GMC Domains

• THE DOCTOR AS A SCHOLAR
  • TD 8: APPLICATION OF BIOMEDICAL SCIENTIFIC PRINCIPLES, METHOD AND KNOWLEDGE
    • Medical knowledge: ANATOMY (TD 8.1)
    • Medical knowledge: PHYSIOLOGY (TD 8.2)
    • Medical knowledge: BIOCHEMISTRY (inc. Metabolism) (TD 8.3)
    • Medical knowledge: CELL BIOLOGY (TD 8.4)
    • Medical knowledge: MOLECULAR BIOLOGY and GENETICS (TD 8.5, 8.6)
    • Medical knowledge: PATHOLOGY (TD 8.7)
    • Medical knowledge: CANCER
    • Medical knowledge: IMMUNOLOGY and INFLAMMATION (TD 8.8)
    • Medical knowledge: MICROBIOLOGY and INFECTION (TD 8.9)
    • Medical knowledge: PHARMACOLOGY (TD 8.10)
    • Medical knowledge: NUTRITION (TD 8.11)
    • Medical knowledge: CLINICAL FEATURES of DISEASE (TD 8 b)
  • TD 9: APPLICATION OF PSYCHOLOGICAL PRINCIPLES, METHOD AND KNOWLEDGE
    • Medical knowledge: PSYCHOLOGY (TD 9 a-g)
  • TD 10: APPLICATION OF SOCIAL SCIENCE PRINCIPLES, METHOD AND KNOWLEDGE
    • Medical knowledge: SOCIOLOGY (TD 10 a-e)
  • TD 11. PRINCIPLES, METHODS AND KNOWLEDGE OF POPULATION HEALTH
    • Medical knowledge: PUBLIC HEALTH and GLOBAL HEALTH (TD 11 a-j)
  • TD 12; APPLICATION OF SCIENTIFIC METHOD AND APPROACHES TO MEDICAL RESEARCH
    • Medical knowledge: EPIDEMIOLOGY
    • Medical Knowledge: SCIENTIFIC METHOD & RESEARCH
• THE DOCTOR AS A PRACTITIONER
  • TD 13: CARRY OUT A CONSULTATION WITH A PATIENT
    • Clinical skills: HISTORY (TD 13 a-b)
    • Clinical skills: PHYSICAL EXAMINATION (TD 13 c)
    • Clinical skills: MENTAL STATE EXAMINATION (TD 13 d)
  • TD 14: DIAGNOSE AND MANAGE CLINICAL PRESENTATIONS
    • Clinical skills: INTERPRETING FINDINGS AND INITIAL ASSESSMENT (TD 14 a-b)
    • Clinical skills: PLANNING AND INTERPRETING INVESTIGATIONS (TD 14 c-d)
    • Clinical skills: MAKING A DIAGNOSIS and CLINICAL JUDGEMENT (TD 14 e-f)
    • Clinical skills: FORMULATING A TREATMENT PLAN (TD 14 g)
    • Clinical skills: SURGERY and ANAESTHETICS (TD 14 g)
    • Clinical skills: SUPPORTING PATIENTS and IDENTIFYING ABUSE and NEGLECT (TD 14 h-i)
    • Clinical Skills: CARE OF PATIENTS AND RELATIVES AT END OF LIFE (TD 14 j)
  • TD 15: COMMUNICATE EFFECTIVELY WITH PATIENTS AND COLLEAGUES
    • Clinical skills: INTERACTION WITH PATIENTS (TD 15 a-b)
    • Clinical skills: MANAGING INFORMATION (TD 15 c)
  • TD 16: PROVIDE IMMEDIATE CARE IN MEDICAL EMERGENCIES
    • Emergency Management of Patients (TD 16 b-e)
  • TD 17: PRESCRIBE DRUGS SAFELY, EFFECTIVELY AND ECONOMICALLY
    • Clinical skills: PRESCRIBING DRUGS SAFELY AND EFFECTIVELY (TD 17 a-h)
  • TD 18: CARRY OUT PRACTICAL PROCEDURES SAFELY AND EFFECTIVELY
    • Clinical skills: DIAGNOSTIC PROCEDURES (TD 18 a)
    • Clinical skills: THERAPEUTIC PROCEDURES (TD 18 b)
  • TD 19: USE INFORMATION EFFECTIVELY IN A MEDICAL CONTEXT
    • Clinical skills: EVIDENCE BASED MEDICINE
• THE DOCTOR AS A PROFESSIONAL
  • TD 20: BEHAVE ACCORDING TO ETHICAL AND LEGAL PRINCIPLES
    • Professional issues: ETHICS and LAW (TD 20 a-g)
  • TD 21: REFLECT, LEARN AND TEACH OTHERS
    • Professional Issues: PERSONAL LIMITS OF CARE (TD 21e)
    • Professional issues: LEARNING (TD 21 a-d)
    • Professional issues: TEACHING AND MENTORING (TD 21 f)
  • TD 22: LEARN AND WORK EFFECTIVELY WITHIN A MULT-PROFESSIONAL TEAM
    • Professional issues: WORKING IN TEAMS (TD 22 a-c)
  • TD 23: PROTECT PATIENTS AND IMPROVE CARE
    • Professional issues: DUTIES OF A DOCTOR (TD 23 a-b)
    • Professional issues: MEDICAL FRAMEWORK IN THE UK (TD 23 c)
    • Professional issues: RISK MANAGEMENT and PATIENT SAFETY (TD 23 d)
    • Professional issues: GOVERNANCE, QUALITY MATTERS and AUDIT (TD 23 e)
    • Professional issues: PERSONAL ATTITUDES and SELF CARE (TD 23 f-j)

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TD 8: APPLICATION OF BIOMEDICAL SCIENTIFIC PRINCIPLES, METHOD AND KNOWLEDGE: Medical knowledge: PHYSIOLOGY (TD 8.2)

Introduction

Physiology: The branch of medical science that deals with the healthy functions of different organs, and the changes that the whole body undergoes in the course of its activities.

Index

• General Outcomes for Physiology
• Cardiovascular Physiology
• Respiratory Physiology
• Lymphoreticular System and Blood
• Gastrointestinal Physiology
• Hepato-biliary Physiology
• Renal Physiology
• Endocrine Physiology
• Reproductive Physiology (inc.Puberty and Menopause)
• Physiology of Pregnancy
• Physiological Adaptation from Fetus to Neonate
• Physiology of Human Development (inc. Ageing)
• The Nervous System and Special Senses
• The Musculoskeletal System (inc. Skin)

• General Outcomes for Physiology
  • General Outcomes for Physiology
    1. Indicate how there is maternal recognition of pregnancy. (HD1)
    2. Identify the major molecular groups involved in human development.
    3. Describe the origins of steroids, prostaglandins and glycoproteins. (HD1)
    4. Understand the principal mechanisms of steroids, prostaglandins and glycoproteins in normal human development.
    5. Summarise the important features of implantation and placentation. (HD1)
    6. Explain the normal ovarian cycle (HD1)
    7. Identify the hormones released during the ovarian cycle and explain how they act on the endometrium. (HD1)
    8. Understand the normal process of ovulation. (HD1)
    9. Know the patient physiology and pathology relevant to the peri-operative period
  • Homeostasis
    1. Be able to apply the principles of homeostasis to one human physiological system - body temperature; blood glucose concentration; body fluid volume
    2. Be able to apply the principles of homeostasis to one human physiological system, from: body temperature; or blood glucose concentration; or body fluid volume. (FM1)
    3. Be able to define homeostasis in relation to the physiological systems (FM1)
    4. Be able to discuss the contribution of negative feedback, positive feedback and positive feedforward to the process of body homeostasis. (FM1)
    5. Be able to discuss the contribution of negative feedback, positive feedback and positive feed-forward to the process of body homeostasis
    6. Explain how the thick-walled, ascending limb of the loop of Henle plays a key role (in conjunction with ADH) in the production of either a dilute or concentrated urine to meet the requirements of water balance. (GEP/CO2)
  • Homeostasis
    1. State the source, nature and mechanisms of release of ADH. Describe the stimuli for the release of ADH and explain how ADH controls urine volume and osmolality
    2. Explain how the thick-walled, ascending limb of the loop of Henle plays a key role (in conjunction with ADH) in the production of either dilute or concentrated urine to meet the requirements of water balance
    3. Quantify the factors that contribute to the water balance of the body
    4. Explain how total body water and total body sodium are regulated by mechanisms that are sensitive to plasma volume and plasma osmolality
  • Acid-Base Balance
    1. Be able to define the term buffer system and explain how it resists changes in pH
    2. Be able to state the normal pH and hydrogen concentration of human blood plasma and the ranges compatible with life
    3. Be able to cite a common clinical example of acid-base becoming unbalanced
  • Body Fluids
    1. Be able to describe the distribution of body fluids within the body and the composition of intracellular and extracellular fluids. (FM1)
    2. Be able to describe how water moves between different compartments of the body. (FM1)
    3. Be able to discuss the contribution of ion pumps to the regulation of cell volume. (FM1)
    4. Be able to discuss fluid balance and the role of the kidney in regulating blood osmolality and volume. (FM1)
    5. State general disorders of fluid balance. (FM1)
  • Body Fluid Compartments and Water Balance
    1. Distinguish between the terms water diuresis, osmotic diuresis, diabetes insipidus and diabetes mellitus. State typical values (and normal ranges) for the osmolality and of urine and daily urine production
    2. Quantify the factors that contribute to the water balance of the body
    3. Explain how total body water and total body sodium are regulated by mechanisms that are sensitive to plasma volume and plasma osmolality
    4. Name the main fluid compartments of the body, commenting on their volumes and predominant cations
    5. Distinguish between the terms 'osmolarity' and 'osmolality' and between the terms 'isosmotic' and 'isotonic'. State a normal value for plasma osmolality.
• Cardiovascular Physiology
  • General Cardiovascular Physiology
    1. Discuss the changes that occur in the cardiorespiratory system during exercise, and how these may be compromised in cases of cardiorespiratory disease (CR2)
    2. Describe the role of the vascular endothelium . (CR1)
    3. Explain the role of nitric oxide in the coronary and skeletal arterioles
    4. Explain the role of nitric oxide in the coronary and skeletal arterioles (GEP/CO2)
    5. Explain the role of nitric oxide in exercise (GEP/CO2)
    6. Explain the role of nitric oxide in exercise
    7. Note the differences between pulmonary and systemic capillaries. (GEP/CO2)
    8. Explain what determines oxygen demand and supply in the heart “cardiac economics”; describe how treatment alters this oxygen balance
  • Development of the Heart and Fetal Circulation
  • Smooth and Cardiac Muscle
    1. List the structures where smooth muscle is found (CR1, GEP/CO2)
    2. Describe the heterogeneity of smooth muscle and link to function (CR1, GEP/CO2)
    3. Describe the excitation - contraction coupling in smooth muscle and briefly contrast with cardiac and skeletal muscle (CR1, GEP/CO2)
    4. Explain briefly the electrophysiology of smooth muscle
    5. Describe how external factors may contract or relax smooth muscle (CR1, GEP/CO2)
    6. Describe the innervation of smooth muscle
  • The Heart as a Pump
    1. Explain how the chambers of the heart and the heart valves cause blood to flow in sequence through the pulmonary and systemic circulations
    2. Explain the cardiac cycle, particularly the valvular functions during this cycle (CR3)
    3. Define cardiac output and comment on how this is matched to demand
    4. Explain how the first and second heart sounds are generated and relate these to the cardiac cycle and valve openings and closures (CR3)
    5. Be able to draw a diagram of the pressure profiles in the left atrium, left ventricle and the aorta for a single cardiac cycle. Indicate the points at which the cardiac valves open and close, and the periods of iso-volumetric contraction and relaxation.
    6. Briefly describe the structure of the heart valves, and state what causes them to open and close
    7. State the reasons for the occurrence of the dichrotic notch of the aortic pressure pulse
    8. Draw the typical pressure / volume diagram for the heart and relate this to the difference phases of the cardiac cycle
    9. Outline the main processes ensuring adequate venous return to the heart.
  • Cardiac Muscle
  • The Conducting System of the Heart and the ECG
    1. Learn about cardiac cycle and cardiac electrophysiology and learn how this relates to the ECG waveform (CR3)
    2. Describe the structural and functional properties of cardiac muscle, and explain how it differs from skeletal muscle
    3. Briefly describe the events of cardiac muscle cell contraction
    4. Briefly describe the events of cardiac muscle cell contraction. (CR1, GEP/CO2)
    5. Briefly explain the term 'functional syncytium' and the importance of coordinated contraction of cardiac muscle fibres.
    6. Identify common arrhythmias on an ECG (CR3)
    7. Describe how the heart beat is generated
    8. Define the term 'pacemaker potential' and draw a labelled diagram of the pacemaker potential of a sino-atrial node cell. Briefly explain the reasons for the main potential changes. State the effects of sympathetic and parasympathetic input.
    9. Using history (symptoms), signs and ECG findings be able to diagnose and distinguish between the following: cardiac arrest; atrial flutter and atrial fibrillation (AF); respiratory arrest; ventricular tachycardia; pulse; Peri-arrest; ventricular fibrillation; supraventricular tachycardia; 1st, 2nd & 3rd degree heart block (CR3)
    10. Explain why the shape of the ECG varies between the 12 leads.
    11. Draw a labelled diagram of a generalised cardiac action potential and briefly describe the ionic currents underlying each phase. Explain the importance of the long refractory period.
    12. Name the components of the conduction system of the heart, and trace the conduction pathway
    13. Describe the significance of the electrical axis of the heart and show qualitatively how to calculate its angle.
    14. Draw a diagram of a normal electrocardiogram tracing; name the individual waves and intervals and indicate what each represents
    15. Name some abnormalities that can be detected on an ECG tracing
    16. Describe normal cardiac conduction and explain how this relates to the ECG waveform; describe how abnormalities in this process lead to arrhythmias
  • Haemodynamics
    1. Define the terms systolic and diastolic blood pressure, pulse pressure and mean blood pressure and state values for these in the normal healthy young adult
    2. Explain the relationships between cardiac output, peripheral resistance and blood pressure (CR1, GEP/CO2)
    3. Explain the concept of arterial compliance, and describe the relationship between pulse pressure, stroke volume and compliance (CR1, GEP/CO2)
    4. Know the importance of Poiseuille's Law relating vessel radius and resistance to flow, and the relevance of this to changes in pressure in the circulation (CR1)
    5. Be able to comment on the importance of Laplace's Law relating vessel radius and pressure, and how this relates to aneurysm formation. (GEP/CO2)
    6. Draw and explain the Starling Curve describing the relationship between cardiac filling and cardiac output
    7. Explain how preload, after load and cardiac contractility determine cardiac output
  • Blood Pressure
    1. Describe the renin-angiotensin-aldosterone system and explain its role in blood pressure regulation (CR1, GEP/CO2)
    2. Explain how the body controls blood volume.
    3. Describe the physiological sensors and effectors for neuronal control of arterial blood pressure (GEP/CO2)
    4. List common drugs which can be used to control hypertension and explain their mechanism of action (CR1, GEP/CO2)
    5. Describe the position and innervation of the aortic and carotid sinus baroreceptors, their central connections, and the role of the brainstem in the control of blood pressure (GEP/CO2)
    6. Describe the role of the vagus nerve and the sympathetic nervous system in the control of blood pressure (GEP/CO2)
    7. Describe the hormonal control of blood pressure
    8. Describe the renin-angiotensin-aldosterone system and explain its role in blood pressure regulation (CR1)
  • Pulses
  • Haemorrhage and Shock
  • Sympathetic Nervous System and Circulation
    1. Describe the anatomy of the sympathetic nervous system with particular reference to the innervation of blood vessels
    2. Describe the transmitters used by the sympathetic nervous system
    3. Describe the role of the sympathetic nervous system in the control of blood pressure and cardiac output
    4. Describe the changes in the blood flow to muscle during exercise
    5. Describe how the sympathetic nervous system reacts after injury or haemorrhage
  • Microcirculation and Oedema
    1. Draw a labelled diagram showing the anatomy of the microcirculation.
    2. Describe the three types of capillaries, continuous, fenestrated and discontinuous, with reference to their structure, distribution and function.
    3. Describe how the capillary permeability of lipid soluble molecules can be explained in terms of their oil:water partition coefficients.
    4. Describe how lipid insoluble molecules can move across the capillary endothelium.
    5. Draw a labelled diagram showing filtration and reabsorption of fluid along an average capillary.
    6. Explain how capillary pressure, plasma colloid osmotic pressure and interstitial colloid osmotic pressure can affect fluid movements between plasma, interstitium and lymph.
• Respiratory Physiology
  • General Outcomes for Respiratory Physiology
    1. List the functions of the respiratory system. (GEP/CO2)
    2. List the functions of the respiratory system. (CR1)
    3. Describe the physiological processes important for normal lung defence from infection (CR3)
    4. Name the main structural features of the lungs (GEP/CO2)
    5. Name the main structural features of the lungs. (CR1)
    6. Distinguish between respiratory and non-respiratory components of the lungs and show how histological features are related to function. (GEP/CO2)
    7. Distinguish between respiratory and non-respiratory components of the lungs and show how histological features are related to function. (CR1)
    8. Describe the branching pattern of the respiratory tree, commenting on the significance of the cross-sectional area at different levels (GEP/CO2)
    9. Describe the branching pattern of the respiratory tree, commenting on the significance of the cross-sectional area at different levels. (CR1)
  • The Lungs and Pulmonary Circulation
    1. Explain how the pulmonary and systemic circulations differ in terms of pressure and other factors
    2. Explain the changes that occur in the pulmonary circulation at birth
    3. Describe the theory of nitric oxide function in the pulmonary circulation (GEP/CO2)
    4. Describe the theory of nitric oxide function in the pulmonary circulation
  • Lung Mechanics
    1. Outline the relationships between the lungs, pleura, chest wall and diaphragm.
    2. List the components of the total work of breathing
    3. Define the term compliance, as applied to the lungs (or chest wall). Comment on the significance of surface tension forces and the role of pulmonary surfactant.
    4. Explain why a negative pressure exists in the (potential) pleural space
    5. Compare and contrast the structure of conducting components of the respiratory system and relate their structural differences to differing functions. (GEP/CO2)
    6. Explain the relationship between airflow, airway calibre and airway resistance at different levels in the respiratory tree and name two conditions which may significantly affect the work of breathing.
    7. Identify the respiratory components of the lung and understand their functions. (GEP/CO2)
    8. Explain why alterations to lung recoil (in for example emphysema and pneumonia) may produce alterations to the shape of the chest.
    9. Show, by means of graphs how the main components of the work of breathing contribute to the total work done in normal, tidal ventilation.
    10. Show, by means of simple diagrams, how the ribs move during breathing.
    11. List the muscles active in a) quiet breathing; and b) vigorous breathing.
  • Lung Volumes and the Rates of Air Flow
    1. Describe and demonstrate the use of a spirometer, to measure tidal volume, respiratory rate, inspiratory reserve volume, expiratory reserve volume and vital capacity.
    2. Name those lung volumes which cannot be measured using a spirometer and describe one method for their measurement.
    3. Describe and demonstrate the use of the Vitalograph to measure the FVC and FEV1. Define the terms forced vital capacity (FVC), Forced Expiratory Volume 1 (FEV1) and the ratio FEV1/FVC expressed as a percentage (FEV1 %).
    4. Describe how the Vitalograph may be used to distinguish between restrictive and obstructive types of lung function disorders.
    5. Describe and demonstrate the use of a Peak Flow Meter to a patient. Be able to interpret the values obtained using charts and tables for normal values with respect to age, gender and height. (CR2)
  • Ventilation and Perfusion
    1. Outline the responses of bronchiolar and arteriolar smooth muscle which maintain a balance between ventilation of the alveoli and blood flow (perfusion) to the alveoli in normal conditions.
    2. Define the term ventilation to perfusion ratio (Va/Q); give values for the whole lung, the base, and apex in a normal subject in the upright position, explaining why these differ.
    3. Illustrate, by means of diagrams, how the perfusion of the lung may be considered as a ‘three zone model’.
    4. Comment briefly on the effects, on blood passing through the lungs, of a high or a low Va/Q.
  • Blood Gases, Control of Ventilation and Plasma pH
    1. Have a basic understanding of Arterial Blood Gases (ABG’s), to allow interpretation of patient oxygenation and ventilation with respect to the inspired oxygen concentration.
    2. State normal values of the partial pressures of oxygen and carbon dioxide in arterial blood (PaO2, PaCO2). How are these measured directly and estimated indirectly?
    3. Describe the location and properties of the peripheral and central chemoreceptors and show, by means of simple graphs, how alterations in PaO2 and PaCO2 alter ventilation.
    4. Name the FOUR simple classes of acid-base disturbance, stating the primary disturbance and the form of compensation for each class. Comment on the time scale for renal as compared with respiratory compensation and give ONE clinical cause for each class.
    5. Describe the normal mechanical process of ventilation (CR3)
  • Carriage of Gases
    1. Describe the unique features of haemoglobin that make it able to transfer oxygen from lungs to tissues.
    2. By means of an annotated diagram, show how red blood cells are involved in the transport of carbon dioxide.
    3. Show, by means of graphs, the contributions of dissolved carbon dioxide, bicarbonate ion and carbamino-Hb to carbon dioxide transport in arterial and venous blood.
    4. Explain how the allosteric properties of haemoglobin may affect oxygen binding (the Bohr effect) and carbon dioxide transport (the Haldane effect).
  • Gas Exchange and Lung Function Testing
    1. Draw a simple diagram of an alveolus (and its blood supply), annotated to show how the microscopic structure is suited to efficient gas exchange.
    2. Know what pulmonary surfactant is, where is it produced and why is it important.
    3. Be able to tabulate the normal partial pressures of oxygen and carbon dioxide in room air, alveolar air, pulmonary arterial (or ‘mixed venous’) blood, pulmonary venous (or systemic arterial) blood and expired air; comment on why these differ.
    4. Give an equation for Fick’s law of diffusion as applied to gas exchange in the lung the lung, identify the components of the equation, and name one pulmonary disorder affecting each component.
    5. Show, by means of simple graphs, how gas exchange comes to equilibrium along a pulmonary capillary; relate this information to physical exercise and progressive loss of lung function.
    6. Define, and give typical values for, commonly used terms in lung function testing and explain how clinically important measures of lung function are obtained.
    7. Explain how matching of ventilation and perfusion is achieved in the normal lung (CR3)
  • Acid Base and the Control of Breathing
    1. Review the definition of gas partial pressure in a mixture of gases and gas partial pressure in a solution.
    2. State the normal pH of arterial plasma, define the terms acidosis, alkalosis, acidaemia and alkalaemia, and explain the effects on arterial pH of hyper- and hypo-ventilation.
    3. State the normal pH of arterial plasma, define the terms acidosis, alkalosis, acidaemia and alkalaemia, and explain the effects on arterial pH of hyper- and hypo-ventilation
    4. Briefly describe the brainstem structures involved in the production of breathing, and list the inputs to the brainstem which influence breathing. Describe the types of pathological respiratory patterns that can occur. (GEP/BB)
    5. Briefly describe the brainstem structures involved in the production of breathing, and list the inputs to the brainstem which influence breathing. Describe the types of pathological respiratory patterns that can occur.
    6. Briefly describe the brainstem structures involved in the production of breathing, and list the inputs to the brainstem which influence breathing. Describe the types of pathological respiratory patterns that can occur.
    7. State the normal pH of arterial plasma, define the terms acidosis, alkalosis, acidaemia and alkalaemia, and explain the effects on arterial pH of hyper- and hypo-ventilation.
    8. Describe the normal process of control of breathing (CR3)
  • Physiological Adaptation to Altitude
    1. Explain the changes in the atmospheric and alveolar partial pressures during accent to high altitude.
    2. Describe the chemical/physical changes to blood expected in high altitude acclimation.
    3. Explain the acid base disturbance common in rapid accent to high altitude.
    4. Outline the changes in the control of respiration at altitude.
    5. Outline the pharmacological approach to altitude sickness
• Lymphoreticular System and Blood
  • Blood Groups
    1. Explain the nature of blood group antigens and antibodies, and outline of how blood group antibodies develop, using ABO and Rhesus (Rh) blood groups as examples.
    2. Describe the difference between phenotypes and genotypes, and blood group inheritance, using ABO and Rh blood groups as examples.
  • Carriage of Oxygen in the Blood
    1. Describe the structure of haemoglobin and explain why it is uniquely suitable for the carriage of oxygen in the blood (CR1)
    2. Explain the significance of the subunit structure of haemoglobin and the consequences of mutations in the haemoglobin genes. (CR1)
    3. Comment on the significance of methaemoglobin in erythrocytes (CR1)
    4. Explain what is meant by haematocrit and how it is regulated. (CR1)
    5. Explain the ways in which carbon dioxide is transported by the blood (CR1)
  • Structure and Function of Blood
    1. List the cellular components of blood cells and outline their roles in the carriage of oxygen and carbon dioxide, immunity / allergy and haemostasis (GEP/CO2)
    2. Recall normal platelet structure and function (CR3)
    3. Recall the basic structure and function of circulating leucocytes (CR3)
    4. Recall the process of erythropoiesis and the function of erythropoietin (CR3)
    5. Recall normal red cell metabolism and red cell breakdown
    6. List the major chemical components of plasma, and comment on the role of these in clotting, immunity, colloid pressure and buffering (GEP/CO2)
    7. Draw the proliferation and differentiation pathways of the different white cell lines (CR3)
    8. Recall the structure and function of the red cell and haemoglobin
    9. Outline the production of blood cells from pluripotent haemopoietic stem cells and the regulation of erythropoiesis and myelopoiesis (GEP/CO2)
    10. Learn the common causes of increases and reductions in the numbers of various leucocytes (CR3)
    11. Recall the normal process of red cell breakdown
    12. Outline the response to anaemia (GEP/CO2)
    13. Define the parameters of a full blood count and give an outline classification of anaemia (GEP/CO2)
  • Haemostasis and Thrombosis
    1. Recall the key elements of the haemostatic mechanism (CR3)
    2. Describe the nature and function of platelets; explain what is meant by thrombocytopenia (GEP/CO2)
    3. Understand how a balance is maintained between the control of bleeding and thrombosis
    4. Describe the normal coagulation pathway and how it is activated by: tissue damage, contact of blood with tissue collagen or glass. (GEP/CO2)
    5. Describe the roles of Vitamin K, platelets, calcium, serine proteases and modifier proteins in the clotting process (GEP/CO2)
    6. Describe the key elements of the haemostatic mechanism; relate these elements to the essential functions of the control of bleeding and the prevention of thrombosis
    7. Discuss, in broad terms, the way in which problems may arise as a result of inherited or acquired pathology.
  • Lymphatics
• Gastrointestinal Physiology
  • Gastrointestinal Physiology - General
    1. Analyse how the gut handles carbohydrate
    2. Critical role of the intestine in animal/human evolution (GEP/DGM, MET1)
    3. Normal gastrointestinal tract (GEP/DGM)
    4. List techniques by which energy expenditure can be measured in the living human. (GEP/DGM)
    5. Diseases of oesophagus - Reflux and cancer
    6. Describe the hormonal control of blood glucose
    7. Diseases of stomach - acid secretion; cancer and bleeding
    8. Small intestine - absorption; immune system, coeliac disease and inflammatory bowel disease (GEP/DGM)
    9. Summary - reasons for gastroenterology being an interesting and important area in which to work (GEP/DGM)
  • Function of the GI Tract
    1. Distinguish between the handling of simple and complex carbohydrates
    2. Outline control of gastrointestinal function by the autonomic nervous system. (GEP/DGM)
  • Gastrointestinal Motility
    1. Know the normal function of the large bowel (MET3A)
    2. Describe the control of the lower oesophageal sphincter
    3. Know the volumes of fluid secreted in the GI tract
    4. Understand the term Gastro-oesophageal Reflux Disease (GORD)
    5. Describe the process of gastric emptying
    6. Understand the process of fluid losses and replacement in bowel obstruction
    7. Understand the biochemical derangements resulting from large bowel obstruction (MET3A)
    8. Describe the mechanisms and causes of vomiting
    9. State approximate gastrointestinal transit times
    10. Describe the propulsive and non-propulsive movements of the small and large intestines
    11. Describe the process of defaecation
    12. Define constipation and diarrhoea and list causes of each condition
    13. Understand the biochemical derangements resulting from small bowel obstruction (MET3A)
  • Digestion and Absorption
    1. Compare and contrast the fate of absorbed fat with that of endogenous fat during the post-absorptive phase
    2. List the main energy sources present in food
    3. Outline the route taken by chylomicra from intestinal mucosa cells to the liver and describe the overall changes in their lipid content during their journey
    4. Describe the roles of the salivary glands, stomach, liver, pancreas and small intestine in the digestion of carbohydrates, lipids and proteins
    5. Distinguish between portal and lymphatic routes of nutrient transport
    6. Describe the synthesis and transport of triacylglycerol from the liver to the periphery as very low density lipo-protein (VLDL)
    7. Draw a diagram summarising the transformation of very low density lipo-protein (VLDL) to low density lipo-protein (LDL) showing the subsequent fates of the latter
    8. Describe the main characteristics of the transport systems for amino acids and monosaccharides
    9. Outline the role of lipoprotein lipase in the hydrolysis of lipoprotein triacylglycerol
    10. Explain how digested lipids are absorbed by the intestinal epithelium. Describe how the lipids are further metabolised and incorporated into chylomicra
    11. Explain how low density lipoprotein (LDL) particles are taken up by cells
• Hepato-biliary Physiology
  • Hepato-biliary Physiology - General
    1. Give an overview of the role of the liver in carbohydrate, lipid and protein metabolism (GEP/DGM)
    2. Describe the role of the liver in glucose homeostasis (GEP/DGM)
    3. To be able to describe the physiology of bilirubin metabolism (MET3A)
    4. Describe how the liver acts as an organ of detoxification (GEP/DGM)
    5. Discuss the role of the liver in protein synthesis (GEP/DGM)
    6. Describe the storage functions of the liver (GEP/DGM)
    7. Describe how the liver degrades alcohol &how excess alcohol produces a fatty liver. (GEP/DGM)
    8. Describe the components of the biliary tree (including the sphincter of Oddi) (GEP/DGM)
    9. Outline the formation and functions of bile (GEP/DGM)
    10. Describe the function of the gallbladder and its control (GEP/DGM)
    11. Describe the enterhepatic circulation of bile (GEP/DGM)
    12. Describe the origin, metabolism and excretion of bilirubin (GEP/DGM)
• Renal Physiology
  • Bladder, Urethra and Ureters
    1. Outline the structural components of the urinary passageways and bladder and describe how micturition is controlled
    2. Describe the reservoir and emptying functions of the bladder and outline the neurological control of each (GEP/DGM)
  • Renal Function
    1. Explain how the thick-walled, ascending limb of the loop of Henle plays a key role (in conjunction with ADH) in the production of either dilute or concentrated urine to meet the requirements of water balance
    2. By means of labelled diagrams, show the changes in volume and osmolality of tubular fluid along the length of the nephron, in the presence or absence of anti-diuretic hormone (ADH)
    3. Identify the parts of the nephron and describe the role of each component in the physiologic processes involved in urine production (CR1, GEP/CO2)
    4. Relate the structure of the glomerulus to its role in the filtration of blood.
    5. Describe the vasculature of the kidney, relating its unique features to the physiology of urine production and nourishment of the nephron (CR1, GEP/CO2)
    6. Explain how the thick-walled, ascending limb of the loop of Henle plays a key role (in conjunction with ADH) in the production of either a dilute or concentrated urine to meet the requirements of water balance. (GEP/CO2)
    7. Identify the components of the juxtaglomerular apparatus and describe its role in regulation of blood and urine volumes and renal homeostasis. (CR1, GEP/CO2)
    8. Outline the role of hydrogen carbonate, phosphate and ammonium ions in the renal excretion of acid, noting the relationship between tubular pCO2, hydrogen carbonate reabsorption and proton excretion
    9. Name the FOUR simple classes of acid-base disturbance, stating the primary disturbance and the form of compensation for each class. Comment on the time scale for renal as compared with respiratory compensation and give ONE clinical cause for each class.
  • Nephrotic Syndrome
• Endocrine Physiology
  • Hypothalamus and Pituitary Gland
    1. List the hormones secreted by both the anterior and posterior pituitary and in each case explain the role of the hypothalamus in regulating their secretion (GEP/DGM)
    2. Use the concept of negative feedback to explain the principles underlying clinical tests for pituitary hormone secretion (GEP/DGM)
    3. List the factors regulating growth
    4. Be able to describe the structural and functional relationships between the hypothalamus and the pituitary gland
    5. State the source, nature and mechanisms of release of ADH. Describe the stimuli for the release of ADH and explain how ADH controls urine volume and osmolality
    6. Describe the structural and functional relationships between the hypothalamus and the pituitary gland (MET2, MET2, MET2)
    7. Know the physiology of the Hypothalamo-pituitary-ovarian axis
    8. Physiology of the growth hormone axis and the pathophysiology of over-secretion of growth hormone
    9. To understand the position and function of the pituitary
    10. Be able to list the hormones secreted by both the anterior and posterior pituitary and in each case explain the role of the hypothalamus in regulating their secretion
    11. Explain the relationship between growth and puberty
  • Thyroid Gland
    1. Outline the synthesis, storage and release of thyroid hormones (GEP/DGM)
    2. Describe the effects of thyroid stimulating hormone on the thyroid gland (GEP/DGM)
    3. Outline the actions of thyroid hormones (GEP/DGM)
    4. Outline the source and actions of calcitonin and explain its role in calcium metabolism
  • Parathyroid Glands and Calcium Balance
    1. Explain the relationship between the various forms of circulating calcium in blood
    2. Describe the transformation of vitamin D3 into an active hormone and explain how this is regulated
    3. Recognise the structure of vitamin D3 and describe the sources of this vitamin in the body
    4. Describe the source of parathyroid hormone and explain how its secretion is regulated
    5. Describe the actions of parathyroid hormone and 1, 25-dihydroxyvitamin D3 and account for the effects of vitamin D3 deficiency, and for hypo- and hyper-secretion of parathyroid hormone
    6. Briefly explain how the body excretes excess calcium
    7. Understands the causes of elevated and reduced serum calcium levels, the pathophysiology of vitamin D deficiency, and the effects of parathyroid disorders on the musculoskeletal system (MusSkel4)
  • Pancreas
    1. Outline the influence of the liver on circulating insulin levels
    2. Outline how insulin secretion is regulated
    3. Describe the main structural features of the insulin molecule
    4. Describe the structure of the pancreatic islet of Langerhans; list the major cell types and the hormones that they secrete
  • Adrenal Gland
    1. Describe the blood supply to the adrenal gland and the functional relationship between the adrenal medulla and the nervous system
    2. Describe the regulation of hormone secretion by each zone
    3. Describe the physiological actions of the adrenal hormones
• Reproductive Physiology (inc.Puberty and Menopause)
  • General Outcomes for the Reproductive System
    1. 1. Describe the normal process of oogenesis and spermatogenesis.
    2. Explain the biological principles involved in the two learning outcomes above (GEP/HD, HD2)
  • The Hormones of Reproduction
    1. 1. Carry out analyses, present & interpret findings
    2. Carry out analyses, present and interpret findings
    3. 1. Explain the normal ovarian cycle.
    4. 6. Outline the role of the main glycoproteins involved in reproductive physiology including maternal recognition and maintainance of pregnancy
    5. 2. Understand the use of antibodies in analytical methods
    6. 5. Explain the importance of the structure of glycoproteins
    7. 3. Understand the principles of sensitivity & specificity of analytical methods
    8. Understand the use of antibodies in analytical methods
    9. Describe the origins of steroids, prostaglandins and glycoproteins.
    10. Understand the principal mechanisms of steroids, prostaglandins and glycoproteins in normal human development.
    11. Understand the principles of sensitivity and specificity of analytical methods
    12. Recognise testing anomalies
    13. Explain the importance of the structure of glycoproteins
    14. Outline the role of the main glycoproteins involved in reproductive physiology incuding maternal recognition and maintainance of pregnancy
    15. Understand the changes in levels of the main glycoproteins at the menopause
    16. Recognise that molecules can be produced ectopically
  • Physiology of Growth and Puberty
    1. Describe the regulation of normal growth (GEP/HD, HD1)
    2. 5. Understand the techniques of measuring children of all ages and be able to plot and interpret measurements on a growth chart.
    3. Understand the normal physiological and anatomical changes at puberty (GEP/HD, HD1)
    4. Identify the stages of puberty in boys and girls (GEP/HD, HD1)
    5. Understand the relationships between growth and the onset of puberty (GEP/HD, HD1)
    6. Understand the techniques of measuring children of all ages and be able to plot and interpret measurements on a growth chart (GEP/HD, HD1)
    7. Understand the biological features influencing normal growth patterns (GEP/HD, HD1)
  • Male Reproductive Physiology
    1. Describe the normal process of spermatogenesis (HD1)
    2. Describe the normal process of oogenesis and spermatogenesis
    3. Describe the lifetime changes of the prostate and its examination (GEP/HD, HD2)
    4. Discuss erectile dysfunction in relation to the relevant anatomy, physiology, biochemistry and pharmacology (GEP/HD, HD2)
  • Female Reproductive Physiology
    1. Be able to describe the physiology of pregnancy and the associated physical changes
    2. Describe the normal processes of oogenesis and ovulation leading to a normal ovarian cycle (HD1)
    3. 1. Explain the normal ovarian cycle.
    4. Describe the normal process of oogenesis and spermatogenesis
    5. Describe the lifetime changes of the uterus
    6. Outline how normal menstrual function is related to conception (GEP/HD, HD1)
    7. Understand the normal process of ovulation
    8. Understand that ovarian and menstrual cycles are closely linked
  • Fertility, Fertilisation and Implantation
    1. Describe implantation, the development of the placenta and the establishment of the feto-maternal circulation (HD1)
    2. Outline how normal menstrual function is related to conception (GEP/HD, HD1)
    3. Describe the essential ingredients for fertilisation (GEP/HD, HD1)
    4. Summarise the important features of implantation and placentation
    5. Explain the normal processes which occur from fertilisation to implantation (GEP/HD, HD1)
    6. Indicate how there is maternal recognition of pregnancy
  • Menopause
    1. 7. Understand the changes in levels of the main glycoproteins at the menopause
    2. 1. Describe the normal physiological and anatomical changes at the menopause.
    3. Describe the normal physiological and anatomical changes at the menopause. (GEP/HD, HD1)
• Physiology of Pregnancy
  • Physiology of Pregnancy - General
    1. Describe implantation, the development of the placenta and the establishment of the feto-maternal circulation (HD1)
    2. Be able to describe the physiology of pregnancy and the associated physical changes
    3. Describe the physiology of normal pregnancy and childbirth (MedSoc1)
    4. Describe the physiological changes in pregnancy, with particular reference to maternal cardiovascular, respiratory, haematological and endocrine systems. (GEP/HD, HD1)
    5. Describe the physiological changes in pregnancy with particular reference to maternal cardiovascular, respiratory, haematological and endocrine systems
    6. Describe implantation and development of the placenta and establishment of the feto-maternal circulation
    7. Describe implantation and development of the placenta and establishment of feto-maternal circulation. (GEP/HD)
    8. Explain the function of the placenta in supporting fetal development (GEP/HD)
    9. Explain the physiological changes prior to parturition. (GEP/HD, HD1)
    10. Explain the function of the placenta in supporting fetal development (HD1)
    11. Explain the physiological changes prior to parturition
    12. Understand maternal recognition of pregnancy (GEP/HD, HD1)
    13. Describe the physiological changes in preparation for lactation (GEP/HD, HD1)
    14. Explain the changes to the cervix in pregnancy
    15. Describe the physiological changes in preparation for lactation
    16. Describe the different sites of placentation
    17. Describe the different sites of placentation
  • Labour, Delivery and Puerperium (inc. Lactation)
    1. 3. Describe the nature and control of processes associated with lactation.
    2. Define the stages of labour (GEP/HD, HD2)
    3. Demonstrate the normal physiological and anatomical changes associated with the puerperium. (GEP/HD, HD1)
    4. 3. Describe the stages of normal labour resulting in the delivery of the fetus and placenta.
    5. Describe the signs of labour
    6. Describe the signs of labour. (GEP/HD, HD1)
    7. Explain the physiological processes involved in parturition. (GEP/HD, HD1)
    8. Describe the establishment of breast feeding, and its physiological and anatomical advantages to the mother and infant. (GEP/HD, HD1)
    9. Explain the physiological processes involved in parturition
    10. Discuss the complications of Stage 1 - failed induction, primary and secondary arrest, fetal distress (GEP/HD, HD2)
    11. Describe the stages of normal labour resulting in the delivery of the fetus and placenta. (GEP/HD, HD1)
    12. Describe the nature and control of processes associated with lactation
    13. Discuss the complications of Stage 2 - failure to progress, maternal and fetal distress, operative delivery and uterine rupture (GEP/HD, HD2)
    14. Understand factors preventing the establishment of breast-feeding (GEP/HD, HD1)
    15. Understand factors preventing the establishment of breast feeding
• Physiological Adaptation from Fetus to Neonate
  • Adaptation of Fetus to Neonate - General
    1. Understand the processes whereby a fetus makes the transition from being dependent on the placenta to being able to live independently (GEP/HD, HD1)
    2. 1. Describe immunological factors that change during development from fetus to the early years.
    3. Understand the processes whereby a fetus makes the transition from being dependent on the placenta to being able to live independently
    4. Highlights of week 4, to include the closure of the neural tube, folding of the embryo, the pharyngeal arches and the beginnings of the limbs. (GEP/HD, HD1)
    5. Understand the circulatory changes at birth and the neonatal transitional circulation (GEP/HD, HD1)
    6. Understand the circulatory changes at birth and the neonatal transitional circulation
    7. Understand the changes in pulmonary physiology at birth (GEP/HD, HD1)
    8. Understand the changes in pulmonary physiology at birth
    9. Describe the basic metabolic adaptations which take place in the neonate (GEP/HD, HD1)
    10. Describe the basic metabolic adaptations which take place in the neonate
• Physiology of Human Development (inc. Ageing)
  • Physiology of Ageing - General
    1. Understand the aging process as a normal physiological process (MedSoc1)
    2. Identify the major molecular groups involved in human development.
    3. Can describe the physiology of ageing (NB: British Geriatric Society Outcome). (HCOE4)
    4. Briefly outline the patterns of disease noted in human development and diseases of premature ageing (HD1)
    5. Outline the current theories on human ageing
    6. Know the difference between chronological, biological and functional age. (HCOE4)
    7. Outline the patterns of body and organ growth during normal human development
    8. Know the differences between normal ageing 'senescence' and common pathologies of old age. (HCOE4)
    9. Outline the current theories on human ageing (HD1)
    10. Explain how age, metabolic rate, weight and surface area change during normal human development
    11. Briefly outline the patterns of disease noted in human development and diseases of premature ageing
  • Developmental Issues
    1. 2. Outline the patterns of body and organ growth during normal human development
    2. 4. Understand the methods by which development may be objectively assessed in young children.
    3. Identify the major molecular groups involved in human development.
    4. Understand psychological development during adolescence.
• The Nervous System and Special Senses
  • The Peripheral Nervous System
    1. List the changes that occur after nerve injury - distal to the injury; in the dorsal root ganglion; proximal to the injury (GEP/BB)
  • General Outcomes for Nervous System Physiology
    1. Describe how sensory nerve endings transduce and encode stimuli with examples including peripheral stretch (mechano) and thermoreceptors
    2. To understand the basis of the resting membrane potential
    3. to obtain quantitative data on the 2-point discrimination thresholds on different parts of the body
    4. Review how action potentials are generated, propagated along axons and explain reasons for failure. (GEP/BB)
    5. Describe the main types of peripheral sensory receptors
    6. Describe the basic organisation of the peripheral and central nervous system (GEP/BB)
    7. Know the basic anatomy and physiology of hearing. (ENT4)
    8. Define the term neurotrophic factor and explain the neurotrophic hypothesis (GEP/BB)
    9. What are the membrane properties essential for excitability? Including an introduction to resting and action potentials and voltage-gated ion channels
    10. Be able to describe the biophysical requirements for action potentials to take place
    11. Describe the structure of a typical cell membrane (GEP/M&P)
    12. State the main neurotransmitters employed in the CNS and understand how the associated receptors mediate their action
    13. Be able to draw a table showing the different types of primary afferent and efferent fibres found in mammalian peripheral nerves. Indicate the function and conduction velocity of the different fibre types.
    14. Be able to describe the essential differences between afferent and efferent nerves.
    15. Why everything depends on the Na-pump
    16. Explain the origin of osmotic forces acting in the cell (GEP/M&P)
    17. Explain the effects of nerve fibre diameter and myelination on conduction velocity
    18. Define the term neuromodulator and give examples of such
    19. Outline the pathway of, and name the enzymes involved in, the synthesis of noradrenaline and adrenaline.
    20. Briefly describe how nerve conduction studies and electromyography are performed and how they can detect peripheral nerve abnormalities. (GEP/BB)
    21. Be able to discuss the principle characteristics of an action potential
    22. Name and identify the major parts of the adult nervous system and describe their primary functions (GEP/BB)
    23. Describe the synthesis, storage and release of acetylcholine.
    24. Describe the types of peripheral axons and sensory nerve fibres and their conduction velocities (including ANS fibres)
    25. To explain the simple action potential & saltatory conduction
    26. What is the basic mechanism of local anaesthetics (an example of pharmacological manipulation of excitability)
    27. Explain how noradrenaline and adrenaline are released from sympathetic nerves, how they act, and how they are inactivated.
    28. Review synaptic transmission and explain the importance of termination of transmitter action, and give two different examples of how this is achieved. (GEP/BB)
    29. Describe what is meant by threshold, sub-threshold and supra-threshold responses, and how a neuronal dendritic tree can integrate many synaptic inputs, taking the spinal a-motor neuron as an example
    30. Be able to differentiate between mechanoreceptors and chemoreceptors, and describe how action potentials arise from generator potentials in each kind of receptor.
    31. Explain the different ways in which plant and animal cells cope with osmotic forces (GEP/M&P)
    32. Describe the role of glial cells in the nervous system (GEP/BB)
    33. Differentiate nicotinic from muscarinic effects.
    34. Have an understanding of the importance of saltatory nerve conduction for activities of daily life
    35. Describe how epsps and ipsps are generated at excitatory and inhibitory synapses within the CNS
    36. Describe the process of nerve regeneration and state the criteria for determining its success (GEP/BB)
    37. Describe the role of polysynaptic reflexes in the spinal cord
    38. Describe the distribution of α- and ß-adrenoceptors and how different tissues/organs respond to adrenoceptor stimulation.
    39. Describe the control of muscle length and tension involving muscle spindles and tendon organs.
    40. Be able to list the changes that occur after nerve injury.
    41. Describe how epsps and ipsps are generated at excitatory and inhibitory synapses within the CNS. (GEP/BB)
    42. Describe a synapse and the role of both excitatory and inhibitory neurotransmitters with examples
    43. Explain the importance of termination of transmitter action, and give two different examples of how this is achieved
    44. Explain why there is an imbalance in potassium concentration inside and outside animal cells (GEP/M&P)
    45. Briefly explain why regeneration in the CNS fails to occur (GEP/BB)
    46. Give examples of drugs (agonists / antagonists) selective for α- and ß-adrenoceptors, and for subtypes of these receptors. Discuss the therapeutic uses of these drugs.
    47. Why is pre-synaptic Ca2+ important?
    48. Review how action potentials are propagated along axons and explain reasons for failure
    49. Explain the necessity for a sodium pump (GEP/M&P)
    50. State the main neurotransmitters employed by sensory afferents and in CNS neurons and their associated receptors. (GEP/BB)
    51. Understand the concept of a ligand-gated receptor
    52. Describe the special features of voltage gated sodium channels (GEP/M&P)
    53. Briefly describe how nerve conduction studies and electromyography are performed and how they can detect peripheral nerve abnormalities
    54. Define the term neuromodulator and give examples of such (GEP/BB)
    55. Draw a diagram of the ionic currents occurring during an action potential (GEP/M&P)
    56. Describe and explain the effects of anti-cholinesterase drugs (neostigmine, pyridostigmine)
    57. What are the membrane properties essential for excitability? Including an introduction to resting and action potentials, and voltage-gated ion channels.
    58. Why everything depends on the Na-pump
    59. What is the basic mechanism of local anaesthetics (an example of pharmacological manipulation of excitability)?
    60. Describe a synapse and the role of both excitatory and inhibitory neurotransmitters with examples
    61. Why is pre-synaptic Ca2+ important?
    62. Understand the concept of a ligand-gated receptor
  • Basal Ganglia
    1. Describe the morphology and blood supply of the caudate and lentiform nuclei and the associated internal capsule (BB2, GEP/BB)
    2. Describe the principal afferent and efferent connections of the caudate nucleus and putamen (striatum). (BB2, GEP/BB)
    3. Describe the connections of the globus pallidus & subthalamic nucleus. (BB2, GEP/BB)
    4. Explain the circuitry of the substantia nigra and its association with Parkinson's disease. (BB2)
    5. Describe the role of the basal ganglia in motor control and discuss how their damage can lead to Parkinson’s disease, Huntington’s chorea, ballismus and athetosis. (BB2)
  • Spinal Reflexes
    1. Define the term motor unit and describe how the force of muscle contraction is controlled by impulse frequency and by recruitment of motor units.
    2. Describe the anatomy and physiology of muscle spindle and Golgi tendon organs.
    3. Draw a diagram of the monosynaptic reflex arc (for patellar or ankle jerk).
    4. Describe the control of muscle length and tension involving muscle spindles and tendon organs.
    5. Describe the role of polysynaptic reflexes in the spinal cord
    6. Describe the concept of lower and upper motoneurone lesions, muscle tone & spasticity.
  • The Vestibular System
    1. Be able to list the functional roles of the vestibular system
    2. Have a basic understanding of the physiology of balance. (ENT4)
    3. Describe how the vestibular system detects angular and linear acceleration
    4. Describe the vestibule-ocular reflexes and how they are tested. Define nystagmus and vertigo. (GEP/BB)
    5. Be able to describe the central pathways of the vestibular system
    6. Be able to list the clinical signs of vestibular system dysfunction
    7. Describe the function of the saccule and utricle in assessing linear motion, and of the semicircular canals in assessing rotatory motion.
    8. Be able to describe tests for balance disorders
  • Motor Systems
    1. Identify the brain regions involved in the control of voluntary movement.
    2. Be able to describe the regions of the cortex involved in motor control
    3. Describe the anatomy and physiology of muscle spindle and Golgi tendon organs.
    4. Understand the functions of the specific brain regions in the control of voluntary movement.
    5. Be able to describe the functional characteristics of the major motor tracts (pyramidal, reticulospinal and vestibulospinal) and their origins (GEP/BB)
    6. Describe the pathophysiologic mechanisms of spasticity, clonus, hyperreflexia and decorticate and decerebrate postures. (GEP/BB)
    7. Describe the main descending motor tracts.
    8. Explain the main medical conditions associated with the damage to the motor system.
    9. Describe the concept of lower motoneurone and upper motoneurone lesions, muscle tone & spasticity.
    10. Describe the acute and chronic deficits arising from lesioning of individual motor tracts and the acute and chronic deficits arising from lesioning the motor cortex; be able to compare with lesions of the lower motorneurone.
    11. Name cholinergic agonists and antagonists; describe their receptor selectivity and possible therapeutic uses.
    12. Explain the mechanisms of action of different kinds of neuromuscular blocking agents.
  • Somatosensory Pathways
    1. Describe the pathways to the brain for touch receptors; describe the clinical manifestations of lesions in these pathways (GEP/BB)
    2. Describe the pathways to the brain for proprioceptive receptors; describe the clinical manifestations of lesions in these pathways (GEP/BB)
    3. Describe the pathways to the brain for pain receptors; describe the clinical manifestations of lesions in these pathways (GEP/BB)
    4. To produce a clear description of the changes in sensory perception in a subject with circulation occluded in one arm. Discuss the neurophysiological processes in the arm that are responsible for these perceptual changes.
    5. Describe the organisation of somatosensory (VP) thalamus (GEP/BB)
    6. to discuss the concept of somatosensory receptive fields on the body surface, how density and size of these fields may affect the localisation of touch stimuli
    7. List the differences that may be encountered when a lesion is located at the peripheral, spinal, posterior fossa (brainstem), or supra-tentorial (thalamus/cortex) levels (GEP/BB)
  • Autonomic Nervous System
    1. Explain what transmitters are used in these systems (GEP/BB)
    2. Describe the anatomy of the peripheral sympathetic and parasympathetic nervous systems (GEP/BB)
    3. Explain the functions of the cortical association areas, particularly the posterior parietal association area and the frontal association areas (GEP/BB)
    4. Explain the hierarchical model of visual perception. (GEP/BB)
    5. Discuss the function of the sympathetic and parasympathetic nervous systems (GEP/BB)
    6. Compare and contrast the SNS and ANS (FM1)
    7. Draw labelled diagrams to show the general arrangement of motor and somatic reflexes. (FM1)
    8. Name the divisions of the ANS, and describe the segmental organisation of the sympathetic and parasympathetic nervous systems. (FM1)
    9. Draw a series of labelled diagrams to show the arrangement of nerve fibres in the divisions of the ANS at the anatomical and neurochemical and receptor levels, (FM1)
    10. Describe how the adrenal medulla acts as a modified post-ganglionic cell. (FM1)
    11. Briefly describe how the enteric nervous system can control gut function. (FM1)
  • Brainstem and Cranial Nerves
    1. List the symptoms associated with damage to cranial nerves
    2. Define the main sub-regions of the brainstem and their associated functions.
    3. Explain the consequences of raised pressure in the posterior cranial fossa
    4. Explain the consequences of vascular or physical lesions to the different areas of the brainstem in terms of clinical signs
    5. Briefly state the main functions of the reticular formation
    6. Briefly describe functions of the reticular formation
    7. Review the blood supply to the brainstem
  • The Neural Control of Movement
    1. Draw a diagram of the connections of the major components of the motor system (motor cortex, basal ganglia, cerebellum, brainstem, spinal cord and a-motoneurons) (GEP/BB)
    2. Review the main functions of non-neuronal cells in the PNS and CNS in health and disease (BB2)
    3. Outline the main fuction of each part of the motor system (GEP/BB)
    4. Review the main neurotransmitters used by the nervous system (BB2)
    5. Define the area of the brain occupied by the motor cortex, its major inputs and outputs and its topographic arrangement (in terms of the distorted motor homunculus representation) (GEP/BB)
    6. Review the main pathways by which the sensory modalities of touch, pain and proprioception are transmitted from the periphery to the brain, where they decussate, the basic tests used to assess their integrity and the clinical signs associated with damage (BB2)
    7. Define the main functions of the motor association cortex (GEP/BB)
    8. Know the main components of the motor system with particular emphasis on the monosynaptic reflex and the corticospinal (pyramidal) tract, their clinical significance, how to test reflexes and how to recognise damage to the motor system (BB2)
    9. Name the pathways that comprise the pyramidal and extra-pyramidal systems and describe their main functions (GEP/BB)
    10. Review the organisation and functions of the cranial nerves, the basic tests used to assess their integrity and the clinical signs associated with their damage (BB2)
    11. Review the functional organisation of the cerebral hemispheres, including higher mental functions and tests associated with them (BB2)
    12. Describe the basic neurological sequence involved in executing a voluntary movement (GEP/BB)
    13. Know the distribution of the principal arteries of the brain and spinal cord and the main functional areas of the brain and spinal cord that they cover (BB2)
  • The Physiology of Pain
    1. Be able to define the following terms: pain, nociceptor, allodynia, hyperalgesia, spontaneous pain and referred pain.
    2. Be able to state the four main components involved in pain transmission & perception
    3. Be able to describe how tissue damage leads to altered activation of nociceptors and cells in the spinal cord.
    4. Be able to describe the biological significance of acute, prolonged and chronic pain.
    5. Be able to describe the chemical anatomy of nociceptors.
    6. Describe the main mechanisms whereby nociceptive transmission can be blocked or modulated.
    7. Review the ascending pathways by which fast and slow pain is transmitted from the periphery to the cortex.
    8. To understand the mechanism of action of local anaesthesia
    9. Be able to discuss the role of cells in the substantia gelatinosa in the gating of nociceptive transmission and comment on its clinical importance.
    10. Be able to summarise the functions of different brain areas in pain processing
    11. Be able to explain the concepts of peripheral and central sensitisation.
  • Consciousness, Coma and Persistent Vegetative States
    1. Define the terms consciousness, coma and sleep (BB2)
    2. Describe the functional neuro-anatomy underlying coma (NEURO4)
    3. Define what consciousness is and its components. (BB2)
    4. Describe the anatomical correlates of consciousness.
    5. Describe how consciousness is measured using the Glasgow coma scale (BB2)
    6. To understand the mechanism of action of general anaesthesia
    7. Give a classification of unconscious states. (BB2)
    8. Describe the neuroanatomical systems (reticular formation) which govern arousal
    9. Define the terminology used for vegetative states. (BB2)
    10. Describe the neurophysiological processes behind sleep and consciousness
    11. Explain the difference between conditions closely related to the vegetative state such as minimally conscious state and akinetic mutism.
    12. Appreciate the effect of pathological processes of this system on conscious level (BB2)
    13. Explain the prognosis and outcome of the vegetative state. (BB2)
  • Multiple Sclerosis
  • Cerebral Function
    1. Explain the term cerebral dominance, how it may be demonstrated, and describe the lateralisation of functions associated with language, and how it is related to left or right handedness
    2. Describe the functions of the non-dominant hemisphere
    3. Define the terms agnosia, apraxia and aphasia
    4. Describe the main effects of lesions of the occipital, parietal, temporal and frontal cortices
    5. Describe the consequences of severing the corpus callosum - split brain syndrome
  • Blood Brain Barrier and CSF
  • Control of Behaviour
    1. Describe the neural control of drinking
    2. Describe the neural control of food intake
    3. Describe the neural control of urination
    4. Describe the neural control of defecation
    5. Describe how hypothalamic lesions can modify motivated behaviour
  • Headaches and Migraine
  • Vision
    1. Describe the visual pathway from optic nerve to visual cortex
    2. Describe the receptive fields of cells in the visual cortex
    3. Describe the structure of the eye and the signficance of the cornea, lens, aqueous and vitreous humours
    4. Describe the mechanism for the production of lacrimal secretions and the role of these secretions in vision (GEP/BB)
    5. Explain the conditions of glaucoma and cataract and their probable causes
    6. Explain the 'grandmother cell' or hierarchical model of visual perception.
    7. Explain how information from one half of the visual field reaches the contralateral visual cortex
    8. Explain the functions of the following cortical areas: the posterior parietal association area; the inferotemporal association area; the dorsolateral association area
    9. Describe the normal pupillary and accommodation reflexes and their clinical significance (GEP/BB)
    10. Explain the conditions of glaucoma and cataract and their probable causes (GEP/BB)
    11. Describe how photons absorbed by photoreceptor cells (rods and cones) cause changes in the membrane potential of these cells (GEP/BB)
    12. Describe the mechanism of photo-transduction in the photoreceptors
    13. Describe the retinal basis of colour vision. (GEP/BB)
    14. Explain what is meant by the retinal ‘dark current’ (GEP/BB)
    15. Describe the visual pathway from photoreceptor to optic nerve
    16. Describe the effect of lesions at various points within the visual pathways
  • Hearing
    1. Describe the main functions of the auditory system
    2. State the role of the middle ear in impedance matching, and the role of the intra-aural reflex.
    3. Give an account of the anatomy of the cochlea, and explain how it enables us to determine the frequency and loudness of incoming sound; explain how the direction of incoming sound may be determined
    4. Define the unit of sound intensity and draw a typical human hearing curve
    5. Describe the auditory pathways
    6. Define conduction and nerve deafness, and state tests for these
  • Dementia
  • Schizophrenia
    1. Review the neurobiology of schizophrenia. (BB2)
  • Neuropharmacology
    1. Review the circuitry of the basal ganglia, its main neurotransmitters and its pathological modifications in Parkinson’s disease and Huntington’s disease
    2. Define drug targets within a typical chemical synapse in the nervous system
    3. Be able to explain how neurotransmitters can produce electrical changes by activating / inhibiting receptors in the post-synaptic cell (FM1)
    4. Explain the importance of the blood-brain barrier as a determinant of efficacy
    5. Be able to outline the role of G-proteins in coupling a hormone/NT receptor complex to a) adenylate cyclase; b) hydrolysis of inositol phospholipids (FM1)
    6. Describe the mechanisms of action, pharmacokinetics, adverse effects and limitations of drugs used in the treatment of Parkinson’s disease (e.g. L-DOPA, dopaminergic agonists, cholinergic antagonists, MAOB inhibitors).
    7. Appreciate the importance of drug delivery systems in neurology.
    8. Give examples of side-effects fo drugs used in neuropharmacology and describe their impact on disease management
    9. Describe the treatment of Huntington’s disease.
    10. By means of simple diagrams and suitable examples, be able to describe the properties of the receptor-regulated ion channels and the neurotransmitters which activate them (FM1)
    11. Define the concept of treatment-resistance, and give examples of causes underlying this phenomenon
    12. Describe the major neurotransmitter systems in the central and peripheral nervous systems (FM1)
    13. Briefly review future directions in the management of Parkinson’s disease and Huntington’s disease.
    14. Describe the role of dopamine in the limbic system
    15. Describe the role of protein kinases in transmitting the intracellular effects of second messengers (FM1)
    16. Explain how an action potential is initiated by the summation of synaptic inputs (FM1)
  • Physiology of Memory and Learning
    1. Define learning, and describe the conditions under which it occurs.
    2. State the differences between classical conditioning and operant conditioning
    3. Define short- and long-term memory, and consolidation.
    4. Define anterograde and retrograde amnesia, and state some of the major causes of these.
    5. Describe the possible synaptic mechanisms underlying memory formation
    6. State the role of the hippocampus and the amygdala in memory.
    7. Briefly outline the effects of frontal and temporal lobe lesions on memory.
• The Musculoskeletal System (inc. Skin)
  • General Musculoskeletal Physiology
    1. Review the normal muscle anatomy and physiology
    2. Be able to explain how bones grow postnatally both in length and width
    3. Be able to explain the process of intramembranous and endochondral bone development
    4. Understand how the musculoskeletal system allows growth post natally
    5. Understand what happens to bone metabolism with age and disease
    6. Explain how injury to the median and ulnar nerves effect the function of the hand
    7. Identify bone and sutures in developing intramembranous bone. (GEP/M&P)
    8. Understand key concepts in endochondral ossification including ossification centres and the epiphyseal growth plate. (GEP/M&P)
    9. Understand the movements that are possible at the various joints of the hand, and the muscles involved
    10. Understand the two main categories of grip and the main sub-divisions within each
    11. Understand the functional anatomy and modification of the lower limb for stability and locomotion (LOC1)
  • Joint Structure and Function
    1. Be able to describe the different types of synovial joints (LOC1)
    2. To describe the normal microanatomy of the articular cartilage and how this changes with normal ageing and in disease states (GEP/M&P)
    3. To describe the normal anatomy of synovial joints including the composition of synovial fluid and how this changes in different disease states (LOC2)
    4. To describe the normal microanatomy of the articular cartilage and how this changes with normal ageing and in disease states (LOC2)
    5. Be able to identify the three main types of joints and how, structurally, they influence the amount of movement possible (GEP/M&P, LOC1)
    6. Understand how the articular cartilage and synovial fluid contribute to the function of synovial joints (GEP/M&P)
    7. Understand the components of a synovial joint (LOC1)
  • Synovial Fluid
    1. Understand how glycosaminoglycans contribute to lubricating properties of the synovial joint. (LOC1)
    2. To describe the normal anatomy of synovial joints including the composition of synovial fluid and how this changes in different disease states (LOC2)
    3. Understand how synovial fluid is produced (LOC1)
    4. Understand how synovial fluid is produced (GEP/M&P)
  • Muscle Function and the Neuromuscular Junction
    1. Know the structure and function of skeletal muscle
    2. Know the anatomy, physiology and pharmacology relating to the neuromuscular junction (LOC1)
    3. Understand the anatomy of the neuromuscular junction
    4. Understand the pharmacology of the neuromuscular junction.
    5. Be able to describe the physiology of skeletal muscle
    6. Understand the physiology of the neuromuscular junction
    7. Be able to describe the neuromuscular juntion to include: a) muscle fibre contraction; b) muscle metabolism; c) muscle adaptation
  • Skeletal Muscle (Striated Muscle)
    1. Review the normal muscle anatomy and physiology
    2. To describe the structure and anatomical location of the superficial and deep fascia of the lower and upper limb and the structures that are related to these fascial layers (GEP/M&P)
    3. Understand the structure of skeletal muscle fibre (LOC1)
    4. Understand the physiology of the skeletal muscle fibre (GEP/M&P)
    5. To describe how the deep fascia leads to the formation of muscular compartments (GEP/M&P)
    6. To explain how muscle function is enhanced by the fascia (GEP/M&P)
    7. Understand the physiology of the skeletal muscle fibre (LOC1)
  • Peripheral Systems
    1. Be able to describe the main types of peripheral sensory receptors
    2. Be able to describe the main types of peripheral sensory receptors
    3. Be able to describe the types of peripheral axons and sensory nerve fibres and their conduction velocities (including ANS fibres)
    4. Understand how the force of muscle contraction is controlled by impulse frequency and by the recruitment of motor units
  • Skin
    1. To describe how the structure/function of skin provides an important contribution to natural defence against micro-organisms. (LOC2)
    2. Identify microanatomical structures of the skin and relate these to functional properties. (GEP/M&P)
  • Walking and Posture
    1. Describe the changes of moving from a double to a single support (LOC1)
    2. Describe the events in the normal walking cycle (GEP/M&P)
    3. Describe the events in the normal walking cycle (LOC1)
    4. Understand the actions of the main muscle groups of the lower llimb in the walking cycle (LOC1)

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