Physiology Objectives Detailed

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EDUCATIONAL OBJECTIVESFOR

MEDICAL PHYSIOLOGY (MDPL 203)

DEPARTMENT OF PHYSIOLOGYCOLLECGE OF MEDICINE & MEDICAL SCIENCES

KING FAISAL UNVIERSITY

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TABLE OF CONTENTS

PagesIntroduction 3Textbooks 5

I. Introductory Lectures, Excitable 6Tissues, Nerve & Muscle PhysiologyPhysiological Control System.

II. Blood 8III. Cardiovascular Physiology 11IV. Respiratory Physiology 15V. BMR and Exercise 21VI. Kidney and Body Fluids 22

VII. Acid - Base Balance 22VIII. Gastrointestinal System 28IX. Endocrines 32X. Reproduction 30XI. Temperature Regulation 40

INTRODUCTION

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The instructional objectives presented in this manual are for Physiology 208 which is oneof the 4 courses presently offered by the department. They describe the final behaviourexpected of the student at the end of this course. i.e. how he / she should be able to applyhis / her knowledge. These objectives serve two purposes. Firstly, they define the contentof the curriculum more sharply than would a textbook so that student has a clear outlineof the material he is expected to know. Secondly, they provide a basis for the necessaryevaluation during the course. In defining the core content of physiological knowledge, wehave drawn somewhat arbitrary limits in many instances. This is due in part to theassumption that the student will acquire related information in the other basic medicalsciences courses and also later in the clinical courses.

In accordance with the general educational objectives of the program, the student isexpected to:

1) Know those basic facts, concepts and scientific principles of physiologynecessary for the practice of medicine.

2) Apply these concepts and principles in the understanding of diseaseprocesses.

3) Demonstrate the rudiments of skill in clinical observation and measurementand apply his / her findings towards making a diagnosis.

4) Understand how new knowledge and information is produced.

Structure of the Course:This course is spread over the whole year. Time is provided during the formal teachingschedule for lectures, tutorials and laboratory exercises.

LecturesDefinition of specific learning objectives is not intended to reduce flexibility in the lecturecourse. The content of lectures may go beyond the specific learning objectives when this

seems desirable to indicate the relevance of physiology to medical practic or the solutionof experimental problems. Equally, the lectures may not cover every specific objectivesdetailed, if it is felt that the material is adequately covered by reference to the textbook orsuitable handouts.

TutorialsThese are scheduled weekly and are intended to provide the student with and opportunityto assess his / her progress on a regular basis. The student is strongly advised to preparefor and treat these as an important part of the course. The tutorials are organized aroundproblems or questions pertaining to the material covered in the lectures of the previoustwo weeks. After a brief opportunity to go through the material on the tutorial handout,

the students are expected to discuss the problems in depth under the guidance of aninstructor and allowed to ask questions that may help them understand the material.

Analysis of case historiesThese are designed specifically to illustrate the relevance of physiological concepts tomedical practice. Simple case histories of various medical problems will be presented inclass or tutorial. The student is expected to analyzed the case history and with the help ofa member of the department staff, bring forth the relevant physiological concepts.

Laboratory exercises

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Laboratory exercises are scheduled at weekly intervals. The procedural details for eachexercise are outlined in the laboratory manual. Written practical reports are required. Thepractical books are graded and the grades count as a part of the final mark in the course.In addition questions on laboratory theory and practice are also included in a finallaboratory examination. These questions emphasize the analysis and interpretation oftypical laboratory data and practical procedures and measurements previously carried outin the laboratory.

EVALUATIONFour small quizzes (multiple choice questions only) are held each semester. Besides a mid-year exam (end the first semester exam) and a final exam at the end of the year are heldseparately. The final examination will be set on the material presented during the entireyear. The written examinations will consist of various types of multiple choice questionsand short essays.

The final grade for each course is computed as follows:1. Quizzes in the first semester 10%

2. Mid - year exam 25%3. Quizzes in the second semester 10%4. Tutorials and dry lab sessions 10%5. Final exam 35%6. Lab exam and lab reports 10%(Not the lab reports have 2.0% and the lab exam 8.0% grads)

The faculty of the Department of Physiology are always available to give advice andstudents are urged to seek assistance if they encounter problems during the entire year.Finally, it should be understood that the objectives are not intended as a course outline andare not necessarily stated in the order in which the material will be covered in lectures.

TEXTBOOKS

Assigned texts1. Lauralee Sherwood, Human Physiology: From cells to systems second edition,

West Publishing company, New York, 1993.2. Vander 3. Sukkar, M.Y., El-Munshid, H.H. and Ardawi, M.SM. (Editors). Concise Human

Physiology. Ist Edition. Blackwell scientific Publications. Oxford, 1993.

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4. Guyton, A.C., Textbook of Medical Physiology, 8th Edition, Saunder,Philadelphia, 1991.

I. INTRODUCTORY LECTURES

Introduction:Describe the functional organization of the human body and outline theconcept

of homeostasis and the concept of physiological control systems.2. Describe the divisions of body fluids into intracellular, extracellular and

intravascular compartments and give the approximate values for the volumes.3. Describe the structure of the cell membrane and the processes of transportacross membranes: simple diffusion, osmosis, filtration, carrier-mediated transport,phagocytosis, pinocytosis and exocytosis.

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Excitable Tissue: NerveA. Resting Membrane Potentials

1. Define the term membrane potential.2. Explain the importance of the sodium-potassium pump and the differential permeability

of the membrane to ions for the establishment of the membrane potential.B. Action Potentials (for nerve & striated muscle in general)

1. Draw a diagram of an action potential, showing its magnitude and divisions.2. State the approximate duration of the action potential.3. Explain the meaning of electrotonic potentials and local response.

C. Excitability1. State that excitability means the ability of tissues to react to a stimulus.2. Define, a threshold stimulus and explain the statement; nervous tissues obeys the all-or-

none law.3. Describe the changes in excitability during the course of an action potential.4. State that excitation causes changes in the permeability of the nerve

membrane to sodium and potassium, and give an account of how thesechanges lead to the action potential.

5. Explain the saltatory conduction of the action potential.Excitable Tissue: MuscleA. Muscle Action Potentials

1. Give the difference between the time courses of the action potential ofskeletal and cardiac muscle.

2. Give the time relations between the muscle action potential and thecontraction of cardiac and skeletal muscle.

3. Explain the difference between the refractory periods of the two typesof muscle.

B. Neuromuscular Transmission and Muscle Contraction.1. Outline the morphological structure of the muscle end-plate

2. Describe how the impulse is transmitted from the nerve into the muscleMembrane basing the description on the release of acetylcholine andchanges in the permeability of ions.

3. Describe the current view on the mechanism of muscle contraction.4. Define isotonic and isometric contraction.5. Explain summation, complete and partial tetanus.6. Explain why the cardiac muscle cannot undergo fatigue and tetanized contraction.7. Draw and explain the length-tension diagram for skeletal muscle.8. Define a motor unit and describe how muscle contraction is graded in vivo.

C. Smooth Muscle, Special Properties1. State that smooth muscle shows spontaneous activity in the form of:a) rhythmic contraction and/orb) tonic contractions2. Explain the double innervation of smooth muscle and the effect of humoral transmitters.3. Define plasticity of smooth muscle.

D. The Autonomic Nervous System1. Describe the general organization of the autonomic nervous system and the

major distribution of sympathetic and parasympathetic outflows.2. State the neurotransmitters at the autonomic ganglia and target organs.

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3. Name at least one blocker for each type of neuro-transmission at the autonomic ganglia andtarget organs.

II. BLOOD

A. Constituents of Blood And Functions:1. State the functions of the blood using terms as transport, homeostasis,

hemostasis and protective function.2. Describe the composition of blood.3. Give the normal circulating blood and plasma volumes for adult males

and females.4. Define the term haematocrit and give the normal range, and state the

sex difference in hematocrit values. Mention two common conditionsin which it is:a) Increased b) Decreased

5. Differentiate between plasma and serum. Describe and explain howyou would obtain a sample of each.

6. a) Describe the morphology of the red cell, give the normal red

cell count and haemoglobin concentration in the peripheralblood.

b) Indicate the effect of sex difference on these parameters.c) Describe the RBC membrane and shape. Mention importance of each.

7. Define the terms osmotic fragility and ESR. Mention 2 conditionswhere each is abnormal. Explain the value of measurements ofosmotic fragility and ESR in clinical practice.

8. Define and state the normal ranges for:a) Mean Corpuscular Haemoglobin Concentration (MCHC)b) Mean Corpuscular Haemoglobin (MCH)c) Mean corpuscular Volume (MCV)

B. Hemopoiesis1. a) Describe briefly the stages in erythropoiesis and give the sites

where it occurs during:1. foetal life2. infancy and childhood3. adult life

b) Describe briefly the significance of reticulocyte count.2. State the normal average survival time for red cells and mention one

method for determining it.3. List:

a) the nutritional factors required for erythropoiesis includingprotein, iron, vitamin B12, folic acid and describe the red cellmorphology when a deficiency of any one of the above factorsis present.

b) the hormones influencing erythropoiesis and explain the role oferythropoietin.

4. Describe the factors regulating iron absorption and storage.5. Define the term anaemia and list the types according to cell size and

haemoglobin concentration.6. Given such information as Hb concentration, RBC, count, PCV and

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blood picture, be able to calculate MCHC, MCH, MCV and deduce thetype of anemia and the possible pathophysiological cause.

7. Give the approximate WBC count and the normal differential count.8. a) Describe briefly the morphological features of each type of

leucocyte, their sites of formation, stages in development, lifespan and their function.

b) Describe briefly the functions of Neutrophil, basophil andeosinophil.

c) Describe briefly the tissue macrohage system and their relationto blood monocytes.

d) Describe briefly immunity and role of lymphocyte in immuneresponse.

9. State the normal range of platelet count in the blood, and describebriefly:a) their mode of formationb) role in haemostasis

C. Blood Groups

1. Describe the ABO group system in terms of the four major groups andgive the normal distribution in the local population.

2. Describe the Rhesus blood group system and explain how Rhantibodies are produced by the body.

3. Explain the term Rh incompatibility and the mechanism of jaundice inthe foetus and newborn with Rh incompatibility.

4. a) Describe the major steps taken to ensure a compatible bloodtransfusion.

b) State the major consequences of a mismatched bloodtransfusion.

D. Blood Clotting and Hemostasis

1. Define the term hemostasis and list the major processes involved.2. Describe the mechanisms of vasoconstrictive response to local injury.3. Describe the role of platelets in hemostasis.4. Describe briefly the intrinsic and extrinsic mechanism of blood

coagulation.5. Explain the mechanisms that prevent blood clotting in the normal

cardiovascular system.6. Explain how the following anticoagulants act:

a. sodium citrateb. ethylene diamine tetra acetate (EDTA)c. heparind. coumarin drugs

7. State the main laboratory test used to evaluate haemostasis.8. Describe briefly the fibrinolytic system and indicate how this system

limits intravascular coagulation.9. List and explain the main causes of bleeding disorders and increased

tendency for intravascular clotting (thrombosis).

III. CARDIOVASCULAR SYSTEM

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A. Introduction To CVS1. Identify the functional divisions of the CVS2. Briefly describe the functional anatomy of the heart.

3. Give a brief account on the histological structure of the cardiac muscle;mention the main differences between it and the skeletal muscle.

B. Electrophysiology1. State the two types of action potential present in heart muscle.2. Draw an action potential recorded from a ventricular muscle fiber and

explain the changes in ion permeability responsible for the different phases.

3. Draw an action potential from an SA nodal cell and explain the genesis of thepacemaker potential.

4. Describe the effects of vagal and sympathetic stimuations on the pacemakerpotential.

5. Describe the origin and spread of the electrical impulse from the SA node tothe ventricular muscle; explaining the role of the conducting system.

C. Electrocardiography1. Define the terms; electrocardiogram (ECG) and electrocardiograph.2. Draw and label a typical normal ECG tracing. Describe the electrical events

occurring within the heart that are responsible for each wave and state thecauses and clinical significance of P-R interval and S-T segment.

3. Describe briefly the bases of ECG recording; stressing an Einthovenstriangle and law.

4. Describe the correct location of the different ECG leads and state the shapeof ECG waves in each lead.

5. Given an ECG, be able to:a. calculate the heart rate

b. measure the P-R interval and explain the significance of a prolongedP-R interval.

c. Recognize the most common abnormalities in rate and rhythm (e.g.tachycardia, bradycardia, fibrillations, heartblock)D. The Cardiac Cycle

1. Make a correlation between the electrical activity of the heart and themechanical events of the cardiac cycle.

2. Draw a diagram to illustrate normal changes in the following variables during the cardiaccycle and explain the mechanism of each change.

a. ventricular pressureb. atrial pressurec. aortic and pulmonary pressuresd. ventricular volumee. ECG

3. List the normal heart sounds, indicate their timing in relation to phases of cardiac cycle andECG tracing and explain the causes and characteristics of each sound.

4. Define murmurs, briefly explain the four main murmurs caused by defective valves.E. Cardiac Output

1. Define heart rate, stroke volume and cardiac output and give normal

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values for each.2. State the relationship between cardiac output, heart rate and stroke volume.3. State the factors that regulate heart rate including nervous and hormonal

regulation. Explain the mode of action of each and the effect of changes inheart rate on cardiac output.

4. Describe the factors that regulate stroke volume including initial fiber length(preload) in addition to the nervous & hormonal factors.

5. Discuss the effects of sex, age, body surface area, sleep and exercise oncardiac output, list the various conditions that increase or decrease thecardiac output.

6. Describe the measurement of cardiac output by Fick method.F. Hemodynamics: Pressure-volume Relationships:

1. State that a pressure difference across the wall of the vessel is the force responsible for achange in vessel size.

2. Define distensibility and explain how the veins act as a variable volume reservoir.3. Describe Laplace Law in relation to wall tension, vessel radius and pressure gradient and

how this relationship allows the capillary to withstand a pressure of 100 mmHg.

4. Describe the effects of a hydrostatic column on intravascular pressure.G. Hemodynamics: Pressure-flow Relationships

1. Explain, briefly the principles of blood flow and how Reynoldsnumber expresses the probability of turbulance.

2. State that a pressure gradient along the length of a vessel is the force responsible for flow.3. State that resistance can be calculated as driving pressure divided by flow, explaining

briefly Ohms & Poiseuiles laws.4. Define peripheral resistance, briefly describe how length of the blood

vessel and blood viscosity is determined by arteriolar diameter.5. Explain how arterioles determine the relative blood flow to different

organs; describe briefly the factors regulating arteriolar diameter

including local (metabolic and myogenic autoregulation) and extrinsic(nervous & hormonal) controls.

6. Define the terms: a) reactive hyperemia b) active hyperemiaH. Functions of the Circulatory System

1. Describe the relative magnitudes of pressure, velocity of flow and cross-sectional area in the various divisions of the systemic vascular tree.

2. Explain how aorta and large arteries help to convert intermittent flowto continuous pulsatile flow (Wind-Kessel function)

3. State that arterioles act as variable resistance vessels and describe thestructural features enabling them to do so.

4. State that capillaries function as exchange vesels.5. State that the veins function as capacitance vessels and discuss the

factors that influence venous tone and venous return.I. The Lymphatics

1. Describe the lymph capillary and list the factors that determine lymphflow.

2. List the functions of the lymphatics.3. Describe the role of lymphatic circulation in maintaining normal Starling

forces across the capillary wall.J. Capillary Circulation

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1. Describe briefly the structural features, innervation and blood flow ofthe capillary system.

2. Mention the characteristics of capillaries that allow them to function asexchange vessels.

3. Name and give approximate values to the forces that influence the movementof fluid between the capillary lumen and the interstitial spaces.

4. Explain briefly the state of near equilibrium at the arteriolar & venular end ofcapillaries (Starlings law of capillaries).

5. Describe the pathophysiological basis for edema formation.e.g. increasedcapillary hydrostatic pressure, hypoalbuminemia, lymphatic obstruction andincreased capillary permeability.K. Neural Regulation of the CVS

1. Explain briefly the innervation of the blood vessels and the heart.2. Define vasomotor center its situation and state its component.3. Describe the effect of stimulation of the vasomotor, center on arteriolar

resistance, venous capacitance, heart rate and stroke volume.4. Explain why arterial pressure increases in response to stimulation of

the vasomotor center.5. Describe the role of the hypothalamus in the regulation.

L. Arterial Blood Pressure1. Define arterial blood pressure, state the function and the normal values

for systolic, diastolic and mean arterial blood pressure and describe thevariations that occur with age.

2. State that blood pressure is determined by:a) total peripheral resistanceb) cardiac output3. Explain briefly the mechanisms regulating arterial blood pressure,

including:

a) short term regulation through the baroreceptorsb) long term regulation through the lcidney.4. Describe the location of the baroreceptors, their response to a change in the level of pressure

in the arteries and their effect on the vasomotor center.5. Outline the effect of carotid clamping & cutting buffer nerves and explain carotid sinus

syndrome.M. Coronary Circulation

1. Outline the anatomical and functional distribution of the coronaryvessels.

2. State the relative magnitude of coronary blood flow and oxygenconsumption at rest and during exercise.

3. Describe the pattern of coronary blood flow during the cardiac cycle.4. Describe the mechanisms by which coronary flow is regulated.5. Give short account on coronary artery disease (e.g. angina pectoris and

myocardial infarction).N. Circulatory Shock

1. Define the term circulatory shock, name the different types of shockand possible causes of each.

2. Explain the pathophysiology and treatment of each type.

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3. Describe effect of a loss of more than 20% of the blood volume on thecirculation and the short and long term physiological mechanisms thatattempt to compensate for the blood gas.

4. Define progressive shock and explain why it occurs.5. Define irreversible shock.

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IV. RESPIRATORY PHYSIOLOGY

A. Functional Anatomy:1. Identify the principal anatomical features of the respiratory system and

explain the functional significance of :a) conducting zoneb) gas exchange zone.

B. Symbols And Abbreviations:1. Recognize international symbols and abbreviations of respiratory

physiology.C. Pulmonary Ventilation: (Mechanics of ventilation)

1. List the muscles of respiration and explain their mode of action in alteringthe dimensions of the thoracic cage during inspiration and

expiration.2. Explain how the enlargement of the thoracic cage expands the lungs.3. Describe the changes in intraalveolar and intrapleural pressures and state

their typical magnitudes during the respiratory cycle and explain

their causes.D. Compliance:

1. Define the term compliance.2. State that the normal position of rest is a balance between the elastic forces

of the lungs and of the chest wall.3. Give an account of how the amount of elastic tissue and alveolar surface

tension influence compliance, and give examples.4. Recognize the existence of pulmonary surfactant, its chemical nature and

origin, its functional significance and the consequences of itsabsence.E. Respiratory Work:

1. State that the energy cost of the work of breathing at rest and during heavyexercise is approximately the same.

2. State that respiratory work comprises work done in:a. Stretching of elastic structures in lungs and chest wall.b. Overcoming the freictional resistance in tissues.c. Overcoming airway resistance in bronchial system.

3. Give clinical examples of conditions where energy cost of breathing islarger than normal.

F. Lung Volume: Its Sub-divisions:1. Define and state typical values for the following, and be able to draw a

normal spirogram.a. Volume:

i. tidal (TV)ii. inspiratory reserve (IRV)iii. expiratory serve (ERV)iv. residual (RV)

b. Capacities:I. inspiratory (IC)ii. functional residual (FRC)iii. Vital (VC)

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iv. total (TLC)2. Describe the methods by which pulmonary volumes and capacities listed in

(1) above are measured and explain briefly the clinical significanceof such measurements.

3. Account for the chang in FRC in the following conditions: aging bodyposition, obesity, emphysema, fibrosis, pneumothorax.

G. Ventilation:1. Define the terms anatomical and physiological dead space. State theri

typical values and functional significance.2. (a) Define the terms alveolar ventilation and minute ventilation, their

typical values.(b) Given TV, dead space volume and respiratory rate, be able to

calculate alveolar ventilation.3. State that the filling and emptying pattern of the air in the alveoli can vary

from section to section even under normal conditions.4. Explain briefly the effect of gravity on air distribution in different regions of

the lung.

H. Pulmonary Circulation:1. State that the lung has two circulations - a very large pulmonary and a

small bronchial.2. Contrast the systemic and pulmonary circulation with regards to pressures,

resistance and volume flow:- Describe the rotes of passive dilation and recruitment of pulmonery

capillacis in changing pulmonary bload flow and pulmonaryvascular releslance.

3. State that the blood from the bronchial and the thebesina veins empties intothe pulomonary veins and explain that this is the main reason why, in

normal persons PaO2 is less than PAO2.

4. State that gravity has the effect of increasing blood flow at the bases(relative to ventilation) and of the decreasing it at the apices of hte

lungs.5. State the functions of pulmonary cuscalation.

I. Ventilation / Perfusion VA / Q ratio:1. State that a normal VA / Q is important for maintaining normal blood gases

Give the normal value forthis ratio.2. State that regions of the lung with a high VA / Q leads to a Wasted

ventilation and that with low VA / Q leads to a Physiologcalshunt and descrbe the consequences of each.

3. Explain the reason why there is a difference in VA / Q between the apexand base of upright lung.

- Contrast the airway and Vascukr control Mechansms that helpmainkin anormal VA / Q ralion.

J. Diffusion of O2 across the respiratory membrane:Genral Aspects:1. Students should be familiar with.

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Boyles law (temerature constant)Charles law (pressure constant)Ideal gas lawDaltons law of partial pressures.

2. Define water vapour pressure, describe its temperature dependence andstate its value at body tempreature.

3. State the gas composition of atmospheric air (dry), humidified air at 37oC,alveolar and expired air and the rationale for their differences.

4. Define the rate of diffusion for a substance as the amount of substance thatpasses a given cross-sectional area per unit time.

5. State that the rate of diffusion for a gas in a gaseous phase is:a. proportional to the partial pressure gradientb. proportional to the absolute temperaturec. inversely properional to the square root of the mol. wt. f the gas.

Diffusion of gases across the alveolar membrane:1. State that the volume of a gas that moves across the alveolar capillary

membrane per unit time depends on:

a. characteristics of the gas (mol. wt. gas temperature, solubilitycoefficient)

b. characteristics of lung (sunface area and the kncss of alwol or -capillarry memlirane.

c. pressure gradient across the alveolo-capillar membrane (alveolarventilation, capillary blod flow).

2. Explain hwo the effective surface area of the lungs in principle can bereduced (loss of tissue, ventilation and perfusion errors).

3. Outline the variation in PO2 along the pulmonary capillary during the flowof blood through the capillary at rest and during work.

4. a) Define diffusion capacity. State its normal values for O2 and CO2

and explain the rational of using CO for the measurement ofO2 diffusion capacity.

b) State that the solubility coefficient of CO2 is 20 times that for O2.5. State that the time taken for complete gas diffusion is 1/3 of the total

pulmonary circulation time and its mention sigmticanle.6. Give an account of why reduced oxygen saturation of the blood in one

pulmonary section can only to a slight degree, be compensated forby hyperventilation in another pulmonary section of corresponsingsize.

7. Give an account of why reduced CO2 elimination from the blood in onepulmonary section can be compensated for by hyperventilation in

other pulmonary sections.

K. Transport of O2 in Blood and Body Fluids:Oxygen Transport:1. List the forms in which O2 exists in the blood and give the normal value for

each form.

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2. State that the reaction between O2 and Hb. is weak and reversible andmention the underlying structural basis.

3. Define oxygen capacity and oxygen saturation.4. Give the quantitative relationship between the oxygen capacity and the

hemoglobin content of blood.5. a) Outline the oxyhemoglobin dissociation curve as a functioon of

PO2.b) Indicate the alveolar and mixed venous points on the curve.c) Describe the structural basis and the physiological significance of

the shape of this cruve.6. Factors affecting oxygen transport:

a) Explain the meaning of shift of the curve to right & to left. Accounton PO250.

b) Give the qualitative effect of pH (non-volatile acids and bases )PCO2 and temperature on the affinity of hemoglobin for

oxygen.c) Describe the Bohr effect.

d) Explain how 2 , 3-DPG in ervythrocytex influences the affinity ofhemoglobin for oxygen.

7. Explain the characteristic differences between the dissociation curves ofhemoglobin and myoglobin.

8. Explain how fetal hemoglobin differs fromadult hemoglobin and state howthe affinity for oxygen in the two typesof hemoglobin differ and

describe the functional significance of these differences.9. Account for the factors which influence the transfer of oxygen from blood

to tissue.CO2 Transport:1. Describe the forms in which CO2 exists in blood and give normal values for

he concentration of the different forms in arterial and mixed venous bloodat reast.

2. Describe the reactions taking place within the red cell leading to theformation of bicarbonate and explain the chloride shift mechanism.

3. Describe CO2 dissociation curve4. Describe the Haldane effect.

L. Regulation Of Respiration:1. Give the anatomical location of the four major centres which are

responsible for the generation and the maintenance of a normalrespiratory pattern and give an account of the function of thses centres.

2. Give an account of the effects of the following on the respiratory centres:a. stretch and irritant receptors in the lungsb. higher centersc. muscle, joint and tendon receptors.d. other areas as skin, CVS, GIT

3. a) Define chemoreceptors, identify their anatomical location and statein geeran their role in chemical regulation.

b) Describe briefly how receptors are stimulated by O2 , CO2 and H+cancenlration.

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4. Describe the role of PaCO2 and H+ concentration in regulating normal

breathing in man.5. Explain why normally CO2 rather than O2 is important in regulation of

respiration.6. Explain the changes occuring during breath - holding and voluntary

hyperventilation and state that these procedures are used to assessthe function of chemoreceptors.

7. State that the respiration although normally is an involuntary proces, it canbe controlled voluntarily by the cerebral cortex, and explain the

significance of this control.8. Mention that in chronic respiratory failure, hypoxia becomes the only drive

to repiratory center. State the clinical significance of this in terms ofO2 therapy.

9. Define the following patterns of breathing, eupnea, tachypnea,hyprventilation, hypovntilation, dyspnea, apnea and Cheyne-Stokes

brething.M. Clinical Correlates:

1. Identify the major types of respiratory insufficiency, their major causes andtheir consequneces.

2. List the 4 main types of hypoxia, define them and mention some potentialcaues and consequences. State the rationale for the use of oxygen

therapy in different forms of hypoxia.3. Define cyanosis and state its causes.4. List the effects of oxygen poisoning.5. State the causes and consequencies of CO poisoning.

N. Effects Of Changes in Ambient Pressure:Hypobaric Surroundings (Altitude):1. Explain the changes of pressure with altitude and state that the decrease in

barometric pressure is the basic cause of hypoxia at high altitude.2. Explain the effect of decreased barometric pressure on PaO2 and

hemoglobin saturation.3. Explain the advantage of brathing pure oxygen over air at high altitude.4. List the major effects of hypoxia in man as they appear during ascent.5. Explain the main physiological adaptations to a low ambient PO2.

O. Tests Of Lung Functions:1. a) Define Forced Vital Capacity (FVC) and Forced Expiratory

Volume in 1.0 sec. (FEV1.0)b) Describe briefly a method for measurement of FVC and FEV1.0.c) Explain the significance of determination of FEV1 / FVC ratio in

clinical practice.2. Describe the factors that influence vital capacity and mention 3

pathological conditions in which VC is reduced.3. Define Peak Expiratory Flow Rate (PEFR) and Mid-expiratory flow rate

(FEF 25 - 75%). Name insttruments used for their measurementsand describe the significance of these measurements in assessing lungfunction.

4. Define closing volume, describe the method for its measurement andexpalin the clinical significance of its measuremet.

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5. State the normal values for PaO2 , PaCO2 and pH and describe briefly thechanges occureing in these parameters in respiratory disease e.g.

chronic respiratory failure.

V. BMR AND EXERCISE

A. General Aspects of Energy Balance1. State that the energy liberated by catabolism appears as external work, heat or is stored in

the organism by anabolic processes.2. Define the term metabolic rate as the amount of catabolic energy liberated per unit time and

state that this energy derives from energy of oxidation and other chemical degradations.3. Justify the use of oxygen consumption for the determination of metabolic rate by the

indirect calorimetric method.4. Explain the relevance of the R.Q. to the measurement of the metabolic

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rate and describe conditions in which the R.Q. may be altered.5. Define the term basal metabolic rate by giving the experimental

conditions for its determination.6. Describe a method for measuring BMR.7. Give a reasonable value for BMR in a young adult male. State how

BMR varies with sex, age, starvation, body temperature, secretion ofthyroid hormones and adrenaline.

8. Explain the term specific dynamic action (SDA) of food and state theapproximate percentage SDA of protein, fat and carbohydrate. Explainthe relevance of SDA to measurement of BMR.

B. Exercise1. State that the contraction of skeletal muscles is the primary event in

exercise and energy is utilized for mechanical work and heatproduction.

2. a) List the sources of energy available for exercising musclesb) Mention differences between slow and fast muscles.

3. Define VO2 max and explain its relevance to the level of exercise and

list the factors which influence it such as age, sex, physical fitness.4. Define the term anaerobic threshold and explain its importance.

5. Define O2 debt and state its significance:a) indicate graphically the relationship of O2 debt to exercise.b) Describe how the extra oxygen taken up, when paying off an oxygen

debt is utilized.6. Describe briefly the cardiovascular response to exercise and explain the

changes in the microcirculation, cardiac output, blood pressure anddistribution of blood flow. Explain the physiological basis for thesechanges.

7. Describe briefly the factors which increase O2 delivery to exercising

muscles. Mention the oxygen requirements in light, moderate andsevere exercise compared to basal requirements.

8. Describe briefly the respiratory resonse to exercise and explain themechanisms responsible for changes in ventilation and O2 diffusioncapacity.

VI - KIDNEY AND BODY FLUIDS

A. Body fluids & Electrolytes:1. State approximate values for the distribution of body water and solutes in a

normal adult.2. Describe the effect of age, sex, and body fat content on the value for total

body water when expressed as a percentage of body weight.3. Give approximate normal values for the daily intake and output (External

Balance) of water, sodium and potassium.4. State that sites of rapid fluid and electrolyte exchange within the body are

gut, kidney and capillary beds. State the forces responsible for fluidand electrolyte exchange across cellular membranes.

5. Describe the effects of alterations in body water or solute content of ECFcompartment on the size and osmolality of ICF compartment.

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Sodium = 135-145 mEq / LPotassium = 3.5-5.0 mEq / LCalcium = 4.5-5.5 mEq / LBicarbonate = 24 - 28 mEq / LChloride = 100-106 mEq / LUrea Nitrogen (BUN) = 8 - 25 mg / 100 mlProtein = 6 - 8 g / 100 mlOsmolality = 285 + 10 m0sm / kg

2. Describe features of active transport and state that nutrional substance andcations in general are reabsorbed actively.

3. Describe the charactristics of Tm- limited reabsorption with specificreference to glucose.

4. Describe passive reabsorption with specific reference to anions and urea.5. Describe reabsorption in different tubular segments and indicate that H2O

reabsorption is controlled only at DT and CD by ADH.6. Describe the physical forces which operate to transfer fluid from the lateral

clefts to the peritubular capillaries.

E. Tubular Secretion:1. State that few endogenous substances and ions (creatinin, uric acid, K+ and

H+) and a lot of exogenous substances are secreted by renal tubules.2. Describe the characteristics of TM- limited secretion (Use PAH as an

example).3. Describe gradient - time limited transport process i.e. H+ion secretion and

Na+ reabsorption.F. Concentration of Urine:

1. Define filtered load and state the average proportion of the filtrate that isreabsorbed at each segment of the nephron.

2. State that hyperosmolar state in renal medulla is required to excrete

concentrate urine and this is created by accumulation of salts andurea.

3. State that hyperosmolar state require the counter current system and ADH.4. Describe the counter-current multiplier system of the loop of Henle due to

the passive transport of sodium and active transport of Cl- in thethick ascending limb of the loop fo Henle.

5. State that the transfer of NaCl out of the ascending limb is not followed bywater.

6. Indicate that the vasa recta are the counter-current exchange system anddescribe their role in preserving the hyperosmolar state in renal

medulla.7. Describe the role of urea in establishment of hyperosmolar medullary state.8. Describe the role of ADH in urine concentration.9. State that in the absence of ADH, hypotonic urine can be produced.

G. Sodium Metabolism:1. Describe mechanisms of sodium reabsorption in different tubular segments.2. Describe the effect of GFR, aldoesterone, atrial natriuretic factor and Na+

load at DT and rate of sodium reabsorption.H. Calcium Metabolism:

1. Describe the renal influence on calcium metabolism.

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7. Describe the effect of altered PCO2 , Cl- , potassium, aldosterone and blood

volume on HCO3 reabsorption and H+ secretion.

8. Describe excretion of NaH2PO4 and ammonium ion by the distal nephroand its adaptation in acidosis.

VII - ACID - BASE BALANCE

A- State the biological importance of regulation of PH of body fluids in relation tohomeostais and defence mechanishms under following headings1. buffers2. respiratory function3. kidney function

B- Buffers1. briefly outline how a buffer works2. state and define the different types of buffers present in our body in its

different compartments

3. briefly explain the special Properties of the carbonic acid - bicarbonatebuffer

C- Processing of H2CO3 by the body1. outine the rate of production of H2CO3

- in the body2. explain how the CO2 eliminated by lungs is3. Describe the acid - base aspects of CO2 transport by blood

D- Processing of fixed acids by the body1. mention the source and rate of production of fixed acids in the body2. explain how the fixed acids are buffered in body fluids.3. Describe the mechanism by which the fixed acids are eliminated by the

kidney from the body.

E- Processing of alkali by the body1. what are sources of alkali Production in the body2. explain how the alkali is buffered in the body.3. Describe briefly the mechanism of elimination of alkali by the kidney.

F- Acid - base diagramsDraw the Acid - base diagrams of the following and label them.1. PH Vs HCO3

-

2. PCO2 Vs H+

G- Metabolic Acidosis1. outline few cauises of metabolic acidosis2. Briefly describe how the Intracellulbr (ICF) and extracellular (ECF) fluids

are buffered during metabolic acidosis.3. How the respiratory system compensates the metabolic acidosis4. explain how the kidney compensates the metabolic acidosis

H- Respiratory Alkalosis1. outline few causes of metabolic alkalosis2. Briefly describe how the intracellular (ICF) and extracellular (ECF) fluids

are buffered during respiratory alkalosis.3. how the respiratory system compensates the respiratory alkalosis

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4. explain how the renal system (Kidney) compensates the respiratoryalkalosis

I. Respiratory Acidosis1. outline some causes of respiratory acidosis2. explain the mechanisms by which extracellular (ECF) and intracellular

(ECF) fluids are buffered durning respiratory acidosis3. briefly describe the mechanism how kudney compensates the respiratory

acidosisJ- Respiratory AlKalosis

1. mention few causes of repiratory alkalosis2. explain the mechansims of how the extracellular and intracellular fluids are

buffered during respiratory alkalosis3. briefly describe the mechanism how kidney compensates the respiratory

alkalosis.

VIII - GASTROINTESTINAL SYSTEM

A. General Regulation of Gastrointestinal Tract1. Describe the functional organization of the gastrointestinal tract.2. Describe the extrinsic and intrinsic innervation of the gut, the location of the submucosal

and myenteric plexuses and appreciate the complexity of the enteric nervous system.3. Understand that control of gastrointestinal function is by neuro-hormonal mechanisms.

B. Oral Physiology: Salivation and Swallowing1. Be familiar with the histology and innervation of the three main salivary glands in man.2. Describe the reflex control of salivary secretion, and list the stimuli

which elicit the reflex.3. Define conditioned and unconditioned reflex salivation, and state their

relative importance to man.4. Describe the secretory and vascular effects of stimulating sympathetic

and para-sympathetic nerves to the salivary glands, and give examplesof drugs which effect salivary secretion.

5. State the major constituents and describe the major functions of saliva.6. Describe the mechanism of swallowing in terms of the three stages;

buccal, pharyngeal and oesophageal.7. Describe the factors responsible for the competence of the gastro-

oesophageal junction and the consequences of their failure.8. Describe the nervous and hormonal control of the lower oesophageal

sphincter.C. Stomach

1. Label a diagram of the stomach with the terms cardia, fundus, body,antrum (pyloric antrum), pylorus.

2. Describe the extrinsic and intrinsic innervation of the stomach.3. Outline the major functions of the stomach.

D. Gastric Secretion1. Describe the main constituents of gastric juice, and their functions.

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2. Describe the process of hydrochloric acid production by the parietalcell.

3. Describe the neural and chemical factors which stimulate gastricsecretion.

4. Define the three classical phases of gastric secretion (cephalic, gastricand intestinal), explain the neural and hormonal mechanisms involved.

5. State that gastrin is a polypeptide hormone existing in several formsand secreted from the gastric antrum and upper small intestine. Listthe conditions under which gastrin is normally secreted and describe itsimportant physiological actions.

6. Describe the mechanisms responsible for inhibiting gastric acidsecretion, including those initiated in the pyloric antrum and uppersmall intestine.

E. Gastric Motility and Emptying1. Describe the Basic Electrical Rhythm (BER) and state its significance.2. Describe receptive relaxation of the stomach and briefly explain its

mechanism and control.3. Describe gastric peristalsis and its control.4. Describe the process of gastric emptying.5. State that the pylorus is usually relaxed and that gastric emptying is mainly

due to the intensity of the gastroduodenal pump.6. Describe the effect and the mechanism of the following on gastric motility and the rate of gastric

emptying.a) volume of meal remaining in stomachb) fat in the intestinec) hypertonic solutions in the duodenumd) acid in the duodenum

e) fear or stressf) vagotomy

F. Vomiting1. Describe the mechanism of vomiting, using such terms as stimulus,

receptor, vomiting center, afferents and efferents and the act of vomiting.

2. List the agents capable of eliciting vomiting through their action on thechemoreceptor trigger zone.

3. Describe the effects of prolonged vomiting on water, electrolyte andacid-base balance.

G. Gastric Function Tests1. Describe how gastric juice may be collected in man to estimate basal

acid output (BAO) and maximal or peak acid output (MAO-PAO).2. List the names of three stimuli to gastric acid secretion in man.3. State that MAO is directly proportional to the parietal cell mass

(PCM).4. Explain the physiological basis for the use of insulin hypoglycemia

(Hollander insulin test) as a test for the completence of vagotomy inman.

H. Exocrine Pancreas

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1. Draw a labelled diagram of a lobule of the exocrine panceas, showingthe cells which secrete:

a) electrolytesb) enzymes2. State the approximate daily volume of pancreatic juice, its pH, and list the main constituents.3. Explain the function of each of the main constituents of pancreatic juice.4. Describe the nervous and hormonal mechanisms controlling pancreatic

secretion in terms of cephalic, gastric and intestinal phases.5. Describe the origin, main structural features, mode of release and physiological actions

of secretin and cholecystokinin pancreozymin (CCK-pZ)6. Describe the principles underlying tests of pancreatic function and describe the effects

of pancreatic deficiency on digestion and absorption of major food constituents.I. The Liver 1. Draw a diagram of a louble of the liver. Label it with the terms:a) loubleb) central lobular branch of hepatic veinc) hepatic artery

d) (hepatic) portal veine) bile canaliculif) bile duct)) parenchymah) sinusoidi) Kuffer cell (macrophage)2. Give the normal portal pressures and describe the causes and

consequences of raised portal blood pressure.3. State and explain the functions of the liver4. Describe the principles underlying the commonly used tests of liver

function.

5. Describe the effects of liver failure in terms of ascites and oedema.6. Define the term bile salt pool. Describe the enterohepatic circulation

of bile salts, and give an estimate of the efficiency of this process.7. Describe the actions of the gall mucosa in concentrating the hepatic

bile during storage.K. The Small Intestine1. Draw and label a diagram of the cross-section of the small bowel,

using the terms longitudinal muscle, circular muscle, muscularismucosa, villus, lacteal, crypts of lieberkuhn, columnar epithelium ofmucosa.

2. List 3 anatomical characteristics of the small intestine which increasethe surface area.

3. Explain the way in which the intestinal mucosa is continually replacedby succeeding generations of cells, and give an estimate of the turnovertime for this process.

4. Describe the composition and functions of succus entericus andexplain the importance of brush border enzymes.

5. List and explain the factors influencing the secretion of intestinal juice.6. Describe briefly the intestinal breakdown of carbohydrate, fat and

protein.

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7. Describe the absorption of carbohydrates, fats and proteins in terms of themechanism, site in the small intestine and state the proportion absorbed.

8. Describe the absorption of water soluble and fat soluble vitamins.9. Describe the common cause and consequences of lactase deficiency.10. State that bile salts and vitamin B12 are absorbed in the terminal ileum and

hence predict the effect of loss of function of removal of the terminal ileum.11. Describe the process of absorption of water and electrolytes, and

explain the importance of their internal turnover.12. Describe the non-propulsive movements of the small intestine and mention

their importance for intestinal digestion and absorption.13. Describe peristalsis in terms of mechanisms, rate, direction, function

and regulation.L. The Large Intestine

1. Compare and contrast the main structural features of the colon withthose of the small intestine.

2. Describe the function of the ileo-caecal valve, and the large intestine inman.

3. Describe the movements of the colon using such terms as propulsiveand non-propulsive and give approximate transit times for a meal.

4. Describe the process of secretion and absorption in the colon givingthe approximate volume of water absorbed per day and naming somesubstances and drugs which can be absorbed from the colon.

5. Describe the significance of normal bacterial flora in the intestine.6. Describe the gastrocolic response and explain how it can be modified.7. Describe the general composition of faeces and understand that it is

mainly derived from non-dietary sources.

IX - ENDOCRINES

A- General Endocrinology:1. a) Define the term hormone and list importnat criteria required to

establish that an organ has an endocrine function.b) Define the term paracrine secretion and give atleast one example.

2. Draw a simple diagram to show the integration of nervous and hormonalcontrol systems in the body.

3. Classify the hormones into:a) local and general hormonesb) protein and steroid hormonesc) hormones other than the proteins and steroids.

4. Control of endocrine secretion generally involves feedback systems ofvarying complexity. Give one example of systems controlled in the

following manner.a) The metabolite regulated by the hormone acts directly on the

endocrine gland .b) The physiological variable acts on the hypothalamus which directly

regulates hormone secretion.

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3. Give the primary stimulus which results in increased vasopressin (ADH)secretion.

4. Describe the actions of vasopressin on the kidney and the cardiovascularsystem .

5. Give a general definition of the term neuroendocrine reflex and illustrateusing oxytocin release as your example.

6. Name the two target organs of oxytocin and describe its effects on eachorgan.

7. Describe the effects of destruction of the neurohypophysis and explain thesymptoms of diabetes insipidus.

8. Describe the consequences of the antidiuretic action of vasopressin whenthe hormone is inappropriately secreted.

E- The Thyroid:1. Name the plasma proteins which bind thyroid hormones in plasma, and

state the need for plasma protein binding. Give two clinicalexamples of the application of this knowledge.

2. List the physiologically important actions of thyroid stimulating hormoneTSH, on the thyroid gland.

3. Give the effect of T3 and T4 on TSH secretion and explain what is meantby autoregulation of thyroid function.

4. Compare the effectiveness and degree of boilogic activity of T3 and T4.5. Define the term basal metabolic rate and describe how it is affected by

thyroidectomy.6. Describe the changes in growth and development after thyroidectomy in

early life.7. Discuss the physiological basis for the production of symptoms in:

a) iodine deficiency

b) myxoedema8. Give a definition of the term endemic goiter.9. Briefly account for the changes, associated with hyper secretion of the

thyroid hormones (Graves disease).10. Define the term LATS and Thyroid Stimulating Immunoglobulins (TSI).11. Expalin the physiological principles of thyroid function testing using

radioactive iodine and hormone measurements, and TRHstimulation test.

F- The Adrenal Gland1. Draw a labelled diagram of a section through the adrenal gland to show the

three zones of the cortex, and the medulla.2. List the main hormones secreted by each part of the gland.3. Give the relative importance for life for the products of the cortex and the

medulla.

G- Adrenal Medulla:1. Describe the evidence for the dependence of catecholamine secretion on

the innervation of the adrenal medulla.

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2. Name three physiological conditions which result in the release ofcatecholamines.

3. List three actions of adrenaline which distinguish its role from that ofpostganglionic sympathetic nerves.

H- Adrenal Cortex:1. Name three major groups of steroids secreted by the adrenal cortex and say

which zones produce them.

a- Glucocorticoids1. Name the main glucocorticoid in man and describe the form in

which it circulates in the blood.2. Describe the diurnal variations in plasma cortisol levels and explain

their clinical significance.3. Name the hormone which controls the rate at which cortisol is

synthesized and secreted.4. Describe the effect of stress on the hypothalamic pituitary adrenal

axis and discuss the importance of the changes in cortisollevels.

5. List three mechanisms by which glucocorticoids elevate bloodglucose concentration and show diagrammatically how

these relate to cortisol effects on protein and fat metabolism.6. Explain briefly the effect of cortisol on wound healing, and the

inflammatory and immune responses.b- Mineralocorticoids

1. Name the major mineralocorticoid in man.2. Give the cellular actions of aldostreone and say in which tissues it

acts.

3. Give three factors which control the rate of aldosterone production.4. Describe the role of aldosterone and angiotensin system and say

what effect increased angiotensin has on aldosterone output.Illustrate with examples from clinical situations and the use

of blockers of the renin-angiotensin system.5. Describe the role of aldosterone and angiotensin in the restoration

of blood pressure after sodium depletion and water loss.

c- Adrenocortical Sex Hormones1. Name the main androgens produced by the human adrenal cortex

and comment on their possible physiological role in thefoetus and adult.

2. State whether oestrogen secreted by the cortex has anyphysiological role.

d- Disorders of Adrenal FunctionLocate the lesions and list, and explain the main signs and symptoms in the

following conditions:a) primary aldosteronismb) secondary aldosteronism

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c) Cushings syndromed) adrenogenital syndromee) phaeochromocytomaf) Addisons disease

I- The Pancreas1. State the three major endocrine cell types of the pancreas, and the

respective hormones secreted by them.2. Give the actions of glucagon on:

a) hepatic glycogenolysisb) gluconeogenesis

3. Say what effect low plasma glucose has on glucagon secretion andstate two other stimuli of glucagon release.

4. List the effects of insulin on:a) protein metabolismb) lipid metabolism

5. List the five principle hormones upon whose co-ordinated activityblood glucose concentration depends in the fed and fasting

state and explain briefly how each acts in this regard.

6. Explain the effect of the following endocrine disorders on bloodglucos levels:

a) diabetes mellitusb) insulinomac) Cushings disease

7. Explain briefly the use of the glucose tolerance test in studyingnormal and pathological carbohydrate metabolism.

8. List three mechanisms for control of insulin secretion.9. Describe three ways in which insulin lowers blood glucose

concentration.J- Calcium Metabolism:

1. Name three forms and approximate proportions in which calcium iscarried in the blood, and say which of these can diffuse from theplasma into interstitial fluid.

2. a) Explain how parathormone and calcitonin act in order tomaintain the plasma calcium concentrations within

normal limits.b) Identify the main stimulus for the release, and give the site

of production, of each hormone.3. Describe and explain one of the signs or symptoms that can occur

when the level of plasma calcium is:i) higher and lower ii) higher than normal

4. a) Describe three sites from which calcium can be lost from thebody and the source of calcium in each case. Explain whichof these losses are inevitable, and state what factors cancontrol some of the loss for each site.

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5. Explain how the bone can act as a reservoir of calcium in he body,mentioning two of the differences between the rapidly exchangeablepool of calcium and the reservior that depends on breakdown of thecollagen matrix of bone.

6. Explain how vitamin D deficiency can arise, one of its signs ininfants and how it may be treated, giving a dietary and a non-dietarysource of the vitamin. State which are the two main sites of actionof the hormone 1.25 dihydroxycholecalciferol formed from vitaminD , explaining how its action at each site could prevent rickets.

X. REPRODUCTION

A. Male Reproductive System:1. Draw a labeled diagram to show the arrangement of the internal and

external reproductive organs (including accessory glands) in a man.

Sex differentiation:- Describe the role of testosterone and Mullerian inhibitory factor in the

development of phenotypic sex.- State the basis of how occasionally discrepancies occur between genetic

and anatomical sexes.- Explain role Y chromosome in determining gonadal sex.2. State that the testes descends into the scrotum, and explain the

consequencs when the testis fails to desend.3. Explain the relative importance of the testes and adrenal cortex in

producing androgens of varying potency.4. State that the functions of testes include sperm production and secretion of

androgens.5. Recognize that the Leydig cells are the cells which secrete testosterone and

describe the actions of testosterone in the foetue, at puberty and in adultlife on.

a) internal genitaliab) external genitaliac) secondary sex characteristicsd) metabolism of bone growth and behavior.

6. Predict the ultimate effects of castration before and after puberty.7. Briefly describe the functional importance of the different parts of

spermatozoa.8. Describe the process of spermatogenesis and state its duration.9. Describe the Sertoli cell and its importance in spermatogenesis.10. State the importance of x-chromosome for sperm development and

recognize that packaging does not involve change in the number ofchromosomes.

11. Draw a diagram to show the relationship between the hypothalamus,anterior pituitary and testes in the controls of spermatogenesis and

testosterone production.12. Give the principla features of ejaculate of normal fertile semen.

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13. Indicate that infertility could result from abnormalities in nuber, motility ormorphology of sperms.

14. State that the male sex act has got tow components: erection andejaculation.

15. Describe erection reflex and explain how a defect in erection reflex couldlead to impotence.

16. Describe the mechanism of ejaculation (emission and explsion phases).17. Describe the functions of male reproductive tract and accessory glands.

B. Female Reproductive System:1. Draw a labeled diagram to show the principal structural features of the

female reproductive system.2. Describe the major events in the reproductive life of a female using such

terms as: Puberty, Gonadotrophins, Ovulation, Endometrium,Menstrual Cycle, Fertilization, Pregnancy and Menopause.

3. Describe the actions of estrogen and progestrones on:- Internal genitalia

- External genitalia- Secondary sex characteristics- Non reproductive functions.

4. State that the functions of femal gonads (ovaries) includes secretin offemale sex hormones as well as ovum production.

5. State the duration of an idealized menstrual cycle and explain how the daysof the cycle are numbered.

6. With the help of a diagram explain.a) Menstrual, proliferative and secretory phases.b) Time of ovulation.c) Estrogen and Progesterone chages

d) LH and FSH changes.7. a) Describe the development , maturation and regression of primodial

follicles during the menstrual cycle.b) Explain the significance of the LH- Surge.

8. Name the main source of estrogen and progesterone in the adult woman.9. Describe the endometrial changes during the menstrual cycle and relate

them to the circulating levels of estrogen and progesterone.10. Describe the changes in structure and secretions of the vaginal mucosa andcervix during the menstrual cycle and relate them to the circulating levelsof estrogens and progesterone.11. With the aids of diagrams deagrams describe the endocrine control of the

mentstrual cycle (folliculr phase and luteal phase).12. Describe the explain the endocrine changes which occur in the post-

menopausal woman.13. Explain how it is possible to prevent ovulation by the administration of

estrogen and progesterone and discuss the mechanisms of action.14. Briefly describe the mechanism of female sex ual.

C- Pregnancy, Parturition and Lactation:1. Explain how the ovum reaches the uterus and where:

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a) fertilization andb) implantation usually occur

2. Give the time in the menstrual cycle at which ovulation usually occurs, andthe intervals before subsequent.

a) fertilization andb) implantation of the ovum and zygote.

3. Give the normal length of gestation in days and the rule by which the dateof delivery is predicted.

4. Explain the prolongation of the life of the corpus luteum at the begininingof pregnancy of pregnancy and discuss its importance in the maintenance ofpregnancy.

5. Describe the role of placental hormones in the maintenance of pregnancy:this includes human chorionic somatomammotropin and relaxin

6. Describe the use of hormone estimation in the diagnosis of pregnancy andthe assessment of the viability of fetus.

7. a) Define the stages of labour and indicate the endocrine changesinfluencing each of these stages.

b) Describe the mechanism of parturition.8. Describe the hormonal control of mammary development both at puberty

and during pregnancy.9. a) Distinguish between and describe the control of mild secretion and

the suckling reflex (milk ejection reflex)b) State how lactation is initiated after parturition and how lactation is

maintained?10. State the composition of human milk, commenting on its suitability for the

new born baby.11. Describe the physiologyical basis of lactational amenorrhea.

XI - TEMPERATURE REGULATION

1. Define the temperature and heat content.2. Define the thermal unit 1 calorie.3. Give an account of the physical laws that apply to various forms of heat exchange

between the body and its surroundings, and to the transport of heat in the body.4. Define the terms homeothermic and poikilothermic.5. Write the equations for heat balance in the body as:

a) rate of heat accumulation = rate of heat production - rate of heat lossb) rate of heat accumulation = body weight (g) X specific heat of body (0.83

Cal / g ) X change in mean body temperature / unit time.6. Describe the regulating system and the mechanisms which come into operation

when heat production and heat loss change, mentioning that there are twocenters; explain the effect of either stimulation or injury on each of them.

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7. State that the homeothermic animal tries to maintain a constant internal bodytemperature, whereas the temperature of the peripheral parts depends on theenvironmental temperature and the cutaneous blood flow.

8. State that the rectal for oral temperature gives a fair measure of the internal bodytemperature.

9. State that the oral temperature lies approximately 0.5oC below the rectaltemperature.

10. State that during more or less basal conditions body temperature, measuredrectally or orally, is a regulated variable that has individual variaitons (SD = 0.2 oC)and 24 hour variations (approx. 0.5oC higher in the evening than in the morning)around 37oC.

11. Give the possible ways of heat exchange between the body and its environment,and for the transport of heat in the body.

12. Account for the possibilities that the body has a changingheat production and heatloss respectively under certain physical circumstances.

13. Give a few physiological circumstances under which body temperature changes(muscular activity, ovulation).

14. State that babies and anaesthetized patients have poorer temperature regulationthan awake adults and give reasons for this difference.

15. Describe how the thyroid gland can affect body temperature.16. Give the changes that take place in circulation, respiration and energy metabolism

in cases of hyper and hypothermia, and state that temperature regulation ceaseswhen the rectal temperature is below 28oC or above 40oC.

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Physiology Objectives Detailed

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