PHYSIOLOGY Objectives
Goal
The broad goal of the teaching of undergraduate students in Physiology aims at providing the student comprehensive knowledge of the normal functions of the organ systems of the body to facilitate an understanding of the physiological basis of health and disease.
Objectives
a. Knowledge:
At the end of the course the student will be able to:
b. Skills
At the end of the course the student will be able to:
c. Attitude and communication skills:
At the end of the course the student will be able to:
d. Integration:
At the end of the integrated teaching the student should acquire an integrated knowledge of organ structure and function and the regulatory mechanisms.
List of systems included in Physiology:
Physiology Syllabus
Theory:
General Physiology (PY 1.1-1.9) (8 hrs)
Structure and functions of a mammalian cell; Homeostasis, Intercellular communication; Apoptosis; Transport mechanisms across cell membranes; Fluid compartments of the body; pH & Buffer systems in the body; Evaluation of functions of the cells and products in clinical care and research.
Hematology: (PY 2.1 – 2.13) (16 hrs)
Components of blood: formation, regulation and functions; plasma proteins – origin, types, variations and functions; Hemoglobin- synthesis, variants, functions and its breakdown & Jaundice; Blood indices; Anemia and its classification; Hemostasis: mechanism, regulation & disorders Anticoagulants; Blood groups, blood banking and transfusion; Immunity: types, mechanism & regulation; ESR; Lymph-composition, circulation and functions
Nerve & Muscle Physiology: (PY 3.1 – 3.18) (10hrs)
Neuron and neuroglia: structures, types, functions; Resting membrane potential; Action potential in nerve, skeletal & smooth muscle; Nerve fibres: classification, functions & properties; nerve injuries, degeneration and regeneration in peripheral nerve; Neuromuscular junction: structure, transmission of impulses, neuro-muscular blocking agents, Myasthenia gravis; Muscle fibres: structure, types & functions; Muscle contraction; molecular basis (skeletal, smooth), Isotonic Vs. Isometric, Energy sources and metabolism, gradation of muscle activity; muscle dystrophy, Myopathies; Strength-duration curve
Gastrointestinal Physiology: (PY 4.1 – 4.10) (10hrs)
Functional anatomy and broad functions of digestive system, enteric nervous system; GI Secretions- composition, mechanism of secretion, functions, and regulation of saliva, gastric, pancreatic, intestinal juices and bile secretion; GI movements- types, regulation, functions, reflexes; role of dietary fibres; Digestion and absorption of nutrients; GI hormones- source, regulation, functions; Gut-brain axis; structure and functions of liver and gall bladder; gastric function tests, pancreatic exocrine function tests & liver function tests, Pathophysiology – Achalasia cardia, peptic ulcer, gastro oesophageal reflux disease, vomiting, diarrhoea, constipation, Adynamic ileus, Hirschsprung’s disease.71
Cardiovascular Physiology: (PY 5.1 – 5.16) (25hrs)
Functional anatomy of heart; Pacemaker tissue and conducting system-generation, conduction of cardiac impulse; Properties of cardiac muscle; Cardiac cycle; ECG- recording, normal ECG, uses, cardiac axis, Abnormal ECG in common arrhythmias, changes with hypertrophy & MI; Haemodynamics; Heart rate- factors affecting, regulation; Cardiac output- factors, regulation, measurement; Blood pressure- components, determinants, factors, regulation and applied aspect, Regional circulation- autoregulation, microcirculation, lymphatic circulation, coronary, cerebral, capillary, skin, fetal, pulmonary and splanchnic circulation; Pathophysiology- shock, syncope, heart failure & coronary artery disease
Respiratory Physiology: (PY 6.1-6.10) (12hrs)
Functional anatomy of respiratory tract, dead space; Mechanics of respiration; Pressure volume changes during ventilation; Lung volume and capacities; Alveolar surface tension; Compliance; Airway resistance; alveolar ventilation, V/P ratio; Diffusion capacity of lungs; Transport of respiratory gases- Oxygen and Carbon dioxide; Neural and chemical regulation of respiration; Physiology of high altitude and deep sea diving; Principles of artificial respiration, oxygen therapy; Patho-physiology of dyspnoea, hypoxia, cyanosis, asphyxia, drowning, periodic breathing; Lung function tests & its clinical significance
Renal Physiology: (PY 7.1 – 7.9) (10hrs)
Structure and functions of kidney & juxta glomerular apparatus, role of renin-angiotensin system ; Renal blood flow; Mechanism of urine formation, concentration and diluting mechanism; Concept and significance of ‘clearance’ tests; Renal regulation of fluid and electrolytes & acid base balance; Structure and innervation of urinary bladder, physiology of micturition, cystometry, and its abnormalities; Artificial kidney(dialysis) and renal transplantation; Renal Function Tests
Endocrine Physiology: (PY 8.1 – 8.6) (16 hrs)
Mechanism of action of steroid, protein and amine hormones; Synthesis, secretion, transport, physiological actions, regulation and effect of altered (hypo and hyper) secretion of pituitary gland, thyroid gland, parathyroid gland, adrenal gland, pancreas and hypothalamus; Physiology of bone and calcium metabolism; Physiology of growth; Physiology of Thymus & Pineal Gland; Hormone function tests ; Obesity & metabolic syndrome; Stress response
Reproductive Physiology: (PY 9.1 – 9.12) (10hrs)
Sex determination; sex differentiation and their abnormalities; Puberty: onset, progression, stages; early and delayed puberty; Male reproductive system: functions of 72 testis, spermatogenesis and its regulation, Cryptorchidism ; Female reproductive system: functions of ovary and its control, menstrual cycle: Hormonal, uterine and ovarian changes; Tests for ovulation; Physiological effects of sex hormones; Contraceptive methods for male and female; Effects of removal of gonads on physiological functions; Physiology of pregnancy, fetoplacental unit, pregnancy tests, parturition & lactation; Semen analysis; Causes and principles of management of infertility; Hormonal changes and their effects during perimenopause and menopause; Psychological and psychiatric disturbances associated with reproductive physiology.
Neurophysiology: (PY 10.1 – 10.20) (37 hrs)
Organization of nervous system; Sensory system: types, functions and properties of synapse, receptors, reflex; Somatic sensations & sensory tracts; Physiology of pain; Motor system: organization, motor tracts, mechanism of maintenance of tone, control of voluntary movements ; Posture and equilibrium & vestibular apparatus; Reticular activating system, Autonomic nervous system ; Spinal cord: functional organization and lesions ; Formation, circulation and function of CSF; Blood brain barrier; Neurotransmitters. Organization, connections and functions of cerebral cortex, basal ganglia, thalamus, hypothalamus, cerebellum and limbic system and their abnormalities; Higher mental functions ; Physiology of sleep, memory, learning and speech and their disorders; EEG. Special senses- Smell and taste sensation and their abnormalities; Functional anatomy of ear and auditory pathways & physiology of hearing, Deafness, hearing tests; Functional anatomy of eye, Image formation, Visual pathway and its lesions, Physiology of vision including acuity of vision, colour vision, field of vision, refractive errors, physiology of pupil; light reflex, accommodation reflex, dark and light adaptation; Auditory & visual evoked potentials
Integrated Physiology: (PY 11.1 – 11.14) (6 hrs)
Temperature regulation: mechanism, adaptation to altered temperature (heat and cold environment), mechanism of fever, cold injuries and heat stroke; Exercise- cardio-respiratory and metabolic adjustments during exercise (isotonic and isometric), exercise in heat and cold, physical training effects; Physiological consequences of sedentary lifestyle; Brain death; Physiology of Infancy*; Physiology of aging-free radicals and antioxidants*; Physiology of meditation*.
(* ‘Non-core’ competencies as per “Competency based Undergraduate Curriculum for the Indian Medical Graduate 2018: Medical Council of India”).
PRACTICAL
The following list of practical is minimum and essential. Additional exercises can be included as and when feasible and required. All the practicals have been categorized as ‘Procedures to be performed’ and ‘Demonstrations’. The procedures are to be performed by the students during practical classes to acquire skills. These would be included in the practical during University examination. Those categorized as ‘Demonstrations’ are to be shown to students during practical 73 classes. Questions based on these would be given in the form of data, charts, graphs, problems and case histories for interpretation by students during university examination.
I. Procedures to be performed by the students:
a. Haematology:
b. Procedures to be performed on human subjects:
c. Clinical Examination:
II. Demonstrations:
1.Haematology:
2.Human:
(* ‘Non-core’ competencies as per “Competency based Undergraduate Curriculum for the
Indian Medical Graduate 2018: Medical Council of India”)
III. Interpretation–
charts: clinical case histories, graphs, charts, problems (Suggested topics for preparation of these are given under ANNEXURE I. However, many more could be developed which is under discretion of each institution) Chart also includes – Interpret growth chart*, Interpret anthropometric assessment of infants*: (*these two charts are ‘Non-core’ competencies as per “Competency based Undergraduate Curriculum for the Indian Medical Graduate 2018: Medical Council of India”)
IV. Computer assisted learning:
(i) Amphibian nerve – muscle experiments and interpretation of graphs
List of graphs on nerve-muscle experiments:
(ii) Amphibian cardiac experiments and interpretation of graphs
List of graphs on cardiac experiments:
SKILL CERTIFICATION:
The list of certifiable skills is given below. The general instructions, blank template, samples of certification checklist suggested for skill certification are provided as ANNEXURE – IIa, IIb, IIc, IId.
List and number of sessions for skill certification as prescribed by MCI:
| TOPICS | Number required to certify as per MCI | |
|---|---|---|
| PY5.12 | Record blood pressure & pulse at rest and in different grades of exercise and postures in a volunteer or simulated environment | 1each x 3 |
|
PY6.9
|
Demonstrate the correct clinical examination of the respiratory system in a normal volunteer or simulated environment | 1 |
|
PY 10.11
|
Demonstrate the correct clinical examination of the nervous system: Higher functions, sensory system, motor system, reflexes, cranial nerves in a normal volunteer or simulated environment |
1 each (total 5)
|
|
PY 10.20
|
Demonstrate (i) Testing of visual acuity, colour and field of vision and (ii) hearing (iii) Testing for smell and (iv) taste sensation in volunteer / simulated environment |
1 each (total 4)
|
SUGGESTED AREAS FOR INTEGRATION:
As per the “Competency based Undergraduate Curriculum for the Indian Medical Graduate 2018: Medical Council of India”
EARLY CLINICAL EXPOSURE:
Clinical visits: 12 hours (Suggested format for assessing participation in ECE sessions is provided as ANNEXURE III which could be a part of the practical record book) Suggested hospital visits: (can include more than the below suggestions) Anemia, Jaundice, Visit to blood bank, Computerized lung function tests, acid peptic disease, endoscopy procedure, dialysis unit, hemiplegia, etc.
Basic science correlations: 18 hours
Discussion based on case vignettes, graphs, clinical videos, patient in classroom setting, etc linked to various systems in physiology.
SELF-DIRECTED LEARNING:
Twenty-five hours of dedicated time for self-directed learning is provided for physiology.
AETCOM MODULES TO BE COVERED UNDER PHYSIOLOGY:
| AETCOM module number (as per MCI document) * | TOPIC |
|---|---|
| 1.2 | What does it mean to be a patient? |
| 1.3 | The doctor-patient relationship |
| 1.4 | Demonstrate the ability to communicate the patients in a respectful Nonthreatening, on-judgemental and empathetic manner |
* https://www.mciindia.org/CMS/wp-content/uploads/2019/01/AETCOM_book.pdf
Suggested format for reflective writing for the above AETCOM modules is given in
ANNEXURE IV. This could be a part of the practical record book.
LOG BOOK:
Suggested Template of logbook is attached as annexure. The minimum elements that needs to be
included are mentioned in the template provided for log book.
TEACHING HOURS AND METHODS:
| Curricular component | Time allotted in hours |
| Lectures | 130 |
| Small group teaching / tutorials / integrated learning /practical | 300 |
| Self-directed learning | 10 |
| Early clinical exposure (basic science correlation and clinical skills) | 27 (09) |
| TOTAL | 440 |
| AETCOM module 1.2 and 1.3 () | 18 (7+5+6) |
Note: It is recommended that didactic teaching be restricted to less than one third of the total time allotted for that discipline.
SCHEME OF EXAMINATION:
INTERNAL ASSESSMENT:
Scheme for calculation of Internal Assessment marks:
As per NMC guidelines
| Theory (maximum marks) | Marks | Practicals | Marks |
|---|---|---|---|
| Theory written paper | 30* | Practical exam (25 marks) and viva- voce(5 marks) | 30 |
| Formative assessment | Formative assessment | ||
| (Part completion tests/ (system-wise reviews) | Early clinical exposure + Skill certification | 7 | |
| Record | 3 | ||
| Total | 40 | Practical record | 40 |
|
Please note: • *Prior to submission to the University, the marks for each of the three internal examination theory assessments must be calculated out of 30 marks, regardless of the maximum marks. • **Prior to submission to the University, the marks for each of the three internal examination practical assessments must be calculated out of 30 marks, regardless of the maximum marks. • Only the final marks out of 40 needs to be submitted to the University, separately for theory and practical for each internal assessment. |
|||
Guidelines: For general guidelines on Internal Assessment refer section II
UNIVERSITY EXAMINATION
SCHEME FOR MARKS DISTRIBUTION FOR UNIVERSITY EXAM:
| type of questions | Number of questions | marks | Total Marks |
|---|---|---|---|
| Long essay | 2 | 10 | 20 |
| Short essay | 8 | 5 | 40 |
| Short answers | 10 | 3 | 30 |
| Mulktple choice questions | 10 | 1 | 10 |
| Total marks | 100 | ||
Blue print for theory question papers:
Paper 1 (Max 100 marks)
| Systems | Marks allotted |
|---|---|
| General Physiology | 5 |
| Hematology | 20 |
| Cardiovascular Physiology | 25 |
| Respiratory Physiology | 20 |
| Gastrointestinal Physiology | 15 |
| Renal Physiology | 15 |
Paper II (Max 100 marks)
| Systems | Marks allotted |
|---|---|
| NMP | 12 |
| Central nervous system | 35 |
| endocrine | 20 |
| Reproductive system | 15 |
| Special senses | 10 |
| Intergrated | 08 |
Note:
PRACTICAL: 80 Marks
There shall be four practical sessions, each carrying 20 marks. The distribution of content and marks for the practical would be as follows:
| Practical session | Allotted topics | Marks allotted |
|---|---|---|
| Practical – I | Clinical examination – I (CNS – sensory / motor/ reflexes / cranial nerve) | 15 |
| Chart: Clinical case histories | 5 | |
| Total | 20 | |
| Practical – II | Clinical examination-II (CVS / RS) | 15 |
| Clinical examination (general physical examination / abdomen examination) | 05 | |
| Total | 20 | |
| Practical – III |
Human experiments • Mosso’s ergography • Effect of posture / exercise on BP and Pulse rate • Effect on BP and pulse rate during exercise using the Harvard step test • Record and interpret Lead II ECG • Spirometry and PEFR • Perimetry • Demonstrate BLS |
15 |
| Amphibian charts | 5 | |
| Total | 20 | |
|
Practical – IV
|
Hematology • RBC count • WBC count • Making a peripheral smear + DLC on the provided stained slide • BT + blood group • CT + blood group • Hb + blood group |
15 |
| Chart: calculations / problem solving (note: there should not be duplication of charts between practical – I and IV for a given student) | 05 | |
| Total | 20 | |
| GRAND TOTAL | 80 |
Viva-Voce Examination: 20 Marks
The viva-voce examination shall carry 20 marks and all examiners will conduct the examination. Viva should focus on application and interpretation. Charts and graphs should be prepared on all systems which could be divided amongst 4 examiners (system-wise) and could be used in viva. (viva marks to be added to practical and not theory).
