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2015
LIAQUAT NATIONAL MEDICAL COLLEGE 1ST YEAR MBBS, SEMESTER 2 LOCOMOTOR MODULE
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STUDY GUIDE FOR LOCOMOTOR SYSTEM
S.No CONTENTS: Page No
1 Overview 03
2 Introduction to Study Guide 04
3 Learning Methodologies 05 4 Assessment Methods 06
5 Semester Examination Rules And Regulations of JSMU 08
6 Module 1: Locomotor System
6.1 Importance of Locomotor System 11 6.2 Objectives and strategies 11
6.2.1 Anatomy 11
6.2.2 Biochemistry 17 6.2.3 Community Medicine 18
6.2.4 Neurology 19 6.2.5 Orthopedics 19
6.2.6 Pathology 19
6.2.7 Pharmacology 20 6.2.8 Physiology 22
6.2.9 Physiotherapy 23 6.2.10 Research & Skill Lab 24
6.2.11 Rheumatology 24 6.3 Skills &Practicals 25
7 Learning Resources 26
8 Modular Examination Rules And Regulations (LNMC) 27 9 Schedule 28
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Module name: Locomotor System
Semester: Two Year: One Duration: 6 weeks
Timetable hours: Lectures, Case-Based Learning (CBL), Self-Study, Practical, Skills,
Demonstrations, First Aid, Visit to Wards
Credit hours:6 credit hours in theory and 3 credit hours in practical
MODULE INTEGRATED COMMITTEE
DEPARTMENTS’& RESOURCE PERSONS’ FACILITATING LEARNING
BASIC HEALTH SCIENCES CLINICAL AND ANCILLARY DEPARTMENTS
ANATOMY
Professor Zia-ul-Islam
Professor Faiz Muhammad
NEUROLOGY
Dr Naveeduddin Ahmed
Dr. Hazim Brohi
BIOCHEMISTRY
Professor Jawed Altaf Baig
ORTHOPEDICS
Professor Shahid Noor
Dr.Zaki Idrees
COMMUNITY MEDICINE
Professor Rafiq Soomro
PHYSIOTHERAPY
Mr. Hassan Abbas
PATHOLOGY
Professor Naveen Faridi
RADIOLOGY
Dr Muhammad Ayub Mansoor
PHARMACOLOGY
Professor Nazir Ahmad Solangi
RESEARCH AND SKILLS DEVELOPMENT CENTER
Dr Kahkashan Tahir
Dr Sara
PHYSIOLOGY
Professor Syed Hafeezul Hassan
RHEUMATOLOGY
Dr Tahira Perveen
Dr Lubna Nazir
DEPARTMENT of HEALTHCARE EDUCATION
Professor Nighat Huda Dr. Mirza Aroosa Beg
LNH&MC MANAGEMENT
Professor Amir Ali Shoro, Dean & Principal, Director FHS LNH&MC
Dr. Shaheena Akbani, Controller A.A & R.T LNH&MC
STUDY GUIDE COMPILED BY: Department of Health Care Education
Dr. Muhammad Suleman Sadiq
Dr. Rabia Mahmood
MODULE COORDINATOR: Professor Zia-ul-Islam CO-COORDINATOR: Professor Nighat Huda
LIAQUAT NATIONAL MEDICAL COLLEGE 1ST YEAR MBBS, SEMESTER 2 LOCOMOTOR MODULE
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INTRODUCTION
WHAT IS A STUDY GUIDE?
It is an aid to:
Inform students how student learning program of the semester-wise module has been
organized
Help students organize and manage their studies throughout the module
Guide students on assessment methods, rules and regulations
THE STUDY GUIDE:
Communicates information on organization and management of the module.
This will help the student to contact the right person in case of any difficulty.
Defines the objectives which are expected to be achieved at the end of the module.
Identifies the learning strategies such as lectures, small group teachings, clinical skills,
demonstration, tutorial and case based learning that will be implemented to achieve the
module objectives.
Provides a list of learning resources such as books; computer assisted learning program, web-
links, journals, for students to consult in order to maximize their learning.
Highlights information on the contribution of continuous and semester examinations on the
student’s overall performance.
Includes information on the assessment methods that will be held to determine every student’s
achievement of objectives.
Focuses on information pertaining to examination policy, rules and regulations.
CURRICULUM FRAMEWORK
Students will experience integrated curriculum similar to previous modules of the first semester.
INTEGRATEDCURRICULUM comprises of system-based modules such as locomotor system, respiratory,
cardiovascular, endocrine which links basic science knowledge to clinical problems. Integrated teaching
means that subjects are presented as a meaningful whole. Students will be able to have better
understanding of basic sciences when they repeatedly learn in relation to clinical examples.
Case based discussions, computer-based assignments, early exposure to clinics, wards, and skills
acquisition in skills lab, Physiotherapy department are characteristics of integrated teaching program.
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LEARNING METHODOLOGIES
The following teaching / learning methods are used to promote better understanding:
Interactive Lectures
Hospital / Clinic visits
Small Group Discussion
Case- Based Learning
Practicals
Skills session
Self-Directed Study
INTERACTIVE LECTURES
In large group, the lecturer introduces a topic or common clinical conditions and explains the underlying
phenomena through questions, pictures, videos of patients’ interviews, exercises, etc. Students are
actively involved in the learning process.
HOSPITAL VISITS: In small groups, students observe patients with signs and symptoms in hospital or
clinical settings. This helps students to relate knowledge of basic and clinical sciences of the relevant
module.
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SMALL GROUP SESSION: This format helps students to clarify concepts acquire skills or attitudes.
Sessions are structured with the help of specific exercises such as patient case, interviews or discussion
topics. Students exchange opinions and apply knowledge gained from lectures, tutorials and self study.
The facilitator role is to ask probing questions, summarize, or rephrase to help clarify concepts.
CASE- BASED LEARNING: A small group discussion format where learning is focused around a series of
questions based on a clinical scenario. Students’ discuss and answer the questions applying relevant
knowledge gained in clinical and basic health sciences during the module.
PRACTICAL: Basic science practicals related to anatomy, biochemistry, pathology, pharmacology and
physiology are schedule for student learning.
SKILLS SESSION: Skills relevant to respective module are observed and practiced where applicable in
skills laboratory or Department of Physiotherapy.
SELF-DIRECTED STUDY: Students’ assume responsibilities of their own learning through individual study,
sharing and discussing with peers, seeking information from Learning Resource Center, teachers and
resource persons within and outside the college. Students can utilize the time within the college
scheduled hours of self-study.
ASSESSMENT METHODS:
Theory: Best Choice Questions (BCQs)also known as MCQs (Multiple Choice Questions) is used to asses
objectives covered in each module.
A BCQ has a statement or clinical scenario followed by four to five options (likely answer).
Students after reading the statement/scenario are supposed to select ONE, the most
appropriate response from the given list of options.
Correct answer carries one mark, and incorrect ‘zero mark’
Students mark their responses on specified computer-based sheet designed for LNHMC.
OSPE: Objective Structured Practical Examination
The content may assess application of knowledge, or practical skills.
A structured examination that will have observed, unobserved, interactive and rest stations.
Observed and interactive stations will be assessed by internal or external examiners.
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Unobserved will be static stations in which students will have to answer the question on the
provided response sheet.
Rest station is a station where there is no task given and in this time student can organize
his/her thoughts.
Internal Evaluation
During the module, students will be assessed to determine achievement of module objectives.
Module Examination: will be scheduled on completion of each module. The method of
examination comprises theory exam which includes BCQs, and practical (Objective Structured
Practical Examination).
20% marks of internal evaluation will be added in theory of semester exam. That 20% will
include class attendance, class tests and the modular exam which all have specific marks
allocation.
Formative Assessment
Individual department may hold quiz or short answer questions to help students assess their
own learning. The marks obtained are not included in the internal evaluation
Example : Number of Marks allocated for Semester Theory and Internal Evaluation
Semester
Semester Examination Theory Marks
Internal Evaluation (Class test + Attendance +
Modular Exam) Total (Theory)
80% 20% 100%
More than 75% attendance is needed
to sit for the modular and semester
examinations
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SEMESTER EXAMINATION RULES & REGULATIONS OF JINNAH SINDH MEDICAL UNIVERSITY
(JSMU)
In one academic year there will be two semesters. The semester duration is approximately sixteen weeks.
Each semester may have two to three modules from two to eight weeks duration.
JSMU EXAMINATIONS:
JSMU will schedule and hold Semester Examinations on completion of each semester.
In one academic year, there will be two semester examinations and one Retake Examination.
MBBS first year:
Semester I examination is scheduled on completion of Foundation Module and Blood Module
Semester II Examination is scheduled on completion of Locomotor Module, Respiratory and
Cardiovascular Modules.
Examination Protocols:
In each semester, there will be ONE Theory paper comprising MCQs and practical OSPE
(Objective Structured Practical Examination).
1. Theory
Theory paper will comprise of 100 one best type MCQs.
Time duration for theory paper will be 120 minutes.
Students will mark their responses on JSMU specified response sheets assessed by computer software.
It will carry out 80% contribution in theory results of the Semester.
2. OSPE:
It is to be held at the respective college unless specified by JSMU.
Each OSPE examination will be in two shifts at 4/5 tracks (depending on number of candidates).
It may comprise between 12- 25 stations. Each station will carry 10 marks.
All students begin and end at the same time.
The content assessed is the same for all students
The time allocated for each station is the same.
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3. JSMU Grading System
It will be based on GPA – 4 system
Marks obtained in Percentage range
Numerical Grade Alphabetical Grade
80-100 4.0 A+
75-79 4.0 A
70-74 3.7 A-
67-69 3.3 B+
63-66 3.0 B
60-62 2.7 B-
56-59 2.3 C+
50-55 2.0 C
<50 Un-grade-able 0 U
A candidate obtaining GPA less than 2.00 (50%) is declared un-graded (fail).
Cumulative transcript is issued at the end of clearance of all modules.
4. Retake Examination
The failures are to re-appear in subsequent examinations.
It is held once a year that is after the even number semesters. For example at the end of second, fourth, sixth, eighth or tenth semester.
Retake examinations are for those students who fail in semester examinations, and who wish to improve grades (GPA) secured in semester examinations.
The candidate who has passed the semester examinations with GPA less than 3.0 GPA may re-appear in respective retake examination to improve grades.
MBBS first year Candidates failing in retake examinations may re-appear in semesters’ examinations of the following year. The format is exactly the same as in semester examinations.
EXAMPLE OF PROMOTION RULES:
A student who fails in Semester One Examination and passes Semester Two, s/he will take Retake for
Semester One Examination. S/he passes Semester Two and is promoted to 2nd year. If that student
FAILS in Retake, s/he will be promoted to 2nd year BUT will have to Pass Semester One examination in
Second year along with Semester Three and Four examinations for promotion to third year.
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Never regard study as a duty, but
as the enviable opportunity to
learn to know the liberating
influence of beauty in the realm of
the spirit of your own personal joy
and to the profit of the community
to which your later work belongs.
(Albert Einstein)
5. Promotion to next class
Students who pass both semester examinations are promoted from first year to second year.
Students who fail the MBBS first year semester retake examination will be promoted to second year.
Students will be promoted from second year to third year and onward only if they have passed the semester examinations of that year.
Clearance of all modules and their components of semester one to four are mandatory for promotion from second year to third year (as per PMDC rules).
As per PMDC rules any candidate failing to clear a module or its component in four (1+3) attempts is not allowed to carry out further medical education.
Clearance of all modules and their components of semester/s are mandatory for promotion from third year onward.
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MODULE 1 : LOCOMOTOR SYSTEM
IMPORTANCE OF LOCOMOTOR SYSTEM
It is likely that everyone will, at some time, suffer from a problem related to the musculoskeletal system,
ranging from a very common problem such as osteoarthritis or back pain to severely disabling limb
trauma or rheumatoid arthritis. Many musculoskeletal problems are chronic conditions. The most
common symptoms are pain and disability, with an impact not only on individuals’ quality of life but
also, importantly, on people’s ability to earn a living and be independent. It has been estimated that one
in four consultations in primary care is caused by problems of the musculoskeletal system. Healthy
lifestyle such as exercise and diet can help one maintain good health.
COURSE OBJECTIVES AND STRATEGIES
ANATOMY
At the end of the module the students will be able to:
Objectives of upper limb Strategy
Describe the Osteology and muscular attachment of clavicle and scapula
Demonstration
Identify microscopic features of bone and cartilage
Lecture\ skills
Identify break in weight transmission from upper limb to axial skeleton due to fractures of bones of pectoral girdle and resulting disabilities
Small Group Discussion\CBL
Identify the importance of mesoderm in embryological basis of diseases
Lecture
Describe the normal structure and development of mammary gland. Correlate the involvement of upper limb in carcinoma breast
Lecture
Describe the Osteology and muscular attachments on bones of Humerus
Demonstration
Describe the shoulder joint and anastomosis around it
Demonstration
Correlate the clinical manifestation of shoulder region (winging of scapula and drooping of shoulder by relating the muscle, ligaments and neurovascular bundle of scapula region)
Small Group Discussion\CBL
Identify the congenital anomalies of cartilage by discussing its structure and chemistry
Lecture
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Identify the boundaries and content of axilla and pectoral region
Demonstration
Describe the histological features of muscle
Lecture\Skills
Identify the lesions and dermatological distribution of brachial plexus, with knowledge of its structure and formation
Small Group Discussion
Recognize the congenital anomalies of upper and lower limbs by knowing their development with special emphasis on the following: a)Polydactyly b)Meromelia c)Coxavara d) CoxaValga e)Talipesequino varies
f) Talipesequino valgus
Lecture
Describe the course, branches and applied anatomy of: Vessels: Axillary and brachial artery and vein Nerves: Axillary, musculocutaneous, ulnar, radial and median nerve
Demonstration
Describe the Osteology and muscular attachments on bones of upper limb(radius and ulna)
Demonstration
Describe the development of muscles
Lecture
Describe the elbow joint and anastomosis around it
Small Group Discussion
Describe the actions of the muscles and neurovasculature of Compartments of forearm
Demonstration
Describe the osteology, actions of the muscles and neurovasculature of hand
Demonstration
Identify the boundaries and contents of cubital fossa, and anatomical snuff box and palmer spaces
Demonstration
Describe the wrist and hand joint
Demonstration\Skills
Describe the lymphatic drainage of upper limb
Lecture
Mark the following structures/areas on a simulator Arteries: axillary, brachial, ulnar, radial, superficial and deep palmar arches Nerves: axillary, musculocutaneous, ulnar, radial and median Retinacula: Flexor and Extensor Retinacula Area for intramuscular injection in upper limb Area for venepuncturein upper limb Dermatomes
Skills\Practical
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Explain the anatomical basis of: a) Common dislocation of shoulder joint b) Painful arc of shoulder joint c) Tennis elbow d) Students elbow e) Pulled elbow / slipped elbow f) Posterior dislocation of elbow joint g) Wrist drop h) Wrist fracture (Colle’s and smith fracture) i) Boxer and Bennett’s fracture j) Saturday night palsy k) Dupuytren’s contracture l) Volksman contracture m) Klumkey’s and Erb’s palsy n) Winged scapule o) Claw hand p) Cricket finger q) Carpel tunnel syndrome r) Ape like han
Small Group Discussion
Differentiate between the normal and abnormal radiographs of upper limb
Lecture\Demonstration
Recognize the importance of venous system of upper limb with localization of antecubital vein for drawing blood
Lecture
Enumerate the muscles and joints of upper limb involved in daily life activities
Demonstration
Mark the surface anatomy of major nerves and vessels of upper limb
Skills
At the end of the module, students will be able to:
Objectives of Lower Limb Strategy Describe the gross structure and muscular attachment of hip bone and
femur
Demonstration
Identify the effect of break in weight transmission from axial skeleton to lower limb
CBL
Describe the group actions and clinical relevance of the muscles of following regions / compartments: a) Gluteal region b) Anterior, posterior and medial compartments of leg
Demonstration
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Describe the boundaries and contents of : a)Femoral triangle b)Femoral sheath c)Adductor canal d)Saphenous opening
Demonstration
Describe formation, branches, lesions and dermatological distribution of the following nerves/plexus a) Lumbar plexus b) Sacral plexus c) Femoral &Obturator nerve d) Sciatic nerve
Demonstration
Identify the clinical effects of lumbosacral root and nerve compression
CBL
Identify the injuries as a result of stab wound on the front of thigh
CBL
Describe the deep fascia of thigh its modification, inguinal ligament
Lecture
Differentiate femoral from inguinal hernia
Lecture
Describe the gross structure, anastomosis and applied anatomy of hip joint
Lecture\Demonstration
Indicate the features of avascular necrosis of hip joint
Lecture
Describe the course, branches and clinical significance of femoral and popliteal artery
Demonstration
Describe the osteology and muscular attachment of tibia and fibula
Demonstration
Describe the boundaries and contents of popliteal fossa
Demonstration
Describe the group actions and clinical relevance of the muscles of anterior, posterior and lateral compartments of leg
Demonstration
Describe the gross structure, possible movements and applied anatomy of knee joint
Demonstration
Differentiate between normal and abnormal knee joint
Demonstration
Describe formation, branches, lesions and dermatological distribution of the following nerves/plexus. a) Tibial nerve. b) Common peroneal nerve
Demonstration
Describe the course, branches and clinical significance of anterior and posterior tibial artery.
Demonstration
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Describe the gross structure of bones of foot with their muscular attachment.
Demonstration
Describe the gross structure, possible movements and applied anatomy of the following joints:- a) Ankle joint b) Superior and inferior tibiofibular joint c) Subtalar joint
Demonstration
Describe the group actions and clinical relevance of the muscles of sole of foot
Small Group Discussion
Describe formation, branches, lesions and dermatological distribution of common perennial nerve
Small Group Discussion
Describe the course, branches and clinical significance of dorsalispedis artery
Demonstration
Describe the attachment and structure passing beneath extensor and flexor retinaculum
Demonstration
Describe the venous and lymphatic drainage of lower limb
Lecture
Identify and mark the anatomical points used for surface marking of: a) Femoral, popliteal, anterior and posterior tibial and dorsalispedis arteries. b) Great saphenous, small saphenous and femoral vein c) Sciatic, tibial, common peroneal, superficial and deep peroneal nerves
Demonstration
Identify and mark the anatomical points used for: a) Femoral artery catheterization b) Venous cut down
Small Group Discussion
Identify the above-mentioned blood vessels and nerves on dissected limb, models & photographs
Demonstration
Describe the layers of sole of foot
Lecture
Describe arches of foot and the role of foot as a weight bearer and a lever
Lecture
Recognize the importance of varicose veins of lower limb
Lecture
Identify the applied anatomy of foot drop
Small Group Discussion
Recognize the importance of soleal pump in relation to deep vein thrombosis
Small Group Discussion
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Recognize the effects of ischemia and neuropathy of foot
Small Group Discussion
Identify “flat foot” and its mechanical effects
Small Group Discussion
Enumerate the muscles, joint and nerves of lower limb involved in daily life activities
Small Group Discussion
Mark the surface anatomy of major nerves and vessels of lower limb
Demonstration
Differentiate between the normal and abnormal radiographs of lower limb
Demonstration
At the end of the module the students will be able to:
Objectives of Back Strategy
Describe the main distinguishing characteristic of vertebrae in different regions of vertebral column
Demonstration
Describe the atlanto-occipital and atlanto-axial joints
Lecture
Describe the muscles, ligaments of back and intervertebral joints
Lecture
Describe the structure of intervertebral disc and mechanism of its prolapsed
Small Group Discussion
List common sites of disc prolapsed
Small Group Discussion
Describe the reason for more common rupture of intervertebral disc in the lumber region.
Small Group Discussion
Deduce the nerve root compressed and identify the appropriate herniated disc on a given scenario or MRI.
Demonstration
Describe the normal primary and secondary curves of the spine
Lecture
Describe the important pathological curves of the spine
Lecture
Describe posture and its maintenance.
Lecture
Identify different component of vertebral column on a given radiograph and MRI
Demonstration
Identify the muscles/group of muscles on model or photograph
Demonstration
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BIOCHEMISTRY
By the end of this module students will be able to:
OBJECTIVES LEARNING STRATEGY
BIOCHEMISTRY OF CONNECTIVE TISSUES (GLYCOSAMINOGLYCAN)
Describe the chemical composition of connective tissue
Explain the composition of ground substance
Explain the functions of Glycosaminoglycans
Lecture
CONNECTIVE TISSUES (ECM) COLLAGEN & ELASTIN
Describe the chemistry of collagens
Classify collagen and identify its uses
Explain the chemical composition of elastin
Explain the functions of elastin
Lecture
COLORIMETRY
Understand the functions of colorimeter in Lab Practical
HORMONAL REGULATION OF CALCIUM AND PHOSPHATE, HYPER AND HYPOCALCEMIA.
Relate mineral metabolism, role of hormones and Vitamin D in connection with bones
Describe Ca, PO4, metabolism
Explain the synthesis, regulation, functions, sources and deficiency of Vitamin D
Give an over view of regulation and release of PTH
Explain the regulation and release of Calcitonin
Recall normal values of calcium and phosphate in serum
Relate hypocalcaemia and hypercalcemia and its consequences
Describe hypophosphatemia & Hyperphosphatemia
Lecture
Explain the major components of cartilage
Explain the structure and chemical composition of myelin sheath
Describe the types of lipids present in the myelin sheath, their structure, functions & biomedical importance
Describe types of proteins present in myelin sheath, their structure, function & biomedical importance
Explain the biochemical role of vitamin B12 in the synthesis of fatty acids in the myelin sheath
Explain the significance of enzymes present in myelin sheath
Discuss the metabolic Changes in muscles during and after exercise and their effects
Lecture
Estimate serum Ca level in blood/serum
Practical
Estimate serum PO4 level in blood/serum Practical
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Describe the composition of nucleotides and nucleoside
Explain digestion of nucleic acids
Explain Biosynthesis of purine nucleotide
Describe degradation of purine nucleotides
Lecture
ESTIMATION OF SERUM ALKALINE PHOSPHATASE IN SERUM
Estimate and interpret enzyme Alkaline Phosphatase in serum
Practical
COMMUNITY MEDICINE
By the end of this module the students will be able to:
OBJECTIVES STRATEGY OCCUPATIONAL HEALTH
Explain promotion and maintenance of the physical, mental and social well- being of workers in all occupations
Categorize occupational diseases, their prevention and treatment
Describe the placement of worker in an occupational environment suitable for physiological and psychological needs
Lectures
HEALTH EDUCATION
Relate principles of health education in individuals, family and community to develop health consciousness
Relate various stages of health education to bring positive behavioral changes in individuals and community
Use different methods of health education to educate, instruct and influence the communities
Lectures
INTRODUCTION TO BIOSTATISTICS
Describe briefly biostatics, vital statistics, vital index etc and main types of biostatistics
Identify the role of biostatistics in the field of Public Health, Medicine and Research
Lecture
INTRODUCTION TO EPIDEMIOLOGY I
Define epidemiology and enumerate its uses
Classify the types of epidemiology and its importance in Public Health, Clinical medicine and Research
Lecture
DEMOGRAPHY
Define demography
Describe sources of demographic data and measures of fertility
Lectures
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Explain the stages of Demographic Transition Cycle and relate it with Pakistan scenario
Describe and compare Population Pyramid and Age-sex composition of a population
NEUROLOGY
At the end of the module the students will be able to:
OBJECTIVES STRATEGY MYOPATHIES
Explain Myopathies, its types, causes and its signs & symptoms
CBL
ORTHOPAEDICS
At the end of the module the students will be able to:
OBJECTIVES STRATEGY Discuss the various types of limb trauma and its clinical implications
Identify the various types of limb fractures /dislocations and there clinical presentations
CBL
PATHOLOGY
At the end of the module the students will be able to:
OBJECTIVES STRATEGY OSTEOPOROSIS
Define Osteoporosis
Discuss the different types of osteoporosis
Differentiate the histological features of an osteoporotic bone with normal bone
Discuss sequence of pathological events leading to osteoporosis
Lecture
Explain the histopathology of Osteomalacia, Osteomyelitis and Rickets
CBL
FRACTURE REPAIR
Define bone fracture
Describe the stages of bone repair (internal, intermediate and external callus formation)
Lecture
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Outline the role of the periosteum and endosteum in repair
List common factors affecting repair of bone and their resulting pathology BONE TUMORS
Classify soft tissue and bone tumors
Correlate the pathology with the clinical presentation, behavior and spread
Describe giant cell tumor of bone and Ewing sarcoma regarding common sites, age, prognosis and morphology
BREAST TUMORS
Classify breast tumors
Differentiate the histopathological features of different types of breast tumor
Lecture
Explain breast abscess formation and common breast tumors
CBL
PHARMACOLOGY
At the end of the module the students will be able to:
OBJECTIVES STRATEGY NSAIDs & OPIOID Analgesics ASPRIN:
Explain its mechanism of action
Discuss its therapeutic effects and clinical uses
Explain its adverse effects
Enlist its contraindications
Explain drug interactions
Explain symptoms and treatment salicylate overdose
Lecture
ACETAMINOPHEN & OTHERS:
Compare Acetaminophen with Aspirin
Explain the symptoms and treatment of Acetaminophen overdose
Compare Indomethacin with Aspirin
Discuss the advantages and disadvantages of COX2
Compare Brufen with Aspirin
Discuss the uses and adverse effects of Diclofenac
Lecture
OPIOIDS:
Explain Opioid receptors and mechanism of action of drug
Discuss the systemic side effects of Morphine
Enlist uses of Morphine
Enlist adverse effects of Morphine
Discuss contraindications of Morphine
Lecture
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Discuss treatment of Morphine dependence
Discuss symptoms and treatment of acute Morphine overdose
Enlist Morphine antagonists
Compare Pethidine with Morphine
MUSCLE RELAXANTS
NEUROMUSCULAR BLOCKING DRUGS:
Classify the neuromuscular blocking drugs
Explain mechanism of action of depolarizing and non-depolarizing NMBDs
Discuss adverse effects of depolarizing and non-depolarizing NMBDs
Explain the indications for use of NMBDs
Enlist drug interactions of NMBDs
Lecture
CENTRALLY ACTING MUSCLE RELAXANTS
Discuss the mechanism of action of centrally acting muscle relaxants
Explain the uses of centrally acting muscle relaxants
Lecture
TREATMENT OF MUSCULOSKELETAL DISORDERS
GOUT
Discuss the treatment of acute gout attack
Explain mechanism of action and adverse effects of Colchicine
Discuss Allopurinol as treatment of chronic gout
Identify uricosuric drug
Lecture
OSTEOPOROSIS
Explain the mechanism of action of Bisphosphonates
Explain Pharmacokinetics of Bisphosphonates
Explain adverse effects of Bisphosphonates
Discuss the indications for the use of Selective Estrogen Receptor Modulators
Discuss the indications for the use of Calcitonin
Discuss the indications for the use of Teriparatide
Lecture& CBL
RHEUMATOID ARTHRITIS
Explain mechanism of action of Methotrexate
Discuss adverse effects of Methotrexate
Explain mechanism of action of Leflunomide
Discuss adverse effects of Leflunomide
Discuss the drugs used in combination with Methotrexate
Discuss the contra-indications of D-Penicillamine
Discuss the adverse effects of gold salts
Explain the therapeutic indications of Etanercept& Infliximab apart from Rheumatoid Arthritis
Explain the mechanism of action of Etanercept& Infliximab
Discuss the adverse effects of Infliximab
Explain the mechanism of action of Adalimumab
Discuss the therapeutic indications of Adalimumab
Lecture&CBL
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PHYSIOLOGY
At the end of the module the students will be able to:
OBJECTIVES STRATEGY ELECTRICAL PROPERTIES OF NEURONS
Describe the introduction to nerve and muscle physiology
Explain the types of Glial cells
Describe the structure, function and types of Neuron
Define and discuss Resting Membrane Potential
Lecture
INTRODUCTION TO POWER LAB
Identify the different parts and function of Power Lab.
Practical
ACTION POTENTIAL GENERATION AND PROPAGATION
Define and discuss Membrane potential
Define Nernst Potential and explain the equation
Describe the Goldman Hodgin Katz equation
Define and Discuss nerve action potential and its stages
Explain the initial & propagation of Action potential
Describe the Plateau in some action potential
Define and discuss mono phase and bi phase action potential
Lecture
Explain Action Potential of Skeletal Muscle
Small Group Discussion
EMG
Demonstrate the Electromyography (EMG) with the help of Power Lab
Practical
FUNCTIONAL CLASSIFICATION OF NERVE FIBERS
Describe the types and function of Nerve fibers
Lecture
NCV
Demonstrate the Nerve Conduction Velocity (NCV) with the help of Power Lab
Practical
SKELETAL MUSCLE CONTRACTION MECHANISM
Describe the structure and characteristics of Skeletal muscles
Enlist the contractile filaments and their molecular characteristics
Describe the Sliding mechanism and Walk Along theory
Differentiate between slow and fast muscle fibers
Define Motor Unit, Muscle tone, Muscle fatigue, Muscle Hypertrophy, and Atrophy, effects of Muscle Denervation, Rigor Mortis
Lecture
Explain skeletal muscle structure &contraction
Presentation
Discuss structure of skeletal muscle and theories of muscle contraction Small Group Discussion
LIAQUAT NATIONAL MEDICAL COLLEGE 1ST YEAR MBBS, SEMESTER 2 LOCOMOTOR MODULE
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SUMMATION & TETANIZATION
Illustrate the summation and tantalization through Kymograph
Practical
NMJ/TRANSMISSION
Define and explain the structure and function of Neuromuscular Junction
Lecture
Discuss neuro-muscular Junction
Small Group Discussion
DISORDERS OF NEUROMUSCULAR TRANSMISSION I
Describe Myasthenia Gravis and Lambert-Eaton syndrome
Lecture
Discuss Rigor Mortis
CBL
DISORDERS OF NEUROMUSCULAR TRANSMISSION II
Explain the excitation-contraction coupling
Describe the drugs that effect nerve transmission at NMJ
Lecture
MUSCLE ADAPTATION TO EXERCISE/MUSCLE METABOLISM
Describe the muscle adaptation to exercise
Lecture
MUSCLE BULK POWER AND TONE OF MUSCLE
Measure the muscle bulk power and tone of muscle on the Human Subject
Practical
SUPERFICIAL & DEEP TENDON REFLEXES
Demonstrate the superficial and deep tendon reflexes
Practical
PHYSIOTHERAPY
At the end of the module the students will be able to:
OBJECTIVES STRATEGY CORRELATE THE CLINICAL MANIFESTATION OF SHOULDER REGION
Explain functions of important muscles, ligaments and nerves supply of upper limb
Identify different structures responsible for any shoulder problem e.g. winging of scapula, dropping of shoulder
Discuss different structures, which can lead to shoulder problems
Discuss the benefits of Exercises in the management of shoulder problems
Small Group Teaching
DIFFERENTIATE BETWEEN NORMAL AND ABNORMAL KNEE JOINT
Discuss important functions of different muscles, ligaments and nerves for knee stability and its dynamic function
Explain most commonly knee problem that can limit the daily life activities
Clinically differentiate between normal and abnormal knee
Discuss the benefits of Exercises in the management of knee problems
Small Group Teaching
LIAQUAT NATIONAL MEDICAL COLLEGE 1ST YEAR MBBS, SEMESTER 2 LOCOMOTOR MODULE
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ENUMERATE THE MUSCLES AND JOINTS OF UPPER LIMB INVOLVED IN DAILY LIFE ACTIVITIES
Explain the role of important muscles of upper limb that primarily participate in performing functions of daily activities
Explain the role of major joints in upper limb that provide support to muscles
Discuss the benefits of Exercises in the management of impaired muscle function involved in activities of daily living
Small Group Teaching
RESEARCH & SKILLS DEVELOPMENT
At the end of the module the students will be able to:
OBJECTIVES STRATEGY LOCALIZATION OF UPPER LIMB VEINS FOR DRAWING BLOOD
Know the different indications of I/V Cannulation
Select the appropriate size of cannula for effective use
Demonstrate technique of venous engorgement (via use of venous tourniquets, dependent positioning, “pumping” via muscle contraction) for localization of vessels
Demonstrate proper technique of I/V Cannulation to minimize damage to layers of vessel walls and reduce the risk of PHELIBITIS
Small Group Teaching
FIRST AID SKILLS
Know how to stop visible bleeding
Apply Bandaging skills
Use tourniquets
Take care of amputated digit
Provide First Aid Care in Head Neck and Spine Injuries
Apply Splints
Small Group Teaching
RHEUMATOLOGY
At the end of the module the students will be able to:
OBJECTIVES STRATEGY ARTHRITIS
Identify the common musculoskeletal findings in arthritis
Lecture
GOUT
Identify clinical findings along with radiological and lad abnormalities
CBL
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PRACTICALS & SKILLS:
Microscopic Anatomy
1. Bone
2. Cartilage
3. Muscle
Surface anatomy of upper and lower limb
Movement of joint of upper and lower limb
Nerve lesions of brachial and lumbosacral plexus
Introduction to Power Lab
EMG
NCV
Summation &Tetanization
Superficial and deep reflexes
Measurement of Bulk, power and tone
Estimation of Ca in Serum
Estimation of PO4 in Serum
Role of colorimeter in Lab
Estimation of Alk.Po4 in Serum
Demonstrate first aid-skill in simulated environment
LIAQUAT NATIONAL MEDICAL COLLEGE 1ST YEAR MBBS, SEMESTER 2 LOCOMOTOR MODULE
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LEARNING RESOURCES
SUBJECT RESOURCES
ANATOMY
A. GROSS ANATOMY 1. K.L. Moore, Clinically Oriented Anatomy 2. Neuro Anatomy by Richard Snell
B. HISTOLOGY 1. B. Young J. W. Health Wheather’s Functional Histology 2. Langman’s Medical Embryology
C. EMBRYOLOGY 1. Keith L. Moore. The Developing Human 2. Langman’s Medical Embryology
BIOCHEMISTRY
A. TEXTBOOKS 1. Harper’s Illustrated Biochemistry 2. Lehninger Principle of Biochemistry 3. Biochemistry, Devlin
COMMUNITY MEDICINE
A. TEXT BOOKS 1. Community Medicine Parikh 2. Community Medicine by M Illyas 3. Basic Statistics for the Health Sciences by Jan W Kuzma
PATHOLOGY/MICROBIOLOGY
A. TEXT BOOKS 1. Robbins & Cotran Pathologic Basis of Disease, 9th edition. 2. Rapid Review Pathology, 4th edition by Edward F. Goljan MD
1. http://library.med.utah.edu/WebPath/webpath.html 2. http://www.pathologyatlas.ro/
PHYSIOLOGY
A. TEXTBOOKS 1. Textbook Of Medical Physiology By Guyton And Hall 2. Ganong ‘ S Review Of Medical Physiology 3. Human Physiology By Lauralee Sherwood 4. Berne & Levy Physiology 5. Best & Taylor Physiological Basis Of Medical Practice
B. REFERENCE BOOKS 1. Guyton & Hall Physiological Review 2. Essentials Of Medical Physiology By Jaypee 3. Textbook Of Medical Physiology By InduKhurana 4. Short Textbook Of Physiology By Mrthur 5. NMS Physiology
CDs/DVDs
Internet Recourses
Skill Lab
Computer Lab
LIAQUAT NATIONAL MEDICAL COLLEGE 1ST YEAR MBBS, SEMESTER 2 LOCOMOTOR MODULE
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MODULAR EXAMINATION RULES & REGULATIONS (LNH&MC)
Student must report to examination hall/venue, 30 minutes before the exam.
Exam will begin sharp at the given time.
No student will be allowed to enter the examination hall after 15 minutes of scheduled
examination time.
Students must sit according to their roll numbers mentioned on the seats.
Cell phones are strictly not allowed in examination hall.
If any student is found with cell phone in any mode (silent, switched off or on) he/she will be not
be allowed to continue their exam.
No students will be allowed to sit in exam without University Admit Card, LNMC College ID Card
and Lab Coat
Student must bring the following stationary items for the exam: Pen, Pencil, Eraser, and
Sharpener.
Indiscipline in the exam hall/venue is not acceptable. Students must not possess any written
material or communicate with their fellow students.
LIAQUAT NATIONAL MEDICAL COLLEGE 1ST YEAR MBBS, SEMESTER 2 LOCOMOTOR MODULE
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SCHEDULE:
WEEKS 1ST YEAR SEMESTER 2 MONTH
WEEK 1
LOCOMOTOR MODULE
8th July 2015
WEEK 2
WEEK 3
WEEK 4
WEEK 5
WEEK 6
WEEK 7
WEEK 8
MODULAR EXAM Mid August 2015*
WEEK 1
RESPIRATORY MODULE
WEEK 2
WEEK 3
WEEK 4
WEEK 5
WEEK 6
MODULAR EXAM
WEEK 1
CVS MODULE
WEEK 2
WEEK 3
WEEK 4
WEEK 5
WEEK 6
MODULAR EXAM
PREPARATORY LEAVE
SEMESTER EXAM
RETAKE *Final dates will be announced later.