Syllabus of Medical Year 2

The Chinese University of Hong Kong
Faculty of Medicine
MBChB Programme
COURSE SYLLABUS
YEAR TWO 2015/2016
Course Title: Human Structure I

Course Code: MEDU2300
Course Content: Lecture (L) 32 hours; Practical (P) 7.5 hours; Dissection (D) 50 hours;
Demonstration (Demo) 6 hours; Clinical Skill Practical (CSP) 6.5 hours
Code
Teaching
Activity
Topics
Hour
Syllabus
Human
Structure I
Handbook
THORAX AND CARDIOVASCULAR/ RESPIRATORY SYSTEM

HUS1-1
Organization of the thorax
6.1, 6.2, 6.13, 6.14
p.5
HUS1-2
Pleura, lungs and diaphragm
6.2, 6.4, 6.5
p.5 6
HUS1-3
Thoracic wall
6.2
p.9
HUS1-4
Pleural cavities and lungs
6.4, 6.5
p.10
HUS1-5
The heart and mediastinum
6.7, 6.8, 6.9, 6.11,
p.6 7
6.13
HUS1-6
The heart
6.7, 6.8, 6.9, 6.10,
p.10 11
6.11
HUS1-7
Posterior and superior mediastinum
HUS1-8
Surface anatomy of the thorax
HUS1-9
Radiology of the thorax

Body measurements and examination
of vital signs
Cardiovascular examination
HUS1-10
HUS1-11
6.13
p.11
Demo
6.1
P.12 15
6.15
p.8
CSP x3
1.5
6.16
CSP x3
1.5
6.17
6.6
P x2
1.5
6.6
HUS1-14
Histology of the respiratory tract and

lungs
Histology of the respiratory tract and
lungs
Histology of the cardiovascular system
HUS1-15
Histology of the cardiovascular system
P x2
1.5
Organization of the abdomen and
pelvis
Anterior abdominal wall and inguinal
canal
Anterior abdominal wall and scrotum
HUS1-12
HUS1-13
p.88
6.10, 6.12,
6.12
p.89 91
8.1, 8.2, 8.3, 10.1
p.21
8.1, 17.1
p.21 - 22
8.1, 17.1
p.25 26
8.6, 8.7,
p.22
8.4, 8.10, 8.12
p.22 23
8.6, 8.7, 8.10
p.26 27
8.4, 8.10, 8.12
p.28 29
ABDOMEN AND DIGESTIVE SYSTEM

HUS1-16
HUS1-17
HUS1-18
HUS1-19
HUS1-20
HUS1-21
HUS1-22
Stomach and the intestines, coeliac

trunk and mesenteric vessels
Liver and biliary ductal system,
pancreas and spleen
Peritoneal cavity, biliary system and GI
tract
Examination of GI organs
1
HUS1-23
Surface anatomy of the abdomen
HUS1-24
HUS1-25
HUS1-26
HUS1-27
HUS1-28
Demo
8.1, 8.15
p.30 32
Radiology of the abdomen
8.14
p.24
Histology of the digestive system: GI
8.8
P x2
1.5
8.8
8.11, 8.12, 8.13
P x2
1.5
8.11, 8.12, 8.13
p.95 98
8.2, 8.9, 10.3
p.37
8.2, 8.9, 10.3
p.41 42
tract
Histology of the digestive system: GI
p.92 94
tract
Histology of the digestive system:
glands
Histology of the digestive system:
glands
PELVIS AND UROGENITAL SYSTEM
HUS1-29
HUS1-30
Kidneys, adrenals and posterior

abdominal wall
Posterior abdominal structures and the
lumbar plexus
HUS1-31
The pelvis I
10.1, 10.2, 10.4
p.37
HUS1-32
The pelvis II
17.1, 17.2
p.38
HUS1-33
The perineum
10.1, 10.2
p.38 39
Pelvic structures
10.1, 10.2, 10.4,
p.42 44
HUS1-34
HUS1-35
HUS1-36
HUS1-37
17.1, 17.2
Anal and urogenital triangles
10.1, 10.2, 17.1,
p.44 45
17.2
Radiology of the pelvis and perineum
Clinical skills - abdominal and rectal
10.6
CSP x3
1.5
8.15
p.40
Exam
HUS1-38
Histology of the kidney
10.5
HUS1-39
P x2
1.5
10.5
17.3
17.3
The back
18.1,
p.49
Joints and movements of the upper
18.2, 18.3
p.56
HUS1-40
HUS1-41
Histology of the male reproductive
p.99 100
system
Histology of the female reproductive
system
MUSCULOSKELETAL SYSTEM
HUS1-42
HUS1-43
limb
HUS1-44
Shoulder
18.3,
p.57
HUS1-45
Axilla and arm
18.3, 18.4
p.57
HUS1-46
Vertebral column and back muscles
18.1, 18.6
p.50
HUS1-47
Shoulder and joints
18.2, 18.3
p.60 61
HUS1-48
Flexors of forearm and palm
18.3, 18.4, 18.5
p.58
Extensors of forearm and dorsum of
18.3, 18.4, 18.5
p.58 59
HUS1-49
hand
HUS1-50
Axilla and arm
18.3, 18.4, 18.5
p.61 62
HUS1-51
Forearm and hand
18.3, 18.4, 18.5
p.63 65
CSP x4
18.8
18.2
p.70 71
18.3, 18.4, 18.5
p.71
HUS1-52
HUS1-53
HUS1-54
An Introduction to musculoskeletal
examination upper limb
Joints and movements of the lower
limb
Anterior and medial thigh, femoral
triangle
HUS1-55
Gluteal region and posterior thigh
18.3, 18.4, 18.5
p.71 72
HUS1-56
The leg and foot
18.3, 18.4, 18.5
p.72 73
HUS1-57
Anterior and medial thigh
18.3, 18.4, 18.5
p.76 77
HUS1-58
Gluteal region and posterior thigh
18.3, 18.4, 18.5
p.77
HUS1-59
Popliteal fossa and leg
18.3, 18.4, 18.5
p.78 79
HUS1-60
Joints of the lower limb
18.2
p.79 80
Demo
18.1, 18.3, 18.6
p.81 85
18.7
p.73 75
CSP x4
18.9
HUS1-61
HUS1-62
HUS1-63
Surface anatomy of the back, upper

limb and lower limb
Radiology of musculoskeletal system
An Introduction to musculoskeletal
examination lower limb and spine
Total Teaching Hours
102
Course Title: Human Function I

Course Content: Lecture (L) 67 hours; Practical (P) 13 hours; Tutorial (T) 22 hours;
Demonstration (Demo) 1 hours; Case Discussion (Case) 1 hours; Question and Answer Session
(Q&A) 1 hours.
Code
Topic
Teaching
Activity
Hour
Syllabus
PHYSIOLOGY OF EXCITABLE CELLS

HUF1-1
Resting membrane potential
4.1
HUF1-2
Synaptic transmission
4.2
HUF1-3
Generation and propagation of action potential
4.3
HUF1-4
Sensory receptors
4.4
HUF1-5
Reflexes
4.5
HUF1-6
Autonomic nervous system I
4.6
HUF1-7
Autonomic nervous system II
4.6
HUF1-8
Excitable cells
1.5
MUSCLE PHYSIOLOGY
HUF1-9
Smooth muscle physiology
5.1
HUF1-10
Skeletal muscle physiology I
5.2
HUF1-11
Skeletal muscle physiology II
5.2
HUF1-12
Muscle physiology
Case
5.3
HUF1-13
Smooth Muscle
1.5
CARDIOVASCULAR PHYSIOLOGY
HUF1-14
Electrical Activity of the Heart
7.1
HUF1-15
Cardiac Cycle
7.2
HUF1-16
Origin of the ECG
7.3
HUF1-17
Interpretation of the 12 lead ECG
Demo
HUF1-18
ECG: Session with student participation
P x2
HUF1-19
Cardiac electrophysiology
T x2
HUF1-20
Cardiac Output
7.4
HUF1-21
Haemodynamics I
7.5
HUF1-22
Haemodynamics II
7.6
HUF1-23
Haemodynamics
T x2
HUF1-24
Endothelium
7.7
HUF1-25
Vascular tone regulation
7.8
HUF1-26
Microcirculation
7.9
HUF1-27
Blood pressure control I
7.10
HUF1-28
Blood pressure control II
7.11
HUF1-29
Blood pressure/heart rate measurement
P x2
HUF1-30
Cerebral and coronary circulation
7.12
HUF1-31
Blood flow and vasodilators
T x2
HUF1-32
Integrated cardiovascular physiology
7.13
HUF1-33
Integrative cardiovascular function
T x2
HUF1-34
Hypertension
7.14
HUF1-35
Heart Failure
7.15
HUF1-36
Question and Answer session
Q&A
GASTROINTESTINAL PHYSIOLOGY
HUF1-37
Overview of GI system
9.1
HUF1-38
Regulation of GI function
9.2
HUF1-39
GI motility
9.3
HUF1-40
Gastric physiology
9.4
HUF1-41
Salivary & pancreatic physiology
9.5
HUF1-42
Hepatobiliary physiology
9.6
HUF1-43
Digestion & absorption I
9.7
HUF1-44
Digestion & absorption II
9.7
HUF1-45
Digestion & absorption III
9.7
HUF1-46
GI disorders I
9.8
HUF1-47
GI disorders II
9.8
HUF1-48
GI - Tutorial 1
T x2
HUF1-49
GI - Tutorial 2
T x2
HUF1-50
GI - Tutorial 3
T x2
RENAL PHYSIOLOGY
HUF1-51
Renal tubular functions
11.1
HUF1-52
Regulation of plasma osmolarity and water balance
11.2
HUF1-53
Regulation of Na balance and effective circulating volume
11.3
HUF1-54
Regulation of K+ balance
11.4
HUF1-55
Renal function
P x2
HUF1-56
Kidney I
T x2
HUF1-57
Drugs on the kidney
11.6
HUF1-58
Micturition
11.7
HUF1-59
Renal handling of bicarbonate
11.8
HUF1-60
Acid-base disturbance: the basics I
11.9
HUF1-61
Acid-base disturbance: the basics II
11.9
HUF1-62
Kidney II
T x2
HUF1-63
Renal and cardiovascular demonstration
11.10
HUF1-64
Fluid and electrolyte disturbance (data interpretation)
T x2
HUF1-65
Acid-base disturbance - data interpretation
T x2
BASIC MECHANISMS OF DRUG ACTIONS

HUF1-66
Receptor-mediated cell signaling and tissue response
12.1
HUF1-67
Introduction to pharmacology I
12.2
HUF1-68
Introduction to pharmacology II
12.3
HUF1-69
Drug-receptor interactions I
12.4
HUF1-70
Drug-receptor interactions II
12.5
HUF1-71
Properties of drugs
T x2
HUF1-72
Understanding agonists and antagonists
P x2
HUF1-73
Drug-receptor interactions
T x2
PHARMACOKINETICS
HUF1-74
Drug ADME I
13.1
HUF1-75
Drug ADME II
13.1
HUF1-76
Drug ADME III
13.1
HUF1-77
Drug absorption, distribution, metabolism and excretion
T x2
HUF1-78
Pharmacokinetics I
13.2
HUF1-79
Pharmacokinetics II
13.2
HUF1-80
Pharmacokinetics III
13.2
HUF1-81
Pharmacokinetics - tutorial
T x2
DRUG ACTION ON THE PERIPHERAL NERVOUS SYSTEM

HUF1-82
Drug actions in the autonomic nervous system I
14.1
HUF1-83
Drug actions in the autonomic nervous system II
14.2
DRUG ACTION ON THE CARDIOVASCULAR SYSTEM

HUF1-84
Drugs used in cardiovascular diseases I
15.1
HUF1-85
Drug used in cardiovascular diseases II
15.1
HUF1-86
Pharmacology I: anti-arrhythmic drugs
15.3
HUF1-87
Pharmacology II: anti-hypertensive drugs
15.4
HUF1-88
Pharmacology III: drugs for ischaemic heart disease
15.5
HUF1-89
Pharmacology IV: drugs for heart failure
15.6
HUF1-90
Drugs Used in cardiovascular diseases
T x2
15.2
DRUGS AND THE GASTROINTESTINAL SYSTEM

HUF1-91
Overview of drugs acting on the GI tract I
16.1
HUF1-92
Overview of drugs acting on the GI tract II
16.2
HUF1-93
Antiemetics
16.3
HUF1-94
Antiemetics and drugs used for GI disorders
T x2
Total
105
16.4
Course Title: Molecular Medicine and Genetics

Course Content: Lecture (L) 52 hours; Tutorials (T) 9 hours
Code
Topic
Teaching
Activity
Hour
Syllabus
MOLECULAR STRUCTURE AND FUNCTION OF CELLS

MMG-1
Membrane transport
1.1
MMG-2
Cell junctions and cell adhesion
1.2
MMG-3
Cell cycle and cell death
1.3
MMG-4
Stem cells and differentiation
1.4
CELLULAR METABOLISM
MMG-5
Principles of enzymology
2.1
MMG-6
Principles of bioenergetics
2.2
MMG-7
Glycolysis
2.3
MMG-8
Gluconeogenesis
2.3
MMG-9
Citric acid cycle
2.4
MMG-10
Oxidative phosphorylation
2.5
MMG-11
Pentose phosphate pathway
2.6
MMG-12
Glycogen metabolism
2.7
MMG-13
Disorders of carbohydrate metabolism
2.8
MMG-14
Carbohydrate metabolism
T x2
MMG-15
Functions and properties of lipids
2.9
MMG-16
Triacylglycerols, phospholipids and cholesterol
2.10
MMG-17
Lipoproteins: structure and function
2.11
MMG-18
Metabolism of fatty acids and ketone bodies
2.12
MMG-19
Cholesterol metabolism
2.13
MMG-20
Disorders of lipid metabolism
2.14
MMG-21
Lipid metabolism
T x2
MMG-22
Metabolism of amino acids
2.15
MMG-23
Nitrogen excretion and the urea cycle
2.16
MMG-24
Metabolism of nucleotides
2.17
MMG-25
Disorders of nitrogen metabolism
2.18
MMG-26
Nitrogen metabolism
T x2
MMG-27
Integration of metabolism I
2.19
MMG-28
Integration of metabolism II
2.20
MMG-29
Integrative metabolism
T x2
MOLECULAR GENETICS AND GENOMICS

MMG-30
DNA replication
3.1
MMG-31
Gene transcription
3.2
MMG-32
Translation and post-translational modifications
3.3
MMG-33
Gene regulation I
3.4
MMG-34
Gene regulation II
3.5
MMG-35
DNA mutations and repair
3.6
MMG-36
Epigenetics and non-coding RNA
3.7
MMG-37
Characterization of genes and gene products I
3.8
MMG-38
Characterization of genes and gene products II
3.9
MMG-39
Molecular genetics
T x2
MMG-40
Organization of the human genome
3.10
MMG-41
Chromosomes and DNA recombination
3.11
MMG-42
Mendelian inheritance
3.12
MMG-43
Biochemical genetics and clinical molecular genetics
3.13
MMG-44
Non-Mendelian inheritance
3.14
MMG-45
Clinical genomics
3.15
MMG-46
Mitochondrial inheritance
3.16
MMG-47
Cytogenetics
3.17
MMG-48
Molecular cytogenetics
3.17
MMG-49
Multifactorial inheritance
3.18
MMG-50
Clinical genetics / dysmorphology
3.19
MMG-51
Population genetics
3.20
MMG-52
Screening and genetic counseling
3.21
MMG-53
Prenatal genetics
3.22
MMG-54
Clinical genetics
T x2
MMG-55
Pharmacogenomics
3.23
MMG-56
Personalized medicine
3.24
MMG-57
Teratology
3.25
MMG-58
Bioinformatics
3.26
MMG-59
Clinical genomics
T x2
Total Teaching Hours
61
Faculty of Medicine, The Chinese University of Hong Kong

Syllabus of Medical Year 2
Content of the Syllabus
This syllabus contains learning outcomes of the programme and learning objectives of the courses in Medical Year 2. These courses cover topics
on fundamental basis of cellular organization and function, on which a human body is structured and functioned. Some scientific bases, such as
composition of a cell, organization of cells into tissues and systemic anatomy have been covered in the foundation Year (Med 1).
Contents of the course are segregated into core and advanced. Core materials are those that are fundamental and basic to all medical students,
which are essential for their clinical training. Advanced materials contain topics that are either of significant clinical importance, or with recent
advances in scientific research. You are expected to work on the advanced materials by reading the recommended articles or doing your own
research on internet on recent scientific findings. Students who have mastered the core knowledge would be able to pass the Year-end
examination. A few questions will be set on the advanced topics in order to distinguish the deep learners.
A course on Doctor and Patient is also included, which provides student learning experience in a real clinical setting.
Expected Learning Outcomes of Medical Year 2
Students who have completed Medical Year 2 are able to:
1.
Describe basic principles of structure and function of human body.
2.
3.
4.
Understand clinical relevance of basic knowledge on human body.

Perform basic skills in clinical examinations.
Acquire skills in writing essay and presenting research findings.
10
Courses covered in Medical Year 2

1.
MEDU2300 Human Function I
2.
MEDU2400 Human Structure I
3.
MEDU2600 Molecular Medicine and Genetics
4.
MEDU2500 Doctor and Patient I
Drug List
A drug list is included to define the scope of study on various types of drug included in the Medical Year 2 teaching.
11
Table of Content
Major Topic
Page
Major Topic
Page
1.
13
11. Renal Physiology
52
2. Cellular metabolism
14
12. Basic mechanisms of drug actions
55
3.
Molecular genetics and genomics
18
13. Pharmacokinetics
56
4.
Physiology of excitable cells
23
14. Drug action on the peripheral nervous system
58
5.
Muscle physiology
26
15. Drug action on the cardiovascular system
58
6.
Thorax and cardiovascular/respiratory system
28
16. Drugs and the gastrointestinal system
62
7.
Cardiovascular physiology
34
17. Reproductive system
63
8.
Abdomen and digestive system
38
18. Musculoskeletal system
65
9.
Gastrointestinal physiology
47
Doctor and Patient I
73
49
Drug list of Medicine Year 2
76
Molecular structure and function of cells
10. Pelvis and urogenital system
12
CORE
1.
1.1.
ADVANCED
MOLECULAR STRUCTURE AND FUNCTION OF CELLS
Membrane transport
The importance of selective permeability in cell membrane

Various mechanisms that cells use to transport substances across the cell membrane
Differentiation and examples of simple diffusion, facilitated diffusion, primary active transport and
secondary active transport
1.2 Cell junctions and cell adhesion
Basic concepts about cell junction
Different types of cell adhesion
Clinical relevance of cell junctions and adhesion
1.3. Cell cycle and cell death
Different stages of the cell cycle
Cell cycle patterns between normal and cancer cells
Compare and contrast necrotic cell death and apoptosis
Pathways that control apoptosis
1.4.
Stem cells and differentiation
Embryonic stem cells

Differentiation of pluripotent cells from unipotent cells
Producing of cells with different functions based on selective gene expression
Establishment of tissues by progressive restriction of developmental potential
Stability of cell differentiation
Regulation of tissue structure and function by hormones and growth factors
13
2. CELLULAR METABOLISM
2.1. Principle of enzymology
Revision of the basic concepts of enzyme
Classification of enzymes
enzymes used in medical diagnosis and treatments
2.2. Principles of bioenergetics
Basic principles of metabolism
Stages in the extraction of energy from foodstuffs
Examples of high-energy phosphate compounds
ATP serves as the link between catabolism and anabolism
Coenzymes as electron carriers in oxidation-reduction reactions
Metabolic processes are regulated
2.3. Glycolysis and gluconeogenesis
Importance of glucose metabolism in all cells and tissues of the body
Glycolytic pathway as the anaerobic oxidation of glucose to pyruvate
Fate of pyruvate depends on the metabolic status and tissue type
Significance of the Cori cycle
Significance of gluconeogenesis in glucose homeostasis
2.4. Citric acid cycle
Overview of the citric acid cycle and its subcellular location
Enzymes and stoichiometry of the cycle
Importance of the reaction catalyzed by the pyruvate dehydrogenase complex
Anabolic and catabolic roles of the citric acid cycle
Regulation of the citric acid cycle
14
2.5.
Oxidative phosphorylation
Mitochondrial process of electron transport and oxidative phosphorylation

Biological significance of mitochondrial ATP synthase
How electron transport and oxidative phosphorylation can be uncoupled
Relevance of glycerol phosphate and malate aspartate shuttles to stoichiometry of ATP synthesis
2.6. Pentose phosphate pathway
The significance of the pentose phosphate pathway in the provision of NADPH for reductive biosynthesis
and pentose for nucleotide synthesis
The irreversible reactions and reversible reactions in the pentose phosphate pathway
The flux of metabolites through the pentose phosphate pathway depends on the metabolic status and
tissue type
2.7. Glycogen metabolism
The chemical structure of glycogen
The entry of sugars other than glucose into
The reactions of glycogen synthesis and glycogen degradation
glycolysis
The physiological significance of glycogen metabolism in the supply of instant energy and glucose
The metabolism of fructose, galactose and
homeostasis
glycerol
The regulation of glycogen metabolism

2.8. Disorders of carbohydrate metabolism
Example of derangements in carbohydrate metabolism
Diabetes mellitus
Glucose-6-phosphate dehydrogenase and pyruvate kinase deficiency
Defects in gluconeogenesis
Defects in fructose metabolism, citric acid cycle, glycogen metabolism and galactose metabolism
Lactase deficiency and mucopolysaccharidosis
15
2.9.
Functions and properties of lipids
Acetyl CoA as key precursor in the biosynthesis of many structurally different lipids
Fatty acids beneficial to health and fatty acids harmful to health
2.10.
Triacylglycerols, phospholipids and cholesterol
Functions, properties and structures of lipids (i) Fatty acids, (ii) triacylglycerols, (iii) phospholipids, (iv)
glycolipids, (v) eicosanoids, (vi) cholesterol, and (vii) steroid hormones
2.11.
Lipoproteins: Structure and function
Plasma lipoproteins (chylomicrons, LDL, IDL, VLDL, HDL) : structures, functions and diagnostic
significance
Classes of familial hypercholesterolemia mutations (FH mutations).
Types of hyperlipidemia and treatment
2.12.
Metabolism of fatty acids and ketone bodies
Beta-oxidation and biosynthesis of fatty acids

Differences between fatty acid beta-oxidation and biosynthesis
Inborn errors of fatty acid metabolism
Ketone bodies and ketoacidosis
Regulation of fatty acid metabolism and ketone body formation
2.13.
Cholesterol metabolism
Metabolism and functions of cholesterol, bile salt, vitamin D, and steroid hormones
Regulation of cholesterol level
2.14.
Disorders of lipid metabolism
Disorders of lipid metabolism: (i) obesity, (ii) dyslipidemia, (iii) lipid storage disease, and (iv) inborn
errors of steroid biosynthesis
16
2.15.
Metabolism of amino acids
Essential and non-essential amino acids
Antimetabolite as antiviral and anticancer
Functions of amino acid metabolism
drugs
General reactions of amino acids: transamination, deamination, decarboxylation

Value of plasma transaminase (aminotransferases) in diagnosis of tissue injury
Glutathione in antioxidative defense and amino acid transport
Vitamin B12
2.16.

Treatment of urea cycle disorders
2.17.
Metabolism of nucleotides
Functions of nucleotides
Purine nucleotide biosynthesis (de novo and salvage pathways) and regulation
Pyrimidine nucleotide biosynthesis and regulation
Degradation of purine nucleotides into uric acid
Causes, symptoms and treatment of gout and Lesch-Nyhan syndrome
2.18.
Disorders of nitrogen metabolism
Disorders of nitrogen (amino acid + nucleotide) metabolism

Liver failure
Inherited defects in amino acid metabolism
2.19.
Integration of metabolism I
Mechanism of metabolic action of steroid hormones, thyroid hormone, epinephrine and insulin
Metabolic effects of insulin (anabolic), glucagon and epinephrine
Defects of hormone receptors
Catabolism versus anabolism
17
Major metabolic pathways and control sites

Metabolic profiles of major organs
Postprandial (= post-absorption-feeding)
2.20.
Integration of metabolism II
Metabolism of glucose and lipid

Fasting and starvation
Carbohydrate, Lipid and Protein metabolism in starvation
Anaerobic exercise and aerobic exercise
Metabolic changes in disease/pathological states
Hypoglycemia and hyperglycemia
Hyperglycemia and protein glycation
Hyperglycemia and advanced glycation end products
Insulin and diabetes mellitus
3.
MOLECULAR GENETICS AND GENOMICS
3.1. DNA replication

Structure of nucleosomes
Process and enzymes involved in DNA replication
Importance of telomere and telomerase
3.2. Gene transcription
Mechanism of gene transcription and process involved in post-transcriptional modification
Mechanism of action of some toxins and antibiotics targeting transcription
18
3.3. Translation and post-translational modifications

Mechanism of translation
Differences between the prokaryotic and eukaryotic translation machinery
Mechanism of action of some toxins and antibiotics targeting translation
Different types of post-translational modifications and their importance
3.4. Gene regulation I
Fundamental principle of gene regulation underlying the lac operon model.
Different mechanisms of gene regulation
Binding of transcription factors on regulatory elements
3.5. Gene regulation II
Post-transcriptional mechanisms of gene regulation
Alternative splicing
Modulation of mRNA stability by proteins
3.6. DNA mutations and repair
Different causes and types of DNA mutation
Repair of mutations by different types of repair mechanisms
Diseases associated with the deficiency in DNA repair
3.7. Epigenetics and non-coding RNA
Gene silencing by promoter methylation
The mechanism and significance of histone modifications
Functions and mode of action of microRNA and long non-coding RNA
3.8. Characterization of genes and gene products I
Principles and applications of molecular techniques including gel electrophoresis, nucleic acid
hybridization, Southern blotting, Northern blotting, Western blotting, Elisa, FISH and
immunoprecipitation
19
3.9. Characterization of genes and gene products II

Principles and applications of PCR, recombinant DNA techniques, RFLP, gene chips, allele specific
oligonucleotide (ASO) hybridization, DNA fingerprinting and DNA sequencing
3.10.
Organization of the human genome
Characteristics of the human genome, including chromosome number and nomenclature, Composition
of the human genome, and notation for indicating chromosomal location
Significance of different genome projects, including Human Genome Project, International HapMap
Project, Thousand genomes Project, Human Microbiome Project and ENCODE Project
3.11.
Chromosomes and DNA recombination
Cell division: Mitosis and meiosis and their correlations with chromosome morphology and
reorganization
Importance and mechanism of DNA recombination
3.12.
Mendelian inheritance
Understand the various patterns of Mendelian inheritance.

Learn how to construct and interpret pedigrees.
Analyses of the confounding issues in pedigree analyses Understand the basic mechanism of inborn
errors of metabolism.
Learn the clinical outcome of common inborn errors of metabolism and treatment.
Appreciate the molecular mechanism of some common monogenic disorders.
Understand the relationship between genetic mutation and disease phenotype.
3.13.
Biochemical genetics and clinical molecular genetics
Basic genetic mechanisms which underlie inborn errors of metabolism

More commonly affected biochemical pathways that manifest as metabolic disease
Subtle signs and some of the constellations of symptoms that may point toward a specific metabolic
disease
20
The goals and systems of newborn screening programs to identify correctable or treatable disorder.
3.14.
Non-Mendelian inheritance
Appreciate different causes of genetic diseases.

Understand the basic genetic features of the non-Mendelian genetic disorders.
Know some examples of each type of non-Mendelian genetic disorders.
3.15.
Clinical Genomics
Introduce the importance of variation in the human genome useful for genetic analysis
Linkage analysis and identification of genes responsive for single gene defects
Identification of genetic factors conferring susceptibility to common multifactorial conditions
Recent advances in genomic science
Modern high throughput DNA sequencing technology
Different types of genomic technology, including genomics, transcriptomics and epigenomics analysis
Differentiation of errors from mutations
Applications of genomic technology in biomedicine and clinical medicine
3.16.
Mitochondrial inheritance
Composition of the mitochondrial genome

Diseases that can be associated with mutations of the mitochondrial genome
Inheritance pattern of mitochondrial diseases
3.17.
Cytogenetics and molecular cytogenetics
Chromosome abbreviations: Robertsonian translocation and non-disjunction

Chromosome staining techniques
Construction of karyotypes and their correlation with genetic conditions, such as Downs and Turner
Syndromes
Molecular cytogenetic including fluorescence in-situ hybridization and comparative genomic
hybridization
21
3.18.
Multifactorial inheritance
Factors which affect the relative recurrence risk for a multifactorial trait within a family;
Concept of threshold liability and use it to explain why inheritance patterns in males and females may
differ in certain multifactorial disorders
Twin concordance studies in determining the genetic component of multifactorial disorders.
Determination of the estimated risk to first degree relatives of an individual affected with a
multifactorial disorder
3.19.
Clinical genetics/dysmorphology
Relationship between embryological development with phenotypic presentation

Common malformations and deformations associated with the dysmorphic patient
Development of a differential diagnosis by associating similar presentations
3.20.
Population genetics
Application of Hardy-Weinberg equation to calculate frequency of a mutant gene in a

population from the occurrence of a specific trait
Principles of population genetics account for varying frequencies of particular mutations in populations
Calculation of risk using pedigree analysis and population gene frequency
3.21.
Screening and Genetic Counselling
Types of genetic screening and their limitations

Fundamental principles for practicing genetic counseling, including skills in obtaining histories, pedigree
construction and analysis, and genetic evaluation
Potential issues of genetic screening
3.22.
Prenatal Genetics
Factors affecting the choices of tissues and methods for prenatal diagnosis and genetic screening
Prenatal genetic tests: efficacy, benefits and risks
Psychosocial aspect of birth defects and genetic diseases
22
3.23.
Pharmacogenomics
Definition of pharmacogenomics
Genomics basis of drug dose, drug efficacy and side effects
Applications of pharmacogenomics in clinical settings
Example of pharmacogenomics
3.24.
Personalized medicine
Understanding the differences in disease diagnosis, prognosis and treatments based on genetic
variations
The basic principles and advantages of personalized medicine
The clinical practice of personalized medicine based on the advancement of genomics science
3.25.
Teratology
Basic concepts of genes and human development

Teratogen
Effects and mechanism of action of teratogenic agents on development
3.26.
Bioinformatics
Manipulation of genomic data by bioinformatics

Retrieving genomic information by bioinformatics
Bioinformatics tools and databases essential for clinical genomics
Studying gene-gene interaction and gene pathways by bioinformatics
4.
PHYSIOLOGY OF EXCITABLE CELLS
4.1. Resting membrane potential

General ion distribution across the cell membrane (i.e. intracellular and extracellular fluid
compartments, ICF/ECF)
23
Concept of ion equilibrium potential (Nernst equation)

Factors determining the establishment of a resting membrane potential (e.g. differential membrane
permeability/conductance to K+ and Na+)
Resting membrane potential given by the Goldman Equation
Effect of varying external K+ on membrane potential
Factors affecting K+ shift between ICF and ECF
4.2.
Synaptic transmission
General structure and function of a neuron

Different structural classes of neurons (multipolar, pseudounipolar and bipolar), and their functional
regions (dendrite, axon, soma, trigger zone)
Structural and functional organization of a chemical synapse (and that of an electrical synapse/gap
junction)
Binding of neurotransmitters to ionotropic or metabotropic receptors, generation of synaptic potential excitatory or inhibitory postsynaptic potential (EPSP and IPSP)
A neuron functioning as an integrator: synaptic integration spatial and temporal summation of
synaptic potential, at the axon hillock; generation of action potential at the trigger/spike initiation zone
Post- (axodendritic, axosomatic) and pre-synaptic (axoaxonic) modulation
4.3. Generation and propagation of action potential
Generation of action potential (AP) in a neuron - ionic mechanisms, different phases, and threshold
potential
Unique properties of action potentials
Basis for the development of absolute and relative refractory period after AP generation
Local current in the spread of depolarization
Unidirectional propagation of action potential
Continuous conduction of AP in unmyelinated nerve and saltatory conduction of AP in myelinated nerve
24
Factors determining conduction velocity of AP (e.g. fibre diameter, myelination), and advantages of
myelination
4.4.
Sensory receptors
Types of senses special, somatic and visceral

Classifications of sensory receptors based on their locations or the energy form of the stimulus
Two basic structural forms of sensory receptors - specialized sensory nerve endings and separate
receptor cell
Generation of receptor or generator potential - as illustrated by examples of sensory signal transduction
mechanisms
Sensory unit, and primary and secondary receptive field
Understanding of referred pain - from the convergence of primary somatic and visceral pain fibres to the
same secondary sensory neuron
Frequency and population coding of sensory stimulus intensity
Tonic (slow adapting) and phasic (fast adapting) sensory receptors
Lateral inhibition and contrast enhancement
4.5. Reflexes
General organization of a homeostatic (or feedback) control system divided into different components
(sensor/receptor, afferent pathway, integrator/controller, efferent pathway and effector)
Classification of reflexes (innate/acquired, somatic/autonomic, monosynaptic/polysynaptic,
spinal/cranial)
Examples: stretch reflex, withdraw reflex and cross-extensor reflex, with illustration on reciprocal
inhibition
Autonomic reflex (e.g. baroreceptor reflex) and neuroendocrine reflex (e.g. osmotic stimulation of ADH
secretion)
White and gray matters of the spinal cord, and dorsal root ganglion (with cell bodies of sensory nerve
25
fibers)
Dorsal horn (receiving somatic and visceral sensory inputs), lateral horn (visceral motor neurons) in the
gray matter of spinal cord and ventral horn (somatic motor neurons)
4.6. The autonomic nervous system I and II
Organization of autonomic nervous system (ANS) contrasting with that of somatic nervous system to
illustrate the characteristic features of ANS in typically diffuse, widespread and relatively slow (e.g.
disynaptic, nerve fiber types, neuroeffector junction)
Two divisions of ANS - parasympathetic and sympathetic, introducing their differences in anatomical
organization, effects (often opposing each other), and neurochemical control (e.g. neurotransmitters,
receptor types)
Three major arrangements of sympathetic nerve pathways and the involvement of adrenal medulla
Autonomic neurotransmitters and their receptors, including their signaling mechanisms (in general)
Difference in the affinity of norepinephrine and epinephrine towards a and b adrenergic receptors
Selected examples of autonomic control (e.g. pupillary reflex, accommodation reflex, sweat gland,
salivary gland, gastrointestinal function, control of heart and blood vessels, control of micturition with
somatic input)
5.
5.1.
MUSCLE PHYSIOLOGY
Smooth muscle physiology
General structure, distribution and functions

Molecular basis of contraction-relaxation: Ca binding to calmodulin, activation of myosin light chain
kinase, cross-bridge cycle, formation of latch-bridge
Excitation-contraction coupling: sources of Ca2+ and three types of coupling (i.e. electro-, pharmaco- and
mechano-mechanical coupling)
Single- and multi-unit smooth muscle
26
Tonic and phasic contraction

Cell signaling mechanisms (actions of neurotransmitters, hormones, drugs) in producing smooth muscle
contraction or relaxation
5.2.
Skeletal muscle physiology
Structural and functional organization of skeletal muscle fibers (sarcomere, T-tubule, sarcoplasmic
reticulum, triad)
Synaptic transmission at the neuromuscular junction and end plate potential
Excitation-contraction coupling and role of Ca2+
Sliding filament model and cross-bridge cycle
Isometric and isotonic (concentric and eccentric) contraction; length-tension relation in isometric
contraction
Motor unit and size principle of motor unit recruitment
Frequency summation (twitches, unfused and fused tetanus)
Energy supply for muscle activity
Muscle fiber types: slow and fast twitch, glycolytic and oxidative
Actions of proprioceptors: muscle spindle and Golgi tendon organ
5.3.
Muscle physiology (Case studies)
Pathophysiological mechanism of myasthenia gravis (MG)

Disease presentation, diagnosis and management of myasthenia gravis
Lambert-Eaton myasthenic syndrome (LEMS)
Drug actions at the neuromuscular junction (e.g. acetylcholinerase inhibitor, botulinum toxin,
tubocurarine, succinylcholine).
Non-depolarizing and depolarizing block of neuromuscular transmission
27
6. THORAX AND CARDIOVASCULAR/RESPIRATORY SYSTEM

6.1.
Surface anatomy of the thorax
Division lines on the chest (mid-sternal line, mid-clavicular line, anterior axillary line, mid-axillary line,
posterior axillary line, vertebral line, scapular line)
Palpation of sternum (jugular notch, sternal angle), clavicle (supraclavicular and infraclavicular fossae),
scapula (coracoid acromion, spine, borders, inferior angle), ribs, intercostal space, costal margin and
fossa for xiphoid process
Surface projection of the heart: borders of heart, apex; the trachea and lung: center of trachea,
bifurcation of trachea, apex of lung, lung fissure, lower border of lung, diaphragm
Percussion of chest wall: locate heart, lung and liver
Sites for auscultation: heart valve sounds; breath sounds over trachea, bronchi and lung
6.2.
Morphology of the thoracic cage
Inlet and outlet (anatomical and surgical)
Costophrenic angle and its importance
Structures and body articulations: thoracic vertebrae, sternum, ribs, costal cartilages, clavicle and
Breast cancer and routes of metastasis
scapula
Sternum components: manubrium, body, xiphisternum (xiphoid process)
Anterolateral wall: muscles (pectoralis major and minor and serratus anterior); nerves
(thoraco-abdominal and long thoracic); vessels (internal thoracic artery and vein, lateral thoracic artery)
Intercostal spaces: Intercostal muscles (external & internal), intercostal nerves and vessels
Principles of normal respiratory movements; role of intercostal muscles, diaphragm; accessory muscles
Diaphragm and nerve innervation (phrenic nerve, C3,4,5)
Structures of diaphragm: crura, central tendon; openings (caval, oesophageal, aortic)
Azygos system of veins; drainage of thoracic wall
The breast: tail; position of nipple (variable) and areola; internal structures (lactiferous ducts, suspensory
28
ligaments, axillary tail); lymphatic drainage; blood supply

Concept of innervation and dermatomes of anterior chest wall
MORPHOLOGY OF THE RESPIRATORY SYSTEM
6.3.
Upper airway
(To be covered in Human Structure II)
Overall organization and functions of the nose
Muscles involved in phonation
Paranasal sinuses and its relation to the nasal cavity

Nasal conchae and meati; openings of the paranasal sinuses
Divisions of pharynx (nasopharynx, oropharynx, and laryngopharynx)
Roles of the mouth, tongue, soft palate, pharynx, epiglottis and larynx during breathing and swallowing
Vertebral level, extents and boundaries of the larynx
Structural arrangement of the larynx: cartilages, joints, muscles
Movements of vocal cords in phonation
Innervation of nose, nasopharynx, larynx and trachea
6.4. Pleura and pleural cavities
Correlation of pleura with lungs, thoracic wall and diaphragm; pulmonary ligament
Pleuritis
Parietal pleura: costal, mediastinal, diaphragmatic and cervical
Haemothorax; pneumothorax; hydrothorax
Somatic innervation of parietal pleura and autonomic innervation of visceral pleura

Recesses of pleural cavity: costodiaphragmatic and costomediastinal
6.5. Lower airway and lungs
Overall organization of the lower airway: trachea; carina, left and right main bronchi; lobar bronchi;
Effect of bronchial constriction on airflow,
bronchopulmonary segmentation
asthma
Left and right lungs features (apex, base, surfaces, borders, fissures, lobes)
Foreign bodies in bronchus; comparsion
Roots of lung: bronchi and pulmonary vessels
between left and right main bronchi
Pulmonary arterial and bronchial supply of the lung and bronchi
Lymph nodes around trachea and main

29
Venous and lymphatic drainages of the lungs and bronchi
bronchi
Autonomic innervation of the airway and lungs

6.6. Tissues of the respiratory system
Trachea: mucosa (respiratory epithelium, lamina propria), submucosa (glands and blood vessels),
Epithelial cells: Brush, neuroendocrine, Clara
cartilage and adventitiaCells in respiratory epithelium: ciliated and Goblet cells; their functions
and basal cells
Bronchus: epithelium, smooth muscle and cartilageBronchioles: epithelium and smooth muscleLung:
alveolar sacs, alveolar ducts, alveoli (type I and type II pneumocytes, alveolar macrophages), capillaries
and elastic fibers
Concept of blood-air-barrier
MORPHOLOGY OF THE CARDIOVASCULAR SYSTEM
6.7. The heart: External features
Normal position of the heart; its borders, surfaces and apex
Pericarditis
Fibrous pericardium; relation to diaphragm and phrenic nerves
Fluid accumulation in pericardial cavity;
Serous pericardium: pericardial cavity; parietal and visceral layers
pericardiocentesis
Transverse and oblique pericardial sinuses; in relation to great vessels

Great venous vessels draining to the heart (superior and inferior venae cavae, pulmonary veins; coronary
sinus)
Great arterial vessels leaving the heart: aorta & pulmonary trunk
6.8. The heart: Internal features
Chambers: atria and ventricles
Valvular diseases of the heart
Interior of the heart chambers: right atrium (atrial appendage, openings of superior and inferior venae
cavae, opening of coronary sinus, tricuspid valve, interaterial septum); right ventricle (tricuspid valve,
chordae tendineae, papillary muscles, interventricular septum, moderator band); left atrium (opening of
pulmonary veins, mitral valve, atrial appendage); left ventricle: (mitral valve, chordae tendineae,
30
interventricular septum)
Heart valves: right (tricuspid) and left (bicuspid or mitral) atrioventricular valves; pulmonary valve; aortic
valve; their functions
6.9. Blood supply of the heart
Arterial supply: left and right coronary arteries (first branches of aorta); major branches: anterior and
Angina pectoris
posterior interventricular, circumflex and marginal

Venous drainage: cardiac veins (great, middle, small); coronary sinus drains into right atrium
6.10.
The conducting system
Principles of impulse conducting system in heart

Importance of sinu-atrial and atrioventricular nodes; atrioventricular bundle; Purkinje fibers
Innervation of heart: parasympathetic (vagus) and sympathetic systems
6.11.
The great vessels
Major arteries and veins bringing blood to and from the heart
Left recurrent laryngeal nerve hooks with
Divisions of aorta: ascending, arch, descending (thoracic and abdominal)
aortic arch; right recurrent laryngeal nerve
Branches from aortic arch: brachiocephalic trunk (to right side of the body), left common carotid (to left
hooks with right subclavian artery
neck and head) and left subclavian (to left upper limb) arteries
Branches from brachiocephalic trunk: right common carotid (to right neck and head) and right
subclavian (to right upper limb) arteries
Bifurcation of common iliac artery: external (to lower limb) and internal iliac (to pelvis and perineum)
arteries
Brachiocephalic veins return blood from head, neck, upper limbs to superior vena cava
Inferior vena cava returns blood from abdomen, pelvis and lower limbs
Ligamentum arteriosum (reminant of ductus arteriosus)
31
6.12.
Histology of the heart and blood vessels
Heart wall: endocardium (Purkinje fibers), myocardium (cardiac muscle cells) and epicardium
Types of junctions between cells
Fibrous skeleton and cardiac valves

Basic pattern of blood vessels: tunica intima, tunica media and tunica adventitia; continuations of heart
wall layers
Vasa vasorum (small nutrient vessels)
Types of arteries: elastic and muscular
Smooth muscle in small arteriole (regulation of blood flow)
Types of capillaries: continuous, fenestrated and discontinuous
Vein valves
Compare the size and wall structure of arteries, arterioles, capillaries, venules and veins
6.13.
Mediastinum
Organization and divisions of the mediastinum (anterior, superior, posterior)
Compression on esophagus (left main
Thymus: location, functional changes with age
bronchus)
Position of heart, great vessels, azygos vein, thoracic duct, trachea, thoracic oesophagus, phrenic nerves,
Oesophageal varicose veins
vagus nerves and sympathetic trunks; lymph nodes at hilus of lung

Concept of lymphatic drainage: thoracic duct draining lymph into left subclavian vein; right lymphatic
duct draining lymph into right subclavian vein
Hemiazygos vein and intercostal veins relation to azygos vein
6.14.
Autonomic innervation of thoracic viscera
Sympathetic system: sympathetic trunk and ganglia; origin of preganglionic fibers; innervations to heart
and lung
Thoracic splanchnic nerves to abdominal viscera
Parasympathetic system: vagus nerves; innervation to heart and lung
Esophageal plexus
32
6.15.
Imaging of the thorax
Chest X-Ray: border of the heart and mediastinum, airways and lung, thoracic cage
Clinical cases with abnormal anatomy of the
Computed tomography (CT) of the thorax
thorax
3-Dimensional CT: coronary angiography

6.16.
Clinical skills body measurements and examination of vital signs
BMI and waist circumference

Competence in measuring the height and weight of an adult, and measuring waist circumference using
WHO method
Awareness of different methods of measuring waist circumference
Knowledge of how to calculate body mass index (BMI) and interpret the result according to appropriate
standards
Examination of vital signs
Competence in measuring pulse, blood pressure, body temperature, respiratory rate and pulse oximetry
This should include:
Use of different devices (digital thermometers) to measure body core temperature at different sites
(sublingual, ear, rectal) and to understand concept of core temperature
Identification of radial and brachial pulses and measurement of the pulse rate
Counting of the respiratory rate
Measurement of blood pressure using 3 different types of sphygmomanometers (mercury, aneroid and
oscillometric)
Understanding normal variations and factors that may affect the vital signs
6.17.
Clinical skills cardiovascular examination
Inspection
General examination for dyspnea, orthopnoea, anaemia , cyanosis, clubbing, peripheral oedema
Palpation of arterial pulses for rate, rhythm, volume and character
33
Blood pressure measurement supine and erect

Recognition of jugular venous waveforms and measurement of jugular venous pressure
Inspection and palpation of the apex beat
Proper use of stethoscope in auscultation of the heart
Classic sites of cardiac auscultation
Auscultation of the first and second heart sounds and ways to differentiate the two
Recognition of physiological splitting of the second heart sound
Understand the following signs and their significance in heart disease and know how to elicit them
Rhythm irregularities
Abnormal position of the apex beat
Parasternal heave in right ventricular hypertrophy
Cardiac thrills
Third and fourth heart sounds
Cardiac murmurs systolic and diastolic
Grading of cardiac murmurs
Pericardial friction rubs
7. CARDIOVASCULAR PHYSIOLOGY
7.1. Electrical activity of the heart
Overview of the CVS system
AP generation in the intrinsic conductive system
The electrical events of the cardiac cycle
Autonomic control of heart rate
L-type Calcium channels and blockers
Refractory period and plateau phase
34
7.2. Cardiac cycle

Ventricular cycle
Systole and Diastole
Atrial cycle and central venous pressure
Ventricular filling and ejection
Isovolumetric contraction and relaxation
How pressure and volume change during a cardiac cycle
Ejection fraction
7.3.
Origin of the ECG
How ECG reflects the electrical activity of the heart

Concept of ECG leads
Significance of ECG waveforms
Deflections of ECG waves
Significance of an cardiac vector
Abnormal ECG patterns
7.4. Cardiac output
Multiple factors that affect stroke volume and cardiac output
Length-Tension Relationships and the Frank-Starling Law of the Heart
Stroke volume and venous return
Control of cardiac contractility by neural and endocrine factors
Concept of afterload on stroke volume and cardiac output
Haemodynamics I
7.5. Haemodynamics I
Different types of vessels and their specific functions
Factors that determine arterial pulse pressure
Relationships between flow, pressure and resistance
35
Concept of total peripheral resistance in CV system

Arteriole as the resistance vessel
Poiseuilles law
7.6. Haemodynamics II
Multiple factors that affect central venous pressure
Neurotransmitters and hormones that affect TPR
Vasoconstrictors and vasodilators on TPR
Autoregulation of arteriolar smooth muscle
Metabolic and myogenic regulation
7.7. Endothelium
Structural and functional features of the endothelium
Paracrine regulation of blood flow
Endothelium-derived relaxing factors
NO-mediated relaxation
Important functions of NO
Endothelial dysfunction in hypertension and diabetes
Risk factors in cardiovascular diseases
7.8.
Vascular tone regulation
Importance of Ca2+ ion in excitation contraction coupling

Types of ion channels
Types of K+ channels that are important for vascular tone regulation
Electro-mechanical coupling versus pharmaco-mechanical coupling
Hormones and neurotransmitters that are affect the vascular tone of smooth muscle cell
7.9.
Microcirculation
Structure and function of microcirculation

36
Main methods of capillary transport

Exchange of fluid between capillary and tissue space
Concept of Starling forces in causing fluid movement across the capillary
Structure and function of lymphatic system
Causes and types of edema
7.10.
Blood pressure control I
Definition of mean arterial pressure

Approximation of MAP using systolic and diastolic BP
Equation relating MAP, CO and TPR
Summary of factors that affect CO, TPR and MAP
Renin-angiotensin aldosterone system
7.11.
Blood pressure control II
Control of MAP by cardiovascular reflexes

Baroreceptor reflex
Cardiopulmonary reflex
Chemoreceptor reflex
Summary of neural, hormonal and local factors that regulate MAP
7.12.
Cerebral and coronary circulation
Importance of a steady cerebral blood flow

Function of blood brain barrier
Common problems in cerebral circulation
Structural and functional features of the coronary circulation
Common problems in cerebral circulation
Other types of circulation
37
7.13.
Integrated cardiovascular physiology
Cardiovascular responses in exercise

Concept of active and reactive hyperemia
Definition of shock
Conditions associated with shock (hemorrhagic, septic, cardiogenic, etc)
7.14.
Hypertension
Definition of hypertension
Classification of hypertension
Common causes or conditions related to hypertension
Treatment approaches for hypertension
Drugs and chemicals that are effective in treating hypertension
7.15.
Heart failure
Main causes and consequences of heart failure

Systolic and diastolic heart failure
Compensatory responses to heart failure
Neurohumoral changes associated with heart failure
Relationship of heart failure and exercise intolerance
Treatment strategy of heart failure
8. ABDOMEN AND DIGESTIVE SYSTEM
ABDOMINAL ANATOMY
38
8.1. Anterior abdominal wall

Basic structures of the anterior abdominal wall: muscles, fascia, nerves and vessels; its function in
Reflex contraction of abdominal wall muscles
respiration, spine movement, changing of intra-abdominal pressure and protection of viscera
Hernia: inguinal (direct and indirect), femoral
Surface features: umbilicus
McBurney's point
Subdivision of the abdomen: four quadrants; nine regions
Applied anatomy of common surgical incisions
Horizontal planes: transpyloric, subcostal, intertubercular; vertical planes: mid-clavicular

Surface projections of major organs: liver, gallbladder, transverse colon, sigmoid colon, spleen, lower
pole of kidneys, caecum and appendix
Body landmarks: costal margin, pubic symphysis, pubic tubercle, anterior superior iliac spine and iliac
crest
Fasciae: superficial (fatty and membranous); transversalis
Muscles: oblique (internal, external); abdominis (transversus, rectus)
Aponeuroses of the muscle layers; rectus sheath (arculate line); linea alba; linea semilunaris
Position of inguinal canal and inguinal ligament
Inguinal canal: deep and superficial rings; relationship with abdominal wall muscles
Arteries: superior and inferior epigastric arteries; their origins and routes
Innervation and dermatomes (T7-T12, L1): xiphisternum (T6/7); umbilicus (T10); symphysis pubis (L1)
39
8.2. Posterior abdominal wall

Basic structure of the posterior abdominal and pelvic walls: muscles, nerves and vessels
Psoas abscess
Concept of the continuation of the abdomen into the pelvis: abdominopelvic cavity
Aortic aneurysm
Muscles: psoas major; quadratus lumborum, transversus abdominis, iliacus

Costovertebral angle
Abdominal space: paracolic gutter
Branches of abdominal aorta: coeliac trunk (left gastric, common hepatic, splenic), superior and inferior
mesenteric, renal, gonadal, parietal branches for diaphragm and body wall; surrounding lymph nodes
Inferior vena cava and its main tributaries
Lymph drains into cisterna chyli
Subcostal nerves; nerves of the lumbar plexus (lateral cutaneous, ilioinguinal, iliohypogastric, obturator,
femoral, lumbosacral, genitofemoral) and their course; innervation targets
Sympathetic trunks and ganglia
Lumbar vertebrae; body landmarks: T11, T12 and iliac crest
8.3. Peritoneal cavity and peritoneum
Peritoneal cavity in relation to abdominal organs; concepts of intraperitoneal and retroperitoneal
organs
Peritoneum: visceral and parietal layers; and their innervation
Position of greater and lesser sacs/omental bursa; opening of lesser sac or omental foramen
Position and function of peritoneal reflections: falciform ligament, lesser and greater omenta,
mesenteries, transverse and sigmoid mesocolons
Peritoneal spaces or recesses: subphrenic and hepatorenal; spread of infection and fluid
40
8.4.
Spleen
Position of spleen in the abdomen and function
Enlargement of the spleen
Surfaces and features: notches and hilum

Major relations to stomach, colon, kidney and diaphragm
Arterial supply (from coeliac trunk) and venous drainage (to portal vein)
GASTROINTESTINAL TRACT
8.5.
Morphology of upper gastrointestinal tract
(To be covered in Human Structure II)
Organization of the oral cavity: roof, floor, walls

Upper and lower jaws: maxilla and mandible
Temporomandibular joint: stability and movements; muscles of mastication and their innervation
Facial muscle involved in chewing process: buccinator
General features of the teeth; types of teeth and functions; deciduous and permanent teeth set; dental
formulae; sensory innervation
Mouth and tongue; motor and sensory innervations; mechanism of chewing
Hard and soft palate; functions of soft palate to close the nasopharynx
Palatine tonsils; anterior and posterior pillar (palatopharyngeal and palatoglossal arches)
Movements of mouth, tongue, soft palate, pharynx, epiglottis during swallowing
Tongue muscles: intrinsic and extrinsic; lingual tonsil
Salivary glands: parotid, submandibular and sublingual; openings of salivary ducts; parasympathetic
control and ganglia
Pharynx and its division: nasopharynx, oropharynx and laryngopharynx; constrictor muscle groups;
motor and sensory innervation
Pharyngeal recess and tonsils (adenoid)
Oesophagus
41
8.6.
Morphology of lower gastrointestinal tract
Abdominal oesophagus; gastro-oesophageal junction
Differences in presentation of an anterior and
Stomach: regions (cardia, fundus, body, pyloric); pyloric sphincter; peritoneal attachment
posterior perforation of stomach ulcer
External features of stomach: greater and lesser curvatures; cardiac and angular notches
Divisions and disposition of small and large intestines
Duodenum: parts (1st to 4th); drainage of bile and pancreatic juice into 2nd part
Jejunum and ileum: mesentery and its root
Internal features of stomach (gastric rugae), duodenum (major duodenal papilla), and jejunum and
ileum (plicae circulares; comparison of structural differences)
Caecum; appendix: orifice inside caecum
Colon: parts (ascending, transverse, descending, sigmoid colon, rectum); anal canal; anus; peritoneal
covering; mesocolon
Gastrointestinal tract relationship to peritoneum
Junctions between intestinal parts: duodenojejunal; ileocecal (ileocaecal orifice and valve)
Flexures of large intestine: left and right colic
External features of large intestine: haustrae; taeniae coli; epiploic appendages
Anus: pectinate line; sphincters (external and internal)
42
8.7.
Vascular system of gastrointestinal tract
Blood supply from coeliac trunk to stomach, spleen, abdominal esophagus, liver, proximal half of
Portal hypertension
duodenum
Three main sites for portal systemic
Arteries to stomach: left and right gastric, left and right gastroepiploic, gastroduodenal and short gastric
anastomoses: oesophagus, rectum
(from splenic artery)
(haemorrhoids); around umbilicus
Blood supply from superior mesenteric artery to distal half of duodenum, jejunum, ileum, caecum,
appendix, ascending colon and proximal 2/3 transverse colon
Blood supply from inferior mesenteric artery to distal 1/3 transverse colon, descending colon, sigmoid
colon and superior rectum
Arteries to colon: left and right colic; marginal
Arteries to rectum: superior, middle and inferior rectal; venous drainage
Portal venous drainage (splenic, superior and inferior mesenteric veins) and portal systemic
anastomoses
43
8.8. Histology of gastrointestinal tract

General organization of digestive tract: mucosa, submucosa, muscularis externa and serosa/adventitia
Mucosa: epithelium, lamina propria and muscularis mucosae; their components
Submucosa: connective tissue, blood and lymph vessels, nerve plexus (Meissner's plexus), glands and
lymphoid aggregation
Muscularis externa: muscle and nerve plexus (Auerbach's plexus)
Serosa: visceral peritoneumAdventitia: loose connective tissue
Oesophagus: epithelium, glands in submucosa and muscle in muscularis externa (transition of muscle
type)
Stomach: epithelium, gastric glands and cells (mucous neck, parietal, chief, enteroendocrine, stem)
Structures for efficient absorption in small intestine: plicae circulares, villi and microvilli
Small intestine: epithelial cells (Goblet cells, Paneth cells) and glands (crypts)
Villus: lacteal and blood capillaries
Duodenum: Brunner's glands in submucosaIleum: Peyer's patches (lymphoid nodules) in mucosa and
submucosa
Large intestine: epithelial cells (Goblet cells) and glands
Transition of epithelial types: oesophageal-gastric junction, ano-rectal junction
8.9. Autonomic innervation of abdominal viscera
Concepts of nerve innervation of abdominal viscera
Sympathetic: trunk and ganglia; splanchnic nerves; parasympathetic: vagus and pelvic splanchnic
nerves (sacral S2-S4)
Regulation of alimentary tract motility, sphincters activities, glands secretion
Control of anal sphincters (external and internal)
Sensation of viscera
44
Varicosities of submucosal veins in anal canal
LIVER AND PANCREAS

8.10.
Liver, gall bladder and biliary tract
Position of liver and gall bladder
Passage of a gall stone; referred pain
Surfaces and borders of liver
Obstruction of biliary tract
Lobes of liver: right and left lobes, caudate and quadrate

Peritoneal covering and ligaments of liver: attachment to diaphragm; falciform ligament; lesser
omenum
Porta hepatis and its contents: portal vein, hepatic artery, hepatic ducts
Venous drainage of liver: portal veins into inferior vena cava
Portal systemic anastomoses
Parts of gall bladder: fundus, body and neck; spiral valve
Biliary tract: extra-hepatic parts (left and right hepatic duct, common hepatic duct, cystic duct, gall
bladder, common bile duct); course; termination
Connection of common bile duct and pancreatic duct; common drainage of contents into the
duodenum; hepatopancreatic ampulla (Ampulla of Vater); duodenal papilla; sphincter of Oddi
8.11.
Histology of liver and biliary system
Liver: lobule (central vein, hepatic sinusoids, columns of hepatocytes, bile canaliculi); portal area (portal
Liver pit cells, hepatic natural killer
vein, hepatic artery, bile duct)
lymphocytes
Kupffer cells in sinusoids

Microscopic organizations of the liver: liver lobule, portal lobule and liver acinus
Direction of flow of blood and bile in liver lobule
45
8.12.
Pancreas
Position of pancreas; relation to peritoneum (retroperitoneal), duodenum and biliary tract

Divisions of pancreas: head, uncinate process, neck, body, tail of pancreas
Endocine and exocrine functions; transport of pancreatic juice via main and accessory pancreatic ducts
Main and minor duodenal papilla inside duodenum
Control of pancreatic juice release into duodenum: sphincter of Oddi
Relation to superior mesenteric and splenic vessels
8.13.
Histology of salivary glands and pancreas
Structural organization of compound exocrine glands: acini (secretory units) and ducts
Types of cells in Islets of Langerhans: a cells, b
Comparsion of exocrine and endocrine glands
cells and d cells
Types of exocrine glands: mucous, serous, and mixed

Major salivary glands (exocrine): parotid, submandibular and sublingual
Pancreas: both exocrine and endocrine glands
Exocrine pancreas: acini; acinar and centroacinar cells; intercalated ductEndocrine pancreas: islets of
Langerhans (insulin and glucagon secretion)
8.14.
Imaging of the abdomen
X-Ray
Fluoroscopy: intravenous urogram of the urinary tract, barium enema of the bowel
abdomen
Computed tomography (CT): colonography, angiogram

Ultrasound and magnetic resonance imaging (MRI) of the abdomen
8.15.
Clinical skills abdominal and rectal examination
Abdominal Examination
Inspection
General signs which may indicate abdominal disease such as anaemia, jaundice and clubbing.
Quadrants and regions of the abdomen.
46
Surface projection of intra-abdominal organs

Shape and symmetry of the abdominal wall
Presence of surgical scars and abnormal venous markings on the abdominal wall
Normal and abnormal abdominal wall movements
Light Palpation
Check for tenderness, guarding, rigidity.
Deep Palpation
For abnormal intra-abdominal mass and/or enlarged abdominal organs
For liver, spleen, and kidneys
Murphys sign
Percussion
Define upper and lower borders of liver. Also borders of other masses or enlarged organs.
Check for ascites (fluid thrill and shifting dullness).
Auscultation
Normal and abnormal bowel sounds
Succussion splash
Abnormal vascular sounds (bruits)
Rectal Examination
Inspection and palpation of perineum and anus including Surface projection of ischiorectal space and
anal margin
Digital palpation of anal canal and anal sphincter tone, rectum and peri-rectal space and prostate (size,
lateral lobes, median sulcus, consistency, texture, nodules, tenderness)
9. GASTROINTESTINAL PHYSIOLOGY
9.1.
Overview of GI system
47
The general functions of different parts of GI tract and its associated organs
The structural organization and specialization of various regions of GI tract
GI function in term of motility, secretion, digestion and absorption
The general concept of non-immunological and immunological defense mechanism of the GI system
9.2. Regulation of GI function
Basic stimuli for GI regulation: volume and composition of food (distension, acidity, osmolarity and
digestion products)
GI functions are highly regulated by neural and hormonal systems: the role of enteric nervous system
Pathways for neuro-humoral regulation (neurocrine, paracrine and endocrine)
Roles of secretin, gastrin, CCK, GIP & motilin; somatostatin & histamine; VIP, GRP & Ach
9.3. GI motility
The basic mechanisms by which the motility of gut smooth muscle is regulated (slow waves vs spike
potential)
Types of gut movement and their physiological significance (segmentation, peristalsis, tonic contraction
and migrating motor complex)
The general concept for the regulation of esophageal, gastric and intestinal motility
Neural and hormonal regulation of gastric emptying
9.4. Gastric physiology
Different cell types and functions that contribute to gastric secretions (surface epithelial cell, mucous
neck cell, parietal cell, chief cell & endocrine cell)
The cellular mechanism for the regulation of gastric acid secretion by the parietal cells
Roles of acetylcholine, histamine and gastrin and phases of gastric secretion
The mechanism of gastric mucosal barrier and its implications on ulceration
9.5.
Salivary and pancreatic physiology
The function and regulation of saliva: parasympathetic vs sympathetic stimulation

48
Cellular mechanism for the regulation of pancreatic ductal HCO3- and acinar cell secretion of digestive
enzymes by secretin, Ach and CCK
Phases of pancreatic secretion and potentiation effect of secretin with Ach and CCK
9.6. Hepatobiliary physiology
Bile acid vs bile pigment; the solubility of bile acids and its physiological significance
The significance of enterohepatic circulation of bile acids
The function and regulatory mechanism of gallbladder
Formation and excretion of bile pigment
9.7. Digestion and absorption I and II
The structural modifications and functionality of cells for intestinal digestion and absorption
Basic principle of digestion and absorption of carbohydrates, proteins and lipids
Basic principles of absorption of fat-soluble and water-soluble vitamins
Basic principles of absorption of electrolytes and water
9.8. GI disorders I and II
Factors that influence the LES motility and the basic concept of motility dysfunction exemplified by
achalasia
Negative feedback of gastrin and acid and the basic concept of secretory dysfunction exemplified by
gastrinoma
H. pylori and its pathogenesis of peptic ulceration
Category of diarrhea and mechanisms of action
10.
PELVIS AND UROGENITAL SYSTEM
PELVIS AND PERINEUM
49
10.1.
Morphology of pelvis and perineum
Pelvis
Retropubic space; clinical importance
Orientation and organization of pelvis: bones (sacrum, pubis, ilium, ischium), muscles, fascia, vessels
Rectal examination; vaginal examination
and nerves
Pain referred from pelvis
Inlet (sacral promontary, pelvic brim); outlet (coccyx, ischial tuberosities and spines, pubic arch);
Anterior extension of ischioanal fossa; fistula;
muscular wall (obturator internus, piriformis); pelvic diaphragm (levator ani)
perianal abscess
Obturator foramen, superior and inferior pubic rami; greater and lesser sciatic notches (formed by
Extravasation of urine
sacrospinous and sacrotuberous ligaments); sacroiliac joint

Differences between male and female pelvis
Importance of levator ani as a support for pelvic viscera and sphincter for defaecation and micturation
Disposition of pelvic viscera in male and female
Peritoneal folds: male (rectovesical); female (rectouterine/pouch of Douglaus, uterovesical)
Perineum
Boundaries of urogenital and anal triangles in male and female
Contents of urogential triangle: perineal membrane, perineal body, superficial perineal pouch,
sphincter urethrae, ischiocavernosus and bulbospongiosus muscles, erectile tissues and urethra
Perineum of the female: mons pubis, labia majora and minora, clitoris, vestibule
Contents of anal triangle: ischioanal fossa, anal canal and sphincters
Perineal body
10.2.
Neurovascular supply of pelvis and perineum
Branches of common iliac artery: internal (to pelvis) and external (to lower limb) iliac arteries
Branches of internal iliac artery: obturator, superior and inferior vesical, superior and inferior gluteal,
uterine and vaginal in female, internal pudendal and its branches (inferior rectal and perineal)
Innervation of pelvic organ: lumbosacral plexus
Innervation of perineum: pudendal nerve and its branches (inferior rectal and perineal)
50
Pudendal block
ANATOMY OF URINARY SYSTEM

10.3.
Kidney and ureter
Position of left and right kidneys in abdomen; relationship with ribs, adrenal glands and peritoneum
Ectopic locations of kidneys
(retroperitoneal)
Anterior and posterior relations of the kidneys
Exterior: renal fascia, fat and fibrous capsuleInterior: cortex and medulla (renal pyramids and papilla);
sinus filled with fat
Renal hilum: pelvis of ureter, renal veins and arteries
Direction of urine flow: minor calyx, major calyx, renal pelvis and ureter
Course of ureter; relation to uterine artery in female and vas deferens in male
10.4.
Urinary bladder and urethra
Position of bladder in pelvis when empty and in abdomen when full
Injury of the bladder and urethra
Location of trigone and its boundaries (openings of ureters, interureteric fold, internal urethral
Ureter at risk during colonic and
opening)
gynaecological surgery
Urinary bladder: fundus, body and preprostatic sphincter
Urethral catheterization
Urethra: sphincters (internal and external); orifices (internal and external); differences between female
and male
Male urethra: prostatic, membranous, penile/spongy
Autonomic and somatic innervation of urinary bladder and urethral sphincters
51
10.5.
Kidneys: fibrous capsule; renal cortex and renal medulla; blood supply
Cortical and juxtamedullary nephrons
Microscopic functional units: nephrons

Renal cortex: corpuscles (glomeruli and Bowman's capsules); afferent and efferent arterioles;
proximal and distal convoluted tubules
Glomeruli: fenestrated glomerular capillaries; Bowmans capsule (podocytes)
Juxtaglomerular apparatus: macula densa, juxtaglomerular cells and mesangial cells
Renal medulla: pyramids and columns; proximal and distal convoluted tubules, loop of Henle and
collecting ducts
Transitional epithelium in renal pelvic and ureter
10.6.
Imaging of pelvis and perineum
Pelvis X-ray
Fluoroscopy (hysterosalpingogram)
pelvis and perineum
Computed tomography (CT) and magnetic resonance imaging (MRI) of male and female pelves, visceral
organs, blood vessels and pouches
11.
RENAL PHYSIOLOGY
11.1. Renal tubular functions

Concept of renal clearance (measurement of glomerular filtration rate [GFR] and renal plasma flow
[RPF])
Autoregulation of GFR and RPF
Contribution of tubuloglomerular feedback mechanism to autoregulation
Effect of sympathetic nerve on GFR
Other factors controlling RPF and GFR
52
11.2. Regulation of plasma osmolarity and water balance

Importance of water balance
Two important features of loop of Henle: solute and water permeability in ascending and descending
limbs
Role of countercurrent multiplier in the generation of a concentration gradient in the medullary
interstitium and a hypotonic fluid in the lumen
Role of urea recycling in the urinary concentrating mechanism
Role of countercurrent exchanger in the preservation of the concentration gradient in the medullary
interstitium
Regulation of urine concentration by anti-diuretic hormone (ADH)
ADH secretion response to changes in plasma osmolarity and blood volume
Clinical examples of disordered ADH secretion (Diabetes insipidus and Syndrome of Inappropriate ADH
secretion)
11.3. Regulation of Na+ balance and effective circulating volume
Control of Na+ and effective circulating volume (ECV)
Na+ handling in different nephron sites
Regulation of Na+ reabsorption (Glomerulotubular [GT] balance; Renin-angiotensin-aldosterone system;
neural and hormonal factors)
Integrated response to a decrease in ECV
11.4. Regulation of K+ balance
Importance of K+ balance
K+ handling by the kidney: importance of regulated distribution of K+ between ICF and ECF, and
secretion of K+ in the distal nephron
Factors affecting K+ secretion (Plasma K+ and aldosterone; distal flow rate; distal nephron H+ secretion)
Factors affecting transcellular K+ movement (acid-base status; cell lysis; hormonal effects)
53
Treatment of hyperkalemia
11.5. Renal function
To study the renal responses to different forms of fluid and electrolyte loading
To illustrate the effects of water restriction, water loading, saline loading and alcohol consumption on
the volume and tonicity of urine
To determine GFR based on a 24-hour urine collection and the measurement of creatinine clearance
11.6.
Drugs on the kidney
Angiotensin converting enzyme (ACE) inhibitors and their effect on GFR

Basic mechanisms of diuretics (ADH antagonists; osmotic diuretics; transport inhibitors)
11.7.
Micturition
Innervation of the bladder and sphincters

Control of bladder function
Micturition reflex
11.8. Renal handling of bicarbonate
Basic components in the regulation of [H+]
ICF buffering
ECF buffering and the bicarbonate buffer system
Reabsorption of filtered bicarbonate (bicarbonate trapping) by various segments of the renal tubule
Generation of new bicarbonate by combining with filtered phosphate or ammonia
Factors affecting bicarbonate reabsorption and their clinical significance
11.9.
Acid-base disturbance: the basics I and II
Contributions from buffers, kidneys and lungs

Carbon dioxide excretion - ventilatory responses to H+ and CO2
Respiratory acidosis and compensations
Respiratory alkalosis and compensations
54
Non-respiratory acidosis and compensations

Non-respiratory alkalosis and compensations
Some examples of causes of acid-base disturbances (list only)
11.10. Renal and cardiovascular demonstration
To demonstrate how the renal and cardiovascular systems work together to maintain homeostasis, and
in particular, the regulation of blood volume and pressure
To demonstrate the effects of osmotic diuretics and the actions of diuretic drugs
12.
12.1. Receptor-mediated cell signalling and tissue response

The relationship between receptors/cell signalling pathways/tissue responses and how these are
affected by drug action
G-protein cycles
The role of phosphorylation reactions in relation to the activity of kinases and adaptor proteins
Adaptation of receptors to changes in their environment
Cell-specific nature of cell signalling responses
12.2.
Introduction to pharmacology I
Definitions (drugs, therapeutics, etc)

Sources of drugs
Properties of drugs that are important for their clinical uses
Drug development
Drug information sources
12.3.
Introduction to pharmacology II
Methods of studying drug action
55
Modes of action of drugs

Receptors (Agonist, antagonist, functional antagonist, dose response, potency, specificity)
Enzymes
Ion channels
Transporters
12.4.
AGONISTS
Receptor occupancy as a function of agonist concentration
The concept of Affinity
Full and partial agonists (The concept of efficacy, receptor reserve)
12.5.
ANTAGONISTS
Competitive reversible and irreversible receptor antagonists
Effects on log concentration-response curves
Potency and the pA2 scale
Specificity
Non-competitive and functional antagonism
13.
13.1.
PHARMACOKINETICS
Drug ADME I, II, III
DRUG ABSORPTION
Membrane barriers and transport systems
Routes of administration
pH-partition hypothesis - ion trapping
Physiological and pathological factors that affect drug absorption
56
DRUG DISTRIBUTION
Factors that affect drug distribution
Drug-protein binding
Apparent volume of distribution
DRUG METABOLISM
The major drug metabolizing systems
The first-pass effect
Phase I reactions
Phase II conjugation reactions
Enzyme induction and inhibition
Genetic polymorphism on drug metabolism
Other factors that affect drug metabolism
DRUG EXCRETION
Renal excretion
Extra-renal excretion
Enterohepatic circulation
13.2.
Pharmacokinetics I, II, III
PHARMACOKINETICS
Basic concepts
Compartmental models
Simple calculations
Half-life, volume of distribution, clearance, area under curve (AUC), bioavailability
Multiple-dose regimens
Calculation of loading and maintenance doses
Drug accumulation
57
Clinical implications
14.
14.1.
DRUG ACTION ON THE PERIPHERAL NERVOUS SYSTEM

Sites of actions for cholinergic drugs

Classification of cholinergic receptors
Drug actions at postganglionic parasympathetic synapses
Drug actions at autonomic ganglia
Drugs that inhibit acetylcholine release
Drugs that inhibit acetylcholinesterase
14.2.
Sites of actions for adrenergic drugs

Classification of adrenergic receptors
Examples of adrenergic drugs
Drug actions at postganglionic sympathetic synapses
Clinical uses of adrenergic drugs
15.
15.1.

Drugs used in cardiovascular diseases I
Causes and Consequences of Intermittent Claudication

Goals of therapy
Drugs for treating Intermittent Claudication: Vasodilators; Anti-platelet agents; Cilostazol;
Pentoxifylline; Naftidrofuryl
Mechanisms of action
58
Causes and Consequences of Cardiac Arrest

Drugs for treating Cardiac Arrest: Vasoconstrictor sympathomimetics; Ionotropic
sympathomimetics
Causes and Consequences of Septic Shock
Drugs for treating Septic Shock
Importance of Cardiopulmonary Resuscitation
Drugs for treating global ischemia
Blood Coagulation Cascades and Formation of Blood Clots
Uses of anti-fibrinolytic agent
Pheochromocytoma and High Blood Pressure
Drug for treating Pheochromocytoma
Alpha-adrenoceptors and Blood Pressure Regulation
Uses of alpha1-adrenoceptor blockers in treating hypertension
15.2.
Drugs used in cardiovascular diseases II
Clinical case of Intermittent claudication is introduced.

Discussion on the proper uses of appropriate and non-effective drugs in treating Intermittent
claudication.
15.3.
Pharmacology I: anti-arrhythmic drugs
Introduction of electrical activities / ion channels / action potential of the heart

59
Causes of cardiac arrhythmias

Drugs for treating cardiac arrhythmias
Class I: Na+ channel block
Class II: -Adrenoceptor block
Class III: Lengthening of refractoriness (without Na+ channel block)
Class IV: Ca2+ channel block
Clinical uses and Precautions
15.4.
Pharmacology II: anti-hypertensive drugs
Introduction of physiological regulation of blood pressure and the development of hypertension.

Causes of high blood pressure
Non-pharmacological strategies in lowering blood pressure
Drugs for treating hypertension
Diuretics
-adrenoceptor (-AR) Blockers
Angiotensin Converting Enzyme (ACE) Inhibitor
Angiotensin Receptor (AR) Antagonist
Ca2+ Channel Blockers
-adrenoceptor (-AR) Blockers
Direct Acting Vasodilators
Diuretic plus -AR Blocker
Diuretic plus ACE Inhibitor (or AR Blocker)
Ca2+ Channel Blocker plus -AR Blocker
Ca2+ Channel Blocker plus ACE Inhibitor
-AR Blocker plus -AR Blocker: Mechanisms of action
60
15.5.
Pharmacology III: drugs for ischaemic heart disease
Physiological factors affecting coronary blood flow

Risk Factors
Non-pharmacological strategies in alleviating ischemic heart disease
Uses of drugs
Lipid Regulating Drugs
Malfunction of coagulation cascades
Uses of drugs
Anti-platelet drugs
Anti-coagulants
Thrombolytic Drugs
-adrenoceptor blocker
Angiotensin-converting enzyme inhibitor
Nitrates
Ca2+ channel blockers
Metabolic modulator
15.6.
Pharmacology IV: drugs for heart failure
Introduction of heart failure and risk factors for heart

failure development
Management of heart failure
Objectives of treatment
Uses of drugs
Diuretics
Digoxin
61

-adrenoceptor blockers
Nitrate plus Hydralazine
Spironolactone
16.
16.1

Control of acid secretion

Pathways and receptor targets modulating acid secretion/mucous secretion
Causes of ulcer (drugs, H. pylori)
Ulcer treatment
Antacids; misoprostol; sucralfate; carbenoxolone
Anti-muscarinic; Anti-histamines; proton pump inhibitor
Triple therapy; bismuth
16.2.
Mechanisms of Peristalsis
GERD
Mechanism of prokinetic drugs; metoclopramide; domperidone; erythromycin; motilin; ghrelin
Drugs causing constipation
Drugs to facilitate defecation: bulk/osmotic/stimulant laxatives
Diarrhoea: causes, anti-diarrhoeal drugs, loperamide; diphenoxylate; kaolin; bismuth; charcoal
16.3.
Antiemetics
Causes of nausea and emesis: Central and peripheral pathways involved in nausea and emesis control
Drugs used to induce emesis for emergency purposes: apomorphine, ipecacuanha
62
Drugs used to prevent nausea and emesis: dopamine receptor antagonist (different classes), 5-HT3
receptor antagonist, NK1 receptor antagonists, other agents including dexamethasone
16.4.
Antiemetics and drugs used for GI disorders
Understanding affinity and mechanisms of action of anti-emetic drugs

Receptor selectivity of dopamine, 5-HT3, muscarinic, histamine antagonists
Side effect profile
Brain penetration mechanism of chemotherapy-induced emesis
17.
17.1
REPRODUCTIVE SYSTEM
Male urogenital system
Overall organization of the male reproductive tract
Prostate gland and bladder outlet obstruction
Scrotum: dartos muscle and fascia

Position and functions of testes and epididymides
Testis: tunica vaginalis, tunica albuginea
Lymphatic drainage of testes
Components of spermatic cord (vas deferens, testicular artery, pampiniform plexus, nerves, lymphatic
vessels, spermatic fasciae, cremaster muscle) and its course inside and outside inguinal canal
Origins of spermatic fasciae and cremaster muscle
Course of vas deferens
Position and functions of accessory sex organs and ducts: prostate, seminal vesicles, ejaculatory ducts
Penis: root (bulb and crura); body; glans penis; prepuce; erectile tissue (corpora cavernosa, corpus
spongiosum); parts of urethra (prostatic, membranous, penile); vascular supply
Penile urethra inside corpus spongiosum; internal and external urethral openings
Arterial supply and venous drainage of testis
Mechanisms in the control of testis temperature
63
17.2.
Female urogenital system
Overall organization of the female reproductive tract
Prolapse of uterus
Position and functions of ovaries

Support of ovary: suspensory and ovarian ligaments
Parts of uterus: fundus, body, cervix, cavity; uterine tube
Uterine tube: isthmus; ampulla (fertilization site); infundibulum, fimbrae
Normal position of uterus (anteversed and anteflexed); support of uterus: broad ligament, round
ligament, levator ani
Course of round ligament Cervix: canal, internal and external os
Vagina: vestibule, fornices (posterior and lateral), hymen; relationship with peritoneum
Arterial supply and venous drainage of reproductive tract and ovaries
17.3.
Histology of the reproductive system
Male
Testis: seminiferous tubules and interstitial (Leydig) cells; germinal epithelium, Sertoli cells, different
developmental stages of spermatogenic cells
Epididymis: epithelium; principal (stereocilia) and basal cells
Seminal vesicles: fibrous coat; mucosal folds; epithelium, tall non-ciliated columnar cells
Prostate: epithelium; glands
Penis: superior and deep vessels; sinusoids; urethra in corpus spongiosum
Female
Ovary: germinal epithelium; cortex and medulla (contains ovarian follicles)
Different developmental stages of ovarian follicles: primordial, growing, atretic and mature (Graafian)
Growing and mature follicles: oocyte, zona pellucida, granulosa cells, corona radiata and internal and
external thecal cells
Corpus luteum: granulosa lutein and theca lutein cells
64
Fallopian tube: epithelium and muscle

Uterus: endometrium, myometrium, and perimetrium (peritoneum); uterine glands; spiral arteries
Cervix: endometrium (different from the rest of the uterus) and cervical glands
Structural changes of endometrium at different phases of the menstrual cycle: proliferative, secretory
and menstrual
18.
MUSCULOSKELETAL SYSTEM
18.1.
Bones of the limbs
Organization of bones in the upper and lower limbs
Names of other carpal bones
Structural and functional comparison of bones of the upper limb (e.g. flexible movements) with bones
Cubital (carrying) angle of upper limbs
of the lower limb (e.g. weight bearing and locomotion)
Blood supply to scaphoid in relation to
Articulation and muscle attachment sites; special features in relation to the course of nerves
fractures
Clavicle: medial and lateral ends

Scapula: glenoid cavity, processes (coracoid, acromion), spine, borders, angles, fossae and scapular
notch
Humerus: head, neck (surgical), tuberosities, intertubercular/bicipital groove, spiral/radial groove,
epicondyles (medial - common flexor origin, lateral - common extensor origin), olecranon fossa,
trochlea and capitulum
Ulna: olecranon process, coronoid process, styloid process; radius: head, neck, tuberosity, styloid
process
Carpal bones: scaphoid (inside anatomical snuff box; force transmission), hamate, pisiform, carpal arch;
metacarpals; phalanges
Femur: trochanters, linea aspera, epicondyles and condyles
Patella
65
Tibia: condyles, intercondylar eminence, tibial tuberosity, medial malleolus; fibula: head, lateral
malleolus
Tarsal bones: talus, calcaneus, navicular, cuboid and cuneiform; metatarsals; phalanges
Arches of the foot: longitudinal and transverse arches; functions
Coxal: ilium (iliac crests, iliac spines), ischium (ischial tuberosities), pubis (arch); acetabulum;
ischiopubic rami; sciatic notch
18.2.
Joints of the limbs
Classification of joints: fibrous, cartilaginous and synovial (capsule, capsular ligaments, synovial
Lock' and 'unlock' knee
membrane)
Capsular ligaments: iliofemoral, ishiofemoral
Compare the relative free movements of the shoulder joint and its stability with hip joint
and pubofemoral
Shoulder (glenohumeral) joint: articulation of humeral head with glenoid cavity of scapula; glenoid
Dislocation of shoulder joint and possible
labrium; characteristics of its mobility and stability (reinforcement by ligaments and muscle tendon);
damage to related nerve (axillary nerve)
bursae
Bursitis, tendosynovitis and tendonitis at
Elbow joint: articulation of humerus and ulna
shoulder and elbow joints
Radioulnar joint: Proximal and distal joints between radius and ulna; annular ligament; rotation of
Intracapsular and extracapsular fractures
radius over ulna; interosseous membrane
Torn collaterals and cruciate ligaments,
Wrist (radiocarpal) joint: radius and triangular fibrocartilage articulate with proximal row of carpal
bursitis, genu varum and genu valgum of knee
bones
joints; clinical test for knee ligament injuries
Hip joint: articulation of femoral head with acetabulum; labrum; capsular ligaments; ligamentum teres;
Pott's fracture
bursae
Sprained ankle; clinical tests
Knee joint: articulation of femur and tibia; fibrous capsule; cruciate and collateral ligaments; menisci;
bursae (supra-, infra-, pre-patellar)
Tibiofibular joint: interosseous membrane
Ankle joint: Tibia articulation with talus; fibrous capsule; medial/deltoid and lateral ligaments;
Movements at joints of the hand and foot:
joints between metacarpals/metatarsals and phalanges

66
(metacarpophalangeal and metatarsophalangeal joints) as well as between phalanges (interphalangeal

joint) in hand and foot
Carpometacarpal joint of the thumb; subtalar and transverse tarsal joints in foot (ligaments: spring,
short and long plantar, anterior talofibular)
18.3.
Muscles and movements of the limbs
Overall organization of functional muscle groups; muscle attachments (origins and insertions),
Carpal tunnel syndrome
movements, and innervation
Lateral rotators of hip
Superficial and deep fasciae; fascial compartments
Gluteal injection: how to avoid gluteal and
Principle of muscle actions: prime movers and synergists
sciatic nerves
Muscles around the shoulder and shoulder joint: latissimus dorsi, serratus anterior, trapezius, deltoid,
The main nerves at risk and consequence on
pectoralis major, biceps brachii, rotator cuff muscles; formation of anterior and posterior axillary folds
motor and sensory functions
Movements of the shoulder and muscles involved: humeral and scapular movements
Rupture of calcaneal tendon (Achilles tendon)
Muscle groups of the arm and movements: anterior (biceps and brachialis; flexion of the elbow) and
and its diagnosis
posterior (triceps; extension of the elbow)
Plantar fasciitis
Flexors and extensors of the forearm; movements of the wrist and fingers
The gait cycle
Pronation and supination of the forearm; joints and muscles involved

Muscles of the hand: thenar and hypothenar, interossei and lumbricals
Movements of thumb and fingers: flexion, extension, abduction, adduction, opposition and
circumduction of the thumb
Concept of the supinator and the three long thumb muscles (anatomical snuff box)
Roles of tendons, tendon sheaths, synovial sheaths, aponeuroses and retinacula; carpal tunnel
Muscles of gluteal region: iliotibial tract, gluteus muscles,
Muscle groups of the thigh: anterior (iliopsoas, sartorius, quadriceps, ligamentum patella), medial
(gracilis, adductors) and posterior (hamstring muscles)
67
Flexion of knee: hamstring muscles; extension of knee: quadriceps; unlock knee: popliteus
Borders and contents in femoral triangle and cubital and popliteal fossae
Muscle groups of the leg: anterior (extensors of ankle and toes; inversion of foot), lateral (two
fibular/peroneal muscles; eversion of foot ) and posterior (gastrocnemius, soleus; calcaneal tendon;
flexors of ankle and toes)
Movements at ankle joint: dorsiflexion (extensors of ankle and toes); plantar flexion (gastrocnemius
and soleus; flexors of ankle and toes); eversion (peroneal muscles); inversion (anterior leg muscles)
Dorsum (tendons of long extensor of toes) and sole (short muscles) of the foot
Maintenance of foot arches by long tendons, ligaments and plantar aponeurosis
18.4.
Vascular system of the limbs
Overall organization of arterial supply, venous drainage (deep and superficial) and lymphatic drainage
Axillary artery and its main branches
of the limbs
Common sites for venipuncture and insertion
Upper limb arteries: subclavian, axillary, brachial, radial, ulnar and palmar arches (superficial, deep);
of catheter or hypodermic needle
veins: deep (axillary, subclavian, radius, ulnar); superficial (cephalic, basilic, median cubital); venae
Blood supply of the head of femur in relation
comitantes
to fractures
Lower limb arteries: femoral, popliteal, fibular, anterior and posterior tibial, dorsalis pedis, plantar arch;
Concept of cruciate anastomosis (inferior
veins: deep (femoral, popliteal, fibular, anterior and posterior tibial); superficial (great and small
gluteal and femoral system)
saphenous); venae comitantes
Angiogram as a map of circulation
Positional relation of femoral and lymphatic vessels with inguinal ligament
Localization of level of arterial blockade
Arterial anastomoses around scapula, elbow and palm
Radicular pain: location of pain versus
Mechanisms of venous return: fascial compartment; contraction of muscles; valves in veins; perforating
localization of origin of pathology
veins
Varicose veins
Lymphatic drainage: valves in lymph vessels; positions of superficial and deep lymph nodes
Axillary lymph nodes - drainage of breast
68
Sites for taking arterial pulse and measurement of blood pressure

18.5.
Nerve innervation of the limbs
Segmental origin, composition, and organization of limb plexuses (roots, trunks, divisions, cords)
Clinical presentations of radial nerve lesion,
Course, distribution, and branches of brachial and lumbosacral plexuses (e.g. ulnar nerve at the elbow
ulnar nerve lesion and median nerve lesion
and the wrist; fibular nerve in proximity to fibular neck)
Carpal tunnel syndrome
Motor innervation of different muscle groups of the limbs (flexors, extensors, adductors, abductors)
Obturator nerve: pain referred to skin of
Nerves of the upper limbs: axillary, musculocutaneous, median, radial and ulnar nerves
medial thigh
Nerves of the lower limbs: gluteal, femoral, obturator and sciatic nerves
Fibular nerve supply in relation to functional
Course and branches of sciatic nerve (tibial, fibular or peroneal, plantar)
loss
Dermatomes of the shoulder, arm, forearm and hand in the upper limbs; the dorsum and sole of foot in
the lower limbs
Myotome: concepts of innervation by more than one segment
Concepts of tendon reflex: biceps and knee and ankle jerks (importance in mapping injuries to spinal
nerve roots)
Main nerves at risk and consequence on motor and sensory functions
69
18.6.
Morphology of the spine
Overall organization of the spine and its divisions
Whiplash injuries
Normal curvatures and their changes with age; line of center of gravity
Hyperflexion of neck
Functional adaptation of the spine: movement and weight support
Cervical spondylosis; spondylolisthesis
Basic features of a typical vertebra: body, vertebral arch, articular facets, vertebral foramen, and
Disc herniation (e.g. sciatica)
transverse and spinous processes
Foot drop
Structural specialization of vertebrae for function at cervical (transverse foramen for passage of
Lumbar puncture
vertebral arteries), thoracic (costal facets for articulations with ribs), lumbar (large body for supporting),
Caudal analgesia
sacral (fused vertebrae for weight bearing) and coccygeal (fused vertebrae) regions
Atypical features of atlas (no body and spinous process) and axis (with dens)
Joints between occipital condyles of the skull and atlas (atlantooccipital joint) and between atlas and
axis (atlantoaxial joint)
Intervertebral joints: intervertebral discs between two vertebrae; range of movements at different
regions
Intervertebral disc: nucleus pulposus and annulus fibrosus
Ligaments between vertebrae and ligaments attached to skull (ligamentum nuchae, ligamentum
flavum, anterior and posterior longitudinal ligaments)
Joints of the vertebral arches: intervertebral foramen for passage of spinal nerves
Joints between vertebrae and ribs
Sacroiliac joint
Principles of back muscle (trapezius, latissimus dorsi, rhomboids, levator sacpulae, erector spinae);
main actions; innervation
Contents of the vertebral canal: spinal cord, cauda equina, dural thecal sac, subarachnoid space,
terminal filum
Vertebral level of termination of spinal cord
70
18.7.
Imaging of the musculoskeletal system
Imaging modalities: plain X-ray, magnetic resonance imaging (MRI), angiogram
Spiral cord on MRI
Vertebra and intervertebral discs on plain radiograph, CT and MRI
Spinal nerve roots on Myelogram and MRI
Paraspinous muscles on CT and MRI
Abnormal radiological anatomy of bones and
Normal radiological anatomy of bones and soft tissues of upper limb: shoulder, elbow, wrist, carpal
soft tissues of upper limb: shoulder, elbow,
tunnel and hand; lower limb: hip, knee, ankle and foot
wrist and hand (scaphoid fracture); lower
Angiograms of arteries and veins in limbs
limb: hip (fracture neck of femur), knee (tear

of anterior cruciate ligament), ankle and foot
(fracture of calcaneus)
Angiograms of abnormal arteries (arterial
blockage) and veins (deep vein thrombosis) in
limbs
18.8.
An Introduction to musculoskeletal examination upper limb
Inspection
Always compare both sides
Contour, swelling, deformity, skin condition and colour, evidence of pain or discomfort
Muscle bulk
Identify anatomical landmarks
Palpation
Anatomical landmarks of both joints, as well as adjacent structures
Temperature, tenderness, swelling, crepitation, muscle bulk, muscle tone, contracture
Movements
Be aware of the components resulting in movement of the shoulder girdle as a unit
Active and passive movements
Range, limitation, abnormality
71
Assess for both functional & physical (pathological) defects

Test flexion, extension, abduction, adduction, internal & external rotation, circumduction, supination
and pronation
Measurement of carrying angle of elbow, using goniometer
Muscle power (MRC grading)
18.9.
An Introduction to musculoskeletal examination lower limb and spine
Inspection
Observe for evidence of pain or discomfort.
Always compare both sides
Include ability to stand and walk, posture and gait (if possible)
Skin, muscle bulk/wasting, swelling, deformities
Palpation and Measurement
Assess for any limb length discrepancy apparent and true leg length
Palpate anatomical landmarks
Check for temperature differences, swelling, mass, tenderness
Movements
Squaring of pelvis
Passive and active range of movement in supine and prone positions.
Flexion, abduction, adduction,
internal and external rotation in supine position. Extension in prone position.

Goniometry
Functional and pathological assessment
Special Tests: Thomas test for fixed flexion deformity
72
DOCTOR AND PATIENT 1

Year 2
Topic
Format
Hours Session Content
Family Doctor
1) Introduction to Family
lecture
Attachments
Doctor visits
Introduction of Family Doctor Visited and the expected professional behavior from
students. Distribution of information of assigned family doctors. Discussion on
expected professional behavior during visits. Guidance for clinical visits.
2) Family doctor visit 1
Visit
The relationship between a doctor and a patient is unique. During this visit, students
are encouraged to think about the elements that make the interaction different from
other social interactions and settings. Students will start to record details of
consultations in your reflective log sheets as they observe the variety and nature of
patients seen during a consultation.
3) Family doctor visit 2
Visit
After this visit, a seminar will be conducted for students to discuss one or more of
patients who they have seen on visits. Students will record brief details of at least one
consultation to discuss with their groups- this can be patient with an interesting clinical
diagnosis or something else which was interesting. Students will observe the types of
questioning that the attached FPs use. E.g. open, closed, probing, or clarifying? To
identify key communication skills that students will need to develop over time.
4) Debriefing of FP visit
Seminar
1.5
Debriefing and sharing of visits with FPs and presentation and sharing of 1 or 2 patient
encounters. There will be discussion on the content and the use of reflective logs.
Family Follow
Up Projects
1) Family FU Project-Intro Lecture &

Tutorial
2+1
The Family follow up project would be introduced to the students in year with an
introductory lecture by the 4 departments which include the outcomes of the project
and also basic knowledge of childbirth, the postpartum period and early neonatal
development and family adjustment. Students would then meet with their tutors to
prepare for their ward interview with their mothers and to discuss concerns and
expectations of the course.
73
Course objectives: (year 2)

1) Describe normal child birth experience and show awareness of common
difficulties around pregnancy and child birth.
2) Describe normal physical development of a child from birth to 3 months old
3) Discuss issues around parental concerns and care provision, feeding and
family adjustment
4) Demonstrate professionalism: communication skills, confidentiality
and
attitude
2) Family FU Project-Field
Visit
The students (in pairs or threes) obtain written consent and interview mothers post
work: Ward Visit for
delivery on the wards. The interview is semi structured in nature and would
interview &
encompass pregnancy expectations and preparation, experience of child birth and child
assessment
rearing plans.
3) Family FU
Tutorial
The tutorial will enable sharing and appreciation of the differences in families
Project-Tutorial post
background, expectation and experiences and in creating a rapport with the mother.
Ward Visit & Briefing
The group tutor would facilitate discussion and facilitation of the upcoming visit of the
st
for 1 FU
4) Family FU
family at home.
Visit
Project-Home Visit
This visit would enable students to see the family in their home environment and initial
adjustments to the new born who is now 3 months old. The students would conduct a
semi structured interview looking at carer responsibilities and routine, health and
feeding practices, health care provision and immunization and to assess the child
growth and development
5) Family FU ProjectTutorial post Home Visit
Tutorial
The tutorial would enable sharing of the health and development of the child at 3
months and to appreciate the differences in growth and development as well as family
circumstances and adjustment.
74
Following this visit, the students would be required to hand in a report which includes
the description of various aspects of the family, pregnancy, child birth and family
function with personal reflection and learning points
75
Drug List of Medical Year 2

CORE
11.6.
ADVANCE
Drugs on the kidney
Diuretics
Acetazolamide, furosemide, bumetanide,

hydrochlorothiazide, mannitol, spironolactone,
amiloride, triamterene, lithium carbonate
12.
12.4.

AGONISTS
Acetylcholine, adrenaline, histamine,

noradrenaline
12.5.
ANTAGONISTS
Atropine, diphenhydramine, mepyramine,

phenoxybenzamine
13.
13.1.
14.
14.1.
PHARMACOKINETICS
Drug ADME I, II, III
Paracetamol (Acetaminophen)
Drug Action on the peripheral nervous system

Muscarinic receptor agonists
Acetylcholine
Carbachol, methacholine,
bethanechol,
Muscarinic receptor antagonists
Atropine, hyoscine
Tropicamide, homatropine,
tiotropium, pirenzepine,
76
hyoscine-N-butyl bromide
Nicotinic receptor agonists
Nicotine
Acetylcholine
Ganglion blockers
Hexamethonium
Trimetaphan
Drugs that inhibit acetylcholine release
Botulinum toxin
-bungarotoxin
Short-duration anticholinesterase
Edrophonium
Medium-duration anticholinesterases
Neostigmine
Physostigmine
Long-duration anticholinesterases
Dyflos
Ecothiopate
Cholinesterase reactivators
Pralidoxime
Obidoxime
14.2.
Adrenoceptor agonists
Noradrenaline (1, 2, 1) , adrenaline (1, 2,

1, 2), isoprenaline (1, 2)
1-adrenoceptor agonist
Phenylephrine
Clonidine
Dobutamine
2-adrenoceptor agonists
Terbutaline
Salbutamol, ritodrine, salmeterol,

formoterol
1-adrenoceptor antagonists
Phentolamine , phenoxybenzamine
2-adrenoceptor antagonist
Yohimbine
-adrenoceptor antagonists
Propranolol (1, 2), atenolol (1 >2)
77
Terazosin, prazosin, tamsulosin
Metoprolol, celiprolol, caervedilol
Adrenergic neurone blocking drugs
Guanethedine
Bretylium,reserpine, clonidine,
-methyl-DOPA
Indirectly acting sympathomimetics
Tyramine
Amphetamine, ephedrine
Uptake-1 inhibitors
Cocaine
Imipramine, phenoxybenzamine
15.
15.1. & 15.2
Drugs used in cardiovascular diseases
Intermittent Claudication
Pentoxifylline; naftidrofuryl, cilostazol
Cardiac Arrest
Ephedrine; noradrenaline; phenylephrine
Septic Shock
Dopamine; dobutamine
Cardiopulmonary Resuscitation
Adrenaline; atropine
Formation of Blood Clots
Aprotinin
Pheochromocytoma
Phenoxybenzamine
15.3.
Pharmacology I: Anti-arrhythmic drugs
Drugs for treating cardiac arrhythmias

Class I: Na+ channel block
Disopyramide, flecainide
Mexiletine, procainamide, quinidine,

metoprolol, bisoprolol, carvedilol,
nadolol
Class II: -Adrenoceptor block
Atenolol
Metoprolol, bisoprolol, carvedilol,

nadolol, propranolol
Class III: Lengthening of refractoriness (without Na+ channel
Sotalol, amiodarone
block)
Class IV: Ca2+ channel block
Verapamil
78
Others
15.4.
Digoxin, adenosine, bretylium

Pharmacology II: Anti-hypertensive drugs
Drugs for treating hypertension

Diuretics
Hydrochlorothiazide, frusemide, amiloride
Indapamide, metolazone, bumetanide,

spironolactone
-adrenoceptor (-AR) blockers
Atenolol, metoprolol
Bisoprolol, propranolol, carvedilol
Angiotensin converting enzyme (ACE) inhibitors
Ramipril, lisinopril
Captopril, enalapril, perindopril
Angiotensin receptor (AR) antagonists
Losartan, candesartan
Irbesartan, telmisartan, valsartan
Ca2+ channel blockers
Amlodipine, diltiazem
Felodipine, nifedipine, nimodipine
-adrenoceptor (-AR) blockers

Direct acting vasodilators
15.5.
Phentolamine, prazosin, terazosin

Hydralazine, sodium nitroprusside
Pharmacology III: Drugs for ischaemic heart disease
Lipid Regulating Drugs
Simvastatin, gemfibrozil, nicotinic acid
Atorvastatin, rosuvastatin
Anti-platelet drugs
Aspirin
Clopidogrel
Anti-coagulants
Warfarin, nadroparin
Dabigatran, rivaroxaban
Thrombolytic drugs
Streptokinase, urokinase
-adrenoceptor blocker
Propranolol
Ramipril, lisinopril
Nitrates
Glyceryl trinitrate; isosorbide mononitrate
2+
Ca channel blockers
Verapamil, nifedipine, amlodipine
Metabolic modulator
Trimetazidine
79
16.
16.1

Control of acid secretion

Pathways and receptor targets modulating acid
Betazole, pentagastrin
secretion/mucous secretion
Prostanoids
Causes of ulcer
Indomethacin, dexamethasone
Histamine, gastrin, acetylcholine
Ulcer treatment
Antacids
Aluminium hydroxide, sucralfate,
Sodium bicarbonate
carbenoxolone
Prostaglandin
Misoprostol
Anti-muscarinic
Pirenzepine
Anti-histamines
Ranitidine
Famotidine
Proton pump inhibitor
Omeprazole
Pantoprazole
Triple therapy (H. pylori)
Omeprazole, ranitidine bismuth citrate,
Metronidazole
amoxicillin, clarithromycin
16.2.
GERD
Prokinetic drugs
Metoclopramide, domperidone, erythromycin,
Cisapride, bethanechol
prucalopride
Drugs causing constipation
Atropine
Clonidine
Drugs to facilitate defecation: bulk/osmotic/stimulant
Bassorin, MgSO4, lactulose, bisacodyl
Methylcellulose
Loperamide, diphenoxylate, kaolin, bismuth
Hydration
Laxatives
Anti-diarrhoeal drugs,
80
16.3.
Antiemetics
Drugs used to induce emesis for emergency purposes:
Apomorphine, ipecacuanha
Drugs used to prevent nausea and emesis:
Metoclopramide, domperidone,
Dopamine receptor antagonist (different classes)
chlorpromazine, droperidol
Antihistamine
Cyclizine, promethazine
Antimuscarinic
Scopolamine
5-HT3 receptor antagonist
Ondansetron, palonosetron
Granisetron
NK1 receptor antagonists
Aprepitant
Netupitant
Other agents
Dexamethasone in combination with other
Nabilone
Haloperidol
Cinnarizine
drugs
Notes:
Core column are drugs that are representative of the group and students should be able to name and have thorough understanding of their detail
pharmacology.
Advance column are drugs that are clinically used from the group and students are expected to recognize and describe any significant differences
from the representative drug(s) in the core column.
81

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The Chinese University of Hong Kong

Course Title: Human Structure I

THORAX AND CARDIOVASCULAR/ RESPIRATORY SYSTEM

Organization of the thorax

6.1, 6.2, 6.13, 6.14

Pleura, lungs and diaphragm

6.2, 6.4, 6.5

Pleural cavities and lungs

The heart and mediastinum

6.7, 6.8, 6.9, 6.11,

6.7, 6.8, 6.9, 6.10,

Posterior and superior mediastinum

Surface anatomy of the thorax

Radiology of the thorax

Histology of the respiratory tract and

Histology of the cardiovascular system

Organization of the abdomen and

8.1, 8.2, 8.3, 10.1

8.4, 8.10, 8.12

8.6, 8.7, 8.10

8.4, 8.10, 8.12

ABDOMEN AND DIGESTIVE SYSTEM

Stomach and the intestines, coeliac

Surface anatomy of the abdomen

Radiology of the abdomen

Histology of the digestive system: GI

8.11, 8.12, 8.13

8.11, 8.12, 8.13

8.2, 8.9, 10.3

8.2, 8.9, 10.3

Kidneys, adrenals and posterior

10.1, 10.2, 10.4

10.1, 10.2, 10.4,

10.1, 10.2, 17.1,

Histology of the kidney

Histology of the kidney

Joints and movements of the upper

Histology of the male reproductive

Axilla and arm

Vertebral column and back muscles

Shoulder and joints

Flexors of forearm and palm

18.3, 18.4, 18.5

Extensors of forearm and dorsum of

18.3, 18.4, 18.5

Axilla and arm

18.3, 18.4, 18.5

Forearm and hand

18.3, 18.4, 18.5

18.3, 18.4, 18.5

Gluteal region and posterior thigh

18.3, 18.4, 18.5

The leg and foot

18.3, 18.4, 18.5

Anterior and medial thigh

18.3, 18.4, 18.5

Gluteal region and posterior thigh

18.3, 18.4, 18.5

Popliteal fossa and leg

18.3, 18.4, 18.5

Joints of the lower limb

18.1, 18.3, 18.6

Surface anatomy of the back, upper

Course Title: Human Function I