disturbances
● Memory
● Confusional states
● Dementia
● Tremor
● Fasiculations
● Athetosis
● Chorea
● Gait abnormalities
● Convulsions/fits
● Coma
● Syncope/dizziness
● Vertigo
● Deafness
● Blindness
● Numbness, tingling, sensory loss
● Rigidity / paralysis.
● Movement disorders
Examination
At the end of clinical rotation, students must be able to perform following examination in a patient
coming with clinical features of CNS disease.
● • Higher mental functions – level of consciousness, behavior, speech, memory.
Examination of :
● Higher Mental functions/Speech
● Cranial nerves.
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● Motor system.
● Sensory system – crude/fine touch, pain, temperature, vibration, Cortical Sensations
● Cerebellar system
● Signs of Meningeal Irritation
Assessment of movement disorders
Clinical skills
At the end of clinical rotation, it would be better for students to know the importance, indications,
contraindications, complications and observe/assist doctors in ward during following procedures.
● Lumbar puncture
● Fundoscopy
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Must know topics
At the end of clinical rotation, students must be able to define, describe the clinical features,
enlist investigations and outline the brief management steps of following:
● Sepsis
● PUO
● Bacterial diseases
o Bacterial infections of skin & soft tissue
staphylococcal infections
Streptococcal infections
o Systemic bacterial infections
Brucellosis
Leptospirosis
Typhoid / paratyphoid fevers
o Gastrointestinal bacterial infections
staphylococcal food poisoning
Clostridium / campylobacter /salmonella/ E. Coli infections
Cholera
Bacillary dysentery
o Respiratory bacterial infections
Diphtheria
o Neurological involvement
Leprosy
o Chlamydial infections
o Rickettsial infections
Viral diseases
● systemic viral infections with exanthum
o Measles
o Rubella
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o Chicken pox
o Shingles
o Human herpes virus 6&7
● Systemic viral infections without exanthum
o Mumps
o Influenza
o Infectious Mononucleosis
o Cytomegalovirus
o Dengue
● Viral infections of skin
o herpes simplex virus 1&2
● Gastrointestinal viral infections
o Rota virus
● Respiratory viral infections
o Rhino virus / adeno virus/ enteroviruses
● Hydatid diseases
● Protozoal diseases
o Malaria
o Amoebiasis
o Giardiasis
● HIV
Good to know topics
At the end of clinical rotation, it would be better for students to define, describe the clinical
features, enlist investigations and outline the brief management steps of following:
● Fungal diseases
o candidiasis
o Histoplasmosis
● Helminthic diseases
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o Hookworm infestation/ round worm
o Filariasis
o Schistosomiasis
● STD's
Investigations
At the end of clinical rotation, it would be better for students to know the importance, know the
basics of following investigations and interpretation to reach the diagnosis.
● Serology
● Blood culture
● Complete blood count
● Complete urine examination
● Chest X-ray PA view
Case Discussion
At the end of clinical rotation, students must be able to define, describe the clinical features,
enlist investigations, possible differential diagnosis and outline the brief management steps of
following:
● Fever
● Sepsis
● Acute diarrhea and vomiting
● Dengue fever
Mandatory clinical methods
History
A comprehensive history of symptomatology of patients with infectious diseases.
● Fever
● Headache
● Pain
● Anorexia/ weight loss
● Cough/expectorations/sputum
● Dysuria/ hematuria
● Diarrhea/vomiting
● Melena / Hematemesis
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● Eruptions/rashes
Examination
● General physical examination :all vitals including BP, pulse, R /R and temperature,
examination of skin, examination of hands and nails, oropharynx, head&neck, eyes
and relevant systemic examination.
● Examination of genitalia and DRE
● General management steps and prescription writing in infectious diseases
Clinical skills
At the end of clinical rotation, it would be better for students to know the importance, indications,
Contraindications, observe and assist doctors in ward during following procedures.
● O2 therapy
● Foley’s insertion
● IV line / fluid/ blood products
● NG passing and feeding
● IOP record
● Aspiration of fluid ( pleural, pericardial, peritoneal, knee)
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Must know topics
At the end of clinical rotation, students must be able to define, describe the clinical features,
enlist the differential diagnosis, the important investigations and outline the brief management
steps of the following:
● Hyperglycemia
o Diabetes Mellitus and its types
o DKA (Diabetic Ketoacidosis)
o Complications of diabetes (Microvascular, Macrovascular and Neuropathies)
o Non-Ketotic Hyperosmolar coma
● Anterior pituitary.
o Growth hormone disorders
o Acromegaly
o Gigantism.
o Short stature
o Prolactinoma
● Diseases of hypothalamus and posterior pituitary.
o Diabetes insipidus
o Syndrome of inappropriate ADH secretion (SIADH).
● Thyroid gland.
o Hyperthyroidism (thyrotoxicosis)
o Hypothyroidism (myxedema, cretinism)
o Inflammatory lesions/Thyroiditis and its types
o Benign and malignant tumors
● Parathyroid gland
o Hyperparathyroidism
o Hypoparathyroidism
● Adrenal Gland.
o Cushing Syndrome
o Hypo/HyperAldosteronism
o Hirsutism/Congenital Adrenal Hyperplasia.
o Addison’s disease
o Acute Addisonian crisis
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o Adrenocortical tumors including Pheochromocytoma
● Multiple endocrine neoplasia (MEN)
o Type I
o Type II
Good to know topics
At the end of clinical rotation, it would be better for students to define, describe the clinical
features, enlist investigations and outline the brief management steps of following:
● Infertility and common reproductive disorders
● Testes
o Sexual precocity
o Heterosexual precocity
o Gynecomastia
o Inflammations
o Tumors
● PCOS(Polycystic ovarian syndrome)
● Klinfelter’s syndrome
● Turner’s syndrome
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CLINICAL TRAINING
CASE DISCUSSION
At the end of clinical rotations students must be able to define, describe the clinical features,
enlist the causes, differential diagnosis, and investigations and outline the brief management
steps of following.
● Indoor cases
o Diabetes mellitus and its complications(DKA, HONK)
o Myxedema coma
o Addison’s crisis
o Diabetes Insipidus
● Outdoor cases
o Hypothyroidism
o Hyperthyroidism
o Cushing’s syndrome
o Pheochromocytoma
Mandatory clinical methods.
● History taking and correlation to reach a specific diagnosis regarding endocrine
disorders.
● GPE: relevant GPE regarding different Endocrine disorders to reach a specific
diagnosis.
● Examination of thyroid gland, male and female genital organs and systemic
examination related to endocrine disorders etc.
● Interpretation of related radiological and laboratory investigations
● General medication and prescription writing in endocrinology.
Clinical skills
At the end of clinical rotation, it would be good for students to know the indications of following
procedures and they should be able to assist the doctors in performing these procedures.
● Water Deprivation test
● Dexamethasone suppression test
● Short and Long Synecthin test
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Must know topics
At the end of clinical rotation, students must be able to define, describe the clinical features,
enlist investigations and outline the brief management steps of following:
● Chronic kidney disease
o Causes
Glomerular
Tubulointerstitial
Vascular
Cystic and congenital
o Complications
Anemia
Acidosis
Mineral bone Disease
Electrolyte imbalance
Cardiovascular disease
Hormonal abnormalities
● Acute kidney injury
o Causes
Pre-Renal
Renal
Post-renal
o Complications
Glomerular diseases
● Nephritic spectrum
o Post infectious glomerulonephritis
● Nephrotic spectrum
o Minimal change disease
o Focal segmental glomerulosclerosis
o Membranoproliferative glomerulonephritis
o IgA nephropathy
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● Hemolytic uremic syndrome (HUS)
● Henoch-Shonleinpurpura (HSP)
● Electrolyte imbalance
o Hyperkalemia
o Hypokalemia
o Hyponatremia
o Hypernatremia
● Acid base disorder
o Metabolic acidosis
o Metabolic alkalosis
o Respiratory acidosis
o Respiratory alkalosis
Good to know topics
At the end of clinical rotation, it would be better for students to define, describe the clinical
features, enlist investigations and outline the brief management steps of following:
● Nephrolithiasis
● HELLP syndrome
● Prostatic cancer and BPH
Investigations
At the end of clinical rotation, students must be able to interpret the following investigations and
enlist possible causes leading to acute or chronic kidney disease.
● Renal function test
● Serum electrolytes
● Urine complete examination
o Casts (RBC cast, WBC casts and granular casts)
o Crystals
● Proteinuria
o Microalbuminuria
o Minimal proteinuria
o Moderate proteinuria
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o Heavy proteinuria
● Hematuria
o Glomerular hematuria
o Extra glomerular hematuria
● Ultrasound KUB
o Normal ultrasound
o Corticomedullary differentiation
o Renal asymmetry
● IV urogram
● CT scan KUB
Case Discussion
At the end of clinical rotation, students must be able to define, describe the clinical features,
enlist possible causes, investigations, important differentials and outline brief management steps
of following :
● Acute renal failure
● Chronic Kidney Disease
● Nephrotic syndrome/edema
● Proteinuria
● Hematuria
Mandatory clinical methods
History
A comprehensive history of symptomatology of patients with renal disorders to reach the
diagnosis.
● Periorbital swelling/ generalized body swelling
● Increase / decrease in urine output
● Blood/pus in urine
● Flank pain
● Frequency /Urgency
● Burning micturition
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Examination
At the end of clinical rotation, students must be able to perform following examination in a patient
coming with clinical features of renal disease.
● General physical examination : all vitals including BP, pulse, R/R and temperature, nail
pigmentations, skin complexion, bruising, skin turgor, JVP, ankle edema, etc.
●
● Examination of abdomen : Front and back of abdomen including inspection, palpation,
percussion and auscultation
● Examination of genitalia and DRE : Phimosis, BPH
Brief management steps and prescription writing in kidney and urinary tract diseases
Clinical skills
At the end of clinical rotation, it would be better for students to know the importance, observe
and assist doctors in ward during following procedures.
● Foley’s catheterization, it's indications and complications
● Double lumen catheterization, it's indications and complications
● Hemodialysis, it's types, indications and complications
● Plasmaheresis, its types, indications and complications
● Peritoneal Dialysis, Types, inications
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Must know topics
At the end of clinical rotation, students must be able to define, describe the clinical features,
enlist investigations, possible differentials and outline the brief management steps of following.
● Affective (Mood) disorder
o Depression
o Bipolar disorder
● Anxiety disorder
o panic disorder
o Generalized anxiety
● Schizophrenia
● Organic disorder
o Dementia
● Somatoform disorder
o conversion disorder
● Stress related disorder
o Post traumatic disorder
Good to know topics
At the end of clinical rotation, it would be better for students to define, describe the clinical
features, enlist investigations and outline the brief management steps of following :
● Delirium
● Personality disorders
● Eating disorder
o anorexia nervosa
o Bulimia nervosa
● Puerperal mental disorder
o puerperal psychosis
o Post partum blues and depression
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Investigations
At the end of clinical rotation, it would be better for students to know the basics and interpret
relevant radiological and neurological investigations in a patient coming with clinical features of
mental illness.
Case Discussion
At the end of clinical rotation, students must be able to define, describe the clinical features,
enlist investigations, possible differentials and outline the brief management steps of following:
● Depression
● Bipolar disorder
● Alcohol/ substance misuse
● Anxiety
● Delusions / Hallucinations / confusion
Mandatory clinical methods
History
A comprehensive history of symptomatology of patients with mental illness to reach the
appropriate diagnosis.
● Apprehension
● Palpitations
● Chest pain
● Tremors
● Hallucinations
● Obsessive thoughts
● Fear of situation
● Elevated mood
● Confusion
Examination
Mental state examination: General appearance and behaviour, speech, mood, thoughts,
abnormal beliefs, abnormal perceptions and cognitive function including
o Concentration
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o Orientation
o Memory
HISTORY AND MENTAL STATE EXAMINATION
Age/marital status/Education/Occupation/Residence Source of referral/Informants
● PC/HOPI (Presenting complaint/history of presenting complaint) Principle Symptoms
or complaints and their duration: Associated Disturbance in appetite, Weight, Sleep,
and sexual drive, Effects on patients ability to cope socially or with work.
● PPH (Past Psychiatric History)
● Previous Hospital Admission with Psychiatric illness, treatment given. How well did
patient remain I between admissions?
● PMSH (Past Medical and Surgical History)
● Previous hospital admissions with Physical illness or for operations, any know
allergies.
● FH (Family History)
o Mother and father current age, or if dead, age at death and cause of death, occupations.
o Sisters and brothers names ages, marital status, occupation.
o Family psychiatric history, history of any psychiatric illness in the family.
o Family medical history, history of any physical illness in the family.
o Current relationships with parents, siblings and other relatives.
● PH (Personal History)
o Birth- any prematurity or low birth weight, any difficulties during delivery.
o Developmental milestones- any delay in achieving.
o Early childhood- childhood illnesses; any separation with parents. Relationship with
parents, siblings and other children and adults at this age.
o School – age of starting and finishing; school phobia or truancy; type of school,
academic qualifications, relationship with pupils and teachers.
o Occupations- chronological list of jobs; if multiple changes, inquire about reason,
relationship with workmates and superiors.
o Psychosexual history – age of onset of puberty; any sexual relationships,; masturbation
fantasies and guilt; if married, age at marriage and age of spouse ; if children give
chronological list of their names, age, and sex, occupation; any psychiatric or physical
illness in children; relationship with children.
o Drugs – prescribed or over the counter, illicit drugs, alcohol. Tobacco, Naswar.
o Forensic history – any trouble with the law or police, any convictions.
● PSC ( Present social circumstances)
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o Composition of household, type of house, main bread earner, status of patient,
financial difficulties etc.
● PMP (Pre Morbid personality)
o The patient’s personality before first admission to hospital with psychiatric illness.
● relationships – few friends or many, depth of relationships.
● Character outgoing or reserved, sensitive to criticism, worrier.
● Mood – cheerful or gloomy, steady or changeable.
● Religious – ideas about religion, regular in prayers or otherwise.
● Leisure activities – hobbies, preference for company or solitude.
PHYSICAL EXAMINATION
MENTAL STATE EXAMINATION
● Appearance and behavior – dress sand self care (tidy or disheveled, well groomed or
unkempt, Describe actual clothes); Manner (hostile or helpful, aggressive or
cooperative) posture and movement (tense or relaxed, over active or slowed up ) Eye
contact and rapport.
● Talk – rate, rhythm and volume
● Mood – subjective and objective, depressed, elated, incongruent, blunt, flat.
● Thoughts; form (pressure, poverty, thought block, loosening of association, flight of
ideas or preservation), content (preoccupation; obsessions; delusions; over valued
idea; suicidal ideas).
●
● Perception – Hallucination (Modality, person, content) illusions; depersonalization, de
realization.
● Cognitive Functions – (a)orientation (in time, place and person)
● (b) Attention and concentration (subjective report, days of week backward, months of
year backward, serial seven or three test, digit span.)
● (c) Memory I. Registration (5-7 items/address) II. Short term memory (subjective
account, name and address, 5 minute recall; days in hospital, menu or recent meal),
III. Long term memory – (personal, events recalled from several years ago, assessed
in history, historical events)
● Abstract thinking (meaning of proverbs)
● Insight (does the patient consider himself ill in psychological terms, does the patient
feel in need of treatment).
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Clinical skills
At the end of clinical rotation, it would be better for students to know the importance,
indications/contraindications, complications, observe/assist doctors in ward during following
procedures:
● Psychotherapy
● Electroconvulsive Therapy
● Electroencephalogram (EEG)
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Must know topics
At the end of clinical rotation, students must be able to define, describe the clinical features,
enlist investigations and outline the brief management steps of following:
● Scabies
● Eczema
● Psoriasis
● Acne vulgaris
● ErythemaNodosum
● Steven Johnson syndrome
● Autoimmune Blistering Disorder
● Bacterial infections of skin
● Various types and patterns of eczema
Good to know topics
At the end of clinical rotation, it would be better for students to define, describe the clinical
features, enlist investigations and outline the brief management steps of following:
● Skin bacterial infections
● Fungal infection
● PyodermaGangreonosum
● Blistering diseases
● Bullouspemphigoid
● Pemphigusvulgaris
● Sexually transmitted infections
● Cutaneous feature of HIV
● Leprosy
● Leishmaniasis
● Erythroderma
● Connective Tissue diseases involving skin
Mandatory Clinical Methods.
History
A comprehensive history of symptomatology of patient’swith skin disorders to reach the
diagnosis.
● Alopecia
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● Eruption and rashes
● Itching
● Pigmentation and depigmentation.
● Detailed drug history
● Evolution of skin lesions
● Pattern of Skin lesions
● Morphology of skin lesions
● Differentiation between primary and secondary skin lesions
History taking in dermatology
Introduction
● Introduce yourself – name/role
● Confirm patient details – name/DOB
● Explain the need to take a history
● Gain consent
● Ensure the patient is comfortable
Presenting complaint
● It’s important to use open questioning to elicit the patient’s presenting complaint
● “So what’s brought you in today?” Or “Tell me about your symptoms” ● Allow the patient time to answer, trying not to interrupt or direct the conversation
● Facilitate the patient to expand on their presenting complaint if required
● “Ok, so tell me more about the rash” “Can you explain what that pain was like?”
History of presenting complaint
● Onset:
● When did the skin problem start?
● Was the onset acute or gradual?
● Course – has the rash/skin lesion changed over time
● Intermittent or continuous – is the skin problem always present or does it come and
go?
● Duration of the symptom if intermittent – minutes/hours/days/weeks/months/years
Location/distribution:
● Where is the skin problem?
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● Number of lesions?
● Is it spreading?
o Precipitating factors – are there any obvious triggers for the symptom?
o Relieving factors – does anything appear to improve the symptoms (e.g. steroid
cream)?
o Associated features – are there other symptoms that appear associated (e.g.
fever/malaise)?
o Previous episodes – has the patient experienced this problem previously?
o When?
o How long for?
o Was it the same or different than the current episode?
o Contact history – has the patient been in contact with an infectious skin problem (e.g.
chickenpox)?
o Sun exposure (including sunbed use)
o Important when considering skin cancer in the differential diagnosis
o Ask the patient about how their skin reacts to sun exposure to help determine their skin
type (Fitzpatrick scale)
Key dermatology symptoms:
● Pain
● Itch
● Bleeding
● Discharge
● Blistering
Systemic symptoms
● fever / malaise / weight loss / arthralgia
● If any of these symptoms are present, gather further details as shown above (Onset /
Duration / Course / Severity / Precipitating factors / Relieving factors / Associated
features / Previous episodes)
Pain
● If pain is a symptom, clarify the details of the pain using SOCRATES
● Site – where is the pain?
● Onset – when did it start? / Sudden vs gradual?
● Character – sharp / dull ache / burning
● Radiation – does the pain move anywhere else?
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● Associations – other symptoms associated with the pain?
● Time course – worsening / improving / fluctuating / time of day dependent
● Exacerbating / Relieving factors – does anything make the pain worse or better?
● Severity – on a scale of 0-10, how severe is the pain?
● Ideas, Concerns and Expectations
● Ideas – what are the patient’s thoughts regarding their symptoms?
● Concerns – explore any worries the patient may have regarding their symptoms
● Expectations – gain an understanding of what the patient is hoping to achieve from the
consultation
Past medical history
● Skin disease:
● Skin cancer
● Atopy – eczema / hay fever / asthma
● Other dermatological conditions
● Other medical conditions – many of which can have dermatological manifestations
● Diabetes – acanthosis nigricans / scleroderma diabeticorum / necrobiosis lipoidica
diabeticorum
● Inflammatory bowel disease – pyoderma gangrenosum / erythema nodosum
Drug history
● Skin treatments – creams / ointments / UV therapy / antibiotics / biologics
● Regular medication – including length of treatment (paying particular attention to those
started around the time of the skin problem)
● Antibiotics
● Over the counter drugs
● Cosmetics
● Herbal remedies
ALLERGIES
● (a common cause of rashes) – ensure to document these clearly
Family history
● Skin conditions – e.g. psoriasis / hereditary hemorrhagic telangiectasia
● Skin cancer
● Atopy – eczema / asthma / hay fever
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Social history
● Occupation:
● Are the skin problems worse at work?
● Do the skin problems improve when the patient is off from work?
● Is the patient exposed to any skin irritants or other hazardous substances?
● Smoking – How many cigarettes a day? How many years have they smoked for?
● Alcohol – How many units a week? – type / volume / strength of alcohol
● Recreational drug use – e.g. cellulitis from IV drug injection site
Living situation:
● Own home/care home – adaptations / stairs?
● Who lives with the patient? – is the patient supported at home?
● Any carer input? – What level of care do they receive?
● Any recent changes at home that could be related to skin problems (e.g. new
detergent causing allergic reaction to clothing)
Activities of daily living:
● Is the patient independent and able to fully care for themselves?
● Can they manage self-hygiene/housework/food shopping?
● Travel history
● Where did the patient travel to?
● How long was the patient there?
● Is the patient aware of any exposure to infectious disease?
● Sun exposure – was the skin problem worsened by sun exposure? (e.g. facial rash in
lupus)
Systemic enquiry
● Systemic enquiry involves performing a brief screen for symptoms in other body
systems.
● This may pick up on symptoms the patient failed to mention in the presenting
complaint.
● Some of these symptoms may be relevant to the diagnosis (e.g. arthralgia in psoriatic
arthritis).
● Choosing which symptoms to ask about depends on the presenting complaint and
your level of experience.
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● Cardiovascular – Chest pain / Palpitations / Dyspnoea / Syncope / Orthopnoea /
Peripheral oedema
● Respiratory – Dyspnoea / Cough / Sputum / Wheeze / Haemoptysis / Chest pain
● GI – Appetite / Nausea / Vomiting / Indigestion / Dysphagia / Weight loss / Abdominal
pain / Bowel habit
● Urinary – Volume of urine passed / Frequency / Dysuria / Urgency / Incontinenc
● CNS – Vision / Headache / Motor or sensory disturbance/ Loss of consciousness /
Confusion
● Musculoskeletal – Bone and joint pain / Muscular pain
● Closing the consultation
● Thank the patient
● Summarise the history
Examination
At the end of clinical rotation, students should be able to performfollowing examination in a
patient coming withsymptomatology of skin disorders.
● Clinical examination of various skin lesions
● Examination of scalp
● Examination of oral cavity
● Examination of nails
● Examination of genitalia
● Scheme of examination for full skin.
Clinical skills
At the end of clinical rotation, it would be better for students to know the importance, indications,
complications, observe and assist doctors in ward during following procedures.
● Scraping for fungus
● Use of magnifying glass
● Observe skin biopsy
● Use of Wood’s lamp. ● Fungal scraping
● Tzank smear
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DEPARTMENT OF MEDICINE
PARTICULARS ABOUT THE PATIENT
History No.______________
Bed No.________________
Patient’s Name_____________________________________ Age________ Sex_______
Occupation ________________Married/Unmarried__________ Religion______________
Address__________________________________ Date of Admission________________
Through Outdoor/Emergency.
Date of History Taking ________________ Date of Discharge_______________________
A. The Presenting Complaints with Duration. (Presenting complaint is the complaint 1.
Which made the patient come to the doctor. 2.
Write in chronological order) 3.
4.
B. The History of Present Illness.
History in chronological order
(No Direct Questions)
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(2) Symptomatic enquiry (Mention relevant positive as well as negative points).
(3) Special features (Weight, Sleep, Energy & questions regarding all the systems, in view of
patient’s illness & psychiatry).
C. The Past History.
All important illnesses from infancy onwards.
(ii) Relevant diseases, especially Dysentery, Rheumatic fever, Infectious diseases, venereal
diseases, Diabetes, Hypertension & previous similar attacks with duration.
(iii) Operations and accidents.
(iv) Previous admission to hospital & treatment.
(v) Travel abroad.
(vi) ALLERGY.
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D. The Menstrual History
Regularity regarding cycle & amount, Menarche, Menopause, Premenstrual tension, Pain at
periods, Oral contraceptives, Pregnancies & outcome).
E. The Treatment History.
(Visits to doctors, previous investigations, Details of drugs taken, including psychotropic drugs,
Surgery, Radiotherapy and Psychotherapy. Adverse reaction to drugs, including hypersensitivity).
F. The Family History.
(i) Patient’s position in family, ages of children if any.
(ii) Ask about immediate relatives and close contacts, parents, siblings, children,
Companion.
(iii) H/o similar diseases.
(iv) Communicable diseases.
(v) Relevant hereditary diseases.
(vi) Health, illness and cause of death of relatives and close contacts.
(vii) H/o Diabetes, Hypertension, T.B. in family.
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G. The Social and Occupational History.
● Exact nature of occupation and earning.
● Domestic and marital relationships.
● Home surroundings and hygienic conditions.
● Diet (mixed or vegetarian, approximate aount of CHO, protein and fat when indicated).
● Addictions, use of alcohol and tobacco.
● Living abroad.
H. The Psychiatric History.
Worries, depression, anxieties, phobias, delusions, hallucinations, any H/o fits.
I. Systemic Direct Questioning.
Ask direct questions about the symptoms affecting all the systems of the body.
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EXAMINATION
A. GENERAL PHYSICAL EXAMINATION.
Temperature…………………………… Pulse (rate &rhythm)……………………………
Respiration (rate &rhythm)………….. Blood Pressure………………………………….
1. Decubitus & Comfortability 7. Jaundice
2. Mental & Emotional state 8. Odours
3. Attitude 9. Clubbing
4. Physique 10. Koilonychia
5. Pallor 11. Edema
6. Cyanosis Dependant/non-dependant
-Central Pitting/non-pitting.
-Peripheral 12. Lymph nodes.
13. Thyroid gland.
14. Other features
(face, hands, feet)
B. SKIN & ITS APPENDAGES.
1. Color & Pigmentation 7. Allergy
2. Haemorrhages 8. Hair
3. Eruptions, (Macules, papules, vesicles, 9. Nails
Pustules, scales, ulceration, scar 10. Exam. For parasites.
Formation, keloids). 11. Raynaud’s phenomenon. 4. Edema 12. Peripheral vascular disease
5. Subcutaneous emphysema (Diabetes, hypertension).
6. Skin lessions.
C. CARDIOVASCULAR SYSTEM
1. Arterial Pulses. Pulse………… Rate…………. Rhythm………. Volume…………
Character…………Condition of vessel wall………..Comparison with other pulses….. Blood Pressure, Supine………….Sitting…………..Standing……………………………
2. Venous Pulses.
Neck Veins Venous pulsations
85
J.V.P (at an angle of 45)
3. Inspection of Praecordium.
Shape Visible Veins over the chest
Apex beat & cardiac impulse
Other Pulsations:
Suprasternal Lt. Parasternal Epigastric Rt 2nd
space
Lt 2nd
space
4. Palpation.
Apex beat, Position……………. Character-Heaving/Tapping/Normal.
Pulsation:- Suprasternal. Lt. Parasternal Epigastric
Venous pulsations in Neck.
Thrills, position, timing and variation with respiration Rt. 2
nd space
Lt 2nd
space
5. Auscultation
-Rate & Intensity of I & II heart sounds on all Auscultatory areas.
-Splitting.
-Triple rhythm III, IV.
-Additional sounds, clicks, murmurs, site,
Timing, radiation, character, change during respiration.
-Exocardial sounds, venous hum, pericardial
Friction rub.
6. Peripheral Vascular System.
Arterial & Venous, Blanching test, Bruit,
Ray naud’s phenomenon, Varicosity, Capillary pulsation, Intermittent claudication.
D. RESPIRATORY SYSTEM
1. Inspection.
-Respiration, Rate……………….Rhythm…………….Character………………. -Nose………..Alae……………….Sinuses……………Throat…………………..
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-Form of the chest………………………Movements of chest……………………
-Visible veins over chest………………..Expansion of chest……………………. -Any other abnormality, especially of spine.
2. Palpation.
-Tender spots……………………………Swelling……………………………………
-Trachea………………………………….Apex beat…………………………………
-Respiratory movements, 3 levels Ant & Post.
-Vocal fremitus Normal Increased Diminished.
3. Percussion.
Upper border of Liver.
Resonance (areas).
-Normal/Dull/Stony-dull/Hyper resonant.
4. Auscultation.
-Breath sounds. Vesicular-Harsh vesicular Broncho vesicular-Bronchial-Amphoric.
-Vocal resonance. Normal-Increased-Diminished-Absent.
-Added sounds.
-Rhonchi-(Sibilant-Sonorous).
-Crepitations, (fine, coarse, timing).
-Friction sound or Pleural rub.
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E. GASTROINTESTINAL SYSTEM
1. Mouth & Throat
(Orodental hygiene, lips, gums, teeth, tongue, buccal mucosa, palate, tonsils, pharynx, breath
smell).
2. Abdomen
a) Inspection-shape, symmetry, umbilicus, movement of abdominal wall, visible pulsation or
peristalsis, skin and surface of abdomen, scars, pigmentation, prominent veins.
b) Palpation-Tenderness, rigidity, hyperaesthesia-palpation for viscerae,-liver, gall bladder, spleen,
kidneys, urinary bladder and uterus in females-feel for aorta, & common femoral vessels-If mass
palpable, note site, size, shape, surface, edge, consistency, mobility and attachment, bimanual
palpation & any pulsation.
c) Percussion-Tympanitic, dullness, shifting dullness and fluid thrill.
d) Auscultation-Peristaltic sounds, Bruit (Renal).
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3. Groins.
Femoral vessels, Inguinal canal, expansile impulse, lump in the groin.
4. Genitalia.
5. Rectal Examination.
F. NERVOUS SYSTEM
1. Skull & Spine.
2. Mental Functions:
a) Appearance & behavior.
b) Emotional states.
c) Orientation in time, space, person.
d) Clouding of consciousness.
e) Memory, Recent/old.
f) Delusions & Hallucinations.
g) Sleep disturbances.
h) General intelligence.
i) Released reflexes
3. Speech.
Dysarthria, stammering, lalling, scanning, spastic, cortical, aphasia, spoken & written speech.
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4. Cranial Nerves.
a) 1st or Olfactory Nerve.
Smell anosmia, parosmia, hallucinations.
b) 2nd or Optic Nerve.
(i) Acuity of vision. Far & Near.
(ii) Field of vision.
(iii) Colour vision.
(iv) Fundoscopy
c) 3rd, 4th, 6th or Oculomotor, Trochlear & Abducent Nerves.
(i) Movement of Eye ball.
(ii) Pupils, size, shape, equality, accommodation reflex, reaction to light (Light
reflex Cr. 2, 3), consensual reflex.
(iii) Strabismus, paralytic, concomitant, diplopia.
d) 5th or Trigeminal Nerve.
(i) Sensory part, Corneal & Conjunctival reflex (Cr-5,7) sensations in 3 divisions.
(ii) Motor part, Muscles of mastication, movement of jaw, clenching of teeth, jaw
jerk, (Cr-5).
e) 7th or Facial Nerve.
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Upper part of face.
Lower part of face.
Judge whether the lesion is in UMN or LMN.
-Frowning.
-Closing of eye.
-Nasolabial fold.
-Angle of mouth.
-Whistling out.
-Blowing cheeks.
-Showing of teeth.
- Taste on Ant 2/3 of tongue.
f) 8th or Vestibulocochlear Nerve,
((i) Hearing, Rinne’s test, Weber’s test.
(ii)Test for vertigo
g) 9th or Glossopharyngeal Nerve.
Taste on post, 1/3 of Tongue, Tickling of pharynx reflex (gag-reflex Cr.9, 10).
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h) 10th or Vagus Nerve.
Regurgitation of fluids, Movement of palate during phonation (Ah-test).
Nasal twang Larynx
Voice Hoarseness
i)-11th or Accessory Nerve.
Power of sternomastoid.
Power of trapezius.
j) 12th or Hypoglossal Nerve.
Tongue, Position, deviation.
Movement of Tongue, comparison & power.
Wasting and fasiculation of tongue.
4. Motor System.
a. Bulk of Muscle.
b. Tone of muscle (exclude myotonia).
c. Strength of muscles.
d. Tendon reflexes.
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o Jaw jerk (cranial 5)
o Biceps jerk (C.5, 6)
o Triceps jerk (C-5, 6).
o Supinator jerk (C-5, 6).
o Knee jerk (L-2, 3, 4).
o Ankle jerk (S-1, 2).
o Patellar clonus.
o Ankle clonus.
o Haffman’s sign.
e. Superficial reflexes.
o The plantar reflex (S-1)
o Abdominal reflexes (T 6-T 12)
o Corneal reflex (Cr-5, 7).
o Sphincter reflexes. (S-3, 4)
o Cremasteric reflex (L-1, 2)
f) Coordination of Movements.
(i) In the upper limb. (finger-nose test).
(ii) In the lower limb. (Heel-knee test).
(iii) Dysdiadochokinesia.
(iv) Romberg\s Sign (sensory ataxia).
g) GAIT
Spastic, Hemiplegic, Stamping.
Drunken, Festinant Retropulsion.
Wadding High stepping gait.
5. Involuntary Movements.
Epilepsy, Myoclonus, Tremors, Athetosis, Chorea, Dyskinesia, Dystonia. Hemibalismus, Tics,
Metabolic flap, Tetany, Fasciculation.
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6. Sensory System
a) Tactile sensibility (Light touch, pressure, cotton wool-test).
b) Position sense (passive movement-degree direction).
c) Stereognosis.
d) Vibration.
e) Pain-Superficial, Pressure.
f) Temperature, Hot
7. Signs of Meningeal Irritation.
Neck stiffness.
Brudzinski’s sign. Kernig’s sign. Straight leg raising.
8. Cerebellum.
Muscular hypotonia, Tendon reflexes, Gait. Disorders of Movement, Dysmetria, Dyssynergia.
Intention tremors, Dysdiadochokinesia, Rebound phenomenon, Scanning speech, Jerking
nystagmus.
G. Locomotor system,
i) Bones, shape, swelling, tenderness, deformity.
ii) Joints, tenderness, muscle wasting, crepitus, swelling, Temerature& color of skin.
iii) Range of active & passive movements, on all joints & any restriction in degrees.
iv) Special features, Heberden’s nodes, Rheumatoid subcutaneous nodules, Gouty tophi, etc.
H. LOCAL EXAMINATION.
PROFISIONAL DIAGNOSIS
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DIFFERENTIAL DIAGNOSIS
INVESTIGATIONS
URINE Colour…………..Quantity………..Reaction…………….Sp. gravity………….. Albumin…………Sugar……….Acetone………..Urobolin……….Bilesalts……….Bile pigments…………. Microscopic examination…………………………………………….
BLOOD, Hb%.............TLC……….DLC……..P…….L…….M……..E………B………….. ESR………
Blood urea……….Serum Creatinine………., LFT’s………………. RBS……….., Na+………K+……….HCO3………, Cl……….., Ca++………..Mg++……..
IMAGING
X-RAYS
CT Scan
MRI
OTHER TESTS.
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DAILY PROGRESS REPORT
Date
Presenting complains:
Today’s complains:
Examination:
Vitals & GPE
GIT
Respiratory System
Cardiovascular System
Musculoskeletal System
CNS
Investigation:
Assessment:
Plan:
Signature………………….
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Some Common Complaints in History of Present Illness
( Guideline to explore the symptoms)
Pain:
● Site_____
● Mode of onset__
● Intensity___
● Radiation ______
● Shift ____
● Character______
● Frequency _______
● Special time of occurrence ____________
● Aggravating factors_______
● Relieving factors_______
● Associated phenomena
Fever:
● Mode of onset___
● Rigors of Chills_______
● Grade_____
● Pattern ______
● Associated symptoms_________
Weight :
● Ask about Appetite
● ( if decreased then ask about ____ fever, night sweats, cough, Expectoration)
● If normal or increased then ask about _____ Polyuria, Polydypsia, Palpitation
Edema:
● Site _____
● Where did it start first? ( periorbital, feet)
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Dyspnea
Exertional Dyspnea:
● Duration___________
● How much exertion does precipitates dyspnea ( Climbing stairs, running, distance ,
walked)
● Onset ( sudden or insidious)_____
● PND______
● Orthopnea ______
● Associated symptoms (Breathlessness, Chest pain. Loss of weight despite good
appetite , heat intolerance)
Non- Exertional Dyspnea (at rest)
● Age of onset ________
● Wheeze _______
● Frequency, severity & duration of attacks _______
● Any change since first attack_____
● Nasal or skin allergy ______
● Family history _______
● Is treatment required to remain symptoms free?
Palpitations:
● Attacks at rest (Paroxysmal tachycardia) /on exertion_____
● Duration _______
● Onset & Termination (Sudden, Gradual) ______
● Associated symptoms (Breathlessness, Chest pain. Loss of weight despite good
appetite, heat intolerance
Cough:
● Duration ________
● Frequency & Severity_________
● More at night/ day_____
● Dry/ productive __________
● Quantity, Color, Viscosity, odor…
● More in early morning ______
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● Hemoptysis ( Blood Mixed with sputum / Pure ( Frank) / Blood streaked ______
● Frequency & Quantity )
Vomiting:
● Duration ______
● Frequency _____
● Relation with food intake ______
● Any special timing ______
● Loss of weight ______
● Quantity, color smell & Contents of vomitus _____
● Hematemesis (Color, Quantity & Frequency ________
● Associated Melena )_________
● pain abdomen _________
● Constipation & Distension _________
● Anorexia & Oliguria _______
● Headache.
Diarrhea:
● Duration_____
● Frequency ________
● Quantity ________
● Difficult to flush ________
● Consistency _________
● Blood / Mucus __________
● Tenesmus________
● If acute ( Any relation with food intake , any other, Individual who took same food,
interval between intake & onset) ___
● Nocturnal _________
● Other symptoms ( Fever , Abdominal pain, Vomiting, Weight loss)
Constipation:
● Usual bowel habits_______
● Duration ( recent change in bowel habits) _______
● Blood _________
● Alternating diarrhea ____________
● Drug history _____________
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● Change in eating habits ______________
● Other symptoms( Abdominal pain, Distension & vomiting , Weight loss)
Dysphagia:
● Duration __________
● More to Solids or liquids ______
● Or progressive ________
● Feeling of good Sticking ( site) ___________
● Swallowing painful weight loss______________
● vomiting ___
● Does vomitus contain food eaten 48-72 hours earlier ________
● Past history of retrosternal burning ________
Jaundice:
● Pain right hypochondrium ________
● Anorexia ____________
● Distaste for smoking _________
● Color of Stools and urine _________
● Itching __________
● Weight loss_________
● Past history of injections _____________
● Contact with jaundice patients ______________
● Family history.
Polyuria:
● Duration_____
● In frequency (Quantity of urine is smell) While in Polyuria (Quantity passed each time
is large)
Hematuria;
● Duration ______________
● Exact color________
● Difference in color in beginning, middle or at end of micturation____
● Associated Symptoms (Fever, Burning micturation ,
● pain in hypogastrium, lumber region or loin to groin)
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Fits( Convulsions)
● Age at time of first attack ______________
● Gather following info from patients & eye witness ( Aura, loss of consciousness,
Rigidity.
● Tonic/ Clonic contractions,
● Fits: Generalized or Localized, Tongue bite, Urinary incontinence, Fall Trauma
● Duration after symptoms.
Weakness/ Paralysis:
● Part involved ( Monoplegia. Hemiplegia, paraplegia) ___________
● Weakness complete / Partial________
● onset (Sudden / Gradual)_____________
● Static / Progressive ___________
● Headache, Vomiting ___________
● loss of consciousness___ ________
● Fits____________
● Speech____ ______
● Sensory Symptoms.
Headache:
● Site_______
● Severity _____________
● Duration _____________
● Continuous/ Intermittent _______________
● Character______________
● Special times of occurrence ______________
● Aggravating & Relieving factors _______________
● Associated Phenomena _________________
● Insomnia__________
● Anxiety/ Depression____________
● Effects of Analgesics.
Joint Pain:
● Age of onset____________
● Joint involved first_____________
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● Sequence of involvement of other joints ________________
● Did pain in previous joint persist / Disappear after involvement of other
joints_____________
● Swelling ______________
● Pain on movements_______________
● Morning stiffness___________
● past history of trauma to the joint__________
● Systemic symptoms.
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Disclaimer:
Medicine is a very broad field. Any Important Clinical Case according to Curriculum of University of
Health Sciences can be asked in the examination. Some common short case list is shared here as
a guideline for your exam preparation. It is not the final list.
Short Cases
Assessment of your short case will be done at three levels.
1. Good Performance
2. Proper description of findings
3. Viva to assess your knowledge about case including differential diagnosis, investigations and
management.
Short Cases of Central Nervous System
1. Assessment of Higher Mental Functions (including orientation with time, space and
person and assessment of speech of person)
2. Examination of the Cranial Nerves
3. Examine the Motor System of Upper Limbs.
4. Examine the Motor System of Lower Limbs
5. Examine the Sensory System of Upper Limbs.
6. Examine the Sensory System of Lower Limbs
7. Examine Cerebellar System of the Patient.
8. Examination Relevant to Cerebellar System
9. Examination for Signs of meningeal irritation
Examination of CVS
● Examination of the Pulse
● Examination of blood pressure
● JVP measurement including hepatojugular reflex
● General Physical Examination relevant to Cardiovascular System.
● Examination of Precordium.
Examination of Respiratory system
● General Physical Examination Relevant to Respiratory System.
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● Examine the Front of the Chest.
● Examine the Back of the Chest.
Examination of GIT
● Examine the front of Abdomen.
● Examine of the back of Abdomen.
● General Physical Examination relevant to GI System.
Short cases of musculoskeletal system
● Examination of a joint (shoulder, elbow, wrist, Ankle, Knee, Hip)
● Examination of spine of the patient.
Miscellaneous topics/commands that can be given
● General Physical Examination of patient.
Example of a Case presentation
Command: Examine the Motor System of Lower Limbs
● After listening to this command you’d proceed in following steps.
● Informed Consent
● Proper Exposure
● Observe for posture and obvious wasting.
● Check for muscle tenderness and fasciculation as in upper limb.
● Measure the muscle bulk bilaterally.
● Check tone of the muscles bilaterally.
o At small joints of the foot
o At ankle joint
o At hip joint
● Check power of the muscles. (Ask the patient to raise legs to assess the power.)
o At toes
o Ankle
Dorsiflexion
Plantar flexion
106
Inversion
Eversion
o Knee
Flexion
Extension
o Hip
Flexion
Extension
Abduction
Adduction
● Check deep tendon reflexes
o Ankle jerk
o Knee jerk
o Check for the clonus
o Ankle clonus
o Patellar clonus
o Check for the plantar reflex (Babinski sign)
o Perform heel-knee-shin test.
● Ask patient to stand. Look for Romberg’s sign. ● Ask patient to stand from sitting position. (For proximal muscle weakness)
● Ask patient to stand on his toes.
● Ask patient to stand on his heel.
● Ask patient to walk and note his gait.
● Check for vertebral column pathology if weakness found.
● Say thanks to the patient.
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Next step is proper description of all the important findings.Just be
confident, calm and look at examiner to explain your findings.(don’t look at the patient)
“A healthy looking patient is sitting comfortably on bed with IV cannula on left forearm (this sentence varies according to situation).
On examination of lower limbs, there is no obvious posture abnormality, gross wasting or
fasciculation. There is no muscle tenderness and muscle bulk is symmetrically normal on both
sides. Tone is normal in all muscle groups at all joints bilaterally. Tone is normal at all joints and
power is 5/5 in all muscle groups (both proximal and distal) at all joints on both sides. Knee jerk and
ankle jerk are well preserved i.e. grade 2 and no patellar or ankle clonus was elicited. Plantars are
down going on both sides and patient has no heel-shin ataxia. Patient can easily stand from sitting
position and has no obvious gait-abnormality. In summary, normal lower limb examination”. (Description will change according to patient’s disease and findings present.)
Next step is viva. e.g. examiner can ask gradings of power, difference b/w UMNL and LMNL, root
values of reflexes, causes of upgoing planters or whatever he wants to ask according to the patient.
Exercise to assess your understanding.
● If you are asked to examine a coma patient, how will you proceed?
● Make your own checklist for this command.
● Examine sensory system of lower limb.
109
Disclaimer:
Medicine is a very broad field. Any Important Clinical Case according to Curriculum of University of
Health Sciences can be asked in the examination. Some common long cases are discussed below.
Each long case comprises of History Taking, Examination, Enlisting investigations, Differential
Diagnosis and Management Steps. At the end there is viva and discussion.
Important Long cases are:-
1) Cardiovascular System
● CCF (Congestive Cardiac Failure)
● Valvular Heart Diseases
● Rheumatic Fever
● Infective Endocarditis
● Cardiomyopathies
2) Acute & Chronic Kidney Diseases
3) Respiratory System
● COPD (Chronic Obstructive Pulmonary Disease)
● Bronchial Asthma
● Pneumonia
● Adult Respiratory Distress Syndrome
● Interstitial Lung Disease
4) Central Nervous System
● CVA (Cerebrovascular accidents)
● Epilepsy
● Meningitis/Encephalitis
● Guillain Barre Syndrome
● Multiple Sclerosis
● Paraplegia
110
5) Gastrointestinal System & Liver Diseases
● Chronic liver disease and its Complications
● Acute Hepatitis
● Acute/Chronic Pancreatitis
● Upper GI Bleed
● Lower GI Bleed
● Peptic Ulcer Disease
6) Rheumatology
● Rheumatoid Arthritis
● Osteoarthritis
● Septic Arthritis
● Gout
● Osteomyelitis
7) Infectious Diseases
● Chickenpox
● HIV
● Dengue
● Malaria
● Enteric fever
● Meningitis
8) Endocrine system
● Diabetes Mellitus and its Complications
● Hypothyroidism
● Hyperthyroidism
● Addison Disease
● Cushing Syndrome.
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Case No. 1
Date__________________
Name __________________________ S/D/o ________________________ Age __________
Sex ___________ MaritalStatus _______________ Religion __________________________
Occupation _______________ Hospital Reg. no.____________________ Bed no _________
D.O.A ______________________ N.I.C. No ______________________________________
Address ________________________________________________ via OPD ____________
Emergency _______________ Reference _________________________________________
Presenting Complaints
113
History of Present illness
Systemic Inquiry
Normal ___________________ Increased _________________ Decreased _______________
Weight____________________ (Increased__________________ Decreased _______________)
Sleep disturbance: Insomnia ______________________ Somnolence_____________________
Presenting Complaints
114
Systemic Inquiry
General:
Normal ___________________ Increased _________________ Decreased _______________
Weight____________________ (Increased__________________ Decreased _______________)
Sleep disturbance: Insomnia ______________________ Somnolence_____________________
Cvs:
Chest Pain _________________ Compression ____________ Breathlessness _____________
Paroxysmal nocturnal dyspnea ________________________ Orthopnea __________________
Feet Swelling _____________________ Pain in legs on walking _________________________
Palpitation ________________________
Respiratory system:
Cough __________________ Sputum __________________ Hemoptysis _________________
Breathlessness ____________________ wheeze _____________ Rhinitis _________________
Seasonal variation ___________________________ Chest pain __________________________
Headache ___________________ Epistaxis ___________________ Hoarseness ____________
GIT:
Nausea _________________ Vomiting ___________________ Abdominal pain ____________
heart burn _________________________ Dysphagia __________________________________
Altered bowel habits ______________________________ Hematemesis ___________________
Black tarry stools ___________ yellow sclera ___________ abdominal distension ___________
115
Urinary System:
Pain _______________ Frequency __________ Urgency white micturition __________________
Hematuria ______________________ Anuria ________________ Polyuria _________________
Oliguria ______________ Passage of gravel in urine _____________ Flank pain _____________
Burning discharge ________________________________________________________________
Nervous System:
Weakness _________________ Numbness __________________ Headache _______________
Vomiting ________________ Giddiness ___________________ Blackouts __________________
Fits ____________ Visual Loss ____________ Diplopia __________ Vertigo _________________
Locomotors System:
Joint pain _____________________ Stiffness ___________________ Swelling _____________
Restriction of movements __________________________________________________________
Skin:
Rash ____________________ Itch ______________________ Pigmentation ________________
Ulcers ____________________ Patchy hair loss _______________________________________
Hematology:
Purpuric rash ________________ bleeding gums ________________ Leg ulcers _____________
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Endocrinology:
Polyuria __________________ Polyphagia _______________ Polydipsia ____________________
Sweating ________________ Heat _______ Cold ________ Wt. gain _______/ Loss ___________
Palpitations _____________________________________________________________________
Explain for any symptom found in the systemic review:
Past History
DM _____________________ Hypertension ___________________ Asthma ______________
Ischemic Heart disease __________________ H/O blood transfusion _____________________
Past Surgical History ____________________________________________________________
Detail if relevant:
117
Personal History:
Pt’s socioeconomic status _________________________________________________________
Dietary habits ______________________________ Drug addiction ________________________
Smoking ____________ Age at started ____________ No. of packs/ Cigarettes per day _______
Time at which stopped ( ex-smoker) ____________ Health of wife / husband / children _________
H/O foreign travel ______________ Immunization __________ Allergy to anything ____________
Pets ( if any) ___________________________________ Animal contact ____________________
Occupational History:
Exact nature of present job (Working hours) ______________ past jobs _____________________
Exposure to chemicals / radiations ___________________________________________________
Family History:
Similar disease in the family _________________________ DM ______________ IHD _________
HTN _____________ Hepatitis ____________ Arthritis _____________ Stroke _______________
TB __________ Malignancy _______________ Deaths at early ages in the family ______________
Other __________________________________________________________________________
118
Menstrual History:
Age at menarche ___________ Length of cycle _________________ Frequency ______________
Treatment / Drug History:
GENERAL PHYSICAL EXAMINATION:
My _____________________________ Looking Patient _______________________________
in position ____________________ Oriental in time a place with fops _____________________
Cannula on _________________________ having pulse rate of _________________________
pulse is of ________________ Volume _____________________ in rhythm _______________
in character , condition of the vessel is _________ patient is having blood pressure of ________
must temperature ___________________________, Respiratory rate _____________________
pulse Oximetry SaO2 ______________________________________________________________________________________________
119
On examination of hands the
● Shape / Size
● Skin + Sweaty / dry / coarse +pigmentation
● Muscle wasting ( atrophy)
● Thenar with Hypothenar examinences
● Planar pallor , palmer erythema , Duputyren’s contracture
● Creases, Grip of the hands Flapping Tremors.
Nails:
● Pallor, Cyanosis
● Koilonychia
● Splinter Hemorrhages
● Pitting of nails Half and Half nails
● Capillary Filling
Fingers:
● Osler’s nodes
● Heberdon’s nodes, Bouchard’s nodes, ● Joint swelling / Deformity(Swan Neck, Button-hole, Z-deformity)
● Arachnodactyly
Face and Neck:
● Puffiness
● Pallor of lower conjunctive
● Yellow discolouration of sclera
● Cyanosis
o Central
o Peripheral
● Rash + Hirsuitism
● Xanthalesmas,
● Exopthalmos / Proptosis
● Parotid glands
120
● Tongue
● Halitosis
● Lymph nodes
● JVP
● Thyroid Gland
● Buffalo hump
● Acanthosis Nigricans
Feet:
● Edema
o Pitting
o Non-Pitting
● Cyanosis, Early signs of peripheral vascular Disease
o Loss of hair
o Shiny skin
Provisional Diagnosis:
Provisional
122
Case No. 2
Date__________________
Name __________________________ S/D/o ________________________ Age __________
Sex ___________ MaritalStatus _______________ Religion __________________________
Occupation _______________ Hospital Reg. no.____________________ Bed no _________
D.O.A ______________________ N.I.C. No ______________________________________
Address ________________________________________________ via OPD ____________
Emergency _______________ Reference _________________________________________
Presenting Complaints
History of Present illness
129
General Physician Examination
Respiratory rate _____________________________ pulse Oximetry SaO2__________________________
Provisional Diagnosis:
Notes:
130
Case No. 3
Date__________________
Name __________________________ S/D/o ________________________ Age __________
Sex ___________ MaritalStatus _______________ Religion __________________________
Occupation _______________ Hospital Reg. no.____________________ Bed no _________
D.O.A ______________________ N.I.C. No ______________________________________
Address ________________________________________________ via OPD ____________
Emergency _______________ Reference _________________________________________
Presenting Complaints
History of Present illness
137
General Physician Examination
Respiratory rate _____________________________ pulse Oximetry SaO2__________________________
Provisional Diagnosis:
Notes:
138
Case No. 4
Date__________________
Name __________________________ S/D/o ________________________ Age __________
Sex ___________ MaritalStatus _______________ Religion __________________________
Occupation _______________ Hospital Reg. no.____________________ Bed no _________
D.O.A ______________________ N.I.C. No ______________________________________
Address ________________________________________________ via OPD ____________
Emergency _______________ Reference _________________________________________
Presenting Complaints
History of Present illness
143
Personal History
Occupational History
Malignancy __________________ Deaths at early ages in the family ______________________
Other _________________________________________________________________________
Menstrual History
144
Treatment / Drug History
General Physician Examination
Respiratory rate _____________________________ pulse Oximetry SaO2__________________________
Provisional Diagnosis:
146
Case No. 5
Date__________________
Name __________________________ S/D/o ________________________ Age __________
Sex ___________ MaritalStatus _______________ Religion __________________________
Occupation _______________ Hospital Reg. no.____________________ Bed no _________
D.O.A ______________________ N.I.C. No ______________________________________
Address ________________________________________________ via OPD ____________
Emergency _______________ Reference _________________________________________
Presenting Complaints
History of Present illness
153
General Physician Examination
Respiratory rate _____________________________ pulse Oximetry SaO2__________________________
Provisional Diagnosis:
Notes:
154
Case No. 6
Date__________________
Name __________________________ S/D/o ________________________ Age __________
Sex ___________ MaritalStatus _______________ Religion __________________________
Occupation _______________ Hospital Reg. no.____________________ Bed no _________
D.O.A ______________________ N.I.C. No ______________________________________
Address ________________________________________________ via OPD ____________
Emergency _______________ Reference _________________________________________
Presenting Complaints
History of Present illness
161
General Physician Examination
Respiratory rate _____________________________ pulse Oximetry SaO2__________________________
Provisional Diagnosis:
Notes:
162
Case No. 7
Date__________________
Name __________________________ S/D/o ________________________ Age __________
Sex ___________ MaritalStatus _______________ Religion __________________________
Occupation _______________ Hospital Reg. no.____________________ Bed no _________
D.O.A ______________________ N.I.C. No ______________________________________
Address ________________________________________________ via OPD ____________
Emergency _______________ Reference _________________________________________
Presenting Complaints
History of Present illness
170
Case No. 8
Date__________________
Name __________________________ S/D/o ________________________ Age __________
Sex ___________ MaritalStatus _______________ Religion __________________________
Occupation _______________ Hospital Reg. no.____________________ Bed no _________
D.O.A ______________________ N.I.C. No ______________________________________
Address ________________________________________________ via OPD ____________
Emergency _______________ Reference _________________________________________
Presenting Complaints
History of Present illness
177
General Physician Examination
Respiratory rate _____________________________ pulse Oximetry SaO2__________________________
Provisional Diagnosis:
Notes:
178
Case No. 9
Date__________________
Name __________________________ S/D/o ________________________ Age __________
Sex ___________ MaritalStatus _______________ Religion __________________________
Occupation _______________ Hospital Reg. no.____________________ Bed no _________
D.O.A ______________________ N.I.C. No ______________________________________
Address ________________________________________________ via OPD ____________
Emergency _______________ Reference _________________________________________
Presenting Complaints
History of Present illness
185
General Physician Examination
Respiratory rate _____________________________ pulse Oximetry SaO2__________________________
Provisional Diagnosis:
Notes:
186
Case No. 10
Date__________________
Name __________________________ S/D/o ________________________ Age __________
Sex ___________ MaritalStatus _______________ Religion __________________________
Occupation _______________ Hospital Reg. no.____________________ Bed no _________
D.O.A ______________________ N.I.C. No ______________________________________
Address ________________________________________________ via OPD ____________
Emergency _______________ Reference _________________________________________
Presenting Complaints
History of Present illness
204
Attendance and Performance evaluation
Sr..No. Date Topic Place Tutor’s Sign
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
206
PERFORMA FOR EXTRA CURRICULAR ACTIVITIES
Sr..No. Activity Distinction / Medal Participation
1 Event Organization/ management
2 Sport/ Extracurricular
3 Debates / Literary activity
4 Editorial
5 Writing (Scientific / Research)
6 Elective/ Internship
( Mention department)
7 Medical camp / Voluntary work
8 Charity / Fund raising
9 CPR Workshop
10 Certificate of Blood Donation
11 Any Other
207
Class Room Activity
Presentation/Group Discussion/CPC Presentation/Assignment)
Sr..No. Topic Date Signature
1
2
3
4
5
6
7
8
9
10
209
3rd Year Lecture Schedule and Distribution of Topics
Wednesday 12:15 – 1:00am
Topic Friday
10:00 – 10:45am Topic
1. 20-11-2019 Spot Diagnosis
Med
ical U
nit I
1 22-11-2019 Spot Diagnosis
Med
ical U
nit I
3. 27-11-2019 Approach to Chest Pain
2 29-11-2019 Approach to Chest Pain
4. 04-12-2019 Spot Diagnosis
3 06-12-2019 Spot Diagnosis
4. 11-12-2019 Spot Diagnosis 4 13-12-2019 Spot Diagnosis
Winter Vacation
(18-12-19 to 25-12-19)
Winter Vacation (18-12-19 to
25-12-19)
5. 01-01-2020 Test 5 27-12-2019 Approach to Headache
6. 08-01-2020 Approach to Fever 6 03-01-2020 Approach to Fever
7. 15-01-2020 Approach to Pyrexia of Unknown Origin
7 10-01-2020 Approach to Fever with Rash
8 17-01-2020 Test
8. 22-01-2020 Approach to Backache
Med
ical U
nit II
9. 24-01-2020 Approach to Abdominal Pain
Med
ical U
nit II
9. 29-01-2020 Approach to Syncope 10. 31-01-2020 Test
10. 05-02-2020 Approach to Diarrhea 11. 07-02-2020 Approach to Diarrhea
11. 12-02-2020 Approach to Vomiting 12. 14-02-2020 Approach to Vomiting
12. 19-02-2020 Approach to Confusion and Delirium
13. 21-02-2020 Approach to Confusion and Delirium
13. 26-02-2020 Test
14. 04-03-2020 Approach to Upper GI Bleeding
Med
ical U
nit III
14. 28-02-2020 Approach to Upper GI Bleeding
Med
ical U
nit III
15. 11-03-2020 Approach to Lower GI Bleeding
15. 06-03-2020 Approach to Lower GI Bleeding
16. 18-03-2020 Approach to Jaundice 16. 13-03-2020 Approach to Jaundice
17. 20-03-2020 Test
210
17. 25-03-2020 Approach to Anemia
Med
ical U
nit IV
18. 27-03-2020 Approach to Anemia
Med
ical U
nit IV
18. 01-04-2020 Approach to Cough and Haemoptysis
19. 03-04-2020 Approach to Cough and Haemoptysis
19. 08-04-2020 Approach to Edema 20. 10-04-2020 Approach to Edema
20. 15-04-2020 Approach to Bleeding Tendencies
21. 17-04-2020 Approach to Palpitations
21. 22-04-2020 Approach to Enlarged Lymph nodes
22. 24-04-2020 Test
22. 29-04-2020 Approach to Seizures
Me
dic
al U
nit V
23. 01-05-2020 Approach to Focal Weakness
Me
dic
al U
nit V
23. 06-05-2020 Approach to Dementia 24. 08-05-2020 Approach to Dizziness and Vertigo
24. 13-05-2020 Test
Note: Winter Vacations (18-12-2019 to 25-12-2019)
Spring Vacations (17-05-2020 to 25-05-2020)
Summer Vacations (14-06-2020 to 12-07-2020)
211
TIME TABLE FOR 3RD
YEAR MBBS CLASS SESSION 2019-2020 STARTED FROM 18-11-2019
DAY 08:00 – 10:00
10:00 –
10:40
10:40 – 11:20
11:20 –
11:40
11:40 – 12:20
12:20 –
01:00
1:00 – 02:30
Monday
PHARMA/FORENSIC
LECTURE &
ASSESSMENT
FORENSIC
MEDICINE PHARMACOLOGY
SELF
STUDY
TIME
PATHOLOGY
Beh.
Sciences PRACTICAL
Tuesday
WARD
Surgery PRACTICAL
Wednesday Medicine PRACTICAL
Thursday Surgery PRACTICAL
Friday WARD MEDICINE PRACTICAL
Saturday
ENT
08:00 –
09:00am
EYE
09:00 –
10:00am
FORENSIC
MEDICINE PHARMACOLOGY
SELF
STUDY
TIME
PATHOLOGY
Beh.
Sciences PRACTICAL
212
WARD PROGRAMME
WARDS
18.11.2019
to
26.01.2020
27.01.2020 to
03.04.2020
04.04.2020 to
13.06.2020 WARDS
18.11.2019
to
26.01.2020
27.01.2020 to
03.04.2020
04.04.2020 to
13.06.2020
Surgical – I A-1 B-1 C-1 Medical -I B-1 C-1 A-1
Surgical – II A-2 B-2 C-2 Medical
Unit-II B-2 C-2 A-2
Surgical –
III A-3 B-3 C-3 Medical - III B-3 C-3 A-3
WARDS
18.11.2019
to
10.12.2019
11.12.2019 to
07.01.2020
08.01.2020 to
26.01.2020 WARDS
27.01.2020
to
16.02.2020
17.02.2020 to
11.03.2020
12.03.2020 to
31.03.2020
E.N.T C-3 C-1 C-2 E.N.T A-3 A-1 A-2
Eye C-2 C-3 C-1 Eye A-2 A-3 A-1
Beh.
Sciences C-1 C-2 C-3
Beh.
Sciences A-1 A-2 A-3
WARDS
09.04.2020
to
29.04.2020
30.04.2020 to
16.05.2020
26.05.2020 to
13.06.2020
E.N.T B-3 B-1 B-2
Eye B-2 B-3 B-1
Beh.
Sciences B-1 B-2 B-3
213
BATCHES FOR MEDICINE, SURGERY, ENT, EYE AND BEH.
SCIENCES PROGRAMME
Ba
tche
s
A-1
A
-2
A-
3
B-
1
B-2
B
-3
C-
1
C
-2
C
-3
Roll N
os.
1-36,
43,114,
279
3
7-
42,
44-
79
80-
113,
115-
117
11
8-65,
188
167
-187,
189-
205
2
06-
245
24
6-
278,
280-
287
2
88-
330
3
31-
376
Note: Winter Vacations (18-12-2019 to 25-12-2019)
Spring Vacations (17-05-2020 to 25-05-2020)
Summer Vacations (14-06-2020 to 12-07-2020)
214
Third year curriculum for wards 2019-20
DAYS TOPIC
CLINICAL CLASSES 8-10AM
TUESDAY TO FRIDAY NAME OF TEACHERS
Class Room
Activity Not
More Than 30
Min For
History &
Knowledge
Transfer
Bed Side Techniques
& Skills
MU-I
MU-II
MU-III
Tuesday
19-11-19 CVS
History taking
with
reference to
CVS
History taking by the
students + interactive
session
Dr.
Usman Dr. Arif
Dr.
Salman
Shakoor
Wednesday
20-11-19
Respiratory
System
History taking
with
reference to
Respiratory
History taking +
interactive session
Dr.
Abbas
Dr. M.
Irfan
Dr.
Jamshaid
Thursday
21-11-19 CNS
History taking
with
reference to
CNS system
Assessment of
Conscious level
Eliciting and
recognition of signs
Of meningeal
irritation (20mint)
done in class
rehearsal in group of
2 then involved
Dr.
Javed
Iqbal
Dr. M
Shahzad
Dr.
Maroof
Friday
22-11-19 GIT
History taking
with
reference to
GIT
History taking +
interactive session
Dr.
Owais
Dr.
Umair
Dr.
Zakria
Tuesday
26-11-19 CVS
History taking
with
reference to
CVS
Positioning the Pt +
general appearance
Dr.
Usman Dr. Arif
Dr.
Salman
Shakoor
Wednesday
27-11-19
Respiratory
System
History taking
with
reference to
Respiratory
Positioning the Pt +
general appearance
Dr.
Abbas
Dr. M.
Irfan
Dr.
Jamshaid
Thursday
28-11-19 CNS
History taking
with
Examination of
cranial nerves
Dr.
Javed
Dr. M
Shahzad
Dr.
Maroof
215
reference to
CNS system
1. I 2. II 3. III 4. IV 5. VI
Finish in20mint,
includes 20min
rehearsal on hands &
then 20 mint in ward.
Iqbal
Friday
29-11-19 GIT
History taking
with
reference to
GIT
Positioning the Pt +
general appearance
Dr.
Owais
Dr.
Umair
Dr.
Zakria
Tuesday
03-12-19 CVS
History taking
with
reference to
CVS
Pulse, BP
measurement, JVP
examination
Dr.
Usman Dr. Arif
Dr.
Salman
Shakoor
Wednesday
04-12-19
Respiratory
System
History taking
with
reference to
Respiratory
Differential diagnosis
of respiratory
symptoms on
bedside
Dr.
Abbas
Dr. M.
Irfan
Dr.
Jamshaid
Thursday
05-12-19 CNS
History taking
with
reference to
CNS system
Examination of
cranial nerves
1. V 2. VII 3. VIII
Finish in20mint,
includes 20min
rehearsal on hands &
then 20 mint in ward.
Dr.
Javed
Iqbal
Dr. M
Shahzad
Dr.
Maroof
Friday
06-12-19 GIT
History taking
with
reference to
GIT
Systemic
Examination related
to GIT
Dr.
Owais
Dr.
Umair
Dr.
Zakria
Tuesday
10-12-19 CVS
History taking
with
reference to
CVS
General Physical
examination
Dr.
Usman Dr. Arif
Dr.
Salman
Shakoor
Wednesday
11-12-19
Respiratory
System
History taking
with
reference to
General Physical
Examination related
to Respiratory.
Dr.
Abbas
Dr. M.
Irfan
Dr.
Jamshaid
216
Respiratory
Thursday
12-12-19 CNS
History taking
with
reference to
CNS system
Examination by the
students
IXIX,XI,XII Nerves
Performed by trainer,
rehearsal
in group of two, finish
in 20
min and 20 min in
ward
Dr.
Javed
Iqbal
Dr. M
Shahzad
Dr.
Maroof
Friday
13-12-19 GIT
History taking
with
reference to
GIT
General physical
Examination
related to GIT
Dr.
Owais
Dr.
Umair
Dr.
Zakria
Tuesday
17-12-19 CVS
History taking
with
reference to
CVS
Palpation of
precordium
Dr.
Usman Dr. Arif
Dr.
Salman
Shakoor
Winter Vacations (18-12-2019 to 25-12-2019)
Wednesday
Holiday
Respiratory
System
History taking
with
reference to
Respiratory
Inspection/Palpation
(Front / Back)
Dr.
Abbas
Dr. M.
Irfan
Dr.
Jamshaid
Thursday
26-12-19 CNS
History taking
with
reference to
CNS system
Motor System (Upper
limb)+ cerebellum
Performed by trainer
Rehearsal in group
of two, finish
in 20 min and 20 min
in ward
Dr.
Javed
Iqbal
Dr. M
Shahzad
Dr.
Maroof
Friday
27-12-19 GIT
History taking
with
reference to
GIT
Inspection of
abdomen
Dr.
Owais
Dr.
Umair
Dr.
Zakria
Tuesday
31-12-19 CVS
Systemic
Examination related
To CVS/Auscultation
of Precordium
Dr.
Usman Dr. Arif
Dr.
Salman
Shakoor
Wednesday Respiratory Percussion Dr. Dr. M. Dr.
217
01-01-2020 System (Front/Back) Abbas Irfan Jamshaid
Thursday
02-01-20 CNS
Motor System (Lower
limbs)+cerebellum ,
gait
Performed by trainer
Rehearsal in group
of two, finish
in 20 min and 20 min
in ward
Dr.
Javed
Iqbal
Dr. M
Shahzad
Dr.
Maroof
Friday
03-01-20 GIT
Superficial and
deeply Palpation,
visceral palpation.
Dr.
Owais
Dr.
Umair
Dr.
Zakria
Tuesday
07-01-20 CVS Auscultation
Dr.
Usman Dr. Arif
Dr.
Salman
Shakoor
Wednesday
08-01-20
Respiratory
System
Examination of
muslkloskeletal
system
Dr.
Abbas
Dr. M.
Irfan
Dr.
Jamshaid
Thursday
09-01-20 CNS
Sensory system
Demonstration of
dermatomes
Performed by trainer
Rehearsal in group
of two, finish
in 20 min and 20 min
in ward
Dr.
Javed
Iqbal
Dr. M
Shahzad
Dr.
Maroof
Friday
10-01-20 GIT
Visceral palpation
+causes of
Hepatosplenomegaly
Dr.
Owais
Dr.
Umair
Dr.
Zakria
Tuesday
14-01-20 CVS
Investigations
related to
CVS
Inspection
Palpation
Percussion,
auscultation
Dr.
Usman Dr. Arif
Dr.
Salman
Shakoor
Wednesday
15-01-20
Respiratory
System
Percussion,
auscultation of
abdomen and
genitourinary system
Dr.
Abbas
Dr. M.
Irfan
Dr.
Jamshaid
Thursday
16-01-20 CNS
Cerebral examination
Performed by trainer
Rehearsal in group
of two, finish
Dr.
Javed
Iqbal
Dr. M
Shahzad
Dr.
Maroof
218
in 20 min and 20 min
in ward
Friday
17-01-20 GIT
Discussion of
investigations
related to GIT
Dr.
Owais
Dr.
Umair
Dr.
Zakria
Tuesday
21-01-20 CVS
POSITIONING
GPE
Inspection
Palpation
Percussion
auscultation
Dr.
Usman Dr. Arif
Dr.
Salman
Shakoor
Wednesday
22-01-20
Respiratory
System
POSITIONING
GPE
Inspection
Palpation
Percussion
auscultation
Dr.
Abbas
Dr. M.
Irfan
Dr.
Jamshaid
Thursday
23-01-20 CNS
CNS Examination
Dr.
Javed
Iqbal
Dr. M
Shahzad
Dr.
Maroof
Friday
24-01-20 GIT
Positioning
GPE
Inspection
Palpation
Percussion
auscultation
Dr.
Owais
Dr.
Umair
Dr.
Zakria
Tuesday
25-01-20 CVS Test Test
Dr.
Usman Dr. Arif
Dr.
Salman
Shakoor
Wednesday
26-01-20
Respiratory
System Test Test
Dr.
Abbas
Dr. M.
Irfan
Dr.
Jamshaid
Thursday
27-01-20 CNS Test Test
Dr.
Javed
Iqbal
Dr. M
Shahzad
Dr.
Maroof
Friday
28-01-20 GIT Test GIT Test
Dr.
Owais
Dr.
Umair
Dr.
Zakria
219
4TH Year Revised Distribution of Topics
and Lecture Schedule2019-2020
Unit Topic
Medical Unit I
Medical Unit II
Medical Unit IV
Month Monday
08:45 AM to 09:30 AM Lectures to be delivered by
Sign.
Unit
December 2019
09 ACS
Dr. Ghulam Abbas
Med
ical U
nit I
16 ACS + Hypertension
Dr. Ghulam Abbas
Winter Vacation (18-12-19 to 25-12-19)
30 Hypertension
Dr. Ghulam Abbas
January 2020
06 Infective endocarditis
Prof. Dr Ahmed Bilal Dr.
AtaurRehman
13 Rheumatic Heart Disease
Dr. Ata ur Rehman
20 COPD
Dr. Ghulam Abbas
27 Asthma
Dr. Usman Musharraf
February
03-08
ASSESSMENT WEEK
Med
ical U
nit II
10 Iron deficiency Anemia
17 Megaloblastic Anemia
24 A plastic Anemia
220
March
02 Acute Leukemia + Chronic Leukemia
09 IBD/Malabsorption
16 Hepatitis
23 Hepatic Failure
30 Hypothyroid
April
06-11 TENTATIVE ASSESSMENT WEEK
12 Hyperthyroid
20 Hypo/Hyper parathyroidism
27 Acute Renal Failure
May
04 Chronic Renal Failure
11 Rheumatoid arthritis
Spring Vacation (17-05-2020 to 25-05-2020)
June
01-06 TENTATIVE ASSESSMENT WEEK
08 Osteomalacia, Rickets, Paget Disease
15 Summer Vacations
Su
mm
er
Vac
atio
ns
(14-0
6-2
020 to
12
-
07-2
020)
22 Summer Vacations
29 Summer Vacations
July
06 Summer Vacations
13 Mixed C.T disorders
Med
ical
Un
it IV
20 SLE
27
221
Seronegative Spondyloarthropathies
August
03 Fibromyalgia / Systemic Sclerosis
10 Bone & Joint Infection
Behcet’s Disease /Cryglobulinemia
17 Dermatomyosits/Polymyositis/Sjogren
Syndrome
24
31
Note: Winter Vacations (18-12-2019 to 25-12-2019)
Spring Vacations (17-05-2020 to 25-05-2020)
Summer Vacations (14-06-2020 to 12-07-2020)
222
WARD PROGRAMME FOR 4TH YEAR SESSION 2019-2020
MEDICINE (Including Cardiology AHF and Nephrology AHF)
Batch A (09-12-19 TO 08-02-20)
WARD 09-12-19 to
16-12-19
17-12-19
to 28-12-19
29-12-19
to 03-01-19
04-01-20
to 11-04-20
13-01-20
to 18-01-20
20-01-20
to 25-01-20
27-01-20
to 01-02-20
02-02-20
to 08-02-20
M-IV A-1 A-3 A-4 A-2
M-V A-3 A-1 A-2 A-4
Cardio A-3 A-1 A-2 A-4
Nephro A-3 A-1 A-2 A-4
Batch B (10-02-20 TO 04-04-20)
WARD 10-02-20 to
15-02-20
17-02-20
to 22-02-20
24-02-20
to 29-02-20
02-03-20
to 07-03-20
09-03-20
to 14-09-20
16-03-20
to 21-03-20
23-03-20
to 28-03-20
30-03-20
to 04-04-20
M-IV B-3 B-1 B-4 B-2
M-V B-1 B-3 B-2 B-4
Cardio B-1 B-3 B-2 B-4
Nephro B-1 B-3 B-2 B-4
Batch C (06-04-20 TO 13-06-20)
WARD 06-04-20 to
11-04-20
13-04-20
to 18-04-20
20-04-20
to 25-04-20
27-04-20
to 02-05-20
04-05-20
to 09-05-20
11-05-20
to 26-05-20
27-05-20
to 04-06-20
05-06-20
to 13-06-20
M-IV C-3 C-1 C-4 C-2
M-V C-1 C-3 C-2 C-4
Cardio C-1 C-3 C-2 C-4
Nephro C-1 C-3 C-2 C-4
D (13-07-20 TO 05-09-20)
WARD 13-07-20 to
18-07-20
20-07-20
to 25-07-20
27-07-20
to 03-08-20
04-08-20
to 08-08-20
10-08-20
to 15-08-20
17-08-20
to 22-08-20
24-08-20
to 29-08-20
31-08-20
to 05-09-20
M-IV D-3 D-1 D-4 D-2
M-V D-1 D-3 D-2 D-4
Cardio D-1 D-3 D-2 D-4
Nephro D-1 D-3 D-2 D-4
223
Pulmonology / Dermatology / Psychiatry/ C. Medicine
TWO WEEKS ROTATION
Batch C D
WARD 09-12-19
To
28-12-19
30-12-19
To
11-01-20
13-01-20
To
25-01-20
27-01-20
To
08-02-20
10-02-20
To
22-02-20
24-02-20
To
07-03-20
09-03-20
To
21-03-20
23-03-20
To
04-04-20
Pulmonology C-4 C-1 C-2 C-3 D-4 D-1 D-2 D-3
Dermatology C-3 C-4 C-1 C-2 D-3 D-4 D-1 D-2
Psychiatry C-2 C-3 C-4 C-1 D-2 D-3 D-4 D-1
C.Med: C-1 C-2 C-3 C-4 D-1 D-2 D-3 D-4
Batch A B
WARD
06-04-20
To
18-04-20
20-04-20
To
02-05-20
04-05-20
To
16-05-20
28-05-20
To
13-06-20
13-07-20
To
25-07-20
27-07-20
To
08-08-20
10-08-20
To
22-08-20
24-8-20
To
05-09-20
Pulmonology A-4 A-1 A-2 A-3 B-4 B-1 B-2 B-3
Dermatology A-3 A-4 A-1 A-2 B-3 B-4 B-1 B-2
Psychiatry A-2 A-3 A-4 A-1 B-2 B-3 B-4 B-1
C.Med: A-1 A-2 A-3 A-4 B-1 B-2 B-3 B-4
224
BATCHES FOR WARD PROGRAMME
Batc
hes
A-1 A-2 A-3 A-4 B-1 B-2 B-3 B-4
Roll
Nos.
1-20,
22,23
24-38, 40-46
47-
68
69-74, 76-88,
90, 92,93
94-96,98,
100,101,102, 104-
118
120,
123-143
144,145,
147-150
152-167
168-182
184-190
Batches C-1 C-2 C-3 C-4 D-1 D-2 D3 D-4
Roll
Nos.
192,193
195-211
213-215
216-
237 238-259
183, 260-262,
264,266, 268-275,
277-280,285-288,290
291-301
303-309
311-314
315,317-321,
323,324,326-331,
333-338, 340,341
342,
344-355
358-368
369-393
225
FAISALABAD MEDICAL UNIVERSITY
4TH YEAR MBBS CALENDER
FIRST TERM (9TH DECEMBER 2019 – 8TH FEBRUARY 2020)
Subject/ Topics
1st
Week 09-14-Dec
2nd
Week 8-25 Dec
3rd
Week 16-17-Dec 26-29-Dec
4th
Week 30-Dec
– 04-Jan
5th & 6
th
Week 06-18-Jan
2020
7th
Week 20-25-Jan
8th
Week 27-Jan
– 1-Feb
9th
Week 3-8-Feb
Clinico – Pathological
basics of Dieseases
Blood Vessel Diseases
WIN
TE
R B
RE
AK
Cardiac Pathologies Respiratory Pathologies
CNS Pathologies
Breast Tumors
AS
SE
SS
ME
NT
WE
EK
Ophthalmic Medicine &
Surgery
Retinal Vascular Diseases
Retinal Vasuclar
Dieseases IOP and Glaucoma
Pallledema Optic Atrophy
Retinoblastoma
Otorhinolaryngology
Ear Anatomy Ear
Physiology Diseases
of Ear
Hearing Loss
Deaf Child
Vertigo Otosclerosis
Ear Tumors Otalgin
Community Medicine
Epidemiology & Research
Epidemiology &
Research
Health & Diseases
Medical Statistics
Nutrition
CPC SCHEDULE Community Medicine field trips will be on (Thursday) 23
rd Jan 2020
and 27th
Feb 2020 Assessment will consist of written papers based on the pattern of University Professional examinations. Topics of Medicine will be included in Ophthalmology Paper Topics of Surgery will be included in ENT paper.
ASSESSMENT WEEK
12-Dec-19 Pathology 03-02-2020 Monday
Pathology
26-Dec-19 Eye 04-02-2020 TUESDAY
Self-study / Library
02-Jan-20 ENT 05-02-2020 WEDNESDAY
Community Medicine
09-Jan-20 Community 06-02-2020 THURSDAY
Self-study / Library
07-02-2020 FRIDAY
Eye
08-02-2020 SATURDAY
ENT
LECTURE TIME TABLE FOR FINAL YEAR MBBS CLASS
SESSION 2019-2020 STARTED W.E.F 30-12-2019
226
S.
NO. SUBJECT MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY REMARKS
1 Medicine
Lecture
08:00 to
08:45am
08:45 to
09:30am
09:30 to
10:15am
M-5
08:00 to
08:45am
08:45 to
09:30am
09:30 to
10:15am
M-4
08:00 to
08:45am
08:45 to
09:30am
09:30 to
10:15am
M-2
08:00 to
08:45am
08:45 to
09:30am
09:30 to
10:15am
M-3
08:00 to
08:45am
08:45 to
09:30am
09:30 to
10:15am
M-1
Medicine
Test
and
Assessment
08:00 to
10:15
2 Surgery
Lecture
12:00 to
02:00
12:00 to
02:00
12:00 to
02:00
12:00 to
02:00
12:00 to
02:00
3 Gynaecology
& Obst.
08:00 to
10:15
08:00 to
10:15
08:00 to
10:15
08:00 to
10:15
08:00
to
10:15
08:00 to
10:15
4 Paediatrics
Lecture
08:00 to
10:15
08:00 to
10:15
08:00 to
10:15
08:00 to
10:15
08:00
to
10:00
(SDL in
ward)
08:00 to
10:00
(Written
Assessment)
10:00 to
02:00
Assessment
in ward)
5 Psychiatry
Lecture
01:30 to
02:00
01:30 to
02:00
01:30 to
02:00
01:30 to
02:00
01:30 to
02:00
30-12-20
to
13-01-20
6 Dermatology
Lecture
01:30 to
02:00
01:30 to
02:00
01:30 to
02:00
01:30 to
02:00
01:30 to
02:00
14-01-20
to
27-01-20
7 In/Out Door
Patients
10:30 to
01:15
10:30 to
01:15
10:30 to
01:15
10:30 to
01:15
10:30
to
01:15
10:30 to
01:15
Self Study Time: 10:15am to 10:30am & 02:00pm to 2:30pm
Evening Ward Class: 3pm to 8pm
Note: Spring Vacations (17-05-2020 to 25-05-2020)
Summer Vacations (14-06-2020 to 12-07-2020)
227
Final Year Lecture and Topic Distribution for Medicine
1st
Week 30-12-19
to
04-01-20
Monday
M-5
1
Type 1
Diabetes
2
Treatment of
Type I DM
3
Hyper Osmolar
State
DKA
Psychiatry
01:30 to 02:00pm 2:00-230pm
Self Study Time
Tuesday
M-4
Type 2
Diabetes
Treatment of
Type II DM
Diabetic
Nephropathy
Psychiatry
01:30 to 02:00pm
WEDNESD
AY
Neuro
Departme
nt
NEUROLOGY NEUROLOGY NEUROLOGY Psychiatry
01:30 to 02:00pm
THURSDA
Y
Neuro
Departme
nt
NEUROLOGY NEUROLOGY NEUROLOGY Psychiatry
01:30 to 02:00pm
FRIDAY
Neuro
Departme
nt
NEUROLOGY NEUROLOGY NEUROLOGY
Saturday ALUMNI
DAY
2nd
Week 06-01-20
to
11-01-20
Monday
M-5
Complications
of DM other
than
Nephropathy
Dyslipidemias
Management
of
Dyslipidemias
Psychiatry
01:30 to 02:00pm 2:00-230pm
Self Study Time
228
Tuesday
M-4
Investigations
in
cardiovascular
diseases.
Hypertension
Hypertension
Psychiatry
01:30 to 02:00pm
Wednesda
y
M-2
MS MR Atrial
Fibrilation
Psychiatry
01:30 to 02:00pm
Thursday
M-3
Infective
Endocarditis
Pericardial
Disease
Cardiomyopathi
es / Myocarditis
Psychiatry
01:30 to 02:00pm
Friday
M-1 ACS ACS RHD
Saturday
Medicine Test
Saturday
11-01-20
08:15 to 10:15
Psychiatry
01:30 to 02:00pm
3rd
Week 13-01-20
to
18-01-20
Monday
M-5
Cardiomyopat
hies /
Myocarditis
Heart Failure
SVT/ VT/VF
Test Psychiatry
01:30 to 02:00pm
2:00-230pm
Self Study Time
Tuesday
M-4
Peripheral
Vascular
Disease /
Aortic
Dissection/
Aortic
Aneurysm
AS AR Dermatology
01:30 to 02:00pm
Wednesda
y
M-2
Hemolytic
Anemia, Blood
Group and
Blood
Transfusions
Bone Marrow
Transplant
Hemolytic
Anemia, Blood
Group and
Blood
Transfusions
Bone Marrow
Transplant
ANEMIA OF
CHRONIC
DISEASE
Dermatology
01:30 to 02:00pm
Thursday
M-3
Lymphomas
Lymphomas
MYELOPROLIFE
RATIVE
DISORDERS
Dermatology
01:30 to 02:00pm
Friday
M-1
Iron
Deficiency
Anemia
Megaloblastic
Anemia
Aplastic
Anemia
Dermatology
01:30 to 02:00pm
229
Saturday
Medicine Test
Saturday
18-01-20
08:15 to 10:15
Dermatology
01:30 to 02:00pm
4th
Week 20-01-20
to
25-01-20
Monday
M-5
Hemoglobinpat
hies, Venous
Thrombosis,
Pulmonary
Embolism
Anticoagulants
Therapy ,
Heparin, Oral
(warfarin) Vit K,
Antiplatlets .
Hemoglobinpathi
es, Venous
Thrombosis,
Pulmonary
Embolism
Anticoagulants
Therapy ,
Heparin, Oral
(warfarin) Vit K,
Antiplatlets .
Hemoglobinpat
hies, Venous
Thrombosis,
Pulmonary
Embolism
Anticoagulants
Therapy ,
Heparin, Oral
(warfarin) Vit K,
Antiplatlets .
Dermatology
01:30 to 02:00pm
2:00-230pm
Self Study Time
Tuesday
M-4
Multiple
Myeloma, ITP
Paraproteine
mia
Disorders Of
Coagulaton ITP
Thromohilias
Dermatology
01:30 to 02:00pm
Wednesda
y
M-2
Acute
Leukemia
Chronic
Leukemia
Other
Haematological
Malignancies
Dermatology
01:30 to 02:00pm
Thursday
M-3
Investigations
in Respiratory
Illness
Pneumonia
Pneumonia
Dermatology
01:30 to 02:00pm
Friday
M-1
ASTHMA &
ARDS
ASTHMA &
ARDS
COPD
Saturday
Medicine Test
Saturday
25-01-20
08:15 to 10:15
Dermatology
01:30 to 02:00pm
5th
Week 27-01-20
to
01-02-20
230
Monday
M-5
Fungal
Infections and
ABPA
Interstitial lung
Disease
Sarcoidosis
Occupational
lung Disease
Test Dermatology
01:30 to 02:00pm
2:00-230pm
Self Study Time
Tuesday
M-4
Pleural
Disease , Dry
Pleurisy,
Empyema,
Pneumothora
x
Pleural Disease
, Dry Pleurisy,
Empyema,
Pneumothorax
Tumors of the
Lung and
Respiratory
Tract
Wednesda
y
M-2
Pulmonary TB
Bronchiec
tasis
Pulmonary
Eosiniphilia,
Pulmonary
Vasculitis
Thursday
M-3
Cholestatic Liver
Disease
Primary
Billiary
Cirrhosis
Primary
Sclerosing
Colangitis
Friday
M-1
Hepatitis A,,B,C,D,E
Hepatitis
A,,B,C,D,E
Acute Liver
Failure
Saturday
Medicine Test
Saturday
01-02-20
08:15 to 10:15
6th
Week 03-02-20
to
08-02-20
Monday
M-5
Liver Abscess
Drug Induced Liver
Injury
Approach
to
Dysphagia
,
Malabsor
btion
causing
Disorder
Approach to
Jaundice
2:00-230pm
Self Study Time
Tuesday
M-4
Wilsons Disease
Hemochromatosis
Alpha 1 Antitrypsin
Deficiency
Irritable
Bowel
Syndrome
Ischemic Gut
Injury
Wednesda
y KASHMIR DAY
231
M-2
Thursday
M-3
Hepatoma
Acid Peptic Disease
Non Ulcer Dyspepsia
Oesophageal
Motility Disorder
GERD
Friday
M-1
Autoimmune Hepatitis
Cirrhosis and
Complications
Cirrhosis and
Complications
Saturday
Medicine Test
Saturday
08-02-20
08:15 to 10:15
7th
Week 10-02-20
to
15-02-20
Monday
M-5
Acute and Chronic
Pancreatitis
Approach to
Diarrhea
Inflammatory Bowel
GI MALIGNANCIES 2:00-230pm
Self Study Time
Tuesday
M-4
Hypoparathyroidism
HyperParathyroidism
Autoimmune
Thyroid Disease
Transient Thyroiditis
Iodine Associated
Thyroid Disease
Wednesda
y
M-2
Anterior Pituitary,
Growth Hormone
Disorders
Acromegaly
Gigantism, Short
Stature
infertility
Diseases Of
Hypothalamus and
Posterior Pituitary
Diabetes Incipedous
SIADH
Thursday
M-3 Addison Disease
Cushing Syndrome
Congenital Adrenal
Hyperplasia
Cushing Syndrome
Congenital Adrenal
Hyperplasia
Friday
M-1
Primary and
Secondary
Hyperaldosteronism
Hyperthyroidism
Hypothyroidism
Saturday
Medicine Test
Saturday
15-02-20
08:15 to 10:15
8th
Week 17-02-20
232
to
22-02-20
Monday
M-5
Pheochromocytoma
Polycystic Ovarian
Syndrome
Turner Syndrome
Klienfilter Syndrome
MEN 1
MEN 2
Polyglandular
Symdrome
2:00-2:30pm
Self Study Time
Tuesday
M-4
08:00 -2:00
Clinical Indoor
Classes
08:00 -2:00
Clinical Indoor
Classes
08:00 -2:00
Clinical Indoor
Classes
Wednesda
y
M-2
08:00 -2:00
Clinical Indoor
Classes
Thursday
M-3
08:00 -2:00
Clinical Indoor
Classes
Friday
M-1
08:00 -2:00
Clinical Indoor
Classes
Saturday
Medicine Test
Saturday
22-02-20
08:15 to 10:15
9th
Week 24-02-20
to
29-02-20
10th
Week 02-03-20 to
07-03-20
11th
Week 09-03-20 to
14-03-20
ASSESSMENT WEEKS
233
PRACTICAL PROCEDURES FOR FINAL YEAR
Roll No. ----------- Batch: -------- Year: ----------- Session: ----------
Sr.
#. Practical Procedures for Final Year
Name &
Designation of
Supervisor
Signature Date &
Time
1.
How to check patient vitals(Pulse,
B.P, Temperature, Respiratory
Rate)
2. How to pass a nasogastric tube
3. How to pass a Foley catheter
4. How to give Intramuscular
injection
5. How to give Intravascular injection
6. How to pass an I/V cannula
7. How to observe passing & care of
CVP line /double lumen line
8. How to give insulin injection
9. Preparation & regulation of
Ionotropic Support
10. Observe and assist how to do a
lumbar puncture
11. Observe and assist how to do a
diagnostic ascitic tap
12. Observe and assist how to do a
diagnostic pleural tap
13.
Observe how to do a
Cardiopulmonary Resuscitation in
emergency and be a part of CPR
Team
14. Observe how to pass Endotracheal
tube in unconscious patient
15. How to take a blood sample
16. How to pass an airway
17. Care of unconscious patient for
06 hours
18. How to do suction
234
19. Nebulization
20. How to use Gluco meter &
checking of RBS
21. How to do ECG
22. How to check O2 saturation by
Pulse oximeter
23. How to use Vein Detector
24.
Workshop for self protection
(Needle stick injury, HIV, Congo
virus, Bird Flu, Tuberclosis, Ebola
Virus, Self needle disposal)
(HIV can be transmitted through
polythene gloves)
25.
Workshop for infusion protocol
(Streptokinase, MgSO4,
Solumedrol, Insulin, Labetolol,
Nitrate, Na Nitroprusside,
Hydralazine)
26. How to give IM Inj. Benzathine
Penicillin
235
FEED BACK
● What was atmosphere in Medical unit?
● What was best thing in Medical unit ?
● What was worst thing in Medical unit ?
● Is evening classes are beneficial and which extent?
● Any improvement, which can be made/Suggestion?
236
FIRST WEEK (CVS)
DISCUSSION CLASS
Timing (10:30am to 11:15am)
ECG:
1. Basic Principals of ECG
2. Reading a normal ECG
3. Tachyarrhythmia, Bradyarrhythmia
4. Ischemia infraction
5. Hypertrophy
6. Heart Block
LONG CASE
Timing (11:15am to 01:00pm)
SHORT CASES
Timing (01:00pm to 02:00pm)
● General physical examination
● Inspection of precordium
237
SECOND WEEK (CVS)
DISCUSSION CLASS
Timing (10:30am to 11:15am)
1. IDH (Angina, Acute Coronary Syndrome, Myocardial Infection)
2. Pericarditis , Pericardial effusion, Electrolyte Changes
3. B.P apparatus and B.P recording
4.
LONG CASE
Timing (11:15am to 01:00pm)
SHORT CASES
Timing (01:00pm to 02:00pm)
● Palpation and Auscultation of precordium (CVS)
List of Short Cases
● Mitral stenosis
● Mitral regurgitation
● Mixed mitral valve disease
● Aortic regurgitation
● Aortic stenosis
● Jugular venous pulse
● Mixed aortic valve disease
● Infective endocarditis
● Examination of pulse
● Ventricular septal defect
● Tricuspid regurgitation
● Atrial septal defect
238
List of Long Cases:
● Heart Failure
● Rheumatic Fever
● Infective endocarditis
● ACS
● MI & Complications
● Hypertension
● Pericarditis
● Cardiomyopathy
THIRD WEEK (GIT)
DISCUSSION CLASS
Timing (10:30am to 11:15am)
1. NG tube, Sangsataken tube
2. Endotracheal Tube, Ambu Bag, Air Way
3. IV line, Double lumen, CVP line
4. Foleys Catheter
5. Nebulizer
6. Pulse Oximeter, Glucometer
LONG CASE
Timing (11:15am to 01:00pm)
SHORT CASES
Timing (01:00pm to 02:00pm)
● Inspection of Examination of GIT
List of Long Cases:
● Cirrhosis
● Auto immune Hepatitis
● Jaundice
● Acute Hepatitis
● Primary Billiary cirrhosis
239
● Primary Sclerosing cholangitis
● Inflammatory bowel disease
● Coeliac disease
● Acute pancreatitis
List of Short Cases:
● Hepatomegally
● Jaundice
● Ascites
● Splenomegaly
3rd Week
DISCUSSION CLASS
Timing (10:30am to 11:15am)
1. CT Scan/MRI, Normal
2. Cerebral, Infarction, Intracerebral Bleed, SAH
3. SOL, Abscess, Encephalitis, Hydrocephalus
4. Brain Atrophy, Tuberculoma
5. L.P needle
6. Ophthalmoscope
LONG CASE
Timing (11:15am to 01:00pm)
SHORT CASES
Timing (01:00pm to 02:00pm)
● Examination of CNS + Cranial Nerves
o Stroke
o Spastic paraplegia
240
o Cerebellar syndrome
o Third nerve palsy
o Parkinson disease
o Seventh nerve palsy
o Myasthenia gravis
4th Week
DISCUSSION CLASS
Timing (10:30am to 11:15am)
● X-Ray Chest
o Normal X-ray Chast
o Pulmonary Diseases
o Cardiac Diseases
o Emergency Drugs
1. Inj. Solucortef Inj. Adrenaline Inj. Dopamine Inj. Dobutamine Inj. Nikethamide Inj. 25% D/W
2. Inj. NaHCO3 Inj. KCL Inj. Atropine S/L angisid Disprin
3. Inj. Isoket Inj. Heparine Inj. Amidarone Inj. Xylocaine
LONG CASE
Timing (11:15am to 01:00pm)
SHORT CASES
Timing (01:00pm to 02:00pm)
● Examination of Chest (Respiratory System)
241
WARD PROGRMME FINAL YEAR SESSION 2019-2020
DURATION OF FIRST BATCH
30-12-2019 TO 14-03-2020 (10 WEEKS)
WARD 30-12-2019 TO
14-03-2020
16-03-2020 TO
06-06-202
08-06-2020 TO
26-09-2020
MEDICAL UNIT-I A-1 C-1 B-1
MEDICAL UNIT-II A-2 C-2 B-2
MEDICAL UNIT-III A-3 C-3 B-3
● WARD/OPD ACTIVITY: 10:30 AM TO 1:15 PM IN FIRST 4 WEEKS THEN 20:30 – 2
● EACH BATCH OF STUDENTS WILL BE APPROXIMATELY 38 STUDENTS IN EACH
WARD.
● EACH WARD WILL DEVIDE STUDENTS INTO TWO GROUPS A & B (19 EACH).
● BATCH A WILL DO OPD ON MONDY.
● BATCH B WILL DO OPD ON THURSDAY.
● LECTURE TIME: 8:00 – 10:15 AM BY TWO CONSULTANTS.
● EVENING ACTIVITY: 3-8 PM EACH EVENING CLASS WILL BE CONDUCTED BY 2
MASTER TRAINERS.
● EACH WARD WILL DEVIDE STUDENTS INTO TWO GROUPS A & B (19 EACH).
DEPARTMENT OF MEDICINE
242
WEEK-1 (30-12-2019 to 04-01-2020)
Day 1 & 2 : DM Module
Day 3, 4 & 5: Wards off d/t final prof.
Week-2 (06-01-2020 to 11-01-2020)
Day 1 & 2: HTN Module
Day 3: MS/MR
Day 4: Infective endocarditis
Day 5: Rheumatic fever
Day 6: Weekly assessment
Week-3 (13-01-2020 to 18-01-2020)
Day 1: Heart failure
Day 2: AS/AR
Day 3 & 4: Anemia, Lymphoma & Miscellaneous
Day 5: Weekly assessment.
Week-4
Day 1: DVT
Day 2: ITP
Day 3: Leukemia/Miscellaneous/Asthma
Day 4: Pneumonia
Day 5: COPD
Day 6: Weekly assessment
Week-5
Day 1: ILD
Day 2: Pneumothorax, Pleural effusion
Day 3: Pulmonary tuberculosis
Day 4: Primary biliary cirrhosis/sclerosing cholangitis
Day 5: Acute hepatitis
Day 6: Weekly assessment
Week-6 (03-02-2020 to 08-02-2020)
Day 1: Jaundice
Day 2: Wilson/Haemachematosis
243
Day 3: 5th Feb
Day 4: HCC
Day 5: CLD, Cirrhosis
Day 6: Weekly assessment
Week-7 (10-02-2020 to 15-02-2020)
Day 1: Acute pancreatitis / Inflammatory Bowel Disease
Day 2: Flypothyroidism
Day 3: Accomegaly
Day 4: Diabetes Inspidus / SIADM
Day 5: Hyperthyroidism
Day 6: Weekly assessment
Week-8 (12-02-2020 to 22-02-2020)
Day 1: Pheochromocytoma
CVS
DAY 1
3-4: Protocol of Examination + introduction + position, exposure
4-5 Inspection f precordium
6-7 General physical examination
7-8 General physical examination and IVP
DAY 2
3-4 Palpation of precordium
Apex beat
RV Heart
Palpable heart sounds
4-5 Auscultation of precordium
5-6 First and second heart sounds
Added sounds
6-7 Revision and practice of palpation and auscultation
7-8 Revision and practice of palpation and auscultation
DAY 4
Individual practice and revision of examination of CVS
244
CHEDULE OF 4TH YEAR MBBS CPC (EVERY THURSDAY)
TIMING: 8:45am to 10:00am
VENUE: Pathology Lecture Hall, FMU
SR.NO DATE TOPIC ORGANIZING
UNIT
1.
12-12-2019
Pathology Pathology
2.
26-12-2019 Red Eye Eye
3.
02-01-2020
Management of Deaf
Child ENT
4.
09-01-2020 Balanced nutrition Community
5.
16-01-2020 Liver cirrhosis Medical Unit-IV
6.
23-01-2020 Pneumothorax Surgical Unit-IV
7.
30-01-2020 BLS Anesthesia
245
Prescription Writing
Name:____________________ Age:_________________ Address:_______________________
Diagnosis:__________________ Essential Hypertension_____________________
: Target Pre drug BP
Target LDL
Life style modification
Tab. Zestril (Lisinopril) 10mg
1+0+0
246
Prescription Writing
Name:____________________ Age:_________________ Address:_______________________
Diagnosis:__________________ Type-II Diabetes Mellitus ____________________________
: Target Pre Meal BSL
Target Post Meal BSL
Target HbA1C
Target LDL Life style modification
Weight reduction
Tab. Glucophage 500mg
1+0+1
Life style modification
Tab. Zestril (Lisinopril) 10mg
1+0+0
247
SCENARIOS:
1. A 47 year old obese man presented to Outpatient Department with history of
Hypertension for 3 months not adequately controlled with lifestyle modifications alone.
Family History of Hypertension is also positive. His recent B.P is 150/90 mmHg. What
will be the first line Anti-Hypertensive Drug for this patient?
● Methyldopa
● Clonidine
● Frusemide
● Lisinopril
● Metoprolol
2. A 53 year old lady presented in Clinic with Essential Hypertension very well controlled on
lifestyle modifications and ACE Inhibitors. But she Developed dry cough after start of ACE
inhibitors. On further evaluation no specific reason was found for dry cough. Now what is be the
most appropriate treatment option?
● Switch ACE Inhibitors with Beta Blockers
● Switch ACE Inhibitors with Frusemide
● Switch ACE Inhibitors with ARB’S
● Switch ACE Inhibitors with Methyldopa
● Continue ACE Inhibitors and Reassure
3. A 60 year old male with H/O Stable Angina and Hypertension presented to you with
Hypertension. What antihypertensive drug will be the drug of choice in this patient
besides lifestyle modifications?
● ACE Inhibitors
● Ca Channel Blockers
● Beta Blockers
● Diuretics
● ARB’s
4. A 49 year old man with history of Myocardial infarction presented with complains of Exertional
SOB, Orthopnea and PND. He is taking Antiplatelet, Statins, Nitrates, Loop Diuretics . His B.P
248
is uncontrolled. What antihypertensive drug need to be added in this patient in order to control
B.P and also for cardiac remodeling?
● ACE Inhibitors
● Ca Channel Blockers
● Alpha Blockers
● Thiazide Diuretics
● Centrally acting drugs
5. A 62 year old male with History of Type 2 Diabetes Mellitus for 15 years presented with
uncontrolled B.P despite of lifestyle modifications. His RFT’s are within normal limit but there is microscopic proteinuia. What antihypertensive drug will be the treatment of choice in this
patient?
● ARB’S
● Ca Channel Blockers
● Alpha Blockers
● Thiazide Diuretics
● Centrally acting drugs
6. A 41 year old obese lady Presented in Diabetic Clinic with History of Polyurea for last 6 months.
On examination there is Acanthosis Nigricans and Hepatomegly. She also had checked her
random blood sugar level which ware above 200 mg/dl on most of the occasions. Her recent
HbA1c was 8.1 % . She is on lifestyle modifications for the last 6 months. What
antihyperglycemic drug you will add to control her Blood sugar levels.
● Gliclazide
● Metformin
● Empagliflozin
● Acarbose
● Sitaglipin