verily, along with every al-quran: 94; 5 study...

YUSRA MEDICAL & DENTAL COLLEGE, ISLAMABADZaraj Housing Scheme, Opp DHA Phase II, Gate 3

Main GT Road, Islamabad.Phone: 5709443-5 Fax: 5709428

& D l ea nci tade l CM oa llr es gu eY

Al-Quran: 94; 5

Verily, along with everyhardship is relief

STUDY GUIDE

YUSRA MEDICAL &

DENTAL COLLEGE, ISLAMABAD

st1 Year MBBS

2017

Hematology and Immunology Module


Al-Quran: 94; 5


Index S.No Topic Page

1 Team members 1

2 Introduc�on 2

3 Curriculum framework 4

4 Main content areas 5

5 Teaching / learning methods 6

6 Student assessment 7

7 Recommended reading material 8

8 Module organiza�on 9

9 Anatomy 10

10 Physiology 14

12 Biochemistry 22

13 Ver�cal integra�on 28

14 Timetable 35

1

Team Members 2017

Name Committee Department

Prof Dr. Idress Farooq Butt

Chief Coordinator

Physiology

Dr. Aysha Babar

Assistant Professor Coordinator Physiology

Dr. Shaista Khalid

Senior Lecturer Member Anatomy

Miss Gul Zareen Asifa

Senior Lecturer Member Biochemistry

Dr. Huma Ameen

Assistant Professor Member Pathology

Dr. Fatima Qasim Malik

Senior Lecturer Member Pharmacology

Dr. Shahid Pervaiz Khan

Assistant Professor Member Community Medicine

Dr. Kausar Malik

Assistant Professor Member Medicine

Dr. Sidra-Tul-Munteha

Assistant Professor Member Pediatrics

Prof Dr. Muhammad Luqman

Director Member Medical Education

2

INTRODUCTION

Assalam - u-Alaikum and a very warm welcome to medical students in the hematology

and immunology module. This module has been developed to impart integrated teaching as

a part of modular curriculum in Yusra Medical & Dental College, Islamabad. It will be

covered in six weeks. The module has been planned to study the normal composi�on and

func�ons of blood in context of related clinical problems. This will benefit the learners to

understand the basic informa�on in rela�on to applied sciences. The study of immunology

will help the students to understand the defense system of body.

In the founda�on module you have studied the cell which is the basic structural and

func�onal unit of the body. When cells group together to perform specific func�on, they

form �ssues and organs. Blood being the specialized connec�ve �ssue is one of the basic

�ssues essen�al for nourishment and viability of all body �ssues. The general body needs of

oxygen, nutrients, vitamins and minerals are fulfilled by blood. Being an excellent transport

medium, blood also helps human body in transport of hormones to target �ssues and

excre�on of wastes.

This module will comprehensively cover the components and func�ons of blood and

immune system of body and their role in preven�on of disease. Moreover, the study of

plasma proteins, their types and role in homeostasis, and its biochemical aspects will be the

part of this module.

3

GENERAL LEARNING OBJECTIVES:

By the end of this module, the students will be able to:

ANATOMY

· Identify the gross structure and functions of haemopoietic system.

· Identify and describe the blood forming organs, and the locations where blood is formed.

· Describe the development of components of lymphoid system.

· Describe the production of lymph and pattern of lymph flow from lymphatic capillaries to the

venous system.

PHYSIOLOGY

· Describe hemopoiesis and functions of different blood cells.

· Explain physiological basis of different hematological disorders and transfusion reactions.

· Comprehend the role of immune system in defense against microorganisms.

BIOCHEMISTRY

· Outline the types, structure, functional importance and disorders related to hemoglobin and

myoglobin.

· Describe heme proteins, heme metabolism, porphyrins, porphyrias and jaundice.

· Explain the role of plasma proteins and immunoglobulins in health and disease.

5

FIRST YEAR MBBS

MAIN CONTENT AREAS

ANATOMY

General anatomy:

· Production of lymph and pattern of lymph flow

Gross anatomy:

· Gross anatomy of blood forming organs

· Gross anatomy of lymphoid organs

Histology:

· Components of haemopoietic system

· Microscopic structure of lymph node, spleen, tonsil and thymus

Embryology

· Development of blood elements

· Development of component of lymphoid organs

PHYSIOLOGY

· RBCs; physiology and anemia · White blood cells and immunity

· Allergy, hypersensitivity and transplant rejection

· Haemostasis

· Blood groups and blood transfusions · Hemorrhagic and haemostatic disorders · Immune system and disorders

BIOCHEMISTRY

· Heme metabolism, porphyrins, porphyrias · Jaundice · Hemoglobin and myoglobin · Plasma proteins and immunoglobulins

6

Teaching / Learning Methods

The teaching and learning sessions of this module will be of diverse types:

a. Large group interactive sessions (LGIS)

b. Small group teaching will include interactive tutorials

c. Problem – based learning sessions (PBL)

d. Practical sessions will comprise sessions on early exposure to clinical methods and

practical laboratory demonstrations

e. Seminars: on different topics, in which students will make oral presentations on different

aspects of the allocated topics

f. Self-directed learning sessions (SDL): This is the time during which students are expected

to study what they have learnt in the class, clear their concepts by consulting different text

books, reference material and prepare their assignments and projects.

7

Students Assessment

At the end of module 3 and 4 (Block -2) there will be an examination which will comprise the

following sections:

i. Written Assessment

The theory paper will be of two hours duration and have components of one best type multiple

choice questions (MCQs), short – essay questions (SEQs) and short-answer questions (SAQs).

ii. Practical / lab examination:

This will comprise Objective Structured Practical Examination (OSPE) and practical examination.

The OSPE will have both observed and non-observed stations. A viva voce session will also be

incorporated.

The OSPE / Practical / viva voce will be conducted in batches in the subjects of anatomy,

physiology and biochemistry.

iii. Seminars

Assessment of seminar presentation will be done in the following categories:

Student Name

Seminar Topic

Facilitator

Marks

Subject Knowledge

(05)

Body Language

(01)

Interaction with

Audience (0.5)

Standard of Presentation

(02)

Delivery Style (0.5)

Eye Contact

(0.5)

Attitude Towards

Questioning (0.5)

Total (10)

8

Recommended Reading Material

Gross Anatomy

i. Cunningham’s Manual of Practical Anatomy vol. I- 15th edition, 1986.

ii. Clinical Anatomy by Regions. Richard S. Snell, 9th edition, 2012.

iii. Netter Atlas of Human Anatomy. 5th edition 2011.

Reference Books

iv. Clinically Oriented Anatomy. Keith L Moore, 6th edition, 2010.

v. Gray’s Anatomy. 40th edition, 2008.

General Anatomy

i. General Anatomy.Dr. Laiq Hussain, 3rd edition, 2011.

ii. Understanding General Anatomy. Professor Tassaduq Hussain, 14th edition, 2014.

Embryology

i. Langman’s Medical Embryology. 12th edition, 2012.

Histology

i. Medical Histology. Dr. Laiq Hussain, 5th edition, 2015.

ii. Basic Histology. Junqueira, 13th edition, 2013.

iii. DiFiore’s Atlas of Histology. 12th edition, 2013.

Physiology

i. Guyton and Hall Text book of Medical Physiology. 13th edition. 2016.

ii. Human Physiology: From Cells to Systems. Lauralee Sherwood, 9th edition, 2014.

iii. Lippincott’s Illustrated Reviews: Physiology, 1st edition, 2013.

iv. Lab Manual Physiology, part 1st, 3rd edition.

Biochemistry

i. Lippincott’s Illustrated Reviews: Biochemistry 6th edition, 2014.

ii. Harper’s Illustrated Biochemistry. 30th edition, 2012.

iii. Essentials of Medical Biochemistry. Mushtaq Ahmed, Vol I and II, 8 th edition, 2011.

9

Organization

Time Distribution

Horizontal Integration Basic Medical Sciences

· Anatomy 81 Hours

· Physiology 87 Hours

· Biochemistry 75 Hours

· PBL 12 Hours

Vertical Integration

· Medical Education 2 Hours

· Pathology 4 Hours

· Pharmacology 1 Hour

· Medicine 1 Hour

· Pediatrics 1 Hour

Longitudinal Integration

· Community Medicine 5 Hours

· Islamiat & Pak studies 6 Hours

_______________________________

Total 275 Hours

_______________________________

Anatomy

10

Anatomy Lectures

*K: Knowledge

S NO

Learning Objectives By the end of the session, students will be

able to: Content Areas

Teaching Activity

(Duration) Assessment

1.

Development of blood element

· Describe the development of different

types of blood cells. (K)

· Outline the development of

component of lymphoid system. (K)

· Explaine Teratogenesis and describe

which is the most vulnerable

period.(K)

· Formation of blood (erythropoiesis)

· Island of blood in yolk sac third week of

development, Haemopoietic stem cells

around aorta near kidney, Liver as

hematopoietic organ. Stem cells from liver

colonize bone marrow – definitive blood

forming tissue

LGIS 1 hour

MCQs SEQs SAQs Viva

2. General Anatomy of Blood

· Explain morphology of Plasma and formed element of blood .(K)

· Morphology of

Erthyrocytes,Leucocytes Granulocytes,

Agranaulocytes ,Platelets

LGIS 1 hour

MCQs SEQs SAQs Viva

3.

Lymphoid tissue – I

· Describe the microscopic features of

lymph node and spleen. (K)

· Lymph nodes

Afferent and efferent of lymph node,

cortex Medulla, sinuses of lymph node

Spleen

Red and white pulp of spleen

Periarterial lymphatic sheath ( PALS)

Spleenomegaly ,Spleenectomy

LGIS 1 hour

MCQs SEQs SAQs Viva

4.

Lymphoid tissue – II

· Explain the microscopic features of

thymus and tonsils. (K)

· Thymus

Thymic lobule Hassel’s corpuscles

Tonsils

Tonsilar crypt, Lymphatic nodules,

Epithelium covering of the tonsilar crypt

Tonsilar Abscess.

LGIS 1 hour

MCQs SEQs SAQs Viva

5.

General Anatomy of lymphatic system

· Describe how and where lymph is formed. (K)

· Lymphatic flow from the right side of the

body, Lymphtic flow from the left side of

the body and its ultimate drainage into

venous system.

LGIS 1 hour

MCQs SEQs SAQs Viva

6.

Development of lymphoid organ

· Describe the development of lymphatic organs. (K)

· Development of lymph node, spleen,

thymus and tonsils

LGIS 1 hour

MCQs SEQs SAQs Viva

11

Anatomy Practicals

S NO



Teaching Activity


1.

Spleen

· Demonstrate the gross feature of spleen

with the help of models. (S)*

· Anatomical position of spleen

,General feature of spleen

· Visceral impression of the spleen and

hilum of spleen

Demonstration 2 hours

OSPE*

2.

Lymph node

· Identify and demonstrate the location of

lymph nodes in different areas of the

body. (S)

· Demonstrate the gross features of lymph

node with the help of model. (S)

· Afferent and efferent of lymph node,

Sinuses of lymph node, cortex,

medulla and lymphatic nodule.


OSPE

3.

Tonsils

Identify the location of different types of

tonsils with the help of models. (S)

· Palatine tonsils, Pharyngeal tonsils

and Lingual tonsils. Demonstration

2 hours OSPE

4.

Thymus

Identify the location and gross features of

thymus with the help of model. (S)

· Thymus, Location in the neck and its

descent in the thorax in superior

mediastinum.


OSPE

5.

Microscopic picture of spleen

Identify the microscopic picture of spleen by

slide. (S)

· Spleen, White pulp, Red pulp, Cords

of bilroth, PALS. Demonstration

2 hours

OSPE

6.

Microscopic picture of Lymph node

Identify the microscopic picture of lymph node

with the help of slide. (S)

· Lymph node,Cortex,Medulla,Afferent

and efferent lymphatic, Lymphatic

nodule, sinuses.


OSPE

7.

Microscopic picture of Thymus

Identify the microscopic picture of thymus

with the help of slide. (S)

· Thymus,Thymiclobule,Cortex,

· Medulla,Hassel’s corpuscles


OSPE

8.

Microscopic picture of Tonsils

Identify the microscopic picture of tonsils with

the help of slide. (S)

· Tonsils, Tonsils crypt,Epithelium

over the tonsil ,Lymphatic nodule

and Tonsilar abscesses.


OSPE

*S: Skills *OPSE: Objective Structural Practical Examination

12

Anatomy Seminars

S NO



Teaching Activity


1.

Development of blood element

· Describe the development of different

types of blood cells. (K)

· Enumerate components of lymphoid

system and explain teratogenesis. (K)

· Formation of blood (erythropoiesis)

· Island of blood in yolk sac third week of

development

· Haemopoietic stem cells around aorta

near kidney

· Liver as hematopoietic organ

· Stem cells from liver colonize bone

marrow – definitive blood forming tissue

Student Presentation

7 mins

Marking /

Evaluation Marks 10

2.

General anatomy of blood · Plasma and formed element of blood.

(K)

· Morphology of

Erythrocytes

Leucocytes

Granulocytes

Agranaulocytes

Platelets


7 mins

Marking /

Evaluation Marks 10

3.

Lymphoid tissue – I

· Describe the microscopic features of

lymph node and spleen. (K)

· Lymph nodes

Afferent and efferent of lymph node

Red and white pulp of spleen

Periarterial lymphatic sheath ( PALS)

Spleenomegaly

Spleenectomy


7 mins

Marking /

Evaluation Marks 10

4.

Lymphoid tissue – II

· Explain the microscopic features of

thymus and tonsils. (K)

· Thymus

Thymic lobule

Hassel’s corpuscles

Spleen

Tonsils

Tonsilar crypt

Lymphatic nodules

Epithelium covering the tonsilar crypt


7 mins

Marking /

Evaluation Marks 10

5.

General anatomy of lymphatic system

· Describe how and where lymph is

formed. (K)

· Lymphatic flow from the right side of the

body

· Lymphatic flow from the left side of the

body

· Ultimate drainage into venous system


7 mins

Marking /

Evaluation Marks 10

13

6.

Development of lymphoid organs

· Describe the development of

lymphatic organs. (K)

· Development of lymph node

· Development of spleen

· Development of thymus

· Development of tonsils


7 mins

Marking /

Evaluation Marks 10

Physiology

14

Physiology Lectures

S

NO

Learning Objectives

By the end of the session, students will be able to:

Content Areas

Teaching Activity

(Duration)

Assessment

1.

Introduction to physiology of blood

· Enlist components of blood and explain

its functions. (K)

· Blood composition

· Plasma proteins and their functions

· Blood cells types and their significance

LGIS

1 hour

MCQs

SEQs

SAQs

Viva

2.

RBCs Physiology

· Define and explain hemopoiesis along

with morphological characteristics of red

blood cells. (K)

• Sites of hemopoiesis

• Bone marrow types

• Factors controlling growth and

differentiation.

• Morphology of RBCs

• Erythrocytes (RBCs) functions

• Physiological variations in RBC Count

LGIS

1 hour

MCQs

SEQs

SAQs

Viva

3.

Erythropoiesis

· Define erythropoiesis and explain the

stages of erythropoiesis along with its

regulation.(K)

• Sites of erythropoiesis

• Stages of erythropoiesis

• Appearance of Hemoglobin

• Regulation of erythropoiesis

• Erythropoietin.

• Growth and differentiation inducers

• Maturational factors for erythropoiesis

• Nutritional needs for erythropoiesis

• Deficiency of maturational factors and

nutritional requirements for

erythropoiesis.

• Reticulocytosis

LGIS

1 hour

MCQs

SEQs

SAQs

Viva

4.

Fate of red blood cells

· Describe iron metabolism. (K)

· Explain the fate of RBC and subsequent

metabolism of its various components.

(K)

• Iron absorption, transport and storage in

the body.

• Life span of RBCs

• Fate of RBCs

• Erythrocyte degradation inside

macrophages

• Degradation of heme to bilirubin.

• Hemolysis and jaundice

• Types of hemoglobin.

LGIS

1 hour

MCQs

SEQs

SAQs

Viva

15

5.

Red blood cell indices and anemia

• Define blood indices and explain the

significance of each. (K)

• Define and classify anemias. (K)

• Parameters needed to calculate RBC

indices.

• Normal range of RBC count, Hematocrit

and Hb in male and female.

• Calculation of Mean Corpuscular

Hemoglobin (MCH), Mean Corpuscular

Hemoglobin Concentration (MCHC),

Mean Corpuscular Diameter (MCD) and

Colour Index (CI).

• Etiological classification of anemias

• Morphological classification of anemias

•

LGIS

1 hour

MCQs

SEQs

SAQs

Viva

6.

Anemia

· Discuss the role of blood indices in the

diagnosis of various types of anemias.

(K)

· Define polycythemia and explain the

effects of polycythemia. (K)

• Iron deficiency anemia

• Megaloblastic anemia

• Pernicious anemia

• Sickle cell anemia

• Hereditary Spherocytosis

• Polycythemia Vera and secondary

Polycythemia

LGIS

1 hour

MCQs

SEQs

SAQs

Viva

7.

White blood cells:

· Classify white blood cells and explain

leucopoiesis. (K)

· List the properties of WBCs. (K)

· Neutrophils

· Eosinophils

· Basophils

· Monocytes

· Macrophages

· Mast cells

· Genesis of myelocytes and lymphocytes

· Concentration of different W.B.Cs in

blood

· Life span of WBCs

· Draw a flow chart showing steps of

leucopoiesis

LGIS

1 hour

MCQs

SEQs

SAQs

Viva

8.

Functions of WBCs

· Describe the properties of different types

of leucocytes. (K)

· Explain the role of neutrophils and

macrophages in inflammation. (K)

· Diapedesis

· Amoeboid motion

· Chemotaxisis

· Phagocytosis by neutrophils and

macrophages

· Mediators of inflammation

· Walling-off effect of inflammation

· Feedback control of the macrophage and

Neutrophil responses

· Formation of Pus

LGIS 1 hour

MCQs SEQs SAQs Viva

16

9.

Monocyte-macrophage system

· List the components of monocyte

macrophage system (reticuloendothelial

system). (K)

· Enumerate disorders involving increase

or decrease in different types of WBCs.

(K)

· Tissue macrophages

· Alveolar macrophages

· Macrophages of spleen and bone

marrow

· Kupffer cells

· Macrophages of spleen and bone

marrow

· Leucopenia, Leukocytosis, leukemoid

reaction, leukemia

· Causes of neutropenia and Neutrophilia

· Causes of Basophilia, Eosinophilia,

Monocytosis and Lymphocytosis

LGIS 1 hour

MCQs SEQs SAQs Viva

10.

Immunity

· Define and classify immunity and

explain the preprocessing of B and T-

lymphocytes. (K)

· Define humoral immunity and explain the

mechanism for activation of a clone of

lymphocytes. (K)

· immune system

· innate and acquired immunity

· antigens, antibodies, haptens and

immune system

· preprocessing of T-Lymphocytes

· preprocessing of B-Lymphocytes

· Mechanism of activation of clone of

lymphocytes

· Formation of memory cells

· Primary and secondary response

· Active and Passive immunity

· Antigen presenting cells and their role

LGIS 1 hour

MCQs SEQs SAQs Viva

11.

Humoral and cell mediated immunity

· Classify immunoglobulins and mention

the functions of each. (K)

· Define and explain the cell mediated

immune responses with examples. (K)

· Nature of antibodies

· Classes of antibodies(IgA,IgM,IgG,IgD

and IgE)

· Mechanism of activation of antibodies

· Direct actions of antibodies

· Complement system(Classic and

alternate pathways)

LGIS 1 hour

MCQs SEQs SAQs Viva

12.

Allergy and hypersensitivity

· Define allergy, hypersensitivity, allergens

and reagins. (K)

· Outline the physiological basis of

inflammatory response in allergy. (K)

· immediate and delayed allergic

responses (Anaphylaxis, Urticaria, Hay

Fever)

· Role of mast cells, Basophils and

eosinophils

LGIS 1 hour

MCQs SEQs SAQs Viva

17

13.

Platelets

· Enlist the functions of platelets and

explain their role in haemostatic

responses of the body. (K)

· Platelet ultra structure and functions

· Platelet activation

· Platelet plug formation

· Qualitative and quantitative platelet

disorders

LGIS 1 hour

MCQs SEQs SAQs Viva

14.

Haemostasis

· Define haemostasis and explain the

mechanism of blood coagulation. (K)

· List the clotting factors. (K)

· Intrinsic and extrinsic pathway

· Formation of clot

· fate of clot

LGIS 1 hour

MCQs SEQs SAQs Viva

15.

Anti-clotting mechanisms

· List the factors that prevent coagulation

in vivo and vitro. (K)

· Describe the fibrinolytic system and its

clinical significance. (K)

· Endothelial surface factors

· Antithrombin

· Heparin

· Plasminogen activator system

LGIS 1 hour

MCQs SEQs SAQs Viva

16.

Haemorrhagic/haemostatic disorders

· List various bleeding and clotting

disorders and explain their physiological

basis. (K)

· List various qualitative and quantitative

platelet disorders. (K)

· Bleeding time, clotting time, and their

significance

· Purpura and its causes

· Hemophilia

· Thrombocytopenia

· Disseminated intravascular coagulation

· Role of vitamin K and liver disease in

clotting defects.

· Thromboembolic conditions

LGIS 1 hour

MCQs SEQs SAQs Viva

17.

Blood groups

· Classify blood groups and describe the

antigens and antibodies present in the

ABO and the Rh blood group system. (K)

· Explain the terms universal donors and

universal recipient. (K)

· Discuss Rh incompatibility during

pregnancy. (Erythroblastosis Foetalis)

(K)

· Significance of blood groups

· The antigens and antibodies present in

the ABO blood group system.

· The antigens and formation of antibodies

in the Rh blood group system.

· The principles of inheritance in the ABO

the Rh blood group system.

· Blood typing.

LGIS 1 hour

MCQs SEQs SAQs Viva

18.

Blood transfusion

· List the Indications of blood transfusion.

(K)

· List the hazards of blood transfusions

and explain the physiological basis of

· ABO incompatibility

· Rh incompatibility during pregnancy.

(Erythroblastosis Foetalis )

· Acute renal shutdown

LGIS 1 hour

MCQs SEQs SAQs Viva

18

complications of mismatched and

matched blood transfusion. (K)

19.

Transplantation of tissues and organs

· Explain the physiological basis of organ

transplant and graft rejection. (K)

.

· Autologous and homologous blood

transfusion

· Transplantation of tissues and organs.

· Types of grafts and Tissue typing

· Rejection of graft.

LGIS 1 hour

MCQs SEQs SAQs Viva

Physiology Practicals

S

NO

Learning Objectives

By the end of the session, students will be

able to:

Content Areas

Teaching

Activity

(Duration)

Assessment

1.

Determination of RBCs count

· Identify RBC squares in Neubauer’s

chamber and count RBC in relevant

boxes using Thomas rule of counting and

then calculate the RBC count by using the

appropriate formula. (S)

· Draw blood sample in the RBC pipette,

and should be able to charge the

chamber appropriately. (S)

· Use of Neubauer’s chamber and

compound microscope

· Demonstration of procedure

· Significance of RBCs

Practical

2 hours

OSPE

2.

Determination of total leukocyte count

(TLC)

· Identify WBC square in Neubauer’s

chamber and count WBC in relevant

boxes using Thomas rule of counting and

then calculate the WBC count by using

the appropriate formula. (S)

· Draw blood sample in the WBC pipette,

and should be able to charge the

chamber appropriately. (S)

· Use of Neubauer’s chamber for

WBC counting


· Significance of WBCs

Practical

2 hours

OSPE

3.

Determination of differential leukocyte

count (DLC)

· Demonstrate the preparation of blood film

· Demonstration of procedure for

preparing blood film, staining blood film

and counting the different WBC types

Practical

2 hours

OSPE

19

and its staining. (S)

· Identify various types of WBCS and count

them properly by the method

demonstrated to them. (S)

· Significance of each type of WBC

4.

Determination of platelet count

· Identify the platelet s in RBC counting

area in Neubauer’s chamber and count

platelets in relevant boxes using Thomas

rule of counting and then calculate the

platelet count by using the appropriate

formula. (S)

· Draw blood sample in the RBC pipette

and to charge the chamber appropriately.

(S)

· Use of Neubauer’s chamber for platelet

count


· Significance of platelets and their role in

hemostasis Practical

2 hours

OSPE

5.

Determination of clotting time (CT)and

determination of bleeding time(BT)

· Demonstrate the Dukes method for

measuring bleeding time and measure the

Clotting time using capillary tube method.

(S)

· calculate the bleeding and clotting times

and compare them with normal values.

(S)

· Interpret the clinical significance of CT

and BT in various clotting and bleeding

disorders. (S)

· Demonstration of procedure for bleeding

time by Duke’s method.

· Demonstration of procedure for

measuring clotting time by capillary tube

method.

· Significance of bleeding time and clotting

time in hemorrhagic disorders

Practical

2 hours OSPE

20

Physiology Seminars

S

NO

Learning Objectives


able to:

Content Areas

Teaching

Activity

(Duration)

Assessment

1.

RBCs Physiology

· Define erythropoiesis and explain the

stages of erythropoiesis along with its

regulation. (K)

· Explain iron metabolism ,classify

anemias and discuss the role of blood

indices in the diagnosis of various types

of anemias. (K)

· Define Polycythemia and explain the

effects of Polycythemia. (K)

· Blood composition

· Plasma proteins and their functions

· Blood cells types and their significance

· Sites of hemopoiesis

· Bone marrow types

· Factors controlling growth and

differentiation.

· Morphology of RBCs

· Iron absorption, transport and storage in

the body.

· Life span of RBCs

· Fate of RBCs

· Iron deficiency anemia

· Megaloblastic anemia

· Polycythemia

Student

Presentation

7 mins

Marking /

Evaluation

Marks 10

2.

WBCs Physiology and Immunity

· Classify white blood cells and explain

leucopoiesis. (K)

· List the properties of WBCs the

components of monocyte macrophage

system. (Reticuloendothelial System)

(K)

· Define and classify immunity and

explain the preprocessing of B and T-

Lymphocytes. (K)

· Neutrophils

· Eosinophils

· Basophils

· Monocytes

· Macrophages

· Mast cells

· Genesis of myelocytes and lymphocytes

· Concentration of different W.B.Cs in

blood

· Life span of WBCs

· preprocessing of T and B-Lymphocytes

· Mechanism of activation of clone of

lymphocytes

· Formation of memory cells

· Primary and secondary response

· Active and Passive immunity

· Antigen presenting cells and their role

· Mechanism of activation of antibodies

· Direct actions of antibodies

· Complement system(Classic and

alternate pathways)

Student

Presentation

7 mins

Marking /

Evaluation

Marks 10

21

3.

Platelets

· Define haemostasis and explain the

mechanism of blood coagulation (K)

· Classify blood groups , Explain the

terms universal donors and universal

recipient.

· List the hazards of blood transfusions

and explain the physiological basis of

complications of mismatched and

matched blood transfusion. (K)

· Intrinsic and extrinsic pathway

· Formation of clot

· fate of clot

· Anticlotting mechanism

· Hemophilia

· Thrombocytopenia

· Disseminated intravascular coagulation

· Role of vitamin K and liver disease in

clotting defects.

· Thromboembolic conditions

· Rh incompatibility during pregnancy.

(Erythroblastosis Foetalis

Student

Presentation

7 mins

Marking /

Evaluation

Marks 10

Biochemistry

22

Biochemistry Lectures

S

NO

Learning Objectives


able to:

Content Areas

Teaching

Activity

(Duration)

Assessment

1.

Introduction to hemoglobin

· Discuss structure, functions and types of

hemoglobin and myoglobin. (K)

· Definition of hemoglobin

· Structure of heme

· Structural organization of hemoglobin

· Types of hemoglobin

· Functions of hemoglobin

· Structure and functions of myoglobin

LGIS

1 hour

MCQs

SEQs

SAQs

Viva

2.

Binding and transport of oxygen by

hemoglobin

· Discuss the binding and transport of

oxygen by hemoglobin and myoglobin.

(K)

· Tense (t) and relaxed (r) forms of

hemoglobin

· Cooperative oxygen binding of

hemoglobin

· Oxygen dissociation curve

· Heme-heme interaction and

cooperativity

· Bohr effect

· Allosteric effects

LGIS

1 hour

MCQs

SEQs

SAQs

Viva

3.

Hemoglobinopathies

· Discuss the causes and clinical

manifestations of

hemoglobinopathies.(K)

· Sickle cell anemia

· Hemoglobin C disease

· Hemoglobin SC disease

· Methemoglobinemia

· Thalassemias

LGIS

1 hour

MCQs

SEQs

SAQs

Viva

4.

Heme proteins and their functions

· Enumerate heme proteins along with

their important functions. (K)

· Hemoglobin

· Myoglobin

· Cytochromes

· Peroxidase

· Catalase

LGIS

1 hour

MCQs

SEQs

SAQs

Viva

5.

Synthesis of heme

· Explain the heme biosynthesis and its

regulation. (K)

· Definition of heme.

· Steps involved in the synthesis of heme

· Regulation of heme synthesis

LGIS

1 hour

MCQs

SEQs

SAQs

Viva

6.

Disorders of heme synthesis

· Explain the classification,causes and

· Definition of porphyrias.

· Classification of porphyrias.

LGIS

1 hour

MCQs

SEQs

23

effects of different porphyrias.(K)

· Causes (enzyme involved) and clinical

manifestations of different types of

porphyrias:

ü Acute intermittent porphyria

ü Erythropoietic protoporphyria

ü Variegate porphyria

ü Hereditary coproporphyria

ü Porphyria cutanea tarda

ü Congenital Erythropoietic porphyria

SAQs

Viva

7.

Breakdown of hemoglobin

· Discuss the metabolism and fate of

bilirubin. (K)

· Breakdown of hemoglobin into heme and

globin

· Definition of bilirubin

· Steps in the synthesis of bilirubin

· Fate of bilirubin:

ü Uptake of bilirubin by liver

ü Conjugation of bilirubin in the liver

ü Secretion of conjugated bilirubin into

the bile

ü Excretion of bilirubin.

LGIS

1 hour

MCQs

SEQs

SAQs

Viva

8.

Hyperbilirubinemias: Jaundice I

· Explain the causes, types, differential

diagnosis with help of lab investigations

and clinical manifestations of jaundice.

(K)

· Definition of Hyperbilirubinemia

· Definition of jaundice

· Causes, types, differential diagnosis with

help of lab investigations and clinical

manifestations of jaundice:

ü Hemolytic or prehepatic

ü Hepatocellular or hepatic

ü Obstructive or post hepatic

ü Jaundice in newborns

LGIS

1 hour

MCQs

SEQs

SAQs

Viva

9.

Hyperbilirubinemia II

· Discuss the causes and clinical

manifestations of inherited

Hyperbilirubinemia. (K)

· Causes and clinical manifestations of

inherited Hyperbilirubinemia:

ü Gilbert’s syndrome

ü Crigler-Najjar syndrome

ü Dubin-Johnson syndrome

LGIS

1 hour

MCQs

SEQs

SAQs

Viva

10.

Plasma proteins

· Discuss the classification, functions and

clinical significance of plasma protein.

(K)

· Definition of plasma protein

· Major types of plasma proteins

· Functions and clinical significance of:

ü Albumin

ü Fibrinogen

· Principle and results of protein

separation techniques:

ü Electrophoresis

ü Chromatography

LGIS

1 hour

MCQs

SEQs

SAQs

Viva

24

11.

Plasma Proteins II

· Explain the functions and clinical

significance of globulins. (K)

· Definition of globulins

· Functions and clinical significance of:

ü α1-globulin

ü α2-globulin

ü β-globulin

ü γ-globulin

LGIS

1 hour

MCQs

SEQs

SAQs

Viva

12.

Immunoglobulins (Ig)

· Describe the types, structure, functions

and clinical significance of different types

of immunoglobulins. (K)

· Definition of immunoglobulin

· Structure of immunoglobulin

· Functions and clinical significance of

immunoglobulins:

ü IgG

ü IgA

ü IgM

ü IgD

ü IgE

LGIS

1 hour

MCQs

SEQs

SAQs

Viva

25

Biochemistry Practicals

S

NO

Learning Objectives


able to:

Content Areas

Teaching

Activity

(Duration)

Assessment

1.

Urine analysis-I

· Perform routine urine analysis. (S)

· Collection of urine samples

· Physical properties of urine

Practical

2 hours

OSPE

2.

Urine analysis-II

· Perform physical examination of urine.

(S)

· Determination of pH of urine

· Determination of specific gravity of urine

Practical

2 hours

OSPE

3.

Urine analysis-III

· Perform the biochemical examination of

inorganic constituents of urine. (S)

· Chemical properties of urine

· Biochemical examination of inorganic

constituents:

ü Chlorides

ü Calcium

ü Phosphates

Practical

2 hours

OSPE

4.

Urine analysis-IV

· Perform the biochemical examination of

organic constituents in urine. (S)

· Chemical properties of urine

· Biochemical examination of organic

constituents:

ü Creatinine

ü Uric acid

Practical

2 hours

OSPE

5.

Microscopic examination of urine-I

· Examine urine sample microscopically.

(S)

· Types of deposits in urine:

ü Blood cells

ü Epithelial cells

ü Casts

ü Crystalline and amorphous deposits

· Microscopic examination of urine sample:

ü Blood cells

ü Epithelial cells

Practical

2 hours

OSPE

6.

Microscopic examination of urine-II

· Examine urine sample microscopically.

(S)

· Microscopic examination of urine sample:

ü Casts

ü Crystalline and amorphous deposits

Practical

2 hours

OSPE

26

Biochemistry Seminars

S

NO Title of Seminar Content Areas

Teaching

Activity

(Duration)

Assessment

1.

Plasma proteins and their significance

· Classification of plasma proteins

· Biomedical importance of plasma

proteins

Student

Presentation

7 minutes

Marking /

Evaluation

Marks 10

2.

Immunoglobulins

· Types of Immunoglobulins

· Structure of Immunoglobulins

Student

Presentation

7 mins

Marking /

Evaluation

Marks 10

3.

Bilirubin production, its transport and fate

in the body

· Bilirubin Synthesis, its transport and

fate in body

Student

Presentation

7 mins

Marking /

Evaluation

Marks 10

4.

β Thalassemias

· Types of Thalassemias

· Pathogenesis of β Thalassemias

Student

Presentation

7 mins

Marking /

Evaluation

Marks 10

5.

Hemoglobin-S

· Structure and functions of Hemoglobin-

S

Student

Presentation

7 mins

Marking /

Evaluation

Marks 10

6.

Hemoglobin structure, functions and its

types

· Structure of Hemoglobin

· Types of Hemoglobin

· Functions of Hemoglobin

Student

Presentation

7 mins

Marking /

Evaluation

Marks 10

7.

Heme proteins, their functions and

disorders linked

· Functions and disorders linked with

heme proteins

Student

Presentation

7 mins

Marking /

Evaluation

Marks 10

8.

Heme synthesis and its regulation

· Synthesis of heme

· Regulation of heme synthesis

Student

Presentation

7 mins

Marking /

Evaluation

Marks 10

9.

Hyperbilirubinemia

· Classification of Hyperbilirubinemia

Student

Presentation

7 mins

Marking /

Evaluation

Marks 10

10.

Catabolism of Heme

· Heme catabolism Student

Presentation

7 mins

Marking /

Evaluation

Marks 10

11.

Discussion on jaundice, lab results

showing patients with different causes of

jaundice

· Types of jaundice

· Discussion on lab reports of patients

Student

Presentation

7 mins

Marking /

Evaluation

Marks 10

27

12.

Met hemoglobin and Methemoglobinemia

· Met hemoglobin and disorders linked to

it

Student

Presentation

7 mins

Marking /

Evaluation

Marks 10

VerticalIntegration

28

Medical Education Lectures

S

NO

Learning Objectives


able to:

Content Areas

Teaching

Activity

(Duration)

Assessment

1.

Revision

· Plan revision of knowledge and skills in a

realistic way. (K)

· Concept of revision

· Techniques of revision

· Drawing up a plan

· Revision of knowledge and skills

LGIS

1 hour -

2.

Life – work balance

· Plan and develop a healthy life-work

balance during the medical

education. (K)

· Importance of life-work balance

· Time management

· Stress management

LGIS

1 hour -

Learning resource: How to succeed at medical school. Evans and Brown, BMJ Books, 2009.

29

Pathology Lectures

S

NO

Learning Objectives


able to:

Content Areas

Teaching

Activity

(Duration)

Assessment

1.

Diagnostic approach to anemia

· Enlist basic hematological

parameters in complete blood count

(CBC)and identify the abnormalities

in complete blood count. (K)

· Differentiate types of anemia, their

etiology and outline the relevant

diagnostic tests. (K)

· Basic hematological parameter eg.

Hemoglobin content, Hematocrit,

RBC count, MCV, MCH, MCHC

RDW, WBC count and Platelet

count.

· Definition of anemia

· Pathophysiology of different types

of anemia

· Clinical features of anemia

· Differential diagnosis and

laboratory findings of

microcytic,macrocytic and

normocytic anemia

LGIS

1 hour

MCQs

SEQs

2.

Leukemia

· Define leukemia and its types. (K)

· Explain pathophysiology of leukemia.

(K)

· Definition of leukemia.

· Types of leukemia – acute and

chronic

· Types of leukemia based on cell

type-myeloid and lymphoid

· Pathophysiology of clinical

symptoms in patient of acute and

chronic leukemia

LGIS

1 hour

MCQs

SEQs

3.

CClliinniiccaall pprreesseennttaattiioonn aanndd llaabb ddiiaaggnnoossiiss ooff

bblleeeeddiinngg ddiissoorrddeerrss

·· Identify the abnormalities of primary

and secondary haemostatic system.

(K)

·· Differentiate between the clinical

presentation of patient with primary

versus secondary haemostatic

disorder and outline the laboratory

tests used for their diagnosis. (K)

· Process and component of normal

haemostasis

· Classification of bleeding disorders

( Vascular Defects, Platelets

disorders and Coagulation

Disorders )

· Clinical evaluation of bleeding

patient

· Screening tests for platelets

defects

· Screening tests for coagulation

defects

LGIS

1 hour

MCQs

SEQs

30

4.

Hazards of transfusion

· Explain the Indica�ons of blood

transfusion. (k)

·· Enumerate the major hazards

and the diseases transmi�ed by

blood transfusion. (k)

· Blood components

· Hemoly�c transfusion reac�ons

– ABO and Rh incompa�bility.

· Non hemoly�c transfusion

reac�ons - Allergic and febrile

reac�ons.

· Transmission of disease by

transfusion ( Viral, bacterial,

protozoal) and their preven�on

LGIS

1 hour

MCQs

SEQs

Learning resource: Robins Basic Pathology. B. Kumar.9th edition, 2013.

31

Pharmacology Lecture

Learning resource: Basic and Clinical Pharmacology. Betram G. Katzung, 13th edition, 2015,

Chapter: 34.

.

S

NO

Learning Objectives


able to:

Content Areas

Teaching

Activity

(Duration)

Assessment

1.

Introduction to anti-coagulants

· Enumerate anticoagulants. (K)

· Comprehend the mechanism of

action of anticoagulants with

regards to blood coagulation

pathways. (K)

· Enlist therapeutic uses and major

adverse effects of anticoagulants.

(K)

· Explain the pharmacological basis

of tests used to monitor the action

of anticoagulants. (K)

· Classification of anticoagulant drugs

· Mechanism of action of anticoagulants

in relation to the Coagulation pathways

· Basic pharmacology of anticoagulant

drugs

· Clinical uses and adverse effects of

Anticoagulant drugs

LGIS

(1 hour)

MCQs

SEQs

SAQs

Viva

32

Community Medicine Lectures

S

NO

Learning Objectives


able to:

Content Areas

Teaching

Activity

(Duration)

Assessment

1.

Immunity

· Differentiate between types of immunity

and immunizing agents. (K)

· Types of Immunity

· Concept of herd immunity

· Types of immunizing agents

LGIS

(1 hour)

MCQs

SEQs

2.

EPI program

· Describe the concept of EPI program of

Pakistan.(K)

· EPI Schedule

· Cold chain maintenance

· Adverse events following

immunization

LGIS

(1 hour)

MCQs

SEQs

3.

Blood borne infections

· Discuss the preventive measures of

different blood borne infections. (K)

· Explain the importance of genetics in

blood related disorders

· Modes of transmission

· Preventive measures of blood

borne infections

· Prevention of Genetically

transmitted blood disorders

LGIS

(1 hour)

MCQs

SEQs

4.

Nutritional anemias

· Identify the epidemiological determinants

and preventive strategies of nutritional

anemias. (K)

· Epidemiological determinants

· Strategies for prevention of

nutritional anemia

LGIS

(1 hour)

MCQs

SEQs

5.

Infectious disease epidemiology

· Explain the concept of infectious disease

epidemiology. (K)

· Basic terminology

· Dynamics of disease transmission

LGIS

(1 hour)

MCQs

SEQs

Learning resource:Parks Textbook of Preventive and social Medicine.K.Park,23rd edition.2016.

33

S

NO

Learning Objectives


able to:

Content Areas

Teaching

Activity

(Duration)

Assessment

1.

Anemias

· Enlist symptoms of anemias and explain

their physiological basis. (K)

· Plan relevant investigations for a patient

of anemias. (K)

· Interpret the relevant blood reports of the

patient and classify anemia. (K)

· Definition

· Normal values of hemoglobin

· Classification of anaemias by

pathophysiology

· Classification of anaemias by mean cell

volume

· History taking in anaemia patient

· Physical examination

· Investigations

LGIS

(1 hour)

MCQs

SEQs

SAQs

Viva

Learning resource:Davidsons Principle and Practice of Medicine,22nd,edition,part 2,chapter24

Medicine Lecture

34

S

NO

Learning Objectives


able to:

Content Areas

Teaching

Activity

(Duration)

Assessment

1.

Thalasemias

· Define thalasemia ,explain its

pathophysiology and genetic basis. (K)

· Describe the salient clinical features

with which the patient usually present.

(K)

· Enumerate and interpret the diagnostic

lab investigates. (K)

· Types of thalasemias

· History taking in thalasemia patient

· Physical examination

· Investigations

· Complications of thalasemias

· treatment modalities

· Parents Counselling

LGIS

(1 hour)

MCQs

SEQs

SAQs

Viva

Learning resource:Basis of pediatrics,Pervaiz Akbar Khan,8th edition,chapter 15

Pediatrics Lecture

Timetable

35

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080

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1100

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Wednesday

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Pre

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D

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ha

hid

YUSRA MEDICAL & DENTAL COLLEGE, ISLAMABADZaraj Housing Scheme, Opp DHA Phase II, Gate 3

Main GT Road, Islamabad.Phone: 5709443-5 Fax: 5709428


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