2018

CLINICAL
GUIDELINES
FMAS RUSL

Education sub-committee,
Medical student’s union,
Faculty of Medicine and Allied sciences,
Rajarata university of Sri Lanka
Dear colleagues,

This book "Clinical Guidelines FMAS RUSL" is primarily meant to use as a guide
to learn effectively and efficiently in clinical appointments.

This book was created as a solution to a common issue, which is not knowing
what objectives to cover in each appointment.

All the objectives and guidelines are based on " MBBS Curriculum 2016 of
FMAS, RUSL". When creating this objectives and guidelines authors have
referred objectives of clinical appointments of other state medical faculties in
order to refine and improve the content of this book.
This is a result of commitment and effort of the members of the academic
committee of the Medical Students' Union, RUSL.

Authors earnestly hope that this book will be a valuable assistance to guide
you through the clinical appointments to collect knowledge and skills
necessary to be a good practitioner.

Thank you!

Nandasiri HHDR
The president,
Medical student’s Union
Faculty of Medicine and allied Sciences,
Rajarata University of Sri Lanka.
 Contents
 Section 1 (Medicine) ……………………………………………………………………01
i. Respiratory ……………………………………04
ii. Dermatology …………………………………06
iii. Clinical pathology ………………………….07
iv. Cardiology …………………………………….08
v. Neurology …………………………………….09
vi. Rhuematology ………………………………10
vii. Oncology ………………………………………10
viii. STD ……………………………………………….10
ix. Nephrology ……………………………………11
 Section 2 (Surgery) …………………………………………………………………….13
Principles of surgery ……………………………….15
Common short cases ………………………………16
Common long cases ………………………………..19
Surgical emergencies ………………………………20
Operation theatre practice…………………….. 21
i. Ophthalmology ………………………………………..22
ii. ENT ………………………………………………………….23
iii. Anaesthesia ……………………………………………..24
iv. Vascular surgery ……………………………………….26
v. Urology …………………………………………………….27
vi. Gastroentrology ………………………………………..27
vii. Orthopaedic ……………………………………………..28
viii. Paediatric surgery …………………………………….28
ix. Cardiothoracic surgery ……………………………..28
x. Neurosurgery ……………………………………………28
xi. Radiology ………………………………………………….29
 Section 3 (GYN and OBS) …………………………………………………………….30
OBS cases …………………………………………………………….32
GYN cases …………………………………………………………….33
 Section 04 (Paediatrics) ……………………………………………………………….35
 Section 05 (Psychiatry) ………………………………………………………………..40
SECTION (01)

MEDICINE
 MEDICINE
 Learning outcomes of 1st Medicine appointment
1) Be able to take a history from an adult patient in order to reach a
provisional diagnosis, gain the patient’s confidence and find about the
patient’s life.
2) Be able to examine an adult patient with regard the following:
 General examination
 Cardiovascular system
 Central Nervous system
 Respiratory system
 Abdomen
3) Be able to perform the following procedures under supervision on an
adult patient.
 Venipuncture
 Collection and dispatch of blood and other specimens for
laboratory investigations.
 Intravenous, intramuscular and subcutaneous injections.
 Intravenous cannulation
 Set up an intravenous infusion.
 Urine tests for protein, sugar, ketones and bile.
4) Have observed and be able to explain the principles of how to do the
following procedures:
 Giving a blood transfusion
 Urinary catheterization
 Insertion of a naso-gastric feeding tube
 Lumbar puncture
 Gastric lavage
 Pleural aspiration
 Peritoneal tap
 Pleural biopsy
 Bone marrow biopsy
5) Have observed and actively participated in cardio-pulmonary
resuscitation.
 6) Have observed and be able to list the items on the drug trolley, the
emergency trolley and the construction of patient’s diets in hospital.

 Learning outcomes of 2ndand 3rd Medicine appointment

To demonstrate ability in comprehensive history taking, examination,
interpretation and planning of the management of basic medical problems
 Learning outcomes of Professorial Medicine appointment
To be competent in management of medical problems and medical
emergencies

Medical emergencies

1. Acute ST elevation myocardial infarction

2. Other acute coronary syndromes
3. Acute left ventricular failure
4. Arrhythmia- tachyarrhythmia
5. Arrhythmia- bradyarrhythmia
6. Hypertensive Emergencies
7. Acute respiratory failure
8. Acute severe asthma
9. Pneumothorax
10. Haematemesis
11. An unconscious patient
12. Stroke
13. Seizure
14. Acute renal failure
15. Snake bite envenoming
16. Organophosphate poisoning
17. Paracetomol over dose
18. Hypokalaemia and hyperkalaemia
19. Diabetes keto acidosis
20. Dengue shock syndrome or hemorrhagic shock
 Short Appointments in Medicine

I) Chest Medicine
Students are expected to consolidate their skills in history-taking and examinati
on of the respiratory system, during this two-week appointment as well as to
see a wide range of diseases of the respiratory tract.

Learning objectives
At the end of the appointment they should:
1. Be able to take a history, elicit and interpret symptoms and signs in relati
on to the respiratory system,
in order to formulate a differential diagnosis.
2. Be able to describe the basic principles of management of the following
common respiratory conditions:
 Tuberculosis
 Bronchial asthma
 Chronic obstructive airways disease
 Pneumonia
 Lung cancer
 Interstitial lung disease.
3. Be able to identify the changes commonly seen in the chest X-ray in the
conditions listed above.
4. Have observed and be able to explain the principles of the following proc
edures:
 Mantoux test
 Chest physiotherapy bronchoscopy
 Pleural aspiration & biopsy
 Insertion of intercostal tubes
 Lung function tests
 Bronchoscopy
 Case list
1. Bronchial asthma
2. Chronic obstructive pulmonary disease
3. Pneumonia
4. Pulmonary tuberculosis
5. Bronchial carcinoma
6. Interstitial lung disease
7. Pleural effusion
8. Respiratory emergencies
9. Management of acute exacerbation of Bronchial asthma
/Chronic obstructive pulmonary disease
a. Pneumothorax
b. Pulmonary embolism
10.Procedures
a. Nebulization
b. Usage of different types of inhalers
c. Pleural aspiration and biopsy
d. Intercostal tube insertion
e. Bronchoscopy
f. Direct observation therapy in tuberculosis
11. Investigations
a. Chest radiograph
b. CT chest
c. Lung function tests
d. Interpretation of pleural fluid analysis
e. Mantaoux test
ii) Dermatology
Students are expected to consolidate their skills in history taking and
examination during this two weeks’ appointment as well as to see a wide range
of dermatological conditions.

Learning Objectives
1. Be able to explain the terms used in common dermatology (eg:- papule,
plauque, macule, vesicle, bulla, pustule etc)
2. Be able to describe the basic principles of management of the following
common dermatological conditions:
 Pityriasis infections
 Taenia infections
 Psoriasis
 Leprosy
 Scabies
 Eczema
 Blister disorders
3. Have observed and able to explain the principles of the following
procedures
 Skin biopsy
 Cryotherapy
 Patch testing
 Electro cauterization
4. Have observed and be able to identify the different types of
preparations used for the treatment of skin diseases.

Case list
1. Eczema and Glandular Diseases
2. Nail Disease
3. Follicular Disease
4. Dermatologic Infections (Bacterial, Viral, Fungal)
5. Dermatologic eruptions of Insects and Infestations
6. Papulosquamous and Inflammatory Diseases
7. Benign and Malignant skin lesions
iii) Clinical Pathology

At the end of this two-week appointment student should be able to do the

following

1. Fill the request form for rooting laboratory investigations, according to

appropriate criteria and with regard to the implications of making an
urgent request.
2. Instruct patients clearly on how to collect urine samples for urine FR,
Urine foe culture and 24-hour urine collection for protein, creatinine etc.
3. Collect blood samples for the following routing investigations, in
appropriate quantities in the appropriate types of containers and
preservatives and observing any special precautions in collection of
samples.
 Hb, ESR, WBC/DC, Blood picture, platelet content etc.
 Prothrombrin time and other coagulation studies.
 Blood sugar, serum electrolytes, serum enzymes, Acid
phosphatase
 Plasma proteins, Hormone assays, serum ion estimations
 Other routine biochemical and heamatological tests
4. Observe and explain the precautions and procedures in collection and
dispatching samples from HIV &HBV infected patients and universal
precautions.
5. Observe and explain the types of investigations available for the study of
diseases in tissues: routine paraffin sections, frozen sections, exfoliative
cytology.
6. Explain the principle of electron microscopy, immuno-cytochemistry and
immune-fluorescence microscopy etc and how samples should be
dispatched for these different types of investigations.
7. Observe and describe how to dispatch samples and explain the
complications of the following:
 Fine needle aspiration cytology
 Bone marrow aspiration
 Liver biopsy
 Peritoneal and pleural tap
 8. Examine a urine sample for the detection of reducing substances,
glucose, protein, urobilin, ketone bodies and interpret the results of the
test
9. Identify the following in the centrifuged deposits of urine, and interpret
the results:
 Red cells
 Pus cells
 Granular casts
 Hyaline casts
 Crystals
10.Observe, set up and read results of ESR and PCV.
11.Identify the following in a stained blood film:
Normal red cells, white cells and platelets
Macrocytes and Microcytes
Polychromatic cells, and Spherocytes
Target cells and sickle cells
Fragmented red cells and EDTA changes
Malaria parasites
White cell abnormalities such as hypersegmented cells, reactive
lymphocytes, virocytes
12.Examine and interpret WBC/DC
13.Have observed and be able to describe the procedures in the routine
investigation of CSF (sugar, protein culture and cytology) and stools
(occult blood, AOC, red cells, pus cells). Dispatch such samples for
different investigations and interpret results.

iv). Cardiology
1. Stable angina
2. Acute coronary syndrome (Unstable Angina /Non ST Segment Elevation
Myocardial Infarction/ST Segment Elevation Myocardial Infarction)
3. Heart failure
4. Common arrhythmias (Atrial fibrillation/ Supraventricular
tachycardia/ventricular tachycardia/ventricular fibrillation)
5. Common valvular disorders
6. Infective endocarditis
7. Emergencies
 a. Management of Acute coronary syndrome including thrombolysis
in ST Segment Elevation Myocardial Infarction
b. Management of Acute Pulmonary Oedema
c. Cardio pulmonary resuscitation
d. Management of bradyarrhythmias and tachyarrhythmias
8. Procedures
a. Thrombolysis
b. Trans thoracic and trans oesophageal echocardiography
c. Exercise ECG
d. DC cardioversion
e. Holter monitoring
f. Temporary pace maker insertion
g. Coronary angiogram

v). Neurology
1. Epilepsy
2. Stroke
3. Speech disorders
4. Headache
5. Common cranial nerve and spinal root lesions
6. Peripheral neuropathy
7. Common gait disorders
8. Spinal cord compression
9. Meningitis and encephalitis
10. Parkinson’s disease
11. Myasthenia gravis
12. Motor neuron disease and syringomylia
13. Neurological Emergencies:
a. Unconscious patient
b. Status epilepticus
c. Acute stroke
d. Meningitis/Encephalitis
e. Respiratory muscle paralysis
14. Neurological investigations and imaging
a. Lumbar puncture (does)
b. Tensilon test (Shows how)
c. Nerve conduction study (knows)
d. EEG (knows)
e. EMG (knows)
f. X-ray(knows)
g. CT(knows)
h. MRI(knows)
vi). Rhuematology

1. Rheumatoid arthritis
2. Osteoarthritis
3. Sero- negative arthritis (spondyloarthropathies)
4. Connective tissue diseases such as Systemic lupus erythematosus
5. Crystal arthropathies such as gout
6. Rehabilitation

vii). Oncology

1. Breast cancer
2. Cervical cancer
3. Oesophageal cancer
4. Thyroid cancer
5. Lung cancer
6. Head and neck cancer
7. treatment modalities
8. paraneoplastic syndrome
9. Tumor markers
10. cancer prevention
11. cancer screening-cervical, breast, colo-rectal
12. educate / make public awareness regarding self-breast examination, well
women clinic, self-oral cavity examination
13. palliative care of cancer patients

viii). STD

1. Syphilis
2. Gonorrhea
3. Herpes
4. Genital warts
5. Human immunodeficiency virus
6. Trichomoniasis
7. Non gonococcal urethritis
8. Candidiasis
9. Chancroid
10. counsel suspected and diagnosed patients with common Sexually
transmitted diseases
ix). Nephrology

At the end of rotation in nephrology the student should be able to:

 State the epidemiology, aetiology and clinical features of common renal

diseases, especially chronic kidney disease of unknown aetiology
affecting rural areas of Sri Lanka.
 Take a history from a patient with a nephrological problem with
emphasis to aetiology complications and further management.
 Examine the nephrological system with special emphasis to general
examination, examination of the abdomen and genital system.
 Arrive at a diagnosis or a differential diagnoses based on above
information.
 Perform a detailed clinical evaluation of a patient having,
 Urinary tract infection
 Pyelonephritis
 Obstructive uropathy
 Acute renal failure
 Chronic renal failure
 Diabetic neuropathy
 Nephrotic syndrome
 Nephritic syndrome
 Systemic disease with renal manifestation
 Malignancies of genitourinary system
6. State indications and interpret

1. Urinalysis
2. Urine culture
3. Blood urea and serum creatinine estimation
4. Creatinine clearance
5. X-ray Kidney – ureter – bladder ( KUB )
6. Ultra sound scan of the abdomen
7. Intra venous urogram
7. Explain the results of

5. Renal biopsy
6. Micturating cyseourethrogram ( MCUG )
 7. DPTA/ DMSA scan
8. Basic cystoscopy findings
9. Renal arteriogram
8. Perform the following procedures

1. Digital examination of the rectum to evaluate the prostate gland

2. Urethral catheterization ( in a model )
3. Suprapubic puncture in a model
4. Collection of urine for examination
5. Maintenance of fluid balance chart
6. Analysis of urine for reducing substances, protein
9. Manage the following as a first contact doctor

 Acute renal failure ( oliguric and non oliguric )

 Acute retention of urine
 Ureteric colic and renal pain
 Hyperkalaemia
 Acidosis
 Preparation and care of a person undergoing renal biopsy
10. State the indications, contraindications and adverse effects of

1. Peritoneal dialysis
2. Haemodialysis
3. Extracorporeal shock wave lithotripsy ( ESWL )
11. Should have been exposed to post renal transplant patients and have a
base understanding of common complications and drug therapy after
transplantation.
SECTION (02)

SURGERY
 SURGERY
Learning objectives

In the 3rd year, students undertake a 4- week clerkship in Surgery. This will be
there first contact with surgical patients. Their knowledge of theory is limited.
The learning objectives enlisted below have been formulated with these
constraints in mind. At the end of the appointment student should:

1. Be able to conduct themselves with the discipline required of a

medical student and a future doctor.

2. Be able to take a history from a patient accurately.

3. Be able to explain the principles of examination, elicit physical signs

and interpret them.

4. Examine a patient with regard to the following:

 General examination
 Abdomen (including digital examination of the rectum)
 Cardiovascular system
 Central nervous system
 Respiratory system

5. Be able to come to a provisional diagnosis, based on clinical features

elicited, in common surgical problems e.g. hernia, hydrocele etc.

6. Be able to explain the principle of assessing patients with trauma and

maintain a Glasgow coma scale.

7. Be able to perform the following procedures under supervision:

 Venepuncture
 Intravenous cannulation
 Set up an intravenous infusion
 Undertake urine analysis of protein, sugar, ketones, and bile.
 8. Have observed and be able to explain the principles of the following
procedures:
 Giving a blood transfusion
 Urinary catheterization
 Suturing of wounds.

9. Be able to scrub up in the theatre and put on gloves and gown accor
ding to the accepted protocol.

10.Be able to explain principles of the following with regard to surgical t

heatres:
 Concepts of sepsis and antisepsis
 Principles of the use of different types of suture materials.

11.Be able to explain the principles of

 The preparation of a patient for surgery
 The care of a patient after major surgery
 Management of surgical wounds.

Principals of surgery
At the end of the surgical programme, student should have knowledge of the
following topics related to principles of surgery.
1. Initial management of critically ill patient (ABC of trauma)
2. Surgical response to trauma
3. Diagnosis and the management of the shock
4. Blood and blood product transfusion and it’s complications
5. Burns (assessment & management
6. Asepsis/antisepsis/sterilisation
7. Surgical site infections
8. Antibiotics/use and abuse/drug resistance
 9. Analgesic therapy
10.Intravenous fluids fluid, electrolytes and acid base balance
11.Surgical nutritions
12.Local anesthetic agent and their usage
13.Suture materials and needles
14.Commonly used instruments in the theatre
15. Endoscopic procedures (types, scopes, indications, preparation,
procedure and complications)
16.Cancer, premalignant lesions/ early diagnosis/principles of treatments
17.Surgical audit
18.Principles of transplantations

SOME COMMON SHORT CASES

Skin and subcutaneous tissues Neck

1. Cystic hygroma / Lymphocoel 4. Thyroid
2. Haemangioma in skin 5. Branchial cyst / sinus
3. Cavernous haemangioma 6. Enlarged lymph nodes
4. Chronic ulcers 7. Torticollis
5. Burns contracture 8. Sternocleidomastoid tumour
6. Cellulitis 9. Laryngeal carcinoma
7. Sebaceous cyst & complications 10.Lingual thyroid
8. Abscess, Carbuncle 11.Thyroglossal cyst
9. Synergistic gangrene 12.Solitary nodule /Simple diffused
10.Erysipelas / folliculitis enlargement / multi nodular goiter
11.Keloid 13.Thyrotoxicosis/ hypothyroidism
12.Sinus 14.Carcinoma of thyroid
13.Lipoma
14.Solar keratoses
15. Benign melanoma
16.Papilloma
17.Squamous carcinoma
18.Basal cell carcinoma
19.Malignant melanoma
20.Congenital and implanted dermoid
cyst
 Head Abdominal wall
1. Sequestration 1. Inguinal hernia
2. Dermoid internal /external angular 2. Femoral hernia
3. Pre auricular sinus 3. Umbilical hernia
4. Tongue tie 4. Para umbilical hernia
5. Ranula 5. Incisional hernia
6. Cleft palate & lip 6. Epigastric hernia
7. Torn ear lobe
8. Black eye Scrotum
9. Mucous cyst (retention) 1. Scrotal lymphoedema
10.Recurrent parotitis 2. Hydrocele of cord
11.Submandibular duct calculus/SM 3. Hydrocele primary and secondary
lump 4. Varicocoele
12.Mixed parotid tumour / CA of 5. Spermatocoele
parotid 6. Epididimal cyst
13.Trismus 7. Epididimoorchitis
14.Facial palsy 8. Retractile testicles
15.Exophthalmos 9. Undescended / maldescended testes
16.Granuloma of scalp
17.Leukoplakia Penis
18.Carcinoma of oral cavity (inducing 1. Meatal stenosis
tongue) 2. Phimosis
3. Paraphimosis

Breast Anorectal
1. Fibroadenoma/fibradenosis/cyst 7. 2nd and 3rd degree haemorrhoids
2. Nipple discharge 8. Fissure in ano
3. Carcinoma of breast 9. Perianal haematoma
4. Paget’s disease 10.Fistula in ano
5. Gynaecomastia 11.Rectal prolapse
6. Intermammary sinus 12.Ishio rectal abscess /Perianal abscess
13.Pilanoidal sinus
14.Condylomata
15. Patients with stomas
 Peripheral vascular disease Bones and joints
1. Varicose veins 1. Trigger finger
2. Complications DVT with ulcers 2. Tennis elbow
3. Gangrene of a finger 3. Golfers elbow
4. AV fistula 4. Painful heel syndrome
5. Lymphoedema 5. POP cast on a fracture
6. Thrombophlebitis 6. Malunited fracture / nonunited
fracture
Nerves 7. Osteomyelitis – chronic
1. Cervical rib / thoracic inlet syndrome 8. Osteoma of skull / Oschondroma /
2. Meralgia paresthetica Bone trauma
3. Carpal tunnel syndrome / tarsal 9. Bursae around knee / Olecranon
tunnel syndrome bursa / semimembranous bursa
4. Nerve palsies &their manifestations 10.OA of knee
eg: median , radial, ulnar nerve palsy

Hands, feet and limbs

1. Callosity
2. Viral warts
3. Paronychia
4. Ingrowing toe nail
5. Hyperhydrosis
6. Ganglion
7. Implantaation dermoid
8. Dupuytren’s contracture
9. Foreign body in soft tissue
10.Madura foot
SOME COMMON LONG CASES
Urinary
1. Hematurea
2. Urinary calculi
3. Renal carcinoma / Renal masses
4. Bladder carcinoma
5. Bladder outflow obstruction /voiding dysfunction
6. Prostate carcinoma / Benign prostatic hyperplasia
7. Testicular cancers

Gastro intestinal tract

1. Dysphagia – Oesophageal carcinoma
2. Upper GI bleeding / PUD
3. Gastric Carcinoma
4. Gastric outlet obstruction
5. Abdominal pain
6. Obstructive jaundice
7. Biliary pain
8. Pancreatic CA
9. Chronic pancreatitis
10.Epigastric masses – gastric CA/ pancreatic pseudo cyst
11.Abdominal masses- RIF, mesenteric , bowel , omental , retroperitoneal
12.Rectal bleeding/ colorectal CA
Vascular system
1. Peripheral vascular disease
Endocrine system
1. Thyroid cancer
2. Thyroid mass with toxicosis myxodema
Breast
1. Breast cancers
2. Breast masses
SURGICAL EMERGENCIES

Emergencies following injuries

1. Head injuries
2. Spinal injuries
3. Chest injury – penetrating/blunt
4. Abdominal injury – penetrating/blunt
5. Vascular injuries
6. Nerve injuries
7. Muscle and tendon injury
8. Skin and soft tissue injuries
9. Fractures, dislocations- mechanisms, reduction & principles of
immobilization
10.Simple and compound fractures / complications
11.Burns – scalds/flame/electrical/corrosive
12.High velocity missile/blast injuries
Emergencies following infections/inflammations
8. Bacteraemia / septicaemia/pyaemia
9. Tetanus
10.Gas gangrene
11.Synergistic gangrene
12.Erisipelas/Erysipeloid
13.Cellulitis
14.Lymphangitis/Lymphadinitis
15.Abcess
16.Causes for “acute abdomen”
17.Acute appendicitis
18.Acute pancreatitis
19.Enteritis necroticans
20.Meckel’s diverticulum
21.Liver abscess
22.Intestinal obstruction following strangulation hernia, bands and
adhesions, volvulus and intussusception etc.
23.Acute cholecystitis
24.Peritonitis
Other causes
1. Ureteric colic
2. Acute retention of urine
3. Deep vein thrombosis

OPERATION THEATER PRACTICE

During 3rd, 4th and final year students get opportunity to visit surgical operation
theatre.
Objectives
1. Have an idea about basic arrangement of the theatre (sterile areas, no
sterile areas etc.)
2. Be able to perform proper technique of scrubbing and preparation for
assisting to surgeries
3. Have an idea about basic surgical instruments and their sterilization
technique.
4. Have adequate knowledge about sutural material and their uses.
5. Observe and assist to major and minor surgeries
6. Be able to perform following procedures
I. Surgical knot tying & type of knots
II. Suturing of simple uncomplicated wounds
III. Incision & drainage of abscess
IV. Simple wound toilet
7. Be preparing with history and examination of the patient who are waiting
to surgeries.
 Short Appointments in Surgery

i) Opthalmology
During the 2-week appointment in the 3rd or 4th year, students are expected to
see a wide range of diseases affecting the eye.

Learning objective

At the end of the appointment, student should:

1. Be able to explain the pathogenesis and management of common eye

conditions such as
 Catract
 Glaucoma
 Uveitis
 Corneal ulcer
 Refractive errors & squints
 Chelazion and Pterigium
 Cojuctivitis
 Chronic tearing
 Ocular injuries
 Retinopathy (diabetic, hypertensive)
 Optic atrophy
2. Be able to identify patients who need referral for specialized care.
3. Have observed and be able to explain the principles of
 Suturing a lid laceration
 Removal of a foreign body
 Perimetry
 Slit lamp examination
 Visual acuity
This 2 weeks’ appointment is for the student to "develop clinical skills to care
for patients with eye diseases. The undergraduate is expected to achieve
following.

1) Ability to test distance vision, near vision & colour vision

2) Acquire skills to use ophthalmoscope and familiarize with normal
appearance. Should get some experience to identify abnormal
appearances in ophthalmoscopy and interpret them.
3) Ability to recognize common eye diseases existing in Sri Lanka and
treat them
4) Ability to recognize sight threatening eye diseases and to refer them to
a Secondary or tertiary Eye Care Center
5) Ability to suspect refractive errors in patients and refer them to an
Optician
6) To have a reasonably accurate knowledge of the causes, prevalence
and incidence of blindness in Sri Lanka
7) To be able to administer necessary first aid, instill drops or ointments
and bandage a traumatized eye.
8) To acquire skills to diagnose and manage following ophthalmological
conditions or refer them to an appropriate ophthalmologist

ii) Otolaryngology (ENT)

During this 2-week appointment in the third year, students are expected to see
a wide range of diseases affecting the ear.

Learning objectives
At the end of the appointment, students should:
1. Be able to carry out the following examination procedures;
 Otoscopy.
 Assessment of hearing.
 Anterior rhinoscopy.
 Posterior rhinoscopy.
 Examination of the nasal ainivay.
 Testing for smell.
 Indirect Iaryngoscopy to examine the larynx.
  Examination of the buccal mucosa, tongue, teeth, gums, palate,
floor of mouth, pharynx, tonsils, posterior pharyngeal wall.
2. Identify and be able to use the under mentioned instruments under
supervision.
 Otoscope, aural speculum, wax probe, aural forceps, tuning fork,
head mirror
 Nasal speculum, post nasal mirror, nasal polypectomy forceps.
 Tongue depressor, laryngeal mirror, laryngoscope, mouth gag,
tracheostomy tubes.
 Ribbon gauze packs, post nasal packs, ear wicks
3. Be able to explain the pathogenesis and management of common ENT
conditions such as: otitis media, hearing impairment, sinusitis, tosilitis
adenoid enlargement, hoarseness and stridor; tracheostomy; epistaxis

Should be able to use the

1. Tounge depressor
2. Nasal speculum
3. Aural speculum
4. Otoscope
Should be able to
 Know how indirect laryngoscopy is done
 Know how post nasal examination is done
 Should know how to syringe an ear
 Observe the tracheostomy is performed and management of the
patient with tracheostomy in the ward
 Identify normal external auditory meatus, tympanic membrane, oral
cavity, pharynx and nasal passage
 Acquire skills to treat patients with epistaxis, acute nasal obstruction,
acute tonsillitis, quinsy, post tonsillectomy bleeding and airway
obstruction.
iii) Anaesthesia
At the end at this two weeks’ appointment, the students should achieve followin
gs:
1. Skills to insert an IV cannula confidently.
2. with regard to the unconscious patient: Skills to maintain the airway with
triple maneuver or using an oral/nasal airway
3. Ability to explain the principles of
a. protection of the eye
b. prevention of bed sores
c. bladder and bowel care
4. Ability to perform pre-anaesthetic assessment and optimize the patient p
rior to invasive interventions.
5. Understand of the basic techniques of anaesthetic induction, maintenanc
e and recovery.
6. Understand the prevention and management of post-anaesthetic / Operat
ive complications such as
a. Airway obstruction
b. Hypoventilation
c. Hypotension
d. Headache after spinal anaesthesia
7. Skills to insert a laryngeal mask airway (LMA).
8. Skills to insert an endotracheal tube under supervision of possible in OT
/ ICU.
9. Ability to carry out a lumbar puncture under supervision (in a dummy).
10.Recognize equipment for monitoring the unconscious patient and descri
be their uses
11.Explain the principles and describe the protocol with regard to cardiopul
monary resuscitation, including the following
a. Maintenance of the airway
b. Cardiac massage in the adult, child and neonate
c. Defibrillation
12.Observe and identify their toxic features of local anaesthetics know how
to manage them.
 13.Observe method of giving local anesthesia e.g.: ring block, ankle block,
penile block
14.Recognize the early features of blood loss and dehydration and know the
principles of their management.
15.Interpret a blood as report
16.Know different methods of pain relief end their advantages and disadvant
ages.
17.understand the principles of organ support in intensive care with respect
to
a. Cardiovascular system
b. Respiratory system
c. Renal failure (dialysis)
d. Hepatic failure
18.Understand the methods available for obstetric analgesia and their advant
ages and disadvantages.
19.oxygen therapy.

iv) Vascular surgery

1. Acute arterial thrombosis and embolism
2. Arterial trauma
3. Chronic oculsive arterial disease
I. Atherosclerosis
II. Thromboangitis obliterans
III. Vaculitis
4. Aortic and peripheral aneurism
5. Haemangioma
6. Arterio venous fistulas
7. Venous anomalies
8. Varicose veins
9. Deep vein thrombosis / post phlebitis limb / pulmonary embolism
10.Lymph oedema and other lymphatic disorders
v). Urology
1. Urinary tract infection
Simple/complicated Urinary tract infection, recurrence, fistulae, , Foreign
body associated infections cystitis, pyelonephritis, pyonephrosis, importa
nce of drainage, prostatis and epididymal infections
2.Bladder dysfunctions
Incontinence and retention
3.Urolithiasis and nephrolithiasis –
Types of stones, stones + Urinary tract infections, obstructions and conse
quences, long term effects, treatment options
4.Urological tumours –
Renal, urothelial, overview of management, associated complications
5.Prostate disease –
benign/malignant - Benign prostatic hyperplasia and Prostate carcinoma, i
mportance of Prostatespecific antigen/Digital rectal examination. Cancer
screening, Transurethral resection of the prostateandTransurethral resect
ion of the prostate syndrome
6.Testicular problems -
Maldescent/non-descended testis/torsion /infection/tumours

vi). Gastro-enterology
Symptomatology and investigations of the Gastrointestinal tract
Overview of salivary glands Benign and malignant diseases,
salivary calculi, infections,
inflammation
Carcinoma of the oesophagus and As a model of dysphagia, as a
stomach disease of Loss of weight with
retained appetite
Peptic ulcer disease and Gastro Dyspepsia, oesophagitis,
oesophageal reflux disease Diffential Diagnoses epigastric
pain, acute/chronic gastritis,
gastric/duodenal ulcers, Medical/
surgical treatment modalities,
Helicobacter pylorias a cause
Upper Gastro intestinal bleeding Peptic ulcer disease, varices,
carcinomas, duodenal bleeds,
vascular malformations,
importance of endoscopy in
management,
Lower Gastro intestinalbleeding Malignancies, Inflammatory
bowel disease, bowel ischaemia,
diverticulosis, vascular
malformation, endoscopy,
angiogram, short and long term
treatment and management
Pancreatitis – acute/chronic Causes, diagnosis, management
Gall stone disease Cholecystitis, obstructive
jaundice, cholangitis, pancreatitis
Carcinoma of pancreas and biliary Biliary obstruction, as an
system Gastrointestinal cancer
Peritonitis Appendicitis, Cholecystitis,
gynaecological causes, bowel
perforations, trauma
Colorectal carcinoma as a model for carcinogenesis screening and
surveillance
Intestinal obstruction Include gastric outlet obstruction,
small bowel
Large bowel emergencies Bleeding, perforations, closed loop
obstructions, volvulus, megacolon, colitis
Colorectal tumours
Ano-rectal non malignant diseases Anal tissue, fistula, Haemorrhoid,
pilonoidal sinus, perianal abscess
Hernias Internal and external, existing
defects and incisional

vi). Orthopaedics
1. Introduction to orthopaedics
2. Fractures dislocations and their management
3. Spinal injuries(Cervical
spine/ thoracic/ lumbar)
4. Bone and joint infections
5. Bone tumours
6. Back pain
7. Paediatric orthopaedic problems
8. Osteoarthritis and osteoporosis
 vii). Paediatric surgery
Overview of common paediatric Pyloric stenosis, Malrotation,
surgical problems Tracheo oesophageal fistula,
Hirschpurng disease, imperforated
anus

viii). Cardio-thoracic surgery

Outline Ischemic Heart Disease Ischemic heart disease/
and congenital heart disease Congenital heart disease,
Coronary artery bypass grafting,
valve replacements
Trauma – tamponade
Surgery related pulmonary Trauma – flail chest, haemo
problems pneumothorax, contusions,
hydrothorax/empyema, lung abscess, overview lung Continuous
Assessment, drainage of pleural cavity

ix). Neurosurgery
1. Congenital disorders
2. Head injuries including skull fractures, intercranial hemorrhages
(presentation, diagnosis, relavant investigations, monitoring immediate
management, follow up management)
3. Cerebral Abscess
4. Intercranial tumors
5. Spinal cord and root compression & rehabilitation
6. Peripheral nerve entrapment neuropathies
7. Peripheral nerve injuries
8. Surgical management of pain
x). Radiology
Students are expected to consolidate the knowledge gained during the main
appointments (general medicine, general surgery, pediatrics, etc..) together
with the inputs from the basic sciences and applied sciences streams.

1. Be able to fill X –ray request forms

2. Be able to describe the commonly used radiological procedures
including
 Indications
 Limitations, precautions and hazards
 Preparation of patients
3. Be able to explain the basic principles of interpretation of the following
types of radiographs.
 Chest
 Abdomen
 Skeletal system, including the vertebral column
 Intravenous urogram
 Barium studies (upper GI and lower GI)
4. Observe the following procedures and be able to describe the underlying
principles and the preparation of patients for these procedures.
 Intravenous pyelogram
 Ultrasound scan
 Barium studies (upper GI and lower GI)
 Micturating cystourethrogram
 Computer Tomography (CT scan)
 Magnetic Resonance Imaging (MRI scan)
 Hysterosalpingogram
 Myelogram
 Investigation of the hepatobiliary system
 Digital substraction Angiogram
 SECTION (03)

OBSTETRICS &
GYNAECOLOGY
 OBSTETRICS & GYNAECOLOGY

Learning objectives
At the end of this one-month appointment in the third year, students should,
1. Be able to take a history form an Obstetric or a Gynaecological patient
2. Be able to perform a clinical examination of the patient, with regard to th
e following:
 General examination relevant to the patient
 Systemic examination.
3. Be able to perform the following clinical tasks under supervision.
 Advice to maintain a kick count chart
 Determine the Apgar score in newborn
 Setup an intra-venous drip
 Give intramuscular injections
 Do blood grouping and cross matching
 Test urine for albumin and sugar
 Supervise and advice on lactation
 Advice on postnatal exercise
 Monitor patients following surgery
 Write a diagnosis card
4. Have carried out the following tasks
 Observed the management of normal deliveries
 Acquired operating theatre discipline
 Observed common gynaecological operations.
 Observed instrumental deliveries and caesarean section
Obstetrics cases

1. Physiological changes in pregnancy

2. Routine antenatal care
3. Antenatal screening
a. Biochemical screening
b. Ultrasound screening
c. Invasive prenatal diagnosis
4. Normal labour and delivery
a. Normal labour
b. Induction of labour
c. Analgesia and anaesthesia in labour
d. Fetal monitoring
5. Abnormal labour
a. Abnormal labour patterns
b. Malpresentations and malpositions in labour
c. Instrumental delivery
6. Vaginal birth after caesarean section
7. Breech presentation
8. Multiple pregnancy
9. Rhesus isoimmunisation
10. Medical disorders in pregnancy
a. Cardiac disease
b. Respiratory diseases
c. Diabetes mellitus
d. Haematological conditions
e. Autoimmune conditions
f. Renal diseases
g. Hypertensive disorders in pregnancy
 h. Urinary tract infection
11. Late pregnancy complications
a. Preterm labour
b. Pre-labour rupture of membranes
c. Antepartum haemorrhage
d. Intra uterine fetal death
e. Prolonged pregnancy
12. Fetal growth restriction
13. Postpartum
a. Perineal trauma
b. Mental health in the puerperium
c. Neonatal assessment and resuscitation
d. Post partum pyrexia
14. Obstetrics emergencies
a. Maternal collapse - obstetric and non-obstetric causes
b. Postpartum haemorrhage
c. Uterine inversion
d. Eclampsia
e. Shoulder dystocia
f. Cord prolapse
g. Amniotic fluid embolism

Gynaecology cases
1. Menstrual cycle [Reproductive transitions]
a. Puberty and Menarche
b. Delayed and precocious puberty
c. Menstrual dysfunction in adolescence
d. Menopause, hormone replacement therapy
e. Postmenopausal bleeding
2. Menstrual disorders
 a. Heavy menstrual bleeding
b. Fibroids and endometrial polyps
c. Polycystic Ovarian syndrome, hirsutism and virilism
d. Premenstrual syndrome
e. Clinical evaluation and management of amenorrhoea
3. Endometriosis and adenomyosis
4. Fertility and conception
a. Normal conception
b. Female infertility
c. Male infertility
d. Assisted reproduction
e. Reproductive ageing and ovarian reserve
5. Sexual problems in gynaecology
6. Urinary incontinence
7. Urogenital prolapse
8. Benign ovarian tumoursandovarian malignancy
9. Cervical screening and Cancer
10. Endometrial hyperplasia and Cancer
11. Palliative care
12. Problems in early pregnancy
a. Hyperemesis gravidarum
b. Miscarriage
c. Pregnancy of unknown location
d. Gestational trophoblastic disease
13. Pelvic inflammatory disease
 SECTION (04)

PAEDIATRICS
 PAEDIATRICS

Learning objectives

This is the first paediatric appointment. it will consist of 4 weeks of clerkship in

a paediatric ward. At the end of this period. students should,

1. Be able to take a relevant history from a paediatric patient while appreciating

the differences in taking histories from paediatric and adult patients; and be
able to list out a differential diagnosis based on the presenting complaint.
2. Be able to perform a complete physical examination; showing understanding
that the approach to a paediatric patient must vary depending on the age.
3. Be able to identify the negative physical signs relevant to the clinical problem
of the child; measure growth parameters of a child and relate growth of the
child to accepted growth centiles; and perform a developmental assessment.
4. Be able to arrive at a diagnosis or differential diagnosis taking into
consideration the findings in the history and examination.
5. Be able to present a comprehensive history and examination findings with a
summary and a problem list.
6. Be able to describe
 The management of common paediatric problems
 Breast feeding, infant and young child feeding
 The Expanded Programme of Immunization (EPl)
 Common drugs used in paediatric practice
 Delivery of health care to paediatric patients.
7. Be able to take a relevant neonatal history; perform a routine neonatal
examination; identify common neonatal problems; and demonstrate
knowledge of routine newborn care.

Case List :
Perinatal Medicine:
- Examination of the newborn
- Neonatal resuscitation
- Respiratory distress in the newborn
- Prematurity and low birth weight
- Birth asphyxia,Neonatal convulsions and Hypoglycaemia
- Neonatal Infections and Sepsis
- Neonatal Jaundice

Cardiology:
- Evaluation of a heart murmur
- Congenital cyanotic heart diseases
- Congenital acyanotic heart diseases
- Rheumatic Heart Disease
- Kawasaki Disease
- Infective endocarditis
- Heart Failure
Respiratory Diseases:
- Upper respiratory tract infections
- Lower respiratory tract infections
- Bronchial asthma
- Tuberculosis
- bronchiolotis
Gastro-intestinal tract Disorders:
- Acute gastroenteritis
- Blood and mucous diarrhoea
- Chronic diarrhea
- Constipation and Encopresis
- Malabsorption
- Biliary atresia
- Neonatal Hepatitis
- Cirrhosis of liver

Nephrology:
- Congenital abnormalities
- Urinary tract infections
- Evaluation of a Child with proteinuria
- Evaluation of a Child with haematuria
- Acute kidney injury
- Chronic renal failure

Neurology:
- Seizure disorders

- Evaluation child with development delay

- Floppy baby
- Central Nervous System infections
- Headache
- Evaluation child with abnormal occipital frontal circumference
(macrocephaly, microcephaly)
Haematological Disorders:
- Evaluation of a child with anaemia
- Haemolyticanaemias
- Nutritional anaemia
- Evaluation of a child with a bleeding disorder

- Haemoglobinopathies
Endocrinology:
- Hypothyroidism, Hyperthyroidism and Parathyroid disorders
- Diabetes mellitus
- Adrenal disorders
- Puberty (Precocious puberty/Delayed puberty)
- Pituitary disorders
- Evaluation child with short stature

Musculoskeletal Disorders:
- Congenital abnormalities of bones and joints
- Myopathies and Motor Neurone Diseases
- Evaluation of child with arthritis

Infections:
- Vaccines and immunizations
- Tuberculosis
- Hepatitis A and B
- Dengue fever
Oncology:
- leukaemia
- Neuroblastoma
- Nephroblastoma
- Brain tumours
- Lymphomas
- Soft tissue sarcomas
- Bone tumours
- retinoblatomas
Emerging trends and broad health challenges
- Non-communicable diseases
- Child accidents
- Child abuse
- Public health responsibilities
- Current health policy and quality issues

Nutrition
- Failure to thrive
- Nutrition and nutritional disorders
- Rickets
- Neonatal feeding
- Preterm feeding

Other Special Topics:

- Genetics
- Childhood Obesity
- Common Paediatric Skin Conditions
- Growth and development
 SECTION (05)

PSYCHIATRY
 PSYCHIATRY

Learning objectives

At the end of this 2-week appointment in the third year, students should be
able to:
1. Describe the significance of obtaining consent, respecting privacy and
maintaining the confidentiality of patients with psychological ill health.
2. Document a detailed psychiatric history with regard to the following
components:
 Presenting complaint/ problems
 Elaboration of the presenting complaint/ problems.
 Findings of direct questioning of other clinically relevant areas]
issues related to the present complaint/ problems.
 Past psychiatric and medical history ' Family history.
 Personal history including social circumstances, sexual history
and psychoactive substance abuse
 An account of the pre-morbid personality
3. Describe the mental state of a patient under the following subheadings
 Appearance and behaviour
 Speech Mood
 Thought contents (including suicidal and homicidal risk)
 Abnormal beliefs and perceptions
 Cognitive functions (level of consciousness and alertness,
Orientation, Concentration, memory, abstract reasoning,
intelligence)
 Level of insight
4. Gather relevant information from relatives/Informant: and other
sources where necessary
5. Document and present the clinical history and mental state examination
with regard to the following common psychiatric problems:
 Psychoses (Schizophrenia and related disorders, acute and
chronic organic mental disorders and affective disorders)
  Neuroses and stress related disorders (anxiety disorders,
obsessive compulsive disorder, post-traumatic stress disorder)
 Somatoform and dissociative disorders
 Deliberate self-harm
 Psychoactive Substance abuse

 Outcomes of the 1st Psychiatry appointment

to demonstrate a basic ability in history taking, mental state examination,
physical examinations and requesting appropriate investigations,
interpretation of these finding and planning of the basic management of
common psychiatric problems.
 Outcomes of the professorial Psychiatry appointment
To be competent in coming to an aetiological formulation, management
of psychiatric problems and to become a competent and confident
house officer with correct knowledge, skills and attitudes.

Course content
1. Concepts of mental illness
2. Signs and symptoms of psychiatric disorders
3. Classification of Mental and Behavioural Disorders
4. Psychiatric assessment
5. Ethics, civil law and mental Health law
6. Psychopharmacology
7. Delirium and other organic brain disorders
8. Dementia
9. Mental and behavioural disorders due to use of alcohol
10. Treatment of alcohol disorders
11. Other substance use disorders
12. Schizophrenia
13. Treatment of psychosis
14. Bipolar disorder

15. Unipolar depression

16. Treatment of mood disorders
17. Suicide and deliberate self-harm, risk assessment
18. Anxiety disorders and treatment strategies
19. Obsessive compulsive disorder
20. Reaction to Stress and bereavement
21. Somatoform and conversion disorders
22. Eating Disorders

23. Sleep and its disorders

24. Perinatal psychiatry
25. Disorders of adult personality and behavior
26. Sexual dysfunction
27. Gender identity disorders and disorders of sexual preference
28. Learning disability (Mental retardation)
29. Child psychiatry –disorders of psychological development
30. Child psychiatry- behavioural and emotional disorders
31. Forensic psychiatry
32. Managing an aggressive patient
33. Medically unexplained symptoms

Common cases in Psychiatry

Key presenting problems

Students should be able to asses and manage patients with these presentations.

1.Confusion

2.Memory loss

3.Low mood

4.Elevated mood

5.Aggression/violence

6.Problems due to psychoactive substances use

7.Abnormal behaviour

8.Hearing voices

9.Poor self care

10.Obsessional thoughts and rituals

11.Anxiety

12.Seizures

13.Medically unexplained symptoms

14.Sexual problems

15.Suicide and deliberate self halm

16.Reaction to stress

Presentation in children

17.Development delay

18.Autism

19.Attention deficit hyperactivity disorder

20.Poor school performance

21.Behavioural problems such as school refusal,nocturnal enuresis

Key disorders
1.Delirium

2.Dementia

3.Psycoactive substance use alcohol harmful use and dependence

4.Alcohol withdrawal

5.Psycoactive substance use other substances specially heroin and cannabis use
disorders

6.Mood disorders-Depression

7.Mood disorders-Bipolar affective disorder

8.Abnormal grief

9.Adjesment disorder

10.Schizophrenia and other psychotic disorders

11.Suicide and deliberate self halm

12.Psychiatric problems in the physically ill

13.Psychiatric problems during pregnancy and postpartum period

14.Eating disorders

15.Sleep disorders

16.Panic disorder

17.Simple phobias

18.Agoraphobia,social phobia and other anxiety disorders

19.Obsessive compulsive disorder

20.Dissociative disorder

21.Somatoform disorder and hypochondriasis

22.Problems with sexuality and gender erectile

dysfuncion,vaginismus,ejaculation,gender identity disorder

23.Acute stress reaction and post traumatic stress disorder

Key disorders in children

24.Attention deficit hyperactivity disorder

25.Mental retardation

26.Specific learning difficulties

27.Autism spectrum disorder

28.Anxiety disorders in children

 The above objectives were collected from the MBBS Curriculum 2016 of
FMAS, RUSL" and clinical objectives of some other state medical faculties.

@All Rights Reserved

2018.12.08

Education sub-committee

Medical student’s union

Faculty of Medicine and Allied sciences

Rajarata university of Sri Lanka