Download MGR (The Tamil Nadu Dr. M.G.R. Medical University) MBBS (Bachelor of Medicine and Bachelor of Surgery) 1st Year Physiology Syllabus
1
The goal of learning Physiology is to enable an undergraduate student to have a comprehensive knowledge of the normal functions of the organ systems which
facilitates an understanding of the physiological basis of health and disease.
HUMAN PHYSIOLOGY
COMPETENCIES:
At the end of the I MBBS Physiology course, the student must:
- Have an understanding of the functioning of the different organ systems of the human body and their interactions towards maintenance of
homeostasis or a constant internal environment.
- Be able to apply the knowledge of physiological processes to comprehend mechanisms of disease and basis of treatment.
- Be able to perform some basic laboratory tests and interpret their results
- Be able to perform clinical examination to assess various organ systems.
ii) OBJECTIVES
a) KNOWLEDGE
At the end of the course the student should be able to:
(1) Explain the normal functioning of all the organ systems and their interactions for maintenance of a constant internal environment.
(2 ) Describe physiological responses and adaptations to changes in internal and external environment.
2
(3) Describe the physiological principles underlying pathogenesis and treatment of disease.
(4) List normal values and acceptable ranges for relevant physiological parameters
(5) Interpret results of the following laboratory tests:
(i) serum electrolytes, pH, osmolarity and blood gases
(ii) pulmonary function tests
(iii) renal function tests
(iv) cardiac function tests
(6) Diagnose conditions from symptoms and signs and investigative data provided in case scenarios dealing with common disorders of:
hematological, musculoskeletal, alimentary, endocrine, reproductive, renal, cardiovascular, respiratory, and neurological systems.
b) SKILLS
At the end of the course the student should have developed skills in/to:
(1) Basic hematological techniques:
(i) use and maintenance of a compound microscope
(ii) collection of blood by the finger prick method using aseptic techniques
(iii) performance of ESR, total WBC count, Differential count, hemoglobin estimation, PCV, Bleeding and clotting time, blood grouping.
(iv) Calculation of hematological indices
(2) Distinguish between normal and abnormal data derived from the tests mentioned above.
(3) Perform the following tests and clinical examinations in a normal subject with an understanding of the physiological basis of the examination and
the clinical need to do so. The student should be able to:
(i) Measure blood pressure, record ECG and perform clinical examination of the cardiovascular system.
(ii) perform tests of ventilatory function using spirometer and peak flow meter and perform clinical examination of the respiratory system
(iii) do experiments towards understanding the effect of posture and various grades of exercise on cardiorespiratory function.
3
(iv) perform clinical examination of the abdomen
(v) perform clinical examination of the nervous system including special senses
c) ATTITUDE:
The student must
(i) develop a scientific approach in the practice of clinical medicine
(ii) correlate disease manifestation with derangements of physiological mechanisms and understand rationale of treatment
INTEGRATION
The teaching-learning program should be integrated horizontally and vertically, as much as possible, to enable students to understand the physiological
processes in health, derangements in disease and rationale of treatment.
Number of hours:
Lectures + Tutorials: 280
Practicals + OSPE: 160
ECE:
40
---------
480
---------
4
TOTAL HOURS ALLOCATED FOR PHYSIOLOGY AS PER MCI NORMS
S.No
TOPICS
LECTURE AND
PRACTICAL AND
ECE
TUTORIALS
OSPE
1
General physiology and
20 Hours
5 Hours
3 Hours
body fluids
2
Blood
30 Hours
40 Hours
6 Hours
3
Muscle
15 Hours
5 Hours
3 Hours
4
Gastrointestinal System
15 Hours
12 Hours
3 Hours
5
Endocrine System
30 Hours
15 Hours
3 Hours
6
Reproductive System
20 Hours
5 Hours
2 Hours
7
Excretory System
25 Hours
10 Hours
2 Hours
8
Respiratory System
25 Hours
20 Hours
4 Hours
9
Cardiovascular System
35 Hours
20 Hours
5 Hours
10 Central Nervous System
45 Hours
22 Hours
6 Hours
11 Special senses
20 Hours
6 Hours
3 Hours
TOTAL HOURS
280 Hours
160 Hours
40 Hours
5
The teaching learning methods employed will include
Theory
? Lectures
? Tutorials
? Small group discussion
? Case based learning
? Problem based learning
? Integrated teaching module
? Early Clinical Exposure
Practical
? Demonstration of Hematology Experiments
? System wise Clinical Examination
? OSPE
? OSCE
? Case Discussion
? Charts and calculation
6
THEORY AND PRACTICAL SYLLABUS
7
GENERAL PHYSIOLOGY AND BODY FLUIDS (Lectures + Tutorials 20 hours; Practicals + OSPE 5 hours; ECE: 3 hours)
SPECIFIC LEARNING OBJECTIVES
TEACH
NO
TOPIC
ING
CLINICAL
HOURS
INTEGRATION
MUST KNOW
DESIRE TO KNOW
NICE TO KNOW
1
Cell
? Will be discussed in Biochemistry and
Organelles
Anatomy
2
? Describe the concept of maintenance
? State and describe
Homeostasis
of internal environment
examples of negative
and
? Recognize that negative feedback is
feedback
1 Hour
Feedback
System
the most common type of
? State and describe
physiological control
instances of positive
feedback in human
physiology
3
Body Fluids
? List the different body fluid
? Difference between
Changes in electrolyte
with clinical
compartments, - state the volume,
tonicity and osmolarity
concentration in
departments to
osmolarity and electrolyte
? Edema and its causes
Vomiting, Diarrhoea,
2 hours
enable a student to
composition of each of the following
? The dilution principle for severe dehydration and
understand the
compartments
measurement of body
burns
principles of
? Total body water, extracellular,
fluid compartments
Cause for oedema in
intravenous fluid
intracellular, plasma, intravascular
? Methods of measurement Kwashiorkor, Liver
therapy
? Describe the term transcellular fluid
of body fluid
failure,
learn the
? Measurement of volumes of
compartments
glomerulonephritis and
presentations and
compartments
filariasis
management of
? Describe the Starling's forces that
electrolyte disorders
govern fluid exchange across the
(the causes of fluid
membranes separating the various
and electrolyte
compartments
disorders may be
? Define Donnan effect and
discussed later in
equilibrium
the course)
? Use the Concept of electro neutrality
see patients
in the fluid compartments to calculate
presenting with
`Anion gap'
different types of
? Define anion gap as the term referring
edema
8
to unmeasured anions in plasma.
4
Cell
? Describe with diagram the fluid
Membrane
mosaic model
1 Hour
? State the composition of cell
membrane in terms of lipids and
proteins and describe how these
are organised
5
Membrane
?
Classify transport mechanisms as
Describe the differences
State the mechanism
Teaching may be
Transport
Passive and active with examples and
between channel and
of action of botulinum
integrated with
differentiate between them.
carrier-mediated transport
toxin and the basis of
Pharmacology and
? List and describe the following
processes
botox injections
3 Hours
clinical departments
passive transport processes with
State Fick's law of diffusion
to
examples:
? Describe the following
(i) ) enable a
o Simple diffusion of respiratory
active transport
student to have a
gases through lipid film
processes:
perspective about
o Diffusion of ions through ion
o Primary active
Channelopathies
blockers of the
channels
transport:
transporters
Sodium, potassium, calcium
calcium pumps -
(channels and
and chloride channels
plasma
carrier proteins)
Non-gated channels, voltage-
membrane
used as therapeutic
gated, ligand-gated channels
calcium pumps
drugs.
and mechano-gated channels
(PMCA) and
Examples: Digoxin,
o Facilitated diffusion - Glucose
Sarco/endoplasmi
Furosemide,
transporters (GluTs)
c reticulum
thiazide diuretics,
o Osmosis
calcium pumps
amiloride,
? Describe the following active
(SERCA)
omeprazole
transport processes:
Proton pumps - V-
(ii) ) understand
o Primary active transport:
type H ATPase,
disorders arising
sodium-potassium pump,
H/K ATPase
due to mutations of
o Secondary active transport:
o Secondary active
some channels:
sodium-glucose co-transport
transport: sodium-
E.g.: Liddle's
(SGLT) and sodium-aminoacid
hydrogen
syndrome
co-transport
exchangers, sodium-
Brugada syndrome
? Describe the following transport
calcium exchangers,
Congenital Long
processes by formation of membrane
Na/2Cl/K symport
QT syndrome
vesicles
o Endocytosis
9
? Exocytosis
6
Membrane
? Describe the mechanisms
? Patch Clamp Technique
? Describe the term
With Pharmacology
Potential
involved in genesis of resting
? Cathode Ray Oscilloscope
`Depolarizationblock
and Anaesthesia to
membrane potential (RMP) in a
' in terms of
2 Hours understand
prototype cell
inactivation of
(i) The use of drugs
? Recognise the RMP in a nerve or
voltage ?gated
causing
cardiac cell
sodium channels
depolarization
? Nernst or equilibrium potential
during sustained
blockade
`Equilibrium potential'
partial depolarization
(ii))Long QT
? Action potentials in neuron,
and therefore the
syndrome as an
skeletal muscle cell, Sino atrial
inability of the tisse
adverse effect of a
node and cardiac ventricular cell
to develop new
number of drugs
action potential
causing blockade of
a K channel called
HERG channel
10
Blood (Lectures + Tutorials 30 hours; Practical + OSPE 40 hours; ECE: 6 hours)
NO
SPECIFIC LEARNING OBJECTIVES
TOPIC
TEACH
CLINICAL
ING
INTEGRATION
MUST KNOW
DESIRE TO KNOW
NICE TO KNOW
HOURS
1
Introduction
? Describe the normal composition of
? State the difference
blood
between plasma and
1 Hour
? Describe the composition of plasma
serum..
? State the difference between plasma
and serum.
2
Plasma
? State the site of production, normal
? Causes for decrease in
? Acute Phase
? With clinical
Proteins
range and describe the functions of
serum Albumin levels
Proteins
departments to
(Integration
Albumin
with specific examples
(Special
2 Hours
enable a student
with
? Discuss causes for decrease in serum
of disease conditions
consideration of
to examine
Biochemistry)
Albumin levels with specific
? Discuss the significance
Fibrinogen as an
patients with
examples of disease conditions
of albumin/globulin ratio
acute phase protein)
edema, identify
? Explain what is plasma oncotic
? Explain the cause for
? Describe the
and discuss the
pressure
oedema in Kwashiorkor,
significance of
mechanism of
? Discuss the production, various types
Liver failure,
C- Reactive protein
edema in various
and role of Globulins (alpha, beta and
glomerulonephritis and
disease
gamma globulins)
filariasis
conditions
3
Erythrocyte
? Define and state normal values for
? Estimate ESR by
? See evidences
Sedimentation
ESR in men and women
Wintrobe/Westergren's
Practical
for ESR serving
Rate (ESR):
? Describe the factors influencing ESR
method of a provided
3 Hours
as an index of
(fibrinogen particularly)
sample of blood and
acute phase
? Discuss the significance of ESR in
interpret the result
reaction
disease states
4
RBC
? Describe the physical characteristics
? Explain morphological
of red blood cells
characteristics of
? List causes and give explanation for
individual stages of
physiological variations of the normal
2 Hours
11
RBC count
Erythropoiesis
? Explain the functions of RBCs
? Define Packed Cell
? List the changes in sites of
Volume
Practical
erythropoiesis with age
(PCV)/Hematocrit and
3 Hours
? Illustrate the major changes that take
state normal range for
place during the stages of
men and women
erythropoiesis.
? State the physiological
? Describe the factors regulating/
variations in PCV
affecting erythropoiesis,
? Discuss the normal life span and
destruction of RBCs
5
Hemoglobin
? State the components of Hb, the
? Estimate and interpret
? Role of
? With
various types of Hb and normal range
Hb content by Sahli's
phototherapy in
biochemistry to
of Hb in men and women
Acid Hematin method-
treating infants with 2 Hours
discuss about
? Briefly discuss the synthesis of
Estimation of Hb
jaundice due to
structure and
haemoglobin
? Abnormal Hemoglobin
hemolysis
types of Hb
? what is reduced hemoglobin.
? Iron metabolism and iron
? Describe and
? Define and describe cyanosis
overload
detect Cyanosis
? Discuss the types of jaundice
? Discuss the synthesis of
? Describe sickle
? Abnormal Hemoglobin
hemoglobin
Practical
cell anemia &
? Discuss carbon
3 Hours ? Thalassemia
monoxide poisoning and
? Identify and
treatment
describe
? Discuss Iron metabolism
physiological
and iron overload
jaundice of new
born
? Discuss different
types of
jaundice.
6
Anaemia
? Define anaemia
? State the normal
? Discuss the
? With medicine
? Classify anaemia based on etiology
reticulocyte count and its
principle and
departments to
and morphology
significance
indications for Bone 2 Hours
see patients with
? Discuss the principles of treating
? Define reticulocyte
Marrow
anemia and
anemias
response
Transplantation
enable a student
? Describe major symptoms, signs and
? Calculate and interpret
to
effects of anemia
red cell indices
? discuss causes
and effects of
anemia
? Identify signs of
12
anemia in a
patient
? List tests to be
ordered to
diagnose anemia
and interpret the
test results.
7
Polycythemia
? Define what is Polycythemia
? Classification of
? Discuss the
? With medicine
? Explain what is Polycythemia rubra
Polycythemia and its
principles of
1 Hour
departments to
vera
causes
treating
enable a student
? Discuss causes for secondary
Polycythaemia
to discuss
polycythemia
causes and
? Explain what is relative polycythemia
effects of
? Discuss the effects of polycythemia
polycythaemia
8
Platelet
? Describe the formation, structure, life
? Details of the various
? Thrombocytopenic
? With medicine
span & removal of platelets
granules in platelets
Purpura
departments to
? State the normal platelet count
1 Hour
see patients with
? Describe the functions of platelets.
thrombocytopeni
? Discuss the causes and effects of
a and enable a
thrombocytopenia
student to
? Discuss causes
and effects of
thrombo
cytopenia
9
Hemostasis
? Describe the processes involved in
? Explain various causes
? Explain
With Medicine
hemostasis such as:
for abnormal hemostasis
Arachidonic acid
Department to see
?
vasoconstriction
? Perform and interpret
metabolism - COX
patients with
?
Platelet plug formation
simple
tests
of
pathway (and
abnormal
?
Clotting or coagulation
hemostasis like bleeding
lipooxygenase for
2 Hour
hemostasis and
pathways
time by Duke's method
completion)
Theory
enable the students
?
Clot retraction
and clotting time by ? Explain the role of
to discuss causes
? Describe anticlotting and fibrinolytic
capillary method of
Prostaglandins (and
and effects of
mechanisms in the body
Wright on oneself.
leukotrienes)
abnormal
? List anticoagulants and their
? Explain and Interpret
? Discuss the role of
hemostasis
mechanism of action
tests such as platelet
Thrombolysis in
3 Hours
? Explain various causes for abnormal
count, Prothrombin
therapeutics
Practical
hemostasis
Time, Activated Partial
? Explain
? List the clotting factors and Explain
Thromboplastin Time
Disseminated
13
the pathways of coagulation
and clotting factor
Intravascular
? Explain various causes for abnormal
assays.
Coagulation
hemostasis
? Discuss the use of anti-
? Explain reason for
? Perform and interpret simple tests of
platelet agents in
thrombosis and
hemostasis like bleeding time by
therapeutics
embolism in
Duke's method and clotting time by
atherosclerotic
capillary method of Wright on oneself
vascular disease and
by collecting blood using finger prick
venous stasis
method using aseptic method
? Explain Lee and White's method for
determining clotting time
10
Blood groups ? Describe the importance of blood
? Discuss the minor blood ? Bombay Blood
? Visit to Blood
& Blood
groups
group systems.
Group
Bank Storage
banking
? Explain the genetic determination of
? Perform and interpret
1 Hour
and Cross
blood groups
blood grouping/typing on
Theory
matching
? Describe the ABO system of blood
oneself by collecting
grouping
blood using finger prick
? With clinical
? State the frequency of different blood
method under aseptic
pathology for a
groups
conditions (or on a
visit to the blood
? Describe the Rh system of blood
provided blood sample)
3 Hours
bank to observe
grouping
? Explain the process and
Practical
and discuss
? Explain the mechanism and
interpretation of blood
procedures done
consequence of ABO and Rh
cross match
to separate
incompatibility
components of
? Explain the condition Erythroblastosis
blood for clinical
Fetalis, state preventive measure and
use and
treatment option for the same.
procedures done
in the blood bank
for safe blood
transfusion.
? Teaching may be
integrated with
clinical
pathology to
discuss
transfusion
reaction
14
11
WBC
? State the normal Total and
? Make a peripheral blood
? Monocyte
? With medicine -
macropha
altered total and
and state t
Differential count
smear on their own blood
ge system
? Classify types of WBC as
/ provided blood
heir
2 Hours
differential
granulocytes, agranulocytes
? Perform and interpret the
function
theory
counts
? Describe the morphology and
differential leucocyte
? Brief
functions of neutrophils, eosinophils,
count using aseptic
introduction to
basophils, mast cells; Lymphocytes ,
precautions
hematological
monocytes.
6 Hours
malignancies
? Perform and interpret total leucocyte
Practical ? Bone marrow
on their own blood / provided blood
transplantation
using aseptic precautions
? List Conditions in which total
leucocyte counts is increased or
decreased.
? List conditions in which counts of
each type of WBC are increased or
decreased
? Describe the various cells that
constitute the monocyte- macrophage
system and state their function
12
Leucopoiesis
? Outline the process of maturation
of white blood cells
1 Hour
13
Immunity
? Classify immunity and state the
? Classify
? Name important
? To integrate with
differences between innate and
immunoglobulins and
cytokines.
medicine to
acquired immunity
state their functions
? State their source
5 Hours
discuss and
? Discuss the cells and mechanisms
? Explain primary and
and functions
observe patients
involved in innate
secondary immune
with
? immunity
response
? Auto Immune
Immunodeficien
? Name the lymphoid organs in the
? Illustrate the role of
Disease
cy syndromes,
body and outline the development of
Complement system in
Immunodeficiency
? Autoimmune
T and B cells
immunity
Syndrome
diseases
? Classify acquired immunity and
? Organ transplant
? To integrate with
mention the cells involved in
and
dermatology to
acquired immunity
? Immunosuppresio
discuss and
? Describe the cells and mechanisms
n
observe patients
involved in cell mediated immunity
with
? Describe the cells and mechanisms
? Allergy and
15
involved in humoral immunity
Hypersensitivity
? To integrate with
nephrology to
discuss immune
response related
to
? Organ
Transplantation
and
immunosuppress
ive therapy
14
Lymph
? Describe the formation and
Discuss the
? Integrate with
composition of lymph
pathophysiology of
surgery to
? Illustrate the lymphatic circulation.
lymphedema
1 Hour
discuss and
? Discuss functions of lymph.
observe patients
with
lymphedema
(filariasis, Ca
Breast with
upper arm
edema)
16
Autonomic nervous system (Lecture 2 Hours)
No
Topic
SPECIFIC LEARNING OBJECTIVES
TEACH
ING
CLINICAL
HOURS
INTEGRATION
MUST KNOW
DESIRE TO KNOW
NICE TO KNOW
1
Organization ? Sympathetic and
? B type nerve fibres
parasympathetic divisions
? Unmyelinated C fibres
? Pre-ganglionic neuron
? Post-ganglionic neuron
2
Sympathetic
? Thoraco-lumbar outflow
division
? Ganglia close to vertebral
column
? Post ganglionic neurons longer
? travel along vessels to reach
viscera
? Adrenal medullary cells are
neuroendocrine cells
3
Parasympath ? Cranio-sacral outflow
etic division
? Supply to organs in head -
through oculomotor, facial
and glossopharyngeal
2 Hours
nerves
? Supply to thoracic and
upper abdominal viscera-
through the vagus
? Supply to lower abdominal
and Pelvic viscera- through
S2, S3 and S4 sacral nerves
? Ganglia are within or close
to the organ of supply
? post-ganglionic neurons are
short
4
Chemical
? Acetylcholine - all pre-
? Acetylcholine has shorter
transmission
ganglionic neurons, post-
duration of action due to the
ganglionic parasympathetic
degradation by
neurons, sympathetic post-
acetylcholinesterase
ganglionic neurons that
? Nor-epinephrine has a
17
innervate sweat glands,
longer duration of action
? All other sympathetic post-
Otto Loewi's experiment
ganglionic neurons secrete
nor-epinephrine
5
Acetylcholine ? Removal by
? Muscrarinic blocker ?
acetylcholinesterase
atropine
? Receptors
? Ganglion blocker -
? Muscarinic receptors -
hexamethonium
distribution and difference
in action through these
receptors
? Nicotinic receptors ?
distribution
6
Catechol
? Receptors
? phechromocytoma
amines
? alpha 1 ? vasoconstriction ? Vanillyl mandelic acid
? alpha 2
? Nor-epinephrine has greater
? beta 1 increases heart rate
affinity for alpha receptors
? beta 2 ? bronchodilation
and epinephrine has greater
? beta 3
affinity for beta receptors
7
General
? Sympathetics - fight or flight ? Wal?ter Cannon
functions
respons
? Walter Cannon
8
Eye
? Parasympathetic ?
Accommodation, miosis
?
? Sympatheti cac-cm
omydmrioadsaistion, miosis
- mydriasis
9
Heart
? SA node
? Parasympathetic - decreases
heart rate ? muscarinic
receptor
? Sympathetic - Increases
heart rate - beta 1 receptors
? Atria & Ventricle
? Parasympathetic - decreases
18
force of contraction
? Sympathetic - increases
force of contraction - beta 1
& 2 receptors
? AV node and Purkinje fibers
? Parasympathetic - decreases
conduction velocity
? Sympathetic - increases
conduction velocity - beta 1
& 2 receptors
10
Lungs
? Parasympathetic ?
bronchoconstriction
? Sympathetic -Dilation -
beta 2
11
Vessels
? Arterioles
? Sympathetic -
vasoconstriction - 1 & 2
? Veins
? Sympathetic - constriction -
1 & 2
12
Stomach and Parasympathetic
Intestine
o Increases motility &
secretion
o Relaxes sphincters
o Decreases motility &
secretion
o Contracts sphincters
13
Gall Bladder ? Parasympathetic ?
contraction
? Sympathetic ? relaxation
14
Urinary
? Detrusor
Bladder
? Parasympathetic ?
contraction
? Sympathetic ? relaxation
19
?
\
Sphincter
? Parasympathetic ?
relaxation
? Sympathetic ? contraction
15
Male Organ
? Erection ? parasympathetic
?
?
Sympathetic
16
Skin
? Pilomotor - Sympathetic ?
contraction
? Sweat glands
? Parasympathetic -
generalized dilute secretion
17
Liver
? Sympathetic -
glycogenolysis
18
Pancreas
? Exocrine
? Endocrine
? Parasympathetic increases
? Sympathetic - decreases
secretion
? Sympathetic ?decreases
19
Salivary
? Parasympathetic - profuse
Gland
watery secretion
? Sympathetic - thick viscous
secretion rich in enzyme
20
Lacrimal
? Parasympathetic ? secretion
Gland
21
Adipose
? Sympathetic - lipolysis
Tissue
22
Drugs
? Atropine, Neostigmine,
physostigmine
? Propranalol, Salbutamol
? Isoprenalin, dopamine
23
Higher
? Hypothalamus, Medulla ?
? Head ganglion -
Control
RVLM
Sherrington
20
Muscle (Lectures + Tutorials 15 hours; Practicals + OSPE 5 hours; ECE: 3 hours)
SPECIFIC LEARNING OBJECTIVES
No
Topic
TEACHIN
CLINICAL
G HOURS INTEGRATION
MUST KNOW
DESIRE TO KNOW
NICE TO KNOW
1
Skeletal
? Describe and draw the structure of
? Describe the functions of
? Role of Dystrophin
? Muscular
Muscle
sarcomere marking actin filament,
other structural proteins
in muscle
dystrophy
Morphology
myosin filament, I band, A band, H
like Titin, Desmin etc
Dystrophies
2 Hours
(Neurology/P
band, Z line and sarcomere
MR)
? Describe the functions of contractile
and regulatory proteins involved in
muscle contraction
? Draw and describe the structure of the
sarco-tubular system
2
Neuromuscul
? Draw and Describe the structure of ? Pseudocholinesterase
? Neuromuscular
Succinyl choline
ar junction
the neuromuscular junction
Lambert-Eaton
Blockers
and
? Describe the events involved in
Syndrome
2 Hours
depolarization
neuromuscular transmission
? Organophosphorus
block ?
? Describe the pathophysiology of
poisoning
(Anaesthesia)
diseases affecting the neuromuscular ? EMG.
Therapeutic use
junction like myasthenia gravis
of Botox
? Describe the mechanism of action
Myesthenia
cholinesterase inhibitors
Gravis ?
? Motor Unit
(Neurology)
Organophosphor
us Poisoning
(Medicine)
Factors affecting force of
3
Muscle
? Describe the molecular Basis of
contraction:
pre
after load, b
? Types of Muscle
effect.
load,
Contraction
muscle contraction
eneficial
, events involved
fibres
Rigor Mortis
in excitation contraction coupling.
? Energy sources in
(Forensic
? Explain the types of Muscle ? Describe the
muscle
2 Hours Medicine)
contraction
physiological basis of the
length-tension
? Denervation
? Describe the sliding filament theory
hypersensitivity
of muscle contraction
? Describe the
21
? Role of ATP and calcium pumps in
relationship.
concept of oxygen
the mechanism of relaxation of the
debt
muscle
? Describe the Factors affecting the
force of contraction
4
Smooth
? Structure,
distribution,
types, ? Comparison between
Muscle
molecular mechanism of contraction
smooth, skeletal and
1 Hour
cardiac muscle
5
Factors
? List the various factors that modulate ?
modulating
smooth muscle contraction like
Cystometrogram
smooth
stretch, sympathetic nerveous system,
1 Hour
(PMR, Urology)
muscle
circulating substances etc.
contraction
And
? Describe the special properties of
Properties
smooth muscle like latch-bridge
mechanism and plasticity
22
Gastrointestinal System (Lectures + Tutorials 15 hours; Practicals + OSPE 12 hours; ECE: 3 hours)
SPECIFIC LEARNING OBJECTIVES
TEACH
NO
TOPIC
ING
CLINICAL
HOURS
INTEGRATION
MUST KNOW
DESIRE TO KNOW
NICE TO KNOW
1
Salivary
? Name the Salivary Glands
? Deficient salivation ?
? Formation of saliva
Gland
? Functions of saliva.
Xerostomia
Composition of
1 Hour
? Describe the regulation of salivary
saliva
secretion
2
Enteric
? State the location and components of ? Explain the physiological
nervous
the enteric nervous system.
basis of Congenital
system
? Explain the functions of the Myenteric
Megacolon
1 Hour
plexus and Meissner's plexus
? Explain the effect of the autonomic
nervous system on the enteric nervous
system
3
Mouth and
? Explain the process of mastication
? Achalasia Cardia
? Gastro-esophageal
Reflux esophagitis
oesophagus
? Outline the process of Deglutition.
reflux disease
1 Hour
(Medicine)
? State the importance of lower
(GERD)
oesophageal sphincter
4
Gastric
? Describe the composition and functions ? State an example of ? Gastric Function
secretion
of gastric secretion
proton pump inhibitor
Tests
APD Cases shown
? Describe the mechanism of gastric acid
and histamine receptor ? Role of H.Pylori in
in Medicne
secretion
blocker
peptic ulcers
Department
? State the role of chief cells and parietal ? Explain the reason for
cells
Pernicious anemia
2 Hours
? Describe the different phases of gastric ? Physiological basis for
secretion
the use of proton pump
? Discuss regulation of gastric secretion
blockers and histamine
? Explain the importance of mucus-
receptor blockers for
bicarbonate barrier
peptic ulcers
? Explain the cause of acid peptic disease
5
Liver and
? Explain the portal system
? Explain the
? Explain the
Integrated teaching
gall bladder
? Describe the functions of liver
pathophysiology of
consequences of
with Anatomy to
23
(Horizontal
? Describe the composition and functions
? Portal Hypertension
liver Failure
understand the
Integration)
of Bile
? Ascites
functional Anatomy
? Explain Micelle formation and its
? Gall Stone
1 Hour
of Liver
functions
? Jaundice
With Biochemistry
? Explain what is emulsification of fat
to discuss LFT
? Explain the process of Entero-hepatic
With Medicine ?
circulation
Liver Failure
With Surgery ?
Jaundice
6
Gall Bladder ? State the factors regulating bile
? State the composition of
? State what is ERCP
Integrated with
secretion
gall stones and factors
and when it is
Surgery to discuss
? Explain the function of Gall Bladder
involved in the formation
performed
1 Hour
about Gall Stones
? Explain how concentration of Bile
of gall stones
? State what is
Cholecystectomy
and what are the
indication of the
same
7
Pancreatic
? List the Enzymes present in pancreatic
? Reason for the alkaline
? what is pancreatitis
secretion
juice and explain their functions
pH of pancreatic
? Explain
? Explain the regulation of secretion the
secretion and its
Steatorrhoea
role of enterokinase
importance
1 Hour
8
Small
? Explain the functional anatomy of the
? Enterokinase
? Cholera
Intestine
small intestine
Malabsorption syndrome
? Discuss the secretions of small intestine
and their functions
1 Hour
? Describe how small intestinal secretion
regulated
9
Gastric
? Explain the process of mixing of food
? Explain the
? Dumping syndrome
Motility
in the stomach
Chemoreceptor trigger
? Explain the factors influencing gastric
zone
motility and gastric emptying
? Discuss the role of
1 Hour
? Describe the mechanism of vomiting
Anti-emetics
10 Movements
? Describe peristalsis
? State what is basic
? Define paralytic
of small
? Explain the stimuli and factors which
electrical rhythm of the
ileus
intestine
influence peristalsis
gastrointestinal tract and
? Describe `segmentation contractions'
it's role
1 Hour
24
and `mixing contractions' and their
functions
? Explain what is Migrating Motor
Complex
11 Large
? Explain the functions of large intestine ? State the importance of ? Pathophysiology of
intestine &
and formation of faeces
dietary fibre
Hirschprung's
Movements
?
? Constipation
Disease
1 Hour
of Large
What is segmentation and mixing
Intestine
contractions of large intestine
? What is Gastro colic
? Explain Defecation Reflex
reflex
12 Digestion and ? Digestion
and
Absorption
of ? Glucose Transporters
? Lactose Intolerance
Absorption
carbohydrates
? Fat soluble vitamins
? Digestion and Absorption of proteins
? Function of short chain
? Digestion and Absorption of fat
fatty acids
1 Hour
13 Iron
? Absorption of Iron
? Transferrin, Ferritin
Absorption
? Hemosiderin
? Hemosiderosis
14 GI Hormones ? Source of Hormones
? Functions and regulation of secretion of
1 Hour
Gastrin, Cholecystokinin and Secretin
15 Water
? Physiological basis of treatment of Cholera ? Increased
Movement in
Diarrhoea
chloride and water
Intestine
secretion
25
Endocrinology (Lectures + Tutorials 30 hours; Practicals + OSPE 15 hours; ECE: 3 hours)
SPECIFIC LEARNING OBJECTIVE
TEACHIN
CLINICAL
NO
TOPIC
G HOURS
INTEGRATION
MUST KNOW
DESIRE TO KNOW
NICE TO KNOW
1
Introduction to ? Define Hormone
? Describe the
? Hormone
Endocrinology ? Classify and list the hormones based on
mechanism of action of
measurement
chemical nature
hormones including the ? Radioimmuno
2 Hours
? Mechanism of negative and positive
receptors and second
Aassay
feedback regulation of hormone release
messengers
? ELISA
2
Hypothalamus ? Describe the relationship between
hypothalamus and pituitary including
the Hypothalamohypophyseal tract and
1 Hour
the hypothalamohypophyseal portal
circulation
? List the various releasing and inhibiting
hormones released by the
hypothalamus
3
Pituitary
? List the various types of secretary cells
? Describe the
? Plasma Levels,
Clinical cases of
Gland
of Anterior and Posterior Pituitary
physiological basis and ? Plasma Protein
Hyper and Hypo
? List the Hormones secreted by the
importanrt features of
Binding, and
secretion can be
anterior and posterior pituitary.
abnormalities of
Metabolism
demonstrated
Growth hormone:
growth hormone
? List the important actions of growth
secretion like -
? Prolactinoma
Pituitary tumours
hormone, its effects on growth and
Gigantism, acromegaly
2 Hours
case with
metabolism
and pituitary dwarfism
symptoms can be
? Describe the regulation of growth
? Describe the
shown
hormone secretion
mechanism of action of
? List important stimuli that increases or
Growth hormone
decreases the secretion of GH
(JAK-STAT Pathway)
? Prolactin:
? Explain howInsulin
? Describe the actions and regulation of
like growth factor
prolactin secretion
(IGF) or Somatomedin
? List the features of excess Prolactin
mediates the actions of
secretion
growth hormone
26
? Antidiuretic hormone (ADH)
? Explain the synthesis, release and
? Syndrome of
mechanism, functions and regulation of
inappropriate
actions of ADH
hypersecretion of
1 Hour
? Discuss the disorders of ADH secretion
antidiuretic hormone
- Diabetes Insipidus
(SIADH)
? Oxytocin
Role of Oxytocin in
? Explain the synthesis, release
labour and post
mechanism, functions and regulation
partum
of Oxytocin\List the functions of
haemorrhage
Oxytocin
? Types of Diabetes
(Obstetrics)
? Role in milk ejection reflex and
Insipidus
parturition
? Panhypopituitarism
? Shehan's Syndrome
? Postpartum Pituitary
Necrosis
4
Thyroid Gland ? Explain the functional Anatomy of
? Explain the
? Describe the
Cases of Hypo and
(Horizontal
Thyroid Gland
physiological basis for
important thyroid
Hyperthyroidism
and Vertical
? List the steps involved in the synthesis
Simple Goitre
function tests and its
can be shown
Integration)
of thyroid hormones
? List the differences
clinical use
? Explain the mechanism of release of
between dwarfism and
Thyroid Hormone
cretinism
? Explain the transport actions of thyroid
hormone
3 Hours
? Describe the regulation of thyroid
hormone secretion
? List the causes and features of Hypo
secretion of thyroid hormones -
Myxedema and Cretinism, Goitre and
features of Hypothyroidism
? List the causes and features
Hypersecretion of thyroid hormones ?
Gigantism and Acromegaly
? Calcitonin
? Secretion and action of Calcitonin
27
5
Parathyroid
? Parathormone
? List the different types ? List the causes of
Case of Tetany can
Gland
? Discuss the actions of parathyroid
of cells present in the
secondary
be shown
hormone
Parathyroid Gland
hyperparathyroidism
? Describe the causes and features of
? Describe the secretion
? Recognize its
2 Hours
hyper/hypoparathyroidism
of parathyroid hormone
emerging role as an
? Descibe Calcium Homeostasis
? Explain he regulation
immunomodulator.
? Vitamin D (Calcitriol)
of secretion of
? Mention the sources, synthesis
parathyroid hormone
mechanism of action and
? Differences between
? List the features of vitamin D
Tetanus and Tetany
deficiency in children and in adults ?
Cases of Rickets
Rickets and Osteomalacia
and Osteomalacia
?
can be shown
Calcitonin
? Actions of calcitonin
6
Adrenal Gland ? List the hormones secreted by the
? Disorders produced by ? Discuss the causes of
Indications for
different layers of Adrenal Cortex
the deficiency of
? Cushing's
steroid therapy,
? Describe the Functional Anatomy of
enzymes involved in
Syndrome
adverse effects 0f
Adrenal Cortex
adrenocortical hormone
? Adrenal Tumour
steroid therapy and
? Describe the mechanism of action,
synthesis
? Adrenal
tapering of steroid
functions and regulation of action of
? Diseases related to
Hyperplasia,
therapy( Integration
Mineralocorticoids, Glucocorticoids
Mineralococorticoids
? Secondary
3 Hours
with Medicine)
and sex steroids
? Conn's Syndrome
Hyperaldosteroni
? Discuss the causes and features of
? Aldosterone Escape
sm
Cases of Cushing's
Cushing's Syndrome and Addison's
? Atrial Natriuretric
Disease and
Disease
Peptide (ANP)
Addison's Disease
? Adrenal medulla:
ca be shown
? Synthesis and physiological effects of
epinephrine and norepinephrine on
various systems of the body
1 Hour
Medical uses of
?
?
Factors that regulate the secretion of
List the features of
adrenaline and
adrenal medullary hormones
Phaeochromocytoma
dopamine
7
Endocrine
? Name the different cells present in the
? Describe the steps in
? Compare and contrast
Glucose tolerance
Pancreas
Islets of Langerhans
biosynthesis of Insulin
Type I and Type II
test and role of
? Physiological stimulus for Insulin
and the origin of the C
Diabetes Mellitus and
HbA1C
peptide (Connecting
their complications
(Biochemistry)
peptide)
secretion
? List the target cells of Insulin and the
? Mention the clinical
cells that do not require insulin action
? Diabetes Mellitus:
feature of Diabetes
2 Hours
Mechanism of
Mellitus
action of insulin
28
for glucose uptake
? Discuss the
? List the features of
and oral
? Mention the mechanism of action of
Pathophysiology of
hypoglycemia and the
hypoglycemic
Insulin on its receptor
Diabetes mellitus
counter regulatory
agents
? List the important actions of insulin
? List the hormones that
hormones
(pharmacology)
? List the various factors that regulate
raise blood sugar level
? Diabetic Ketoacidosis
insulin secretion
Diabetic
? Describe the features of hypersecretion
ketoacidosis and
of Insulin and Hypoglycemia
1 Hour
principles of
? Glucagon
treatment of
? List the important actions of glucagon
Diabetes Mellitus
(medicine)
8
Other
? Pineal gland
Endocrine
? Mention the role of hypothalamus and
Glands
melatonin on circadian rhythm
? Thymus
? Local Hormones
1 Hour
9
Atrial
? List the important actions of ANP
Natriuretic
Peptide (ANP)
31
Reproductive Physiology (Lectures + Tutorials 20 hours; Practicals + OSPE 5 hours; ECE: 3 hours)
CLINICAL
SPECIFIC LEARNING OBJECTIVE
TEACHING
HOURS
INTEGRATION
NO
TOPIC
MUST KNOW
DESIRE TO KNOW
NICE TO KNOW
1
Sex
? Differentiate between Genetic
? Discuss the role of
? Describe the cause and
Determination
sex, Gonadal sex and
dihydrotestosterone in
features of abnormalities
phenotypic sex.
the development of
of sex differentiation
? Describe the role of SRY gene
external genitalia
? (Klinefelter's syndrome
and testis determining factor in
? Turner's syndrome
development of gonads
? XXX superfemale
1 HOUR
? Describe the role of testosterone
? Female ? Pseudo
and Mullerian inhibiting
substance in the development of
hermaphroiditisim
male and female internal
? Male ? Pseudo
genitalia
hermaphroiditisim ?
androgen resistance)
2
Male
? Describe the functional anatomy of ? Outline the steps
?
Reproductive
the male reproductive tract (Testis
involved
Physiology
seminiferous tubules, Sertoli cells,
in spermatogenesis
Leydig cells, Blood Testis barrier, ? State the composition
Epididymis, Vas deferens, Seminal
of semen and
vesicle, Prostate gland).
recognize use of
? Describe the blood- testis barrier and
semen analysis as a
its function
test to evaluate
? Discuss
factors
that
infertility
regulate Spermatogenesis
? Discuss about
? Describe the structure of spermatozoa
abnormalities of the
? Describe the source, mechanism of
male reproductive
action and functions of testosterone
system:
and dihydrotestosterone
? Hypogonadism
? State the source and functions of
? Cryptorchidism
inhibin
32
? Discuss the hypothalamic and
?
?
pituitary control on testicular
function and Feed back control of
testicular
hormones
on
hypothalamus and pituitary
? Describe the role of prostate, seminal
vesicles in reproductive function
? Describe the mechanisms that
cause erection and ejaculation
? State what is capacitation and
discuss the changes that occur
during capacitation
3
Puberty
? Describe the mechanism of action
? Discuss causes of
? Discuss the problems
functions and regulation of
precocious and
associated with
Menopause
secretion of pituitary gonadotropins
delayed puberty
Menopause
1 Hour
and prolactin
Pituitary
1Hour
Gonadotropins ? Explain the changes that occur
(FSH,LH) and
during puberty and describe the
Prolactin
mechanism of onset of puberty
? Define menopause and describe
the physiological changes
during menopause
33
4 Female
? Describe the Functional anatomy of ? Differences
Define:
? Investigatio
reproductive
the female reproductive system
between
? Menorrhagia,
n for male
system
? Outline the stages of Oogenesis
oogenesis and
? Dysmenorrhea,
and female
? State differences between
spermatogenes
? Amenorrhea, and
infertility
oogenesis and spermatogenesis
is
? Premenstrual
?
? Describe the development of
? Discuss the
syndrome
ovarian follicles (Stages of follicle
physiological basis ? Discuss role of
development, ovulation,
of use of synthetic
selective estrogen
luteinisation, luteal regression )
estrogens and
receptor modulators
? Describe the control of follicular
progestins as oral
? List important causes of
development, ovulation and
contraceptives
male and female
luteinisation (role of FSH,
? Describe the
infertility
estrogen and LH)
mechanism of
? Assisted Reproductive
? Describe the process of
ovulation
Techniques (IVF)
follicle attrition
? State the
? Abnormalities
3 Hours
? List the hormones produced by
tests for
leading to infertility
the ovary
ovulation
? Assisted
? Illustrate the synergistic role of
and their
Reproductive
thecal and granulosa cells in
physiological
Technics (IVF)
steroidogenesis
basis
(Gynaecology)
? Discuss the mechanism of action
? Common causes
and functions of estrogen and
of anovulatory
progesterone
cycles
? Describe the feedback regulation
(physiological,
of ovarian function
PCOD)
? Describe the physiological
? Protein hormones
changes occurring in ovaries,
produced by the
uterus, cervix , vagina and breast
ovary and state
during a menstrual cycle
their source and
? Discuss and illustrate the
functions
hormonal changes during the
? Identify common
menstrual cycle (changes in FSH,
causes of
LH, estrogen and progesterone)
anovulatory cycles
(physiological,
PCOD)
34
7 Physiology of
? Outline the process of
? Physiological basis
1Hour
?
Pregnancy
fertilization, implantation and
of immunological
placental formation
tests for pregnancy
? Discuss the importance of
based on hCG
corpus luteum of pregnancy
? Parturition
? Discuss the functions of placenta.
? Source and
? Discuss the secretion and function
functions of
of hCG from the placenta.
relaxin
? Describe the role of hormonal
? Describe the
and mechanical factors influencing
fetoplacental unit
labor
? Describe the changes that occur in
the various organ systems in the
mother during pregnancy
8 Lactation
? Describe the Role of estrogen
? Role prolactin
? Gynacomastia
?
and progesterone in breast
inhibitory factor
? Composition of
1Hour
development
(Dopamine) in
human milk
? Describe the mechanism that
lactation
? Prolactinomas
causes initiation of lactation
? Discuss the
? Role of
after delivery
effect of
bromocriptine in prevention
? Describe the role of Prolactin and
lactation on
of lactation
prolactin inhibitory factor
menstrual cycle
(Dopamine) in lactation
? Describe the Milk ejection reflex
9.
Contraception ? Classify contraceptive methods
? Details of
?
1 Hour
contraceptive
? Describe the physiological basis of
contraceptives
devices and
the various methods of
devices, side
procedures
contraception
effects
(Gynaecology)
35
Excretory system (Lectures + Tutorials 25 hours; Practicals + OSPE 10 hours; ECE: 3 hours)
NO
TOPIC
SPECIFIC LEARNING OBJECTIVE
TEACH
CLINICAL
ING
INTEGRATION
HOURS
MUST KNOW
DESIRE TO KNOW
NICE TO KNOW
1
Functional
? Describe the gross Anatomy of Kidney
Histology of
Anatomy of
1 Hour
Kidney (Anatomy)
Kidney
?
Structure of
Describe the structure of the cortical and
Nephron
Juxtamedullary nephrons
? Describe the salient features of Renal
circulation
? Describe the structure of the
juxtaglomerular apparatus.
2
Glomerular
? Describe the structure of glomerular
? Concept of Renal
? Proteinuria/
filtration and
capillary membrane and the factors
Clearance
Albuminuria /
renal blood flow
affecting glomerular filtration
? Inulin Clearance ? to
Hemoglobinuria
? Measurement of GFR
measure GFR
? Renal Blood Flow
? PAH clearance to measure
? Discuss the factors determining and
RBF
regulating renal blood flow and the
? Creatinine Clearance to
2 Hours
mechanisms of autoregulation of renal
assess GFR
blood flow
? Explain Tubulo-glomerular feed back
? Juxtaglomerular Apparatus
? Explain the structure of
Juxtaglomerular Apparatus
Discuss the role of Juxtaglomerular
Apparatus in Autoregulation of GFR and
RBF (TG Feedback) and the regulation of
blood pressure via the Renin-AT-
Aldosterone axis.
3
Proximal
? Describe the reabsorption of sodium,
? The concept of the
Convoluted
chloride and water in the proximal
transport maximum for
tubules (PCT)
tubule Describe the functioning of the
glucose, renal threshold,
36
important sodium transporters in PCT ?
types of glycosuria
sodium-glucose, sodium-aminoacid co-
(diabetes mellitus, renal,
1 Hour
transporters and sodium-hydrogen
alimentary)
exchanger in the luminal border,
? Describe the action of
sodium-potassium pump in the
parathormone on PCT
basolateral border.
? Describe the mechanism of
glomerulotubular balance
? Discuss the renal handling of glucose,
bicarbonate and amino acids in the PCT
? Recognize the almost complete
reabsorption of glucose, bicarbonate and
amino acids in the PCT
? Describe the role of Carbonic
anhydrase, the sodium-hydrogen
exchanger in luminal border, and the
bicarbonate transporter in basolateral
border in bicarbonate reabsorption in
the PCT
4
Loop of Henle
? Distinguish between permeability
? Mechanism of action of
characteristics of the two limbs of loop
Loop diuretics
of Henle.
(Furosemide) as due to
? Describe the role of the Na/2Cl/K
blockade of Na/2Cl/K
1 Hour
transporter and the sodium potassium
transporter
pump in the thick ascending limb
(TAL)
? Describe the function of the Function
of LOH in the creation of hyperosmolar
medullary interstitium (MI) by the two
mechanisms :
? Active transport of salt in TAL
segment
? Counter current multiplication of
the active transport
? Describe the role of the vasa recta in
maintaining the hyperosmolarity of the
medullary interstitium by counter-
current exchange.
37
5
Distal
? Describe the regulated reabsorption of
? Mechanism of diuretic
? Features of
Convoluted
sodium (aldosterone) via Epithelial
action of thiazide and
hyperaldosteronism
tubules (DCT)
sodium channels (ENaC) and Na/Cl
amiloride
and the occurrence
symporter in luminal border
? Action of Atrial
of metabolic
? Describe the regulated secretion of
Natriuretic peptide.
alkalosis
1 Hour
potassium (aldosterone) via potassium
? `Aldosterone escape'.
channels in luminal border
? Describe the generation of bicarbonate
including factors affecting this.
? Describe the role of the Phosphate and
ammonia as buffers in the formation of
urine
? Describe the action of Atrial Natriuretic
peptide
6
Collecting duct
? Describe the role of ADH in regulated
(CD)
water absorption
? Describe the role of the
hyperosmolarity of the medullary
interstitium, created by the Loop of
Henle in producing a gradient for water
absorption.
1 Hour
? Describe the role of ADH in urea
absorption, abetting the hyperosmolarity
of MI.
? Describe the role of aquaporins in water
absorption.
7
Concentration
? Countercurrent Mechanism
? Bartter's Syndrome
of Urine
? Countercurrent Multiplier
? Countercurrent Exchanger
? Role of Urea
8
Regulation of
? Describe the role of osmoreceptors in
? List common causes and
? Discuss the
osmolarity, Na+
sensing body fluid osmolarity.
effects of hypo and hyper
importance of the
and K+ levels
? Describe the mechanism of sensing
natremia
intracellular shifts
thirst.
? List common causes and
of potassium
1 Hour
? Describe the role of ADH, Aldosterone,
effects of hypo and
? Discuss the use of
Angiotensin II and ANP in sodium and
hyperkalemia
insulin/glucose
water balance.
infusions to treat
38
? Discuss the effect of aldosterone in the
hyperkalemia
renal handling of K+ at DCT
? Discuss the relationship between K+
concentrations and the pH of blood.
9
Regulation of
? Describe the different buffer systems in
? Explain the concept of
? Identify Primary
Acid base
the body
Anion gap
acid base
balance
? Explain the respiratory regulation of
? List common conditions
disturbances i.e.
acid base balance
that can lead to primary
? Respiratory
? Describe the role of the kidney in
acid base disorders.
acidosis,
1 Hour
regulation of acid base balance
? Respiratory
alkalosis
? Metabolic acidosis,
? Metabolic alkalosis
from Arterial blood
gas and serum
electrolyte values
10 Micturition
? Describe the innervation of Bladder and ? Explain the use of a
reflex pathway of micturition.
cystometrogram to
1Hour
?
diagnose urinary problems
11 Renal Function ? List the abnormal constituents in urine
? Concept of Anion gap
? Sigre Anderson
Tests
? Recognize the normal urinary volume
Curve
? Discuss the significance of the presence
1 Hour
of albumin in urine
? Discuss the role of serum creatinine in
the measurement of renal function
39
Respiratory system (Lectures + Tutorials 25 hours; Practicals + OSPE 20 hours; ECE: 6 hours)
SPECIFIC LEARNING OBJECTIVE
TEACHI
CLINICAL
NO
TOPIC
NG
INTEGRATION
HOURS
MUST KNOW
DESIRE TO KNOW
NICE TO KNOW
1
Functional
? Functional Anatomy of the respiratory
Examination of RS
Anatomy
tract
1 Hour
? Functions of nose and para-nasal
Practical
sinuses
? Conducting zone and respiratory zone
? Pulmonary vasculature
? Structure of alveolus & alveolo-
capillary membrane
1 Hour
2
Muscles of
? Muscles of Inspiration and Expiration
Respiration
? Accessory Muscles of respiration
3
Surface
? Surface Tension in air liquid interface
? Respiratory Distress
Tension
? Law of Laplace
Syndrome
Surfactant
? Role of surfactant
4
Mechanics of
?
respiration
State the normal respiratory rate and
define inspiration & expiration
Pulmonary
? List the muscles of inspiration,
Ventilation
expiration & accessory muscles of
respiration
? Describe the movements of chest wall
3 Hours
and the changes in chest wall
dimensions produced by respiratory
muscles
? Recognise the difference between quiet
breathing and forceful breathing
? Discuss the factors affecting
airflow between the atmosphere and
alveoli
? State the recoil nature of Lungs and
40
chest wall
? State the values of intra alveolar
pressure, Intra pleural pressure
? Discuss the changes in alveolar and
intra pleural pressures during
respiration
? Identify the sites of air way resistance
? Indicate changes in airway resistance
with inspiration and expiration
? Explain the action of autonomic
nervous system on bronchial tone
? List histamine as a bronchoconstrictor
? Recognise that airway resistance is
increased in obstructive lung diseases
? Define lung compliance and relate it to
clinical conditions in which it is altered
? State clinical conditions in which work
of breathing is increased
5 Lung Volumes ? Define the lung volumes and capacities; ? List the common causes
? Methods of
and Capacities
state the normal values and discuss their
Pathology & clinical
determining FRC
physiological variations
features of obstructive and
and RV
3 Hours
? Explain the recording of the Spirogram
restrictive lung diseases.
? Artificial ventilation Theory
with a diagram and recognize the
? Asthma
volumes and capacities which cannot be
? COPD
measured by spirometry
? Emphysema
? Record the lung volumes and capacities
? Chronic bronchitis
of a normal subject using a spirometer
? State the physiological
? Discuss the physiological significance
basis of tests to
of the Residual volume & functional
differentiate them.
3 Hours
residual capacity
Practical
? Describe the forced expiratory
For
spirogram and describe FEV1, FVC and
Spirome
the FEV1/FVC ratio and its variations in
-try
obstructive and restrictive lung diseases.
? Define peak expiratory flow & state its
? Recognize the flow-volume
normal value
curves
? Record peak expiratory flow in a
? Methods of determining
FRC and RV
41
normal subject
? Helium dilution method
? Record FEV1, FVC and calculate the
? Whole body
FEV1/FVC ratio in a normal subject
plethysmography
? Interpret altered values of absolute lung
? Measurement of dead space
volumes, peak expiratory flow and
FEV1/FVC ratio in restrictive and
obstructive lung diseases
? Define minute ventilation, anatomical
dead space, physiological dead space &
alveolar ventilation
? Discuss the effect of changes in
respiratory rate and tidal volume on
alveolar ventilation
6
Alveolar
? Total ventilation = Tidal Volume x
? Measurement of Dead
Ventilation
Respiratory Rate
Space
? Dead Space and Classification
1 Hour
? Alveolar Ventilation
? Factors affecting alveolar ventilation
7
Pulmonary
? State the normal rate of pulmonary
Circulation
blood flow & normal range of
pulmonary blood pressures
1 Hour
? Discuss the special features of
pulmonary circulation, pulmonary
veins, pulmonary vascular resistance,
its response to hypoxia
8
Ventilation
? Explain the regional differences in
? Type I respiratory failure
? State the
perfusion Ratio
perfusion, ventilation & V/Q ratio in the
physiological
(V/Q Ratio)
lungs
mechanisms
1 Hour
? State normal values of V/Q ratio and
operating to keep
recognize that physiological dead space
the lungs dry
is associated with high V/Q and
? Pulmonary
`physiological shunt' is associated with
hypertension
low V/Q.
? Pulmonary
embolism
? Cor-pulmonale
9
Gas Exchange
? Discuss the factors that affect rate of
? Define Type I respiratory
gas exchange at lung & tissue level,
failure and state the
with application to clinical conditions
common causes
42
? State Fick's law of diffusion
? Explain Type I respiratory
? Discuss normal composition of
failure due to unequal V/Q
atmospheric, tracheal and alveolar air
distribution even when
and recognize the conditions which can
total ventilation and
1 Hour
affect it
perfusion may be normal
? Discuss the normal partial pressures of
? State the Alveolar gas
gases in blood entering and leaving
equation and discuss its
lung
application
? Explain oxygen uptake and carbon-
? Recognize that arterial
dioxide elimination by lungs & tissues
PCO2 is equal to alveolar
and state the normal rates of the same
PCO2 and that arterial
? Define respiratory exchange ratio and
PCO2 can be used in the
state its normal values
alveolar gas equation
? State normal time taken for gas
? State the causes for
equilibration & its application in
abnormal Alveolar ?
exercise
arterial oxygen difference
? State the physiological causes for
? Distinguish between
normal alveolar-arterial oxygen
intrapulmonary and
difference
extrapulmonary right to
? Explain the dependence of carbon
left shunts.
dioxide elimination on ventilation
? Define physiological shunt
10 Transport of
? State the physiological
? State what pulse
Oxygen
? Explain the forms of oxygen transport
basis of oxygen therapy
oximetry measures
in blood
as treatment for the
? Discuss hemoglobin affinity for
different types of
2 Hours
oxygen
hypoxias
? Explain & illustrate oxygen-
hemoglobin dissociation curve and
discuss the factors affecting it and the
physiological advantages of the curve
? Explain Bohr effect
? Discuss oxygen carrying capacity of
blood
? Differentiate between oxygen content
of blood & % oxygen saturation of
hemoglobin
? Define hypoxemia and hypoxia;
explain the physiological basis of
40
types of hypoxia with examples
? Define cyanosis and differentiate
between conditions in which it occurs
and may not occur
11 Transport of
? Explain the forms of carbon dioxide
Carbon dioxide
transport in blood
1 Hour
? Explain the role of chloride shift and
Haldane effect
12 Regulation of
? Express the concept of the sensors,
? State the normal values of
? State the causes of
Respiration
central controller in brain & effectors in
arterial blood gases (ABG)
respiratory acidosis
the respiratory control system
and interpret altered values
and alkalosis
? Describe the location and functions of
? Define hypercapnoea and
? Define Type II
the respiratory centres in brain; describe
hypocapnoea
respiratory failure
the current explanation for the basic
? State the causes of
and mention its
3Hours
rhythm of respiration
asphysxia
causes
? Describe the effects of neural inputs on
respiration in terms of the voluntary
cortical control, motor cortical input,
limbic input, peripheral afferent inputs
(Hering breuer reflexes, J receptor
input, proprioceptor input, and other
peripheral inputs)
? Express the aim of chemical control of
respiration; explain the role of
peripheral and central chemoreceptors;
explain the feedback control of
ventilation to regulate gas exchange &
maintain normal levels of arterial blood
gases and pH
3 hours
? Discuss and compare the influence of
practicals
arterial carbon dioxide and oxygen on
for expts
ventilation in health and in disease
on
? Describe Cheyne-stokes breathing, state
stethogra-
its causes, explain the physiological and
phy
pathophysiological mechanisms that
produce it; state the abnormality in
Biot's breathing
? Demonstrate the effect of apnoea &
41
hyperventilation on respiration;
demonstrate the effect of breathing
through a tube and the effect of speech
& cough on respiration
13 Physiological
? State the physiological effects of zero
adaptations in
gravity
special
? State the physiological basis of
environments
Caisson's disease & Nitrogen narcosis
1 Hour
(High Altitude, ? State the physiological adaptations
Deep Sea
occurring at high altitude Physiological
Diving and
effects of zero gravity
Gravity)
? Aviation Physiology
14 Exercise
? Describe the effects of exercise on the
respiratory system and explain the
physiological basis of these effects;
1 Hour
explain the physiological need for these
changes
? Define VO2 max and oxygen debt
15 Pulmonary
? Spirometry
Function Tests ? Arterial Blood Gas Analysis
? Peak Flow Meter
1 Hour
? Pulseoxymetry
16 Miscellaneous
? List the Non-Respiratory functions of
lung
? State the physiological mechanism of
1 Hour
cough, sneeze and gag reflexes
17 Clinical
? Demonstrate the methods of Clinical
? Pathology & clinical
examination of
examination of the respiratory system
features of
respiratory
? Recognize normal Clinical findings of
? Pleural effusion
system
respiratory system examination
? Pneumothorax
3 Hours
? State the abnormal findings that may be
? Pneumonia,
Practical
present in a patient and list the common
consolidation
clinical conditions in which these
? Fibrosis
abnormalities occur and the
? Collapse
physiological explanations for these
? Bronchiectasis
abnormalities if any
42
Cardiovascular system (Lectures + Tutorials 35 hours; Practicals + OSPE 20 hours; ECE: 6 hours)
SPECIFIC LEARNING OBJECTIVE
TEACH
CLINICAL
NO
TOPIC
ING
INTEGRATION
HOURS
MUST KNOW
DESIRE TO KNOW
NICE TO KNOW
1 Functional
? Describe the functional anatomy of the
Examination of CVS
anatomy of
heart, with respect to its chambers,
1 Hour
heart
valves, input and output vessels, AV
Practical
ring and electrical discontinuity,
Conducting system, Coronary supply
2
Conducting
? Describe the following:
? Intrinsic rate of the SA
system of Heart ? Contour of SA node action potential
SA Node
node and influence of
with a diagram, depicting the various
autonomic nervous system,
phases (4, 0 and 3)
hormones and temperature.
? Prepotential (phase 4 depolarization)
? Currents responsible for generation
? Sinus arrhythmia, sinus
of SA node action potential: The funny
bradycardia, sinus
current (I
tachycardia
f), T-type calcium current
(ICa
? Record respiration with a
T), L-type calcium current ( ICaL)
?
stethograph or respiration
belt transducer, as well as
ECG or pulse
simultaneously, to
demonstrate respiratory
sinus arrhythmia.
Atrial Cell
? Recognize that AP in atrial cell is
3
similar to ventricular cell (fast AP)
?
Ventricular
? Describe the contour of the ventricular
? Be able to describe the
? Be able to correlate
4
Cell
action potential with the aid of a
mechanisms by which
Starling's law with
diagramDescribe the ionic currents
calcium is extruded from
sarcomere length
responsible for phases 0,1,2,3,4 of the
cytoplasm to terminate
and actin-myosin
ventricular action potential
systole ? the role of the
interaction
? State the differences between the SA
Plasma membrane calcium ? Identify the
node action potential (slow AP) and the
ATPase and sodium-
relationship between
43
ventricular cell action potential (fast
calcium exchanger (NCX)
heart failure and
AP).
sarcomere length
? Describe how the action potential leads
to an increase in cytosolic calcium
concentration
? Describe excitation-contraction
coupling
? State the basic concepts of the sliding
filament theory of contraction
Cells of
? State the type of:
5
conducting
? AV node AP - similar to
pathway
SA nodal cell (slow AP)
? His Bundle cell: fast AP
? Purkinje fibres: fast AP
Properties of
? Automaticity
6
Cardiac Muscle ? Excitability
? Conductivity
? Contractility
7
Cardiac Cycle
? Describe with a diagram, the
? Concept of Murmurs
chronological relationship of the
? Timing of Murmurs
following events shown on the same
? State the timing of
time axis:
murmurs in various
? ECG
valvular and congenital
? Valvular events
heart defects
? Heart sounds
? Cardiac Catheterization
? Pressure curves: Left ventricular
pressure, Atrial pressure and
aortic pressure
? Ventricular Volume curve:
8 Stroke Volume ? Discuss the determinants of stroke
? Recognize
volume
echocardiographiy as a
method of measuring
stroke volume
9 ECG
? Describe the electrocardiogram as a
? List the ECG changes in the ? Heart Block
With medicine for
surface recording of electrical changes
following conditions:
? Ischemia
reading normal and
occurring on the external surface of the
? Myocardial ischemia
? Infarction changes
1Hour
abnormal ECGs
heart during the passage of an action
? Myocardial infarction
Theory
44
potential.
? Hyperkalemia
? Describe the 12 Leads in which ECG is
? Ventricular tachycardia
recorded.
? State the causes for PR
? State the rationale of recording from
prolongation
multiple leads.
? Describe the types of Heart
? Identify the lead which is commonly
block as represented by
used to monitor patients continuously.
ECG changes
1Hour
? Describe the P, QRS, T and U waves of
? Arrhythmias
ECG
an ECG in lead II configuration and
? Vector cardiogram
recordin
describe the electrical events
? Calculation of axis
g to be
responsible for these waves
? His bundle electrogram
shown
? Describe PR and QT intervals and state
what they represent
? Describe the significance of ST segment
being on the isoelectric line in a normal
ECG
? Record an ECG in a human subject in all
12 leads
? Calculate rate from a normal ECG
tracing
? Identify if every QRS complex is
preceded by a P wave and if every P
wave is followed by a QRS complex
? State in what conditions the above will
not happen
10 Properties of
? Describe the function of the sinoatrial
? Understand that there is
cardiac muscle:
node as the pace-maker of the heart
redundancy in pace-maker
1 Hour
? Describe the determinants of heart rate
function ? if the sinus node
and the neural and chemical regulation
fails, there are alternate
Automaticity
of heart rate
sites of rhythm generation
? Describe the ionic currents
? Arrhythmias
responsible for rhythm-generation in
the SA node
Excitability
? Define refractory period, describe its
? Describe refractory period
and
relation to the duration of the ventricular
in terms of properties of
Refractoriness
action potential, and state its
voltage-gated sodium
physiological significance.
channels
? State factors which cause
45
prolongation of action
potential duration
? Define Long QT syndrome
Conductivity
? Describe the normal mode of
? Alternate conducting
conduction of the cardiac impulse
pathways
? Define the causes of
arrhythmias in terms of
abnormal site of rhythm-
generation or re-entry
Contractility
? Describe the determinants of force of
? Discuss Ejection fraction
contraction of the ventricle in terms of
(EF) as a measure of
o Preload (Starling's law)
cardiac contractility
o Afterload
(inotropic status).
o Inotropic status (contractility)
? State the different modes of
o Frequency (or heart rate),
and indications for Cardiac
(Bowditch phenomenon or Force-
catheterization
frequency relation)
? State how
? Discuss the clinically measurable
echocardiography may be
parameters reflecting preload, afterload
used as a non-invasive
and force of contraction of the heart
means to assess cardiac
? Describe Starling curves or ventricular
function
function curves
11 Cardiac
? Definition of Stroke Volume, Cardiac
? Methods of Measuring
? Discuss high output
Output
Index, EDV, ESV, and EF
Cardiac Output
and low output
? Discuss the determinants of cardiac
states
2 Hours
output
? Describe the regulation of cardiac
output
? Discuss high output and low output
states
12 Heart Rate
? Innervation of Heart ? Parasympathetic
and Sympathetic
? Normal Values
1 Hour
? Regulation of Heart Rate
? Factors affecting Heart Rate
13 Vascular
? Describe the function of Aorta and large ? Discuss the role of
? State what would
Physiology
Arteries as elastic, windkessel vessels
capillaries as exchange
happen to pulse
? Describe what would happen to pulse
vessels
volume (as assessed
46
pressure in case of thickening and loss
? Describe the Starling's
by taking the radial
of elasticity of aorta
forces determining fluid
pulse) in case of
? Describe the role of arterioles as
movement across the
thickened arteries
2 Hours
resistance vessels
capillary membrane
? Discuss the
? Describe the term Total Peripheral
? Describe the function of
physiological/pathop
resistance (TPR)
Veins as capacitance
hysiological role of
? Discuss the determinants of TPR and
vessels
the following
the relationship of TPR to blood
? Define the term Venous
vasoactive
pressure and cardiac output.
return (VR) and discuss its
substances:
? Discuss the role of arteriolar resistance
role as preload
Histamine,
as a determinant of blood flow to a
? Describe the determinants
bradykinin,
specific organ
of VR
serotonin,
? Discuss the determinants of arteriolar
? Discuss the significance of
thromboxane A2,
resistance in terms of Poiseulle's
assessing jugular venous
prostacyclin, Endoth
equation
pulse
elin
? Identify that the arteriolar diameter is
? Discuss the interactions
? Describe Venous
the major determinant of arteriolar
between Right atrial
return curves
resistance
pressure, VR and Cardiac
? Describe the
? Discuss the global and local factors
output (CO)
interaction of
affecting arteriolar diameter and
Venous return and
therefore the TPR, blood pressure and
Cardiac output
blood flow ? vasodilator and
curves
vasoconstrictor mechanisms
? Discuss the clinical
? Discuss the physiological role of
significance of
endothelium-derived relaxing factor
monitoring of CVP
(EDRF) or Nitric oxide (NO)
14 Blood Pressure ? Define the following terms:
? Hypertension
? Mean arterial blood pressure, Systolic
? Hypotension
pressure, Diastolic pressure, pulse
pressure
? Describe the determinants of blood
1 Hour
pressure
Theory
? Discuss the short-term (neural and
hormonal) and long term (renal)
mechanisms regulating blood pressure
(with special reference to shock and
exercise).
? Demonstrate the method of
47
measurement of blood pressure using a
sphygmomanometer.
1 Hour
? Describe the principle of measuring
Practical
blood pressure by sphygmomanometry
? Discuss other methods of measuring
blood pressureby sphygmomanometer
15 Cardiovascular ? Describe the physiological role of the
? Define Diving reflex
autonomic
following reflexes, their receptors,
reflexes
specific stimuli, afferent and efferent
neural pathways, and the responses.
1 Hour
? Baroreceptor reflexes
? Chemoreceptor reflexes
? Vasovagal syncope
? Cushing's reflex
? Bainbridge reflex
? Bezold Jarisch reflex
16 Effects of
? Discuss the effects of exercise on the
exercise on
cardiovascular system
1 Hour
cardiovascular ? Demonstrate the effects of mild to
Theory
system
moderate and high intensity exercise on
1 Hour
the blood pressure and heart rate in a
Practical
normal subject
17 Regional
? Features and regulation of the
? Discuss the term Coronary
circulations
following circulations:
artery disease
? Coronary
Define the following terms:
? Cerebral
Transient Ischemic attacks
? Renal circulation - Auto-regulatory
(TIA), Stroke,
mechanisms (myogenic factors and
Cerebrovascular accidents
Tubuloglomerular feedback)
(CVA)
3 Hours
? Pulmonary (its pressures, hypoxic
? List the effects of gravity
vasoconstriction)
and acceleration on CVS
? Splanchnic
? Discuss the physiology of
? Cutaneous circulation and temperature
Fetal circulation before
regulation
and after birth
? Skeletal muscle
? Recognize the importance of
48
sympathetic regulation versus local
metabolic factors in the regulation of
the regional circulations mentioned
above.
18 Hypertension
? State the normal ranges for systolic and
? Discuss the risk factors for
diastolic blood pressures in the various
essential hypertension and
age groups
causes of secondary
? Define hypertension
hypertension
19 Hypotension
?
Describe the term Vasovagal
1 Hour
Define the term `Shock' or
(Shock)
Cardiovascular shock
syncope
? State the different types of shock
? Discuss the pathophysiology of the
following types of shock: Hypovolemic,
cardiogenic, Distributive (septic,
anaphylactic, neurogenic) Obstructive
20 Heart Failure
? Define the term cardiac failure or heart
? State some causes of heart
failure.
failure
? State the clinical features of left heart
? Discuss the physiological
failure and right heart failure.
basis of treatment of heart
? Define the term congestive cardiac
failure
failure
21 Myocardial
? Define the following terms:
infarction or
? Angina
heart attack
? Ischemia
1 Hour
? Myocardial infarction or heart attack
? Discuss the major ECG changes in:
? Myocardial ischemia
? Myocardial infarction
Valvular
? State the causes for
22 diseases
stenosis and regurgitation
of the valves
? State the murmurs
associated with the various
valvular defects
23 Congenital
? State the hemodynamic
heart diseases
abnormalities and murmurs
in ASD, VSD, PDA
49
Central nervous system (Lectures + Tutorials 45 hours; Practicals + OSPE 22 hours; ECE: 6 hours)
SPECIFIC LEARNING OBJECTIVE
TEACHIN
CLINICAL
NO
TOPIC
G HOURS
INTEGRATION
MUST KNOW
DESIRE TO KNOW
NICE TO KNOW
1
Organization
of the nervous
system
o Somatic NS
1 Hour
o Autonomic NS
o Enteric NS
2
Neural Tissue
? State the cell types present in the
nervous system
? Describe the morphology of different
types of neurons and neuroglia
1Hour
? Describe the process of myelination
and its significance
? Differentiate between white matter and
grey matter.
? Define the terms `nuclei' and
`ganglia'.
3
Nerve Fibres
? Define the term `Peripheral nerve'.
? Numerical classification of
With medicine or
? State the types of fibres in a mixed
sensory fibres
neurology to see
peripheral nerve.
? Mechanism of axoplasmic
1 Hour
cases of peripheral
? Describe Ehrlanger & Gasser's
transport
neuropathy
classification of peripheral nerve fibres
?
? Describe nerve injury, degeneration
With anaesthesia to
and regeneration of injured fibres
study mechanisms
of local or regional
aneasthesia
4
Electrical
? Describe the ionic basis of Resting
? `excitatory or inhibitory
? Strength-duration
properties of
membrane potential of a nerve cell.
post-synaptic potentials
curve - Rheobase
the nerve cell
? Describe the term electrotonic
(EPSP and IPSP)' in a
voltage, chronaxie
1 Hour
membrane
potentials with reference to:
post-synaptic neuron
& utilization time
? `receptor or generator potential' in a
? `end-plate potential' at
? Define the concept
sensory receptor
the neuromuscular
of depolarisation
50
? `excitatory or inhibitory post-synaptic
junction
block in terms of the
potentials (EPSP and IPSP)' in a post-
properties of
synaptic neuron
voltage-gated
? `end-plate potential' at the
sodium channels.
neuromuscular junction
? Define the
? Define the term `Action potential' and
mechanism of
describe the currents responsible for the
action of local
different phases of the action potential
anaesthetics.
in the neuron.
? Describe the process of transmission of
action potential in unmyelinated and
myelinated neurons
? Describe the phenomenon of saltatory
conduction in a myelinated neuron.
? List the factors affecting conduction
velocity in a nerve.
5
Synapses
Define the terms electrical & chemical
? Define the following
? Define synaptic
synapse
properties of synapse:
fatigue
Describe the morphological features of a ? One-way conduction
? Define the
chemical synapse ? pre and post synaptic ? Synaptic delay
following synaptic
neurons
? Convergence and
phenomena
List the morphological types of chemical
Divergence of synapses
Occlusion &
synapse ? axosomatic, axodendritic and
? Spatial summation
subliminal fringe
axoaxonic
? Temporal summation
effects
2 Hours
Describe the process of synaptic
? Define the term synaptic
transmission.
plasticity
List the events in the pre-synaptic neuron, ? Describe the differences
culminating in release of neurotransmitter.
between Pre-synaptic and
Describe the events in the post-synaptic
post-synaptic inhibition.
neuron ? Excitatory and inhibitory post-
? Define the term Pre-
synaptic potentials, Summation (spatial
synaptic facilitation
and temporal) of synaptic inputs at the
axon hillock, formation of action
potential.
6
Neurotransmitt ? List the important small molecule
? State whether the action of ? Glutamate-induced
ers
neurotransmitters in the CNS and their
each of the above
excitotoxicity
1 Hour
receptors:
neurotransmitters on the
Organic brain
? Glutamate and its ionotropic
various receptors is
syndromes ?
receptors:
excitatory or inhibitory.
Schizophrenia,
51
NMDA, and non-NMDA
? State the major excitatory
Depression
? GABA
neurotransmitter in the
(Psychiatry)
? Glycine
CNS
? Dopamine
? State the inhibitory
? Serotonin or 5-HT
neurotransmitters of the
? Acetylcholine
CNS.
? Noradrenalin
? State the mechanism of
inhibition.
? Denervation
hypersensitivity
? Criteria for a substance to
be called a
neurotransmitter
Introduction to ? Anatomical parts of CNS
7
CNS
? Functional divisions
8
Sensations
? Classify the types of sensations (sensory ? Describe the common
modalities
attributes of sensory
information ? modality,
1 Hour
location, intensity and
duration
9
Sensory
? Differentiate between usage of the term
? Define rapidly adapting
receptors
`Receptors' i.e., sensory receptors
and slowly adapting
versus neurotransmitter or ligand
receptors
1 Hour
receptors.
? Describe the mechanism
? List the sensory receptor for each
of sensory transduction
modality of sensation
taking a particular receptor
? Touch receptors
as example (e.g., pacinian
? Receptors for proprioception
corpuscle, hair cells of
? Pain and temperature receptors
inner ear, rods and cones,
?
muscle spindle etc)
52
9
Ascending
Ascending sensory pathways
? State the mechanism
sensory
? Sensory Cortex ? Primary sensory
proposed by
pathways
area SI and SII
V.S.Ramachandran
? Sensory Homenculus
to explain the
? Cortical Sensations
phantom limb
? Cortical Plasticity
phenomenon.
3 Hours
Three neuron pathway of sensory
Theory
Pathway for
systems
fine touch
? I order neurons, dorsal root
? Medial to lateral
(Posterior
ganglia, Fasciculi gracilis and
arrangement of fibres in
Column)
cuneatus in posterior column and
posterior column
termination in medulla
? Lateral to medial
? II order neurons (cross over) :
arrangement of fibres in
Medial lemniscus from medulla to
spinothalamic tract
contralateral thalamus
? III order neurons:
1Practical
Thalamocortical neurons
session
? Cortical termination of pathway:
(3 hrs for
Post-central gyrus.
examinatio
? Sensory Cortex-Primary sensory
n of the
area SI & SII
sensory
system)
Pathway for
proprioception Important receptors for Proprioception
(other than touch and pressure
(Dorsal and
receptors):
Ventral
? Muscle spindle (muscle length
Spinocerebellar
detectors)
Tract)
? Golgi tendon organ
? Joint receptors (Pacinian
corpuscles)
? Fate of proprioceptive input:
? Posterior column pathway ? same
as fine touch
? Spinocerebellar tracts ? dorsal
and ventral; Clarkes column
? Spinal reflex arcs ? stretch and
53
Pathway for
inverse stretch reflex arcs
crude touch
Receptors for crude touch, pain and
(Anterior
temperature : Mechanoreceptors,
Spinothalamic
Nociceptors and Thermoreceptors
tract)
Major pain pathway:
Pain and
? I order neurons ? end in spinal
Temperature
cord; Lissauer's tract; substantia
(Lateral
gelatinosa
Spinothalamic
? Fast pain through A fibres and
Tract)
slow pain through C fibres
? II order neurons cross over ?
forming lateral spinothalamic
tract
? III order neurons ?
Sensations
thalamocortical, end in Post-
from face
central gyrus.
? Pathway for sensations from face
Physiology of
Briefly describe receptors for pain.
? Describe the gate control
? List a few opiates
Pain
? Describe the pathway for transmission
theory of pain
used to treat pain.
of pain from receptors to the cortex.
? Discuss the principle of
? Define the following terms: Substantia
using pain balms and
gelatinosa, Lissauer's tract, fast pain,
Acupuncture for pain
slow pain.
relief.
? State the type of peripheral nerve fibres
? List the endogenous
2 Hours
carrying fast pain and slow pain
opioids and the types of
respectively.
Opiate receptors.
? Describe the following phenomena:
? Describe the role of
? Referred pain
endogenous opioids in pain
? Peripheral sensitization of pain
transmission
? Central sensitization of pain ?
(wind-up) ? role of glutamate
and NMDA receptors
? Dissociated anaesthesia
? Phantom limb pain
? Describe descending pain control
pathways: from Periaqueductal grey,
Locus ceruleus and Nucleus Raphae
magnus
54
10 Motor system
? Describe the features of organization of ? Arrangement of LMNs in
the motor system.
the anterior horn
? Define UMN & LMN
? `Motor homunculus'
Descending
? List the descending tracts involved in
? Describe the physiological
Motor Tracts
motor control.
basis and the clinical
? Describe origin, course, termination and
significance of
functional role of the Pyramidal tracts.
? Decerebrate posture
State why the pyramidal tracts are called
? Decorticate rigidity
3 Hours
so.
Theory
? Describe the role of corticobulbar tracts.
? List the extrapyramidal descending
tracts.
? State the origin, termination and
physiological role of the following
1 Practical
extrapyramidal tracts:
session
? Rubrospinal
(3 hrs for
? Pontine reticulospinal
examinatio
? Medullary reticulospinal
n of the
? Lateral vestibulospinal
motor
? Describe the influence of the
system)
extrapyramidal tracts on spinal motor
neurons & spinal reflexes
? Describe the effects of lesion of the
pyramidal and extrapyramidal tracts
respectively on spinal motor neurons,
spinal reflexes & muscle tone
11 UMN and
? Describe the features and Physiological
? Define the following terms: ? Definition of
Clinical cases can
LMN Lesions
basis of Upper motor neuron & lower
Hemiplegia, quadriplegia,
terminology:
be shown
motor neuron lesion.
paraplegia
o Transient ischemic
? Describe the features of:
? Hemiparesis,
attacks
? Hemisection of spinal cord at a
quadriparesis &
o Stroke
given level (e.g. T8, L3 etc)
paraparesis
o Cerebrovascular
? Brown Sequard syndrome
accidents
? Complete transaction of spinal
? Neurogenic bladders
cord at a given level.
55
12 Reflexes
? Define the term `reflex'.
? Alpha-gamma co-
Tonic neck reflexes
Pediatrics
? Describe the components of a reflex arc
activation
(upper cervical cord)
with a diagram.
? Physiological basis for
? Symmetrical
Neurology
? Classify reflexes:
Jendrassik's maneuver
tonic neck
? based on the location of receptors ? Crossed extensor reflex
reflex (STNR)
Medicine
(deep and superficial)
? Importance of using a
? Other
? Based on number of synapses in
painless stimulus to elicit
Primitive
PMR
the reflex arc (mono, di or
plantar response
reflexes:
polysynaptic)
? Central excitatory state &
- Sucking reflex
Study of patients
? Describe in detail, the stretch reflex and
irradiation of stimulus in
- Rooting reflex
with postural
its physiological significance.
spinal cord
- Grasp reflex - 6
abnormalities as a
? List the other terms which are
? Mass reflex & its use in
months
2 Hours
result of primitive
commonly used to refer to the stretch
spinal cord injury patients
- Plantar ? Babinski ?
Theory
reflexes being
reflex.
1 year
expressed.
? Identify that the clinically tested deep
o Postural reflexes other than Should not remain
reflexes (or tendon jerks) are stretch
stretch reflex and crossed
active beyond 6-12
reflexes.
extensor reflex:
months of life.
? Differentiate between alpha and gamma o Brain stem reflexes:
motor neurons.
Righting reflexes
If they do, and they are
? Name the receptor for the stretch reflex
(Midbrain)
not integrated, they
and describe its basic structure with a
oLabyrinthine righting
can interfere with
diagram. State the functional role of
oNeck righting
voluntary control of
gamma motor neurons.
oBody on head righting
specific movements
? State the effects of supraspinal
oBody on body righting
and result in immature
influences on the stretch reflex
patterns of movement
? Describe the effects of UMN lesions.
? Vestibular or
(eg. Cerebral palsy)
? Describe the effects of LMN lesions.
Labyrinthine reflexes
? The primitive 1 Practical
? Describe the inverse stretch reflex arc.
(Medulla)
reflexes may
session
State the stimulus and response for the
o Vestibulospinal or tonic
re-emerge in
(3 hrs for
inverse stretch reflex.
labyrinthine reflex (TLR)
an adult after examinatio
? Describe the functional role of Golgi
Vestibulocollic reflex
brain injury
n of
tendon organ.
Vestibuloocular reflex
reflexes)
? Describe the physiological basis of
(VOR)
"Clasp-knife" rigidity
oVestibular placing
? Describe the flexion withdrawal reflex.
reaction
State its functional role?
? Describe the afferent, efferent pathways ? Tonic neck reflexes (upper
and the centre of integration for the
cervical cord)
56
following superficial reflexes: Corneal,
conjunctival, Abdominal, cremasteric
? State the rationale in assessing
superficial reflexes, while examining the
nervous system.
? Describe flexor and extensor plantar
reflexes.
? Recognize the importance of using a
painless stimulus to elicit plantar
response
? Describe Babinski's sign and state its
clinical significance.
? List the physiological conditions, where
plantar response is extensor.
? Demonstrate how to elicit the clinically
significant superficial and deep reflexes
in normal subject.
13 Cerebellum
? Describe the structure of cerebellum, its
? Describe the features of
? Cerebellar lesions
Anatomy:
somatotopic organization, deep
cerebellar lesions
Structure,
cerebellar nuclei, afferent pathways,
? Describe cerebellar
3 Hours
connections and
internal connections, efferent pathways.
function tests.
blood supply to
? Name the afferent and efferent fibres of
cerebellum
cerebellum
1 Hour
? Describe the functions of cerebellum.
Practical
Medicine
Neurology
14 Basal ganglia
? Define the term basal ganglia.
? Describe the features of
? List the nuclei forming the basal
Parkinson's disease.
ganglia.
? Describe the
? List the following:
pathophysiological basis
? Input nuclei ? which receive
of Parkinson's disease.
2Hours
afferents from cortex
? Output nuclei ? which send
output to thalamus and spinal
cord
? Describe the internal connections
between input and output nuclei ? give
details of the direct pathway and
indirect pathway.
57
? Describe the origin and termination of
the nigro-striatal pathway. State the
neurotransmitter in this pathway.
? Describe the physiological role and
clinical significance of the nigrostriatal
pathway.
15 Reticular
? Describe the organization of the
? List the neurotransmitters
formation
reticular formation and its physiological
of various nuclei of RF.
role.
? Give an outline of
1 Hour
? Describe the ascending Reticular
afferent & efferent
Activation System
connections
16 Thalamus
? List the groups of thalamic nuclei
? List the important
? Give an outline of connections of
features of thalamic
1 Hour
thalamus
syndrome
? List the functions of thalamus.
17 Hypothalamus ? List the major regions and functions
Hypothalamic Obesity
of hypothalamus.
? Connections of hypothalamus
1 Hour
? Describe the functions of the
hypothalamus
18 Limbic system ? State the components of Limbic system ? New concept of the Limbic ? Recognize
? Describe the physiological role of the
System ? Emphasis on
differences between
limbic system Recognize the importance
amygdala.
the new concept of
1 Hour
of Papez's contributions
? Kluverbucy Syndrome
Limbic circuit and
? Recognize the central role of amygdala.
? Shamrage
Papez's circuit.
? Identify nuclei
involved in addiction
19 Cortex
? Identify the major somatic and special
Define the role of corpus
? Sperry's Split Brain
sensory, motor & association areas in
callosum ? inter-
Experiments
the cortex.
hemispheric transfer of
? Dyslexia
? Recognize the somatotopy of the motor
information
? Prefrontral
1 Hour
and somatic sensory areas (homunculi)
Lobotomy
? Recognize the phenomena of
? Define the
hemispheric specialization
following terms:
(dominance), handedness.
? hemi-neglect
syndrome
? cortical
58
blindness
? synaesthesia
20 EEG
? State the physiological basis of EEG,
types of EEG waves,
? Uses of EEG
1 Hour
21 Sleep
? Define the various stages of a sleep
Sleep Disorders
? Theories of sleep ?
cycle.
? Hypersomnolence
Wakw Cycle
? Distinguish between NREM and REM
? Obstructive sleep
1 Hour
sleep.
apnea
? Insomnia
22 Language &
? Define the role of Wernicke's &
speech
Broca's areas in language & speech
1 Hour
? Define aphasia and state the site of
lesion in motor and sensory aphasia
23 Learning and
? Describe the classification of learning
? List Alzheimer's
memory
and memory
disease and
? Describe the following phenomena of
Korsakoff's
implicit or Non-declarative learning:
psychosis as
o Non-associative ? Habituation
disorders of learning
1 Hour
Sensitization
and memory
o Associative ?
Classical
conditioning
Operant
conditioning
? Define Explicit or declarative memory.
? Define the term synaptic plasticity
? Describe the synaptic phenomenon
associated with Short term memory.
? Describe the phenomenon leading to
long-term memory.
? Describe the role of hippocampus in
memory formation.
? Describe the role of cerebellum in
motor learning.
24 CSF
? Describe the composition, Secretion,
? Papilledema
Circulation, Drainage and Functions
? Hydrocephalus
59
? Define Blood Brain Barrier
1 Hour
? Define Blood CSF barrier
25 Cranial Nerves ?
? Examine the integrity of
the cranial nerves I-XII
2 Practical
in a normal subject
session (6
hrs)
60
Special Senses (Lectures + Tutorials 20 hours; Practicals + OSPE 6 hours; ECE: 3 hours)
SPECIFIC LEARNING OBJECTIVE
TEACH
CLINICAL
NO
TOPIC
ING
INTEGRATION
HOURS
MUST KNOW
DESIRE TO KNOW
NICE TO KNOW
EYE
1
Functional
? List the structures within the eyeball
? State the normal range of
anatomy
? Name the extraocular muscles and
intraocular pressure
describe their functions
? Describe the functions of Iris, Ciliary
body, Intra-ocular muscles, Lens,
1 Hour
Aqueous humor, Vitreous body and
Optic nerve
? Describe the formation and drainage of
aqueous humour
2
Optics of eye
? List the structures through which light
? Concept of the ,,reduced
Ophthalmology:
passes before falling on the retina
eye
? State the important refracting surfaces
? Accommodative power of
To observe testing
of the eye and the extent of contribution
lens and near point of
of refraction
of each to image formation.
vision
1 Hour
? State that the image formed on the retina ? "Reduced eye"
To observe the use
is inverted and diminished in size.
of tonometer
? Describe the role of crystalline lens in
focusing the light rays and describe the
To get familiar with
changes that happen while focusing a
case charts of
near object ? accommodation reflex
refractive errors
? List the common refractive errors ?
Myopia, hypermetropia, presbyopia and
To observe
astigmatism
examination of
? Describe the cause for the refractive
fundus using
errors and explain their correction
Ophthalmoscope
Observe perimetry
3
Retina
? List the retinal cells contributing to the
? Cone & rod density
visual pathway. (photoreceptors,
distribution in retina
61
bipolar cells and ganglion cells)
? Convergence of synapses
Ophthalmology:
? Describe optic disc, macula lutea and
1 Hour
fovea as important structural features in
To observe testing
the retina
of visual acuity
? Classify photoreceptors ? Rods and
cones
? List major structural and functional
differences between rods and cones
? Demonstrate visual acuity on a subject
using Snellen's chart
4
Photo
? Visual pigments
? Decomposition of
transduction
? "Dark current" ? at rest in the
rhodopsin - biochemical
photoreceptors
steps involved
1 Hour
? Hyperpolarizing receptor potential in
Neurotransmitters involved
rods & cones in response to light
? Wavelengths of light best
? Transmission of Action potential to the
absorbed by pigments
optic nerve.
5
Light & Dark
? Describe the changes that happen
? Nyctalopia
adaptation
during dark and light adaptation
6
Colour vision
? Name the types of photoreceptors
? Color constancy and
responsible for colour vision
Purkinje shift
? Classify cones based on their spectral
? Theories of color vision
1 Hour
sensitivity
? List the types of colour blindness
? Describe theories of colour vision
? Demonstrate the use of Ishihara's chart
to check for colour blindness
7
Optic Pathway ? Draw and describe the optic pathway
? List the conditions
from the photoreceptors to the visual
producing pupillary
cortex
constriction & pupillary
1 Hour
? Describe the visual field defects
dilatation
produced by lesions at various levels of
the pathway
8
Pupillary
? Describe the pupillary light reflex
? Describe the
? Conditions
Reflexes
pathway
accommodation reflex
producing pupillary
? Differentiate between direct and
pathway
constriction &
1 Hour
consensual pupillary light reflexes
? List the features of
pupillary dilatation
62
? Demonstrate direct and consensual light
Horner's syndrome
reflexes on a subject provided
Explain Argyll-Robertson
pupil
9
Eye
? List the extraocular muscles and
? Saccadic & smooth pursuit
Movements
describe their actions
movements
? Name the cranial nerves innervating the ? Opto-kinetic reflexes
1 Hour
extraocular muscles
? List the types of eye movements
(saccadic, smooth pursuit, vergences
EAR
1
Functional
? List different parts of the ear.
anatomy of the ? Mention functions of outer ear
ear
? Describe the role of middle ear in
impedance matching
1 Hour
? List structures within the inner ear and
specify their functions
? Describe the importance of attenuation
reflex
2
Inner Ear
? Draw the cross-section of cochlea with
? Volley effect or Frequency
Function of
all 3 three scalae.
principle of hearing
cochlea
? Describe the `travelling wave theory' of
hearing
1 Hour
? Describe the function of basilar
membrane in frequency discrimination -
'Place principle' of hearing
3
Sound
? Physics of sound
? Noise - as an occupational
? Concept of the Decibel scale
hazard
Sensory
?
1 Hour
Recognize the importance of
transduction in
endocochlear potential and sensory
4
cochlea
transduction in the cochlea.
5
Processing of
? Describe the auditory pathway
? Describe the mechanisms
? Describe the
auditory
underlying sound
concept of tonotopic 1 Hour
signals
localization and masking
maps
effect of sounds
6
Assessment of
? Define an audiogram
? Principle of hearing
hearing
? Identify a normal air-conduction and
aids
bone-conduction tracing
1 Hour
63
? Identify conductive hearing loss and
sensory neural hearing loss using
audiogram
? Describe the principle of Rinne's and
Weber's test
7
Deafness
? Types of deafness - Conductive & ? Audiogram
? Speech Audiometry
Neural
? Distinguish between
conductive hearing loss and
1 Hour
sensory neural hearing loss
based on audiogram
VESTIBULAR APPARATUS
1
Functional
? List the structures which make up
anatomy of
vestibular apparatus and their functions
1 Hour
vestibular
apparatus
2
Mechanism of
? Describe the mechanism of stimulation
stimulation
of otolith organs - deflection of hair
vestibular hair
cells using gravitational force/inertial
cell
force of otolith membrane
1 Hour
? Describe the mechanism of stimulation
of semicircular canals - deflection of
hair cells using inertial force of
endolymph
3
Vestibular
? Describe the connections of vestibular
? Connections to cranial
pathway
nucleus to the cortex and cerebellum
nerve nucleii controlling
? Describe the projections through
? Eye movements -
vestibulospinal tracts
Vestibulo-ocular reflex
1 Hour
? Describe the functions of Vestibular
? Head & neck movements
system - Maintenance of balance,
equilibrium and posture
4
Tests of
? Identify nystagmus in a
? Meniere's disease
Vestibular
patient
function
? Caloric test
1 Hour
? Rotation in a Barany chair
SMELL
Microscopic
? Describe the arrangement of olfactory
? List the types of cells
? Pheromones
1
anatomy of
sensory neuron within the olfactory
within the olfactory bulb
64
olfactory
epithelium
? Describe the connections of
epithelium and
olfactory sensory neurons
1 Hour
olfactory bulb
with cells in the olfactory
bulb
The olfactory
? Describe the olfactory pathway from
?
?
2
pathway
the olfactory sensory neurons to the
1 Hour
cortex
TASTE
Receptors for
? Describe the arrangement of taste cells
1
Taste
within taste buds and organization of
taste buds within papillae.
Basic qualities
? The student must be able to:
? List umami as the fifth
2
of taste
? List the four basic qualities of taste
taste sensation
sensation
sensation
1 Hour
? Demonstrate how to test for the four
basic qualities of taste sensation
Taste pathway ? Draw and describe the taste pathway
3
from the anterior two-third and posterior
one-third of the tongue to the gustatory
cortex
65
REFERENCE LEARNING BOOKS
Text Book of Medical Physiology by Guyton and Hall ? A South Asian Edition
Ganong's Review of Medical Physiology
Text Book of Physiology by Dir.Prof.A.K.Jain (Volume I & II )
Understanding Medical Physiology ? A Text Book for Medical Students by RL Bijlani and S Manjunath Best &
Taylor's Physiological Basis of Medical Practice by O.P.Tandon and Y.Tripathi
Text Book of Human Physiology by Sarada Subramanyam A
Text Book of Practical Physiology by CL Ghai
Manual of Practical Physiology by
Dir.Prof.A.K.Jain
66
THEORY EXAMINATION
Theory Examination - Pattern of Question Paper I and II
1 Essay
1 x 10 marks
= 10 marks
1. Brief Answers
5 x 4 Marks
= 20 marks`
2. Short Answers 10 x 2 Marks
= 20 marks
--------------
Total
50 Marks
--------------
Physiology Practical Examination Including OSCE, OSPE and Viva
Practical : Total 40 marks
I Haematology : 16 marks ( Major -10 marks, Minor 6 marks)
Major experiment
1. Total RBC Count
2. Total Leukocyte count
3. Differential count
4. Absolute Eosinophil count
(Students can be taught to dilute the blood, charge the chamber, focus the counting grid and one sample square
can be counted and the steps for calculation to be mentioned correctly. They need not count all squares)
Minor
experiment
1.Hemoglobin
Estimation
2.Blood Grouping
3.Bleeding Time and Clotting Time
4.ESR or PCV
67
Suggestion:
(To avoid mouth sucking in doing hematology experiments with RBC and WBC pipettes instead, automated
micro pipettes can be used)
II Clinical Examination : 20 marks (CNS-10marks +CVS/RS?5marks+Clinical discussion or chart?5
marks) (One question from CNS Examination for 10 marks and one question from CVS/RS for 5 marks)
(Clinical Discussion includes giving a case scenario pertaining to the First M.B.B.S. level and student should
identify the disease with the given data)
Charts will have a picture and two or three questions to be relevant to the picture given
III OSPE (2 Skilled stations): 2x2=4 marks (1 station in Hematology and one in clinical examination)
VIVA : (20 marks)
General Physiology, Blood, Muscle, Digestive system - 6 marks
Endocrinology, Reproduction, excretory system
- 4 marks
Cardiovascular system, Respiratory system
- 4 marks
Central nervous system and Special senses
- 6 marks
68
INTERNAL ASSESSMENT (40 marks) (Theory 20 & Practical 15 + Record 5)
Theory to asses knowledge
-
Periodic Test in the first week of Oct, Dec, Jan, Mar and May (5 test totally)
and Model Exam Paper I & II in June last week.
Practical to asses skill
-
One Practical Exam in Hematology and one in clinical examination.
Model Practical in June.
Viva to asses communication -
Viva marks to be included in internal assessment calculation.
MEDICAL ETHICS
Privacy and confidentiality of Students
Ethical Issues
INTEGRATED TEACHING
2 vertical and 3 horizontal integration to be done in each Academic Year
e.g. Horizontal ? Gastric secretion, Liver, Kidney
Vertical ? Anemia, Jaundice and Hemiplegia
RECORD
Record should be followed as recommended by this university
*********
69
This post was last modified on 02 July 2021