STUDY GUIDE

MUSCULOSKELETAL MODULE
1st Professional MBBS (Session 2018-19)
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CONTENTS

 List of Abbreviations 2
 Module Planning Committee 3
 Distribution of subjects 4
 Introduction to Musculoskeletal Module and Themes 5
 General Learning Outcomes 6
 Individual Themes 7
o Introduction
o Learning objectives
o List of Practicals
o List of SGDs
o List of DSLs / Others
o Timetable (with designated teachers and venues)
 Books and other reading resources 38
 Assessments
o SAQs 39
o MCQs 41
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LIST OF ABBREVIATIONS

Anat-L Anatomy Lecture IPS Islamiyat/Pak Studies

Anat-SGD Small Group Discussion in Anatomy JVP Jugular Venous Pulse

BCLS Basic Cardiac life Support MCQs Multiple Choice Questions

Bio-L Biochemistry Lecture Med-L Medicine Lecture

Objectively Structured Practical

Bio-P Biochemistry Practical OSPE
Examination
BP Blood Pressure Path-L Pathology Lecture
Small Group Discussion in
Bio-SGD PBL Problem Based Learning
Biochemistry
CCF Congestive Cardiac Failure Phar-L Pharmacology Lecture

Card-L Cardiology Lecture Phy-L Physiology Lecture

CMed Community Medicine Phy-P Physiology Practical

Small Group Discussion in

CVS Cardio Vascular System Phy-SGD
Physiology

DSL Directed Self Learning SA Sino-atrial

ECG Electro Cardio Gram SDL Self-Directed learning

FDT Film/Demonstration/Tutorial SAQs Short Essay Questions

FMed Forensic Medicine SGD Small Group Discussion

Histo-P Histology Practical Skill Lab Skill Laboratory

Professionalism and communication skills, Research, Identity formation,

PRIME
Management and leadership, Ethics
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MODULE PLANNING COMMITTEE

Prof. Dr. Noor Ul Iman

Patron
Dean, KMC
Prof. Dr. Mushtaq Ahmad Marwat
Chairman
Chairman College Curriculum Committee, KMC
Prof. Dr. Farooq Ahmed
Co-Chairman
Director Medical Education, KMC
Dr. Saleem Abbas
Course Coordinator
Department of Physiology, KMC
Dr. M Ikram
Module Director
Department of Anatomy, KMC
Prof. Dr. Mudassir Ahmad Khan
Member
Chairman, Department of Biochemistry, KMC
Prof. Dr. Qaiser Inayat
Member
Chairman, Department of Anatomy, KMC
Prof. Dr. Shafiq ur Rahman
Member
Chairman, Department of Physiology, KMC
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DISTRIBUTION OF SUBJECTS IN MUSCULOSKELETAL MODULE

Large Group Format Small Group Format

Basic and Clinical (LGA, LGB) (Batch A, B, C, and D)
S No
Sciences Practicals/ SGDs/FDT/
Lectures DSLs DSLs SDLs
Skill Lab Dissections
1 Anatomy 31+17 3 39+8
2 Histology 5 6
3 Embryology 7
4 Physiology 11 1 2 4
5 Biochemistry 9 2 8 1
6 Pharmacology 2
7 Pathology 3 10
8 Medicine 3
9 Forensic Medicine 1
10 Com. Medicine 3
11 Behavioral sciences 4
12 Medical Education 1
13 Islamiyat /Pak St. 8
Sub Totals 105 6 16 52 0 10
Grand Total 111 78
Total Contact Hours = 111 + (78x2) = 267
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Introduction to Musculoskeletal Module

A graduate of Khyber Medical College Peshawar should be able to manage (Diagnose,
Investigate, Treat, Refer, Prevent and Counsel) common musculoskeletal diseases.
Musculoskeletal Module has been designed to define the scope of Knowledge/ Skills/
Attitudes of a first year medical student of the Basic Medical Sciences i.e. Anatomy,
Physiology and Biochemistry with the introduction to the Clinical Sciences and an emphasis
of Radiological understanding and birth abnormalities. This is the Third module of 1 st year of
MBBS and will be followed by an assessment. Musculoskeletal module is 8 weeks’ theme
based module, the contents of which will be thought in lectures, SGDs, DSLs and practical
work. MSK module consists of the following themes:
1) Introduction, Frozen Shoulder (Duration: 2 week)
2) Tennis Elbow (Duration: 1 week)
3) Carpal Tunnel Syndrome (Duration: 1 week)
4) Waddling Gait (Duration: 2 weeks)
5) House Maids Knee (Duration: 1 week)
6) Foot Drop (Duration: 1 week)
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General Learning Outcomes

By the end of this module, students will be able to:
1. Develop an understanding of the fundamental components of the musculoskeletal
system.
2. Explain the structure & function of the musculoskeletal (MSK) components of limbs and
back.
3. Describe how injury and disease alter the MSK structure & function.
4. Integrate concepts relating to various metabolic processes, their disorders and relevant
laboratory investigations in the study of human MSK system.
5. Describe the role of the limbs (upper/lower) in musculoskeletal support, stability and
movements.
6. Describe the development of the limbs & correlate it with organization and gross
congenital anomalies of the limbs.
7. Identify the anatomical features of bones, muscles & neurovascular components of the
limbs and correlate them with their functions, injuries and clinical problems.
8. Describe the types, formation, stability, function & clinical significance of joints of the
upper and lower limb.
9. Describe the basic histology of muscle fibers including its molecular structure
(Sarcomere).
10. Explain the mechanism of excitation and contraction of skeletal and smooth muscles.
11. Describe the basis for the use of therapeutic agents to modulate neuromuscular
transmission.
12. Describe the general principles of MSK pain management.
13. Describe ergonomics and its principles.
14. Give an overview of pathology of bones, muscles and joints.
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Theme-1 (Orientation and Frozen Shoulder)

Introduction
The duration of this theme is 2 weeks which mainly covers the gross anatomy of pectoral
region, axilla, brachial plexus, and shoulder joint along with back and front of the arm.
Somitogenesis and development of the cartilage will also be discussed. Physiology of
skeletal muscles will include mechanism of contraction, energetics and mechanics.
Biochemistry of connective tissues and metabolism of minerals like calcium, phosphorus,
sodium, potassium and chloride will be discussed.
Specific Learning Objectives and Topics Covered
Subject /Topic S No Learning Objectives
Anatomy
Introduction to 1. Identify the extent of the upper limb.
locomotion
and upper limb 2. Identify various regions of upper limb.
3. Describe the division of the regions into compartments.
Pectoral 4. Recognize the role of muscles of pectoral region in
Region stabilizing the pectoral girdle.
5. List the muscle of pectoral girdle.
6. Describe & demonstrate the attachments of muscle of
pectoral girdle, nerve supply and actions.
7. Describe the structural organization of the clavi-pectoral
fascia.
8. Describe the nerves and blood vessels of this region
Breast 9. Describe Extent and location of breast.
10. Describe Arterial supply and lymphatic drainage of breast.
Axilla 11. Describe the position, shape of axilla.
12. Describe the muscles forming the boundaries of Axilla
13. Describe the contents of axilla
14. Describe the formation, course and relations of axillary
vessels.
15. Describe arrangement and groups axillary lymph nodes
Brachial plexus 16. Mention the formation of brachial plexus (roots, trunk,
division, and cords)
17. Describe the relation of brachial plexus also in connection
to clavicle (Supra, retro, infra clavicular parts).
18. State the branches arising the different cords.
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19. Draw the brachial plexus.

20. Describe the clinical correlates of the brachial plexus.
Erb duchane palsy
Klumpke’s palsy
Saturday night palsy
Muscles of the shoulder 21. Recognize the extent of shoulder region.
Region 22. Describe the muscle of shoulder region.
23. List the muscles of shoulder region.
24. State the detailed structures of each muscle with respect to
Origin, Insertion, Nerve supply and Action of muscles with
any characteristic features.
Osteology of clavicle 25. Recognize the bone
26. Identify the site of bone
27. State the bony land marks of clavicle: like borders, surfaces
& land mark used for bone determination
28. Describe & demonstrate the attachments of muscles.
29. Describe the common fractures of the bone.
30. Describe the surface anatomy clavicle
31. Describe the radiological anatomy clavicle
32. Describe the applied anatomy clavicle
Superficial back 33. Muscles of the back connecting the axial skeleton to the
shoulder girdle along with their nerve supply
34. Anastomosis around the scapula and its clinical significance
Osteology of scapula 35. Recognize the bone.
36. Identify the site of bone.
37. State the bony landmarks of scapula: like borders, surfaces
& land mark used for bone determination.
38. Demonstrate the attachment of muscles on scapula
39. Describe the surface anatomy scapula
40. Describe the radiological anatomy scapula.
41. Describe the applied anatomy scapula
The shoulder joint & its 42. Identify the type of shoulder joint
movements 43. Describe the structure of shoulder joint
44. Name the muscles acting on the joint/rotator cuff muscles
45. Explain the range of mobility
46. Describe the movements of shoulder joint
Arm 47. Describe the compartments of arm and how they are
formed
48. Identify and explain the muscles and their actions found in
the arm
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49. Describe the nerve supply of arm

50. Describe the course of the nerves
51. Identify the branches of the nerves
52. Relate & integrate with the clinical correlations
53. Describe cutaneous supply of arm
54. Describe the extension, relation and branches of the
Brachial artery
55. Describe the course of the Basilic and cephalic veins
Osteology of humerus 56. Recognize the bone
57. Identify the site of bone
58. State the bony landmarks of humerus: like borders, surfaces
& land mark used for bone determination
59. Demonstrate the attachment of muscles & ligaments
60. Describe the common fractures of the bone
61. Identify the attachments to humerus
62. Describe the surface anatomy humerus
63. Describe the radiological anatomy of humerus
64. Describe the applied anatomy of humerus
Embryology
Somitogenesis 65. Define the process of gastrulation
66. Describe the development of mesoderm
67. Describe the process of somitogenesis
68. Describe the formation of cartilage
Development of 69. Describe the Development of cartilage(hyaline, fibrous &
cartilage elastic)
Histology
Classification & histology 70. Describe the General properties of cartilage
of cartilage 71. Describe the Different types of cartilage
72. Describe the Hyaline, Elastic and Fibrocartilage
73. Explain the growth of cartilage
Histology of cartilage 74. Identify types of cartilages on microscopy, including
distinctive features of each
75. Describe the structural basis
76. Classify and distinguish three types of cartilages
77. Describe the microscopic structure of hyaline cartilage
78. Describe the microscopic structure of Elastic cartilage
79. Describe the microscopic structure of fibrous cartilage
80. Describe important functional correlates of three types of
cartilages
Classification & histology 81. Recognize bone and its functions and composition
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of bone 82. Differentiate between woven bone and lamellar bone

83. Differentiate between compact bone and spongy bone
84. Describe the applied aspect of bone
Physiology
Physiological Anatomy 85. Explain the physiologic anatomy of the skeletal muscle
of Skeletal Muscles fiber.
(Introduction) Skeletal muscle fiber
Sarcolemma
Myofibrils
I band
A band
Z disk
M line
Sarcomere
Titin microfilament molecules
Mechanism of Muscle 86. Describe the general mechanism of muscle contraction.
contraction 87. Describe the molecular mechanism of muscle contraction
Energetics of Skeletal 88. Describe the energetics of muscle contraction
muscle contraction 89. Describe the three sources of energy for muscle contraction
Mechanics of skeletal 90. Define motor unit
Muscle contraction 91. Describe multiple fiber summation
92. Describe frequency summation and tetanization
93. Describe Staircase effect
94. Describe muscle fatigue
Biochemistry
Connective tissues 95. Explain in detail the biochemistry of connective tissues.
Glycosaminoglycan 96. Discus the role of glycosaminoglycan (GAG) in the formation
of the connective tissues, cartilage, skin, blood vessels and
tendons
Collagen 97. Describe the chemical structures of cellular matrix of
collagen and elastin
Minerals: Classification 98. Discuss RDA, serum Levels
Calcium & Phosphorus 99. Enlist sources of Calcium & Phosphorus
metabolism 100. Describe functions, absorption and excretion of Calcium &
Phosphorus
101. Describe disorders related to increase and decrease in
amount of Calcium & Phosphorus
102. Hormonal regulation of Calcium & Phosphorus levels
Sodium, Potassium & 103. Enlist sources of Sodium, Potassium and chlorine
Chloride: Metabolism
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104. Describe functions, absorption and excretion of Sodium,

Potassium and chlorine
105. Describe disorders related to increase and decrease in
amount of Sodium, Potassium and chlorine
Orthopedics
Frozen Shoulder 106. Describe presentation and Management of Frozen Shoulder

List of Practicals
Subject /Topic Learning Objectives Teacher Venue
At the end of this practical work, the 1st year
students will be able to;
Histology
Hyaline Identify the slide of Hyaline cartilage under the Dr. Asif Anat-7
cartilage microscope Kamal
Fibrous & Identify the slides of Fibrous & Elastic cartilage Dr. Asif Anat-7
Elastic under the microscope Kamal
cartilage
Physiology
Power Lab: Understand the parts of power lab. Dr. Aslam Physio-11
Software and Describe the indicator, trigger, analog output and Dr. Durre
Hardware analog input Dr. Ayesha
Enlist the application of isolated stimulator Dr.Gulshan
Understand the functioning of bioamp cable
Power Lab: Describe the principles of Electromyography Dr. Aslam Physio-11
Perform Dr.Gulshan
experiment, Dr. Durre
Dr. Ayesha
data
acquisition,
and analysis
Biochemistry
Detection of Detect peptone in a given solution of protein Dr. Naheed Biochem-9
Peptone Dr. Ubaid
Dr. Iqbal

Milk analysis Describe precipitation of milk , constituents of milk Dr. Naheed Biochem-9
Demonstration filtrate and milk precipitate Dr. Faiza
Dr. Ubaid
Dr. Iqbal
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List of DSLs / others

Subject /Topic Learning Objectives Teacher Venue
At the end of this DSL, the 1st year
students will be able to;
Physiology
Physiological Anatomy Describe the physiologic anatomy of Dr. Gulshan Anat-2
of Skeletal Muscles skeletal muscles
Biochemistry
Biochemistry of Describe the biochemical composition of Dr. Ubaid Anat-2
Connective tissues connective tissues
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Timetable (Week-1) with Designated Teachers and Venues

Timetable (Week-2) with Designated Teachers and Venues

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Theme-2 (Tennis elbow)

Introduction
The duration of this theme is one week dealing with the gross anatomy of cubital fossa,
elbow joint and forearm. Development and histology of bones will also be covered.
Characteristics of whole muscle contraction and muscle remodeling will also be discussed.
Metabolism of iron, magnesium, copper and trace elements will be explained.

Specific Learning Objectives and Topics Covered

Subject /Topic S No Learning Objectives
Anatomy
Cubital fossa 107. Describe the boundaries, the contents and the relationship
among structures of Cubital fossa
108. Demonstrate the surface anatomy of the Cubital fossa.
109. Explain the clinical importance of the Cubital fossa
Anterior 110. List the muscles of forearm
compartment of 111. State the nerve supply of these muscles
Forearm 112. Explain actions of the muscles of anterior compartment of
forearm
113. Describe attachment and functions of flexor retinaculum
114. Identify/Describe muscles of the anterior compartment of the
arm (origin, insertion, nerve supply, blood supply, and action)
Posterior 115. Explain the organization of muscles of posterior compartment
compartment of of forearm
Forearm 116. Identify/Describe muscles of the posterior compartment of the
arm (origin, insertion, nerve supply, blood supply, and action)
117. State the nerve supply of these muscles
118. Explain the actions of the muscles of posterior compartment of
forearm
119. Describe the structural organization of the Extensor
Retinaculum
Osteology of ulna 120. Recognize the bone
121. Determine the side of bone
122. Identify the features of bone
123. Identify the muscles attached to bone
124. Describe the common fractures of the bone
125. Describe and Identify the salient features of the ulna
126. Identify the attachments to ulna
127. Describe the surface anatomy ulna and the radiological
anatomy ulna
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128. Describe the applied anatomy ulna

Osteology of radius 129. Determine side of bones
130. Identify the features of bones
131. Identify the muscles attached to bones
132. Describe the ossification of bones
133. Explain the clinical significance of bones
134. Describe the common fractures of the bone
135. Describe and Identify the salient features of the radius
136. Identify the attachments to radius
137. Describe the surface anatomy radius and the radiological
anatomy radius
138. Describe the applied anatomy radius
Elbow joint 139. Identify the type of the joint.
140. State and Identify the muscles acting on the elbow joint
141. Describe the neurovascular supply of the joint
142. Describe the carrying angle and applied aspect of the joint
143. Describe the anastomosis and collateral circulation
144. Describe formation of anastomosis around elbow joint
Radio-ulnar joint 145. Recognize the details of Radio-ulnar joint
146. Describe and explain the movements occurring on Radio-ulnar
joint
147. Name the muscles acting in pronation and supination
148. Describe the nerve supply and blood supply of Radio-ulnar
joint
149. Describe clinical problems related to Radio-ulnar joints
Blood vessels & 150. Describe the different vessels & nerves in forearm
nerves of the forearm 151. Describe the location, destination, course & relations of radial
and ulnar arteries & their branches in forearm
152. Describe the deep veins of forearm and their tributaries
153. Describe the location, destination, course & relations of ulnar,
radial and median nerves & their branch
Surface anatomy of 154. Demonstrate the surface markings for various arteries and
upper limb nerves of upper limb
Embryology
Development of 155. Describe the development of skeletal muscle
muscles 156. Describe the development of Myotomes and derivatives of
epaxial divisions of myotomes and derivatives of hypaxial
divisions of myotomes
Development of 157. Describe histogenesis of Bone
bones and joints 158. Describe the Intramembranous Ossification
159. Describe the Endochondral Ossification
160. Describe the Ossification of limb bones
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161. Describe the development of joints

162. Describe developmental events of fibrous joints
163. Describe developmental events of cartilaginous joint
164. Describe developmental events of synovial joints
165. Describe important congenital correlates
Histology
Classification & 166. Recognize bone and its functions and composition
histology of bone 167. Differentiate between woven bone and lamellar bone
168. Differentiate between compact bone and spongy bone
169. Describe the applied aspect of bone
Bone histology 170. Define and identify compact and spongy bone
171. Describe and identify bone matrix (organic and inorganic
component)
172. Describe and identify cells of boney tissue i.e.
(osteoprogenitor, osteoblasts, osteoclast, and osteocytes)
173. Describe and identify periosteum and endosteum
174. Describe and identify the microscopic structure of bone i.e.
(primary bone, secondary bone and haversian system)
175. Describe Functions of various bone cells
Physiology
Characteristics of 176. Identify the characteristics of whole muscle contraction
whole muscle 177. Compare isotonic and isometric exercises
contraction 178. Compare and contrast slow and fast muscle fibers
Muscle Remodeling 179. Describe following
Muscle hypertrophy
Muscle atrophy
Muscle hyperplasia
Rigor mortis
Muscle dystrophy
Recovery of muscle contraction in poliomyelitis
Biochemistry
Iron: Metabolism 180. Discuss RDA, serum Levels
181. Enlist sources
182. Describe functions, absorption and excretion
183. Describe disorders related to increase and decrease in amount
Magnesium, Copper 184. Discuss RDA, serum Levels
metabolism 185. Enlist sources
186. Describe functions, absorption and excretion
187. Describe disorders related to increase and decrease in amount
Trace elements 188. Discuss RDA, serum Levels of
Molybdenum, Selenium, Zinc, chromium, manganese, silicon,
vanadium in biology
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189. Enlist sources

190. Describe functions, absorption and excretion
191. Describe disorders related to increase and decrease in amount

List of Practicals
Subject /Topic Learning Objectives Teacher Venue
At the end of this practical work, the 1st year
students will be able to;
Histology
Mammary glands Identify the slide of Mammary glands under the Dr Asif Anat-7
microscope
Biochemistry
Analysis of Milk Detect constituents of milk precipitate i.e., casein Dr Naheed Biochem-9
Precipitate and fats Dr Ubaid
Dr Iqbal
Dr Shabir

List of Small Group Discussion (SGD) Sessions

Subject /Topic Learning Objectives Scenario Teacher Venue
st
At the end of this SGD, the 1
year students will be able to;
Physiology
Length Tension Define isometric and A 15 years old boy presented to Dr Gulshan Physio-12
Relation in isovolumic contraction a physician with progressive
Skeletal Muscles To describe length, tension muscle weakness and inability to
diagram for a single fully walk properly. His legs muscles
contracted sarcomere were found to be bulky and
Describe the relation of thigh muscles were wasted. A
muscle length to tension in skeletal muscle biopsy revealed
the muscles both before and features of muscular dystrophy
during contraction of Duschene type.
Describe the relation of
velocity of contraction to
load
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Timetable (Week-3) with Designated Teachers and Venues

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Theme-3 (Carpal tunnel syndrome)

Introduction
During this one week theme, gross anatomy of hand and the wrist joint will be covered
along with the development of the limbs. Physiology of neuromuscular junctions and muscle
action potential and the process of excitation-contration coupling will be discussed. Vertical
integration will cover the topics of osteoporosis, fractures and x-rays of the upper limb.
Finally neuromuscular blocking drugs will be highlighted.
Specific Learning Objectives and Topics Covered
Topic S No Learning Objectives
Anatomy
Bones of wrist & 192. Recognize the bones of wrist & hand
hand 193. Identify the features of bones
194. Describe the ossification of bones
195. Explain the clinical significance of bones
196. Describe the common fractures of the bone
197. Describe and Identify the salient features bones of hand
198. Identify the attachments to bones of hand
199. Describe the surface anatomy main bones of hand and the
radiological anatomy of main bones
200. Describe the applied anatomy main bones of hand including
carpal tunnel and fractures
Muscles of hand 201. Recall the structure and functions of palmar aponeurosis
202. Describe the attachments, nerve supply & actions of muscles of
hand
203. Describe the thenar Muscles
204. Correlate the movements of thumb with hand anatomy
205. Identify the anatomical snuffbox
206. Relate applied with gross anatomy of few structures of hand
207. Enumerate, describe and identify the small muscles of the hand

208. Describe Surface anatomy of important muscles of hand

209. Identify structures on transverse MRI hand taken at various
levels
210. Describe relevant clinical anatomy of important muscles
211. Identify/Describe joints of the hand and fingers (intercarpal
joints, carpometacarpal and intermetacarpal joints,
carpometacarpal joint of the thumb, and metacarpophalangeal
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joints
212. Describe surface , radiological and clinical anatomy of important
joints
Vessels & nerves of 213. Identify different vessels in hand
the Hand 214. Describe the location, destination course relations of radial and
ulnar arteries in hand
215. State the branches of radial and ulnar arteries in hand
216. Describe the formation of superficial and deep palmar arch,
veins of hand and their tributaries
217. Describe the nervous supply of the hand
Wrist joint 218. Recognize the details of wrist joints
219. Describe and explain the movements occurring on wrist joints
220. Name the muscles acting in pronation and supination
221. Describe the nerve supply and blood supply of wrist joints
222. Describe wrist joint, nerve supply and blood supply
223. Describe clinical problems related to Wrist joints
Spaces of the palm 224. Identify the different spaces of the hand on both palmar and
dorsal aspects
225. Describe the clinical importance of these spaces
Embryology
Development of 226. Describe the early stages of limb development
limbs 227. Describe the development of limb buds
228. Describe the final stages of limb development
229. Describe and explain the anomalies of the limb
Physiology
Neuromuscular 230. Describe the transmission of impulses from nerve endings to
junction and skeletal muscle fibers
Transmission 231. Explain Formation and Secretion of acetylcholine at nerve
terminals
232. Describe Action of acetylcholine at postsynaptic membrane
233. Describe Degradation/Destruction of released acetylcholine
234. Describe End plate potential
235. Describe Fatigue of junction
Muscle action 236. Describe the muscle action potential
potential
Excitation 237. Discuss the process of excitation contraction coupling in skeletal
contraction muscles
coupling 238. Explain Transverse tubule-sarcoplasmic reticulum system
239. Describe Release of Calcium ions by sarcoplasmic reticulum
240. Explain Role of Calcium pump
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241. Describe Excitatory pulse of Ca+

Biochemistry
Toxic Elements 242. Discuss different effects of the following toxic Elements
Aluminum , Arsenic, Antimony, Boron, Bromine, Cadmium,
Cesium, Germanium, Lead, Mercury, Silver, Strontium
Pathology
OSTEOPOROSIS 243. Describe the Pathogenesis and clinical course of osteoporosis
Pathogenesis and
clinical course
Pharmacology
Neuromuscular 244. Describe the physiologic basis of the drugs used in the
Blocking Drugs neuromuscular disorders (Drugs that enhance or block the
An Overview transmission at neuromuscular junction)
245. Drugs that stimulate the muscle fiber by acetylcholine like
action
246. Drugs that stimulate neuromuscular junction by inactivating
acetylcholinesterase
247. Drugs that block transmission at the neuromuscular junction
Orthopedics
Fractures of Upper 248. Describe types, presentation and management of Fractures of
Limb Upper Limb
Radiology
Normal & 249. Describe and differentiate between normal Abnormal X-rays of
Abnormal X-rays of Upper Limb
Upper Limb

List of Practicals
Subject /Topic Learning Objectives Teacher Venue
At the end of this practical work, the 1st year
students will be able to;
Histology
Compact bone Identify the Compact bone under the microscope Dr Asif Anat-7

Biochemistry
Analysis of Milk Detect constituents of Milk Filtrate i.e. lactose and Dr Naheed Biochem-9
Filtrate I minerals Dr Ubaid
Dr Iqbal
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List of Small Group Discussion (SGD) Sessions

Subject Learning Objectives Scenario Teacher Venue
At the end of this SGD, the 1st
year students will be able to;
Physiology
Polio, Rigor Describe the pathophysiology A 5 years old boy from Khyber Dr Durre Physio-12
Mortis and of poliomyelitis, and agency presented to a children
Muscular muscular dystrophies specialist with the complaints
Dystrophy
Describe the mechanism of of weakness of right lower
development of rigor mortis limb for the last 1 week and
fever. He was admitted in the
unit and was diagnosed as a
case of Poliomyelitis

List of DSLs / others

Subject /Topic Learning Objectives Teacher Venue
At the end of this DSL, the 1st year
students will be able to;
Anatomy
Osteology of upper Revise osteology of upper limbs bones Dr. Shagufta Anat-1
limbs bones
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Timetable (Week-4) with Designated Teachers and Venues

 24

Theme-4 (Waddling Gait)

Introduction
This theme will last for 2 weeks and gross anatomy of lower limb such as thigh, hip joint,
gluteal region and femoral triangle will be covered. Congenital anomalies of limbs and
development and histology of muscles will be discussed. Physiology of smooth muscles will
include mechanism of contraction, action potentials and their nervous and hormonal
control. Biochemical role of vitamins C and D will also be discussed. Clinical topics will
include Complications and management of osteoporosis and osteomalacia.
Specific Learning Objectives and Topics Covered
Subject /Topic S No Learning Objectives
Anatomy
Introduction to lower 250. Recognize different parts of lower limb
limb 251. Describe regions of lower limb
252. List the bones of lower limb
253. Identify different land marks in different regions of lower
limb
Deep fascia of thigh, 254. Describe the arrangement of deep fascia in thigh
Iliotibial tract and 255. Describe how the iliotibial tract participates in walking and
saphenous vein running
256. Describe the location of saphenous opening and its
relations
257. Describe the great saphenous vein
258. Describe clinical correlates of saphenous vein
Anterior fascial 259. Describe Boundaries of femoral triangle and its contents
compartment of 260. Describe the muscles of anterior compartment of thigh
261. Describe the nerve supply of anterior Compartment
thigh and femoral
262. Describe the blood supply and the venous drainage of
triangle
anterior compartment of thigh
263. Describe the action of these muscles
The medial 264. Describe the muscles of medial compartment of the thigh
compartment of thigh. 265. Describe the nerve supply of these muscles
Adductor canal 266. Describe the actions of the muscles of medial compartment
of thigh
267. Describe the vessels of medial compartment of the thigh
268. Describe the boundaries and contents of Adductor canal
Lumbo sacral plexus 269. Describe the formation of lumbosacral Plexus
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270. List the branches of lumbosacral plexus with their root

values
271. Describe relation of the nerves with Psoas major muscle
272. List the structures supplied by lumbosacral plexus
Gluteal region 273. Describe the boundaries of gluteal region
274. Describe bones and ligaments of gluteal region
275. Describe the different structures entering and leaving
gluteal region
276. Describe muscles of the gluteal region
277. Describe Vessels of the gluteal region
278. Describe nerves of the gluteal region
279. Describe certain clinical correlates regarding gluteal region
280. Describe clinical anatomy of important muscles
Hip bone 281. Identify the different parts of the bone
282. Describe side determination
283. Describe muscle attachments
284. Describe ligamentous attachments
285. Describe the different bones articulating with the hip bone
286. Describe the common fractures of the bone
287. Describe the surface anatomy of hip bone
288. Describe the radiological anatomy of hip bone
289. Describe the applied anatomy of hip bone
The hip joint and 290. Describe the Articular surfaces of hip joint
movements 291. Identify the capsule of hip joint
292. Describe the synovial membrane, cavity & fluid of hip joint
293. Enumerate the ligaments of hip joint & describe their
attachments
294. Describe the movements possible at hip joint
295. Describe the clinical correlates of the hip joint
296. Describe radiological anatomy (X-rays and MRI) and clinical
of hip joints
Posterior compartment 297. Describe the muscles of posterior compartment of thigh
of Thigh 298. Describe the arterial supply of posterior compartment of
thigh
299. Discuss the trochanteric and cruciate anastomosis at the
back of thigh
300. Describe the venous drainage of this Region
301. Describe the nerves of posterior compartment of thigh
Femur 302. Identify different parts of the femur
303. Determine the side of the bone
 26

304. Identify the surfaces and borders of the bone

305. Describe the attachments of the different muscles and
ligaments on the bone
306. Describe the arterial supply of the bone
307. Describe the surface anatomy of femur
308. Describe the radiological anatomy of
Femur
309. Describe the common fractures of the bone
310. Describe the applied anatomy of femur
Popliteal fossa 311. Describe the boundaries of popliteal fossa
312. Describe the contents of the popliteal fossa
313. Describe some clinical correlates regarding popliteal fossa
Embryology
Congenital anomalies of 314. Describe and explain the anomalies of the upper limb
limbs 315. Describe and explain the anomalies of the lower limb
Development of Muscles 316. Describe the development of skeletal muscle
317. Describe the development of Myotomes and derivatives of
epaxial divisions of myotomes and derivatives of hypaxial
divisions of myotomes
Histology
Histological classification 318. Identify three types of muscles on microscopy, including
of muscles distinctive features of each muscle fiber
Histology of skeletal, 319. Describe the structural basis of muscle striations
cardiac and smooth 320. Recognize the structural elements that produce muscle
muscles contraction and brings the movement of a body part
321. Recognize the function and organization of the connective
tissue in muscle.
322. Classify and distinguish three types of muscles
323. Describe the microscopic structure of skeletal muscle
324. Describe important functional correlates of skeletal muscle
Physiology
Contraction of smooth 325. Describe the contractile mechanisms in smooth muscles
muscle 326. Describe excitation and contraction of smooth muscle
327. Identify the types of smooth muscles
328. Describe the chemical and physical basis for smooth muscle
contraction
329. Compare smooth and skeletal muscle contraction
330. Explain how the calcium ions regulate the contraction
331. Enlist the excitatory and inhibitory transmitter substances
secreted at the smooth muscle neuromuscular junction
 27

Membrane Potentials 332. Describe the membrane potentials and action potentials in
and action potentials in smooth muscles
smooth muscles 333. Describe Spike potentials
334. Describe Action potentials with plateaus
335. Describe Role of calcium channels in generating the smooth
muscle action potential
336. Describe Slow wave potentials
337. Describe Excitation of visceral smooth muscle by muscle
stretch
338. Describe Depolarization of multi-unit smooth muscle
without action potentials
Nervous and hormonal 339. Describe the nervous and hormonal control of smooth
control of smooth muscle Contraction
muscle contraction 340. Compare the smooth muscle contraction and skeletal
muscle contraction
Biochemistry
Vitamin C 341. Discuss sources, Serum levels and RDA
342. Describe Structure and functions
343. Describe disorders relate to Vitamin C
Vitamin D 344. Discuss sources, Serum levels and RDA
345. Describe Structure and functions
346. Describe disorders relate to Vitamin D
Medicine
OSTEOPOROSIS: 347. Discuss Complications and Management of OSTEOPOROSIS
Complications
and Management
Osteomalacia/Rickets: 348. Discuss Complications and Management of
complications and Osteomalacia/Rickets
management
 28

List of Practicals
Subject /Topic Learning Objectives Teacher Venue
At the end of this practical work, the 1st year
students will be able to;
Histology
Spongy bone Identify the slide of Spongy bone under the Dr. Asif Anat-7
microscope Kamal
Skeletal muscle Identify the slide of Skeletal muscle under the Dr. Asif Anat-7
microscope Kamal
Biochemistry
Analysis of Milk Detect constituents of Milk Filtrate i.e. Dr. Iqbal Biochem-9
Filtrate II lactalbumin/ lactglobulin Dr. Naheed
Dr. Faiza
Dr. Ubaid
Analysis of Describe the constituents of abnormal urine and Dr. Iqbal Biochem-9
abnormal urine explain the tests for their analysis Dr. Naheed
(Demonstration) Dr. Faiza
Dr. Ubaid

List of Small Group Discussion (SGD) Sessions

Subject /Topic Learning Objectives Scenario Teacher Venue
st
At the end of this SGD, the 1
year students will be able to;
Physiology
Role of Calcium Describe the mechanism of A 45 year old male patient Dr Saleem Physio-12
Ions in Smooth smooth muscle contraction complained of painful
Muscle Describe the role of Calcium- swallowing (Dysphagia) to solids
Calmodulin- complex in and liquids, regurgitation,
Contraction
smooth muscle contraction retrosternal pain and weight
Describe the Latch loss. Investigations revealed
mechanism for prolonged Achalasia which is a failure of
holding of contraction of the lower esophageal sphincter
smooth muscles (LES) to relax that is caused by
the degeneration of inhibitory
neurons within the esophageal
wall. The doctor prescribed
calcium channel blocker
(nifedipine) along with other
medical treatment.
 29

List of DSLs / others

Subject /Topic Learning Objectives Teacher Venue
At the end of this DSL, the 1st year
students will be able to;
Physiology
Smooth muscle Describe the mechanisms of smooth Dr.Gulshan Anat-1
contraction muscle contraction
Timetable (Week-5) with Designated Teachers and Venues

Timetable (Week-6) with Designated Teachers and Venues

 30

Theme-5 (House Maid’s Knee)

Introduction
During this one week gross anatomy of leg, knee and ankle joint will be discussed.
Pathophysiology of osteomyelitis and osteoarthritis and the drugs in their management will
also be covered.

Specific Learning Objectives and Topics Covered

Subject /Topic S No Learning Objectives
Anatomy
Posterior 349. Explain the muscles of posterior Compartment of leg
compartment of 350. Describe nerve supply of these muscles
leg 351. Explain the actions of the muscles of posterior compartment of
leg
352. Describe the blood vessels of the posterior compartment of leg
Anterior and lateral 353. Identify the boundaries of the compartments of leg
compartment of leg 354. State the muscles of anterior and lateral compartment of leg
355. Describe the vessels of anterior and lateral compartment of leg
356. Describe the nerves of lateral and anterior compartment of leg
357. Describe action of these muscles
Tibia bone 358. Describe the division of tibia bone in 3 parts
359. Identify the surfaces and borders of tibia
360. Describe the attachments of muscles
on the tibia bone
361. Describe the common fractures of the bone
362. Describe the radiological anatomy of leg
363. Describe the applied anatomy of leg
Fibula 364. Determine the side of bone
365. Describe the bony features along with its different
attachments on the fibula
Knee joint 366. Describe the type of knee joint
367. Describe the articular surfaces of this joint
368. Describe the articular capsule
369. Describe the synovial membrane and the synovial cavity
370. Enumerate the ligaments of knee joint
371. Describe the bursa around the knee
joint
372. Describe the blood and nerve supply of the knee joint
373. Describe the mechanism of locking and unlocking of knee joint
 31

374. Describe surface and radiological anatomy (X rays and MRI)

and clinical aspects of knee joints
Surface anatomy of 375. Demonstrate the surface anatomy of arteries of lower limb.
lower limb 376. Demonstrate the surface anatomy of superficial & deep veins
lower limb
377. Demonstrate the surface anatomy of nerves of lower limb
Pathology
OSTEOMYELITIS: 378. Discuss Pathogenesis and Types of OSTEOMYELITIS
Pathogenesis and
Types
Pathophysiology of 379. Discuss Pathogenesis of Osteoarthritis
Osteoarthritis
Pharmacology
Drugs Used in the 380. List the drugs Used in the Management of arthritis
Management of
arthritis

List of Practicals
Subject /Topic Learning Objectives Teacher Venue
At the end of this practical work, the 1st year
students will be able to;
Biochemistry
Analysis of Detect the constituents of abnormal urine i.e. Dr Naheed Biochem-9
abnormal urine I Proteins and reducing sugars Dr Ubaid
Dr Shabir
 32

List of Small Group Discussion (SGD) Sessions

Subject /Topic Learning Objectives Scenario Teacher Venue
st
At the end of this SGD, the 1
year students will be able to;
Biochemistry
Role of vitamin Explain the role of calcium An elderly male patient Dr Faiza Pharma-16
C, D, calcium & and phosphorus in bone presented to a physician with Dr Shabir
phosphorus in remodeling the complaints of generalized Dr Iqbal
body aches and day time fatigue.
bone and Describe the role of Vitamin
There were no other complaints.
connective tissue C and D in bone and
He was investigated thoroughly
health connective tissues growth
and no other major problem was
Describe the disorders of
detected. Finally vitamin D levels
bone and connective tissues
were carried out which was
due to the abnormalities of
8ng/ml. he was treated for
vitamin C, D, calcium &
vitamin D Deficiency.
phosphorus

List of DSLs / others

Subject /Topic Learning Objectives Teacher Venue
At the end of this DSL, the 1st year
students will be able to;
Biochemistry
Vitamin-D Describe the role of vitamin D in bone Dr Naheed Anat-1
growth.
Describe the deficiency states of vitamin
D in children and adults
 33

Timetable (Week-7) with Designated Teachers and Venues

 34

Theme-6 (Foot Drop)

Introduction
This is the last theme of this module lasting for one week. It will cover the gross anatomy of
the foot, venous and lymphatic drainage, and nerve injuries of the lower limb. Medico-legal
aspects of injury and wound will also be discussed. Clinical topics include neuromuscular
diseases, common fractures and x-rays of the lower limb.
Specific Learning Objectives and Topics Covered
Topic S No Learning Objectives
Anatomy
Muscles and 381. Describe the dorsal muscles of foot
neurovascular 382. Describe the origin and insertion of planter muscles of foot
supply of the foot 383. Describe their nerve supply and actions
384. Describe vascular and nervous supply of sole and dorsum of
foot
385. Describe their course through foot and relationships
Bones of foot 386. Identify and describe the salient features of the bones of foot
387. Identify the attachments to the bone of the foot
388. Describe the surface anatomy of foot
389. Describe the radiological anatomy of foot
390. Describe the applied anatomy of foot
Arches of foot 391. Describe the arches of foot
392. Describe the factors responsible for their maintenance of the
arches of the foot
393. Recognize the injury when it occurs and be able to evaluate
plantar fasciitis
394. Describe about counseling regarding the rehabilitation for
plantar fasciitis
Nerves of lower 395. Identify the names of nerves and their main branches
limb and their innervating lower limb
injuries 396. Identify the nerves closely related to a bone or other structure
of lower limb
397. Recognize the main nerves commonly vulnerable to injury
398. Identify the main area and loss of function if particular nerve is
injured
399. Define and understand terms neuritis, anesthesia, paraesthesia,
paralysis, neuralgia, sciatica
Lymphatic Drainage 400. Describe Lymphatic Drainage of lower limb
 35

of lower limb
Forensic Medicine
Injury/ Wound 401. Define injury on medico legal basis
402. Classify injury
403. Define mechanical injury
404. Classify mechanical injury
405. Describe mechanisms of injury
406. Interpret the nature (manner) of injury
407. Define wound
408. Define hurt
409. Identify factors affecting appearance of wound
Medicine
Clinical 410. Describe Clinical Presentations Of Neuromuscular Disease
Presentations Of
Neuromuscular
Disease
Radiology
Difference B/W 411. Describe and differentiate between normal Abnormal X-rays of
normal and Lower Limb
abnormal
Radiographs of
Lower Limb
Orthopedics
Common Fractures 412. Describe types, presentation and management of Fractures of
of Lower Limb Lower Limb

List of Practicals
Subject /Topic Learning Objectives Teacher Venue
At the end of this practical work, the 1st year
students will be able to;
Biochemistry
Analysis of Detect the constituents of abnormal urine i.e. Dr Naheed Biochem-9
abnormal urine Ketone bodies, blood (Hb), bile pigments and bile Dr Ubaid
II salts
 36

List of Small Group Discussion (SGD) Sessions

Subject Learning Objectives Scenario Teacher Venue
At the end of this SGD, the 1st
year students will be able to;
Physiology
Compare the Compare skeletal, smooth A 55 years old non-diabetic Dr Aisha Physio-11
smooth and cardiac muscles and non-hypertensive female
muscle (7 differences) presented to a hospital with
contraction
breathlessness on mild
and skeletal
muscle exertion and ankle swelling.
contraction Her investigations revealed
that she was in heart failure
and was ultimately diagnosed
as a case of dilated
cardiomyopathy, a condition in
which the heart muscles
become weak and unable to
contract and relax properly.

List of DSLs / others

Subject /Topic Learning Objectives Teacher Venue
At the end of this DSL, the 1st year
students will be able to;
Anatomy
Venous and lymphatic Describe the venous drainage and Dr Haroon Anat-1
drainage of the lower lymphatic drainage of the lower limbs Dr Harris
limbs

Role of vitamin D and Describe the role of calcium and vitamin Dr Ubaid Anat-1
Calcium in bone D in bone growth and development
growth
 37

Timetable (Week-8) with Designated Teachers and Venues

 38

Books and other reading resources

Gross Anatomy Netter`s “Atlas of Human Anatomy-6th Edition
Gray`s Anatomy-4th Edition
Cunningam`s “Textbook of Anatomy’-12th Edition
Snell`s Clinical Anatomy by regions-9th Edition
Snell`s Clinical Neuroanatomy-7th Edition
Last`s Anatomy-10th Edition
Embryology Langman`s Medical Embryology-14th Edition
The Developing Human “by Keith L Moore”-10th Edition
Histology Textbook of Histology “by Leslie Gartner-3rd Edition
Basic Histology-Text and Atlas- “by Luiz Carlos-11th Edition
Physiology Guyton`s “Textbook of Medical Physiology”-13th edition
Ganong`s “Review Of Medical Physiology”-25th Edition
“Human Physiology-From cell to system” by Lauralee Sherwood-
8th Edition
Biochemistry Harper`s Biochemistry-31st Edition
Principles of Medical Biochemistry-3rd Edition
Lippincot`s Biochemistry-6th Edition
Pharmacology Katzung`s Basic and Clinical Pharmacology-12th Edition
Pathology Robbin`s Basic Pathology-9th Edition
Community Medicine Essential Community Medicine-
Medicine Davidson`s Principles and Practice of Medicine-22nd Edition
Clinical Examination Talley and O'Connor's Clinical Examination-6th Edition
 39

Block Assessment
Block Assessment consists of Theory Paper (MCQs, SAQs) and Skill assessment (OSPE).

Short Answer Questions

1) Write down names of the rotator cuff muscles
2) Describe the attachment, nerve and action of supraspinatus.

Key:
S.No Answers for questions Marks
awarded
1. 1) Teres minor 2) subscapular 3) supraspinatus 4) infraspinatus 2.5
2. Origin of Insertion Action Nerve supply
supraspinatus 2.5

Supraspinatus Greater Abduction Suprascapular

fossa tubercle of of shoulder nerve
humerus

1) Write down the type, ligaments, neurovascular supply and movements of knee joint.

Key:
S.N Answers for questions Marks
o awarde
d
1. Type Ligaments Movements Neurovascula
r supply

Comple a) Intracapsular: a) Flexion: Nerve supply:

x anterior and semimembra Femoral,
Synovial posterior nous, obturator
hinge cruciate semitendinos nerve and
joint ligments us and bicep sciatic nerve 5
 40

b) Extracapsular: femoris Vascular

Patellar, oblique b) Extension: supply:
popliteal , medial quadricep Femoral and
collateral and lateral muscle popliteal
collateral ligaments c) Medial artery
rotation:
Sartorius,
gracillus and
semitendinos
us
d) Lateral
rotation:
bicep femoris
 41

Multiple Choice Questions

1) A 40 years male patient presented with retracted scapula and he is unable to

protract it. Which one of the following nerve is damaged?

Options:
a. Dorsal scapular nerve
b. Suprascapular nerve
c. Subscapular nerve
d. Long thoracic nerve
e. Thoracodorsal nerve

Key: d. long thoracic nerve

2) A 30 years patient presented with injury of obturator nerve which supplied the
adductor compartment of thigh. Which muscle of the adductor compartment in the
following will be spared due to its dual nerve supply?

Option:
a. Adductor longus
b. Adductor brevis
c. Adductor magnus
d. gracillus
e. obturator externus

Key: c. adductor magnus