Clinicl physiology course

Clinical Physiology (243- هيل)Course Objectives
1. Nerve and Muscle
    The student should be able to comprehend the properties of excitable cell membrane:
 

1. Positive and active forces determining the movements of ions across the cell membrane concentration and voltage gradients;  permeability; ionic channels; conductance and gates; Na+ - K+ pump
2. Generation and propagation of the action potential: myelination; salutatory Conduction
3. Clinical correlates of excitable tissues in the light of the understanding of physiology

2. Neuromuscular Transmission and Muscle Contraction.
The student should be able to:
 

1.  Give reasonable comprehension of the mechanism of excitation-concentration coupling with reference to neurotransmitters, receptors, Ca++ and esterase
2. Comprehend muscle contraction on the basis of molecular structures
3.  Explain biophysics in terms of length-tension and force velocity-relationship

 
3.  NEURON
 The student should be able to:
 

• Identify and describe structural components of neurons and ascribe functions.
• Identify and describe in equal or unequal distribution of ions across the cell membrane creating concentration and electrical gradients.
• Define permeability and list factors influencing permeability.
• Identify and describe diffusional and equilibrium potential and explain the negativity of inside of the cell.
• Using single ion, apply Nernst equation to calculate equilibrium potential.
• Classify neurons by using letters or numbers on basis of diameters and velocity.
• Acquire themselves with nerve growth factors and its clinical uses.

 
4.  RESTING MEMBRANE POTENTIAL (RMP)
 The student should be able to:
 

• Identify describe genesis of resting membrane potential (RMP) and the roles of ions channels, Na+ - K+ pump and Gribbs- Donnan effect.
• Apply Goldman field equation in calculating resting membrane potential.
• Appreciate the effect of changes in ionic composition and/or permeability on resting membrane potential.
• Appreciate the principles involved in voltage-clamp technique.

 
 
5. ACTION POTENTIALS
 The student should be able to:
 

• Define and draw potentials giving membrane potential in mV and time course in msec and label all components such as latency, threshold (firing level), spike overshoot, after depolarization and after hyperpolarization.
• Account the above changes in excitability in terms of conductance changes of Na+ (gNa) and K+ (gK+).
• Correlate the conductance changes with opening (activation) or closing (inactivation) of relevant gates.
• Distinguish between a local potential and an action potential.

 
6. Properties of nerve fibers:
 The student should be able to.
 

• Describe the highest excitability of nerve cell compared to all other excitable cells in terms of rapid change over of selected ions across the membrane.
• Construct a strength-duration relationship.
• Define chronaxae and rheobase and appreciate its usefulness.
• Define absolute and relative refractory period and give their ionic basis.
• Define all and none law accommodation.
• Describe differences in the propagation of action potential in myelinated and unmyelinated nerve fibers.
• Appreciate effects of local anesthetic, cooling, hypoxia, acidosis and alkalosis on nerve conduction.
• Differentiate monophasic, biphasic and compound action potential.

 
7. Neuromuscular transmission:
 The student should be able to.
 

• Draw and describe the ultramicroscopic structures of a neuromuscular junction.
• Describe the pre junction and post-junction event in sequence in the neuromuscular transmission and appreciate special roles of transmitter, receptor, esterase and calcium.
• List neuromuscular blocking agents and state site and action.
• Identify the pathogenesis of myasthenia gravis and appreciate the rationality.

 
8.  Molecular basis of muscle contraction:
The student should be able to:
 

• Describe steps in sequence in excitation–contraction coupling b) describes sliding filaments theory of muscle contraction.
• Describe molecular structures of muscle proteins and their arrangements at resting phase, contraction and relaxation phase.
• Explain the rigidity of rigor mortis.

 
 
 
 
 
9. Physiology of muscle:
The student should be able to:
 

• Classify muscles on histological and functional basis.
• Describe microscopic and ultramicroscopic structures.
• Describe the biophysics of muscle properties in terms of length-tension and force velocity relationship, application of size principle, isometric and isotonic contraction. Response to exercise and oxygen debt d) appreciate bioenergetics and muscle fatigue.
• Define motor unit and physiological and clinical implications of motor potential (MUP) in relation to electromyography (EMG)
• Appreciate clinical correlates such as muscle dystrophy, significance of H-reflex, etc.

 
10.  Smooth and cardiac muscles:
The student should be able to make comparison of the properties of skeletal, cardiac and smooth muscles.
 
 
 
Autonomic Nervous System
GENERAL OBJECTIVES
Upon completion of the course, the student should:
1-   Appreciate the main differences between the somatic and autonomic nervous system.
2-   Understand the general organization of the sympathetic and parasympathetic systems.
3-   Understand the functional roles of the sympathetic and parasympathetic systems in control of visceral function.
4-   Appreciate that autonomic function is regulated by the hypothalamus and limbic system, as well as portions of the cerebral cortex.
5-   Understand the mode of chemical transmission, receptor actions and consequences of blocking or enhancing these receptor actions.
6-   Have some applied physiology background in the form of autonomic function tests, the effects of normal aging and a few selected examples of diseases.