1 st year mbbs study guide - cmh lahore medical and dental ...€¦ · ovulation & implantation...

1

1st Year MBBS

STUDY GUIDE

CMH Lahore Medical College & Institute of

Dentistry

2

MBBS ANATOMY PROGRAMME AT NUMS

Vision: To train undergraduate students by qualified faculty and state of the art infrastructure and technology so that students can meet the community challenges of 21st century.

Mission: To impart core knowledge of anatomy in interesting, compact and practical way to undergraduate students by Hybrid/Spiral integrated system of teaching so that they can differentiate between normal and abnormal structure at gross, microscopic and embryological level.

Objectives: For this we need to impart: Knowledge of Anatomy - On principles of pedagogy Skills Dissection & Prosection

Simulation – Models Cyber teaching Surface Anatomy Modern Histological techniques

Attitude: Communication Skills

- Lecture & Presentation Self directed learning

- CBL, Museum Atlas - Integrated Journal - Cyber Teaching - E-Learning

Quest for Research - Journal club meeting

- Library Professionalism

Empathy Inter Personal Skills Extra Curricular activities

3

Contents

Description Page No

List of Faculty 4

Overview 5

Time Table 6

Block –I 7

Block – II 16

Block – III 30

Table of Specifications 43

List of Recommended Books 44

4

List of Faculty

Dr. Nazreen Sharif Professor & Head of Department

Dr. Ansa Rabia Professor

Dr. Shaista Arshad Jarral Associate Professor

Dr. Tayyaba Mahmud Assistant Professor

Demonstrators

Dr. Ayesha Taimur

Dr. Yumna Muzaffar

Dr. Arwa Khawar

Dr. Falaq Shahid

Dr. Saman Rauf

Dr. Sarah Ismail

Dr. Hammad Ali

5

Overview

Module No

Subject

Teaching & Learning

Evaluation

Block-I (14 Weeks)

Gross Anatomy Upper Limb 3 Substages *EOB - I

General Anatomy General anatomical

terms Bone

Joints Muscular system

Nervous system-I

(Introduction)

*EOB - I

Embryology Mitosis and meiosis,

Gametogenesis

Ovulation &

Implantation 1st week of

development 2nd week

of development 3rd

week of development

*EOB - I

Histology Cell (Introduction,

staining, cytoskeleton,

cell junctions)Surface

and glandular

epithelium Connective

tissue (General)Bone

Cartilage Muscle

*EOB - I

Block-II (10 Weeks)

Gross Anatomy Thorax 2 Substages *EOB - II

Embryology Embryonic period,

Fetal period

Placenta and fetal

membranes Twining

CVS

*EOB – II

Histology Circulatory System

Immune system *EOB – II

General Anatomy Lymphatic system

Circulatory system

*EOB - II

Block-III (10 weeks)

Gross Anatomy Lower Limb 3 Substages *EOB – III

General Anatomy Skin Fascia Vertebral

column Nervous system-

II

*EOB - III

Embryology Birth defects Body

cavities

Respiratory system

Muscular System

Skeletal system except

head and neck

Development of limbs

*EOB - III

Histology Respiratory system *EOB - III

6

Pre Prof / Send-up exam

*EOB – End of Block Exam

8

Block-I

Anatomy

9

COURSE CONTENTS, PROPOSED LEARNING OBJECTIVES

SUGGESTED MIT (mode of information transfer)

Summary

Code MODULE - I

Name Anatomy

Duration 14 weeks

Broad Themes of Module

(Theme: a subject that is being

integrated a majority of time of module)

Introduction 2. Cells and genetics 3. Blood 4. Loco motor (Upper limb)

Subject Themes

Gross anatomy

Upper limb

General Anatomy

General anatomical terns

Bone Joints Muscular system Nervous system-I (Introduction)

Embryology

Mitosis and meiosis, Gametogenesis

Ovulation &Implantation

1st week of development

2nd week of development

3rd week of development

Histology

Cell(Introduction, staining, cytoskeleton, cell junctions)

Surface and glandular epithelium

Connective tissue(General)

Bone Cartilage

Muscle Prerequisite Module None

Mode of Information Transfer:

MIT

Lectures

Dissection

Demonstration

CBL

Practical

Dissection movies

10

GROSS ANATOMY

Topic Learning Objectives Students should be able to:

MIT (Mode of information transfer)

GROSS ANATOMY UPPER LIMB

Identify important bony land marks of Scapula

Describe the attachment of muscles& ligaments of Scapula

Identify important bony land marks of Clavicle

Describe the attachments of muscles and ligaments of clavicle.

Identify important bony land marks of Humerus.

Identify the different types of fractures of humerus and nerve injuries

Describe the attachment of muscles & ligaments of Humerus

Identify important bony land marks of radius &Ulna.

Describe the attachments of muscles & ligaments of radius and Ulna

Identify the common sites of fractures of radius &Ulna.

LGIS/ Demo

Bones of upper limb

Breast Knowledge

Discuss the structure and divisions of breast tissue

Discuss importance of fibrous septa

Discuss its blood supply and venous drainage

Discuss lymphatic drainage of each quadrant of breast

Discuss the importance of sentinel lymph node

Describe supernumerary and retracted nipples Describe breast abscess and CA breast

LGIS/ Demo

Scapular region Knowledge

Describe muscles connecting the upper limb to thoracic wall

Describe muscles connecting the scapula to humerus

Discuss origin insertion, nerve and blood supply of these muscles

Identify the boundaries of quadrangular and triangular spaces

Identify structures present in these spaces

Discuss arteries and nerves present in this region Skill

Study prosected specimen and identify the muscles of this region

LGIS/ Demo

Acromioclavicular Knowledge

Describe formation, ligaments and articulation of these joints

Discuss scapulohumeral mechanism

Discuss blood supply and nerve supply of these joints Discuss injury and dislocation of these joints

and

sternoclavicular LGIS/ Demo

joint

Shoulder joint Knowledge

Describe movements, ligaments, nerve supply & blood supply of Shoulder joint

Describe arterial anastomosis around shoulder joint Describe the Dislocation of shoulder joint

LGIS/ Demo

Anatomy learning outcomes:

11

Explain Rotator Cuff & enumerate the injuries to it.

Discuss rotator cuff tendinitis

Describe rupture of supraspinatus tendon

Discuss dislocation of shoulder joint

Discuss shoulder pain

Skill

Perform movements of shoulder joint

Study the model of shoulder joint and mark its ligaments and

rotator cuff muscles around it

Axilla Knowledge

Describe the boundaries & contents of Axilla

Describe the relation of cords of brachial plexus

Describe injury to the Axillary Vein and artery

Describe axillary lymph nodes, their location, division and

area of drainage

Discuss lymphangitis and lymphadenitis

Describe the importance of axillary lymph nodes in CA

breast Skill

Study prosected specimen and models of axilla

LGIS/ Demo

Arm Knowledge

Discuss anterior and posterior compartment of arm and

structures present in it

Discuss origin, insertion of muscles of anterior and posterior

compartment of arm

Discuss blood supply and nerve supply of these

compartments Skill

Study the models and prosected specimen of arm and

identify the structures present in this region.

LGIS/ Demo

Elbow joint

Proximal and

distal

radioulna

r joints

Knowledge

Describe the type, capsule and ligaments of these joints

Discuss the movements of these joints

Discuss muscles performing these movements

Discuss blood supply and nerve supply of these joints

Describe the anatomical significance of carrying angle

Discuss dislocation and clinical correlation of these joints

Discuss structures getting damaged in elbow

joint dislocation Skill

Perform movements at elbow joint and discuss the muscles

involved in these movements

Study the models of elbow joint and recognize the bones and ligaments forming the joint

LGIS/ Demo

Cubital fossa Describe the boundaries of cubital fossa

Enlist the contents of cubital fossa and their arrangement

Discuss the importance of structures present in cubital fossa Skill

Mark the boundaries and contents of cubital fossa on a

model

LGIS/ Demo

12

Forearm Knowledge

Discuss contents of anterior lateral and posterior fascial

compartments of forearm

Discuss muscles of these compartments and their blood

supply

Discuss the course of nerves and arteries present in this

region

Discuss boundaries of anatomical snuff box and its

importance

Describe flexor and extensor retinaculum

Discuss clinical correlations of this compartment including

tennis elbow Skill

Study prosected specimen of forearm and identify muscles,

blood vessels and nerves present in this region

Study the models of forearm and discuss origin and insertion

of muscles Mark the extensor and flexor retinacula on the model

LGIS/ Demo

The region of

wrist and palm of

hand

Knowledge

Discuss bones of Hand

Describe functions of muscles in Thenar, Hypothenar &

Central compartments

Describe the fibrous sheaths of the digits of the hand

Discuss the anatomical structures involved in Tenosynovitis

Describe Palmar aponeurosis

Enumerate fascial spaces of Palm

Describe boundaries & contents of spaces of palm

Discuss clinical importance of spaces of palm

Discuss wrist joint

Explain the movements at wrist joint

Discuss ligaments of wrist joint and its relations

Discuss the anatomical structures involved in Wrist fractures

Explain the formation of Carpal tunnel and its contents

Explain the Carpal tunnel syndrome

Describe the course & branches of nerves in Hand

Discuss metacarpophalangeal and interphalangeal joints of

hand Skill

Perform movements of wrist joint and recognize the muscles

involved in these movements

Study the model of hand to visualize muscles of hand and

insertion of long tendons

Study prosected specimen of hand to identify muscles and

blood vessels of hand.

LGIS/ Demo

Nerves of upper

limb & brachial

plexus

Knowledge

Describe formation of Brachial Plexus with emphasis on

Cords, Roots & trunk

Discuss injuries of the brachial plexus:

Klumpke paralysis & Erb-Duchenne palsy

Describe formation, distribution & important relations of following nerves:

LGIS/ Demo

13

Axillary nerve Musculocutaneous nerve Median nerve Radial nerve Ulnar nerve Describe the innervation of each compartment and the specific deficits that occur with lesions of individual nerves at different parts along the course of following nerves: Musculocutaneous nerve Median nerve Radial nerve Ulnar nerve discuss the anatomical sites of lesion of nerve correlating them to sensory and motor loss within area of distribution

Cutaneous nerves of upper limb

Knowledge

Describe the cutaneous innervation of the arm, forearm and hand.

Compare and contrast dermatomes with the cutaneous innervation of specific nerves in Arm & forearm

Skill

Draw & label cutaneous innervation of lower limb

Draw & label the dermatomes of lower limb

LGIS/ Demo

Blood supply of upper limb

Knowledge

Discuss the course, extent & branches of Axillary, Brachial, Ulnar and Radial arteries

Describe the anatomical sites of lesion of artery correlating them to ischemia within area of distribution

Describe the formation of Superficial and Deep Palmar Arches in hand

Describe the structures involved in Laceration of Palmar Arches

Describe the formation & drainage of following Veins:

Axillary vein

Basilic vein

Cephalic vein

Median cubital vein

Discuss the importance of Median Cubital Vein in

venipuncture

LGIS/ Demo

Lymphatic drainage of upper limb

Discuss the lymphatic drainage of upper limb in detail

LGIS/ Demo

DISSECTION Perform dissection to identify main muscles of scapular region along with their nerve supply Perform dissection to identify main muscles of arm along with their nerve supply Perform dissection to identify main muscles of forearm along with their nerve supply. Perform dissection to identify main muscles of hand along with their nerve supply Perform dissection to identify muscles forming boundaries of cubital fossa

Dissection

14

Perform dissection to identify contents of cubital fossa

IMAGING Identify the common sites of fracture on radiographs correlating its

predisposition to fracture in the following bones:

Scapula

Clavicle

Humerus

Radius

Ulna Identify the bones and bony articulations of upper limb on AP and

Lateral view of Radiographs

Demo

EMBROLOGY

MITOSIS & MEIOSIS Define Meiosis

Differentiate first and second meiotic divisions.

State the phases of meiotic divisions.

Justify the importance and result of meiosis in both sexes

Differentiate between mitosis and meiosis.

Describe the structure abnormalities in chromosomes like

Euploid, Aneuploid, Trisomy, Non-disjunction, Translation

Correlate the structure abnormalities with clinical conditions

like: Down’s syndrome Klinefelter and Tuner syndromes

LGIS

GAMETOGENESIS-I Describe the events of spermatogenesis.

Describe the morphological changes during maturation of the

gametes

Enlist the differences between spermiogenesis and spermatogenesis

GAMETOGENESIS-II Define the ovarian cycle

Describe the stages of follicular maturation primary preantral,

secondary, preovulatory, Explain the hormonal control (FSH,

LH) of ovarian cycle Discuss the transport of ovum from the surface of ovary to

ampulla of fallopian tube

LGIS

OVULATION &

IMPLANTATION

Define fertilization

State normal site of fertilization

Describe the results of fertilization Mentions the factors affecting fertilization

Enumerate the changes that occur in spermatozoa before

fertilization

Explain the factors affecting penetration of sperm through the

zona pellucida for formation of Pro nuclei Discuss the formation of zygote

Correlate the transport of zygote from ampulla of fallopian tube

to the uterine cavity and cleavage Explain the formation of blastocyst

LGIS

1ST WEEK OF

DEVELOPMENT

Explain the formation of outer and inner cell masses

Discuss the further development of outer cell mass

(trophoblast),

Differentiate syncytiotrophoblast and cytotrophoblast with its

microscopic appearance Describe the process of implantation (day wise change)

LGIS

15

2ND WEEK OF

DEVELOPMENT

State the differentiation of embryonic pole and development of

bilaminar germ disc with formation of Epiblast and hypoblast,

their cavities (amniotic cavity and primary yolk sac) Discuss the

development of the chorionic sac and formation of primary

chorionic villi and growth of syncytiotrophablast Explain the establishment of utero placental circulation Explain

why the second week is known “ as week of two’s”

LGIS

3RD WEEK OF

DEVELOPMENT

Define gastrulation (formation of three germ layers)

Discuss the development of primitive streak and related

congenital anomalies (Sacrococcygeal teratoma)

Describe the development of notochordal process, notochord

canal, prechordal plate and cloacal membrane

Define Neurulation

List the steps of development of Neural Tube

Enumerate the derivatives of Neural Crest Cells

State the congenital anomalies resulting from abnormal

neurulation

Describe the formation of three germ layers and enlist their

derivatives

Differentiate three components of Mesoderm (Paraxial,

Intermediate and Lateral Plate Mesoderm) Define Somites

LGIS

HISTOLOGY

CELL

(INTRODUCTION,

STAINING,

CYTOSKELETON,

CELL JUNCTIONS)

KNOWLEDGE

Identify parts of Light Microscope

Discuss the working & magnification of Light Microscope

Identify different types of Microscopes and their functions

Define resolution

Describe the steps involved in tissue processing Define

cell, identify various types of cells and shapes Define

Cytoskeleton.

Enumerate the cell junctions and describe their histological

structure SKILL

Identify and draw the different parts of microscope and

illustrate their usage.

Focus the prepared slide at different magnifications. Identify

the different shapes of cells and their examples Draw a

labelled diagram of different types of shapes of cells

LGIS

Lab

SURFACE

& GLANDULAR

EPITHELIUM

Classify the body tissue into categories

Define Epithelium Classify various types of Epithelium

Discuss general features of Epithelial cells (basal, apical and

lateral surfaces)

Explain the different types of epithelium with examples

Describe glandular epithelium

Differentiate the structure of serous and mucus secreting

cells SKILL

Identify the different types of Epithelia and their examples

Draw a labelled diagram of different types of simple and

stratified epithelia

LGIS

Lab

16

Identify mucous and serous acini with haematoxylin and

eosin Draw a labelled diagram of mucous and serous acini with haematoxylin and eosin

CONNECTIVE TISSUE

(GENERAL)

KNOWLEDGE

Explain the components of connective tissue Describe

different types of cells in connective tissue Describe

different types of fibers in connective tissue Discuss

various constituents of ground substance Classify

various types of connective tissues

Describe the histology of different types of adipose tissue

SKILL

Identify the microscopic structure of loose connective tissue,

dense regular and irregular connective tissue

Draw a labeled diagram showing the microscopic structure of

loose connective tissue, dense regular and irregular connective

tissue with haematoxylin and eosin

Draw a labeled diagram of the connective tissue

wit

h haematoxylin and eosin

LGIS

Lab

BONE KNOWLEDGE

Describe microscopic features of bones and types of ossification

Enlist the location of different types of bones

SKILL

Identify different types of bone microscopically

Draw a labelled diagram showing the histological structure of

different types of bone with hematoxylin and eosin

LGIS

Lab

CARTILAGE KNOWLEDGE Describe microscopic features of various types of cartilage SKILL

Identify different types of cartilage microscopically

Draw a labeled diagram showing the histologic structure of different types of cartilage with hematoxylin and eosin

LGIS

Lab

MUSCLE KNOWLEDGE

Describe the microscopic features of skeletal, smooth and

cardiac muscle SKILL

Identify the different types of muscle microscopically

Draw a labeled histological diagram of different types of muscles with hematoxylin and eosin

LGIS

Lab

List of Histology Practical’s- 1st Year MBBS Class first module

Topic

Histology and Its Methods of Study

Epithelial Tissue

Connective Tissue

Muscle tissue

Bone

Cartilage

17

Block-II

Anatomy

18



Summary

Code MODULE - II

Name Anatomy

Duration 10 weeks



integrated a majority of time of

module)

1.Thorax

2.Cardiovascular system

Subject Themes

Gross anatomy

Thorax

Embryology

Embryonic period, Fetal period

Placenta and fetal membranes

Twining

CVS

Histology

Circulatory System

Immune system

General Anatomy

Lymphatic system

Circulatory system

Prerequisite Module Y1M1


MIT

Lectures

Dissection

Tutorials (PTT)

CBL

Practicals

Class tests

19

Anatomy learning outcomes

Anatomy

PROPOSED LEARNING OBJECTIVES AND SUGGESTED MITs (mode of

information transfer)

GENERAL ANATOMY

S.NO. TOPICS LEARNING OBJECTIVES MIT

Circulatory

System

Discuss the general structural plan of

blood vessels.

Classify blood vessels on anatomical and

functional basis

Explain each type of blood vessel and give

examples

Discuss general plan of systemic,

pulmonary and coronary circulatory

system.

Discuss general plan of portal system with

brief accounts of arterial and venous

portal systems giving examples.

Differentiate between anatomic end

arteries and functional end arteries giving

examples

Define anastomosis; describe various

types of anastomosis with examples and

their clinical significance.

Describe blood supply of arteries and

veins.

Explain the importance of collateral

circulation

LGIS

(Large

group

interactive

session)

Lymphatic

System

Discuss general plan of the lymphatic

circulatory system of the body.

Explain the mechanism of formation and

flow of lymph.

Enumerate the factors responsible for

flow of lymph.

Discuss the structural plan of lymphatic

vessels.

Describe the structural plan of lymph

nodes and their role in lymphatic system

Enumerate the capsulated

lymphoid

organs

LGIS

20

Correlate the role of lymphatic system

with spread of cancer and infection.

Correlate the role of lymphatic system

with development of edema.

HISTOLOGY

Circulatory

System

KNOWLEDGE:

Discuss the general histological plan of

blood vessels.

Describe and compare the histological

structure of:

Elastic artery

Muscular artery

Arteriole

Different types of Capillaries

Venule

Medium sized vein

Large vein

Describe histological changes in intima in

atherosclerosis or arteriosclerosis

SKILLS:

Identify elastic artery, muscular artery and

large vein under light microscope and

enlist at least two identification points for

each.

Draw labelled diagram of elastic artery,

muscular artery and large vein with the

help of eosin and hematoxylin pencils on

the histology notebook

LGIS

Lab

Immune

System

KNOWLEDGE:

Enumerate the cells of immune system.

Describe the structure of primary and

secondary lymph nodule.

Describe the histological features of:

Lymph node

Thymus

Spleen

Tonsils

Compare the histological structure of

thymus, lymph node, spleen and tonsils.

SKILLS:

Identify slides of lymph node, thymus,

spleen and palatine tonsils under light

microscope and enlist at least two

identification points for each.

LGIS

Lab

21

Draw labelled diagram of lymph node,

thymus, spleen and palatine tonsils with

the help of eosin and hematoxylin pencils

on the histology notebook

EMBRYOLOGY

KNOWLEDGE

Embryonic

period

(3rd to 8th week)

Define neurulation

Describe process of formation of neural

plate, neural tube and neural crest cells.

Enlist derivatives of:

Surface ectoderm

Neurectoderm

Neural crest

Intraembryonic mesoderm (paraxial,

intermediate, lateral plate)

Endoderm

Describe somitogenesis and early

differentiation of somites.

Describe the development of

intraembryonic coelom

Describe the folding of the embryo in the

longitudinal plane and correlate it with its

consequences

Describe the folding of the embryo in the

horizontal plane and correlate it with its

consequences

Describe relocation of connecting stalk to

the anterior abdominal wall and its

differentiation into umbilical cord.

Describe the process of formation of blood

and blood vessels and differentiate

between angiogenesis and

vasculogenesis

Explain the embryological basis of the

neural tube defects like anencephaly and

spina bifida

Define hemangioma and explain its

embryological basis

LGIS

Fetal period

(third month to

birth)

Define fetal period

Enumerate various methods to estimate

fetal age

Describe factors affecting fetal growth

LGIS

22

Enlist the external body landmarks from

third month to birth

Define intrauterine growth retardation

Placenta and

fetal

membranes

Enlist types of chorion and give fate of

each.

Enlist types of decidua and give fate of

each.

Enumerate the fetal and maternal

components of placenta.

Differentiate between stem, anchoring and

terminal villi

Enumerate the layers forming placental

barrier

Describe placental circulation (maternal

and fetal)

Enumerate functions of the placenta Enlist

the features of maternal and fetal surfaces

of placenta.

Enumerate placental changes by the end

of pregnancy

List fetal membranes and their functions

Describe production, circulation and

significance of the amniotic fluid.

Describe the development of umbilical cord

Define preeclampsia and correlate it with

trophoblastic differentiation

Describe the embryological basis of

amniotic bands, umbilical cord defects,

erythroblastosis fetalis and hydrops fetalis

Define poly and oligohydramnios.

Enumerate their embryological causes and

adverse effects

LGIS

Twining

Name two basic types of twins.

Describe the mechanism behind

occurrence of dizygotic & monozygotic

twins.

Discuss the possible arrangements of fetal

membranes in case of monozygotic twins.

Discuss fetus papyraceus, twin

transfusion syndrome and conjoined

LGIS

23

twins on basis of knowledge of

embryology

CVS-I

(Heart)

Explain the formation of heart tube.

Describe the mechanism of cardiac

looping

Enlist the parts of heart tube and their

definitive derivatives

Explain the embryological basis of

dextrocardia

Describe histogenesis of heart

Describe contribution of bulbs cordis and

sinus venosus to the development of heart

Explain different methods of septal

formation

Describe division of atrioventricular canal

Explain the embryological steps involved

in formation of interatrial septum

Correlate the internal differentiation of

right atrium with internal structure of

right atrium of definitive heart

Describe the formation of left atrium and

pulmonary veins

Explain the division of conotruncus

Describe the formation of interventricular

septum and identify sources of

its different parts

Describe the development of valves of

heart

Describe the development of conducting

system of heart

Explain the embryological basis of the

following heart defects:

Various forms of atrial septal defects

Ventricular septal defects

Fallot’s tetralogy

Transposition of great vessels

Persistent truncus arteriosus

Pulmonary stenosis

Aortic stenosis

Tricuspid atresia

Hypertrophic right and left heart

syndromes

LGIS

24

Ectopia cordis

CVS-II

(Arteria

l

system)

Define aortic arches

Explain the development and fate of aortic

arches

Enumerate the developmental sources of

aorta

Justify the relationship of recurrent

laryngeal nerves on the basis of your

knowledge of embryology

Enumerate the segmental branches of

dorsal aortae & give their fate

Explain the fate of vitelline & umbilical

arteries

Explain the development of arteries of the

limbs

Enumerate & explain the congenital

anomalies of arterial system which

include:

Patent Ductus Arteriosus

Coarctation of aorta

Double aortic arch

Right aortic arch

Abnormal origin of the Right Subclavian

Artery

An interrupted aortic arch

LGIS

CVS-III

(Venous

system)

Explain the fate of vitelline, umbilical and

cardinal veins

Explain the development of inferior vena

cava

Explain the development of superior vena

cava

Correlate following anomalies of venae

cavae with their development

Double Inferior Vena Cava

Absence of Inferior Vena Cava

Left Superior Vena Cava Double

Superior Vena Cava

Explain the development of lymphatic

system

LGIS

25

CVS-IV

(Fetal

circulation

)

Describe fetal circulation

Describe following fetal

circulatory changes at birth:

Closure of the umbilical vein and ductus

venosus

Closure of the ductus arteriosus

Closure of the oval foramen

LGIS

SKILLS

Embryology

Identify the structures related to general

development and development of

cardiovascular system on given models

and diagrams

SGD

(Small

group

discussion)

GROSS ANATOMY

THORAX

KNOWLEDGE:

Thoracic wall

(Bones and soft

parts)

Enumerate the bones contributing in

thoracic cage

Describe the bony framework of the

thoracic cage with topographic placement

of each bone

Identify structures forming the thoracic

inlet and outlet/costal margin

Discuss sternum, with reference to its parts

and attachments

Define sternal angle and discuss its

importance in clinical practice

Classify ribs into true and false

Determine side of ribs

Discuss parts of a typical rib

Differentiate between typical and atypical

ribs

Identify typical thoracic vertebra, describe

its different parts and identification points

Compare a typical and atypical thoracic

vertebra

Describe the joints of thorax

with reference to their types and

movements Discuss and differentiate

between the pump handle and

bucket handle movements and

their effect on diameters

of chest cavity

SGD and

dissection

26

Discuss the role of the accessory

respiratory muscles during inspiration

and expiration

Enlist the contents of a typical intercostal

space including muscles, nerves and

vessels

Describe the attachments, actions and

nerve supply of thoracic muscles Discuss

the arterial supply and venous drainage of

the thoracic wall.

Discuss the course and distribution of a

thoracic spinal nerve

Identify and justify the most suitable site

for an invasive procedure in an intercostal

space

Analyze the clinical scenario related to

blunt chest trauma and its complications

with anatomical reasoning

Diaphragm

Describe the parts, attachments and nerve

supply of diaphragm

Enlist the apertures in diaphragm with

their levels and structures passing

through each

Discuss the role of diaphragm and scalene

muscles in increasing the vertical diameter

of thoracic cavity

Analyze the clinical scenario related to

diaphragmatic hernia and phrenic nerve

lesions with anatomical reasoning

Correlate the tip of shoulder pain with

irritation of diaphragm

SGD and

dissection

Pleura

Enumerate and discuss various parts of

pleura and identify their locations

Describe the pleural reflections and

recesses

Describe the innervation of the visceral and

parietal layers of the pleura

Discuss the clinical significance of

reflections and recesses of pleura and

pleural cavity

Define pleural effusion, pneumothorax,

empyema and hemothorax

SGD and

dissection

27

Enlist the anatomical structures

encountered in chest tube insertion

Lungs

Identify the side of lungs

Enlist borders and surfaces of lungs

Discuss the topographic arrangement of

structures in hilum of each lung

Discuss the blood supply, nerve supply ,

lymphatic drainage and relations of

various surfaces of both lungs

Define bronchopulmonary segments.

Enlist them in each lung. Discuss their

significance.

Discuss with anatomical reasoning, the

clinical presentation of bronchogenic

carcinoma and lung trauma

SGD and

dissection

Mediastinum

(General

outline)

Define mediastinum

Describe how the mediastinum is further

divided

Enlist the structures lying at the level of

transverse thoracic plane

Outline the boundaries of each division of

mediastinum

Enumerate contents of each division of

mediastinum

SGD and

dissection

Anterior

mediastinum

Outline the boundaries of

anterior mediastinum

Enumerate the contents of

anterior mediastinum

Describe the shape, relations and blood

supply of thymus

SGD and

dissection

Superior

mediastinum

Outline the boundaries of superior

mediastinum and describe its general

topography

Enumerate the contents of

superior mediastinum

Identify carina at the site of bifurcation of

trachea into main principal bronchi

Describe immediate relations, blood and

nerve supply of thoracic part of trachea

SGD and

dissection

28

Justify the right bronchus being the most

probable site of foreign body impaction in

respiratory tract

Describe the orientation, relations and

branches of arch of aorta

Describe the formation, relations and

tributaries of superior vena cava and

brachiocephalic veins

Determine the site of ligamentum

arteriosum and its relation to left recurrent

laryngeal nerve

Describe the origin, course, relations and

distribution of both phrenic nerves

Analyze the clinical scenarios related to

compression of trachea and

damage/irritation of phrenic nerve based

upon your knowledge of Anatomy

Posterior

mediastinum

Outline the boundaries of posterior

mediastinum and describe its general

topography

Enumerate the contents of posterior

mediastinum

Describe the relations and branches of

descending aorta

Describe the course, relations and

constrictions of thoracic part of esophagus

Discuss the reason behind esophageal

varices in case of portal hypertension

Describe the thoracic duct with reference

to its formation, course,

tributaries, termination and area of

drainage Analyze the clinical scenarios

related to chylothorax with the help

of your knowledge of Anatomy

Describe the course, relations and

distribution of both vagus nerves in thorax

Discuss the azygos system of veins with

reference to formation, course, relations,

tributaries and area of drainage of both

azygos and hemiazygos veins

Discuss the role of azygos vein in case of

caval obstruction

SGD and

dissection

29

Identify the lymph nodes in the posterior

mediastinum

Define splanchnic nerves and identify the

location of thoracic sympathetic chain

Pericardium

Enumerate various layers of pericardium

Describe the gross features of fibrous

pericardium

Describe the gross features of serous

pericardium (both parietal and visceral

layers)

Describe the reflections of parietal and

visceral pericardium resulting in formation

of transverse and oblique sinuses Identify

the locations of

pericardial sinuses

Describe the surgical significance of the

Transverse Pericardial Sinus

Discuss the innervation of various layers

of the pericardium

Define pericarditis and pericardial

effusion

Identify the best location for and enlist the

anatomical structures encountered

in pericardiocentesis

SGD and

dissection

Heart

Describe anatomical position, borders,

surfaces, apex and base of heart Describe

external features of the heart Describe

internal structure of various chambers of

heart

Compare the functional anatomy of right

and left ventricles

Describe structure of various valves of

heart

Enumerate the structures comprising the

cardiac skeleton and describe its

significance

Describe the arterial supply of heart

Explain the basis of right or

left dominance of heart

Describe the venous drainage of heart

Describe nerve supply of heart

Define angina pectoris, myocardial

infarction and cardiac tamponade

SGD and

dissection

30

Describe variations of coronary arteries in

context of myocardial infarction

Justify the chest pain, left upper limb pain,

jaw pain and epigastric discomfort as

presenting complaint of ischemic heart

disease with anatomical reasoning

SKILLS:

Gross Anatomy

of Thorax

Identify muscles, bones, ligaments, nerves,

vessels, organs and their parts located in

thorax:

on a cadaver after performing dissection

on prossected specimens

on provided models

SGD and

dissection

Surface

marking

Identify the important bony landmarks of

thorax and mark them on a subject.

Mark the borders of lungs, pleural

reflections, borders and apex of heart,

valves of heart, thoracic duct, esophagus,

trachea, main vessels and nerves of

thorax on the given subject

SGD and

Skills lab

Imaging of

head and neck

Identify the bones of thorax, aortic

knuckle, borders of heart, lungs, trachea,

hilar shadows, diaphragm and its recesses

on chest radiographs

SGD and

skills lab

List of Practical Histology (Anatomy):

Cardiac muscle

The Circulatory System-I

The Circulatory System-II

The Circulatory System-III

31

Block-III

Anatomy

32



Summary

Code MODULE - III

Name Anatomy

Duration 10 weeks



integrated a majority of time of

module)

Lower Limb

Respiratory System

Subject Themes

Gross anatomy

Lower Limb

General Anatomy

Skin Fascia

Vertebral column

Nervous system-II

Embryology

Birth defects

Body cavities

Respiratory system

Muscular System

Skeletal system except head and neck

Development of limbs

Histology

Respiratory system

Prerequisite Module Y1M1 & Y1M2


MIT

Lectures

Dissection

Tutorials (PTT)

CBL

Practicals

Class tests

33

Anatomy learning outcomes:

ANATOMY

LEARNING OUTCOMES

S.

N

TOPIC DISCI-

PLINE

MIT LEARNING OUTCOMES

1 Hip bone Gross

Anatomy

SG

D

Skill:

Demonstrate the anatomical position of bone and

determine the side

Recognize important bony land marks on gross

inspection as well as on radiographs

Identify the muscles & ligamentous attachments on

bone

Knowledge:

Describe the muscles & ligamentous attachments on

bone

Discuss injuries of hip bone and identify them on

radiographs

Compare gender differences of hip bone

2 Gluteal Region Gross

Anatomy

SG

D

Skill:

Explore and identify the structural anatomy of

gluteal region of the cadaver after performing

dissection.

Knowledge:

Describe in tabulated form the origin, insertion,

nerve supply and action of gluteal muscles

Enumerate structures deep to gluteus maximus

Describe boundaries of greater sciatic and lesser

sciatic foramina and enumerate structures

passing through them

Summarize the origin, relations and main

branches of nerves and vessels of gluteal region

Analyze clinical scenarios regarding:

Injury to superior gluteal nerve

Injury to inferior gluteal nerve

Injury to sciatic nerve

Intragluteal injections

3 Femur Gross

Anatomy

SG

D

Skill:

Demonstrate the anatomical position of bone and

determine the side



Knowledge:

34

Describe the muscle & ligamentous attachments on

bone

Describe femoral fractures and identify them on

radiographs

Analyze clinical scenarios related with coxa vera

and coxa valga

Analyze clinical scenarios related with interruption

of blood supply to head & neck of femur

4 Anterior fascial

Compartment of

Thigh

Gross

Anatomy

SG

D

Skill:

Dissect the front of thigh to:

Trace continuity of fascial layers of abdominal wall

with perineum & thigh

Explore the arrangement of superficial inguinal

lymph nodes & their drainage area

Locate the superficial inguinal ring

Reveal the course of great saphenous vein Explore

the fascia lata and opening contained in it Identify

the attachments of muscles of anterior facial

compartments of thigh along with their blood and

nerve supply

Explain the boundaries and contents of femoral

canal

identify the boundaries and contents of femoral

triangle

Knowledge:

Describe the boundaries, compartments, contents

and importance of femoral sheath


blood and nerve supply and actions of muscles of

anterior facial compartments of thigh

Analyze the clinical scenarios related with: Varicose

veins

Great saphenous vein cutdown

5 Medial fascial

Compartment of

Thigh

Gross

Anatomy

SG

D

Skill:


medial compartment of thigh of the cadaver after

performing dissection.

Knowledge:

Describe the origin, insertion, nerve supply and

actions of muscles of medial facial compartments of

thigh

Analyze the clinical scenario related with obturator nerve injury

35

6 The back of the

thigh

Gross

Anatomy

SG

D

Skill:

Explore and identify the structural anatomy of back

of thigh of the cadaver after performing dissection.

Knowledge:


actions of muscles of posterior facial compartments

of thigh

Mark the deep seated structures on the surface of

region

Analyze the clinical scenario related with sciatic

7 Hip joint Gross

Anatomy

SG

D

Skill:

Demonstrate the articulation of hip joint

Knowledge:

Describe the articulation, type, capsule, ligaments,

synovial membrane, nerve supply, blood supply

and important relations of hip joint

Discuss the various movements of hip joint along

with muscles responsible for these movements

Discuss the importance of artery to the ligament of

the femoral head in Fractures of the Femoral Neck

Discuss the anatomical structures involved in

Dislocation of Hip Joint

Analyze the clinical scenarios related with hip joint stability and trendelenburg’s sign

8 Bones of leg Gross

Anatomy

SG

D

Skill:

Identify the patella and its landmarks Demonstrate

the anatomical position of tibia & fibula and

determine their side



Knowledge:

Discuss patellar dislocations & patellar fractures

Describe and identify the muscle & ligamentous

attachments on tibia & fibula

Identify the common sites of fractures of tibia and

fibula and correlate them with their clinical

presentation based on the knowledge of Anatomy

Discuss clinical importance of intraosseous

infusion of tibia in infants

9 Popliteal fossa Gross

Anatomy

SG

D

Skill:


popliteal fossa of the cadaver after performing

dissection.

Knowledge:

36

Enlist the structures forming various boundaries of

popliteal fossa

Enumerate the contents of popliteal fossa and

discuss their inter-relationships

Draw and label genicular anastomosis and

discuss its clinical significance

10 Fascial

compartments of

leg

Gross

Anatomy

SG

D

Skill:


fascial compartments of leg of the cadaver after

performing dissection

Knowledge:

Enumerate the contents of anterior, lateral and

posterior compartments of leg.

Describe origin, insertion and actions of muscles

contained within anterior, lateral and posterior

compartment of leg.

Explain blood and nerve supply of anterior, lateral

and posterior compartment of leg

Discuss the following clinical conditions related

with structures in the region of leg:

Anterior compartment of leg syndrome

Tenosynovitis & dislocation of peroneus longus &

brevis tendons

Gastrocnemius & soleus muscle tears

Ruptured tendocalcaneus

Rupture of plantaris tendon

Plantaris tendon & autografts

Deep vein thrombosis & long distance air travel

Describe the retinaculae of ankle with reference to

their attachments and structures passing

underneath them

Analyze the clinical scenarios related with

common peroneal and tibial nerve injuries

37

11 Knee joint Gross

Anatomy

SG

D

Skill:

Demonstrate the articulation of knee joint

Knowledge:

Describe the articulation, type, capsule, ligaments

(extra and intra articular), synovial membrane,

nerve supply, blood supply, important relations,

and movements related to the knee joint

Explain the mechanism of locking and unlocking of

the knee joint

Name the bursae related to knee joint and point

out those which communicate with the joint cavity

Analyze the clinical scenarios related with patellar

tendon reflex and various types of bursitis Discuss

the following:

Quadriceps femoris as knee joint stabilizer

Strength of knee joint

Knee injury and synovial membrane

Ligamentous injury of knee joint

Meniscal injury of knee joint

Pneumoarthrography

12 Proximal &

distal

Tibiofibular joints

Gross

Anatomy

SG

D

Knowledge:


nerve supply, blood supply, and movements

related to these joints

13 Ankle joint Gross

Anatomy

SG

D

Skill:

Demonstrate the articulation of ankle joint

Knowledge:


synovial membrane, nerve supply, blood supply,

movements and important relations of the joint

Differentiate between acute sprains of lateral ankle

and medial ankle

Describe the fracture dislocation of ankle joint

Discuss the sensory and motor loss associated with

tibial nerve entrapment in tarsal tunnel syndrome

Analyze the clinical scenario related with achilles

38

14 Articulated foot Gross

Anatomy

SG

D

Skill:

Identify the bones of foot

Demonstrate anatomical position and determine

their side of calcaneus and talus

Recognize important bony landmarks, muscular &

ligamentous attachments on calcaneus & talus

Knowledge:

Describe articulation among various bones of foot

Describe foot as a functional unit

Describe arches of foot with reference to bones of

arches, and mechanisms of arch support

Discuss mechanism of walking

Discuss the clinical problems associated with the

arches of foot 15 Intertarsal joints Gross

Anatomy

SG

D

Skill:

Identify articulation, type of joint,

important ligaments and movements at

these joints on an

16 Sole of foot Gross

Anatomy

SG

D

Skill:

Explore and identify the structural anatomy of six

layers of sole of foot of the cadaver after

performing dissection

Knowledge:

Describe the attachments and relations of plantar

aponeurosis


nerve supply and action of muscles of sole of foot

Describe arteries and nerves of sole of foot

17 The dorsum of foot Gross

Anatomy

SG

D

Knowledge:


action of extensor digitorum brevis

Describe arteries and nerves of dorsum of foot

18 Cutaneous

innervations of

lower limb

Gross

Anatomy

SG

D

Knowledge:

Describe the cutaneous nerve supply of lower limb

Draw & label cutaneous innervation of lower limb

Draw & label the dermatomes of lower limb

39

19 Blood supply of

lower limb

Gross

Anatomy

SG

D

Knowledge:

Describe blood supply of lower limb

Discuss the following:

Arterial palpation

Collateral circulation

Traumatic injury to femoral artery

Arterial occlusive disease of the leg

Saphnous cut down

20 Lymphatic drainage

of lower limb

Gross

Anatomy

SG

D

Knowledge:

Describe the lymphatic drainage of lower limb

21 Surface marking Gross

Anatomy

SG

D

Skill:

Mark the nerves and vessels of lower limb on the

surface of region with the help of important bony

HISTOLOGY

22 Respiratory system Histolog

y

IL Enlist the main divisions of respiratory passage

along with the structures constituting each?

Define respiratory and olfactory epithelium

Enumerate cells comprising respiratory & olfactory

epithelium. Describe their light microscopic

structure with the help of diagram

Describe the histological structure of the following

with the help of diagram:

Paranasal air sinuses

Nasopharynx

Larynx

Trachea

Lungs

Pleura

Differentiate various parts of bronchial tree on the

basis of lining epithelium, presence of cilia, glands,

cartilage, smooth muscles, and elastic fibers Analyze

clinical scenario regarding:

Immotile cilia syndrome

EMBRYOLOGY

40

23 Birth defects Embryo IL Enumerate types of birth abnormalities & define

each of them with at least one example Summarize

principles of teratology

Classify teratogens with associated human

malformations in tabulated form

Enlist numerical & structural chromosomal

abnormalities

Discuss the following numerical chromosomal

abnormalities:

Trisomy 21

Trisomy 18

Trisomy 13

Klinefelter syndrome

Turner syndrome

Discuss the following structural chromosomal

abnormalities:

Cri-du-chat syndrome

Angelman’s syndrome

Prader-willi syndrome

Miler-dieker syndrome

Define mosaicism & discuss its embryological basis

Discuss critical periods of prenatal human

development

Discuss invasive and noninvasive approaches for

assessing growth & development of fetus in utero

24 Development of

body cavities

Embryo IL Explain transformation of single intraembryonic

coelom into pericardial, pleural and peritoneal

cavities

Enlist development sources of diaphragm Describe

development of diaphragm

Discuss positional changes of diaphragm with

reference to age of fetus

Explain the innervation of diaphragm with

reference to its developmental sources


41

25 Development of

respiratory system

Embryo IL Describe the development of the following:

Larynx

Trachea

Bronchi

Lungs

Describe different stages of lung maturation Enlist

factors responsible for normal lung

maturation

Enlist the postnatal changes that occur in lungs


Various types of tracheoesophageal fistulas

Respiratory distress syndrome

26 Development of

skeletal system

Embryo IL Describe histogenesis of cartilage

Describe histogenesis of bone

Explain development of joints

Describe development of vertebral column

Define spina bifida. Enlist its different types. Give

embryological basis of bifid spine

alongwith methods of prenatal

assessment in this anomaly Explain development

of ribs and sternum with congenital defects

Discuss embryological basis and associated birth

defects of:

Klippel feil syndrome

Accessory ribs Fused

ribs Hemivertebra

Rachiscisis

Anomalies of sternum

42

27 Development of

muscular system

Embryo IL Describe development of skeletal musculature

Define lateral somitic frontier. Enlist the structures

whose borders are defined by lateral somitic

frontier.

Enumerate the muscles derived from primaxial and

abaxial domains

Summarize the innervation of axial skeletal

muscles

Enlist the developmental source of:

Head muscles

Limb muscles

Cardiac muscles

Smooth muscles

Discuss the following clinical anomalies:

Poland sequence

28 Development of

limbs

Embryo IL Describe the formation of limb buds

Define apical ectodermal ridge and discuss its role

in limb development including digits

Describe limb growth and development

Discuss rotation of limbs during development.

Describe the relationship between rotation of limbs

& cutaneous nerve supply of limbs Differentiate

between development of upper and lower limbs

Discuss development of limb musculature

Enumerate and describe the various types of limb

defects. Discuss their embryological basis

General Anatomy

29 Skin & fascia General

Anatomy

SG

D

Enumerate the components of integumentary

system.

Enlist the functions of integumentary system Enlist

the two main parts of skin. Enumerate its layers

with their general features.

Enumerate appendages of skin. Describe their

general features.

Define cleavage lines? Describe their clinical

importance.

30 Vertebral column General

Anatomy

SG

D

Describe the anatomy of vertebral column with

reference to:

Number of vertebra in different regions

Curvatures of vertebral column

Describe defects in the curvature of vertebral

43

31 Nervous system-II General

Anatomy

SG

D

Describe division of nervous system on gross

anatomical basis

Enumerate components of central and peripheral

nervous system. Describe their general features

Define autonomic nervous system (ANS). Enlist the

differences between autonomic and somatic

nervous system

Enlist the main divisions of ANS? Describe

differences of its two main divisions in tabulated

form.

Enumerate cranial parasympathetic ganglia.

Describe their general features

Define enteric nervous system. Describe its

general features.

List of Practical work:

Histology of Bronchial

Tree Histology of Lung -I

Histology of Lung -II

44

First Professional MBBS Examination

ANATOMY

Table of Specifications for Annual First Professional Examination: Theory

Time Allowed =03 hrs (Including MCQs)

Marks of theory paper =90

Internal assessment =10

Total marks =100

Pass Marks =50

Paper- 1

45 x MCQs (on separate sheet) (45 Marks) Time =50 min

Paper- 2

6x SAQs/SEQs (Recall) = 05 marks each

3 x SAQs/SEQs (Application) = 05 marks each (45 Marks) Time = 2 hours 10 minutes

S.No

Topic

NUMBER OF MCQs (45)

Recall:25

Application: 20

1 mark each

NUMBER OF SAQs/SEQs (09)

05 marks each

Recall Application

1. Embryology 08 01 01

2. Histology 07 01 -

3. General Anatomy 05 - -

4. Upper limb 09 1.5 01

5. Lower limb 09 1.5

6. Thorax 07 01 01

Total 45 (45 Marks) 06(30 Marks) 03(15 Marks)

09(45 Marks)

Viva 50 Marks Practical 40 Marks

Internal Assessment Calculation 20 Marks (10% of Exam)

Module I Module II Module III Sendup Total Written & VIVA

05 Marks 05 Marks 05 Marks 05 Marks 20 Marks 10+10 Marks

CBL/Assignments / Gross Sketch copy included in each modular assessment.

42

HISTOLOGY

Text Books Reference Books

Basic Histology

By Luiz carlos Junqeira (14th

Edition)

Medical Histology by Prof. Laiq

Hussain (6th

edition)

Di-fiore`s Atlas of Histology (12th

Edition) Histology

By Michel H. Ross (6th

Edition)

Contextual journal of Histology Vol-I (For

both MBBS and BDS)

By Prof. Dr. Nazreen Sharif

Contextual journal of Histology Vol-II

By Prof. Dr. Nazreen Sharif (for BDS only)

1 st year mbbs study guide - cmh lahore medical and dental ...€¦ · ovulation & implantation...

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