PAHS MBBS Curriculum PDF

PAHS OVERVIEW
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Patan Academy of Health Science
Patan Academy of Health Science (PAHS) is dedicated to sustained improvement of the

health of the people in Nepal, especially those who are poor and living in rural areas,
through innovation, equity, excellence and love in education, service and research.
We will give our students the practical skills and knowledge that they need to practice
good medicine, but we also hope to inculcate an attitude of social responsibility and
compassion so that they have a heart felt desire and drive to meet the needs of the
Nepali people.
In order to achieve this vision we are employing a number of innovative strategies.

These have been decided upon after extensive review of the academic literature and
broad consultation with experts from all over the world. We have looked particularly at
the experience of medical schools in the developing world which have successfully
produced doctors who then choose to serve remote, rural populations.
The strategies we have chosen are as follows:
 Careful selection of our students

 A premedical six month block
 Problem based learning during the basic sciences
 Introduction to Clinical medicine as a parallel course during the premedical and
basic science years
 Clinical presentation curriculum during the clinical years
 Integrated community health, forming 25% of the total curriculum
 Integrated primary health curriculum
 Regular exposure to poor urban and rural settings
 Six month rural posting to a district general hospital during the final year
 Assessment of attributes in addition to clinical knowledge and skills
For each of these strategies we will set out a detailed description in this document. In
this introduction, we will give a brief overview to demonstrate how the individual
strategies interrelate and complement one another to achieve our ultimate goal.
Our strategy begins with the selection of our medical students. It is well documented in
the literature that selection of students from rural areas is the most important factor in
whether students will eventually return to those areas to work. Our selection process
will therefore include rural recruitment, bias to those coming from disadvantaged
people groups and careful interviews and psychometric testing to find those most suited
to fulfill PAHS attributes and goals. We are also keen to include those who come from
a health assistant background, as experience in Nepal suggests that these people are also
more likely to be willing to serve in rural areas.
Since we are recruiting students from a wide range of backgrounds, some of whom
have studied in more disadvantaged schools, we are providing a six month premedical
block to ensure that all students are brought up to the same level of science knowledge
prior to starting the course proper. This will also be an opportunity to upgrade the
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students English language skills, as our educational strategy of Problem based learning
in small groups requires good language skills.
The basic science curriculum will be taught using Problem based learning. This
educational strategy has been extensively tested and used internationally and has been
shown to encourage deep, independent learning amongst students. Students are
introduced to basic science concepts according to systems of the body rather than
medical subspeciality, to give an integrated approach which can be applied to real
patient problems. Students develop skills of independent enquiry as well as learning to
identify gaps in knowledge, which are vital lifelong learning skills for all doctors, but
particularly those working in remote rural areas.
A parallel course running throughout the basic science and premedical block is the
Introduction to Clinical Medicine (ICM). This course introduces students to the
concepts of professionalism, ethics and communication skills in addition to teaching the
basics of history taking and examination skills. In PAHS we believe that the students’
attitudes and professional behaviour should be nurtured right from the beginning of the
course, so that we can inculcate the values expressed in our mission statement.
During the clinical years we have chosen to implement a Clinical Presentations

curriculum. This will build on the integrated, system based approach used in the basic
science years. Students will learn to approach a patient based on the clinical problem
with which they present (e.g. cough or shortness of breath) rather than on disease
processes. The Clinical Presentation curriculum is explained in more detail later on in
this document, but in essence it teaches the student how an expert will approach a
patient with any given clinical presentation in order to arrive at a diagnosis or decide on
a management plan.
Community health is a core part of the PAHS curriculum, and forms 25% of the
teaching time. It runs parallel throughout the course. PAHS believes that in order to
make a significant impact on the health of Nepali citizens, doctors need to have a firm
grasp of concepts of preventive health and social determinants of health as well as
having skills in management, epidemiology and research. It is not enough to focus
purely on the sick patient that comes to the hospital, providing technically competent
secondary or tertiary level care.
A significant part of the community health course will take place in urban slums or
rural community postings. These will allow students to keep their feet grounded in the
reality of life for the majority of their patients, as well as encouraging an attitude of
compassion and desire to contribute to their society. Students will learn about the
health care system in Nepal, what their role in that system should be and will have the
opportunity to think about how they might improve that system.
In the same way, Primary Care is internationally recognized to be a key area that must
be implemented to make a nations’ health care system effective and efficient. PAHS is
including a longitudinal primary care course during the clinical years, and the six month
rural posting in a District general hospital during the final year will be supervised by a
primary care physician (the MDGP). This rural posting will allow students to integrate
all the knowledge and skills they have acquired whilst working in Patan hospital, and
apply it to the rural context. They will experience the practical difficulties of working
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in rural areas and hopefully be challenged and stimulated to make a difference to those
who live in these places.
Finally, we believe that assessment drives learning. We need our assessment process to
reflect the innovative, problem-based, patient-centered curriculum that we are running
in PAHS. To this end we are using frequent formative assessment tools, to give
feedback to students and staff as to how the students are performing, so that they can
address any deficiencies. We are assessing not only clinical skills, and knowledge, but
also attitudes and professionalism – using the PAHS attributes assessment tool.
Students who fail to demonstrate adequate professionalism and attitudes will not
graduate.
Our summative exams will use Multiple Choice Questions and Modified Essay
Questions to assess knowledge. Traditional long and short cases are widely agreed to
be inadequate for the valid and reliable assessment of students’ clinical skills. Instead
we are planning to use the OSCE method – Objective Structured Clinical Examination,
which is described in more detail in the Assessment section.
In summary then, the PAHS curriculum uses a variety of innovative strategies in order
to produce doctors who are committed and equipped to address the real health care
needs of Nepal. After graduation all doctors will be required to serve in rural areas for
at least two years or longer if they have received a scholarship for their studies. PAHS
is committed to make a difference to the health of all Nepali citizens regardless of
where they live.
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MISSION AND GOALS
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PATAN ACADEMY OF HEALTH SCIENCES (PAHS)
Mission Statement:
PAHS is dedicated to sustained improvement of the health of the people in Nepal,

especially those who are poor and living rural areas, through innovation, equity,
excellence and love in education, service and research.
Goals:
 Train technically competent, caring and socially responsible physicians and other
health care professionals who:
o Believe in compassion, love, respect, fairness and excellence.
o Communicate well with patients, family and colleagues.
o Are committed to life long learning and
o Have the willingness and ability to become inspiring leaders in their respective
fields and deal with the existing and emerging health care challenges in Nepal
 Sustain and upgrade the quality of the current health services of PAHS related
hospitals preserving the tradition of giving special consideration to needs of the poor
and disadvantaged.
 Undertake appropriate clinical, public health and biomedical research.
 Work in collaboration with the National Health System (NHS) to contribute to the
improvement of the health status of the people in Nepal and proactively encourage the
national government in the development of appropriate health policies, programs and
systems to uplift the health of the rural poor.
 Enable deserving students from disadvantaged sectors of Nepali society to access

health science education including medical, nursing and other allied health science
education.
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PAHS ATTRIBUTES
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Attributes:
The PAHS Graduate will demonstrate all of the following attributes:
1. Compassion and empathy to their patients at all times

a. Demonstrates concern for patients and colleagues
2. Good communication skills
a. Listens, explains concepts clearly
3. Commitment to serve the disadvantaged, particularly those in remote, rural areas
a. Demonstrates enthusiasm for serving in rural areas
b. Relates well to local people
4. Awareness of socio-economic and cultural issues
a. Uses cost effective approaches in investigation and management decisions,
taking into account the patients financial and social issues.
b. Demonstrates respect for patient’s cultural and religious beliefs
5. Awareness of community health needs and social determinants of health
a. Identifies and explains social determinants of health using a public/community
perspective.
b. Demonstrates active involvement with the local community to help address
their own health needs.
c. Discusses preventive, and promotive aspects for the community as well as the
individual
6. Professionalism
a. Respects patients rights and dignity
b. Acts without prejudice
c. Puts societal/patient needs before one’s own
d. Takes responsibility for the education of other health workers
e. Takes responsibility for own ongoing education
f. Demonstrates meticulous and dedicated approach to work
g. Demonstrates integrity
7. Leadership and team spirit
a. Works well in a team to accomplish a common goal.
b. Uses resources (time, money, equipment and people) efficiently.
c. Able to make appropriate decisions and act on them.
8. Technically competent
a. Sound core medical knowledge, up to date with recent advances, applies
knowledge appropriately.
9. Critical thinking
a. Asks critical questions, evaluates the evidence and acts accordingly
10. Life long learning
a. Is aware of own limitations, seeking help when needed.
b. Demonstrates a continuing desire to learn
c. Utilizes available learning opportunities
11. Innovation
a. Comes up with new, practical ideas to meet challenges
12. Commitment to research
a. Actively engages in research to address health care needs of Nepal.
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CODES OF CONDUCT
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PAHS STUDENT CODE OF CONDUCT:
PURPOSE:
The purpose of this Code of Conduct is to make certain that:

 The regulations available under the legislation are applied fairly and consistently
across the academy
 Students have a personal responsibility to ensure their behavior and conduct.
 Proper arrangements are in place for the smooth administration of the system.
The Patan Academy of Health Sciences (PAHS) is committed to produce the doctors who are
socially responsible, compassionate, service orientated and believe in equity. In order to be
retained in the institution, a student must demonstrate the personal traits of honesty, integrity
and regard for others. Both the students and faculty are responsible for monitoring each
others professional conduct. Any violations of the Honor Code will be dealt with by the
Student Affairs Committee.
Student Code of Honor and Professional conduct
1. I realize that upon entering medical school, I am beginning my career as a physician

and I do so intending to serve the people of Nepal, both rural and urban, as a
competent, caring doctor.
2. I pledge to show compassion and empathy to my patients and colleagues at all times.
I will, both in my behavior and speech, show respect for all patients, their families,
fellow students and colleagues in the health profession, regardless of their age,
gender, race, caste, religion, socio-economic status, state of health or handicap, sexual
orientation, personal habits and cleanliness.
3. As part of showing respect for patients I will maintain a professional appearance,
hygiene and clothing suitable for the patient care setting.
4. I pledge to listen to patients carefully and explain their problem to them clearly
5. I am committed to serve the disadvantaged, particularly those in remote, rural areas of
Nepal
6. I promise to demonstrate respect for patient’s cultural and religious beliefs
7. I promise to use cost effective approaches in investigation and management decisions,
taking into account the patients financial and social issues
8. I am committed to addressing the social determinants of health and will work actively
with the local community to do this.
9. As the health and lives of patients may depend in the future, upon my knowledge and
skills I will strive to develop these to the best of my ability. I will keep up to date
with recent advances and apply that knowledge to my daily practice.
10. I pledge to maintain an attitude of life-long learning throughout my medical career
11. As a physician in training I pledge to act professionally at all times.
12. I promise not to cheat in examinations, or to participate in any form of academic
dishonesty. Where asked to complete an individually assigned task I will do so using
only the help that is allowed by the faculty. I understand that failing to report
dishonesty in another student is also a violation of the honor code on my part.
13. When participating in medical research I promise to pursue original knowledge
addressing the health care needs of Nepal, and record truthfully the data that I collect.
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14. I promise to recognize the confidentiality of medical records and their importance as
legal documents. Under no circumstances will I knowingly record false information
or statistics.
15. I will respect the confidentiality of patients whom I meet. I will not discuss cases
except under appropriate professional or academic circumstances.
16. I will not participate in patient care under circumstances in which I am under the
influence of any substance (including alcohol) or other conditions that impair my
ability to function. If I recognize that one of my colleagues is impaired (substance
abuse or emotional instability) I will try to help them and if necessary, take an active
role in preventing them from being involved in patient care.
17. I will not take any drugs of abuse whilst I am a student at PAHS
18. I will clearly identify myself as a medical student to each patient. I will not undertake
any clinical procedure unless I am supervised by a qualified instructor. I will not
attempt to advise a patient or prescribe treatment for them without consulting an
appropriate senior.
19. I recognize that I am an important member of the health care team and I will abide by
the rules and regulations and Code of Honor in all settings in which I train or work. I
will work respectfully with my fellow colleagues in the health care system, regardless
of their qualifications or medical background.
20. When given some responsibility for patient care, I will do so to the best of my
abilities. If for some reason I am unable to fulfill my obligation, I will promptly notify
the physician in charge of the patient and make sure that someone else assumes their
care.
21. I will be punctual, reliable, conscientious and truthful in carrying out my clinical
responsibilities, never deliberately falsifying information or misrepresenting a
situation.
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PAHS FACULTY CODE OF CONDUCT:
PURPOSE:
The purpose of this Code of Conduct is to make certain that:

 The regulations available under the legislation are applied fairly and consistently
across the academy
 Faculty has a personal responsibility to ensure their behavior and conduct.
 Faculty have a duty to set excellent standards of conduct
 Proper arrangements are in place for the smooth administration of the system.
The Patan Academy of Health Sciences (PAHS) is committed to produce doctors who are
socially responsible, compassionate, service orientated and believe in equity. We recognize
that unless such exemplary behavior is also modeled by the faculty, students will not take the
code of conduct seriously. Students emulate what we do rather than what we say. In order to
be retained in the institution, a faculty member must demonstrate the personal traits of
honesty, integrity and regard for others. Both the students and faculty are responsible for
monitoring each others professional conduct. Any violations of the Faculty Honor Code will
be dealt with by the dean in consultation with Faculty Development Committee
Faculty Code of Honor and Professional conduct
1. I pledge that as a member of the Patan Academy of Health Sciences I will serve the
people of Nepal, both rural and urban, as a competent, caring doctor.
2. I pledge to show compassion and empathy to my patients and colleagues at all times.
I will, both in my behavior and speech, show respect for all patients, their families,
students and colleagues, regardless of their age, gender, race, caste, religion, socio-
economic status, state of health or handicap, sexual orientation, personal habits and
cleanliness.
3. In particular, when teaching students in the clinical setting I will ensure that the
patient has given full informed consent. I will ensure that I and the students respect
the patient’s dignity and privacy.
4. I will work respectfully with my fellow colleagues (including students) in the health
care system, regardless of their qualifications or medical background. As part of
showing respect for patients I will maintain a professional appearance, hygiene and
clothing suitable for the patient care setting. I pledge to listen to patients carefully and
explain their problem to them clearly
5. I am committed to help PAHS achieve its objectives of serving the disadvantaged,
particularly those in remote, rural areas of Nepal
6. I promise to demonstrate respect for patient’s cultural and religious beliefs
7. I promise to use cost effective approaches in investigation and management decisions,
taking into account the patients financial and social issues
8. I will keep up to date with recent advances in my specialty and apply that knowledge
to my daily practice as well as my teaching of students.
9. I pledge to act professionally at all times.
10. When participating in medical research I promise to pursue original knowledge
addressing the health care needs of Nepal, and record truthfully the data that I collect.
I promise not to participate in any form of academic dishonesty.
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11. I promise to recognize the confidentiality of medical records and their importance as
legal documents. Under no circumstances will I knowingly record false information
or statistics.
12. I will respect the confidentiality of patients under my care. I will not discuss cases
except under appropriate professional or academic circumstances.
13. I will not participate in patient care or training of students during academic activities
under circumstances in which I am under the influence of any substance (including
alcohol) or other conditions that impair my ability to function.
14. If I recognize that one of my colleagues is impaired (substance abuse or emotional
instability) I will try to help them and if necessary, take an active role in preventing
them from being involved in patient care.
15. I will not take any drugs of abuse.
16. I will be punctual, reliable, conscientious and truthful in carrying out my clinical and
teaching responsibilities.
17. I will be loyal to the institution of PAHS and will not participate in any activities that
harm the reputation or bring disgrace to the institution’s good name
18. When taking a teaching session with a student I will prepare carefully and do my best
to enhance their learning experience.
19. When assessing a student, I will do so honestly, without bias. I will not allow a
student to cheat and I will not divulge any examination materials to students or others
except within the examination itself.
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FOUNDATION COURSE
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FOUNDATION COURSE
INTRODUCTION
An eight-weeks long foundation course has been introduced in order to provide a common
educational foundation for the students from different backgrounds.The course is designed
with the main objective of introducing students to PAHS mission, vision, its innovative
educational strategies and sensitize them towards professionalism and social accountability. It
is intended to make a smooth transition for the learners from a traditional system to a self
directed adult learners.
The main aims of the course are:

• To familiarize students with the specific PAHS mission, goals and attributes.
• To introduce relevant terminologies frequently applied in basic medical and clinical
sciences.
• To familiarize students with the basics of medical ethics, communication, first aid and
patient safety.
• To enable students to acquire basic knowledge in medical informatics and apply them
appropriately.
• To introduce students to scientific writing and communication.
• To train students to be active self directed-learners.
COMPONENTS
• Introduction to Basic Medical Sciences

• Medical Humanities
• Applied Medical informatics
• Scientific Writing and Communication Skills
• Community Health Science
• Introduction to Clinical Medicine
Teaching methodology
1. Problem Based Learning (PBL)

2. Lecture
3. Practical Class / Demonstration
4. Community Posting
5. Seminars
6. Assignment
The details of the curricular goals have been elaborated in the respective discipline as follow:
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INTRODUCTION TO BASIC MEDICAL SCIENCES (BMS)
General Objectives:
 At the end of the course student should be able to:

 Understand the basic terminologies applied in Basic Medical Sciences
 Learn the language of medicine including medical pneumatics, suffixes and prefixes.
 Understand the priciples of Physics behind X-ray, Ultrasound, MRI
Contents:
• Introduction to Basic Medical Sciences 6 sessions
• Duration of each session 1 hr.
• Language of Medicine 3 sessions
• Duration of each session 1 hr.
• Visit to Radiology Department 2 hrs.
MEDICAL HUMANITIES (MH)
Medical humanities is an interdisciplinary field of medicine which includes the humanities

(literature, philosophy, ethics, history and religion), social science (anthropology, cultural
studies, psychology, sociology, health geography) and the arts (literature, theatre, film, and
visual arts) and their application to medical education and practice to understand human
experience especially in relation to life process like birth, aging, disease, disability and death.
General Objectives:
The aim of integrating medical humanities in the curriculum is for the students to develop a
holistic understanding of human experience in relation to illness and disability, death and
dying.
• Understand how disease, disability affects a person and family
• Understand concept of suffering in relation to illness, disability
• Understand difference between caring and treating, curing and healing
• Understand aging, dying as a part of life
• Understand role of health professional in alleviation of suffering
Contents:
• Total number of Medical Humanities sessions 7
• Duration of each session 2 hrs.
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APPLIED MEDICAL INFORMATICS (MI)
General Objectives:
The aim of this course is to enable students to practically retrieve (from electronic databases
and other resources), manage, and utilize biomedical information for solving problems and
making decisions that are relevant to the care of individuals and populations.
Contents:
• Knowledge of Medical Informatics including Telemedicine, M-health
• Application of Medical Informatics
• Electronic word processing and basic concepts of worksheet, chart, etc.
• Basic Concepts of Database and office package (word, excel, PowerPoint) and
e-mail/ internet
Topics:
Weeks 1 & 2 – Introduction to computer system, software and applications
Weeks 3 & 4 – Introduction to electronic word and processing (practical
sessions 1 & 2)
Weeks 5 & 6 – Introduction to spreadsheet its other features (practical sessions 3 & 4)
Weeks 7 & 8 – Introduction of database and DBMS (practical sessions 5 & 6)SCIENTIFIC
WRITING AND COMMUNICATION SKILLS (SC)
General Objectives:
The main aim of this course is to prepare the students to understand, write and present data
from journals to others in a clear coherent fashion.
Contents:
Total number of sessions 14
Duration of each session 2hrs
Topics:
1. Taking notes, extracting and summarizing data (Session 1)

2. Analyzing argument (Session 2)
3. Scientific writing (Session 3)
4. Synthesis of data (Session 4)
5. Platform skills and feedback (Session 5)
6. Alternative forms of communication (Session 6)
7. Debate (Session 7)
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COMMUNITY HEALTH SCIENCE (CHS)
General Objectives:
The main aim of this course is to sensitize/induct students about the specific PAHS values,
attributes, issues of community health sciences and health communication; to sensitize about
the importance of interrelationship between health, environment and development; to be
familiar about the ways of approaching and building relationship with the people in the
community; to provide opportunities to collect information and data that are necessary to
prepare a health plan; to know that such data are not necessarily confined to health matters
only but also include physical, social, economical and cultural conditions.
Contents:
Total number of lectures 15

Duration of each lecture 1 hr.
Total number of PBL cases 2
PBL case 1 Is Green Really Green?
PBL case 2 Panchakanya
Community postings 1.5 week
INTRODUCTION TO CLINICAL MEDICINE (ICM)
General Objectives:
The main aim of this course is to orient the students to understand and
acknowledge basic medical ethics, develop communication skills, learn common
first aid and patient safety.
Contents:
• Total number of sessions

• Duration of each session
12
• History taking sessions
2 hrs.
• Duration of each session
6
• Total number of PBL cases
1 hr.
• PBL case 1 2
• PBL case 2 Junu’s Wish!
• Old age home visit Maiya’s Right to Know!
1 day
Topics:
• Medical Ethics
• Communication skills
• First Aid
• Patient Safety
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BASIC SCIENCE
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Basic Science Curriculum
Introduction:
Basic Science at PAHS is two years duration starting after the six months of introductory
block. Curriculum integration module that has been developed in Basic Science
curriculum moves in the context of organ system block with the emphasis on clinical case
scenarios. Interdisciplinary integration in the context of clinical cases gives the platform
for the horizontal integration which helps to learn the curricular content effectively. Also,
the spiral movement of curriculum within Basic Science and throughout the entire
curriculum renders vertical integration which reinforces the progressive and explicit
learning.
The main aims of Basic Science are:
 To build the understanding of the structure and function of the human body and
mind in both healthy and disease states; understanding of the causes and
mechanism of diseases.
 To build the strong foundation of Basic Sciences that is essential for understanding
the underlying principle for clinical cases that will be applied in the clinical years.
Components of Basic Science:

 Human Anatomy
 Human Physiology
 Medical Biochemistry
 Medical Microbiology and Immunology
 Pathology
 Clinical Pharmacology
 Community Health Science
 Introduction to Clinical Medicine
Main Teaching Methodology:

 Problem Based Learning (PBL)
 Lecture
 Practical Class / Demonstration
 Residential Community Posting
 Seminars
 Assignment
Two years of Basic Science curriculum is delivered in the organ system basis. It starts
with the Principle of Human Biology where basics of all the disciplines are covered. This
will facilitate the students learning efficiently when the organ system block starts.
Community health science curriculum runs parallel throughout the basic science courses.
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Arrangement of different blocks in Basic Science:
Basic Science
First year blocks Second year blocks
Principle of Human Biology I Gastrointestinal and Hepatobiliary System
Principle of Human Biology II Renal System and Electrolytes
Hemopoetic System Endocrine, Metabolism and Reproductive System
Respiratory System Musculoskeletal System and Skin
Cardiovascular System Nervous System and Special Senses
The details of the curricular goals have been elaborated in the respective organ system
block as follow:
1. Block: Principle of Human Biology I
2. Block: Principle of Human Biology II
3. Hemopoietic System
4. Respiratory System
5. Cardiovascular System
6. Gastrointestinal and Hepatobiliary System
7. Renal and Electrolytes
8. Endocrine, Metabolism and Reproductive System
9. Musculoskeletal System and Integumentary System
10. Nervous System and Special Sense
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1. BLOCK: PRINCIPLE OF HUMAN BIOLOGY I
Course Description:
This block covers:

 The basic concepts in general structure and organization of human body, cellular
mechanism and regulation of homeostasis.
 The basic concepts of biomolecules, metabolism, nutrition
 Essentials of pharmacology viz. pharmacokinetics, pharmacodynamics and adverse
drug reaction.
 The medically important microorganisms
 Fundamentals of immune system
 The basics of general pathology
Anatomy
Objectives:
At the end of the block, student should be able to:
 Discuss various positions, planes and terms in relation to body and various organs.
 Describe types, different parts and ossification of bone.
 Discuss the subdivision of nervous system and the functional significance.
 Explain the various joints.
 Discuss the principles of routine histological technique.
 Relate the histological features of different types of general tissue with their functions.
 Describe the anatomy of upper and lower limb and explain the common clinical
conditions related to it.
 Relate the radiological features of upper limb & lower limb to the different parts,
types and ossification of the bone.
 Demonstrate the surface landmarks and the surface markings of nerve and vessels of
upper limb and lower limb.
Contents:
 Introduction to Anatomy
 Introduction to Osteology
 Introduction to Nervous System
 Introduction to Arthrology
 Introduction to Histology
 Epithelial tissue
 Connective tissue
 Bone and Cartilage
 Muscular tissue
 Nervous Tissue
 Upper Limb
 Lower Limb
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Physiology
Objectives:
At the end of the block, the student should be able to:
 Define homeostasis and discuss its regulatory process with examples.

 Discuss the nature and maintenance of body fluid compartments and their
significance.
 Correlate the structure of cell organelles to their functions.
 Discuss the types and functions of cytoskeleton and the junctions between the cells.
 Explain the different processes of transport across the cell membrane.
 Explain how the body attempts to maintain the normal temperature under various
conditions.
 Define resting membrane potential and action potential and discuss their genesis.
 Discuss the types and general properties of sensory receptors.
Content:
 Introduction to physiology, body fluid compartments.

 Homeostasis
 Cell organelles. Types and functions of cytoskeleton.
 Types of junctions between two adjacent cells.
 Cell membrane and transport across it.
 Control of body temperature, its regulation in hot climates and cold climates.
 Resting membrane potential and action potential.
 Classification and the properties of sensory receptors.
Biochemistry
Objectives:
 Explain the medical importance of the major groups of molecules (Carbohydrates,

lipids, amino acids, proteins and nucleic acids) by reference to their biochemical
properties.
 Describe the mechanism of action of enzymes, their regulation and their significance
in sustaining human life.
 Describe the basic metabolism of carbohydrates, proteins and lipids and discuss their
regulation and interrelationship.
 Discuss the metabolism of ketone bodies.
 Describe the basic concept about how ATP is generated.
 Describe the role of vitamins and minerals in various biochemical functions with their
deficiency symptoms.
 Identify the metabolic pathways that occur during starvation and obesity and explain
its significance.
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 Perform the test for the biochemical reactions of carbohydrates, lipids, amino acids
and proteins.
 Perform the test for the total protein estimation in blood and interpret the result.
Contents:
 Importance of Biochemistry in Medicine

 Carbohydrates
 Lipids
 Amino Acids
 Proteins
 Enzymes
 Metabolism
o Carbohydrate Metabolism and regulation
o Lipid Metabolism and regulation
o Ketone Body Metabolism
o Bioenergetics and Metabolism
 Nutrition
o Vitamins
o Minerals & Trace Elements Biochemical function
o Biochemistry of Starvation and Obesity.
Microbiology
Objective:
At the end of the block, Students should be able to:
 Describe the categories of microorganisms, their biological characteristics and their

distribution in nature.
 Differentiate between prokaryotes and eukaryotes
 Describe the types of interactions between microbes and human host.
 Explain principles of pathogenicity, virulence and infection.
 List the growth requirements of microbes.
 Explain the bacterial growth curve.
 Classify bacteria on the basis of their morphology and staining reactions
 Describe different mechanisms of gene transfer in bacteria.
 Outline the principles of isolation and identification of bacteria, fungi and viruses.
 List the methods of anaerobiosis.
 Discuss the life cycle of bacteriophage.
 Discuss the nature, classification and replication of viruses.
 Discuss the role of parasites in the etiology of human diseases.
 Discuss the role of fungi in causing human diseases.
 Identify the different culture medias along with their applications.
 Perform different staining methods and identify tests employed for microbial
identification
 Define sterilization and disinfection and describe the available methods.
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Contents
 Introduction to medical microbiology:

o Classification of Microorganism
o Host-pathogen relationship
o Pathogenicity, virulence and infection
 Bacteriology:
o Bacterial structure
o Classification of bacteria
o Growth and Nutrition
o Bacterial Genetics
o Anaerobes and methods of anaerobiasis.
o Isolation and Identification of Bacteria
 Virology:
o Bacteriophage
o General properties, Classification, Replication and laboratory diagnosis of
viruses
 Parasitology:
o Medically Important Parasitic infections
 Mycology:
o Fungi of medical importance
o Types of fungal infections
o Sample collection and fungal isolation and identification methods
 Infection Control:
o Basic concept of infection control and prevention measures
o Methods of sterilization and disinfection
o Biohazard waste and disposal methods
Pathology
Objectives:
At the end of the course, student should be able to:
 Discuss the important terminologies used in pathology.

 Discuss the role of FNAC and exfoliative cytology in diagnosis of diseases.
 Explain the cell injury, its types, causes, mechanism and consequences.
 Discuss cellular adaptation explaining its mechanisms and different types.
 Explain the different types of intracellular accumulation, its causes and various
consequences.
 Describe pathologic calcification, its types and mechanism.
 Define inflammation and describe its types with suitable examples.
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 Discuss vascular and cellular responses, role of chemical mediators and
inflammatory cells in inflammation.
 Discuss the mechanism of wound healing and factors affecting it.
Contents:
 Introduction to Pathology
 Cellular responses to injury
o Cellular adaptation
o Cell injury and cell death
o Cellular accumulation
o Pathologic calcification
 Inflammation and Repair
Pharmacology
Objectives:
At the end of the block the student should be able to:
 Define drug and explain different routes of drug administration and the concepts of
Pharmacokinetics: absorption, distribution, biotransformation and elimination of
drugs.
 Differentiate the concept of Bioavailability and Bioequivalence.
 Explain the significance of therapeutic drug monitoring, and optimization of dosage
regimen.
 Explain the concepts of Pharmacodynamics: Principles of drug action, Drug receptor
interaction, factors affecting drug response, principles of drug-drug and drug-food
interactions.
 Explain different types of Adverse Drug Reactions and their clinical significance
during drug therapy.
 Discuss the principle of management of different types of poisoning and drug
overdose.
 Summarize the basics of essential drug concept, rational drug therapy and
Pharmacoeconomics.
 Apply the concepts of posology in compounding simple formulations.
Contents:
 Introduction to General Pharmacology

o Definition of relevant terminologies
 Sources and routes of drug administration
o Sources and nature of drugs
o Different Routes of Drug administration
 Pharmacokinetics
o Introduction
o Drug Absorption and Bioavailability
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o Drug disposition
o Kinetics of drug elimination.
o Optimization of dosage regimen
o Therapeutic Drug Monitoring (TDM)
 Pharmacodynamics
o Introduction
o Principles of drug action, drug- receptor interactions.
o Dose response relationship
o Factors affecting drug response
 Adverse Drug Reactions
 Poisoning and Overdose.
 Essential Drug Concept, Rational drug therapy and Pharmacoeconomics
Introduction to Clinical Medicine
Objectives
 Elicit history of presenting complaint and chief complaint

 Elicit past medical history, drug history and allergies
 Elicit family history and Social history
 Elicit patient’s ideas, concerns and expectations
 Elicit specific history relating to
o Skin and joints/musculoskeletal
o Respiratory system
o Cardiovascular system
o GI and abdomen
o Psychiatry
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BLOCK: PRINCIPLE OF HUMAN BIOLOGY II
Course description:
This block covers:

 Basic concepts of structure, development and function of lymphoid tissue/organ
 Immunoglobulins
 Host defense and related immunological disorders
 Basic concept and pharmacology of antimicrobial agents
 Basic concept of cell and molecular biology
 Basic concept of developmental biology (embryology)
 Basic concept of medical genetics
 Basic concept of molecular techniques
 Basic concept of neoplasia and its pharmacological management
 Basic concept of autonomic nervous system
 Synthesis, mechanism of action of neurotransmitters of autonomic nervous system
 Classes of drugs related to autonomic nervous system.
Anatomy
Objectives:
 Host Defense and Immunology

o Describe gross features of spleen, thymus & tonsil
o Identify and describe histological features of lymphoid organs.
o Relate the above with different clinical conditions.
 Developmental Biology
o Describe the process and significance of gametogenesis.
o Describe the fate of ovarian follicle.
o Describe the process and result of fertilization.
o Discuss the sequential developmental process during intra-uterine life.
o Explain the types and basis of twinning.
o Identify the critical stages of development and the factors causing
congenital malformations.
 Medical Genetics
o Discuss the importance of genetics in medicine.
o Explain the common genetic disorders and pattern of inheritance.
o Classify the chromosome and discuss various types of chromosomal
abnormalities.
o Explain the diagnostic methods and genetic counseling on prevention and
management of genetic disorders.
o Discuss the ethics in medical genetics.
Contents:
 Host-defense/Immunology
o Thymus
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o Spleen
o Tonsil
o Lymph node
o Mucosa associated lymphoid tissue (MALT)
 General Embryology
o Gametogenesis
o First two weeks of development: Ovulation to implantation
o Second week of development
o Embryonic period: Third to eighth week of development
o Fetal period
o Placenta and fetal membranes
o Twinning
o Birth defects and teratogen
o Introduction to Medical Genetics
o Mode of Inheritance of Single Gene Disorder
o Introduction to Cytogenetic
o Chromosomal Abnormalities
o Autosomal and the Sex Chromosomal Disorders
o Pedigree Analysis
o Prenatal Diagnosis
o Genetic Counseling
o Ethics in medical genetics
Physiology
Objectives:
At the end of the course the student should be able to:
 Classify the hormones according to their nature, properties and mechanism of action
and discuss their methods of regulation of secretion.
 Define ligand, receptor and second messenger and the mechanism of signal
transduction.
 Describe different types of synapses and their proqperties.
 Describe the components of the neuromuscular junction and transmission through it.
 Discuss the physiological organization and function of the autonomic nervous system.
Contents:
 Hormonal control mechanism.

 Signal transduction mechanism.
 Types of synapses and their properties.
 Structure and function of neuromuscular junction.
 Autonomic nervous system
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Biochemistry
Objectives:
At the end of the course, the student should be able to:
 Immunology and Host Defense

o Describe the structure of immunoglobulin and molecular basis of the
immunoglobulin diversity.
 Cell Biology and Genetics

o Describe the underlying biochemical structure of cell with its organization.
o Describe cell cycle and its role in controlled cell division.
o Discuss about the central dogma (replication, transcription and
translation) of life.
o Explain the role of gene expression in physiological function of body and
its derangement leading to cancer and other diseases.
o Outline different molecular techniques and their application.
o Give example of diseases occurring at molecular level with the knowledge
of medical genetics.
o Identify different mode of inheritance.
o Describe cytogenetics and its application in the diagnosis of genetic
disorders.
o Discuss the population genetics with commonly occurring genetic disorder
and genetic counseling.
 Autonomic Nervous System

o Discuss the biosynthesis of neurotransmitters of autonomic nervous system
and their mechanism of action.
Contents:
Immunology
 Immunoglobulins:
o Structure of immunoglobin
o Antibody diversity
Cell Biology and Genetics
 Cell and its organization

o Prokaryote type and Eukaryote type
o Cell Membrane, Channels and Pumps
o Cell-cell interactions
o Cell Organelles and Nucleus
 Molecular Biology:
o Cell cycle and Cell division
o DNA Replication, Mutation and Repair
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o Transcription and it’s Regulation
o Translation and regulation of gene expression
o Stem Cell and differentiation
o Apoptosis
o Oncogenetics
o Recombinant DNA technology
o Recent molecular techniques
o Introduction to Medical Genetics
o Inheritance Pattern
o Chromosome and Cytogenetics
o Inborn error of metabolism
o Population genetics
o Genetic Counseling
Autonomic Nervous System
 Neurotransmitters
Microbiology
Objectives:
Host Defense/Immunology
 Explain the different types of immunity.

 Describe antigen, antibodies and classes of antibodies.
 Describe different types of antigen-antibody reactions.
 Discuss different components of innate immunity.
 Explain the roles of B and T lymphocytes in immune system.
 Explain the role of major histocompatibility complex in immune system
 Explain the mechanism of different types of hypersensitivity reactions.
 Explain the mechanism of immune tolerance and autoimmunity.
 Explain the immunological reactions in transplantation.
 Identify the common serological tests and interpret the results.
 Explain the mechanism of resistance to antimicrobial agents and describe the
different methods to determine antimicrobial resistance.
Contents:
 Introduction to Immunity
 Types of immunity
 Cells of the immune system and their roles
 First and second line of defense
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 Antigens, Antibodies and Antigen- Antibody reactions
 Major Histocompatibility Complex
 Hypersensitivity reactions
 Immune tolerance
 Autoimmunity
 Immunology of transplantation
 Immunity to infections
 Antimicrobial agents.
Pathology
Objectives:
 Enlist the causes of lymphadenitis and describe the microscopic features of

tuberculous and reactive lymphadenitis.
 Classify Lymphoma. Describe the microscopic features of Hodgkin’s and non-
Hodgkin’s lymphoma.
 Enlist the causes of splenomegaly.
 Define edema and explain its pathogenesis.
 Explain the mechanism and consequences of thromboembolism.
 Define shock. Explain its aetiopathogenesis and complications.
 Define infarction and enumerate its types along with common sites.
 Enlist the gross and microscopic changes seen in lung, liver and spleen in chronic
venous congestion.
 Define dysplasia, carcinoma-in situ and neoplasia.
 Classify neoplasia. Enumerate the differences between benign and malignant tumors.
 Enlist the important carcinogens.
 Enumerate the modes of metastasis in carcinomas and sarcomas.
 Discuss the paraneoplastic syndromes.
 Enlist the common modalities used for the laboratory diagnosis of tumors.
 Classify amyloidosis and discuss its aetiopathogenesis.
Contents:
 Lymphadenitis
 Lymphomas
 Splenomegaly
 Haemodynamic disorders
 Thromboembolism
 Shock
 Neoplasia
 Amyloidosis
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Pharmacology
Objectives:
 For each of the following group of drugs:

o Antimicrobials
o Anticancer drugs
o Immunomodulators
o Drugs affecting the autonomic nervous system
i. Describe the general principles of their use
ii. Explain the mechanisms of action
iii. Explain the adverse effects, indications and contraindications
iv. Discuss common regimens of use of the drugs
 Explain the mechanism of resistance to antimicrobials
 Discuss the general principles of pharmacogenetics with clinically relevant examples.
Contents:
 Antimicrobial Agents
 Anticancer Agents
 Immunomodulators
 Pharmacogenetics
 Autonomic Nervous System
o Adrenergic receptor agonists
o Adrenergic receptor antagonists
o Cholinergic receptor agonists
o Cholinergic receptor antagonists
Objectives:
 Elicit specific history relating to

o ENT
o Eyes
o Renal/genitourinary tract
o CNS/headache
o Obstetrics and gynaecology
o Endocrinology
 Discuss ethical issues surrounding

o Duty of care/negligence
o Transplant/genetics
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2. BLOCK: HEMOPOIETIC SYSTEM
Course Description:
This block covers:

 Synthesis and function of hematological components
 Common hematological diseases
 Common Blood infections
 Pharmacological management of hematological disorders and blood parasite infection.
Physiology
Objectives:
At the end of the block, students should be able to:
 Discuss the composition of blood.

 Describe the components of plasma and their functional importance.
 Describe the different types of normal blood cells with their functions.
 Determine the level of hemoglobin of a given blood sample.
 Describe how blood cells are produced.
 Determine the bleeding and clotting time of an individual.
 Read the values of ESR, PCV and Osmotic fragility and interpret the findings.
 Explain the biochemical basis and functional significance of blood groups.
 Discuss the principles of blood transfusion and transfusion reactions.
 Explain the mechanism of blood coagulation.
Contents:
 Blood as a Body Fluid

 Plasma
 Blood cells
 Erythropoiesis and its regulation
 Blood groups
 Blood transfusion
 Haemostasis
Biochemistry
Objective:
At the end of the block, the students should be able to:
 Discuss haem biosynthesis and its disorder leading to porphyria and

hemoglobinopathies.
 Describe the metabolism of iron, folic acid and Vitamin B12 and its role in haem
synthesis.
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 Discuss different component of RBC membrane and their role in its structural
stability.
 Discuss different metabolic pathways in RBC and their significance in its functioning.
Contents:
 Haemoglobin
o Haem Biosynthesis
o Haemoglobinopathy
o Molecular Basis of Thalassemias
o Porphyrias
 Iron Metabolism
 Folic acid and Vitamin B12 Metabolism
 Red Blood Cell Structure and Metabolism
o Components of RBC membrane
o Glycolysis Pathway
o HMP Shunt Pathway
o Glutathione (Redox) System
Microbiology
Objectives
 List different agents involved in blood-stream infections.

 Explain the causes of hospital acquired blood-stream infections.
 Describe transient, continuous and intermittent bacteraemia.
 Describe the etiology, pathogenesis and laboratory diagnosis of Leptospirosis, Typhus
fever and Brucellosis.
 Enumerate microorganisms responsible for infections associated with intravenous
catheter.
 Enumerate the viruses causing hemorrhagic fever along with their characteristics.
 Describe the etiology and laboratory diagnosis of systemic fungal infections.
 Explain the precautions to be taken while collecting blood for culture.
 Plan appropriate investigation and interpret the blood culture result and antibiotic
sensitivity test.
 Describe life cycle, pathogenesis of blood parasites.
 Plan the appropriate method for laboratory diagnosis of blood parasites
 Perform staining to identify the blood parasites.
Contents:
 Bloodstream infections
 Bacteremia
 Blood/tissue parasitic infections
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 Systemic fungal infections
 Viral hemorrhagic fever
Pathology
Objectives:
 Define anemia and classify it based on aetiology and morphology.

 Describe aetiopathogenesis, morphological features, laboratory diagnosis and
complications of
o Iron deficiency anemia
o Megaloblastic anemia
o Haemolytic anemia
 Thalassemia
 Hereditary spherocytosis
 Sickle cell disease
 Discuss aetiopathogenesis and laboratory diagnosis of aplastic anaemia
 Discuss myelodysplastic syndrome.
 Define leukemia and leukemoid reaction and differentiate them.
 Classify leukemia and discuss its clinical presentation and laboratory diagnosis.
 Enlist the chronic myeloproliferative disorders.
 Discuss the clinical manisfestations, aetiopathogenesis, complications and laboratory
diagnosis of multiple myeloma.
 Enlist the aaetiology of bleeding disorders.
 Discuss the aetilopatholgenesis and laboratory diagnosis of common haemorhagic
diathesis.
o Hemophilia (A &B),
o von Willebrand disease
o Idiopathic thrombocytopenic purpura (ITP)
o Disseminated Intravascular Coagulation (DIC)
Contents:
 Anemia
o Iron deficiency anemia
o Thalassemia
o Megaloblastic anemia
o Aplastic anemia
o Hereditary spherocytosis
o Sickle cell disease
 Leukemia
 Multiple myeloma
 Haemorrhagic Diathesis
o Hemophilia (A & B)
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o von Willebrand disease
o Idiopathic Thrombocytopenic Purpura (ITP)
o Disseminated Intravascular Coagulation (DIC)
 Myelodysplastic syndrome
 Chronic myeloproliferative disorders
Pharmacology
Objectives

o Anticoagulants
o Thrombolytic and Antifibrinolytic agents
o Antiplatelet agents
o Hematinics
o Antimalarial agents
o Antifilarial agents
o Antileishmanial agents
i. Describe the general principles of their use.
ii. Explain the mechanisms of action, indications and adverse effects
iii. Explain the contraindications and drug interactions
Contents:
 Anticoagulants
 Thrombolytic and antifibrinolytic agents
 Antiplatelet agents
 Hematinics
 Therapy of Parasitic Infections
o Malaria
o Leishmaniasis
o Filariasis
Introduction to Clinical Medicine:
Objectives:

 Perform a general physical examination for
o anaemia and lymph nodes
o Blood pressure and pulses
o End of life
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3. BLOCK: RESPIRATORY SYSTEM
Course Description:
This block covers:

 Structure and function of respiratory system
 Gaseous exchange, mechanism and regulation of respiration.
 Oxygen transport and cellular respiration
 Aetiopathogenesis, pathology and drug management of common respiratory diseases.
Anatomy
Objectives:
 Summarize the development and derivatives of pharyngeal apparatus.

 Discuss the normal development of respiratory system and diaphragm and relate it
with common developmental anomalies.
 Discuss the anatomy of different parts of respiratory tract (upper and lower
respiratory tract) and diaphragm.
 Identify and describe the histological features of different parts of the respiratory
system.
 Identify the different bones of thoracic cage and summarize their features.
 Discuss the respiratory muscles and explain their role in mechanism of respiration.
 Identify the radiological features of respiratory system on standard diagnostic images.
 Demonstrate surface landmark on chest wall and surface marking of lung and pleura
and discuss their significance in physical examination.
Contents:
 Pharyngeal apparatus
 Nose and nasal cavity
 Paranasal sinuses
 Larynx
 Trachea
 Bronchus
 Lungs and pleura
 Thoracic cage
 Diaphragm
20
Physiology
Objectives:
At the end of the course the student should be able to:
 Discuss the mechanics of breathing.

 Perform the lung function tests measuring the lung volume and capacities and
interpret the findings.
 Describe the pulmonary circulation and the alveolar gas exchange.
 Discuss respiratory shunt and its significance.
 Discuss the transport of oxygen and carbon dioxide.
 Describe the regulation of normal respiration.
 Discuss the regulation of respiration at high altitude.
Contents:
 Mechanics of Breathing
 Spirometry
 Diffusion capacities and factors influencing diffusion of gases
 Pulmonary circulation
 Respiratory shunt
 Oxygen transport
 Carbon dioxide transport
 Regulation of Respiration
 Respiration in high altitude
Biochemistry
Objectives:
 Compare the structural difference in hemoglobin and myoglobin and its importance in
their function as oxygen carrier and oxygen storage.
 Explain the role of biological oxidation in various body functions.
 Discuss electron transport chain (ETC) and oxidative phosphorylation and relate
their role in ATP synthesis.
 Compare inhibitors and uncouplers of ETC and its clinical application.
 Describe generation of reactive oxygen species in the body and discuss the role of
antioxidant in neutralizing reactive oxygen species to prevent oxidative stress.
 Discus the importance of blood buffers in maintaining Acid base homeostatis.
 Describe the role of respiratory system in pH regulation; its imbalance leading to
respiratory acidosis/alkalosis and biochemical basis of the clinical intervention in
respiratory acidosis/alkalosis.
 Discuss the method of arterial blood gas analysis and its interpretation.
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Contents:
 Oxygen transport
 Bioenergetics, biological oxidation and oxidative phosphorylation
 Oxidative stress – Antioxidant systems
 Blood buffers
 Blood pH regulation
Microbiology
Objectives:
 List the normal flora of respiratory tract.

 List the possible pathogenic agents of respiratory tract and their site of infection.
 Suggest appropriate sample collection procedure for laboratory diagnosis of
respiratory tract infections.
 Describe the morphology, cultural characteristics, pathogenesis and laboratory
diagnosis of bacterial and fungal agents causing upper and lower respiratory tract
infections.
 List the viruses causing respiratory tract infection.
 Discuss the classification, morphology and laboratory diagnosis of influenza virus.
 Describe the morphology, pathogenesis and laboratory diagnosis of agents causing
opportunistic infections in immunocompromised host.
 Perform simple test to determine the presence of Mycobacterium tuberculosis.
 Perform tests to determine the presence of bacteria in respiratory specimens and
interpret the result.
 Interpret the culture and sensitivity result.
 Discuss the consequence of group A Strep sore throat infection including the
underlying mechanism.
Contents:
 Normal flora of respiratory tract.

 Potential pathogens of respiratory tract.
 Upper and lower Respiratory tract infections
 Opportunistic infections of Respiratory tract
Pathology
Objectives:
 Discuss the aetiopathogenesis and clinical features of chronic bronchitis.

 Explain the aetiopathogenesis of emphysema and enlist its types and complications.
 Describe the pathogenesis of atelectasis and enlist its types and complications.
 Explain the aetiopathogenesis of bronchial asthma and enlist its various types.
 Explain the aetiopathogenesis, clinical features and complications of bronchiectasis.
22
 Explain the pathogenesis of hyaline membrane disease and adult respiratory distress
syndrome.
 Explain the aetiopathogenesis of pneumonia. Enlist its types, stages and
complications.
 Explain the aetiopathogenesis of lung abscess and enlist its complications.
 Classify and explain the aetiopathogenesis,, gross and microscopic features of
bronchogenic carcinoma.
 Describe the aetiopathogenesis and microscopic features of tuberculosis. Explain
primary and re-infection tuberculosis.
 Explain Ghon’s focus and primary complex.
 Discuss pleural lesions (Infective, benign and malignant).
 Differentiate between transudative and exudative pleural effusions.
 Describe aetiology and types of pneumothorax.
 List the investigations required to diagnose diseases of the respiratory tract.
 Define pneumoconiosis and explain its pathogenesis with special reference to
anthracosis, asbestosis and silicosis.
Contents:
 Chronic bronchitis
 Bronchial asthma
 Bronchiectasis
 Emphysema
 Atelectasis
 Hyaline membrane disease and adult respiratory distress syndrome
 Pneumonia
 Lung abscess
 Tuberculosis of lung
 Bronchogenic carcinoma
 Pleural lesions
 Pneumoconiosis
Pharmacology
Objectives:

o Drugs used in Bronchial asthma
o Antitubercular agents
 Describe for the following drug categories when they are used, how they act, their
contra-indications and their side effects:
o H1 antihistamines
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o Antitussive and Expectorants.
 Discuss pharmacotherapeutic approaches to common forms of respiratory tract
infections
Contents:
 Therapy of Bronchial asthma

 Therapy of Allergic conditions
 Therapy of Cough
 Therapy of Tuberculosis
 Pharmacotherapeutic approaches to respiratory tract infections.
Objectives:
 Take a history from an adult or child with respiratory symptoms

 Perform examination of the respiratory system
24
4. BLOCK: CARDIOVASCULAR SYSTEM
Course Description:
This block covers:

 Development, general structure, function and regulation of cardiovascular system
 Aetiopathogenesis and common pathological conditions affecting the cardiovascular
system
 The pharmacological management of common cardiovascular abnormalities.
Anatomy
Objectives:
 Discuss normal development of cardiovascular system (CVS) and relate it with

common developmental anomalies.
 Explain the changes in circulation of blood before and after the birth.
 Describe the gross and histological features of different parts of cardiovascular
system.
 Describe the features of pericardium and its relationship with the heart.
 Describe the mediastinum and its contents.
 Identify the radiological features of CVS and mediastinal contents on standard
diagnostic images.
 Demonstrate the surface landmarks and surface marking of heart, major blood
vessels, auscultatory areas and valves and discuss their significance in physical
examination.
Contents:
 Heart
 Pericardium
 Mediastinum
 Aorta
 Superior venacava
 Azygous system of vein
 Thoracic duct
 Sympathetic trunk
Physiology
Objectives:
 Describe the properties of the cardiac muscles and the conducting system of the heart.
 Describe the events in the cardiac cycle.
25
 Interpret the normal electrocardiogram and explain its genesis.
 Describe cardiac output and factors affecting it.
 Describe the haemodynamics of circulation.
 Describe the regulation of the arterial blood pressure.
 Discuss lymph circulation, its functions and factors affecting it.
 Discuss coronary circulation during different phases of cardiac cycle and factors
affecting it.
 Comprehend the cardiovascular changes during exercise.
 Describe the genesis of normal heart sounds.
 Describe the basis of hypovolemic shock.
Contents:
 Properties of cardiac muscle

 Conducting system of the heart
 Electrocardiography
 Cardiac Cycle
 Cardiac Output
 Haemodynamics of circulation
 Arterial Blood Pressure and its Regulation
 Coronary circulation
 Circulation of lymph
 Effect of exercise on cardiovascular system
 Pathophysiology of hypovolemic shock
Biochemistry
Objectives:
 Describe cholesterol biosynthesis and its degradation into bile acid.

 Discuss the pathway for endogenous and exogenous lipid transport.
 Describe the risk of dyslipidemia in cardiovascular disease.
 Describe cardiac muscle metabolism and the metabolic alteration during anoxic state.
 Discuss different types of cardiac markers and its application in detecting cardiac
injury.
 Interpret lipid profile test and biochemical basis of clinical intervention to normalize
lipid profile.
 Perform cholesterol estimation and its interpretation.
Contents:
 Fatty Acid – TAG Metabolism

 Cholesterol Metabolism
 Lipoprotein Metabolism
 Metabolism in Cardiac Muscle
 Cardiac markers
26
Microbiology
Objectives:
 Describe cause and pathogenesis of acute rheumatic fever and rheumatic heart
disease
 Plan the tests necessary for establishing the diagnosis of acute rheumatic fever and
rheumatic heart disease.
 List the agents causing infective endocarditis.
 Plan the laboratory diagnosis of endocarditis.
Contents:
 Acute rheumatic fever

 Rheumatic heart disease
 Infective endocarditis
Pathology
Objectives:
 Discuss the aetiopathogenesis and complications of atherosclerosis.

 Explain the morphology of an athermatous plaque.
 Define and enlist the types of aneurysm.
 Define and classify hypertension. Discuss its aetiopathogenesis and complications.
 Discuss aetiopathogenesis and clinical features of rheumatic fever and rheumatic
heart disease.
 Describe the morphology of Aschoff bodies.
 Discuss the aetiopathogenesis, clinical features and complications of infective
endocarditis.
 Explain the aetiopathogenesis, clinical features and complications of ischemic heart
diseases.
 Discuss the morphological changes of an acute myocardial infarction.
 Explain the aetiopathogenesis of cardiomyopathies.
 Discuss the aetiopathogenesis of myocarditis and pericarditis.
 Discuss the pathophysiology of congestive cardiac failure.
 Enumerate the common congenital heart diseases. Explain morphology of Fallot’s
tetralogy.
Contents:
 Atherosclerosis
 Rheumatic fever and rheumatic heart disease
 Infective endocarditis
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 Ischaemic heart diseases
 Cardiomyopathies
 Myocarditis,
 Pericarditis
 Hypertension
 Aneurysm
 Congenital heart diseases
Pharmacology
Objectives:

o Antihypertensive agents
o Drugs used in the management of ischemic heart diseases
o Drugs used in the management of congestive cardiac failure
o Antiarrhythmic agents
o Hypolipidemic agents
 List the drugs used in different types of shock and the rationale for their use.
 Describe the general principles of therapy and prophylaxis of rheumatic heart disease
and endocarditis.
Contents:
 Therapy of Hypertension
 Therapy of Myocardial Ischemia
 Therapy of Cardiac failure
 Therapy of Cardiac arrhythmias
 Hypolipidemic Agents
 Therapy of Shock
 Therapy and prophylaxis of rheumatic heart disease and endocarditis
28
Objectives:
 Take a history from an adult or child with cardiovascular disease

 Perform examination of the cardiovascular system
29
5. BLOCK: GASTROINTESTINAL AND HEPATOBILIARY SYSTEM
Course Description:
This block covers:

 The structure, development and function of the gastrointestinal tract (GIT).
 Common pathological conditions of the gastrointestinal and hepatobiliary system and
their pharmacological management.
 Functions of the liver.
 Common microbial infections and helminthic infestations of the GIT and
chemotherapy of the same.
Anatomy
Objectives:
 Discuss normal development of gastrointestinal tract (GIT) and associated organs

and relate it with common developmental anomalies.
 Describe the anatomy of anterior abdominal wall.
 Discuss the anatomy of inguinal canal and basis of different types of herniation.
 Describe the anatomy of different parts of GIT and associated organs and relate it
with common clinical conditions.
 Describe the peritoneum and its arrangements and relate it with clinical conditions.
 Describe the histological features of different parts of the gastrointestinal system
(GIS) and associated organ.
 Demonstrate the feature of lumbar vertebra.
 Identify different parts of GIS and associated organs on standard diagnostic images.
 Demonstrate the surface landmarks and surface marking of abdominal viscera and
discuss their significance in physical examination.
Contents:
 Oral cavity and salivary glands

 Tongue and Palate
 Pharynx
 Oesophagus
 Stomach
 Small and large intestine
 Caecum and appendix
 Rectum and anal canal
 Liver and extra hepatobiliary apparatus
 Pancreas
 Peritoneum
 Portal vein and portocaval anastomosis
 Anterior abdominal wall and inguinal canal
 Lumbar vertebrae
30
Physiology
Objectives:
At the end of the course the students should be able to:
 Discuss the functional organization and types of smooth muscles.

 Discuss the electrical activity of gastrointestinal smooth muscle and their
significance.
 Discuss the mechanism of contraction of smooth muscle and factors affecting it.
 Discuss the types of motility in different parts of the gastrointestinal tract along with
their functions.
 Explain the mechanism, composition and control of secretion of salivary, gastric,
biliary and pancreatic secretions.
 Describe the mechanism of vomiting and defecation.
Contents:
 Physiology of smooth muscle

 Salivary secretion, mastication and deglutition
 Gastric secretion and motility
 Biliary and pancreatic secretions
 Secretion and motility of the intestine
 Vomiting and defecation
Biochemistry
Objectives:
 Describe different types of plasma proteins synthesized by liver.

 Describe bilirubin metabolism and differentiate different types of jaundice.
 Explain the role of liver in foreign substance (xenobiotics) detoxification.
 Explain synthesis of bile acid and it role in lipid digestion and absorption.
 Discuss and interpret the liver function test
 Perform and interpret urobilinogen, bile pigment and bile salt.
 Describe the digestion and absorption of carbohydrate, protein and lipids.
 Discuss the digestive disorder associated with maldigestion and malabsorption.
 Describe the gastrointestinal endocrine system and its role in digestion.
Contents:
 Digestion and absorption

 Gastrointestinal endocrine system
 Bilirubin metabolism
 Functions of Liver
 Liver Function Tests
31
Microbiology
Objectives:

 List the normal flora of intestine.
 List organisms responsible for GI tract infections (bacterial, Viral, and parasites).
 Discuss the aetiology, pathogenesis and laboratory diagnosis of enteric fever.
 Discuss the role of bacterial agents in causing diarrhea and dysentery.
 Discuss the role of Helicobacter pylori in peptic ulcer.
 Describe the life cycle, pathogenesis and laboratory diagnosis of intestinal and
hepatobiliary parasites.
 List the common pathogens responsible for food poisoning.
 Discuss specimen collection, transport and processing.
 Interpret the stool analysis and culture result.
 Plan the laboratory investigation of amoebic liver abscess.
 Discuss the structure, properties and laboratory diagnosis of different viruses causing
hepatitis.
 Interpret the serological diagnosis of hepatitis.
Contents:
 Normal flora of intestine

 Diarrhoea and Dysentery
 Enteric fever
 Helicobacter pylori
 Parasitic infections of GIT
 Viral infections of GIT
 Food poisoning
 Hepatitis viruses
 Amoebic liver abscess
 Hydatid cyst
 Hepato-biliary parasites
Pathology
Objectives:
 Enlist the common inflammatory, premalignant and malignant lesions of the oral
cavity.
 Enlist the inflammatory and common tumors of the salivary glands.
 Enlist the gross and microscopic features of a pleomorphic adenoma.
 Define and explain the aetiopathogenesis and consequences of Barrett’s esophagus.
 Enlist the common tumors of the oesophagus.
32
 Explain the aetiopathogenesis of acute and chronic gastritis. Discuss the morphology
of chronic gastritis.
 Explain the aetiopathogenesis, gross and microscopic features and complications of
peptic ulcer.
 Differentiate the gross features of a benign and malignant gastric ulcer.
 Classify gastric tumours. Discuss the aetiopathogenesis, clinical features,
complications, gross and microscopic feature of a gastric carcinoma.
 Enlist the important inflammatory diseases of small and large intestine.
 Discuss the aetiopathogenesis, clinical features and complications of intestinal
tuberculosis, ulcerative colitis, Crohn’s disease, amoebic colitis and typhoid ulcer.
 Enumerate the differentiating features of an ulcerative colitis and Crohn’s disease.
 Enlist the gross and microscopic features of an acute appendicitis and its
complications.
 Classify the tumours of the small and large intestine.
 Enumerate the gross and microscopic features of colorectal carcinoma.
 Enlist the common causes of liver abscess.
 Enlist the causes of jaundice.
 Discuss the aetiopathogenesis and sequelae of viral hepatitis.
 Discuss portal hypertension and its consequences.
 Discuss the aetiopathogenesis and complications of cirrhosis. Enlist its gross and
microscopic features.
 Discuss the aetiopathogenesis of hepatocellular carcinoma and enlist its gross and
microscopic features. .
 Explain the aetiopathogenesis, morphology and complications of acute and chronic
pancreatitis.
 Discuss the aetiopathogenesis, and complications of chronic cholecystitis.
 Identify gross and microscopic features of chronic cholecystitis and carcinoma of the
gall bladder.
Contents:
 Oral Pathology
 Salivary gland lesions
 Barrett’s esophagus
 Carcinoma of esophagus
 Gastritis
 Peptic ulcer
 Carcinoma of stomach
 Tuberculosis of intestine
 Typhoid of intestine
 Appendicitis
 Amoebic colitis
 Ulcerative colitis and Crohn’s disease
 Tumours of the small and large intestine
 Jaundice
 Cirrhosis of liver
 Viral hepatitis
 Portal hypertension
33
 Liver abscess – amoebic and pyogenic
 Hepatocellular carcinoma
 Chronic cholecystitis
 Carcinoma of gall bladder
 Acute and chronic pancreatitis
Pharmacology
Objectives:

o Drugs used in peptic ulcer diseases
o Drugs used in constipation
o Antiemetics and emetics
o Oral rehydration salt (ORS) and Antidiarrhoeal agents
o Antiprotozoal Drugs
o Antihelmentics
ii. Explain the mechanisms of action, Indications and adverse effects
 Discuss the management of H. Pylori infection
 List the drugs that can cause significant hepatotoxicity
Contents:
 Therapy of Peptic Ulcer

 Therapy of Diarrhea
 Therapy of Protozoal infections
 Antiemetics and emetics
 Laxatives and purgatives
 Therapy of Worm Infestations
 Hepatotoxicity of Drugs
Objectives:
 Take a history from an adult or child with gastrointestinal symptoms

 Perform examination of the gastrointestinal system
34
6. BLOCK: RENAL AND ELECTROLYTES
Course Description:
This block covers:

 The basic concept of renal structure, development, functions (including fluid
electrolytes and acid base homeostasis).
 The basic concept of common aetiopathogenesis and pathological conditions of renal
system.
 The basic concept and pharmacology of diuretic, antidiuretic, renal antiseptic and
nephrotoxicity.
Anatomy
Objectives:
 Discuss the normal development of urinary system and relate it with common
developmental anomalies.
 Describe the anatomy of different parts of urinary system and relate it with clinical
conditions.
 Identify and describe histological features of different parts of urinary system.
 Demonstrate the different parts of the urinary system on standard diagnostic images.
 Demonstrate of the surface marking of kidney.
Contents:
 Kidney
 Ureter
 Urinary Bladder
 Urethra
Physiology
Objectives:
 Describe the mechanism of glomerular filtration and factors affecting it.

 Discuss the peculiarities and control of renal blood flow.
 Describe the process of absorption and secretion of different substances across the
renal tubule.
 Explain the formation of dilute and concentrated urine.
 Discuss the process of micturation.
35
Contents:
 Glomerular filtration rate (GFR) and renal blood flow

 Functions of different parts of the nephron.
 Mechanism of urine formation.
 Physiology of micturation.
Biochemistry
Objectives:

 Describe the metabolism of individual amino acid and their disorder leading to
diseases.
 Discuss nitrogen balance and urea biosynthesis and their medical importance.
 Discuss the role of kidney in acid-base and electrolyte balance and their imbalance
leading to metabolic acidosis / alkalosis.
 Perform urea estimation and interpret the result.
 Interpret renal function tests and calculate creatinine clearance and urea clearance.
 Perform the test for normal constituent of urine and urinary protein.
Contents:
 Amino Acid Metabolism

 Nitrogen balance and Urea cycle
 Role of Kidney in Acid – Base Regulation and Electrolyte Balance
 Renal Function Test
Microbiology
Objectives:
 List the normal flora of the urinary tract.

 Describe the routes of urinary tract infections.
 List etiologic agents of Urinary tract Infections.
 Discuss the role of streptococcal infection in causing glomerulonephritis.
 Plan the investigation to diagnose renal tuberculosis.
 Suggest appropriate method for urine specimen collection.
 Plan lab investigation and interpretation of urine culture report.
Contents:
 Normal flora of urinary tract.

 Urinary tract infections
 Post streptococcal glomerulonephritis
 Renal tuberculosis
36
Pathology
Objectives:
 Describe adult and childhood polycystic kidney. Enlist its gross features.
 Classify glomerular diseases and discuss the aetiopathogenesis, morphology and
clinical presentations of acute post-streptococcal glomerulonephritis, rapidly
progressive glomerulonephritis and chronic glomerulonephritis.
 Explain the pathophysiology of nephrotic syndrome and differentiate nephrotic and
nephritic syndromes.
 Describe the aetiopathogenesis of benign and malignant nephrosclerosis.
 Explain the aetiopathogenesis, morphology, clinical features and consequences of
acute tubular necrosis.
 Discuss the aetiopathogenesis and sequelae of acute and chronic pyelonephritis.
Enlist the gross and microscopic features of chronic pyelonephritis.
 Enlist the types, morphology and consequences of renal calculi.
 Define hydronephrosis. Discuss its causes and morphology.
 Enlist common kidney tumors. Identify gross and microscopic features of renal cell
carcinoma and Wilm’s tumour.
 Discuss the aetiopathogenesis of cystitis.
 Enlist the tumours of the urinary bladder. Describe the aetiopathogenesis, and
microscopic features of transitional cell carcinoma.
Contents:
 Polycystic kidney
 Glomerulonephritis
 Nephrosclerosis
 Nephrotic Syndrome
 Acute Tubular Necrosis (ATN)
 Pyelonephritis
 Hydronephrosis
 Urolithiasis
 Tumors of kidney
 Inflammation and tumours of urinary bladder
37
Pharmacology
Objectives:
 Classify the diuretic and antidiuretic agents and describe their use in different
situations, their mechanisms of action, adverse effects and contraindications
 Discuss nephrotoxic drugs with their mechanism of nephrotoxicity.
 Discuss common antibiotics used in treating urinary tract infections (UTIs).
Contents:
 Diuretics and antidiuretics

 Nephrotoxicity of drugs
 Treatment of Urinary Tract Infections
Objectives:
 Take a history from an adult or child with renal or genitourinary symptoms.

 Perform examination of the renal and genitourinary system.
38
7. BLOCK: ENDOCRINE, METABOLISM & REPRODUCTIVE
Course Description:
This block covers:

 The essential knowledge about structure and development of different endocrine
glands
 Synthesis, secretion, functions and metabolic effects of different hormones.
 The pathophysiological basis of common endocrine abnormalities and their
pharmacological management
 The structure, development and function of the male and female reproductive
systems
 Aetiopathogenesis and pathology of common reproductive abnormalities
 Pharmacological management of common reproductive abnormalities
Anatomy
Objectives:
 Discuss the normal development of the endocrine glands and relate it with
 Describe the anatomy of endocrine glands and relate it with clinical conditions.
 Identify and describe the histological feature of endocrine glands.
 Discuss the normal development of male and female reproductive and associated
organs and relate it with common developmental anomalies
 Describe the gross features of pelvis and perineum.
 Describe the anatomy of male and female reproductive and associated organ and
relate it with common clinical conditions.
 Identify and describe the histological feature of various parts of male and female
reproductive organs and associated organs.
 Demonstrate the various parts of male and female reproductive and associated
organs on standard diagnostic images.
 Describe the features and sex differences of bony pelvis and discuss their clinical
importance.
Contents:
 Endocrine glands
 Male reproductive organs
 Female reproductive organs
 Pelvis and Pelvic diaphragm
 Perineum and External Genitalia
 Breast
39
Physiology
Objectives:
 Discuss the endocrine function of hypothalamus and describe the hypothalamo-

hypophyseal system.
 Enlist the hormones secreted by the anterior and released by posterior pituitary.
 Discuss the functions and mechanism of action of hormones secreted by the
anterior and posterior pituitary.
 Discuss the functions and mechanism of action of thyroid and parathyroid
hormones.
 Discuss the function and mechanism of action of hormones of the adrenal gland,
pancreas, testes and ovary.
 Describe the physiological basis of growth and puberty.
 Discuss the hormonal regulation of reproduction.
 Discuss the physiological hormonal modifications in pregnancy and lactation.
 Discuss the physiological mechanism of coping with stress.
 Perform pregnancy test and interpret the result.
Contents:
 Regulation and function of hypothalamus and hypothalamus-hypophyseal system

 Regulation and function of hypothalamus-pituitary-thyroid axis
 Regulation and function of hypothalamus-pituitary-adrenal axis
 Regulation and function of hypothalamus-pituitary-testes axis
 Regulation and function of hypothalamus-pituitary-ovary axis
 Regulation of calcium homeostasis
 Regulation of blood glucose homeostasis: insulin and counter-regulatory
hormones
 Physiology of growth and puberty.
 Physiology of male reproductive system.
 Physiology of female reproductive system and physiology of menstrual cycle.
 Physiology of fertilization, implantation, pregnancy, parturition and lactation.
 Physiological basis of contraceptive methods.
Biochemistry
Objectives:
 Classify different types of hormones.

 Outline the regulation and mechanism of action of hormone in general.
40
 Describe the nature, synthesis, secretion and mechanism of action of pituitary
hormones.
 Describe the nature, synthesis, secretion and mechanism of action of thyroid
hormones.
 Describe the nature, synthesis, secretion and mechanism of action of
corticosteroid hormones.
 Describe the nature, synthesis, secretion and mechanism of action of testicular
hormones.
 Describe the nature, synthesis, secretion and mechanism of action of ovarian
hormones.
 Describe the nature, synthesis, secretion and mechanism of action of pancreatic
hormones.
 Describe different types of diabetes mellitus, metabolic changes that occurs in
diabetes and biochemical basis of diabetic complication.
 Describe the role of hormones in the control of body weight.
 Perform glucose estimation test and interpret the result.
 Interpret the result of oral glucose tolerance test (OGTT) and HbA1c.
 Interpretation of thyroid function test.
Contents:
 Hormone: classification, Regulation and mechanisms of action

 Pituitary hormones
 Thyroid Hormones
 Steroid hormones
 Endocrine Pancreas
 Hormones and body weight
Microbiology
Objective:
At the end of the course, the students should be able to:
 List the normal flora of genital tract.
 Explain the aetiology, pathogenesis and laboratory diagnosis of sexually
transmitted and genital tract infections.
 Plan lab investigation for Sexually Transmitted Infections and interpret lab
results.
 Describe the structure, pathogenesis and laboratory diagnosis of HIV.
 Interpret the tests for HIV diagnosis.
 Describe etiologic agents of intrauterine growth retardation and its consequences.
 Plan for lab diagnosis of TORCH Infection and interpret the result.
Content:
 Normal flora of genital tract

 Sexually transmitted infections
41
 Genital tract infections
 TORCH
Pathology
Objectives:

 Explain the causes of hyper and hypopitutarism and discuss Sheehan’s syndrome,
Empty Sella Tursica Syndrome and pituitary adenoma.
 Discuss prolactinoma, diabetes insipidus and craniopharangioma.
 Discuss the aetiopathogenesis and clinical features of hypothyroidism and
hyperthyroidism.
 Discuss the aetiopathogenesis and clinical consequences of hypoparathyroidism
and hyperparathyroidism.
 Discuss the aetiopathogenesis of the various types of thyroiditis and goiter.
 Classify the tumors of thyroid gland. Enlist the gross and microscopic features of
papillary carcinoma and follicular adenoma.
 Discuss the aetiopathogenesis and clinical features of Cushing’s syndrome.
 Discuss neuroblastoma and pheochromocytoma.
 Classify diabetes mellitus and discuss the aetiopathogenesis, clinical features and
complications of diabetes.
 Discuss the aetiopathogenesis, gross and microscopic features of benign prostatic
hyperplasia (BPH).
 Classify testicular tumors and enlist the gross and microscopic features of
seminoma.
 Enlist the causes and consequences of inflammatory lesions of testis.
 Enlist the inflammatory premalignant and malignant lesions of penis.
 Describe the aetiology of cervicitis.
 Discuss intraepithelial neoplasia and squamous cell carcinoma of cervix and
enlist its microscopic features.
 Discuss the importance of pap smear examination.
 Define endometriosis and adenomyosis enlist their consequences.
 Discuss aetiopathogenesis, gross and microscopic features of endometrial
adenocarcinoma.
 Enlist the gross and microscopic features of leiomyoma and its secondary
changes.
 Classify ovarian tumors and enlist the gross and microscopic features of serous
and mucinous tumors and teratoma.
 Classify the trophoblastic tumors and enlist the gross and microscopic features of
hydatidiform mole and choriocarcinoma.
 Enumerate the causes of breast lump.
 Classify benign and malignant tumors of the breast and enlist the gross and
microscopic features of fibroadenoma.
 Discuss the aetiopathogenesis, clinical features, risk factors, gross and
microscopic features of breast carcinoma.
 Enlist the causes of gynaecomastia.
Content:
42
 Diseases of pituitary gland
 Diseases of thyroid
 Diseases of Parathyroid gland
 Diseases of Adrenal gland
 Diabetes mellitus
 Benign prostatic hyperplasia (BPH)
 Prostatic carcinoma
 Tumors of testis
 Carcinoma of penis
 Cervicitis
 Carcinoma of cervix
 Endometrial carcinoma
 Leiomyoma and adenomyosis
 Ovarian tumours
 Trophoblastic diseases
 Breast diseases- male and female
Pharmacology
Objectives:

o Thyroid hormone analogues and Antithyroid agents
o selective estrogen receptor modulators
o Synthetic analogues and antagonists of adenocorticosteroids
o Insulin and oral hypoglycemic agents
o Analogues and antagonists of sex hormones
o Oxytocics and Tocolytics
1. Describe general principles of their use.
2. Explain the mechanisms of action, indications and adverse
effects
3. Explain the contraindications and drug interactions
 Discuss the therapeutic uses of parathormone, calcitonin and Vitamin D.
 Explain the concept of hormonal contraception, enumerate various hormonal
contraceptives available and describe their mechanism of action, adverse effects,
contraindications and drug interactions.
 Identify the drugs of choice and alternate drugs in sexually transmitted diseases.
 Define teratogenicity, categorize drugs that have established or potential
teratogenic effects and analyze the risk in using such drugs in pregnancy
Contents:
 Thyroid hormone analogues and Antithyroid agents
43
 Selective estrogen receptor modulators
 Synthetic analogues and antagonists of adenocorticosteroids
 Insulin and oral hypoglycemic agents
 Analogues and antagonists of sex hormones
 Oxytocics and tocolytics
 Parathormone, calcitonin and Vitamin D
 Hormonal contraceptives
 Drugs used in Sexually transmitted diseases
 Use of drugs in Pregnancy
Objectives:
 Perform examination of the thyroid gland

 Measure growth indices in adults and children
 Examine the pregnant abdomen
 Examine the breasts
o Confidentiality
o Human reproduction (abortion, assisted conception)
44
BLOCK: MUSCULOSKELETAL SYSTEM AND INTEGUMENTARY SYSTEM
Course Description:
This block covers:
 Gross Anatomy of spinal column, head and neck.

 Physiology of skeletal muscles.
 Metabolism of skeletal muscle and bone.
 Structure and function of integumentory system
 Pathophysiology and aetiopathogenesis of common diseases related to
musculoskeletal and integumentary systems.
 Principle of management of musculoskeletal and skin disorders.
Anatomy
Objectives:
 Discuss the normal development of face and relate it with common birth defects.
 Describe the organization of spinal column, the developmental changes, principle
group of muscles acting upon it; intervertebral articulations and intervertebral discs
and relate it with common back problems.
 Describe the layers, innervation, blood supply and applied anatomy of scalp.
 Describe the muscle of facial expression, innervation, blood supply and lymphatic
drainage and relate it with common clinical conditions.
 Describe the disposition of cervical fascia and its clinical significance.
 Describe the boundaries and contents of the different regions or fossa in head and
neck.
 Discuss the cranial duramater and dural venous sinuses.
 Describe the temporo-mandibular joint (TMJ), atlantooccipital joint and
atlantoaxial joint and clinical condition related to these joints.
 Identify individual bones of the skull and cervical vertebra and discuss the gross
features of the skull and the bones of skull, joints of the skull, gross feature of the
cervical vertebra.
 Demonstrate the radiological feature of head on standard diagnostic images.
 Demonstrate the surface landmarks and surface marking of head and neck.
 Discuss the normal development of the skin and its appendages and relate it with
 Identify and describe the histological features of skin and its appendages.
Contents:
 Spinal Column
 Triangles of Neck
 Cervical fascia
 Atlanto-occipital and atlantoaxial Joints
 Face
45
 Scalp
 Parotid Region
 Temporal and infratemporal Fossa
 Temporomandibular Joint
 Submandibular Region
 Cranial Duramater, Dural folds and Dural Venous Sinuses
 Bony orbit
 Skin and its appendages
Physiology
Objectives:
 Describe the functional organization of skeletal muscles and compare with other
types.
 Describe the structural organization of neuro-muscular junction and the sequence
of neuro-muscular transmission.
 Describe the mechanism of excitation – contraction coupling in skeletal muscle.
 Define and compare isotonic and isometric muscle contraction and its
physiological significances in exercise.
 Compare different types of muscle fibers and discuss the factors that influence
their force of contraction.
 Describe muscle tone, its common abnormalities and responses of muscle after
nerve injury.
 Discuss different functions of skin.
Contents:
 Functional organization and properties of striated muscle

 Neuro-muscular junction (Motor end plate)
 Neuro-muscular transmission
 Mechanism of contraction of skeletal muscle: types of contraction; muscle tone
 Type of Muscle fibers
 Functions of skin
Biochemistry
Objectives:
At the end of the block, students will be able to:
 Discuss different types of metabolism occurring in muscle and relate these

metabolic pathways under different conditions.
 Differentiate type I and type II muscle fibre on biochemical basis.
 Describe the synthesis of structural component of bone.
46
 Discuss the integrated role of parathyroid hormone, calcitonin and vitamin D in
bone mineralization and correlate it with common clinical conditions.
 Discuss the nucleic acid metabolism and its regulations.
 Describe significance of muscle marker in diagnosing muscle injury.
 Describe the melanin biosynthesis along with the associated disorders.
Contents:
 Muscle metabolism
 Bone Metabolism and calcium homeostasis
 Nucleic acid metabolism
 Muscle Markers
 Melanin Synthesis
Microbiology
Objectives:
At the end of the block the students should be able to:
 List the resident microbial flora of the skin.

 Discuss the etiology, pathogenesis and laboratory diagnosis of different types of
skin infections.
 Discuss the etiology, pathogenesis and laboratory diagnosis of different types of
muscle infections.
 Discuss the etiology and laboratory diagnosis of different types of wound
infections.
 Discuss the etiology, pathogenesis and laboratory diagnosis of poliomyelitis and
tetanus.
 Analyze skin scrapings and culture result of fungal skin infections.
 List the common pathogens associated with infective arthritis and osteomyelitis.
 Plan the microbiological investigation to isolate and identify the pathogens
associated with arthritis and osteomyelitis.
Contents:
 Normal flora of the skin

 Skin infections
o Pyogenic skin infections
o Leprosy
o Atypical mycobacterial infection
o Fungal infections of Skin
o Viral skin infections
o Parasitic skin infections
 Infections of the muscle fascia and muscles

o Necrotizing fascitis
o Gas gangrene
47
o Poliomyelitis
o Tetanus
 Wound infections
 Bone and joint infections
o Infectious arthritis
o Osteomyelitis
Pathology
Objectives:
 Describe the sequence of events in fracture healing and factors delaying healing.
 Explain the aetiopathogenesis, clinical features and complications of
osteomyelitis.
 List the metabolic diseases and explain rickets, osteomalacia, osteopenia and
osteoporosis on the basis of clinical features, aetiology, and pathogenesis.
 Classify bone tumours. Enumerate the gross and microscopic features of an
osteosarcoma and giant cell tumour.
 Discuss the aetiopathogenesis of osteoarthritis, rheumatoid arthritis and gouty
arthritis.
 Classify different types of soft tissue tumors. Enlist the gross and microscopic
features of lipoma and a sarcoma.
 Explain the aetiopathogenesis and clinical features of Duchenne muscular
dystrophy and Becker muscular dystrophy.
 Enlist the common benign and malignant lesions of the skin. Enlist the types and
the microscopic features of common benign naevi.
 Discuss the aetiopathogenesis and morphology of a melanoma, squamous cell
carcinoma and a basal cell carcinoma.
Contents:
 Fracture
 Osteomyelitis
 Metabolic bone diseases
 Bone tumors
 Diseases of joints
 Soft tissue tumors
 Muscular dystrophies
 Naevus
 Common tumours of skin
Pharmacology
48
Objectives:

o Nonsteroidal anti-inflammatory drugs
o Drugs used in acute and chronic gout
o Antirheumatic agents- DMARDs
o Calcitonin, Parathyroid hormone, vitamin D and Bisphosphonates
o Antileprotic Agents
o Antifungal agents
ii. Explain the mechanisms of action and adverse effects
 Discuss the common treatment regimens for leprosy and rheumatic arthritis
 List the peripherally and centrally acting muscle relaxants. Describe their
mechanism of action, indications, adverse effects, contraindications and drug
interactions.
Contents:
 Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

 Hypouricaemic Drugs
 Disease modifying antirheumatic drugs (DMARDs)
 Skeletal Muscle Relaxants
 Calcitonin, Parathyroid hormone, vitamin D and Bisphosphonates
 Antileprotic agents
 Antifungal agents
Objectives:
 Perform examination of
o Skin
o Neck
o Joints including shoulder, hip and lower back
o Allocation of resources
49
BLOCK: NERVOUS SYSTEM AND SPECIAL SENSES
Course Description:
This block covers:

 Structure and function of the nervous system and special senses.
 Mechanism and pathway involved in functioning of nervous system and special
senses.
 Aetiopathogenesis and pathophysiology of common diseases and disorders and
principles of management.
Anatomy
Objectives:
 Discuss the normal developmental process of the different parts of CNS and relate
it with developmental anomalies
 Discuss the normal developmental process of the special senses and relate it with
developmental anomalies
 Describe the gross features of different parts of the CNS and the neuronal
circuitry in brain and spinal cord and relate it with clinical conditions.
 Describe the gross features of Special senses and related cranial nerves in terms
of origin, functional component, course and termination in respective part of brain
and relate it with common clinical conditions.
 Describe the blood supply of the brain and spinal cord and apply the knowledge to
explain the functional deficit resulting from ischemic injuries.
 Describe the functional component, nuclei of origin, course, distribution and
functional significance of cranial nerves and relate it with clinical conditions.
 Identify and describe the histological features of spinal cord, cerebrum and
cerebellum and cytoarchitecture of cerebrum and cerebellum.
 Identify and describe the histological features of special senses
 Identify the radiological features of different parts of CNS on standard diagnostic
images.
Contents:
 Cerebrum
 Thalamus and Hypothalamus
 Brainstem
 Cerebellum
 Basal ganglia,
 Ventricles
 Meninges and Cerebrospinal Fluid
 Spinal Cord
 Blood supply
 Cranial Nerves
50
 Eye
 Ear
Physiology
Objectives:
 Describe the mechanism of synaptic transmission and discuss synaptic plasticity.

 Discuss formation of blood-brain barrier, blood-CSF barrier and the circulation
of cerebrospinal fluid (CSF).
 Discuss responses of nerves to injury.
 Describe pathways of sensory perception and motor responses.
 Describe the motor functions of cerebellum and basal ganglia.
 Discuss neuronal basis of spinal reflexes.
 Explain the effect of section of spinal cord at different levels with reference to
underlying anatomy and physiology.
 Discuss the mechanism of maintenance of equilibrium and the support of body
against gravity.
 Discuss the physiology of sleep, speech, learning and memory.
 Discuss the role of limbic system and hypothalamus in behavior and motivation.
 Perform the tests for sensory and motor system and interpret the observations.
 Perform the tests for the cranial nerves and interpret the observations.
 Correlate the functional anatomy of special senses with physiological function.
 Describe the formation and absorption of aqueous humor and explain
maintenance of normal intraocular pressure.
 Describe visual acuity, errors of refraction, visual field and their clinical
significance.
 Perform the tests of visual acuity, field of vision and interpret the observations.
 Describe the mechanism of visual transduction, visual pathway including central
mechanism of vision and the effect of transection of visual pathway at different levels.
 Discuss color vision and its abnormalities.
 State the auditory pathway and discuss the central mechanism of hearing and
deafness.
 Describe the pathway of taste and smell sensation.
 Perform hearing tests and interpret the observations.
Contents:
 Neural organization
 Synaptic transmission and plasticity
 Response of neurons and nerve fibers to injury
 Cerebrospinal fluid system.
 Sensory system
 Spinal cord reflexes
 Motor system
 Higher cortical function
51
 Mechanism of maintenance of equilibrium and posture
 Cerebellum and basal ganglia
 Physiological basis of sleep and consciousness
 Limbic system and hypothalamus
 Visual System
 Auditory System
 Olfactory system
 Gustatory system
Biochemistry
Objectives:
 Describe the special feature of nerve cell and synthesis of different

neurotransmitters.
 Discuss the chemistry of vitamin A and its role in protecting from night blindness.
 Interpret the result of CSF analysis.
Contents:
 Nerve Cell
 Neurotransmitters
 Vitamin A
 Cerebrospinal fluid (CSF) Analysis
Microbiology
Objectives:
At the end of the block, students should be able to:
 Enumerate the normal microbial flora of special senses.

 Discuss the agents responsible for causing encephalitis along with pathogenesis
and laboratory diagnosis.
 Discuss the agents responsible for causing meningitis along with pathogenesis and
laboratory diagnosis.
 Describe the collection and transport of sample for diagnosis of Central Nervous
system infections.
 Interpret the result of rapid tests for diagnosis of Central Nervous system
infections.
 Perform staining and examine the smears for pathogenic organisms
 Describe the aetiology, pathogenesis and laboratory diagnosis of Rabies.
 Discuss the aetiology and laboratory diagnosis of eye and ear infections.
52
Contents:
 Meningitis
 Encephalitis
 Botulism
 Rabies
 Infections of eye
 Infections of ear
Pathology
Objectives:
 Discuss the aetiopathogenesis of bacterial, viral and tubercular meningitis.

 Explain the aetiopathogenesis of brain abscess.
 Enlist the common causes of encephalitis.
 Discuss the pathophysiology of hydrocephalus.
 Describe aetiopathogenesis, and complications of cerebrovascular accidents.
 Classify degenerative diseases. Discuss the aetiopathogenesis and clinical
features of Alzheimer’s disease and Parkinson’s disease.
 Classify demyelinating diseases and explain the aetiopathogenesis of multiple
sclerosis.
 Classify common brain tumours. Enlist the microscopic features of astrocytoma,
glioblastoma multiforme and meningioma.
 Explain the aetiopathogenesis of retinoblastoma and enlist its gross and
microscopic.
Contents:
 Meningitis
 Viral encephalitis
 Brain abscess
 Hydrocephalus
 Cerebrovascular accidents
 Degenerative diseases
 Demyelinating diseases
 Brain tumors
 Retinoblastoma
Pharmacology
Objectives:
 Explain the treatment of chronic and acute alcoholism ,clinical consequences and
management of methanol poisoning
53
 Explain the different stages of anesthesia. Classify general and local anesthetics
and describe their mechanism of action, rational for use, adverse drug reactions,
contraindication and drug interaction.
 Describe the mechanism of action, side effects, important drug interactions and
contraindications of antiepileptic agents; identify the drug of choice in different types
of epilepsies and epilepsy in special situations.
 Classify the drugs used in Parkinsonism and describe the mechanism of action,
side effects and rationale of drug combination of Antiparkinsonian agents.
 Classify opioid analgesics. Explain their mechanism of action, pharmacological
effects, indications, adverse effects, contraindications, management of overdose and
treatment of dependence.
 Classify the sedative and hypnotic agents. Describe the mechanism of action,
indications, adverse effects, limitations, drug interactions and contraindication of
sedating and non sedating anxiolytic agents.
 Classify antipsychotic and antidepressant agents; describe their mechanism of
action, indications, adverse effects, limitations and contraindications.
 Explain why certain drugs have abuse potential and addiction capability and
enumerate important drugs which fall under this category.
Contents:
 Pharmacology of aliphatic alcohols

 General and Local anesthetics
 Therapy of Epilepsy
 Therapy of Parkinsonism
 Opioid analgesics and antagonists
 Sedatives and hypnotics
 Anxiolytic agents
 Psychopharmacology
o Antidepressants, Antipsychotics and mood stabilizers
 Drug abuse
Objectives:
 Take a full psychiatric history

 Perform a mental state examination
 Examine the neurological system
 Examine the eyes and ENT system
 Discuss ethical issues surrounding mental disorders/disability
54
RESOURCES LIST FOR BASIC SCIENCE
Anatomy
Textbooks
 Langman’s Medical Embryology: 10th Edition, Sadler TW; Lippincott Williams &
Wilkins.
 Wheater’s Functional Histology: A Text and Colour Atlas: 5th Edition,Young B,
Heath JW; Churchill Livingstone.
 Basic Histology: 11th Edition, Junqueira LC, Carneiro J; McGraw-Hill Medical.
 Clinically Oriented Anatomy: 5th Edition, Moore KL, Dalley AF; Lippincott
Williams & Wilkins
 Gray’s Anatomy for Students: 1st Edition, Richard Drake, Wayne Vogl, Adam
Mitchell; Churchill Livingstone
 Clinical Anatomy by Region: 8th Edition, Richard S Snell; Lippincott Williams
and Wilkins.
 Thompson & Thompson Genetics in Medicine:7th Edition, Nussbaum RL,
McInnes RR, Willard HF; Saunders
 Clinical Neuroanatomy for Medical Students: 6th Edition, Richard S Snell;
Lippincott Williams & Wilkins
Reference books
 Larsen’s Human Embryology: 4th Edition, Gary C Schoewolf, Steven B Bleyl,
Philip R Brauer, Philippa H Francis-West; Churchill Livingstone.
 Gray’s Anatomy: The Anatomical Basis of Clinical Practice: 39th Edition, Susan
Standring; Elsevier.
 Emery's Element of Medical Genetics: 13th Edition, Peter Turnpenny, Sian Ellard;
Churchill Livingstone.
 Carpenter's Human Neuroanatomy: 9th Edition, Andre P; Williams & Wilkins
Physiology
Textbooks
 Textbook of Medical Physiology: 11th Edition, Guyton and Hall; WB Saunders
publication.
Reference books
 Review of Medical Physiology: 22nd Edition, William F Ganong; McGraw-Hill.
 Berne and Levy Physiology: 6th Edition, Bruce M Koeppen, Bruce A Stanton;
Mosby.
 Vander, Sherman, Luciano's Human Physiology: The Mechanisms of Body
Function; C Edition, Eric P. Widmaier, Hershel Raff, Kevin T Strang; McGraw-Hill
Ryerson.
 Essentials Medical Physiology: 3rd Edition, Leonard R Johnson; Academic Press.
 Medical Physiology: 4th Edition, Rodney A Rhoades, George A Tanner; Academic
Press.
55
Biochemistry
Textbooks
 Lehninger Principle of Biochemistry: 4th Edition. David L. Nelson, Michael M.
Cox; W. H. Freeman.
Reference books
 Biochemistry 6th Edition Jeremy Mark Berg, John L. Tymoczko, Lubert Stryer; W.
H. Freeman
 Harper’s Biochemistry: 27th Edition, Robert K. Murray, Daryl K Grammer, Peter
A. Mayes, Victor W Rodwell; McGraw-Hill Medical.
 Lippincott's Illustrated Reviews: Biochemistry: 2nd Edition. Pamela C Champe,
Richard A Harvey; Lippincott Williams & Wilkins.
 Textbook of Biochemistry with clinical correlations: 6th Edition, Thomas M.
Devlin; Wiley-Liss.
 Marks' Basic Medical Biochemistry; A Clinical Approach: 3rd Edition, Colleen M
Smith, Allan D Marks, Michael A; Lieberman Lippincott Williams & Wilkins.
 Clinical Chemistry: 6th Edition, Marshall W J and Bangert S K; Mosby.
 Clinical Chemistry: Principles, procedures and correlations: 5th Edition, Bishop M
L, Duben-Engelkirk J L & Fody E P; Lippincott Williams & Wilkins.
 Fundamentals of Clinical Chemistry: 6th Edition, Burtis CA & Ashwood; ER
Saunders.
 Clinical Chemistry: Theory, analysis, correlation: 4th Edition Kaplan L A, Pesce A
J, Kazmierczak; S C Mosby.
 Student Companion for Stryer's Biochemistry: 4th Edition, Richard I Gumport,
Lubert Stryer; WH Freeman & Company.
 Modern Experimental Biochemistry: 3rd Edition Rodney F. Boyer Prentice Hall.
 The Cell: A Molecular Approach: 4th Edition, Geoffrey M Cooper, Robert E
Hausman; Sinauer Associates, Inc.
 Molecular Cell Biology: 6th Edition, Harvey Lodish; WH Freeman.
 Emerys’s elements of Medical genetics: 11th Edition, Robeert F Muller, Ian D
Young; Churchill Livingstone.
Microbiology
Textbooks
 Jawetz, Melnick & Adelberg's Medical Microbiology: 24th Edition, Geo Brooks,
Karen C Caroll, Janet Butel, Stephen Morse; Mc Graw-Hill Medical.
 Sherris Medical Microbiology; An Introduction to Infectious Diseases: 4th
Edition, Kenneth J. Ryan , C. George Ray; Mc Graw-Hill Medical.
 Text Book of Medical Mycology: 1st Edition, Jagdish Chander; Interprint / Mehta
Publisher.
 Text book of Medical Parasitology: 1st Edition, Chakraborty P; New Central Book
Agency (P) Ltd.
Reference books
 Practical Medical Microbiology (Mackie & Mc Cartney's Medical Microbiology):
13th Edition, Collee; Churchill Livingstone.
56
 Bailey & Scotts Diagnostics Microbiology: 11th Editon, Betty A Forbes, Daniel F
Sahm, Alice S Weissfeld; Mosby.
 Koneman's color Atlas and Text book of Diagnostic Microbiology: 6th Edition,
Elmer W. Koneman; Lippincott Williams & Wilkins.
 Roitt's Essential Immunolgy: 11th Edition, Peter J Delves, Ivan M Roitt, Seamus J
Martin; Blackwell Publishers
 Fields Virology 2 Volume Set: 5th Edition, David M Knipe; Lippincott Williams &
Wilkins.
 Diagnostic Medical Parasitology: 5th Edition, Lynne Shore Garcia; ASM Press.
Pathology
Textbooks
 Pathologic basis of disease: 7th Edition, Robbins and Cotran; Elsevier.
Reference books
 Sternberg's Diagnostic Surgical Pathology: 5th Edition, Lippincott Williams and
Wilkins
 Rosai and Ackerman's Surgical Pathology: 9th Edition, Rosai, Juan; Elsevier
Health Sciences
 Wintrobe's Clinical Hematology: 12th Edition; Lippincott Williams and Wilkins
 Enzinger and Weiss's Soft Tissue Tumors: 5th Edition, Weiss Sharon W,
Goldblum JR; Elsevier Health Sciences
 Lever's Histopathology of the Skin: 10th Edition, Elder, David E; Lippincott
Williams and Wilkins
 Atlas of Clinical Hematology: 2nd Edition, Hoffbrand, A.V.; Pettit, J.E; Elsevier
Health Sciences
Pharmacology
Textbooks
 Basic and Clinical Pharmacology: 10th Edition, Bertram G Katzung; McGraw Hill.
 Essentials of Medical Pharmacology: 6th Edition, K D Tripathi; Jaypee Brothers,

Medical publishers, India.
 The Pharmacological Basis of Therapeutics: 11th Edition, Goodman and Gillman;
McGraw Hill.
 Pharmacology and Pharmacotherapeutics: 10th Edition, Satoskar Bhandarkar
Ainpure; Popular Prakashan Pvt Ltd, India.
Reference books
 Clinical Pharmacy and Therapeutics: 4th Edition, Roger Walker; Churchill
Livingstone.
 Clinical Pharmacology (with student consult access): 10th Edition, Benette Brown;
57
 Pharmacology (with student access consult online): Rang, Dale, Ritter, Moore;
 Text Book of Pharmacology (Hardcover): S D Seth; Elsevier.
 Pharmacology: Lippincott’s Illustrated Reviews; Lippincott Williams and Wilkins
 Pharmacotherapy: A pathophysiological approach (Hardcover): 7th Edition,
Dipiro; McGraw Hill.
Introduction to clinical medicine

Text books
 Hutchinson’s Clinical Method: 3rd Edition, Michael Swash, Michael Glynn;
Elsevier
58
CLINICAL SCIENCE
59
CLINICAL SCIENCE
Introduction
The clinical years will consist of clinical specialties, community health and a six month
district health postings.
General Objectives:
At the end of the clinical rotation, the student should be able to:
 Identify the major health problems in Nepal.
 Demonstrate good communication skills with patients, their relatives, colleagues
and other stakeholders.
 Demonstrate a holistic approach in patient care (taking into account physical,
psychological, socioeconomic and cultural factors).
 Elicit and record a relevant history and perform a complete physical examination.
 Correlate the history and examination findings to arrive at a logical diagnosis and
to be able to list a few common differentials.
 Identify relevant investigations to order and interpret their results.
 Explain the natural history, management options, rehabilitation, prognosis and
complications of clinical conditions.
 Perform counseling on prevention and health promotion issues.
 Describe and participate in the various national health programs of Nepal
 Demonstrate good medical record keeping.
 Apply the principles of critical thinking and Evidence based practice
 Discuss the ethical and legal implications of medical decisions.
 Identify medico legal problems and describe statutory obligations of a registered
medical practitioner
 Perform Primary care for common conditions. Identify conditions that need
referral, and refer appropriately
 Identify life threatening conditions and perform emergency management including
basic life support.
 Demonstrate leadership and management skills
 Demonstrate an ability to work with locally available resources
 Demonstrate skill in breaking bad news
60
CLINICAL PRESENTATION CURRICULUM
Introduction
Clinical presentations are the common symptoms, signs or laboratory abnormalities with
which a patient or population can present to a doctor. The underlying principle or
philosophy of Clinical Presentation Curriculum (CPC) is that: "The reaction of human
body to infinite number of insults is always finite and stable over time". For example, any
insult to the respiratory system whether infectious, inflammatory, immunological,
traumatic or iatrogenic, respiratory system responds either as cough, cyanosis, chest pain,
difficulty breathing, noisy breathing or hemoptysis.
Medical education is vast and is expanding very fast while the duration of medical school
is short and limited. It is virtually impossible to teach or make the student learn everything
during their medical school years. So our aim during MBBS years is to teach the students
the basic 'must know areas' of medicine. To achieve this, CPC will be very helpful as we
will be able to cover most of the conditions that we need to cover while focusing the
teaching learning activities around the defined clinical presentations. In this method, the
focus is always on the patient. Additional attention will be given to the conditions where
students are required to attain competency level 3 and 4.
CP curriculum will help the graduates to scientifically approach each clinical presentation,
categorize them into different groups with the help of their basic science knowledge,
clinical examination findings and some investigations and finally come to the closest
possible diagnosis or diagnoses by excluding other conditions. They will learn to follow
the schema for each CP with practice. This is a forward reasoning process with inductive
reasoning.
The list of Clinical Presentations (CPs) is outlined. Schemas for all the CPs have been
developed. Commonly seen conditions in different specialties e.g.. Medicine/ Surgery/
Obstetrics-Gynecology etc. will be taught during the respective clinical postings.
Repetition and further refinement will continue to occur in subsequent postings.
Repetition of a systematic approach to key clinical presentations is an important method
for reinforcing learning of the essential clinical knowledge, skills and attitudes that a
medical student needs to acquire.
The method of teaching Clinical Presentations is as follows:

On the first day, for 1hour, there will be an overview of the particular CP with the schema
at the background. For example if the CP is COUGH, then the overview begins with the
mechanism of cough, possible causes, patho-physiology, physical examination findings,
investigations needed and treatment outlines of different clinical conditions leading to
cough. After that, there will be an hour of self study. Then student will be seeing different
cases presenting with that particular clinical presentation either in the wards or in the
OPD, take history, examine and discuss with the clinical preceptors. At this point, we
choose a few conditions with the competency level 3 or 4,out of the diseases we intend to
cover with that particular CP and allot them to the students for self study. Next day we
will have small group discussion on those topics. Finally there will be a wrap up session
of two hours where we encourage the students to come up with their own schema for the
particular CP and discuss and compare it with the standard schema.
61
Some important conditions or diseases which are not covered by the defined CPs, will be
covered through lectures. We have outlined list of common lectures for that purpose.
(Please see Annex 1 Page no 174). See Annex 2 Page No175 for full list of clinical
presentations according to organ system and Annex 3 Page No. 176 for distribution of
clinical presentations in different clinical postings. One sample Case Presentation is
written in detail in Annex 4 Page No. 177
Introduction to competency level

Within each specialty it has been decided to which competency level a student will need
to be familiar with specific clinical conditions
Levels of ability expected at the end of basic medical education
1. Competency level 1
Based on familiarity with the literature, the graduating doctor will be able to recognise the
clinical picture of the disease. Correspondingly, he/she knows the clinical picture and knows
how to get more information. This is the overview level. The doctor will refer a patient with
this clinical picture.
Be able to make a clinical diagnosis by means of physical examination, simple tests, and
additional investigations requested by the doctor him/herself (such as simple laboratory
investigations or x-rays). The doctor is able to refer the patient immediately to the relevant
specialists to take over subsequent treatment.
Be able to make a clinical diagnosis by means of physical examination, simple tests, and
additional investigations requested by the doctor him/herself (such as simple laboratory
investigations or x-rays). The doctor is able to make the judgment which initial treatment is
needed and is able to carry out that treatment, and to refer the patient to the relevant
specialist/s.
- Level 3A: in non-emergency cases;

- Level 3B: in emergency cases.
Competency level 4
Be able to make a clinical diagnosis by means of physical examination, simple tests and
additional investigation requested by the doctor him/herself (such as simple laboratory
investigations or X-rays). The doctor is able to make a decision and manage independently.
(See Annex5, Page No. 201 for detail list in each speciality)
62
General Medicine
Specific Objectives:
At the end of each clinical rotation, the student should demonstrate the ability to:
 Understand the clinical implication, patho-physiology and arrive at possible

differential diagnoses of each clinical presentation.
 Correlate the various symptoms and signs, compile and create common
possible differential diagnoses.
 Apply the knowledge of medicine with special focus on geriatric disorders with
reference to underlying co-morbidities, nutritional status and drug toxicity and
interaction.
 Identify the infective and communicable disorders and perform proper
precautionary measures for self, patient, attendant and to the community, with
proper counseling.
 Understand clinical examination, elicit relevant clinical signs and arrive at
possible differential diagnosis for each clinical presentation in medicine.
 Describe appropriate therapy for a given diagnosis and an understanding of
the mode of action of frequently prescribed drugs, their known side effects,
including toxicity, indications, contraindications, and interactions.
 Formulate effective management plans including therapeutic drug plan,
treatment, and prevention strategies for diseases and other health problems.
 Monitor the course of illnesses and appropriately revise the management plan.
 Identify the forthcoming complication, assess the severity, and manage the
emergency conditions and seek help/refer whenever appropriate.
 Assess the disability likely to result from a given medical diagnosis and decide
on appropriate measures for rehabilitation.
 Participate in discharge planning of the patient after his recovery.
Skills
 The art of history taking, communication skills and the method of disclosing
facts or bad news.
 General and physical examinations of various systems which include
cardiovascular, respiratory, hepato-biliary and renal, locomotor and joints,
and nervous system.
 Students will be able to perform independently the following procedures:
o Opening IV line, blood drawing from various sites including femoral
puncture
o ECG recording and basic interpretation
o Catheterize bladder in both males and females
o Naso-gastric tube insertion and stomach wash
o Lumber puncture
o Pleural fluid aspiration, both diagnostic and therapeutic
o Ascetic fluid aspiration, both diagnostic and therapeutic
o Bone marrow aspiration and biopsy
o Bag mask ventilation
o Emergency thoracostomy for pneumothorax
63
 Students should observe the following procedures and have knowledge of
o Pericardiocentesis
o Central line placement
o Chest tube insertion and pleurodesis
o Endotracheal intubation
o Attain ACLS training
Contents
 Clinical Presentations
o Chest pain
o Shortness of breath
o Palpitation
o Oedema
o Haemoptysis
o Hypertension
o Syncope
o Jaundice
o Dyspepsia/indigestion
o Oliguria/anuria
o Polyuria
o Weakness of extremities
o Movement disorder
o Abnormal sensation (parasthesia/hypoasthesia)
o Ataxia
o Vertigo
o Fever/sepsis
o Infection in immunocompromised host
o Abnormal clotting (thromboembolic)
o Bites and stings
64
General Surgery
 Identify common surgical conditions,

 Discuss preliminary diagnosis, outline a few differential diagnoses, order and
interpret relevant investigations and plan treatment for each clinical presentation
in surgery.
 Identify and discuss primary management of emergency conditions needing
immediate intervention.
 Identify conditions requiring referral to specialized centers.
 Describe principles of basic peri-operative management
 List and describe commonly used surgical instruments.
Skills
 Elicit a proper, relevant history

 Perform a complete clinical examination, elicit relevant clinical signs.
 Demonstrate common surgical skills
Contents
o Abdominal pain
o Abdominal swelling/distension
o Nausea/vomiting
o Constipation
o Haematemesis
o Blood in stool/malaena
o Dysphagia
o Haematuria
o Urinary retention
o Scrotal pain/swelling
o Lymphadenopathy
o Neck mass (thyroid)
o Erectile dysfunction/impotence
o Breast lumps/nipple discharge
o Lumps and bumps
o Burn
o Dying patient
65
Paediatrics
At the end of Paediatric rotation the students should be able to
 Diagnose and perform primary care for the common neonatal and childhood
diseases/ conditions.
 Identify and perform primary care for neonatal and paediatric emergencies.
 Identify neonatal and paediatric conditions/ diseases that require referral and
refer them appropriately.
 Elicit and record relevant history with special reference to antenatal, natal & post
natal periods, growth, development, nutrition and immunization and conduct
relevant physical exam.
 Interpret the growth charts, (weight, height, head circumference, body
proportions).
 Conduct developmental milestone assessment (gross motor, fine motor, social,
emotional and language skills) and identify deviations from normal.
 Identify children with cerebral palsy and mental retardation, and be able to
provide primary care, parental counseling, appropriate referral and
rehabilitation.
 Conduct nutritional status assessment, plan and advice on nutritional
requirements of children at different ages, identify specific nutritional deficiencies
(e.g. Vitamins and micronutrients) and address the underlying cause.
 Describe how to counsel parents of children with special needs, chronic diseases
and acute life threatening condition.
 Discuss the national programs related to child health and describe the national
immunization schedule.
 Describe and explain NMR, IMR, PMR, UFMR, MMR and enumerate the common
causes of NMR, IMR, PMR and UFMR in Nepal.
Skills
 Intravenous cannula insertion
 ECG recording and basic interpretation
 Lumbar Puncture
 Nasogastric tube insertion
 Foley’s catheter insertion
 Emergency needle thoracostomy for pneumothorax
 Pleural fluid aspiration
 Ascitic fluid aspiration
 Bag mask ventilation
 Intubation
 Cardiopulmonary resuscitation of infant and child
 Newborn resuscitation
 Breast feeding counseling
 Umbilical vein cannulation
 Introsseous needle insertion
 Bone marrow aspiration
66
Contents
o Cough
o Cyanosis
o Noisy breathing
o Diarrhoea
o Dysuria
o Proteinuria/Chyluria
o Electrolyte imbalance
o Preterm/low birth weight/IUGR
o Depressed newborn
o Respiratory distress
o Neonatal seizure
o Paediatric Fever/sepsis
o Hepatosplenomegally
o Abnormal bleeding
o Growth disorder (short stature/tall stature)
o Obesity
o Dysmorphic child
o Developmental delay
o Failure to thrive & malnutrition
o Eneuresis
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Gynecology Obstetrics
At the end of course student should be able:
 Define commonly used terms in Obstetrics and Gynecology.

 List the components and goals of National Health Policy with reference to
reproductive health and safe motherhood.
 List the important causes of maternal and perinatal mortality.
 Describe the process of conception and fetal growth.
 Discuss the physiological changes during pregnancy and puerperium
 Identify the high risk situation in pregnancy and refer appropriately.
 Demonstrate the ability of ante natal checkup, recognize complications and
provide post natal care.
 Classify the drugs that are safe during pregnancy and lactation.
 Discuss labor and interpret the partograph and basic pattern of fetal monitoring
strip.
 Demonstrate ability to recognize complicated labor, consult and refer
appropriately.
 Demonstrate the skill of appropriate counseling about various contraceptive
methods.
 Diagnose intrauterine fetal death and plan management.
 Discuss the various causes of early pregnancy bleeding.
 Demonstrate the ability to provide safe abortion care.
 Describe the causes of subfertility.
 List the causes of chronic pelvic pain.
 List the causes pelvic mass.
 Discuss the management of post-operative infection.
 List the high risk factors for cervical cancer, endometrial and ovarian cancer.
 Demonstrate the ability to diagnose different gynecological cancer and refer them
appropriately.
 Demonstrate the skill to perform medicolegal examination
Skills
 Obstetrics Skills:
o Perform under supervision:
 Examination of a pregnant lady including internal examination.
 Conduct Normal delivery
 Episiotomy and repair
 Vacuum delivery
 Manual removal of placenta
o Observe and assist:

 Abnormal deliveries including breech and twins.
 Forceps delivery
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 Observe caesarean delivery
 Gyne Skills:
o Under supervision:
 Examination of Gyne patient (Per speculum and PV examination)
 Insertion of ring pessary
 Insertion of Cu T
 Evacuation of retained product of conception (ERPC)
 Taking pap smear
 Perform endometrial and cervical biopsy
Contents
o PV bleeding
o Amenorrhoea
o Abnormal vaginal discharge
o Mass in female genital tract
o Subfertility
o Complicated pregnancy
o Labour pain
o Puerperium
o Contraception
o Pubertal disorder
o Virilisation/hirsuitism
o Incontinence
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General Practice
At the end of their undergraduate training in General practice students should be able
to:
 Describe the scientific concept of General practice.
 Discuss the place of General Practice within the health care system of Nepal,
both rural and urban.
 Describe how the General Practitioner works as part of a primary health care
team, particularly in a community setting, providing an integrated approach to
patient management with appropriate referral and feedback mechanisms.
 Describe what is meant by a holistic patient-centered approach.
 Describe how a patient’s socio-cultural background and economic
circumstances influence the way they present with a medical problem and how
they should be managed.
 Discuss the importance of continuity of care, particularly in the context of
chronic disease management.
 Demonstrate familiarity with the key health problems met in the context of
Nepal.
 Describe the role of health promotion and disease prevention (including
screening) both within a consultation and at a population level.
 Discuss the particular role of the General Practitioner in the management of
the elderly and dying.
possible differential diagnosis for each clinical presentation in General
Practice.
Skills
 Demonstrate good consultation and communication skills, both with patients

and their families, and with other health care professionals
 Perform a targeted, focused physical examination
 Demonstrate a logical problem orientated approach to undifferentiated
presentations making a rational initial differential diagnosis with efficient
appropriate use of investigations, rational prescribing and development of a
treatment plan, with appropriate follow-up
 Demonstrate a holistic, patient-centred approach (taking into account how
social, cultural and psychological factors influence the way a patient
experiences and deals with ill health)
 Demonstrate an ability to involve patients and their family in the management
plan.
 Demonstrate the ability to use time and repeated follow-up as a diagnostic
tool, particularly where there is diagnostic uncertainty
 Demonstrate good team work, in particular making use of community
resources
 Demonstrate an evidence based approach to their work, employing critical
thinking skills
 Recognize a seriously ill patient and give initial care
 Perform triage in a trauma situation
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 Perform initial assessment and stabilization of a trauma patient
 Perform bag and mask ventilation
 Discuss the indications for intubation and perform intubation
 Perform basic screening techniques (e.g. smear)
 Demonstrate leadership and management skills
 Demonstrate an ability to work with limited resources
 Conduct health education in an effective, patient-centered manner
 Demonstrates skill in breaking bad news
Contents
o Loss of appetite
o Headache
o Pallor/fatigue
o Unexplained physical symptoms
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Psychiatry
At the end of Psychiatric rotation the students should be able to:
 Demonstrate the ability to diagnose and provide primary care for the common
mental disorders
 Demonstrate the ability to identify and provide immediate care for psychiatric
emergencies
 Discuss mental disorders that require referral and refer them appropriately
 Demonstrate the ability to elicit and record relevant history with special reference
to personal history and pre-morbid personality and conduct relevant mental state
examination
 Identify and provide emergency management / primary care for alcohol and
substance use disorders
 Use the Mini Mental State Examination and identify deviations from normal
 Identify children with mental retardation, and be able to provide parental
counseling and appropriate referral.
 Identify common psychiatric disorders / behavioral problems in children and be
able to provide parental counseling and appropriate referral
 Demonstrate the basic counseling skills and apply them to counsel family
members of patients with chronic mental disorders / substance use disorders
 Discuss about the legal implications of mental disorders
 Discuss the national mental health act and policy along with Community Mental
Health Program / Services
 Outline the relevance of diagnostic investigations in Psychiatry including
Psychological tests, EEG, CT Scan (Head), Thyroid function test, CSF
Examination and Serum Lithium estimation
Skills
 Under supervision
o Approach to a violent patient
o Approach to a suicidal patient
o Conducting Psychiatric Interview
o Mini mental state examination
o Counseling
Contents
o Abnormal mood
o Suicide & intentional harm
o Substance abuse
o Violent behaviour
o Abnormal thought
o Reaction to stress and adjustment disorder
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Dermatology, Genito-urinary medicine and Leprosy
At the end of the course the students should be able to:
 Discuss the history and the role of dermatology and venereology in modern
medicine.
 Define commonly used terminologies in these subjects.
 Discuss the structure and function of skin.
 Demonstrate the ability to take history and perform physical examination and
order investigations.
 Demonstrate the ability to manage the common diseases in Dermatology and
venereology.
Skills
 After proper history taking and examinations they should be able to diagnose most
of the skin diseases. Many skin diseases that are prevalent in our country fall
under competency level 4.
 Perform simple tests like taking skin scrapping and nail clippings to demonstrate
the type of fungus whether it is dermatophyte or yeasts
 Take skin biopsies.
 Perform simple procedures like electrocautery, chemical cautery and cryotherapy
like liquid nitrogen or carbon dioxide snow.
 Demonstrate sarcoptes scabie by using needles.
 Perform skin smear for AFB under Zeihl-Neelsen’s staining and determine BI and
MI
 Perform endourethral smear for gonococci and pus cells.
 Perform endourethral smear test for haemophilus ducreyi.
 Demonstrate spirochetes under dark ground illumination microscope.
 Interpret laboratory tests like VDRL (screening test) and TPHA & TPI
(confirmatory tests), HIV Screening and confirmatory tests.
 Proper counseling for STD patients and contact tracings.
Contents
o Rash and pruritis
o Abnormal pigmentation
o Hair & nail problems
o Skin manifestation of systemic disease
o Urethral discharge
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Anaesthesia
 Perform a preanaesthetic check up

 Discuss the principles of administration of the general and the regional
anaesthesia
 Discuss intra operative and post operative anaesthetic complications and
management
 Describe the monitoring techniques for anaesthetized and critically ill patients.
 Discuss the basic pharmacology of commonly used local and general anaesthetic
drugs.
 Explain the basic principles of Fluid and electrolyte balance
 Describe the principles of basic and advanced life support.
 Describe the process of transferring a critically ill patient
 Discuss the principles of acute and chronic pain management
 Describe the basic concept of the anaesthetic machine and monitoring equipment
Skills
 Under supervision
o Set up I.V. canulation and intravenous line.
o Clear and maintain patent airway with basic technique with airways
(nasopharyngeal, oropharyngeal and laryngeal mask)
o Oxygen therapy
o Observe a patient during process of recovery from general anaesthesia.
 The students should observe and have the knowledge of the following procedures:
o Endotracheal intubation
o Local, regional and central nerve blocks
o Basic and advance life support technique.
o Monitoring anaesthetised and critically ill patients.
o Central venous and arterial cannulation
Contents
o Shock
o Acid base balance
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Forensic medicine
 Describe the ethical and legal responsibilities of the physician towards the patient,
profession, society and humanity at large.
 Enumerate relevant legal/court procedures applicable to medico legal and
medical practice.
 Examine and prepare reports or certificates in medico legal cases in accordance
to Law of Nepal.
Skills
 Perform medicolegal postmortem
 Interpret autopsy findings and conclude the cause of death and time since death.
Contents
o Sexual assault
o Physical assault
o Hanging
o Near drowning
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Emergency
 Identify patients with life threatening conditions and initiate appropriate

treatment.
 Perform measures to stabilize the seriously ill patient, address reversible
conditions and refer if needed.
 Perform triage in a trauma situation.
 Perform initial assessment and stabilization of a trauma patient.
 Discuss the indications for intubation and perform intubation.
 Demonstrate the ability to monitor the patient’s vital signs, identify complications
and outline a management plan.
 Identify medico legal problems and describe statutory obligations of a registered
medical practitioner.
 Describe the principle and process for Disaster preparedness.
 Discuss how to deal with angry and violent patients.
 Describe the process of counseling an individual, relative, or attendant in relation
to the type, severity, prognosis and medico-legal implication of the emergency.
possible differential diagnosis for each clinical presentation in Emergency.
Skills
 Local anesthesia and sedation.

 Triage.
 CPR.
 Take part in management of a Disaster/Mass casualty incident (MCI).
 Administration of oxygen and drugs and its complications.
 ECG recording and interpretation.
 Defibrillator, types and its use.
 Chest tube insertion/IV cannula insertion/Foley’s catheter insertion.
 Management of common poisonings, know when to seek help.
 Gastric lavage
 Lumber puncture.
 Endotracheal intubation.
 Thoracocentesis
 Anterior nasal packing
 Posterior nasal packing
 FB removal from ear, nose, throat and eye.
 Management of airway obstruction.
 Application of splint.
 Abdominal paracentesis.
 Proctoscopy.
 Emergency drug administration.
 Management of bites, stings, human bites.
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 Management of Physical assaults
 Breaking bad news.
 Examine and prepare reports/certificates in medico legal cases/situations
according to the law of government of Nepal
Contents
o Shock
o Diminished level of consciousness
o Seizure
o Poisoning/Drug overdose
o Mass Casualty incident (Chemical/Bio/Nuclear/Earthquake/Flood)
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Orthopedics
 Describe common orthopaedic terminologies.

 Describe different orthopaedic instruments and implants.
 Identify common orthopaedic conditions, both traumatic and non-traumatic.
 Elicit a proper, relevant history.
 Perform a thorough orthopaedic examination.
 Discuss preliminary diagnosis, outline a few differential diagnoses, plan and
interpret relevant investigations for each clinical presentation in Othopedics.
 Plan and institute appropriate initial treatment.
 Identify and institute primary management of emergency conditions needing
immediate intervention.
 Identify conditions requiring referral to specialized centers.
 Describe different modalities of physiotherapy and rehabilitation.
Skills
 Apply POP slabs and simple casts.

 Temporary splinting of injured limbs.
 Apply Skin / Skeletal tractions and discuss their principles.
 Release tight casts or bandages.
 Describe different orthopaedic instruments and implants.
 Demonstrate scrubbing and draping of different sites of surgery.
Contents
o Joint pain/swelling
o Limb pain/swelling
o Limb deformity
o Limping
o Fracture
o Dislocation
o Backache
o Soft tissue infection
o Head and spinal injury
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Ophthalmology
 Discuss the common and major preventable blinding diseases.

 Describe common Ophthalmic manifestations of systemic diseases-Diabetes
Mellitus, Hypertension, Thyroid, TB, and Leprosy.
differential diagnosis of each clinical presentation in ophthalmology.
 Correlate the various presentations, compile and create common possible
differential diagnosis.
 Discuss the common and preventable blinding diseases of the eye.
 Identify the communicable and infectious eye disease and perform proper
precautionary measures for self, patient, attendant and to the community, with
proper counseling.
 Describe all forms of appropriate therapy for a given diagnosis and an
understanding of the mode of action of frequently prescribed drugs, their known
side effects, including toxicity, indications, contraindications, interactions and the
knowledge about relieving pain and ameliorating the suffering of patients.
 Formulate effective management plans including therapeutic drug plan, treatment,
and prevention strategies for diseases and other eye health problems.
 Identify the forthcoming complication, assess the severity, and manage/refer the
emergency conditions.
 Assess the disability likely to result from a given ophthalmological diagnosis.
Skills
 The art of history taking

 Ocular examinations of eye including the following -
o Visual acuity
o Ocular motility/cover test
o Pupillary reaction
o Direct ophthalmoscopy
Contents
o Red eye/Eye discharge
o Squint/Diplopia
o Pain in eye
o Visual abnormality/night blindness
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Otorhinolaryngology
diagnosis of each clinical presentation in Otorhinolaryngology.
 Correlate the various presentations compile and create common possible
differential diagnosis.
 Discuss the common and preventable diseases of the ear, nose and throat.
 Identify the communicable and infectious diseases of ears, nose and throat and
perform proper precautionary measures for self, patient, attendant and to the
community, with proper counseling.
 Describe different forms of appropriate therapy for a given diagnosis and an
understanding of the mode of action of frequently prescribed drugs and their
known side effects, including toxicity, indications, contraindications, and
interactions and the knowledge about relieving pain and ameliorating the
suffering of patients.
 Formulate effective management plans including therapeutic drug plan, treatment,
and prevention strategies for common ENT diseases.
 Identify the forthcoming complication, assess the severity, and manage/refer the
emergency conditions.
 Assess the disability likely to result from a given diagnosis.
Skills
 The art of history taking

 Use of common Instruments like head mirror, tuning forks and otoscope
Clinical skills
 Syringing
 Removal of simple foreign bodies from ear, nose and throat
 Anterior nasal packing
Contents
o Abnormal hearing/tinnitus
o Earache/ear discharge
o Sore throat/hoarseness
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Dentistry
 The student should demonstrate adequate knowledge on identification of common

oro-facial structures.
 The student should be capable of arriving at a logical diagnosis and institute
primary care management for common oro-facial problems.
 The student should be capable of categorizing the oro-facial problem \that needed
immediate management or referral.
 The student should be capable of imparting preventive oral health education to the
individual and community.
Skills:
 Administration of Local Anesthetic including infiltrations and blocks

 Tooth extractions (simple)
 Management of post extraction bleeding and pain
 Immediate management of gum swelling and facial swelling
Contents
o Orofacial swelling/pain
o Mouth sores/oral ulcers
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Laboratory Medicine
 Collect and store various specimens for laboratory tests in pathology,

biochemistry and microbiology.
 Identify relevance of requisitioned laboratory tests.
 Perform urine analysis for normal characteristics and abnormal constituents
including microscopy.
 Perform and interpret hemogram, BT and CT and blood smears for parasites and
red cell morphology.
 Interpret the bone marrow/splenic aspirates smear for Leishmania donovani
bodies.
 Perform and interpret aldehyde tests for kala-azar.
 Perform stool examination for ova and cysts and hanging drop for Vibrio
cholerae.
 Perform and examine a wet film for vaginal smear for Trichomonas and Candida.
 Perform and interpret Gram’s stain, Albert’s stain and Ziehl Neilsen stains.
 Interpret Mantoux test.
 Interpret commonly done biochemistry tests.
 Interpret common serological tests such as Widal test, VDRL test, HIV ELISA, etc.
 Interpret culture and sensitivity reports from bacteriology.
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Electives Posting
Elective system is a system whereby students have a choice of subject, teacher or method
of study which leads to more broadly educated students. It also helps students to develop
good organizational and planning skills.
PAHS envisions sending medical doctors to rural Nepal. Therefore, in order to broaden
the knowledge of the students and understand the meaning of life in a greater dimension,
the elective options that PAHS opens to the students have non-school and within-school
options.
There is the provision of 2 weeks electives during the junior clerkship. It is entirely
student initiated and organized. Student should decide where he wants to do his elective.
Some suggested elective options

a. Specialties (clinical and basic science)
b. Non-medical exposure (literature, painting, sculpture, philosophy, music,
drama etc)
c. Alternative medicine
d. Community Health
e. International Health
f. Research
g. Anatomy dissection
h. Rehabilitation
i. Orphanage
j. Old age home
k. Nutrition Center
Procedure of arranging of elective posting:
1. Students should submit learning goals of the elective of their choice to Dean’s
office for the approval.
2. Dean’s committee approves the elective choice the students make.
3. Approval needs to be obtained two months before starting electives.
4. After approval:
a. Dean’s committee will issue letter of recognition to the students to
facilitate them during electives.
b. Students themselves need to arrange the elective.
5. At the end of the electives, students will write a short reflective report and
submit to Dean’s committee including:
a. Supervisor report from where elective was done.
b. Student report on his/her elective including:
i. Whether the clerkship met their learning objectives.
ii. A personalized account of a unique experience gained from the
electives.
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COMMUNITY HEALTH SCIENCES
84
COMMUNITY HEALTH SCIENCES
Introduction
There is a dire national need of training and enthuse medical students to work together
with other health workers for the benefit of people in both the remote rural areas and the
fast-growing urban towns in Nepal.
It is realized that a community health science curricula must include experience-based

learning, with problems in real population, in order to show that health is influenced by
many factors including culture, politics, economy, environment and individual behavior.
The course introduces and explores the principles of public health sciences including
sociology, anthropology, management sciences for doctors and other health care
professionals, health communication as well as emphasizing the importance of
management of population health problems by working with and learning from the
community. The course also reviews several major health issues and current
developments in the organization, financing, regulating and delivery of health services in
Nepal.
The course combines classroom presentations with opportunity for student participation,
individual and group exercises, integrated learning and real world learning in community.
Overall processes and expectation

 Provide opportunities for integration of classroom learning in the community
health course with experience based learning in community posting.
 Students will acquire adequate theoretical and conceptual knowledge on the
different sub-disciplines of community health.
 Training in community settings is expected to motivate students to potentially seek
careers in those setting and engage in local social and political processes that
impact individual, family and community health.
The Community Health course fundamentally rests on three components:

1. Community health course: theory
2. Integrated case study with basic and clinical disciplines
3. Community Based learning and education through postings.
All three will be delivered in an integrated manner.
Objectives:
At the end of the course the students are expected to be able to:
 Apply the principles and methods of public health sciences, behavioral and social
sciences, biostatistics and epidemiology.
 Assess, define and understand the health status of a population, dynamics and
determinants of health and illness, and factors contributing to health promotion
and disease prevention.
 Design appropriate interventional programs by mobilizing all the available
resources.
 Work as a team with other members of the health care team and community.
85
 Demonstrate attitudes of helping people and acknowledging responsibility and
accountability of their own profession and to the people.
Teaching and learning strategies:
 Problem based learning: Community Health Sciences will be integrated in

relevant PBL cases.
 Lectures
 Small group discussion: including individual and group exercises, assignments,
role play and demonstration
 Integrated Workshop:
 Laboratory
 Community Based Learning and education through rotation:
a. Field orientation
b. Community
c. Peripheral health facility
d. Outreach post
e. Ilaka –Sub district
f. District Health office and district hospital
The community health course will comprise around 25% of the total duration of the
MBBS course. From the beginning of the course, students will be exposed to communities
with different population characteristics. They are encouraged to explore what they need
to learn in order to understand and manage that problem. After each community posting,
students will present the results of their findings, readings, discussions and group work.
Each case or situation is carefully designed with key community objectives enumerated,
the range of skills to be acquired and a list of requested and suggested readings. Faculties
and other experts in the field of community health will be available for consultation. We
believe that this programme will have long term effect on improving and promoting
health of people in Nepal.
Content of the Community Health Sciences Course
The course will cover the following main subject areas:
1. Management Science for Health care Professionals
2. Epidemiology
o Basic
o General
o Applied
3. Laboratory and Public Health Program Appraisal
4. Family Health
5. Food and Nutrition
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6. Biostatistics
7. Demography
8. Culture, Society, Health and Illness
9. Health education and behavioural change
10. Ecological Health
87
Overview of Community Health Sciences Courses Deliveries
Subject Year 1 Year 2 Year 3 Year 4 Year 5
Introductory Basic Sciences Clinical Sciences
Health, Culture and Society
Health Education and Behavior Change
Health, Culture and Society
Epidemiology I
Biostatics I
Management Science for Health I
Ecologic Health
Family Health I
Demography
Public Health Laboratory
Epidemiology II
Family Health II
Biostatics II
Epidemiology III
Management Science for Health II
Food and Nutrition
Integrated Workshops / Field
Orientations
Site Field rotation

Urban Slum 1
Ward 2
VDC and Sub-health Post 3
Ilaka and Health Post 4 5
PHC 6
District 7
1 Community Health + Basic Sciences (individual/ household) 5 Community Health + Basic Sciences (CPD/VDC)
6 Community Health + Obs./Gynae. + Medicine + Surgery + Pediatric + Pathology (PHC)

2 Community Health + Basic Sciences (Family / Ward)
3 Community Health + Pediatrics +Microbiology (SHP) 7 Community Health + Clinical Sciences
4 Community Health + Medicine + Obs. / Gyane. +Pharmacology (HP/SHP)
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Management Science for Healthcare Professional (Part 1)
General description:
This course provides a core foundation on health care management.
It is intended to provide the student with a very basic understanding of components of public
health services, inventory management, time management, hospital production, health
services accessibility and affordability.
It is a longitudinal course giving students opportunity to acquire real life experiences in

health management issues. In addition to theory, the students will be given practical exposure
on curative (hospital) and population (community) health management system during each
CBLE posting.
General Objectives:
At the end of the course students should be able to:
 Describe management evolution and physician’s role in health care

 Explain philosophy of management
 Describe value of management science for health care professionals /doctors
 Describe public health and health systems
 Explain medical service delivery system of Nepal
 Describe health care service delivery in the community
 Describe expanding a clinical service and sustainability
 Describe managing money effectively
 Describe decisions making process in health care organization
 Describe management concepts for healthcare leaders (managers/directors)
 Describe health management systems (comparative) –part 1
 Describe delivering of essential health care services in rural Nepal
 Describe alternative being used in patient care in rural Nepal
 Health policy and health politics
 Describe the development of the Nepal public health care system
 Explain application of management tools in health and care
Management Science for Healthcare Professional (Part II)
General description:
This second part of the management course aims at preparing graduates to take a crucial role
in managing public health services and optimum utilization of scarce resources. It presents a
systematic coverage of management theory and practice.
The course is intended to provide the student with an understanding of components of public
health services, inventory management, resource mobilization (state/local), total quality
management, time management, conflict management, communication skills, hospital
production, outcomes assessment, globalization and its impact on health services accessibility
and affordability.
Students are expected to learn and apply health care management theories at different levels
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(district, village development committee, wards) of health institutions during each CBLE
posting. This will enable students to understand the type of work they are expected to
perform once they are posted in district heath system after their graduation.
In addition to programme management, students are expected to acquire knowledge and skill
about project management, health care institutions and hospitals administration.
Specific objectives
At the end of the course students should be able to:
 Describe the fundamental principles of healthcare institution and hospital
management.
 Describe the concept of management and its application in health care including
hospital.
 Discuss and compare the health care management system in Nepal and other parts of
the world
 Describe introduction of preventive, curative, promotive, rehabilitative health
services
 Describe organizational development issues in the health system
 Describe and discuss the philosophies behind investing in health
 Describe effective hospital management principles
 Describe book-keeping
 Discuss the purpose of medical and non-medical data and records
 Discuss planning and budgeting
 Describe the rules and regulations of Ministry of Health and Population, Nepal
 Discuss the ethics and responsibility of management
Recommended text Books:

1. Haimann's Healthcare Management, Seventh Edition by Rose Dunn
2. Accounting for Financial Analysis and Planning. Dangol, R.M., Talaju Prakashan,
Kathmandu
3. Fundamentals of Health Care Financial Management: A Practical Guide to Fiscal Issues
and Activities, 3rd Edition by Steven Berger
References:
1. Managing Health Services Organizations, Fifth Edition, Jonnathon S. Rakich, Beaufort B.
Longest, Jr. Kurt Darr, Health Professions Press
4. Principles of Management, Agrawal, GR, M. K. Publishers
& Distributors, Kathmandu
5. The Yale Management Guide for Physicians, Stephen Rimar, John Wiley & Sons, Inc.
2. The Well-Managed Healthcare Organization, John R. Griffith and Kenneth R. White, 6th
Edition, Health Administration Press, Chicago, Illinois, AUPHA Press, Washington, DC,
AUPHA/HAP
3. Nepal’s Quest for Health, Hemang Dixit, Educational Publishing House, Jamal,
Kathmandu, 2005.
6. Annual Report, Department of Health Services (current publication), MOHP, Kathmandu,
Nepal
7. Better Management 100 Tips, Managers Guide, Jack Reynolds, Maria Franscisco, Susan
Gearon, Aga Khan Health Services/ ISBN 1-882839-17-X.
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Basic Epidemiology (Epidemiology I)
The basic epidemiology course is designed to equip the undergraduate students with a basic
knowledge on the need, philosophy, concepts, methods, strategy and use of epidemiology. This
course enables students to develop competency skills and attitude to apply epidemiological
principles and logic in the community and individual diagnosis, and also health care practices.
General Objectives:
At the end of this course students should be able to:
 Identify and differentiate the health and non-health factors affecting the population
exposed, the environment and ecosystem including social in which they live in and the
specific agents which influence or determine health and disease, as a basis for the health
care of communities
 Use epidemiology principles and approaches in understanding and analyzing health
problems and developing community health care for population
 Design and organize control and prevention programs
 Manage diseases and other health problems appropriate to the existing physical, eco-
biological and socio-cultural conditions through integrated application of knowledge and
skills from other disciplines
Students will be able to:
 Describe and differentiate descriptive, comparative, analytical, interventional
and experimental epidemiology
 Review, apprise, present, and apply (commonly use) various epidemiological
studies
 Apply basic knowledge of epidemiology in the community:
 Understand and explain cause and effect relationship, types of associations and
their use
 Use epidemiological concepts for prevention and management of health problem
 Discuss hypothesis regarding the cause or determinants and the distribution of
disease and problem in the population or area
 Formulate a hypothesis and test it scientifically

 Explain the need and underlying principles of classifying diseases
Discuss and apply measurement of disease frequency
 Describe different sources of epidemiological data, their types, uses, reliability

and weakness, and appraise the data critically
 Describe the types and nature of various epidemiologic studies and their uses.
Recommended Text Books:

 Beaglehole, R. Bonita, R., Kjellstrom, T, Basic Epidemiology, WHO
References:
 Lilienfeld D. E. and Stolley P.D., Foundations of Epidemiology, Oxford University Press
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General Epidemiology (Epidemiology II)
The General epidemiology course is designed to enable students to develop competency skills
for different levels of prevention program. In addition students will be able to use acquired
knowledge for health promotion at communities during Community Based Learning Education
processes.
General Objectives:
At the end of this course students will be able to:

 Discuss the basic epidemiological nature of commons insects and microbes important
for human health and disease state
 Describe the interrelationship between host, agent and environment
 Design health promotion and prevention programs based on epidemiological principles
 Explain various terminologies used in the epidemiological description of diseases

Explain mechanism of transmission of infection
 Describe and plan for prevention and control of communicable diseases
 Explain immunity and the part played by the body defenses
 Discuss immunization
 Carry out descriptive epidemiological investigations of infectious and non-infectious
diseases
 Solve problems such as epidemics of common health problems, occuring during
community level exposure

 Sompayrac, How the immune system work, BMA / Blackwell
 Playfair, J.H.L., Infection and Immunity, Oxford University Press
 Marqualdt WC. ELSEVIER, Biology of Disease Vectors, Academic Press
References:
 Barker, D.J.P, Rose, G., Epidemiology in Medical Practice, Churchill Livingstone
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Applied Epidemiology (Epidemiology III)
In this final section of the epidemiology course students will become familiarized with the
broader thematic areas of applied epidemiology and will use these concepts in the day to day
management of clinical cases and program management at a population level. The course
consists of three thematic parts:
(1) Epidemiology of infectious diseases
(2) Epidemiology of non infectious diseases
(3) Health services for communicable and non communicable diseases.
Group 1: Epidemiology of infectious diseases

 Recognize infectious diseases, and their causative agent by clinical and laboratory
methods (laboratory recommendation and interpretation of report)
 Discuss magnitude and seriousness of public health problems of infectious diseases
 Discuss agent, route, mode and factors responsible for the transmission
 Develop and implement immediate management plan of the case and effective and
efficient prevention and control measures
 Discuss infectious disease caused by bacteria, viruses, protozoa and helminths.
Group 2: Epidemiology of non infectious diseases:

 Describe the epidemiology of non-communicable diseases
 Identify the determinants and discuss the impact on population of non communicable
diseases, like accident, industrial hazards, COPD, bronchial asthma, alcohol and drug
addiction, cancers, congenital anomalies, myocardial disease and cerebral vascular
accidents.
Group 3: Health service for communicable and non communicable diseases in Nepal:
Students will visit a numbers of programs and describe their operation. Programs include a
leprosy hospital, TB hospital and program, infectious disease hospital, Heart centers, cancer
hospital and different divisions, centers and sections of Department of Health services.
 Heymann, David L., Control of Communicable Disease Manual, WHO

 Hawker, Communicable Disease Control Handbook, BMA/ Blackwell
 Loeb, Evidence-based infectious Diseases, BMA/ Blackwell
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Community Health Sciences Laboratory and Public Health Program Appraisal
This course is designed to help students apply knowledge of basic community health sciences
(including epidemiology, bio-statistics, demography, medical sociology and anthropology,
environment health, and family health) in both clinical and public health in an integrated and
balanced way.
 Assess the quality and quality assurance mechanism of physical facilities, such as
latrines and water supplies, designed and installed for public health reasons
 Perform simple laboratory procedures in health program and public health research
 Assess nutritional status of under five year olds

Prepare effective communication media methods for promotive and preventive care
in rural areas.
Appraise various control program activities of the Ministry of Health , such as

Malaria, TB, Leprosy, Diarrhea diseases, ARI,
Appraise the activities of water supply and sewerage system; solid waste disposal
system, Food Research Laboratory, Control of Diarrhea Diseases.
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Family Health I
This course is designed to enable the students to understand the social, psychological, and
economical dimensions of illnesses.
General Objectives:
Student will develop knowledge and insight on what will happen when a person falls sick in a
family. They will be able to identity the roles and responsibilities of family, community and
health institution to help the sick person to recover

 Describe and analyze the need of follow up of a patient at home, community and plan
and implement appropriate mechanisms
 Describe the socio-psychological and economical impact of illness on family,
community, and environment
 Discuss the impact of positive and negative communication on illness
 Discuss how the knowledge, attitude and practices of the patients towards his or her
own illness affect the management of their condition, especially chronic and
disabling conditions
 Elicit adequate information and cooperation from patients and family when needed
for management of condition
 Provide necessary information and skill to patients and family to help them manage
the problem
Teaching strategies
Two students will be assigned a village and they will have to maintain a diary for that assigned
village for 4 years. They have to submit their village diary and have to make a presentation at
PAHS.

Park J.E, Park K. Text book of preventive and social medicine
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Family Health II
The course is designed to help students appreciate the importance of family size and
environment. The course includes Family Planning and Maternal and Child Health Service,
essential health care package and rehabilitation.
General Objectives:
Students will be able to apply and evaluate family health principles in terms of:
 Family Planning
 Maternal and child health
 Nutrition: integrate with Food and Nutrition
 Primary Health Care and Essential Health Care
 Care of elderly and disabled
 Rehabilitation

 Discuss the basic concepts of family health
 .Discuss population growth and its effects on health
 Discuss the development of family planning programs in Nepal
 Describe the different contraceptives available.
 Explain patterns of maternal, infant and child morbidity and mortality in Nepal
 Discuss and analyze the components of MCH Services
 Discuss MOH policies, strategies and programs related to MCH services
 Describe issues surrounding nutrition and health from a family health prospective
 Discuss the ethics of primary health care
 Apply the principles of primary health care in rural and urban contexts of Nepal
 Discuss the medical, social and legal aspects of rehabilitative services for the disabled
 Explain the role of rehabilitation in the physically and mentally handicapped person, the
neonate, the elderly and the person with HIV/AIDS

1. Park J.E, Park K. Text book of preventive and social medicine
2. Ebrahim GJ. Child care in Tropics. ELBS.
3. William CD, Jelliffe DB. Mother and child health: delivering the services. ELBS.
4. Morley D. Pediatric priorities in developing countries.
5. Adhikari RK, Krnatz M. Child nutrition and health. HLMC, IOM, Kathmandu
6. Hatcher R et. al. Family Planning methods and practice.
7. Hatcher R et. al. Contraceptive technology. Inft. Ed.
References:
1. Dawn CS. Text book of obstetrics and neonatology. Smt. Arai Dawn. Dawn Books,
Calcutta
2. Ebrahim GJ. Case of newborns and developing countries ELBS
3. MOHP/DoHS Policy, Strategies & Program Documents on related topics
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Food and Nutrition
The course is designed to help students develop basic knowledge and competency in the areas of
food and nutrition with the emphasis of problems encountered in Nepal.
General Objective
To understand, apply, evaluate and manage nutrition and food related problem at individual and
population level using integrated knowledge and skills of basic, community and clinical science
disciplines.
Specific Objectives
 Discuss food and nutrition and its importance in human life

 Describe the metabolism of protein, fat, carbohydrate, fat soluble vitamins, water soluble
vitamins, iron, B12, folic acid, iodine and water
 Describe normal requirement for maintaining health at various periods of human life
 Recognize the nutritive value of locally available food, vegetable, meat, fish and dairy
products
 Describe the importance of nutrition for intrauterine growth and development
 Explain the importance of nutrition for mental and physical development in the first five
years of life
 Describe the relation of malnutrition with mental and physical growth retardation.
 Discuss the anthropometric parameters of nutrition
 Assess the nutritional status of a given community.
 Describe the clinical features of various nutrition deficiency diseases (protein-calorie
malnutrition, specific vitamin deficiencies etc)
 Discuss prevention strategies for nutrition deficiencies
 Discuss management of important nutrition deficiency diseases
 Discuss breastfeeding, weaning and supplementary food
 Discuss food hygiene, adulteration and food processing
 Discuss food sanitation
 Describe Food and Nutrition education and behavioral change communication
 Describe clinical nutritional surveys

 Edited by Richard D. Semba and Martin W. Bloem., Nutrition and Health in Devleoping
Countries, HUMANA PRESS
 Ramesh K. Adhikari, Miriam E. Krantz, Child Nutrition and Health, Health Learning
Materials Center, TU, IOM
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Biostatistics I – Basic Biostatistics (Descriptive Statistics)
This part of the biostatistics course is designed to provide the undergraduates students with a
basic knowledge on the need, concepts, methods, and use of descriptive statistics in health
sciences.
General Objectives:

 Apply descriptive statistics in health sciences;
 Use tools and techniques of descriptive statistics in understanding and analyzing
population health;
 Integrate the statistical findings with other disciplines and identify/decide upon
appropriate statistical tools and techniques to prove the findings.
At the end of the course, students should be able to:

 Describe the concept of statistics and biostatistics, historical development of
biostatistics and practices and uses of biostatistics in health care management and
research;
 Describe entities, variables, data and their measurements:
 Describe different sources of statistical data, their types, uses, quality and
limitations;
 Describe the process collection, classification and tabulation and coding of data:
 Illustrate the variable and data using appropriate graphical and mapping tools;
 Define/describe and apply the measures of central tendency:
 Define/describe and apply the measures of location:
Define/describe and apply the measures of dispersion/variability:
 Define/describe the measures of skewness and kurtosis and apply them to explain the
characteristics of normal distribution:
Define/describe measures of relative position:
 Define/describe sampling techniques in health sciences:
 Define/describe measures of relationship:
 Apply basic statistical knowledge in the community health diagnosis;
 Compute the descriptive statistics manually as well as with the aid of statistical
software such as Epi-Info®/SPSS® etc. and/or spreadsheets like Microsoft® Excel®
etc.

 Bluman AG (2005). Elementary Statistics: A Step by Step Approach (A Brief
Version). McGraw-Hill Science Engineering.
 Rosner B. Fundamentals of Biostatistics (1999). Duxbury Press, Fifth Edition.
Reference Books:
 Bland M. An Introduction to Medical Statistics. Third Edition. Oxford University
Press.
 Swinscow TDV (2002). Statistics at Square One (Revised by M J Campbell). 10th
Edition, BMJ Books, United Kingdom.
 Le CT (2003). Introductory Biostatistics. John Wiley and Sons. New Jersey, USA.
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 Belle GV, Fisher LD, Heagerty, PJ, Lumley T. (2004). Biostatistics: A Methodology
for Health Sciences. Wiley Series in Prabability and Mathematical Statistics.
 Campbell MJ, Machin D and Walters SJ (2007). Medical Statistics: A Textbook for
the Health Sciences, 4th Edition, Wiley, United Kingdom.
 Greasley P (2007). Quantitative Data Analysis using SPSS: An Introduction for
Health and Social Science. Open University Press.
 Hills M and Stavola BLD (2007). A Short Introduction to Stata for Biostatistics. Stata
Press: Timberlake Consultants Ltd.
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Biostatistics II – Advanced Biostatistics (Inferential Statistics)
This part of the biostatistics course is designed to provide the undergraduates students with basic
knowledge, competency skills and attitude in applied biostatistics for the practice of evidence
based medicine, health care management and research as well as CBLE processes.
General Objectives:
 Discuss the use and misuse of the inference statistics
 Identify and apply the appropriate statistical methods
 Integrate statistical methods with other disciplines
Specific Objectives
At the end of this course, students should be able to:
 Define probability and apply its concepts in statistical methods:

 Explain the concept of standard error:
 Describe how sample size affects standard error
 Discuss and apply the statistical estimation based on means and proportions.
 Perform tests of hypotheses on health science data and research.
 Define the null and alternative hypothesis:
 Describe the purpose of a test of significance:
 Describe Type I and Type II errors
 Describe the concept of significance level (probability level)
 Describe appropriate use of one-tailed and two-tailed tests
 Explain the parametric tests and nonparametric tests
 Apply measures of relationship in health sciences:
 Discuss parametric tests and apply z-test, t-test and F-tests
 Describe non-parametric tests and apply contingency tables to calculate chi-square
test for independence, Yate’s correction and Fisher’s exact test
 Discuss, compute and interpret simple, multiple and logistic regressions
 Describe non-linear regression, survival analysis and Receiver Operating
Characteristics (ROC) curve and internal consistency analysis
 Apply inferential statistical knowledge, methods and tools in the community health
residential rotations and projects/reports
 Demonstrate proficiency in deciding which method of statistical inference is
appropriate
 Compute and interpret the applied inferential biostatistics manually as well as with
the aid of statistical software such as SPSS®/STATA®/GraphPad® etc. and/or
spreadsheets like Microsoft® Excel® etc.

 Rosner B. Fundamentals of Biostatistics (1999). Duxbury Press, Fifth Edition.
 Motulsky H. Intuitive Biostatistics (2005). Oxford University Press.
Reference Books:
 Swinscow TDV (2002). Statistics at Square One (Revised by M J Campbell). 10th
Edition, BMJ Books, United Kingdom.
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 Campbell M J (2006). Statistics at Square Two: Understanding Modern Statistical
Applications in Medicine. 2nd Edition, BMJ Books, United Kingdom.
 Campbell MJ, Machin D and Walters SJ (2007). Medical Statistics: A Textbook for
the Health Sciences, 4th Edition, Wiley, United Kingdom.
 Belle GV, Fisher LD, Heagerty, PJ, Lumley T. (2004). Biostatistics: A Methodology
for Health Sciences. Wiley Series in Prabability and Mathematical Statistics.
 Juul S (2008). An Introduction to Stata for Health Researchers. 2nd Edition. Stata
Press.
 Gaur AS and Gaur SS (2009). Statistical Methods for Practice and Research: A
Guide to Data Analysis using SPSS (Respose Books). 2nd Edition. Sage Publication
Pvt. Ltd.
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Demography
Demography is divided into two parts: formal and social demography. Formal demography deals
with measurement of the population size, distribution, structure and change in population
whereas social demography analyzes the relationships between economic, social, cultural and
biological processes influencing a population. Medical demography concentrates on the
application of formal and social demography in health. Demographic methods and tools are
important to assess and devise health plans and policies at local, national and international
levels.
General Objectives:
 Describe the use and importance of demography.

 Discuss the demographic phenomenon to understand the population dynamics.
 Apply the commonly used demographic indicators, tools and techniques in medical and
health studies and researches.
 Explain the demographic concepts, principles and approaches in understanding and
analyzing health problems and community health care programs.
 Integrate the knowledge of medical demography with other disciplines to effectively
deliver health care to the people from local to national/international levels.
At the end of the course, students should be able to:

 Describe the concept of demography, historical development of demography and its
use in public health and medicine
 Distinguish different sources of demographic data and their types, and discuss their
quality and uses in medicine and population health
 Discuss Data Quality:
 Discuss and apply demographic phenomenon and its implication in population and
health dynamics
 Discuss commonly used demographic tools and techniques in medicine
 Calculate important demographic indicators
 Calculate Mortality Measurements:
 Calculate Fertility Measurements:
 Perform migration Measurements:
 Discuss the importance and limitations of Population projection
 Describe the demography of Marriage, Labor Force, Education and Urbanization:
 Integrate and explain various demographic studies with health
 Show ability to use appropriate software to analyze the demographic and health
indicators and apply it to formulate relevant population health plans and policies at
various geo-political levels

 Siegel and Swanson (eds) 2004. Methods and Materials of Demography. ELSEVIER
Academic Press, Second Edition.
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 Ministry of Health and Population (2008). Population Report of Nepal 2007.
(http://www.moh.gov.np/population/publications.asp)
Reference Materials:
 Central Bureau of Statistics/UNICEF/New ERA (1995 – 98). Nepal Multiple
Indicator Survey: Cycle I – VI. (http://www.cbs.gov.np/nmis_contents.php)
 Central Bureau of Statistics/UNICEF (2000). Between Census Household
Information, Monitoring and Evaluation System (BCHIMES).
(http://www.cbs.gov.np/BCHIMES.php)
 Gurung, H (2001). Nepal: Social Demography and Expressions, New ERA, Himal
Books, Second Edition.
 Central Bureau of Statistics/UNFPA (2002). National Report 2001. Kathmandu,
Nepal. (http://www.cbs.gov.np/national_report_2001.php)
 Central Bureau of Statistics/UNFPA (2003). Population Monographs of Nepal: 2001.
Nepal. (http://www.cbs.gov.np/population_1_contents.php and
http://www.cbs.gov.np/population_2_contents.php)
 New ERA, Ministry of Health, MACRO International. Nepal Demographic and
Health Survey: 1996, 2001 and 2006 Final Reports.
 (http://www.measuredhs.com/pubs/pub_details.cfm?ID=669)
 Central Bureau of Statistics/World Bank (. Nepal Living Standard Survey:
2003/2004. (http://www.cbs.gov.np/Surveys/NLSSII/NLSSIIReportVol1.pdf and
http://www.cbs.gov.np/Surveys/NLSSII/NLSSIIReportVol2.pdf)
 Department of Education (2005). School Level Educational Statistics of Nepal:
Consolidated Report. Sanothimi, Bhaktapur, Nepal.
 Central Bureau of Statistics. Nepal Labour Force Survey Reports, Kathmandu,
Nepal. (http://www.cbs.gov.np/nlfs_report_contents.php)
 Singh ML. Introduction to Mathematical Demography, Koseli Prakashan.
 Graziella Caselli, Jacques Vallin, and Guillaume Wunsch (eds) (2006). Demography:
Analysis and Synthesis. ELSEVIER Academic Press, Vol I – IV.
 Institute for Social and Environment Research/University of Michigan (2001 – till
date). Chitwan Valley Family Study.
(http://perl.psc.isr.umich.edu/researchprojects.htm)
 Park K (2009). Park’s Textbook of Preventive and Social Medicine. Banarasida
Bhanot Publishers (20th Edition).
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Culture, Society, Health and Illness
This course aims to provide students training in society, culture and social development and the
contribution which behavioral science can make to the prevention and control of health
problems
Objectives:
After completion of this course students should be able to:
 Discuss the concept of medical sociology, medical anthropology, nature and subject
matter of medical sociology and anthropology, in determining health and health related
needs of the family and the community.
 Describe cross-cultural understanding of health, illness, and disease.
 Describe various perspectives on health and illness.
 Explore and analyze the social determinants of health and disease.
 Compare the differentials in health status of people in the community and identify their
causes.
 Explore and describe the health care pluralism in the family and the community.
 Compare the communication patterns among various service providers and service
receivers.
 Describe how health and disease distributed is influenced by different social classes,
ethnic groups and ecological regions within countries.
 Define the social problems, describe various social problems, and compare the social
problems in urban and rural areas.
 Describe various components of health system, health care philosophy and health care
expenditure.
 Describe and compare various level of health planning.
 Describe the rights of patients and professionals.
 Compare the theory versus practice of the health rights in the community.
 Describe the health care ethics and explore the dilemma of health care ethics in the
community.
 Describe qualitative and quantitative research methods, apply various tools to collect
qualitative and quantitative information, summarize and compare the findings.
 Formulate and propose the culturally competent program to promote the health in rural
community.
Text Books
 Helman, Cecil G. (2001). Culture, Health and Illness (Fourth Edition). London: Arnold.
 Scambler, Graham (ed.) (2003). Sociology as Applied to Medicine (Fifth Edition).
Edinburgh: Saunders.
References
 Annandale, Ellen (1998). The Sociology of Health and Medicine: A Critical
Introduction. UK: Polity Press.
 Beine, David K. (2003). Ensnared by AIDS: Cultural Contexts of HIV/AIDS in Nepal.
Kathmandu: Mandala Book Point.
 Davey, Basiro, Alastair Gray and Clive Seale (eds.) (2001). Health and Disease: A
Reader. Buckingham: Open University Press.
 Hahn, Robert A. (ed.) (1999). Anthropology in Public Health: Bridging Differences in
Culture and Society. New York: Oxford University Press.
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 McElroy Ann and Patricia K. Townsend (1996). Medical Anthropology in Ecological
Perspectives (Third Edition). Westview Press.
 Nichter, Mark and Mini Nichter (1996). Anthropology and International Health: Asian
Case Studies. Gordon and Breach Publishers.
 Piotrow, Phyllis Tilson; D. Lawrence Kincaid; Jose G. Rimon II and Ward Rinehart
(eds) (1997). Health Communication: Lessons from Family Planning and Reproductive
Health. USA: Praeger Publishers.
 Schwartz, Howard D (ed). (1994). Dominant Issues in Medical Sociology (Third
Edition). New York: McGraw-Hill, Inc.
 Subedi, Madhusudan Sharma (2001). Medical Anthropology of Nepal. Kathmandu:
Udaya Books.
 White, Kevin (2002). An Introduction to the Sociology of Health and Illness. London:
Sage Publication.
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Health Education and Behavioral Change
Health education and behavioural change is an inseparable part of providing a comprehensive

care service. This course enables students to understand fundamental theory, basic principles
and approach of health education and behavioral change applicable in a wide range of health
service institutions and community settings. The course is organized into five thematic areas .
Specific objectives:
1. Introduction

 Explain the concept and theory of health education and behavioral change.
 Describe the place of health education in health and medical services
 Describe the importance and scope of health education in a range of settings
2. Health education in health care settings

 Explain the importance of health education and behavioral change in health programs
and medical care settings
 Describe the roles and functions of health and medical care providers in behavioral
change
 Explain interpersonal communication and health care providers
3. Interpersonal communication and health and medical care providers

 Explain the concept of patient counseling
 Describe the opportunities for patients education
 Describe the planning procedures for delivering patient education
 Demonstrate the process of implementing patient education/counseling by using
appropriate methods and media
 Assess the effectiveness of health education/counseling activities
4. Method and media of health education and counseling in a medical care setting.

 List the patient education/counseling methods appropriate for different situations
 Describe the nature, process and limitations of interview, counseling and group
discussion methods
 Explain participants selection criteria for interview, counseling, demonstration and
group discussion for health promotion
 Demonstrate the process of patient education and counseling methods
 List the health education materials and equipment appropriate for health education
5. Communication in the patient education process
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 Explain effective interpersonal and group communication with patient and patient
parties
 Define communication and its elements
 Describe interpersonal and group communication barriers and the ways to overcome
these barriers
Students will be provided with an opportunity to visit the National Information, Education and
Communication center during course delivery.
During the rural rotation, students will apply BEHAV or similar Framework for health
promotion as part of a teaching-learning exercise.
Evaluation:
Periodic assessments of the teaching learning activities of students will be done during the
period of the course, including class tests, project report, presentation and interaction.
Community health will be included in the integrated examinations that take place at the end of
each academic year.
Text Books:
 L. Ramachandran, T. Dharmalingam, Health Education (A New Approach), Vikas

Publishing House Pvt. Ltd, 1998 (Referred latest edition)
Reference Books:
 Egger, G.;Spark, R., Health promotion strategies and methods, Mcgraw-Hill Publication
 Shreehari Sharma, Swastha Pariwaar Saral Upaya, Premier Printing Industry, Chitwan,
2008
 J. Kishore, A Dictionary of Public Health, Century Publications, New Delhi, 2002
 Steve Sussman, Hand Book of Program Development for Health (Behavior Research &
Practice), Sage Publications Inc., 2000
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Ecologic Health
The course aims to provide basic theoretical and practical knowledge and skills on
environmental health. The course is thematically divided into:
1. Environmental sanitation
2. Eco-health
3.Climate change and health.
Students will learn and understand management of environmental sanitation and understand
effects of environment, ecology and climate change on human health and development.
General Objectives:

 Apply the basic principles of environmental health to approach problems of human
health and development in relation to ecology.
 Identify problems related to environmental sanitation and health, and be able to develop
programs to solve or mitigate the effects on human health and environment.
 Evaluate and assess environmental and health status and to conduct research in
environmental health.
1. Ecology:

 Define ecology, ecosystem, biosphere, cycle of energy circulation, interdependence of
environment; plant, animal and human health.
 Discuss community participation in ecological preservation.
2. Water

 Explain health economics and health benefits of water.
 List the sources of drinking water in general and particularly in the mountains, hills,
valleys and plains of Nepal.
 Define safe and unsafe drinking water using standard criteria and their practical
implication in daily life.
 Describe water-borne diseases prevalent in Nepal and prevention strategies.
 Describe the methods used for providing drinking water to the towns and cities in Nepal.
 Describe methods used for protecting water sources in pipe water supply and household
supply.
 Describe cross-connection, faulty joints, hair-line cracks and how they lead to polluted
water.
 Perform water sampling from wells, rivers and water supply systems.
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3. Air

 Describe the Interrelationship between air and human health.
 Explain the composition of atmosphere and atmospheric stratification.
 Describe air pollution, sources of air pollution and its impact.
 Discuss O3 depletion, Global warming Phenomenon and its consequences.
 Define Air quality index, Air pollution standard, Air quality management.
 Describe air-borne diseases prevalent in Nepal and prevention strategies.
 Discuss International agreements and the legislation.
4. Climate Change and Health

 Describe the common terms used in climate change and health.
 Discuss changing human exposure to weather and climate change,
 Discuss the trend of climate change, extrapolate the future trend and likely health
impacts of climate extremes
 Discuss mitigation approaches for climate change
5. Waste Disposal Systems:

 Discuss solid waste disposal
 Discuss hospital waste management issues
 Describe methods for the disposal of excreta
 Describe methods of sewage disposal
6. Environmental Health Management

 Explain management of environmental health
 Describe the role of governmental and non-governmental agencies and community in
environmental preservation and promotion of environmental health.
7. Insects and Rodent Control

 Define entomology
 Describe the nature of insects and arthropods as vectors/agents
 Describe the salient features and brief life cycle of common insects found in Nepal
 Describe diseases transmitted by these insects.
 Describe different types of prevention strategies and control measures..
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8. Housing

 Explain the relation between housing and health.
 Describe the growth of cities and its consequence on ecology and health.
 Describe rural housing and low cost, functional and sanitary housing including
appropriate site.
9. Policies and Strategies

 Describe salient features of Nepalese law in relation to food hygiene.
 State the principles of safe food handling and food supply.
 Explain health aspects of food preservation, processing, cooking, catering, handling,
trade and marketing, distribution and consumption.
 Describe mycotoxins in food and its prevention.
 Discuss hospital waste management policy and strategies.
1. Climate Change and Human Health-Risks and Responses, WHO, WMO and UNEP
2. Moeller, Dade W., Environmental health, Harvard University Press
3. Frumkin, Howard, Environmental health, Jossey-Bass Publication
4. Metcalfe, Sarah; Derwent, Dick, Atmospheric pollution and environmental change,

Oxford University Press
5. De Sadeleer, Nocolas, Environmental principles, Oxford Univ Press
6. Ojha S. “ Vatavarania Swasthya ra Sarsafai, 1989 Ed. HLMC, TUTH
Reference books:
1. Ecosystem and Human Health: Some findings from Millennium Ecosystem Assessment
2. United States Environmental Protection Agency, Climate Change and Public Health,
EPA 236-F-97-005 October 1997
3. Brugge, Doug; Hynes, P., Community research in environmental health, Ashgate

Publication
4. Lerche, Ian; glaesser, W, Environmental risk assessment, Springer
5. Ministry of Health, Nepal, Health Care Waste Management in Nepal, June 2003
6. Rijal, H.B., H. Yoshida, T. Miyazaki and I Uchiyama, Indoor air pollution from firewood
combustion in traditional houses in Nepal.
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COMMUNITY BASED LEARNING AND EDUCATION
- 150 -
Community Based Learning and Education
Community Based Learning and Education (CBLE) is an important part of Patan Academy of
Health Sciences strategy to achieve its stated goals. The Academy will have a long-term
commitment with the community, where students and faculty learn in the real life situation..
PAHS will develop the necessary infrastructure and skills to establish linkage with the
communities and the national health system. PAHS will initially work in several communities
and gradually cover a whole district over time. In the teaching district, PAHS engagement and
commitment will be long-term and will not be considered as merely for posting students. The
broader aim of CBLE is to provide benefits to the communities, the students and the faculty and
eventually to the national health system.
PAHS has a philosophical commitment for community based learning and education, therefore,
there will be on going development of institutional support mechanisms and infrastructure. This
will be reflected primarily through the curriculum and the job responsibilities of faculty. The
implementation strategies will be designed in such a way that PAHS educational and service
objectives and activities will be coherently linked and bridged together.
Pillars of Broader Institutional System for CBLE:
A. Institutional commitment: PAHS, as an institution is committed to train health

professionals for service in rural communities. This will be reflected in the overall
curriculum. There will be appropriate timing and adequate duration for field level programs
to achieve the stated objectives. PAHS will work with local communities to avoid
inappropriate times like just before harvesting. Similarly, PAHS will avoid inappropriate
timing for students such as before examinations as they will not be able to concentrate on
field work. There will be optimal and appropriate arrangement of senior faculties for
supportive supervision.
B. Basic minimum necessary infrastructure: In the context of CBLE the most important
infrastructure is well informed and supported communities. The Department of Community
Health Sciences will arrange local family support for students when they are posted at
village level. This is important for motivation and fulfillment of daily basic needs.in order to
provide an optimal learning opportunity and environment.
C. Link with the National Health System: There will be formal and informal linkage with the
national health system from the Ministry of Health to the village health system.
D. Link with the communities: PAHS will develop and establish teaching districts and
communities. PAHS and the teaching communities will jointly develop long-term
engagement plans from the very beginning of the program.
E. Adequate numbers of communities: As specified in the curriculum, there will be an

adequate number of communities representing the socio-cultural and geographical diversity
of the country as required to achieve the educational objectives.
F. Shared benefits with communities: PAHS will invest its knowledge and skills to build the
capacity of local health facilities. Local health facilities workers will be our local supervisors
also. In addition we will organize periodic service outlets which will be used for three
purposes:
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a. training students
b. training local health facilities staff
c. providing services to local communities.
G. Community will serve as community based research area: Teaching communities and
district will be developed with the necessary community based infrastructure and
information database for community based research. GIS technology will be used in addition
to basic demographic information and all health related events will be recorded. A separate
plan will be developed for the implementation of research activities.
CBL and Ministry of Health
The Government of Nepal has committed to achieve the Millennium Development Goals
(MDG) by the year 2015 and Ministry of Health has been putting resources and efforts to realize
goals 4, 5 and 6 within this time frame. Furthermore, Primary Health Care (PHC) approach has
been the strategy to achieve these goals. Significant efforts have been made to train health
personnel to work at various levels, in the community and at primary, secondary and tertiary
levels health facilities.
The inception and establishment of Patan Academy of Health Sciences is to provide support to
MOH for the realization of its objectives through training of a health workforce with adequate
competency to work in the most under served areas. There are clear roles and responsibilities:
PAHS programs have a broad aim to train a health workforce with adequate competency skills
to deliver services especially in rural area of Nepal; MOH will provide an enabling structural
frame for this health workforce to work at peripheral levels in rural areas. Therefore, the role of
MOH and concerned other ministry is important not only by serving as client-consumer of the
products of an academic institution but also to provide input to the process of implementation,
overall program design, and most importantly to create an enabling environment.
PAHS students will have different opportunities to equip them to be effective and efficient for
their job later. Their training will take place in a real life setting, with the specific aim of
developing the student's understanding of community problems, and their ability to work with
the community in tackling such problems. Thus, the PAHS students and future ‘health leaders’
will be prepared to work toward fulfilling the Millennium Development Goals.
The particular educational strategy chosen to meet the goal is field-based, responsive, problem-
solving methods. These encourage students to become responsive to their future responsibilities
while they learn, and develop clinical, management and communication competencies under
supervision in the community.
It will be necessary for PAHS to periodically review the relevance of its educational and training
programs in the light of overall context and policy changes, and to consider the wisdom of
making curriculum revisions.
Why Community Based Learning and Education?
For the last several decades it was believed that health problems could be solved through the
advancement of medical technology. It is true that 100 years ago, people died prematurely due to
lack of technology and knowledge of proper diagnosis and proper treatment. Much emphasis
was given to explore the secret of diseases and their remedy. The goal of the medical school was
to produce doctors who were smart in identifying diseases and treating them. Although many of
- 152 -
the secrets of diseases are known today, many people on this planet still lose their lives
unnecessarily because of many other factors. These factors include social contexts where the
poor do not have access to the technology. Therefore, the doctors of the present generation, if
they wish to save human lives, cannot do so just by mastering knowledge and skills of medical
sciences. They have to play a new role, as a community-oriented health professional.
What are the attributes of community-oriented health professionals?
Community-oriented health professionals are adaptive to a variety of settings, and demonstrate

leadership capacities and humility. They have the skills and interest for continuous learning.
Whether specialist or generalist, they have to advocate for the disadvantaged. Consequently,
contemporary medical schools should produce doctors who, along with technical competency,
can play this new role. To this end, medical schools are in continuous search of pedagogic
methods and approaches. Problem based learning (PBL) and Community based learning and
educations (CBLE) are the results of such a search.
Considering Nepal’s specific needs in health and dealing with Nepal’s specific problems in the
context of its socio-economic development, PAHS should put a lot of emphasis on CBLE.
The WHO Expert Committee on Public Health Education has stated:
"If the student in public health is to become familiar with the educational approach to health
problems, training methods must become adjusted to this objective and --- needs to work WITH
and IN the community as a part of -- training. Thus, in advanced training for public health - and
in training for public health education of the public - the community should be used as the
laboratory of the school."
Source: WHO Expert Committee on Public Health Education 1995. Series No. 156-25.
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Fundamentals of Community Based Learning and Education (CBLE)
 CBLE is not merely community oriented learning or learning to serve the community.
Rather, it is a process of learning from the community and with the community. CBLE
encourages engagement in community and socio-political processes.
 CBLE helps to understand about health, disease, their interrelationship and their
determinants in real life contexts (ecology).
 CBLE helps to understand health and disease in longitudinal ways rather than in cross
section, as is typical in the setting of a clinic or hospital.
 CBLE helps to internalize the suffering and pain related to the diseases.
 CBLE helps to inform and empower the population about their health risks and
behaviors, and in whatever context they chose to live.
Strategies of CBLE
Department of Community Health Sciences will be the focal point for the implementation of
the CBLE program.
Broad Function of Department of Community Health Sciences:

 To co-ordinate field and field related activities both at central and local levels to ensure
and maintain the co-operation of the Ministry of Health and Population and other
stakeholders (Non-Governmental Organizations, Community Based organization), to
assess new field sites and facilities, and maintain standards for field placement.
 To co-ordinate the field activities of different groups of students
 To define geographical areas for field work, where PAHS also have its own peripheral
facility and staff or supported existing institution
 Responsibility for service provision.
Specific functions:
 To co-ordinate with Department of Health Professional Education and its activities
 To assess the needs of the CBLE support, identify areas and resources available for field
and maintain up-to-date records of these activities.
 To enlist and maintain the co-operation and participation of local administration and the
community.
 To assess new facilities and develop their role as sites for CBLE.
 To provide support for staff & students in field teaching sites.
 To assist the program co-coordinators with the evaluation of the effect of field education
activities, on the performance of their students, and through this means, to monitor the
CBLE component's contribution to the student's education
 To prepare and distribute periodic reports on CBLE activities.
The following section illustrates the platforms, educational resources and the expected function
of students in the particular levels of rotations. In the subsequent sections objectives, procedure
and expected outcome of each posting is further discussed to provide scope and guideline for
implementation.
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Scheme of Community Based Learning and Education
Figure 1: Urban Slum for 1.5 week
Strategy Platform Expected function Support and

supervision
Urban slum
 General observation of community

 Individual and group interaction
 Meeting and discussion with local leader / institutions
 Overall understanding of social system: knowledge, Support system:
practices, norms and value regarding health practices Day to day by
Educational resources:
 Familiarity with qualitative data collection local supervisor,
Around 50-100 houses and
 Overall assessment of language spoken and ethnicity and Periodic by field
Families, different age and interest group
place of origin faculty
of population (CBOs), houses, water
Field Posting: 1 supply, sanitation especially human  Observation and assessment of drinking water
excreta disposal, health services,  Provision of social services, health, housing, education,
1 education (formal / informal) etc.
 Housing
 Waste disposal: human and animal drop
 Harmony and conflict
- 155 -
Figure 2: Ward of a VDC for 2 weeks

supervision
Ward

General observation of community

Individual and group interaction

Meeting and discussion with local leader / institution

Assessment of social system: knowledge, practices,
norms and value,
 Familiarity with qualitative data collection
Support system:
Educational resources: Around 50-100  Review of materials of Female Community Health
Volunteer Day to day by
houses and Families, different age and local supervisor,
 Observation FCHV work specially child assessment and
interest group of population, Periodic by field
drug dispensing and her communication
community based organizations and  Recording and reporting system of FCHV faculty, At least
Field Posting: 2 groups, chronically sick and disabled  FCHV commodities and supply system once by Central
individual, meeting of organizations,  Observation and assessment of drinking water faculty
1 traditional healers, Female  Community development activities
Community Health Volunteer and her  Accessibility and affordability of health services
supply, water supply and waste  Land and cropping pattern (agro-economics)
disposal  Housing
 Waste disposal: human and animal drop
Scheme of Community Based Learning
Village harmonyand Education
and conflict
- 156 -
Figure 3: Health Post for 2 weeks

supervision
VDC / Health Post
 Collection and critical appraisal of secondary data

 Compare primary and secondary data and appreciate
their use and limitation
 In-depth study of village health system, organization of
service delivery mechanism
 Interaction and participation at local level groups and Support system:
meeting Day to day by
Educational resources: Several village  Assessment of social system: knowledge, practices, local supervisor,
development areas and health norms and value Periodic by field
facilities, management of function at  Collection, analysis and use of qualitative data faculty,
Field Posting: 3 village and Ilaka level health service  Review of materials used at local health facilities At least once by
management, recording reporting and  Observation and participation on day to activity of health Central faculty
1 use of local data for local planning, facility
stakeholders and their role, local  Community health development activities
community participation  Understand local planning process
 Observation and appraisal logistic system
 Observation and overall assessment of ongoing
development program and their impact on health
 Housing, Waste disposal- human and animal drop
 Institutional harmony and conflict
- 157 -
Figure 4: Four weeks duration at Village Development Committee (VDC) Area for Community Diagnosis
Strategie Platform Expected function

s Support and
supervision
Village
Educational resources: Around 1000  Tools development, pre-testing and application of data
households and 5000 population, a collection tools (questionnaire)
local health facility, promotive,  Questionnaire to have geographical location, Support system:
demographic, socio-economic, cultural and health Day to day by
preventive and curative care services
related information
through national health system, local supervisor,
 Prepare data entry tool and analysis plan
village, functioning of village health Periodic by field
Field Posting: 4  House to house visit and administer questionnaires
system, recording and reporting, faculty,
 Identify the households with GPS device
supportive supervision and  Compilation, tabulation and presentation of data at:
At least once by
333333222121
monitoring, organization and function a. Community Central faculty
of outreach activities, support and b. PAHS
supply to Female Community Health  Preparation of village health status popularly known as
Volunteers ‘Community Diagnosis’
- 158 -
Figure 5: Sub-district level (PHCC /NGO /Community Hospital) for 6 weeks duration
Strategys Platform Expected function Support and

supervision
Sub-district
 Compilation and use of secondary data

 Compare primary and secondary data and appreciate
their use and limitation
 Interaction and participation at local level groups and Support system:
meeting
Educational resources: Several village Day to day by
 Assessment of social system: knowledge, practices,
development areas and health norms and value
local supervisor,
facilities, management of function  Collection, analysis and use of qualitative data Periodic by field
above Ilaka and below district level  Review of materials use at local health facilities faculty,
health services, recording reporting,  Observation and participation on day to activity of above At least once by
Field Posting: 5
supportive supervision and Ilaka level facility activities Central faculty
1 monitoring, supply, and use of local  Understand and participate in local planning process,
data for local planning, stakeholders implementation and monitoring process
and their role, local community  Observation and appraisal of logistic system
participation  Observation and overall assessment of on going
development program and their impact on health
 Institutional harmony and conflict
- 159 -
Figure 6: District Health System rotation for 5 months

Strategy Platform Expected Function Support and
supervision
District
 Secondary data collection and use

 Appraisal of function of district public health office
 Appraisal of function district hospital
 Participation of district level management work Support system:
Educational resources: Several  Participation of district hospital clinical work Day to day by
hundred thousands population, several  Collect and use district level essential and adequate local supervisor,
peripheral level health facilities information for planning Periodic by field
including a district hospital, private  Organize district level stakeholders workshop for faculty,
Field Posting: 6
sector service provider, local strategic planning
At least once by
government, function of district public  Identify local resources (DDC, NGOs financial
1 resources)
Central faculty
health office and district hospital,
 Identify constraint: contextual and management
district logistics system including cold
 Overall health development prospect of district over next
chain system five year period (Project Planning/Strategic planning)
 Refer to Clinical Sciences Curriculum for detailed
learning objectives of clinical rotation in district
hospital.
- 160 -
The Community Based Learning and Education offers a unique opportunity for
students to understand and internalize the community and health institution in which
they are supposed to manage program and provider services in their later career. The
CBLE process yields useful data and information to help health care program planning
locally and at national level. In addition, students have close contact with people in
families and communities who, in the future, will be their patients and comprise their
target population in management of district public health services.
This course outline has been prepared to assist students and faculty in the various
departments in particular for Department of Community Health Sciences for the
implementation of CBLE program.
It should be pointed out that Lesson Plans for different level will be prepared and this
will be the responsibility of assigned faculty. Relevant and useful materials will be
incorporated as they are available and agreed upon by the DCHS. In addition to
cognitive inputs, suggestions will be collected from different academics to enable
students to develop needed skills and appropriate attitudes for successful teaching
learning work. There will a standard detailed teaching material available for faculty and
reading materials and handouts for students.
Implementation of Community Based Learning and Education
The implementation strategy of CBLE is through posting of students in the carefully

selected teaching communities, institutions and district health system. DCHS is
responsible for overall planning for CBLE program. There will be different levels of
posting with different objectives.
- 161 -
Step: One
The first rotation will be non-residential and in one of the growing slum areas in
Kathmandu valley.
Goal:
To describe current population movement in Nepal and ascertain the opportunities and
challenges faced by migrants in relation to health and other basic social services in
Nepal.
Student will be able to:
 Observe the settlement through ‘rapid walk in’ technique
 Assess in general: total population and density
 Assess housing condition
 Provision of drinking water system
 Assess and availability of health services and other social services
 Food availability
 Health service coverage / waste disposal
 Identify major determinants of health (literature review and findings)
Platform: Slum settlements in Kathmandu valley

 Students work in groups consisting of 5-10 members.
 Total duration: 1.5 weeks
Assessment:
 Students will be able to discuss growing slum settlement and challenges faced
by slum dwellers
 Report presentation at PAHS
 Report preparation and submission to the Department
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Step: Two (Ward)
The second posting will be residential and in one of the identified ward of PAHS
program Village Development Area in the rural part outside Kathmandu valley.
Goal:
To understand overall village ecology (physical and socio-cultural) and its relation to
health
Specific objectives
 Assess in general: total population and density
 Identify population composition and characteristic through group informants
 Identify major source of income, occupation of different age and sex
 Identify major type of economic system
 Identify socio-cultural practices and their relation to health
 Identify village institutions and organizations and their role and responsibilities
in the village health and development process
 Identify role and responsibilities of Female Community Health Volunteer
 Participate in FCHV work process including assessment of sick child
 Assess FCHV and outreach health service coverage
 Participate with FCHV in her counseling process to mother
 Identify and understand importance of IEC and job aid materials being used by
FCHV
 Participate in mothers’ group meeting
 Assess housing condition
 Assess drinking water system
 Assess food security situation
 To identify major determinants of health (literature review and findings)
 Identify opportunity and constraints existing in the village for health and
development process
 Identify other existing multi-sectoral development extension work (eg. JTA,
Vetenary, Community forestry initiative, Cooperative, etc.)
Platform: A ward in the rural area

1. There will be two students in a ward.
2. Total duration: 2 weeks
Assessment:
1. Report presentation at PAHS
2. Report preparation and submission to the DCHS
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Step: Three
Goal:
To assess overall health status of catchment area of a Health Post and understand
priority health programs and management plan of the facility
 Identify population composition and characteristics
 Identify characteristics of catchment area
 Identify and briefly discuss economic system
 Identify role and responsibilities of Health Post
 Participate in day to day activity of health facility
 Participate and understand management of health facility, i.e. personnel,
logistics, services
 Collect and analyze available data and information
 Demonstrate management and follow up of a sick child (Integrated
Management of Childhood Illness)
 Assess pregnant mother and participate in education process (Birth
Preparedness Package)
 Demonstrate management of adult patients with chronic shortness of breath
 Perform Family planning counseling and dispense commodity of client’s choice
 Assess infection prevention situation in the facility and develop plan of action
including follow up plan
Platform: Health Posts

1. There will be five students in a Health Post.
2. Total duration: Two weeks
Assessment:
2. Report submission to the Department
- 164 -
Step: Four
Goal:
To assess overall population health status and its determinants using household census
at family, household, ward and village level
 Construct, pre-test and finalize the household survey instrument (questionnaire)
 Design a questionnaire to assess sanitation and health related information
 Plan the household survey
 Prepare data entry tool and analysis plan
 Conduct the household survey
 Compute survey data and interpret it.
 Present the key findings in the community during the visit
 Perform data entry, validation and finalization at PAHS
Platform: A Village Development Area

1. There will be around 10 students in a village development area.
2. Total duration: 4 weeks
Supportive supervision and monitoring:
DCHS and Basic Science departments will engage in the supportive supervision and
monitoring. Statistician/demographer will be the in charge.
Assessment:
1. Detail presentation at PAHS
2. Prepare a detailed Community Diagnosis Report and submit it to the DCHS
- 165 -
Step: Five
Goal:
To assess overall health status of Sub-District (Ilakas) and develop one year priority 1
and 2 interventions management plan
 Identify characteristics of catchment area
 Identify village institutions and organizations and their role and responsibilities
in the village health and development process
 Identify role and responsibilities of PHCC
 Assist and participate in a normal delivery
 Appraise institutional harmony and conflict in the Ilaka
 Participate in day to day activity of PHCC
 Participate and understand management of PHCC i.e. personnel, logistics,
services
 Collect and analyze available data and information
 Demonstrate management and follow up of the sick child (Integrated
Management of Childhood Illness)
 Assess pregnant mother and participate in education process (Birth
Preparedness Package)
 Perform simple abscess management process
 Demonstrate management of adult patients with chronic shortness of breath
 Assist and participate in Family planning counseling and dispense commodity
of client’s choice
Platform: A Sub-District Area facility (PHCC or sub-district level hospital)

1. There will be five students in an Ilaka.
2. Total duration: Six weeks
Assessment:
1. Report presentation at PAHS and submit to DCHS
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Step: Six
Goal:
To familiarize students with the District Health System and help them acquire all the
basic skills on management and basic clinical competency which will be expected by
MOHP for a district public health and medical officer to manage district health
programs.
Specific objectives
 Identify characteristics’ different catchment area
 Identify institutions and organizations and their role and responsibilities in the
district health and development process
 Identify role and responsibilities of district health system
 Identify opportunity and constraints existed in the district
 Participate and assist in managing all health services in the district health
office i.e. district hospital, district public health office, laboratory, etc
 Participate and assist in logistics management activities
 Participate and assist in infection prevention activities
 Participate and assist in personnel management activities
 Participate and assist financial and accounting activities
 Participate and assist performance appraisal activities
 Appraise one management issue in-depth
 Conduct an epidemiological study of a selected disease
 Acquaint with medico-legal problem
 Perform Quick assessment of private sector service providers.
 Organize district level stakeholders workshop and incorporate inputs for next
Five Year Strategic Planning
Platform: A district and district hospital and district public health office
1. There will be five students in a district.
2. Total duration: six month
Assessment:
2. Report preparation on Five Year Strategic Plan based on situation assessment
and submission to the Department of Community Health Sciences
3. Epidemiological report of selected disease
4. Critical appraisal paper of a management issue
- 167 -
Internship
One year rotating compulsory rotating internship will be 6th year of the curriculum.
Scheme II from National Guidelines for Medical Internship Training 2007, NMC will
be followed.
PAHS Internship Rotation/ NMC Scheme II
Subject PAHS NMC

(Scheme II)
General Medicine
(including Psychiatry -2 weeks, Dermatology -1 11 weeks 3 months
week)
General Surgery
( including Orthopedics- 4weeks, Dentistry-1 week) 13 weeks 3 months
OB/GYN (including Anaesthesia- 2 weeks) 10 weeks 2 ½ months
Pediatrics 8 weeks 1½ months
Emergency 4 weeks 1 month
ENT/EYE 2 weeks 2 weeks
Elective/ Family Planning 2 weeks 2 weeks
Trainings 2 weeks
Total 52 weeks 12 Months
- 168 -
Student Assessment plan
The PAHS medical curriculum is divided into two main phases for the purposes of assessment–
the basic sciences and the clinical sciences
In each phase, there is internal assessment of the process of learning as well as content
evaluation. The assessment of whether PAHS attributes have been achieved will be integrated
into these.
During the basic science phases, learning process assessment is via Problem based learning
assessment. In the clinical phase, it will be via Clinical Presentation assessment.
Basic science phase

In the Basic science phase there will be a formative theory exam at the end of each block, using
MCQ and PBQ. There will be a formative practical exam, using OSPE/OSCE, combining two
or three blocks together at roughly the midpoint during both basic sciences years. The same
style of examination will be used for summative purposes at the end of each year of the
preclinical course.
Clinical phase
In the clinical phase, content evaluation will be undertaken using a similar format of formative
and summative assessments. A formative theory exam, employing MCQ and PBQ will occur at
the end of each rotation. Formative assessment of practical skills will take place during the
clinical rotations, using the Mini-CEX (mini-Clinical Examination) and DOPS (Directly
observed procedural skills) and a logbook.
There will be a formative practical exam (i. e. OSCE) at the middle of the junior clerkship
(after the end of two clinical rotations). There will be one internal summative examination,
using MCQ, PBQ and OSCE at the end of the first major clerkship.
From each of the formative exams, in each of the phases of the curriculum, 10% of the marks
will be added to the next summative examination score. There will also be self-assessment
MCQs available for students in each of the phases of the curriculum.
Summative examinations
There will be three comprehensive final summative examinations during the MBBS program:
 Comprehensive Basic Science Examination (CBSE- at the end of basic science)
 Comprehensive Clinical Science Examination I (CCSE I) - at the end of one and half
years of clinical sciences. This is the final examination for all the minor specialties
 Comprehensive Clinical Science Examination II (CCSE II) - at the end of five years of
curriculum.
The Summative examinations will continue to employ the same format of MCQ, PBQ and
OSCE examinations with structured vivas.
- 169 -
Summary table of content examination schedule
Basic science Basic Science Junior Clinical District Advanced

1st yr 2nd yr Clerkship Rotation Clinical
(1 ½ years) Clerkship
(6 months)
Formative theory Formative theory Formative theory Formative Formative
end of each block end of each end of each assessment theory end
Formative block placement of each
practical mid year Formative Formative placement
Summative exam practical mid practical during CCSE II at
end of year year placements and end of
Summative exam after 6 months 6months
end of year Summative exam (end of
Comprehensive end of 1 year course)
Basic science CCSE I end of 1
exam end of year ½ years
Process Evaluation (~PAHS Attribute Assessment):
PBL Process Evaluation:
Type Method
Formative Peer, Self and Tutor Feedback
Summative Tutor Feedback
 Students must meet expectation (pass) in the process evaluation to appear in summative
(final) exam.
CBLE Process Evaluation:
Type Method
Formative Feedback from Local facilitator, PAHS facilitator, community
presentation, presentation at PAHS (each Community Field Visits)
Summative Presentation at PAHS
 Students must meet expectation (pass) in the process evaluation to appear in summative
(final) exam.
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ANNEXES
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Annex 1: List of Common Lectures
1. Shock
2. Acute abdomen
3. Food & Nutrition
4. Fluid & electrolyte balance
5. Wound pathopthysiology & management
6. Fracture & dislocation
7. Skin manifestation of systemic diseases
8. blood count abnormalities
9. Sepsis
10. Autoimmune disorder & collagen vascular disorders
11. Infection in immunocompromised host
12. Allergy & anaphylaxixs
13. Mentally & physically challenged people
14. Breast feeding counseling
15. Genetic counseling
16. Adolescent health
17. Behavioral problem in children
18. Congenital anomalies
19. Immunization
20. Diabetes Mellitus
21. Menstrual cycle
22. Post traumatic stress disorder
23. Psychosexual disorder
24. Sleep hygiene
25. Alcohol
26. Poisoning – general management
27. Disaster management
28. Polytrauma
29. Sexual assault
30. Ethics
31. Medico legal problems
32. Principles of CPR, brain death
33. Palliative & terminal care
34. Tuberculosis
35. HIV
36. Parasitic infestation
37. Geriatric patient care
38. Acute encephalitic syndrome
39. Principles of GP & it,’s role in Nepal
40. Principles of holistic patient centered care
41. Principles of chronic care
42. Patients with multiple somatic complaints
43. Evidence based practice
44. Rational prescribing
45. Breaking bad news
46. Tumors & neoplasm
47. Research methodology
48. Ocular manifestations of systemic diseases
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Annex 2: Clinical Presentation by Organ System
 Cardiovascular / Respiratory
o Chest pain
o Shortness of breath
o Palpitation
o Oedema
o Shock
o Cough
o Haemoptysis
o Hypertension
o Cyanosis
o Arterial blood gas abnormalities
o Syncope
o Wheezing and respiratory difficulty
 Hematological
o Pallor
o Fatigue (GP)
o Abnormal bleeding
o Abnormal clotting
o Lymphadenopathy
 Gastrointestinal / Nutritional
o Mouth sores/ oral ulcers
o Abdominal pain
o Abdominal swelling / distension / mass
o Nausea / Vomiting
o Diarrhea
o Constipation
o Jaundice
o Haematemesis
o Blood in stool / Melena
o Dyspepsia / Indigestion
o Dysphagia
o Loss of appetite
o Weight loss / Malnutrition
 Genitourinary / Fluid electrolyte

o Dysuria
o Oliguria / Anuria
o Polyuria
o Haematuria
o Urinary retention
o Scrotal pain / swelling
o Proteinuria / Chyluria
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Annex 3: Distribution of clinical presentations in different clinical
postings
Junior Senior Total No.

Department
Clerkship Clerkship of CPs
Medicine 15 6 21
Paediatrics 15 5 20
Surgery 15 3 18
Gyne Obs 8 4 12
Psychiatry 6 - 6
General Practice 4 - 4
Emergency 3 1 9
Orthopedics 7 2 4
Dermatology 4 - 4
Forensic 4 - 4
ENT 4 - 4
Opthalmology 4 - 4
Dentistry 2 - 2
Anesthesia 2 - 2
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Annex 4: Sample Clinical Presentation: Musculoskeletal pain
Musculoskeletal trauma is a process whereby energy imparted to the extremities (upper

and lower, arms and legs) and spine causes damage or injury to the affected tissues.
Every injury has a specific personality defined by the energy which has caused it and
by the victim or host (age, health etc.) and his/her reaction(s) (tissue damage). In other
words, in the management of a person who sustained trauma, always consider these 3
separate components:
1. Energy
2. Host
3. Tissue damage
Kinetic energy = ½ mass x velocity². Bigger objects moving with higher speed (car,
bullet, are high energy) will cause more damage than smaller and slower objects (lower
energy) that have an impact with live tissue. Damaged tissues could be skin,
subcutaneous tissue, fascia, muscles and muscle tendons, ligaments, joints, bones,
blood vessels, lymphatic vessels and nerves. In this clinical presentation, the diagnosis
of “fractures / dislocations / joint injuries” will be the main concern. The complications
of fracture and dislocations shall also be discussed, with special attention to
compartment syndrome. Injuries to the head, spine, and the spinal nerves and
polytrauma will be considered in the clinical presentation “head and spinal injury”.
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Figure: High energy injuries
A. Clinical clues
 Ask about:
o Mechanism of injury (driver or passenger, with/without seatbelt on;
motorcycle rider w/wo helmet; hit as pedestrian, fall from higher
than standing height etc.)
o Timing of injury. Six hours is in general turning moment up to
when:
 open wounds have to be surgically treated (cleaned, debrided
- excised and closed or covered) in order to prevent
infections
 vascular injuries have to be repaired / reconstructed in order
to avoid amputations
 tight compartments with increased pressures have to be
released in order to avoid irreversible damages, tissues
necrosis and amputations
 dislocated joints have to be reduced (in order to preserve
cartilage and avoid avascular necrosis – bone death; diminish
pressure on neurovascular bundle)
o Ability to ambulate, pre-injury functional level (w/wo assistive
devices like walker, cane; house or community ambulatory)
 Look for:
o Deformities (swelling, “funny” – unusual extremity positions
o Presence of skin breakage – wound and bleeding (arterial – pulsatile
bright red blood, or venous: dark – bluish, oozing blood) and
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whether are in vicinity of joint or broken bone (open joint or bone
injury - high risk of infection, which is an orthopedic emergency)
 Visible bone fragments, ruptured tendons and muscles, foreign
material – grass, pieces of clothing, car paint, glass, sand
particles, dirt and alike in the wound
o Spontaneous motion (or absence) of digits and toes, extremities
distal to the injury level (nerve damage, muscles damage)
B. Investigations
 History:
o Cooperative patient:
 chief complaint, symptoms
 pertinent medical and surgical history, allergies
o Non-cooperative patient (child, intubated, comatose, intoxicated) –
get report from paramedics, bystanders, family
o Physical exam
 Vital signs
 Presence of arterial pulse and capillary refill distal to the injury;
color and temperature of the skin (diminished or absent in main
vessel arterial injuries)
 Ability to move and feel extremity distal to the injury level
(spontaneously if comatose; on request if cooperative)
 Tightness on palpation of compartments at/or distal to the level
of injury; presence of pain out of proportion (if cooperative) and
increased by passive stretch of muscles going through
compartment in question (plantar flexion of toes for antero-
lateral leg compartment)
o Align and immobilize extremity and obtain
 X-ray in two plains of injured area and neighboring joints
(orthogonal, 90°-90°)
 CT – for complex joint injuries and most spine injuries
 MRI – for better evaluation of soft tissue injuries, spine and
occult fractures
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 Bone scans – when looking for isolated (scaphoid, femoral neck
fracture; they are strongly positive after three days) or more often
when looking for multiple occult fractures (spine, sacrum… in
multiple injured and non-cooperative patients; pathological
fractures – looking for other lesions) or infection.
C. Comments
 Patients with high energy trauma could have multiple injuries (brain, chest,
intra-abdominal, extremities), and such severely injured patients are at risk for
permanent disability or even death (polytrauma). In order to get optimal care
and maximize the possibility of improvement and recovery, they require an
organized, trained team approach utilizing established and validated trauma
protocols. This type of approach will be considered in the clinical presentation
or lecture “trauma”. In the current clinical presentation, only isolated
musculoskeletal injuries will be considered.
 Isolated injuries still could be severe and grave, but they require less
involvement of other specialists besides orthopedic surgeon (as plastic surgeon,
vascular surgeon) in delivering care for their damages.
 It is important to evaluate whether the patient is able to cooperate (level of
consciousness) and move and feel her/his extremities. Moreover, the patient
need to be completely exposed (all clothing is removed) and all parts of the
body is visually inspected and palpated to ensure the absence of any other injury
and confirm that the injury identified is indeed isolated. If possible, obtaining
and storing digital photos on presentation and during the course of treatment,
might be extremely helpful:
o medically (for other members of the team to be able to evaluate
covered wounds and non-aligned, original presentation of the
injuries) and
o legally (family, patient, jury and lawyers will appreciate more the
severity of injuries and eventual less than perfect outcome if they
had chance to see the original damages).
 Secondary and tertiary surveys (each part of the body is examined, visually and
palpated) have to be repeated later (hours and days; when situation is less urgent
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and/or patient is able to be more cooperative), preferably by different members
of the team, in order to avoid the risks of missing other injuries. One severe
injury could be distracting and masking other, less severe injuries. It is
important to notify relatives that up to 20% of injuries (mostly minor, like foot,
spine, ribs etc) might be missed in non-cooperative (intubated, comatose,
intoxicated, brain injured and so on) patients, and that family members’
cooperation could help us in finding out what is bothering the patient
(occasionally they spend more time with their loved ones). From a medico-legal
point of view, it is important to record the patient’s neurological status (if
attainable) prior to any diagnostic or therapeutic interventions.
 The age of the injured patient is very important. It is expected that most children
who are victims of injury are healthy. Their body is “elastic”, light, and mobile.
If even light skeletal injury is sustained, it is indicative of high impact injury. If
the cause of injury is low energy mechanism, be aware that child could have
bone abnormalities, fragile bones like in osteogenesis imperfecta or some
underlying bone tumor. Children do have good healing potential and excellent
chance for fast and full recovery. It is very important to involve
parents/caregivers in their care from the beginning. When dealing with minors,
consent, for medico-legal reasons, must be obtained from parents. Finally, their
musculoskeletal condition could be changing until growth ceases, meaning that
there is need for long term follow-up.
 In the adult population, the use of nicotine could hinder recovery (slow
wound/bone healing, increased risk of pulmonary problems). In addition, drugs
and alcohol will significantly influence pain treatment (need for more narcotics)
and cooperation as well as general medical condition (liver and nerve problems
in alcoholics, immune status and possibility of HIV and hepatitis in drug
abusers).
 Elderly patients have multiple medical problems, less healing potential and
lower activity capacities and needs than younger patients. They tend to sustain
severe, potentially life threatening injuries after low energy trauma (e.g., hip
after fall from standing height) or even without trauma (e.g., osteoporosis of the
spine or bones invaded by tumors). Their medical/ surgical care is complex.
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 The occupation of the patient might also affect treatment (violin player will
need a different approach to the treatment of a small finger injury than security
guard). Patients who are hurt at work may require special attention and
documentation since Workmen’s Compensation Fund may be involved.
 Women in childbearing age require pregnancy testing. The fetus could sustain
injury as a result of the trauma or diagnostic and therapeutic interventions
(anesthesia, irradiation, medications etc).
 The mode of injury is very important, not only for determining the high or low
energy trauma, but also for proper documentation. The patients who have
sustained Motor Vehicle Accident, or who have sustained injury as a result of
fall from height might need proper documentation as regards to the mode of
injury for medicolegal purposes.
D. Diagnoses to consider
 High energy
o Polytrauma. Patients have injuries of two or more organ systems
(like cranio-cerebral, cardio-vascular, respiratory, gastrointestinal,
urogenital, musculoskeletal) and are in serious medical condition
(like hemorrhagic shock, respiratory insufficiency, renal
insufficiency…) with potentially endangered life.
o Multiple trauma – usually there are two or more severe injuries
within one organ system (e.g. musculoskeletal: broken femur and
tibia, humerus and so on).
o Isolated severe injuries, fractures and fracture-dislocations (closed or
open femoral or tibial fractures, dislocated hip or knee joint, ankle or
wrist fracture dislocation, amputation etc).
o Morbidly obese patients with dislocated knee after fall from height
(their weight - mass makes it high energy with potentially severe
consequences like neurovascular injuries, amputations).
o Major wounds or burns (depth and area).
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Figure: Low energy injuries
A. Clinical clues
 Ask about
o Mechanism of injury (standing height fall, minimal activity vs.
repetitive stress activities – marching or running, overuse injuries)
o Timing of injury (very important in dislocations and extremities with
neuro-vascular compromise)
o Functional capabilities before injury (walking)
 Look for
o Deformities (swelling, “funny” – unusual extremity positions)
o Presence of skin breakage – wound and bleeding
o Extent of disability
 Mental status: patient could be fully cooperative or obtunded
to comatose (no contact or response possible).
 If non-cooperative (intoxicated, agitated, somnolent,
comatose), identify others who could provide information
about the injury.
 If patient is able to cooperate, determine movement and
sensation in the upper and lower extremities (neurological
exam to determine whether spinal cord and main peripheral
nerves are intact). Also, look for spontaneous motion (or
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absence) of digits and toes, extremities distal to the injury
level (nerve damage, muscles damage) in non-cooperative
patients.
o Visually inspect and palpate all parts of the body from head to toe in
order to establish the extent of injuries.
 Examine chest for respiratory motion
 Eyes, size of pupils and reaction
 Contusion marks, bruises, wounds, swelling, gross
deformities, instability of extremities and pelvis, skin color
and temperature, blood in orifices (mouth, urethra, rectum).
B. Investigations
 Vital signs
 Clinical exam
 X-rays, CT, MRI, Bone Scans
 Labs
C. Diagnoses to consider
 Low energy
o Bruises, sprains (stretched or ruptured ligaments of different joints)
or strains (stretched or ruptured tendons or muscles).
o Minor wounds or burns.
o Broken pathologically changed bones (in elderly population: distal
radius, hip, proximal humerus, spine).
o Nondisplaced or minimally displaced fractures (adults with normal
bone structure and pediatric fractures like: distal radius, radial head,
forearm, elbow etc).
o Stress fractures (foot fractures in soldiers, dancers, players; femoral
neck fractures in runners).
o Overuse injuries (elbow pain in tennis or golf players; shoulder pain
in pitchers and gymnasts).
A. Clinical clues
 Ask about
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o Pain
o Diminished or limited function, suggestive of fracture and/or
dislocation.
 Look for
o Swelling
o Contusions
o Deformity
o Discoloration
o Superficial skin damage
o Wounds in communication with bone fragments (draining
hematoma, open fractures)
o Crepitations by trial of active or passive motion at fracture level
(audible or palpable rubbing of bone pieces against each other,
always painful).
B. Investigations
 Definitive sign of fracture is provided by diagnostic imaging
o Radiography (x-ray)
o Computer tomography (CT)
o Magnetic resonance imaging (MRI)
o Radionuclide (bone) scans.
 After studying diagnostic imaging results, determine whether there is a non-
displaced or minimally displaced fracture present. Even without some or all
symptoms and signs discussed above.
 Fractures can be outside of the joint (shaft and metaphyseal area), inside of the
joint (epiphyseal fractures) or a combination thereof.
C. Comments
 About 75% of patients who sustain trauma have injured extremities.
 The bones give mechanical strength and support to the extremities. The bones
are connected via joints (bone ends encapsulated in joint capsule and ligaments)
that allow controlled motion. Muscles are attached to the bones via tendons and
some cross joints in different directions allowing for motion through contraction
- 183 -
or shortening of the muscle bellies. Muscle contractions are controlled by
nerves as is sensation of all parts of the extremities. All tissues are nourished by
vessels (arterial, venous and lymphatic), and all of them work in harmony in
order to have a normal, functional extremity. Trauma could damage all these
tissues and it is necessary to evaluate each one separately.
 Contusion or sprain
 Fracture
 Dislocation
Figure: Fractures
Fractures are breaks in the continuity of bone caused by trauma which exceeds bone
resistance to mechanical load. If a patient presents soon after injury, then any bone
break sustained is an acute fracture; if the bone break is presented to the physician late
(weeks and months), than it is termed a chronic or old fracture.
A. Clinical clues
 Ask about:
o Mechanism of injury
o Timing
o Function (motion and sensitivity)
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 Look for
o Damaged soft tissue protective envelop (complete skin breakage,
open wounds). Such breaks provide openings for contamination of
fracture or hematoma which could result in acute or chronic
infection. Such complications can significantly affect bone healing
and final outcomes.
o Distal pulses for presence and quality in every injured extremity
(absence of pulse in patient who is not in shock will need further
evaluation by ultrasound, angiography, or exploration) in order to
prevent ischemia and eventual loss of extremity.
o Tightness of osteo-fascial extremity compartments; evaluate in order
to rule out increased intra-compartmental pressure which could
destroy all tissues within compartments (nerves, muscles and
vessels).
o Damaged nerves (ability to move and feel) have to be evaluated in
order to avoid further harm (to remove the cause – pressure caused
by fragment(s), displacement, or increased soft tissue intra-
compartmental pressure).
B. Investigations
 X-rays, two orthogonal (90°-90°) planes, consider special views for hand foot,
shoulder, calcaneum
 Intra-compartmental pressure monitoring
 CT (intra-articular fractures)
 MRI (occult fractures, soft tissues)
 Bone scan
C. Comments
 Acute fractures are result of relatively recent injury. Pain, swelling, deformity,
limited function is present as well as instability (motion) at level of injury (for
unstable, displaced fractures).
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 If fracture presents late (weeks or even months), all symptoms will be
diminished and there is possibility that motion is abolished (fracture in healing
or healed). In cases where reduction is needed (better alignment, rotation and
length), it would be impossible to mobilize fragments without surgery.
 Late presentation might be in form of united cresidual pain and limited range of
motion or non-united fracture (no bone bridging formed, gaps visible on x-rays
nonunion).
 Contusions, sprains or strains
 Dislocations
 Fractures (acute or chronic)
o Upper limb fracture
o Lower limb fracture
o Pelvic fracture
o Spinal fracture
A. Clinical clues
 Ask about
o Time of injury
o Treatments before (reduction attempts, immobilization, surgery)
o History of osteopenia (osteoporosis)
o History of hormonal problems (parathyroid, suprarenal)
o History of cancer (metastases)
 Look for
o Deformity, scars, signs of drainage (infection)
o Function (inability to bear weight, pain at fracture level)
o Signs of muscles atrophy, joint contractures (stiffness)
B. Investigations
 Clinical exam
o pain at fracture level - spontaneous, on touch and/or at weight
bearing
o Instability at chronic fracture level (on stress)
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 Diagnostic
o X-ray, multiple views, non-weight bearing and weight bearing
(difference – instability)
o CT – bone bridging (healing), yes or no
o Bone scans
o Labs (exclusion of infection, hormonal status of the patient)
- 187 -
C. Comments
 All fractures will heal in favorable circumstances (adequate stability, preserved
blood supply and innervations, absence of bone destroying infection, normal
hormonal and nutritional status) in certain, expected time. Usual timing to bone
healing is historically known and dependant on the age of the patient,
localization and fracture type:
o Younger patient will have faster healing (weeks) than older (months
needed).
o Epiphyseal and metaphyseal fracture (joint and close to the joint)
with a lot of cancellous, well vascularized bone will heal faster than
diaphyseal, mostly cortical bone with less abundant blood supply.
o Simple, long spiral fracture (with two main fragments and broad
fracture - contact surfaces) will heal faster than transverse fracture
(small contact area) or complex, multifragmentary fracture.
 Non-union is defined as
o absence of healing in expected time for respectful localization, type
of fracture and age of the patient,
o lack of three bridging cortices on two orthogonal x-rays views,
o pain at non-union (chronic fracture) site on weight bearing there is
no progress of healing (radiological and clinical) in the last three
months of follow up.
 Mal-union (healed in non-anatomical position)

 Delayed union (slower than expected progress of healing)
 Nonunion (radiological and clinical diagnosis)
 Pathological condition, bone structure at fracture level is changed by:
o Infection
 Abrupt (clinical and laboratory signs present)
 Occult (clinical signs absent, laboratory positive: CRP, ESR,
WBC, Bone Scans, MRI, CT etc.).
o Bone tumor
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Figure: Dislocations
A. Clinical clues
 Ask about
o Timing of injury, pain and swelling
o Ability to bear weight after injury
o About similar problems in the past
 Look for
o Appearance of joint
o Presence of wounds, draining hematoma or synovial - joint fluid
o Ability to move and feel extremity at level of injury and distal to it
o Color and temperature of the skin distal to the injury
B. Investigations
 Clinical exam
o Ability to actively move the joint
o Pulse, sensation and active motion distal to the joint
o Presence of fluid into the joint
o X-rays, two orthogonal (90° - 90°) views
o CT
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 in uncertain diagnosis just with x-rays
 when intra-articular fractures present
o Aspiration of joint fluid and instillation of local anesthetic
o Joint stability testing (if pain control obtained)
C. Comments
 Joint injury can present acutely soon after trauma (immediately, hours or
days), as an old injury (after weeks), or as result of chronic repetitive
injuries (months or years).
 Bone ends of two neighboring bones are covered by cartilage, held together
by their symmetrical shape, secured by capsule, ligaments, and muscle
tonus, and innervated by local nerves. If trauma exceeds joint resistance, it
could result in:
o Sprain (stretching or tearing of ligaments and capsule), with some
pain, swelling and difficulties to bear weight. On stress x-rays
(weight bearing or under specific load), joint surfaces are still
aligned well, parallel. On clinical exam joint appears to be stable
although testing the stability could be painful in acute setting (pain
control necessary).
o Subluxation – on x-ray exam (weight bearing or stress view) joint
surfaces are apart (still in some contact, but not parallel any more).
On clinical stress exam joint is “opening” more than opposite,
uninjured joint. Underlying problem is partial or full tear of some or
all supporting structures (ligaments and capsule) or their chronic
elongation (old or repetitive injuries and healing).
o Dislocation - when there is complete separation of adjacent joint
surfaces as result of major disruptions, avulsions and tears of
supporting structures. There could be additional neuro-circulatory
damage as well.
o Fracture dislocation, besides joint asymmetry has additional intra-
articular bony fragments.
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 For joints to function properly (stable, without pain and with full range of
motion, long lasting), it is necessary to reestablish stability, alignment ,
congruity and motion:
o Non-operatively (by immobilization using static or dynamic splints,
muscles strengthening, anti-inflammatory and pain medications) or
o Surgically (repair and reconstructions).
o In cases of fracture-dislocation, all bone pieces have to be put
together and articular surfaces have to be restored back to anatomical
shape as much as possible (to allow early smooth range of motion
and avoid cartilage damage). Also, the rest of the fractured extremity
needs to have good alignment in order to distribute weight evenly on
the articular surface and prevent posttraumatic arthritis.
 Sprains
 Subluxation
 Dislocation
 Fracture/Dislocation
Figure: Low energy injury
- 191 -
If minimal trauma such as falling at the same level or activity of daily living (like
lifting or pushing) causes bone discontinuity, consider both the level of energy as well
as whether pathological changes may be producing excessively fragile bones
(osteopenia, bone tumors).
A. Clinical clues
 Ask about
o Pain, variable in quality, sharp or dull, in the absence of preceding
trauma or exercise.
o Acute pain, if any, resolving after 4 – 6 weeks.
o Diminished or limited function, suggestive of fracture.
o On occasion, history of minor trauma such as going over speed
bumps.
 Look for
o Kyphosis
B. Investigations
 X-rays
 CT
 MRI
 Bone scans
C. Comments
 Insufficiency fracture occurs when the mechanical strength of a bone is

reduced to the point that a stress, which would not fracture a healthy bone,
breaks the weak one. The condition that causes reduced bone strength
typically does so throughout the skeleton (e.g., osteoporosis, osteomalacia,
osteogenesis imperfecta etc.) but may be more localized (e.g.,
demineralization in a limb due to disuse, residue of poliomyelitis).
 Pathologic fracture is due to a localized loss of strength in a bone from a
disease process immediately underlying the bone. Examples of pathologic
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fractures include those that occur at sites of bone tumors (primary or
metastatic), bone cysts, and infections.
 Insufficiency fractures
 Pathological fractures
A. Clinical clues
 Ask about
o History of malignancy
o Age
o Recent weight loss
o Medications
 Look for
o Patient nutritional status (undernourished?)
B. Investigations
 X-rays (orthogonal)
 Chest x-rays (metastases?)
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 Bone scan (metastases)
 CT (cortical involvement)
 MRI (soft tissue involvement, skipped intramedullary lesions)
 Labs (ESR, CRP, metabolic panel)
C. Comments
 There should be high suspicion of pathological fracture if trauma is
minimal, pain is mild, fracture edges on x-rays are not sharp and
surrounding bone does not appear normal (like the rest of neighboring bone
tissue).
 Age is significant factor in making diagnosis (in elderly population we are
expecting more malignant tumors and mostly metastases) and in younger
population benign tumors (like benign bone cysts) or occasionally
malignancy (Ewing, osteosarcoma)
 Staging of the disease (local versus generalized disease – metastases) and
early involvement of oncologists, internal medicine or pediatric and
orthopaedic, is crucial in taking care of these rare but severe pathology.
Surgeries are much more difficult, specific and eventually life saving.
 Tumors
o Benign
o Malignant
 Primary
 Secondary
 Osteomyelitis
Stress fractures are due to loads that stress (either compress or stretch) a bone, but
which would not individually be expected to cause it to break. Stress fractures may be
the result of a small number of repetitions with a relatively large load (e.g., a military
recruit marching for several miles with a heavy backpack), a large number of
repetitions with a usual load (e.g., an athlete training for a long distance race), or some
intermediate combination of increased load and number of repetitions. If a fracture is
- 194 -
caused by repetitive minor stress, like femoral neck fractures in runners or metatarsal
fracture in marching solders, then the injury is termed a stress fracture. Underlying
cause might be unrecognized bone metabolism deficiency (nutritional, hormonal etc.).
A. Clinical clues
 Ask about
o Insidious onset of localized pain that is initially activity related and
increases in severity with increased activity. Eventually the pain is
present during less strenuous activity and ultimately during rest.
Occasionally, the patient experiences an abrupt increase in pain at
the site of milder chronic symptoms indicating that a repeatedly
stressed area of bone has finally fractured.
o Any repeated tensile or compressive stresses in a person who is not
known to have an underlying disease that would be expected to
cause abnormal bone fragility.
o Occupation or type/frequency/extent of exercise
o Any abrupt increase in the duration, intensity, or frequency of
physical activity without adequate periods of rest.
o Risk factors
 White race
 Alcohol, cola, and/or tobacco use
 Less weight-bearing exercise prior to exercise
 Lower adult weight (lowest adult weight)
 Glucocorticoid use
 Use of depo-medroxyprogesterone acetate (DMPA) for
contraception (DMPA increased the risk for stress fracture in
white women)
o Dietary history (vitamin D deficiency)
o Past history: general health, past medical history, current
medications, occupation, and previous injuries.
o Sites of possible fracture in order to assess risk of complications.
 Second through fourth metatarsal shafts, posteromedial tibial
shaft, proximal humerus or humeral shaft, ribs, sacrum, and
pubic rami are considered low risk.
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 Stress fractures of the superior side of the femoral neck (i.e.,
tension side), patella, anterior cortex of the tibia (i.e., tension
side), medial malleolus, talus, tarsal navicular, proximal fifth
metatarsal, great toe sesamoids, and the base of the second
metatarsal bone are considered to be at high risk for
complications.
 Look for
o Muscle strains, joint sprains, nerve entrapment syndromes and
compartment syndrome that share some features with stress
fractures.
o Among runners, the shin splint syndrome is most common.
o The most worrisome competing diagnoses are neoplasm and
infection. (see clinical presentations “localized pain” and “lumps,
MSK”
B. Investigations
 Radiography (x-ray)
 Computer tomography (CT)
 Magnetic resonance imaging (MRI).
 Bone scan
C. Comments
 Fracture refers to the breaking of a bone. Complete fractures divide the
affected bone into two or more pieces, while partial (incomplete) fractures
do not extend contiguously through the cortex. An example of an
incomplete fracture is the "greenstick" fracture, in which the convex side of
a long bone is disrupted, while the concave surface remains intact; or
femoral neck stress fracture – just one side has broken cortex.
 Stress fracture occurs when a bone breaks after being subjected to repeated
tensile or compressive stresses, none of which, individually, would be large
enough to cause the bone to fail, in a person who is not known to have an
underlying disease that would be expected to cause abnormal bone fragility.
- 196 -
 Stress fracture
 Insufficiency fracture
 Pathological fracture
- 197 -
Annex 5: Level of ability expected at the end of basic medical
education
Competency Level for
1. General Medicine:
Cardiac disorders Level of Competency

Angina pectoris 1 2 3A 3B 4
Unstable angina 1 2 3A 3B 4
Myocardial Infarction 1 2 3A 3B 4
Cardiac aneurysm 1 2 3A 3B 4
Heart failure 1 2 3A 3B 4
Cardiorespiratory arrest 1 2 3A 3B 4
Mitral stenosis 1 2 3A 3B 4
Mitral regurgitation 1 2 3A 3B 4
Aortic stenosis 1 2 3A 3B 4
Aortic regurgitation 1 2 3A 3B 4
Other valvular heart diseases 1 2 3A 3B 4
Ventricular septal defect 1 2 3A 3B 4
Atrial septal defect 1 2 3A 3B 4
Sinus tachycardia 1 2 3A 3B 4
Supraventricular tachycardia 1 2 3A 3B 4
Atrial fibrillation 1 2 3A 3B 4
Atrial flutter 1 2 3A 3B 4
Bundle branch block 1 2 3A 3B 4
Other arrhythmias 1 2 3A 3B 4
Endocarditis 1 2 3A 3B 4
Pericarditis 1 2 3A 3B 4
Myocarditis 1 2 3A 3B 4
Cardiomyopathy 1 2 3A 3B 4
Aorta and arterial disorders
Essential hypertension 1 2 3A 3B 4
Secondary hypertension 1 2 3A 3B 4
Pulmonary hypertension 1 2 3A 3B 4
Raynaud's disease 1 2 3A 3B 4
Coarctation of the aorta 1 2 3A 3B 4
Buerger's disease 1 2 3A 3B 4
Arterial embolism 1 2 3A 3B 4
Atherosclerosis 1 2 3A 3B 4
Aortic aneurysm 1 2 3A 3B 4
Dissecting aneurysm 1 2 3A 3B 4
Cardiogenic shock 1 2 3A 3B 4
Septic shock 1 2 3A 3B 4
Hypovolaemic shock 1 2 3A 3B 4
- 198 -
Veins
Deep vein thrombosis 1 2 3A 3B 4
Thrombophlebitis 1 2 3A 3B 4
Lymph vessels
Lymphangitis 1 2 3A 3B 4
Lymphadenitis 1 2 3A 3B 4
Lymphoedema, primary and secondary 1 2 3A 3B 4
Respiratory
Uncomplicated pulmonary tuberculosis 1 2 3A 3B 4
Tuberculosis with HIV 1 2 3A 3B 4
Acute bronchitis 1 2 3A 3B 4
Bronchial asthma 1 2 3A 3B 4
Status asthmaticus 1 2 3A 3B 4
Lung emphysema 1 2 3A 3B 4
Atelectasis 1 2 3A 3B 4
Bronchiectasis 1 2 3A 3B 4
Chronic obstructive pulmonary disease (COPD) 1 2 3A 3B 4
Severe acute respiratory syndrome (SARS) 1 2 3A 3B 4
Pneumonia 1 2 3A 3B 4
Avian influenza 1 2 3A 3B 4
Lung abscess 1 2 3A 3B 4
Pulmonary embolism 1 2 3A 3B 4
Lung infarction 1 2 3A 3B 4
Pleurisy (tuberculous) 1 2 3A 3B 4
Pleurisy (malignant) 1 2 3A 3B 4
Pleurisy (lupus) 1 2 3A 3B 4
Pneumothorax 1 2 3A 3B 4
Cystic fibrosis 1 2 3A 3B 4
Aspiration pneumonia 1 2 3A 3B 4
Gastrointestinal
Mouth
Leukoplakia 1 2 3A 3B 4
Candidiasis 1 2 3A 3B 4
Mouth ulcers (aphthous, herpes) 1 2 3A 3B 4
Glossitis 1 2 3A 3B 4
Oesophagus
Corrosive lesions of oesophagus 1 2 3A 3B 4
- 199 -
Oesophageal varices 1 2 3A 3B 4
Oesophageal rupture 1 2 3A 3B 4
Gastro-oesophageal reflux 1 2 3A 3B 4
Stomach and duodenum
Gastritis 1 2 3A 3B 4
Gastric/duodenal ulcer 1 2 3A 3B 4
Gastrointestinal bleeding 1 2 3A 3B 4
Zollinger-Ellison syndrome 1 2 3A 3B 4
Mallory-Weiss syndrome 1 2 3A 3B 4
Gastroenteritis 1 2 3A 3B 4
Liver
Fatty liver 1 2 3A 3B 4
Hepatitis A 1 2 3A 3B 4
Uncomplicated hepatitis B 1 2 3A 3B 4
Active hepatitis C 1 2 3A 3B 4
Hepatic cirrhosis 1 2 3A 3B 4
Amoebic liver abscess 1 2 3A 3B 4
Liver failure 1 2 3A 3B 4
Pancreas
Pancreatitis (acute and chronic) 1 2 3A 3B 4
Jejunum, ileum
Enteritis 1 2 3A 3B 4
Colon
Irritable bowel syndrome 1 2 3A 3B 4
Necrotizing enterocolitis 1 2 3A 3B 4
Diverticulosis/diverticulitis 1 2 3A 3B 4
Colitis 1 2 3A 3B 4
Crohn's disease 1 2 3A 3B 4
Ulcerative colitis 1 2 3A 3B 4
Nephrourology
Acute renal failure 1 2 3A 3B 4
Chronic renal failure 1 2 3A 3B 4
Nephrotic syndrome 1 2 3A 3B 4
Acute glomerulonephritis 1 2 3A 3B 4
Chronic glomerulonephritis 1 2 3A 3B 4
Interstitial nephritis 1 2 3A 3B 4
Polycystic kidneys (ADPKD) 1 2 3A 3B 4
- 200 -
Urinary tract infection 1 2 3A 3B 4
Acute tubular necrosis 1 2 3A 3B 4
Uncomplicated pyelonephritis 1 2 3A 3B 4
Urinary incontinence 1 2 3A 3B 4
Male genitalia
Infertility 1 2 3A 3B 4
Erection disorders 1 2 3A 3B 4
Ejaculation disorders 1 2 3A 3B 4
Haematology
Aplastic/hypoplastic anaemia 1 2 3A 3B 4
Iron deficiency anaemia 1 2 3A 3B 4
Macrocytic anaemia 1 2 3A 3B 4
Haemolytic anaemia 1 2 3A 3B 4
Haemoglobinopathy 1 2 3A 3B 4
Anaemia associated with chronic diseases 1 2 3A 3B 4
Polycythaemia 1 2 3A 3B 4
Thrombocytopenia 1 2 3A 3B 4
Thrombocytosis 1 2 3A 3B 4
Haemophilia 1 2 3A 3B 4
Von Willebrand's disease 1 2 3A 3B 4
Disseminated intravascular coagulation (DIC) 1 2 3A 3B 4
Agranulocytosis 1 2 3A 3B 4
Haemorrhagic disorders 1 2 3A 3B 4
Antiphospholipid syndrome 1 2 3A 3B 4
Immunology
Autoimmune rheumatological and
autoimmune disorders
Uncomplicated systemic lupus erythematosus
(SLE) 1 2 3A 3B 4
Complicated systemic lupus erythematosus
(SLE) 1 2 3A 3B 4
Scleroderma 1 2 3A 3B 4
Polyarteritis nodosa 1 2 3A 3B 4
Lupus vasculitis 1 2 3A 3B 4
Polymyalgia rheumatica 1 2 3A 3B 4
Rheumatoid arthritis 1 2 3A 3B 4
Immunological/allergic reactions
Anaphylactic reaction 1 2 3A 3B 4
Rheumatic fever 1 2 3A 3B 4
- 201 -
Henoch-Schönlein purpura 1 2 3A 3B 4
Erythema multiforme 1 2 3A 3B 4
Stevens-Johnson syndrome 1 2 3A 3B 4
Transplantation immunology 1 2 3A 3B 4
Immunodeficiency – HIV 1 2 3A 3B 4
Genetics/newborn/chromosomal disorder
Genetics/congenital disorders
Down syndrome 1 2 3A 3B 4
Turner's syndrome 1 2 3A 3B 4
Klinefelter's syndrome 1 2 3A 3B 4
Marfan's syndrome 1 2 3A 3B 4
Endocrine, metabolic disorders and nutrition

Endocrinological disorders
Insulin-dependent diabetes mellitus (IDDM) 1 2 3A 3B 4
Non insulin-dependent diabetes mellitus
(NIDDM) 1 2 3A 3B 4
Complication of diabetes mellitus (acute and
chronic) 1 2 3A 3B 4
Hypoglycaemia 1 2 3A 3B 4
Diabetes insipidus 1 2 3A 3B 4
Acromegaly, gigantism 1 2 3A 3B 4
Growth hormone deficiency 2 3A 3B 4
Hyperparathyroidism 1 2 3A 3B 4
Hypoparathyroidism 1 2 3A 3B 4
Hyperthyroidism
1 2 3A 3B 4
Hypothyroidism 1 2 3A 3B 4
Thyroiditis 1 2 3A 3B 4
Cushing's disease 1 2 3A 3B 4
Adrenal cortex failure 1 2 3A 3B 4
Primary hyperaldosteronism 1 2 3A 3B 4
Phaeochromocytoma 1 2 3A 3B 4
Precocious puberty 1 2 3A 3B 4
Testicular feminization syndrome 1 2 3A 3B 4
Hypogonadism 1 2 3A 3B 4
Adrenogenital syndrome 1 2 3A 3B 4
- 202 -
Addison's disease 1 2 3A 3B 4
Multiple endocrinological neoplasia (MEN
syndrome) 1 2 3A 3B 4
Tumour with ectopic production of hormone 1 2 3A 3B 4
Errors of metabolism
Hyperlipoproteinaemia 1 2 3A 3B 4
Porphyria 1 2 3A 3B 4
Gout 1 2 3A 3B 4
Obesity 1 2 3A 3B 4
Central and peripheral nervous system

Loss of consciousness
Metabolic encephalopathy 1 2 3A 3B 4
Coma 1 2 3A 3B 4
Brain death 1 2 3A 3B 4
Headache
Tension headache 1 2 3A 3B 4
Migraine 1 2 3A 3B 4
Cranial arteritis 1 2 3A 3B 4
Trigeminal neuralgia 1 2 3A 3B 4
Cluster headache 1 2 3A 3B 4
Cerebro Vascular Diseases
Transient ischaemic attacks (TIA) 1 3A 3B 4
Cerebral infarction 1 2 3A 3B 4
Intracerebral haematoma 1 2 3A 3B 4
Subarachnoid haemorhage 1 2 3A 3B 4
Hypertensive encephalopathy 1 2 3A 3B 4
Cranial nerve and brain stem lesions
Bell’s palsy 1 2 3A 3B 4
Brainstem lesions 1 2 3A 3B 4
Disorders of vestibular system
Menière's disease 1 2 3A 3B 4
Benign paroxysmal positional vertigo 1 2 3A 3B 4
Central vertigo
1 2 3A 3B 4
Memory deficit
- 203 -
Vascular dementia 1 2 3A 3B 4
Alzheimer's disease 1 2 3A 3B 4
Pick's disease 1 2 3A 3B 4
Movement Disorders
Parkinson's disease 1 2 3A 3B 4
Tremor 1 2 3A 3B 4
Secondary parkinsonism 1 2 3A 3B 4
Huntington’s disease 1 2 3A 3B 4
Sydenham’s chorea 1 2 3A 3B 4
Dystonia
2
Hemifacial spasm
2
Epilepsy and other seizures
Focal epilepsy 1 2 3A 3B 4
Generalized epilepsy 1 2 3A 3B 4
Absence seizure 1 2 3A 3B 4
Status epilepticus 1 2 3A 3B 4
Narcolepsy 1 2 3A 3B 4
Sleep apnoea syndrome 1 2 3A 3B 4
Demyelination diseases
Multiple sclerosis 1 2 3A 3B 4
Optic neuromyelitis (Devic's disease) 1 2 3A 3B 4
Diseases of spine and spinal cord
Amyotrophic lateral sclerosis (ALS) 1 2 3A 3B 4
Complete spinal transaction 1 2 3A 3B 4
Brown-Sequard syndrome 1 2 3A 3B 4
Cauda equina syndrome 1 2 3A 3B 4
Neurogenic bladder 1 2 3A 3B 4
Syringomyelia 1 2 3A 3B 4
Myelopathy 1 2 3A 3B 4
Dorsal root syndrome 1 2 3A 3B 4
Acute medullary compression 1 2 3A 3B 4
Radicular syndrome/HNP 1 2 3A 3B 4
Tuberculous spondylitis
1 2 3A 3B
Neuromuscular diseases and neuropathy
Horner’s syndrome 1 2 3A 3B 4
Carpal tunnel syndrome 1 2 3A 3B 4
Tarsal tunnel syndrome 1 2 3A 3B 4
- 204 -
Neuropathy 1 2 3A 3B 4
Guillain-Barré syndrome 1 2 3A 3B 4
Myasthenia gravis 1 2 3A 3B 4
Polymyositis 1 2 3A 3B 4
Duchenne muscular dystrophy 1 2 3A 3B 4
Neurofibromatosis (von Recklinghausen’s disease) 1 2 3A 3B 4
Infectious diseases
Meningitis 1 2 3A 3B 4
Encephalitis 1 2 3A 3B 4
Cerebral malaria 1 2 3A 3B 4
Tetanus 1 2 3A 3B 4
Cerebral toxoplasmosis 1 2 3A 3B 4
Tuberculoma 1 2 3A 3B 4
Brain abscess 1 2 3A 3B 4
HIV AIDS 1 2 3A 3B
Neurobehavioural Disorders
Post-traumatic amnesia 1 2 3A 3B 4
Aphasia 2 2 3A 3B 4
Mild cognitive impairment (MCI) 1 2 3A 3B 4
Vascular cognitive impairment) (VCI) 2
CNS Tumors
Primary tumour 1 2 3A 3B 4
Secondary tumor 1 2 3A 3B 4
Pain
Nociceptive pain 1 2 3A 3B 4
Neuropathic pain 1 2 3A 3B 4
Visual disturbances
Sudden blindness 1 2 3A 3B 4
Visual field disorders 1 2 3A 3B 4
- 205 -
Infectious and tropical diseases
Gram-positive cocci
Staphylococcal and streptococcal infections
Staphylococcal pneumonia 1 2 3A 3B 4
Staphylococcal bacteraemia 1 2 3A 3B 4
Streptococcal infection
Rheumatic fever 1 2 3A 3B 4
Rheumatic heart disease 1 2 3A 3B 4
Meningococcal infection
Meningitis 1 2 3A 3B 4
Gonococcal infections
Gonorrhoea 1 2 3A 3B 4
Gram-negative bacilli
Urinary tract infection (UTI) 1 2 3A 3B 4
Typhoid fever 1 2 3A 3B 4
Bacillary dysentery 1 2 3A 3B 4
Cholera 1 2 3A 3B 4
Pertussis 1 2 3A 3B 4
Plague 1 2 3A 3B 4
Chancroid 1 2 3A 3B 4
Toxin producing bacteria
Tetanus 1 2 3A 3B 4
Mycobacterial diseases
Cuticular tuberculosis 1 2 3A 3B 4
Leprosy 1 2 3A 3B 4
Lepra reaction 1 2 3A 3B 4
Spirochaetal diseases
Syphilis 1 2 3A 3B 4
Yaws 1 2 3A 3B 4
Leptospirosis 1 2 3A 3B 4
Deep fungal infections
Actinomycosis 1 2 3A 3B 4
Chromoblastomycosis 1 2 3A 3B 4
Maduromycosis 1 2 3A 3B 4
- 206 -
Viral infections
Influenza 1 2 3A 3B 4
Poliomyelitis 1 2 3A 3B 4
Rabies 1 2 3A 3B 4
Measles 1 2 3A 3B 4
Varicella 1 2 3A 3B 4
Herpes zoster 1 2 3A 3B 4
Herpes simplex 1 2 3A 3B 4
Mumps 1 2 3A 3B 4
Cytomegalovirus (CMV) infections 1 2 3A 3B 4
Dengue hemorrhagic fever (DHF) 1 2 3A 3B 4
HIV-AIDS 1 2 3A 3B 4
Protozoal infections
Amoebiasis 1 2 3A 3B 4
Malaria 1 2 3A 3B 4
Leishmaniasis and tripanosomiasis 1 2 3A 3B 4
Toxoplasmosis 1 2 3A 3B 4
Giardiasis 1 2 3A 3B 4
Trichomoniasis 1 2 3A 3B 4
Worm infestations
Hookworm diseases 1 2 3A 3B 4
Strongyloidiasis 1 2 3A 3B 4
Ascariasis 1 2 3A 3B 4
Filariasis 1 2 3A 3B 4
Schistosomiasis 1 2 3A 3B 4
Cutaneous larva migrans 1 2 3A 3B 4
Taeniasis 1 2 3A 3B 4
Neoplasms
Blood and lymph nodes
Non-hodgkin's lymphoma 1 2 3A 3B 4
Hodgkin's lymphoma 1 2 3A 3B 4
Acute leukaemia 1 2 3A 3B 4
Chronic leukaemia 1 2 3A 3B 4
Myelodysplastic syndromes 1 2 3A 3B 4
Multiple myeloma 1 2 3A 3B 4
Langerhans' cell histiocytosis 1 2 3A 3B 4
Lung
Bronchogenic carcinoma 1 2 3A 3B 4
Bronchoalveolar carcinoma 1 2 3A 3B 4
Neuroendocrine tumor (carcinoid tumor) 1 2 3A 3B 4
Mesothelioma 1 2 3A 3B 4
- 207 -
Gatrointestinal
Benign polyps 1 2 3A 3B 4
Squamous cell carcinoma 1 2 3A 3B 4
Adenocarcinoma 1 2 3A 3B 4
Carcinoid tumor 1 2 3A 3B 4
Lymphoma 1 2 3A 3B 4
Liver
Liver cell adenoma 1 2 3A 3B 4
Hepatocellular carcinoma 1 2 3A 3B 4
Pancreas
Carcinoma of the pancreas 1 2 3A 3B 4
Kidney
Cortical adenoma 1 2 3A 3B 4
Renal cell carcinoma 1 2 3A 3B 4
Wilm's tumor 1 2 3A 3B 4
Male genitals
Seminoma 1 2 3A 3B 4
Teratoma of the testis 1 2 3A 3B 4
Benign prostatic hyperplasia 1 2 3A 3B 4
Carcinoma of the prostate 1 2 3A 3B 4
Breast
Gynaecomastia 1 2 3A 3B 4
Endocrine glands
Thyroid adenoma 1 2 3A 3B 4
Thyroid carcinoma 1 2 3A 3B 4
Thymus
Thymoma 1 2 3A 3B 4
Astrocytoma 1 2 3A 3B 4
Oligodendroglioma 1 2 3A 3B 4
Ependymoma 1 2 3A 3B 4
Medulloblastoma 1 2 3A 3B 4
Retinoblastoma 1 2 3A 3B 4
Meningioma 1 2 3A 3B 4
Neurofibroma 1 2 3A 3B 4
- 208 -
Schwannoma 1 2 3A 3B 4
Psych-organic syndromes and disorders due to drugs
Intoxication 1 2 3A 3B 4
Withdrawal syndrome 1 2 3A 3B 4
Delirium 1 2 3A 3B 4
Dementia 1 2 3A 3B 4
Amnesic syndrome 1 2 3A 3B 4
Other organic disorders 1 2 3A 3B 4
miscellaneous
Drowning 1 2 3A 3B 4
4
Poisoning
1 2 3A 3B
Suffocation 1 2 3A 3B 4
- 209 -
2. Surgery:
Cardiovascular
Arterial thrombosis 1 2 3A 3B 4
Aortic aneurysm 1 2 3A 3B 4
Dissecting aneurysm 1 2 3A 3B 4
Veins
Obstructed venous return/VARICOSE VEIN 1 2 3A 3B 4

Lymph vessels 1 2 3A 3B 4
Respiratory
PYOTHORAX
2 3A
HYDATID CYST OF LUNG
2
Gastrointestinal
Mouth (mouth will be dealt in dental)
Candidiasis 1 2 3A 3B 4
Mouth ulcers (aphthous, herpes) 1 2 3A 3B 4
Mucus cyst 3A
Oesophagus
Oesophageal atresia 1 2 3A 3B 4
Achalasia 1 2 3A 3B 4
Corrosive lesions of oesophagus 1 2 3A 3B 4
Oesophageal rupture 1 2 3A 3B 4
Reflux oesophagitis 1 2 3A 3B 4
CORrOSIVE OESOPHAGITIS 1 2 3A 3B 4
OESOPHAGEAL CA 1 2 3A 3B 4
PRIMARY MEDIASTINAL TUMORS 1 2 3A 3B 4
- 210 -
Diaphragm
Diaphragmatic hernia 1 2 3A 3B 4
Hiatus hernia 1 2 3A 3B 4
Abdominal wall and herniae
Inguinal hernia, direct and indirect (Bedah) 1 2 3A 3B 4

Femoral hernia – Bedah 1 2 3A 3B 4
Epigastric hernia 1 2 3A 3B 4
Incisional hernia 1 2 3A 3B 4
Umbilical hernia 1 2 3A 3B 4
OBST HERNIA
Acute abdomen
Peritonitis / PRIMARY~ , SECNDARY ~ 1 2 3A 3B 4

Abscess in pouch of Douglas / SUBDIAPHRAGMATIC / INTERLOOP 1 2 3A 3B 4
Ileus 1 2 3A 3B 4
Perforation 1 2 3A 3B 4
Acute appendicitis 1 2 3A 3B 4
Appendicular abscess / APPENDICULAR LUMP 1 2 3A 3B 4
Mesenteric lymphadenitis 1 2 3A 3B 4
Intestinal Obstruction 1 2 3A 3B 4
Stomach and duodenum
Gastritis 1 2 3A 3B 4
Gastric/duodenal ulcer 1 2 3A 3B 4
Liver
Amoebic liver abscess, Pyogenic Liver abscess 1 2 3A 3B 4

Gall bladder, bile duct and pancreas
Chole(docho)lithiasis, Symptomatic cholangitis 1 2 3A 3B 4

Acute cholecystitis 1 2 3A 3B 4
Hydrops of gall bladder 1 2 3A 3B 4
Empyema of gall bladder 1 2 3A 3B 4
Pancreatitis 1 2 3A 3B 4
CHOLEDOCHAL CYST 1
Jejunum, ileum
Intestinal atresia 1 2 3A 3B 4
Meckel's diverticulum 1 2 3A 3B 4
Umbilical fistula, omphalocoele-gastroschisis 1 2 3A 3B 4
Malrotation 1 2 3A 3B 4
Intestinal TB
Colon/ RECTUM / ANUS
- 211 -
Irritable bowel syndrome 1 2 3A 3B 4
Necrotizing enterocolitis 1 2 3A 4
Diverticulosis/diverticulitis 1 2 3A 4
Colitis, ULCERATIVE ~ 1 2 3A 3B 4
Rectal, anal prolapse 1 2 3A 3B 4
Proctitis 1 2 3A 3B 4
Haemorrhoids 1 2 3A 3B 4
THROMBOSED PILES 1 2 3A 3B 4
Perianal fistula 1 2 3A 3B 4
Rectal polyps 2
Rectal cancer 2
Anal fissure 1 2 3A 3B 4
INTESTINAL OBST- INTUSSUSCEPTION, VOLVULOUS, OBST HERNIA 2
Pediatrics Surgery
Anal atresia/IMPPERFORATED ANUS 1 2 3A 3B 4
Diaphragmatic hernia (congenital) 1 2 3A 3B 4
Pyloric stenosis/HYPERTROPHIC ~ 1 2 3A 3B 4
Gastro-oesophageal reflux 1 2 3A 3B 4
Intestinal obstruction-worms 1 2 3A 3B 4
Acute abdomen 1 2 3A 3B 4
Ileus 1 2 3A 3B 4
Tuberculous peritonitis 1 2 3A 3B 4
Peritonitis due to pancreatitis 1 2 3A 3B 4
Intussusception 1 2 3A 3B 4
Umbilical hernia 1 2 3A 3B 4
Meckel's diverticulum 1 2 3A 3B 4
Hirschsprung's disease 1 2 3A 3B 4
Biliary atresia 1 2 3A 3B 4
NephrOlogy/ UROLOGY/ ANDROLOGY

Renal colic / URETRIC COLIC 1 2 3A 3B 4
Urinary stone disease or urinary calculi without colic / RENAL STONE,
UETERIC STONE, BLADDER STONE, URETHRAL STONE 1 2 3A 3B 4
Polycystic kidneys (symptomatic) 1 2 3A 3B 4
Horseshoe kidney 1 2 3A 3B 4
- 212 -
Nocturnal and diurnal enuresis 1 2 3A 3B 4
Prostatitis 1 2 3A 3B 4
Pyonephrosis, perinephric abscess, cystitis, orchitis 1 2 3A 3B 4
Single kidney, ectopic kidney, partial/complete duplication of
collecting system, ureterocele 1 2 3A 3B 4
Renal/bladder/epididymal tb 1 2 3A 3B 4
Obst uropathy/bph, post urethral valv 1 2 3A 3B 4
Male genitalia
Hypospadias 1 2 3A 3B 4
Epispadias 1 2 3A 3B 4
Undescended testes/cryptorchidism 1 2 3A 3B 4
Retractile testes 1 2 3A 3B 4
Torsion of testis 1 2 3A 3B 4
Epididymitis 1 2 3A 3B 4
Spermatocoele 1 2 3A 3B 4
Varicocoele 1 2 3A 3B
Hydrocoele 1 2 3A 3B 4
Phimosis 1 2 3A 3B 4
Paraphimosis 1 2 3A 3B 4
Ruptured urethra 1 2 3A 3B 4
Ruptured bladder 4
1 2 3A 3B
Ruptured kidney 4
1 2 3A 3B
Urethral stricture 3A 4
1 2 3B
Priapism 3A 4
1 2 3B
Peyronie’s disease 3A 4
1 2 3B
Extrophy of the bladder 3A 4
1 2 3B
Infertility 1 2 3A 3B 4
Erection disorders 1 2 3A 3B 4
Ejaculation disorders 1 2 3A 3B 4
Gynaecological Surgery
Inflammations / BREAST ABSCESS 1 2 3A 3B 4

LUMPS 1 2 3A 3B 4
CA 1 2 3A 3B 4
NIPPLE DISCHARGE/RETRACTED NIPPLE 1 2 3A 3B 4
Haematology
Immunology
Autoimmune rheumatological and autoimmune orthopaedic disorders 1
Immunological/allergic reactions
- 213 -
Transplantation immunology 1 2 3A 3B 4
Disorders of newborns
Infection of umbilicus 1 2 3A 3B 4

Complication of diabetes mellitus (acute and chronic) 1 2 3A 3B 4
1
Hyperthyroidism
2 3A 3B 4
CONN’S syndrome 1 2 3A 3B 4
Multiple endocrinological neoplasia (MEN syndromeS)
1 2 3A 3B 4
Tumour with ectopic production of hormone/Paraneoplastic Synd 1 2 3A 3B 4
Coma 1 2 3A 3B 4
Cardio Vascular Diseases
Subarachnoid haemorhage 1 2 3A 3B 4
HEAD INJURY 1 2 3A 3B 4
SUBDURAL HAEMATOMA 1 2 3A 3B 4
Infectious diseases
HIV AIDS 1 2 3A 3B
Congenital disorders
Hydrocephalus 1 2 3A 3B 4
Spina bifida 1 2 3A 3B 4
Pediatric neurological disorders
Cerebral abscess 1 2 3A 3B 4
Neurobehavioural Disorders
- 214 -
CNS Trauma
Epidural haematoma 1 2 3A 3B 4
Subdural haematoma 1 2 3A 3B 4
Subarachnoid haemorrhage 1 2 3A 3B 4
Spinal and medullary trauma 1 2 3A 3B 4
CNS Tumors
Primary tumour 1 2 3A 3B 4
Secondary tumor 1 2 3A 3B 4
Ears, hearing and equilibrium
Nose and sinus disorders

Foreign body in nose 1 2 3A 3B 4
Medial and lateral branchial cyst and fistula 1 2 3A 3B

Cystic hygroma 1 2 3A 3B
Lumps in neck- TB, branchial cyst, thyroglosal cyst 3A
Lymphoma, metastatic tumor/ln
Thyroid gland and parathyroid glands
Cyst 1 2 3A 3B 4
Goitre 1 2 3A 3B 4
Hyperthyroidism 1 2 3A 3B 4
Trachea
Aspiration 1 2 3A 3B 4
Foreign body/ies 1 2 3A 3B 4

Localized infections and abscesses
Infections of the hand/ FOOT
Paronychia 1 2 3A 3B 4
Suppurative tenosynovitis 1 2 3A 3B 4
Human bite 1 2 3A 3B 4
Corn 1 2 3A 3B 4
Ingrown toenail 1 2 3A 3B 4
Infections of the head and neck
Suppurative parotitis 1 2 3A 3B 4
Suppurative cervical adenitis 1 2 3A 3B 4
Peritonsilar abscess 1 2 3A 3B 4
Ludwig's angina 1 2 3A 3B 4
Neoplasms
Lung
- 215 -
Bronchogenic carcinoma 1 2 3A 3B 4
Bronchoalveolar carcinoma 1 2 3A 3B 4
Neuroendocrine tumor (carcinoid tumor) 1 2 3A 3B 4
Mesothelioma 1 2 3A 3B 4
Head and neck
Polyps 1 2 3A 3B 4
Nasopharynx carcinoma 1 2 3A 3B 4
Pleomophic adenoma 1 2 3A 3B 4
Warthin’s tumor 1 2 3A 3B 4
Gatrointestinal
Benign polyps 1 2 3A 3B 4
Adenocarcinoma 1 2 3A 3B 4
Carcinoid tumor 1 2 3A 3B 4
Lymphoma 1 2 3A 3B 4
Liver - Hepatoma
Liver cell adenoma 1 2 3A 3B 4
Hepatocellular carcinoma 1 2 3A 3B 4
Cholangiocarcinoma 1 2 3A 3B 4
Pancreas
Carcinoma of the pancreas 1 2 3A 3B 4
Kidney
Cortical adenoma 1 2 3A 3B 4
Renal cell carcinoma 1 2 3A 3B 4
Wilm's tumor 1 2 3A 3B 4
Male genitals
Seminoma 1 2 3A 3B 4
Teratoma of the testis 1 2 3A 3B 4
Benign prostatic hyperplasia 1 2 3A 3B 4
Carcinoma of the prostate 1 2 3A 3B 4
Female genitals
Breast
Fibrocystic change 1 2 3A 3B 4
Fibroadenoma mammae 1 2 3A 3B 4
Phyllodes tumor 1 2 3A 3B 4
Breast carcinoma 1 2 3A 3B 4
Paget's disease of the breast 1 2 3A 3B 4
Gynaecomastia 1 2 3A 3B 4
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Bloody Nipple discharge 3A
Endocrine glands
Somatotrophic adenoma 1 2 3A 3B 4
Prolactinoma 1 2 3A 3B 4
Thyroid adenoma 1 2 3A 3B 4
Thyroid carcinoma 1 2 3A 3B 4
Thymus
Thymoma 1 2 3A 3B 4
Skin
Benign epithelial tumors 1
Seborrheic keratosis 1 2 3A 3B 4
Epithelial cyst 1 2 3A 3B 4
Premalignant and malignant epithelial tumors
Actinic keratosis 1 2 3A 3B 4
Bowen's disease 1 2 3A 3B 4
Basal cell carcinoma 1 2 3A 3B 4
Tumors of the dermis
Xanthoma 1 2 3A 3B 4
Haemangioma 1 2 3A 3B 4
Lymphangioma 1 2 3A 3B 4
Angiosarcoma 1 2 3A 3B 4
Tumors of immigrant cells to the skin
Mycosis fungoides 1 2 3A 3B 4
Mastocytosis 1 2 3A 3B 4
Tumors of melanocytic cells
Lentigo 1 2 3A 3B 4
Naevus pigmentosus 1 2 3A 3B 4
Malignant melanoma 1 2 3A 3B 4
Bone and soft tissue
Ganglion cyst 1 2 3A 3B 4
Lipoma 1 2 3A 3B 4
Desmoid tumor 1 2 3A 3B 4
Fibroma 1 2 3A 3B 4
Fribrosarcoma 1 2 3A 3B 4
Benign fibrous histiocytoma 1 2 3A 3B 4
Malignant fibrous histiocytoma (MFH) 1 2 3A 3B 4
Rhabdomyosarcoma 1 2 3A 3B 4
Leiomyoma 1 2 3A 3B 4
Leiomyosarcoma 1 2 3A 3B 4
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Psychiatry and mental health
Musculoskeletal system
Traumatology
Trauma (depends on the severity)
Burning 1 2 3A 3B 4
Bleeding 1 2 3A 3B 4
Rib fractures/contusion 1 2 3A 3B 4
Injury caused by rib fractures 1 2 3A 3B 4
Haemothorax 1 2 3A 3B 4
Injury to specific internal organs, such as liver, kidney, lung, etc 1 2 3A 3B 4
PNEURMOPERITONEUM 1 2 3A 3B 4
HAEMOPERITONEUM 1 2 3A 3B 4
FROST BITE 1 2 3A 3B 4
Accident and emergency neurology
Head injuries 1 2 3A 3B 4
Diffuse brain damage 1 2 3A 3B 4
Cerebral concussion and contusion 1 2 3A 3B 4
Extradural haemorrhage 1 2 3A 3B 4
Subdural haemorrhage 1 2 3A 3B 4
Fracture of base of skull 1 2 3A 3B 4
Acute traumatic spinal transaction 1 2 3A 3B 4
Reproductive system
Puerperium
Mastitis 1 2 3A 3B 4
Cracked nipple 1 2 3A 3B 4
Inverted nipple 1 2 3A 3B 4
Incontinence of urine 1 2 3A 3B 4
Incontinence of faeces 1 2 3A 3B 4
Deep venous thrombosis 1 2 3A 3B 4
Embolism 1 2 3A 3B 4
- 218 -
Principle of surgery/history/evolution/ recent advances/future
development/surgical ethics/communication 1 2 3A 3B 4
Aseptic technique/ot
Methods of sterilization, antiseptics, preparation for surgeon,
1 2 3A 3B 4
patient, operative field, gowning, gloving, painting, draping
Basic principle of ot/ design/ person/basic equipment/supplies 1 2 3A 3B 4
Anaesthesia/pain management
1 2 3A 3B 4
Introduction, pre anaesthetic prepartion/checkup, types of
anaesthesia- ga/reginal/la, recovery from anaesthesia
Fluid and electrolyte imbalance 1 2 3A 3B 4
Dehydrartion, hyponatremia, hypokalemia 1 2 3A 3B 4

Metabolic/respiratory acidosis/alkalosis 1 2 3A 3B 4
War surgery
Principle of battlefield victim managemnent 1 2 3A 3B 4

Firearm injury 1 2 3A 3B 4
Blast injury 1 2 3A 3B 4
Nuclear warfare 1 2 3A 3B 4
Chemical warfare 1 2 3A 3B 4
- 219 -
3. PAEDIATRIC CONDITIONS
Cardiovascular
Cardiac disorders Level of Competency
Heart failure 1 2 3A 3B 4
Cardiorespiratory arrest 1 2 3A 3B 4
Mitral stenosis 1 2 3A 3B 4
Mitral regurgitation 1 2 3A 3B 4
Aortic stenosis 1 2 3A 3B 4
Aortic regurgitation 1 2 3A 3B 4
Other valvular heart diseases 1 2 3A 3B 4
Ventricular septal defect 1 2 3A 3B 4
Atrial septal defect 1 2 3A 3B 4
Patenent ductus arteriosus 2
Tetralogy of Fallot 2
Sinus tachycardia 1 2 3A 3B 4
Supraventricular tachycardia 1 2 3A 3B 4
Bundle branch block 1 2 3A 3B 4
Other arrhythmias 1 2 3A 3B 4
Endocarditis 1 2 3A 3B 4
Pericarditis 1 2 3A 3B 4
Myocarditis 1 2 3A 3B 4
Cardiomyopathy 1 2 3A 3B 4
Systemic hypertension 1 2 3A 3B 4
Pulmonary hypertension 1 2 3A 3B 4
Raynaud's disease 1 2 3A 3B 4
Coarctation of the aorta 1 2 3A 3B 4
Cardiogenic shock 1 2 3A 3B 4
Veins
Lymph vessels
- 220 -
Respiratory
Tonsillitis 1 2 3A 3B 4
Pharyngitis 1 2 3A 3B 4
Croup 1 2 3A 3B 4
Tracheitis 1 2 3A 3B 4
Epiglottitis 3B
Bronchiolitis 1 2 3A 3B 4
Bronchitis 4
Bronchial asthma 1 2 3A 3B 4
Status asthmaticus 1 2 3A 3B 4
Pleural effusion 1 2 3A 3B 4
Empyema 1 2 3A 3B 4
Bronchiectasis 1 2 3A 3B 4
Acute otits media 1 2 3A 3B 4
Tubeculosis of lungs / Pleura 4
Pneumonia 1 2 3A 3B 4
Avian influenza 1 2 3A 3B 4
Pulmonary embolism 1 2 3A 3B 4
Pleuritis 1 2 3A 3B 4
Respiratory failure 1 2 3A 3B 4
Aspiration / Choking 3B
Congenital abnormalities of upper airway 2
Gastrointestinal
Cleft lip and palate 1 2 3A 3B 4

Micrognathia and macrognathia 1 2 3A 3B 4
Achalasia 1 2 3A 3B 4
Gastroeosophageal Reflux disease (GERD) 1 2 3A 3B 4
Diaphragmatic hernia (Congenital) 1 2 3A 3B 4
Mesenteric lymphadenitis 1 2 3A 3B 4
Acid peptic disease 1 2 3A 3B 4
1 2 3A 3B 4
- 221 -
Gastroenteritis
Dysentry 4
Cholera
1 2 3 4 4
Uncomplicated Infective hepatitis 1 2 3A 3B 4
Chronic liver disease 3A

Hepatic cirrhosis 1 2 3A 3B 4
Portal hypertention 3A
Amoebic liver abscess 1 2 3A 3B 4
Liver failure 1 2 3A 3B 4
Hypertrophic Pyloric stenosis 1 2 3A 3B 4
Umbilical fistula, omphalocoele-gastroschisis 1 2 3A 3B 4
Rectal prolapse 1 2 3A 3B 4
Imperforate anus / Anal atresia 1
Worms 1 2 3A 3B 4
Chronic diarrhea 1 2 3A 3B 4
Malabsorption 1 2 3A 3B 4
Food intolerance 1 2 3A 3B 4
Acute abdomen 1 2 3A 3B 4
Ileus 1 2 3A 3B 4
Tuberculosis abdomen 1 2 3A 3B 4
Intussusception 1 2 3A 3B 4
Crohn's disease 1 2 3A 3B 4
Hirschsprung's disease 1 2 3A 3B 4
Biliary atresia 1 2 3A 3B 4
Reye's syndrome 1 2 3A 3B 4
Nephrourology
Chronic renal failure 1 2 3A 3B 4
Uncomplicated Nephrotic syndrome 1 2 3A 3B 4
Acute post streptococcal glomerulonephritis 1 2 3A 3B 4
Chronic glomerulonephritis 1 2 3A 3B 4
Interstitial nephritis 1 2 3A 3B 4
Polycystic kidneys 1 2 3A 3B 4
Other congenital abnormalities of urinary
system 1
- 222 -
Acute tubular necrosis 1 2 3A 3B 4
Horseshoe kidney 1 2 3A 3B 4
Nocturnal and diurnal enuresis 1 2 3A 3B 4
Haematology
Aplastic / Hypoplastic anaemia 1 2 3A 3B 4
Iron deficiency anaemia 1 2 3A 3B 4
Macrocytic anaemia 1 2 3A 3B 4
Haemolytic anaemia 1 2 3A 3B 4
Haemoglobinopathy 1 2 3A 3B 4
Anaemia associated with chronic diseases 1 2 3A 3B 4
Polycythaemia 1 2 3A 3B 4
Idiopathic thrombocytopenic purpura 1 2 3A 3B 4
Chronic Idiopathic thrombocytopenic purpura 1 2 3A 3B 4
Haemophilia 1 2 3A 3B 4
Von Willebrand's disease 1 2 3A 3B 4
Agranulocytosis 1 2 3A 3B 4
Immunology
Autoimmune / Immunological / allergic
disorders
Uncomplicated systemic lupus erythematosus
(SLE) 1 2 3A 3B 4
Complicated systemic lupus erythematosus
(SLE) 1 2 3A 3B 4
Uncomplicated Juvenile Rheumatoid arthritis 1 2 3A 3B 4
Rheumatic fever
1 2 3 3B 4
Rheumatic heart disease
1 2 3A 3B 4
Juvenile chronic arthritis 1 2 3A 3B 4
Dermatomyositis
2
Atopy 1 2 3A 3B 4
Drug reactions 3A
- 223 -
Stevens-Johnson syndrome 1 2 3A 3B 4
Genetics/congenital disorders
Down syndrome 1 2 3A 3B 4
Turner's syndrome 1 2 3A 3B 4
Klinefelter's syndrome 1 2 3A 3B 4
Gonadal XY-dysgenesis 1 2 3A 3B 4
Testicular feminization 1 2 3A 3B 4
Fragile X syndrome 1 2 3A 3B 4
Phenylketonuria (PKU) 1 2 3A 3B 4
Galactosaemia 1 2 3A 3B 4
Glycogen storage disease 1 2 3A 3B 4
Other storage diseases 1 2 3A 3B 4
Anencephaly 1 2 3A 3B 4
Hydrocephalus 1 2 3A 3B 4
Marfan's syndrome 1 2 3A 3B 4
Disorders of newborns
Hypothermia 1 2 3A 3B 4
Bacteraemia and septicaemia 1 2 3A 3B 4
Respiratory distress syndrome 1 2 3A 3B 4
Bronchopulmonary dysplasia 1 2 3A 3B 4
Pneumothorax
1 2 3A 3B 4
Apnoeic attacks 1 2 3A 3B 4
Jaundice of newborn 1 2 3A 3B 4
Severe neonatal jaundice (kernicterus) 1 2 3A 3B 4
Child of diabetic mother 1 2 3A 3B 4
Neonatal convulsion 1 2 3A 3B 4
Necrotizing enterocolitis 1 2 3A 3B 4
Retinopathy of prematurity 1 2 3A 3B 4
Anaemia 1 2 3A 3B 4
Polycythaemia
2
Rhesus incompatibility 1 2 3A 3B 4
Other Blood group incompatibility 1 2 3A 3B 4
Haemorrhagic disease of newborn 1 2 3A 3B 4
Cerebral haemorrhage 1 2 3A 3B 4
Infection of umbilicus 1 2 3A 3B 4
- 224 -
Common neonatal skin conditions 1 2 3A 3B 4
Opthalmia neonatarum 1 2 3A 3B 4
Birth asphyxia 1 2 3A 3B 4
Birth trauma 1 2 3A 3B 4
Near sudden infant death syndrome (SIDS) 1 2 3A 3B 4
Endocrinological disorders
Insulin-dependent diabetes mellitus (IDDM) 1 2 3A 3B 4
Non insulin-dependent diabetes mellitus
(NIDDM) 1 2 3A 3B 4
Diabetic ketoacidosis 1 2 3A 3B 4
Other complication of diabetes mellitus (acute
and chronic) 1 2 3A 3B 4
Diabetes insipidus 1 2 3A 3B 4
Acromegaly, gigantism 1 2 3A 3B 4
Growth hormone deficiency 1 2 3A 3B 4
1
Hyperthyroidism
2 3A 3B 4
Adrenal cortex failure 1 2 3A 3B 4
Primary hyperaldosteronism 1 2 3A 3B 4
Precocious puberty 1 2 3A 3B 4
Delayed puberty 1 2 3A 3B 4
Adrenogenital syndrome 1 2 3A 3B 4
Multiple endocrinological neoplasia (MEN
syndrome) 1 2 3A 3B 4
Tumour with ectopic production of hormone 1 2 3A 3B 4
Nutritional deficiency/ Disorder

Marasmus 1 2 3A 3B 4
Kwashiorkor 1 2 3A 3B 4
Rickets 4
Other Vitamin deficiencies 1 2 3A 3B 4
- 225 -
Obesity 1 2 3A 3B 4
Metabolic encephalopathy 1 2 3A 3B 4
Coma 1 2 3A 3B 4
Tension headache 1 2 3A 3B 4
Migraine 1 2 3A 3B 4
Hypertensive encephalopathy 1 2 3A 3B 4
Cerebral palsy /
1 2 3A 3B 4
Mental retardation 1 2 3A 3B 4
Kernicterus 1 2 3A 3B 4
Bell’s palsy 1 2 3A 3B 4
Brainstem lesions 1 2 3A 3B 4
Movement Disorders
Tremor 1 2 3A 3B 4
Ataxia 2
Sydenham’s chorea 1 2 3A 3B 4
Dystonia 1 2 3A 3B 4
Seizure disorders
Focal seizure 1 2 3A 3B 4
Generalized seizure 1 2 3A 3B 4
Absence seizure 1 2 3A 3B 4
Infantile spasms 3A
Febrile seizure 4
Status epilepticus 1 2 3A 3B 4
Acute flaccid paralysis
1 2 3A 3B 4
Hemiperesis / paraperesis / Monoperesis
1 2 3A 3B 4
Hypotonia
1 2 3A 3B 4
- 226 -
Hydrocephalus
1 2 3A 3B 4
Spina bifida
1 2 3A 3B 4
Infections
Uncomplicated Meningitis 1 2 3A 3B 4
Encephalitis 1 2 3A 3B 4
Cerebral malaria 1 2 3A 3B 4
Tetanus 1 2 3A 3B 4
Tuberculoma 1 2 3A 3B 4
Tuberculosis of spine
1 2 3A 3B 4
Neurocysticercosis
1 2 3A 3B 4
Autism 1 2 3A 3B 4
Attention-deficit hyperactivity disorder (ADHD) 1 2 3A 3B 4
CNS tumors (Primary) 1 2 3A 3B 4
CNS tumor (secondary) 1 2 3A 3B 4

Ludwig's angina 1 2 3A 3B 4
Superficial infections, including folliculitis,
hydradenitis 1 2 3A 3B 4
Acute osteomyelitis /Septic arthritis 1 2 3A 3B 4
Sinusitis, mastoiditis, peritonsilar abscess 1 2 3A 3B 4
Bacillary dysentry 4
Cholera 4
Typhoid fever 1 2 3A 3B 4
Pertussis 1 2 3A 3B 4
Plague 1 2 3A 3B 4
Toxin producing bacteria

Diphteria 1 2 3A 3B 4
Tetanus 1 2 3A 3B 4
Mycobacterial diseases
Cuticular tuberculosis 1 2 3A 3B 4
Leprosy 1 2 3A 3B 4
Lepra reaction 1 2 3A 3B 4
- 227 -
Spirochaetal diseases
Cogenital Syphilis 1 2 3A 3B 4
Leptospirosis 1 2 3A 3B 4
Fungal infections
Actinomycosis 1 2 3A 3B 4
Oral Candidiasis 4
Mucocutaneous candidiasis 1 2 3A 3B 4
Viral infections
Influenza 1 2 3A 3B 4
Viral gastroenteritis 1 2 3A 3B 4
Rabies 1 2 3A 3B 4
Measles 1 2 3A 3B 4
Varicella 1 2 3A 3B 4
Herpes zoster 1 2 3A 3B 4
Herpes simplex 1 2 3A 3B 4
Mumps 1 2 3A 3B 4
Cytomegalovirus (CMV) infections 1 2 3A 3B 4
Dengue hemorrhagic fever (DHF) 1 2 3A 3B 4
HIV-AIDS 1 2 3A 3B 4
Protozoal infections
Amoebiasis 1 2 3A 3B 4
Malaria 1 2 3A 3B 4
Leishmaniasis 1 2 3A 3B 4
Toxoplasmosis 1 2 3A 3B 4
Giardiasis 1 2 3A 3B 4
Trichomoniasis 1 2 3A 3B 4
Worm infestations
Hookworm diseases 1 2 3A 3B 4
Strongyloidiasis 1 2 3A 3B 4
Ascariasis 1 2 3A 3B 4
Filariasis 1 2 3A 3B 4
Schistosomiasis 1 2 3A 3B 4
Cutaneous larva migrans 1 2 3A 3B 4
Taeniasis 1 2 3A 3B 4
Neoplasms
- 228 -
Neuroblastoma 1 2 3A 3B 4
Nephroblastoma 1 2 3A 3B 4
Wilms tumor
1
Retinoblastoma
1
Hepatoblastoma
1
Thymoma 1 2 3A 3B 4
Skin
1
Seborrheic dermatitis 1 2 3A 3B 4
Infantile Eczema 3A
Haemangioma 1 2 3A 3B 4
Psychiatry and mental health
Developmental and behavioral disorders
Mental deficiency 1 2 3A 3B 4
Autistic disorder 1 2 3A 3B 4
Disorder of motor development 1 2 3A 3B 4
Disorder of coodination 1 2 3A 3B 4
Attention deficit hyperactive disorder 1
Sleep disorders
Nightmares 1 2 3A 3B 4
Night terrors 1 2 3A 3B 4
Sleep disorders 3A
- 229 -
Eating disorders
Anorexia nervosa 1 2 3A 3B 4
Bulimia 1 2 3A 3B 4
Pica 1 2 3A 3B 4
Rumination in infancy 1 2 3A 3B 4
Gender identity disorder 1 2 3A 3B 4
Tics
Gilles de la Tourette syndrome 1 2 3A 3B 4
Chronic focal tic disorders 1 2 3A 3B 4
Transient tic disorders 1 2 3A 3B 4
Disorders of excretion
Functional encopresis 1 2 3A 3B 4
Functional enuresis 1 2 3A 3B 4
Speech disorders
Uncoordinated speech 1 2 3A 3B 4
Stammer 1 2 3A 3B 4
Psych-organic syndromes and disorders due to
drugs
Bone and joints
Congenital dislocation of the hips 1 2 3A 3B 4
Genu varum (bow legs) 1 2 3A 3B 4
3A
Genu valgum (knock knee)
1 2 3B 4
Achondroplasia 1 2 3A 3B 4
Club foot 1 2 3A 3B 4
Congenital scoliosis
1 2 3A 3B 4
Limb length discrepancy
1
Arthrogryposis
1
Sternomastoid tumor
1
Hypophosphataemic rickets/ Vitamin D depentant rickets
1
Renal oesteodystrophy
2
- 230 -
4. Gyne/obst department
Vulva/Vagina
Vulvovaginitis
1 2 3A 3B 4
Vulval dystrophy
1 2 3A 3B 4
Bartholin’s cyst, Bartholin’s abscess

1 2 3A 3B 4
Abscess of hair follicle or sebaceous gland

1 2 3A 3B 4
Condylomata accuminata
1 2 3A 3B 4
Cysto/ Recto/ Enterocele 1
Vulval Ca 2
Congenital malformations
1 2 3A 3B 4
Vaginal discharge syndrome

1 2 3A 3B 4
Gärtner duct/Cyst
1 2 A 3B 4
Fistula (vesico-vaginal, uretero-vaginal, recto-vaginal)

1 2 3A 3B 4
Foreign body
1 2 3A 3B 4
Cervix
Cervicitis
1 2 3A 3B 4
Polyps
1 2 3A 3B 4
Nabothian cyst
1 2 3A 3B 4
Cervical intraepithelial neoplasia (CIN) 2
Body of the uterus
- 231 -
Congenital malformations
1 2 3A 3B 4
Uterine prolapse (Pelvic organ prolapse)

1 2 3A 3B 4
Haematocolpos, Hematometra
1 2 3A 3B 4
Fibroid
1 2 3A 3B 4
DUB 1 2 3A
3B 4
Endometrial hyperplasia/ carcinoma 1 2 3A

3B 4
Adnexae
Pelvic inflammatory disease

1 2 3A 3B 4
Functional ovarian cyst

1 2 3A 3B 4
Ovarian tumor
1 2 3A 3B 4
Polycystic ovarian disease

1 2 3A 3B 4
Ovarian tumor
1 2 3A 3B 4
Carcinoma of ovary
1 2 3A 3B 4
Ectopic pregnancy
1 2 3A 3B 4
Adnexal Torsion
1 2 3A 3B 4
Tubo Ovarian mass/Abscess

1 2 3A 3B 4
Ovulatory pain
1 2 3A 3B 4
- 232 -
Reproductive system
Infection during pregnancy/delivery
Syphilis 1 2 3A 3B 4
Toxoplasmosis, Rubella, Cytomegalo virus, Herpes
infection 1 2 3A 3B 4
HIV infection 1 2 3A 3B 4
Herpes virus infection type 2 1 2 3A 3B 4
Drugs and harmful substance during pregnancy
Mother taking tobacco 1 2 3A 3B 4
Mother with substance abuse 1 2 3A 3B 4
Pregnancy disorders
Threatened Miscarriage 1 2 3A 3B 4
Incomplete spontaneous Miscarriage 1 2 3A 3B 4
Completed spontaneous miscarriage 1 2 3A 3B 4
Inevitable miscarriage 1 2 3a 3b 4
Induced septic abortion 1 2 3A 3B 4
Hyperemesis gravidarum 1 2 3A 3B 4
1 2 3A
Hydatidiform mole
3B 4
Rh incompatibility 1 2 3A 3B 4
Gestational hypertension/ Pre-eclampsia 1 2 3A 3B 4
Pregnancy induced diabetes mellitus 1 2 3A 3B 4
Fetal growth disorder 1 2 3A 3B 4
Antepartum hemorrhage 1 2 3A 3B 4
Cervical incompetence 1 2 3A 3B 4
Polyhydramnios/ Oligohydramnios 1 2 3A 3B 4
Jaundice in pregnancy 1 2 3A 3B 4
Pyelonephritis in pregnancy 1 2 3A 3B 4
Anemia during pregnancy 1 2 3A 3B 4
Intra-uterine fetal demise 1 2 3A 3B 4
1 2 3A
Inverted nipple
3B 4
Delivery
Preterm contractions 1 2 3A 3B 4
Preterm delivery 1 2 3A 3B 4
Uterine rupture 1 2 3A 3B 4
Post-term pregnancy 1 2 3A 3B 4
Pre-labor rupture of membranes (PPROM) 1 2 3A 3B 4
Unstable lie / malposition after 36 weeks 1 2 3A 3B 4
- 233 -
Dystocia/ Prolonged labor 1 2 3A 3B 4
Cord presentation / cord prolapse 1 2 3A 3B 4
Suspected fetal jeopardy 1 2 3A 3B 4
Normal labor 1 2 3A 3B 4
Failure to rotate / incorrect rotation 1 2 3A 3B 4
Cervical tear 1 2 3A 3B 4
Episiotomy & repair 1 2 3A 3B 4
Shoulder dystocia 1 2 3A 3B 4
4th degree perineal tear 1 2 3A 3B 4
Retained placenta & Manual removal of placenta 1 2 3A 3B 4
Partograph
1 2 3A 3B 4
Vacuum delivery
1 2 3A 3B 4
Postpartum
Retained placental tissue 1 2 3A 3B 4
Uterine inversion 1 2 3A 3B 4
Postpartum haemorrhage 1 2 3A 3B 4
Puerperium
Cracked nipple 1 2 3A 3B 4
Puerperal sepsis 1 2 3A 3B 4
Deep venous thrombosis Embolism 1 2 3A 3B 4
Post-natal psychosis / Depression 1 2 3A 3B 4
Secondary PPH 1 2 3A 3B 4
Contraception
Temporary 1 2 3A 3B 4
Permanent 1 2 3A 3B 4
- 234 -
5. PSYCHIATRY ROTATION
Organic Brain Syndromes

Delirium 1 2 3A 3B 4
Dementia 1 2 3A 3B 4
1 2 3A 3B 4
1 2 3A 3B 4
Epilepsy
1 2 3A 3B 4
1 2 3A 3B 4
Psychiatric manifestations / sequels of Seizure
disorder 1 2 3A 3B 4
Psychoactive Substance Use Disorders

Dependence Syndrome 1 2 3A 3B 4
Other substance induced Neuro-psychiatric
disorders 1 2 3A 3B 4
Harmful use / abuse of psychoactive substances 1 2 3A 3B 4
Psychosis
Schizophrenia 1 2 3A 3B 4
Acute psychosis 1 2 3A 3B 4
Affective disorders
Bipolar disorders
Bipolar disorder, manic episode 1 2 3A 3B 4
Bipolar disorder, depressive episode 1 2 3A 3B 4
Unipolar disorders
Depressive Disorder, single episode and recurrent 1 2 3A 3B 4
Dysthymic disorder 1 2 3A 3B 4
Anxiety disorders
Panic disorder 1 2 3A 3B 4
1 2 3A 3B 4
Social phobia 1 2 3A 3B 4
Specific phobia 1 2 3A 3B 4
Obsessive compulsive disorder 1 2 3A 3B 4
Generalised anxiety disorder 1 2 3A 3B 4
- 235 -
Reactions to Stress
Adjustment Disorder 1 2 3A 3B 4
Acute Stress Reaction 1 2 3A 3B 4
Post traumatic stress disorder 1 2 3A 3B 4
Somatoform disorders
Conversion disorder 1 2 3A 3B 4
Hypochondriasis 1 2 3A 3B 4
Somatisation disorder 1 2 3A 3B 4
Somatoform pain disorder 1 2 3A 3B 4
1 2 3A 3B 4
Dissociative disorders
Mass Hysteria 1 2 3A 3B 4
Trance and possession disorder
1 2 3A 3B 4
1 2 3A 3B 4
Sexual Perversions
Paraphilia 1 2 3A 3B 4
Sexual dysfunctions
Disorder of sexual desire 1 2 3A 3B 4
Disorder of sexual excitement 1 2 3A 3B 4
Disorder of orgasm 1 2 3A 3B 4
Sexual pain disorders 1 2 3A 3B 4
Gender identity disorder 1 2 3A 3B 4

Sleep disorders
Dyssomnia
Insomnia 1 2 3A 3B 4
1 2 3A 3B 4
Sleep-wake cycle disturbances 1 2 3A 3B 4
Parasomnia
Nightmares 1 2 3A 3B 4
Night terrors 1 2 3A 3B 4
Sleep walking 1 2 3A 3B 4
1 2 3A 3B 4
Psychological factors affecting physical 1 2 3A 3B 4
- 236 -
condition
Personality disorders
Paranoid personality 1 2 3A 3B 4
Schizoid personality 1 2 3A 3B 4
Schizotypal personality 1 2 3A 3B 4
Antisocial personality 1 2 3A 3B 4
Borderline personality 1 2 3A 3B 4
Histrionic personality 1 2 3A 3B 4
Narcisistic personality 1 2 3A 3B 4
Avoidant personality 1 2 3A 3B 4
Dependent personality 1 2 3A 3B 4
Obsessive-compulsive personality 1 2 3A 3B 4
Passive-aggressive personality 1 2 3A 3B 4
Mental Disorders with Childhood Onset
Mental retardation 1 2 3A 3B 4
Specific Learning Disorders 1 2 3A 3B 4
Attention Deficit Hyperactive Disorder 1 2 3A 3B 4
Conduct Disorder 1 2 3A 3B 4
Tic disorders 1 2 3A 3B 4
Functional encopresis 1 2 3A 3B 4
Functional enuresis 1 2 3A 3B 4
Stammering 1 2 3A 3B 4
Neurotic disorders of childhood 1 2 3A 3B 4
Breath holding spells 1 2 3A 3B 4
Extrapyramidal side effects (eg. Acute dystonia,
tardive dyskinesia, parkinsonism) 1 2 3A 3B 4
Anticholinergic side effects 1 2 3A 3B 4
1 2 3A 3B 4
Neuroleptic malignant syndrome 1 2 3A 3B 4
1 2 3A 3B 4
Other items of knowledge
Knowledge of forensic psychiatry 1 2 3A 3B 4
Knowledge of National Mental Health act /
Policy 1 2 3A 3B 4
Knowledge of basic principles of different

Psychological Methods of Treatment 1 2 3A 3B 4
Knowledge of basic principles of Community
Psychiatry 1 2 3A 3B 4
Knowledge of Electro convulsive Therapy (ECT) 1 2 3A 3B 4
- 237 -
6. Orthopedics
Immunology
Polymyalgia rheumatica 1 2 3A 3B 4
Juvenile chronic arthritis 1 2 3A 3B 4
Errors of metabolism
Gout 1 2 3A 3B 4
Diseases of spine and spinal cord
Amyotrophic lateral sclerosis (ALS) 1 2 3A 3B 4
Complete spinal transaction 1 2 3A 3B 4
Brown-Sequard syndrome 1 2 3A 3B 4
Cauda equina syndrome 1 2 3A 3B 4
Neurogenic bladder 1 2 3A 3B 4
Syringomyelia 1 2 3A 3B 4
Myelopathy 1 2 3A 3B 4
Dorsal root syndrome 1 2 3A 3B 4
Acute medullary compression 1 2 3A 3B 4
Radicular syndrome/HNP 1 2 3A 3B 4
Tuberculous spondylitis
1 2 3A 3B 4

Horner’s syndrome 1 2 3A 3B 4
Neuropathy 1 2 3A 3B 4
Peroneal palsy 1 2 3A 3B 4
- 238 -
Pediatric neurological disorders

Cerebral palsy 1 2 3A 3B 4
Neck
Torticollis 1 2 3A 3B

Localized infections and abscesses
Infections of the hand
Paronychia 1 2 3A 3B 4
Suppurative tenosynovitis 1 2 3A 3B 4
Human bite 1 2 3A 3B 4
Deep palmar space infection 1 2 3A 3B 4
Gram-positive cocci
Staphylococcal and streptococcal infections
Chronic Osteomyelitis 1 2 3A 3B 4
Acute Osteomyelitis 1 2 3A 3B 4
Neoplasms
Bone and soft tissue

Osteoma 1 2 3A 3B 4
Osteoid osteoma 1 2 3A 3B 4
Osteoblastoma 1 2 3A 3B 4
Osteosarcoma 1 2 3A 3B 4
Osteochondroma 1 2 3A 3B 4
Chondroblastoma 1 2 3A 3B 4
Chondrosarcoma 1 2 3A 3B 4
Fibrous dysplasia 1 2 3A 3B 4
Fibrosarcoma 1 2 3A 3B 4
Ewing’s sarcoma 1 2 3A 3B 4
Giant cell tumor 1 2 3A 3B 4
- 239 -
Ganglion cyst 1 2 3A 3B 4
Lipoma 1 2 3A 3B 4
Liposarcoma 1 2 3A 3B 4
Fibromatosis 1 2 3A 3B 4
Desmoid tumor 1 2 3A 3B 4
Fibroma 1 2 3A 3B 4
Fribrosarcoma 1 2 3A 3B 4
Benign fibrous histiocytoma 1 2 3A 3B 4
Malignant fibrous histiocytoma (MFH) 1 2 3A 3B 4
Leiomyoma 1 2 3A 3B 4
Leiomyosarcoma 1 2 3A 3B 4
Synovial sarcoma 1 2 3A 3B 4
Bone and joints (pediatrics)
Congenital dislocation of the hip 1 2 3A 3B 4
Marfan's disease 1 2 3A 3B 4
Inflammatory Arthritis 1 2 3A 3B 4
Septic Arthritis 1 2 3A 3B 4
Genu varum (bow legs) 1 2 3A 3B 4
Genu valgum (knock knee) 1 2 3A 3B 4
Pes planus 1 2 3A 3B 4
Scoliosis 1 2 3A 3B 4
Kyphosis 1 2 3A 3B 4
Lordosis 1 2 3A 3B 4
Perthes disease 1 2 3A 3B 4
Slipped epiphysis 1 2 3A 3B 4
Osgood-Schlatter disease 1 2 3A 3B 4
Chondromalacia patellae 1 2 3A 3B 4
Osteogenesis imperfecta 1 2 3A 3B 4
Bone cyst 1 2 3A 3B 4
Achondroplasia 1 2 3A 3B 4
Generalized disorders of the musculoskeletal system

Rickets, osteomalacia 1 2 3A 3B 4
Osteoporosis ∆1 2 3A 3B 4
Fibrous dysplasia ∆1 2 3A 3B 4
Paget's disease ∆1 2 3A 3B 4
- 240 -
Localized disorders of the musculoskeletal system
Physical overload 1 2 3A 3B 4
Aseptic necrosis of bone 1 2 3A 3B 4
Osteomyelitis, acute 1 2 3A 3B 4
Arthritis 1 2 3A 3B 4
Trauma of joint cartilage 1 2 3A 3B 4
Trauma of joint capsule 1 2 3A 3B 4
Simple ganglion 1 2 3A 3B 4
Compound Ganglion 1 2 3A 3B 4
Primary bone tumors 1 2 3A 3B 4
Bone metastasis 1 2 3A 3B 4
Pathological fracture 1 2 3A 3B 4
Degenerative disorders of joints

Arthrosis deformans 1 2 3A 3B 4
Crystal arthropathy 1 2 3A 3B 4
Bechterew’s disease 1 2 3A 3B 4
Spine
Sacrococcygeal teratoma 1 2 3A 3B 4
Scoliosis 1 2 3A 3B 4
Kyphosis 1 2 3A 3B 4
Lordosis 1 2 3A 3B 4
Spondylarthrosis, spondylosis 1 2 3A 3B 4
Spondylitis, spondylodiscitis 1 2 3A 3B 4
Hernia of nucleus pulposus 1 2 3A 3B 4
Spondylolisthesis 1 2 3A 3B 4
Spondylolysis 1 2 3A 3B 4
Metastases from elsewhere 1 2 3A 3B 4
Pathological fractures 1 2 3A 3B 4
Fractures and dislocations of spine 1 2 3A 3B 4
Spinal transection 1 2 3A 3B 4
Pelvic and lower extremities

Congenital hip dislocation 1 2 3A 3B 4
Hip dysplasia 1 2 3A 3B 4
Femoral head necrosis 1 2 3A 3B 4
Intermittent arthritis of the hip 1 2 3A 3B 4
- 241 -
Fractures of pelvis 1 2 3A 3B 4
Fractures of hip 1 2 3A 3B 4
Dislocation of hip 1 2 3A 3B 4
Ligamentous lesions of hip 1 2 3A 3B 4
Arthritis of hip 1 2 3A 3B 4
Fractures of femur 1 2 3A 3B 4
Fractures, capsule, tendon and ligament lesions of knee 1 2 3A 3B 4
Lesion of meniscus, medial and lateral 1 2 3A 3B 4
Abnormal patellar cartilage 1 2 3A 3B 4
Genu varum, genu valgum 1 2 3A 3B 4
Osteochondritis dissecans 1 2 3A 3B 4
Arthritis of the knee 1 2 3A 3B 4
Achilles tendonitis 1 2 3A 3B 4
Rupture of achilles tendon 1 ∆2 3A 3B 4
Instability of ankle 1 2 3A 3B 4
Ingrowing toe nail 1 2 3A 3B 4
Pes planus 1 2 3A 3B 4
Claw foot 1 2 3A 3B 4
Hallux valgus 1 2 3A 3B 4
Hammer toe 1 2 3A 3B 4
Metatarsalgia 1 2 3A 3B 4
Onychogryphosis 1 2 3A 3B 4
Anisomelia 1 2 3A 3B 4
- 242 -
Traumatology
Birth trauma
Caput succedaneum 1 2 3A 3B 4
Brachial plexus injury 1 2 3A 3B 4
Fracture (clavicle, humerus, rib) 1 2 3A 3B 4
Trauma (depends on the severity)

Dislocation of knee 1 2 3A 3B 4
Dislocation of patella 1 2 3A 3B 4
Prepatellar bursitis 1 2 3A 3B 4
Fractures of tibia 1 2 3A 3B 4
Rib fractures/contusion 1 2 3A 3B 4
Injury caused by rib fractures 1 2 3A 3B 4
Sternal fractures 1 2 3A 3B 4
Fractures of toes 1 2 3A 3B 4
Crush injury to the heel (in children) 1 2 3A 3B 4
Fractures of fibula 1 2 3A 3B 4
Whiplash 1 2 3A 3B 4
Fractures, capsule, tendon and ligament lesions of ankle 1 2 3A 3B 4
Haemothorax 1 2 3A 3B 4
Injury to specific internal organs, such as liver, kidney, lung, etc 1 2 3A 3B 4
Peripheral nerves
Injury of peripheral nerves 1 2 3A 3B 4
Neck, shoulder girdle and upper extremities

Fractures of shoulder 1 2 3A 3B 4
Dislocation of shoulder 1 2 3A 3B 4
Ligamentous lesions of shoulder 1 2 3A 3B 4
Instability of shoulder 1 2 3A 3B 4
Frozen shoulder 1 2 3A 3B 4
Fracture of clavicle 1 2 3A 3B 4
Fracture of humerus 1 2 3A 3B 4
Fracture of radius/ulna 1 2 3A 3B 4
Dislocation of elbow 1 2 3A 3B 4
Fractures, capsule, tendon, ligament lesions of elbow 1 2 3A 3B 4
Fractures, capsule, tendon, ligament lesions of wrist 1 2 3A 3B 4
Fractures, capsule, tendon, ligament lesions of fingers and thumb 1 2 3A 3B 4
- 243 -
Lateral epicondylitis (tennis elbow) 1 2 3A 3B 4
Dislocation of distal radius 1 2 3A 3B 4
Dislocation of wrist 1 2 3A 3B 4
Progressive inflammation of finger following injury 1 2 3A 3B 4
Olecranon bursitis 1 2 3A 3B 4
Injury to finger tendon, e.g. Boutonniere-deformity 1 2 3A 3B 4
Mallet finger 1 2 3A 3B 4
Dupuytren's contracture 1 2 3A 3B 4
Nail loss 1 2 3A 3B 4
Subungual haematoma 1 2 3A 3B 4
Traumatic vessel injury 1 2 3A 3B 4
Accident and emergency neurology

Head injuries 1 2 3A 3B 4
Diffuse brain damage 1 2 3A 3B 4
Cerebral concussion and contusion 1 2 3A 3B 4
Extradural haemorrhage 1 2 3A 3B 4
Subdural haemorrhage 1 2 3A 3B 4
Fracture of base of skull 1 2 3A 3B 4
Acute traumatic spinal transaction 1 2 3A 3B 4
Injury of plexus and peripheral nerves 1 2 3A 3B 4
- 244 -
Annex 6: Basic Procedural skills
Procedure Level of skill Before Level of skill End of

rural placement final year
Dental extraction SH
Venepuncture SH
IV cannulation SH
Universal precaution SH
Intra osseous KH SH
Fluid resuscitation KH SH
Aseptic techniques SH
Central venous access/cut down KW KH
Lumbar puncture KH SH
Pleural tapping KH SH
Ascites tapping KH SH
Chest tube insertion KW KH
Needle thoracostomy KH
Airway maintenance SH
Bag and mask resuscitation SH
Endotracheal intubation KW SH
Basic suturing skills SH
Incision and Drainage KH SH
Aspiration of abscess KH SH
Proctoscope KW SH
Splinting SH
Catheterization SH
Stabilizing cervical spine SH
Foreign body removal – eye SH
Foreign body removal – ear and nose KW
Wound care
Bone marrow
KW – knows what
KH – knows how
SH – shows how
- 245 -

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PAHS OVERVIEW

Patan Academy of Health Science (PAHS) is dedicated to sustained improvement of the

In order to achieve this vision we are employing a number of innovative strategies.

The strategies we have chosen are as follows:

 Careful selection of our students

During the clinical years we have chosen to implement a Clinical Presentations

PAHS is dedicated to sustained improvement of the health of the people in Nepal,

 Undertake appropriate clinical, public health and biomedical research.

 Enable deserving students from disadvantaged sectors of Nepali society to access

The PAHS Graduate will demonstrate all of the following attributes:

1. Compassion and empathy to their patients at all times

The purpose of this Code of Conduct is to make certain that:

Student Code of Honor and Professional conduct

1. I realize that upon entering medical school, I am beginning my career as a physician

The purpose of this Code of Conduct is to make certain that:

Faculty Code of Honor and Professional conduct

The main aims of the course are:

• Introduction to Basic Medical Sciences

1. Problem Based Learning (PBL)

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

MEDICAL HUMANITIES (MH)

Medical humanities is an interdisciplinary field of medicine which includes the humanities

WRITING AND COMMUNICATION SKILLS (SC)

1. Taking notes, extracting and summarizing data (Session 1)

Total number of lectures 15

INTRODUCTION TO CLINICAL MEDICINE (ICM)

• Total number of sessions

The main aims of Basic Science are:

Components of Basic Science:

Main Teaching Methodology:

This block covers:

At the end of the block, student should be able to:

At the end of the block, the student should be able to:

 Define homeostasis and discuss its regulatory process with examples.

 Introduction to physiology, body fluid compartments.

At the end of the block, the student should be able to:

 Explain the medical importance of the major groups of molecules (Carbohydrates,

 Importance of Biochemistry in Medicine

At the end of the block, Students should be able to:

 Describe the categories of microorganisms, their biological characteristics and their

 Introduction to medical microbiology:

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

 Discuss the important terminologies used in pathology.

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

 Introduction to General Pharmacology

Introduction to Clinical Medicine

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

 Elicit history of presenting complaint and chief complaint

This block covers:

At the end of the block, student should be able to:

 Host Defense and Immunology

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

 Hormonal control mechanism.

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

 Immunology and Host Defense

 Cell Biology and Genetics

 Autonomic Nervous System

Cell Biology and Genetics

 Cell and its organization