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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
2
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.
5
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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SMALL GROUP TUTORIAL
WORKSHEET
1. Clinical feature of dehydration
________________________
________________________
________________________
________________________
________________________
2. List of causes of dehydration
________________________
________________________
________________________
________________________
________________________
3. Name of fluid compartment
________________________
________________________
________________________
________________________
________________________
Size
_______
_______
_______
_______
_______
Method measurement
________________
________________
________________
________________
________________
4. Distribution of fluid in a 74Kg man
______________________
________________________
________________________
________________________
________________________
5. Osmotic equilibria and fluid movement
ICE=301
290 mOsm/Kg
ECF=151
21 H2O added to ECF
290 mOsm/Kg
Osmotic equilibrium
Osmotic equilibrium
Re-establishment of
Osmotic equilibrium
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SELF-EVALUATION QUESTIONS
1. Which of the following substance is used for measuring the plasma volume?
A- Antipyrine.
B- Inulin.
C- PAH
D- Evan’s blue.
2. Which of the following criterion is not included for suitability of the substance for
measuring ECF?
A- The substance must distribute itself only in the ECF.
B- Should not diffuse into the cell.
C- Should be non-toxic.
D- Should be sweet to taste.
3. Which of the following is an example of trans-cellular fluid?
A- Interstitial fluid.
B- CSF.
C- Plasma.
D- Intra-vascular fluid.
4. Total Body Water (TBW) - Extra-cellular Fluid (ECF) gives:
A- Interstitial fluid.
B- Intra-vascular fluid.
C- Intra-cellular fluid.
D- Plasma volume.
5. The body fluid compartment with the highest protein concentration is the:
A- Extra-cellular fluid.
B- Intracellular fluid.
C- Plasma.
D- Interstitial fluid.
6. Primary force moving water molecules from the blood plasma to the interstitial fluid is:
A- Filtration.
B- B. Active transport.
C- Facilitated diffusion.
D- Co-transport with sodium.
7. In a subject TBW is 42 liters and ECF is 14 liters. This means the intra-cellular
fluid volume is:
A- 56 L
B- 28 L
C- 7 L
D- 9 L
8
8. The property of primary active transport include all of the following EXCEPT:
A- Uphill movement from lower to higher concentration.
B- Uphill movement form lower to higher electrochemical potential.
C- Coupled directly to continuous supply of energy.
D- Independent of the downhill movements of any other solute or water.
9. Which one of the following statements is NOT true for carrier-mediated transport?
A- Is always active.
B- May require ATP.
C- May be electrogenic.
D- Faster than simple diffusion.
9
Answers
1. You have to follow a process of exclusion. Antipyrine or aminopyrie is distributed to all fluid
compartments. It is used for measuring total body water (Not A). Inulin is used for measuring ECF
(Not B). PAH is used for renal plasma flow measurement (Not C). Of the four items, you have
rightly excluded three items. So, the fourth item, Evan’s blue is the answer. Circle D only.
2. You are looking for exception. The substance must distribute itself only to ECF. It should not
diffuse into the cell and should be non-toxic. These three criteria, i.e., necessary that the substance
should be sweet. So fourth item, D, is the answer.
3. Trans-cellular fluid is found in the lumen of structures lined by epithelial cells. Items A, C and D
are all examples of ECF but don’t contribute to trans-cellular compartment. A, C and D are not
answers. So, CSF is the only possible answer. The correct answer is B.
4. Interstitial fluid= ECF- plasma volume (Not A, B and D). So, Total Body Water –ECF= Intracellular fluid. C is the right answer.
5. Ions constitute approximately 95% of the solutes in body water. In the ECF or plasma, protein
concentration is 15 meq/1 (1 mmol/1). So, not A and not C. In the ICF, protein concentration is 60
meq/1 (4 mmol/1). So, B is the answer because interstitial fluid has even less, 1 meg/1 (0.06
mmol/1). Not D.
6. Active transport, co-transport or facilitated diffusion are not included. Therefore, the answer is not
B, C or D. Filtration, i.e., A is the answer.
7. Total Body Water – ECF= Intra-cellular fluid. So, 42 L= 28 L therefore, B is the answer.
8. A, B and C are criteria for primary active transport system. D is the only exception. Therefore, D
is the answer.
9. B, C and D are true. These are correct statements about carrier mediated transport. Only A is not
true for carrier mediated transport. Therefore, A is the answer.
10
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
11
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
12
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
13
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
 Leucopenia
 Leucocytosis
 Leukemia
14
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.
15
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.
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.
16
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.
SELF ASSESSMENT QUIZ
True or False Quiz
1. Plasma is about 45% of total blood volume
a. True
b. False
2. Male has more RBC than female
a. True
b. False
3. Monocytes become macrophages as they leave the blood and enter the tissue spaces
a. True
b. False
4. Iron deficiency anemia is characterized by the presence of small red blood
Cells
a. True
b. False
5. A large reticulocyte count in the blood reflects a slow production of erythrocytes from the
bone marrow
a. True
b. False
6. Hypoxia will cause the production of more red blood cells
a. True
b. False
7. In pernicious anemia, the lack of vitamin Vit B12 results in red blood cells
Having larger size than normal (macrocytic)
a. True
b. False
8. Pregnancy requires the addition of supplements containing iron to meet the increase demand
due to fetal growths
a. True
b. False
9. High erythrocyte count (physiological) is found in people living at high Attitude
a. True
b. False
10. Vessel spasm can be an effective method of hemostasis
a. True
b. False
11. Damage to tissues initiates the intrinsic phase of clotting
a. True
b. False
17
12. Persons with type A agglutinogen will have anti-B agglutinin in their blood also
a. True
b. False
Put (T) for true statement and (F) for false statement:
1. Erythrocytes formation:
a. Takes place in the liver and spleen during adult life
(
b. Increases at high altitude
c. Is stimulated by reduction in arterial oxygen content
(
d. Is increased in renal disease
2. The main feature of erythrocytes maturation from stem cells
include:
a. increased size
b. Segmentation of the nucleus
(
c. Enlargement of mitochondria
(
d. Appearance of hemoglobin
(
3. Iron:
a. Is stored in the form of haemosiderin
b. Absorption is reduced by ascorbic acid
c. Deficiency causes anaemia characterized by larger red
Cell volume (MCV).
d. Is transported in the blood to the bone marrow after
Combining with apoferritin
4. Anaemia results from the following conditions:
a. Haemolytic disease of newborn
b. Depression of bone marrow
c. Deficiency of folic acid
d. Living at high altitudes
)
( )
)
( )
( )
)
)
)
( )
( )
( )
( )
( )
( )
( )
( )
5. All of the following statements are correct about the mechanism
of the Coagulation
a. factor VIII is essential for the intrinsic pathway
( )
b. Factors X and V are involved in both the intrinsic and
extrinsic pathways
( )
c. Tissue thromboplastin active factor XII and the intrinsic ( )
pathway
e. Removal of calcium ion from the blood inhibits clot
( )
formation
18
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:
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.
19
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.
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.
20
STUDY QUESTIONS
1) The following statements about Resting Membrane Potential (RMP) are true
EXCEPT:
A- The resting membrane potential in nerve is about -70mV.
B- Is such that ions carry current into and out of the cell at the same rate.
C- Is solely due to K+ diffusion potential.
D- Would be expected to decrease (become less negative) if the extracellular K+ concentration (K+
out) increased.
2) Which of the following statement about action potential in nerves is
correct?
A- Has a rapid depolarizing phase owing to an inward sodium current.
B- Depolarization is due to a rapid increase in inward K+ current.
C- Depend on voltage-dependent activation and inactivation of both Na+ and K+ channels.
D- Has no threshold.
3) The propagation or conduction o f action potentials in myelinated axons
share all of the following properties EXCEPT.
A- Occurs at about the same speed for the same diameter axon.
B- Occur in either direction if stimulation occurs in the center of along nerve fiber.
C- Occur only if currents bring the adjacent regions to threshold.
D- Accomplished by flow of local circuit currents.
4. In a patient the amount of acetylcholine contained in each vesicle at the
neuromuscular junction is decreased from normal value. A drug which would
relieve the effect of the condition is:
A- A curare-like drug.
B- A local anesthetic.
C- Hemicholinium (block uptake of choline by nerve terminals.
D- An antiacethylcholinesterase.
5) These are four events during skeletal muscle contraction EXCEPT:
A- The myofilaments do not change length.
B- Cross bridges are formed between myosin and actin.
C- The A and I bands don’t change in length.
D- Maximal tension can be generated when the muscle is close to it normal resting length.
6) All of the following statements are true for the myosin head EXCEPT:
A- It has an actin binding site.
B- It has an ATP binding site.
C- It has a Ca2+binding site.
D- It has capacity for movement.
21
Answeres
1)
a- True, in the nerve. It is more negative in skeletal muscle, about -90mV.
b- True the resting potential is not equal to any one ion’s equilibrium Potential. So
There is a driving force for outward movement o f K+ and inward movement of
Na+.
c-False the resting potential has contribution from Na+ and other ions diffusion.
d-True, the concentration gradient driving K+ out of the cell is decreased so the
Voltage gradient necessary because to balance it, EK is less negative. The
Membrane potential decreases because at rest K+ is the dominant permeation
Ion.
2)
a- Correct, positive feedback accelerates this.
b- Incorrect, the repolarizing K+ current is outward.
c- Incorrect, K+ channels do not inactivate.
d- Incorrect, it must reach to a threshold potential or firing level to get propagated.
3)
a- Correct, myelinated axons have much higher conduction velocities than unmyelinated axon of
the same diameter. In myelinated nerve: diameter in microns=6x in meters per second is the
velocity.
b- No, this is not the exception. Action potential can propagate in either Direction. They usually
have one-way conduction because of synapse.
c- No, this is not exception. This statement is explaining the action of local circuit current for both
myelinated and unmyelinated axons.
d- This is not the exception. This statement is the mechanism of propagation of action potential in
nerve fibers.
4.)
a- No, the patient might die. Your treatment would have exactly the “opposite effect o f what is
needed. The small amount of Ach would be even less effective in the presence of the
competitors, curare.
b- No, a local anesthetic would block nerve conduction and make this condition worse.
c- No, this drug blocks the uptake of choline by the presynaptic terminal and all by itself could
produce exactly the same symptoms displayed by this patient.
d- Correct, this would prolong the action of the small amount of Ach released and partially relieve
this condition. A disease is diagnosed using a very rapid acting anticholinesterase, tensilon and
treated with a longer acting cholinesterase.
5)
a- True, this slide past each other.
b- True.
c- False, the A bands do not, but the I bands shorten as the thin myofilaments slide between the
thick.
d- Active tension depends on the resting length and the normal length in the body seems close to
optimal.
6)
a. True.
b. True.
c. Wrong. so, this is the answer.
d. True
22
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.
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
23
STUDY QUESTIONS
1- Administration of atropine-like drug is likely to cause:
abcd-
decrease in heart rate
intestinal colic
blurred vision
excessive salivation
2- Nicotine, in low doses:
abcd-
acts directly on the smooth muscle of the urinary bladder, causing urination
blocks the discharge of post-ganglionic parasympathetic neurons
increases the discharge of post-ganglionic sympathetic nerves
decreases the release of acetylcholine in sympathetic ganglia
3- Propranolol is a drug that can:
abcd-
block cholinergic transmission at ganglia
cause diarrhea (or diarrhea <- American)
be used in treatment of bronchial asthma
can help in treatment of pathologic tachycardia
4- In the sympathetic nervous system:
abcd-
the cell-bodies of pre-ganglionic nerves are located in the dorsal root ganglia
the axons of pre-ganglionic neurons are in the ventral roots of spinal nerves in
the sacral region
pre-ganglionic nerves are myelinated
5- An increase in acetylcholine activity:
abcd-
can worsen (or aggravate) the pain of peptic ulcer
may be associated with generalized arteriolar constriction
leads to decreased production of sweat
causes constipation
24
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.
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.
25
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
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.
26
GENERAL STUDY QUESTIONS
1234567-
Enumerate cardiac properties. Discuss the mechanism and factors affecting rhythmicity
Describe the changes occurring during left ventricular systole
Discuss the extrinsic control of cardiac output
What are the factors that affect the end diastolic volume?
Discuss the role of baroreceptors in the regulation of arterial blood pressure
Explain the factors which affect the left coronary blood flow
Discuss the mechanism of formation of oedema
MULTIPLE CHOICE QUESTIONS:
a- From the above diagram select the correct answer as A, B, C, D, E:
1- The fourth heart sound is caused by:
a- closure of the aortic and pulmonary valves
b- vibrations in the ventricular wall during systole
c- ventricular filling
d- closure of the mitral and tricuspid valve
e- Atrial contraction
2- The dicrotic notch on the aortic pressure curve is caused by:
a- closure of the mitral valve
b- closure of the tricuspid valve
c- closure of the aortic valve
d- closure of the pulmonary valve
e- rapid filling of the left ventricle
3- Which of the labels identifies the part of the ECG that corresponds to ventricular repolarization?
4- Which of the labels identifies the Q wave?
5- Which of labels identifies the part of the ECG that corresponds to maximum opening of ventricular
Ca2 channels?
6- Which of the following normally has a prominent prepotential?
a- Sinoatrial node
b- Atrial muscle cells
c- Bundle of His
d- Purkinje fibers
e- Ventricular muscle cells
27
7- Currents caused by opening of which of the following channels contribute to the repolarization
phase of the action potent ventricular muscle fibres?
a- Na+ channels
b- Cl‾ channels
c- Ca2+ channels
d- K+ channels
8-When the radius of the resistance vessels is increased, which of
the following is increased?
a- Systolic blood pressure
b- Diastolic blood pressure
c- Viscosity of the blood
d- Hematocrit
e- Capillary blood flow
9-When the viscosity of the blood is increased/ which of the following
is increased?
a- Mean blood pressure
b- Radius of the resistance vessels
c- Radius of the capacitance vessels
d- Central blood flow
e- Capillary blood flow
28
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.
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.
29
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:
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.
30
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.
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.
31
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.
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,
SELF-EVALUATION
1- A low lung diffusion capacity (DL) could be caused by:
a. increased diffusion distance
b. decreased surface area
c. decreased capillary blood flow
d. all of the above
32
2- Which of the following is true regarding cerebrospinal fluid:
a. it is freely accessible to blood hydrogen ions
b. its protein content is equal to that of plasma
c. its pH is a functional of Pa CO2
d. its Pa CO2 is equal to that of systemic arterial blood
3- In which of the following disorders is the lung most likely to show a steep compliance curve?
a. edema
b. fibrosis
c. emphysema
d. congestion
4- Arterial PO2 will decrease with which of the following?
a. anemia
b. carbon monoxide poisoning
c. hemorrhage
d. alveolar hypoxia
5- Transpulmonary pressure is equal to:
a. alveolar pressure minus pleural pressure
b. airway pressure minus pleural pressure
c. pleural pressure minus atmospheric pressure
d. atmospheric pressure minus alveolar pressure
6- Oxygen unloading:
a. increases with increased pa CO2
b. decreases with increase in temperature
c. decreases with increase in 2,3 DPG
d. increases with increase pH
7- In acclimatization to altitude:
a. P50 is reduced, improving 02 uptake in the lungs
b. P50 is increased, improving 02 off loading in the tissues
c. 2, JDPG levels are reduced, improving 02 offioading in the tissues
d. Alkalaemia reduces the affinity for 02, increasing p50.
e. increases in 2, 3 DPG and a decrease in p50.
8- Central chemoreceptors:
a. bathed in CSF
b. respond to increase in CSF pH
c. bathed in ECF
d. in medullary respiratory center
33
9- Peripheral chemoreceptors:
a. in the carotid sinus
b. have glomus cells
c. low A- V difference
d. innervated by glossopharyngeal nerve e. blood flow of 200mls/G/minute
10- Surfactant:
a. is produced by type I pneumocyte
b. is commonly deficient in term neonates
c. acts like detergent in water
d. reduced the amount of negative intrapleural pressure
e. increases pulmonary compliance
11- The normal arterio-venous difference for C02 is:
a. 2ml/100
b. 4mI/100
c. 6ml/I00
d. I0ml/100
12- The lung:
a. removes/inactivates serotonin (5HT)
b. activates bradykinin
c. converts angiotensin II to I
d. inactivates aldosterone
e. takes up noradrenaline
13- Which of the following substances is removed? (inactivated) by the lung?
a. serotonin
b. noradrenaline
c. angiotensin I
d. bradykinin
e. all of the above
14- For normal Hb- 02 dissociation curve, the most correct relationship is:
a. P a02 340mmHg, Sa02 99%
b. Pa02 132mmHg, Sa02 98%
c. Pa02 68mmHg, Sa02?
d. do Pa02 60mmHg, Sa02 91% e.
e. none of the above
15- Carbon dioxide carriage:
a. 10% dissolved
b. 30% carbamino
c. 85 bicarbonate
d. 60 bicarbonate
e. unaffected by pO2
34
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.
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.
35
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.
 Bile and its secretion.
 Constituents of bile.
Gall bladder and its functions.
Emptying of the gall bladder.
36
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.
G.I.T practice examination
5. Secretin hormone:
a- is a GIT hormone secreted from the pylorus
b- stimulates pancreatic secretion rich in enzymes
c- act as a powerful cholagogues
d- is released as a result of contact of acid chyme to duodenal mucosa
6. Bile salts:
a- are essential for vitamin B12 absorption
b- are formed from fatty acids
c- are essential for protein digestion
d- undergo enterohepatic circulation
7. Which of the following hormones tends to stimulate pancreatic secretion that is
rich in bicarbonate?
a- somatostatin
b- secretin
c- CCK
d- gastrin
8. Which of the following hormones cause the gall bladder to contract?
a- gastrin
b- secretin
c- somatostatin
d- CCK
37
9. Salivary secretion is inhibited by: a
a- atropine
b- VIP
c- Cimetidine (H2 receptor antagonist)
d- aspirin
10. Which of the following secretins is exclusively under neural control?
a- gastric secretion
b- intestinal secretion
c- pancreatic secretion
d- salivary secretion
11. Secretion of acid by the stomach can be inhibited by:
a- acidification of the antrum
b- acidification of the duodenum
c- blocking histamine receptors
d- inhibition of the H+ -K+ ATPase.
12. Diarrhea can be caused by:
a- excessive secretion
b- decreased colonic motility
c- increased motility of the small intestine
d- osmotic agents trapped within the lumen
e- destruction of enterocyte function
38
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.
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.
QUESTIONS :
1- What is meant by peptic ulcer?
2- Fill in the blanks:
Substance
Cellular source
Function
a- Hcl
……………………. ……..
……………………. ……..
b- Pepsinogen
.............................. ……..
……………………. ……..
c- Intrinsic factor
39
3- Draw a schematic diagram showing the mechanism of HCI formation.
4- How HCI secretion can be stimulated and inhibited?
5- Give examples of three classes of drugs commonly used in treating peptic ulce.
6- Why don’t antihistamines has no effect on acid secretion?
7- Mention two main factors predisposing to peptic ulceration.
40
8- Why don’t the components of gastric juice damage the wall of the stomach in
the absence of a Helicobacter pylori infection?
9- Why don’t most other types of bacteria produce ulcers?
TUTORIAL -2
A problem related to hepatobiliary system:
A fat, female of about 50 years age complaining of severe pain in the abdomen is admitted in the
hospital. She describes the pain as excruciating (meaning unbearable) and usually radiating between
the shoulder blades. She noticed that pain appears when she takes. Khapsa" and meat (fatty foods) and
last several hours. Her personal history reveals that she is multipara (having several children) and is
obese (over weight )
On examination it is found that:
i) the pain is localized in the right hypochondria.
ii) the sclera of her eyes are markedly yellow in color .
iii) blood examination show conjugated bilirubin level high but normal free bilirubin,
normal ammonia, urea, pancreatic amylase and normal CBC.
iv) black tarry stools.
v) ultrasonography shows the presence of gall stones.
vi) oral cholecystography reveal radio opaque shadow in the biliary tree.
Provisional diagnosis
The attending doctor diagnosed the condition as obstructive Jaundice (Gall stones obstructing
the flow of bile at the cystic duct).
In order to understand the problem of this lady, we have to review some basic anatomical and
physiological fact:
41
1- Identify and demarcate right hypochordial region. What abdominal structure(s)
are likely to be located in this regions?
2- Draw the hepatobiliary tree and locate the (i) cystic duct (ii) sphincter of Oddi.
3- Outline the role of liver in fat metabolism.
4- What vitamins which may be affected? And which one of them will affect
haemostasis and how?
5- Compare and contrast the liver bile with gall bladder bile.
6- Draw a schematic diagram of entero-hepatic circulation of bile.
7- Define and classify Jaundice.
8- What is meant by free and conjugated bilirubin?
9- Can you explain:
(a) yellow coloration of sclera of the eye.
(b) black tarry stool.
42
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
Factors affecting GFR
Filtration fraction
Filtration Equilibrium
Tubulo-glomerular feed back
43
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
44
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
 Renal blood flow
• H'
 Important for HCO3-
45
 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
• 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
46
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
• Define and explain tubulo-glomerular feedback and glomerulotubular balance and describe its
physiological importance
47
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
48
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.
SELF ASSESSMENT QUIZ
1. What is the minimum amount of water a day the kidneys are "obliged" to put out?
A- 0 liters
B- 0.5 liters
C- 1.0 liters
D- 3 Liters
49
2. Which vitamin do the kidneys convert to its active form?
A.C
B.K
C.D
D.E
3. Which part of the kidney collects urine after it has been formed?
A- The renal cortex
B- The renal medulla
C- The renal pyramid
D- The renal pelvis
4. What channel transports urine from the kidneys to the bladder?
A- The urethra
B- The ureter
C- The glomerulus
D- The renal pyramid
5. Urine composition is further altered by the bladder.
A- True
B- False
6. What component of a nephron collects glomerular filtrate?
A- Bowman's capsule
B- The loop of Henle
C- The distal tubule
D- The juxtaglomerular apparatus
7. What percentage of the plasma that actually enters the glomerulus is filtered?
A- 10%
B- 20%
C- 80%
D- 90%
8. Once substances are filtered out by glomerular filtration they cannot be
recovered.
A- True
B- False
9. What are fenestrae?
A- Flattened endothelial cells in the glomerular capillary walls
B- Large pores in the glomerular capillary walls
C- Large pores in the walls of the proximal tubule
D- Glycoproteins sandwiched between the glomerulus and Bowman's apsule
50
10. What prevents 99% of albumin escaping into Bowman's capsule?
A- Fnestrae
B- Fegatively charged glycoproteins
C- Collagen
D- Podocytes
11. Of the three forces involved in glomerular filtration, which "favors" rather than "opposes"
filtration?
A- Bowman's capsule hydrostatic pressure
B- Plasma-colloid osmotic pressure
C- Glomerular capillary blood pressure
D- All of the above
12.What cells forming the walls of the distal tubule in the juxtaglomerular apparatus can detect
changes in the rate at which fluid flows past them?
A- Granular celts
B- Pdocytes
C- Endothelial cells
D- Mmacula densa
13. It has been suggested that release of the vasoactive chemical, bradykinin. Can help return
GFR to normal after it has declined.
A- True
B- False
14. What are mesangial cells?
A- Cells that hold together glomerular capillaries and have the ability to contract and relax so as
to alter the filtration coefficient.
B- Cells in the inner membrane of Bowman's capsules that can contract or relax and so alter the
filtration coefficient
C- Cells which can trigger the release of chemicals capable of inducing vasoconstriction
D- Cells which can trigger the release of chemicals capable of inducing vasodilation
15. What blood vessels are involved in the reabsorption of materials that the body does not want
to lose?
A- The efferent arterioles
B- The afferent arterioles
C- The peritubular capillaries
D- The proximo! tubules
16. To be reabsorbed from the kidney tubules back into the blood, how many distinct barriers
must a substance cross?
A- 2
B- 3
C- 8
D- 5
51
17. What percentage of filtered glucose is reabsorbed?
A- 100%
B- 99%
C- 10%
D- b. 50%
18. In what part of the nephron is sodium reabsorption an important aspect of the reabsorption
of glucose and amino acids?
A- The loop of Henle
B- The distal tubule
C- The proximal tube
D. All of the above^
19. The net transport of Na+ from the tubular lumen into the blood can be considered passive
reabsorption:
A- True
B- False
20. In the renin-angiotensin-oldosterone system, where does the
aldosterone originate from?
A- The liver
B- The kidneys
C- The lungs
D- The adrenal cortex
21. What triggers the atria to release atrial natriuretic peptide?
A- Na+ retention
B- Expansion of ECF volume
C- Increase in the arterial blood pressure
D- All of the above
22. The cotransport of glucose and amino acids with Na+ from the tubular lumen to the tubular
cells demands additional energy than that already used to transport the Na+.
A- True
B- False
23. Which is the only substance not to have a tubular maximum?
A- Phosphate
B- Glucose
C- Name=23C. Na+
D- Amino acids
52
24. Under normal conditions, how high must the plasma glucose concentration be before glucose
would start escaping in urine?
A- Oover 100 mg/ml
B- Over 375 mg/ml
C- Over 300 mg/ml
D- Over 125 mg/ml
25. The point at which the plasma concentration of a particular substance is high enough to
cause it to appear in the urine is called:
A- The tubular maximum
B- The renal threshold
C- The tubular threshold
D- The renal maximum
26. Which two substances can parathyroid hormone regulate the reabsorption of?
A- phosphate and calcium
B- calcium and chloride
C- calcium and urea
D- phosphate and chloride
27. What causes variable water reabsorption in the distal region of the nephron?
B- regulation of channels by parathyroid hormone
C- regulation by atrial natriuretic peptide
D- regulation by vasopressin
E- regulation by aldosterone
28. Which waste product can be passively reabsorbed back into the blood?
A- Urea
B- Creatinine
C- Phenol
D- All of the above
29. Which process truly regulates K+ content in the plasma?
A- Glomerular filtration
B- Tubular reabsorption
C- Ttubular secretion
D- All exert an equally regulatory influence
30. Increased acidity of body fluids leads to a reduction in K+ secretion.
A- True
B- False
31. Monitoring which substance can give the most accurate measure of GFR?
A- Insulin
B- Creatinine
C- Para-aminohippuric acid
D- Inulin
53
32. Which part of the juxtamedullary nephron establishes the vertical osmotic gradient?
A- The loop of Henle
B- The vasa recta
C- The collecting tubules
D- The proximal tubule
33. The presence of vasopressin causes the distal and collecting tubules to become permeable to
water:
A- True
B- False
34. What results form alcohol ingestion?
A- Suppression of vasopressin leading to water diuresis
B- Elevation of vasopressin leading to water diuresis
C- Suppression of vasopressin leading to osmotic diuresis
D- Elevation of vasopressin leading to osmotic diuresis
35. What is the maximum concentration of solutes in urine?
A- 500 mosm/liter
B- 800 mosm/liter
C- 1.200 mosm/liter
D- 1.500 mosm/liter
36. The distal portion of the tubule is highly permeable to urea:
A- True
B- False
37. In chronic renal failure, how much loss of kidney tissue can occur
before loss of function becomes apparent?
A- 25%
B- 40%
C- 75%
D- 90%
38. What aspect of renal failure can lead to changes in cardiac and neural excitability?
A- Uremic toxicity
B- Potassium retention
C- Metabolic acidosis
D- Inability to vary urine concentration
54
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.
55
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
56
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.
57
 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.
58
 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.
59
Self-evaluation questions
1. Which one of the following glands is not under the hypophyseal
control?
A- Thyroid.
B- Adrenal cortex.
C- Parathyroid
D- The Gonad.
2. All of the following hormones act on their target cells via second
messenger mechanism EXCEPT:
A- Growth hormone.
B- Prolactin.
C- Glucagon.
D- Thyroxin.
3. Parathyroid hormone:
A- Is secreted by cells of the thyroid gland.
B- Is not essential for life.
C- Increase plasma phosphorus.
D- Convert vitamin –D into its form in the kidney.
4. The hormones secreted by islets of Langerhans is likely to have the
following actions EXCEPT:
A- Elevating blood glucose level.
B- Lowering blood glucose level.
C- Causing salt and water retention.
D- Inhibiting GIT secretion, motility and absorption.
5. Which of the following is a neurohormone?
A- Growth hormone.
B- Glucagon.
C- Antidiuretic hormone.
D- Aldosterone.
6.Glucocortocoids:
Not essential for life.
Are synthesized in the zona fasciculate and reticularis.
Are protein in nature.
Decrease blood glucose level.
7. Thyroid hormones:
A- are free (unbounded) to plasma proteins.
B- Produced their effect on target cells by causing gene expression.
C- Inhibit glucose absorption.
D- Are only regulated by the hypothalamic thyrotropin releasing hormone.
60
8.The secretion of sex hormones from the adrenal cortex is controlled
by:
A- The gonadotropic hormones.
B- The luteininzing releasing hormone.
C- ACTH.
D- Aldosterone.
13. A list of endocrine gland should include the heart, liver, hypothalamus and kidneys since
these organs all secret hormones that affect target cells around the body:
A- True
B- False
14. Secreted hormone generally do not remain in blood stream and accumulate since they are
rapidly removed by the liver or the target organs themselves.
A- True
B- False
15. A Physiological” dose refers to an abnormally high concentration of substance than
normally present in the bloodstream:
True
False
16. The priming effect of hormones may actually decrease the number of receptor protein their
cells causing down regulation:
A- True
B- False
17. To prevent desensitization of receptors from occurring under normal circumstances many
polypeptide and glycoprotein hormones are secreted in a pulsatile fashion, raththan being
secreted continuously:
A- True
B- False
18. Adrenal cortex is controlled by the blood to every cell in the body, but only the target cells
with specific receptor protein for that hormone are able to response:
A- True
B- False
19. Hormones bind to receptor proteins with high capacity and low affinity:
A- True
B- False
20. The anterior pituitatary develps as a down of the brain, while the posterior pituitary is
derived from embryonic epithelium from Rathke’s pouchk:
A- True
B- False
61
21.The pars nervosa of the pituitary gland is poorly understood, producing different form of
melanocyte-stimulating-hormone (MSH) and large amount of B- endorphin:
A- True
B- False
22. The axons of the hypothalamo-hypophyseal tract joins the hypothalamus to the anterior
pituitary:
A- True
B- False
23. The anterior lobe of the pituitary is more a storage organ for hormones than a true gland:
A- True
B- False
24. Any tissue deserves the title, the hypothalamus rather than the anterior pituitary should be
considered the “Master gland” in the body:
A- True
B- False
25. The vascular link between the hypothalamus and the anterior pituitary is called the
hypothalamo-hypophyseal system, transporting releasing and inhibitng hormone of the
hypothalamus toward specific target cells in the adenohypophysis:
A- True
B- False
26. Anterior pituitary secretion of ACTH, TSH, and the gonadotropins (FSH and LH) is
controlled by negative feedback loops from hormones by target cells.
A- True
B- False
27. When individuals are under stressful condition, there is increased secretion of ACTH and,
thus increased secretion of adrenal corticoids:
A- True
B- False
28. Hormones secreted from the adrenal medulla are expected to increase cardiac rate and
cardiac output, respiratory rate, and other major functions:
A- True
B- False
29. Pheochromcytoma is a tumor of the adrenal cortex, releasing large quantities of epinephrine
and norepinephrine:
A- True
B- False
62
31. The thyroid gland is the only gland in the body that expands metabolic energy in the active
transport of iron atoms from the blood and into the colloid of the thyroid follicles:
A- True
B- False
32. Under secretion of thyroxine (hypothyroidism) in infants result in myxedema, whereas
hypothyrodism in adult causes cretinsm:
A- True
B- False
33. Between the follicles of the thyroid gland are epithelial cells called parafollicular cells that
secret the hormone known as calcitonin, (or thyrocalcitonin).
A- True
B- False
34. When most of the patient’s thyroid gland surgically removed, the blood levels of tyhyroxine
drop rapidly since it has extremely short half-life:
A- True
B- False
35. The major action of parathyroid hormone (PTH) is to control the iodine levels of the blood
control the secretion of thyroxine from the thyroid glands:
A- True
B- False
36. The secretion of hormones makes the pancreas endocrine, and secretion o f pancreatic
‘juice” into the digestive system makes the pancreas and exocrine:
A- True
B- False
37. Glucagon is a hormone that active when an individual is fasting or starving, stimulating the
hydrolysis of stored fat (lipolysis) and liver glycogen (glycogenolysis) so that fuel levels will rise
in the blood, providing energy to cells:
A- True
B- False
38. After a meal. glucagons secretion is decreased and insulin secretion is increased- an example
of the antagonistic action of hormones:
A- True
B- False
63
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



Memory
Behaivior
Hypothalamus
64
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
65
WEEK 1
CELL MEMBRANE AND BODY FLUIDS
Lecture
No./
Practical
Day
Time
Sat
2-4
pm
Mon
8-9 am
2
Cell membrane, Structure and
Functions.
9-10
Tue
8-10
am
3-4
Body fluid composition and
Transport accross the cell
membrane
34-44
Extra
Lecture.
1
Topic
Reference Pages
Extra Lecture.
Intoduction to Physiology
WEEK 2
BLOOD PHYSIOLOGY
Day
Time
Lecture No./
Practical
Sat
2-4
pm
Extra
Lecture
5
Extra Lecture
Composition & Functions of
Blood.
Functions of Plasma Proteins.
6
RBCs:
Erythropoesis:
Site, Regulation & Factors
Affecting.
Mon
Tue
8-9
am
8-10
am
Topic
WBC WBCs:
Types and functions of WBCs.
7-8
Phagocytosis.
Monocyte-Macrophage System.
Immunity in brief.
Reference Pages
203
568
275-278
281-287
288-291, 293
66
WEEK 3
Day
Time
Lecture No./
Practical
Topic
Sat
2-4
pm
Practical
1st Practical on Blood
TLC, DLC
Mon
Tue
8-9
am
8-10
am
9
Blood groups
 ABO System
 Rh System
Complications of Blood
Transfusion
Reference Pages
295 - 298
Haemostasis and blood
coagulation.
1. Events of hemostasis
Initiation of coagulation.
 The Extrinsic pathway.
 The Intrinsic pathway.
 Interaction between both
the pathways.
10-11
299-306
2. Mechanism of Coagulation.
Conversion of prothrombin
to thrombin.
 Conversion of
fibrinogen to fibrin
 Formation of a clot.
3. Bleeding Disorders & AntiCoagulants.
67
WEEK 4
Day
Sat
Time
2-4
pm
Lecture No./
Practical
Tutorial
Topic
Reference Pages
Tutorial.
Anemias
 Types and classification.
 Clinical importance
 Physiological basis of
treatment.
Jaundice.
NERVE AND MUSCLE
Day
Mon
Tue
Time
8-9 am
8-10
am
Lecture No./
Practical
12
Topic
Basic Physics of Membrane
Potentials and resting membrane
potential.


13-14

The Nerve Action Potential.
Plateau in some Action
Potentials.
Physiological Anatomy of
Skeletal Muscle.
Reference Pages
47-50
51-60
68
WEEK 5
Day
Time
Lecture No./
Practical
Topic
Sat
2-4
pm
Practical
2nd Practical on Blood
Blood Group, BT, CT


Mon
8–9
am
15

Tue
8-10
am
16-17
Molecular Mechanism of
Muscle Contraction.
Molecular
Characteristics of the
Contractile Filaments.
Initiation of Muscle
Contraction.
Excitation-Contraction
Coupling.
Mechanics of Skeletal Muscle
Contraction.
 The Motor Unit
 Summation of Muscle
Contraction
Muscle Fatigue.
Reference Pages
60 - 64
65-69
WEEK 6
AUTONOMIC NERVOUS SYSTEM
Day
Sat
Time
2-4
pm
Lecture No./
Practical
CD Session
Topic
Reference Pages
Quiz 1 will preceed this CD
session.
Nerve and Muscle
Mon
8-9 am
18
Autonomic Nervous System.
495-502
Tue
8-10
am
19-20
Autonomic Nervous System.
69
WEEK 7
CARDIOVASCULAR PHYSIOLOGY
Day
Sat
Mon
Time
2-4
pm
8-9 am
Lecture No./
Practical
Extra
Lecture
21
22
Topic
Extra Lecture
Heart Muscle: Heart as a pump.
 Physiology of the cardiac
muscle.
 Properties of the cardiac
muscle.
 Cardiac excitationcontraction coupling.
Reference Pages
85-87
Cardiac cycle:
 Systole and Diastole.
 Function of the Atria as a
“Primer” pump.
 Function of the
Ventricles as a pump.
 Function of the valves.
87-93
Tue
8-10
am
23-24
Cardiac cycle:
 Aortic pressure curves.
 Relationship of heart
sounds.
 Regulation of the heart
pump.
 Effects of K+ and Ca++.
70
WEEK 8
Day
Time
Sat
2-4
pm
Lecture No./
Practical
Practical.
Topic
1st
Reference Pages
Practical.
Practical on CVS
(Heart Sounds)
25
Rythmical excitaion of the
heart.
 Specialized excitatory and
conductive system of the
heart.
 Control of excitation and
conduction in the heart.
 S.A. node as a pacemaker.
 Control by the cardiac
nerves.
94-99
Mon
8-9 am
Tue
8-10
am
26-27
The Electrocardiogram
100-112
Day
Time
Lecture No./
Practical
Topic
Reference Pages
Sat
2-4
pm
CD
Session
Cardiac Action Potential
Cardiac Cycle
28
Circulation.
 Overview of the
circulation.
 Pressure difference
throughout the
circulatory system.
 Systemic and pulmonary
circulation.
WEEK 9
Mon
8-9
am
115-120
71
8-10
am
Tue
29-30
Cardiac output and Venous
Return.
 Factors affecting cardiac
output and venous
return.
Blood pressure(B.P)
 Defination.
Factors affecting B.P
169-173
118-120
WEEK 10
FIRST CONTINUOUS ASSESSMENT EXAMINATION WEEK
WEEK 11
Day
Time
Lecture No./
Practical
Topic
Sat
2-4
Practical
2nd Practical on CVS
(E.C.G.)
31
Regulation of blood pressure.
 Nervous regulation (Short
term regulation).
 Role of Baro-receptors
and Chemoreceptors
 The central nervous
system’s Ischemic
response.
152-156
32-33
Role of the Kidney in long term
regulation of blood pressure.
 The Renin-Angiotensin Aldosterone System.
157-164
Mon
Tue
8-9
pm
8-10
pm
Reference Pages
72
WEEK 12
Day
Time
Lecture No./
Practical
Topic
Sat
2-4
pm
Practical
3rd Practical on CVS
(B.P)
34
Pulmonary ventilation.
 Mechanics of
pulmonary
ventilation.
 Respiratory muscles.
 Movement of air in
and out of the lungs.
 Various pressure in
the lungs.
 Surfactant and
surface tension
311-313
35-36
Pulmonary volumes &
capacities,
 Pulmonary volumes.
 Pulmonary capacities.
 Alveolar Ventilation.
 Dead Spaces.
 Functions of
Respiratory passages.
314-318
Mon
Tue
8-9 am
8-10
am
Reference Pages
EID-AL-ADHA AND HAJJ HOLIDAYS
WEEK 13
Day
Sat
Time
2-4
pm
Lecture No./
Practical
Extra Leture
37
Topic
QUIZ 2 will preceed this
lecture.
Extra Leture
Pulmonary circulation.
 Physio-anatomy of
Pulmonary
Circulation.
Reference Pages
318-322
73
 Pressures in the
pulmonary system.
 Pulmonary capillary
dynamics.
 Pulmonary edema
Mon
8-9 am
38
Transport of gasses between
heart and the lungs.
 Diffusion of O2 and
CO2.
 Partial pressure of
individual gasses.
 Diffusion of gasses
through the respiratory
membrane.
324-332
Loading and deloading of
gasses at alveolar and
tissue levels.

8-10
am
Tue
39-40



Loading of O2 at
alveolar level.
Deloading of O2 at
tissue level.
Loading of CO2 at
tissue level.
Deloading of CO2 at
alveolar level
324-332
WEEK 14
Day
Sat
Mon
Time
Lecture No./
Practical
Topic
2-4
Practical.
1st Practical on Respiration.
Simple Spirometry
41
Oxy-Hemoglobin dissociation
curve.
 Factors affecting it.
 Transport of O2.
 Transport of CO2.
 Transport of CO
8-9
Reference Pages
332-335
74
Tue
8-10
42-43
Regulation of respiration
 Respiratory centers.
 DRG.
 Pneumotaxic center.
 VRG.
 Hearing-Breuer reflex.
 Chemical control of
respiration.
 Peripheral
chemoreceptors and the
role of O2.
337-340
WEEK 15
GASTRO-INTESTINAL PHYSIOLOGY
Day
Time
Lecture No./
Practical
Topic
Sat
2-4
pm
Extra Lecture
Extra Lecture
44
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.
Mon
8-9
Reference Pages
514 &
524 - 26
75
Tue
8-10
45-46
Stomach and its functions. Pages. 515 - 18 &
 Gastric glands.
527 - 531
 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.
WEEK 16
Day
Sat
Mon
Tue
Time
2-4
pm
8-9 am
8-10
am
Lecture No./
Practical
Topic
Tutorial
Tutorial:
Gastric Secretion.
 Contents and functions
of gastric juice.
 Peptic ulcers.
47
Liver, bile and the billiary tree.
 Pysio-anatomy.
 Bile and its secretion.
 Constituents of bile.
Gall bladder and its functions.
Emptying of the gall bladder.
531 - 534
48-49
Process of digestion and
absorption.
 Digestion and
absorption of CHO.
 Digestion and
absorption of Proteins.
 Digestion and
absorption of Fats.
 Role of bile salts in fat
absorption.
537 - 541
Reference Pages
76
WEEK 17 &
MID-YEAR PRACTICAL EXAMINATION
WEEK 18
MID-YEAR THEORY EXAMINATION
WEEK 19
MID-YEAR BREAK
TERM 2 – 1428- 1429 (2007-8)
LECTURE TIME TABLE – MALE SECTION
WEEK 1
GASTRO-INTESTINAL PHYSIOLOGY
Day
Time
Lecture No./
Practical
Topic
Sat
2-4
pm
Extra Lecture
Extra Lecture
44
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.
Mon
Tue
8-9
8-10
45-46
Reference Pages
514 &
524 - 26
Stomach and its functions. Pages. 515 - 18 &
 Gastric glands.
527 - 531
 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.
77
WEEK 2
Day
Sat
Mon
Time
2-4
pm
8-9 am
Lecture No./
Practical
Topic
Tutorial
Tutorial:
Gastric Secretion.
 Contents and functions
of gastric juice.
 Peptic ulcers.
47
Liver, bile and the billiary tree.
 Pysio-anatomy.
 Bile and its secretion.
 Constituents of bile.
Gall bladder and its functions.
Emptying of the gall bladder.
Reference Pages
531 - 534
78
Tue
8-10
am
48-49
Process of digestion and
absorption.
 Digestion and
absorption of CHO.
 Digestion and
absorption of Proteins.
 Digestion and
absorption of Fats.
 Role of bile salts in fat
absorption.
537 - 541
WEEK 3
RENAL PHYSIOLOGY
Day
Time
Sat
2-4
pm
Mon
8-9 am
Lecture No./
Practical
Topic
Reference Pages
Extra Lecture
1
Functional Anatomy of the
Kidneys.
 Renal Circulation.
212-222
Tue
8-10
am
2&3
Glomerular Filtration.
G.F.R.
79
WEEK 4
Day
Sat
Mon
Time
2-4
pm
8-9 am
Lecture No./
Practical
Practical





4
8-10
am
5&6
Day
Time
Lecture No./
Practical
Sat
2-4
pm
Mon
8-9 am
Tue
8-10
am
Tue
Topic



Reference Pages
1st Practical on Kidney
Diuresis
Normal control subject
Subject given Saline
Subject given water
Subject given Lassix
Modes of action of all
tests.
Concept of Clearance
223-235
Tubular Transport.
Reabsorption
Secretion.
223-235
WEEK 5
Tutorial
7
8&9
Topic
Reference Pages
CD Session:
Urine Concentration and
Countercurrent Mechanism.
236-252
Buffer Systems. Role of the
Respiratory and Renal
Systems.
254-266
80
WEEK 6
ENDOCRINOLOGY .
Day
Time
Lecture No./
Practical
topic
Referance Pages
Quiz 1 (II term)
Sat
Mon
2-4
pm
8-9 am
Extra Lecture.
10
Introduction to Endocrinology.
 Nature of hormones.
Mechanisms of hormone
action.


Tue
8-10
am
11&12
595 - 98
Receptors.
Second messenger
systems. (basic
concepts)
The Pituitary gland, its
functions and relation to the
Hypothalamus.
 Hypothalamic control
of the ant. Pituitary.
 Hormones of the ant.
Pituitary.
 Hormones of the post.
Pituitary.
Human Growth Hormone.
(hGH)
 Functions of the hGH.
 Metabolioc effects of
hGH.
 Regulation of hGH.
Abnormalities of HypoHypersecretion.
599 - 603
81
WEEK
Day
Time
Sat
2-4
pm
Mon
Tue
8-9 am
8-10
am
Lecture No./
Practical
Tutorial
13
14&15
topic
Tutorial:
 Hormones of the
Pituitary.
 Hypothalimic and
Pituitary connections.
 Growth Hormone
Thyroid Hormone
 Steps in the synthesis
of thyroid hormones.
 Functions of thyroid
hormones.
 Regulation of thyroid
hormones.
 Diseases of the thyroid
hormones.
Insulin Secretion.
 Physio-anatomy of the
pancreas.
 Functions of Insulin.
 Effects of Insulin on
CHO metabolism.
 Effects of Insulin on fat
metabolism.
 Effects of Insulin on
Protein metabolism.
 Control of I nsulin
secrretion.
 Blood glucose
regulation.
 Diabetes Mellitus.
Referance Pages
599 - 603
607 - 615
625 - 633
82
WEEK 8
Lecture No./
Practical
topic
2-4
pm
Practical.
1st Practical on Endocrines.
(OGTT)
Interpretation of all four
graphs
Mon
8-9 am
16
Tue
8-10
am
17&18
Day
Time
Sat
Referance Pages
Parathyroid Gland.
(Parathormone)
634 - 646
Calcium Homeostasis.
634 - 646
MID-YEAR BREAK
WEEK 9
THIRD CONTINUOUS ASSESSMENT WEEK
WEEK 10
Day
Sat
Time
2-4
pm
Lecture No./
Practical
Topic
Referance Pages
Extra Lecture:
Adrenal Gland
Anantomy
Corticosteroids
616-618
Mineralocorticoids
Aldosterone
 Effects and mechanism
of action
 Regulation of
aldosterone.
83
Mon
Tue
8-9 am
8-10
am
19
20&21
Glucocorticoids
Cortisol
Functions and affects
 Effectson CHO Meta.
 Effects on protein Met.
 Fat meta.
 Functions in stress
 Regulation of Cortisol
Abnormalities
 Hypo-adrenalism
(Addison’s disease)
 Hyper-adrenalism
(Cushing’s disease)
 Primary Aldosteronism
Adrenal Androgens
618-621
622-624
WEEK 11
CENTRAL NERVOUS SYSTEM & SPECIAL SENSES.
Day
Sat
Time
Lecture No./
Practical
topic

2-4
pm


Mon
8-9 am
22
Tue
8-10
am
23&24
Referance Pages
Extra Lecture:
Fuctional Anatomy
of the CNS.
Orientation of the
cerebral cortex.
Receptors, afferent
pathways and
functions.
Orientation of the
cerebral cortex.
 Receptors, afferent
pathways and
functions.
UMN & LMN.
84
WEEK 12
Lecture No./
Practical
Day
Time
Sat
2-4
pm
Mon
8-9 am
25
Tue
8-10
am
26&27
topic
Referance Pages
Extra Lecture:
Motor system.
 Paramydal and
extraparamydal
system.
Cerebellum
Basal Ganglion.
 Control of
movements.
 Postural reflexes.
WEEK 13
Lecture No./
Practical
topic
2-4
pm
Practical.
1st Practical on CNS.
Examination of motor
system
8-9 am
28
Reflex.
Day
Time
Sat
Mon
Referance Pages
Quiz 2 (II term)
Tue
8-10
am
29&30



Memory
Behaivior
Hypothalamus
85
WEEK 14
Lecture No./
Practical
Day
Time
topic
Sat
2-4
Mon
8-9
31
Speech.
Tue
8-10
32&33
Hearing
Smell and Taste
Referance Pages
Extra Lecture:
Vision
WEEK 15
PRACTICAL EXAM WEEK
FINAL PRACTICAL EXAMINATION
Final Examination Weeks
86