Proposed Physiology Syllabus

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Program(s) Title Course code

Bachelor of Medicine and Surgery; MB,BCh1104 I ,1204II

Department offering the course Physiology department

Academic year / Level First and second year

Total Teaching Hours Total : 240

Lecture : 195

Practical : 45

Allocated Marks 300

Allocated Duration 2 academic years

Course Director Dr. Basma Gatani

Teaching Staff 1 associat prof, 3 lecturer, 4 assisstant lecturer

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I) Course specification

1. provide our students with a thorough understanding of the basic principles of Medical Physiology.

2. enable them to integrate what they have learned about body structure, biochemistry, and physiology into a meaningful body of biomedical knowledge.

3. Provide insights into the pathophysiologic mechanisms of disease, thereby giving our students a solid foundation for their future medical training and clinical practice.

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

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

(A) Knowledge

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

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

controlled.

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II) The overall objectives of the present course

III) General Intended Learning Outcomes (ILOs) of the Course

(B) Cognitive Skills

Students should be able to:

Illustrate the integration of the functions of the different body organ systems in maintaining homeostasis.

Depict the Patho-physiological consequences of dysfunctions of the different body organ systems.

(C) Interpersonal Skills and ResponsibilitySkills

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

Students will:

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

encountered.

(D) Communication, Information Technology, and Numerical Skills

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

Students will:

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

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(E) Psychomotor Skills:

Students demonstrate the basic skills of:

Determining the hematocrit value and hemoglobin content, blood indices Estimation of ESR, bleeding time , clotting time Heart rate and pulse determination Blood pressure measurement. Recording electrocardiogram (ECG). Interpreting the normal sinus rhythm and comment on the ECG waves and

intervals. Auscultating the heart. Conducing a spirometry test and interpretation of the results Examining the sensory system. Examining the deep tendon reflexes. Examining the light reflex. Examining the visual acuity.

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

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IV) Instructional MethodsV) the Course

Cellular Physiology and Nerve &Muscle Physiology (15 h)

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

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

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

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

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

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

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V) Intended Contents for first year students

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

NERVE / MUSCLE PHYSIOLOGY

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

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

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

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

5. Striations Sarcomere Myosin Actin Troponin

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

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

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

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

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

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

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

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

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

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

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

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

Autonomic nervous system (15)

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

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Blood physiology (12h)1. Introduction : Fluid connective tissue, its relationship to total body fluids, normal

volume, increase/decrease of it and its effect on the body function in general. Composition in detail.

2. Plasma :- fluid component of the blood, % present, plasma proteins, different types of proteins present, origin of each, function of each protein, variation in each one of it and its implication on the body function.

3. Red blood cells :- origin, stages of formation, stimulus for the formation, normal values, function destruction and the end products. Anemia, different types, polycythemia.

4. White blood cells :-Different types of WBCs, formation, % of each one of them in the blood, stimulus for the formation, functions of each of them, Reticuloendothelial system, inflammation, immunity and different types.

5. Blood groups :- ABO and Rh blood groups should be discussed in detail. Blood transfusion, blood bank and its importance.

6. Platelets: - Count, formation, function, variations of it and its effect, bleeding Aspirin and its importance.

7. Blood coagulation :- Should be discussed in detail. Clotting factors, mechanism of clotting and bleeding disorders, Anticlotting mechanisms (Antithrombin, Fibrinolytic system), Anticoagulants. Hemostasis.

Cardiovascular System (25h) 1. Introduction to CVS , basic function, in few sentences. How cardiovascular system, fits

in the functioning of the body, to sustain the life. Properties of cardiac muscle, Anatomy of the cardiac muscle, Cardiac pacemaker, Generation of an action potential, Comparison of cardiac and skeletal muscle.

2. Conducting system of the heart , in detail, Impulse generation from the peacemaker and conduction through the conducting system, rhythmic excitation of heart, Autonomic nerves supply to the heart and to the pacemaker, and its influence over the function, Abnormal rhythm of the heart (heart block, cardiac arrest, ectopic focus, artificial pacemaker).

3. Normal ECG , principle of different waves, method of recording in detail. Clinical uses of ECG, HR calculation, arrhythmia, IHD, and electrolyte disturbance. Cardiac axis, vector analysis. Changes in the ECG during cardiac abnormalities and its interpretation, Vectrocardiography, Echocardiography

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4. Definition of cardiac cycle , mechanical events, pressure & volume changes in cardiac cycle (their graphs or waves). Its related issues like pulse, JVP and heart sounds.

5. Factors regulating the cardiac funct ion, perfusion of mammaliam heart and effects of different ions, on the heart functions. The effect of increase or decrease of minerals on the heart function.

6. Cardiac output , factors controlling it, venous return, relation of cardiac output and Venous return, Starling law of heart and heart failure..

7. Blood pressure , definition, details of factors regulating it, principles of measurements, importance of regulation, certain common abnormalities .Mean arterial pressure, pulse pressure, their importance.

8. Regulation of blood pressure short and long term. Physiological basis of hypertension treatment.

9. Hemodynamic of circulation , anatomical structure of blood vessels, at different levels, their innervations and control physical characteristic of blood. Interrelationship between pressure, flow and resistance.

10. Systemic circulation , in all its details. Exchanges of fluid at the capillaries, starling forces, veins, venous pressure, venous pump. Role of lymphatic circulation, pathogenesis of edema.

11. Tissue perfusion , factors effecting the tissue perfusion. Metabolic, humoral and nervous factors to be discussed in detail.

12. Special circulation :Pulmonary, Cardiac , cerebral , Splanchnic (intestinaland hepatic circulation) Cutaneous Circulation.

13. Coronary circulation : vessel organization, normal blood flow, age related disorders of the coronary vessels, myocardial infraction, cardiac failure, cardiac arrest.

14. Pulmonary circulation :structure of pulmonary vasculature, pressure flow through the lungs, capillary dynamic, pulmonary edema, embolism.

15. Circulatory shock , definition, causes, types, and management in short.16. Circulatory adjustments during physical exercise .

Respiration (22 h)1. Anatomy of the Lung, mechanics of respiration, muscles of respiration.2. Ventilation, lung volume and capacities Anatomical and physiological dead space.3. Dynamics of ventilation, alveolar stability, surfactant, lung compliance.4. Gas exchange in the lung, diffusion of gas across alveolar capillary membrane,

Ventilation - perfusion ratio.5. Gas transport between the lung and the tissues:- oxygen transport and carbon dioxide

transport in the blood and body fluids.6. Regulation of respiration:- introduction, respiratory centers,neural control of breathing,

Chemical control of breathing, nonchemical influence on respiration.

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7. Respiratory adjustment:- hypoxia,hypoxic hypoxia, exercise, respiratory abnormalities 8. Lung function tests.

Gastrointestinal Physiology (12 h) 1. Introduction to gastrointestinal tract , its innervation, and function in general. Salivary

glands, types of glands, Innervation, , saliva, composition, stimulus, secretion, and functions.

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

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

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

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

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

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

8. Large Intestine : Functions and motility abnormalities.

9. Defection :- defection Reflex

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Renal Physiology (23 h)

Learning Objectives

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

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

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

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

4- Explain the concept of renal clearance.

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

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

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

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

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

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

9- List the major functions of the kidney

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V) Intended Contents for second year students

10- Describe the voiding reflex and draw a cystometrogram

Acid-Base Balance

Learning Objectives:

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

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

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

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

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

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

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

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

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

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

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

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

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Endocrinology (18 h)1. Introduction to endocrinology :- Role of these endocrine glands in general, how does

these glands with its function contributes towards HOMEOSTASIS.2. Classification of hormones :-Nature of the hormone and the general mechanism of

action. Negative feedback mechanism, relation of a hormone and its own receptors. What is the relationship between the endocrine glands and brain function.

3. Names of all the endocrine glands. Pituitary gland, anterior and posterior. Hormones released by anterior pituitary gland (TSH, ACTH, LH,FSH, prolactin, and Growth hormone).Except growth hormone, the functions of other hormones must be mentioned in brief, the details of each will be taught at the respective places.

4. Posterior pituitary gland , hormone, release and its relationship with hypothalamus .Hypothalamus and its relationship with endocrine glands. Hypothalamo-hypophyseal portal system.

5. Growth hormone :-Release, control, normal function, abnormalities. Physiology of growth: This should be discussed in detail, as growth hormone is one, other hormones, nutrition, and genetic makeup the total picture.

6. Thyroid gland :- Hormone synthesis, release, control, function, Its action at cellular level, should be discussed. Pathophysiology of the thyroid gland

7. Parathyroid gland :-Synthesis of the hormone, stimulus, release, its function, its relationship to Vitamin C, and kidney, abnormalities. Calcitonin, its function. Over all function of blood calcium. Calcium and phosphate metabolism.

8. Pancrease :- endocrine function only. Cells concern with endocrine function.All hormones released by pancreas.Insulin in detail, synthesis,stimulus, release, functions on all the three metabolism. Regulation of blood glucose concentration. Glucagon, release and function. Pathophysiology of Diabetes mellitus in short.

9. Adrenal glands :- Aldosterone and Glucocorticoids. There synthesis, stimulus for release, regulation of release. Fate of the hormone, Functions in detail.

10. Abnormalities of Aldosterone and Glucocorticoids.

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Reproduction (8h)Sex Determination

i) Chromosomal Sex / The Sex Chromosomesii) Chromosomal and Hormonal Abnormalitiesiii) Sexual Differentiation in Embryo

Puberty and its Control

i) Onset of Puberty ii) Precocious and Delayed Puberty

3) Male Reproductive Physiology

i) Physiological anatomy of male sexual organsii) Spermatogenesis, or the Formation of Sperm, takes place in the Seminiferous Tubules

of the Testesiii) Physiology of the Mature Spermiv) Sertoli Cells Serve Several Functions that are Important for Spermatogenesisv) Maturation of Sperm in the Epididymisvi) Storage of Mature Spermvii) Addition of Nutrient Fluid by Seminal Vesicles, Prostate Gland, and Bulbo-Urethral

Glands viii) Neuro-endocrine Control of Male Reproduction involves an interaction Between the

Hypothalamus, Pituitary, and Testesix) Testosterone, the major Male Sex Hormone, has Physiological Effects on Many

Tissues of the BodyX) Male sexual act and its stagesXI) SemenXII) Abnormalities of Male Sexual Function, including Prostate Gland Hypertrophy,

Testicular Tumors and Hyper-gonadism in male.

4) Female Reproductive Physiology

i) Physiological Anatomy of Female Sexual Organs

ii) Oogenesis, or the Formation of Ova, Takes Place in the Ovaries

iv) Ovulation, or the release of an ovum from one of the two Ovaries, Occurs once in each Month from Puberty Until Menopause

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v) Neuro-endocrine Control of Reproduction in the Female involves an interaction Between the Hypothalamus, Pituitary, Ovaries, and Uterus (Control of Follicular i.e. Pre-ovulatory phase, Ovulation, Luteal i.e. Post-ovulatory phase, and Menstrual Phase)

x) Estrogen and Progesterone, the major Sex Hormones in the Female, have Physiological Effects on Many Tissues of the Body

vi) Menopause, i.e. Cessation of Menstruation in the Female

5) Pregnancy and Lactation

i) Process of Fertilization (i.e. Fusion of Sperm and Ovum)

ii) Following Ovulation, the Ovum is Transported Through the

Uterine Tube to the Uterus

iii) Following Ejaculation into the Vagina, Sperm Are Transported by

way of the Vagina, Cervix, and Uterus into the Uterine Tube

iv) Sperm must undergo the Acrosomal Reaction Before they are

Capable of Fertilizing an Ovum

v) Zona reaction Normally only one sperm penetrates to the inner portion of the zonapellucida surrounding the ovum).Multiple Births may be Monozygotic, Dizygotic, or a Combination of Both

vi) Cell division and Implantation following Fertilizationvii) Formation of Embryonic Membraneviii) Functions of Placenta and Placental Hormonesix) Hormonal Changes during Pregnancyx) Parturition (Labor)xi) Lactation, Breast Development, Initiation of Lactation, Milk Secretion and Ejection

(Let-down of Milk)

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Body temperature regulation(6h) 1. Introduction to body temperature regulation :- Homoeothermic and Pokilothermic.2. Source of increasing the body temperature.3. Source of decreasing the body temperature.4. Sweat glands in detail, types of glands , its distribution, Innervation and neurotransmitter

released.5. Vaporization of sweat and its importance in temperature regulation.6. Hypothalamu s :- Its role in regulation of temperature should be discussed in detail.7. Hypothermia and its clinical implications, should be discussed.(Blood bank, Organ bank

,and sperm bank) and Cryosurgery.

Physiology of Exercise (4h) 1. Introduction to exercise physiology, Physical activity, Exercise definition, Types of exercise, Resistance & Endurance exercise, Physical fitness.

2. Strength, power and endurance of muscle

3. Metabolism in exercise, Energy sources and types in different type of exercise, nutrients using during exercise, muscle fibers types and type of exercise

4. Cause of Post Exercise fatigue& Post Exercise Oxygen Consumption (PEOC)

5. Principle of myo-plasticity, Hypertrophy & atrophy

6. Cardiovascular physiology during exercise, HR, SV, CO, BP, cardiac hypertrophy, blood flow, ECG changes, myocardial oxygen consumption.

7. Maximal Oxygen consumption & Cardiopulmonary Exercise Test (CPET)

8. Respiratory Physiology during exercise.( all the changes should be mentioned in their details).

9. High lighting the importance of exercise in maintaining the normal health at all ages & recommend amount of exercise for adults

10. Benefits of regular exercise for normal health & Comparison of effects of aerobic endurance with resistance strength exercise training on health and fitness.

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11. Hormonal changes during exercise, temperature and sweat during exercise, hormonal disturbance in female athletic

12. Drugs and sports.

13. The recommendations provided by the American college of sports medicine for the weight loss and maintenance .

Neurophysiology: Central Nervous System (30 h)

Basic Concepts of Brain Function

1. An introduction to the brainfunction (Nervous System).

2. Organization of Nervous System :- Central Nervous System and Peripheral Nervous System.

3. Central Nervous System :- Brain :- Forebrain (Prosencephalon) Midbrain (Mesencephalon) and Hindbrain (Rhombencephalon).

4. Forebrain :- Telencephalon (Cerebral Cortex, Basal Ganglion), Diencephalon (Thalamus and Hypothalamus).

5. Rhombencephalon :- Metencephalon (Pons and cerebellum),Myelencephalon (Medulla Oblongata).

6. Spinal Cord :- , Spinal segment, Spinal nerves and Cranial nerves.

7. Functional Unit of the nervous system :- Nerve cell, (Neuron), different types of nerve cells. Unipolar cell, Pseudo-Unipolar cell, Bipolar cell, multipolar cell, with examples of each. A typical nerve cell, its different components like dendrites, dendritic spines, axon, (axon collateral, axon terminal, and synaptic end bulb). Detailed structure and functions.

8. Synaptic Vesicles :- What is synaptic vesicles, its presence, It has neurotransmitters vesicles, Axoplasmic transport,( Antrograde and Retrograde transport) Fast and slow transport.

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9. Nerve fiber :-Classification of nerve fibers, their diameter and rate of transmission of impulse. Myelinated and non-myelinated nerve fibbers. Importance of these two and other factors in impulse transmission.(Central and peripheral nerve myelination),

10. Glial cells :-Different types and their functions in the nervous system.

11. Information transmission :-Electrical and chemical transmission.

12. Electrical transmission :-Action Potential, in detail, ionic basis of action potential, sodium and potassium pump. Transmission of impulse in myelinated and unmyelinated nerve fiber. In brief about demyelinating disease (Multiple Sclerosis)

13. Synapses and synaptic transmission :-Types of synapses (Axosomatic, Axodendritic, Axoaxonic synapses). Electrical synapses, a brief information about it. Importance of electrical synapses. Chemical synapses, sequence of events at a chemical synapses. Properties of synaptic transmission.

14. Neurotransmitter and Receptor interaction :- a) Transmitter gated ionic channels b) G-Protein coupled receptor.(Metabotropic receptors)

a) Transmitter gated ionic channels :- Excitation (EPSP), Inhibition (IPSP).Summation, (Spatial summation and temporal summation).

b) G-Protein Coupled receptor:-Detail account of the receptor, its structure, activation, inactivation, formation of second messenger, and functions of each one of the second messenger. How this can explain the higher functions of the nervous system.? Nitric Oxide, its formation and function.

15. Neurotransmitters :-Criteria for a chemical to be called as a neurotransmitter. Neurotransmitter Candidates under Amines, Amino Acids, Peptides and Opioids. What is the clinical importance of these neurotransmitters.

16. Reaction of Neurons to injury:- Regeneration in the central and peripheral nervous system.

17. Organization of nerve cells :- Principle of Divergence and Convergance.

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18. Organization of Spinal Cord :- Disposition of gray and white matter, Anterior horn, Lateral horn and Posterior horn. In brief about the ascending and descending tracts, their location in the white matter of the cord. There functions.

19. Motor neurons of the spinal cord :- General distribution of the motor neuron, in the anterior horn of the cord. Laterally placed neurons and medially placed neurons and their innervations and functions. Alpha, Beta and Gama motor neurons.

20. What is a motor unit, :- and its functional importance .Small and Large motor units. Muscle tension. Final common pathway. In brief, how the pathways from the cerebral cortex, descend to spinal cord motor neuron, and influence its function.

21. Reflexes :-Definition, Reflex arc, (a functional unit at the level of spinal cord) Reflex action, Different components of a reflex arc, Propertiesof Reflexes.Bell-Megendi Law

22. Stretch Reflex :- Myotatic reflex In detail. Classification of reflexes. Monosynaptic and polysynaptic reflexes and their examples. Their anatomical organization .Superficial and deep reflexes. Inverse stretchreflex. and reciprocal innervations.

23. Receptors present in the muscle: _- Muscle spindle and Golgi tendonorgan. Their location, arrangementwith respect to extrafusalfibersInnervation,Function,Stimulus,Response,number of synapse and type reflex.

24. Organization of inhibitory systems :- Presynaptic inhibition, Postsynaptic inhibition and negative feedback inhibition.

Motor Neurons:- Lower motor neuron and Upper motor neuron, their definition , examples and their clinical importance

Sensory System:-Introduction to sensory system, Receptors, classification, location, Teleceptors ( Smel,Vision,Hearing and Taste), Exteroceptors, Proprioceptors, Interoceptors. Mechanoceptora:- Nociceptora, Thremoreceptors, Chemoreceptors. Sensory modalities, Adequate Stimulus.

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Cutaneous receptors distributed over the skin:- Morphology, distribution, properties, Adequate Stimulus, Doctrine of specific nerve energy, Law of projection, Receptive field. Intensity discrimination, Weber-Fechner Law and Adaptation ( Phasic receptors and Tonic receptors) Mechanism of adaptation, Electrical activity (Generator potential and generation of an action potential)

Sensory pathways:-Spinal cord cross section, Dorsal column pathway (Lemniscal Pathway), Antero-Lateral Pathway ( Anterior spinothalamic pathway, Lateral spinothalamic pathway), and Spinocerebellar pathway (Anterior and posterior cerebellar pathway).

Introduction to physiology of pain:- Superficial or cutaneous pain, Deep pain, Visceral pain, Neuropathic pain, and inflammatory pain. Nociceptors:-Types of Nerve fibers caring pain information, Fast pain (First pain),Slow pain (Secondpain), difference between the fast and slow pain. Pain pathways:- Neo-spinothalamic pathway and Paleospinothalamicpathway. Pain modulation:- (Gate control hypothesis, Mid-brain control,Opioid peptides)Referred Pain.

Roll of Glia in pathological pain.

Sensations from head and neck:-Trigeminal pathways.

Sensory disturbances:- Syringomyelia, TabesDoralis ,Peripheral Neuropathy

Motor System:-Introduction motor system, high-light that the sensory information should and must for the motor function to occur. Sensory and motor both function as a unit. Over all motor plan as as follows.

Spinal cord, Pyramidal/Extra pyramidal, cerebellum / vestibular apparatus, Basal ganglion, motor/premotor and sensory areas of the cerebral cortex foms the complete motor system of the brain. Each one has to be discussed.

1. Spinal motor system :- A section of the cord, distribution of motor neurons, Types of motor neuron, location and supply to muscles, Receptors in the skeletal muscle Muscle spindle/Golgi tendon organ, Location, arrangement, innervations, function, stimulus, response, number of synapses, reflex.

2. Function of muscle spindle,Golgi tendon organ .Interaction between the receptors and the motor neurons present in the cord. Functions of gamma motor neuron, Alpha-Gamma Linkage, motor unit (small and large) and its importance in motor function. Types of muscle fibers and their function. Size principle.

3. Pyramidal pathway ( corticospinal tract) :- Lateral/Anterior, their origin,course, and termination in the motor neurons in cord.The function and lesion effect.

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4. Extrapyramidal pathways :-Lateral vestibulospinal tract ,Medial vestibulospinal tract, Pontine reticulospinal tract, Medullary reticulospinal tract and tectospinal tract Their origin, course and termination and function.

Lower motor neuron, definition. and example .Lower motor neuron. Symptoms of lower motor neuron lesion.

Upper motor neuron, definition . Upper motor neuron lesion and its symptoms, Spasticity (spastic paralysis) Clasp-Knife phenomenon. Brown-Sequard syndrome (Hemi-section of spinal cord).

5. Cerebellum :-Vestibulocerebellum, Spinocerebellum and Cerebrocerebellum. (Functional Division) Functions in general.

a) Vestibulocerebellum:- Connections, functions and Abnormalities.( (ataxia of gait, Vertigo , Nystagmus)

b) Spinocerebellum:- Connections, functions,andAbnormalities.(ataxia of gait, incordination of lower limb)

c) Cerebrocerebellum (Neocerebellum) :- Connections, functions.Abnormalities:- Hypotonia, Dyssynergia, Dysmetria, Dysdiado-chokinesia, intention tremor and atxia of gait.

6. Vestibular apparatus :- Internal ear—vestibular apparatus—equilibrium. Bone and membranous labyrinth. Fluid present and its composition. Utricle, Saccule and Semicircular canal ( 3pairs).Their detailed structure of the vestibular receptors, stimulus and normal function. Generation of an action potential and transmission to the vestibular area of the cortex through vestibular pathway. Abnormalities in case of damage.

7. Basal Ganglia :-Definition, structures included in the basal ganglion. Connections of basal ganglion, neurotransmitters released in the basal ganglion, Functions of it.

8. Abnormalities of Basal ganglion:- Chorea, athetosis, ballism (Hyperkinetic movement). Akinesia, Bradykinesia (Hypokinetic movement).

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9. Parkinson's Disease (Paralysis Agitans) symptoms should be discussed in detail Akinesia, Bradykinesia, Tremor at rest ,Decreased associated movements, Rigidity ( lead/Cog-wheel rigidity)and Psychological disturbances. Non-motor symptoms.Pain in Parkinson patient should be discussed .L- DA, Futurehope:- neural transplant, Stem cell research may help these patients. should be mentioned ( Non-motor symptoms like pain, autonomic and psychological abnormalities)

10. Regulation of posture and locomotion :- Principal postural reflexes. What is muscle tone? Definition and tonic stretch reflex is the basis of muscle tone.

11. Spinal and cerebral shock :- Spinal shock, loss of all reflexes, Return of reflexes. Complication of quadriplegia and paraplegia.

12. Decerebrate Rigidity and decorticate rigidity.

13. Terms to be introduced :-Which part of the neural substrate damage will result in the following condition has to be discussed.Cortical Paraplegia, Monoplegia/Hemiplegia, Hemiplegia (Contralateral), Hemiplegia (ipsilateral), Quadriplegia, Paraplegia, Motor neuron disease.

Hypothalamus ( Diencephalon):-Introduction, its location, its functional relationship with other neural substrate. Names of different nuclei of hypothalamus. Functions of hypothalamus, inbrief :- (Control of autonomic function, temperature regulation, Control of endocrine glands, Thirst, feeding behavior, Reward and punishmentbehaviour, Sexual behavior, rage and placiditybehavior, Circadian rhythms, Immunological function and sleep)

Temperature regulation:- Only the role of anterior and posterior hypothalamus in temperature regulation.

Control of endocrine function:- Mention of releasing factors, and posterior pituitary hormones ( Supra-optic and paraventricular nucleus) release. Function is discussed in endocrine system.

Feeding behavior:-Most complex behavior, it is related to obesity, a major public health issue. Hence should be discussed in detail.

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General introduction:-It should be made very clear to the youngster, that this life sustaining behavior, is closely related to other system function, like digestive system, Taste/olfaction, other neural substrate, endocrine function, exercise, energy homeostasis, genetic make-up and at large to OBESITY / METABOLIC disorder, a major public health issue aroundthe world.

Neural substrates for feeding:- (1940-1950)Lateral hypothalamus (feeding center), Ventromedial hypothalamus (Satiety center)—Experimental evidence. Hypothalamic Obesity.

Current Concepts:-Other hypothalamic areas related to feeding.Paraventricularnucli (PVN), Dorsomedialnucli (DMH) and Arcuate nuclei (ARC)Arcuate nuclei:- POMC Neurons , Neuropeptide Y neuron. There detailed describtion, Inter-relationship, and the influence of Peripheral signals:- From G.I. Tract and from adipose tissue.

Thirst:- How this area can influence, the fluid intake, and maintain the body fluids within the normal range.

Reward or approach system and punishment or avoidance system :- The neural substrates, there distribution, the major chemical pathways associated with reward behavior are Dopaminergic and Noradrenergic pathways.

Significance of reward system:- Normal behavior:- ( Learning and memory) and abnormal behavior (Drug of ABUSE).

A special mentioned should be made, that reward and punishment regions of the brain, influence and shape the behavior of an organism or human throughout the LIFE.

Sexual behavior:-In brief, how hypothalamus influence the sexual behavior of the organism.

Circadian rhythms:- What is circadian rhythms? With some examples. How this rhythm influence the biological function. About suprachismatic nuclei, which sets up this rhythm. Some expermential evidence, how these nuclei understands day or night. molecular and genetic basis for this behavior.

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Immunological function:- A few sentences, about how hypothalamus , integrates, the psychology of an individual with the neural substrates, and endocrine to influence the immunological function.

Thalamus:-Anatomical location. Names of different group of nuclei, the afferent and efferent connections of different nuclear mass, Functions of nuclear mass.

Reticular Formation:- Location ofreticular formation, in the nervous system. Structures present. Important functions. Ascending reticular activating system, its function.

Chemical Pathways:- Noradrenergic, Dopaminergic, Serotonergic, and Cholinergic Pathways. Functions. Abnormalities of function, due to damage or altered function of these chemical pathways.

Limbic System ( Physiology of Emotions):- Introduction to this topic, how much this aspect of physiology is important in the life of an individual.Brain regions responsible for the emotions, Charateristic of emotions, Genes and expression of emotions, Influence of emotions on functions like:- Autonomic nervous system, Sexual behavior, Maternal behavior, Fear, Reward and punishment behavior. Role of limbic system in learning and memory.

Role of Amygdala and fear behavior, Hippocampus in learning/memory.Stress:- short term and long term stress—Physiological responses.

Cerebral Cortex:-Introduction to the highest mantle. Different areas of cortex, Specific areas, and Assocations areas. There functions in detail. Somatosensory area, Primary motor cortex. Frontal association area, parietal-temporal-occipital association area and temporal association cortex.Dominant (Categorical hemisphere) and Non-dominant (Representational hemisphere)Difference in functions of categorical and respresentational hemisphere. Clinical cases .Functions of frontal cortex.

Electroencephalogram (EEG):-Hans Berger, his discovery. Unipolar and Bipolar recording, Rhythm , Alpha rhythm, Alpha block, Desychronization, Synchronization of EEG,

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Variation of EEG, Sleep and EEG.

Physiology of Language (Speech):- General introduction, Expression of ideas in terms of language.Handedness and language, Anatomical areas associated with speech, What is a meaningful speech, A small description of each region concern with speech. Abnormalities of speech, Aphasia—definition, Types of aphasia—Broca's aphasia , Wernicke's aphasia, Conductive aphasia, Global aphasia and Apraxia of Speech. Agraphia. Agraphia.

Learning and Memory:- Definition,Types of learning:- Non-associative learning and Associativelearning. Non-associative learning, Ex:- Habituation , Sensitization.Associative Learning:- Conditioned Reflex. Pavlov's Classic Experiment:- Unconditioned Stimulus, Conditioned Stimulus.Intercortical transfer of Learning.

Memory:-Definition:- Non-declarative memory and Declarative memory. in detail.Biological basis :- Habituation, Sensitization, Post-Tetanic Potentiation, and long-term Potentiation.Anatomical structures related to memory, Abnormalities of memory:- Amnesia, Retrograde amnesia and Antergrade Amnesia.

Physiology of Sleep:- Introduction , in what way sleep is an important behavior for all the organism. Why do we sleep .Importance of sleep? In the absence of sleep, what will be the condition of the organism? How many hours sleep is necessary.

Types of Sleep:- NREM and REM Sleep, stages of sleep,

Electroencephalographic pattern:- during NREM sleep, in stage I,2,3 and 4.

Characteristic : - of NREM and REM sleep.

Neural substrate of sleep:- Factors that induce sleep.Abnormalities of sleep: - Narcolepsy, Sleep apnea , insomnia and Somnambulism.

Special Senses (12 h)

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Introduction to special senses. What is special when compared to general sensations. Physiology of olfaction, Taste, Vision and hearing, are included.

1. Olfaction :- Introduction:-About evolution of olfaction, its importance in lower species, and how much it is important in higher species.

a) Olfactory epithelium:-location and area covered by it. Its detailed structures present like olfactory sensory neurons, olfactory receptors.

b) Olfactory bulb:- Different types of neurons present, and their organizations.

c) Generation of action potential by interaction of olfactory receptors, and odorant molecules.

d) Olfactory pathway and its relay to other brain structures. Olfactory cortex (What are the different brain regions included in it)

e) What is the functional signifance of olfaction in day to day life? .Its relationship to feeding and emotional behavior. Odorant binding protein ,Adapatation , pain fibers in the nose. Olfactory thresholds, discrimination,Sniffing.

f) Abnormalities of odor detection:- Hyposmia, hyperosmia, and dysosmia.

2. Physiology of Taste :- a) Taste buds,location,papillae of the tongue.

b) Nerve supply to the tongue for general sensations and special sensation.

c) Basic taste modalities( sweet, sour, bitter, salt, and umami)

d) Interaction between the taste molecules and the receptors resulting in generation of an action potential. Taste pathways.

e) Taste thresholds and intensitydiscriminations.

d) Abnormalities of taste detection:- Ageusia,Hypogeusia and Dysgeusia.

Vision:-Introduction to physiology of vision.

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a) Functional anatomy of the eye. Different components of the eye and associated structures like voluntary muscles, lacrimal glands, its innervations.

b) General structures of the human eye:- Sclera/Cornea, Choroid and Retina.

Cornea:- Properties of it, brief histological features, nerve supply, supply of nutrition, function, The ways of protection, as it is exposed to the atmosphere always. Abnormalities of cornea, Corneal ulceration, Corneal transplantation, why it is most successful of all organ transplantations.

c) Choroid:- Location, Its relationship to structures like Iris and ciliary body.

IRIS:-Location, structure, innervations, function. Pupillary constriction, papillary dilatation, Pupillary light reflex, Abnormalities of lesions of papillary light reflex pathways. Argyll Robertson pupil.

Clinical importance of papillary light reflex in assessing and unconscious patient.( reactive pupil, Fixed pupil). Atropine and its usage.

d) Crystalline Lens:- Location, structure, shape, Characteristic ( Elasticity, Transparent) Function of the lensPrinciples of optics Common and defects of the image –forming mechanism, (Myopia, hyperopia, Astigmatism) Accommodation, age related abnormalities in the lens. Presbyopia., cataract Near point of vision, near response.

Chambers of the eye:-Anterior chamber and Posterior chamber. Their location, aqueous humor, formation, drainage, composition function. Intraocular pressure, abnormality GLAUCOMA.

Vitrous humor and its function.

e) RETINA:-Its location, extension, detailed histological organization . Visual receptors Rods andCones plus four types of neurons bipolar cells, ganglioncells, horizontal cells and amacrine cells. Pigment epithelium and itsfunctions, Optic disk (blind spot) macula lutea (fovea centralis) visual acuity.

RODS and CONES:-Their detailed structure. Differences between rods and cones, and their neural system. Pigments present The PhotoreceptorMechanism:- Electrical response, ionic photoreceptor potentials. Ganglionic receptive field Generation of an action potential.

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Optic pathway in detail, Visual field defects due to lesion at different levels of optic pathway. Visual cortex. Perception of visual information and extrastriate visual cortex.

Some clinical important conditions:- Retinal detachment, Age related macular degeneration, Retinitis pigmentosa.

Field of vision (monocular field, binocular field of vision), Duplicity theory (Photoic and Scotopic vision) Dark and Light adaptation.Effect of vitaminA deficiencies. Visual acuity and Snellen latter chart. Critical fusion frequency

Color Vision, Ishihara Charts, Colour weakness and colour blindness.

Melanopsin a novel photo pigment in the retinal ganglion cells for non-image forming function.

3. Physiology of Hearing ( Auditory System ) :-Introduction to auditory system:-Anatomical structures included in this syste.1. The External ear (Outer ear) 2. The Middle ear. and 3. The Internal ear.

External ear:-Anatomy of external auditory canal, general description, Function, Ceruminous glands, ear wax, Clinical significance.

Tympanic membrane its location, function, its clinical importance damage to it by foreign body, pressure, infection. Perforation amd sound transmission of sound.

Middle ear:-Extension, contents, function and abnormalities:-Sound transmission, impedance matching.

2 muscles, Names of the muscles and their function.---Tympanic reflex.

Ossicular system:- Ossicules their attachment and function in transmission of sound.

Two windows , Their function and Auditory (Eustachian ) Tube its function.

Clinical importance:- Middle ear infection, ossicular dislocation, or congenital absence and otosclerous will hinder the transmission of sound.

Internal ear:- ( Cochlea ) Introduction to the internal ear, Chambers Scala vestibule, media and tympani, 2 membranes Reissner's and Basilar membrane. Fluids present in the internal ear Perilymph and endolymph, their distribution and composition, formation of endolymph and composition.

Basilar membrane:- ,its description, measurement. characteristic of base and apex portion of basilar membrane and function.

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Organ of Cotri:- The auditory receptors. Types of hair cells present ( inner and outer hair cells) , their innervations, and functions . Arrangement of cilia,(stereocilia and Kinocilia) Travelling wave theory. Analysis of different frequencies of sound waves by the basilar membrane. Generation of action potential by the auditory receptors and transmission of it through the auditory pathway for perception by the auditory cortex.

Deafness :- Conductive deafness, sensory - neural deafness masking

Sound waves:-Characteristic of waves Frequency and amplitude.

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Exam time Form Allocated markMid term MCQs

Lab reports3010

Final MCQs 70Lab 10Oral 30

Total 150

Review of medical physiology. (2009) .William F. Ganong .Twenty fourthedition..Mc Graw Hill. LIBRAIRE DU LIBAN

Text Book of medical physiology.(2006) Guyton& Hall .Eleventh edition.Inter-national edition. ELSEVIER SAUNDERS.

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VI) Assessment and evaluation

VII) List of refrences