Simon Baron-Cohen is the director of the autism research center at Cambridge University and the author of "The Essential Difference: The Truth About the Male and Female Brain." at
New York Times
The Male Condition : Published: August 8, 2005 : Cambridge, England
TWO big scientific debates have attracted a lot of attention over the past year. One concerns the causes of autism, while the other addresses differences in scientific aptitude between the sexes. At the risk of adding fuel to both fires, I submit that these two lines of inquiry have a great deal in common. By studying the differences between male and female brains, we can generate significant insights into the mystery of autism.
So was Lawrence Summers, the president of Harvard, right when he remarked that women were innately less suited than men to be top-level scientists? Judging from current research, he was and he wasn't. It's true that scientists have documented psychological and physiological differences between male and female brains. But Mr. Summers was wrong to imply that these differences render any individual woman less capable than any individual man of becoming a top-level scientist.
In fact, the differences that show up in brain research reflect averages, meaning that they emerge only when you study groups of males and females and compare the two groups' averages on particular psychological tests or physiological measures. The evidence to date tells us nothing about individuals - which means that if you are a woman, there is no evidence to suggest that you could not become a Nobel laureate in your chosen area of scientific inquiry. A good scientist is a good scientist regardless of sex.
Nonetheless, with brain scanning, we can discern physiological differences between the average male and the average female brain. For example, the average man's cerebrum (the area in the front of the brain concerned with higher thinking) is 9 percent larger than the average woman's. Similar, though less distinct, overgrowth is found in all the lobes of the male brain. On average, men also have a larger amygdala (an almond shaped structure in the center of the brain involved in processing fear and emotion), and more nerve cells. Quite how these differences in size affect function, if at all, is not yet known.
In women, meanwhile, the connective tissue that allows communication between the two hemispheres of the brain tends to be thicker, perhaps facilitating interchange. This may explain why one study from Yale found that when performing language tasks, women are likely to activate both hemispheres, whereas males (on average) activate only the left hemisphere.
Psychological tests also reveal patterns of sex difference. On average, males finish faster and score higher than females on a test that requires the taker to visualize an object's appearance after it is rotated in three dimensions. The same is true for map-reading tests, and for embedded-figures tests, which ask subjects to find a component shape hidden within a larger design. Males are over-represented in the top percentiles on college-level math tests and tend to score higher on mechanics tests than females do. Females, on the other hand, average higher scores than males on tests of emotion recognition, social sensitivity and language ability.
Many of these sex differences are seen in adults, which might lead to the conclusion that all they reflect are differences in socialization and experience. But some differences are also seen extremely early in development, which may suggest that biology also plays a role. For example, girls tend to talk earlier than boys, and in the second year of life their vocabularies grow at a faster rate. One-year-old girls also make more eye contact than boys of their age.
In my work I have summarized these differences by saying that males on average have a stronger drive to systemize, and females to empathize. Systemizing involves identifying the laws that govern how a system works. Once you know the laws, you can control the system or predict its behavior. Empathizing, on the other hand, involves recognizing what another person may be feeling or thinking, and responding to those feelings with an appropriate emotion of one's own.
Our research team in Cambridge administered questionnaires on which men and women could report their level of interest in these two aspects of the world - one involving systems, the other involving other people's feelings. Three types of people were revealed through our study: one for whom empathy is stronger than systemizing (Type E brains); another for whom systemizing is stronger than empathy (Type S brains); and a third for whom empathy and systemizing are equally strong (Type B brains). As one might predict, more women (44 percent) have Type E brains than men (17 percent), while more men have Type S brains (54 percent) than women (17 percent).
What of Mr. Summers's other claim, that such sex differences are innate? We know that culture plays a role in the divergence of the sexes, but so does biology. For example, on the first day of life, male and female newborns pay attention to different things. On average, at 24 hours old, more male infants will look at a mechanical mobile suspended above them, whereas more female infants will look at a human face.
It has also been found that the amount of prenatal testosterone, which is produced by the fetus and measurable in the amniotic fluid in which the baby is bathed in the womb, predicts how sociable a child will be. The higher the level of prenatal testosterone, the less eye contact the child will make as a toddler, and the slower the child will develop language. That is connected to the role of fetal testosterone in influencing brain development.
Males obviously produce far more prenatal testosterone than females do, but levels vary considerably even across members of the same sex. In fact, it may not be your sex per se that determines what kind of brain you have, but your prenatal hormone levels. From there it's a short leap to the intriguing idea that a male can have a typically female brain (if his testosterone levels are low), while a female can have a typically male brain (if her testosterone levels are high). That notion fits with the evidence that girls born with congenital adrenal hyperplasia, who for genetic reasons produce too much testosterone, are more likely to exhibit "tomboy" behavior than girls with more ordinary hormone levels.
What does all this have to do with autism? According to what I have called the "extreme male brain" theory of autism, people with autism simply match an extreme of the male profile, with a particularly intense drive to systemize and an unusually low drive to empathize. When adults with Asperger's syndrome (a subgroup on the autistic spectrum) took the same questionnaires we gave to non-autistic adults, they exhibited extreme Type S brains. Psychological tests reveal a similar pattern.
And this analysis makes sense. It helps explain the social disability in autism, because empathy difficulties make it harder to make and maintain relationships with others. It also explains the "islets of ability" that people with autism display in subjects like math or music or drawing - all skills that benefit from systemizing.
People with autism often develop obsessions, which may be nothing other than very intense systemizing at work. The child might become obsessed with electrical switches (an electrical system), or train timetables (a temporal system), or spinning objects (a physical system), or the names of deep-sea fish (a natural, taxonomic system). The child with severe autism, who may have additional learning difficulties and little language ability, might express his obsessions by bouncing constantly on a trampoline or spinning around and around, because motion is highly lawful and predictable. Some children with severe autism line objects up for hours on end. What used to be dismissed by clinicians as "purposeless, repetitive behavior" may actually be a sign of a mind that is highly tuned to systemize.
One needs to be extremely careful in advancing a cause for autism, because this field is rife with theories that have collapsed under empirical scrutiny. Nonetheless, my hypothesis is that autism is the genetic result of "assortative mating" between parents who are both strong systemizers. Assortative mating is the term we use when like is attracted to like, and there are four significant reasons to believe it is happening here.
FIRST, both mothers and fathers of children with autism complete the embedded figures test faster than men and women in the general population.
Second, both mothers and fathers of children with autism are more likely to have fathers who are talented systemizers (engineers, for example).
Third, when we look at brain activity with magnetic resonance imaging, males and females on average show different patterns while performing empathizing or systemizing tasks. But both mothers and fathers of children with autism show strong male patterns of brain activity.
Fourth, both mothers and fathers of children with autism score above average on a questionnaire that measures how many autistic traits an individual has. These results suggest a genetic cause of autism, with both parents contributing genes that ultimately relate to a similar kind of mind: one with an affinity for thinking systematically.
In order to fully test this theory, we still need to do a lot of work. The specific genes involved must be identified. It is a theory that may be controversial and perhaps unpopular among those who believe that the cause of autism is largely or totally environmental. But controversy is not a reason not to test it - systematically, as we might say
Monday, November 7, 2005
The Syllabus for Anatomy in MBBS Course
The Syllabus for Anatomy in MBBS Course
A) GENERAL Anatomy
I) Descriptive terms
Terms used for describing the position of the body, Anatomical planes, Commonly used terms in Gross Anatomy , Terms used in Embryology, Terms related to limbs, for hollow organs, for solid organs, to indicate the side, for describing muscle, for describing movements
II) General Osteology
Definition, Nutrition & Morphological Classification, Distribution and Functions of bone Appendicular, Axial.
Diaphysis, Metaphysis, Epiphysis, Types of epiphysis
Primary centres, Secondary centers, Law of ossification, Epiphyseal plate, Blood supply of long bone
CARTILAGE
Definition, Types, structure, Distribution, Nutrition
III) General Arthrology
Classification, Synarthrosis, Amphiarthrosis, Diarthrosis.
Cartilaginous. Primary, Secondary
Synovial - Axis of movement, Structure of typical synovial joints
Classification of synovial joints, according to the shape ,axes of movement and morphology
Simple, Compound ,Complex joints,Blood supply & nerve supply.
IV) General Myology
Definition, types: Origin, Insertion, Morphological classification
Actions of muscles, nerve supply
Functional classification, Prime movers, Fixators, Antagonists, Synergists
BURSA, Structure, Functions,types:
LIGAMENTS, Types & functions,Sprains
RETINACULA & APONEUROSES
V) Integument
a) SKIN -
Introduction : Surface area
Types :Thin, Thick, hairy, Functions, innervation
Structure :
Epidermis, Dermis, Appendages
b) SUPERFICIAL FASCIA
Distribution of fat, functions
c) DEEP FASCIA
Features, Modifications, Functions
VI) General Angiology
Arteries: Muscular, Elastic; Arterioles; Capillaries: Sinusoids, Veins - Anastomosis: End arterial; Vasa vasorum, nerve supply of blood vessels
Lymphatic system
Lymph vessels, Central lymphoid tissue, Peripheral lymphoid organs, Circulating lymphocytes - T and B lymphocytes
VII) General Neurology
Structure of nervous tissue,
Neurons:Synapses :Structural – type, Functional types
Classification of neurons : According to polarity and According to relative lengths of axons and dendrites:
Neuroglia:Nerves :Cranial – Spinal, Structure of typical spinal nerve
Autonomic nervous system :Sympathetic :Sympathetic ganglia, postganglionic fibres
Parasympathetic :Cranial outflow, sacral outflow
Level 2: Mechanical properties of bones.
synthesis, histogenesis, growth of Cartilage,Factors limiting range of movement,
Kinesiologically: Sellar, Ovoid, Joint position: Loose-packed, Close-packed
Number and diameter of fibres, Range of contraction, Active insufficiency,Passive insufficiency, shunt, swing, spin
Adventitious bursae - Housemaid’s knee, Clergyman’s knee, Student’s elbow, Weaver’s bottom, Porter’s shoulder
Clinical correlation, significance of Langer’s lines, Tension lines, flexure lines Transplant
Collateral circulation, Functional end arteries, Arteriosclerosis,
Level 3: Effect of hormones on bony growth, Wolff’s law, Surface topology of articular surfaces, Spin, Swing, Cartilage Grafts, Kinesiology, Body liver system,SKIN grafts,Ischaemia, Infarct,Bursitis
B) REGIONAL Anatomy
I) UPPER LIMB
REGIONS : Mammary gland, Axilla, Cubital fossa, Fascial spaces of the hand
Relations and functional importance of individual structures, Dupuytren’s contracture, Hand as a functional unit – grips, Nerve injury, carpal tunnel syndrome, Clavipectoral fascia; Salient features about carpals;
ARTHROLOGY
Shoulder girdle; Shoulder joint; Elbow; Radioulnar joints; Wrist; Carpometacarpal joint of thumb; Bones taking part
Classification of joints, Movement with muscles causing movements,
midcarpal joint, metacarpophalangeal joints,
interphalangeal joints
Fall on the outstretched hand
Level 2Axilla: Collaterals Lymph nodes (breast) Axillary sheath cervico-axillary canal, Abscess drainage, Palm: comparative Anatomy (thumb, palmaris brevis), position of rest and of function, collaterals, Fascial spaces: Surgical significance
OSTEOLOGY
Identification; Anatomical position; Parts; Joints formed; Development; identification of individual carpals in and articulated hand)
Clavicle: Line of force transmission, commonest site of FRACTURE
Humerus: fractures -
Colles’ FRACTURE , Smith’s FRACTURE
Carpals, Metacarpals, Phalanges: Carpal tunnel syndrome, FRACTURE scaphoid
Surgical approaches, Subluxation of head of radius, carrying angle
MYOLOGY:
Muscles of upper limb, attachment, Nerve supply, Actions
Applied aspects: Volkmann’s ischaemic contracture
Quadrangular and triangular spaces, Triangle of auscultation
ANGIOLOGY: Axillary, Brachial, Radial, Ulnar Arteries, veins, lymphatics
Commencement, Termination, Main area of distribution and drainage, Anastomosis –
Applied aspects, Artery : Damage to vessels, Raynaud’s disease, Veins: Thrombosis, Lymphatics: Lymphangitis (red streaks), lymphadenitis,
NEUROLOGY:
A. Nerves
Axillary, median, ulnar, musculocutaneous, radial, Origin, course, distribution, Root value
B. Plexus: Brachial
Applied aspects: Nerve injury at various sites - Tendon reflex - Winging of scapula, Erb’s palsy, Klumpke’s palsy, Crutch palsy, ulnar paradox
II) LOWER LIMB
REGION: boundaries, major contents; Gluteal, femoral triangle; Adductor canal, compartments of thigh, leg; Popliteal fossa, Adductor canal , Sole, Arches of foot,; Gluteal IM injections
Femoral hernia
blood supply to head of femur; FRACTURE neck of femur, mechanics movement of joints; hip and knee, Trendelenburg test; Knee joint : derangement, injuries to cruciate ligaments, menisci; (tear - bucket handle type); Ankle : Sprain
mechanism of venous return, varicose veins
Applied aspects of Adductor canal, popliteal aneurysms
OSTEOLOGY: Identification, region, anatomical position; parts, joints formed,
For tarsals - identification of individual tarsals in an articulated foot.
Level 2
Applied aspects: Bony specialization for bipeds, walking and transmission of weight,
FRACTURE , femoral torsion, neck shaft angle, bone grafts
ARTHROLOGY
Hip, knee, ankle, subtalar, Tibiofibular
Hip joint : dislocation, congenital, traumatic, surgical approaches to joints (anatomical basis), traumatic effusion, bursitis
MYOLOGY
Attachments, nerve supply, actions of: Muscles of lower limb
calf pump, antigravity muscles
ANGIOLOGY
Artery: Femoral, profunda femoris, popliteal, dorsalis pedis, Commencement, termination, main area of supply, course, relations & applied
Vein: Venous drainage of lower limb, long and short saphenous veins, Communication and valves. Varicose
Lymphatics: Inguinal group of lymph nodes
Lever 2 :intermittent claudication, clinical significance of anastomosis: around knee, venous thrombosis
NEUROLOGY
a. Plexus: Lumbar and sacral, Location, Formation, Distribution
b. Nerves: Root value of sciatic, femoral, obturator, tibial, common peroneal nerves; Origin, course, distribution; sciatica, foot drop
Level 2 :Pes cavus, equinovarus, clawing of toes
III) ABDOMEN
i) Anterior abdominal wall
Rectus sheath, quadrants and regions, Testes, epididymis, spermatic cord, scrotum
Level 2: Surgical incisions of abdomen types of inguinal herniae
Peritoneum, Lesser Omentum, Omental Bursa, Epiploic Foramen, Testes
Morphology, blood supply, lymphatic drainage
SPERMATIC CORD
Definition, beginning, end, course and contents, coverings, vasectomy
ii) Abdominal organs : Morphology relations blood supply, lymphatics nerve supply & applied Anatomy of following organs
stomach, spleen , liver :,biliary apparatus, pancreas, small intestine,large intestine and vermiform appendix,kidneys, ureters,suprarenal glands
Level 2: peptic ulcer ,Splenic circulation, splenic vascular segments,liver , biopsy, Support of liver ,Gall stones ,Duct system of pancreas ,Surgical approach to kidney , stones (Renal), Ureter,Sites of constrictions, Hydronephrosis, pheochromocytoma
Level 3: Gastroscopy, Achlorhydria,Splenectomy ,liver transplant,Pancreatitis, diabetes,Renal transplant,Stones in ureter, Cushing’s disease
iii) Pelvic Viscera :- Morphology, relations, blood supply nerve supply & applied Anatomy
urinary bladder & urethra, uterus, ovaries and uterine tubes, prostate, rectum and anal canal, urogenital diaphragm (ugd)
Level 2: Supports and micturition, stones in bladder ,Ovarian cyst, enlargement complications, Fistula, Fissure, piles
Level 3: cystoscopy, Hysterectomy,cancer, Supports of rectum
iv) Perineum – Ischiorectal fossa, pudendal canal, perianal spaces Urogenital diaphragm, male urethra, penis – perineal pouches
Level 2: Ischiorectal hernia
v) Myology
Anterior abdominal wall, Rectus sheath, Psoas major, Quadratus lumborum, Thoracoabdominal diaphragm, pelvic diaphragm, Thoracolumbar fascia, perineal spaces & muscles
Level 3: Psoas abscess
vi) Osteology
Level 2: Pelvis - types
(various diameters), lumbar vertebrae, anatomical basis of disc prolapse, nerve compression
Level 3: Sacralization, Lumbarization
ARTHROLOGY
Movements of lumbar vertebrae, lumbosacral, sacroiliac, sacrococcygeal joints
vii) Angiology :- Origin, course, termination, relations, branches & applied Anatomy of
PORTAL VEIN
Level 2: portasystemic communications
Level 3: Portasystemic communications in detail; Development
INFERIOR VENA CAVA,ABDOMINAL AORTA,INTERNAL ILIAC ARTERY
viii) Neurology, lumbar plexus, sacral plexus
IV) THORAX
i) Thoracic wall,Thoracic inlet
Boundaries and contents
THORACIC OUTLET, Boundaries and contents, major openings and levels,
Typical intercostal space, Boundaries and contents, muscles Atypical intercostal space, Movements of respiration
Level 2: importance and minor openings in outlet, Accessory muscles of respiration
Level 3: Applied aspects: Barrel chest, pectus excavatum, rickety rosary
ii) Mediastinum
Divisions and major contents
Level 2: Mediastinitis, mediastinoscopy
SUPERIOR AND POSTERIOR MEDIASTINA, LIST OF STRUCTURES
Boundaries and contents:
Level 2 : Superior mediastinal Syndrome, Course, relation and branches / area of drainage
Level 3: Coarctation of aorta, aneurysm, developmental anomalies
iii)Pleura
Pleural reflections, recesses, innervation
Level 2: importance of recesses
Level 3: pleural effusion
LUNGS
Gross description including lobes, fissures and bronchopulmonary segments
Level 2: relations, blood supply, nerve supply
Level 3: Postural drainage, surgical importance, of bronchopulmonary segments, foreign body inhalation
iv)Pericardium & heart
Divisions of pericardium and sinuses
Level 2: referred pain
Level 3: Pericardial effusion
heart
Anatomical position, location, surfaces and borders, interior of all chambers, conducting system of heart ; vessels of heart
Level 2: Relations, nerve supply - foramen ovale, patent IV septum, over-riding aorta, referred pain, functional end arteries - coronaries
Level 3: PDA, Fallot’s tetralogy, etc.
v)Osteology
IDENTIFICATION and parts of VERTEBRAE , RIBS - and STERNUM
Level 2: Identification of T1, T9, T10, T11, T12, vertebrae and atypical ribs - 1, 2, 11, 12. relations, attachments, ossification
Level 3: FRACTURE ribs, flail chest, compression FRACTURE of vertebra
V) HEAD-FACE NECK
i) Regions and organs, fasciae of the neck triangles of neck
Level 2 Spaces and spread of infections, axillary sheath , Relations of contents, Damage to accessory nerve, sialogram, approach to gland, bidigital palpation of submandibular gland, Dangerous area of face, squint
Level 3: surgical neck incisions, external jugular vein - air embolism, LN biopsy, JVP, pulse, Frey’s syndrome
GLANDS
Thyroid, Parathyroid, Parotid, Submandibular, sublingual, Pituitary
Morphology, capsule, relations, nerve supply, blood supply
FACE
Muscles, nerve supply - blood supply
scalp,palate,tongue,larynx, pharynx, orbit, eyeball,styloid apparatus,nasal cavity, ear ,internal ear ,middle ear ,external ear ,meninges
ii) Osteology
Identification, anatomical position, parts, foramina in the skull, structures passing through them, norma basalis, verticalis, frontalis, lateralis, occipitalis and interior of cranial cavity
Foetal skull; Mandible: Age changes
Level 2: Fontanelles, Dental formula
Level 3: Fractures of the skull, Age of dentition, cervical rib, disc herniation
iii) Arthrology
TM JOINT
Level 2: Dislocation
iv) Myology
Sternomastoid, Digastric, Mylohyoid, Hyoglossus, Muscles of facial expression, mastication, larynx, pharynx, tongue, palate and, Extra-ocular muscles
Level 2 Relations, development
Level 3 facial nerve palsy
v) Angiology
ARTERIES
Origin, parts, course, relations, branches of:
Subclavian, Internal carotid, External carotid, Vertebral, Lingual, Facial, Maxillary
Level 2: Sub-branches, distributions
Level 3: Subclavian steal syndrome, Subclavian-axillary anastomosis
VEINS
External and internal Jugular veins, venous drainage of face
VENOUS SINUSES
Names, locations, drainage, classification
emissary veins, cavernous sinus, lymphatic drainage of head face neck
vi) Neurology
Cranial nerves,Nucleus, course, relations, branches, distribution, reflex pathways & applied Anatomy , plexus: Cervical, Brachial, parasympathetic ganglia, cervical sympathetic chain
VI) NEUROANATOMY
i) SPINAL CORD
Gross features: Extent (child / adult), enlargements, conus medullaris,
filum terminale, spinal meninges Tracts Ascending and Descending
Level 2: Spinal segments, vertebral correlation, significance of enlargements
nuclei of grey matter at upper & lower cervical, mid-thoracic, Lumbar & sacral levels
Clinical correlation of lesions
Level 3: anomalies,lamination, syringomyelia, PID, tumours, TB, trauma, dislocation, myelography
ii) MEDULLA OBLONGATA
Gross features: Motor decussation: Sensory decussation: Inferior olivary nucleus Cranial nerve nuclei
Level 2: Tuber cinereum, pontobulbar body, Order of neurons, Details of nuclei and organisation of white matter
Level 3: medullary syndromes-Bulbar palsy, increased ICT, Arnold-Chiari malformation,
iii) PONS
Cross sections at the level of:
¨ Facial colliculus, Trigeminal nucleus
General features: Peduncles, Floor of the fourth ventricle
Level 2: Relations
Level 3: Tumours, pontine haemorrhage
iv) CEREBELLUM
Gross features: Division, Lobes, relations, internal structure -
Level 2: connections of,cerebellar cortex and intracerebellar nuclei,
white matter classification, Purkinje neuron,
Level 3: dysfunction,-dysequilibrium, ataxia, hypotonia
Nuclei: Names of nuclei and important connections
Peduncles : Important tracts in the peduncles
Functions : Of archicerebellum, paleocerebellum & neocerebellum
v) MIDBRAIN
General features :
relations, contents of interpeduncular cistern, connections of red nucleus
Level 2: Weber’s syndrome, Benedikt’s syndrome
Level 1 :T.S. at inferior colliculus, TS at superior colliculus
vi) CEREBRUM
CORTEX, WHITE MATTER, BASAL NUCLEI, LIMBIC LOBE
Surfaces, borders, major sulci, gyri, poles, lobes, major functional areas, interior - gray and white matter
Gray - cortex - granular / agranular, striate, Basal nuclei - names, White matter - classification with examples; Components of limbic lobe
Level 2: handedness, Connections of limbic lobe
vii) DIENCEPHALON
Dorsal thalamus Epithalamus Metathalamus Hypothalamus Subthalamus
Boundaries, parts, relations (gross), cavity, major nuclei, gross connections
viii) VENTRICULAR SYSTEM
Parts, boundaries, foramina, correlation with parts of brain
Level 2: Choroid fissure, recesses, Queckenstedt’s test
Level 3: Hydrocephalus, VA shunt
ix) BLOOD SUPPLY OF brain
Circle of Willis, subarachnoid space, arteries, veins
Level 2: blood brain barrier, Hemiplegia
Level3: End arteries, CSF formation
x) MENINGES
Cerebral and spinal meninges, folds of dura, contents of subarachnoid spaces, arachnoid villi and granulations, direction of flow of CSF , lumbar puncture Cisterns, Definition, terminology, cisterna magna
Level 2: cisternal puncture, Queckensted’s test, vertebral venous plexus, choroid plexus
Extracerebral and intracerebral communication, CSF block,
Level 3: Epidural space
C) MICROANATOMY
I) GENERAL HISTOLOGY
i) Microscope,
Light microscope: parts, magnification, resolution,Electron microscope,
Level 2 Micro techniques, H and E staining
Level 3: Polarizing microscope, phase contrast, scanning EM
ii) Cytology
Cell,Cytoplasm and nucleus,Cytomembranes,Unit membrane, Cell organelles
Mitochondrial DNA, mitochondrial myopathy
Level 2 Specialisations of cell surface, Sarcoplasmic reticulum of muscle, Primary and secondary lysosomes, residual bodies, Effect of colchicine and anticytotic drugs on spindles preventing mitosis, Endocytosis, exocytosis, movement of microvilli; Cell mitotic activity
Level 3 Lysosomal storage disease
NUCLEUS - Structure, nuclear envelope, chromatin, Barr body, nucleolus
iii) Epithelial
Definition, Classification, Structure of various types & subtypes of epithelia
Level 2: Nutrition, Renewal, Innervation,
Level 3: Metaplasia;
Surface modifications,Cilia; Microvilli; Stereocilia; Cell junction and junctional complexes;
Glands, Classification; Unicellular and Multicellular; Exocrine, Endocrine, Amphicrine. Exocrine: Simple, Compound; Apocrine, Merocrine, Holocrine; Tubular, alveolar, tubuloalveolar; Serous; Mucous ; Mixed
iv) Connective tissue, classification, structure, fibres, ground substance,
loose areolar tissue, adipose tissue
Level 2 : Glycosaminoglycans
Level 3 : Scurvy, oedema, inflammation
v) Bone & Cartilage
Bone, Compact, Cancellous, Developing bone; ossification, Woven, lamellar bone
Cartilage, Classification, types, Perichondrium, functions
Level 2: Growth: Interstitial, Appositional; Bone callus, Osteomalacia , Osteoporosis , Osteoma
Level 3: Chondroma
vi) Muscle
Skeletal muscle Plain muscle Cardiac muscle Intercalated disc, syncitium; Sarcomere, I and A bands, myofibrils, myofilaments,; Sarcoplasmic reticulum,
Level 2: Innervation, Red fibres, white fibres
Level 3: Hypertrophy, Hyperplasia ,Rigor mortis , Myasthenia gravis
vii) Nervous
Neurons, types; Neuroglia, types; Myelinated nerve fibre LS; Non-myelinated nerve fibre; Peripheral nerve ; Nodes of Ranvier; Synapses;
viii) Vessels
Large sized artery Medium sized artery, Arteriole; Capillary, Sinusoid; Medium sized vein;
Level 2: Atherosclerosis, Aneurysm, Infarcts, clotting
Lymphoid tissue
T cells, B cells; Mucosa Associated Lymphoid Tissue; Humoral immunity, Cell mediated immunity; Lymph node section; Thymus, spleen , Tonsil
Level 2: Blood-thymus barrier, Open and closed circulation in the spleen
Level 3: Organ transplantation, Graft rejection, Autoimmune disease
II) SYSTEMIC HISTOLOGY
Basic organization, salient features, Identification
Structure and function correlation, individual features
i) Integumentary system
SKIN - Types; Epidermis and dermis; various cells, Appendages of SKIN
Level 2: Renewal of epidermis
Level 3: Albinism, melanoma, Acne
ii) Alimentary system
a) Oral tissues
Lip, Tongue, taste buds, Papillae; Tooth, Developing tooth, Salivary glands
Level 2: Striated duct, ion transport
b) GI Tract
Basic organization - 4 layers; Oesophagus with glands Stomach - Fundus, Chief cells, Parietal cells, intrinsic factor; Stomach - Pylorus Duodenum Brunner’s glands; Small intestine - with Peyer’s patch, Appendix, Large intestine
Level 3: Pernicious anaemia, ulcer, gastritis, Hirschsprung’s disease or megacolon
c) Glands
Pancreas: Exocrine, islets of Langerhans; liver , Hepatic lobule, portal lobule,; portal acinus; Gall bladder
Level 2: liver as an endocrine gland
Level 3: Diabetes mellitus, Cirrhosis of liver , liver regeneration, Chalones
iii) Respiratory system
Olfactory mucosa; Epiglottis; Trachea, Lung, Bronchus, bronchiole, alveolar duct, sac, alveoli, pulmonary type I and II cells
Level 2: Double spirally arranged bronchial smooth muscle
Level 3: Bronchial asthma, Hyaline membrane disease, heart failure cells
iv) Urinary system
Basic organization; Nephron - Parts, podocytes, Collecting system; kidney - Cortex, Medulla Ureter; Urinary bladder, Urethra
Level 2: Juxtaglomerular apparatus
v) Male reproductive system
Basic organization; Gonads, Tract, Accessory glands; Testis; Epididymis ; Vas deferens; Prostate ; Penis; Seminal vesicle
Level 2: Stages of spermatogenesis
Level 3: Immotile sperm
Female reproductive system
Basic organization; Gonads, Tracts, Accessory glands; ; Ovary - with corpus luteum; Fallopian tube; Uterus ; Cervix; Vagina, Mammary gland Active , Passive
Level 2: Stages of maturation of ovarian follicle , Phases of menstruation
Colostrum, IgA, Placenta : Maternal unit, Foetal unit, Umbilical cord: Wharton’s jelly
vi) Endocrine system: Pituitary; Adenohypophysis; Neurohypophysis; Thyroid ; Follicular, parafollicular cells; Parathyroid ; Chief cells, oxyphil cells; Adrenal; Pancreas; Testis ; Ovary
Level 2: Hypothalamo-pituitary Portal system
Level 3: Pheochromocytoma
vii) Nervous system
A. Central
Basic organization; Cerebrum; Cerebellum; Spinal cord; Cervical; Thoracic; Lumbar;
Sacral;
B. Peripheral
Sensory ganglia; Autonomic ganglia (sympathetic ganglion); Peripheral nerve
Special senses
I. Visual: Eyeball
Cornea ; Sclerocorneal junction ; Canal of Schlemm; Lens ; Retina ; Optic nerve
Level 3: Kerattoplasty, eye donation, glaucoma, retinal detachment
2. Auditory:
Internal ear ; Cochlea ; Semicircular canals; Vestibule;
3. Olfactory
Nasal cavity
4. Gustatory
Tongue with taste buds
D) DEVELOPMENT Anatomy
I) General Embryology
i) Introduction: Stages of human life phylogeny
Ontogeny, Trimester, Viability,
Terms of reference: e.g. Cranial, Rostral, Caudal, Dorsal, Ventral, Lateral, Medial, Median, Planes of section
Level 3: The law of recapitulation, "Critical period", malformations, USG, Amniocentesis Chorionic Villus Biopsy, Fetoscopy, etc Teratology History of Embryology
ii) Gametogenesis: Menstrual cycle other reproductive cycles, Germ cell Transport and Fertilisation, Sperm capacitation, Methods of contraception, SEX determination
Level 3: Teratogenic influences; Fertility and Sterility, Surrogate motherhood; Social significance of “SEX -ratio”,
iii) Cleavage, Blastocyst, Cytotrophoblast, Syncytiotrophoblast
Implantation: Normal sites, Abnormal sites,; Placenta praevia, Extra-embryonic Mesoderm and Coelom; Bilaminar disc - Prochordal plate
Level 2: “abortion”; Decidual reaction, Chorionic Gonadotropins - Pregnancy test,
iv) Primitive streak Notochord, Neural tube and its fate Neural crest cells
- their fate, Development of somites, Intra-embryonic coelom, Foetal membranes :Chorionic villi, Amnion, Yolk sac, Allantois
Level 2: Congenital malformations, Nucleus pulposus, Sacrococcygeal teratomas, Neural tube defects, Anencephaly
Level 3: Signs of pregnancy in the first trimester, Role of teratogens, Alpha-fetoprotein levels
v) Folding of the embryo: Derivatives of germ layers,
Pharyngeal arches
Level 2: Thalidomide tragedy, Estimation of Embryonic Age - Superfoetation & superfoecundation
vi) Fetal membranes: Formation Functions, fate of: Chorion ; Amnion; Yolk sac; Allantois; Decidua; Umbilical cord; Placenta - Physiological functions; Foetomaternal circulation, Placental barrier, Twinning: monozygotic, dizygotic
Level 2: Placental hormones, Uterine growth, Parturition, Estimation of fetal age,
Level 3: Types of cord attachments, Chorion villus biopsy and Amniocentesis;
Uses of amniotic membranes, Trophoblastic tumours - Rh incompatibility, Haemolytic disease of newborn,
II) Systemic Embryology
i) Cardiovascular System - Venous System; heart - Chambers - Septa - Truncus -
Aortic arches - Fetal circulation - Changes at birth, ASDs, VSDs, PDA, Fallot’s Tetralogy.
Level 2: Veins, abnormalities, Surgical corrections
ii) The Respiratory System: Development of Larynx, Trachea, Bronchi, Lungs; Tracheo-oesophageal Fistula
Level 2: malformations
Level 3: Respiratory Distress Syndrome; Premature births
iii) The Alimentary System: Foregut: Oesophagus, Stomach, (Lesser sac); Duodenum - Hepatobiliary apparatus, Pancreas, spleen, Portal vein; Midgut : Rotation and Fixation, Caecum and Appendix, Meckel’s diverticulum; Hindgut : Cloaca; Rectum and Anal Canal
Level 2: Malformation - Tracheo-oesophageal fistulae; Congenital Hypertrophic Pyloric Stenosis; Atresia; Omphalocele, Hernia; Malformations - Fistulae, Situs inversus; Nonrotation; Mixed rotation of gut
iv) The Urogenital System, Development of Kidneys and Ureters; Cloaca - Urinary Bladder and Urethra; Suprarenal gland; Genital System - Testis and Ovary; Ducts and associated glands; External genital organs, Mesonephric and paramesonephric ducts, Uterine tube, Uterus and vagina
Level 2: congenital malformations; Ambiguous genitalia and Hermaphroditism ; Remnants and Vestiges of Ducts and Tubules
v) Integument : Development of mammary gland, SKIN & appendages
vi) Pharyngeal arches, nerves, muscles, cartilage, development of face, palate
vii) Endocrine : Glands, Adrenal, Thyroid, Parathyroid, Pituitary
viii) The Nervous System: Neural Tube: Spinal Cord and brain i.e., Forebrain, Midbrain and Hindbrain, Hypophysis cerebri; Neural Crest : Peripheral Nervous System,
Level 2: correlation Spina bifida; Anencephaly, Hydrocephalus, Retinal detachment; glaucoma; Coloboma iris,
Level 3: Myelination of tracts shortening of spinal cord, Neural Tube Defects
Organs of the special senses - eye and ear
ear - Internal ear -; External and middle ear - anomalies of the ear
E) GENETICS
i) Introduction – Mendelism, Laws Genetic code
Level 2: Evolution, Eugenics and Polygenic inheritance, Radiation and mutation , SEX chromatin, Population genetics
ii) Cytogenetics
Structure and function of chromosomes, Cell cycle, Cell divisions, Spermatogenesis, Oogenesis
iii) Molecular genetics (Normal)
Gene, Genetic code, Structure and types of DNA, Structure of RNA
iv) Inheritance: Single gene inheritance, Multifactorial inheritance, Polygenic inheritance, Mitochondrial inheritance, Pedigree charts with symbols
Genetic basis of variation
Mutation, Polymorphism, Multiple allelism
Level 2: Types, Factors influencing mutational load
Developmental genetics
chromosomes; Lyon’s hypothesis; Hermaphroditism and pseudohermaphroditism; teratogenesis
Gonadal dysgenesis, Adrenogenital syndrome Androgen insensitivity
Level 3: Counselling
Pedigree charting
Chromosomal basis of disease: Numerical, Structural abnormalities Down’s, Cri-du-chat, Turner’s, Klinefelter’s
Level 2: Dermatographics
Level 3: Counselling
Prenatal diagnosis
Maternal Serum Sampling; Fetal USG; Fetal Amniocentesis; Fetal Chorion Villus Sampling
Level 2: (cordocentesis); Foetoscopy
Level 3: Eugenics
F) RADIOLOGICAL Anatomy
I) Introduction
Principles of plain radiograms and CT scan.
Identification of gross anatomical features in plain and contrast radiographs.
Identification of gross anatomical features in normal CT scan especially of the Abdomen and Head-Face-Neck-brain regions.
Diagnostic procedures. Technical details (e.g. dye) are not necessary.
Level 2 :Estimation of age if epiphyseal line seen.
II) UPPER LIMB – X-Ray of III) LOWER LIMB
Shoulder region Hip region
Arm Thigh
Elbow region Knee region
Fore arm Leg
Wrist and hand Ankle region
Foot
IV) ABDOMEN V) THORAX
Plain X-ray Plain X-ray
Ba meal Ba swallow
Ba meal follow through Bronchogram
Ba enema CT mediastinum
Oral cholecystogram High resolution CT lung
Intravenous urogram
Cystogram
Ascending pyelogram
Abdominal Aortogram
Hystero-salpingogram
Myelogram
CT abdomen
VI) HEAD-FACE
X-ray skull plain
Carotid angiogram
Vertebral arteriogram
CT Scan brain
NECK
Plain X-ray cervical region
G) SURFACE Anatomy
I) SURFACE MARKING:
i) Upper Limb
NERVES: Radial nerve, Median nerve, Ulnar nerve, Axillary nerve,
Musculocutaneous nerve
VESSELS: Axillary artery, Brachial artery, Radial artery, Ulnar artery, Superficial
and deep palmar arches
ii) Lower Limb
NERVES: Femoral, Sciatic, Common peroneal nerves
VESSELS: Great saphenous & Small saphenous veins; Femoral, Popliteal & Dorsalis pedis arteries
iii) ABDOMEN
ORGANS: 9 regions and projection of organs in them; Stomach, Duodenum, Caecum, Appendix, Ascending,, transverse and descending colon, Pancreas, liver , Gall bladder, spleen , Kidneys (ventral and dorsal)
Abdominal aorta
iv) THORAX
heart and valves, Lungs, fissures and hilum; Pleurae, Trachea
v) HEAD FACE NECK
ORGANS: Parotid gland & duct
Middle meningeal artery, Facial artery
Pterion, Bregma, Reid’s base line, Suprameatal triangle
Thyroid gland
Common carotid artery, External carotid artery, Internal carotid artery, Internal jugular vein, Trachea
vi) brain : Lateral sulcus, Central sulcus, Median longitudinal fissure, Superior sagittal sinus, Sigmoid sinus, transverse sinus
II) LIVING Anatomy :
i) UPPER LIMB
(BONY) LANDMARKS(PALPATION OF):
Clavicle, Spine of scapula, Inferior angle, Coracoid process, Epicondyles of humerus, Olecranon process of ulna; Head and styloid processes of radius and ulna, Heads of metacarpals (knuckles), Pisiform, Hook of Hammate
JOINTS (DEMONSTRATION OF MOVEMENTS):
Shoulder girdle, Shoulder joint, Elbow joint, Radio-ulnar joints, Wrist joint, 1st carpo-metacarpal joint, MP and IP joints
MUSCLES (DEMONSTRATION OF ACTION)
Principle of testing: Trapezius, Serratus anterior, Latissimus dorsi, Pectoralis major, Deltoid, Biceps Brachii, Brachioradialis, Brachialis, Extensors at the elbow, Supinators, Wrist extensors, Wrist flexors, Small muscles of the hand
NERVES: Dermatomes, Ulnar
Ulnar nerve thickening in Leprosy
VESSELS (PALPATION OF): Axillary artery, Brachial artery, Radial artery
OTHERS: Axillary groups of lymph nodes; Anatomical snuff-box (boundaries)
ii) LOWER LIMB
(BONY) LANDMARKS (PALPATION OF): Anterior superior iliac spine, Iliac crest, Tubercle of the iliac crest, Ischial tuberosity, Greater trochanter, Adductor tubercle, Head and neck of fibula, Lateral and medial malleoli, Tibial tuberosity, Subcutaneous surface of tibia, Patella
JOINTS (DEMONSTRATION OF MOVEMENTS): Hip , Knee , Ankle , Subtalar Joints
MUSCLES (DEMONSTRATION OF ACTION): Hip-Flexors, Extensors, Abductors, Adductors
Knee: Flexors, Extensors,
Ankle: Dorsiflexors, Plantar flexors
Subtalar: Invertors, Evertors
NERVES: Dermatomes, Sciatic, Tibial, Common peroneal, Femoral, Obturator
Thickening of common peroneal nerve in Leprosy
VESSELS (PALPATION OF): Femoral, Popliteal, Dorsalis pedis, Posterior tibial
OTHERS: Ligamentum patellae, Inguinal lymph nodes
TENDONS: Semitendinosus, Semimembranosus, Biceps femoris, Iliotibial tract
iii) ABDOMEN
(BONY) LANDMARKS (PALPATION OF): Anterior superior iliac spine, Pubic tubercle
JOINTS (DEMONSTRATION OF MOVEMENTS): Intervertebral
MUSCLES (DEMONSTRATION OF ACTION): Obliques, Transversus abdominis, Rectus abdominis
NERVES: Dermatomes
OTHERS: Enlarged liver , spleen , kidneys, Abdominal quadrants and regions; Position of superficial and deep inguinal rings; Renal angle; McBurney’s point;
Level2: Murphy’s sign
iv) THORAX (BONY) LANDMARKS(PALPATION OF): Sternal angle, Counting of rib spaces, locating thoracic spines
JOINTS (DEMONSTRATION OF MOVEMENTS): Intervertebral
MUSCLES (DEMONSTRATION OF ACTION): Respiratory movements
NERVES: Dermatomes
OTHERS: Apex beat, Apices of the lungs, Triangle of auscultation
v) HEAD FACE NECK - (BONY) LANDMARKS(PALPATION OF): Nasion, Glabella, Inion, Mastoid process, Suprameatal triangle, Zygoma, Zygomatic arch, Angle of mandible, Head of mandible,
JOINTS (DEMONSTRATION OF MOVEMENTS): Temporomandibular joint
MUSCLES (DEMONSTRATION OF ACTION): Of Mastication, Of Facial expression
Cranial nerves (I to XIII) testing
(PALPATION OF): Superficial temporal artery, Facial artery
(PALPATION OF): Symphysis menti, Hyoid bone, Thyroid cartilage, Cricoid cartilage, Tracheal rings, Suprasternal notch, Transverse process of atlas, Spine of C7
(DEMONSTRATION OF MOVEMENTS): Atlanto-occipital joint, Cervical joints
(DEMONSTRATION OF ACTION): Sternocleidomastoid, Neck flexors and extensors
(PALPATION OF): Common carotid artery, External carotid artery
OTHERS: Thyroid gland, Cervical lymph nodes, (Horizontal and vertical), Midline structures in the neck
NOTE :- Level 2 and 3 mentioned in the above syllabus includes the topics " desirable to know" (level-2) and " Nice to know" ( level-3. The remaining topics fall under the group " Must Know" ( level-1.)
A) GENERAL Anatomy
I) Descriptive terms
Terms used for describing the position of the body, Anatomical planes, Commonly used terms in Gross Anatomy , Terms used in Embryology, Terms related to limbs, for hollow organs, for solid organs, to indicate the side, for describing muscle, for describing movements
II) General Osteology
Definition, Nutrition & Morphological Classification, Distribution and Functions of bone Appendicular, Axial.
Diaphysis, Metaphysis, Epiphysis, Types of epiphysis
Primary centres, Secondary centers, Law of ossification, Epiphyseal plate, Blood supply of long bone
CARTILAGE
Definition, Types, structure, Distribution, Nutrition
III) General Arthrology
Classification, Synarthrosis, Amphiarthrosis, Diarthrosis.
Cartilaginous. Primary, Secondary
Synovial - Axis of movement, Structure of typical synovial joints
Classification of synovial joints, according to the shape ,axes of movement and morphology
Simple, Compound ,Complex joints,Blood supply & nerve supply.
IV) General Myology
Definition, types: Origin, Insertion, Morphological classification
Actions of muscles, nerve supply
Functional classification, Prime movers, Fixators, Antagonists, Synergists
BURSA, Structure, Functions,types:
LIGAMENTS, Types & functions,Sprains
RETINACULA & APONEUROSES
V) Integument
a) SKIN -
Introduction : Surface area
Types :Thin, Thick, hairy, Functions, innervation
Structure :
Epidermis, Dermis, Appendages
b) SUPERFICIAL FASCIA
Distribution of fat, functions
c) DEEP FASCIA
Features, Modifications, Functions
VI) General Angiology
Arteries: Muscular, Elastic; Arterioles; Capillaries: Sinusoids, Veins - Anastomosis: End arterial; Vasa vasorum, nerve supply of blood vessels
Lymphatic system
Lymph vessels, Central lymphoid tissue, Peripheral lymphoid organs, Circulating lymphocytes - T and B lymphocytes
VII) General Neurology
Structure of nervous tissue,
Neurons:Synapses :Structural – type, Functional types
Classification of neurons : According to polarity and According to relative lengths of axons and dendrites:
Neuroglia:Nerves :Cranial – Spinal, Structure of typical spinal nerve
Autonomic nervous system :Sympathetic :Sympathetic ganglia, postganglionic fibres
Parasympathetic :Cranial outflow, sacral outflow
Level 2: Mechanical properties of bones.
synthesis, histogenesis, growth of Cartilage,Factors limiting range of movement,
Kinesiologically: Sellar, Ovoid, Joint position: Loose-packed, Close-packed
Number and diameter of fibres, Range of contraction, Active insufficiency,Passive insufficiency, shunt, swing, spin
Adventitious bursae - Housemaid’s knee, Clergyman’s knee, Student’s elbow, Weaver’s bottom, Porter’s shoulder
Clinical correlation, significance of Langer’s lines, Tension lines, flexure lines Transplant
Collateral circulation, Functional end arteries, Arteriosclerosis,
Level 3: Effect of hormones on bony growth, Wolff’s law, Surface topology of articular surfaces, Spin, Swing, Cartilage Grafts, Kinesiology, Body liver system,SKIN grafts,Ischaemia, Infarct,Bursitis
B) REGIONAL Anatomy
I) UPPER LIMB
REGIONS : Mammary gland, Axilla, Cubital fossa, Fascial spaces of the hand
Relations and functional importance of individual structures, Dupuytren’s contracture, Hand as a functional unit – grips, Nerve injury, carpal tunnel syndrome, Clavipectoral fascia; Salient features about carpals;
ARTHROLOGY
Shoulder girdle; Shoulder joint; Elbow; Radioulnar joints; Wrist; Carpometacarpal joint of thumb; Bones taking part
Classification of joints, Movement with muscles causing movements,
midcarpal joint, metacarpophalangeal joints,
interphalangeal joints
Fall on the outstretched hand
Level 2Axilla: Collaterals Lymph nodes (breast) Axillary sheath cervico-axillary canal, Abscess drainage, Palm: comparative Anatomy (thumb, palmaris brevis), position of rest and of function, collaterals, Fascial spaces: Surgical significance
OSTEOLOGY
Identification; Anatomical position; Parts; Joints formed; Development; identification of individual carpals in and articulated hand)
Clavicle: Line of force transmission, commonest site of FRACTURE
Humerus: fractures -
Colles’ FRACTURE , Smith’s FRACTURE
Carpals, Metacarpals, Phalanges: Carpal tunnel syndrome, FRACTURE scaphoid
Surgical approaches, Subluxation of head of radius, carrying angle
MYOLOGY:
Muscles of upper limb, attachment, Nerve supply, Actions
Applied aspects: Volkmann’s ischaemic contracture
Quadrangular and triangular spaces, Triangle of auscultation
ANGIOLOGY: Axillary, Brachial, Radial, Ulnar Arteries, veins, lymphatics
Commencement, Termination, Main area of distribution and drainage, Anastomosis –
Applied aspects, Artery : Damage to vessels, Raynaud’s disease, Veins: Thrombosis, Lymphatics: Lymphangitis (red streaks), lymphadenitis,
NEUROLOGY:
A. Nerves
Axillary, median, ulnar, musculocutaneous, radial, Origin, course, distribution, Root value
B. Plexus: Brachial
Applied aspects: Nerve injury at various sites - Tendon reflex - Winging of scapula, Erb’s palsy, Klumpke’s palsy, Crutch palsy, ulnar paradox
II) LOWER LIMB
REGION: boundaries, major contents; Gluteal, femoral triangle; Adductor canal, compartments of thigh, leg; Popliteal fossa, Adductor canal , Sole, Arches of foot,; Gluteal IM injections
Femoral hernia
blood supply to head of femur; FRACTURE neck of femur, mechanics movement of joints; hip and knee, Trendelenburg test; Knee joint : derangement, injuries to cruciate ligaments, menisci; (tear - bucket handle type); Ankle : Sprain
mechanism of venous return, varicose veins
Applied aspects of Adductor canal, popliteal aneurysms
OSTEOLOGY: Identification, region, anatomical position; parts, joints formed,
For tarsals - identification of individual tarsals in an articulated foot.
Level 2
Applied aspects: Bony specialization for bipeds, walking and transmission of weight,
FRACTURE , femoral torsion, neck shaft angle, bone grafts
ARTHROLOGY
Hip, knee, ankle, subtalar, Tibiofibular
Hip joint : dislocation, congenital, traumatic, surgical approaches to joints (anatomical basis), traumatic effusion, bursitis
MYOLOGY
Attachments, nerve supply, actions of: Muscles of lower limb
calf pump, antigravity muscles
ANGIOLOGY
Artery: Femoral, profunda femoris, popliteal, dorsalis pedis, Commencement, termination, main area of supply, course, relations & applied
Vein: Venous drainage of lower limb, long and short saphenous veins, Communication and valves. Varicose
Lymphatics: Inguinal group of lymph nodes
Lever 2 :intermittent claudication, clinical significance of anastomosis: around knee, venous thrombosis
NEUROLOGY
a. Plexus: Lumbar and sacral, Location, Formation, Distribution
b. Nerves: Root value of sciatic, femoral, obturator, tibial, common peroneal nerves; Origin, course, distribution; sciatica, foot drop
Level 2 :Pes cavus, equinovarus, clawing of toes
III) ABDOMEN
i) Anterior abdominal wall
Rectus sheath, quadrants and regions, Testes, epididymis, spermatic cord, scrotum
Level 2: Surgical incisions of abdomen types of inguinal herniae
Peritoneum, Lesser Omentum, Omental Bursa, Epiploic Foramen, Testes
Morphology, blood supply, lymphatic drainage
SPERMATIC CORD
Definition, beginning, end, course and contents, coverings, vasectomy
ii) Abdominal organs : Morphology relations blood supply, lymphatics nerve supply & applied Anatomy of following organs
stomach, spleen , liver :,biliary apparatus, pancreas, small intestine,large intestine and vermiform appendix,kidneys, ureters,suprarenal glands
Level 2: peptic ulcer ,Splenic circulation, splenic vascular segments,liver , biopsy, Support of liver ,Gall stones ,Duct system of pancreas ,Surgical approach to kidney , stones (Renal), Ureter,Sites of constrictions, Hydronephrosis, pheochromocytoma
Level 3: Gastroscopy, Achlorhydria,Splenectomy ,liver transplant,Pancreatitis, diabetes,Renal transplant,Stones in ureter, Cushing’s disease
iii) Pelvic Viscera :- Morphology, relations, blood supply nerve supply & applied Anatomy
urinary bladder & urethra, uterus, ovaries and uterine tubes, prostate, rectum and anal canal, urogenital diaphragm (ugd)
Level 2: Supports and micturition, stones in bladder ,Ovarian cyst, enlargement complications, Fistula, Fissure, piles
Level 3: cystoscopy, Hysterectomy,cancer, Supports of rectum
iv) Perineum – Ischiorectal fossa, pudendal canal, perianal spaces Urogenital diaphragm, male urethra, penis – perineal pouches
Level 2: Ischiorectal hernia
v) Myology
Anterior abdominal wall, Rectus sheath, Psoas major, Quadratus lumborum, Thoracoabdominal diaphragm, pelvic diaphragm, Thoracolumbar fascia, perineal spaces & muscles
Level 3: Psoas abscess
vi) Osteology
Level 2: Pelvis - types
(various diameters), lumbar vertebrae, anatomical basis of disc prolapse, nerve compression
Level 3: Sacralization, Lumbarization
ARTHROLOGY
Movements of lumbar vertebrae, lumbosacral, sacroiliac, sacrococcygeal joints
vii) Angiology :- Origin, course, termination, relations, branches & applied Anatomy of
PORTAL VEIN
Level 2: portasystemic communications
Level 3: Portasystemic communications in detail; Development
INFERIOR VENA CAVA,ABDOMINAL AORTA,INTERNAL ILIAC ARTERY
viii) Neurology, lumbar plexus, sacral plexus
IV) THORAX
i) Thoracic wall,Thoracic inlet
Boundaries and contents
THORACIC OUTLET, Boundaries and contents, major openings and levels,
Typical intercostal space, Boundaries and contents, muscles Atypical intercostal space, Movements of respiration
Level 2: importance and minor openings in outlet, Accessory muscles of respiration
Level 3: Applied aspects: Barrel chest, pectus excavatum, rickety rosary
ii) Mediastinum
Divisions and major contents
Level 2: Mediastinitis, mediastinoscopy
SUPERIOR AND POSTERIOR MEDIASTINA, LIST OF STRUCTURES
Boundaries and contents:
Level 2 : Superior mediastinal Syndrome, Course, relation and branches / area of drainage
Level 3: Coarctation of aorta, aneurysm, developmental anomalies
iii)Pleura
Pleural reflections, recesses, innervation
Level 2: importance of recesses
Level 3: pleural effusion
LUNGS
Gross description including lobes, fissures and bronchopulmonary segments
Level 2: relations, blood supply, nerve supply
Level 3: Postural drainage, surgical importance, of bronchopulmonary segments, foreign body inhalation
iv)Pericardium & heart
Divisions of pericardium and sinuses
Level 2: referred pain
Level 3: Pericardial effusion
heart
Anatomical position, location, surfaces and borders, interior of all chambers, conducting system of heart ; vessels of heart
Level 2: Relations, nerve supply - foramen ovale, patent IV septum, over-riding aorta, referred pain, functional end arteries - coronaries
Level 3: PDA, Fallot’s tetralogy, etc.
v)Osteology
IDENTIFICATION and parts of VERTEBRAE , RIBS - and STERNUM
Level 2: Identification of T1, T9, T10, T11, T12, vertebrae and atypical ribs - 1, 2, 11, 12. relations, attachments, ossification
Level 3: FRACTURE ribs, flail chest, compression FRACTURE of vertebra
V) HEAD-FACE NECK
i) Regions and organs, fasciae of the neck triangles of neck
Level 2 Spaces and spread of infections, axillary sheath , Relations of contents, Damage to accessory nerve, sialogram, approach to gland, bidigital palpation of submandibular gland, Dangerous area of face, squint
Level 3: surgical neck incisions, external jugular vein - air embolism, LN biopsy, JVP, pulse, Frey’s syndrome
GLANDS
Thyroid, Parathyroid, Parotid, Submandibular, sublingual, Pituitary
Morphology, capsule, relations, nerve supply, blood supply
FACE
Muscles, nerve supply - blood supply
scalp,palate,tongue,larynx, pharynx, orbit, eyeball,styloid apparatus,nasal cavity, ear ,internal ear ,middle ear ,external ear ,meninges
ii) Osteology
Identification, anatomical position, parts, foramina in the skull, structures passing through them, norma basalis, verticalis, frontalis, lateralis, occipitalis and interior of cranial cavity
Foetal skull; Mandible: Age changes
Level 2: Fontanelles, Dental formula
Level 3: Fractures of the skull, Age of dentition, cervical rib, disc herniation
iii) Arthrology
TM JOINT
Level 2: Dislocation
iv) Myology
Sternomastoid, Digastric, Mylohyoid, Hyoglossus, Muscles of facial expression, mastication, larynx, pharynx, tongue, palate and, Extra-ocular muscles
Level 2 Relations, development
Level 3 facial nerve palsy
v) Angiology
ARTERIES
Origin, parts, course, relations, branches of:
Subclavian, Internal carotid, External carotid, Vertebral, Lingual, Facial, Maxillary
Level 2: Sub-branches, distributions
Level 3: Subclavian steal syndrome, Subclavian-axillary anastomosis
VEINS
External and internal Jugular veins, venous drainage of face
VENOUS SINUSES
Names, locations, drainage, classification
emissary veins, cavernous sinus, lymphatic drainage of head face neck
vi) Neurology
Cranial nerves,Nucleus, course, relations, branches, distribution, reflex pathways & applied Anatomy , plexus: Cervical, Brachial, parasympathetic ganglia, cervical sympathetic chain
VI) NEUROANATOMY
i) SPINAL CORD
Gross features: Extent (child / adult), enlargements, conus medullaris,
filum terminale, spinal meninges Tracts Ascending and Descending
Level 2: Spinal segments, vertebral correlation, significance of enlargements
nuclei of grey matter at upper & lower cervical, mid-thoracic, Lumbar & sacral levels
Clinical correlation of lesions
Level 3: anomalies,lamination, syringomyelia, PID, tumours, TB, trauma, dislocation, myelography
ii) MEDULLA OBLONGATA
Gross features: Motor decussation: Sensory decussation: Inferior olivary nucleus Cranial nerve nuclei
Level 2: Tuber cinereum, pontobulbar body, Order of neurons, Details of nuclei and organisation of white matter
Level 3: medullary syndromes-Bulbar palsy, increased ICT, Arnold-Chiari malformation,
iii) PONS
Cross sections at the level of:
¨ Facial colliculus, Trigeminal nucleus
General features: Peduncles, Floor of the fourth ventricle
Level 2: Relations
Level 3: Tumours, pontine haemorrhage
iv) CEREBELLUM
Gross features: Division, Lobes, relations, internal structure -
Level 2: connections of,cerebellar cortex and intracerebellar nuclei,
white matter classification, Purkinje neuron,
Level 3: dysfunction,-dysequilibrium, ataxia, hypotonia
Nuclei: Names of nuclei and important connections
Peduncles : Important tracts in the peduncles
Functions : Of archicerebellum, paleocerebellum & neocerebellum
v) MIDBRAIN
General features :
relations, contents of interpeduncular cistern, connections of red nucleus
Level 2: Weber’s syndrome, Benedikt’s syndrome
Level 1 :T.S. at inferior colliculus, TS at superior colliculus
vi) CEREBRUM
CORTEX, WHITE MATTER, BASAL NUCLEI, LIMBIC LOBE
Surfaces, borders, major sulci, gyri, poles, lobes, major functional areas, interior - gray and white matter
Gray - cortex - granular / agranular, striate, Basal nuclei - names, White matter - classification with examples; Components of limbic lobe
Level 2: handedness, Connections of limbic lobe
vii) DIENCEPHALON
Dorsal thalamus Epithalamus Metathalamus Hypothalamus Subthalamus
Boundaries, parts, relations (gross), cavity, major nuclei, gross connections
viii) VENTRICULAR SYSTEM
Parts, boundaries, foramina, correlation with parts of brain
Level 2: Choroid fissure, recesses, Queckenstedt’s test
Level 3: Hydrocephalus, VA shunt
ix) BLOOD SUPPLY OF brain
Circle of Willis, subarachnoid space, arteries, veins
Level 2: blood brain barrier, Hemiplegia
Level3: End arteries, CSF formation
x) MENINGES
Cerebral and spinal meninges, folds of dura, contents of subarachnoid spaces, arachnoid villi and granulations, direction of flow of CSF , lumbar puncture Cisterns, Definition, terminology, cisterna magna
Level 2: cisternal puncture, Queckensted’s test, vertebral venous plexus, choroid plexus
Extracerebral and intracerebral communication, CSF block,
Level 3: Epidural space
C) MICROANATOMY
I) GENERAL HISTOLOGY
i) Microscope,
Light microscope: parts, magnification, resolution,Electron microscope,
Level 2 Micro techniques, H and E staining
Level 3: Polarizing microscope, phase contrast, scanning EM
ii) Cytology
Cell,Cytoplasm and nucleus,Cytomembranes,Unit membrane, Cell organelles
Mitochondrial DNA, mitochondrial myopathy
Level 2 Specialisations of cell surface, Sarcoplasmic reticulum of muscle, Primary and secondary lysosomes, residual bodies, Effect of colchicine and anticytotic drugs on spindles preventing mitosis, Endocytosis, exocytosis, movement of microvilli; Cell mitotic activity
Level 3 Lysosomal storage disease
NUCLEUS - Structure, nuclear envelope, chromatin, Barr body, nucleolus
iii) Epithelial
Definition, Classification, Structure of various types & subtypes of epithelia
Level 2: Nutrition, Renewal, Innervation,
Level 3: Metaplasia;
Surface modifications,Cilia; Microvilli; Stereocilia; Cell junction and junctional complexes;
Glands, Classification; Unicellular and Multicellular; Exocrine, Endocrine, Amphicrine. Exocrine: Simple, Compound; Apocrine, Merocrine, Holocrine; Tubular, alveolar, tubuloalveolar; Serous; Mucous ; Mixed
iv) Connective tissue, classification, structure, fibres, ground substance,
loose areolar tissue, adipose tissue
Level 2 : Glycosaminoglycans
Level 3 : Scurvy, oedema, inflammation
v) Bone & Cartilage
Bone, Compact, Cancellous, Developing bone; ossification, Woven, lamellar bone
Cartilage, Classification, types, Perichondrium, functions
Level 2: Growth: Interstitial, Appositional; Bone callus, Osteomalacia , Osteoporosis , Osteoma
Level 3: Chondroma
vi) Muscle
Skeletal muscle Plain muscle Cardiac muscle Intercalated disc, syncitium; Sarcomere, I and A bands, myofibrils, myofilaments,; Sarcoplasmic reticulum,
Level 2: Innervation, Red fibres, white fibres
Level 3: Hypertrophy, Hyperplasia ,Rigor mortis , Myasthenia gravis
vii) Nervous
Neurons, types; Neuroglia, types; Myelinated nerve fibre LS; Non-myelinated nerve fibre; Peripheral nerve ; Nodes of Ranvier; Synapses;
viii) Vessels
Large sized artery Medium sized artery, Arteriole; Capillary, Sinusoid; Medium sized vein;
Level 2: Atherosclerosis, Aneurysm, Infarcts, clotting
Lymphoid tissue
T cells, B cells; Mucosa Associated Lymphoid Tissue; Humoral immunity, Cell mediated immunity; Lymph node section; Thymus, spleen , Tonsil
Level 2: Blood-thymus barrier, Open and closed circulation in the spleen
Level 3: Organ transplantation, Graft rejection, Autoimmune disease
II) SYSTEMIC HISTOLOGY
Basic organization, salient features, Identification
Structure and function correlation, individual features
i) Integumentary system
SKIN - Types; Epidermis and dermis; various cells, Appendages of SKIN
Level 2: Renewal of epidermis
Level 3: Albinism, melanoma, Acne
ii) Alimentary system
a) Oral tissues
Lip, Tongue, taste buds, Papillae; Tooth, Developing tooth, Salivary glands
Level 2: Striated duct, ion transport
b) GI Tract
Basic organization - 4 layers; Oesophagus with glands Stomach - Fundus, Chief cells, Parietal cells, intrinsic factor; Stomach - Pylorus Duodenum Brunner’s glands; Small intestine - with Peyer’s patch, Appendix, Large intestine
Level 3: Pernicious anaemia, ulcer, gastritis, Hirschsprung’s disease or megacolon
c) Glands
Pancreas: Exocrine, islets of Langerhans; liver , Hepatic lobule, portal lobule,; portal acinus; Gall bladder
Level 2: liver as an endocrine gland
Level 3: Diabetes mellitus, Cirrhosis of liver , liver regeneration, Chalones
iii) Respiratory system
Olfactory mucosa; Epiglottis; Trachea, Lung, Bronchus, bronchiole, alveolar duct, sac, alveoli, pulmonary type I and II cells
Level 2: Double spirally arranged bronchial smooth muscle
Level 3: Bronchial asthma, Hyaline membrane disease, heart failure cells
iv) Urinary system
Basic organization; Nephron - Parts, podocytes, Collecting system; kidney - Cortex, Medulla Ureter; Urinary bladder, Urethra
Level 2: Juxtaglomerular apparatus
v) Male reproductive system
Basic organization; Gonads, Tract, Accessory glands; Testis; Epididymis ; Vas deferens; Prostate ; Penis; Seminal vesicle
Level 2: Stages of spermatogenesis
Level 3: Immotile sperm
Female reproductive system
Basic organization; Gonads, Tracts, Accessory glands; ; Ovary - with corpus luteum; Fallopian tube; Uterus ; Cervix; Vagina, Mammary gland Active , Passive
Level 2: Stages of maturation of ovarian follicle , Phases of menstruation
Colostrum, IgA, Placenta : Maternal unit, Foetal unit, Umbilical cord: Wharton’s jelly
vi) Endocrine system: Pituitary; Adenohypophysis; Neurohypophysis; Thyroid ; Follicular, parafollicular cells; Parathyroid ; Chief cells, oxyphil cells; Adrenal; Pancreas; Testis ; Ovary
Level 2: Hypothalamo-pituitary Portal system
Level 3: Pheochromocytoma
vii) Nervous system
A. Central
Basic organization; Cerebrum; Cerebellum; Spinal cord; Cervical; Thoracic; Lumbar;
Sacral;
B. Peripheral
Sensory ganglia; Autonomic ganglia (sympathetic ganglion); Peripheral nerve
Special senses
I. Visual: Eyeball
Cornea ; Sclerocorneal junction ; Canal of Schlemm; Lens ; Retina ; Optic nerve
Level 3: Kerattoplasty, eye donation, glaucoma, retinal detachment
2. Auditory:
Internal ear ; Cochlea ; Semicircular canals; Vestibule;
3. Olfactory
Nasal cavity
4. Gustatory
Tongue with taste buds
D) DEVELOPMENT Anatomy
I) General Embryology
i) Introduction: Stages of human life phylogeny
Ontogeny, Trimester, Viability,
Terms of reference: e.g. Cranial, Rostral, Caudal, Dorsal, Ventral, Lateral, Medial, Median, Planes of section
Level 3: The law of recapitulation, "Critical period", malformations, USG, Amniocentesis Chorionic Villus Biopsy, Fetoscopy, etc Teratology History of Embryology
ii) Gametogenesis: Menstrual cycle other reproductive cycles, Germ cell Transport and Fertilisation, Sperm capacitation, Methods of contraception, SEX determination
Level 3: Teratogenic influences; Fertility and Sterility, Surrogate motherhood; Social significance of “SEX -ratio”,
iii) Cleavage, Blastocyst, Cytotrophoblast, Syncytiotrophoblast
Implantation: Normal sites, Abnormal sites,; Placenta praevia, Extra-embryonic Mesoderm and Coelom; Bilaminar disc - Prochordal plate
Level 2: “abortion”; Decidual reaction, Chorionic Gonadotropins - Pregnancy test,
iv) Primitive streak Notochord, Neural tube and its fate Neural crest cells
- their fate, Development of somites, Intra-embryonic coelom, Foetal membranes :Chorionic villi, Amnion, Yolk sac, Allantois
Level 2: Congenital malformations, Nucleus pulposus, Sacrococcygeal teratomas, Neural tube defects, Anencephaly
Level 3: Signs of pregnancy in the first trimester, Role of teratogens, Alpha-fetoprotein levels
v) Folding of the embryo: Derivatives of germ layers,
Pharyngeal arches
Level 2: Thalidomide tragedy, Estimation of Embryonic Age - Superfoetation & superfoecundation
vi) Fetal membranes: Formation Functions, fate of: Chorion ; Amnion; Yolk sac; Allantois; Decidua; Umbilical cord; Placenta - Physiological functions; Foetomaternal circulation, Placental barrier, Twinning: monozygotic, dizygotic
Level 2: Placental hormones, Uterine growth, Parturition, Estimation of fetal age,
Level 3: Types of cord attachments, Chorion villus biopsy and Amniocentesis;
Uses of amniotic membranes, Trophoblastic tumours - Rh incompatibility, Haemolytic disease of newborn,
II) Systemic Embryology
i) Cardiovascular System - Venous System; heart - Chambers - Septa - Truncus -
Aortic arches - Fetal circulation - Changes at birth, ASDs, VSDs, PDA, Fallot’s Tetralogy.
Level 2: Veins, abnormalities, Surgical corrections
ii) The Respiratory System: Development of Larynx, Trachea, Bronchi, Lungs; Tracheo-oesophageal Fistula
Level 2: malformations
Level 3: Respiratory Distress Syndrome; Premature births
iii) The Alimentary System: Foregut: Oesophagus, Stomach, (Lesser sac); Duodenum - Hepatobiliary apparatus, Pancreas, spleen, Portal vein; Midgut : Rotation and Fixation, Caecum and Appendix, Meckel’s diverticulum; Hindgut : Cloaca; Rectum and Anal Canal
Level 2: Malformation - Tracheo-oesophageal fistulae; Congenital Hypertrophic Pyloric Stenosis; Atresia; Omphalocele, Hernia; Malformations - Fistulae, Situs inversus; Nonrotation; Mixed rotation of gut
iv) The Urogenital System, Development of Kidneys and Ureters; Cloaca - Urinary Bladder and Urethra; Suprarenal gland; Genital System - Testis and Ovary; Ducts and associated glands; External genital organs, Mesonephric and paramesonephric ducts, Uterine tube, Uterus and vagina
Level 2: congenital malformations; Ambiguous genitalia and Hermaphroditism ; Remnants and Vestiges of Ducts and Tubules
v) Integument : Development of mammary gland, SKIN & appendages
vi) Pharyngeal arches, nerves, muscles, cartilage, development of face, palate
vii) Endocrine : Glands, Adrenal, Thyroid, Parathyroid, Pituitary
viii) The Nervous System: Neural Tube: Spinal Cord and brain i.e., Forebrain, Midbrain and Hindbrain, Hypophysis cerebri; Neural Crest : Peripheral Nervous System,
Level 2: correlation Spina bifida; Anencephaly, Hydrocephalus, Retinal detachment; glaucoma; Coloboma iris,
Level 3: Myelination of tracts shortening of spinal cord, Neural Tube Defects
Organs of the special senses - eye and ear
ear - Internal ear -; External and middle ear - anomalies of the ear
E) GENETICS
i) Introduction – Mendelism, Laws Genetic code
Level 2: Evolution, Eugenics and Polygenic inheritance, Radiation and mutation , SEX chromatin, Population genetics
ii) Cytogenetics
Structure and function of chromosomes, Cell cycle, Cell divisions, Spermatogenesis, Oogenesis
iii) Molecular genetics (Normal)
Gene, Genetic code, Structure and types of DNA, Structure of RNA
iv) Inheritance: Single gene inheritance, Multifactorial inheritance, Polygenic inheritance, Mitochondrial inheritance, Pedigree charts with symbols
Genetic basis of variation
Mutation, Polymorphism, Multiple allelism
Level 2: Types, Factors influencing mutational load
Developmental genetics
chromosomes; Lyon’s hypothesis; Hermaphroditism and pseudohermaphroditism; teratogenesis
Gonadal dysgenesis, Adrenogenital syndrome Androgen insensitivity
Level 3: Counselling
Pedigree charting
Chromosomal basis of disease: Numerical, Structural abnormalities Down’s, Cri-du-chat, Turner’s, Klinefelter’s
Level 2: Dermatographics
Level 3: Counselling
Prenatal diagnosis
Maternal Serum Sampling; Fetal USG; Fetal Amniocentesis; Fetal Chorion Villus Sampling
Level 2: (cordocentesis); Foetoscopy
Level 3: Eugenics
F) RADIOLOGICAL Anatomy
I) Introduction
Principles of plain radiograms and CT scan.
Identification of gross anatomical features in plain and contrast radiographs.
Identification of gross anatomical features in normal CT scan especially of the Abdomen and Head-Face-Neck-brain regions.
Diagnostic procedures. Technical details (e.g. dye) are not necessary.
Level 2 :Estimation of age if epiphyseal line seen.
II) UPPER LIMB – X-Ray of III) LOWER LIMB
Shoulder region Hip region
Arm Thigh
Elbow region Knee region
Fore arm Leg
Wrist and hand Ankle region
Foot
IV) ABDOMEN V) THORAX
Plain X-ray Plain X-ray
Ba meal Ba swallow
Ba meal follow through Bronchogram
Ba enema CT mediastinum
Oral cholecystogram High resolution CT lung
Intravenous urogram
Cystogram
Ascending pyelogram
Abdominal Aortogram
Hystero-salpingogram
Myelogram
CT abdomen
VI) HEAD-FACE
X-ray skull plain
Carotid angiogram
Vertebral arteriogram
CT Scan brain
NECK
Plain X-ray cervical region
G) SURFACE Anatomy
I) SURFACE MARKING:
i) Upper Limb
NERVES: Radial nerve, Median nerve, Ulnar nerve, Axillary nerve,
Musculocutaneous nerve
VESSELS: Axillary artery, Brachial artery, Radial artery, Ulnar artery, Superficial
and deep palmar arches
ii) Lower Limb
NERVES: Femoral, Sciatic, Common peroneal nerves
VESSELS: Great saphenous & Small saphenous veins; Femoral, Popliteal & Dorsalis pedis arteries
iii) ABDOMEN
ORGANS: 9 regions and projection of organs in them; Stomach, Duodenum, Caecum, Appendix, Ascending,, transverse and descending colon, Pancreas, liver , Gall bladder, spleen , Kidneys (ventral and dorsal)
Abdominal aorta
iv) THORAX
heart and valves, Lungs, fissures and hilum; Pleurae, Trachea
v) HEAD FACE NECK
ORGANS: Parotid gland & duct
Middle meningeal artery, Facial artery
Pterion, Bregma, Reid’s base line, Suprameatal triangle
Thyroid gland
Common carotid artery, External carotid artery, Internal carotid artery, Internal jugular vein, Trachea
vi) brain : Lateral sulcus, Central sulcus, Median longitudinal fissure, Superior sagittal sinus, Sigmoid sinus, transverse sinus
II) LIVING Anatomy :
i) UPPER LIMB
(BONY) LANDMARKS(PALPATION OF):
Clavicle, Spine of scapula, Inferior angle, Coracoid process, Epicondyles of humerus, Olecranon process of ulna; Head and styloid processes of radius and ulna, Heads of metacarpals (knuckles), Pisiform, Hook of Hammate
JOINTS (DEMONSTRATION OF MOVEMENTS):
Shoulder girdle, Shoulder joint, Elbow joint, Radio-ulnar joints, Wrist joint, 1st carpo-metacarpal joint, MP and IP joints
MUSCLES (DEMONSTRATION OF ACTION)
Principle of testing: Trapezius, Serratus anterior, Latissimus dorsi, Pectoralis major, Deltoid, Biceps Brachii, Brachioradialis, Brachialis, Extensors at the elbow, Supinators, Wrist extensors, Wrist flexors, Small muscles of the hand
NERVES: Dermatomes, Ulnar
Ulnar nerve thickening in Leprosy
VESSELS (PALPATION OF): Axillary artery, Brachial artery, Radial artery
OTHERS: Axillary groups of lymph nodes; Anatomical snuff-box (boundaries)
ii) LOWER LIMB
(BONY) LANDMARKS (PALPATION OF): Anterior superior iliac spine, Iliac crest, Tubercle of the iliac crest, Ischial tuberosity, Greater trochanter, Adductor tubercle, Head and neck of fibula, Lateral and medial malleoli, Tibial tuberosity, Subcutaneous surface of tibia, Patella
JOINTS (DEMONSTRATION OF MOVEMENTS): Hip , Knee , Ankle , Subtalar Joints
MUSCLES (DEMONSTRATION OF ACTION): Hip-Flexors, Extensors, Abductors, Adductors
Knee: Flexors, Extensors,
Ankle: Dorsiflexors, Plantar flexors
Subtalar: Invertors, Evertors
NERVES: Dermatomes, Sciatic, Tibial, Common peroneal, Femoral, Obturator
Thickening of common peroneal nerve in Leprosy
VESSELS (PALPATION OF): Femoral, Popliteal, Dorsalis pedis, Posterior tibial
OTHERS: Ligamentum patellae, Inguinal lymph nodes
TENDONS: Semitendinosus, Semimembranosus, Biceps femoris, Iliotibial tract
iii) ABDOMEN
(BONY) LANDMARKS (PALPATION OF): Anterior superior iliac spine, Pubic tubercle
JOINTS (DEMONSTRATION OF MOVEMENTS): Intervertebral
MUSCLES (DEMONSTRATION OF ACTION): Obliques, Transversus abdominis, Rectus abdominis
NERVES: Dermatomes
OTHERS: Enlarged liver , spleen , kidneys, Abdominal quadrants and regions; Position of superficial and deep inguinal rings; Renal angle; McBurney’s point;
Level2: Murphy’s sign
iv) THORAX (BONY) LANDMARKS(PALPATION OF): Sternal angle, Counting of rib spaces, locating thoracic spines
JOINTS (DEMONSTRATION OF MOVEMENTS): Intervertebral
MUSCLES (DEMONSTRATION OF ACTION): Respiratory movements
NERVES: Dermatomes
OTHERS: Apex beat, Apices of the lungs, Triangle of auscultation
v) HEAD FACE NECK - (BONY) LANDMARKS(PALPATION OF): Nasion, Glabella, Inion, Mastoid process, Suprameatal triangle, Zygoma, Zygomatic arch, Angle of mandible, Head of mandible,
JOINTS (DEMONSTRATION OF MOVEMENTS): Temporomandibular joint
MUSCLES (DEMONSTRATION OF ACTION): Of Mastication, Of Facial expression
Cranial nerves (I to XIII) testing
(PALPATION OF): Superficial temporal artery, Facial artery
(PALPATION OF): Symphysis menti, Hyoid bone, Thyroid cartilage, Cricoid cartilage, Tracheal rings, Suprasternal notch, Transverse process of atlas, Spine of C7
(DEMONSTRATION OF MOVEMENTS): Atlanto-occipital joint, Cervical joints
(DEMONSTRATION OF ACTION): Sternocleidomastoid, Neck flexors and extensors
(PALPATION OF): Common carotid artery, External carotid artery
OTHERS: Thyroid gland, Cervical lymph nodes, (Horizontal and vertical), Midline structures in the neck
NOTE :- Level 2 and 3 mentioned in the above syllabus includes the topics " desirable to know" (level-2) and " Nice to know" ( level-3. The remaining topics fall under the group " Must Know" ( level-1.)
Maharashtra MBBS Students Transfer
Maharashtra UNIVERSITY OF HEALTH SCIENCES
No. MUHS / EO / 71 /3097 / 2005 Date : 08/09/2005
Academic Notification No. 04/2005
Sub :- Students Transfer from one recognised College to other recognised College.
This is notified to all concerned that, the University has framed the Rules governing transfer for 1st year passout candidates of MBBS / BDS / BAMS / BUMS / BHMS / OT / PT / B.Sc. (HLS) Courses. The said rules are available on the University Website. The students desirous of transfer to another College shall have to apply to the University in the prescribed form along with necessary fee, before cut off date for respective faculties.
The applications for student transfer may be submitted on or before cut off date mentioned below along with necessary documents and D.D. of Rs. 500/- drawn in favour of 'Registrar, Maharashtra University of Health Sciences, Nashik' from any Nationalised Bank, payable at Nashik.
Applications received after cut off date shall stand rejected.
For student transfer rules and application form, refer Direction No. 03/2002, which is available on the Website.
Maharashtra UNIVERSITY OF HEALTH SCIENCES
Mhasrul, Dindori Road, Nashik – 422 004.
Phone: 0253-2539190 - 94 / EPABX: 0253-2539100, 300 / Fax: 0253-2539195
E-mail: academic at muhsnashik.com / Web: www.muhsnashik.com
No. MUHS / EO / 71 /3097 / 2005 Date : 08/09/2005
Academic Notification No. 04/2005
Sub :- Students Transfer from one recognised College to other recognised College.
This is notified to all concerned that, the University has framed the Rules governing transfer for 1st year passout candidates of MBBS / BDS / BAMS / BUMS / BHMS / OT / PT / B.Sc. (HLS) Courses. The said rules are available on the University Website. The students desirous of transfer to another College shall have to apply to the University in the prescribed form along with necessary fee, before cut off date for respective faculties.
The applications for student transfer may be submitted on or before cut off date mentioned below along with necessary documents and D.D. of Rs. 500/- drawn in favour of 'Registrar, Maharashtra University of Health Sciences, Nashik' from any Nationalised Bank, payable at Nashik.
Applications received after cut off date shall stand rejected.
For student transfer rules and application form, refer Direction No. 03/2002, which is available on the Website.
Maharashtra UNIVERSITY OF HEALTH SCIENCES
Mhasrul, Dindori Road, Nashik – 422 004.
Phone: 0253-2539190 - 94 / EPABX: 0253-2539100, 300 / Fax: 0253-2539195
E-mail: academic at muhsnashik.com / Web: www.muhsnashik.com
Internship transfer in Maharashtra
Maharashtra UNIVERSITY OF HEALTH SCIENCES
No. MUHS / EO / 54 /3098 / 2005 Date : 08/09/2005
Academic Notification No. 03/2005
Sub :- Internship Transfer from one affiliated College to other affiliated College.
This is notified to all concerned that, the University has framed the Rules governing Internship Training Programme for final year passout candidates of MBBS / BDS / BAMS / BUMS / BHMS / OT / PT / B.Sc. (HLS) Courses. The said rules are available on the University Website. The students desirous of transfer to another College for doing Internship Training Programme shall have to apply to the University in the prescribed form along with necessary fee, before cut off date for respective faculties.
The applications for internship transfer may be submitted on or before cut off date mentioned below along with necessary documents and D.D. of Rs. 1000/- drawn in favour of 'Registrar, Maharashtra University of Health Sciences, Nashik' from any Nationalised Bank, payable at Nashik.
Applications received after cut off date shall stand rejected.
For internship transfer rules and application form, refer Internship Training Programme of respective Faculty, which is available on the Website.
Maharashtra UNIVERSITY OF HEALTH SCIENCES
Mhasrul, Dindori Road, Nashik – 422 004.
Phone: 0253-2539190 - 94 / EPABX: 0253-2539100, 300 / Fax: 0253-2539195
E-mail: academic at muhsnashik.com / Web: www.muhsnashik.com
No. MUHS / EO / 54 /3098 / 2005 Date : 08/09/2005
Academic Notification No. 03/2005
Sub :- Internship Transfer from one affiliated College to other affiliated College.
This is notified to all concerned that, the University has framed the Rules governing Internship Training Programme for final year passout candidates of MBBS / BDS / BAMS / BUMS / BHMS / OT / PT / B.Sc. (HLS) Courses. The said rules are available on the University Website. The students desirous of transfer to another College for doing Internship Training Programme shall have to apply to the University in the prescribed form along with necessary fee, before cut off date for respective faculties.
The applications for internship transfer may be submitted on or before cut off date mentioned below along with necessary documents and D.D. of Rs. 1000/- drawn in favour of 'Registrar, Maharashtra University of Health Sciences, Nashik' from any Nationalised Bank, payable at Nashik.
Applications received after cut off date shall stand rejected.
For internship transfer rules and application form, refer Internship Training Programme of respective Faculty, which is available on the Website.
Maharashtra UNIVERSITY OF HEALTH SCIENCES
Mhasrul, Dindori Road, Nashik – 422 004.
Phone: 0253-2539190 - 94 / EPABX: 0253-2539100, 300 / Fax: 0253-2539195
E-mail: academic at muhsnashik.com / Web: www.muhsnashik.com
Saturday, November 5, 2005
Where Does a Post Plabber Stand?
Author: bindasnikhilg, Posted on Wednesday, November 02 @ 11:32:06 IST by RxPG at http://www.rxpgonline.com/article1492.html
This is basically a message to all UK bound doctors, please read this, these thoughts have given me strength and i hope it helps you somehow! I am yet to leave for UK but this is based on general views of doctors at UK.
The joy of a hard working doctor has no bounds on clearing the PLAB1.
Wishes of congratulations come from all corners; the excitement of having cleared one step of an important exam takes time to sink in.
Then the person starts enquiring about books and possible dates, coaching, places where he can stay.
This leads him to contact all people at UK known to family and friends. Then the real picture starts emerging. Some people reply and some regular contacts seem to vanish into thin air ;-)
Still he doesn’t loose hope, he sits for hours together on the computer, sending letters to consultants at UK requesting for clinical attachment. For every negative reply he gets, he sends 3 more requests for clinical attachment. His spirits are high in spite of the odds.
Then comes the time to book his PLAB Part 2 seat, book his coaching, he gets ready to battle the UK winter, shopping tops the 'TO DO' list.
All is set, the big days arrives he leaves his homeland for so called greener pastures, while there at UK he slogs it out at the coaching centre, he may have been a king back home but the bitter reality starts staring him straight into his eye.
He clears the PLAB Part 2, there is joy, the emotional burden which he was carrying on his shoulders eases and the vigour and vitality returns. After a long wait for criminal verification is over, he starts clinical attachment with full enthusiasm.
This attachment gets over; he tries for another and another.
His resources, his stores are getting depleted, then he feels the crunch, he has no job, no security and nothing to fall back on in case he returns, all seems dark but that ray of hope is still shining in the distance.
Months pass, but that first job is still a mirage.
Where does he go from there, what should he do?
My advice to all is don’t stretch yourself till you feel your going to snap, man is like an elastic band which can only be stretched to a certain extent.
Realise this fact that you have tried your best, in case you don’t succeed it is not your failure; it just goes to show that the system could not accommodate you in the time frame you had set for yourself.
At this stage instead of loosing hope, gather yourself and arise from this situation, find solutions (in fact i would suggest all of you to plan your trip in such a way that even if you have to return back to your country, you do so in such a way that you give yourself enough time to plan for something else without giving yourself too much time to sit and dissect what went wrong at UK).
I hope and pray that whoever tires their level best at UK gets what they want but in case you don’t, please don’t feel dejected, be like the phoenix which arose from its ashes to fly higher than before.
Failure is all in your mind, if you believe you have failed then you have failed, if you believe that you have learnt something from the experience of staying at UK and have returned out of your own free will you can consider yourself a WINNER of sorts.
One article I had read had the caption, "end of Indian holiday”, what I believe is that if you consider it a holiday then I guess it doesn’t matter as one day every holiday has to end, and just in case you have one bad holiday you can make up for it by having another one.
This is basically a message to all UK bound doctors, please read this, these thoughts have given me strength and i hope it helps you somehow! I am yet to leave for UK but this is based on general views of doctors at UK.
The joy of a hard working doctor has no bounds on clearing the PLAB1.
Wishes of congratulations come from all corners; the excitement of having cleared one step of an important exam takes time to sink in.
Then the person starts enquiring about books and possible dates, coaching, places where he can stay.
This leads him to contact all people at UK known to family and friends. Then the real picture starts emerging. Some people reply and some regular contacts seem to vanish into thin air ;-)
Still he doesn’t loose hope, he sits for hours together on the computer, sending letters to consultants at UK requesting for clinical attachment. For every negative reply he gets, he sends 3 more requests for clinical attachment. His spirits are high in spite of the odds.
Then comes the time to book his PLAB Part 2 seat, book his coaching, he gets ready to battle the UK winter, shopping tops the 'TO DO' list.
All is set, the big days arrives he leaves his homeland for so called greener pastures, while there at UK he slogs it out at the coaching centre, he may have been a king back home but the bitter reality starts staring him straight into his eye.
He clears the PLAB Part 2, there is joy, the emotional burden which he was carrying on his shoulders eases and the vigour and vitality returns. After a long wait for criminal verification is over, he starts clinical attachment with full enthusiasm.
This attachment gets over; he tries for another and another.
His resources, his stores are getting depleted, then he feels the crunch, he has no job, no security and nothing to fall back on in case he returns, all seems dark but that ray of hope is still shining in the distance.
Months pass, but that first job is still a mirage.
Where does he go from there, what should he do?
My advice to all is don’t stretch yourself till you feel your going to snap, man is like an elastic band which can only be stretched to a certain extent.
Realise this fact that you have tried your best, in case you don’t succeed it is not your failure; it just goes to show that the system could not accommodate you in the time frame you had set for yourself.
At this stage instead of loosing hope, gather yourself and arise from this situation, find solutions (in fact i would suggest all of you to plan your trip in such a way that even if you have to return back to your country, you do so in such a way that you give yourself enough time to plan for something else without giving yourself too much time to sit and dissect what went wrong at UK).
I hope and pray that whoever tires their level best at UK gets what they want but in case you don’t, please don’t feel dejected, be like the phoenix which arose from its ashes to fly higher than before.
Failure is all in your mind, if you believe you have failed then you have failed, if you believe that you have learnt something from the experience of staying at UK and have returned out of your own free will you can consider yourself a WINNER of sorts.
One article I had read had the caption, "end of Indian holiday”, what I believe is that if you consider it a holiday then I guess it doesn’t matter as one day every holiday has to end, and just in case you have one bad holiday you can make up for it by having another one.
Sunday, October 30, 2005
Books for Pathology - Complete List
Books for MD Pathology
Standard Text Books
01. Robbins Pathological basis
02. Anderson
03. de Gruchy Clinical Hematology
04. Dacie and Lewis Practical hematology
05. Walter and Isravel - General pathology
06. Oxford Text book of Pathology
For Undergraduates - Reference:
07. Williams Hematology
08. Symmers Systemic pathology
09. John.B.Miale laboratory medical hematology
10. Govan Mac Farlane Callander Pathology Illustrated
For Practical
11. Frank N.Miller Pathology - review for national boards
12. Dr.Ramnik Sood Medical Lab technology
13. Jhala and Mansuri Clinical pathology
14. K.S.Ratnakar and R.R.Rao Principles and practices of Laborary Medicine
For Postgraduates - Reference
15. Ackermann
16. Evans Histologic Appearance of Tumours
17. Lever Skin
18. Shiela Sherlockl
19. Bernad Knight The coroners autopsy
20. Wintrobe Clinical Hematology
21. Wiontrobe, Williams, Butler Hematology
22. Butler Cytology of Body Cavity Fluids
23. Huges and Dodd Diagnostic Cytology
24. Todd Clinical Diagnosis and Management in Lab Methods
The above list is taken from the list given by Department of Pathology Tirunelveli Medical College
Standard Text Books
01. Robbins Pathological basis
02. Anderson
03. de Gruchy Clinical Hematology
04. Dacie and Lewis Practical hematology
05. Walter and Isravel - General pathology
06. Oxford Text book of Pathology
For Undergraduates - Reference:
07. Williams Hematology
08. Symmers Systemic pathology
09. John.B.Miale laboratory medical hematology
10. Govan Mac Farlane Callander Pathology Illustrated
For Practical
11. Frank N.Miller Pathology - review for national boards
12. Dr.Ramnik Sood Medical Lab technology
13. Jhala and Mansuri Clinical pathology
14. K.S.Ratnakar and R.R.Rao Principles and practices of Laborary Medicine
For Postgraduates - Reference
15. Ackermann
16. Evans Histologic Appearance of Tumours
17. Lever Skin
18. Shiela Sherlockl
19. Bernad Knight The coroners autopsy
20. Wintrobe Clinical Hematology
21. Wiontrobe, Williams, Butler Hematology
22. Butler Cytology of Body Cavity Fluids
23. Huges and Dodd Diagnostic Cytology
24. Todd Clinical Diagnosis and Management in Lab Methods
The above list is taken from the list given by Department of Pathology Tirunelveli Medical College
Thursday, October 27, 2005
Microfractures and Objective Questions (MCQs)
Microfracture is a surgical procedure aimed at cartilage regeneration.
The arthroscopic technique involves clearing damaged tissue from the knee joint and creating tiny holes ("microfractures") in the bone area where the cartilage is defective.
The underlying bone marrow seeps out through the holes and becomes part of a blood clot that forms over the area.
The marrow contains stem cells, which have the ability to form replacement cartilage between the bare-bone surfaces of the knee. Appropriate rehabilitation of the knee after surgery is critical to the success of the operation.
Continuous Passive Motion (CPM), where the knee is moved gently by a machine for 5-8 hours a day for several weeks, keeping weight off of the joint for a period of 6-8 weeks, and strict adherence to an aggressive physical therapy program following surgery all appear to enhance the success of the procedure.
Isolated articular cartilage lesions in the knee are common and are difficult to treat. A number of treatment modalities have been utilized in an effort to promote the regeneration of articular cartilage, including microfracture (MFX) and autologous chondrocyte Implantation (ACI).
Management of focal chondral defects
Isolated superficial cartilage injuries that do not penetrate the vascular subchondral bone do not heal and may enlarge for several years following the initial injury, potentially leading to overt degenerative arthritis. Full-thickness cartilage injuries that penetrate the more vascular subchondral bone permit local access to an undifferentiated cell pool (primitive mesenchymal stem cells) capable of forming fibrocartilage or "scar cartilage." Fibrocartilage is composed predominantly of type I collagen and is biochemically and mechanically inferior to normal hyaline articular cartilage, which is composed predominantly of type II collagen. Fibrocartilage formation is the biological basis for the MSTs commonly used to treat symptomatic full-thickness cartilage defects.
Abnormal shear and blunt forces are manifested at the junction of the uncalcified and calcified cartilage layers, potentially creating isolated cartilage injury extending to the subchondral bone. This is otherwise known as a focal or full-thickness cartilage defect. Typically, femoral lesions result from shear stress due to a twisting injury; patellofemoral joint lesions result from direct trauma to the front of the knee. The natural history of an asymptomatic full-thickness cartilage defect and its relationship to the development of secondary degenerative changes typically seen in osteoarthritis is poorly understood. However, lesions that become symptomatic inexorably progress, leading to reciprocal degenerative changes at the opposing articular surface.
The goals of any surgical option used to treat articular cartilage defects are to restore the joint surface, leading to full, painless range of motion; and halting cartilage degeneration. Surgical options can be palliative (ie, arthroscopic debridement and lavage), reparative (ie, MSTs), or restorative (ie, ACI and osteochonral grafts). Osteochondral grafts can be obtained from the patient (ie, autografts) or from cadaveric donors (ie, allografts). Arthroscopic debridement and lavage was discussed previously. Most studies reflect outcomes following the treatment of established osteoarthritis, not of isolated focal chondral defects.
Determining the appropriate surgical option is a complex process.24 Decision-making is affected by the following variables: the size of the defect (ie, smaller or larger than 2 cm2), the number and type of previous surgeries (ie, primary or secondary), location of the defect (ie, femoral condyle, trochlea, or patella), patient demands and expectations, and coexisting pathologic lesions (ie, ligament tears, malalignment)
Source: Steadman J, Rodkey W, Singleton S, et al. Microfracture technique for full-thickness chondral defects. Op Tech Ortho 1997;7(4):300-4
The arthroscopic technique involves clearing damaged tissue from the knee joint and creating tiny holes ("microfractures") in the bone area where the cartilage is defective.
The underlying bone marrow seeps out through the holes and becomes part of a blood clot that forms over the area.
The marrow contains stem cells, which have the ability to form replacement cartilage between the bare-bone surfaces of the knee. Appropriate rehabilitation of the knee after surgery is critical to the success of the operation.
Continuous Passive Motion (CPM), where the knee is moved gently by a machine for 5-8 hours a day for several weeks, keeping weight off of the joint for a period of 6-8 weeks, and strict adherence to an aggressive physical therapy program following surgery all appear to enhance the success of the procedure.
AIIMS NOV 2003 question
microfracture is done for?
1) delayed union femur
2) non union of tibia
3) loose bodies of ankle joint
4) osteochondral defect of femur
Answer is 4) Osteochondral defect of femur
Isolated articular cartilage lesions in the knee are common and are difficult to treat. A number of treatment modalities have been utilized in an effort to promote the regeneration of articular cartilage, including microfracture (MFX) and autologous chondrocyte Implantation (ACI).
Management of focal chondral defects
Isolated superficial cartilage injuries that do not penetrate the vascular subchondral bone do not heal and may enlarge for several years following the initial injury, potentially leading to overt degenerative arthritis. Full-thickness cartilage injuries that penetrate the more vascular subchondral bone permit local access to an undifferentiated cell pool (primitive mesenchymal stem cells) capable of forming fibrocartilage or "scar cartilage." Fibrocartilage is composed predominantly of type I collagen and is biochemically and mechanically inferior to normal hyaline articular cartilage, which is composed predominantly of type II collagen. Fibrocartilage formation is the biological basis for the MSTs commonly used to treat symptomatic full-thickness cartilage defects.
Abnormal shear and blunt forces are manifested at the junction of the uncalcified and calcified cartilage layers, potentially creating isolated cartilage injury extending to the subchondral bone. This is otherwise known as a focal or full-thickness cartilage defect. Typically, femoral lesions result from shear stress due to a twisting injury; patellofemoral joint lesions result from direct trauma to the front of the knee. The natural history of an asymptomatic full-thickness cartilage defect and its relationship to the development of secondary degenerative changes typically seen in osteoarthritis is poorly understood. However, lesions that become symptomatic inexorably progress, leading to reciprocal degenerative changes at the opposing articular surface.
The goals of any surgical option used to treat articular cartilage defects are to restore the joint surface, leading to full, painless range of motion; and halting cartilage degeneration. Surgical options can be palliative (ie, arthroscopic debridement and lavage), reparative (ie, MSTs), or restorative (ie, ACI and osteochonral grafts). Osteochondral grafts can be obtained from the patient (ie, autografts) or from cadaveric donors (ie, allografts). Arthroscopic debridement and lavage was discussed previously. Most studies reflect outcomes following the treatment of established osteoarthritis, not of isolated focal chondral defects.
Determining the appropriate surgical option is a complex process.24 Decision-making is affected by the following variables: the size of the defect (ie, smaller or larger than 2 cm2), the number and type of previous surgeries (ie, primary or secondary), location of the defect (ie, femoral condyle, trochlea, or patella), patient demands and expectations, and coexisting pathologic lesions (ie, ligament tears, malalignment)
Source: Steadman J, Rodkey W, Singleton S, et al. Microfracture technique for full-thickness chondral defects. Op Tech Ortho 1997;7(4):300-4
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