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🧬 MBBS 1st Year Physiology - Complete Exam Prep Guide

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SECTION 1: GENERAL PHYSIOLOGY & CELL

1.1 Homeostasis

• Homeostasis = maintenance of stable internal environment
• Regulated variables: temperature, blood glucose, pH, plasma osmolarity, blood pressure
• Negative feedback - the dominant control mechanism (e.g., thermoregulation, blood pressure control)
• Positive feedback - amplifies a response; can be physiological (childbirth, blood clotting) or pathological (vicious cycle leading to death)
• Feed-forward control - anticipatory (e.g., salivation before eating)
• Gain of a control system = Correction achieved / Error remaining

Stimulus → Disturbance in variable
         → Detected by sensor/receptor
         → Control centre processes signal
         → Effector activated
         → Response OPPOSES the change
         → Variable returns to set point

Q: The most common control mechanism in the body is? A) Positive feedback B) Negative feedback C) Feed-forward D) Open loop Answer: B

Q: An example of physiological positive feedback is? A) Thermoregulation B) Blood pressure control C) Parturition (childbirth) D) Blood glucose regulation Answer: C

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1.2 Membrane Potentials & Action Potentials

• Neuron: -70 mV
• Skeletal muscle: -90 mV
• Cardiac ventricular cell: -90 mV
• SA node: -55 to -65 mV
• Red blood cell: -8 to -12 mV
• Maintained by: Na⁺/K⁺-ATPase pump (pumps 3 Na⁺ OUT, 2 K⁺ IN)
• K⁺ is the main ion responsible for RMP (membrane most permeable to K⁺ at rest)
• Nernst equation for K⁺: E_K = -94 mV; for Na⁺: E_Na = +61 mV
• Goldman equation gives the actual RMP considering all ions

Vdf = Vm - Veq

• For Na⁺ at rest: Vdf = -70 - (+61) = -131 mV → strong inward driving force for Na⁺

Q: The Na⁺/K⁺-ATPase pump creates the resting potential by pumping? A) 2 Na⁺ out, 3 K⁺ in B) 3 Na⁺ out, 2 K⁺ in C) 3 Na⁺ in, 2 K⁺ out D) Equal amounts Answer: B

Q: The ion responsible for the RISING phase of action potential is? A) K⁺ B) Ca²⁺ C) Na⁺ D) Cl⁻ Answer: C

Q: Absolute refractory period is due to? A) K⁺ channel inactivation B) Na⁺ channel inactivation C) Ca²⁺ influx D) Cl⁻ efflux Answer: B

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1.3 Synaptic Transmission

• Neurotransmitter released from presynaptic terminal → diffuses across synaptic cleft → binds postsynaptic receptor
• EPSP (excitatory postsynaptic potential) - depolarizes the membrane
• IPSP (inhibitory postsynaptic potential) - hyperpolarizes the membrane
• Spatial summation: multiple synapses fire simultaneously
• Temporal summation: same synapse fires repeatedly
• Main excitatory NT: Glutamate (CNS); Acetylcholine (NMJ)
• Main inhibitory NTs: GABA (brain); Glycine (spinal cord)

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SECTION 2: BLOOD & BODY FLUIDS

2.1 Body Fluid Compartments

• TBW → Antipyrine or Tritiated water
• ECF → Inulin or Mannitol
• Plasma volume → Evans Blue dye or Radioactive albumin

Q: The largest body fluid compartment is? A) Plasma B) Extracellular fluid C) Intracellular fluid D) Interstitial fluid Answer: C

2.2 Blood

• Total: 6-8 g/dL
• Albumin: 3.5-5 g/dL (most abundant; maintains oncotic pressure)
• Globulins: 2.3-3.5 g/dL
• Fibrinogen: 0.2-0.4 g/dL
• A:G ratio = 1.2:1 to 1.7:1

Q: The protein responsible for colloid oncotic pressure of plasma is? A) Fibrinogen B) Globulin C) Albumin D) Prothrombin Answer: C

Q: Normal ESR in males (Westergren method) is? A) 0-7 mm/hr B) 0-15 mm/hr C) 0-20 mm/hr D) 5-25 mm/hr Answer: B

2.3 Hemoglobin & Oxygen Transport

• Adult Hb (HbA): 2α + 2β chains
• HbA2: 2α + 2δ chains (minor adult)
• HbF (Fetal): 2α + 2γ chains - higher O₂ affinity than HbA
• Sickle Hb (HbS): glutamate → valine substitution in β chain

• Sigmoidal shape due to cooperativity (each O₂ bound makes next binding easier)
• P50 = 26-27 mmHg (pO₂ at which Hb is 50% saturated)
• Normal pO₂ in lungs ~100 mmHg → Hb ~97% saturated
• Normal pO₂ in tissues ~40 mmHg → Hb ~75% saturated

RIGHT SHIFT (↓ O₂ affinity = MORE O₂ released to tissues):
  Caused by: ↑ CO₂, ↑ H⁺ (acidosis), ↑ temperature, ↑ 2,3-DPG, ↑ exercise
  
LEFT SHIFT (↑ O₂ affinity = LESS O₂ released):
  Caused by: ↓ CO₂, ↓ H⁺ (alkalosis), ↓ temperature, ↓ 2,3-DPG
  HbF, CO poisoning (CO-Hb) → left shift

• CO₂ ↑, Altitude ↓ (acclimatization), DPG ↑, Exercise, Temperature ↑

Q: Fetal hemoglobin (HbF) has a _____ shift in the ODC compared to adult HbA? A) Right B) Left C) No shift D) Depends on pH Answer: B (HbF has higher O₂ affinity)

Q: Carbon monoxide poisoning causes? A) Right shift of ODC B) Left shift of ODC C) No effect D) Both Answer: B (CO binds avidly to Hb and causes left shift)

2.4 ABO Blood Groups

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SECTION 3: CARDIOVASCULAR PHYSIOLOGY

3.1 Cardiac Cycle

1. Isovolumetric contraction - all valves closed, pressure builds (no volume change)
2. Rapid ejection - aortic/pulmonic valves open, blood flows out
3. Reduced ejection - slower outflow
4. Isovolumetric relaxation - all valves closed again
5. Rapid filling - mitral/tricuspid valves open
6. Reduced filling
7. Atrial systole (kick) - adds last 20-30% of ventricular filling

• End-diastolic volume (EDV) = 120-130 mL
• End-systolic volume (ESV) = 50-60 mL
• Stroke volume (SV) = EDV - ESV = 70 mL
• Ejection fraction (EF) = SV/EDV = 70/130 = ~55-60% (normal ≥55%)

3.2 Cardiac Output

Cardiac Output (CO) = Stroke Volume × Heart Rate CO = 70 mL × 70 beats/min = ~5 L/min

• Preload (EDV): ↑ preload → ↑ SV (Starling mechanism)
• Afterload (aortic pressure): ↑ afterload → ↓ SV
• Contractility (inotropy): ↑ contractility → ↑ SV at same preload
• Heart rate: ↑ HR → ↑ CO (up to a point; too high → ↓ filling time → ↓ CO)

Q: According to Frank-Starling law, stroke volume depends on? A) Heart rate B) End-diastolic volume C) Afterload D) Aortic pressure Answer: B

Q: Normal ejection fraction is? A) 30-40% B) 40-50% C) 55-70% D) 75-85% Answer: C

3.3 Cardiac Action Potential

• Phase 4: Pacemaker potential - slow depolarization due to I_f (funny current - Na⁺ inward)
• Phase 0: Ca²⁺ channels open (no fast Na⁺ channels in SA/AV nodes!)
• Intrinsic rate: SA node 60-100/min; AV node 40-60/min; Purkinje/ventricle 20-40/min

Q: The plateau phase of ventricular action potential is due to? A) Na⁺ influx B) K⁺ efflux C) Ca²⁺ influx D) Cl⁻ efflux Answer: C

Q: In SA node, the upstroke of action potential is caused by? A) Fast Na⁺ channels B) Slow Ca²⁺ channels C) K⁺ channels D) Cl⁻ channels Answer: B

3.4 Blood Pressure Regulation

• Systolic = peak pressure during systole
• Diastolic = minimum pressure during diastole
• Pulse pressure = Systolic - Diastolic = 40 mmHg
• Mean arterial pressure (MAP) = Diastolic + 1/3 Pulse pressure = 80 + 13 = 93 mmHg

MAP = CO × Total Peripheral Resistance (TPR)

1. Short-term: Baroreceptors (carotid sinus & aortic arch) → autonomic nervous system
2. Intermediate: Renin-Angiotensin-Aldosterone system (RAAS)
3. Long-term: Kidney (pressure natriuresis and diuresis) - most powerful long-term regulator

Q: Mean arterial pressure is calculated as? A) (Systolic + Diastolic)/2 B) Diastolic + 1/3 Pulse pressure C) Systolic - Diastolic D) Diastolic × 2 Answer: B

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SECTION 4: RESPIRATORY PHYSIOLOGY

4.1 Lung Volumes & Capacities

• Anatomical dead space: 150 mL (conducting airways - no gas exchange)
• Physiological dead space: anatomical + alveolar dead space
• Alveolar ventilation = (TV - Dead space) × RR = (500-150) × 12 = 4200 mL/min

Q: Which of the following CANNOT be measured by spirometry? A) Tidal volume B) Vital capacity C) Functional residual capacity D) Inspiratory reserve volume Answer: C

Q: Normal tidal volume in an adult is? A) 150 mL B) 350 mL C) 500 mL D) 1200 mL Answer: C

4.2 Ventilation-Perfusion (V/Q) Ratio

• Normal V/Q = 0.8 (ventilation ~4 L/min, perfusion ~5 L/min)
• V/Q = 0: No ventilation (shunt) → blood not oxygenated
• V/Q = ∞: No perfusion (dead space) → wasted ventilation
• In upright lungs: Apex has highest V/Q (~3.3); Base has lowest V/Q (~0.6)
• Zone 1 (apex): alveolar pressure > arterial pressure (dead space in disease)
• Zone 2 (middle): arterial > alveolar > venous
• Zone 3 (base): arterial > venous > alveolar (most perfusion)

4.3 Oxygen & CO₂ Transport

• 97-98%: bound to hemoglobin (as oxyhemoglobin)
• 1.5-3%: dissolved in plasma (Henry's law: 0.003 mL O₂/100 mL blood/mmHg pO₂)
• O₂ capacity of Hb: 1.34 mL O₂/g Hb (Hufner's constant)

• 70%: as bicarbonate (HCO₃⁻) in plasma - main form
• 23%: carbamino compounds (bound to Hb proteins)
• 7%: dissolved CO₂

Q: The main form in which CO₂ is transported in blood is? A) Dissolved in plasma B) As carbamino compound C) As bicarbonate D) Bound to albumin Answer: C

Q: Hufner's constant (O₂ combining capacity of Hb) is? A) 1.14 mL/g B) 1.34 mL/g C) 1.54 mL/g D) 0.34 mL/g Answer: B

4.4 Acid-Base Balance

• pH: 7.35-7.45
• PaCO₂: 35-45 mmHg
• HCO₃⁻: 22-26 mEq/L
• Base excess: ±2

pH = 6.1 + log [HCO₃⁻] / (0.03 × pCO₂)

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SECTION 5: RENAL PHYSIOLOGY

5.1 Glomerular Filtration

Favoring filtration:         Opposing filtration:
Glomerular capillary         Bowman's capsule
hydrostatic pressure         hydrostatic pressure
(~55 mmHg)                   (~15 mmHg)
                             + Colloid osmotic
                               pressure (~30 mmHg)

Net filtration pressure = 55 - 15 - 30 = 10 mmHg

• Clearance = (U × V) / P

Q: Normal GFR is approximately? A) 100 mL/min B) 125 mL/min C) 150 mL/min D) 75 mL/min Answer: B

Q: The gold standard for measuring GFR is? A) Urea clearance B) Creatinine clearance C) Inulin clearance D) PAH clearance Answer: C

5.2 Tubular Reabsorption

• Na⁺, Cl⁻, HCO₃⁻, glucose, amino acids, phosphate, K⁺
• Glucose: completely reabsorbed up to Tm = 375 mg/min (renal threshold = 180 mg/dL)
• Obligatory water reabsorption follows Na⁺ (isosmotic)

• Descending: water out (no solute transport)
• Ascending: NaCl out actively (no water)

• Aldosterone → ↑ Na⁺ reabsorption, ↑ K⁺ secretion
• ADH (vasopressin) → ↑ water reabsorption (aquaporin-2 channels)

Q: Renal threshold for glucose is? A) 120 mg/dL B) 150 mg/dL C) 180 mg/dL D) 250 mg/dL Answer: C

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SECTION 6: NEUROPHYSIOLOGY

6.1 Neurons

• Cell body (soma): metabolic center
• Axon: conducts AP away from soma
• Dendrites: receive input toward soma
• Types: Unipolar, Bipolar, Multipolar (most neurons in CNS)

6.2 Special Senses

• Rods: Scotopic (dim light), contain rhodopsin, no color
• Cones: Photopic (bright light), color vision (S-Blue, M-Green, L-Red)
• Fovea centralis: sharpest vision, only cones
• Blind spot (optic disc): no photoreceptors

• Organ of Corti on basilar membrane
• High frequency → base of cochlea; Low frequency → apex
• Hair cells are the transducers

• Semicircular canals → angular acceleration
• Utricle & Saccule (maculae) → linear acceleration & gravity

6.3 Autonomic Nervous System

Q: Sweat glands receive which type of nerve supply? A) Parasympathetic (muscarinic) B) Sympathetic (adrenergic) C) Sympathetic (cholinergic) D) Somatic Answer: C (Sweat glands are the exception - sympathetic but use ACh/muscarinic)

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SECTION 7: ENDOCRINE PHYSIOLOGY

7.1 Pituitary Hormones

• ADH (Vasopressin): water reabsorption, vasoconstriction; released by ↑ osmolality or ↓ BP
• Oxytocin: uterine contractions, milk ejection (let-down reflex)

7.2 Thyroid Hormones

• T4 (thyroxine, inactive) and T3 (active)
• T4 → T3 by deiodinases in peripheral tissues
• Effects: ↑ BMR, ↑ O₂ consumption, ↑ heart rate, promotes growth and development
• Hyperthyroidism: ↑ BMR, weight loss, tachycardia, heat intolerance, exophthalmos (Graves')
• Hypothyroidism: ↓ BMR, weight gain, bradycardia, cold intolerance, myxedema
• Congenital hypothyroidism → Cretinism (mental retardation + dwarfism)

7.3 Adrenal Hormones

GFR rule: Glomerulosa → Fasciculata → Reticularis
          Mineralocorticoids → Glucocorticoids → Sex steroids
          (Aldosterone)      → (Cortisol)      → (DHEA)

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SECTION 8: MUSCLE PHYSIOLOGY

8.1 Skeletal Muscle Contraction

1. AP reaches motor end plate → ACh released
2. ACh binds nicotinic receptors → end plate potential → AP in muscle
3. AP travels along T-tubules → Ca²⁺ release from SR
4. Ca²⁺ binds troponin-C → conformational change in troponin-tropomyosin complex
5. Tropomyosin moves aside → actin-myosin binding sites exposed
6. Myosin heads form cross-bridges with actin → power stroke (ATP hydrolysis)
7. Thin filaments slide over thick → sarcomere shortens → muscle contracts
8. Ca²⁺ pumped back into SR → relaxation

• Thin filament: Actin, Troponin (T, I, C), Tropomyosin
• Thick filament: Myosin (heavy and light chains)
• Titin: elastic protein maintaining sarcomere structure

Q: Calcium binds to which protein during muscle contraction? A) Troponin-T B) Troponin-I C) Troponin-C D) Tropomyosin Answer: C

Q: The neurotransmitter at the neuromuscular junction is? A) Norepinephrine B) Dopamine C) Acetylcholine D) GABA Answer: C

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SECTION 9: GI PHYSIOLOGY

• H⁺ pumped by H⁺/K⁺-ATPase (proton pump) in parietal cells
• Stimulated by: Gastrin, Histamine (H₂ receptors), ACh (vagus)
• Inhibited by: Secretin, GIP, pH <3 (feedback)

Q: The hormone that stimulates gallbladder contraction and pancreatic enzyme secretion is? A) Secretin B) Gastrin C) GIP D) CCK Answer: D

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HIGH-YIELD NUMBERS TO MEMORIZE

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RAPID-FIRE MCQ DRILL (Mixed)

1. The longest phase of SA node action potential is? → Phase 4
2. Purkinje fibers conduct at? → 2-4 m/s (fastest in heart)
3. Which receptor mediates bronchoconstriction by ACh? → M₃ (muscarinic)
4. The most abundant WBC is? → Neutrophil (60-70%)
5. Life span of RBC? → 120 days
6. Platelet life span? → 8-11 days
7. "Law of intestine" (Peristalsis) is mediated by? → Myenteric (Auerbach's) plexus
8. Intrinsic factor for B12 absorption is secreted by? → Parietal cells of stomach
9. The FEV₁/FVC ratio in obstructive lung disease? → <70% (<0.7)
10. Which hormone causes milk ejection? → Oxytocin
11. Insulin is produced by? → Beta (β) cells of Islets of Langerhans
12. Glucagon is produced by? → Alpha (α) cells
13. Normal blood glucose (fasting)? → 70-100 mg/dL
14. The Bowman's capsule hydrostatic pressure is? → ~15 mmHg
15. Erythropoietin is produced by? → Peritubular cells of kidney (90%) + liver (10%)

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STUDY STRATEGY TIPS

• Master the basics first: Membrane potential and action potential underpin cardiac, neural, and muscle physiology - nail this topic first.
• Draw it out: The cardiac cycle, ODC, and lung volumes are all best understood with diagrams. Draw them repeatedly.
• Link topics: Starling's law (cardiac) connects to fluid balance (renal) connects to ADH/Aldosterone - see the body as one integrated system.
• Normal values are exam gold: Learn every number in the table above - they come up constantly.
• Practice MCQs daily: In 1st year physiology exams, most questions are either "what is X" (fact) or "what happens when Y changes" (mechanism).

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📅 4-WEEK MBBS 1st Year Physiology Exam Prep Plan

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🗺️ OVERVIEW - THE BIG PICTURE

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WEEK 1 - FOUNDATION (July 15-21)

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Day 1 (Tue July 15) - General Physiology & Homeostasis

• Composition of body fluids (ICF/ECF, 60-40-20 rule)
• Homeostasis - definition, negative/positive feedback, feed-forward
• Normal ranges of ECF constituents
• Control systems - gain, error

1. Read Guyton Ch 1 + Ch 25 (body fluid compartments) - 1.5 hrs
2. Make a one-page summary table of all body fluid compartments with volumes
3. Draw the negative feedback loop from memory
4. Solve 15 MCQs on homeostasis and body fluids

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Day 2 (Wed July 16) - Cell Membrane & Transport

• Cell membrane structure (fluid mosaic model)
• Transport mechanisms: diffusion, facilitated diffusion, active transport
• Na⁺/K⁺-ATPase pump
• Osmosis and tonicity (isotonic, hypertonic, hypotonic)
• Vesicular transport (endocytosis, exocytosis)

1. Read Guyton Ch 4 - 1.5 hrs
2. Draw a cell membrane and label all transport proteins
3. Compare primary vs secondary active transport with examples
4. 15 MCQs

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Day 3 (Thu July 17) - Membrane Potentials

• Resting membrane potential (RMP) - origin, Nernst equation, Goldman equation
• Equilibrium potentials (E_K = -94 mV, E_Na = +61 mV)
• Electrochemical driving force
• Graded potentials vs action potentials
• Threshold, all-or-nothing law

1. Read Guyton Ch 5 (first half) - 1.5 hrs
2. Draw the RMP origin diagram showing K⁺ and Na⁺ contributions
3. Derive why RMP = -70 mV (not -94 mV)
4. 15 MCQs

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Day 4 (Fri July 18) - Action Potential & Nerve Conduction

• Phases of action potential (depolarization, repolarization, hyperpolarization)
• Absolute and relative refractory periods
• Saltatory conduction
• Nerve fiber classification (A, B, C fibers with diameters and speeds)
• Velocity of conduction - factors affecting it

1. Read Guyton Ch 5 (second half) - 1.5 hrs
2. Draw AP curve and label every phase with the ion responsible
3. Make a table of nerve fiber types
4. 20 MCQs (this is a high-yield topic)

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Day 5 (Sat July 19) - Synaptic Transmission & NMJ

• Synaptic structure (pre/postsynaptic, synaptic cleft)
• Neurotransmitter release (Ca²⁺-dependent)
• EPSP and IPSP
• Summation (spatial and temporal)
• Neuromuscular junction (NMJ) - steps in detail
• Acetylcholine synthesis, release, and degradation

1. Read Guyton Ch 7 + NMJ section - 1.5 hrs
2. Draw NMJ step-by-step flowchart
3. Understand myasthenia gravis (anti-NMJ antibodies) as a clinical application
4. 15 MCQs

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Day 6 (Sun July 20) - Muscle Physiology

• Skeletal muscle structure (sarcomere, Z discs, A/I bands, H zone)
• Sliding filament theory - all 8 steps
• Excitation-contraction (EC) coupling
• Length-tension relationship
• Smooth muscle and cardiac muscle differences
• Motor unit, summation, tetanus

1. Read Guyton Ch 6 + Costanzo muscle chapter - 2 hrs
2. Draw sarcomere and label every band, zone, and disc
3. Write out the 8 steps of contraction from memory
4. Understand what changes in each band during contraction (A band stays same, I band shortens, H zone disappears)
5. 20 MCQs

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Day 7 (Mon July 21) - WEEK 1 REVISION

• Re-read all one-page summaries from Days 1-6
• Do a 50-question mixed MCQ test covering all Week 1 topics
• Review all questions you got wrong - understand WHY
• Target: Score ≥70% before moving to Week 2

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WEEK 2 - CORE SYSTEMS I (July 22-28)

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Day 8 (Tue July 22) - Blood: Composition & Plasma Proteins

• Blood composition, normal values (Hb, PCV, RBC, WBC, platelets)
• Plasma proteins - types, normal values, functions
• Albumin: oncotic pressure, transport
• ESR - normal values, factors affecting, Westergren method
• Viscosity of blood

1. Read Guyton Ch 32 + Ganong blood chapter - 1.5 hrs
2. Make a master table of ALL blood normal values
3. Memorize A:G ratio, oncotic pressure value
4. 15 MCQs

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Day 9 (Wed July 23) - RBCs, Hemoglobin & Erythropoiesis

• RBC structure, life span (120 days), destruction
• Erythropoiesis - stages, sites (yolk sac → liver/spleen → bone marrow)
• Role of erythropoietin (kidney), iron, B12, folate, intrinsic factor
• Hemoglobin structure: HbA, HbA2, HbF, HbS
• Hemoglobin synthesis

1. Read relevant sections in Ganong + Guyton - 1.5 hrs
2. Draw erythropoiesis stages
3. Know clinical correlates: iron deficiency vs megaloblastic anemia
4. 15 MCQs

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Day 10 (Thu July 24) - Oxygen Transport & Hemoglobin

• O₂-Hb dissociation curve (shape, P50, cooperativity)
• Factors shifting curve left and right (full list)
• CO₂ transport (3 forms, percentages)
• Chloride shift (Hamburger shift)
• Bohr effect (pH/CO₂ on O₂ binding) vs Haldane effect (O₂ on CO₂ binding)

1. Read Guyton Ch 41 - 1.5 hrs
2. Draw the O₂-Hb curve and mark P50, arterial point (100 mmHg/97%), venous point (40 mmHg/75%)
3. Add both left and right shift curves with labeled causes
4. 20 MCQs (very high-yield)

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Day 11 (Fri July 25) - Hemostasis & Blood Groups

• Platelets - structure, function, activation
• Coagulation cascade (intrinsic/extrinsic pathways, common pathway)
• Clotting factors (key ones: I, II, V, VII, VIII, IX, X, XIII)
• ABO blood groups - antigens, antibodies, universal donor/recipient
• Rh system - D antigen, erythroblastosis fetalis, prevention
• Tests: PT, aPTT, bleeding time, clotting time

1. Read Guyton Ch 37 - 2 hrs
2. Draw coagulation cascade from memory
3. Make ABO compatibility table
4. 20 MCQs

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Day 12 (Sat July 26) - Cardiovascular: Cardiac Cycle & Output

• Cardiac cycle - phases in detail (isovolumetric contraction, ejection, isovolumetric relaxation, filling)
• Heart sounds - S1 (MV/TV closure), S2 (AV/PV closure), S3, S4
• Pressure-volume loop
• Cardiac output - Fick principle, measurement
• Frank-Starling law - full understanding
• Factors affecting CO (preload, afterload, contractility, HR)
• Ejection fraction

1. Read Costanzo CVS chapter + Guyton Ch 9-10 - 2 hrs
2. Draw the cardiac cycle Wiggers diagram (pressure vs time)
3. Draw the pressure-volume loop and explain each corner
4. Work through the sample problem: calculate SV, CO, EF from given EDV/ESV/HR
5. 20 MCQs

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Day 13 (Sun July 27) - CVS: Electrophysiology, ECG & Blood Pressure

• Cardiac action potentials: ventricular cell (phases 0-4) vs SA node
• Pacemaker hierarchy: SA (60-100) > AV (40-60) > Purkinje (20-40)
• ECG - P wave, PR interval, QRS, ST segment, T wave (what each represents)
• Blood pressure regulation - short (baroreceptors), medium (RAAS), long-term (kidney)
• Hypertension, MAP = CO × TPR
• Microcirculation and Starling forces across capillaries

1. Read Guyton Ch 13, 17-18 - 2 hrs
2. Draw a labeled ECG tracing
3. Draw SA node AP and ventricular AP side-by-side, mark differences
4. 20 MCQs

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Day 14 (Mon July 28) - Respiratory: Mechanics & Volumes

• Lung volumes and capacities - all 4 volumes + 4 capacities with values
• What cannot be measured by spirometry (RV, FRC, TLC)
• Compliance of lungs - static vs dynamic, surfactant (DPPC)
• Airway resistance
• Work of breathing
• Pleural pressure, transpulmonary pressure
• Dead space (anatomical vs physiological)

1. Read Guyton Ch 38 + Costanzo respiratory - 2 hrs
2. Draw the spirometry tracing and label all volumes/capacities
3. Derive alveolar ventilation equation
4. 15 MCQs

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Day 15 (Tue July 29) - Respiratory: Gas Exchange & Transport

• Alveolar gas equation (PAO₂ = PiO₂ - PaCO₂/R)
• Diffusion of O₂ and CO₂ (Fick's law)
• V/Q ratio - normal = 0.8, zones of West
• O₂ transport (oxyhemoglobin)
• CO₂ transport (detailed)
• Acid-base balance - 4 disorders, compensation, Henderson-Hasselbalch

1. Read Guyton Ch 39-41 - 2 hrs
2. Draw West's zones and label V/Q at apex vs base
3. Do 3-4 ABG interpretation problems
4. 20 MCQs (acid-base is very high-yield)

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Day 16 (Wed July 30) - Respiratory: Control of Breathing & WEEK 2 REVISION

• Respiratory centres (DRG, VRG, pneumotaxic, apneustic)
• Central vs peripheral chemoreceptors (CO₂/H⁺ vs O₂)
• Hypoxic drive (COPD)
• Reflexes (Hering-Breuer, J receptor reflex)

• Re-read all Week 2 summaries
• 60-question mixed MCQ test (Blood + CVS + Respiratory)
• Target: ≥70%

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WEEK 3 - CORE SYSTEMS II (July 31 - Aug 6)

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Day 17 (Thu July 31) - Renal: Glomerular Filtration

• Kidney structure review (nephron types, blood supply)
• GFR = 125 mL/min - derivation from Starling forces
• Filtration fraction = 20%
• Clearance concept (inulin, creatinine, PAH)
• Autoregulation of GFR (myogenic reflex, tubuloglomerular feedback)
• Factors affecting GFR

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Day 18 (Fri Aug 1) - Renal: Tubular Function

• Proximal tubule: bulk reabsorption (Na⁺, glucose, amino acids, HCO₃⁻)
• Transport maximum (Tm) concept - glucose Tm = 375 mg/min, threshold = 180 mg/dL
• Loop of Henle - countercurrent mechanism
• Distal tubule and collecting duct - aldosterone, ADH
• Concentration and dilution of urine

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Day 19 (Sat Aug 2) - Renal: Regulation of Body Fluids & Acid-Base

• Regulation of ECF volume and osmolarity
• RAAS in detail
• ADH secretion - osmoreceptors, baroreceptors
• Renal acid-base regulation (HCO₃⁻ reabsorption, H⁺ secretion, NH₃/NH₄⁺)
• Renal compensation for acid-base disorders

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Day 20 (Sun Aug 3) - GI Physiology

• GI motility - peristalsis, segmentation, MMC (motilin)
• Salivary secretion (composition, functions, regulation)
• Gastric secretion - HCl (parietal cells), pepsin (chief cells), intrinsic factor
• Phases of gastric secretion: cephalic, gastric, intestinal
• Pancreatic secretion - enzymes + HCO₃⁻ (secretin)
• Bile - composition, enterohepatic circulation
• GI hormones table (Gastrin, Secretin, CCK, GIP, Motilin)
• Absorption - carbohydrates, proteins, fats, vitamins

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Day 21 (Mon Aug 4) - Endocrine I: Pituitary & Thyroid

• Hypothalamo-pituitary axis - releasing and inhibiting hormones
• Anterior pituitary hormones (6) - source, stimulus, target, effect
• Posterior pituitary: ADH and Oxytocin
• GH: effects, IGF-1, excess (gigantism/acromegaly), deficiency (dwarfism)
• Thyroid: synthesis, T3/T4, peripheral conversion
• Hypothyroidism vs hyperthyroidism (causes, features)
• Calcitonin

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Day 22 (Tue Aug 5) - Endocrine II: Adrenal, Pancreas, Parathyroid

• Adrenal cortex: GFR zones (Glomerulosa/Aldosterone, Fasciculata/Cortisol, Reticularis/Sex steroids)
• Cortisol: effects, regulation, Cushing's vs Addison's
• Adrenal medulla: catecholamines (80% epinephrine, 20% NE)
• Pancreas: insulin (β cells) vs glucagon (α cells) - synthesis, actions, regulation
• Diabetes mellitus basics: Type 1 vs Type 2
• Calcium regulation: PTH, Calcitonin, Vitamin D
• Parathyroid: PTH actions on bone, kidney, GI

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Day 23 (Wed Aug 6) - Endocrine III: Reproductive & WEEK 3 REVISION

• Male: testosterone, spermatogenesis, FSH/LH roles
• Female: menstrual cycle phases (follicular/luteal), estrogen, progesterone, LH surge, ovulation
• Pregnancy: hCG, estrogen/progesterone rise
• Puberty changes

• 60-question mixed MCQ test (Renal + GI + Endocrine)
• Target: ≥70%

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WEEK 4 - NEUROPHYSIOLOGY + FULL REVISION (Aug 7-14)

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Day 24 (Thu Aug 7) - Sensory Physiology & Special Senses

• Receptor types, adequate stimulus, generator potential
• Sensory modalities and pathways
• Vision: rods vs cones, visual pathways, visual field defects
• Hearing: cochlea, basilar membrane tonotopy, Organ of Corti
• Vestibular system: semicircular canals (angular), utricle/saccule (linear)
• Olfaction and taste

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Day 25 (Fri Aug 8) - Motor System & Higher Functions

• Motor cortex and corticospinal tract
• UMN vs LMN lesions (key differences)
• Basal ganglia - function and diseases (Parkinson's, Huntington's)
• Cerebellum - function (PAST: Posture, Ataxia, Synergy, Tone) and lesions
• Reflexes: stretch reflex (monosynaptic), withdrawal reflex
• Sleep: stages, NREM vs REM, sleep cycles

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Day 26 (Sat Aug 9) - Autonomic Nervous System & Neurotransmitters

• SNS vs PNS comparison (full table)
• Adrenergic receptors (α1, α2, β1, β2, β3) - location and effects
• Cholinergic receptors (Nicotinic, Muscarinic M1-M5) - location and effects
• Sympathetic exceptions: sweat glands (cholinergic), adrenal medulla (direct)
• Autonomic pharmacology basics (agonists, antagonists - exam correlates)
• Enteric nervous system

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Day 27 (Sun Aug 10) - FULL INTEGRATED REVISION I

• Active recall: cover your notes and write out each topic from memory
• 80-question mock test (mixed from all Week 1-2 topics)
• Review wrong answers with explanations
• Identify your 3 weakest topics - note them for Day 29

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Day 28 (Mon Aug 11) - FULL INTEGRATED REVISION II

• Active recall all remaining topics
• 80-question mock test (mixed from all Week 3-4 topics)
• Review wrong answers
• Add to your "weak topics" list

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Day 29 (Tue Aug 12) - WEAK TOPIC DEEP DIVE

• Take your identified weak topics (from Days 27-28) and redo them properly
• Focus on understanding mechanisms, not just memorizing facts
• Re-do the MCQs from those specific topics
• No new topics - only reinforcement

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Day 30 (Wed Aug 13) - EXAM SIMULATION DAY

• Morning: Full 150-question mock exam under timed conditions (2.5-3 hours)
• Afternoon: Mark and review every wrong answer
• Evening: Revise high-yield numbers table and mnemonics only
• Sleep by 10 PM - no studying after that

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Day 31 (Thu Aug 14) - EXAM DAY PREP

• Flip through your one-page summary sheets only
• Review the high-yield numbers table one last time
• Review the normal values table
• No MCQ drilling - trust the work you have done

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📌 DAILY STUDY STRUCTURE (template)

TIME          ACTIVITY
─────────────────────────────────────────────
0-30 min     Revise yesterday's topic (quick recall)
30-150 min   Study today's new topic (reading + notes)
150-180 min  Break
180-240 min  MCQs on today's topic + review answers
240-270 min  Make/update one-page summary sheet

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📚 RESOURCES (prioritized)

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🔄 REVISION SCHEDULE WITHIN THE MONTH

Day 1  → Learn topic
Day 3  → First revision (2 days later)
Day 7  → Second revision (1 week later)
Day 14 → Third revision (2 weeks later)
Day 30 → Final revision

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🧠 TOPIC PRIORITY (High → Low Yield for Exams)

• Membrane potential + Action potential
• Cardiac cycle + Frank-Starling + Cardiac output
• Hemoglobin + ODC + Blood groups
• Lung volumes + Gas exchange + Acid-base
• GFR + Tubular reabsorption
• GI hormones
• Pituitary + Thyroid + Adrenal hormones

• Neuromuscular junction
• Autonomic NS receptors
• Coagulation cascade
• RAAS
• Calcium regulation
• Menstrual cycle

• Special senses
• Basal ganglia/Cerebellum
• Sleep
• Reproductive physiology

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✅ WEEKLY CHECKPOINTS

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🗒️ NOTES & MNEMONICS SHEET (Start from Day 1)

• 60-40-20 rule: TBW-ICF-ECF
• 3 Na out, 2 K in: Na⁺/K⁺ pump
• A stable, I shrinks: Band changes in contraction
• CADET face right: Causes of right shift ODC
• GFR zones: Glomerulosa → Aldosterone, Fasciculata → Cortisol, Reticularis → Sex hormones
• SA > AV > Purkinje: Pacemaker hierarchy (100 > 60 > 40)
• Extrinsic = PT, Intrinsic = aPTT: Coagulation tests
• Secretin = Serenity (calms acid): Secretin inhibits gastric acid
• CCK = Calls for Contraction (gallbladder): CCK contracts gallbladder

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