• Anatomy & Physiology
• Medical-Surgical Nursing
• Pharmacology
• Community Health Nursing
• Obstetrics & Gynecology Nursing
• Pediatric Nursing
• Mental Health Nursing
• Microbiology & Pathology
• Nutrition & Biochemistry
• Nursing Research & Statistics

• Ask me concept questions on any topic
• Request MCQ practice questions
• Get explanations for difficult topics
• Review important drug dosages and mechanisms
• Clarify clinical nursing procedures

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NORCET High-Scoring Topics - Complete Study Guide

Exam Pattern at a Glance

• Prelims: 20 GK/Aptitude + 80 Nursing
• Mains: 4 sections of 40 questions each, all nursing, case scenario-based

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Subject Weightage (2024-2026 Trend)

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Subject-Wise High-Yield Topics

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1. Medical-Surgical Nursing (MSN)

• ECG interpretation: Normal values, sinus rhythms, AF, VF, VT, heart block
• Myocardial Infarction: Signs, STEMI vs NSTEMI, enzyme markers (Troponin I/T, CK-MB), nursing management
• Heart failure: Left vs right sided, nursing interventions, medications (digoxin toxicity signs)
• Hypertension: JNC classifications, antihypertensives, hypertensive crisis

• ABG analysis: Normal values (pH 7.35-7.45, PaO2 80-100, PaCO2 35-45, HCO3 22-26), acid-base disorders
• COPD vs Asthma: Differences, nursing care, pursed lip breathing
• Chest tube drainage: Water seal, drainage positions, troubleshooting
• Mechanical ventilation: SIMV, PEEP, FiO2 basics

• Glasgow Coma Scale scoring
• Increased ICP: Signs (Cushing's triad), nursing - HOB 30 degrees
• Stroke: Ischemic vs hemorrhagic, tPA eligibility, FAST assessment
• Seizures: Types, status epilepticus management

• Fluid & electrolyte imbalances (Na, K, Ca, Mg) - classic signs to know
• Acute vs Chronic Renal Failure, dialysis nursing care
• Urinary catheterization - CAUTI prevention

• Diabetes: Insulin types, DKA vs HHS management
• Thyroid disorders: Hyperthyroid (Grave's) vs Hypothyroid signs, thyroid storm
• Cushing's vs Addison's disease

• Pre/intra/post-operative nursing care
• Wound care, dressings, drain management
• Pressure ulcer staging (Stage I-IV + unstageable)

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2. Psychiatric Nursing

• Defense mechanisms: Repression, projection, rationalization, displacement, sublimation - with examples
• Mental status examination (MSE) components
• DSM-5 criteria for major disorders: Schizophrenia, Depression, Bipolar, OCD, PTSD, Anxiety disorders
• Schizophrenia: Positive vs negative symptoms, antipsychotics (typical vs atypical), side effects - EPS, tardive dyskinesia, NMS
• Depression: Beck's triad, SSRI side effects, serotonin syndrome
• Suicide risk assessment: SAD PERSONS scale, nursing interventions
• Therapeutic communication: Techniques and blocks
• Milieu therapy, ECT - nursing care, indications
• Substance use disorders: CAGE questionnaire, withdrawal symptoms (alcohol, opioids)
• De-escalation techniques, restraints - legal and ethical aspects

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3. OBG / Midwifery Nursing

• ANC schedule: 4 vs 8 visits
• TORCH infections, Rh incompatibility, Coombs test
• Preeclampsia vs Eclampsia: BP criteria, HELLP syndrome, MgSO4 protocol (dose, toxicity, antidote - calcium gluconate)
• Fetal heart monitoring: Baseline FHR, accelerations, decelerations (early/late/variable)

• Stages of labor, Bishop score
• Cardinal movements of labor
• Oxytocin administration nursing care
• Shoulder dystocia (McRoberts maneuver), cord prolapse

• BUBBLE-HE assessment
• Postpartum hemorrhage: 4 Ts (Tone, Trauma, Tissue, Thrombin), oxytocin, ergometrine
• Mastitis vs breast engorgement
• Postpartum depression vs psychosis

• APGAR scoring: 0/1/2 for each parameter, assessment at 1 and 5 minutes
• Breastfeeding - latch, positions, benefits
• Phototherapy for jaundice - nursing care

• Cancer screening: Pap smear (ASCUS, CIN grading), HPV vaccine schedule
• PCOS, endometriosis, fibroid management

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4. Pediatric Nursing

• Milestones: Motor, language, social at 3, 6, 9, 12, 18 months and 2, 3, 4, 5 years
• Weight formula: 2n + 8 (for children 3-12 years)
• Immunization schedule (National Immunization Program - India)

• Respiratory: Croup (barking cough, steeple sign) vs Epiglottitis (thumb sign, drooling), RSV bronchiolitis
• Cardiac: VSD, ASD, Tetralogy of Fallot (boot-shaped heart, tet spells, squatting)
• Neurological: Febrile seizures, Meningitis (Kernig's, Brudzinski's signs)
• Renal: Nephrotic vs Nephritic syndrome differences
• Hematologic: Thalassemia, Sickle cell crisis, ITP, ALL
• GI: Pyloric stenosis (projectile vomiting, olive mass), Intussusception (currant jelly stool), Hirschsprung's disease

• Dehydration assessment (mild/moderate/severe)
• ORS preparation (standard WHO formula)
• PALS/BLS for children - compression ratio

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5. Fundamentals of Nursing (FON)

• Infection control: Standard precautions, transmission-based precautions (contact, droplet, airborne)
• PPE sequence: Don and doff order
• Sterilization methods: Autoclave (121°C/15 psi/20 min), dry heat (160-170°C), chemical - ETO
• Vital signs normal ranges (across age groups)
• Bedmaking: Occupied, unoccupied, surgical bed
• Body mechanics and positioning: Fowler's, Trendelenburg, lithotomy, Sim's, prone
• Pressure ulcer prevention (Braden scale)
• Medication administration: 10 rights, Z-track injection, deltoid landmarks
• IV fluid types: Normal saline, Ringer's lactate, D5W - indications

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6. Community Health Nursing

• Levels of prevention: Primary (health promotion), Secondary (screening), Tertiary (rehabilitation)
• Epidemiology: Incidence vs prevalence, attack rate, case fatality rate
• Vaccines: Cold chain maintenance (2-8°C), VVM indicator, open vial policy
• National Health Programs: RNTCP, NVBDCP, NPCB, RKSK, PMSMA, JSSK
• Family planning: Copper-T (IUCD 380A), OCP mechanism, permanent methods
• ASHA, ANM, MPW roles and responsibilities
• PHC structure: Functions, manpower, coverage
• Malnutrition: SAM vs MAM criteria, MUAC measurement (< 11.5 cm = SAM), RUTF

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7. ICU / Emergency / OT Nursing

• ABCDE approach
• Triage color codes: Black (expectant/dead), Red (immediate), Yellow (delayed), Green (minor)
• BLS sequence: C-A-B, compression rate 100-120/min, depth 5-6 cm, ratio 30:2
• ACLS drugs: Epinephrine 1mg IV every 3-5 min, Amiodarone 300mg for VF/pVT

• Hemodynamic monitoring: CVP normal (2-8 mmHg), PCWP (6-12 mmHg)
• Ventilator alarms: High pressure vs low pressure causes
• Sepsis: qSOFA criteria, Sepsis-3 definition, Septic shock MAP < 65 mmHg
• Swan-Ganz catheter, arterial line care

• Surgical conscience
• Instrument counting, correct counts before closure
• Positioning complications

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Quick Revision: Must-Memorize Values

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Study Strategy (12-Week Plan)

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Tips for NORCET Specifically

1. Case-based questions dominate the Mains - practice reading scenarios quickly and identifying the priority nursing action
2. Negative marking is -1/3 - skip questions you are genuinely unsure about
3. Each section (Mains) is timed at 45 minutes - do not get stuck on one question; flag and move
4. Psychiatric and OBG now have equal weight to MSN - do not neglect them
5. GK section in Prelims: Focus on current affairs (last 6 months), important health schemes, and basic arithmetic

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Cell and Tissue - NORCET Study Notes

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PART 1: THE CELL

Basic Cell Concept

• The cell is the basic structural and functional unit of the body
• However, it is really tissues (collaborative cell groups) that maintain body functions
• Cells connect via specialized junctions and communicate through gap junctions, membrane receptors, hormonal, neural, and mechanical signals

Cell Organelles - High Yield Table

Cell Membrane - Quick Points

• Structure: fluid mosaic model (Singer & Nicolson, 1972)
• Phospholipid bilayer - hydrophilic heads face outward, hydrophobic tails face inward
• Functions: selective permeability, signal reception, cell recognition

Cell Division

• Mitosis: somatic cells, 46 chromosomes (2n) → 46 chromosomes - PMAT (Prophase, Metaphase, Anaphase, Telophase)
• Meiosis: sex cells (gametes), 46 chromosomes → 23 chromosomes (n)
• Interphase: G1 (growth), S (DNA synthesis), G2 (preparation) - NOT a phase of mitosis

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PART 2: THE FOUR BASIC TISSUE TYPES

Mnemonic: ECMN - Epithelial, Connective, Muscle, Nerve

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TISSUE TYPE 1: Epithelial Tissue

Key Characteristics

• Cells closely packed with minimal extracellular matrix
• Always has a free (apical) surface and a basal surface resting on basement membrane
• Avascular (no blood supply) - gets nutrients by diffusion from underlying connective tissue
• High regeneration capacity (continuous renewal)
• Functions: protection, absorption, secretion, sensation

Classification of Epithelium

Combined Classification - NORCET Favorites

Basement Membrane

• Thin extracellular layer between epithelium and connective tissue
• Two layers:
  • Basal lamina: type IV collagen + laminin (made by epithelial cells)
  • Reticular lamina: type III collagen + anchoring fibrils of type VII collagen (made by connective tissue cells)
• Functions: attach epithelium, filter substances, guide tissue regeneration after injury

Cell Junctions - HIGH YIELD for NORCET

Mnemonic for junctions (apical to basal): TADGH - Tight, Adherens, Desmosome, Gap, Hemidesmosome

Apical Surface Modifications

Glands - Types of Secretion (HIGH YIELD MCQ)

Mnemonic: M-A-H → Merocrine = Most common; Apocrine = Apical bud; Holocrine = Hara-kiri (cell dies)

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TISSUE TYPE 2: Connective Tissue

Key Characteristics

• Characterized by its extracellular matrix (ECM)
• Most abundant and widely distributed tissue
• Vascular (except cartilage, cornea, and lens)
• Underlies and supports all other tissues
• Derived from mesoderm (mostly) and neural crest cells

Components of Connective Tissue

• Fills space between cells and fibers
• Contains proteoglycans (hyaluronic acid, chondroitin sulfate) and glycoproteins (fibronectin, laminin)

Classification of Connective Tissue

• Cartilage (hyaline, fibrocartilage, elastic)
• Bone (osseous tissue)
• Blood (vascular connective tissue)
• Adipose tissue

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TISSUE TYPE 3: Muscle Tissue

Mnemonic for cardiac muscle: "CINS" - Central nucleus, Intercalated discs, Not voluntary, Striated

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TISSUE TYPE 4: Nerve Tissue

Components

Neuron Structure

• Cell body (soma): contains nucleus and organelles (Nissl bodies = RER)
• Dendrites: receive impulses → carry toward cell body
• Axon: single; carries impulses away from cell body
• Myelin sheath: speeds up nerve conduction (saltatory conduction)

Neuroglia Types (CNS)

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TISSUE ORIGINS (Germ Layers) - HIGH YIELD

Trick: Adrenal cortex = mesoderm; Adrenal medulla = ectoderm (neural crest)

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MCQ Practice - Cell & Tissue

• a) Gap junction
• b) Desmosome
• c) Tight junction ✅
• d) Hemidesmosome

• a) Cell-to-basement membrane attachment
• b) Communication between cells ✅
• c) Prevention of substance leakage
• d) Cell strength against mechanical stress

• a) Merocrine
• b) Apocrine
• c) Holocrine ✅
• d) Eccrine

• a) Connective tissue
• b) Muscle tissue
• c) Epithelial tissue ✅
• d) Nerve tissue

• a) Mesoderm
• b) Endoderm
• c) Ectoderm (neural crest) ✅
• d) Lateral plate mesoderm

• a) Skeletal
• b) Cardiac ✅
• c) Smooth
• d) Both skeletal and cardiac

• a) Actin filaments
• b) 9+2 microtubule arrangement ✅
• c) Intermediate filaments
• d) Vimentin

• a) Fibroblast
• b) Macrophage
• c) Plasma cell
• d) Mast cell ✅

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Quick Memory Cards

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Cell Organelles & Cell Cycle - Detailed NORCET Notes

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PART 1: CELL ORGANELLES

Overview

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1. NUCLEUS

• Largest organelle in the cell
• Surrounded by a double membrane = nuclear envelope
  • Outer membrane: studded with ribosomes, continuous with rough ER
  • Inner membrane: smooth, faces nucleoplasm
  • The space between membranes = perinuclear cisternal space (continuous with RER lumen)
• Nuclear pores: where outer and inner membranes meet; transport pathway between cytoplasm and nucleus

• Human cell has 46 chromosomes, ~6 billion base pairs, 1.8 m of DNA per cell
• DNA is packed using histones (5 basic proteins: H1, H2A, H2B, H3, H4)
• Nucleosome = DNA wound around 8 histones (H2A, H2B, H3, H4 × 2 each)
• Human genome sequenced in 2003 (Human Genome Project, 13 years)
• ~23,000 protein-coding genes

Mnemonic: PKL - Pyknosis → Karyorrhexis → Karyolysis (sequence of nuclear death)

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2. MITOCHONDRIA

• "Balloon within a balloon" - two membranes
• Outer membrane: smooth, permeable to small molecules
• Inner membrane: impermeable; thrown into folds = cristae (increases surface area)
• Intermembrane space: between outer and inner membrane
• Matrix: inside inner membrane; contains mitochondrial DNA, ribosomes, enzymes

• ATP production (oxidative phosphorylation) - primary role
• Fatty acid beta-oxidation
• Citric acid (Krebs) cycle occurs in matrix
• Electron transport chain on inner membrane cristae
• Calcium homeostasis
• Apoptosis initiation (releases cytochrome c)

• Has its OWN DNA (circular, like bacteria) - supports endosymbiotic theory
• Has own ribosomes (70S, like bacteria; cytoplasmic ribosomes are 80S)
• Inherited maternally (mitochondrial DNA diseases - maternal inheritance)
• Can self-replicate (binary fission)
• ~0.2 μm diameter (at limit of light microscope resolution)

Mnemonic: Mitochondria = Maternal inheritance, Matrix has Krebs cycle, Makes ATP

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3. ENDOPLASMIC RETICULUM (ER)

• ER is a large interconnected network of tubules and saccules
• RER outer membrane is continuous with outer nuclear membrane
• SER contains Ca²⁺ pump (uses ATP) → pumps Ca²⁺ from cytoplasm into ER lumen → released for intracellular signaling
• In muscle cells, SER is called sarcoplasmic reticulum (releases Ca²⁺ to trigger muscle contraction)

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4. GOLGI APPARATUS (GOLGI COMPLEX)

• Structure: Stack of flattened membrane saccules (looks like "stack of pancakes")
• Has a cis face (receives vesicles from RER) and trans face (sends vesicles out)
• Functions:
  • Processes and modifies proteins from RER (glycosylation, phosphorylation, sulfation)
  • Packages proteins into secretory vesicles
  • Produces lysosomes
  • Targets proteins to correct subcellular destinations
  • Produces mucus (glycoproteins)

Called the "Post office" or "processing station" of the cell

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5. LYSOSOMES

• Structure: Membrane-bound vesicle containing ~60 hydrolytic enzymes
• pH: ~5 (acidic) - maintained by H⁺ pump in lysosome membrane
• Functions:
  • Intracellular digestion (autophagy - digestion of own organelles)
  • Phagocytosis (destroys bacteria and debris)
  • Receptor recycling (endocytosis pathway)

• Lysosomal storage diseases = enzyme deficiencies → substrates accumulate
  • Gaucher disease: glucocerebrosidase deficiency
  • Tay-Sachs: hexosaminidase A deficiency
  • Pompe disease: alpha-glucosidase deficiency (affects cardiac and skeletal muscle)

Called the "Suicide bag" because rupture causes cell self-destruction

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6. RIBOSOMES

• Size in eukaryotes: 80S (60S large subunit + 40S small subunit)
• Size in prokaryotes and mitochondria: 70S (50S + 30S)
• Made of rRNA + proteins
• Polyribosomes (polysomes) = multiple ribosomes on one mRNA strand

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7. PEROXISOMES

• Small membrane-bound organelles
• Functions:
  • Beta-oxidation of very long chain fatty acids (VLCFAs)
  • Detoxification of hydrogen peroxide (H₂O₂) using catalase
  • Bile acid synthesis
  • Cholesterol synthesis
• Disease: Zellweger syndrome = absence of functional peroxisomes → VLCFA accumulation

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8. CYTOSKELETON

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9. CENTRIOLES & CENTROSOME

• Centrioles are paired cylindrical structures made of 9 triplets of microtubules (9×3 arrangement)
• Centrosome = pair of centrioles + surrounding pericentriolar material
• Functions: form the mitotic spindle during cell division
• Absent in: mature neurons (cannot divide), mature red blood cells, cardiac muscle cells

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10. CELL MEMBRANE (PLASMA MEMBRANE)

• Fluid Mosaic Model (Singer & Nicolson, 1972)
• Composition: phospholipid bilayer + proteins + cholesterol + glycolipids
• Hydrophilic heads face outward (toward water); hydrophobic tails face inward
• Cholesterol: maintains membrane fluidity (prevents too rigid in cold, too fluid in heat)
• Proteins:
  • Integral proteins: embedded in bilayer (e.g., ion channels, receptors, transporters)
  • Peripheral proteins: on surface (e.g., enzymes, structural proteins)
• Glycocalyx: carbohydrate coat on outer surface; cell recognition, adhesion, immune response

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PART 2: THE CELL CYCLE

Overview

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Phases of the Cell Cycle

G1 → S → G2 → M (Mitosis) → G1...
         ↑
    (Interphase = G1 + S + G2)

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Cell Cycle Checkpoints - HIGH YIELD

p53 = "Guardian of the genome"; mutated in >50% of all cancers; triggers apoptosis or cell cycle arrest when DNA is damaged

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Cyclin-CDK Regulation

• Cyclins are synthesized and degraded at regular intervals
• CDKs are always present but need cyclin to activate them
• MPF (Maturation Promoting Factor) = Cyclin B + CDK1 → triggers entry into mitosis

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MITOSIS - Phases in Detail (M Phase)

Mnemonic: PMAT - Prophase, Metaphase, Anaphase, Telophase

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MEIOSIS (vs. Mitosis)

• Prophase I: Homologous chromosomes pair (synapsis) → crossing over (genetic recombination) occurs at chiasmata
• Produces 2 cells with haploid number of chromosomes but diploid DNA content

• Similar to mitosis
• Separates sister chromatids
• Produces 4 haploid cells (23 chromosomes each)

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CELL DEATH

• Intrinsic pathway: triggered by internal signals (DNA damage, hypoxia) → mitochondria releases cytochrome c → activates caspases
• Extrinsic pathway: triggered by death receptors (Fas/FasL, TNF) → caspase cascade
• Bcl-2 family: anti-apoptotic (Bcl-2, Bcl-XL); pro-apoptotic (Bax, Bak)
• p53 promotes apoptosis when DNA damage is irreparable

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ORGANELLES AT A GLANCE - Quick Reference

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MCQ Practice - Cell Organelles & Cell Cycle

• a) Lysosome
• b) Mitochondria
• c) Peroxisome ✅
• d) Smooth ER

• a) Paternal
• b) Maternal ✅
• c) Both equally
• d) Random

• a) G1
• b) S phase ✅
• c) G2
• d) Prophase

• a) Spindle assembly checkpoint
• b) Restriction point ✅
• c) S-phase DNA damage checkpoint
• d) G2/M checkpoint

• a) Prophase
• b) Anaphase
• c) Metaphase ✅
• d) Telophase

• a) Metaphase I of meiosis
• b) Prophase I of meiosis ✅
• c) Anaphase II of meiosis
• d) Prophase of mitosis

• a) Necrosis
• b) Traumatic death
• c) Apoptosis ✅
• d) Infarction

• a) Glucocerebrosidase
• b) Alpha-galactosidase
• c) Hexosaminidase A ✅
• d) Sphingomyelinase

• a) 80S
• b) 60S
• c) 70S ✅
• d) 40S

• a) Rb protein
• b) Cyclin B
• c) p53 ✅
• d) CDK4

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• Cardiovascular system (heart, blood vessels, cardiac cycle)
• Respiratory system (lung physiology, gas exchange)
• Nervous system (neurons, action potential, CNS/PNS)
• Renal system (kidney, nephron, filtration)