Medicine and Surgery HT

CELLULAR PHYSIOLOGY THE CELL AND THE INTERNAL ENVIRONMENT: The cell as a unit of the functional systems of the organism. The internal environment and the concept of homeostasis. Concept of biological feedback and homeostatic control systems. The water compartments of the organism. Composition of intra- and extracellular fluid. Composition, structure and function of the plasma membrane. EXCHANGES BETWEEN CELL AND ENVIRONMENT: Plasma membrane permeability. Fick's law. Passive permeation mechanisms: simple diffusion. Osmosis. Facilitated diffusion, carrier proteins. Primary active transport: the Na + / K + pump. Secondary active transport. Endo and exocytosis. Trans-epithelial transport. Ion channels: classification, characteristics and functions, forces that drive transport across the membrane (chemical force, electrochemical force). Ionic bases of the membrane potential. PHYSIOLOGY OF NEURONAL CELLS Equilibrium potential (Nernst equation); resting potential (Goldman-Hodgkin-Katz equation). The neuron and its structure. Genesis and characteristics of the local potential. Membrane excitability threshold and action potential: general characters, ionic genesis. Saltatoria conduction of the action potential. Myelin. Chemical synapses and synaptic transmission. Neurotransmitters and neurotransmitter receptors (ionotropic and metabotropic receptors). Ionic and electrical events in excitatory and inhibitory synapses. Synaptic integration: temporal and spatial summation of synaptic potentials, global synaptic presynaptic inhibition, selective presynaptic inhibition. Electrical synapses. Neuro-effector junctions of the autonomic nervous system. Cholinergic receptors. Adrenergic receptors. ORGANIZATION OF THE NERVOUS SYSTEM Summary of the anatomical-functional organization of the central and peripheral nervous system (orthosympathetic and parasympathetic). The spinal cord. The somatic reflex arc. The cerebellum. Nuclei of the base The trunk of the brain (outline). The motor cortical areas. The cortical areas of projection. The associative cortical areas. SENSITIVITY: sensory receptors, classification of afferent fibers, different sensory modalities and afferent pathways, thalamus, primary sensory cortex. PAIN: pain receptors, visceral and deep pain, afferent spinal tracts, thalamus. Gating theory. MUSCLE SYSTEM Types of muscle cells and their general characteristics. SKELETAL MUSCLE: Structure of the skeletal muscle. Sarcomere. Molecular basis of contraction. Neuromuscular junction, excitation-contraction coupling. Musculoskeletal metabolism: slow oxidative fibers, fast glycolytic fibers, fast oxidative fibers. Motor unit. Muscle strength. Simple muscle twitch and tetanic contraction. SMOOTH MUSCLE: Characteristics of smooth muscle. Smooth muscle fiber structure. Molecular mechanism of contraction and relaxation of the smooth muscle fiber. Stimulation of smooth muscle contraction CARDIOVASCULAR SYSTEM General scheme of the cardiovascular system. ELECTRICAL ACTIVITY OF THE HEART: Structure of the heart, heart valves, and their functioning. Characteristics of the cardiac muscle fiber and the molecular mechanism of contraction and relaxation. Conduction system: origin and propagation of cardiac excitation. Features and bioelectric activity of the conduction myocardium and the common working myocardium (nodal action potential, working myocardial action potential, refractory period of the heart). MECHANICAL ACTIVITY OF THE HEART: Structure of the heart muscle. The cardiac cycle and relationship of pressure and ventricular volume. Notes on the electrocardiogram. Cardiac output and its intrinsic and extrinsic regulation. Frank-Starling's law of the heart. HEMODYNAMICS: structural and functional characteristics of blood vessels. Innervation of the vessels. Pressure profile of the systemic circulation. Physical laws involved in the relationship between flow, resistance and pressure. The return of venous blood to the heart. Blood pressure regulation. Nervous mechanisms of blood pressure control. The cardiovascular centers. Role of the renin-angiotensin-aldosterone system in blood pressure control. PHYSIOLOGY II RENAL SYSTEM Renal hemodynamics and glomerular filtration (GFR, filtration fraction); autoregulation of renal blood flow. Segmental reabsorption and secretion (proximal tubule, loop of Henle, distal tubule, collecting duct) for water and major solutes. Countercurrent exchange and maintenance of the medullary osmotic gradient; urine concentration/dilution. Regulation of volume and pressure: RAAS, sympathetic system, natriuretic peptides. Concepts of clearance and fractional excretion (at a formative level). ACID–BASE BALANCE Physiological buffers (bicarbonate, phosphates, proteins) and the Henderson–Hasselbalch equation. Respiratory vs metabolic disorders and principles of compensation. Basic arterial blood gas analysis: identification of the primary disorder and estimation of the expected compensation (e.g., Winter’s rule). Renal roles in HCO₃⁻ reabsorption, H⁺ secretion, NH₄⁺ generation and titratable acidity; systemic effects of acidosis/alkalosis. HORMONES (NEUROENDOCRINOLOGY AND MAJOR AXES) Classification by chemical nature and receptor mechanisms (membrane vs nuclear). Hypothalamic–pituitary axes and short/long feedback. Physiology of the thyroid, adrenal cortex, gonads, and endocrine pancreas (insulin/glucagon). Circadian rhythms and integrated regulation of metabolism, growth, stress, and reproduction; basal hormone profiles and conceptual dynamic testing. DIGESTIVE SYSTEM Gastrointestinal motility: slow waves, peristalsis, migrating motor complex; sphincter function. Salivary, gastric, pancreatic, and biliary secretions and their neuro-hormonal control (cephalic, gastric, intestinal phases). Digestion and absorption of carbohydrates, proteins, lipids, water, and electrolytes along the tract; intestinal fluid–electrolyte balances and physiological consequences of diarrhea/vomiting. AUTONOMIC NERVOUS SYSTEM (ANS) Anatomo-functional organization of the sympathetic, parasympathetic, and enteric divisions: central origins, ganglia, pre-/post-ganglionic fibers. Neurotransmitters and receptors (cholinergic and adrenergic), autonomic transmission and pre-/post-synaptic modulation. Integrated autonomic reflexes (baroreceptor, chemoreceptor, visceral). ANS effects on the heart, vessels, respiratory and digestive systems, kidney, eye, and glands. Responses to orthostasis, exercise, acute stress, and hypovolemia. SOMATOSENSORY SYSTEM Somatosensory receptors (tactile, vibration, proprioception, thermal), properties (modality, adaptation, receptive fields). Main afferent pathways: dorsal columns–medial lemniscus and anterolateral system; thalamic organization and primary somatosensory cortex (S1). Somatotopy along the spinal cord–thalamus–cortex axis and coding principles (intensity, duration, location). Dermatomal maps and lesion–deficit correlations. VISION Basic ocular optics and accommodation (brief); phototransduction in rods and cones; essential retinal circuits. Visual pathways: retina, optic nerve, chiasm, tract, lateral geniculate nucleus, optic radiations, visual cortex. Visual fields and clinico-anatomical correlations (scotomas by lesion site). Light/dark adaptation, spectral and contrast sensitivity; basics of visual evoked potentials (brief). HEARING Mechanics of the outer and middle ear; cochlea, basilar membrane, traveling wave and tonotopy. Transduction in inner/outer hair cells and synapse with the cochlear nerve. Central auditory pathways and acoustic reflexes. Basic audiogram and principles of sound localization (interaural time and intensity differences). PAIN (NOCICEPTION) Peripheral nociceptors and Aδ/C fibers; coding of intensity and localization. Anterolateral (spinothalamic) pathways up to thalamus and cortex; subcortical/cortical integration. Descending modulation of pain (PAG–RVM) and control at the dorsal horn; brief notes on peripheral and central hyperalgesia from a physiological perspective. MOTOR PATHWAYS Motor unit (functional recall), spinal control of reflexes (stretch, withdrawal, role of the Golgi tendon organ). Corticospinal and extrapyramidal tracts: organization, functions, and distinguishing signs of upper vs lower motor neuron lesions. Contribution of the cerebellum (coordination, feedforward) and basal ganglia (selection and initiation of movement, scaling). PHYSIOLOGY OF GLIAL CELLS Astrocytes: ion homeostasis (K⁺ buffering), neurotransmitter recycling (glutamate/GABA), tripartite synapse, neurovascular coupling, and contribution to the blood–brain barrier. Microglia: surveillance, synaptic pruning, activation profiles with effects on plasticity. Oligodendrocytes: myelination, nodes of Ranvier, saltatory conduction, and myelin plasticity. Ependymal cells: cerebrospinal fluid dynamics and the glymphatic system.

For an easy approach to the subject, it is necessary to review the knowledge, acquired in previous years, of Physics (electricity, work, and machines, dynamics of fluids and gases), Chemistry (laws of gases, properties of solutions, osmotic pressure, pH), Histology and Anatomy (main biochemical processes of the cell, histology, and anatomy of organs and systems).

Fisiologia” D’Angelo, Peres, Edi-Ermes Fisiologia medica Fiorenzo Conti Fisiologia medica C. Guyton, J.E. Hall German Stanfield, Fisiologia II EdiSES Fisiologia Umana:un approccio integrato D U: Silverthorn

The teacher delivers lectures with traditional methods with audiovisual aids and scheduling of lessons as reported on GOMP Aure/Orari system, published on the website

student is required to attend educational activities. The frequency is checked by the teachers through signature / updated lists provided by the Academic Office. The certificate of mandatory attendance to the teaching course is required to the student to be admitted at the final test.

The exam is unique for Physiology I and II and takes place in a first part with a written exam in the form of a multiple choice quiz that will be preparatory for the oral exam that will take place in the form of an interview in which the ability to : describe physiological processes and use appropriate language. The written exam will be carried out with two types of questions: 1. Type A questions (with a question and the choice of only one answer out of 5 possible answers, one of which is correct); 2. Type K 'questions (with a question or assumption and the choice of the possible right answers from 4 available answers). Continuously updated information on the course and teaching material can be found on the elearning2.uniroma1.it website.

Teaching will be provided in the presence. There will be days of reverse teaching, in-depth analysis, and group work.