Human Physiology

Course Code and Title:  BIOL 441 - Human Physiology

Number of Credits: 4

Days and Times: Wednesday 8:30 AM, Thursday 1:00 PM, Friday 8:30AM

Semester and Year: Spring 2022

Classroom Location: Online and On-site Delivery

Course Email Address: physiology441@sgu.edu (to be used for all course related matters)

Course Director Name: Dr. Janine and Dr. Esther Johnson

Course Director Contact Information: jpaul@sgu.edu  and ejohnso3@sgu.edu  

Course Lecturer(s) Office Hours: varies according to faculty 

Course Director Office Hours: varies weekly 

Course Director Office Location: Lower Charter Hall, 

Course Support: Ms. Kamille Williams, kwilliams@sgu.edu

Course Management tool:  Sakai, To learn to use the Course management tool, access the link https://apps.sgu.edu/members.nsf/mycoursesintro.pdf

BI O L 4 4 1 H U M AN P H Y S I O L O G Y – C O U R S E D E S C R I P T I O N

Human Physiology (BIOL 441) is a 4-credit course presented over 16 weeks as part of the discipline-based Premedical Science curriculum of St George’s University School of Medicine. It is designed to provide a fundamental basis for understanding human physiology pertinent to clinical medicine based on the Medical Physiology Learning Objectives published by the American Physiological Society (APS). It is one of the final prerequisite courses for the third-year Premedical Sciences and Biology students, and a central component of the Charter Foundations to Medicine program. Course topics teaching the essential elements, concepts and organ systems in human physiology are delivered across four consecutive blocks:

Module Name	Duration (weeks)
Block 1- (CTP) Cell and Tissue Physiology: Homeostasis, Excitable tissue, & Intro to Nervous System	4
Block 2- (S1) Systems: Neurophysiology, Autonomic Nervous, & Cardiovascular Systems	4
Block 3- (S2) Systems: Pulmonary, Gastrointestinal Systems	4
Block 4- (S3) Systems: Renal, Endocrine Systems	4
Total:	16

(CTP) CELL AND TISSUE PHYSIOLOGY: HOMEOSTASIS, EXCITABLE TISSUES, & INTRO TO NEUROPHYSIOLOGY

The theme of this block is to provide a solid foundation with the basic concepts of physiology and their application to the organ systems subsequently encountered in this course and throughout undergraduate medical education. Students will be introduced to the language embedded in physiology, the biological molecules associated with cells, tissues and organs and their roles in physiological processes. This block includes homeostasis and its control, properties of excitable tissues, and an introduction to neurophysiology. This will lead the students towards functional of understanding normal and abnormal human physiology, interpretation of clinical data, and eventual recognition of pathophysiological conditions. Group-based interactive sessions are introduced early in the block to facilitate both student learning and the development of collaborative interpersonal skills in accordance with the Association of Medical Colleges (AAMC) guidelines on professional competencies1,2.

(S1) SYSTEM:  NEUROPHYSIOLOGY, AUTONOMICS, & CARDIOVASCULAR SYSTEM

The goal of this block is to provide students with a comprehensive knowledge base for understanding the Nervous and Cardiovascular systems. Building upon the concepts from block 1, the normal gross and microscopic anatomy, molecular mechanisms, physiologic functions will be presented. Particular attention is given to the interrelation of these two systems via the autonomic nervous system (ANS), and provides the foundation upon which all of the body’s homeostatic responses are further considered. Collaborative group sessions are an integral component for mastering the content explored in this module.

(S2) SYSTEMS: RESPIRATORY & GASTROINTESTINAL SYSTEMS

Systems 2 expands students' knowledge base with the Pulmonary and Gastrointestinal systems. Again, lectures introduce the normal gross and microscopic anatomy, molecular mechanisms, physiologic functions of these systems, and integration with content from previous blocks continues to be emphasized. Diseases such as Asthma and COPD are used to illustrate key principles. Additionally, significant attention is given to the dynamic physiologic relationship between the Nervous, Cardiovascular, and Pulmonary systems underlying the body’s capacity to preserve homeostasis and adapt to life’s everchanging conditions. The GI system provides several examples of how its structure and function compare and contrast to processes covered previously. Group sessions remain essential for student understanding of the complex interactions between these systems.

(S3) SYSTEMS: ENDOCRINE & RENAL SYSTEMS

This block culminates with the Endocrine and Renal systems. Normal gross and microscopic anatomy, molecular mechanisms, and physiologic functions are presented. The vital role that these systems play in regulation of fluid balance, electrolytes, nutrients, and energy are incorporated with previous systems to explain the body’s ability to maintain the homeostatic environment necessary for sustained health and growth over the longterm. The mechanisms of reproduction are discussed, as well as diabetes and the impact of hyperglycemia across multiple organ systems. Group sessions continue to be instrumental as consideration of physiological function throughout the whole human body is discussed and applied to clinical situations.

GOALS AND OBJECTIVES 

MI S SION

The BIOL441 Human Physiology Course embraces the mission of the Doctor of Medicine Program of St. George’s University School of Medicine:

“To provide an international, culturally diverse environment in which students learn the knowledge, skills and attitudes required for postgraduate training in the health profession while being inspired to develop compassion, curiosity, tolerance and commitment to patients and society, dedication to life-long learning and an understanding of the vital role of research in healthcare.”

ENTERING MEDICAL STUDENT EXPECTATIONS

As an integral component of St George’s University’s Premedical Sciences course offerings,

BIOL441Human Physiology prepares students to meet several of the AAMC’s Entering

Medical Student Expectations, or Entrance Competencies (E1.1, 1.2, 1.3, 1.6, 1.7; E3.1, 3.2, 3.4, 3.6; E4.3, 4.4, 4.5; E5.1, 5.2; E6.1-6.4; E7.1-7.3 below) by providing students with opportunities to:

“Demonstrate both knowledge of and ability to use basic principles of mathematics and statistics, physics, chemistry, biochemistry, and biology needed for the application of the sciences to human health and disease; demonstrate observational and analytical skills and the ability to apply those skills and principles to biological situations.”

ADMINISTRATIVE QUESTIONS

For all administrative questions (including notification of absence from lab or small group activities) contact our departmental secretaries, module coordinators and course directors at:

SGU Premedical Science Department, 

Physiology Department Grenada – physiology441@sgu.edu  

(Please do not send a message to all faculty or to individual faculty members). Faculty and staff will not respond to emails during the weekend. Last email responded to will be Friday at 4:00pm.

CONTENT RELATED QUESTI ONS & FAQ

For all content-related questions, the most efficient way of interacting with your peers and faculty is by using the Discussion Form in Sakai, the learning management system. Students can find a more detailed description of the Discussion Forum in the student support section below.

Frequently asked questions can be found in a supplemental document on Sakai resources folder.

C O U R S E L E A D E R S H I P T E A M

SGU BIOL441, Grenada	Department	Email Address
Course Directors Dr Janine Paul Dr Esther Johnson	Physiology/Neuroscience	jpaul@sgu.edu   ejohnso3@sgu.edu

 T EA C H I N G F A C U L T Y

SGU BIOL441, Grenada	Department	Email Address
Dr Gabrielle Walcott-Bedeau	Physiology/Neuroscience	gwalcott@sgu.edu
Dr. Noah Leton	Physiology/Neuroscience	nleton@sgu.edu
Dr Kesava Mandalaneni	Physiology/Neuroscience	kmandalaneni@sgu.edu
(SumDr Nilo Alvarez Toledo mer	Physiology/Neuroscience	Nalvare1@sgu.edu
Dr Juanette McKenzie	Physiology/Neuroscience	JMckenzi@sgu.edu
Dr Earlan Charles	Physiology/Neuroscience	echrle3@sgu.edu
Dr Alvin Chitterman	Physiology/Neuroscience	Achitte1@sgu.edu
Dr. Janine Paul	Physiology/Neuroscience	jpaul@sgu.edu
Dr. Esther Johnson	Physiology/Neuroscience	ejohnso3@sgu.edu

SUP  PO RT ST AFF                          

SGU BIOL441, Grenada	Department	Email Address
Kamille Williams              Executive Secretary	Physiology and Neuroscience	kwilliams@sgu.edu

C O P Y R I G H T

Copyright 2021 St. George's University. All rights reserved.

All course material, whether in print or online, is protected by copyright. Course materials, in part or in their entirety, may not be copied, distributed or published in any form, printed, electronic or otherwise.

As an exception, students enrolled in the course are permitted to make electronic or print copies of all downloadable files for personal and classroom use only, provided that no alterations to the documents are made and that the copyright statement is maintained in all copies.

Lecture recordings are explicitly excluded from download and creating copies of these recordings by students and other users is strictly prohibited.

COURSE WEBSITE

The BIOL441 Human Physiology course offers a website through Sakai, our learning management system. This site is used for COMMUNICATION (including Announcements, Calendar and Discussion Forums), COURSE TOOLS (including Lessons, Tests & Quizzes, Gradebook, a web link to the student resources of the Required Books, and a link to Lecture Recordings).

To login, go to https://mycourses.sgu.edu/portal, type in your user ID and password.

ELECTRONIC RESOURCES

Distribution of course material will be in electronic format, with a table of contents hyperlinked to the different sections within each document. Links to external websites are included, where appropriate. In accordance with Committee for Technology based Teaching and Learning (CTTL) recommendation, students are provided with unlocked PDF files, which may be annotated for personal use. This format facilitates active learning, as it allows highlighting and annotations, using a variety of platforms, operating systems and annotation software. Copyright restrictions regarding the duplication of materials apply (see copyright statement above).

Resources folder contains multiple subfolders in which you will be able to find the course material provided.

Please note: electronic versions of course materials posted on the course website are the most up-to-date versions. It is the responsibility of each student to check on the latest available electronic versions for possible updates and corrections.

REQUIRED TEXTBOOK S

Medical Physiology: Principles for Clinical Medicine; 5th ed, Rhoades and Bell

This textbook is also available for free online through the SGU library via this link: https://mededlwwhealthlibrary-com.periodicals.sgu.edu/book.aspx?bookid=2188  Optional additional resources for self-study:

List of all online medical textbooks available through SGU library: https://mycampus.sgu.edu/group/library/ebooks

Free online access for SGU students (requires log-in with SGU credentials) AccessMedicine https://accessmedicine.mhmedical.com.periodicals.sgu.edu/

Searchable medical textbooks. Highly recommended with search function to look up concepts relevant to pre-medical student education. Clinical Key https://www.clinicalkey.com/student/  

R E Q U I R E D E L EC T R O N IC E Q U I P M E N T

Laptop

Students need a personal laptop as specified by SGU Examination Services. It is the responsibility of each student to ensure his/her laptop is in full working condition, as specified by Examination Services, and keep it up to date and equipped for the SGU wireless network at all times.

Clicker/ Turning Point App

An Audience Response System (clicker/app) is used to assess student participation and performance in instructional sessions. Its use reflects the participation and performance of the student to whom the device is registered. Students are recommended to respond to questions using the web browser (ttpoll.com) or via the turning Point app for smart phones to fully participate in live sessions. 

Throughout the term, a student may use only a single clicker(login), which has been registered to their name. Clicker devices are not to be shared with any other student, temporarily re-registered under a different name, or used on behalf of any other student. Each student is responsible for the registration of their individual clicker and is further responsible to keep it in full working condition at all times during the course. Any problems with the device should be reported to the Course Director on the day the problem occurs and adequate steps should be taken to resolve the issue, e.g. battery replacement, or repair or replacement of device. Students are required to bring their clicker to every scheduled teaching session.

L E C T U R E S

Lectures are an essential component of the BIOL441 course. They are designed to provide students with an outline of what they are expected to know, to prioritize important aspects of course content, to clarify complex material, and to make relevant connections to clinical contexts. Most lecturers will focus more on difficult concepts than on self-explanatory facts.

Many of the course sessions are delivered through on-line recordings of full-length lectures. The delivery of asynchronous on-line lectures allows students greater flexibility for when and where the lectures are viewed and promotes self-directed learning. Content from all lectures, synchronous or asynchronous are testable material. 

The posted lecture slides may not be comprehensive and do not replace the need to read textbooks. It is an important learning exercise for students to read textbooks and glean important information related to course objectives. Lecture slides are not intended to be used in isolation, but rather as a complement to the lecturer’s narrative.

Each lecture contains formative assessment, usually in the format of at least 2 clicker questions of which the first and last questions must be answered. Students must submit a minimum number of these formative lecture assessments in order to pass the course. The minimum number of submissions for this course component is listed in the tables below.

DIRECTED LEARNING ACTIVITIES  

Pre-requisite knowledge or simple content may be presented online as short videos. These videos will be available via the course management site and can be viewed at any time. The videos are designed to focus on key topics that are pre-requisite knowledge or where there is benefit to reviewing core knowledge before its application in lecture.

DLAs are exercises developed by Faculty to support, complement, and/or supplement the learning of the class and are available through the course management site in different formats, including PDF handouts, Panopto videos, Research papers etc. These DLAs are mandatory and the content of the DLA’s is testable material. The sequence in which the exercises should be completed is important as it coordinates with the lecture(s) they are supporting. The DLAs and the timeline will be available via the course management site and can be viewed at any time.

S M A LL G R O U P (SG) P R A C T I C AL S E S SI O N S

Small Group Practical Sessions (SGs) are an essential component of the BIOL441 course, organized with approximately 8-10 students per group and supervised by Clinical Tutors who facilitate and encourage critical thinking through group discussions. A clinical case will also be provided during every session to allow students the opportunity to apply the basic physiological concepts to real life situations. The key of these sessions is student-student interaction and the success of these sessions largely depends on all members of the team coming prepared and actively participating in the discussion.

Details on the organization of the Small group discussion sessions are provided in the small group discussion manual, which will be distributed via sakai the week before the small group session is scheduled to begin.

Each small group practical session contains a formative assessment. These can take the form of clicker questions, a worksheet or an online prerequisite or post SG assessment. Students must submit a minimum number of these formative practical assessments in order to pass the course. The  minimum number of submissions for this course component is listed in the tables below.

Small Group Requirements:  white board markers, clickers

Textbooks and small group handout/supplement for the topic being covered Dress Code (see below)

SG Regulations:

• Students must wear their SGU Photo ID at all times and place it in such a way that it is clearly visible by faculty.
• The laboratory learning resources such as plastic models, and surface pros are expensive and limited in number. Students should take special care when they handle them.
• Food and drinks are not permitted in the lab at any time (that includes chewing gum and drinking water).
• Taking pictures is not allowed in the lab at any time.
• Use of cell phones is restricted. If at all necessary in the lab, students should use the vibration mode and not answer the phone while in the lab.
• For any lost items in the SG session please ask the assistance of any of the technicians for that venue.

D R E SS C O D E (S M A LL G R O U P)

Students are expected to dress in a professional manner when attending lectures and small group/ Lab sessions.

Professional Dress includes:

Clean, odor-free, and not overly worn or revealing clothing.

Unprofessional Dress includes:

Tank tops, see through clothing, short shorts, sunglasses, flip flops, heels, etc.

IN T E R A C T I V E M U L T I P L E C H O I C E Q U E S T I O N ( I M C Q ) S E S SI O N S OR PROBLEM-BASED LEARNING SESSION 

Interactive multiple-choice question (IMCQ) sessions aim to enhance a student’s test-taking skills and increase their exposure to USMLE style multiple choice single best answer questions, which is the standard style for all electronic examinations at St George’s University School of Medicine. These sessions will improve students’ approach to answering MCQs and emphasize the link between questions and course objectives. As a learning tool, IMCQs provide students with valuable formative feedback enabling them to modify their approach to learning course content, and to identify weaknesses that require remediation.

There will be several non-graded IMCQ and problem-based learning sessions over the semester, 

It is essential to actively participate in the discussions with classmates to train yourself in the critical clinical thinking and reasoning process in order to be able to master IMCQs from these sessions. In order to adequately prepare for the critical thinking and clinical reasoning processes required in IMCQ sessions, students are encouraged to actively participate in discussions with classmates during their study sessions. Questions used during IMCQ sessions will be posted on the course Sakai after delivery. 

D I R E C T ED S E L F S T U D Y / G R O U P ST U D Y

Apart from studying independently, students are encouraged to form their own study groups of 3 to 5 active members. These groups should meet about once a week to discuss difficult course concepts. Active participation in these small group discussions is essential to students’ successful understanding, application, and mastery of course material.

O N L I N E A C T I VI T I E S : W EEK L Y S A K AI P R A C T I C E Q U I Z Z E S A N D

EXAMSOFTQUIZZES 

Practice quizzes will be provided every week, each comprised of 20 questions delivered via SAKAI within a 30-minute time window. Students earn 1 point for each of the practice quizzes. A minimum number of correct answers is NOT required. Students will earn the point for uploading a completed quiz irrespective of the number of correct answers. Detailed feedback for each question will be provided at the closing time of each quiz.  ESoft Quizzes are announced on Sakai each week. 

Scoring of E-Soft Quiz: Students must complete the quiz and upload the results before the specified deadline to earn the 2 points associated with each quiz (2 points x 4 quizzes = 8 possible points). Accuracy is not considered.

C O U R S E A N D I N ST R U C T O R C R I T I Q U E

Students are expected to attend all classes and other related academic activities as defined for each course by the course director*. One such academic activity is participation in the St. George’s University (SGU) Course and Instructor Critique Program.

Student Participation in the Evaluation Process is Mandatory

When requested, students enrolled in a course are expected to complete all required faculty and course evaluations. Failure to complete all required course and instructor critiques will mean that students did not fulfill all course requirements. The critiques coordinator will notify students when evaluation periods have begun and send periodic reminders to ensure that critiques are submitted within the allotted time frame.

The Importance of Evaluation

Evaluation is a necessary component of any course. Just as students anticipate a fair and accurate evaluation of their performance and achievement in a course, SGU requires that faculty and course evaluations be completed each term. Continual evaluation and assessment of faculty ensures that the instructional program not only remains consistent, but also improves to meet the needs and expectations of students.

Feedback

At the beginning of each term, course directors address the class and summarize the results of the course and instructor critiques from the previous term. In this summary, course directors will report areas that students rated highly and areas that received the lowest ratings. For areas receiving low ratings, the course director details what changes were made to address students’ concerns, thus ensuring that course evaluation influences course design and delivery.

L A B E V A L U A T I O N

At the end of every SG session for pre-midterm and post-midterm, students are given the opportunity to evaluate the SG experience. The evaluation will be on Sakai and should be completed before the end of the specified deadline. Students will assess the session based on the criteria outlined in the Sakai evaluation form.

COURSE ASSESSMENTS

Course assessments may be summative (counting towards points in the gradebook), formative (giving valuable feedback to students to optimize their learning strategies), or both.

Summative assessments include written (electronic) examinations, and the assessment of professionalism.

Formative assessments are essential components of each scheduled course session. A minimum number of submissions of these formative assessments is required in order to pass the course.

A SS ESS M E N T P O I N T S

Course assessments may be summative (counting towards points in the gradebook), formative (giving valuable feedback to students to optimize their learning strategies but do not contribute to the gradebook), or both. 

Summative Assessments

Include electronic examinations (ExamSoft), lab examinations and SG/LA assessments. These contribute points to your course grade.

Summative Assessment Points

The total assessment points that can be earned in the course are listed in the table below:

The total assessment points that can be earned in the course are listed in the table below:

Assessment	Points	Points Breakdown	%
Exam 1	50	50 MCQ x 1 point	20
Exam 2	50	50 MCQ x 1 point	20
Exam 3	50	50 MCQ x 1 point	20
Exam 4	50	50 MCQ x 1 point	20
Small Group Practical Assessments	20	10 SG x 2 point	8.4
Exam-soft Quizzes	4	2 points per quizz	1.6
Weekly Online Quizzes	10	1 quiz x 1 point	4.2
Professionalism	6		2.6
Total:	240		100

Each exam consists of 50 questions from the lecture block preceding the exam date. These questions can be in first order, second or third order questions. Each exam will have a small percentage of clinical vignettes (approximately 5-10 questions). Exams 2- 4 will contain questions on cumulative material from the contents covered in previous exams. This is geared towards preparation for PMSCE exams and long-term memory. 

Each question is allotted an approximate time of 82 seconds (one hour and 15 minutes per exam).

Electronic examinations are in multiple-choice-single-best-answer format, following the guidelines of the National Board of Medical Examiners (NBME). The NBME provides the United States Medical Licensing Examination (USMLE), a three-step examination for medical licensure in the United States, which is sponsored by the Federation of State Medical Boards (FSMB) and NBME.

The final grade will include scores obtained from the 4 exams and points assigned to lab activities/ quizzes/ IMCQ sessions and discussion forums.

Grades are awarded based on percentage scores (see scoring and grading policy below). The following table is intended to help you to determine your letter grade based on raw points earned in the BIOL441 course:

Raw Points	Percentage %	Letter Grade
240	100	A+
216-239	90-99	A
204 - 215	85-89	B+
192-203	80-84	B
180-191	75-79	C+
168-179	70-74	C
156- 167	65-69	D
<155	<65	F

In order to pass the course the student will need 155 points or above, and has to meet all participation criteria (group participation and submission of minimum number of formative assessments). A student fails the course with less than 155 points.

Disclaimer: To protect against any errors in the calculation of the equivalent raw points above, grades will be determined purely based on the officially published grading scale (in percentage scores) in the Sakai gradebook listed in the scoring and  grading policy (see below).

W R IT T EN (E L E C T R O N I C) E X A M I N A T I O N S

Written electronic examinations are in multiple-choice-single-best-answer format, following the guidelines of the National Board of Medical Examiners (NBME). The NBME provides the United States Medical Licensing Examination (USMLE), a three-step examination for medical licensure in the United States, which is sponsored by the Federation of State Medical Boards (FSMB) and NBME.

Question Format

The time allocation per question is 82 seconds. The vast majority of the questions are in Clinical Vignette format, with some in Experimental Vignette format. There may be a few questions in Non-Vignette (first order) format. Most questions, however, are higher order questions.

The figure below shows a model developed by Rex Heer (2012), a revision of Bloom’s taxono y, and illustrates knowledge and cognitive process dimension of learning objectives related to questions. A “first order question”, which is in essence factual recall through memorization, represents the lowest level of learning.

“Higher order questions”, in contrast, require integration, differentiation and judgment, to list just a few of the learning attributes.

Model created by: Rex Heer, Iowa State University, Center for Excellence in Learning and Teaching, Updated January 2012.

Retrieved from: http://www.celt.iastate.edu/wp-content/uploads/2015/09/RevisedBloomsHandout-1.pdf (2016-08-12)

Axis of Truth

According to NBME guidelines, answer choices are located at any point along an “axis of truth” (see illustration on the right from: http://download.usmle.org, retrieved 2014- 08-19). The axis ranges from “unequivocally true” to “absolutely false”

The vast majority of questions has 5 choices, while some may have only 4 choices, others may have 10 choices (A to J) or more, according to the most recent 2016 sample presented on the USMLE website (http://usmle.org/pdfs/step- /2016samples_step1.pdf, retrieved 2016-05- 17).

Choices are rarely “unequivocally true” or “absolutely false”. It is a common misunderstanding that a multiple-choice question has to have one “unequivocally true” answer choice and a series of “absolutely false” answer choices.

In reality, most answer choices are located between these two extremes and the good student will be able to determine the one best answer that will earn the point.

Experimental Questions

Testing of new, previously untested/ experimental questions is an essential component of question bank development. Such questions may not be used untested to count towards students’ grades. For each written examination, approximately 10 untested questions will be included to determine their validity and reliability. These questions will not count toward a student’s grade. The term “experimental question” does not imply a different format or difficulty level. These are standard questions. If these questions generate reliable statistics during the testing process, they will become part of the regular question bank for use in future exams as regular exam items. This process ensures that all assessments are set with well performing exam items only.

For quality control across all courses offered by St George’s University School of Medicine, the Curriculum Committee regularly monitors and reviews all test items used in School of Medicine examinations.

S M A L L G R O U P PR A C T IC A L

In each session there will be an assessment given in the form of a online activity, clicker questions or a worksheet which will be worth 2 points. Students will be given points based on the accuracy of their answers. (50% earns your 2 points). Make up sessions will not be offered.

P R O F E S SI O N A L I S M A SS ESSMENT

Professional behavior, communication and interpersonal skills will be assessed based on the assessment form shown in Section C. This form has been adapted to the needs of a basic science course from the American Association of Medical Colleges (AAMC) Medical Student Performance Evaluation (MSPE) advisory committee. It addresses timeliness, compliance, accountability, appearance, interactions, teamwork, motivation and respect.

The total number of professionalism points is listed in the table above. It is anticipated that students will demonstrate professional behavior at all times, and therefore, earn their full professionalism points, should there be documented evidence of students failure to demonstrate expected professional behavior as assessed in the BIOL441 course, he/she may lose one or more professionalism points and/or the incident can be reported to the Dean of Students and may result in disciplinary action. The number of points deducted is at the discretion of the Course Director, which is not negotiable.

FO R MAT I VE A SSE S SME NT S

Formative assessments are an essential component of the BIOL441 course. In addition to the formative character, some of the assessments may in addition have a small summative character (for points contributing to the final course grade). These assessments are delivered during every scheduled course session (see course components above). A student needs to submit/attend a minimum number of 80% of these assessments in each category in order to pass the course. 

According to the Student Manual, participation in all scheduled activities is mandatory. Students are not entitled to miss any scheduled activities. The reduced participation requirement provides for any unavoidable circumstances that may occur.

Failure to meet the minimum requirement of formative assessment submissions may result in an F grade for the BIOL441 course irrespective of the reason for non-submission. Medical and non-medical excuses are only accepted for summative assessments.

Makeup sessions are not offered for the formative assessment components of the course.

S T U D E N T SU P P O R T D I S C U S S I O N F O R U M

The major platform for all content related questions is the Discussion Forum on the course website. Students are encouraged to post their questions on the Discussion Forum and to respond to questions posted by others.

Students are expected to make use of the Discussion Forum rather than emailing questions to individual faculty. Many students have the same questions; therefore, posting on the Discussion Forum allows all students benefit from the posted questions and their timely responses. Course faculty will regularly monitor the Discussion Forum and participate, whenever appropriate.

When posting questions on the discussion forum, you must tag each post with the lecture number, the small group, IMCQ or Exam Soft quiz that the question is referring to. This will ensure that the relevant faculty members will be available to answer your questions.

Students should only use professional language. Discussions should remain relevant to course material. Use of derogatory remarks or inappropriate language is not allowed. All posts must also be accompanied with the full name of the person posting it. Failure to do so will result in deletion of the post. Anonymous messages are considered unprofessional behavior and a violation of the student honor code.

R O U N D T A B L E M E E T I N G S

The Course Director may organize Round Table Meetings (either online, or with physical presence), where faculty members representing the different disciplines contributing to the course will be present. Students can come in and ask individual questions, which will be answered by the team of faculty. 

O F FI C E H O U R S

Office hours will be provided by the teaching faculty as open office hours (walk in) or by appointment. The available hours (open or appointments) for the different faculty members will be posted weekly on Sakai. All appointment requests should be emailed to physiology441@sgu.edu . Students should not contact individual faculty members to make appointments (unless otherwise specified).

Through consistent and proactive participation during the activities and exercises presented in this course, a student should be able to:

• Understand and describe the relationship between the structure and function of the molecules, cells, tissues, organs, and systems underlying normal human physiology.
• Understand and describe the vital molecules, structures, and conditions necessary for normal physiological function and preservation of homeostasis.
• Understand and describe how vital molecules and energy are stored, transported and utilized in physiological processes.
• Understand and describe the mechanisms through which information is sensed, generated, transferred, and targeted to allow the human body to adapt changing conditions, regulate physiological function, and maintain homeostasis.
• Understand the principles of physiology underlying select clinical and diagnostic tests, interpret their results, and apply this information to analyze normal and abnormal physiologic states.
• Analyze and discuss the physiological elements, conditions, and mechanisms and that distinguish abnormal from normal (i.e. diseased vs healthy) physiological conditions, and apply this analysis to principles of medicine.
• Develop communication techniques to critically evaluate and discuss medical cases effectively.
• Cultivate essential interpersonal skills during collaborative activities.
• Demonstrate professional behavior appropriate for the setting, activity, and audience.

Block 1 – Cell and Tissue Physiology (CTP):Homeostasis, excitable tissues, Muscle & Intro to Nervous system

H O M E O ST A SI S

1. Explain the principles of positive feedback and feed forward control of hormone secretion.
2. Given the body weight and percent body fat, estimate the a. total body water b. lean body mass
   3. extracellular fluid volume
   4. intracellular fluid volume
   5. blood volume
   6. plasma volume.
3. Identify normal extracellular fluid (plasma) osmolarity and concentrations of Na+, K+, Cl, HCO3-, proteins, creatinine, and urea, and contrast these values with those for intracellular fluids.
4. Using the volumes/compartments identified in Homeostasis Objective 2, contrast the movement between intracellular and extracellular compartments caused by increases or decreases in extracellular fluid osmolality

E X C I T A B LE T I SS U E S

1. Describe the ionic basis of each of the following local graded potentials: excitatory post synaptic potential (EPSP), inhibitory post synaptic potential (IPSP), end plate potential (EPP) and a receptor (generator) potential.
2. Contrast the generation and conduction of graded potentials (EPSP and IPSP) with those of action potentials.
3. On a diagram of a motor neuron, indicate where you would most likely find IPSP, EPSP, action potential trigger point, and release of neurotransmitter.
4. On a diagram of a sensory neuron, indicate where you would most likely find receptor potential or generator potential, action potential trigger point, and release of neurotransmitter.
5. Describe the cutaneous and proprioceptive mechanoreceptors and their function: Pacinian corpuscles, Meissner’s corpuscles, Ruffini endings, Merkel cell, A-delta and C free nerve endings, Golgi tendon organ, muscle spindle.
6. Distinguish between an endplate potential and an action potential in skeletal muscle.
7. U S C L E P HY SI O L O G Y

FUNCTIONAL MUSCLE HISTOLOGY

1. 1. Draw and label skeletal muscle at all anatomical levels, from the whole muscle to the molecular components of the sarcomere. At the sarcomere level, include at least two different stages of myofilament overlap. 

NEUROMUSCLUAR JUNCTION

1. Draw the structure of the neuromuscular junction.
2. List in sequence the steps involved in neuromuscular transmission in skeletal muscle and point out the location of each step on a diagram of the neuromuscular junction
3. Distinguish between an endplate potential and an action potential in skeletal muscle.

EXCITATION-CONTRACTION COUPLING

1. List the steps in excitation-contraction coupling in skeletal muscle, and describe the roles of the sarcolemma, transverse tubules, sarcoplasmic reticulum, thin filaments, and calcium ions  

SLIDING FILAMENT AND CROSS BRIDGE

1. Diagram the chemical and mechanical steps in the cross-bridge cycle, and explain how the cross bridge cycle results in shortening of the muscle.
2. Explain the relationship of preload, afterload and total load in the time course of an isotonic contraction
3. Distinguish between an isometric and isotonic contraction.
4. Identify the multiple sources, localization, and roles of calcium in muscle contraction and relaxation.
5. Draw the length versus force diagram for muscle and label the three lines that represent passive (resting), active, and total force. Describe the molecular origin of these forces in the three muscle types.
6. Compare the structure and regulation of the contractile units found in smooth vs striated muscle.
7. Explain why smooth muscles can develop and maintain force with a much lower rate of ATP hydrolysis than skeletal muscle

E U R OP H Y SI O L OG Y

NEUROANATOMY

NA01 List the components of the central nervous system (CNS) and the peripheral nervous system (PNS) and describe communication between the CNS and the somatic nervous system

NA02 Differentiate grey matter and white matter

NA03 Identify and summarize the functions of the six cortical lobes of the telencephalon on lateral and medial surfaces

NA04 Describe the three types of cerebral white matter and give one example of each

NA05 Identify four components of the diencephalon and describe the function of each NA06 Identify the mesencephalon, metencephalon and myelencephalon and summarize their associated functions

NA07 Identify the 12 pairs of cranial nerves and classify their function as sensory, motor or mixed

NA08 Describe the origin of the 31 pairs of spinal nerves

NA09 Identify and functionally characterize the grey and white matter of the spinal cord

NA10 Identify two major cell types in the nervous system

NA11 Identify the dendrites, soma, axon hillock, axon and axon terminals of neurons and classify neurons according to number of neurites

NA12 Describe five types of glial cell and their functions in the CNS and PNS

NA13 List the bony and connective tissue elements that protect the CNS

NA14 Identify the six components of the ventricular system and describe the production, flow, composition and function of CSF.

BLOCK 2 – Systems 1: Neurophysiology, Autonomic Nervous, & Cardiovascular Systems  

N E U R OP H Y SI O L OG Y, FUNCTIONAL NEUROPHYSIOLOGY

SOMATOSENSORY SYSTEM

SP01-01 Understand the general properties of sensory systems

SP01-02 Explain the terms adequate stimulus, transduction, threshold, receptor potential and receptive field in relation to sensory receptors

SP01-03 Explain why two-point discrimination measurements are different in different regions of the body

SP01-04 Explain the functional importance of lateral inhibition

SP02-05 List the properties of Pacinian corpuscles, Meissner corpuscles, Merkel receptors, Ruffini corpuscles and free nerve endings

SP02-06Describe the path from sensory receptor to cerebral cortex for discriminative touch, vibration and proprioception, and pain and temperature signals SP02-07 Classify the different sensory nerve fibers according to physical properties and function

SP02-08 Describe the two major classes of pain

SP02-09 Give two examples of pharmacological mechanisms for controlling pain SP02-10 Describe the composition of the component organs of taste and explain the steps in gustatory signal transduction

SP02-11Identify the component parts of the olfactory epithelium and describe the process of olfactory signal transduction        

MOTOR            

13. Identify motor cortex and motor association cortex and their roles in movement and speech 
14. Identify cerebellum as part of CNS and its roles in regulating movement  
15. Describe the functions of the medial and lateral motor pathways. Describe their origins and terminations within the spinal cord.              
16. Describe the effects of lesions in the medial and lateral descending motor pathway
17. Describe the various types of reflexes        
18. Describe some disorders affecting movement.  

AUTONOMIC NERVOUS SYSTEM 

19. Define the sympathetic and parasympathetic systems. 
20. Differentiate the components of the sympathetic and parasympathetic systems. 
21. Contrast the functions of the sympathetic and parasympathetic systems.  
22. Compare and contrast terms and concepts related to the sympathetic and parasympathetic systems, including: the central location of cell body of origin, number of synapses between CNS and effector organs, degree of myelination, and general effects on target tissues.     
23. Describe the synaptic characteristics, receptors, and neurotransmitters for the parasympathetic and sympathetic division of the ANS. 
24. Describe the ANS signaling mechanism and the effects of sympathetic and parasympathetic stimulation of lungs, heart, arteries, and veins; gastrointestinal function; renal function; and sexual function.         
25. Understand the pharmacological action of Sympathethic and Parasympathethic drugs, giving examples of each.       

AUDITORY AND VESTIBULAR SYSTEM    

26. Describe the function of the outer, middle and inner ear, listing in order the mechanical structures over which sound energy is transmitted to auditory receptors
27. Explain how hair cells convert sound energy into an action potential       
28. Explain the frequency analysis performed by the basilar membrane with reference to its physical structure 
29. Explain how deformations of the basilar membrane relate to the intensity of sound perceived are converted to action potentials in auditory nerve fibers                  
30. Describe what is bone conduction 
31. Explain how vestibular apparatus provides information about movement and position         
32. Describe the pathways from ears to auditory cortex and cerebellum 

VISION             

33. Describe the refraction of light as it passes through the eye to the retina           
34. Describe the pathways for vision 
35. Describe the process of accommodation, contrasting the refraction of light by the lens in near and far vision  
36. Describe the refractive deficits that account for myopia, hyperopia and their correction by glasses or contact lenses  
37. Explain the differing light sensitivities of the fovea and optic disc
38. List and compare the functional properties of scotopic and photopic vision        
39. Contrast the transduction process for rods and cones         
40. Describe the functional properties of ON- and OFF- bipolar cells             
41. Describe the functional properties of antagonistic center-surround receptive fields of retinal ganglion cells           
42. Predict the visual field deficits resulting from the following lesions in the visual pathway:         
43. optic nerve, optic chiasm, optic tract, LGN (in thalamus), primary visual cortex 

C A R DI O VA SC U LA R P HY S I OL OG Y 

CARDIAC CYCLE       

1. Draw, in correct temporal relationship, the pressure, volume, heart sound, and ECG changes in the cardiac cycle. Identify the intervals of isovolumetric contraction, rapid ejection, reduced ejection, isovolumetric relaxation, rapid ventricle filling, reduced ventricular filling and atrial contraction. 
2. Know the various phases of ventricular systole and ventricular diastole. Contrast the relationship between pressure and flow into and out of the left and right ventricles during each phase of the cardiac cycle. 
3. Know the factors that contribute to the formation of turbulent flow.      
4. Describe the timing and causes of the four heart sounds.        
5. Define arterial systolic, diastolic, mean arterial, and pulse pressure and identify them on a Wigger’s diagram

CARDIAC ELECTROPHYSIOLOGY 

6. Sketch a typical action potential in a ventricular muscle and a pacemaker cell. Describe how ionic currents contribute to the four phases of the cardiac action potential. Use this information to explain differences in shapes of the action potentials of different cardiac cells.         
7. Explain what accounts for the long duration of the cardiac action potential and the resultant long refractory period. What is the advantage of the long plateau of the cardiac action potential and the long refractory period?        
8. Beginning in the SA node, diagram the normal sequence of cardiac activation (depolarization).         
9. Explain why the AV node is the only normal electrical pathway between the atria and the ventricles and explain the functional significance of the slow conduction through the AV node. Describe factors that influence conduction velocity through the AV node.           
10. Name the parts of a typical bipolar (Lead II) ECG tracing and explain the relationship between each of the waves, intervals, and segments in relation to the electrical state of the heart. 

VENTRICULAR FUNCTION 

11. State the steps in excitation-contraction coupling in cardiac muscle. Outline the sequence of events that occurs between the initiation of an action potential in a cardiac muscle cell and the resulting contraction and then relaxation of that cell. Provide specific details about the special role of calcium in the control of contraction and relaxation of cardiac muscle.  
12. Describe the role of Starling's Law of the Heart in keeping the output of the left and right ventricles equal. 
13. Draw a ventricular pressure-volume loop and on it label the phases and events of the cardiac cycle (ECG, valve movement).    
14. Define ejection fraction and be able to calculate it from end diastolic volume, end systolic volume, and/or stroke volume. Predict the change in ejection fraction that would result from a change in a) preload, b) afterload, and c) contractility.
15. Construct a vascular function curve. Predict how changes in total peripheral resistance, blood volume, and venous compliance influence this curve. 

PRESSURE REGULATION 

16. List the anatomical components of the baroreceptor reflex.             
17. Explain the sequence of events in the baroreflex that occur after an acute increase or decrease in arterial blood pressure. 
18. Explain the sequence of events mediated by cardiopulmonary (volume) receptors that occur after an acute increase or decrease in arterial blood pressure and in central venous pressure. 
19. Contrast the relative contribution of neural and renal mechanisms in blood pressure and blood volume regulation.  
20. Describe the release, cardiovascular target organs, and mechanisms of cardiovascular effects for angiotensin, atrial natriuretic factor, bradykinin, and nitric oxide. 

MICROCIRCULATION AND HEMODYNAMICS  

21. Be able to differentiate between flow and velocity in terms of units and concept.
22. Understand the relationship between pressure, flow, and resistance in the vasculature and be able to calculate for one variable if the other two are known. Apply this relationship to the arteries, arterioles, capillaries, venules, and veins. Explain how blood flow to any organ is altered by changes in resistance to that organ.           
23. Define autoregulation of blood flow. Distinguish between short-term and long- term autoregulatory responses and the mechanisms responsible for each.      
24. Identify the role of PO2, PCO2, pH, adenosine, and K+ in the metabolic control of blood flow to specific tissues.        
25. Understand the relationship between flow, velocity, and cross-sectional area and the influence vascular compliance has on these variables. 
26. Differentiate the following terms: osmotic pressure, oncotic pressure, and hydrostatic pressure, as they pertain to movement across the endothelium of the capillaries.         
27. Define the Starling equation and discuss how each component influences fluid movement across the capillary wall      

SPECIAL CIRCULATIONS     

28. Discuss the interaction of a) intrinsic (local), b) neural, and c) humoral control mechanisms and contrast their relative dominance in the CNS, coronary, splanchnic, renal, cutaneous, and skeletal muscle vascular beds.           
29. Describe the phasic flow of blood to the ventricular myocardium through an entire cardiac cycle.            
30. Contrast the local and neural control of the splanchnic circulation.         
31. Contrast the local and neural control of cerebral blood flow. Discuss the relative importance of O2, CO2, and pH in regulating cerebral blood flow.             

Block 3 – Systems 2: Pulmonary & Gastrointestinal 

R E S P I R A T OR Y P H Y S I O LO G Y 

THE BREATHING CYCLE      

1. Diagram how pleural pressure, alveolar pressure, airflow, and lung volume change during a normal quiet breathing cycle or a deep breathing cycle with forced expiration. Identify on the figure the onset of inspiration, cessation of inspiration, and cessation of expiration. Describe how differences in pressure between the atmosphere and alveoli cause air to move in and out of the lungs. 
2. Identify the forces that generate the negative intrapleural pressure when the lung is at functional residual capacity and predict the direction that the lung and chest wall will move if air is introduced into the pleural cavity (pneumothorax).      

 MECHANICS 

3. Draw a normal pulmonary pressure-volume (compliance) curve (starting from residual volume to total lung capacity and back to residual volume), labeling the inflation and deflation limbs. Explain the cause and significance of the hysteresis in the curves.         
4. Define compliance and identify two common clinical conditions in which lung compliance is higher or lower than normal. Explain how compliance changes observed with an obstructive or restrictive disease alter the work of breathing. 
5. Identify the forces that generate the negative intrapleural pressure when the lung is at functional residual capacity and predict the direction that the lung and chest wall will move if air is introduced into the pleural cavity (pneumothorax).      

MEASUREMENT OF LUNG VOLUMES AND CAPACITIES     

6. Define the factors that determine total lung capacity, functional residual capacity, and residual volume. Describe the mechanisms responsible for the changes in those volumes that occur in patients with emphysema and pulmonary fibrosis. 
7. Describe the effects of airway diameter and turbulent flow on airway resistance.
8. Draw a spirogram resulting from a maximal expiratory effort. Label the forced vital capacity (FVC), timed forced expiratory volumes (FEVs), and the maximal expiratory flow rate between 25-75% of FVC (FEF25-75%). Describe the mechanical forces that contribute to these pulmonary function indexes (also RV, FRC and TLC) and how they change with obstructive or restrictive disease.         
9. Differentiate between the two broad categories of restrictive and obstructive lung disease, including the spirometric abnormalities associated with each category.         

VENTILATION AND GAS DIFFUSION         

10. Define partial pressure and fractional concentration as they apply to gases in air. List the normal fractional concentrations and sea level partial pressures for O2, CO2 and N2. 
11. List the normal airway, alveolar, arterial, and mixed venous PO2 and PCO2 values. List the normal arterial and mixed venous values for O2 saturation, [HCO3-], and pH. 
12. Describe in quantitative terms the effect of ventilation on PCO2 according to the alveolar ventilation equation. 
13. Name the factors that affect diffusive transport of a gas between alveolar gas and pulmonary capillary blood.          

OXYGEN AND CARBON DIOXIDE TRANSPORT 

14. Define oxygen partial pressure (tension), oxygen content, and percent hemoglobin saturation as they pertain to blood. 
15. Draw an oxyhemoglobin dissociation curve (hemoglobin oxygen equilibrium curve) showing the relationships between oxygen partial pressure, hemoglobin saturation, and blood oxygen content. On the same axes, draw the relationship between PO2 and dissolved plasma O2 content (Henry’s Law). Compare the relative amounts of O2 carried bound to hemoglobin with that carried in the dissolved form. 
16. Describe how the shape of the oxyhemoglobin dissociation curve influences the uptake and delivery of oxygen.         
17. Define P50. 
18. Show how the oxyhemoglobin dissociation curve is affected by changes in blood temperature, pH, PCO2, and

2,3-DPG and describe a situation where such changes have important physiological consequences.        

CONTROL OF BREATHING 

19. Identify the regions in the central nervous system that play important roles in the generation and control of cyclic breathing.      
20. List the anatomical locations of chemoreceptors sensitive to changes in arterial PO2, PCO2, and pH that participate in the control of ventilation. Identify the relative importance of each in sensing alterations in blood gases.            
21. Describe how changes in arterial PO2 and PCO2 alter alveolar ventilation, including the synergistic effects when PO2 and PCO2 both changes.      
22. Describe the mechanisms for the shift in alveolar ventilation that occur immediately upon ascent to high altitude, after remaining at altitude for two weeks, and immediately upon return to sea level.

E N D O C R I N E P H Y SI O L OG Y  

GENERAL CONCEPTS          

1. Define the endocrine system         
2. Compare hormones to neurotransmitters and neurohormones 
3. Compare and contrast the three major chemical classes of hormones in terms of their a) storage and release; b) transport in blood; and c) action at the cell         
4. Discuss how hormone release is controlled     
5. Describe hormonal breakdown         
6. Describe endocrine disorders         

PITUITARY      

7. List the hormones released from the Posterior Pituitary 
8. Discuss the control of hormonal release 
9. Discuss the actions of the hormones in the body 
10. List the hormones released from the Anterior Pituitary           
11. Discuss the control of hormonal release 
12. Discuss the actions of the hormones in the body 
13. Describe the hypothalamic pituitary axis 

ADRENAL GLAND      

14. List the regions of the adrenal gland and the hormones released      
15. Discuss the stimulus for release, cellular actions, body actions and regulation of aldosterone, cortisol and the sex hormones         
16. Describe the renin-angiotensin system         

THYROID HORMONE             

17. List the two thyroid hormones         
18. Discuss thyroid hormone synthesis     
19. Discuss the stimulus for release, cellular actions, body actions and regulation of the thyroid hormones    

PARATHYROID HORMONE 

20. Discuss the function of calcium in the body  
21. Describe how PTH and Vitamin D3 maintain calcium homeostasis            
22. Discuss the stimulus for release, cellular actions, body actions and regulation of PTH and Vitamin D3  

ENDOCRINE PANCREAS      

23. Discuss the importance of the anatomy of the pancreas to hormone release     
24. Discuss the control of hormonal release 
25. Discuss the cellular actions of the hormones          
26. Discuss the actions of the hormones in the body 
27. Describe the relationship between insulin and glucagon and glucose homeostasis
28. Describe the pathophysiology of Type 1 Diabetes mellitus    

MALE REPRODUCTIVE         

29. Describe spermatogenesis
30. Hormonal control of male reproductive physiology      
31. Functions of testosterone 
32. The role of the accessory organs 

FEMALE REPRODUCTIVE 

33. Changes in the follicle over the ovarian cycle           
34. Changes in hormone levels throughout the ovarian cycle         
35. The uterine cycle 
36. Puberty and menopause 
37. Birth             

PARTURITION AND LACTATION      

38. Understand how labor is initiated 
39. Discuss the hormonal control of childbirth 
40. Discuss the hormonal control of lactation 

Block 4 – Systems 3: Renal & Endocrine Systems                   

R E N A L P H Y SI O L OG Y                 

THE KIDNEY: STRUCTURE, FUNCTION, & REGULATION   

1. List the basic functions of the kidneys        
2. List and identify the structures of the nephron and associated vasculature              
3. Discuss filtration and the factors that affect filtration  
4. Discuss reabsorption, secretion and the different mechanisms involved in both processes giving examples      
5. Discuss the tubuloglomerular feedback mechanism and the renin- angiotensin II- aldosterone system 
6. Discuss the various hormones involved in concentrating and diluting urine            

ACID-BASE STATUS AND PH REGULATION       

7. Define acidosis and alkalosis         
8. Discuss how chemical buffers regulate pH              
9. Discuss how the pulmonary system regulates pH
10. Discuss how the kidney regulates pH            
11. Be able to diagnose an acid-base imbalance       
12. Describe processes that lead to acid base disturbances and list common cause
13. Define base excess (or deficit) and anion gap         
14. Explain what is meant by primary and secondary acid base disturbances using the concept of “compensation”         
15. From blood values, identify simple and mixed metabolic and respiratory acid base disturbances 

G A ST R O EN T ER O L OG Y PH Y SI O L OG Y

FUNCTIONS AND REGULATION OF GI TRACT   

1. Identify the sources and typical amounts of fluid and nutrients entering and leaving the gastrointestinal tract daily     
2. For major classes of nutrients (carbohydrates, proteins, fats), differentiate the processes of ingestion, digestion, absorption, secretion, and excretion; include the location in the GI tract where each process occurs. 
3. Describe the functions of splanchnic blood flow in sustaining intestinal viability and as a source/sink for material transported across the GI tract epithelium.       
4. Know how afferent and efferent extrinsic nerves (sympathetic and parasympathetic) interact with the enteric nervous system and regulate the functions of the GI track.
5. Understand the neural circuitry driving major GI reflexes and the neural pathways and neurotransmitters that accomplish reflex control of GI functions. 
6. Compare and contrast the regulation of gut function by nerves, hormones, and paracrine regulators.           

SALIVARY GLANDS 

7. Describe the volume and composition of salivary fluid coming from major salivary glands 
8. Describe the physiological function of the components of saliva. 
9. State the components of the saliva important in oral hygiene        

ESOPHAGUS 

10. Describe the afferent neuro-muscular pathways activated to initiate swallowing, the motor pathways and general targets for innervation that accomplish the swallowing reflex, and major nuclei of in the brain stem that integrate these afferent inputs.
11. Understand the differences in the neural and muscular composition and function in the upper versus lower esophagus. Explicitly consider the upper and lower esophageal sphincters. 
12. Describe the dynamic pressure changes that occur in the regions of the esophagus after initiation of the swallowing reflex and how these pressure changes would propel a bolus of food from the mouth to the stomach. 

STOMACH       

13. Describe the storage, digestion, and motility roles of the stomach           
14. Identify the proteins secreted into the gastric lumen by chief cells, parietal cells, and mucous cells. Contrast the functions and regulation of these secretions. 
15. Identify the gastric cell types secreting gastrin, somatostatin, histamine, and gastrin releasing peptide. Describe the stimuli that promote and inhibit release of these peptides, and their cellular targets.        
16. Describe the role of HCl in the gastric digestion of carbohydrates and protein, and how pepsinogen is activated 
17. List the stomach cell types and secreted substances that contribute to regulation of gastric acid secretion via paracrine, hormonal, and neuroendocrine pathways. Understand the integrated feedback regulation of acid secretion via these pathways during a meal 
18. List the mechanisms contributing to gastric mucosal defense and how they can be compromised by drugs or pathogens. 

HEPATOBILIARY        

19. Describe the mechanisms whereby the gall bladder concentrates bile, and the endocrine mechanism stimulating gall bladder contraction and the secretion of bile through the sphincter of Oddi into the small intestine.  
20. Describe the amphipathic structure of bile salts and describe how this property assists the solubilization and digestion of fats.           

SMALL INTESTINE 

21. Describe the sequential digestion of ingested proteins by gastric pepsin, pancreatic enzymes, and enzymes at the intestinal apical membrane. Make sure to include the role of duodenal enteropeptidase.         
22. Compare the membrane transport mechanisms responsible for uptake of sugars, aminoacids and di-peptides by intestinal epithelial cells. 
23. Describe the mechanisms and molecules mediating the solubilization and digestion of lipids in the small intestine.        
24. Describe the location and the mechanisms that mediate the intestinal transepithelial movement of water, the major electrolytes, iron and calcium. 

            LARGE INTESTINE       

25. Describe the mechanisms, localization and regulation of colonic sodium absorption. 
26. Describe the mechanisms mediating colonic bicarbonate and potassium transport. 
27. Describe the role of dietary fiber in promoting colonic motility.        

         GASTROINTESTINAL MOTILITY AND ENTERIC NERVOUS SYSTEM                 

28. Describe the characteristics of the spontaneous and stimulated electrical activity of GI smooth muscles (Electrical slow waves, action potentials, and contraction).                              
29. Describe the anatomical locations and role of interstitial cells of Cajal as slow wave pacemakers and mediators of inputs from the enteric nervous system.        
30. Describe major motor patterns in the GI tract and their functions during fasting (migrating motor complex or MMC) and during digestion        
31. Describe the role of colonic motility in facilitating the recovery of water and electrolytes.        
32. Describe the function of colonic motility, in mediating formation of haustra and haustral shuttling, mass movements through the transverse and distal colon, and defecation.         
33. Describe the sequence of events in the colon and anal sphincters occurring during reflexive defecation, differentiating those movements under voluntary control and those under autonomic control.