Areas of special interest: Base of skull The thoracic inlet and Ist rib

Intercostal spaces icluding paravertebral space. Coronary circulation and angiogram

Anatomy of imaging: identification and location of normal structure by radiography

Radiography of chest, heart, lungs and diaphragm

CT scanning of brain, Thorax and abdomen (Normal findings)

The abdominal wall including the inguinal region

Antecubital fossa

Large veins of upper arm

Axilla laege veins of leg femoral triangle, large veins of neck

Anatomy of tracheostomy, laryngotomy, cricothyrotomy

Eye and orbit

Surface anatomy related to the following nerve blocks:Cervical ganglion block,Cervical epidural block, Thoracic epidural block Lumbar epidural block Sacral epidural block All approaches of Brachial plexus block

Obrurator nerve block Sciatic nerve block

Surface marking of the joints of the upper and lower limbs, temporo-mandibular joints and intervertebral joints

Group B : General Pathology

Cellular adaptation-cell injury & cell death

-Cellular adaptation of growth and differentiation –

Overview of cell injury & cell death:

Depletion of ATP

Mitochondrial damage-Influx of intracellular calcium and loss of Ca homoeostasis – Accumulation of 02 derived free radicals

Difference in membrane permeability

Reversible & irreversible cell injury

Morphology of cell injury and necrosis: Apoptosis

Sub-cellular response to injury – Intracellular accumulations

Pathologic calcifications

Cellular ageing

Acute & Chronic Inflammation

acute inflammation

chemical medications of inflammations outcome of acute inflammation

Morphologic pattern of acute inflammation – Chronic inflammation

systemic effects of inflammptions

Tissue renewal and repair; Regeneration, Healing and Fibrosis:

– Definition

Control of normal cell proliferation

Mechanism of tissue regeneration

– Extracellular matrix & cell matrix interaction Repair by healing, scar formation and fibrosis Cutaneous wound healing

– Fibrosis

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Haemodynamic disorder, Thromboembolic diseases & Shock: Oedema, Hyperanaemia, congestion, haemorrhage, Haemostasis & thrombosis, Embolism, Infarction, Shock, Pathogenesis of septic shock

Environmental and Nutritional Pathology: Environment and disease Common environmental and occupational exposures – Nutrition and disease Obesity and systemic disease Chromoprevention of cancer

Acute Lung Injury: Pulmonary oedema Classification Causes: Haemodynamic oedema, oedema due to alveolar injury, oedema of undetermined injury, oedema caused by Microvascular injury

Acute Respiratory Distress Syndrome: – Causes Pathogenesis – Clinical Course

Acid aspiration syndrome: Aetiology – Causes – Clinical features – Treatment – Prevention

Liver Drug & toxin induced liver disease Jaundice and cholestasis – Bilirubin and bile formation Causes of jaundice Alcoholic liver disease

Heart

Heart failure: Cardiac hypertrophy Pathophysiology & progression of failure – Left-sided heart failure Right-sided heart failure

Heart disease-

Congenital heart disease Left to right shunts Right to left shunts Obstructive congenital Anomali Hypertensive heart disease Valvular heart disease-causes, pathogenesis

 SYLLABUS FOR FCPS PART – I Pediatrics COURSE OF BCPS PAPER – II : Physiology and Biochemistry

Candidates should have a good general understanding of human physiology in order to recognise the need to apply physiological principles and knowledge aimed at correcting functional abnormality and save lives of patients.

GROUP A : PHYSIOLOGY

General

Organisation of the human body and control of internal environment

The ageing process. Characteristics of neonates, infants, children, adults and the elderly.

Function of cells; genes and their expression

Cell membrane characteristics; receptors

Protective mechanisms of the body

Body fluids and their constitution

Capillary dynamics and interstitial fluid

Osmolarity : osmolality, partition of fluids across membranes Lymphatic system

Special fluids : cerebrospinal fluid, ocular, pleural, pericardial and peritoneal

Haematology and Immunology

Red blood cells: haemoglobin and its variants

Blood groups

Haemostasis and coagulation

White blood cells

Inflammation : cellular response and cytokine production Immunology and allergy

Muscle Action potential generation and its transmission Neuromuscular junction and its transmission Muscle types

Skeletal muscle Heart and CirculationCardiac muscle contraction 

The cardiac cycle, pressure and volume relationships 

Regulation of cardiac function; general and cellular

Rhythmicity of the heart

Electrocardiogram of the heart and physiological `dysrhythmias’ Neurological and humoral control of blood pressures, blood volume and blood flow (at rest and during physiological disturbances e.g. exercise, haemorrhage and Valsalva manoeuvre) Peripheral circulation; capillaries,vascular endothelium and arteriolar smooth muscle, tissue

Characteristics of special circulation including pulmonary, coronary, cerebral, renal, splanchnic, portal and foetal

Renal tract

Blood flow and glomerular filtration and plasma clearance Tubular function and urine formation

Regulation of fluid and electrolyte balance

Regulation of acid base balance

Micturition

Respiration

Gaseous exchange : 0₂ and CO₂ transport, effects of altitude, hypoxia and hypercarbia

Pulmonary ventilation : volumes, flows, dead space. Effect of IPPV on lungs

Mechanics of respiration : ventilation / perfusion abnormalities Regulation of respiration

Non-respiratory function of the lungs

Function of nerve cells and synaptic mechanisms

The brain : Functional divisions — cortex, midbrain, medulla, limbic system, brain stem and cerebellum

Intracranial pressure: cerebrospinal fluid, blood flow. Maintenance of posture

Autonomic nervous system

Neurological reflexes

Sleep, wakeful and unconscious states, electroencephalogram Motor function : spinal and peripheral

Senses : receptors, nociception, special senses Pain : afferent sensory and efferent modulatory pathways; peripheral and central mechanisms and response to nociception Spinal cord : anatomy and blood supply, effects of spinal cord section

Liver Functional anatomy and blood supply Metabolic functions

Gastrointestinal Gastric function : secretions, nausea and vomiting Deglutition, act of vomiting Gut motility, sphincters and reflex control Digestive functions Metabolism Nutrients : carbohydrates, fats, proteins, vitamins and minerals Metabolic pathways, energy production and enzymes, metabolic rate Hormonal control of metabolism : regulation of plasma glucose, response to trauma Physiological alterations : starvation, obesity, exercise, stress response Body temperature and its regulation

Endocrinology Mechanisms of hormonal control : feedback mechanisms, effects on membrane and intracellular receptors Hypothalamic and pituitary function Adrenocortical hormones. Adrenal medulla Pancreas Thyroid and parathyroid hormones and calcium homeostasis Pregnancy Physiological changes associated with normal pregnancy Functions of the placenta : dynamics of placental transfer Foetus : changes at birth Topics of special interest Stress response Fasting, volume and pH of stomach content Postoperative nausea and vomiting Act of vomiting Spinal headache Natural sleep and arousal, consciousness, unconsciousness

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GROUP B : BIOCHEMISTRY

Biochemistry is essential for understanding of physiological processes. Management of critically ill patients in ICU requires a fair amount of knowledge of biochemical changes in diseases and recovery. Candidates should know about the basic biochemical substances and processes and their functions and interactions in the human body.

Body fluids Types and physicochemical properties of different body fluids

Acid base Acid base balance and buffers Ions e.g. Na+, K+, Ca++, Mg++, Or, HCO3-

Metabolism Metabolic pathways and bioenergetics, enzymes, coenzymes and catalysts

Nutritional substances Carbohydrates, lipids, proteins and their metabolism, intermediary metabolic pathways. Metabolism of minerals

DNA and RNA Nucleic acids and nucleoproteins

Hormones Insulin, Adrenaline, noradrenaline, corticosteroids, thyroid and pituitary hormones

Eicosanoids Prostaglanins, prostacyclines, and thromboxanes.

Biochemical changes in diseases Stress response, Circulatory arrest, trauma, inflammation, dehydration, near drowning

Assessment of biochemical functions Biochemical tests to assess respiratory, circulatory, renal and liver and hormonal functions. 

SYLLABUS FOR FCPS PART – I COURSE OF BCPS PAPER – III : (Pharmacology, Basic Physics and Basic Biostatistics)

GROUP A : PHARMACOLOGY

I. General Pharmacology (In addition to all those that are already in the syllabus, the following topics may also be incorporated): Basic chemistry and biochemistry pH, pKa, mole, molar, osmolarity, osmolality, etc. etc. Types and nature of solutions, protein binding Ionization, solubility, partition coefficient Diffusion, biological membrane characteristics, osmosis, Carreer mechanism, active and passive transport system Cell membrane, pores, etc. Isomerism

Receptors

Type and nature

Location

Mechanism of action

Bonding

Occupancy Agonists,

 partial agonists and antagonists

Routes of drug administration

Uptake and distribution

Inhalational agents

Intravenous and orally administered drugs Drug interaction Metabolism/detoxification

Elemination/clearance Mechanism of drug action

II. Systemic Pharmacology

No change from the current syllabus is necessary

III. Applied Pharmacology Routes of drug administration EMLA Uncommon routes in anaesthesia, advantages and disadvantages, etc. (Special emphasis on inhalational, trans-tracheal, sub-lingual, transdermal, epidural or intra-thecal routes, their complications, per rectal, etc.) Drug and fluid infusion, uptake by containers and their clinical importance, in-vitro drug interactions Phlebitis of infusion Incidence

 Agents

 Assessment

Prevention, etc.

Bolus versus infusion of anesthetic agents

Drug effect in special circumstances: heart failure & drug

absorption from gut, protein binding & hypo-proteinemia.

 Hoffman elimination

SYLLABUS FOR FCPS PART – I COURSE OF BCPS PAPER – III : (Pharmacology, Basic Physics and Basic Biostatistics)

I. Basic Physics

1. General principles of physics applied to medicine with specific reference to anaesthesiology. This may include, why and how physics may play a role. Which part of physics may affect anaesthesia, etc.

 2. Specific chapters of physics:

a. Liquid, gas and vapours

 i. Definition

ii. Different forms of liquids, gases and vapours

iii. Difference between the states of substances

 iv. Gas laws, intermolecular attraction, atomic structure, etc.

b. Pressure

 i. Definition

ii. Role in medicine and in anaesthesiology

iii. Atmospheric pressure, partial pressure, saturated vapour pressure

c. Flow

i. Definition

ii. Types of flow

iii. Bernoulli Principle

 iv. Venturi effect and applications

v. Basic fluidics

d. Energy

 i. Definition

 ii. Forms of energy

iii. Hazards iv. Uses and complications

e. Electromagnetic radiation

 i. Definition

 ii. Radionuclide and isotopes

iii. Application in medicine

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f. Sound

 i. Use of sound in medicine, types, frequency/intensity, etc.

g. Electricity

i. Natures of electricity, ac/dc, electrocution.

ii. Static electricity

h. Heat and Temperature i. Units and scales of measurement and interrelations

i. Humidity i. Types of humidity

3. Units of measurement a. SI units of measurements and their interrelationships b. Derived units in relation to anaesthesia and intensive care

II. BASIC BIOSTATISTICS

Candiates will be required to demonstrate understanding of basic statistical concepts, but will not be expected to have practical experience of statistical methods. Emphasis will be placed on methods by which data may be summarised, and presented, and on the section on the statistical measures for different data types. Candidates will be expected to understand the statistical background to measurement error and statistical uncertainty

Descriptive statistics Categories of data. Statistical distributions (Gaussian, x2 binomial) and their parameters. Non-parametric measures of location and variability. Graphical presentation of data Deductive and inferential statistics Simple probability theory. Confidence intervals. Linear regression. Linear correlation.The null hypothesis. Type I and type II errors. Probability of error occurrence, and the power of a test to detect significant difference.Choice of simple statistical tests for different data types. 

SYLLABUS FOR FCPS PART – II COURSE OF BCPS Paper – II: (Medicine, Surgery, Applied Physics & Clinical Measurements and Applied Biostatistics)

APPLIED CLINICAL MEASUREMENTS

1. General principles of physics and clinical measurement:

 a. How physics and clinical measurement may affect medicine with specific reference to anaesthesiology.

2. Specific chapters of physics: a. Liquid, gas and vapours

i. Definition ii. Different forms of liquids, gases and vapours

iii. Difference between the states

iv. Gas laws v. Why and how gas affects anaesthesia?

vi. Risks and dangers of compressed gases.

vii. Measurement of flow of gases and liquids

 viii.Measurement of cardiac output (including Fick’s principle)

 ix. Manufacture of different anaesthetic gases (02, N20,CO2 & compressed air)

x. Flow characteristics of

1. Gases through endoracheal and tracheostomy tubes

 2. Fluids through spinal needles

b. Pressure

 i. Definition

ii. Role in anaesthesiology

iii. Measurement of pressure, in vivo and in vitro

 iv. Transducer (all about transducers)

v. Testing the cylinders for compressed gases.

c. Energy

 i. Definition

ii. Forms of energy

iii. Electrical hazards and safety in the theatre.

 iv. Flow of electrons, measurement of electricity and use of electricity. v. Electrical circuits, grounding and neutrality, their importance, etc.

 vi. Thermal and other forms of energy, including nuclear.

vii. Radiation, use of radiation in medicine, radiation safety.

 d. Sound

i. Use of sound in medicine

ii. Ultrasound, echo, etc.

 e. Temperature & humidity

i. Units of measurement

 ii. Definition

iii. Measurement of temperature

iv. Measurement of humidity (Absolute & relative)

v. Humidifiers vi. Patient cooloing/warming

3. Units of measurement

a. SI units

b. Other units (simplified)

4. Medical gas

a. Sources

i. Compressed cylinders

 ii. Gas pipeline

b. 02 and N20 manufacture and storage, risk and hazards.

 c. Compressed medical air

5. Ventilators:

a. Basic principles

 b. Humidity, humidification

c. Basic modes of ventilation and terminologies

6. Anaesthesia machines

a. Basic configuration

b. Flow principles

c. Safety features

d. Alarms e. Ergonomics f. Pre use anaesthesia machine check

7. Environment and anaesthesia

a. OT pollution

i. Types and nature of pollution ii. Preventing pollution

 b. Anaesthetic gas scavenging

8. Waste disposal

a. Types of medical waste

b. Disposal of waste c. Incineration

9. Breathing circuits, components of breathing circuits and their geometry, intra circuit gas mixing, CO2 absorption.

10. Monitoring

a. Patient monitoring: Principles, calibration of equipments, fallacies & limitations.

b. Equipment monitoring

 c. Equipment calibration and pre-use check

11. Filters in anaesthesia: a. Blood filtration: Pall, Swank, etc b. Filters in breathing circuit c. Efficiency of filters, pore size, filtration pressure, flow rates, etc.