BHAVNAGAR UNIVERSITY, BHAVNAGAR

DEPARTMENT OF PHYSIOLOGY including Biophysics

Govt. Medical College, Bhavnagar

SYLLABUS FOR POST GRADUATE COURSE

IN

PHYSIOLOGY

( M.D. Doctor of Medicine)

(i) GOAL:

The broad goal of the teaching to postgraduate students in Human Physiology aims at providing thorough knowledge of the Principles of Physiology, Biochemical and Biophysical Basis of Physiology, Molecular biology, History and evolution of Physiological functions, Recent advances in understanding of Physiological functions and mechanisms of Physiological actions of the organ systems of the body to facilitate understanding of the Physiological Basis of health and disease. The ultimate goal of teaching Physiology to postgraduate student is to prepare them for research work in Physiology and to become undergraduate (M.B.B.S.) teacher of Physiology.

(ii) OBJECTIVES:

(A) KNOWLEDGE:

At the end of the course the student shall be able to:

(a) Explain the normal functioning of all the organ systems and their interactions for well co-ordinated total body function;

(b) Explain the Biochemical and Biophysical principles behind Physiological functions.

(c) Assess the relative contribution of each organ system to the maintenance of the milieu interior;

(d) Elucidate the physiological aspects of normal growth and development;

(e) Describe the physiological response and adaptations to various kind of environmental stresses;

(f) List the Physiological principles underlying pathogenesis and treatment of disease.

(g) Independently perform, analyze, discuss and present/publish the research experiments or study of physiological principals in detail

(h) Independently perform undergraduate teaching activity and can work as expert in academic activity in the subject.

(B) SKILLS:

At the end of the course the student shall be able to

a. Conduct experiments designed for study of physiological, biophysical, electrophysiological and biochemical phenomena;

b. Interpret experimental/investigative data;

c. Distinguish between normal and abnormal data derived as a result of tests, which he/she has performed and can statistically analyze and discuss with reference to relevant data.

(C) INTEGRATION:

At the end of the integrated teaching the student shall acquire an integrated knowledge of organ structure and function and its regulatory mechanisms. Can explain physiological basis of health, physiologically varied conditions, extremes of environment, various investigations, treatment and patho-physiology of the disease state.

(D) CURRICULUM:

I. SYSTEMIC PHYSIOLOGY:

Introduction to physiology

~ Introduction to Physiology

~Historical aspects referring to various doctrines

~Scope of Physiology

~Basic controlling mechanisms of body and feed back gains

~Homeostasis

~Evolution of various systems

a. Cell Physiology

~Structure of the cell

~Functions of cells,

~Cell growth, division & differentiation, variations,

~Intercellular communication,

b. Biophysics

~Transport across the membrane, Donnan equilibrium, Osmosis, Diffusion, Facilitated diffusion, Active transport,

~Surface tension,

~Adsorption, Colloids, Suspensoids, True solution,

~Hemodynamics,

~Ventilation through airways,

~Bioelectrical phenomena, Resting Membrane Potential, Equilibrium potential, Nernst and Goldmann equations.

~Action potential in various tissues with their ionic basis,

~Cathode Ray Oscilloscope and recording of Action Potential in various tissues i.e. ERG, ECG, EMG, EOG, EEG, Nerve conduction velocity,

~Evoked potentials like VEP, SSEP, BSAEP, MEP

~Patch clamp technique, Voltage gated technique

c. Blood

~Functions of blood

~Composition of blood

~Properties of blood,

~Plasma proteins,

~Formed elements of blood,

~Hemo-poiesis,

~Functions of blood cells, counting and its importance of blood cells,

~Blood clotting,

~Blood groups-importance, type, estimation, transmission,

~Reticulo-endothelial system,

~Lymphatic system, lymph composition and function,

~Immunity, AMI, CMI, Active & Passive Immunity,

~Anaemia, Poly-cythemia,

~Bleeding disorders,

~Blood transfusion,

~Blood storage & banking, bone marrow,

~Hemoglobin-chemistry, type, derivatives, synthesis, fate, Jaundice,

~Organ transplantation, Graft rejection etc.

d. Gastro-Intestinal System

~Physiological Anatomy,

~Gastrointestinal secretions with composition,

~Functions, mechanism of secretion,

~Regulation ie, salivary, gastric, pancreatic-exocrine, succus entericus,

~Bile, entero-hepatic circulation, gall bladder.

~Gastro intestinal tract movements-oesophagus, deglutition,

~Stomach, gastric emptying,

~Small and large intestine, defeacation, gastrointestinal reflexes,

~Gastrointestinal hormones,

~Faeces. Gastric function tests, liver function tests

e. Cardiovascular System

~Blood volume. Its measurement and blood depot.

~Electric and mechanical properties of cardiac muscles,

~Origin and spread of cardiac impulse,

~ECG- principles, Procedure

~Interpretation of normal variations in ECG.

~Cardiac cycle, Heart sounds

~Heart rate,

~Cardiac output,

~Venous return, peripheral resistance, hemodynamics,

~Pulse,

~Blood Pressure: types, importance, measurement, determinants,

~Factors affecting, regulation, clinical importance,

~Clinical examination of CVS,

~Regional circulations: Coronary,

~Cerebral circulation

~Pulmonary circulation

~Cutaneous & Skeleta muscle circulation,

~Splanchnic, Hepatic, foetal-Neonatal etc.

~Effect of exercise on CVS, hemorrhage and shock.

~Hypertension and heart failure

f. Respiratory System

~Physiological anatomy. Broncho-pulmonary segments,

~Respiratory and non respiratory functions of lung,

~Mechanics of breathing: Muscles of respiration, rib movements, compliance, Intra-pleural and intra pulmonary pressures, surfactants.

~Spirometry, Pulmonary function tests,

~Clinical examination of respiration,

~Transport of blood gases,

~Neural and chemical regulation of respiration.

~Artificial respiration, periodic breathing, respiratory rate and variations, dyspnoea, dyspnoeic index, orthopnea, asphyxia,

~hypoxia, hypercarbia, Oxygen therapy, Hyperbaric oxygen therapy, Oxygen poisoning,

~High altitude physiology: mountaineering, Aviation physiology, space physiology. ~Underwater physiology,

~Occupational hazards and respiratory system

g. Excretory System, Skin, Body Temperature

~Physiological anatomy,

~Functions of kidney,

~Glomerular filtration ,

~Tubular secretion

~Tubular reabsorption, formation of urine,

~Juxta-glomerular apparatus,

~ Concentration and dilution of Urine

~Roll of kidney in acid base balance,

~Renal function tests,

~Clearance tests,

~Maintenance of blood volume, blood pressure, tonicity, electrolytes by kidney.

~Structure and functions of skin,

~Body temperature: importance of temp. regulation, measurement,

~Mechanism of heat loss and heat generation, temperature regulating center.

~Roll of brown fat, hypo and hyperthermia its importance and effects on the body.

h. Nerve And Muscle Physiology

~Physiological anatomy, macroscopic and microscopic, E.M of sarcomere,

~Composition and functions of muscle

~Excitable tissue, stimulation, Resting Membrane Potential, role of Na-K pump ~Generation of local response( electrotonus) and action potential,

~Characteristic of action potential and its properties,

~Ionic basis of action potential,compound action potential

~Properties and skeletal muscles

~Properties of smooth muscles,

~Comparison of cardiac, skeletal and smooth muscles,

~Structure and classification of nerve

~Properties of nerve fiber

~Mechanism of conduction of nerve impulse, Nerve metabolism,

~Mechanism of contraction of muscle,

~Neuromuscular transmission,

~Mechanical, thermal, electrical and chemical changes during muscle contraction, ~Effect of exercise, oxygen debt

~Myelination and degeneration and regeneration of nerve fiber.

i. Autonomic Nervous System

~Characteristics and differences from somatic nervous system,

~Differences between sympathetic and parasympathetic nervous system,

~Distribution and action of sympathetic

~Distribution and parasympathetic supply,

~Autonomic neurotransmission,

~Autonomic function tests, Biofeedback studies, polygraph tests.

j. Central Nervous System

~Physiological anatomy,

~Cerebrospinal fluids(properties, composition, function, mechanism of secretion, examination),

~Blood brain barrier, blood CSF barrier, circumventricular oregans, Neuroglia, ~Receptors: classification, properties, mechanism of stimulation,

~Synapses: types, structure, properties and synaptic transmission,

~Reflexes: type, properties, reflex arc,

~Stretch reflex, withdrawal reflex, inverse stretch reflex, crossed extensor reflex, lengthening reaction,

~Regulation of muscle tone and posture,

~Muscle spindle,

~Pontine medial gamma facilitatory and medullary lateral gamma inhibitory pathways, plastic and spastic type rigidity(cogwheel, clasp-knife, lead pipe)(decerebrate: classical and ischemic type, decorticate rigidity) ,

~Postural reflexes, spinal cord, anatomy, section study ,

~Ascending (Dorsolateral-lemniscal system and antero-lateral system)

~Descending tracts (Medial and lateral motor system),

~Spinal reflexes, study of spinal reflexes, hemisection and transection of spinal cord, spinal shock,

~Pathway of touch, Pressure, vibration

~Pathway of temperature, pain and other sensations, endogeneous pain inhibitory system,

~Thalamus (nuclei, connections, functions and disorders),

~Cerebral cortex, primary (somatosensory, visual, auditory, motor), secondary(somatosensory, visual auditory, premotor, supplemental motor), association(parieto-occipito-temporal, prefrontal and limbic), handedness, dominant brain(Categorical and representational),

~Cerebellum: Gross and microscopic anatomy, physiological divisions,

~Functions, disorders,

~Basal ganglia :nuclei, connections, functions and disorders,

~Hypothalamus :nuclei, connections, functions and disorders,

~Limbic system, importances, parts included, disorders and connections.

~Reticular formation, RAS, RDS, EEG

~Sleep, REM and NREM sleep, theories of sleep,

~Pyramidal tract and upper motor neurone lesion

~Extra pyramidal tract and lower motor neurone lesions Non-auditory labyrinth.

~Physiology of speech.

~Memory, learning motivation and clinical examination of CNS

k. Endocrines

~Structure and functions of various endocrine organs. Types, mechanism of action of hormone,

~Hypothalamo-hypophyseal axis, and anterior pituitary hormones,

~Posterior pituitary hormones

~Hormones of thyroid gland,

~Parathyroid gland and calcium & phosphorous metabolism

~Adrenal cortex- Glucocorticoids

~Adrenal cortex-Mineralocorticoids and Na & K & Blood volume balance

~Adrenal medulla,

~Endocrine pancreas (their synthesis, actions, mechanism of secretion, mechanism of regulation, disorders and tests for diagnosis),

~Endocrine disprders

l. Reproductive system

~Primary and secondary sex characters. Sex differentiation, Puberty and adolescence

~Male and female sexual act,

~Andrology-physiology of testes. Spermatogenesis, blood testes barrier,

~Actions of testesterone

~Actions of Oestrogen and Progesteron

~Menstruation, Menarche, Menopause, menstrual disprders

~Ovulation, Corpus luteum, Fertilization and formation of the germinal layers.

~Formation and role of placenta.

~Mammary glands and lactation.

~Physiological changes during pregnancy. Pregnancy tests

~Principles of contraception – fertility control.

m. Special Senses:

Eye:

~structure of eye, eye as camera and function of various parts.

~Refraction, refractory index, refractory power and optics of eye

~Refractory media, concept of reduced eye,

~Refractory errors,

~Nutrition of eye and intra-ocular pressure,aqueous humour formation and drainage, ~Field of vision and

~Mechanism of accommodation.

~Errors of visual path

~Visual perception

~Ocular reflexes. Muscles of eye and eye movements.

~Color vision and colour blindness

~Binocular vision after images.

~Photochemistry of vision, dark and light adaptation,

Ear:

~Auditory apparatus-unit of sound, Attenuation reflex , Basilar Membrane, Organ of Corti, Eustachian tube

~Labyrinthine conduction of sound waves and mechanism of hearing , Endocochlear potential

~Auditory pathway and auditory perception

~Tests for hearing, audiometry etc. Deafness, type and hearing tests, hearing aids,

Vestibular Apparatus

~Physiological anatomy, Otolith organs of macula and saccule, Semicircular canals

~Mechanism of stimulation

~Role of vestibular nuclei, VSR,VOR, motion sickness, vestibular function tests

Taste and Smell:

~Structure, distribution and function of the receptors.

~Mechanisms of stimulation and their different pathways. disorders, methods of examination

Applied physiology

Physiology of Yoga

Sports physiology

Aviation physiology

Marine physiology

Nutrition

Physiology as a basis of medicine

PRACTICALS

(a) Experimental Physiology:

Amphibian practicals,

1~Selection of laboratory animals, care of animals in laboratory, introduction to animal experiments with special reference to function of CPCSEA, Act for prevention of cruelty on animals, Animal disposal etc.

2~Biomedical instrumentation

3~Amplifiers

4~Transducers

5~Electrodes

6~Averaging and softwares

7~Introducing use of various instruments in the laboratory circuits.

8~Muscle-Nerve preparation. pithing, dissection, smoking, varnishing, fixing and preservation of graph

9~Simple muscle twitch.

10~Effects of Temperature

11~Effect of free and after load.

12~Effect of strength of stimuli

13~Effect of multiple stimuli: Two successive stimuli,

14~Fatigue and Ergography,

15~Staircase & Incomplete and complete Tetanus,

16~Study of conduction velocity in nerve

17~Study of perfusion of frog heart

18~Study of perfusion of frog blood vessels

19~Study of capillary circulation in frogs

20~Study of spinal and decerebrate preparation of frog

21~Study Normal cardiogram and heart-block(stannous ligatures).

22,23~Study of properties of cardiac muscles

24,25,26,27~Study of effect of sympathomimetic, parasympathomimetic, Parasympatholytic and ganglion blocking drugs on cardiac muscle

28~Effect of stimulation of vagus and crescent on cardiac contraction. And study of

vagal escape

29~Demonstration of reciprocal innervation in frogs

(b) Haemotology

1. Study of Microscope

2. Study of Micrometry and Price Jones Curve

3. Study of Peripheral Smear

4. Study of Bone Marrow Smear

5. Study of Platelet count

6. Study of Reticulocyte count

7. Study of Arneth and Absolute Count

8. Total W.B.C. Count.

9 Differential W.B.C. Count.

10. Total R.B.C. Count.

11 Hb Estimation.

12 P.C.V. & Blood indices.

13 E.S.R.

14 Study of Specific Gravity and Viscosity of blood

15 Study of Isotonic, Hypotonic and Hypertonic solution on RBCs

16 Study of effect of Osmotic fragility on RBCs

17 Bleeding Time and Clotting Time

18 Prothrombin Time, Partial Prothrombin Time, Clot Retraction Time, Capillary Fragility Test.

19. Haemin crystals.

20. Cross matching and blood banking

(c) Applied and Clinical Physiology

1. History taking and principles of clinical examination, general examination.

2. Examination of cardiovascular system.

3. Measuring Blood Pressure and study of effect of posture, exercise and stress.

4. Examination of pulse.

5. Cardiac efficiency tests.

6. Examination of Respiratory systems.

7. Spirometry.

8. Resuscitation: Artificial Respiration.

9. Closed thorax, Cardiac Massage.

10. Respiratory efficiency tests.

11. Examination of Reflexes-Superficial and Deep.

12. Examination of Motor Systems

13. Examination of Sensory System

14. Examination of Cranial nerves. I,VII

15. Examination of Gastro-intestinal System

16. Examination of higher functions.

17. Visual Acuity, Optometry, Retinoscopy

18. Field of vision

19. Colour vision

20. Auditory tests.

21. Audio-metry

22. Recording of body temperature and study of effect of hot and cold environment.

23. Reflex time and Reaction time.

24. Stetho-graphy.

25. Phono-cardiography and

26. Plethysmography.

27. Sphygmography.

28. E.C.G.

29. Pregnancy tests.

30. Opthalmoscopy

31. Ergography.

32. Circulation time.

33. Study of EEG

34. Study of EMG

35. Study of Evoked potentials like Brainstem Auditory Evoked Potential

36. Visual evoked potential

37. Somesthetic Sensory Evoked potential, Motor Evoked Potential

38. Study of Nerve Conduction Velocity

39. Pulmonary Function Tests, FEV

40 Pulmonary function tests, FRC,RV,TLC

41. Pulmonary function rate: MVV, VC

42. Autonomic function tests

43. Study of Bicycle ergometry

44. Study of Treadmill test

45. Study of Alveolar gas

46. Study of Blood gases

47. Study of BMR

48. Vestibular function tests

49. Event related potentials

50. Biofeedback experiments

51. G.T.T.

52. Gastric function tests

53. Semen Analysis

54. Study of vascular reactions in cutaneous blood vessels e.g. white line, triple response, reactive hyperaemia.

Mammalian Experiments.

1.Determination of blood volume in experimental animals.

2.Recording of movements of isolated loop of mammalian intestine and effect

of drugs.

3.Mammalian blood pressure and respiration recording and factors influencing

them.

4.Perfusion of mammalian heart on Langendorf’s preparation

5.Study of effect of drugs on rat uterus

6.Study of activity and effect of drugs on Guinea pig ileum

7.Study of stereo-taxic stimulation and effect of drugs on various parts of

rat/rabbit brain

8.Study of mechanics of breathing in rat lung

9.Determination of blood volume by dye dilution method

10.Study of salivary secretion in Dogs

11.Study of actions of valves in mammalian heart- Gad’s experiment

Biochemistry experiments:

1. Detection of unknown substances

2. Chemistry of carbohydrates and preparation of osazones

3. Chemistry of proteins

4. Chemistry of fats

5. Chemistry of milk

6. Chemistry of egg white

7. Chemistry of certain food stuffs

8. Tests of Vit A & Vit C

9. Chemistry of saliva

10. Clotting of milk by enzyme rennin

11. Chemistry of gastric juice total and free acidity

12. Estimation of pepsin in gastric juice

13. Chemistry of bile

14. Spectroscopic examination of blood pigments (Hb and its derivatives)

15. Estimation of Calcium in Serum

16. Lipid profile

17. A:G ratio and total proteins

18. Glucose in Urine(Einhorn’s saccharometer)

19. Albumin in Urine(Esbach’s albuminometer)

20. Estimation of serum Uric acid

21. Estimation of Serum Creatinine

22. Estimation of Direct and indirect billirubin

23. Clearance tests

24. Enzymes and isozymes

25. CSF study

26. Concentrating and diluting capacity of kidney

27. Chemistry of urine-Normal and abnormal

28. Estimation of glucose in blood

29. Estimation of chloride in urine (Volhard’s method)

30. Estimation of titrable acidity and Ammonia in urine

31. Diastase in urine (Urine amylase activity)

32. Urea in urine (Doremus ureometer)

33. colorimetry

34. Spectrophotometry

35. Electrophoresis

36. Chromatography

37. Flame photometry & estimation of Na,K and lithium

38. Estimation of nitrogen in organic substances ( Kjeldfal’s method)

39. Chemistry of meat, bread, wheat flour, potato, fruits & vegetables

40. Study of monosacharides

41. Study of disachharides

42. Study of polysachharides

43. Study of enzymatic hydrolysis of starch

44. Estimation of specific gravity by copper sulphate soln.

45. Study of relative viscosity of blood (Ostwald viscometer)

46. Study of osmotic phenomena

47. Study of surface tension with stalagmometer

48. Estimation of plasma proteins

49. Colour reactions of proteins

50. Coagulation and precipitation reaction of proteins

51. Study of fats and oils

52. Estimation of reducing sugars

53. Estimation of serum alkaline phosphatase

54. Estimation of Serum amylase