physiology essays

final exam syllabus (categorised with mcq topics)

cell physiology and general physiology of excitable tissues

1. organization of the cell. physical structure of the cell. functional systems of the cell. properties of the cell membrane and junctions between the cells. intercellular signaling. transport of substances through the cell membrane.

2. the human body. homeostasis. general principles of the homeostatic regulation - regulatory systems and elements of the homeostatic regulatory system. levels of physiological regulation.

• the body as a system. functions of the human body - types and definition.

• resistance of the body - homeostasis.

• regulatory principles of physiological functions.

• types of regulation. positive and negative feedback.

3. physiology of the excitable tissues. irritability and excitability. general and specific properties of the excitable cells. membrane potential - ionic basis of the membrane potential.

• irritability and excitability of living tissues; excitation.

• excitable tissues. generation of the resting membrane potential.

• general features of excitable tissues - the action potential.

• excitation characteristics of electrically excitable and nonexcitable membranes; frequency and amplitude coding.

4. measurement of excitability. changes in the excitability during excitation. inhibition. conduction of excitation.

• excitability measurements. accommodation.

• changes in excitability during excitation - phases.

• physiological characteristics of the stimuli; types of stimuli.

• the time factor in excitation - utilization time, minimum time, and chronaxie.

5. transmission of the excitation (inhibition) between excitable cells. synapses - types of synapses. chemical synapses. neurotransmitters and neuromodulators. postsynaptic potentials. summation of the postsynaptic potentials.

• transmission of excitation from one excitable cell to another - synapses. types of synapses.

• characteristics of the electrical synapses.

• characteristics of the chemical synapses.

• neurotransmitters, neuromodulators and neurohormones - definition and examples.

general physiology of the nervous system

6. functions of the nervous system - functional morphology of the nervous system. physiology of the nerve cell. glial cells. neuronal circuits and processing of information in groups of nerve cells - convergence, divergence, reverberatory circuits, inhibition.

• main functions of the nervous system.

• physiological properties of the neurons.

• information processing by groups of neurons.

7. reflex regulation of the physiological functions. type of reflexes according to the mechanism of formation and the characteristics of the reflex arc.

• defining the reflex; types of reflexes according to their formation - comparative characteristics.

• unconditioned reflexes - definition and types.

• clinically important reflexes.

• conditioned reflexes - definition; conditions for and mechanism of formation.

• the reflex arc - definition, components. reflex types according to the reflex arc.

• analysis of the reflex arc; reflex time.

8. nerve centers. types and properties. cerebral blood flow. cerebrospinal fluid.

• nerve centres - definition, types, and characteristics, related to the neural pathways.

• properties of the nerve centers, derived from the functional properties of the nerve cells and their synaptic connections.

9. the autonomic nervous system (ans). general organization of the autonomic nervous system. autonomic nerve centers, ganglia, neurotransmitters and receptors in the autonomic nervous system.

• excitation and inhibition in the cns - main neurotransmitters.

• the autonomic nervous system (ans) - functional morphology.

• ans ganglia - functional characteristics.

10. effects of sympathetic and parasympathetic stimulation on specific organs. autonomic reflexes.

• functional characteristics of the sympathetic division of ans - neurons, neurotransmitters they secrete, and receptors.

• functional characteristics of the parasympathetic division of ans - neurons, neurotransmitters they secrete, and receptors.

• types of adrenoceptors - mechanism of action, effects, and regions of abundance.

• types of cholinoceptors - mechanism of action, effects, and regions of abundance.

• ans effects on the conduction system of the heart and the working myocardium.

• ans effects on the blood vessels.

• ans effects on the bronchial muscles.

• ans effects on the gastrointestinal tract.

• ans effects on the urinary system.

• spinal control on visceral functions.

• nerve centers, controlling visceral functions in the brain stem and midbrain.

11. role of the hypothalamus, reticular formation, cerebellum, basal ganglia and cerebral cortex in the control of autonomic functions. integration of the central nervous system in the adaptation processes of the body - "alarm" or "stress" response of the sympathetic nervous system.

• the role of ans in adaptation. the sympathico-adrenal system.

• stress and distress.

endocrine

12. general principles of the humoral control of physiological functions. telecrinia and paracrinia. classification, synthesis and mechanism of action of the hormones. control of the hormone secretion.

• humoral regulation of physiological functions - general principles. telecrine and paracrine effects.

• hormones - classification, synthesis, and mechanism of action.

• regulation of the hormonal effects.

13. hypothalamic-neurohypophysial system. neurosecretion. hormones of the neurohypophysis. physiological effects and control of secretion.

• hypothalamo-neurohypophiseal system.

• neurosecretion. hormones of the posterior pituitary gland - physiological effects and regulation.

14. hypothalamo-adenohypophysial system. hormones of the adenohypophysis. physiological effects and control of secretion.

• hormones of the anterior pituitary (adenohypophisis) - physiological effects and regulation.

15. functional morphology of the thyroid gland. iodine containing thyroid hormones. physiological effects and control of secretion. hyperthyroidism and hypothyroidism.

• function and structure of the thyroid gland. iodine-containing hormones - physiological effects and regulation.

• thyroid disorders and related pathology.

• thyroid function tests. radioactive iodine uptake test (raut; werner's test).

16. functional morphology of adrenal glands. hormones of the adrenal medulla. physiological effects and control of secretion of adrenaline (epinephrine) and noradrenaline (norepinephrine).

• function and structure of the adrenal glands.

• medulla hormones. functional effects of adrenalin (epinephrine) and regulation.

17. hormones of adrenal cortex - glucocorticoids. physiological effects and control of secretion. pharmacological effects of glucocorticoids.

• adrenal cortex hormones - glucocorticoids. functional effects and regulation.

• pharmacological effects of the glucocorticoids.

18. hormones of adrenal cortex - mineralcorticoids and adrenal androgens. abnormalities of adrenocortical secretion.

• mineralcorticoids and adrenal sex hormones - functional effects and regulation.

• pathological effects of adrenal cortex disorders.

• adrenal gland tests. thorn's test, dexamethasone suppression test, saline suppression test.

19. endocrine functions of the pancreas - type of hormones, physiological effects and control of secretion. diseases of the endocrine pancreas.

• the pancreas - hormones. functional effects and regulation.

• pancreatic endocrine pathology.

• pancreas function tests. oral glucose tolerance test.

20. the calcium-phosphate homeostasis. parathyroid hormone, calcitonin, vitamin d - physiological effects and control of secretion. disorders of the calcium and phosphate homeostasis.

• calcium-phosphorus homeostasis. the parathyroid hormone, calcitonin and calcitriol - functional effects and regulation.

• disturbances of calcium-phosphorus homeostasis.

21. physiology of reproduction. male reproductive system. spermatogenesis. male sex hormones (androgens) - types, physiological effects and control of secretion. erection and ejaculation.

• hormonal function of the testes - androgens: types, functional effects and regulation to secretion.

• erection and ejaculation.

22. physiology of reproduction. female reproductive system. ovogenesis. female sex hormones (estradiol and progesterone) - types, physiological effects and control of secretion. regulation of the female monthly rhythm. pregnancy and lactation. pregnancy tests.

• hormonal effects of the ovaries - estrogens and progesterone: functional effects and regulation.

• the menstrual cycle. the ovulation tests.

• pregnancy, delivery and lactation.

• tests for early pregnancy. the galli-mainini test. immunological tests.

23. epiphysis, thymus and non-endocrine organs with endocrine functions. tissue hormones - types, physiological effects and control of secretion.

• the epiphysis, thymus and non endocrine organs with glandular effects.

• tissue hormones - types, description and effects.

physiology of muscles

24. physiology of the skeletal muscles - functional morphology, mechanism and energetics of muscle contraction. types of muscle contractions. types of muscle fibers. muscle work and muscle fatigue. electromyography.

25. functional morphology of the smooth muscles. excitation, electrophysiological characteristics and mechanism of contraction of the smooth muscles.

blood

26. blood physiology. functions of the blood. composition and volume of the circulating blood - regulation of the blood volume. blood plasma - composition and its regulation. hematocrit. blood reservoirs.

• functions of blood.

• blood volume - normal, increased and reduced volume; regulation.

• blood reservoirs.

• hematocrit; reference values. normal, reduced and increased hematocrit values.

• organic constituents of blood plasma - types and physiological functions.

• plasma proteins - types, volumes and functions.

• osmotic pressure and ph of blood and their regulation.

27. erythrocytes (red blood cells). count and functions. erythrocyte sedimentation rate. hemoglobin. erythrocyte indices. iron metabolism. hemolysis. control of erythropoiesis and erythrocyte count.

• rbcs - functions. counting methods and reference values. increased and reduced number.

• hemolysis - types. osmotic resistance of rbcs; reference values.

• hemoglobin - reference values. normal and abnormal compounds.

• methods for determining the hemoglobin volume; reference values.

• esr. erythrocyte indices.

• regulation of erythropoiesis and the number of rbcs in the peripheral blood.

28. blood types. physiological and clinical significance. the abo and rh blood type systems. methods of analysis. principles of blood transfusion.

• blood type systems and defining factors.

• blood typing methods of the abo and rh systems.

• incompatible transfusion of whole blood, rbc and plasma.

• mandatory transfusion tests.

29. leukocytes (white blood cells). count and functions of the different leukocyte types. control of leucopoiesis and leukocyte count. immunity.

• wbcs - types and functions.

• wbcs count; counting methods; reference values; conditions of increased and reduced number.

• wbcs differential count. conditions related to changes in the percentage of the different types.

• regulation of leucopoiesis.

30. hemostasis and blood coagulation. vascular-thrombocytic and coagulation hemostasis. fibrinolysis and anticoagulant mechanisms. control of hemostasis.

• bleeding and clotting. laboratory indices.

• platelets - functions. reference values. conditions linked to reduced number.

• vascular-platelet hemostasis.

• blood clotting - main factors and stages.

• fibrinolysis and anticlotting substances. external and internal (primary and secondary) anticoagulants.

31. physiology of lymphatic system. formation, composition and functions of lymph. physiology of the spleen.

• formation, composition and functions of lymph.

• physiological functions of the spleen.

• immunity - definition. innate immunity.

• acquired immunity.

cardiovascular system

32. the cardiovascular system. systemic and pulmonary circulation. the heart - functional morphology of the pericardium, endocardium and myocardium. nerve supply. myocardial blood supply.

• the cardiovascular system. systemic and pulmonary circulation - overview.

• the heart - functional morphology of the pericardium, myo- and endocardium.

• afferent and efferent innervation of the heart.

• myocardial blood flow and its regulation.

33. functional morphology and physiological characteristics of the conduction system of the heart. automaticity. cardiac rhythm. abnormalities of conductivity.

• the cardiac conduction system; automaticity.

• the leading role of the sinus node in cardiac function. the stannius ligatures. temperature effects on a frog's sinus venosus.

• heart rhythm; conduction abnormalities.

34. physiological characteristics of the working myocardium. excitation and contraction. refractory periods. extrasystoles, flutter and fibrillation. myocardial metabolism.

• physiological characteristics of the cardiac muscle: excitation, contraction, refractory periods, extrasystoles.

35. electrical events during cardiac performance. origin, registration and evaluation of the electrocardiogram (ecg).

• electrocardiography - leads. electrical axis of the heart.

• ecg analysis.

36. dynamics of the cardiac contractions - cardiac cycle. cardiac cycle - phases. heart valves during different phases of the cardiac cycle.

• structure and functions of the heart valves. position of the valves during the cardiac cycle.

37. functions of the heart valves. heart sounds. methods of examination. stenosis and insufficiency of the valves. correlation between a synchronous phonocardiographic and electrocardiographic record.

• methods of physical examination of the heart. heart sounds - characteristics and auscultation areas of the valves.

• analysis of ecg and phonocardiogram recorded simultaneously.

38. heart rate. stroke volume and cardiac output at rest and during activity.

• heart rate. rate and rhythm changes.

• stroke volume (sv) and cardiac output (c.o.); changes in sv and c.o. under different conditions; methods of measurement.

39. control of cardiac output - intrinsic control. myocardial energetics.

40. extrinsic neural regulation of the cardiac performance - characteristics of the sympathetic and parasympathetic effects. humoral factors affecting cardiac performance.

• humoral factors affecting cardiac activity.

• extracardiac neural regulation of cardiac activity. mechanisms of the sympathetic and parasympathetic regulation.

• intrinsic and integrated reflex control of cardiac activity.

• humoral factors causing vasoconstriction.

• humoral factors causing vasodilatation.

41. functional characteristics of the blood vessels. hemodynamic principles - characteristics of the vessels and the blood. hemodynamic indices. volume and linear velocity of the blood flow through the various parts of vascular system and factors determining them.

• functional classification of the blood vessels. hemodynamics - the laws of poiseuille and laplace.

• volume and linear blood flow velocities - definition and determining factors.

42. blood pressure in the various parts of the cardiovascular system. arterial blood pressure - methods of measurements and normal values. factors determining blood pressure levels.

• arterial pressure in different parts of the vascular system. factors affecting the gradient of arterial pressure.

• arterial pressure - invasive and non-invasive methods for its measurement.

• arterial pressure. types of arterial pressure - reference intervals, arterial pressure changes - terminology.

43. arterial blood flow. arterial pressure pulsations. sphygmography. characteristics of the arterial pressure pulsations. venous blood flow. venous pressure pulsation. phlebography.

• arterial pulse - definition and factors determining it. pulse characteristics and examination.

• sphygmography as a method. sphygmogram's analysis. simultaneous recordings of ecg, phonocardiogram and sphygmogram. measurement of pulse wave velocity.

• venous pulse. phlebogram's analysis.

• plethysmography - principles and predictive value.

44. physiology of the microcirculation. functional organization of the microcirculation unit. organ-related features of the capillaries. control of microcirculation.

• the microcirculatory unit - forces of filtration and reabsorption.

• specific characteristics of the capillaries in the different organs. regulation of the blood flow through microcirculation.

• principles of capillaroscopy and its predictive value.

• intracardiac regulation - mechanisms of overcoming increased venous return and higher resistance.

45. vascular tone. basal tone of blood vessels. local, neural and humoral regulatory mechanisms of the vascular tone.

46. control of circulation. characteristics and localization of the receptors. vasomotor centre. supramedular control of circulation.

• innervation of the blood vessels. the vasomotor centre.

• intrinsic and integrated vasomotor reflexes.

47. control of arterial blood pressure. mechanisms of quick short-term, quick ongoing, and long-term regulation.

• mechanisms of rapid short-term regulation of arterial pressure.

• mechanisms of rapid long-term regulation of arterial pressure.

• mechanisms of long-term regulation of arterial pressure.

• cardiovascular changes during physical exercise.

respiration

48. physiology of respiration. pulmonary ventilation. functional organization of the airways, lungs and thoracic cage. mechanics of breathing. intrapleural and intrathoracic pressure. the role of surfactant. cough and sneeze.

49. rate and rhythm of breathing. pulmonary and alveolar ventilation. elastic and non-elastic resistance to breathing. air flow during breathing. work of breathing.

50. pulmonary volumes and capacities and their functional importance. anatomical and physiological dead space. estimation of the pulmonary ventilation.

51. physical principles of gas exchange. solubility, diffusion coefficient and diffusion capacity of the gases. composition of the gases in the air, lungs and blood. diffusion of gases through the respiratory membrane. ventilation-perfusion ratio.

52. transport of o2 in the blood. oxyhemoglobin dissociation curves. oxygen exchange in the lungs and tissues.

53. transport of co2 in the blood. carbon dioxide exchange in the lungs and tissues. carbon dioxide dissociation curve.

54. control of respiration. respiratory center and the rhythm of breathing. chemical control of respiration. reflex control of respiration. effects of the cerebral cortex on respiration.

SUBCATEGORIES

• stages of breathing. pulmonary ventilation.

• structural and functional features of the respiratory system.

• static conditions in the thoracic cavity.

• functional structure of the pulmonary alveoli. the effect of surfactant.

• elastic forces of the lungs.

• nervous control of the bronchi.

• pulmonary blood supply - anatomical and physiological features.

• breath rate and rhythm. types of breathing. description of different breath rates.

• protective reflexes - cough and sneeze.

• elastic and non-elastic resistance to breathing.

• alveolar, intrapleural and transpulmonary pressure - defining factors.

• the pleura and its functions. pneumothorax - types.

• anatomical and physiological dead space.

• lung volumes - reference values and physiology.

• lung capacities - reference values and physiology.

• ventilation of the lungs - indices.

• airflow. flow-volume loop.

• the work of breathing.

• the physics of gas exchange. gas solubility, diffusion coefficient and capacity.

• gas composition in the air, lungs and blood.

• gas diffusion through the alveolo-capillary (respiratory) membrane.

• ventilation-perfusion ratios in the lungs.

• transport of oxygen in the blood.

• transport of carbon dioxide in the blood.

• dissociation curve of oxygen hemoglobin.

• dissociation curve of co2.

• oxygen and carbon dioxide exchange in the lungs.

• oxygen and carbon dioxide exchange in tissues.

• oxygen content of the arterial and venous blood. arteriovenous oxygen difference.

• disorders resulting from changes in the blood oxygen and carbon dioxide content and their effects on respiration.

gastrointestinal system

55. the gastrointestinal system - functions. digestion in the mouth: mastication, secretion, enzyme activity and absorption. swallowing - phases and regulation.

functions of the GI system

• primary functions: mechanical and chemical breakdown of food (ingestion/digestion), nutrient absorption and waste elimination (excretion)

digestion in the mouth

• mastication

  • also known as chewing

  • mechanical process of food breakdown into smaller particles

  • increasing the SA for enzymatic action

  • involves the coordinated action of teeth, tongue and jaw muscles

• secretion

  • salivary glands secrete saliva

  • saliva contains enzymes and mucus

  • saliva moistens food, facilitating its movement and forming a bolus for swallowing

• enzyme

  • saliva contains enzyme amylase, which initiates the breakdown of starches into simpler sugars

• absorption

  • some substances/medication can be absorbed through the oral mucosa

swallowing

• also known as deglutition

• phases

  • oral

    • voluntary phase where tongue pushes bolus to the back of the mouth

  • pharyngeal

    • involuntary phase where bolus passes through the pharynx

    • soft palate elevates to prevent food form entering the nasal cavity

    • epiglottis closes over the trachea to prevent aspiration

  • esophageal

• regulation

  • regulated by the swallowing center in the medulla oblongata

  • this coordinates the sequential muscle contractions required for safe swallowing

56. motility in the stomach - hunger contractions, storage function, mixing and propulsion of food. emptying of the stomach. regulation of gastric movements. vomiting.

• gastric motility: hunger contractions, peristaltic contractions when food is present in the stomach and its storage function. emptying of the stomach.

• regulation of stomach emptying.

• the vomiting act and its trigger zones.

57. secretion, enzyme activity and absorption in the stomach. gastric juice: composition, mechanism of secretion and functions. gastric secretion and its regulation: cephalic, gastric and intestinal phases. protective functions of the gastric barrier.

• secretion, enzyme activity and absorption in the stomach.

• gastric juice: composition, secretion and functions.

• regulation of gastric secretion - cephalic, gastric and intestinal phases.

• protective functions of the gastric barrier.

58. motility of the small intestine - type of movements and regulation; secretion, digestion and absorption.

• motility of the small intestine - types.

• regulation of the motility of the small intestine.

• secretion, digestion and absorption in the small intestines.

59. motility of the colon - type of movements and regulation; secretion, digestion and absorption. defecation.

• motility of the colon and its regulation.

• secretion, digestion and absorption in the colon.

• defecation.

60. pancreatic juice - composition and functions. regulation of the pancreatic secretion.

• pancreatic juice - composition and effects.

• regulation of pancreatic secretion.

61. formation and secretion of bile. composition and functions of the bile. regulation of bile secretion. the liver as an organ - functions of the liver.

• formation and secretion of bile: volume, composition and functions.

• regulation of bile secretion.

• liver functions.

62. digestion and absorption of proteins, fats and carbohydrates in the gastrointestinal tract. absorption of salts, water and vitamins.

• digestion and absorption of proteins.

• digestion and absorption of fats.

• digestion and absorption of carbohydrates.

• absorption of salts, water and vitamins.

63. metabolism of nutrients in the body. carbohydrate metabolism. regulation of glucose concentration in blood. protein metabolism and its regulation. lipid metabolism and its regulation.

• carbohydrate metabolism.

• blood sugar level and its regulation.

• protein metabolism and its regulation.

64. energy metabolism in the body. energy values of the nutrients. the oxygen energy equivalent. measurement of the metabolic rate: direct and indirect calorimetry. the basal metabolic rate (bmr) and daily energy requirements under different physiological conditions.

• energy metabolism in the body; energy value of foods; the oxygen energy equivalent.

• measurement of the metabolic rate - direct and indirect calorimetry.

• basal metabolic rate and daily energy needs under different physiological conditions.

65. nutrition - main principles in defining the physiological standards - plastic and energy needs of the body. physiology of starvation and satiety.

• nutrition - rational, prophylactic and dietetic.

• main principles in defining the physiological standards of nutrition - plastic and energy needs.

• physiology of starvation and satiety.

• principles of rational nutrition.

• daily nutrient requirements (per kg/body weight).

• food intake distribution based on energy content.

• short- and long-term mechanisms of hunger. pre- and post-resorptive mechanisms of satiety.

• respiratory quotient (respiratory coefficient) and energy equivalent of oxygen of different foods.

• energy requirements at rest and during different types of physical exercises.

temperature regulation

66. temperature regulation. body temperature and isothermia. mechanisms of heat production and heat loss. neurophysiological bases of temperature regulation. hyperthermia and hypothermia. acclimatization. regulation of body temperature during exercise.

urinary system

67. the kidneys - functional structure. specific features of their blood supply and innervation. mechanism and control of glomerular filtration. methods of glomerular function assessment.

• excretory functions and systems of the body.

• the nephron - structure and types.

• functional morphology of the juxtaglomerular apparatus.

• specific characteristics of the blood supply and innervation of the kidneys.

• glomerular filtration. area and forces of filtration, volume and composition of primary urine.

68. functions of renal tubules. transport in different parts of the tubules. reabsorption and secretion along different parts of the nephron. urine concentration and dilution. regulation of tubular reabsorption.

• passive reabsorption in the different parts of the tubules.

• active reabsorption of substances, driving forces and localizations in the tubular system.

• active and passive reabsorption of water.

• reabsorption of glucose; glucose transport maximum.

• sodium reabsorption in the different parts of the tubules.

• concentration and dilution of urine: cortical medullary osmotic gradient, countercurrent multiplier system; passive countercurrent exchanger.

• water and osmotic diuresis; antidiuresis.

69. renal clearance tests as a tool to quantify kidney function. urine volume and the composition. micturition. endocrine and metabolic functions of the kidneys. regulation of the renal functions.

• clearance: definition, formula and its clinical informative value.

• measurement of the glomerular filtration rate (gfr) using clearance.

• measurement of renal plasma and blood flow using clearance.

• determination of maximum reabsorption.

• determination of maximum secretion.

• endogenous clearances and their clinical importance.

• renin - its secretion site and role in the regulation of blood pressure.

• erythropoietin - formation and function.

• micturition (urination).

70. water-electrolyte balance of the body - fluids and electrolytes. dynamics of volume and osmolality. regulation of water-salts homeostasis. physiology of thirst.

• volume and components of body fluids: water balance, balance and function of the major electrolytes.

• dynamics of volume and osmolality of body fluids.

• regulation of body fluids osmolality.

• regulation of body fluids volume.

• regulation of ph by the blood buffering systems.

• regulation of ph by the renal buffering systems.

• respiratory regulation of ph.

71. acid-base balance of the body. buffer systems of the body fluids. respiratory regulation of ph. renal regulation of ph. abnormalities of the acid-base balance.

sensory systems

72. the sensory systems - functional morphology. general principles of coding and processing of information. adaptation.

73. somatic sensations - general organization and modalities. the tactile and position senses. pain and thermal sensations.

74. vision. functional morphology of the eye - optics, accommodation and refraction errors. the pupillary reflex. eye movements and their regulation. protective structures of the eyes.

75. detection, transmission and processing of the information in the retina. physiology of vision. light and dark adaptation. visual acuity. colour vision. central neurophysiology of vision.

76. the sense of hearing. functional morphology of the external, middle and inner ear. processing of sound. central auditory mechanisms. the vestibular apparatus. regulation of balance. vestibular reflexes.

77. physiology of the chemical senses - taste and smell. peripheral and central mechanisms of taste and smell.

higher nervous functions

78. general characteristics of motor control. muscle receptors - functions of the muscle spindles and tendon receptors. spinal cord control of motor activity. reflexes of the spinal cord. higher levels of motor control.

79. brain activity and sleep. neural structures involved in brain activity. physiological changes during sleep. electroencephalography.

80. higher nervous activity - types and characteristics. learning and memory. primary and secondary signalling systems. communication skills. reading, writing and speech praxis. auditory and visual gnosis.