Proposed Physiology Syllabus

Proposed Physiology Syllabus

1. provide our students with a thorough understanding of the basic principles of Medical Physiology.
2. enable them to integrate what they have learned about body structure, biochemistry, and physiology into a meaningful body of biomedical knowledge.
3. Provide insights into the pathophysiologic mechanisms of disease, thereby giving our students a solid foundation for their future medical training and clinical practice.

Several Physiology disciplines, including General Physiology, Neuro-Muscular Physiology, Cardiovascular Physiology, Respiratory Physiology, Gastrointestinal Physiology, Renal Physiology, Endocrine Physiology, Physiology of Growth, and Reproduction Physiology will contribute to the instructional program of the course. The course also covers the relevant topics of Biophysics and Acid-Base Balance.

Great Emphasis will be on presenting an integrated view of how the functions of the body organ systems are integrated and controlled for maintaining homoeostasis.

(A) Knowledge

Upon completion of this course, students should be able to:

• Describe the basic physiological concepts of homeostasis.
• Discuss the functions of the different body organ systems.
• Explain how the functions of the different body organ systems are controlled.

(B) Cognitive Skills

Students should be able to:

• Illustrate the integration of the functions of the different body organ systems in maintaining homeostasis.
• Depict the Patho-physiological consequences of dysfunctions of the different body organ systems.

(C) Interpersonal Skills and ResponsibilitySkills

Students must demonstrate a combination of interpersonal skills, attitudes, and behaviors necessary to function as a respected member of a learning team.

Students will:

• Behave professionally including attendance, punctuality, and preparedness.
• Able to interact effectively with their classmates.
• Recognize and effectively deal with unethical behavior of their classmates if encountered.

(D) Communication, Information Technology, and Numerical Skills

Students must have demonstrated the communication skills and attitudes that allow effective interaction with their peers and faculty members.

Students will:

• Use verbal language effectively.
• Use effective listening skills.
• Facilitate the learning of other students, including giving effective feedback.
• Communicate essential information effectively within their classmates.

(E) Psychomotor Skills:

Students demonstrate the basic skills of:

• Determining the hematocrit value and hemoglobin content, blood indices
• Estimation of ESR, bleeding time , clotting time
• Heart rate and pulse determination
• Blood pressure measurement.
• Recording electrocardiogram (ECG).
• Interpreting the normal sinus rhythm and comment on the ECG waves and intervals.
• Auscultating the heart.
• Conducing a spirometry test and interpretation of the results
• Examining the sensory system.
• Examining the deep tendon reflexes.
• Examining the light reflex.
• Examining the visual acuity.

1. Lectures.
2. Laboratory sessions and demonstrations.
3. Toutorials

1

Cellular Physiology and Nerve &Muscle Physiology (15 h)

1. Introduction:- Origin of the word physiology.( from Greek word PHYSIOLOGIKOS), this subject becomes the basis of Medicine, Every year Nobel Prize is give under the field of physiology/Medicine. Physiological functional unit, CELL .Its organelles, and function in brief.

1. Evolution:- Evolution, from unicellular, to Multicellular organism have evolved, which has given rise to cell, body fluids, and many complex systems have evolved at the same time, and made life possible from aquatic to terrestrial.

1. Body fluids:- introduction to the fluid system in the body, how much % of fluid is present with respect to body weight. Body fluid compartments:- Intracellular, Extracellular fluids,( Interstitial fluid + Blood ) and transcellular fluid. Male and female body fluid %.Body fluid variation with respect to age. Intake/output of body fluids, % of body fluids present in different compartments in terms of liters. Internal Environment/ Homeostasis.

1. Body fluids and Electrolyte:- The electrolytes present in the body. How they are distributed in the body fluids., unites in which they are expressed. Measurement of body fluids volume.(Dilution Principle)

1. Cell membrane:-Introduction, how essential is the cell membrane, and its relation to life itself. Structure of the membrane in detail. Bilipid layer, and proteins which are incorporated in the membrane Integral and peripheral proteins. Membrane proteins and their functions, Receptors, Channel proteins, Na+/K+ pump, Carrier proteins, Cell-adhesion molecules,(Tight junction, Desmosome and Gap junction), Enzymes and Proteins which identify self and nonself. Cytoskeleton proteins and its functions.

1. Transport System:-Vesicular transport (endocytosis, exocytosis, pinocytosis and phagocytosis),Simple diffusion (Lipid transport, ) ionic transfer (Voltage gated, chemical gated and some open ionic channel), Carriermediated transport:- Facilitated diffusion, Active ( Primary active transport, Symport and Antiport) and Secondary active transport. Osmosis. Isotonic solution, 300M0sm, Hypertonic and Hypotonic solutions, What happens if a cell is suspended in these solutions?

1. Cell to Cell communication:- a) Hormones b) Neurotransmitter and c) Neurohormone

NERVE / MUSCLE PHYSIOLOGY

1. Nerve cell (Neuron):- Description of the functional unite of the brain. Cell body, Dendtire, Dendritic Spines, Axon initial segment ,Axon terminal.

1. Function of nerve cell:- Action Potential Resting membrane potentialDifferent components (Depolarization, repolarization and hyperpolarization)Events of action potential in detail.

1. Muscle :- Three types of muscles .Skeletal muscle, Cardiac Muscle and Smooth Muscle.

1. Contractile Proteins in detail :- Characteristic of skeletal muscle. Myosin Actin Tropomyosin Troponin I T C.

1. Striations Sarcomere Myosin Actin Troponin

1. Figures should be used to explain, if not the students will not understand.

1. Sarcotubular System:- a) T-tubule b) Sarcoplasmic reticulum., Functions of both.

1. Electrical-Mechanical responses:- Electrical responses Mechanical responses. The importance of electrical responses, should be mentioned to the students, if not they will forget, that electrical events does occur in any tissue, before mechanical response. Its clinical importance.

1. Abnormalities in the electrical responses of different tissues are used in clinical practice for diagnostic purpose example:- EEG EKG and EMG.

1. Neuromuscular Junction:- Structure, Transmission of impulse, and how it results in muscle contraction. Biosynthesis and catabolism of Acetylcholine.Abnormalities of neuromuscular junction function should be discussed.

1. Molecular basis of muscle contraction:- Steps in contraction and steps in relaxation. Excitation-Contraction Coupling:- The process by which depolarization of the muscle fiber initiates contraction is known as excitation-contraction coupling.

1. Response of a muscle for a single stimulus:- Latent period, contraction period, and relaxation period.

1. Summation:- Incomplete – tetanus, Threshold stimulus, All or None Law.

1. Types of muscle fibers:- Red (dark) muscle fibers, White (pale) muscle fibers. Characteristic of these muscle fibers and functions.

1. Types of muscle contraction:- Isotonic muscle contraction and Isometric muscle contraction and their function. Muscle receptors:- Muscle spindle and Golgi tendon organ.

1. Abnormalities of muscle:- Denervation hypersensitivity (Supersensitivity) , Myasthenia gravis, Contracture, Muscular dystrophies, Lambert-Eaton syndrome and poliomyelitis, Rigor Mortis, Muscle hypertrophy, Hyperplasia, Muscle atrophy.

1. SMOOTH MUSCLE:- Single unit smooth muscle and multiunit smooth muscle.

Autonomic nervous system (15)

1. General organization of the autonomic nervous system.
2. Comparison of somatic and autonomic nervous system.
3. Divisions of autonomic nervous system and autonomic ganglia.
4. comparison between sympathetic and parasympathetic nervous system.
5. Distribution and functions of sympathetic nervous system.
6. Distribution and functions of para-sympathetic nervous system.
7. Chemical transmission at autonomic junctions.
8. Regulation of autonomic functions by higher centers.

Blood physiology (12h)

1. Introduction: Fluid connective tissue, its relationship to total body fluids, normal volume, increase/decrease of it and its effect on the body function in general. Composition in detail.
2. Plasma:- fluid component of the blood, % present, plasma proteins, different types of proteins present, origin of each, function of each protein, variation in each one of it and its implication on the body function.
3. Red blood cells:- origin, stages of formation, stimulus for the formation, normal values, function destruction and the end products. Anemia, different types, polycythemia.
4. White blood cells:-Different types of WBCs, formation, % of each one of them in the blood, stimulus for the formation, functions of each of them, Reticuloendothelial system, inflammation, immunity and different types.
5. Blood groups:- ABO and Rh blood groups should be discussed in detail. Blood transfusion, blood bank and its importance.
6. Platelets:- Count, formation, function, variations of it and its effect, bleeding Aspirin and its importance.
7. Blood coagulation:- Should be discussed in detail. Clotting factors, mechanism of clotting and bleeding disorders, Anticlotting mechanisms (Antithrombin, Fibrinolytic system), Anticoagulants. Hemostasis.

Cardiovascular System (25h)

1. Introduction to CVS, basic function, in few sentences. How cardiovascular system, fits in the functioning of the body, to sustain the life. Properties of cardiac muscle, Anatomy of the cardiac muscle, Cardiac pacemaker, Generation of an action potential, Comparison of cardiac and skeletal muscle.
2. Conducting system of the heart, in detail, Impulse generation from the peacemaker and conduction through the conducting system, rhythmic excitation of heart, Autonomic nerves supply to the heart and to the pacemaker, and its influence over the function, Abnormal rhythm of the heart (heart block, cardiac arrest, ectopic focus, artificial pacemaker).
3. Normal ECG, principle of different waves, method of recording in detail. Clinical uses of ECG, HR calculation, arrhythmia, IHD, and electrolyte disturbance. Cardiac axis, vector analysis. Changes in the ECG during cardiac abnormalities and its interpretation, Vectrocardiography, Echocardiography
4. Definition of cardiac cycle, mechanical events, pressure & volume changes in cardiac cycle (their graphs or waves). Its related issues like pulse, JVP and heart sounds.
5. Factors regulating the cardiac function, perfusion of mammaliam heart and effects of different ions, on the heart functions. The effect of increase or decrease of minerals on the heart function.
6. Cardiac output, factors controlling it, venous return, relation of cardiac output and Venous return, Starling law of heart and heart failure..
7. Blood pressure, definition, details of factors regulating it, principles of measurements, importance of regulation, certain common abnormalities .Mean arterial pressure, pulse pressure, their importance.
8. Regulation of blood pressure short and long term. Physiological basis of hypertension treatment.
9. Hemodynamic of circulation, anatomical structure of blood vessels, at different levels, their innervations and control physical characteristic of blood. Interrelationship between pressure, flow and resistance.
10. Systemic circulation, in all its details. Exchanges of fluid at the capillaries, starling forces, veins, venous pressure, venous pump. Role of lymphatic circulation, pathogenesis of edema.
11. Tissue perfusion, factors effecting the tissue perfusion. Metabolic, humoral and nervous factors to be discussed in detail.
12. Special circulation:Pulmonary, Cardiac , cerebral , Splanchnic (intestinaland hepatic circulation) Cutaneous Circulation.
13. Coronary circulation: vessel organization, normal blood flow, age related disorders of the coronary vessels, myocardial infraction, cardiac failure, cardiac arrest.
14. Pulmonary circulation:structure of pulmonary vasculature, pressure flow through the lungs, capillary dynamic, pulmonary edema, embolism.
15. Circulatory shock, definition, causes, types, and management in short.
16. Circulatory adjustments during physical exercise.

Respiration (22 h)

1. Anatomy of the Lung, mechanics of respiration, muscles of respiration.
2. Ventilation, lung volume and capacities Anatomical and physiological dead space.
3. Dynamics of ventilation, alveolar stability, surfactant, lung compliance.
4. Gas exchange in the lung, diffusion of gas across alveolar capillary membrane,

Ventilation - perfusion ratio.

1. Gas transport between the lung and the tissues:- oxygen transport and carbon dioxide transport in the blood and body fluids.
2. Regulation of respiration:- introduction, respiratory centers,neural control of breathing, Chemical control of breathing, nonchemical influence on respiration.
3. Respiratory adjustment:- hypoxia,hypoxic hypoxia, exercise, respiratory abnormalities
4. Lung function tests.

Gastrointestinal Physiology (12 h)

1. Introduction to gastrointestinal tract, its innervation, and function in general. Salivary glands, types of glands, Innervation, , saliva, composition, stimulus, secretion, and functions.

1. Stomach:-structure of it, histology, types of cell and its location innervation, secretion of gastric juice, phases of secretion, composition, stimulus for the release, function.( digestion in the stomach)

1. Acid release in the stomach:- Detailed mechanism of acid release, Normal function ,abnormal release, of acid in the stomach ,hyperacidity, peptic ulcer, role of HELICOBACTERI PYLORI causing peptic ulcer disease.

1. Hormones released by G.I. tract:-Gastric motility, emptying time.

1. Pancreas:- Exocrine function, In detail the composition of pancreatic juice, stimulus for the release, hormones acting on it, activation of the enzymes in the G.I tract, digestion of different components of food by the pancreatic juice.

1. Bile:-bilesecretion, composition, enterohepatic circulation, functions of bile.bile pigments, direct and indirect van den bergh reactions. Excretion of bilirubin, cholecystography.

1. SmallIntestine:- Hormones,/ Enzymes released, digestion of different component of the food, in detail, absorption of digested food in detail, the motility of small intestine.

1. Large Intestine: Functions and motility abnormalities.

1. Defection:- defection Reflex

Renal Physiology (23 h)

Learning Objectives

At the end of this section and after reading the assigned material, the student should be able to:

1- Describe the functional anatomy of the kidney, renal circulation, and the factors that influence renal vascular resistance and renal blood flow (RBF).

2- Define autoregulation of renal blood flow (RBF) and explain the theories advanced to explain it.

3- Describe the glomerular filtration barrier and the process of glomerular filtration and the factors that determine its rate (GFR).

4- Explain the concept of renal clearance.

5- Explain how glomerular filtration rate (GFR) can be measured in the lab., and describe the different ways GFR can be estimated in clinical practice.

4- Outline the handling of Na+ and water in the different segments of the renal tubules and describe how Na+ transport mechanisms differ from segment to segment.

5- Describe the rennin-angiotensin-aldosterone system (RAAS) and its role in the control of Na balance and the long-term regulation of blood pressure.

6- Describe the Na co-transport mechanism and the renal handling of glucose.

7- Describe the balance and renal handling of each of potassium, calcium, and magnesium.

8- Describe how the cortico-papillary osmotic gradient is generated and how the kidney produces concentrated or dilute urine.

9- List the major functions of the kidney

10- Describe the voiding reflex and draw a cystometrogram

Acid-Base Balance

Learning Objectives:

1.Define acid-base balance and explain in specific terms why it is important.

2. Describe a few medical conditions that result in acid-base disorders.

3. Describe in general terms the metabolic reactions that lead to H+ production.

4. Describe the basic mechanisms responsible for the maintenance of acid-base homeostasis.

5. Describe the biological buffer systems & the unique attributes of the HCO3- / CO2 buffer pair.

6. Describe how buffers work and explain the unique, dynamic characteristic of hemoglobin.

7. Describe the general scheme of the control of breathing & the role of the respiratory system in acid-base homeostasis.

8. Define the three elements of the acid-base picture & describe the 4 primary acid-base disorders (ABDs).

7. List examples of conditions that can cause each of the primary ABDs.

8. Describe apractical three-step approach for the evaluation of ABDs.

9. Explain how the direction & extent of respiratory compensation is used in the diagnosis of ABDs.

10. Define anion gap (AG) & explain how it is used in the diagnosis of metabolic ABDs.

Endocrinology (18 h)

1. Introduction to endocrinology:- Role of these endocrine glands in general, how does these glands with its function contributes towards HOMEOSTASIS.
2. Classification of hormones:-Nature of the hormone and the general mechanism of action. Negative feedback mechanism, relation of a hormone and its own receptors. What is the relationship between the endocrine glands and brain function.
3. Names of all the endocrine glands. Pituitary gland, anterior and posterior. Hormones released by anterior pituitary gland (TSH, ACTH, LH,FSH, prolactin, and Growth hormone).Except growth hormone, the functions of other hormones must be mentioned in brief, the details of each will be taught at the respective places.
4. Posterior pituitary gland, hormone, release and its relationship with hypothalamus .Hypothalamus and its relationship with endocrine glands. Hypothalamo-hypophyseal portal system.
5. Growth hormone:-Release, control, normal function, abnormalities. Physiology of growth: This should be discussed in detail, as growth hormone is one, other hormones, nutrition, and genetic makeup the total picture.
6. Thyroid gland:- Hormone synthesis, release, control, function, Its action at cellular level, should be discussed. Pathophysiology of the thyroid gland
7. Parathyroid gland:-Synthesis of the hormone, stimulus, release, its function, its relationship to Vitamin C, and kidney, abnormalities. Calcitonin, its function. Over all function of blood calcium. Calcium and phosphate metabolism.
8. Pancrease:- endocrine function only. Cells concern with endocrine function.

All hormones released by pancreas.Insulin in detail, synthesis,stimulus, release, functions on all the three metabolism. Regulation of blood glucose concentration. Glucagon, release and function. Pathophysiology of Diabetes mellitus in short.