Class of 2027

General Objectives for the Musculoskeletal System Module

By the end of the module, the student should be able to:

Identify
1. the bones and joints of upper and lower extremities on the basis of gross anatomical features
2. the muscles of upper and lower extremities on the basis of locations/compartments, their
attachments, innervations and actions
3. the blood vessels of upper and lower extremities on the basis of their area of supply, key relations
and compartmental organization
4. lumbosacral vertebral column on the basis of gross anatomical features, function and
organization
5. boundaries and contents of axilla, cubital fossa, femoral triangle and popliteal fossa
6. the bones and joints of upper and lower extremities on the basis of radiological images
7. lumbosacral vertebrae on the basis of radiological images
8. common etiological agents of acute and chronic bone and joint infection in relation to different
age groups (neonates, children and adult)
9. common bone tumors in children

Relate
10. movements of upper and lower limbs joints with the type/structural organization of joints
11. changes in structural organization of joints of upper and lower limb to dysfunction of these joints
12. structural organization of tendons, synovial sheaths (pulleys), long and short muscles, osteo-
fascial compartments and aponeurosis of hand with their roles
13. structural organization of foot (bony arches, ligaments, plantar aponeurosis, muscles and
tendons) with weight bearing action and propulsive movements
14. organization of axillary lymph nodes with lymphatic drainage of upper limb and breast
15. sensory and motor deficits with structural organization of brachial and lumbosacral plexuses
16. peripheral nerve injuries/compression in upper and lower limbs with their clinical presentation
i.e. sensory, motor and functional loss
17. lymphatic of upper and lower limbs with their area of drainage
18. embryological development of limbs and vertebral column with their gross anatomy
19. significance of DEXA scan with the diagnosis of osteoporosis
20. role of electron transport chain and oxidative phosphorylation with the production of ATP
21. role of vitamin D, calcium, fibrous proteins and proteoglycans with the composition of bone
matrix and process of bone mineralization
22. process of aging with factors influencing growth and remodeling of bone and cartilage including
role of vitamin D and calcium.
23. role of calcium, vitamin D, chondroitin sulphate and glucosamine in arthritis
24. sliding mechanism of contraction and cross bridge cycling with the arrangement of various
myofilament bands
25. molecular basis of muscle contraction and relaxation with the availability of ATP & calcium ion
26. length-tension relationship with the process of muscle contraction
27. altered muscle functions with the deprivation of microcirculation of muscles
28. muscle weakness with the changes in skeletal muscle metabolism during muscular dystrophies
29. role of electromyography with the diagnosis of neuromuscular disorders
30. the use of NSAIDs/Nonsteroidal anti-inflammatory drugs (naproxen, indomethacin, diclofenac
sodium, sodium ketorolac, nabumetone, celecoxib) to their therapeutic action(s),
pharmacokinetics, important adverse effects, important drug–drug interaction(s) and
contraindication(s), revisit (aspirin, acetaminophen)

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 Class of 2027
31. the use of disease modifying antirheumatic agents (methotrexate, leflunomide,
hydroxychloroquine, D-penicillamine) to their therapeutic action(s), pharmacokinetics,
important adverse effects, important drug–drug interaction(s) and contraindication(s)
32. the use of biological therapies in rheumatoid arthritis (adalimumab, etanercept, abatacept,
anakinra, rituximab, tofacitinb) to their therapeutic action(s), pharmacokinetics, important
adverse effects, important drug–drug interaction(s) and contraindication(s)
33. the use of methylprednisolone (Steroids) to its therapeutic actions, pharmacokinetics, important
adverse effects, important drug-drug interaction(s), and contraindication(s) (REVISIT)
34. the use of antigout drugs (colchicine, allopurinol, probenecid, sulphinpyrazone, pegloticase) to
their therapeutic action(s), pharmacokinetics, important adverse effects, important drug–drug
interaction(s) and contraindication(s)
35. the use of antiosteoporosis drug (bisphosphonates) to their therapeutic actions,
pharmacokinetics, important adverse effects, important drug–drug interaction(s) and
contraindication(s)
36. the use of opioid analgesic (morphine) to its therapeutic actions, pharmacokinetics, important
adverse effects, important drug–drug interaction(s) and contraindication(s)
37. risk factors of metabolic bone and joint diseases with their presenting features
38. pathophysiological changes with clinical, laboratory and radiological features of metabolic bone
and joint diseases (osteoarthritis, osteoporosis, osteomalacia and rickets)
39. synovial membrane thickening and proliferative changes with pathophysiology of rheumatoid
arthritis
40. mechanism of crystal formation with the pathophysiology of gout and pseudogout

Differentiate between
41. types of joints (synovial, fibrous and cartilaginous) in the upper limb, lower limb and
lumbosacral spine on the basis of their structural organization and movements
42. types of bones in the upper limb, lower limb and lumbosacral spine on the basis of shape,
development and microscopic features
43. types of cartilages on the basis of microscopic features
44. types of muscles and their actions on the basis of gross anatomic and microscopic features
45. endochondral and intramembranous ossification in bone (fracture) repair and development
46. mature and immature skeleton on radiological basis
47. various physiological properties of skeletal muscles (twitch, tetanus, treppe, summation)
48. contractile properties of different types of muscles (skeletal, smooth and cardiac)

Discuss/describe
49. factors limiting and facilitating movements of the upper and lower limbs and lumbosacral spine
50. pathogenesis of acute and chronic osteomyelitis including various routes of transmission of
etiological agents, risk factors for infection and chronic complications
51. the general characteristics (habitat, morphology, virulence factors, pathogenesis, disease,
laboratory diagnostic features) of Staphylococcus aureus and Hemophilus influenzae

Demonstrate/Perform
52. history taking of painful joint
53. surface anatomy, muscle examination and action, joints and range of motion (ROM) and
peripheral pulses of upper limbs
54. surface anatomy, muscle examination and action, joints and range of motion (ROM) and
peripheral pulses of lower limbs

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OBJECTIVES FOR COMMUNITY HEALTH SCIENCES:
Health Systems Module

Define
1. a health system, its components, objectives, and goals
2. quality of care (QOC) and its six elements based on the IOM classification.

Discuss
3. the importance of EHR in improving quality of hospital care
4. why planning is important in the health sector.
5. the process of health planning in Pakistan
6. the challenges associated with development and subsequent implementation of health plans.

Describe
7. the essential elements and values of PHC and its evolution since Alma Ata
8. the critical role of hospital in the health system
9. Electronic Health Records (EHR)
10. the critical role of hospital in the health system
11. the essential elements of managing hospitals including – workforce, finances, logistics,
information etc.
12. planning cycle and its steps

Apply
13. the understanding of health system principles and concepts to assess the Pakistan’s health
system.
14. methods and tools of QOC to a real-life situation in a hospital/PHC facility

Demonstrate
15. basic understanding of how to determine performance of a health system.

Differentiate
16. between a strategic and operational planning

Identify
17. challenges and opportunities on the road towards UHC
18. the methods and tools for improving quality and safety of care.
19. measures to determine performance of hospitals.

Explain
20. why well-functioning health systems are essential for improve health outcomes.
21. how to monitor progress towards the financial, service and population dimension of UHC
22. quality assurance, clinical governance, accreditation for improving QOC.

Understand
23. the concept and components of UHC and how PHC based health systems are, essential for
achieving UHC.