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LECTURE OBJECTIVES
MEDICAL PHYSIOLOGY 2005
1.
Explain the concept of
a stable internal environment and explain its importance.
2.
Define homeostasis,
and be able to give several examples of homeostatic variables and how they are
controlled.
3.
Distinguish between
negative and positive feedback systems, being able to list the component parts
of, and to give several examples of each.
4.
Distinguish between
the conditions of equilibrium and steady state.
5.
Describe the various
forms of intercellular communication.
Lectures 2-6: Cell
Physiology by Chris Clausen, PhD
Objectives:
Lecture
2: Regulation of Cell Volume:
This lecture will begin our consideration of cellular physiology.
Following completion of this topic, students should be able to:
1.
Describe the diffusional nature of osmosis.
2.
Know how to calculate the osmolarity of a solution.
3.
Explain the role and properties of the aquaporins
4.
Recall the factors that govern fluid movement across a membrane and the
physical basis of each (i.e., osmotic plus hydrostatic pressure and membrane
hydraulic conductivity).
5.
Explain the relationship of membrane resting voltage and cell volume.
6.
Calculate changes in steady-state cell volume when the extracellular
concentration of permeant or impermeant solutes is changed.
1.
Report/Recognize the
physical basis of membrane capacitance and its effect on trans-membrane voltage.
2.
Describe conductance
and the physical basis of membrane conductance.t
3.
Recognize the factors
that govern passive ion fluxes across a membrane
and the physical basis of each factor including: physical voltage, chemical
potential, and membrane conductance.
4.
Define what is meant
by selectivity of a channel and know the factors that can affect gating.
5.
Explain the
relationship between single channel conductance and whole cell conductance.
1.
Recognize how the Na+/
K+ pump sets the ion gradients but the conductance for Na+
and K+ sets the resting voltage.
2.
Calculate equilibrium
potentials and understand the difference between an equilibrium potential and
the actual membrane potential.
3.
Calculate the actual
membrane potential given concentration gradients and conductances for several
permeant ions.
4.
Define the role and
structure of gap junctions.
5.
Explain how epithelia
are polarized.
1. Describe the
various nerve and muscle action potentials and know the respective physiological
roles of each..
2. Describe the roles
of Na+ channels and K+ channels in the generation of the
action potential.
3. Describe the steady
state and time dependent properties of Na+ channel and K+
channel gating.
4. Define the
definition of threshold and the factors that can change it.
5. Describe the
refractory periods and their causes.
6. Describe
accommodation and voltage dependent inactivation.
7. Describe how
changes in serum calcium affect the nerve action potential.
8.
Discuss the relative kinetics of Na+, Ca2+, and K+
channel gating.
1.
Define the definition of a length constant and its relationship to
propagation velocity.
2.
Describe how an action potential propagates and the effect of capacitance
on propagation.
3.
Describe the process of myElination, its effect on action potential
propagation and the mechanisms responsible for its effect.
4.
Describe saltatory conduction, the Node of Ranvier and associated
currents.
Lectures 7-9:
Muscle by Chris Clausen, PhD
1.
Describe the structure of a typical synapse and the characteristics of
electrical and chemical synapses
2.
Describe the structure and function of the neuromuscular junction (NMJ)..
3.
Name all the steps in transmission at the NMJ.
4.
Recognize the basis of the MEPP and EPP and their relation to quantal
release of ACh at the NMJ
1.
Describe the structure of a skeletal muscle from a contractile standpoint
2.
Describe the sliding filament theory of muscle contraction.
3.
Contrast the structure and contraction of skeletal, cardiac, and smooth
muscle.
4.
Recognize the length-tension curve, its relation to the sliding filament
theory and its functional implications for skeletal, cardiac, and smooth muscle.
5.
Describe the mechanisms of phosphorylating ADP to ATP and their relative
importance in different types of muscle cells.
Lecture
9: Excitation-Contraction Coupling:
Following completion of this topic, students should be able to:
1.
Describe initiation and propagation of skeletal muscle action potentials.
2.
List the various membrane systems in a skeletal muscle fiber and the role
of each in excitation-contraction coupling.
3.
Contrast the roles of the action potentials in skeletal, cardiac, and
smooth muscle
4.
Contrast the mechanisms of regulating force production in skeletal,
cardiac, and smooth muscle.
5. Describe the effects of weight lifting vs. endurance exercise on skeletal muscle fiber types.
Lecture 10: Muscle
Energetics by Margaret McNurlan, PhD
1.
Understand substrate
utilization in skeletal muscle during rest and activity.
2.
Understand the
consequences of fitness training.
3.
Describe the various
methods and consequences of performance enhancement.
Lecture 11:
Trans-epithelial Transport by Chris Clausen, PhD
1. Identify the
location and different functions of various epithelia including planar and
tubular epithelia.
2. Describe the
cellular structure of epithelial cells with particular emphasis on membrane
specialization including the structure and function of intercellular junctions
such as tight junctions, desmosomes, and gap junctions.
3. Differentiate/Classify
the determinants of paracellular versus transcellular transport across
epithelia.
4. Describe the source
and function of trans-epithelial
electrical potentials.
5. Describe the
mechanism of active NaCl absorption (i.e., the pump-leak hypothesis) and its
regulation via such agents as aldosterone.
6. Describe the
mechanism of Na+ coupled nonelectrolyte absorption and electrogenic
Cl- secretion.
7. Illustrate the
above concepts by describing the mechanisms that underlie such processes as
gastric acid secretion and active water transport.
Lectures 12: The
Autonomic Nervous System by Roger Cameron, PhD
1.
Understand how the autonomic nervous system in combination with the
visceral afferent system participates in maintaining homeostasis of the organ
systems.
2.
Describe the general organization of the sympathetic, parasympathetic,
and enteric nervous systems.
3.
Describe the general organization of the visceral afferent system.
4.
List the neurotransmitters and receptor types found within autonomic
ganglia and target tissues for the sympathetic and parasympathetic systems.
5.
Understand the mechanism of cholinergic transmission including the sites
and actions of pharmacological agents that affect cholinergic function.
6.
Understand the mechanism of adrenergic transmission including the sites
and actions of pharmacological agents that affect adrenergic function.
7.
Develop an overall understanding of the distribution and actions of the
different receptor types in the various tissues and organs of the body.
1.
Explain how cardiac action
potentials differ from those in nerve.
2. Recognize that
cardiac action potentials from different regions of the heart are heterogenous.
3. Identify the
determinants of maximum diastolic potential.
4. List the phases of
the Purkinje fiber action potential and their ionic determinants.
5. Understand the
mechanism of contraction of cardiac muscle.
Lecture
14: Electrophysiology of the Heart II.
Continuing the topic of the
electrical activity of the heart, students should be able to:
1. Identify the
determinants of pacemaker activity (phase 4) in terms of the role of funny
current if and differences within the conduction system.
2. Distinguish action
potentials in regions of the heart other than the Purkinje System, specifically
the SA and AV nodes, atrium, and ventricle.
3. Define
refractioness in the heart.
4. Describe conduction
in the heart.
5. Describe the
actions of the autonomic transmitters.
1. Discuss the
relationships between extracellular and intracellular recording.
2. Describe the
methods and results of recording the basic EKG beginning with recording from a
muscle strip in a bath, followed by recording from the body surface.
3. Describe the
sequence of normal ventricular activation.
4. Describe the output
of Lead I of the normal EKG.
5. Read EKG’s in
terms of the events of the normal EKG and a brief look at some abnormal EKG’s.
Lectures 16-20: The Heart as a Pump by
Roger Cameron, PhD
1. Describe the
structure of the sarcomere in cardiac muscle.
2. Explain the
measurement of isotonic contraction and the effect of sarcomere length.
3. Explain the
measurement of the velocity of contraction and the relation between force and
velocity.
4. Identify the
relation between preload and the force-velocity relationship.
5. Explain the work
done in muscle contraction.
6. Recognize the
effects of catecholamines on the sarcomere and on contractility.
7. Discuss the
Starling heart-lung preparation and the measurement of cardiac output as a
function of initial filling. The Starling curve.
8. Identify the effect
of catecholamines on cardiac output.
1. Relate the ECG to
changes in the pressures and volumes of the chambers of the heart, the opening
and closing of the valves, and the rate of blood flow into the aorta.
2. Determine cardiac
output in man.
3. Determine the work
done by the heart.
4. Determine energy
utilization by the heart and the efficiency of the heart.
5. Explain how cardiac
output changes in exercise.
1. Identify the
effects of sympathetic and parasympathetic stimulation on the performance of the
heart.
2. Describe the
baroreceptor reflex, the Bainbridge reflex, atrial naturitic peptide,
respiratory sinus arrhythmia, the chemoreceptor reflex, ventricular receptor
reflexes, and rate-induced regulation.
3. Explain the effects
on the heart of: adrenomedullary hormones,
adrenocortical hormones, thyroid hormone, insulin, glucagon, anterior
pituitary hormones, and blood gases.
1. Explain how
the vascular function curve is determined.
2. Explain how
cardiac output depends on the intersection of the Starling curve and the
vascular function curve.
3. Explain how
changes in blood volume alter cardiac output.
4. Predict
changes in the two curves with moderate and severe heart failure.
1. Classify
cardiac valvular disorders.
2. Distinguish
between systolic and diastolic murmurs and relate these to specific types of
cardiac valve problems.
3. Explain
patient symptoms and findings of the physical exam for patients with aortic
stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation.
4. Suggest
treatment options for patients with cardiac valvular disorders.
1. Identify the
distribution of total body water between plasma, interstitial fluid, and
intracellular fluid.
2. Describe the ionic
composition of the body fluid compartments.
3. Estimate the size
of the body fluid compartments using indicator dilution methods.
4. Describe the
general organization of the circulatory system.
5. Describe the
distribution of cardiac output versus O2 consumption for different
organs.
6. Describe important
control mechanisms in the blood supply to the heart, skeletal muscle, the brain,
the skin, the lungs, the intestines, and liver.
1. Apply general
hydraulic principles to understand the determinants of blood flow.
2. Distinguish between
laminar flow, turbulent flow, and flow through capillaries.
3. Describe how human
blood pressure is measured and compute mean arterial pressure.
4. Identify pulsatile
flow in arteries and describe transmission of the pressure wave and how this
varies with vessel compliance.
5. List the
determinants of vascular resistance (Poiseuille’s Law) and understand the
factors that affect vessel radius and blood viscosity.
6. Explain how
autoregulation affects pressure-flow curves for intact vascular beds.
7. List the
determinants of arterial pressure and understand how altered cardiac output and
peripheral resistance affect arterial pressure.
8. Explain why small
changes in venous pressure have large effects on venous blood volume and how
this relationship is altered by gravity and other factors.
1.
Identify the main features of VSM cells including their principal ion
channels and contraction mechanisms.
2.
Describe electromechanical and pharmacomechanical coupling mechanisms as
well as VSM relaxation mechanisms.
3.
Describe local control mechanisms involving autoregulation and the
myogenic response, key autocoids and nitric oxide, and metabolic vasodilation.
4.
Describe extrinsic control involving sympathetic vasoconstriction,
vasodilator nerves, and vasoactive hormones.
1. Describe the
structural features of capillary walls.
2. Restate Fick’s
Law, diffusion and hydraulic flow.
3. Describe solute
permeabilities and restricted diffusion.
4. Recall Starling’s
Principle of capillary fluid exchange.
5. List factors
contributing to capillary pressure colloid osmotic pressure, interstitial
pressure and filtration rates.
6. Describe lymph flow
and function.
7. Recognize the
various causes of edema.
Lectures 25-32:
Pulmonary Physiology by Irene Solomon, PhD and Norman Edelman, MD
1. Recognize the
meaning of symbols and terminology used in respiratory physiology.
2. Describe the
exchange of oxygen and carbon dioxide with the atmosphere and relate gas
exchange to the metabolism of the tissues of the body.
3. List the
non-respiratory functions of the lungs.
4. Describe the
alveolar-capillary unit, the site of gas exchange in the lungs.
5. Describe the
structural characteristics of the airways.
6. List the components
of the chest wall and relate the functions of the muscles of respiration to the
movement of air into and out of the alveoli.
1. Describe the
actions of the respiratory muscles and the resultant motions of the rib cage and
abdomen during breathing.
2. Appreciate the
relationship between intrapleural and alveolar pressure, airflow, and lung
volume changes.
3. Identify the
factors determining elastic recoil properties of the lungs and the meaning of
lung compliance.
4. Describe the role
of alveolar surface forces in generating lung recoil, and the function of
surfactant.
5. Explain how lung
compliance is measured in humans.
6. Identify the
elastic recoil properties of the chest wall.
7. Define what is
meant by airway resistance and tissue resistance.
8. Describe the
various factors that influence airway resistance.
9.
Distinguish the two components of intrapleural pressure: elastic recoil
pressure and resistive pressure.
1. Identify which
measurements can be made with a spirometer, and which require indirect
measurements.
2. Define the
different subdivisions of lung volumes.
3. Describe the
difference between obstructive and restrictive pulmonary disorders.
4. Describe the
effects of alterations in lung and chest wall mechanics, due to normal or
pathological processes, on the lung volumes.
5. Interpret
information obtained from tests of forced expiration.
6. Describe the
effects of obstructive and restrictive pulmonary disorders on flow-volume curves.
Lectures
28:Alveolar Ventilation and Pulmonary Circulation.
Following completion of these topics, students should be able to:
1. Define alveolar
ventilation.
2. Describe the
relationship between anatomic dead space, tidal volume, and alveolar
ventilation.
3. Calculate minute
and alveolar ventilation.
4. Memorize the normal
values of O2 and CO2 in the lungs and blood, and the
effects of breathing O2.
5. Define the concepts
of hyper- and hypoventilation and the accompanying changes in alveolar and blood
gases.
6. Recognize the
causes of uneven distribution of alveolar ventilation in normal and diseased
lungs.
7. Compare and
contrast the bronchial circulation and the pulmonary circulation.
8. Describe the
differences between the pulmonary and systemic circulations.
9. Describe forces
(pressures) in the lungs and thorax that surround and influence blood flow
resistance in capillaries, veins, and arteries.
10. List the factors
that can actively influence pulmonary vascular smooth muscle.
11. Explain the cause
of uneven distribution of blood flow in upright lungs.
12. Identify the
factors that determine fluid movement across capillary and alveolar membranes,
and the influence of surfactant.
Lecture
29: Pulmonary Diffusion/Blood Gas Transport.
Following completion of these topics, students should be able to:
1. Recall the
fundamental law of diffusion, and the factors in the lungs that influence or
determine each of its components.
2.
Describe the dynamics of CO2 and O2 movement across
the alveolar-capillary membranes that lead to diffusional equilibrium
3. Explain how CO2
and O2 are reversibly bound and stored in blood, and have facility
with a graphic description of this process (i.e., the CO2 and O2
dissociation curves for whole blood).
4. Describe the
relationship between gas pressure and content and explain its molecular basis.
5. Identify factors
influencing the above relationship, and describe qualitatively the direction of
dissociation curve shifts, and explain the effects on the delivery of O2
to the tissues.
6. Calculate the O2
uptake and the CO2 production by tissues and the respiratory
quotient.
1. Recognize the
importance of arterial blood gas measurements.
2. Describe regional
gas exchange in normal lungs.
3. Recall the
potential causes of arterial hypoxemia.
4. Describe the
mechanisms by which hypoventilation, diffusion impairment, shunting and
ventilation/perfusion inequality produce arterial hypoxemia.
5. Explain how
ventilation/perfusion inequality can lead to arterial hypoxemia and only minor
changes in arterial CO2.
6. Describe how
intrapulmonary shunting and ventilation/perfusion inequality cause arterial PO2 to
be lower than alveolar PO2.
7. Identify intrinsic
mechanisms that match ventilation and perfusion.
1. Describe the
general organization of the respiratory control system.
2. Outline the central
neural structures responsible for generation of spontaneous rhythmic breathing.
3. List other central
neural structures that can influence spontaneous breathing and their function.
4. Describe the
cardiopulmonary and other reflexes that influence the breathing pattern.
5. Explain how the
respiratory control system maintains normal arterial blood gas composition.
6. Describe the
location, function, and special features of the respiratory chemoreceptors.
7. Describe the
responses of the respiratory system to acute exercise.
8. Describe the
responses of the respiratory system during sleep.
.
1. Restate the
four basic elements of renal function, including: glomerular filtration, tubular
reabsorption, tubular secretion, and endocrine function.
2. Recall the
distribution of hydrostatic and oncotic pressures in the renal vasculature.
3. Recognize the
structural features of the glomerular capillary wall and the permselective
characteristics of the glomerular capillary wall.
4. Describe the
determinants of glomerular filtration rate (GFR), including glomerular capillary
hydrostatic and oncotic pressures, intratubular pressure, and the
ultrafiltration coefficient and be able to calculate
GFR given values for the determinants of GFR.
5. Define the
concept of filtration fraction and how it is calculated and how changes in the
filtration fraction influence the net reabsorptive pressure in the peritubular
capillaries.
6. Describe the
effects of changes in pre- and postglomerular resistances on renal blood flow (RBF)
and GFR.
7. Restate RBF
autoregulation and tubuloglomerular feedback mechanisms.
8. Identify the
effects of the sympathetic nervous system and vasoactive humoral factors on GFR
and RBF.
9. Describe how
contraction of mesangial cells or podocytes can alter the ultrafiltration
coefficient.
10. Recognize the fundamental
aspects of epithelial cell structure and function and describe the different
membranes in epithelial cells, including basolateral and apical membranes, and
tight junctions.
11. Define the following:
osmosis, primary and secondary active transport, passive transport, and
secretory mechanisms.
Lecture 34:
Mechanisms of Solute and Water Transport in the Nephron.
Following the completion of this topic, students should be able to:
1. Identify the
mechanisms responsible for proximal tubular reabsorption and secretion of Na+,
Cl- water, other ions, and organic solutes.
2. Describe how
proximal reabsorption is regulated by angiotensin II and “physical forces”.
3. Recallosmotic
equilibration of the descending limb tubular fluid with the medullary
interstitium.
4. Recognize the
cellular mechanism of tubular fluid dilution in the ascending limb and the
central importance of the Na,K,2Cl-cotransporter in this process.
5. Restate that sodium
and chloride reabsorption in the early distal tubule involves a
Na,Cl-cotransporter in the apical membrane.
6. Identify the
mechanisms whereby sodium reabsorption is regulated by aldosterone and atrial
natriuretic factor in the distal tubule and collecting ducts.
7. Explain how
potassium secretion in the distal tubule and collecting duct is regulated by
aldosterone.
8. Recall that ADH
regulates water reabsorption in the distal tubule and collecting duct by
altering the density of water channels (“aquaporins”) in the apical
membrane.
1. Define
filtered load, excretion rate, and renal clearance.
2. Calculate GFR
values using inulin clearance.
3. Calculate
renal plasma flow and RBF using PAH clearance and hematocrit.
4. Characterize
tubular transport using solute clearance.
5. Define the
basis for the clinical use of plasma creatinine and urea levels to assess renal
function.
6. Construct and
analyze renal solute excretion curves, and know how they can be used to study
carrier-mediated tubular transport.
1. Differentiate
obligatory water excretion vs. ADH-dependent water excretion.
2. Restate that
the generation of concentrated urine occurs via active countercurrent
multiplication.
3. Identify the
mechanism of passive equilibration of the tubular fluid in the descending limb.
4. Describe the
process of active dilution of tubular fluid in the ascending limb and the
concurrent deposition of NaCl into the medullary interstitium.
5. Explain ADH-dependent
dissipation of distal tubular fluid hypotonicity in the cortex.
6. Understand ADH-dependent
osmotic withdrawal of water in the CD.
7. Describe urea
recycling in the medulla.
8. Explain how
hypotonic urine is generated and excreted.
9. Describe
passive countercurrent exchange in the vasa recta.
10. Describe typical body water and solute balance.
11. Explain the cellular actions of ADH in the renal tubule.
12. Describe how water balance is regulated by ADH secretion and
thirst.
1. Recognize the
effect of dietary sodium intake on extracellular renal sodium excretion.
2. Describe the
components of the RAS and factors that control renin secretion, including: renal
baroreceptors, the sympathetic nervous system, and the macula densa.
3. Describe/Identify
the actions of angiotensin II (and III), including: inhibition of renin
secretion, stimulation of aldosterone and ADH secretion, and peripheral and
renal vasoconstriction.
4. Describe the
actions of aldosterone in the distal tubule and collecting ducts to increase
luminal membrane Na+ and K+ permeabilities and sodium-pump
activity.
5. Recognize the
effects of aldosterone on renal sodium and potassium excretion.
6. Recall that atrial
distension stimulates ANP secretion.
7. Describe the
actions of ANP, including: peripheral and renal vasodilation, plasma
extravasation, inhibition of collecting duct Na+ transport and
enhancement of renal sodium excretion.
8. Describe the
integrated actions of the ADH, ANP and RAS in response to expansion/contraction
of extracellular fluid volume.
1. Describe the
distribution of potassium in the body, and understand the factors that influence
plasma potassium, including: dietary intake, cell lysis, and plasma pH.
2. Appreciate how
excess plasma potassium is buffered by cellular potassium uptake.
3. Recall that plasma
potassium concentration is regulated by the kidney and that most of the filtered
potassium is reabsorbed in the proximal tubule and Henle’s loop.
4. Recall that active
reabsorption in the distal tubule and CD can reduce potassium excretion to low
levels in states of potassium depletion.
5. Identify the
mechanism of secretion of potassium in the distal tubule and CD and that passive
potassium secretion occurs across the luminal membrane.
6a. Recognzize how potassium secretion and excretion are regulated
by aldosterone and explain the interactions between renal sodium and potassium
excretion.
6b. Explain how potassium secretion can be influenced by tubular
fluid flow rate and ADH.
7. Describe the
production of fixed and volatile acids in the body and know the major body
buffer systems.
8. Describe the
bicarbonate-CO2 buffer system and appreciate the importance of
respiratory regulation of CO2 and responses to changes in blood pH.
9. Describe and use
the Henderson-Hasselbalch equation to analyze buffering of fixed acids and bases
and the impact of changes in blood CO2, hydrogen ion, and bicarbonate
levels;
10. Describe buffering
by phosphate, protein, bone, and other buffer systems.
11. Explain how the kidney
responds to basic acid-base disorders by altering H+ and/or HCO3-
excretion.
12. Identify the renal
response to metabolic acidosis and alkalosis.
13. Explain the role of
respiratory compensation for metabolic acidosis/alkalosis.
14. Restate that the kidneys provide compensation for respiratory
acidosis and alkalosis.
15. Identify basic cellular mechanisms of tubular proton secretion
and the generation of new bicarbonate.
16. Describe the major tubular fluid buffers: filtered
bicarbonate, titratable buffers, ammonia.
17. Calculate net renal acid excretion.
Lecture 39:
Nephrology and Hypertension.
Following completion of this topic, students should be able to:
1. Understand renal
regulation of effective circulating volume: Congestive heart failure and portal
hypertension.
2. Recognize the
relationships between renal sodium excretion, arterial blood pressure, and
“escape” from hyperaldosteronism.
3.
Define renal resetting of arterial blood pressure: Renal-vascular
hypertension.
Reading
Assignment: The primer
entitled “Fundamentals of Gastrointestinal Physiology" by Peter Brink.
Objectives:
Lecture
40: An Overview of Gastrointestinal Function: Motility, Secretion, and
Absorption: Following completion of
this topic, students should be able to:
1. Describe the
digestive tract and the accessory glands in terms of their interactions with
regard to motility, digestion and absorption.
2. Identify the
cellular basis of motility and the factors that modulate and regulate those
cells.
3. Explain how smooth
muscle cells cause the movement of luminal contents within the digestive tract
and which factors alter cellular contractility.
4. Describe the role
of sensory input from extrinsic and intrinsic sources in reflex action and how
these affect motility within the gut.
Lecture
41:Secretions of the Stomach, Small ,and Large Intestines:
Following completion of this topic, students should be able to:
1. Identify the
general cellular mechanism involve with secretion of material into the lumen of
the GI Tract.
2. List the cellular
components responsible for acid secretion within the stomach.
3. Describe the
mechanism of acid secretion within the stomach, including an understanding of
how these secretions can be modified by intrinsic and extrinsic regulation.
4. List the cellular
components responsible for fluid secretion within the small and large
intestines.
5. Describe the mechanism of fluid
secretion within the small and large intestines, including an
understanding of how these secretions can be modified by intrinsic and extrinsic
regulation.
1. Describe the
general cellular mechanisms involved with secretion by the pancreas.
2. Describe the
general cellular mechanisms involved with secretion by the salivary glands
3. Describe the
general cellular mechanisms involved with secretion by the liver and
gallbladder.
4. Explain how the
various accessory gland secretions function in the digestion of food stuffs and
how they are related to secretions of the GI tract.
5. Describe hormonal
and autonomic regulation of accessory gland function.
1. Describe the
cellular mechanisms involves with the absorption of various electrolytes and
water.
2. Describe the
general cellular mechanisms involved with the absorption and transport of sugars
and proteins in both the small and large intestines.
3. Describe the
mechanism of fat absorption, including an understanding of transport processes
intracellularly, intercellularly and vascularly.
4. Explain how lipids
are delivered to tissues, including being able to describe the role of LDLs,
HDLs, and similar lipoproteins.
1.
Describe the sequence of events associated with food intake in terms of
reflex behaviors.
2.
Describe volume and pH changes within the various chambers (e.g.,
stomach, small and large intestines).
1. Identify and
discuss the cellular and molecular basis of cases presented involving specific
examples of motility, secretion and absorption malfunctions.
2. Distinguish among
the different forms and causes of diarrhea.
3. Recognize the
underlying causes and effects involved with cases presented involving specific
examples of noninfectious inflammation.
Lectures 46-52:
Endocrine System Physiology by M. Raafat El-Maghrabi, PhD
1. Define hormone
classification, transport, metabolism, and action.
2. Compare the
structure, biosynthesis, and secretory mechanisms of the different hormones.
3. List the various
mechanisms of action of different hormones, and an understanding of the
differences among hormone receptors.
4. Identify the
various clinical and laboratory assays used to assess hormone function.
1. Describe the
relation between neural and endocrine physiology as it pertains to the
hypothalamus and pituitary.
2. List the various
classes of hormones (peptides, proteins, amines and steroids) along with details
of their synthesis, release, transport and mechanisms of action.
3. Identify methods of
hormone measurement and kinetic evaluation of hormone action.
4. Define
neuron-neuron interactions, hypophysiotropic hormones, and the concepts of feed
back and feed forward loops.
5. Describe the
embryological development and anatomy of the pituitary (anterior and posterior),
hypothalamus, median eminence, and hypothalamus-pituitary portal systems.
6. List the
characteristics and actions of the hypophysial hormones: thyrotropin releasing
hormone (TRH); gonadotropic releasing hormone (GRH); somatostatin; corticotropin
releasing hormone (CRH); growth hormone releasing hormone (GHRH); prolactin
inhibiting factor (PIF) and releasing factor (PRF).
1.
Identify the hormones released in the pituitary gland.
2.
Describe the synthesis, transport, release, mechanism of action, and
effects of these various hormones:
·
Antidiuretic hormone.
·
Oxytocin.
·
ACTH.
·
Growth hormone.
·
Prolactin.
·
TSH.
·
Gonadotropins LH and
FSH
1. Describe the
gross anatomy and microstructural organization of the thyroid gland.
2. Describe
thyroid hormone chemistry, synthesis, interconversions, transport, cellular
binding, and mechanisms of action.
3. Explain how
circulating levels of thyroid hormones are regulated.
4. Evaluate
thyroid function in health and disease and physiological variables affecting
pituitary-thyroid function.
5. Describe the
effects of various drugs on thyroid function.
6. Recognize the role
of thyroid hormones and the hypothalamus in thermoregulation, with particular
attention to their relation to skin.
1. Describe the
embryology and anatomy of the adrenal cortex and some history of the discovery
of “cortisone”.
2. Describe the
processes of steroid hormone biosynthesis in the three zones of the adrenal
cortex along with the regulation of synthesis, storage, release, and transport
of adrenal steroids.
3. Identify the
molecular mechanisms and physiological actions of each class of steroid hormone
(mineralocorticoids glucocorticoids, and sex hormones).
4. Define
structure-activity relationships of the glucocorticoids and mineralocorticoids
as a basis for their biological activity and rationale for drug development.
5. Describe laboratory
evaluation techniques of adrenocortical function.
6. Recall the
biochemistry of the catecholamines, physiology of adrenergic axon terminals and
chromaffin cells, biological effect of catecholamines, and the biological roles
of epinephrine and norepinephrine as hormones and neurotransmitters.
1. Develop a working
knowledge of pathways of carbohydrate metabolism (glycolysis, glycogenesis,
glycogenolysis, gluconeogenesis); extracellular fat metabolism (lipoprotein
structure, biosynthesis and fates); and protein metabolism.
2. Develop clear
concepts of glucose homeostasis during absorptive and post-absorptive phases,
and storage and mobilization of alternative fuels.
1. Define islet cell
metabolism as it relates to control of insulin secretion and insulin gene
transcription.
2. Describe insulin
receptor structure and genetics.
3. Recognize
intracellular events associated with insulin action.
4. Identify
tissue-specific sites of insulin action.
5. Describe the
structure, biosynthesis and action of somatostatin.
6. Identify the
neuronal control of pancreatic hormones.
7. Recognize the role
of growth hormone in metabolic regulation during starvation and the effects of
abnormal levels of growth hormone.
Objectives:
1. Identify the major
organ systems and hormones that participate in maintaining multivalent ion
homeostasis throughout the course of a person’s life.
2. Describe the
relative distribution of calcium within the body including:
the cellular mechanisms involved with calcium metabolism; the regulation
of and the clinical symptoms of altered plasma calcium; and the average daily
calcium turnover (including calcium absorption in the gut; renal handling of
calcium; and exchange with the skeleton).
3. Describe the
relative distribution of phosphate within the body including:
the phosphate content of body compartments; and the average daily
phosphate turnover (including phosphate absorption in the gut; renal handling of
phosphate; soft tissue exchange; and exchange with the skeleton).
4. Briefly describe
the magnesium pools of the body.
1. Formulate an
overall understanding of the histogenesis of the skeletal system being able to
explain the embryonic origin of the relevant cell types as well as the concepts
of ossification and modeling. This
information should culminate in an appreciation of the final microstructure and
ultrastructure of bone and the other relevant tissue types.
2. List and describe
the functional attributes of osteoblast secretory products and have an
appreciation of the temporal sequence of gene expression of these various
proteins.
3. Describe the
inorganic component of bone matrix in terms of its chemistry and solubility.
Specifically students should be able to account for the source of both
the rapidly and the slowly exchanged pools of calcium.
4. Describe the origin
and regulation of osteoclast formation culminating in the multinucleated cells
capable of bone resorption.
5. Describe the
mechanisms of osteoclastic bone resorption including an understanding of agents
that promote resorptive activity and feedback inhibition of the process.
6. Develop an overall
understanding of skeletal remodeling specifically in terms of its regulation and
role in multivalent ion homeostasis.
1. Describe the
biosynthetic pathway of vitamin D and its metabolites including an understanding
of the relevant enzymes and their regulation.
Specifically students should understand how changes in plasma
concentrations of calcium and/or phosphate affect these processes.
2. Develop a general
understanding of the various mechanisms (genomic vs. non-genomic) of vitamin D
receptor activation.
3. Identify and
restate the details of vitamin D receptor activation and the functional
consequences of target cell activation in bone and the GI system.
4. Describe the
biosynthetic pathway of PTH, with a specific understanding of how PTH regulation
by chief cells is regulated. Students
should be able to describe how changes in not only plasma calcium but also
plasma phosphate affect the secretion rate of PTH.
5. Describe the
details of PTH receptor activation and the functional consequences of target
cell activation in bone and the kidney in terms of plasma calcium and phosphate,
and PTH effects on vitamin D synthesis.
6. Develop a general
understanding of the role of calcitonin in multivalent ion homeostasis including
its synthesis and secretion, and the mechanisms and functional consequences of
target cell activation.
7. Describe the
integrated body response to hypocalcemia and hypophosphatemia.
Objectives:
Lecture
56: Physiology of the Testis.
After completion of this topic, students should be able to:
1. Describe the
general structures and functions of the male reproductive system including the
gonads (testes) and duct system.
2. Distinguish sexual
differentiation of the male and female reproductive systems.
Specifically, students should be able to identify the primitive cell
lines involved, and the factors that contribute to the establishment of genetic
sex, gonadal sex, and phenotypic sex for males and females.
3. List mechanisms of
temperature regulation of the testis.
4. Describe the
structure and functions of the blood-testis barrier.
5. Understand the
process of spermatogenesis and the role of Sertoli cells in the nutritional
support of the developing spermatocytes.
6. Describe the site
and mechanism of androgen synthesis and secretion.
7. Appreciate the role
of the duct system and associated exocrine glands, particularly in terms of
spermatozoa function.
1. Recall the biology
of the gonadotropic hormones LH and FSH including their structure and
mechanistic details pertaining to their synthesis, secretion, actions, and
metabolism.
2. List feedback
control mechanisms of gonadotropin secretion at the level of the hypothalamus,
pituitary, and testis.
3. Diagram the pathway
of androgen synthesis and secretion, noting similarities and differences between
males and females.
4. Identify the
mechanisms of androgen action, both in terms of intracellular mechanisms, and
the role of androgens in regulating spermatogenesis and other processes in the
male.
5. Appreciate the role
of adrenal androgens in the male.
6. Describe the role
of paracrine agents in regulating cell-cell interactions within the testis.
1. Recognize and
distinguish the various disorders of gonadal differentiation including
seminiferous tubule dysgenesis, Turner’s syndrome, complete and incomplete
forms of XX and XY gonadal dysgenesis, and true hermaphroditism.
2. Define female
pseudohermaphroditism and list and understand some common causes.
3. Define male
pseudohermaphroditism and list and understand some common causes.
4. List the various
steps that must occur normally for a male to be fertile.
5. Recognize and list
some common examples of pre-testicular causes of male infertility, including how
one would make the appropriate diagnosis.
6. Recognize and list
some common examples of testicular causes of male infertility, including how one
would make the appropriate diagnosis.
7. Recognize and list
some common examples of post-testicular causes of male infertility, including
how one would make the appropriate diagnosis.
Lectures
59-61: Female Reproductive
Physiology by Barbara Rosati, PhD
Reading
Assignment
All
the material necessary for understanding the topics presented in these lectures
and for the preparation of the final test will be reported in the handout
entitled “The Female Reproductive System” by Barbara Rosati.
Objectives:
Lecture
59: The Ovarian Cycle and Oogenesis: By the completion of
this topic, students should be able to:
-
Identify the hypothalamo-pituitary axis and its control of reproduction: hormones and feedback regulation.
-
Describe the process of formation and maturation of oocytes (oogenesis).
-
Recognize the role of ovarian and pituitary hormones in determining the different phases of the ovarian cycle.
-
Define the morphology and mechanisms underlying the histological changes in the endometrium during the so-called endometrial cycle.
-
Describe the biochemical and histological events that take place during menstruation.
-
Define the physiological and biochemical events that characterize puberty.
-
Describe and discuss the characteristics of menopause and its effects on various organs.
1.
Recognize the main
events underlying the fertilization of the oocyte and the blastocyst
implantation in the uterus.
2.
Define the structure
and function of the placenta.
3.
Recognize the function
of hormones during pregnancy.
4.
List the hormonal
factors and mechanics of parturition.
5.
Identify the main anatomical changes and hormonal mechanisms underlying
lactation