Medico Guides 3rd Block (Module No 04) Physiology Guidelines

Prepared by:

                            Asma Shafique (G15)                

Compiled by:

                            Muhammad Ahmed Bhatti (G14)

Recommended Book:

• Guyton and Hall Textbook of Medical Physiology 14^th Edition (Chapter numbers are mentioned according to this edition)

Reference Books:

• Jaypee Essentials of Medical Physiology 6^th Edition

Recommended lectures:

• Medical gateway 
• Byte sized med 

CARDIOVASCULAR SYSTEM

THE HEART

Chapter 9:

(CV-P-001 and 002)

• Complete chapter.
• Fig 9.5, 9.6, 9.7, 9.8(Imp)
• Physiological anatomy of cardiac muscles 
• Importance of intercalated disc 
• Properties of cardiac muscles 
• Phases of action potential of ventricle
• Phases of action potential of SA node 
• Mechanism of self excitation of SA node 
• Refractory period with types and duration (from any short book)
• Excitation contraction coupling mechanism 
• Pressure and volume changes in left ventricle during cardiac cycle 
• Cardiac cycle (most imp) complete (phases which are systole and diastole with events occurring in these phases)
•  Relationship of cardiac cycle with ECG and heart sounds 
• Atrial pressure waves in relation to cardiac cycle (in blue box)(imp for viva)
• Aortic pressure curve (phases) with dicrotic notch or incisura (imp for viva) (from AI)
• Definitions and normal values of cardiac output, stroke volume, end diastolic volume, and end systolic volume.
• Frank starling mechanism( imp)
• Autonomic regulation of heart 
• Effect of calcium, potassium and temperature on heart 
• Definitions of chronotropic, bromotropic, dromotropic, and ionotropic effects. (Given below)
• Location of adrenergic and cholinergic receptors in heart  

(Adrenergic receptors are located in atria and ventricles 

Cholinergic receptors are found in atria, especially SA node)

• Receptors present in coronary arterioles (adenosine receptors present in coronary arterioles, help in regulating blood flow)
• Sympathetic and parasympathetic effects.

Chapter 10:

(CV-P- 003, Ectopic Pacemaker)

• Read the chapter thoroughly and mark the mcq points.
• fig 10.2 and 10.4
• Conducting system of heart 
• AV nodal delay with significance (imp)
• Control of excitation and conduction in heart (ectopic pacemaker)
• Why is the SA node considered the heart’s pacemaker?

Chapter 11:

(CV-P-004)

     (Read whole chapter for concept)

• Normal ECG labelling, characteristics and time intervals

(vv imp for MCQs and Ospe as there is a separate station for ECG in Ospe)

• Memorize name, placements and polarity of leads.
• Einthoven’s law (v imp) and Einthoven’s triangle .

Chapter 12:

(CV-P-004)

     (Read whole chapter for concept)

• Fig 12.2 and 12.3
• Mean electrical axis.
• Physiological basis of upright T wave in normal ECG 
• Current of injury, including location and significance of J point (imp)
• ECG changes in angina pectoris and myocardial infarction

(must do 4-5 changes )(imp)(from any short book or Al)

• T wave abnormalities (v important)
• Physiological and pathological causes of right and left deviation of axis of heart
• Do the flowchart given below( can be done from AI)

Effect of electrolytes:

(CV-P-005)

Chapter 13: 

(CV-P-006)

• Most important chapter.
• Complete except paroxysmal tachycardia
• AV block, ventricular fibrillation (v.v.imp)
• Also compare fibrillation and flutter 
• Should be able to recognize ECGs

(ECG changes are given and you have to identify the associated disorder

 from the given options)

CIRCULATION

Chapter 14, 15, 16:

(CV-P-007 and 008)

• From Firdaus
• Starling forces and Reynold’s number (with significance) are important
• Functional parts of circulation 
• Pressures in systemic and pulmonary circulation 
• Types of Blood Flow 

Chapter 17:

(CV-P-009)

• Complete (Guyton)

Chapter 18:

(CV-P-010 and 011)

• From Guyton (v.imp)
• Do all reflexes and make flow charts of them
• Figure 18.10 (vv imp.)

Chapter 19:

(CV-P-012)

(You may read the whole chapter if you want,

 but only three topics are included in your LOs)

• MEMORIZE three flowcharts: fig 19.6, fig 19.9, fig 19.12 (imp)

Chapter 20:

 (CV-P-013)

• Normal values
• Cardiac index
• Hyper and hypo-effective heart 
• Nervous control
• Physiological and pathologically high and low CO.
• Venous return (read and focus on headings)
• Different methods for measuring cardiac output ( only names and fick’s oxygen method)

Chapter 21:

 (CV-P-014 and 015)

 (Can do from Firdous)

• Regulation of skeletal muscle blood pressure 
• Physiological anatomy of coronary circulation 
• Regulation of coronary blood flow 
• Angina pectoris, myocardial infarction and subendocardial infarction.

Chapter 23:

• Heart sounds (v.v.v.imp) Table Given
• Full chapter is v important
• Should be able to recognize phonocardiograms.

Chapter 24:

• Most important
• Scenario based MCQS 
• Do it complete from Guyton

Note: Watch Dr. Najeeb ECG lectures for UNDERSTANDING, however nothing from them will be asked in exam, it is only to understand how characteristic ECG is produced