SYLLABUS OF SECOND PROFESSIONAL M.B.B.S.(A) GENERAL PATHOLOGY
(B) PHARMACOLOGY AND THERAPEUTICS
(C) FORENSIC MEDICINE AND TOXICOLOGY
(A) GENERAL PATHOLOGY
CELL INJURY1. Necrosis, Ischemia, Hypoxia, Infarction and Gangrene
Oncosis and Autolysis.
2. Sequence of the ultrastructural and biochemical changes
which occur in the cell in response to the following:
Immunological injury, e.g., Asthma / SLE / Anaphylactic
Physical agents, e.g., Radiation
Genetic defects, e.g., Thalassemia / Hemophilia
Nutritional deficiency,e.g., Kwashiorkor
Viruses, e.g., Hepatitis
Bacteria, e.g., Staphylococcus aureus
Fungi, e.g., Candida
Parasites, e.g., Malaria
3. Irreversible and reversible injury
4. Apoptosis and its significance.
5. Necrosis and its types
6. Exogenous and endogenous pigmentation.
7. Dystrophic and metastatic calcification along with clinical
8. Metabolic disorders
• Lipid disorders, Steatosis of liver, Hyperlipidemia
• Protein disorders
• Carbohydrate disorders
INFLAMMATION, MEDIATORS OF INFLAMMATION1. Role of inflammation in the defense mechanisms of the body.
2. Vascular changes of acute inflammation and their relation to
morphological and tissue effects.
3. Process of Chemotaxis, Opsonization and Phagocytosis.
4. Role of cellular components in inflammatory exudate.
5. Exudates and transudate.
6. Important chemical mediators of inflammation.
7. Pathway of Arachidonic Acid metabolism.
8. Role of products of Arachidonic acid metabolism in inflammation.
9. Mechanism for development of fever, with reference to exogenous and
10. Chronic inflammation including Granulomas.
11. Granuloma and its types along with causes.
12. Systemic effects of acute and chronic inflammation and their possible
13. Significance of ESR.
14. Induced hypothermia in medicine.
15. Healing in specialized tissue.
WOUND HEALING1. Repair and regeneration.
2. Wound healing by first and second intention.
3. Factors that influence the inflammatory reparative response.
4. Wound contraction and cicatrisation.
5. Formation of granulation tissue.
6. Complications of wound healing.
DISORDERS OF CIRCULATIONa. Thrombo-embolic disorders and their modalities
1. Etiology and pathogenesis of thrombosis.
2. Possible consequences of thrombosis
3. Difference between thrombi and clots
4. Classification of emboli according to their composition.
5. Difference between arterial and venous emboli.
b. Hemorrhage, Hyperemia and Congestion
1. Definitions of common types of Hemorrhage
2. Types of hyperemia
3. Difference between hyperemia and congestion
1. Types of infarction
2. Difference between anemic and hemorrhagic infarct
3. Morphological picture of infraction in different organ systems
d. Disorders ofthe circulation and shock
1. Edema, ascites, hydrothorax and anasarca.
2. Pathophysiology of edema with special emphasis on CHF.
3. Pathogenesis of four major types of shock (Hypovolemic,
cardiogenic, vasovagal & septic) and their causes.
4. Compensatory mechanisms involved in shock.
MICROBIOLOGY1. Defence mechanisms of the body.
2. Microbial mechanisms of invasion and virulence.
3. Difference between sterilization and disinfection.
4. Methods of disinfection and sterilization of the following:
a. Facility where the doctor practices,
b. Examination table,
c. Any spillage e.g. sputum, vomitus, stool, urine, blood,
d. Examination tools,e.g., thermometer, nasal and ear specula and
5. Principles of aseptic techniques such as Venepuncture, urinary
catheterization, bandaging, suturing and lumber puncture.
6. Universal precautions for infection control.
7. General principles of the following serological tests:
a. ELISA – Hepatitis (A,B,C,D,E,G) Rubella, CMV and HIV
c. Haemagglutination – TPHA
d. Western Blot –HIV
8. Interpretation of :
a. Culture reports
b. Serological reports and
c. Microscopic reports of gram stain and ZN stain.
9. Principles of proper collection and submission of specimens for
9. General characteristics and taxonomy of Bacteria, Rickettsia,
Chlamydia, Viruses and Fungi.
11. Communicable, Endemic, Epidemic, and Pandemic Diseases, Carriers
Pathogens, Opportunists, Commensals and Colonizers.
12. Microorganisms responsible for infection of the following organ
Central Nervous System
Infections of Bones and Joints
Infection of the Skin
13 Pathogenesis, Treatment, Epidemiology, Prevention and Control of the
Beta hemolytic streptococcus group a & b
Hepatitis A, B, C, D, E
PRINCIPLES OF ANTI MICROBIAL ACTION.1. Antibiotics, selective toxicity, bacteriostatic and bactericidal.
2. Host determinants in relation to selection of an antimicrobial drug for
3. Minimum inhibitory concentration (MIC) and minimum bactericidal
4. Bacterial resistance and the mechanisms involved in acquiring bacterial
5. Mechanisms involved in transfer of drug resistance to bacterial
6. Mode of action of variousantimicrobial drug groups.
7. Superinfection and cross sensitivity.
LIST OF COMMON ORGANISMS CAUSING ORGAN SYSTEM EFFECTSa. Common organisms causing CNS Infections
Beta hemolyticus srteptococcus group b
B. Common organisms causing respiratory tract infection
Beta hemolyticus streptococcus group b
C. Organisms causing gastrointestinal tract infection / infestation
D. Common organisms causing hepatic infections
Hepatitis A, B, C, D, E
E. Common organisms causing skin infection
f. Common organisms causing bone and joint infection
Bacteria: Staph aureus, Streptococcus pyogenes, Haemophilus
influenzae, Neisseria gonorrhoeae, Brucella melitenesis, Salmonella
typhi, Strep. pneumonae, Pseudomonas sp. and Mycobacterium
g. Common organisms causing genital infection
(i) Bacteria: Mycoplasma urealyticum
(ii) Viruses: Pox, Herpes, Hepatitis B, HIV
(iii) Fungus: Candida albicans
(iv) Arthropodes: Sarcoptes scabiei
(v) Protozoa: Tricomonas vaginalis
h. Common organisms causing zoonosis
(i) Viruses: Rabies,
(ii) Protozoa: Toxoplasma gondii, Leishmania sp.
(iii) Helmenthics: Echinococcus sp.
GENETICS1. Common sex linked, autosomal recessive and autosomal dominant
2. Common genetic mutations.
3. Diseases associated with consanguineous marriages.
4. Molecular biology techniques.
GROWTH DISORERS/NEOPLASIA1. Atrophy and Hypertrophy, Agenesis,Dysgensis, Aplasia, Hypoplasia,
Hyperplasia, Metaplasia, Dysplasia, Neoplasia, Anaplasia,.
2. Cell cycle and cell types (stable, labile, permanent)
3. Mechanisms controlling cell growth
4. Classification systems of tumors.
5. Characteristics of benign and malignant tumors
6. Difference between Carcinoma and Sarcoma.
7. Grading and staging system of tumors.
8. Biology of tumor growth
9. Process of carcinogenesis
10. Host defense against tumors.
11. Mechanism of local and distant spread.
12. Local and systemic effects of tumors.
13. Tumor markers used in the diagnosis and management of cancers.
14. Common chemical, physical agents and viruses related to human
15. Epidemiology of common cancers in Pakistan.
16. Radiation and its effects on tissues.
17. Cancer screening.
IMMUNOLOGY1. Antigen, antibody, epitope,hapten and adhesion molecules.
2. Difference between innate and acquired immunity.
3. Structure and function of major histocompatibility complex (MHC).
5. Mechanism of humoral and cell medicated immunity.
6. Hypersensitivity reactions, Type I, Type II, Type III and Type IV.
7. Autograft, homograft, allograft and xenograft.
8. Immunotolerance and immunoparalysis.
9. Mechanism involved in allograft rejection and steps that can be taken
to combat rejection.
10. Classification of Immunodeficiency disorders
11. Basis of autoimmunity.
12. Tissue transplantation.
13. Pathology and pathogenesis of AIDS.
14. Lab diagnosis of immunological diseases.
RECOMMENDED BOOKS1. Pathological Basis of Diseaseby Kumar, Cortan and Robbins, 7th Ed., W.B. Saunders.
2. Medical Microbiology and Immunology by Levinson and Jawetz, 9th Ed., Mc Graw-Hill.
3. Medical Genetics by Jorde, 3rd Ed., Mosby.
4. Clinical Pathology Interpretations by A. H. Nagi
B. PHARMACOLOGY AND THERAPEUTICSThe course outline is as follows:
1) General Pharmacology:1. Definition of pharmacology, objectives of learning pharmacology,
definition of drug and drug nomenclature.
2. Branches/divisions of pharmacology.
3. Sources of drugs.
4. Active principles ofdrugs and pharmacopoeias.
5. Dosage forms and doses of drugs.
6. Route of drug administration.
7. Absorption of drugs and processes involved in drug absorption.
8. Factors modifying absorption of drugs.
9. Transport of drugs across cell-membrane.
10. Bio-availability, its clinical significance and factors affecting bio-
11. Drug reservoirs, distribution and redistribution of drugs, plasma protein
12. Pro-drug, bio-transformation of drugs, enzyme induction, enzyme
inhibition and entero-hepatic circulation.
13. Plasma half-life of drugs, steadystate concentration, its clinical
importance and factors affecting it.
14. Excretion of drugs.
15. Mechanism of drug action.
16. Dose response curves, structure-activity relationship.
17. Factors modifying action and doses of drugs.
18. Pharmacokinetics, pharmacodynamics and receptors.
2) Dermatological and topical drugs (Locally Acting Drugs) Demulcents, emollients, irritants,counter irritants, astringents.
Antiseborrhoeics, locally acting enzymes.
Antiseptics and disinfectants.
3) Drugs Acting on Gastrointestinal Tract: Emetics and anti emetics.
Drugs affecting motility of GIT.
Ulcer healing drugs.
4) Cardiovascular DrugsAntiarrhythmic drugs.
Thrombolytics/ anticoagulants/ antiplatelets.
Drug management of CCF.
7) Drugs Acting on Autonomic Nervous System Cholinergic Drugs.
Anticholine-esterases cholinomimetic alkaloids.
- Anti muscarinic
- Anti nicotinic
Sympathomimetics / adrenergic drugs:
- Non catecholamine
- Alpha adrenergic receptor blockers.
- Beta adrenergic receptor blockers
Adrenergic neuron blockers
Autonomic ganglionic blockers
Skeletal muscle relaxants
A) neuromuscular blocking agents - d-tubocurarine, suxamethonium, etc.
B) central muscle relaxants , meprobamate, mephenesin, diazepam, etc.
8) Central Nervous Systema. Sedative-hypnotics.
c. General anaesthetics.
d. Local anesthetics.
e. Drugs for movement disorder/ muscle relaxant.
g. Drugs for migraine.
h. Stimulants of the central nervous system:
- Caffeine, theophyline, theobromine
- Brain stem stimulants: picrotoxin, nikethamide.
- Ethamivan, doxapram.
- Spinal cord stimulants: strychnine.
- Anti-depressant / anti mania drugs.
- Alcohol and drugs of abuse.
- Anti-parkinson drugs.
- Anti epileptic drugs
9) Analgesicsa. Opioids and narcotics analgesics.
b. Nonsteroidal anti inflamatory drugs (nsaid).
c. Antigout drugs.
10) Drugs Acting on Respiratory Systema. Drugs used in treatment of bronchial asthma.
11) Drugs Acting on Endocrine Systema. Pituitary-hypothalamic drugs.
c. Sex hormones
d. Thyroid/ parathyroid drugs.
e. Pancreatic hormones and oral anti diabetic drugs.
f. Oral contraceptives and anabolic steroids.
12) Drugs Acting on Uterusa. Ergometrine.
13) Antimicrobial Drugsa. Sulfonamides.
h. Anti- tuberculous drugs.
i. Antileprosy drugs.
j. Anti fungal drugs.
k. Antiviral drugs.
l. Anti-protozoal drugs:
- Anti- malarial drugs.
- Anti-amoebic drugs.
m. Urinary tract antiseptics.
n. Anti cancer drugs.
o. Immunosuppressive agents.
q. Vaccines and immunoglobulin drug interaction.
P R A C T I C A L SA - EXPERIMENTAL PHARMACOLOGY
Experiments designed to observe the action of drugs on animals and
Experiments on the actions of selected drugs to be demonstrated to the
1. Effects of drugs on reflex time.
2. Effects of drugs on frog's heart in situ.
3. Effects of drugs on rabbit's eye.
4. Effects of Acetylcholine and Atropine on isolated rabbit's ileum.
5. Effects of histamine and antihistamines on isolated rabbit's ileum.
6. Schemes to find out unknown drug having stimulatory or inhibitory
effect on isolated rabbit's ileum.
7. Effects of neuromuscular blocking agents on frogs rectus abdominus
8. Methodology of clinical trials.
9. Introduction to Biostatistics.
B. PRESCRIPTION WRITING
Guideline for rational use of drugs
Prescription writing for common ailments
¾ Acute watery diarrhea
¾ Acute streptococcal pharyngitis
¾ Iron deficiency anemia
¾ Acute malarial fever
Clinico-Pharmacological Seminars on Rational Drug Therapy and
Drug Interaction should be conducted
Frequency distribution of antibiotic prescribed in different clinical settings/units.
Rational prescribing pattern of antibiotics.
Parameters: provisional diagnosis, investigation, empirical therapy. Prescribing
after culture and sensitivity.
Groups of vitamin prescribed.
Vitamins prescribed on basis of therapeutic indication or empirical.
Single / multiple vitamins
Frequency of prescribing and rationaluse of vitamins/ otherwise.
a. Frequency distribution of variousgroups of analgesic prescribed.
b. Single / multipledrug prescription.
c. Non specific indications of analgesic prescription.
Adverse Drug Reactions
a. Anti-microbials, Cytotoxic drugs , Steroids etc.
RECOMMENDED BOOKS1. Basic and Clinical Pharmacology by Katzung, 10th Ed., Mc Graw-Hill.
2. Pharmacology by Champe and Harvey, 2nd Ed., Lippincott Williams & Wilkins.
C. FORENSIC MEDICINE & TOXICOLOGYThe course outline is as follows :
1. FORENSIC MEDICINE
The powers and jurisdiction of courts, procedures for inquest, and
a) Pakistan’s Legal System:
legal procedures. Important legal terms. Application of relevant
Legal Sections of the Penal Code. The role of a medical doctor in
the medico-legal system. To give Medical evidence in courts.
Document information to be prepared by a medical doctor for legal
procedures. Procedure of court attendance and recording of
b) Forensic Sciences:Role of Forensic Sciences in crime detection.
c) Law in relation to medical men:Privileges and obligations of Registered medical practitioner.
Doctor-patient relationship in the context of the highest ethical
standards. Temptations to professional misconduct. Guarding
professional secrets and privileged communication. Maintaining
highest ethical principles in medical examination and when
obtaining consent. Medical negligence. Declaring Brain death,
using the highest ethical and biological principles for the decision.
The pros and cons of organ transplantation in each individual
Develop and defend a personal moral view on Artificial
insemination, Therapeutic abortions, Euthanasia, Biomedical
research etc. in keeping with the norms of society and highest
d) Personal IdentityParameters of personal identity, methods of identifying living,
dead, decomposed, mutilated and burnt bodies, and skeletal and
fragmentary remains, using special techniques (Dentistry
Radiology, Neutron Activation Analysis etc.), and objective
methods of identification (Osteomtery, Dactyloscopy, D.N.A.
Technique, Super imposition photography, etc.) Describe the role
of various blood groups in resolving paternity and maternity
disputes. Methods to determine time since death.
Methods of determination of age, sex and race by various
methods with their medico-legal aspects.
Methods to trace evidence, Locard’s Principle of exchange and its
e) ThanatologyScientific concepts regarding death, medico-legal aspect of brain
death, indicators of death, medico-legal aspects of sudden and
unexpected deaths, causes, manner, mode and mechanisms of
Physicochemical changes subsequent to death occurring in
various body tissues and organsunder various environmental
To write a certification of death according to W.H.O guidelines.
f) Traumatologyi) Mechanical Injuries: Mechanisms of wound production,
classification of wounds, wounds produced by conventional
weapons and their medico-legal aspects. Firearms,
ammunition, classification, nomenclature, wound ballistics and
Ii) Mechanical injuries medicolegal considerations: Laws in
relation to causing bodily harm, wounding and homicide.
- Examination of an injured person, certify nature, manner of
injury, causative agent and dating of wounds.
- Link Sequelae of trauma to its original cause and search
for the relationship of sequelae to pre-existing disease.
- Causes of death from wounds.
- Difference between ante-mortem and post-mortem
- To diagnose whether death is suicidal, homicidal or
Iii) The student should also have knowledge of and be able to
describe methods of treatment and possible etiologies of
regional injuries, and should be able to suture simple
superficial wounds of:
Head (scalp, skull, brain) and face, vertebral column and its
contents, neck, chest, abdomen,limbs, bones and joints.
Special trauma such as transportation injuries, police torture,
Death in custody
Should be able to determine the medico-legal aspects of heat,
cold, electrical injuries.
g) Violent deaths due to asphyxiaAnatomical, physiological, biochemical and pathological signs of
violent death and of mechanical, chemical and environmental as
physical death and their medico-legalimplications. Death due to
h) Autopsy:- Types, objectives, rules, and techniques and describe
procedure for postmortem.
- Methods for assessment of fatal period and postmortem
interval. Post-mortem artifacts.Risks and hazards of autopsy,
and autopsy protocol.
- Procedure for selection and preservation, labeling and
dispatch of biological and non-biological materials for
laboratory examination; and collection of relevant samples.
- Exhumation procedures, and their value and limitations.
i) Forensic Sexology.Virginity, pregnancy and criminal processes during delivery, their
medico-legal aspects, examination procedure and reporting.
j) Sexual offences and relevant sections of law (Zina and
- Natural and unnatural sexual offences. Medical examination
of victim and assailant, collection of specific specimens and
writing a required certification.
- Common sexual perversions and their cause.
k) MiscarriageMedico-legal aspects applicable to miscarriage examining mother
and aborted material.
Sending aborted material in properpreservative for examination.
l) Crime against new born, infants and child:Infanticide, and criminal and non-accidental violence or abuse to a
newborn, infant or child.
m) Forensic Psychiatry- To diagnose mental illness.
- To distinguish between true and feigned insanity.
- To advise on procedure of restraint of the mentally ill,
Limitations to civil and criminal responsibilities of mentally ill.
n) Examination of biological specimens- Forensic importance of biological specimens (blood, semen,
salvia, vomitus, breath, urine, hair),
- The method of their collection,preservation, dispatch and the
common laboratory tests performed.
- The scope of Toxicology.
a) General principles of Toxicology
- To access the laws regulating drugs and noxious products.
- Common Toxicants in our environments and their abuse.
- Cause of drug dependence, the fate and detoxification of
poisons in the biological tissues.
- To diagnose toxicological cases in acute and chronic
exposure in living and dead. Utilize general principles of
treatment with antidotaltherapy and management.
- To handle specimens, work within the framework of duties of
Doctor in cases of poisoning toprepare and interpret chemical
b) Autopsy techniques with collection, preservation and dispatch of
Poisons/drugs of abuse prevailing in our society along with
biological material to analytical laboratory.
c) Specific Poisons
ii) Opiates, opioids and other narcotics
iii) Salicylates and paracetamol
iv) Hypnotics and sedatives
v) Stimulants (cocaine), cannabis
vi) Poisonous plants (aconite, belladonna, hyoscyamus,
stramonium, digitalis, ergot, mushrooms, nux vomica,
vii) Venomous insects (snakes)
viii) Inorganic elements, antimony, arsenic, lead, mercury,
ix) Volatile poisons and corrosives (carbon monoxide, hydro
carbons, cyanides, sulfuric acid, oxalic acid, carbolic acid
x) Pesticides, herbicides and insecticides
c) Note book
c) Note book
Recommendations are as under:-
A) Theory in the form of tutorials, seminars, videos and lectures
B) Practical in the form of :
Posting in autopsy rooms
Postings such as in medico-legal clinics / casualty departments /
Experiments in biological laboratory.
D) Periodical tests will provide feedback to the teachers and assess
adequacy of learning.
Practical work will include
1. In Forensic Medicine
¾ Medico-legal examination of injured
¾ Estimation of age and forensic radiology
¾ Sexual assaults and sex related cases (impotence, pregnancy etc.).
¾ Procedure of preservation, dispatch of biological and other
¾ Practical in biological laboratory (identification of blood, semen,
¾ Procedure of consent taking and medical certification.
2. In Toxicology, students should have an understanding of and be able to
¾ Diagnostic and management process (alcohol, narcotics and
¾ Collection, preservation and dispatch of biological materials.
¾ Visual, olfactory and tactile identification of common poisons found
in communities and country.
For proper orientation and practical demonstration, visits are also
suggested to a :
¾ Forensic science laboratory.
¾ Psychiatric unit or jail
¾ Site during conduction of exhumation.
RECOMMENDED BOOKS1. Simpson’s Forensic Medicine by Barnard Knight, 11th Ed., Edward Arnold, London.
2. Parikh’s Text book of Medical Jurisprudence, Forensic
Medicine and Toxicology by C.K. Parikh 6th Ed., CBS Publisher.
3. Buchanan’s Text book of Forensic Medicine and Toxicology by
Buchanan, 9th Ed., Livingstone.
4. G. Principles and Practice of Forensic Medicine by Prof. Nasib
5. Medical Jurisprudence and Toxicology by Dr. Siddique Hussain.
2nd Professional MBBS Examination:
To be held at the end of the 3rd year in the following subjects:
(a) Pharmacology & Therapeutics
Theory 135 Marks
Internal Evaluation 15 Marks
Oral & Practical 100 Marks
Animal experiment 35 Marks
Internal evaluation 15 Marks
Total 300 Marks
(b) Pathology General & Microbiology
Theory 135 Marks
Internal Evaluation 15 Marks
Practical & Oral Exam 135 Marks
Internal Evaluation 15 Marks
Total 300 Marks
(c) Forensic Medicine
Theory 90 Marks
Internal Evaluation 10 Marks
Viva Voce 90 Marks
Internal Evaluation 10 Marks
Total 200 Marks