Early Clinical Exposure: A Case Based Approach in Clinical Physiology Manjinder Kaur, Naren Kurmi, Sangita Chauhan
INDEX
ABCDEFGHIJKLMNOPRSTUVWX
Page numbers followed by f refer to figure and t refer to table.
A
Abdominal examination 14
Aberrant conducting tissue 40f
Acetone breath 80
Achalasia cardia, pathophysiology of 32f
Acid neutralizing drugs 28
Acid peptic disease 26
etiology of 27f
Acidosis 76
Acne 71
Acromegaly 71
clinical features of 72f
Activated partial thromboplastin time 13
Acute mountain sickness 56
pathophysiology of 56f
Air conduction 105, 106
Aluminium salts 28
Alzheimer's brain 103f
Alzheimer's disease 102
Amenorrhea 88
primary 114
Anemia 5
classification of 2
clinical classification of 3t
etiological classification of 2t
grades of 3
hemolytic 8
morphological classification of 2, 2t
Anorexia 80
Antacids 28
Anticholinesterase drugs 17
Antihypertensive medication 75
Antisecretory drugs 28
mechanism of action of 28f
Apathy 1
Aphasia 100
types of 101t
Apoferritin 3
Appetite, loss of 1, 82
Atrioventricular
conduction block 38
nodal blocks 38
node 38
Autoimmune 76
thyroiditis 64
Azoospermia 115
B
Barium swallow 32f
Basal ganglia 95f
Beta-amyloid plaques cause 103
Bicarbonate therapy 81
Bird beak appearance 32f
Bleeding time 13
Blood
loss 2, 73
pressure 61
urea nitrogen 61
Blurred vision 24
Body
ache 54
fluids, loss of 45
Bone conduction 105, 106
Botulism, pathophysiology of 24f
Breast enlargement 90
Breath 54
severe shortness of 41
shortness of 41
Breathlessness 1, 41, 50
Brown tumor, physiological basis of 83f
Brown-Sequard syndrome 92
clinical features of 93f
Brushfield spots 112
C
Caisson's disease 54
pathophysiology of 54f
Carbohydrate metabolism 77
Cardiac failure 41
Cardiac muscle 38f
Cardiovascular system 23
Carpopedal spasm, physiological basis of 85f
Caudate nuclei 95
Central nervous system 23, 102
examination 58
Cerebellar ataxia 96
Cerebellar function test 100
Cerebellum, functional division of 97f
Cerebrocerebellum 96
Chest
heaviness 47
muscles 24
Cholesterol, serum 73
Chromosomal aberrations, physiology of 112
Chronic obstructive pulmonary disease 50, 52, 53
clinical features of 53f
pathophysiology of 52, 52f
Chronic renal failure 61, 61t, 62
pathophysiology of 62f
Clostridium botulinum 24
Cochlear implants 106
Cold
intolerance 63
weather 99, 99t
Color vision 107, 109
Concave lens, use of 107f
Concussion, severe 96
Conductive deafness 105
Confrontation test 107, 109, 110
Congestive cardiac failure
management of 44, 44f
pathophysiology of 42, 43f
Consciousness, loss of 100
Constipation 35, 63, 82
Convulsions 54
Cornea 108
Cortical sensations 94
Cortisol 73
Cranial nerve examination 100
Creatinine, serum 61
Crude touch, sensation of 92
Cry, excessive 10
Cushing's syndrome 73
clinical features of 74f
D
Deaf ear 105t
Death 23
Deep vein thrombosis 89
Dehydration, signs of 80
Dehydroepiandrosterone 73
Diabetes mellitus 75
juvenile 79
pathophysiology of 78f
primary 76
secondary 76
Diabetic ketoacidosis 79
clinical features of 80f
pathophysiology of 80
Diarrhea 5
Digestive tract 26
Diplopia 16
Distant vision 110
Divalent metal transporter 3
Dizziness 37, 56, 98
Double vision 16
Down's syndrome 112
pathophysiology of 113f
Dry skin 63
Duchenne muscular dystrophy 21
clinical features of 21f
pathophysiology of 21f
Duodenal ulcer 27, 27t
Dysarthria 101
Dyspnea, mild 47
E
Ear 105, 105t, 106
Echocardiography 42f
Edema, lower extremity 61
Electrodiagnostic repetitive nerve stimulation 17
Elevated fasting blood sugar, basis of 71
Embolism, pulmonary 89
Emesis 61
Endocrinal functions 90
Endocrine physiology 63
Enteric nervous system 35f
Enterochromaffin 28
Epigastrium 26
Erectile dysfunction 86
Erythroblastosis 11
fetalis 10
Erythroblasts 11
Extracorpuscular defects 8
Extreme tiredness 24
Eye 107f
F
Facial expressions 94
Facial hair 73
Far vision 107, 109
Fasting blood
glucose 75
sugar 73
Fat metabolism 77
Fatigability 16
Fatigue 56, 63
Ferro protein transporter 3
Fever 100
Fluent aphasia 101
Fluid replacement 81
Follicle stimulating hormone 89
Foodborne botulism 24
sources of 24
Fracture 96
G
G-6-PD deficiency 8
pathophysiology of 8, 9f
Gait, shuffling 94
Gastric 7
ulcer 27, 27t
Gastroesophageal reflux disease 30
pathophysiology of 31f
Gastrointestinal system 23, 26
Gastrointestinal tract 3, 3f, 5, 6f
organization of 35f
Giddiness 22
Global aphasia 101
Globus pallidus 95
Glomerular filtration rate 89
Glucosuria 76, 89
H
Hair cells, loss of 106
Hashimoto's thyroiditis 64
HCL, mechanism of secretion of 28f
Headache 56, 71, 107
Healthy neuromuscular junction 18f
Hearing
aids 106
loss 104, 106
conductive 104
test 105
Heart 38f
block 37
classification of 39f
first degree 38
second degree 38
third degree 38
types of 38
rate 1, 89
Heat
balance, methods of 98f
gain 99
loss 99
stroke 98
Helicobacter pylori infection 27
Hematology 1
Hemoglobin 1
beta-globin chain of 14
concentration of 3
electrophoresis 14
Hemolytic anemia 8
causes of 8t
Hemolytic disease, pathophysiology of 10, 11f
Hemophilia 12
A 13f
pathophysiology of 12f
Hemorrhage 45
intracranial 103
Hepatobiliary system 90
High performance liquid chromatography 14
Hirschsprung's disease 35
pathophysiology of 36f
Hirsutism 71
Hormone assay 87
Hot weather 99, 99t
Human chorionic somatomammotropin 90
Hydrops fetalis 10
Hyperglycemia 76, 77
Hyperkalemia 76
Hyperkinetic features, causes of 95
Hyperparathyroidism 83f
primary 82, 83
secondary 83
Hypertension 61
Hyperthyroidism 67
clinical features of 68f, 69f
pathophysiology of 67f
Hypertonia 94
Hypocalcemia 85f
Hypoparathyroidism, secondary 84
Hypothyroidism 63
Hypovolemic shock 45
causes of 45, 45t
management of 46f
pathophysiology of 46f
I
Icterus 14
gravis neonatorum 10
Immunity, passive 10
Immunological test 88f
Impulse, transmission of 18f, 38f
Indigestion 5
Infertility
male 86
primary 86
Insulin
deficiency of 77t
infusion of 80
lack of 79
physiological actions of 77f
Interstitial fluid 28
Intracorpuscular defects 8
Iodine deficiency 64
Iron
absorption of 3, 3f
deficiency anemia 1, 2
clinical features of 4f
pathophysiology of 4
Ishihara's color plates 107, 109
J
Jaeger's chart 107, 109
Jargon speech 101
Jaundice 10
obstructive 33
Joint pains 14
K
Kent bundle 40f
Ketosis 76
Kidneys 45
Klinefelter's syndrome 115
pathophysiology of 115f
Knee, hematoma of 12
Koilonychia 1
Kussmaul breathing 80
L
Lambert-Eaton syndrome, pathophysiology of 20f
Legs 24
Lens, curvature of 108
Lesions, effects of 111f
Lethargy 61
Libido, loss of 86
Lightheadedness 37
Limbs 100
Lipid profile 75
Lipoprotein lipase 77
Lithium 64
Logorrhea 101
Lower esophageal sphincter 89
Lower motor neuron 92
Lung disease, restrictive 53
Luteinizing hormone 89
M
Magnesium 28
Malaise 98
Mean corpuscular
hemoglobin concentration 1
volume 1
Menstrual cycles 67, 71
Mental retardation, mild degree of 112
Metabolism 77f
Micturition 58, 75
frequency of 75
Mini-mental state examination test 102
Mood swings 67
Motor
aphasia 101
examination 100
functions 94
loss 92
vehicle accident 96
Mountain sickness, acute 56
Murmur, systolic 1
Musculoskeletal physiology 16
Myasthenia gravis 16, 20f
pathophysiology of 19f
Myocardial infarction 47
Myopia 107
Myopic eye 107f
N
Nausea 47, 56, 61, 98
Near vision 107, 109
Neologism 101
Neostigmine 17
Nerve deafness 105
Nervousness 67
Neurogenic bladder 58
dysfunction, pathophysiology of 59f
Neuropathy, peripheral 5
Non-fluent aphasia 101
Nonsteroidal anti-inflammatory drugs 27
O
Obstructive jaundice 33
features of 34f
pathophysiology of 34
Obstructive lung disease 53
Oily skin 71
Orthodontics 112
P
Packed cell volume 1
Pain 8f, 26, 104
abdominal 80
retrosternal 30
Pallor 1, 14
Palpitations 40
Paraphasia 101
Parkinson disease 94
pathophysiology of 95
Peripheral blood film 1, 14
Phalanges, subperiosteal bone resorption of 82f
Phospholipid 12
Plasma
glucose level 77
volume, loss of 45
Poikilocytosis 8
Polychromasia 8
Polydipsia, physiological basis of 78f
Polyphagia, physiological basis of 78f
Polyuria 80
physiological basis of 78f
Post-thyroidectomy
hypoparathyroidism 84
hypothyroidism 85f
Potassium replacement 81
Pregnancy 88, 89f
normal 88
Presbycusis 106
Presbyopia 109
pathophysiology of 109f
Primary hyperparathyroidism 82, 83
clinical features of 83f
Primary hyperthyroidism 70
Prophylaxis 10
Proprioception 92
Prostaglandin analogs 29
Protein metabolism 77
Prothrombin time 13
Proton pump inhibitors 29
Proximal muscle weakness 16
Pruritus 61
Ptosis 16
Puffer fish 22f
Punctum proximum 109
Putamen 95
R
Rapid breathing 80
Reflexes, pupillary 107, 109
Refractive error, correction of 107f
Renal blood flow 89
Renal failure 61
acute 61, 61t, 62
chronic 61, 61t, 62
Renal function tests 75
Renal transplant, indications of 58
Repetitive speech, sudden onset of 100, 100f
Reproductive physiology 86
Respiratory physiology 50
Respiratory system 23, 89
examination of 50
Restlessness 100
Retina 107f
Rinne's test 105, 106
Road traffic accident 58
Romberg sign 97
S
Salt and pepper sign 82f
Schwabach test 105, 106
Semen analysis 87
normal 87t
Sensory
aphasia 101
ataxia 97
function 94
loss 92
Shock
hypovolemic 45
management of 46
stages of 45, 45t
Short stature 114
webbed neck 114
Sickle cell anemia 14
pathophysiology of 15f
Sickling test 14
Slight memory loss 63
Snare proteins, types of 25
Snellen's chart 107, 109
Snore 71
Sore throat 104
Special senses, physiology of 104
Speech 100, 101f
agrammatic 101
slow 63
Sperm
count 87
morphology 87
Spinal cord 58f
Spinocerebellum 96
Spirometer, parameter of 53
Spirometry 51, 51f
Stiffness 92
Stimulates hormone sensitive lipase 77
Stokes-Adams syndrome 38
Stress management 28
Striatum 95
Substantia nigra 95
Subthalamic nucleus 95
Supraventricular tachycardia 40
Sweating 99
excessive 71
Swollen knee 12
Synaptobrevin 25
Syncope 37, 40
Syntaxin 25
T
Tachycardia 50
Tachypnea 50
Tactile discrimination 92
Tanner stage 114
Tau proteins 103
Testosterone 73
levels 71
Tetrodotoxin poisoning 22
pathophysiology of 23f
Thyroid
Gland
abnormal 64
removal of 84
hormone secretion, regulation of 66f
nodule 84
synthesis, inborn errors of 64
Thyroidectomy 84
Total iron binding capacity 1
Touch sensation, loss of 92
Trans ferritin 3
Tremors 94
Tuning fork test 105t, 106t
Turner's syndrome 114
pathophysiology of 114f
U
Ulcer 29
Upper motor neuron 92
Urinary bladder 58
Urinary tract infection 89
V
Vasoactive crisis 15
Vestibulocerebellum 96
Vibration 92
Vision, field of 107, 109
Visual acuity 107, 109, 110
Visual disturbance 71
Visual pathway 110, 111f
Vitamin B12
absorption of 5, 6f
deficiency 5
causes of 7t
Vomiting 45, 98
W
Water loss 34
Weakness 16
signs of 100
Webbed neck 114
Weber test 105, 106
Weight
gain 63, 90
loss 30
Wolff-Parkinson-White syndrome 40, 40f
X
X chromosome 114, 115
X-ray
chest 51f
hand 82f
skull 82f
×
Chapter Notes

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Early Clinical Exposure A Case Based Approach in Clinical Physiology
Early Clinical Exposure A Case Based Approach in Clinical Physiology
As per the Revised Competency-based Medical Education Curriculum (NMC-2024)
Second Edition
Manjinder Kaur MBBS MD (Physiology) MAMS CMCL-FAIMER ACME Professional Certificate in Healthcare Management and Analytics (IIM Kozhikode) Professor and Head Department of Physiology Additional Principal Geetanjali Medical College and Hospital Udaipur, Rajasthan, India Co-authors Suman Sharma MSc PhD (Medical Physiology) ACME Professor Department of Physiology ESIC Medical College and Hospital Faridabad, Haryana, India Suman Sharma MSc PhD (Medical Physiology) ACME Professor Department of Physiology ESIC Medical College and Hospital Faridabad, Haryana, India Naren Kurmi MBBS MD (Physiology) Professor Department of Physiology Geetanjali Medical College and Hospital Udaipur, Rajasthan, India Sangita Chauhan MBBS MD (Physiology) Professor Department of Physiology Pacific Medical College and Hospital Udaipur, Rajasthan, India
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Early Clinical Exposure: A Case Based Approach in Clinical Physiology
First Edition: 2023
Second Edition: 2025
9789366168265
Printed in India
Preface to the Second Edition
Welcome to the second edition of Early Clinical Exposure: A Case Based Approach in Clinical Physiology. This book has been crafted with the intention of bridging the gap between theoretical knowledge and clinical practice, particularly for first-year MBBS students. Understanding the physiological basis of clinical conditions is fundamental for developing sound clinical acumen, and this book aims to provide a comprehensive resource to achieve that goal.
The salient features of this book are designed to facilitate effective learning and retention:
  1. Ample cases: Each section of the book includes numerous cases that elucidate the physiological underpinnings of various clinical conditions. These cases are tailored to enhance the practical understanding of physiological concepts.
  2. Simplified diagrams and flowcharts: Complex information is presented in simplified diagrammatic and flowchart forms to ensure easy understanding and replication. This approach helps students visualize and internalize key concepts more effectively.
  3. Quick revision and examination aid: The book is structured to serve as a quick revision tool for students. Its concise and focused content makes it an ideal resource for examination preparation.
  4. Versatile usage: While the book is specifically crafted for first-year MBBS students, its comprehensive content makes it useful for students across all professional years. It is designed to be a valuable reference throughout medical education.
  5. Strong foundation in physiology: By providing a solid foundation in physiology, this book aims to enhance the understanding of clinical conditions. A robust grasp of physiological principles is essential for the development of competent and confident clinicians.
We hope this book serves as a valuable resource in your medical education journey, helping you build a strong foundation in physiology and enhancing your clinical skills. We welcome feedback and suggestions for further improvement, as we strive to make this book an indispensable tool for students and educators alike.
Thank you for choosing this book as part of your learning experience. We wish you success in your studies and future medical career.
Manjinder Kaur
Preface to the First Edition
The early clinical exposure (ECE) has been introduced in the 1st MBBS curriculum as a part of vertical integration between the first year and the final year subjects. According to Bloom's Taxonomy (cognitive domain, based on acquisition of knowledge) has been reclassified in 2001 as:
According to this, the learner has to atleast use the factual concepts in application of knowledge (level 3 of Bloom's taxonomy) during the First Professional MBBS. Hence, ECE provides a platform for easily attaining this level. Further, ECE gives a good exposure to the students, in gaining an insight into clinical and social aspects of patient care. In the second professional, the student gets to attend the clinics and starts applying the knowledge gained through the ECE chapters. Understanding the medicine through physiological basis of disease and its management will help the students to build a proper perspective that embraces the clinical content and helps them become a good medical professional and a competent Indian Medical Graduate.
Manjinder Kaur
Acknowledgments
First and foremost, I am deeply grateful to Almighty God for His countless blessings and guidance throughout this journey.
I would like to express my heartfelt gratitude to my parents—my father, Late Dr OPS Kande, a thorough clinician who played an instrumental role in refining my clinical skills and whose constant emphasis on polishing clinical skills has been a cornerstone of my professional development, and my mother, Mrs Surinder Kaur, whose unwavering support, patience, and virtue have been a constant source of strength.
My deepest appreciation goes to my husband, Dr Harpreet Singh, for his unwavering support, encouragement, and motivation. His belief in me has been a driving force behind this endeavor.
I am also grateful to my daughter, Muskan Singh, a final-year MBBS student, for her valuable feedback and insights into the requirements of learners. Her perspective has been invaluable in shaping this book.
I extend my heartfelt thanks to my son, Guntesh Singh, for his support and nondemanding attitude amidst his own challenging times. His understanding and patience have been truly commendable.
Finally, I would like to acknowledge the invaluable contributions of my coauthors: Dr Naren Kurmi, Dr Suman Sharma, and Dr Sangita Chauhan. Together, we formed a great team and partnership that brought this project to life. Their dedication and hard work have been instrumental in making this book a reality.
I acknowledge the inspiration and support of our students, colleagues, and family in completion of this book.
I wish to thank Dr Rishi Sharma, Professor of Respiratory Medicine, and Dr Pankaj Gupta, Consultant Gastroenterology, for their help in constructing the clinical cases in Respiratory and Gastrointestinal Physiology, respectively.
I also extend my gratitude toward the whole team of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President), Dr Madhu Choudhary (Director–Educational Publishing), Ms Pooja Bhandari [Director–Production (Books and Journals)], and Dr Aditya Tayal (Editorial Manager-Content Strategy) for the successful completion of this book.
Manjinder Kaur
Competency Table
Number
COMPETENCY
The student should be able to:
Chapter number
Page number
PY2.5
Describe anemias and jaundice. Discuss their physiological principles of management.
1
1
PY2.9
Describe hemostasis, coagulation pathways, mechanism of action of anticoagulants and briefly discuss pathophysiological aspects of bleeding and clotting disorders (e.g., hemophilia, purpura).
PY3.4
Describe the microscopic structure of neuromuscular junction (NMJ) and mechanism of neuromuscular transmission.
2
16
PY3.5
Discuss the applied aspects of neuromuscular junction: Myasthenia gravis, Lambert-Eaton syndrome and neuromuscular blocking agents.
PY3.10
Enumerate and briefly discuss myopathies.
PY4.11
Discuss (in brief) the applied physiology of GIT viz. Peptic ulcer, gastroesophageal reflux disease, vomiting, diarrhea, constipation, adynamic ileus, Hirschsprung's disease.
3
26
PY5.6
Discuss physiological variations in ECG waveforms, abnormal waveforms and intervals, arrhythmias, heart blocks and myocardial infarction.
4
37
PY5.13
Describe the pathophysiology of shock, syncope and heart failure with physiological basis of its management.
PY6.6
Describe and discuss the pathophysiology of dyspnea, hypoxia, cyanosis, asphyxia, drowning, periodic breathing and oxygen therapy.
5
50
PY6.7
Discuss various lung function tests and their clinical significance in obstructive and restrictive lung diseases.
PY6.8
Discuss the physiology of high altitude and acclimatization.
PY6.9
Discuss the physiology of deep-sea diving and decompression sickness.
PY7.6
Describe the innervations of the urinary bladder, physiology of micturition and its abnormalities.
6
58
PY7.9
Discuss the role of artificial kidneys, dialysis and indications of renal transplant.
PY8.2
Describe the synthesis, secretion, transport, physiological actions, regulation and effect of altered (hypo and hyper) secretion of pituitary gland.
7
63
PY8.3
Describe the synthesis, secretion, transport, physiological actions, regulation and effect of altered (hypo and hyper) secretion of thyroid gland including thyroid function tests.
PY8.4
Describe the synthesis, secretion, transport, physiological actions, regulation and effect of altered (hypo and hyper) secretion of adrenal gland and its function tests.
PY8.5
Describe the synthesis, secretion, transport, physiological actions, regulation and effect of altered (hypo and hyper) secretion of parathyroid gland with emphasis of physiology of bone and calcium metabolism.
PY8.6
Describe the synthesis, secretion, transport, physiological actions, regulation and effect of altered (hypo and hyper) secretion of pancreatic gland including pancreatic function tests.
PY9.7
Discuss the physiology of pregnancy, parturition and lactation.
8
86
PY9.8
Discuss the physiological basis of various pregnancy tests.
PY9.10
Discuss the common causes of infertility in a couple and role of IVF in managing a case of infertility.
PY10.9
Describe the course of descending tracts (pyramidal and extrapyramidal), its clinical implications including difference in upper motor neuron (UMN) and lower motor neuron (LMN) lesions.
9
91
PY10.10
Discuss types and clinical features of spinal cord lesions (complete, incomplete transection and hemisection—Brown-Sequard syndrome).
PY10.11
Describe functional anatomy of cerebellum, its connections, functions and clinical abnormalities.
PY10.12
Discuss functional anatomy of basal ganglia, its connections, functions and clinical abnormalities.
PY10.14
Discuss functional anatomy of thalamus, its connections, functions and clinical abnormalities.
PY10.15
Discuss functional anatomy of hypothalamus and limbic system, its connections, functions and clinical abnormalities.
PY10.16
Discuss functional anatomy of cerebral cortex, its connections, functions and clinical abnormalities.
PY10.18
Discuss the physiological basis of memory, learning and speech and clinical alterations in speech.
PY11.4
Discuss physiology of hearing, pathophysiology of deafness and hearing tests.
10
104
PY11.5
Discuss functional anatomy of eye, visual pathway, light and pupillary reflex and clinical implication of lesions in visual pathway.
PY11.6
Discuss physiology of image formation, refractive errors and physiological principles of its management.
PY11.7
Discuss physiology of vision including color vision and color blindness.
PY9.1
Explain sex determination, sex differentiation and their abnormalities.
11
112