Download MGR MBBS 1st Year Biochemistry Syllabus

BIOCHEMISTRY

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Goals and objectives given below are as per the Medical Council of India Regulations on Graduate
Medical Education, 1997.
GOAL
The broad goal of the teaching of undergraduate students in biochemistry is to make them understand the

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scientific basis of the life processes at the molecular level and to orient them towards the application of
the knowledge acquired in solving clinical problems.
SPECIFIC LEARNING OBJECTIVES
a.KNOWLEDGE
At the end of the course, the student should be able to:

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(1) describe the molecular and functional organization of a cell and list its subcellular components;
(2) delineate structure, function and inter-relationships of biomolecules and consequences of deviation
from normal;
(3) summarize the fundamental aspects of enzymology and clinical application wherein regulation of
enzymatic activity is altered;

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(4) describe digestion and assimilation of nutrients and consequences of malnutrition;
(5) integrate the various aspects of metabolism and their regulatory pathways;
(6) explain the biochemical basis of inherited disorders with their associated sequelae;
(7) describe mechanisms involved in maintenance of body fluid and pH homeostasis;
(8) outline the molecular mechanisms of gene expression and regulation, the principles of genetic

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engineering and their application in medicine;
(9) summarize the molecular concepts of body defence and their application in medicine;
(10) outline the biochemical basis of environmental health hazards, biochemical basis of cancer and
carcinogenesis;
(11) explain the principles of various conventional and specialized laboratory investigations and

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instrumentation analysis and interpretation of a given data;
(12) suggest experiments to support theoretical concepts and clinical diagnosis.
b. SKILLS:
At the end of the course, the student should be able to :
(1) make use of conventional techniques/instruments to perform biochemical analysis relevant to clinical

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screening and diagnosis;
(2) analyze and interpret investigative data;
(3) demonstrate the skills of solving scientific and clinical problems and decision making;
c.INTEGRATION
The knowledge acquired in biochemistry should help the students to integrate molecular events with

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structure and function of the human body in health and disease.
TEACHING HOURS:
Theory classes: Total: 115 hours
Seria Topic
Number of hours

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l no.
1.
Cell
2 hours
2.

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Enzymes
5 hours
3
Chemistry and metabolism of carbohydrates
15 hours

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4
Chemistry and metabolism of lipids
15 hours
5
Chemistry and metabolism of proteins

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15 hours

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6
Vitamins
10 hours
7

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Nucleotide chemistry and metabolism
6 hours
8.
Integrated metabolism
3 hours

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9
Bioenergetics
3 hours
Homeostatic mechanisms in the body (pH, water
4 hours

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10
and electrolyte balance)
11
Immunology
2 hours

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12
Minerals
5 hours
13
Haem metabolism

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6 hours
14
Function tests
4 hours
15

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Molecular biology
12 hours
16.
Metabolism of xenobiotics
2 hours

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17.
Oxidative stress
1 hour
18.
Nutrition

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3
hours
19.
Importance of and ethical issues in laboratory
2 hours

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medicine
Total
115 hours
TEACHING METHODOLOGY
Lectures, tutorials, small group discussions, integrated teaching modules, use of charts (paper-based

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clinical scenarios) for case discussions, practical exercises and demonstrations

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THEORY SYLLABUS FOR FIRST YEAR M.B.B.S.
Note: The syllabus has been prepared keeping in mind the requirements of a doctor at the end of the
MBBS course. It is also to emphasize that the teaching of Biochemistry needs to continue throughout the
clinical phase of training of the MBBS students, when they will be in a better position to make correlations

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between derangements in biochemical processes and disease conditions. The content of the syllabus has
been divided into 3 categories: "must know", "desirable to know" and "nice to know".
Total number of hours recommended: 112
DESIRABLE TO
NICE TO

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TEACHING
TOPIC
MUST KNOW
KNOW
KNOW

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HOURS
RECOMMENDED
1
2 hours
. CELL

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Cell and cellular Basics of structure of a
Functions of
organelles
eukaryotic cell.
peroxisomes.

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Overview of cellular
Markers of sub- cellular
organelles and their
organelles
functions (mitochondria,

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nucleus, ribosomes,
proteasomes, lysosomes,
endoplasmic reticulum
and golgi apparatus)
2 ENZYMES

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5 hours
.
Nomenclature Systematic and
IUBMB classification
and

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recommended nomenclature. of enzymes - main
classification
classes of enzymes only
(names, definition,
general reaction

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catalysed and one
example for each class)
Properties of
Mechanism of action of an
Lock and key and

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enzymes
enzyme with regard to its
induced fit models of
effect on activation energy of enzyme-substrate
a reaction.

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binding
Concept of active site in
enzymes.
Specificity of enzymes:
reaction and substrate

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specificity, with an example
for each.
Cofactors - metals and
coenzymes (definition,
examples of coenzymes) and

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examples of enzymes that
require them
Factors that
Effect of pH (concept of
influence

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optimal pH with examples).
enzyme
activity
Effect of temperature
(concept of optimal

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temperature).
Effect of substrate
concentration (Michaelis-
Menten equation [no
derivation of equation

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required], concept of Km and
Vmax).
Effects of enzyme and
product concentration.
Inhibition of

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Types of enzyme inhibition -
enzymes
competitive, non-
competitive, suicide
inhibition.

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Effects of competitive and
non-competitive inhibition
on Km and Vmax of the
enzyme.
Examples of commonly used

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drugs that act by competitive
inhibition of enzymes.
Examples of non-
competitive enzyme
inhibition ?

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organophosphorus/cyanide
poisoning
Isoenzymes
Definition and examples
Isoenzymes of lactate

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dehydrogenase (LDH)
Clinical significance of
and ALP
elevated plasma levels of
isoenzymes of creatine kinase

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(CK)

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Diagnostic
Aspartate aminotransferase
Clinical utility of 5-
and

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(AST), alanine
nucleotidase and
therapeutic
aminotransferase (ALT),
gamma-glutamyl

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enzymes
alkaline phosphatase (ALP), transferase
(clinically
lactate dehydrogenase
useful

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(LDH), creatine kinase (CK)
enzymes)
and amylase as markers of
various disease conditions.
Plasma markers of

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myocardial infarction and
liver damage.
Examples of enzymes used in
treatment and indications for
their use.

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Regulation of
Overview of
enzyme
mechanisms involved
activity

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in regulating the
activity of enzymes:
allosteric activation and
inhibition, covalent
modifications

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(phosphorylation and
dephosphorylation),
induction and
repression; concept of
feedback inhibition

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Process of regulation
of glycogen
metabolism may be
used as an example to
explain the

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mechanisms of enzyme
regulation, as listed
above.
3 CHEMISTRY AND METABOLISM OF CARBOHYDRATES
15 hours

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Chemistry of
Overview of classification Concept of deoxy and
carbohydrates
of carbohydrates, with
amino sugars and their

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physiologically important functions.
examples and functions
of each of these.
Heteropolysaccharides
(heparin, hyaluronic

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Benedict's test for
acid,
reducing sugars.
chondrointinsulphate,
heparansulphate,

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Components of
dermatan sulphate) and
physiologically important their importance in the
disaccharides and
body.

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polysaccharides.

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Homopolysaccharides ?
starch, glycogen and
cellulose
Digestion of

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Examples of common
carbohydrates
dietary carbohydrates and
the foods that they are
present in.

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Enzymes involved in
digestion of
carbohydrates.
Sources, sites and actions
of the enzymes that digest

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carbohydrates.
End products of
digestion and their
absorption.
Rationale for the

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composition and use of
oral rehydration solution
(ORS) in the treatment of
dehydration.
Lactose intolerance.

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Importance of dietary
fibre.
Glucose
Types, functions, tissue
transporters

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specificity and
physiological relevance
Glycolysis
Definition, importance,
cellular site and pathway

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involved (with emphasis
on the importance of the
pathway, sites of
utilization and generation
of energy and irreversible

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reactions involved).
Importance of aerobic
and anaerobic forms of
glycolysis.
Energetics.

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Concept of substrate level
phosphorylation.
Overview of regulation of
glycolysis.

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Rapaport- Leubering

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shunt and its
physiological importance.
Concept of lactic acidosis
and common causes and
conditions in which it

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occurs.
Importance of inhibition
of enolase by fluoride in
blood samples collected
for glucose estimation.

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Citric acid cycle/ Pyruvate dehydrogenase
Overview of
Krebs' cycle /
as a link between
regulation of

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tricarboxylic acid glycolysis and
pathway (no
(TCA) cycle
Krebs' cycle (no details of
details

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reaction mechanism
required).
required).
Definition, importance,
cellular site, pathway

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(including intermediates
and enzymes involved,
but excluding details of
reactions involved).
Concept of anaplerosis,

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amphibolic nature of
Krebs' cycle.
Energetics.
Pentose
Importance of pathway -

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Definition, cellular site
phosphate
ribose for nucleic acid
and overview of
pathway (PPP)

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synthesis and NADPH
pathway, showing
for synthesis of various
starting material and
lipids, maintenance of

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products (intermediates
reduced form of iron in
not required).
haemoglobin, reduced
glutathione and its

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importance in
maintaining red cell
membrane integrity.
Clinical relevance of the
deficiency of glucose-6-

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phosphate dehydrogenase
(G6PDH).

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Glycogenesis
Physiological importance Glycogen storage
of glycogen in the body

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disorders
(including role of
glycogen in the liver and
in the muscle).
Overview of pathway of

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synthesis (starting
material, action of
glycogen synthase and
branching enzyme and
the end product).

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Glycogenolysis
Physiological importance Role of insulin and
of glycogen breakdown in glucagon in reciprocal
the body.
regulation of

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glycogenesis and
Overview of pathway of glycogenolysis (details
breakdown in the liver of reactions involved in
and muscle (starting regulation not
material, action of required).

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glycogen phosphorylase
and debranching enzyme Examples of glycogen
and products obtained).
storage diseases (Von
Gierke's disease and

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McArdle's disease) may
be used to illustrate
functions of glycogen
in the liver and muscle
and the reasons for

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different manifestations
of the diseases.
Gluconeogenesis Definition, substrates
Concept of reciprocal
used, physiological

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regulation of glycolysis
importance, sites in the
and gluconeogenesis
body and in cell where
(no details required).

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the pathway occurs.
Role of insulin and
Overview of pathway
glucagon in regulation.
with key intermediates

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and enzymes.
Importance of Cori's
cycle and glucose-alanine
cycle.
Uronic acid

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Overview of
pathway
pathway
showing
starting

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material
(glucose)
and product

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(glucuronic
acid).

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Importance
of
glucuronic
acid in
conjugation

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of bilirubin
and drugs
and
synthesis of
heteropolysa

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ccharides.
Essential
pentosuria
Metabolism of
Dietary sources of

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galactose
galactose.
Overview of pathway by
which galactose is
metabolized (showing the

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sites of 3 main enzymes
involved).
Eventual fate of galactose
in the body.
Galactosemia (definition,

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causes, biochemical basis
of clinical manifestations
and rationale of
treatment).
Metabolism of

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Dietary sources of
Disorders of
fructose
fructose.
fructose

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metabolism
Overview of pathway by
which fructose is
metabolized (showing
entry into glycolysis and

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formation of
triacylglycerol).
Importance of fructose in
seminal fluid.
Minor pathways

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Polyol pathway and its
of carbohydrate
importance in
metabolism
pathogenesis of

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complications of diabetes
mellitus.

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Regulation of
Factors maintaining
blood glucose

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blood glucose levels - role
levels
of dietary carbohydrates,
role of hormones (insulin,
glucagon, glucocorticoids

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and catecholamines) and
roles of liver and kidney.
Diabetes
Types and pathogenesis
Pathogene-

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mellitus
of diabetes mellitus.
sis of
chronic
Concept of insulin

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complicati-
resistance.
ons of
diabetes
Metabolic derangements

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mellitus.
and clinical features.
Diagnostic criteria (ADA
criteria).
Concept of impaired

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fasting glucose and
impaired glucose
tolerance.
Gestational diabetes ?
definition and diagnosis

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Acute and chronic
complications of diabetes
mellitus.
Pathogenesis of diabetic
ketoacidosis.

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Laboratory
Blood glucose estimations
investigations in (fasting and post-
diabetes
prandial).

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mellitus
Glycated haemoglobin
(HbA1c).
Urinalysis for detection of
glucose, ketone bodies

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and proteins in urine.
Detection and
importance of
microalbuminuria.
Role of glucose tolerance

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test in diagnosis of
diabetes mellitus.

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Indications for and
interpretation of results
of glucose tolerance test

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(OGTT), including use in
gestational diabetes
mellitus (GDM).
Serum lipid profile in
diabetics.

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Hypoglycemia
Definition, importance,
causes, clinical
manifestations.
4 CHEMISTRY AND METABOLISM OF LIPIDS

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15 hours
Definition of a lipid.
Properties with regard to
solubility and
hydrophobicity.

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Important functions of
General
lipids in the human body.
featuresof lipids
Concept of importance of

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lipids in causation of
disease (atherosclerosis
with subsequent
myocardial infarction and
stroke; obesity,

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cholelithiasis, etc).
Classification of Major types of lipids in
lipids
the body (classification
into simple, complex and

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precursor or derived
lipids).
Relevant examples of each
type and the importance
of each type in the body.

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Fatty acids
Concept of system of
nomenclature (concept of
systematicnames and
symbols), with C and n

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numbering of fatty acids.
Classification system
based on chain length,
degree of
saturation (saturated and

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mono- and
polyunsaturated fatty

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acids), and nutritional
requirement.
Concept of saturated fatty

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acids in animal fat and
unsaturated fatty acids in
plant fats.
Names of essential fatty
acids and their functions.

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Importance of 3 and 6
fatty acids (dietary sources
and their health benefits).
Simple lipids
Concept of importance of

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(fats)
saturated and unsaturated
fats in one's diet
(including hydrogenation
of oils).

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Basic concept of cis and
trans forms of fatty acids
and the health hazards of
trans fats.
Basic concept of mono,

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di- and triacylglycerols and
where they are found in
the body.
Derived lipids ?
Functions of cholesterol

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steroids
Health hazards associated
with high blood levels of
cholesterol.
Complex lipids

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Lipoproteins - definition, Phospholipids
Glycolipids -
general structure, types, (definition, types,
definition,
components of each type, components,

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types,
function of each type, role amphipathic nature,
components,
of apoproteins,
functions, clinically

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functions,
importance in health and relevant examples)
examples.
disease.
Importance of each

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Basic concepts
type of phospholipid: of cerebrosides
phosphatidylcholine
and
(including

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gangliosides
importance of
and
surfactant in health
importance of

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and disease, concept each type in
of
the body.
lecithin/sphingomye-
lin [L/S] ratio),

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Basic concept

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phosphatidylinositol
of
and sphingomyelin
abnormalities

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in lipids in
Liposomes
demyelinating
(definition, structure diseases and
and importance)

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sphingolipido-
sis
Miscellaneous
Micelles (definition,
Basic concepts of

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structure and importance). transport
mechanisms across
Biological membranes
membranes
(structure and

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importance).
Metabolism of
lipids
Digestion of
Names of main lipids

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lipids
present in the diet.
Enzymes responsible for
digestion of lipids and
their sources and sites of

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action.
Role of bile in lipid
digestion and absorption.
End-products of lipid
digestion.

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Process of absorption of
lipids.
Steatorrhoea.
Salient features of
formation, metabolism

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and physiological
importance of
chylomicrons.
Fate of fatty
acids

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Fatty acid
Importance of oxidation
End-products of
Conditions
oxidation

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of fatty acids in the body.
beta- oxidation of
where fatty
odd chain fatty acids. acid oxidation
Types of oxidation of fatty

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is impaired.
acids.
Alpha oxidation of
fatty acids.
Beta-oxidation of even

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chain fatty acids (site,
activation of a fatty acid,
the role of carnitine, steps

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involved and energetics of
the process).

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Biosynthesis of
Conditions under which it
fatty acids
occurs and sites involved.
(lipogenesis)

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Starting material and end
products of fatty acid
synthesis.
Source of acetyl CoA.
Regulatory role of acetyl

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CoA carboxylase.
Overall reaction catalyzed
by fatty acid synthase
(individual enzymes and
reactions not required).

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Importance of NADPH in
the pathway and its
sources.
Role of the nutritional
state and insulin as factors

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that regulate synthesis of
fatty acids
Metabolism in
Metabolism in the
the adipose

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adipose tissue with
tissue
regard to lipogenesis
and lipolysis
(conditions where it

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occurs, and products
obtained) and its
regulation by
hormones, including
enzymes involved

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Metabolism of
Names of the ketone
ketone bodies
bodies and their
importance.

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Pathway of ketogenesis
and utilization of ketone
bodies and sites where
these occur.
Factors that favour ketone

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body formation.
Causes and clinical
importance of

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ketoacidosis.
Metabolism of

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Functions of cholesterol.
Cellular site of
Role of lipids
cholesterol
biosynthesis of

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in formation of
Sources of cholesterol in
cholesterol.
gall stones.
the body (dietary and

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endogenous).
Basic overview of
biosynthesis of
Importance of HMG CoA cholesterol (showing
reductase in the regulation starting material,

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of biosynthesis of
HMG CoA [HMG
cholesterol.
CoA synthase],
mevalonate [action

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Importance of maintaining of HMG CoA
normal cholesterol levels
reductase] and
in blood and ways to
formation

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reduce blood cholesterol
ofcholesterol,
levels (including
without showing any
mechanism of action of

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other intermediates).
statins and other lipid
lowering agents).
Overview of
synthesis (including

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Bile acids (names, source
regulatory enzyme).
and functions).
Enterohepatic circulation
of bile acids.

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Metabolism of
Association of high levels
Brief overview of
lipoproteins
of LDL with

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metabolism of
atherosclerosis.
VLDL, LDL and
HDL (including
Anti-atherogenic effect of reference values).

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HDL
Lipoprotein (a)
Dyslipidemias ?
causes (with
emphasis on

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secondary causes of
dyslipidemia and
familial
hypercholesterol-
emia) and

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consequences.
Risk factors for
atherosclerosis and
coronary artery
disease; prevention

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of coronary artery
disease.

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Overview of
metabolic syndrome.
Eicosanoids

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Names and functions of
Mechanism of action Therapeutic
various eicosanoids.
of NSAIDs and their uses of
effect as anti-

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prostaglandins.
Role of aspirin as an anti-
inflammatory agents
platelet agent.
Phospholipids

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Clinical relevance of
Biochemical defect
Sites of action
lecithin-sphingomyelin
and clinical features

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of various
(L/S) ratio in amniotic
of Niemann-Pick's,
phospholipases
fluid

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Tay- Sach's and
.
Gaucher's disease.
Sphingolipido-
sis other than

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the examples
specified.
Miscellaneous
Role of liver in lipid
metabolism.

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Fatty liver (causes,
including role of lipotropic
factors, and
consequences).
5 CHEMISTRY AND METABOLISM OF PROTEINS

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15 hours
Amino acids
Classification based on
Classification of
nutritional requirement

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amino acids based on
and metabolic fates.
side chain
Peptide bond formation
by amino acids.

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Reaction with ninhydrin as
a general reaction for all
amino acids (details of
reaction not required).
Peptides and

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Structural organization of
Oxygen dissociation
proteins
proteins - primary,
curve of

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secondary, tertiary and
haemoglobin; Bohr
quaternary structures.
effect.
Denaturation of proteins

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? definition, agents
causing denaturation and
consequences (loss of
biological activity of
protein).

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Overview of structure-
function relationship of
haemoglobin, myoglobin
and collagen.

---

Hemoglobinopathies:

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sickle cell anaemia and
thalassemia
Digestion and
Mechanism of activation
Disorders associated

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absorption
of enzymes involved in
with amino acid
the digestion of proteins
absorption

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in the stomach and small
(cystinuria/
intestine (conversion of
Hartnup's disease).
zymogens to active

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proteases) ? proteolytic
enzymes of the gastric and
pancreatic secretions.
Role of gastric acid in
protein digestion.

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Overview of amino acid
absorption.
General
Overview and biochemical
pathways of

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importance of the
amino acid
processes of
catabolism
transamination and

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oxidative deamination.
Enzymes and coenzymes
involved in the above
processes.
Ammonia

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Sources of ammonia in the Overview of
metabolism
body.
disorders of the urea
cycle

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Urea cycle - overview of
reactions involved,
including regulatory
enzyme.
Role of glutamine in

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detoxification of ammonia
in the brain.
Hepatic coma (hepatic
encephalopathy);biochemi
cal basis of clinical

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features
Reference range for blood
urea and blood urea
nitrogen
(BUN).

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---

Metabolism of
Functions of individual amino
Metabolism of
Uncommon
individual

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acids.
methionine and
disorders of
amino acids
homocysteine

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amino acid
Important specialized products
metabolism:
from tyrosine ? melanin,
Roles of folic acid,

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maple syrup
catecholamines, thyroid
vitamin B12 and
urine disease
hormones.

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pyridoxine in their
(MSUD),
metabolism.
alkaptonuria,
Formation of tyrosine from

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tyrosinemias,
phenylalanine.
Role of homocysteine methymalonyl
as a risk factor for
aciduria,

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Pathogenesis, clinical features,
cardiovascular
disorders of
diagnosis and treatment of
diseases.

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glycine
phenylketonuria.
metabolism, etc.
Important specialized
products from glycine Importance of

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(glutathione, creatine,
neonatal
creatinine, haem and
screening for
purines) and

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inborn errors of
tryptophan (serotonin, amino acid
melatonin and niacin). metabolism.
Neurotransmitters
Principle of the

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derived from amino
technique of
acids (glutamate ?
chromatography
gamma-amino butyric

--- Content provided by‌ FirstRanker.com ---

acid [GABA], histidine
[histamine], arginine
[nitric oxide]).
Plasma proteins
Functions of albumin.

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Classification of
Principle of the
plasma proteins, based technique of
Examples of specialized
on electrophoretic

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electrophoresis
transport proteins present in
mobility.
plasma.
Reference values of total

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proteins and albumin.
Common clinical conditions in
which plasma protein levels
are abnormal and the reasons
why these changes occur

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(malnutrition, cirrhosis of the
liver, nephrotic syndrome,
chronic renal failure, multiple
myeloma).
Importance of the albumin:

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globulin ratio (A: G ratio). `
Normal value for the A:G ratio

---

and common clinical conditions
in which the ratio is abnormal.
6

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VITAMINS
10 hours
General
Definition, classification,
properties of

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comparison of clinically relevant
vitamins
features of fat- and water-
soluble vitamins.
Concepts of hypo- and

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hypervitaminosis and
recommended dietary
allowances (RDA).
Fat-soluble vitamins
Vitamin A

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Dietary sources.
Hypervitaminosis A
Various forms of vitamin A and
their functions
Precursor form.

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Biochemical functions.
Role in Wald's visual cycle.
RDA
Deficiency ? causes,
manifestations and treatment.

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Vitamin D
Dietary sources of vitamin D.
Synthesis in the body and
conversion to calcitriol.
Biochemical functions.

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Role in calcium absorption in
small intestine, calcium
homeostasis and bone
mineralization.
RDA

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Deficiency (rickets and
osteomalacia) ? causes,
manifestations, biochemical
findings in blood
Vitamin E

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Dietary sources
Role as an antioxidant.
Relationship to action of
glutathione peroxidase.
RDA

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Deficiency leading to fragility of
RBCs.
Vitamin K
Sources.
Biochemical role in

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RDA.
gamma carboxylation
Deficiency ? causes,
reactions.
manifestations (including

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hemorrhagic disease of the new Vitamin K cycle.
born).
Basis of action of
warfarin and other
dicumarol derivatives.

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---

Water-soluble vitamins
Thiamine
Dietary sources.
Functions (coenzyme form,
physiologically important

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reactions for which it is
required).
RDA
Deficiency (beri-beri) ? causes
and manifestations

--- Content provided by‌ FirstRanker.com ---

Wernicke-Korsakoff syndrome
- causes, clinical features
Riboflavin
Dietary sources.
Functions (coenzyme forms,

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physiologically important
reactions for which they are
required).
RDA
Deficiency ? causes and

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manifestations.
Niacin
Sources (including from
tryptophan).
Functions (coenzyme forms,

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examples of physiologically
important reactions for which
they are required).
RDA
Deficiency ? causes and

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manifestations of pellagra.
Pyridoxine
Dietary sources.
Functions (coenzyme form,
physiologically important

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reactions for which they are
required, including
transamination and
decarboxylation of amino acids).
RDA.

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Deficiency ? causes and
manifestations.
Rationale for supplementation in
treatment of tuberculosis.
Pantothenic acid Sources, functions and RDA

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Biotin
Sources.
Role in carboxylation reactions.
Examples of important enzymes
that require biotin.

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Folic acid
Dietary sources.
Role of folic acid in
Functions (coenzyme forms,
one-carbon

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physiologically important
metabolism (one-
reactions for which they are
carbon donor
required).

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reactions (e.g., serine

---

RDA
hydroxymethyl
Relationship with vitamin B12
transferase), one-

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and concept of "folate trap".
carbon acceptor
Deficiency ? causes and
reactions (methionine
manifestations (megaloblastic

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synthase, thymidylate
anemia).
synthase and de novo
Importance of supplementation purine synthetic
in peri-conceptual period.

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pathway).
Folate antagonists (action of
methotrexate, aminopterin and
sulphonamides).
Vitamin B12

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Dietary sources.
Absorption and role of intrinsic
factor of Castle.
Functions (coenzyme forms,
reactions for which they are

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required).
Role in folic acid metabolism
(concept of "folate trap" in B12
deficiency)
RDA

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Deficiency ? causes and
manifestations (megaloblastic
and pernicious anemia).
Importance of combined B12
and folic acid administration in

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treatment of megaloblastic
anemia.
Vitamin C
Dietary sources.
Role of vitamin

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Functions (in collagen synthesis,
C in the
iron absorption and as an
conversion of
anti-oxidant).

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tyrosine to
RDA.
catecholamines,
Deficiency ? causes and
cholesterol to

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manifestations of scurvy.
bile acids and
in catabolism
of tyrosine.
Vitamin-like

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Role in
substances
reactions
involving
Lipoic acid

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pyruvate
dehydrogenase
and alpha-
ketoglutarate
dehydrogenase.

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7
NUCLEOTIDE CHEMISTRY AND METABOLISM
6 hours
Nucleotide
Purine and pyrimidine bases

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Examples of synthetic
chemistry
found in DNA and RNA.
analogues of purine
and pyrimidine bases

--- Content provided by‍ FirstRanker.com ---

Definition and types of
and nucleosides used

---

nucleosides and nucleotides.
as therapeutic agents
(anti-cancer drugs,

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Functions of physiologically
anti-viral drugs and
important nucleotides.
allopurinol).
Nucleotide

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Role of folic acid in purine
Names of compounds Overview of the
metabolism
synthesis.
required for purine

--- Content provided by‍ FirstRanker.com ---

pathway of de
and pyrimidine
novo synthesis
Overview of the pathway of
synthesis.

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of purine
degradation of purines to form
nucleotides
uric acid, including role of
Salvage pathway for

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(names of only
xanthine oxidase.
purine bases and
starting material
nucleosides.

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and end
Hyperuricemia and gout (causes, Lesch- Nyhan
products - AMP
clinical features, principles of
syndrome (cause and

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and GMP -
treatment, including mechanism biochemical basis of
required).
of action of allopurinol and
clinical features).

--- Content provided by‍ FirstRanker.com ---

probenecid).
Overview of
Mechanism of action
pathway of de
of methotrexate and

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novo synthesis
5-flurouracil, as
of pyrimidine
examples of drugs
nucleotides,

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used in cancer
showing only
chemotherapy.
starting
material, rate-

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limiting enzyme
and end
products.
Disorders of
pyrimidine

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metabolism:
orotic aciduria
8.
INTEGRATED METABOLISM
3 hours

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Overview of metabolism in the
Overview of
fed and fasting states
metabolism in liver,
brain and adipose

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tissue
9
BIOENERGETICS
3 hours
Role of ATP

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Role of ATP as the "energy
Role of high
currency" of the cell.
energy
phosphates in

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energy capture
and transfer
e.g., role of
creatine
phosphate in

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muscle.

---

The respiratory
Sources of reducing equivalents
Transport of
chain and

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in the cell (NADH and
cytosolic
oxidative
FADH2).
NADH into the

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phosphorylation
mitochondria
Role of mitochondria as the
(mitochondrial
"power house" of the cell.

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shuttle systems).
Substrate level and oxidative
Examples of
phosphorylation.
inhibitors of

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electron
Schematic representation of the
transport chain
electron transport chain.
(carbon

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monoxide,
Role of the respiratory chain as
cyanide) and
an electron transporter and a
uncouplers of

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proton pump.
oxidative
phosphorylatio
Chemiosmotic theory of
n (free fatty

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oxidative phosphorylation.
acids, thyroxine,
thermogenin).
Amount of ATP synthesized
when NAD and FAD act as

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Role of brown
hydrogen acceptors.
fat (non-
shivering
thermogenesis

--- Content provided by​ FirstRanker.com ---

and role of
uncoupling
protein/
thermogenin).
Overview of

--- Content provided by FirstRanker.com ---

complex V
(ATP synthase).
10
HOMEOSTATIC MECHANISMS IN THE BODY
4 hours

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---

Acid base balance
Definitions of acid, base and
buffer.
Normal pH of body fluids and
importance of maintaining

--- Content provided by⁠ FirstRanker.com ---

normal pH
Sources of hydrogen ions in the
body.
Mechanisms involved in
regulation of pH

--- Content provided by‍ FirstRanker.com ---

Buffers of body fluids
Henderson ? Hasselbalch
equation.
Role of buffers (with emphasis
on the bicarbonate buffer

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system)
Role of the lungs and kidneys in
maintaining acid- base balance.
Simple acid-base disorders:
Major causes and clinical

--- Content provided by⁠ FirstRanker.com ---

features of:
? Metabolic acidosis
(including importance of
anion gap) and alkalosis
? Respiratory acidosis and

--- Content provided by‌ FirstRanker.com ---

alkalosis.
Arterial blood gases (ABG)
analysis and interpretation of
results.
Compensatory mechanisms in

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metabolic/respiratory
acidosis/alkalosis.

---

Fluid and
Distribution of water in various
Regulation of

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electrolyte
body compartments.
osmolality? role of
balance
anti-diuretic hormone

--- Content provided by‌ FirstRanker.com ---

Intra- and extracellular fluid
(ADH).
composition (sodium and
potassium)
Blood volume and osmolality.

--- Content provided by​ FirstRanker.com ---

Major causes and clinical features
of dehydration.
Sodium:
Normal levels in the blood.
Physiological functions.

--- Content provided by​ FirstRanker.com ---

Regulation of sodium
homeostasis (including the role
of renin-angiotensin-aldosterone
system).
Major causes, clinical features of

--- Content provided by⁠ FirstRanker.com ---

hyponatremia and hypernatremia
Potassium:
Normal levels in the blood.
Physiological functions.
Regulation of potassium

--- Content provided by‍ FirstRanker.com ---

homeostasis.
Major causes and clinical features
of hypokalemiaandhyperkalemia.
11
IMMUNOLOGY

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2 hours
Immunology
Introduction to
immunoglobulins
Types, properties and functions

--- Content provided by FirstRanker.com ---

of different classes of
immunoglobulins.
Multiple myeloma ? biochemical
abnormalities and laboratory
diagnosis.

--- Content provided by‍ FirstRanker.com ---

12
MINERALS
5 hours
Concept of macro and micro
minerals and examples.

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Sources and daily requirement.
CALCIUM
Normal blood levels.
Functions of calcium.
Role of vitamin D in absorption

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of calcium.
Regulation - role of parathyroid
hormone (PTH), calcitonin and

---

vitamin D in calcium
homeostasis.

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Important causes, clinical
features, laboratory diagnosis of
hypocalcemia and hypercalcemia
Osteoporosis and osteomalacia -
major causes, clinical features.

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Iron
Sources and daily requirement.
Iron overload
Distribution of iron in the body. conditions, e.g.,
Functions of iron.

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hereditary
Absorption of dietary iron in the haemochromatosis.
duodenum - overview of role of
divalent metal transporter-1
(DMT-1), duodenal cytochrome

--- Content provided by‌ FirstRanker.com ---

b (dcytb), hephaestin,
ferroportin.
Storage and transport (role of
ferritin and transferrin).
Causes, clinical features of iron

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deficiency anemia.
Copper
Biochemical functions of copper. Biochemical basis of
Role of ceruloplasmin.
Menke's disease

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Genetic basis, clinical features of
Wilson's disease.
Zinc
Functions of zinc.
Causes and clinical features of

--- Content provided by⁠ FirstRanker.com ---

zinc deficiency.
Magnesium and
Functions of
manganese:
magnesium and

--- Content provided by FirstRanker.com ---

manganese.
Iodine:
Sources and daily requirement of
iodine.
Functions of iodine.

--- Content provided by‌ FirstRanker.com ---

Causes and clinical features of
iodine deficiency.
Flouride:
Sources and daily requirement of
fluoride.

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Functions of fluoride.
Causes and clinical features of
fluorosis.
Selenium
Functions of selenium

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13
HAEM METABOLISM
6 hours
Heme synthesis
Importance of haem (heme-

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Heme synthesis and its
containing proteins ?
regulation in the liver
hemoglobin, myoglobin,
and bone marrow.

--- Content provided by‌ FirstRanker.com ---

cytochromes).

---

Porphyrias: Definition,
biochemical basis of clinical
features of porphyrias
(neurological features and

--- Content provided by​ FirstRanker.com ---

photosensitivity).
Acquired porphyria: lead
poisoning.
Heme
Degradation of haem and fate of Congenital disorders

--- Content provided by​ FirstRanker.com ---

degradation
bilirubin.
of conjugation and
excretion of bilirubin
Hyperbilirubinemia ? causes and ? Crigler-Najjar

--- Content provided by⁠ FirstRanker.com ---

role of laboratory investigations
syndrome, Dubin-
in the differential diagnosis of
Johnson syndrome,
jaundice.

--- Content provided by​ FirstRanker.com ---

Gilbert's syndrome
and Rotor's syndrome.
Jaundice in the newborn
14
FUNCTION TESTS:

--- Content provided by​ FirstRanker.com ---

4 hours
Renal function
Functions of the kidney
test:
Clinical importance of blood

--- Content provided by‌ FirstRanker.com ---

urea and serum creatinine levels
in renal disease.
Estimation of GFR: Creatinine
Proteinuria ? types
Renal tubular

--- Content provided by‌ FirstRanker.com ---

clearance and its importance.
(glomerular, tubular
acidosis.
and overflow
Nephrotic syndrome ? major

--- Content provided by‍ FirstRanker.com ---

proteinuria) and
Lab
clinical features and laboratory
characteristic proteins investigations
diagnosis.

--- Content provided by⁠ FirstRanker.com ---

present in urine in
in
each type.
acute kidney
injury and

--- Content provided by‌ FirstRanker.com ---

Microalbuminuria and chronic kidney
its importance.
disease
Concepts of tests to
Laboratory

--- Content provided by‌ FirstRanker.com ---

assess tubular function tests to
? measurement of
diagnose pre-
plasma and urine
renal, renal and

--- Content provided by⁠ FirstRanker.com ---

osmolality
post- renal
causes of acute
renal failure.
Liver function

--- Content provided by‍ FirstRanker.com ---

Functions of the liver.
tests
Major causes of liver
dysfunction.
Tests done to assess liver

--- Content provided by​ FirstRanker.com ---

---

function in clinical practice:
1. Tests to assess ability to
detoxify and excrete substances:
conjugated and unconjugated
bilirubin (van den Bergh's test),

--- Content provided by‌ FirstRanker.com ---

blood ammonia levels.
2. Tests to assess biosynthetic
functions: total protein and
serum albumin levels,
prothrombin time

--- Content provided by​ FirstRanker.com ---

3. Markers of liver injury: alanine
transaminase (ALT) and
aspartate transaminase (AST)
4. Marker of cholestasis: alkaline
phosphatase (ALP).

--- Content provided by⁠ FirstRanker.com ---

Differential diagnosis of
jaundice, based on liver function
tests.
Thyroid
Regulation of secretion of

--- Content provided by‌ FirstRanker.com ---

Importance of
function test:
thyroid hormones.
estimation of
TSH in

--- Content provided by‌ FirstRanker.com ---

assessment of
thyroid
function.
Measurement of
total and free

--- Content provided by‌ FirstRanker.com ---

thyroxine levels.
Role of TSH
and free
thyroxine in
laboratory

--- Content provided by‍ FirstRanker.com ---

diagnosis of
hypothyroidism
and
hyperthyroidism
Adrenal function

--- Content provided by FirstRanker.com ---

Hormones
tests
produced by the
adrenal cortex
and medulla.

--- Content provided by‌ FirstRanker.com ---

Regulation of
secretion of
adrenocortical

---

hormones.
Basic tests done

--- Content provided by FirstRanker.com ---

for the
laboratory
diagnosis of
adrenal
hypofunction

--- Content provided by⁠ FirstRanker.com ---

and
hyperfunction
(serum and
urine cortisol)
15

--- Content provided by⁠ FirstRanker.com ---

MOLECULAR BIOLOGY
12 hours
The cell cycle,
Watson and Crick model of
Overview of the

--- Content provided by⁠ FirstRanker.com ---

DNA and RNA
DNA structure (including simple
cell cycle
structure
diagrammatic representation of

--- Content provided by‍ FirstRanker.com ---

the salient features of DNA
Differences
structure).
between nuclear
and

--- Content provided by​ FirstRanker.com ---

Types and functions of different
mitochondrial
types of RNA.
DNA.
Overview of organization of

--- Content provided by⁠ FirstRanker.com ---

DNA in a chromosome.
DNA replication Overview of the process of
Inhibitors of DNA
Importance of
and repair

--- Content provided by⁠ FirstRanker.com ---

DNA replication in eukaryotes
replication as anti-
telomeres and
cancer drugs.
telomerase

--- Content provided by​ FirstRanker.com ---

Roles of DNA polymerase,
helicase, primase, topoisomerase Overview of role of
and DNA ligase
major DNA repair
mechanisms

--- Content provided by​ FirstRanker.com ---

?
Diagrammatic representation of mismatch repair, base
the events at the replication fork
excision
repair,

--- Content provided by⁠ FirstRanker.com ---

Okazaki fragments and its nucleotide excision
importance in replication.
repair and double
strand break repair.
Diseases associated

--- Content provided by⁠ FirstRanker.com ---

with abnormalities of
DNA repair systems
? xeroderma
Pigmentosa and
hereditary non-

--- Content provided by FirstRanker.com ---

polyposis colon
cancer (HNPCC).

---

Transcription
Structure of a gene - concepts of
exons and introns, promoter,

--- Content provided by‍ FirstRanker.com ---

enhancers/repressors and
response elements.
Overview of the process of
transcription in eukaryotes ?
initiation, elongation and

--- Content provided by‌ FirstRanker.com ---

termination
Post-transcriptional processing ?
capping, tailing and splicing.
Translation and Genetic code - definition.
Overview of the

--- Content provided by‍ FirstRanker.com ---

genetic code:
process of translation
Characteristics of the genetic
? initiation,
code ? universal, unambiguous,

--- Content provided by⁠ FirstRanker.com ---

elongation and
degenerate, without punctuation termination
(continuous/commaless).
Inhibition of
Basis of degeneracy of the

--- Content provided by FirstRanker.com ---

prokaryotic
genetic code (wobble
translation by
hypothesis).
antibiotics.

--- Content provided by⁠ FirstRanker.com ---

Components of eukaryotic
Post-translational
ribosomes.
modifications ?
examples.

--- Content provided by⁠ FirstRanker.com ---

Structure of tRNA (diagram of
clover leaf model of tRNA
structure) and its function in
protein synthesis.
Function of aminoacyl tRNA

--- Content provided by‍ FirstRanker.com ---

synthase.
Mutations and
Mutations:
Relationship of
Prokaryotes:

--- Content provided by​ FirstRanker.com ---

regulation of
Definition.
mutations with
The operon
gene expression

--- Content provided by⁠ FirstRanker.com ---

specific diseases ? eg, concept in
Mutagens- examples of physical, sickle cell anemia and prokaryotes
chemical and biological
chronic myeloid
(using Lac

--- Content provided by‍ FirstRanker.com ---

mutagens.
leukemia.
operon as an
example).
Types of mutations.

--- Content provided by⁠ FirstRanker.com ---

point mutation (deletion,
Eukaryotes:
insertion, substitution ?
Overview of
transition and

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regulation of
transversion, frame shift
initiation of
mutation,
eukaryotic

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? missense mutation,
transcription:
nonsense mutation and
role of general
silent mutation

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and gene-
? chromosomal mutations
specific
(deletion, inversion and
transcription

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translocation).
factors
Recombinant
Importance and applications of
Restriction

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Human genome
DNA
recombinant DNA technology
endonucleases.
project

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technology and
techniques in
Importance and applications of
Vectors for cloning ? DNA
molecular

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Polymerase chain reaction (PCR) plasmids and phages.
fingerprinting
biology:
?
Genomic and cDNA

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DNA
libraries.
sequencing
Principles and
Microarrays

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applications of
techniques in
Fluorescent in-
molecular
situ

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biology: (Southern,
hybridization
northern and western (FISH)
blotting, restriction
fragment length

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DNA vaccines
polymorphism
[RFLP])
Transgenic
animals

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Applications of
recombinant DNA
technology in
medicine. General
principles of

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production of
therapeutic proteins,
e.g., insulin
Gene therapy
Diagnosis of genetic

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diseases and genetic
counseling
Forensic investigation
16. METABOLISM OF XENOBIOTICS
2 hours

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Xenobiotics- definition and
The cytochrome P450
examples
enzyme system
? Functions

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Biochemical importance of the
? Properties (especially
two phases of xenobiotic
induction by drugs)
metabolism

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Overview of
Conjugation reactions:
metabolism of alcohol.
? Biochemical role of
conjugation reactions (with

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Health hazards
suitable, clinically relevant
associated with alcohol
examples) - glucuronidation,
consumption.

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sulfation, conjugation with
glutathione, acetylation.
Metabolic alterations
induced by alcohol
metabolism.

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17. OXIDATIVE STRESS
1 hour
Concepts of
reactive oxygen
species (ROS),

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free radicals
and oxidative
stress and
antioxidants.
Mechanisms of

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generation of
reactive oxygen
species (ROS)
in cells.
Role of

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antioxidants ?
vitamin E and
glutathione.
Role of
antioxidant

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enzymes ?
glutathione
peroxidase,
superoxide
dismutase

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18. NUTRITION
3 hours
Importance of various macro
Calorific value of
Dietary protein

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and micro-nutrients in diet.
various
quality ?
Components and importance of macronutrients.
biological value

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each type in diet.
and net protein
Principles of
utilization.
Concept of balanced diet and

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calculation of energy
glycemic index of food.
requirements of a
Concept of
person.

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nitrogen
Importance of dietary fibre.
balance.
Basal metabolic rate.
Specific dynamic action

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(thermogenic effect of food) and
respiratory quotient
Common sources of saturated,
polyunsaturated and
monounsaturated fats in diet and

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their impact on health.
Importance of trans fats
Concept of limiting amino acids
and supplementary action of
dietary proteins.

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Protein-energy malnutrition
(PEM): marasmus and
kwashiorkor - causes and main
differences.
Obesity (including calculation

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and interpretation of body
mass index [BMI]; health risks
associated with obesity)
19.
IMPORTANCE OF LABORATORY MEDICINE

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2 hours
ETHICAL ISSUES IN LABORATORY MEDICINE
The concept that laboratory
Ensuring
testing should respect principles

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quality and
of medical ethics (non-
integrity of
maleficence, beneficence, patient
laboratory

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autonomy, informed consent,
services, role
respect for patient, etc)
and
responsibilities

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when
participating in
clinical
research,
optimal use of

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resources,
confidentiality
of laboratory
results, use of
results from

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screening and
testing
programs, etc.
PRACTICAL SYLLABUS
Estimation of important biochemical analytes in blood (glucose, creatinine, urea, uric acid and total protein)

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Identification of abnormal constituents in urine; interpretation of the findings and correlation of the
findings with pathological states
Tests (including dipstick tests) to detect abnormal constituents in urine include heat coagulation test,
sulphosalicylic acid test and Heller's test for proteins, Benedict's test for reducing sugar, benzidine test for
blood, Rothera's test for ketone bodies, Hay's test for bile salts and Fouchet's test for bile pigments

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Interpretation of laboratory results in the context of a patient's presenting complaints.

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Principles of spectrophotometry (including the Beer-Lambert Law)
Principles of electrophoresis (with specific reference to separation of serum proteins) and paper
chromatography
Practical classes: Total: 125 hours

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Seria Topic
Number of hours
l no.
1.
Estimations of biochemical analytes

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40
2.
Qualitative tests
20
3

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Demonstrations
15
4
Charts and integrated teaching
25

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5
Small group discussions/tutorials
25
Total
125 hours

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INTERNAL ASSESSMENT : (40 marks)
(Theory 20 marks + Practical 15 marks + Record 5 marks)
Theory
-
To access knowledge.

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Practical
-
To access skill.
Vivo voce
-

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To access communication.
Internal Assessment test will be conducted on 3rd Saturday.
Given below is a division of topics for periodic assessments.

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Unit I -
September

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Cell and chemistry carbohydrates, lipids and proteins
Unit II -
October
Enzymes and vitamins
Unit III -

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December
Metabolism of carbohydrates and biological oxidation and electron transport chain
Unit IV -
January
Metabolism of lipids

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Unit V -
February
Metabolism ofproteins and metabolism of heme
Unit VI -
April

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Organ function tests, acid?base homeostasis and associated disorders, water and electrolyte balance and associated
disorders
Unit VII -
May
Nutrition, minerals and metabolism of xenobiotics

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Unit VIII -
June
Chemistry and metabolism of nucleotides and molecular biology
Model exam -1st week of July
RECOMMENDED TEXTBOOKS

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The most recent editions of the following books are suggested.
1. Text book of Biochemistry for Medical Students by DM Vasudevan, SreeKumari S and Kannan
Vaidyanathan
2. Medical Biochemistry by AR Aroor
3. Principles and Applications of Biochemistry in Medicine by Rafi

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4. Biochemistry ? Lippincott's Illustrated Reviews

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5. Harpers Illustrated Biochemistry
Theory Examination - Pattern of Question Paper I and II
Essays
1 X 10 Marks = 10 Marks

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Brief Answers
5 X 4 Marks
=
20 Marks
Short Answers

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10 X 2 Marks
= 20
Marks
TOTAL
50

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Marks
PRACTICAL EXAMINATION (Total: 40 marks)
1. A short paper-based clinical scenario will be given to each student. The student will be asked to
estimate one of the relevant analytes (glucose, creatinine, urea, uric acid and total protein) in a serum
sample provided and asked to interpret this in the context of the given clinical scenario. The clinical

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relevance and metabolism of the analytes estimated will be discussed. (12 marks)
2. Clinical case histories and laboratory results with 3 clinical charts
Students will be expected to interpret laboratory results supplied, with reference to the
history of the patient and to make a provisional diagnosis. (12 marks)
3. Identification of abnormal constituents in urine

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Students will be expected to carry out of relevant tests and interpret and discuss their results (12 marks)
4. Objective structured practical exercise (OSPE) (2 stations x 2 marks each = 4 marks)
Only performance stations may be kept. Suggested questions for OSPE are given below.
a. Perform a test to identify the presence of bile salts in the given sample.
b. Perform a test to demonstrate the presence of areducing sugar /protein/ ketone bodies in the

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given sample.
c. Demonstrate the presence of heat-coagulable proteins in the given sample.
VIVA VOCE: 20 marks
The viva voce is meant to assess understanding, comprehension and applications of the subject and not
rote memory.

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The topics in Biochemistry will be divided into 4, as detailed below, for the viva voce. Each examiner will
assess the students in one of these areas and will award marks out of 5.
Seria Topics
Marks
l no.

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1.
Carbohydrates, cell, biological oxidation and
5 marks
vitamins
Proteins, enzymes, plasma proteins, function tests,

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5 marks
2.
metabolism of xenobiotics, basics of immunology
Lipids, minerals, nutrition, metabolism of haem,
5 marks

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3
oxidative stress
4
Nucleic acids, molecular biology, water and
5 marks

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electrolyte balance, acid- base balance

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5
Total marks
20 marks
RECORD BOOKS

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It is suggested that students be issued a printed Biochemistry Record Notebook in which they are
expected to write only the observations, inferences and calculations of experiments they do in the practical
classes conducted.
INTEGRATED TEACHING:
Suggested topics that may be used for integrated teaching:

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Clinically important enzymes, plasma markers of myocardial, infarction and liver and renal damage,
rationale of oral rehydration solutions, lactose intolerance, galactosemia, diabetes mellitus, ketoacidosis,
dyslipidemias, atherosclerosis and coronary artery disease, liver disease, haemoglobinopathies,
phenylketonuria, hyperuricemia and gout, deficiencies of vitamins A, D, K, B12, thiamine, pyridoxine and
folic acid, acid-base and electrolyte disorders, disorders of calcium homeostasis, iron deficiency anemia,

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iodine deficiency, disorders of bilirubin metabolism, renal and thyroid function tests, protein-energy
malnutrition.
RECORD
Record should be followed as recommended by the University.

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