Medicine and Surgery - Roma Azienda Ospedaliera Sant'Andrea

Activity type

Funzioni biologiche integrate di organi, sistemi e apparati umani

SSD

BIO/09

Year

N/D

Semester

N/D

CFU

9

Hours distribution

84 classroom hours, 13 laboratory hours, 13 seminars hours

Lecturers

FRANCESCA GRASSI
ELEONORA PALMA
ROBERTA LIZIO

Activity type

Funzioni biologiche integrate di organi, sistemi e apparati umani, Formazione clinica interdisciplinare e medicina basata sulle evidenze

SSD

BIO/09, BIO/09

Year

N/D

Semester

N/D

CFU

7

Hours distribution

48 classroom hours, 13 seminars hours, 26 laboratory hours

Lecturers

General Objectives
At the end of the course, students must know the function of the organs in the human body; the dynamical integration of the various organs into systems; the general mechanisms of functional control under normal conditions; the normal values of the main functional parameters in healthy humans; the medical application of biophysical and biotechnological principles. They must also know some of the techniques used to measure physiological parameters.

Specific Objectives
Knowledge and understanding: passing the exam guarantees the understanding of the function of the organs in the human body; the dynamical integration of the various organs into systems; the general mechanisms of functional control under normal conditions; the normal values of the main functional parameters in healthy humans.
Ability to apply knowledge and understanding: passing the exam guarantees the ability to understand the normal values of the main functional parameters in healthy humans underlying the pathological processes in the biomedical field; the medical application of biophysical and biotechnological principles; ability to know and apply some of the techniques used to measure physiological parameters
Autonomy of judgment: passing the exam implies the ability to critically judge the normal values of the main functional parameters in healthy humans, underlying diseases.
Communication skills: passing the exam implies the ability to effectively use the communication tools of publications and scientific communications. Learning skills: passing the exam implies the transversal learning capacity common to the logic of scientific investigation in the biomedical field.

Knowledge and understanding: passing the exam guarantees the understanding of the function of the organs in the human body; the dynamical integration of the various organs into systems; the general mechanisms of functional control under normal conditions; the normal values of the main functional parameters in healthy humans.
Ability to apply knowledge and understanding: passing the exam guarantees the ability to understand the normal values of the main functional parameters in healthy humans underlying the pathological processes in the biomedical field; the medical application of biophysical and biotechnological principles; ability to know and apply some of the techniques used to measure physiological parameters
Autonomy of judgment: passing the exam implies the ability to critically judge the normal values of the main functional parameters in healthy humans, underlying diseases.
Communication skills: passing the exam implies the ability to effectively use the communication tools of publications and scientific communications.
Learning skills: passing the exam implies the transversal learning capacity common to the logic of scientific investigation in the biomedical field.

Module: HUMAN PHYSIOLOGY I
N/D
Module: HUMAN PHYSIOLOGY II
N/D

Core Curriculum

HUMAN PHYSIOLOGY I (2nd year – 1st semester, 9 credits)

Formal teaching
The cell as a fundamental unit: electrical parameters of the cell membrane and equivalent circuits; resting membrane potential; action potential. Voltage-dependent ion channels. Biophysical methods for the investigation of the membrane electrical activity.
Membrane receptors. Families of ionotropic receptors: structural analogies and functional peculiarities. Families of metabotroic receptors: structural analogies and functional peculiarities. Second messengers systems and signal transduction pathways.
Electrical synapses: structure and function. Chemical synapses. Spontaneous and evoked neurotransmitter release. Postsynaptic potential: spatial and temporal summation. The neuromuscular junction.
The muscle: structure and function of the three muscle types. The contraction of skeletal, smooth and cardiac muscle. Metabolic support of muscle contraction.
The autonomic nervous system: neurotransmitters; receptors; effects on target organs.
Functional organization of the central nervous system – Functions of the cortical areas
The nervous control of skeletal muscle. Motor units. Muscle spindles; muscle tone; simple and polysynaptic spinal reflexes. Reflex movements.
Functional organization of the motor system. The fundamental motor functions: posture; locomotion; reaching and handling; ocular movements. Role of motor cortex, cerebellum, basal ganglia.
Integrative brain functions: the hypothalamus and the circadian rhythms; sleep. The limbic system and affectivity; psychiatric disorders.
Thermal regulation: body temperature; mechanisms of heath production and loss – Hypothalamic regulation of body temperature- Fever.
Biological transducers: excitation of sensory receptors; encoding of sensory information; the transmission of sensory information to higher-order brain centres and its processing (sensation and perception).
The somatosensory system. Pain. Descending nociceptive pathways. Preliminary notions on gender differences in pain perception.
Biophysics and Physiology of vision. The eye and dioptric media; phototransduction; optic pathways; photo-accomodation reflexes and nistagmus. Principles of cortical processing of visual information.
Biophysics and Physiology of the ear. Audition: transmission of acoustic stimuli to the cochlea; biophysics of the Organ of Corti; auditory pathways. Vestibular apparatus: signal transduction; use of vestibular signals; vestibulo-ocular reflex.
Chemical senses: taste and smell (optional).
HUMAN PHYSIOLOGY II (2nd year – 2nd semester)

Formal teaching
General blood functions. Blood constituents: plasma, erythrocytes, leucocytes, platelets. Haemostasis.

The heart: physiological aspects of the myocardium; the cardiac cycle; regulation of the heart pump action. Myocardium excitation and conduction pathways; control mechanisms. Principles of Electrocardiography; the normal ECG. The circulation and the physical laws of haemodynamics. The functions of the arterial and venous systems. Cardiac output and venous return. Microcirculation and lymphatic system: blood-tissue exchanges. Control of blood flow and arterial pressure. Cardiovascular diseases.

Respiration: structure of the lungs. Pulmonary pressure and ventilation; Pulmonary volumes. Mechanical properties of the lungs. Pulmonary circulation. Gas exchange. Respiratory gas transport. Control of breathing.

The kidney and the body fluids. Body fluid compartments; water and salt equilibrium. Urine formation: glomerular filtration, tubular transport of the electrolytes, tubular water reabsorption and the regulation of fluid osmolarity. Micturition. Renal mechanisms for the control of blood and extracellular fluid volume. Regulation of the concentration of the principal electrolytes (sodium, potassium, calcium, magnesium, phosphate).

Acid-base balance: Body buffer systems for extracellular pH: plasma proteins, bicarbonate, phosphate. Renal regulation of the acid-base balance. Respiratory regulation of the acid-base balance. Disturbances of the acid-base balance.

Gastrointestinal physiology: motility, nervous control and blood circulation in the gastrointestinal tract. Food progression and mixing in the digestive tract. Gastrointestinal secretion: salivary, gastric, pancreatic, biliary, intestinal secretions. Food digestion. Absorption of water, nutrients and electrolytes in the small intestine. Absorption in the large intestine.

Endocrinology: hormone structure and action. Measurement of hormone levels. Pituitary hormones and hypothalamic control mechanisms. Thyroid hormones. Adrenocortical steroid hormones. Endocrine pancreas: insulin and glucagon. Parathyroid hormone and calcitonin: calcium and phosphate metabolism. Male and female sex steroid hormones. Reproduction and pregnancy.

Interactive activities
Clinical seminars from Faculty members. Students seminars, prepared under professors' supervision, to deepen some aspects of the formal program.

Optional activities

Seminars on themes of scientific research

Towards the clinics: Seminars by clinicians

Insights into the physiopathology of synaptic transmission:
Demyelinating diseases
Spinal reflexes: functional role and clinical use

Insights into the physiology of the cardiovascular system:
The electrocardiogram

Insights into renal physiology:
Electrolyte transport in the tubular system

Insights into gastrointestinal physiology:
Gastrointestinal motility

Boron & Boulpaep: Medical Physiology, 3rd edition. Elsevier

Module: HUMAN PHYSIOLOGY I
N/D
Module: HUMAN PHYSIOLOGY II
N/D

The course will mainly consist of lectures, with some clinical and practical seminaries by clinicians (towards the clinics). Some elective activities (optional) might be on-line. Continuously updated information on the course and course materials are available on the websites elearning.uniroma1.it/course/view.php?id=2133 (1st semester) and elearning.uniroma1.it/course/view.php?id=2134 (2nd semester)

Obliged

A unique exam for Physiology I and II takes place in the form of an interview, in which students are evaluated based on their ability in: describing physiological processes; relating different processes; using an adequate language.
In detail, during the exam the Students will be asked to describe and discuss, also drafting of pertinent graphs, aspects of the physiology of neuronal and muscle cells; of the integrated functioning of the nervous and muscular systems, of the cardiovascular, renal, respiratory, gastrointestinal and endocrine systems. The requirements for achieving the maximum score (30/30 with honors) are: Fully exhaustive answers to the questions posed - Critical vision of the interactions between the various physiological mechanisms - Excellent presentation skills with reference to the terminology and logical structure of the topics covered

In particular, Students must be capable to:
Describe water compartments of the body, the composition of intracellular and extracellular fluid, the methods to measure their volumes. Describe the main alterations of water compartments (hypo–, iso–, hyper–osmotic dehydration or hyper–hydration) and the body response to these changes

Describe the structure and function of ion channels. Describe the genesis of membrane potential. Describe the generation and propagation of action potential in myelinated and non–myelinated axons.. Explain the function of myelin and the consequences of myelin loss

Describe the structure and function of electrical synapses. Describe the structure and function of chemical synapses and the mechanism of neurotransmitter release. Explain post–synaptic potential, the mechanisms of temporal and spatial summation, the process of synaptic potentiation

Describe the structure and function of the neuromuscular junction, the safety margin, the genesis and propagation of action potential in skeletal muscle fibres. Describe the process of excitation–contraction coupling in skeletal muscle. Describe the sliding filaments theory and the cross–bridge cycle. Explain the impact on muscle function of different myosin isoforms and the relation with different pathways of ATP production. Describe isometric and isotonic contraction and the mechanisms of force regulation in skeletal muscle. Discuss the contribution of skeletal muscle to glucose and temperature homeostatic control

Describe the various modalities of excitation–contraction coupling in smooth muscle cells. Explain the molecules and mechanisms regulating thin and thick filament interaction in smooth muscle. Describe how contraction of smooth muscles is controlled and force regulated

Describe the functional organization of the Central Nervous System
Know the principles of sensory information coding Explain the functional meaning of the receptor potential Describe the functioning of the receptors involved in tactile, thermal, proprioceptive and pain perception Know how to outline the transmission paths of somatosensory information Describe the concept of receptive field in the periphery, in the thalamus and in the primary somatosensory cortex Describe the concept of somatotopy Know the main features of information processing in higher centers Describe the role of the nociceptive descending pathways Have basic information on gender differences in pain perception.

Describe the ocular globe and the function of the dioptric means Explain the functioning mechanisms of cones rods Describe the function and control of the intrinsic and extrinsic musculature of the eye Describe the photo-accommodation reflexes and nystagmus. Outline the visual pathway from eyes to the visual cortex Define the visual fields.

Describe the transmission of sound stimuli to the cochlea Correlate the function of the inner, middle and external ear to the most common hearing problems Describe the auditory transduction process in the organ of Corti Define the tonotopic organization of the cochlea Describe the auditory pathway to the cerebral cortex. Describe the mechanisms of signal transduction in the vestibular system Describe the principles of vestibular information processing in the central nervous system Describe the vestibulo-ocular reflex and its function

Describe the different types of voluntary and reflex movements Explain the mechanisms of muscle receptor function Draw the stretch reflex Define muscle tone Describe simple and polysynaptic spinal reflexes Describe basic motor functions Explain how body posture is maintained Describe the principles of control of rhythmic movements with particular regard to human locomotion Describe the functional anatomy of motor systems Outline the neural basis of voluntary movements of reaching, grasping, manipulating Describe the control of eye movements Describe the cortical areas involved in motor control Describe the functioning of the cerebellum and its role in motor control Describe the functioning of the basal ganglia circuitry and their role in motor control

Describe the integrative functions of the nervous system Describe the structure and function of the hypothalamus Explain circadian rhythms and sleep Know the principles of acquisition and analysis of an EEG tracing Define the limbic system, affectivity and psychiatric disorders Know the mechanisms of regulation of body temperature Describe the processes of heat production and loss Explain the regulation of temperature by the hypothalamus Define fever and indicate its functional significance

Describe blood composition and the functions of each component (plasma, erythrocytes, leukocytes, platelets)

Describe the overall function of the cardiovascular system and synthetically present the anatomical features related to each functional aspect Explain autorhythmicity in cardiac pacemaker cells, with reference to the ion currents underlying diastolic depolarization and action potential generation Sketch the time course of the action potential in each type of cardiomyocytes and discuss the differences Describe the phases of the action potential in working cardiomyocytes and explain their functional role Describe the process of excitation–contraction coupling in cardiac muscle Discuss the action of sympathetic and parasympathetic nervous systems on each of the processes listed above
Describe (and draw) the normal electrocardiogram (ECG) and the principles of electrocardiography: Einthoven triangle, vectorial interpretation. Summarize the main changes under pathological conditions (infarction, extra–systolic beat, bundle block) Describe the cardiac cycle and its relations with ECG and heart sounds Define stroke volume, cardiac output, preload, afterload, cardiac work, cardiac efficiency Describe how changes in preload, afterload and contractility affect cardiac work, drawing the corresponding pressure–volume graphs. Explain the intrinsic and extrinsic regulation of cardiac output: Frank–Starling law, nervous and humoral regulation. Describe the regulation of venous return and the relation with cardiac output, sketching Guyton's diagrams.
Define the relation among blood pressure, total peripheral resistance and cardiac output Explain the relation between blood pressure and wall tension (Law of Laplace) Describe the global functions of the vessels and introduce the concept of compliance Define vessel resistance Explain the role of aorta in the regulation of blood flow. Define systolic, diastolic and mean arterial pressure Describe the methods to measure arterial blood pressure and the origin of Korotkoff sounds
Explain the effects of gravity on blood flow Describe function of veins, venous valves and the venous pump Describe the functions of arterioles, capillaries and lymphatic vessels. Define Starling equation for fluid filtration and explain edema formation Explain the short, middle and long term regulation of blood pressure. Describe the nervous mechanisms of blood pressure control Describe the renin–angiotensin–aldosterone system Explain the regulation of local blood flow Describe the coronary circulation Summarize the main differences between systemic and pulmonary circulation Discuss the integrated response to hemorrhage

Describe the overall function of the renal system and synthetically present the anatomical features related to each functional aspect Introduce renal clearance and describe the methods for its measurements Describe glomerular filtration and the relevant mechanisms of control (autoregulation, tubulo–glomerular feedback, nervous and hormonal regulation). Define the glomerular filtration rate and filtered load. Discuss the main transport pathways across tubular epithelium Describe the main processes of reabsorption and secretion in the proximal tubule and their regulation. Explain the glomerulotubular balance Describe the function of the different tracts of the loop of Henle Describe the main processes of reabsorption and secretion in the distal tubule and the collecting duct and their hormonal regulation Explain the countercurrent mechanism and its relevance to the regulation of urine volume Discuss the integrated process of control of urine volume and concentration. Define water balance Describe the homeostatic control of Na+ excretion and define Na+ balance Describe K+ balance and the control of K+ excretion Describe the control of Ca2+, Mg2+ and Pi excretion Explain pressure diuresis and the involvement of the different nephron segments Describe urine transport to the bladder, storage and micturition

Describe the overall function of the pulmonary system and synthetically present the anatomical features related to each functional aspect Discuss the peculiar features of pulmonary circulation Describe the functions of the airways Introduce alveolar and pleural pressure and transmural pressures. Explain the relation between volume and pressure in the lungs (Boyle's law). Describe the function of inspiratory and expiratory muscles in normal and forced breathing Define lung volumes and capacities and draw the time course of lung volume changes during normal and forced respiration (spirometric exam) Define pulmonary ventilation and alveolar ventilation Define static and dynamic compliance of the lungs, chest wall and total system Describe the function of surfactant Explain respiratory work and introduce the main changes occurring in lung diseases Describe gas exchange in alveoli, also writing the alveolar gas equation and Fick's law of diffusion Describe transport of oxygen and carbon dioxide in bloodstream and draw hemoglobin saturation curve Describe gas exchange in peripheral tissues, with reference to factors enhancing or limiting the exchange Define ventilation–perfusion ratio and explain how it is influenced by posture, exercise and disease Explain how ventilation is regulated and adapted to body needs Describe pH values in intracellular and extracellular fluids and explain how lungs and kidneys cooperate to maintain reference values

Describe the overall function of the digestive system and synthetically present the anatomical features related to each functional aspect Describe the processing of a piece of food from mouth to anus Describe the organization and function of the enteric nervous system, explaining reflexes Describe the motility patterns in each tract of the gastrointestinal system (mastication, deglutition, peristalsis, mixing movements, mass movements, migrating motor complex) Define the function of sphincters Describe the glands in each tract of the gastrointestinal system (mouth, stomach, pancreas, liver small and large intestine) Describe the secretions of each tract of the gastrointestinal system (saliva, gastric juice, pancreatic juice, bile, mucus) and the mechanisms regulating secretion Explain hormonal regulation of gastrointestinal function Explain the cross–talk between stomach and small intestine Describe the digestion and absorption of the main food constituents (carbohydrates, proteins, lipids) Describe the absorption of inorganic elements (sodium, calcium, iron) Define transit time Explain reverse peristalsis and vomiting Discuss the control of food intake Introduce the intestinal microbiota and its relevance to health and disease

Describe the overall function of the endocrine system and synthetically present the anatomy of each gland Describe the classes of hormone structure and action Describe the main techniques to measure hormone levels. Describe the hypotalamic-pituitary axis. List pituitary hormones and hypothalamic releasing factors. Describe mechanisms that regulate secretion of releasing factors and hormones. Contrast feed–back and feed–forward processes. Describe the synthesis, release and transport of thyroid hormones. Explain the action of T3 and T4 on target organs. Discuss the regulation of hormone production and release Describe the synthesis, release and transport of adrenocortical steroid hormones. Explain the action of the hormones on target organs. Discuss the regulation of hormone production and release Describe the synthesis, release and transport of pancreatic hormones (insulin and glucagon). Explain the action of the hormones on target organs. Discuss the regulation of hormone production and release. Describe glucose homeostasis and its dysregulation. Introduce diabetes mellitus. Describe the synthesis, release and transport of parathyroid hormone and calcitonin. Explain the action of the hormones on target organs. Discuss the regulation of hormone production and release. Describe calcium and phosphate metabolism. Describe the synthesis, release and transport of male and female sex steroid hormones. Explain the action of the hormones on target organs. Discuss the regulation of hormone production and release. Describe the main hormonal changes underlying reproduction and pregnancy.

At the end of the 1st semester, enrolled students can take an exemptive test in the form of multiple choice quizzes. The number of questions and their structure varies from 30 to 60 depending on the support available (manual correction, automatic correction, use of exam.net). The time available is typically 1.5 minutes/question.

Typical questions for Physiology 1 + 2
NOTE: THESE ARE NOT THE ONLY QUESTIONS ASKED
1. What is an action potential? Describe action potentials in neurons/ skeletal muscle/
cardiac muscle
2. Synaptic transmission
3. Muscle contraction; excitation-contraction coupling in / skeletal muscle/ cardiac
muscle/ smooth muscle
4. Cardiac output and its regulation
5. Short-term blood pressure regulation
6. Long-term blood pressure regulation
7. Sodium handling in the kidneys
8. Control of urine volume
9. Functions of proximal/ distal tubule of nephrons
10. Gastric functions
11. Digestion and absorption of carbohydrates / proteins/ lipids
12. Motility patterns in gastro-intestinal tract
13. Calcium homeostasis: main hormones and their mechanism of action
14. Glucose homeostasis: main hormones and their mechanism of action
15. Mechanics of respiration
16. Regulation of respiration
17. Gas exchange at alveoli/blood interface
18. Acid-base equilibrium: maintenance and response to alterations

• Fundamental processes of cell excitability; synaptic transmission (15 hours)
  • Books: v. Testi


• Physiology of skeletal, smooth and cardiac muscle  (15 hours)
  • Books: v. Testi


• Physiology of sensory functions (15 hours)
  • Books: v. Testi


• Hypothalamic control of vital functions (12 ore)
  • Books: v Testi


• Neural control of motor functions (15 hours)
  • Books: v. Testi


• Physiology of cardiovascular system (15 hours)
  • Books: v. Testi


• Physiology of respiratory system (15 hours)
  • Books: v. Testi


• Physiology of renal system (15 hours)
  • Books: v. Testi


• Physiology of digestive system (15 hours)
  • Books: v. Testi


• Physiology of endocrine system (15 hours)
  • Books: v. Testi


• Integrated control of vital functions (10 hours)
  • Books: v. Testi