Learning Objectives and Course Contents in Medicine
Introduction to Medicine (to be covered in 3rd-year classes)
Overview of Medicine as a discipline and subject
Learning Clinical Approach
- Doctor-patient relationship, Medical Ethics, Patient safety.
- Communication Skills
- Behavioural Science
Approach to common symptoms of the disease:
- General concept of Pain, chest pain, and abdominal pain
- Fever
- Dyspnoea
- Cough, expectoration, and Haemoptysis
- Anorexia, Nausea, Vomiting, Weight loss, and Weight gain
- Haematemesis, Melaena, Haematochezia
- Diarrhea, Dysentery, and Constipation
- Edema and Ascites
- Jaundice
- Syncope and Seizures
- Fainting and Palpitations
- Headache and Vertigo
- Paralysis, movement disorders & disorders of gait
- Coma and other disturbances of consciousness
- Common urinary symptoms including anuria, oliguria, nocturia, polyuria, incontinence, and enuresis
- Anaemia and Bleeding
- Enlargement of Lymph nodes, Liver, and Spleen
- Joint pain, neck pain and backache
Clinical Medicine: Nutritional Factors in Diseases
Core
- Energy-yielding nutrients
- Protein-energy malnutrition in adult
- The vitamins- deficiency
Additional
- Nutrition of patients in the hospital
- Obesity
Climatic and environmental factors in disease
Core
- Disorders related to temperature
- Disorders related to pollution
- Drowning, electrocution, and radiation hazards
- Health hazards due to climate change
Diseases due to infections
Core
- Approach to infectious diseases-diagnostic and therapeutic principles
- General principles and rational use of antibiotics
- Enteric fever
- Acute Diarrhoeal Disorders
- Cholera & food poisoning
- Amoebiasis, Giardiasis
- Tetanus
- Influenza and infectious mononucleosis
- Malaria
- Kala-azar
- Filariasis
Helminthic diseases
- Nematodes
- Cestodes
- Trematodes
- HIV and infections in the immunocompromised conditions
- Rabies
- Herpes simplex & herpes zoster
- Chickenpox
- Viral hemorrhagic fever: dengue
- Anthrax
- Brucellosis
- Covid -19,Influenza,MARS,SARS
Diseases of the blood
Core
- Anemia
- Leukaemia
- Lymphoma
- Multiple myeloma
- Bleeding disorders
- Coagulation disorders
- Transfusion medicine
Additional
- Bone marrow transplantation
Diseases of the respiratory system
Core
- Applied anatomy and physiology
- Investigations for respiratory diseases
- Upper respiratory tract infections
- Pneumonias
- Tuberculosis: 1(Pulmonary)
- Tuberculosis:2 (Extra-pulmonary)
- Lung abscess and bronchiectasis
- Diseases of the pleura: Pleurisy, Pleural effusion & empyema, Pneumothorax
- Chronic Obstructive lung diseases and corpulmonale
- Bronchial asthma & pulmonary eosinophilia
- Acute and chronic respiratory failure
- Neoplasm of the lung
Additional
- Common occupational lung disease with DPLD
Diseases of the cardiovascular system
Core
- Applied anatomy and Physiology and investigations
Ischemic heart disease
- Angina pectoris
- Myocardial infarction
- Sudden (cardiac) death
Valvular diseases of the heart
- Mitral stenosis & regurgitation
- Aortic stenosis & regurgitation
- Tricuspid & pulmonary valve diseases
- Infective endocarditis
- Hypertension
Cardiac arrhythmias (common)
- Sinus rhythms
- Atrial tachyarrhythmias
- Ventricular tachyarrhythymias
- Cardiac arrest
- Anti-arrhythmic drugs
- Heart block and pacemakers.
- Heart failure – acute and chronic
- Acute and chronic pericarditis, pericardial effusion, & cardiac tamponade
Additional
- Peripheral arterial diseases
- Common congenital heart diseases in children and adult
- Venous Thrombosis and Pulmonary Thromboembolism
Congenital heart diseases
- ASD
- VSD
- PDA
- TOF
- Coarctation of the Aorta
Acute circulatory failure
Diseases of pericardium
- Acute pericarditis
- Pericardial effusion
Cardiac tamponade
Cardiomyopathies
Diseases of the Gastro-intestinal and Hepatobiliary systems
Core
- Applied physiology and investigation of the alimentary tract.
- Stomatitis and Mouth Ulcers
- Peptic Ulcer disease and non-ulcer dyspepsia
- Malabsorbption syndrome
- Irritable bowel syndrome
- Inflammatory bowel disease
- Acute viral hepatitis
- Chronic Liver Diseases and their complications
- Acute and Chronic Pancreatitis
Additional
- Dysphagia
- Hepatotoxicity of drugs
- Carcinoma of the stomach/colon, Hepatocellular carcinoma
Nephrology & Urinary System
Core
- Nephritic & Nephrotic Illness
- UTI/ Pyelonephritis
- ARF/Acute Kidney Injury
- Chronic Kidney Disease
- Renal manifestations of systemic diseases
Additional
- Adult polycystic kidney disease
Neurology
- Concept of neurological diagnosis including investigations
- Cerebrovascular diseases (I & II)
- Headache
- Meningitis: viral, bacterial, and tuberculous
- Encephalitis
- Peripheral neuropathy
- Disorder of cranial nerves
- Epilepsy
- Extrapyramidal diseases
- Common compressive and non-compressive spinal cord syndromes
- Myasthenia gravis
- Myopathies and skeletal muscle disease
Water and electrolytes and acid-base homeostasis
Core
- Disorders due to Sodium and Potassium imbalance
- Disorders of acid-base balance
Endocrine and Metabolic diseases
Core
- Diabetes mellitus (I & II)
- Thyrotoxicosis
- Hypothyroidism.
- Cushing’s syndrome and Addison’s disease.
- Hypo- and Hyperparathyroidism
- Calcium and Vitamin –D related disorders
Additional
- Acromegaly and Sheehan’s syndrome
Connective tissue Disorder
Core
- Rheumatoid arthritis
- Degenerative joint diseases
- Gout
- Ankylosing spondylitis and other spondyloarthropathies.
- Collagen vascular diseases including systemic lupus erythematosus, systemic sclerosis
- Osteoporosis
Geriatric medicine
Core
- General Principles of treating the elderly/senior citizen
- Health problems of the elderly/ senior citizen
- Four Geriatric Giants – Acute confusional State, Falls, Incontinence, and Frailty
- Healthy Aging
- Rehabilitation and Physical medicine
Genetic Disorders
Core
- General concept of genetic diseases and management of the genetic disorder
- Single gene disorder
- Clinical aspects of medical biotechnology
- Chromosomal disorder (Down, Turner, Klinefelter’s)
Immunologic disorders
Core
- Immunologic deficiency diseases
- Autoimmunity, Allergy & hypersensitivity and immunogenetics & transplantation
- Immunosuppressive drugs
Oncology, Principles
Core
- General principles of diagnosis and management of neoplastic diseases
- Palliative care
Poisoning and drug overdose
Core
- Initial evaluation of the patient with poisoning or drug overdose and general principles of management
Treatment of common specific poisonings
- Organophosphorous compounds
- Sedatives and Hypnotics
- Household Poisons
- Venomous stings, insect bites, poisonous snakes, and insects
Additional
- Acute and chronic effects of alcohol and Methanol and their management
- Copper sulfate, Paracetamol, Kerosene, etc
Emergency medicine
Core
- Cardiac Arrest – ALS, BLS
- Acute pulmonary edema and severe acute asthma
- Hypertensive emergencies
- Diabetic ketoacidosis and hypoglycemia
- Status epileptics
- Acute myocardial infarction, shock, and anaphylaxis
- Upper G.I bleeding and hepatic coma
- Diagnosis and management of comatose patient
Environmental disease & heat illness Global warming & Health hazards
Clinical Methods in the Practice of Medicine
Core
- History Taking
- Physical Examination
- Investigations
- Diagnosis
- Principles of treatment
- Interpersonal skills
- Communication skills
- Doctor-Patient relationship
- Ethical Behaviour
- Patient Safety
- Referral services
- Medical Certificate
Common Clinical Procedures
- Injections
- IV infusion and transfusion
- FIRST AID
- Intubation
- CPR
- Hyperpyrexia
- ECG
- Skin Sensitivity Test
Procedural skill
Core
- Lumbar puncture
- Bone marrow aspiration
- Thoracocentesis / paracentesis
- Oxygen Therapy
- Oropharyngeal suction
- Shock management
- Bronchodilator inhalation technique, nebulization
- Urethral Catheterisation
Additional
- Administration of Enema
- Postural drainage
- Dialysis
- Electro convulsive therapy
Clinical Teaching
Introduction to clinical ward duties and approach to a patient
- Art of Medicine
- Doctor
- patient relationship
- The different components of history
- Symptom analysis in relation to diseases of different systems:
- Respiratory System
- Shortness of breath
- Haemoptysis
- Cough
- Sputum
- Chest pain
- Fever
CVS
- Palpitation
- Chest pain
- Leg edema
- Shortness of breath
GIT
- Abdominal pain
- Haematemesis and Melaena
- Loss of appetite
- Diarrhoea & Constipation
-
Haematochezia
- Nausea, Vomiting
- Weight loss
- Difficulty in swallowing
Hepatobiliary
- Jaundice
- Abdominal swelling
- Impaired consciousness
Rheumatology
- Multiple joint pain
- Monoarticular joint pain
Nervous System
- Loss of consciousness
- Fit or convulsion
- Syncope
- Paralysis
- Headache
- Vertigo
Urinary System
- Puffiness of face
- Oliguria & anuria, Polyuria
- Dysuria
- Incontinence
- Nocturnal enuresis
- Loin pain
- Pus per urethra
Endocrine System
- Swelling of the neck
- Weight gain
- Weight loss
Hemopoietic system
Other
- Tropical and infectious diseases
General examination
- Appearance <= Facies
- Built
- Nutrition
- Hydration status
- Decubitus
- Anthropometric measurement
- Anaemia, Jaundice, Cyanosis
- Clubbing, Koilonychia, leukonychia
- Oedema, Dehydration, Pulse, BP, Temperature, Respiration
- JVP
- Lymph node
- Thyroid, salivary gland
- Skin, Hair, and Nail
- Skin (Petichae, purpura, ecchymosis, bruise, hematoma, rashes), pigmentation, etc
- Hair distribution
- Nail
- Breast
- Eye – Proptosis
Systemic examination
CVS
- Pulse, BP, JVP
- Pericardium
- Inspection
- Palpation
- Percussion
- Auscultation of heart
- Auscultation of lung base
- Related G/E of CVS e.g. clubbing, cyanosis, edema.
Respiratory System
- Respiration rate /Type
- Inspection
- Palpation
- Percussion, Auscultation
- Examination of sputum
- Lung function test
- Pleural fluid aspiration
Nervous System
- Higher mental function
- Co-operation
- Appearance
- Level of consciousness
- GCS
- Memory
- Speech
- Orientation of time, space, person
- Hallucination, Delusion, Illusion
- Cranial nerves. (1st -12th)
- Motor function
- Sensory function
- Gait
- Signs of meningeal irritation
- Examination of peripheral nerves
- Involuntary movement
CSF Study
Ophthalmoscopy
Rheumatology
- Joints <= (Look & feel)
- Inspection
- Palpation
- Movement
Muscle
Skeleton
GIT
- Inspection of oral cavity & oropharynx
- Abdomen Inspection / Palpation
- Test for ascites
- Percussion/ auscultation
- Per-rectal examination
- Examination of stool, vomitus, groin, genitalia, perianal region
- Aspiration of peritoneal fluid
Urinary system
- Kidneys
- Bladder
- Urethral orifice
- Urine analysis
Hemopoietic system
Tropical and infectious illness
Animal bite – snakebite, dog bite
Clinical Teaching (2nd round)
Approach to Sign & Symptom
GIT & HBS
- Ascites
- Hepatosplenomegaly
- Oral ulcer
- Abdominal swelling
- Abdominal pain
- Vomiting &diarroehea
- Haematemesis, melaena
- Jaundice
CVS
- Respiratory distress
- Chest pain
- Jugular Venous Pulse (JVP)
- Hypertension
- Abnormal heart sound & murmur
- Pulse
Respiratory System
- Haemoptysis
- Cough
- Pleural effusion
- Pneumothorax
- Collapse, Consolidation, Fibrosis
- Breath sound
- Sputum analysis
Urinary System
Approach the patient with:
- Oliguria, polyuria, anuria
- Anasarca
- Urine analysis
Nervous System
- Unconscious patient
- Hemiplegia, monoplegia, paraplegia
- Upper Motor Neuron Lesion (UML)
- Lower Motor Neuron Lesion (LML)
- Cerebellar sign
- Extrapyramidal sign
- Involuntary movement
- Vertigo & Headache
Hematology
Approach the patient with
- Bleeding disorder
- Anaemia
- Lymphadenopathy
Rheumatology
Approach to patients with
- polyarthritis
- oligoarthritis
Clinical skills
- Lumbar puncture
- Bone marrow aspiration
- Aspiration of serous fluid/ synovial fluid
- Ryles tube
- Catheterization
- I/V fluid, IV Canula
- Stomach wash
Clinical Teaching (3rd round)
Review of history taking & clinical examinations (3rd year, 4th year)
Case discussion
Respiratory System
- COPD
- Bronchogenic carcinoma
- Pneumonia
CVS
- CCF
- CHD
- IHD
- VHD
- Rheumatic heart disease
- Hypertension
- Pericardial diseases
GIT
- Haematemesis&mealena
- PUD
- V. Hepatitis
- CLD
- Carcinoma of the Liver
- Pancreatitis
- Hepatic failure
Endocrine
- Hyperthyroidism
- Hypothyroidism
- DM
Rheumatology
- Rheumatoid arthritis
- Seronegative arthritis
- Osteoarthritis
- Gout
Urinary
- Glomerulonephritis
- Nephrotic Syndrome
- Acute Kidney Injury
- Chronic Kidney Disease
- Urinary Tract Infection
Hematology
- Anaemia
- Leukaemia
- Bleeding diathesis
Nervous System
- CVD
- Multiple Sclerosis
- Myasthenia Gravis
- Parkinsonism
- Peripheral neuropathy
- GBS
- Cranial neuropathy
Infection
- Enteric fever
- Malaria
- Kala Azar
- Filariasis
- Amoebiasis
- Tetanus
- Rabies
- Poisoning
- Snakebite
- Tuberculosis
- Diarroehea & Dysentery
- Shock
- Dengue
Short Cases
- Hepato or Splenomegaly or both
- Pleural effusion
- Pneumothorax
- Consolidation
- Collapse
- Fibrosis
- Hemiplegia
- Paraplegia
- Facial nerve palsy (UMN + LMN)
- Ascites
- Lymphadenopathy
- Thyroid
- Examination of the knee
- Examination of the precordium
- Auscultation of lung
Clinical skills
- Bone Marrow aspiration
- Aspiration of serous fluid
- Pleural
- Peritoneal
- Pericardial
- Foley’s catheterization
- Intercostal tube
- I/V canula
- Lumbar puncture
- Venesection
- CPR
- Interpretation of Laboratory Data
General
- Blood for R/E
- Urine for R/E
- Stool for R/E
- FBS / GTT
Specific
- Liver function test (LFT)
- Thyroid function test (TFT)
- Kidney function test
- Pulmonary function tests (PFT)
- Test for malabsorption
- Test for rheumatology
- Test for neurology
- Cardiac function test
- Hematological test
- Test for certain infectious diseases, e.g. Widal test.
Radiology
- X-ray chest
- X-ray
- Bones
- Skull
- Joints
- X-ray abdomen
Contrast X-rays
- Barium Meal
- Barium Follow through
- Barium Enema
- ERCP
- Myelogram
- IVU.
- USG
- CT & MRI
- Communication Skills
- Terminal Care
- Care of death and dying
Physical Medicine & Rehabilitation
Core
- Principles of management and rehabilitation of musculoskeletal and neurological disorders
Physical Medicine and Rehabilitation
Clinical Attachment (WARD DUTY)
- Introduction to Physical Medicine & Rehabilitation
- History
- Background
- Spectrum
- Visit to Physical Medicine & Rehabilitation Ward
- Modalities of Physical Therapy
- Management and Rehabilitation of
- Neck pain & Back pain
- Soft tissue Rheumatism
- Painful Conditions of upper & lower extremities
- Neurological conditions including Stroke
- Spinal cord injuries
- Arthritis & allied conditions
- Orthopedic conditions
- Cerebral Palsy
- Non-surgical & post-operative complications
- Cardiopulmonary rehabilitation
