1

KATHMANDU UNIVERSITY SCHOOL OF MEDICAL SCIENCES

BACHELOR OF MEDICINE & BACHELOR OF SURGERY (MBBS) CURRICULUM

Revised Version 2011

2

CURRICULUM FOR

BACHELOR OF MEDICINE & BACHELOR OF SURGERY (MBBS)

KATHMANDU UNIVERSITY DHULIKHEL, KAVREPLANCHOWK

NEPAL 2011

3

FOREWORD

Kathmandu University was established in November 1991 by an act of Parliament. Kathmandu University started functioning from December 11, 1991. The University operates through the School of Sciences, Engineering, Management, Arts, Education and Medical Sciences.

The University first granted affiliation to a private medical college, Manipal Colleges of Medical Sciences, at Pokhara to start MBBS program since December 1994. Since then six other medical colleges have been granted affiliation college of Medical Sciences, Bharatpur, Chitwan, in August 1996; Nepalgunj Medical College, Chisapani, Banke, in December 1997; Kathmandu Medical College, Kathmandu, in December 1997; Nepal Medical College, Kathmandu, in December 1997; Nobel Medical College, Biratnagar, in February 2007 and Lumbini Medical College, Palpa, in February 2009.

Kathmandu University School of Medical Sciences started its own Medical College in collaboration between Kathmandu University and Dhulikhel Hospital. KUSMS launched its own constituent MBBS program in August 2001.

The first MBBS curriculum in now called Pre-Clinical Science was developed in association with the Manipal Academy of Higher Education, Manipal, India. In Keeping with developments in modern medical education, the first review of the Pre-Clinical Science curriculum was carried out in 1996 along with the participation of the Institute of Medicine, Tribhuvan University and Manipal Academy of Education, Manipal, India. The outcome was the second version of Pre-Clinical Science curricumum in December 1996.

The University is in touch with the changing scenario in Medical education. The emphasis is now on problem-based learning. With this concept in mind, another review of the Pre-Clinical Sciences curriculum was carried out in March 2001. The new version emphasizes teaching Pre-Clinical Science subjects system-wise and in an integrated way. Appropriate common clinical problems related to each organ system was revised in consonance with the existing health situation; and practical activities were identified in each subject. A chapter on medical ethics was added. Also during that phase the student were introduced to clinical knowledge and skills utilizing a problem solving approach. Medical informatics was added in newly to enhance computer literacy relevant to medical education. These changes fostered in students the ability to learn through self-directed and independent study.The Third Version was introduced in august 2001 academic session; there was rearrangement of the Community Medicine curriculum.

The present edition of the Fourth version which begins from August 2011 academic session contains rearrangement of semesters (instead of Unit) and evaluation scheme. Extensile information gathering from all concerned was done. Workshops were conducted inviting all representatives from all affiliated colleges of KU; TU-IOM and Nepal Medical Council necessary changes in the curriculum were done. Common curriculum and evaluation scheme for both constituent and affiliated colleges is adapted. PBL (Problem Based Learning) teaching methodology and Introduction to Clinical Medicine (ICM) are introduced in both constituent as well as affiliated colleges. The University is aware of the fact that there is no best way but always a better way and is always commited to improve the curriculum, as necessity demands.

4

Table of Contents

Pre-Clinical Sciences

Contents Page

Kathmandu University Mission ................................................................................................... 1 Overall Goals of the School of Medical Sciences ........................................................................ 2

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

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

The Curriculum Outline .............................................................................................................. 5

Objectives of the MBBS Program ............................................................................................... 6 Guidelines to Medical College and Faculty ............................................................................... 10

First Year

Semesters I & II Objectives & Contents..11 Semester - I ........................................................................................................................ 12-40

Basic Concepts .............................................................................................................. 12 Genetics ........................................................................................................................ 22 Immune system and immunology .................................................................................. 25 Autonomic Nervous system ........................................................................................... 32 Integumentary System ................................................................................................... 35 Musculo-Skeletal System...36 Community Medicine.40 Introduction to Clinical Medicine (ICM) ....................................................................... 39 Medical Informatics....................................................................................................... 40

Semester - II ................................................................................................................... (41-59) Haemopoetic System39 Respiratory System ........................................................................................................ 41 Cardiovascular System .................................................................................................. 48 Community Medicine .................................................................................................... 55 Introduction to Clinical Medicine (ICM) ....................................................................... 59

5

Second Year

Semesters III & IV Objectives & Contents..11 Semester - III ................................................................................................................... (60-98)

Gastrointestinal System ................................................................................................. 61 Hepatobiliary System .................................................................................................... 69 Renal-Electrolyte System .............................................................................................. 73 Metabolism and Endocrine System ................................................................................ 79 Community Medicine .................................................................................................... 95 Introduction to Clinical Medicine (ICM) ....................................................................... 98

Semester - IV ................................................................................................................. (99-121) Reproductive System ..................................................................................................... 99 Central Nervous System and Special Senses ................................................................ 105 Community Medicine .................................................................................................. 118 Introduction to Clinical Medicine (ICM) ..................................................................... 121

List of Practical Classes .......................................................................................................... 122 List of Formate of ICM..222

ANNEXES: Annex I Subject wise break down of Semester hours: Semesters I- IV ..................... 217-218 Annex II Calendar of Operation for an Academic Year...219 Annex III Scheme for Semester Examinations ...................................................... .220 Annex IV Flow Chart of Modules in Community Medicine...221 Annex VIII List of Reference Books ....................................................................... ...234 Annex IX List of Participants .................................................................................... 238

6

KATHMANDU UNIVERSITY MISSION

The Kathmandu University has the mission to:

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

b) develop an awareness of the role of sciences and its application in the understanding of problems of contemporary society.

c) extend and disseminate knowledge and encourage its application.

d) develop a community of scholars, students and staff in which understanding and wisdom can grow and flourish.

7

OVERALL GOALS OF THE SCHOOL OF MEDICAL SCIENCES

The School of Medical Sciences of Kathmandu University is headed by the Dean and has the following overall goals:

1. conduct and give permission to conduct academic programs of certificate, bachelor, masters and doctoral levels in medical sciences including other branches of health sciences.

2. collaborate and coordinate with medical schools of other universities for the growth and development of academic programs, research undertakings and health care services.

3. promote and conduct research for the growth of new scientific knowledge.

4. participate and provide health care to the people.

8

GENERAL DESCRIPTION OF THE CURRICULUM

This curriculum, which has been designed embracing modern Educational Science Technology as applied to Medical Education, provides for acquisition of

a core knowledge, the basic medical doctor must possess. clinical skills to diagnose and manage disease. desirable characteristics and attitudes ingrained in the profession. competency to determine and resolve health problems of the community. proficiency to function in diverse health care settings. interest in continuing medical education.

9

FEATURES OF THE CURRICULUM

The curriculum is

Student centered (rather than teacher centered) Problem based (rather than subject based) Integrated (rather than discipline based)

Community oriented (rather than hospital centered) Electives embodied (rather than standard program oriented)

Systematic (rather than apprentice based)

10

THE CURRICULUM OUTLINE

The aim of this curriculum for the MBBS degree is to produce a well-rounded medical graduate, who as a result of the five and half years of undergraduate education program in medical sciences will be competent to carry out preventive, promotive and curative functions expected of a basic doctor. The accent of the curricular approach is community orientation, integrated teaching-learning and problem-based learning.

The curriculum synthesized initially (in 1994) consulting the curricula of medical institutions in Nepal is aptly revised and presented here.

The four-and-half year span of the MBBS course of study is divided into nine semesters, each of six months duration. The first four semesters are devoted to the Pre-Clinical Sciences. The next five semesters are devoted to Clinical Sciences. After successful completion of the course of study of four-and-half years, and having passed the final MBBS examination, the student will have to complete one year of compulsory Rotating Residential Internship to become eligible for being conferred with the degree of MBBS of the Kathmandu University.

The MBBS curriculum is divided into two Parts. Pre-Clinical sciences include the curriculum of the first and the second year. Whilst, the Clinical Sciences include the curriculum of the remaining two and a half years.

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

The First year and the Second year instruction cover Integrated Pre-Clinical Sciences, Community Medicine and Introduction to Clinical Medicine.

Pre-Clinical Sciences include Anatomy, Biochemistry, Microbiology, Pathology, Pharmacology and Physiology. These subjects will be taught in an integrated manner and would be threaded into Community Medicine and Introduction to Clinical Medicine, as appropriate. Also, during this phase the student will be introduced to clinical knowledge and skills utilizing a problem solving approach. Medical Informatics will provide computer literacy relevant to medical education.

11

OBJECTIVES OF THE MBBS PROGRAM

On completion of the five and a half year of MBBS program, the Medical Graduate should be able to: a) Demonstrate the understanding of principles and practice of modern medicine with an in-depth

knowledge of structure and functions of human body. b) Develop a holistic approach to the practice of modern medicine. c) Advance ones own knowledge and skills through higher education via continuing medical education

programs and research. d) Demonstrate an understanding of contemporary knowledge and skills. e) Possess qualities of a compassionate and socially accountable human being. f) Discharge job responsibilities with concern and care. g) Provide immediate management care to life threatening situations by self. h) Identify common health problems, manage them initially, ask opinion from seniors or refer to

appropriate health institutions when required. i) Provide education to people on health and health related matters. j) Participate in immunization programs and in health camps. k) Communicate well with patient and patients relatives by explaining matters known and refer them to

appropriate persons when matters are not clear to self. l) Provide all information on matters of management of patients to the patient and the relatives. m) Identify medico legal cases and function as required. n) Develop a health care team-approach and give respect to all the other members of the team. o) Give due care to children, elder citizens and women. p) Provide health care by becoming aware of the ethos of medical ethics.

12

CURRICULUM FLOWCHART

PRE - CLINICAL SCIENCES

11st year SEMESTER I Basic concepts Genetics Immune System and Immunology Autonomic Nervous System Integumentary System Musculo-skeletal System Community Medicine Introduction to Clinical Medicine (ICM) Medical Informatics

SEMESTER II Haemopoietic System Respiratory System Cardiovascular System Community Medicine Introduction to Clinical Medicine (ICM)

2nd year SEMESTER III Gastrointestinal System Hepatobiliary System Renal - Electrolyte System Metabolism and Endocrine System Community Medicine Introduction to Clinical Medicine (ICM)

SEMESTER IV Reproductive System (including breast) Central Nervous System and Special Senses Community Medicine Introduction to Clinical Medicine (ICM)

13

COURSE REGULATIONS (Eligibility; Attendance; Examinations)

1. The candidate must complete Intermediate Science or 10+2 years of education or equivalent with English, Biology, Physics and Chemistry as main subjects and having secured not less than 50% of marks in the subjects mentioned above put together and an aggregate of 50% overall. The candidate should have completed 17 years of age on or before the date of admission, or

completed B.Sc. Degree recognized by the university with one of the following subjects viz. Physics, Chemistry or Biology and at least one other prescribed science subject of study up to the ancillary level and should have scored not less than aggregate of 50% marks and provided that such candidate shall have passed the earlier qualifying examination (I. Sc. or equivalent) with the subjects English, Biology, Physics and Chemistry.

2. In order to derive maximum benefit from integrated teaching the student is expected to have 100% attendance in all the subjects; however to meet unavoidable contingencies the student should have not less than 80% of the attendance separately in theory and practical / clinical to be eligible for the university examination.

5. A student should clear all the subjects of Pre-Clinical Sciences, before he/she is allowed into Semester V.

6. A student must complete the different subjects of the Pre-Clinical Sciences - I MBBS Examination within three years from the date of admission. Similarly, a student must complete the different subjects of the Pre-Clinical Sciences - II MBBS Examination within four and half years from the date of admission.

7. Internal assessment: At the end of every system, formative evaluation may be conducted to enable the students to learn and to get a feed back of the progress in all subjects. Average of these marks should constitute 50% of an individuals internal assessment for theory component. The average of marks obtained in the semester examinations (two in a year) in that subject should account for the remaining 50%. The average of the sessional marks in practical shall constitute the internal assessment for practical. To qualify for the University examination a student is required to obtain a minimum of 50% internal assessment in both theory and practical separately in each subject.

9. The mandatory minimum mark for passing the theory examination in any subject is 50% of the marks in the theory segment (i.e. written, viva-voce and internal assessment components put together), including not less than 50% of the maximum marks in the written component. Both written and viva-voce are compulsory components of university theory examination.

The mandatory minimum mark for passing the practical examination in any subject likewise is 50% of the maximum marks in the practical segment (i.e. practical plus internal assessment).

10. The evaluation scheme for Kathmandu University School of Medical Sciences will be according to the KUSMS Evaluation Scheme.

General Recommendations

Each semester consists of 20 weeks of 6 working days per week, 7 hours/ day. The time frame may not be relevant for hospital postings.

Curriculum should be approached in a manner so that not more than one third of the time allotted for each subject is spent as didactic teaching.

14

The examinations in theory and practical will be as objective and structured as possible.

The University will maintain Question Bank for every system subject wise, consisting of different types of questions.

The University will conduct workshops for faculty development (teaching-learning and student evaluation) as necessary.

15

GUIDELINES TO MEDICAL COLLEGE AND THE FACULTY

The Medical College should follow the curriculum guidelines in imparting knowledge to the undergraduate student.

Emphasis should be laid to ensure that the undergraduate student grasps the basic concepts throughout the course.

When time-tabling the semester schedules, the concerned academic departments should get together and identify in an integrated manner, the instructional objectives to be covered.

As a rule, the departments concerned should ensure integration of related subject matter of a particular System / Topic by carrying out teaching synchronously.

In instruction, common clinical problems should form the prologue to establish relevance of basic sciences to clinical medicine.

In correlation seminars, the student should be guided to address common problems / common clinical problems serving as themes, around which discipline-wise subject is threaded coherently.

Pre-Clinical sciences should be revisited as a rule whilst implementing Clinical Sciences of the curriculum of clinical disciplines.

Clinical symptoms and clinical signs must be emphasised upon and should be explained, referring to Pre-Clinical sciences, wherever possible.

16

PRE - CLINICAL SCIENCES

17

PRE - CLINICAL SCIENCES

11st year SEMESTER I Basic concepts Genetics Immune System and Immunology Autonomic Nervous System Integumentary System Musculo-skeletal System Community Medicine Introduction to Clinical Medicine (ICM) Medical Informatics

SEMESTER II Haemopoietic System Respiratory System Cardiovascular System Community Medicine Introduction to Clinical Medicine (ICM)

2nd year SEMESTER III Gastrointestinal System Hepatobiliary System Renal - Electrolyte System Metabolism and Endocrine System Community Medicine Introduction to Clinical Medicine (ICM)

SEMESTER IV Reproductive System (including breast) Central Nervous System and Special Senses Community Medicine Introduction to Clinical Medicine (ICM)

18

FIRST YEAR

SEMESTERS I & II

OBJECTIVES:

SEMESTER I Facilitates acquisition of fundamental knowledge in pre-clinical sciences, required to understand the human body systems to follow. Provides learning inputs in structural-functional aspects on the immune system and immunology, integumentary and musculo-skeletal to understand diseases process affecting these systems.

SEMESTER II Provides learning inputs in respiratory, cardiovascular, function-dysfunction with a basis for understanding, common clinical disorders, affecting respiratory and cardiovascular systems.

CONTENTS:

Basic Concepts

Genetics

Immune System and immunology

Autonomic Nervous System

Integumentary System

Musculo-skeletal System

Haemopoietic System

Respiratory System

Cardiovascular System

Community Medicine

Introduction to Clinical Medicine (ICM) Medical Informatics

19

SEMESTER - I

BASIC CONCEPTS

COMMON CLINICAL PROBLEMS: Understanding the Human Body and Its Functions Maintaining Normal Health Understanding Disease Human Values and Value-Systems Medical Profession and Professional Ethics

ANATOMY General Anatomy General Histology General Embryology BIOCHEMISTRY Importance of Biochemistry in Medicine Introduction to cells Carbohydrates Amino acids Proteins Lipids Nucleic acids-Gene Expression Enzymes Metabolism Vitamins MICROBIOLOGY Historical perspectives and contributions of Microbiology to medical sciences. Differences between Prokaryotic and Eukaryotic cells, Fungi, Bacteria, Viruses and Parasites. Introduction, classification and nomenclature of microbes. Bacteria - Introduction Anaerobiosis Sterilization, Disinfections, Decontamination: Normal Flora Infection Bacteria - Introduction Fungi - Introduction Viruses - Introduction Parasites - Introduction Antimicrobial Agents Microbial genectics Laboratory diagnosis of Viral, Bacterail, fungal and parasitic infections. Biomedical waste management. Hospitalacquired infection and HICC.

PATHOLOGY Cellular adaptations, cell injury and cell death Inflammation and Repair Hemodynamic disorders Neoplasia

PHARMACOLOGY Introduction

20

Sources and Routes of Drug Administration Pharmacokinetics Pharmacodynamics Adverse Drug Reactions Essential Drugs Concept and Rational Drug Therapy P-drug concept

PHYSIOLOGY Introduction Homeostasis Bioelectricity

COMMUNITY MEDICINE Human and Medicine Concepts of Health Nutrition Environmental Sciences Biostatistics

INTRODUCTION TO CLINICAL MEDICINE Medical Ethics Art of History Taking Clinical Examination

MEDICAL INFORMATICS Fundamentals of Computer Windows 98/2000 Applications Word Processing (Microsoft Word) Working With Worksheets (Microsoft Excel) Graphic Presentation (MS-Power Point and Multimedia) Statistical Treatment of Data (Using Epi Info WHO Epidemiological Software) Retrieving Information (Internet WEB)

CONTENTS

ANATOMY

General Anatomy:

Introduction to anatomy - anatomical positions, planes and terms.

Cell divisions

Skin and fasciae - introduction.

Locomotor system.

Bones - classification, functions, development, growth.

Long bones - parts and blood supply.

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

21

Joints - classification, examples of each variety.

Muscles - classification, examples of each type.

Nervous tissue- introduction to nervous system, subdivisions and their functions, neurons- types, structure, nerve fibres, synapses

General Histology:

Cell and sub-cellular organelles - electron microscopic structure. Structure and function of nucleus, mitochondrion, endoplasmic reticulum, Golgi Apparatus, lysosome.

Epithelial tissues - definition, classification, functions.

Connective tissues classification, functions structural components.

Skin & Fascia- structure

Exocrine glands classification with examples.

Muscles types with example.

Bone- TS & LS

Blood vessels: artery large & medium size and vein.

Nervous tissue- nerve, spinal ganglia, sympathetic ganglia, neurons & neuroglia.

Microanatomy of adrenal medulla

General Embryology:

Menstrual cycle

Gametogenesis

Graafian follicle, spermatozoon - structure

Corpus luteum formation, fate

Ovulation, fertilisation, implantation

Morula and blastocyst formation

Bilaminar embryonic disc

Neurulation

Formation and fate of notochord

Intraembryonic mesoderm and its subdivisions (somites)

Ectoderm, mesoderm, endoderm derivatives

22

Folding of embryo

Embryonic period

Placenta: Structure, formation, types, function and twinning

Foetal membranes: chorion, decidua, umbilical cord amnion, yolk sac and allantois brief account

Foetal period

Teratogens and teratology

BIOCHEMISTRY

Importance of Biochemistry in Medicine: Molecular basis of disease, role of biochemistry in diagnosis

Introduction to cells: Prokaryotic and Eukaryotic cells, cell structure, biochemical functions of organelles

Carbohydrates: Biomedical importance, functions, classification, isomerism Monosaccharides, disaccharides, polysaccharides: starch, glycogen, cellulose - structure and properties, glycosaminoglycans, proteoglycans and glycoproteins

Amino acids: Classification, special structural features, functions, optical activity, iso-electric pH, acid-base properties and characteristics of peptide bond

Proteins: Classification and structural organisation, functions

Lipids: Classifications, Fatty acids and its classifications, poly unsatuarated fatty acids, triacylglycerols, phospholipids, prostaglandins, steroids and lipoproteins

Nucleic acids - Gene Expression: Purine - pyrimidine bases, purine pyrimidine derivatives, DNA and RNA structure and functions, concept of exons, introns, gene expression.

Enzymes: Definition, International Union of Biochemistry (IUB), classification, enzyme kinetics, factors affecting activity, regulation of activity, inhibition of activity, measurement of enzyme activity isoenzymes, enzymology in medicine.

Metabolism: Essentials of metabolism, metabolic pathways, regulation, integration

Vitamins: Definition, classification, vitamin cofactors - biochemical functions, deficiency symptoms

MICROBIOLOGY`

23

Historical perspectives and contributions of Microbiology to medical sciences Differences between Prokaryotic and Eukaryotic cells, Fungi, Bacteria, Viruses and Parasites Introduction, classification and nomenclature of microbes

Bacteria - Introduction: a. Morphology of bacteria and Bacterial spore b. Bacterial growth requirements, bacterial growth curve and its relationship with infection and disease, growth media and types of culture. c. Anaerobiosis: Definition, classification and method of anaerobiosis and anaerobic culture.

Sterilization, Disinfections, Decontamination: Definitions, Principles, methods and their applications

Normal flora: Preliminary concepts, anatomical distributions, factors influencing normal flora, bacteriocin, role of normal flora in nosocomial infections and opportunistic infections

Fungi: Introduction, general characteristics and classification of fungal infections

Viruses Introduction: a. Introduction, general characteristics and classification of viruses and bacteriophage b. Replication, pathogenesis of viral diseases

Parasites Introduction: Classifications of parasites (by morphology, infection sites/disease) Host parasite relationship

Infections: Types of infections (local and systemic), source of infections (including Zoonotic diseases), Mode of transmission of microorganisms, Virulence factors and Mechanism of pathogenesis Host parasite relationship of medically important bacteria, viruses, fungi and parasites

Complement system: Role of complement, different pathways

Laboratory diagnosis of Viral, Bacterial, fungal and parasitic infections: Principles, specimen collection, storage and transport, methods of diagnosis

Antimicrobial agents: Antibiotic susceptibility test, reliability of tests, factors influencing susceptibility tests.

Infectious waste management Hospital acquired infection and HICC

PATHOLOGY

Cellular Adaptations: Atrophy, hypertrophy, hyperplasia, metaplasia - definitions, examples and mechanism

Cell Injury:

24

Reversible and irreversible - mechanism and changes produced in different types of degeneration including fatty change in liver and heart. Necrosis - definition, types, examples and morphology. Differences between necrosis and apoptosis Mechanism of apoptosis

Pathologic Calcification: Definition, types, mechanism, examples

Inflammation and Repair: Definition, acute and chronic inflammation - morphological types, vascular and cellular response, chemical mediators and their role in inflammation, Granuloma - definition, description, diseases. Wound healing - mechanisms, factors affecting healing.

Shock, Oedema, Thrombosis, Embolism, Infarction and Chronic Venous Congestion: Shock -definition, morphological changes in target organs and aetiopathogenesis. Oedema - pathogenesis. Thrombosis - types, pathogenesis, morphology, fate of thrombus. Embolism - definition, types, sequelae. Infarction - sites, types, consequences. Chronic venous congestion - gross and microscopic changes in lungs, liver, spleen.

Neoplasia: Definitions of neoplasia - tumour - dysplasia, carcinoma in situ and allied definitions Benign - malignant neoplasia - differences Mode of spread of malignant tumours with suitable examples Histogenetic classification - epithelial, mesenchymal, totipotent Aetiopathogenesis, oncogenesis and clinical presentation of tumors - benign-malignant Paraneoplastic syndromes - brief discussion Laboratory diagnosis

PHARMACOLOGY

Introduction to General Pharmacology: Explanation of terms Pharmacology, drug, pharmacokinetics, pharmacodynamics, therapeutics, chemotherapy, pharmacy, Clinical pharmacology, orphan drug Terminology of allied branches, sources of information, drug nomenclature Definition of terms: Alkaloid, glycoside, oil, tannin

Sources and Routes of Drug Administration: Sources and nature of drugs: common sources e.g., natural (plant, animal) & synthetic Routes of drug administration: common routes, advantages - disadvantages, new drug delivery systems

Pharmacokinetics: Absorption and bioavailability of a drug Methods of absorption, factors affecting drug absorption and bioavailability Bioavailability, Bioequivalence: definition - significance Distribution of drugs: concept of apparent volume of distribution,protein-binding of drugs and its clinical importance Blood brain barrier, placental barrier

25

Biotransformation: definition, types of reactions, consequences, factors affecting biotransformation, clinical significance. Excretion: routes, factors affecting. Kinetics: first order, zero order, biological half-life. Optimization of dosage regimen: loading dose, maintenance dose and steady state plasma concentration. Therapeutic drug monitoring: importance. Methods of prolonging the duration of action of a drug

Pharmacodynamics: Principles of drug action, drug - receptor interactions. Dose response relationships, types of DRC different components like ED50, LD50. Therapeutic index. Factors affecting drug response: Drug factor , Factors related to patient: age, body weight, sex, Pharmacogenetics, Drug Tolerance, Drug Dependence.Drug antagonism, synergism, cumulation.

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

Essential Drug Concept and Rational Drug Therapy: Essential drug concept: principles, importance, model list preparation. Rational drug therapy: concept, examples: p-drug concept

PHYSIOLOGY

Introduction General functional organization of human body. Body fluid compartments- Functions of electrolytes: Dehydration and over hydration. Define and explain terminology: Isotonic, hypertonic, hypotonic fluids Osmotic pressure crystalloid and oncotic. Osmosis Cell membrane transport. Cell to cell and local commutation. Intracellular mechanism of signal transduction

Homeostasis: Definition, maintenance, control of internal environment, different regulatory systems in homeostasis. Principles of control systems general characteristics and components of biological control systems, concept of negative and positive feedback correction, error, gain. Hormonal control mechanisms definition of hormones, receptors and target cell, role of hormones in homeostasis. Neural control mechanism role in homeostasis.

Bioelectricity: Terminology Excitable cells, neurons and muscles and their excitable properties. Functional anatomy of neurons. Resting membrane potential, Nernst equation. Action potential - ionic basis of its genesis and propagation Its refractory period Receptor Classification and functions. Cutaneous receptors - classification and function, generator potential, properties and transduction.

26

27

SEMESTER - I

GENETICS

COMMON CLINICAL PROBLEMS: Cerebral Palsy Downs Syndrome Intra-Uterine Growth Retardation Lactose Intolerance Prematurity

ANATOMY Genetic Terms, Symbols Used in Pedigree Chart Mendelian Inheritance Structure of Chromosomes, Chromosomal Aberrations Sex Determination and Hermaphrodites

BIOCHEMISTRY Nucleic acids and Genetics Biochemistry of Tumor Metabolism Trace Element Metabolism

MICROBILOGY Microbial genectics

PHARMACOLOGY Pharmacogenetics

PHYSIOLOGY Growth and Development Disorders of Normal Growth Physiology of Aging

CONTENTS

ANATOMY

Genetic Terms, Symbols Used in Pedigree Chart

Mendelian inheritance (single gene and multifactorial patterns)

Chromatin and Chromosomes (morphology and classification)

Karyotyping

Chromosomal aberrations (numerical and structural)

Autosomal disorders of chromosomes (Pataus, Edwards, and Downs syndromes)

Sex-chromosomal disorders (Turners, Klinefelters, and fragile-X syndromes, metafemales)

28

BIOCHEMISTRY

Nucleic Acids DNA and RNA: Chemistry, Structure of DNA, types of RNAs. Watson - Crick Model of DNA

Genes: Definition, base sequence determination, types of mutation, mutagens.

Replication: Cell cycle, semi-conservative replication, mechanism

Protein Synthesis: Transcription, translation, fundamental differences between prokaryote-eukaryote protein synthesis.

Regulation of gene expression: Control of gene expression in prokaryotes (Lac operon) and eukaryotes

Recombinant DNA Technology: Knowledge of: Recombinant DNA, vector, cloning, restriction enzyme, blot techniques application in medicine.

Purine and Pyrimidine Metabolism: Synthesis and degradation salvage pathway, uric acid, gout.

Genetic Disorders: Mutation and repair, biochemical disorders of carbohydrate, lipid, amino, purine and pyrimidine, seen in the local hospital. Enzyme Deficiency Disorders Cytogenetic Disorders

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

Trace Element Metabolism: Zinc, Copper, Chromium, Selenium, Molybdenum, Iodine, Fluoride. Iron, cobalt & manganese .

MICROBIOLOGY

Microbial genetics: Introduction, genetic materials, mutation and repair mechanism, gene transfer, genetic basis of pathogenicity, antibiotic resistant and toxogenic gene, molecular diagnostic techniques

PHARMACOLOGY Pharmacogenetics: general concept

PHYSIOLOGY

29

Growth and Development: Definition Physical growth: prenatal period, birth to puberty, pubertal growth. Skeletal age and physical maturity Organ growth: differential growth of specific organs and tissues i.e. brain, head, lymphoid tissue, visceral, reproductive organs at various ages. Growth spurts in human life: infancy, late puberty. Growth rates in boys and girls, mental growth and IQ. Factors influencing growth: genetic, nutritional, hormonal

Disorders of Normal Growth: Abnormalities of foetal and postnatal growth Hereditary short stature

Physiology of Aging: Changes in various systems and mechanisms involved. Factors affecting aging

30

SEMESTER - I

IMMUNE SYSTEM AND IMMUNOLOGY ANATOMY Lymphoid organs

MICROBIOLOGY Immunity Antigens Antibody Immune response Complement system Hypersensitivity Autoimmune diseases Primary and secondary immune deficiency diseases AIDS Immuno-prophylaxis

PATHOLOGY Amyloidosis Organ transplant rejection

PHARMACOLOGY Immunosuppresant and Immunostimulants

PHYSIOLOGY Spleen and Lymph Nodes Lymph and Tissue Fluids Immunology- Plasma Cells and Immune Scenario Immunoglobulins Innate and acquired immunity Plasma Cells and Immune Scenario

CONTENTS

ANATOMY

Gross features and development of Spleen, Tonsil and Thymus

Microanatomy of Lymph node, Spleen, Tonsil and Thymus

MICROBIOLOGY

Immunity: Introduction, basic concepts role of immunity in health and diseases Mechanism of innate, acquired, active, passive immunity

Antigens: Hapten, carrier, epitope, heterophilic antigens

Antibody: Classes, structure and functions of immunoglobulins

Immune response:

31

Humoral and cellular immunity

Complement system: Role of complement, different pathways Common immunological and serological tests used for diagnosis

Hypersensitivity: Types and mechanisms

Immunological disorders: Primary, Secondary immune deficiency diseases A.I.D.S. Auto immune disorders

Immuno-prophylaxis: Introduction, basic concepts; active and passive, vaccines monovalent, polyvalent, live, killed, subunit, synthetic and KBMA vaccines (killed but metabolically active) Common immunological and serological tests used for diagnosis

PATHOLOGY Amyloidosis - definition, classification, morphology, special stains. Organ transplant rejection Types, mechanism, and morphology

PHARMACOLOGY Immunosuppresant and Immunostimulants List the drugs and therapeutic uses

PHYSIOLOGY Spleen and Lymph Nodes: Functions of reticuloendothelial system

Lymph and Tissue Fluids: Formation and functions

Immunology: Introduction. Role of B & T lymphocytes and macrophages in immunity Concepts of function of interleukins and complement system

Immunoglobulins: Types, plasma concentration, functions, special features

Plasma Cells and Immune Scenario: Development, morphology, functions, antibody production

32

SEMESTER - I

AUTONOMIC NERVOUS SYSTEM

COMMON CLINICAL PROBLEMS: Shock Colic Organophosphorous Poisoning Mushroom Poisoning Myasthenia Gravis

ANATOMY Autonomic Nervous System Adrenal Medulla

BIOCHEMISTRY Neurotransmitters

PHARMACOLOGY Introduction Cholinergic Receptor Agonists Muscarinic Receptor Antagonists Adrenergic Receptor Agonists Adrenergic Receptor Antagonists Antimicrobials

PHYSIOLOGY Organisation of Nervous System Physiological Role of Autonomic Nervous System

CONTENTS

ANATOMY

Autonomic Nervous System: Sympathetic nervous system Parasympathetic nervous system

Adrenal Medulla Gross anatomy, microanatomy

BIOCHEMISTRY

Neurotransmitters: Definition Synaptic transmission, Nuromuscular transmission, Neuro transmitter receptors Acetylcholine, dopamine, nor-epinephrine, epinephrine, GABA, Serotonin, Nitric oxide Biosynthesis and metabolism of Polyamines and their medical importance Biochemical basis of Myasthenia gravis Parkinsons disease, organophospherous poisoning. Neuropsyciatric disorders

33

PHARMACOLOGY

Introduction to Autonomic Pharmacology: Review briefly physiology of autonomic nervous system. Define the terms cholinergic receptors, adrenergic receptors. Outline of actions.

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

Cholinergic Receptor Antagonists: Definition List the drugs belladonna alkaloids and atropine substitutes Discussion atropine (prototype) Advantages and disadvantages of clinically used atropine substitutes

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

Adrenergic Receptor Antagonists: Definition, types. - Blockers Classification (selective and non-selective), Mechanism of action, Adverse effects, Contraindications, Therapeutic Uses and Drug interactions .

-blockers Classification (selective and non-selective), Mechanism of action, Adverse effects, Contraindications, Therapeutic Uses and Drug interaction, Propanolol (prototype)

Antimicrobials: Introduction General principles Classification, Mechanism of action, adverse effects, Contraindications, Therapeutic Uses & Drug interactions of Cotrimoxazole, sulphonamides Fluoroquinolons.

34

-lactam antibiotics: penicillins, cephalosporins etc. -lactamase inhibitors: examples. Rationale of combining with -lactams. Aminoglycosides: list of important drugs - Streptomycin, gentamicin, amikacin, netilmicin, tobramicin, neomycin: general features, mechanisms, kinetics, adverse effects, comparison of clinically most useful preparations. Tetracyclines, chloramphenicol. Macrolides:Erythromycin: prototype. Miscellaneous groups of antibiotics: very brief discussion, e.g. bacitracin, vancomycin, clindamycin, polymyxin-B, spectinomycin.

Antifungal Agents: Introduction General principles- Classification, Mechanism of action, Adverse effects, Contraindications, Therapeutic Uses and Drug interactions

PHYSIOLOGY

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

Functional organisation of Autonomic Nervous System: divisions, distribution, . Transmitters and receptors in ANS Higher control of autonomic nervous system

Physiological role of autonomic nervous system in the control of various body functions

35

SEMESTER - I

INTEGUMENTARY SYSTEM

COMMON CLINICAL PROBLEMS: Burn Scabies Dermatitis Leprosy Malignancies

ANATOMY Skin Thick and Thin with Appendages

BIOCHEMISTRY Melanin Synthesis

MICROBIOLOGY Introduction to skin infections Bacillus anthracis Mycobacterium Leprae Atypical Mycobacteria Gas gangrene Superficial mycosis Dermatophytosis Subcutaneous Mycoses Viral infections Parasite infection

PATHOLOGY Tumours Leprosy

PHARMACOLOGY Antileprotic Drugs

PHYSIOLOGY Skin Functions Sweat Glands Thermoregulation

CONTENTS

ANATOMY

Skin (microscopic structure of thin, thick, and pigmented skin)

Appendages of Skin (hair, nail, pilosebaceous unit)

BIOCHEMISTRY

36

Melanin: Synthesis - cells involved, abbreviated pathway. Albinism: The molecular defect, implications.

MICROBIOLOGY

Introduction to skin infections: Types of infections, common etiological agents, Staph aureus, Strept pyogenes and its complication (PSGN= post streptococcal glomerular nephritis).

Bacillus anthracis: Morphology, culture, pathogenicity, laboratory diagnosis.

Mycobacterium leprae: Morphology, pathogenicity, clinical classifications, laboratory diagnosis, lepromin test.

Atypical Mycobacteria: Swimming pool granuloma, Buruli ulcer.

Gas gangrene: Cl perfringens etc

Superficial mycosis: P. versicolor, T. nigra etc. clinical features and laboratory diagnosis.

Dermatophytosis: classification, clinical features and laboratory diagnosis.

Subcutaneous Mycoses: Mycetoma, chromomycosis, Sporothrix schenkii- Sources, types of infection, clinical features, laboratory diagnosis.

Viral infection: Varicella zoster clinical features, laboratory diagnosis; viral exanthematic diseases.

Parasite infection: T spiralis, Larva migrans

PATHOLOGY

Leprosy: Classification. Tuberculoid and Lepromatous leprosy: Pathogenesis, immunology, complications, microscopic features and diagnosis.

Tumours: Squamous papilloma. Aetiology, morphology, mode of spread of squamous cell carcinoma. Nevus: definition, types (intradermal Junctional and compound), morphology. Malignant melanoma.

PHARMACOLOGY

Antileprosy Drugs: Introduction, aetiopathogenesis Classification of antileprosy drugs, multiple drug therapy. Discussion of individual drugs.

PHYSIOLOGY

Skin:

37

Functions.

Sweat Glands: Types, control of secretion, functions.

Thermoregulation: Mechanism, receptors, hypothalamic thermostat. Physiological responses on acute exposure to hot and cold environment. Acclimatisation, disorders of thermoregulation - hypothermia, hyperthermia, fever.

38

SEMESTER - I

MUSCULO-SKELETAL SYSTEM

COMMON CLINICAL PROBLEMS: Tetanus Hemiplegia Osteomyelitis Varicose Veins Arthritis Injuries

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

Lower Limb Gross Anatomy Bones: Hip bones, femur, tibia, fibula, patella and bones of foot Thigh and leg Hip joint, knee joint, ankle joint Gluteal region, sole, dorsum of foot Arches of foot Lymph nodes Muscles Nerves Arteries Veins Surface anatomy Radiological anatomy

BIOCHEMISTRY Muscle Metabolism Creatine Creatine Phosphate Markers of Muscle Damage Calcium homeostasis

MICROBIOLOGY Infectious Arthritis Osteomyelitis

PATHOLOGY Congenital disorders Fracture Osteomyelitis Osteoporosis

39

Osteomalacia and rickets Paget disease of bone Bone Tumors Rheumatoid Arthritis, Gout, Osteoarthritis Soft Tissue Tumors Muscular Dystrophies

PHARMACOLOGY NSAIDS Drugs for RA and Gout Skeletal muscle relaxant

PHYSIOLOGY Functional organization of striated muscles Neuromuscular transmission Excitation contraction coupling (ECC) Mechanical events during muscle contraction Denervated muscle Types of muscle fibers Physiology of smooth muscle

CONTENTS

Upper Limb: (cross section at the level of insertion of deltoid and middle of forearm) Boundaries, contents, applied aspects of: axilla, cubital fossa, anatomical snuff box, carpal tunnel.

Joints: Types, subtypes, ligaments, movements of sterno-clavicular, acromio-clavicular joints. Type and subtypes: capsular attachments, ligaments, movements, muscles involved, blood supply, nerve supply and applied aspects of : shoulder joint, elbow joint, radio-ulnar joints, first carpo-metacarpal joint, wrist joint, carpo-metacarpal joint.

Palm: fascial spaces in the palm and Palmer aponeroses and their applied aspects. Actions and nerve supply of interossei and lumbricals.

Bones: clavicle, scapula, humerus, radius, ulna, carpals and metacarpals Side determination: parts, immediate relations; capsular attachments and blood supply of bones. Identification of bones in an articulated hand.

Axillary lymph nodes: Subgroups, relations, applied aspects.

Flexor extensor compartments: Contents of arm and forearm.

Muscles: Origin, insertion, nerve supply and actions of Trapezius, Latissimus dorsi, pectoralis major, pectoralis minor, deltoid, biceps brachii, pronator teres, supinator, adductor pollicis.

Nerves: Origin, root value, course, branches, distribution and applied anatomy of axillary, radial, median, ulnar nerves.

Brachial plexus:

40

Formation, parts, branches and applied aspects.

Arteries: Origin, course, termination and branches of axillary, brachial, radial, ulnar arteries, palmar arches.

Veins: Formation, tributaries, termination, position, applied anatomy of - basilic, cephalic, median cubital veins.

Radiological Anatomy X-rays of shoulder, elbow, and wrist

Surface Anatomy Acromion process of scapula, medial and lateral humeral epicondyles, olecranon process of ulna, head of radius bone, and styloid processes of radius and ulna bones. Brachial, radial, and ulnar arteries, and superficial and deep palmar arches Cephalic, basilic, and median cubital vein

Development of the limb bud

Lower Limb Gross Anatomy: (cross section at the level of apex of femoral triangle and middle one-third of the leg)

Bones: Hip bone, femur, tibia, fibula, patella, tarsals and metatarsals Side determination, parts, immediate relations, capsular attachments, blood supply. Identification of bones in an articulated foot.

Boundaries, Contents, applied aspects of: femoral triangle, adductor canal, popliteal fossa.

Thigh and leg: Compartments and contents. Identification of structures in gluteal region, sole, dorsum of foot.

Hip joint, knee joint, ankle joint: Type, subtype, capsular attachments, ligaments, movements-muscles involved, nerve supply, blood supply and applied aspects.

Arches of foot: Formation, supports, applied anatomy.

Inversion Eversion

Lymph nodes: Inguinal group, popliteal groups subgroups, afferents, efferents and applied aspects.

Muscles: Origin, insertion, nerve supply, actions of: gluteus maximus, gluteus medius, triceps surae, biceps femoris, semimembranosus, rectus femoris, adductor magnus, popliteus, tibialis anterior and tibialis posterior, and peroneus longus.

Nerves:

41

Origin, root value, course, branches, applied aspects of : sciatic, common peroneal, tibial, femoral and obturator. Arteries: Origin, course, branches of: femoral, popliteal, arteria dorsalis pedis, peroneal, anterior and posterior tibial, plantar arch.

Veins: Origin, termination, tributaries, applied aspects: long and short saphenous veins, popliteal, femoral.

Radiological Anatomy X-rays of hip, knee, and ankle

Surface Anatomy Anterior superior iliac spine, pubic tubercle, greater trochanter of femur, adductor tubercle, patella, medial and lateral malleoli, femoral, popliteal, anterial and posterior tibial, and dorsalis pedis arteries, long and short saphenous, and femoral veins,

Development of limb bud and axis artery

BIOCHEMISTRY

Muscle Metabolism: Glycogen metabolism. Energy metabolism switch over in conditions: from resting to contracting, adequate O2 to hypoxic, fed to fasting, Cori Cycle, powre stroke of contraction, role of calcium, tetany and rigor mortis.

Creatine and Creatine Phosphate: Synthesis from precursors, catabolism, creatine phosphate function.

Markers of Muscle Damage: Myoglobin, troponins, enzymes.

Calcium homeostasis: Role of parathyroid hormone (PTH), calcitriol, calcitonin in regulation of Plasma calcium level.

MICROBIOLOGY

Infectious Arthritis: Causative organisms. Pathogenesis, laboratory diagnosis.

Osteomyelitis: Acute and chronic, agents, pathogenesis, laboratory diagnosis.

PATHOLOGY

Congenital Disorders: Achondroplasia, Osteogenesis imperfecta, Osteopetrosis

Fracture: Types, morphology of healing, factors delaying the healing.

42

Osteomyelitis: Aetiology, pathogenesis, clinical features and complications.

Osteoporosis: Classification, pathogenesis, morphology, clinical features

Osteomalacia, rikets: Classification, pathogenesis, morphology, clinical features Paget disease of bone

Bone Tumours: Classification, gross and microscopic features, clinical features and X-ray findings of: Ewings Sarcoma, Giant cell tumor (Osteoclastoma), Osteosarcoma, chondrio sarcoma.

Rheumatoid Arthritis, Osteoarthritis, Gout: Aetiopathogenesis, morphological features and complications.

Soft Tissue Tumors: Gross and microscopic features of lipoma , fibrosarcoma, rhabdomyosarcoma,

Muscular Dystrophies: Definition. Mode of inheritance, clinical features, morphology, investigations of Duchennes muscular dystrophy, Beckers muscular dystrophy. Polymyositis. Myasthenia gravis: Investigations.

PHARMACOLOGY

Nonsteroidal Antiinflammatory Drugs (NSAID) (Analgesic antipyretic and antiinflammatory drugs) Classification, salient features of various groups. Prostaglandins, kinins and mediators of inflammation.

Drug therapy for gout Acute and chronic drug treatment and prophylaxis.

Drug therapy for Rheumatoid Arthritis Drugs, actions, limitations, adverse effects.

Skeletal Muscle Relaxants Classification, mechanisms of action, uses and cautions. Comparison of salient features of various groups.

PHYSIOLOGY

Functional organization of striated muscles: Muscle cell, sarcomere and organization of contractile proteins and sarcoplasmic reticulum

Neuromuscular transmission:

43

Structure, mechanism of transmission, mechanism of generation of end plate potential (EPP) and muscle action potential; myasthenia gravis

Excitation contraction coupling (ECC): Role of T tubules and SR in the release of calcium; cross bridge cycle, mechanism of contraction and relaxation, rigor mortis

Mechanical events during muscle contraction: Isotonic and isometric contraction, effect of two or more stimuli on muscle contrction- titanic contraction, preload and after load, effect of load on velocity of contraction, effect of length on tension developed.

Denervated muscle: Neurotropic factor/s and their role in maintenance of structure and function of the striated muscle (fibrillation and paralysis), reinnervation, cross innervations, EMG and streangth duration curve, chronaxie and rheobase

Types of muscle fibers: Structural and functional differences between slow and fast twitch muscle fibers

Effect of exercise and training on skeletal muscle structure and function. Physiological basis of fatigue.

Physiology of smooth muscle: Structure, types, mechanism of contraction and relaxation, properties of smooth muscle and effect of neural, humoral and local factors on it.

44

SEMESTER I

COMMUNITY MEDICINE

HUMAN AND MEDICINE Themes and Topics: Medicine in antiquity (Primitive Medicine, Indian Medicine, Chinese Medicine, Egyptian Medicine, Greek Medicine, Roman Medicine) Dawn of Scientific Medicine Modern Medicine Medical Revolution Health Care Revolution Socio-Cultural aspects of Health in Nepal Eugenics Alternative medicine Medical Ethics

Objectives: Appreciate that knowledge of past prevents repetition. Describe medical and health in various time, place and person. Acquaintance of past health and medical practice in Nepal.

Principal Teaching Learning Methods to be used: Group discussion Seminar presentation

CONCEPTS OF HEALTH & DISEASE

Themes and Topics: Definition of health and well-being Dimensions and determinants of health Indicators of health Epidemiological triad Theories of disease causation Natural history of disease Risk factor concept Concept of control of disease Levels of prevention Modes of intervention Primary Health Care Goals / targets set to achieve Health for All Critical review of HFA 2000 Revitalizing Primary Health Care MDGs in the context of Nepal

Objectives: Orientation to the basic concepts of health and its determinants. Orientation to the concept of epidemiological triad and theories of disease occurrence. Describe the levels of prevention and modes of intervention. Describe the principles of Primary Health Care and other related concepts.

45

List the goals / targets set to achieve Health for All. Describe the socio-cultural structure of the community. Identify the environmental problems. Describe the existing health facilities. Make a simple presentation regarding the above. Suggest and conduct a simple intervention for an identified problem State the National Health Policy and planning.

Principal teaching-learning methods to be used: Lecture discussion Small group discussion Practical exercises

NUTRITION -I

Themes and Topics:

Common problems: Protein-energy malnutrition Iron deficiency Vitamin A deficiency

Determinants of nutritional status of individual / community Nutritional sources and requirements Balanced diet Nutritional deficiency disorders e.g. PEM, Iron deficiency, Vitamin A deficiency. Nutritional problems in Nepal. Practical exercise: Nutritional status assessment in a community and presentation of data collected.

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

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

NUTRITION -II

Themes and Topics: Iodine Deficiency Disorders (IDD) Magnitude of the Problem in Nepal

46

Community Assessment of IDD Zinc deficiency Salt Fortification

Objectives: State the magnitude of the problems on IDD in Nepal. Describe the steps in the community assessment of IDD. Describe the importance of salt fortification (iodisation).

Principal teaching-learning methods to be used: Lecture discussion. Demonstration: use of field testing kits for iodine levels in salt. Small group discussion. Student action: The students as a group will conduct a survey in 10 houses to collect information about IDD, level of Iodine in salt at the household level and analyze and present the data. Follow up intervention by the students regarding nutrition education. Problem based learning: integrated seminar, presentation with other departments.

ENVIRONMENTAL SCIENCES

Themes and Topics:

Environment: physical environment inside and outside the home Water: safe water, Potable water, purification of water at the household and community levels Waste disposal - necessity of waste disposal General principles of waste disposal Excreta disposal - necessity of excreta disposal General principles of excreta disposal Family environment and principles of good housing

(In all of the above topics the general principles are to be taught avoiding engineering details)

Objectives:

Describe the physical environment: both inside and outside the home. Describe the family environment and principles of good housing. Define and analyze the importance of water and sanitation in human health. Define safe water obtained from tap, hand-pump, well. Describe appropriate methods for making water safe at the household level. Understand the methods of waste and excreta disposal. Suggest feasible methods of environmental control.

Principal teaching-learning methods to be used: Lecture discussion Demonstration Small group discussion Practical exercises Student action - during the family health exercise students will identify environmental problems and suggest feasible and appropriate remedial measures

BIOSTATISTICS

Themes and Topics:

47

Need of biostatistics in medicine Statistical methods Frequency distribution Measure of central tendency Proportions Presentation of statistical data Tables: simple and frequency distribution tables Charts and diagrams: bar, histogram, frequency polygon, line diagram, pie-chart, pictogram

Objectives: Define, calculate and interpret commonly used statistical treatment. Select and use appropriate diagrammatic representation of statistical data.

Principal Teaching-Learning Methods To Be Used:

Lecture discussion Small group discussion Simulated practical exercises in the classroom: calculate various statistical values using data from hospital or community

48

SEMESTER - I

INTRODUCTION TO CLINICAL MEDICINE

Themes and Topics:

Medical Ethics Art of History Taking Clinical Examination

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

emergency room / hospital wards.

Musculo-skeletal System

1. appraise the common problems related to Musculo-skeletal System. 2. take relevant history on Musculo-Skeletal System. 3. correlate anatomical structures and Pathophysiology involved in giving rise to different clinical

signs in relation to Musculo-Skeletal System. 4. identify laboratory and radiological investigations required in making diagnosis. 5. list steps of testing patients clinically in relation to motor, reflexes, , sensory, gait and coordination.

Instructional Method: Lectures in class-room, practical demonstrations, practice on peers and on patients, supplementary video.

49

SEMESTER - I

MEDICAL INFORMATICS

Fundamentals of Computer Windows 98/2000 Applications Word Processing (Microsoft Word) Working with Worksheets (Microsoft Excel) Graphic presentation (MS-PowerPoint and Multimedia) Statistical Treatment of Data (Epi Info WHO Epidemiological software) Retrieving Information (Internet Web)

Aim : To provide hand-on-practice in order to increase and improve students ability to use computers to an extent that he / she will utilise computers effectively to improve learning.

Objectives: On completion of the course in Medical Informatics, the student will be able to 1. write reports using word and excel software. 2. use MS-Powerpoint with multimedia facility when presenting to audiences, presenting correlation seminars and project findings. 3. obtain subject matter from CD ROMs, computerised tutorials, computerised patient-records and from patient simulations. 4. download subject matter from the Internet and Websites of other medical schools and journal publications. 5. carry out statistical analysis using Epi Info package.

Instructional Method: Demonstration, practice under supervision, independent practice to achieve mastery.

50

SEMESTER - II

HAEMOPOIETIC SYSTEM

COMMON CLINICAL PROBLEMS: Haemorrhage Anaemia Leishmaniasis Filariasis Malaria

BIOCHEMISTRY Haemoglobin Iron Metabolism Vitamin B12 Metabolism Folic Acid Metabolism Blood pH Regulation Glycolysis HMP Shunt Glutathione (Redox) System Plasma Proteins

MICROBIOLOGY Introduction to blood borne infections Blood borne parasites

PATHOLOGY Anaemias Haemorrhagic Diathesis Idiopathic Thrombocytopenic Purpura Disseminated Intravascular Coagulation Blood Groups Blood Banking Blood Transfusion Lymphadenitis Leukaemia Lymphomas Hodgkins Lymphoma and Non-Hodgkins Lymphoma Splenomegaly

PHARMACOLOGY Haemostatics Therapy of Thromboembolic Disorders Therapy of Iron Deficiency Anaemia Therapy of Megaloblastic Anaemia, Pernicious Anaemia Therapy of Parasitic Infections Anti cancer agents

PHYSIOLOGY Blood as a Body Fluid Plasma Blood Cells Blood Groups Haemostasis

51

CONTENTS

BIOCHEMISTRY

Haemoglobin: Structure, functions, structure-function relation, comparison with myoglobin. role of 2,3-BPG Biosynthesis: Chromosomes globin genes, chronology of gene expression. Haem Biosynthesis: Building materials, reaction at commencement/ termination, general overview of pathway, key intermediates, significance of fetal Hb Haemoglobinopathy: Definition, genetic basis. Abnormal haemoglobin: HbS as an example - genetic basis, molecular disease concept, laboratory identification of HbS. Thalassaemias: Molecular basis of -thalassaemia, -thalassaemia. Porphyrias: Definition, acquired - one example, congenital - one example.

Iron Metabolism: Functions, absorption, transport, storage, release, utilisation, requirement for haemopoiesis, elimination, menstrual losses, Fe-cost per pregnancy. Iron deficiency anaemia: Biochemical indicators, laboratory diagnosis.

Vitamin B12 Metabolism: General metabolism, biochemical functions, biochemical impairments in deficiency.

Folic acid Metabolism: General metabolism, RDA, biochemical functions as 1-C carriage, biochemical impairments in deficiency.

Blood pH Regulation: Blood hydrogen ion concentration, buffers - [H+] buffering, clinical relevance of [H+] measurement, respiratory acidosis/ alkalosis, clinical intervention in respiratory acidosis / alkalosis, arterial blood gas analysis.

Glycolysis: Importance, definition, overview of pathway, committed step, regulated steps, irreversible steps, mechanisms of regulation, hormonal regulation in fed / fasted conditions, net energy yield, intermediates at metabolic junctions, glycolysis in RBC, hepatocyte, in adipocyte, entry of fructose / galactose into glycolysis.

HMP Shunt: Importance, NADPH generating steps, ribose generating step, transketolase, interconnection with glycolytic pathway, G6PD deficiency - haemolysis.

Glutathione (redox) System: Composition, functions, biochemical mode of action, glutathione-reductase, GSH-peroxidase, selenium.

Plasma Proteins: Introduction, classification, diagnostic importance.

MICROBIOLOGY

Introduction to blood borne infections:

52

Bacteraemia, septicemia, pyaemia, viremia, fungemia, parasitemia: Definitions, differentiations, list of common organisms and diseases caused by them. Brucellosis, Leptospirosis, Borreliosis

Blood borne parasites: Leishmanisis, Toxoplasmosis, Malaria, Filariasis: Morphology, life cycles, pathogenesis, clinical

features, laboratory diagnosis.

PATHOLOGY

Anaemias: Definition, classification based on aetiology and morphology. Iron deficiency anaemia: Aetiology, laboratory diagnosis. Megaloblastic anaemia: Aetiology, laboratory diagnosis. Aplastic anaemia: Aetiology, laboratory diagnosis. Hereditary spherocytosis: Aetiopathogenesis, laboratory diagnosis. Thalassaemia: Aetiopathogenesis, laboratory diagnosis, complications. Sickle cell anaemia: Aetiopathogenesis, laboratory diagnosis.

Haemorrhagic Diathesis: Basic screening tests, significance of the tests. Coagulation disorders: Haemophilia, Christmas disease.

Idiopathic Thrombocytopenic Purpura: Aetiopathogenesis, laboratory diagnosis.

Disseminated Intravascular Coagulation: Definition, aetiopathogenesis.

Blood Groups: ABO blood group and Rh blood group.

Blood Banking, Blood Transfusion: Blood Grouping and cross matching Blood transfusion reactions.

Lymphadenitis: Definition and causes, reactive and tuberculous gross and microscopic features. Sarcoidosis.

Leukaemias: FAB classification of acute leukaemias, differences between myeloblast and lymphoblast, peripheral blood smear, bone marrow findings, clinical presentations in AML, ALL, CML and CLL. Multiple Myeloma: Clinical manifestations, aetiopathogenesis, morphology, laboratory diagnosis.

Lymphomas: Classification with special reference to Working International Formulation for Non Hodgkins lymphoma.

Hodgkins Lymphoma and Non-Hodgkins Lymphoma: Gross and microscopic features.

53

Splenomegaly: Causes, Morphology; Hyperspleenism.

PHARMACOLOGY

Haemostatics Agents: Classification, their actions and uses.

Therapy of Thromboembolic Disorders:

Anticoagulants : Introduction General principles- Classification, Mechanism of action, Adverse effects, Contraindications, Therapeutic Uses and Drug interactions.

Thrombolytics: preparations, pharmacological basis for their actions and related usefulness.

Antiplatelet agents: Classification, Mechanism of action, Adverse effects, Contraindications, Therapeutic Uses.

Therapy of Iron Deficiency Anaemia: Introduction Iron Preparations, indications, adverse effects, treatment of overdose.

Therapy of Megaloblastic Anaemia With / Without Neurological Involvement, Pernicious Anaemia: Folic acid and vitamin B12: Preparations, actions, uses, inter-relationship between folic acid and vitamin B12 .

Therapy of Parasitic Infections: Anti Malarial Drugs:- Introduction General principles- Classification, Mechanism of action, Adverse effects, Contraindications, Therapeutic Uses and Drug interactions Drug therapy for Leishmaniasis: classification of drugs, uses of Stibogluconate and pentamidine. Drug therapy for Filariasis: classification of drugs, uses of diethylcarbamazine citrate and Ivermectin.

Anticancer Drugs: Introduction General principles- Classification, Mechanism of action, Adverse effects, Contraindications, Therapeutic Uses and Drug interactions General adverse effects of anti-cancer drugs.

PHYSIOLOGY

54

Blood as a Body Fluid: Composition, physical characteristics and functions of blood.

Plasma: Normal constituents. Plasma proteins: types, concentrations, properties, functions.

Red Blood Cells: Types, distribution, overview of haematopoiesis. Erythrocytes: morphology, functions, fate, normal count, PCV, ESR, MCV, MCH, MCHC, fragility, haemolysis. Erythropoiesis: definition, stages, regulating factors, RBC indices and clinical usefulness. Anaemia : Physiological basis of causes and treatment

White Blood Cells: classification, morphology, development, normal counts and functions,.

Platelets: morphology, functions.

Blood Groups: Agglutinogens, agglutinins, Landsteiners law, ABO group, Rh group. Blood transfusion: relation to blood groups, indications, hazards. Inheritance, erythroblastosis foetalis, hemolytic disease of the new-born.

Hemostasis: Physiology of coagulation intrinsic and extrinsic mechanism, clot retraction, fibrinolysis, tests for clotting. Natural and other anticoagulants.

55

SEMESTER - II

RESPIRATORY SYSTEM

COMMON CLINICAL PROBLEMS Acute Respiratory Infections Tuberculosis Bronchial Asthma Chronic Obstructive Pulmonary Disease Bronchogenic Carcinoma

ANATOMY Nasal Cavity Paranasal Air Sinuses Larynx, Trachea Bronchial Tree, Pleura and Lung Applied anatomy Surface anatomy Radiological anatomy

BIOCHEMISTRY Cellular Respiration Biological Oxidation Oxidative Stress Antioxidant Systems Vitamin E

MICROBIOLOGY Introduction to respiratory system infections Approach to diagnosis of respiratory pathogens Bacteria as respiratory pathogens Fungi as respiratory pathogens Viruses as respiratory pathogens Parasites as respiratory pathogens

PATHOLOGY Lesions of Upper Respiratory Tract Bronchial Asthma Bronchiectasis Atelectasis Hyaline Membrane Disease and Adult Respiratory Distress Syndrome Chronic Obstructive Pulmonary Disease and Cor-Pulmonale Pneumonia Lung Abscess Tuberculosis Pneumoconiosis Bronchogenic Carcinoma Pleural Lesions

PHARMACOLOGY Therapy of Bronchial Asthma - Bronchodilators Therapy of Allergic Rhinitis - Antihistaminics Therapy of Cough - Antitussives and Mucolytics Therapy of Tuberculosis - Antitubercular Drugs

56

PHYSIOLOGY Functional Anatomy Mechanics of Breathing Spirometry Pulmonary Circulation Pulmonary Gas Exchange Gas Transport Regulation of Respiration Respiration in Unusual Environments Abnormal Breathing Respiratory Failure and Principles of Artificial Respiration Lung Function Tests Cyanosis and Asphyxia

CONTENTS

ANATOMY

Nasal Cavity: Lateral wall of nasal cavity: boundaries, gross features, blood supply, nerve supply lymphatic drainage, applied anatomy. Nasal septum : formation, blood supply, nerve supply, applied anatomy.

Paranasal Air Sinuses: Names, sites of opening of various air sinuses and functions. Maxillary air sinus: Boundaries, blood supply, nerve supply, lymphatic drainage, applied anatomy.

Larynx, Trachea: Names of cartilages. Names of intrinsic muscles, innervations, actions. Parts and features of cavity of larynx with blood supply, nerve supply, lymphatic drainage, applied anatomy. Rima glottidis. Trachea: gross features, relations, blood supply, nerve supply, applied anatomy.

Bronchial Tree, Pleura, Lung: Names of parts of bronchial tree. Bronchial tree and bronchopulmonary segments and their applied anatomy. Bronchi: right & left. Root and hilum of lung.

Pleura and lung: parts, relation, blood supply, nerve supply, applied anatomy. Pleural recesses. Microanatomy of epiglottis, trachea, lungs. Relations and lymphatic drainage of lungs. Development of pleura, lung and bronchial tree.

Thoracic Cage Skeletal framework Components (thoracic vertebrae, ribs or costae, and sternum), and congenital and acquired anomalies Intercostals space: boundaries, contents and applied aspects Intercostal muscles Nerve-supply and actions Intercostal nerves Superior thoracic aperture ( thoracic inlet)

57

Inferior thoracic aperture (thoracic outlet)

Diaphragm: Development, attachments, relations, blood-supply, nerve-supply, applied aspects, and structures passing through its major openings.

Respiratory movements

Azygous vein- formation, course, termination & tributaries

Thoracic duct- origin, course, termination, tributaries & area of drainage

Surface Anatomy Sternal angle, xiphoid process, counting of ribs Pleura and lungs

Radiological Anatomy Chest X-rays A.P, P.A & lateral views, X-rays of skull showing paranasal air sinuses

BIOCHEMISTRY

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

Oxidative Stress and Antioxidant Systems: Free radicals, sources of free radicals, antioxidant systems, other biological anti-oxidants, failure of antioxidant systems clinical implications.

Vitamin E: Dietary sources, metabolism and antioxidant function.

MICROBIOLOGY

Introduction to respiratory system infections: Normal flora- list the normal flora; classification of respiratory diseases, Pathogen of RTI - List common pathogens Causative organisms of various

respiratory diseases (Rhinitis, pharyngitis, laryngitis, sinusitis, community acquired pneumonia, hospital acquired pneumonia, ventilator associated pneumonia etc. Approach to diagnosis of respiratory pathogens: procedure of sample collection, storage, transport, processing and laboratory diagnosis of common respiratory pathogen.

Bacteria as respiratory pathogens: Streptococcus pyogenes (Streptococcal sore throat and consequences), Streptococcus pneumoniae and other Streptococci, Staphylococcus, Haemophilus influenzae, Corynebacterium diphtheria, Bordetella pertusis, Organisms causing Hospital Associated

Pneumonia including Ventilator Associated Pneumonia (e.g. Klebsiella, Pseudomonas etc), Atypical

58

pneumonia (Legionella, Chlamydia, Mycoplasma, Uearaplasma), Mycobacterium tuberculosis and MOTT

Fungi as respiratory pathogens: Histopalsma capsulatum; Candida albicans, Aspergilus fumigatus; Cryptococcus neoformans -morphology, pathogenesis and diagnosis. Viruses as respiratory pathogens: Orthomyxo and paramyxo viruses, Adenovirus, Rhinovirus, SARS.

Parasites as respiratory pathogens: Pneumocystis jerovicii, Paragonimus westermani. Morphology, life cycle, pathogenesis, laboratory diagnosis.

PATHOLOGY

Lesions of Upper Respiratory Tract: Tumours of larynx.

Bronchial Asthma: Mechanism and pathogenesis.

Bronchiectasis: Pathogenesis, gross and microscopic features, complications.

Atelectasis: Definition, types, morphology pathogenesis and complications.

Hyaline Membrane Disease and Adult Respiratory Distress Syndrome: Definition, pathogenesis.

Chronic Obstructive Pulmonary Disease and Cor Pulmonale: Chronic Bronchitis: Aetiology, gross and microscopic features. Emphysema: Definition, types, pathogenesis.

Pneumonia: Types, aetiopathogenesis, stages, complications.

Lung Abscess: Aetiopathogenesis, morphology.

Tuberculosis: Aetiopathogenesis, primary complex - definition, Ghons focus morphology. Secondary tuberculosis - types of lesion. Fibrocaseous, cavitary and miliary tuberculosis. Gross and microscopic features, complications.

Pneumoconiosis: Definition, pathogenesis. Anthracosis, asbestosis, silicosis.

Bronchogenic Carcinoma: Aetiology, gross and microscopic features of:

59

Squamous cell carcinoma, adenocarcinoma, small and large cell carcinomas, bronchioloalveolar carcinoma.

Pleural Lesions: Mesothelioma, pleural effusion, pneumothorax. Investigations: examination of sputum and pleural fluid. Sex hormones: preparation and antagonists.

PHARMACOLOGY

Therapy of Bronchial Asthma - Bronchodilators: Types of bronchial asthma acute, chronic, Severe acute asthma (status asthmaticus) Classification of drugs, mechanism of action/pharmacological basis for the use, advantages and disadvantages of each group, adverse effects, drugs interactions, contraindications and special features.

Therapy of COPD.

Antihistaminics: Classification, comparison of various groups, mechanism of action, therapeutic uses and adverse effects.

Therapy of Cough: Antitussives and mucolytic agents - examples for each group. Mechanism of action, usefulness and limitations. Adverse reactions and cautions.

Therapy of Tuberculosis: Classification according to antibacterial effect. Comparison between primary and secondary antitubercular drugs. Regimens and prophylaxis. Discussion of individuals drugs under mechanism of actions, adverse effects, contraindications and drug interaction. List drugs for resistant tuberculosis, their limitations.

PHYSIOLOGY

Functional Anatomy of Respiratory System. Functional anatomy, composition of air in atmosphere and alveoli, gas laws

Mechanism and Mechanics of Breathing: Movements of thoracic cage during respiration. Muscles involved and their nerve supply. Intrapleural, intrapulmonary pressures and volume changes during inspiration & expiration. Pressure-volume inter-relationships. Lung compliance, surfactant, airway resistance. Work of breathing.

Spirometry: Lung volumes capacities: definitions, normal values, significance.

60

Pulmonary Circulation: Functional anatomy, distribution, special features & factors influencing.

Pulmonary Gas Exchange: Alveolocapillary membranes, diffusion capacities, partial pressure gradients, factors influencing diffusion of gases. Measurement of diffusion capacity using carbon monoxide. Applied physiology shunt and alveolocapillary block. Ventilation perfusion ratio and its importance in respiratory diseases.

Gas Transport: Oxygen transport: factors influencing the combination of haemoglobin with oxygen. Oxygen dissociation curve: plot, features, physiological advantage of its shape, factors affecting the shift of curve, Bohr effect. Carbon dioxide transport: tissue production, carriage in blood and release at the lungs. Role of red blood cell, chloride shift, role in acid-base balance, Haldane effect. Carbon monoxide transport and its effects

Regulation of Respiration: Neural control: medulla, pons, vagus. Chemo-receptors: peripheral, central, chemical, non-chemical. Influences on respiration, integrated responses.

Respiration in Unusual Environments: Ttypes of hypoxia High altitude hypoxia, space flight. Deep sea diving nitrogen narcosis. Hyperbaric oxygen and oxygen toxicity.

Abnormal Breathing: Apnoea, hyperpnoea, tachypnoea, dysponea: definition, features, physiolological basis.

Principles of Artificial Respiration: Definition, types, principles, indications, advantage and disadvantages, Oxygen therapy; respiratory failure.

Principles of Lung Function Tests and non respiratory functions of the respiratory system

Applied respiratory physiology Cyanosis and Asphyxia. Pneumothorax, Emphysema, Restrictive and Obstructive Pulmonary Diseases

61

SEMESTER - II

CARDIOVASCULAR SYSTEM

COMMON CLINICAL PROBLEMS: Hypertension Ischaemic Heart Diseases Rheumatic Fever Rheumatic Heart Diseases

ANATOMY Mediastinum Heart and Blood Vessels Applied anatomy Surface anatomy Radiological anatomy

BIOCHEMISTRY Cholesterol TAG Metabolism Fatty Acid Metabolism Ketone Body Metabolism Lipoprotein Metabolism Eicosanoids Cardiac Muscle Metabolism

MICROBIOLOGY Acute Rheumatic Fever Rheumatic Heart Disease Infective Endocarditis

PATHOLOGY Atherosclerosis Hypertension Inflammatory Disease of Blood Vessels Rheumatic Heart Disease Infective Endocarditis Myocardial Infarction Cardiomyopathies Myocarditis Congestive Cardiac Failure Congenital Heart Disease Diseases of the Pericardium

PHARMACOLOGY Therapy of Myocardial Ischaemia and angina Therapy of Hypertension Therapy of Congestive heart failure Therapy of Arrhythmia - Antiarrythmic Drugs Therapy of Hyperlipoproteinaemias

PHYSIOLOGY Heart a Mechanical Pump Properties of Myocardiac Cells Cardiac Cycle

62

Electrocardiography Cardiac Output Haemodynamics of Circulation Arterial Blood Pressure and Its Regulation Microcirculation, formation & absorption of tissue fluid & lymph Regional Circulation Cardiovascular Changes During Exercise Heart Sounds and murmurs Arterial Pulse Hypovolemic Shock

CONTENTS

ANATOMY

Divisions of Mediastinum and Their Contents:

Pericardium: Parts, sinuses, blood supply, nerve supply, lymphatic drainage, development, applied anatomy.

Heart Surfaces, borders, positions, relations.

Internal structures: right atrium, right ventricle, left atrium, left ventricle, interatrial septum - development and anomalies, interventricular septum - development and anomalies. Conducting system of heart.

Arch of aorta; superior vena cava.

Microscopic structure of heart and blood vessels.

Development of various chambers of the heart.

Development of major arteries and veins.

Congenital anomalies of heart and major vessels.

Foetal circulation and changes at birth.

Blood supply of heart.

Surface Anatomy Heart, arch of aorta, pulmonary trunk, superior and inferior vena cavae, innominate veins

Radiological Anatomy X-ray chest A.P. view, coronary angiogram

BIOCHEMISTRY

Cholesterol Metabolism: Absorption, transport, functions.

63

Synthesis, regulation of synthesis - factors - mechanism, conversion to bile acids and excretion- blood plasma cholesterol lowering agents biochemical basis of action, hypercholesterolaemia-implications.

Fatty acid - TAG Metabolism: Aspects on fatty acid synthesis tissues, precursors, overview of conversion of Acetylcoenzyme-A fatty acid (e.g. palmitic acid), regulatory step mechanism. Mechanism of conversion of e.g. palmitic acid to the next higher saturated / unsaturated fatty acid, biochemical basis of nutritionally essential fatty aci