SECTION I RULES AND REGULATIONS

The rules and regulations proposed for the MBBS degree course based on the recommendations of the Medical Council of India 1997 are detailed under the following heads. 1. Introduction 2. General considerations and teaching approach 3. Objectives of medical graduate training programme 4. Admission, selection and migration 5. Training 6. Examination regulations I INTRODUCTION MCI regulations on graduate medical education in 1997 envisage a change in the pattern of medical education. The basic concept is to increase vertical integration of medical curriculum. A reduction of six months is made for the I MBBS course, increasing the training period of the II and III MBBS. The overall course duration is the same, but is reorganized into nine semesters of six months each. The reduction of six months of the I MBBS is meant to reduce the quantum of teaching of preclinical subjects to the medical students and to give time during the later years for revising the preclinical subjects with relevance to the clinical teachings. Organisation of teaching of clinical subjects should be done concentrating on vertical integration, incorporating the teaching staff of preclinical and paraclinical subjects also. A new pattern is designed for the internal assessment and University examinations. Paediatrics is being separated from Medicine and organized as a separate examination in Final MBBS Part II. The calendar for the new batch is made ready on the starting of the course. House surgeons postings is reorganized according to the IMC norms with suitable modifications. GENERAL CONSIDERATIONS AND TEACHING APPROACH (1) Graduate medical curriculum is oriented towards training students to undertake the responsibilities of a physician of first contact who is capable of looking after the preventive, promotive, curative and rehabilitative aspects of medicine. (2) With the wide range of career opportunities available today, a graduate has a wide choice of career opportunities. Training though broad based and flexible should aim to provide an educational experience of the essentials required for health care in our country. (3) To undertake the responsibilities of service situation which is a changing condition and of various types, it is essential to provide adequate placement training tailored to the needs of such services as to enable the graduates to become effective instruments of implementation of those requirements. To avail of opportunities and be able to conduct professional requirements, the graduate shall endeavour to have acquired basic training in different aspects of medical care. (4) The importance of the community aspects of health care and of rural health care services is to be recognized. This aspect of education and training of graduates should be adequately recognized in the prescribed curriculum. Its importance has been systematically upgraded over the past years and adequate exposure to such experiences should be available throughout all the three phases of education and training. This has to be further emphasized and intensified by providing exposure to field practice areas and training during the internship period. The aim of the period of rural training during internship is to enable the fresh graduate to function efficiently under such settings. (5) The educational experience should emphasize health and community orientation instead of only disease and hospital orientation or being concentrated on curative aspects. As such, all the basic concepts of modern scientific medical education are to be adequately dealt with. (6) There must be enough experiences to be provided for self learning. The methods and techniques that would ensure this must become a part of teaching learning process. (7) The medical graduate of modern scientific medicine shall endeavor to become capable of functioning independently in both urban or rural environment. He/ She endeavor to give emphasis on fundamental aspects of the subjects taught and on common problems of health and diseases avoiding unnecessary details of specialization.

II

MBBS curriculum 2007 (8)

(9)

(10)

(11)

(12)

(13)

(14)

(15)

(16)

(17)

(18)

(19)

The importance of social factors in relation to the problems of health and diseases should receive proper emphasis throughout the course and to achieve this purpose the educational process should also be community based than only hospital based. The importance of population control and family welfare planning should be emphasized throughout the period of training with the importance of health and development duly emphasized. Adequate emphasis is to be placed on cultivating logical and scientific habits of thought, clarity of expression, independence of judgement and ability to collect and analyze information and to correlate them. The educational process should be placed in a historic background as an evolving process and not merely as an acquisition of a large number of disjointed facts without a proper perspectives. The history of medicine with reference to the evolution of medical knowledge both in this country and the rest of the world should form a part of this process. Lectures alone are generally not adequate as a method of training and are a poor means of transferring / acquiring information and even less effective at skill development and in generating the appropriate attitudes. Every effort should be made to encourage the use of active methods related to demonstrations and on first hand experience. Students will be encouraged to learn in small groups through peer interactions, so as to gain maximal experience through contacts with patients and the communities in which they live. While the curriculum objectives often refer to areas of knowledge or science, they are best taught in a setting of clinical relevance and hands on experience for students who assimilate and make this knowledge a part of their own working skills. The graduate medical education in clinical subjects should be based primarily on outpatient teaching emergency departments and within the community including peripheral health care institutions. The outpatient departments should be suitably planned to provide training to graduates in small groups. Clinics should be organized in small groups of preferably not more than 10 students so that a teacher can give personal attention to each student with a view to improve his skill and competence in handling of the patient. Proper records of the work should be maintained which will form the basis of the students internal assessment and should be available to the inspectors at the time of inspection of the college by the Medical Council of India. Maximal efforts have to be made to encourage integrated teaching between traditional subject areas using a problem based learning approach starting with clinical or community cases and exploring the relevance of various preclinical disciplines in both understanding and resolution of the problem. Every attempt should be made to de-emphasize compartmentalization of disciplines so as to achieve both horizontal and vertical integration in different phases. Every attempt is to be made to encourage students to participate in group discussions and seminars to enable them to develop personality, character, expression and other facilities which are necessary for a medical graduate to function either in solo practice or as a team leader when he begins his independent career. A discussion group should not have more than 20 students. Faculty members should avail of modern educational technology while teaching the students and to attain this objective, Medical Education Units/ Departments should be established in all medical colleges for faculty development and providing learning resource material to teachers. To derive maximum advantage out of this revised curriculum, the vacation period to students in one calendar year should not exceed one month, during 4 years Bachelor of Medicine and Bachelor of Surgery (MBBS) Course. In order to implement the revised curriculum in toto, State Governments and Institutional Bodies must ensure that adequate financial and technical inputs are provided.

MBBS curriculum 2007 III (1) OBJECTIVES OF MEDICAL GRADUATE TRAINING PROGRAMME National Goals

(a)

(b) (c) (d) (e) (2)

I.

II. III. IV.

V. VI.

VII. VIII. IX. X. XI.

At the end of undergraduate programme, the medical student shall endeavor to be able to : recognize health for all as a national goal and health right of all citizens and by undergoing training for medical profession, fulfill his/her social obligations towards realization of this goal; learn every aspect of national policies on health and devote himself/herself to its practical implementation; achieve competence in practice of holistic medicine, encompassing promotive, preventive, curative and rehabilitative aspects of common diseases; develop scientific temper, acquire educational experience for proficiency in profession and promote healthy living; become exemplary citizen by observation of medical ethics and fulfilling social and professional obligations, so as to respond to national aspirations. Institutional Goals (a) In consonance with the national goals each medical institution should evolve institutional goals to define the kind of trained manpower (or professionals) they intend to produce. The undergraduate students coming out of a medical institute should: be competent in diagnosis and management of common health problems of the individual and the community, commensurate with his/her position as a member of the health team at the primary, secondary or tertiary levels, using his/her clinical skills based on history, physical examination and relevant investigations; be competent to practice preventive, promotive, curative and rehabilitative medicine in respect to the commonly encountered health problems; appreciate rationale for different therapeutic modalities, be familiar with the administration of the essential drugs and their common side effects; be able to appreciate the socio-psychological, cultural, economic and environmental factors affecting health and develop human attitude towards the patients in discharging ones professional responsibilities; possess the attitude for continued self learning and to seek further expertise or to pursue research in any chosen area of medicine; be familiar with the basic factors which are essential for the implementation of the National Health Programmes including practical aspects of the following: (i) Family Welfare and Maternal and Child Health(MCH), (ii) Sanitation and water supply, (iii) Prevention and control of communicable and non-communicable diseases, (iv) Immunization, (v) Health Education, acquire basic management skills in the area of human resources, materials and resource management related to health care delivery; be able to identify community health problems and learn to work to resolve these by designing, instituting corrective steps and evaluating outcome of such measures; be able to work as a leading partner in health care teams and acquire proficiency in communication skills; be competent to work in a variety of health care settings; have personal characteristics and attitudes required for professional life such as personal integrity, sense of responsibility and dependability and ability to relate to or show concern for other individuals.

MBBS curriculum 2007 IV ADMISSION, SELECTION AND MIGRATION 1. Eligibility Criteria

No candidate shall be allowed to be admitted to the medical curriculam of first Bachelor of Surgery (MBBS) course until: (a) (b) He/She has completed the age of 17 years on or before the 31st of December of the year commencing the prescribed academic session of the said course. He/She has passed qualifying examination as under: (i)The higher Secondary Examination or the Indian School Certificate Examination which is equivalent to 10+2 Higher Secondary Examination after a period of 12years study, the last two years of study comprising of Physics, Chemistry, Biology and Mathematics or any other elective subject with English at a level not less than the core course for English as prescribed by the National Council for Education Research and Training after the introduction of the 10+2+3 years educational structure as recommended by the National Committee on education; Note: Where the course content is not as prescribed for 10+2 education structure of the National Committee, the candidates will have to undergo a period of one year pre-professional training before admission to Medical Colleges. or (ii) The intermediate examination in science of an Indian University/Board or other recognized examining body with Physics, Chemistry and Biology which shall include a practical test in these subjects and also English as a compulsory subject. or (iii) The pre-professional/pre-medical examination with Physics, Chemistry and Biology, after passing either the Higher Secondary school examination, or the preuniversity or an equivalent examination. The pre-professional/pre-medical examination shall include a practical test in Physics, Chemistry and Biology and also English as a compulsory subject; or (iv) The first year of the three years degree course of a recognized University, with Physics, Chemistry and biology including a practical test in these subjects provided the examination is a University Examination and candidate has passed 10+2 with English at a level not less than a core course. or (v) [Link] examination of an Indian University, provided that he/she has passed the [Link] examination with not less than two of the following subjects Physics, Chemistry, Biology(Botany, Zoology) and further that he/she has passed the earlier qualifying examination with the following subjects Physics, Chemistry, Biology and English. or (vi) Any other examination which, in scope and standard is found to be equivalent to the intermediate science examination of an Indian University/ Board, taking Physics, Chemistry and Biology including practical test in each of these subjects and English. Note: The pre-medical course may be conducted either at Medical College or a Science College. Marks obtained in Mathematics are not to be considered for admission to MBBS course. After the 10+2 course is introduced, the integrated courses should be abolished.

MBBS curriculum 2007 2. Selection of Students

The selection of students to Medical Colleges shall be based solely on merit of the candidate and for determination of merit, the following criteria be adopted uniformly throughout the country: 1) In states having only one Medical college and one University/board/examining body conducting the qualifying examination, the marks obtained at such qualifying examination may be taken into consideration; 2) In states, having more than one university/board/examining body conducting the qualifying examination(or where there are more than one Medical Colleges under the administrative control of one authority) a competitive entrance examination should be held so as to achieve a uniform evaluation as there may be a variation of standard at qualifying examination conducted by different agencies; 3) Where there are more than one colleges in a state and only one university/board conducting the qualifying examination, then a joint selection board be constituted for all the colleges; 4) A competitive entrance examination is absolutely necessary in cases of Institutions of All India character; 5) To be eligible for competitive entrance examination, the candidate must have passed any of the qualifying examinations as enumerated under the head note Eligibility Criteria; 6) Procedure for selection to MBBS course shall be as follows: (i) In case of admission on the basis of qualifying examination, based on merit, candidate for admission to MBBS course must have passed in the subjects of Physics, Chemistry, Biology and English individually and must have obtained a minimum of 50% of marks taken together in Physics, Chemistry, and Biology as the qualifying examination as mentioned. In respect of candidates belong to Scheduled Casts, Schedules Tribes or Other Backward Classes the marks obtained in Physics, Chemistry and Biology taken together in qualifying examination be 40% instead of 50% as above. In case of admission on the basis of a competitive entrance examination a candidate must have passed in the subjects of Physics, Chemistry, Biology and English individually and must have obtained a minimum of 50% marks taken together in Physics, Chemistry and Biology at the qualifying examination and in addition must have come in the merit list prepared as a result of such competitive entrance examination by securing not less than 50% marks in Physics, Chemistry and Biology taken together in the competitive examination. In respect of candidates belonging to scheduled casts/scheduled tribes or other Backwards class the marks obtained in Physics, Chemistry and Biology taken together in qualifying examination and competitive entrance examination be 40% instead of 50% as stated above. Provided that a candidate who have appeared in the. qualifying examination the result of which has not been declared, he may be provisionally permitted to take up the competitive entrance examination and in case of selection for admission to the MBBS course he shall not be admitted to that course until he fulfils the eligibility criteria. Provided that the eligibility criteria for admission to persons with locomotory disability of lower limbs will be a minimum of 45% marks instead of 50% taken together in qualifying examination and competitive entrance examination for admission in MBBS course. Provided further that in respect of candidates belonging to Scheduled Caste/Scheduled Tribes and other Backward Classes (OBCs) the marks obtained be read as 40% instead of 50%. 3% seats of the annual sanctioned intake capacity shall be filled up by candidates with locomotory disability of lower limbs between 50% to 70%.

(ii)

(iii)

(iv)

MBBS curriculum 2007

Provided that in case any seat in the 3% quota remains unfilled on account of unavailability of candidates with locomotory disability of lower limbs between 50% to 70% then any such unfilled seats in the 3% quota shall be filled by persons with locomotory disability of lower limbs between 40 to 50% - before they are included in the annual sanctioned seats for general category candidates. Provided further that this entire exercise shall be completed by each Medical college/Institution ad per the statutory time schedule for admissions and in no case any admission will be made in the MBBS course after 30thof September. 2. Migration 1. Migration of students from one Medical College to another Medical College may be granted on any genuine ground subject to the availability of vacancy in the college were migration is sought and fulfilling the other requirements laid down in the Regulations. Migration would be restricted to 5% of the sanctioned intake of the college during the year. No migration will be permitted on any ground from one Medical college to another located within the same city. Migration of students from one College to another is permissible only if both the colleges recognized by the Central Government under section-11 (2) of the Indian Medial Council Act, 1956 and further subject to the conduction that it shall not result in increase in the sanctioned in take capacity for the academic year concerned in respect of the receiving Medical college. The applicant candidate shall be eligible to apply for migration only after qualifying in the first professional MBBS examination. Migration during clinical course of study shall not be allowed on any ground. For the purpose of migration an applicant candidate shall first obtain ' No Objection Certificate' from the College where he is studying for the present and the University to which that college is affiliated and also from the college to which the migration is sought and the University to it that college is affiliated. He/She shall submit his application for migration within a period of one month of passing (declaration of result of the first professional MBBS examination) along with the above cited four 'No Objection Certificates' to: (a) the Director of Medical Education of the State, if migration is sought from one college to another within the same state or (b) the Medical Council of India, if the migration is sought from one college to another located outside the state. A student who has joined another college on migration shall be eligible to appear in the IInd professional MBBS examination only after attaining the minimum attendance in that college in the subjects, Lectures, Seminars etc. required for appearing in the examination prescribed under Regulation 12 (1). The State Governments/Universities/Institutions may frame appropriate guidelines for grant of No Objection Certificate or Migration, as the case may be, to the students subject to provisions of these Regulations. Any request for migration not covered under the provisions of these Regulations shall be referred to the Medical council of India for consideration on individual merits by the director (Medical education) of this State or the Head of Central Government Institution concerned. The Decision taken by the Council on such requests shall be final. The College/Institutions shall send intimation to the Medical Council of India about the number of students admitted by them on migration within one month of their joining. It shall be open to the Council to undertake verification of the compliance of the provisions of the regulations governing migration by the Colleges at any point of time.

2.

3.

4.

5.

Note-1:

Note:2

Note-3:

MBBS curriculum 2007 V. 1. TRAINING Training Period and Time Distribution

The admission should be organized in such a way that teaching in first semester starts by August 1 each year. (1) Every student shall undergo a period of certified study extending over 4 academic years divided into 9 semesters (i.e of 6 months each) from the date of commencement of his study for the subjects comprising the medical curriculum to the date of completion of examination and followed by one year compulsory rotating internship. Each semester will consist of approximately 120 teaching days of 8 hours each college working time, including one hour of lunch. The nomenclature of semester system will be uniformly followed in place of years as they are nomenclatured now. (2) The Period of 4 years is divided into three phases as follows:-

a) Phase-I (2 semesters) consisting of pre-clinical subjects (Human Anatomy,

Physiology including Bio-Physics, Bio-chemistry and introduction to community Medicine including Humanities). Besides 60 hours for introduction to Community Medicine including Humanities, rest of the time shall be somewhat equally divided between Anatomy and Physiology plus Biochemistry combined (Physiology 2/3 and Biochemistry 1/3) b) Phase-II (3 Semesters) consisting of para clinically/clinical subjects. During this

phase teaching of para-clinical and clinical subjects shall be done concurrently. The para-clinical subjects shall consist of Pathology, Pharmacology, Microbiology, Forensic Medicine including Toxicology and part of Community Medicine.
The clinical subjects shall consist of all those detailed below in Phase III. Out of the time for Para-clinical teaching approximately equal time to be allotted to Pathology, Pharmacology, Microbiology and Forensic Medicine and Community Medicine combined (1/3 Forensic Medicine and 2/3 Community Medicine. c) Phase-III (Continuation of study of clinical subjects for seven semesters after passing Phase-I) The clinical subjects to be taught during Phase II and III are Medicine and its allied specialities, Surgery and its allied specialities, Obstetrics and Gynaecology and Community Medicine. Besides clinical posting as per schedule mentioned herewith, rest of the teaching hours be divided for didactic lectures, demonstrations, seminars, group discussions, etc, in various subjects. The time distribution shall be as given in subject wise syllabus. The Medicine and its allied specialities training will include General Medicine, Paediatrics, Tuberculosis and Chest, Skin and Sexually Transmitted Diseases, Psychiatry, Radio-Diagnosis, Infectious Diseases etc. The Surgery and its allied specialities training will include General Surgery, Orthopaedic Surgery including Physio-therapy and Rehabilitation, Ophthalmology, Otorhinolaryngology, Anaesthesia, Dentistry, Radio-therapy etc. The Obstetrics and Gynaecology training will include family medicine, family welfare planning etc. (3) The first 2 semesters (approximately 240 teaching days) shall be occupied in the Phase I(Pre-clinical) subjects and introduction to a broader understanding of the perspectives of medical education leading to delivery of health care. No student shall be permitted to join the Phase II(Para-clinical/clinical) group of subjects until he has passed in all the Phase I (Pre-clinical) subjects for which he will be permitted not more than four chances (actual examination), provided four chances are completed in three years from the date of enrollment.

MBBS curriculum 2007 (4)

After passing pre-clinical subjects, 1 year (3 semesters) shall be devoted to para-clinical subjects. Phase II will be devoted to para-clinical and clinical subjects, along with clinical postings. During clinical phase (Phase III) pre-clinical and para-clinical teaching will be integrated into the teaching of clinical subjects where relevant.

(5) Didactic lectures should not exceed one third of the time schedule, two third schedule should include practicals, clinicals or/and group discussions. Learning process should include living experiences, problem oriented approach, case studies and community health care activities. (6) The Universities and other authorities concerned shall organize admission process in such away that teaching in first semester starts by 1st of August each year. 6 (A) There shall be no admission of students in respect of any academic session beyond 30th September under any circumstance. The university shall not register any students admitted beyond the said date. (B) The Medical Council of India may direct, that any student identified as having on btained admission after the last date of closure of admission be discharged from the course of study, or any Medical qualification granted to such a student shall not be a recognized qualification for the purpose of the Indian Medical Council Act, 1956. The Institution which grants admission to any students after the last date specified from the same shall also be liable to face such action as may be prescribed by MCI including surrender of seats equivalent to the extent of such admission made from its sanctioned intake capacity for the succeeding academic year. (7) The Supplementary examination for First Professional MBBS Examination may be conducted within 6 months so that the students who pass can join the main batch and the failed students will have to appear in the subsequent year provided that the students who pass the supplementary examination shall be allowed to appear in the Second Professional MBBS Examination only after he/she completes the full course of study of three semesters (ie:18 months) for the Second Professional MBBS Examination irrespective of the examination of the main batch.. Phase Distribution and Timing of Examinations The nine semesters of six months each are distributed to three phases as detailed below:

2.

Phase Phase I Semesters

Semesters I and II I MBBS Biochemistry

Examination Anatomy, Physiology,

Phase II

Semesters

III, IV and V

II MBBS, Pharmacology, Pathology, Microbiology, Forensic Medicine III MBBS Part I Ophthalmology, Otolaryngology, Community Medicine

Semesters Phase III

VI and VII

Semesters

VIII and IX

III MBBS Part II General Medicine, General Surgery, Obstetrics and Gynaecology and Peadiatrics

MBBS curriculum 2007

Note: (a) Passing the Ist professional examination (I MBBS) of this University or any other University recognized by the University as equivalent thereto is compulsory before proceeding to Phase II training A student who fails in the II nd professional examination, shall not be allowed to appear in IIIrd professional Part I examination unless he passes all subjects of II nd professional examination. Passing in IIIrd professional (Part I ) examination is not compulsory before entering into semesters VIII and IX training, however passing of IIIrd professional (Part I) is compulsory for being for appearing for IIIrd professional (Part II) examination.

(b)

(c)

CLINICAL POSTING IN VARIOUS DEPARTMENTS Subjects Semesters and duration in weeks III General Medicine* Clinical Pathology Paediatrics T.B & Chest Skin & STD Radiology General Surgery Anaesthesia Orthopaedics** Ophthalmology ORL(E.N.T) Obst. & Gyn. Family Planning Community Medicine Psychiatry Radiotherapy Casualty Dentistry Total 8 8 8 24 IV 2 2 2 4 4 4 2 4 24 V 4 2 2 2 2 2 2 16 VI 4* 4 6 4** 4 2 24 VII 4 4 4 4 16 VIII 8 4 8 4 24 IX 4 2 2 2 2 12 Total 24 02 10 02 06 02 24 02 10 08 08 22 02 10 02 02 02 02 140

* **

Clinical Orientation classes in medicine and Surgery will start in the 3rd semester. This posting in Semester VI includes exposure to infectious diseases. This posting in Semester VI includes exposure to Rehabilitation Physiotherapy. EXAMINATION REGULATIONS

MBBS curriculum 2007 1. Essentialities for qualifying to appear in professional examinations. The performance in essential components of training are to be assessed, based on: (a) Attendance

10

75% of attendance for lectures in a subject is compulsory for appearing in the examination provided he/she has 80% attendance in non Lecture teaching, ie, Seminars, group discussions, tutorials, Demonstrations, Practicals, Hospitals(Tertiary, Secondary, Primary) postings, bed-side clinics etc. (b) Internal Assessment

It shall be based on periodical assessment, evaluation of student assignment, preparation for seminar, clinical case presentation etc. Regular examinations shall be conducted throughout the course. The question of number of examinations is left to the institution. Day to day assessment should be given importance during internal assessment, Weightage for internal assessment shall be 20% of the total marks in each subject. The candidate must secure at least 35% marks of the total marks fixed for
internal assessment in a particular subject in order to be eligible to appear in the final university examination of that subject. 2. University Examinations. The examinations are to be designed with a view to ascertain whether the candidate has acquired the necessary knowledge, minimum skills, as detailed in Appendix A along with clear concepts of the fundamentals which are necessary for him to carry out his day to day work competently. Evaluation will be carried out on an objective basis. An examination calendar should be prepared with designated dates for all internal and University Examinations by the Institutional Curriculum Committee every year.( Pattern given as Appendix D). A candidate before presenting himself for any University Examination shall produce certificates of having attended the recognized courses of instruction in the subject. The theory question papers will be designed in such a way that the questions include structured essays, short answer questions and other objective types that call for specific answers. The theory papers in pre and paraclinical subjects will give due weightage to the applied aspects and clinical subjects will include questions based on basic sciences also. The present pattern of question papers is provided along with subject wise syllabus given in part II. The Practical / clinical examination will be conducted in the laboratories or hospital wards. Objective will be to assess proficiency in skills, conduct of experiment, interpretation of data and logical conclusion. Clinical cases should preferably include common diseases the student is likely to come across in practice. Rare cases/obscure syndromes, long cases of neurology etc. shall not be kept for the final examination. Emphasis should be on candidates capability in eliciting physical signs and their interpretation. Practical examination should be objective and should test skills and ability to interpret the results. Structured evaluation should be done. OSCE (Objective Structured Clinical Evaluation) should be incorporated in the practical examinations. Viva/ oral includes evaluation of management approach and handling of emergencies. Candidates skill in interpretation of common investigative data, x-rays, identification of specimens, ECG, etc. also is to be evaluated.

MBBS curriculum 2007

11

Pass, First Class and Distinction for University Exam In each of the subjects, a candidate must obtain 50% in aggregate for a pass. This 50% in aggregate includes :A separate minimum of 50% in aggregate for theory including viva. (University theory + Viva + Internal Assessment) & A separate minimum of 50% in aggregate for Practicals (University Practicals + Internal assessment) (See Table for the distribution of marks in various disciplines) Example : Anatomy Total 200 marks Paper I 50 Marks Theory Paper II 50 Marks 120 Int. Asses. 20 Marks 140 Viva 20 Practicals Uni. Exam 40 Marks Int. Asses. 20 Marks 60 Total 200 Out of a total of 140 marks for theory, a student should secure a minimum of 70 marks in aggregate and out of 60 marks for practicals, a separate minimum of 30 is essential for a pass. Eligibility for the appear for the University Examination A student for secure 35% marks for internal assessment is qualified to appear for university examination provided he/she satisfies that percentage of attendance requirement as said already. (see table for resume of marks in other disciplines) Candidates who pass the whole examination shall be ranked in the order of proficiency as determined by the total marks obtained by each in both parts and shall be arranged in three classes, the first consisting of those who have obtained not less than 75% of the aggregate marks (Passed with Distinction), the second consisting of those who have obtained not less than 65% of the aggregate marks (Passed in First Class) and all the others (Passed in Second Class). All candidates who fail in the first attempt in any subject and pass subsequently shall not be ranked in distinction or first class. Grace marks upto a maximum of 5 in total may be awarded for an examination at the discretion of the passing board for a student to pass one subject (theory/practical/oral) provided the student has passed in all other subjects. Grace marks will not be awarded to change internal assessment marks. A candidate who fails in any one subject but obtains pass marks in another subject of the same examination shall be exempted from re-examination in the subject, which the candidate has passed. Candidates who fail in any subject shall be required to produce a certificate for further study for the period, which shall extend to the next succeeding examination. In the case of candidates who fail at the M.B.B.S. examinations or having applied for admission, do not appear for the examination or having obtained the prescribed certificate, do not apply for admission to the examination although qualified to do so, shall be required to produce a certificate of further study including hospital posting/ practical work in the subject concerned for the period between the last examination at which they had failed or not appeared and the next succeeding examination, which shall not be less than one semester. In the case of candidates who do not appear for the next succeeding examination, the period of further study shall be decided by the Principal of the College concerned, provided that such study does not exceed two terms. No candidate shall be admitted to the examination unless he/she has produced satisfactory evidence of having compiled with the provisions contained in the regulations and has produced the prescribed certificates of study. The examinations shall be held twice an year and every effort will be made to complete the course and examinations in time so as to prevent course lag.

MBBS curriculum 2007

12

Resume of marks for different Disciplines Sl. No. 1. 2. 3 4. 5. 6 7. 8. 9. 10 11 12 13 14 Theory Theory Paper I Paper II Anatomy 50 50 Physiology 50 50 Biochemistry 50 50 Pharmacology 40 40 Pathology 40 40 Microbiology 40 40 Forensic Medicine 40 Ophthalmology 40 Otorhinolaryngology 40 CommunityMedicine 60 60 General Medicine 60 60 General Surgery 60 60 Obstetrics & 40 40 Gynaecology Pediatrics 40 Subject IA Oral 20 20 20 15 15 15 10 10 10 20 30 30 20 10 20 20 20 15 15 15 10 10 10 10 20 20 30 10 Total Practical T+IA+O 140 40 140 40 140 40 110 25 110 25 110 25 60 30 60 30 60 30 150 30 170 100 170 100 130 50 60 30 IA 20 20 20 15 15 15 10 10 10 20 30 30 20 10 Total Subject total 60 200 60 200 60 200 40 150 40 150 40 150 40 100 40 100 40 100 50 200 130 300 130 300 70 200 40 100

Note: Internal Assessment examinations may be conducted as per the discretion of the departments (minimum of one examination per semester) without violating MCI norms. Internal assessment in Medicine and surgery will include subspecialities also.

MBBS curriculum 2007

13

CLINICAL POSTINGS OF M.B.B.S STUDENTS

Semester III 24 weeks Semester IV 24 weeks Orthopedics 4 wks Semester V 16 weeks Pediatrics 4 wks Semester VI 24 weeks Medicine 2 wks Infectious Diseases 2 weeks Dermatology 4 weeks Orthopedics 2 weeks Physical Medicine 2 weeks Ob&Gyn 4 weeks SemesterVII 16 weeks Ophthalmology 4 wks Semester VIII 24 weeks Medicine 4 wks Semester IX 12 weeks Medicine 4 wks Surgery2wks ENT 4 wks Medicine 4 wks Orthopedics 2 wks Obs&gyn 2 wks Pediatrics 2 wks Study Leave 1 wk Internal Asst Exam 4 wks Study leave 1wk University Examination

8 wks Medicine Ophthalmology 4 wks 8 wks Surgery ENT 4 wks RD 2 wks Anaesth 2 wks ROME 2 RT 2 wks CLIP 2 wks 8 wks O&G Comm Medicine 4 wks TB&Chest 2 wks Skin &STD 2 Wks Family Planning 2 Wks Internal Asst Exam Psych 2 Dentistry 2 wks Final Internal Assessment Examination University Examination

[Link] 4 wks

Surgery 4 wks

Obs& gyn 4 weeks Final Internal Assessment Examination University Examination

Surgery 4 wks

General Surgery 2 wks Casualty - 2 weeks Surgery 4 wks [Link] Ex

Obs & Gyn 4 wks Pediatrics 4 wks [Link] Exam

MBBS curriculum 2007

14

CLINICAL POSTINGS - SUBJECT WISE

Semester III 24 weeks Gen. Med. 8 Semester IV 24 weeks Clin. Path. 2 TB & Chest D 2 Gen. Surg. 8 Skin & STD 2 Ortho 4 O&G8 Ophthal 4 ENT 4 FP 2 Comm. Med. 4 Semester V 16 weeks Peads. 4 RD 2 Anesthesia 2 ROME 2 Psych. 2 RT 2 Dentistry 2 Semester VI 24 weeks Gen. Med. 2 Inf. Dise. 2 Skin & STD 4 Gen Surg. 6 Ortho 2 Phy. Med. 2 O&G4 Casualty 2 Semester VII 16 weeks Opthal. 4 ENT 4 O&G4 [Link]. 4 Semester VIII 24 weeks Gen. Med. 4 Gen. Med. 4 Peads. 4 Gen surg. 8 O&G4 Semester IX 12 weeks Gen. Med. 4 Peads.2 Gen. Surg. 2 Ortho 2 O&G2 -

MBBS curriculum 2007 SECTION III - INTERNSHIP

15

1. GENERAL
Internship is a phase of training wherein a graduate is expected to conduct actual practice of medical and health care and acquire skills under supervision so that he/she may become capable of functioning independently. 2. SPECIFIC OBJECTIVES At the end of the internship training, the student shall be able to: a) diagnose clinically common disease conditions encountered in practice and make timely decision for referral to higher level; b) use discreetly the essential drugs, infusions, blood or its substitutes and laboratory services; c) manage all type of emergencies medical, surgical, obstetric, neonatal and paediatric, by rendering first level care; d) demonstrate skills in monitoring of the National Health Programmes and schemes,oriented to provide preventive and promotive health care services to the community; e) develop leadership qualities to function effectively as a leader of the health team organized to deliver the health and family welfare service in the existing socio-economic, political and cultural environment; f) render services to chronically sick and disabled (both physical and mental) and to communicate effectively with patient and the community g) computer knowledge, data entry in connection with admission and discharge of patients. 3. TIME ALLOCATION Time allocation to each discipline is approximate and shall be guided more specifically by the actual experience obtained. Thus a student serving in a District or Taluk hospital emergency room, may well accumulate skills in Surgery, Orthopaedics, Medicine, Obstetrics and Gynaecology and Paediatrics during even a single night on duty. Responsible authorities from the Medical College shall adjust the interns opportunities to practice skills in patient care in rough approximation of the time allocation suggested. 4. INTERNSHIP-TIME DISTRIBUTION Internship training program will include COMPULSORY Medicine (a) (b) Surgery (a) (b) (c) Obstetrics & Gynaecology (a) (b) Community Medicine (a) ELECTIVE

2 months Medicine 15 days Ophthalmology 2 months surgery including casualty 15 days Orthopedics 15 days ENT 2 months Obstetrics & Gynaecology 1 month Paediatrics Three months Community Medicine

including family welfare planning

15 days Radiology/ Dermatology/ Forensic Medicine/ Psychiatry/ Blood bank/ Anesthesia / Physical medicine / Resp. Med

MBBS curriculum 2007

5. OTHER DETAILS (a) All parts of the internship shall be done as far as possible in institutions of India. In case of any difficulties, the matter may be referred to the Medical Council of India to be considered on individual merit. (b) Every candidate will be required after passing the final MBBS examination to undergo compulsory rotational internship to the satisfaction of the College authorities and University concerned for a period of 12 months so as to be eligible for the award of the degree of Bachelor of Medicine and Bachelor of Surgery (MBBS) and full registration. (c) The University shall issue a provisional MBBS pass certificate on passing the final examination. (d) The State Medical Council will grant provisional registration to the candidate on production of the provisional MBBS pass certificate. The provisional registration will be for a period of one year. In the event of shortage or unsatisfactory work, the period of provisional registration and the compulsory rotating internship may be suitably extended by the appropriate authorities. (e) The intern shall be entrusted with clinical responsibilities under direct supervision of a senior medical officer. They shall not be working independently. (f) Interns will not issue a medical certificate or a death certificate or a medicolegal document under their signature. (g) In recognition of the importance of hands-on experience, full responsibility for patient care and skill acquisition, internship should be increasingly scheduled to utilize clinical facilities available in District specific experiences and skills as listed in major areas: Provided that where an intern is posted to District/Sub Divisional Hospital for training, there shall be a committee consisting of representatives of the College/ University, the State Government and the District administration, who shall regulate the training of such trainee; Provided further that for such trainee, a certificate of satisfactory completion of training shall be obtained from the relevant administrative authorities which shall be countersigned by the Principal/Dean of the College. (h) Adjustment to enable a candidate to obtain training in elective clinical subjects may be made. (i) Each medical college shall establish links with one entire district extending out- reach activities. Similarly, Re-orientation of Medical Education(ROME) scheme may be suitably modified to assure teaching activities at each level of District health system which will be coordinated by Dean of the Medical College; (j) Out of one year, 6 months shall be devoted to learning tertiary care being rendered in teaching hospital/district hospital suitably staffed with well qualified staff, 3 months of secondary care in a small District or Taluk Hospital/ Community HealthCentre and 3 months in Primary Health care out of which 2 months should be in Primary Health Centre with full attention to the implementation of National Health Programme at the community level. One month of primary care training may be in the form of perceptorship with a practicing family physician or voluntary agency or other primary health care provider. (k) One years approved service in the Armed Forces Medical Services, after passing the final MBBS examination shall be considered as equivalent to the pre-registration training detailed above; such training shall, as far as possible, be at the Base/General Hospital. 6. ASSESSMENT OF INTERNSHIP (A) The intern shall maintain a record of work in the form of a log book, which is to be verified and certified by the medical officer under whom he works. This shall cover all aspects including the essential skills - covering all Taxonomic Domains, Ethical skills, Communication skills and computer skills in connection with data entry regarding admissions and discharges - that would have to be learned during Internship training. An assessment and grading of these skills would be made by the concerned authorities in each department periodically. Assessment and grading of the computer skills should be made by the HODs and entered in the log book. Performance of the skills should be taught, supervised and certified by a member of the teaching staff. Apart from scrutiny of the record of work, assessment and evaluation of training shall be undertaken by an objective approach using situation tests in knowledge, skills and attitude during and at the end of training. Based on the record of work and date of evaluation, the Dean/Principal shall issue certificate of satisfactory completion of training, following which the University shall award the MBBS degree or declare him eligible for it.

16

MBBS curriculum 2007

Satisfactory completion shall be determined on the basis of the following score ranging from 0 to 5. 0 Poor, 1 Average, 2 Satisfactory, 3 Good, 4 Very Good and 5 Excellent i) Proficiency of knowledge required for each case. ii) The Competency in skills expected to manage each case: namely iii) competency for performance of self performance, b) of having assisted in procedures and c) of having observed procedures. iv) Responsibility, punctuality, work up of case, involvement in treatment, follow-up reports. v) Capacity to work in a team (behaviour with colleagues, nursing staff and relationship with paramedicals) vi) Initiative, participation in discussions, research aptitude. A score of less than 3 any of above items will represent unsatisfactory completion of internship. 7. FULL REGISTRATION. (b)

17

Full registration shall only be given by the State Medical Council/Medical Council of India on the award of the MBBS degree by the university or its declaration that the candidate is eligible for it. APPENDIX A
A COMPREHENSIVE LIST OF SKILLS RECOMMENDED AS DESIRABLE FOR BACHELOR OF MEDICINE AND BACHELOR OF SURGERY (MBBS) GRADUATE: 1. Clinical Evaluation: (a) (b) (c) (d) (e) To be able to take a proper and detailed history. To perform a complete and thorough physical examination and elicit clinical signs. To be able to properly use the Stethoscope, Blood Pressure Apparatus, Auroscope, Thermometer, Nasal Speculum, Tongue Depressor, Weighing Scales, Vaginal Speculum etc; To be able to perform internal examination Per Rectum (PR), Per Vaginum (PV) etc; To arrive at a proper provisional clinical diagnosis.

II. Bed Side Diagnostic Tests: To do and interpret Haemoglobin (HB), Total Count (TC), Erythrocyte Sedimentation Rate (ESR), Blood smear for parasites, Urine examination albumin/ sugar/ ketone/ microscopic; (b) Stool exam for ova and cysts; (c) Gram staining and Ziehl-Nielsen staining for AFB; (d) To do skin smear for lepra bacilli; (e) To do and examine a wet film vaginal smear for trichomonas; (f) To do skin scraping and Potassium Hydroxide (KOH) stain for fungus infections; (g) To perform and read Mantoux Test. III. Ability to carry out Procedures: (a)

MBBS curriculum 2007

(a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) To conduct CPR (Cardiopulmonary resuscitation) and First aid in newborns, children and adults; To give Subcutaneous (SC)/ Intramuscular (IM)/ Intravenous (IV) injections and start Intravenous (IV) infusions; To pass a nasogastric tube and give gastric lavage; To administer oxygen by mask/ catheter; To administer enema To pass a urinary catheter male and female; To insert flatus tube; To do pleural tap, ascitic tap & lumbar puncture; Insert intercostals tube to relieve tension pneumothorax; To relieve cardiac tamponade; To control external haemorrhage.

18

IV. Anaesthetic Procedures: (a) Administer local aneasthesia and nerve block; (b) Be able to secure airway patency and administer Oxygen by Ambu bag; V. Surgical Procedures: (a) (b) (c) (d) (e) (f) To apply splints, bandages and Plaster of Paris (POP) slabs; To do incision and drainage of abscesses; To perform the management and suturing of superficial wounds; To carry on minor surgical procedures, e.g, excision of small cysts and nodules, circumcision, reduction of paraphimisis, debridement of wounds etc; To perform vasectomy; To manage anal fissures and give injections for piles.

VI. Mechanical Procedures: (a) To perform thorough antenatal examination and identify high risk pregnancies; (b) To conduct normal delivery; (c) To apply low forceps and perform and suture episiotomies; (d) To insert and remove IUDs and perform tubectomy. VII. Paediatrics: (a) To assess new born and recognize abnormalities and intra uterine retardation; (b) To conduct immunization; (c) To teach infant feeding to mothers; (d) To monitor growth by the use of road to health chart and to recognize development retardation; (e) To assess dehydration and prepare and administer Oral Rehydration Therapy (ORT); (f) To recognize acute respiratory infection clinically. VII. ENT Procedures:

MBBS curriculum 2007

(a) (b) (c) To be able to remove foreign bodies; To perform nasal packing of epistaxis; To perform tracheostomy;

19

IX. Ophthalmic Procedures. (a) To evert eye-lids; (b) To give Subconjunctival injection; (c) To perform epilation of eye-lashes; (d) To measure the refractive error and advise correctional glasses; (e) To perform nasolacrimal duct syringing for patency. X. Dental Procedures. (a) To perform dental extraction. XI. Community Health. (a) To be able to supervise and motivate community and para-professionals for corporate efforts for the health care; (b) To be able to carry on managerial responsibilities; e.g. Management of stores, indenting and stock keeping and accounting; (c) Planning and management of health camps; (d) Implementation of national health programmes; (e) To effect proper sanitation measures in the community;e.g. disposal of infected garbage and chlorin-ation of drinking water; (f) To identify and institute control measures for epidemics including its proper data collecting and reporting. XII. (a) (b) (c) (d) XIII. (a) (b) (c) (d) (e) (f) (g) (h) Forensic Medicine including Toxicology. To be able to carry on proper medicolegal examination and documentation of injury and age reports; To be able to conduct examination for sexual offences and intoxications; To be able to preserve relevant ancillary materials for medicolegal examination; To be able to identify important post-mortem findings in common un-natural deaths; Management of Emergencies. To manage acute anaphylactic shock; To manage peripheral vascular failure and shock; To manage acute pulmonary oedema and left ventricular failure; Emergency management of drowning, poisoning and seizures; Emergency management of bronchial asthma and status asthmatics; Emergency management of hyperpyrexia; Emergency management of comatose patients regarding airways, positioning prevention of aspiration and injuries; Assess and administer emergency management of burns

MBBS curriculum 2007

20 APENDIX B
Time Table - Semester I

Day Monday Tuesday Wednesday Thursday Friday Saturday

8am to 9am Biochemistry Physiology Anatomy Physiology Biochemistry Anatomy

9am to 10am Physiology (9 11) Biochemistry Physiology Biochemistry Anatomy Physiology

10am to 1pm Anatomy Dissection

1 to 2 pm

2 pm to 4 pm Practicals Phy/Bio/Hist

Lunch
do

do

do

do
do
Do (10 to12) Community Medicine

do
do do

do
do
Physiology Ana/Bio/Phy

do

Time table -Semester-II

Day
Monday Tuesday Wednesday Thursday Friday Saturday

8am to 9am
Anatomy Physiology Biochemistry Physiology Anatomy Biochemistry

9am to 10am
Biochemistry Anatomy Physiology Biochemistry Biochemistry Anatomy

10am to 12 noon
Practicals Phy/Bio/Hist

12 to 1

1 to 4pm
Anatomy Dissection

Lunch
do

do

do

do
do
Physiology Physiology

do
do do

do
do
Do (2 to 4) Phy/Ana/Bio /Phy

do

MBBS curriculum 2007 Time Table - Semester III 24 weeks

Day 8am to 9am Clinical Lecture 9 to 12 noon Clinical Posting do 12 to 1pm Lunch do 1 to 2pm
Pathology L Microbiology L Pathology L Microbiology L Pharmacology L CommMedicineL PharmacologyL Medicine L

21

2 to 3pm

3 to 4pm

Monday Tuesday
Wednesday

Practicals Path/ Pharmac/Micro

do do do
do

do

do
do do

do
do do

do
Forensic L Pharmacology L Sugery L

Thursday Friday Saturday

do

do

do

Time table Semester IV 24 Weeks

Day 8am to 9am Clinical Lecture 9 to 12 noon Clinical Posting do 12 to 1pm Lunch do 1 to 2pm
Patholog yL Microbiology L Pathology L PharmacologyL Microbiology Forensic Medicine PharmacologyL Medicine L

2 to 3pm

3 to 4pm

Monday Tuesday
Wednesday

PracticalsPath/ Pharmac/Micro

do do do
do

do

do
do do

do
do do

do
[Link] Forensic Medicine Sugery L

Thursday Friday Saturday

do

do

do

MBBS curriculum 2007 Time Table - Semester V 16 weeks

Day Monday Tuesday
Wednesday

22

8am to 9am
Clinical Lecture

9 to 12 noon
Clinical Posting do

12 to 1pm
Lunch

1 to 2pm
Pathology L Microbiology L Pathology L PharmacologyL

2 to 3pm

3 to 4pm

Practicals Path/ Pharmac/Micro

do do do
do

do do do do do

do do
Pharmacology L Forensic L Medicine L Forensic L Sugery L

do
do do

Thursday Friday Saturday

do

do

PharmacologyL

[Link]

Time Table - Semester VI 24 weeks

Day
Monday Tuesday Wednesday Thursday Friday Saturday

8am to 9am
Clinical Lecture do do do do do

9 to 12 noon
Clinical Posting do do do do do

12 to 1pm
Clinical Lecture do do do do do

1 to 2pm
Lunch do do do do do

2 to 4pm

Integrated Lectures to be organised by the concerned coordinators and vice principals

MBBS curriculum 2007

Time table -semester VII 16 weeks

23

Day
Monday Tuesday Wednesday Thursday Friday Saturday

8am to 9am
Clinical Lecture do do do do do

9 to 12 noon
Clinical Posting do do do do do

12 to 1pm
Clinical Lecture do do do do do

1 to 2pm
Lunch do do do do do

2 to 4pm

Integrated Lectures to be organised by the concerned coordinators and vice principals

Time Table - Semester VIII 24 weeks

Day
Monday Tuesday Wednesday Thursday Friday Saturday

8am to 9am
Clinical Lecture do do do do do

9 to 12 noon
Clinical Posting do do do do do

12 to 1pm
Clinical Lecture do do do do do

1 to 2pm
Lunch do do do do do

2 to 4pm
Integrated Lectures to be organised by the concerned co-ordinators and vice principals

MBBS curriculum 2007

24

Time table -semester IX 12 weeks

Day
Monday Tuesday Wednesday Thursday Friday Saturday

8am to 9am
Clinical Lecture do do do do do

9 to 12 noon
Clinical Posting do do do do do

12 to 1 pm
clinical Lecture do do do do do

1 to 2pm
Lunch do do do do do

2 to 4pm
Integrated Lectures to be organised by the concerned co-ordinators and vice principals

MBBS curriculum 2007

25 APPENDIX-C
ASSESSMENT OF INTERNSHIP

Name:

Date of Posting

From

To

(Grading: 0 Poor, 1 Average, 2 Satisfactory, 3 Good, 4 Very Good, 5 Excellent)

CRITERIA

GRADING

General 1.
Knowledge Competency and skill (Self competence, assisting observing procedures)

0
procedures,

2.

3. 4. 5. 6. 7. 8.

Resposibility, punctuality, work involvement in treatment, follow up Capability to work in a team Intiative, research participation in

up,

0 0

1 1 1 1 1 1

2 2 2 2 2 2

3 3 3 3 3 3

4 4 4 4 4 4

5 5 5 5 5 5

discussion,

0 0 0 0
performance

Number of topics presented Number of seminars attended Proficiency score (Points given outstanding during the posting)

MBBS curriculum 2007

26

Specific 1
Diagnosis

2 3 4 5

Resuscitation of critically ill

Monitoring patients with serious illness First line management of acute illness Performing Procedures (venisection, tracheostomy, intubation, catherisation, LP, liver biopsy, pleural aspiration etc)

0 0 0

1 1 1

2 2 2

3 3 3

4 4 4

5 5 5

FINAL GRADE:

(Grading: 0-10 Poor, 11-21 Average,

22-32 Satisfactory,

33-43 Good, 44-54 Very Good, 55-65 Excellent

MBBS curriculum 2007

27 Appendix-D Academic calendars for Different Semesters. Academic Calendar for -- 2007 to 2008 Semesters I & II

From Semester I Internal Assessment Semester II Study leave Final Internal Assessment Do Study Leave University Examination

To

Duration 24 weeks 1 week 16 weeks 1 week

Remarks

1 week

Theory Practicals 1 week 1 week

Academic Calendar for-------------------------------------------------------

MBBS curriculum 2007

28
Semesters III, IV & V

From Semester III Internal Assessment Semester IV Internal Assessment Semester V Study Leave Final Internal Assessment Study Leave University Exam

To

Duration 24 weeks 1 week 24 weeks 1 week 16 weeks 1 week 4 weeks 1 week

Remarks

Academic Calendar for --------------------------------------------------Semesters VI & VII

From Semester VI Internal Assessment Semester VII Study Leave Final Internal Assessment Study Leave University Examination To Duration 24 weeks 1 week 16 weeks 4 weeks 1 week 4 weeks Theory & Practicals Proposed date Remarks

MBBS curriculum 2007

29

Academic Calendar for --------------------------------------------------------------------Semesters VIII & IX

From Semester VIII Internal Assessment Semester IX Study Leave Final Internal Assessment Study Leave University Examination House Surgeoncy To Duration 24 weeks 1 week 12 weeks 1 week 4 weeks 1 week Proposed Date 12 months Remarks

Theory

Note: Detailed Schedule for Theory and Practical examination(Internal Assessment) will be put up by the Course Co-ordinator Clinical Examination after each posting during 7th and 8th Semesters There will not be regular classes or posting during the examination week

SECTION II-SYLLABUS(SUBJECT-WISE) Pre-Clinical Subjects-Phase1: In the teaching of these subjects stress shall be laid on basic principles of the subjects with more emphasis on their applied aspects. HUMAN ANATOMY (1) GOAL The broad goal of teaching of undergraduate students in Anatomy aims at providing comprehensive knowledge of the gross and microscopic structure and development of human body to provide a basis for understanding the clinical correlation of organs or structures involved and the anatomical basis for the disease presentations (II ) OBEJECTIVE (A) Knowledge At the end of the course the students shall be able to: a) Comprehend the normal disposition, clinically relevant interrelationships, functional and cross sectional anatomy of the various structures in the body. b) Identify the microscopic structure and correlate elementary ultra structure of various organs and tissues and correlate the structure with the functions as a prerequisite for understanding the altered state in various disease processes. c)Comprehend the basic structure and connections of the central nervous system and analyse the integrative and regulative func tions of the organs and systems. He/She shall be able to explain the developmental basis of the major variations and abnormalities. d)demonstrate knowledge of the basic principles and sequential development of the organs and systems, recognize the critical stages of development and the effects of common teratogen , genetic mutations and environmental hazards. He /She shall able to explain the developmental basis of the major variations and abnormalities. (B) Skills At the end of the course the student shall be able to : (a) Identify and locate all the structures of the body and mark the topography of the living anatomy (b) Identify the organs and tissues under the microscope (c) Understand the principles of Karyotyping and identify the gross congenital anomalies . (d Understand principles of newer imaging techniques and interpretation of Computerized Tomography (CT) Scan sonogram etc.

(e)Understand clinical basis of some common clinical procedures i.e. intramuscular and intravenous injection, lumbar puncture and kidney biopsy etc. ( C) Integration From the integrated teaching of other basic sciences, students shall be able to comprehend the regulation and integration of the functions of the organs and systems in the body and thus interpret the anatomical basis of disease process. (III) DETAILED SYLLABUS-DETAILS OF THE COURSE Duration of the Course : 2 Semesters Total number of hours : 650 Lectures : 89 Seminars : 42 Practicals : 519 Innovation session (projects ,structured discussion, integrated teaching, formative evaluation and revision): Part of practicals DETAILS OF LECTURES 1. General Anatomy Epithelium : Classification, simple and compound epithelium, glandular and 2hr sensory epithelium Connective tissue : Cells, matrix 2hr Cartilage : Classification, structure , cells 1hr and matrix Bone : Types , types of epiphysis, microscopy. Ossification in brief, 2hr blood supply Joints : Classification and structure of synovial joint ( Details of joints-to be taught in 1hr Orthopaedics) Vascular tissue :Elastic artery, medium sized artery, large vein, medium sized vein Lymphatic tissue : Gen. features, lymph node- structure and function, spleen, structure and circulation ,Tonsil, Thymus Muscular tissue :Structure of Skeletal, Smooth and cardiac Muscles Skin: Structure of thin and thick skin

14hr

1hr

1hr 1hr 1hr

Nervous tissue : Neurons, Neuroglia, peripheral nerve structure optic nerve structure Schwann cells, myelination myelinated nerve fibre, Ganglia 2. General Embryology Oogenesis, Ovarian Cycle Menstrual cycle Male reproductive system Spermatogenesis Fertilization, Implantation, assisted reproductive techniques Bilaminar embryo Trilaminar embryo Intraembryonic mesoderm and folding of embryo Formation and circulation of placenta Foetal membranes Twinning and teratology( Structure of Umbilical cord and placenta to be taught along with General Embryology) ( X-rays and surface marking of each region to be taken after the dissection of the corresponding region is completed ) Upper Limb Brachial plexus Mammary gland Shoulder joint Palmar space Seminars ( Give more importance to applied Anatomy ) Radio-Ulnar joints Axilla and Axillary artery Venous and lymphatic drainage of upper limb Brachial artery Anastomoses around elbow joint Radial nerve, Ulnar nerve, Median nerve Rectinacula Elbow joint , wrist joint, Ist carpometacarpal Joint (X-rays to be demonstrated) 4 Lower Limb Hip joint

2hr

11hrs 1hr 1hr 1hr 1hr 1hr 1hr 2hr 1hr 1hr 1hr

4hrs

1hr 1hr 1hr 1hr 8hrs 1hr 1hr 1hr 1hr 1hr 1hr 1hr 1hr 4 hrs 1hr

Arches of foot 1hr Knee joint 1hr Development of Limbs, Dermatomes of Upper and 1hr Lower Limbs Seminars ( Give more importance to applied 6hrs Anatomy) Venous and lymphatic drainage of lower limb 1hr Sub talar joint , inversion and eversion of foot1hr Femoral triangle, Adductor canal 1hr Obturator nerve 1hr Femoral artery and nerve 1hr Ankle joint, Popliteal fossa 1hr 5 Thorax 9hrs Thoracic wall ( including movements of thoracic cage 1hr Pleura 1hr Lungs including development of lungs-very breifly 1hr Pericardium 1hr Blood supply of heart 1hr Arterial arches 1hr Foetal circulation 1hr Development of heart and developmental anomalies 2hr Seminars (Give more importance to applied 5hrs Anatomy) Mediastinum-Boundaries and contents, Arch of Aorta 1hr Thoracic duct, Esophagus, Thoracic Aorta 1hr Veins of Thorax 1hr Chambers of heart-All chambers 1hr Splanchnic nerves, sympathetic trunk 1hr 6 Genetics 4hrs Classification of chromosomes, 1hr karyotyping ,sex chromosomes, Barr body Normal male, normal female, 1hr Chromosomal aberrationsin brief Turner's syndrome , Klienfelter's syndrome and Down's syndromes ( Charts to be shown Genetic 1hr Counselling , Pedigree Chart, Genetic Engineering and inheritance 7 Head& Neck 17hrs Scalp 1hr Parotid Gland 1hr Development of face 1hr

Pituitary gland 1hr Dural venous sinuses 1hr Cervical fascia 1hr Development of branchial arches 1hr Extra Ocular muscles 1hr [Link] 1hr Thyroid gland 1hr Cervical Sympahtetic 1hr Pharynx 1hr Larynx 1hr Eyeball, layers-development of eye 1hr ball in brief Tongue 1hr Facial Nerve 1hr Middle Ear 1hr Seminars (Give more importance to applied 13 hrs Anatomy) Suboccipital triangle 1hr Eyelid and lacrimal apparatus 1hr Nasal cavity , PNS 1hr Soft palate 1hr Muscles of facial expression 1hr Vessels and nerves of the face 1hr Posterior triangle of neck 1hr Anterior triangle of neck 1hr Mandibular nerve, occulomotor nerve 1hr Submandibular and sublingual glands 1hr Palatine tonsil 1hr Lymph nodes of head and neck 1hr Hyoglossus muscle 1hr 8 Brain and Spinal Cord 14hrs Spinal cord- external features and 1hr blood supply Blood supply of brain- Superficial 1hr and deep, meninges Medulla oblongata 1hr Pons 1hr Cerebellum 1hr 4th Ventricle 1hr 3rd Ventricle , Lateral ventricles 1hr Midbrian 1hr Sulci, gyri and functional areas of cerebrum 1hr Internal capsule 1hr Visual pathway 1hr

Basal ganglia 1hr Thalamus 1hr Development of CNS in breif including 1hr functional column 8 Abdomen, Pelvis, and Perineum 16hrs Anterior abdominal wall and Rectus Sheath 1hr Inguinal canal, Spermatic cord and descent 1hr of testis Peritoneum in brief 1hr Development of GIT , derivatives 1hr and anomalies Stomach including development 1hr Portal vein 1hr Liver 1hr Kidney -gross features , 1hr development and anomalies Diaphragm-gross features ,development 1hr and anomalies Uterus-gross features, development 1hr and anomalies Prostate and male urethra 1hr Rectum and Anal canal 1hr Urinary bladder 1hr Perineal Pouches 1hr Ischiorectal fossa 1hr Pelvic floor 1hr Seminars (Give more importance to applied Anatomy Lymphatic drainage 6hrs and blood supply of all organs should be given importance Duodenum and development 1hr Pancreas 1hr Extra hepatic biliary apparatus 1hr Supra renal gland 1hr Ureter 1hr Pudendal nerve 1hr

Diagrams
I a Cross Section Diagrams Upper limb Name Fig No Page No Book

Section through middle of arm

68

Cunningh am's manual of 68 pracical Anatomy 15th Edn Cunningh am's manual of 90 pracical Anatomy 15th Edn Gray's 872 Anatomy 38 th Edn Cunningh am's manual of 196 pracical Anatomy 15th EdnVol-1 218

Oblique section through the hand

88

b 1

Lower limb Transverse section thorugh middle of right thigh 124

Transverse section thorugh middle of leg

182

4 C 1 D 1 E 1 2 3 F 1

Transverse section through knee joint Neck Transverse section through the neck at the level of cricoid (C6 level )cartilage Thorax Horizontal section through the thorax at the level of T-4 Vertebra Abdomen Horizontal section through the abdomen at the level of epiploic foramen-T12 vertebra Horizontal section thorugh the abdomen at the level pylorus -L1 vertebra Horizontal section through the abdomen at the level of -L4 vertebra Brain Transverse section of medulla at the level of Pyramidal decussation

202

62

76 Vol-3

70

58 Vol-2

139 128 129

124 116 116

" " "

11.1

137 Vol-3

2 3 4 5 6 7 8 II 1 2 3

Transverse section little above pyramidal decussation Transverse section at the level of olive Transverse section at the level of lower part of pons Transverse section at the level of upper part of pons Transverse section through lower part of mid brain Transverse section through the upper part of Mid brain Superior colliculus Horizontal section at the level of interventricular foramen Sagittal Section Sagittal section through shoulder joint Median section of brain

11.2 11.3 11.5 11.7 11.8 11.9 282

138 140 143 143 144 146 286

" " " " " " "

64 238 235 236

65 Vol-1 Cunningh 255 am Vol-315th Edn 216 Vol-2 216 Vol-2

Median section thorugh male pelvis Median section through female 4 pelvis 111 Gross Anatomy Upper limb- (1) Typical spinal a Nerve 1 Brachial plexus 2 Anastomosis around elbow joint 3 Superficial palmar arch 4 Deep palmar arch b Lower limb 1 Femoral triangle 2 Longtudinal arches of foot -Medial Lateral Strucutures surrounding the hip joint Thorax Typical intercostal space

2 24 80 90 131 213

6 33 Vol-1 82 Vol-1 92 140 226 Clinical Anatomy 591 Richard.S. Snell Cunningh am's 12 manual 15th EdnVol-2

3 c 1

10.33

16

Relations of heart & great vessels to the anterior wall of thorax Surface marking- Borders , Surfaces, valves of heart) Sternocostal surface of the heart Mediastinal surface of lung -Left lung 41 41 -Right lung Abdomen Visceral surface of liver Strucutures seen posterior to the stomach Anterior surface of right and left kidney showing relations Posterior surface of right and left kidney showing relations Head & neck Diagramatic section of eyeball Dissection of submandibular region showing lyoglossus muscle and its relations Distribution of cutaneous nerves to Head & Neck Brain Circle of willis Blood supply of cerebrum Inferior Surface Superolateral surface

53 51 32 33

44 Vol-2 41 Vol-2 Vol-2

176 149 191 190 184 111 75 196 197 201

156 Vol-2 132 Vol-2 169 Vol-2 168 Vol-2 164 Vol-3 131 Vol-3 98 Vol-3 218 Vol-3 198 Vol-3 221 Vol-3

232 250 Vol-3 Medial surface Floor of IV ventricle- posterior view 227 243 Vol-3 of brainstem The question on the diagrams in the question paper carrying 4 marks ( 2 marks each in both Paper 1 & paper 2 should be STRICTLY limited from the above list only DETAILS OF PRACTICALS- Dissection inlcuding Osteology and Histology Upper Limb Introduction, Pectoral region and axilla, Cutaneous nerves and vessels The brachial plexus, The dissection of back The free upper limb Lymph vesels and lymph nodes of upper limb Cutaneous nerves of upper limb and deep fascia of upper limb The shoulder- movements of the limb at the shoulder, the shoulder joint The arm- arterior compartment ,Posterior compartment of arm The forearm and hand, Palmer aponeurosis, Superficial palmar arch, Flexor retinaculum, Flexor tendons

The arteries and nerves of the flexor compartment of the forearm Muscles of the front of the forearm and hand, Fascial compartments of the palm The extensor compartment of the forearm and hand ,Extensor tendons of the finger Joints of the upper limb- elbow joint , wrist joint, radio-ulnar joints, intercarpal-carpo metacarpal Intermetacarpal joints Lower limb 60hrs Sole of the foot I and II layers, IIIand IV layers, V layer & VI layers Front of thigh, Adductor canal, Medial side of thigh, Gluteal region Popliteal fossa, Back of thigh , Hip joint Front of leg and dorsum of foot, Superficial dissection Anterior compartment of leg, Lateral and medial compartments of leg, Back of leg Ankle, Tibio-fibular and other joints, revision Thorax 30hrs Introduction: Walls of thorax, Cavity of thorax Mediastinum, Root of lungs Autonomic nervous system The lungs ,Anterior mediastinum, Middle mediastinum Surface anatomy of the heart , Chambers of heart, Right atrium, Right ventricle, Left ventricle Aorta, Superior mediastinum, Arch of aorta, Left atrium, conducting system of heart Thoracic part of aorta Vagus, Oesophagus, Thoracic duct Posterior intercostal vessels, Joints of thorax, Revision Head & Neck 130hrs Cervical vertebrae, Skull, The scalp The temple and the face, Nerves and vessels of scalp and superficial temporal region The superficial dissection of face The side of the neck, Suboccipital triangle The anterior triangle of neck, The median region of the front of neck, subdivisions of anterior triangle The cranial cavity: Structures seen after removal of cerebrum Anterior cranial fossa, middle cranial fossa, posterior cranial fossa Deep dissection of the face: Nerves of the face Structures in the cheek and lips The eyelids, The lacrimal apparatus The orbits, The structures in the orbits The parotid region, The parotid gland The temporal and infratemporal region Temporal fascia, Temporalis muscle The Superficial contents of the infratemporal fossa

Temporomandibular joint, The deeper contents of the infratemporal fossa The submandibular gland, Mylohyiod muscle, Hyoglossus , Styloyoid ligament The mouth and pharynx , The cavity of the nose, The larynx, The tongue The organs of hearing and equilibrium The eye ball The contents of the vertebral canal, the joints of the neck Brain 42hrs Introduction: The membranes of the brain- meninges The blood vessels of the brain The cerebellum, The fourth ventricle, The midbrain, pons, medulla The cerebrum , The White matter of cerebrum III ventricle , the lateral ventricle and the choroid fissure The thalami and the optic tracts The deep dissection of the hemisphere The deep muclei of the telencephalon The nuclei and connections of the thalamus, Cerebral topography Abdomen 125hrs Introduction: Anterior abdominal wall muscles, inguinal canal Nerves and vessels of anterior abdominal wall Male external genital organs Dissection of the loin Abdominal Cavity Shape, Boundaries, Divisions of peritoneal cavity Ligaments of liver, Spleen Oesophagus, Vagal trunk , Stomach, Mesentery Superior mesenteric artery, Inferior mesenteric artery, Arterial anastomosis in GI tract Structure of small intestine, Large intestine Duodenum, Portal vein, Ducts of liver Pancreas, Liver, Gall bladder, Cystic duct Abdominal structures in contact with diaphragm Autonomic nervous system Supra renal glands The kidneys, Abdominal part of ureter The diaphragm, The posterior abdominal wall muscles The inferior vena cava Lumph nodes of posteior abdominal wall, The nerves of posterior abdominal wall The pelvic viscera, ovaries, uterine tubes Pelvic part of ureters Urinary bladder, Internal surface of urinary bladder Ductus deferens, Prostate ,Male urethra Uterus , Rectum, Anal canal

Vessels of lesser pelvis, nerves of lesser pelvis, Obturator nerve, Autonomic nerves The muscles of lesser pelvis, joints of pelvis Perineum 12hrs Ischiorectal fossa, Perineal pouches Perineal body, Pudendal canal Histology 60hrs Epithelium Connective tisue Cartilage- Hyaline, elastic, fibro cartilage Bone- C.S.L.S Muscles- Skeletal, Smooth, cardiac Nervous tissue- neuron, nerve fibre, sciatic and optic nerves, sympathetic, spinal ganglia Blood vessel- Large and medium sized artery, large and medium sized vein Lymphoid tissue- lymph node, spleen, thymus, palatine tonsil Skin- thin, thick Mammary gland-active inactive Placenta- umbilical cord Respiratory system- trachea , lung Nervous system- spinal cord, cerebrum cerebellum, cornea, retina Endocrine system- thyroid , parathyroid, supra renal, pituitary Excretory system- kidney, ureter, urinary bladder Testis epididymis, vas deferens, Reproductive system- Male prostate -Female Ovary uterus- proliferative and secretory, fallopian tube, cervix Digestive system- Salivary gland- mucous, serous , mixed pancreas, liver, gall bladder, tongue ,oesophagus stomach-fundus, pylorus, duodenum, jejunum, ileum, large intestine, appendix Demonstration of karyotyping charts- Normal male, Normal female, Down syndrome, Tuener's Syndrome, Klinefelter's Syndrome, Chormosome spread

Prescribed text books. [Link]-3Volumes,15thEdition [Link],3Volumes [Link],3volumes [Link]-InderBirSingh [Link]-InderBirSingh [Link]-VishramSingh [Link]-InderBirSingh [Link]-Gunasekharan [Link]&[Link] [Link] [Link] [Link].

Reference text Books 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Gray's Anatomy- 39th Edition/40th edition Cunningham's text book of Anatomy- 11th edition Grant's Method of Anatomy- [Link] Langman's Medical Embryology- [Link] 11th edictio Clinical Neuro Anatomy- Richar S Snell Clinical Embryology- Richard S Snell Essentials of Human Embryolgy- [Link] Essentials of Human Genetics- Bhatnagar, Kothari and Lopa Mehta Histology Atlas- De Fiore Text Book of Histology -Hamilton Bailey Clinically Oriented Anatomy- Keith L Moore, 3 rd edition Gray's Anatomy for students- Richard L Drake The Developing Human- Moore and Persaud 8th edition Clinical Anatomy by Regions Richard S Snell -8th edition Human genetics -[Link]

Evaluation UniversityExamination TheoryTopicDivision

PaperIGeneralEmbryolgoy,GeneralAnatomy,Genetics,UpperLimb,LowerLimb,Thorax PaperIIHeadandNeck,Brain,Abdomen,Pelvis,Perineum

BIOCHEMISTRY
(INCLUDING MEDICAL PHYSICS AND MOLECULAR BIOLOGY) I) GOAL The broad goal of teaching undergraduate students in Biochemistry is to make them understand the scientific basis of life processes at the molecular level and to orient them towards the application of this knowledge in solving clinical problems II) OBJECTIVES (A) Knowledge : At the end of the course, the student shall be able to; (a) Describe the molecular and functional organization of a cell and lists its sub cellular components. (b) Delineate structure, function and inter-relationship of bimolecular and consequences of deviation from normal. ( c) Summarize the basic and clinical aspects of Enzymology with emphasis on diagnostic enzymes. ( d ) Describe digestion,& assimilation of nutrients and consequences of malnutrition ( e ) Integrate the various aspects of metabolism and their regulatory pathways (f) Explain the biochemical basis of inherited disorders with their associated sequelae ( g ) Describe mechanisms involved in maintenance of body fluid ,and pH homeostasis ( h ) Outline the molecular mechanisms of gene expression and regulations, the principles of genetic engineering and their application in medicine. (I ) Summarize the molecular concept of defenses and their application in medicine. ( j ) Outline the biochemical basis of environmental health hazards, biochemical basis of cancer and carcinogenesis (k ) Familiarize with the principles of various conventional and specialized laboratory investigations, instrumentation analysis and interpretation of a given data. (l) Suggest experiments to support theoretical concepts and clinical diagnosis. 1

(B) Skills At the end of the course, the student shall be able to 1. Make use of conventional techniques and instruments to perform biochemical analysis relevant to clinical screening and diagnosis 2. Analyze and interpret investigative data 3. Demonstrate the skills of solving scientific and clinical problems and decision making (C) Integration The knowledge acquired in Biochemistry shall help the students to integrate molecular events with structure and function of the human body in health and diseases.

111.

DETAILED SYLLABUS DETAILS OF COURSE

Duration of the course Total number of hours Lectures Practicals + Seminar

2 semesters

: 240 : 160 : 80

Innovative session (projects, seminars, structured discussion, integrated teaching, formative evaluation and revision): Along with practicals .

DETAILS OF LECTURES

Hours allotted 1 hour 15 hours

(1) (2) A.

Introduction- Struture and functions of cell, cellular organelles and biomembranes, (details of transport and ion channels in physiology). Biomolecules Proteins Amino acids - classifications based on structure, polarity, nutritional requirement and metabolic fate Important biochemical properties-ionic properties of amino acids, iso-electric pH, buffering action of amino acids and proteins, biologically important peptides Structural organization of proteins with examplesinsulin, collagen, primary, secondary,teritiory and quaternary structure Classification of proteins ,Denaturation, Coagulation ,isoelectric precipitation, precipitation using salt solutions, ( colour reactions to be covered with practicals) , Electrophoresis & chromatography briefly mention on separation techniques (details of techniques and application in practical demonstration)

B.

Carbohydrates Classification - Monosacharides glucose, fructose, galactose, mannose. Reactions- reducing property, oxidation, reduction, furfurals, osazone (details along with practicals) Isomers, anomers and [Link] like aminosugars and deoxy [Link] bond. C. Disacharides lactose, sucrose, maltose. Polysacharides starch, glycogen, dextrins , use of dextrans as plasma expanders, blood group [Link] ( basic structural features and functions), Mucopolysaccharidoses 3 2

classification and enzyme defect only, blood group antigens 2 (3) Lipids Definition Classification with examples, saturated and unsaturated fatty acids, essential fatty acids , PUFA including omega 3 fatty acid ,triacyl glycerols, phospholipids classification, structure and functions Struture and function of biomembrane , Enzymes Nature of enzymes, Coenzymes & cofactors, Classification Mechanism of enzyme activity, active site, specificity Enzyme kinetics, Factors affecting enzyme activity, Km value and its significance(derivation not required) (4) Types of enzyme inhibition - competitive, non competitive,uncompetitive, suicidal, allosteric , feed back inhibition,kinetics and their clinical applications Enzyme regulation in biological systems allosteric regulation, covalent modification,zymogen activation,induction and repression. Clinical enzymology functional and non functional enzymes, Isoenzymes, Diagnostic importance of enzymes LDH, CPK, AST, ALT, ALP, ACP, GGT, NTP, GPD, cholinesterase, amylase, lipase Cardiac markers Therapeutic enzymes Digestion and absorption of nutrients Carbohydrates ,Glucose transporters, disorders associated, dietary fiber Digestion of lipids and Malabsorption syndrome. Digestion and absorption of proteins, nitrogen balance, PEM 4. 3 METABOLISM OF CARBOHYDRATES 5. EMP Pathway -reactions, regulation in brief, energetics 4 2 10 hours 1 1 2

2 1 3

5 hours 2 1 2

(5) A. 1.

18hours 3 1 2

2. 3.

6.

Rappaport-Leubering cycle, Fate of pyruvate in aerobic anaerobic conditions, PDH reaction Gluconeogenesis,key enzymes, regulation and significance, Cori cycle Glycogenesis, glycogenolysis ,regulation in brief , inborn errors associated

7.

3 1 1 17 hours

8. 9. B. 1.

HMP Shunt pathway ,tissues where operating, NADPH generation, Transketolase reaction, G6PD deficiency, functional significance of HMP shunt (non-oxidative phase need not be elaborated) Uronic acid pathway, Metabolism of galactose, fructose, polyol pathway, inborn errors assosciated RegulationofBloodGlucoselevelActionofinsulin,recept ors,glucagon,cortisol,growth hormone, adaptation during fed state,fasting state.&in starvation.

3 2 3 Diabetes mellitus, aetiology, biochemical abnormalities symptoms & biochemical basis of complications( acute in detail and chronic in brief),Lab diagnosis and monitoring of Diabetes mellitus ,microalbuminuria, Glycated hemoglobin. Metabolic syndrome - Insulin resistance Glycosurias and reducing substances . GTT- procedure,criteria of normal and diabetic status, interpretation of graph. METABOLISM OF LIPIDS 5 Fatty acid oxidation- beta oxidation, transport of fattyacids across mitochondrial membrane, regulation, energetics, alpha oxidation-points only, Refsums disease, Zellwegers syndrome. Oxidation of odd chain fatty acid ( need not be elaborated ), fate of propionyl Co A Synthesis of fatty acids, fattyacid synthase complex, regulation, elongation and desaturation Formation and utilization of ketone bodies, ketoacidosis, in diabetes and starvation 7 8 Metabolism of adipose tissue, hormone sensitive lipase, action of hormones insulin,glucagon, epinephrine and cortisol .Lliver-adipose tissue axis, Fatty liver and lipotropic factors, obesity, 5 1 1 2 2 2

C 1

metabolic syndrome in brief. Struture ,synthesis of cholesterol upto mevalonate in detail then mention the intermediates with basic chemical changes, regulation, metabolic fate, bile acids formation, bile salts, steroid hormones. Transport of plasma lipids, Lipoproteinsclassification, metabolism, functions and disorders dyslipidaemias, atherosclerosis, biochemical basis of management of hyper lipidaemia diet and drugs, lipid profile. Phospholipids and sphingolipids-inborn errors. Eicosanoids - Prostaglandins, thromboxanes and leukotrienes-formation (major steps only), biochemical actions. METABOLISM OF AMINOACIDS Body aminoacid pool, dynamic state of body proteins, inter organ transport of amino acids , glucogenic and ketogenic aminoacids Reactions - Transamination, decarboxylation, oxidative deamination, transdeamination, formation and detoxification of ammonia, urea cycle, regulation and energetics, hyperammonemias acquired and congenital Metabolism of glycine, compounds synthesized,, inborn errors associated

16hours 1

2. 3

3 4.

2 2

5 6 7 8

2 2 1

3 6hours 3

D. 1

3 2 Metabolism of Sulphur containing aminoacidsmethionine and cysteine, transsulphuration, transmethylation, formation of taurine, PAPS, excretion of sulphur, inborn errors associated. Phenyl alanine and tyrosine metabolism, compounds synthesized inborn errors associate and VMA Tryptophan- metabolism, compound synthesized and inborn errors associated, Hartnups disease,5HIAA & carcinoid syndrome 6hours 4

(6) 1

2 (7)

Histidine metabolism and inborn errors Glutamic acid, GABA, Glutamine,asparagin, Aspartic acid- serine, threonine, arginine, NO and polyamines ( synthesis and function ), Brached chain aminoacids- MSUD ( pathway not required ). Biologically important amines, organic acidurias TCA CYCLE AND E T C

2 9 hours

1. 2. 3. 4. (8) Electron transport system - components and site of ATP Synthesis, Mechanism of Oxidative Phosphorylation . ATP Synthase, uncouplers and inhibitors , brown adipose tissue . HAEMOGLOBIN 2. 3. (9) Heme synthesis& porphyrias- Breakdown of Hb, Biochemical basis of jaundice and distinguishing features of different types of jaundice, neonatal hyperbilirubinemias, lab diagnosis Haemoglobinopathies and thalassemias, haemoglobin derivatives and significance VITAMINS (Classification, chemical nature, (detailed structure not required) Dietary sources, coenzyme form biochemical role, deficiency manifestations, daily requirement and toxicity of following vitamines . Vitamin A, D, K ,E Thiamine, Riboflavin, Niacin, Pyridoxine, Biotin, Pantothenic acid 3. Folic acid, one carbon metabolism and B12 4. Ascorbic acid and anti vitamins Reactions, regulation, energetics,and significance, Inter relationship of carbohydrate, lipid, aminoacid metabolism Anaplerotic reactions, Amphibolic role , Metabolic adaptation during fed state and starvation

4 2 2 1 7 hours

2 1 4 3hours

(10) 1.

6Hours 1 2

2.

2 1

(11) A. 1. 2.

MINERAL METABOLISM Classification Dietary sources, requirements absorption, biochemical role deficiency and toxicity of the following minerals Calcium and phosphorus - role of PTH, 1,25 DHCC and calcitonin Iron metabolism and disorders

24 hours 2

3.

Copper, magnesium , trace elements - Zinc ,iodine, Fluoride, Selinium, Manganeese Sodium, Potassium chloride 2 XENOBIOTICS Biochemical basis of environmental health & environmental toxicology, mechanism of detoxification and role of cytochrome p 450 Deleterious effects of smoking , alcohol metabolism ,free radicals free radical scavenging system, lipid peroxidatrion,antioxidants MAINTENANCE OF HOMEOSTASIS

4. B.

2 2 2

C. D. E. Acid base regulation: pH, Acids,Bases,Buffers, Henderson Hasselbalch Equation in relation to body systems ( derivation not required ), buffer capacity Body buffers, Role of kidneys and lungs in Acid base homeostasis. Acid base disorders, causes , compensatory mechanisms , anion gap, assessment of acid base status

1 3 2

F. G.

3 H. Fluid and electrolyte balance distribution of body water and disorders ( hormonal regulation not in detail ) 3 NUCLEIC ACIDS and MOLECULAR BIOLOGY Structure of purines, pyrimidines, nucleosides, nucleotides (12) Purine:nucleotide synthesis and catabolism and inborn errors (synthetic pathway need not be considered in detail, with names of intermediates. Only the source of different atoms and sequence of 8 3 hours

addition).Salvage pathway and regulation, hyperuricemia and gout, Lesch Nyhan syndrome, [Link] (13) Pyrimidine: nucleotide synthesis, regulation, orotic aciduria, formation of deoxy nucleotides, thymidylate synthase reaction, folicacid antagonists and nucleotide analogues as chemotherapeutic agents( Antimetabolites ) Nucleic acids: structure and organisation of DNA, different types of DNA, mitochondrial DNA, base pairing rule, differences between DNA and RNA, different types of RNA DNA replication, Telomerase, DNA polymerase, DNA repair ( basic mechanism of repair and disorders Transcription, RNA polymerase, post-transcriptional modifications, splicing, inhibitors, reverse transcriptase, ribozyme Genetic code, tRNA, ribosomes Translation, steps, post-translational modifications, inhibitors, Protein folding in brief and conformational disorders - chaperon,prion disease, protein targeting Regulation of gene expression, induction, repression and derepression. Gene rearrangement in brief Recombinant DNA technology, restriction endonucleases; southern, Northern and Western blotting. RFLP,DNA finger printing, Polymerase chain reaction, anti sense therapy, Gene therapy,clinical application of above techniques, cloning Biochemical basis of inherited disorders: Mutations, Pathogenesis of inborn errors of metabolism in general, types of mutations with examples in each case, mode of inheritance, Mitochondrial DNA and mitochondrial myopathies PLASMA PROTEINS & IMMUNOGLOBULINS . Functions of plasma proteins,transportproteins,acute phaseproteins Structure and functions of immunoglobulins, hyper and hypo gammaglobulinemias, monoclonal antibodies,multiple myeloma and Bence-Jones 9 2 2 2 4hours 3 1 9 hours 2 1

(14)

proteins, biochemistry of AIDS immunology,reverse transcriptase and lab diagnosis- ELISA,Southern blot, PCR BIOCHEMISTRY OF CANCER Cell cycle, apoptosis, mutagens,Role of carcinogens in carcinogenesis, Tumor suppressor genes , oncogenes, viruses in carcinogenesis Tumor markers- common parameters and their utility in clinical practice. CLINICAL CHEMISTRY 1. Liver function tests- Common tests performed serum bilrubin, enzymes,AG ratio, BSP test, urine tests and and interpretation of laboratory reports. 2. Thyroid function test and interpretation 3. Renal function tests- BUN ,NPN, Clearence test , tests of tubular function urine analysis and clinical interpretation of laboratory reports, newer renal markers Cystatin C 4. Special laboratory investigations RIA,[Link] of colourimetry, 5. Radioactivity diagnostic,research,& therapeutic applications and radiation hazards (The topics mentioned above have to be covered within the stipulated period of one year. Hence the basic fundamentals may be covered as lectures and the other topics as tutorials, group discussions, integrated teaching sessions (horizontal and vertical), seminars and symposia. In all these sessions active participation of students must be ensured. A few topics have been identified for the non conventional type of learning)

10

TOPIC DIVISION

PAPER-1

Topics (1) to (5)

Introduction, biomolecules, Enzymology , Digestion and Absorption of nutrients,Metabolism of Carbohydrates , Lipids , Proteins , TCA cycle & ETC

PAPER - II

Topics (6) to (14)

Haemoglobin,, Vitamins , minerals, Xenobiotics, maintenance of homeostasis , NucleicAcids&MolecularBiology, plasmaproteins& Immunoglobulins, Biochemistry of Cancer and clinical chemistry

DETAILS OF PRACTICALS 35sessions [Link] of carbohydrates:glucose,fructose,lactose,sucrose 4 sessions [Link] of proteins 3sessions [Link] of urea and uricacid/creatinine 1session (Hypobromite and specific urease test for urea and Benedicts test and Schiffs test for uric acid,Jaffes test) [Link] of biochemically important compounds in given solution 3sessions [Link] urine-organic and inorganic constituents 2sessions

11

[Link] urine-urinalysis(physical and chemical) 3sessions [Link] of electrophoresis-agargel-interpretation of simple patterns 1session [Link] of chromatography-paper/TLC-Diagnostic importance 1session [Link] crystals 1session [Link] to clinical chemistry-collection of samples,anticoagulants and Preservatives,principles of colorimetry 1session [Link] of glucose-GTT curves-lab data analysis 1sessions [Link] of urea in serum-calculation of clearance from given values of U and V 1session [Link] of creatinine in urine or serum-calculation of clearance 1session [Link] of total protein and albumin-A/G ratio 1session [Link]-Demonstration Simple instruments,graphs,tests etc. 1session 16.(a)Laboratory data interpretation-liver diseases,renal diseases,acid base disturbances, diabetes mellitus,cardiac diseases,lipid profile-data interpretation,lipid disorders 2sessions (b)Problem solving exercises-short history of different conditions may be given And students will be asked to suggest investigations to arrive at a diagnosis 2sessions [Link] 5 sessions

12

TEACHING LEARNING METHODS Structured Interactive sessions, Tutorials, Group Discussions, Seminars, Projects, Self learning modules and e- modules etc. 5 sessions

SUGGESTED BOOKS IN BIOCHEMISTRY

Books for study: 1. Text of Biochemistry for Medical students by Vasudevan & Sreekumari latest edition 2. Harpers review of Biochemistry- latest edition 3. Medical Biochemisty by Dinesh Puri -latest edition 4. Lippincotts Illustrated Review of Biochemistry -latest edition Books for Reference: 1. Principles of Biochemistry by Lehninger 2. Biochemistry with Clinical Correlations by Thomas . M. Devlin 3. Biochemistry by Stryer 4. Biochemistry-A case oriented Approach by Montgomery 5. Textbook of medical Biochemistry by Bhagwan

Evaluation
University examination Theory paper I & II Internal assessment Viva Practical I & II Internal assessment Total 13 20 + 20 = Marks 50 + 50 = 100 20 20 40 20 200

HUMAN PHYSIOLOGY INCLUDING BIO-PHYSICS

(1) GOAL The broad goal of the teaching of undergraduate students in physiology aims in providing the student, a comprehensive knowledge of the normal functions of the organ systems of the body and their interactions to facilitate understanding of the physiological basis of health and changes in disease. The broad goal of teaching Biophysics to undergraduate students is that they should understand basic physical principles involved in the functioning of body organs in normal and diseased conditions. (II) LEARNING OBJECTIVES (A) Knowledge At the end, a medical student in Physiology should be able to explain: (a) Functions of organ systems in a normal subject. (b) Contribution of organ systems and their integration in maintenance of homeostasis (c) Altered physiology on exposure to stress, and during disease process (d) Compare the normal and abnormal data; interpret the same to assess health status (e) Physiological principles underlying pathogenesis and treatment of disease. (f) Reproductive physiology as relevant to National Family Welfare programme (g) Basic laboratory investigations relevant for a rural set up (h) Concept of professionalism (i) Approaches to the patient with humanity and compassion (B) Skills At the end of the course the student shall be able to: (a) Conduct experiments designed for study of physiological phenomena (b) Interpret experimental / investigative data (c) Distinguish between normal and abnormal data derived as a result of tests which he/she has performed and observed in the laboratory (C) Integration At the end of the integrated teaching, the student shall acquire an integrated knowledge of organ structure and function and its regulatory mechanisms.

(III) DETAILED SYLLABUS DETAILS OF THE COURSE Duration of the course Total number of hours Lectures Practicals Innovative session(Projects, seminars, structured discussion, integrated teaching, formative evaluation and revision : : : : : 2 semesters 480 160 120 200

DETAILS OF CLASSES IN PHYSIOLOGY

General Physiology
LECTURES Introduction to Physiology Principles of Homeostasis Structure of cell membrane Transport Mechanism Intercellular communication 3 hrs

2 hrs

Body Fluid compartments divisions, composition, and determination (mention Ficks principle) Blood volume normal value, abnormalities hypovolemia & hypervolemia 1 hr SEMINAR/ TUTORIAL Apoptosis and aging Homeostasis

1 hr 2hrs

Hematology
LECTURES Introduction Blood - Functions, composition, Properties specific gravity, viscosity definition, normal values & variations Plasma proteins: types, quantity, functions, A: G ratio, abnormal proteins (2) - Bence Jones & C reactive proteins Red Blood Cells Morphology, composition and functions, normal RBC count and variations Properties PCV, ESR, Osmotic fragility definition, normal values, factors affecting and variations (methods in practical classes). Haemoglobin outline only normal basic structure, normal content, functions, types (Hb A, Hb A2 and Hb F) abnormal Hbs (only two - Thalassemias & Haemoglobin S) Erythropoiesis sites (intra and extrauterine)different stages, Factors influencing & regulating Erythropoiesis Life Span of RBC and its destruction (outline), jaundice (mention) Anaemias definition, classifications (etiological, morphological), physiological basis of anaemias (briefly), iron deficiency anaemia,.Pernicious anaemia, aplastic anaemia, Hemolytic anaemia (briefly), Polycythemia- primary and secondary 1 hr 20 hrs

1 hr

1 hr

1hr

1 hr

Bone marrow study Importance, myeloid: erythroid ratio

White Blood Cells: Classification, morphology (details in practical classes), lifespan Properties and functions Neutrophil, Eosinophil, Basophil, Monocyte, Lymphocyte Normal total and differential count (methods in practicals), variations Leucocytosis , Leucopenia, leukaemia (definition, mention difference from leucocytosis), agranulocytosis, Leucopoiesis 4 hrs

Immunity Definition, Types innate and acquired, Humoral and cellular Mechanisms of immune response, plasma cell, immunoglobins, Autoimmune disorders, AIDS (mention) Platelets: Morphology, properties and functions, normal count, variations, thrombopoesis, and factors Influencing this Reticuloendothelial system (briefly) Haemostasis Primary (vasospasm, platelet plug formation) and Secondary (extrinsic and intrinsic mechanisms of coagulation of blood) Clot retraction (mention) Anticlotting mechanisms in vivo -factors that limit clot formation (Protein C, Protein S and antithrombin III) and fibrinolytic system (all in brief) Anticoagulants - used in lab and in vivo Bleeding disorders Purpura, Hemophilia, Vitamin K deficiency Tests for bleeding disorders bleeding time, clotting time (in practicals) Prothrombin time and PTT (principles only) Thrombosis and Embolism mention Blood groups ABO and Rh systems, inheritance, differences, Bombay group, Landsteiners laws I and II Mention about other minor blood groups, bombay blood group (mention) Blood grouping and cross matching (importance), concept of universal donor and recipient ABO and Rh incompatability important manifestations, erythroblastosis foetalis Management and preventive measures, Medicolegal and clinical importance (briefly) Blood banking and transfusion Blood transfusion indications, precautions and complications Blood Banking anticoagulants used, storage, changes during storage Transfusion of blood components with special reference to recent advances Lymph formation, circulation, functions Tissue fluid formation, circulation and functions Starling's hypothesis edema formation SEMINARS / TUTORIAL Reticuloendothelial system INTEGRATED TEACHING Immune mechanisms (with microbiology department) Modern trends in blood banking (with transfusion medicine department) Blood and bone marrow smears normal and abnormal (with pathology dept)

1 hr

1 hr hr

4 hrs

2 hrs

1 hrs

1 hr

2 hrs 6 hrs

Cardiovascular system
LECTURES Functional anatomy of heart and blood vessels Chambers, valves, great vessels, Systemic and pulmonary circulations Structure and functions of different segments of blood vessels correlate with functions 24 hrs

Properties of cardiac muscle Excitability, rhythmicity, conductivity, contractility, distensibility, Treppe (mention) Conducting system of heart Parts of conducing system, origin and spread of cardiac impulse, Abnormal pacemakers, conduction defects Cardiac cycle: Definition, phases, events of cardiac cycle Pressure changes Atria, Jugular vein (mention clinical significance). Ventricles right and left Aorta and Pulmonary artery Methods of measurement, cardiac catheterization basic principle Volume changes in different chambers. Heart sounds causes, character, murmer (definition, physiological basis) Arterial Pulse genesis and characters of normal pulse Common abnormalities in practical classes Venous blood flow- Venous tone, valves Correlation between different events of cardiac cycle (diagrammatic representation) Echo cardiography (principle only) ECG Definition, Principles of recording of ECG (details in practical) Leads unipolar and bipolar, commonly used 12 Leads Normal tracing in Lead II normal waves, intervals and segments, how HR is determined, correlation with action potential and phases of cardiac cycle Clinical uses of ECG (mention) Abnormal ECG pattern in myocardial infarction, cardiac arrhythmias (briefly) Effect of changes in ECF K+, Ca++ and Na+ Conduction defects - define I0, 20 and 30 block (mention) Cardiac output: Definition, normal values, variations Method of measurement (Ficks principle mention) Regulation of cardiac output heart rate - Regulation of heart rate, stroke volume determinants, regulation Correlation of normal ECG pattern with events of cardiac cycle in a diagram Haemodynamics Functional organisation correlated with structure of vascular system (review) General principles including physical laws governing flow of blood in heart and blood vessels - Pressure resistance - flow relationship, PoiseuilleHagen formulae, law of Laplace Laminar flow, turbulent flow, Reynolds number, critical closing volume Importance of peripheral resistance, venous circulation, venous tone Regulation of blood flow Arterial Blood pressure Systolic and diastolic pressures definition, normal values, variations Define end pressure and lateral pressure, Bernoullis principle (mention) Pulse pressure, Mean arterial pressure - definition, normal values Determinants of Systolic and diastolic pressures Measurement details in practical class Regulation - neural and humoral.( short term, intermediate and long term) Cardiovascular reflexes Local regulation including auto regulation of blood flow, vasoconstrictors and vasodilators, substances secreted by endothelium (important ones) Effects of gravity, Posture and Exercise on B.P Hypertension & hypotension

1 hr

1 hr

5 hrs

2 hrs

5 hrs

2 hrs

3hrs

Regional circulation Coronary, capillary, cutaneous, cerebral, foetal Pulmonary, renal and splanchnic circulations to be taught in respective systems Circulatory shock Types, pathophysiology, stages, compensatory mechanisms Cardio-vascular adjustments in health and disease Effects of exercise, Effect of gravity (+ve and ve G), Weightlessness (brief)

3hrs 1 hr 1 hr

SEMINAR / TUTORIAL Cardiovascular changes in exercise Effect of gravity (+ve and ve G), Weightlessness INTEGRATED TEACHING Current investigative procedures in cardiology (with cardiology dept)

2hrs 2hrs

Respiratory System
LECTURES Introduction Define respiration Organisation and functional anatomy of respiratory system Tracheobronchial tree, Respiratory unit, Alveoli (structure and functions), Pleura, pleural fluid Functions of different parts of respiratory system including non respiratory functions Mechanics of respiration Inspiration and expiration, muscles of inspiration and expiration and their actions, Pump handle and bucket handle movements, expansion of thorax and lungs, Types of breathing Pressure changes during normal respiratory cycle intra (alveolar) pulmonary and intra thoracic (alveolar) pressure changes, development of negative intra thoracic pressure Surfactant functions (surface tension, alveolar stability, alveoli kept dry, interdependence of alveoli), hyaline membrane disease, ARDS Law of laplace application 16 hrs

1hr

2hrs

Measurement of pulmonary ventilation Lung volumes (mention) static & dynamic lung volumes TV, IRV, ERV, RV, VC TLC, FEV, FRC Residual volume (measurement not needed) RMV, MVV, breathing reserve, closing volume (mention) Ventilation pulmonary and alveolar Dead space Anatomical & Physiological- definition, normal values, variations (1-2 eg) (Measurement not needed) 2 hrs Pressure volume relation ship Elastic behaviour of lungs, total and lung compliance normal values Airway resistance, work of breathing (brief outline it is to overcome elastic, nonelastic and airway resistance), factors affecting bronchial tone, 1-2 conditions where work of breathing is increased Pulmonary blood flow Volume, pressure, factors influencing nervous and chemical factors, unique features. Variations in regional pulmonary blood flow, ventilation perfusion ratio and its importance Pulmonary gas exchange Composition of inspired air, expired air, partial pressures gas composition of Arterial & venous blood

1 hr

1 hr

Mechanism of gas exchange Structure of blood gas barrier, factors affecting diffusion across respiratory Membrane diffusion capacity for O2 & CO2, O2 transport in blood - oxygenation of Hb, O2 carrying capacity, O2 content, % saturation, coefficient of O2 utilization, Properties of Hb that facilities O2 transport O2 dissociation curve, factors shifting curve to right and left, P50 foetal Hb, Myoglobin, carboxy Hb Co2 transport in blood Different forms of transport, chemical reactions involved, changes occurring in lungs Haldane and Bohr effect Regulation of respiration Neutral control neural centres, genesis of respiratory rhythmicity, ramp signal (experimental evidence not required), Voluntary control, Reflex control Breath holding and braking point Chemical control stimuli, chemoreceptors (peripheral and central), ventilatory response to hypercapnea, hypoxia and change in H ion concentration, Interactions between these chemical stimuli (mention details not required) Hypoxia Definition, types, clinical features, differences Oxygen therapy Cyanosis, asphyxia and dyspnoea Definition, CO poisoning (mention) Periodic breathing Cheyne stokes and biots breathing, voluntary hyperventilation Environmental Physiology High altitude, rapid ascent, mountain sickness, acclimatization Effects of UV rays, dysbarism Effects of increased barometric pressure Nitrogen narcosis, High pressure nervous syndrome, Oxygen toxicity Decompression sickness (Caissons disease) Artificial respiration Mouth to mouth, Holger-Neilson method, mechanical methods, ventilators

2 hrs 1 hr

3hrs

1hr

1hr

1hr 1 hr

SEMINAR / TUTORIAL Respiratory changes during exercise Space physiology effect of G forces on respiratory system INTEGRATED TEACHING Pulmonary (Lung) function tests (with respiratory medicine dept) Cardiopulmonary resuscitation

4 hrs

4 hrs

Gastrointestinal System
LECTURES Introduction to G.I. Physiology General organization of G.I. tract Neural control of G.I function Enteric nervous system, autonomic control Mechanism of enzyme secretion by glands in general 12 hrs

1hr

Salivary glands Functional anatomy (types and location) with relevant histology in brief Saliva Composition, functions, control of secretion Conditioned and unconditioned reflexes Disturbances in salivary secretion in anxiety and dehydration Gastric secretion Functional anatomy of stomach and different gastric glands Gastric juice: Composition, functions Gastric HCl secretion - mechanism and regulation of secretion Gastric juice -Functions, phases of secretion and regulation Gastrin functions and regulation of secretion Mucosal barrier, pathophysiology of peptic ulcer in brief Pancreatic secretion -- exocrine Pancreas Functional anatomy with relevant histology Pancreatic juice: Composition, function, and regulation of secretion (neural and humoral CCK and secretin)-applied importance (mention steatorrhoea) Liver and gall bladder Functions of Liver, Functional anatomy with relevant histology Composition and functions of bile, control of secretion Functions of gall bladder, filling and emptying of gall bladder Enterohepatic circulation, Jaundice prehepatic, hepatic and post hepatic in brief Small intestine Functional anatomy with relevant histology Composition, regulation of secretion, and functions of intestinal juice Small intestine Functions Movements of G.I. tract Electrophysiology of smooth muscle in the GIT (revise) BER, MMC Peristalsis definition, basis, functions Mastication definition, muscles involved, functions and regulation Deglutition definition, muscles involved, stages, functions and regulation Gastric motility types, regulation, abnormal movements (vomiting, diarrhoea) Gastric emptying duration, factors affecting Movements of small intestine Types with reference to BER mixing, pendular, movements of villi and peristalsis Large intestine Functions secretory, motor, absorptive, synthesis of short chain fatty acids Defecation reflex Role of dietary fibre, bacterial flora

1 hr

3hrs

2hrs

1 hr

1 hr 1 hr 1 hr

1 hr

SEMINAR / TUTORIAL 4hrs Gastro intestinal hormones (Gastrin, CCK-PZ, Secretin, Villikinin, VIP, GIP) Renal System ASSIGNMENT 4hrs Bowel function test and blind loop syndrome LECTURES 12hrs Digestion and absorption of carbohydrates, fats and lipids Introduction Functions of kidneyTEACHING as an endocrine organ INTEGRATED homeostasis, 2hrs Functional anatomy of Kidney (depts of physiology, anatomy, biochemistry and internal medicine) Liver and biliary system Nephron-structure, parts, function, types (in detail) 1hr Renal circulation Normal flow, regulation, peculiarities, and principle of measurement

Juxtaglomerular apparatus Site, structure, function Glomerular filtration Definition, rate, filtration membrane, forces governing filtration and permeability of the memebrane, measurement of GFR Clearence values definition, values for glucose, inulin, and urea Tubular functions Tubular reabsorption define Sodium, glucose, water, urea, electrolytes - sites, mechanisms involved Water - reabsorption in different segments obligatory and facultative Tubular secretion H+ (acidification), K+ Filtered load, Tubular maximum, glomerulo tubular feed back, and renal threshold

1hr

2 hrs

2hrs

Acidification of urine Mechanisms and sites of H+ secretion, pH changes along renal tubules, fate of H+ in the renal tubule (buffer systems), non ionic diffusion Concentration of urine Counter current system multiplier, exchanger Cortico medullary gradient factors maintaining (ADH, permeability characteristics of renal tubule, role of urea and vasa recta) Osmotic gradient along renal tubules Diuresis definition, osmotic and pressure diuresis Micturition Functional anatomy of bladder - muscles and sphincters and innervation of bladder, Filling and emptying of bladder, Cystometrogram Micturition reflex and its higher control, voluntary control Abnormalities of micturition deafferented, decentralised and automatic bladder Urine Normal volume, constituents Abnormal constituents albuminuria, glucosuia (mention) Polyuria, Oliguria, Anuria (mention) Dialysis artificial kidney (basic principles of hemo and peritoneal dialysis) Renal function tests (mention) SEMINAR / TUTORIAL Acid base balance Juxtaglomerular apparatus Water and electrolyte balance

1 hr

2hrs

2 hrs

1 hr 6 hrs

Skin and Temperature regulation

Structure and function of skin Methods of heat conservation and loss in human body Regulation of body temperature role of skin, hypothalamus Hyperthermia, Fever, Heat stroke, hypothermia, cold injuries (frost bite)

2 hrs

Nerve Muscle Physiology

LECTURERS Excitable tissue Definition, properties Neuron Structure of a typical neuron, types, properties, functions Stimulus Definition, types threshold, subthreshold, suprathreshold Nerve fibres Types, classification, and functions Resting membrane potential Definition, ionic basis and genesis Nerve action potential Definition, ionic basis and properties, Monophasic, biphasic and compound action potential Transmission of nerve impulses Types (myelinated and unmyelinated), differences in impulse transmission Velocity of conduction and factors affecting it Peripheral nerve injury Wallerian degeneration, regeneration, denervation hypersensitivity Neuromuscular junction Functional anatomy, transmission of impulses across neuromuscular junction, EPP Neuromuscular blocking drugs (important ones with clinical correlation) Pathophysiology of Myesthenia Gravis 10 hrs

1 hr

1 hr

1 hr

1hr

1hr

Muscles Classification Skeletal muscle Structure including molecular details, properties Action potential - Definition, ionic basis and properties, Comparison with nerve action potential Molecular basis of muscle contraction - Excitation contraction coupling Types of muscle contraction isotonic and isometric with examples Muscle types fast and slow, differences Energy sources and metabolism in muscle at rest and during contraction Muscular changes during exercise Length tension relationship EMG basic knowledge of what it is and clinical importance Fasiculation, fibrillation (briefly) 2hrs Cardiac muscle Structure, properties Action potential- Definition, ionic basis and properties, Comparison with nerve and muscle action potential Pacemaker potential - molecular basis, properties Mechanism of contraction Length tension relation ship Smooth muscle Types, Structure, innervation and neuromuscular junction Potentials types, ionic basis Mechanism of contraction - Excitation contraction coupling Plasticity (cystometrogram to explain) Length tension relation ship (mention)

2hr

1 hr

SEMINAR / TUTORIAL Comparison of structure and functions of the three types of muscles Comparison of the excitation contraction coupling in the three types of muscles INTEGRATED TEACHING EMG

Nervous system
LECTURES Organisation of nervous system General organisation Functional anatomy of brain and spinal cord, Coverings, white and grey mater review briefly Brain lobes, functions, Brodmanns areas important ones with functions Neuron, neuroglia functions Spinal cord Functional anatomy -coverings, structure, white and grey mater Cross section with location of sensory, motor and autonomic neurons and tracts Cerebro spinal fluid Ventricles of brain,Blood-brain barrier- importance CSF formation, circulation, composition, functions, Lumbar puncture (brief) Synapse Types Functional anatomy of typical chemical synapse and synaptic transmission Synaptic potentials EPSP, IPSP ionic basis and comparison with action potential Properties of synapses (one way conduction, synaptic delay, synaptic inhibition, convergence, divergence, summation, fatigue, after discharge and synaptic plasticity) Synaptic inhibition types, mechanisms with examples Neurotransmitters facilitatory and inhibitory with 2-3 eg and clinical applications Reflex action Definition, reflex arc - components Classification with examples -Mono and polysynaptic, Somatic and visceral, Superficial and deep with mention of examples (details of reflexes in motor system) Sensory receptors Classification (recent view), types (phasic and tonic), properties - adaptation Receptor potential, comparison with action potential Sensations Classification Sensory tracts Organisation of sensory pathways Name all ascending pathways of spinal cord Tracing of pathways from body and face o Medial leminiscal system dorsal column sensations o Spino thalamic system Sensation of touch and pressure Sensation of pain and temperature o Synthetic sensations o Other ascending tracts salient features- spinoreticular, spinocerebellar o Pain Sensation details Different types of pain Slow and fast pain types of fibres, tracts and terminations Modulation of pain - Spinal level, supra spinal level 30 hrs

2hrs

11/2 hrs

3hrs

1hr

Visceral pain, referred pain, radiating pain, - clinical correlates Altered pain sensations Thalamus Functional anatomy, nuclei classification, connections, Functions of thalamus Thalamic syndrome Sensory Cortex Location primary area, secondary area, association areas Salient histological features Body representation - sensory homonculus Functions of primary, secondary and association areas Lesions Cerebral Cortex Brodmanns areas other than sensory & motor areas, Functions Motor system Introduction, levels of motor control, review cross section of spinal cord Reflex action Definition, reflex arc - components Classification with examples (brief review) Stretch reflex, inverse stretch reflex, reciprocal innervation, withdrawal reflex o Review cross section of spinal cord various ascending and descending Pathways o Strech reflex details and function Inverse stretch reflex, Reciprocal innervation, Other poly synaptic reflexes Pathological Babinske sign Motor Cortex Primary motor area and pre motor areas, Histological features Body representations - homonculus Functions Descending tracts General organisation, Pyramidal and extra pyramidal tracts, their functions Mention as medial and lateral systems, Upper motor neurons and lower motor neurons Upper motor neuron and lower motor neuron lesions differences Effects of lesions at various levels - hemiplegia, paraplegia, monoplegia Spinal cord injuries Injuries of spinal cord: complete transection, incomplete transection, hemisection, section of anterior and posterior roots, injury to motor nerve Basal ganglia Organisation Normal Neuronal masses included Connections (afferent, efferent, inter connections) Functions Disorders Parkinsonism, Chorea, Athetosis with explanation of the Physiological basis of the sings and symptoms Wilsons disease mention Cerebellum Functional anatomy, Functional and evolutional divisions, functions Deep cerebellar nuclei, connections in relation to functions, functions Neuronal circuit (mention) Cerebellar lesion features and their physiological basis Reticular formation ARAS, descending reticular system explain control of muscle tone Limbic system Organisation, connections (mention important ones) and functions

3 hrs

1hr

1 hr

2 hrs

3 hrs

2hrs

2 hrs

2 hrs

1 hr

EEG and sleep Define EEG, principle of recording, Normal waves (, , and ), alpha block, Clinical uses (mention) Vestibular apparatus Functional anatomy - gross structure, receptors, receptor potential Connections and Vestibular pathway, Functions Muscle tone, posture, equilibrium Basis of maintenance stretch reflex, higher control, Postural reflexes mention with levels of integration (details not required) Regulation of muscle tone and posture Hypothalamus Functional anatomy, Nuclei, connections and functions (neural) Higher functions of the brain Learning Memory types Speech Types, Mechanisms of speech, Aphasia classification Autonomic nervous system Organisation and functions SEMINAR / TUTORIAL Autonomic nervous system: sympathetic and parasympathetic systems. Higher control role of reticular formation and hypothalamus Hypothalamus: Nuclei, connections and functions Limbic system: parts and functions CS of Spinal cord: to show tracts: Effects of lesions of spinal cord, nerve roots and nerves CSF: Formation, circulation, composition and functions

1hr

2hrs

1 hr 1hr

2hrs 1 hr 8 hr

2hrs 2 hrs 2hrs 2 hrs

Special Senses
LECTURES 10 hrs

Olfaction
Receptor, pathway, lesions anosmia, parosmia 1 hr

Taste
Taste buds, receptor, primary tase sensations, pathway 1 hr

Vision
LECTURES 8hrs

Introduction
Functional anatomy of eye Review Chambers of the eye, intraocular fluids - aquous humor, vitreous humor Lens - characteristics, changes with age, aphakia, cataract Retina Histology to be reviewed, Macula lutea, fovea centralis Explain Basic optics Optical system of the eye Refractive media of eye - Refracting surfaces & refractive indices Concepts of reduced eye, Image formation on retina Emmetropic eye Far and near points Accommodation and accommodation reflex (Near response)

11/2 hrs

3 components - Pupillary constriction, convergence of eye balls, increased anterior curvature of lens. Range and Amplitude of accommodation Errors of refraction chromatic and spherical aberrations, hypermetropia, myopia, and Astigmatism presbyopia, causes (brief) features and corrective lenses Contact lenses (mention) Visual receptors (cones and rods) Structure in detail Visual pigments, role of vitamin A Phototransduction Adaptations of visual receptors - Dark adaptation and light adaptation Electrophysiology of receptors, receptor potential, lateral inhibition Electroretinogram (mention) Duplicit theory of vision, photopic and scotopic vision Muscles of eye Names, nerve supply and movements of eyeball Corresponding points, double vision and squint (mention) Colour vision Primary, secondary and complementary colors (mention) Hue, brightness and saturation (mention) Receptors Trichromatic and Opponent Process Theories Color blobs location and function Color blindness Afterimages, contrasts Visual pathway Mono ocular and binocular vision Visual signals - Processing in the Retina Pathway -Important features to be specified at all levels (on- off mechanism and details of cellular organization in different levels not required) Effects of lesion at different levels Macular sparing (recent views) Visual cortex all areas and functions Visual reflexes Papillary light reflex (direct and indirect) - pathway, lesion, Miosis & mydriasis (mention) Accomodation reflex pathways, lesions Corneal reflex - pathway Tests of Vision -Field of vision, Visual acuity, Color vision definition, details of tests in practicals

2hrs

3hrs

11/2 hrs 4hrs

Audition
LECTURES Acoustics frequency, amplitude of sound, pitch, intensity, and quality of sound Functional anatomy of the ear Functions of external, middle and inner ear Cochlea structure, Organ of corti, Hair cell physiology- receptor potential Mechano-electrical transduction by hair cells Endocochlear potential Descrimination of pitch (travelling wave theory) and intensity of sound Auditory pathway Sound localisation, pitch discrimination, masking of sounds Deafness (conduction and nerve deafness) tests in practicals Audiometry (details in practicals)

1hr

2hrs

1hr

SEMINARS / TUTORIALS Lacrimal apparatus and tear, Aqueous tumor, intraocular pressure Role of Vitamin A in vision Functions of middle and inner ear

6hrs

Endocrinology
LECTURES General endocrinology Names and organisation of Endocrine glands in human body Hormone definition, and classification on chemical nature-. General hormones and local hormones autocrine, paracrine and [Link] . Mechanism of action of hormones. Hormone receptors cell membrane and intracellular, Mechanism of action via the different receptors basics with 2 examples, Second messenger system -brief Control of secretion of hormones in general the + ve and ve feed back with 2 examples Abnormalities of hormone function decrease, increase, receptor dysfunction, abnormal hormones or antibodies Hormonal assay mention about RIA, ELISA (no details) Hypothalamus Functional anatomy, Hormones (Releasing and inhibiting), their physiological actions Interrelationship between hypothalamus and pituitary glands Infundibulum -hypothalmo pituitary tract and portal system Pituitary gland Functional anatomy, cell types Hormones of anterior and posterior pituitary Growth hormone - physiological actions and regulation of secretion in detail Hyper and hypofunction Acromegaly, Gigantism and Dwarfism Other hormones to be dealt with the target glands, Mention intermediate lobe hormones - pro opiomelanocortin and MSH 15 hrs

2 hrs

3 hrs

Thyriod gland Hormones- names, biosynthesis (details in biochemistry), transport, physiological actions (physiologic, pharmacologic and pathologic) and regulation of secretion (H-P-T axis) Thyroid function tests (details in biochemistry) Hyper and hypofunction in children and adults Cretinism, Myxedema, Hyperthyroidism 2 hrs Pancreas endocrine Functional anatomy, Hormones- physiological actions and regulation of secretion Insulin - receptors and insulin resistance (mention) Physiological actions Regulation of secretion Hyper and hypofunction diabetes mellitus and hypoglycemia Glucagon physiologic actions on carbohydrate, proteins and fat metabolism, on heart Regulation of secretion Somatostin site of production, actions, stimuli for secretion, paracrine regulations. Pancreatic polypeptide site of secretion, factors which increase secretion, actions Adrenal gland Adrenal Cortex Functional anatomy 3 layers (briefly) Biosynthesis of adrenal cortical hormones (details in biochemistry) Hormones of adrenal cortex - glucocrticoids, mineralocorticoids, sex steroids Transport, physiological actions and regulation of secretion

2 hrs

glucocorticoids - metabolic, permissive, anti inflammatory, anti allergic and in stress Regulation of secretion H-P-A axis mineralocorticoids role in salt and water balance, stress Regulation of secretion effects of K+, Na+, ACTH Hyper and hypofunction Cushings syndrome Primary and secondary hyperaldosteronism, Addisons disease Adrenal medulla Hormones (catecholamines) , regulation of secretion, Pheochromocytoma Calcium homeostasis Normal calcium metabolism (outline) Parathyroid hormone, calcitonin and vitaminD - target organs and physiological actions Hypocalcemia and tetany Other endocrine glands Hormones, physiological actions and regulation of secretion Kidney Pineal body (retino hypothalamic tract very brief) Thymus Heart Local hormones Histamine, Sub P, bradykinin, serotonin, prostaglandins, Sources and physiological actions Physiology of growth and development Correlation of actions of different hormones from childhood, puberty and adulthood (briefly)

3 hrs

1 hr

1 hr 1 hr

SEMINARS / TUTORIALS 6hrs Calcium homeostasis : parathormone, vitamin D and Calcitonin, Other regulating hormones Adrenal medulla Physiology of growth and development: Hormonal and other influences

Physiology of Reproduction
LECTURES Introduction Sex organs, genetic basis of sex Sex differentiation and development of Reproductive system Briefly on factors influencing development of genitalia hormones Aberrant sexual differentiation Chromosomal (Turners and Klinefelters), developmental (adrenogenital, hermaphroditism) Puberty normal, precocious and delayed puberty Male reproductive system Functional anatomy Functions of testis endocrine -testosterone (functions and regulation of secretion) - Spermatogenesis and factors influencing and regulating this Abnormalities of testicular function - cryptorchidism, male hypogonadism (mention) Erection, ejaculation, composition of semen, sterility Female reproductive system Functional anatomy Ovary - oogenesis, ovulation, corpus luteum, ovarian hormones- estrogens, progesterone, relaxin Control of ovarian functions by H- P- Gonadal axis Pituitary gonadotropins (FSH, LH), Prolactin physiologic actions, regulation of secretion 11 hrs

1 hr

2hrs

2 hrs

Menstrual cycle Menstrual, proliferative and secretary phases Ovarian, uterine and vaginal changes during menstrual cycle Hormonal regulation Abnormalities of ovarian function - anovulatory cycle, infertility Menarche, menopause Castration before and after puberty Pregnancy Fertilisation, implantation, Corpus luteum of pregnancy Placenta functions, Placental hormones Foetoplacental unit Pregnancy tests immunological (currently done) Parturition physiology of labour Lactation Hormones influencing and their actions Contraception Temporary and permanent methods in males and females, and their physiological basis

2hrs

3hrs 1hr

INTEGRATED TEACHING

4hrs

Induction of ovulation, in vitro fertilization (with O &G dept) Infertility (with O &G dept)

DETAILS OF PRACTICALS

Human Physiology
1. Use and care of microscope and microscopic examination of blood 2. PCV, ESR, osmotic fragility 3. Haemoglobin estimation and blood indices 4. RBC count 5. WBC count 6. Examination of peripheral blood smear 7. Differential WBC count normal, abnormal, anaemias 8. ABO grouping, Rh typing 9. Bleeding time, clotting time 10. Recording of BP effects of posture and exercise 11. Recording of arterial pulse only 12. Respiratory movements demonstration 12. General examination 13. Examination of Respiratory system 14. Examination of CVS 15 Examination of higher functions and sensory system 16 Examination of Motor system 17. Examination reflexes 18. Examination of cranial nerves 1-6 19. Examination of cranial nerves 7-12 20. Revisions as required (38 hrs)

76hrs

Experimental physiology
1. 2. 3. 4. 5. 6. Appliances in experimental physiology Laboratory including physiograph Pithing, muscle nerve preparation, mounting, effects of different types of stimuli Simple muscle twitch Two successive stimuli, repetitive stimuli and fatigue Genesis of tetanus and Starlings law of muscle (demonstration) Effect of load and after load on muscle contraction

28 hrs

7. 8. 9. 10. 11. 12. 13. 14.

Effects of variations of temperature on muscle contraction Velocity of nerve impulse (demonstration) Normal cardiogram of frogs heart and effects of heat and cold. Effect of temperature on frogs heart Refractory period of frogs heart Stannius ligatures. Properties of cardiac muscle all or none law, treppe, summation of subminimal stimuli (demonstration) Effect of vagal stimulation on frogs heart Perfusion of frogs heart action of ions, action of drugs (Nos. 4 to 8 & 10 to 14 demonstration through e-modules/recorded graphs)

DEMONSTRATE SIMPLE MUSCLE TWITCH and NORMAL CARDIOGRAM Others can be demonstrated with e- modules / recorded graph

Demonstrations (with e- modules / recorded graph/ clinical postings)

I. Mammalian experiments 1. Heart perfusion 2. Intestinal movements II. Biopotentials on Osciloscope Electro encephalogram (EEG), Electro miogram (EMG), Electro Cardio Gram (ECG), III. Audiometry, Perimetry, Spirometry

16hrs

Recommended Text Books

Prescribed Books 1. Text book medical physiology Arthur C. Guyton : W.B. Saunders 2. Review of Medical Physiology W.F. Ganong Lange Medical Book ed. 22nd. 3. Understanding Medical Physiology. R.I. Bijalani Jaypee Publishers 4. Best and Taylors physiologic basis of medical practice J B West (edn) William and Walkins Reference Books 1. Text book of Human Physiology. Madhavan Kutty, Sarada Subramaniam, HD Sing, S. Chand and Company 2. Wintrobes Hematology 3. Williams text book of Endocrinology 4. Snells neuroanatomy EVALUATION M.C.I. Guidelines o Problem solving exercises o OSPE (Objective Structured Practical Examination) o Records review o Viva Voce with practicals o Written case scenario

University Examination
Theory Paper I, II Internal Assessment Practicals I , II Internal Assessment Viva Voce Total

Marks
50+50=100 20 20+20= 40 20 20 200

Internal Assessment Based on day to day performance assessed by daily evaluation, short examinations, tutorials, seminars, sessional examinations etc. Theory Pattern of Question paper - Two papers of three hours duration (50 marks each)