motto of department of medicine

MOTTOOF

DEPARTMENT OF MEDICINE

NOT FAILUREBUT LOW AIM IS CRIME

MEDICINECLERKSHIP BOOKStudent's Identity

Faisalabad Medical Univeristy

Medicine Clerkship Book

Name

Father's Name

Residence

Roll #

Session

Photograph

This gives a great pleasure in writing these few lines for an excellent workbook for students of Medicine in Final year of MBBS. It covers all expects of clinical knowledge and skills required by the medical students in their formative years. The students at this stage of their career require some direction and guidance which if properly provided can go a long way in building their clinical sense and acumen. I must congratulate all those involved in the compilation of this book and especially the faculty of Medicine department for conceiving this idea and bringing it into reality. These are the footprints that we leave on the sand of time for many to follow and in turn serve the humanity in real sense of the word. What are we in this world there for? It is only to illuminate our surroundings with knowledge, wisdom and hope. I would expect all the departments catering for education at undergraduate level must produce such clinical record books which provide a format to the students to follow and learn the clinical clerkship which is the most essential armamentarium of a doctor in active practice.

In the end, I wish all the best to the teachers and students for successful completion of their academic pursuits which in fact are never ending. Keep doing good by trusting your abilities and with strong faith in our Creator Allah the Almighty.

Message fromVice Chancellor

PROFESSOR DR. ZAFAR ALI CHAUDARYFCPS, FRCS Ed (Surgery)Faisalabad Medical University



Dear students We all know that medicine is a noble profession and every noble profession has some privileges and obligations. The ultimate goal of medical education is the delivery of quality health care services for the society. In the present educational system, you are introduced with basic knowledge of medicine till 2nd year MBBS. 3rd year is a transformation year, where you integrate the knowledge with real life patients. Being a good physician is not only confined to knowledge, it demands skills and attitude training. Designing and implementation of a program which integrates knowledge with skills and attitude is not an easy task. Department of Medicine has recognized it and have tried to make a guidebook for our students to facilitate your learning experience on Medical floor. It has been prepared according to basic educational principles. I hope you will like this structured training guide. Your feedback will help us to improve it. I wish you a very pleasant learning experience

Message fromPrincipal

PROF. DR. SAJID HAMEEDMBBS, FCPS (Peads Surgery)Principal Punjab Medical College, Faisalabad



My dear StudentsI congratulate you all on passing your professional exams and welcome you to the final year of your professional degree program. It is an exciting and at the same time very challenging task for the students as well as for the faculty to get prepared for future and help you to complete this basic degree . The department of Medicine has always tried to help the students learn the basic principles of a good medical practice. Disease pattern is changing with every passing day and preparing the new doctors to meet the future needs is an untiring effort.

This academic effort becomes interesting if things are structured in a proper way. To accomplish this task, Department of Medicine has prepared a detailed curriculum document and a study guide. This will guide the teachers and students towards their desired goals. You have a road map in your hands now. It will be a log book and remind you for your achievements. It is a learning log and help you to improve your skills through reflection. I thank all my colleagues and team who have put a great effort in designing this guide.

Best Wishes

Message fromDean

PROF. DR. AHMED BILALMBBS, FCPS (Medicine)Dean/Head of Medicine PMC/FMU, Faisalabad.





PROFESSOR DR AHMED BILALHead of Department of MedicineDean of Medicine & Allied

Faculty of Medicine

PROFESSOR DR AAMIR SHAUKATHead of Medical Unit IIDean of Post Graduate Medical Sciences

PROFESSOR DR AMIR HUSSAINHead of Medical Unit III

DR HANIF NAGRAAssociate ProfessorHead of Medical Unit IV

DR MAQSOOD AHMADAssociate ProfessorHead of Medical Unit V



Authors

PROF. DR. AHMED BILAL

PROF. DR. AAMIR SHAUKAT

PROF. DR. AAMIR HUSSEIN

DR. UMAIR AHMAD

DR. MUHAMMAD USMAN MUSHARRAF

DR. SUMERA EHSAN

DR. MUHAMMAD OWAIS FAZAL



Co-Authors

DR. MUHAMMAD HANIF NAGRA

DR. DILSHAD MUHAMMAD

DR. YASIR YAQOOB

DR AHMAD ZEESHAN CHAGHUTAI



Special thanksFor help

DR. MEMOONA JAHANGIR

DR. MEMOONA FAKHAR

DR. HABIB UR REHMAN

MR. MUHAMMAD ASAD MEHBOOB

MR. MUHAMMAD ASIF



Faculty of Medicine

MEDICAL UNIT-I1. Prof. Dr. Ahmed Bilal (Professor/HOD)2. Dr. Fraz Saeed Qureshi (Assistant Professor)3. Dr. M. Owais Fazal (Assistant Professor)4. Dr. Ahmed Zeeshan (Assistant Professor)5. Dr. Yasir Yaqoob (Assistant Professor)6. Dr. Ghulam Abbas Tahir (Assistant Professor)7. Dr. Muhammad Usman Musharraf (Assistant Professor)8. Dr. Adnan Sarwar (Assistant Professor)9. Dr. Atta-ur-Rehman (Assistant Professor)

MEDICAL UNIT-II1. Prof. Dr. Aamir Shaukat (Professor)2. Dr. Muhammad Arif (Assistant Professor)3. Dr. Umair Ahmad (Assistant Professor)4. Dr. Muhammad Irfan (Assistant Professor))5. Dr. M. Shahzad Khan (Assistant Professor)6. Dr. Israr Hussain (Senior Registrar)7. Dr. M. Yousaf Ayub (Senior Registrar)

MEDICAL UNIT-III1. Prof. Dr. Amir Hussain (Professor)2. Dr. M. Adrees Shani (Assistant Professor)3. Dr. M. Aamir (Assistant Professor)4. Dr. Rai Masood Arif (Senior Registrar)5. Dr. Salman Shakoor (Senior Registrar)6. Dr. Maroof Vaince (Senior Registrar)7. Dr. Zikriya Anwar (Senior Registrar)

MEDICAL UNIT-IV1. Dr. M. Hanif Nagra (Associate Professor)2. Dr. Tahir Habib Rizvi (Associate Professor)3. Dr. Amin Anjum (Assistant Professor)4. Dr. Hafiz Amjed (Assistant Professor)5. Dr. Shahid Maqbool (Senior Registrar)6. Dr. Huma Muzaffar (Senior Registrar)7. Dr. Talha Zahid (Senior Registrar)



Faculty of Medicine

MEDICAL UNIT-V1. Dr. Maqsood Ahmad (Associate Professor)2. Dr. Seher Rasool (Senior Registrar)3. Dr. M. Kashif (Senior Registrar)4. Dr. Muzammal (Senior Registrar)5. Dr. Ahmad Zameer (Senior Registrar)6. Dr. Mehwish (Senior Registrar)7. Dr. Owais Khalid (Senior Registrar)

MEDICAL UNIT-VI1. Dr. Dilshad Muhammad (Associate Professor)2. Dr. Nazir Ahmad (Assistant Professor)3. Dr. Ahmed Ayaz Sabri (Consultant Physician)4. Dr. M. Shoaib (Senior Registrar)

GASTROENTEROLOGY 1. Dr. Dr. Mughees Ather (Associate Professor)2. Dr. Muhammad Arfan (Assistant Professor

NEUROLOGY1. Dr. Javed Iqbal (Assistant Professor)2. Dr. Naveed Alam (Senior Registrar)3. Dr. Nouman Akram (Senior Registrar)

NEPHROLOGY1. Dr. Bilal Javed (Assistant Professor)2. Dr. Ejaz Nabi Kisana (Senior Registrar)3. Dr. Muhammad USman (Senior Registrar)

RADIOLOGY1. Prof.Dr. Asim Shaukat (Professor)2. Dr. Anjum Mehdi (Associate Professor)3. Dr. Nosheen Ahmad (Assistant Professor)4. Dr. Amna Rehan (Assistant Professor)5. Dr. Abdul Rauf (Assistant Professor)6. Dr. Hassan Bokhari (Assistant Professor)7. Dr. Khalid Mahmood (APMO)8. Dr. Azhar Nasim Gill (Senior Consultant)



ContentsSection-1

Guideline and University Rules for Medicine Examination

Section-2Medicine ClerkshipCardiologyGastroenterologyHepatologyHematologyRheumatologyPulmonologyNeurology

Module-IIInfectious DiseasesEndocrinology & metabolism (including Diabetes)Nephrology PsychiatryDermatology

Section-3Clinical rotation guidelines for history taking and examination

Section-4

Section-5

Section-6

Short casesLong cases

Attendance and performance EvaluationPerforma for extracurricular activitiesClassroom activities

Academic Year CalendarPrescription WritingClinical Scenarios

12

Section 1

Guideline and University Rules

For

Medicine Examination

13

Table of Specification By The University Of Health Sciences

This table shows number of questions that are to be asked in the written examination of Final Year

MBBS in the subject of Medicine.

NAME OF UNIT NUMBER OF QUESTIONS

1. GIT 2

2. LIVER 1

3. CVS 2

4. INFECTIOUS DISEASES 2

5. ENDOCRINOLOGY AND DIABETES 2

6. RENAL AND ACID BASE BALANCE 2

7. PSYCHIATRY 2

8. HEMATOLOGY 1

9. CNS 1

10. RESPIRATION 1

11. RHEUMATOLOGY 1

12. DERMATOLOGY 1

14

Paper Scheme as per University of Health Sciences Guidelines

● Medicine Paper-1

o CVS (02 SEQs + 07 MCQs)

o Pulmonology (01 SEQs + 07 MCQs)

o CNS (01 SEQs + 07 MCQs)

o GIT (02 SEQs + 07 MCQs)

o Liver (01 SEQs + 06 MCQs)

o Blood (01 SEQs + 05 MCQs)

o Rheumatology (01 SEQs + 06 MCQs)

● Medicine Paper-2

o KIDNEY(02 SEQs + 10 MCQs)

o Endocrinology(02 SEQs + 07 MCQs)

o Psychiatry(02 SEQs + 10 MCQs)

o Dermatology(01 SEQs + 06 MCQs)

o Infectious diseases(02 SEQs + 07 MCQs)

15

Assessment as per University of Health Sciences Guidelines

At the end of final year MBBS, university examination (final professional MBBS) will include

theory paper of Medicine Paper-1 of 90 marks (45 MCQs and 9 SEQs), Medicine Paper-2 of 85

marks(40 MCQs, 9 SEQs) and viva voice / clinical/practical examination of 275 marks(210

clinical, 65 OSPE). Internal assessment of 50 Marks (25 theories, 25 practical) will be calculated

from 3rd year, 4th year and final year.

S.N

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ct

Theory Su

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Clin

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nd

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SEQs MCQs Int.

Assessment

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45

Marks

9

SEQs

5

Marks Each

45

Marks

45

MECQS

1

Marks Each

25

200

210

65

25

300

500

2 Hours 2 Hours

2

Me

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ine-II

45

Marks

9

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5

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45

Marks

45

MECQS

1

Marks Each

2 Hours 2 Hours

16

Section 02

Medicine Clerkship

● Must know topics

● Good to know topics

● Case Discussion

● Clinical skills and Procedure

17

CARDIOLOGY

18

Must know Topics

At the end of clinical rotation, students must be able to define, describe the clinical features,

enlist the important investigations and outline the brief management steps of following:

● Rheumatic Fever

● Infective Endocarditis

● Hypertension

● Ischemic heart disease

o Stable angina

o Unstable angina

o Prinzmetal angina

o Myocardial infarction

o Cardiomyopathies esp. HOCM

● Heart failure

o Right heart failure

o Left heart failure

o High output cardiac failure

o Congestive cardiac failure

● Valvular heart disease

o Mitral valve

o Aortic valve

o Tricuspid Valve

o Pulmonary Valve

● Cardiac arrhythmias

o Atrial fibrillation

o Ventricular fibrillation

o Premature atrial and ventricular beats

● Pericardial diseases

19

Good to know topics

At the end of clinical rotation, it would be better for students to define, describe the clinical

features, enlist important and relevant investigations and outline brief management steps of

following:

● Congenital heart diseases

o Cyanotic heart diseases

o Acyanotic heart diseases

● Peripheral vascular diseases

o Venous thromboembolism

o Acute limb ischemia

o Chronic limb ischemia

Investigations.

At the end of clinical rotation, it would be better for students if they are able to describe

indications/complications of following investigations:

● Echocardiography

● Thallium scan

● Angiography

20

CLINICAL TRAINING

Case Discussion

At the end of ward rotations students must be able to define, describe the clinical features, enlist

the causes, differential diagnosis, and investigations and outline the brief management steps of

following.

● Systemic hypertension

● Chest pain and its causes

● Shortness of breath and its differentials

● Pedal edema and its causes

● Cardiogenic shock

● Palpitations

● Syncope and Presyncope

Mandatory Clinical Methods

At the end of clinical rotation, students must be able to perform following:

History

A comprehensive history of symptomatology of patients coming with cardiovascular disorder to

reach the diagnosis.

● Chest pain

● Shortness of breath/ breathlessness/dyspnea

● Orthopnea

● Paroxysmal nocturnal dyspnea

● Palpitation

● Leg swelling

● Discoloration of limbs

Examination

At the end of clinical rotation, students must be able to perform following clinical methods in a

patient coming with cardiovascular symptomatology.

● General physical examination: cyanosis, clubbing, splinter hemorrhages, Osler nodes,

Janeway lesions, delay in pulses, JVP, blood pressure, etc.

21

● Examination of precordium: inspection, palpation, percussion and auscultation of

precordium.

o Mitral area

o Tricuspid area

o Aortic area

o Pulmonary area

Investigations

At the end of clinical rotation, students must be able to describe the indications, important

positive findings of following investigations regarding cardiovascular disorders.

● ECG

o Normal ECG, acute MI, ischemic changes and heart blocks

● Chest X ray

o Normal anatomy, blunting CP angles, pulmonary edema, cardiomegaly

Clinical skills

At the end of clinical rotation, it would be good for students to know the importance of following

procedures, observe and assist the doctors in the wards during these procedures.

● Cardioversion/defibrillation (Indications & Complications)

● Thrombolysis/ anticoagulation (Indications & Complications)

● Cardiac monitoring

22

PULMONOLOGY

23

Must know topics


enlist the Differential diagnosis/Causes, important investigations and outline the brief

management steps of following:

● Obstructive pulmonary diseases

o Bronchial asthma

o Bronchiectasis

o Chronic obstructive pulmonary disease

Emphysema

Chronic bronchitis

● Infections of respiratory tract

o Pneumonia

Community acquired pneumonia

Hospital acquired pneumonia

Pneumonia in immunocompromised

o Tuberculosis

o Aspergilloma

● Pleural effusion

● Pneumothorax

● Interstitial and infiltrative pulmonary diseases

o Diffuse parenchymal lung disease

o Lung diseases due to systemic inflammatory disease

o Pulmonary eosinophilia and vasculitides

● Pulmonary vascular disease

o Pulmonary embolism

o Pulmonary hypertension

● Adult respiratory distress syndrome

24

Good to know topics


features, enlist investigations and outline brief management steps of following:

● Tumors of lung

● Tumors of the mediastinum

● Lung diseases due to radiation and drugs

● Rare Interstitial lung diseases

● Occupational and environmental lung disease

o Occupational airway disease

o Pneumoconiosis

o Lung diseases due to organic dusts

o Asbestos-related lung and pleural diseases

o Occupational lung cancer

o Occupational pneumonia

● Diseases of the upper airway

o Diseases of the nasopharynx

o Sleep-disordered breathing

o Laryngeal disorders

o Tracheal disorders

Investigations

At the end of clinical rotation, it would be better for students if they are able to interpret and

explain the following investigations:

● Pulmonary function test

● Chest X-ray PA view

● CT chest

25

CLINICAL TRAINING

Case Discussion

At the end of clinical rotations students must be able to define, describe the clinical features,

enlist the causes, differential diagnosis, and investigations and outline the brief management

steps of following.

● Shortness of breath and its causes

● Chest pain

● Cough

● Hemoptysis

● Pleural Effusion

Mandatory clinical methods

At the end of clinical rotation, final year MBBS students must be able to perform following:

History

A comprehensive history of symptomatology of patients with respiratory disorders to reach the

diagnosis.

● Cough, sputum/expectoration/hemoptysis

● Breathlessness/dyspnea/ SOB

● Chest pain

● Discoloration of extremities

Examination

At the end of clinical rotation, students should be able to perform following examination in a

patient coming with respiratory symptomatology.

● General physical examination: clubbing, cyanosis, pulse, blood pressure, lymph

nodes, etc.

● Front of chest: inspection, palpation, percussion and auscultation.

● Back of chest: inspection, palpation, percussion and auscultation.

Clinical skills

26

At the end of clinical rotation, it would be good for students to know the importance of following

procedures, observe and assist the doctors in the wards during these procedures.

● How to start O2 therapy, indications and complications

● Airway insertion, indications and complications

● Endotracheal tube insertion, indications and complications

● Endotracheal suctioning

● Pleural aspiration, Indications and complications

27

GASTROENTEROLOGY

28

Must know topics


enlist the Differential diagnosis/causes, important investigations and outline the brief

management steps of following:

● Esophagus.

o GERD

o Achalasia

● Stomach.

o Peptic ulcer disease

Intestines

● Malabsorption syndromesesp. Coeliac disease

● Inflammatory bowel diseases.

● Ulcerative colitis

● Crohn’s disease

● Irritable bowel syndrome (IBS)

Acute and chronic pancreatitis

Good to know topics


features, enlist investigations and outline the brief management steps of following:

● Candidiasis

● Plummer-Vinsonsyndrome

● Ischemic Gut Injury

● Constipation, Anal fissure, hemorrhoids.

● Perforation of the esophagus

● Tumors

o Esophagus

o Stomach

o Colon

o Pancreas

29

Investigations

At the end of clinical rotation, it would be better for students if they are able to describe the

investigations, their indications/complications:

● Barium swallow

● Abdominal X-ray

● CT abdomen

● Upper and lower endoscopies

30

CLINICAL TRAINING

CASE DISCUSSION



steps of following.

● Upper and lower GI bleed

● Abdominal distension/ascites

● Dysphagia

● Dyspepsia

● Heartburn and regurgitation

● Vomiting

● Diarrhea

● Malabsorption

● Weight loss

● Constipation

● Abdominal pain

Mandatory Clinical Methods.

History

A comprehensive history of symptomatology of patients with GIT disorders to reach the

diagnosis.

● Melena, Hematemesis.

● Abdominal Distension/Ascites

● Heart burn

● Diarrhea

● Constipation

● Oral ulceration

● Dysphagia

● Nausea/Vomiting

● Indigestion/Flatulence

Examination

31

At the end of clinical rotation, students must be able to perform following examination in a

patient coming with clinical features of GIT diseases.

● General physical examination: all vitals including BP, pulse, R/R and temperature,

clubbing, jaundice, etc.

● Examination of front of abdomen: inspection, palpation, percussion and auscultation.

● Examination of back of abdomen; bulging in renal area, deformity e.g. scoliosis,

Murphy’s renal punch, any tenderness of spine.

● Digital rectal examination; sphincter tone, tenderness, mucosa , mass, tags , fecal

impaction.

Clinical skills

At the end of clinical rotation, it would be good for students to know the importance of

following procedures (Indications/contraindications, complications), observe and assist

the doctors in the wards during these procedures.

● N/G tube passing and feeding

● Aspiration of peritoneal fluids

● Endoscopies, upper and lower GIT

● Preparation of a patient for GI endoscopies

32

HEPATOLOGY

33

Must know topics


enlist investigations, possible differential diagnosis and outline the brief management steps of

following:

● Jaundice

o Pre hepatic

o Hepatic

o Post hepatic

● Upper and lower GI bleed

● Cirrhosis of liver and portal Hypertension

o Complications

● variceal bleed

● Congestive gastropathy

● Hypersplenism

● Ascites

● Hepatic encephalopathy

● Renal failure ( Hepatorenal syndrome)

● Hepatopulmonary syndrome

Infections of liver

● Viral hepatitis

o Hepatitis A/B/C/D/E

● Liver abscess

Autoimmune diseases of liver and billiary system

● Autoimmune hepatitis

● Primary billiary cirrhosis

● Primary sclerosing cholangitis

Inherited liver diseases

● Haemochromatosis

● Alpha 1 antitrypsin deficiency

34

● Wilson disease

Vascular liver diseases

● Bud Chiari syndrome

Congenital hyperbillirubinemia

● Unconjugatedhyperbillirubinemia

o Gilbert syndrome

o Criglarnajjarsyndrome

● Conjugated hyperbillirubinemia

o DubinJohnson syndrome

o Rotor syndrome

Good to know topic


features, enlist investigations and outline the brief management steps of following :

● Hepatocellular carcinoma

● Cholestatic and biliarydiseses

o extrahepaticbiliary diseases

o Intrahepatic biliary diseases

● Liver transplantation

o indications

o Contraindications

o Complications

o Prognosis

Investigations

At the end of clinical rotation, it would be better for students to know the basics and interpret the

following investigations in a patient coming with clinical features of hepatobiliary disease

● Liver blood biochemistry

35

● Hematological tests

● Immunological tests

● Ultrasound abdomen

● CT abdomen

● Non-invasive markers of hepatic fibrosis

Case Discussion


enlist possible causes, investigations, possible differentials and outline the brief management

steps of following:

● Jaundice

● Acute liver failure

● Ascites

● Hepatomegaly

● Variceal bleed


History

A comprehensive history of symptomatology of patients with liver and billiary system disease.

● Yellowish eye discoloration

● Hematemesis

● Melena

● Abdominal distension

● Itching

Examination

● General physical examination : all vitals including BP, pulse, temperature and R/R,

clubbing, flapping tremors, Duputyren's contracture, palmer erythema, jaundice,

edema, etc.

● Abdominal examination : Front and back of abdomen including inspection, palpation,

percussion and auscultation

● Examination of genitalia and DRE

36

Clinical skills

At the end of clinical rotation, it would be better for students to know the importance, observe

and assist doctors in ward during following procedures.

● Diagnostic ascitic tap, it's indications and complications

● Therapeutic ascitic tap, it's indications and complications

37

HEMATOLOGY

38

Must know topics


enlist investigations, possible differentials and outline the brief management steps of following:

● Anemia

o Non Hemolytic anemia

Microcytic (iron deficiency anemia / Thalassemia / Sideroblastic anemia)

Macrocytic ( folate and B12 deficiency anemia)

Normocytic ( anemia of chronic disease / Aplastic anemia)

o Hemolytic anemia

Autoimmune Hemolytic Anemia

o Cold autoimmune Hemolytic anemia

o Warm autoimmune hemolytic anemia

Hereditary spherocytosis

G6PD deficiency

Hereditary elliptocytosis

Bleeding disorders

● Primary disturbance in homeostasis

o ITP

● Disorders of coagulation

o Hemophilia (A/B)

o Von Willibrand disease

o Disseminated intravascular coagulation (DIC)

Leukemia /Lymphoma

● Acute myeloblastic leukemia / Acute lymphocytic leukemia

● Chronic myeloid leukemia / Chronic lymphocytic leukemia

● Multiple myeloma

● Hodgkin /non Hodgkin Lymphoma

39

Good to know topics



● Thrombotic thrombocytopenic purpura (TTP)

● Paroxysmal nocturnal hemoglobinuria (PNH)

● Blood transfusion, it's indications and complications

● Bone marrow transplant, it's indications and complications

Investigations

At the end of clinical rotation, students must be able to know the basics, interpret and describe

following investigations to reach appropriate hematological abnormality.

● Complete blood count and reticulocyte count

● Peripheral blood film

● PT/APTT /D-dimer /FDP /INR

● MCV/MCH/MCHC

● Hematocrit

Case Discussion


enlist possible causes, investigations, important differentials and outline the brief management

steps of following :

● Anemia

● Leukopenia

● Pancytopenia

● Lymphadenopathy

● Bleeding

● Thrombocytosis


History

A comprehensive history of symptomatology of patients with hematological disorders to reach a

diagnosis.

● Lassitude

40

● Dyspnea

● Infections

● Edema

● Gum hypertrophy

● Bleeding tendency

● Bruising / pupura

Examination

General physical examination and examination of relevant system to reach a diagnosis in

hematological disorders.

Clinical skills



● Injections ( IM, IV, S/C, intradermal) indications and complications

● Maintain IV line (fluid, blood products) indications and complications

● Bone marrow biopsy, it's indications and complications

41

Rheumatology

42

Must know topics


enlist investigations and outline the brief management steps of following:

● RA(Rheumatoid arthritis)

● Osteoarthritis

● Crystal-induced arthritis

o Gout

o pseudogout

● Bone and joint infections

o Septic arthritis

o osteomyelitis

● Seronegative Spondyloarthropathies

o Ankylosing spondylitis

o Reactive arthritis

o Psoriatic arthritis

o Enteropathic arthritis

● Autoimmune connective tissue diseases

o SLE

o Systemic Sclerosis

o Mixed connective tissue disease

o Polymyositis

o Sjogren’s Syndrome

● Vasculitis

o Takayasu disease

o ANCA associated vasculitis

o Kawasaki disease

● Diseases of bone

● Osteoporosis

● Osteomalacia, rickets and vitamin D deficiency

● Paget's disease of bone

43

Good to know topics



● Fibromyalgia

● Juvenile Rheumatoid Arthritis

● Wegner’s &PollyarteritisNodusa

● Other vasculitis

● Polymyalgia Rheumatica

● Bone and joint tumors

o Osteosarcoma

o Metastatic bone disease

● . Rheumatological involvement in other diseases

Mandatory clinical methods.

History

A comprehensive history of symptomatology of patients with rheumtological disorders to reach

the diagnosis.

● • Joint pain and joint swelling

● • Joint deformities

● • Muscle cramps

● • Muscle weakness

● • Muscular wasting

● • Other related systemic symptoms

Examination

At the end of clinical rotation, students should be able to perform following examination in a

patient coming with rheumatological disorders.

● General physical examination: vitals, clubbing, cyanosis, lymph nodes examination of

hands, etc.

● Examination of joints

o Wrist

o Elbow

44

o Shoulder

o Hip

o Knee

o Ankle

o Spine

● Brief systemic examination to reach differential diagnosis.

Clinical skills



● Aspiration of fluids from joints (knee)

● Bone marrow aspiration/trephine Biopsy.

45

Neurology

46

Must know topics


enlist the differential diagnosis, the important investigations and outline the brief management

steps of following:

● Infections of the nervous system

o Meningitis

o Parenchymal viral infections

o Parenchymal bacterial infections

o Diseases caused by bacterial toxins

● Intracranial mass lesions and raised intracranial pressure

o Raised intracranial pressure

o Idiopathic intracranial hypertension

o Head injury

● Disorders of cerebellar function

● Disorders of the Spine and Spinal cord

o Cervical spondylosis

o Spinal cord compression

● Diseases of peripheral nerves

o Guillian-Barre syndrome

● CVA (infarctive, embolic, hemorrhagic)

● Epilepsy

● Diseases of the neuromuscular junction

o Myasthenia gravis

o Lambert-Eaton myasthenic syndrome

● Movement disorders

o Parkinson’s disease

● Multiple sclerosis

● Headache syndromes (especially migraine)

● Motor neuron disease

● Diseases of muscle

47

o Muscular dystrophies

o Inherited metabolic myopathies

o Acquired myopathies

Good to know topics



● Transverse myelitis

● Cerebral venous thrombosis

● Trigeminal neuralgia

● Intracranial Mass Lesions

o Brain tumors

o Paraneoplastic neurological disease

o Hydrocephalus

● Entrapment neuropathy

● Polyneuropathy

● Chronic polyneuropathy

● Brachial plexopathy

● Spinal root lesions

Case Discussion


enlist possible causes, investigations, important differentials and outline brief management steps

of following:

● Headache and facial pain

● Status epilepticus

● Coma /Delirium

● Weakness/Sensory disturbance

● Abnormal movements

48


Following clinical methods are mandatory.

History

A comprehensive history of symptomatology of patient’s withCNS disorders to reach the

diagnosis.

● Behavior

● I.Q

● Speech disturbances

● Memory

● Confusional states

● Dementia

● Tremor

● Fasiculations

● Athetosis

● Chorea

● Gait abnormalities

● Convulsions/fits

● Coma

● Syncope/dizziness

● Vertigo

● Deafness

● Blindness

● Numbness, tingling, sensory loss

● Rigidity / paralysis.

● Movement disorders

Examination

At the end of clinical rotation, students must be able to perform following examination in a patient

coming with clinical features of CNS disease.

● • Higher mental functions – level of consciousness, behavior, speech, memory.

Examination of :

● Higher Mental functions/Speech

● Cranial nerves.

49

● Motor system.

● Sensory system – crude/fine touch, pain, temperature, vibration, Cortical Sensations

● Cerebellar system

● Signs of Meningeal Irritation

Assessment of movement disorders

Clinical skills

At the end of clinical rotation, it would be better for students to know the importance, indications,

contraindications, complications and observe/assist doctors in ward during following procedures.

● Lumbar puncture

● Fundoscopy

50

Medicine Paper II

51

Infectious Diseases

52

Must know topics



● Sepsis

● PUO

● Bacterial diseases

o Bacterial infections of skin & soft tissue

staphylococcal infections

Streptococcal infections

o Systemic bacterial infections

Brucellosis

Leptospirosis

Typhoid / paratyphoid fevers

o Gastrointestinal bacterial infections

staphylococcal food poisoning

Clostridium / campylobacter /salmonella/ E. Coli infections

Cholera

Bacillary dysentery

o Respiratory bacterial infections

Diphtheria

o Neurological involvement

Leprosy

o Chlamydial infections

o Rickettsial infections

Viral diseases

● systemic viral infections with exanthum

o Measles

o Rubella

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o Chicken pox

o Shingles

o Human herpes virus 6&7

● Systemic viral infections without exanthum

o Mumps

o Influenza

o Infectious Mononucleosis

o Cytomegalovirus

o Dengue

● Viral infections of skin

o herpes simplex virus 1&2

● Gastrointestinal viral infections

o Rota virus

● Respiratory viral infections

o Rhino virus / adeno virus/ enteroviruses

● Hydatid diseases

● Protozoal diseases

o Malaria

o Amoebiasis

o Giardiasis

● HIV

Good to know topics



● Fungal diseases

o candidiasis

o Histoplasmosis

● Helminthic diseases

54

o Hookworm infestation/ round worm

o Filariasis

o Schistosomiasis

● STD's

Investigations

At the end of clinical rotation, it would be better for students to know the importance, know the

basics of following investigations and interpretation to reach the diagnosis.

● Serology

● Blood culture

● Complete blood count

● Complete urine examination

● Chest X-ray PA view

Case Discussion


enlist investigations, possible differential diagnosis and outline the brief management steps of

following:

● Fever

● Sepsis

● Acute diarrhea and vomiting

● Dengue fever


History

A comprehensive history of symptomatology of patients with infectious diseases.

● Fever

● Headache

● Pain

● Anorexia/ weight loss

● Cough/expectorations/sputum

● Dysuria/ hematuria

● Diarrhea/vomiting

● Melena / Hematemesis

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● Eruptions/rashes

Examination

● General physical examination :all vitals including BP, pulse, R /R and temperature,

examination of skin, examination of hands and nails, oropharynx, head&neck, eyes

and relevant systemic examination.

● Examination of genitalia and DRE

● General management steps and prescription writing in infectious diseases

Clinical skills


Contraindications, observe and assist doctors in ward during following procedures.

● O2 therapy

● Foley’s insertion

● IV line / fluid/ blood products

● NG passing and feeding

● IOP record

● Aspiration of fluid ( pleural, pericardial, peritoneal, knee)

56

Endocrinology & Metabolism

(Including diabetes)

57

Must know topics


enlist the differential diagnosis, the important investigations and outline the brief management

steps of the following:

● Hyperglycemia

o Diabetes Mellitus and its types

o DKA (Diabetic Ketoacidosis)

o Complications of diabetes (Microvascular, Macrovascular and Neuropathies)

o Non-Ketotic Hyperosmolar coma

● Anterior pituitary.

o Growth hormone disorders

o Acromegaly

o Gigantism.

o Short stature

o Prolactinoma

● Diseases of hypothalamus and posterior pituitary.

o Diabetes insipidus

o Syndrome of inappropriate ADH secretion (SIADH).

● Thyroid gland.

o Hyperthyroidism (thyrotoxicosis)

o Hypothyroidism (myxedema, cretinism)

o Inflammatory lesions/Thyroiditis and its types

o Benign and malignant tumors

● Parathyroid gland

o Hyperparathyroidism

o Hypoparathyroidism

● Adrenal Gland.

o Cushing Syndrome

o Hypo/HyperAldosteronism

o Hirsutism/Congenital Adrenal Hyperplasia.

o Addison’s disease

o Acute Addisonian crisis

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o Adrenocortical tumors including Pheochromocytoma

● Multiple endocrine neoplasia (MEN)

o Type I

o Type II

Good to know topics



● Infertility and common reproductive disorders

● Testes

o Sexual precocity

o Heterosexual precocity

o Gynecomastia

o Inflammations

o Tumors

● PCOS(Polycystic ovarian syndrome)

● Klinfelter’s syndrome

● Turner’s syndrome

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CLINICAL TRAINING

CASE DISCUSSION



steps of following.

● Indoor cases

o Diabetes mellitus and its complications(DKA, HONK)

o Myxedema coma

o Addison’s crisis

o Diabetes Insipidus

● Outdoor cases

o Hypothyroidism

o Hyperthyroidism

o Cushing’s syndrome

o Pheochromocytoma


● History taking and correlation to reach a specific diagnosis regarding endocrine

disorders.

● GPE: relevant GPE regarding different Endocrine disorders to reach a specific

diagnosis.

● Examination of thyroid gland, male and female genital organs and systemic

examination related to endocrine disorders etc.

● Interpretation of related radiological and laboratory investigations

● General medication and prescription writing in endocrinology.

Clinical skills

At the end of clinical rotation, it would be good for students to know the indications of following

procedures and they should be able to assist the doctors in performing these procedures.

● Water Deprivation test

● Dexamethasone suppression test

● Short and Long Synecthin test

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Nephrology

61

Must know topics



● Chronic kidney disease

o Causes

Glomerular

Tubulointerstitial

Vascular

Cystic and congenital

o Complications

Anemia

Acidosis

Mineral bone Disease

Electrolyte imbalance

Cardiovascular disease

Hormonal abnormalities

● Acute kidney injury

o Causes

Pre-Renal

Renal

Post-renal

o Complications

Glomerular diseases

● Nephritic spectrum

o Post infectious glomerulonephritis

● Nephrotic spectrum

o Minimal change disease

o Focal segmental glomerulosclerosis

o Membranoproliferative glomerulonephritis

o IgA nephropathy

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● Hemolytic uremic syndrome (HUS)

● Henoch-Shonleinpurpura (HSP)

● Electrolyte imbalance

o Hyperkalemia

o Hypokalemia

o Hyponatremia

o Hypernatremia

● Acid base disorder

o Metabolic acidosis

o Metabolic alkalosis

o Respiratory acidosis

o Respiratory alkalosis

Good to know topics



● Nephrolithiasis

● HELLP syndrome

● Prostatic cancer and BPH

Investigations

At the end of clinical rotation, students must be able to interpret the following investigations and

enlist possible causes leading to acute or chronic kidney disease.

● Renal function test

● Serum electrolytes

● Urine complete examination

o Casts (RBC cast, WBC casts and granular casts)

o Crystals

● Proteinuria

o Microalbuminuria

o Minimal proteinuria

o Moderate proteinuria

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o Heavy proteinuria

● Hematuria

o Glomerular hematuria

o Extra glomerular hematuria

● Ultrasound KUB

o Normal ultrasound

o Corticomedullary differentiation

o Renal asymmetry

● IV urogram

● CT scan KUB

Case Discussion


enlist possible causes, investigations, important differentials and outline brief management steps

of following :

● Acute renal failure

● Chronic Kidney Disease

● Nephrotic syndrome/edema

● Proteinuria

● Hematuria


History

A comprehensive history of symptomatology of patients with renal disorders to reach the

diagnosis.

● Periorbital swelling/ generalized body swelling

● Increase / decrease in urine output

● Blood/pus in urine

● Flank pain

● Frequency /Urgency

● Burning micturition

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Examination

At the end of clinical rotation, students must be able to perform following examination in a patient

coming with clinical features of renal disease.

● General physical examination : all vitals including BP, pulse, R/R and temperature, nail

pigmentations, skin complexion, bruising, skin turgor, JVP, ankle edema, etc.

●

● Examination of abdomen : Front and back of abdomen including inspection, palpation,

percussion and auscultation

● Examination of genitalia and DRE : Phimosis, BPH

Brief management steps and prescription writing in kidney and urinary tract diseases

Clinical skills



● Foley’s catheterization, it's indications and complications

● Double lumen catheterization, it's indications and complications

● Hemodialysis, it's types, indications and complications

● Plasmaheresis, its types, indications and complications

● Peritoneal Dialysis, Types, inications

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Psychiatry

66

Must know topics


enlist investigations, possible differentials and outline the brief management steps of following.

● Affective (Mood) disorder

o Depression

o Bipolar disorder

● Anxiety disorder

o panic disorder

o Generalized anxiety

● Schizophrenia

● Organic disorder

o Dementia

● Somatoform disorder

o conversion disorder

● Stress related disorder

o Post traumatic disorder

Good to know topics



● Delirium

● Personality disorders

● Eating disorder

o anorexia nervosa

o Bulimia nervosa

● Puerperal mental disorder

o puerperal psychosis

o Post partum blues and depression

67

Investigations

At the end of clinical rotation, it would be better for students to know the basics and interpret

relevant radiological and neurological investigations in a patient coming with clinical features of

mental illness.

Case Discussion


enlist investigations, possible differentials and outline the brief management steps of following:

● Depression

● Bipolar disorder

● Alcohol/ substance misuse

● Anxiety

● Delusions / Hallucinations / confusion


History

A comprehensive history of symptomatology of patients with mental illness to reach the

appropriate diagnosis.

● Apprehension

● Palpitations

● Chest pain

● Tremors

● Hallucinations

● Obsessive thoughts

● Fear of situation

● Elevated mood

● Confusion

Examination

Mental state examination: General appearance and behaviour, speech, mood, thoughts,

abnormal beliefs, abnormal perceptions and cognitive function including

o Concentration

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o Orientation

o Memory

HISTORY AND MENTAL STATE EXAMINATION

Age/marital status/Education/Occupation/Residence Source of referral/Informants

● PC/HOPI (Presenting complaint/history of presenting complaint) Principle Symptoms

or complaints and their duration: Associated Disturbance in appetite, Weight, Sleep,

and sexual drive, Effects on patients ability to cope socially or with work.

● PPH (Past Psychiatric History)

● Previous Hospital Admission with Psychiatric illness, treatment given. How well did

patient remain I between admissions?

● PMSH (Past Medical and Surgical History)

● Previous hospital admissions with Physical illness or for operations, any know

allergies.

● FH (Family History)

o Mother and father current age, or if dead, age at death and cause of death, occupations.

o Sisters and brothers names ages, marital status, occupation.

o Family psychiatric history, history of any psychiatric illness in the family.

o Family medical history, history of any physical illness in the family.

o Current relationships with parents, siblings and other relatives.

● PH (Personal History)

o Birth- any prematurity or low birth weight, any difficulties during delivery.

o Developmental milestones- any delay in achieving.

o Early childhood- childhood illnesses; any separation with parents. Relationship with

parents, siblings and other children and adults at this age.

o School – age of starting and finishing; school phobia or truancy; type of school,

academic qualifications, relationship with pupils and teachers.

o Occupations- chronological list of jobs; if multiple changes, inquire about reason,

relationship with workmates and superiors.

o Psychosexual history – age of onset of puberty; any sexual relationships,; masturbation

fantasies and guilt; if married, age at marriage and age of spouse ; if children give

chronological list of their names, age, and sex, occupation; any psychiatric or physical

illness in children; relationship with children.

o Drugs – prescribed or over the counter, illicit drugs, alcohol. Tobacco, Naswar.

o Forensic history – any trouble with the law or police, any convictions.

● PSC ( Present social circumstances)

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o Composition of household, type of house, main bread earner, status of patient,

financial difficulties etc.

● PMP (Pre Morbid personality)

o The patient’s personality before first admission to hospital with psychiatric illness.

● relationships – few friends or many, depth of relationships.

● Character outgoing or reserved, sensitive to criticism, worrier.

● Mood – cheerful or gloomy, steady or changeable.

● Religious – ideas about religion, regular in prayers or otherwise.

● Leisure activities – hobbies, preference for company or solitude.

PHYSICAL EXAMINATION

MENTAL STATE EXAMINATION

● Appearance and behavior – dress sand self care (tidy or disheveled, well groomed or

unkempt, Describe actual clothes); Manner (hostile or helpful, aggressive or

cooperative) posture and movement (tense or relaxed, over active or slowed up ) Eye

contact and rapport.

● Talk – rate, rhythm and volume

● Mood – subjective and objective, depressed, elated, incongruent, blunt, flat.

● Thoughts; form (pressure, poverty, thought block, loosening of association, flight of

ideas or preservation), content (preoccupation; obsessions; delusions; over valued

idea; suicidal ideas).

●

● Perception – Hallucination (Modality, person, content) illusions; depersonalization, de

realization.

● Cognitive Functions – (a)orientation (in time, place and person)

● (b) Attention and concentration (subjective report, days of week backward, months of

year backward, serial seven or three test, digit span.)

● (c) Memory I. Registration (5-7 items/address) II. Short term memory (subjective

account, name and address, 5 minute recall; days in hospital, menu or recent meal),

III. Long term memory – (personal, events recalled from several years ago, assessed

in history, historical events)

● Abstract thinking (meaning of proverbs)

● Insight (does the patient consider himself ill in psychological terms, does the patient

feel in need of treatment).

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Clinical skills

At the end of clinical rotation, it would be better for students to know the importance,

indications/contraindications, complications, observe/assist doctors in ward during following

procedures:

● Psychotherapy

● Electroconvulsive Therapy

● Electroencephalogram (EEG)

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Dermatology

72

Must know topics



● Scabies

● Eczema

● Psoriasis

● Acne vulgaris

● ErythemaNodosum

● Steven Johnson syndrome

● Autoimmune Blistering Disorder

● Bacterial infections of skin

● Various types and patterns of eczema

Good to know topics



● Skin bacterial infections

● Fungal infection

● PyodermaGangreonosum

● Blistering diseases

● Bullouspemphigoid

● Pemphigusvulgaris

● Sexually transmitted infections

● Cutaneous feature of HIV

● Leprosy

● Leishmaniasis

● Erythroderma

● Connective Tissue diseases involving skin

Mandatory Clinical Methods.

History

A comprehensive history of symptomatology of patient’swith skin disorders to reach the

diagnosis.

● Alopecia

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● Eruption and rashes

● Itching

● Pigmentation and depigmentation.

● Detailed drug history

● Evolution of skin lesions

● Pattern of Skin lesions

● Morphology of skin lesions

● Differentiation between primary and secondary skin lesions

History taking in dermatology

Introduction

● Introduce yourself – name/role

● Confirm patient details – name/DOB

● Explain the need to take a history

● Gain consent

● Ensure the patient is comfortable

Presenting complaint

● It’s important to use open questioning to elicit the patient’s presenting complaint

● “So what’s brought you in today?” Or “Tell me about your symptoms” ● Allow the patient time to answer, trying not to interrupt or direct the conversation

● Facilitate the patient to expand on their presenting complaint if required

● “Ok, so tell me more about the rash” “Can you explain what that pain was like?”

History of presenting complaint

● Onset:

● When did the skin problem start?

● Was the onset acute or gradual?

● Course – has the rash/skin lesion changed over time

● Intermittent or continuous – is the skin problem always present or does it come and

go?

● Duration of the symptom if intermittent – minutes/hours/days/weeks/months/years

Location/distribution:

● Where is the skin problem?

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● Number of lesions?

● Is it spreading?

o Precipitating factors – are there any obvious triggers for the symptom?

o Relieving factors – does anything appear to improve the symptoms (e.g. steroid

cream)?

o Associated features – are there other symptoms that appear associated (e.g.

fever/malaise)?

o Previous episodes – has the patient experienced this problem previously?

o When?

o How long for?

o Was it the same or different than the current episode?

o Contact history – has the patient been in contact with an infectious skin problem (e.g.

chickenpox)?

o Sun exposure (including sunbed use)

o Important when considering skin cancer in the differential diagnosis

o Ask the patient about how their skin reacts to sun exposure to help determine their skin

type (Fitzpatrick scale)

Key dermatology symptoms:

● Pain

● Itch

● Bleeding

● Discharge

● Blistering

Systemic symptoms

● fever / malaise / weight loss / arthralgia

● If any of these symptoms are present, gather further details as shown above (Onset /

Duration / Course / Severity / Precipitating factors / Relieving factors / Associated

features / Previous episodes)

Pain

● If pain is a symptom, clarify the details of the pain using SOCRATES

● Site – where is the pain?

● Onset – when did it start? / Sudden vs gradual?

● Character – sharp / dull ache / burning

● Radiation – does the pain move anywhere else?

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● Associations – other symptoms associated with the pain?

● Time course – worsening / improving / fluctuating / time of day dependent

● Exacerbating / Relieving factors – does anything make the pain worse or better?

● Severity – on a scale of 0-10, how severe is the pain?

● Ideas, Concerns and Expectations

● Ideas – what are the patient’s thoughts regarding their symptoms?

● Concerns – explore any worries the patient may have regarding their symptoms

● Expectations – gain an understanding of what the patient is hoping to achieve from the

consultation

Past medical history

● Skin disease:

● Skin cancer

● Atopy – eczema / hay fever / asthma

● Other dermatological conditions

● Other medical conditions – many of which can have dermatological manifestations

● Diabetes – acanthosis nigricans / scleroderma diabeticorum / necrobiosis lipoidica

diabeticorum

● Inflammatory bowel disease – pyoderma gangrenosum / erythema nodosum

Drug history

● Skin treatments – creams / ointments / UV therapy / antibiotics / biologics

● Regular medication – including length of treatment (paying particular attention to those

started around the time of the skin problem)

● Antibiotics

● Over the counter drugs

● Cosmetics

● Herbal remedies

ALLERGIES

● (a common cause of rashes) – ensure to document these clearly

Family history

● Skin conditions – e.g. psoriasis / hereditary hemorrhagic telangiectasia

● Skin cancer

● Atopy – eczema / asthma / hay fever

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Social history

● Occupation:

● Are the skin problems worse at work?

● Do the skin problems improve when the patient is off from work?

● Is the patient exposed to any skin irritants or other hazardous substances?

● Smoking – How many cigarettes a day? How many years have they smoked for?

● Alcohol – How many units a week? – type / volume / strength of alcohol

● Recreational drug use – e.g. cellulitis from IV drug injection site

Living situation:

● Own home/care home – adaptations / stairs?

● Who lives with the patient? – is the patient supported at home?

● Any carer input? – What level of care do they receive?

● Any recent changes at home that could be related to skin problems (e.g. new

detergent causing allergic reaction to clothing)

Activities of daily living:

● Is the patient independent and able to fully care for themselves?

● Can they manage self-hygiene/housework/food shopping?

● Travel history

● Where did the patient travel to?

● How long was the patient there?

● Is the patient aware of any exposure to infectious disease?

● Sun exposure – was the skin problem worsened by sun exposure? (e.g. facial rash in

lupus)

Systemic enquiry

● Systemic enquiry involves performing a brief screen for symptoms in other body

systems.

● This may pick up on symptoms the patient failed to mention in the presenting

complaint.

● Some of these symptoms may be relevant to the diagnosis (e.g. arthralgia in psoriatic

arthritis).

● Choosing which symptoms to ask about depends on the presenting complaint and

your level of experience.

77

● Cardiovascular – Chest pain / Palpitations / Dyspnoea / Syncope / Orthopnoea /

Peripheral oedema

● Respiratory – Dyspnoea / Cough / Sputum / Wheeze / Haemoptysis / Chest pain

● GI – Appetite / Nausea / Vomiting / Indigestion / Dysphagia / Weight loss / Abdominal

pain / Bowel habit

● Urinary – Volume of urine passed / Frequency / Dysuria / Urgency / Incontinenc

● CNS – Vision / Headache / Motor or sensory disturbance/ Loss of consciousness /

Confusion

● Musculoskeletal – Bone and joint pain / Muscular pain

● Closing the consultation

● Thank the patient

● Summarise the history

Examination

At the end of clinical rotation, students should be able to performfollowing examination in a

patient coming withsymptomatology of skin disorders.

● Clinical examination of various skin lesions

● Examination of scalp

● Examination of oral cavity

● Examination of nails

● Examination of genitalia

● Scheme of examination for full skin.

Clinical skills


complications, observe and assist doctors in ward during following procedures.

● Scraping for fungus

● Use of magnifying glass

● Observe skin biopsy

● Use of Wood’s lamp. ● Fungal scraping

● Tzank smear

78

● Woods lamp examination

● Punch skin biopsy

● Orientation regarding different types of lasers.

79

Section 3

Clinical Rotation Guidelines

for History Taking

& Examination

80


PARTICULARS ABOUT THE PATIENT

History No.______________

Bed No.________________

Patient’s Name_____________________________________ Age________ Sex_______

Occupation ________________Married/Unmarried__________ Religion______________

Address__________________________________ Date of Admission________________

Through Outdoor/Emergency.

Date of History Taking ________________ Date of Discharge_______________________

A. The Presenting Complaints with Duration. (Presenting complaint is the complaint 1.

Which made the patient come to the doctor. 2.

Write in chronological order) 3.

4.

B. The History of Present Illness.

History in chronological order

(No Direct Questions)

81

(2) Symptomatic enquiry (Mention relevant positive as well as negative points).

(3) Special features (Weight, Sleep, Energy & questions regarding all the systems, in view of

patient’s illness & psychiatry).

C. The Past History.

All important illnesses from infancy onwards.

(ii) Relevant diseases, especially Dysentery, Rheumatic fever, Infectious diseases, venereal

diseases, Diabetes, Hypertension & previous similar attacks with duration.

(iii) Operations and accidents.

(iv) Previous admission to hospital & treatment.

(v) Travel abroad.

(vi) ALLERGY.

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D. The Menstrual History

Regularity regarding cycle & amount, Menarche, Menopause, Premenstrual tension, Pain at

periods, Oral contraceptives, Pregnancies & outcome).

E. The Treatment History.

(Visits to doctors, previous investigations, Details of drugs taken, including psychotropic drugs,

Surgery, Radiotherapy and Psychotherapy. Adverse reaction to drugs, including hypersensitivity).

F. The Family History.

(i) Patient’s position in family, ages of children if any.

(ii) Ask about immediate relatives and close contacts, parents, siblings, children,

Companion.

(iii) H/o similar diseases.

(iv) Communicable diseases.

(v) Relevant hereditary diseases.

(vi) Health, illness and cause of death of relatives and close contacts.

(vii) H/o Diabetes, Hypertension, T.B. in family.

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G. The Social and Occupational History.

● Exact nature of occupation and earning.

● Domestic and marital relationships.

● Home surroundings and hygienic conditions.

● Diet (mixed or vegetarian, approximate aount of CHO, protein and fat when indicated).

● Addictions, use of alcohol and tobacco.

● Living abroad.

H. The Psychiatric History.

Worries, depression, anxieties, phobias, delusions, hallucinations, any H/o fits.

I. Systemic Direct Questioning.

Ask direct questions about the symptoms affecting all the systems of the body.

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EXAMINATION

A. GENERAL PHYSICAL EXAMINATION.

Temperature…………………………… Pulse (rate &rhythm)……………………………

Respiration (rate &rhythm)………….. Blood Pressure………………………………….

1. Decubitus & Comfortability 7. Jaundice

2. Mental & Emotional state 8. Odours

3. Attitude 9. Clubbing

4. Physique 10. Koilonychia

5. Pallor 11. Edema

6. Cyanosis Dependant/non-dependant

-Central Pitting/non-pitting.

-Peripheral 12. Lymph nodes.

13. Thyroid gland.

14. Other features

(face, hands, feet)

B. SKIN & ITS APPENDAGES.

1. Color & Pigmentation 7. Allergy

2. Haemorrhages 8. Hair

3. Eruptions, (Macules, papules, vesicles, 9. Nails

Pustules, scales, ulceration, scar 10. Exam. For parasites.

Formation, keloids). 11. Raynaud’s phenomenon. 4. Edema 12. Peripheral vascular disease

5. Subcutaneous emphysema (Diabetes, hypertension).

6. Skin lessions.

C. CARDIOVASCULAR SYSTEM

1. Arterial Pulses. Pulse………… Rate…………. Rhythm………. Volume…………

Character…………Condition of vessel wall………..Comparison with other pulses….. Blood Pressure, Supine………….Sitting…………..Standing……………………………

2. Venous Pulses.

Neck Veins Venous pulsations

85

J.V.P (at an angle of 45)

3. Inspection of Praecordium.

Shape Visible Veins over the chest

Apex beat & cardiac impulse

Other Pulsations:

Suprasternal Lt. Parasternal Epigastric Rt 2nd

space

Lt 2nd

space

4. Palpation.

Apex beat, Position……………. Character-Heaving/Tapping/Normal.

Pulsation:- Suprasternal. Lt. Parasternal Epigastric

Venous pulsations in Neck.

Thrills, position, timing and variation with respiration Rt. 2

nd space

Lt 2nd

space

5. Auscultation

-Rate & Intensity of I & II heart sounds on all Auscultatory areas.

-Splitting.

-Triple rhythm III, IV.

-Additional sounds, clicks, murmurs, site,

Timing, radiation, character, change during respiration.

-Exocardial sounds, venous hum, pericardial

Friction rub.

6. Peripheral Vascular System.

Arterial & Venous, Blanching test, Bruit,

Ray naud’s phenomenon, Varicosity, Capillary pulsation, Intermittent claudication.

D. RESPIRATORY SYSTEM

1. Inspection.

-Respiration, Rate……………….Rhythm…………….Character………………. -Nose………..Alae……………….Sinuses……………Throat…………………..

86

-Form of the chest………………………Movements of chest……………………

-Visible veins over chest………………..Expansion of chest……………………. -Any other abnormality, especially of spine.

2. Palpation.

-Tender spots……………………………Swelling……………………………………

-Trachea………………………………….Apex beat…………………………………

-Respiratory movements, 3 levels Ant & Post.

-Vocal fremitus Normal Increased Diminished.

3. Percussion.

Upper border of Liver.

Resonance (areas).

-Normal/Dull/Stony-dull/Hyper resonant.

4. Auscultation.

-Breath sounds. Vesicular-Harsh vesicular Broncho vesicular-Bronchial-Amphoric.

-Vocal resonance. Normal-Increased-Diminished-Absent.

-Added sounds.

-Rhonchi-(Sibilant-Sonorous).

-Crepitations, (fine, coarse, timing).

-Friction sound or Pleural rub.

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E. GASTROINTESTINAL SYSTEM

1. Mouth & Throat

(Orodental hygiene, lips, gums, teeth, tongue, buccal mucosa, palate, tonsils, pharynx, breath

smell).

2. Abdomen

a) Inspection-shape, symmetry, umbilicus, movement of abdominal wall, visible pulsation or

peristalsis, skin and surface of abdomen, scars, pigmentation, prominent veins.

b) Palpation-Tenderness, rigidity, hyperaesthesia-palpation for viscerae,-liver, gall bladder, spleen,

kidneys, urinary bladder and uterus in females-feel for aorta, & common femoral vessels-If mass

palpable, note site, size, shape, surface, edge, consistency, mobility and attachment, bimanual

palpation & any pulsation.

c) Percussion-Tympanitic, dullness, shifting dullness and fluid thrill.

d) Auscultation-Peristaltic sounds, Bruit (Renal).

88

3. Groins.

Femoral vessels, Inguinal canal, expansile impulse, lump in the groin.

4. Genitalia.

5. Rectal Examination.

F. NERVOUS SYSTEM

1. Skull & Spine.

2. Mental Functions:

a) Appearance & behavior.

b) Emotional states.

c) Orientation in time, space, person.

d) Clouding of consciousness.

e) Memory, Recent/old.

f) Delusions & Hallucinations.

g) Sleep disturbances.

h) General intelligence.

i) Released reflexes

3. Speech.

Dysarthria, stammering, lalling, scanning, spastic, cortical, aphasia, spoken & written speech.

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4. Cranial Nerves.

a) 1st or Olfactory Nerve.

Smell anosmia, parosmia, hallucinations.

b) 2nd or Optic Nerve.

(i) Acuity of vision. Far & Near.

(ii) Field of vision.

(iii) Colour vision.

(iv) Fundoscopy

c) 3rd, 4th, 6th or Oculomotor, Trochlear & Abducent Nerves.

(i) Movement of Eye ball.

(ii) Pupils, size, shape, equality, accommodation reflex, reaction to light (Light

reflex Cr. 2, 3), consensual reflex.

(iii) Strabismus, paralytic, concomitant, diplopia.

d) 5th or Trigeminal Nerve.

(i) Sensory part, Corneal & Conjunctival reflex (Cr-5,7) sensations in 3 divisions.

(ii) Motor part, Muscles of mastication, movement of jaw, clenching of teeth, jaw

jerk, (Cr-5).

e) 7th or Facial Nerve.

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Upper part of face.

Lower part of face.

Judge whether the lesion is in UMN or LMN.

-Frowning.

-Closing of eye.

-Nasolabial fold.

-Angle of mouth.

-Whistling out.

-Blowing cheeks.

-Showing of teeth.

- Taste on Ant 2/3 of tongue.

f) 8th or Vestibulocochlear Nerve,

((i) Hearing, Rinne’s test, Weber’s test.

(ii)Test for vertigo

g) 9th or Glossopharyngeal Nerve.

Taste on post, 1/3 of Tongue, Tickling of pharynx reflex (gag-reflex Cr.9, 10).

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h) 10th or Vagus Nerve.

Regurgitation of fluids, Movement of palate during phonation (Ah-test).

Nasal twang Larynx

Voice Hoarseness

i)-11th or Accessory Nerve.

Power of sternomastoid.

Power of trapezius.

j) 12th or Hypoglossal Nerve.

Tongue, Position, deviation.

Movement of Tongue, comparison & power.

Wasting and fasiculation of tongue.

4. Motor System.

a. Bulk of Muscle.

b. Tone of muscle (exclude myotonia).

c. Strength of muscles.

d. Tendon reflexes.

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o Jaw jerk (cranial 5)

o Biceps jerk (C.5, 6)

o Triceps jerk (C-5, 6).

o Supinator jerk (C-5, 6).

o Knee jerk (L-2, 3, 4).

o Ankle jerk (S-1, 2).

o Patellar clonus.

o Ankle clonus.

o Haffman’s sign.

e. Superficial reflexes.

o The plantar reflex (S-1)

o Abdominal reflexes (T 6-T 12)

o Corneal reflex (Cr-5, 7).

o Sphincter reflexes. (S-3, 4)

o Cremasteric reflex (L-1, 2)

f) Coordination of Movements.

(i) In the upper limb. (finger-nose test).

(ii) In the lower limb. (Heel-knee test).

(iii) Dysdiadochokinesia.

(iv) Romberg\s Sign (sensory ataxia).

g) GAIT

Spastic, Hemiplegic, Stamping.

Drunken, Festinant Retropulsion.

Wadding High stepping gait.

5. Involuntary Movements.

Epilepsy, Myoclonus, Tremors, Athetosis, Chorea, Dyskinesia, Dystonia. Hemibalismus, Tics,

Metabolic flap, Tetany, Fasciculation.

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6. Sensory System

a) Tactile sensibility (Light touch, pressure, cotton wool-test).

b) Position sense (passive movement-degree direction).

c) Stereognosis.

d) Vibration.

e) Pain-Superficial, Pressure.

f) Temperature, Hot

7. Signs of Meningeal Irritation.

Neck stiffness.

Brudzinski’s sign. Kernig’s sign. Straight leg raising.

8. Cerebellum.

Muscular hypotonia, Tendon reflexes, Gait. Disorders of Movement, Dysmetria, Dyssynergia.

Intention tremors, Dysdiadochokinesia, Rebound phenomenon, Scanning speech, Jerking

nystagmus.

G. Locomotor system,

i) Bones, shape, swelling, tenderness, deformity.

ii) Joints, tenderness, muscle wasting, crepitus, swelling, Temerature& color of skin.

iii) Range of active & passive movements, on all joints & any restriction in degrees.

iv) Special features, Heberden’s nodes, Rheumatoid subcutaneous nodules, Gouty tophi, etc.

H. LOCAL EXAMINATION.

PROFISIONAL DIAGNOSIS

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DIFFERENTIAL DIAGNOSIS

INVESTIGATIONS

URINE Colour…………..Quantity………..Reaction…………….Sp. gravity………….. Albumin…………Sugar……….Acetone………..Urobolin……….Bilesalts……….Bile pigments…………. Microscopic examination…………………………………………….

BLOOD, Hb%.............TLC……….DLC……..P…….L…….M……..E………B………….. ESR………

Blood urea……….Serum Creatinine………., LFT’s………………. RBS……….., Na+………K+……….HCO3………, Cl……….., Ca++………..Mg++……..

IMAGING

X-RAYS

CT Scan

MRI

OTHER TESTS.

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FINAL DIAGNOSIS

TREATMENT

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DAILY PROGRESS REPORT

Date

Presenting complains:

Today’s complains:

Examination:

Vitals & GPE

GIT

Respiratory System

Cardiovascular System

Musculoskeletal System

CNS

Investigation:

Assessment:

Plan:

Signature………………….

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Some Common Complaints in History of Present Illness

( Guideline to explore the symptoms)

Pain:

● Site_____

● Mode of onset__

● Intensity___

● Radiation ______

● Shift ____

● Character______

● Frequency _______

● Special time of occurrence ____________

● Aggravating factors_______

● Relieving factors_______

● Associated phenomena

Fever:

● Mode of onset___

● Rigors of Chills_______

● Grade_____

● Pattern ______

● Associated symptoms_________

Weight :

● Ask about Appetite

● ( if decreased then ask about ____ fever, night sweats, cough, Expectoration)

● If normal or increased then ask about _____ Polyuria, Polydypsia, Palpitation

Edema:

● Site _____

● Where did it start first? ( periorbital, feet)

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Dyspnea

Exertional Dyspnea:

● Duration___________

● How much exertion does precipitates dyspnea ( Climbing stairs, running, distance ,

walked)

● Onset ( sudden or insidious)_____

● PND______

● Orthopnea ______

● Associated symptoms (Breathlessness, Chest pain. Loss of weight despite good

appetite , heat intolerance)

Non- Exertional Dyspnea (at rest)

● Age of onset ________

● Wheeze _______

● Frequency, severity & duration of attacks _______

● Any change since first attack_____

● Nasal or skin allergy ______

● Family history _______

● Is treatment required to remain symptoms free?

Palpitations:

● Attacks at rest (Paroxysmal tachycardia) /on exertion_____

● Duration _______

● Onset & Termination (Sudden, Gradual) ______

● Associated symptoms (Breathlessness, Chest pain. Loss of weight despite good

appetite, heat intolerance

Cough:

● Duration ________

● Frequency & Severity_________

● More at night/ day_____

● Dry/ productive __________

● Quantity, Color, Viscosity, odor…

● More in early morning ______

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● Hemoptysis ( Blood Mixed with sputum / Pure ( Frank) / Blood streaked ______

● Frequency & Quantity )

Vomiting:

● Duration ______

● Frequency _____

● Relation with food intake ______

● Any special timing ______

● Loss of weight ______

● Quantity, color smell & Contents of vomitus _____

● Hematemesis (Color, Quantity & Frequency ________

● Associated Melena )_________

● pain abdomen _________

● Constipation & Distension _________

● Anorexia & Oliguria _______

● Headache.

Diarrhea:

● Duration_____

● Frequency ________

● Quantity ________

● Difficult to flush ________

● Consistency _________

● Blood / Mucus __________

● Tenesmus________

● If acute ( Any relation with food intake , any other, Individual who took same food,

interval between intake & onset) ___

● Nocturnal _________

● Other symptoms ( Fever , Abdominal pain, Vomiting, Weight loss)

Constipation:

● Usual bowel habits_______

● Duration ( recent change in bowel habits) _______

● Blood _________

● Alternating diarrhea ____________

● Drug history _____________

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● Change in eating habits ______________

● Other symptoms( Abdominal pain, Distension & vomiting , Weight loss)

Dysphagia:

● Duration __________

● More to Solids or liquids ______

● Or progressive ________

● Feeling of good Sticking ( site) ___________

● Swallowing painful weight loss______________

● vomiting ___

● Does vomitus contain food eaten 48-72 hours earlier ________

● Past history of retrosternal burning ________

Jaundice:

● Pain right hypochondrium ________

● Anorexia ____________

● Distaste for smoking _________

● Color of Stools and urine _________

● Itching __________

● Weight loss_________

● Past history of injections _____________

● Contact with jaundice patients ______________

● Family history.

Polyuria:

● Duration_____

● In frequency (Quantity of urine is smell) While in Polyuria (Quantity passed each time

is large)

Hematuria;

● Duration ______________

● Exact color________

● Difference in color in beginning, middle or at end of micturation____

● Associated Symptoms (Fever, Burning micturation ,

● pain in hypogastrium, lumber region or loin to groin)

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Fits( Convulsions)

● Age at time of first attack ______________

● Gather following info from patients & eye witness ( Aura, loss of consciousness,

Rigidity.

● Tonic/ Clonic contractions,

● Fits: Generalized or Localized, Tongue bite, Urinary incontinence, Fall Trauma

● Duration after symptoms.

Weakness/ Paralysis:

● Part involved ( Monoplegia. Hemiplegia, paraplegia) ___________

● Weakness complete / Partial________

● onset (Sudden / Gradual)_____________

● Static / Progressive ___________

● Headache, Vomiting ___________

● loss of consciousness___ ________

● Fits____________

● Speech____ ______

● Sensory Symptoms.

Headache:

● Site_______

● Severity _____________

● Duration _____________

● Continuous/ Intermittent _______________

● Character______________

● Special times of occurrence ______________

● Aggravating & Relieving factors _______________

● Associated Phenomena _________________

● Insomnia__________

● Anxiety/ Depression____________

● Effects of Analgesics.

Joint Pain:

● Age of onset____________

● Joint involved first_____________

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● Sequence of involvement of other joints ________________

● Did pain in previous joint persist / Disappear after involvement of other

joints_____________

● Swelling ______________

● Pain on movements_______________

● Morning stiffness___________

● past history of trauma to the joint__________

● Systemic symptoms.

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SECTION 04 Short cases

(4 Cases of 25 Marks Each)

104

Disclaimer:

Medicine is a very broad field. Any Important Clinical Case according to Curriculum of University of

Health Sciences can be asked in the examination. Some common short case list is shared here as

a guideline for your exam preparation. It is not the final list.

Short Cases

Assessment of your short case will be done at three levels.

1. Good Performance

2. Proper description of findings

3. Viva to assess your knowledge about case including differential diagnosis, investigations and

management.

Short Cases of Central Nervous System

1. Assessment of Higher Mental Functions (including orientation with time, space and

person and assessment of speech of person)

2. Examination of the Cranial Nerves

3. Examine the Motor System of Upper Limbs.

4. Examine the Motor System of Lower Limbs

5. Examine the Sensory System of Upper Limbs.

6. Examine the Sensory System of Lower Limbs

7. Examine Cerebellar System of the Patient.

8. Examination Relevant to Cerebellar System

9. Examination for Signs of meningeal irritation

Examination of CVS

● Examination of the Pulse

● Examination of blood pressure

● JVP measurement including hepatojugular reflex

● General Physical Examination relevant to Cardiovascular System.

● Examination of Precordium.

Examination of Respiratory system

● General Physical Examination Relevant to Respiratory System.

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● Examine the Front of the Chest.

● Examine the Back of the Chest.

Examination of GIT

● Examine the front of Abdomen.

● Examine of the back of Abdomen.

● General Physical Examination relevant to GI System.

Short cases of musculoskeletal system

● Examination of a joint (shoulder, elbow, wrist, Ankle, Knee, Hip)

● Examination of spine of the patient.

Miscellaneous topics/commands that can be given

● General Physical Examination of patient.

Example of a Case presentation

Command: Examine the Motor System of Lower Limbs

● After listening to this command you’d proceed in following steps.

● Informed Consent

● Proper Exposure

● Observe for posture and obvious wasting.

● Check for muscle tenderness and fasciculation as in upper limb.

● Measure the muscle bulk bilaterally.

● Check tone of the muscles bilaterally.

o At small joints of the foot

o At ankle joint

o At hip joint

● Check power of the muscles. (Ask the patient to raise legs to assess the power.)

o At toes

o Ankle

Dorsiflexion

Plantar flexion

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Inversion

Eversion

o Knee

Flexion

Extension

o Hip

Flexion

Extension

Abduction

Adduction

● Check deep tendon reflexes

o Ankle jerk

o Knee jerk

o Check for the clonus

o Ankle clonus

o Patellar clonus

o Check for the plantar reflex (Babinski sign)

o Perform heel-knee-shin test.

● Ask patient to stand. Look for Romberg’s sign. ● Ask patient to stand from sitting position. (For proximal muscle weakness)

● Ask patient to stand on his toes.

● Ask patient to stand on his heel.

● Ask patient to walk and note his gait.

● Check for vertebral column pathology if weakness found.

● Say thanks to the patient.

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Next step is proper description of all the important findings.Just be

confident, calm and look at examiner to explain your findings.(don’t look at the patient)

“A healthy looking patient is sitting comfortably on bed with IV cannula on left forearm (this sentence varies according to situation).

On examination of lower limbs, there is no obvious posture abnormality, gross wasting or

fasciculation. There is no muscle tenderness and muscle bulk is symmetrically normal on both

sides. Tone is normal in all muscle groups at all joints bilaterally. Tone is normal at all joints and

power is 5/5 in all muscle groups (both proximal and distal) at all joints on both sides. Knee jerk and

ankle jerk are well preserved i.e. grade 2 and no patellar or ankle clonus was elicited. Plantars are

down going on both sides and patient has no heel-shin ataxia. Patient can easily stand from sitting

position and has no obvious gait-abnormality. In summary, normal lower limb examination”. (Description will change according to patient’s disease and findings present.)

Next step is viva. e.g. examiner can ask gradings of power, difference b/w UMNL and LMNL, root

values of reflexes, causes of upgoing planters or whatever he wants to ask according to the patient.

Exercise to assess your understanding.

● If you are asked to examine a coma patient, how will you proceed?

● Make your own checklist for this command.

● Examine sensory system of lower limb.

108

Long Cases

(Total Marks 110)

109

Disclaimer:

Medicine is a very broad field. Any Important Clinical Case according to Curriculum of University of

Health Sciences can be asked in the examination. Some common long cases are discussed below.

Each long case comprises of History Taking, Examination, Enlisting investigations, Differential

Diagnosis and Management Steps. At the end there is viva and discussion.

Important Long cases are:-

1) Cardiovascular System

● CCF (Congestive Cardiac Failure)

● Valvular Heart Diseases

● Rheumatic Fever

● Infective Endocarditis

● Cardiomyopathies

2) Acute & Chronic Kidney Diseases

3) Respiratory System

● COPD (Chronic Obstructive Pulmonary Disease)

● Bronchial Asthma

● Pneumonia

● Adult Respiratory Distress Syndrome

● Interstitial Lung Disease

4) Central Nervous System

● CVA (Cerebrovascular accidents)

● Epilepsy

● Meningitis/Encephalitis

● Guillain Barre Syndrome

● Multiple Sclerosis

● Paraplegia

110

5) Gastrointestinal System & Liver Diseases

● Chronic liver disease and its Complications

● Acute Hepatitis

● Acute/Chronic Pancreatitis

● Upper GI Bleed

● Lower GI Bleed

● Peptic Ulcer Disease

6) Rheumatology

● Rheumatoid Arthritis

● Osteoarthritis

● Septic Arthritis

● Gout

● Osteomyelitis

7) Infectious Diseases

● Chickenpox

● HIV

● Dengue

● Malaria

● Enteric fever

● Meningitis

8) Endocrine system

● Diabetes Mellitus and its Complications

● Hypothyroidism

● Hyperthyroidism

● Addison Disease

● Cushing Syndrome.

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SECTION 5

HISTORY TAKING

112

Case No. 1

Date__________________

Name __________________________ S/D/o ________________________ Age __________

Sex ___________ MaritalStatus _______________ Religion __________________________

Occupation _______________ Hospital Reg. no.____________________ Bed no _________

D.O.A ______________________ N.I.C. No ______________________________________

Address ________________________________________________ via OPD ____________

Emergency _______________ Reference _________________________________________

Presenting Complaints

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History of Present illness

Systemic Inquiry

Normal ___________________ Increased _________________ Decreased _______________

Weight____________________ (Increased__________________ Decreased _______________)

Sleep disturbance: Insomnia ______________________ Somnolence_____________________


114

Systemic Inquiry

General:

Normal ___________________ Increased _________________ Decreased _______________

Weight____________________ (Increased__________________ Decreased _______________)

Sleep disturbance: Insomnia ______________________ Somnolence_____________________

Cvs:

Chest Pain _________________ Compression ____________ Breathlessness _____________

Paroxysmal nocturnal dyspnea ________________________ Orthopnea __________________

Feet Swelling _____________________ Pain in legs on walking _________________________

Palpitation ________________________

Respiratory system:

Cough __________________ Sputum __________________ Hemoptysis _________________

Breathlessness ____________________ wheeze _____________ Rhinitis _________________

Seasonal variation ___________________________ Chest pain __________________________

Headache ___________________ Epistaxis ___________________ Hoarseness ____________

GIT:

Nausea _________________ Vomiting ___________________ Abdominal pain ____________

heart burn _________________________ Dysphagia __________________________________

Altered bowel habits ______________________________ Hematemesis ___________________

Black tarry stools ___________ yellow sclera ___________ abdominal distension ___________

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Urinary System:

Pain _______________ Frequency __________ Urgency white micturition __________________

Hematuria ______________________ Anuria ________________ Polyuria _________________

Oliguria ______________ Passage of gravel in urine _____________ Flank pain _____________

Burning discharge ________________________________________________________________

Nervous System:

Weakness _________________ Numbness __________________ Headache _______________

Vomiting ________________ Giddiness ___________________ Blackouts __________________

Fits ____________ Visual Loss ____________ Diplopia __________ Vertigo _________________

Locomotors System:

Joint pain _____________________ Stiffness ___________________ Swelling _____________

Restriction of movements __________________________________________________________

Skin:

Rash ____________________ Itch ______________________ Pigmentation ________________

Ulcers ____________________ Patchy hair loss _______________________________________

Hematology:

Purpuric rash ________________ bleeding gums ________________ Leg ulcers _____________

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Endocrinology:

Polyuria __________________ Polyphagia _______________ Polydipsia ____________________

Sweating ________________ Heat _______ Cold ________ Wt. gain _______/ Loss ___________

Palpitations _____________________________________________________________________

Explain for any symptom found in the systemic review:

Past History

DM _____________________ Hypertension ___________________ Asthma ______________

Ischemic Heart disease __________________ H/O blood transfusion _____________________

Past Surgical History ____________________________________________________________

Detail if relevant:

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Personal History:

Pt’s socioeconomic status _________________________________________________________

Dietary habits ______________________________ Drug addiction ________________________

Smoking ____________ Age at started ____________ No. of packs/ Cigarettes per day _______

Time at which stopped ( ex-smoker) ____________ Health of wife / husband / children _________

H/O foreign travel ______________ Immunization __________ Allergy to anything ____________

Pets ( if any) ___________________________________ Animal contact ____________________

Occupational History:

Exact nature of present job (Working hours) ______________ past jobs _____________________

Exposure to chemicals / radiations ___________________________________________________

Family History:

Similar disease in the family _________________________ DM ______________ IHD _________

HTN _____________ Hepatitis ____________ Arthritis _____________ Stroke _______________

TB __________ Malignancy _______________ Deaths at early ages in the family ______________

Other __________________________________________________________________________

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Menstrual History:

Age at menarche ___________ Length of cycle _________________ Frequency ______________

Treatment / Drug History:

GENERAL PHYSICAL EXAMINATION:

My _____________________________ Looking Patient _______________________________

in position ____________________ Oriental in time a place with fops _____________________

Cannula on _________________________ having pulse rate of _________________________

pulse is of ________________ Volume _____________________ in rhythm _______________

in character , condition of the vessel is _________ patient is having blood pressure of ________

must temperature ___________________________, Respiratory rate _____________________

pulse Oximetry SaO2 ______________________________________________________________________________________________

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On examination of hands the

● Shape / Size

● Skin + Sweaty / dry / coarse +pigmentation

● Muscle wasting ( atrophy)

● Thenar with Hypothenar examinences

● Planar pallor , palmer erythema , Duputyren’s contracture

● Creases, Grip of the hands Flapping Tremors.

Nails:

● Pallor, Cyanosis

● Koilonychia

● Splinter Hemorrhages

● Pitting of nails Half and Half nails

● Capillary Filling

Fingers:

● Osler’s nodes

● Heberdon’s nodes, Bouchard’s nodes, ● Joint swelling / Deformity(Swan Neck, Button-hole, Z-deformity)

● Arachnodactyly

Face and Neck:

● Puffiness

● Pallor of lower conjunctive

● Yellow discolouration of sclera

● Cyanosis

o Central

o Peripheral

● Rash + Hirsuitism

● Xanthalesmas,

● Exopthalmos / Proptosis

● Parotid glands

120

● Tongue

● Halitosis

● Lymph nodes

● JVP

● Thyroid Gland

● Buffalo hump

● Acanthosis Nigricans

Feet:

● Edema

o Pitting

o Non-Pitting

● Cyanosis, Early signs of peripheral vascular Disease

o Loss of hair

o Shiny skin

Provisional Diagnosis:

Provisional

122

Case No. 2

Date__________________

Name __________________________ S/D/o ________________________ Age __________



D.O.A ______________________ N.I.C. No ______________________________________

Address ________________________________________________ via OPD ____________




123

Systemic Inquiry

General:

CVS:

Respiratory System:

124

GIT:

Urinary System:

Nervous System:

125

Locomotors System:

Skin:

Hematology:

126

Endocrinology:


Past History

127

Detail if relevant

Personal History

Occupational History

128

Family History

Menstrual History

Treatment / Drug History

129

General Physician Examination

Respiratory rate _____________________________ pulse Oximetry SaO2__________________________


Notes:

130

Case No. 3

Date__________________

Name __________________________ S/D/o ________________________ Age __________



D.O.A ______________________ N.I.C. No ______________________________________

Address ________________________________________________ via OPD ____________




131

Systemic Inquiry

General:

CVS:

Respiratory System:

132

GIT:

Urinary System:

Nervous System:

133

Locomotors System:

Skin:

Hematology:

134

Endocrinology:


Past History

135

Detail if relevant

Personal History


136

Family History

Menstrual History


137




Notes:

138

Case No. 4

Date__________________

Name __________________________ S/D/o ________________________ Age __________



D.O.A ______________________ N.I.C. No ______________________________________

Address ________________________________________________ via OPD ____________




139

Systemic Inquiry

General:

CVS:

Respiratory System:

140

GIT:

Urinary System:

Nervous System:

141

Locomotors System:

Skin:

Endocrinology:

142


Past History

Detail if relevant

143

Personal History


Malignancy __________________ Deaths at early ages in the family ______________________

Other _________________________________________________________________________

Menstrual History

144





145

Notes:

146

Case No. 5

Date__________________

Name __________________________ S/D/o ________________________ Age __________



D.O.A ______________________ N.I.C. No ______________________________________

Address ________________________________________________ via OPD ____________




147

Systemic Inquiry

General:

CVS:

Respiratory System:

148

GIT:

Urinary System:

Nervous System:

149

Locomotors System:

Skin:

Hematology:

150

Endocrinology:


Past History

151

Detail if relevant

Personal History


152

Family History

Menstrual History


153




Notes:

154

Case No. 6

Date__________________

Name __________________________ S/D/o ________________________ Age __________



D.O.A ______________________ N.I.C. No ______________________________________

Address ________________________________________________ via OPD ____________




155

Systemic Inquiry

General:

CVS:

Respiratory System:

156

GIT:

Urinary System:

Nervous System:

157

Locomotors System:

Skin:

Hematology:

158

Endocrinology:


Past History

159

Detail if relevant

Personal History


160

Family History

Menstrual History


161




Notes:

162

Case No. 7

Date__________________

Name __________________________ S/D/o ________________________ Age __________



D.O.A ______________________ N.I.C. No ______________________________________

Address ________________________________________________ via OPD ____________




163

Systemic Inquiry

General:

CVS:

Respiratory System:

164

GIT:

Urinary System:

Nervous System:

165

Locomotors System:

Skin:

Hematology:

166

Endocrinology:


Past History

167

Detail if relevant

Personal History


168

Family History

Menstrual History


169



Notes:

170

Case No. 8

Date__________________

Name __________________________ S/D/o ________________________ Age __________



D.O.A ______________________ N.I.C. No ______________________________________

Address ________________________________________________ via OPD ____________




171

Systemic Inquiry

General:

CVS:

Respiratory System:

172

GIT:

Urinary System:

Nervous System:

173

Locomotors System:

Skin:

Hematology:

174

Endocrinology:


Past History

175

Detail if relevant

Personal History


176

Family History

Menstrual History


177




Notes:

178

Case No. 9

Date__________________

Name __________________________ S/D/o ________________________ Age __________



D.O.A ______________________ N.I.C. No ______________________________________

Address ________________________________________________ via OPD ____________




179

Systemic Inquiry

General:

CVS:

Respiratory System:

180

GIT:

Urinary System:

Nervous System:

181

Locomotors System:

Skin:

Hematology:

182

Endocrinology:


Past History

183

Detail if relevant

Personal History


184

Family History

Menstrual History


185




Notes:

186

Case No. 10

Date__________________

Name __________________________ S/D/o ________________________ Age __________



D.O.A ______________________ N.I.C. No ______________________________________

Address ________________________________________________ via OPD ____________




187

Systemic Inquiry

General:

CVS:

Respiratory System:

188

GIT:

Urinary System:

Nervous System:

189

Locomotors System:

Skin:

Hematology:

190

Endocrinology:


Past History

191

Detail if relevant

Personal History


192

Family History

Menstrual History


193



Notes:

194

Students’ Notes:

Students’ Notes

195

Students’ Notes

196

Students’ Notes

197

Students’ Notes

198

Students’ Notes

199

Students’ Notes

200

Students’ Notes

201

Students’ Notes

202

Students’ Notes

203

Section 6

204

Attendance and Performance evaluation

Sr..No. Date Topic Place Tutor’s Sign

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

205

23

24

25

26

27

28

29

30

206

PERFORMA FOR EXTRA CURRICULAR ACTIVITIES

Sr..No. Activity Distinction / Medal Participation

1 Event Organization/ management

2 Sport/ Extracurricular

3 Debates / Literary activity

4 Editorial

5 Writing (Scientific / Research)

6 Elective/ Internship

( Mention department)

7 Medical camp / Voluntary work

8 Charity / Fund raising

9 CPR Workshop

10 Certificate of Blood Donation

11 Any Other

207

Class Room Activity

Presentation/Group Discussion/CPC Presentation/Assignment)

Sr..No. Topic Date Signature

1

2

3

4

5

6

7

8

9

10

208

SECTION 7

Academic Year Calendar

Prescription Writing

Scenarios

209

3rd Year Lecture Schedule and Distribution of Topics

Wednesday 12:15 – 1:00am

Topic Friday

10:00 – 10:45am Topic

1. 20-11-2019 Spot Diagnosis

Med

ical U

nit I

1 22-11-2019 Spot Diagnosis

Med

ical U

nit I

3. 27-11-2019 Approach to Chest Pain

2 29-11-2019 Approach to Chest Pain

4. 04-12-2019 Spot Diagnosis

3 06-12-2019 Spot Diagnosis

4. 11-12-2019 Spot Diagnosis 4 13-12-2019 Spot Diagnosis

Winter Vacation

(18-12-19 to 25-12-19)

Winter Vacation (18-12-19 to

25-12-19)

5. 01-01-2020 Test 5 27-12-2019 Approach to Headache

6. 08-01-2020 Approach to Fever 6 03-01-2020 Approach to Fever

7. 15-01-2020 Approach to Pyrexia of Unknown Origin

7 10-01-2020 Approach to Fever with Rash

8 17-01-2020 Test

8. 22-01-2020 Approach to Backache

Med

ical U

nit II

9. 24-01-2020 Approach to Abdominal Pain

Med

ical U

nit II

9. 29-01-2020 Approach to Syncope 10. 31-01-2020 Test

10. 05-02-2020 Approach to Diarrhea 11. 07-02-2020 Approach to Diarrhea

11. 12-02-2020 Approach to Vomiting 12. 14-02-2020 Approach to Vomiting

12. 19-02-2020 Approach to Confusion and Delirium

13. 21-02-2020 Approach to Confusion and Delirium

13. 26-02-2020 Test

14. 04-03-2020 Approach to Upper GI Bleeding

Med

ical U

nit III

14. 28-02-2020 Approach to Upper GI Bleeding

Med

ical U

nit III

15. 11-03-2020 Approach to Lower GI Bleeding

15. 06-03-2020 Approach to Lower GI Bleeding

16. 18-03-2020 Approach to Jaundice 16. 13-03-2020 Approach to Jaundice

17. 20-03-2020 Test

210

17. 25-03-2020 Approach to Anemia

Med

ical U

nit IV

18. 27-03-2020 Approach to Anemia

Med

ical U

nit IV

18. 01-04-2020 Approach to Cough and Haemoptysis

19. 03-04-2020 Approach to Cough and Haemoptysis

19. 08-04-2020 Approach to Edema 20. 10-04-2020 Approach to Edema

20. 15-04-2020 Approach to Bleeding Tendencies

21. 17-04-2020 Approach to Palpitations

21. 22-04-2020 Approach to Enlarged Lymph nodes

22. 24-04-2020 Test

22. 29-04-2020 Approach to Seizures

Me

dic

al U

nit V

23. 01-05-2020 Approach to Focal Weakness

Me

dic

al U

nit V

23. 06-05-2020 Approach to Dementia 24. 08-05-2020 Approach to Dizziness and Vertigo

24. 13-05-2020 Test

Note: Winter Vacations (18-12-2019 to 25-12-2019)

Spring Vacations (17-05-2020 to 25-05-2020)

Summer Vacations (14-06-2020 to 12-07-2020)

211

TIME TABLE FOR 3RD

YEAR MBBS CLASS SESSION 2019-2020 STARTED FROM 18-11-2019

DAY 08:00 – 10:00

10:00 –

10:40

10:40 – 11:20

11:20 –

11:40

11:40 – 12:20

12:20 –

01:00

1:00 – 02:30

Monday

PHARMA/FORENSIC

LECTURE &

ASSESSMENT

FORENSIC

MEDICINE PHARMACOLOGY

SELF

STUDY

TIME

PATHOLOGY

Beh.

Sciences PRACTICAL

Tuesday

WARD

Surgery PRACTICAL

Wednesday Medicine PRACTICAL

Thursday Surgery PRACTICAL

Friday WARD MEDICINE PRACTICAL

Saturday

ENT

08:00 –

09:00am

EYE

09:00 –

10:00am

FORENSIC

MEDICINE PHARMACOLOGY

SELF

STUDY

TIME

PATHOLOGY

Beh.

Sciences PRACTICAL

212

WARD PROGRAMME

WARDS

18.11.2019

to

26.01.2020

27.01.2020 to

03.04.2020

04.04.2020 to

13.06.2020 WARDS

18.11.2019

to

26.01.2020

27.01.2020 to

03.04.2020

04.04.2020 to

13.06.2020

Surgical – I A-1 B-1 C-1 Medical -I B-1 C-1 A-1

Surgical – II A-2 B-2 C-2 Medical

Unit-II B-2 C-2 A-2

Surgical –

III A-3 B-3 C-3 Medical - III B-3 C-3 A-3

WARDS

18.11.2019

to

10.12.2019

11.12.2019 to

07.01.2020

08.01.2020 to

26.01.2020 WARDS

27.01.2020

to

16.02.2020

17.02.2020 to

11.03.2020

12.03.2020 to

31.03.2020

E.N.T C-3 C-1 C-2 E.N.T A-3 A-1 A-2

Eye C-2 C-3 C-1 Eye A-2 A-3 A-1

Beh.

Sciences C-1 C-2 C-3

Beh.

Sciences A-1 A-2 A-3

WARDS

09.04.2020

to

29.04.2020

30.04.2020 to

16.05.2020

26.05.2020 to

13.06.2020

E.N.T B-3 B-1 B-2

Eye B-2 B-3 B-1

Beh.

Sciences B-1 B-2 B-3

213

BATCHES FOR MEDICINE, SURGERY, ENT, EYE AND BEH.

SCIENCES PROGRAMME

Ba

tche

s

A-1

A

-2

A-

3

B-

1

B-2

B

-3

C-

1

C

-2

C

-3

Roll N

os.

1-36,

43,114,

279

3

7-

42,

44-

79

80-

113,

115-

117

11

8-65,

188

167

-187,

189-

205

2

06-

245

24

6-

278,

280-

287

2

88-

330

3

31-

376




214

Third year curriculum for wards 2019-20

DAYS TOPIC

CLINICAL CLASSES 8-10AM

TUESDAY TO FRIDAY NAME OF TEACHERS

Class Room

Activity Not

More Than 30

Min For

History &

Knowledge

Transfer

Bed Side Techniques

& Skills

MU-I

MU-II

MU-III

Tuesday

19-11-19 CVS

History taking

with

reference to

CVS

History taking by the

students + interactive

session

Dr.

Usman Dr. Arif

Dr.

Salman

Shakoor

Wednesday

20-11-19

Respiratory

System

History taking

with

reference to

Respiratory

History taking +

interactive session

Dr.

Abbas

Dr. M.

Irfan

Dr.

Jamshaid

Thursday

21-11-19 CNS

History taking

with

reference to

CNS system

Assessment of

Conscious level

Eliciting and

recognition of signs

Of meningeal

irritation (20mint)

done in class

rehearsal in group of

2 then involved

Dr.

Javed

Iqbal

Dr. M

Shahzad

Dr.

Maroof

Friday

22-11-19 GIT

History taking

with

reference to

GIT

History taking +

interactive session

Dr.

Owais

Dr.

Umair

Dr.

Zakria

Tuesday

26-11-19 CVS

History taking

with

reference to

CVS

Positioning the Pt +

general appearance

Dr.

Usman Dr. Arif

Dr.

Salman

Shakoor

Wednesday

27-11-19

Respiratory

System

History taking

with

reference to

Respiratory


general appearance

Dr.

Abbas

Dr. M.

Irfan

Dr.

Jamshaid

Thursday

28-11-19 CNS

History taking

with

Examination of

cranial nerves

Dr.

Javed

Dr. M

Shahzad

Dr.

Maroof

215

reference to

CNS system

1. I 2. II 3. III 4. IV 5. VI

Finish in20mint,

includes 20min

rehearsal on hands &

then 20 mint in ward.

Iqbal

Friday

29-11-19 GIT

History taking

with

reference to

GIT


general appearance

Dr.

Owais

Dr.

Umair

Dr.

Zakria

Tuesday

03-12-19 CVS

History taking

with

reference to

CVS

Pulse, BP

measurement, JVP

examination

Dr.

Usman Dr. Arif

Dr.

Salman

Shakoor

Wednesday

04-12-19

Respiratory

System

History taking

with

reference to

Respiratory

Differential diagnosis

of respiratory

symptoms on

bedside

Dr.

Abbas

Dr. M.

Irfan

Dr.

Jamshaid

Thursday

05-12-19 CNS

History taking

with

reference to

CNS system

Examination of

cranial nerves

1. V 2. VII 3. VIII

Finish in20mint,

includes 20min

rehearsal on hands &

then 20 mint in ward.

Dr.

Javed

Iqbal

Dr. M

Shahzad

Dr.

Maroof

Friday

06-12-19 GIT

History taking

with

reference to

GIT

Systemic

Examination related

to GIT

Dr.

Owais

Dr.

Umair

Dr.

Zakria

Tuesday

10-12-19 CVS

History taking

with

reference to

CVS

General Physical

examination

Dr.

Usman Dr. Arif

Dr.

Salman

Shakoor

Wednesday

11-12-19

Respiratory

System

History taking

with

reference to

General Physical

Examination related

to Respiratory.

Dr.

Abbas

Dr. M.

Irfan

Dr.

Jamshaid

216

Respiratory

Thursday

12-12-19 CNS

History taking

with

reference to

CNS system

Examination by the

students

IXIX,XI,XII Nerves

Performed by trainer,

rehearsal

in group of two, finish

in 20

min and 20 min in

ward

Dr.

Javed

Iqbal

Dr. M

Shahzad

Dr.

Maroof

Friday

13-12-19 GIT

History taking

with

reference to

GIT

General physical

Examination

related to GIT

Dr.

Owais

Dr.

Umair

Dr.

Zakria

Tuesday

17-12-19 CVS

History taking

with

reference to

CVS

Palpation of

precordium

Dr.

Usman Dr. Arif

Dr.

Salman

Shakoor

Winter Vacations (18-12-2019 to 25-12-2019)

Wednesday

Holiday

Respiratory

System

History taking

with

reference to

Respiratory

Inspection/Palpation

(Front / Back)

Dr.

Abbas

Dr. M.

Irfan

Dr.

Jamshaid

Thursday

26-12-19 CNS

History taking

with

reference to

CNS system

Motor System (Upper

limb)+ cerebellum

Performed by trainer

Rehearsal in group

of two, finish

in 20 min and 20 min

in ward

Dr.

Javed

Iqbal

Dr. M

Shahzad

Dr.

Maroof

Friday

27-12-19 GIT

History taking

with

reference to

GIT

Inspection of

abdomen

Dr.

Owais

Dr.

Umair

Dr.

Zakria

Tuesday

31-12-19 CVS

Systemic

Examination related

To CVS/Auscultation

of Precordium

Dr.

Usman Dr. Arif

Dr.

Salman

Shakoor

Wednesday Respiratory Percussion Dr. Dr. M. Dr.

217

01-01-2020 System (Front/Back) Abbas Irfan Jamshaid

Thursday

02-01-20 CNS

Motor System (Lower

limbs)+cerebellum ,

gait


Rehearsal in group

of two, finish


in ward

Dr.

Javed

Iqbal

Dr. M

Shahzad

Dr.

Maroof

Friday

03-01-20 GIT

Superficial and

deeply Palpation,

visceral palpation.

Dr.

Owais

Dr.

Umair

Dr.

Zakria

Tuesday

07-01-20 CVS Auscultation

Dr.

Usman Dr. Arif

Dr.

Salman

Shakoor

Wednesday

08-01-20

Respiratory

System

Examination of

muslkloskeletal

system

Dr.

Abbas

Dr. M.

Irfan

Dr.

Jamshaid

Thursday

09-01-20 CNS

Sensory system

Demonstration of

dermatomes


Rehearsal in group

of two, finish


in ward

Dr.

Javed

Iqbal

Dr. M

Shahzad

Dr.

Maroof

Friday

10-01-20 GIT

Visceral palpation

+causes of

Hepatosplenomegaly

Dr.

Owais

Dr.

Umair

Dr.

Zakria

Tuesday

14-01-20 CVS

Investigations

related to

CVS

Inspection

Palpation

Percussion,

auscultation

Dr.

Usman Dr. Arif

Dr.

Salman

Shakoor

Wednesday

15-01-20

Respiratory

System

Percussion,

auscultation of

abdomen and

genitourinary system

Dr.

Abbas

Dr. M.

Irfan

Dr.

Jamshaid

Thursday

16-01-20 CNS

Cerebral examination


Rehearsal in group

of two, finish

Dr.

Javed

Iqbal

Dr. M

Shahzad

Dr.

Maroof

218


in ward

Friday

17-01-20 GIT

Discussion of

investigations

related to GIT

Dr.

Owais

Dr.

Umair

Dr.

Zakria

Tuesday

21-01-20 CVS

POSITIONING

GPE

Inspection

Palpation

Percussion

auscultation

Dr.

Usman Dr. Arif

Dr.

Salman

Shakoor

Wednesday

22-01-20

Respiratory

System

POSITIONING

GPE

Inspection

Palpation

Percussion

auscultation

Dr.

Abbas

Dr. M.

Irfan

Dr.

Jamshaid

Thursday

23-01-20 CNS

CNS Examination

Dr.

Javed

Iqbal

Dr. M

Shahzad

Dr.

Maroof

Friday

24-01-20 GIT

Positioning

GPE

Inspection

Palpation

Percussion

auscultation

Dr.

Owais

Dr.

Umair

Dr.

Zakria

Tuesday

25-01-20 CVS Test Test

Dr.

Usman Dr. Arif

Dr.

Salman

Shakoor

Wednesday

26-01-20

Respiratory

System Test Test

Dr.

Abbas

Dr. M.

Irfan

Dr.

Jamshaid

Thursday

27-01-20 CNS Test Test

Dr.

Javed

Iqbal

Dr. M

Shahzad

Dr.

Maroof

Friday

28-01-20 GIT Test GIT Test

Dr.

Owais

Dr.

Umair

Dr.

Zakria

219

4TH Year Revised Distribution of Topics

and Lecture Schedule2019-2020

Unit Topic

Medical Unit I

Medical Unit II

Medical Unit IV

Month Monday

08:45 AM to 09:30 AM Lectures to be delivered by

Sign.

Unit

December 2019

09 ACS

Dr. Ghulam Abbas

Med

ical U

nit I

16 ACS + Hypertension

Dr. Ghulam Abbas

Winter Vacation (18-12-19 to 25-12-19)

30 Hypertension

Dr. Ghulam Abbas

January 2020

06 Infective endocarditis

Prof. Dr Ahmed Bilal Dr.

AtaurRehman

13 Rheumatic Heart Disease

Dr. Ata ur Rehman

20 COPD

Dr. Ghulam Abbas

27 Asthma

Dr. Usman Musharraf

February

03-08

ASSESSMENT WEEK

Med

ical U

nit II

10 Iron deficiency Anemia

17 Megaloblastic Anemia

24 A plastic Anemia

220

March

02 Acute Leukemia + Chronic Leukemia

09 IBD/Malabsorption

16 Hepatitis

23 Hepatic Failure

30 Hypothyroid

April

06-11 TENTATIVE ASSESSMENT WEEK

12 Hyperthyroid

20 Hypo/Hyper parathyroidism

27 Acute Renal Failure

May

04 Chronic Renal Failure

11 Rheumatoid arthritis

Spring Vacation (17-05-2020 to 25-05-2020)

June

01-06 TENTATIVE ASSESSMENT WEEK

08 Osteomalacia, Rickets, Paget Disease

15 Summer Vacations

Su

mm

er

Vac

atio

ns

(14-0

6-2

020 to

12

-

07-2

020)

22 Summer Vacations

29 Summer Vacations

July

06 Summer Vacations

13 Mixed C.T disorders

Med

ical

Un

it IV

20 SLE

27

221

Seronegative Spondyloarthropathies

August

03 Fibromyalgia / Systemic Sclerosis

10 Bone & Joint Infection

Behcet’s Disease /Cryglobulinemia

17 Dermatomyosits/Polymyositis/Sjogren

Syndrome

24

31




222

WARD PROGRAMME FOR 4TH YEAR SESSION 2019-2020

MEDICINE (Including Cardiology AHF and Nephrology AHF)

Batch A (09-12-19 TO 08-02-20)

WARD 09-12-19 to

16-12-19

17-12-19

to 28-12-19

29-12-19

to 03-01-19

04-01-20

to 11-04-20

13-01-20

to 18-01-20

20-01-20

to 25-01-20

27-01-20

to 01-02-20

02-02-20

to 08-02-20

M-IV A-1 A-3 A-4 A-2

M-V A-3 A-1 A-2 A-4

Cardio A-3 A-1 A-2 A-4

Nephro A-3 A-1 A-2 A-4

Batch B (10-02-20 TO 04-04-20)

WARD 10-02-20 to

15-02-20

17-02-20

to 22-02-20

24-02-20

to 29-02-20

02-03-20

to 07-03-20

09-03-20

to 14-09-20

16-03-20

to 21-03-20

23-03-20

to 28-03-20

30-03-20

to 04-04-20

M-IV B-3 B-1 B-4 B-2

M-V B-1 B-3 B-2 B-4

Cardio B-1 B-3 B-2 B-4

Nephro B-1 B-3 B-2 B-4

Batch C (06-04-20 TO 13-06-20)

WARD 06-04-20 to

11-04-20

13-04-20

to 18-04-20

20-04-20

to 25-04-20

27-04-20

to 02-05-20

04-05-20

to 09-05-20

11-05-20

to 26-05-20

27-05-20

to 04-06-20

05-06-20

to 13-06-20

M-IV C-3 C-1 C-4 C-2

M-V C-1 C-3 C-2 C-4

Cardio C-1 C-3 C-2 C-4

Nephro C-1 C-3 C-2 C-4

D (13-07-20 TO 05-09-20)

WARD 13-07-20 to

18-07-20

20-07-20

to 25-07-20

27-07-20

to 03-08-20

04-08-20

to 08-08-20

10-08-20

to 15-08-20

17-08-20

to 22-08-20

24-08-20

to 29-08-20

31-08-20

to 05-09-20

M-IV D-3 D-1 D-4 D-2

M-V D-1 D-3 D-2 D-4

Cardio D-1 D-3 D-2 D-4

Nephro D-1 D-3 D-2 D-4

223

Pulmonology / Dermatology / Psychiatry/ C. Medicine

TWO WEEKS ROTATION

Batch C D

WARD 09-12-19

To

28-12-19

30-12-19

To

11-01-20

13-01-20

To

25-01-20

27-01-20

To

08-02-20

10-02-20

To

22-02-20

24-02-20

To

07-03-20

09-03-20

To

21-03-20

23-03-20

To

04-04-20

Pulmonology C-4 C-1 C-2 C-3 D-4 D-1 D-2 D-3

Dermatology C-3 C-4 C-1 C-2 D-3 D-4 D-1 D-2

Psychiatry C-2 C-3 C-4 C-1 D-2 D-3 D-4 D-1

C.Med: C-1 C-2 C-3 C-4 D-1 D-2 D-3 D-4

Batch A B

WARD

06-04-20

To

18-04-20

20-04-20

To

02-05-20

04-05-20

To

16-05-20

28-05-20

To

13-06-20

13-07-20

To

25-07-20

27-07-20

To

08-08-20

10-08-20

To

22-08-20

24-8-20

To

05-09-20

Pulmonology A-4 A-1 A-2 A-3 B-4 B-1 B-2 B-3

Dermatology A-3 A-4 A-1 A-2 B-3 B-4 B-1 B-2

Psychiatry A-2 A-3 A-4 A-1 B-2 B-3 B-4 B-1

C.Med: A-1 A-2 A-3 A-4 B-1 B-2 B-3 B-4

224

BATCHES FOR WARD PROGRAMME

Batc

hes

A-1 A-2 A-3 A-4 B-1 B-2 B-3 B-4

Roll

Nos.

1-20,

22,23

24-38, 40-46

47-

68

69-74, 76-88,

90, 92,93

94-96,98,

100,101,102, 104-

118

120,

123-143

144,145,

147-150

152-167

168-182

184-190

Batches C-1 C-2 C-3 C-4 D-1 D-2 D3 D-4

Roll

Nos.

192,193

195-211

213-215

216-

237 238-259

183, 260-262,

264,266, 268-275,

277-280,285-288,290

291-301

303-309

311-314

315,317-321,

323,324,326-331,

333-338, 340,341

342,

344-355

358-368

369-393

225

FAISALABAD MEDICAL UNIVERSITY

4TH YEAR MBBS CALENDER

FIRST TERM (9TH DECEMBER 2019 – 8TH FEBRUARY 2020)

Subject/ Topics

1st

Week 09-14-Dec

2nd

Week 8-25 Dec

3rd

Week 16-17-Dec 26-29-Dec

4th

Week 30-Dec

– 04-Jan

5th & 6

th

Week 06-18-Jan

2020

7th

Week 20-25-Jan

8th

Week 27-Jan

– 1-Feb

9th

Week 3-8-Feb

Clinico – Pathological

basics of Dieseases

Blood Vessel Diseases

WIN

TE

R B

RE

AK

Cardiac Pathologies Respiratory Pathologies

CNS Pathologies

Breast Tumors

AS

SE

SS

ME

NT

WE

EK

Ophthalmic Medicine &

Surgery

Retinal Vascular Diseases

Retinal Vasuclar

Dieseases IOP and Glaucoma

Pallledema Optic Atrophy

Retinoblastoma

Otorhinolaryngology

Ear Anatomy Ear

Physiology Diseases

of Ear

Hearing Loss

Deaf Child

Vertigo Otosclerosis

Ear Tumors Otalgin

Community Medicine

Epidemiology & Research

Epidemiology &

Research

Health & Diseases

Medical Statistics

Nutrition

CPC SCHEDULE Community Medicine field trips will be on (Thursday) 23

rd Jan 2020

and 27th

Feb 2020 Assessment will consist of written papers based on the pattern of University Professional examinations. Topics of Medicine will be included in Ophthalmology Paper Topics of Surgery will be included in ENT paper.

ASSESSMENT WEEK

12-Dec-19 Pathology 03-02-2020 Monday

Pathology

26-Dec-19 Eye 04-02-2020 TUESDAY

Self-study / Library

02-Jan-20 ENT 05-02-2020 WEDNESDAY

Community Medicine

09-Jan-20 Community 06-02-2020 THURSDAY

Self-study / Library

07-02-2020 FRIDAY

Eye

08-02-2020 SATURDAY

ENT

LECTURE TIME TABLE FOR FINAL YEAR MBBS CLASS

SESSION 2019-2020 STARTED W.E.F 30-12-2019

226

S.

NO. SUBJECT MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY REMARKS

1 Medicine

Lecture

08:00 to

08:45am

08:45 to

09:30am

09:30 to

10:15am

M-5

08:00 to

08:45am

08:45 to

09:30am

09:30 to

10:15am

M-4

08:00 to

08:45am

08:45 to

09:30am

09:30 to

10:15am

M-2

08:00 to

08:45am

08:45 to

09:30am

09:30 to

10:15am

M-3

08:00 to

08:45am

08:45 to

09:30am

09:30 to

10:15am

M-1

Medicine

Test

and

Assessment

08:00 to

10:15

2 Surgery

Lecture

12:00 to

02:00

12:00 to

02:00

12:00 to

02:00

12:00 to

02:00

12:00 to

02:00

3 Gynaecology

& Obst.

08:00 to

10:15

08:00 to

10:15

08:00 to

10:15

08:00 to

10:15

08:00

to

10:15

08:00 to

10:15

4 Paediatrics

Lecture

08:00 to

10:15

08:00 to

10:15

08:00 to

10:15

08:00 to

10:15

08:00

to

10:00

(SDL in

ward)

08:00 to

10:00

(Written

Assessment)

10:00 to

02:00

Assessment

in ward)

5 Psychiatry

Lecture

01:30 to

02:00

01:30 to

02:00

01:30 to

02:00

01:30 to

02:00

01:30 to

02:00

30-12-20

to

13-01-20

6 Dermatology

Lecture

01:30 to

02:00

01:30 to

02:00

01:30 to

02:00

01:30 to

02:00

01:30 to

02:00

14-01-20

to

27-01-20

7 In/Out Door

Patients

10:30 to

01:15

10:30 to

01:15

10:30 to

01:15

10:30 to

01:15

10:30

to

01:15

10:30 to

01:15

Self Study Time: 10:15am to 10:30am & 02:00pm to 2:30pm

Evening Ward Class: 3pm to 8pm

Note: Spring Vacations (17-05-2020 to 25-05-2020)


227

Final Year Lecture and Topic Distribution for Medicine

1st

Week 30-12-19

to

04-01-20

Monday

M-5

1

Type 1

Diabetes

2

Treatment of

Type I DM

3

Hyper Osmolar

State

DKA

Psychiatry

01:30 to 02:00pm 2:00-230pm

Self Study Time

Tuesday

M-4

Type 2

Diabetes

Treatment of

Type II DM

Diabetic

Nephropathy

Psychiatry

01:30 to 02:00pm

WEDNESD

AY

Neuro

Departme

nt

NEUROLOGY NEUROLOGY NEUROLOGY Psychiatry

01:30 to 02:00pm

THURSDA

Y

Neuro

Departme

nt

NEUROLOGY NEUROLOGY NEUROLOGY Psychiatry

01:30 to 02:00pm

FRIDAY

Neuro

Departme

nt

NEUROLOGY NEUROLOGY NEUROLOGY

Saturday ALUMNI

DAY

2nd

Week 06-01-20

to

11-01-20

Monday

M-5

Complications

of DM other

than

Nephropathy

Dyslipidemias

Management

of

Dyslipidemias

Psychiatry

01:30 to 02:00pm 2:00-230pm

Self Study Time

228

Tuesday

M-4

Investigations

in

cardiovascular

diseases.

Hypertension

Hypertension

Psychiatry

01:30 to 02:00pm

Wednesda

y

M-2

MS MR Atrial

Fibrilation

Psychiatry

01:30 to 02:00pm

Thursday

M-3

Infective

Endocarditis

Pericardial

Disease

Cardiomyopathi

es / Myocarditis

Psychiatry

01:30 to 02:00pm

Friday

M-1 ACS ACS RHD

Saturday

Medicine Test

Saturday

11-01-20

08:15 to 10:15

Psychiatry

01:30 to 02:00pm

3rd

Week 13-01-20

to

18-01-20

Monday

M-5

Cardiomyopat

hies /

Myocarditis

Heart Failure

SVT/ VT/VF

Test Psychiatry

01:30 to 02:00pm

2:00-230pm

Self Study Time

Tuesday

M-4

Peripheral

Vascular

Disease /

Aortic

Dissection/

Aortic

Aneurysm

AS AR Dermatology

01:30 to 02:00pm

Wednesda

y

M-2

Hemolytic

Anemia, Blood

Group and

Blood

Transfusions

Bone Marrow

Transplant

Hemolytic

Anemia, Blood

Group and

Blood

Transfusions

Bone Marrow

Transplant

ANEMIA OF

CHRONIC

DISEASE

Dermatology

01:30 to 02:00pm

Thursday

M-3

Lymphomas

Lymphomas

MYELOPROLIFE

RATIVE

DISORDERS

Dermatology

01:30 to 02:00pm

Friday

M-1

Iron

Deficiency

Anemia

Megaloblastic

Anemia

Aplastic

Anemia

Dermatology

01:30 to 02:00pm

229

Saturday

Medicine Test

Saturday

18-01-20

08:15 to 10:15

Dermatology

01:30 to 02:00pm

4th

Week 20-01-20

to

25-01-20

Monday

M-5

Hemoglobinpat

hies, Venous

Thrombosis,

Pulmonary

Embolism

Anticoagulants

Therapy ,

Heparin, Oral

(warfarin) Vit K,

Antiplatlets .

Hemoglobinpathi

es, Venous

Thrombosis,

Pulmonary

Embolism

Anticoagulants

Therapy ,

Heparin, Oral

(warfarin) Vit K,

Antiplatlets .

Hemoglobinpat

hies, Venous

Thrombosis,

Pulmonary

Embolism

Anticoagulants

Therapy ,

Heparin, Oral

(warfarin) Vit K,

Antiplatlets .

Dermatology

01:30 to 02:00pm

2:00-230pm

Self Study Time

Tuesday

M-4

Multiple

Myeloma, ITP

Paraproteine

mia

Disorders Of

Coagulaton ITP

Thromohilias

Dermatology

01:30 to 02:00pm

Wednesda

y

M-2

Acute

Leukemia

Chronic

Leukemia

Other

Haematological

Malignancies

Dermatology

01:30 to 02:00pm

Thursday

M-3

Investigations

in Respiratory

Illness

Pneumonia

Pneumonia

Dermatology

01:30 to 02:00pm

Friday

M-1

ASTHMA &

ARDS

ASTHMA &

ARDS

COPD

Saturday

Medicine Test

Saturday

25-01-20

08:15 to 10:15

Dermatology

01:30 to 02:00pm

5th

Week 27-01-20

to

01-02-20

230

Monday

M-5

Fungal

Infections and

ABPA

Interstitial lung

Disease

Sarcoidosis

Occupational

lung Disease

Test Dermatology

01:30 to 02:00pm

2:00-230pm

Self Study Time

Tuesday

M-4

Pleural

Disease , Dry

Pleurisy,

Empyema,

Pneumothora

x

Pleural Disease

, Dry Pleurisy,

Empyema,

Pneumothorax

Tumors of the

Lung and

Respiratory

Tract

Wednesda

y

M-2

Pulmonary TB

Bronchiec

tasis

Pulmonary

Eosiniphilia,

Pulmonary

Vasculitis

Thursday

M-3

Cholestatic Liver

Disease

Primary

Billiary

Cirrhosis

Primary

Sclerosing

Colangitis

Friday

M-1

Hepatitis A,,B,C,D,E

Hepatitis

A,,B,C,D,E

Acute Liver

Failure

Saturday

Medicine Test

Saturday

01-02-20

08:15 to 10:15

6th

Week 03-02-20

to

08-02-20

Monday

M-5

Liver Abscess

Drug Induced Liver

Injury

Approach

to

Dysphagia

,

Malabsor

btion

causing

Disorder

Approach to

Jaundice

2:00-230pm

Self Study Time

Tuesday

M-4

Wilsons Disease

Hemochromatosis

Alpha 1 Antitrypsin

Deficiency

Irritable

Bowel

Syndrome

Ischemic Gut

Injury

Wednesda

y KASHMIR DAY

231

M-2

Thursday

M-3

Hepatoma

Acid Peptic Disease

Non Ulcer Dyspepsia

Oesophageal

Motility Disorder

GERD

Friday

M-1

Autoimmune Hepatitis

Cirrhosis and

Complications

Cirrhosis and

Complications

Saturday

Medicine Test

Saturday

08-02-20

08:15 to 10:15

7th

Week 10-02-20

to

15-02-20

Monday

M-5

Acute and Chronic

Pancreatitis

Approach to

Diarrhea

Inflammatory Bowel

GI MALIGNANCIES 2:00-230pm

Self Study Time

Tuesday

M-4

Hypoparathyroidism

HyperParathyroidism

Autoimmune

Thyroid Disease

Transient Thyroiditis

Iodine Associated

Thyroid Disease

Wednesda

y

M-2

Anterior Pituitary,

Growth Hormone

Disorders

Acromegaly

Gigantism, Short

Stature

infertility

Diseases Of

Hypothalamus and

Posterior Pituitary

Diabetes Incipedous

SIADH

Thursday

M-3 Addison Disease

Cushing Syndrome

Congenital Adrenal

Hyperplasia

Cushing Syndrome

Congenital Adrenal

Hyperplasia

Friday

M-1

Primary and

Secondary

Hyperaldosteronism

Hyperthyroidism

Hypothyroidism

Saturday

Medicine Test

Saturday

15-02-20

08:15 to 10:15

8th

Week 17-02-20

232

to

22-02-20

Monday

M-5

Pheochromocytoma

Polycystic Ovarian

Syndrome

Turner Syndrome

Klienfilter Syndrome

MEN 1

MEN 2

Polyglandular

Symdrome

2:00-2:30pm

Self Study Time

Tuesday

M-4

08:00 -2:00

Clinical Indoor

Classes

08:00 -2:00

Clinical Indoor

Classes

08:00 -2:00

Clinical Indoor

Classes

Wednesda

y

M-2

08:00 -2:00

Clinical Indoor

Classes

Thursday

M-3

08:00 -2:00

Clinical Indoor

Classes

Friday

M-1

08:00 -2:00

Clinical Indoor

Classes

Saturday

Medicine Test

Saturday

22-02-20

08:15 to 10:15

9th

Week 24-02-20

to

29-02-20

10th

Week 02-03-20 to

07-03-20

11th

Week 09-03-20 to

14-03-20

ASSESSMENT WEEKS

233

PRACTICAL PROCEDURES FOR FINAL YEAR

Roll No. ----------- Batch: -------- Year: ----------- Session: ----------

Sr.

#. Practical Procedures for Final Year

Name &

Designation of

Supervisor

Signature Date &

Time

1.

How to check patient vitals(Pulse,

B.P, Temperature, Respiratory

Rate)

2. How to pass a nasogastric tube

3. How to pass a Foley catheter

4. How to give Intramuscular

injection

5. How to give Intravascular injection

6. How to pass an I/V cannula

7. How to observe passing & care of

CVP line /double lumen line

8. How to give insulin injection

9. Preparation & regulation of

Ionotropic Support

10. Observe and assist how to do a

lumbar puncture


diagnostic ascitic tap


diagnostic pleural tap

13.

Observe how to do a

Cardiopulmonary Resuscitation in

emergency and be a part of CPR

Team

14. Observe how to pass Endotracheal

tube in unconscious patient

15. How to take a blood sample

16. How to pass an airway

17. Care of unconscious patient for

06 hours

18. How to do suction

234

19. Nebulization

20. How to use Gluco meter &

checking of RBS

21. How to do ECG

22. How to check O2 saturation by

Pulse oximeter

23. How to use Vein Detector

24.

Workshop for self protection

(Needle stick injury, HIV, Congo

virus, Bird Flu, Tuberclosis, Ebola

Virus, Self needle disposal)

(HIV can be transmitted through

polythene gloves)

25.

Workshop for infusion protocol

(Streptokinase, MgSO4,

Solumedrol, Insulin, Labetolol,

Nitrate, Na Nitroprusside,

Hydralazine)

26. How to give IM Inj. Benzathine

Penicillin

235

FEED BACK

● What was atmosphere in Medical unit?

● What was best thing in Medical unit ?

● What was worst thing in Medical unit ?

● Is evening classes are beneficial and which extent?

● Any improvement, which can be made/Suggestion?

236

FIRST WEEK (CVS)

DISCUSSION CLASS

Timing (10:30am to 11:15am)

ECG:

1. Basic Principals of ECG

2. Reading a normal ECG

3. Tachyarrhythmia, Bradyarrhythmia

4. Ischemia infraction

5. Hypertrophy

6. Heart Block

LONG CASE

Timing (11:15am to 01:00pm)

SHORT CASES

Timing (01:00pm to 02:00pm)

● General physical examination

● Inspection of precordium

237

SECOND WEEK (CVS)

DISCUSSION CLASS


1. IDH (Angina, Acute Coronary Syndrome, Myocardial Infection)

2. Pericarditis , Pericardial effusion, Electrolyte Changes

3. B.P apparatus and B.P recording

4.

LONG CASE


SHORT CASES


● Palpation and Auscultation of precordium (CVS)

List of Short Cases

● Mitral stenosis

● Mitral regurgitation

● Mixed mitral valve disease

● Aortic regurgitation

● Aortic stenosis

● Jugular venous pulse

● Mixed aortic valve disease

● Infective endocarditis

● Examination of pulse

● Ventricular septal defect

● Tricuspid regurgitation

● Atrial septal defect

238

List of Long Cases:

● Heart Failure

● Rheumatic Fever

● Infective endocarditis

● ACS

● MI & Complications

● Hypertension

● Pericarditis

● Cardiomyopathy

THIRD WEEK (GIT)

DISCUSSION CLASS


1. NG tube, Sangsataken tube

2. Endotracheal Tube, Ambu Bag, Air Way

3. IV line, Double lumen, CVP line

4. Foleys Catheter

5. Nebulizer

6. Pulse Oximeter, Glucometer

LONG CASE


SHORT CASES


● Inspection of Examination of GIT

List of Long Cases:

● Cirrhosis

● Auto immune Hepatitis

● Jaundice

● Acute Hepatitis

● Primary Billiary cirrhosis

239

● Primary Sclerosing cholangitis

● Inflammatory bowel disease

● Coeliac disease

● Acute pancreatitis

List of Short Cases:

● Hepatomegally

● Jaundice

● Ascites

● Splenomegaly

3rd Week

DISCUSSION CLASS


1. CT Scan/MRI, Normal

2. Cerebral, Infarction, Intracerebral Bleed, SAH

3. SOL, Abscess, Encephalitis, Hydrocephalus

4. Brain Atrophy, Tuberculoma

5. L.P needle

6. Ophthalmoscope

LONG CASE


SHORT CASES


● Examination of CNS + Cranial Nerves

o Stroke

o Spastic paraplegia

240

o Cerebellar syndrome

o Third nerve palsy

o Parkinson disease

o Seventh nerve palsy

o Myasthenia gravis

4th Week

DISCUSSION CLASS


● X-Ray Chest

o Normal X-ray Chast

o Pulmonary Diseases

o Cardiac Diseases

o Emergency Drugs

1. Inj. Solucortef Inj. Adrenaline Inj. Dopamine Inj. Dobutamine Inj. Nikethamide Inj. 25% D/W

2. Inj. NaHCO3 Inj. KCL Inj. Atropine S/L angisid Disprin

3. Inj. Isoket Inj. Heparine Inj. Amidarone Inj. Xylocaine

LONG CASE


SHORT CASES


● Examination of Chest (Respiratory System)

241

WARD PROGRMME FINAL YEAR SESSION 2019-2020

DURATION OF FIRST BATCH

30-12-2019 TO 14-03-2020 (10 WEEKS)

WARD 30-12-2019 TO

14-03-2020

16-03-2020 TO

06-06-202

08-06-2020 TO

26-09-2020

MEDICAL UNIT-I A-1 C-1 B-1

MEDICAL UNIT-II A-2 C-2 B-2

MEDICAL UNIT-III A-3 C-3 B-3

● WARD/OPD ACTIVITY: 10:30 AM TO 1:15 PM IN FIRST 4 WEEKS THEN 20:30 – 2

● EACH BATCH OF STUDENTS WILL BE APPROXIMATELY 38 STUDENTS IN EACH

WARD.

● EACH WARD WILL DEVIDE STUDENTS INTO TWO GROUPS A & B (19 EACH).

● BATCH A WILL DO OPD ON MONDY.

● BATCH B WILL DO OPD ON THURSDAY.

● LECTURE TIME: 8:00 – 10:15 AM BY TWO CONSULTANTS.

● EVENING ACTIVITY: 3-8 PM EACH EVENING CLASS WILL BE CONDUCTED BY 2

MASTER TRAINERS.

● EACH WARD WILL DEVIDE STUDENTS INTO TWO GROUPS A & B (19 EACH).


242

WEEK-1 (30-12-2019 to 04-01-2020)

Day 1 & 2 : DM Module

Day 3, 4 & 5: Wards off d/t final prof.

Week-2 (06-01-2020 to 11-01-2020)

Day 1 & 2: HTN Module

Day 3: MS/MR

Day 4: Infective endocarditis

Day 5: Rheumatic fever

Day 6: Weekly assessment

Week-3 (13-01-2020 to 18-01-2020)

Day 1: Heart failure

Day 2: AS/AR

Day 3 & 4: Anemia, Lymphoma & Miscellaneous

Day 5: Weekly assessment.

Week-4

Day 1: DVT

Day 2: ITP

Day 3: Leukemia/Miscellaneous/Asthma

Day 4: Pneumonia

Day 5: COPD


Week-5

Day 1: ILD

Day 2: Pneumothorax, Pleural effusion

Day 3: Pulmonary tuberculosis

Day 4: Primary biliary cirrhosis/sclerosing cholangitis

Day 5: Acute hepatitis


Week-6 (03-02-2020 to 08-02-2020)

Day 1: Jaundice

Day 2: Wilson/Haemachematosis

243

Day 3: 5th Feb

Day 4: HCC

Day 5: CLD, Cirrhosis


Week-7 (10-02-2020 to 15-02-2020)

Day 1: Acute pancreatitis / Inflammatory Bowel Disease

Day 2: Flypothyroidism

Day 3: Accomegaly

Day 4: Diabetes Inspidus / SIADM

Day 5: Hyperthyroidism


Week-8 (12-02-2020 to 22-02-2020)

Day 1: Pheochromocytoma

CVS

DAY 1

3-4: Protocol of Examination + introduction + position, exposure

4-5 Inspection f precordium

6-7 General physical examination

7-8 General physical examination and IVP

DAY 2

3-4 Palpation of precordium

Apex beat

RV Heart

Palpable heart sounds

4-5 Auscultation of precordium

5-6 First and second heart sounds

Added sounds

6-7 Revision and practice of palpation and auscultation

7-8 Revision and practice of palpation and auscultation

DAY 4

Individual practice and revision of examination of CVS

244

CHEDULE OF 4TH YEAR MBBS CPC (EVERY THURSDAY)

TIMING: 8:45am to 10:00am

VENUE: Pathology Lecture Hall, FMU

SR.NO DATE TOPIC ORGANIZING

UNIT

1.

12-12-2019

Pathology Pathology

2.

26-12-2019 Red Eye Eye

3.

02-01-2020

Management of Deaf

Child ENT

4.

09-01-2020 Balanced nutrition Community

5.

16-01-2020 Liver cirrhosis Medical Unit-IV

6.

23-01-2020 Pneumothorax Surgical Unit-IV

7.

30-01-2020 BLS Anesthesia

245


Name:____________________ Age:_________________ Address:_______________________

Diagnosis:__________________ Essential Hypertension_____________________

: Target Pre drug BP

Target LDL

Life style modification

Tab. Zestril (Lisinopril) 10mg

1+0+0

246


Name:____________________ Age:_________________ Address:_______________________

Diagnosis:__________________ Type-II Diabetes Mellitus ____________________________

: Target Pre Meal BSL

Target Post Meal BSL

Target HbA1C

Target LDL Life style modification

Weight reduction

Tab. Glucophage 500mg

1+0+1

Life style modification

Tab. Zestril (Lisinopril) 10mg

1+0+0

247

SCENARIOS:

1. A 47 year old obese man presented to Outpatient Department with history of

Hypertension for 3 months not adequately controlled with lifestyle modifications alone.

Family History of Hypertension is also positive. His recent B.P is 150/90 mmHg. What

will be the first line Anti-Hypertensive Drug for this patient?

● Methyldopa

● Clonidine

● Frusemide

● Lisinopril

● Metoprolol

2. A 53 year old lady presented in Clinic with Essential Hypertension very well controlled on

lifestyle modifications and ACE Inhibitors. But she Developed dry cough after start of ACE

inhibitors. On further evaluation no specific reason was found for dry cough. Now what is be the

most appropriate treatment option?

● Switch ACE Inhibitors with Beta Blockers

● Switch ACE Inhibitors with Frusemide

● Switch ACE Inhibitors with ARB’S

● Switch ACE Inhibitors with Methyldopa

● Continue ACE Inhibitors and Reassure

3. A 60 year old male with H/O Stable Angina and Hypertension presented to you with

Hypertension. What antihypertensive drug will be the drug of choice in this patient

besides lifestyle modifications?

● ACE Inhibitors

● Ca Channel Blockers

● Beta Blockers

● Diuretics

● ARB’s

4. A 49 year old man with history of Myocardial infarction presented with complains of Exertional

SOB, Orthopnea and PND. He is taking Antiplatelet, Statins, Nitrates, Loop Diuretics . His B.P

248

is uncontrolled. What antihypertensive drug need to be added in this patient in order to control

B.P and also for cardiac remodeling?

● ACE Inhibitors


● Alpha Blockers

● Thiazide Diuretics

● Centrally acting drugs

5. A 62 year old male with History of Type 2 Diabetes Mellitus for 15 years presented with

uncontrolled B.P despite of lifestyle modifications. His RFT’s are within normal limit but there is microscopic proteinuia. What antihypertensive drug will be the treatment of choice in this

patient?

● ARB’S


● Alpha Blockers

● Thiazide Diuretics

● Centrally acting drugs

6. A 41 year old obese lady Presented in Diabetic Clinic with History of Polyurea for last 6 months.

On examination there is Acanthosis Nigricans and Hepatomegly. She also had checked her

random blood sugar level which ware above 200 mg/dl on most of the occasions. Her recent

HbA1c was 8.1 % . She is on lifestyle modifications for the last 6 months. What

antihyperglycemic drug you will add to control her Blood sugar levels.

● Gliclazide

● Metformin

● Empagliflozin

● Acarbose

● Sitaglipin

motto of department of medicine

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