Download KUHS MBBS 4th Year Medicine and its Allied Specialities Syllabus

University VIVA
: 10 Marks
Internal assessment : 10 marks
Total

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: 60 Marks
Practical
University
: 30 Marks
Internal assessment : 10 marks

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Total
: 40 Marks
Grand total

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: 100 Marks
MEDICINE AND ITS ALLIED SPECIALITIES
MEDICINE
A. GOAL

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The broad goal of teaching of undergraduate students Medicine is to have the knowledge,
skills and behavioural attributes to function effectively as the first contact physician/ family
doctor.
B. OBJECTIVES (1)
Knowledge

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At the end of the course, the student shall be able to:
a. Diagnose common clinical disorders with special reference to infectious diseases,
nutritional disorders, tropical and environmental diseases;
b. Outline various modes of management including drug therapeutics especially dosage, side
effects, toxicity, interaction, indications and contraindications:

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c. Propose diagnostic and investigative procedures and ability to interpret;
d. Provide first level management of acute emergencies promptly and efficiently and decide
the timing and level of referral of required.;
e. Recognize geriatric disorders and their management
f. Approach to terminal phase, end of life care,

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bereavement
g. Current Laws relevant to end of life care decisions ?
withholding, withdrawing artificial life interventions
2. Skills
At the end of the course, the student shall be able to:

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a. Develop clinical skills (history taking, clinical examination and other instruments of
examination) in various common medical disorders and emergencies.
b. Refer a patient to secondary and/or tertiary level of health care after having instituted
primary care.
c. Perform& interpret simple routine investigation like hemogram, stool, urine, sputum and

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biological examinations
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d. Assist the common bed-side investigate procedures like pleural tap, lumbar puncture, bone
marrow aspiration/biopsy and liver biopsy.

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e. Learn to Commuicate with patients regarding common Medical
problems, investigations and treatment .
f. Learn to address Common ethical issues in medical ward and OPD .
g. * Student should be aware of the rights of the patient, issues like autonomy, consent etc
- Integrated Care for chronic diseases? Assess, advice, agree, arrange, assist

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- Principles of managing symptoms of advanced progressive diseases
- Palliative Care for advanced cardiac failure, renal failure
- Palliative Care for breathlessness, Nausea/Vomiting, Delirium
Palliative care for neurological disorders
3. Integration

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a. With community medicine and physical medicine and rehabilitation to have the knowledge
and be able to manage important current national health programs, also to be able to view the
patient in his/her total physical, social and economic milieu:
b. With other relevant academic input which provide scientific basis of clinical medicine eg:
anatomy, physiology, biochemistry, microbiology, pathology and pharmacology.

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C. DETAILED SYLLABUS
DETAILS OF THE COURSE
Duration of the course
:5 semesters ? III, V, VI, VIII & IX
Total number of theory

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: 300
Lectures
: 100
Innovative sessions
: 200

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Practicals
: Clinical posting as per schedule attached
(Project work,
Integrated teaching, Formative
Seminars, Structured

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evaluation, Revision)
LECTURES
1. Molecular and Genetic factors in disease
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a. Basics of cell and molecular biology; DNA,RNA, Genes, mitochondria, cell
membrane, receptors; protein production and degradation
b. Cell division, cell death
c. Patterns of inheritance and common disorders, investigations, counseling
d. Stem cell therapy, gene therapy, new horizons

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Exercises : Eg.The cell ; a family tree for various common inherited diseases
2. Nutrition and nutritional disorders
a. Macronutrients, dietary recommendations
b. Micronutrients-vitamins, minerals, deficiencies & excess
c. Energy balance- body fat distribution, regulation, needs, responses to over

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nutrition and under nutrition, assessment of nutritional status
d. Assessment & Management of Obesity & under nutrition
e. Nutritional support in hospital, in pregnancy & lactation
Exercises: eg western vs Indian (also different parts of India) meals ; role of
fiber in diet

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3. Environmental and Occupational problems
a. Environmental effects on health, alcohol, smoking, air pollution, radiation
hazards, Temperature regulation and extremes of temperature, high altitude,
under water, problems of air travel, epidemics- Triage & Resuscitation
b. Hanging, drowning, electrical injuries; lightning injury

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c. Fluorosis
d. Food hygiene and poisoning
Exercises: eg how to plan an epidemiological study; Minamata disease, others
4. Poisoning
a. Evaluation of a patient with suspected poisoning,

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b. Sedatives, antidepressants, antipsychotics;
c. insecticides, pesticides, rodenticides- organophosphorus, organochlorides, Rat
poison, Paraquat
d. Odollum
e. Acid & alkali, Ethyl & Methyl alcohol

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f. Bites of venomous animals, including snakes, spiders, scorpion, wasps
g. Evaluation of a patient with suspected envenomation, general principles of
management
Exercises: Eg, Common poisons in the region, presentations, management;
Composition of common Tablets/ capsules/ household remedies/ chemicals

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around the house and workplace- with measures to eliminate the poison
5. Immunological factors
a. Anatomy, physiology of the immune system; B & T lymphocytes,
immunoglobulin, immune reaction
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b. The inflammatory response- physiology, pathology, presentations, assessment
c. Autoimmune diseases- pathology, susceptibility, assessment
d. Immune deficiency- presentation, syndromes
e. Anaphylaxis, urticaria, angioedema, transplantation immunology

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6. Infectious disease
a. Viral infections-
i. with exanthem: measles, chicken pox, herpes zoster, herpes simplex 1 &
2, dengue, hand foot and mouth disease
ii. Without exanthem- influenza, mumps

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iii. With rheumatological involvement- Chikungunya
iv. With GI, Respiratory, Neurological involvement
b. Bacterial infections-
i. Common gram positive infections-overview, then specifics- skin, soft
tissue, bone infections, cellulitis,

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ii. Common gram negative infections- overview, then specifics
iii. Enteric infections. Salmonella including typhoid, paratyphoid, bacillary
dysentery-shigella, different causes of food poisoning, cholera, C. Difficile,
iv. Respiratory infections- Sinusitis, bronchitis, diphtheria, pneumonias,
pneumocystis carinii, chlamydia

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v. Mycobacterial infections- tuberculosis, Hansen's; atypical Mycobacteria
vi. HIV infection, AIDS
1. Clinical presentations, investigations, diagnosis of HIV infections
2. The importance of pre-test & post- test counseling, breaking bad
news

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3. Natural history and Staging of HIV
4. Antiretroviral therapy, Preventing opportunistic infections
vii. CNS-
1. Meningitis -viral, bacterial,tuberculous, fungal, how to
differentiate, management principles ; Chemoprophylaxis for

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purulent meningitis
2. Parenchymal ?viral encephalitis, Rabies,
Poliomyelitis,H.zoster,SSPE
3. Cerebral abscess, neurosyphilis
viii. Diseases caused by bacterial toxins- tetanus, botulism

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ix. Rickettsial fevers- typhus
x. Protozoa infections. Malaria, Leishmaniosis, Amoebiasis, Giardiasis
xi. Helminthic infestations Ancylostomiasis, filariasis (Luminal & tissue
nematodes)
xii. Tape worms

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xiii. Fungal infections.
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1. Superficial- candidiasis
2. Subcutaneous- mycetoma

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3. Systemic-aspergillosis, cryptococcosis, histoplasmosis,
coccdiomycosis
c. General principles of use of antimicrobial agents, abuse of antimicrobials;
antimicrobial resistance; antiviral, antifungal agents
d. Approah to a patient with suspected infection, sepsis, eosinophilia, PUO

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e. Adult immunisation
7. Fluid and Electrolytes
a. Water &Electrolyte balance, hypovolemia, dehydration- assessment, correction
b. disorders of Sodium, Potassium balance, acidosis, alkalosis
Exercises:

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8. Renal medicine
a. Functional anatomy, Structure & function of the Nephron, Clinical assessment of
the Kidney & Urinary tract; significance of examining the urine, assessing GFR,
proteinuria, investigating for renal vascular disease, infections of the urinary tract
b. Glomerular vs tubular disease, Nephrotic syndrome, acute kidney injury- causes,

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complications, management; Chronic kidney disease- causes, complications,
including anemia, bone disease, management- conservative, preventing
deterioration; renal replacement therapy, renal transplantation- indications,
problems, costs
c. Pregnancy and renal disease, drugs and the kidney

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Exercises:
9. CVS
a. Functional anatomy & physiology, cardiac Cycle, Ventricular function, Biomarkers,
Clinical assessment of the heart and circulation- ECG, chest Xray, basics of
angiography

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b. Coronary circulation, coronary artery disease, its complications, angina,
myocardial infarction, management
c. Conducting system of the heart, abnormalities of cardiac rate and rhythm,
principles of identification & basic management
d. Acute Rheumatic fever, rheumatic heart disease, assessment, complications,

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management options, infective endocarditis
e. Congenital heart disease, assessment, complications, management options
f. Myocardial disease. Myocarditis, cardiomyopathy
g. Acute & Chronic pericarditis
h. Deep vein thrombosis, pulmonary embolism, management

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Exercises: Cardiac cycle, normal ECG, ECG in Myocardial infarction, atrial
fibrillation, complete heart block
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10. Respiratory System

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a. Functional anatomy & physiology, Bronchopulmonary segments, Clinical
assessment of the lungs, control of breathing, investigations - pulmonary function
tests, imaging
b. Bronchal Asthma, bronchitis, bronchiectasis, Lung abcess, bronchogenic Ca,
obstructive sleep apnoea

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c. COPD, corpulmonale
d. Pleural diseases
e. Interstitial Lung disease
f. Respiratory failure- assessment, management
Exercises: Bronchopulmonary segments, PFTs, clinical importance

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11. GIT
a. Functional anatomy & physiology, Digestion, absorption, gut hormones, Clinical
assessment & investigations of the GIT,
b. Functional anatomy & physiology, Clinical assessment & investigations of the
hepatobiliary system; interpreting Liver Function tests

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c. Dysphagia, Gastroesophageal reflux, peptic ulcer disease, gastric Ca, upper GI
Bleeding,
d. Symptoms and signs, investigations of Diseases of the small & large gut- diarrhea,
malabsorption, lactose intolerance, infections of the small gut, irritable bowel
syndrome, ischemic of the gut

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e. Inflammatory bowel disorders, diverticulosis of the large gut, tumors of the large
gut, constipation
f. Acute & chronic pancreatitis, gallstones, other GB diseases
g. Acute and chronic Hepatitis
h. Chronic liver disease

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i. Assessment of a patient with jaundice, ascites, Acute liver failure, hepatic
encephalopathy, portal hypertension, portal vein thrombosis, chronic liver
disease
j. Alcoholic, non-alcoholic liver disease, autoimmune liver disease, primary &
secondary malignancy of the liver

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k. Drug- induced liver disease
l. Inherited liver diseases- Wilson's, haemochromatosis, Gilbert's
m. Pregnancy & the liver
n. Liver transplantation
Exercises: Liver function tests- various abnormalities; abnormalities in ascitic

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fluid
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12. Hematology
a. Functional anatomy & physiology, Haemopoesis, Clinical assessment &

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investigations of the haemopoietic system; Iron, B12, Folate absorption,
abnormalities
b. Interpreting a haemogram
c. Bleeding & Clotting disorders, Tests of coagulation, Bleeding & clotting disorders,
d. Thrombotic disorders

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e. Anemia- presenting features, assessment, investigations, management
f. Different types of anemia, Fe deficiency, B12, Folate, Hemolytic, anemia of
chronic disease
g. Haemoglobinopathies- assessment, sickle cell disease, thalassemias
h. Polycythemia- Primary & Secondary, presenting features, assessment,

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management
i. High and low White cell counts- clinical assessment, investigations, management
j. High and low platelet counts- clinical assessment, investigations, management
k. Pancytopenia
l. Hematological malignancies, lymphoma, Lymphadenopathy, splenomegaly

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m. Paraproteinemias
n. Blood products, transfusions, adverse effects, safe transfusions, stem cell
transplantation
Exercises: Abnormalities in a Haemogram, blood smear
13. Rheumatology

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a. Presenting problems , Clinical examination, assessment, investigations of
rheumatological disease: Osteoarthritis, Rheumatoid arthritis, crystal
arthropathy, SLE, systemic sclerosis, seronegative spondyloarthropathies,
reactive arthritis, connective tissue diseases, vasculitis
b. Non-Pharmacological & pharmacological therapy of rheumatological disease-

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principles, problems, side effects
c. Osteoporosis, vitamin D deficiency
Exercises: abnormalities in the joint fluid
14. Endocrinology
a. Organization of the endocrine system, functional anatomy & physiology, clinical

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presentations, overview of investigations
b. Disorders of Pituitary function
c. Thyroid gland-anatomy, physiology, abnormalities (hyper & Hypo function,
thyroiditis)
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d. Adrenal glands ? functional anatomy, physiology, assessment, Cushing's,
Addison's, Hyperaldosteronism, Phaochromocytoma
e. Calcium metabolism, hyperparathyroidism, hypercalcemia, hypocalcemia, tetany
f. Diabetes mellitus

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i. Clinical presentations, examination; diabetes mellitus Types 1&2 , other
forms
ii. Diagnosis of diabetes mellitus, complications
iii. Managing diabetes: Life style management, Diet and Drugs in the
management of diabetes mellitus, oral medications, insulin, incretin based

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therapy
iv. Hypoglycemia, diabetes in special situations
v. Managing the complications of diabetes mellitus
Exercises: Inter-relation of the Pituitary with other endocrine organs; Thyroid
function tests; diagnosing diabetes mellitus; identification & management of

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the complications of Diabetes; differences in management of type 1 and Type 2
diabetes
15. Nervous system
a. Overview of the nervous system, basic anatomy & blood supply of the Brain, csf
production& circulation, abnormalities, the need for localization; the value of

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history and physical examination, overview of tests available
b. Headache syndromes, migraine, seizures, anticonvulsant therapy
c. Clinical features of Meningitis ?how to differentiate & manage the varioustypes,
d. Intracranial space occupying lesions- including subdural haemorrhage, the need
to identify and treat early

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e. Delirium, Coma, brain death
f. Strokes : infarction vs hemorrhage, assessment, broad principles of localization ,
the need for urgent intervention when possible
g. Amnesia, dementias, neurodegenerative disorders
h. Demyelinating disorders, paraneoplastic neurological disorders

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i. Parkinson's disease, Motor neurons disease, CNS Tuberculosis
j. Anatomy & Overview of diseases of the spinal cord, transverse myelitis,
Syringomyelia, tumors,
k. Polyneuropathy, Guillain Barr? syndrome, Peripheral neuropathy
l. Myasthenia gravis, other myasthenia syndromes, disorders of muscle

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Exercises: The structure of the Neuron; clinical differences between upper
motor and lower motor neurone lesions; differentiating hemispheric from
brainstem lesions; differentiating spinal cord,peripheral nerve and muscle
disease
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16. Medical disorders of Pregnancy
a. Prenatal genetic testing, infections in the antenatal period, prescribing in
pregnancy, air travel
b. Gestational diabetes mellitus

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c. Endocrine disorders- pituitary, thyroid, adrenal,
d. Liver, kidney, cardiac, respiratory, neurologic disease , venous thromboembolism
in pregnancy
17. Critical care
a. Severe sepsis, shock, Multi-organ failure

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b. Management of acute LVF, acute severe asthma, acute coronary syndrome
c. Cardiopulmonary resuscitation, BLS, ACLS, when / whether to resuscitate
d. Disseminated intravascular coagulation
e. Coma, hepatic encephalopathy
f. Bioterrorism, disaster management , mass casualty, the concept of triage.

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18. Ageing
a. Biology of ageing, comprehensive assessment, Frailty, problems in old age- falls,
delirium, dizziness, urinary incontinence, cardiac, GI, neurological problems
b. How much to investigate? How aggressive must one be?
c. Prescribing in the elderly

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d. Rehabilitation
19. Pain and Palliative care
a. Assessment and measurement of pain, psychological aspects of chronic pain
b. Management of pain, breathlessness, cough, nausea, vomiting, dehydration, GI
obstruction, weight loss, lassitude, anxiety, depression

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c. How to break bad news, how to prepare a person to face terminal disease, dying
20. Clinical Pharmacy and Therapeutics
a. General principles of prescribing, rational use of drugs, monitoring drug therapy
b. Drug interactions, Adverse drug reactions,
TEXT BOOKS RECOMMENDED

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1. Principles and practice of Medicine by Davidson
2. Davidsons clinical cases by Mark W Stratchan and S.K.Sharma
3. Text Book of Medicine by Kumar and Clark
4. Text Book of Medicine byDr.K.V.Krishnadas
5. Clinical Medicine by Dr.K.V.Krishnadas

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6. Macleod's clinical examination
7. Hutchison's textbook of clinical methods
8. Hari's Essentials of Clinical Medicine by Dr. P.Baburaj
9. Introduction to clinical methods in medicine ? 2nd edition edited by Dr. V.K
Lakshmanakumar

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REFERENCE TEXT BOOKS
1. Harrison's Principles of Internal Medicine
2. Text Book of Medicine Cecil & Loeb

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3. API textbook of Medicine
4. Oxford Textbook of Medicine
5. Clinical Medicine-Vakil and Golwala
6.
Psychiatry 20Hrs

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? Classification and aetiological factors in psychiatric disorder
? Delirium and Dementia
? Schizophrenia
? Bipolar affective disorders
? Depressive disorders

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? Anxiety disorders and OCD
? Stress and adjustment disorders
? Psychiatric presentations in general practice
? Personality disorders
? Substance use disorders

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? Attempted suicide and suicide risk
? Mental retardation and learning disability
? Autism spectrum disorder and ADHD
? Sexual disorders
? Breaking bad news and crisis intervention

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? Treatment of psychiatric disorders
? Basic communication and counseling skills
? Rehabilitation
? Legal aspects of psychiatry
DERMATOLOGY LECTURES -30 HOURS

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?
Structure and function of skin
?
Infections of Skin
?

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Care of skin, preventing and managing bed sore in a bed ridden patient
?
Eczematous diseases
?
Bullous skin diseases

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?
Connective Tissue Diseases
?
Pigmentary diseases
?

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Papulo squamous diseases
?
Neoplastic diseases of skin
?
Lesions of skin appendages

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?
Adverse drug reactions
?
Veneral diseases
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Leprosy
?
Stigma in medicine and its management in diseases like HIV,STD, Leprosy

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Communicating with dermatology/STD/Leprosy patients
RADIOLOGY LECTURES (INCLUDING RADIOTHERAPY)-20 HOURS
Production of X-rays
Biological changes Skeletal
Radiology Chest &

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Mediastinum
Gastrointestinal system
Hepatobiliary system
Genitourinary system
Neuroimaging modalities

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Emergency Radiology
Respiratory Medicine Lectures 20 hrs
Evaluation of cough
Evaluation of dyspnoea
Investigations in pulmonary medicine

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Bronchial Asthma
COPD
Pneumonia
Lung abscess
Tuberculosis pathogenesis

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Diagnosis & management
Control program
Pleural effusion
Empyema
Neoplasms of lung

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Environmental & occupational lung diseases
Sleep disordered breathing
Pulmonary hypertension
Pulmonary embolism
Interstitial lung diseases

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Basic procedures
Conservative management of irreversible breathlessness in terminally ill patients.
Home Oxygen therapy ? Pros and cons; considerations
before prescribing ambulatory oxygen

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INNOVATIVE SESSIONS
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(Project work, Seminars, Structured discussion, integrated
teaching, Formative evaluation, Revision and Morning sessions)

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A seminar on Pain ? acute, chronic, classification, management, concept of total
pain Controlled substances ? essential analgesics Pain relief as Human Right
I. Common symptoms of disease/clinical approach to
a) Pain
b) Fever

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c) Respiratory symptoms
d) Pallor, Jaundice, Oedema
e) GI symptoms(Chronic constipation as a seminar ? practical skills on high up enema)
f) Haematemesis, Melaena, Bleeding PR/ Haematochezia
g) Urinary symptoms

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h) Neurological symptoms : headache, dizziness, vertigo, weakness, sensory loss
i) Musculoskeletal symptoms : joint swelling,
j) Weight loss and gain

Applied Basic Sciences topics with relevance to Medicine

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Cardiac cycle and ventricular functions
Cardiac biomarkers, (LFT/RFT/PFT) Normal CSF
Blood supply of brain
Lobar function of brain
Functional anatomy of spinal cord Functional anatomy of cranial

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nerves Bronchopulmonary segments Pulmonary circulative
Lympatic drainage of Lung Structure and functions of Nephrons Digestion and absorption
Haemopoesis and Iron metabolism
Thyroid functions and hormones Calcium metabolism
Physiology of pain (&Pathophysiology) Chronic pain as a disease

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Survey of pain score in every In-patient of a chosen ward)
III. Project
work IV.
Seminars
V. Structured discussion

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VI. Formative evaluation
VII. Morning sessions
VIII. Revision
EXAMINATION
At the end of the course the student should have sufficient

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a) Knowledge to diagnose clinical disorders with special reference to Infectious Diseases,
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nutritional diseases, outline various modes of management including drug therapy.
b) Skills in history taking, clinical examination and diagnosis. c)

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d) Perform simple routine investigations
e) Assist the common bed side investigative procedures like pleural tap, lumbar puncture
Part ? II
a)
Medicine

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Theory ? two papers 60 marks each
120 marks
Paper I ? General Medicine
Paper II ? General Medicine (including psychiatry,
dermatology and STD)

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(Shall contain one question on basic sciences and allied
Subjects)
Oral (Viva) interpretation of Xray , ECG etc.
20 marks
Clinical (bedside)

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100 marks
Internal Assessment
60 marks
(Theory ? 30: Practical ? 30)
Total

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300 marks
Paper -I
General Medicine ? Section ? A
I.
10 marks x 1 = 10 marks

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(problem oriented question)
II.
2 marks x 10 = 20 marks)
(short answers)
Section -B

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III. structured question 10 marks x 1 = 10 marks
IV. short question
2 marks x 10 = 20 marks
Paper ? II
General Medicine including Psychiatry, Dermatology and Radio diagnosis

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Section ? A
1.Problem oriented question
10 marks x 1

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= 10 marks
II.
Short answer question
2 marks x 10
= 20 marks

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Section ? B
II.
Structured question
10 marks x 1
= 10 marks

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III.
short answer question
2 marks x 10
= 20 marks
Problem oriented and structured questions must be from General Medicine. There should not

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be more than one question each from radiology, dermatology and psychiatry.
Ensure questions include Pain, - ethical concerns, whole person concerns, symptom
management questions are assessed along with management of the disease
-Role of Multi-disciplinary team work is assessed

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SCHEME OF Practical Examination
Long case
= 40 Marks
Time (60 minutes)
(Marks to be allotted for History- 10 marks, Physical examination- 10 marks, Case sheet writing-

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10 marks; Discussion- arriving at a diagnosis + simple beside investigations +basics of EBM - 10
marks)

Asessment of Long case should be based on
1. Case sheet writing Methodology, Symptoms Signs Diagnosis

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2. Elicitation of findings
3. Differential diagnosis
4. Suggested investigation for diagnosis
5. Treatment of the situation

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OSCE (4 stations- 2.5 marks each, total 10 the objective shall be to assess the candidate on his
knowledge, psychomotor skills and communication skills.
Time for each OSCE station 2 minutes
Total = Long Case (40) + OSCE (10) : 50 marks .
Short Cases (2x 25= 50 marks)

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(15 minutes each)
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(Questions for the Long Case, OSCE, Short Cases shall be on the basis of 60% 'must know',
30% 'good to know' and 10% 'nice to know'

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Viva voce: 4 stations, 5 marks each (Total 20 marks)
PAEDIATRICS&NEONATOLOGY
DETAILS OF THE COURSE
Duration of course
: 10 weeks in 3

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VI ,VIII &IX
semesters
Total number of hours theory
:100
Lectures

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:34 (including pediatric surgery)
Clinical
8-9 AM Tutorials
9 AM 1 PM Case discussions &
Innovative sessions

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Exposure of students to newborns and emergency management is inadequate during
ten weeks of under graduate postings. During evening hours they should be posted in
causality, ICU and new born nursery.

General guidelines

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Apart from bedside discussion there should be 66 hours of Innovative sessions during clinical
sessions in the forenoon session. This comprises of project work, seminars, structured
discussion, and integrated teaching.
Simple day to day problems should be given more importance.

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Sessions which will improve communication skills and attitude should be given more
importance.
Pediatric casualty posting is compulsory during the final year posting. They should be posted in
Intensive care unit and new born nurseries during evening hours with due care to prevent
infections in nurseries .

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There should be enough pediatric surgery case exposure during clinical sessions
The training in pediatrics should prepare the student to deliver preventive, promotive, curative
and rehabilitative services for care of children both in the community and rehabilitative services
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