HEAD AND NECK MODULE

CARBOHYDRATE METABOLISM

DR. SADIA HAROON)

S.NO / Title / Learning Outcomes / Content / TLM

1)

/

INTRODUCTION TO CARBOHYDRATE METABOLISM

/ KNOWLEDGE
  • Describe the role of dietary carbohydrate in the body
  • Enumerate the various compounds of carbohydrate of biological importance
/
  • Biomedical importance of carbohydrate in body
  • Simple and compound carbohydrate present in the body
  • Clinical importance of types of dietary carbohydrate.
/ LGF / SEQ
MCQ
OSPE

2)

/

Sources of carbohydrate andtheir digestion and absorption

/ KNOWLEDGE
  • Describe various pathways of carbohydrate metabolism.
  • Describe various factors regulating blood glucose level.
/
  • Carbohydrate metabolism overview
  • Definition of anabolism and catabolism .
  • Clinical abnormalities
/ LGF / SEQ
MCQ
OSPE

3)

/

GLYCOLYSIS INTRODUCTION

/ Knowledge
  • Describe the metabolic pathways and biomedical importance of glucose breakdown.
  • Enumerate various glucose transporters in the cell and their location and function
  • Describe the overall purpose of glycolysis, its reactants and products, its cellular localization, and its tissue distribution and sequence of reaction.
  • Calculate energetic of the glycolysis in different conditions.
  • Describe the roles of hexokinase/glucokinase, phosphofructokinase-1 (PFK-1), and pyruvatekinase in glycolysis and predict the biochemical and potential clinical consequences in deficiencies of these enzymes
/
  • Definition of glycolysis.
  • Types of glycolysis
  • Glycolysis in brain liver and different tissues of the body
  • Role of different transporters present in the body.
  • Two phases of glycolysis
  • Reactions of glycolysis
/ LGF / SEQ
MCQ
OSPE

4)

/

TYPES OF GLYCOLYSIS

/
  • Compare and contrast the mechanisms for regulating glycolysis including allostery, hormonal regulation and covalent.
  • Correlate the regulation of glycolysis with its substrate and products and hormones.
  • Compare and contrast aerobic and anaerobic glycolysis in terms of the tissues in which they occur, reactants and products, purposes, and the conditions in which they occur
  • Explain the concept of substrate level phosphorylation and its importance.
  • Describe the purpose of the reaction catalyzed by lactate dehydrogenase, its reactants and products, cellular and tissue localization, and how it is regulated
/
  • Regulation and types of glycolysis
  • Reactions of glycolysis
  • Enzymes and regulation of enzymes

5) / METABOLISM OF PYRUVATE / KNOWLEDGE
  • Describe formation of puruvate and lactate in different conditions
  • Illustrate the Fate of pyruvate in the body in the form of flow chart
  • Describe the purpose of the reaction catalyzed by lactate dehydrogenase, its reactants and products, cellular and tissue localization, and how it is regulated
SKILLS
  • List conditions (inherited genetic defects in various pathways; drugs) that increase the risk of lactic acidosis
  • Explain the biochemical basis of the hemolytic anemia observed in deficiency of erythrocyte pyruvatekinase
SKILL
  • Illustrate the Fate of pyruvate in the body in the form of flow chart
  • Predict the results of a complete blood count (CBC) and iron studies in a person with pyruvatekinasedeficiencies.
ATTITUDE
  • Demonstrate punctuality
  • Participate in group discussion
  • Contribute to group learning by sharing information
  • Communicate effectively
/
  • Enzymes of pyruvate metabolism
  • Coenzymes of puruvatedehydrogenasecompex
  • Lactic acidosis and
  • Hemolytic anemia
/ SDL (BIO LAB) / SEQ
MCQ
OSPE
6) / TCA CYCLE / KNOWLEDGE
  • Describe the overall purpose of the TCA cycle, its cellular localization, and its tissue distribution
  • Describe the reactants and products of the TCA cycle, as related to the fates of the breakdown products of carbohydrates, fatty acids, and amino acids
  • Describe the roles enzymes in the TCA cycle and predict the biochemical and potential clinical consequences of deficiencies of these enzymes
  • Explain the effect of the following parameters on the activity of the TCA cycle and the mechanism(s)
  • by which the effect occurs: mitochondrial NADH:NAD ratio, ADP:ATP ratio, succinylCoA concentration
  • Describe the central role of the TCA cycle in connecting glycolysis, gluconeogenesis, oxidative phosphorylation, fatty acid metabolism, and amino acid metabolism .
SKILLS
  • Describe the Fate of acetyl co Ainflow chart.
  • Illustrate the reactions of TCA cycle along with its energetic highlighting the key enzymes /steps.
/
  • Steps of TCA
(reactions generating NADH,FADH2 and substrate level phophorylation)
  • Regulation of key enzymes of citric acid cycle.
  • The role of
/ LGF / SEQ
MCQ
OSPE
7) / The recycling in citric acid cycle / KNOWLEDGE
Explain the amphibolic nature of TCA cycle to replenish tits intermediate
SKILLS
With the help of diagram illustrate amphibolic and anaplruritic reactions of tca cycle. / Amphibolic and anaplerotic reactions involving intermediates of citric acid cycle. And their significance as means of replenishing intermediates in TCA. / SGD / MCQ
SEQ
OSPE
8) / ROLE OF TCA CYCLE
As the cross road of energy metabolism / Describe the role of TCA cycle intermediates as sources of reactants for biosynthetic pathways
 Describe the clinical result of severe thiamin deficiency, and connect the symptoms to the biochemical role of thiamin in the PDH complex and TCA cycle
 Explain the rationale for providing thiamin along with glucose to patients with suspected hypoglycemia .
KNOWLEDGE
Explain the amphibolic nature of TCA cycle to replenish tits intermediate. /
  • TCA cycle intermediates
/ LGF / SEQ
MCQ
OSPE
9) / ROLE OF GLUCONEOGENESIS / KNOWLEDGE
  • Explain the metabolic pathways and importance of different precursors for gluconeogenesis in feeding, fasting, and exercise.
  • Differentiate the enzymes involved in glycolysisvsgluconeogenesis
  • Explain the contribution of gluconeogenesis to blood glucose regulation
/
  • Precursors for gluconeogenesis
  • Steps of gluconeogenesis along with enzymes
/ LGF / SEQ
OSPE
MCQ
10) / REGULATION OF GLUCONEOGENESIS IN DIFFERENT STATES /
  • Regulation of gluconeogenesis by allosteric and covalent modification
  • Explain with the help of diagramhow the activities of glycolysis and gluconeogenesis are regulated in response to fatty acid metabolism and protein metabolism, and in response to insulin and glucagon
/
  • Role of GN in feeding, fasting, starvation and exercise
/ LGF
SDL
E PORTFOLIO / SEQ
MCQ
OSPE
11) / PENTOSE PHOSPHATE PATHWAY IN BODY / KNOWLEDGE
Describe the pentose phosphate pathway and its role in WBC,RBC and
Discuss the advantages of PPP over glycolysis . /
  • Oxidative reactions of PPP
  • Non oxidative reactions of PPP
/ LGF
SDL
E PORTFOLIO / SEQ
MCQ
OSPE
12) / PURPOSE OF PENTOSE PHOSPHATE PATHWAY IN METABOLISM / KNOWLEDGE
  • For different tissue types, compare and contrast the overall purpose of the pentose phosphate pathway,
  • its reactants and products,
  • its cellular localization
  • Describe the role of reduced glutathione in the body, and the contribution of NADPH to its formation.
/
  • Pentose phosphate pathway, its reactants and products, and its cellular localization
  • Importance of NADPH and ribose
/ LGF / SEQ
MCQ
OSPE
13) / INTEGRATION OF METABOLISM /
  • Explain changes of carbohydrate metabolism at various tissue levels
indifferent tissues. /
  • Fed state
  • Post absorptive state
/ LGF
14) / INTEGRATION OF METABOLISM / KNOWLEDGE
  • Explain the metabolic adjustment of fed, fasting and starvation state.
  • Describe changes in carbohydrate metabolism in organs of the body.
/
  • Difference between Fed and fasting state
  • Consequences of prolonged starvation
/ LGF / SEQ
MCQ
OSPE
15) / ROLE OF GLYCOGEN METABOLISM
IN MUSCLES AND LIVER / KNOWLEDGE
  • Discuss the role of glycogen metabolism in Musclesand liver.
  • Describe the reactions of glycogenesis and its regulation.
/
  • Glycogenesis and its enegetics
  • Regulation and steps and enzymes of glycogenesis
/ LGF / SEQ
MCQ
OSPE
16) / ROLE OF GLYCOGEN
DEGRADATION / Knowledge
  • Discuss the role of glycogenolysis
  • Glycogenolysis in muscles and liver
  • clinical significance glycogen storage diseases.
/
  • Glycogenolysis in starvation .
  • Glycogen storage diseases presentation and diagnosis.
/ SGD / SEQ
MCQ
OSPE
17) / ROLE OF MONSACHARIDES METABOLISM IN THE BODY / Knowledge
  • Discuss the role of fructose metabolism .
  • Explain derangement of metabolism of fructose.
  • Describe the biochemical basis for the symptoms seen in aldolase B deficiency (hereditary fructose intolerance)
  • Describe features of fuctosurias.
/
  • Fructose in diet and its pathways of metabolism
  • fructose intolerance anffructoseurias
/ LGF / SEQ
MCQ
OSPE
18) / URONIC ACID PATHWAYS(ALTERNATE PATHWAYS OF GLUCOSE OXIDATION) / Describe the biomedical importance of uronic acid pathwayand its role in the body
Describe the reaction of uronic acid pathways with enzymes and coenzymes.
Enumerate and briefly describe the disorder related to this pathway. /
  • Uronic acid pathways
  • Disorders associated with this pathway
/ LGF / SEQ
MCQ
OSPE
19) / GAGS METABOLISM / Define and classify GAGS and outline its metabolic pathway.(synthesis and degradation)
Discuss its role in different tissues of the body. /
  • Definition and types of gags
  • Physical characteristics
  • Function and classification
  • Synthesis and degradation
  • Clinical disorders of GAGS
/ SGD / SEQ
MCQ
OSPE
20) / GP METABOLISM / Define and classify glycoproteins .
List the functions of glycoprotein. /
  • Definition and biochemical structure
  • Classify them with examples of important GP
/ SGD / SEQ
MCQ
OSPE
21) / ROLE GALACTOSE METABOLISM IN THE BODY / Knowledge
  • Describe the galactose metabolism in the body.
Various disorders of galactose metabolism.
 Compare and contrast the symptoms seen in deficiency of galactokinase and galactose-1-phosphate uridyltransferase (GALT) deficiency and explain their biochemical basis .
 Appraise and present current scientific evidence related to the contribution of fructose to obesity and risk for heart disease
  • Compare and contrast the symptoms seen in deficiency of galactokinase and galactose-1-phosphate uridyltransferase (GALT) deficiency and explain their biochemical basis
  • Appraise and present current scientific evidence related to the contribution of fructose to obesity and risk for heart disease
/
  • Galactose metabolism
  • Steps of reactions
  • Clinical significance and galactosemias .
/ LGF
SDL
CBL / SEQ
MCQ
OSPE
22) / REGULATION OF PATHWAYS / KNOWLEDGE
  • Explain how the activities of glycolysis and gluconeogenesis are regulated in response to insulin and glucagon.
  • Compare and contrast postprandial blood glucose changes in a patient with type 1 and type2 diabetes with someone who does not have diabetes
SKILLS
  • Generate a problem list with potential biochemical causes of hypoglycemia, hepatomegaly, or lactic acidosis .
  • Create a diagram that shows the ways that the following branch point intermediates can be generated and utilized: glucose 6-phosphate, pyruvate, acetyl CoA.
/
  • Gluconeogenesis in feeding, fasting, and exercise
  • Hormonal regulation of metabolism.
/ LGF
SDL
E PORTFOLIO / SEQ
MCQ
OSPE
23) / bioenergetics /
  • Describe the purpose of the electron transport chain (particularly complexes I, III, and IV) and ATP synthase, their substrates and products, their cellular localization, and their tissue distribution
  • Explain how electron transport and ATP synthase are functionally coupled
  • Explain how the process of oxidative phosphorylation is influenced by the availability of oxygen and NADH Compare the mitochondrial content of different tissues and relate this characteristic to the function of the particular tissue (e.g. parietal cells, which utilize an ATP-requiring proton pump, have high mitochondrial content
/
  • Electron transport chain
  • Working of oxidative phophorylation
/ LGF
SDL
E PORTFOLIO / SEQ
MCQ
OSPE
24) / bioenergetics / Describe the effects of electron transport chain inhibitors, ATP synthase inhibitors, and uncouplers on oxidative phosphorylation, and predict the effects of these agents on glycolysis, the citric acid cycle, and lactate production
 Describe the biochemical and clinical features associated with ingestion/overdose of electron transport inhibitors (e.g. industrial exposure to cyanide and sodium azide) and uncouplers (e.g. aspirin, phthalate plasticizers) of oxidative phosphorylation
SKILLS
 List known mutations that cause defects in oxidative phosphorylation which result in myopathies and neuropathies (including exercise intolerance) and explain the pathophysiologic basis and genetics of each mitochondrial disease
 Make diagramtic presentation ofcomparison and contrasting the activities of glycolysis and oxidative phosphorylation in cancer cells to those of non-cancerous cells . /
  • Inhibitors and uncouplers of electron transport chain
/ LGF
SDL
E PORTFOLIO / SEQ
MCQ
OSPE

LABORATORY WORK OF HEAD AND NCK MODULE

S.NO / TITLE / LEARNING OUTCOMES / CONTENTS / TLM
Interpretation of constituents of CSF / Knowledge
Enlist methods of determination of csf sugar and proteins. / 1.Indications and contraindications of CSF interpretations .
2.Importance and methods of interpretation of glucose in CSF
Interpretation of proteins in CSF / Demonstration
Presentation
Video
Interpretation
Ospe question preperation / OSPE
Interpretation of blood chemistry and CPC / Interpretation of blood for lactic acidosis and hemolytic anemias / List conditions (inherited genetic defects in various pathways; drugs) that increase the risk of lactic acidosis
Explain effects of G6 PD defeciency
Explain the biochemical basis of the hemolytic anemia observed in deficiency of erythrocyte pyruvatekinase
 Predict the results of a complete blood count (CBC) and iron studies in a person with pyruvatekinase deficiency who is in hemolytic crisis / Demonstration
Video
CBL(case based learning)
SDL
(self directed learning) / OSPE
3 / Determination blood glucose concentration / Describe various causes of Hyper glycemia and its diagnosis and
Hypoglycemia and its diagnosis and its interpretations / Methods of glucose estimation
Causes and Types of hyperglycemias
hypoglycemias / Demonstrations
Presentation
CBL / OSPE
4 / Determination of urinary reducing sugarsconcentration. / Determination of reducing sugars in urine / ITERPRETATION AND IMPORTANCE OF Different conditions of Glycosuia,
fructoseuria
And galactoseuria / Demonstration
Video
CBL / OSPE
5 / Interpretation of glucose tolerance test (GTT) / interpret glucose tolerance curve for diagnosis and prognosis of disease (diabetes mellitus / for diagnosis and prognosis of disease (diabetes mellitus) / Demonstration
Video
CBL / OSPE
6 / Interpretation of glycated hemoglobin (HbA1c) concentration in blood. / Describe the importance of glycatedHaemoglobin in diagnosis and prognosis. / ITERPRETATION AND IMPORTANCE OF glycatedhaemoglobinn / Demonstration
Video
CBL / OSPE
7 / Interpretation of Thyroid function tests. / Interpret thyroid function test / ITERPRETATION AND IMPORTANCE OF Thyroid function test / Demonstration
Video
CBL / OSPE
8 / Interpretation of serum Vitamin A concentration / Importance / ITERPRETATION AND IMPORTANCE OF Vitamin Acycle and forms of vitamin A / Demonstration
CBL / OSPE