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EDUCATIONAL OBJECTIVES FOR MEDICAL PHYSIOLOGY (MDPL 203 )

DEPARTMENT OF PHYSIOLOGY COLLECGE OF MEDICINE & MEDICAL SCIENCES KING FAISAL UNVIERSITY

TABLE OF CONTENTS Introduction Textbooks I. II. III. IV. V. VI. VII. VIII. IX. X. XI. Introductory Lectures, Excitable Tissues, Nerve & Muscle Physiology Physiological Control System. Blood Cardiovascular Physiology Respiratory Physiology BMR and Exercise Kidney and Body Fluids Acid - Base Balance Gastrointestinal System Endocrines Reproduction Temperature Regulation Pages 3 5 6 8 11 15 21 22 22 28 32 30 40

INTRODUCTION

3 The instructional objectives presented in this manual are for Physiology 208 which is one of the 4 courses presently offered by the department. They describe the final behaviour expected of the student at the end of this course. i.e. how he / she should be able to apply his / her knowledge. These objectives serve two purposes. Firstly, they define the content of the curriculum more sharply than would a textbook so that student has a clear outline of the material he is expected to know. Secondly, they provide a basis for the necessary evaluation during the course. In defining the core content of physiological knowledge, we have drawn somewhat arbitrary limits in many instances. This is due in part to the assumption that the student will acquire related information in the other basic medical sciences courses and also later in the clinical courses. In accordance with the general educational objectives of the program, the student is expected to: 1) Know those basic facts, concepts and scientific principles of physiology necessary for the practice of medicine. 2) Apply these concepts and principles in the understanding of disease processes. 3) Demonstrate the rudiments of skill in clinical observation and measurement and apply his / her findings towards making a diagnosis. 4) Understand how new knowledge and information is produced. Structure of the Course: This course is spread over the whole year. Time is provided during the formal teaching schedule for lectures, tutorials and laboratory exercises. Lectures Definition of specific learning objectives is not intended to reduce flexibility in the lecture course. The content of lectures may go beyond the specific learning objectives when this seems desirable to indicate the relevance of physiology to medical practic or the solution of experimental problems. Equally, the lectures may not cover every specific objectives detailed, if it is felt that the material is adequately covered by reference to the textbook or suitable handouts. Tutorials These are scheduled weekly and are intended to provide the student with and opportunity to assess his / her progress on a regular basis. The student is strongly advised to prepare for and treat these as an important part of the course. The tutorials are organized around problems or questions pertaining to the material covered in the lectures of the previous two weeks. After a brief opportunity to go through the material on the tutorial handout, the students are expected to discuss the problems in depth under the guidance of an instructor and allowed to ask questions that may help them understand the material. Analysis of case histories These are designed specifically to illustrate the relevance of physiological concepts to medical practice. Simple case histories of various medical problems will be presented in class or tutorial. The student is expected to analyzed the case history and with the help of a member of the department staff, bring forth the relevant physiological concepts. Laboratory exercises

4 Laboratory exercises are scheduled at weekly intervals. The procedural details for each exercise are outlined in the laboratory manual. Written practical reports are required. The practical books are graded and the grades count as a part of the final mark in the course. In addition questions on laboratory theory and practice are also included in a final laboratory examination. These questions emphasize the analysis and interpretation of typical laboratory data and practical procedures and measurements previously carried out in the laboratory. EVALUATION Four small quizzes (multiple choice questions only) are held each semester. Besides a midyear exam (end the first semester exam) and a final exam at the end of the year are held separately. The final examination will be set on the material presented during the entire year. The written examinations will consist of various types of multiple choice questions and short essays. The final grade for each course is computed as follows: 1. Quizzes in the first semester 10% 2. Mid - year exam 25% 3. Quizzes in the second semester 10% 4. Tutorials and dry lab sessions 10% 5. Final exam 35% 6. Lab exam and lab reports 10% (Not the lab reports have 2.0% and the lab exam 8.0% grads) The faculty of the Department of Physiology are always available to give advice and students are urged to seek assistance if they encounter problems during the entire year. Finally, it should be understood that the objectives are not intended as a course outline and are not necessarily stated in the order in which the material will be covered in lectures.

TEXTBOOKS Assigned texts 1. Lauralee Sherwood, Human Physiology: From cells to systems second edition, West Publishing company, New York, 1993. 2. Vander 3. Sukkar, M.Y., El-Munshid, H.H. and Ardawi, M.SM. (Editors). Concise Human Physiology. Ist Edition. Blackwell scientific Publications. Oxford, 1993.

5 4. Guyton, A.C., Textbook of Medical Physiology, 8th Edition, Saunder, Philadelphia, 1991.

I. 1.

INTRODUCTORY LECTURES

Introduction: Describe the functional organization of the human body and outline the concept of homeostasis and the concept of physiological control systems. 2. Describe the divisions of body fluids into intracellular, extracellular and intravascular compartments and give the approximate values for the volumes. 3. Describe the structure of the cell membrane and the processes of transport across membranes: simple diffusion, osmosis, filtration, carrier-mediated transport, phagocytosis, pinocytosis and exocytosis.

6 Excitable Tissue: Nerve A. Resting Membrane Potentials Define the term membrane potential. Explain the importance of the sodium-potassium pump and the differential permeability of the membrane to ions for the establishment of the membrane potential. B. Action Potentials (for nerve & striated muscle in general) Draw a diagram of an action potential, showing its magnitude and divisions. State the approximate duration of the action potential. Explain the meaning of electrotonic potentials and local response. C. Excitability State that excitability means the ability of tissues to react to a stimulus. Define, a threshold stimulus and explain the statement; nervous tissues obeys the all-ornone law. Describe the changes in excitability during the course of an action potential. State that excitation causes changes in the permeability of the nerve membrane to sodium and potassium, and give an account of how these changes lead to the action potential. Explain the saltatory conduction of the action potential. Excitable Tissue: Muscle A. Muscle Action Potentials Give the difference between the time courses of the action potential of skeletal and cardiac muscle. 2. Give the time relations between the muscle action potential and the contraction of cardiac and skeletal muscle. 3. Explain the difference between the refractory periods of the two types of muscle. B. Neuromuscular Transmission and Muscle Contraction. Outline the morphological structure of the muscle end-plate Describe how the impulse is transmitted from the nerve into the muscle Membrane basing the description on the release of acetylcholine and changes in the permeability of ions. Describe the current view on the mechanism of muscle contraction. Define isotonic and isometric contraction. Explain summation, complete and partial tetanus. Explain why the cardiac muscle cannot undergo fatigue and tetanized contraction. Draw and explain the length-tension diagram for skeletal muscle. Define a motor unit and describe how muscle contraction is graded in vivo. C. Smooth Muscle, Special Properties State that smooth muscle shows spontaneous activity in the form of: rhythmic contraction and/or tonic contractions Explain the double innervation of smooth muscle and the effect of humoral transmitters. Define plasticity of smooth muscle. D. The Autonomic Nervous System Describe the general organization of the autonomic nervous system and the major distribution of sympathetic and parasympathetic outflows. State the neurotransmitters at the autonomic ganglia and target organs.

1. 2. 1. 2. 3. 1. 2. 3. 4. 5. 1.

1. 2. 3. 4. 5. 6. 7. 8. 1. a) b) 2. 3. 1. 2.

7 3. Name at least one blocker for each type of neuro-transmission at the autonomic ganglia and target organs. II. BLOOD A. 1. 2. 3. 4. Constituents of Blood And Functions: State the functions of the blood using terms as transport, homeostasis, hemostasis and protective function. Describe the composition of blood. Give the normal circulating blood and plasma volumes for adult males and females. Define the term haematocrit and give the normal range, and state the sex difference in hematocrit values. Mention two common conditions in which it is: a) Increased b) Decreased Differentiate between plasma and serum. Describe and explain how you would obtain a sample of each. a) Describe the morphology of the red cell, give the normal red cell count and haemoglobin concentration in the peripheral blood. b) Indicate the effect of sex difference on these parameters. c) Describe the RBC membrane and shape. Mention importance of each. Define the terms osmotic fragility and ESR. Mention 2 conditions where each is abnormal. Explain the value of measurements of osmotic fragility and ESR in clinical practice. Define and state the normal ranges for: a) Mean Corpuscular Haemoglobin Concentration (MCHC) b) Mean Corpuscular Haemoglobin (MCH) c) Mean corpuscular Volume (MCV) Hemopoiesis 1. a) Describe briefly the stages in erythropoiesis and give the sites where it occurs during: 1. foetal life 2. infancy and childhood 3. adult life b) Describe briefly the significance of reticulocyte count. State the normal average survival time for red cells and mention one method for determining it. List: a) the nutritional factors required for erythropoiesis including protein, iron, vitamin B12, folic acid and describe the red cell morphology when a deficiency of any one of the above factors is present. b) the hormones influencing erythropoiesis and explain the role of erythropoietin. 4. Describe the factors regulating iron absorption and storage. 5. Define the term anaemia and list the types according to cell size and haemoglobin concentration. 6. Given such information as Hb concentration, RBC, count, PCV and

5. 6.

7. 8.

B.

2. 3.

8 blood picture, be able to calculate MCHC, MCH, MCV and deduce the type of anemia and the possible pathophysiological cause. 7. Give the approximate WBC count and the normal differential count. 8. a) Describe briefly the morphological features of each type of leucocyte, their sites of formation, stages in development, life span and their function. b) Describe briefly the functions of Neutrophil, basophil and eosinophil. c) Describe briefly the tissue macrohage system and their relation to blood monocytes. d) Describe briefly immunity and role of lymphocyte in immune response. 9. State the normal range of platelet count in the blood, and describe briefly: a) their mode of formation b) role in haemostasis Blood Groups 1. Describe the ABO group system in terms of the four major groups and give the normal distribution in the local population. 2. Describe the Rhesus blood group system and explain how Rh antibodies are produced by the body. Explain the term Rh incompatibility and the mechanism of jaundice in the foetus and newborn with Rh incompatibility. a) Describe the major steps taken to ensure a compatible blood transfusion. State the major consequences of a mismatched blood transfusion. Blood Clotting and Hemostasis 1. Define the term hemostasis and list the major processes involved. 2. Describe the mechanisms of vasoconstrictive response to local injury. 3. Describe the role of platelets in hemostasis. 4. Describe briefly the intrinsic and extrinsic mechanism of blood coagulation. 5. Explain the mechanisms that prevent blood clotting in the normal cardiovascular system. 6. Explain how the following anticoagulants act: a. sodium citrate b. ethylene diamine tetra acetate (EDTA) c. heparin d. coumarin drugs 7. State the main laboratory test used to evaluate haemostasis. 8. Describe briefly the fibrinolytic system and indicate how this system limits intravascular coagulation. 9. List and explain the main causes of bleeding disorders and increased tendency for intravascular clotting (thrombosis). III. CARDIOVASCULAR SYSTEM

C.

3. 4. b) D.

3. 1. 2. 3. 4. 5. C. 1. 2. 3. 4. 5. a. b. c. 1. 2. a. b. c. d. e. 3. 4. 1.

Introduction To CVS 1. Identify the functional divisions of the CVS 2. Briefly describe the functional anatomy of the heart. Give a brief account on the histological structure of the cardiac muscle; mention the main differences between it and the skeletal muscle. B. Electrophysiology State the two types of action potential present in heart muscle. Draw an action potential recorded from a ventricular muscle fiber and explain the changes in ion permeability responsible for the different phases. Draw an action potential from an SA nodal cell and explain the genesis of the pacemaker potential. Describe the effects of vagal and sympathetic stimuations on the pacemaker potential. Describe the origin and spread of the electrical impulse from the SA node to the ventricular muscle; explaining the role of the conducting system. Electrocardiography Define the terms; electrocardiogram (ECG) and electrocardiograph. Draw and label a typical normal ECG tracing. Describe the electrical events occurring within the heart that are responsible for each wave and state the causes and clinical significance of P-R interval and S-T segment. Describe briefly the bases of ECG recording; stressing an Einthovens triangle and law. Describe the correct location of the different ECG leads and state the shape of ECG waves in each lead. Given an ECG, be able to: calculate the heart rate measure the P-R interval and explain the significance of a prolonged P-R interval. Recognize the most common abnormalities in rate and rhythm (e.g. tachycardia, bradycardia, fibrillations, heartblock) D. The Cardiac Cycle Make a correlation between the electrical activity of the heart and the mechanical events of the cardiac cycle. Draw a diagram to illustrate normal changes in the following variables during the cardiac cycle and explain the mechanism of each change. ventricular pressure atrial pressure aortic and pulmonary pressures ventricular volume ECG List the normal heart sounds, indicate their timing in relation to phases of cardiac cycle and ECG tracing and explain the causes and characteristics of each sound. Define murmurs, briefly explain the four main murmurs caused by defective valves. E. Cardiac Output Define heart rate, stroke volume and cardiac output and give normal

A.

10 values for each. State the relationship between cardiac output, heart rate and stroke volume. State the factors that regulate heart rate including nervous and hormonal regulation. Explain the mode of action of each and the effect of changes in heart rate on cardiac output. Describe the factors that regulate stroke volume including initial fiber length (preload) in addition to the nervous & hormonal factors. Discuss the effects of sex, age, body surface area, sleep and exercise on cardiac output, list the various conditions that increase or decrease the cardiac output. Describe the measurement of cardiac output by Fick method. F. Hemodynamics: Pressure-volume Relationships: State that a pressure difference across the wall of the vessel is the force responsible for a change in vessel size. Define distensibility and explain how the veins act as a variable volume reservoir. Describe Laplace Law in relation to wall tension, vessel radius and pressure gradient and how this relationship allows the capillary to withstand a pressure of 100 mmHg. Describe the effects of a hydrostatic column on intravascular pressure. G. Hemodynamics: Pressure-flow Relationships Explain, briefly the principles of blood flow and how Reynolds number expresses the probability of turbulance. State that a pressure gradient along the length of a vessel is the force responsible for flow. State that resistance can be calculated as driving pressure divided by flow, explaining briefly Ohms & Poiseuiles laws. Define peripheral resistance, briefly describe how length of the blood vessel and blood viscosity is determined by arteriolar diameter. Explain how arterioles determine the relative blood flow to different organs; describe briefly the factors regulating arteriolar diameter including local (metabolic and myogenic autoregulation) and extrinsic (nervous & hormonal) controls. 6. Define the terms: a) reactive hyperemia b) active hyperemia H. Functions of the Circulatory System Describe the relative magnitudes of pressure, velocity of flow and crosssectional area in the various divisions of the systemic vascular tree. Explain how aorta and large arteries help to convert intermittent flow to continuous pulsatile flow (Wind-Kessel function) State that arterioles act as variable resistance vessels and describe the structural features enabling them to do so. State that capillaries function as exchange vesels. State that the veins function as capacitance vessels and discuss the factors that influence venous tone and venous return. I. The Lymphatics Describe the lymph capillary and list the factors that determine lymph flow. List the functions of the lymphatics. Describe the role of lymphatic circulation in maintaining normal Starling forces across the capillary wall. J. Capillary Circulation

2. 3. 4. 5. 6. 1. 2. 3. 4. 1. 2. 3. 4. 5.

1. 2. 3. 4. 5. 1. 2. 3.

11 1. 2. 3. 4. 5. Describe briefly the structural features, innervation and blood flow of the capillary system. Mention the characteristics of capillaries that allow them to function as exchange vessels. Name and give approximate values to the forces that influence the movement of fluid between the capillary lumen and the interstitial spaces. Explain briefly the state of near equilibrium at the arteriolar & venular end of capillaries (Starlings law of capillaries). Describe the pathophysiological basis for edema formation.e.g. increased capillary hydrostatic pressure, hypoalbuminemia, lymphatic obstruction and increased capillary permeability. K. Neural Regulation of the CVS Explain briefly the innervation of the blood vessels and the heart. Define vasomotor center its situation and state its component. Describe the effect of stimulation of the vasomotor, center on arteriolar resistance, venous capacitance, heart rate and stroke volume. Explain why arterial pressure increases in response to stimulation of the vasomotor center. Describe the role of the hypothalamus in the regulation. L. Arterial Blood Pressure Define arterial blood pressure, state the function and the normal values for systolic, diastolic and mean arterial blood pressure and describe the variations that occur with age. State that blood pressure is determined by: total peripheral resistance cardiac output Explain briefly the mechanisms regulating arterial blood pressure, including: short term regulation through the baroreceptors long term regulation through the lcidney. Describe the location of the baroreceptors, their response to a change in the level of pressure in the arteries and their effect on the vasomotor center. Outline the effect of carotid clamping & cutting buffer nerves and explain carotid sinus syndrome. M. Coronary Circulation Outline the anatomical and functional distribution of the coronary vessels. State the relative magnitude of coronary blood flow and oxygen consumption at rest and during exercise. Describe the pattern of coronary blood flow during the cardiac cycle. Describe the mechanisms by which coronary flow is regulated. Give short account on coronary artery disease (e.g. angina pectoris and myocardial infarction). N. Circulatory Shock Define the term circulatory shock, name the different types of shock and possible causes of each. Explain the pathophysiology and treatment of each type.

1. 2. 3. 4. 5. 1. 2. a) b) 3. a) b) 4. 5. 1. 2. 3. 4. 5. 1. 2.

12 3. 4. 5. Describe effect of a loss of more than 20% of the blood volume on the circulation and the short and long term physiological mechanisms that attempt to compensate for the blood gas. Define progressive shock and explain why it occurs. Define irreversible shock.

13 IV. RESPIRATORY PHYSIOLOGY A. Functional Anatomy: 1. Identify the principal anatomical features of the respiratory system and explain the functional significance of : a) conducting zone b) gas exchange zone. B. Symbols And Abbreviations: 1. Recognize international symbols and abbreviations of respiratory physiology. C. Pulmonary Ventilation: (Mechanics of ventilation) 1. List the muscles of respiration and explain their mode of action in altering the dimensions of the thoracic cage during inspiration and expiration. 2. Explain how the enlargement of the thoracic cage expands the lungs. 3. Describe the changes in intraalveolar and intrapleural pressures and state their typical magnitudes during the respiratory cycle and explain their causes. D. Compliance: 1. Define the term compliance. 2. State that the normal position of rest is a balance between the elastic forces of the lungs and of the chest wall. 3. Give an account of how the amount of elastic tissue and alveolar surface tension influence compliance, and give examples. 4. Recognize the existence of pulmonary surfactant, its chemical nature and origin, its functional significance and the consequences of its absence. E. Respiratory Work: 1. State that the energy cost of the work of breathing at rest and during heavy exercise is approximately the same. 2. State that respiratory work comprises work done in: a. Stretching of elastic structures in lungs and chest wall. b. Overcoming the freictional resistance in tissues. c. Overcoming airway resistance in bronchial system. 3. Give clinical examples of conditions where energy cost of breathing is larger than normal. F. Lung Volume: Its Sub-divisions: 1. Define and state typical values for the following, and be able to draw a normal spirogram. a. Volume: i. tidal (TV) ii. inspiratory reserve (IRV) iii. expiratory serve (ERV) iv. residual (RV) b. Capacities: I. inspiratory (IC) ii. functional residual (FRC) iii. Vital (VC)

14 iv. total (TLC) 2. Describe the methods by which pulmonary volumes and capacities listed in (1) above are measured and explain briefly the clinical significance of such measurements. 3. Account for the chang in FRC in the following conditions: aging body position, obesity, emphysema, fibrosis, pneumothorax. G. Ventilation: 1. Define the terms anatomical and physiological dead space. State theri typical values and functional significance. 2. (a) Define the terms alveolar ventilation and minute ventilation, their typical values. (b) Given TV, dead space volume and respiratory rate, be able to calculate alveolar ventilation. 3. State that the filling and emptying pattern of the air in the alveoli can vary from section to section even under normal conditions. 4. Explain briefly the effect of gravity on air distribution in different regions of the lung. H. Pulmonary Circulation: 1. State that the lung has two circulations - a very large pulmonary and a small bronchial. 2. Contrast the systemic and pulmonary circulation with regards to pressures, resistance and volume flow: Describe the rotes of passive dilation and recruitment of pulmonery capillacis in changing pulmonary bload flow and pulmonary vascular releslance. 3. State that the blood from the bronchial and the thebesina veins empties into the pulomonary veins and explain that this is the main reason why, in normal persons PaO2 is less than PAO2. 4. State that gravity has the effect of increasing blood flow at the bases (relative to ventilation) and of the decreasing it at the apices of hte lungs. 5. State the functions of pulmonary cuscalation. I. Ventilation / Perfusion VA / Q ratio: 1. State that a normal VA / Q is important for maintaining normal blood gases Give the normal value forthis ratio. 2. State that regions of the lung with a high VA / Q leads to a Wasted ventilation and that with low VA / Q leads to a Physiologcal shunt and descrbe the consequences of each. 3. Explain the reason why there is a difference in VA / Q between the apex and base of upright lung. Contrast the airway and Vascukr control Mechansms that help mainkin anormal VA / Q ralion.

J.

Diffusion of O2 across the respiratory membrane: Genral Aspects: 1. Students should be familiar with.

15 Boyles law (temerature constant) Charles law (pressure constant) Ideal gas law Daltons law of partial pressures. 2. Define water vapour pressure, describe its temperature dependence and state its value at body tempreature. 3. State the gas composition of atmospheric air (dry), humidified air at 37oC, alveolar and expired air and the rationale for their differences. 4. Define the rate of diffusion for a substance as the amount of substance that passes a given cross-sectional area per unit time. 5. State that the rate of diffusion for a gas in a gaseous phase is: a. proportional to the partial pressure gradient b. proportional to the absolute temperature c. inversely properional to the square root of the mol. wt. f the gas. Diffusion of gases across the alveolar membrane: 1. State that the volume of a gas that moves across the alveolar capillary membrane per unit time depends on: a. characteristics of the gas (mol. wt. gas temperature, solubility coefficient) b. characteristics of lung (sunface area and the kncss of alwol or capillarry memlirane. c. pressure gradient across the alveolo-capillar membrane (alveolar ventilation, capillary blod flow). 2. Explain hwo the effective surface area of the lungs in principle can be reduced (loss of tissue, ventilation and perfusion errors). 3. Outline the variation in PO2 along the pulmonary capillary during the flow of blood through the capillary at rest and during work. 4. a) Define diffusion capacity. State its normal values for O2 and CO2 and explain the rational of using CO for the measurement of diffusion capacity. b) State that the solubility coefficient of CO2 is 20 times that for O2. 5. State that the time taken for complete gas diffusion is 1/3 of the total pulmonary circulation time and its mention sigmticanle. 6. Give an account of why reduced oxygen saturation of the blood in one pulmonary section can only to a slight degree, be compensated for hyperventilation in another pulmonary section of corresponsing 7. other Give an account of why reduced CO2 elimination from the blood in one pulmonary section can be compensated for by hyperventilation in pulmonary sections.

O2

by size.

K.

Transport of O2 in Blood and Body Fluids: Oxygen Transport: 1. List the forms in which O2 exists in the blood and give the normal value for each form.

16 2. 3. 4. 5. State that the reaction between O2 and Hb. is weak and reversible and mention the underlying structural basis. Define oxygen capacity and oxygen saturation. Give the quantitative relationship between the oxygen capacity and the hemoglobin content of blood. a) Outline the oxyhemoglobin dissociation curve as a functioon of PO2. b) Indicate the alveolar and mixed venous points on the curve. c) Describe the structural basis and the physiological significance of the shape of this cruve. Factors affecting oxygen transport: a) Explain the meaning of shift of the curve to right & to left. Account on PO250. b) Give the qualitative effect of pH (non-volatile acids and bases ) PCO2 and temperature on the affinity of hemoglobin for c) d)

6.

oxygen. Describe the Bohr effect. Explain how 2 , 3-DPG in ervythrocytex influences the affinity of hemoglobin for oxygen. 7. Explain the characteristic differences between the dissociation curves of hemoglobin and myoglobin. 8. Explain how fetal hemoglobin differs fromadult hemoglobin and state how the affinity for oxygen in the two typesof hemoglobin differ and describe the functional significance of these differences. 9. Account for the factors which influence the transfer of oxygen from blood to tissue. CO2 Transport: 1. Describe the forms in which CO2 exists in blood and give normal values for he concentration of the different forms in arterial and mixed venous blood at reast. 2. Describe the reactions taking place within the red cell leading to the formation of bicarbonate and explain the chloride shift mechanism. 3. Describe CO2 dissociation curve 4. Describe the Haldane effect. L. Regulation Of Respiration: 1. Give the anatomical location of the four major centres which are responsible for the generation and the maintenance of a normal respiratory pattern and give an account of the function of thses centres. 2. Give an account of the effects of the following on the respiratory centres: a. stretch and irritant receptors in the lungs b. higher centers c. muscle, joint and tendon receptors. d. other areas as skin, CVS, GIT 3. a) Define chemoreceptors, identify their anatomical location and state in geeran their role in chemical regulation. b) Describe briefly how receptors are stimulated by O2 , CO2 and H+ cancenlration.

17 Describe the role of PaCO2 and H+ concentration in regulating normal breathing in man. 5. Explain why normally CO2 rather than O2 is important in regulation of respiration. 6. Explain the changes occuring during breath - holding and voluntary hyperventilation and state that these procedures are used to assess the function of chemoreceptors. 7. State that the respiration although normally is an involuntary proces, it can be controlled voluntarily by the cerebral cortex, and explain the significance of this control. 8. Mention that in chronic respiratory failure, hypoxia becomes the only drive to repiratory center. State the clinical significance of this in terms of O2 therapy. 9. Define the following patterns of breathing, eupnea, tachypnea, hyprventilation, hypovntilation, dyspnea, apnea and Cheyne-Stokes brething. M. Clinical Correlates: 1. Identify the major types of respiratory insufficiency, their major causes and their consequneces. 2. List the 4 main types of hypoxia, define them and mention some potential caues and consequences. State the rationale for the use of oxygen therapy in different forms of hypoxia. 3. Define cyanosis and state its causes. 4. List the effects of oxygen poisoning. 5. State the causes and consequencies of CO poisoning. N. Effects Of Changes in Ambient Pressure: Hypobaric Surroundings (Altitude): 1. Explain the changes of pressure with altitude and state that the decrease in barometric pressure is the basic cause of hypoxia at high altitude. 2. Explain the effect of decreased barometric pressure on PaO2 and hemoglobin saturation. 3. Explain the advantage of brathing pure oxygen over air at high altitude. 4. List the major effects of hypoxia in man as they appear during ascent. 5. Explain the main physiological adaptations to a low ambient PO2. O. Tests Of Lung Functions: 1. a) Define Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1.0 sec. (FEV1.0) b) Describe briefly a method for measurement of FVC and FEV1.0. c) Explain the significance of determination of FEV1 / FVC ratio in clinical practice. 2. Describe the factors that influence vital capacity and mention 3 pathological conditions in which VC is reduced. 3. Define Peak Expiratory Flow Rate (PEFR) and Mid-expiratory flow rate (FEF 25 - 75%). Name insttruments used for their measurements and describe the significance of these measurements in assessing lung function. 4. Define closing volume, describe the method for its measurement and expalin the clinical significance of its measuremet. 4.

18 5. chronic State the normal values for PaO2 , PaCO2 and pH and describe briefly the changes occureing in these parameters in respiratory disease e.g. respiratory failure.

V. 1. 2. 3. 4.

BMR AND EXERCISE

A. General Aspects of Energy Balance State that the energy liberated by catabolism appears as external work, heat or is stored in the organism by anabolic processes. Define the term metabolic rate as the amount of catabolic energy liberated per unit time and state that this energy derives from energy of oxidation and other chemical degradations. Justify the use of oxygen consumption for the determination of metabolic rate by the indirect calorimetric method. Explain the relevance of the R.Q. to the measurement of the metabolic

19 rate and describe conditions in which the R.Q. may be altered. Define the term basal metabolic rate by giving the experimental conditions for its determination. Describe a method for measuring BMR. Give a reasonable value for BMR in a young adult male. State how BMR varies with sex, age, starvation, body temperature, secretion of thyroid hormones and adrenaline. Explain the term specific dynamic action (SDA) of food and state the approximate percentage SDA of protein, fat and carbohydrate. Explain the relevance of SDA to measurement of BMR. Exercise State that the contraction of skeletal muscles is the primary event in exercise and energy is utilized for mechanical work and heat production. 2. a) List the sources of energy available for exercising muscles Mention differences between slow and fast muscles. 3. Define VO2 max and explain its relevance to the level of exercise and list the factors which influence it such as age, sex, physical fitness. 4. Define the term anaerobic threshold and explain its importance. Define O2 debt and state its significance: indicate graphically the relationship of O2 debt to exercise. Describe how the extra oxygen taken up, when paying off an oxygen debt is utilized. Describe briefly the cardiovascular response to exercise and explain the changes in the microcirculation, cardiac output, blood pressure and distribution of blood flow. Explain the physiological basis for these changes. Describe briefly the factors which increase O2 delivery to exercising muscles. Mention the oxygen requirements in light, moderate and severe exercise compared to basal requirements. Describe briefly the respiratory resonse to exercise and explain the mechanisms responsible for changes in ventilation and O2 diffusion capacity. VI - KIDNEY AND BODY FLUIDS A. Body fluids & Electrolytes: 1. State approximate values for the distribution of body water and solutes in a normal adult. 2. Describe the effect of age, sex, and body fat content on the value for total body water when expressed as a percentage of body weight. 3. Give approximate normal values for the daily intake and output (External Balance) of water, sodium and potassium. 4. State that sites of rapid fluid and electrolyte exchange within the body are gut, kidney and capillary beds. State the forces responsible for fluid electrolyte exchange across cellular membranes. 5. Describe the effects of alterations in body water or solute content of ECF compartment on the size and osmolality of ICF compartment.

5. 6. 7. 8. B. 1.

b)

5. a) b) 6.

7. 8.

and

20

B.

their

Renal Anatomy 1. Demonstrate gross anatomy of kidney 2. Describe the types of nephrons and indicate the approximate nuber present in a kidney. State the various segments of the nephron and describe location in the kidney. 3. Describe the renal vasculature and give the pressure values in different renal vasculature. 1. 2. 3. 4. Glomerular Filtration: State that the functional characteristics of the glomerular membrane are in some respects like those of on ultrafilter. Describe the effects of size and the change of the molecule on the rate of filtration through the glomerular membrane. Describe the physical forces which operate to produce glomerular ultrafiltration. State the approximate magnitude of these forces. State that the glomerular pressure and GFR are autoregulated, explain the mechanism of renal autoregulation in terms of myogenic mechanism tubulo-glomerular balance. State that the renal clearance of a substance S is the volume of plasma which is cleared of S by the kidney each minut. The clearance substance (s) it the ratio of the amount of S excreted in the urine per minute. The UsV to the concentration in plasma Ps.

and 5. (Cs) of any

C.

D.

i. e. C = UsV Ps Where Us = urine concentration of S V = volume of urine Ps = plasma concentration of S 6. Calculate clearance values from data provided. 7. Describe the conditions under which the clearance of a substance will be a measure of glomerular filtration rate - GFR. 8. State that the clearance of inulin and creatinine may be used to estimate GFR. 9. State that the clearance of inulin and creatinine is approximately 129ml / min for a normal adult. 10. Mention of effect of aging and pregnancy on GFR. Renal Circulation: 1. State approximate values for renablood flow (RBF) and renal plasma flow (RPF) in a normal adult. 2. Describe how RPF can be estimated by the clearance principle. State that para-amino-hippuric acid (P.A.H.) is frequently used as the test substance. 3. Describe the effect of sympathetic stimulation RPFon. 4. Describe autoregulation of renal blood flow and how this autoregulation is overwhelmed by adrenergic stimulation. 5. State that RbF can be considered as reserve cardiac output. Tubular Reabsorption: 1. State the following normal plasma concentrations:

21 Sodium = 135-145 mEq / L Potassium = 3.5-5.0 mEq / L Calcium = 4.5-5.5 mEq / L Bicarbonate = 24 - 28 mEq / L Chloride = 100-106 mEq / L Urea Nitrogen (BUN) = 8 - 25 mg / 100 ml Protein = 6 - 8 g / 100 ml Osmolality = 285 + 10 m0sm / kg 2. Describe features of active transport and state that nutrional substance and cations in general are reabsorbed actively. 3. Describe the charactristics of Tm- limited reabsorption with specific reference to glucose. 4. Describe passive reabsorption with specific reference to anions and urea. 5. Describe reabsorption in different tubular segments and indicate that H2O reabsorption is controlled only at DT and CD by ADH. 6. Describe the physical forces which operate to transfer fluid from the lateral clefts to the peritubular capillaries. Tubular Secretion: 1. State that few endogenous substances and ions (creatinin, uric acid, K+ and H+) and a lot of exogenous substances are secreted by renal tubules. 2. Describe the characteristics of TM- limited secretion (Use PAH as an example). 3. Describe gradient - time limited transport process i.e. H+ion secretion and Na+ reabsorption. Concentration of Urine: 1. Define filtered load and state the average proportion of the filtrate that is reabsorbed at each segment of the nephron. 2. State that hyperosmolar state in renal medulla is required to excrete concentrate urine and this is created by accumulation of salts and 3. 4. thick 5. 6. State that hyperosmolar state require the counter current system and ADH. Describe the counter-current multiplier system of the loop of Henle due to the passive transport of sodium and active transport of Cl- in the ascending limb of the loop fo Henle. State that the transfer of NaCl out of the ascending limb is not followed by water. Indicate that the vasa recta are the counter-current exchange system and describe their role in preserving the hyperosmolar state in renal

E.

F.

urea.

medulla. 7. Describe the role of urea in establishment of hyperosmolar medullary state. 8. Describe the role of ADH in urine concentration. 9. State that in the absence of ADH, hypotonic urine can be produced. G. Sodium Metabolism: 1. Describe mechanisms of sodium reabsorption in different tubular segments. 2. Describe the effect of GFR, aldoesterone, atrial natriuretic factor and Na+ load at DT and rate of sodium reabsorption. H. Calcium Metabolism: 1. Describe the renal influence on calcium metabolism.

22 2. State that the action of parathyroid hormone, plasma pH and vitamin D transformation in the kidney are important determinants of Ca++

excretion. I. Potassium Metabolism: 1. State that most of the potassium is reabsorbed from the filtrate in the proximal tubules. 2. Describe the secretion of K+ in the distal tubule and collecting duct. 3. Describe the effects of aldosterone on K+ and H+ in the distal tubule and collecting duct. 4. Indicate the effect of increased distal delivery of Na+ and K+ secretion. 5. Discuss the effect of ECF-pH on K+ secretion and ECF-K+. J. Blood Volume Regulation: 1. Describe the fluid shifts occuring following moderate blood loss. 2. Indicate that redistribution of blood from the venous to the arterial system is the early response followed by redistribution of arterial blood to selected organs. 3. Indicate that extracellular fluids redistribute from the ISF to plasma. 4. State that total body water redistributes form ICF to ECF due to osmotic pressure changes. 5. Describe the role of the renin-angiotensin-aldosterone system in reabsorption of fluids, thirst and vascular dynamics. 6. Describe the direct effect of blood pressure on renal function and define an integral control system for pressure and blood volume regulation. K. Osmotic Pressure Regulation: 1. State that the mean plasma osmolality is 300 m0sm / kg. 2. Describe the function of osmoreceptors in the supraoptic nucleus of the hypothalamus. 3. Describe the effect of ADH on the collecting ducts and distal tubules. 4. Define the term osmolar clearance (Cosm), free water clearance CH2 free water reabsorption (Tc H2O) L. Micturition: 1. Describe the functional anatomy of the bladder 2. Describe the pressure - volume relationship during bladder filling. 3. Discuss the neural control of bladder emptying under following headings. a) spinal reflex b) higher CNS regulation. M. Renal Control of Acid-Base Balance: 1. State that some of the waste products of the body are acidic in nature. 2. Indicate that chemical buffers in the body are first line of defence against H+ and prevent pH changes. 3. Indicate that the pulmonary response is the second line of defence against acid-base shifts. 4. State the isohydric principle and indicate its importance in acid-base balance. 5. Indicate that H+ excretion and HCO3- reabsorption occure in the kidney over a longer period of time. 6. Demonstrate by a diagram the means by which HCO3- is reabsorbed and H+ is secreted.

23 7. 8. Describe the effect of altered PCO2 , Cl- , potassium, aldosterone and blood volume on HCO3 reabsorption and H+ secretion. Describe excretion of NaH2PO4 and ammonium ion by the distal nephro and its adaptation in acidosis. VII - ACID - BASE BALANCE AState the biological importance of regulation of PH of body fluids in relation to homeostais and defence mechanishms under following headings 1. buffers 2. respiratory function 3. kidney function Buffers 1. briefly outline how a buffer works 2. state and define the different types of buffers present in our body in its different compartments 3. briefly explain the special Properties of the carbonic acid - bicarbonate buffer Processing of H2CO3 by the body 1. outine the rate of production of H2CO3- in the body 2. explain how the CO2 eliminated by lungs is 3. Describe the acid - base aspects of CO2 transport by blood Processing of fixed acids by the body 1. mention the source and rate of production of fixed acids in the body 2. explain how the fixed acids are buffered in body fluids. 3. Describe the mechanism by which the fixed acids are eliminated by the kidney from the body. Processing of alkali by the body 1. what are sources of alkali Production in the body 2. explain how the alkali is buffered in the body. 3. Describe briefly the mechanism of elimination of alkali by the kidney. Acid - base diagrams Draw the Acid - base diagrams of the following and label them. 1. PH Vs HCO32. PCO2 Vs H+ Metabolic Acidosis 1. outline few cauises of metabolic acidosis 2. Briefly describe how the Intracellulbr (ICF) and extracellular (ECF) fluids are buffered during metabolic acidosis. 3. How the respiratory system compensates the metabolic acidosis 4. explain how the kidney compensates the metabolic acidosis Respiratory Alkalosis 1. outline few causes of metabolic alkalosis 2. Briefly describe how the intracellular (ICF) and extracellular (ECF) fluids are buffered during respiratory alkalosis. 3. how the respiratory system compensates the respiratory alkalosis

B-

C-

D-

E-

F-

G-

H-

24 4. I. explain how the renal system (Kidney) compensates the respiratory alkalosis Respiratory Acidosis 1. outline some causes of respiratory acidosis 2. explain the mechanisms by which extracellular (ECF) and intracellular (ECF) fluids are buffered durning respiratory acidosis 3. briefly describe the mechanism how kudney compensates the respiratory acidosis Respiratory AlKalosis 1. mention few causes of repiratory alkalosis 2. explain the mechansims of how the extracellular and intracellular fluids are buffered during respiratory alkalosis 3. briefly describe the mechanism how kidney compensates the respiratory alkalosis.

J-

VIII - GASTROINTESTINAL SYSTEM 1. 2. 3. 1. 2. 3. 4. 5. 6. 7. 8. 1. 2. 3. 1. A. General Regulation of Gastrointestinal Tract Describe the functional organization of the gastrointestinal tract. Describe the extrinsic and intrinsic innervation of the gut, the location of the submucosal and myenteric plexuses and appreciate the complexity of the enteric nervous system. Understand that control of gastrointestinal function is by neuro-hormonal mechanisms. B. Oral Physiology: Salivation and Swallowing Be familiar with the histology and innervation of the three main salivary glands in man. Describe the reflex control of salivary secretion, and list the stimuli which elicit the reflex. Define conditioned and unconditioned reflex salivation, and state their relative importance to man. Describe the secretory and vascular effects of stimulating sympathetic and para-sympathetic nerves to the salivary glands, and give examples of drugs which effect salivary secretion. State the major constituents and describe the major functions of saliva. Describe the mechanism of swallowing in terms of the three stages; buccal, pharyngeal and oesophageal. Describe the factors responsible for the competence of the gastrooesophageal junction and the consequences of their failure. Describe the nervous and hormonal control of the lower oesophageal sphincter. C. Stomach Label a diagram of the stomach with the terms cardia, fundus, body, antrum (pyloric antrum), pylorus. Describe the extrinsic and intrinsic innervation of the stomach. Outline the major functions of the stomach. D. Gastric Secretion Describe the main constituents of gastric juice, and their functions.

25 2. 3. 4. 5. Describe the process of hydrochloric acid production by the parietal cell. Describe the neural and chemical factors which stimulate gastric secretion. Define the three classical phases of gastric secretion (cephalic, gastric and intestinal), explain the neural and hormonal mechanisms involved. State that gastrin is a polypeptide hormone existing in several forms and secreted from the gastric antrum and upper small intestine. List the conditions under which gastrin is normally secreted and describe its important physiological actions. Describe the mechanisms responsible for inhibiting gastric acid secretion, including those initiated in the pyloric antrum and upper small intestine. E. Gastric Motility and Emptying Describe the Basic Electrical Rhythm (BER) and state its significance. Describe receptive relaxation of the stomach and briefly explain its mechanism and control. Describe gastric peristalsis and its control. Describe the process of gastric emptying. State that the pylorus is usually relaxed and that gastric emptying is mainly due to the intensity of the gastroduodenal pump. Describe the effect and the mechanism of the following on gastric motility and the rate of gastric emptying. volume of meal remaining in stomach fat in the intestine hypertonic solutions in the duodenum acid in the duodenum fear or stress vagotomy F. Vomiting Describe the mechanism of vomiting, using such terms as stimulus, receptor, vomiting center, afferents and efferents and the act of vomiting. List the agents capable of eliciting vomiting through their action on the chemoreceptor trigger zone. Describe the effects of prolonged vomiting on water, electrolyte and acid-base balance. G. Gastric Function Tests Describe how gastric juice may be collected in man to estimate basal acid output (BAO) and maximal or peak acid output (MAO-PAO). List the names of three stimuli to gastric acid secretion in man. State that MAO is directly proportional to the parietal cell mass (PCM). Explain the physiological basis for the use of insulin hypoglycemia (Hollander insulin test) as a test for the completence of vagotomy in man. Exocrine Pancreas

6.

1. 2. 3. 4. 5. 6. a) b) c) d) e) f) 1. 2. 3. 1. 2. 3. 4. H.

26 1. a) b) 2. 3. 4. 5. 6. I. 1. a) b) c) d) e) f) )) h) i) 2. 3. 4. 5. 6. 7. K. 1. Draw a labelled diagram of a lobule of the exocrine panceas, showing the cells which secrete: electrolytes enzymes State the approximate daily volume of pancreatic juice, its pH, and list the main constituents. Explain the function of each of the main constituents of pancreatic juice. Describe the nervous and hormonal mechanisms controlling pancreatic secretion in terms of cephalic, gastric and intestinal phases. Describe the origin, main structural features, mode of release and physiological actions of secretin and cholecystokinin pancreozymin (CCK-pZ) Describe the principles underlying tests of pancreatic function and describe the effects of pancreatic deficiency on digestion and absorption of major food constituents. The Liver Draw a diagram of a louble of the liver. Label it with the terms: louble central lobular branch of hepatic vein hepatic artery (hepatic) portal vein bile canaliculi bile duct parenchyma sinusoid Kuffer cell (macrophage) Give the normal portal pressures and describe the causes and consequences of raised portal blood pressure. State and explain the functions of the liver Describe the principles underlying the commonly used tests of liver function. Describe the effects of liver failure in terms of ascites and oedema. Define the term bile salt pool. Describe the enterohepatic circulation of bile salts, and give an estimate of the efficiency of this process. Describe the actions of the gall mucosa in concentrating the hepatic bile during storage. The Small Intestine Draw and label a diagram of the cross-section of the small bowel, using the terms longitudinal muscle, circular muscle, muscularis mucosa, villus, lacteal, crypts of lieberkuhn, columnar epithelium of mucosa. List 3 anatomical characteristics of the small intestine which increase the surface area. Explain the way in which the intestinal mucosa is continually replaced by succeeding generations of cells, and give an estimate of the turnover time for this process. Describe the composition and functions of succus entericus and explain the importance of brush border enzymes. List and explain the factors influencing the secretion of intestinal juice. Describe briefly the intestinal breakdown of carbohydrate, fat and protein.

2. 3. 4. 5. 6.

27 7. 8. 9. 10. 11. 12. 13. 1. 2. 3. 4. 5. 6. 7. Describe the absorption of carbohydrates, fats and proteins in terms of the mechanism, site in the small intestine and state the proportion absorbed. Describe the absorption of water soluble and fat soluble vitamins. Describe the common cause and consequences of lactase deficiency. State that bile salts and vitamin B12 are absorbed in the terminal ileum and hence predict the effect of loss of function of removal of the terminal ileum. Describe the process of absorption of water and electrolytes, and explain the importance of their internal turnover. Describe the non-propulsive movements of the small intestine and mention their importance for intestinal digestion and absorption. Describe peristalsis in terms of mechanisms, rate, direction, function and regulation. L. The Large Intestine Compare and contrast the main structural features of the colon with those of the small intestine. Describe the function of the ileo-caecal valve, and the large intestine in man. Describe the movements of the colon using such terms as propulsive and non-propulsive and give approximate transit times for a meal. Describe the process of secretion and absorption in the colon giving the approximate volume of water absorbed per day and naming some substances and drugs which can be absorbed from the colon. Describe the significance of normal bacterial flora in the intestine. Describe the gastrocolic response and explain how it can be modified. Describe the general composition of faeces and understand that it is mainly derived from non-dietary sources. IX - ENDOCRINES AGeneral Endocrinology: 1. a) Define the term hormone and list importnat criteria required to establish that an organ has an endocrine function. b) Define the term paracrine secretion and give atleast one example. 2. Draw a simple diagram to show the integration of nervous and hormonal control systems in the body. 3. Classify the hormones into: a) local and general hormones b) protein and steroid hormones c) hormones other than the proteins and steroids. 4. Control of endocrine secretion generally involves feedback systems of varying complexity. Give one example of systems controlled in the following manner. a) The metabolite regulated by the hormone acts directly on the endocrine gland . b) The physiological variable acts on the hypothalamus which directly regulates hormone secretion.

28 c) hypothalamic d) BThe endocrine secretion is controlled by secretion of trophic hormone whose release is in turn controlled by a releasing factor. The endocrine gland is directly innervated and its release is a part of neuroendocrine reflex.

Mechanisms Of Hormone Action: 1. Explain how the specificity of hormone action to a particular organ is vested in the molecular structure of the hormone. 2. Identify the receptor site for two named protein or peptide hormones. 3. Show that different peptide hormones exert their primary effects either on permeability or cyclic AMP concentration. 4. Decribe the production of cyclic AMP 5. Briefly describe the action of cyclic AMP using such terms as phosphodiesterase and protein kinase. 6. Outline the action of steroid hormones on intracellular receptors and the subsequent effects on the nucleus.

C-

Anterior Pituitary: 1. Draw a diagram illustrating the nature of the connections between the hypothalamus and anterior pituitary. 2. List six hormones produced by the anterior pituitary and mention which cells, identified histologically, are thought to be involved in the synthesis of each. 3. 4. 5. 6. List the hypothalamic releasing or inhibiting factors, the existence of which may be supported by experimental evidence. Describe the principle of regulation by feedback control in relationship to the anterior pituitary, target organs and hypothalamus. Describe the actions of four trophic hormones on their target organs. Describe the effects of hypophysectomy on: a) growth b) the adrenal cortex c) blood glucose regulation List the effects on their target organs of hypersecretion of ACTH and TSH. with respect to growth hormone or ACTH, explain the physiological principles for the basis of tests designed to investgate the integrity control mechanisms. Describe the physiological basis for the clinical use of releasing factors in the assessment of anterior pituitary function.

7. 8. of 9. D-

Posterior Pituitary: 1. Draw a simple diagram to show the relationship between the paraventricular and supraoptic nuclei of the hypothalamus and posterior pituitary. 2. Name the two hormones which are released from the posterior pituitary: give their general chemical nature and indicate the form in which they are stored.

29 3. 4. 5. 6. 7. 8. EGive the primary stimulus which results in increased vasopressin (ADH) secretion. Describe the actions of vasopressin on the kidney and the cardiovascular system . Give a general definition of the term neuroendocrine reflex and illustrate using oxytocin release as your example. Name the two target organs of oxytocin and describe its effects on each organ. Describe the effects of destruction of the neurohypophysis and explain the symptoms of diabetes insipidus. Describe the consequences of the antidiuretic action of vasopressin when the hormone is inappropriately secreted.

The Thyroid: 1. Name the plasma proteins which bind thyroid hormones in plasma, and state the need for plasma protein binding. Give two clinical examples of the application of this knowledge. 2. List the physiologically important actions of thyroid stimulating hormone TSH, on the thyroid gland. 3. Give the effect of T3 and T4 on TSH secretion and explain what is meant by autoregulation of thyroid function. 4. Compare the effectiveness and degree of boilogic activity of T3 and T4. 5. Define the term basal metabolic rate and describe how it is affected by thyroidectomy. 6. Describe the changes in growth and development after thyroidectomy in early life. 7. Discuss the physiological basis for the production of symptoms in: a) iodine deficiency b) myxoedema 8. Give a definition of the term endemic goiter. 9. Briefly account for the changes, associated with hyper secretion of the thyroid hormones (Graves disease). 10. Define the term LATS and Thyroid Stimulating Immunoglobulins (TSI). 11. Expalin the physiological principles of thyroid function testing using radioactive iodine and hormone measurements, and TRH stimulation test. FThe Adrenal Gland 1. Draw a labelled diagram of a section through the adrenal gland to show the three zones of the cortex, and the medulla. 2. List the main hormones secreted by each part of the gland. 3. Give the relative importance for life for the products of the cortex and the medulla. Adrenal Medulla: 1. Describe the evidence for the dependence of catecholamine secretion on the innervation of the adrenal medulla.

G-

30 2. 3. HName three physiological conditions which result in the release of catecholamines. List three actions of adrenaline which distinguish its role from that of postganglionic sympathetic nerves.

Adrenal Cortex: 1. Name three major groups of steroids secreted by the adrenal cortex and say which zones produce them. aGlucocorticoids 1. Name the main glucocorticoid in man and describe the form in which it circulates in the blood. 2. Describe the diurnal variations in plasma cortisol levels and explain their clinical significance. 3. Name the hormone which controls the rate at which cortisol is synthesized and secreted. 4. Describe the effect of stress on the hypothalamic pituitary adrenal axis and discuss the importance of the changes in cortisol 5. List three mechanisms by which glucocorticoids elevate blood glucose concentration and show diagrammatically how to cortisol effects on protein and fat metabolism. 6. Explain briefly the effect of cortisol on wound healing, and the inflammatory and immune responses. Mineralocorticoids 1. Name the major mineralocorticoid in man. 2. Give the cellular actions of aldostreone and say in which tissues it acts. 3. Give three factors which control the rate of aldosterone production. 4. Describe the role of aldosterone and angiotensin system and say what effect increased angiotensin has on aldosterone output. Illustrate with examples from clinical situations and the use blockers of the renin-angiotensin system. 5. Describe the role of aldosterone and angiotensin in the restoration of blood pressure after sodium depletion and water loss. Adrenocortical Sex Hormones 1. Name the main androgens produced by the human adrenal cortex and comment on their possible physiological role in the adult. 2. State whether oestrogen secreted by the cortex has any physiological role. Disorders of Adrenal Function Locate the lesions and list, and explain the main signs and symptoms in the following conditions: a) primary aldosteronism b) secondary aldosteronism

levels. these relate b-

of

cfoetus and

d-

31 c) Cushings syndrome d) adrenogenital syndrome e) phaeochromocytoma f) Addisons disease The Pancreas 1. State the three major endocrine cell types of the pancreas, and the respective hormones secreted by them. 2. Give the actions of glucagon on: a) hepatic glycogenolysis b) gluconeogenesis 3. Say what effect low plasma glucose has on glucagon secretion and state two other stimuli of glucagon release. 4. List the effects of insulin on: a) protein metabolism b) lipid metabolism 5. List the five principle hormones upon whose co-ordinated activity blood glucose concentration depends in the fed and fasting and explain briefly how each acts in this regard.

I-

state

6.

J-

normal

Explain the effect of the following endocrine disorders on blood glucos levels: a) diabetes mellitus b) insulinoma c) Cushings disease 7. Explain briefly the use of the glucose tolerance test in studying normal and pathological carbohydrate metabolism. 8. List three mechanisms for control of insulin secretion. 9. Describe three ways in which insulin lowers blood glucose concentration. Calcium Metabolism: 1. Name three forms and approximate proportions in which calcium is carried in the blood, and say which of these can diffuse from the plasma into interstitial fluid. 2. a) Explain how parathormone and calcitonin act in order to maintain the plasma calcium concentrations within limits. b) Identify the main stimulus for the release, and give the site of production, of each hormone. 3. Describe and explain one of the signs or symptoms that can occur when the level of plasma calcium is: i) higher and lower ii) higher than normal 4. a) Describe three sites from which calcium can be lost from the body and the source of calcium in each case. Explain which of these losses are inevitable, and state what factors can control some of the loss for each site.

32 5. Explain how the bone can act as a reservoir of calcium in he body, mentioning two of the differences between the rapidly exchangeable pool of calcium and the reservior that depends on breakdown of the collagen matrix of bone. Explain how vitamin D deficiency can arise, one of its signs in infants and how it may be treated, giving a dietary and a non-dietary source of the vitamin. State which are the two main sites of action of the hormone 1.25 dihydroxycholecalciferol formed from vitamin D , explaining how its action at each site could prevent rickets.

6.

X. REPRODUCTION A. Male Reproductive System: 1. Draw a labeled diagram to show the arrangement of the internal and external reproductive organs (including accessory glands) in a man. Sex differentiation: Describe the role of testosterone and Mullerian inhibitory factor in the development of phenotypic sex. State the basis of how occasionally discrepancies occur between genetic and anatomical sexes. Explain role Y chromosome in determining gonadal sex. 2. State that the testes descends into the scrotum, and explain the consequencs when the testis fails to desend. 3. Explain the relative importance of the testes and adrenal cortex in producing androgens of varying potency. 4. State that the functions of testes include sperm production and secretion of androgens. 5. Recognize that the Leydig cells are the cells which secrete testosterone and describe the actions of testosterone in the foetue, at puberty and in adult life on. a) internal genitalia b) external genitalia c) secondary sex characteristics d) metabolism of bone growth and behavior. 6. Predict the ultimate effects of castration before and after puberty. 7. Briefly describe the functional importance of the different parts of spermatozoa. 8. Describe the process of spermatogenesis and state its duration. 9. Describe the Sertoli cell and its importance in spermatogenesis. 10. State the importance of x-chromosome for sperm development and recognize that packaging does not involve change in the number of chromosomes. 11. Draw a diagram to show the relationship between the hypothalamus, anterior pituitary and testes in the controls of spermatogenesis and testosterone production. 12. Give the principla features of ejaculate of normal fertile semen.

33 13. 14. 15. 16. 17. B. Indicate that infertility could result from abnormalities in nuber, motility or morphology of sperms. State that the male sex act has got tow components: erection and ejaculation. Describe erection reflex and explain how a defect in erection reflex could lead to impotence. Describe the mechanism of ejaculation (emission and explsion phases). Describe the functions of male reproductive tract and accessory glands.

Female Reproductive System: 1. Draw a labeled diagram to show the principal structural features of the female reproductive system. 2. Describe the major events in the reproductive life of a female using such terms as: Puberty, Gonadotrophins, Ovulation, Endometrium, Menstrual Cycle, Fertilization, Pregnancy and Menopause. 3. Describe the actions of estrogen and progestrones on: Internal genitalia External genitalia Secondary sex characteristics Non reproductive functions. 4. State that the functions of femal gonads (ovaries) includes secretin of female sex hormones as well as ovum production. 5. State the duration of an idealized menstrual cycle and explain how the days of the cycle are numbered. 6. With the help of a diagram explain. a) Menstrual, proliferative and secretory phases. b) Time of ovulation. c) Estrogen and Progesterone chages d) LH and FSH changes. 7. a) Describe the development , maturation and regression of primodial follicles during the menstrual cycle. b) Explain the significance of the LH- Surge. 8. Name the main source of estrogen and progesterone in the adult woman. 9. Describe the endometrial changes during the menstrual cycle and relate them to the circulating levels of estrogen and progesterone. 10. Describe the changes in structure and secretions of the vaginal mucosa and cervix during the menstrual cycle and relate them to the circulating levels of estrogens and progesterone. 11. With the aids of diagrams deagrams describe the endocrine control of the mentstrual cycle (folliculr phase and luteal phase). 12. Describe the explain the endocrine changes which occur in the postmenopausal woman. 13. Explain how it is possible to prevent ovulation by the administration of estrogen and progesterone and discuss the mechanisms of action. 14. Briefly describe the mechanism of female sex ual. CPregnancy, Parturition and Lactation: 1. Explain how the ovum reaches the uterus and where:

34 a) fertilization and b) implantation usually occur 2. Give the time in the menstrual cycle at which ovulation usually occurs, and the intervals before subsequent. a) fertilization and b) implantation of the ovum and zygote. 3. Give the normal length of gestation in days and the rule by which the date of delivery is predicted. 4. Explain the prolongation of the life of the corpus luteum at the beginining of pregnancy of pregnancy and discuss its importance in the maintenance of pregnancy. 5. Describe the role of placental hormones in the maintenance of pregnancy: this includes human chorionic somatomammotropin and relaxin 6. Describe the use of hormone estimation in the diagnosis of pregnancy and the assessment of the viability of fetus. 7. a) Define the stages of labour and indicate the endocrine changes influencing each of these stages. b) Describe the mechanism of parturition. 8. Describe the hormonal control of mammary development both at puberty and during pregnancy. 9. a) Distinguish between and describe the control of mild secretion and the suckling reflex (milk ejection reflex) b) State how lactation is initiated after parturition and how lactation is maintained? 10. State the composition of human milk, commenting on its suitability for the new born baby. 11. Describe the physiologyical basis of lactational amenorrhea.

XI - TEMPERATURE REGULATION 1. 2. 3. Define the temperature and heat content. Define the thermal unit 1 calorie. Give an account of the physical laws that apply to various forms of heat exchange between the body and its surroundings, and to the transport of heat in the body. 4. Define the terms homeothermic and poikilothermic. 5. Write the equations for heat balance in the body as: a) rate of heat accumulation = rate of heat production - rate of heat loss b) rate of heat accumulation = body weight (g) X specific heat of body (0.83 Cal / g ) X change in mean body temperature / unit time. 6. Describe the regulating system and the mechanisms which come into operation when heat production and heat loss change, mentioning that there are two centers; explain the effect of either stimulation or injury on each of them.

35 7. 8. 9. 10. State that the homeothermic animal tries to maintain a constant internal body temperature, whereas the temperature of the peripheral parts depends on the environmental temperature and the cutaneous blood flow. State that the rectal for oral temperature gives a fair measure of the internal body temperature. State that the oral temperature lies approximately 0.5 oC below the rectal temperature. State that during more or less basal conditions body temperature, measured rectally or orally, is a regulated variable that has individual variaitons (SD = 0.2 oC) and 24 hour variations (approx. 0.5oC higher in the evening than in the morning) around 37oC. Give the possible ways of heat exchange between the body and its environment, and for the transport of heat in the body. Account for the possibilities that the body has a changingheat production and heat loss respectively under certain physical circumstances. Give a few physiological circumstances under which body temperature changes (muscular activity, ovulation). State that babies and anaesthetized patients have poorer temperature regulation than awake adults and give reasons for this difference. Describe how the thyroid gland can affect body temperature. Give the changes that take place in circulation, respiration and energy metabolism in cases of hyper and hypothermia, and state that temperature regulation ceases when the rectal temperature is below 28oC or above 40oC.

11. 12. 13. 14. 15. 16.

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