BLOOD MODULE. For MBBS First Professional (Session )

Transcription

1 BLOOD MODULE For MBBS First Professional (Session ) 1

2 BLOOD MODULE For First Year MBBS (Session ) MODULE PLANNING COMMITTEE Patron Chairperson Chief Coordinator Coordinator Coordinator Coordinator Member Member Member Member Member Prof. Dr. Noor ul Iman Dean, KMC Prof. Dr. Mushtaq Marwat Department of Pharmacology, KMC Prof. Dr. Hashim Uddin Azam Khan Department of Medical Education, KMC Prof Dr. Saadia Ashraf Department of Medical Education, KMC Prof Dr. Amber Ashraf Department of Medical Education, KMC Dr. Sajid Department of Medical Education, KMC Prof. Dr. Qaiser Inayat Department of Anatomy, KMC Assoc. Prof. Shafiq ur Rahman Department of Physiology, KMC Assoc. Prof. Hamid Ali Khan Department of Anatomy, KMC Assoc. Prof. Dr. Zahoor Ahmad Department of Biochemistry, KMC Dr. Saleem Abbas (Lecturer) Department of Physiology, KMC 2

3 LIST OF ABBREVIATIONS Anat-L Anatomy Lecture MCQs Multiple Choice Questions Med-L Medicine Lecture Bio-L Biochemistry Lecture OSPE Objectively Structured Practical Examination Bio-P Biochemistry Practical Path-L Pathology Lecture PBL Problem Based Learning Phar-L Pharmacology Lecture CS Clinical Skills Phy-L Physiology Lecture Phy-P Physiology Practical FDT Film/Demonstration/Tutorial DSL Directed Self Learning Histo-P Histology Practical SEQs Short Essay Questions IPS Islamiyat/Pak Studies SGD Small Group Discussion 3

4 MODULE SPECIFICATIONS Course Title BLOOD Module (Duration: 6weeks) Contact Hours (155 hrs.) Lectures/DSL Lab Work SGD/ /Practical Dissection Anatomy 15 25x2=50 Histology 05 5x2=10 Embryology 02 Physiology 16 9x2=18 Biochemistry 17 1x2=02 1x2=02 Peadiatrics 01 Pathology 01 Medicine 02 PBL 1x2=02 DSL 02 IPS 05 Behavioral Sc. 05 TOTAL= = 155 hrs. OBJECTIVES/OVERVIEW/FINAL COMPETENCIES Knowledge of blood, immunity and inflammation is essential, as blood is responsible for the supply of micro-nutrients, O2 delivery to the tissues and maintenance of homeostasis and body responses and defense mechanisms against injurious agents and various diseases encountered in daily life. By the end of Blood module the students should be able to: 1. Describe the composition of blood in relation to its biochemistry and physiology 2. Define anemia and its pathophysiology. 3. Classify different types of anemias on the basis of its pathophysiology 4. Recognize ABO/RH blood grouping system 5. Practice history taking of a patient presented with blood disorders 6. Explain hemostasis and role of thrombolysis 4

5 7. Describe pathophysiology of bleeding disorders & identify its different types. 8. Identify role of pharmacology in anemia and bleeding disorders 9. Define and explain research methodology. 10. Identify and describe immunology on the basis of its pathophysiology 11. Enlist pharmaceutical agents used in different immunological disorders In order to achieve these defined competencies, the CVS Module has been designed to define the scope of Knowledge/ Skills/ Attitudes of a first year medical student of the Basic Medical Sciences i.e. Anatomy, Physiology and Biochemistry with the introduction to the Clinical Sciences. Major contribution in this Module will be from departments of Anatomy, Physiology and Biochemistry while minor contribution will be from departments like Medicine, Pathology and Pharmacology. The Basic Sciences Module in first year MBBS will be taught Theme Based so that the student can correlate the basic science Knowledge with Disease i.e. Symptoms and Signs. The duration of Module will be 6 weeks in first year MBBS. KNOWLEDGE INTENDED LEARNING OUTCOMES By the end of the BLOOD Module the student should be able to: EBRYOLOGY 1. Discuss the development of lymphoid organs. 2. Understand the development of Spleen 3. Know the development of Thymus 4. Understand the development of tonsils, lymph nodes and gut associated lymphoid organs 5. Know the congenital anomalies associated with these organs HITOLOGY 6. Discuss the overview of lymphatic tissue including MALT 7. Tell the functions of lymph node 8. Describe and identify the histological features of Lymph node 5

6 9. Discuss the function of thymus 10. Describe and identify the histological features of thymus 11. Identify the locations of tonsils. 12. Learn the histological features of tonsils. 13. Discuss the functions of tonsils. 14. Describe the histological features of spleen. 15. Know the Functions of spleen GROSS ANATOMY OF UPPER LIMB 16. Understand the different subdivisions of upper limb 17. Identify various muscles in their compartments 18. Describe formation and distribution of Brachial plexus 19. Know about different injuries to Brachial plexus 20. Describe general and special features of various bones of upper limb 21. Identify various types of fractures of upper limb 22. Describe blood supply, venous and lymphatic drainage of upper limb 23. Know shoulder, elbow and wrist joints of upper limb 24. Understand flexor and extensor compartments of forearm 25. Describe the lymph nodes of upper limb 26. Understand the gross anatomy of mammary glands 27. Describe surface features of upper limb 28. Identify differences B/W normal and abnormal radiographs of upper limb GROSS ANATOMY OF LOWER LIMB 29. Know different fascial compartments of front and back of thigh 30. Describe and identify various muscles of these compartments 31. Describe formation and distribution of Lumbosacral plexus 32. Understand femoral triangle, femoral sheath and femoral canal 33. Understand differences B/W femoral and inguinal hernias 34. Describe Sciatic nerve and its distribution 35. Know about various joints of lower limb and their common injuries 36. Understand blood supply and venous drainage of lower limb 37. Describe lymphatic drainage of lower limb 38. Describe Popliteal fossa and its contents 39. Identify superficial veins 40. Identify differences B/W normal and abnormal radiographs of lower limb 6

7 GROSS ANATOMY OF UPPER LIMB 41. Understand the different subdivisions of upper limb 42. Identify various muscles in their compartments 43. Describe formation and distribution of Brachial plexus 44. Know about different injuries to Brachial plexus 45. Describe general and special features of various bones of upper limb 46. Identify various types of fractures of upper limb 47. Describe blood supply, venous and lymphatic drainage of upper limb 48. Know shoulder, elbow and wrist joints of upper limb 49. Understand flexor and extensor compartments of forearm 50. Describe the lymph nodes of upper limb 51. Understand the gross anatomy of mammary glands 52. Describe surface features of upper limb 53. Identify differences B/W normal and abnormal radiographs of upper limb GROSS ANATOMY OF LOWER LIMB 54. Know different fascial compartments of front and back of thigh 55. Describe and identify various muscles of these compartments 56. Describe formation and distribution of Lumbosacral plexus 57. Understand femoral triangle, femoral sheath and femoral canal 58. Understand differences B/W femoral and inguinal hernias 59. Describe Sciatic nerve and its distribution 60. Know about various joints of lower limb and their common injuries 61. Understand blood supply and venous drainage of lower limb 62. Describe lymphatic drainage of lower limb 63. Describe Popliteal fossa and its contents 64. Identify superficial veins 65. Identify differences B/W normal and abnormal radiographs of lower limb PHYSIOLOGY 66. Describe the composition and physical characteristics of whole blood 67. List the main functions of blood 68. Discuss the composition and functions of plasma/ plasma proteins 69. Describe the morphology, function, and production of erythrocytes 7

8 70. Describe the physiological role of hemoglobin. 71. Give examples of disorders caused by abnormalities of erythrocytes 72. List the classes, structural characteristics, and functions of leukocytes 73. Describe how leukocytes are produced 74. Give examples of leukocyte disorders 75. Describe the structure and function of platelets 76. Describe the process of hemostasis 77. List factors that limit clot formation and prevent undesirable clotting 78. Hemostatic disorders (Bleeding disorders; Thrombo-embolic Disorders) 79. Describe the ABO and Rh blood groups 80. Explain the basis of transfusion reactions 81. Describe fluids used to replace blood volume and the circumstances for their use 82. Explain the diagnostic importance of blood testing BIOCHEMISTRY 83. Describe Porphyrin & Hemoglobin Structure 84. Discuss Types of Hemoglobin 85. Study Synthesis of Hemoglobin & errors of synthesis, Porphyrias 86. Explain Degradation of Hemoglobin 87. Describe Hemoglobinopathies & thalassemia 88. Describe Classification, structure & functions of Immunoglobulins 89. Describe Biochemical Functions of Liver & Detoxification 90. Describe Bilirubin Metabolism & Disorders of Bilirubin Metabolism: hyperbilirubinemias 91. Describe Liver Function Tests & their clinical interpretation 92. Describe Classification of vitamins: Water Soluble Vitamins Fat Soluble Vitamins Sources & Daily Allowances Biochemical functions Deficiency Diseases Hypervitaminosis Teaching strategies to be used to develop these OUTCOMES: Lectures Dissection Audiovisual Aids Practical sessions Tutorial 8

9 Problem Based Learning (PBL) Directed Self Learning (DSL) Discussions Multidisciplinary Lectures Methods of assessment of knowledge acquired: 1. End Of Module Assessment (MCQs, SEQs) PSYCHOMOTOR SKILLS Description of the psychomotor skills to be developed and the level of performance required: A. By the end of BLOOD Module, the student should be able to: 1. Carry out practical work as instructed in an organized and safe manner 2. Make and record observations accurately. 3. Identify slide of Lymph node 4. Identify slide of Thymus 5. Identify slide of Tonsils 6. Identify slide of Spleen 7. Identify slide of Gut associated lymphoid tissue 8. Determine percentage of formed blood elements. 9. Identify RBC and should be able to do its counting on counting chamber and to know normal values. And also classify Anemia morphologically. 10. Determine the Hemoglobin with the apparatus and have knowledge of normal and abnormal value. 11. Identify WBC morphology and its different types, should be able to count them on counting chamber and to know the normal values. Diagnostic importance of each WBC. 12. Identify Platelets and should be able to do its counting on counting chamber and to know normal values. Its diagnostic importance in relation to bleeding disorders 13. Perform bleeding time and clotting time and to know normal values and its diagnostic importance in relation to bleeding disorders. 14. Type Blood groups and Rh factor. 15. Perform ESR and to know its normal value and prognostic importance. 16. Detect blood, bile pigments & bile salts in the given sample of urine 9

10 B. Teaching strategies to be used to develop these skills: Laboratory sessions Practice on virtual models/ dry bones Visiting Anatomy museum/dissection hall C. Methods of assessment of student s psychomotor skills: Evaluation of the activities in laboratories, homework assigned and Practical examination (OSPE) ATTITUDE AND BEHAVIOUR A. By the end of BLOOD Module the student shall gain the ability and carry responsibility to: 1. Demonstrate ability to give and receive feedback, respect for self and peers. 2. Demonstrate empathy and care to patients. 3. Develop respect for the individuality and values of others - (including having respect for oneself) patients, colleagues and other health professionals 4. Organize & distribute tasks 5. Exchange opinion & knowledge 6. Develop communication skills and etiquette with sense of responsibility. 7. To equip themselves for teamwork 8. Regularly attend the classes B. Teaching strategies to be used to develop attitude and behavior: 1. PBL 2. DSL 3. Assignment formation through team work C. Methods of assessment of students interpersonal skills and capacity to carry responsibility: 1. Class attendance should be recorded 2. Score for performance during PBL session using a designed Pro forma. 10

11 INSTRUCTIONAL METHODS Principles and concepts applicable to the structure and function of the BLOOD System will be studied by: Lectures on general aspects of the BLOOD system will be given for the purpose of conveying deeper understanding of the general concepts and principles underlying normal and abnormal structure and function during the module. Dissection of cadaver will be carried out to demonstrate the various anatomical structures related to BLOOD system Practical sessions will be timetabled to enforce theoretical aspects of the subject but will be used for demonstrating skills/procedures and the use of electronic material will be encouraged. Tutorials, the small group sessions on special topics will be organized for the purposes of enriching the students' general knowledge and overall understanding of the BLOOD system. It allows students to apply newly acquired knowledge and it is suitable for higher order cognitive objectives. Problem-Based Learning sessions will be encouraged and timetabled to facilitate higher cognitive objectives: problem solving and decision making; can incorporate objectives that cross domains. They will be organized into small groups and facilitated by a staff faculty member. Self-Directed Learning sessions will promote self-learning and thus, time will be available for further study by the students using all available learning resources including electronic learning materials. Small Group Discussion will engage the students in small groups of about 35 students which will help in Complementing knowledge in lectures Expanding on the concepts considered in lectures Encouraging student reflection Developing students' communication skills Encouraging active life-long learning 11

12 WEEKLY ACTIVITIES OF DIFFERENT DEPARTMENTS WEEK 1 Department of Anatomy Activity Code Topics Teacher/ Facilitator Anat-L1 Introduction to upper limb, sub divisions of upper limb and surface anatomy Anat-L2 Gross anatomy of Pectoral region Anat-L3 Introduction to Axilla Anat-L16 Introduction to lower limb Anat-L17 Surface anatomy of lower limb and sub divisions of lower limb Anat-L18 Lumbosacral plexus, cutaneous supply and Dermatomes of lower limb Emb-L1 (Development of thymus and lymph node and gut associated lymphoid tissue) Dissection-CD1 Osteology of Clavicle (General features) Dissection-CD2 Osteology of Clavicle (special features) Dissection-CD3 Gross and surface anatomy of Back (Scapular region) Dissection-CD4 Muscles, nerves and vessels of superficial back Dissection-CD5 Osteology of Scapula (General features) Dissection-AB1 Introduction to hip bone & osteology of Ileum (General features) Dissection-AB2 Osteology of Ileum(Special features) Dissection-AB3 Osteology of Pubis (General features) Dissection-AB4 Osteology of Pubis (Special features) Dissection-AB5 Osteology of Ischium (General features) Histo-P1 Lymph Node 12

13 Department of Physiology Phy-L1 Phy-L2 Phy-L3 Phy-P1 Phy-P2 Composition & Functions of Blood Physiology of RBC Pathophysiology of Anemia/ Hematological values Hematocrit RBC Count Department of Biochemistry Bio-L1 Bio-L2 Bio-L3 Bio-L4 Bio-P1 Chemistry of Hemoglobin: Structure & Functions Metabolism of Hemoglobin: Porphyrias Normal & Abnormal Types of Hemoglobin Hemoglobinopathies, Thalassemias Detection of Blood, Bile Pigments & other abnormal constituents in the given sample of Urine Department of Medicine Med-L1 Clinical Effects Anemia and Polychythemia WEEK 2 Department of Anatomy Anat-L4 Anat-L5 Anat-L6 Anat-L19 Anat-L20 Anat-L21 Histo-L1 Brachial plexus (Formation) Brachial plexus (distribution & injuries) Shoulder joint (Articulation, gross anatomy and movements) Deep fascia of thigh, Ileotibial tract & Saphenous Opening Femoral sheath, Femoral ring, Femoral canal and its contents Femoral Triangle (Boundaries and Contents) Lymph Node 13

14 Histo-L2 Dissection-CD6 Dissection-CD7 Dissection-CD8 Dissection-CD9 Dissection-CD10 Dissection-AB6 Dissection-AB7 Dissection-AB8 Dissection-AB9 Dissection-AB10 Histo-P2 Thymus Osteology of Scapula (Special features) Walls and contents of Axilla Axillary vessels and lymphatics Lymph nodes of axilla Osteology of Humerus (General features) Osteology of Ischium (Special features) Osteology of Femur (General features) Osteology of Femur (Special features) Anterior compartment of thigh (Femoral triangle, muscles, nerves and vessels) Medial compartment of thigh (muscles, nerves and vessels) Thymus Department of Physiology Phy-L4 Phy-L5 Phy-L6 Phy-L7 Phy-L8 Phy-P3 Phy-P4 WBC: Types; Concentration; Characteristics Body Defenses: Classification & Components Monocyte-Macrophage System ; Complement System Lymphocytes: 1 Types & Distribution Lymphocytes: II T-Lymphocytes Maturation/ Mech. of Action Hb Estimation WBC Count Department of Biochemistry Bio-L5 Bio-L6 Bio-SGD1 Immunoglobulins: Classification, Structure & Functions Immunoglobulins: Classification, Structure & Functions Disorders of Hemoglobin Synthesis 14

15 WEEK 3 Department of Anatomy Anat-L7 Anat-L8 Anat-L9 Anat-L22 Anat-L23 Anat-L24 Dissection-CD11 Dissection-CD12 Dissection-CD13 Dissection-CD14 Dissection-CD15 Dissection-AB11 Dissection-AB12 Dissection-AB13 Dissection-AB14 Dissection-AB15 Histo-P3 Anastomosis around scapula and elbow joint Elbow joint (Articulation, gross anatomy & movements) Wrist joint (Articulation, gross anatomy and movements) Hernia (Femoral and inguinal hernias and the difference B/W them) Adductor canal and its contents Hip joint (Articulation, gross anatomy and movements) Osteology of Humerus (Special features) Muscles, nerves and vessels of shoulder Muscles, nerves and vessels of front of arm Muscles, nerves and vessels of back of arm Boundaries and contents of Cubital fossa Femoral artery and its branches Femoral nerve and its branches Gluteal region (muscles, nerves and vessels) Posterior compartment of thigh Sciatic nerve and its divisions Tonsil Department of Physiology Phy-L5 Phy-L6 Phy-L7 Phy-L8 Phy-P5 Phy-P6 B-lymphocyte Activation & Mech. of action of Antibodies Cytokines-Interferon Review of Immunity Types; Genotypes & Phenotypes DLC Blood Group 15

16 Department of Biochemistry Bio-L7 Bio-L8 Bio-L9 Biochemical Functions of Liver Metabolism of Bile Pigments, Hyperbilirubinemia: Types & Differentiation Jaundice: Types, Biochemical Causes Department of Pathology Path-L1 Hypersensitivity Reactions Department of Gynecology and Obstetrics GynObs-L1 Erythroblastosis Fetalis WEEK 4 Department of Anatomy Anat-L10 Superior and inferior Radio-ulnar joints Anat-L11 Gross anatomy of Mammary glands Anat-L12 Lymphatic drainage of upper limb and surface markings of vessels Anat-L25 Anastomosis around Knee joint Anat-L26 Genicular anastomosis Anat-L27 Knee joint (Articulation, gross anatomy and movements) Histo-L3 Gut associated lymphoid tissue Dissection-CD16 Osteology of Ulna (General features ) Dissection-CD17 Osteology of Ulna (Special features) Dissection-CD18 Osteology of Radius (General features) Dissection-CD19 Osteology of Radius (Special features) Dissection-CD20 Flexor compartment of forearm, Flexor retinaculum& Carpal tunnel Dissection-AB16 Popliteal fossa (boundaries and contents) Dissection-AB17 Osteology of Tibia (General features) Dissection-AB18 Osteology of Tibia (Special features) 16

17 Dissection-AB19 Dissection-AB20 Histo-P4 Osteology of Fibula (General features) Osteology of Fibula (Special features) Spleen Department of Physiology Phy-L13 Phy-L14 Phy-L15 Phy-P7 Phy-P8 Hazards of Blood transfusion (Early & late) Clotting factors; Platelet plug Formation Extrinsic-Intrinsic Pathways; Clot Lysis Platelet Count BT, CT Department of Biochemistry Bio-L10 Bio-P11 Bio-P12 Liver Function Tests and Clinical Interpretation Metabolism of Vitamin E & vitamin K Metabolism of vitamin C Department of Medicine Med-L2 Thrombo-Embolic Diseases Department of Paediatrics Paeds-L1 Immunization: Active/Passive WEEK 5 Department of Anatomy Anat-L13 Anat-L14 Anat-L15 Anat-L28 Summary of blood supply of upper limb Differentiate B/W normal and abnormal radiographs (Radiology) Common fractures of upper limb (Orthopedic) Ankle joint, Superior and Inferior Tibiofibular joints(articulation, gross anatomy 17

18 Anat-L29 Anat-L30 Histo-L4 Histo-L5 Emb-L2 Dissection-CD21 Dissection-CD22 Dissection-CD23 Dissection-AB24 Dissection-AB21 Dissection-AB22 Dissection-AB23 Dissection-AB24 Dissection-AB25 Histo-P5 and movements Difference B/W normal and abnormal Radiographs (Radiology) Common fractures of lower limb (Orthopedic) Tonsils Spleen Spleen and Tonsils Extensor compartment of forearm, extensor retinaculum Osteology of hand Gross anatomy of hand (muscles, palmer spaces, anatomical snuff box & movements of thumb Nerves and vessels of hand Muscles, nerves and vessels of Anterior compartment of leg Muscles, nerves and vessels of Lateral compartment of leg Muscles, nerves and vessels of Posterior compartment of leg Osteology of foot & arches of foot Venous and lymphatic drainage of lower limb Gut Associated Lymphoid Tissue Department of Physiology Phy-L16 Phy-P9 Factors preventing clot formation in normal circulation Erythrocytes Sedimentation Rate Department of Biochemistry Bio-L13 Bio-L14 Metabolism of Vitamin D Classification. Vitamin A metabolism 18

19 Bio-L15 Bio-L16 Bio-L17 Intro to B-Complex vitamins. Metabolism of Vitamin B1 & B5 Metabolism of B2, B3, B6 & B7 Metabolism of B9 (Folic Acid) & Viamin B 12 (Cyanocobalamine) WEEK 6: END OF MODULE ASSESSMENT It will consist of MCQs, SEQs and skill assessment (OSPE). Formative: This form of assessment is designed to help the students to identify areas for improvement. It includes a multiple choice questions, problems-solving exercises and independent learning activities in all subjects. These will be given during tutorial and practical sessions. The Answers are presented and discussed immediately with you after the assessment. The results will be made available to the students. Summative This type of assessment is used for judgment or decisions to be made about the students performance. It serves as: 1. Verification of achievement for the student satisfying requirement 2. Motivation of the student to maintain or improve performance 3. Certification of performance 4. Grades All the three basic sciences i.e. Anatomy, Physiology and Biochemistry should be made compulsory so that the students do not ignore one subject as an option. The theory paper should consist of three sections such as: Section A: This section will deal with the Anatomical aspects of BLOOD module. Section B: This section will deal with the Physiological aspects of BLOOD module. Section C: This section will deal with the Biochemical aspects of BLOOD module FEEDBACK: From the students and faculty to further improve the module. 19

20 LEARNING RESOURCES Textbooks: 1. The Developing Human: Clinically Oriented Embryology, by Dr. Keith L. Moore, T.V.N. Persaud, and Mark G. Torchia, 9th edition,elsevier Saunders; Clinical Anatomy by Regions. by Richard S. Snell MD.PhD 9th edition ; Lippincott Williams and Wilkins; Clinical Neuroanatomy by Richard S. Snell MD.PhD 7th edition ; Lippincott Williams and Wilkins; Last s Anatomy, Regional and Applied by Chummy S. Sinnatamby FRCS Twelfth Edition Churchill Livingstone; Langman's Medical Embryology, by T.W.Sadler 13th edition; Lippincott Williams and Wilkins; Junqueira's Basic Histology, Text and Atlas by Anthony L. Mescher, Ph.D...13th edition... McGraw Hill ; Gray's Anatomy, the Anatomical Basis of Clinical Practice, by Susan Standring PhD,DSc 41st edition, Elsevier USA; Color Textbook of Histology; 3rd ed.; Gartner LP & Hiatt JL; WB Saunders Company; Textbook of Medical Physiology; 13 th ed.; Guyton AC and Hall JE; Saunders / Elsevier Co.; Human Physiology from Cell to System; 9 th ed.; Lauralee Sherwood; Brooks/Cole Pub. Co.; Harper s Illustrated Biochemistry; 30 th ed.; Robert K Murray; Textbook Medical Biochemistry, 8th ed.; Chatterjea MN, Shinde Rana, JAYPEE, Robbins Basic Pathology; 9 th ed.; Cotran RS, Robbins SL and Kumar V; WB Saunders Company; Lippincott s Illustrated Review of Pharmacology; 6 th ed.; Richard A Harvey & Pamela C Champe; Lippincott s Williams & Wilkins; ABC of Learning and Teaching in Medicine; Cantillon P, Hutchinson L and Wood D; BMJ Publishing Groups Books; Davidson s Principles and Practice of Medicine; 22th ed; Katzung Basic and Clinical Pharmacology; 12 th ed.; Katzung B; McGraw Hill Medical Company; Kumar & Clerk Internal Medicine; 8 th ed.; Saunders;