[Including Exercise Physiology]

Total hours:	210
Theory:	150
Practical:	60
Total Hours/ Week:	7 hours
Lecture:	4 hours /week
Practicals:	2 hours/ week
Seminars/ Tutorials:	1 Hour/ week
Method of assessment:	Written, Oral, Practical

Course Description:
At the end of the course the student will be able to explain the normal functioning of all the organ systems and their interaction for well coordinated total body functions with special reference to musculoskeletal, nervous, cardio-respiratory, female Urogenital system & alteration in functions of organs due to aging, Analyze physiological responses & adaptation to environmental stresses with special emphasis on physical activity & temperature. Acquire the skill of basic clinical examination with special emphasis to peripheral & central nervous system, cardio-vascular & respiratory system, exercise tolerance.

Practical classes include hematology experiments, clinical examinations, and recommended demonstrations.

Theory:
General Physiology [in brief only] [2 Hours] Cell: Morphology. Organelles: their structure and functions, Transport Mechanisms across the cell membrane, Body fluids: Distribution, composition. Tissue fluid – formation.

SECTION – I

• Blood [10 Hours]
  • Introduction: Composition and functions of blood.
  • Plasma: Composition, formation, functions. Plasma proteins.
  • RBC: structure formation, functions, count and its variations. Erythropoiesis- stages, factors regulating. Reticulo-endothelial system (in brief) Haemoglobin – Anemia (in detail), types of Jaundice. Blood indices, PCV, ESR.
  • WBC: Classification. Morphology, functions, count, its variation of each. Immunity: Innate and acquired.
  • Platelets: Morphology, functions, count, its variations
  • Haemostatic mechanisms: Blood coagulation–factors, mechanisms. Their disorders. Anticoagulants.
  • Blood Groups: Landsteiner’s law. Types, significance, determination, Erythroblastosis foetalis.
  • Blood Transfusion: Cross matching. Indications and complications.
  • Lymph: Circulation and functions.
• Nerve Muscle Physiology [15 Hours]
  • Introduction: Resting membrane potential. Action potential – ionic basis and properties.
  • Nerve: Structure and functions of neurons. Classification, Properties and impulse transmission of nerve fibers. Nerve injury – degeneration and regeneration.
  • Muscle: Classification. Skeletal muscle: Structure. Neuromuscular junction : Structure. Neuromuscular transmission. Excitation- Contraction coupling. Rigor mortis. Motor unit. Properties of skeletal muscles, Length-tension relationship, fatigue, load.
  • Smooth muscle: Structure, types, mechanism of contraction.
• Nervous System [ 20 Hours]
  • Introduction: Organisation of CNS – Central and Peripheral nervous system. Functions and properties of nervous system.
  • Sensory Mechanism including Sensory receptors: function, classification and properties. Sensory pathway: The ascending tracts –their origin, course, termination and functions. The trigeminal pathway. Somatic sensations: include superficial;, Deep and Cortical Sensation. Types of Pain: mechanism & Gate control theory of pain.
  • Motor Mechanism: Motor Cortex. Motor pathway: The descending tracts – origin, course, termination and functions. Upper motor neuron and lower motor neuron.
  • Reflex Action: definition, types and properties of reflexes in brief.
  • Introduction: Spinal cord Lesion, level of injury in brief.
  • Brainstem: function of Pons, midbrain and medulla oblongata.
  • Cerebellum: functional anatomy of cerebellum connection and their parts.
  • Thalamus and Hypothalamus: Nuclei. Functions and connection.
  • Reticular Formation, internal capsule and Limbic System: Components and Functions.
  • Basal Ganglia: Structures included and functions.
  • Cerebral Cortex: Lobes. Brodmann’s areas and their functions. Higher functions of cerebral cortex – learning, memory and speech.
  • Posture and Equilibrium: Postural reflexes – spinal, medullary, midbrain,cerebral reflexes and stretch reflexes.
  • Vestibular apparatus: Function of vestibular apparatus.
  • EEG: Waves and features in brief. Sleep: REM and NREM sleep.
  • CSF: Formation, composition, circulation and functions. Lumbar puncture and its significance. Blood brain barrier.
  • ANS: Features and actions of parasympathetic and sympathetic nervous system.
• Special Senses [ 10 Hours]
  • Vision: Introduction: Functional anatomy of eye ball. Functions of cornea, iris, pupil, aqueous humor – glaucoma, lens – cataract, vitreous humor, rods and cones. Photopic vision. Scotopic vision.
  • Visual Pathway and the effects of lesions.
  • Refractive Errors: Myopia, hypermetropia, presbyopia and astigmatism in brief.
  • Visual Reflexes: Accommodation, direct and indirect reflexes. Light adaptation. Dark adaptation. Color vision, color blindness.
  • Audition: Functions of external ear, middle ear and inner ear. Auditory pathway. Tests for hearing.
  • Taste: Taste buds, gustatory pathway.
  • Smell: Olfactory pathway.
• Renal System [ 8 Hours]
  • Introduction: Functional anatomy of kidney, Nephrons, juxtamedullary. Juxta- glomerular apparatus. Renal blood flow and its regulation.
  • Mechanism of Urine Formation: Mechanism of glomerular filtration. GFR – normal value and factors affecting. Insulin clearance. Creatinine clearance. Diuretics, dieresis.
  • Tubular Reabsorption: Reabsorption of Na+, glucose, HCO3-, urea and water. Filtered load.
  • Renal tubular transport. Glucose clearance: TmG. Renal threshold for glucose.
  • Tubular Secretion: Secretion of H+ and K+. PAH clearance.
  • Introduction and Mechanism of concentrating and diluting the Urine, Regulation of water excretion.
  • Micturation: Mechanism of micturation. Cystometrogram. Atonic bladder, automatic bladder.
  • Acid-Base balance in brief
  • Artificial Kidney: Principle of haemodialysis.
  • Skin and temperature regulation.
• Physiology of Exercise [10 Hours]
  • Effects of exercise on:
    • Muscle strength/power/endurance
    • Neuro-musculoskeletal system
  • Effect of gravity/ Altitude/ pressure on physical parameters.

SECTION – II

• Cardiovascular System [ 20 Hours]
  • Introduction: Physiological anatomy and nerve supply of the heart and blood vessels. Cardiac muscles: Structure. Ionic basis of action potential and pacemaker potential. Properties.
  • Conducting system: Components. Cardiac Cycle: Definition. Phases of cardiac cycle. Heart sounds – causes, character.
  • Cardiac Output: Definition. Normal value. Determinants. Stroke volume and its regulation. Heart rate and its regulation and their variations.
  • Arterial Blood Pressure: Definition. Normal values and its variations. Determinants. Peripheral resistance. Regulation of BP.
  • Arterial pulse.
  • Shock – Definition. Classification–causes and features
  • Regional Circulation: Coronary, Cerebral and Cutaneous circulation.
• Respiratory System [ 15 Hours]
  • Function of respiratory system: Pleura, tracheo-bronchial tree, alveolus, respiratory membrane and their nerve supply. Respiratory muscles.
  • Mechanics of breathing: Intrapleural and Intrapulmonary pressure changes during respiration. Lung compliance: Normal value, pressure-volume curve, factors affecting compliance and its variations. Surfactant – Composition, production, functions.
  • Spirometry: Lung volumes and capacities. Timed vital capacity and its clinical significance. Maximum ventilation volume. Respiratory minute volume.
  • Dead Space: Types and their definition.
  • Pulmonary Circulation. Ventilation-perfusion ratio and its importance.
  • Transport of respiratory gases: Diffusion across the respiratory membrane. oxygen-haemoglobin dissociation curve. Factors affecting it. Haldane and Bohr Effect. Carbon dioxide transport: Different forms, chloride shift.
  • Neural Regulation of Respiration. Hering-breuer’s reflex. Voluntary control. Chemical Regulation.
  • Hypoxia: Effects of hypoxia. Types of hypoxia. Asphyxia. Cyanosis – types and features.
  • Periodic breathing – definition and types.
  • Artificial respiration
• Reproductive System [ 5 Hours]
  • Introduction: Physiological anatomy, reproductive organs. Sex determination and Sex differentiation.
  • Male Reproductive System: Functions of testes. Pubertal changes in males. Spermatogenesis.
  • Testosterone: action. Regulation of secretion. Seminal vesicles, seman.
  • Female Reproductive System: Functions of ovaries and uterus. Pubertal changes in females. Oogenesis. Hormones: oestrogen and progesterone-action. Regulation and function of secretion. Mentrual Cycle: Phases. Ovarian cycle. Uterine cycle. ovulation. Menarche. Menopause. Pregnancy: Pregnancy tests. Physiological changes during pregnancy. Functions of placenta. Lactation. Contraception methods
• Endocrine System [10 Hours]
  • Introduction: Major endocrine glands. Hormone: classification, mechanism of action. Functions of hormones
  • Pituitary Gland: Anterior Pituitary and Posterior Pituitary hormones: action, regulation of secretion of each hormone. Physiology of growth and development.
  • Thyroid Gland: Thyroid hormone and calcitonin: secretory cells, action, function and regulation of secretion.
  • Parathyroid hormones: action, function and regulation of secretion.
  • Adrenal Gland: Adrenal Cortex: Secretory cells, synthesis, action, regulation of secretion of Aldosterone, Cortisol, And Androgens. Adrenal Medulla: Secretory cells, action, regulation of secretion of adrenaline and noradrenaline.
  • Endocrine Pancreas: Secretory cells, action, regulation of secretion of insulin. Glucose metabolism and its regulation.
  • Calcitrol, Thymus and Pineal gland in brief.
  • Local Hormones in brief.
• Digestive System (in brief) [ 5 Hours]
  • Introduction: Physiological anatomy and nerve supply of alimentary canal. Enteric nervous system
  • Salivary Secretion: Saliva: Functions. Regulation. Mastication (in brief)
  • Swallowing: Definition. Different stages. Functions.
  • Stomach: Functions. Gastric juice: function. Gastrin: function. Gastric motility. Gastric emptying. Vomiting.
  • Pancreatic Secretion: production, function. Regulation.
  • Liver: Functions of liver. Bile secretion: functions and regulation. Gall bladder: Functions.
  • Intestine: Succus entericus: function and regulation of secretion. Intestinal motility and its function.
  • Mechanism of Defecation.
• Physiology of Exercise [10 Hours]
  • Effects of exercise on:
    • Hormonal and metabolic effect
    • Cardiovascular system
    • Respiratory system
  • Physiology of Aging.

Applied Physiology [10 Hours] [not for exam]:
More detailed study of the physiology and practical applications of the following selected topics with emphasis on aspects, which should help in understanding the nature and treatment of common clinical situations of interest in Physiotherapy.

• Muscles and Nervous System Functions
  • Hypotonicity, hypertonicity, myotonia, myasthenia gravis.
  • Pathological reflexes. UMN & LMN disease.
  • Spinal cord disorder: syringomyelia, tabes dorsalis and etc.
  • Ataxia, involuntary movements, involuntary movements.
  • Cerebellar disorders.
  • Parkinson’s disease, Wilson’s disease.
  • Special senses disease- Vision, taste, hearing, vestibular, Olfaction
• Blood functions
  • Thalassemia Syndrome, Hemophilia, VWF
  • Anemia, Leucocytosis
  • Bone marrow transplant
• Renal system disorders
  • Renal failure: acute and chronic.
• Pulmonary Functions
  • Brief introduction of respiratory disease including obstructive and restrictive.
  • Disorders of Respiration: Dyspnoea. Orthopnoea. Hyperpnoea, hyperventilation, apnoea, tachypnoea.
  • Artificial respiration
  • Breath sounds.
• Cardio vascular Functions
  • Arrhythmia.
  • Hypertension, hypotension.
  • Myocardial infarction, angina pectoris.
  • PDA. Varicose vein.
• Metabolic Functions & digestive system
  • Diabetes Mellitus, Physiological basis of Peptic Ulcer, Jaundice, GIT disorder
  • Thyroid dysfunctions, Vitamins deficiency.

Theory Paper having Maximum: 80 Marks. (Two Sections)
Type of question	Number of Questions	Marks for Each Question
Section – I: 40 Marks
Long Essay Type	(Any One out of Two) Blood Nerve muscle Physiology Nervous system Special senses	10x1=10
Short Essay Type	(Any Three out of Four) Blood Nerve muscle Physiology Nervous system Special senses Renal System Physiology of Exercise	5x3=15
Short Answer Type	(Any Five out of Six) General Physiology Blood Nerve muscle Physiology Nervous system Physiology of Exercise	3x5=15
Section – II: 40 Marks
Long Essay Type	(Any One out of Two) Cardiovascular System Respiratory system Reproductive system Endocrine System	10x1=10
Short Essay Type	(Any Three out of Four) Cardiovascular System Respiratory system Reproductive system Endocrine System. Digestive System. Physiology of Exercise.	5x3=15
Short Answer Type	(Any Five out of Six) General Physiology Cardiovascular System Respiratory system Reproductive system Physiology of Exercise. Endocrine System	3x5=15

PRACTICAL [60 HOURS]

• Hematology-[demonstration only] [10 hours]: RBC Count, WBC Count, Differential WBC Count, Bleeding & Clotting Time, Hb Estimation, ABO & Rh Blood Group, PCV, ESR, platelet count.
• Graphs [8 hours]: i] Skeletal muscle-properties ii] ECG: definition, different types of leads, waves
• Physical fitness [8 hours]: Breathe holding time ii] mercury column test (40 mm Hg test) iii] Cardiac efficiency test-Harward’s step test, Master’s step test, treadmill test, six minute walk test.
• Blood pressure– palpatory and auscultatory method [6 hours]: Variation of blood pressure in posture and exercises.
• Stethography [2 hours]: Auscultation of breath sound & heart sound;-(Normal , Abnormal)
• Spirometry [2 hours]: Recording of Lung volumes & capacities.
• Mosso‘s finger ergography [2 hours]
• Clinical examination [22 hours]: Respi/cvs/nervous system including higher functions, reflexes, motor & sensory System.

Practical Exam Format
Practical- 80 Marks; Internal Assessment – 20 Marks; Total – 100 Marks

• Spots-based on 1 to 8 mentioned in practical syllabus [3×5=15 marks]
• Viva- based on 1 to 8 mentioned in practical syllabus [20 marks]
• Clinical Physiology based on CVS, Respiratory system, Nervous system, Abdomen [4×10= 40 marks]
• Journal [05 marks]

Recommended text books:

• Text book of medical physiology – Guyton Arthur
• Concise medical physiology – Chaudhuri Sujit K.
• Human Physiology – Chatterjee C.C.
• Text book of practical Physiology – Ranade.
• Text of Physiology – A. K. Jain.
• Basics of Medical physiology- Venkatesh D & Sudhakar H H
• Manipal Manual of Physiology – Prof. C N Chandrashekar
• Exercise Physiology – McArdle, Katch & Katch

Reference:

• Review of Medical Physiology – Ganong William F.
• Physiological basis of Medical practice – Best & Taylor