Download MGR (The Tamil Nadu Dr. M.G.R. Medical University) MBBS (Bachelor of Medicine and Bachelor of Surgery) 1st Year Biochemistry Syllabus
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
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:
(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;
(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
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
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
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
structure and function of the human body in health and disease.
TEACHING HOURS:
Theory classes: Total: 115 hours
Seria Topic
Number of hours
l no.
1.
Cell
2 hours
2.
Enzymes
5 hours
3
Chemistry and metabolism of carbohydrates
15 hours
4
Chemistry and metabolism of lipids
15 hours
5
Chemistry and metabolism of proteins
15 hours
6
Vitamins
10 hours
7
Nucleotide chemistry and metabolism
6 hours
8.
Integrated metabolism
3 hours
9
Bioenergetics
3 hours
Homeostatic mechanisms in the body (pH, water
4 hours
10
and electrolyte balance)
11
Immunology
2 hours
12
Minerals
5 hours
13
Haem metabolism
6 hours
14
Function tests
4 hours
15
Molecular biology
12 hours
16.
Metabolism of xenobiotics
2 hours
17.
Oxidative stress
1 hour
18.
Nutrition
3
hours
19.
Importance of and ethical issues in laboratory
2 hours
medicine
Total
115 hours
TEACHING METHODOLOGY
Lectures, tutorials, small group discussions, integrated teaching modules, use of charts (paper-based
clinical scenarios) for case discussions, practical exercises and demonstrations
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
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
TEACHING
TOPIC
MUST KNOW
KNOW
KNOW
HOURS
RECOMMENDED
1
2 hours
. CELL
Cell and cellular Basics of structure of a
Functions of
organelles
eukaryotic cell.
peroxisomes.
Overview of cellular
Markers of sub- cellular
organelles and their
organelles
functions (mitochondria,
nucleus, ribosomes,
proteasomes, lysosomes,
endoplasmic reticulum
and golgi apparatus)
2 ENZYMES
5 hours
.
Nomenclature Systematic and
IUBMB classification
and
recommended nomenclature. of enzymes - main
classification
classes of enzymes only
(names, definition,
general reaction
catalysed and one
example for each class)
Properties of
Mechanism of action of an
Lock and key and
enzymes
enzyme with regard to its
induced fit models of
effect on activation energy of enzyme-substrate
a reaction.
binding
Concept of active site in
enzymes.
Specificity of enzymes:
reaction and substrate
specificity, with an example
for each.
Cofactors - metals and
coenzymes (definition,
examples of coenzymes) and
examples of enzymes that
require them
Factors that
Effect of pH (concept of
influence
optimal pH with examples).
enzyme
activity
Effect of temperature
(concept of optimal
temperature).
Effect of substrate
concentration (Michaelis-
Menten equation [no
derivation of equation
required], concept of Km and
Vmax).
Effects of enzyme and
product concentration.
Inhibition of
Types of enzyme inhibition -
enzymes
competitive, non-
competitive, suicide
inhibition.
Effects of competitive and
non-competitive inhibition
on Km and Vmax of the
enzyme.
Examples of commonly used
drugs that act by competitive
inhibition of enzymes.
Examples of non-
competitive enzyme
inhibition ?
organophosphorus/cyanide
poisoning
Isoenzymes
Definition and examples
Isoenzymes of lactate
dehydrogenase (LDH)
Clinical significance of
and ALP
elevated plasma levels of
isoenzymes of creatine kinase
(CK)
Diagnostic
Aspartate aminotransferase
Clinical utility of 5-
and
(AST), alanine
nucleotidase and
therapeutic
aminotransferase (ALT),
gamma-glutamyl
enzymes
alkaline phosphatase (ALP), transferase
(clinically
lactate dehydrogenase
useful
(LDH), creatine kinase (CK)
enzymes)
and amylase as markers of
various disease conditions.
Plasma markers of
myocardial infarction and
liver damage.
Examples of enzymes used in
treatment and indications for
their use.
Regulation of
Overview of
enzyme
mechanisms involved
activity
in regulating the
activity of enzymes:
allosteric activation and
inhibition, covalent
modifications
(phosphorylation and
dephosphorylation),
induction and
repression; concept of
feedback inhibition
Process of regulation
of glycogen
metabolism may be
used as an example to
explain the
mechanisms of enzyme
regulation, as listed
above.
3 CHEMISTRY AND METABOLISM OF CARBOHYDRATES
15 hours
Chemistry of
Overview of classification Concept of deoxy and
carbohydrates
of carbohydrates, with
amino sugars and their
physiologically important functions.
examples and functions
of each of these.
Heteropolysaccharides
(heparin, hyaluronic
Benedict's test for
acid,
reducing sugars.
chondrointinsulphate,
heparansulphate,
Components of
dermatan sulphate) and
physiologically important their importance in the
disaccharides and
body.
polysaccharides.
Homopolysaccharides ?
starch, glycogen and
cellulose
Digestion of
Examples of common
carbohydrates
dietary carbohydrates and
the foods that they are
present in.
Enzymes involved in
digestion of
carbohydrates.
Sources, sites and actions
of the enzymes that digest
carbohydrates.
End products of
digestion and their
absorption.
Rationale for the
composition and use of
oral rehydration solution
(ORS) in the treatment of
dehydration.
Lactose intolerance.
Importance of dietary
fibre.
Glucose
Types, functions, tissue
transporters
specificity and
physiological relevance
Glycolysis
Definition, importance,
cellular site and pathway
involved (with emphasis
on the importance of the
pathway, sites of
utilization and generation
of energy and irreversible
reactions involved).
Importance of aerobic
and anaerobic forms of
glycolysis.
Energetics.
Concept of substrate level
phosphorylation.
Overview of regulation of
glycolysis.
Rapaport- Leubering
shunt and its
physiological importance.
Concept of lactic acidosis
and common causes and
conditions in which it
occurs.
Importance of inhibition
of enolase by fluoride in
blood samples collected
for glucose estimation.
Citric acid cycle/ Pyruvate dehydrogenase
Overview of
Krebs' cycle /
as a link between
regulation of
tricarboxylic acid glycolysis and
pathway (no
(TCA) cycle
Krebs' cycle (no details of
details
reaction mechanism
required).
required).
Definition, importance,
cellular site, pathway
(including intermediates
and enzymes involved,
but excluding details of
reactions involved).
Concept of anaplerosis,
amphibolic nature of
Krebs' cycle.
Energetics.
Pentose
Importance of pathway -
Definition, cellular site
phosphate
ribose for nucleic acid
and overview of
pathway (PPP)
synthesis and NADPH
pathway, showing
for synthesis of various
starting material and
lipids, maintenance of
products (intermediates
reduced form of iron in
not required).
haemoglobin, reduced
glutathione and its
importance in
maintaining red cell
membrane integrity.
Clinical relevance of the
deficiency of glucose-6-
phosphate dehydrogenase
(G6PDH).
Glycogenesis
Physiological importance Glycogen storage
of glycogen in the body
disorders
(including role of
glycogen in the liver and
in the muscle).
Overview of pathway of
synthesis (starting
material, action of
glycogen synthase and
branching enzyme and
the end product).
Glycogenolysis
Physiological importance Role of insulin and
of glycogen breakdown in glucagon in reciprocal
the body.
regulation of
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).
glycogen phosphorylase
and debranching enzyme Examples of glycogen
and products obtained).
storage diseases (Von
Gierke's disease and
McArdle's disease) may
be used to illustrate
functions of glycogen
in the liver and muscle
and the reasons for
different manifestations
of the diseases.
Gluconeogenesis Definition, substrates
Concept of reciprocal
used, physiological
regulation of glycolysis
importance, sites in the
and gluconeogenesis
body and in cell where
(no details required).
the pathway occurs.
Role of insulin and
Overview of pathway
glucagon in regulation.
with key intermediates
and enzymes.
Importance of Cori's
cycle and glucose-alanine
cycle.
Uronic acid
Overview of
pathway
pathway
showing
starting
material
(glucose)
and product
(glucuronic
acid).
Importance
of
glucuronic
acid in
conjugation
of bilirubin
and drugs
and
synthesis of
heteropolysa
ccharides.
Essential
pentosuria
Metabolism of
Dietary sources of
galactose
galactose.
Overview of pathway by
which galactose is
metabolized (showing the
sites of 3 main enzymes
involved).
Eventual fate of galactose
in the body.
Galactosemia (definition,
causes, biochemical basis
of clinical manifestations
and rationale of
treatment).
Metabolism of
Dietary sources of
Disorders of
fructose
fructose.
fructose
metabolism
Overview of pathway by
which fructose is
metabolized (showing
entry into glycolysis and
formation of
triacylglycerol).
Importance of fructose in
seminal fluid.
Minor pathways
Polyol pathway and its
of carbohydrate
importance in
metabolism
pathogenesis of
complications of diabetes
mellitus.
Regulation of
Factors maintaining
blood glucose
blood glucose levels - role
levels
of dietary carbohydrates,
role of hormones (insulin,
glucagon, glucocorticoids
and catecholamines) and
roles of liver and kidney.
Diabetes
Types and pathogenesis
Pathogene-
mellitus
of diabetes mellitus.
sis of
chronic
Concept of insulin
complicati-
resistance.
ons of
diabetes
Metabolic derangements
mellitus.
and clinical features.
Diagnostic criteria (ADA
criteria).
Concept of impaired
fasting glucose and
impaired glucose
tolerance.
Gestational diabetes ?
definition and diagnosis
Acute and chronic
complications of diabetes
mellitus.
Pathogenesis of diabetic
ketoacidosis.
Laboratory
Blood glucose estimations
investigations in (fasting and post-
diabetes
prandial).
mellitus
Glycated haemoglobin
(HbA1c).
Urinalysis for detection of
glucose, ketone bodies
and proteins in urine.
Detection and
importance of
microalbuminuria.
Role of glucose tolerance
test in diagnosis of
diabetes mellitus.
Indications for and
interpretation of results
of glucose tolerance test
(OGTT), including use in
gestational diabetes
mellitus (GDM).
Serum lipid profile in
diabetics.
Hypoglycemia
Definition, importance,
causes, clinical
manifestations.
4 CHEMISTRY AND METABOLISM OF LIPIDS
15 hours
Definition of a lipid.
Properties with regard to
solubility and
hydrophobicity.
Important functions of
General
lipids in the human body.
featuresof lipids
Concept of importance of
lipids in causation of
disease (atherosclerosis
with subsequent
myocardial infarction and
stroke; obesity,
cholelithiasis, etc).
Classification of Major types of lipids in
lipids
the body (classification
into simple, complex and
precursor or derived
lipids).
Relevant examples of each
type and the importance
of each type in the body.
Fatty acids
Concept of system of
nomenclature (concept of
systematicnames and
symbols), with C and n
numbering of fatty acids.
Classification system
based on chain length,
degree of
saturation (saturated and
mono- and
polyunsaturated fatty
acids), and nutritional
requirement.
Concept of saturated fatty
acids in animal fat and
unsaturated fatty acids in
plant fats.
Names of essential fatty
acids and their functions.
Importance of 3 and 6
fatty acids (dietary sources
and their health benefits).
Simple lipids
Concept of importance of
(fats)
saturated and unsaturated
fats in one's diet
(including hydrogenation
of oils).
Basic concept of cis and
trans forms of fatty acids
and the health hazards of
trans fats.
Basic concept of mono,
di- and triacylglycerols and
where they are found in
the body.
Derived lipids ?
Functions of cholesterol
steroids
Health hazards associated
with high blood levels of
cholesterol.
Complex lipids
Lipoproteins - definition, Phospholipids
Glycolipids -
general structure, types, (definition, types,
definition,
components of each type, components,
types,
function of each type, role amphipathic nature,
components,
of apoproteins,
functions, clinically
functions,
importance in health and relevant examples)
examples.
disease.
Importance of each
Basic concepts
type of phospholipid: of cerebrosides
phosphatidylcholine
and
(including
gangliosides
importance of
and
surfactant in health
importance of
and disease, concept each type in
of
the body.
lecithin/sphingomye-
lin [L/S] ratio),
Basic concept
phosphatidylinositol
of
and sphingomyelin
abnormalities
in lipids in
Liposomes
demyelinating
(definition, structure diseases and
and importance)
sphingolipido-
sis
Miscellaneous
Micelles (definition,
Basic concepts of
structure and importance). transport
mechanisms across
Biological membranes
membranes
(structure and
importance).
Metabolism of
lipids
Digestion of
Names of main lipids
lipids
present in the diet.
Enzymes responsible for
digestion of lipids and
their sources and sites of
action.
Role of bile in lipid
digestion and absorption.
End-products of lipid
digestion.
Process of absorption of
lipids.
Steatorrhoea.
Salient features of
formation, metabolism
and physiological
importance of
chylomicrons.
Fate of fatty
acids
Fatty acid
Importance of oxidation
End-products of
Conditions
oxidation
of fatty acids in the body.
beta- oxidation of
where fatty
odd chain fatty acids. acid oxidation
Types of oxidation of fatty
is impaired.
acids.
Alpha oxidation of
fatty acids.
Beta-oxidation of even
chain fatty acids (site,
activation of a fatty acid,
the role of carnitine, steps
involved and energetics of
the process).
Biosynthesis of
Conditions under which it
fatty acids
occurs and sites involved.
(lipogenesis)
Starting material and end
products of fatty acid
synthesis.
Source of acetyl CoA.
Regulatory role of acetyl
CoA carboxylase.
Overall reaction catalyzed
by fatty acid synthase
(individual enzymes and
reactions not required).
Importance of NADPH in
the pathway and its
sources.
Role of the nutritional
state and insulin as factors
that regulate synthesis of
fatty acids
Metabolism in
Metabolism in the
the adipose
adipose tissue with
tissue
regard to lipogenesis
and lipolysis
(conditions where it
occurs, and products
obtained) and its
regulation by
hormones, including
enzymes involved
Metabolism of
Names of the ketone
ketone bodies
bodies and their
importance.
Pathway of ketogenesis
and utilization of ketone
bodies and sites where
these occur.
Factors that favour ketone
body formation.
Causes and clinical
importance of
ketoacidosis.
Metabolism of
Functions of cholesterol.
Cellular site of
Role of lipids
cholesterol
biosynthesis of
in formation of
Sources of cholesterol in
cholesterol.
gall stones.
the body (dietary and
endogenous).
Basic overview of
biosynthesis of
Importance of HMG CoA cholesterol (showing
reductase in the regulation starting material,
of biosynthesis of
HMG CoA [HMG
cholesterol.
CoA synthase],
mevalonate [action
Importance of maintaining of HMG CoA
normal cholesterol levels
reductase] and
in blood and ways to
formation
reduce blood cholesterol
ofcholesterol,
levels (including
without showing any
mechanism of action of
other intermediates).
statins and other lipid
lowering agents).
Overview of
synthesis (including
Bile acids (names, source
regulatory enzyme).
and functions).
Enterohepatic circulation
of bile acids.
Metabolism of
Association of high levels
Brief overview of
lipoproteins
of LDL with
metabolism of
atherosclerosis.
VLDL, LDL and
HDL (including
Anti-atherogenic effect of reference values).
HDL
Lipoprotein (a)
Dyslipidemias ?
causes (with
emphasis on
secondary causes of
dyslipidemia and
familial
hypercholesterol-
emia) and
consequences.
Risk factors for
atherosclerosis and
coronary artery
disease; prevention
of coronary artery
disease.
Overview of
metabolic syndrome.
Eicosanoids
Names and functions of
Mechanism of action Therapeutic
various eicosanoids.
of NSAIDs and their uses of
effect as anti-
prostaglandins.
Role of aspirin as an anti-
inflammatory agents
platelet agent.
Phospholipids
Clinical relevance of
Biochemical defect
Sites of action
lecithin-sphingomyelin
and clinical features
of various
(L/S) ratio in amniotic
of Niemann-Pick's,
phospholipases
fluid
Tay- Sach's and
.
Gaucher's disease.
Sphingolipido-
sis other than
the examples
specified.
Miscellaneous
Role of liver in lipid
metabolism.
Fatty liver (causes,
including role of lipotropic
factors, and
consequences).
5 CHEMISTRY AND METABOLISM OF PROTEINS
15 hours
Amino acids
Classification based on
Classification of
nutritional requirement
amino acids based on
and metabolic fates.
side chain
Peptide bond formation
by amino acids.
Reaction with ninhydrin as
a general reaction for all
amino acids (details of
reaction not required).
Peptides and
Structural organization of
Oxygen dissociation
proteins
proteins - primary,
curve of
secondary, tertiary and
haemoglobin; Bohr
quaternary structures.
effect.
Denaturation of proteins
? definition, agents
causing denaturation and
consequences (loss of
biological activity of
protein).
Overview of structure-
function relationship of
haemoglobin, myoglobin
and collagen.
Hemoglobinopathies:
sickle cell anaemia and
thalassemia
Digestion and
Mechanism of activation
Disorders associated
absorption
of enzymes involved in
with amino acid
the digestion of proteins
absorption
in the stomach and small
(cystinuria/
intestine (conversion of
Hartnup's disease).
zymogens to active
proteases) ? proteolytic
enzymes of the gastric and
pancreatic secretions.
Role of gastric acid in
protein digestion.
Overview of amino acid
absorption.
General
Overview and biochemical
pathways of
importance of the
amino acid
processes of
catabolism
transamination and
oxidative deamination.
Enzymes and coenzymes
involved in the above
processes.
Ammonia
Sources of ammonia in the Overview of
metabolism
body.
disorders of the urea
cycle
Urea cycle - overview of
reactions involved,
including regulatory
enzyme.
Role of glutamine in
detoxification of ammonia
in the brain.
Hepatic coma (hepatic
encephalopathy);biochemi
cal basis of clinical
features
Reference range for blood
urea and blood urea
nitrogen
(BUN).
Metabolism of
Functions of individual amino
Metabolism of
Uncommon
individual
acids.
methionine and
disorders of
amino acids
homocysteine
amino acid
Important specialized products
metabolism:
from tyrosine ? melanin,
Roles of folic acid,
maple syrup
catecholamines, thyroid
vitamin B12 and
urine disease
hormones.
pyridoxine in their
(MSUD),
metabolism.
alkaptonuria,
Formation of tyrosine from
tyrosinemias,
phenylalanine.
Role of homocysteine methymalonyl
as a risk factor for
aciduria,
Pathogenesis, clinical features,
cardiovascular
disorders of
diagnosis and treatment of
diseases.
glycine
phenylketonuria.
metabolism, etc.
Important specialized
products from glycine Importance of
(glutathione, creatine,
neonatal
creatinine, haem and
screening for
purines) and
inborn errors of
tryptophan (serotonin, amino acid
melatonin and niacin). metabolism.
Neurotransmitters
Principle of the
derived from amino
technique of
acids (glutamate ?
chromatography
gamma-amino butyric
acid [GABA], histidine
[histamine], arginine
[nitric oxide]).
Plasma proteins
Functions of albumin.
Classification of
Principle of the
plasma proteins, based technique of
Examples of specialized
on electrophoretic
electrophoresis
transport proteins present in
mobility.
plasma.
Reference values of total
proteins and albumin.
Common clinical conditions in
which plasma protein levels
are abnormal and the reasons
why these changes occur
(malnutrition, cirrhosis of the
liver, nephrotic syndrome,
chronic renal failure, multiple
myeloma).
Importance of the albumin:
globulin ratio (A: G ratio). `
Normal value for the A:G ratio
and common clinical conditions
in which the ratio is abnormal.
6
VITAMINS
10 hours
General
Definition, classification,
properties of
comparison of clinically relevant
vitamins
features of fat- and water-
soluble vitamins.
Concepts of hypo- and
hypervitaminosis and
recommended dietary
allowances (RDA).
Fat-soluble vitamins
Vitamin A
Dietary sources.
Hypervitaminosis A
Various forms of vitamin A and
their functions
Precursor form.
Biochemical functions.
Role in Wald's visual cycle.
RDA
Deficiency ? causes,
manifestations and treatment.
Vitamin D
Dietary sources of vitamin D.
Synthesis in the body and
conversion to calcitriol.
Biochemical functions.
Role in calcium absorption in
small intestine, calcium
homeostasis and bone
mineralization.
RDA
Deficiency (rickets and
osteomalacia) ? causes,
manifestations, biochemical
findings in blood
Vitamin E
Dietary sources
Role as an antioxidant.
Relationship to action of
glutathione peroxidase.
RDA
Deficiency leading to fragility of
RBCs.
Vitamin K
Sources.
Biochemical role in
RDA.
gamma carboxylation
Deficiency ? causes,
reactions.
manifestations (including
hemorrhagic disease of the new Vitamin K cycle.
born).
Basis of action of
warfarin and other
dicumarol derivatives.
Water-soluble vitamins
Thiamine
Dietary sources.
Functions (coenzyme form,
physiologically important
reactions for which it is
required).
RDA
Deficiency (beri-beri) ? causes
and manifestations
Wernicke-Korsakoff syndrome
- causes, clinical features
Riboflavin
Dietary sources.
Functions (coenzyme forms,
physiologically important
reactions for which they are
required).
RDA
Deficiency ? causes and
manifestations.
Niacin
Sources (including from
tryptophan).
Functions (coenzyme forms,
examples of physiologically
important reactions for which
they are required).
RDA
Deficiency ? causes and
manifestations of pellagra.
Pyridoxine
Dietary sources.
Functions (coenzyme form,
physiologically important
reactions for which they are
required, including
transamination and
decarboxylation of amino acids).
RDA.
Deficiency ? causes and
manifestations.
Rationale for supplementation in
treatment of tuberculosis.
Pantothenic acid Sources, functions and RDA
Biotin
Sources.
Role in carboxylation reactions.
Examples of important enzymes
that require biotin.
Folic acid
Dietary sources.
Role of folic acid in
Functions (coenzyme forms,
one-carbon
physiologically important
metabolism (one-
reactions for which they are
carbon donor
required).
reactions (e.g., serine
RDA
hydroxymethyl
Relationship with vitamin B12
transferase), one-
and concept of "folate trap".
carbon acceptor
Deficiency ? causes and
reactions (methionine
manifestations (megaloblastic
synthase, thymidylate
anemia).
synthase and de novo
Importance of supplementation purine synthetic
in peri-conceptual period.
pathway).
Folate antagonists (action of
methotrexate, aminopterin and
sulphonamides).
Vitamin B12
Dietary sources.
Absorption and role of intrinsic
factor of Castle.
Functions (coenzyme forms,
reactions for which they are
required).
Role in folic acid metabolism
(concept of "folate trap" in B12
deficiency)
RDA
Deficiency ? causes and
manifestations (megaloblastic
and pernicious anemia).
Importance of combined B12
and folic acid administration in
treatment of megaloblastic
anemia.
Vitamin C
Dietary sources.
Role of vitamin
Functions (in collagen synthesis,
C in the
iron absorption and as an
conversion of
anti-oxidant).
tyrosine to
RDA.
catecholamines,
Deficiency ? causes and
cholesterol to
manifestations of scurvy.
bile acids and
in catabolism
of tyrosine.
Vitamin-like
Role in
substances
reactions
involving
Lipoic acid
pyruvate
dehydrogenase
and alpha-
ketoglutarate
dehydrogenase.
7
NUCLEOTIDE CHEMISTRY AND METABOLISM
6 hours
Nucleotide
Purine and pyrimidine bases
Examples of synthetic
chemistry
found in DNA and RNA.
analogues of purine
and pyrimidine bases
Definition and types of
and nucleosides used
nucleosides and nucleotides.
as therapeutic agents
(anti-cancer drugs,
Functions of physiologically
anti-viral drugs and
important nucleotides.
allopurinol).
Nucleotide
Role of folic acid in purine
Names of compounds Overview of the
metabolism
synthesis.
required for purine
pathway of de
and pyrimidine
novo synthesis
Overview of the pathway of
synthesis.
of purine
degradation of purines to form
nucleotides
uric acid, including role of
Salvage pathway for
(names of only
xanthine oxidase.
purine bases and
starting material
nucleosides.
and end
Hyperuricemia and gout (causes, Lesch- Nyhan
products - AMP
clinical features, principles of
syndrome (cause and
and GMP -
treatment, including mechanism biochemical basis of
required).
of action of allopurinol and
clinical features).
probenecid).
Overview of
Mechanism of action
pathway of de
of methotrexate and
novo synthesis
5-flurouracil, as
of pyrimidine
examples of drugs
nucleotides,
used in cancer
showing only
chemotherapy.
starting
material, rate-
limiting enzyme
and end
products.
Disorders of
pyrimidine
metabolism:
orotic aciduria
8.
INTEGRATED METABOLISM
3 hours
Overview of metabolism in the
Overview of
fed and fasting states
metabolism in liver,
brain and adipose
tissue
9
BIOENERGETICS
3 hours
Role of ATP
Role of ATP as the "energy
Role of high
currency" of the cell.
energy
phosphates in
energy capture
and transfer
e.g., role of
creatine
phosphate in
muscle.
The respiratory
Sources of reducing equivalents
Transport of
chain and
in the cell (NADH and
cytosolic
oxidative
FADH2).
NADH into the
phosphorylation
mitochondria
Role of mitochondria as the
(mitochondrial
"power house" of the cell.
shuttle systems).
Substrate level and oxidative
Examples of
phosphorylation.
inhibitors of
electron
Schematic representation of the
transport chain
electron transport chain.
(carbon
monoxide,
Role of the respiratory chain as
cyanide) and
an electron transporter and a
uncouplers of
proton pump.
oxidative
phosphorylatio
Chemiosmotic theory of
n (free fatty
oxidative phosphorylation.
acids, thyroxine,
thermogenin).
Amount of ATP synthesized
when NAD and FAD act as
Role of brown
hydrogen acceptors.
fat (non-
shivering
thermogenesis
and role of
uncoupling
protein/
thermogenin).
Overview of
complex V
(ATP synthase).
10
HOMEOSTATIC MECHANISMS IN THE BODY
4 hours
Acid base balance
Definitions of acid, base and
buffer.
Normal pH of body fluids and
importance of maintaining
normal pH
Sources of hydrogen ions in the
body.
Mechanisms involved in
regulation of pH
Buffers of body fluids
Henderson ? Hasselbalch
equation.
Role of buffers (with emphasis
on the bicarbonate buffer
system)
Role of the lungs and kidneys in
maintaining acid- base balance.
Simple acid-base disorders:
Major causes and clinical
features of:
? Metabolic acidosis
(including importance of
anion gap) and alkalosis
? Respiratory acidosis and
alkalosis.
Arterial blood gases (ABG)
analysis and interpretation of
results.
Compensatory mechanisms in
metabolic/respiratory
acidosis/alkalosis.
Fluid and
Distribution of water in various
Regulation of
electrolyte
body compartments.
osmolality? role of
balance
anti-diuretic hormone
Intra- and extracellular fluid
(ADH).
composition (sodium and
potassium)
Blood volume and osmolality.
Major causes and clinical features
of dehydration.
Sodium:
Normal levels in the blood.
Physiological functions.
Regulation of sodium
homeostasis (including the role
of renin-angiotensin-aldosterone
system).
Major causes, clinical features of
hyponatremia and hypernatremia
Potassium:
Normal levels in the blood.
Physiological functions.
Regulation of potassium
homeostasis.
Major causes and clinical features
of hypokalemiaandhyperkalemia.
11
IMMUNOLOGY
2 hours
Immunology
Introduction to
immunoglobulins
Types, properties and functions
of different classes of
immunoglobulins.
Multiple myeloma ? biochemical
abnormalities and laboratory
diagnosis.
12
MINERALS
5 hours
Concept of macro and micro
minerals and examples.
Sources and daily requirement.
CALCIUM
Normal blood levels.
Functions of calcium.
Role of vitamin D in absorption
of calcium.
Regulation - role of parathyroid
hormone (PTH), calcitonin and
vitamin D in calcium
homeostasis.
Important causes, clinical
features, laboratory diagnosis of
hypocalcemia and hypercalcemia
Osteoporosis and osteomalacia -
major causes, clinical features.
Iron
Sources and daily requirement.
Iron overload
Distribution of iron in the body. conditions, e.g.,
Functions of iron.
hereditary
Absorption of dietary iron in the haemochromatosis.
duodenum - overview of role of
divalent metal transporter-1
(DMT-1), duodenal cytochrome
b (dcytb), hephaestin,
ferroportin.
Storage and transport (role of
ferritin and transferrin).
Causes, clinical features of iron
deficiency anemia.
Copper
Biochemical functions of copper. Biochemical basis of
Role of ceruloplasmin.
Menke's disease
Genetic basis, clinical features of
Wilson's disease.
Zinc
Functions of zinc.
Causes and clinical features of
zinc deficiency.
Magnesium and
Functions of
manganese:
magnesium and
manganese.
Iodine:
Sources and daily requirement of
iodine.
Functions of iodine.
Causes and clinical features of
iodine deficiency.
Flouride:
Sources and daily requirement of
fluoride.
Functions of fluoride.
Causes and clinical features of
fluorosis.
Selenium
Functions of selenium
13
HAEM METABOLISM
6 hours
Heme synthesis
Importance of haem (heme-
Heme synthesis and its
containing proteins ?
regulation in the liver
hemoglobin, myoglobin,
and bone marrow.
cytochromes).
Porphyrias: Definition,
biochemical basis of clinical
features of porphyrias
(neurological features and
photosensitivity).
Acquired porphyria: lead
poisoning.
Heme
Degradation of haem and fate of Congenital disorders
degradation
bilirubin.
of conjugation and
excretion of bilirubin
Hyperbilirubinemia ? causes and ? Crigler-Najjar
role of laboratory investigations
syndrome, Dubin-
in the differential diagnosis of
Johnson syndrome,
jaundice.
Gilbert's syndrome
and Rotor's syndrome.
Jaundice in the newborn
14
FUNCTION TESTS:
4 hours
Renal function
Functions of the kidney
test:
Clinical importance of blood
urea and serum creatinine levels
in renal disease.
Estimation of GFR: Creatinine
Proteinuria ? types
Renal tubular
clearance and its importance.
(glomerular, tubular
acidosis.
and overflow
Nephrotic syndrome ? major
proteinuria) and
Lab
clinical features and laboratory
characteristic proteins investigations
diagnosis.
present in urine in
in
each type.
acute kidney
injury and
Microalbuminuria and chronic kidney
its importance.
disease
Concepts of tests to
Laboratory
assess tubular function tests to
? measurement of
diagnose pre-
plasma and urine
renal, renal and
osmolality
post- renal
causes of acute
renal failure.
Liver function
Functions of the liver.
tests
Major causes of liver
dysfunction.
Tests done to assess liver
function in clinical practice:
1. Tests to assess ability to
detoxify and excrete substances:
conjugated and unconjugated
bilirubin (van den Bergh's test),
blood ammonia levels.
2. Tests to assess biosynthetic
functions: total protein and
serum albumin levels,
prothrombin time
3. Markers of liver injury: alanine
transaminase (ALT) and
aspartate transaminase (AST)
4. Marker of cholestasis: alkaline
phosphatase (ALP).
Differential diagnosis of
jaundice, based on liver function
tests.
Thyroid
Regulation of secretion of
Importance of
function test:
thyroid hormones.
estimation of
TSH in
assessment of
thyroid
function.
Measurement of
total and free
thyroxine levels.
Role of TSH
and free
thyroxine in
laboratory
diagnosis of
hypothyroidism
and
hyperthyroidism
Adrenal function
Hormones
tests
produced by the
adrenal cortex
and medulla.
Regulation of
secretion of
adrenocortical
hormones.
Basic tests done
for the
laboratory
diagnosis of
adrenal
hypofunction
and
hyperfunction
(serum and
urine cortisol)
15
MOLECULAR BIOLOGY
12 hours
The cell cycle,
Watson and Crick model of
Overview of the
DNA and RNA
DNA structure (including simple
cell cycle
structure
diagrammatic representation of
the salient features of DNA
Differences
structure).
between nuclear
and
Types and functions of different
mitochondrial
types of RNA.
DNA.
Overview of organization of
DNA in a chromosome.
DNA replication Overview of the process of
Inhibitors of DNA
Importance of
and repair
DNA replication in eukaryotes
replication as anti-
telomeres and
cancer drugs.
telomerase
Roles of DNA polymerase,
helicase, primase, topoisomerase Overview of role of
and DNA ligase
major DNA repair
mechanisms
?
Diagrammatic representation of mismatch repair, base
the events at the replication fork
excision
repair,
Okazaki fragments and its nucleotide excision
importance in replication.
repair and double
strand break repair.
Diseases associated
with abnormalities of
DNA repair systems
? xeroderma
Pigmentosa and
hereditary non-
polyposis colon
cancer (HNPCC).
Transcription
Structure of a gene - concepts of
exons and introns, promoter,
enhancers/repressors and
response elements.
Overview of the process of
transcription in eukaryotes ?
initiation, elongation and
termination
Post-transcriptional processing ?
capping, tailing and splicing.
Translation and Genetic code - definition.
Overview of the
genetic code:
process of translation
Characteristics of the genetic
? initiation,
code ? universal, unambiguous,
elongation and
degenerate, without punctuation termination
(continuous/commaless).
Inhibition of
Basis of degeneracy of the
prokaryotic
genetic code (wobble
translation by
hypothesis).
antibiotics.
Components of eukaryotic
Post-translational
ribosomes.
modifications ?
examples.
Structure of tRNA (diagram of
clover leaf model of tRNA
structure) and its function in
protein synthesis.
Function of aminoacyl tRNA
synthase.
Mutations and
Mutations:
Relationship of
Prokaryotes:
regulation of
Definition.
mutations with
The operon
gene expression
specific diseases ? eg, concept in
Mutagens- examples of physical, sickle cell anemia and prokaryotes
chemical and biological
chronic myeloid
(using Lac
mutagens.
leukemia.
operon as an
example).
Types of mutations.
point mutation (deletion,
Eukaryotes:
insertion, substitution ?
Overview of
transition and
regulation of
transversion, frame shift
initiation of
mutation,
eukaryotic
? missense mutation,
transcription:
nonsense mutation and
role of general
silent mutation
and gene-
? chromosomal mutations
specific
(deletion, inversion and
transcription
translocation).
factors
Recombinant
Importance and applications of
Restriction
Human genome
DNA
recombinant DNA technology
endonucleases.
project
technology and
techniques in
Importance and applications of
Vectors for cloning ? DNA
molecular
Polymerase chain reaction (PCR) plasmids and phages.
fingerprinting
biology:
?
Genomic and cDNA
DNA
libraries.
sequencing
Principles and
Microarrays
applications of
techniques in
Fluorescent in-
molecular
situ
biology: (Southern,
hybridization
northern and western (FISH)
blotting, restriction
fragment length
DNA vaccines
polymorphism
[RFLP])
Transgenic
animals
Applications of
recombinant DNA
technology in
medicine. General
principles of
production of
therapeutic proteins,
e.g., insulin
Gene therapy
Diagnosis of genetic
diseases and genetic
counseling
Forensic investigation
16. METABOLISM OF XENOBIOTICS
2 hours
Xenobiotics- definition and
The cytochrome P450
examples
enzyme system
? Functions
Biochemical importance of the
? Properties (especially
two phases of xenobiotic
induction by drugs)
metabolism
Overview of
Conjugation reactions:
metabolism of alcohol.
? Biochemical role of
conjugation reactions (with
Health hazards
suitable, clinically relevant
associated with alcohol
examples) - glucuronidation,
consumption.
sulfation, conjugation with
glutathione, acetylation.
Metabolic alterations
induced by alcohol
metabolism.
17. OXIDATIVE STRESS
1 hour
Concepts of
reactive oxygen
species (ROS),
free radicals
and oxidative
stress and
antioxidants.
Mechanisms of
generation of
reactive oxygen
species (ROS)
in cells.
Role of
antioxidants ?
vitamin E and
glutathione.
Role of
antioxidant
enzymes ?
glutathione
peroxidase,
superoxide
dismutase
18. NUTRITION
3 hours
Importance of various macro
Calorific value of
Dietary protein
and micro-nutrients in diet.
various
quality ?
Components and importance of macronutrients.
biological value
each type in diet.
and net protein
Principles of
utilization.
Concept of balanced diet and
calculation of energy
glycemic index of food.
requirements of a
Concept of
person.
nitrogen
Importance of dietary fibre.
balance.
Basal metabolic rate.
Specific dynamic action
(thermogenic effect of food) and
respiratory quotient
Common sources of saturated,
polyunsaturated and
monounsaturated fats in diet and
their impact on health.
Importance of trans fats
Concept of limiting amino acids
and supplementary action of
dietary proteins.
Protein-energy malnutrition
(PEM): marasmus and
kwashiorkor - causes and main
differences.
Obesity (including calculation
and interpretation of body
mass index [BMI]; health risks
associated with obesity)
19.
IMPORTANCE OF LABORATORY MEDICINE
2 hours
ETHICAL ISSUES IN LABORATORY MEDICINE
The concept that laboratory
Ensuring
testing should respect principles
quality and
of medical ethics (non-
integrity of
maleficence, beneficence, patient
laboratory
autonomy, informed consent,
services, role
respect for patient, etc)
and
responsibilities
when
participating in
clinical
research,
optimal use of
resources,
confidentiality
of laboratory
results, use of
results from
screening and
testing
programs, etc.
PRACTICAL SYLLABUS
Estimation of important biochemical analytes in blood (glucose, creatinine, urea, uric acid and total protein)
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
Interpretation of laboratory results in the context of a patient's presenting complaints.
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
Seria Topic
Number of hours
l no.
1.
Estimations of biochemical analytes
40
2.
Qualitative tests
20
3
Demonstrations
15
4
Charts and integrated teaching
25
5
Small group discussions/tutorials
25
Total
125 hours
INTERNAL ASSESSMENT : (40 marks)
(Theory 20 marks + Practical 15 marks + Record 5 marks)
Theory
-
To access knowledge.
Practical
-
To access skill.
Vivo voce
-
To access communication.
Internal Assessment test will be conducted on 3rd Saturday.
Given below is a division of topics for periodic assessments.
Unit I -
September
Cell and chemistry carbohydrates, lipids and proteins
Unit II -
October
Enzymes and vitamins
Unit III -
December
Metabolism of carbohydrates and biological oxidation and electron transport chain
Unit IV -
January
Metabolism of lipids
Unit V -
February
Metabolism ofproteins and metabolism of heme
Unit VI -
April
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
Unit VIII -
June
Chemistry and metabolism of nucleotides and molecular biology
Model exam -1st week of July
RECOMMENDED TEXTBOOKS
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
4. Biochemistry ? Lippincott's Illustrated Reviews
5. Harpers Illustrated Biochemistry
Theory Examination - Pattern of Question Paper I and II
Essays
1 X 10 Marks = 10 Marks
Brief Answers
5 X 4 Marks
=
20 Marks
Short Answers
10 X 2 Marks
= 20
Marks
TOTAL
50
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
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
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
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.
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.
1.
Carbohydrates, cell, biological oxidation and
5 marks
vitamins
Proteins, enzymes, plasma proteins, function tests,
5 marks
2.
metabolism of xenobiotics, basics of immunology
Lipids, minerals, nutrition, metabolism of haem,
5 marks
3
oxidative stress
4
Nucleic acids, molecular biology, water and
5 marks
electrolyte balance, acid- base balance
5
Total marks
20 marks
RECORD BOOKS
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:
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,
iodine deficiency, disorders of bilirubin metabolism, renal and thyroid function tests, protein-energy
malnutrition.
RECORD
Record should be followed as recommended by the University.
This post was last modified on 02 July 2021