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COURSE TITLE: PSL – 211 (HUMAN PHYSIOLOGY DENTAL COURSE)
CREDIT HOURS: 6
CONTACT HOURS
Lectures: 3 hours per week
Practical : 3 hours per week
COURSE OBJECTIVES
This course is intended to help the student to:
 Acquire a comprehensive and balanced understanding of physiology from the cellular and
molecular to the whole organism level.
 Understand the physiological mechanisms underlying the normal functioning of various
Systems of the human body, from applied and practical viewpoints.
 Appreciate the logical consequences of derangement of these systems by understanding the
functional abnormalities that occur in various lesions which can involve these systems.
 Develop the ability of deductive thinking, analysis and data interpretation.
 Develop academic competence at the highest level attainable leading them to the forefront of
current knowledge in physiology.

Develop the capacity for individual work and teamwork.
1
TEACHING FORMAT
1.
Formal lectures.
2.
Practical
3.
Tutorial
4.
Student’s Seminar
RECOMMENDED TEXT BOOKS

Human Physiology, and Mechanisms of Disease By Gyuton and Hall
Reference Books

Text Book of Medical Physiology, By Gyuton and Hall

Review of Medical Physiology By Ganong
METHOD OF EVALUATION
Students are assessed by written (MCQs) examination consist of ;
▪ 4 Quizzes
▪ 3 Continuous Assessment exam
▪ 2 Practical Exam
▪ Final comprehensive exam at the end of the term
EXAMINATION SCHEDULE AND DISTRIBUTION OF MARKS
First Term
1. Ist Quiz
( in 6th week )
= 2.5 marks
2. Ist Continuous Assessment
( in 10th week)
= 10 marks
3. 2nd Quiz
( in 13th week )
= 2.5 marks
4. 2nd Continuous Assessment
( in 16th week)
= 15 marks
5. Practical exam
( in 16th week)
= 05 marks
6. Ist Quiz
( in 6th week )
= 2.5 marks
7. 3rd Continuous Assessment
( in 9th week)
= 15 marks
8. 2nd Quiz
( in 13th week )
= 2.5 marks
9. Practical exam
( in 15th week)
= 5 marks
Second Term
10. Final Written Examination at the end of the year
= 40 marks
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Summary of marks distribution:
Continuous Assessment
= 60 marks
Final Examination
= 40 marks
Total Marks:
= 100
Grading:
The pass mark is 60 % of the total course performance.
Marks
Grades
95 – 100
A+
90 – 94
A
85 – 89
B+
80 – 84
B
75 – 79
C+
70 – 74
C
65 – 69
D+
60 – 64
D
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COURSE CONTENT
Term I
No. of lectures
1. Introduction to physiology
1
2. Cell membrane and body fluids
3
3. Blood physiology
7
4. Nerve and Muscle
6
5. ANS
3
6. Cardiovascular physiology
13
7. Respiratory physiology
10
8. Gastrointestinal physiology
7
Term II
9. Renal and acid-base physiology
9
10. Endocrinology
9
11. Central Nervous System and the Special Senses
12
12. Special senses
4
PRACTICAL SCHEDULE
Term I
1. Blood physiology
2 classes
2. Cardiovascular physiology
3 classes
3. Respiratory physiology
1 class
Term II
4. Renal physiology
1 class
5. Endocrinology
1 class
6. Central Nervous System and the Special Senses
2 class
4
INSTRUCTIONAL OBJECTIVES
Unit – I
Cell and Body Fluids
General Objectives
1- Given the body weight, should be able to estimate:
a) Total Body Water (TBW)
b) Extra-cellular fluid (ECF)
c) Intra-Cellular Fluid (ICF)
d) Blood volume
e) Plasma volume
Identify normal ECF (plasma) osmolarity and concentrations of Na, K, Cl, HCO, Proteins, Creatinine
and urea and contrast these values with those for intracellular fluid.
2. Movements of fluids between different compartments caused by increase or decrease in the extracellular fluid osmolarity.
3. Identify major routes and normal ranges for water intake and loss and predict how changes in intake
and loss affect the distribution of total body.
4. Demonstrate the ability to use the indicator (dye) dilution principle to measure plasma volume,
blood volume, ECF volume, And total body water, and identify compounds used to measure each
volume.
5. Predict the changes in extra-cellular volume, extra-cellular osmolarity, intra- cellular volume and
intra –cellular osmolarity caused by infusion of 3 liters of 0.9% NaCl, Lactated ringer’s 0.45 NaCl
Solution and 7.5%NaCl solution.
6. Describe the composition of a cell membrane, diagram of its cross section and explain how the
distribution of phospholipids and proteins influence the membrane permeability to ions, hydrophilic
and hydrophobic compounds and describe carrier mediated primary and secondary active transport.
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INSTRUCTIONAL OBJECTIVES
Lecture 1: Introduction
At the end of this session, the students should be able to:
a) Appreciate the level of development of human being from cells to tissues to organs and organ
systems and their co-relations to physiological functions.
b) Identify and describe the internal environment.
c) Identify and describe the homeostasis control be physiological processes.
Lecture 2: Cell membrane structure and transport across cell
membrane.
At the end of this session, the students should be able to:
a) Describe the fluid mosaic model of membrane structure and function.
b) Define permeability and list factors influencing permeability.
c) Identify and describe carried-mediated transport processes: Primary active transport, secondary
active transport, facilitates diffusion.
Lecture 3: Body fluids and Electrolytes (1)
At the end of this session, the students should be able to:
a) Identify and describe daily intake and output of water and maintenance of water balance.
b) List and describe of body fluid compartments as intra-cellular fluid (ICF) Extra-cellular fluid
(ECF), interstitial fluid, trans-cellular fluid and total body water.
c) Describe the composition of each fluid compartment, in terms of volume and ions and
represent them in graphic forms.
Lecture 4: Body fluids and Electrolytes (2)
At the end of this session, the students should be able to:
a) Describe indicator (dye) dilution technique employed in the measurement of each
compartment.
b) List factors influencing fluid compartments.
c) Physiology factor: age, sex, adipose tissue, etc. Pathological factors:
Dehydration, fluid infusion.
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Unit – II
BLOOD PHYSIOLOGY
GENERAL OBJECTIVES
At the end of this course, the student should be able to:1) Understand the general composition and functions of blood.
2) Understand the processes of blood cell formation and their requirements.
3) Describe the morphology and functions of the different types of cells found in the blood, so as
to recognize any abnormalities.
4) Describe the basis of blood group classification, the precautions and complications of blood
transfusion.
5) Understand the mechanisms of haemostasis, so as to be able to explain the causes of abnormal
haemostasis.
LECTURES CONTENTS
LECTURE 1:
 FUNCTIONS OF BLOOD
I. Transport
i. O2
ii. Nutrient
iii. CO2
iv. Waste product
v. Hormones
II. Homoeostasis
i. Temperature
ii. pH
III. Protection against infections
i.
WBC
ii.
Antibodies
IV. Blood clotting prevent blood loss
 Composition of blood
I. Cells
i.
RBC
ii.
WBC
iii. Platelets
II. Plasma
i.
Water
ii.
Ions
iii. Plasma protein
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Lecture 2:
RED BLOOD CELLS
1. Erythropoiesis
2. Site of blood formation
I. Foetus (York sac, Bone marrow)
II. After delivery (Red marrow, liver spleen)
III. Adult (flat bone, epiphysis)
IV. Extramedullary Erythropoiesis
3. RBC development
4. RBC structure
I. Membrane
II. Composition
III. Life span
5. RBC function, and metabolism
6. Nutritional requirements for RBC
I. Amino acid
II. Iron
III. Vitamins
a. Vit B12
b. Folic acid
c. Vit C
d. Vit B6
e. Riboflavin
f. Vit E
IV. Essential elements
a. Copper
b. Cobalt
c. Zinc
Lecture 3:
A. CONTROL OF ERYTHROPOIESIS
1. hypoxia
2. erythropoietin
 Chemistry
 Source
 Action
3.other hormones
 Androgens, thyroid, growth hormones, cortisol
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B. IRON METABOLISM
1. Distribution of iron in the body
 HB
 Storage (available, unavailable)
 Tissue iron
 Plasma iron
2. Food iron
3. Iron absorption
4. Transport and storage of iron
5. Excretion and daily requirement
Lecture 4:
1. HAEMOGLOBIN
 Structure
 Typed (HBA, HBA2, HBF)
 Functions of HB
 Breakdown of HB
 Jaundice
2. ANAEMIAS
 Definition
 Causes of classification
o Blood loss
 Acute
 Chronic
o Diminished RBC formation
 Nutritional
 Bone marrow diseases
o Excessive destruction of RBC (hemolytic)
 Abnormal HB
 Mismatch transfusion
3. POLYCYTHAEMIA
 Classification
o True or absolute
 Primary
 Secondary
o Relative
 Fluid loss
 Decreased water intake
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Lecture 5:
1. WHITE BLOOD CELLS
 Classification
 Granulocytes (Neutrophils, Eosinophils, Basphils)
 A granulocytes (Monocytes, Lymphocytes)
2. FORMATION OF LEUCOCYTES
 Sites of formation
 Granulocytes-bone marrow
 Lymphocytes-bone marrow, thymus, lymphoid tissue
 Monocytes-bone marrow
 Formation of granulocytes
 Neutrophils in blood stream
3.FUNCTION OF LEUCOCYTES
 Function of neutrophils
 Chemotaxis
 Opsonisation
 Phagocytosis
 Microbial killing
 Function of Eosinophils
o Chemotaxis
o Phagocytosis
o Eosinophilia
 Parasitic
 Allergic (asthma, rhinitis, drugs)
 Tropical
 Dermatological
 Function of Basophils
 Function of Monocytes (blood macrophage)
Lecture 6:
LYMPHOCYTES
1. Morphological classification
o Small and large
2. Functional classifications
o Thymus dependent (T lymphocytes)
 T helper
 T cytotoxic
 NK cells
o Thymus independent (B lymphocytes)
3. Total WBC count
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 Leucopenia
 Leucocytosis
 Leukemia
4. Reticuloendothelial system
 Cellular component
5. Basis of immunity
6. Immunocompetent cells
7. Immune response (primary and secondary)
8. Innate immunity & Acquired immunity
9. Humoral immunity & Cellular immunity
10. AIDS
Lecture 7:
BLOOD GROUPS
 ABO System
 RBC Agglutinogens
 Plasma agglutinins
 Inheritance of blood groups
 Rh blood groups
 Haemolytic disease of new born
 Complication of transfusion
Lecture 8:
 HAEMOSTASIS
 Vascular
 Platelets
 Blood coagulation
 Intrinsic pathway
 Extrinsic pathway
 Fibrinolysis
 Anticoagulant
 Bleeding & thrombotic disorders
TUTORIAL PSL -211
BLOOD
1. Erytropoiesis , Anaemia, Polycythemia
2. Body defense Mechanism
3. Blood Groups
4. Intrensic & Extrinsic Mechanism of Coagulation Bleeding & clotting disorders.
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PRACTICALS IN BLOOD
BLOOD PRATICAL CLASS – 1
Determination of red blood cell (RBC) and total white blood cell (WBC) counts, platelet or
thrombocyte count, haemoglobin concentration. Haematocrit value or packed cell volume, red blood
cell indices i.e mean corpuscular volume (MCV), granulocyte number and percentage, lymphocyte
number and percentage and monocyte number and percentage. To determine osmotic fragility of red
blood cells.
OBJECTIVES:
T o be familiar with:The principles of methods used to measure the different haematological values.
The normal values recorded when making these measurements.
The red blood cell indices i.e., the mean corpuscular volume (MCV) , the mean corpuscular
haemoglobin (MCH) , the mean corpuscular haemoglobin concentration (MCHC) , how these
values can be calculated? Their normal values and their importance in diagnosis of different types of
anaemias.
The procedures used for taking both capillary and nervous blood and for every student to have some
practical experience of collection of blood.
to know:
How to measure the osmotic fragility of red blood cell.
What is the clinical importance of osmotic fragility test?
BLOOD PRACTICAL CLASS 2 – The different leucocytes count.
OBJECTIVES:
To be able to identify the different types of leucocytes under the microscope using theoretical
knowledge of the histological characteristics of these cells.
To practice the procedure for differential leucocyte counting.
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To know the normal values expected for the different white cell count.
To understand the use of the differential white cell count in the diagnosis of disease processes.
BLOOD PRACTICAL CLASS 3 - To determine blood groups, the coagulation/clotting time, the
bleeding time,
OBJECTIVES:
To understand and practice the method used in determining blood groups according to the ABO
and Rhesus (Rh) systems.
to familiar with the ABO and Rh systems and be able to explain their importance in blood
transfusion.
to know the normal range of values expected for the bleeding and clotting time in haemotasis.
to know (a) how to measure both the osmotic fragility of blood and the erythrocyte sedimentation
rate and (b) what is the value of taking these measurements.
Unit – III
Nerve & Muscle Physiology
GENERAL OBJECTIVES
A. Nerve and Muscle
To comprehend the properties of excitable cell membrane:
1. Positive and active forces determining the movements of ions across the cell membrane
concentration and voltage gradients; permeability; ionic channels; conductances and gates; Na+
- K+ pump.
2. Generation and propagation of the action potential: mylinization; salutatory.
3. Conduction.
4. Clinical correlates of excitable tissues in the light of the understanding of normal function.
B. Neuromuscular Transmission and Muscle Contraction.
1. To give reasonable comprehension of the mechanism of excitation-concentration coupling with
reference to neuro-transmitters, receptors Ca++ and esterase.
2. To comprehend muscle contraction on the basis of molecular structures.
3. To explain biophysics in terms of length-tension and force velocity-relationship.
Lecture 1: NEURON
By the end of this lecture, the student should be able to:
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a- Identify and describe structural components of neurons and ascribe functions.
b- Identify and describe in equal or unequal distribution of ions across the cell membrane creating
concentration and electrical gradients.
c- Define permeability and list factors influencing permeability.
d- Identify and describe diffusional and equilibrium potential (Em) and explain the negatively of
inside of the cell.
e- Using single ion, apply Nernst equation to calculate equilibrium potential.
f- Classify neurons by using letters or numbers on basis of diameters and velocity.
g- Acquire themselves with nerve growth factors and its clinical uses.
Lecture 2: RESTING MEMBRANE POTENTIAL (RMP).
By the end of this lecture, the student should be able to:
a- Identify describe genesis of resting membrane potential (RMP) and the roles of ions channels,
Na+ - K+ pump and Gribbs- Donnan effect.
b- Apply Goldman field equation in calculating resting membrane potential.
c- Appreciate the effect of changes in ionic composition and/or permeability on resting
membrane potential.
d- Appreciate the principles involved in voltage-clamp technique.
Lecture 3: ACTION POTENTIALS
By the end of this lecture, the student should be able to:
a- Define and draw potentials giving membrane potential in mV and time course in msec and label
all components such as latency, threshold (firing level), spike overshoot, after depolarization
and after hyperpolarization.
b- Account the above changes in excitability in terms of conductance changes of Na+ (gNa) and
K+ (gK+).
c- Correlate the conductance changes with opening (activation) or closing (inactivation) of
relevant gates.
d- Distinguish between a local potential and an action potential.
Lecture 4: Properties of nerve fibers:
At the end of this lecture, the student should be able to.
a- Describe the highest excitability of nerve cell compared to all other excitable cells in terms of
rapid change over of selected ions across the membrane.
b- Construct a strength-duration relationship.
c- Define chronaxae and rheobase and appreciate its usefulness.
d- Define absolute and relative refractory period and give their ionic basis.
e- Define all and none law accommodation.
f- Describe differences in the propagation of action potential in myelinated and unmylinated nerve
fibers.
g- Appreciate effects of local anesthetic, cooling, hypoxia, acidosis and alkalosis on nerve
conduction.
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h- Differentiate monophasic, diphasic and compound action potential.
Lecture 5: Neuromuscular transmission:
By the end of this lecture, the student should be able to.
a- Draw and describe the ultramicroscopic structures of a neuromuscular junction.
b- Describe the pre junction and post-junction event in sequence in the neuromuscular
transmission and appreciate special roles of transmitter, receptor, esterase and calcium.
c- List neuromuscular blocking agents and state site and action.
d- Identify the pathogenesis of myasthemia gravis and appreciate the rationality.
Lecture 6: Molecular basis of muscle contraction:
By the end of this lecture, the student should be able to.
a- Describe steps in sequence in excitation–contraction coupling b) describes sliding filaments
theory of muscle contraction.
b- Describe molecular structures of muscle proteins and their arrangements at resting phase,
contraction and relaxation phase.
c- Explain the rigidity of rigor mortis.
Unit – IV
AUTONOMIC NERVOUS SYSTEM
GENERAL OBJECTIVES
Upon completion of the course, the student should:
1- Appreciate the main differences between the somatic and autonomic nervous system.
2- Understand the general organization of the sympathetic and parasympathetic systems.
3- Understand the functional roles of the sympathetic and parasympathetic systems in control of
visceral function.
4- Understand the mode of chemical transmission, receptor actions and consequences of blocking or
enhancing these receptor actions.
6- Have some applied physiology background in the form of autonomic function
effects of normal aging and a few selected examples of diseases.
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SPECIFIC OBJECTIVES
Lecture 1
At the end of this lecture the students should be able to:
- understand the main differences between the somatic and autonomic nervous system
- contrast the sympathetic and parasympathetic branches of the autonomic nervous system based on:
- spinal cord division of origin, length of preganglionic and post- ganglionic neurons,
neurotransmitters and receptors at the ganglionic and target organ synapse
Lecture 2
At the end of this lecture, the student should be able to:
- list the sensory input of the ANS, and the responses of different organs in the body to
and parasympathetic stimulation
sympathetic
- list the major central nervous system control centers of the ANS
- briefly describe the functional effects of normal and abnormal ANS activity or lack of activity
Unit –V
CARDIOVASCULAR SYSTEM
LECTURE CONTENTS
The first six lectures are concerned with introducing the cardiovascular system to the students and
giving them detailed information about the different cardiac Properties.
Lecture 1
1) Introduction
2) Functional anatomy of the heart
3) Properties of the cardiac muscle/ for example:
A) Excitability and the electrical properties of the heart
Definition/ mechanism and factors affecting excitability
Lecture 2
B) Conductivity
i. Conductive system of the heart e.g.: S.A. node, A.V. node ... etc.
ii. factors affecting conductivity
C) Contractility; mechanism of contraction and factors affecting.
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D) Rhythmicity: prepotential (ionic basis) and factors influencing
Lecture 3:
CARDUAC CYCLE: Definition and different phases of the cardiac cycle.
i. pressure changes during the cycle (atrial, ventricular, aortic and pulmonary)
Lecture 4:
ii. Volume changes during the cycle, regulation of the heart and effect of various substances such as
K+ ions and Ca++ ions.
Lecture 5: Heart sounds and mechanisms of hearts sounds. Auscultation and its sites. Some
pathological sounds such as murmurs.
Lecture 7: Genesis and understanding of the normal ECG pattern
Lecture 7: Interpretation and information derived from normal ECG
Lecture 6: Circulation. Overview of circulation and pressure changes in the systemic and pulmonary
circulation.
Lecture 8: Cardiac output and venous circulation and factors affecting both.
Lecture 9: Venous return curves.
Lecture 10: - Preload, after load and contractility: intrinsic control
Lecture 11: Blood pressure: Physiological variations affecting blood pressure e.g. age, sex, emotion,
race, respiratory movements, exercise, gravity, posture and sleep
Lecture 12: Factors that determine the normal B.P. e.g. heart rate,
Stroke Volume, blood volume. Peripheral resistance
Lecture 13: Nervous regulation of the cardiovascular system
- Short term regulation by baro and chemoreceptors
- Intermediate regulatory mechanisms of arterial Pressure.
- Long term regulatory mechanism.
CARDIOVASCULAR PRACTICALS 1.
HEART SOUNDS
OBJECTIVES
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1. To understand why the different heart sounds are produced.
2. To know the sites at which heart sounds are best recorded.
3. To recognize the value of phonocardiography.
PRACTICAL 2
THE ELECTROCARDIOGRAM (ECG)
OBJECTIVES
To Understand and record normal electrocardiograms.
PRACTICAL 3.
ARTERIAL BLOOD PRESSURE
OBJECTIVES:
1. To be able to measure arterial blood pressure using a sphygmomanometer.
2. To recognize the effects of (a) gravity and (b) muscular exercise on the arterial blood
pressure.
Unit – VI
RESPIRATORY PHYSIOLOGY
General Objective
The objectives of this course are to have students master, and be able to:1- Correlate lung structure with functions.
2- Learn lung mechanics, gas transfer, and control of breathing.
3- Understand lungs circulation, fluid exchange, and oxygen and carbon dioxide transport.
4- Understand the regulation of respiration during exercise, the effect of exposure to low and high
pressures on the body.
5- Use applied physiology to understand clinical problems; Obstructive and restrictive lung disease,
sleep apnea, pulmonary edema, hypoxia and cyanosis.
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Instructional Objectives.
Lecture 1: Functions and Organization of the Respiratory System.
By the end of this lecture the Students should be able to: 1- Understand the difference between internal and external respiration.
2- Describe the structures and functions of the conductive and respiratory zones.
3- Understand functions of the respiratory system, including non- respiratory functions, like clearance
mechanism by mucus and cilia, production of surfactant and converting enzyme.
Lecture 2: Mechanics of breathing.
By the end of this lecture the students should be able to:
1- List the muscles of respiration and describe their roles during inspiration and expiration.
2- Understand the importance of the following pressures in respiration: Atmospheric, alveolar,
intrapleural, and transpulmonary.
3- Explain why intrapleural pressure is always subatmospheric under normal conditions, and the
significance of the thin layer of the intrapleural fluid surrounding the lung.
4- Describe pneumothorax.
5- Describe the pressure and volume relationships in a single respiratory cycle.
6- Define lung compliance and list the determinants of compliance.
7- Describe the physiological significance of surfactant and provide an example of abnormal lung
function due to a deficiency of surfactant.
Lectures 3 and 4:
Respiratory ventilation.
By the end of these lectures the students should be able to: I- Define the various Lung Volumes and capacities and provide
typical values for each.
2- Describe FEV1.o and its role in differentiating obstructive and restrictive lung diseases;
3- Understand air movement and airway resistance:
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Definition, determinants, role of autonomic nervous system and mechanical factors.
4- Describe the types of dead space. State a volume for the anatomical dead space.
5- Define the term minute ventilation and state a typical value.
6- Distinguish minute ventilation from alveolar ventilation.
Lecture 5: Gas Transfere
By the end of this lecture the students should able to: 1- Define partial pressure of a gas. Describe how partial pressure of a gas is influenced by altitude.
2- Understand that the pressure exerted by each gas in a mixture of gases is
pressure exerted by the other gases (Dalton's Law)
independent of the
3- Understand that gases in a liquid diffuse from higher partial pressure to lower partial pressure (
Henry’s Law )
4- Describe the factors that determine the concentration of a gas in a liquid.
5- Describe the components of the alveolar-capillary membrane (i.e., what does a molecule of gas pass
through).
6- Knew the various factors determining gas transfer: - Surface area, thickness, partial pressure
difference, and diffusion coefficient of gas.
7- State the partial pressures of oxygen and Carbon dioxide in the atmosphere, alveolar gas, at the end
of the pulmonary capillary, in systemic capillaries, and at the beginning of a pulmonary capillary .
Lecture 6:
Oxygen Transport
By the end of this lecture the students should be able to: 1- Understand the forms of oxygen transport in the blood, the importance of each form and,
2- Describe: a- The relationship between PO2 and % saturation of hemoglobin with oxygen, and the
significance of the shape of this relationship.
b- How DPG, temperature, H+ ions and PCO2 affect affinity of O2 for Hb and the
physiological importance of these effects.
Lecture 7:
Carbon dioxide transport.
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By the end of this lecture the students should be able to: 1- Describe the three forms of Carbon dioxide that are transported in
the blood, and the chloride shift.
2- Describe the role of the enzyme Carbonic anhydrase and the CO2 dissociation curve.
3- Describe how H+ is transported in the blood.
4- Define respiratory acidosis and respiratory alkalosis, and explain how these are related to
hypoventilation and hyperventilation respectively.
Lecture 8: Control of breathing.
By the end of this lecture the students should be able to: 1- Understand the role of the medulla oblongata in determining the
basic pattern of respiratory activity .
2- Describe the pacemaker activity of the medullary inspiratory neurons.
3- Describe the role of pulmonary stretch receptors in the control of respiration.
4- List some factors that can modify the basic breathing pattern.
5- Understand the respiratory consequences of changing PO2, PCO2, and pH.
6- Describe the locations and roles of the peripheral and central chemoreceptors.
7- Compare and contrast metabolic and respiratory acidosis and metabolic and respiratory alkalosis.
Lecture 9: Alveolar- Arterial equilibration.
By the end of this lecture the students should be able to: 1- Define hypoxia and list its physiological causes.
2- Define cyanosis
3- Understand regional variations in alveolar ventilation and blood flow.
4- List causes of abnormal ventilation/perfusion (V A/Q) ratios.
5- Understand pulmonary capillary fluid exchange, and pulmonary edema.
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RESPIRATION PRACTICALS
RESPIRATION PRACTICALS
SPIROMETERY
OBJECTIVES:
To be able to:
a) Use a spirometer and- determine lung volumes and capacities,
b) Define and provide normal values for the various lung volumes and capacities and
c) Recognize the physiological factors that modify lung volumes and capacities,
Unit - VII
GASTRO INTESTINAL TRACT PHYSIOLOGY
General objectives
At the end of this course, the student should be able to:
1-Describe the Physiologic anatomy and the general organization of the gastrointestinal
to relate structure to functions.
tract so as
2- Differentiate between the various types of intestinal movements so as to comprehend their role
digestion and to interpret symptoms and signs related to gut motility .
3- Understand the neurological and hormonal mechanisms, which control the digestive functions, in
particular;
a- Control of salivary secretions.
b- Control of gastric secretions.
c- Control of secretions of pancreatic juice.
d- Control of formation and release of bile.
e- Control of intestinal secretions.
4- Be able to describe clinical tests used to evaluate functions of the stomach, pancreas,
liver and gall-bladder.
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5- Understand the process of digestion and absorption of various food substances so as to give
appropriate principle of nutrition and dietary advice to patients.
6- Understand the functions of the colon in order to explain clinical problems such as
diarrhea and constipation.
INSTRUCTIONAL OBJECTIVES
Lecture 1 : General organization and functions of the G. I. T
At the end of 'this session 'the student should be able to:
Gastro-Intestinal tract.

Parts of the oral cavity.

Salivary glands.

Secretion of saliva.

Contents of saliva.

Functions of saliva.
Control of salivary secretion.

Digestion of CHO in the mouth.
Lecture 2 & 3: Deglutation & vomiting. Stomach And pancreas.
At the end of this session the student should be able to:
Stomach and its functions.
 Gastric glands.
 Gastric secretion and digestion.
 Regulation of gastric secretion.
Deglutation and vomiting
Pancreatic secretions.
 Physio-anatomy of the Pancreas.
 Enzymes of the pancreas and the intestinal brush border.
Regulation of the pancreatic secretion.
Lecture 4 & 5: Liver Bile and biliary tree
At the end of this session the student should be able to:
Liver, bile and the billiary tree.
 Pysio-anatomy.
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 Bile and its secretion.
 Constituents of bile.
Gall bladder and its functions.
Emptying of the gall bladder.
Lecture 6 & 7: Digestion and absorption
At the end of this session the student should be able to:
a- Describe the anatomy of the stomach in the term of regions, secretory epithelium
and individual types of secretory cells.
b- List the secretions of the stomach, their cells of origin and their function.
c- Discuss the various factors that stimulate and inhibit the secretory activity of the
parietal cells.
d- Discuss the long and short neural reflexes that influence HCI secretion.
e- Discuss the hormonal influence on HCI secretion
f- Describe the secretion of HCI in terms of the three phases and appreciate the
rationale of treatment of peptic ulcer.
g- Describe the control of the secretion of pepsinogen.
h- Discuss the potentially damaging effects of HCl on gastric and esophageal
mucosa.
i- Describe the effects of the absence of parietal cells.
j- Describe some of the causes of ulcer formation in the stomach and small intestine.
TUTORIAL - I
A problem related to gastric secretion
A school Teacher, 29 years of age, had severe pain and discomfort in the upper central abdomen. He
described the pain as burning. The pain started usually after food intake, so he avoided taking food
and became anemic. He used to vomit sometimes.
In hospital, he made an appointment for a procedure called an endoscopy. During the
procedure, a long, thin tube was inserted into his mouth and directed into his digestive tract. The end
of the tube was equipped with a light source and a small camera which allowed the doctor to observe
the interior of his stomach. The endoscope was also equipped with a small claw-like structure that the
doctor could use in order to obtain a small tissue sample from the lining of the stomach, if required.
24
The endoscopy revealed that he had a peptic ulcer. Analysis of a tissue sample taken from the
site showed that he also had an infection that was caused by Helicobacter pylori bacteria.
Unit – VIII
RENAL AND ACID – BASE PHYSIOLOGY
RENAL PHYSIOLOGY LECTURES CONTENTS
LECTURE 1:
FUNCTIONAL ANATOMY OF THE KIDNEY
 General function of the kidney
 Functional Anatomy of the Nephron
• Different parts of nephron: glomerulus, renal tubules, uxtaglomerular
apparatus, afferent & efferent arterioles, vasa recta
• Comparison between cortical and juxtamedullary nephron
 Innervation
 Renal Circulation
LECTURE 2:
GLOMERULAR FILTRATION
 Principle of urine formation
• Glomerular Filtration
• Tubular Reabsorption & secretion
 Structure of Glomerular Membrane
 Factors affecting Glomerular membrane permeability
 Net Filtration pressure
 Composition of filtrate
LECTURE 3:
GLOMERULAR FILTRATION RATE
 Definition and normal value
 Measurement of 6FR
25
 Factors affecting GFR
 Filtration fraction
 Filtration Equilibrium
 Tubulo-glomerular feed back
LECTURE 4:
RENAL CLEARANCE
 Renal circulation
 Definition & Formula of Renal clearance
 Inulin clearance" and GFR
 Creatinine clearance and GFR
 Glucose and urea clearance
 PAH clearance and measurement of renal blood flow
LECTURE 5:
TUBULAR TRANSPORT & Na+ REABSORPTION
 TUBULAR TRANSPORT
• Reabsorption
• Secretion
 Type of transport
• Transcellular Reabsorp+ion

Primary active transport

Secondary active transport

Ton channel - passive transport
• Para cellular Reabsorption
 Proximal convoluted tubule
• Tubular Reabsorption of sodium and water
 Basola+eral – Na/K+ ATPase
 Lumenal
o Na+ channel
o In exchange for H+
o Glucose
 Dragging of water - isosmotic, 65% of filtered Na, CI- follow sodium
• Glomerulo-tubular balance
26
LECTURE 6:
TUBULAR REABSORPTEON OF 6LUCOSE. AMINO ACIDS. UREA
& OTHER ELECTROLYTES
 Glucose reabsorp+ion
• Mechanism of glucose reabsorp+ion
• Lumenal membrane; co-transport with sodium
• Basolateral membrane - GLUT
• Relationship between filtration, absorption, excretion and plasma
glucose level (glucose titration curve)
• Explanation of splay
• Tubular maximum (Tmg) and renal threshold of glucose
 Amino acids reabsorption
• Lumenal membrane; co-transport with sodium
• Basolatera! membrane - diffusion
 Bicarbonate
• Filtered HCO2- + H+ = H2CO3 C.A H2O + CO2
• Intracellular CO2 + H2O = H2CO3 — HCO3 + H+
• HCO3- absorption and H+ excretion
 Phosphate
• Co-transport with sodium
• Parathyroid and Vit. D
 Urea
• Passively following sodium reabsorption
LECTURE 7:
TUBULAR FUNCTION
 PROXIMAL TUBULE SECRETION
• PAH
27
 Renal blood flow
• H'
 Important for HCO3 The loop of Henle
• Descending limb
 Water permeable
 No solute absorption
• Ascending limb
 Water impermeable
 Na+/K+/Cl- co-transport
 Na+ / K+ ATPase in baso-lateral membrane
 Distal convoluted tubule
 Collecting duct
• Water permeable under ADH
• Urea absorption with ADH
• Sodium reabsorption in exchange for K+ under the influence of aldosterone
LECTURE 8 & 9:
CONCENTRATION OF URINE & COUNTER CURRENT MECHANISM
 Urine concentration
• Filtrate osmolality along the nephron
• Counter current multiplier mechanism
 Formation of graded hyperosmolar medulla
 Thick ascending limb and collecting duct
 NaCl- and Urea
• Counter current exchanger
 Vasa recta
 Maintenance of medullary hyperosmolarity
 Diuresis
• Water diuresis - ADH
• Osmotic diuresis - diabetes
• Potyurea " diabetes insipidus
INSTRUCTIONAL OBJECTIVES
Lecture 1:
Functional Anatomy of the kidney
At the end of this session, the students should be able to:
• Make a list of general functions of the kidney
• Identify and describe that the nephron is the structural and function Unit of the kidney
• Draw a nephron and label each part
• Identify and describe the histological! characteristics of the different parts of the nephron
• Correlate the structures with functions
28
• Compare and contrast Cortical with Juxtamedullary nephron
• Identify and describe juxtamedullary apparatus and its function
• Be able to diagram the path of blood flow from the renal artery through the kidney back to the
renal vein
Lecture 2:
Glomerular filtration
At the end of this session, the students should be able to:
• Identify and describe that the mechanism of urine formation include three basic processes;
glomerular filtration, tubular reabsorption and tubular secretion
• Identify and describe the ultramicroscopic structures of the glomerular filtration membrane
• Identify and explain why the capillary hydrostatic pressure is highest in the kidney compared to
all other systemic capillaries and given the data. Calculate the net filtration pressure using parameters
of Starling forces
• Describe the importance of the size of the capillary bed and pores
• Correlate between net filtration pressure along glomerulus and plasma flow
• Identify and describe the composition of the filtrate
Lecture 3:
Glomerular filtration rate
At the end of this session, the students should be able to:
• Define GFR and quote normal value in men and women
• Identify and describe the factors controlling 6FR in terms of starling forces, permeability with
respect to size. shape and electrical charges and ultra-filtration coefficient
• List the characteristics that a compound must have before it can be used for measuring GFR
e.g. Inulin, creatinine etc.
• Given the data, calculate GFR in relation to renal hemodynamics
Lecture 4:
Renal clearance
At the end of this session, the students should be able to:
• Describe the concept of renal plasma clearance
• Define clearance in term of volumes of plasma
• Use the formula for measuring renal clearance
• Use clearance principles for inulin, creatinine etc. for determination of GFR
• Explain why it is easier for a physician to use creatinine clearance Instead of Inulin for the
estimation of GFR
• Describe glucose and urea clearance
• Use PAH clearance for measuring renal blood flow
• Define and calculate filtration fraction (FF)
• Define filtration equilibrium
Lecture 5:
Tubular Transportation & Na+ Reabsorption
At the end of this session, the students should be able to;
• Define tubular reabsorption and tubular secretion
• Identify and describe mechanisms of tubular transport
• Describe tubular reabsorption of sodium and water
• Use the clearance principles for calculating reabsorption and or secretion
29
• Define and explain tubulo-glomerular feedback and glomerulotubular balance and describe its
physiological importance
Lecture 6:
Tubular Reabsorption of Glucose, Amino Acids, Urea & other Electrolytes
At the end of this session, the students should be able to:
• Identify and describe mechanism involved in Glucose reabsorption
• Study glucose titration curve in terms of renal threshold, tubular transport maximum, splay,
excretion and filtration
• identify the tubular site and describe how Amino Acids, HCO3, P04And Urea are reabsorbed
• Describe the movement of Urea into and out of the renal tubules
Lecture 7: Tubular Function
At the end of this session, the students should be able to:
• Describe tubular secretion with PAH transport and K+
• Identify and describe the characteristic of loop of Henle, distal convoluted tubule and collecting
ducts for reabsorption and secretion
• Understand the role of ADH in the reabsorption of water and urea
• Identify the site and describe the influence of aldosterone on reabsorption of Na+ in the late
distal tubules.
• List and explain the factors that control aldosterone and ADH release
Lecture 8 & 9: Concentration of Urine & Countercurrent mechanism
At the end of this session, the students should be able to;
• Identify and describe that the loop of Henle is referred to as countercurrent multiplier and the
loop and vasa recta as countercurrent exchange systems in concentrating and diluting urine
• Explain what happens to osmolarity of tubular fluid in the various Segments of the loop of
Henle when concentrated urine is being produced.
• Explain the factors that determine the ability of loop of Henle to make a concentrated medullary
gradient
• Differentiate between water diuresis and osmotic diuresis
• Appreciate Clinical Correlates of diabetes mellitus and diabetes insipidus
30
RENAL PRACTICALS
DIURESIS – PART 1
OBJECTIVES:
1. To measure the volumes and determine the compositions of urine excreted by volunteers
who have drunk:
a) No fluids for several hours
b) A litre of water
c) A litre of isotonic saline
2. to be able to discuss the mechanisms by which the :
a) Conserves fluids and sodium if neither food nor water is taken
b) Exrcetes more water when extracellular fluids are diluted by the ingestion of water
c) Slowly eliminates sodium and when the extracellular fluid volume is increased
without altering its osmolality.
DIURESIS – PART 2
OBJECTIVES:
1. T o measure the volume and determine the composition of urine excreted by volunteers who
have:
a) Drunk a litre of water and then continued with their normal activities (i.e. remained
active)
b) Drunk a litre of water and then rested quitly (supine)
c) Swallowed a lasix tablet (furosemide) with 25ml water
2. To be able to explain why a man who drinks a litre of water and remains active does not
excrete the same:
a) Volume of urine, or
b) Amount of sodium
As a man who drinks the same volume of water but then rest quitly for the subsequent 3 hours.
To be able to discuss the mechanisms whereby a man taking Lasix excretes large quantities of both
water and sodium.
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Unit – IX
GENENERAL OBJECTIVES OF THE ENDOCINE SYSTEM
On the completion of the course, the students should be able to:
 Describe the neural and hormonal control of the pituitary gland by the Hypothalamus and
other parts of the nervous system, so as to investigate patients with endocrine disorders.
 Describe the chemical nature and metabolism of the hormones secreted by the endocrine
glands in order to use appropriate methods if investigation and therapy.
 Explain the control and actions of hormones secreted by the major endocrine organs in the
human body so as to interpret the manifestation of endocrine disorders.
 Describe and start to recognize the manifestation of clinical endocrine disorders so as to reach
an early diagnosis.
 Explain the basis of commonly used tests of endocrine functions.
32
LECTURES:
1) Introduction:
a- Definition of hormone
b-Target cells
c- Receptors
- Chemical nature
- Down and upregulating
- Key and lock analogy
d- Diagram showing the different Endocrine glands.
e- Mechanism of action of hormone
2) The hypothalamic-pituitary axis: Control of the pituitary gland by
the hypothalamus.
a- Direct neural tracts
b- Releasing and inhibitory hormones
3) The anterior pituitary gland and Growth hormone:
a- Glycoprotein
- FHS
- LH
- TSH
b- Growth hormone and prolactin
c- Effects of over and under secretion of GH
d- Propiomelanocortin (POMC)
ACTH
MSH
b-Endorphin
4&5) The thyroid gland:
a- Biosynthesis, storage and secretion of T3 and T4
b- Iodine metabolism
c- Understand the significance of the conversion of T4 and T3 (rT3 in
exrta thyroid tissues
d- Action of thyroid hormones on development and metabolism.
Understand the cause and consequences of:
- Over secretion
- Under secretion of thyroid hormones

Explain why either condition can cause an enlargement of
the thyroid gland
6&7) Endocrine pancreas:
- Insulin
- Glucagon
- Glucose homeostasis
- Diabetes Mellitus
33
8) Calcium homeostasis
a- Parathyroid hormone
b- Calcitonin
c- Vitamin D
d- Causes and consequences of:
- Over secretion
- Under secretion of PTH
e- Consequences of Vit. D deficiency and excess
9) Adrenal gland and Cortisol:
Cortex: Glucocorticoids, Mineral cortocoids and Androgens
- Cause and consequences of excess and deficiency of the adrenal
cortical hormone
Medulla: Catecholamine
- Disease caused by over secretion of catecholamines
INSTRUCTIONAL OBJECTIVES
PSL- 211 ENDOCRINE PROGRAMME
LECTURE – 1
INTRODUCTION:
At the end of this session the students should be able to:
 List the endocrine glands of the body with their location in the males and females.
 Identify and describe the differences between exocrine and endocrine glands.
 Define hormone and describe the mechanism of the action of hormone.
 Define target cells.
 Identify and describe receptors in terms of their chemical nature, down and up regulation
and appreciate the key and lock analogy.
LECTURE - 2
HYPOTHALAMO-PITUITARY AXIS:
At the end of this session the students should be able to:
 Identify and describe the hypothalamic control of the posterior pituitary through the direct
hypothalamo-neuro hyphophyseal trct.
 List the releasing and inhibitory hormones of the hypothalamus.
 Identify and describe the hypothalamic control of the anterior pituitary by the releasing and
inhibitory hormones through negative feedback mechanisms.
LECTURE – 3
ANTERIOR PITUITARY GLAND:
 List then anterior pituitary hormones and identify the cell types that produce there.
 Identify and describe the major effects of growth hormone on the body tissues and on lipid
and carbohydrate metabolism.
 Identify and describe the role of somatomedin.
 Identify and describe the regulating mechanism of growth hormone.
34
 Identify and describe the characteristic feature of hypo and hyper secretion of growth
hormone before and after closure of epiphysis.
 Identify and describe the action of TSH.
 Identify and describe the actions of propiomelanocortins-ACTH, MSH and betaendoprhin.]
LECTURE – 4&5
THE THYROID GLAND.
At the end of this session the students should be able to:
 Identify and describe the biosynthesis, storage and secretion of T3 and T4 thyroid hormone.
 Give an account of iodine metabolism.
 Explain the significance of the conversion of T4 to T3 and reverse (rT3) in extra thyroid
tissue.
 Describe the function of the thyroid hormone.
 Describe the action of thyroid hormone on development and metabolism.
 Identify and describe the causes and the consequences of over secretion and under secretions
of the thyroid hormone.
 Explain why other condition can cause an enlargement of the thyroid gland.
 List thyroid function test.
 Identify the regulatory mechanism controlling thyroid hormone secretion.
LECTURE – 6 & 7
ENDOCRINE FUNCTION OF THE PANCREAS
At the end of this session the students should be able to:
 Identify and describe the cellular source, chemical nature and mechanism of action of
insulin.
 Identify the role of insulin on glucose transport through cellular membranes.
 Identify and describe the hepatic and extra hepatic effects of insulin on carbohydrate, protein
and fat metabolism.
 Identify the effects of insulin lack or excess on lipid metabolism.
 Identify and describe glucagon, its target actions, factors that influence its secretions and its
means of regulation.
 Identify somatostatin.
 Identify and describe the principal and supporting regulatory mechanisms for blood glucose
levels, their significances and the glucose buffer function of the liver.
 Identify the roles of catecholamines, thyroid hormones cortisol and growth hormones as
diabetogenic mellitus.
 Identify clinical co-relation with diabetes mellitus.
LECTURE- 8,
CALCIUM HOMEOSTASIS:
At the end of this session the students should be able to:
 List the function of calcium.
 Give an account of calcium metabolism.
35
 Identify and describe parathyroid hormone and its effect on bone, kidneys, and the intestinal





epithelium.
Identify and describe the function of calcitonin.
Identify and describe vitamin D compounds, the sequences of event leading to the formation
o and active form of vitamin D3 and its regulatory role in calcium reabsoption.
Identify the major consequences of the altered concentrations of calcium phosphates in the
body fluids.
Identify consequences of vitamin D deficiency and excess.
Identify and describe the consequences of hyperthyroidism and suggest some means of
prevention and treatment.
LECTURE- 9
ADRENAL GLAND
At the end of this session the students should be able to:
 Identify and describe the structure of adrenal cortex consisting o f the zona glomerulosa,
zona fasciculate and zona reticularis and list the adrenal corticoid hormones secreted by
zones.
 Characterize the chemical nature of the hormones.
 Identify and describe the major glucocortocoids, their general significance and the effects o f
cortisol on the carbohydrate, protein and fat metabolism.
 Identify and describe the actions and function of cortisol during states of stress and on
inflammatory responses.
 Identify and describe the control of secretion of cortisol.
 Describe clinical correlates of Addison,s diseases.
 Identify and describe the mineralcortocoids and the effects of aldosterone on renal functions,
body fluid and cardiovascular dynamics and also sweat and salivary glands and intestinal
absorption.
 Identify and describe the control of secretion of aldosterone.
 Identify and describe the feature of Cushing’s disease, primary aldosteronism and the
adregogenetal syndrome.
 Identify and describe the adrenal medullary hormones.
 Characterize the chemical nature of the catecholamines.
 Describe the consequences of over secretions of catecholamines.
ENDOCRINE PRACTICALS 1.
GLUCOSE TOLERANCE TEST (GTT) PRACTICAL
OBJECTIVES:
1. To determine the blood glucose concentration following an oral glucose load.
2.
To be able to discuss the physiological mechanisms by which blood glucose concentrations
are controlled.
3. To recognize the importance of GTTs in diagnosis, particularly of diabetes mellitus.
36
Unit – X
Central Nervous System & Special Senses
INSTRICTIONAL OBJECTIVES
LECTURE TOPICS
Lecture 1.



Fuctional Anatomy of the CNS.
Orientation of the cerebral cortex.
Receptors, afferent pathways and functions.
Lecture 2.
Orientation of the cerebral cortex.
 Receptors, afferent pathways and functions.
Lecture 3.
UMN & LMN.
Lecture 4 & 5
Motor system.
 Paramydal and extraparamydal system.
Lecture 6
Cerebellum
Lecture 7 & 8
Basal Ganglion.
 Control of movements.
 Postural reflexes.
Lecture 9
Reflex.
Lecture 10& 11
37
Memory
 Behaivior
 Hypothalamus
Lecture 12

Vision
Lecture 13
Speech.
Lecture 14& 15
Hearing
Smell and Taste
CNS PRACTICALS
Examination of the motor system
OBJECTIVES:
To be able to:
d) Examine the motor system thoroughly and reliably,
e) To establish the protocols for the examination
38