Revised Ordinance Governing

MBBS DEGREE COURSE AND CURRICULUM

of phase I Subjects – November 2019
[Amended]

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

4th T Block, Jayanagar, Bengaluru- 560041

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 SECTION I

Introduction to CBME based curriculum

The Medical Council of India has revised the undergraduate medical education curriculum so that
the Indian Medical Graduate is able to recognize ʺhealth for allʺ as a national goal and should be
able to fulfill his/her societal obligations. The revised curriculum has attempted to enunciate the
competencies the student must be imparted and should have learnt, with clearly defined teaching‐
learning strategies and effective methods of assessment. Communicating effectively and
sympathetically with patients and their relatives has been visualized as a core area of the revised
curriculum. These and other goals identified in the curriculum are to be implemented in all medical
colleges under the ambit of Medical Council of India from August 2019 and to smoothen this
process Guidelines have been prepared for its effective implementation. In response to the need for
a seamless introduction of the curriculum into the Undergraduate system, all medical colleges need
to upgrade the teaching‐learning skills of their faculty. Earlier experience with implementation of
curricular changes suggests that a carefully managed, sustainable approach is necessary to ensure
that every college has access to the new skills and knowledge enunciated in the new curriculum.
Faculty training and development thus assumes a key role in the effective implementation and
sustenance of the envisaged curricular reforms.

Curriculum Committees along with Medical Education Units/ Departments of Medical Colleges
would help the colleges to implement the new UG curriculum including the AETCOM (Attitude,
Ethics & Communication) program. Each college should develop the framework for the Foundation
Course. The Foundation course which will be of 1‐month duration after admission, aims to orient
the students to national health scenarios, medical ethics, health economics, learning skills &
communication, Basic Life Support, computer learning, sociology & demographics, biohazard
safety, environmental issues and community orientation. Foundation course may also include 1)
Orientation program 2) language and computer skills 3) communication skills and 4) time
management skills and 5) Professional development program highlighting ethical and humanities
issues. Each College should select elements of Foundation course as per local needs and develop
faculty expertise from initial years. However, experts and other teachers may be invited as per need.
It is emphasized that interactive case scenarios, movies, videos, and small group discussions may
be used for each concept along with the principles of reflective learning.

Four of the many new key areas recommended in the Vision 2015, were identified for
implementation across the entire duration of the course at Phase I. The areas identified were such
that they would be helpful to initiate the process of curricular reforms from first year of the
undergraduate course. These areas are Foundation course, Early Clinical Exposure, Integrated
teaching & Learning & Skill development & training.

a. Foundation Course: This is a one month to orient medical learners to MBBS program and
provide them with requisite knowledge, communication (including electronic), technical and
language skills.

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b. Early clinical exposure: The clinical training would start in the first year, focusing on
communication, basic clinical skills and professionalism. There would be sufficient clinical
exposure at the primary care level and this would be integrated with the learning of basic and
laboratory sciences. Introduction of case scenarios for classroom discussion/case‐based learning
would be emphasized. It will be done as a coordinated effort by the pre‐clinical, para‐clinical and
clinical faculty.
c. Integrated teaching and learning: The innovative new curriculum have been structured to
facilitate horizontal and vertical integration between and among disciplines, bridge the gaps
between theory & practice, between hospital-based medicine and community medicine. Basic and
laboratory sciences (integrated with their clinical relevance) would be maximum in the first year
and will progressively decrease in the second and third year of the training when clinical exposure
and learning would be dominant.
d. Skill development and learning (throughout curriculum): A mandatory & desirable
comprehensive list of skills has been planned and would be recommended for the Indian Medical
Graduate. Certification of skills would be necessary before licensure.
e. Electives: The aim of adding electives is to allow flexible learning options in the curriculum and
may offer a variety of options including clinical electives, laboratory postings or community
exposure in areas that students are not normally exposed as a part of regular curriculum. This will
also provide opportunity for students to do a project, enhance self‐directed learning, critical
thinking and research abilities. Examples: Bio‐Informatics, Tissue Culture, Tissue
Engineering/Processing, Computer and Computer applications, Immunology, Genetics, Human
Nutrition, Sports Medicine, Laboratory Sciences, Research Methodology, Ethics, Accident and
Emergencies (A&E), Community Projects, HIV Medicine, Pharmacokinetics/ Pharmacodynamics/
Pharmacoeconomics, Assisted Reproductive Technology, Ethics & Medical Education.

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 PREAMBLE

The undergraduate medical curriculum of the medical council of India is created to ensure that the
medical doctor who emerges from the MBBS training program is capable of assisting the nation to
achieve its goal of health for all. In addition, it aspires to ensure that the “graduate” meets or exceeds
global bench‐mark in knowledge, attitude, skills and communication. This intent is at the core of the
Graduate Medical Regulations, 2019.

The Graduate Medical Regulations, 2019 represents the first major revision to the medical
curriculum since 1997 and hence incorporates changes in science and thought over two decades. A
significant advance is the development of global competencies and subject‐wise outcomes that
define the roles of the “Indian Medical Graduate”. Learning and assessment strategies have been
outlined that will allow the learner to achieve these competencies/outcomes. Effective appropriate
and empathetic communication, skill acquisition, student‐doctor method of learning, aligned and
integrated learning and assessment are features that have been given additional emphasis in the
revised curriculum.

The revised curriculum is to be implemented by all medical colleges under the ambit of Medical
Council of India from August 2019. The roll out will be progressive over the duration of the MBBS
course.

This document represents a compilation of the resource material that was used in the Curricular
Implementation Support Program (CISP) and has attempted to provide a stepwise and
comprehensive approach to implement the curriculum. It details the philosophy and the steps
required in a simple and richly illustrated manner. Teaching slide decks, faculty guides and online
resource material supplement this document. The document is to be used in conjunction with the
Competency document, AETCOM module and the GMR document.

This draft syllabus has been created from the list of competencies mentioned in the Competency
Based Curriculum (CBC) developed by the Medical Council of India for the First MBBS Batch of
2019‐20.

The content to be covered under each topic has been mentioned as bulleted points. For each topic,
competency numbers have been mentioned as per the competency list mentioned above. The
content that is related to non‐core competencies (these competencies need not be assessed in the
summative examination) have been marked by an asterisk (*).

Guidelines have been suggested for the various teaching and learning (TL) methods along with the
time allotted for them in the curriculum. Relevant information has also been provided about the
recent additions in the CBC, namely integration, early clinical exposure (ECE), self‐directed
learning (SDL), the AETCOM (attitude ethics and communication skills) modules and electives.
Regardless of the TL methods that are used, it is expected that they follow adult learning principles.
The regulations related to the internal examination and university examination have been
mentioned along with detailed suggestions for the conduct of the theory, practical and viva‐voce
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examinations. The document ends with a list of learning resources that both the students and
teachers can utilize.

INTEGRATION

Integration is a learning experience that allows the learner to perceive relationships from blocks of
knowledge and develop a unified view of its basis and its application. It is recommended that the
principles of integration be applied to such an extent that the curriculum retains the strengths of
subject based education and assessment, while also providing experiences that will allow learners
to integrate concepts. Integration must be horizontal (i.e. across disciplines in a given phase of the
course) and vertical (across different phases of the course). As far as possible, it is desirable that
teaching/learning occurs in each phase through study of organ systems or disease blocks in order
to align the learning process. Clinical cases must be used to integrate and link learning across
disciplines.

Alignment implies the teaching of subject material that occurs under a particular organ system /
disease concept from the same phase in the same time frame i.e., temporally. It is recommended
that alignment be the major method to be followed, allowing similar topics in different subjects to
be learnt separately but during the same time frame.

Integration implies that concepts in a topic / organ system that are similar, overlapping or
redundant are merged into a single teaching session in which subject based demarcations are
removed. For the purpose of this document, topics from other phases that are brought into a
particular phase for the purpose of reinforcement or introduction will also be considered as
integrated topics. A linker is a session that allows the learner to link the concepts presented in an
aligned topic. In a small proportion (not to exceed 20% of the total curriculum) an attempt can be
made to share topics or correlate topics by using an integration or linker session. The integration
session most preferred will be a case‐based discussion in an appropriate format ensuring that
elements in the same phase (horizontal) and from other phases are addressed.

Care must be taken to ensure that achievement of phase‐based objectives is given primacy ‐ the
integrative elements from other phases are used only to provide adequate recall and understand
the clinical application of concepts. It must be emphasized that integration does not necessarily
require multiple teachers in each class. Experts from each phase and subject may be involved in the
lesson planning but not it in its delivery unless deemed necessary. As much as possible, the
necessary correlates from other phases must also be introduced while discussing a topic in a given
subject. Topics that cannot be aligned and integrated must be provided adequate time in the
curriculum throughout the year. Assessment will continue to be subject based. However, efforts
must be made to ensure that phase appropriate correlates are tested to determine if the learner has
internalized and integrated the concept and its application.

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In summary:

Horizontal integration can be facilitated by the following methods.

• Alignment of timetables of the three first year subjects wherever possible
• Consciously connecting what is learned in one subject with the other subjects during teaching
and learning activities
• Joint sessions by all the three departments which may be in the form of lectures, case‐based
learning or seminars

Vertical integration can be facilitated by the following methods

• Discussing relevant clinical case scenarios during teaching and learning sessions
• Guest lectures by clinicians or para‐clinical faculty
• Hospital visits to see relevant patient presentations, radiological imaging and operative
procedures.

EARLY CLINICAL EXPOSURE

Objectives: The objectives of early clinical exposure of the first‐year medical learners are to
enable the learner to:
a. Recognize the relevance of basic sciences in diagnosis, patient care and treatment
b. Provide a context that will enhance basic science learning
c. Relate to experience of patients as a motivation to learn
d. Recognize attitude, ethics and professionalism as integral to the doctor‐patient
relationship
e. Understand the socio‐cultural context of disease through the study of humanities

Elements
a. Basic science correlation: i.e. apply and correlate principles of basic sciences as they relate
to the care of the patient (this will be part of integrated modules).
b. Clinical skills: to include basic skills in interviewing patients, doctor‐patient
communication, ethics and professionalism, critical thinking and analysis and self‐
learning (this training will be imparted in the time allotted for early clinical exposure).
c. Humanities: To introduce learners to a broader understanding of the socio‐economic
framework and cultural context within which health is delivered through the study of
humanities and social sciences.

Planning of activities & its distribution:

ECE has to be done in practically each of the sessions of basic sciences, preferably for first 10‐15
minutes as we do not want it to happen in isolation but want it as an integral part of the basic
science curriculum. Total allotted hours in first year (as per GMR, 2019) is 90 hours which has to
be equally divided among the three preclinical subjects. Therefore, the time available for each
subject is 30 hours, which can be further divided as follows:

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 a. Basic sciences correlation ‐ 18 hours ‐ 3‐hour session per month for 6 months which can
take place with charts, graphics, videos, reports, field visits etc. in classrooms / hospital
labs.
b. Clinical Skills ‐ 12 hours ‐ one 3‐hour session per month for four months per department.
Students accompanied by preclinical faculty in small groups equipped with observation
guides are introduced to specified cases being demonstrated by clinicians. Each 3‐hour
session of clinical skills will have:
i. Introduction & instruction: 30 minutes
ii. Hospital visit: 1 hour 30 minutes
iii. Summary & conclusion: 30 minutes d. Reflection: 30 minutes
c. Humanities ‐ will be merged with AETCOM (no additional time)

Some methods that may be utilized for ECE are as follows:

• Clinical case scenarios during lectures and dissections

• Guest lectures delivered by clinicians
• Videos of clinical presentations and procedures
• Performance of simple clinical procedures on cadavers or simulators
• Hospital / laboratory visits to see carefully selected patients and relevant procedure
• Demonstrations on peers after taking their consent

SELF‐DIRECTED LEARNING

Self‐Directed Learning (SDL) is defined as the “preparedness of a student to engage in learning

activities defined by himself rather than a teacher”. The Graduate Medical Education 2019
document brought out by the MCI lists life‐long learning as one of the roles of the Indian Medical
Graduate (IMG). One of the methods suggested achieving this is SDL. Seven key components of
SDL have been described. These include the identification of learning needs, formulation of
learning objectives, utilization of appropriate learning resources, employing suitable learning
strategies, commitment to a learning contract, evaluating learning outcomes and the teacher as
a facilitator. Dedicated time for SDL is provided for each subject in the first phase.

AETCOM MODULE:

The overall goal of undergraduate medical education program as envisaged in the revised
Graduate Medical Education Regulations - 2019 is to create an “Indian Medical Graduate” (IMG)
possessing requisite knowledge, skills, attitudes, values and responsiveness, so that she or he
may function appropriately and effectively as a physician of first contact of the community while
being globally relevant. In order to fulfill this goal, the IMG must be able to function
appropriately, ethically and effectively in her/his roles as clinician, leader and member of the
health care team and system, communicator, lifelong learner and as a professional. In order to
effectively fulfill the above-mentioned roles, the IMG must obtain a set of competencies at the
time of graduation. In order to ensure that training is in alignment with the goals and

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competencies, Medical Council of India has proposed new teaching learning approaches
including a structured longitudinal programmeon attitude, ethics and communication

Five AETCOM modules will be taught in first phase and following departments will be
responsible for implementation and assessment of these modules

• MODULE 1.1 AND MODULE 1.5 ANATOMY

• MODULE 1.2 AND MODULE 1.3 PHYSIOLOGY
• MODULE 1.4 BIOCHEMISTRY

GUIDELINES: Reflection writing to be recorded in practical record/log book in each subject

ELECTIVES

An elective can be defined as a brief course made available to the learner during his/her
undergraduate study period, where she/he can choose from the available options depending
upon their interest and career preferences. Introduction of electives in undergraduate medical
curriculum is an important step for providing flexible choices in student’s areas of interest, direct
individual experience and this will help in developing self‐ directed learning skills. The range of
electives that can be offered to the students will depend upon the local logistics and resources
available for the medical institutions (within or nearby). These can be in a wide range that can
include electives from educational, community and research‐project related, directly or
indirectly with health care, super‐ specialty clinical electives and specific laboratory electives.

Method:

• Two months are allotted for elective rotations after completion of the exam at end of the third
MBBS Part I examination and before commencement of third MBBS Part II.
• It is compulsory for learners to do an elective. The protected time for electives should not be
used to make up for missed clinical postings, shortage of attendance or any other purpose.
• The learner shall rotate through two elective blocks of 04 weeks each.
• Block 1 shall be done in a pre‐selected preclinical or para‐clinical or other basic sciences
laboratory OR under a faculty researcher in an ongoing research project. During the electives
regular clinical postings shall continue.
• Block 2 shall be done in a clinical department (including specialties, super‐specialties, ICUs,
blood bank and casualty) from a list of electives developed and available in the institution
OR as a supervised learning experience at a rural or urban community clinic.
• Institutions will determine the number and nature of electives beforehand, names of the
supervisors, and the number of learners in each elective based on the local logistics, available
resources and faculty.
• Each institution will develop its own mechanism for allocation of electives.
• It is preferable that electives are made available to the learners in the beginning of the
academic year.
• The learner must submit a learning logbook based on both blocks of the elective.
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• 75% attendance in the electives and submission of logbook maintained during elective is
mandatory for eligibility to appear in the final MBBS examination.
• Students will be assessed in between and at the end of each elective posting.
• Feedback, comments and /or grades about the student’s performance by the faculty mentor
can be documented with the help of a checklist where both professional and academic
attributes can be included.
• The performance of the students in the electives will also contribute towards internal marks.
• Student’s feedback about the elective also needs to be documented in a structured format.
This will help in gathering student’s perceptions about various aspects of elective posting
and help in program evaluation.
• Institutions may use part of this time for strengthening basic skill certification. The list of
electives offered by the institution must be displayed for students.
• Each elective should have well defined objectives, expected outcomes, expectations from the
students, their assessment mechanism and faculty guide or mentors.
• A faculty mentor should guide the student, monitor their learning activities and assess the
students’ performance with regular feedback.
• Examples of general electives include bioinformatics, tissue engineering / processing,
computer and computer applications, genetics, human nutrition, laboratory sciences,
research methodology, ethics and medical education.

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 SECTION II

REGULATIONS GOVERNING MBBS DEGREE COURSE

[Eligibility for Admission, Duration, Attendance and Scheme of Examination]

1. ELIGIBILITY

As per guidelines of Medical Council of India

2. DURATION OF THE COURSE

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Foundation
I MBBS
course
I MBBS Phase II MBBS
I
exam
II MBBS Phase III MBBS PART 1
II
exam
III MBBS PART 1 Phase Electives
III and skills
part 1
exam
III MBBS PART 2
Phase III Internship
part 2 exam
Internship

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 DISTRIBUTION OF SUBJECTS BY PROFESSIONAL PHASE

Phase and Subjects and new teaching elements Duration University

Year of examination
MBBS
Training
First • Foundation course (1month) 1+13 I Professional
professional • Human Anatomy, Physiology& months
MBBS Biochemistry
• Introduction of Community
Medicine, Humanities
• Early Clinical Exposure
• Attitude. Ethics and Communication
Module (AETCOM)
Second • Pathology, Microbiology, 12 months II Professional
professional Pharmacology, Forensic Medicine
MBBS And Toxicology
• Introduction to clinical subjects
including community Medicine
• Clinical postings
• AETCOM
Third • General Medicine ,General Surgery, 12 months III
professional OBG, Paediatrics, Orthopaedics, Professional-
MBBS-part I Dermatology, Pyschiatry, part I
Otorhinolaryngology,
Ophthalmology, Community
Medicine, Forensic Medicine and
Toxicology, Respiratory Medicine,
Radiodiagnosis & Radiotherapy,
Anaesthesiology
• Clinical Subjects /postings
• AETCOM
Electives • Electives ,skills and assessment 2 months
Third • General Medicine ,Paediatrics, 13 months III
professional General Surgery, Orthopaedics, Professional-
MBBS-part Obstetrics and Gynaecology, part II
II including Family welfare and allied
specialties
• Clinical Postings /subjects
• AETCOM

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FOUNDATION COURSE

Subjects/contents Total Teaching hours

Orientation1 30

Skills Module2 35

Field visit to Community Health Centre 8

Professional Development including ethics 40

Sports and Extracurricular Activities 22

Enhancement of language/computer skills3 40

Total teaching hours 175

1. Orientation course will be completed as single block in the first week and will contain
elements outlined in 9.1. ((vide Medical Council of India Notification on Graduate Medical
Education (Amendment) Regulations 2019, published in the Gazette of India Part III, Section 4,
Extraordinary issued on 4th November 2019)
2. Skills modules will contain elements outlined in 9.1.

3. Based on perceived need of learners, one may choose language enhancement (English or

local spoken or both) and computer skills. This should be provided longitudinally through
the duration of the Foundation Course.

Note:
• Teaching of Foundation Course will be organized by pre-clinical departments
• The Foundation Course will have compulsory 75% attendance. This will be certified
by the Dean of the college

3. ATTENDANCE

Every candidate should have attendance not less than 75% of the total classes conducted in
theory which includes didactic lectures, early clinical exposure and self-directed learning and
not less than 80% of the total classes conducted in practical which includes small group
teaching, tutorials, integrated learning and practical sessions in each calendar year calculated
from the date of commencement of the term to the last working day as notified by the University
in each of the subjects prescribed to be eligible to appear for the university examination. 75%
attendance in Professional Development Programme (AETCOM Module) is required for

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eligibility to appear for final examination in each professional year (vide Medical Council of
India Notification on Graduate Medical Education (Amendment) Regulations 2019, published in
the Gazette of India Part III, Section 4, Extraordinary issued on 4th November 2019)

The Principal should notify at the College the attendance details at the end of each term without
fail under intimation to this University.

A candidate lacking in the prescribed attendance and progress in any subject(s) in theory or
practical should not be permitted to appear for the examination in that subject(s).

4. TEACHING HOURS

Small group
Self-
teaching/tutorials/in
Lecture directed Total
Subjects tegrated
hours learning (hours)
teaching/practical
(SDL)
(hours)
Human anatomy 220 415 40 675

Physiology 160 310 25 495

Biochemistry 80 150 20 250

Early clinical exposure* 90 - 0 90

Community Medicine 20 27 5 52

Attitude, Ethics &

Communication module - 26 8 34
(AETCOM)**

Sports and extracurricular

- - - 60
activities

Formative assessment and term

- - - 80
examinations

Total - - - 1736

*Early clinical exposure hours to be divided equally in all three subjects

**AETCOM module shall be a longitudinal programme

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 SCHEME OF EXAMINATION

5. INTERNAL ASSESSMENT:

General guidelines

• Regular periodic examinations shall be conducted throughout the course. There shall be
minimum three internal assessment examinations in each preclinical subject. In
addition, there shall be one Internal Assessment in Community Medicine in Phase I
MBBS.
• The third internal examination should be conducted on the lines of the university
examination.
• There shall be one short essay on ECE in each internal assessment in each subject.
• There should be at least one short question from AETCOM in each subject in any of the
internal assessment.
• Questions on ECE and AETCOM in Internal Assessments must be assessed by the faculty
of the respective pre-clinical departments (Anatomy/Physiology/Biochemistry)
• An average of the marks scored in the three internal assessment examinations will be
considered as the final internal assessment marks.
• Learners must secure not less than 40 % marks in theory and practical separately and
not less than 50% marks of the total marks (combined in theory and practical) assigned
for internal assessment in a particular subject in order to be eligible for appearing at the
final University examination of that subject.
• A candidate who has not secured requisite aggregate in the internal assessment may be
subjected to remedial measures by the institution. If he/she successfully completes the
remediation measures, he/she is eligible to appear for University Examination. Remedial
measures shall be completed before submitting the internal assessment marks online to
the university.
• Internal assessment marks will reflect under separate head in the marks card of the
university examination. The internal assessment marks (theory/practical) will not be
added to the marks secured (theory/practical) in the university examination for
consideration of pass criteria.
• The results of IA should be displayed on the notice board within a 1-2 week of the test.
• Learners must have completed the required certifiable competencies for that phase of
training and completed the logbook appropriate for that phase of training to be eligible
for appearing at the final university examination of that subject.

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 6. UNIVERSITY EXAMINATION

Examination schedule
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Foundation
I MBBS
course
I MBBS Phase II MBBS
I
exam
II MBBS Phase III MBBS PART 1
II
exam
III MBBS PART 1 Phase Electives
III and skills
part 1
exam
III MBBS PART 2
Phase III Internship
part 2 exam
Internship

General guidelines

• University examinations are to be designed with a view to ascertain whether the candidate
has acquired the necessary knowledge, minimal level of skills, ethical and professional values
with clear concepts of the fundamentals which are necessary for him/her to function
effectively and appropriately as a physician of first contact. Assessment shall be carried out
on an objective basis to the extent possible.

• Nature of questions will include different types such as structured essays (Long Answer
Questions - LAQ), Short Essays and Short Answers Questions (SAQ). Marks for each part
should be indicated separately.

• The learner must secure at least 40% marks in each of the two papers with minimum 50%
of marks in aggregate (both papers together) to pass.

• Practical/clinical examinations will be conducted in the laboratories. The objective will be to

assess proficiency and skills to conduct experiments, clinical examination, interpret data and
form logical conclusion, wherever applicable.

• Viva/oral examination should assess candidate’s skill in analysis and interpretation of

common investigative data, X-rays, identification of specimens, ECG, etc. [wherever
applicable] and attitudinal, ethical and professional values.

• There shall be one main examination in an academic year and a supplementary to be held
not later than 90 days after the declaration of the results of the phase I university
examination.

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• A learner shall not be entitled to graduate after 10 years of his/her joining of the first part
of the MBBS course.

Phase 1 university examination

• The first Professional examination shall be held at the end of first Professional training (1+12
months), in the subjects of Human Anatomy, Physiology and Biochemistry.

• A maximum number of four permissible attempts would be available to clear the first
Professional University examination, whereby the first Professional course will have to be
cleared within 4 years of admission to the said course. Partial attendance at any University
examination shall be counted as an availed attempt.

Phase I

Table: Examination components, Subjects and Distribution of Marks

THEORY ANATOMY PHYSIOLOGY BIOCHEMISTRY

Written Paper
No. of Papers & Maximum Marks 2×100=200 2×100=200 2×100=200
for each paper.
Total theory 200 200 200
PRACTICAL
1. Practical exam 80 80 80
2. Viva-voce 20 20 20
Total practical 100 100 100
Internal assessment*
Internal Assessment (Theory) 40 40 40
Internal assessment (Practical) 40 40 40

* Internal assessment marks will reflect under separate head in the marks card of the university
examination.

Table: Type, number of questions and distribution of marks for written paper

TYPES OF QUESTION NUMBER OF QUESTIONS MARKS FOR EACH

QUESTION
Long essay 2 10
Short essay 10 5
Short answers 10 3

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7. SUBMISSION OF LABORATORY RECORD

a. At the time of Practical Examination each candidate shall submit to the Examiners his/her
laboratory record duly certified by the Head of the Department as a bonafide record of the
work done by the candidate.

8. ELIGIBILITY FOR EXAMINATION

The following criteria to be met by the students to be eligible for the university exams:

a. Shall have undergone satisfactorily the approved course of study in the subject/subjects for
the prescribed duration.
b. Shall have attended not less than 75% of the total classes conducted in theory and not less
than 80% of the total classes conducted in practical separately to become eligible to appear
for examination in that subject/subjects.
c. Minimum of 40% marks to be obtained separately in theory and practical to appear for
University exam. At least 50% marks of the total marks combined in theory and practical
assigned for internal assessment is to be obtained in a particular subject. (average of 3
internal assessments theory and practical separately)
d. Learners must have completed the required certifiable competencies for that phase of
training and completed the logbook appropriate for that phase of training to be eligible for
appearing at the final university examination of that subject.

9. CRITERIA FOR PASS

For declaration of pass in any subject in the University examination, a candidate shall pass both
in Theory and Practical examination components separately as stipulated below:

• The Theory component consists of marks obtained in University Written papers only. For a
pass in theory, a candidate must secure at least 40% marks in each of the two papers with
minimum 50% of marks in aggregate (both papers together).
• For a pass in practical examination, a candidate shall secure not less than 50% marks in
aggregate, i.e., marks obtained in university practical examination and viva voce added
together.
• Internal assessment marks will reflect as a separate head of passing at the university
examination.
• A candidate not securing 50% marks in aggregate in Theory or Practical examination + viva
in a subject shall be declared to have failed in that subject and is required to appear for both
Theory and Practical again in the subsequent examination in that subject.

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10. DECLARATION OF CLASS

a. A candidate having appeared in all the subjects in the same examination and passed that
examination in the first attempt and secures 75% of marks or more of grand total marks
(university examination + internal assessment) prescribed will be declared to have passed
the examination with distinction.

b. A candidate having appeared in all the subjects in the same examination and passed that
examination in the first attempt and secures 65% of marks or more but less than 75% of
grand total marks (university examination + internal assessment) prescribed will be
declared to have passed the examination in First Class.

c. A candidate having appeared in all the subjects in the same examination and passed that
examination in the first attempt and secures 50% of marks or more but less than 65% of
grand total marks (university examination + internal assessment) prescribed will be
declared to have passed the examination in Pass Class.

d. A candidate passing a university examination in more than one attempt shall be placed in
Pass class irrespective of the percentage of marks secured by him/her in the examination.

Note: Please note fraction of marks will not be rounded off for clauses (a), (b) and (c)

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 SECTION III
COURSE CONTENTS

ANATOMY
PREAMBLE

The journey into the fascinating field of medicine begins by trying to understand the structure of
the human body. The subject of anatomy deals with the study of the human body from the
cellular to the macroscopic level. The marvellous and complex design of the human body will be
studied in the context of the competencies that a basic medical doctor needs to achieve by the end
of the MBBS course. Thus, the emphasis will be on clinical, functional and applied anatomy that
can be utilized by a clinician, rather than on factual details that may not have relevance to clinical
practice.

This draft syllabus has been created from the list of competencies mentioned in the Competency
Based Curriculum (CBC) developed by the Medical Council of India for the First MBBS Batch
of 2019-20. The subject has been divided into the following broad areas:

A. General anatomy
B. General histology
C. Genetics
D. General embryology
E. Upper limb
F. Thorax
G. Abdomen
H. Pelvis
I. Lower limb
J. Head and neck
K. Neuroanatomy
L. Ethics in anatomy

In each of these broad areas, topics have been specified. The content to be covered under each
topic has been mentioned as bulleted points. For each topic, competency numbers have been
mentioned as per the competency list mentioned above. The content that is related to non-core
competencies (these competencies need not be assessed in the summative examination) have
been marked by an asterisk (*).

18
 Goals and departmental objectives for the undergraduate (MBBS) Curriculum in
Anatomy

Goal
The broad goal of the anatomy curriculum is to provide a comprehensive, scientific knowledge
of the structure and development of the human body in order to understand the anatomical basis
of disease presentations and patient management.

Objectives
A. Knowledge
At the end of the course student should be able to:
a. Explain the gross structure, normal disposition and integrated functions of organ
systems in order to understand the anatomical basis of common disease presentations
and clinical procedures.
b. Describe the microscopic structure of various organs and correlate their structure with
functions, in order to understand their altered state in various disease processes.
c. Describe the basic principles behind the sequential development of organs systems as
a prerequisite to explaining the developmental basis of common variations and
congenital anomalies.
d. Describe the normal structure and functions of chromosomes and genes so as to
understand the genetic basis of common genetic abnormalities.
B. Skills
At the end of the course the student should be able to:
a. Demonstrate the surface marking of clinically important structures in the cadaver and
correlate it with living anatomy.
b. Locate and identify tissues and cells under the light microscope.
c. Identify important structures visualized by imaging techniques, specifically
radiographs, computerized tomography (CT) scans, MRI and ultrasonography.
d. Demonstrate the various movements at the important joints in the human body.
e. Accurately palpate the pulsations of arteries at the most appropriate sites.
C. Attitude and communication skills
At the end of the course the student should be able to:
a. Show due respect in handling human body parts and cadavers during dissection.
b. Communicate effectively with peers and teachers in small group teaching-learning
activities.
c. Demonstrate the ability to work effectively with peers in a team.
d. Demonstrate professional attributes of punctuality, accountability and respect for
teachers and peers.
e. Appreciate the issues of equity and social accountability while undergoing early
clinical exposure.

19
 CURRICULUM

A. GENERAL ANATOMY

Topic: Anatomical terminology (AN1.1)

• Normal anatomical position
• Planes of the body
• Terms used for relations and comparison
• Terms used for movements of the body

Topic: General features of bones and Joints (AN1.2, AN2.1 to AN2.6)

• Composition of bone and bone marrow
• Parts, blood and nerve supply of a long bone
• Laws of ossification*
• Special features of a sesamoid bone*
• Types of cartilage with its structure and distribution in body
• Joints with subtypes and examples
• Nerve supply of joints and Hilton’s law

Topic: General features of Muscle (AN3.1 to AN3.3)

• Classification of muscle tissue according to structure and action
• Parts of skeletal muscle
• Differences between tendons and aponeuroses with examples
• Shunt and spurt muscles*

Topic: General features of skin and fascia (AN4.1 to AN4.5)

• Types of skin and dermatomes in body*
• Structure and function of skin
• Superficial fascia along with fat distribution in body
• Modifications of deep fascia with its functions
• Principles of skin incisions*

Topic: General features of the cardiovascular system (AN5.1 to AN5.8)

• Differences between blood vascular and lymphatic system
• Differences between pulmonary and systemic circulation
• General differences between arteries and veins
• Functional differences between elastic, muscular arteries and arterioles
• Concept of portal system with examples
• Concept of anastomoses and collateral circulation with significance of end-arteries
• Functions of meta-arterioles, precapillary sphincters, arterio-venous anastomoses*
• Definition of thrombosis, infarction and aneurysm*

Topic: General Features of lymphatic system (AN6.1 to AN6.3)

• Components and functions of the lymphatic system*
20
 • Structure of lymph capillaries and mechanism of lymph circulation*
• Concept of lymphoedema and spread of tumors via lymphatics and venous system*
Topic: Introduction to the nervous system (AN7.1 to AN7.8)
• General plan of nervous system with components of central, peripheral and autonomic
nervous systems
• Components of nervous tissue and their functions
• Parts of a neuron
• Classification of neurons based on structure and function
• Structure of a typical spinal nerve
• Principles of sensory and motor innervation of muscles*
• Concept of loss of innervation of a muscle with its applied anatomy
• Type of synapses*
• Differences between sympathetic and spinal ganglia*

B. GENERAL HISTOLOGY

Topic: Epithelium (AN65.1 to AN65.2)

• Identification of epithelium under the microscope
• Correlation of structure and function of epithelia
• Ultrastructure of epithelium*

Topic: Connective tissue histology (AN66.1 to AN66.2)

• Types of connective tissue with functional correlation
• Ultrastructure of connective tissue*

Topic: Muscle histology (AN67.1 to AN67.3)

• Classification of muscle
• Structure-function correlation of muscle
• Ultrastructure of muscle tissue*

Topic: Nervous tissue histology (AN68.1 to AN68.3)

• Description and identification of unipolar and multipolar neurons, ganglia, peripheral
nerve
• Structure-function correlation of neuron
• Ultrastructure of nervous tissue*

Topic: Blood vessels – histology (AN69.1 to AN69.3)

• Identification of elastic and muscular blood vessels, capillaries under the microscope
• Types and structure-function correlation of blood vessels
• Ultrastructure of blood vessels*

Topic: Glands and Lymphoid tissue (AN70.1 to AN70.2)

• Identification of exocrine glands under the microscope

21
 • Differentiation between serous, mucous and mixed acini
• Identification of lymphoid tissue under the microscope
• Microanatomy of lymph node, spleen, thymus, tonsil and correlation of structure with
function

Topic: Bone and Cartilage (AN71.1 to AN71.2)

• Identification of bone under the microscope
• Types and structure-function correlation of bone
• Identification of cartilage under the microscope
• Types and structure function correlation of cartilage

Topic: Integumentary System (AN72.1)

• Identification of skin and its appendages under the microscope
• Correlation of structure and function

C. GENETICS

Topic: Chromosomes (AN73.1 to AN73.3)

• Structure of chromosomes with classification
• Technique of karyotyping with its applications
• Lyon's hypothesis

Topic: Patterns of Inheritance (AN74.1 to AN74.4)

• Various modes of inheritance with examples
• Pedigree charts for the various types of inheritance
• Examples of diseases of each mode of inheritance
• Multifactorial inheritance with examples
• Genetic basis and clinical features of achondroplasia, cystic fibrosis, vitamin D resistant
rickets, haemophilia, Duchenne’s muscular dystrophy and sickle cell anaemia*

Topic: Principle of Genetics, Chromosomal Aberrations and Clinical Genetics (AN75.1 to

AN75.5)
• Structural and numerical chromosomal aberrations
• Mosaics and chimeras with examples
• Genetic basis and clinical features of Prader Willi syndrome, Edward syndrome and Patau
syndrome*
• Genetic basis of variation: polymorphism and mutation
• Principles of genetic counselling

D. GENERAL EMBRYOLOGY

Topic: Introduction to embryology (AN76.1 TO AN76.2)

• Stages of human life

22
 • Terms - phylogeny, ontogeny, trimester, viability

Topic: Gametogenesis and fertilization (AN77.1 to AN77.6)

• Uterine changes occurring during the menstrual cycle
• Synchrony between the ovarian and menstrual cycles
• Spermatogenesis and oogenesis
• Stages and consequences of fertilization
• Anatomical principles underlying contraception
• Teratogenic influences; fertility and sterility, surrogate motherhood, social significance of
“sex-ratio”*

Topic: Second week of development (AN78.1 to AN78.5)

• Cleavage and formation of blastocyst
• Development of trophoblast
• Process of implantation and common abnormal sites of implantation
• Formation of extra-embryonic mesoderm and coelom, bilaminar disc and prochordal plate
• Abortion, decidual reaction, pregnancy tests

Topic: 3rd to 8th week of development (AN79.1 to AN79.6)

• Formation and fate of the primitive streak
• Formation and fate of notochord
• Process of neurulation
• Development of somites and intra-embryonic coelom
• Embryological basis of congenital malformations, nucleus pulposus, sacrococcygeal
teratomas, neural tube defects
• Diagnosis of pregnancy in first trimester*
• Role of teratogens, alpha-fetoprotein*

Topic: Fetal membranes (AN80.1 to AN80.7)

• Formation, functions and fate of chorion, amnion, yolk sac, allantois and decidua
• Formation and structure of umbilical cord
• Formation of placenta, its physiological functions, foeto-maternal circulation and placental
barrier
• Embryological basis of twinning in monozygotic and dizygotic twins
• Role of placental hormones in uterine growth and parturition
• Embryological basis of estimation of fetal age*
• Types of umbilical cord attachments*

Topic: Prenatal Diagnosis (AN81.1 to AN81.3)

• Methods of prenatal diagnosis
• Indications, process and disadvantages of amniocentesis
• Indications, process and disadvantages of chorion villus biopsy

23
 E. UPPER LIMB

Topic: Features of individual bones (Upper Limb) (AN8.1 to AN8.6)

• Clavicle, scapula, humerus, radius, ulna - side determination, anatomical position and
important features
• Joints formed by the given bone
• Peculiarities of clavicle
• Muscle group attachments on above bones
• Identification and naming of bones in articulated hand
• Parts of metacarpals and phalanges
• Peculiarities of pisiform
• Scaphoid fracture and basis of avascular necrosis*

Topic: Pectoral region (AN9.1 to AN 9.3)

• Pectoralis major, pectoralis minor - attachment, nerve supply and action
• Breast - location, extent, deep relations, structure, age changes, blood supply, lymphatic
drainage, microanatomy and applied anatomy
• Development of breast*

Topic: Axilla, Shoulder and Scapular region (AN 10.1 to AN10.13)

• Axilla - boundaries and contents
• Axillary artery and tributaries of vein - origin, extent, course, parts, relations and branches
• Brachial plexus - formation, branches, relations, area of supply of branches, course and
relations of terminal branches
• Axillary lymph nodes - anatomical groups and areas of drainage
• Variations in formation of brachial plexus
• Erb’s palsy and Klumpke’s paralysis - anatomical basis and clinical features*
• Enlarged axillary lymph nodes – anatomical basis*
• Latissmus dorsi and trapezius- location, attachment, nerve supply and actions
• Arterial anastomosis around the scapula*
• Boundaries of triangle of auscultation*
• Deltoid and rotator cuff muscles
• Serratus anterior - attachment and actions
• Shoulder joint - type, articular surfaces, capsule, synovial membrane, ligaments, relations,
movements, muscles involved, blood supply, nerve supply and applied anatomy
• Anatomical basis of injury to axillary nerve during intramuscular injections*

Topic: Arm and Cubital fossa (AN11.1 to AN11.6)

• Muscle groups of upper arm
• Biceps and triceps brachii
• Important nerves and vessels in arm - origin, course, relations, branches (or tributaries),
termination
• Venepuncture of cubital veins - anatomical basis

24
 • Saturday night paralysis - anatomical basis
• Cubital fossa - boundaries and contents
• Anastomosis around elbow joint*

Topic: Forearm and hand (AN12.1 to AN12.15)

• Ventral forearm - muscle groups with attachments, nerve supply and actions
• Nerves and vessels of forearm - origin, course, relations, branches (or tributaries),
termination
• Flexor retinaculum - identification and attachments
• Anatomical basis of carpal tunnel syndrome
• Small muscles of hand
• Movements of thumb and muscles involved
• Blood vessels and nerves in hand - course and branches
• Anatomical basis of claw hand
• Fibrous flexor sheaths, ulnar bursa, radial bursa and digital synovial sheaths
• Infection of fascial spaces of palm*
• Dorsal forearm - muscle groups, attachments, nerve supply and actions
• Origin, course, relations, branches (or tributaries), termination of important nerves and
vessels of back of forearm
• Wrist drop - anatomical basis
• Compartments deep to extensor retinaculum
• Extensor expansion – identification and formation

Topic: General Features, joints, radiographs and surface marking (AN13.1 to AN13.8)
• Fascia of upper limb and compartments
• Veins of upper limb
• Lymphatic drainage of upper limb
• Dermatomes of upper limb*
• Elbow joint, proximal and distal radio-ulnar joints, wrist joint and first carpometacarpal
joint - type, articular surfaces, capsule, synovial membrane, ligaments, relations,
movements, blood and nerve supply
• Sternoclavicular joint, acromioclavicular joint, carpometacarpal joints and
metacarpophalangeal joints*
• Bones and joints of upper limb seen in anteroposterior and lateral view radiographs of
shoulder region, arm, elbow, forearm and hand
• Bony landmarks of upper limb - jugular notch, sternal angle, acromial angle, spine of the
scapula, vertebral level of the medial end, inferior angle of the scapula
• Surface projection of cephalic and basilic vein
• Palpation of brachial artery and radial artery
• Testing of muscles: trapezius, pectoralis major, serratus anterior, latissimus dorsi, deltoid,
biceps brachii, brachioradialis
• Development of upper limb*

25
 F. THORAX

Topic: Thoracic cage (AN21.1 to AN21.11)

• Salient features of sternum, typical rib, 1st rib and typical thoracic vertebra
• Features of 2nd, 11th and 12th ribs*
• Features of 1st, 11th and 12th thoracic vertebrae*
• Boundaries of thoracic inlet, cavity and outlet
• Extent, attachments, direction of fibres, nerve supply and actions of intercostal muscles
• Course, relations and branches of a typical intercostal nerve
• Origin, course and branches / tributaries of anterior, posterior intercostal vessels and
internal thoracic vessels
• Origin, course, relations and branches of atypical intercostal nerve, superior intercostal
artery and subcostal artery*
• Type, articular surfaces and movements of manubriosternal, costovertebral,
costotransverse and xiphisternal joints
• Mechanics and types of respiration
• Costochondral and interchondral joints*
• Boundaries and contents of the superior, anterior, middle and posterior mediastinum

Topic: Heart and Pericardium (AN22.1 to AN22.7)

• Pericardium - subdivisions, sinuses, blood supply and nerve supply
• External and internal features of each chamber of the heart
• Origin, course and branches of coronary arteries
• Anatomical basis of ischaemic heart disease
• Formation, course, tributaries and termination of coronary sinus
• Fibrous skeleton of heart
• Position and arterial supply of the conducting system of heart

Topic: Mediastinum (AN23.1 to AN23.7)

• Oesophagus - external appearance, relations, blood supply, nerve supply, lymphatic
drainage and applied anatomy
• Thoracic duct - extent, relations, tributaries and applied anatomy
• Origin, course, relations, tributaries and termination of superior venacava, azygos,
hemiazygos and accessory hemiazygos veins
• Branches and relations of arch of aorta and descending thoracic aorta
• Location and extent of thoracic sympathetic chain
• Description of splanchnic nerves*
• Right lymphatic duct – extent, relations and applied anatomy

Topic: Lungs and Trachea (AN24.1 to AN24.6, AN25.1 to AN25.6)

• Pleura – extent, recesses with their applied anatomy, blood supply, lymphatic drainage
and nerve supply
• Lungs – side determination, external features including root and clinical correlates

26
 • Description of bronchopulmonary segments
• Phrenic nerve - formation and distribution
• Blood supply, lymphatic drainage and nerve supply of lungs
• Extent, length, relations, blood supply, lymphatic drainage and nerve supply of trachea*

Topic: Radiological anatomy of thorax (AN25.7 and AN25.8)

• Identification of structures seen on a plain x-ray chest (PA view)
• Identification of and description in brief of a barium swallow*

Topic: Surface marking of thorax (AN25.9)

• Demonstrate surface marking of lines of pleural reflection, lung borders and fissures,
trachea, heart borders, apex beat and surface projection of valves of heart

Topic: Histology of thorax (AN25.1)

• Identification, drawing and labelling of a slide of trachea and lung

Topic: Embryology of thorax (AN25.2 to AN25.6)

• Development of pleura, lung and heart
• Fetal circulation and changes occurring at birth
• Embryological basis of: 1) atrial septal defect, 2) ventricular septal defect, 3) Fallot’s
tetralogy and 4) tracheo-oesophageal fistula
• Developmental basis of common cardiac congenital anomalies, transposition of great
vessels, dextrocardia, patent ductus arteriosus and coarctation of aorta
• Development of aortic arch arteries, superior vena cava, inferior vena cava and coronary
sinus*

G. ABDOMEN AND PELVIS

Topic: Anterior abdominal wall (AN44.1 to AN44.7)

• Planes (transpyloric, transtubercular, subcostal, lateral vertical), regions and quadrants
of abdomen
• Anterior abdominal wall – fascia, blood vessels and nerves
• Rectus sheath – formation, contents, linea alba and linea semilunaris
• Inguinal canal - extent, boundaries, contents of inguinal canal, Hesselbach’s triangle
• Anatomical basis of inguinal hernia
• Attachments of muscles of anterior abdominal wall
• Common abdominal incisions*
• Umbilicus - position, dermatome and applied aspects*

Topic: Posterior abdominal wall (AN45.1 to AN45.3)

• Thoracolumbar fascia
• Lumbar plexus – root value, formation and branches
• Other nerve plexuses of posterior abdominal wall*

27
 • Major subgroups of back muscles, nerve supply and action*

Topic: Male external genitalia (AN46.1 to AN46.5)

• Testes - coverings, internal structure, side determination, blood supply, nerve supply
and lymphatic drainage
• Descent of testis with its applied anatomy
• Parts of epididymis
• Penis - parts, components, blood supply and lymphatic drainage
• Anatomical basis of varicocoele*
• Anatomical basis of phimosis and circumcision*
• Spermatic cord and its contents

Topic: Abdominal cavity (AN47.1 to AN47.14)

• Greater and lesser sac - boundaries and recesses
• Naming and identification of peritoneal folds and pouches
• Anatomical basis of ascites, peritonitis and subphrenic abscess*
• Spleen - anatomical position, external features, peritoneal and visceral relations, blood
supply, nerve supply, lymphatic drainage and applied aspects
• Anatomical basis of splenic notch, accessory spleens and Kehr’s sign*
• Coeliac trunk- origin, course, important relations and branches
• Abdominal part of oesophagus - anatomical position, blood supply, nerve supply,
lymphatic drainage and applied aspects
• Stomach - anatomical position, external features, peritoneal and visceral relations, blood
supply, nerve supply, lymphatic drainage and applied anatomy
• Anatomical basis of lymphatic spread in carcinoma stomach and different types of
vagotomy*
• Mesentery – extent, borders, contents, relations and applied aspects
• Small Intestine - parts, macroscopic difference between jejunum and ileum, nerve supply
and lymphatic drainage
• Superior mesenteric artery - origin, course, termination, important relations and branches
• Large intestine - features, extent, peritoneal and other relations
• Caecum - anatomical position, external and internal features, important peritoneal and
other relations, blood supply, nerve supply, lymphatic drainage and applied aspects
• Vermiform appendix - anatomical position, external and internal features, important
peritoneal and other relations, blood supply, nerve supply, lymphatic drainage and
applied aspects
• Inferior mesenteric artery - origin, course, important relations and branches
• Duodenum - anatomical position, external and internal features, important peritoneal and
other relations, blood supply, nerve supply, lymphatic drainage and applied aspects
• Pancreas - anatomical position, external and internal features, important peritoneal and
other relations, blood supply, nerve supply, lymphatic drainage and applied aspects

28
 • Liver and extrahepatic biliary apparatus - anatomical position, external features,
important peritoneal relations and visceral relations, blood supply, nerve supply,
lymphatic drainage and applied aspects
• Clinical importance of Calot’s triangle*
• Anatomical basis of site of needle puncture in liver biopsy, referred pain in cholecystitis
and obstructive jaundice*
• Portal vein – formation, course, relations, tributaries and sites of porta-systemic
anastomoses
• Anatomical basis of haematemesis and caput medusae in portal hypertension
• Kidneys - anatomical position, side determination, coverings, external features, important
visceral relations, blood supply, nerve supply, lymphatic drainage and applied anatomy
• Anatomical basis of radiating pain of kidney to groin*
• Ureter – extent, parts, course, relations, constrictions, blood supply, nerve supply,
lymphatic drainage and applied aspects
• Suprarenal gland - anatomical position, coverings, external features, important visceral
and other relations, blood supply, nerve supply, lymphatic drainage and applied aspects
• Thoraco-abdominal diaphragm – attachments, major and minor openings, nerve supply
and actions
• Thoraco-abdominal diaphragm - abnormal openings and diaphragmatic hernia*
• Abdominal aorta - origin, course, important relations and branches
• Inferior vena cava - formation, course, relations and tributaries

Topic: Pelvic wall and viscera (AN48.1 to AN48.8)

• Muscles of pelvic diaphragm
• Position, features, important peritoneal and other relations, blood supply, nerve supply,
lymphatic drainage and clinical aspects of important male and female pelvic viscera
• Origin, course, important relations and branches of internal iliac artery
• Branches of sacral plexus
• Anatomical basis of suprapubic cystostomy, urinary obstruction in benign prostatic
hypertrophy, retroverted uterus, prolapse uterus, internal and external haemorrhoids,
anal fistula, vasectomy, tubal pregnancy and tubal ligation*
• Neurological basis of automatic bladder*
• Lobes involved in benign prostatic hypertrophy and prostate cancer*
• Structures palpable during vaginal and rectal examination*

Topic: Perineum (AN49.1 to AN49.5)

• Boundaries and contents of superficial and deep perineal pouch
• Perineal body - identification and description
• Perineal membrane in male and female
• Ischiorectal fossa - boundaries, contents and applied anatomy
• Anatomical basis of perineal tear, episiotomy, perianal abscess and anal fissure*

29
Topic: Vertebral column (AN50.1 to AN50.4)
• Curvatures of the vertebral column
• Type, articular ends, ligaments and movements of intervertebral joints, sacroiliac joints
and pubic symphysis
• Site, direction of the needle and structures pierced during lumbar puncture
• Anatomical basis of scoliosis, lordosis, prolapsed disc, spondylolisthesis and spina
bifida*

Topic: Sectional Anatomy of Abdomen and Pelvis (AN51.1, AN51.2)

• Cross-sections at T8, T10 and L1 (transpyloric plane) levels
• Midsagittal section of male and female pelvis

Topic: Histology and embryology (AN52.1 to AN52.8)

• Microstructure of oesophagus, cardiooesophageal junction*, fundus of stomach, pylorus
of stomach
• Microstructure of duodenum, jejunum, ileum
• Microstructure of colon, appendix
• Microstructure of liver, gallbladder, pancreas
• Microstructure of kidney, ureter, suprarenal gland
• Microstructure of testis, epididymis, vas deferens, penis, prostate gland
• Microstructure of ovary, uterus, uterine tube, cervix*, placenta, umbilical cord, corpus
luteum*
• Development of anterior abdominal wall*
• Development and congenital anomalies of diaphragm
• Development and congenital anomalies of foregut
• Development and congenital anomalies of midgut
• Development and congenital anomalies of hindgut
• Development of urinary system
• Development of male reproductive system
• Development of female reproductive system

Topic: Osteology (AN53.1 to AN53.4)

• Lumbar vertebrae - anatomical position, salient features, articulations and attachments of
muscle groups
• Sacrum and coccyx - anatomical position, salient features, articulations and attachments
of muscle groups
• Bony pelvis - anatomical position, boundaries of pelvic inlet, pelvic cavity and pelvic
outlet,
• True and false pelvis with sex differences
• Clinical importance - sacralization of lumbar vertebra, lumbarization of 1st sacral
vertebra, types of bony pelvis*

30
Topic: Radiological anatomy (AN 54.1 to AN54.3)
• Features of plain X ray abdomen
• Contrast X ray - barium swallow, barium meal, barium enema
• Cholecystography
• Intravenous pyelography
• Hysterosalpingography
• ERCP*
• CT abdomen*
• MRI abdomen and pelvis*
• Abdominal arteriography*

Topic: Surface marking (AN 55.1 and AN55.2)

• Regions and planes of abdomen
• Superficial inguinal ring
• Deep inguinal ring
• McBurney’s point
• Renal angle
• Murphy’s point
• Surface projections of - stomach, liver, fundus of gall bladder, spleen, duodenum,
pancreas, ileocaecal junction, kidneys and root of mesentery, abdominal aorta and inferior
vena cava

H. LOWER LIMB
Topic: Features of individual bones (lower limb) (AN 14.1 – 14.4)
• Hip bone, femur, patella, tibia, fibula - side determination, anatomical position and
important features
• Joints formed by the given bone
• Muscle group attachments on above bones
• Importance of ossification of lower end of femur and upper end of tibia
• Identification and naming of bones in articulated foot with individual muscle
attachments*

Topic: Front & Medial Side of Thigh (AN15.1 to AN15.6)

• Origin, course, relations, branches (or tributaries), termination of important nerves and
vessels of anterior thigh
• Major muscles with their attachment, nerve supply and actions
• Femoral triangle - boundaries and contents
• Anatomical basis of psoas abscess & femoral hernia*
• Adductor canal – boundaries and contents

31
Topic: Gluteal region & Back of thigh (AN16.1 to AN16.6)
• Origin, course, relations, branches (or tributaries), termination of important nerves and
vessels of gluteal region
• Major muscles with their attachment, nerve supply and actions
• Anatomical basis of sciatic nerve injury during gluteal intramuscular injections
• Anatomical basis of Trendelenburg sign
• Hamstring group of muscles with their attachment, nerve supply and actions
• Origin, course, relations, branches (or tributaries), termination of important nerves and
vessels on the back of thigh
• Popliteal fossa - boundaries, roof, floor, contents and relations

Topic: Hip joint (AN17.1 to AN17.3)

• Type, articular surfaces, capsule, synovial membrane, ligaments, relations, movements
and muscles involved, blood and nerve supply, bursae around the hip joint
• Anatomical basis of complications of fracture neck of femur*
• Dislocation of hip joint and surgical hip replacement*

Topic: Knee joint, Antero-lateral compartment of leg & Dorsum of foot (AN18.1 to AN18.7)
• Major muscles of anterolateral compartment of leg with their attachment, nerve supply
and actions
• Origin, course, relations, branches (or tributaries), termination of important nerves and
vessels of anterolateral compartment of leg
• Anatomical basis of foot drop
• Type, articular surfaces, capsule, synovial membrane, ligaments, relations, movements
and muscles involved, blood and nerve supply, bursae around the knee joint
• Anatomical basis of locking and unlocking of the knee joint
• Anatomical basis of knee joint injuries*
• Anatomical basis of osteoarthritis*

Topic: Back of leg & Sole (AN19.1 to AN19.7)

• Major muscles of back of leg with their attachment, nerve supply and actions
• Origin, course, relations, branches (or tributaries), termination of important nerves and
vessels of back of leg
• Concept of “peripheral heart”
• Sole - layers, muscles, vessels and nerves
• Anatomical basis of rupture of calcaneal tendon*
• Factors maintaining arches of the foot and their importance
• Anatomical basis of flat foot and club foot*
• Anatomical basis of metatarsalgia and plantar fasciitis*

Topic: General features, joints, radiographs & surface marking (AN 20.1 – 20.10)
• Tibiofibular and ankle joints - type, articular surfaces, capsule, synovial membrane,
ligaments, relations, movements and muscles involved, blood and nerve supply

32
 • Subtalar and transverse tarsal joints*
• Fascia lata, venous drainage, lymphatic drainage, retinacula and dermatomes of lower
limb
• Anatomical basis of enlarged inguinal lymph nodes*
• Anatomical basis of varicose veins and deep vein thrombosis
• Bones and joints of lower limb seen in anteroposterior and lateral view radiographs of
various regions of lower limb
• Important bony landmarks of lower limb - vertebral level of highest point on iliac crest,
anterior and posterior superior iliac spines, iliac tuberosity, pubic tubercle, ischial
tuberosity, adductor tubercle, tibial tuberosity, head of fibula, medial and lateral malleoli,
condyles of femur and tibia, sustentaculum tali, tuberosity of fifth metatarsal and
tuberosity of the navicular
• Palpation of arterial pulses in a simulated environment - femoral, popliteal, anterior tibial,
posterior tibial and dorsalis pedis
• Surface marking - mid inguinal point, saphenous opening, great and small saphenous
veins, femoral nerve, sciatic, tibial, common peroneal and deep peroneal nerve
• Basic concept of development of lower limb*

I. HEAD AND NECK

Topic: Skull osteology (AN26.1 to AN26.7)

• Anatomical position of skull
• Identification and naming of individual skull bones
• Features of norma frontalis, verticalis, occipitalis, lateralis and basalis
• Cranial cavity - subdivisions, foramina and structures passing through them
• Morphological features of mandible
• Features of typical and atypical cervical vertebrae (atlas and axis)
• Concept of membranous ossification*
• Features of the 7th cervical vertebra*

Topic: Scalp (AN27.1 and AN27.2)

• Scalp - layers, blood supply, nerve supply and surgical importance
• Emissary veins and their role in spread of infection from extracranial route to intracranial
venous sinuses

Topic: Face and parotid region (AN28.1 to AN28.10)

• Muscles of facial expression and their nerve supply
• Sensory innervation of face
• Origin / formation, course, branches / tributaries of facial vessels
• Branches of facial nerve with distribution
• Cervical lymph nodes and lymphatic drainage of head, face and neck
• Superficial muscles of face, their nerve supply and actions

33
 • Anatomical basis of facial nerve palsy
• Surgical importance of deep facial vein
• Parotid gland - parts, borders, surfaces, contents, relations, nerve supply, course of its
duct and surgical importance
• Anatomical basis of Frey’s syndrome*

Topic: Posterior triangle of neck (AN29.1 to AN29.4)

• Sternocleidomastoid - attachments, nerve supply, relations and actions
• Anatomical basis of Erb’s and Klumpke’s palsy
• Anatomical basis of wry neck*
• Attachments of inferior belly of omohyoid, scalenus anterior, scalenus medius and levator
scapulae*

Topic: Cranial cavity (AN30.1 to AN30.5)

• Cranial fossae and related structures
• Major foramina with structures passing through them
• Identification and description of dural folds and dural venous sinuses
• Clinical importance of dural venous sinuses
• Effect of pituitary tumours on visual pathway*

Topic: Orbit (AN31.1 to AN31.5)

• Extraocular muscles – demonstration and description
• Nerves and vessels in the orbit - demonstration and description
• Anatomical basis of Horner’s syndrome*
• Components of lacrimal apparatus
• Anatomical basis of oculomotor, trochlear and abducent nerve palsies along with
strabismus

Topic: Anterior triangle of neck (AN32.1 and AN32.2)

• Boundaries and subdivisions of anterior triangle
• Boundaries and contents of muscular, carotid, digastric and submental triangles

Topic: Temporal and infratemporal region (AN33.1 to AN33.5)

• Temporal and infratemporal fossae - extent, boundaries and contents
• Muscles of mastication - attachments, direction of fibres, nerve supply and actions
• Temporomandibular joint - articulating surface, type and movements
• Clinical significance of pterygoid venous plexus
• Features of dislocation of temporomandibular joint*

Topic: Submandibular region (AN34.1 and AN34.2)

• Submandibular salivary gland - morphology, relations and nerve supply including
submandibular ganglion
• Anatomical basis of formation of submandibular stones*

34
Topic: Deep structures in the neck (AN35.1 to AN35.10)
• Deep cervical fascia - parts, extent, attachments and modifications
• Thyroid gland - location, parts, borders, surfaces, relations and blood supply
• Subclavian artery - origin, parts, course and branches
• Internal jugular and brachiocephalic veins - formation, course, relations, tributaries and
termination
• Cervical lymph nodes - extent, drainage and applied anatomy
• Cervical sympathetic chain - extent, formation, relation and branches
• IX, X, XI and XII cranial nerves - course and branches in the neck
• Anatomical basic of clinical features of thyroid swellings*
• Anatomical basis of clinical features of compression of subclavian artery and lower trunk
of brachial plexus by cervical rib*
• Fascial spaces of neck*

Topic: Mouth, pharynx and palate (AN36.1 to AN36.5)

• Palatine tonsil - morphology, relations, blood supply and applied anatomy
• Composition of soft palate
• Waldeyer’s lymphatic ring - components and functions
• Pyriform fossa - boundaries and clinical significance*
• Anatomical basis of tonsillitis, tonsillectomy, adenoids and peri-tonsillar abscess*
• Clinical significance of Killian’s dehiscence*

Topic: Cavity of nose (AN37.1 to AN37.3)

• Nasal septum and lateral wall of nose – features, blood supply and nerve supply
• Paranasal sinuses - location and functional anatomy
• Anatomical basis of sinusitis and maxillary sinus tumours*

Topic: Larynx (AN38.1 to AN38.3)

• Larynx - morphology, structure of the walls, nerve supply, blood supply and actions of
intrinsic and extrinsic muscles
• Anatomical aspects of laryngitis*
• Anatomical basis of recurrent laryngeal nerve injury*

Topic: Tongue (AN39.1 and AN39.2)

• Tongue - morphology, nerve supply, embryological basis of nerve supply, blood supply,
lymphatic drainage and actions of extrinsic and intrinsic muscles
• Anatomical basis of hypoglossal nerve palsy*

Topic: Organs of hearing and equilibrium (AN40.1 to AN40.5)

• External ear - parts, blood supply and nerve supply
• Middle ear and auditory tube - boundaries, contents, relations and functional anatomy
• Features of internal ear*
• Anatomical basis of otitis externa and otitis media*

35
 • Anatomical basis of myringotomy*

Topic: Eyeball (AN41.1 to AN41.3)

• Eyeball - parts and layers
• Anatomical aspects of cataract, glaucoma and central retinal artery occlusion*
• Intraocular muscles - position, nerve supply and actions*

Topic: Back region (AN42.1 to AN42.3)

• Contents of the vertebral canal
• Suboccipital triangle - boundaries and contents
• Semispinalis capitis and splenius capitis - position, direction of fibres, relations, nerve
supply and actions*

Topic: Head and neck joints, histology, development, radiography and surface marking
(AN43.1 to AN43.9)
• Atlantooccipital joint and atlantoaxial joint - movements with muscles producing them
• Microanatomy of pituitary gland, thyroid gland, parathyroid gland, tongue, salivary
glands, tonsil, epiglottis, cornea and retina
• Microanatomy of olfactory epithelium, eyelid, lip, sclero-corneal junction, optic nerve,
cochlea, organ of Corti and pineal gland*
• Development and developmental basis of congenital anomalies of face, palate, tongue,
branchial apparatus, pituitary gland, thyroid gland and eye
• Testing of muscles of facial expression, extraocular muscles and muscles of mastication,
• Palpation of arteries - carotid, facial and superficial temporal arteries
• Location of - hyoid bone, thyroid cartilage and cricoid cartilage with their vertebral levels
• Surface marking - thyroid gland, parotid gland and duct, pterion, common carotid artery,
internal jugular vein, subclavian vein, external jugular vein, facial artery in the face and
accessory nerve
• Identify the anatomical structures in 1) Plain X-ray skull – AP and lateral view; 2) Plain X-
ray cervical spine - AP and lateral view; 3) Plain X-ray of paranasal sinuses
• Carotid and vertebral angiograms - anatomical route and anatomical structures*

J. NEUROANATOMY

Topic: Meninges and CSF (AN56.1 and AN56.2)

• Meninges - layers with their extent and modifications
• Circulation of CSF with its applied anatomy

Topic: Spinal cord (AN57.1 to AN57.5)

• Spinal cord - external features, extent in child and adult with its clinical implications
• Transverse section of spinal cord at mid-cervical and mid-thoracic level

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 • Ascending and descending tracts at mid thoracic level of spinal cord
• Anatomical basis of syringomyelia*

Topic: Medulla oblongata (AN58.1 to AN58.4)

• Medulla oblongata - external features
• Transverse section of medulla oblongata at the level of 1) pyramidal decussation; 2)
sensory decussation; 3) inferior olivary nucleus
• Cranial nerve nuclei in medulla oblongata with their functional components
• Anatomical basis and effects of medial and lateral medullary syndrome*

Topic: Pons (AN59.1 to AN59.3)

• Pons - external features
• Transverse section of pons at the upper and lower level
• Cranial nerve nuclei in pons with their functional components

Topic: Cerebellum (AN60.1 to AN60.3)

• Cerebellum - external and internal features
• Connections of cerebellar cortex and intracerebellar nuclei
• Anatomical basis of cerebellar dysfunction*

Topic: Midbrain (AN61.1 to AN61.3)

• Midbrain - external and internal features
• Internal features of midbrain at the level of superior and inferior colliculus
• Anatomical basis and effects of Benedikt’s and Weber’s syndrome*

Topic: Cranial nerve nuclei and cerebral hemispheres (AN62.1 to AN62.6)

• Cranial nerve nuclei with their functional components
• Cerebral hemispheres – poles, surfaces, sulci, gyri and functional areas
• White matter of cerebrum
• Basal ganglia and limbic lobe - parts and major connections
• Dorsal thalamus, hypothalamus, epithalamus, metathalamus and subthalamus -
boundaries, parts, gross relations, major nuclei and connections
• Circle of Willis - formation, branches and major areas of distribution

Topic: Ventricular system (AN63.1 and AN63.2)

• Lateral, 3rd and 4th and ventricles - parts, boundaries and features
• Anatomical basis of congenital hydrocephalus*

Topic: Histology and Embryology (AN64.1 to AN64.3)

• Microanatomical features of spinal cord, cerebellum and cerebrum
• Development of neural tube, spinal cord, medulla oblongata, pons, midbrain, cerebral
hemispheres and cerebellum
• Various types of open neural tube defects with their embryological basis*

37
 K. ETHICS IN ANATOMY – AN82.1
• Demonstrate respect and follow the correct procedure when handling cadavers and other
biologic tissue.

Summary of time allotted, teaching and learning methods and student assessment

TIME ALLOTTED

Curricular component Time allotted in hours

Lectures 220
Small group teaching / tutorials / integrated learning /practical 415
Self-directed learning 40
Early clinical exposure (basic science correlation and clinical 30 (18 +12)
skills)
Total 705
AETCOM module 1.1 and 1.5 12 (8+4)

To be noted:

• The number of hours mentioned above are rough guidelines that can be modified to
suit the specific requirements of a medical college.
• It is recommended that didactic teaching be restricted to less than one third of the total
time allotted for that discipline.
• Greater emphasis is to be laid on hands-on training, symposia, seminars, small group
discussions, problem-oriented and problem-based discussions and self-directed
learning.
• Students must be encouraged to take active part in and shared responsibility for their
learning.

Suggested guidelines for the teaching and learning methods

Lectures
• All lectures to have well defined specific learning objectives which are linked to the
relevant competencies. Learning objectives should be observable and assessable. Bloom’s
taxonomy can be used as a reference in choosing verbs for defining the learning objectives.
• The focus should be on the must-know component of the topic.
• As anatomy is a largely visually based subject appropriate pictures and videos can be
utilized.
• The anatomical basis of clinical conditions pertaining to the topic to be addressed.

38
 • Interactivity needs to be built into the lecture by asking open ended questions, quizzes,
incomplete handouts, creation of models, solving problems or a flipped classroom
approach, to name a few methods.

Other methods
• Team based learning can be used in place of didactic lectures.
• Case based learning can be used for tutorials.
• Seminars and assignments will encourage active learning by the students.

Dissection
• All dissections to have specific learning objectives which are linked to the relevant
competencies and are clinically relevant.
• The focus should be on identifying and how to identify important structures of the region
being dissected.
• Students should be encouraged to perform the dissections using relevant resources like
a good dissection manual and dissection videos, with faculty as facilitators.
• The dissection can be accompanied by relevant surface anatomy exercises, demonstration
of suitable radiological images and analysis of joint movements.
• The students should be encouraged to observe the dissection of cadavers in neighboring
tables so that they appreciate common anatomical variations.
• Each dissection can be accompanied by suitable clinical case scenarios which can be
discussed at the end of the dissection to bring out its clinical relevance.
• Each dissection session is a good opportunity to reiterate the concepts of respect for the
cadaver and professionalism.

Histology practical
• All histology sessions to have specific learning objectives which are linked to the relevant
competencies and are clinically relevant.
• The focus should be identifying and how to identify important structures in the sections
being viewed.
• Students should be encouraged to independently identify the salient features of the
section with faculty as facilitators.
• Each session can be accompanied by suitable clinical case scenarios which can be
discussed at the end of the session to bring out its clinical relevance.
• Each session is a good opportunity to reiterate the concept of professionalism.

Osteology
• All sessions to have specific learning objectives which are linked to the relevant
competencies and are clinically relevant.
• The focus should be identifying important structures of the bone being studied, the joints
formed by the bone and analysis of movements occurring at these joints.
• Students should be encouraged to independently identify the salient features of the bone
being studied with faculty as facilitators.
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 • The session can be accompanied by the demonstration of suitable radiological images.
• Each session can be accompanied by suitable clinical case scenarios which can be
discussed at the end of the session to bring out its clinical relevance.
• Each session is a good opportunity to reiterate the concept of professionalism.

INTEGRATION [Kindly refer section II for general guidelines on integration]

Suggested areas for integration

• Physiology
o Structure and functions of a neuron and neuroglia
o Nerve growth factor and other growth factors/cytokines
o Different types of muscle fibres and their structure
o Muscular dystrophy and myopathies
o Structure and functions of digestive system
o Functional anatomy of heart including chambers, heart sounds, pacemaker tissue
and conducting system
o Abnormal ECG, arrhythmias, heart block and myocardial infarction
o Sex determination, sex differentiation and their abnormities, psychiatric and
practical implications of sex determination
o Organization of nervous system
o Functions and properties of synapses, reflexes and receptors
o Somatic sensations and sensory tracts
o Motor tracts, mechanism of maintenance of tone, control of body movements,
posture and equilibrium and vestibular apparatus
o Structure and functions of reticular activating system and autonomic nervous
system (ANS),
o Spinal cord, its functions, lesions and sensory disturbances
o Functions of cerebral cortex, basal ganglia, thalamus, hypothalamus, cerebellum
and limbic system and their abnormalities
o Correct clinical examination of the nervous system: higher functions, sensory
system, motor system, reflexes, cranial nerves in a normal volunteer or simulated
environment

• Biochemistry
o Functions of the kidney, liver, thyroid and adrenal glands
o Tests that are commonly done in clinical practice to assess the functions of kidney,
liver, thyroid and adrenal glands
o Abnormalities of kidney, liver, thyroid and adrenal glands

40
• Pathology
o Etiology, pathogenesis, pathology, laboratory findings, distinguishing features
progression and complications of acute and chronic pyelonephritis and reflux
nephropathy
o Types, etiology, pathogenesis, pathology and hormonal dependency of benign
and malignant breast disease
o Etiology, pathogenesis, pathology and iodine dependency of thyroid swellings
o Etiology, pathogenesis, manifestations, laboratory and morphologic features of
adrenal neoplasms
o Etiology, pathogenesis, manifestations, radiologic and morphologic features and
complications of osteomyelitis

• Forensic Medicine
o Signs of intrauterine death, signs of live birth, viability of foetus, age
determination of foetus, ossification centres, hydrostatic test, sudden infant death
syndrome and Munchausen’s syndrome by proxy
o Corpus delicti, establishment of identity of living persons including race, sex,
religion, complexion, stature, age determination using morphology, teeth
eruption, decay, bite marks, bone ossification centres, medico-legal aspects of age

• Anesthesiology
o Anatomy of the airway and its implications for general anaesthesia
o Correlative anatomy of the brachial plexus, subarachnoid and epidural spaces
o Principles and steps/ techniques involved in peripheral nerve blocks
o Anatomical correlates and physiologic principles of pain
• ENT
o Anatomy and physiology of ear, nose, throat, head & neck

• Ophthalmology
o Aetiology, clinical presentations and diagnostic features of common conditions of
the lid and adnexa including hordeolum externum / internum, blepharitis,
preseptal cellulitis, dacryocystitis, hemangioma, dermoid, ptosis, entropion, lid
lag, lagopthalmos
o Types and causes of corneal ulceration
o Surgical anatomy and the metabolism of the lens
o Aetiology, pathology, clinical features and management of vascular occlusions of
the retina

• Dentistry
o Parts of the tooth and supporting structures

41
• General medicine
o Distinguish between community acquired pneumonia, nosocomial pneumonia
and aspiration pneumonia
o Demonstrate in a mannequin the correct technique for performing breast exam,
rectal examination, cervical examination and Pap smear
o Classification, presenting features, precipitating and relieving factors of various
kinds of headache
o Functional and the vascular anatomy of the brain
o Functional anatomy of the locomotor system of the brain

• Obstetrics and gynaecology

o Development and anatomy of the female reproductive tract, relationship to other
pelvic organs, applied anatomy as related to obstetrics and gynaecology
o Basic embryology of fetus, factors influencing fetal growth and development,
anatomy and physiology of placenta and teratogenesis
o Diameters and types of maternal pelvis

• General surgery
o Etiology and classification of cleft lip and palate
o Principles of reconstruction of cleft lip and palate
o Applied anatomy and physiology of the thyroid gland
o Applied anatomy of the parathyroid gland
o Applied anatomy of the adrenal glands
o Clinical features, principles of investigation, prognosis and management of
pancreatitis
o Applied anatomy and appropriate investigations for breast disease
o Clinical features, investigations and principles of management of congenital
anomalies of the genitourinary system
o Applied anatomy and physiology of the esophagus
o Applied anatomy and physiology of the stomach
o Applied anatomy of the liver
o Clinical features, investigations and principles of management of liver abscess,
hydatid disease, injuries and tumors of the liver
o Applied anatomy of the spleen
o Clinical features, investigations, principles of management of splenic injuries and
post-splenectomy sepsis prophylaxis
o Applied anatomy of the biliary system
o Clinical features, investigations and principles of management of diseases of the
biliary system
o Applied anatomy of the small and large intestines
o Applied anatomy including congenital anomalies of the rectum and anal canal
o Applied anatomy, clinical features, investigations and principles of management
of undescended testis

42
 o Applied anatomy, clinical features, investigations and principles of management
of epidydimo-orchitis
o Applied anatomy, clinical features, investigations and principles of management
of varicocele
o Applied anatomy, clinical features, investigations and principles of management
of hydrocele

• Orthopaedics
o Mechanism of Injury, clinical features, investigations and management of fracture
of clavicle
o Mechanism of Injury, clinical features, investigations and management of
fractures of proximal humerus
o Mechanism of Injury, clinical features, investigations and management of
supracondylar fracture of humerus
o Mechanism of injury, clinical features, investigations and principles of
management of fracture of shaft of humerus and intercondylar fracture of
humerus with emphasis on possible neurovascular deficits
o Aetiopathogenesis, clinical features, mechanism of injury, investigations and
principles of management of fractures of both bones of the forearm and Galeazzi
and Monteggia injury
o Aetiopathogenesis, mechanism of injury, clinical features, investigations and
principles of management of fractures of distal radius
o Aetiopathogenesis, mechanism of injury, clinical features, investigations and
principles of management of pelvic injuries with emphasis on hemodynamic
instability
o Aetiopathogenesis, mechanism of injury, clinical features, investigations and
principles of management of spine injuries with emphasis on mobilization of the
patient
o Mechanism of injury, clinical features, investigations and principle of
management of acetabular fractures
o Aetiopathogenesis, mechanism of injury, clinical features, investigations and
principles of management of fractures of proximal femur
o Aetiopathogenesis, mechanism of injury, clinical features, investigations and
principles of management of fractures of (a) patella; (b) distal femur; (c) proximal
tibia with special focus on neurovascular injury and compartment syndrome
o Aetiopathogenesis, clinical features, Investigation and principles of management
of fracture shaft of femur in all age groups and the recognition and management
of fat embolism as a complication
o Aetiopathogenesis, clinical features, Investigation and principles of management
of fractures of (a) both bones leg (b) calcaneus (c)
small bones of foot
o Aetiopathogenesis, clinical features, Investigation and principles of management
of ankle fractures

43
 o Investigations to diagnose complications of fractures like malunion, non-union,
infection and compartmental syndrome
o Mechanism of injury, clinical features, investigations and principles of
management of open fractures with focus on secondary infection prevention and
management
o Aetiopathogenesis, clinical features, Investigations and principles of
management of peripheral nerve injuries in diseases like foot drop, wrist drop,
claw hand, palsies of radial, ulnar, median, lateral popliteal and sciatic nerves
o Clinical features, investigations and principles of management of congenital and
acquired malformations and deformities of (a) spine - scoliosis and spinal bifida;
(b) hip - congenital dislocation; (c) neck – torticollis; (d) foot - congenital talipes
equino varus

• Physical medicine and rehabilitation

o Causes of disability in patients with a cerebrovascular accident
o Clinical features, types, evaluation, diagnosis and management of cerebral palsy

• Paediatrics
o Genetic basis, risk factors, complications, prenatal diagnosis, management and
genetic counselling in Down’s Syndrome

EARLY CLINICAL EXPOSURE [Kindly refer section II for general guidelines]

SUGGESTED TOPICS AND DEPARTMENTS FOR ECE

General embryology and genetics

• Abnormal implantation - Obstetrics and Gynaecology
• The role of antenatal ultrasound examination - Radiology / Obstetrics and Gynaecology
• The role of teratogens in the causation of congenital anomalies - Pharmacology /
Neonatology / Paediatrics
• Foetal diagnosis - Obstetrics and Gynaecology
• Genetic basis of common congenital malformations - Neonatology / Paediatric surgery
• Role of genetics in chronic non-communicable diseases – hypertension, diabetes mellitus,
depression and schizophrenia - Medicine / Psychiatry
• Molecular diagnostic techniques - Clinical pathology / Genetics / Haematology / Medical
oncology

Upper limb
• Nerve injuries of the median, ulnar and median nerves at different levels – Orthopaedics
/ Neurology
• Peripheral pulsations and their clinical importance – General surgery / Vascular surgery
• Concept of common fractures and dislocations – Orthopaedics

44
 • Concept of growing end of the upper limb bones and their medicolegal importance –
Orthopaedics / Forensic medicine
• Surgical approaches for orthopaedic surgery – Orthopaedics
• Testing muscles for tone, power, range of movement and reflexes – Physiology / Medicine
/ Neurology
• Basic concepts of skin and muscle flaps and their use in plastic surgery - Plastic surgery

Thorax
• The surgical importance of the mediastinum – General surgery / Chest medicine / Cardio-
thoracic surgery
• Ischaemic heart disease - Medicine / Cardiology / Cardiothoracic surgery / Physiology
• Congenital anomalies of the heart - Neonatology / Paediatric surgery
• Common radiological abnormalities on chest X rays - Radiology / General medicine
• Pleural effusion, pneumothorax, pleural tapping – General medicine / Chest medicine
• Tracheo-oesophageal fistula / role of surfactant in neonatal breathing - Neonatology /
Paediatric surgery / Physiology

Abdomen and pelvis

• Anatomy of abdominal incisions, hydrocoele and inguinal hernia – General surgery
• Cross sectional Anatomy - X- Ray, CT, MRI, Ultrasound – Radiology
• Surgical anatomy of GI tract, liver and EHBA - Physiology / Biochemistry / General
surgery / Radiology / Medical gastroenterology
• Surgical anatomy of the urogenital System - Physiology / Biochemistry / General surgery
/ Radiology / Urology / Nephrology
• Surgical anatomy of the pelvis - Physiology / Obstetrics and Gynaecology
• Applied anatomy of the lumbar spine - Orthopaedics

Lower limb
• Femoral hernia and its anatomical correlates – General surgery
• Nerve injuries and resultant gait abnormalities – Orthopaedics / General medicine /
Neurology / Physiology
• Varicose veins and deep vein thrombosis – General surgery
• Elephantiasis – General surgery / Microbiology
• Peripheral pulsations and their clinical importance – General surgery / Vascular surgery
• Common fractures of the lower limb with a focus on fractures of the neck of the femur –
Orthopaedics
• Common clinical conditions affecting the joints of the limbs with a focus on the knee joint
- Orthopaedics

Head and neck

• Surgical anatomy of the thyroid gland – General surgery / Pathology
• Surgical anatomy of the salivary glands – General surgery / Pathology

45
 • Lymphatic drainage of the head and neck and its applied importance – General surgery /
ENT / Pathology
• Endoscopic anatomy of the paranasal air sinuses – ENT
• Surgical anatomy of the middle ear and mastoid cavity – ENT
• Surgical anatomy of the palatine and pharyngeal tonsils – ENT
• Anatomical basis of common eye diseases - Ophthalmology / Physiology
• Column concept for fractures – Orthopaedics

Neuroanatomy
• The blood supply of brain / cerebro-vascular accident – General medicine / Neurology
• Extradural, subdural and subarachnoid haemorrhage – Neurosurgery
• Brain tumours - Neurology / Neurosurgery
• Congenital anomalies of the brain - Neonatology / Paediatrics
• Ascending / descending tracts – Physiology / Neurology
• CSF and its clinical importance - Physiology / Neurology
• Parkinson’s disease – Physiology / Neurology

AETCOM (Attitude Ethics and Communication Skills)

Module 1.1
Background
It is important for new entrants to get a holistic view of their profession, its ups and downs,
its responsibilities and its privileges. It is important to start this discussion early in their
careers when their minds are still fresh with the thrill of joining medical school. Such a
discussion will help them remember the big picture through the program and remind them
why they have chosen to be doctors.

Competencies addressed
1. Enumerate and describe professional qualities and roles of a physician
2. Describe and discuss the commitment to lifelong learning as an important part of
physician growth
3. Describe and discuss the role of a physician in health care system
4. Identify and discuss physician’s role and responsibility to society and the community
that she/ he serves

Hours: 8 (6 hours + 2 hours self-directed learning)

i. Exploratory session- 1 hour
ii. Facilitated panel discussion – 2 hours
iii. Self-directed learning - 2 hours
iv. Introductory visit to the hospital – 2 hours
v. Discussion and closure of case - 1 hour

Contents of the session

46
 1. An exploratory session with the students to find out (a) why they chose to become doctors,
(b) what do they think are the privileges and the responsibilities of the profession, (c) what
do they expect from society and what do they think society expects from them, and (d)
what will they have to do and give up in order to meet their own and society’s
expectations. This is preferably done in a small group discussion.
2. A facilitated panel discussion involving doctors who are at different stages of their careers
(senior, midlevel, young) during which these doctors share their experiences and also
answer questions from the students.
3. Self-directed learning where students write a report from reflections based on sessions 1
& 2 and on other reading materials, TV series, movies etc. that they have chosen from the
lay press about doctors’ experiences.
4. Introductory visit to the hospital / community medical centres
5. A closure session with students to share their reflections based on 1, 2, 3 and 4 that
includes their plans for the next 5 years in order to fulfill their professional and personal
roles as doctors.
6. A coat ceremony in the Foundation Course may be considered. A white coat ceremony is
held in many institutions, as a symbolic transition of the medical student prior to their
first day of exposure to clinical teaching, in order to emphasize the importance of their
new role as budding doctors.

Assessment
1. Formative: not required
2. Summative: not required
Resources
1. Whitcomb ME. What does it mean to be a physician? Acad Med.2007; 82: 917-8.
2. Eisenberg C. It is still a privilege to be a doctor? N Engl J Med 1986; 314:1113-1114.
3. Ofri D. Neuron overload and the juggling doctor. The Lancet 2010; 376: 1820 – 21. Module 1.5

Module 1.5

Background
Medical students enter college and their first encounter is with the cadaver, the memories of
which last for a lifetime. Respect for the cadaver as a teacher translates later into respect for
human beings as teachers and a lifelong respect for learning. Throughout the world, the emphasis
on “humanizing” the cadaver as the first patient or first teacher has gained momentum.

Competency addressed
Demonstrate respect and follows the correct procedure when handling cadavers and other
biologic tissues

Hours: 4 (2+2) hours

i. Opening session- 2 hours
ii. Closing session - 2 hours

47
Contents of session
1. An initial introductory session (large or small group) should be held on the importance of
biologic tissues and cadavers in their learning. The discussion should focus on the fact that
some of these cadavers were unclaimed, but also that many of them are were donated by
families. It must be emphasized that respect for donor families, cadavers and tissues is
important. The session should also include safe and clean handling and disposal of biologic
tissues (2 hours).
2. A session at the end of the phase is a small group or large group discussion with reflective
presentations by students on how the cadaver helped them to learn, their experience with
dissection etc. These sessions should allow the students to display their creativity and may
include prose, poetry, sketches etc. An example of such a project is found in the link below (2
hours).

Assessment
1. Formative: The student may be assessed based on their active participation in the sessions.
The respect and the manner in which students handle biologic tissues throughout the
phase may be part of the overall formative assessment of the student.
2. Summative: may not be required.

Resource: http://medicine.yale.edu/education/donation/reflections/ (An example of the project is found here).

SELF-DIRECTED LEARNING [Kindly refer section II for general guidelines]

Forty hours of dedicated time for SDL is provided for anatomy in the first phase.

48
 Suggested guidelines for student assessment
Internal assessment [Kindly refer section II for general guidelines]

TABLE SHOWING SCHEME FOR CALCULATION OF INTERNAL EXAMINATION MARKS

Theory (maximum marks) Practical (maximum marks)

Theory papers 30 Gross anatomy, histology (25 marks) 30
marks* viva-voce (5 marks) marks**
Professionalism 5 marks Histology record 5 marks
Part completion tests 5 marks Level of participation in early clinical 5 marks
exposure
TOTAL 40 marks TOTAL 40 marks
Please note:
• *Prior to submission to the University, the marks for each of the three internal examination theory
assessments must be calculated out of 30 marks, regardless of the maximum marks.
• **Prior to submission to the University, the marks for each of the three internal examination
practical assessments must be calculated out of 30 marks, regardless of the maximum marks.
• Only the final marks out of 40 needs to be submitted to the University, separately for theory and
practical for each internal assessment.

• Internal assessment should be based on competencies and skills.

• Professionalism (punctuality, respect for teachers and the cadaver, communication with
peers, timely completion and submission of record books and level of preparedness for
classes) must be assessed and form a component of the marks given for internal
assessment as shown in the table above.
• A suggested format for assessing professionalism is shown in ANNEXURE 1.
• A proportion of marks from part completion tests must be added to the internal
assessment marks as shown in the table above.
• Histology records must be assessed and contribute to the internal assessment marks as
shown in the table above.
• Level of participation in early clinical exposure must be assessed and contribute to the
practical component as shown in the table above.
• A suggested format for assessing participation in ECE is shown in ANNEXURE 2
• The scheme for calculation of the internal examination marks is given the table above.
• A clear record of all components that add to the internal assessment marks needs to be
maintained by the institution and retained by them for at least 5 years after completion of
the examination. Institutions may be asked to provide these details by the University as
and when required.
• The internal and formative assessments provide ideal opportunities for students and
teachers to identify learning gaps. Teachers should provide high quality feedback to each
student to enable them to bridge these learning gaps.
• A suggested format for providing feedback is shown in ANNEXURE 3.
49
 UNIVERSITY EXAMINATIONS
TABLE SHOWING SCHEME FOR CALCULATION OF UNIVERSITY EXAMINATION MARKS
Theory (maximum marks) Practical (maximum marks)

Paper 1 100 marks Gross anatomy

i. Spotters (10X2) 20 marks

ii. Window discussion 1 (above diaphragm) 15 marks
iii. Window discussion 2 (below diaphragm) 15 marks
Total 50 marks

Paper 2 100 marks Histology

i. Spotters (10X1) 10 marks
ii. Slide discussion 1 (general histology) 10 marks
iii. Slide discussion 2 (systemic histology) 10 marks
Total 30 marks
TOTAL 200 marks Viva-voce
i. Osteology 05 marks
ii. Surface marking 05 marks
iii. Radiological anatomy 05 marks
iv. Embryology 05 marks
Total 20 marks
TOTAL 100 marks

• University examinations are to be designed with a view to ascertain whether the candidate
has acquired the necessary knowledge, minimal level of skills, ethical and professional
values with clear concepts of the fundamentals which are necessary for him/her to function
effectively and appropriately as a physician of first contact. Assessment shall be carried out
on an objective basis to the extent possible.
• Nature of questions will include different types such as structured essays, modified essays
(case based), short essays and short answers questions.
• The objective will be to assess proficiency and skills to identify key structures (on cadavers,
dry bones, histology slides and genetics charts, radiographs and embryology models),
demonstrate surface marking and movements at joints, with functional and clinical
correlations.
• Viva/oral examination should assess the student’s ability to explain key concepts with
functional and clinical correlates related to osteology, embryology, surface marking and
radiological anatomy.
• The marks obtained in the viva examination will be added to the practical marks.
• In subjects that have two papers, the learner must secure at least 40% marks in each of the
papers with minimum 50% of marks in aggregate (both papers together) to pass.
• The student must secure a minimum of 50% of marks in aggregate in the viva and practical
examination (both combined) to pass.
• There shall be one main examination in an academic year and a supplementary to be held
not later than 90 days after the declaration of the results of the main examination.
50
 Theory
Preparation of question papers

• All the question papers to follow the suggested blueprint (ANNEXURE 4).
• The marks allotted to a particular topic are to be strictly adhered to.
• A minimum of 35% marks shall be allocated to assess the higher order thinking skills of
the student.
• All the different types of structures given in the blueprint (eg. arteries, veins, nerves etc) are
to be compulsorily covered in each question paper.
• Systemic histology and systemic embryology are NOT TO BE COVERED in paper 1.
• The question paper layout give below must be strictly adhered to (ANNEXURE 5). Both paper
1 and paper 2 have TWO POSSIBLE LAYOUTS, either of which may be followed based on
the paper setters’ preference.
• Please note that only core competencies (list provided in the MCI document) are to be
assessed in the university examinations.
• All questions to contain appropriate verbs as shown in the example (ANNEXURE 6).
• One short essay question (5 marks) and one short answer question (3 marks) to be of the
modified variety containing a clinical case scenario or requiring an explanation of a concept
or the drawing of a diagram (ANNEXURE 7). This question can be from any component
(general anatomy, histology, embryology, genetics, gross anatomy and neuroanatomy) of the
curriculum.
• The questions related to general and systemic histology must be of a higher level than simply
drawing and describing a histology slide, as this will anyway be covered in the practical
component.

Practical
Gross anatomy

• There will be 10 spotters each of two marks and two window discussions for 15 marks each.
• The spotters should be from the following regions:
- Neuroanatomy – 1
- Head and neck – 2
- Thorax – 2
- Upper limb – 1
- Abdomen – 2
- Lower limb – 1
- Pelvis – 1
• There will be a subdivision of the spotters as follows:
- Artery - 1
- Vein – 1
- Nerve – 1
- Muscle – 1

51
 - Connective tissue structure - 1
- Bone – 1
- Organ – 1
- Cross section - 1
- Picture based clinical cases (eg. Erb’s palsy, foot drop etc.) - 2
• The window discussions will be one from the above diaphragm structures and one from the
below diaphragm structures. It is advised that musculo-skeletal window discussions be
combined with organs. A combination of two musculo-skeletal structures or two organs is to
be avoided.
• For the window discussions, the students should first be asked to identify key structures,
questioned further on these structures and then asked about important clinical applications.
• The marking scheme for window discussions could be as follows:
- Identifies key structures – maximum 6 marks
- Answers questions related to these structures – maximum 6 marks
- Clinical applications – maximum 3 marks
Histology
• There will be 10 spotters each of one mark and two slide discussions for 10 marks each.
• Of the 10 spotters, four must be from general histology, five from systemic histology and
one genetics chart.
• The suggested list of histology slides is shown in ANNEXURE 8.
• For the slide discussion, one slide must be from general histology and one from systemic
histology.
• For the slide discussion, the students should first be asked to identify and draw the slide
with suitable justification, demonstrate key structures in a section, questioned further on
these structures and then asked about important clinical/functional applications.
• If the student does not identify the slide correctly at first, he or she should be given another
chance.
• The marking scheme for each slide for the slide discussion could be as follows:
- Draws and identifies the slide correctly with justification – maximum 3 marks
- Demonstrates key structures – maximum 3 marks
- Answers questions related to these structures – maximum 3 marks
- Clinical/functional applications – maximum 1 mark
• The histology record books duly signed by the Head of the Department must be
submitted during the examination and verified by the external examiner.

Viva voce

• The four viva-voce stations will be radiological anatomy, embryology, osteology and
surface marking, each carrying 05 marks.
• Though the questions may be different for each student, the pattern of questioning must
be similar. This could be ensured by utilizing previously prepared viva cards.
• In addition to plain and contrast X-rays, cross sectional anatomy (either gross or relevant
CT and MRI images) may be assessed in the radiological anatomy station.

52
• Students must be assessed using relevant embryology models and charts in the
embryology station.
• In the osteology station, questions related to bone articulations with movements are to
be included.
• For surface marking, the students must perform surface marking and subsequently state
the clinical importance of the surface marking. These structures must be restricted to those
mentioned in the curriculum. Five marks are allotted for surface marking (maximum of
4 marks for the surface marking plus 1 mark for the clinical importance). This should be
conducted in the form of an OSPE (either on a cadaver or volunteer) with a standard
checklist to be prepared on the day of the examination by the examiners.
• For the other viva topics students should first be asked to identify basic structures,
questioned further on these structures and then asked about important clinical
applications.
• The marking scheme could be as follows:
- Identifies the structures (the side and anatomical position if applicable) –
maximum 2 marks
- Answers questions related to these structures – maximum 2 marks
- Clinical applications – maximum 1 mark
• A list of suggested topics for radiological anatomy, surface marking, cross-sectional
anatomy and muscle testing is shown in ANNEXURE 9.

53
 ANNEXURE 1

Suggested format for assessing professionalism

Quarter Overall Timely Takes Behaves Total Date Signature Signature

attendance submission the respectfully (20) of of
(5) of record trouble with peers student mentor
books (5) to and
complete teachers (5)
the
record
book
well (5)

1st

2nd

3rd

Guidelines for scoring (to be shown to the student and discussed with them)

Attendance – 95-100% - 5; 90-94% - 4; 85-89% - 3; 80-84% - 2;

Timely submission of records – Always submits the record on time – 5; Often submits the record on time
– 4; Sometimes submits the record on time – 3; Rarely submits the record on time – 2;

Takes the trouble to complete the record well – Diagrams are neatly drawn with complete labelling – 5;
Diagrams are of above average quality with nearly complete labelling – 4; Diagrams are of average quality
with partial labelling- 3; Diagrams are of below average quality with inadequate labelling – 2;

Behaves respectfully with peers and teachers – Always speaks politely and demonstrates the appropriate
body language with peers and teachers – 5; Often speaks politely and demonstrates the appropriate body
language with peers and teachers – 4; Sometimes speaks politely and demonstrates the appropriate body
language with peers and teachers – 3; Rarely speaks politely and demonstrates the appropriate body
language with peers and teachers – 2;

54
 ANNEXURE 2

Suggested format for assessing participation in ECE sessions

Name:…………………………………………………………………………………………………

Date:………………………………………………………………………………………………….

ECE session………………………………………………………………………………………….

1 = strongly agree. 2 = agree. 3 = no preference. 4 = disagree. 5 = strongly disagree.

Critical appraisal 1 2 3 4 5

1 Clarifies, defines and analyses the problem from the scenario /

interaction with patient
2 Identifies learning objectives
3 Demonstrates initiative and curiosity
Utilization of learning resources
4 Utilizes relevant resource materials effectively
5 Applies knowledge to new situations to solve problems and to reach
decisions
Group work
6 Organized and prepared for small group sessions
7 Shares thoughts and opinions with peers actively
Attitudes and Communication Skills
8 The oral expression is clear enough to be understood
9 Provides and accepts constructive feedback
10 Contributes to group harmony (listens to conflicting opinions and
tolerates shortcomings of others)

Comment:
To describe the strengths and suggested areas for improvement of the reviewed student and to assist
him/her to be a more effective learner.

55
 ANNEXURE 3

Suggested format for monitoring academic performance and providing

feedback

Sl. Marks obtained Feedback provided Signature Signature

No. Date of of mentor
Positive Could be
student
improved
1. Test 1

2. 1st Internal
Examination
Theory
Practical
3. Overall 1st
quarter
marks
4. Test 2
5. 2nd Internal
Examination
Theory
Practical
6. Overall 2nd
quarter
marks
7. Test 3
8. 3rd Internal
Examination
Theory
Practical
9. Overall 3rd
quarter
marks

56
 ANNEXURE 4
Blueprint for the anatomy theory examinations
Paper 1

Connective
Muscles
Arteries

Organs
Nerves

Others
Bones
Space

Joints
Veins

tissue
TOPIC Marks
General
anatomy 6
General
histology 5
General
embryology 8
Upper limb 18
Thorax
(including
diaphragm) 21
Head and neck 29
Neuroanatomy 13
TOTAL 100

Paper 2
Connectiv
Muscles
Arteries

e tissue

Organs
Nerves

Others
Bones

Joints
Veins

Space

Marks
Systemic
histology 11
Systemic
embryology 11
Genetics 8
Lower limb 18
Abdomen 31
Pelvis 21
TOTAL 100

57
 ANNEXURE 5

Question paper layouts for theory examinations

PAPER 1

Version 1
Long Essay: 2X 10 = 20
1 Upper limb
2 Head and neck
Short Essays: 5x 10 = 50
3 Upper limb
4 Thorax including diaphragm
5 Thorax including diaphragm
6 Thorax including diaphragm
7 Head and neck
8 Head and neck
9 Neuroanatomy
10 Neuroanatomy
11 General embryology
12 General histology
Short Answers: 3X10 = 30
13 Upper limb
14 Thorax including diaphragm
15 Thorax including diaphragm
16 Head and neck
17 Head and neck
18 Head and neck
19 Neuroanatomy
20 General anatomy
21 General anatomy
22 General embryology

58
 ANNEXURE 5

Question paper layouts for theory examinations

PAPER 1

Version 2
Long Essay: 2X 10 = 20
1 Thorax including diaphragm
2 Head and neck
Short Essays: 5x 10 = 50
3 Upper limb
4 Upper limb
5 Upper limb
6 Thorax including diaphragm
7 Head and neck
8 Head and neck
9 Neuroanatomy
10 Neuroanatomy
11 General embryology
12 General histology
Short Answers: 3X10 = 30
13 Upper limb
14 Thorax including diaphragm
15 Thorax including diaphragm
16 Head and neck
17 Head and neck
18 Head and neck
19 Neuroanatomy
20 General anatomy
21 General anatomy
22 General embryology

59
 ANNEXURE 5

Question paper layouts for theory examinations

PAPER 2

Version 1

Long Essay: 2 X 10 = 20
1 Lower limb
2 Abdomen
Short Essays: 5 X 10 = 50
3 Lower limb
4 Abdomen
5 Abdomen
6 Abdomen
7 Pelvis
8 Pelvis
9 Pelvis
10 Genetics
11 Systemic histology
12 Systemic embryology
Short Answers: 3 X 10 = 30
13 Lower limb
14 Abdomen
15 Abdomen
16 Pelvis
17 Pelvis
18 Genetics
19 Systemic histology
20 Systemic histology
21 Systemic embryology
22 Systemic embryology

60
 ANNEXURE 5

Question paper layouts for theory examinations

PAPER 2

Version 2

Long Essay: 2X 10 = 20
1 Lower limb
2 Pelvis
Short Essays: 5 X 10 = 50
3 Lower limb
4 Abdomen
5 Abdomen
6 Abdomen
7 Abdomen
8 Abdomen
9 Pelvis
10 Genetics
11 Systemic histology
12 Systemic embryology
Short Answers: 3 X 10 = 30
13 Lower limb
14 Abdomen
15 Abdomen
16 Pelvis
17 Pelvis
18 Genetics
19 Systemic histology
20 Systemic histology
21 Systemic embryology
22 Systemic embryology

61
 ANNEXURE 6

Example of a question paper

Paper 2
Time: 3 hours Marks: 100
Your answers should be specific to the questions asked.
Draw neat labelled diagrams (with conventional colours) wherever necessary.

Long essays (2 X 10 = 20 marks)

1) Describe the knee joint under the following headings: a) Bones forming; b) Ligaments; c)
Movements with muscles causing them; Nerve supply; d) Applied aspects. (1+3+3+1+2)
2) Describe the stomach under the following headings: a) Location; b) Parts; c) Relations; d) Blood
supply; e) Lymphatic drainage; f) Applied aspects. (1+1+3+2+2+1)

Short essays (10 X 5 = 50 marks)

3) Explain the course, relations and distribution of the common peroneal nerve. At which site is the
nerve commonly injured and why? Explain the anatomical basis of the clinical features observed
as a result of such an injury. (3+1+1)
4) Describe the mechanism, location and applied importance of porta-caval anastomoses. (1+2+2)
5) Describe the gross anatomy and applied importance of the vermiform appendix. (3.5+1.5)
6) Explain the protective mechanisms of the inguinal canal that prevent the occurrence of inguinal
hernia.
7) Describe the lobes, relations and applied anatomy of the prostate gland. (2+2+1)
8) Describe the boundaries, contents and applied aspects of the ischiorectal fossa. (2+2+1)
9) Describe the supports of the uterus and their applied importance. (4+1)
10) What is Down syndrome? Explain the genetic mechanism underlying it. (2+3)
11) Correlate the structure and function of the juxta-glomerular apparatus.
12) Explain the mechanism of midgut rotation during development and its consequences.
Short answers (10 X 3 = 30 marks)
13) What is Trendelenburg gait? Explain its anatomical basis. (2+1)
14) A man sustained severe trauma to the lower chest wall on the left side in a road traffic accident.
He was taken to the emergency department where he was found to have a fracture of the 9th and
10 ribs and a ruptured spleen. Explain the probable mechanism by which splenic rupture might
have occurred.
15) Name the attachments and contents of the lesser omentum. (1.5+1.5)
16) Name the attachments and contents of the broad ligament of the uterus. (1.5+1.5)
17) Describe briefly the gross anatomy of the perineal body and its applied importance. (2+1)
18) Draw a typical pedigree chart showing sex-linked recessive inheritance.
19) Draw a neat, labelled diagram (high-power view) of a haematoxylin and eosin stained section of a
pancreatic acinus.
20) Compare and contrast the histology of the duodenum, jejunum and ileum.
21) Enumerate the derivatives of the paramesonephric duct.
22) Enumerate the derivatives of the 2nd pharyngeal arch.

62
 ANNEXURE 7

Examples of questions assessing higher cognitive levels

Short essays (5 marks)

1. Explain the course, relations and distribution of the common peroneal nerve. At which
site is the nerve commonly injured and why? Explain the anatomical basis of the clinical
features observed as a result of such an injury. (3+1+1)
2. A 50-year-old man suffered a myocardial infarction as a result of thrombosis of the left
anterior descending artery and collapsed. Cardiopulmonary resuscitation was performed
as an emergency measure. Explain the anatomical basis of the chest compression
technique. Describe the structures that can possibly be affected as a result of such a
blockage. Where would the pain in this patient be felt and why? (1+2+2)
3. A 30-year-old lady developed right sided pleural effusion secondary to pulmonary
tuberculosis. The treating physician decided to do a pleural tap in this patient. Where in
the pleural cavity would fluid have initially collected and why? Describe the structures
that the needle has to pass through to reach the pleural cavity. What is the ideal location
to introduce the needle and why? (1+3+1)

Short answers (3 marks)

1. Compare and contrast the microstructure of a mucous and serous acinus.
2. Explain the mechanism of closure of the foramen ovale of the heart.
3. Explain the mechanism of locking and unlocking of the knee joint.
4. Draw a neat, labelled diagram to show the boundaries and subdivisions of the
mediastinum. (1.5+1.5)
5. Explain the role of the soleus muscle in promoting venous return from the lower limb.

63
 ANNEXURE 8
List of histology slides

General histology Systemic histology

1. Epithelial tissue 1. Breast 38. Eyelid*
2. Connective tissue 2. Lung 39. Eyeball*
3. Serous salivary gland 3. Trachea 40. Cornea
4. Mucous salivary gland 4. Oesophagus 41. Optic nerve*
5. Mixed salivary gland 5. Stomach fundus 42. Retina
6. Hyaline cartilage 6. Stomach pylorus 43. Sclero-corneal junction*
7. White fibrocartilage 7. Duodenum 44. Cochlea*
8. Elastic cartilage 8. Jejunum 45. Organ of Corti*
9. TS of compact bone 9. Ileum 46. Spinal cord
10.LS of compact bone 10. Large intestine 47. Cerebellum
11.TS of skeletal muscle 11. Appendix 48. Cerebrum
12.LS of Skeletal muscle 12. Liver
13.Cardiac muscle 13. Gall bladder
14.Large artery 14. Pancreas
15.Large vein 15. Kidney
16.Medium sized artery 16. Ureter
17.Medium sized vein 17. Urinary bladder
18.Lymph node 18. Testis
19.Thymus 19. Epididymis
20.Palatine Tonsil 20. Vas deferens
21.Spleen 21. Prostate
22.Peripheral nerve TS 22. Penis
23.Peripheral nerve LS 23. Ovary
24.Sensory ganglia 24. Fallopian tube
25.Autonomic ganglia 25. Uterus
26.Thick skin 26. Cervix
27.Thin skin 27. Placenta
28. Umbilical cord
29. Lip*
30. Tongue
31. Epiglottis
32. Olfactory epithelium*
33. Pituitary gland
34. Thyroid
35. Parathyroid gland
36. Adrenal gland
37. Pineal gland*
* Please note that the slides marked with an asterisk are non-core competencies.

64
 ANNEXURE 9

List of surface marking / muscle testing / radiological anatomy / cross sections

UPPER LIMB

Arteries Veins Nerves Connective Testing of Radiological

(palpation) tissue/other muscles anatomy
1. Axillary 1. Basilic 1. Axillary 1. Flexor 1. Trapezius AP and lateral
artery vein Nerve retinaculum view of
radiographs of
2. Brachial 2. Cephalic 2. Radial 2. Pectoralis 1. Shoulder
Artery vein Nerve major region
3. Radial Artery 3. Median 3. Ulnar 3. Serratus 2. Arm
cubital Nerve anterior
vein
4. Ulnar artery 4. Median 4. Latissimus 3. Elbow
Nerve dorsi
5. Superficial 5. Deltoid 4. Forearm
palmar arch
6. Deep palmar 6. Biceps brachii 5. Hand
arch
7. Brachioradialis
LOWER LIMB
1. Femoral 1. Great 1. Femoral 1. Saphenous 1. Gluteus AP and lateral
artery saphenous nerve opening maximus view of
vein radiographs of
2. Popliteal 2. Small 2. Sciatic 2. Mid- 2. Gluteus 1. Hip
artery saphenous nerve inguinal medius and
vein point minimus
3. Posterior 3. Common 3. Hamstring 2. Knee
tibial artery peroneal muscles
nerve
4. Dorsalis 4. Deep 4. Quadriceps 3. Ankle
pedis peroneal femoris
nerve
5. Dorsiflexors of 4. Foot
ankle
6. Plantar flexors
of ankle
7. Muscles
causing
inversion and
eversion
65
 ANNEXURE 9

List of surface marking / muscle testing / radiological anatomy / cross sections

THORAX

1. Lines of pleural reflections 1. Plain X ray chest PA view

2. Lung borders and fissures
3. Trachea
4. Heart borders
5. Apex beat
6. Surface projections of valves of heart

HEAD AND NECK

Arteries Veins Nerve Gland On simulation Radiological

/other anatomy

1. Common 1. Internal 1. Accessory 1. Thyroid 1. Testing of muscles 1. Plain X-ray

carotid jugular nerve gland of facial skull - AP
artery vein expression and lateral
view
2. Facial 2. Subclavian 2. Parotid 2. Extraocular 2. Plain X-ray
artery in vein gland and muscles cervical
the face duct spine - AP
and lateral
view
3. External 3. Pterion 3. Muscles of 3. Plain X-ray
jugular mastication paranasal
vein sinuses
4. Palpation of
carotid arteries
5. Facial artery

6. Superficial
temporal artery
7. Location of
internal and
external jugular
vein
8. Location of hyoid
bone, thyroid
cartilage, cricoid
cartilage with
their vertebral
level

66
 ANNEXURE 9

List of surface marking / muscle testing / radiological anatomy / cross sections

ABDOMEN & PELVIS

Surface marking of Surface Sectional Radiological anatomy
projection of Anatomy
1. Regions and planes of 1. Stomach 1. Cross 1. Plain x ray of abdomen
abdomen section at
the level of
T8, T10, L1
(transpyloric
plane)
2. Superficial inguinal ring 2. Liver 2. Mid sagittal 2. X ray barium swallow
section of
male and
female
pelvis
3. Deep inguinal ring 3. Fundus of gall 3. Barium meal
bladder
4. McBurney’s point 4. Spleen 4. Barium enema
5. Renal angle 5. Duodenum 5. Cholecystography
6. Murphy’s point 6. Pancreas 6. Intravenous pyelography
7. Ileo-caecal 7. Hysterosalpingography
junction
8. Kidneys
9. Root of
mesentery

67
 LIST OF RECOMMENDED BOOKS
General anatomy
• Handbook of General Anatomy, BD Chaurasia / General Anatomy, Vishram Singh

Histology
• diFiore’s Atlas of Human Histology with Functional Correlation, Victor P Eroschenko /
Wheater's Functional Histology: A Text and Colour Atlas
• Textbook of Human Histology with colour Atlas, Inderbir Singh / Textbook of Histology
and Practical Guide, Gunasegaran / Histology: Text and Atlas, Brijesh Kumar

Embryology
• Textbook of Human Embryology, Inderbir Singh / Langman's's textbook of Medical
Embryology, TW Sadler

Human genetics
• Human Genetics, SD Gangane / Medical Genetics, GP Pal / Emery’s Elements of Human
Genetics, Peter Turnpenny and Sian Ellard

Gross anatomy including neuroanatomy

• Cunningham’s Manual of Practical Anatomy Volumes I,II and III
• BD Chaurasia’s / Dutta’s / Vishram Singh’s Textbook of Anatomy – all volumes
• Grant’s atlas / McMinn’s atlas / Netter’s atlas
• Clinically Oriented Anatomy, K L Moore / Clinical Anatomy by Regions, Richard Snell /
Clinical Anatomy (A Problem Solving Approach) (2 volumes), Neeta Kulkarni
• Gray's Anatomy for Students, South Asia Edition
• Clinical Neuroanatomy, Richard Snell / Textbook of Neuroanatomy, IB Singh / Textbook
of Clinical Neuroanatomy, Vishram Singh

Surface and radiological anatomy

• Surface and radiological anatomy, A Halim / Surface and radiological anatomy, Ashwini
Appaji and Roopa Kulkarni

Others
• Stedman’s Medical Dictionary
• Gray's Anatomy - The Anatomical Basis of Clinical Practice

Please note: It is suggested that students use the latest editions of the above books.

68
PHYSIOLOGY

Goal:

The broad goal of the teaching of undergraduate students in Physiology aims at providing the
student comprehensive knowledge of the normal functions of the organ systems of the body to
facilitate an understanding of the physiological basis of health and disease.

Objectives

a. Knowledge:
At the end of the course the student will be able to:
1. Explain the normal functioning of all the organ systems and their interactions for well-
coordinated total body function;
2. Assess the relative contribution of each organ system to the maintenance of the milieu
interior;
3. Elucidate the physiological aspects of normal growth and development;
4. Describe the physiological response and adaptations to environmental stresses;
5. List the physiological principles underlying pathogenesis and treatment of disease
b. Skills
At the end of the course the student will be able to:
1. conduct experiments designed for study of physiological phenomena;
2. interpret experimental/investigative data;
3. Conduct and interpret clinical examination in normal healthy subject;
4. distinguish between normal abnormal data derived as a result of tests, which he/she has
performed and observed in the laboratory.
c. Attitude and communication skills:
At the end of the course the student will be able to:
1. show due respect to persons who volunteer to be examined for the purpose of learning
clinical examination.
2. communicate effectively with peers, teachers and volunteer in clinical examination
3. demonstrate the ability of teamwork
d. Integration:
At the end of the integrated teaching the student should acquire an integrated knowledge of organ
structure and function and the regulatory mechanisms.

List of systems included in Physiology:

• General Physiology
• Hematology
• Nerve-Muscle Physiology
• Gastro-Intestinal Physiology
• Cardiovascular physiology
69
 • Respiratory physiology
• Renal Physiology
• Endocrine Physiology
• Reproductive Physiology
• Neurophysiology (Central Nervous System and Special Senses)
• Integrated Physiology
Physiology Syllabus
THEORY

General Physiology (PY 1.1-1.9) (8 hrs)

Structure and functions of a mammalian cell; Homeostasis, Intercellular communication;
Apoptosis; Transport mechanisms across cell membranes; Fluid compartments of the body; pH
& Buffer systems in the body; Evaluation of functions of the cells and products in clinical care
and research.

Hematology: (PY 2.1 - 2.13) (16 hrs)

Components of blood: formation, regulation and functions; plasma proteins – origin, types,
variations and functions; Hemoglobin- synthesis, variants, functions and its breakdown &
Jaundice; Blood indices; Anemia and its classification; Hemostasis: mechanism, regulation &
disorders Anticoagulants; Blood groups, blood banking and transfusion; Immunity: types,
mechanism & regulation; ESR; Lymph-composition, circulation and functions

Nerve & Muscle Physiology: (PY 3.1 - 3.18) (10hrs)

Neuron and neuroglia: structures, types, functions; Resting membrane potential; Action potential
in nerve, skeletal & smooth muscle; Nerve fibres: classification, functions & properties; nerve
injuries, degeneration and regeneration in peripheral nerve; Neuromuscular junction: structure,
transmission of impulses, neuro-muscular blocking agents, Myasthenia gravis; Muscle fibres:
structure, types & functions; Muscle contraction; molecular basis (skeletal, smooth), Isotonic Vs.
Isometric, Energy sources and metabolism, gradation of muscle activity; muscle dystrophy,
Myopathies; Strength-duration curve

Gastrointestinal Physiology: (PY 4.1 - 4.10) (10hrs)

Functional anatomy and broad functions of digestive system, enteric nervous system; GI
Secretions- composition, mechanism of secretion, functions, and regulation of saliva, gastric,
pancreatic, intestinal juices and bile secretion; GI movements- types, regulation, functions,
reflexes; role of dietary fibres; Digestion and absorption of nutrients; GI hormones- source,
regulation, functions; Gut-brain axis; structure and functions of liver and gall bladder; gastric
function tests, pancreatic exocrine function tests & liver function tests, Pathophysiology -
Achalasia cardia, peptic ulcer, gastro oesophageal reflux disease, vomiting, diarrhoea,
constipation, Adynamic ileus, Hirschsprung's disease.
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Cardiovascular Physiology: (PY 5.1 - 5.16) (25hrs)

Functional anatomy of heart; Pacemaker tissue and conducting system-generation, conduction of

cardiac impulse; Properties of cardiac muscle; Cardiac cycle; ECG- recording, normal ECG, uses,
cardiac axis, Abnormal ECG in common arrhythmias, changes with hypertrophy & MI;
Haemodynamics; Heart rate- factors affecting, regulation; Cardiac output- factors, regulation,
measurement; Blood pressure- components, determinants, factors, regulation and applied aspect,
Regional circulation- autoregulation, microcirculation, lymphatic circulation, coronary, cerebral,
capillary, skin, fetal, pulmonary and splanchnic circulation; Pathophysiology- shock, syncope,
heart failure & coronary artery disease

Respiratory Physiology: (PY 6.1-6.10) (12hrs)

Functional anatomy of respiratory tract, dead space; Mechanics of respiration; Pressure volume
changes during ventilation; Lung volume and capacities; Alveolar surface tension; Compliance;
Airway resistance; alveolar ventilation, V/P ratio; Diffusion capacity of lungs; Transport of
respiratory gases- Oxygen and Carbon dioxide; Neural and chemical regulation of respiration;
Physiology of high altitude and deep sea diving; Principles of artificial respiration, oxygen
therapy; Patho-physiology of dyspnoea, hypoxia, cyanosis, asphyxia, drowning, periodic
breathing; Lung function tests & its clinical significance

Renal Physiology: (PY 7.1 - 7.9) (10hrs)

Structure and functions of kidney & juxta glomerular apparatus, role of renin-angiotensin system
; Renal blood flow; Mechanism of urine formation, concentration and diluting mechanism;
Concept and significance of ‘clearance’ tests; Renal regulation of fluid and electrolytes & acid-
base balance; Structure and innervation of urinary bladder, physiology of micturition,
cystometry, and its abnormalities; Artificial kidney(dialysis) and renal transplantation; Renal
Function Tests

Endocrine Physiology: (PY 8.1 - 8.6) (16 hrs)

Mechanism of action of steroid, protein and amine hormones; Synthesis, secretion, transport,
physiological actions, regulation and effect of altered (hypo and hyper) secretion of pituitary
gland, thyroid gland, parathyroid gland, adrenal gland, pancreas and hypothalamus; Physiology
of bone and calcium metabolism; Physiology of growth; Physiology of Thymus & Pineal Gland;
Hormone function tests ; Obesity & metabolic syndrome; Stress response

Reproductive Physiology: (PY 9.1 - 9.12) (10hrs)

Sex determination; sex differentiation and their abnormalities; Puberty: onset, progression,
stages; early and delayed puberty; Male reproductive system: functions of

71
testis, spermatogenesis and its regulation, Cryptorchidism ; Female reproductive system:
functions of ovary and its control, menstrual cycle: Hormonal, uterine and ovarian changes; Tests
for ovulation; Physiological effects of sex hormones; Contraceptive methods for male and female;
Effects of removal of gonads on physiological functions; Physiology of pregnancy, fetoplacental
unit, pregnancy tests, parturition & lactation; Semen analysis; Causes and principles of
management of infertility; Hormonal changes and their effects during perimenopause and
menopause; Psychological and psychiatric disturbances associated with reproductive
physiology.

Neurophysiology: (PY 10.1 - 10.20) (37 hrs)

Organization of nervous system; Sensory system: types, functions and properties of synapse,
receptors, reflex; Somatic sensations & sensory tracts; Physiology of pain; Motor system:
organization, motor tracts, mechanism of maintenance of tone, control of voluntary movements ;
Posture and equilibrium & vestibular apparatus; Reticular activating system, Autonomic nervous
system ; Spinal cord: functional organization and lesions ; Formation, circulation and function of
CSF; Blood brain barrier; Neurotransmitters.
Organization, connections and functions of cerebral cortex, basal ganglia, thalamus,
hypothalamus, cerebellum and limbic system and their abnormalities; Higher mental functions ;
Physiology of sleep, memory, learning and speech and their disorders; EEG.
Special senses- Smell and taste sensation and their abnormalities; Functional anatomy of ear and
auditory pathways & physiology of hearing, Deafness, hearing tests; Functional anatomy of eye,
Image formation, Visual pathway and its lesions, Physiology of vision including acuity of vision,
colour vision, field of vision, refractive errors, physiology of pupil; light reflex, accommodation
reflex, dark and light adaptation; Auditory & visual evoked potentials

Integrated Physiology: (PY 11.1 - 11.14) (6 hrs)

Temperature regulation: mechanism, adaptation to altered temperature (heat and cold

environment), mechanism of fever, cold injuries and heat stroke; Exercise- cardio-respiratory and
metabolic adjustments during exercise (isotonic and isometric), exercise in heat and cold, physical
training effects; Physiological consequences of sedentary lifestyle; Brain death; Physiology of
Infancy*; Physiology of aging-free radicals and antioxidants*; Physiology of meditation*.

(* ‘Non-core’ competencies as per “Competency based Undergraduate Curriculum for the Indian
Medical Graduate 2018: Medical Council of India”).

PRACTICAL

The following list of practical is minimum and essential. Additional exercises can be included as
and when feasible and required. All the practicals have been categorized as 'Procedures to be
performed’ and 'Demonstrations'. The procedures are to be performed by the students during
practical classes to acquire skills. These would be included in the practical during University
examination. Those categorized as ‘Demonstrations’ are to be shown to students during practical
72
 classes. Questions based on these would be given in the form of data, charts, graphs, problems
and case histories for interpretation by students during university examination.
I.Procedures to be performed by the students:
a. Haematology:
1. RBC count
2. WBC Count
3. Differential Leucocyte Count
4. Estimation of haemoglobin
5. Blood grouping
6. Bleeding time
7. Clotting time
8. Calculate RBC indices - MCV, MCH, MCHC.

b. Procedures to be performed on human subjects:

1. Mosso’s ergography.
2. Recording of Blood Pressure, pulse rate at rest and effect of posture.
3. Effect of mild and moderate exercise on blood pressure, pulse rate and respiratory rate
using Harvard step test.
4. Record and interpret Lead II ECG. Given a normal ECG, determine cardiac axis.
5. Spirometry – Lung volumes and capacities, MVV, Timed vital capacity.
6. Peak Expiratory Flow Rate
7. Demonstrate Basic Life Support in a simulated environment
8. Visual field by Perimetry

c. Clinical Examination:
1. Components of history taking and general physical examination
2. Examination of radial pulse
3. Examination of Cardiovascular system
4. Examination of Respiratory system
5. Examination of abdomen
6. Examination of Higher mental functions
7. Examination of Sensory system
8. Examination of Motor system including reflexes.
9. Examination of Cranial Nerves

II. Demonstrations:
I.Haematology:
1. Erythrocyte sedimentation rate
2. Haematocrit
3. Reticulocyte count
4. Platelet count
5. Osmotic fragility
73
2. Record Arterial pulse tracing using finger plethysmography*
3. Stethography
4. Tests of cardiovascular autonomic functions*

(* ‘Non-core’ competencies as per “Competency based Undergraduate Curriculum for the

Indian Medical Graduate 2018: Medical Council of India”)

III. Interpretation- charts: clinical case histories, graphs, charts, problems

(Suggested topics for preparation of these are given under ANNEXURE I. However, many more
could be developed which is under discretion of each institution)
Chart also includes - Interpret growth chart*, Interpret anthropometric assessment of infants*:
(*these two charts are ‘Non-core’ competencies as per “Competency based Undergraduate
Curriculum for the Indian Medical Graduate 2018: Medical Council of India”)

IV. Computer assisted learning:

(i) Amphibian nerve - muscle experiments and interpretation of graphs
List of graphs on nerve-muscle experiments:
• Simple muscle twitch
• Effect of various strengths of stimuli on Simple muscle twitch
• Effect of changes in temperature on Simple muscle twitch
• Effect of two successive stimuli on muscle contraction
• Effect of multiple successive stimuli (treppe, clonus, tetanus)
• Study of fatigue in skeletal muscle
• Velocity of nerve conduction
• Effect of load on muscle
• Measurement of isometric contractions using nerve muscle preparation

(ii) Amphibian cardiac experiments and interpretation of graphs

List of graphs on cardiac experiments:
• Normal cardiogram
• Effect of temperature on frog heart
• Effect of Stannius ligatures
• Properties of cardiac muscle – all or none law, staircase effect, refractory period in a
beating heart (extrasystole and compensatory pause), refractory period in a quiescent
heart
• Effect of vagus on frog’s heart
• Action of drugs on vagus (nicotine and atropine)
• Perfusion of isolated heart and effect of ions (NaCl, KCl, CaCl2)
• Perfusion of isolated heart and effect of drugs (adrenaline, acetyl choline, atropine
followed by Ach)

74
SKILL CERTIFICATION:

The list of certifiable skills is given below. The general instructions, blank template, samples of
certification checklist suggested for skill certification are provided as ANNEXURE - IIa, IIb, IIc,
IId.

List and number of sessions for skill certification as prescribed by MCI:

Topics Number
required
to
certify
as per
MCI
PY5.12 Record blood pressure & pulse at rest and in different grades of 1each x 3
exercise and postures in a volunteer or simulated environment
PY6.9 Demonstrate the correct clinical examination of the respiratory 1
system in a normal volunteer or simulated environment
PY Demonstrate the correct clinical examination of the nervous 1 each
10.11 system: Higher functions, sensory system, motor system, reflexes, (total 5)
cranial nerves in a normal volunteer or simulated environment
PY Demonstrate (i) Testing of visual acuity, colour and field of vision 1 each
10.20 and (ii) hearing (iii) Testing for smell and (iv) taste sensation in (total 4)
volunteer / simulated environment

SUGGESTED AREAS FOR INTEGRATION:

As per the “Competency based Undergraduate Curriculum for the Indian Medical Graduate
2018: Medical Council of India”

EARLY CLINICAL EXPOSURE:

• Clinical visits: 12 hours (Suggested format for assessing participation in ECE sessions is
provided as ANNEXURE III which could be a part of the practical record book)
Suggested hospital visits: (can include more than the below suggestions)
Anemia, Jaundice, Visit to blood bank, Computerized lung function tests, acid peptic
disease, endoscopy procedure, dialysis unit, hemiplegia, etc.
• Basic science correlations: 18 hours
Discussion based on case vignettes, graphs, clinical videos, patient in classroom setting,
etc linked to various systems in physiology.

SELF-DIRECTED LEARNING:
Twenty-five hours of dedicated time for self-directed learning is provided for physiology.

75
AETCOM MODULES TO BE COVERED UNDER PHYSIOLOGY:

AETCOM module number Topic

(as per MCI document) *
1.2 What does it mean to be a patient?
1.3 The doctor-patient relationship

* https://www.mciindia.org/CMS/wp-content/uploads/2019/01/AETCOM_book.pdf

Suggested format for reflective writing for the above AETCOM modules is given in
ANNEXURE IV. This could be a part of the practical record book.

LOG BOOK:
Suggested Template of logbook is attached as annexure. The minimum elements that needs to be
included are mentioned in the template provided for log book.

TEACHING HOURS AND METHODS:

Curricular component Time allotted in hours

Lectures 160
Small group teaching / tutorials / integrated learning /practical 310
Self-directed learning 25
Early clinical exposure (basic science correlation and clinical 30 (18 +12)
skills)
Total 525
AETCOM module 1.2 and 1.3 () 15 (8+7)

Note: It is recommended that didactic teaching be restricted to less than one third of the total
time allotted for that discipline.

76
 SCHEME OF EXAMINATION:
INTERNAL ASSESSMENT:
Scheme for calculation of Internal Assessment marks:

Theory (maximum marks) Marks Practicals Marks

Theory written paper 30* Practical exam (25 marks) and viva- voce 30**
(5 marks)
Formative assessment Formative assessment
(Part completion tests/ (system-wise 10 Early clinical exposure + Skill certification 7
reviews) Practical record 3
Total 40 40
Please note:
• *Prior to submission to the University, the marks for each of the three internal examination
theory assessments must be calculated out of 30 marks, regardless of the maximum marks.

• **Prior to submission to the University, the marks for each of the three internal examination
practical assessments must be calculated out of 30 marks, regardless of the maximum
marks.

• Only the final marks out of 40 needs to be submitted to the University, separately for theory
and practical for each internal assessment.

Guidelines: For general guidelines on Internal Assessment refer section II

UNIVERSITY EXAMINATION

SCHEME FOR MARKS DISTRIBUTION FOR UNIVERSITY EXAM:

Theory Practical

Paper I 100 Practical exam 80

(Practical I to IV)

Paper II 100 Viva voce 20

Total 200 Total 100

Internal assessment 40 Internal assessment 40

77
A. THEORY: 200 Marks

There shall be two theory papers of 100 marks each and duration of each paper will be of 3 hours.

Type of questions Number of questions Marks for each question Total Marks
Long essay 2 10 20
Short essay 10 5 50
Short answers 10 3 30
Total Marks 100

Blue print for theory question papers:

Paper 1 (Max 100 marks) Paper 2 (Max 100 marks)

Systems Marks Systems Marks

Allocated Allocated

General Physiology 05 Nerve and muscle Physiology 12

Hematology 20 Endocrine physiology 20
Cardiovascular Physiology 25 Reproductive physiology 15
Respiratory Physiology 20 Central nervous system 35
Gastrointestinal Physiology 15 Special senses 10
Renal Physiology 15 Integrated Physiology 08

Note:

• All the questions should be structured compulsorily. One short essay (5 marks) to be
preferably a case vignette in each paper.
• The systems assigned to the different papers are generally evaluated under those
sections. However, a strict division of the subject may not be possible and some
overlapping of systems is inevitable. Students should be prepared to answer
overlapping systems.
• Example of the structured questions and case vignettes are given in the example
question papers in ANNEXURE Va, Vb. This is only a sample paper. The systems under
each section of the paper (long essay, short essay and short answer) and the system from
which the case vignette may be prepared can vary. However, marks allotted to the
various systems as given in the above tables must be adhered to (with a variation of
distribution of 1-2 marks between systems).
• A minimum of 35% marks shall be allocated to assess the higher order thinking skills of
the student.

78
B. PRACTICAL: 80 Marks

There shall be four practical sessions, each carrying 20 marks. The distribution of content and marks
for the practical would be as follows:

Practical Allotted topics Marks

session allotted
Clinical examination – I 15
Practical – I (CNS – sensory / motor/ reflexes / cranial nerve)
Chart: Clinical case histories 5
Total 20
Clinical examination-II (CVS / RS) 15
Practical – II Clinical examination 5
(general physical examination / abdomen examination)
Total 20
Human experiments 15
• Mosso’s ergography
• Effect of posture / exercise on BP and Pulse rate
• Effect on BP and pulse rate during exercise using the Harvard
step test
Practical – • Record and interpret Lead II ECG
III • Spirometry and PEFR
• Perimetry
• Demonstrate BLS
Chart: Amphibian charts (nerve muscle / cardiac) 5
Total 20
Hematology 15
• RBC count
• WBC count
Practical – • Making a peripheral smear + DLC on the provided stained slide
IV • BT + blood group
• CT + blood group
• Hb + blood group
Chart: calculations / problem solving 5
(note: there should not be duplication of charts between practical – I
and IV for a given student)
Total 20
Grand total 80

Note: the ‘allotted topics’ for practical exam under different sections (I to IV) mentioned
above needs to be strictly adhered to. The experiments kept under clinical examination
should allow for an assessment of the marks allotted (and not be a very small component of
the experiment for eg. “elicit a knee jerk” is not a complete experiment).

79
 Viva-Voce Examination: 20 Marks

The viva-voce examination shall carry 20 marks and all examiners will conduct the examination.
Viva should focus on application and interpretation. Charts and graphs should be prepared on
all systems which could be divided amongst 4 examiners (system-wise) and could be used in
viva. (viva marks to be added to practical and not theory).

80
 ANNEXURE – I
List of suggested topics for the preparation of charts, clinical cases, graphs, clinical problems

(Note: many other topics from the syllabus can be considered and charts developed which is left
to the discretion of individual institution)

i. General Physiology – Blood volume, feedback mechanisms flowchart

ii. Nerve muscle physiology – Myesthenia gravis, picture chart of neuromuscular
junction
iii. Hematology – clinical cases of anemia, blood indices, peripheral smear, jaundice
(prehepatic, post hepatic and hepatocellular),
iv. Cardiovascular system – problems on cardiac output, cardiac index, ejection fraction,
clinical cases on hypertension, shock, heart failure; interpretation of ECG and
calculation of heart rate from ECG,
v. Respiratory system – spirogram with calculation of lung volumes and capacities,
dyspnoeic index, respiratory reserve, charts with FEV1/FVC in obstructive and
restrictive conditions
vi. Renal system – Clearance tests, cystometrogram
vii. Gastrointestinal system- clinical cases on peptic ulcer, OGTT, Gastrooesophageal
reflux disease
viii. Endocrine system – clinical case histories / pictorial charts for various endocrine
disorders
ix. Reproductive system - spinnbarkeit pattern pictorial chart, Fern pattern chart, clinical
case history of infertility, hormonal changes during menstrual cycle graph,
x. Central nervous system - pictorial chart of properties of synapses, reflex arc, clinical
cases on any of the 12 cranial nerves, Brown Sequard syndrome, cerebellar
dysfunction, sensory ataxia, Parkinson’s disease, UMN lesion, LMN lesion.
xi. Special senses – visual acuity, perimetry, hearing loss, audiogram
xii. Basal metabolic rate
xiii. Integrated Physiology: Chart also includes - Interpret growth chart*, Interpret
anthropometric assessment of infants*: (*these two charts are ‘Non-core’ competencies
as per “Competency based Undergraduate Curriculum for the Indian Medical
Graduate 2018: Medical Council of India”)
xiv. Others

81
 ANNEXURE- IIa
SUGGESTED FORMAT FOR CERTIFICATION OF SKILLS IN PHYSIOLOGY
GENERAL INSTRUCTIONS

General information:
1. There are 13 skills that need to be certified in Physiology
2. These skills will be tested in normal, healthy volunteers or simulated environment
3. The focus will be on whether students perform the procedures correctly
4. Since these are skills that need to be recertified at the end of clinical training, this certification
is a “First level Certification”

Role of the certifier:

1. Observe the student perform the skill without any prompting or interference
2. At the end of the assessment ask the specific questions that need to be asked (based on the skill
checklist)
3. Grade the student (A, B, C, D – see below)
4. Give feedback to the student on the errors, if any, at the end of the skill assessment.
5. Fill in the Certification Sheet

Assessment

Professional conduct and communication:

1. Is the student adequately groomed
2. Does the student introduce him/herself, greet the subject and obtain consent?
3. Does the student use the hand sanitizer?
4. Does the student give clear instructions to the subject?
5. Does the student thank the subject?
6. Does the student use the hand sanitizer at the end of the session?

Skill specific assessment:

1. Has the student conducted the given assessment completely?
2. Has the student conducted the given assessment correctly?
(for the above two points please refer to the checklist for the specific skill)
3. How do you rate the student for this session?

82
 Grade Explanation of Grade Action to be taken

A Student has performed the assessment without Can be certified for skill
any error

B Student has performed the assessment with Re-assessment for parts that have
minor errors that need to be rectified been performed incorrectly

C Student has performed the assessment with Re-assessment of whole skill

major errors

D Student has not been able to perform the Re-assessment of whole skill
assessment

(Note: columns for ‘number of attempts’ can be added in the template attached below)

83
 ANNEXURE – IIb
CERTIFICATION SHEET – Blank Template:

Name of Student:

Subject:

Skill:

Competency Number:

Grading of Student (please circle the appropriate letter – A, B, C, D)

A Student has performed the assessment without any error

B Student has performed the assessment with minor errors that need to be rectified

C Student has performed the assessment with major errors

D Student has not been able to perform the assessment

SKILL CHECKLIST
Satisfactory ( √ ), unsatisfactory ( X )
Attempt Attempt Attempt ‘n’
I II ………..
Date: Date: Date:

Professional conduct and communication

Steps
•
• ....
• ...

Grade

Name and Signature of the assessor

I have received detailed feedback on my performance

including my grade, the errors that I have committed and
actions to be taken.
(student’s signature)

Certifiers name and signature with date of certification:

Signature of the student:

84
 ANNEXURE – IIc

Sample Skill certification checklist: Examination of reflexes

Name of Student:

Subject:

Skill:

Competency Number:

Grading of Student (please circle the appropriate letter – A, B, C, D)

A Student has performed the assessment without any error

B Student has performed the assessment with minor errors that need to be rectified

C Student has performed the assessment with major errors

D Student has not been able to perform the assessment

(Note: columns for ‘number of attempts’ can be added in the template attached below)
SKILL CHECKLIST (Examination of Reflexes)
Satisfactory ( √ ), unsatisfactory ( X )

Attempt Attempt Attempt

I II ‘n’…………
Date: Date: Date:

Professional conduct and communication

Step
Superficial reflexes:
• Explains procedure to subject for each of the
following:
Plantar reflex:
• Asks the subject to lie down with foot wear removed
• With the help of a blunt object stroke the sole, from
heel along the lateral border of foot and medially
along the metatarso-phalangeal joint.
• Reports the finding (flexor response/Babinski’s sign)
• Mentions the level of integration on asking (L5, S1)
Abdominal reflex:

85
 • Asks the subject to lie down with foot wear removed
• With the help of a key, strokes parallel to costal
margin. Both below and above naval region
• Observes and reports the contraction of abdominal
muscles
• Mentions the level of integration on asking (T8 to
T12)
Deep reflexes:

Biceps jerk:
• Places subject’s forearm in semi-flexed position
supported by his/her forearm in relaxed state.
• Places thumb on the tendon of biceps in cubital fossa.
• With the help of knee hammer taps on the thumb.
• Observes and reports (the contraction of biceps and
flexion of forearm)
• Mentions the level of integration on asking (C5, C6)
Triceps jerk:
• Supports the forearm of subject on his/her arm at
right angles.
• Taps the tendon of triceps just above olecranon.
• OR
• Asks the subject to place his hand on opposite
shoulder and taps triceps tendon.
• Observes and reports. (the contraction of triceps and
extension of forearm)
• Mentions the level of integration on asking (C6, C7)
Supinator jerk:
• The subject’s forearm is held in semi-prone position
and asks to rest his hand on the student’s hand.
• Taps the styloid process of the radius.
• Observes and reports (contraction of supinator
flexion of elbow and eversion of wrist)
• Mentions the level of integration on asking (C5, C6)
Knee jerk: (ask to demonstrate either sitting or supine
position)
Sitting position:
• Asks the subject to sit on chair with legs relaxed and
not touching the ground / legs crossed. Knee of the
examining lower limb is exposed. With knee
hammer, taps on the patellar tendon just above tibial
tuberosity

86
 Lying down position:
• Asks the subject to liedown supine
• Positions the limb at 60 angle from bed
0

• The student passes the hand underneath the testing

limb, rests the hand on the opposite limb and the limb
to be tested is slightly raised
• The tendon is tapped
• Observes and reports (contraction of quadriceps and
extension of knee)
• Mentions level of integration (L2, L3, L4)
Ankle jerk: (ask to demonstrate either sitting or supine
position)
Standing position:
• Asks the subject to place the limb to be examined on
the stool with knee flexed at right angles to thigh
• Dorsiflexes the ankle
• Taps the tendoachillis with knee hammer
Lying down position:
• Makes the subject lie down. Positions the leg slightly
flexed at the knee and foot slightly dorsiflexed.
• Holds the big toe gently and taps tendoachillis
• Observes and reports (contraction of gastrocnemius
muscle with plantar flexion)
Mentions level of integration (S1, S2)

Grade

Name and Signature of the assessor

I have received detailed feedback on my performance

including my grade, the errors that I have committed and
actions to be taken.

(student’s signature)

Certifiers name and signature with date of certification:

Signature of the student:

87
 ANNEXURE IId
Sample Skill certification checklist: Measurement of Blood pressure at rest
Name of Student:

Subject:

Skill:

Competency Number:

Grading of Student (please circle the appropriate letter – A, B, C, D)

A Student has performed the assessment without any error

B Student has performed the assessment with minor errors that need to be rectified

C Student has performed the assessment with major errors

D Student has not been able to perform the assessment

(Note: columns for ‘number of attempts’ can be added in the template attached below)

SKILL CHECKLIST (measurement of Blood Pressure)

Attempt Attempt Attempt

I II ‘n’…………
Date: Date: Date:

Professional conduct and communication

Steps:
·Positions subject (sitting-with their feet on floor, legs uncrossed and their back
supported/ supine-lying down) and rests for 5min approx
· Exposes the subjects arm at least 5 inches above the elbow: Sleeve can be
rolled up but must be able to fit a finger under it or remove constrictive
clothing.
· Squeezes all air out of cuff before applying to subject
· Arm is supported, at heart level, palm of hand turned up
· Place cuff snugly on bare arm.

88
·The centre of the bladder is positioned over the line of the artery.
·The lower edge of the bladder is 2-3 cm above the elbow crease
·The palpatory systolic pressure is measured by palpating for the radial artery,
closing the valve, and pumping up the cuff. (Deflates cuff slowly and notes the
point of reappearance of pulse)
· The student reports the Palpatory Systolic Pressure
·Releases the air from the cuff and waits 30 seconds.
-Elevates the pressure 20-30mm Hg above the palpatory systolic pressure.
· Uses stethoscope properly (direction of ear pieces). Checks the stethoscope
amplification for sound.
· Position the diaphragm of the stethoscope over the brachial artery.
· Deflates slowly at about 2mmHg/ second
·Releases the remaining air in the cuff after recording BP by opening the valve
completely and removing the cuff.
· If the student needs to recheck, completely deflates, waits 1-2 minutes and
then reinflates.
·Documents: pt. position, arm used, cuff size, blood pressure
Measurement

Grade

Name and signature of the assessor

I have received detailed feedback on my performance including my grade, the

errors that I have committed and actions to be taken.
(student’s signature)
Certifiers name and signature with date of certification:
Signature of the student:

89
 ANNEXURE III
(Note: questions could be added/modified to this document which is at the discretion of individual
institution. This appendix could be a part of practical record/logbook of Physiology)

SUGGESTED FORMAT FOR ASSESSING PARTICIPATION IN EARLY CLINICAL

EXPOSURE SESSIONS

Session number: Date:

Roll No:

Department visited:

Objectives

1.

2.

3.

1. Briefly describe what you learnt from this session/ clinical visit in relation to the objectives. (in
100-150 words)

2. Apart from the above learning, what did you observe that influenced (Positive/negative)
you? (in 100-150 words)

Remarks of teacher: Satisfactory / Not satisfactory

Name and Signature of Teacher with date:

90
 ANNEXURE IV
(Note: questions could be added/modified to this document which is at the discretion of individual
institution. This appendix could be a part of practical record/logbook of Physiology)

SUGGESTED FORMAT FOR AETCOM SESSIONS

Name of the Facilitator: Date:

AETCOM module Number: Session number:

AETCOM Topic:

Competencies / Objectives:

1.

2.

3.

1. Briefly describe what you learnt from this AETCOM session in relation to the objectives.
(in 100-150 words)

2. Apart from the above learning, what did you observe that influenced (Positive/negative)
you during this session? (in 100-150 words)

Remarks by Facilitator:

Signature of Facilitator:
91
 ANNEXURE Va

MODEL question paper - Paper I

Time: 3 hours Marks: 100

Your answers should be specific to questions. Draw neat labelled diagrams wherever necessary.

Long essay questions: (10marks x 2 = 20 marks)

1. Describe the mechanics of breathing. Define compliance. Mention two conditions which reduce lung
compliance. (7+1+2)
2. With the help of Wigger’s diagram discuss the mechanical events of a cardiac cycle with the pressure-
volume changes of left ventricle. Correlate the events with ECG and heart sounds. (6+2+2)
Short essays: (5marks x 10 = 50 marks)
3. Discuss the types of transport across cell membrane with one example for each. Explain Secondary
active transport (4+1)
4. Draw and label the Juxta glomerular apparatus. Explain briefly Renin-Angiotensin system. (2.5+2.5)
5. Define and classify shock. Discuss physiological basis of tachycardia, pale and clammy extremities in
haemorrhagic shock. (1+2+2)
6. A 42-year woman with 3-month history of abdominal pain, diarrhoea and rectal bleeding. She has
progressive tiredness and appears pale. Her MCV, MCHC and MCH are low. (a) What is the
morphological type of anaemia that you expect in this patient? (1mark) (b) What is the treatment
option for the above-mentioned condition (1 mark) (c) Describe briefly the morphological types of
anaemia with an example for each (3marks).
7. Discuss the special features of coronary circulation with functional significance of each feature.
8. Describe the mechanism of HCl production in the stomach. How is it regulated? (3+2)
9. What is Glomerular filtration rate? Describe the various factors that can affect it. How is it measured?
(1+3+1)
10. Describe the changes during acclimatization to high altitudes with the physiological basis of each.
11. Discuss the steps involved in micturition reflex. Explain Cystometrogram with a neat labelled
diagram. (2.5+2.5)
12. Define jaundice. List the types of Jaundice. Explain the physiological basis of the tests to differentiate
the types of jaundice. (1+1+3)
Short answers: (3marks x 10 = 30 marks)
13. List any six functions of saliva.
14. What is AV nodal delay? Briefly explain its physiological significance (1+2)
15. Name any 3 anticoagulants and briefly explain their mechanism of action (1.5+1.5)
16. Define functional residual capacity. Explain its physiological significance. (1+2)
17. List the enzymes of pancreatic juice.
18. Define and classify hypoxia with an example for each. (1+2)
19. Discuss the types of movements of small intestines.
20. Define autoimmunity. Name any 2 autoimmune disorders. (1+2)
21. With the help of a neat labelled diagram explain the ionic basis of an action potential in the
ventricular muscle. (1.5+1.5)
22. Define Landsteiner’s law. List two uses of blood grouping. (1+2)

92
 ANNEXURE Vb
Model question paper - Paper II

Time: 3 hours Marks: 100

Your answers should be specific to questions. Draw neat labelled diagrams wherever necessary.

Long essay questions: (10marks x 2 = 20 marks)

1. Describe in detail the biosynthesis of thyroid hormone. Enumerate the functions of the thyroid
hormone in different organ systems. List the conditions caused due to the alterations in serum thyroid
hormone levels. (3+5+2)
2. Describe the pain pathway from right lower limb. What are the important features of slow and fast
pain? Add a note on referred pain. (5+2+3)

Short essays: (5marks x 10 = 50 marks)

3. Define and classify synapse. Discuss any two properties of synapse in detail. (2+ 3)
4. Describe the physiological actions of Insulin. What is diabetic keto-acidosis? (4+1)
5. Describe the steps involved in the transmission of impulses across the neuromuscular junction.
Discuss the role of neuromuscular blocking agents. (3+2)
6. Discuss the connections and functions of basal ganglia. (2.5+2.5)
7. Classify sensory receptors with an example for each.
8. Compare and contrast the actions of adrenaline and noradrenaline on CVS.
9. Describe the endometrial changes of menstrual cycle with hormonal basis for the same.
10. A 54-year old male presented with the history of numbness in the tongue and persistent changes in
taste perception, after a year-long oral exposure to a commercial cleaning agent. Lingual tactile and
two-point discrimination test showed reduced somatic sensation. Taste threshold testing on anterior
part of tongue demonstrated severe hypogeusia. (a) Which are the cranial nerves affected here
(2marks). (b) Describe the pathway involved in carrying the taste sensation (3marks)
11. List the functions of cerebellum. Add a note on features of cerebellar dysfunctions. (2.5+2.5)
12. List the theories of hearing. Discuss the functions of middle ear. (2+3)

Short answers: (3marks x 10 = 30 marks)

13. Discuss the significance of fetoplacental unit.

14. Define the following terms i) perinatal ii) neonatal iii) infancy (1+1+1)
15. What are the contraceptive methods in females? Briefly explain the mechanism of action of
intrauterine contraceptive devices. (1.5+ 1.5)
16. Discuss the steps of spermatogenesis.
17. List the implications of brain death.
18. List the Factors affecting conduction velocity in a nerve fiber. Name the classification system based
on it. (2+1)
19. Classify smooth muscle fibers and List the differences between them.
20. Differentiate between REM and NREM sleep.
21. List the acute cardio respiratory responses to whole body isotonic exercise.
22. List any six functions of hypothalamus.

93
SUGGESTED TEXT BOOKS

Note: A single text book may not cover the entire curriculum. Referring to more than one book is
recommended.

TEXT BOOKS (latest editions)

1. Guyton and Hall. Text of Medical Physiology. South Asian edition. Mario Vaz, Anura
Kurpad, Tony Raj.
2. Ganong’s Review of Medical Physiology.
3. Vander’s Human Physiology.
4. Principles of Medical Physiology. Sabyasachi Sircar
5. Text book of Medical Physiology. Indu Khurana
6. Text book of Medical Physiology. D Venkatesh, H H Sudhakar
7. Text book of medical physiology. G K Pal.
8. Essentials of Medical Physiology. ABS Mahapatra
9. Berne and Levy Physiology. BM Koeppen, BA Stanton
10. Human Physiology. Lauralee Sherwood.

Reference books for practical

1. McLeod’s Clinical Examination

2. Hutchison’s Clinical Methods.
3. Text book of practical physiology. GK Pal and Pravati Pal
4. A textbook of Practical Physiology. CL Ghai

94
BIOCHEMISTRY

GOAL
The broad goal is to teach Biochemistry to undergraduate students to make them understand
the scientific basis of the life processes at the molecular level and to orient them towards the
application of the knowledge acquired in solving clinical problems.

OBJECTIVES

A. KNOWLEDGE
At the end of the course, the student should be able to:

1. Describe the molecular and functional organization of a cell and its subcellular
components;
2. Delineate structure, function and inter‐relationships of biomolecules and consequences
of deviation from normal;
3. Summarize the fundamental aspects of enzymology and clinical application wherein
regulation of enzymatic activity is altered;
4. Describe digestion and assimilation of nutrients and consequences of malnutrition;
5. Integrate the various aspects of metabolism and their regulatory pathways;
6. Explain the biochemical basis of inherited disorders with their associated sequelae;
7. Describe mechanisms involved in maintenance of body fluid and pH homeostasis;
8. Outline the molecular mechanisms of gene expression and regulation, the principles of
genetic engineering and their application in medicine;
9. Summarize the molecular concepts of body defence and their application in medicine;
10. Outline the biochemical basis of environmental health hazards, biochemical basis of
cancer and carcinogenesis;
11. Familiarize with the principles of various conventional and specialized laboratory
investigations and instrumentation analysis and interpretation of a given data;
12. Suggest laboratory investigations to support theoretical concepts and clinical
diagnosis.

B. SKILLS:
At the end of the course, the student should be able to:

1. Make use of conventional techniques/instruments to perform biochemical analysis

relevant to clinical screening and diagnosis;
2. Analyze and interpret investigative data;
3. Demonstrate the skills of solving scientific and clinical problems and decision making;

95
C. INTEGRATION
The knowledge acquired in Biochemistry should help the students to integrate molecular
events with structure and function of the human body in health and disease.

COURSE CONTENT AND TEACHING HOURS

A. TEACHING HOURS

Curricular component Time allotted in hours

Lectures 80
Small group teaching / tutorials / integrated learning /practical 150
Self-directed learning 20
Early clinical exposure (basic science correlation and clinical 30 (18 +12)
skills)
Total 280
AETCOM module 1.4 7

B. Course content
(i) Theory Topics

96
Syllabus

Teaching hours – 160 hours

Sl Topic (Competency No) No.

1. Relevance of Biochemistry in Medicine Core: 1 hr
Importance of Biochemistry in health and disease ‐ (Orient
Examples of normal biochemical process ation
‐ Examples of biochemical derangements involved in disease development lecture)
‐ Examples of application of laboratory medicine in screening, diagnosis and
prognosis of diseases
2 Cell and organelles, Cell membrane, Transport across cell membranes (BI1.1) 2 hrs
Core:
Prerequisite: Concept of prokaryotic and eukaryotic cell
Cell organelles – Structure, Biochemical functions, Marker enzymes
Cell Membrane ‐ Fluid mosaic model, composition, Fluidity of membrane
Transport across cell membranes with examples
Passive transport – Diffusion and facilitated transport (ion channels)
Active transport – Primary and Secondary
Endocytosis and Exocytosis
Aquaporins
ABC family of transporters
Non core:
Cytoskeleton –
Structure and functions of microtubules, actin filaments, intermediate filaments
Intercellular communication
Separation of cell organelles 9 hrs
3 Enzymes (BI2.1, BI2.3, BI2.4, BI2.5, BI2.6, BI2.7)
Core:
Enzymes‐ Definition, General properties, IUBMB Classification.
Coenzymes and Cofactors
Mechanism of Enzyme action ‐ Concept of activation energy, transition state, binding energy, active
site; Substrate binding to active site ‐ Koshlands Induced fit theory
Factors affecting enzyme activity
Effect of substrate concentration ‐ Michaelis ‐Menton theory, Km value, Vmax and its significance
(derivation not required)
Enzyme specificity
Enzyme inhibition ‐ Competitive and Non‐competitive inhibition with examples of clinical
importance
Suicide inhibition
Enzymes as toxins – Eg. Snake venom phospholipase
Enzyme regulation by‐ Short term (Covalent modification, Zymogen activation,

97
Allosteric regulation, Feedback regulation) and long term regulation (Induction
and repression)
Clinical Enzymology – Concept of plasma functional and non‐functional enzymes
Diagnostic Importance of enzymes – LDH, CK, AST, ALT, ALP, GGT, Amylase,
Lipase, G6PD, Cholinesterase, ACP, 5’nucleotidase
Isoenzymes – Definition, Diagnostic Importance of isoenzymes with examples.
Enzymes as Therapeutic agents
Enzymes used in diagnostic assays
Ribozymes
Non core:
Mechanisms of enzyme catalysis (List)
4 Chemistry of Carbohydrates (BI3.1) 3 hrs
Core:
Definition, Biomedical importance
Classification with examples
Monosaccharide derivatives – Uronic acids, aminosugars, Glycosides, Sorbitol,
Mannitol and their Clinical significance.
Disaccharides, oligosaccharides ‐composition, importance
Polysaccharides –Homopolysaccharides – Composition and Importance of starch,
glycogen, Dextran, Cellulose and Inulin.
Heteropolysaccharides – Mucopolysaccharides (Composition and function)
Concept of glycation and glycosylation
Importance of Glycoproteins
Non core:
Sialic acid – importance
Blood group substances
5 Carbohydrate metabolism (BI3.2, BI3.3, BI3.4,BI3.5, BI3.6, BI3.7, BI3.9) 14hrs
Core:
Digestion and absorption
Mechanism of absorption
Lactose intolerance
Glucose transporters
Insulin dependent and Insulin independent uptake of glucose by tissues
PATHWAYS – Significance, Site, reactions, key steps, energetics, regulation,
inhibitors and associated disorders of ‐
• Glycolysis, Rapaport Leubering cycle and its significance
• Citric acid cycle, Amphibolic role, Anaplerotic reactions
• Gluconeogenesis, Cori’s cycle
• Glycogenesis, Glycogenolysis, Glycogen storage disorders
Significance of HMP shunt pathway and uronic acid pathway
Glucose‐6‐Phosphate dehydrogenase deficiency

98
Galactosemia, Essential Fructosuria, Hereditary fructose intolerance Regulation
of blood glucose levels in well fed condition and fasting/starvation
Non core:
Galactose and Fructose metabolism
Details of Pyruvate dehydrogenase (PDH) reaction
Essential pentosuria
6 Chemistry of lipids (BI4.1, BI11.24) 3 hrs
Core:
Definition, Modified Bloor’s classification with examples.
Biomedical importance of lipids
Fatty acids ‐ Definition, examples and importance of Essential fatty acids, Mono
and Polyunsaturated fatty acids, n3 and n6 fatty acids, Trans‐fatty acids.
Triacylglycerol – composition and importance
Phospholipids ‐ Types, functions with clinical importance
Respiratory distress syndrome
Glycolipids – Types and importance
Cholesterol ‐ structure and biological importance
Lipoproteins ‐ Types and functions
Amphipathic lipids ‐ Definition, examples and importance, Liposomes
Non core:
Fatty acids – nomenclature and different types of classification
Synthesis of lung surfactant

7. Lipid metabolism (BI4.2, BI4.3, BI4.4, BI4.6) 12 hrs

Core:
Digestion and Absorption
Steatorrhea
Biosynthesis and breakdown of triacylglycerol
PATHWAYS – Significance, Site, reactions, key steps, energetics, regulation, and
associated disorders of ‐
Beta oxidation
Ketogenesis, ketolysis
Cholesterol biosynthesis upto mevalonate.
Other types of Oxidation of fatty acids and associated disorders
Lipoprotein metabolism Structure, Composition, Types, Functions, metabolism of
Chylomicrons, VLDL, LDL, HDL
Formation and functions of bile acids and bile salts
Fatty liver and lipotropic factors
Hyperlipoproteinemias
Biochemical basis of use of hypolipidemic drugs
Prostaglandins – types and biomedical importance
Non core:
99
Fatty acid synthase multienzyme complex
Outline of Fatty acid biosynthesis
Lipid Storage Disorders
8 Chemistry of amino acids and Proteins (BI5.1, BI5.2) 3 hrs
Core:
Prerequisite: Amino acids – Classification based on side chain properties, nutritional
requirement
Classification of Amino acids based on metabolic fate
Standard and non-standard amino acids
Biologically important peptides
Proteins – Definition, Classification based on chemical nature and solubility,
functions, nutritional value
Structural organisation of proteins (primary, secondary, super secondary
structures/ motifs, domains, tertiary and quaternary structures)
Bonds stabilizing protein structure
Structure function relationship of proteins ‐ haemoglobin, myoglobin, collagen
and Insulin
Denaturation ‐ definition, causes, properties of a denatured protein, significance.
Non core:
Isoelectric pH
Non‐protein amino acids, Non‐alpha amino acids, D‐amino acids
9 Protein and amino acid metabolism (BI5.3, BI5.4, BI5.5, BI11.17) 13 hrs
Core:
Digestion and absorption and associated disorders
Amino acid pool
General reactions – Transamination, Transmethylation, Transdeamination,
Deamination ‐ Oxidative and nonoxidative and their significance.
Biogenic amines
Sources and fate of ammonia ‐ Trapping, Transport and Disposal of ammonia,
ammonia toxicity
Urea cycle and its disorders
Amino acid metabolism
Glycine – specialised products and their importance
Phenylalanine, Tyrosine – metabolic pathway, synthesis of catecholamines.
Pheochromocytoma
Other specialised products formed from tyrosine and their importance
Tryptophan‐ synthesis of serotonin and melatonin and their importance
Carcinoid syndrome
Sulphur containing amino acids – functions of cysteine, methionine synthesis of
SAM, SAH, Homocysteine
Formation of Nitric oxide and its importance

100
Inborn errors of metabolism – enzyme defects, clinical features, laboratory
diagnosis and biochemical basis of management of – PKU, Tyrosinosis,
Alkaptonuria, Albinism, Homocystinuria, Maple syrup urine disease (MSUD)
Important functions/products from histidine, serine, Aspartate, Asparagine,
glutamate, glutamine, serine, branched chain amino acids
Polyamines ‐ Examples and importance
Non core:
Techniques to separate and identify amino acids.
10 Plasma proteins (BI5.2) 3 hrs
Core:
Functions and clinical significance of plasma proteins ‐ Albumin, α, β and γ globulins.
Acute phase reactants ‐ Positive and Negative (clinical significance)
Biological Reference range of serum total protein, albumin, total globulin, C reactive
protein
Multiple Myeloma
Non core:
Separation and identification of plasma proteins by electrophoresis and precipitation
reactions
11 Metabolism and homeostasis (BI6.1, BI3.8, BI4.5, BI4.7, BI3.10, BI11.17) 6 hrs
Core:
Metabolic processes taking place in specific organs in the body in fed, fasting and
exercise states.
Metabolic changes during starvation
Adipose tissue – Hormones secreted from adipose tissue (adipokines – leptin,
adiponectin) their functions and role in hunger and satiety.
Diabetes mellitus – types, metabolic changes, complications.
Guidelines for diagnosis of Diabetes mellitus
Artificial sweeteners‐ list, use, metabolic effects(briefly) and concerns (to be
discussed with in context of their use in Diabetes Mellitus).
Lipid profile, Dyslipidemia
Atherosclerosis – definition, role of lipids in atherogenesis (LDL, Oxidised LDL, Lp(a), Small
dense LDL, HDL)
Lab tests in Myocardial infarction
Non core:
Advanced Glycation End (AGEs) products
12 Biological Oxidation (BI6.6) 3 hrs
Core:
Prerequisite: Bioenergetics – Laws of thermodynamics, Free energy, Exergonic and
endergonic reactions, Chemical Coupling Redox pair, Redox potential.
High Energy Compounds – Definition, Classification, biological significance.
Transport of reducing equivalents across mitochondria

101
Electron Transport Chain – Organization, components, flow of electrons.
Oxidative Phosphorylation – Sites, mechanism (Chemiosmotic theory).
Binding change mechanism of ATP synthesis by ATP synthase.
Inhibitors of Electron Transport Chain and oxidative phosphorylation. Uncouplers
and their significance.
Brown adipose tissue metabolism.
Non core:
ATP‐ADP cycle.
Structure and organization of ATP synthase complex.
Mitochondrial myopathies
13 Heme metabolism (BI6.11, BI6.12, BI5.2, BI11.17) 7 hrs
Core:
Heme –Outline of Synthesis, porphyrias
Degradation of Heme, Bilirubin metabolism – synthesis, transport, conjugation,
excretion
Jaundice – definition, types, causes, lab diagnosis
Congenital hyperbilirubinemias
Hemoglobin – Adult, fetal and embryonic types
Abnormal hemoglobins– carboxy, sulph, metHb.
Hemoglobinopathies – molecular defects, pathophysiological changes in
thalassemias and sickle cell anemia
Non core:
p50 of hemoglobins
14. Extracellular matrix (BI9.1, BI9.2) 4 hrs
Core:
Composition of ECM – Proteins (Composition and functions of Collagen, elastin,
fibrillin, fibronectin, laminin) and Proteoglycans.
Involvement of ECM components in health and disease. Eg.
Osteogenesis Imperfecta, Ehler‐Danlos syndrome etc
Non core:
Bone tissue– Concept of Bone turnover, factors affecting bone turnover, Peak bone
mass, List of markers of bone formation and bone resorption.
15. Vitamins (BI6.5) 12 hrs
Core:
Prerequisite: Definition, difference between water and fat soluble vitamins
RDA, Sources, Metabolism, Biochemical functions, Deficiency manifestations,
Hypervitaminoses of Fat soluble vitamins (A,D,E,K), Water soluble vitamins ‐
Vitamin C, Folic acid, Vitamin B12, Thiamine, riboflavin, Niacin, Pyridoxine, Biotin,
Pantothenic acid
Antivitamins
Non core:
Vitamers
102
Lipoic acid

16 Minerals (BI6.9, BI6.10) 8 hrs

Core:
Major elements and trace elements
Sources, RDA, absorption and transport, Homeostasis, Functions, Biological
reference range, disorders associated with – Calcium, phosphorus, Iron
Functions and disorders associated with ‐ Copper, Zinc, Selenium, Fluoride,
Iodine, Magnesium, Molybdenum.
17 Chemistry of Nucleic acids (BI7.1) 2 hrs
Core:
Prerequisite: Nitrogenous bases: Purines and Pyrimidines (Major, Minor, Free Bases);
Nucleosides and Nucleotides – Structure, examples, Importance
Nucleoside derivatives: NMP, NDP, NTP cAMP, SAM, PAPS, UDP sugars etc
Synthetic Nucleotide Analogues and their application
Structure and function of DNA (B‐DNA)
Structural organization of DNA to form chromatin (Primary and Secondary)
Types of RNA (hnRNA, mRNA, rRNA, tRNA, snRNA) with structure and
functions
microRNA (miRNA) and small interfering RNA (siRNA) and their applications in
medicine
Non core:
Different types of DNA
18 Nucleotide metabolism (BI6.2, BI6.3, BI6.4) 4 hrs
Core:
Prerequisite: Sources of atoms of Purine and pyrimidine ring
Salvage pathways of Purine and pyrimidine synthesis
Catabolism of Purines, Uric acid and its importance
Etiology, manifestations and biochemical basis of clinical manifestations of – Gout,
LeschNyhan syndrome,
Non core:
SCID, Oroticaciduria
Diagnostic importance of Adenosine deaminase
19 Molecular Biology (BI7.1, BI7.2, BI7.3, BI9.3) 11 hrs
Core:
Concept of Genomics, proteomics and metabolomics
DNA Metabolism
Cell cycle
DNA replication ‐ prokaryotic and eukaryotic replication, requirements, process,
inhibitors
Telomere, Telomerase and its importance
DNA repair mechanisms
103
Diseases associated with DNA repair – Eg. Xeroderma Pigmentosum
Mutations, causes, types of mutation, Consequences with examples
RNA Metabolism
Transcription process
Transcriptional units, promoter regions, RNA polymerases in prokaryotes and
eukaryotes
Differences between prokaryotic and Eukaryotic transcription
Inhibitors of transcription process
Post transcriptional modifications of all types of RNA
Protein Biosynthesis
Genetic Code and its characteristics
Requirements and activation of amino acids
Translation in Eukaryotes
Inhibitors of Translation
Post translational modifications
Regulation of Gene expression
Gene, introns, exons, cistron
Regulation of gene expression in prokaryotes with illustration of Lac Operon
Regulation of gene expression in eukaryotes – Role of enhancers, repressors, DNA
regulatory elements, gene amplification, gene rearrangement, RNA processing,
RNA editing, mRNA stability.
Non core:
Role of transcriptional activators and coregulators
Protein folding – Role of Chaperones and Heat shock proteins, Alzheimers
disease, Prion diseases
Protein targeting and sorting with associated disorders Eg, I cell disease
Protein motifs in DNA regulatory proteins
Chromatin remodeling in regulation
Epigenetics
20. Molecular biology techniques and Gene therapy (BI7.4) 4 hrs
Core:
Recombinant DNA technology, DNA cloning ‐ process and application
PCR technique and its application
Blotting techniques
Concept, types and application of gene therapy.
DNA Polymorphism, SNP, VNTR, RFLP
DNA genomic and cDNA libraries
DNA Probes
DNA Microarrays
Overview of Human Genome Project HGP
21 Biochemistry of Cancer (BI10.1, BI10.2) 5 hrs
Core:
104
Cell cycle, regulation, abnormal cell growth, programmed cell death (apoptosis)
Cell signaling (action of hormones and growth factors) – Cell surface receptors ‐ G
protein coupled signaling, catalytic receptor signaling, steroid receptor signaling.
Mutagens and carcinogens: Definitions, examples and their actions in carcinogenesis
Protooncogenes and their activation, oncogenes, tumour suppressor genes and
their role in development of cancer
Oncogenic viruses (HPV and cervical cancer)
Growth factors and their receptors
Tumour markers and their importance in diagnosis and prognosis of cancer
Biochemical basis of cancer therapy – alkylating agents, antimetabolites,
topoisomerase inhibitors, antibiotics, hormones, receptor blockers, radiotherapy etc
Monoclonal antibodies and their application
Non core:
Hybridoma technology
Estrogen and progesterone receptors and their clinical importance in breast cancer
22 Immunology (BI10.3, BI10.4, BI10.5) 1 hr
Core:
Cellular and humoral components of immune system
Immunoglobulins – Classes, structure function relationship
Innate and adaptive immune responses, self/non‐self‐recognition
Role of T‐helper cells in immune responses
Ig class switching
Concept of Immune tolerance and Autoimmunity
Antigens and concepts in vaccine development – types of vaccines, immunological
basis of vaccine development, recombinant DNA technology in vaccine development.
Non core: Hypersensitivity reactions
Concept of graft rejection
Phases of vaccine development.
23. Nutrition and dietetics (BI8.1, BI8.2, BI8.3, BI8.4, BI8.5, BI11.17, BI11.23, BI11.24) 7 hrs
Core:
Energy content of food items
BMR – Definition, Normal values, Factors affecting and biomedical importance
SDA – Definition and significance (Thermogenic effect of food)
Nitrogen balance
Balanced diet – definition, composition
Dietary fibers – definition, examples, importance
Glycemic index – definition, calculation, importance
Nutritional importance of Carbohydrates, Lipids, Proteins, Vitamins and minerals,
commonly used food items including fruits and vegetables.
Nutritional indices
Calculation of calorie requirement

105
Dietary advice for optimal health in childhood and adults, special conditions like
diabetes mellitus , coronary artery disease, pregnancy.
Types, causes and effects of Protein energy malnutrition
Obesity – Definition, BMI, types, causes, role of GI peptides and adipokines in
obesity, associated health risks (eg., metabolic syndrome)
24 Organ function tests (BI6.13, BI6.14, BI6.15, BI11.17) 11 hrs
Core:
Functions of Liver, Kidney, Thyroid and adrenals.
Liver Function Tests: Tests based on Synthetic, Excretory, and Role of enzymes in
hepatic dysfunction
Renal Function tests – Tests to assess glomerular and tubular functions
Mechanism of action of Group I and Group II hormones
Thyroid function tests
Adrenal function tests
Non core:
Lab tests for evaluation of Infertility.
25 Acid base balance (BI6.7, BI6.8, BI11.17) 4 hrs
Core:
Prerequisite: Concept of Acids, Bases and buffers, HH Equation and its application
Regulation of pH of blood by buffers, respiratory and renal mechanisms
Anion gap and its significance
Acidosis and alkalosis (metabolic and respiratory) – causes, compensatory mechanisms
and lab findings
26 Water and electrolyte balance (BI6.7) 3 hrs
Core:
Distribution of water and electrolytes in ICF and ECF
Osmolality of ECF
Regulation of water and electrolyte balance
Disorders of electrolyte imbalance – causes and clinical features of Hyperkalemia,
Hypokalemia, Hypernatremia, Hyponatremia
Dehydration
27 Free Radicals and Antioxidants (BI7.6, BI7.7) 3 hrs
Core:
Free radicals, Reactive oxygen species (ROS), Reactive nitrogen species (RNS)
Damaging effects of ROS on biomolecules, lipid peroxidation
Anti‐oxidant defence system of our body – enzymes, vitamins, metabolites as antioxidants
Role of oxidative stress in atherosclerosis, diabetes mellitus and cancer
Non core:
Fenton and Haber Weiss reactions
28 Xenobiotics and Detoxification (BI7.5) 1 hr
Core:

106
Xenobiotics and disease caused. Biotransformation
Phase –I reactions
Oxidation
Hydroxylation
Cytochrome P450
Phase‐II reactions
Conjugation reactions‐Glucuronic acid, Glutathione, Glycine
Non core:
Other detoxification reactions reduction, hydrolysis, Acetylation, Methylation and reduction
29 Clinical chemistry (BI11.16) 2 hrs
Core:
Basic concepts of clinical chemistry laboratory
Automation ‐ advantages
Quality control concepts (Internal and external quality control, precision, accuracy)
Specimen collection and Common Preanalytical errors
Biological reference intervals
Critical alerts
Ethics in Laboratory Medicine

Note:
1. Students are expected to familiarize by themselves the contents mentioned as prerequisite (in
italics)

107
 SUGGESTED DISTRIBUTION OF THEORY TEACHING HOURS
Sl Topic Suggested TL methods (hours)
No
Lecture SGT CBL Total Integration
(80) (40) (40) (160) (20)
Shared extra
hours
1 Relevance of Biochemistry in Medicine 1 Orientation lecture
2 Cell and organelles, Cell membrane, Transport 2 ‐ ‐ 2 2
across cell membranes

3 Enzymes 5 2 2 9 ‐

4 Chemistry of Carbohydrates 3 ‐ ‐ 3 ‐

5 Carbohydrate metabolism 8 2 4 14 ‐

6 Chemistry of lipids 3 ‐ ‐ 3 ‐

7 Lipid metabolism 8 2 2 12 ‐

8 Chemistry of amino acids and Proteins 3 ‐ ‐ 3 ‐

9 Protein and amino acid metabolism 7 2 4 13 ‐

10 Plasma proteins 1 ‐ 2 3 1

11 Metabolism and homeostasis 2 4 ‐ 6 2

12 Biological Oxidation 3 ‐ ‐ 3 ‐

13 Heme metabolism 3 ‐ 4 7 2

14 Extracellular matrix 2 2 ‐ 4 ‐

15 Vitamins 2 4 6 12 ‐

16 Minerals 2 4 2 8 2

17 Chemistry of Nucleic acids 2 ‐ ‐ 2 ‐

18 Nucleotide metabolism 2 ‐ 2 4 ‐

19 Molecular Biology 7 4 ‐ 11 ‐

20 Molecular biology Techniques and Gene therapy 2 2 ‐ 4 1

21 Biochemistry of Cancer 3 ‐ 2 5 2

22 Immunology 1 ‐ ‐ 1 2

23 Nutrition and dietetics 3 2 2 7 2

24 Organ function tests 1 4 6 11 2

25 Acid base balance 2 ‐ 2 4 1

26 Water and electrolyte balance 1 2 ‐ 3 1

27 Free Radicals and Antioxidants 1 2 ‐ 3 ‐

28 Xenobiotics and Detoxification 1 ‐ ‐ 1 ‐

29 Clinical chemistry ‐ 2 ‐ 2 ‐

108
Note: The above table containing teaching hours assigned to different topics
under large and small group teaching may be used as a guide by the Institutes.

i. Assessment methods for Theory (Formative and Summative):

Written (Structured Long essay Questions/Short essay questions /short
answer questions/ clinical vignette based questions)
Viva Voce
Case based learning Sessions with lab data interpretation ‐ 20 X2=40 hrs

Sl. Topic Suggested Cases for No. of Domain Assessment Tool

No discussion sessions (2 / Level
hrs each)

1 Diagnostic enzymology Myocardial infarction 1 K/KH Case chart

BI2.7, BI11.17 Acute pancreatitis discussion /OSPE

2 Carbohydrate Diabetes Mellitus 2 K/KH Case chart

metabolism GTT charts/GST discussion /OSPE
BI3.8, BI3.10, BI11.17 Galactosemia
Von Gierke disease
3 Lipid metabolism Dyslipidemia 1 K/KH Case chart
BI3.10, BI4.7, BI11.17 Ketoacidosis discussion /OSPE
Familial
hypercholesterolemia
4 Protein metabolism PKU 2 K/KH Case chart
Inborn errors of Alkaptonuria discussion /OSPE
metabolism Homocystinuria
BI5.5, BI11.17 MSUD
Albinism

5 Plasma proteins BI5.5, Multiple myeloma 1 K/KH Case chart

BI11.16, BI11.17 discussion /OSPE

6 Nucleotide metabolism Gout 1 K/KH Case chart

BI6.4, BI11.17 discussion /OSPE

109
7 Liver Function tests and Hemolytic Jaundice 2 K/KH Case chart
Hemoglobinopathies Hepatic jaundice discussion /OSPE
BI6.2, BI6.14, BI11.17 Obstructive jaundice
Neonatal jaundice
Alcoholic cirrhosis
Non alcoholic
steatohepatitis
Sickle cell anaemia
Thalassemia
8 Renal function tests Normal renal function 2 K/KH Case chart
BI6.14, BI11.17 Renal failure discussion /OSPE
Nephrotic syndrome
Acute
glomerulonephritis
9 Thyroid function tests Hypothyroidism 1 K/KH Case chart
BI6.14, BI11.17 Hyperthyroidism discussion /OSPE

10 Vitamin deficiency Vitamin A 3 K/KH Case chart

disorders BI6.5 deficiency discussion
Rickets/Osteomala /OSPE
cia Scurvy
Beri Beri
Pellagra
Megaloblastic anemia
11 Minerals BI6.10 Iron deficiency 1 K/KH Case chart
anaemia Tetany discussion
Wilson’s /OSPE
disease Goitre
Fluorosis
12 Nutritional Kwashiorkor 1 K/KH Case chart
disorders BI8.2 Marasmus discussion
Metabolic /OSPE
syndrome

13 Cancer BI10.2 Prostate 1 K/KH Case chart

carcinoma Breast discussion
carcinoma /OSPE

14 Disturbances in acid‐ Metabolic acidosis 1 K/KH Case chart

base balance Metabolic alkalosis discussion
BI6.8, BI11.17 Respiratory /OSPE
acidosis
Respiratory
alkalosis

110
ii. PRACTICAL: 35X2 = 70 hours

Part 1: Qualitative Experiments – 9X2=18hrs

Part 2: Quantitative Experiments – 14X2=28hrs
Part 3: Demonstration Experiments – 12X2=24hrs

Sl. Type of Suggested Teaching learning No. of Domain/ Assessment

No Experiment method ‐ Practical tests to be practical Level method
performed classes

Part 1: Qualitative Experiments ‐ 9 Classes

1 Analysis of DOAP sessions – Examine 3 S/P Qualitative

Normal Physical properties, Inorganic analysis
constituents constituents (Calcium,
of urine Phosphorus and Ammonia) and
BI11.3, Organic constituents
BI11.4 (Urobilinogen, Urea,
Uric acid and Creatinine)

2 Analysis of DOAP sessions ‐ Physical 4 S/P Qualitative

Pathological examination, chemical tests analysis
Constituents of for Glucose, Ketone Bodies,
Urine BI11.4, Blood, Proteins, Bile salts and
BI11.20 Bile Pigments Demonstration
by using Dip sticks

3 Urine screening Newborn screening tests‐ 1 K/KH OSPE/ Viva

tests for Inborn Interpretation of laboratory
errors of reports
metabolism
BI11.5, BI5.5

4 Calculate the Small group discussion 1 K/KH OSPE/ Viva

energy – Calculate
content of
food items
11.23

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Part 2: Quantitative Experiments ‐ 14 Classes
1 Estimation of DOAP sessions ‐ Perform 2 S/P Quantitative
plasma glucose and Interpret analysis/
by Enzymatic OSPE/Case
method and chart
Glucometer as interpretation
point of care
testing BI11.21,
BI3.10
2 Estimation of DOAP sessions ‐ Perform 2 S/P Quantitative
serum and urine and Interpret analysis/
creatinine by OSPE/Case
Jaffe’s method, chart
Creatinine interpretation
clearance
BI11.7, BI11.21
3 Estimation of DOAP sessions ‐ Perform 2 S/P Quantitative
blood urea by and Interpret analysis/
end point OSPE/Case
method chart
BI11.21 interpretation

4 Estimation of DOAP sessions ‐ Perform 2 S/P Quantitative

Total Protein and Interpret analysis/
and Albumin OSPE/Case
in serum by chart
Biuret and interpretation
BCG method,
A:G ratio
BI11.8, BI11.21

5 Estimation Practical ‐ Perform and 1 S/P Quantitative

of Total Interpret analysis/
cholesterol OSPE/Case
and High chart
density interpretation
lipoprotein(
HDL)
cholesterol
BI11.9

112
6 Estimation of Practical ‐ Perform 1 S/P Quantitative analysis/
Triacylglycerols and Interpret OSPE/Case chart
BI11.10 interpretation

7 Estimation of Calcium Practical ‐ Perform 1 S/P Quantitative analysis/

and Phosphorous and Interpret OSPE/Case chart
BI11.11 interpretation

8 Estimation of Serum Practical ‐ Perform 1 S/P Quantitative analysis/

Bilirubin and Interpret OSPE/Case chart
BI11.12 interpretation

9 Estimation of AST, ALT Practical ‐ Perform 1 S/P Quantitative analysis/

activity and Interpret OSPE/Case chart
BI11.13 interpretation

10 Estimation of ALP Practical ‐ Perform 1 S/P Quantitative analysis/

activity and Interpret OSPE/Case chart
BI11.14 interpretation

Part 3: Demonstrations ‐12 Classes

1 Lab safety and Small group 1 K/KH Viva
Biomedical waste discussion, lab visit
disposal, Commonly
used lab equipment,
glassware and reagents
BI11.1
2 Preparation of buffers Demonstration ‐ 1 K/KH Viva
and estimation of pH Observe
using pH meter BI11.2,
11.16, 11.19
3 Colorimetry, Demonstration ‐ 1 K/KH Viva
Spectrophotometry Observe
BI11.6, BI11.18,
4 Clinical chemistry Demonstration ‐ 1 K/KH OSPE/ Viva
autoanalyser and quality Observe and
control (Internal and interpret
External quality control,
Precision, Accuracy, QC
rules), Biological reference
intervals BI11.16, BI11.19

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5 Specimen collection and Collection centre 1 K/KH Viva
preanalytical errors in and lab visit
clinical Biochemistry lab

6 Serum protein Demonstration ‐ 1 K/KH OSPE/ Viva

electrophoresis, types Observe and
and applications interpret
BI11.16, BI11.19
7 Paper Demonstration ‐ 1 K/KH OSPE/ Viva
chromatography/TLC of Observe and
amino acids/sugars, types Interpret
and applications BI11.5,
BI5.5, BI11.16, BI11.19

8 Analysis of CSF Small group 1 K/KH OSPE/ Viva

BI11.15 discussion ‐ Interpret
9 Estimation of serum Demonstration ‐ 1 K/KH OSPE/ Viva
electrolytes by ISE Observe and
BI11.16, BI11.19 Interpret
10 Blood gas analysis using Demonstration‐ 1 K/KH OSPE/ Viva
ABG analyser Observe and
BI11.16, BI11.19 Interpret

11 Principle, procedure and Demonstration‐ 1 K/KH Viva

applications of ELISA, Observe
protein extraction,
Blotting techniques,
PAGE
BI11.16, BI11.19
12 Principle, procedure and Demonstration‐ 1 K/KH Viva
applications of PCR, DNA Observe
isolation
BI11.16, BI11.19

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 CERTIFICATION OF SKILL ACQUISITION:

To be certified using checklists

Suggested Checklist format for Certification of Skills (refer logbook)

Sl Competency to be certified with Competency number No.

No required to
1 Perform urine analysis to estimate and determine normal constituents (BI11.4) 1 P
certify
2 Perform urine analysis to estimate and determine abnormal constituents (BI11.4) 1

3 Identify abnormal constituents in urine, interpret the findings and correlate 1

these with pathological states (BI11.20)
4 Demonstrate estimation of glucose in serum (BI11.21) 1
5 Demonstrate the estimation of serum Creatinine and Creatinine clearance 1
(BI11.7, BI11.21)
6 Demonstrate estimation of urea in serum (BI11.21) 1
7 Demonstrate estimation of serum protein, albumin and A:G ratio (BI11.7, 1
BI11.21)

Note: In Theory, Practicals and Certification of Skill sections, topics with corresponding
competency numbers as mentioned in Volume 1 of Competency based Undergraduate
Curriculum for Indian Medical graduate (2018), prescribed by Medical Council of India ,
have been mentioned.

iii. SUGGESTED AREAS FOR INTEGRATION:

As per the “Competency based Undergraduate Curriculum for the Indian Medical Graduate
2018: Medical Council of India”

iv. EARLY CLINCAL EXPOSURE (ECE): Needs to be entered in Log book

CLINICAL SKILLS ‐ 12 hours Suggested cases for hospital visit
• Anemia
• Jaundice
• Renal failure
• Diabetes Mellitus
BASIC SCIENCE CORRELATION ‐ 18 hours Suggested topics ‐
• Biochemical basis of myocardial infarction (dyslipidemia, atherosclerosis, diagnostic
tests)
• Biochemical basis of acute complications of diabetes mellitus
• Biochemical alterations in diarrhea (acid base and electrolyte and ORS management
• Biochemical basis of Metabolic syndrome
• Critical alerts in Biochemistry lab test results.
115
 • Evidence based laboratory medicine
v. SELF DIRECTED LEARNING (SDL):
Suggested topics for log book entry in the form of concept mapping
• RBC membrane composition and Biochemical basis of Hereditary spherocytosis
• Respiratory distress syndrome
• Advanced glycation end products and complications of Diabetes
Mellitus
• Hormonal basis of osteoporosis
• Cardiovascular risk assessment score
• Biochemical basis of Alzheimer disease

AETCOM MODULES TO BE COVERED UNDER BIOCHEMISTRY:

AETCOM module number Topic
(as per MCI document)
1.4 The foundations of communication - 1

Suggested format for reflective writing for the above AETCOM modules is given in
ANNEXURE III. This could be a part of the practical record book.

SCHEME OF EXAMINATION

INTERNAL ASSESSMENT
[Kindly refer section II for general guidelines]

Scheme for calculation of Internal assessment marks:

Theory (maximum marks) Marks Practicals Marks
Theory written paper 30* Practical exam (25 marks) and viva‐ 30**
voce (5 marks)
Formative assessment Formative assessment

MCQs/unit 10 Early clinical exposure + Skill 5

test/seminars/assignments/ Case certification
based learning tests
Practical record 5
Total 40 40

116
Please note:

*Prior to submission to the University, the marks for each of the three internal examination
theory assessments must be calculated out of 30 marks, regardless of the maximum marks.

**Prior to submission to the University, the marks for each of the three internal examination
practical assessments must be calculated out of 30 marks, regardless of the maximum marks.

Only the final marks out of 40 needs to be submitted to the University, separately for theory
and practical for each internal assessment.

UNIVERSITY EXAMINATIONS
[Kindly refer section II for general guidelines]

TABLE SHOWING SCHEME FOR CALCULATION OF UNIVERSITY EXAMINATION MARKS

Theory (maximum marks) Practical (maximum marks)

Paper 1 100 Practical exam 80
(Practical Exercise 1 to 4)

Paper 2 100 Viva‐voce 20

TOTAL 200 TOTAL 100

A. THEORY: 200 Marks

There shall be two theory papers of 100 marks each and duration of each paper shall be 3
hours. The pattern of questions in each paper shall be as mentioned below

Type of Question Number of Maximum Marks Total

Questions for each question
Structured Long essay questions (SLEQ) 2 10 20
[Includes one case vignette-based question (CVBQ)]
Short ESSAY questions (SEQ) 10 05 50
[includes two case vignette-based questions
(CVBQ)]

Short answer questions (SAQ) 10 03 30

Total marks 100

Note:
1. A suggested format for blueprint of question paper is shown in Annexure I
2. Please refer Annexure II for suggested model question paper
117
B. PRACTICAL:
Practical exercises – 80 marks
1. Exercise 1: OSPE ‐ 20 Marks
2. Exercise 2: Qualitative analysis of Normal or Pathological constituents of
Urine ‐ 20 Marks
3. Exercise 3: Quantitative estimation and interpretation ‐ 20 Marks
4. Exercise 4: Case studies ‐ 20 Marks

Exercise 1: OSPE (20 Marks)

No. of Stations: 4 (1 performance station, 3 response stations)
Marks for Each Station: 5
Time for each station: Max 5 min

Exercise 2: Qualitative analysis of Normal or Pathological constituents of Urine (20 Marks)

Selection, principle and performance of tests :10 marks
Interpretation and Discussion :10 marks
Note: Alphabetically arranged test procedures shall be given.

Exercise 3: Quantitative estimation and interpretation (20 Marks)

Principle:5 Marks
Performance, Calculation and Results: 5 Marks
Interpretation and Discussion:10 Marks

Note : Procedure sheets shall be given.

Exercise 4: Case studies (20marks)

Total No. of case reports: 2
1 Major Case study for 12 marks and 1 Minor Case study for 8 marks
Suggested Major Case studies: Organ function tests/Diabetes mellitus/Acid base
disorders/Myocardial infarction/ Dyslipidemia/PEM
Note : Questions for Quantitative experiments may preferably be case based scenarios.

C. Viva voce : 20 marks

The viva‐voce examination shall carry 20 marks and all examiners will conduct the
examination. Viva should focus on application and interpretation. (viva marks to be
added to practical and not theory)

118
Distribution of topics for Paper 1 and Paper 2 for University examination Topic wise weightage

Sl No Paper 1 Topics Weightage Up to (in marks)

1 Cell, cellular organelles and membrane transport 5

2 Extra cellular matrix 3
3 Enzymes 13
4 Carbohydrate Chemistry 5
5 Carbohydrate Metabolism 13
6 Lipid Chemistry 5
7 Lipid Metabolism 13
8 Metabolism and homeostasis 8
9 Biological Oxidation 5
10 Vitamins 13
11 Minerals 13
12 Nutrition 10
13 Acid Base Balance 13
14 Water and Electrolyte Balance 6

Sl No Paper 2 Topics Weightage Upto (in marks)

1 Protein Chemistry 6
2 Plasma proteins 5
3 Immunology 5
4 Protein and amino acid Metabolism 13
5 Nucleic acid Chemistry 6
6 Nucleotide metabolism 10
7 Molecular Biology 13
8 Molecular Biology Techniques 13
9 Biochemistry of Cancer 10
10 Heme Metabolism 13
11 Organ function tests 13
12 Free radicals and Antioxidants 6
13 Xenobiotics and Detoxification 3
14 Clinical Chemistry 5

119
Note:
• Weightage of marks assigned to topics may add to more than 100
• Structured Long essay question should be from the topics with weightage of MORE
THAN 10 marks. However, a part of structured long essay may be from other topics
adhering to the weightage of marks allotted for that topic.
• The topics to different paper are generally evaluated under those sections. However, a
strict division of the subject may not be possible and some overlapping of topics is
inevitable. Students should be prepared to answer overlapping topics.

120
 ANNEXURE I

BLUE PRINT FOR QUESTION PAPER

(to be filled by the question paper setter)

• Total marks under each type of question from each topic needs to be entered by QP Setter.
• It should be in accordance with RGUHS guideline
•
BIOCHEMISTRY PAPER 1
A B C D E G H I

Sl Topic Total SLEQ SEQ SAQ Total Higher order

No max as 10 marks 5 marks 3 marks thinking skills
per (including each marks from each questions
RGUHS one (including each topic (including
guideline CVBQ of two (total of CVBQs)
10 marks) CVBQ of columns Question Marks
5 marks) from D to number
G)
1 Cell, cellular 5
organelles and
membrane transport
2 Extra cellular matrix 3
3 Enzymes 13
4 Carbohydrate 5
Chemistry
5 Carbohydrate 13
Metabolism
6 Lipid Chemistry 5
7 Lipid Metabolism 13
8 Metabolism and 8
homeostasis
9 Biological Oxidation 5
10 Vitamins 13
11 Minerals 13
12 Nutrition 10
13 Acid Base Balance 13
14 Water and 6
Electrolyte Balance
SLEQ- Structured Long Essay Question; SEQ- Short Essay Question; SAQ- Short Answer Question ;
CVBQ- Case Vignette Based Question
Marks allocated to questions that assess higher order thinking skills (%) =

121
 BIOCHEMISTRY PAPER 2

A B C D E G H I

Sl Topic Total SLEQ SEQ SAQ Total Higher order

No max as 10 marks 5 marks 3 marks thinking skills
per (including each marks from each questions
RGUHS one (including each topic (including
guideline CVBQ of two (total of CVBQs)
10 marks) CVBQ of columns Question Marks
5 marks) from D to number
G)
1 Protein Chemistry 6
2 Plasma proteins 5
3 Immunology 5
4 Protein and amino 13
acid Metabolism
5 Nucleic acid 6
Chemistry
6 Nucleotide 10
Metabolism
7 Molecular Biology 13
8 Molecular Biology 13
Techniques
9 Biochemistry of 10
Cancer
10 Heme Metabolism 13
11 Organ function 13
tests
12 Free radicals and 6
Antioxidants
13 Xenobiotics and 3
Detoxification
14 Clinical Chemistry 5
SLEQ- Structured Long Essay Question; SEQ- Short Essay Question; SAQ- Short Answer
Question; CVBQ- Case Vignette Based Question
Marks allocated to questions that assess higher order thinking skills (%) =

Note:
1. Question paper may be framed using “Blue print “table as guideline
2. A minimum of 35% marks in each paper shall be allocated to questions that assess the
higher order thinking skills of the student. This includes Case Vignette based questions.
3. Column ‘I’ has been provided for calculating percentage of marks allotted for questions
assessing higher order thinking skills.

122
 ANNEXURE II

Rajiv Gandhi University of Health Sciences, Karnataka

First Phase MBBS Degree examination
Model Question paper
Biochemistry (RS-4)
Draw a neat labelled diagram wherever necessary

Time= Three hours Paper I Maximum marks= 100

Long essays 2X10= 20 marks

1. A 30-year-old male came to the Physician with complaints of excessive hunger, weight loss
and increased thirst since few months. Following results were obtained on testing-
i. Blood: Random Blood Sugar- 400 mg/dL
ii. Urine: Benedict’s Test – Orange precipitate
a. What is the probable diagnosis?
b. What is the biochemical basis of symptoms?
c. Name the lab tests used to monitor the patient after confirmation of diagnosis?
d. Discuss the mechanism of regulation of blood glucose levels?
(1+3+1+5=10 marks)
2. Discuss iron with respect to the following aspects-
a. Dietary sources
b. Absorption and transport
c. Deficiency manifestations
d. Laboratory findings in deficiency (1+5+2+2=10 marks)
Short essays (10X5= 50 marks)

3. A 50-year-old male presented to emergency medicine department with complaints of severe

chest pain and sweating since 6 hours. After further examination and testing, he was
diagnosed as having Myocardial infarction.
a. What would be the best marker for diagnosing Myocardial infarction in this patient
(1 mark)
b. What is the biochemical basis of using such a marker (3 marks)
c. List other markers that have been used to diagnose myocardial infarction (1 mark)
4. A 60-year-old female presented with tingling and numbness in fingers, and muscle cramps
in hands. On examination, Chvostek’s and Trousseau’s signs were observed. She had
previously undergone Thyroidectomy for Grave’s disease. Following results were obtained
on testing-
i. Serum Calcium- 6 mg/dL
ii. Serum Phosphrous – 7 mg/dL

a. What is your diagnosis? (1 mark)

123
 b. What is the biochemical basis for symptoms and laboratory findings? (3 marks)
c. Name another mineral deficiency which has similar manifestations as the above
(1 mark)
5. Discuss the metabolic changes in starvation.
6. Describe the mechanism of Oxidative phosphorylation
7. What are mucopolysaccharides. Mention the composition and biological importance of any
4 mucopolysaccharides. (1+4 marks)
8. Discuss the functions and clinical significance of lysosomes
9. Prescribe a balanced diet for a 70 kg male with moderate physical activity
10. Discuss the β-oxidation of fatty acids under following headings-
a. Biological significance (0.5 marks)
b. Steps (4 marks)
c. Energy released by oxidation of one molecule of palmitic acid (0.5 marks)
11. Give biochemical reasons for the following
a. Neurological and dermatological manifestations in Vitamin B6 deficiency (2 marks)
b. A patient on Anti-tuberculous treatment may develop Vitamin B6 deficiency (1 mark)
c. Neurological manifestations in Vitamin B12 deficiency (2 marks)
12. Explain the biochemical basis for the following-
a. LDL is called the ‘bad’ cholesterol and HDL is called the “good’ cholesterol (2 marks)
b. Fasting hypoglycemia and hyperuricemia in Von Gierke disease (2 marks)
c. Lung surfactant prevents Respiratory distress syndrome (1 mark)
Short answers (10X3= 30 marks)

13. Explain the renal regulation of pH with diagram.

14. Mechanism of Renin angiotensin system in maintaining fluid balance
15. Discuss briefly Vitamin B1 with respect to deficiency manifestations and laboratory findings
in deficiency (2+1 marks)
16. a. List two functions of collagen. (1 mark)
b. Mention the nature of collagen abnormality in (2 marks)
i. Osteogenesis Imperfecta
ii. Ehlers- Danlos Syndrome
17. Briefly explain Kohsland’s induce fit theory
18. Name essential fatty acids. Mention their biological significance (1+2 marks).
19. Differentiate between high and normal anion gap metabolic acidosis with an example.
20. Give biochemical reasons for the following-
a. Selenium has a sparing action on Vitamin E (1 mark)
b. Fluoride is used as preservative for blood glucose (2 marks)
21. Explain the metabolic changes leading to production of ketone bodies.
22. Give biochemical reasons for the following
a. Urine is acidic in metabolic alkalosis (1 mark)
b. Hyperkalemia is generally associated with metabolic acidosis (1 mark)
c. Hyperkalemia is a critical alert in laboratory (1 mark)

124
1. A guide to preparation of Case based question for Practical Examination
Q. An elderly man was brought to the emergency ward with chief complaints of nausea,
vomiting, decreased urine output, bilateral swelling of feet and increased thirst. On examination
he was lethargic, and disoriented with pedal oedema, tachycardia, BP – 100/60 mmHg, dry
tongue and decreased skin turgor.

• Interpret the history and mention the possible diagnosis.

• Write the principle and estimate the concentration of given quantitative parameter in the
sample provided and write your interpretation.
• What other biochemical investigations can be carried out to arrive at a final diagnosis?

125
 ANNEXURE III
(Note: questions could be added/modified to this document which is at the discretion of individual
institution. This appendix could be a part of practical record/logbook of Biochemistry)

SUGGESTED FORMAT FOR AETCOM SESSIONS

Name of the Facilitator: Date:

AETCOM module Number: Session number:

AETCOM Topic:

Competencies / Objectives:

1.

2.

3.

1. Briefly describe what you learnt from this AETCOM session in relation to the objectives.
(in 100-150 words)

2. Apart from the above learning, what did you observe that influenced (Positive/negative)
you during this session? (in 100-150 words)

Remarks by Facilitator:

Signature of Facilitator:
126
5. RECOMMENDED BOOKS

TEXT BOOKS: (Recent editions)

1. DM Vasudevan. Textbook of Biochemistry for Medical students
2. Lippincotts’ Illustrated reviews – Biochemistry
3. S.K.Gupta. Biochemistry for MBBS
4. Pankaja Naik. Biochemistry
5. Dinesh Puri. Textbook of Medical Biochemistry
6. Namrata Chhabra. Case oriented approach towards Biochemistry
7. Divya shanti D’sza, Sowbhagyalakhsmi. An easy guide to Practical Biochemistry.

REFERENCE BOOKS: (Recent editions)

1. Harpers’ Illustrated Biochemistry
2. Marshall and Bangert. Clinical Chemistry
3. Baynes and Dominiczak. Medical Biochemistry
4. Bhagavan and Ha. Essentials of Medical Biochemistry with clinical cases
5. Stryer. Biochemistry
6. James Watson. Molecular biology of gene

127