YEAR, SEMESTER, & QUARTER | HEALTH SCIENCES: Integrated Problem based learning with laboratory, clinical, and community medicine correlations | PATIENT CARE: Bed side clinical skills and clinical laboratory experience | COMMUNITY HEALTH Community health problem solving skills | P R O F E S S I O N A L A N D P E R S O N A L S K I L L D E V E L O P M E N T | ||
Ethico-Legal-Fiqh Skills | Professionalism And Personal Development | Research Skills | ||||
SEMESTER 1 Quarter 1 (Physiology & Biochemistry) | Concepts: Mathematical and conceptual foundations[13] | |||||
SEMESTER 1 Quarter 2 (Pathology, microbiology, parasitology, pharmacology) | Epidemiology: Basic Issues of disease epidemiology[25] | . | Biostatistics: Descriptive Statistics[28] | |||
SEMESTER 2 Quarter 1 Transport Organ Systems | Clinical skills: Cardiovascular system: history taking[33], physical examination[34], profiles for cases[35], clinical skills laboratory[36], profiles for cases[37]. Hematogenous system: history taking, physical examination, clinical skills laboratory, profiles for cases[38]. Respiratory system: history taking[39], physical examination[40]., clinical skills laboratory[41], profiles for cases | Epidemiology: Incidence & prevalence of cardiovascular, hematogenous, and respiratory disorders[42]: | Ethico Legal fiqh Issues In Clinical Practice: start and end of life[43] | Personal: Communication Skills[44] | Biostatistics: Inferential Statistics[45] | |
SEMESTER 2 Quarter 2 Input / Output Organ Systems: | Clinical skills: Gastro-Intestinal System: History Taking[49], Physical Examination[50], Clinical Skills Laboratory[51]. Hepatobiliary System: History Taking[52], Physical Examination,: Profiles For Cases[53], Exretory System: History Taking[54]., Physical Examination, Profiles For Cases[55] | Epidemiology: Incidence and prevalence of Non-Communicable Diseases of Input/Output Organ Systems[56] | Ethico legal fiqh: occupational health, public health, civil transactions, judicial transactions[57] | Personal: Negotiation Skills[58] | Epidemiology:Quantitative Disease Measures[59] | |
YEAR, SEMESTER, & QUARTER | HEALTH SCIENCES: Integrated Problem based learning with laboratory, clinical, and community medicine correlations | PATIENT CARE: Bed side clinical skills and clinical laboratory experience | COMMUNITY HEALTH Community health problem solving skills | P R O F E S S I O N A L A N D P E R S O N A L S K I L L D E V E L O P M E N T | ||
Ethico-Legal-Fiqh Skills | Professionalism And Personal Development: | Research Skills | ||||
SEMESTER 3 Quarter 1 Support, Locomotion, & Protective Organ Systems: | Clinical skills: Musculoskeletal System: History Taking[64], Physical Examination[65] , Profiles For Cases[66]. Integumentary System: History Taking[67], Physical Examination[68], Clinical Skills Laboratory[69], Profiles For Cases[70]. Immune System: History, Physical Examination[71], Profiles For Cases[72] | Epidemiology: Incidence and prevalence of Non-Communicable Diseases of Support, Locomotion, And Protective Organ Systems[73] | Ethico-Legal-Fiqh Issues In Clinical Practice: activities of daily living, ibadat for patients, medical procedures [74]: | Leadership: Leadership Skills[75] | Epidemiology: Statistical Parameters Of Screening And Diagnostic Tests[76] | |
SEMESTER 3 Quarter 2 Command, Control, & Communication Organ Systems: | Clinical skills: Sensory System: History Taking[80], Physical Examination[81],Clinical Skills Laboratory[82]. Nervous System: History Taking[83], Physical Examination[84], Clinical Skills Laboratory[85]. Endocrine System: History Taking[86]Endocrine System: Physical Examination[87], Profiles For Cases[88]: | Epidemiology: Incidence and prevalence of Non-Communicable Diseases of Command, Control, And Communication organ systems | Ethico-Legal-Fiqh Issues In Clinical Practice: multi system pathophysiological disorders, age and sex related disorders [89] | Leadership: Management Skills For Health Services[90] | Epidemiology: Data Collection And Management[91] | |
SEMESTER 4 Quarter 1 Reproductive Systems & The Life Cycle | Clinical skills: Male Reproductive System: History Taking, Physical Examination, Profiles For Cases[95]. Female Reproductive System: History Taking, Physical Examination., Female Reproductive System: Profiles For Cases[96]. Growth And Development: History Taking, Growth And Development: Physical Examination, Profiles For Cases[97] | Epidemiology: Epidemiology Of Exposures[98] | Ethico-Legal-Fiqh Issues In Clinical Practice: physiological conditions of the reproductive system[99] | Professionalism: Collegial Relations / Etiquette In A Health Team[100] | Epidemiology: Data Analysis[101] | |
SEMESTER 4 Quarter 2 Transport Organ Systems | Diagnosis: Cardiovascular System Investigations[106]. Hematogenous System Investigations. Respiratory System Investigations[107]. Clinical rotation/posting: Internal medicine | Epidemiology: Risk Factors And Prevention Of cardiovascular and respiratory diseases | Ethico-Legal-Fiqh Issues In Clinical Practice: cardio vascular & respiratory diseases[108] | Epidemiology: Observational Epidemiological Studies[110] | ||
SUMMER RESEARCH | Research Project In Science Lab | Research Project in Clinical Research Laboratory | Community Health Research Project | Forensic Pathology Research Project | Quality Assurance Project | Statistics / Epidemiology Project |
YEAR, SEMESTER, & QUARTER | Health Sciences: Integrated Problem Based Learning With Laboratory, Clinical, And Community Medicine Correlations | PATIENT CARE: Bed side clinical skills and clinical laboratory experience | COMMUNITY HEALTH Community health problem solving skills | P R O F E S S I O N A L A N D P E R S O N A L S K I L L D E V E L O P M E N T | ||
Ethico-Legal-Fiqh Skills | Professionalism And Personal Development | Research Skills | ||||
SEMESTER 5 Quarter 1 Input / output organ systems | Pathophysiology: Diseases Of The Gastro-Intestinal System[111]. Diseases Of The Hepato-Biliary And Pancreatic Systems[112]. Diseases Of The Excretory System[113] | Diagnosis: Investigations of gastro-intestinal, hapato-biliary, and excretory disease Clinical rotation / posting: General Surgery | Epidemiology: Risk Factors And Prevention Of gastro-intestinal and excretory diseases | excretory system disease[115] | Professionalism: Fidelity Obligations[116] | Epidemiology: Design of randomized studies[117] |
SEMESTER 5 Quarter 2 Support, Locomotion, & Protective Organ Systems | Diagnosis: Musculoskeletal System: Investigations[121]. Intergumentary System: Investigations[122]. Immune Protection: Investigations Clinical rotation / posting: Accident & emergency, Orthopedic Surgery and traumatology | Epidemiology: Risk Factors And Prevention of musculoskeletal and immune diseases | Ethico-Legal-Fiqh Issues In Clinical Practice[123] | Epidemiology: Analysis of epidemiological studies[126] | ||
SEMESTER 6 Quarter 1 Command, Control, & Communication Systems | Pathophysiology: Diseases Of The Sensory System[127]. Diseases Of The Nervous System[128]. Diseases Of The Endocrine System[129] | Clinical rotation / posting: Pediatrics | Epidemiology: Risk Factors And Prevention Of Non-Communicable Diseases Of command, control, and communication organ systems[132]: | Ethico-Legal-Fiqh Issues In Clinical Practice: Sensory System[133], Nervous System[134], Endocrine System | Professionalism: Professional Misconduct[135] | Epidemiology: Interpretation Of Epidemiological Studies[136]: |
SEMESTER 6 Quarter 2 Reproductive Systems | Pathophysiology: Diseases Of The Male Reproductive System[137]. Diseases Of The Female Reproductive System[138]. Disorders Of Growth And Development[139]: | Diagnosis: Reproductive System: Investigations[140] Clinical rotation / posting: Obstetrics & Gynecology | Epidemiology: Incidence, Prevalence, Risk Factors, And Prevention Of Age-Related Disorders[141]: | Ethico legal fiqh issues reproductive disorders: male and female[142] | Professionalism: Professional Malpractice / Negligence[143]. | Epidemiology: Critique And Writing Of Scientific Literature[144] |
CURRICULUM MAP FOR PHASE 2: BACHELOR OF MEDICINE AND BACHELOR OF SURGERY
Mornings | Afternoons | |
SEMESTER 7 Quarter 1 | Internal Medicine | Medical specialties |
SEMESTER 7 Quarter 2 | General Surgery | Orthopedics & Traumatology |
SEMESTER 8 Quarter 1 | Pediatrics | Community Health |
SEMESTER 8 Quarter 2 | Obstetrics and Gynecology | Surgical specialties |
SEMESTER 9 Quarter 1 | Internal Medicine | Medical specialties |
SEMESTER 9 Quarter 2 | General Surgery | Orthopedics & Traumatology |
SEMESTER 10 Quarter 1 | Pediatrics | Community Health |
SEMESTER 10 Quarter 2 | Obstetrics and Gynecology | Surgical specialties |
NOTES
[1] Characteristics of life (organization, responsiveness, growth and differentiation, reproduction, movement, metabolism and excretion). Review of chemical bonds (ionic and organic). Review of biochemical reactions (types, processes, and kinetics). Enzymes, co-enzymes, co-factors (structure, function, mechanism of work, kinetics, and metabolism). Water (properties that make it a universal solvent and chemical reactivity). Buffer systems and pH maintenance. Biological membranes (structure, transport functions). Biological signaling (gated ion channels, sensory transduction, hormones, oncogenes, tumor suppessor genes, apoptosis). Carbohydates: mono-, di-, and poly- sccharides (structure, functions, effects of deficiency). Glycoconjugates (proteoglycans, glycoproteins, and glycolipids). Proteins (3-D structure, denaturation, folding, binding to ligands. functions, effects of deficiency). Lipids (structure, storage, functions, effects of deficiency). Carbohydrate metabolism (transport through membranes, storage as glycogen in the liver and muscle, glycogenolysis, glycolysis: erobic and anerobic, phosphate-pentose pathway, citric acid / ATP cycle, anerobic glycosysis, generation of ATP, and gluconeogenesis, biosynthesis of glycogen). Lipid metabolism (lipolysis and oxidation to yield Acetyl Coa, and ATP, biosynthesis of fatty acids, biosynthesis of tryglycerides from fatty acids, synthesis of lipids / lipogenesis from fatty acids, synthesis of phospholipids, synthesis of cholesterol, synthesis of steroids, synthesis of tryglycerides from carbohydrates and proteins, transport of lipids as lipoproteins chylomicrons, very low density lipoproteins, very low density lipoproteins, intermediate density lipoproteins, low density lipoproteins, high density lipoproteins). Phospholipids metabolism. Cholesterol metabolism). Protein metabolism (active transport of amino acids into cells, protein synthesis from amino acids, breakdown of amino acids / catabolism into urea and actyl CoA, urea cycle and nitrogen excretion, transamination. Deamination). Vitamins-fat solube A, D, E, and K (structure, functions, effects of deficiency, and metabolism. Vitamins – water soluble: B1, B2, niacin, B5, B6, folacin, B12, biotin, C (structure, functions, effects of deficiency, and metabolism. Minerals: sodium, potassium, calcium (functions, effects of deficiency, and metabolism of minerals. Minerals: trace elements. Hormones structure (amino acid derivatives, peptide hormones, lipid derivatives). Hormone transport (free / bound). Hormones and stress (GH-RH simulates release of GH and ACTH). Hormones and behavior (reproductive hormones and adolescence). Hormones and ageing (lower hormone secretion, dcreased tissue response to hormones). Hormones and growth (GH, T3 & T4, insulin, PTH, androgens, estrogens). Mechanisms of hormone action (activation of genes to synthethise enzymes of protein, turn on/off existing enzymes, increase/decrease rate of synthesis of enzymes or protein). Hormone receptors (membrane, intracellular). Control of hormone activity (negative feedback, hypothalamic regulatory hormones, hypothalamic hormonal secretions). Hormone interactions (antagonistic, synergistic, permissive, integrative). Hemoglobin (structure, functions, metabolism). Nucleic acids (structure, functions, catabolism, synthesis). High energy molecules: ADP & ATP (structure and function)
[2] Levels of organization (molecular, cellular, tissue, organ, and organ system). Over view of components and functions of various tissues (epithelial, connective, and membranes). Over view of components and functions of organ systems (cardiovascular, hematogenous, respiratory, alimentary, excretory, immune protection, musculoskeletal, intergumentary, sensory, nervous, endocrine, reproductive). Anatomical descriptive terms (major surface anatomical landmarks of the body. Major body regions as described from the surface. Body cavities: ventral, dorsal, cranial, and spinal). Description of directions (superior/inferior, cranial/caudal, posterior/anterior, lateral/medial, proximal/distal). Description of planes (sagittal, frontal, transverse).
[3] Diversity/differentiation/classification (somatic vs sex cells. structure according to tissue/function). Cell membranes (cell & nuclear), Cytosol (cytoplasm and organelles). Non-membranous organelles (cytoskeleton, microvilli, cilia., ribosomes). Membranous organelles (endoplasmic reticulum: rough & smooth, Golgi apparatus, lysosomes, perixisomes, mitochondria). Nucleus (nucleolus, chromatin, chromosomes, genes). Cell membrane transport (diffusion, osmosis, filtration, carrier-assisted, endocytosis, phagocytosis, exocytosis). Protein synthesis. Energy (ATP). Cell movements (ameboid, ciliary). Cell metabolism. Cell respiration. Membrane transport (active, passive). Normal cell growth (differentiation, multiplication / replication). The cell life cycle (Interphase - G1, S, G2; & mitosis - prophase, metaphase, anaphase, & telophase). Meiosis. Apoptosis. Regulation of the cell life cycle (M phase promoting factor, growth factor). Chromosomes (autosomal, sex-linked, karyotype, locus). Alleles (homozygous vs heterozygous, dominant, incomplete dominant / recessive, codominance, penetrance and expressivity). Punnet square. Simple inheritance. Polygenic inheritance. Genes and the genetic code. Nucleic acids (DNA, RNA, mRNA, tRNA, rRNA). DNA (Replication. Transcription. Translation. Repair, recombination, RNA-dependent synthesis). RNA (DNA-dependent synthesis). Genetic control of protein synthesis (genetic code, protein synthesis and ribosomes, post translation modifications). Gene activation (operon, promoter. repressor). Recombinant DNA technology.
[4] :Homeostasis. Autoregulation vs extrinsic regulation. Negative feedback loop (receptor – controlling center – effector – receptor). Body fluid components (extracellular: interstitial & plasma, intracellular). Methods of measuring fluid volumes. Control of body fluids (water intake, renal excretion: osmotic / electrolyte controls, anti-diuretic hormone, aldosterone, atrial natriuretic peptide). Water gain (alimentary system, small quantity of metabolic generation). Water loss (renal excretion, sweating, respiratory losses). Gain of electrolytes (food, drink). Loss of electrolytes (urine, sweat, feces). Sodium balance (absorption from digestive tract, excretion in kidney). Potassium balance (digestive intake, urinary loss). Calcium balance (bone resorption, dietary intake, urinary loss, loss in bile and feces). Magnesium balance. Phosphate balance. Chloride balance. Gain of H+ ions (metabolic acids). Loss of H+ ions (renal, lung excretion of carbon dioxide). Plasma control of pH by buffer systems (bicarbonate, ammonia, phosphate, proteins). Respiratory regulation of pH (carbon dioxide expiration). Renal control of pH (tubular secretion / reabsorption of H+, tubular reabsorption / reabsorption of bicarbonate). Bioenergetics and thermoregulation: terminology (heat balance, energy balance, temperature regulation: bioenergetics / calorimetry). The laws of thermodynamics. The concept of entropy. Whole Body Metabolic Rate (definition, factors, measurement by indirect calorimetry under basal conditions). Normal body temperature. Mechanisms of heat loss / transfer (radiation, conduction, convection, evaporation, sweating). Brain control of heat loss / gain (heat-loss and heat-gain centers in the pre-optic area of the anterior hypothalamus). Methods of excessive heat loss (sweating, vasodilation to increase skin blood flow, increase in respiration). Methods of heat conservation (vasoconstriction, piloerection, abolition of sweating, increase heat production, shivering thermogenesis, epinephrine mediated increase in glycogenolysis, thyroxine induced increase in catabolism of carbohydrates and other nutrients, stimulate cellular metabolism, increased thyroxine). Regulation of food intake (hunger and satiety centers. Overweight and obesity).
[5] Getting consent. Socio-demographic information (age, race, marital status, occupation, education). Past medical history. Social history. The 4 Ds (discomfort, disfigurement, disability, and death). Pain: site and radiation. Pain: severity (verbal scale: none, mild, moderate, severe; vertical analog scale: None-0 cm, worst possible 10 cm). Pain: nature. Pain: duration. Pain: precipitating factors. Pain: relieving factors. Pain: aggravating factors. Pain: associations. Fever / rigors (high temperature, rigors, sweating, headache, delirium, muscle pain, recurrent fever, rash, neck stiffness, lymph node enlargement, eyes, mouth, ears, sinuses, joints swelling, travel history, personal history, social history, contact with infected person, contact with animals, insect bite, untreated water, raw / uncooked food, fresh water swimming, sexual contact). Malaise. Tiredness. Lightheadedness. Weight loss. Pallor of membranes. Bleeding (Site. Duration. Family history. Drugs. Medical history).
[6] General principles (inspection, palpation, percussion, auscultation). Basic physical examination for vital signs (pulse rate, respiratory rate, blood pressure, temperature measurement). Anthropometric examination for nutritional status (body weight, body mass index, triceps skinfold thickness, grip strength). Examination of a lump: breast & lymph node (position, location, shape, size, temperature, tenderness, surface discoloration, mobility, consistency, dullness, resonance, trans-illumination, vascular swellings). Nutritional assessment (diet history, clinical exam, BMI, anthropometry, serum albumin, and specific nutrients). Nutritional / metabolic disorders (obesity, lipoprotein disorders, cholesterol, TG, PEM, porphyries, amyloidosis).
[7] Operational theater guidelines (asceptic techniques, scrubbing, gowning, donning gloves).
[8] Electrolytes, creatinine, and urea (Sodium, Potassium, Chloride, Creatinine & Urea). General health check (CBC, Glucose,Albumin, ALP, ALT, AST, Calcium, CO2, Chloride, Creatinine, Potassium, Sodium, Total Bilirubin, Protein, BUN, Lipid Profile,Uric Acid, GGT, TSH). Lipid profile (Total Cholesterol, HDL Cholesterol, LDL Cholesterol, Triglycerides, Total Chol/HDL Chol Ratio). Pre-operative profile (CBC / FBC, Blood grouping,Random Blood Sugar,HIV, HbsAg, HCV, RPR, BUN, ABO & Rh(D), HBsAg, RPR (with titre & TPHA if reactive), HIV I & II (Ag / Ab)). Comprehensive metabolic profile (Glucose,Albumin, ALP, ALT, AST,Calcium, CO2,Chloride, Creatinine, Potassium, Sodium,Total Bilirubin, Protein, BUNGlucose,Albumin, ALP, ALT,AST,Calcium, CO2,Chloride, Creatinine, Potassium, Sodium,Total Bilirubin, Protein, BUN). Insurance Medical Panel (FBE, Urea, Creatinine, Uric Acid, Glucose, ALP, AST, ALT, GGT, Lipid Profile (LIP), HIV I / II (Ag+Ab), HBsAg / HBsAb, Urine FEME). Pre-Employment Studies (Morphine and cannabinoids, Urine FEME, UPG (if female), HIV I/II (Ag/Ab), HBsAg, RPR (with titre & TPHA if reactive), Malarial parasites). Pre-marital Screen (Female): FBC, ABO & Rh (D), RPR (with titre & TPHA if reactive), Haemoglobin Analysis, HBsAg, HBsAb, Rubella IgG, HIV, HCV and Herpes IgG 1& 2
[9] The family institution (Gender. Family as a Natural Social Unit. Marriage. Parents and Relatives. Children). Community institutions (Masjid. Ukhuwwat. Takaful. Shuura. Maal). Community problems (Life-Style. Sexual Perversions. Addiction. Poverty. Violence). Community action (Dawa. Enjoining the good and forbidding the bad. Social change. Professional and Occupational Organizations. Social Welfare and Disaster Relief Organizations).
[10] Public Health Progams (Health Promotion, Health Protection, And Disease Prevention. Medical And Social Services. Environmental Protection). Public Health Strategies (Surveillance. Screening. Intervention. Evaluation. Economic Strategies With Impact On Health).
[11] RELIGIOUS BACKGROUND: Religion: Islam: Other creeds (milal). HISTORICAL BACKGROUND: Civilization: History of medicine. EPISTEMOLOGICAL BACKROUND: Theory Of Knowledge (epistemology). BASIC SCIENCES BACKROUND: Creation and afterlife. Transitions in the status of life. Transitions in the status of health. The human life cycle. The human organism (perfection, optimality, incomparability). Correlation of structure and function by organ systems:
[12] Success as a medical student. The nature of medical education. Towards developing a scientific culture.
[13] Introduction to Epidemiology. Introduction to biostatistics. Probability theory in science. Variables and distributions. The scientific method and hypothetico-deductive inference.
[14] Biological determinants of disease (age, gender, genetic). Behavioral determinants of disease (lifestyle, malnutrition). Environmental determinants of disease (infections and physical agents such as heat, cold, and radiation, air pollution, water pollution, soil pollution, ecopoisons, pesticides). Social determinants of disease (the socio-economic status, occupation, race, ethnicity, and medical care). Basic disease terminology (natural history, etiology, pathogenesis, sequelae). Basic abnormalities in disease conditions (genetic, physiological / biochemical, structural). Causes of cellular injury (trauma, toxins, infection, immune reaction, nutrition, chemical and physical agents, genetic, endocrine, anoxia). Pathological processes at cellular levels (necrosis, apoptosis, adaptation). Theories of cell aging (programmed aging, DNA repair defects, degeneration of the extracellular matrix, free radical damage, protein catabolic inefficiency, cumulative injury). Sub-lethal cell injury (reversible, structural damage to mitochondria, swelling of organelles, fatty change). Sites of cellular damage (cell membrane, mitchondria, cytoskeleton, DNA). Molecular basis of cell necrosis (reactive oxygen metabolites, ATP loss, and free calcium in the cytosol). Nuclear changes (pyknosis, karyorrhesis, karyolysis). Proteins released from dead cells can be detected in serum. Patterns of cell necrosis (coagulative, liquefactive, caseous, gummatous, hemorrhagic, fat necrosis, fibrinoid). Cell apoptosis. Functions of cell apoptosis (elimination of excess cells in embryological growth, elimination of cells no longer needed eg endometrial, clonal selection, elimination of older cells where a high turnover is needed eg epithelial cells, elimination of cells infected by viruses, elimination of cells with DNA damage, elimination of neoplastic cell). Cell apoptosis (induction, effector, degradation, phagocytosis). Cell metabolic adaptations to injury (increased activity, decreased activity, change cell morphology). Cell growth adaptations to injury (atrophy, hypertrophy, involution, hyperplasia, metaplasia, agenesis, aplasia, dysgenesis, hypoplasia).Cell growth factors (epidermal growth factors, colony stimulating factors, interferons, plateler derived growth factors, fibroblast growth factors, TGBF growth factors, interleukin growth factors, erythropoietin, nerve growth factor, ciliary neurotrophic growth factor). Tissue reaction to injury / pathological processes at tissue level (inflammation, genetic disorders, infection, immunity, and neoplasia). Tissue damage causing cell death is followed by acute inflammation. Acute inflammation follows cellular death. Acute inflammation – consequences (regeneration, healing by repair forming scar tissue, or chronic inflammation). Types of inflammatory response (acute inflammation, chronic inflammation, granulomatous inflammation). Cardinal signs of acute inflammation (rubor, calor, dolor, tumor). Contents of the inflammatory exudate (fluid & electrolytes, fibrin, neutrophil polymorphs, macrophages, lymphocytes). Cellular mediators of acute inflammation (histamine, prostaglandins, leukotrienes, platelet activating factor, cytokines, nitric oxide, chemokines). Plasma mediators of acute inflammation (bradykinin, activated Hageman factor, plasmin, complement pathway: C3a, C3b, and C5a). Clinical manifestations of acute inflammation (malaise, fever, pain, raised pulse rate). Laboratory manifestations of acute inflammation (raised neutrophils, raised ESR, raised acute phase proteins espp C-reactive protein). Organ injury and reaction (wound healing, thrombosis, embolism, edema).
[15] Concepts (Epidemiological Characterization. The Agent: Micro-Organism. The Host. The Disease. Control and Prevention of Communicable Disease). Interaction with the microbiological environment (infection and immunity). Classification, structure, epi1emiology, and infections of common bacteria, viruses, fungi, protozoa, and helminthes. Barriers to bacterial invasion (skin, IgA, secretions eg respiratory, bacterial commensals eg in vagina and gut). Spread of infection in the body (local, lymphatic, hematogenous, tissue fluids, neural). Bacterial pathogenicity (exotoxins, endotoxins). Granulomatous bacterial infections (mycobacterium tuberculosis, mycobacterium leprae, syphilis, yersinia enterocolitica). Outcome of viral infections(cell necrosis, cell proliferation, and latent infection). Common bacterial infections: S.aureus (acute gastroenteritis, toxic shock syndrome, scalded skin syndrome). S.pyogenes direct infection (impetigo, erysipelas, cellulites, necritising fascilitis, pharyngitis, laryngitis, puerperal sepsis). S.pyogenes toxic/immunological infection (scarlet fever, acute glumerulonephritis, rheumatic fever). S. pneumonae (acute otitis media, pneumonia, meningitis). S. viridans (endocarditis). S.bovis (endocarditis). N. gonorrhea. N. meningitides. C. diphtheraae. Bacillus cereus (vomiting and diarrhea). Bacillus anthracis (anthrax). Cl. perfringes (gas gangrene). Cl. Tetani (tetanus). Cl. Botulinum (botulism). Listeria monocytogenes (neonatal meningitis, abortion). E.coli (urinary tract infection, neonatal meningitis, diarrheal diseases). Proteus spp (wound infections, atypical pneumonia, otitis media, mastoiditis). Salmonella spp (diarrhea). Shigella spp (diarrhea). V. cholerae (diarrhea). Y. enterocolitica (enterocolitis). Y.pestis (plague). Campylobacter jejuni (diarrhea). H.pylori (gastritis, duodenal ulcer). H. influenzae (meningitis in children). Mycobacteria spp (tuberculosis and leprosy). Tr pallidum (syphilis). Leptospirosis (septicemia and liver failure). Borrelia burgdorferi (lyme disease). Legionella pneumophilia (legionnaire’s disease). Chlamydia trachomatosis types D-K (cervicitis, urethritis, salpingitis, PID, epididymo-orchitis, Reiter’s syndrome). Chlamydia trachomatosis type L (LGV). Chlamydia psitaccosis (pneumonitis). Chlamydia pneumonae (atypical pneumonia). Bartonella henselae (cat scratch fever). Rickettsia spp. Common fungal infections: C.albicans (oral thrush, vulvo vaginitis, endocarditis). Aspergillus fumigatus (opportunistic infection). Aspergillus niger (otitis externa). Cryptococcus neoformans (pneumonia and meningitis), Histoplasma capsulatum (lung lesions). Coccidioidiomycosis. Blastomycosis. Pneumocitis carinii. Common viral infections (Parvoviruses, Papovaviruses, Adenoviruses, Hepadnaviruses, Herpes viruses, Pox viruses, Orthomyxo viruses, Paramyxoviruses, Picorna viruses, Rhabdoviruses, Togaviruses, Arenaviruses, Retroviruses). Common protozoan diseases (Malaria, Amebiasis, Trypanosomiasis, Leishmaniasis, Toxoplasmosis, Trichomoniasis, Giardia lamblia, Crytptosporodiosis). Common helminthic diseases (Schostosomiasis, Teniasis, Echinococcus, Ascaris spp, Ancylostoma spp, Toxocariasis, Pinworm - enterobius). Anti-bacterial drugs. Anti-viral drugs. Anti-fungal drugs. Anti-protozoal drugs. Anti-helminthic drugs. Anti-neoplastic drugs.
[16] Common teratogens (drugs and chemicals, ionizing radiations, microbial infections, genetic/chromosomal abnormalities). Methods of molecular genetic investigation (restrictive analysis and Southern blotting, polymerase chain reaction, linkage analysis). Chromosomal abnormalities. Karyotype analysis (cells from blood lymphocytes or skin fibroblasts and are cultured and stained to show chromosomes). Types of chromosomal abnormalities (number or structure). Forms of structural abnormalities (translocation, Robertsonian translocation, ring chromosomes, inversion, deletion, duplication). Chromosomal number anomalies (Down / trisomy 21, Patau / trisomy 13, trisomy 18 / Edward, X- / Turner, XXY / Klinefelter). Causes of chromosomal number anomalies (failure to separate / disjunction during meiosis or mitosis). Detection of chromosomal / genetic disorders (gene products, karyotyping, gene typing). Patterns of Mendelian single gene defect inheritance (autosomal dominant producing disease in both homo and heterozygous, autosomal recessive producing disease only in homozygous, sex linked recessive, sex linked dominant-very rare). Other genetic anomalies (polygenic, multifactorial, mitochondrial and not nuclear DNA). Examples of autosomal dominant diseases (achondroplasia, neurofibromatosis 1 & 2, familial poliposis coli, hereditary spherocytosis, Huntington’s disease, myotonic dystrophy, familial hypercholesterolemia, osteogenesis imperfecta, Marfan’s syndrome, Ehler’s-Danlos syndrome, retinoblastoma). Punnet squares for auosomal dominant inheritance. Examples of autosomal recessive diseases (cystic fibrosis, sickle cell anemia, thalassemia, glycogenoses, mucopolysaccharidoses, lipidoses, phenyketonuria, albinism, Wilson’s disease). Modifications of genetypic expression (non-penetrance). Punnet squares for autosomal recessive inheritance. Examples of X-linked recessive diseases (hemophilia A & B, G-6-PD deficiency, Duchenne muscular dystrophy, Becker muscular dystrophy, X-linked (Bruton) agammaglobuninemia, X-linked ichthyosis). Punnet squares for X-linked diseases. Examples of polygenic / multifactorial diseases that manifest as familial with abnormal gene unknown (hare lip, cleft palate, congenital heart malformations, psoriasis, diabetes mellitus, hypertension, atopic diseases, schizophrenia, manic depressive psychosis, rheumatoid arthritis).
[17] Mechanical injury (abrasions, contusions, lacerations, puncture wounds). Thermal injury (burns, heat cramps, heat exhaustion, heat stroke, hypothermia-frostbite). Radiational injury (acute and chronic effects). Electrical injury. Chemical injury (alcohol, drugs of addiction, metal poisoning).
[18] Primary immunodeficiency (X linked hypo gammaglobulinemia-sntibodies, thymic aplasia-T cells, severe combined immunodeficiency – B & T cells, chronic granulomatous disease-phagocytes, C2 & C4 deficiency- complement). Secondary immunodeficiency (old age, chronic malnutrition, metastatic malignancy, metabolic disease eg diabetes mellitus, drug therapy eg cytotoxics, splenectomy, HIV). Type I hypersensitivity reactions / excessive IgE response with release of histamine (analphylaxis, atopic dermatitis, allergic rhinitis, atopic conjunctivitis, extrinsic allergic asthma, food allergies). Type II hypersensitivity reactions / antibodies cause damage by attaching to cells (immune hemolytic anemia, antibody-induced thrombocytopenic purpura, antibody-induced neutropenia, pemphigus, Goodpasture syndrome). Type III hypersensitivity reactions due to deposition of antigen-antibody complexes activating complement. Type IV hypersensitivity reactions cell mediated due to sensitized T cells. Inappropriate immune response (organ-specific autoimmune disease (vitiligo, Grave’s disease, Hashimoto disease, Addison disease, type A gastritis, type 1 diabetes mellitus, myasthenia gravis). Non-organ-specific autoimmune disease (systemic lupus erythromatosis, progressive systematic sclerosis, polymyositis, dermatomyositis, rheumatoid arthritis). Antibodies used to diagnose autoimmune disease.
[19] Disorders of food and energy balance (overweight. obesity. marasmus. Kwashiorkor). Disorders of fluid balance (overhydration, edema, dehydration. Disorders of acid-base balance (acidosis-respiratory and metabolic; and alkalosis:respiratory and metabolic)
[20] Abnormal cell growth (mutation & neoplasia, hyperplasia, metaplasia, hypertrophy, and dysplasia). Characteristic of neoplastic cells. Clinical manifestations of neoplasia (weight loss, loss of appetite, fever, general malaise, anemia). Differences between benign and malignant neoplasms. Process of neoplasia (genetic change leading to a transformed cell which proliferates with poor growth regulation, atypical cells, and lack of differentiation). Chemical carcinogens (genotoxic, mitogenic, cytotoxic, direct acting, procarcinogens). Viral carcinogens (EBV, HBV,TLV-1, HSV-8). EBV as a viral carcinogen (Burkitt’s lymphoma, nasophayngeal carcinoma, other B cell lymphomas, some Hodgkin’s disease). HBV as a viral carcinogen (hepatocellular carcinoma). HPV as a viral carcinogen (cervical carcinoma, some skin cancer). TLV-1 as a viral carcinogen (T cell leukemia / lymphoma). HSV-8 as a viral carcinogen (Kaposi sarcoma). Irradiation as a carcinogen (DNA breaks and DNA instability). Hormones as carcinogens (breast, prostate, vaginal cancers). Chemical carcinogens. Stages of chemical carcinogenesis (initiation, promotion, progression). Causes of genetic change (point mutation, gene amplification, chromosomal rearrangement resulting in inappropriate gene stimulation). Types of oncogenes (proto-oncogenes, viral oncogenes, and cellular oncogenes). Effects of the oncogene stimulation (growth factors, growth factor receptors, signal transduction, transcription regulation, DNA repair). Tumor suppressor genes. Genes that regulate DNA repair. Causes and regulators of tumor angiogenesis (vascular endothelial growth factor, basic fibroblast growth factor, angioproteins, and anti-angiogenesis factors). Grading of a tumor (degree of differentiation, pleomorphism, mitotic figures). Spread of malignant cells (local invasion, lymphatic spread, vascular spread, transcoelomic spread). Staging of tumors/ TNM and others. Benign epithelial tumors (papilloma, adenoma). Malignant epithelial tumors (carcinoma, adenocarcinoma). Benign mesenchymal tumors (fibroma, osteoma, chodroma, lipoma, leiomyoma, rhabdomyoma). Malignant mesenchymal tumors (fibrosarcoma, osteosarcoma, chondrosarcoma, leiomyosarcoma, and rhabdomyosarcoma). Other tumors (lymphomas, malignant melanomas, leukemias, embryonal tumors, gliomas, germ cell tumors, teratomas, neuro-endocrine tumors, hamartomas, chorustomas). Tumor markers (alpha feto protein, human chorionic gonadotrophin, acid phosphatase, carcinoembryonic antigen, hormone products for endocrine tumors).
[21] Target proteins for drug binding (enzymes, carrier molecules, ion channels, receptors). Reciprocal drug-target specificity. Drug-receptor binding (binding followed by receptor activation, curves of binding vs concentration, affinity, efficacy, agonist, antagonist). Types of antagonism (chemical, pharmacokinetic, receptor block, non-competitive, physiological). Causes of drug resistance / desensitization / tachyphyllaxis / tolerance / refractoriness (change / loss of receptors, exhaustion of mediators, increased metabolic degradation, physiological adaptation). Receptor proteins (Type 1: ligand gated ion channels, Type 2: G protein coupled receptors, Type 3: kinase linked receptors, Type 4: nuclear receptors). Disease related to receptors (autoantibodies against receptor proteins, mutations in genes coding for receptor proteins). Regulation of cell function by calcium. Regulation of cell function by comudulin. Sodium channels. Potassium channels. Pharmacological research (bioassay, animal models, clinical trials). Therapeutic index. Number needed to treat. Transport of drug molecules (across cell barriers, binding to plasma proteins). Drug disposition / fate (absorption from administration site, distribution in the body, metabolism, excretion). Routes of drug administration (oral, sublingual, rectal, epithelial surfaces, inhalation, injection: im, sc, iv). Stages of drug metabolism (1: catabolism, 2: anabolism / synthesis /conjugation, 3: induction of microsomal enzymes, first-pass / pre-systemic metabolism, pharmacologically actie drug metabolites). Excretion of drug metabolites (kidney, hepatobiliary system, lungs). Drug elimination measured as clearance. Pharmaco kinetics (what the body does to the drug). Pharmacodynamics (what the drug does to the body). Transmitters in the autonomic nervous system (acetylcholine, nor adrenaline, others). Cholinergic receptors (nicotinic and muscurinic). Events at the synapse. Drugs acting at the synapse (pre or post). Adrenergic receptors (alpha and beta, agonists and antagonists). Anti-inflammatory drugs (non-steroids, histamine antagonists, anti-gout, anti-rheumatoid, immunosuppressive). Therapeutic agents (classes, properties, kinetics, mechanisms of action, and therapeutic uses of pharmacological agents, metabolism, drug interactions, adverse drug reactions, writing and reading drug prescriptions). Risk-benefit considerations in drug therapy. Adverse drug reactions. Drug interactions. Drug nomenclature. Types of poisons (chemicals, pesticides, drugs of abuse). Poisoning by pharmaceutical agents (analgesics, cardiotoxic drugs, anti-malarials, anti-diabetic agent). Drugs of misuse (cannabis, benzodiazepins, crack/cocaine, ecstasy / amphetamine, gamma hydroxybutyrate-GHB, LSD). Poisoning by chemicals and pesticides (carbon monoxide and smoke, organophosphorus insecticides, carbamate insecticides, aluminium and phosphide,). Venoms (snake bitesm scorprion bites, and spider bites).
[22] Reading a hematology laboratory report: full blood count (hemoglobin, packed cell volume, red cell count, mean corpuscular volume, mean corpuscular hemoglobin, white cell count: total & differential, platelet count, prothrombin time). Reading a biochemistry laboratory report (sodium, potassium, urea, creatinine, glucose, calcium, phosphate, bicarbonate, uric acid, total protein, osmolality, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, creatine phosphokinase). Reading a microbiology laboratory report (microscopy, Gram stain, culture and sensitivity). Reading an imaging report: Plain x-ray (femur, abdomen, thorax). X-ray with contrast media. Computer tomography. Ultrasonography. Radionuclide imaging / scintigraphy. Positron emission tomography. Magnetic resonance imaging. Writing and reading a drug prescription.
[23] Taking a swab for microbiological examination (throat, cervical)
[24] Fever profile (CBC, ESR, MP,WIDAL, CRP,Urine Routine). Urine toxicology screen (Alcohol, Amphetamines, Barbiturates, Benzodiazepines, Cannabinoids, Cocaine, Opiates). Cancer markers (male) (AFP, Ca 19.9, CEA, PSA, HCG). Cancer markers (female): (AFP, Ca 15.3, Ca 19.9, Ca 125, CEA, HCG). Febrile studies + dengue (FBE, Malarial parasites, Urine FEME, WWF (Widal & Weil Felix), Monospot, IgG and IgM antibodies). Heavy metal screen (Cadmium (Cd), Chromium (Cr), Lead (Pb), Arsenic (As), Mercury).
[25] Disease classification, description, measurement, diagnosis, and prognosis (Classification of Disease, Disease Description, Disease Measurement, Disease Diagnosis, Disease Prognosis). Disease control and prevention (Concepts of Control, Eradication, and Prevention. Preventive Medicine: Legal Basis. Preventive Medicine: Moderation, Balance and Equilibrium). Disease surveillance (Definition, history, objectives, methods, scope, surveillance System, Data Collection, Analysis, and Interpretation). Disease screening (Definition, Objectives, Organization, and Benefits. Characteristics Of Disease & Screening Tests. Epidemiologic Evaluation of Screening Programs. Cost Benefit Analysis of Screening Programs).
[26] BASICS OF LAWS: Fundamentals of the Law: sources, purposes, theories. The Brunei civil and criminal justice system. The Brunei shari’at legal system.
THEORIES AND PRINCIPLES OF MEDICAL ETHICS: Theories of medical and biomedical ethics. Principles of medical and biomedical ethics. ISSUES OF CONSENT: Medical consent for competent patients. Medical consent for incompetent patients. PRIVACY, CONFIDENTIALITY AND DISCLOSURE: Privacy, confidentiality, disclosure. RESEARCH: Research policies and procedures. Animal research. Human research
[27] Character and behavior. Self Development and personality enhancement. Intellectual development. Social development. Skill development. Professional development
[28] Introduction to computers. Data storage and retrieval. Data presentation as diagrams. Discrete data summary. Continuous data summary I: averages. Continuous data summary II: measures of variability (based on the mean; based on the median, the range, other measures of variability)
[29] MICROSCOPIC ANATOMY / HISTOLOGY: The heart (epicardium, myocardium, endocardium, Purkinje fibers, valves). DEVELOPMENTAL ANATOMY: Heart primordium forms in the cardiogenic area cranial and lateral to the brain . A lateral endocardial tubes form and in the 4th week migrate to the thorax where it the fuse to form the primitive heart tube. In weeks 5-8 the tube folds, remodels, and septates to form the 4 heart chambers. Valves form from heart muscles). MACROSCOPIC ANATOMY: Heart (superficial anatomy, epicardium, myocardium, endocardium, atria, ventricles, septa, valves, fibrous skeleton, blood supply, coronaries). PHYSIOLOGY: The heart as a pump & the cardiac cycle (chambers, valves). Heart sounds. Electrical events in the cardiac cycle (SAN, VAN, AV bundle, Purkinje system, the normal ECG). Regulation of the cardiac cycle (Frank Sterling law: force is proportional to stretching; sympathetic and parasympathetic nervous impulses, effect of ions). Physics of circulation /cardiodynamics (Cardiac output = stroke volume x heart rate;. Factors of stroke volume (EDV, ESV). Factors of heart rate (autonomic activity and circulating hormones). Cardiac output (measurement, regulation, effect of exercise). PHARMACOLOGY. Drugs acting on the heart (autonomic transmitters and related drugs, anti-arythmic drugs, drugs that increase myocardial contraction, and anti-anginal drugs).
[30] MICROSCOPIC ANATOMY: Arteries, arterioles, and veins (emdothelium, tunica intima, tunica media, and tunica adventitia). Differences between arteries and veins. Blood capillaries (continuous vs fenestrated endothelium). Lymphatic vessels (valves). DEVELOPMENTAL ANATOMY: Vasculogenesis (blood vessels form in the yolk sac on the 17th day). Development of arteries (aortic arches and great arteries). Development of veins (vitelline, umbilical, cardinal venous systems). Coronary circulation. Changes at birth. MACROSCOPIC ANATOMY: Components of the circulatory system. Blood vessels (arteries, veins, capillaries, and lymphatics, difference between arteries and veins). Types of circulation (systemic, pulmonary, fetal). Lymphatic system (lymphatic vessels, lymph, and lymphoid organs). PHYSIOLOGY: Ohm’s law relating flow to pressure and resistance: vessel diameter. Vascular compliance (arterial vs venous). Arterial blood pressures (systolic, diastolic, elastic rebound). Measurement of blood pressure using Doppler flowmeters. The microcirculation & capillaries (Interstitial fluid exchange and lymph flow). Control of circulation (nervous, humoral, local vasodilation). Renal regulation of arterial pressure Renin-angiotensin system. Coronary circulation (normal changes, control). Factors of blood flow (vessel diameter, hematocrit, and vascular resistance). Capillary exchange (diffusion, filtration, reabsorption, osmotic pressure). Cardiovascular regulation (tissue autoregulation, neural mechanisms, hormones). Cardiovascular responses (hemorrhage and exercise. Venous return (pressures, valves). PHARMACOLOGY: Drugs that act on the vasculature / vasoactive (vasoconstrictors, vasodilators).
[31] MICROSCOPIC ANATOMY/HISTOLOGY: Erythrocytes, reticulocytes, granulocytes (neutrophils, esinophils, and basophils), mononuclear leukocytes (lymphocytes and monocytes), platelets, bone marrow. DEVELOPMENTAL ANATOMY: Hematopoiesis / hemopoiesis (hemocytoblast / pluripotential stem cells divide to produce myeloid stem cells and lymphoid stem cell. Lymphoid stem cells produce lymphocytes. Myeloid stem cells produce erythrocytes, platelets, basophils, esinophils, neutrophils, and monocytes). Erythropoiesis (stages of differentiation, effect of erythropoietin and tissue oxygenation, vitamin B12, vitamin B6, and folic acid). Synthesis of hemoglobin. Destruction of erythrocytes. MACROSCOPIC ANATOMY: Components of the hematogenous system. PHYSIOLOGY: Red blood cells /erythrocytes (structure & shape, life span). Hemoglobin (structure, function, metabolism, recycling). RBC antigens (A, B, & Rh / D, cross-reaction, cross matching). Functions of WBC (specific immune defence by lymphocytes and non-specific defence by neutrophils, esinophils, basophils, and monocytes). Plasma proteins (albumin, globulin, fibrinogen, hormones). Functions of blood (transport, pH regulation, electrolyte regulation, hemostasis, immune reaction by WBC, temperature stabilization). Hemostasis by vascular constriction. Hemostasis by platelet plug (platelet adhesion, platelet aggregation). Hemostasis by coagulation (clotting factors, intrinsic pathway, extrinsic pathway, common pathway, feedback and control). Regulation of clotting (anti-thrombin, fibrinolysis / plasmin). Neonatal physiological jaundice. PHARMACOLOGY: Drugs that act on the coagulation cascade. Anti-platelet drugs. Fibrinolytic drugs. Anti-fibrinolytic drugs. Anti-hemostatic drugs. Hematinic agents (iron and folate). Hemopoietic growth factors (erythropoietin and colony stimulating factors)
[32] MICROSCOPIC ANATOMY/HISTOLOGY OF CELLS AND TISSUES: Trachea, bronchus, bronchiole, alveolus, pleura, respiratory mucosa (pseudostratified ciliated columnar epithelium, areolar tissue, lamina propia). DEVELOPMENTAL ANATOMY: Development of the lungs (embryo folding followed by division of the intraembryonic coelomic cavity into primitive pericardial and peritoneal cavity. In the 5th weel the primitive pericardial cavity divides into the pericardial cavity proper and 2 pleural cavities). MACROSCOPIC ANATOMY: Components of the respiratory system. Upper respiratory tract (nose, nasal cavity, paranasal sinuses, pharynx). Lower respiratory tract (larynx, trachea, bronchi, bronchioles, and alveolar duct, alveolus). Lungs (apex, base, lobes). Pleural cavity and pleural membranes. PHYSIOLOGY: Functions of the respiratory system (gaseous exchange, sound production). Internal / cellular respiration. Pulmonary ventilation /external respiration (diaphragm and thoracic muscles, inspiration and expiration, respiratory muscles). Quiet breathing /eupnea (deep / diaphragmatic, shallow / costal). Forced breathing / hyperpnia. Lung pressures (intrapulmonary, intrepleural, pleural, intra alveolar). Dalton’s law and partial pressures. Henry’s law and diffusion between gas and liquid. Respiratory minute volume. Lung volumes (tidal volume, expiratory reserve volume, residual volume, inspiratory reserve volume). Lung capacities (inspiratory capacity, functional residual capacity, vital capacity, total lung capacity). Boyle’s law: relation between volume and pressure. Lung compliance (surfactant and lung connective tissue). Regulation of breathing (respiratory center, chemo-receptors: oxygen, hydrogen+). Alveolar ventilation. Alveolar oxygen / carbon dioxide exchange. Hemoglobin and oxygen transport. Pulmonary blood circulation. Respiration during exercise. Oxygen transport (the oxygen-hemoglobin saturation curve (effect of pH – the Bohr effect, effect of temperature, effect of BPG). Carbon dioxide transport (carbonic acid, hemoglobin binding, plasma transport). Local control of respiration (lung perfusion, alveolar ventilation). Brain respiratory control centers (respiratory centers in the medulla oblongata, apneustic and pneumotaxic centers in the pons). Respiratory reflexes (chemoreceptor reflexes, baroreceptor reflexes, Hering-Breuer reflexes). Voluntary control of respiration. PHARMACOLOGY: Drugs for asthma. Drugs for cough.
[33] Major manifestations of disease (Circulatory failure / shock, respiratory failure, disseminated intravascular coagulation). Breathlessness (common causes of dysnea p. 377, exertional dyspnea). Syncope / presyncope (exertional syncope). Palpitations (history of palpitations p. 400.) Sweating. Headache. Loss of consciousness. Diminished exercise tolerance. Chest / retrosternal pain (site of origin, radiation, character, provocation, pattern of onset, associated features, differential diagnosis, common causes p. 375). Fatigue. Hemoptysis. Stroke. Limb pains (intermittent pain in limbs, pain in limbs at rest). Limb gangrene. Family history. Lifestyle (exercise. diet. Smoking).
[34] Pallor. Coldness. Sweating. Cyanosis. Palpation of the precordium. Auscultation of the heart (normal and abnormal heart sounds p. 395, auscultatory features of heart murmurs p.396). Arterial pulse (rate, strength, large volume or collapsing, bounding peripheral pulse, Quincke’s sign-capillary pulsation in the nail bed, Durozirzis sign – fenoral bruit / pistol shot, de Musset’s sign – head nodding with pulse, regularity, change with respiration, radial-femoral delay). Jugular venous pulse-JVP. Blood pressure. Heart rate. Postural hypotension. Enlarged kidney. Abdominal bruits. Pedal edema. Ascites. Hepatosplenomegaly. Digital clubbing. Hypertensive retinopathy – grades. Features of chronic lower limb ischemia (p. 444), Features of acute lower limb ischemia (p. 446). Hematuria – microscopic.
[35] Anti-cardiolipin antibody (AntiCardiolipin Antibody IgA,IgG & IgM 8 : cardiolipin antibodies are useful in identifying patients with an increased risk of thrombosis, recurrent spontaneous abortions and phospholipid antibody syndrome. Cardiolipin antibody may be elevated in patients with SLE and related autoimmune disorders. AntiCardiolipin Antibody). Cardiac enzymes (CK, LDH, AST, CK-MB performed if CK is elevated). Coronary risk factors panel (Lipids – Cholesterol, Triglycerides, HDL and LDL, Total Chol / HDL Chol Ratio, High Sensitivity CRP, Homocysteine). Hypertension studies (Urea, Creatinine, Uric Acid, Glucose, Potassium, Sodium, Chloride, Total Cholesterol, HDL, LDL, Triglycerides, Total Cholesterol / HDL Ratio). NY Heart Association Functional classification (1,2,3,4). Plasma biomarkers of MI (creatine kinase, protein troponins (I and II), C-reactive protein). Urinary catecholamines. Plasma rennin.
[36] ECG recording using 12 leads. Taking venous blood. Inserting an iv cannula.
[38] Hb analysis (HbA, HbA2, HbF, HbH). Anemia profile (Iron, B12, Folate, TSH, CBC with indices, Reticulocyte Count, P.S. & ESR, Iron, Ferritin, Transferrin, TIBC, % Saturation, B12, Folate). Iron profile (Iron, TIBC, Ferritin, Iron Saturation Index, Transferrin). DIC profile (Platelet Count, CBC with P.S.,Thrombin Time, Fibrinogen, FDP, PT, APTT). Hemolysis profile (CBC, Coombs Test (Direct & Indirect),Reticulocyte Count; Hb Electrophoresis, Bilirubin, Haptoglobin, LDH). Clotting profile (coagulation profile) (Prothrombin Time, Platelets, PT, APTT, Platelet Count). Full blood examination (Haemoglobin (Hb), Haematocrit (PCV), Red Cell Count (RCC), MCV, White Cell Count, 5 part differential, Platelet Count, ESR, Film comment). Multiple Myeloma Follow-up Studies (Immunoglobulins A, G and M, Protein Electrophoresis, Urine Electrophoresis). Protein Electrophoresis (Total Protein, Albumin, Alpha 1 Antitrypsin, Alpha 2 Macroglobulin, Haptoglobin, Transferrin, Complement (C3), Paraproteins (if present), Gammaglobulin10ml GEL (white / yellow)). Thalassaemia (Haemoglobin, Haemotocrit, Red Cell Count, MCV / MCH, WCC (TWDC), 5 Part Differential Count, Platelet Count, FBC, Hb Analysis, Iron, Transferrin, TIBC, % Saturation, Ferritin). Thrombophilia Screen (Anti Thrombin III, Protein C, Protein S). Biochemistry (Hb-F and Hb-A2). Erytrocute resistance to osmotic lysis. Blood film (hemoglobinopathies. Malaria).
[39] Cough. Hemoptysis. Stridor. Expectoration. Breathlessness. Wheezing. Chest pain. Diminished exercise tolerance. Sleep disorders of breathing.
[40] Cyanosis. Pallor/anemia. Digital clubbing. Tar-stained nails. Symmetry of chest expansion. Indrawn intercostals. Paradoxical abdominal movements. Trachea central?. Pursed lip breathing. Wheeze. Breath sounds (crackle, rub). Chest percussion. Lung function tests. Peak flow curves.
[41] Life support(basic). Respiratory measurements (peak flow). Arterial gases and oximetry. Diffusing capacity. Lung cytology.
[42] CARDIOVASCULAR: HEMATOGENOUS: RESPIRATORY
[43] BEGINNING OF LIFE ISSUES: Prenatal / pre-implantation gender testing in IVF. Induced abortion (maternal disease, unwanted pregnancy, gender selection, congenital anomalies). STEM CELL TECHNOLOGY & EMBRYO/FETAL RESEARCH: Sources of embryos. Types of research that uses embryos. GENETIC TECHNOLOGY: Genetic therapy. Genetic banks and patenting issues. Human-animal hybrids. The Human genome project. Genetic testing. Genetic screening. Pre-implantation diagnosis. Genetic engineering and therapy. END OF LIFE ISSUES: Terminal illness. Diagnosis of brain death. Initiating / withdrawing artificial life support. Euthanasia. Physician assisted suicide. Solid organ transplantation. Post-mortem examination. Cadavers
[44] Concepts and theory of communication. Communication in small groups. Purposes and types of written communication. Special characteristics of medical/technical writing. Publishing a paper. Problems in writing. Public speaking. Dealing effectively with the mass media.
[45] Discrete data analysis; Continuous data analysis. Correlation analysis. Linear Regression analysis. Logistic Regression analysis. Time series analysis (patterns and trends, forecasting, longitudinal regression, autoregression, auto-correlation). Basics of survival analysis
[46] MICROSCOPIC ANATOMY/HISTOLOGY OF CELLS & TISSUES: General histological organization (mucosa, submucosa, muscularis externa, serosa). Esophagus Gastroesophageal junction. Stomach. Gastro-duodenal junction. Duodenum. Small intestine. Colon. Rectum. Appendix. Recto-anal junction. Exocrine pancreas. DEVELOPMENTAL ANATOMY: Stomach. Digestive glands. Spleen. Organization of the mesenteries. Folding and rotation of the midgut. Septation of the cloaca and formation of the anus. MACROSCOPIC ANATOMY: Components of the alimentary system (oral cavity, teeth, tongue, salivary glands, pharynx, esophagus, stomach, small intestine, large intestine, pancreas). Oral cavity (tongue, salivary glands, teeth). Pharynx. Esophagu. Peritoneum (visceral and parietal, mesenteries, lesser omentum, greater omentum. PHYSIOLOGY: General functions / processes of the digestive system (ingestion, mechanical processing, digestion, secretion, absorption, excretion). GIT wall muscles (muscle fibers functioning as a syntium, electrical activity). Neural control of GIT movements (enteric nervous system secreting neurotransmitters, autonomic control, hormonal control). GIT motility (peristalsis-propulsive and mixing movements /segmentation). Motor functions (chewing-mastication, swallowing-deglutition, esophageal emptying-lower sphincter, gastric storage, mixing in the stomach, stomach emptying, regulation of gastric activity, small intestine movements-mixing and propulsion, ileocecal valve, colon mixing-haustrations, colon mass movement, defecation-reflexes and sphincters). Changes in GIT blood flow. Oral secretion of saliva (serous and mucous). Gastric secretions (HCL, pepsinogen, intrinsic factor, cholecystokinin, gastrin-17, secretin). Pancreatic secretions (sodium bicarbonate, trypsin, chymotrypsin, carboxypolypeptidase, pancreatic amylase, pancreatic lipase, cholesterol esterase, phospholipase). Control of pancreatic secretions (by acetylcholine, cholecystokinin, and secretin). Small intestine secretions (mucus, peptidases, sucrase, maltase, isomaltase, lactase, intestinal lipase). Colon secretions (mucus, water, electrolytes). Digestion and absorption of carbohydrates. Digestion and absorption of proteins. Digestion and absorption of lipids. Mechanisms of absorption in the small and large intestines (water, ion, vitamins). PHARMACOLOGY: Drugs that inhibit / neutralize gastric secretions. Drugs that protect the gastric mucosa. Treament of H pylori. Emetic drugs. Anti-emetic drugs. Purgatives. Drugs that increase gastro-intestinal motility. Anti-diarrheal agents. Anti-spasmodic agents. Drugs used for chronic inflammatory bowel disease.
[47] MICROSCOPIC ANATOMY/HISTOLOGY OF CELLS & TISSUES: Liver (liver lobule, liver parenchyma, hepatocyte). Gall bladder. DEVELOPMENTAL ANATOMY: Endodermal buds sprout from the inferior end of the foregut to form the liver, gall bladder, and pancreas. MACROSCOPIC ANATOMY: Liver. Gall bladder. Bile ducts. PHYSIOLOGY: Metabolism. Liver secretion of bile and its excretion through the gallbladder. PHARMACOLOGY: Drugs that act on the biliary system.
[48] MICROSCOPIC ANATOMY/HISTOLOGY OF CELLS & TISSUES: Nephron (glomerulus). Renal corpuscle. Proximal convoluted tubule. Loop of Henle. Distal convoluted tubule. Collecting system. DEVELOPMENTAL ANATOMY: Ureteric buds branch from the mesonephric ducts to form the metanephric blastema. Differentiation within the metanephric blastema form nephrons. Bifurcation of the ureteric bud forms the urinary collecting system that empties into the bladder. The bladder is formed as the superior portion from the partition of the primitive urogenital sinus. The prostate and the urethra are formed from the constricted part of the primitive urogenital sinus. The definitive urogenital sinus forms the penis and the vestibule of the vagina. MACROSCOPIC ANATOMY: Components of the excretory system (kidney produces urine which is transported, stored, and eliminated by the ureters, the bladder, and the urethra). Kidney (renal cortex, renal corpuscle, glomerulus, convoluted tubule, collecting tubule, juxta glomerular apparatus, collecting tubule, collecting duct). Ureter. Badder. Urethra. PHYSIOLOGY: Physiological functions (filteration & reabsorption, micturition). Organic waste products (urea, creatinine, and uric acid). Process of urine formation (glomerular filtration, tubular reabsorption, tubular secretion, Loop of Henle and counter current exchange, collecting system). Control of urine volume and concentration (water reabsorption, ADH). Glomerular filtration pressures (hydrostatic pressure, colloid osmotic pressure). Glomerular filtration rate (determinants, and measurement). Regulation of GFR (autoregulation, hormones, autonomic). Renal blood flow (determinants, regulation, and measurement). Determining renal function by measurement of renal clearance (inulin, PAH). Micturition (filling of the bladder, micturition reflex, CNS inhibition of micturition). Tests of function (blood urea, serum creatinine, glomerular filtration rate). PHARMACOLOGY: Diuretics. Drugs that alter the pH of urine. Drugs that alter the excretion of organic molecules.
[49] Loss of appetite. Nausea. Dysphagia-Difficulty in swallowing. Smooth tongue. Dyspepsia. Indigestion. Abdominal pain (visceral, parietal, referred, psychohenic). Diarrhea. Constipation. Vomiting (frequency, bile content, food particles?, fresh blood?, coffee grounds). Bowel habits (constipation, diarrhea, tenesmus, steatorrhoea, melena). Abdominal fullness. Stool (color, consistency, blood).
[50] Inspection of the abdomen (abdominal wall movements, contour of the abdomen, surface markings, hernial defects). Palpation of the abdomen (masses, tenderness, rebound tenderness, guarding, liver spleen kidney, fluid thrill / shifting dullness). Percussion of the abdomen (fluid, dullness, resonance). Auscultation of the abdomen (bowel sounds, bruits, syccution splash). Rectal digital examination (masses, impacted stool). Anal examination (tags, hemorrhoids, polyps). Ascitic fluid (appearance p. 856, proteinm WBC, culture, cytology).
[51] Naso-gastric tube insertion.
[52] Nausea and vomiting. Pain. Pale stool. Jaundice, Itching. Bleeding tendency. Weight gain / loss. Clinical features of cholestatic jaundice (p. 845).
[53] Investigation of acute hepatic failure (p 847). Serological investigation of hepatitis (p. 863). Liver function tests (p. 836). Biochemical test for jaundice (p. 837). Coagulation tests. Specific etiological investigation of liver disease (p. 838). Profiles for cases: Acute hepatitis profile (HAV IgM, HBcAb IgM, HBsAg, HCV Ab). Auto-immune hepatic profile (ANA, ASMA, AMA). Autoimmune hepatic profile (Glucose, Calcium, CO2, Chloride, Creatinine,Potassium, Sodium, BUN). Chronic hepatitis serology (HBeAb, HBsAg, HBeAg, HCV). Hepatic function profile (PT, Albumin, Bilirubin (Indirect,Direct & Total), GGT, Total Protein, Globulin, AST (SGOT), ALT (SGPT), GGT (Gamma Glutamyl Transferase), ALP (Alkaline Phosphatase), Bilirubin, Cholesterol). Hepatitis B activity (Bilirubin - total & direct, LFT, HBsAg). Hepatitis B carrier status (HBsAg, HBeAg & HBeAb, ALT). Hepatitis B follow-up studies (ALT, AFP, HBsAg & HBsAb, HBeAg & HBeAb). Hepatitis B screen (HBsAg & HBsAb). Hepatitis diagnostic studies (ALP, AST, ALT, Bilirubin, HAV IgM Antibody, HBsAg, HBc IgM (if HBsAg is positive), Hep C Antibody). Hepatitis pre-immunization studies (HBsAg & HBsAb, HAV IgG, HBs Ag + HBsAb, HIV I & II, HCV Ab).
[54] Pain: loin / suprapubic. Fever. Micturition (polyuria, anuria, polyuria, oliguria, dysuria, nocturia, hematuria, pyuria, poor stream, hesitancy, incomplete emptying, dribbling and incontinence). Urinary retention. Loin pain / tenderness. Ureteric colic. Edema.. Neurogenic bladder (atonic due to LMN, hypertonic due to UMN. Cortical).
[55] Renal profile (Glucose,CBC,24hr Urinary Protein, Creatinine Clearance, Calcium, CO2, Chloride, Creatinine, Potassium, Sodium, BUN, Magnesium, Albumin, Phosphorus, Protein, 24 Hr Creatinine). Haemodialysis profile (ECU, Albumin, ALP, Phosphate, Calcium, Haemoglobin, Hb, RBC, WCC, Platelet Count, PCV, MCH / MCV, MCHC, Sodium, Potassium, Chloride, Urea, Post Urea, Creatinine, Calcium, Corrected Calcium, Phosphate, Total Protein, Total Bilirubin, ALT, Serum Iron, TIBC, Transferrin, HBsAg, HBsAb, HCV, Total Cholesterol, Triglycerides, HDL Cholesterol, LDL Cholesterol, Total Chol / HDL Chol, HbA1c, HIV, VDRL, Serum Ferritin). Renal Function Test (Sodium, Potassium, Chloride, Urea, Creatinine, Calcium, Phosphate, Uric Acid). Renal Follow Up (Albumin, Urea, Creatinine, Calcium, Phosphate, Uric Acid, Total Protein, Creatinine Clearance, Urinary Protein, Urinary Calcium, Urinary Phosphate). Renal Profile (Electrolytes + Urea, Albumin, Phosphate, Calcium).
[56] GASTRO-INTESTINAL. HEPATOBILIARY. EXCRETORY
[57] OCCUPATIONAL HEALTH ISSUES: Pre-employment testing. Testing during employment. PUBLIC HEALTH INTERVENTIONS: Public health measures in an epidemic without consent. HIV, HIV prevention. HIV: discrimination in employment, immigration, and healthcare. Vaccination / immunization:cost benefit analysis). CIVIL TRANSACTIONS: Health-related ethico-legal issues in marital contracts. Divorce & annulment. Inheritance. Endowments & gifts. JUDICIAL TRANSACTIONS: legal competence: ahliyyat
[58] Nature and purpose of win-win negotiation. Negotiation strategies. Negotiation tactics Management of a negotiation session. Difficult negotiations
[59] Measures of incidence (incidence number, incidence rate, cumulative incidence, surrogate measures). Prevalence (point prevalence, period prevalence, lifetime prevalence, uses of prevalence, limitations of prevalence for etiological studies, relation between prevalence and incidence). Rates & proportions (crude, specific, and standardized).. Measures of excess disease occurrence (OR, RR, RD, and AR; difference between OR and RR, concept of the null value).
[60] MICROSCOPIC ANATOMY/HISTOLOGY: CARTILAGE: Cartilage types (hyaline, fibro, and elastic). Cells (chondroblats and chondrocytes). BONE: Bone cells (osteoblasts, osteocytes, and osteoclasts). Bone matrix (calcium phosphate, collagen fibers). Bone layers (articular cartilage, periosteum, compact bone, cancellous / spongy bone, endosteum, medullary cavity). DEVELOPMENTAL ANATOMY: Upper limb buds develop from somites in the lower cervical region. Lower limb buds develop later from the lumbar region somites. Apical ectodermal ridges and mesodermal core. Hand and foot plates. Appendicular skeleton. Ossification (intramembranous & endochondral, ossification centers). Calcification. Bone growth and remodeling. MACROSCOPIC ANATOMY: BONES: Classification of bones by shape (long, short, flat, irregular, sesamoid, sutural). Parts of a long bone (diaphysis, epiphysis, metaphysic, marrow cavity, cortex). Bone blood and nerve supply. The skull (cranial bones, foramina and fissures, the orbit, the nasal complex). The vertebral column (pelvic girdle, regions, curvatures, structure of the vertebrum). The thoracic cage (ribs, sternum). Pectoral girdle and upper limb (clavicle, scapula, humerus, ulna, radius, carpals, metacarpals, phalanges). Pelvic girdle and lower limb (hip bone, femur, patella, fibula, tibia, tarsals, and metatarsals). JOINTS: Joint moveability (synarthroses, amphiarthroses, and diarthroses). Joint movements (linear/gliding, angular, abduction, adduction, circumduction, rotation, inversion, dorsiflexion, plantar flexion, protraction, elevation, depression, lateral flrxion). Synovial joints (gliding, hinge, pivot, ellipsoid, saddle, ball-and-socket). Intervertebral disc and vertebral movements. Special joints (shoulder, elbow, hip, and knee). PHYSIOLOGY: Functions of the skeletal system (support, storage of minerals, hematogenesis, protection, movement). PHARMACOLOGY: Drugs used in bone disorders.
[61] MICROSCOPIC ANATOMY/HISTOLOGY: Microanatomy of muscle fibers (sarcolemma, sarcoplasm, transverse tubules, myofibrils: that are bundles of myofilaments of actin and myosin, sarcoplasmic reticulum, sarcomeres). DEVELOPMENTAL ANATOMY: Development of musculature from the mesoderm. MACROSCOPIC ANATOMY: Classification of muscles (skeletal, smooth, and cardiac). Muscle structure (epimysium, perimysium, endomysium, tendon, aponeurosis). Origin, insertion, and functions of various muscles (shoulder and upper limb muscles, pelvic girdle and lower limb muscles, vertebral column muscles, rectus muscles). PHYSIOLOGY: Contraction / relaxation of muscles (sliding filament theory, neuromuscular junction, muscle tension). PHARMACOLOGY.
[62] MICROSCOPIC ANATOMY/HISTOLOGY: Epidermis (layers and cells). Dermis (layers). Hypodermis/subcutis. Skin appendages / accessory structures (nail, sebaceous glands, sweat glands). DEVELOPMENTAL ANATOMY: Skin. Hair. Epidermal glands. Nails. Teeth. MACROSCOPIC ANATOMY. PHYSIOLOGY: Skin color. Skin circulation. Skin innervation. PHARMACOLOGY.
[63] MICROSCOPIC ANATOMY/HISTOLOGY: T lymphocytes (cytotoxic T cells, helper cells, suppressor cells). B lymphocytes / plasma cells – produce antibodies. NK cells / large granular lymphocytes. Lymph node. Thumus. DEVELOPMENTAL ANATOMY: Hemocytoblasts produce lymphoid stem cells. Lymphoid stem cells produce B cells and NK cells or migrate to the thymus where they produce T cells. MACROSCOPIC ANATOMY: Lymphoid organs (lymph nodes, thymus, spleen). PHYSIOLOGY: Non-specific defenses (physical barriers, phagocytes, NK cells and immunological surveillance, interferons, complement system, inflammatory response, fever). Specific defenses (T cells / cell mediated and B cells antibody-mediated). Innate immunity. Acquired immunity (cellular and humoral). Forms of specific acquired immunity (passive-natural, passive-induced, active-natural, active-induced). Cell mediated immunity (cytotoxic T cells, helper T cells, and suppressor T cells, antigen activation of T cells). Humoral antibody mediated immunity (antigen activation, primary and secondary response). Hormones of the immune system (interleukins, interferons, tumor necrosis factors, etc). Allegy and hypersensitivity. Blood groups (ABO & Rh: transfusion. Immune response and stress. Immune response and aging. PHARMACOLOGY
[64] Arthralgia. Instability. Movements (restricted and resisted). Swelling. Stiffness. Deformity. Crepitus. Pain (back, joint, neck, bone, muscle). Stress pain. Cramps. Myalgia. Initial screen (gait, arms, legs, spine). History of self-dressing. History of walking up and down stairs. Stiff hand. Frozen shoulder. Contracture. Carpal tunnel syndrome.
[65] Inspection of limbs (scars, muscle wasting). Palpation of limbs. Measuring length of limbs. Movements of limbs (flexion, adduction, abduction, rotation). Inspection of the knee (scars). Palpation of the knee (tenderness). Movements of the knee (flexion, extension, rotation). Movements of the spine (flexion, lateral flexion, straight leg raising,). Examination of the elbow & forearm: (Inspection, pronation, supination). Examination of the hand (inspection. Extension, Adduction. Abduction. Sensation). Swollen leg (p.909). Assessment of muscle weakness (p. 1137). Muscle wasting. Charcot joints. Tennis elbow. Golfer’s elbow.
[66] Acute phase response (ESR, CRP, cytokines). Rheumatoid factors. Antinuclear antibody. Synovial fluid analysis. Serum creatine kinase. Serum PTH. Serum alkaline phosphatase. Arthritis profile: Uric Acid, ANA, CRP, RA, CCP,ESR, WCC & Diff, ESR, ASOT, ANF, RPR (with titre & TPHA if reactive), Rheumatoid Factor
[67] Pruritis (itch). H/o pruritis (time worse, localization, exacerbating facors, alleviating factors, family, general health). H/o rush (drugs? Where did it start?, evolution. Itchy? Preceding illness. Any syetemic symptoms, h/o photosensitivity in relation to sun exposure). ). Hair loss. Photosensitivity. Blisters. Leg ulcers. Hair (too much. Too little). Hair (alopecia, hirsuitism). Xeroderma=dry skin. Classification of eczema p. 1072. The exzema reaction p. 1072. H/o drugs. Family h/o of skin disorders. Occupation.
[68] Examination of an ulcer: (site, size, shape, floor, base, edge, surrounding skin, regional lymph nodes). Examination of a rash (macular / maculo-papular, maculo-squamous eruption / scaly. hemorrhagic, urticarial, vesicular/pustular, nodular, erythematous, chancrous). Plamar telengiectasia. Palmar erythema. Bruises, Purpura. Collateral vessels. Variceal bleeding. Skin Pigmentation (albinism & hypermelanosis). Vitiligo.. Grey hair. Mole. Erythroderma. Urticaria. Drug eruptions (p. 1100). Skin reactions in systemic disease (p. 1097). Nail disoders (koilonynchia, clubbing)). Clinical features of a scaly rush (p. 1161).
[69] Injection (im, iv, sc, id). Wounds (cleaning, dressing, and simple suturing, close wound using steri strips). Excising a lesion. Malignant mole (asymmetrical, irregular border, irregular color, diameter >0.5 cm, irregular elevation)..
[70] Skin investigations (Total igE, antinuclear factors, CH50 as a guide to complement activation and C3 & C4 as evidence of complement consumption). SLE profile (ESR, ANA, Anti dsDNA, Anti Sm, Anti RNP, Anti Histone). Lupus Serology (ANA, dsDNA, C3 & C4, RF (Rheumatoid Factor)). Lupus full assessment (ANA, dsDNA, C3 & C4, Urine FEME, FBC, Albumin, Creatinine, CPK, Reticulocyte count, Direct Coombs test). Lupus follow up (dsDNA, C3 & C4, Urine FEME, FBC, Albumin, Creatinine).
[71] Thymus, lymph nodes.
[72] Profiles for cases: Auto-antibody profile 1 (Anti SS-A, Anti SS-B (IgG), Anti JO-1, Anti La, Scl-70 2 of 8). Auto-antibody profile 2 (Anti RNP, Anti Sm, Anti SS-A, Anti Ro-52, Anti SS-B, Anti Scl-70, Anti Jo-1, Anti Centromere B, Anti dsDNA, Anti Nucleosomes, Anti Histones, Anti Ribosomal-P-Protein, Anti AMA-M2). HIV confirmation profile (HIV Western Blot,CD4/CD8,HIV Viral Load). HIV monitoring profile (CD4/CD8,HIV Viral Load). Torch profile (Toxo IgG/ IgM; Rubella IgG/IgM; CMV IgG/IgM; HSV-I IgG/IgM; HSV-II IgG/ IgM.). Dengue fever studies (FBE IgG and IgM antibodies). Respiratory Viral Studies (Influenza A and B, Adenovirus, Respiratory Syncytial Virus, Parainfluenzae Type 1, 2, 3). STD Profile (RPR (with titre & TPHA if reactive), TPHA (confirmation if VDRL is reactive), HIV I/II (Ag+Ab), Herpes simplex 1 & 2 IgG, Chlamydia IgG, Chlamydia PCR, Gonococcal PCR
[73] MUSCULOSKELETAL. INTEGUMENTARY. IMMUNE
[74] ISSUES IN ACTIVITIES OF NORMAL LIVING: Personal hygiene: excreta disposal, and toilet etiquette. Physiological secretions and wudhu / salat. Environmental hygiene. Foods & drinks. Physical activity and rest. PHYSICAL ACTS OF WORSHIP FOR THE SICK: Toilet hygiene. Wudhu Tayammum Ghusl for the sick. Salat. Puasa,. Hajj. MEDICAL PROCEDURES: Diagnostic procedures. Therapeutic procedures: Balance of benefit and injury. Prescriptions and administration of medications. Surgical procedures
[75] Basic characteristics of effective leadership. Personal Attributes of leaders. Conceptual leadership skills. Technical leadership skills. Human skills of leaders. Model leaders in medicine. Diseases of leaders. Diseases of followers.
[76] Diagnostic tests (TP, TN, FP, FN, sensitivity, specificity, predictive value, ROC). Screening tests (definition, types, methods, suitable disease, suitable test, evaluation, cost benefit analysis, ethical issues). Parameters of screening tests (false positive, false negative, sensitivity, specificity, predictive value).
[77] MICROSCOPIC ANATOMY/HISTOLOGY: Taste buds. Olfactory cell. Eye (eye wall, retina, fovea, optic nerve, lens, cornea, conjuctiva, eye lid, lachrymal gland / apparatus). Ear (external meatus, tympanic membrane, ossicles, cochlea, organ of corti, semi circular canal). DEVELOPMENTAL ANATOMY: Development of the eyes. Development of the ears. MACROSCOPIC ANATOMY: The eye (orbital fat, posterior cavity, anterior cavity, sclera, cornea, uvea, iris, papillary muscles, ciliary body, choroids, retina, optic disk, acqeous humor, canal of Schlemm, vitreous body, lens). External ear (auricle, external auditory canal, tympanic membrane, ceruminous glands). Middle ear (tympanic cavity, auditory tube, auditory ossicles). Inner ear (membranous labrynth / endolymph, perilymph, bony labrynth: vestibule, semi circular canals, cochlea). PHYSIOLOGY: Sensory function (detection, interpretation, processing, and adaptation). Types of sensory receptors (mechano, thermo, noci, and chemo). Transduction of sensory stimuli into nerve impulses. Transmission, reception, and integration of signals leading to sensory perception. The eye (eye movements, accommodation, refraction, visual acuity, the retina, visual physiology / photochemistry: rods & cones, photo reception,color vision, visual pathways to the brain). The ear (transmission through the tympanic membrane and the ossicular chain, transmission through the cochlea, organ of corti, auditory pathway). Equilibrium and balance (hairs in the ampulla of the semicircular ducts: anterior, posterior, and lateral; utricle and saccule; vestibule-cochlear nerve, hearing process ). Taste (primary sensation by the taste bud / taste receptors, signal transmission to CNS / gustatory pathway, gustatory discrimination). Smell (stimulation of the olfactory cells / olfactory receptors, transmission of signals to the CNS/ olfactory pathway, olfactory discrimination). The vestibular apparatus / semi circular canals. PHARMACOLOGY.
[78] MICROSCOPIC ANATOMY/HISTOLOGY: Neuronal cell body/soma (perikaryon, neurofilaments, neurotubules, neurofibrils). Neuronal dendrites. Neuronal axon (axoplasm, axolemma, initial segment, axon hillock, collaterals, tolodendria, synaptic terminal). Synapse (presynaptic cell, post synaptic cell, neurotransmitter, neuromuscular junction, neuroglandular junction, synaptic knob). CNS neuroglia (ependymal cells, astrocytes, oligodendrocytes, microglia). Peripheral neuroglia (ganglia, satellite cells, Schwann cells, neurilemma). DEVELOPMENTAL ANATOMY: DEVELOPMENT OF THE BRAIN: Neural tube develops 3 prominences / primary brain vesicles (prosencephalon, mesencephalon, rhomboencephalon). The prosencephalon becomes the teleencephalon (cerebrum) and the diencephalon. The rhomboencephalon becomes the metencephalon (cerebellum and pons) and the myelencephalon (medulla oblongata). The neurocele becomes the ventricles of the brain. DEVELOPMENT OF THE PERIPHERAL NERVOUS SYSTEM. MACROSCOPIC ANATOMY: Central nervous system (Spinal cord. Medulla oblongata. Pons. Cerebellum, substantia nigra, thalamus, cerebral cortex). Peripheral nervous system (afferent & efferent, sensory & motor, cranial & spinal, somatic & autonomic: sympathetic & parasympathetic). Classification of neurons by structure (axonomic, bipolar, unipolar, multipolar). Classification of neurons by function (sensory, motor, interneurons). Regions of the brain (cerebrum, cerebellum, diencephalon, mesencephalon, pons, medulla oblongata). Cerebrum (cerebral hemispheres, cerebral cortex, landmarks, fissures, motor areas, sensory areas, association areas, cerebral nuclei). Diencephalon (left and right thalamus, hypothalamus, pituitary). Mesencephalon / midbrain (visual and auditory stimuli, reflexive motor responses, consciousness). Pons (relay sensory stimuli to cerebellum and thalamus, subconscious somatic and visceral motor centers). Medulla oblongata relays signals to thalamus and other parts of brain stem and regulates cardiovascular, respiratory, and digestive functions. Brain stem consists of diencephalons, mesencephalon, the pons and the medulla oblongata. Protection of the brain (cranium, meninges, cerebrospinal fluid). Spinal cord meninges (dura mater, arachnoid, pia mater). Spinal cord cross section (central canal & horns, sensory nuclei,motor nuclei, columns, tracts). Spinal nerves (epineurium, perineurium, endoneurium, autonomic ganglion, white ramus, grey ramus, dorsal ramus, ventral ramus, concept of a dermatome). Nerve plexuses (brachial, lumbar, sacral). PHYSIOLOGY: Generation of trans membrane potential (membrane potential, resting potential, graded potential, action potential). Transmission of the action potential. Synaptic transmission (electric and chemical synapses, neurotransmitters: excitatory and inhibitory, synaptic delay, synaptic fatigue). Information processing (post synaptic potential, summation: temporal & spatial, divergence, convergence). The muscle spindle functions (intrafusal muscle fibers and extrafusal muscle fibers). Reflexes (reflex arc, innate & acquired, somatic & visceral). Monosynaptic spinal reflexes (stretch, patellar/knee jerk). Polysynaptic spinal reflexes (withdrawal, flexor, crossed extensor). Control of motor function (motor cortex, basal ganglia, cerebellum). Intellectual functions of the cerebral cortex (functional mapping, left/tight dominance). Thoughts and memory. Wakefulness (reticular excitatory area, inhibitory retuclar area, neurohumoral mechanisms). Limbic system (emotions, link between cerebrum and brain stem, memory and retrieval, & behavior: reward, punishment, rage). Sleep (slow and REM, neuronal control). Autonomic nervous system (adrenergic receptors: alpha & beta; cholinergic receptors: muscurinic & nicotinic, excitatory vs inhibitory actions on organs). PHARMACOLOGY: Anesthetic agents. Anxiolytics and sedatives. Anti-psychotic drugs. Anti-depressant drugs. Anti-epileptic drugs. Analgesic drugs. Psychomotor stimulants. Psychomimetic drugs.
[79] Hypothalamus. Pituitary gland. Thyroid gland. Parathyroid gland. Adrenal gland (cortex & medulla). Pancreas (islets of Langerhans). Pineal gland. Mucosal neuroendocrine cells. Gastrointestinal neuroendocrine cells. Testis. Ovary. DEVELOPMENTAL ANATOMY. MACROSCOPIC ANATOMY: hypothalamus, pituitary, thyroid, parathyroid, adrenal, pancreas, GIT, ovary, testes. PHYSIOLOGY: SYNTHESIS, SECRETION, AND FUNCTIONS OF HORMONES: Hypothalamus (ADH, oxytocin, regulatory hormones). Anterior pituitary (ACTH, TSH, GH, PRL, FSH, LH, MSH). Posterior pituitary (release of oxytocin, ADH). Thyroid follicles (Thyroxine-T4, Triiodothyroxine-T3, Calcitonin-CT). Thyroid C cells (calcitonin). Parathyroid (parathyroid-PTH). Adrenal cortex (cortisol, corticosterone, aldosterone, androgens). Adrenal medulla (epinephrine and nor epinephrine). Pineal gland (melatonin). Intestine (various hormones). Kidney (erythropoietin-EPO, Calcitriol). Heart (atrial natriuretic peptide-ANP). Thymus (Thymosins). Pancreatic islets (insulin, glucagons). Testes (androgens-espp testosterone, inhibin). Ovaries (estrogens, progestins, inhibin). INSULIN: Functions of Insulin (muscle glucose metabolism, liver uptake storage and use of glucose; synthesis, storage and use of fat; protein synthesis and storage; switch between carbohydrate and lipid metabolism). Control of insulin secretion (blood glucose, some amino acods). Glucagon (liver glycogenlolysis and gluconeogenesis). Regulation of glucagons secretion (blood glucose, some amino acids). Adrenocortical mineralocorticoids (minerocorticoids espp aldosterone for electrolyte balance). Adrenocortical glucocorticoids (espp cortisol for carbohydrate, lipid, and protein metabolism, Androgens). PHARMACOLOGY: Drugs used for treatment of diabetes mellitus. Drugs for pituitary disorders. Drugs for adrenal disorders. Drugs for thyroid disorders.
[80] Altered color vision. Visual hallucinosis. Visual disturbance.
[81] Xerostomia, Keratoconjuctivitie sicca. Optic disc swelling. Optic atrophy. Eye movement disorders (diplopia, nystagmus).Papillary disorders p. 1156.
[82] Audiometric measurements. Refraction measurements. Vestibular function (Rosenberg sign, caloric test, gait, positional testing, past pointing, heel-shin test). Visual field loss p 1153.
[83] Headache. Common headache and facial pain syndromes p. 1116. headache of raised ICP p. 1117. Nausea and vomiting. Dizziness (vertigo, loss of balance, light-headed, syncope, seizure). Blackout. Funny turns. Visual disturbance. Paralysis. Incordination. Sensory loss / sensory disturbance. Altered consciousness. Poor memory. Syncope (cardiac, vascular, and neurogenic).
[84] General appearance. Mood. Handedness. Skull (skull size, skull shape). Neck (neck stiffness, Kernig sign, carotid bruit). Back (scoliosis, spina bifida occulta, winged scapula). Cerebral function (orientation, memory, speech, language, localized cortical function). Gait and posture p. 1105. Gait (arm swing, pattern, tandem: heel-toe). Gait disorders (extrapyramidal, pyramidal gait, foot drop, waddling gait, cerebellar ataxia, gait apraxia, marche a petits pas, sensoty ataxia). Sensory (pin prick, temperature, joint position, vibration, 2-point discrimination). Cranial nerves p. 1105. Motor (wasting, fasciculation, abnormal movements, strength, coordination, Nerve roots of reflexes p. 1105. tendon reflexes. Abdominal reflexes. Plantar reflexes. Signs of motor deficit p. 1136. Involuntary movements (chorea, athetosis, ballism, dystonia, myoclonus, tics). Pattern of sensory loss p. 1141. Glasgow coma scale p. 1143. Cortical lobar functions p. 1248. Psychiatric examination p. 247. Mini mental state examination p. 248. Symptoms of depression p 251. Symptoms of anxiety p. 252. Investigation of stroke p. 1164. Types of epilepsy p. 1125. Investigation of epilepsy p. 1127. Investigation of dementia p. 1146. Speech problems (aphasia, dysphonia, and dysarthria).
[85] Lumbar puncture
[86] Common symptoms of endocrine disease p. 685. Clinical features of hyperthyroidism p. 691. Clinical features of hypothyroidism p. 692.
[87] Tests for Cushing p. 725. Tests for Pituitary / hypothalamic disease p. 735. Acromegaly p. 743.
History for diabetes: sweating. Trembling. Hunger. Amxiety. Confusion. Drowsiness. Incordination. Nausea. Tiredness. Headache. Examination in diabetes mellitus: impaired visual acuity, opaque lens, fundus, injection sites, feet ulcers, fungal infections.
[88] Investigation of diabetes: glucose, GTT, ketones, glycated Hb, blood lipids. Profiles for cases: Diabetic profile 1 (Glucose F/PP, HbA1c, Microalbuminuria, Creatinine, MA/Creatinine Ratio, Lipid Profile, HbA1c, Microalbuminuria, Sodium, Potassim, Chloride, CO2, BUN, Creatinine, Calcium). Pancreatic profile (Glucose,Amylase, Calcium, Triglycerides, Lipase). Thyroid profile (T3, T4, TSH, FT3, FT4). Thyroiditis profile (Anti Microsomal (Antithyroperoxidase Ab) and Anti Thyroglobulin Ab). Tuberculosis profile (TB IgG, TBIgM, TBIgA). Catecholamines (Noradrenaline, Adrenaline, Dopamine). Diabetic screen (Glucose. HbA1C (glycosylated Hb). Urea, Creatinine, Electrolytes, Microalbumin (albumin / creatinine ratio). Pituitary Studies (Cortisol, FSH, LH, Prolactin, TSH, Growth Hormone). Thyroid Function Test (TSH (Thyroid Stimulating Hormone), FT4 (free thyroxine), FT3 (free tri-iodo thyronine)).
[89] MULTI-SYSTEM: SYSTEMIC PATHO-PHYSIOLOGICAL DISTURBANCES: fever, dehydration, infecrtions. ISSUES OF SPECIAL AGE AND GENDER GROUPS: Women and maternal conditions. Neonatal and infant conditions. Congenitally abnormal fetii / infants. Child conditions. Geriatric physical dysfunction. Geriatric psychoneurological conditions and dementias. Geriatric psychosocial dysfunction. Disabilities: rights and obligations. Research on the elderly.
[90] Strategy, planning, and implantation. Control and evaluation. Quality assurance/quality improvement. Decision-making. Problem-solving. Crisis management. Economic analysis in health. Health policy. Health finance. Health services delivery. Basics of organizational management. Basics of organizational financial management. Health information management systems.
[91] Sample selection (target and study populations, methods of sampling). Sample size (purposes, factors, determination). Sources of data (primary: questionnaire, clinical, measurements and secondary: census, routinely collected data). Questionnaire data collection (face to face, mail, telephone, computer)..Data management (coding, editing, replication, transformation, editing).
[92] MICROSCOPIC ANATOMY/HISTOLOGY: Components of the male reproductive system (Testis. Seminiferous tubule. Spermatozoa. Epididymis. Ductus deferens. Seminal vesicle). DEVELOPMENTAL ANATOMY: Genital ridges. Primitive sex chords. Development of the gonads. Development of the genitalia. Descent of the testes. Spermatogenesis. MACROSCOPIC ANATOMY: Components of the male reproductive system (testes, scrotum, penis, epididymis. ductus deferens. urethra. seminal vesicles. prostate. bulbo-urethral glands. penis). PHYSIOLOGY: Hormones and the male reproductive system (FSH, LH, GnRH, testosterone). Male sexual function (arousal, emission, ejaculation, orgasm, detumescence). Male climacteric. PHARMACOLOGY: Androgens. Anti-androgens. GnRH agonists and antagonists. GnRH analogues. Drugs for erectile dysfunction. Male contraceptives.
[93] MICROSCOPIC ANATOMY/HISTOLOGY: Ovary (cortex, secondary follicle, Graafian follicle, corpus luteum, corpus atreticus, corpus albicans). Fallopian tube. Uterus (endometrium, mymetrium). Cervix (endo cervix and ecto cervix). Vagina. Placenta. Breast. Sperm. DEVELOPMENTAL ANATOMY: Genital ridges. Primitive sex chords. Development of the gonads. Development of the genitalia. Oogenesis. MACROSCOPIC ANATOMY: Components of the female reproductive system (ovary, uterine tubes, uterus, vagina, external genitalia). Mammary glands. PHYSIOLOGY: Hormones of the female reproductive system (GnRH, FSH, LH, estrogens). Uterine cycle. Menopause. Pregnancy (fertilization, first trimester, second trimester, third trimester, labor and delivery, post natal development). PHARMACOLOGY: Estrogens. Anti-estrogens. Progesterones. Anti-progesterones. GnRH agonists and antagonists. GnRH analogues. Oral contraceptives. Post coital contraception. Deprovera. Drugs acting on the uterus.
[94] Week 1 intra-uterine (gametogenesis in the male. Gametogenesis in the female. Fertilization. Cleavage). Week 2 intra-uterine (bilaminar germ disk, utero-placental circulation). Week 3 intrauterine (gastrulation, formation of the trilaminar germ disk, development of first somites and neural tube). Week 4 intra-uterine (differentiation of the somites, differentiation of the nervous system, segmental development and integration). Organogenesis. Pregnancy. Labor and delivery. Childhood. Youth. Middle age. Old age.
[95] Male fertility profile (FSH, LH, PRL, TESTOSTERONE - TOTAL/FREE). Infertility Studies (male): (FSH, LH, Prolactin, SHBG (Sex Hormone binding globulin), Testosterone). Male Hormone Studies (Testosterone, SHBG (Sex Hormone Binding Globulin), Free Androgen Index ).
[96] Extended female fertility profile (FSH, LH, PRL, E2, TSH, PGN, AFP, HCG, DHEAS). Extended prenatal profile (CBC, Blood Grouping,Glucose,Urinanalysis, Urine Culture, PAP Smear,BUN, Uric Acid, Toxo Ab, CMV Ab, HBsAg, HIV, Creatinine, FT4, Rubella,Titre, RPR, HSV I & II Ab.). Female fertility profile (FSH, LH, PRL). Amenorrhoea studies (E2 (Oestradiol), LH, FSH, Prolactin, FT4). Infertility Studies (Female) (FSH, LH, Progesterone, Prolactin, E2 (Oestradiol), HCG). Menopausal Hormones: (E2 (Oestradiol), LH, FSH, Prolactin, Free T4).
[97] Measure GH levels. Profiles for cases: Ante-natal profile (ABO & RH, RBS, HIV, HBsAg, RPR, Urine Routine, Hb). Antenatal screen (ABO & Rh (D), Hb and Red Cell indices, HBsAg / HBsAb, HIV I / II, Rubella IgG, RPR (with titre & TPHA if reactive), HIV I/II). Cord blood A (TSH, G6PD, RPR (VDRL), ABO & RH (D), TSH, G6PD). Breast tumor prognosis (ER/PR/Her2Neu). Triple marker with graph (AFP, HCG, E3). Anti aging profile – ladies (GT9 profile, CEA, Ca 19.9, Ca 125, Ca 15.3, DHEAS, Estradiol, LH, FSH, IGF-1, Insulin). Anti aging profile – men (GT9 profile, CEA, Ca 19.9, DHEAS, PSA, Total Testosterone, IGF-1, Insulin). Antenatal / thalassaemia screen: ABO & Rh (D) Antibody Screen, Hb, HBs Ag, Rubella IgG, RPR (with titre & TPHA if reactive). Down Syndrome (Triple Test): (AFP, UE3, Free Beta HCG). Executive male & female (FBE, RFT, LFT, Glucose, Lipid Studies, Urine FEME, RPR (VDRL), ABO Blood Gp & Rhesus, HBsAg / HBsAb, Free T4, Rheumatoid Factor (RF), Alpha Feto Protein (AFP), Carcino-Embryonic Antigen (CEA), Prostate Specific Antigen (PSA) Male Only, Ca 125 Female Only, Homocysteine. Life Extension Profile – Female (GT9 profile, DHEAS, Estradiol, Homocysteine, C-Reactive Protein, Free Testosterone, Total Testosterone, Progesterone). Life Extension Profile – Male (GT9 profile, DHEAS, Estradiol, Homocysteine, C-Reactive Protein, Free Testosterone, Total Testosterone, PSA). New Anti Aging Profile – Female (Dheas, Estradiol, Progesterone, Free Testosterone, FT3, Serum Cortisol, IGF-1). New Anti Aging Profile – Male (Dheas, Estradiol, Free Testosterone, FT3, Serum Cortisol, IGF-1, Serum Insulin). Osteoporosis Profile (Calcium, Phosphate, Alkaline phosphatase (ALP), Vitamin D, Urine deoxypyridinoline (DPD)). Women Plus Forty (FBE, RFT, LFT, Glucose, LIP, Urine FEME, RPR (VDRL), ABO & Rh (D), HBsAg / HBsAb, FT4, Rheumatoid Factor, AFP, CEA). Young Women (FBE, RFT, LFT, Glucose, LIP, Urine FEME, RPR (with titre & TPHA if reactive), ABO & Rh (D), HBsAg / HBsAb, FT4, Rheumatoid Factor, AFP, CEA, Iron Studies).
[98] Environmental exposures (The Environmental Problem, Environmental Pollution, Epidemiological Studies, Risk Assessment and Management). Occupational exposures (Introduction. Occupational Hazards and Diseases. Occupational Health Studies. Prevention of Occupational Disease). Nutritional exposures (Introduction. Incidence and Prevalence of Malnutrition. Diseases Associated with Malnutrition. Assessment of Nutritional Status. Epidemiological Studies of Nutritional Exposures). Radiation exposures (Over-View. Radiations: Types, Sources, and Measurement. Effects of Radiation. Epidemiological Studies of Radiation. Prevention of Radiation Damage). Other exposures (Genetic Exposures. Pharmaceutical Agents).
[99] REPRODUCTIVE SYSTEM 1: NORMAL CONDITIONS: Menstruation. Pre-menstrual tension. Irregular menstruations in the climacteric period. Prolonged menstruation. Dysmenorrhea. Menopause. Human sexuality & sexual behavior. Contraception. Pregnancy. Prenatal screening & diagnosis genetic/non-genetic. Labor. Delivery. Postnatal care. Breast-feeding.
[100] Principles of successful group work. General and special group dynamics. Student-teacher relation. Mutual respect and cooperation. Conflict resolution. Whistle blowing on unethical behavior. Cooperation with traditional healer
[101] Summarizing and inference (principles, preliminary steps). Methods for continuous data. Methods for discrete data.
[102] CORONARY HEART DISEASE (stable angina, unstable angina, myocardial infarction). VALVE DISEASE (rheumatic heart disease, mitral valve disease, aortic valve disease, tricuspid valve disease, pulmonary valve disease, infective endocarditis). CONGENITAL HEART DISEASE (patent ductus arteriosus, coarctation of the aorta, atrial septal defect, ventricular septal defect, tetralogy of Fallot). DISEASES OF THE MYOCARDIUM (acute myocarditis, cardiomyopathy, cardiac tumors, specific disease of the myocardium)
DISEASES OF THE PERICARDIUM.
[103] ACUTE CIRCULATORY FAILURE (Hemorrhage, hypovilemia.shock). HYPERTENSION. CARDIAC FAILURE. ARTERIAL DISEASE (disease of the aorta, peripheral occlusive arterial disease, diabetic foot, thromboangitis obliterans - Buerger’s disease, Raynaud’s syndrome, aneurysms). VENOUS DISEASE (venous thrombosis / thrombormbolism, pulmonary embolism, varicose veins). LYMPHATIC DISEASE (lymphedema, tumors of lymphatics). ATHEROSCLEROTIC VASCULAR DISEASE.
[104] ANEMIAS (iron deficiency, megaloblastic, hemolytic, hemoglobinopathies). HEMATOLOGICAL MALIGNANCIES (leukemias, lymphomas, aplastic anemia). MYELOPROLIFERATIVE DISORDERS (multiple myeloma). BLEEDING DISORDERS (primary hemostatic disorders, vessel wall abnormalities, platelet function disorders, coagulation disorders, bleeding disorders). SPLEEN (infarction, splenomegaly, tumors, splenic vein thrombosis, ectopic spleen, cyst)
[105] Chest trauma. OBSTRUCTIVE PULMONARY DISEASES (chronic obstructive pulmonary disease-COPD, asthma, bronchiectasis, emphysema). INFECTIVE DISEASES OF THE RESPIRATORY SYSTEM (upper respiratory tract infection). NEOPLASTIC DISEASE (lung carcinoma, secondary tumors of the lung, mediastinal tumors). INFECTION (lobar pneumonia). INTERSTITIAL/INFILTRATIVE (organic dusts, inorganic dusts). PULMONARY VASCULAR (venous thromboembolism, pulmonary hypertension, pulmonary embolism). NASOPHARYNX and LARYNX (nasopharynx, larynx). PLEURA, DIAPHRAGM, and CHEST WALL (pleura, pneumothorax, hydrothorax, ptothorax, lung collapse, diaphragm, chest wall).
[106] Physical: Ambulatory venous pressure. Trandelenburg tourniquet test
Electrical / electronic: electrocardiography (rest & exercise), Holter monitoring
Imaging: arteriography, echocardiography, radionuclide cardiac scanning, thallium scan, Duplex imaging / scanning, Ascending venography, CT, plethysmography, Doppler techniques (Doppler velocimetry, Duplex color ultrasonography), Cardiac catheterization, Plethysmography. Other forms of stress testing (myocardial perfusion scanning and stress electrocadiography). ECG (rest and exercise). Coronary arteriography.
Biochemistry: blood gases
[107] Pulmonary function tests: peak expiratory flow rate, spirometry
Biochemical: blood gas analysis (pulse oximetry, P-CO2, P-O2, pH )
Imaging: .X ray. Mediastinocopy, Ventilation-perfusion lung scan, Pulmonary angiography,
Microbiology: Sputum culture. Sputum cytology
Biopsy: CT guided lung biopsy. Bronchoscopy with cytology of washings
Imaging: Plain x-ray. CT. Ventilation-perfusion imaging. Positron emission tomography. Pulmonary angiography. Laryngoscopy. Bronchoscopy. Mediastinoscopy.
Pleural histology. Pleural aspiration. Pleural biopsy. Skin tests (TB and allergy). Microbiology.
[109] Competence, responsibility, accountability, compassion, competence, disclosure & truthfulness, confidentiality, etiquette of the patient, bedside visit, uncovering awrat, interaction with the opposite gender, interaction with the family).
[110] Cross sectional study (definition, strengths, weaknesses); Ecological study. Health surveys. Case control study (definition, strengths and weaknesses). Follow-up / cohort study (definition, strengths and weaknesses).
[111] MOUTH. SALIVARY GLANDS (salivary calculi – sialolithiasis, mumps, parotitis-acute & chronic, Sjogren’s syndrome, Mikulicz disease). ESOPHAGUS (gastro-esophageal reflux / esophagitis, strictures, Barret’s columnar metaplasia, motility disorders, diverticulae, tumors, perforation, Plummer-Vinson syndrome). Esophagus (gastro-esophageal reflux, esophageal strictures, Barret’s columnar epithelium, hiatus hernia, motility disorders,perforation, Plummer-Vinson). STOMACH and DUODENUM (gastritis, peptic ulcer, functional, tumors). SMALL INTESTINE (malabsorption, motility, infections, tumors, appendix, diverticulum, intestinal tuberculosis). INFLAMMATORY BOWEL DISEASE. COLON and RECTUM (tumors, diverticulosis, volvulus, constipation /disorders of defecation, carcinoma-colon, chronic bowel inflammagory disease, colonic polyps, ). ANORECTAL DISORDERS (carcinoma, hemorrhoids). The acute abdomen (peritonitis, intestinal obstruction, trauma, vascular). Abdominal trauma. Hernia
[112] HEPATIC DISEASE (viral hepatitis, autoimmune hepatitis, cirrhosis, hepatic encephalopathy, fulminant liver failure, cysts, fatty liver, haemochromatosis, Wilson’s disease-hapatolenticular degeneration, tumors-HCC, matastases, liver abscess, portal hypertension, Budd Chiari syndrome). GALLBLADDER DISEASE (gall stones, cholecystitis, cholelithiasis, tumors, Biliary cirrhosis, Sclerosing cholangitis, cysts, biloenteric fistula, ). PANCREAS (acute /chronic pancreatitis, congenital anomalies, tumors-endocrine and exocrine)
[113] GLOMERULAR DISEASE (glomerulonephritis). TUBULO-INTERSTITIAL DISEASE (interstitial nephritis, cystic kidney disease). INFECTIONS (lower urinary tract, upper urinary tract). URINARY TRACT CALCULI. TUMORS (kidney, renal pelvis, ureters, bladder, prostate, testes). BLADDER (incontinence, tumors). Acure renal failure (pre-renal failure of blood perfusion, damage to renalparenchyma, outflow obstruction). ELECTROLYTE DISTUBANCES: Water intoxication (edema, confusion, coma, convulsions, low serum Na). Water depletion (thirst, drowsiness, coma, oliguria, high sodium, high uresa, high hematocrit). Hypernatrimea (edema, confusion, coma, convulsions, low serum Na). Hyponatrimea (confusion, oliguria, hypovolemia, dry skin, loss ot turgor, sunken eyeballs, convulsions, coma). Hyperkalemia (diarrhea, colicky abdominal pain, cardiac arrest). Hypokalemia (lethargy, muscle weakness, ileus, cardiac arrest, metabolic alkalosis). Hypercalcemia (muscle weakness, lassitude, drowsiness, hyperreflexia, polydipsia, polyuria, nausea, vomiting, peptic ulceration, anxiety, mania, coma). Hypocalvemia (tetany, parasthesia, muscle cramps, carpopedal spasm, Chevostek sign, Trosseau sign)
[114] Upper GIT conditions: nausea, vomiting /hemetamesis, peptic ulcer Lower GIT conditions: rectal bleeding, incontinence, fistulae.
[115] Chronic renal failure. Urinary incontinence, fistulae, and catheters. Renal colic
[116] Patient-doctor contract, dual obligations: army, police, prisons, sports, factory, school & university, conflict of duties and conflict of interests.
[117] Community randomized study (definition, strengths and weaknesses). Clinical trial (definition, phases, protocol, randomization, censoring).
[118] Head injury. Fracture (femur, humerus). Dislocation. Soft tissue trauma. INFLAMMATORY JOINT DISEASE (rheumatoid arthritis). OSTEOARTHRITIS. DISEASE OF BONE (osteoporosis, osteomalacia, rickets, Paget’s disease). SYSTEMIC CONNECTIVE TISSUE DISEASE (SLE, scleroderma, Sjogren’s syndrome, polymyositis, dermatomyositis). JOINTS, KNEE, BACKACHE, MECKACHE
[119] ECZEMA. PSORIASIS. INFECTIONS AND INFESTATIONS. PRESURE SORES. PIGMENTATION DISORDERS. NAIL DISORDERS. SKIN TUMORS (cysts-sebaceous, dermoid; ganglion; neavus; hemangioma-capillary & cavernous; lymphangioma; , sweat gland tunors; papilloma; verruca vulgaris (warts); keloid scar; keratoses; tumors- benign , pre malignant, malignant). Burns
[120] Pyrexia of unknown origin. Generalized infections: glandular fever syndromes (infectious mononucleosis, CMV, toxoplamosis ). Generalized infections: others (brucellosis, leptospirosis, lyme borreliosis, Q fever). Direct skin and soft tissue infections (impetigo, bullous impetigo, ecthyma, folliculitis, furuncles, carbuncles, Staph skin infections, erysipelas, cellulitis, necrotizing soft tissue infections eg necritizing fascitis, clostridial soft tissue infections, bacteroides infections, anthrax). Toxic erythemouts rashes (streptococcal scarlet fever, strep/staph toxic shock syndrome. Erythematous and vesiculopapular eruptions (HSV, Chicken pox VZV, shingles-herpes zoster). Viral exanthema (measles, rubella-German measles, parvovirus, mumps). Food poisoning and gastro-enteritis: toxin mediated (bacillus cereuas, staphylococcal enterotoxin, clostridial spp,). Food poisoning and gastro-enteritis: infective (rotavirus, camphylobacter spp, salmonella spp, E.coli, shigella spp, clostridium difficile). Food poisoning and gastro-enteritis: protozoal (giardiasis, amebic dysentery, cryptosporidium spp, ). Tropical infections: fever (malaria, schistosomiasis, typhoid/paratyphoid, dengue, trypanasomiasis, yellow fever, viral hemorrhagic fevers eg Lass, rickettsia, Lyme disease, louse borne relapsing fever, amebiasis, lesihmaniasis, diphtheria). Tropical infections: esinophilia (ancylostomiasis, strongyloidiasis, ascaris lumbricoides, trichinosis). Tropical infections: non-esinophila (enterobius vermicularis, trichuris trichuria). Tropical infections: filariases (W. bancrofti, loa loa, O.volvulus, Mansonella spp). Schistosomiass, Cysticercosis, Tenia spp, Echincococcus granulosus, leprosy, tropical splenomegaly syndrome, Sexually transmitted diseases (syphilis, gonorrhoea, Chlamydia spp, Herpes simplex, HPV-genital warts, molluscum contagiosum, ). HIV. Vaccines.
[121] Fracture (pain, loss of function, deformity, tendrness, discoloration/ bruising, crepitus, x ray in 2 planes, tomography, ultrasonography). Imaging: CT. Scintigraphy. MRI. US. Arthography. Bone mineral density measurement (BMD) – bone densimetry. Radionuclide bone scanning. Bone biopsy.
[122] Investigations: Diascopy. Dermatoscopy (epiluminiscence microscope). Wood’s light. Mycology samples. Swabs. Prick test. Histology. Immunofluorescence. Electron microscopy. Photo testing. Antibody (circulating and fixed).
[123] Orthopedic problems: sprains & fractures, orthopedic fixation, osteomyelitis, osteoporosis, malignant bone neoplasms. Limb disorders, Gait disorders Involuntary movements. Myasthenia gravis. Joint disorders with restricted/painful movements: osteoarthritis and rheumatoid arthritis. Vertebral column pain: spondylosis, intervertebral disease, sponylolidthesis, ankylosing spondylitis, root compression, etc. Laryngeal, pharyngeal, or oral disease. . Skin disorders: eczema, psoriasis, SLE, etc. Diabetes mellitus.
[124] The terminally ill / dying (comfort, hygiene, alleviation of pain, acts of worship, legal preparation, spiritual preparation)
[125] (customs, mourning,). Bereavement.
[126] studies Measures of association: t test; F test; chi square. Measures of effect: risk ratio and odds ratio. The Odds ratio (properties, advantages, disadvantages, interpretation).
[127] EAR. NOSE and SINUSES. THROAT (cancer). EYE (infection, diabetic, glaucoma, squint, eyelid disorders, tumors)
[128] CEREBROVASCULAR DISEASE. DEGENERATIVE DISEASE (dementia, Parkinson, Wilson, Huntington, Hereditary ataxia, Motor neurone disease, spinal muscular atrophies). DISEASES OF NERVES AND MUSCLES (peripheral nerves, cranial nerves, neuromuscular junction). DISORDERS OF THE SPINAL CORD (injury, compression). INFECTIONS (meningitis, parenchymal viral and bacterial infections, prion). INTRACRANIAL MASSES and PRESSURE (neoplasms, hydrocephalus, hemorrhage). PSYCHIATRIC ().
[129] DIABETES MELLITUS. THYROID (hyperthyroidism, hypothyroidism). PARATHYROID (hyperparathyroisidm). ADRENALS (Cushing’s syndrome, Conn’s syndrome –primary hyperaldosteronism, pheochromocytoma, multiple endocroine neoplasia). PANCREAS. HYPOTHALAMUS. PITUITARY (pan hypopituitarism-Simmond’s disease, prolactinoma, acromegaly due to GH,
[130] Endoscopy: Otoscopy, Fundoscopy. Physical: Audiometry (Rinne, Weber, hearing measurements), Tympanometry. Electrophysoiological tests: (evoked response audiometry). Ophthalmic exam
[131] Electrophysiological: EEG. Somatosensory evoked potential. Nerve conduction studies. Evoked potential. Electromyography. SSEP (for sensory pathways). EMG (for peripheral nerves). Imaging: Plain x ray. CT scan. MRI. US/Doppler. Myelography of spinal cord, cerebral angiography. Radiisotope (PET and SPEC). PET: Dynamic scan of brain function. Lumbar puncture: CSF parameters p. 1115. Tyoes of stroke: transient, completed. Evolving.
[132] COMMAND, CONTROL, and COMMUNICATION ORGAN SYSTEMS. SENSORY. NERVOUS. ENDOCRINE
[133] Blindness and deafness. Olfactory disorders. Taste disorders. Tactile disorders. Temperature disorders. Pain disorders. Hunger and thirst
[134] Stroke. Epilepsy. Parkinson disease. Dementias. Brain tumors. Brain /skull trauma. Spinal cord injury. Aphasia/dysphasia. Vestibular disturbances. Peripheral neuropathies. Legal impact of loss of competence. Human drives and the genesis of emotions positive and negative. Anxiety disorders. Stress. Loss of consciousness. Personality disorders. Psychiatric conditions /psychosis/schizophrenia. Depression and suicide / para-suicide / harm to self and others. Psychogenic sexual disorders. Neurotic / anxiety / compulsive-obsessive disorders
[135] Abuse of privileges. Private misconduct derogatory to the profession. Financial misconduct. Felonies. Conflict of financial interests. Dealing with the pharmaceutical industry. Un-ethical business practices Violation of Licensing and registration
[136] Biases in epidemiological studies: detection and cure (Selection bias. misclassification bias. Confounding bias). Interaction and effect modification. Validity and precision (internal and external). Meta-analysis (purposes, methods, ethics, limitations).
[137] Hypogonadism. Gynecomastia. Erectile dysfunction. Cryptorchism
[138] DISORDERS OF MENSTRUATION (Secondary amenorrhoea). DISORDERS OF SEXUAL FUNCTION. INFERTILITY. PREGNANCY (antenatal disorders, multiple pregnancy, antepartum hemorrhage, abnormal labor, psychiatric disorders of birth). DISORDERS OF THE GENITAL TRACT (vulva, vagina, cervix, uterus, Fallopian tubes, ovary). Hirsuitis. DISORDERS OF THE BREAST (benign breast disease, breast cancer).
[139] Embryological growth disorders: Patterns of embryological maldevelopment (agenesis, hypoplasia, dysplasia, dysrphism-failure of fusion, failure of involution, atresia-failure of lumen formation, ectopia).
[140] Imaging: mammogram. Pap. Breast biopsy. Breast estrogen receptors
[141] INTRA-UTERINE DISORDERS. MATERNAL DISORDERS. INFANT AND CHILD DISORDERS. ADOLESCENT DISORDERS. DISORDERS OF THE ELDERLY
[142] Menopausal disorders. Dysfunctional uterine bleeding. Sexually transmitted disease. Pre-natal diagnosis / screening / genetic testing/treatment. Assisted reproduction for infertility.
[143] Definition Of Negligence/Malpractice. Ingredients Of A Negligence Suite. Avoiding / Preventing Negligence Suits. The Standard Of Care (Bolam Principle As Modified By Bolitho). Patient Complaint / Grievance System (As A Tool To Prevent Malpractice)
[144] Critical reading of scientific literature. Critical appraisal of epidemiological studies. Critical appraisal of clinical trials. Writing of scientific literature.
