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Fundamentals of Medical Physiology-Ebook

Fundamentals of Medical Physiology-Ebook

Harminder Singh | Itika Singh

(2018)

Additional Information

Book Details

Abstract

Enhanced learning in the form of animations for functioning of organ systems


Table of Contents

Section Title Page Action Price
Cover Cover
Title page iii
Copyright page iv
Dedication v
Foreword vii
Preface ix
Acknowledgements xi
Reviewers xiii
Contents xv
Section I - General physiology 1
1 - General Principles in Physiology 3
Knowledge goals 3
Distribution of body fluids 3
Body compartments 3
Ions in ECF and ICF 3
Measurement of body fluids 4
Nonionic diffusion 4
Homeostasis 5
Feedback regulation in body 6
Negative feedback regulation 6
Positive feedback regulation/vicious cycle 6
2 - Cellular Physiology 9
Knowledge goals 9
The cell and its organelles 9
Functions of cell 9
Cell membrane 9
Singer and Nicolson Model of Cell Membrane (1972) or Fluid Mosaic Model of Cell Membrane 10
Cytoplasm 10
Transport across cell membrane 13
Passive transport 13
Diffusion 13
Simple Diffusion 13
Facilitated Diffusion 13
Osmosis 14
Active transport 15
Primary Active Transport 15
Na+-K+ ATPase Pump 16
Calcium Pump 17
Potassium Pump (H+-K+ Pump) 17
Secondary Active Transport 17
Sodium Cotransport of Glucose 17
Endocytosis and exocytosis 17
Endocytosis 18
Forms of Endocytosis 18
Exocytosis (Reverse of Endocytosis) 18
Oxidative phosphorylation 18
Uncouplers 19
Diseases associated with mitochondria 19
Molecular motors 19
Cell adhesion molecules 19
Intercellular connections 20
Cell signalling mechanisms 21
Intercellular communication 21
Chemical messengers 22
Cell signalling pathway 22
G-proteins 22
Types of G-protein 23
Stimulators of Transcription 25
Summary of cell signalling pathways 26
3 - Genetics 29
Knowledge goals 29
Deoxyribonucleic acid 29
Watson and Crick model of DNA (B-DNA) 29
DNA replication 30
Cell cycle and cell division 30
Mitosis 30
Meiosis 30
Chromosomal anomalies 30
Numerical anomalies 31
Down Syndrome (Mongolism) 31
Structural anomalies 31
Hermaphroditism 31
Causes 31
Karyotype 33
Gene mutations 33
Ribonucleic acid 33
Types of RNA 33
Transcription 34
Translation 34
Ubiquitination 35
Chaperones 35
Cloning 35
Gene therapy 35
Gene expression 35
Central dogma of genetic information 35
Gene amplification 35
Bone marrow transplantation (stem cell transplantation) 36
Gene targeting or replacement strategy 36
Heat shock proteins or stress proteins 36
4 - Topics of Special Interest 37
Knowledge goals 37
Aquaporins 37
Patch clamp technique 38
Calcium binding proteins 38
Apoptosis 38
Mechanism of apoptosis 39
Free radicals and anti-oxidants 39
Generation of free radicals 39
Eicosanoids 40
Prostaglandins 40
Leukotrienes 41
Introduction 1
Section II - Blood 43
5 - Red Blood Cells and Haemoglobin 45
Knowledge goals 45
Red blood cells (RBCs) 45
RBC membrane 45
Composition of red cells 45
Normal count 46
Variations in size, shape and number of red cells 46
Packed cell volume and erythrocyte sedimentation rate 46
Red cell indices 47
Osmotic fragility 48
Haemopoiesis or haematopoiesis 48
Erythropoiesis 48
Sites of erythropoiesis 48
Red and yellow bone marrow 49
Stages of erythropoiesis 50
Erythropoietin (EPO) 52
Source of EPO 52
Stimulus for EPO synthesis 52
Release of EPO 53
Factors affecting EPO secretion 53
Role of EPO in body 53
Reticulocytes 53
Haemoglobin 54
Normal values of Hb 54
Structure of haemoglobin 54
Synthesis of haemoglobin 54
Fate of haemoglobin 55
Functions of haemoglobin 55
Types of haemoglobin 56
Variants of haemoglobin 56
Haemoglobinopathies 57
Sickle cell anaemia 57
Forms 57
Pathophysiology 57
Clinical Features 57
Diagnosis 58
Treatment 58
Thalassemia 58
Jaundice 59
Bilirubin Metabolism 59
Clinical Features 60
Types of Jaundice 60
Complications 60
Management 60
6 - Anaemias 63
Knowledge goals 63
Classification of anaemia 63
Whitby’s classification 63
Wintrobe’s classification 63
Iron deficiency anaemia 63
Aetiology 63
Clinical features 63
Diagnosis 64
Treatment 64
Response to treatment 65
Megaloblastic anaemia 65
Causes 65
Clinical features 65
Diagnosis 65
Treatment 66
Folic acid deficiency anaemia 67
Features 67
Section III - Cardiovascular system 117
13 - Cardiac Muscle and Properties 121
Knowledge goals 121
Cardiac muscle 121
Properties of cardiac muscle 121
Innervation of heart 122
Length tension relationship in cardiac muscle 122
Force-velocity relationship in cardiac muscle 122
Conduction of impulse in cardiac tissue 123
Pacemaker potential and cardiac muscle action potential 124
Pacemaker potential 124
Effect of autonomic nervous system on PMP 125
Cardiac muscle action potential 126
14 - Cardiac Cycle 129
Knowledge goals 129
Cardiac cycle 129
Jugular venous pressure, carotid arterial pulse, heart sounds 132
Jugular venous pressure (JVP) 132
Heart sounds 132
Carotid artery pulse 133
Correlation between ECG, carotid pulse and heart sounds 133
Arterial pulse 134
15 - Cardiac Output 137
Knowledge goals 137
Cardiac output 137
Factors affecting cardiac output 137
Stroke Volume 137
Intrinsic Regulation (Heterometric Regulation) of cardiac output 138
Preload and Afterload in Cardiac Tissue 138
Venous Return 138
Extrinsic Regulation (Homometric Regulation) of cardiac output—Regulated by ANS 139
Role of Myocardial Contractility 139
Factors Affecting Heart Rate 140
Methods of measurement of cardiac output 140
16 - Electrocardiogram (ECG) 143
Knowledge goals 143
Abnormalities and significance of ECG waves, segments and intervals 143
Uses of ECG 144
Leads for ECG recording 144
Physiological basis of ECG 146
Cardiac vector concept 149
Vector cardiography 150
ECG changes in myocardial infarction 151
Physiological basis of ECG in MI 151
Ecg changes in hyperkalaemia and hypokalaemia 152
ECG changes in HYPERCALCAEMIA and hypocalcaemia 152
Long QT syndrome (LQTS) 154
His bundle electrogram (HBE) 154
Cardiac arrhythmias 155
Atrial arrythmias 156
Ventricular arrhythmias 157
Sinus arrhythmia 157
Heart block 158
Bundle branch block 158
Wolff–Parkinson–White (WPW) syndrome or accelerated AV conduction 159
17 - Regulation of Blood Pressure and Blood Flow 161
Knowledge goals 161
Blood pressure (BP) 161
Classification of baroreceptors 162
Atrial baroreceptors 165
Bainbridge reflex 165
Ventricular baroreceptors 166
Bezold–Jarisch reflex 166
Pulmonary baroreceptors 166
Functions of angiotensin II 168
Functions of angiotensin III 168
Mayer waves and Traube—Hering waves 168
Regulation of blood flow 169
Neural regulation 169
Humoral regulation 170
Autoregulation of blood flow 172
18 - Circulatory Shock and Heart Failure 173
Knowledge goals 173
Circulatory shock 173
Stages of shock 173
Compensatory Mechanisms in Shock 174
Heart failure 176
Types of heart failure 176
Acute and Chronic Heart Failure 176
Left-Sided Heart Failure and Right Sided Heart Failure 176
Forward Failure and Backward Failure 176
High and Low Output Failure 177
Systolic and Diastolic Failure 178
Compensatory and Decompensatory Heart Failure 178
19 - Haemodynamics 181
Knowledge goals 181
Measurement of blood flow 181
Blood vessels 181
Microcirculation 182
Functions of microcirculation 182
Concept of laminar and turbulent blood flow 182
Shear stress 183
Poiseuille–Hagen formula 183
Factors on which resistance depends 184
Factors affecting viscosity 184
Critical closing pressure 184
Law of laplace 185
Physiological significance 185
Concept of average velocity 186
Windkessel effect 186
Starling forces at capillary level 186
20 - Regional Circulation 189
Knowledge goals 189
Peculiarities of coronary circulation 189
Factors affecting coronary blood flow 189
Methods of measurement of coronary blood flow 191
Applied aspect: diseases of coronary circulation (coronary artery diseases) 191
Foetal circulation 192
Cerebral circulation 192
Anatomy 192
Regulation of cerebral blood flow 192
Measurement of cerebral blood flow 193
Cutaneous circulation 193
21 - Topics of Special Interest 195
Knowledge goals 195
Goldblatt hypertension 195
Murmurs 195
Types of murmurs 195
Hypertension 195
Atherosclerosis 196
Introduction 117
Section IV - Pulmonary physiology 199
22 - Functional Organisation of Pulmonary System 201
Knowledge goals 201
Branching of pulmonary tree 201
Cells present in alveolus 201
Respiratory membrane 202
Factors affecting diffusion of gases across respiratory membrane 202
Non respiratory functions of lungs 203
23 - The Mechanics of Respiration 207
Knowledge goals 207
Mechanics of respiration 207
Pressure and volume changes during respiration 209
Factors affecting intrapleural pressure along with applied aspect 209
Intrapleural pressure can be measured by 209
Various lung volumes and capacities 210
Spirometry 210
Lung volumes and capacities 210
Static Lung Volumes and Capacities 210
Dynamic Lung Volume and Capacities 211
Functional Residual Capacity (FRC) 211
Vital Capacity (VC) 212
Factors Affecting VC 213
Importance of VC 213
Alveolar surface tension and surfactants 214
Functions of surfactant 215
Compliance 216
Curves are not straight— they are curved 217
Shift of compliance curve 217
Factors affecting compliance 219
Ventilation perfusion ratio (V/P Ratio) 220
24 - Alveolar Ventilation 223
Knowledge goals 223
Composition and partial pressure of air 223
Dead space 223
Calculation of anatomical dead space (Fowler’s method or single breath nitrogen method) 223
Single Breath Nitrogen Curve 225
Calculation of physiological dead space (Bohr’s equation method) 225
Alveolar ventilation 226
How does gravity affect alveolar ventilation? 226
25 - Regulation of Respiration 227
Knowledge goals 227
Regulation of respiration 227
Neural regulation of respiration 227
Automatic control 227
How the Effect of Respiratory Centres is Shown Experimentally 229
Voluntary control 230
Chemical regulation of respiration 230
Peripheral chemoreceptors—Carotid body and aortic body 231
Medullary chemoreceptors or central chemoreceptors 232
Chemical changes affecting ventilator responses 234
Effect of prolonged hyperventilation 235
Complications 236
Non chemical regulation of respiration 236
Genesis of respiration 238
26 - Gas Transport 241
Knowledge goals 241
Oxygen transport 241
O2–Hb dissociation curve 241
T–R configuration of Hb 242
Factors affecting O2–Hb dissociation curve 242
Bohr effect 243
Double Bohr effect 243
Oxygen–myoglobin curve 244
CO2 transport in blood 245
Dissolved in plasma 245
As bicarbonate ion in RBCs 245
As carbaminohaemoglobin 246
Haldane effect 246
CO2 dissociation curve 246
27 - Respiratory Adjustments at High Atmospheric Pressure 249
Knowledge goals 249
Dysbarism 249
Self-contained underwater breathing apparatus (SCUBA) 249
28 - High Altitude Physiology 251
Knowledge goals 251
Physiological changes taking place in body at high altitude 251
Hypoxia 253
Types of hypoxia 253
Signs of hypoxia 253
Oxygen therapy 254
Effective In 255
Uses of Hyperbaric Oxygen Therapy 255
Oxygen Toxicity 255
Side Effects of Hyperbaric Oxygen Therapy 255
29 - Exercise Physiology 257
Knowledge goals 257
Grading of exercise 257
Adjustments in exercise 257
Blood pressure changes during exercises 257
Reasons 258
Respiratory changes during exercise 258
At tissue level 259
Other changes during exercise 259
VO2 max, oxygen deficit and oxygen debt 259
VO2 max 259
Oxygen deficit and oxygen debt 259
30 - Pulmonary Circulation 261
Knowledge goals 261
Pulmonary circulation 261
Features of pulmonary circulation 261
Factors affecting pulmonary blood flow 261
Zones of lungs 261
Regulation of pulmonary blood flow 262
Clinical aspect 262
31 - Abnormalities Associated with Respiration 265
Knowledge goals 265
Asphyxia 265
Causes 265
Effects and sequelae 265
Drowning 265
Freshwater drowning 265
Sea water drowning 265
Management 265
Periodic breathing 265
Kussmaul breathing 267
Sleep apnea syndrome 267
COPD—Chronic obstructive pulmonary disease 268
Bronchial asthma 268
Emphysema 268
How Cigarette Smoke Affects Lungs 268
Pathogenesis 268
Effects and Sequelae 268
Chronic bronchitis 269
Bronchiectasis 269
Cystic fibrosis 269
32 - Topics of Special Interest 271
Knowledge goals 271
Foetal lung 271
Placenta consists of two parts 271
Carbon monoxide poisoning 271
Diffusion capacity of lung 272
Artificial respiration 273
Iron lung (Drinker’s method or negative pressure ventilation) 273
Continuous positive airway pressure (CPAP) 274
Introduction 199
Physiological shunt 200
Section V - Renal physiology 275
33 - Nephron and Renal Circulation 277
Knowledge goals 277
Structure of nephron 277
Juxtaglomerular apparatus (JGA) 278
Functions of JGA 279
Peculiarities of renal circulation 279
Peculiar points about renal circulation 280
Renal autoregulation 280
Myogenic mechanism 280
Tubuloglomerular and glomerulo tubular feedback mechanism 281
34 - Mechanism of Urine Formation 283
Knowledge goals 283
Glomerular filtration rate (GFR) 283
Factors affecting GFR 283
Conditions affecting GFR 286
Measurement of GFR 286
Tubular transport 287
In loop of Henle 287
Transport of Na+ and other solutes like glucose, , , amino acids 288
In Early PCT 288
In Late PCT 288
In Loop of Henle 288
In Early DCT 290
Late DCT and Collecting Duct 290
Renal transport of K 290
In PCT 290
In loop of Henle 291
In early DCT 291
In late DCT and collecting duct 291
Factors affecting urinary K+ excretion 291
Renal handling of glucose 291
In early PCT 291
In late PCT 291
Glucose titration curve 292
Renal handling of urea 293
Urea recycling 293
35 - Physiology of Micturition 295
Knowledge goals 295
Micturition reflex 295
Nerve supply of urinary bladder 295
Cystometrogram 296
Components of cystometrogram 297
Diuretics 297
Classification of diuretic drugs 297
Mnemonics 297
Water diuresis and osmotic diuresis 299
Diabetes insipidus 300
SIADH—Syndrome of inappropriate secretion of ADH 300
36 - Renal Function Tests 303
Knowledge goals 303
Renal function tests 303
37 - Haemodialysis and Peritoneal Dialysis 307
Knowledge goals 307
Haemodialysis (artificial kidney) 307
Peritoneal dialysis 307
38 - Counter Current Mechanism in Kidney 311
Knowledge goals 311
Counter current mechanism in kidney (or hyperosmolality of medullary interstitium) 311
Concentration dilution of urine (or factors affecting counter current mechanism) 313
39 - Acidification of Urine 317
Knowledge goals 317
Acidification of urine 317
Acidification of urine in renal tubules 317
Fate of H+ Secreted by Tubular Cells 318
40 - Acid Base Balance 319
Knowledge goals 319
Henderson Hasselbalch equation 319
Acid base disturbances 320
Anion gap 322
Buffer system 322
41 - Topics of Special Interest 327
Knowledge goals 327
Nephrotic syndrome and nephritic syndrome 327
Acute renal failure and chronic renal failure 327
TAMM–horsfall proteins 327
Introduction 275
Section VI - Gastrointestinal tract 329
42 - Organisation of GIT 331
Knowledge goals 331
Histology of gut (from inside to outside) 331
Innervation of gut 331
Plexus present in intrinsic nervous system 332
Immunology of gut 333
43 - Salivary Secretion and Oesophagus 335
Knowledge goals 335
Salivary secretion 335
Saliva 335
Functions of Saliva 335
Oesophagus 335
Oesophageal sphincters 336
Deglutition (swallowing) 336
Phases of deglutition 336
Disorders of deglutition 337
Achalasia cardia 337
Gastroesophageal reflex disease (GERD) 337
44 - Gut Peptides 339
Knowledge goals 339
Gut peptides 339
Gastrin 339
Actions of Gastrin 339
CCK—Cholecystokinin-pancreozymin 339
Actions of CCK 339
Secretin (1st hormone) 340
Bayliss and Starling 340
Stimuli for Secretin Release 340
Section VII - Nerve muscle physiology 389
52 - Classification of Nerve Fibres 391
Knowledge goals 391
Classification of nerve fibres 391
Different types of neurons 391
Transport system in neuron 393
Sheaths around nerve 393
53 - Properties of Nerve 395
Knowledge goals 395
Excitation 395
Resting membrane potential (RMP) 395
Technique to record RMP 395
Genesis of RMP 395
Nernst equation 396
Action potential in nerve fibre 397
Findings 397
Phases and ionic basis (Hodgkin and Huxley theory) 398
Action potential in mixed nerve 399
Characteristic features of stimulus 399
Technique of Recording Electrotonic Potential 401
Conduction 402
Summation 404
Unfatigability 404
Glial cells 404
Microglia cells 404
Functions of Microglia Cells 404
Macroglia cells 405
Myelinogenesis 405
54 - Neuromuscular Junction 407
Knowledge goals 407
Neuromuscular junction 407
Sequence of events 407
Applied aspect 407
Myasthenia gravis 407
Lambert – eaton syndrome 408
55 - Nerve Injury and Regeneration 411
Knowledge goals 411
Nerve injury and degeneration 411
Causes 411
Sunderland classification of nerve injuries 411
Degenerative changes in nerve fibre 411
Complications of nerve injury 412
Nerve regeneration 412
Neurotropins 412
Nerve growth factor (NGF) 412
Brain derived neurotrophic factor (BDNF) 413
Other growth factors 413
Mechanism of action of growth factors 414
56 - Skeletal Muscle 415
Knowledge goals 415
Sarcomere and muscle proteins 415
Sarcotubular system 419
Excitation contraction coupling in skeletal muscle 419
Sequence of events 419
Isotonic and isometric contraction 420
Fast muscle and slow muscle 421
Length tension relationship in skeletal muscle 421
Recording 423
ForcE-Velocity relationship in skeletal muscle 424
57 - Smooth Muscle 425
Knowledge goals 425
Types of smooth muscles 425
Excitation contraction in smooth muscle 425
Electrophysiology of smooth muscle 425
58 - Topics of Special Interest 429
Knowledge goals 429
Differences between skeletal muscle, smooth muscle and cardiac muscle 429
Ryanodine receptor 429
Rigor mortis 429
Electromyography 430
Types of EMG 432
Nerve physiology 389
Introduction 389
Function of neuron 390
Section VIII - Endocrine 433
59 - General Principles of Endocrine System 435
Knowledge goals 435
Control of hormonal secretion 435
Feedback regulation 435
Negative Feedback Regulation 435
Positive Feedback Regulation 436
Nervous regulation 436
Chronotropic regulation 436
Mechanism of action of hormones 436
Classification of hormones 436
Hypophysiotropic hormones 437
60 - Pituitary Gland and Growth Hormone 439
Knowledge goals 439
Structure of pituitary gland (the master gland) 439
Histology of pituitary gland 439
Hypothalamus-pituitary axis (HPA) 440
Hormones secreted by anterior pituitary 440
Growth hormone (GH) 440
Actions of GH 441
Growth curves 441
Hormones affecting growth 442
Somatomedins 442
Applied aspect associated with growth hormone 443
Dwarfism 443
Types of Dwarfism 444
Gigantism 445
Acromegaly 445
Posterior pituitary hormones 446
Functions of oxytocin 446
Functions of vasopressin and associated applied aspect 446
61 - Thyroid Gland and Thyroid Hormones 447
Knowledge goals 447
Structure of thyroid gland 447
Histological features of thyroid gland 447
Hormones of thyroid 448
Metabolism of iodine 448
Synthesis of thyroid hormones 449
Actions of thyroid hormones 450
Causes of hyperthyroidism and hypothyroidism 451
Causes of hypothyroidism 451
Graves’ disease (thyrotoxicosis) 451
Thyroid storm (thyrotoxic crisis) 452
Goitre 452
Cretinism 452
Myxoedema 453
62 - Calcium Homeostasis and Calcitropic Hormones 455
Knowledge goals 455
Role of calcium in body 455
Calcium homeostasis or calcium balance 455
Absorption of calcium 456
Role of calcitropic hormones in calcium homeostasis 456
PTHrP 459
Bone 459
Cells present in bones 459
Types of bone tissue 459
Applied aspect associated with calcium homeostasis 459
Rickets 459
Osteomalacia 460
Osteoporosis 460
Osteopetrosis 461
Tetany 461
Hyperparathyroidism 462
63 - Adrenal Cortical Hormones 465
Knowledge goals 465
Synthesis of adrenal cortical hormones 465
Actions of glucocorticoids 466
Glucocorticoids as anti-inflammatory (pharmacological actions of glucocorticoids) 466
Other actions of glucocorticoids 467
Regulation of secretion 468
Aldosterone 469
Aldosterone escape 469
Effect of renin on aldosterone 470
Applied aspect associated with adrenocortical hormones 470
Cushing syndrome 470
Hyperaldosteronism 471
Addison disease 471
Adrenogenital syndrome 471
64 - Pancreatic Hormones 473
Knowledge goals 473
Islets of Langerhans 473
Insulin 473
Actions of insulin 474
Regulation of insulin secretion 476
Effect of insulin excess and insulin deficiency 476
Effects of insulin excess 476
Effects of insulin deficiency 477
Diabetes Mellitus 477
Oral hypoglycaemic drugs 479
Glucose transporters 481
Forms of insulin 481
Glucagon 481
Synthesis 481
Mechanism of action 481
Insulin-Glucagon Molar Ratio 481
Diabetogenic hormones 482
65 - Stress Hormones 485
Knowledge goals 485
Stress hormones 485
Neuroendocrinal response to stress 486
66 - Pineal Gland and Melatonin 489
Knowledge goals 489
Pineal gland 489
Melatonin 489
Functions of melatonin 489
67 - Topics of Special Interest 493
Knowledge goals 493
Differences between enzymes and hormones 493
Metabolic syndrome 493
Treatment 493
Biological rhythm or circadian rhythm 493
Kallmann syndrome 494
Sheehan’s syndrome or Simmond’s syndrome 494
Introduction 433
Section IX - Nervous system 495
68 - Synaptic Transmission and Neurotransmitters 497
Knowledge goals 497
Structure of chemical synapse 497
Events taking place during chemical synaptic transmission 497
Properties of synapse 499
Types of inhibition in CNS 501
Neurotransmitters 502
Criteria of neurotransmitter 502
Classification of neurotransmitters 502
Receptors 503
Glutamate 503
Acetylcholine 504
GABA—Gamma amino butyric acid 504
Receptors 504
Mechanism of Action 504
Glycine 505
Catecholamines 505
Fate of Catecholamines 505
Histamine 506
Neuropeptides 506
Opioid peptides 506
69 - Motor Cortex 509
Knowledge goals 509
Cerebral cortex 509
Layers of cerebral cortex 509
Cells in cerebral cortex 509
Lobes of cerebral cortex 509
Motor cortex and descending tracts 511
Motor cortex 511
Descending tracts 512
Corticospinal Tract (Pyramidal Tract) 512
Extrapyramidal Tracts 513
Upper and lower motor neurons 515
Brown-Sequard syndrome 516
70 - Somatosensory Transmission 519
Knowledge goals 519
Sensory receptors 519
Mechanoreceptors 519
Nociceptors 520
Properties of sensory receptors 521
Somatosensory cortex 522
Somatosensory pathways or ascending tracts of spinal cord 523
Spinothalamic tract 523
Pain 525
Referred pain 527
Theories of referred pain 527
Gate control theory of pain 529
71 - Posture Regulating Mechanisms 533
Knowledge goals 533
Posture 533
The stretch reflex/myotatic reflex 533
Muscle Spindle: Structure 533
Mechanism of Stretch Reflex 535
Functions of Stretch Reflex 535
Inverse stretch reflex /golgi tendon reflex/inverse myotatic reflex 536
Righting reflexes 536
Tonic neck and tonic labyrinthine reflexes 537
Procedure for studying tonic reflexes 537
Role of tonic reflexes 537
Placing and hopping reactions 537
Mechanism of standing in man 537
Spinal animal 538
Stage of areflexia or stage of spinal shock 538
Stage of recovery or stage of reflex activity 538
Decerebrate animal or bulbospinal animal 538
Mid-brain animal or ‘mesenchephalic animal’ or ‘high decerebrate animal’ 539
Decorticate animal 539
Decerebellate animal 539
Spinal shock 540
72 - Cerebellum 543
Knowledge goals 543
Anatomy 543
Circuits of cerebellum 543
Layers of cerebellar cortex (outside to inside) 543
Functional connections of cerebellum 545
Cerebellar functions 545
Cerebellar dysfunction 547
Cerebellar function tests 547
73 - Basal ganglia 549
Knowledge goals 549
Circuits of basal ganglia 549
Major connections within basal ganglia 549
Neural pathways through basal ganglia involved in controlling motor activities 549
Functions of basal ganglia 549
Diseases of basal ganglia 550
Parkinsonism 550
Chorea 552
Athetosis 552
Huntington disease 552
Hemiballismus 552
Wilson disease (hepatolenticular degeneration) 552
Tardive dyskinesia 552
74 - Hypothalamus and thalamus 555
Knowledge goals 555
Hypothalamus 555
Connections of hypothalamus 555
Functions of hypothalamus 555
Theories of Food Intake 555
Role in Sex Regulation 556
Rage and sham rage 558
Thalamus 558
Thalamic nuclei 558
Connections of thalamic nuclei 558
Functions of thalamus 559
Thalamic pain syndrome 560
75 - Electrical Activity of Brain: EEG, RAS, Sleep 561
Knowledge goals 561
Electroencephalogram (EEG) 561
Physiological basis of EEG 561
Technique of EEG recording 561
Waves of EEG 561
Alpha waves 561
Reticular activating system (RAS) 563
Functions of RAS 564
Sleep 564
Genesis of sleep 565
Role of melatonin 566
Sleep disorders 567
Parasomnias 567
76 - Higher Functions of CNS 569
Knowledge goals 569
Memory 569
Neurological basis of memory 570
Role of hippocampus and amygdala 570
Synaptic plasticity and memory 570
Post-tetanic potentiation 570
Long-term potentiation and long-term depression 571
Types of LTP 571
Learning 572
Associative learning 572
Non associative learning 572
Senile dementia and Alzheimer disease 573
Speech 574
Categorical and representational hemisphere 575
Physiology of emotions 576
Arnold theory of emotions 576
Neural mechanisms of genesis of emotions 576
77 - CSF Flow 579
Knowledge goals 579
CSF formation and circulation 579
Functions of CSF 579
Collection of CSF 580
Applied aspect 580
Hydrocephalus 580
Countrecoup injury 580
78 - Blood–Brain Barrier 581
Knowledge goals 581
Blood–brain barrier (BBB) 581
Circumventricular organs 582
Circumventricular organs and physioclinical significance 582
79 - Autonomic Nervous System 583
Knowledge goals 583
Autonomic nervous system 583
Sympathetic division of ANS 583
Neurotransmitters in ANS 584
Acetylcholine (ACh) 584
Mechanism of Action 584
Norepinephrine (NE) 585
Mechanism of Action 585
Non-adrenergic non-cholinergic neurotransmitters 585
Integrated role of parasympathetic and sympathetic divisions of ANS 588
Antagonistic effect 588
Synergistic effect 588
Complementary effect 588
Concept of catabolic and anabolic nervous system 588
Organophosphorus poisoning 589
Autonomic function tests 589
80 - Topics of Special Interest 591
Knowledge goals 591
Rigidity and spasticity 591
Cerebral palsy 591
Addiction 591
Depression 592
Raynaud phenomenon 592
Introduction 495
Section X - Special senses 593
81 - Vision 595
Knowledge goals 595
Anatomy of human eye 595
Flow of aqueous humour 596
Dioptric power of eye 597
Refractive indices 597
Schematic eye and Listing’s reduced eye 597
Errors of refraction 597
Myopia and hypermetropia 597
Astigmatism 597
Presbyopia 598
Accommodation and pupillary light reflexes 598
Accommodation 598
Pupillary light reflexes 599
Retina 599
Photoreceptors 600
Structurally 601
Rhodopsin and phototransduction 602
Rhodopsin (or visual purple) 602
Phototransduction 602
Dark adaptation 603
Visual pathway and lesions 604
Visual pathway 604
Effect of lesions 604
Processing of visual information 605
Primary visual cortex (V1) 607
Cells and columns in primary visual cortex 607
Colour vision 608
Importance of colour vision determination 609
Tests to check colour vision 609
Eye movements 609
Field of vision and binocular vision 609
Field of vision 609
Extent of Normal Field of Vision 609
Charting of Central Field of Vision 610
Binocular vision 611
82 - Hearing 613
Knowledge goals 613
Ear and sound transmission 613
External ear 613
Middle ear 613
Internal ear (labyrinth) 614
Components of Bony Labyrinth 614
Components of Membranous Labyrinth 614
Sound transmission 617
Tip link theory 617
Von Bekesy travelling wave theory/place theory 618
Tympanic reflex or attenuation reflex 618
Impedance matching 619
Qualities of sound waves 619
Deafness 620
Causes of deafness 620
Hearing tests 620
Vestibular disorders 621
Vestibular pathway 621
Auditory cortex 622
Auditory pathway 622
Role of vestibular apparatus in maintaining equilibrium 622
Response to rotational acceleration: functioning of semicircular canals 622
Response towards linear acceleration 623
Role of otolith organs in maintaining equilibrium 623
83 - Taste and Smell 627
Knowledge goals 627
Taste 627
Taste bud 627
Taste pathway 627
Receptors for taste sensation 627
Smell 627
Functions 629
84 - Topics of Special Interest 631
Knowledge goals 631
Electro-oculogram (EOG) 631
Electroretinogram (ERG) 631
Visual evoked potential (VEP) 632
Vitamin A deficiency (VAD) 632
Hearing aids 632
Brain stem auditory evoked potential (baep) or brain stem evoked response audiometry (bera) 632
Applications 632
Introduction 593
Section XI - Reproductive physiology 635
85 - Embryology of Reproductive System 637
Knowledge goals 637
Differentiation of external genitalia from primordial (indifferent) structure 637
Sex differentiation 637
86 - Puberty: Changes, Regulation and Disorders 639
Knowledge goals 639
Puberty 639
Sudden physical growth 639
Development of secondary sexual characters 639
Hormonal changes during puberty 639
Regulation of onset of puberty 640
Disorders of puberty 641
Causes 641
Clinical features 641
Treatment 641
87 - Male Reproductive System 643
Knowledge goals 643
Structure of human testes 643
Sertoli cells 643
Functions 643
Structure of sperm 644
Spermatogenesis 644
Semen 645
Sperm capacitation 646
Endocrine function of testes 646
Androgens 646
Synthesis 647
Actions and Effects of Androgens 647
Other Actions of Androgens 647
Regulation of Testicular Function 648
Abnormalities of male reproductive system 648
Cryptorchidism 648
Male hypogonadism 648
Causes 648
Features 648
Male menopause 649
Prostate cancer 649
Clinical Features 649
Diagnosis 649
Treatment 649
88 - Female Reproductive System 651
Knowledge goals 651
Ovarian hormones 651
Oestrogen 651
Synthesis 651
Effects of Oestrogen 652
Mechanism of Action 652
Oestrogen and Endocrine Regulation 652
Progesterone 653
Synthesis and Degradation 653
Functions 653
Other ovarian hormones 653
Menstrual cycle and hormonal regulation of female sexual cycle 654
Ovarian cycle 654
Uterine cycle (endometrial cycle) 655
Cyclical changes occurring in uterine cervix 656
Cyclical changes occurring in female breasts 656
Reflex ovulation 657
Oestrous cycle 657
Menstrual abnormalities 657
Determinants of ovulation 657
Anovulatory cycle 660
Menopause (or climateric) 660
89 - Pregnancy 661
Knowledge goals 661
Fertilisation and implantation 661
Fertilisation 661
Maternal physiological changes during pregnancy 662
Pregnancy tests 662
Fetoplacental unit 664
Placental progesterone 664
Placental oestrogen synthesis 665
Human chorionic gonadotropin (hCG) 665
Significance of hCG 665
Human chorionic somatomammotropin (hCS) or chorionic growth hormone-prolactin (CGP) or human placental lactogen (HPL) 665
Other placental hormones 665
Medical Termination of Pregnancy (MTP) ACT 665
90 - Parturition and Lactation 667
Knowledge goals 667
Parturition 667
Role of oxytocin during parturition 667
Ferguson reflex 668
Section XII - miscellaneous topics 679
93 - Ageing 681
Age-related changes in different organ systems 681
Theories of ageing 683
Genetic theories of ageing 683
Damage repair theory of ageing concept 683
How to stay young/delay ageing? 684
Knowledge goals 681
94 - Body Temperature and Regulation 685
Knowledge goals 685
Body temperature 685
Factors affecting body temperature 685
Physiological Variations 685
Pathological Variations 686
Heat producing mechanisms 686
Heat loss mechanisms 687
95 - Physiological Changes in Newborn After Birth 691
Knowledge goals 691
Cardiovascular changes 691
Respiratory changes 691
CNS changes 691
Haematological and immunological changes 691
Renal changes 692
Temperature regulatory changes 692
GIT changes 692
Foetal circulation 692
Changes after birth 693
96 - Topics of Special Interest 695
Knowledge goals 695
Yoga and pranayama 695
Benefits of yoga 695
Yoga nidra 695
Benefits of yoga nidra 695
Steps of yoga nidra practice 695
Cognition 696
Introduction 679
Index 697