Physiology

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:

1. Explain the normal functioning of all the organ systems and their interactions for well coordinated total body function;
2. Assess the relative contribution of each organ system to the maintenance of the milieu interior;
3. Elucidate the physiological aspects of normal growth and development;
4. Describe the physiological response and adaptations to environmental stresses;
5. List the physiological principles underlying pathogenesis and treatment of disease

b. Skills

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

1. conduct experiments designed for study of physiological phenomena;
2. interpret experimental/investigative data;
3. Conduct and interpret clinical examination in normal healthy subject;
4. distinguish between normal abnormal data derived as a result of tests, which he/she has performed and observed in the laboratory.

c. Attitude and communication skills:

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

1. show due respect to persons who volunteer to be examined for the purpose of learning clinical examination.
2. communicate effectively with peers, teachers and volunteer in clinical examination
3. demonstrate the ability of teamwork

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:

• General Physiology
• Hematology
• Nerve-Muscle Physiology
• Gastro-Intestinal Physiology
• Cardiovascular physiology
• Respiratory physiology
• Renal Physiology
• Endocrine Physiology
• Reproductive Physiology
• Neurophysiology (Central Nervous System and Special Senses)
• Integrated 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:

1. RBC count
2. WBC Count
3. Differential Leucocyte Count
4. Estimation of haemoglobin
5. Blood grouping
6. Bleeding time
7. Clotting time
8. Calculate RBC indices – MCV, MCH, MCHC.

b. Procedures to be performed on human subjects:

1. Mosso’s ergography.
2. Recording of Blood Pressure, pulse rate at rest and effect of posture.
3. Effect of mild and moderate exercise on blood pressure, pulse rate and respiratory rateusing Harvard step test.
4. Record and interpret Lead II ECG. Given a normal ECG, determine cardiac axis.
5. Spirometry – Lung volumes and capacities, MVV, Timed vital capacity.
6. Peak Expiratory Flow Rate
7. Demonstrate Basic Life Support in a simulated environment
8. Visual field by Perimetry

c. Clinical Examination:

1. Components of history taking and general physical examination
2. Examination of radial pulse
3. Examination of Cardiovascular system
4. Examination of Respiratory system
5. Examination of abdomen
6. Examination of Higher mental functions
7. Examination of Sensory system
8. Examination of Motor system including reflexes.
9. Examination of Cranial Nerves

II. Demonstrations:

1.Haematology:

1. Erythrocyte sedimentation rate
2. Haematocrit
3. Reticulocyte count
4. Platelet count
5. Osmotic fragility

2.Human:

1. Record Arterial pulse tracing using finger plethysmography*
2. Stethography
3. Tests of cardiovascular autonomic functions*

(* ‘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:

• Simple muscle twitch
• Effect of various strengths of stimuli on Simple muscle twitch
• Effect of changes in temperature on Simple muscle twitch
• Effect of two successive stimuli on muscle contraction
• Effect of multiple successive stimuli (treppe, clonus, tetanus)
• Study of fatigue in skeletal muscle
• Velocity of nerve conduction
• Effect of load on muscle
• Measurement of isometric contractions using nerve muscle preparation

(ii) Amphibian cardiac experiments and interpretation of graphs

List of graphs on cardiac experiments:

• Normal cardiogram
• Effect of temperature on frog heart
• Effect of Stannius ligatures
• Properties of cardiac muscle – all or none law, staircase effect, refractory period in a beating heart (extrasystole and compensatory pause), refractory period in a quiescent  heart
• Effect of vagus on frog’s heart
• Action of drugs on vagus (nicotine and atropine)
• Perfusion of isolated heart and effect of ions (NaCl, KCl, CaCl2)
• Perfusion of isolated heart and effect of drugs (adrenaline, acetyl choline, atropine followed by Ach)

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:

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: 

* 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: