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Most comprehensive Colored book on Physiology with Clinical Correlations in Pharmacology,

Pathology & Medicine; Only Book covering Analysis of ECGs & Acid-base disorders.
This book is Compiled by Leading Faculty & Subject Expert of Physiology
2018 Edition with All New Updates/Qs covered up to Jan 2018

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Covering 1450 Qs with Explanations, 60+ IBQs & 300 Colored Illustrations
References and updatesfrom Ganong 25/e, Guyton 13/e, Harrison 19/e, Katzung 13/e
�=tee=t:e�=lo=e=t==t:=ti::=i:=t=ie=,iio=t<=ilo=l=�l

Recent Qs {Jan) 2018 -2012 S Krishna Kumar

AIIMS Nov 2017 - 2010

JIPMER Dec 2017 - 2010

PGI Nov 2017 - 2010
CBS
All India 2011-2000 CBS Publishers & Distributors Pvt. Ltd. Vea'icate<fto <E.fucation
 Clinical importance of Neuromuscular junction
Neuromuscular Junction in Microbiology
Botulinum Toxin
zz C. botulinum inhibits the release of acetylcholine by cleaving the SNARE proteins involved in its exocytosis.
zz Botulinum toxin has been “weaponized” by governments and terrorist organizations-Bioterrorism.
C
zz The toxins are of seven types (A, B, C, D, E, F, and G).
zz Toxins A and E cleave SNAP-25.
R
zz Toxins B, D, F and G cleave Synaptobrevin.
zz Toxin C cleaves Syntaxin.
I
zz Since acetylcholine is not released from nerve terminals, the effect seen is flaccid paralysis.
zz Since botulinum toxin inhibits the release of acetylcholine, it is useful in conditions characterized by excessive muscle contraction. It
S
is available in the form of BOTOX.
Neuromuscular Junction in Forensic Medicine P
Organophosphate Poisoning
zz They are acetylcholine esterase inhibitors. They amplify all actions of acetylcholine.

Sample pages of CRISP 2nd/ed

zz They are highly effective as insecticides. The agents are parathion, Malathion.

zz They are well absorbed from the skin, lung, gut, and conjunctiva.

zz Central nervous system toxicity is an important component of poisoning with these agents

zz Organophosphate poisoning is usually treated with muscarinic antagonist atropine and choline esterase activator namely pralidoxime.

zz Tabun, sarin, soman are the acetylcholine esterase inhibitors used as nerve agents during war fares.

Neuromuscular Junction and Diseases

Myasthenia Gravis (MG) Lambert Eaton Myasthenia Syndrome (LEMS)

• An autoimmune disease due to auto-antibodies directed
against nicotinic acetylcholine receptors (AChRs). It is a post
synaptic disorder
• Due to antibody mediated destruction of receptors, there is
decrease in number of AChRs
• The cardinal features are weakness and fatigability of muscles
but deep tendon reflexes are preserved
• The amount of ACh released per impulse normally declines
on repeated activity. It is the reason behind decremental
response seen in repeated nerve stimulation in myasthenia
gravis called as myasthenic fatigue
• The protein responsible for clustering of AChRs is called as
muscle-specific kinase (MuSK). Anti-MuSK antibody occurs in
about 40% of patients without AChR antibody
• Another protein called low-density lipoprotein receptor
related protein 4 (lrp4) is also involved in clustering of AChRs.
Antibodies against lrp4 are also seen in myasthenia gravis
• Thymus appears to play role in generation of these auto
antibodies. Thymectomy offers long-term benefits in patients
affected by myasthenia gravis
• Medical management includes anti-choline esterase drugs
namely pyridostigmine and immunosuppressive agents like
glucocorticoids, azathioprine, cyclosporine, and rituximab are
also useful
• LEMS is a presynaptic disorder involving
• LEMS is caused by autoantibodies directed against
P/Q-type calcium channels at the motor nerve
terminals
• It is distinguished from myasthenia gravis by two
important reasons. One, LEMS have depressed or
absent reflexes and two, high frequency repetitive
nerve stimulation causes incremental response in
LEMS.
• Many patients with LEMS have an associated
malignancy, most commonly small-cell carcinoma of
the lung
• Treatment involves pyridostigmine and
3,4-Diaminopyridine (3,4-DAP). This drug 3,4-DAP
acts by blocking potassium channels which results
in prolonged depolarization of the motor nerve
terminals and thus enhances ACh release
Theory

Calcium Ions – Couples Excitation to Contraction

zz Calcium ions are responsible for muscle contraction.
zz Calcium ion movement in skeletal muscle is regulated by a structure in muscle called sarcotubular system.
zz Sarcotubular system has two tubules namely T tubule and L tubule. 61
REGULATION OF LEUKOPOIESIS Megakaryocyte Growth Factors in
zz Important factors that regulate Leukopoiesis are: Pharmacology
 Granulocyte-monocyte colony-stimulating factor (GM- • Oprelvekin: Recombinant form of IL-11
CSF) ƒ Commonly used in cancer chemotherapy induced
thrombocytopenia
 Granulocyte colony-stimulating factor (G-CSF) ƒ Injected subcutaneously C
 Monocyte colony-stimulating factor (M-CSF) ƒ Adverse effects - Fatigue, headache, anemia, transient atrial
 Tumor necrosis factor (TNF) arrhythmias R
Interleukins
• Romiplostim: Thrombopoietin agonist


 Interleukin 5 – for eosinophil

ƒ Useful in treatment of chronic immune thrombocytopenia I
ƒ Administered subcutaneously
 Interleukin 3,4 – for basophil • Eltrombopag: Thrombopoietin agonist S
ƒ Useful in treatment of chronic immune thrombocytopenia,

Colony-stimulating Factors in
thrombocytopenia in hepatitis C P
ƒ Administered orally
Pharmacology ƒƒ Adverse effects – It is hepatotoxic. It also causes marrow fibrosis

Sample pages of CRISP 2nd/ed

• Colony-stimulating factor drugs available are,
ƒƒ Filgrastim - Recombinant human G-CSF BLOOD COAGULATION (HEMOSTASIS)
ƒƒ Sargramostim - Recombinant human GM-CSF
zz In response to vessel wall injury, platelets adhere and aggregate
ƒƒ Pegfilgrastim - conjugation product of filgrastim
at the injured site to form a temporary hemostatic plug
ƒƒ Lenograstim - glycosylated form of recombinant G-CSF
zz The most abundant receptor on the platelet surface is
• These drugs are commonly used along with hematopoietic
glycoprotein (Gp) IIb/IIIa (αIIbβ3) complex. This receptor
stem cell mobilizer namely plerixafor
binds fibrinogen and VWF leading to platelet aggregation
• The commonest side effect of these drugs are bone pain,
zz Platelets also release serotonin which causes vasoconstriction
myalgia, fever and capillary leak syndrome
and limits the blood loss
zz This is followed by formation of definite clot with the help of
clotting factors under three major pathways,
Clinical Uses of Colony-Stimulating  Intrinsic pathway or contact activation
Factors 

Extrinsic pathway or tissue factor, pathway
Common pathway
zz Cancer chemotherapy-Induced neutropenia
zz Congenital neutropenia Clotting Factors
zz Cyclic neutropenia
Factor Name Deficiency leads to
zz Myelodysplasia
zz Aplastic anemia I Fibrinogen Afibrinogenemia
II Prothrombin Hypoprothrombine-
mia (hemorrhagic ten-
Thrombopoiesis–Formation of Platelets dency in liver disease)
III Thromboplastin
IV Calcium
V Proaccelerin, labile factor, Parahemophilia
VII Proconvertin, stable factor Hypoconvertinemia
VIII Antihemophilic factor (AHF), Hemophilia A (classic
antihemophilic factor A hemophilia)
IX Plasma thromboplastic Hemophilia B
component (PTC), Christmas (Christmas disease)
factor, antihemophilic factor B
X Stuart-Prower factor Stuart-Prower factor
Regulation of Thrombopoiesis
Theory

deficiency

Important factors that regulate thrombopoiesis are called as XI Plasma thromboplastin PTA deficiency
antecedent (PTA),
megakaryocyte growth factors. They are:
antihemophilic factor C
zz Thrombopoietin (TPO) XII Hageman factor, glass factor Hageman trait 185
zz IL-11
XIII Fibrin-stabilizing factor, Abnormal Clot
Laki-Lorand factor Solubility
zz FRC decreases the energy required to reinflate the lungs during Nitrogen-Washout Technique for Measurement
inspiration. Without FRC, alveoli will be collapsed completely
of FRC
at the end of expiration and it requires tremendous force to
reinflate them. zz In this method, the person breathes 100% oxygen for 6–7
minutes till the nitrogen is washed out of the person’s lungs
Measurement of Functional Residual zz The expired air is usually collected in a bag (Douglas bag) and
Capacity (FRC) zz
its concentration of nitrogen analyzed
FRC can be calculated using the formula,
C
Helium Dilution Technique FRC (V2) =
C1 × V1 R
Why helium is used in this test? C2
zz
 Helium is an inert gas. It can be rebreathed in and out of
Here, I
the lung without diffusing into the blood C1 – Concentration of nitrogen in the collected air
zz In this test, a known concentration of helium (10%) is added to C2 – Normal concentration of nitrogen in the air (80%)
S
a spirometer of known volume
zz At end expiration (FRC), subject breaths into the spirometer
V1 – Volume of air collected P
till the concentration of helium in the lungs and the spirometer V2 – Volume of air at end expiration (FRC)
becomes equal

Sample pages of CRISP 2nd/ed

zz Final concentration of helium is measured at end of expiration Sample calculation of functional residual capacity (FRC)
(FRC) using nitrogen-washout technique
Here, From the following date, calculate functional residual capacity
C1 – Concentration of helium at the beginning of test (FRC)?
C2 – Concentration of helium at the end of test zz Concentration of nitrogen in the collected air – 5%
zz Normal concentration of nitrogen in the air – 80%
V1 – Volume of helium at the beginning of test
zz Volume of air collected – 40 L
V2 – Volume of helium at the end of test (V1 + FRC)
zz Functional residual capacity (FRC) can be calculated by: Answer
V1 (C1 – C2) zz FRC = C1 * V1/C2
FRC = zz FRC= 5 * 40000/80 = 2,500 mL
C2

The Body Plethysmography for

Measurement of FRC
zz Body plethysmography is based on the principle of Boyle’s Law
which states that volume of a gas is inversely proportional to the
pressure of that gas at constant temperature
zz In this method, the subject sits inside an airtight box and
breathes through a mouthpiece.

Helium dilution technique

Sample Calculation of Functional Residual

Capacity (FRC)
Using Helium Dilution Technique
From the following date, calculate Functional residual capacity
(FRC)?
zz Initial volume of air in spirometer = 5,000 mL (V1)
zz Initial concentration of helium in spirometer = 10% (C1)
Theory

zz Final concentration of helium in spirometer = 7% (C2)

Answer
V1 (C1 – C2)
zz FRC = = 5000 * (10 – 7)/7 = 2143 ml
C2 239
Body plethysmography
 Calculations in Respiratory Physiology

Compliance
1.  man inspires 1000 mL from a spirometer. The intrapleural pressure was -4 cm H2O before inspiration and -12 cm H2O the end
A
of inspiration. What is the compliance of the lungs?
C
Sol.
R
� Compliance is change in volume/change in pressure.
� Here its 1000 mL/8 cm H2O = 125mL/ cm H20 I
Dead space – Bohr’s equation S
2. If tidal volume is 500 mL, PEco2 is 30 mm Hg and PAco2 is 45 mm Hg, calculate the dead space ventilation?
P
Sol.

Sample pages of CRISP 2nd/ed

Bohr’s equation is VD = VT × (PAco2–PEco2)/ PAco2
� So, VD = 500 × (45 - 30)/45
� VD = 500 × 0.33
� VD = 167 mL

3. PCO2 at alveoli and expired air is 40 and 30 mm Hg respectively. Calculate dead space to tidal volume ratio.

Sol.
� VD/ VT= (PAco2 - PEco2)/ PAco2
� So, Here it is 40 – 30/40, that comes around 0.25

Diffusion of gases – Fick’s Law

4. if gas X is 4 times as soluble and 4 times as dense as gas Y, what is the ratio of the diffusion rates of X to Y?

Sol.
� Fick’s
 law states that the diffusion rate is directly proportional to the solubility but inversely proportional to the square root of the
density.
� Therefore, the ratio of X to Y is 4/(√4) or 4/2, that is, 2

Diffusion Lung Capacity using Carbon monoxide (DLCO)

5. If the alveolar PCO is 0.5 mm Hg and the CO uptake is 30 mL/min, what is the diffusing capacity of the lung for CO

Sol.
� DLCO equation is CO uptake divided by alveolar PCO
� So, here in this question it is 30/0.5
� The answer is 60 mL/min/mm Hg

Shunt equation – to find out percentage shunting of cardiac output

6.  patient presents with right to left shunt. Oxygen content in arterial and venous side are 18 and 14 mL/100mL respectively.
A
Oxygen content at pulmonary capillary is 20. What is the percentage shunting of cardiac output?

Sol.
� The shunt as a fraction of cardiac output is given by the formula (Cc.oxygen- Ca.oxygen)/(Cc.oxygen - Cv. oxygen)
� Here
 in this formula, Cc.oxygen denotes oxygen content in capillaries, Ca.oxygen denotes oxygen content in artery, Cv.oxygen
denotes oxygen content in veins
Theory

�  here in this question, oxygen content at pulmonary capillary is 20, Oxygen content in arterial and venous side are 18 and 14
So,
mL/ 100mL
� The answer is 20-18/20-14 = 33%
Contd...
269
 zz Most important functions of the kidneys are the regulation of, Types of Nephron
 Water homeostasis
 Electrolyte composition
 Regulation of extracellular volume (blood pressure)
 Acid–base homeostasis
zz The functional unit of kidney is the nephron
C zz Each human kidney has approximately 1 million nephrons

R STRUCTURE OF A NEPHRON
I
S
P

Sample pages of CRISP 2nd/ed

Cortical nephron Juxtamedullary nephron

Feature Cortical Nephron Juxtamedullary Nephron

Location of Upper region of Near junction of cortex and
glomerulus cortex medulla
Percentage 85% 15%
of total
nephron
Size of small Large
glomeruli
Parts of a Lining Major function
Size of loop Small Long- extend deep into
nephron epithelium
of Henle medulla
Glomerulus Simple • Is the site of filtration Capillaries Surrounded Surrounded by Vasa recta
squamous • Filters about 180 L/day by peritubular
Proximal Cuboidal cells • Reabsorbs about 2/3rd of the capillaries
convoluted with brush filtered water, sodium, and
Major Excretion of waste Concentration of urine by
tubule border chloride
function products in urine the counter
• Reabsorbs 100% glucose and current system
amino acids
Descending Simple • Impermeable to solutes
limb of loop squamous but permeable to water RENAL CIRCULATION
of Henle (Concentrating segment) zz Kidneys receive 1.2–1.3 L of blood per minute, or about 23% of
(thin) the cardiac output
CHAPTER 11  Renal Physiology

Ascending Cuboidal • Permeable to solutes but zz Major arterial supply is through Renal artery which arises
limb of epithelium impermeable to water directly from abdominal aorta
loop of (Diluting segment)
Henle(thick)
Distal Cuboidal • Reabsorb some additional salt
convoluted epithelium and water (5%)
tubule
Collecting Cuboidal • Made up of two types of cell:
tubule epithelium principal cells (P cells) and
intercalated cells (I cells)
• Aldosterone enhances sodium
reabsorption and potassium
secretion here
• Antidiuretic hormone (ADH)
406 enhances water reabsorption
here Renal circulation
 Criteria of a Substance to be used in β-Trace protein (BTP)
Estimation of GFR zz It is also called as prostaglandin D synthase
zz BTP is primarily eliminated by glomerular filtration
zz The substance is freely filtered by the glomeruli and neither
zz It has emerged as another promising biomarker for GFR
reabsorbed nor secreted by the tubules
It is biologically inert and non-toxic
C
zz
zz It is neither metabolized nor stored in the kidneys
Filtration Fraction (FF)
zz Its concentration can be easily estimated in the laboratory zz The filtration fraction (FF) is the ratio of GFR to the renal
R plasma flow (RPF)
Remember! FF = GFR/RPF
I zz At normal values of GFR 125 mL/min and RPF 650 mL/ min -
Inulin clearance test – as an estimate of GFR (The the FF = 125/650 = 0.2 (20%)
S Gold standard method) zz This simply means that normally only about 20% (1/5th) of the
zz “Inulin clearance” is used to estimate GFR because renal plasma flow is actually filtered per minute
P inulin meets all the above said criteria zz Increase in filtration fraction can be either due to increased
zz Inulin is a chemical made up of fructopolysaccharide GFR or decreased RPF
zz For this test, a loading dose of inulin is administered zz Substances used to measure filtration fraction are,

Sample pages of CRISP 2nd/ed

intravenously, followed by a sustaining infusion to  For GFR estimation – Inulin is used
keep the arterial plasma level constant  For RPF estimation - Para-aminohippuric acid (PAH) is
zz Then, urine concentration of inulin (UIN), plasma used
concentration of inulin (PIN), urine flow rate(V)
are measured Estimation of Renal Plasma Flow (RPF)
zz Consider the following example, UIN = 35 mg/mL,
– “Para-aminohippuric Acid (PAH)
V = 0.9 mL/min, PIN = 0.25 mg/mL
zz Inulin clearance = UIN * V/ PIN = 35*0.9/0.25 Clearance”
zz Inulin clearance = 126 mL/min zz Para-aminohippuric acid (PAH) is the substance used to
estimate renal plasma flow
Creatinine Clearance Test zz
zz
Renal plasma flow = UPAH*V/PPAH
Consider the following example,
zz This method is less accurate than the inulin clearance test for  Concentration of PAH in urine (UPAH): 14 mg/mL
measurement of GFR  Urine flow (V): 0.9 mL/min
zz But in clinical practice, plasma creatinine level is used as a  Concentration of PAH in plasma (PPAH): 0.02 mg/mL
surrogate to estimate GFR zz Now, RPF = 14*0.9/0.02 = 630 ml/min
zz Plasma creatinine (PCr) is the most widely used marker for zz Only 90% (0.9) of the plasma PAH is extracted by kidney: The
GFR above RPF calculated from the clearance of PAH is referred to
zz Plasma creatinine (PCr) and GFR are inversely related as the effective RPF (ERPF)
zz Since creatinine is secreted by the tubules, Its clearance will be zz True (actual) RPF = 630/0.9 = 700 ml/min
slightly higher than inulin zz Once RPF is known, we can easily find out the Renal blood flow
zz Creatinine clearance = 140 mL/min using the formula,
 Renal blood flow = RPF/1-Hematocrit = 700/1-0.45 =
High Yield Points 1273 ml/min
Formulas are used widely to estimate kidney function
from Plasma creatinine (PCr) Regulation of GFR
zz Cockcroft-Gault formula
CHAPTER 11  Renal Physiology

The factors that regulates GFR are,

zz Modification of Diet in Renal Disease (MDRD) zz Autoregulation
formula  Myogenic mechanism
zz Schwartz formula – used in children.  Tubuloglomerular feedback mechanism
zz Mesangial cells – by contraction or relaxation
zz Changes in the resistance of afferent and/or efferent arterioles
Emerging New Markers of GFR zz Glomerulotubular balance
zz Hormones.
Cystatin C
zz Cystatin C is produced at a relatively constant rate from all Autoregulation
nucleated cells zz Autoregulation is the intrinsic ability of an organ to regulate its
zz It is neither secreted nor reabsorbed by renal tubules but own blood flow
undergoes almost complete catabolism by proximal tubular cells zz In kidney both the renal blood flow and GFR are effectively
zz Normally, it is not excreted in urine. It only appears when there autoregulated
is impairment of reabsorption in proximal tubules zz Autoregulatory pressure range – In spite changes in mean arte-
410 zz Serum cystatin C: More sensitive marker of early GFR decline rial pressure between 80 mm Hg and 180 mm Hg, renal blood
than plasma creatinine flow and GFR are maintained relatively constant
zz PCO2 = 52 mm Hg
zz PO2 = 70 mm Hg

Solution
zz pH is high – so, it is alkalosis
HCO3– is high – so, it is metabolic alkalosis
zz
zz Bicarbonate levels is 20 greater than normal of 24 (44 – 24) C
zz Predicted PaCO2 = (0.7 x rise in HCO3–) + 40 = (0.7 × 20) +40 = 54 mm Hg
zz The difference between the predicted PaCO2 and actual PaCO2 is 2 (within 2). So, the respiratory compensation is adequate R
zz This is a case of metabolic alkalosis with respiratory compensation
I
S
Calculations in Renal Physiology P

Sample pages of CRISP 2nd/ed

Calculations in renal physiology
Glomerular Filtration Rate (GFR) calculation
1. From the following data, calculate GFR
Urine flow rate = 1 ml/min
Urine inulin concentration = 100 mg/ml
Plasma inulin concentration = 2 mg/ml

Sol.
� Basic assumption in GFR or Clearance equation is, Amount filtered = Amount Excreted
� Amount Filtered = Plasma concentration of the substance (P) * GFR
� Amount Excreted = Urine concentration of the substance (U) * Volume of urine (V)
� Here its, Plasma concentration of the substance (P)* GFR = Urine concentration (U) * Volume of urine (V)
� So, GFR = Urine concentration (U) * Volume of urine (V)/ Plasma concentration (P)
� Or simply its GFR = U * V/P
� For this question, GFR = 100 *1/2 = 50 ml/min
Excretion rate of a substance in urine
2.  a patient has a creatinine clearance of 90 ml/min, a urine flow rate of 1 ml/min, a plasma K+ concentration of 4 mEq/L, and a
If
urine K+ concentration of 60 mEq/L, what is the approximate rate of K+ excretion?

Sol.
� Amount Excreted = Urine concentration of the substance (U) * Volume of urine (V)
� Urine concentration of potassium (U) = 60 mEq/L
� Volume of urine (V) = 1 ml/min or 0.001 L/min
� So the answer is 60 * 0.001 L/min = 0.06 mEq/min
Net resorption rate of a substance
3. From the following data, calculate net resorption rate of urea
GFR = 50 ml/min
Urine flow rate = 1 ml/min
Urine urea concentration = 50 mg/ml
Plasma urea concentration = 2.5 mg/ml

Sol.
Theory

� Net resorption rate of a substance = Amount filtered – Amount excreted

� Amount filtered of urea = Plasma concentration of urea (P) * GFR = 2.5 mg/ml * 50 ml/min
� Amount excreted of urea = Urine concentration of urea (U) * Volume of urine (V) = 50 mg/ml × 1 ml/min
� So, the net resorption rate of urea = 125 – 50 = 75 mg/min
429
Contd...
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concepts for cracking future questions... the era is changing and so should the view of people..nice reading this book or making use of it is not a very simple thing. it covers all the AUMS questions and
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initiative and all d best to authors. and each and every concept has been described wonderfully. concept building should be the new trend and

--i..r...l
� RajaSingh

..... Loved it. Excelled work.

29 November 2017
t 11Sually never review books on Amazon ,but this book is seriously so pre<:i!iol' and to the point that I could
Must buy book for surgery pg preparation. Book is lovely to read. If u want to read surgery as a interesting
subject surgery sixer is the right choice. It is thoroughly updated. Full of images and image based questions.
Good thing is pgi chandigarh questions are given in a separate section in each chapter. Important points are
given in the starting of a chapter so that we can revise easily.

fl 0oc69

.........,, Wonderful book.

9J.;muary2018
one of the best books written for surgery, its a treat to read this. i Hope i c.an finish it in about 20 days as
the author outlines a plan for in the begining. the book is quite big, and c.over-s almost everything left right
Wonderful job done by the author._ ltz mo,-e than a miracle book in forensic__ Even if we mis to revise this book in d !.st mOflth still
we can hit the nail almost on 100% quest10ns from forensic becoz of the pictor!al and innovative pattern of this book __ Un�ralleled
book In forensic... I recommend everyl to bl.I)' this book and to see uaself successful...
 Salient Features
Concepts in physiology are explained in simple understandable language
• Information from pharmacology and pathophysiology integrated at the end of every topic
• Analysis of ECG questions
• Analysis of acid-base disorders questions
• Analysis of respiratory physiology calculations
• Image-based questions at the end of every chapter
• Important one liners (IOLs) asked in PGMEE

About the Author

Dr S Krishna Kumar MD Physiology presently working as an Assistant Professor, Physiology at Chennai
Medical College Hospital & Research Centre [CMCHRC, (SRM group)], Trichy, Tamil Nadu. He did his
graduation from IRT Perundurai Medical College (Stalwarts 2003-2009), Tamil Nadu, India and MD in
Physiology (2010-2012) from AIIMS, New Delhi, India. He is actively involved in teaching to undergraduate
and postgraduate students. He is also a popular teacher of physiology for PGMEE aspirants across India.

Sample pages of CRISP 2nd/ed

Join Author's Facebook Discussion Group

Physiology Discussion Forum -Dr. S. Krishna Kumar

Students' Reviews

****
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