Physiology LRR 2024

Dr. Soumen Manna

MD Physiology (AIIMS)

0
-
 Important Topics: NEET W

General physiology: Nervous system:

• Simple & facilitated diffusion • Basal Ganglia disorder
• Cell Cytoskeleton • Renshaw cell
• Body fluid: composition, • Tactile receptor
measurement • Muscle spindle and Golgi tendon organ
• EEG & Sleep

Nerve Muscle Physiology: GIT:

• Nerve fibre classification • Peristalsis mechanism & BER
• AP phases • Stimulus for GI hormones
• Mechanism of muscle contraction

1
 Important Topics: NEET
CVS Respiratory:
• Action potential • Lung Volumes Curves
• PV loop • OHDC
• Baroreceptor • Chemoreceptor
• Bain-Bridge reflex, Bezold Jarisch reflex, • Neural centre
Cushing reflex • High altitude physiology

Renal: Endocrine:
• TGF • Signalling
• Glucose reabsorption • Endocrine receptor (TK, GPCR)
• ADH functions • Calcium & Carpopedal spasm
• Clearance curve • ACTH & circadian rhythm
• Cystometrogram

2
 cell = 3%

Body Water Distribution Blood = 8%

Fo Ky
↓

(s) 7
L
42 Liter

(2/3)
-

idT
28L 14 ECF
-
ICF

Body weight
I
2 T
Trans-cellular
ECF % .

-
lat
Water synovial
ECF-T Body
33 .

23FF
Plamal
sout ito 10-20 m
Peri = 3
 Body Fluid Measurement

·
Compartment Indicator used /

↓
* Total body water -D2O, tritium oxide, Antipyrine
&

:
O
& 4
,

ECF volume Inulin, sucrose, 22Na, 125I-iothalamate, Mannitol

- O
=
-
-

ICF volume ..
&

Plasma Evans’ blue, 125I-albumin -

Plasmal
-

ISF = (ECF -

RBC 51Cr, 59Fe tagged RBC

Volume of Dis

(e)
&
4
v =
C
D-Y Osmitality

2/12F YECF ↳ vol()

voleme # / Vo ume : -

Tro

T h
-

t
↑
-
&
&
-
-
>
-&
-F : -
&
↑
---
- -
-
T

T Flo 5
 Types of transport

1
L

es .
ATPase
-

O
carrier es Lg
protein
7
SGLT J
J
Nall
L
. Nex

Ei
Grrieh

6
 Channel
Proteins

Simple Diffusion
X
Carrier Proteins

Facilitated
↓ X

Energy

Active Transport
sir
~
facilit

(Pri/sec) Rate
Diffusion

Y Simple
Fick's law 7
ware

sanz]
-
G
- Lpetut . 2
SGLT & GLUT
Name
-10 %
Expression Site

zu be
SGLT 1 Kidney (PST), Intestinal luminal membrane
-

SGLT 2 Kidney (PCT)> -

90 %
SGLT 3 Skeletal Muscle, small intestine (glucose sensor)

E
GLUT 1 RBC, BBB, placenta, Basolateral membrane of PST. (universal GLUT)
GLUT 2 B-cell pancreas, liver, Basolateral membrane of PCT & intestinal epithelial cell.
GLUT 3 WBC, Neuronal membrane.
GLUT 4 Insulin responsive GLUT. Muscle & adipose tissue
GLUT 5 Fructose transporter. Luminal membrane of intestine, sperm

FaciDiffen
litates 8
 Neuron: RMP
(main )

S
+
• Resting Permeability though cell membrane: K+ > Cl- > Na+ +k

• RMP of almost all vertebrate cell is close to equilibrium potential of K+

-

• RMP of neuron is equal to equilibrium potential of Cl-

~
• RMP of myocardium is equal to equilibrium potential of K+
-

CDiffusion potention) m
k Del))
+ Nat

Nerust's Egh
:

-
iRMP
L

3
↓ e

on
Equit potential
Iso-electric
c
3 K

la
+t
+
me
-90mf
+ 132 u
Goldman-
Hodgin
Katz .
9
 MCQ
In a 35 years old patient, due to intravascular homolysis, serum K+
increased to 5.5 mEq/L. What will happen to resting membrane potential of
the peripheral nerve in this patient:
-
a. More positive
ECF (rk
-
-
+
)
-

O ↑
-
b. More negative

O
Ex
c. Remain unchanged
d. Zero ki kt
...
Hypokala
*
↓Diffusion ↓
Hypept .

Hyperkale -
~

Depolarization
-
-

10
 Local potential

E
-

Neuron: Action Potential

-
Graded potent ;

Summation
+ 35 mi -
f

Exit)
V

d
⑭d
er
(k
+

ch-
.

De
Y
55 D Threshold vol
-
-

- ne
LoP
After hypepl
~

70
Ysx -
.
-

↑
timulation Exit ScoN]
S-
-
- (k +

-
11
Earlanger & Grassess

↓
Fiber type
Nerve Fibers Classification
Numerical Functions CV (m/sec) D (μm)
Classification

! =
O
A Alpha Ia
Ib
Proprioception &
Somatic motor
O
70-120 12–20

Beta II Touch & Pressure 30-70

-

* Gamma
-
Efferent to muscle spindles 15-30
-

Delta III Pain & 12-30 2-5

Temperature (cold)
-
-

8
B Preganglionic autonomic 3-12 -

C IV Pain & 0.5-2

Temperature (warm) & -

Postganglionic sympathetic
 Points to remember
• Cold sensation: Carried by Ad fibre
• Warm, burning pain and freezing pain: carried by C fibre
• Local anaesthetic: Aγ and Aδ >> Aα and Aβ >> B >> C
• Pressure: Aα > B > C
• Hypoxia: B > A > C
• Spike duration:
• C fiber-2 ms

E • B fiber-1.2 ms
• A fiber- 0.4 to 0.5 ms
• Paresthesias (inappropriate sensations such as burning or pricking) usually seen when
A-delta is involved.
• Pallesthesia is the ability to feel vibration sense. Intact Pacinian corpuscle is required for
-mu
this.
 Electro-
Nee

.
↑ Mechanical

I
Skeletal Muscle: DHPR-RyR Coupling

DHPR
RyR SR

I
·
C Ca
+
-
+

8
FSERCA
#I # -
T

+
Cat

(
Contractioa
-

14
 Electro-
- Chemical
Cardiac Muscle: DHPR-RyR Coupling
++
Ca
⑫ DHPR RyR

&
G
1
I
⑨+
-
+ +

Net
LNat
-

& SERLA
-
-
-

+t
c
T
LCat (80 %)
+

~
(20 ()

Contraction 15
 Calmodulin (north
- Cross-Bridge Cycle

Cat+ in Cytoplasma
↓
1
L Catt
Trop - . C
Detachment
I (A+ P)
=

↑
Attach
- cross-bridge formation -
Power-strike
heads binds contraction)
(Myosin
with Actin) 16
 10 Two-point discrim
② Braillesreading
CNS: Tactile Receptors

L
Point Edge
,

~
>
-

vibration (200 Hz)

corner

↳ Deep pressure

unming
touch
tine
essize
↳ Vibration (~ 50Hz) large
-

↳ moving touch
Skin
itct/tickle 17

Hairly
 Tendo-muscularzi
Proprioceptors ↳ Crendon)
↓
Y
A
Muscle Spindle &T
GTO > Tension
-

↳ Afferent Ib

(2-3) (5-9)
-
a

00
-
-
>

T
L
T
L ↑
Tength/ti
velocity
m e
18
 As
9 It
So
Aft-10
Tension
velocity length
Inverse-Stretch
Monosyna-Reflex ref [di synap)
-
-

to MS
OAp >
-
Efferent
(Sensitivity Ms)
 Ascending tracts
Dorsal Column Pathway:

B full
• Localizing pressure
• Vibration & Fine touch
• Proprioception
• =>
Two-points discrimination

Anterior Spinothalamic Tract:

• Crude touch & pressure
• Tickle and itch
• Sexual sensations

Lateral Spinothalamic Tract:

• Pain & temperature.
19
 Basal ganglia diseases
Hypokinetic:
• Parkinsonism: substantia nigra (some hyperkinetic features also)

Hyperkinetic:
• Hemiballismus: subthalamic nucleus.
• Huntington disease: Striatum (indirect pathway mainly)-involuntary
movement similar to hemiballismus.
• Dystonia: Direct pathway including basal ganglia– thalamocortical
network problem - Slower twisting movement.

20
 Important Nucleus of Hypothalamus

Nucleus Functions

Anterior Nucleus >

- Thermoregulation (Hot), Sexual behavior
Posterior Nucleus Thermoregulation (shivering)
Supra-chiasmatic Biological rhythm (circadian)
-
Lateral >
-
Thirst and hunger
-
Ventero-medial -Satiety

* Medial forebrain bundle -

Reward Centre

&
* Periaqueductal gray (PAG) Punishment centre (rage centre)
Anterior nucleus
--
-
TOsmoreceptor
 fasting motility (90min)
↑- stomach to ileum
Function
-

GIT: BER &L

MMCJ> -

Houskeeping
↳ Interval
↳
spenymic
BER Rate: = 90 min
• Stomach: 4
• Duodenum: 12 motilin
• Jejunum: 11 Muscle
BERIRMP of Smooth

M Spike pot
• Ileum: 8 -
.

• Coecum: 2 40 m -

⑭
-

Contraction
&

u
• Sigmoid: 6
-

-
65
-
S
1
D
Stimulatio
[ -

lose
Adv
,

-
- 22
 GI Hormones
• Gastrin:-G cell

YHi
• Peptides most potent stimulus.
• Distension of stomach & Ca++
• GRP (gastrin releasing peptides)-parasympathetic
• Fat & carbohydrate: NO effect

↳ GBmai am
• CCK:- I cell ,
• Peptides most potent stimulus
• FA
• Carbohydrate: NO effect

• Secretin:- S cell

3H5 Ser
• Acid most potent
• Protein digestive product
• Carbohydrate: NO role
• Fat: minor role
panvease .

23
 Absorption of nutrients in GIT

• Carbohydrate, proteins and lipids: • The daily fluid load approximates 9 L in

max absorption in duodenum, somewhat normal adults.
less in jejunum and much less in ileum.
• Small intestinal absorption is 8.8Lof
• Folate and iron: are only absorbed in water
duodenum (maximum) and proximal
• Jejunum 5.5 L daily
jejunum.
• Ileum 2.0
• Bile salt and cobalamin: are maximally • Colonic absorption 1.3
absorbed in distal ileum.
• Stool 100 mL (1%)

24
 Myocan CVS: Action Potential SA/AV
Phases
Oct
L
(4)
↓ Phases ↓
- r
~
Nat +
~

-n
k 4)
G ++ k V
+ V
~(
phaseo Phase 2

·
W -
5
- ~
-

-
CH
Pre-potential
or
Pacemaker 3 Natintux
potentia
↳ Gt (T-type rapid)
+

closure of
k+ 25
 PV Loop
Premme Ejection A to B -
Filling press
Tr
openit
cloor-Pr
~ -
B
pot is -
of SY

ofsv so-rol
V M
240 As
>
-
D

canocts) relaxation Iso-vol

~
v
A to
38/4t
contraction
~
-

T -FirstH-
N
V
W 3
M
-
n>
>
B Volume
A

"T ↓
-

T
L L EDY
26
 PV Loop in Valvular Diseases

increase
-
nu

↑
>
-
Right - Right T
L shiff

>
-

upward After load iner

-
-
EDVkt ↓
up.

Cardiovascular Physiology Concepts; Klabunde RE

7
L
left Shif 27
 MCQ
Effect of isotonic exercise on blood flow in the calf muscle during strong rhythmic
contractions is shown below. The blood flow was much less during contraction than
between contractions. Rhythmic increase in blood flow is mainly caused by:
-
A. Increase in arterial blood pressure

=B. Metabolic vasodilation main

C. Sympathetic medicated vasodilation
D. Cholinergic sympathetic system ⑭
Sphincter
Pre-Cap.
Arte -Capi
#
O -

O
-
8O
-

~ ~
LAdemosin
~
↓
& tabolites
open
&
R+ LAT
28
 Baroreceptor

Since Stretch Receptor

3
location : Cnotid
or
Antic Arch
Mechano-reupt
,

7 Baro
W
↑ BP

L 1
50mmizo-2oommits >

PPD) MAP
> Bano -
-
-

29
 G
7 ↓ HR

jest sin
R epert i
L
e
↑ ICT
↑ Htm -

Angiography
Venti irrs
CVS-Reflexes
.

M
~

I
Bridge
Bain Reflex Bezold-Janisch
-
-

ventr Wall I
Right Atrium wall Receptor left .

*
septum
Stretch RADQ Chemical
-capsaicin
* on

Cavenous
Return)
Seroton.
Eff- G
↑ HR Eff
. >
-

coronaly
XBP THR
Vasodil .

Aproea 30
 Renal: Glomerular Filtration Barrier
⑦

S
Freely filtrable: molecular radius <1.8nm

O • Na+, K+, H2O, Urea, Cl-, glucose,

Sucrose, polyethylene glycol, Inulin

Selective Permeable: molecular radius

⑦
1.8 to 4.2nm Neutral)) O
• Lysozyme, myoglobin, lactoglobulin,
egg albumin, Bence Jones protein,
Hemoglobin, serum albumin.

Impermeable: >4.2nm

31
 L
T
Epo -
Peritubular
cells of kidney
JG apparatus ↳⑦ CFL-E =

1. JG Cell: >
-

Aft art Smooth muscle

-
(modified)
↳ Intra-renal Baroreceptor (GBP)
↳ secrection Renin
2. Macula Densa:
- TAL(ThiCK) DCTOTAL junction
↳
,

Adenosin
Chemorecplar (Cl-/Nat)
+

3. Lacis Cell:

Extra-flom nusangial
↳ En ·

↳ Anti-infla
 Regulation of GFR
1. Autoregulation:
a) Myogenic mechanism > a -

b) Tubulo-glomerular Feedback Adenosin

c) Angiotensin II–mediated vasoconstriction

--
(contraction)
2. Afferent & Efferent arterioles resistance:

I ↓
T
T
Efferent
L
Afferent
L GFRH(later)
GFR & ↑ (fint

E
GFR fut
RPFL
S RPF ↓

33
 Clearance

GER = 125ml
CINYN =

Y
in
Secrected
-
in Nephron

CDGFR (es(r)
PAI

Absorption in Nephron
FGFR
(eg Net) .

34
 Absorption Curve: MCQ
Which curve describes the alanine profile along the nephron?
-
-

A. Curve A Sear (DAH)

-

B. Curve B "
-r(No
C. Curve C
D. Curve D
Absr/No See
Na 120
,

↓
in PCT
100
% Realsuption
(glucor/AA)
35
 Maxtdiv 3
rivelocity
.

(Cross-See Area
Respiratory: Biophysical Properties
Min)

va

Track- >
Alvedi O
Turbulare
Reynold's
Number

Resistance Max m
-
↳ to 5 (loban/deg bronchi ↓
Div . 4 Max
Trackea 36
-
-
 Stretchabilit
↳
Compliance Curves

Cary Mugsena) C
V

~
= -

compliant old
age) up
10

Namml 2000m
2 lit
8

=
WV
Lung Volume (L)

= .
6

em12o

n
up = 10

e
4

C
2000-200m/embo
2

=
To
10 20 30 40 50
Transpulmonary pressure (cmH2O)
 Spirometry Dynamic

FE !

Static
38
 OHDC & Right Shift

P50 = 23 to 26 mounts
39
 Causes of Left shift

2 . 3 DPG binds with B-chain 40

 Cell Signaling

• Endocrine: • Paracrine:
Diffession
↳-

• Autocrine: • Juxtacrine:

41
 ↑ Gs/Gi
GPCR: Adenylyl cyclase (effector)

G A
C

Gs
cAMP
Giv ↓

PKA
CREB
Gene
transcription
Phosphoprotein Effects

CAMR Res Elect

 Ga
GPCR: Phospholipase C (effect
Gg P
L
C

IP3 -
DAG
-

ER
T
G
PKC

O Ca++ Phosphoprotein Effects

Ca-Calmodulin complex Kinase activation Phosphoprotein Effects

 Hormones act through GPCR
Effector Second
messenger

Gs - AC ↑ cAMP ACTH, TSH, LH, FSH, CRH, PTH, MSH, glucagon,

calcitonin, ADH (V2 receptor),
β-adrenergic

GI - AC ↓ CAMP Somatostatin, ⍺-2 adrenergic, Ach (M2,4)

Gq - PLC ↑ IP3/DAG TRH, GnRH, GHRH, AgII, Oxytocin, ADH (V1

receptor), ⍺-1 adrenergic, Ach (M1,3, 5)
Ca+ /Ra
Cat
- Other Membrane receptors of Hormones

Type Messenger/Signaling Hormones

* Guanylyl cyclase ↑ cGMP ANP, EDRF, Nitric oxide

receptor
Receptor tyrosine MAP kinases, AKT Insulin, IGF-I
* kinase
Ras, Raf, MAPK EGF, NGF

* Cytokine receptor JAK-STAT GH, PRL

* Serine kinase Smads Activin, TGF-beta, MIS

45
 MCQ
Serum level of one hormone X is recorded throughout the day. Identify the
hormone X from the picture given below:
- GR
&
a) Growth hormone Sleep

(NREM)
b) Cortisol

(REM)
=
c) Estrogen

d) Insulin
Leep
↳ PRL
Lif
Aslt

46
 Factor controlling GH

1. Hypoglycaemia
PRL
• Fasting, exercise
O
+
2. Increase amino acids in plasma REM FSH
• Protein meal LI
3. Stressful stimuli
• Surgery, trauma
4. Sleep
• NREM stimulatory. REM inhibitory

47
 GH Functions

GH
Direct
- ↓Glucose uptake Stimulates bone & ↑ Protein synthesis ↑ Na+ K+ &
↑ Insulin resistance Cartilage growth in all tissue Water retention
↑ Lipolysis (↑Chondrogenesis) ↑ lean body mass.
↑ FFA

IGF -
I

Anti-Lipolysis ↑ Protein synthesis in chondrocytes ↑ Protein synthesis in muscle

↑ linear growth ↑ lean body mass.
 MCQ
Hormonal profile study shows of an adult is shown below. This diurnal variation in
plasma level results from the secretion of which of the following hormones?
-
A. Cortisol
B. Oestrogen Moving
C. Insulin
D. Thyroxine

49
Thank You

50