Beruflich Dokumente
Kultur Dokumente
Faculty of Medicine
MBChB Programme
COURSE SYLLABUS
YEAR TWO 2015/2016
Code
Teaching
Activity
Topics
Hour
Syllabus
Human
Structure I
Handbook
p.5
HUS1-2
p.5 6
HUS1-3
Thoracic wall
6.2
p.9
HUS1-4
6.4, 6.5
p.10
HUS1-5
p.6 7
6.13
HUS1-6
The heart
p.10 11
6.11
HUS1-7
HUS1-8
HUS1-9
HUS1-10
HUS1-11
6.13
p.11
Demo
6.1
P.12 15
6.15
p.8
CSP x3
1.5
6.16
CSP x3
1.5
6.17
6.6
P x2
1.5
6.6
HUS1-14
HUS1-15
P x2
1.5
pelvis
Anterior abdominal wall and inguinal
canal
Anterior abdominal wall and scrotum
HUS1-12
HUS1-13
p.88
6.10, 6.12,
6.12
p.89 91
p.21
8.1, 17.1
p.21 - 22
8.1, 17.1
p.25 26
8.6, 8.7,
p.22
p.22 23
p.26 27
p.28 29
HUS1-23
HUS1-24
HUS1-25
HUS1-26
HUS1-27
HUS1-28
Demo
8.1, 8.15
p.30 32
8.14
p.24
8.8
P x2
1.5
8.8
P x2
1.5
p.95 98
p.37
p.41 42
tract
Histology of the digestive system: GI
p.92 94
tract
Histology of the digestive system:
glands
Histology of the digestive system:
glands
PELVIS AND UROGENITAL SYSTEM
HUS1-29
HUS1-30
HUS1-31
The pelvis I
p.37
HUS1-32
The pelvis II
17.1, 17.2
p.38
HUS1-33
The perineum
10.1, 10.2
p.38 39
Pelvic structures
p.42 44
HUS1-34
HUS1-35
HUS1-36
HUS1-37
17.1, 17.2
Anal and urogenital triangles
p.44 45
17.2
Radiology of the pelvis and perineum
Clinical skills - abdominal and rectal
10.6
CSP x3
1.5
8.15
p.40
Exam
HUS1-38
10.5
HUS1-39
P x2
1.5
10.5
17.3
17.3
The back
18.1,
p.49
18.2, 18.3
p.56
HUS1-40
HUS1-41
p.99 100
system
Histology of the female reproductive
system
MUSCULOSKELETAL SYSTEM
HUS1-42
HUS1-43
limb
HUS1-44
Shoulder
18.3,
p.57
HUS1-45
18.3, 18.4
p.57
HUS1-46
18.1, 18.6
p.50
HUS1-47
18.2, 18.3
p.60 61
HUS1-48
p.58
p.58 59
HUS1-49
hand
HUS1-50
p.61 62
HUS1-51
p.63 65
CSP x4
18.8
18.2
p.70 71
p.71
HUS1-52
HUS1-53
HUS1-54
An Introduction to musculoskeletal
examination upper limb
Joints and movements of the lower
limb
Anterior and medial thigh, femoral
triangle
HUS1-55
p.71 72
HUS1-56
p.72 73
HUS1-57
p.76 77
HUS1-58
p.77
HUS1-59
p.78 79
HUS1-60
18.2
p.79 80
Demo
p.81 85
18.7
p.73 75
CSP x4
18.9
HUS1-61
HUS1-62
HUS1-63
102
Topic
Teaching
Activity
Hour
Syllabus
4.1
HUF1-2
Synaptic transmission
4.2
HUF1-3
4.3
HUF1-4
Sensory receptors
4.4
HUF1-5
Reflexes
4.5
HUF1-6
4.6
HUF1-7
4.6
HUF1-8
Excitable cells
1.5
MUSCLE PHYSIOLOGY
HUF1-9
5.1
HUF1-10
5.2
HUF1-11
5.2
HUF1-12
Muscle physiology
Case
5.3
HUF1-13
Smooth Muscle
1.5
CARDIOVASCULAR PHYSIOLOGY
HUF1-14
7.1
HUF1-15
Cardiac Cycle
7.2
HUF1-16
7.3
HUF1-17
Demo
HUF1-18
P x2
HUF1-19
Cardiac electrophysiology
T x2
HUF1-20
Cardiac Output
7.4
HUF1-21
Haemodynamics I
7.5
HUF1-22
Haemodynamics II
7.6
HUF1-23
Haemodynamics
T x2
HUF1-24
Endothelium
7.7
HUF1-25
7.8
HUF1-26
Microcirculation
7.9
HUF1-27
7.10
HUF1-28
7.11
HUF1-29
P x2
HUF1-30
7.12
HUF1-31
T x2
HUF1-32
7.13
HUF1-33
T x2
HUF1-34
Hypertension
7.14
HUF1-35
Heart Failure
7.15
HUF1-36
Q&A
GASTROINTESTINAL PHYSIOLOGY
HUF1-37
Overview of GI system
9.1
HUF1-38
Regulation of GI function
9.2
HUF1-39
GI motility
9.3
HUF1-40
Gastric physiology
9.4
HUF1-41
9.5
HUF1-42
Hepatobiliary physiology
9.6
HUF1-43
9.7
HUF1-44
9.7
HUF1-45
9.7
HUF1-46
GI disorders I
9.8
HUF1-47
GI disorders II
9.8
HUF1-48
GI - Tutorial 1
T x2
HUF1-49
GI - Tutorial 2
T x2
HUF1-50
GI - Tutorial 3
T x2
RENAL PHYSIOLOGY
HUF1-51
11.1
HUF1-52
11.2
HUF1-53
11.3
HUF1-54
Regulation of K+ balance
11.4
HUF1-55
Renal function
P x2
HUF1-56
Kidney I
T x2
HUF1-57
11.6
HUF1-58
Micturition
11.7
HUF1-59
11.8
HUF1-60
11.9
HUF1-61
11.9
HUF1-62
Kidney II
T x2
HUF1-63
11.10
HUF1-64
T x2
HUF1-65
T x2
12.1
HUF1-67
Introduction to pharmacology I
12.2
HUF1-68
Introduction to pharmacology II
12.3
HUF1-69
Drug-receptor interactions I
12.4
HUF1-70
Drug-receptor interactions II
12.5
HUF1-71
Properties of drugs
T x2
HUF1-72
P x2
HUF1-73
Drug-receptor interactions
T x2
PHARMACOKINETICS
HUF1-74
Drug ADME I
13.1
HUF1-75
Drug ADME II
13.1
HUF1-76
13.1
HUF1-77
T x2
HUF1-78
Pharmacokinetics I
13.2
HUF1-79
Pharmacokinetics II
13.2
HUF1-80
Pharmacokinetics III
13.2
HUF1-81
Pharmacokinetics - tutorial
T x2
14.1
HUF1-83
14.2
15.1
HUF1-85
15.1
HUF1-86
15.3
HUF1-87
15.4
HUF1-88
15.5
HUF1-89
15.6
HUF1-90
T x2
15.2
16.1
HUF1-92
16.2
HUF1-93
Antiemetics
16.3
HUF1-94
T x2
Total
105
16.4
Topic
Teaching
Activity
Hour
Syllabus
Membrane transport
1.1
MMG-2
1.2
MMG-3
1.3
MMG-4
1.4
CELLULAR METABOLISM
MMG-5
Principles of enzymology
2.1
MMG-6
Principles of bioenergetics
2.2
MMG-7
Glycolysis
2.3
MMG-8
Gluconeogenesis
2.3
MMG-9
2.4
MMG-10
Oxidative phosphorylation
2.5
MMG-11
2.6
MMG-12
Glycogen metabolism
2.7
MMG-13
2.8
MMG-14
Carbohydrate metabolism
T x2
MMG-15
2.9
MMG-16
2.10
MMG-17
2.11
MMG-18
2.12
MMG-19
Cholesterol metabolism
2.13
MMG-20
2.14
MMG-21
Lipid metabolism
T x2
MMG-22
2.15
MMG-23
2.16
MMG-24
Metabolism of nucleotides
2.17
MMG-25
2.18
MMG-26
Nitrogen metabolism
T x2
MMG-27
Integration of metabolism I
2.19
MMG-28
Integration of metabolism II
2.20
MMG-29
Integrative metabolism
T x2
DNA replication
3.1
MMG-31
Gene transcription
3.2
MMG-32
3.3
MMG-33
Gene regulation I
3.4
MMG-34
Gene regulation II
3.5
MMG-35
3.6
MMG-36
3.7
MMG-37
3.8
MMG-38
3.9
MMG-39
Molecular genetics
T x2
MMG-40
3.10
MMG-41
3.11
MMG-42
Mendelian inheritance
3.12
MMG-43
3.13
MMG-44
Non-Mendelian inheritance
3.14
MMG-45
Clinical genomics
3.15
MMG-46
Mitochondrial inheritance
3.16
MMG-47
Cytogenetics
3.17
MMG-48
Molecular cytogenetics
3.17
MMG-49
Multifactorial inheritance
3.18
MMG-50
3.19
MMG-51
Population genetics
3.20
MMG-52
3.21
MMG-53
Prenatal genetics
3.22
MMG-54
Clinical genetics
T x2
MMG-55
Pharmacogenomics
3.23
MMG-56
Personalized medicine
3.24
MMG-57
Teratology
3.25
MMG-58
Bioinformatics
3.26
MMG-59
Clinical genomics
T x2
61
10
11
Table of Content
Major Topic
Page
Major Topic
Page
1.
13
52
2. Cellular metabolism
14
55
3.
18
13. Pharmacokinetics
56
4.
23
58
5.
Muscle physiology
26
58
6.
28
62
7.
Cardiovascular physiology
34
63
8.
38
65
9.
Gastrointestinal physiology
47
73
49
76
12
CORE
1.
1.1.
ADVANCED
Membrane transport
13
2. CELLULAR METABOLISM
2.1. Principle of enzymology
Revision of the basic concepts of enzyme
Classification of enzymes
enzymes used in medical diagnosis and treatments
2.2. Principles of bioenergetics
Basic principles of metabolism
Stages in the extraction of energy from foodstuffs
Examples of high-energy phosphate compounds
ATP serves as the link between catabolism and anabolism
Coenzymes as electron carriers in oxidation-reduction reactions
Metabolic processes are regulated
2.3. Glycolysis and gluconeogenesis
Importance of glucose metabolism in all cells and tissues of the body
Glycolytic pathway as the anaerobic oxidation of glucose to pyruvate
Fate of pyruvate depends on the metabolic status and tissue type
Significance of the Cori cycle
Significance of gluconeogenesis in glucose homeostasis
2.4. Citric acid cycle
Overview of the citric acid cycle and its subcellular location
Enzymes and stoichiometry of the cycle
Importance of the reaction catalyzed by the pyruvate dehydrogenase complex
Anabolic and catabolic roles of the citric acid cycle
Regulation of the citric acid cycle
14
2.5.
Oxidative phosphorylation
glycolysis
The physiological significance of glycogen metabolism in the supply of instant energy and glucose
homeostasis
glycerol
15
2.9.
Acetyl CoA as key precursor in the biosynthesis of many structurally different lipids
Fatty acids beneficial to health and fatty acids harmful to health
2.10.
Functions, properties and structures of lipids (i) Fatty acids, (ii) triacylglycerols, (iii) phospholipids, (iv)
glycolipids, (v) eicosanoids, (vi) cholesterol, and (vii) steroid hormones
2.11.
Plasma lipoproteins (chylomicrons, LDL, IDL, VLDL, HDL) : structures, functions and diagnostic
significance
Classes of familial hypercholesterolemia mutations (FH mutations).
Types of hyperlipidemia and treatment
2.12.
Cholesterol metabolism
Metabolism and functions of cholesterol, bile salt, vitamin D, and steroid hormones
Regulation of cholesterol level
2.14.
Disorders of lipid metabolism: (i) obesity, (ii) dyslipidemia, (iii) lipid storage disease, and (iv) inborn
errors of steroid biosynthesis
16
2.15.
drugs
Metabolism of nucleotides
Functions of nucleotides
Purine nucleotide biosynthesis (de novo and salvage pathways) and regulation
Pyrimidine nucleotide biosynthesis and regulation
Degradation of purine nucleotides into uric acid
Causes, symptoms and treatment of gout and Lesch-Nyhan syndrome
2.18.
Integration of metabolism I
Mechanism of metabolic action of steroid hormones, thyroid hormone, epinephrine and insulin
Metabolic effects of insulin (anabolic), glucagon and epinephrine
Defects of hormone receptors
Catabolism versus anabolism
17
Integration of metabolism II
18
Characteristics of the human genome, including chromosome number and nomenclature, Composition
of the human genome, and notation for indicating chromosomal location
Significance of different genome projects, including Human Genome Project, International HapMap
Project, Thousand genomes Project, Human Microbiome Project and ENCODE Project
3.11.
Cell division: Mitosis and meiosis and their correlations with chromosome morphology and
reorganization
Importance and mechanism of DNA recombination
3.12.
Mendelian inheritance
The goals and systems of newborn screening programs to identify correctable or treatable disorder.
3.14.
Non-Mendelian inheritance
Clinical Genomics
Introduce the importance of variation in the human genome useful for genetic analysis
Linkage analysis and identification of genes responsive for single gene defects
Identification of genetic factors conferring susceptibility to common multifactorial conditions
Recent advances in genomic science
Modern high throughput DNA sequencing technology
Different types of genomic technology, including genomics, transcriptomics and epigenomics analysis
Differentiation of errors from mutations
Applications of genomic technology in biomedicine and clinical medicine
3.16.
Mitochondrial inheritance
3.18.
Multifactorial inheritance
Factors which affect the relative recurrence risk for a multifactorial trait within a family;
Concept of threshold liability and use it to explain why inheritance patterns in males and females may
differ in certain multifactorial disorders
Twin concordance studies in determining the genetic component of multifactorial disorders.
Determination of the estimated risk to first degree relatives of an individual affected with a
multifactorial disorder
3.19.
Clinical genetics/dysmorphology
Population genetics
Prenatal Genetics
Factors affecting the choices of tissues and methods for prenatal diagnosis and genetic screening
Prenatal genetic tests: efficacy, benefits and risks
Psychosocial aspect of birth defects and genetic diseases
22
3.23.
Pharmacogenomics
Definition of pharmacogenomics
Genomics basis of drug dose, drug efficacy and side effects
Applications of pharmacogenomics in clinical settings
Example of pharmacogenomics
3.24.
Personalized medicine
Understanding the differences in disease diagnosis, prognosis and treatments based on genetic
variations
The basic principles and advantages of personalized medicine
The clinical practice of personalized medicine based on the advancement of genomics science
3.25.
Teratology
Bioinformatics
23
Synaptic transmission
Factors determining conduction velocity of AP (e.g. fibre diameter, myelination), and advantages of
myelination
4.4.
Sensory receptors
fibers)
Dorsal horn (receiving somatic and visceral sensory inputs), lateral horn (visceral motor neurons) in the
gray matter of spinal cord and ventral horn (somatic motor neurons)
4.6. The autonomic nervous system I and II
Organization of autonomic nervous system (ANS) contrasting with that of somatic nervous system to
illustrate the characteristic features of ANS in typically diffuse, widespread and relatively slow (e.g.
disynaptic, nerve fiber types, neuroeffector junction)
Two divisions of ANS - parasympathetic and sympathetic, introducing their differences in anatomical
organization, effects (often opposing each other), and neurochemical control (e.g. neurotransmitters,
receptor types)
Three major arrangements of sympathetic nerve pathways and the involvement of adrenal medulla
Autonomic neurotransmitters and their receptors, including their signaling mechanisms (in general)
Difference in the affinity of norepinephrine and epinephrine towards a and b adrenergic receptors
Selected examples of autonomic control (e.g. pupillary reflex, accommodation reflex, sweat gland,
salivary gland, gastrointestinal function, control of heart and blood vessels, control of micturition with
somatic input)
5.
5.1.
MUSCLE PHYSIOLOGY
Smooth muscle physiology
Structural and functional organization of skeletal muscle fibers (sarcomere, T-tubule, sarcoplasmic
reticulum, triad)
Synaptic transmission at the neuromuscular junction and end plate potential
Excitation-contraction coupling and role of Ca2+
Sliding filament model and cross-bridge cycle
Isometric and isotonic (concentric and eccentric) contraction; length-tension relation in isometric
contraction
Motor unit and size principle of motor unit recruitment
Frequency summation (twitches, unfused and fused tetanus)
Energy supply for muscle activity
Muscle fiber types: slow and fast twitch, glycolytic and oxidative
Actions of proprioceptors: muscle spindle and Golgi tendon organ
5.3.
27
Division lines on the chest (mid-sternal line, mid-clavicular line, anterior axillary line, mid-axillary line,
posterior axillary line, vertebral line, scapular line)
Palpation of sternum (jugular notch, sternal angle), clavicle (supraclavicular and infraclavicular fossae),
scapula (coracoid acromion, spine, borders, inferior angle), ribs, intercostal space, costal margin and
fossa for xiphoid process
Surface projection of the heart: borders of heart, apex; the trachea and lung: center of trachea,
bifurcation of trachea, apex of lung, lung fissure, lower border of lung, diaphragm
Percussion of chest wall: locate heart, lung and liver
Sites for auscultation: heart valve sounds; breath sounds over trachea, bronchi and lung
6.2.
Structures and body articulations: thoracic vertebrae, sternum, ribs, costal cartilages, clavicle and
scapula
Sternum components: manubrium, body, xiphisternum (xiphoid process)
Anterolateral wall: muscles (pectoralis major and minor and serratus anterior); nerves
(thoraco-abdominal and long thoracic); vessels (internal thoracic artery and vein, lateral thoracic artery)
Intercostal spaces: Intercostal muscles (external & internal), intercostal nerves and vessels
Principles of normal respiratory movements; role of intercostal muscles, diaphragm; accessory muscles
Diaphragm and nerve innervation (phrenic nerve, C3,4,5)
Structures of diaphragm: crura, central tendon; openings (caval, oesophageal, aortic)
Azygos system of veins; drainage of thoracic wall
The breast: tail; position of nipple (variable) and areola; internal structures (lactiferous ducts, suspensory
28
Upper airway
Pleuritis
bronchopulmonary segmentation
asthma
Left and right lungs features (apex, base, surfaces, borders, fissures, lobes)
bronchi
cartilage and adventitiaCells in respiratory epithelium: ciliated and Goblet cells; their functions
Bronchus: epithelium, smooth muscle and cartilageBronchioles: epithelium and smooth muscleLung:
alveolar sacs, alveolar ducts, alveoli (type I and type II pneumocytes, alveolar macrophages), capillaries
and elastic fibers
Concept of blood-air-barrier
MORPHOLOGY OF THE CARDIOVASCULAR SYSTEM
6.7. The heart: External features
Normal position of the heart; its borders, surfaces and apex
Pericarditis
pericardiocentesis
Interior of the heart chambers: right atrium (atrial appendage, openings of superior and inferior venae
cavae, opening of coronary sinus, tricuspid valve, interaterial septum); right ventricle (tricuspid valve,
chordae tendineae, papillary muscles, interventricular septum, moderator band); left atrium (opening of
pulmonary veins, mitral valve, atrial appendage); left ventricle: (mitral valve, chordae tendineae,
30
interventricular septum)
Heart valves: right (tricuspid) and left (bicuspid or mitral) atrioventricular valves; pulmonary valve; aortic
valve; their functions
6.9. Blood supply of the heart
Arterial supply: left and right coronary arteries (first branches of aorta); major branches: anterior and
Angina pectoris
Major arteries and veins bringing blood to and from the heart
Branches from aortic arch: brachiocephalic trunk (to right side of the body), left common carotid (to left
neck and head) and left subclavian (to left upper limb) arteries
Branches from brachiocephalic trunk: right common carotid (to right neck and head) and right
subclavian (to right upper limb) arteries
Bifurcation of common iliac artery: external (to lower limb) and internal iliac (to pelvis and perineum)
arteries
Brachiocephalic veins return blood from head, neck, upper limbs to superior vena cava
Inferior vena cava returns blood from abdomen, pelvis and lower limbs
Ligamentum arteriosum (reminant of ductus arteriosus)
31
6.12.
Heart wall: endocardium (Purkinje fibers), myocardium (cardiac muscle cells) and epicardium
Mediastinum
bronchus)
Position of heart, great vessels, azygos vein, thoracic duct, trachea, thoracic oesophagus, phrenic nerves,
Sympathetic system: sympathetic trunk and ganglia; origin of preganglionic fibers; innervations to heart
and lung
Thoracic splanchnic nerves to abdominal viscera
Parasympathetic system: vagus nerves; innervation to heart and lung
Esophageal plexus
32
6.15.
Chest X-Ray: border of the heart and mediastinum, airways and lung, thoracic cage
thorax
Inspection
General examination for dyspnea, orthopnoea, anaemia , cyanosis, clubbing, peripheral oedema
Palpation of arterial pulses for rate, rhythm, volume and character
33
Haemodynamics I
7.5. Haemodynamics I
Different types of vessels and their specific functions
Factors that determine arterial pulse pressure
Relationships between flow, pressure and resistance
35
Microcirculation
37
7.13.
Hypertension
Definition of hypertension
Classification of hypertension
Common causes or conditions related to hypertension
Treatment approaches for hypertension
Drugs and chemicals that are effective in treating hypertension
7.15.
Heart failure
38
McBurney's point
39
Psoas abscess
Concept of the continuation of the abdomen into the pelvis: abdominopelvic cavity
Aortic aneurysm
40
8.4.
Spleen
41
8.6.
Stomach: regions (cardia, fundus, body, pyloric); pyloric sphincter; peritoneal attachment
External features of stomach: greater and lesser curvatures; cardiac and angular notches
Divisions and disposition of small and large intestines
Duodenum: parts (1st to 4th); drainage of bile and pancreatic juice into 2nd part
Jejunum and ileum: mesentery and its root
Internal features of stomach (gastric rugae), duodenum (major duodenal papilla), and jejunum and
ileum (plicae circulares; comparison of structural differences)
Caecum; appendix: orifice inside caecum
Colon: parts (ascending, transverse, descending, sigmoid colon, rectum); anal canal; anus; peritoneal
covering; mesocolon
Gastrointestinal tract relationship to peritoneum
Junctions between intestinal parts: duodenojejunal; ileocecal (ileocaecal orifice and valve)
Flexures of large intestine: left and right colic
External features of large intestine: haustrae; taeniae coli; epiploic appendages
Anus: pectinate line; sphincters (external and internal)
42
8.7.
Blood supply from coeliac trunk to stomach, spleen, abdominal esophagus, liver, proximal half of
Portal hypertension
duodenum
Arteries to stomach: left and right gastric, left and right gastroepiploic, gastroduodenal and short gastric
Blood supply from superior mesenteric artery to distal half of duodenum, jejunum, ileum, caecum,
appendix, ascending colon and proximal 2/3 transverse colon
Blood supply from inferior mesenteric artery to distal 1/3 transverse colon, descending colon, sigmoid
colon and superior rectum
Arteries to colon: left and right colic; marginal
Arteries to rectum: superior, middle and inferior rectal; venous drainage
Portal venous drainage (splenic, superior and inferior mesenteric veins) and portal systemic
anastomoses
43
44
Liver: lobule (central vein, hepatic sinusoids, columns of hepatocytes, bile canaliculi); portal area (portal
lymphocytes
45
8.12.
Pancreas
Structural organization of compound exocrine glands: acini (secretory units) and ducts
X-Ray
Fluoroscopy: intravenous urogram of the urinary tract, barium enema of the bowel
abdomen
Abdominal Examination
Inspection
General signs which may indicate abdominal disease such as anaemia, jaundice and clubbing.
Quadrants and regions of the abdomen.
46
Overview of GI system
47
The general functions of different parts of GI tract and its associated organs
The structural organization and specialization of various regions of GI tract
GI function in term of motility, secretion, digestion and absorption
The general concept of non-immunological and immunological defense mechanism of the GI system
9.2. Regulation of GI function
Basic stimuli for GI regulation: volume and composition of food (distension, acidity, osmolarity and
digestion products)
GI functions are highly regulated by neural and hormonal systems: the role of enteric nervous system
Pathways for neuro-humoral regulation (neurocrine, paracrine and endocrine)
Roles of secretin, gastrin, CCK, GIP & motilin; somatostatin & histamine; VIP, GRP & Ach
9.3. GI motility
The basic mechanisms by which the motility of gut smooth muscle is regulated (slow waves vs spike
potential)
Types of gut movement and their physiological significance (segmentation, peristalsis, tonic contraction
and migrating motor complex)
The general concept for the regulation of esophageal, gastric and intestinal motility
Neural and hormonal regulation of gastric emptying
9.4. Gastric physiology
Different cell types and functions that contribute to gastric secretions (surface epithelial cell, mucous
neck cell, parietal cell, chief cell & endocrine cell)
The cellular mechanism for the regulation of gastric acid secretion by the parietal cells
Roles of acetylcholine, histamine and gastrin and phases of gastric secretion
The mechanism of gastric mucosal barrier and its implications on ulceration
9.5.
Cellular mechanism for the regulation of pancreatic ductal HCO3- and acinar cell secretion of digestive
enzymes by secretin, Ach and CCK
Phases of pancreatic secretion and potentiation effect of secretin with Ach and CCK
9.6. Hepatobiliary physiology
Bile acid vs bile pigment; the solubility of bile acids and its physiological significance
The significance of enterohepatic circulation of bile acids
The function and regulatory mechanism of gallbladder
Formation and excretion of bile pigment
9.7. Digestion and absorption I and II
The structural modifications and functionality of cells for intestinal digestion and absorption
Basic principle of digestion and absorption of carbohydrates, proteins and lipids
Basic principles of absorption of fat-soluble and water-soluble vitamins
Basic principles of absorption of electrolytes and water
9.8. GI disorders I and II
Factors that influence the LES motility and the basic concept of motility dysfunction exemplified by
achalasia
Negative feedback of gastrin and acid and the basic concept of secretory dysfunction exemplified by
gastrinoma
H. pylori and its pathogenesis of peptic ulceration
Category of diarrhea and mechanisms of action
10.
49
10.1.
Pelvis
Orientation and organization of pelvis: bones (sacrum, pubis, ilium, ischium), muscles, fascia, vessels
and nerves
Inlet (sacral promontary, pelvic brim); outlet (coccyx, ischial tuberosities and spines, pubic arch);
perianal abscess
Obturator foramen, superior and inferior pubic rami; greater and lesser sciatic notches (formed by
Extravasation of urine
Branches of common iliac artery: internal (to pelvis) and external (to lower limb) iliac arteries
Branches of internal iliac artery: obturator, superior and inferior vesical, superior and inferior gluteal,
uterine and vaginal in female, internal pudendal and its branches (inferior rectal and perineal)
Innervation of pelvic organ: lumbosacral plexus
Innervation of perineum: pudendal nerve and its branches (inferior rectal and perineal)
50
Pudendal block
Position of left and right kidneys in abdomen; relationship with ribs, adrenal glands and peritoneum
(retroperitoneal)
Anterior and posterior relations of the kidneys
Exterior: renal fascia, fat and fibrous capsuleInterior: cortex and medulla (renal pyramids and papilla);
sinus filled with fat
Renal hilum: pelvis of ureter, renal veins and arteries
Direction of urine flow: minor calyx, major calyx, renal pelvis and ureter
Course of ureter; relation to uterine artery in female and vas deferens in male
10.4.
Location of trigone and its boundaries (openings of ureters, interureteric fold, internal urethral
opening)
gynaecological surgery
Urethral catheterization
Urethra: sphincters (internal and external); orifices (internal and external); differences between female
and male
Male urethra: prostatic, membranous, penile/spongy
Autonomic and somatic innervation of urinary bladder and urethral sphincters
51
10.5.
Kidneys: fibrous capsule; renal cortex and renal medulla; blood supply
Pelvis X-ray
Fluoroscopy (hysterosalpingogram)
Computed tomography (CT) and magnetic resonance imaging (MRI) of male and female pelves, visceral
organs, blood vessels and pouches
11.
RENAL PHYSIOLOGY
52
Treatment of hyperkalemia
11.5. Renal function
To study the renal responses to different forms of fluid and electrolyte loading
To illustrate the effects of water restriction, water loading, saline loading and alcohol consumption on
the volume and tonicity of urine
To determine GFR based on a 24-hour urine collection and the measurement of creatinine clearance
11.6.
Micturition
Introduction to pharmacology I
Introduction to pharmacology II
55
Drug-receptor interactions I
AGONISTS
Receptor occupancy as a function of agonist concentration
The concept of Affinity
Full and partial agonists (The concept of efficacy, receptor reserve)
12.5.
Drug-receptor interactions II
ANTAGONISTS
Competitive reversible and irreversible receptor antagonists
Effects on log concentration-response curves
Potency and the pA2 scale
Specificity
Non-competitive and functional antagonism
13.
13.1.
PHARMACOKINETICS
Drug ADME I, II, III
DRUG ABSORPTION
Membrane barriers and transport systems
Routes of administration
pH-partition hypothesis - ion trapping
Physiological and pathological factors that affect drug absorption
56
DRUG DISTRIBUTION
Factors that affect drug distribution
Drug-protein binding
Apparent volume of distribution
DRUG METABOLISM
The major drug metabolizing systems
The first-pass effect
Phase I reactions
Phase II conjugation reactions
Enzyme induction and inhibition
Genetic polymorphism on drug metabolism
Other factors that affect drug metabolism
DRUG EXCRETION
Renal excretion
Extra-renal excretion
Enterohepatic circulation
13.2.
PHARMACOKINETICS
Basic concepts
Compartmental models
Simple calculations
Half-life, volume of distribution, clearance, area under curve (AUC), bioavailability
Multiple-dose regimens
Calculation of loading and maintenance doses
Drug accumulation
57
Clinical implications
14.
14.1.
58
15.5.
Mechanisms of Peristalsis
GERD
Mechanism of prokinetic drugs; metoclopramide; domperidone; erythromycin; motilin; ghrelin
Drugs causing constipation
Drugs to facilitate defecation: bulk/osmotic/stimulant laxatives
Diarrhoea: causes, anti-diarrhoeal drugs, loperamide; diphenoxylate; kaolin; bismuth; charcoal
16.3.
Antiemetics
Causes of nausea and emesis: Central and peripheral pathways involved in nausea and emesis control
Drugs used to induce emesis for emergency purposes: apomorphine, ipecacuanha
62
Drugs used to prevent nausea and emesis: dopamine receptor antagonist (different classes), 5-HT3
receptor antagonist, NK1 receptor antagonists, other agents including dexamethasone
16.4.
REPRODUCTIVE SYSTEM
Male urogenital system
17.2.
Prolapse of uterus
Male
Testis: seminiferous tubules and interstitial (Leydig) cells; germinal epithelium, Sertoli cells, different
developmental stages of spermatogenic cells
Epididymis: epithelium; principal (stereocilia) and basal cells
Seminal vesicles: fibrous coat; mucosal folds; epithelium, tall non-ciliated columnar cells
Prostate: epithelium; glands
Penis: superior and deep vessels; sinusoids; urethra in corpus spongiosum
Female
Ovary: germinal epithelium; cortex and medulla (contains ovarian follicles)
Different developmental stages of ovarian follicles: primordial, growing, atretic and mature (Graafian)
Growing and mature follicles: oocyte, zona pellucida, granulosa cells, corona radiata and internal and
external thecal cells
Corpus luteum: granulosa lutein and theca lutein cells
64
18.
MUSCULOSKELETAL SYSTEM
18.1.
Structural and functional comparison of bones of the upper limb (e.g. flexible movements) with bones
Articulation and muscle attachment sites; special features in relation to the course of nerves
fractures
65
Tibia: condyles, intercondylar eminence, tibial tuberosity, medial malleolus; fibula: head, lateral
malleolus
Tarsal bones: talus, calcaneus, navicular, cuboid and cuneiform; metatarsals; phalanges
Arches of the foot: longitudinal and transverse arches; functions
Coxal: ilium (iliac crests, iliac spines), ischium (ischial tuberosities), pubis (arch); acetabulum;
ischiopubic rami; sciatic notch
18.2.
Classification of joints: fibrous, cartilaginous and synovial (capsule, capsular ligaments, synovial
membrane)
Compare the relative free movements of the shoulder joint and its stability with hip joint
and pubofemoral
Shoulder (glenohumeral) joint: articulation of humeral head with glenoid cavity of scapula; glenoid
labrium; characteristics of its mobility and stability (reinforcement by ligaments and muscle tendon);
bursae
Radioulnar joint: Proximal and distal joints between radius and ulna; annular ligament; rotation of
Wrist (radiocarpal) joint: radius and triangular fibrocartilage articulate with proximal row of carpal
bones
Hip joint: articulation of femoral head with acetabulum; labrum; capsular ligaments; ligamentum teres;
Pott's fracture
bursae
Knee joint: articulation of femur and tibia; fibrous capsule; cruciate and collateral ligaments; menisci;
bursae (supra-, infra-, pre-patellar)
Tibiofibular joint: interosseous membrane
Ankle joint: Tibia articulation with talus; fibrous capsule; medial/deltoid and lateral ligaments;
Movements at joints of the hand and foot:
Overall organization of functional muscle groups; muscle attachments (origins and insertions),
sciatic nerves
Muscles around the shoulder and shoulder joint: latissimus dorsi, serratus anterior, trapezius, deltoid,
pectoralis major, biceps brachii, rotator cuff muscles; formation of anterior and posterior axillary folds
Movements of the shoulder and muscles involved: humeral and scapular movements
Muscle groups of the arm and movements: anterior (biceps and brachialis; flexion of the elbow) and
Plantar fasciitis
Flexors and extensors of the forearm; movements of the wrist and fingers
67
Flexion of knee: hamstring muscles; extension of knee: quadriceps; unlock knee: popliteus
Borders and contents in femoral triangle and cubital and popliteal fossae
Muscle groups of the leg: anterior (extensors of ankle and toes; inversion of foot), lateral (two
fibular/peroneal muscles; eversion of foot ) and posterior (gastrocnemius, soleus; calcaneal tendon;
flexors of ankle and toes)
Movements at ankle joint: dorsiflexion (extensors of ankle and toes); plantar flexion (gastrocnemius
and soleus; flexors of ankle and toes); eversion (peroneal muscles); inversion (anterior leg muscles)
Dorsum (tendons of long extensor of toes) and sole (short muscles) of the foot
Maintenance of foot arches by long tendons, ligaments and plantar aponeurosis
18.4.
Overall organization of arterial supply, venous drainage (deep and superficial) and lymphatic drainage
of the limbs
Upper limb arteries: subclavian, axillary, brachial, radial, ulnar and palmar arches (superficial, deep);
veins: deep (axillary, subclavian, radius, ulnar); superficial (cephalic, basilic, median cubital); venae
comitantes
to fractures
Lower limb arteries: femoral, popliteal, fibular, anterior and posterior tibial, dorsalis pedis, plantar arch;
veins: deep (femoral, popliteal, fibular, anterior and posterior tibial); superficial (great and small
Mechanisms of venous return: fascial compartment; contraction of muscles; valves in veins; perforating
veins
Varicose veins
Lymphatic drainage: valves in lymph vessels; positions of superficial and deep lymph nodes
Axillary lymph nodes - drainage of breast
68
Segmental origin, composition, and organization of limb plexuses (roots, trunks, divisions, cords)
Course, distribution, and branches of brachial and lumbosacral plexuses (e.g. ulnar nerve at the elbow
Motor innervation of different muscle groups of the limbs (flexors, extensors, adductors, abductors)
Nerves of the upper limbs: axillary, musculocutaneous, median, radial and ulnar nerves
medial thigh
Nerves of the lower limbs: gluteal, femoral, obturator and sciatic nerves
loss
Dermatomes of the shoulder, arm, forearm and hand in the upper limbs; the dorsum and sole of foot in
the lower limbs
Myotome: concepts of innervation by more than one segment
Concepts of tendon reflex: biceps and knee and ankle jerks (importance in mapping injuries to spinal
nerve roots)
Main nerves at risk and consequence on motor and sensory functions
69
18.6.
Whiplash injuries
Normal curvatures and their changes with age; line of center of gravity
Hyperflexion of neck
Basic features of a typical vertebra: body, vertebral arch, articular facets, vertebral foramen, and
Foot drop
Structural specialization of vertebrae for function at cervical (transverse foramen for passage of
Lumbar puncture
vertebral arteries), thoracic (costal facets for articulations with ribs), lumbar (large body for supporting),
Caudal analgesia
sacral (fused vertebrae for weight bearing) and coccygeal (fused vertebrae) regions
Atypical features of atlas (no body and spinous process) and axis (with dens)
Joints between occipital condyles of the skull and atlas (atlantooccipital joint) and between atlas and
axis (atlantoaxial joint)
Intervertebral joints: intervertebral discs between two vertebrae; range of movements at different
regions
Intervertebral disc: nucleus pulposus and annulus fibrosus
Ligaments between vertebrae and ligaments attached to skull (ligamentum nuchae, ligamentum
flavum, anterior and posterior longitudinal ligaments)
Joints of the vertebral arches: intervertebral foramen for passage of spinal nerves
Joints between vertebrae and ribs
Sacroiliac joint
Principles of back muscle (trapezius, latissimus dorsi, rhomboids, levator sacpulae, erector spinae);
main actions; innervation
Contents of the vertebral canal: spinal cord, cauda equina, dural thecal sac, subarachnoid space,
terminal filum
Vertebral level of termination of spinal cord
70
18.7.
Normal radiological anatomy of bones and soft tissues of upper limb: shoulder, elbow, wrist, carpal
tunnel and hand; lower limb: hip, knee, ankle and foot
18.8.
Inspection
Always compare both sides
Contour, swelling, deformity, skin condition and colour, evidence of pain or discomfort
Muscle bulk
Identify anatomical landmarks
Palpation
Anatomical landmarks of both joints, as well as adjacent structures
Temperature, tenderness, swelling, crepitation, muscle bulk, muscle tone, contracture
Movements
Be aware of the components resulting in movement of the shoulder girdle as a unit
Active and passive movements
Range, limitation, abnormality
71
Inspection
Observe for evidence of pain or discomfort.
Always compare both sides
Include ability to stand and walk, posture and gait (if possible)
Skin, muscle bulk/wasting, swelling, deformities
Palpation and Measurement
Assess for any limb length discrepancy apparent and true leg length
Palpate anatomical landmarks
Check for temperature differences, swelling, mass, tenderness
Movements
Squaring of pelvis
Passive and active range of movement in supine and prone positions.
72
Topic
Format
Family Doctor
1) Introduction to Family
lecture
Attachments
Doctor visits
Introduction of Family Doctor Visited and the expected professional behavior from
students. Distribution of information of assigned family doctors. Discussion on
expected professional behavior during visits. Guidance for clinical visits.
Visit
The relationship between a doctor and a patient is unique. During this visit, students
are encouraged to think about the elements that make the interaction different from
other social interactions and settings. Students will start to record details of
consultations in your reflective log sheets as they observe the variety and nature of
patients seen during a consultation.
Visit
After this visit, a seminar will be conducted for students to discuss one or more of
patients who they have seen on visits. Students will record brief details of at least one
consultation to discuss with their groups- this can be patient with an interesting clinical
diagnosis or something else which was interesting. Students will observe the types of
questioning that the attached FPs use. E.g. open, closed, probing, or clarifying? To
identify key communication skills that students will need to develop over time.
4) Debriefing of FP visit
Seminar
1.5
Debriefing and sharing of visits with FPs and presentation and sharing of 1 or 2 patient
encounters. There will be discussion on the content and the use of reflective logs.
Family Follow
Up Projects
2+1
The Family follow up project would be introduced to the students in year with an
introductory lecture by the 4 departments which include the outcomes of the project
and also basic knowledge of childbirth, the postpartum period and early neonatal
development and family adjustment. Students would then meet with their tutors to
prepare for their ward interview with their mothers and to discuss concerns and
expectations of the course.
73
and
attitude
2) Family FU Project-Field
Visit
The students (in pairs or threes) obtain written consent and interview mothers post
delivery on the wards. The interview is semi structured in nature and would
interview &
encompass pregnancy expectations and preparation, experience of child birth and child
assessment
rearing plans.
3) Family FU
Tutorial
The tutorial will enable sharing and appreciation of the differences in families
Project-Tutorial post
background, expectation and experiences and in creating a rapport with the mother.
The group tutor would facilitate discussion and facilitation of the upcoming visit of the
st
for 1 FU
4) Family FU
family at home.
Visit
Project-Home Visit
This visit would enable students to see the family in their home environment and initial
adjustments to the new born who is now 3 months old. The students would conduct a
semi structured interview looking at carer responsibilities and routine, health and
feeding practices, health care provision and immunization and to assess the child
growth and development
Tutorial
The tutorial would enable sharing of the health and development of the child at 3
months and to appreciate the differences in growth and development as well as family
circumstances and adjustment.
74
Following this visit, the students would be required to hand in a report which includes
the description of various aspects of the family, pregnancy, child birth and family
function with personal reflection and learning points
75
ADVANCE
Diuretics
12.
12.4.
AGONISTS
12.5.
Drug-receptor interactions II
ANTAGONISTS
13.
13.1.
14.
14.1.
PHARMACOKINETICS
Drug ADME I, II, III
Paracetamol (Acetaminophen)
Acetylcholine
Carbachol, methacholine,
bethanechol,
Atropine, hyoscine
Tropicamide, homatropine,
tiotropium, pirenzepine,
76
hyoscine-N-butyl bromide
Nicotinic receptor agonists
Nicotine
Acetylcholine
Ganglion blockers
Hexamethonium
Trimetaphan
Botulinum toxin
-bungarotoxin
Short-duration anticholinesterase
Edrophonium
Medium-duration anticholinesterases
Neostigmine
Physostigmine
Long-duration anticholinesterases
Dyflos
Ecothiopate
Cholinesterase reactivators
Pralidoxime
Obidoxime
14.2.
Adrenoceptor agonists
1-adrenoceptor agonist
Phenylephrine
2-adrenoceptor agonist
Clonidine
1-adrenoceptor agonist
Dobutamine
2-adrenoceptor agonists
Terbutaline
1-adrenoceptor antagonists
Phentolamine , phenoxybenzamine
2-adrenoceptor antagonist
Yohimbine
-adrenoceptor antagonists
77
Guanethedine
Bretylium,reserpine, clonidine,
-methyl-DOPA
Tyramine
Amphetamine, ephedrine
Uptake-1 inhibitors
Cocaine
Imipramine, phenoxybenzamine
15.
Intermittent Claudication
Cardiac Arrest
Septic Shock
Dopamine; dobutamine
Cardiopulmonary Resuscitation
Adrenaline; atropine
Aprotinin
Pheochromocytoma
Phenoxybenzamine
15.3.
Disopyramide, flecainide
Atenolol
Sotalol, amiodarone
block)
Class IV: Ca2+ channel block
Verapamil
78
Others
15.4.
Atenolol, metoprolol
Ramipril, lisinopril
Losartan, candesartan
Amlodipine, diltiazem
Atorvastatin, rosuvastatin
Anti-platelet drugs
Aspirin
Clopidogrel
Anti-coagulants
Warfarin, nadroparin
Dabigatran, rivaroxaban
Thrombolytic drugs
Streptokinase, urokinase
-adrenoceptor blocker
Propranolol
Ramipril, lisinopril
Nitrates
2+
Ca channel blockers
Metabolic modulator
Trimetazidine
79
16.
16.1
Betazole, pentagastrin
secretion/mucous secretion
Prostanoids
Causes of ulcer
Indomethacin, dexamethasone
Ulcer treatment
Antacids
Sodium bicarbonate
carbenoxolone
Prostaglandin
Misoprostol
Anti-muscarinic
Pirenzepine
Anti-histamines
Ranitidine
Famotidine
Omeprazole
Pantoprazole
Metronidazole
amoxicillin, clarithromycin
16.2.
GERD
Prokinetic drugs
Cisapride, bethanechol
prucalopride
Drugs causing constipation
Atropine
Clonidine
Methylcellulose
Hydration
Laxatives
Anti-diarrhoeal drugs,
80
16.3.
Antiemetics
Apomorphine, ipecacuanha
Metoclopramide, domperidone,
chlorpromazine, droperidol
Antihistamine
Cyclizine, promethazine
Antimuscarinic
Scopolamine
Ondansetron, palonosetron
Granisetron
Aprepitant
Netupitant
Other agents
Nabilone
Haloperidol
Cinnarizine
drugs
Notes:
Core column are drugs that are representative of the group and students should be able to name and have thorough understanding of their detail
pharmacology.
Advance column are drugs that are clinically used from the group and students are expected to recognize and describe any significant differences
from the representative drug(s) in the core column.
81