Physiology Curriculum
CURRICULUM OF “PHYSIOLOGY WITH ELEMENTS OF PATHOPHYSIOLOGY” COURSE
2nd year (3rd and 4th semesters) of European MD program
Academic year 2018/2019
MAIN TOPIC
subtopics - detailed issues
INTERNAL ENVIRONMENT
Homeostasis – Body fluids; Water distribution in the body – measurement methods
Blood volume in human body – Measurement methods
Functions of blood
Osmotic and oncotic pressures
Composition of blood – Plasma (inorganic components, organic components, proteins, non-proteins); Hematocrit – modulating factors; Red blood cells – number, functions, erythropoiesis, life-span, destruction; Erythrocyte sedimentation rate (OB) – significance in practical medicine; White blood cells – number, classification, functions; Leukocytosis – physiologic vs. pathologic
Hemoglobin (Hb) – Hb concentration in blood; Functions of Hb; Metabolism Hb – Hb derivatives, bile pigments; Hemolysis of erythrocytes – definition, factors
Hemostasis – General diagram of blood clotting; Intrinsic and extrinsic mechanisms of blood clotting; Anticoagulants
Acid-base balance – pH of blood, physiological fluctuations and extreme values; Blood buffer systems; Alkaline reserve; Henderson-Hasselbalch equation; Acidosis and alkalosis – types (compensated and uncompensated, respiratory and metabolic); Lungs and kidneys roles in maintaining of constant pH
Oxygen transport in blood – HbO dissociation curve – influence of CO2, pH, temperature and 2,3-DPG; Haldane effect
Carbon dioxide transport in blood – Forms – bicarbonates, carbaminians, physically dissolved CO2; Role of erythrocytes
Defense functions of blood – Types of immunity – inborn and acquired, cellular and humoral; Antigen and antibody
Group antigens for ABO and Rh systems – Blood typing; Cross matching; General rules of blood transfusion
Lymph – Composition and volume
EXCITABILITY AND PERIPHERAL NERVOUS SYSTEM
Definition of excitability
Stimulus – Definition and characteristics of effective stimulus
Structure of excitable cell membrane – Voltage- and ligand-gated channels; Ionic pumps – role of Na/K-ATPase
Membrane potential – Resting – Gibbs-Donnan effect; Electrochemical potential – Nernst equation; Action potential – components and their ionic basis; Hyperpolarization; “All-or-none” law
Refractory period – types, significance
Cable characteristics of membrane – Electrotonic conduction; Time constant – definition, factors; Space (length) constant – definition, factors
Conduction of action potentials – Types (serial and saltatory, orthodromic and antidromic) – mechanisms and velocities; Demyelinating diseases
Comparison of action potentials in neuron and muscle – skeletal, smooth, and cardiac
Synapse – Synapse structure (Nerve ending; Presynaptic membrane; Synaptic cleft; Postsynaptic membrane; Threshold depolarization); Excitatory and inhibitory postsynaptic potentials; Synaptic delay
Neurotransmitters – Neurotransmitter criteria; Types – classical, amine, neuropeptides, atypical; Transport of neurotransmitters
Characteristics of neurotransmitters – Acetylcholine; Norepinephrine; Dopamine; Glutamate; Serotonin; Histamine; Purines; Peptides – POMC derivatives; GABA; Glycine; Atypical – NO and endocannabinoids
Synaptic proteins – Types and functions; Docking of synaptic vesicle; Neurotoxins influencing fusion of the vesicle
Neuron – Cell body (perikarion); Axon hillock and its specialty; Dendrites and dendritic spines; Neurite, axon, and myelin; Transport of neurotransmitter; Schwann cells and formation of myelin; Myelin in CNS; Oligodendrocytes; Types of neurons; Nerve block – cessation of conduction. Practical significance; Neuronal degeneration and regeneration
Neuronal systems – Convergence; Divergence; Occlusion; Temporal and spatial summation; After-potentials;
STRIATED MUSCLES
Muscle types (skeletal, smooth, cardiac)
skeletal muscle
Skeletal muscles – Arrangement of fibers in skeletal muscle; Sarcomere; Proteins involved in contraction; Electromechanical coupling – role of Ca2+ ions; Mechanism of sarcomere shortening; Refractory period in skeletal muscle; Sarcomere anchoring proteins – dystrophin, dystroglycans, sarcoglycans; Muscular dystrophies
Neuromuscular junction – Transmitter release form the endings – at rest and after stimulation; End-plate receptors; Cessation of transmission in cholinergic synapse
Types of contractions – Single, isotonic and isometric; Tetanic contraction
Motor unit – Definition, size; Regulation of contraction force in motor units
Contraction and accompanying energetic processes – Energy sources; Myoglobin and its dissociation curve; Oxygen debt; White and red muscles; Initial muscle length and force of its contraction
cardiac muscle
Automatism of the heart – definition, slow and fast fibers, evidence for myogenic origin of automatism
Conduction system of the heart – Rhythm maker; Prepotentials (slow resting depolarization); Modulation of prepotentials by nervous and humoral factors; Velocities, pathways, and direction of impulses conduction in conducting system and working musculature of atria and ventricles
Action potential of working musculature – phases and their ionic basis; “All-or-none” law in the heart; Refractory period in the heart; Extrasystole and compensatory pause
Electrochemical coupling in cardiac cells – role of Ca2+ ions
ECG – Theory outline; Components of normal electrocardiogram; Information possible to acquire form an ECG
Innervation of the heart – parasympathetic and sympathetic; effects of innervation (inotropic, chronotropic, dromotropic, batmotropic, lusitropic)
Heart as an effector of reflexes – Bainbridge, Aschner, Bezold-Jarisch, Golz, sinus carotis, Valsalva and Műller maneuvers
Influence on the heart – humoral and physical factors: plasma ionic composition; metabolites; hormones; temperature; gravity and the like
CIRCULATORY SYSTEM
General organization of cardiovascular system, role of valves
Cardiac cycle – individual phases of so-called cardiac resolution, valves behavior, changes of intracardiac pressures; Heart as a spiral
Heart sounds and murmurs – significance in basic clinical diagnosis
Frank-Starling law of the heart – Cardiac autoadaptation: preload and afterload
Cardiac output – measurement methods; Stroke volume. Residual volume
Coronary vessels and their specialties
Heart as a source of hormones
Division of circulatory system
Blood distribution in circulatory system
Rule of constant volume flow
Physical laws regarding blood flow in vessels (Poiseuille, Laplace, Bernoulli)
Flow/peripheral resistance – mutual relations and significance; Vessel radius and blood flow; Resistant vessels; Shear stress
Laminar and turbulent flow – Acoustic features accompanying the turbulent flow and their clinical significance
Arterial blood pressure – normal values, methods of measurement
Factors conditioning the arterial pressure – cardiac output, peripheral resistance, circulating blood volume
Blood volume and vascular bed capacitance
Aorta – role in continuous flow. Air chamber mechanism
Pulse – basic clinical characteristics
Capillaries – Small circulation of water; Mechanism of edema; Types of edema
Blood flow in veins – Factors influencing venous return: heart work, skeletal muscles work, pressure in thoracic cavity (Valsalva and Műller experiments), gravity (G+ i G-)
Cardiovascular center – Action (blood pressure as regulator and regulated value)
Nervous and local regulation of blood flow in resistant vessels
Presoreceptors (baroreceptors) and their distribution in circulatory system
Hormones participation in regulation of arterial blood pressure and blood flow in various regions of circulatory system
Cerebral, coronary circulations
Reaction of circulatory system to work load
Blood stores
Circulatory shock – definition; causes
RESPIRATORY SYSTEM
Mechanics of respiration – Mechanism of inspiration; Mechanism of expiration; Role of pleural fluid; Pneumothorax
Lung capacity and its components – vital capacity and methods of measurements; Spirometry and its interpretation
Anatomic and physiologic (functional) dead spaces and their physiologic significance
Minute and alveolar ventilations – changes during physical effort
Ventilation/perfusion ratio
Anatomic and physiologic (functional) pulmonary shunt – significance in clinical diagnostics, cyanosis
Alveoli – Surfactant and its role
Pulmonary compliance
Gas exchange – Composition of atmospheric, alveolar and exhaled airs; Gas exchange in alveoli – O2 and CO2 in alveolar air, arterial and venous blood in lungs (partial pressures)
Pulmonary diffusion capacity – factors influencing diffusion rate
Hypoxia – types (anoxic, circulatory, anemic, histotoxic)
Increased and decreased atmospheric pressures influence on respiration and gas exchange – Decompression (caisson) disease; Altitude sickness
Regulation of respiration – Brain stem respiratory complex (respiratory center – definition, division, localization, action) – chemical and non-chemical modulation (influence from: peripheral and central chemoreceptors, proprioceptors, thermoreceptors, nerve V receptors and others; lung mechanoreceptors – Hering–Breuer reflex)
Limbic system and hypothalamus influence on respiration
Cortical influence on respiration
SMOOTH MUSCLES
Characteristics – Types; Structure; Innervation; Automatism
Excitability and conductance
Molecular mechanism of contraction – role and sources of Ca2+ ions; “Latch-bridge” mechanism and its significance
Tonic inhibition of filaments – role of caldesmon and calponin
Plasticity of smooth muscles
Tonic contractions
Slow waves – mechanism of origin
VEGETATIVE NERVOUS SYSTEM
Neurotransmitters of VNS; Elimination of mediator from synaptic cleft
Membrane receptors – activation mechanism and signal transduction cascades
Division of vegetative system – sympathetic, parasympathetic, visceral
Centers sympathetic and parasympathetic
Organization of vegetative system – preganglionic and postganglionic neurons
Autonomic ganglia – ganglionic transmission
Specialty of synaptic transmission – neuromediators and neuromodulators; Agonists and antagonists
Vegetative synapse – characteristic; Mechanisms of sympathetic and parasympathetic synapses actions
Central regulation of visceral functions – levels of regulation; Spinal cord centers; Medulla oblongata centers; Solitary nucleus and its significance; Hypothalamic centers – regulation of food and water intake, circadian clock; Limbic system – significance, Papez circuit; Cerebral cortex – interactions with vegetative system
Sympathetic and parasympathetic influence on action of various systems (circulatory, respiratory, alimentary etc.)
ALIMENTARY SYSTEM
Motor activity of alimentary system – Submucosal and myenteric plexuses; Basic electric rhythm of pacemaker cells; Migrating motor complex and its role; Movement types and their regulation
Oral cavity – Grounding of foodstuffs; Swallowing; Saliva: composition, functions, regulation of secretions
Stomach – Phases of gastric juice secretion; Digestion in stomach; Regulation of gastric juice secretion (nervous and humoral); Gastric peristalsis
Duodenum – Pancreatic juice: amount and composition, enzymatic action; nervous and humoral regulation of pancreatic juice secretion
Bile – volume, types, composition of bile; Regulation of bile secretion; Gallbladder and its functions
Liver – functions
Small intestine – Digestion in small intestine; Villi and absorption; Intestinal hormones
Large intestine – Absorption in large intestine; Role of bacterial flora; Defecation reflex
Reflexes of alimentary tract
KIDNEYS AND URINARY SYSTEM
Kidneys function
Structure of nephron
Specialty of renal blood supply
Production of primary urine – Filtration – factors influencing filtration; Composition of primary urine
Ultrafiltrate fates during flow through nephron various parts – Absorption of water and major electrolytes –obligatory and hormone-dependent absorption, role of particular nephron parts, mechanisms of resorption and secretion in nephron
Clearance – Clearance as an example of Fick’s principle application; Measurement of filtration and renal blood flow; Clearance as the marker of renal function (inulin, paraaminohippuric acid, creatinine)
Glucose fates in kidney – diabetes mellitus, glycosuria, glucose as an example of threshold substance, glucose clearance
Countercurrent multiplier and exchanger – mechanisms of urine concentration
Role of kidney in arterial blood pressure and body fluids regulation – Osmodetectors, pituitary, and antidiuretic hormone; Diabetes insipidus; Osmotic and water diuresis; RAA system and kidneys
Role of kidney in acid-base balance regulation – secretion of hydrogen ions in various parts of nephron
Final urine – volume, composition
Kidney as an endocrine organ
Urinary bladder – Micturition reflex
ENDOCRINES AND REPRODUCTION
Hormones – definition, division, mechanisms of action
Regulation of hormones secretion (feedback principle). Long, short, ultrashort feedback loops
Hypothalamus as a superior center of hormonal regulation; Liberating and inhibiting hormones
Pituitary – role in hormonal regulation; Anterior lobe hormones – tropic, growth hormone, prolactin; Posterior lobe hormones
Thyroid gland – Action of thyroid hormones; Regulation of secretion; Examples of pathology
Pancreas – endocrine function – insulin i glucagon; Action; Regulation of secretion; Diabetes mellitus – types
Adrenals – functions and significance of glucocorticoids and mineralocorticoids; Regulation of secretion; Examples of pathology
Calcium and phosphates – hormonal regulation (parathormon, vitamin D3, calcitonin)
Gonadotropins – fluctuations of secretion through life-span
Ovary – menstrual cycle – hormonal regulation, changes in endometrium; Estrogens – role
Pregnancy – hormonal regulation during pregnancy. Placental hormones
Parturition – hormonal basis of initiation and course of the labor
Testis – reproduction and endocrine organ; Androgens – role
CENTRAL NERVOUS SYSTEM - INTRODUCTION
Division of central nervous system
Integration levels of nervous functions
Cerebrospinal fluid – composition, secretion, absorption, pathologies
Meninges, submeningeal spaces – spinal tap
Blood-brain barrier
SOMATOSENSORY SYSTEM
Definition of receptor
Adequate and inadequate stimuli
Specialization of receptors
Mechanism of receptors action (generator potential)
Thresholds of excitability of various receptors. Examples
Adaptation of receptors
Classification of receptors – Regarding localization (Sherrington’s division); Regarding physical nature of the stimulus; Clinical
Receptive field
Mechanoreceptors – Mechanoreceptors of the skin; Proprioreceptors; Other mechanoreceptors
Thermoreceptors – Types; Stimulation mechanism; Distribution
Nociceptors – significance of pain sensation; distribution of nociceptors; Structure; Stimulation mechanism; Chronic pain – mechanism, types; Visceral pain; Conduction of pain sensation; Descending and ascending gating of pain sensation
Somatosensory system – Role of sensation in reflex arcs; Sensory axis; Spinal sensory pathways; Segmental organization of spinal cord; Somatosensory cortex
SPECIALIZED SENSORY SYSTEMS
Smell – Structure of olfactory epithelium; Stimulation mechanism; Olfactory pathways
Taste – types; Stimulation mechanism; Taste pathways; Taste perception
Auditory organ – Structure – elements and their roles; Mechanism of signal transduction and amplifying; Tonotopic organization of cochlea; Organ of Corti; Mechanism of hair cells stimulation; Air and bone conduction; Auditory pathway – examination methods
Equilibrium organ – Structure – elements and their roles; Stimulation mechanism; Adaptation of receptors; Nystagmus – caloric tests
Visual organ – Structure; Optics laws – refraction and its defects, aberrations (spherical and chromatic); Light and accommodation pupillary reflexes – centers; Cornea; Aqueous humor: composition, production, outflow; Glaucoma; Photoreceptors structure and stimulation (pigments, enzymes, role of Ca2+ ions); Types and role of bipolar cells; and role of ganglion cells; Visual pathway – retinotopic organization;
SYSTEM OF MOVEMENT CONTROL
Somatic motor system – Voluntary motor control; Components of motor system; Motor cortex; Descending motor pathways; Spinal motoneuron as common final pathway; Proprioceptors of motor system; Gamma loop – regulation of muscle length and tension, modulation; Reflexes involved in locomotion; Rhythmical patterns of motor activity; Symptoms of upper and lower motoneuron injury
Spinal shock
Basal ganglia – structure, role, characteristic signs of injury
Cerebellum – functional division; Functions; Connections; Signs of injury
Reticular formation of brain stem – ascending and descending parts; Roles
HIGHER FUNCTIONS OF CNS
Electrophysiological CNS tests
Sleep – phases; Centers; Defects
Consciousness defects
Speech– Centers; Defects
Limbic system – functions; Injury signs
Memory – definitions of learning and memory; Types of memory; Disorders
Reflexes – Unconditional reflexes – types, significance, modulation; Conditional reflexes – closure of reflex arcs; Inhibition of conditional reflexes
Specialization of hemispheres
METABOLISM
Definition of metabolism – Anabolism; Catabolism
Energetic value of foodstuffs
Calorimetry – Direct; Indirect (RQ [respiratory quotient] and caloric equivalent of O2)
Basic metabolic rate (BMR) – Definition; Norms; Measurements methods; Factors modifying BMR (physiologic and pathologic)
Working metabolic rate – Work and effort (ergometry); Coefficient of work efficiency
Specific dynamic action of foodstuffs (SDA)
Nutrition – Normal caloric needs of a human; Diet planning; Isodynamic law
Nitrogen balance and protein minimum
Water balance
Starvation – Types (complete and incomplete); Metabolic rate during starvation
THERMOREGULATION
Physical base – Definitions; Ways of heat exchange (conduction; free and forced convection; radiation; evaporation)
Term of thermostat – Constant body temperature as a feature of homeostasis; Internal body temperature as balance between body heat liberation and heat exchange with environment
Temperature norms of human body – Core temperature; Shell temperature; Diurnal fluctuation of body temperature
Thermoregulatory center – Division, thermoregulatory reactions, engagement of cardiovascular and respiratory systems
Physiologic processes preventing reduction of body temperature – thermogenesis: types, endogenic and exogenic factors influencing thermogenesis
Physiologic processes preventing increase of body temperature
Behavioral thermoregulation – examples in various species
Fever – pyrogens and mechanism of their influence on thermoregulatory center, action of antipyretic drugs
Anapyrexia
Hyperthermia – differences between hyperthermia and fever, causes of hyperthermia. Lethal temperature Hypothermia
PHYSICAL EFFORT
Functional organization of motion system
Classification of physical efforts
Absolute and relative work load
Sources of energy for muscle work – short- and long-lasting efforts, static and dynamic efforts; Metabolism in post-effort period
Changes in body functions during physical effort – cardiovascular system, respiratory system, volume and composition of blood, hormonal changes, kidneys, liver, alimentary system, thermoregulation
Physical efficiency – basic terms
Physical training – mechanisms and physiologic effects
Physiology of motor inactivity
Physical effort and diseases – physical efficiency tests
SOURCES
1. lectures
2. "Human Physiology: An Integrated Approach" by Dee Unglaub Silverthorn (7th or newer ed.)
3. "Color Atlas of Physiology" by Stefan Silbernagl, Agamemnon Despopoulos (5th or newer ed.)
4. "Review of Medical Physiology" by William F. Ganong (22nd or earlier ed)
5. "Textbook of Medical Physiology" by Arthur C. Guyton, John E. Hall (12th or newer ed.)
6. "Physiology" by Linda S. Costanzo (4th or newer ed.)