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2019 - Hemant Gupta - Mastering The BDS 1st Year, 8th Ed
2019 - Hemant Gupta - Mastering The BDS 1st Year, 8th Ed
2019 - Hemant Gupta - Mastering The BDS 1st Year, 8th Ed
8TH EDITION
It is a matter of great pride and pleasure to introduce the eighth edition of Mastering the BDS Ist Year (Last 25 Years
Solved Questions). The aim of this text enables the students of dentistry to learn fundamentals. All the sections
are rewritten and the answers of each and every section are revised as per the latest syllabus. This new edition is
updated and expanded, bringing forth new information gained since production of last edition. The text has been
made more clinically oriented so as to better correlate the text with clinical aspects. The text consists of a large
number of illustrations, which enhances the understanding of written description. In this edition, additional matter is
added, which will help students to know the basic pattern of competitive examinations such as AIIMS, NEET, PGI, etc.
I, as an author, wish to express my hope that material presented is clear and understandable. The book is never
meant to replace any of the textbook. All the respective textbooks of all subjects should be read thoroughly to gain
the deep knowledge of subject. This book provides an idea of questions and answers in BDS examinations and
multiple choice questions (MCQs) in pre-PG examinations. I hope that the content will be enough to stimulate the
insight and new trends of thoughts in all the subjects of year.
Any of the suggestions and criticism should be welcomed at macrocyte@gmail.com.
Hemant Gupta
PREFACE TO THE FIRST EDITION
The subjects of first year still ring fear in the minds of students—baseless fear that rest on silent assumptions
and those that distort thinking. However, self-study, dedication, motivation and hard work are the virtues that go
a long way in the making of a genius—a success. Listen, think, read and analyze with an open mind and you
definitely cannot go wrong. I would like to clarify that this book is not meant to replace your standard textbooks, but
yet coupled with your effort and sincerity, it will definitely make you clinch and help you put your best foot forward
to reach great heights of success.
This book is not meant as a replacement for the respective textbook of various subjects. It is truly an
exam-oriented book.
Hemant Gupta
ACKNOWLEDGMENTS
Achievement of this book was possible by the help and support of Almighty “SAI BABA”, my grandparents, parents,
my wife, teachers and friends.
Special thanks to those who remain behind the curtain and help in arrangement of study material for the book.
Finally, my grateful thanks to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS
Mani (Group President) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, especially Dr Madhu
Choudhary (Publishing Head–Education), Ms Pooja Bhandari (Production Head), Ms Sunita Katla (Executive
Assistant to Group Chairman and Publishing Manager), Mr Rajesh Sharma (Production Coordinator), Ms Seema
Dogra (Cover Visualizer), Mr Narsingh (Proofreader), Mr Nitesh (Graphic Designer), and Mr Kuldeep (Typesetter),
for making my dream come true by publishing this book.
CONTENTS
149
Section 1: Anatomy
3 157
3
5 161
10
161
23
162
29
165
34
166
52 166
58 168
169
72 169
72 170
79 174
83
95
105
107 182
114 184
117 186
186
119 190
119 192
121 193
125
127 195
197
129
198
129
Section 2: Embryology
131
137
140
144 206
146 4. Further Development of Embryonic Disc 208
Mastering the BDS Ist Year (Last 25 Years Solved Questions)
348
210 366
216 376
394
221 403
224 423
225 430
Section 3: Osteology
229
440
281
Section 7: Dental Anatomy
287
306 547
315 555
332 3. Chronology of Tooth Development 558
Contents xv
665
672
678
685
706
714
718
719
606
720
609
721
616
617
736
626
Section 9: Oral Physiology
Section 8: Dental Histology
741
639 743
650 744
659 745
1
SECTION
Anatomy
2. In adults:
1. MANDIBLE Mental foramen opens midway between
upper and lower borders because alveolar and
subalveolar parts of bone are equally developed.
(Sep 2001, 4 Marks) Mandibular canal runs parallel with mylohyoid
Ans. The nerves and vessels related to mandible are: line.
Enumeration of nerves and vessels of mandible The angle reduces to about 110 or 120° because
Mental nerve and vessels ramus is vertical.
Inferior alveolar nerve and vessels 3. In old age:
Mylohyoid nerve and vessels Teeth exfoliate and alveolar border is absorbed,
Lingual nerve leading to reduction of height of body of mandible.
Masseteric nerve and vessels Mental foramen and mandibular canal are close
• Auriculotemporal nerve and superficial temporal to alveolar border.
artery The angle again becomes obtuse, i.e. 140° because
Facial artery the ramus is oblique.
A B C
extends from the first molar region and continues 4. Medial pterygoid elevates the mandible and protrude the
upward as the anterior border of the ramus. mandible.
b. Internal oblique ridge: Linear bony elevation 5. The medial and lateral pterygoid muscles of two sides
crest on the medial aspect of the mandible. contact alternately to protrude side to side movement of
4. Notches: mandible.
a. Mandibular/sigmoid notch: The curvature or
Q.5. Write a short note on ossification of mandible.
depression between the condyle and the coronoid
(Apr 2007, 4 Marks)
processes.
b. Coronoid notch: Depression/concavity on the Ans. Mandible is the second bone to ossify after the clavicle.
anterior body of ramus. • Greater part of the mandible ossifies in membrane.
5. Foramina: • Part which ossifies in cartilage is incisive part which
a. Mental foramen: Present on the anterolateral lies below the incisor teeth. Condylar and coronoid
aspect of the body of the mandible between the processes, upper half of ramus above the level of
two premolars. Mental nerve and vessels pass mandibular foramen.
through the foramen. • Each half of the mandible ossifies only from one
b. Mandibular foramen: Present on the medial center which appears at 6th week of intrauterine life
surface of the ramus. The inferior alveolar nerve in mesenchymal sheath of Meckle s cartilage near
and vessels are transmitted through the foramen. future mental foramen.
6. Fossae: At birth mandible consists of two halves which is
a. Submandilbular fossa: Shallow depression connected at symphysis menti by fibrous tissue.
present on the medial surface of the mandible Bony union occurs during first year of life.
to lodge the submandibular gland. Q.6. Write short note on inferior alveolar nerve.
b. Sublingual fossa: Shallow depression present on
(Nov 2009, 5 Marks) (Jan 2012, 5 Marks)
the medial surface of the mandible to lodge the
(Sep 2017, 3 Marks) (Dec 2014, 5 Marks)
sublingual gland.
c. Digastric fossa: Depression on the lingual surface Inferior Alveolar Nerve
of mandible near the symphysis menti from ♦ It is the largest branch of mandibular nerve.
where the anterior belly of digastric muscle ♦ It descends medial or deep to lower head of lateral
originates. pterygoid muscle and lateraloposterior to lingual nerve
7. Tubercle: to the region between sphenomandibular ligament and
a. Genial tubercles: Small bony elevations that medial surface of ramus of mandible; where it enters
provide attachment to the geniohyoid and mandibular canal at the level of mandibular foramen.
genioglossus muscles. ♦ Throughout its path, it is accompanied by inferior alveolar
b. Lingula: Lip-like projection on the medial surface artery (a branch of internal maxillary artery) and inferior
of the mandible just above the mandibular alveolar vein. The artery lies just anterior to the nerve.
foramen.
♦ In the mandibular canal, the three structures together are
Q.4. Name the nerves related to mandible. Describe the referred to as lnferior alveolar neurovascular bundle .
movements of mandible. ♦ It supplies the following structures:
(Sep 2006, 4 Marks) (Mar 2013, 4 Marks) Inferior portion of the ramus of the mandible
Or Entire body of the mandible
Pulps of the mandibular incisors, canines, premolars,
Write short note on movements of mandible.
and molars.
Ans. The nerves related to mandible are:
♦ The nerve, artery and vein travel anteriorly in mandibular
1. Lingual nerve.
canal, as far forward as mental foramen which is located at
2. Inferior alveolar nerve.
a point below and between roots of the premolars where
3. Mylohyoid nerve.
the nerve divides into its terminal branches
4. Mental nerve.
Mental nerve.
5. Nerve to masseter.
Incisive nerve.
6. Auriculotemporal nerve.
1. Mental nerve: It emerges from the mandibular canal
Movements of Mandible through the mental foramen in the form of a major
Muscles of the mastication causes the movements of mandible. bulk and divides into three branches that innervate:
1. Masseter muscle elevates the mandible to close the mouth. i. Skin of chin,
2. Temporalis elevates the mandible and posterior fibers of ii. Skin and mucous membrane of lower lip, and
the muscle retract the protruded mandible. iii. Buccal mucosa from the incisor to the premolars.
3. Lateral pterygoid muscle depresses the mandible to open It carries a few secretomotor fibers from chorda
the mouth. tympani to labial minor salivary glands.
Anatomy 5
2. Incisive nerve: It is the smaller terminal branch and ♦ Genioglossus muscle: It originates from superior genial
the continuation of inferior alveolar nerve within the tubercle.
substance of the body of the mandible, anterior to the Q.9. Write in short on pterygomandibular raphe.
mental foramen. (July 2016, 5 Marks)
It supplies the pulps of anterior teeth, central and lateral
Or
incisors, and canine, and sometimes the first bicuspid,
supporting alveolar bone, periodontal ligament, and the Answer in brief pterygomandibular raphe.
overlying soft tissues anterior to the mental foramen. (Oct 2016, 2 Marks)
It is commonly found that the mandibular central Ans. Pterygomandibular raphé (pterygomandibular ligament)
incisor has a dual nerve supply from the incisive nerve is a tendinous band of the buccopharyngeal fascia,
on its own side and from the terminal twigs of the attached by one extremity to the hamulus of the medial
incisive nerve of the opposite side. pterygoid plate, and by the other to the posterior end of
Q.7. Write the name of various movements that the the mylohyoid line of the mandible.
mandible undergoes. (Oct 2016, 2 Marks) Its medial surface is covered by the mucous membrane of
Ans. Various movements which mandible undergoes are: the mouth.
Protrusion Its lateral surface is separated from the ramus of mandible
Retraction by a quantity of adipose tissue.
Elevation Its posterior border gives attachment to superior constrictor.
Depression Its anterior border, to part of buccinator.
Lateral movements.
Q.8. Write short note on genial tubercle. (Oct 2016, 3 Marks)
Or
Write very short answer on genial tubercles.
(Aug 2018, 2 Marks)
Ans. Genial tubercle is also known as mental spine.
Posterior surface of symphysis menti is marked by four
small elevations known as inferior and superior genial
tubercles.
Superior genial tubercles give origin to genioglossus
muscle and inferior tubercles to geniohyoid muscle.
2. SCALP
Q.1. Describe various layers, innervations, venous drainage
and arterial supply of scalp. (Sep 2002, 10 Marks)
Or
Enumerate the layers of scalp. (Aug 2018, 1 Mark)
Fig. 3: Genial tubercles Ans. Soft tissues covering the cranial vault form scalp.
Skin Pericranium
♦ It is thick and hairy. ♦ This layer is the fifth layer of scalp.
♦ Skin adheres to epicranial aponeurosis via the dense ♦ This layer is loosely attached to surface of bone.
superficial fascia. ♦ Pericranium is firmly attached to their sutures where the
sutural ligaments bind pericranium to endocranium.
Superficial Fascia
Innervation
♦ This layer is more fibrous and is dense in center as
compared to periphery at head. Scalp is supplied by ten nerves on each side. Out of these five
♦ Superficial fascia binds the skin to subjacent aponeurosis nerves (four sensory and one motor) enter the scalp in front of
and provide proper medium for passage of vessels and ear and other five behind the ear.
nerves to the skin.
Arterial Supply
Two set of arteries five on each side, out of these five arteries,
three arteries lie in front of ear and two behind the ear.
Fig. 7: Venous drainage of scalp Arteries
(For colour version see Plate 1)
Preauricular
♦ Superficial temporal vein descend in front of tragus, a. Supratrochlear
enters parotid gland and joins maxillary vein to form b. Supraorbital
retromandibular vein. Retromandibular vein consists of c. Superficial temporal arteries
two divisions, i.e. Out of these arteries 1st and 2nd are the branches of
1. Anterior division of retromandibular vein unites with ophthalmic branch of internal carotid artery. The third
facial vein to form common facial vein which drains artery is branch of the external carotid artery.
into internal jugular vein.
Posterior Auricular
2. Posterior division of retromandibular vein unites with
posterior auricular vein and form external jugular Behind the ear there is posterior auricular artery. One more
vein which drains to subclavian vein. Occipital veins artery which is in the occipital region is known as occipital
terminate in suboccipital venous plexus. artery. These two arteries are branches of external carotid artery.
Clinical Significance Or
♦ Fluid collected in this space tends to gravitate in the eyelid. Draw a well labeled diagram to show the blood vessels
In this way black eye is produced if there is bleeding in this and nerves supplying the scalp. (Oct 2016, 5 Marks)
space due to scalp injury on direct blow to the skull. The Ans. For diagram of venous drainage of scalp refer to Ans 1
infection in this space readily enters the cranium through of same chapter.
3. FACE
Fig. 12: Right eye—black eye due to injury to the scalp; left eye— (Apr 2018, 3 Marks)
black eye due to local injury
♦ In right eye, black eye occur due to injury to scalp. Sensory Nerve Supply
♦ In left eye, black eye is due to local injury. ♦ Ophthalmic divisions of trigeminal nerve:
Q.14. Answer in brief on emissary vein. Supratrochlear
(May 2017, 3 Marks) Supraorbital
Ans. The veins connecting the veins outside the cranium with Lacrimal
the intracranial dural venous sinuses by passing through Infratrochlear
foramina in the cranium are called emissary veins. External nasal.
Emissary vein connect pterygoid venous plexus to the
cavernous sinus. 1. Supratrochlear
2. Supraorbital
Emissary Veins in the Region of the Scalp
3. Lacrimal nerve
On each side of the midline in the region of the scalp two sets 4. Infratrochlear
of emissary veins are encountered, viz. 5. External nasal
1. Parietal emissary vein, which passes through parietal 6. Infraorbital
foramen and communicates with the superior sagittal 7. Zygomaticofacial
sinus. 8. Zygomaticotemporal
2. Mastoid emissary vein, which passes through mastoid 9. Auriculotemporal
foramen and communicates with the sigmoid sinus.
10. Buccal
Emissary Veins of Skull 11. Mental
12. Greater auricular
Name of Foramen of Veins outside Venous 13. Transverse cutaneous nerve
emissary vein skull skull sinuses
Parietal Parietal Veins of scalp Superior Fig. 13: Sensory supply of face
emissary vein foramen saggittal
venous sinus ♦ Maxillary division of trigeminal nerve:
Infraorbital
Mastoid Mastoid Veins of scalp Sigmoid sinus
emissary vein foramen Zygomaticofacial
Zygomaticotemporal.
Contd...
Anatomy 11
fascia, crosses superficial to submandibular gland and hyoid bone. It runs upwards and crosses its passage in
join anterior division of retromandibular vein below angle cervical region in order to reach the face.
of mandible to form common facial vein which drains to
internal jugular vein. Tributaries of facial vein correspond Course of Facial Artery
to branches of facial artery. ♦ Facial artery enters the face by winding around the base
Deep connections of facial vein of mandible and by piercing the deep cervical fascia at
A communication between the supraorbital and anteroinferior angle of massater muscle.
superior ophthalmic vein. ♦ First the artery run forward and upward to a point 1.25 cm
Another connection with the pterygoid plexus lateral to angle of mouth. Now the artery ascends by the
through the deep facial vein which passes backward side of nose till medial angle of an eye where it terminates
over the buccinator deep to ramus of mandible and by supplying lacrimal sac and by anastomosing with dorsal
communicate with pterygoid venous plexus around nasal branch of ophthalmic artery.
lateral pterygoid muscle which communicate with ♦ Facial artery is tortuous and it lies between the superficial
cavernous sinus via emissary vein. and deep muscles of the face.
2. Retromandibular vein: It is formed by union of superficial
temporal and maxillary vein within parotid gland. On
leaving parotid gland, it is divided into two divisions, i.e.
anterior and posterior. Anterior division joins facial vein
to form common facial vein, while posterior division joins
posterior auricular vein to form external jugular vein.
Write a short note on facial artery in the face. 1. The large anterior branches anastomose with arteries of
same name on opposite side and with mental artery.
(Aug 2016, 3 Marks) 2. The posterior branches anastomosis with infraorbital artery
Or and transverse facial artery.
Write short answer on facial artery. (Aug 2018, 3 Marks) 3. At medial angle of eye, terminal branches anastomose
Ans. Facial Artery with branches of ophthalmic artery. So this is a site of
Introduction: Facial artery is the chief artery of face. It anastomosis between external and internal carotid arteries.
is a branch of external carotid artery which is given off Q.5. Write a short note on lymphatic drainage of face.
in carotid triangle just above the tip of greater cornue of (Sep 1999, 4 Marks)
Anatomy 13
Ans. Lymphatic Drainage of Face Write a short note on dangerous area of face.
This is divided into three groups. (Oct 2007, 5 Marks) (Dec 2010, 5 Marks)
1. Upper territory: It drains into preauricular parotid (Dec 2009, 5 Marks) (Sep 2013, 5 Marks)
group of lymph nodes. It drains greater part of (Sep 2017, 2 Marks)
forehead, lateral half of eyelids, conjunctiva, lateral
part of cheek and parotid area.
2. Middle territory: It drains into submandibular
lymph nodes. It drains the median part of forehead,
external nose, upper lip, medial halves of eyelids,
medial part of cheek and greater part of lower jaw.
3. Lower territory: It drains into submental group of
lymph nodes from area which includes central part
of lower lip and chin.
In internal acoustic meatus motor root lies in groove on ♦ Small accessory lacrimal glands are found in conjunctival
vestibulocochlear nerve with sensory root intervening. Here fornices.
facial nerve and vestibulocochlear nerve are accompanied by ♦ It is of J shaped and is indented by the tendon of levator
labyrinthine vessels. At fundus of meatus the two roots sensory palpabrae superioris.
and motor fuse to form a single trunk which lies in petrous ♦ It consists of two parts, i.e.
temporal bone. Within the canal the course of nerve is divided 1. An orbital part: It is large and deeper
by three parts by two of its bands. The first part is directed 2. A palpebral part: It is superficial and smaller lying
laterally above the vestibule and second part run backward in within the eyelid.
♦ Lacrimal gland consists of a dozen of ducts which pierce
relation to medial wall of middle ear above promontory and
conjunctiva of upper eyelid and open in conjunctival sac
third part is directed vertically downward behind promon-
near superior fornix.
tory. First bend at junction of first and second part is sharp
♦ Most of the ducts of orbital part pass through palpebral
and is known as genu. part.
Second bend lies between promontory and aditus to the ♦ It is supplied by lacrimal branch of ophthalmic artery.
mastoid antrum. Facial nerve leaves the skull by passing ♦ It secretes lacrimal fluid which flows in conjunctival sac
through stylomatoid foramen. where it lubricate the front of eye and deep surface of
eyelids.
Extracranial Course
Refer to Ans 7 of the same chapter.
For branches of facial nerve refer to Ans 7 of the same chapter.
For Bell s palsy refer to Ans 9 of the same chapter.
Q.17. Enumerate extracranial branches of facial nerve.
(Jan 2012, 2 Marks)
Ans. The extracranial branches of facial nerve are:
1. Temporal
2. Zygomatic
3. Buccal
4. Marginal mandibular
5. Cervical.
Q.18. Write briefly on bell’s palsy.
(Aug 2012, 5 Marks) (Apr 2007, 5 Marks)
Or
Write short note on bell s palsy. (Jan 2018, 5 Marks)
(Feb 2013, 5 Marks) (Feb 2016, 3 Marks)
Ans. Refer to Ans 9 of the same chapter. Fig. 27: Lacrimal apparatus Conjunctival
Q.19. Describe lacrimal apparatus and its nerve supply.
Sac
(Feb 2014, 4 Marks)
♦ Conjunctiva lining the deep surface of eyelids is known as
Or
palpebral conjunctiva and which lines the front of eyeball
Describe briefly lacrimal gland and its nerve supply. is bulbar eyeball.
(Nov 2008, 5 Marks) ♦ Potential space between palpebral and bulbar part is
Ans. Structures which are related to the secretion and drainage conjunctival sac.
of lacrimal gland forms the lacrimal apparatus. ♦ Lines at which the palpaberal conjunctiva of upper and
Lacrimal apparatus constitutes following parts, i.e. lower eyelids is reflected on eyeball are known as supe-
1. Lacrimal gland and its ducts rior and inferior conjunctival fornices.
2. Conjunctival sac ♦ Palpebral conjunctiva is opaque, thick and is vascular.
3. Lacrimal puncta and lacrimal canaliculi ♦ Bulbar conjunctiva covers the sclera and is thin, transparent
4. Lacrimal sac and is loosely attached to eyeball.
5. Nasolacrimal duct.
Lacrimal Puncta and Canaliculi
Lacrimal Gland
♦ Each single lacrimal canaliculus starts at the lacrimal
♦ Lacrimal gland is a serous gland which is situated chiefly punctum.
in lacrimal fossa on anterolateral part of roof of bony orbit ♦ It is 10 mm long.
and partly on the upper eyelid. ♦ A dilated ampulla is present at the bend.
Anatomy 19
wall (tympanic membrane). Here it crosses medial aspect of Ans. Intracranial Course of Facial Nerve
handle of malleus and lateral aspect of long process of incus. Facial nerve is attached to the brainstem by two roots,
At the anterior margin of tympanic membrane it enters anterior i.e. motor and sensory. Two roots of facial nerve are
canaliculus in the anterior wall of the middle ear and passes via attached to lateral part of lower border of pons which
canaliculus and emerges at the base of skull through medial is just medial to eighth cranial nerve. Two roots run
end of petrotympanic fissure. It then goes medially, forwards laterally and forward with eighth nerve to reach internal
and downwards, grooves the medial side of the spine of the acoustic meatus.
sphenoid, running anteroinferiorly deep to lateral pterygoid to
join the posterior aspect of the lingual nerve about 2 cm below
the base of the skull.
Distribution
♦ Chorda tympani nerve supplies secretomotor fibers to
submandibular and sublingual gland via submandibular
ganglion.
♦ It carries taste sensations from anterior 2/3rd of tongue.
Contd...
22 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Contd...
C. Posteriorly
1. Ligamentum nuchae
2. Spine of seventh cervical vertebrae
D. Anteriorly
1. Symphysis menti
2. Hyoid bone
Both above and below hyoid bone, it is continuous with
fascia of opposite side.
Other Features
1. The investing layer of deep cervical fascia splits to enclose
trapezius, sternomastoid, parotid, submandibular gland
and suprasternal and supraclavicular space.
2. It also forms pulleys to bind tendons of digastric and
omohyoid muscles.
Fig. 34: Vertical disposition of deep cervical fascia
24 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
(Aug 2012, 10 Marks)
Or
(Sep 2013, 5 Marks)
Or
(Feb 2016, 2 Marks)
Or (Oct 2016, 3 Marks)
Write a short note on carotid sheath.
(Sep 2017, 3 Marks) (Oct 2016, 3 Marks) Or
Or
Name the contents of carotid sheath.
(Aug 2018, 1 Mark) (Dec 2012, 4 Marks)
Ans. It is the condensation of the fibroareolar tissue around Ans. Boundaries of Posterior Triangle
main vessels of neck and vagus nerve. • Anterior: Formed by posterior border of sterno-
mastoid.
• Posterior: Formed by anterior border of trapezius.
• Inferior or base: Formed by middle 1/3 of clavicle.
• Apex: Lies on superior nucal line where the trapezius
and sternocleidomastoid meet.
• Roof: Roof is formed by the investing layer of deep
cervical fascia.
• Floor: Floor of posterior triangle is formed by
prevertebral layer of deep cervical fascia covering
the following muscles:
1. Splenius capitis
2. Levator scapulae
3. Scalenus medius
Fig. 35: Carotid sheath 4. Semispinalis capitis may also form part of floor.
Contd...
Relations
The sternocleidomastoid muscle is enclosed in the investing
layer of deep cervical fascia, and is pierced by the accessory
nerve and by the four sternocleidomastoid arteries. It has the
following relations.
Superficial Relations
♦ Skin
♦ Superficial fascia
Superficial lamina of the deep cervical fascia
Fig. 37: Contents of posterior triangle ♦ Platysma.
26 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦ External jugular vein and superficial cervical lymph nodes ♦ When both muscles contract together:
lying along the vein. They draw the head forwards, as in eating and in lifting
♦ Great auricular the head from a pillow.
Transverse or anterior cutaneous. With the longus colli, they flex the neck against
Medial supraclavicular nerves resistance.
Lesser occipital nerve It also helps in forced inspiration.
♦ The parotid gland overlaps the muscle.
Applied Anatomy
Deep Relations
♦ Torticollis or wry neck: It is a clinical condition in which
♦ Bones and joints:
head is bent to one side and chin points to opposite side.
Mastoid process above
This occur because of spasm of sternocleidomastoid and
Sternoclavicular joint below.
trapezius muscles.
♦ Carotid sheath
♦ Muscles: ♦ Sternomastoid tumor: It is the swelling in middle third of
Sternohyoid sternomastoid muscle due to edema and ischemic necrosis
Sternothyroid caused by the birth trauma.
Omohyoid
Three scaleni
Levator scapulae
Splenius capitis
Longissimus capitis
Posterior belly of digastric.
♦ Arteries:
Common carotid
Internal carotid
External carotid
Sternocleidomastoid arteries, two from the occipital
artery, one from the superior thyroid, one from the
suprascapular
Occipital
Subclavian
Suprascapular
Transverse cervical
♦ Veins:
Internal jugular
Fig. 39: Sternocleidomastoid muscle
Anterior jugular
Facial Q.5. Write a short note on external jugular vein.
Lingual (Oct 2016, 3 Marks) (Apr 2008, 5 Marks)
♦ Nerves: (Oct 2007, 5 Marks) (Mar 2009, 5 Marks)
Vagus Ans. It is a large vein present in superficial fascia under cover
Parts of IX, XI, XII of platysma muscle.
Cervical plexus
Upper part of brachial plexus
Phrenic
Ansa cervicalis
♦ Lymph nodes, deep cervical.
Blood Supply
Arterial supply is from one branch, i.e. each from superior
thyroid artery and suprascapular artery and two branches
from the occipital artery supply the big muscle. Veins follow
the arteries.
Actions
♦ When one muscle contracts:
It turns the chin to the opposite side.
It can also tilt the head towards the shoulder of same
side. Fig. 40: The external jugular vein
Anatomy 27
Investing Layer
This layer lies deep to platysma and surrounds neck like a collar.
It forms roof of posterior triangle of neck.
For more details refer to Ans 1 of the same chapter.
Pretracheal Layer
Importance of this fascia is that it encloses and suspends the
thyroid gland and forms its false capsule.
(Oct 2016, 2 Marks)
Prevertebral Fascia
Ans. Muscles forming the floor of posterior triangle of neck
are: It lies in front of prevertebral muscles and forms the floor of
Splenius capitis posterior triangle of neck.
Levator scapulae
Carotid Sheath
Scalenus medius
Semispinalis capitis It is a condensation of fibroareolar tissue around the main
Muscular floor of posterior triangle is covered by the vessels of neck. It is formed on anterior aspect by the pretracheal
prevertebral layer of deep cervical fascia which forms fascia and on posterior aspect by prevertebral fascia. Contents
first carpet of floor of posterior triangle of neck. are common or internal carotid arteries, internal jugular vein
Anatomy 29
Distribution
♦ Superior root: To the superior belly of omohyoid.
♦ Ansa Cervicalis: To sternohyoid, sternothyroid and Fig. 44: Branches of external carotid artery
inferior belly of omohyoid.
Q.4. Write a short note on lingual artery.
Diagram of Ansa Cervicalis (Aug/Sep 1998, 4 Marks)
Ans. The lingual artery arises from the external carotid artery
opposite the tip of the greater cornua of the hyoid bone.
This artery is tortuous in its course. Its course is divided
into three parts by the hyoglossus muscle:
1. First part lies in the carotid triangle. It forms a
characteristic upward loop which is crossed by the
hypoglossal nerve. The lingual loop permits free
movements of the hyoid bone.
2. Second part lies deep to the hyoglossus along the
upper border of hyoid bone. It is superficial to the
middle constrictor of the pharynx.
3. Third part is called the arteria profunda linguae,
or the deep lingual artery. It runs upwards along
the anterior border of the hyoglossus, and then
horizontally forwards on the undersurface of the
tongue as the fourth part.
In its vertical course, it lies between the genioglossus
Fig. 43: Ansa cervicalis medially and the inferior longitudinal muscle of the
tongue laterally. The horizontal part of the artery is
Q.3. Enumerate the branches of external carotid artery. accompanied by the lingual nerve.
(Mar 2000, 4 Marks) (Apr 2007, 3 Marks)
During surgical removal of tongue the first part of artery is
(Sep 2007, 3 Marks) (Feb 2013, 2 Marks) ligated before it gives any branch to tongue or to the tonsil.
Or
Name the branches of external carotid artery.
(Aug 2018, 1 Mark)
Ans. It gives off 8 branches which are:
A. Anteriorly
1. Superior thyroid artery.
2. Lingual artery.
3. Facial artery.
B. Posteriorly
1. Occipital artery.
2. Posterior auricular artery.
C. Medially
1. Ascending pharyngeal artery.
D. Terminally
1. Maxillary artery.
2. Superficial temporal artery. Fig. 45: Lingual artery
Anatomy 31
Anterior Branches
♦ Superior thyroid artery: It passes deep to three long
infrahyoid muscles to reach the upper pole of lateral lobe
of thyroid gland. Apart from its terminal branches to
thyroid gland, it gives one important branch, i.e. superior
laryngeal artery which pierces thyrohyoid membrane in
company with internal laryngeal nerve.
♦ Lingual artery: The lingual artery arises from the external
carotid artery opposite the tip of the greater cornua of the
hyoid bone. This artery is tortuous in its course. Its course
is divided into three parts by the hyoglossus muscle:
First part lies in the carotid triangle. It forms a
Fig. 46: Boundaries of digastric triangle characteristic upward loop which is crossed by the
hypoglossal nerve. The lingual loop permits free
Contents movements of the hyoid bone.
Second part lies deep to the hyoglossus along the
A. Anterior part of the triangle upper border of hyoid bone. It is superficial to the
1. Structures superficial to mylohyoid are: middle constrictor of the pharynx.
a. Superficial part of the submandibular salivary Third part is called the arteria profunda linguae, or the
gland. deep lingual artery. It runs upwards along the anterior
b. The facial vein and submandibular lymph nodes are border of the hyoglossus, and then horizontally
superficial to it and the facial artery is deep to it. forwards on the undersurface of the tongue as the
c. Submental artery. fourth part.
d. Mylohyoid nerve and vessels. In its vertical course, it lies between the genioglossus
2. Structures superficial to the hyoglossus are: medially and the inferior longitudinal muscle of the
a. Submandibular salivary gland tongue laterally. The horizontal part of the artery is
b. Intermediate tendon of the digastric and the accompanied by the lingual nerve.
stylohyoid ♦ Facial artery: It arises from the external carotid just above
c. Hypoglossal nerve. the tip of the greater cornua of the hyoid bone. It runs
32 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Carotid Sinus
Termination of common carotid artery or beginning of internal
carotid artery shows slight dilatation known as carotid sinus. In
carotid sinus, tunica media is thin, while the tunica adventitia
is thick and receives rich innervations from glossopharyngeal
and sympathetic nerves. Carotid sinus act as baroreceptor and
regulates blood pressure. (Apr 2008, 5 Marks)
Anatomy 35
Or External Features
The gland resembles a three-sided pyramid with apex directed
downwards. It presents the following features:
An apex which is directed downwards.
C. The superficial surface: It is the largest of all four surfaces Structures within Parotid Gland
and is covered with:
1. Arteries: External carotid artery enters gland through
Skin
posteromedial surface. Maxillary artery leaves gland
Superfacial facia containing anterior branches of through anteromedial surface. Superficial temporal artery
great auricular nerve, preauricular lymph node and give transverse facial artery and emerges at anterior part
posterior fibers of platysma and risorius. of superior surface.
Parotid fascia is thick and adherent to gland
Few deep parotid lymph nodes embedded in gland.
D. Anteromedial surface: It is grooved by posterior border
of ramus of mandible. It is related to:
Masseter
Lateral surface of temporomandibular joint
Medial pterygoid
Posterior border of ramus of mandible
Emerging branches of facial nerve.
Sensory Supply
Sensory nerves to gland come from the auriculotemporal nerve.
Parotid fascia is innervated by the sensory fibers of greater
auricular nerve.
38 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Relations
♦ Superiorly: Accessory parotid gland, upper buccal branch
of facial nerve and transverse facial vessels.
♦ Inferiorly: Lower buccal branch of facial nerve.
At the anterior border of masseter it turns medially and
pierces:
a. Buccal pad of fat. (June 2010, 15 Marks)
b. Buccopharyngeal fascia. Ans. For nerve supply refer to Ans 1 of same chapter.
c. Buccinator. For histology refer to Ans 17 and 18 of HISTOLOGY
Because of oblique course of duct through buccinator SECTION.
inflation of duct is prevented during blowing. The
duct run forwards for a short distance between the Structures within the Gland
buccinator and oral mucosa. Finally the duct turn Structures within the parotid gland from medial to lateral side
medially and opens in vestibule of mouth opposite
are:
the crown of upper second molar tooth.
1. Arteries: Refer to Ans 1 of same chapter
Q.4. Describe parotid under the following headings. (a) 2. Veins: Refer to Ans 1 of same chapter
Gross anatomy with nerve supply (b) Histology and 3. Facial Nerve: Refer to Ans 1 of same chapter.
Development (in brief). (Apr 2008, 8 Marks)
Q.8. Write very short answer on parotid duct opening.
Ans. For gross anatomy with nerve supply refer to Ans 1 of
the same chapter. For histology refer to Ans 17 and 18 (Aug 2018, 2 Marks)
of HISTOLOGY SECTION. Ans. Parotid duct pierces the buccinator muscle and then
opens into the oral cavity on the inner surface of cheek,
Development: The parotid gland is an elongated
usually opposite the maxillary second molar tooth.
furrow running dorsally from angle of mouth between
mandibular and maxillary prominences. Parotid papilla is a small elevation of tissue that marks
opening of the parotid duct on the inner surface of cheek.
The groove which is converted into a tube looses
its connection with the epithelium of mouth, except at
its ventral end, and grows dorsally into substance of
cheek. The tube persist as parotid duct and its blind 7. TEMPORAL AND
end proliferates in the local mesenchyme to form gland. INFRATEMPORAL REGION
Subsequently size of oral fissure is reduced by partial
fusion between maxillary and mandibular prominences
and duct opens thereafter on inside of cheek at some
distance from angle of mouth.
Q.5. Write in short on parotid gland. (Jan 2012, 5 Marks) (Apr 2010, 20 Marks)
Ans. Refer to Ans 1 of the same chapter. Or
Q.6. Describe parotid gland under following heading:
(Feb 2013, 10 Marks) (May/June 2009, 15 Marks)
a. Introduction Or
b. Capsule
c. Relations Describe muscles of mastication.
d. Development (Sep 2017, 10 Marks)
e. Histology Or
Anatomy 39
Muscles of mastication
Blood Nerve
Muscle Origin Course Insertion supply Relations supply Action
Masseter a. Superficial • Superficial a. Superficial It is • Superficially: Are Masseteric a. Elevates
It is layer: From fibers pass layer: Into supplied skin, platysma, nerve, mandible
quadrilateral anterior 2/3 of downward lower part by risorius, zygomaticus branch of to close the
in shape lower border of and of lateral masseteric major, and parotid anterior mouth to bite
and covers backward gland duct, facial division of
zygomatic arch surface of artery b. Superficial
lateral at 45° nerve and transverse mandilbular
and adjoining ramus of fibers cause
surface of • Middle facial vessels cross nerve
ramus of zygomatic fibers pass mandible the muscle protrusion
mandible. process of vertically b. Middle layer: • Medially: Temporalis
It has three maxilla downwards Into central and Mandibular
layers b. Middle layer: • Deep part of ramus ramus. Fat separates
From lower fibers pass of mandible it anteriorly from
border of vertically c. Deep layer: buccinator. The
posterior 1/3 of downwards Into rest of massetric nerve and
artery
zygomatic arch ramus of
• Posteriorly: Margin
c. Deep layer: From mandible is overlapped by the
deep surface of parotid gland, anterior
zygomatic arch margin projects over
buccinator and is
crossed below by
facial vein.
Contd...
40 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Contd...
Muscles of mastication
Blood Nerve
Muscle Origin Course Insertion supply Relations supply Action
Temporalis a. Temporal fossa Anterior fibers a. Margins and It is • Superficial: Skin, Two deep a. Elevates
It is fan b. Temporal fascia run vertically, deep surface supplied auricularis anterior temporal mandible
shaped middle fibers of coronoid by the and superior, branches b. Posterior
and fills obliquely process anterior temporal fascia, from fibers retract
temporal and posterior superficial temporal
b. Anterior and anterior protruded
fossa fibers vessels, auricular
border of posterior division of mandible
horizontally. temporal nerve,
All of them ramus of deep temporal branches mandibular c. Helps in
converge and mandible temporal of facial nerve, nerve side to side
pass through arteries zygomaticotemporal grinding
a gap deep which are nerve, apocranial movement
to zygomatic branches aponeuresis,
arch of the zygomatic arch and
internal masseter
• Medial: Temporal
maxillary
fossa, lateral
artery pterygoid, superficial
head of medial
pterygoid, a small
part of buccinator,
the maxillary artery
and its deep temporal
branches, deep
temporal nerves and
buccal nerve and
vessels
• Posterior: The
tendon, massetric
vessels and nerve
that traverse the
mandibular incisure.
Fat separates its
anterior border from
the zygomatic bone
Lateral a. Upper Fibers run a. Pterygoid It is Superficial A branch a. Depresses
pterygoid head: From backward and fovea on supplied • Masseter from mandible
It is short intratemporal laterally and the anterior by • Ramus of mandible anterior to open
and conical, surface and crest converge for surface pterygoid • Tendon of temporalis division of mouth with
it consists • Maxillary artery
of greater wing insertion of neck of branches mandibular suprahyoid
of upper Deep
of sphenoid bone mandible of nerve muscle
and lower • Mandibular nerve
b. Lower head: b. Anterior maxillary b. Lateral
heads • Middle meningeal
From lateral margin of artery artery and medial
surface of lateral articular disc • Sphenomandibular pterygoid
pterygoid plate. and capsule ligament protrude
Origin is medial of temporo- • Deep head of the mandible
to insertion mandibular medial pterygoid c. Left lateral
joint Structures Emerging pterygoid
c. Insertion is at the Upper Border and right
posterolateral • Deep temporal medial
nerves
and is at pterygoid
• Masseteric nerve
higher level turn the chin
Structures Emerging
than origin at the Lower Border to left side
• Lingual nerve as a part
• Inferior alveolar nerve of grinding
• The middle meningeal movement
artery passes
upwards deep to it
Contd...
Anatomy 41
Contd...
Muscles of mastication
Blood Nerve
Muscle Origin Course Insertion supply Relations supply Action
Structures passing
through the Gap
between two heads
• Maxillary artery
enters the gap
• Buccal branch of the
mandibular nerve
comes out via gap
Pterygoid plexus of
veins surrounds the
lateral pterygoid
Medial a. Superficial head: Fibers run Roughned It is Superficial and deep Nerve to a. Elevates
pterygoid From tuberosity downwards, area of medial supplied heads of medial medial mandible
It is of maxilla and backwards surface of angle by pterygoid enclose the pterygoid, b. Helps in
quadrilateral adjoining bone and laterally and adjoining pterygoid lower head of lateral branch of protruding
and has b. Deep head: ramus of branches pterygoid muscle. the main mandible
a small From medial mandible below of trunk of c. Right medial
Superficial relations
superficial surface of lateral and behind maxillary mandibular pterygoid
pterygoid plate mandibular artery The upper part of the nerve with left
and a large
and adjoining foramen and muscle is separated lateral
deep head
process of mylohyoid from the lateral pterygoid
palatine bone groove pterygoid muscle by: turn the chin
• Lateral pterygoid to left side
plate
• Lingual nerve
• Inferior alveolar
nerve.
Lower down the muscle
is separated from the
ramus of mandible
by the lingual and
inferior alveolar nerves,
maxillary artery, and
sphenomandibular
ligament.
Deep relations
The relations are:
• Tensor veli palatine
• Superior constrictor
of pharynx
• Styloglossus
• Stylopharyngeus
attached to the styloid
process.
Fig. 54: Masseter muscle (superficial layer) Fig. 55: Masseter muscle (deeper layer)
42 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Fig. 59: Branches of maxillary artery (For colour version see Plate 1)
♦ The articular tubercle ♦ Disc also distributes the weight across temporomandibular
♦ Anterior part of mandibular fossa joint by enhancing area of contact.
♦ Posterior non-articular part is formed by tympanic plate.
Relations of Temporomandibular Joint
Inferior articular surface is formed by the head of mandible.
Fibrocartilage covers the articular surfaces. ♦ Lateral: Skin and fasciae, parotid gland and temporal
Intra-articular disc divides joint cavity into upper and lower branches of facial nerve.
parts. ♦ Medial: Tympanic plate separates the joint from
internal carotid artery, spine of sphenoid with upper
Ligaments of Temporomandibular Joint end of sphenomandibular ligament attached to it,
auriculotemporal and chorda tympani nerves, middle
Following are the ligaments of temporomandibular joint: meningeal artery.
♦ Fibrous capsule: It is attached above the articular tubercle, ♦ Anterior: Lateral pterygoid, masseteric nerve and artery.
in front by circumference of mandibular fossa behind by ♦ Posterior: Parotid gland separates joint from external
squamotympanic fissure and below to neck of mandible. auditory meatus, superficial temporal vessels and
Above intra articular disc the capsule is loose and below auriculotemporal nerve.
it is tight. Synovial membrane lines the fibrous capsule ♦ Superior: Middle cranial fossa and middle meningeal
and neck of mandible. vessels.
♦ Lateral temporomandibular ligament: It reinforces and ♦ Inferior: Maxillary artery and vein.
provides strength to lateral part capsular ligament. Fibers
of ligament are directed downwards and backwards. Blood Supply
Ligament is attached above to articular tubercle and below It is supplied by the branches from superficial temporal and
to posterolateral aspect of ramus of mandible. maxillary arteries, veins usually follow arteries.
♦ Sphenomandibular ligament: This is an accessory
ligament which lies on deep plane away from fibrous Nerve Supply
capsule. The ligament is attached superiorly to spine of
Temporomandibular joint is supplied by the auriculotemporal
sphenoid and inferiorly to lingula of mandibular foramen.
nerve and masseteric nerve.
This is the remnant of dorsal part of Meckle s cartilage.
This ligament is related laterally to lateral pterygoid Lymphatic Drainage
muscle, auriculotemporal nerve and maxillary artery
while it is related medially to chorda tympani nerve Lymph from temporomandibular joint drains into:
and wall of pharynx. Near its lower end, it is pierced ♦ Superficial parotid nodes
by mylohyoid nerve and vessels. ♦ Deep parotid nodes
♦ Stylomandibular ligament: This is another accessory ♦ Upper deep cervical nodes.
ligament of joint. This ligament represents the thick part Movements of Temporomandibular Joint
of deep cervical fascia which causes the separation of
parotid and submandibular salivary glands. This ligament When temporomandibular joint of both the sides are in position
is attached above to lateral surface of styloid process and of rest, there exist a small free space between maxillary and
below to angle as well as adjacent part of posterior border mandibular teeth but lips are in contact. Various movements
of ramus of mandible. of mandible occur in this position.
Lower jaw can be depressed, elevated, protruded, retracted
Articular Disc and move from side to side due to movements of temporo-
♦ It is an oval fibrous plate which divides joint upper and mandibular joint.
lower compartments.
♦ Upper compartment leads to gliding movements and the Mechanism
lower compartment leads to both, i.e. rotatory as well as There are two basic movements which occur at temporoman-
gliding movements. dibular joint but with the help of muscles. Two basic movements
♦ Disc consists of concave convex superior surface and are gliding movement and rotational movement.
concave inferior surface. ♦ Upper meniscotemporal compartment of temporomandi-
♦ Periphery of articular disc gets attached to fibrous capsule. bular joint leads to gliding movements at the time of
♦ It also consists of an anterior extension, anterior thick protraction, retraction and chewing.
band, intermediate zone, posterior thick band and ♦ Lower meniscotemporal compartment permit rotation
bilaminar region which consists of venous plexus around two axis, i.e. transverse axis at the time of
♦ It prevents the friction between articulating surfaces. depression and elevation and vertical axis at the time of
♦ It act as a cushion and absorbs the shock. It also stabilizes side to side (chewing) movements.
the condyle by filling the space between articular surfaces. ♦ Movements occurring at temporomandibular joints are:
♦ Proprioceptive fibers present inside the disc regulate Depression (lowering of jaw to open the mouth):
movements of joint. During depression, head of mandible along with
Anatomy 45
articular disc glide forward in upper meniscotemporal pterygoids of each side. For e.g. chewing from left side is
compartment on both the sides by contraction of produced by right lateral pterygoid, right medial pterygoid
lateral pterygoid muscle. During same time head which pushes the chin over left side. Now left temporalis,
rotates forward underneath the articular disc due left massater chew food. Chewing over the right side
to contraction of suprahyoid muscles, i.e. digastrics involve left lateral pterygoid, left medial pterygoid, right
geniohyoid and mylohyoid. Gravity also provides temporalis and right massater.
help in opening the mouth.
Elevation (elevating of jaw to close the mouth): Applied Anatomy or Clinical Anatomy
At the time of elevation, movements take place in a ♦ Dislocation of mandible: During excessive opening of
reverse order to that take place in depression, i.e., first mouth or during a convulsion, the head of the mandible
head of mandible along with an articular disc glide of one or both sides may slip anteriorly into infratemporal
backward in the upper meniscotemporal compartment fossa due to which there is inability to close the mouth.
by temporalis, masseter, and medial pterygoid, and Reduction is done by depressing the jaw with thumb
then head rotates backward on the lower surface of placed on last molar teeth and at same time elevating the
the disc by posterior fibers of temporalis. chin.
Protrusion/protraction: In protrusion, mandibular ♦ Derangement of articular disc may result from any injury,
teeth move forward in front of maxillary teeth. In like overclosure or malocclusion which causes clicking and
this act, head of the mandible along with the articular pain during movements of jaw.
disc glide forwards in the upper meniscotemporal ♦ In operations on temporomandibular joint facial nerve
compartment on both sides by simultaneous action of as well as auriculotemporal nerve, branch of mandibular
medial and lateral pterygoids of both sides. division of trigeminal nerve should be preserved with care.
Retraction: In retraction, head of mandible along
with articular disc glide backwards in the upper
meniscotemporal compartment by the contraction of
posterior fibers of temporalis muscle and bring the
joint in the resting position. The retraction is assisted
by deep fibers of masseter, digastric, and geniohyoid
muscles. During end of this movement head of
the mandible comes to lie underneath the articular
tubercle.
Side-to-side (Chewing) movements: These move-
ments take place alternately in the right and
left temporomandibular joints. During chewing
movements, head of the mandible on one side glides
forwards along with the disc (as in protraction), but
the head of the mandible on the opposite side merely
rotates on the vertical axis. Due to which the chin
moves forwards and to one side, i.e. towards the side (Feb 2002, 10 Marks)
on which no gliding has taken place. In this movement,
the medial and lateral pterygoids of one side contract Or
alternatively with those of opposite sides.
Alternate movements of this kind on the two sides
result in side-to-side movements of the lower jaw. (Sep 2000, 18 Marks)
Muscles Producing Movements of Temporomandibular Joint Or
♦ Depression (opening of mouth): This is caused mainly by Describe mandibular nerve in detail.
lateral pterygoid. Digastric, geniohyoid and mylohyoid (Mar 2006, 15 Marks) (Nov 2008, 15 Marks)
muscles help when mouth is opened wide or against Or
resistance.
Describe mandibular nerve with its applied anatomy.
♦ Elevation: It is caused by medial pterygoid muscle of both
(Nov 2008, 5 Marks)
sides, masseter, and anterior, vertical and middle oblique
fibers of temporalis muscle. These are antigravity muscles.
♦ Protrusion: It is done by lateral and medial pterygoids
as well as superficial oblique fibers of massater muscle. (Apr 2008, 8 Marks)
♦ Retraction: It is carried out by posterior horizontal fibers
of temporalis and deep vertical fibers of massater.
♦ Lateral or side to side or chewing movements: It is
carried out by alternate contraction of medial and lateral (Apr 2007, 3 Marks)
46 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Nerve to Lateral Pterygoid ♦ During running inside the mandibular canal, the inferior
alveolar nerve gives off the branches that supply the lower
It runs with the buccal nerve and enters deep surface of both
teeth and gums.
heads of lateral pterygoid muscle which it supplies.
♦ Mental nerve emerges at the mental foramen and supplies
From Posterior Trunk to skin of chin and the skin as well as mucous membrane
of the lower lip. Its incisive branch supplies to labial aspect
Auriculotemporal Nerve of gums of canine and incisor teeth.
It arises by two roots which run backwards and encircle
the middle meningeal artery and unite to form a single Applied Anatomy
trunk. It continues backward between neck of mandible and ♦ A lesion at foramen ovale involves mandibular nerve and
sphenomandibular ligament above the maxillary artery. Behind causes paresthesia along the mandible, in mandibular teeth
the neck of mandible it turn upward and ascend on temple and side of the face. There is also paralysis of muscles of
behind superficial temporal vessels. mastication and loss of jawjerk reflex as the nerve supplies
♦ Auricular part of nerve supplies skin of tragus, upper both afferent and efferent limbs for jaw jerk reflex.
parts of pinna, external acoustic meatus and tympanic ♦ Motor part of mandibular nerve is tested clinically by
membrane. asking the patient to clench his teeth and then feeling for
♦ Temporal part supplies skin of temple contracting massater and temporalis muscle on two sides.
♦ In addition auriculotemporal nerve also suppliesparotid If massater of one side is paralyzed, jaw deviates to the
gland and temporomandibular joint. paralyzed side, on opening the mouth by action of normal
lateral pterygoid of opposite side. Activity of pterygoid
Lingual Nerve muscles is tested by asking the patient to move chin from
♦ It is one of the two terminal branches of the posterior side to side.
division of the mandibular nerve. ♦ In patients with the cancer of tongue pain radiates to ear and
♦ It is sensory to the anterior two-third of the tongue and to temporal fossa over the distribution of auriculotemporal
the floor of the mouth. nerve as both lingual and auriculotemporal nerves are
♦ However, the fibers of the chorda tympani (branch of facial branches of mandibular nerve. At times lingual nerve is
nerve) which is secretomotor to the submandibular and divided to relieve interactable pain. This can be done where
sublingual salivary glands and gustatory to the anterior the nerve lies in contact with mandible below and behind
two-third of the tongue are also distributed through the last molar tooth and is covered by mucous membrane.
lingual nerve.
Course and Relations
It begins just l cm below the skull. It runs first between the
tensor palati and lateral pterygoid, and then between the lateral
and medial pterygoids. About 2 cm below the skull it is joined
by the chorda tympani nerve. Emerging at the lower border of
the lateral pterygoid, the nerve runs downwards and forwards
between the ramus of the mandible and the medial pterygoid.
Next it lies in direct contact with the mandible, medial to the
third molar tooth. It soon leaves the gum and runs over the
hyoglossus deep to the mylohyoid. Finally it lies on the surface
of the genioglossus deep to the myelohyoid. Here it winds round
the submandibular duct and divides into its terminal branches.
Relations
♦ Medially: Internal carotid artery and posterior part of
(Sep 2005, 15 Marks) cavernous sinus
Ans. Extracranial Course ♦ Laterally: Middle meningeal artery
Both the roots pass through the foramen ovale and join ♦ Superiorly: Parahippocampal gyrus
to form the main trunk which lies in infratemporal fossa. ♦ Inferiorly: Motor root of the trigeminal nerve, greater
After a short course the main trunk divides into the small petrosal nerve, apex of petrous temporal bone and foramen
anterior and a large posterior division. lacerum.
For branches and distribution refer to Ans 4 of the same Associated Root and Branches
chapter. ♦ Central process of ganglion cells forms the large sensory
Q.7. Describe in brief the mandibular nerve. Add a note on root of trigeminal nerve which is attached to pons at its
trigeminal ganglion. (Sep 2006, 15 Marks) junction with middle cerebellar peduncle.
Ans. For mandibular nerve in brief refer to Ans 4 of the same ♦ Peripheral processes of the ganglion cells form three
chapter. divisions of the trigeminal nerve, i.e. ophthalmic, maxillary
and mandibular.
Trigeminal Ganglion ♦ Small motor root of trigeminal nerve attach to pons
superomedial to sensory root. It passes under the ganglion
♦ Trigeminal ganglion is the sensory ganglion of the fifth from medial to lateral side and joins the mandibular nerve
cranial nerve. at the foramen ovale.
♦ This ganglion is homologus with dorsal nerve root ganglia
of spinal nerves. Blood Supply
♦ It is made up of pseudounipolar nerve cells with a T ♦ Internal carotid artery
shaped arrangement of their processes. ♦ Middle meningeal artery
♦ The ganglion is crescentric or semilunar in shape with its ♦ Accessory meningeal artery
convexity directed anterolaterally. ♦ Meningeal branch of ascending pharyngeal artery.
The three divisions of trigeminal nerve emerges from
Applied Anatomy
this convexity.
The posterior concavity of the ganglion receives the Intractable facial pain due to trigeminal neuralgia or carcino-
sensory root of the nerve. matosis may be abolished by injecting alcohol into the ganglion.
Situation and Meningeal Relation Q.8. Write short note on parts of temporomandibular joint.
(Mar 2006, 5 Marks)
Trigeminal ganglion lies on the trigeminal impression over Ans. Temporomandibular (TMJ) joint has two types of parts:
anterior surface of petrous temporal bone near its apex. Here it 1. Bone or hard tissue parts
occupies a special space of dura matter known as trigeminal cave 2. Soft tissue parts.
or Meckel s cave. Two layers of dura are present below ganglion.
Cave is lined by pia arachnoid, so, the ganglion along with motor Bone or Hard Tissue Parts
root of the trigeminal nerve is surrounded by cerebrospinal fluid. The hard tissue parts of TMJ are:
Ganglion lies at depth of 5 cm from the preauricular point. ♦ Condyles of mandible: They are ovoid, convex processes
which are broader laterally and narrower medially.
Condyles are connected with the body of mandible by
narrow stalk on both the sides.
♦ Glenoid fossa of temporal bone: Articular surface
of temporal bone is situated on the inferior surface of
squamous part of the temporal bone. It articulates with
mandibular condyle and is known as glenoid fossa.
♦ Articular eminence: It binds mandibular fossa anteriorly
and form anterior root of zygomatic process.
Soft Tissue Parts
♦ Articular capsule: It is a thin part of dense cartilaginous
tissue which encloses joint cavity.
♦ Articular disc: It is a rough, oval, firm, thick plate of dense
fibrous cartilage which is located between condyle and
articulating surface of temporal bone. It divides joint into
superior and inferior compartments.
♦ Articular ligaments: TMJ has one major and three minor
Fig. 63: Relation of trigeminal ganglion ligaments. Temporomandibular is major ligament, while
50 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.13. Answer in brief on trigeminal neuralgia. Q.15. Name the branches of maxillary nerve.
(Feb 2016, 2 Marks) (Aug 2016, 2 Marks)
Ans. Trigeminal neuralgia is also known as Tic douloureux
Ans. Following are the branches of maxillary nerve:
or Fothergill s Disease.
• It is a clinical condition which is characterized Region Branches
by sudden paroxysmal attack of lancinating pain
In middle cranial fossa Meningeal branch
which lasts from few hours to several days which is
confined to the distribution of one or more divisions In pterygopalatine fossa • Ganglionic branches
of trigeminal nerve. • Zygomatic branches, i.e.
zygomaticotemporal and
It commonly starts in maxillary territory. zygomaticofacial (sensory branches)
It occurs more frequently on right side. • Posterior superior alveolar
• During attacks there is flushing of face, i.e. redness
In infraorbital canal • Middle superior alveolar
of the face. • Anterior superior alveolar
Q.14. Write short note on sphenomandibular ligament. On face Infraorbital branches, i.e. palpebral,
(Aug 2016, 3 Marks) labial and nasal branches (sensory
branches)
Ans. This is an accessory ligament which lies on deep plane
away from fibrous capsule.
The ligament is attached superiorly to spine of Q.16. Write short note on maxillary nerve.
sphenoid and inferiorly to lingula of mandibular (Apr 2017, 4 Marks)
foramen. Ans. Maxillary nerve is the second division of trigeminal is
This is the remnant of dorsal part of Meckle s
purely sensory.
cartilage.
This ligament is related laterally to: Course and Relations
– Lateral pterygoid muscle
– Auriculotemporal nerve This nerve arises from convex anterior border of trigeminal
– Maxillary artery ganglion and run forward in lateral wall of cavernous sinus
It is related medially to: below ophthalmic nerve. It leaves middle cranial fossa by
– Chorda tympani nerve passing via foramen rotundum. Maxillary nerve crosses upper
– Wall of pharynx. Near its lower end, it is pierced part of pterygopalatine fossa beyond which it continues as
by mylohyoid nerve and vessels. infraorbital nerve. In middle cranial fossa it gives off meningeal
Sphenomandibular ligament is an important branch. In pterygopalatine fossa the nerve is related to
landmark for administration of local anesthetic pterygopalatine ganglion and gives off ganglionic, posterior
during inferior alveolar nerve block. superior alveolar and zygomatic nerves.
52 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Insertion Stylohyoid
Both the heads meet at intermediate tendon which perforates Parotid gland with retromandibular vein
stylohyoid and is held by fibrous pulley to hyoid bone. Submandibular salivary gland and lymph nodes
Angle of mandible with medial pterygoid.
Nerve Supply
B. Deep relation:
a. Anterior belly by nerve to mylohyoid branch of trigeminal Transverse process of atlas with superior oblique and
nerve
rectus capitis lateralis
b. Posterior belly by facial nerve.
Internal carotid, external carotid, lingual, facial and
Action occipital arteries
♦ It depresses mandible when mouth is wide opened or against Internal jugular vein
the resistance; it is secondary to lateral pterygoid muscle. 10th, 11th and 12th cranial nerves
♦ It leads to elevation of hyoid bone. Hyoglossus muscle.
Insertion
(Sep 2000, 4 Marks) (Feb 2016, 3 Marks) ♦ Posterior fibers are inserted into the body of hyoid bone
Ans. This is a flat triangular muscle lying deep to the anterior ♦ Anterior and middle fibers are inserted into median raphae
belly of digastric. The right and left mylohyoid muscles between mandible and hyoid bone.
together form the floor of mouth, deep to anterior belly
of digastric. Nerve Supply
A. Superficial: The relations are mentioned in Ans 3 of the Q.6. Describe submandibular gland. Write a note on its
same chapter. secretomotor fibers. (Sep 2002, 10 Marks)
B. Deep:
Or
Inferior longitudinal muscle of tongue
Genioglossus Write a short note on secretomotor pathway for
Middle constrictor of pharynx submandibular salivary gland. (Sep 2000, 4 Marks)
Anatomy 55
Superficial Part
The part fills digastric triangle. It extends upward deep to
mandible upto mylohyoid line. It has inferior, lateral and medial
surfaces. The gland is partially enclosed between two layers of
deep cervical fascia.
Superficial layer of fascia cover the inferior surface of gland
and is attached to, base of mandible while the deeper layer Fig. 71 Relations of superficial surface as well as relations of
covers medial surface of gland and is attached to mylohyoid anterior part of medial surface
line of mandible.
♦♦ The medial surface: It is extensively divided to three parts:
1. Anterior part is related to mylohyoid muscle,
Relations of Superficial Part
submental branch of facial artery mylohyoid nerves
♦ The inferior surface: It is covered by: and vessels.
Skin 2. Middle part (intermediate part) is related to hyoglossus
Platysma muscle, styloglossus muscle, lingual nerve, submandibular
Cervical branch of facial nerve ganglion and hypoglossal nerve.
Deep fascia 3. Posterior part is related to styloglossus muscle,
Facial vein stylohyoid ligament, the glossopharyngeal nerve and
Submandibular lymph nodes. the wall of pharynx.
Deep Part ♦ Sensory fibers reach the ganglion through the lingual
nerve.
It lies deep to mylohyoid, and superficial to hyoglossus and
styloglossus. Posteriorly, it is continuous with superficial part
round the posterior border of mylohyoid. Anteriorly it extend
to posterior end of sublingual gland.
Name of
muscle Origin Insertion Nerve supply Action
Genioglossus Upper genial tubercle of • Upper fibers in tip of It is supplied It pulls up the root of tongue,
mandible tongue by hypoglossal approximate palatoglossal arches and
• Middle fibers into nerve closes the oropharyngeal isthumus.
dorsum
• Lower fibers in thyoid
bone
Mylohyoid Mylohyoid line of mandible • Posterior fibers: Body Nerve to • Pulls hyoid bone upwards and
of hyoid bone mylohyoid backward
• Middle and anterior • With other hyoid muscles, it fixes
fibers; median raphae, hyoid bone
between mandible and
hyoid bone
Buccinator • Upper fibers: From maxilla • Upper fibers: Straight Lower buccal • Puffing of the mouth and blowing
opposite to molar teeth to upper lip branches of • Flattens cheek against gums and
• Lower fibers: From mandible • Lower fibers: Straight facial nerve teeth
opposite to molar teeth to lower lip • Prevents accumulation of food inside
• Middle fibers: From • Middle fibers: Middle the vestibule
pterygomandibular raphe fibers decussate
Contd...
58 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Contd...
Name of
muscle Origin Insertion Nerve supply Action
Sternomastoid It takes origin from two heads: The muscle is inserted on: • Motor When one muscle contracts:
1. Sternal head: It takes origin • By a thick tendon supply is by • It turn the chin to opposite side
from upper and lateral part of into lateral surface of the spinal • It can also tilt the head towards the
manubrium sterni. mastoid process, from accessory shoulder of same side.
2. Clavicular head: It takes its tip to superior border nerve When both the muscles contract:
origin from medial 1/3 of • By thin aponeurosis • Branches
• They draw head forward, as in
superior aspect of clavicle. into lateral half of from ventral
eating and lifting the head from
It passes vertically upward superior nuchal line of rami of C2 are
pillow
deep to the sternal head occipital bone proprioceptive
• With longus colli they flex the neck
with which it unites to form a against resistance
fusion belly • It also gives help in forced respiration.
Relations
The Lobes
They are conical in shape and consists of:
Venous Drainage
Thyroid is drained by:
1. Superior thyroid vein: It emerges at upper pole and
accompanies superior thyroid artery. It ends in internal
jugular vein.
2. Middle thyroid vein: It emerges at middle of lobe and
enters internal jugular vein.
3. Inferior thyroid vein: It emerge at lower border of isthmus.
They form plexus in front of trachea and drain into left
brachiocephalic vein.
Lymphatic Drainage
♦ Lymph from the upper part of the gland reaches the
upper deep cervical lymph nodes either directly or via
prelaryngeal lymph nodes.
♦ Lymph from the lower part of the gland drains to lower
deep cervical lymph nodes directly and also through
pretracheal and paratracheal nodes.
Anatomy 61
Relations
A. Superficially: Sternomastoid, posterior belly of digastric,
superior belly of omohyoid, parotid gland, styloid process,
internal carotid artery and glossopharyngeal, vagus,
accessory and hypoglossal cranial nerves.
B. Posteriorly: Fig. 80: Tributaries of internal jugular vein
1. Transverse process of Atlas
2. Scalenus anterior ♦ The thoracic duct opens into the angle of union between
3. Cervical plexus left internal jugular vein and left subclavian vein.
4. First part of subclavian artery. ♦ In the middle of the neck the internal jugular vein
C. Medially: Internal carotid artery, common carotid artery, may communicate with the external jugular vein via
and vagus nerve. oblique jugular vein which run across anterior border of
sternocleidomastoid.
Tributaries
The tributaries of internal jugular vein are: Applied Anatomy
1. Inferior petrosal sinus ♦ Deep to lesser supraclavicular fossa, internal jugular
2. Common facial vein vein is very easily accessible for recording venous pulse
tracings. Vein can be cannulated by direct puncture
3. Lingual vein
in interval between sternal and clavicular head of
4. Pharyngeal vein
sternocleidomastoid muscle.
5. Superior thyroid vein ♦ During congestive cardiac failure or any other disease
6. Middle thyroid vein where the venous pressure is raised, internal jugular vein
7. Occipital vein. is markedly dilated and engorged.
62 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.3. Briefly describe cervical part of sympathetic chain. c. The external carotid branches forms a plexus around
(Mar 1998, 6 Marks) external carotid artery.
Ans. Cervical part of sympathetic chain, one on either side d. Pharyngeal branches take part in the formation of
of cervical part of vertebral column lies in front of pharyngeal plexus.
transverse processes of cervical of cervical vertebrae e. Left superior cervical cardiac branch goes to the superficial
and neck of first rib behind carotid sheath and in front cardiac plexus with right branch goes to deep cardiac
of prevertebral fascia. plexus.
Each trunk is continuous upwards into the cranial cavity
Branches of Middle Cervical Ganglion
as the internal carotid nerve accompanying the internal
carotid artery. Inferiorly, it becomes continuous with the a. Gray rami communication are given to ventral rami of 5th
thoracic part of the sympathetic chain at the neck of the and 6th cervical nerves.
lst rib. b. Thyroid branches accompany inferior thyroid artery to
The cervical part of sympathetic trunk does not thyroid gland. They also supply parathyroid gland.
receive the preganglionic fibers through white rami c. Tracheal and esopharyngeal branches.
communicates from the cervical segments of the spinal d. Middle cervical cardiac branches is the largest of
cord, but it does give gray rami communicantes to all the sympathetic cardiac branches. It goes deep to cardiac
cervical spinal nerves. Each trunk receives preganglionic plexus.
fibers from lateral horn cells of T1 to T4 spinal segments.
Theoretically, there should be eight sympathetic ganglia
corresponding to 8 cervical nerves, but due to fusion
there are three ganglia; superior, middle and inferior.
c. Anhydrosis, i.e. loss of sweating on that side of face. belly of digastric, facial vein, and internal jugular vein.
d. Anophthalmos, i.e. retraction of eyeball It is known as jugulodigastric node. It drains the lymph
e. Loss of ciliospinal reflex, i.e. pinching the skin on primarily from the palatine tonsil.
nape of neck does not produce dilatation of pupil. ♦ Lower group of deep cervical lymph nodes: One of the
Horner s syndrome can also be caused by a lesion within lymph nodes of this group lies above the intermediate
the CNS anywhere at or above the first thoracic segment tendon of omohyoid posterior to the internal jugular vein.
of spinal cord involving sympathetic fibers. It is known as jugulo-omohyoid lymph node. Since this
lymph node drains lymph primarily from the tongue, it is
Q.5. Write in brief on cervical lymph node. termed lymph node of the tongue. This node lies deep to
(Apr 2010, 5 Marks) sternocleidomastoid, and therefore, can be palpated only
Ans. if enlarged considerably.
Peripheral Lymph Nodes Some nodes of this group extend into the supraclavicular
fossa and are related to brachial plexus and subclavian
Peripheral lymph nodes are arranged in inner and outer circles
vessels. These are termed supraclavicular lymph nodes
♦ Outer circle: This is formed by lymph node groups which
(Virchow s lymph nodes). The left supraclavicular lymph
form pericervical or cervical collar at junction of head and
nodes are clinically important because they are common
neck and extends from chin in front to occiput behind. They
site of metastasis from malignant disease (cancer) of the
include submental, submandibular, superficial parotid,
stomach.
massater and occipital nodes. Outlying extensions of
lymph node groups of pericervical collar:
Facial nodes: These are extensions of submandibular
nodes and include:
– A small buccal node lying on the lateral surface
of the buccinator along the facial vein.
– A small mandibular node which is frequently
present where facial vessels cross the lower border
of the mandible.
– A small infraorbital node lying just below the
orbit.
Superficial cervical nodes: They are situated superficial
to sternomastoid (upper part) along the external
jugular vein. These are the extensions of parotid nodes.
Anterior cervical nodes: They are situated along
the anterior jugular vein. One member of this group
frequently lies in the suprasternal space (suprasternal
node). They are extensions of submental lymph nodes.
♦ Inner circle: The inner circle is formed by following lymph
node groups which lie deep to the investing layer of deep Fig. 82: Lymph nodes
cervical fascia:
Infrahyoid nodes: These lie in front of thyrohyoid Q.6. Write short note on styloid process.
membrane.
(May 2017, 3 Marks)
Prelaryngeal nodes: These are situated in front of the
Ans. Styloid process with the structures attached to it is known
conus elasticus or cricothyroid membrane.
Pretracheal lymph nodes: These lie in front of trachea as styloid apparatus.
below the isthmus of thyroid gland. • Structures attached to the process are stylohyoid,
styloglossus and stylopharyngeous muscles and
Deep Cervical Lymph Nodes stylohyoid and submandibular ligaments. The five
These lymph nodes lie along and around internal jugular vein, attachments resemble the reins of a chariot
some of them inside the carotid sheath and some on the surface Styloid process is a long, slender and pointed long
of sheath under cover of sternocleidomastoid. process projecting downwards, forwards and slightly
These deep cervical lymph nodes are divided into upper and medially from temporal lobe. It descends between
lower groups. the external and internal carotid arteries to reach the
♦ Superior or upper group of deep cervical lymph nodes: side of pharynx. It is interposed between the parotid
They lie above omohyoid muscle. One lymph node of this gland laterally and internal jugular vein medially.
group is situated below the posterior belly of digastric From anterior surface of styloid process the
between angle of the mandible and anterior border of the styloglossus muscle arises and is inserted inside of
sternocleidomastoid in the triangle formed by posterior tongue.
64 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
the skin covering the lower portion of the parotid form two bundles which pierce the duramater separately
gland. near hypoglossal canal. The nerve leaves the skull via
Deep cervical nodes are as follows: hypoglossal canal.
Jugulodigastric node sits posteroinferiorly to the jaw Extracranial Course: Hypoglossal nerve first lies deep
and drains the tonsils and the tongue. to the internal jugular vein and inclines between the
Jugulo-omohyoid node is found close to the internal jugular vein and internal carotid artery. It
omohyoid muscle and drains the tongue. crosses the vagus and reaches in front of it.
Q.11. Describe hypoglossal nerve under following heads: The nerve descends between the internal jugular vein
(Feb 2014, 3+3+2 Marks) and internal carotid artery in front of vagus deep to
a. Course the parotid gland, styloid process, posterior belly of
b. Branches the digastric. At the lower border of the posterior belly
c. Applied anatomy of the digastric, it curves forwards, crosses the internal
Ans. Course and external carotid arteries and the loop of the lingual
Intraneural course: Fibers pass forwards lateral to the artery. The nerve then passes deep to posterior belly of
medial longitudinal bundle, medial lemniscus and the digastric to enter the submandibular region.
pyramidal tract, and medial to the reticular formation The nerve then continues forwards on the hyoglossus
and olivary nucleus. Hypoglossal nerve is attached to the and genioglossus, deep to the submandibular gland and
anterolateral sulcus of medulla in between the pyramid the mylohyoid muscle and enters the substance of the
and the olive, by 10 to 15 rootlets. These rootlets run tongue to supply all its intrinsic muscles and most of its
laterally behind the vertebral artery, and they join to extrinsic muscles.
Contents
First part of vertebral artery
Cervical part of sympathetic chain.
Relations
Anteriorly: Carotid sheath with common carotid artery,
vertebral vein, inferior thyroid artery and thoracic duct on
left side.
Posterior: Transverse process of C7 vertebrae, stellate
ganglion and ventral rami of C7 and C8 nerves.
b. Second part of vertebral artery: It runs through foramina
transversaria of upper six cervical vertebrae. Its course
is vertically upto axis vertebrae. It then run upward and
laterally to reach foramen transversarium of atlas vertebrae.
Relations:
1. Ventral rami of nerves C2-6 lie posterior to vertebral
artery.
Fig. 87: Course and parts of vertebral artery 2. The artery is accompanied by venous plexus and by
large branch from stellate ganglion.
c. Third part of vertebral artery: This part lies in suboccipital
Parts of Vertebral Artery triangle emerging from foramina transversarium of atlas,
Artery is divided into four parts as follows: the artery winds medially round the posterior aspect of
a. First part of vertebral artery: It extends from origin of lateral mass of atlas. It runs medially lying on the posterior
artery to the transverse process of 6th cervical vertebrae. arch of this bone and enter vertebral canal by passing
This part of artery run upward and backward in triangular deep to lower arch margin of posterior atlanto-occipital
space between scalenus anterio and longus colli muscles membrane.
known as scalenovertebral triangle. Relations
Scalenovertebral triangle Anteriorly : Lateral mass of atlas
It is present at the root of neck. Posteriorly : Semispinalis capitis
Boundaries Laterally : Rectus capitis lateralis
Medial: Lower oblique part of longus colli Medial : Ventral ramus of 1st cervical nerve
Lateral: Scalenus anterior Inferior : Dorsal ramus of C1 nerve
Apex: Transverse process of C6 vertebrae Posterior arch of atlas.
Base: First part of subclavian artery d. Fourth part:
Posterior wall: Transverse process of C7, ventral It extends from posterior atlanto-occipital membrane
ramus of C8 nerve, neck of first rib and cupola pleurae to lower border of pons
Anatomy 69
In vertebral canal, it pierces dura and arachnoid, Posterior inferior cerebellar artery
and ascends in front of root of hypoglossal nerve. Medullary arteries.
As it ascends, it inclines medially to reach the front Development of vertebral artery
of medulla. At lower border of pons, it unites with First part: From branch of dorsal division of 7th
its fellow of contralateral side to form basilar artery. cervical intersegmental artery
Branches of vertebral artery: First part gives off no Second part: From postcostal anastomosis
branches. Third part: From spinal branch of first cervical
Cervical branches intersegmental artery
Spinal branches from second part enter vertebral canal Fourth part: From preneural branch of first cervical
via intervertebral foramina and supply spinal cord, intersegmental artery.
meninges and vertebrae. Q.3. Write on origin, insertion, nerve supply and action of
Muscular branches arise from third part and supply prevertebral muscle in tabular form.
suboccipital muscles. (Apr 2007, 15 Marks)
Cranial branches Ans. Prevertebral muscles are:
These branches originate from fourth part: 1. Longus colli
Meningeal branches 2. Longus capitis
Posterior spinal 3. Rectus capitis anterior
Anterior spinal artery 4. Rectus capitis lateralis.
(Apr 2007, 4 Marks)
Ans. Superior aspect of each lateral mass shows an elongated
concave facet which articulates with corresponding
condyle of occipital bone to form atlanto-occipital
bone.
• Main movement is flexion with a little lateral flexion
and rotation. Flexion is caused by longus capitis and
rectus capitis anterior.
Extension is caused by recti capitis posterior major
and minor, obliques capitis superior, semispinalis
capitis, splenius capitis and upper part of trapezius.
Lateral bending is caused by rectus capitis,
semispinalis capitis, splenius capitis, sternoclei-
domastoid and trapezius.
Fig. 89: Prevertebral muscles
70 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Ans. In its upper part, scalenus anterior get separated from longus
capitis by ascending cervical artery.
Scalenus Anterior Muscle
Q.7. Write very short answer on phrenic nerve.
♦ Origin: Orignates from anterior tubercles of transverse (Apr 2018, 2 Marks)
process of cervical vertebrae 3, 4, 5 and 6. Ans. Phrenic nerve is basically a mixed nerve which carries
♦ Insertion: Scalene tubercle and adjoining ridge on superior motor fibers to diaphragm and sensory fibers from
surface of the first rib. diaphragm, pleura, pericardium as well as part of
♦ Nerve supply: Ventral rami of nerves C4, 5 and 6. peritoneum.
Origin
It arises from ventral rami of third, fourth and fifth cervical
vertebrae but chiefly from fourth cervical vertebrae.
Roof:
11. BACK OF THE NECK 1. Medially: Dense fibrous tissue covered by semi-
spinalis capitis.
2. Laterally: Longissimus capitis and occasionally
(April 2003, 10 Marks) splenius capitis
Or Floor: It is formed by:
Write short note on contents and boundaries of 1. Posterior arch of atlas.
suboccipital triangle. (Aug 2018, 5 Marks) 2. Posterior atlanto-occipital membrane.
Ans. Boundaries of Suboccipital Triangle
Contents of Suboccipital Triangle
Superomedially: Rectus capitis posterior major muscle
supplemented by the rectus capitis posterior minor. 1. Third part of vertebral artery.
Superolaterally: Superior oblique capitis muscle. 2. Dorsal ramus of nerve C1-suboccipital nerve.
Inferiorly: Inferior oblique capitis muscle. 3. Suboccipital plexus of veins.
Communication
♦ The cavernous sinus drains into transverse sinus through
superior petrosal sinus.
♦ Cavernous sinus drains into internal jugular vein through
inferior petrosal sinus and through plexus around internal
carotid artery.
♦ Cavernous sinus drains into pterygoid plexus of veins
through emissary veins.
♦ Cavernous sinus drains into facial vein through superior Fig. 94: Superior saggital sinus
ophthalmic vein. It begins anteriorly at cristae galli by union of tiny
♦ The right and left cavernous sinus communicate with meningeal vessels, there it communicates with veins
each other through anterior and posterior inter cavernous of frontal sinus and occasionally with veins of nose.
sinuses and through basilar plexus of veins. As the sinus run upwards and backwards, it becomes
All the above communications are valueless and blood can flow progressively larger in size. It is triangular in cross-
via them in either direction. section. It ends near internal occipital protuberance
Anatomy 75
Relations
♦ Superiorly: Diaphragma sellae, optic chiasma, tuber
cinerium and infundibular recess of IIIrd ventricle.
♦ Inferiorly: Irregular venous channels between two layers
of dura mater lining the floor of hypophyseal fossa,
sphenoidal air sinus and hypophyseal fossa.
♦ On each side: Cavernous sinus with its contents.
Subdivisions
The gland has two main parts which differ morphologically,
embryologically and anatomically. The two parts are:
♦ Adenohypophysis:
It consists of the following parts:
Anterior lobe or pars anterior, pars distalis or pars
glandularis: This is the largest part of gland.
Intermediate lobe or pars intermedia: This is in the
form of thin strip which is separated from anterior
lobe by intraglandular cleft.
Tuberal lobe or pars tuberalis: It is an upward
extension of anterior lobe that surrounds and forms
the part of infundibulum.
♦ Neurohypophysis:
Posterior lobe: It is smaller than anterior lobe and lies
in the posterior concavity of larger anterior lobe.
Infundibular stem: It contains neural connections of
posterior lobe with hypothalamus.
Median eminence of tuber cinereum which is
continuous with infundibular stem.
Blood Supply
Arterial Supply
♦ The hypophysis cerebri is supplied by the following
Fig. 97: Parts of hypophysis cerebri in saggital section branches of internal carotid artery:
76 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Superior hypophyseal artery on each side. Q.8. Write short note on tentorium cerebelli.
Inferior hypophyseal artery. (Aug 2012, 5 Marks) (Nov 2008, 5 Marks)
♦ Each superior hypophyseal artery supplies to the ventral Ans. Tentorium cerebelli is a tent shaped fold of dura mater
part of hypothalamus, upper part of infundibulum, lower which form roof of posterior cranial fossa.
part of infundibulum via separate descending branch It separates cerebellum from occipital lobes
known as trabecular artery. of cerebrum and divides cranial cavity into
♦ Each inferior hypophyseal artery divides into medial and supratentorial and infratentorial compartments.
lateral parts which join to form arterial ring, the branches Infratentorial compartment is the posterior cranial
from ring supply to posterior lobe. fossa consisting of hindbrain and lower part of
♦ Anterior lobe is supplied by portal vessels arising from the midbrain.
capillary tufts which is formed by superficial hypophyseal Tentorium cerebelli consists of free margin as well
arteries. Long portal vessels drain median eminence and as an attached margin. Anterior free margin is of U-
upper infundibulum while the short portal veins drain shaped and is free. Ends of ‘U’ are attached anteriorly
lower infundibulum. to anterior clinoid processes. Anterior margin
bounds to tentorial notch which is occupied by the
Venous Drainage midbrain as well as the anterior part of superior
vermis.
Short veins emerge on surface gland and drain into neighbouring
Outer or attached margin is convex and post-
venous sinuses. Hormones pass out of gland via venous blood
erolaterally and it is attached to lips of transverse
and carried to their target cells.
sulci on the occipital bone and on the posteroinferior
Applied Anatomy angle of parietal bone. Anterolaterally, it is attached
to superior border of the petrous temporal bone and
Pituitary tumors give rise to two main categories of symptoms: to posterior clinoid processes. Along the attached
A. General Symptoms: These are caused due to pressure over margin, there are the transverse and superior
surrounding structures. The symptoms are: petrosal venous sinuses.
Sella turcica is enlarged in size. Trigeminal or Meckel s cave is a recess of dura mater
Pressure over optic chiasma causes bitemporal which is present in relation to attached margin of
hemianopia. tentorium. Trigeminal cave is formed by evagination
Pressure over hypothalamus causes hypothalamic of the inferior layer of tentorium over the trigeminal
syndromes. impression on petrous temporal bone. It consists of
A large tumor may press upon the third ventricle trigeminal ganglion.
causing rise in intracranial pressure. • Free and attached margins of the tentorium cerebelli
B. Specific symptoms: These symptoms depend on the type cross each other near the apex of the petrous
of cell tumor temporal bone. Anterior to point of crossing, there
Acidophil adenoma causes acromegaly in adults and is presence of triangular area which forms posterior
gigantism in younger patients. part of roof of cavernous sinus, this is pierced by
Basophil adenoma causes Cushing s syndrome. third and fourth cranial nerves.
Chromophobe adenoma causes effects of hypo- Tentorium cerebelli consists of two surfaces i.e
superior surface and inferior surface.
pituitarism.
Superior surface is convex and it slopes to either side
Posterior lobe damage causes diabetes insipidus.
from median plane. Falx cerebri is attached to this
Q.6. Describe pituitary gland under following heads: surface in the midline; the straight sinus lies along
(Dec 2010, 4 + 4 Marks) the line of this attachment. Superior surface is related
a. Gross anatomy to the occipital lobes of the cerebrum.
b. Microscopic anatomy • Inferior surface is concave and fits to convex superior
Ans. For gross anatomy refer to Ans 5 of the same chapter. surface of cerebellum. Falx cerebelli is attached to its
posterior part.
For microscopic anatomy refer to Ans 19 of SECTION
HISTOLOGY. Venous sinuses enclosed in the tentorium cerebelli on
each side are:
Q.7. Enumerate dural venous sinuses. Describe cavernous a. Transverse sinus—Lies within the posterior part of
sinus and give its applied anatomy. the attached margin.
(Dec 2012, 2+4+2 Marks) b. Superior petrosal sinus—Present within the
Ans. For enumeration refer to Ans 2 of the same chapter. anterolateral part of the attached margin.
For description of cavernous sinus along with applied c. Straight sinus—Present along the line of attachment
anatomy refer to Ans 3 of the same chapter. between falx cerebri and tentorium cerebelli.
Anatomy 77
Q.9. Write short note on Meckel’s cave. (Nov 2009, 5 Marks) • The cephalic part of anterior lobe persists as the pars
Ans. Meckel s cave is also known as trigeminal cave or cavum tuberalis.
trigeminale. • Sometimes the stomodeal end of the pouch invades
It is an arachnoidal pouch containing cerebrospinal fluid. the roof of the nasopharynx and persists as the
It is formed by two layers of dura mater which are part pharyngeal hypophysis.
of an evagination of the tentorium cerebelli near the apex
of the petrous part of the temporal bone.
It envelops the trigeminal ganglion.
It is bounded by the dura overlying four structures:
1. Superolaterally: The cerebellar tentorium
2. Superomedially: The lateral wall of the cavernous
sinus
3. Medially: The clivus
4. Inferolaterally: The posterior petrous face.
Q.10. Write a short note on Rathke s Pouch.
(Dec 2010, 5 Marks)
Ans. • Anterior pituitary develops from a diverticulum that Fig. 100: Development of anterior and posterior lobe of pituitary
evaginates from the roof of the stomodeum in front of
the buccopharyngeal membrane. This diverticulum
is known as the Rathke s pouch.
• Rathke’s pouch extends up to the floor of the fore
brain vesicle.
• The Rathke s pouch separates from the stomatodeum
by the second month due to growth of the
surrounding mesenchyme.
• The cells covering the anterior wall of the pouch
gives rise to anterior lobe of pituitary.
• The posterior wall of the pouch forms the par
intermedia.
• Cavity of the pouch persists as the intraglandular
cleft. Fig. 101: Rathke’s pouch
78 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.11. Write about branches of internal carotid artery. which enters pterygoid canal and anastomose with greater
(Dec 2009, 5 Marks) palatine artery.
Ans. Internal carotid artery starts in the neck as terminal
branch of common carotid artery. It is divided into four Cavernous Part
parts which gives off its branches. In the cavernous sinus it gives off cavernous branch to trigeminal
ganglion and superior and inferior hypophyseal branches to
Cervical Part
hypophysis cerebri.
It lies in the carotid sheath. It does not give any branch.
Cerebral Part
Petrous Part
It lies at base of the brain after emerging from cavernous sinus.
It is the part of temporal bone. It gives off caroticotympanic It gives off ophthalmic, anterior cerebral, middle cerebral,
branches which enter middle ear and artery of pterygoid canal posterior communicating and anterior choroidal branches.
Voluntary muscles
Muscle Origin Insertion Nerve supply Action
Voluntary muscle Four recti arise from Recti are inserted into sclera little All recti are a. Superior rectus: At vertical
1. Four recti a common annular posterior to limbus supplied by axis it elevates; At horizontal
a. Superior rectus tendon or tendinous oculomotor axis it adducts and at
b. Inferior rectus ring of zim. Ring is nerve except anteroposterior axis it rotates
c. Lateral rectus attached to middle lateral rectus medially (intorsion)
d. Medial rectus part of superior which is supplied b. Inferior rectus: At vertical
orbital fissure. Lateral by abducent axis it depresses; At
rectus consists of an nerve horizontal axis it adducts
additional tendinous and at anteroposterior axis it
head which arises rotates laterally (extorsion)
from orbital surface c. Lateral rectus: At horizontal
of greater wing of axis it abducts
sphenoid bone lateral d. Medial rectus: At horizontal
to tendinous ring axis it adducts
2. Two oblique muscle a. It is arises from a. It is inserted into sclera behind a. It is supplied a. Superior oblique: At
a. Superior oblique undersurface equator of eyeball between by trochlear vertical axis it depresses;
b. Inferior oblique of lesser wing superior and lateral rectus. nerve At horizontal axis it abducts
of sphenoid, b. It is inserted close. It is supplied b. It is supplied and at anteroposterior axis it
superomedial to by superior oblique a little below by oculomotor rotates medially (intorsion)
optic canal. and posterior to later nerve b. Inferior oblique: At vertical
b. It arises from the axis it elevates; At horizontal
orbital surface of axis it abducts and at
maxilla, lateral to anteroposterior axis it rotates
lacrimal groove laterally (extorsion)
3. Levator palpebrae It arises from the The flat tendon of levator splits It is supplied by It elevates the upper eyelid.
superioris orbital surface into superior and inferior lamella the oculomotor
of lesser wing of superior is inserted to anterior nerve
sphenoid, antero- surface of superior tarsus and skin
superior to optic canal of upper eyelid.
and origin to superior Inferior lamella is inserted to upper
rectus margin of superior tarsus and in
superior conjunctival fornix
Involuntary Muscles
♦ To pretectal nuclei of both sides for light reflex Q.3. Write a short note on ciliary ganglion.
♦ To fourth, sixth and eighth nerve nuclei by medial (Sep 2001, 4 Marks)
longitudinal bundle for coordination of eye movements. Ans. This is a peripheral parasympathetic ganglion placed in
♦ To tectobulbar tract for visuoprotective reflexes. course of oculomotor nerve.
Course and Distribution Location
♦ In its intraneural course, fibers arise from the nucleus and It lies near apex of orbit between the optic nerve and tendon of
pass ventrally via tegmentum, red nucleus and substantia lateral rectus muscle.
nigra.
♦ At the base of brain, nerve get attached to oculomotor Roots
sulcus on medial side of crux cerebri. It has motor, sensory and sympathetic roots. Three roots enter
♦ Nerve passes between superior cerebellar and posterior its posterior end which is as follows:
cerebral arteries and run forward in interpeduncular
♦ The motor or parasympathetic root arises from nerve to
cistern to reach cavernous sinus.
inferior oblique. It consists of preganglionic fibers which
♦ Now, the nerve enters cavernous sinus by piercing the
begin in Edinger-Westphal nucleus. The fibers relay in
posterior part of its roof over lateral side of posterior
ciliary ganglion. Postganglionic fibers arising in ganglion
clenoid process. It descends into lateral wall of sinus where
pass through short ciliary nerves and supply sphincter
it lies above the trochlear nerve. In anterior part of sinus, papillae muscles and ciliaris muscle. These intraocular
nerve divides into superior and inferior division. muscles are used in accommodation.
♦ Both divisions of nerve enter orbit via middle part of ♦ The sensory root comes from nasociliary nerve. It consists
superior orbital fissure. Inside the fissure, nasociliary nerve of sensory fibers from eyeball. The fibers do not relay in
lies in between both the divisions but abducent nerve lies ganglion.
inferolateral to both divisions. ♦ The sympathetic root is branched from internal carotid
♦ Inside the orbit, small upper division descends over lateral plexus. It contains postganglionic fibers arising in superior
side of optic nerve supplies the superior rectus and levator cervical ganglion which pass along internal carotid,
palpebrae superioris. Larger lower division divides into ophthalmic and long ciliary arteries. They pass out of ciliary
three branches of medial rectus, inferior rectus and inferior ganglion without relay in short ciliary nerves to supply
oblique. Nerve to inferior oblique is the longest and gives blood vessels of eyeball. They also supply to dilator papillae.
off parasympathetic root to ciliary ganglion and then it
supplies inferior oblique muscle. Branches
♦ All branches enter the muscles on their ocular surfaces
The ganglion gives off 8 to 10 short ciliary nerves which divides
except that for inferior oblique which enters from its
in 15 to 20 branches and then pierce sclera around entrance of
posterior border.
optic nerve. They consist of fibers from all three roots of ganglion.
Applied Anatomy
♦ Complete and total paralysis of oculomotor results in:
Ptosis, dropping of upper eyelid.
Lateral squint.
Dilatation of pupil.
Loss of accommodation
Diplopia, double vision
Slight proptosis.
♦ A midbrain lesion causing contralateral hemiplegia and
ipsilateral paralysis of oculomotor nerve known as Weber s
syndrome.
♦ Supranuclear paralysis of 3rd nerve causes loss of
conjugate movement of eye.
♦ Ptosis or dropping of upper eyelid because of paralysis
of voluntary part of levator palpabrae superioris muscle.
♦ In an affected eye pupillary light reflex is absent.
♦ Because of paralysis of parasympathetic fibers to sphincter
papillae muscle there occurs dilatation of pupil.
♦ Compression of oculomotor nerve: Due to extradural
hematoma, compression of oculomotor nerve leads to
dilatation of pupil. Parasympathetic fibers which lie
superficially get affected first. Pupil dilates over affected Fig. 106: Ciliary ganglion and its roots
side and there is little response to light. (For colour version see Plate 2)
Anatomy 83
Q.4. Write short note on nasociliary nerve. numerous labial and buccal glands situated
(Sep 2011, 5 Marks) in submucosa of lips and cheeks open into
Ans. It is one of the terminal branches of ophthalmic division vestibule. Four and five molar glands situated on
of trigeminal nerve. buccopharyngeal fascia open inside the vestibule.
Nasociliary nerve begins in the lateral wall of anterior Except for the teeth, the entire vestibule is lined
part of cavernous sinus. It enters orbit via middle part by mucous membrane. Mucous membrane form
of superior orbital fissure between two divisions of median folds which pass from lips to gums and is
oculomotor nerve. It crosses above the optic nerve from called as frenula of lips.
lateral to medial side along with ophthalmic artery and Applied Anatomy
runs along medial wall of orbit between superior oblique
and medial rectus. It ends at anterior ethmoidal foramen by ♦ Papilla of parotid duct inside the vestibule of mouth gives
dividing into anterior ethmoidal and infratrochlear nerves. access to parotid duct for injection of radiopaque dye to
locate calculi in ductal system or gland.
Branches ♦ Koplik s spot are seen as white pin point spots around the
♦ Sensory communicating branch to the ciliary ganglion opening of parotid duct in measles which are diagnostic
form sensory root of ganglion. Often, it is mixed with of the disease.
sympathetic root. Q.2. Write short note on gums. (Apr 2010, 5 Marks)
♦ Long ciliary nerves: They are 2 or 3 in number. These run Ans. It is also known as gingiva.
on medial side of optic nerve, pierce sclera and supply Gums are soft tissue which envelope the alveolar process
sensory nerve to cornea, iris and ciliary body. These nerves of upper and lower jaws and surround neck of teeth.
also carry sympathetic nerve to dilator pupillae.
Each gum has two parts:
♦ Posterior ethmoidal nerve: This passes through posterior
a. Free part surrounds the neck of the tooth like a collar.
ethmoidal foramen and supplies the ethmoidal and
b. Attached part is firmly fixed to the alveolar arch
sphenoidal air sinuses.
♦ Anterior ethmoidal nerve: This is the larger terminal of jaw. Fibrous tissue of gums is continuous with
branch of nasociliary nerve. It leaves orbit by passing periosteum lining the alveoli.
through anterior ethmoidal foramen. It appears for very Nerve Supply
short distance in anterior cranial fossa over the cribriform
plate of ethmoid. It then descends into the nasal cavity by ♦ Labial part of upper gums is supplied by posterior, middle
passing through a slit at the side of anterior part of crista and anterior superior alveolar nerves.
galli. Inside the nasal cavity the nerve lies deep to nasal ♦ Lingual part of upper gums is supplied by anterior palatine
bone. It gives off two internal nasal branches medial and and nasopalatine nerves.
lateral to mucosa of nose. Finally it emerges at lower border ♦ Labial part of lower gums is supplied by buccal branch of
of the nasal bone as external nasal nerve which supply to mandibular and incisive branch of mental nerve.
skin of lower half of nose. ♦ Lingual part of lower gums is supplied by lingual nerve.
♦ Infratrochlear nerve: This is the smaller terminal branch of
Lymphatic Drainage
nasociliary nerve which is given off at anterior ethmoidal
foramen. This nerve emerges from orbit below trochlea Lymphatics of upper gum pass to submandibular nodes.
for tendon of superior oblique and appears on face above The anterior part of lower gum drains into submental nodes,
medial angle of eye. It supplies to conjunctiva, lacrimal whereas posterior part drains into the submandibular nodes.
sac and caruncle, medial end of eyelid and upper half of
Q.3. Enumerate the muscles of palate. (Sep 2000, 4 Marks)
external nose.
Or
Enumerate muscles of soft palate. (Feb 2002, 2 Marks)
14. THE MOUTH AND PHARYNX (Sep 2017, 2 Marks)
Anterior surface is concave and is marked by median ♦ Special sensory or gustatory nerves carry taste sensations
raphe. from oral surface and are contained in lesser palatine nerves.
Posterior surface is convex and is continuous Fibers travel via greater petrosal nerve to geniculate ganglion
superiorly with the floor of nasal cavity. of facial nerve and from here to nucleus of tractus solitaries.
• Superior border is attached to the posterior border ♦ Secretomotor nerves are present in lesser palatine nerves.
of hard palate blending on each side with pharynx
Blood Supply
Inferior border is free and is bound to oropharyngeal
isthmus. From its middle there hangs a conical Arterial Supply
projection known as uvula. From each side of base of a. Greater palatine branch of maxillary artery.
uvula two curved folds of mucous membrane extend b. Ascending palatine branch of facial artery.
laterally and downwards. The anterior fold is called c. Palatine branch of ascending pharyngeal artery.
as palatoglossal arch or anterior pillar of fauces. It
consists of palatoglossus muscle and reaches the Veins
side of tongue at junction of its both oral as well They pass to pterygoid and tonsillor plexus of veins.
as pharyngeal parts. This fold creates the lateral
boundary of oropharyngeal isthmus or isthmus of Lymphatics
fauces. Posterior fold is known as palatophryngeal It drains to upper deep cervical and retropharyngeal lymph nodes.
arch or posterior pillar of fauces. It consists of
palatopharyngeous muscle. It leads to the formation Applied Anatomy
of posterior boundary of tonsillar fossa and merges ♦ Paralysis of muscles of soft palate due to lesion of vagus
inferiorly with the lateral wall of pharynx. nerve produces
Nasal regurgitation of liquids
Structure of Soft Palate Nasal twang in voice
Soft palate is a fold of mucous membrane which consists of Flattening of the palatal arch on the side of lesion
following parts: Deviation of uvula opposite to the side of lesion.
♦ Palatine aponeurosis: It is the flattened tendon of tensor veli ♦ Cleft palate is a congenital defect caused by non-fusion of
palatine which form fibrous basis of palate. Near median right as well as left palatal processes. It can be of different
plane, aponeurosis splits to enclose musculus uvulae. degrees. In most severe case, cleft in palate is continuous
♦ Levator veli palatine and palatopharyngeus lie over with harelip while in least severe type, defect should be
superior surface of palatine aponeurosis. confined to soft palate.
♦ Palatoglossus lie over inferior or anterior surface of Q.4. Write a note on Waldeyer s ring with applied anatomy.
palatine aponeurosis. (Feb 2002, 10 Marks)
♦ Numerous mucus glands as well as some of the taste buds Or
are present at soft palate. Answer in brief on Waldeyer’s ring. (Feb 2016, 2 Marks)
Tonsillar artery enters the tonsil by piercing superior B. Venous drainage: One or more veins leave the lower part
constrictor just behind firm attachment. of deep surface of tonsil, pierce superior constrictor and
Palatine vein descends from the palate in loose areolar join palatine pharyngeal or facial vein.
tissue on lateral surface of capsule and crosses tonsil
before piercing wall of pharynx. Lymphatic Drainage
More laterally, there is facial artery with its tonsillar Lymphatics pass to jugulodigastric node.
and ascending palatine branches. Internal carotid
artery is 2.5 cm posterolateral to tonsil. Nerve Supply
♦ Anterior border: It is related to palatoglossal arch along It is mainly supplied by the two nerves, i.e.
with its muscle. a. Glossopharyngeal nerve
♦ Posterior border: It is related to palatopharyngeal arch b. Lesser palatine nerve
along with its muscle.
♦ Upper pole: It is related to soft palate. Applied Importance or Clinical Importance
♦ Lower pole: It is related to tongue. 1. Tonsillectomy is usually done by guillotine method.
♦ Plica triangularis is a triangular vestigial fold of mucus Hemorrhage after tonsillectomy is checked by removal
membrane covering anteroinferior part of tonsil. of clot from raw tonsillar bed. This is to be compared for
♦ Plica semilunaris is the semilunar fold which may cross method of checking postpartum hemorrhage from uterus.
upper part of tonsillar sinus. These are only two organs in body where bleeding is
Tonsillar Bed checked by removal of clots. In other parts of body clot
formation is encouraged.
The bed of tonsil is formed from within outwards by: 2. Tonsillitis may cause referred pain in ear.
♦ Pharyngobasilar fascia 3. Suppuration in peritonsillar area is called quinsy. A
♦ Superior constrictor and palatopharyngeous muscles peritonsillar abscess is drained by making an incision at
♦ Buccopharyngeal fascia most prominent point of abscess.
♦ In the lower part, the styloglossus 4. Tonsils are often the site of septic focus. Such focus can lead to
♦ The glossopharyngeal nerve. serious diseases like pulmonary tuberculosis, meningitis, etc.
5. Tonsils are larger in children and they retrogress after the
puberty.
Q.6. Enumerate the muscles of pharynx with their nerve
supply. (Sep 2002, 2 Marks)
Ans. Constrictors of Pharynx
There are three constrictors of pharynx namely:
a. Superior constrictor
b. Middle constrictor
c. Inferior constrictor
Blood Supply
A. Arterial supply
1. Main source: Tonsillar branch of facial artery.
2. Additional source:
a. Ascending palatine branch of facial artery
b. Dorsal lingual branch of lingual artery
c. Ascending pharyngeal branch of external carotid
artery
d. Greater palatine branch of maxillary artery. Fig. 110: Constrictor and longitudinal muscles of the pharynx
Anatomy 87
The above muscles are supplied by pharyngeal plexus. Medial surface of mandible at posterior end of
Pharynx also consists of three muscles which run mylohyoid line
longitudinally Side of posterior part of tongue.
a. Stylopharyngeus ♦ Middle constrictor originates from:
b. Palatopharyngeus Lower part of stylohyoid bone
c. Salpingopharyngeus. Lesser cornue of hyoid bone
Upper border of greater cornue of hyoid bone.
Nerve Supply ♦ Inferior constrictor consists of two parts, i.e. the thyroph-
♦ Motor fibers are derived from cranial accessory nerve aryngeous part which originates from thyroid cartilage and
through branches of vagus, they supply all muscles of cricopharyngeal part which originates from cricoid cartilage.
pharynx except stylopharyngeus which is supplied by Insertion of Constrictors
glossopharyngeal nerve.
♦ Inferior constrictor receives an additional supply external Arrangement of all three constrictors is like that the inferior
and recurrent laryngeal nerves. constrictor overlaps the middle constrictor which in turn
overlaps superior constrictor.
Q.7. Write a short note on constrictor muscles of pharynx.
All the three constrictors of pharynx inserted inside the
(Mar 2000, 4 Marks) median raphe on posterior wall of pharynx. Upper end of
Or raphe reaches to base of skull where it is attached to pharyngeal
Write briefly on constrictors of pharynx. tubercle on basilar part of occipital bone.
(Aug 2012, 5 Marks)
Ans. Muscular basis of wall of pharynx is formed by three Nerve Supply
constrictors, i.e. superior, middle and inferior. ♦ Superior constrictor and middle constrictor are supplied
by pharyngeal branch of vagus nerve carrying fibers of
Origin
cranial root of accessory nerve.
Origin of constrictors is situated anteriorly in relation to ♦ Thyropharyngeus part of inferior constrictor is supplied
posterior openings of nose, mouth and larynx. From here the by pharyngeal plexus and external laryngeal nerve,
fibers of muscles pass to lateral and posterior walls of pharynx, while cricopharyngeus part is supplied by the recurrent
fibers of two side meet in midline in fibrous raphe. laryngeal nerve.
♦ Superior constrictor originates from:
Action of Constrictors of Pharynx
Pterygoid hamulus
Pterygomandibular raphae All the constrictors help in deglutition.
Boundaries
♦ Superiorly: It is bounded by base of skull including
posterior part of body of sphenoid and basilar part of
occipital bone in front of pharyngeal tubercle.
♦ Inferiorly: It is continuous with esophagus at the level of
sixth cervical vertebrae corresponding to the lower border
of cricoid cartilage.
♦ Posteriorly: Pharynx glides freely over prevertebral fascia
which separates it from cervical vertebral bodies.
♦ Anteriorly: Its communication is with nasal cavity, oral
cavity and larynx, so anterior wall is incomplete.
♦ Over each side:
Pharynx gets attached to medial pterygoid plate,
pterygomandibular raphae, mandible, tongue, hyoid
bone, thyroid and cricoid cartilages.
Pharynx communicates on each side with middle ear
cavity via auditory tube.
Pharynx is related on either side to styloid process
Fig. 112: Anatomy of pharynx (For colour version see Plate 2)
and muscles attached to it, common carotid, internal
carotid and external carotid arteries along with the
Blood Supply
cranial nerves related to them.
Arterial Supply
Parts of Pharynx
Arteries supplying pharynx are:
Pharynx is divided into three parts from above downwards 1. Ascending pharyngeal branch of external carotid artery
which are as follows: 2. Ascending palatine and tonsillar branches of facial artery
1. Nasopharynx, lie behind the nose 3. Dorsal lingual branches of lingual artery
2. Oropharynx, lie behind the oral cavity 4. Greater palatine, pharyngeal and pterygoid branches of
3. Laryngopharynx, lie behind the larynx maxillary artery.
Structure of Pharynx Venous Drainage
The wall of pharynx is composed of the following five layers Veins form a plexus on posterolateral aspect of pharynx and
from within outwards. collects blood from pharynx, soft palate and prevertebral region.
1. Mucosa It drains into internal jugular vein and facial vein.
2. Submucosa
3. Pharyngobasilar fascia: This is a fibrous sheet internal Lymphatic Drainage
to pharyngeal muscles. It is thickest in upper part where
It drains to retropharyngeal and deep cervical lymph nodes.
it fills the gap between upper border of the superior
constrictor and base of skull, and also posteriorly where it Mechanism of Deglutition or Swallowing
forms pharyngeal raphae. On its superior aspect, fascia get
attached to basiocciput, petrous temporal bone, auditory Swallowing of food occurs in three stages.
tube, posterior border of medial pterygoid plate and First Stage
pterygomandibular raphae. Over its inferior aspect, it lost
gradually deep to muscles and does not extend beyond ♦ First stage is voluntary in character.
superior constrictor muscle. ♦ Anterior part of tongue gets raised and is pressed against
4. Muscular coat: It consists of an outer circular layer made hard palate by intrinsic muscles of tongue mainly the
up of three constrictors and an inner longitudinal layer superior longitudinal and transverse muscles.
made up of stylopharyngeus, salpingopharyngeus and ♦ Movement occurs from anterior to posterior side which
palatopharyngeus muscles. pushes food bolus to oropharynx.
5. Buccopharyngeal fascia: It covers outer surface of ♦ Now the soft palate closes down on the back of tongue
constrictor of pharynx and extend forwards across and helps to form bolus.
Anatomy 89
Bony Part
Bony part forms the posterior one-third of the tube. It is 12 mm
long, and lies in petrous temporal bone near tympanic plate. Its
lateral end is wide and opens on the anterior wall of middle ear
cavity. The medial end is narrow and is jagged for attachment
of cartilaginous part. Lumen of tube is oblong which is widest
from side to side.
Maxillary Branch
♦ It supplies maxillary teeth. During its course when it passes
through pterygopalatine fossa it gives 5 branches out of
which one is posterior superior alveolar branch.
♦ An internal branch of posterior superior alveolar nerve Pulp is covered by a layer of tall columnar cells called
goes along with a branch of the maxillary artery through as odontoblasts which are capable of replacing dentin
the posterior alveolar canal which opens on the posterior during any time in life.
surface of the maxilla. 2. Dentin
♦ In the bone nerve passes down the posterior or posterolateral It is a calcified material containing spiral tubules
wall of the maxillary sinus, giving of sensory fibers. It then radiating from the pulp cavity.
supplies the maxillary molars except the mesiobuccal root Each tubule is occupied by protoplasmic process from
of the first molar. one of the odontoblasts.
♦ Within the depth of the alveolar bone or tooth socket some The calcium and organic matter are in same proportion
nerve fiber passes to supply the periodontal ligament where as in bone.
as other, the pulpal fibers passes through the apical foramina 3. Enamel
of the roots of the molar teeth to supply the dental pulp. It is the hardest substance in the body.
♦ When maxillary nerve passes through inferior orbital It is made up of crystalline prisms laying roughly at
groove and canal it gives the right angles to the surface of tooth.
1. Middle superior alveolar nerve: From inferior orbital 4. Cementum
canal it passes in a downward and anterior direction It is the boney covering over the neck and root of the
and supplies the maxillary bicuspid and mesiobuccal tooth but like enamel and dentin it has neither blood
root of the first molar. supply nor any nerve supply.
Over the neck, cementum overlaps cervical end of
2. Anterior superior alveolar nerve: The anterior superior
enamel or less commonly it can just meet enamel.
alveolar nerve descends in fine canal in the maxilla to
5. Periodontal membrane (ligament)
pass the roots of the maxillary central, lateral incisor
It holds the root in its socket.
and canine teeth.
It is present between the cementum and the socket
Mandibular Division of the root.
It acts as periosteum to both cementum and bony socket.
♦ It supplies mandibular teeth.
♦ Inferior alveolar nerve which is the largest of the branches
of the posterior division of the mandibular part of the
trigeminal nerve supply mandibular teeth
♦ In the inferior alveolar canal it gives off branches to the
mandibular teeth as apical fibers that enter the apical
foramina of the mandibular teeth to supply the dental
pulp of mandibular molars and bicuspid.
4. Palatoglossus Oral surface of palatine Descends in palatoglossal arch, to the side Pulls up root of tongue,
aponeurosis of the tongue at the junction of its oral and approximate palatoglossal
pharyngeal parts. arches, and thus closes
oropharyngeal isthumus
5. Palatopharyn a. Anterior fasciculus: From Descend in the palatopharyngeal arch Pulls up the wall of pharynx
geus posterior border of hard palate and spreads out to form the greater part of and shortens it during
b. Posterior fasciculus: From longitudinal muscle coat of pharynx. swallowing
palatine aponeurosis. It is inserted into:
a. Posterior border of lamina of the thyroid
cartilage
b. Wall of the pharynx and its median
raphae
Ans.
Fig. 116: Structures seen in oral cavity (with mouth wide open)
Q.21. Write briefly on structure of cheek. (Aug 2011, 5 Marks) Ans. Bed of tonsil is formed from within outwards by:
Ans. Cheeks are fleshy flaps which forms large part of each • Pharyngobasilar fascia
side of the face. • Superior constrictor and palatopharyngeus muscle
Cheeks are continuous in front with the lips, and the • Buccopharyngeal fascia
junction is indicated by the nasolabial sulcus or furrow • In lower part, styloglossus
which extends from the side of the nose to the angle of • Glossopharyngeal nerve.
the mouth. Q.23. Write short note on dental formula.
Each cheek is composed of: (May 2008, 3 marks)
1. Skin Ans. The number and type of teeth present in the oral cavity
2. Superficial fascia containing some facial muscles, in one half of the face (either left side or right side)
parotid duct, mucous molar glands, vessels and nerves in primary dentition are expressed by the following
3. Buccinator covered by bucopharyngeal fascia and formula:
pierced by the parotid duct
4. Submucosa with mucous buccal glands I 2 C 1 M 2 = 10
2 1 2
5. Mucous membrane.
• In this formula each tooth is represented by its initial
Buccal pad of fat is best developed in infants and lies on
letter. I for incisor, C for canine and M for molar.
the buccinator partly deep to the masseter and partly in
– Each letter is followed by a horizontal line and
front of it.
the number of each type of tooth is placed above
Lymphatics of the cheek drain chiefly into the sub- the line for maxilla and below the line for the
mandibular and preauricular nodes and partly also to mandible.
the buccal and mandibular nodes. – The formula includes one side only. The above
Q.22. Write short note on bed of tonsil. (Oct 2014, 3 Marks) formula should be read thus:
Or Incisors: Two maxillary and two mandibular.
Enumerate the only structures forming bed of tonsil. Canines: One maxillary and one mandibular.
(Sep 2005, 4 Marks) Molars: Two maxillary and two mandibular.
Anatomy 95
Similarly for permanent dentition (either left side or • The surface of the floor is formed by mucus
right side), the dental formula is as follows: membrane, which connects the tongue to the
mandible.
I 2 C 1 P 2 M 3 = 16 • Laterally the mucus membrane passes from the side
2 1 2 3
of the tongue onto the mandible.
In this premolars have now been added to the
• Anteriorly the mucus membrane stretches from
formula.
In the case of permanent teeth, the formula should one half of the mandible to the other. The anterior
be read as: part of the floor is called sublingual region, which
Incisors: Two maxillary and two mandibular. intervenes between the ventral surface of the anterior
Canines: One maxillary and one mandibular. two-third of the tongue and the floor of the mouth.
Premolars: Two maxillary and two mandibular. • Clinical anatomy: The swellings of the submandibular
Molars: Three maxillary and three mandibular. gland can be palpated bimanually by putting an
To understand dental anatomy, the nomenclature index finger in the mouth and thumb below the angle
should be read first. of the jaw in relation to the position of gland, because
part of the gland lies in the oral cavity above the
Q.24. Answer in brief dental formula for deciduous child. floor of the mouth and part outside the oral cavity
(May 2017, 3 Marks) below the floor of the mouth. The submandibular
Ans. The number and type of teeth present in the oral cavity lymph nodes lying on the surface of the gland
in one half of the face (either left side or right side) cannot be palpated bimanually as they lie below
in primary dentition are expressed by the following the floor of the mouth (oral diaphragm). Thus an
formula. enlarged submandibular gland can be differentiated
I 2 C 1 M 2 = 10 from a mass of the submandibular lymph nodes by
2 1 2
bimanual palpation.
• In this formula each tooth is represented by its initial
letter. I for incisor, C for canine and M for molar.
• Each letter is followed by a horizontal line and the
number of each type of tooth is placed above the line
15. THE NOSE AND
for maxilla and below the line for the mandible. PARANASAL SINUSES
• The formula includes one side only. The above
formula should be read thus: Q.1. Describe gross anatomy, blood supply, nerve supply
Incisors: Two maxillary and two mandibular. and applied anatomy of nasal septum.
Canines: One maxillary and one mandibular. (May/June 2009, 15 Marks)
Molars: Two maxillary and two mandibular.
Or
To understand dental anatomy, the nomenclature
should be read first. Describe the nerve supply and blood supply of nasal
septum. (Sep 2002, 10 Marks)
Q.25. Write short note on effect if soft palate is paralyzed.
(May 2017, 3 Marks) Or
Ans. Following are the effects produced if soft palate gets Write short note on blood supply and nerve supply of
paralyzed: nasal septum. (Aug 2012, 5 Marks)
• Nasal regurgitation of liquids (Aug 2011, 5 Marks) (Aug 2008, 5 Marks)
• Nasal twang in voice
Or
• Flattening of palatal arch on side of lesion
• Deviation of uvula, opposite to side of lesion. Describe formation, blood supply and nerve supply of
Q.26. Enumerate type of pharynx. (Apr 2018, 2 Marks) nasal septum. (Mar 2000, 18 Marks)
Ans. Pharynx is divided into three parts from above Ans. It is a median osteocartilaginous partition between two
downwards which are as follows: halves of nasal cavity.
• Nasopharynx, lie behind the nose On each side it is covered by mucous membrane and
• Oropharynx, lie behind the oral cavity forms medial wall of both nasal cavities. It consists of
• Laryngopharynx, lie behind the larynx. three parts:
Q.27. Write very short answer on oral diaphragm. Formation of Nasal Septum
(Aug 2018, 2 Marks) I. Bony part: It is formed by:
Ans. Oral diaphragm is also known as floor of the mouth. 1. Vomer bone
• The floor of the mouth is a small horseshoe-shaped 2. Perpendicular plate of ethmoid bone. Moreover
region situated beneath the anterior two-third of the its margins recieve contribution from nasal spine
tongue and above the muscular diaphragm formed of frontal bone, rostrum of sphenoid and nasal
by two mylohyoid muscles. crests of nasal, palatine and maxillary bones.
96 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
II. Cartilaginous part: It is formed by: ♦ Posterosuperior part is supplied by sphenopalatine artery
1. Septal cartilage which is the main artery.
2. Septal process of inferior nasal cartilage. ♦ Posteroinferior part is supplied by branches of greater
III. Cuticular part: It is formed by fibro-fatty tissue palatine artery.
covered by skin. ♦ Anteroinferior part or vestibule of septum consists of
Lower margin of nasal septum is known as anastomoses between septal ramus of superior labial
branch of facial artery, branch of sphenopalatine artery,
columella.
greater palatine and of anterior ethmoidal artery. These
Nasal septum is rarely median. Its central part is
form large capillary network known as Kiesselbach’s
deflected to one or other side. Deflection is produced
plexus.
by overgrowth of one or more parts.
Overall, septum, consists of four borders, i.e. Venous Drainage
superior, inferior, anterior, posterior and two
Veins forms a plexus which drains anteriorly into facial vein
surfaces, i.e. right and left surfaces.
and posteriorly through sphenopalatine vein to pterygoid
venous plexus.
Nerve Supply
♦ General sensory nerve arising from trigeminal nerve are
distributed to whole of septum.
• Anterosuperior part of septum is supplied by internal
nasal branch of anterior ethmoid nerve.
• Anteroinferior part: It is supplied by anterior superior
alveolar nerve
• Posterosuperior part: It is supplied by medial posterior
superior nasal branches of pterygopalatine ganglion
• Posteroinferior part is supplied by nasopalatine branch
of pterygopalatine ganglion. This is the main nerve.
♦ Special sensory nerves or olfactory nerves which are
confined to upper part or olfactory area.
Blood Supply
Arterial Supply
♦ Anteriosuperior part is supplied by anterior ethmoidal
artery and posterior ethmoidal artery.
♦ Anteroinferior part is supplied by superior labial branch
of facial artery
Applied Anatomy
♦ Little’s area over the nasal septum is common site of
bleeding from the nose, i.e. epistaxis.
♦ Deviation of nasal septum pathologically is responsible for
repeated attacks of common cold, allergic rhinitis, sinusitis
and needs surgical correction.
♦ Artery of epistaxis is sphenopalatine artery.
Q.2. Enumerate openings in lateral wall of nose.
Fig. 120: Arterial supply of nasal septum (Sep 2000, 4 Marks) (Apr 2010, 5 Marks)
Anatomy 97
Ans. • Opening of nasolacrimal duct is seen at inferior meatus Q.5. Write a short note on maxillary air sinus.
• Opening of frontal air sinus is seen in the anterior (Sep 2004, 5 Marks) (Mar 2000, 4 Marks)
part of hiatus semilunaris (Mar 2007, 3 Marks) (Sep 2007, 4 Marks)
• Opening of maxillary air sinus is seen in the posterior (Mar 2008, 4 Marks) (Apr 2007, 5 Marks)
part of hiatus semilunaris (Feb 2013, 5 Marks)
• Opening of anterior ethmoidal air sinus is present Or
at middle part of hiatus semilunaris
• Opening of middle ethmoidal air sinus is present at Write briefly on maxillary sinus. (Jan 2012, 5 Marks)
upper margin of ethmoidal bulla. Or
• Opening of posterior ethmoidal sinus is seen in the Enumerate paranasal air sinuses. Describe any one of
superior meatus them. (Feb 2002, 10 Marks)
• Opening of sphenoidal air sinus is seen in the
Or
sphenoethmoidal recess.
Enumerate paranasal air sinuses. Describe maxillary
Q.3. Draw a labeled diagram to show features of lateral wall
sinus in detail. Development and applied anatomy.
of nose. (Dec 2003, 7 Marks)
(Mar 1998, 18 Marks)
Ans.
Or
Enumerate paranasal air sinuses. Describe in detail
maxillary air sinus. (Sep 2012, 3 + 5 Marks)
Or
Enumerate paranasal air sinuses. Discuss anatomy of
maxillary air sinus. (Sep 2012, 3 + 5 Marks)
(Apr 2017, 10 Marks)
Or
State names of different paranasal air sinuses. Describe
maxillary air sinus under following headings:
Fig. 122: Features of lateral wall of nose
a. Situation (Aug 2016, 10 Marks)
Q.4. Draw a labelled diagram of lateral wall of nose showing b. Boundaries
various openings. c. Communication
(Dec 2010, 4 Marks) (Feb 2014, 4 Marks) d. Nerve supply
Or e. Blood supply
Draw a labelled diagram to show the openings in Or
lateral wall of nose. (Feb 2004, 7 Marks) Name the paranasal air sinuses. (Aug 2018, 1 Mark)
Ans. Ans.
♦ Maxillary sinus starts developing at 16th week of the Q.6. Describe paranasal air sinuses.
intrauterine life. (Feb 2005, 10 Marks) (Sep 2000, 9 Marks)
♦ It appears as a shallow groove on the medial surface of Or
maxilla during the fourth month of intrauterine life. It
Write short note on paranasal sinuses (PNS).
grows rapidly during 6 to 7 years of life.
(June 2010, 5 Marks) (Aug 2011, 5 Marks)
♦ When the crown-rump length (CRL) of an embryo is (Aug 2012, 5 Marks)
32 mm, the CRL expands vertically in primordium of
Or
maxillary body.
♦ At first, the horizontal shift of the palatal shelves occurs. Describe the paranasal sinuses and their applied
These shelves then fuse with each other and also with anatomy. (Nov 2008, 15 Marks)
the nasal septum. As a result of this the oral cavity gets Ans. There are four paranasal air sinuses on each side and are
separated from the nasal chambers. named after the bones containing them:
♦ All these changes result in the expansion of the lateral nasal 1. Frontal air sinus present in frontal bone.
wall, which starts folding. 2. Maxillary air sinus present in maxilla.
♦ As a result of this folding, three nasal conchae and three 3. Sphenoidal air sinus present in sphenoid bone.
4. Ethmoidal air sinus present in ethmoid bone
meatuses arise. Superior and inferior meatuses remain as
– Anterior ethmoidal air sinus.
shallow depressions along the lateral nasal wall and the
– Middle ethmoidal air sinus.
middle meatus expands into the lateral nasal wall. – Posterior ethmoidal air sinus.
♦ Maxillary sinus expands and modifies in form and it Clinically, sinuses are divided into two main groups viz
reaches its final height after the eruption of all permanent 1. Anterior group: It consists of those sinuses, which drains
teeth. into middle meatus, i.e. frontal, anterior and middle
ethmoidal and maxillary sinus.
2. Posterior group: It includes those sinuses which do not
drain into middle meatus, i.e. posterior ethmoidal and
sphenoidal air sinus.
Applied Anatomy
♦ The maxillary air sinus is commonly involved in the
sinusitis. It may be infected from nose or from carious
tooth. Drainage of sinus is difficult because its ostium lies
at the higher level then its floor. Another factor is that cilia
in lining mucosa are destroyed by the chronic infection.
Hence, the sinus is drained surgically by making an
artificial opening near the floor.
Carcinoma of maxillary air sinus arises from mucosal
Fig. 127: Paranasal air sinuses (For colour version see Plate 2) lining. Symptoms depend on the direction of growth which
are as follows:
• Invasion of orbit causes proptosis or diplopia, i.e.
blindness.
• Invasion of floor may produce bulging or ulceration
of palate.
• Forward growth obliterates canine fossa and produces
swelling on face.
• Backward growth can involve palatine nerves and
produce severe pain referred to upper teeth.
• Growth in medial direction produces nasal obstruction,
epistaxis and epiphora.
• Growth in lateral direction produces swelling on the
face and palpable mass inside labiogingival groove.
♦ Frontal sinusitis and ethmoiditis can cause edema of lids
which is secondary to infection of sinuses.
♦ Pain from ethmoidal air sinus is referred to the forehead
since both of them are supplied by ophthalmic division
of trigeminal nerve.
♦ Pain of maxillary sinusitis can be referred to maxillary teeth
Fig. 128: Formation of conchae and meatuses
as well as infraorbital skin as all of them are supplied by
the maxillary nerve.
Nerve supply: It is supplied by:
• Posterior ethmoidal nerve Q.7. Write a short note on pterygopalatine ganglion.
• Orbital branch of pterygopalatine ganglion. (Mar 1998, 4 Marks)
Lymphatic drainage: It drains to the retropharyngeal nodes. Ans. This is the largest parasympathetic peripheral ganglion.
♦ Ethmoidal air sinus: They are numerous intercommuni- It serves as relay station for secretomotor fibers to
cation spaces which lie in labyrinth of ethmoid bone. They lacrimal gland, paranasal sinuses, palate and pharynx.
get completed from above by orbital plate of frontal bone, Topographically, it is related to maxillary nerve, but
from behind by sphenoidal conchae and orbital process of functionally it is connected to facial nerve via its greater
palatine bone, anteriorly by lacrimal bone. Basically, they petrosal branch.
are three in number, i.e. Connections
1. Anterior ethmoidal sinus: It is made up of 1 to 11 air
cells. It opens in anterior part of hiatus semilunaris ♦ Parasympathetic or motor root:
of nose. It is supplied by anterior ethmoidal nerve • It is formed by the nerve of pterygoid canal.
and vessels. Its lymphatics drain into submandibular • Preganglionic fibers arises from neurons present near
nodes. superior salivatory nucleus and lacrimatory nuclei and
2. Middle ethmoidal sinus: It is made up of 1 to 7 air pass via nervus intermedius, facial nerve, geniculate
cells. It opens in middle meatus of nose. It is supplied ganglion, greater petrosal nerve and nerve to pterygoid
by anterior ethmoidal nerve and vessels and orbital canal to reach the pterygopalatine ganglion and relay.
braches of pterygopalatine ganglion. Lymphatics • Postganglionic fibers arise in pterygopalatine ganglion
drains to submandibular nodes. and supply secretomotor nerves to lacrimal gland,
Anatomy 101
mucous glands of nose, paranasal air sinuses, palate 4. Ethmoidal air sinus present in ethmoid bone:
and nasopharynx. – Anterior ethmoidal air sinus.
♦ Sympathetic root – Middle ethmoidal air sinus.
• It is derived from nerve of pterygoid canal. – Posterior ethmoidal air sinus.
• Postganglionic fibers arise superior cervical sym- Clinically sinuses are divided into two main groups viz:
pathetic ganglion which pass via internal carotid 1. Anterior group: It consists of those sinuses which drains
plexus, deep petrosal nerve and nerve to pterygoid into middle meatus, i.e. frontal, anterior and middle
canal to reach ganglion. Fibers does not relay and ethmoidal and maxillary sinus.
supply to vasomotor nerves to mucous membrane of 2. Posterior group: It includes those sinuses which do not
nose, paranasal sinus, palate and nasopharynx. drain into middle meatus, i.e. posterior ethmoidal and
♦ Sensory roots are derived from maxillary nerve. Fibers of sphenoidal air sinus.
sensory root does not relay in ganglion and they emerge Q.9. Enumerate the paranasal air sinus, give its functions
as various branches, i.e. orbital branch, palatine branches, and openings in nasal cavity. (Mar 2006, 5 Marks)
nasal branches, pharyngeal branch and lacrimal branch. Ans. For enumeration refer to Ans 8 of the same chapter.
♦ Opening of middle ethmoidal air sinus is present at upper 2. Middle part is called as the atrium of the middle meatus.
margin of ethmoidal bulla. 3. Posterior part consists of conchae and the spaces separating
♦ Opening of posterior ethmoidal sinus is seen in the conchae are known as meatus.
superior meatus.
♦ Opening of sphenoidal air sinus is seen in the sphenoe- Conchae and Meatuses form the Main Features of the
thmoidal recess which is the triangular fossa just above Lateral Wall
superior concha. Conchae (also called turbinates) are the curved bony actions
Q11. Enumerate the paranasal air sinuses. What are the directed downwards and medially. Below and lateral to each
functions of these sinuses? Name the nerves supplying concha is a corresponding meatus. From above downwards
them. Add a note on their applied anatomy. the conchae are superior, middle, and inferior nasal conchae.
(Sep 2006, 8 Marks) Sometimes a 4th concha, the concha suprema is also present.
Ans. For enumeration refer to Ans 8 of the same chapter. For Skeleton of the Lateral Wall
function refer to Ans 9 of the same chapter. For applied
anatomy refer to Ans 6 of same chapter. It is partly bony, partly cartilagenous and partly made up of soft
tissues.
Name of the paranasal
air sinus Nerve supplying
♦ Bony part: It is formed by
• Nasal
Frontal sinus Supraorbital nerve • Frontal process of maxilla
Maxillary sinus Posterior superior alveolar nerve • Lacrimal
from maxillary nerve, anterior and • Labryinth of ethamoid with superior and middle
middle superior alveolar nerves from conchae.
infraorbital nerve
• Inferior nasal concha made of spongy bone only.
Sphenoidal sinus Posterior ethmoidal nerve and orbital • Perpendicular plate of the palatine bone together with
branches of pterygopalatine ganglion orbital and sphenoidal processes.
Ethmoidal sinus • Medial pterygoid plate.
• Anterior ethmoidal • Anterior ethmoidal nerve ♦ Cartilaginous part is formed by:
sinus • Anterior ethmoidal nerve and • Superior nasal cartilage
• Midlle ethmoidal sinus orbital branches of pterygopalatine • Inferior nasal cartilage
• Posterior ethmoidal ganglion • 3 or 4 small cartilages of ala.
sinus • Posterior ethmoidal nerve and ♦ Cuticular lower part is formed by fibrofatty tissue covered
orbital branches of pterygopalatine
ganglion
by skin.
Conchae
Q.12. Write a note on lateral wall of the nose.
(Mar 2007, 4 Marks) ♦ Superior and middle nasal conchae are the projections from
Or the medial surface of the ethmoidal labyrinth.
♦ Inferior concha is an independent bone.
Write in short on lateral wall of the nose. ♦ The superior concha is smallest and inferior concha is
(Aug 2012, 5 Marks) (Dec 2010, 5 Marks) largest in size.
Or
Write short note on lateral wall of nose. Meatuses
(Aug 2018, 5 marks) Meatuses are the passages (recesses) beneath the overhanging
Ans. Lateral wall of the nose is irregular and consists of three conchae. They are visualized once conchae are removed.
shelf like bony projections called conchae. ♦ Inferior meatus is the largest and lies underneath the
• Conchae increases the surface area of the nose for inferior nasal concha.
effective conditioning of the inspired air. ♦ Middle meatus lies underneath the middle concha. It
presents following features:
Lateral Wall Leads to Separation of the Nose
• Ethmoidal bulla (bulla ethmoidalis), a round elevation
♦ From orbit above with ethmoidal air sinus and intervening produced by the underlying middle ethmoidal sinuses.
maxillary sinus below • Hiatus semilunaris, a deep semicircular sulcus below
♦ In front by lacrimal groove and nasolacrimal canal. the bulla ethmoidalis.
• Infundibulum, a short passage at the anterior end of
Subdivision of Lateral Wall of Nose
middle meatus.
Lateral wall of nose is subdivided into three parts i.e. ♦ Superior meatus is the smallest and lies below the superior
1. A small depressed area in the anterior part is known as concha.
vestibule. Vestibule is lined by modified skin containing A triangular depression, above and behind the superior concha
short, stiff, curved hair called “Vibrissae”. is known as the sphenoethmoidal recess.
Anatomy 103
Arterial Supply
♦ Anterosuperior quadrant by anterior ethmoidal artery
♦ Anteroinferior quadrant by branches from facial and
greater palatine arteries.
♦ Posteroinferior quadrant by few branches of sphenopalatine
artery. Fig. 131: Arterial supply of lateral wall of nose
♦ Posterionferior quadrant by branches from greater palatine
artery. a. Anterosuperior quadrant by anterior ethmoidal nerve
branch of ophthalmic nerve.
Venous Drainage b. Anteroinferior quadrant by anterior superior alveolar
Venous form a plexus which drains: nerve branch of infraorbital, continuation of maxillary
♦ Anterioly into facial vein nerve.
♦ Posterioly into pharyngeal plexuses of vein c. Posterosuperior quadrant by lateral posterior superior
♦ Middle part by pterygoid plexus of vein. nasal branches from pterygopalatine ganglion.
d. Posteroinferior quadrant by anterior palatine branch
Nerve Supply of pterygopalatine ganglion.
I. General sensory nerves: They are derived from the II. Special sensory nerves: These are the olfactory nerves
branches of trigeminal nerve which supplies to the lateral which are distributed to upper part of lateral wall below
wall. cribriform plate of ethmoid bone upto superior concha.
104 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Contents
♦ Third part of maxillary artery and its branches which have
same name as branches of pterygopalatine ganglia and
accompany them all.
♦ Maxillary nerve and its two branches, i.e. zygomatic and
posterior superior alveolar.
♦ Pterygopalatine ganglion and its numerous branches
which consists of fibers of maxillary nerve mixed with
autonomic nerves.
Lymphatic Drainage
♦ From anterior half to submandibular nodes
♦ From posterior half to retropharyngeal and upper deep
cervical nodes.
Q.13. Write short note on pterygopalatine fossa.
(Dec 2009, 5 Marks)
Ans. It is also known as sphenopalatine fossa or ganglion of
Fig. 133: Pterygopalatine fossa along with its communications
hay fever.
Pterygopalatine fossa is a small pyramidal space which
Q.14. Write short note on openings of paranasal sinuses.
is situated deep below the apex of the orbit.
(Sep 2017, 2 Marks)
Boundaries Ans. Following are the openings of paranasal sinuses:
It is bounded: ♦ Opening of frontal air sinus is seen in the anterior part of
♦ Anteriorly by superomedial part of the posterior surface hiatus semilunaris.
of the maxilla. ♦ Opening of maxillary air sinus is seen in the posterior
♦ Posteriorly by root of the pterygoid process and adjoining part of hiatus semilunaris. It is often represented by the
part of the anterior surface of greater wing of the sphenoid. two openings.
♦ Medially by upper part of the perpendicular plate of the ♦ Opening of anterior ethmoidal air sinus is present at
palatine bone. Orbital and sphenoidal processes of the middle part of hiatus semilunaris. It is mainly present
bone are also involved. behind the opening of frontal air sinus.
♦ Laterally the fossa opens into infratemporal fossa through ♦ Opening of middle ethmoidal air sinus is present at upper
margin of ethmoidal bulla.
the pterygomaxillary fissure.
♦ Opening of posterior ethmoidal sinus is seen in the
♦ Superiorly by the undersurface of body of sphenoid.
superior meatus.
♦ Inferiorly it is closed by the pyramidal process of palatine
♦ Opening of sphenoidal air sinus is seen in the sphenoe-
bone in the angle between the maxilla and pterygoid
thmoidal recess which is the triangular fossa just above
process.
superior concha.
Communications Q.15. Enumerate arterial supply of nasal septum.
It is communicated: (Apr 2018, 2 Marks)
♦ Anteriorly by the orbit through medial end of the inferior Ans. Following is the arterial supply of nasal septum:
orbital fissure. • Anteriosuperior part is supplied by anterior
♦ Posteriorly with the middle cranial fossa via foramen ethmoidal artery and posterior ethmoidal artery.
rotundum; with foramen lacerum via pterygoid canal; and • Anteroinferior part is supplied by superior labial
with pharynx via palatovaginal canal. branch of facial artery.
Anatomy 105
♦ Its upper end is broad and free, it projects upward behind Q.4. Write short note on thyroid cartilage.
hyoid bone as well as tongue. (Sep 2011, 5 Marks)
♦ Lower end or thyroepiglottic ligament is pointed and is Ans. • Thyroid cartilage is V-shaped in its cross section.
attached to upper part of angle between the two laminae • Cartilage consists of right and left laminae. Shape of
of thyroid cartilage. each lamina is roughly quadrilateral.
• Laminae are placed obliquely relative to the midline
Paired Cartilage
and their posterior borders are far apart, but the
Arytenoid Cartilage anterior borders approach each other at an angle
♦ They are two small pyramid shape cartilage which lie over that is about 90° in the male and about l20° in the
upper border of lamina of cricoids cartilage. female.
♦ Apex of arytenoid cartilage is curved posteromedially and • Lower part of anterior borders of right and left
articulates with corniculate cartilage. laminae combine and form a median projection
♦ Base is concave and articulates with lateral part of upper known as laryngeal prominence.
border of cricoids lamina. This prolong anteriorly to form • Upper parts of both the anterior borders do not meet
vocal process and laterally to form muscular process. and are separated by the thyroid notch.
♦ Surfaces of cartilage are anterolateral, medial and posterior. • Posterior borders are free and are extended upwards
and downwards and are named as superior and
Corniculate Cartilage inferior cornua (horns).
• Superior cornua is connected with the greater cornua
♦ These are two small conical nodules which articulate
of the hyoid bone by lateral thyrohyoid ligament.
with apex of arytenoid cartilage which are directed
• Inferior cornua articulate with the cricoid cartilage
posteromedially.
to form the cricothyroid joint.
♦ These conical lie in posterior part of aryepiglottic folds.
• Inferior border of the thyroid cartilage concavo-
Cuniform Cartilage convex, i.e. convex in front and concave behind.
• In the median plane it is connected to the cricoid
These are two small rod shaped pieces of cartilage placed in
cartilage by the conus elasticus.
aryepiglottic fold which are just ventral to corniculate cartilages.
• Outer surface of each lamina is marked by an
Q.2. Write short note on nerve supply of larynx oblique line which extends from the superior thyroid
(Apr 2008, 5 Marks) tubercle in front of root of superior cornua to the
Ans. A. Motor nerve: All intrinsic muscles of larynx are inferior thyroid tubercle behind middle of inferior
supplied by recurrent laryngeal nerve except border.
cricothyroid which is supplied by the external • Thyrohyoid, sternothyroid and thyropharyngeus are
laryngeal nerve. part of inferior constrictor of pharynx is attached to
B. Sensory nerve: The internal laryngeal nerve supply oblique line.
mucous membrane upto level of vocal folds.
Recurrent laryngeal nerve supply it below the level
of vocal folds.
Q.3. Write short note on vocal folds. (Sep 2011, 5 Marks)
Ans. Within the laryngeal cavity, the mucous membrane presents
with two folds that extend on each side posteroanteriorly
from the arytenoid cartilages to the thyroid cartilage.
These are true and false vocal cords.
Vocal folds are also known as true vocal cords:
• These folds are produced by the underlying vocal
ligaments and vocalis muscle and lie below the false
vocal cords. Fig. 136: Anterior and posterior view of thyroid and cricoid cartilage
• Space between the right and left vocal folds is called
as ‘rima glottidis’ Attachments
• Vocal cords act as entry valves. They prevent entry ♦ Lower border as well as inferior cornua provides insertion
of all substances through rima glottis except air. to triangular cricothyroid.
• Speech (phonation) is produced by vibrations of the ♦ At posterior border connecting the superior and
vocal cords. Greater the amplitude of vibration, the inferior cornua is insertion of palatopharyngeus,
louder is the sound. Pitch of sound is controlled by salpingopharyngeus and stylopharyngeus.
the frequency of the vibrations. ♦ Over the inner aspect following are attached:
• Since males have longer vocal cords than females, they • Median thyroepiglottic ligament
have louder but low pitched voices than females. • Thyroepiglottic muscle over each side
Anatomy 107
• Vestibular fold over each side ♦ This area is rich in lymphatics. These lymphatics drain into
• Vocal fold over each side the upper deep cervical group of nodes. Malignancy in this
• Thyroarytenoid area has a tendency for distant metastasis.
• Vocalis muscle over each side. ♦ Foreign bodies such as fish bones commonly gets lodged
Q.5. Write short note on cricoid cartilage. (Sep 2011, 5 Marks) in piriform fossa. These bones scratch mucosa and person
feel foreign body sensation because of dull visceral pain.
Ans. • Cricoid cartilage has a shape of signet ring.
♦ Piriform fossa is also known as smuggler’s fossa as it is
• It encircle larynx below thyroid cartilage.
used to smuggle precious diamonds and stones.
• The cartilage is thick and strong as compared to
♦ Pooling of saliva occurs in pyriform fossa if there is any
thyroid cartilage.
obstruction in the food passage (Jackson’s sign).
• It consists of narrow anterior part known as arch
and broad posterior part known as lamina.
• Projection of lamina is upwards behind the thyroid
cartilage and it articulate superiorly with arytenoid
cartilage.
• Inferior cornua of thyroid cartilage articulate with
side of cricoid cartilage at junction of arch and lamina.
For diagram of cricoid cartilage refer to Ans 4 of same
chapter.
Describe muscles of tongue. (Apr 2010, 5 Marks) – Oral part is also known as anterior two-third of
Or tongue.
Describe the tongue and give its nerve supply. – Oral part presents a median furrow, representing
(Sep 2013, 10 Marks) bilateral origin of tongue as well as large number
Or of papillae
Write short note on nerve supply and lymphatic – Pharyngeal part or posterior one third by a V
drainage of tongue. (Aug 2012, 5 Marks) shaped groove known as sulcus terminalis. Two
Or limbs of V meet at median pit called as foramen
Write short note on blood supply and nerve supply of caecum. Both the limbs run laterally and forwards
tongue. (May/June 2009, 5 Marks) (Nov 2008, 5 Marks) upto palatoglossal arches.
Or – The third part is small posteriomost part.
Write short note on sensory innervations of tongue. 2. An inferior surface: This is confined to oral part only.
(July 2016, 5 Marks) (Apr 2007, 5 Marks) Mucous membrane lining this surface is thin, smooth
Or and purpulish. It is reflected onto the floor of the
mouth. The under aspect of the tongue presents the
Write a short note on innervation of tongue.
following features:
(Sep 2006, 5 Marks)
– Frenulum linguae, a median-fold of mucus
Or
membrane connecting the tongue to the floor of
Write short note on nerve supply of tongue.
the mouth.
(Sep 2007, 3 Marks) (Apr 2015, 3 Marks)
– Deep lingual veins, may be seen through mucous
(Jan 2018, 5 Marks)
membrane on either side of frenulum linguae (the
Or
lingual nerve and lingual artery are medial to the
Write a short note on lymphatic drainage of tongue. vein but not visible).
(Oct 2007, 5 Marks) (Jan 2012, 5 Marks) – Plica fimbriata, a fringed fimbriated fold of
(May 2017, 3 Marks) (June 2010, 5 Marks) mucous membrane lateral to the lingual vein
Or directed forwards and medially towards the tip
Write briefly lymphatic drainage of tongue and its of the tongue.
applied aspect. (Dec 2010, 5 Marks)
Or
Describe tongue in detail and give its applied aspect.
(Nov 2009, 10 Marks)
Or
Describe the tongue in detail. (Jan 2012, 15 Marks)
Or
Write very short answer on lymphatic drainage of
tongue. (Apr 2018, 2 Marks)
Or
Write very short answer on extrinsic muscles of tongue.
(Aug 2018, 2 Marks) Fig. 138: Dorsum of tongue
Parts of Tongue
Tongue consists of following parts:
♦ Root: It is attached to styloid process and soft palate above
and to mandible and hyoid bone below. In between the
mandible and hyoid bones it is related to geniohyoid and
mylohyoid muscles.
♦ Tip: Tip of the tongue forms anterior free end which rest,
lie behind maxillary incisor teeth.
♦ Body: It is divided into two parts:
1. Dorsum:
– This is convex in all the directions. It is divided
into oral and pharyngeal parts by V-shaped sulcus
terminalis. Fig. 139: Inferior surface of tongue
Anatomy 109
Blood Supply
Lymphatic Drainage
♦ Tip of tongue drains bilaterally to submental nodes.
♦ Right and left halves of remaining part of anterior 2/3 of
the tongue drains unilaterally to submandibular nodes.
Few central lymphatics drain bilaterally to deep cervical
lymph nodes.
♦ Posterior 1/3 and posteriomost part drains bilaterally to upper
deep cervical lymph nodes including juglodigastric nodes.
♦ Whole lymph finally drains to jugulo-omohyoid lymph nodes.
Nerve Supply
♦ Motor supply: All extrinsic and intrinsic muscles except
palatoglossus are supplied by the hypoglossal nerve.
Palatoglossus is supplied by the cranial root of accessory
nerve through pharyngeal plexus.
Fig. 143: Nerve supply of tongue
♦ Sensory innervations:
• Lingual nerve is general nerve of sensation and chorda
Venous Drainage tympani is nerve for taste for anterior 2/3 of tongue
♦ Deep lingual vein is largest and principal vein of tongue. except vallate papillae.
It is visible on inferior surface of tongue. • For posterior 1/3 and circumvallate papillae glossophar-
♦ Arrangement of veins of tongue is variable. Two venae yngeal nerve is nerve for both general and taste sensation.
comitants accompany lingual artery and one venae • Posterior most part is supplied by vagus nerve through
comitant the hypoglossal nerve. internal laryngeal branch.
Fig. 144: Arterial supply of tongue (For colour version see Plate 2)
Fig. 145: Lymphatic drainage of tongue (For colour version see Plate 3)
♦ Genioglossus is known as safety muscle of tongue, this is Dorsum of tongue is divided into oral and pharyngeal
because as this muscle get paralyzed, tongue will fall back parts by sulcus terminalis and the inferior surface is
to oropharynx and block passage of air. During anesthesia, confined to the oral part.
tongue should be pulled forward to clear the air passage.
Tip of the tongue forms the anterior free end.
♦ Genioglossus is the only muscle which protrudes forward.
It is used for testing integrity of hypoglossal nerve. If Dorsum of the tongue is convex from all aspects. It is
hypoglossal nerve over right side gets paralyzed, tongue on divided into an
protrusion deviate to right side. Normal left genioglossus will a. An oral part, i.e. anterior two-third
pull base to left side and apex will get pushed to right side. b A pharyngeal part, i.e. posterior one-third part
♦ Glossitis is usually a part of generalized ulceration of c. Posteriomost part.
the mouth cavity (stomatitis). In certain anemias tongue
becomes bald due to atrophy of the filiform papillae. Oral or Papillary Part
♦ Presence of a rich network of lymphatics and of loose
areolar tissue in the substance of the tongue is responsible It lies on the floor of the mouth. Its margins are free and in
for enormous swelling of the tongue in acute glossitis. The contact with the gums and teeth. In front of the palatoglossal
tongue fills up the mouth cavity and then protrudes out of it. arch, each margin consists of 4 to 5 vertical folds known as foliate
♦ Undersurface of the tongue is a good site for observation papillae. Superior surface of the oral part consists of median
of jaundice. furrow and is covered with papillae which make it rough. The
♦ In unconscious patients tongue may fall back and obstruct inferior surface is covered with a smooth mucous membrane,
air passages. This can be prevented either by lying the which shows a median fold known as frenulum linguae. On
patient on one side with head down or by keeping the either side of the frenulum there is a prominence produced by
tongue pulled out mechanically.
the deep lingual veins. More laterally there is a fold known as
♦ In patients with grand mal epilepsy tongue is commonly
plica fimbriata which is directed forwards and medially towards
bitten between the teeth during the attack.
the tip of the tongue.
Q.2. Describe the tongue under the following headings:
(Sep 2007) Pharyngeal (lymphoid) Part of the Tongue
a. Gross anatomy (3 Marks)
b. Histology (2 Marks) It lies behind the palatoglossal arches and sulcus terminalis.
c. Development and anomalies (3 Marks) Posterior surface of this part of tongue forms the anterior wall
Ans. Gross Anatomy of oropharynx and is also known as base of tongue. Mucous
Tongue consists of root, a tip, and a body which is membrane has no papillae, but consists of many lymphoid
divided into a curved upper surface of dorsum and an follicles which collectively constitute lingual tonsil. Mucous
inferior surface. glands are also present.
112 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• Taste from posteriormost part of the tongue and • Point of maximum convexity lies at tip of the handle
epiglottis travels via vagus nerve upto the inferior of the malleus and is known as umbo.
ganglion of vagus. The central process reaches to • Membrane is thick at the circumference and is fixed
tractus solitarius. to tympanic sulcus of temporal bone on tympanic
• After relay in tractus solitarius, solitario thalamic plate. Superiorly sulcus is deficient.
tract is formed which becomes part of trigeminal • At sulcus membrane is attached to tympanic notch.
leminiscus and reaches to posteroventromedial • At ends of the notch two bands, i.e. anterior and
nucleus of thalamus of contralateral side. Another posterior malleolar folds get prolonged to lateral
relay from here takes them to the lowest part of post
process of malleus.
central gyrus which is the specific area for taste.
• Greater part of tympanic membrane is tightly
attached and is known as pars tensa.
18. THE EAR • Part between two malleoler folds is loose and is
known as pars flaccid.
Q.1. Write a short note on tympanic membrane. • Chorda tympani crosses pars flaccid and this part is
(Mar 1997, 4 Marks) more liable to rupture as compared to pars tensa.
Ans. • It is a thin, translucent partition which lies between • Tympanic membrane is held tense by the inward
external acoustic meatus and middle ear. pull of tensor tympani muscle which get inserted
• It is oval in shape and is placed obliquely at an angle in upper end of handle of malleus.
of 55° with floor of meatus.
• Membrane has outer and inner surface. Structure
• Outer surface of membrane is lined by thin skin and
Tympanic membrane consists of following three layers:
is concave.
• Inner surface provides attachment to handle of 1. The outer auricular layer of skin.
malleus which extends upto its center. Inner surface 2. The middle fibrous layer made up of superficial radiating
is convex. fibers and deep circular fibers.
3. The inner mucous layer is lined by a low ciliated columnar
epithelium.
Blood Supply
♦ Outer surface supplied by the deep auricular branch of
maxillary artery.
♦ Inner surface is supplied by anterior tympanic branch
of maxillary artery and by posterior tympanic branch of
stylomastoid branch of posterior auricular artery.
A Venous Drainage
Veins from outer surface drains to external jugular vein. Those
from inner surface drains into transverse sinus and into venous
plexus around auditory tube.
Lymphatic Drainage • Two limbs or crura: Anterior one is shorter and less
curved while posterior one is longer which diverge
Lymphatics pass to preauricular and retropharyngeal lymph
from neck and are attached to the footplate.
nodes.
• Footplate, a footpiece or base: It is oval in shape and
Nerve Supply fits into the fenestra vestibuli.
Malleus
♦ It is so called because it resembles as a hammer.
♦ Malleus is the largest and most laterally placed ossicle.
♦ It consists of following parts:
• Round head: It lies in epitympanic recess. Head
articulates posteriorly with body of incus. Head
provide attachment to superior and lateral ligaments.
• Neck: It lies against pars flaccida and is related
medially to chorda tympani nerve.
• Anterior process: It is connected to the petrotympanic
fissure by the anterior ligament. Fig. 152: Ossicles of ear
• Lateral process: It projects from upper end of handle
and gives attachment to malleolar folds.
Q.3. Write a short note on boundaries of middle ear.
• Handle: It extends downwards, backward and
medially, it is attached to upper half of tympanic (Apr 2010, 5 Marks)
membrane. Ans. Boundaries of middle ear are as follows:
♦ Inferior part of wall is formed by thin plate of bone which forms ♦ Promontory: This is a rounded bulging which is produced
posterior wall of carotid canal. This thin plate of bone separates by first turn of cochlea. This is grooved by tympanic plexus.
middle ear from internal carotid artery. The plate is perforated ♦ Fenestra vestibuli: It is an oval opening posterosuperior
by superior and inferior sympathetic caroticotympanic nerves to promontory. It leads inside vestibule of an internal ear
and tympanic branch of internal carotid artery. and is closed by footplate of stapes.
♦ Bony septum between canals for tensor tympani and ♦ Prominence of facial canal: It run backward just above the
auditory tube continued posteriorly on medial wall as fenestra vestibule and reach lower margin of aditus. Canal
curved lamina known as processes cochleariformis. now descend behind posterior wall to end at stylomastoid
Posterior or Mastoid Wall foramen.
♦ Fenestra cochleae: It is round opening at bottom of
It presents these features from above to downward: depression posteroinferior to promontory. It open inside
♦ Superiorly there is presence of an opening or aditus via scala tympani of cochlea and is closed by secondary
which epitympanic recess communicates with mastoid or tympanic membrane.
tympanic antrum.
♦ Sinus tympani: It is a depression behind promontory,
♦ Fossa incudis is a depression which lodges short process
opposite to ampulla of posterior semicircular canal.
of incus.
♦ Processus cochleariformis.
♦ Conical projection known as pyramid lie near junction of
posterior and medial wall. It consists of an opening at its ♦ Prominance of lateral semicircular canal above facial canal.
apex for passage of tendon of stapedius muscle. Q.4. Draw a labeled diagram of lateral wall of middle ear.
♦ Lateral to the pyramid and near the posterior edge of
(Mar 1998, 4 Marks)
tympanic membrane lies posterior canaliculus for chorda
tympani nerve via which nerve enters middle ear cavity. Ans.
For example, heart and inner aspect of left arm originate from III. Structural and functional classification
some dermatome so, pain in heart is referred to left arm. – Unicellular glands: They are made of single cells
Examples of referred pain: which are interspersed between nonsecretory
epithelial lining, e.g. goblet cell
1. Pain in ovary is referred to umbilicus
2. Pain in testis is referred to abdomen – Multicellular glands: It consists of many cells
3. Pain in diaphragm is referred to right shoulder in sheets or clusters with common secretory
4. Renal pain is referred to loin function, e.g. mucous lining of stomach
5. Tooth pain felt in ear. – Simple tubular glands without ducts: Cells
are arranged in a tubular fashion and open on
Q.4. Write short note on classification of glands. epithelial surface without a duct.
(Mar 2013, 3 Marks) – Simple tubular glands with duct: Secreting cells
Ans. Following is the classification of glands: are arranged in tubular shaped structures with
I. According to mode of secretion upper nonsecretory parts which act as ducts.
– Exocrine glands: Secretions are carried via ducts – Simple branched tubular glands: Consists of
to target cells single duct with branched tubular arrangement
– Endocrine glands: Secretions are secreted of secretory cells.
directly in circulatory system – Simple coiled tubular glands: Secretory part is
– Paracrine glands: Their secretions diffuse locally coiled and they have single duct
to cellular targets in an immediate surrounding. – Simple acinar or alveolar glands: Secretory part
II. According to mechanism of secretion is flask shape with connecting duct.
– Merocrine glands: Secretions are packed into – Compound glands: In these glands ducts are
vesicles. Vesicle membrane fuses with plasma branched. These glands may be branched
membrane to release their contents to exterior, tubuloalveolar or branched tubular or branched
e.g. simple sweat glands alveolar type according to shape of secretory
– Apocrine glands: In these glands some of apical part.
cytoplasm is lost along with secretion, e.g. IV. According to secretion
mammary glands – Mucous secreting or mucus glands: They secrete
– Holocrine glands: Cells are filled with secretory mucous, e.g. sublingual salivary gland.
products and entire cell disintegrate to release – Serous glands: They secrete serum, e.g. parotid
its secretion, e.g. sebaceous glands. gland.
FUNCTIONAL ANATOMY OF MUSCULOSKETAL SYSTEM
Q.2. Describe in brief epiphysis. (Nov 2009, 5 Marks) independent bones which get attached to host bone
Ans. Epiphysis is the rounded end of a long bone, at its joint secondarily to receive nutrition. Example of this is the
with adjacent bone. coracoid process of scapula which has been fused in
• At the joint, epiphysis is covered with articular humans but separate in four legged animals.
cartilage; below that covering is a zone similar to 4. Aberrant epiphysis: These epiphysis are deviations from
the epiphyseal plate, known as subchondral. the normal and are not always present. For example, the
• It is the part of bone which ossifies from secondary epiphyses at the head of the first metacarpal bone.
center
Q.3. Classify bones. (Feb 2013, 5 Marks)
• Epiphysis is filled with red bone marrow, which
produces erythrocytes (red blood cells). Ans. Following is the classification of bones:
According to Shape
♦ Long bones: Each of the long bone consists of an elongated
shaft (diaphysis) and two expanded ends (epiphyses)
which are smooth and articular. Shaft typically consists of
three surfaces separated by 3 borders, a central medullary
cavity, and a nutrient foramen directed away from the
growing end. Examples:
• Typical long bones like humerus, radius, ulna, femur,
tibia and fibula
• Miniature long bones have only one epiphysis like
metacarpals, metatarsals, and phalanges
• Modified long bones have no medullary cavity like
clavicle.
♦ Short bones: Their shape is usually cuboid or scaphoid.
Examples are tarsal and carpal bones.
♦ Flat bones: They resemble as shallow plates and form
boundaries of certain body cavities. Examples are bones
in the vault of the skull, ribs, sternum and scapula.
♦ Irregular bones: Examples are vertebra, hip bone, and
bones in the base of skull.
♦ Pneumatic bones: Certain irregular bones which consists
Fig. 156: Epiphysis of large air spaces which are lined by epithelium. Examples
are maxilla, sphenoid, ethmoid, etc.
Types ♦ Sesamoid bones: These are bony nodules which are found
embedded inside the tendons or joint capsules. They have
There are four types of epiphysis: no periosteum and ossify after birth. Examples are patella,
1. Pressure epiphysis: Region of the long bone that forms the pisiform, fabella, etc.
joint is called pressure epiphysis. For example the head of ♦ Accessory (supernumerary) bones: They are not always
femur which is a part of the hip joint complex is a pressure present. These may occur as ununited epiphyses developed
epiphyses. These epiphyses assists in transmitting the from extra centers of ossification. Examples: sutural bones,
weight of the human body and are the regions of the bone lateral tubercle of talus, tuberosity of 5th metatarsal, etc.
which is under pressure during movement, or locomotion ♦ Heterotopic bones: Bones sometimes develop in soft
hence they are named pressure epiphyses. tissues, e.g. horse riders develop bones in adductor muscles
2. Traction epiphyses: Regions of the long bone which (rider's bones).
are nonarticular, i.e. not involved in the joint formation
is called as traction epiphysis. It is mainly formed due Developmental Classification
to pull of muscles. Traction epiphyses ossify later than ♦ Membrane (dermal) bones: These bones ossify inside
the pressure epiphyses. Examples of these epiphyses are the membrane (intramembranous or mesenchymal
tubercles of humerus (greater tubercle and lesser tubercle), ossification), and are derived from mesenchymal
trochanters of the femur (both greater and lesser), etc. condensations. Examples are bones of the vault of skull
3. Atavistic epiphyses: As Homo Sapiens evolved from as well as facial bones.
being four legged to two legged, their lower limbs became • Cartilaginous bones ossify inside cartilage (intra-
stronger and hands became free from being actively cartilaginous or endochondral ossification), and
involved in locomotion. This fused certain bones together are derived from preformed cartilaginous models.
due to the change in functionality over generations. Examples are bones of limbs, vertebral column and
These type of fused bones are called as Atavistic. These thoracic cage.
Anatomy 121
• Membrano-cartilaginous bones ossify partly inside (bone formation) starts by the osteoblasts situated on the
membrane and partly inside the cartilage. Examples: newly formed capillary loops. The centers of ossification
clavicle, mandible, occipital, temporal, sphenoid. may be primary or secondary. The primary centers appear
♦ Somatic bones: Most of the bones are somatic. before birth usually during 8th week of intrauterine
♦ Visceral bones: These bones develop from pharyngeal life; the secondary centers appear after birth, with a few
arches. Examples are hyoid bones, part of mandible and exceptions of lower end of femur and upper end of tibia.
ear ossicles. Many secondary centers appear during puberty.
Regional Classification A primary center forms diaphysis, and the secondary
centers form epiphyses. Fusion of epiphyses with the
♦ Axial skeleton: It consists of skull, vertebral column, and diaphysis starts at puberty and is complete by the age
thoracic cage. of 25 years, after which no more bone growth can take
♦ Appendicular skeleton: It consists of bones of limbs. place. The law of ossification states that secondary centers
Structural Classification of ossification which appear first are last to unite. The
end of a long bone where epiphysial fusion is delayed
♦ Macroscopically, the architecture of bone may be compact is called the growing end of the bone.
or cancellous:
• Compact bone: It is dense in texture, but is extremely Growth of a Long Bone
porous. It is best developed in the cortex of the long
♦ Bone grows in length by multiplication of cells in the
bones. This is an adaptation to bending and twisting
epiphysial plate of cartilage.
forces.
♦ Bone grows in thickness by multiplication of cells in the
• Cancellous or spongy, or trabecular bone: It is open
deeper layer of periosteum.
in texture and is made up of a meshwork of trabeculae
♦ Bones grow by deposition of new bone on the surface and
between which are marrow containing spaces.
at the ends. This process of bone deposition by osteoblasts
Trabecular meshworks are of three primary types, i.e.:
is called appositional growth or surface accretion.
1. Meshwork of rods
However, in order to maintain the shape the unwanted
2. Meshwork of rods and plates
3. Meshwork of plates. bone must be removed. This process of bone removal by
Cancellous bone is an adaptation to the compressive osteoblasts is called remodelling. This is how marrow
forces. cavity increases in size.
♦ Microscopically: Bone is of five types, namely lamellar,
woven, fibrous, dentine and cementum.
1. Lamellar bone: Most of the mature human bones, 2. JOINTS
either compact or cancellous consist of thin plates of
bony tissue known as lamellae. These are arranged Q.1. Write in brief on fibrous joints.
in piles inside a cancellous bone, but in concentric (Aug/Sep 1998, 4 Marks) (Dec 2010, 5 Marks)
cylinders, i.e. Haversian system or secondary osteon Ans. In fibrous joints bones are joined by fibrous tissue.
inside a compact bone. Fibrous joints are either immovable or permit slight
2. Woven bone: This is seen in fetal bone, fracture repair degree of movement.
and in cancer of bone Fibrous joint are grouped into three types:
3. Fibrous bone: This is found in young fetal bones, but 1. Sutures
is common in reptiles and amphibia. 2. Syndesmosis
4. Dentine
3. Gomphosis
5. Cementum occurs inside the teeth.
Q.4. Write short note on osteogenesis. (June 2010, 5 Marks) Sutures
Ans. Bones are first laid down as mesodermal (connective ♦ They are present only inside the skull.
tissue) condensations. Conversion of mesodermal models ♦ Two of the bones get separated by the connective tissue.
into bone is called intramembranous or mesenchymal ♦ Sutural side of each of the bone is covered by layer of
ossification, and the bones are called membrane (dermal) osteogenic cells or cambial layer, covered by the capsular
bones. layer which is continuous with periosteum.
However, mesodermal stage may pass through ♦ Area between the bones reduces with the age, so osteogenic
cartilaginous stage by chondrification during 2nd month surfaces get opposed.
of intrauterine life. Conversion of cartilaginous model ♦ Sutures become synostose and become obliterated as the
into bone is called intracartilaginous or endochondral age advances.
ossification, and such bones are called cartilaginous ♦ Sutures are peculiar to skull, and are immovable.
bones. ♦ According to the shape of bony margins, the sutures can be:
Ossification takes place by centers of ossification, each • Plane, e.g. internasal suture
one of which is a point where laying down of lamellae • Serrate, e.g. interparietal suture
122 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦ Amphiarthrosis: Permits slight mobility. Most amphiar- of nose and alimentary canal; the coccygeal body; the
throsis joints are cartilaginous joints, e.g. intervertebral erectile tissue of sexual organs; the tongue; the thyroid
discs. gland and sympathetic ganglia.
♦ Diarthrosis: Freely movable. All diarthrosis joints are • Specialized arteriovenous anastomoses are seen inside
synovial joints, e.g. shoulder, hip, elbow, knee, etc. the skin of digital pads as well as nail beds. They form
a number of small units known as glomera.
Regional Classification • Preferential thoroughfare channels are also a kind
♦ Skull type: Immovable. of shunts. They course via capillary network. Many
♦ Vertebral type: Slightly movable. true capillaries arise as their side branches. One
♦ Limb type: Freely movable. thoroughfare channel with its associated capillaries
forms a microcirculatory unit. The size of the unit is
According to Number of Articulating Bones variable from 1–2 to 20–30 true capillaries. The number
♦ Simple joint: When two bones articulate, e.g. inter- of active units varies from time to time.
phalangeal joints Q.2. Write short note on collateral circulation.
♦ Compound joint: More than two bones articulate within (June 2010, 5 Marks)
one capsule, e.g. elbow joint, wrist joint.
Ans. Collateral circulation is the process in which a system
♦ Complex joint: When joint cavity is divided by an
of small, normally closed arteries connect and start to
intra-articular disc, e.g. temporomandibular joint and
carry blood to part of the heart when a coronary artery
sternoclavicular joint.
is blocked, or to part of the brain when a cerebral artery
is blocked. These arteries can serve as alternate routes
of blood supply.
3. CIRCULATORY SYSTEM
Cerebral Collateral Circulation
Q.1. Write short note on anastomosis. (Mar 2006, 3 Marks)
Blood flow to the brain is maintained via a network of collateral
Ans. Precapillary or postcapillary communication between
arteries that anastomose in the circle of Willis, which lies at the
neighboring vessels is known as anastomoses. Circulation
base of the brain. In circle of Willis so-called communicating
via anastomosis is known as collateral circulation.
arteries exist between the front (anterior) and back (posterior)
Types parts of the circle of Willis, as well as between the left and right
side of the circle of Willis.
♦ Arterial anastomoses: This is the communication between
the arteries or branches of arteries. It can be actual or Cardiac Collateral Circulation
potential.
• In an actual arterial anastomosis arteries meet end to Another example is where a person suffers an acute myocardial
end, e.g. palmar arches, plantar arch, circle of Willis, infarction (heart attack). Collateral circulation in the heart tissue
intestinal arcades, labial branches of facial arteries. will sometimes bypass the blockage in the main artery and
• In potential arterial anastomoses communication supply enough oxygenated blood to enable the cardiac tissue
takes place between terminal arterioles. Such to survive and recover.
communications may dilate only gradually for
Collateral Circulation in the Venous System
collateral circulation. So on sudden occlusion of main
artery, anastomoses may fail to compensate the loss, Hepatic cirrhosis arising from chronic congestion in the hepatic
e.g. it is seen in coronary arteries as well as cortical portal vein may give rise to collateral circulation between
branches of cerebral arteries. branches of the portal and caval veins of the liver, or between
♦ Venous anastomoses: This is the communication between the two caval veins. Consequences of newly established venous
veins or the tributaries of veins, e.g. dorsal venous arches collaterals arising from portal hypertension include esophageal
of hand and foot. varices and hemorrhoids (porta-caval collateral circulation).
♦ Arteriovenous anastomosis (shunt): This is a communi-
Q.3. Write short note on pulse points of head and neck.
cation between an artery and a vein. It serves as function
of phasic activity of an organ. (May 2014, 5 Marks)
• When an organ is active such shunts get closed and Ans. Pulse points are those where the arterial pulse is felt.
blood circulates via the capillaries. But, when the organ Following are the pulse points in head and neck:
is at rest, blood bypasses capillary bed and is shunted ♦ Carotid pulse: Common or external carotid artery can be
back via arteriovenous anastomosis. palpated in anterior triangle of neck. It is the strongest
• Shunt vessel can be straight or coiled and possesses pulses in the body. Carotid pulse is obtained by palpating
a thick muscular coat, and is under the influence of either the common carotid artery posterolateral to larynx
sympathetic system. or external carotid artery immediately lateral to pharynx
• Shunts of simple structure are found inside skin of midway between superior margin of thyroid cartilage
nose, lips and external ear; in the mucous membrane below and greater bone of hyoid bone below.
126 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Fig. 161: Pulse points of head and neck. Each pulse point
is named after the artery it is associated with
GENETICS
Symptoms
As in many diseases of all types, symptoms between the
individuals vary in severity and presence.
♦ Most common deformity is short stature, starting out at
birth and continuing for the rest of a individual’s life
♦ About 90% of women experience early ovarian failure,
so that there are only enough hormones and egg cells
produced by the ovaries so that only secondary sexual
development occurs (poor breast development/ irregular
nipple spacing, no menstruation)
♦ Webbed neck (fold of skin stretching from the end of
shoulder to the bottom of chin)
♦ Small, narrow fingernails and toenails that turn up
♦ Elbow deformity called cubitus valgus (arms that turn out
slightly at the elbows)
♦ Nevi (brown spots appearing sparatically on the skin)
♦ Narrow, high-arched palate (roof of the mouth) Fig. 162: Turner syndrome
♦ Retrognathia (receding lower jaw)
Mental Problems
♦ Low-set ears and low hairline
♦ Slight droop to eyes ♦ On an average, most turner syndrome females have an
♦ Strabismus (lazy eye) overall normal intelligence with a variance similar to that
♦ Broad chest of the general population.
♦ Scoliosis (curvature of the spine) ♦ Spatial-temporal processing (imagining objects in relation
♦ Flat feet to each other) difficulties.
♦ Short fourth metacarpals (the ends of these bones form ♦ Nonverbal memory complexities.
the knuckles) ♦ Attention difficulties.
♦ Edema (fluid overload causing noticeable swelling) of These may cause further problems such as trouble with math, a poor
hands and feet especially at birth sense of direction, little manual dexterity, and poor social skills.
♦ Cardiac abnormalities including hypertension (high Karyotype of Turner Syndrome
blood pressure), dissection of the aorta, and a coarctation
(narrowing) of the aorta and bicuspid aortic valve (a valve ♦ Turner syndrome is the monosomy of sex chromosome.
with two leaflets instead of the usual three) ♦ For Turner syndrome the karyotype is 45, XO which is the
♦ Kidney problems that may result in urinary tract infections monosomy of X chromosome.
or an increased risk for hypertension ♦ Here one chromosome is missing, so no Barr body is seen,
♦ Hypothyroidism (low level of thyroid hormone) caused by though the individual is female.
autoimmune thyroiditis (inflammation of thyroid gland) Q.2. Write notes on Down syndrome. (Mar 2006, 5 Marks)
♦ Otitis media (ear infection), mainly in early childhood or (Apr 2010, 5 Marks) (Dec 2010, 3 Marks)
infancy. (Sep 2013, 5 Marks) (Sep 2015, 5 Marks)
♦ Sensorineural (nerve) hearing loss. (Apr 2017, 4 Marks) (Jan 2018, 5 Marks)
128 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Ans. Down syndrome is also known as mongolism or trisomy ♦ By adulthood, XXY males look similar to males without
21. the condition, although they are often taller. They are
♦ Down syndrome is the most common congenital also more likely than other men to have certain health
anomaly which occurs because of nuclear aberration of problems, such as autoimmune disorders, breast cancer,
chromosomes. vein diseases, osteoporosis, and tooth decay.
♦ Dr down describe this syndrome in 1866.
♦ In down syndrome there is trisomy of chromosome 21. Karyotype of Klinefelter Syndrome
The number of chromosomes is 47, i.e. 47XX or 47XY. Sex ♦ Cases of Klinefelter have karyotype of 47, XXY with some
can be either male or female. It is seen to occur as 1 in 700 of the individuals showing mosaic pattern.
newborn. ♦ Here the individual is male with an extra X chromosome.
♦ It is seen in elderly primigravida or mother suffering from ♦ As there are two X chromosomes, one Barr body is present.
viral infection during pregnancy.
♦ In elderly primigravida the syndrome occur due to the
aging of the ovum. Since sperms form fresh everytime, so
aging factor is not applied for sperms.
♦ Males are more commonly affected than females.
Clinical Features of Down Syndrome
♦ Presence of mental retardation
♦ Palpebral fissure slant upwards at lateral end
♦ Protrusion of tongue out of the mouth
♦ Presence of flat nasal bridge
♦ On the eyes there is presence of epicanthic folds
♦ Short broad hands with simian crease
♦ Presence of small ears and small head circumference
Karyotype of Down’s Syndrome
♦ Trisomy of 21st chromosome most commonly leads to
Down syndrome.
♦ Karyotype in a trisomic Down is either 47 + XY or 47 + XX
♦ Source of extra 21st chromosome is mostly from nondys-
junction in maternal meiosis.
Q.3. Write a short note on Klinefelter syndrome.
(Dec 2012, 5 Marks) (Dec 2014, 5 Marks)
(Aug 2018, 5 Marks) (July 2016, 5 marks)
Ans. 47, XXY, or XXY syndrome is a condition in which human
males have an extra X chromosome.
Fig. 163: Klinefelter syndrome
♦ Females have an XX chromosomal makeup, and males an
XY, affected individuals have at least two X chromosomes Q.4. Write short note on karyotypes of Klinefelter and
and at least one Y chromosome. Because of the extra
Turner syndrome. (Sep 2017, 4 Marks)
chromosome, individuals with the condition are usually
Ans. Identification of chromosomes according to the length
referred to as “XXY Males”, or “47, XXY Males”.
of arms including position of centromere is known as
♦ In humans, Klinefelter syndrome is the most common
karyotyping.
sex chromosome disorder and the second most common
condition caused by the presence of extra chromosomes. Karyotype of Klinefelter’s syndrome
♦ Affected males are almost always effectively infertile.
♦ Cases of Klinefelter have karyotype of 47, XXY with some
Features of Disease of the individuals showing mosaic pattern.
♦ Language learning impairment may be present. ♦ Here the individual is male with an extra X chromosome.
♦ In adults, possible characteristics vary widely and include ♦ As there are two X chromosomes, one Barr body is present.
little to no signs of affectedness, a lanky, youthful build
Karyotype of Turner’s Syndrome
and facial appearance, or a rounded body type with
gynecomastia (increased breast tissue). ♦ Turner syndrome is the monosomy of sex chromosome.
♦ Individual has very small pair of testes but a normal penis ♦ For Turner syndrome the karyotype is 45, XO which is the
and scrotum. monosomy of X chromosome.
♦ Secondary sexual characters do not develop fully and pubic ♦ Here one chromosome is missing, so no Barr body is seen,
and facial hair is scanty. though the individual is female.
NEUROANATOMY
Course
First neuron fiber starts in dorsal root ganglia. They relay by
synapsing with neurons which lie in the gray matter of lamina
II and III. Pain fibers relay in lamina II. Second neuron fibers
cross immediately to opposite sides close to central canal and
ascend as tract in lateral white column of spinal cord. 3rd order
neurons lie in the ventro-posterolateral nucleus of thalamus
and axons of these neurons ascend through the internal capsule
and then the thalamic radiations to area no. 3, 1, 2 of the Fig. 165: Lateral spinothalamic tract
cerebral cortex. (For colour version see Plate 3)
132 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Fig. 169: Arterial supply of spinal cord: A. Anterior view, B. Posterior view (For colour version see Plate 3)
Venous Drainage
Veins draining the cord form six longitudinal venous channels
around the cord, i.e.
♦ Two median longitudinal, one in the anterior median
fissure and other in the posteromedian sulcus.
♦ Two anterolateral, one on either side, posterior to the
anterior nerve roots.
♦ Two posterolateral, one on either side posterior to the
posterior nerve roots.
Fig. 173: Transverse section at midcervical region (For colour version see Plate 5)
In the lower part of medulla majority of fibers cross to the Uncrossed fibers descend in anterior white column of spinal
opposite side at pyramidal decussation of medulla and descend cord as anterior corticospinal tract. Anterior corticospinal tract
in lateral white column of spinal cord as lateral corticospinal is located in anterior white column close to anterior median
tract. Lateral corticospinal tract consists of some fibers which fissure.
arise from ipsilateral cerebral cortex. Lateral corticospinal tract At the lower level fibers of anterior corticospinal tract cross
is located in lateral white column in front of posterior horn and to opposite side in the anterior white commissure of spinal cord
medial to posterior spinocerebellar tract. at the level of their termination.
Anatomy 137
Fig. 175: Position of various ascending and descending tracts in transverse section of spinal cord
Course of Intracranial Part of Facial Nerve ♦ Greater petrosal nerve: It arises from the geniculate
Facial nerve is attached to brainstem by two roots, i.e. motor ganglion and leaves the middle ear through tegmen
and sensory. Sensory root is known as nervus intermedius. tympani. It joins with the deep petrosal nerve to form
nerve to pterygoid canal. This nerve conveys secretomotor
Two roots of facial nerve are attached to lateral part of lower
supply to the lacrimal gland, nasal as well as palatal glands.
border of pons medial to vestibulocochlear nerve. Two roots
They relay in the pterygopalatine ganglion. Postganglionic
run laterally and forward along with vestibulocochlear nerve
fibers for lacrimal gland join zygomatic nerve and pass
to reach internal acoustic meatus.
through communicating branches to lacrimal nerve and
In internal acoustic meatus motor root lies in groove on lacrimal gland.
vestibulocochlear nerve with sensory root intervening. Here ♦ Nerve to stapedius: This arises in the facial canal behind
facial nerve and vestibulocochlear nerve are accompanied by the middle ear and runs forward through a short canal to
labyrinthine vessels. At fundus of meatus the two roots sensory reach and supply the stapedius muscle.
and motor fuse to form a single trunk which lies in petrous ♦ Chorda tympani nerve: It arises in the facial canal about
temporal bone. Within the canal the course of nerve is divided 6 mm above the stylomastoid foramen and enters the
by three parts by two of its bands. middle ear. It passes forward across the inner surface of
First part is directed laterally above the vestibule and second the tympanic membrane internal to the handle of malleus
part run backward in relation to medial wall of middle ear above and then leaves the middle ear by passing through the
promontory and third part is directed vertically downward petrotympanic fissure to appear at the base of skull. Here
behind promontory. First bend at junction of first and second it runs downwards and forward in the infratemporal fossa
part is sharp and is known as genu. and joins the lingual nerve at an acute angle. The chorda
tympani nerve carries:
Second bend lies between promontory and aditus to the
Preganglionic secretomotor fibers to submandibular
mastoid antrum. Facial nerve leaves the skull by passing
ganglion for supply of submandibular and sublingual
through stylomastoid foramen.
salivary glands.
Branches of Intracranial Part of Facial Nerve Taste fibers from anterior two-third of the tongue
except circumvallate papillae.
Following are the branches intracranial part of facial nerve: ♦ Posterior auricular nerve: It arises just below the
1. Within the facial canal stylomastoid foramen. It ascends in between the mastoid
Greater petrosal nerve process and external acoustic meatus and supplies to
Nerve to stapedius Auricularis posterior
Chorda tympani nerve Occipitalis
2. At exit from stylomastoid foramen Intrinsic muscles on back of auricle
Posterior auricular ♦ Digastric branch: It arises near the origin of posterior
Digastric auricular nerve. The nerve is short and supplies the
Stylohyoid posterior belly of digastric.
Anatomy 139
5. THE BRAINSTEM
Q.4. Draw a labeled diagram of transverse section of medulla ♦ Central gray matter is pushed backwards.
oblongata at the level of pyramidal decussation. ♦ Nucleus gracilis and nucleus cuneatus appear as narrow
(Sep 2007, 3 Marks) (Mar 2008, 3 Marks) strip like projections and are continuous with central gray
Or matter.
Write short note on section of medulla oblongata at White Matter
the level of motor decussation. (Sep 2017, 3 Marks) ♦ Pyramids, anteriorly
Ans. ♦ Decussation of pyramidal tract form most important
The section at this level passes via the inferior half of medulla feature of medulla at the level of motor decussation. Fiber
and resemble closely to that of spinal cord. of each run backward as well as laterally to reach lateral
white column of spinal cord where they form lateral
Gray Matter corticospinal tract.
♦ Decussating pyramidal fibers separate anterior horn from ♦ Fasciculus gracilis and fasciculus cuneatus occupy broad
central gray matter. Separated anterior horn form spinal posterior white column.
nucleus of accessory nerve laterally and supraspinal ♦ Other features of white matter are similar to that of spinal
nucleus for motor fibers of first cervical nerve medially. cord.
Q.5. Write a short note on red nucleus. It is 0.5 cm in diameter and lies dorsomedial to
(Feb 2005, 5 Marks) (Mar 2009, 5 Marks) substantia nigra.
It appears red in fresh specimen because of high
• Red nucleus is a cigar shaped mass of gray matter. vascular supply and iron containing pigment present
It appears oval shaped in cross-section. in cytoplasm of its cells.
142 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Fig. 181: Transverse section of pons at the level of facial nerve nucleus
Q.7. Draw a well labeled colored diagram of TS of midbrain passing at the level of superior colliculus.
(Aug 2011, 10 Marks)
Or
(Sep 2015, 10 Marks)
Ans.
♦ Vertical limbs of T shaped structure reach the median cerebellar peduncle (ventrally) and peduncle of flocculus
aperture and project into the subarachnoid space via it. dorsally reaching as far as the medial part of flocculus.
The lateral ends of horizontal limbs reach lateral apertures. ♦ One of the recess which is present in the median plane is
called as median dorsal recess. This extends dorsally in
Communication white core of cerebellum and lies cranial to nodule.
Cavity of the fourth ventricle communicates inferiorly with the ♦ Two lateral dorsal recesses, one over each side. Each lateral
central canal and superiorly with cerebral aqueduct. dorsal recess get extend dorsally lateral to nodule and
cranial to inferior medullary velum. These lie over either
Openings Present Inside the Roof side of median dorsal recess.
♦ Inside the caudal part of roof of fourth ventricle there are
three openings present, i.e. one median and two lateral.
♦ Median aperture of fourth ventricle alternatively known
as foramen of Magendie is a large opening which
is situated caudal to nodule. This opening provides
principal communication between the ventricular system
and subarachnoid space. The lateral apertures are also
called as foramina of Luschka and are situated at the
ends of lateral recesses and are partly occupied by parts
of choroid plexuses. Through these fourth ventricle also
communicates with subarachnoid space.
Angles
Following are the angles present, i.e.
♦ Superior angle: It is continuous with cerebral aqueduct.
♦ Inferior angle: It is continuous below with central canal
of spinal cord.
♦ Lateral angle: It lies one on each side towards the inferior
cerebellar peduncles.
(Aug 2018, 2 Marks)
Ans. Inside the caudal part of roof of fourth ventricle there are
three openings present, i.e. one median and two lateral.
Median aperture of fourth ventricle alternatively
known as foramen of Magendie is a large opening
which is situated caudal to nodule. This opening
provides principal communication between,
ventricular system and subarachnoid space.
The lateral apertures are also called as foramina
of Luschka and are situated at the ends of lateral
recesses and are partly occupied by parts of choroid
plexuses. Through these fourth ventricle also
communicates with subarachnoid space.
Fibers of Internal Capsule ♦ Inferior thalamic radiation: They connect medial geniculate
body with primary auditory cortex.
There are three types of fibers present in internal capsule, i.e.
motor fibers, sensory fibers and constituent fibers. Constituent Fibers
Motor Fibers Following are the constituent fibers:
♦ Corticopontine fibers lie in the anterior limb, genu and Part of an
posterior limb. internal
♦ Frontopontine fibers begin from the frontal lobe to reach capsule Descending tract Ascending tract
pontine nuclei where they relay to reach opposite cerebellar Anterior limb Frontopontine Anterior thalamic
hemisphere. These are known as corticopontocerebellar fibers which is a radiation, i.e. fibers from
fibers. part of cortico– anterior and medial nuclei
pontocerebellar of thalamus
♦ Parietopontine and occipitopontine fibers lie inside the
pathway
retrolentiform part of internal capsule.
♦ Temporopontine fibers lie in the sublentiform part of Genu Corticonuclear fibers, Anterior part of superior
internal capsule. i.e. part of pyramidal thalamic radiation, i.e.
tract which is going to fibers from posterior
Pyramidal Fibers motor nuclei of cranial ventral nucleus of
nerves and forming thalamus
♦ Corticonuclear to nuclei of IIIrd, IVth, Vth, VIth, VIIth, their supranuclear
XIIth and nucleus ambiguus for IXth, Xth, XIth nerves of pathway
opposite side. Posterior limb • Corticospinal tract • Superior thalamic
♦ Corticospinal: These are the fibers for anterior horn cells of i.e. pyramidal tract radiation
muscles of head and neck which lie in the genu. for upper limb, • Fibers from globus
♦ Fibers for the upper limb, trunk and lower limb lie in the trunk and lower pallidus to subthalamic
posterior limb of internal capsule in the sequential order. limb nucleus
• Corticopontine
Extrapyramidal Fibers fibers
• Corticorubral fibers
They start from cerebral cortex as corticostriate and corticorubral
fibers and reach corpus striatum and red nucleus. Retrolentiform • Parietopontine and Posterior thalamic radiation
part occipitopontine is formed of:
Sensory Fibers fibers • Optic radiation mainly
• Fibers from or partly by the fibers
Thalamocortical fibers form thalamic radiations, i.e. 3rd order occipital cortex to connecting thalamus
neuron fibers: superior colliculus to parietal and occipital
♦ Anterior thalamic radiation: Fibers from the anterior and and pretectal lobes
region
dorsomedial nuclei of thalamus terminate inside the cortex
at frontal lobe. Sublentiform • Parietopontine and • Auditory radiation
♦ Superior thalamic radiation: Fibers of ventral group of part temporopontine • Fibers connecting
nuclei of thalamus reach sensory areas of frontal and the fibers thalamus to temporal
• Fibers between lobe
parietal lobes.
temporal lobe and
♦ Posterior thalamic radiation: All these fibers connect the thalamus
lateral geniculate body to area 17 and form optic radiation.
♦ Pharyngeal region and tongue are represented in most cingulated gyrus. These include Brodmann s areas 9, 10,
ventral and lower part of precentral gyrus which is 11 and 12.
followed by face, hand, arm, trunk and thigh. Remainder ♦ Prefrontal cortex is connected to other areas of cerebral
of leg, foot and perineum is over medial surface of cortex, corpus striatum, thalamus and hypothalamus.
hemisphere inside paracentral lobule. ♦ It is connected to cerebellum via pontine nuclei.
♦ Another significant feature of this area is the size of cortical ♦ This area controls emotions, concentration, attention,
area for particular part of body is determined by functional initiative and judgement.
importance of part and its need for both sensitivity and
intricacy of movements in that region. Sensory Areas
Premotor Area First Somesthetic Area
♦ It coincides with Brodmann area 6 and is situated anterior ♦ It is the general sensory area and is also known as first
to motor area in superolateral and medial surfaces of somatosensory area (Sm I).
hemisphere. ♦ This area occupies postcentral gyrus on superolateral
♦ This area contributes to motor function by its direct surface of cerebral hemisphere and posterior part of
contribution to pyramidal and other descending motor paracentral lobule on the medial surface. This correspond
pathways. It also carries this by its influence on primary to areas 3, 1 and 2 of Brodmann.
motor cortex. ♦ Representation of body in this area is contralateral half of
♦ Premotor area program skilled motor activity and directs body is represented upside down except the face.
primary motor area in its execution. ♦ Area of cortex which receives sensation from a particular
♦ Both premotor as well as primary motor areas together part of body is not proportional to size of that part, but
referred as somatomotor area (Ms I). Both areas provide rather to intricacy of sensations received from it. So thumb,
origin to corticospinal and corticonuclear fibers and also fingers, lip and tongue have disproportionately large
receive fibers from the cerebellum after relaying in ventral
representation.
intermediate nucleus of thalamus.
♦ Different sensations, i.e. cutaneous and proprioceptive
Supplementry Motor Area (Ms II) are represented in different parts inside the sensory area.
♦ Ventral posterior nucleus of thalamus is the main source
♦ This is predominantly motor in its function.
♦ This area is in the part of area 6 which lie over medial of afferent fibers for sensory area. This nucleus is the site
surface of hemisphere anterior to paracentral lobule. of termination of all fibers of medial lemniscus.
♦ Different parts of body are represented in this area. ♦ Most fibers of spinothalamic and trigeminothalamic tract
carry fibers for cutaneous sensibility end at anterior part of
Motor Speech Area of Broca’s area and those for deep insensibility end at posterior part.
♦ It occupies both opercular and triangular portions of Second Somesthetic Area
inferior frontal gyrus which correspond to area 44 and 45
of Brodmann. ♦ It is also called as second somatosensory area (Sm II).
♦ This is present over left side in 98% of right handed persons. ♦ It is situated in superior lip of posterior ramus of lateral
In 70% of left handers it is present in left hemisphere. Only sulcus with postcentral gyrus.
in 30% of people it is present in right hemisphere. ♦ Parts of body are represented bilaterally.
Frontal Eye Field Somesthetic Association Cortex
♦ This lies inside the middle frontal gyrus just anterior to ♦ It lies in superior parietal lobule over superolateral surface
precentral gyrus. of hemisphere and in precuneus over medial surface.
♦ This is the lower part of area 8 of Brodmann over lateral ♦ It coincides with areas 5 and 7 of Brodmann.
surface of cerebral hemisphere, extending slightly beyond ♦ This area receives afferent from first sensory area and has
this area. reciprocal connection with dorsal tier of nuclei of lateral
♦ Electrical stimulation inside this area leads to deviation mass of thalamus.
of both eyes to opposite side. This is known as conjugate
movement of eyes. Receptive Speech Area of Wernicke
♦ Movement of head as well as dilatation of pupil can also ♦ It is also known as sensory language area.
take place. ♦ It has auditory association cortex and of adjacent parts of
♦ Frontal eye field is connected to the cortex of occipital lobe inferior parietal lobule. i.e. area 22.
which is concerned with the vision.
Areas of Special Sensations
Prefrontal Cortex
Vision
♦ It is the large area which lie precentral area.
♦ It consists of superior, middle and inferior frontal gyri; ♦ Visual area is located both above and below the calcarine
medial frontal gyrus; orbital gyri and anterior half of sulcus over medial surface of occipital lobe.
Anatomy 155
A B
Fig. 199: Functional areas of: A. Superolateral surface of cerebral hemisphere; B. Medial surface of cerebral hemisphere
In this condition, patient is unable to recognize objects of hearing in both ears and loss is greater in opposite
held in hand, while eyes are closed. Person is not able to ear. Impairment is less because of bilateral projection
correlate surface, texture, shape, size and weight of object to the cortex.
or compare the sensation with previous experience. Auditory association cortex or secondary area 22:
Special Sensory Areas Lesion at this region causes loss of sound interpretation.
♦ Primary visual area 17: Lesion in this region causes loss Q.10. Draw diagram of superolateral surface of cerebrum.
of vision in visual field of opposite side, i.e. homonymous (Feb 2013, 5 Marks)
hemianopia Or
♦ Auditory area Draw and label the superolateral surface of cerebrum.
Primary auditory areas 41 and 42: Unilateral lesion (Mar 2007, 3 Marks)
involving auditory area leads to diminution in acuity
Fig. 201: Superolateral surface of cerebral hemisphere showing sulci and gyri (For colour version see Plate 6)
Anatomy 157
Frontal lobe is further divided by following sulci i.e. ♦ Each lateral ventricle communicates with the third
– Precentral gyrus run parallel to central sulcus ventricle through interventricular foramen/foramen of
mostly little in front of it. Precentral gyrus lie Monro.
between two sulci. Each lateral ventricle consist of:
– Area which lie in front of precentral sulcus ♦ Central part.
is divided into superior, middle and inferior ♦ Three horns, i.e. anterior, posterior and inferior.
frontal gyri by superior and inferior frontal sulci.
– Anterior horizontal and anterior ascending rami Central Part
of lateral sulcus subdivides the inferior frontal This part extends from the intraventricular foramen in front to
gyrus into three parts, i.e. pars orbitalis, pars splenium of corpus callosum behind.
triangularis and pars opercularis.
Parietal lobe is further divided by following sulci, i.e. Boundaries
– Postcentral sulcus runs parallel to central sulcus,
Roof: Undersurface of corpus callosum.
little behind it. Postcentral gyrus lies between
two sulci. Floor: Formed lateral to medial side by:
– Area behind postcentral gyrus is divided into ♦ Body of caudate nucleus.
superior and inferior parietal lobules by intra- ♦ Stria terminalis
parietal sulcus. ♦ Thalomostriate vein
– Inferior parietal lobule is invaded by upturned ♦ Lateral portion of upper surface of thalamus.
ends of posterior ramus of lateral sulcus and Medial Wall
of superior and inferior temporal sulci. These
all divide inferior parietal lobule into three ♦ Septum pellucidum.
parts, i.e. anterior, middle and posterior parts. ♦ Body of fornix.
Anterior part is known as supramarginal gyrus
Choroid Fissure
and middle part is known as angular gyrus.
Both superior and inferior temporal sulci divide ♦ It is the line along which the choroid plexus invaginates
temporal lobe into superior, middle and inferior into the lateral ventricle.
temporal gyri. ♦ This is a C-shaped slit inside the medial wall of cerebral
Occipital lobe is further subdivided by following hemisphere.
sulci: ♦ Choroid fissure begins at interventricular foramen and
– Lateral occipital sulcus divides this lobe into passes around the thalamus and cerebral peduncle to
superior and inferior occipital gyri. uncus. So, it is present only in relation to central part and
– Lunate sulcus leads to separation of these gyri inferior horn of lateral ventricle.
from occipital pole. ♦ Convex margin of choroid fissure are bounded by fornix,
Area around the parieto-occipital sulcus is arcus fimbria and hippocampus, while the concave margin is
parieto-occipitalis. This is separated from superior bounded by thalamus, tail of caudate nucleus and stria
occipital gyrus by transverse occipital sulcus. terminalis.
♦ At fissure, pia matter and ependyma contact with each
Q.12. Enumerate parts of corpus callosum.
(Sep 2017, 2 Marks) other and both are invaginated into the ventricle by
Or choroid plexus.
Name the parts of corpus callosum. ♦ In the central part of lateral ventricle, choroid plexus is
(Aug 2018, 1 Mark) the narrow gap between the edge of fornix and upper
surface of thalamus. Invagination of gap is by choroid
Ans. Following are the parts of corpus callosum:
plexus.
Genu
Rostrum Horns
Trunk or body
♦ Anterior horn: It lies in front of the intraventricular
Splenium.
foramen and extends into the frontal lobe. Anterior horn is
directed forward, laterally and downward, it is triangular
in cross-section.
9. THE THIRD VENTRICLE, LATERAL ♦ Posterior horn: It lies behind the splenium of corpus
VENTRICLE AND LIMBIC SYSTEM callosum extends in occipital lobe. It is directed backward
and medially.
Q.1. Briefly describe lateral ventricle of brain. ♦ Inferior horn: It is the largest horn of lateral ventricle
(Apr 2010, 5 Marks) which start at the junction of central part with the posterior
Ans. Lateral ventricle are two irregular cavity which lies in horn of lateral ventricle and extends into the temporal
each cerebral hemisphere. lobe.
158 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Posteriorly
(Mar 2006, 4 Marks) ♦ Occipital artery
Ans. ♦ Posterior auricular artery.
Branches of External Carotid Artery Medially
It gives off 8 branches which are: ♦ Ascending pharyngeal artery.
Anteriorly Terminally
♦ Superior thyroid artery ♦ Maxillary artery.
♦ Lingual artery ♦ Superficial temporal artery.
♦ Facial artery. For description of Circle of Willis refer to Ans 2 of same chapter.
160 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦ Below the external intercostal muscle the clavipectoral Origin of plexus may shift by one segment either
fascia continues as suspensory ligament which is attached upward or downward, resulting in prefixed or
to the dome of axillary fascia and helps to keep it pulled up. postfixed plexus.
♦ Clavipectoral fascia is pierced by: • In prefixed plexus, contribution by C4 is large and that
Lateral pectoral nerve form T2 is often absent.
Cephalic vein • In postfixed plexus, contribution by T1 is large, T2 is
Thoracoacromial vessels. always present, C4 is absent and C5 is reduced in size.
Lymphatics passing from breast and pectoral region Roots join to form trunk.
to apical group of axillary lymph nodes. 2. Trunks
Roots C5 and C6 join to form the upper trunk.
Roots C7 forms the middle trunk.
2. AXILLA Roots C8 and T 1 joins to form the lower trunk.
3. Divisions of the trunks: Each trunk divides into ventral
and dorsal divisions. These divisions join to form
cords.
4. Cords:
Lateral cord is formed by the union of the ventral
division of the upper and middle trunks.
The medial cord is formed by the ventral division of
(Sep 2006, 3 Marks)
the lower trunk.
Or Posterior cord is formed by the union of dorsal division
of all the three trunks.
(Dec 2009, 5 Marks)
Branches of Brachial Plexus
Or
A. Branches of the root
Enumerate branches of posterior cord of brachial
1. Nerve to serratus anterior (C5, C6, C7)
plexus. (Do not describe) (Feb 2013, 2 Marks) 2. Nerve to rhomboids (C5)
Ans. Formation of Brachial Plexus 3. Branches to longus colli and scaleni muscles and
The plexus consist of roots, trunks, divisions and cords. branch to phrenic nerve.
1. Roots B. Branches of the trunk: These arises only from the upper
They are constituted by anterior primary rami of spinal trunk. It gives two branches:
nerves C5, C6, C7, C8 and T1, with contributions from 1. Suprascapular nerve (C5, C6)
anterior primary rami of C4 and T2. 2. Nerve to subclavius (C5, C6)
C. Branches of the cords The deformity is also known as policeman s tip hand or
1. Branches of the lateral cord Porter s tip hand .
a. Lateral pectoral (C5 C7)
b. Musculocutaneous (C5 C7) Disability
c. Lateral root of median (C5 C7). The following movements are lost:
2. Branches of Medial Cord
1. Abduction and lateral rotation of the arm at shoulder joint.
a. Medial pectoral (C8, T1)
2. Flexion and supination of forearm.
b. Medial cutaneous nerve of arm (C8, T1)
3. Biceps and supinator jerks are lost.
c. Medial cutaneous nerve of forearm (C8, T1)
4. Sensations are lost over a small area over the lower part
d. Ulnar (C7, C8, T1). C7 fibers reach by communicat-
of the deltoid.
ing branch from lateral root of median nerve.
e. Medial root of median (C8, T1) Q.3. Write briefly on Erb’s point and Erb’s paralysis.
3. Branches of posterior cord (Aug 2011, 5 Marks)
a. Upper subscapular (C5, C6) Ans. Erb’s Point
b. Nerve to latissimus dorsi (C6, C7, C8)
Erb s point is the one region of upper trunk of brachial
c. Lower subscapular (C5, C6)
plexus.
d. Axillary (C5, C6)
e. Radial (C5 C8, T1). Erb s point is the meeting junction of six nerves, i.e.
A. Ventral ramus of cervical five segment of spinal cord.
Q.2. Write short note on Erb’s paralysis.
B. Ventral ramus of cervical six segment of spinal cord
(Aug 2005, 4 Marks) (Apr 2008, 5 Marks)
(June 2010, 5 Marks) (Aug 2011, 5 Marks) The above two rami join and form upper trunk i.e.
Ans. Injury to the upper trunk of brachial plexus causes Erb s C. Suprascapular nerve from upper trunk
paralysis. D. Nerve to subclavius from upper trunk
E Anterior division of upper trunk
In Erb s paralysis arm cannot be abducted. Elbow is
F. Posterior division of upper trunk.
extended and forearm is pronated. This is Erb s paralysis.
The above divisions give fibers to deltoid, brachialis,
Causes of Injury biceps brachii and supinator.
1. Birth injury
Erb’s Paralysis
2. Fall on shoulder
3. During anesthesia. Refer to Ans 2 of same chapter.
superior border of scapula and medial aspect of coracoid process, Posterior Wall
medially it is bounded by outer border of first rib. This oblique
It is formed by subscapularis above, teres major and latissimus
passage is known as cervicoaxillary canal and axillary vessels,
dorsi below.
axillary veins and brachial plexus pass via this canal to enter axilla.
Medial Wall
Base
It is convex laterally and is formed by upper four ribs with
It is directed downwards. It is formed by skin, superficial, intercoastal muscles and upper part of serratus anterior
axillary fasciae. This is convex upwards in congruence with muscle.
concavity of axilla.
Lateral Wall
Anterior Wall
It is narrow and is formed by Upper part of shaft of humerus
It is formed by pectoralis major in front, clavipectoral fascia in bicipital groove and Coracobrachialis and short head of
and pectoralis major. biceps brachii.
Fig. 211: Wall and contents of axilla (For colour version see Plate 7)
Action
1. Acromial fibers are powerful abductors of the arm at
shoulder joint from starting to 90°.
2. Anterior fibers are flexors and medial rotators of the arm.
3. Posterior fibers are extensors and lateral rotators of the arm.
Structures Under Cover of Deltoid
Bones
♦ Upper end of humerus
♦ Coracoid process
Muscles
There are insertions of:
♦ Pectoralis minor on the coracoid process
♦ Supraspinatus, infraspinatus and teres minor on greater
tubercle of humerus Fig. 212: Origin and Insertion of deltoid
166 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.2. Write in short on quadrangular space. When median cubital vein is absent, the basilic vein
(Aug 2012, 5 Marks) is preferred over cephalic because former is more
Ans. Quadrangular space is one of the three intermuscular efficient. Basilic vein run along straight path whereas
spaces of the scapular region. cephalic vein bend acutely to drain into axillary vein.
In 3% of individuals the ulnar artery may arise high
It is the space in between scapular muscles. in arm and passes superficial to flexor muscles or
forearm and is known as superficial ulnar artery.
Boundaries
This variation should be keep in mind while giving
♦ Superiorly: intravenous injections, because if superficial ulnar
1. Subscapularis in front artery is mistaken for a vein it can be damaged and
2. Capsule of shoulder joint produce bleeding. If an irritating drug is injected
3. Inferior border of teres minor behind. into the artery the result can be fatal.
♦ Inferiorly: Superior border of teres major.
♦ Medially: Lateral border of long head of triceps brachii.
♦ Laterally: Surgical neck of humerus. 5. ARM
Contents Q.1. Write briefly on cubital fossa.
♦ Axillary nerve. (May/June 2009, 5 Marks) (Aug 2011, 5 Marks)
♦ Posterior circumflex humeral vessels. Ans. Cubital fossa is a triangular hollow fossa that is situated
on the front of the elbow.
Fig. 215: Contents of cubital fossa Fig. 216: Biceps brachii muscle
(For colour version see Plate 7) (For colour version see Plate 8)
168 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦ Transverse diameter is increased by elevation for 7th to Boundaries of Typical Intercostal Space
10th ribs.
♦ Superiorly: Sharp lower margin of upper rib and its cartilage.
♦ Vertical diameter is increased by descent of diaphragm.
♦ Inferiorly: Blunt upper margin of lower rib and its cartilage.
Deep Inspiration ♦ Anteriorly: Lateral border of sternum between costal
♦ Movements at the time of deep respiration are increased. notches.
♦ First rib is elevated directly by scalene and indirectly by ♦ Posteriorly: Body of corresponding thoracic vertebra.
sternocleidomastoid.
Contents of Typical Intercoastal Space
♦ Concavity of thoracic spine is decreased by erector spinae.
1. Intercostal muscles.
Forced Inspiration
2. Intercostal arteries: Two anterior and one posterior
♦ Here the movements which are described are exaggerated. intercostals artery in each space.
♦ Scapula is elevated and gets fixed by trapezius, levator 3. Intercostal veins: Anterior and posterior intercostals veins.
scapulae and rhomboids so that serratus anterior and 4. Intercostal nerves: One nerve in each space.
pectoralis minor muscles can act on ribs. 5. Intercostal muscles: External intercostal muscle, Internal
♦ Action of erector spinae is increased. intercostal muscle and Inner intercostal muscle.
Expiration Applied Anatomy of Typical Intercostal Space
♦ Quiet expiration: Air gets expelled by elastic recoil of ♦ Local irritation of the intercostal nerves by such conditions
chest wall and pulmonary alveoli and partly by tone of as Pott’s disease of the thoracic vertebrae (tuberculosis)
abdominal muscles. may give rise to pain that is referred to the front of the chest
♦ Deep and forced expiration: It is carried out by strong
or abdomen in the region of the peripheral termination of
contraction of abdominal muscles and latissimus dorsi.
the nerves.
♦ Local anesthesia of an intercostal space is easily produced
by infiltration around the intercostal nerve trunk and
7. WALL OF THORAX its collateral branch a procedure known as intercostal
nerve block.
♦ Insertion of an emergency chest drain. For example for a
(Oct 2014, 3+3+2 Marks) traumatic haemopneumothorax, is performed through the
a. Boundaries b. Contents 5th intercostal space in the midaxillary line.
c. Applied Anatomy
Ans. Space intervening between typical ribs and traversed by
vessels and nerves which are confined to the thoracic 8. THORACIC CAVITY AND PLEURAE
wall are known as typical intercostal space. Third, fourth,
fifth and sixth intercostals spaces are known as typical Q.1. Write short note on pleura. (June 2010, 5 Marks)
intercostal spaces.
Ans. Pleura is a serous membrane which is lined by
Typical intercostal spaces are typical in nature because mesothelium.
their contents are limited within the thorax. Pleural sacs are two in number and lies one on either
side of mediastinum.
Each of the pleural sac is invaginated from its medial
side by the lung, so each pleural sac consists of outer
layer, i.e. parietal pleura and inner layer, i.e. visceral or
pulmonary pleura. Both the layers are continuous with
each other at hilum of lung and enclose a space between
them which is known as pleural cavity.
Visceral Pleura
♦ It is developed from the splanchopleuric mesoderm.
♦ It lines the surface of lungs including fissures.
♦ It is supplied by sympathetic nerves from T2-T5 ganglia
and parasympathetic innervations from vagus nerve.
♦ Visceral pleura is insensitive to pain.
♦ Blood supply of visceral pleura is through bronchial vessels
and veins drain into bronchial veins.
♦ Lymphatic drainage of visceral pleura is via tracheobron-
Fig. 218: Typical Intercostal space and its contents chial lymph nodes.
170 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
9. LUNGS
Q.2. Write a short note on bronchial artery. On left side there are two bronchial arteries both of
(Sep 2007, 3 Marks) which arises from descending thoracic aorta, The upper
Ans. Bronchial artery supplies nutrition to bronchial tree and opposite vertebra T5 and lower just below left bronchus.
to pulmonary tissue. Deoxygenated blood is brought to lungs by
These are small arteries that vary in number, size and pulmonary arteries and oxygenated blood is
origin. They are as follows: returned to heart by pulmonary veins.
On right side there is one bronchial artery which There are precapillary anastomoses between
arises either from 3rd posterior inter costal artery bronchial and pulmonary arteries. These connections
or from upper left bronchial artery. get enlarge when any of them is obstructed in disease.
Upper Limb and Thorax 171
Bronchopulmonary Segments
Bronchopulmonary segments of right lung
Lobes Segment
Upper 1. Apical
2. Posterior
3. Anterior
Middle 4. Lateral
5. Medial
Lower 6. Superior
7. Medial basal
8. Anterior basal
9. Lateral basal
10. Posterior basal
Bronchopulmonary segments of left lung
Upper
Upper Division 1. Apical
2. Posterior
3. Anterior
Lower Division 4. Superior lingular
Fig. 221: Bronchial Artery 5. Inferior lingular
Lower 6. Superior
Q.3. Write a short note on bronchopulmonary segment. 7. Medial basal
(Sep 2007, 3 Marks) (Mar 2008, 3 Marks) 8. Anterior basal
(Aug 2011, 5 Marks) 9. Lateral basal
10. Posterior basal
Ans. 1. They are well defined sectors of lung, each one of
which is aerated by tertiary or segmental branches. ♦ Relation to pulmonary artery: The bronchi of pulmonary
2. Each segment is pyramidal in shape with its apex artery accompany bronchi. Artery lies dorsolateral to
directed toward root of lung. bronchus. So each segment has its own separate artery.
3. There are 10 segments on right side and 10 on left side. ♦ Relation to pulmonary vein: Pulmonary veins do not
4. Each segment consists of segmental bronchus, segme- accompany bronchi or pulmonary arteries. They run in
ntal artery, autonomic nerves and lymphatic vessels. intersegmental planes. So each segment has more than
5. Segmental venule is surrounded by connective one vein and each vein drains more than one segment.
tissue between adjacent pulmonary units of
Clinical Anatomy
bronchopulmonary segments.
1. Usually infection of segment remains restricted to it, although
some infections may spread from one segment to another.
2. Segments are no barriers to spread of broncheogenic
carcinoma.
3. Knowledge of detailed anatomy of bronchial tree helps in
following.
a. Surgical removal of segment.
b. Drainage of infection.
In understating why abscesses are more common in some
segments.
Q.4. Write short note on bronchopulmonary segments of
right lung. (June 2010, 5 Marks) (Dec 2010, 3 Marks)
Ans. They are well defined sectors of lung, each one of which is
aerated by tertiary or segmental branches. Each segment
is pyramidal in shape with its apex directed toward root
of lung.
There are 10 segments on right side of lung.
There are three lobes in right lung, i.e. upper lobe,
middle lobe and lower lobe.
Fig. 222: Bronchopulmonary segments of lungs. Numbers in the Upper lobe usually consist of three segments, i.e.
table represent the naming of the numerical apical, posterior and anterior.
172 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
A B
Figs 223A and B: Right bronchopulmonary segment. Bronchopulmonary segments of left lung
A. Costal aspect, B. Medial surface Lobes Segments
(For colour version see Plate 9)
Upper Lobe
Bronchopulmonary segments of right lung
Upper Division 1. Apical
Lobes Segments
2. Posterior
Upper 1. Apical 3. Anterior
2. Posterior
3. Anterior Lower Division 4. Superior lingular
Middle 4. Lateral 5. Inferior lingular
5. Medial Lower Lobe 6. Superior
Lower 6. Superior 7. Medial basal
7. Medial basal 8. Anterior basal
8. Anterior basal 9. Lateral basal
9. Lateral basal 10. Posterior basal
10. Posterior basal
Q.6. Describe right lung under following heads:
(Feb 2014, 3+3+2 Marks)
(Aug 2012, 3 Marks) a. Relations of mediastinal surface
Ans. They are well defined sectors of lung, each one of which b. Bronchopulmonary segments
is aerated by tertiary or segmental branches. Each c. Histology of lung.
segment is pyramidal in shape with its apex directed Ans. Relations of Mediastinal Surface of Right Lung
toward root of lung. The relations of mediastinal surface of right lung are:
There are 10 segments on left side of lung. 1. Right atrium and auricle
There are two lobes in left lung, i.e. upper lobe and 2. Small part of right ventricle
lower lobe. 3. Superior vena cava
Upper lobe usually subdivided into two divisions, 4. Lower part of right brachiocephalic vein
i.e. upper division and lower division. 5. Azygos vein
Upper division consists of three segments, i.e. apical, 6. Esophagus
posterior and anterior. 7. Inferior vena cava
Lower division consists of two segments, i.e. 8. Trachea
superior lingular and inferior lingular 9. Right vagus nerve
All over after combining all the segments of both 10. Right phrenic nerve.
divisions of upper lobe there are five segments. For right bronchopulmonary segment refer to Ans 4 of
• Lower lobe consist of five segments, i.e. superior, same chapter.
medial basal, anterior basal, lateral basal and For histology of lung refer to Ans 23 of S E C T I O N
posterior basal. HISTOLOGY.
Upper Limb and Thorax 173
Venous Supply
Heart is mainly supplied by the 3 veins:
1. Coronary sinus: It is longest vein of the heart and receive
following tributaries, i.e. great cardiac vein, middle cardiac
vein, small cardiac vein, posterior vein of left ventricle,
oblique vein of left atrium of Marshall s, right marginal vein.
Great cardiac vein: It accompanies, first the anterior
interventricular artery and then left coronary artery
A
to enter left end of the coronary sinus.
Middle cardiac vein: It accompany the posterior inter-
ventricular artery and join middle part of coronary
sinus.
Small cardiac vein: It accompany right coronary artery
at right posterior coronary sulcus and joins right end
of coronary sinus. Right marginal vein can drain inside
the small cardiac vein.
Posterior vein of left ventricle: It runs over diaphrag-
matic surface of left ventricle and ends into the
coronary sinus.
Oblique vein of left atrium of Marshall: It is the small
vein which runs over posterior surface of left atrium.
It terminates at the left end of coronary sinus.
Right marginal vein: It accompany marginal branch
B of right coronary artery. It may either drain to small
cardiac vein or can open directly inside the right
Fig. 228: Arterial supply of heart, A. Sternocostal surface; atrium.
B. Diaphragmatic surface 2. Anterior cardiac vein: They are 3 to 4 small veins which
1. Right coronary artery: It is smaller than left coronary artery. run parallel to each other on anterior wall of right ventricle
It arises from anterior aortic sinus of ascending aorta. and open directly in right atrium via anterior wall.
Branches of right coronary artery are: 3. Venae cordis minimi: They are smallest cardiac veins and
Large branches: Marginal and Posterior interventricular are numerous valveless veins present in four chambers
Small branches: Nodal, right atrial, Infundibular, terminal, of heart which open in cardiac cavity. They are more
right ventricular and conus. numerous on right side of heart.
Upper Limb and Thorax 175
B
Fig. 229: Venous supply of heart, A. Sternocostal surface;
B. Diaphragmatic surface
External Features
1. Externally, the right ventricle has two surfaces anterior
or sternocostal and inferior diaphragmatic.
2. Interior has two parts.
The inflowing part is rough due to the presence of
muscular ridges called Trabeculae carneae.
The outflowing part or infundibulum is smooth and
forms the upper conical part of the right ventricle
which gives rise to the pulmonary trunk.
The two parts are separated by a muscular ridge called
as supraventricular crest or infundibul ventricular crest
situated between the tricuspid and pulmonary orifices.
Internal Features
1. The interior part has two orifices:
i. The right atrioventricular or tricuspid orifice, guarded
by the tricuspid valve.
ii. The pulmonary orifice is guarded by the pulmonary valve.
2. The interior of the inflowing part shows trabeculae carneae
or muscular ridges of three types:
i. Ridges
ii. Bridges
iii. Pillars or papillary muscles with one end attached to
the ventricular wall, and the other end connected to
the cusps of the tricuspid valve by chordae tendinae.
There are three papillary muscles in the right ventricle,
anterior, posterior and septal.
(Dec 2012, 4+2+2 Marks) Each papillary muscle is attached by chordae to the
a. Gross anatomy contiguous sides of two cusps.
b. Blood Supply 3. The septomarginal trabecula or moderator band is a
c Histology of cardiac muscle muscular ridge which extend from the ventricular septum
Ans. Gross Anatomy of Right Ventricle to the base of the anterior papillary muscle. It contains the
Right ventricle is a triangular chamber which receives right branch of the AV bundle.
blood from the right atrium and pumps it to the lungs 4. The cavity of the right ventricle is crescentic because of the
through the pulmonary trunk and pulmonary arteries. forward bulge of the interventricular septum.
It usually forms the inferior border of the heart and a 5. The wall of the right ventricle is thinner than that of the
large part of the sternocostal surface of heart. left ventricle, i.e. in a ratio of 1:3.
Q.6. Write about internal structure of right atrium of heart. Intra-atrial Septum
(Dec 2009, 5 Marks) ♦ This part is derived from septum primum and septum
Or secundum.
♦ This septum has a shallow saucer shaped depression in its
Write in short on internal structure of right atrium.
lower part which is known as fossa ovalis.
(July 2016, 5 Marks)
♦ A prominent margin of fossa ovalis is known as annulus
Ans. Internal structure of right atrium of heart is divided into ovalis or limbus fossa ovalis.
three parts, i.e. ♦ Annulus ovalis represents lower free edge of septum
1. Smooth posterior part or sinus venarum. secundum.
2 Rough anterior part or Pectinate part including ♦ Annulus ovalis is distinct above as well as at side of fossa
auricle. ovalis and is deficient inferiorly. Its anterior edge continues
3 Interatrial septum. with left end of valve of inferior vena cava.
♦ Foramen ovale is a small slit like valvular opening which
lies between upper part of fossa and limbus. Its remnants
are rarely present.
Q.7. Write about external features of heart.
(Aug 2011, 5 Marks) (Aug 2012, 5 Marks)
Ans. Human heart consists of four chambers i.e. right and
left atria as well as right and left ventricles. Atria lie
above and behind the ventricles. On surface of heart,
atria are separated from ventricles by an inter-atrial
groove. Ventricles are separated from each other by
interventricular groove which get subdivided into
anterior and posterior parts. Surfaces are demarcated
by upper, inferior, right and the left borders.
Grooves or Sulci
♦ Atria get separated from the ventricles by circular
atrioventricular or coronary sulcus.
♦ It is divided into the two parts i.e. anterior part and the
posterior part.
Fig. 232: Internal structure of right atrium ♦ Anterior part has both right and left halves.
(For colour version see Plate 9) ♦ Right half is oblique between right auricle and the right
ventricle and this lodges right coronary artery.
Smooth Posterior Part or Sinus Venarum ♦ Left part is usually small in between the left auricle and left
♦ This part is derived from right horn of sinus venosus. ventricle which lodges circumflex branch of left coronary
artery.
♦ At this surface the superior vena cava and inferior vena
♦ Anteriorly the coronary sulcus is overlapped by ascending
cava open at upper and lower end. Opening is guarded
aorta and pulmonary trunk.
by rudimentary valve or eustachian valve.
♦ Inter-atrial groove is faintly visible posteriorly, while
♦ Between the opening of inferior vena cava and right
anteriorly it is hidden by aorta and pulmonary trunk.
atrioventricular orifice there is opening of coronary sinus.
♦ Anterior interventricular groove lies near to left margin
This opening is guarded by thebesian valve. of heart. It runs downward and to the left. Lower end of
♦ Venae cordis minimi are present over this part, these are the the groove separates apex from the rest of inferior border
small veins which are present on walls of all the chambers. of heart.
These veins open in right atrium via small foramina. ♦ Posterior interventricular groove is situated over
♦ A very small projection, i.e. intervenous tubercle of Lower diaphragmatic or the inferior surface of heart. It lies near
is seen on posterior wall of atrium below the opening of to the right margin of inferior surface.
superior vena cava. ♦ Two of the interventricular grooves meet at inferior border
near to the apex.
Rough Anterior Part
♦ At crux of heart posterior interventricular sulcus meet the
♦ This part is derived from primitive atrial chamber. coronary sulcus.
♦ This part consists of musculi pectinati which is a series of
transverse muscular ridges. Apex of Heart
♦ Musculi pectinati originates from crista terminalis and run ♦ It is formed completely by left ventricle. Apex is directed
forward and downward towards atrioventricular orifice downward, forward and to left and is overlapped by
and provide appearance of teeth of a comb. anterior border of left lung.
Upper Limb and Thorax 179
Fig. 233: External features of heart: 1. Line of incision for right atrium;
2. Line of incision for right ventricle; 3. Line of incision for left ventricle
♦ This is situated inside the left fifth intercostal space 9 cm left auricle. Left atrium is not visible on this surface since
lateral to mid sternal line just medial to mid clavicular line. it is covered by aorta and the pulmonary trunk. Most
♦ In the living person pulsations can be seen and felt at this of this surface is covered by the lungs, but a part of it
region. which lies behind the cardiac notch of left lung remain
♦ Usually in children less than 2 years of age, apex is situated uncovered. While on percussion the uncovered area is
in left fourth intercostal space at midclavicular line.
dull which is clinically referred to as area of superficial
Base of Heart cardiac dullness.
♦ Inferior or diaphragmatic surface rest on central tendon
It is also known as posterior surface. Base of heart is formed by
left atrium and small part of right atrium. Related to base, the of diaphragm. This is formed in its left two third by left
openings of four pulmonary veins which open in left atrium ventricle and in its right one third by right ventricle. This
and the superior and inferior vena cava which opens in right is traversed by posterior interventricular groove and this
atrium are seen. Base of the heart is related to thoracic five to is directed downward as well as slightly backward.
thoracic eight vertebrae in lying posture, and descends by one ♦ Left surface is formed chiefly by left ventricle and at
vertebrae in erect posture. Base is separated from vertebral its upper end by left auricle. Over its upper part, left
column by pericardium, right pulmonary veins, esophagus and surface is crossed by coronary sulcus. This is related to
aorta. left phrenic nerve, left pericardiacophrenic vessels and
Borders of Heart by pericardium.
Q.1. Write in short on thoracic duct. (July 2016, 5 Marks) ♦ Anteriorly: Diaphragm, esophagus, Right pleural recess.
♦ Posteriorly: Vertebral column, Right posterior intercostal
Or
arteries and Terminal parts of the hemiazygos veins
Write short note on thoracic duct. (Oct 2016, 3 Marks) ♦ Toward right: Azygos vein.
Ans. Thoracic duct is the largest lymphatic vessel inside the ♦ Towards left: Descending thoracic aorta.
body.
Thoracic duct extends from upper part of abdomen to In Superior Mediastinum
lower part of neck, crossing posterior and superior parts ♦ Anteriorly: Arch of aorta and Origin of left subclavian artery.
of mediastinum. ♦ Posteriorly: Vertebral column.
It is usually 45 cm and 18 inches long. ♦ Towards right: Esophagus
Duct has beaded appearance due to presence of many ♦ Towards left: Pleura.
valves inside its lumen.
Relations
At Aortic Opening of Diaphragm
♦ Anteriorly: Diaphragm.
♦ Posteriorly: Vertebral column.
♦ Towards right: Azygos vein.
♦ Towards left: Aorta. Fig. 237: Tributaries of thoracic duct
Upper Limb and Thorax 181
Inside the Neck ♦ At the root of neck, efferent vessels of nodes inside the
♦ Thoracic duct forms an arch which rises about 3 to 4 cm neck form left jugular trunk, and those from nodes inside
above the clavicle. The arch has the following relations: axilla form left subclavian trunk. These trunks end inside
♦ Anteriorly: Left common carotid artery, left vagus and Left the thoracic duct.
internal jugular vein. ♦ The left bronchomediastinal trunk drains lymph from left
♦ Posteriorly: Vertebral artery and vein, sympathetic trunk, half of thorax and ends inside the thoracic duct.
thyrocervical trunk and its branches, left phrenic nerve,
medial border of scalenus anterior, prevertebral fascia
covering all the structures mentioned above, first part of Q.2. Write very short answer on muscles in oesophagus.
the left subclavian artery. (Apr 2018, 2 Marks)
Ans. The esophagus consists of an internal circular and
Tributaries external longitudinal layer of muscle. Furthermore,
♦ Thoracic duct receives lymph from both the halves of body the external longitudinal layer is composed of different
below diaphragm and left half above the diaphragm. muscle types in each third of the esophagus:
♦ Inside the thorax, thoracic duct receives lymphatic Superior third: Voluntary striated muscle
vessels from posterior mediastinal nodes and from small Middle third: Voluntary striated and smooth muscle
intercostal nodes. Inferior third: Smooth muscle.
LOWER LIMB, ABDOMEN AND PELVIS
Boundaries
1. FRONT OF THIGH
♦ Base: It is formed by the inguinal ligament
Q.1. Write short note on femoral triangle. (Apr 2008, 5 Marks) ♦ Apex: This is directed downwards and is formed by the
(Mar 2006, 3 Marks) (Mar 2009, 5 Marks) point where medial and lateral boundaries get crossed
(Aug 2011, 5 Marks) (Jan 2012, 5 Marks) ♦ Medially: Medial border of adductor longus
Ans. It is a triangular depression below the inguinal ligament ♦ Laterally: Medial border of sartorius
with the apex directed below, and is present in the upper ♦ Floor: It is formed medially by adductor longus and
1/3rd in front of thigh. pectineus and laterally by iliacus and tendon of psoas major.
♦ Roof: It is formed by the following structures i.e.
Skin
Superficial fascia: It consists of superficial inguinal
lymph nodes, femoral branch of genitofemoral nerve,
branches of ilioinguinal nerve, superficial branches of
femoral artery with accompanying vein and the upper
part of great saphenous vein.
Deep fascia: With saphenous opening and cribriform
fascia.
Contents
Following are the contents of femoral triangle:
♦ Femoral artery and its branches: Femoral artery traverses
the triangle from its base at midinguinal point to apex.
Inside the triangle, it gives off six branches i.e. three
Fig. 238: Boundaries of femoral triangle superficial branches and three deep branches.
Fig. 239: Contents of femoral triangle (For colour version see Plate 10)
Lower Limb, Abdomen and Pelvis 183
Relations
♦ Anteriorly: Skin, superficial fascia, deep fascia and anterior
wall of femoral sheath.
♦ Posteriorly: Psoas major, pectineus, adductor longus.
♦ Medially: Femoral vein.
♦ Laterally: Femoral nerve.
2. Posterior division of medial cutaneous nerve of Popliteal vessels and the tibial nerve cross the fossa
thigh vertically and are arrange one over another. Out of these tibial
3. Peroneal or sural communicating nerve. nerve is most superficial, popliteal vein lies deep or anterior to
6. Floor: It is formed from above downwards by Popliteal tibial nerve and popliteal artery is deepest. Popliteal artery is
surface of femur, capsule of the knee joint and oblique crossed posteriorly by the vein and nerve.
popliteal ligament, and popliteal fascia covering the
popliteal muscle. Q.2. Write short note on common peroneal nerve.
(May/Jun 2009, 5 Marks)
Ans. Root value: Dorsal divisions of ventral rami of L4, L5,
Sl, S2.
Course of Nerve
Common peroneal nerve is the smaller terminal branch of the
sciatic nerve. The nerve lies in the superficial plane in which
the tibial nerve lies. The nerve extends from superior angle of
fossa to the lateral angle, along the medial border of biceps
femoris. It then continue downwards and forwards and winds
around the posterolateral aspect of neck of fibula, nerve than
pierces the peroneus longus, and divides into superficial and
deep peroneal nerves.
Branches
♦♦ Cutaneous branches are of two types, i.e.
• Lateral cutaneous nerve of calf descend to supply skin
of upper two third of lateral side of leg.
• Sural communicating nerve arises inside the upper
Fig. 243: Contents of popliteal fossa part of fossa. It runs over posterolateral aspect of calf
and joins the sural nerve.
1. Popliteal artery and its branches. ♦♦ Articular branches, i.e.
2. Popliteal vein and its tributaries. • Superior lateral genicular nerve accompany artery
3. Tibial nerve and its branches. of same name and lie above lateral femoral condyle.
4. Common peritoneal nerve and its branches. • Inferior lateral genicular nerve run with artery of
5. Posterior cutaneous nerve of the thigh. same name to lateral aspect of knee joint above head
6. Genicular branch of the obturator nerve. of fibula.
7. Popliteal lymph nodes. • Recurrent genicular nerve arises where common
8. Fat. peritoneal nerve divides into superficial and deep
186 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
peroneal nerves. This ascends anterior to knee joint partially covered by tunica vaginalis. Epididymis lies at
and supply to tibialis anterior muscle in addition to lateral part of posterior border. Medial surface of epididymis
knee joint. is seperated from testis by an extension of cavity of tunica
♦♦ Muscular branches donot arise from common peroneal vaginalis. This extension is known as sinus of epididymis.
nerve. But it can give a branch to short head of biceps femoris. 3. There are two surfaces, i.e. medial and lateral.
They both are smooth and convex.
3. JOINTS OF LOWER LIMB
Q.1. Write a short note on movements of ankle joint.
(Feb 2003, 5 Marks)
Ans. Active movements of ankle joint are as follows:
1. Dorsiflexion: In this movement the forefoot is raised
and angle between front of leg and dorsum of foot
is diminished. Wide anterior trochlear surface of
talus fits in the lower end of narrow posterior part
of lower end of tibia. During this movement there
are no chances of dislocation.
Principle muscles involved in dorsiflexion is tibialis
anterior and the accessory muscles are extensor
digitorum longus, extensor hallucis longus and
Peroneus tertius.
2. Plantar flexion: In this fore foot is depressed and
the angle between front of leg and dorsum of foot is
Fig. 245: Lateral aspect of testis
increased. Narrow posterior part of trochlear surface
of talus loosely fit in wide anterior part of lower end
Coverings
of tibia.
Principle muscles involved in plantar flexion are Testis is covered by layers of scrotum and in addition it is also
gastrocnemius and soleus and the accessory muscles covered by three coats. From outward to inward the layers are
are plantaris, tibialis posterior, flexor hallucis longus tunica vaginalis, tunica albuginea and tunica vasculosa.
and flexor digitorum longus. ♦♦ Tunica vaginalis: It represents lower portion of processus
vaginalis. This is invaginated by testis from behind and so it
consists of parietal and visceral layer with cavity in between.
4. MALE EXTERNAL GENITAL ORGANS It covers whole of the testis except its posterior border.
♦♦ Tunica albuginea: It is a dense white fibrous coating which
Q.1. Write a short note on testis. (Feb 2003, 5 Marks) covers the testis all around. This is covered by the visceral
layer of tunica vaginalis except posteriorly where testicular
Ans. • Testis is the male gonad.
vessels and the nerves enter the gland. Posterior border of
• Testis is suspended in scrotum via spermatic cord.
this layer is thickened to form incomplete vertical septum
• Testis lie obliquely, so that its upper pole is tilted
known as mediastinum testis. Numerous septa extend
forwards and medially.
from mediastinum to inner surface of tunica albuginea.
• Left testis is slightly lower shaped size than right
♦♦ Tunica vasculosa: Innermost vascular coat of testis lining
testis.
its lobules.
• Testis is oval in shape and is compressed from side
to side. Structure
• Testis is 3.75 cm long, 2.5 cm broad from before
backwards and 1.8 cm thick from side to side. Glandular part of testis has 200 to 300 lobules. A single lobule
has 2 to 3 seminiferous tubules. Each tubule is coiled. Tubules
External Features are lined by the cells which represent stages in formation of
Testis consists of: spermatozoa. Seminiferous tubules join at apices of lobules to
1. Two poles or ends, i.e. upper and lower. form 20 to 30 straight tubules, which enter mediastinum. In
Upper and lower poles are smooth and convex. Upper pole mediastinum they anastomose and form a network known as
gives attachment to spermatic cord. A small oval body is rete testis. Rete testis produce 12 to 30 efferent ductules which
attached to the testis known as appendix of testis. emerge at upper pole and enter epididymis. Here each tubule
2. There are two borders, i.e. anterior and posterior. become highly coiled and form a lobe of head of epididymis
Anterior border is smooth and convex and is covered by tubules end in single duct which is coiled and form body and
tunica vaginalis while posterior border is straight and is tail of epididymis, it is continuous with ductus deferens.
Lower Limb, Abdomen and Pelvis 187
Location
Stomach lies obliquely in the upper and left part of the abdomen,
occupying the epigastric, umbilicus and left hypochondriac
region. Most of it lies under cover of left costal margin and ribs.
Shape
Empty stomach is ‘J’-shaped (vertical) when partially distended
it becomes piriform in shape. In obese person it is more
horizontal.
♦♦ Body: It lies between the fundus and pyrolic antrum. 3. At greater curvature, it is supplied by right gastroepiploic
It is distended enormously along greater curvature. artery which is the branch of gastroduodenal
Gastric glands which are distributed in fundus and body
of stomach consists of three types of secretory cells, i.e. 4. Left gastroepiploic artery, which is the branch of splenic artery
mucous cells, chief cells and parietal or oxyntic cells. 5. Fundus is supplied by 5 to 7 short gastric arteries which
are also the branches of splenic artery.
Pyloric Part
♦♦ Pyloric antrum: It is separated from pyrolic canal by an Venous Drainage
inconstant sulcus, sulcus intermedius present on greater ♦♦ Veins of the stomach drains into the portal, superior
curvature. This is 7.5 cm long. Pyrolic glands are richest mesenteric and splenic veins.
in having mucous cells. ♦♦ Right and left gastric drains in portal vein.
♦♦ Pyloric canal: It is 2.5 cm long and is narrow and tubular. ♦♦ Right gastroepiploic ends in superior mesenteric vein
At its right end it terminates at pylorus. while left gastroepiploic and short gastric veins terminates
in splenic veins.
Blood Supply
Arterial Supply Lymphatic Drainage
Stomach is supplied along lesser curvature by: ♦♦ Upper part of left one third, i.e. area a drains into
1. Left gastric artery, which is the branch of coeliac trunk pancreaticosplenic nodes lying along splenic artery.
2. Right gastric artery, which is the branch of proper hepatic Lymph vessels from these node travel along splenic artery
artery to reach coeliac nodes.
♦♦ Right two third, i.e. Area b drains in left gastric nodes
which lie along left gastric artery. These nodes drain
abdominal part of oesophagus. Lymph from these nodes
drains into coeliac nodes.
♦♦ Lower part of left one third, i.e. area c drains into the
right gastroepiploic nodes which lie along the right
gastroepiploic artery. Lymph vessels arising in these nodes
drain to subpyrolic nodes which lie in the angle between
first and second part of duodenum. From here lymph drain
to hepatic nodes which lie along hepatic artery and finally
to coeliac nodes.
♦♦ Lymph from pyrolic part, i.e. area d drains into different
directions into pyrolic, hepatic and left gastric nodes and
passes from all these nodes to coeliac nodes.
♦♦ Lymph from all areas of stomach reaches coeliac nodes.
From here it passes via intestinal lymph trunk to cisterna
Fig. 248: Arterial supply of stomach chyli.
Lower Limb, Abdomen and Pelvis 189
Location
Kidneys are present in epigastric, hypochondriac, lumbar and
A umbilical regions.
Vertically kidneys extend from upper border of 12th thoracic
vertebra to centre of body of 3rd lumbar vertebra.
Right kidney is slightly lower in position as compared to left
kidney and left kidney is little bit near to median plane than
right one.
External Features
Kidney has upper and lower poles, medial and lateral borders,
anterior and posterior surfaces.
Poles of Kidney
B
♦♦ Upper pole is broader and is in close contact with supra-
Figs. 251A and B: Nerve supply of stomach: renal gland.
A. Anterior gastric nerve; B. Posterior gastric nerve ♦♦ Lower pole is pointed.
Lower Limb, Abdomen and Pelvis 191
7. DIAPHRAGM
Small Openings of Diaphragm vagina pass up into uterus and from there to uterine
♦♦ Each of the crus of diaphragm is pierced by greater and tubes. Fertilization occurs in lateral part of tube.
lesser splanchnic nerves. Left crus is pierced in addition Situation
to hemiazygos vein.
♦♦ Sympathetic chain passes from thorax to abdomen behind Uterine tubes are situated in free upper margin of broad
medial arcuate ligament or medial lumbocostal arch. ligament of uterus.
♦♦ Subcostal nerve and vessels pass behind the lateral arcuate Dimension
ligament or lateral lumbocostal arch.
♦♦ Superior epigastric vessels and some of the lymphatics pass ♦♦ Each uterine tube is about 10 cm long.
♦♦ At its lateral end, uterine tube opens inside peritoneal cavity
between origins of diaphragm from xiphoid process and
via its abdominal ostium. The ostium is 3 mm in diameter.
7th costal cartilage. This gap is known as Larry’s space or
foramen of Morgagni. Subdivisions
♦♦ Musculophrenic vessels pierce diaphragm at level of 9th ♦♦ Lateral end of uterine tube is funnel shape and is called as
costal cartilage. infundibulum. It consists of number of finger like processes
known as fimbriae and that’s why it is called as fimbriated
end, one of the fimbriae is longer than others and is attached
to tubal pole of ovary and is known as ovarian fimbria.
♦♦ The part of uterine tube medial to infundibulum is called
ampulla. It is thin walled dilated and tortuous and forms
lateral 2/3rd of tube. Ampulla is site for fertilization.
♦♦ Isthmus succeeds the ampulla. It is narrow, rounded and
cord like and form medial one-third of tube.
♦♦ Uterine or intramural or interstitial part of tube lies in the
wall of uterus. It open in superior angle of uterine cavity
by narrow uterine ostium. The ostium is 1 mm in diameter.
1. Name the arteries present in typical intercostal space. 9. Write name of cranial nerve which pass into internal
Ans. One posterior intercostal artery with its collateral branch auditory meatus.
and two anterior intercostals arteries Ans. Vestibulocochlear nerve and facial nerve.
2. Write the names of borders of lung. 10. Write name of unpaired intracranial venous sinuses.
Ans. Anterior, posterior and inferior Ans. Following are the unpaired intracranial venous sinuses:
3. Write name of various parts of stomach. ♦ Superior saggital sinus
Ans. Parts of stomach are: ♦ Inferior saggital sinus
♦ Straight sinus
♦ Cardiac part
• Fundus ♦ Occipital sinus
• Body ♦ Anterior intercavernous sinus
♦ Pyrolic part ♦ Posterior intercavernous sinus
• Pyrolic antrum ♦ Basilar plexus of veins.
• Pyrolic canal 11. Name the nerve supply of orbicularis oculi.
4. Write the name of all arteries which supply the thyroid Ans. Upper half of the orbicularis oculi muscle receives its
gland. innervation from the temporal branch of facial nerve,
Ans. Following are the name of arteries supplying thyroid while the lower half receives its innervation from the
gland: zygomatic branch of facial nerve.
♦ Superior thyroid artery 12. Name the largest sesamoid bone of the body.
♦ Inferior thyroid artery Ans. Patella
♦ Lowest thyroid artery or thyroidea ima artery
13. ........... is the nerve supply of anterior belly of digastrics.
♦ Accessory thyroid artery
Ans. Trigeminal nerve
5. Write the names of various components of hard palate.
Ans. Components of hard palate are: 14. Name two infrahyoid muscles.
♦ Palatine processes of maxillae in anterior two-third Ans. Following are two infrahyoid muscles:
♦ Horizontal plates of palatine bone in posterior one- 1. Sternothyroid
third 2. Sternohyoid
♦ Anterior and posterior parts unite by cruciform 15. Name the parts of corpus callosum.
suture to form hard palate Ans. Parts of corpus callosum are:
6. Write the names of all extrinsic muscles of tongue. ♦ Genu
Ans. Following are extrinsic muscle of tongue: ♦ Rostrum
♦ Genioglossus ♦ Trunk
♦ Hyoglossus ♦ Splenium
♦ Styloglossus 16. Name the branches of first part of maxillary artery.
♦ Palatoglossus Ans. Following are the branches of first part of maxillary
7. Write action of lateral pterygoid muscle. artery:
Ans. It depresses mandible to open mouth with suprahyoid ♦ Deep auricular
muscles. ♦ Anterior tympanic
♦ Middle meningeal
8. Write name of cranial nerve nuclei which are present
in midbrain. ♦ Accessory meningeal
♦ Inferior alveolar.
Ans. Following are the cranial nerve nuclei present in
midbrain: 17. Give two examples of secondary cartilaginous joint
♦ Nucleus of trochlear nerve (symphysis).
♦ Mesencephalic nucleus of trigeminal nerve Ans. Two examples of secondary cartilaginous joints
♦ Nucleus of occulomotor nerve with Edinger– (symphysis) are:
Westphal nucleus 1. Fibrocartilaginous joint
♦ Pretectal nucleus 2. Hyaline joint
196 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
18. Erb’s point lies on……………..trunk of brachial plexus. 24. Define sinusoid.
Ans. Upper Ans. A small irregularly shaped blood vessel found in certain
19. ………. muscle is supplied by glossopharyngeal nerve. organs, especially the liver.
Ans. Stylopharyngeus 25. Name the parts of internal capsule.
20. Skin is lined by………………epithelium. Ans. Following are the parts of internal capsule:
Ans. Keratinized stratified squamous. • Anterior limb
• Genu
21. Name the lobes of left lung.
• Posterior limb
Ans. Following are the lobes of left lung:
• Sublentiform part
• Upper
• Retrolentiform part
– Upper division
– Lower division 26. Why thyroid swelling moves with deglutition?
• Lower Ans. Thyroid swelling moves with deglutition because the
22. Name the branches of maxillary artery. thyroid gland is enclosed within the pretracheal fascia
Ans. Following are the branches of maxillary artery: which is attached to larynx which moves up and down,
while swallowing and along with that thyroid and its
1. Branches of first part of maxillary artery:
swellings also moves up and down.
– Deep auricular
– Anterior tympanic 27. Name the tributaries of internal jugular vein.
– Middle meningeal Ans. Following are the tributaries of internal jugular vein:
– Accessory meningeal • Inferior petrosal sinus
– Inferior alveolar • Common facial vein
2. Branches of second part of maxillary artery: • Lingual vein
– Masseteric • Pharyngeal veins
– Deep temporal • Superior thyroid vein
– Pterygoid • Middle thyroid vein
– Buccal
3. Third part of maxillary artery: 28. Which nerve supply sternocleidomastoid muscle?
– Posterior superior alveolar Ans. It is supplied by accessory nerve (cranial nerve XI) and
– Infraorbital direct branches of the cervical plexus (C1–C2).
– Greater palatine
29. Name the cervical nerves taking part in the formation
– Pharyngeal
of ansa cervicalis.
– Artery of pterygoid canal
– Sphenopalatine. Ans. Following are the cervical nerves taking part in formation
of ansa cervicalis:
23. Name the four structures passing through superior
• Superior root by first cervical nerve
orbital fissure.
• Inferior root or descending cervical nerve from
Ans. Following are the four structures passing through second and third cervical spinal nerves.
superior orbital fissure:
1. Lacrimal nerve 30. Name the arteries supplying the heart.
2. Frontal nerve Ans. Arteries supplying the heart are:
3. Trochlear nerve • Left coronary artery
4. Superior ophthalmic vein • Right coronary artery
Lower Limb, Abdomen and Pelvis 197
IMAGE-BASED QUESTIONS
Additional Matter
Movements of Jaw and Muscles Associated with them Various Parts of Body and their Drainage to Lymph Nodes
Embryology
Spermatocytosis
♦♦ This is the process of conversion of spermatogonia to
primary spermatocytes. It takes 16 days. It is by repeated
mitotic divisions.
♦♦ Formation of stem cells: The primitive germ cells give rise
to spermatogonial stem cells.
♦♦ Cell growth: From these stem cells, a group of cells
are formed at regular intervals and are called type A
spermatogonia. Production of type A spermatogonia
marks the beginning of spermatogenesis.
Fig. 1: Chromosomes ♦♦ Mitotic divisions: Type A spermatogonia (44 + X + Y)
undergo a limited number of mitotic divisions and form
♦♦ The individual of male sex is XY, so he forms gametes a clone of cells. The last division of cells becomes Type B
containing either the X chromosome or the Y chromosome spermatogonia. The Type A spermatogonia are dark and
in a 1:1 proportion. Type B are pale in color. Type A spermatogonia are reserve
♦♦ The individual of female sex is XX and thus she forms only cells. The spermatogonia (Type B) (44 + X + Y) enlarge, or
gametes containing an X chromosome. undergo mitosis, to form primary spermatocytes.
♦♦ It is not only possible that an X chromosome of a woman
is from her father, it is certain. Every woman has an X Meiotic Divisions
chromosome from her father and the other X chromosome ♦♦ In this, there is conversion of primary spermatocytes to
from her mother. secondary spermatocytes and then spermatids. It takes
♦♦ In men, however the X chromosome comes always from 24 days.
his mother and the Y chromosome is always from his ♦♦ Primary spermatocytes (44 + X + Y) now divide so that
father. each of them forms two secondary spermatocytes.
204 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
This is the first meiotic division, i.e. it reduces the number • Golgi apparatus: Golgi apparatus is transformed into
of chromosomes to half. the acrosomic cap. Acrosomal cap covers two-thirds
♦♦ Each secondary spermatocyte has 22 + X or 22 + Y of nucleus.
chromosomes. It divides to form two spermatids. This • Centrosome: Centriole divides into two parts that are
is the second meiotic division and this time, there is no at first close together. The proximal centriole becomes
reduction in chromosome number. It is called equation spherical and comes to lie in the neck. The axial
meiosis. There occurs balancing of species specific filament appears to grow out of it. Distal centriole
chromosome number and DNA content by reduction and forms the distal end of middle piece, i.e. annulus.
equation divisions. Centrioles are concerned for movement.
• Mitochondria: Form a spiral sheath around middle
piece. The part of the axial filament between the
neck and the annulus becomes surrounded by
mitochondria, and together with them forms the
middle piece. The remaining part of the axial filament
elongates to form the principal piece and tail.
• Cytoplasm: Most of it is shed as residual bodies of
Renaud and are engulfed by Sertoli cells.
• Cell membrane: Persists as a covering for the
spermatozoon. Presents specialization for fertilization
that includes sperm-egg recognition, sperm-egg
binding and sperm-egg fusion.
Q.2. Write short note on oogenesis. (May 2014, 5 Marks)
Ans. The process of maturation and differentiation of primitive
germ cells to oogonia, primary oocytes, secondary
oocytes and to mature ova in the female genital tract.
• It is located in ovarian cortex.
• Peculiarities of oogenesis:
– Starts before birth (10th week)
– Stops in the middle (birth to puberty)
– Restarts at puberty (11–13 years)
– Continues up to menopause (45–55 years)
• Various processes in oogenesis are:
– Mitosis
– Meiosis
– Growth of follicles
Fig. 2: Stages in spermatogenesis – Differentiation of follicles.
• Cortex contains many large round cells called
Spermiogenesis “oogonia”. All the oogonia to be utilized throughout
the life of a woman are produced at a very early
♦♦ It is the process of metamorphosis of spermatids to stage (possibly before birth) and do not multiply
spermatozoa and takes 24 days. thereafter.
♦♦ Process by which a spermatid (22 + X/22 + Y) gradually • On arrival in the gonad, the primordial germ cells
changes its shape to become a spermatozoon is called differentiate into oogonia. The oogonia pass through
spermiogenesis. It is the final stage in the maturation of the stages of primary and secondary oocyte and ovum.
spermatids into mature, motile spermatozoa. • Oogenesis at different phases of life can be described
♦♦ The spermatid is a more or less circular cell containing a here:
nucleus, Golgi apparatus, centriole and mitochondria. All
these components take part in forming the spermatozoon. Before Birth
♦♦ Major events in spermiogenesis: ♦♦ Before 3rd month: The primitive germ cells undergo mitosis
• Nuclear morphogenesis and condensation to form oogonia. This occurs in the absence of testicular
• Formation of tail differentiation factor.
• Formation of acrosome ♦♦ Before 7th month: The oogonia continue to divide mitotically.
• Rearrangement of organelles (Mitochondria, centrioles) The oogonia are surrounded by a layer of flat epithelial
• Shedding of excess cytoplasm. cells. Some of the oogonia enlarge to form primary oocytes.
♦♦ Various processes in spermiogenesis: ♦♦ 7th month to birth: Formation of primordial follicles
• Nucleus: Condensation of nucleus and its movement (primary oocyte with its surrounding flat epithelial cells)
to one pole forms the head. and multiplication of primary oocytes to produce millions
Embryology 205
of germ cells occurs. Primary oocyte enters prophase I of ♦♦ If fertilization does not occur, the secondary oocyte fails
meiosis I at that phase the meiosis is arrested by oocyte to complete the second meiotic division and degenerates
maturation inhibitor (OMI) factor. about 24 hours after ovulation.
♦♦ The oogonia are diploid (2n) in chromosome content.
Q.3. Briefly describe graafian follicle.
Many of these oogonia and primary oocytes degenerate
before birth. (Oct 2007, 5 Marks)
Ans. Around 7th day of sexual cycle one of the tertiary follicles
increases in size in response to follicle-stimulating
hormone (FSH) and luteinizing hormone (LH) and forms
the largest mature follicle that is known as “Graafian
follicle”. Remaining follicles degenerate and become
atretic.
• A fully mature Graafian follicle is about 3–5 mm
in size. It reaches the periphery of the cortex and
starts projecting on to the surface of the ovary. The
follicular antrum is filled with fluid pushing the
primary oocyte with a layer of covering cells to one
side of the follicle.
• The layer of cells immediately surrounding the
oocyte and zona pellucida are called corona radiata
cells. The projection of granulosa cells covering the
Fig. 3: Stages in oogenesis
primary oocyte projecting into the follicular antrum
is called cumulus oophorus. The area of attachment
Birth to Puberty of primary oocyte and corona radiata to the wall of
follicle is called discus proligerus.
♦♦ There will be both maturation and degeneration of
• As the follicle expands, the stromal cells surrounding
primordial follicle resulting in reduction in the number
the membrana granulosa become condensed to form
of primary oocytes.
a covering called the theca interna. Theca interna
♦♦ At the time of birth, all primary oocytes are in the prophase
increases in thickness and becomes more vascular.
of first meiotic division. At birth, approximately two lakh
The cells of the theca interna later secrete a hormone
primary oocytes in primordial follicles are present in each
called estrogen; and they are then called the cells of
ovary.
the thecal gland. Outside the theca interna, some
♦♦ Instead of entering metaphase, the primary oocytes enter
fibrous tissue becomes condensed to form another
prolonged resting or diplotene stage.
covering for the follicle called the theca externa. The
After Puberty ovarian follicle is now fully formed.
• The follicle gradually increases in size and finally
♦♦ After puberty, cyclic preparation for fertilization is known bursts and expels the ovum. This process of
as ovarian cycle. shedding of the ovum is called ovulation.
♦♦ From the time of birth to puberty, there is degeneration of • Just before ovulation the primary oocyte of mature
number of primary oocytes. Rest of the primary oocytes Graafian follicle completes first meiotic division and
remain in prophase and do not complete their first meiotic forms secondary oocyte and first polar body.
division until they begin to mature and are ready to ovulate.
♦♦ The first meiotic division of a primary oocyte produces two
unequal daughter cells. Each daughter cell has the haploid
number of chromosomes (23). The large cell, which receives
most of the cytoplasm, is called the secondary oocyte, and
the smaller cell is known as “the first polar body”. The
secondary oocyte immediately enters the second meiotic
cell division.
♦♦ Ovulation takes place while the oocyte is in metaphase.
The secondary oocyte remains arrested in metaphase till
fertilization occurs.
♦♦ The second meiotic division is completed only if
fertilization occurs. This division results in two unequal
daughter cells. The larger cell is called ovum. The smaller
daughter cell is called the second polar body. The first polar
body may also divide during the second meiotic division
making a total of three polar bodies. Fig. 4: Mature Graafian follicle (For colour version see Plate 11)
206 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
2. A depression appears in the center of the primitive 5. However, this process of flattening is soon reversed and
knot. the notochordal plate again becomes curved, to assume the
This depression is called the blastopore. shape of a tube. Proliferation of cells of this tube converts
3. Cells in the primitive knot multiply and pass it into a solid rod of cells. This rod is the definitive (i.e.
cranially in the middle line, between the ectoderm finally formed) notochord. It gets completely separated
and endoderm, reaching up to the caudal margin of from the endoderm.
the prochordal plate. These cells form a solid cord 6. As the embryo enlarges the notochord elongates
called the notochordal process or head process. considerably and lies in the midline, in the position to
The cells of this process undergo several stages of be later occupied by the vertebral column. However, the
rearrangement ending in the formation of a solid notochord does not give rise to vertebral column. Most of
rod called the notochord. it disappears, but parts of it persist in the region of each
intervertebral disc as the nucleus pulposus and its cranial
Formation of the Notochord continuation the apical ligament of dens of axis vertebra.
1. After the formation of the blastopore, its cavity extends 7. Notochord is present in all animals which belong to
into the notochordal process, and converts it into a tube phylum chordate.
called the notochordal canal. 8. Primitive streak is the primary organizer as it induces
2. Cells forming the floor of the notochordal canal become formation of notochord and intraembryonic mesoderm.
intercalated in (i.e. become mixed up with) the cells of the 9. Formation of notochord determines craniocaudal axis as
endoderm. Cells forming the floor of the notochordal canal well as right and left sides of embryo.
now separate the canal from the cavity of the yolk sac.
3. Floor of the notochordal canal begins to break down. At
first, there are small openings formed in it. But gradually 5. FORMATION OF TISSUES OF THE BODY
the whole canal comes to communicate with the yolk sac.
Notochordal canal also communicates with the amniotic Q.1. Write a short note on somites. (Sep 2009, 5 Marks)
cavity through the blastopore. Thus, at this stage, the (Mar 2013, 3 Marks) (Feb 2014, 3 Marks)
amniotic cavity and the yolk sac are in communication with
Ans. Paraxial mesoderm becomes segmented to form 40 to 45
each other.
pairs of somites that lie on either side of the developing
4. Gradually walls of the canal become flattened so that
neural tube and notochord.
instead of a rounded canal, we have a flat plate of cells
called the notochordal plate. • The somites appear between the 20th and 30th day of
development. Hence, the 4th week of development
is known as somite period of development.
• A cross section through a somite shows that it is
triangular structure and has a cavity. The somite is
divisible into three parts:
1. The ventromedial part is called the sclerotome.
The cells of sclerotome migrate medially. They
surround neural tube and give rise to the
vertebral column and ribs.
2. The lateral part is called the dermatome. The
cells of part also migrate, and come to line the
deep surface of the ectoderm covering the entire
body. These cells give rise to the dermis of the
skin and to subcutaneous tissue.
3. The intermediate part is the myotome. It gives
rise to striated muscle.
Recently, it has been held that the dermatome only forms
dermis on the back of the head and trunk, and that dermis
elsewhere is derived from lateral plate mesoderm.
• In the cervical, thoracic, lumbar and sacral regions,
one spinal nerve innervates each myotome. The
number of somites formed in these regions,
therefore, corresponds to the number of spinal
nerves. In the coccygeal region, the somites exceed
the number of spinal nerves but many of them
Fig. 7: Stages of formation of notochord subsequently degenerate.
210 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• As the third pouch also gives origin to thymus, this This leads to hypocalcemia which causes increased
organ is closely related to parathyroid III. When the neuromuscular irritability, muscular spasm and convulsion.
thymus descends toward the thorax, parathyroid III is Q.10. Write about Meckel’s cartilage. (Sep 2013, 5 Marks)
carried caudally along with it for some of the distance. Ans. Cartilage of first arch is called “Meckel’s cartilage”.
• Parathyroid IV is prevented from descending caudally,
• Incus, malleus and spine of sphenoid are derived
due to close relationship of the fourth pouch to the
from dorsal end of Meckle’s cartilage.
developing thyroid gland. As a result, parathyroid III
• Ventral part of Meckle’s cartilage is surrounded
becomes caudal to parathyroid IV.
by mesenchyme that forms the mandible by
• Now, the parathyroid glands derived from the fourth
membranous ossification.
pouch become the superior parathyroid glands and
• Meckle’s cartilage is trapped in developing mandible
those derived from the third pouch become the inferior
and is absorbed.
parathyroid glands.
• The part of cartilage extending from the region of
• Seeing their developmental history, superior the middle ear to the mandible disappears, but its
parathyroid glands are relatively constant in position, sheath (perichondrium) forms the anterior ligament
but the inferior parathyroid glands may descend into of the malleus and the sphenomandibular ligament.
the lower part of the neck or even into the anterior
mediastinum. Alternatively, they may remain at their
site of origin and are then seen near the bifurcation of
the common carotid artery.
Applied Anatomy
Applied anatomy of thyroid gland:
♦♦ Any enlargement of thyroid gland is known as goiter.
♦♦ Removal of thyroid with true capsule is necessary in
hyperthyroidism or thyrotoxicosis.
“bar” of the opposite side to form a pharyngeal – An arterial arch: Ventral to the foregut, an artery
or branchial arch. Each bar when seen from front called the ventral aorta develops. Dorsal to the
is seem to be of horse-shoe shaped. Arches are foregut, another artery called the dorsal aorta,
numbered craniocaudally as I to VI. In the interval is formed. A series of arterial arches connect
between any two adjoining arches, the endoderm ventral and dorsal aortae. One such arterial arch
extends outward in the form of a pouch to meet lies in each pharyngeal arch. In a subsequent
the ectoderm which dips into this interval as an development, the arrangement of these arteries
ectodermal cleft. is greatly modified.
• Pharyngeal arches are six—curved mesodermal – Nerve of the arch: Each pharyngeal arch is
thickenings with each arch having an ectodermal supplied by a nerve derived from hindbrain.
covering and an endodermal lining containing a In addition to supplying the skeletal muscle
mesodermal core. These provide support to the of the arch, it supplies sensory branches to the
ventral and lateral walls of primitive pharynx. By overlying ectoderm, and endoderm. In some
the time that the anterior neuropore closes, the first lower animals, each arch is supplied by two
and second pharyngeal arches are present. nerves. The nerve of the arch itself runs along the
• Mesoderm of arches is derived from paraxial cranial border of the arch. This is called the post-
mesoderm and lateral plate mesoderm. This is trematic nerve of the arch. Each arch also receives
invaded by neural crest cells that contribute for a branch from the nerve of the succeeding
skeletal elements and connective tissue of head and arch. This runs along the caudal border of the
neck region. arch, and is called the pretrematic nerve of
• First arch is also known as mandibular arch; and the the arch. In the human embryo, however, a
second, the hyoid arch. The third, fourth and sixth double innervation is to be seen only in the first
arches do not have special names. The fifth arch pharyngeal arch.
disappears soon after its formation, so that only five
arches remain.
Q.14. Write very short answer on structures developed from Ectopic Thyroid Tissue
second pharyngeal pouch. (Apr 2018, 2 Marks)
♦♦ Small masses of thyroid tissue can be present at abnormal
Ans. Following are the structures developed from second sites.
pharyngeal pouch:
♦♦ Thyroid tissue has been observed in the larynx, trachea,
• Epithelium of ventral part of this pouch contributes esophagus, pons, pleura, pericardium and ovaries.
to the formation of tonsil.
♦♦ Masses of ectopic thyroid tissue have been described
• Dorsal part takes part in formation of tubotympanic
in relation to the deep cervical lymph nodes (lateral
recess.
aberrant thyroids) but these are now believed to represent
Q.15. Describe the development of thyroid gland with its metastases in the lymph nodes from a carcinoma of the
congenital anomalies. (Aug 2018, 10 Marks) thyroid gland.
Ans. For development of thyroid gland refer to Ans 7 of same
chapter. Remnants of the Thyroglossal/Duct
These remnants may persist and lead to the formation of:
Congenital Anomalies of Thyroid Gland
♦♦ Thyroglossal cysts that can occur anywhere along the
Anomalies of Shape course of duct. They can acquire secondary openings on
♦♦ Pyramidal lobe is present so often that it is regarded as the the surface of neck to form fistulae.
normal structure. The lobe may arise from the isthmus or ♦♦ Thyroglossal fistula opening at the foramen cecum.
from one of the lobes. Lobe may have no connection with ♦♦ Carcinoma of the thyroglossal duct.
rest of the thyroid and can be divided into two or more Q.16. Write very short answer on tuberculum impar.
parts. It may vary from a short stump to a process reaching (Aug 2018, 2 Marks)
the hyoid bone.
Ans. Medial most parts of mandibular arches proliferate to
♦♦ Isthmus may be absent.
form two lingual swellings. These lingual swellings are
♦♦ One of the lobes of the gland may be very small or absent.
partially separated from each other by another swelling
Anomalies of Position which appears in the midline. This median swelling is
known as tuberculum impar or median tongue bud.
♦♦ Lingual thyroid: Thyroid may lie under the mucosa of
dorsum of tongue and may form a swelling that can lead ♦ Tuberculum impar appears during third week of
to difficulty in swallowing. embryogenesis.
♦♦ Intralingual thyroid: Thyroid may be embedded in muscular ♦ Immediately behind tuberculum impar, epithelium
substance of tongue. undergoes proliferation to form a downgrowth, i.e.
♦♦ Suprahyoid thyroid: The gland may lie in the midline of thyroglossal duct, from which the thyroid gland
neck, above the hyoid bone. develops.
♦♦ Infrahyoid thyroid: The gland may lie below the hyoid bone, ♦ More recent researches, however, show that this part
but above its normal position. of the tongue is mainly, if not entirely, developed
♦♦ Intrathoracic thyroid: The entire gland, or part of it, may from a pair of lateral swellings which rise from the
lie in the thorax. inner surface of the pharyngeal arch and meet in the
This is to be noted that when thyroid tissue is present in the middle line. The site of their meeting remains post-
anomalous positions which are mentioned above, an additional embryonically as the median sulcus of the tongue.
thyroid may or may not be present at the normal site. ♦ The tuberculum impar disappear in an adult tongue.
♦♦ Ventral part of the nasal septum is attached below to forehead. This anomaly may sometimes affect only one
the primitive palate. More posteriorly the septum is half of the nose and is usually associated with fusion of
at first attached to the bucconasal membrane, but on two eyes also known as cyclops.
disappearance of this membrane, it has a free lower ♦♦ Entire first arch may remain underdeveloped either on
edge. Nasal cavities are separated from the mouth by the one or on both sides, affecting the lower eyelid, maxilla,
development of the palate. mandible and external ear. Prominence of cheek is absent
♦♦ Lateral wall of the nose is derived, on each side, from and the ear may be displaced ventrally and caudally.
the lateral nasal process. The nasal conchae appear as There may be presence of cleft palate and faulty dentition.
elevations on the lateral wall of each nasal cavity. This condition is known as mandibulofacial dysostosis,
♦♦ The original olfactory placodes form the olfactory Treacher Collins syndrome or first arch syndrome. This
epithelium that lies in the roof, and adjoining parts of thin is a genetic condition inherited as autosomal dominant.
walls, of the nasal cavity. ♦♦ One half of face may be under developed or overdeveloped.
♦♦ The mandible may be small compared to the rest of the face
Q.2. Describe the development of face. Add a note on its
resulting in a receding chin, i.e. retrognathia. In extreme
developmental defects. (Dec 2014, 10 Marks)
cases, it may fail to develop, i.e. agnathia.
(Apr 2017, 10 Marks) (Jan 2018, 10 Marks)
♦♦ Congenital tumors may be present in relation to the face.
Or These may represent attempts at duplication of some parts.
Write short note on development of face and anomalies. ♦♦ The eyes may be widely separated also known as
(Nov 2009, 5 Marks) hypertelorism. The nasal bridge is broad. This condition
results from the presence of excessive tissue in the
Or frontonasal process.
Describe development of face. Add a note on its clinical ♦♦ The lips hay show congenital pits or fistulae. The lip may
importance. (May 2014, 10 Marks) be double.
Ans. For development of face refer to Ans 1 of same chapter. Q.3. Describe the development of palate.
(Sept 2001, 12 Marks)
Developmental Defects of Face
Or
Formation of various parts of the face involves fusion of various Write short note on development of palate.
diverse components. This fusion is occasionally incomplete and (June 2010, 5 Marks) (Feb 2016, 3 Marks)
gives rise to various anomalies, i.e. (May 2017, 5 Marks)
♦♦ Harelip: The upper lip of the hare normally has a cleft. Or
Hence, the term harelip is used for defects of the lips. Write short answer on development of palate.
Types of Harelip (Apr 2018, 3 Marks)
Ans. Palate is formed by three components, i.e.
• Unilateral harelip: Failure of fusion of maxillary process
• Primary/primitive palate: Develops from frontonasal
with medial nasal process on one side.
process.
• Bilateral harelip: Failure of fusion of both maxillary
• Secondary palate/palatal processes: From each of
processes with the medial nasal process.
the maxillary processes, a palate like shelf grows
• Midline cleft of upperlip: Defective development of the
medially which is known as palatal process of
lowermost part of the frontonasal process may give
maxilla. They are two in number.
rise to a midline defect of the upper lip.
♦♦ Cleft of lower lips: When the two mandibular processes do Primary Palate
not fuse with each other the lower lip shows a defect in the
midline. The defect usually extends into the jaw. By fusion of two medial nasal processes of frontonasal process at
♦♦ Oblique facial cleft: Non-fusion of the maxillary and lateral a deeper level there forms a wedge-shaped mass of mesenchyme
nasal process gives rise to a cleft running from the medial opposite to the upper jaw which carries four incisor teeth. Part
angle of the eye to the mouth. The nasolacrimal duct is of palate derived from frontonasal process forms premaxilla
not formed. or primary palate which carries the incisor teeth. This ossifies
♦♦ Inadequate fusion of the mandibular and maxillary and represents only small part lying anterior to incisive fossa.
processes with each other can cause abnormally wide
Secondary Palate
mouth, i.e. macrostomia. Lack of fusion may be unilateral;
this leads to formation of lateral facial cleft. Too much Tongue develops inside the floor of oral cavity. Palatine
fusion may result in a small mouth, i.e. microstomia. processes of maxilla are the hook like projections which are
♦♦ The nose may be bifid. This can be associated with median present on either side of tongue. Later, these processes assume
cleft lip. Both of them occur because of bifurcation of horizontal position above the tongue and fuse with each other
frontonasal process. Occasionally one half of it may be which form secondary palate. During later stages, mesoderm
absent. Very rarely the nose ‘forms a cylindrical projection inside the palate undergoes intramembranous ossification and
also known as proboscis jutting out from just below the form hard palate. Moreover, ossification does not extend into the
Embryology 219
most posterior portion, which remains as soft palate. Secondary Give an explanation about cleft palate.
palate forms most of the hard palate and completely soft palate. (Feb 2013, 2 Marks)
Soft palate is invaded by muscles migrating from first arch
Or
(Tensor palati) and fourth arch (Levator palati, palatoglossus,
palatopharyngeus and musculus uvulae). Write very short answer on cleft palate.
(Aug 2018, 2 Marks)
Ans. Palate is formed from the Y-shaped fusion of premaxilla
and two palatine processes.
Imperfect fusion of these processes or developmental
anomalies results in cleft palate.
Cleft palate may result from:
• Failure of shelves and septum to contact each other
because of lack of growth or because of disturbance
in mechanism of shelf elevation.
Fig. 16: Development of palate
• Failure of shelves and septum to fuse after contact
has been made because the epithelium covering the
shelves does not breakdown or is not resorbed.
• Rupture after fusion of shelves has occurred.
• Defective merging and consolidation of mesenchyme
of shelves.
Type
Defective fusion of various components of palate gives rise to
Fig. 17: Palate after ossification clefts in palate.
Definitive/Permanent Palate Complete Cleft Palate
Definitive/permanent palate is formed by fusion of three parts ♦♦ Bilateral complete cleft: Failure of fusion of both palatine
which is as follows:
processes of maxilla with premaxilla. A Y-shaped cleft
1. Fusion of palatal processes of maxilla along with primitive is present between primary and secondary palate and
palate: Each palatal process gets fused with posterior
between two halves of secondary palate. It presents
margin of primitive palate in Y-shaped manner. Each
bilateral cleft of upper lip also.
limb of Y extends between lateral incisor as well as canine
♦♦ Unilateral complete cleft: Non-fusion of one side palatine
teeth. Junction of these two components in the midline is
represented by the incisive fossa. process of maxilla with premaxilia. It presents unilateral
2. Fusion of both palatal processes of maxilla: Both palatal cleft of upper lip.
processes fuse with each other in midline. Fusion of these Incomplete Cleft Palate
two begins anteriorly and then proceeds backward.
3. Fusion of palatal processes with nasal septum: Medial edges ♦♦ Cleft of hard and soft palate: Cleft limited to hard palate.
of palatal processes get fuse with free lower edge of nasal ♦♦ Cleft of soft palate: Cleft limited to hard palate.
septum, thus separating both the nasal cavities from each ♦♦ Bifid uvula: Cleft limited to uvula.
other, and from the mouth.
Anterior three-fourths of permanent palate is ossified in
membrane and forms hard palate. Posterior one-fourth is the
unossified part that forms the soft palate.
Q.4. Short note on development defects of palate.
(Sep 2004, 5 Marks) (Feb 2013, 5 Marks)
Or
Write a short note on cleft palate.
(Aug 2016, 3 Marks) (Aug 2012, 4 Marks)
Or
Write in detail about cleft palate.
(Apr 2008, 4 Marks) (Sep 2007, 3 Marks)
Or Fig. 18: Cleft palate (For colour version see Plate 11)
220 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• From this bony canal, extending from the division ♦♦ Midline cleft of upper lip: Defective development of the
of the mandibular nerve to the midline, medial and lowermost part of the frontonasal process may give rise
lateral alveolar plates of bone develop in relation to a midline defect of the upper lip.
to the forming tooth germs so that the tooth germs
Cleft of Lower Lip
occupy a secondary trough of bone.
• This trough is partitioned, and thus the teeth come When the two mandibular processes do not fuse with each other
to occupy individual compartments, which finally the lower lip shows a defect in the midline. The defect usually
are enclosed totally by growth of bone over the tooth extends into the jaw.
germ. In this way, body of mandible is formed. Q.10. Answer in brief harelip. (Aug 2016, 2 Marks)
• Ramus of mandible develops by rapid spread of
ossification posteriorly into the mesenchyme of first Or
arch, turning away from Meckle’s cartilage. Answer in brief cleft upper lip (harelip).
• Thus by 10 weeks the rudimentary mandible is (May 2017, 3 Marks)
formed almost entirely by membranous ossification.
Or
• Further growth of mandible until birth is influenced
strongly by the appearance of three secondary What is harelip? (Aug 2018, 1 Mark)
cartilages, i.e. condylar cartilage, coronoid cartilage Ans. The upper lip of the hare normally has a cleft. Hence,
and symphyseal cartilage as well as the development the term harelip is used for defects of the lips.
of neural, alveolar and muscular attachments.
Types of Harelip
Q.7. Describe the development of palate. Add a note on its
developmental defect. (Sep 2013, 10 Marks) ♦♦ Unilateral harelip: Failure of fusion of maxillary process
with medial nasal process on one side.
(Apr 2017, 10 Marks) (Jan 2018, 10 Marks) ♦♦ Bilateral harelip: Failure of fusion of both maxillary
Ans. For development of palate refer to Ans 2 of same chapter. processes with the medial nasal process.
For developmental defect of palate refer to Ans 3 of same ♦♦ Midline cleft of upper lip: Defective development of the
chapter. lowermost part of the frontonasal process may give rise
Q.8. Describe development of face and its correlation with to a midline defect of the upper lip.
nerve supply. (Mar 2006, 15 Marks)
Ans. For development of face refer to Ans 1 of same chapter. 8. ALIMENTARY SYSTEM I: MOUTH,
Development of Face and its Correlation with Nerve Supply PHARYNX AND RELATED STRUCTURES
Process Part of face formed Nerve supply Q.1. Write a short note on development of tooth.
Frontonasal Forehead, external nose, Ophthalmic division of (Sep 2007, 4 Marks)
process nasal cavity, nasal septum, trigeminal nerve except Or
philtrum of upper lip philtrum which is innervated
by maxillary nerve Write in details, about development of tooth.
(Apr 2008, 4 Marks) (Mar 2008, 8 Marks)
Maxillary Lateral part of upper lip, Maxillary division of trigeminal
process Upper part of cheek nerve
(Dec 2010, 5 Marks) (Aug 2011, 10 Marks)
Ans. Teeth are developed from “stomatodaeum”.
Mandibular Chin, lower lip and lower Mandibular division of
process part of cheek trigeminal nerve Teeth are formed in relation to alveolar process.
Epithelium overlying the convex border of this process
Q.9. Write short note on cleft lip. gets thickened and projects into underlying mesoderm.
(May/June 2009, 5 Marks) (Nov 2008, 5 Marks) This epithelial thickening is known as dental lamina.
Ans. Cleft lip is present in both upper and lower lip. Dental lamina is apparent even before the alveolar
process itself is defined.
Following are the clefts in upper and lower lip:
• As the alveolar process is semicircular in outline, the
Cleft Upper Lip dental lamina is similarly curved.
• Dental lamina shows a series of local thickenings,
Harelip: The upper lip of the hare normally has a cleft. Hence, each of which form one milk tooth. These thickenings
the term harelip is used for defects of the lips. are known as enamel organs. There are total 10 such
enamel organs (five on each side) in each alveolar
Types of Hairlip
process.
♦♦ Unilateral harelip: Failure of fusion of maxillary process • Stages in formation of an enamel organ and
with medial nasal process on one side. development of a tooth are as follows:
♦♦ Bilateral harelip: Failure of fusion of both maxillary – Stage of dental lamina: Ectoderm over convex
processes with the medial nasal process. upper border of alveolar process thickens and
222 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
projects into underlying mesoderm as dental tooth. Such buds form enamel organs. They give rise
lamina which is U-shaped and corresponds to to permanent incisors, canines and premolars.
alveolar process. • Permanent molars are formed from buds which
– Bud stage: During this stage, ten thickening of arise from dental lamina posterior to region of last
dental lamina appears five on each side. These deciduous tooth.
are called tooth buds/enamel organs. • Dental lamina gets established during 6th week of
– Cap stage: As enamel organ grows downward intrauterine life. At the time of birth germs of all
into the mesenchyme its lower end assumes temporary teeth, and of the permanent incisors,
a cup-shaped appearance. Cup comes to be canines and first molars, show considerable
occupied by a mass of mesenchyme known as development. Germs of permanent premolars and
dental papilla. The enamel organ and dental of second molars are rudimentary. Germ of third
papilla together constitute tooth germ. During molar is formed after birth. Developing tooth germs
this stage, the developing tooth appears like a undergo calcification. All the temporary teeth and
cap and is therefore, described as the cap stage the permanent lower first molar begin to calcify
of tooth development. Cells of enamel organ before birth; the other permanent teeth begin to
which line the papilla become columnar. These calcify at varying ages after birth.
are known as ameloblasts. • Eruption of a tooth is preceded by a major develop
– Bell stage: Mesodermal cells of papilla which are ment of its root.
adjacent to ameloblasts arrange themselves as
a continuous epithelium like layer. Cells of this
layer are known as odontoblasts. Ameloblasts
and odontoblasts are separated by a basement
membrane. Remaining cells of the papilla form
pulp of tooth. Developing tooth now appears
like a bell.
– Apposition stage: Ameloblasts lay enamel
over superficial (outer) surface of basement
membrane. Odontoblasts lay down dentine
over its deeper surface. As layer after layer of
enamel and dentine are laid down, the layer
of ameloblasts and layer of odontoblasts move
away from each other.
• As enamel is fully formed, the ameloblasts disappear
and leave a thin membrane known as dental cuticle,
over the enamel. Odontoblasts continue to separate
the dentine from the pulp throughout the life of
tooth.
• Alveolar parts of maxillae and mandible are formed
by ossification in the corresponding alveolar process.
As ossification progresses, the roots of teeth are
surrounded by bone.
• Root of tooth is established by continued growth
into underlying mesenchyme. Odontoblasts here lay
down dentine. As layers of dentine get deposited,
pulp space becomes progressively narrower and
gradually gets converted into a canal through which
nerves and blood vessels pass inside the tooth.
Fig. 21: Parts of developing tooth
• In the region of the root, there ameloblasts are absent.
Dentine is covered by mesenchymal cells which Q.2. Write a short note on development of tongue.
differentiate into cementoblasts. Cementoblasts lay (Sept 2002, 5 Marks) (Sept 2004, 5 Marks)
down a layer of dense bone known as cementum. (Mar 2008, 4 Marks) (Mar 2013, 3 Marks)
Further to outside, mesenchymal cells form (Feb 2016, 3 Marks) (Sept 2017, 3 Marks)
periodontal ligament which connects root to socket
(Oct 2016, 3 Marks)
in the jaw bone.
Permanent teeth are formed as follows: Or
• Dental lamina gives off a series of buds, one of which Describe innervations and development of tongue.
lies over medial side of each developing deciduous (Mar 2000, 9 Marks)
Embryology 223
Development of Tongue
♦♦ Development of tongue occurs in relation to pharyngeal
arches (1st to 4th) inside the floor of developing mouth. It
develops during 4th to 8th weeks. Each pharyngeal arch
arises as a mesodermal thickening in lateral wall of foregut
and that it grows ventrally to become continuous with the
corresponding arch of opposite side.
♦♦ Medial most parts of mandibular arches proliferate to
form two lingual swellings. These lingual swellings are
partially separated from each other by another swelling
which appears in the midline. This median swelling is
known as tuberculum impar.
♦♦ Immediately behind tuberculum impar, epithelium
undergo proliferation to form a downgrowth, i.e.
thyroglossal duct, from which the thyroid gland develops.
Site of this downgrowth is subsequently marked by a
depression known as foramen caecum.
♦♦ Another, midline swelling is seen in relation to the medial ends
of second, third and fourth arches. This swelling is known
as hypobranchial eminence or copula of His. The eminence
soon shows a subdivision into a cranial part which is related
to second and third arches (called the copala) and a caudal
part related to the fourth arch. Caudal part forms epiglottis.
♦♦ Anterior two-thirds of tongue is formed by fusion of the
tuberculum impar and the two lingual swellings.
♦♦ Anterior two-thirds of tongue is thus derived from
mandibular arch.
♦♦ Posterior one-third of tongue is formed from the cranial Fig. 22: Development of tongue
part of the hypobranchial eminence (copula). In this
situation, the second arch mesoderm gets buried below the Correlation of Development of Tongue with its Nerve Supply
surface. The third arch mesoderm grows over it to fuse with Motor Innervations
the mesoderm of the first arch. The posterior one-third of
Muscles of the tongue are supplied by the hypoglossal nerve
the tongue is thus formed by third arch mesoderm.
♦♦ The posteriormost part of tongue is derived from the because they develop from occipital myotomes.
fourth arch. Sensory Innervation
♦♦ The line of junction of anterior two-thirds and posterior
one-third of tongue is indicated by an inverted V-shaped In keeping with its embryological origin, the anterior two-
sulcus terminalis. thirds of the tongue is supplied by the lingual branch of the
♦♦ Components of tongue include mucous membrane, mandibular nerve, which is the post-trematic nerve of the first
muscles and fibroareolar stroma. Mucosa of tongue is arch, and by the chorda tympani which is the pretrematic nerve
derived from endoderm of foregut. of first arch. The posterior one-third of the tongue is supplied
♦♦ Musculature of the tongue is derived from the occipital by the glossopharyngeal nerve, which is the nerve of the third
myotomes. This explains its nerve supply by the arch. The most posterior part of the tongue is supplied by the
hypoglossal nerve, which is the nerve of these myotomes. superior laryngeal nerve, which is the nerve of the fourth arch.
224 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Osteology
1. Osteology
c. Medial part:
1. OSTEOLOGY – Inferior ophthalmic vein
– Sympathetic nerves from plexus around internal
Q.1. Enumerate the structures passing through foramen carotid artery.
ovale. (Mar 2000, 4 Marks)
Q.4. Enumerate the structures passing through jugular
(Sept 2017, 2 Marks) (Sept 1999, 4 Marks)
foramen. (Feb 1999, 4 Marks)
Or
Ans. Following are the structures passing through jugular
Answer in brief structures passing through foramen foramen:
ovale. (May 2017, 3 Marks) a. Through anterior part:
Ans. Structures passing through foramen ovale are: – Inferior petrosal sinus
• Mandibular nerve. – Meningeal branch of ascending pharyngeal
• Lesser petrosal nerve.
artery.
• Accessory meningeal artery.
b. Through middle part:
• An emissary vein connecting cavernous sinus with
– 9, 10 and 11 cranial nerves, i.e. glossopharyngeal,
the pterygoid plexus of veins.
• Occasionally, the anterior trunk of the middle vagus and spinal accessory nerve.
meningeal vein. c. Through posterior part:
– Internal jugular vein
Q.2. Enumerate the structures passing through foramen
– Meningeal branch of occipital artery.
spinosum. (Sept 2000, 4 Marks)
Ans. Structures passing through foramen spinosum are: Q.5. Write about structures passing through passing
• Middle meningeal artery. foramen magnum. (Sept 2011, 5 Marks)
• Meningeal branch of mandibular nerve or nervous Ans. It is divided into a small anterior and a large posterior com-
spinosus. partment by means of the alar ligaments of axis vertebra.
• Posterior trunk of middle meningeal vein. a. Structures passing through anterior compartment:
Q.3. Enumerate the structure passing through superior 1. Apical ligament of dens
orbital fissure. (Mar 2009, 10 Marks) 2. Vertical band of cruciate ligament
Ans. Three parts of superior orbital fissure transmits the 3. Membrana tectoria.
following structures: b. Structures passing through posterior compartment:
a. Lateral part: 1. Medulla oblongata
– Lacrimal nerve 2. Meninges, i.e. dura, arachnoid and pia mater.
– Frontal nerve c. Through subarachnoid space:
– Trochlear nerve 1. Spinal accessory nerve
– Superior ophthalmic vein 2. Vertebral arteries
– Meningeal branch of lacrimal artery 3. Sympathetic plexus around vertebral arteries
– Anastomotic branch of middle meningeal artery 4. Posterior spinal arteries
which anastomoses with recurrent branch of 5. Anterior spinal artery.
lacrimal artery.
Fig. 4: Axis
♦ Articular facets: Both the superior articular facets occupy ♦ A blow to the pterion, (e.g. in boxing) may rupture the
upper surfaces of body and massive pellicle. Laterally, the artery causing an epidural hematoma. The pterion may
articular facet has foramen transversarium. This foramina also be fractured indirectly. Blows to the top or back of the
is a large, flat, circular facet which is directed upward and head may not cause fracture at the site of impact, but may
laterally. The foramen transversarium articulates with the place sufficient force on the skull that its weakest part, the
inferior facet of atlas vertebra to form atlantoaxial joint. pterion, will fracture.
Each of the inferior articular facets articulates with the
third cervical vertebra.
♦ Transverse process is small and represents true posterior
tubercles.
♦ Spine of the axis is large, thick and strong. Spine is deeply
grooved inferiorly. Tip of spine is bifid and terminate in
the two rough tubercles.
Attachments
♦ Odontoid process gives attachment at its apex to apical
ligament on each side and below the apex to alar
ligaments.
♦ Longus colli is inserted in anterior surface of the body.
Anterior longitudinal ligament is attached to anterior
surface.
♦ Posterior surface of body gives attachment to posterior
longitudinal ligament, membrane tectoria and vertical Fig. 5: Pterion
limb of cruciate ligament.
♦ Laminae provide attachment to ligament flava. Q.8. Write short note on osteogenesis. (June 2010, 5 Marks)
♦ Transverse process provides origin by its tip to levator Ans. Osteogenesis is also known as ossification
scapulae, scalenus medius anteriorly and splenius cervicis • Osteogenesis is the process of laying down new bone
posteriorly. Intertransverse muscles get attached to the material by cells called osteoblasts.
upper and lower surfaces of transverse process. • There are two processes resulting in the formation
♦ Spine of the vertebra provide attachment to ligamentum of normal, healthy bone tissue.
nuchae, semispinalis cervicis, rectus capitis posterior 1. Intramembranous ossification.
major, inferior oblique, spinalis cervicis, interspinalis and 2. Endochondral ossification.
multifidus. Intramembranous Ossification
Q.7. Write a short note on pterion. (Mar 2013, 4 Marks)
♦ Bone is formed by differentiation of mesenchymal cells
Or into osteoblasts.
Answer in brief on pterion. (May 2017, 3 Marks) ♦ It occurs in flat bones of skull and clavicle.
Ans. The pterion is the point corresponding with the posterior ♦ It begins at the end of second month of gestation.
end of the sphenoparietal suture.
Procedure of Intramembranous Ossification
It is situated about 3 cm. behind, and a little above
the level of the zygomatic process of the frontal bone. ♦ In membrane where the future bone formation has to
be taken place, few mesenchymal cells differentiate into
It marks the junction between four bones osteoblast cells. Osteoblasts secrete the organic intercellular
1. The parietal bone matrix of the bone.
2. The squamous part of temporal bone ♦ Area where the osteoblasts first appear in membrane is
3. The greater wing of sphenoid bone called as center of ossification.
4. The frontal bone. ♦ Osteoblasts are now surrounded by bony matrix.
♦ Osteoblasts surrounded by bony matrix are converted to
Clinical Significance
osteocytes.
♦ The pterion is known as the weakest part of the skull. ♦ Osteocyte is a resting cell which lies in lacuna and
♦ Clinically, the pterion is relevant because the anterior processes lie in canaliculi.
division of the middle meningeal artery runs beneath it, ♦ Osteoblasts on surface of bony matrix secrete phosphatase
on the inner side of the skull, which is quite thin at this which helps in calcification of intercellular matrix.
point. The combination of both a vital artery in this area ♦ Osteoblasts proliferate and differentiate in radiating manner
and the relatively thin bone structure has lent itself to the from center of ossification. Osteoblasts form bony trabeculae
name “God’s little joke” by some physicians. on the surface of which bone is formed layer by layer.
232 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦ Bony trabeculae fuse with each other to form spongy bone. ♦ Model is surrounded by perichondrium which is made
♦ Blood vessels grow in spaces between trabeculae and the up of inner chondrogenic layer and outer fibrous layer.
connective tissue surrounding these blood vessels now ♦ Growth of cartilage model is by interstitial and appositional
differentiate into red bone marrow. growth.
♦ Mesenchymal cells on outer surface of developing bone ♦ As the differentiation of cartilage cells move towards
from periosteum membrane. metaphysis, cells organize into longitudinal columns
♦ Spongy bone formed by intramembranous ossification is which are subdivided into following zones.
now replaced by the compact bone.
♦ Bone formed is known as membranous bone. A. Zone of reserved cartilage
It exhibits no cellular proliferation or secretion of active
Endochondral Ossification matrix production.
♦ This ossification involves replacement of the cartilaginous B. Zone of proliferation
model by bone. • This zone lies adjacent to zone of reserve cartilage in
♦ It occurs at extremities of all long bones, vertebrae, ribs, the direction of diaphysis.
articular extremity of mandible and base of skull. • In this zone, cartilage cells undergo division and are
♦ At the site where bone is to be formed there is presence of organized into distinct columns. These cells now can
condensation of mesenchymal cells.
actively produce matrix.
♦ Mesenchymal cells are now transformed to chondroblast
cells which secrete the cartilage matrix.
♦ Thus, a hyaline cartilage covered by perichondrium is
formed.
♦ This cartilaginous model is replaced by formation of
bone and bone formed is known as cartilage bone. Most
of the bones of our body are formed by endochondral
ossification.
Procedure of Endochondral Ossification
Formation of Cartilagenous Model
♦ At a site where limb will later emerge, embryo shows
outgrowth of mesoderm covered by ectoderm.
♦ Mesenchymal cells at this area condense and differentiate
into chondroblasts and form cartilaginous matrix resulting
in the development of hyaline cartilage model.
C. Zone of hypertrophy
• This is the broadest zone.
• It consists of enlarged cartilage cells and in early stages
they secrete type II collagen.
• As the cells become larger in size proteoglycans are
secreted.
• As chondrocytes reach their maximum size, they
Fig. 6: Formation of cartilagenous model secrete Type X collagen as well as noncollagenous
(For colour version see Plate 11) proteins.
Osteology 233
♦ Spongy bone is retained and no medullary cavity is formed • If anterior fontanel is bulged, there is rise in the
in epiphysis. intracranial pressure.
♦ Ossification spreads from secondary center in all direction. • If anterior fontanel is depressed, it causes decrease
♦ After completion of secondary ossification hyaline cartilage in intracranial pressure.
remains at two places on the epiphyseal surface as articular
cartilage and at junction of diaphysis and epiphysis where
it forms epiphyseal plate.
Union of primary and secondary ossification centers is called
as epiphyseal line.
Histology
♦♦ Examples of squamous cuboidal epithelium: Epithelium ♦♦ All cells are attached to the basement membrane but are of
lining the follicles of thyroid gland, ducts of exocrine different heights. Hence, not all reach the apical surface.
glands and pigmented epithelium of retina. Because of this, nuclei of cells are at different levels.
♦♦ The epithelium may be ciliated or non-ciliated and may
Columnar
contain goblet cells.
♦♦ Cells of the epithelium are much taller compared to their ♦♦ The non-ciliated pseudostratified epithelium is found in
width. the large excretory ducts, auditory tube and male urethra.
♦♦ Nuclei are elongated and located in the lower half of the ♦♦ Examples of pseudostratified epithelium is upper
cells. All nuclei are placed at the same level in neighboring respiratory tract.
cells.
♦♦ On their free surface, modifications like microvilli or cilia Transitional Epithelium
may be seen. It may also contain goblet cells. ♦♦ Appearance of epithelium varies during stretched and
♦♦ Examples of squamous columnar epithelium: Epithelial relaxed conditions. When this epithelium is stretched then
lining of gallbladder, ducts of glands, gastrointestinal it looks like stratified squamous epithelium. But when
tract (from stomach to anus), uterine tube, uterine cavity, the epithelium is in relaxed condition it appears stratified
cervical canal and central canal of spinal cord. cuboidal. Due to this apparent change in the shape this
epithelium is called as transitional epithelium.
Stratified Epithelium
♦♦ This epithelium is seen in epithelial lining of the urinary
Stratified Squamous (Nonkeratinized) tract.
♦♦ Cells are arranged in many layers. Basal layer is attached Q.2. Write short note on stratified squamous epithelium.
to basement membrane and is usually columnar, cuboidal (Nov 2009, 5 Marks)
or rounded in shape. Ans. Stratified squamous (nonkeratinized)
♦♦ Intermediate cells are irregularly polyhedral in shape • Cells are arranged in many layers. Basal layer is
and become increasingly flattened as they move towards attached to basement membrane and is usually
superficial layer. columnar, cuboidal or rounded in shape.
♦♦ Superficial layer consists of thin squamous cells. Basal cells • Intermediate cells are irregularly polyhedral in shape
replace surface cells as they are shed off. and become increasingly flattened as they move
♦♦ Examples of non-keratinized stratified squamous towards superficial layer.
epithelium: Epithelial lining of oral cavity, tongue, part • Superficial layer consists of thin squamous cells.
of epiglottis, esophagus and vagina. Basal cells replace surface cells as they are shed off.
• Examples of non-keratinized stratified squamous
Stratified Squamous (Keratinized)
epithelium are epithelial lining of oral cavity, tongue,
♦♦ In this epithelium superficial cells become dead, part of epiglottis, esophagus and vagina.
dehydrated and non-nucleated like scales. Stratified squamous (keratinized)
♦♦ These dead cells become hard (cornified) as they are filled • In this epithelium, superficial cells become dead,
with keratin. dehydrated and non-nucleated like scales.
♦♦ Examples of keratinized stratified squamous simple • These dead cells become hard (cornified) as they are
epithelium is skin. filled with keratin.
Stratified Cuboidal • Examples of keratinized stratified squamous simple
epithelium is skin.
♦♦ Epithelium consists of two or more layers of cells.
♦♦ Cells of superficial layer are cuboidal in shape. Q.3. Enumerate classification of epithelium. (Do not
♦♦ Examples of stratified cuboidal epithelium is ducts of describe). (Feb 2013, 2 Marks)
sweat glands. Ans. Types of Epithelium
1. Simple epithelium (single layer of cells)
Stratified Columnar a. Squamous
♦♦ It contains two or more layers of cells. b. Cuboidal
♦♦ Cells of superficial layer are columnar. c. Columnar
♦♦ Examples of stratified columnar epithelium: Epithelial 2. Stratified epithelium (multiple layer of cells)
lining of large ducts of some glands, fornix of conjunctiva a. Stratified squamous
and cavernous urethra. b. Stratified cuboidal
c. Stratified columnar
Pseudostratified Epithelium 3. Pseudostratified (epithelium appears as it is
♦♦ It is not a true stratified epithelium but appears to be stratified)
stratified. 4. Transitional (shape of epithelium is not fixed)
Histology 241
♦ ,
2. CARTILAGE fi ,
♦ Elastic cartilage contains a meshwork of branching
fi v w
(Feb 2002, 2 Marks) E fi H E
Or v z
fi ( )
Write a short note on types of cartilages with example. (Feb
2005, 5 Marks)
Ans. Cartilage
C fi z v
v ,
, fi
Three types of cartilage are found in the body
H
i. Coastal cartilage
ii. Articular cartilage
2. Elastic cartilage
3. Fibrocartilage
Hyaline Cartilage
♦ ,
x x fi and ground Hyaline cartilage
substance.
♦ x ,
present in small spaces called as lacunae.
♦ H
♦ fi
fi
♦ G ( ) - k
w ( x )
The main constituent of ground substance is sulfated
( ) x
to the presence of chondroitin and keratin sulfate
that are acidic in nature. This dark blue staining around
lacuna is x A w
the lacuna the concentration of sulfated
proteoglycans x
w that intense blue staining that is seen Elastic cartilage
in capsule. This x
x
♦ Only one type of cell (chondrocyte) is seen in the cartilage.
, x
w
♦ v v w
fi
v
♦ H , , w v
w fi v
♦ P w , fi
( fi v )
and an inner cellular layer (made up predominantly of
w v w
is growing).
Elastic Cartilage
♦ Cartilage is highly elastic in nature. It looks yellow in fresh Fibrocartilage
state and hence sometimes called as yellow elastic cartilage. Fig. 2: Various types of cartilage
242 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦♦ Chondrocytes are present in lacunae. These cells are bigger up predominantly of cells which may convert to
than cells present in hyaline cartilage and are present singly chondrocyte when cartilage is growing).
or in groups of two. Cells are closely placed as intercellular
ground substance is much less than in hyaline cartilage.
Fibrocartilage
♦♦ It is also known as white fibrocartilage as it contains
bundles of thick collagen fibers.
♦♦ Histological structure of fibrocartilage resembles dense
regular connective tissue.
♦♦ In fibrocartilage all the collagen fibers are of type I and
type II varieties.
♦♦ Minimal amount of basophilic ground substance is seen
around chondrocyte.
♦♦ Very few chondrcytes are seen which are oriented between
large collagenous fiber bundles. Fig. 3: Hyaline cartilage
♦♦ Chondrocytes are either present in a row or scattered singly (For colour version see Plate 13)
between bundles of fibers.
♦♦ Perichondrium is absent in fibrocartilage. Q.3. Write short note on histology of elastic cartilage.
(Feb 2013, 5 Marks)
Q.2. Write a short note on hyaline cartilage.
(Dec 2012, 3 Marks) (Apr 2008, 5 Marks) Or
Ans. Hyaline Cartilage Write short note on histology of elastic cartilage.
• It consists of homogeneous, transparent and (Apr 2015, 3 Marks)
amorphous intercellular matrix. The matrix consists Ans. Elastic cartilage is highly elastic in nature. It looks yellow
of collagen fibers and ground substance. in fresh state and hence sometimes called as yellow
• Throughout the matrix cartilage cells, i.e. chondro- elastic cartilage.
cytes are present in small spaces called as lacunae.
• Hyaline cartilage is surrounded by perichondrium.
• Ground substance of hyaline cartilage contains fine
type II collagen fibers that are about 15 to 40 nm in
diameter.
• Ground substance is featureless (homogeneous)
gel-like substance that stains blue with basic dye
(hematoxylin). The main constituent of ground
substance is sulfated proteoglycans (aggrecan).
The basophilia of matrix is due to the presence of
chondroitin and keratin sulfate that are acidic in
nature. This dark blue staining around lacuna is
called as capsule or territorial matrix. As far away
from the lacuna, the concentration of sulfated
proteoglycans becomes less and less and thus the
matrix does not show that intense blue staining Fig. 4: Elastic Cartilage (For colour version see Plate 13)
that is seen in capsule. This matrix is called as inter-
territorial matrix. • The elastic cartilage also consists of ground
• Only one type of cell (chondrocyte) is seen in the substance, fibers, cells and perichondrium.
cartilage. These cells occupy lacunae in the matrix. • Elastic cartilage contains a meshwork of branching
• In a young cartilage, chondrocytes show mitotic cell and anastomosing elastic fibers that gives it a yellow
division and give rise to daughter cells. These newly appearance.
formed chondrocytes produce fibers and ground • Elastic fibers are not seen in H&E stain but are
substance around themselves. visualized by special staining methods for elastic
• Hyaline cartilage, on its free surface, is always fibers (orcein stain and verhoeff’s stain).
covered with a fibrovascular membrane called as • Chondrocytes are present in lacunae. These cells are
perichondrium. bigger than cells present in hyaline cartilage and are
• Perichondrium consists of two layers, i.e. an outer present singly or in groups of two. Cells are closely
fibrous layer (made up of dense irregular fibrous placed as intercellular ground substance is much
connective tissue) and an inner cellular layer (made less than in hyaline cartilage.
Histology 243
II.
Based on the development:
(Aug 2016, 2 Marks) 1. Endochondral bone
Ans. For diagram of hyaline cartilage refer to Ans. 2 of same 2. Intramembranous bone.
chapter. III. Based on shape.
1. Long bone
Parts of Hyaline Cartilage
2. Short bone
♦ Perichondrium which consists of fibrous layer and cellular 3. Flat bone
layer. 4. Irregular bone
♦ Matrix which consists of ground substance and collagen 5. Sesamoid bone.
fibers.
♦ Cells, i.e. chondrocytes which reside in lacunae. Compact Bone
♦ Outer aspect of compact bone is surrounded by condensed
3. BONE TISSUE fibrocollagen layer, i.e. periosteum which has two layers
A- Outer layer: Dense irregular connective tissue fibrous
layer.
(Sep 2002, 4 Marks) B- Inner layer: Lies next to bone surface consisting of bone
Or cells, their precursors and rich vascular supply.
Write short note on histology of bone. ♦ Inner surface of compact bone is covered by thin cellular
(Aug 2011, 5 Marks) (Dec 2014, 5 Marks) layer called as endosteum.
Or
Write short note on compact bone.
(Nov 2008, 5 Marks)
Or
Write short note on histological structure of compact
bone. (Apr 2007, 5 Marks)
Ans. Bone is a specialized type of connective tissue. Similar
to all other connective tissues it also consists of ground
substance, fibres and cells.
However, the bone is classified as specialized connective
tissue because of presence of minerals (calcium salts) in
its intercellular matrix.
Bone consist of four types of cells, i.e. osteogenic cells,
osteoblasts, osteocytes and osteoclasts. Fig. 5: Compact bone (For colour version see Plate 14)
Osteogenic cells are present in the cellular layer of
periosteum, endosteum and in haversian canals. These ♦ At periosteal and endosteal surfaces, lamellae are arranged
are stem cells which after cell division give origin to in parallel layers surrounding bony surface known as
osteoblasts. These cells are derived from embryonic circumferential lamellae.
mesenchymal cells. ♦ Haversian canal and concentric lamellae together form
Osteoblasts are bone-forming cells. They synthesize and osteon or haversian system.
secrete matrix (collagen fibers and ground substance). ♦ A cement line of mineralized matrix which is strongly
They are also responsible for calcification of matrix. basophilic delineates haversian system.
Osteocytes are the main cells of bone tissue. They are ♦ This line marks limit of bone erosion prior to formation of
formed from osteoblasts become entrapped in matrix osteon also known as reversal line.
secretion at the time of formation of new bone. These ♦ Resting line denotes the period of rest during bone
cells play role in maintenance of surrounding matrix formation.
as well as they also respond to various pressure and ♦ Adult bone, between osteons, contains interstitial lamellae,
tensions applied on the bone. which are remnants of osteons left behind during
Osteoclasts are the cells involved in the bone resorption. remodelling.
(lacunae) containing osteocytes. Radiating from these Each of the muscle fiber is formed by many
lacunae are canaliculi which are occupied by the processes cells which join from end to end at junctional
of osteocytes. Osteocytes situated in lacunae derive their specializations known as intercalated discs.
nutrition through canalicular system from blood vessels • Each of the myocyte measures from 50 to 100 µm
present in bone marrow. in length and 15 µm in thickness. Myocyte consists
of single oval nucleus which is centrally placed and
is surrounded by sarcoplasm, various organelles
and myofibrils. Due to high energy and oxygen
requirements of cardiac muscle fibers they have huge
amount of mitochondria, glycogen, triglycerides and
abundant myoglobin. Sometimes myocyte may have
two nuclei also.
• Muscle fibers lie almost parallel to each other.
Individual muscle fibers branch and anastomose
with myocytes of neighboring fibers.
• Cardiac muscle fibers also show cross striations. But
these cross striations are less prominent as compared
to cross striations of skeletal muscle fibers.
• Myofibrils of cardiac muscle fibers consist of actin
and myosin filaments. Cardiac muscles also A and
Fig. 6: Cancellous bone I bands and also the Z discs which are also seen in
(For colour version see Plate 14) skeletal muscle fibers.
• Intercalated disc is the irregular transverse
Woven or Immature Bone or Nonlamellar Bone thickening of sarcolemma. Such discs are broken
♦ It is first formed bone with irregularly oriented collagen into number of steps and do not run straight across
fibers of varying diameter. the fibers providing it staircase-like appearance. This
♦ It is not seen after the birth. type of appearance is produced because adjacent
♦ It is seen in alveolar bone and during healing of fractures. sarcolemmas are interdigitating and present
♦ Marrow cavities and spaces in spongy bone contain bone longitudinal and transverse portions.
marrow. • Transverse portions are thick and provide site of
attachment of myofilament to sarcolemma whereas
longitudinal portions are thin and consists of gap
4. MUSCULAR TISSUE junction.
Fig. 12: Lymph node (For colour version see Plate 15)
Ans. • The outer covering of the palatine tonsil consists of 4. Stratum lucidum: This layer is seen only in thick skin.
connective tissue capsule and the pharyngeal part Cells in this layer are flattened, translucent, eosinophilic
is covered by stratified squamous nonkeratinized and without any organelles including nucleus.
epithelium which is invaginated to form crypts. 5. Stratum corneum: It is the most superficial layer of
• Palatine tonsil consist of only efferent lymph vessels. epidermis. It is composed of structureless dehydrated
• Palatine tonsil has no cortex and medulla and the dead cells. The interior of the cell is filled with keratin. The
lymphocytes remain united as small follicles along thickness of stratum corneum is much more in thick skin
the side of crypts. compared to thin skin.
In some of the follicles the germinal centers should
be seen. Dermis
Dermis is predominantly made up of collagen bundles. It also
contains elastic fibers, connective tissue cells, nerves, lymphatics
and blood vessels. Dermis is usually divided into two layers:
1. Papillary layer: It is a narrow band of loose connective
tissue in contact with basement membrane of stratum
basale. This layer shows finger-like processes projecting
into undersurface of epidermis. These projections are called
as dermal papillae. The papillae contain type I collagen
and elastic fibers, nerves, blood vessels and various types
of connective tissue cells.
Palatine Tonsil
♦ Palatine tonsil consists of protective layer of stratified
squamous nonkeratinized epithelium.
♦ It shows invaginations by deep grooves known as crypts.
♦ A dense connective tissue underlies the tonsil and forms
its capsule consisting of some blood vessels.
♦ Below the epithelium, numerous lymphatic nodules are
distributed which merge frequently with each other and
exhibit lighter staining germinal center. Fig. 16: Skin (For colour version see Plate 15)
♦ Tonsillar crypts usually consist of dead antigen, broken
debris, disarmed bacteria, etc. 2. Reticular layer: The reticular layer of skin is an example of
dense irregular connective tissue. It contains coarse bundles
of type I collagen, thick elastic fibers, nerves, blood vessels
7. SKIN and few connective tissue cells, i.e. fibroblasts, mast cells,
lymphocytes, macrophages and fat cells.
Q.1. With the help of labeled diagram briefly describe
histology of skin. (Mar 1996, 5 Marks)
Ans. Skin
Skin consists of two layers, i.e. epidermis and dermis. 8. RESPIRATORY SYSTEM
Epidermis
It consists of stratified squamous (keratinized) epithelium.
Following five layers can be distinguished in thick skin from
deep to superficial surface.
1. Stratum basale: It consists of a single layer of cuboidal
cells which are situated on the dermis. A thin basement (Dec 2010, 5 Marks)
membrane is situated between stratum basale and dermis. Ans. Trachea
2. Stratum spinosum: It consists of several layers of polygonal Trachea divides into two principal (or primary) bronchi.
cells which are held together by desmosomes. The trachea and primary bronchi consist of four layers:
3. Stratum granulosum: This layer is made up of 3–5 layers a. Mucous membrane (epithelium and lamina propria):
of flattened polygonal cells. These cells are filled with The epithelium is pseudostratified ciliated columnar
keratohyalin granules. with goblet cells. The epithelium rests on thick basal
Histology 249
Cementum
♦ Cementum covers the dentine of the root. It extends from
the enamel at the neck (from dentinoenamel junction) to
the apical pore. It is bone-like tissue. It is mineralized. It
contains cementocytes which reside in lacunae.
♦ Cementocyte also contains many processes within
canaliculi which radiate from lacunae. Collagen bundles
of periodontal membrane are anchored to the cementum.
Periodontal Ligament
Fig. 17: Trachea (For colour version see Plate 15) ♦ Periodontal ligament connects cementum to the bone
of alveolar socket. It consists of cells and extracellular
Q.2. Draw a diagram to show histological features of lung. substance. PDL comprises of bundles of collagen fibers.
(Mar 2006, 2.5 Marks) (Mar 2009, 2.5 Marks) ♦ These group of fibers have specific orientation and are
called as principle fibers. They are as follows:
Ans. Lung
1. Alveolar crest group of fibers: Extending from the crest
of alveolar bone to the cervical part of the cementum.
2. Horizontal group: Running horizontally between
cementum and alveolar bone and arranged perpendi-
cular to the long axis of the tooth.
3. Oblique group: Are arranged obliquely from
cementum to alveolar bone and insertion in cementum
is more apical than insertion in bone. These constitute
the major group of fibers.
4. Apical group: Are located in the apical region of the
tooth radiating from the apex of the root to the base
of alveolar socket.
5. Interradicular fibers: Interradicular fibers are inserted
Fig. 18: Lung in cementum from crest of interradicular septum in
(For colour version see Plate 15) the multirooted teeth.
Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Gingival Group of Fibers • Lingual salivary glands of posterior l/3rd of tongue are
mostly mucous in nature and are located in muscular
These are the secondary fibers of periodontal ligament seen in
layer. These glands open into the recesses of mucosa.
the lamina propria of the gingival and supplement the principal
Lingual papillae: Body of tongue (anterior 2/3rd), on
fibers in maintaining the functional integrity of the teeth. These
its dorsal surface, is covered with the specialization
include:
of epithelium called the lingual papillae. Lingual
1. Dentogingival: Extending from the cervical portion of the
papillae are projections of lamina propria covered
cementum to the lamina propria of gingiva.
with stratified squamous epithelium which may
2. Dentoperiosteal: Extending from cementum to the
be keratinized. Many papillae contain taste buds.
periosteum of the alveolar crest and of the vestibular and
The papillae are of four types: Filiform, fungiform,
oral surface of the alveolar bone.
circumvallate and foliate. The foliate papillae are not
3. Alveologingival: Extending from the crest of the alveolar
well developed in humans.
bone to the lamina propria of gingiva. Filiform papillae: These are most numerous of the
4. Circular fibers: These fibers are arranged in the gingival lingual papillae covering most of the anterior 2/3rd
connective tissue, encircling the tooth like a collar. of the tongue. These are conical projections about
5. Trans-septal fibers: Are also accessory fibers extending 2-3 mm in length. Their tips are keratinized. These
interproximally between adjacent teeth. papillae are distributed in parallel rows. Filiform
Dental Pulp papillae contain no taste buds; they increase the
friction between tongue and food.
In the pulp four distinct zones are seen microscopically:
1. Odontoblastic zone: This is the most peripheral zone of
pulp seen adjacent to the predentine layer. Odontoblast
cells are columnar in the crown and flattened in the root.
They have process at their apical portion extending into
the dentinal tubules.
2. Cell free zone: Beneath the odontoblast layer is cell free
zone of Weil which is devoid of cells, but has fibers and
nerves.
3. Cell rich zone: This zone is seen beneath the cell free zone
and is rich in cells. Cells present are mainly fibroblasts and
progenitor cells.
4. Pulp core: Central portion of pulp is called pulp core
that contains cells, large blood vessels and nerves, etc.
distributed in the ground substance.
Q.2. Write a short note on microscopic structure of tongue. Fig. 19: Filiform papillae (For colour version see Plate 16)
(Feb 1999, 4 Marks) (Dec 2010, 5 Marks)
(May 2017, 3 Marks) (Aug 2012, 4 Marks) Fungiform papillae: They are found distributed
among the filiform papillae. Their shape is like
Or mushroom and they project above the filiform
Write a short note on histology of tongue. papillae. They have highly vascularized connective
(Dec 2012, 3 Marks) (Dec 2014, 5 Marks) tissue core; hence, visible as red dots. The taste buds
(Apr 2017, 4 Marks) are present in the epithelium on its dorsal surface.
Ans. Tongue
• Tongue is an accessory digestive organ composed
of skeletal muscle covered with mucous membrane.
Lining mucosa consists of stratified squamous
epithelium and a lamina propria.
• An inverted V-shaped groove, the sulcus terminalis,
divides the dorsal aspect of tongue into anterior 2/3rd
(body of tongue) and posterior l/3rd (root of tongue).
The dorsal aspect of root of tongue (posterior l/3rd)
contains many oval or rounded elevations which
are due to the lingual tonsils. These elevations may
contain lymph nodules and may show presence
of germinal center in it. Elsewhere, where lymph
nodules are not present, the mucosa shows the
general properties of lining mucosa. Fig. 20: Fungiform papillae (For colour version see Plate 16)
Histology 251
Fig. 23: Taste bud (H&E Stain) (For colour version see Plate 16)
Q.7. Write a short note on microscopic structure of sub- ♦ Wharton’s duct is an excretory duct.
mandibular salivary duct. (Oct 2016, 3 Marks) ♦ Submandibular salivary gland duct is lined by stratified
Ans. Submandibular salivary duct is also known as Wharton’s columnar epithelium.
duct. ♦
♦ Wharton’s duct begins as tiny branches in superficial lobe and
runs posteriorly emerging from anterior aspect of deep lobe.
Histology 253
cells. In large ducts occasionally goblet cells and ciliated Muscular Layer
cells can be seen.
It is made up of outer longitudinal and inner circular layers of
♦ Ductal epithelium slowly undergoes a transition to
smooth muscle.
stratified, cuboidal and finally into stratified squamous
epithelium when it merges with the epithelium of oral Serosa/Adventitia
cavity.
♦ It also consists of small number of other types of cells, i.e. As most of duodenum is retroperitoneal, some parts of its
tuft or brush cells with long stiff microvilli. surface may show serosa; otherwise, it is covered by adventitia.
♦ Sometimes cells with pale cytoplasm and dense nuclear
chromatin are seen at the base of duct epithelium. These
are lymphocytes and macrophages. 11. THE DIGESTIVE SYSTEM III:
LIVER, GALLBLADDER AND PANCREAS
10. THE DIGESTIVE SYSTEM II: Q.1. Write a short note on histology of liver.
ALIMENTARY CANAL (Jan 2018, 5 Marks)
Ans. Liver is surrounded by a thin connective tissue capsule
and is divided into many lobes, i.e. right, left, caudate
(Mar 2006, 5 Marks) and quadrate lobes.
Ans. Duodenum Hepatic artery, bile duct and portal vein enter the liver
at porta.
Connective tissue which enters the liver at porta with
other structures branches inside the liver to form partial
boundary of liver lobules and support branching vessels
and ducts. Lobules are not well-defined in humans as
their interlobular connective tissue or interlobular septa
are poorly developed.
Branches of portal vein, hepatic artery and bile duct
course together in intralobular septa as triad known as
portal triad.
♦ A hepatocyte is exposed on its two to three sides to Q.2. Write a short note on histology of bladder.
sinusoids via which blood flows towards the central vein. (Jan 2018, 5 Marks)
Same hepatocyte also forms bile canaliculi over its left out
Ans. There are two important bladders present in human
three or four remaining sides.
body, i.e. gallbladder and urinary bladder.
Gallbladder
Gallbladder is known as the temporary store house of bile and
concentrates it by water re-absorption.
Gallbladder consists of following layers, i.e.
♦ Mucosa
♦ Fibromuscular layer
Mucosa
♦ It has simple tall columnar epithelium and lamina propria
of loose connective tissue.
♦ Serosa/adventitia
♦ Mucosal glands and muscularis mucosae are absent.
♦ Mucosa remains in small folds when gallbladder is
A empty.
♦ Epithelial cells present in gallbladder consist of basally
placed oval nucleus and faintly stained eosinophilic
cytoplasm. These cells consist of many small microvilli
over their apical surface.
♦ Lamina propria is present but submucosa is absent.
Fibromuscular Layer
♦ It consists of randomly arranged smooth muscle fibers.
♦ Between the muscle fibers, there lies the dense connective
tissue which is rich in elastic fibers.
♦ A layer of dense connective tissue lies outside the muscular
layer which has blood vessels, nerves and lymphatics. This
layer is known as adventitia.
Serosa
B Over its inferior surface gallbladder get covered by serosa and
Figs 25A and B: Liver (For colour version see Plate 17) rest of it is covered by adventitia.
Fig. 26: Gallbladder (H&E stain) (For colour version see Plate 17)
Histology 255
Urinary Bladder • Exocrine part forms the major portion and consists
of secretory serous acini and zymogenic cells which
The urinary bladder consists of following layers, i.e.
are arranged in small lobules bounded by thin
♦ Mucosa
intralobular and interlobular connective tissue septa
♦ Muscle layer
which have interlobular ducts and blood vessels.
♦ Serosa/adventitia
Endocrine part is represented by isolated pancreatic
islets or Islets of Langerhans which are present
between serous acini. Islet of Langerhans are small
isolated mass of cells and are distributed throughout
pancreas. These are most numerous in tail.
Each of the acinus has pyramidal shaped protein
secreting cell which surrounds the small lumen.
Ducts of acinus are visible as centroacinar cells
and secretions leave through intralobular ducts to
interlobular ducts.
Fig. 27: Urinary bladder (H&E stain) (For colour version see Plate 20)
Mucosa
♦ It is made up of transitional epithelium as well as lamina
propria.
♦ Empty bladder shows many of the mucosal folds and its
epithelium increases in thickness till eight cell layers.
♦ Superficial layer is stained eosinophilic because of presence
of plaques. These plaques are the modified areas of plasma
Fig. 28: Pancreas (For colour version see Plate 17)
membrane.
♦ When the bladder got filled the mucosal folding disappears Islets get separated from acini by thin layer of
and epithelium become thin from 3 to 4 cells. reticular fibers and are compact cluster of epithelial
♦ Lamina propria is formed by moderately dense connective cells permeated by capillaries and have alpha, beta,
tissue. delta and F cells.
Muscular Layer • Beta cells are most important cells, they form 80%
of the cell population. Beta cells are granular and
♦ Thick muscle coat is formed by smooth muscle fibers which
basophilic.
run in all the directions.
• Alpha cells form 20% of the cell population and are
♦ In between bundles of muscle fibers there present is loose
granular and acidophilic. They have subtypes A1
connective tissue.
♦ Three muscular coats are described, i.e. transverse, and A2.
longitudinal and oblique. These muscular coats are difficult
to distinguish. 12. THE ENDOCRINE SYSTEM
♦ At trigone the mucosa is thin and is directly applied to
muscle layer.
Q.1. Write a short note on light microscopic structure of
Serosa/Adventitia pituitary gland. (Sep 2004, 5 Marks)
Ans. Hypophysis or pituitary gland consists of two parts
Serosa cover the superior surface of bladder and rest all the
which are distinct in structure and function, i.e.
surfaces are covered by tunica adventitia.
adenohypophysis and neurohypophysis.
Q.3. Describe briefly histology of pancreas.
(Apr 2008, 5 Marks) Adenohypophysis
Ans. Pancreas consists of both endocrine part and exocrine ♦ Adenohypophysis consists of three subdivisions, i.e. pars
part. distalis, pars intermedia and pars tuberalis.
Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Neurohypophysis
♦ It consists of median eminence, infundibular stalk and
pars nervosa.
♦ Pars nervosa consists of unmyelinated axons and axon
terminals of more than 100,000 neurosecretory neurons
whose cell bodies are located in paraventricular and
supraoptic nuclei of hypothalamus.
Fig. 30: Pars nervosa (For colour version see Plate 18)
Histology 257
vesicular and rounded nucleus. The cytoplasm takes 3. Zona reticularis: It is a thin zone situated adjacent to
light eosinophilic stain in H&E preparation. medulla. It consists of small, rounded, deeply staining
A few cells called parafollicular cells may be cells which are arranged in three-dimensional network of
embedded within a follicle or lie between follicles. branching and anastomosing cords.
They are not exposed to the lumen of follicle.
Parafollicular cells are either found singly or in small Structure of Adrenal Medulla
groups. Nucleus is round or ovoid and cytoplasm Cells of medulla are large, epithelioid and arranged in groups
contains secretory granules. They are pale or light or short cords. These cells are closely related to sinusoidal
staining cells. They secrete hormone calcitonin. These capillaries which drain into medullary veins. The cytoplasm is
cells are difficult to visualize under light microscope. relatively clear or light basophilic in H&E preparation.
Q.4. Write a short note on histology of adrenal gland. Medulla may show the presence of sympathetic ganglion cells
(Jan 2012, 5 Marks) present between the medullary cells. Cells of adrenal medulla
Ans. Gland consist of two structurally and functionally are innervated by preganglionic sympathetic myelinated fibers.
distinct parts, i.e. a centrally located medulla and an
outer cortex.
13. THE URINARY SYSTEM
other nephrons are called as cortical nephrons. A ♦ Histological structure of thick descending limb of loop
nephron, its collecting tubule and collecting duct of Henle is similar to proximal convoluted tubule, while
together form a unit called as uriniferous tubule. histological structure of thick ascending limb of loop of
Q.2. Write a short note on histology of kidney. Henle is similar to distal convoluted tubule.
(Mar 2009, 2.5 Marks) (Mar 2006, 3 Marks) Distal Convoluted Tubule
(June 2010, 5 Marks) (Nov 2008, 5 Marks)
♦ It is half the length of proximal convoluted tubule.
♦ Tubules are lined by cuboidal epithelium.
Renal Corpuscle ♦ Cytoplasm of cell is light eosinophilic.
♦ Brush border is absent and height of cuboidal cells is less.
♦ This is also known as malpighian corpuscle.
♦ Renal corpuscle consists of Bowman s capsule and Collecting Tubules
glomerulus.
♦ They start inside the cortex and proceed to medullary
♦ Bowman s capsule consists of outer parietal layer and
ray where they join large collecting tubules known as
inner visceral layer.
collecting ducts.
♦ Parietal layer is lined by simple squamous epithelium and ♦ Inside the medulla these collecting ducts run to apex of
visceral layer is lined by podocytes. pyramid and join each other to form duct of Bellini.
♦ Space between parietal and visceral layer is known as ♦ Collecting tubules and ducts are lined by cuboidal to low
urinary space or Bowman s space. columnar epithelium.
♦ At urinary pole space between both visceral and parietal ♦ Cells are lightly stained with eosin and their outline is clear.
layer is continuous with lumen of proximal convoluted ♦ Lumen of tubules and ducts are large.
tubule.
♦ Squamous epithelium of parietal layer at urinary pole
is continuous with cuboidal epithelium of proximal
convoluted tubule.
♦ Visceral epithelium of Bowman’s capsule is very closely
applied to endothelial lining of capillaries.
♦ Cells of visceral layer become modified and are known
as podocytes. These podocytes has many radiating
processes which consist of secondary processes known
as foot processes or pedicles. Foot process of neighboring
podocytes interdigitate with each other.
♦ Foot processes get separated from each other by narrow
intercellular spaces which are known as filtration slits and Fig. 33: Kidney
gap of filtration slit is occupied by filtration slit membrane. (For colour version see Plate 18)
• Cerebellar cortex consists of three layers: cytoplasm. Dendrites of these cells are present in
1. Molecular layer: It is superficial layer, thick and molecular layer but axons form synaptic contact
is made up of nerve fibers and cells, i.e. stellate with glomeruli in granular layer.
cells above and basket cells below. • Deep to granular layer cerebellar cortex lie in contact
2. Purkinje cell layer: It is made up of purkinje cells with white mater.
or Golgi type I cells. The cells are arranged in
a single row between molecular and granular
layer. Purkinje cells is a large pyriform or flask
shaped neuron which send numerous dendrites
in molecular layer. These dendrites synapse
with axon of granular cells.
3. Granular layer: It is densely packed with very
small granule cells which stain deeply with
hematoxylin. Granular cells are small neurons
with round nuclei and are surrounded by
thin rim of cytoplasm. Granular cells receive
impulses from various parts of central nervous
system through Mossy fibers.
• At junction of molecular and granular layer golgi
Type II cells are found. Vesicular nuclei of Golgi
type II cells are larger than granular cells. Golgi Fig. 36: Cerebellum
type II cells consist of chromophil substance in their (For colour version see Plate 19)
Histology 261
1. Which cranial nerve nucleus lies below facial 8. Cavity and hindbrain is:
colliculus: a. Lateral ventricle
a. Sensory nucleus of trigeminal nerve b. Third ventricle
b. Abducent nucleus c. Cerebral aqueduet
c. Motor nucleus of facial nerve d. Fourth ventricle
d. Vestibular nuclei 9. Arch of azygos vein is related to the following surface
2. Motor nerve supplying diaphragm is: of lung:
a. Vagus a. Mediastinal surface of right lung
b. Intercostal b. Mediastinal surface of left lung
c. Phrenic c. Coastal surface of right lung
d. Hypoglossal d. Diaphragmatic surface of left lung
3. Which of the following extraocular muscles are in intor- 10. Lumbar puncture is done at disc between:
sion of eyeball: a. T12 L1
b. L1 L2
a. Superior rectus and Superior oblique
c. L2 L3
b. Inferior rectus and Inferior oblique
d. L3 L4
c. Superior rectus and Inferior oblique
d. Inferior rectus and Superior oblique 11. Transverse facial artery is a branch of:
a. Facial artery
4. Following are the nuclei related to glossopharyngeal b. Maxillary artery
nerve except: c. Superficial temporal artery
a. Nucleus ambiguous d. External carotid artery
b. Superior salivatory nucleus 12. One of the following muscles is multipennate muscle:
c. Nucleus of tractus solitarius a. Teres major
d. Inferior salivatory nucleus b. Pectoralis major
5. Lining epithelium of esophagus is: c. Deltoid
a. Simple squamous d. Serratus anterior
b. Stratified squamous nonkeratinized 13. Structure crossing the sternomastoid is:
c. Stratified squamous keratinized a. Accessory nerve
d. Pseudostratified b. Lesser nerve
c. External vein
6. Example of simple coiled tubular type of gland is: d. Transverse cervical artery
a. Salivary gland
b. Brunner s gland 14. The following muscles are derived from 3rd arch:
a. Mylohyoid nerve
c. Gastric glands
b. Stylohyoid
d. Sweat gland
c. Posterior belly of diagastric
7. How many anterior intercostal arteries are present in d. Stylopharyngeous
each typical intercostal space: 15. Ureter is lined by epithelium :
a. One a. Cuboidal
b. Two b. Stratified squamous
c. Three c. Columnar ciliated
d. Four d. Transitional
Answers: 1. b 2. c 3. a 4. b
5. b 6. d 7. b 8. d
9. a 10. d 11. c 12. c
13. c 14. d 15. d
Mastering the BDS Ist Year (Last 25 Years Solved Questions)
34. Which of the following muscle is supplied by trochlear 42. Medial deviation of eyeball is caused by paralysis of:
nerve: a. Medial rectus muscle
a. Superior rectus b. Lateral rectus muscle
b. Superior oblique c. Superior rectus muscle
c. Inferior rectus d. Inferior rectus muscle
d. Inferior oblique
43. Following structures are contents of the lateral wall of
35. Which part of the internal carotid artery has no cavernous sinus except:
branches: a. Oculomotor nerve
a. Cerebral part b. Trochlear nerve
b. Cervical part
c. Maxillary nerve
c. Petrous part
d. Mandibular nerve
d. Cavernous part
44. Following part of vermis of cerebellum belongs to
36. Following structures are within parotid gland except:
paleocerebellum:
a. External carotid artery
b. Facial nerve a. Culmen
c. Facial artery b. Declive
d. Retromandibular vein c. Folium vermis
d. Tuber vermis
37. Which of the following muscle has got double nerve
supply: 45. Occipital blood sinus lies between the two layers of:
a. Lateral pterygoid a. Falx cerebri
b. Masseter b. Falx cerebelli
c. Medial pterygoid c. Tentorium cerebelli
d. Digastric d. Diaphragma sellae
38. Following structures pass through internal auditory 46. Normally lumbar puncture is done between:
meatus except: a. T12 and L1
a. 6th Cranial nerve b. L1 and L2
b. 8th Cranial nerve c. L4 and L5
c. 7th Cranial nerve d. S1 and S2
d. Labyrinthine artery
47. Supreme intercostal vein draining the first intercostal
39. Nasopharynx has got which of the following type of space drains into:
epithelium: a. Bracheocephalic vein
a. Nonciliated columnar
b. Internal thoracic vein
b. Cuboidal
c. Subclavian vein
c. Ciliated columnar
d. Azygous vein
d. Stratified squamous
48. Following are the branches of left coronary artery
40. Which of the following muscle is depressor of
mandible: except:
a. Temporalis a. Circumflex artery
b. Lateral pterygoid b. Conus artery
c. Masseter c. Marginal artery
d. Medial pterygoid d. Anterior interventricular artery
41. Following are the branches of posterior division of 49. “Alpha cells” of islet of Langerhans are responsible for
mandibular nerve except: secretion of:
a. Buccal a. Glucagon
b. Lingual b. Pancreatic polypeptide
c. Auriculotemporal c. Somatostatin
d. Inferior alveolar d. Insulin
50. Following type of epithelium is also called as 59. Number of chromosomes in human beings:
endothelium: a. 44
a. Stratified squamous b. 48
b. Simple squamous c. 23
c. Simple cuboidal d. 46
d. Simple columnar
60. Through foramen ovale passes:
51. Hypoglossal nerve runs over the muscle: a. Mandibular nerve
a. Myelohyoid b. Lesser petrosal nerve
b. Styloglossus c. Accessory meningeal artery
c. Hyoglossus
d. All of the above
d. Palatoglossus
61. Following is the example of commissural fibers of
52. Following bone is the unpaired bone of skull:
brain:
a. Maxilla
b. Temporal a. Internal capsule
c. Occipital b. Fronto-occipital fasiculus
d. Parietal c. Corpus callosum
d. Corona radiata
53. All of the following are example of fibrous joint except:
a. Sutural 62. Motor nerve supply of superior oblique muscle of
b. Syndesmosis eyeball is:
c. Gomphosis a. Optic
d. Symphysis b. Oculomotor
54. Facial artery is: c. Trochlear
a. Terminates at lateral angle of eye d. Abducent
b. Very tortuous 63. Following are the structures opening in the right atrium
c. Branch of internal carotid artery of the heart except:
d. Within the parotid gland a. Superior vena cava.
55. Which of the following muscles of palate is supplied b. Inferior vena cava
by mandibular nerve: c. Coronary sinus
a. Palatoglossus d. Pulmonary veins
b. Tensor veli palatini
64. Floor of fourth ventricle shows following structures
c. Levator veli palatini
except:
d. Palatopharyngeous
a. Vagal triangle
56. First branch of external carotid artery is: b. Facial colliculus
a. Facial c. Vestibular area
b. Superior thyroid d. Pyramid
c. Lingual
d. Ascending pharyngeal 65. Esophageal opening in the diaphragm lies at the
following vertebral level:
57. Thyroid follicles are lined by:
a. T6
a. Simple squamous epithelium
b. Simple cuboidal epithelium b. T8
c. Simple columnar epithelium c. T10
d. None of the above d. T12
58. Odontoblast gives rise to: 66. Lining epithelium of palatine tonsils is:
a. Pulp a. Simple squamous
b. Enamel b. Stratified squamous nonkeratinized
c. Dentin c. Transitional
d. None of the above d. Pseudostratified
67. Sensory dorsal root ganglion contains following types 76. Crista galli is the part of:
of neurons: a. Sphenoid bone
a. Pseudounipolar b. Temporal bone
b. Unipolar c. Ethmoid bone
c. Bipolar d. Frontal bone
d. Multipolar
77. Digastric triangle contains except:
68. Pulsations of common carotid artery are felt at: a. Facial artery and vein
a. Anterior inferior angle of massetar b. Submandibular gland deep part
b. In front of tragus of ear c. Submandibular lymph node
c. Superior border of thyroid cartilage d. Submandibular gland superficial part
d. Suprasternal space
78. Mental foramen is located near:
69. How many bronchial arteries supply left lung:
a. Canine of mandible
a. One
b. Ist premolar of mandible
b. Two
c. Three c. IInd premolar of mandible
d. Four d. Canine of maxilla
70. Pars distalis of pituitary gland is formed by the 79. Following muscle is supplied by glossopharyngeal
following parts except: nerve:
a. Infundibulum a. Styloglossus
b. Pars anterior b. Stylohyoid
c. Pars intermedium c. Stylopharyngeous
d. Pars tuberalis d. Sternocleidomastoid
71. Bones developing in certain tendons are: 80. Composition of sex hormones in Turner’s syndrome:
a. Sesamoid bones a. XY
b. Short bones b. XO
c. Irregular bones c. XX
d. Pneumatic bones d. XXY
72. Hair like processes on top of cell moving in one 81. Goblet cell is the example of following type of gland:
direction only are: a. Serous
a. Cilia b. Simple tubular
b. Sterocilia c. Compound tubule alveolar
c. Microvilli d. Unicellular
d. Part of spermatozoa
82. Nucleus of hypoglossal nerve is situated in:
73. Following glands are ectodermal except:
a. Midbrain
a. Pitutary gland
b. Pons
b. Mammary gland
c. Liver c. Medulla oblongata
d. Sweat gland d. Pontocerebellar junction
74. Wharton’s duct is duct of: 83. Type of cartilage present in trachea is:
a. Parotid gland a. Hyaline
b. Sub-mandibular gland b. Elastic
c. Sub-lingual gland c. White fibrocartilage
d. Lacrimal gland d. Cellular
75. All the muscles of soft palate are supplied by accessory 84. Which of the following artery is palpated medial to
nerve (cranial part) except: the tendon of biceps brachii at elbow:
a. Tensor palati a. Axillary
b. Levator palati b. Brachial
c. Palatoglossus c. Radial
d. Palatopharyngeous d. Ulnar
85. Motor nerve supplying diaphragm is: 93. Number of chromosome in human beings:
a. Intercostal a. 44
b. Vagus b. 23
c. Phrenic c. 48
d. Vago-accessory complex d. 46
86. Anterior interventricular artery is a branch of following 94. Skin over angle of mandible is supplied by:
artery: a. Mandibular nerve
a. Right coronary b. Facial nerve
b. Left coronary c. Greater auricular nerve
c. Arch of aorta d. None of them
d. Descending thoracic aorta
95. Free mobility is on:
87. Base of the heart is formed by following chambers of
a. Fibrous joint
heart:
b. Primary cartilaginous joint
a. Right ventricle and left atrium
b. Left ventricle and right atrium c. Synovial joint
c. Right and left atrium d. Secondary cartilaginous joint
d. Right and left ventricle 96. External carotid artery gives following branches except:
88. Mediastinal surface of left lung is related to the a. Superior thyroid artery
following structure except: b. Facial artery
a. Superior vena cava c. Inferior thyroid artery
b. Arch of aorta d. Occipital artery
c. Pulmonary trunk 97. Secretion of lacrimal gland is:
d. Left subclavian artery a. Serous
89. Sigmoid sinus is a continuation of following sinus: b. Mucus
a. Superior sagittal c. Oily
b. Inferior saggital d. Seromucous
c. Cavernous
98. Auditory tube opens in:
d. Transverse
a. Oropharynx
90. Lumbar puncture is done at a disc between: b. Inferior meatus of nose
a. L1 L2 c. Nasopharynx
b. L2 L3 d. None of them
c. L3 L4
d. L4 – L5 99. The following structures cross the sternomastoid
muscle except:
91. Tracheal cartilages are:
a. External jugular vein
a. Elastic cartilage
b. Greater auricular nerve
b. Fibrocartilage
c. Hyaline cartilage c. Transverse cervical nerve
d. None of them d. Lesser occipital nerve
92. Which of the following muscle is derivative from first 100. Which of the following muscle has got double (dual)
branchial arch: nerve supply:
a. Platysma a. Masseter
b. Cricothyroid b. Buccinator
c. Tensor tympani c. Digastric
d. Levator veli palatine d. Temporal
101. Pyramids are seen in the following part of the brain: 109. Parietal cells are found in microscopic study of
a. Medulla oblongata following organ:
b. Pons a. Esophagus
c. Midbrain b. Stomach
d. Cerebellum c. Duodenum
102. Lateral rectus muscle of eyeball is supplied by d. Ileum
following nerve: 110. The mediastinal surface of the left lung has all of the
a. Optic following impression except:
b. Oculomotor a. Azygos vein
c. Trochlear b. Arch of aorta
d. Abducent c. Left ventricle
103. Superior and inferior colliculi are seen in: d. Esophagus
a. Spinal cord 111. Patella of knee joint is an example of this type of bone:
b. Medulla oblongata a. Sesamoid
c. Pons b. Short
d. Midbrain c. Irregular
104. Esophageal opening in the diaphragm lies at the d. Pneumatic
following vertebral level: 112. All of the following structures pierce the parotid gland
a. T6 except:
b. T8 a. Facial nerve
c. T10 b. Superficial temporal artery
d. T12 c. Retromandibular vein
105. Epithelium of skin over the palm is: d. Mandibular vein
a. Simple squamous 113. The following is an example of circumpennate muscle:
b. Stratified squamous nonkeratinized a. Bisceps brachii
c. Stratified squamous keratinized b. Pectoralis major
d. Transitional c. Sartorius
106. Following is the most important relay station in pain d. Tibialis anterior
pathway: 114. The hip joint is synovial joint of this type:
a. Medulla oblongata a. Ellipsoid
b. Pons b. Saddle
c. Thalamus c. Hinge
d. Hypothalamus d. Ball and socket
107. Vermilion border is a feature of: 115. The maxillary nerve passes through this foramen at
a. Lip the base of skull:
b. Tongue a. Ovale
c. Esophagus b. Jugular
d. Stomach c. Rotundum
108. Hassal’s corpuscles are histological feature of following d. Lacerum
lymphoid organ: 116. The following organ is extraperitoneal:
a. Lymph node a. Liver
b. Spleen b. Kidney
c. Palatine tonsil c. Stomach
d. Thymus d. Spleen
117. All of the following structures pass throughout the 119. The Kupffer cells are phagocytes found in:
sinus of morgagni in pharynx except: a. Lung
a. Auditory tube b. Liver
b. Ascending palatine artery c. Brain
c. Levator palate muscle d. Skin
d. Stylopharyngeous muscle 120. The myelin sheath of axons in CNS is formed by these
118. The only abductor muscle of vocal folds is: cells:
a. Posterior cricoarytenoids a. Astrocytes
b. Oblique arytenoids b. Stellate
c. Thyroarytenoids c. Oligodendrocytes
d. Cricothyroid d. Schwann
3. z
…………. and ………………. forms base of ,
v
heart. Ans.
Right atria and Left atria 20.
Derivatives of somites are
4. ………………………..
Enlargement of pharyngeal tonsil is
Ans. D S , Ax
called as………………….
A k , R
Ans. Adenoid v ,
5. 21.
Middle meningeal artery enters skull Referred pain of appendicitis is felt at
through ……………….. foramen. …………… …………..
Ans. Spinosum Ans. Around the umblicus
6. 22.
Removal of appendix is known as Br onchopulm onar y s egm ent is t he
…………………. Ans. ………… ……………….
Appendectomy Ans. W fi
7. Superior oblique muscle of eye is tertiary or segmental branch
innervated by …… ……………. 23.
Ans. Trochlear Skin of floor of axilla along with adjacent
area of skin of arm is innervated by
8. Mumps is a infectious disease of ……
………. gland ……………..
Ans. Parotid Ans. 2 N v
9. 24.
Myocardium of heart is supplied by Adenoids is an enlargement of
……………………. artery. …………………….. Ans.
Ans. Coronary Tonsil like glands located at the back of nose
46. Name any one nerve surrounding the oral cavity. 50. What is carotid sheath.
Ans. F v Ans. It is the condensation fi
47. Name any one branch of mandibular nerve. v k v v
Ans. v v 51. Which lung has groove for aorta.
48. What is morula. Ans. Left Lung
Ans. A morula is an embryo at an early stage of embryonic
52. Name the suprahyoid muscles.
v , 6
w z Ans. D , , ,
49. Which is the largest sesamoid bone of the body. 53. What is the nerve supply of lateral rectus muscle.
Ans. Patella Ans. v
Histology 271
54. Name the terminal branches of external carotid artery. 66. Wry neck is deformity occurring due to spasm
Ans. The terminal branches are: of…………………………..
1. Maxillary artery Ans. Sternocleidomastoid muscle
2. Superficial temporal artery
67. Diaphragm separates ………………. cavity from
55. Give any one example of synovial joint. …………………… cavity.
Ans. Knee Joint Ans. Abdominal from thoracic
56. Name any one facial muscle surrounding the oral 68. ERB’s point lies on …………………. trunk of brachial
cavity. plexus
Ans. Orbicularis oris Ans. Upper
57. Bronchopulmonary segment is the …………………. 69. Meckle’s cartilage belongs to ………………………….
Ans. Tertiary bronchi pharyngeal arch
58. Submandibular gland is innervated by following Ans. First
parasympathetic nerve …………… 70. Smallest bone of the body is called as ………………….
Ans. Chorda tympani, a branch of the facial nerve Ans. Stapes
59. Buccinator is innervated by following nerve 71. ………………….. is largest of all paranasal sinuses.
………………………….. Ans. Maxillary sinus
Ans. Motor innervation is from the buccal branch of the facial
72. Coronary sinus is the largest ……………………… of
nerve. Sensory innervation is supplied by the buccal
the heart.
branch of the mandibular part of the trigeminal nerve.
Ans. Vein
60. Skin over parotid region is innervated by ……………..
73. Nutrient artery supplies ………………………. cavity of
Ans. Greater auricular nerve
the bone.
61. Blood supply of scalp is ………………………… Ans. Medullary
Ans. Two set of arteries five on each side, out of these five
arteries, three arteries lie in front of ear and two behind 74. Facial artery is the branch of ……………………. artery
the ear. Ans. External carotid
Arteries 75. 9th, 10th and 11th cranial nerves pass through
…………………. foramen of base of skull.
I. Preauricular
Ans. Jugular
a. Supratrochlear b. Supraorbital
c. Superficial temporal arteries 76. Winging of scapula is caused by paralysis of
II. Posterior Auricular …………………… muscle.
Posterior auricular artery Ans. Serratus anterior
Occipital artery. 77. W r y n e c k ( t o r t i c o l l i s ) i s d u e t o s p a s m o f
…………………………..
Venous Drainage
Ans. Sternocleidomastoid muscle
Three groups of veins supply to the scalp:
78. Apex beat is visible in living at ………………………..
1. Veins proper, i.e. occipital vein
2. Emissary veins, i.e. parietal emissary veins and mastoid Ans. Elderly age
emissary veins 79. If left hypoglossal nerve is damaged, the tongue will
3. Diploic veins, i.e. frontal diploic veins and occipital diploic deviate to …………………….
veins. Ans. Left side
62. Sternocostal surface of heart is formed by ……………….. 80. The glossopharyngeal nerve leaves the skull through
Ans. Left, right, superior and inferior borders of the heart. the …………………….
63. The superior oblique muscle of eye is innervated by Ans. Jugular foramen
………………………..
81. Sometime patient complaint of loss of taste
Ans. Trochlear nerve sensation after tonsillectomy due to involvement of
64. Mandibular nerve leaves the skull through ………….. ……………………….
Ans. Foramen ovale Ans. Lingual branch of glossopharyngeal nerve
65. If levator palpebrae superior is paralysed. The upper 82. Hoarseness of voice is due to the involvement of
lid will ………………………… ………………………….
Ans. Droop Ans. Recurrent laryngeal nerve
Mastering the BDS Ist Year (Last 25 Years Solved Questions)
83. Azygos vein opens in 88. Superior oblique muscle of eyeball moves eyeball
…………………………. Ans. x ………………………
Ans. M
82. Ulcers are common at ………………. of
stomach. Ans. v 89. Foramen rotundum opens into ………………………
85. Shoulder tip pain occur due to Ans. Sphenoid bone
irritation of ………………………… 90. Genioglossus is ………………… the tongue.
Ans. peritoneum Ans. x
86. 91. Bleeding after tonsillectomy is often ...……………..
……………….. teeth are used to tear the Ans. k v
flash Ans. 92. Black eye is related with …………… layer of scalp.
Canine Ans. loose areolar tissue
87. …
………… artery is related to submandibular
gland.
Ans. Facial
Histology 273
1. Who is the father of modern anatomy? 17. Which is the median point at the root of the nose where
Ans. Andreas Vesalius the internasal suture meets the frontonasal suture?
Ans. Nasion
2. How many bones does skull have?
Ans. 22 18. During which age of life the mastoid process appears?
Ans. Second year
3. How many bones does calvarium have?
Ans. 8 19. Which is an H-shaped suture where the frontal,
parietal, sphenoid and temporal bones meet?
4. How many bones does facial skeleton have? Ans. Pterion
Ans. 14
20. What forms the anterior 2/3rd of hard palate?
5. During childhood the sutures of the skull are open but Ans. Palatine process of maxilla
these sutures are closed by which age?
Ans. 30 to 50 years 21. What forms the posterior 1/3rd of hard palate?
Ans. Horizontal plate of palatine bone
6. Which is a horizontal line which is obtained by joining
the infraorbital margin to the center of the external 22. Where does palatovaginal canal opens?
acoustic meatus? Ans. Pterygopalatine fossa.
Ans. Reid s baseline 23. What does foramen of Vesalius is also known as?
7. Which are the unpaired bones of the facial skeleton? Ans. Emissary sphenoidal foramen
Ans. Mandible and vomer 24. Which structure divides the squamotympanic fissure
into petrotympanic and petrosquamous?
8. Which suture lie between the frontal bone and two
Ans. Tegmen tympani
parietal bones?
Ans. Coronal suture 25. Which is the largest foramen of the skull?
Ans. Foramen magnum
9. Which suture lie in the median between two parietal
bone? 26. Which foramen is placed at the posterior end of the
Ans. Sagittal suture pterygooccipital suture?
Ans. Jugular foramen
10. Which suture lies posteriorly between occipital and
two parietal bones? 27. Which structure separates the anterior cranial fossa
Ans. Lambdoid suture from the nasal cavity?
Ans. Cribriform plate of ethmoid bone
11. Which suture is present occasionally and lies in the
median plane and separates the two halves of the 28. Which structure separates the anterior cranial fossa
frontal bone? from the sphenoidal sinuses?
Ans. Metopic suture Ans. Jugum sphenoidal
29. Name the uveal tract of eyeball.
12. Which is the highest point over the sagittal suture?
Ans. Vascular coat
Ans. Vertex
30. Which structure provides attachment to the lateral
13. What is the meeting point of coronal and sagittal suture? check ligament of the eyeball?
Ans. Bregma Ans. Whitnall’s tuburcle
14. What does bregma in fetal skull is known as? 31. Which structure separates orbits from the middle
Ans. Anterior fontanelle cranial fossa?
15. Which is the point on sagittal suture between two Ans. Greater wing of the sphenoid
parietal foramen? 32. Which nerve is transmitted by tympanomastoid fissure?
Ans. Obelion Ans. Auricular branch of vagus nerve
16. Which is a median elevation connecting two 33. Name the bone of skull by which maxilla has no
superciliary arches? articulation.
Ans. Glabella Ans. Temporal bone
Mastering the BDS Ist Year (Last 25 Years Solved Questions)
34. Which are the small irregular bones found in the region 53. Which is the most transparent membrane which covers
of the fossa nerves? the anterior surface of the eyeball?
Ans. Wormian bones Ans. Sclera
35. In which structure of the body wormian bones are seen? 54. Two nostrils which are separated by median partition
Ans. Skull is called as?
36. Which is largest as well as strongest bone of the face? Ans. Columella
Ans. Mandible 55. Which area is known as the dangerous area of the scalp?
37. Which fossa provides origin to the mentalis muscle Ans. Loose areolar tissue
and the mental slips of orbicularis oris? 56. Which is the artery responsible for pulsations in
Ans. Incisive fossa suprasternal space?
38. Which are the nerves and vessels which pass through Ans. Inferior thyroid
mandibular notch? 57. Hard palate receives major blood supply from which
Ans. Massetric nerves and vessels artery?
39. Which is the first bone to ossify in the body? Ans. Greater palatine artery
Ans. Clavicle 58. Ducts of Bellini are associated with which structure?
40. When do the center for ossification of the mandible Ans. Kidneys
appears? 59. Which is the first site for the appearance of renal edema?
Ans. During 6th week of intrauterine life. Ans. Eyelid
41. At what age does bony union of the symphysis takes 60. What is the function of the buccal pad of fat in infants?
place?
Ans. Suckling
Ans. During first year of life.
61. Which arch provides development to facial muscle?
42. When does the mental foramen opens below the
Ans. Second
sockets of the two primary molar teeth?
Ans. During birth 62. Facial artery is given off at which level of hyoid bone?
Ans. Greater cornue
43. At what age does the angle of mandible is obtuse?
Ans. During childhood and old age. 63. Which is the arterial trunk supplying infratemporal
fossa?
44. At what age does the angle of mandible is ll0° to l20°?
Ans. Maxillary artery
Ans. Adult
64. Name the artery through which facial artery
45. At which level of cervical vertebrae the hyoid bone rests?
anastomoses with.
Ans. Third cervical vertebrae
Ans. Dorsal nasal branch of ophthalmic artery
46. Which structures supply blood to cornea?
65. Which is the largest vein of the face?
Ans. Cornea is avascular
Ans. Facial vein
47. What is the identification characteristic of cervical
vertebrae? 66. Name the space between two eyelids.
Ans. Foramina transversaria. Ans. Palpebral fissure
48. Where does carotid artery palpated at neck? 67. Which type of glands are Zeis’ glands?
Ans. Thyroid cartilage Ans. Large sebaceous glands
49. Arterial supply of trachea is facilitated by which artery? 68. Which type of glands are Moll’s glands?
Ans. Inferior thyroid Ans. Modified sweat glands
50. Which cervical vertebra has a large transverse process 69. What is the shape of lacrimal gland?
and acts effectively for rotatory movement? Ans. J shaped
Ans. Atlas vertebrae 70. What is the inflammation of lacrimal sac is called as?
51. Which cervical vertebra is identified by the presence Ans. Dacryocystitis
of dens or odontoid process? 71. Side of the neck which is quadrilateral is divided
Ans. Axis vertebrae obliquely by which of the muscle into anterior and
52. Which cervical vertebra is known as vertebra prominens? posterior triangles.
Ans. Seventh cervical vertebrae Ans. Sternocleidomastoid
Histology 275
72. Skin of the neck is supplied by which nerves? 90. Which ganglia are made up of pseudounipolar nerve
Ans. C2, C3 and C4 cells with T shaped arrangement and homologus with
dorsal nerve root ganglia of spinal nerves?
73. Name the muscle supplied by ansa cervicalis.
Ans. Sternohyoid muscle Ans. Trigeminal
74. Which space contains the sternal heads of right and 91. Which artery is the commonest source of extradural
left sternomastoid muscles jugular venous arch, lymph hemorrhage?
nodes and interclavicular ligament? Ans. Middle meningeal artery
Ans. Suprasternal space. 92. Name the structures to which vena cava does not drain
75. Which vein is examined to assess the venous pressure? blood.
Ans. External jugular vein Ans. Heart and lungs
76. Tonsils are mainly supplied by. 93. Name the fossa by which middle meningeal artery
Ans. Facial artery enters the middle cranial fossa.
Ans. Foramen spinosum
77. Sternomastoid and trapezius muscles are supplied by
which nerves? 94. Which branch of the middle meningeal artery is closely
Ans. Spinal part of accessory nerve associated with the motor area of the brain?
78. Reflection of which of the muscle exposes the Ans. Frontal branch
suboccipital muscle? 95. Which part of internal carotid artery gives no branches?
Ans. Semispinalis capitis Ans. Cervical branch
79. Suboccipital triangle contains which part of the 96. Vidian nerve is formed by which nerves?
vertebral artery. Ans. Greater petrosal and deep petrosal nerves
Ans. Third part
97. Vertebral artery reaches the brain by passing through
80. Which is the thickest cutaneous nerve of the body. which foramina?
Ans. Greater occipital C2. Ans. Foramen magnum
81. Which is the first and largest branch of the first part of 98. Which structure forms the periosteum of the bony
the subclavian artery. orbit?
Ans. Vertebral branch Ans. Orbital fascia
82. Which artery arises from the external carotid artery 99. Which structure forms a thin, loose, membranous
opposite to the origin of facial artery.
sheath around the eyeball extending from the optic
Ans. Occipital artery nerve to the limbus?
83. Lumbar puncture is usually done along by which Ans. Tenon s capsule
vertebrae.
100. Lower part of the Tenon’s capsule is thickened to form
Ans. C3 and C4
which structure?
84. How many pairs of spinal nerves does spinal cord gives Ans. Suspensory ligament of Lockwood
rise to.
101. Four recti muscles arise from which structure and is
Ans. 31
inserted into.
85. How much amount of CSF is formed in a day? Ans. Tendinous ring and sclera
Ans. 5 Liter/day
102. Superior oblique muscle is supplied by which nerve?
86. Which layer of dura mater forms four folds and divides Ans. Trochlear nerve
the cranial cavity into compartments.
Ans. Meningeal layer 103. Weakness or paralysis of ocular muscle leads to.
Ans. Strabismus
87. Which is a sickle shaped fold of dura mater which
occupies the median longitudinal fissures. 104. What does involuntary rhythmic oscillatory movements
Ans. Falx cerebri are known as.
Ans. Nystagmus
88. Which is a tent-shaped fold of dura mater which forms
the roof of the posterior cranial fossa. 105. Which is the first branch of ophthalmic artery?
Ans. Tentorium cerebelli Ans. Central artery of retina
89. Which is a large venous space situated in the middle cranial 106. Lymphatic drainage of the orbit is through which
fossa on either side of the body of the sphenoid bone. lymph node?
Ans. Cavernous Ans. Preauricular nodes
Mastering the BDS Ist Year (Last 25 Years Solved Questions)
107. Which nerve has an intraorbital intracanalicular and 125. Which is the largest terminal branch of external carotid
intracranial course is? artery?
Ans. Optic nerve Ans. Maxillary artery
108. Which is the peripheral parasympathetic ganglion 126. Maxillary artery is divided into three parts by which
placed in the course of oculomotor nerve? muscle. Name it.
Ans. Ciliary ganglion Ans. Lateral pterygoid muscle
109. Name the midbrain lesion causing contralateral 127. Name the synovial joint of condylar variety.
hemiplegia and ipsilateral paralysis of the third cranial Ans. Temporomandibular joint
nerve. 128. Articular surface of the TM joint are covered by which
Ans. Weber’s syndrome cartilage?
110. Which is the only cranial nerve to emerge from the Ans. Fibrocartilage
dorsal aspect of the brainstem? 129. Which ligament reinforces or strengthens the lateral
Ans. Trochlear nerve part of the capsular ligament?
111. Which nerve has the longest intracranial course? Ans. Temporomandibular ligament
Ans. Occulomotor 130. Which is an accessory ligament of TMJ which is pierced
112. Infraorbital nerve is accompanied by which part of the by mylohyoid nerves and vessels.
maxillary artery? Ans. Sphenomandibular ligament
Ans. Third part 131. Skin over the parotid gland receives its sensory supply
113. Right common carotid artery is a branch of which artery. from which nerve.
Ans. Brachiocephalic artery Ans. Greater auricular nerve
132. Which is the only sensory branch of the anterior
114. Where does left common carotid artery arises from?
division of mandibular nerve?
Ans. Arch of aorta
Ans. Buccal branch
115. Which is the largest salivary gland of all the salivary
133. Otic ganglion is an peripheral sympathetic ganglion
glands?
which is topographically related to which nerve and
Ans. Parotid gland functionally related to which nerve?
116. How much is the weight of parotid gland? Ans. Topograhically to glossopharyngeal nerve; functionally
Ans. 15 gms. related to mandibular nerve.
117. Which is the structure which separates the parotid 134. Anterior belly and posterior belly of digastric muscle
gland from submandibular gland? is supplied by which nerve?
Ans. Stylomandibular ligament Ans. Anterior belly by nerve to myelohyoid; posterior belly
by facial nerve.
118. What is the name of sensory root of facial nerve?
Ans. Nervous intermedius 135. A salivary gland which is J-shaped and divided by
the mylohyoid into large superficial and smaller deep
119. Facial nerve leaves the skull by passing through which portion is.
of the foramina? Ans. Submandibular gland
Ans. Stylomastoid foramen
136. Which is the structure which runs forward on and
120. Posterior auricular, digastric and stylohyoid branches between lingual and hyoglossus nerves?
of facial nerve are given off from which of the foramen. Ans. Submandibular duct
Ans. Stylomastoid foramen
137. Which is the smallest of all the salivary gland and
121. Nerve to stapedius is a branch of which nerve. which weighs 3 to 4 gm and is of almond shaped?
Ans. Facial nerve which is given off in the facial canal Ans. Sublingual salivary gland
122. What is the function of temporalis muscle? 138. Which structure separates parotid gland from sub-
Ans. Elevation and retraction of protruded mandible mandibular gland?
123. Lateral pterygoid muscle along with which muscle Ans. Stylomandibular ligament
depresses the mandible to open the mouth. 139. Thyroid gland lies against which cervical vertebrae?
Ans. Suprahyoid muscle Ans. C5, C6, C7 and T1
124. Which are the structures passing between the two heads 140. Superior thyroid artery runs in intimate relation with
of the lateral pterygoid? which nerve?
Ans. Maxillary artery and buccal branch of mandibular nerve. Ans. External laryngeal nerve
Histology 277
141. Inferior thyroid artery is a branch of which nerve? 157. What is the length of trachea?
Ans. Thyrocervical trunk Ans. 10 to 15 cms.
142. Main nerve supply of the thyroid gland is via which 158. Esophagus and trachea begin at the lower border of cricoid
of the structure? cartilage opposite to the lower border of which vertebrae.
Ans. Middle cervical sympathetic ganglion Ans. C6.
143. Name the artery which facilitates the arterial supply 159. What is the length of esophagus?
of trachea. Ans. 25 cm
Ans. Inferior thyroid artery 160. Which is the main lymph node draining the tonsil?
144. Thymus which is an important lymphoid organ Ans. Jugulodigastric lymph node
increase in size during puberty and undergoes atrophy
161. Which is the main lymph node of the tongue?
after puberty and later replaced by which tissue?
Ans. Jugulo-omohyoid
Ans. Fatty tissue
162. Which is the largest lymph trunk of the body?
145. Direct communication of the sigmoid sinus is with.
Ans. Thoracic duct
Ans. Internal jugular nerve
163. Which is the key muscle in the lower part of the neck?
146. How much is the right brachiocephalic vein is shorter
Ans. Scalenus anterior
(2.5 cm) than the left brachiocephalic vein?
Ans. 60 m 164. Which apparatus resembles as the riens of a chariot?
Ans. Styloid
147. Which veins unite to form the superior vena cava?
Ans. Brachiocephalic vein 165. Name the structure which lies interposed between the
parotid gland laterally and the internal jugular vein
148. Which nerve is motor to stylopharyngeus secretomotor
medially.
to the parotid, gustatory to the posterior 1/3rd of
Ans. Styloid process
tongue, and sensory to the pharynx is.
Ans. Glossopharyngeal nerve 166. Which artery unites with the same artery on the
opposite half of the body to form a basilar artery?
149. Which is the branch of vagus which pieces the
Ans. Vertebral artery
thyrohyoid membrane and supplies the mucous
membrane of the larynx above the level of vocal folds? 167. Which is the largest branch of vertebral artery?
Ans. Internal laryngeal branch. Ans. Posterior inferior cerebellar artery
150. Which is the nerve who accompanies the superior 168. How much is the length of pharynx?
thyroid artery and supplies the cricothyroid? Ans. 12 cm
Ans. External laryngeal nerve 169. As foreign bodies are removed from the piriform fossa
151. Which is the nerve who supplies all the intrinsic which may damage internal laryngeal nerve which
muscle of the larynx except cricothyroid and sensory leads to.
innervation of the larynx below the vocal fold? Ans. Anesthesia of supraglottic part of larynx.
Ans. Recurrent laryngeal nerve 170. What is the name of the gap between superior
152. Irritation of which of the branch of vagus can cause constrictor and the base of blank?
death due to sudden cardiac inhibition. Ans. Sinus of Morgagni
Ans. Auricular branch. 171. Name the structures passing through the sinus of
153. Stimulation of which branch of vagus may increase Morgagni.
appetite. Ans. Auditory tube, levator palati muscle and ascending
Ans. Auricular branch palatine artery.
154. Which nerve supplies all the intrinsic and extrinsic 172. What are the structures passing between the superior
muscles of the tongue except palatoglossus which is constrictor and middle constrictors?
supplied by cranial accessory nerve? Ans. Stylopharyngeal and glossopharyngeal
Ans. Hypoglossal nerve 173. Name the structures passing between middle and
155. Name the floating ribs. inferior constrictor.
Ans. 11 and 12 Ans. Internal laryngeal and superior laryngeal vessels and nerve
156. Which nerve provides sole motor supply to the 174. Name the muscle of pharynx which is not supplied by
diaphragm? vago-accessory complex.
Ans. Phrenic nerve Ans. Stylopharyngeus
Mastering the BDS Ist Year (Last 25 Years Solved Questions)
175. Which is the weak region present in the posterior wall 187. Name the space between the vestibular folds.
of the pharynx. ? Ans. Rima vestibule
Ans. Killian s dehiscence
188. Name the space between the vocal folds.
176. Name the structure which is trumpet shaped and Ans. Rima glottides
which connects the middle ear cavity with the
189. When both recurrent laryngeal nerves are interrupted
nasopharynx.
the vocal cords lie in which position.
Ans. Auditory tube
Ans. Cadaveric
177. Name an anastomosing site of superior labial branch
190. From which structure primary germ layer of endoderm
of facial artery, sphenopalatine artery and some large
is derived?
capillary network.
Ans. Yolk sac
Ans. Little’s area or Kiesselbach’s area.
191. What is the location for McBurney’s point?
178. Name the structures opening into the middle meatus
Ans. Cecum
of the nose.
Ans. Frontal, maxillary and ethmoidal sinus 192. Hemopoiesis occur in adults in which areas?
Ans. Bone marrow and lymphoid tissues
179. Name the structures opening into the superior meatus
of the nose. 193. Name the most narrowest part of gastrointestinal tract.
Ans. Middle ethmoidal and posterior ethmoidal Ans. Pharyngoesophageal junction
180. Which is the largest parasympathetic peripheral 194. Development of the tongue occur from which of the
ganglion? structures.
Ans. Pterygopalatine or sphenopalatine ganglion Ans. Tuberculum impar, hypobranchial eminence and lingual
swellings
181. Name the ganglion which is related topographically
to the maxillary nerve and functionally related to the 195. Name the branchial arches which forms tongue.
facial nerve. Ans. First, third and fourth branchial arches.
Ans. Pterygopalatine ganglion 196. Name the safety muscle of tongue.
182. What is the length of the larynx? Ans. Genioglossus
Ans. 36 mm to 44 mm 197. During the fetal circulation a shunt occur between
183. In which organ the sound sensitive hair cells of inner pulmonary trunk and aorta. Name the shunt.
ear are located. Ans. Ductus arteriosus
Ans. Organ of Corti 198. Where does maxillary artery arises from?
184. Name the laryngeal cartilage whose shape is like a ring. Ans. Neck of condyle.
Ans. Cricoid cartilage 199. Name the structure via which the lesser peritoneal sac
185. Name the laryngeal cartilage whose shape is like a communicates with greater peritoneal sac.
leaf. Ans. Epiploic foramen
Ans. Epiglottis 200. At the time of removal of submandibular gland which
186. Name the cartilages of larynx which ossify. nerve get injured?
Ans. Thyroid, cricoids and arytenoid Ans. Hypoglossal nerve
5
SECTION
Physiology
296
that are inserted in cell membrane. The polypeptide
1. GENERAL PHYSIOLOGY chain that form these proteins are extruded endoplasmic
reticulum. Free ribosomes synthesize cytoplasmic
proteins apparatus, which is involved in processing
proteins formed in ribosomes. Ribosomes in eukaryotes
measure approximately 22 by 32 nm. Each is made up
of a large and small subunit called on basis of their rates
of sedimentation in ultracentrifuge, the 60s and 40s
subunits.
Fig. 1: Ribosomes
Q.4. Write a short note on active transport. It is also located in cell membrane and in many cell
(Oct 2007, 5 Marks) organelle membranes.
Or c. K+ H+ Pump: It is present in cells of gastric mucosa and
Write briefly about active transport. renal tubules where it causes secretion of H+.
(Aug 2016, 2 Marks)
Secondary Active Transport Process
Or
In some tissues, active transport of Na+ is coupled to transport
Write very short answer on active transport and its
of other substances that is transport of many ions and nutrients
examples. (Aug 2018, 2 Marks)
against electrochemical energy gradient is accomplished by Na+
Ans. Substances are transported against their chemical and
dependent secondary active transport.
electrical gradient. This form of transport require energy
and is called as active transport. Examples are:
It includes: ♦ Glucose and amino acids are reabsorbed from proximal
1. Primary active transport process. renal tubules and absorbed from intestinal lumen only if
2. Secondary active transport process. sodium binds to the protein and is transported down its
3. Carrier type process. electrochemical gradient at same time.
4. Vesicular transport process. ♦ Calcium is exchanged from cytoplasm of cardiac and other
muscle cells for extracellular sodium known as Na+ Ca+
These active processes require energy so that’s why they
exchanger.
are called as pumps.
♦ Iodine pump.
Primary Active Transport Processes
Carrier Type Process
They directly use the energy obtained from hydrolysis of ATP.
Carriers are transport proteins that binds ions and other
It consist of:
molecules and they change their configuration, moving
a. Na+ K+ Pump. bounded molecules form one side of cell membrane to other.
b. Ca+ Pump. They are of three types, i.e. uniporters, symporters, antiporters.
c. K+ H+ Pump.
1. Uniporters: They transport a single particle in one
a. Na+ K+ Pump: Refer to Ans 3 of the same chapter. direction, e.g. facilitated diffusion of glucose.
b. Ca+ Pump: 2. Symporters: They transport two particles together in same
It is present in sarcoplasmic reticulum of muscle cells, direction, e.g. secondary active transport of glucose.
which maintains intracellular ionic 102+ concentration 3. Antiporters: They transport molecules in opposite
below 0.1 mmol/L. direction, i.e. exchange one substance from another.
Physiology 283
plasma membrane on the surface of cells form microvilli • Morphologically endoplasmic reticulum is of two
which increases absorptive surface of cells. types, i.e. smooth and rough.
♦ Functions of microtubules and microfilaments: Agranular or smooth endoplasmic reticulum: Granules
They lead to movement of chromosomes. are absent in this type. It is the site of lipid and steroid
They causes movement of cell synthesis. In skeletal and cardiac muscles, smooth en-
These processes move secretion granules in cell. doplasmic reticulum is modified to form sarcoplasmic
They lead to the movement of proteins in the cell reticulum which gets involved in release and seques-
membrane. tration of calcium ions during muscular contraction.
Granular or rough endoplasmic reticulum: It consists of
Nucleus
granules known as ribosomes. These granules are
Nucleus is a spherical structure which consists of nuclear attached to cytoplasmic side of membrane. Three to
membrane, nucleoplasm and nucleolus. five ribososmes clump together and form polyribo-
somes or polysomes. Rough endoplasmic reticulum
Nuclear Membrane
is well developed in cell which is active in protein
♦ It is a double layered porous structure which consists of 40 synthesis. For example, Russell body of plasma cell,
to 70 nm wide space known as perinuclear cistern which is nissl granule of nerve cell.
continuous with lumen of endoplasmic reticulum.
Q.11. Write about feedback mechanism. (Sep 2015, 7 Marks)
♦ Exchange of materials between nucleoplasm and cyto-
Ans. Since homeostasis is a complex phenomenon the mode
plasm occurs through nuclear membrane.
of operation of all the systems which are involved in
Nucleoplasm homeostasis is through ‘feedback mechanism’. Feedback
mechanism is of two types, i.e.
♦ Nucleoplasm or nuclear matrix is a gel like ground sub-
stance having large quantity of genetic material in form 1. Negative feedback mechanism.
of DNA. 2. Positive feedback mechanism.
♦ When cell does not undergo division nucleoplasm appears Negative Feedback Mechanism
as dark staining thread like material known as nuclear
chromatin. Most of the homeostatic mechanisms of body act by negative
♦ At the time of division chromatin material become rod feedback mechanism, i.e. if the activity of particular system
shaped and is known as chromosomes. become increased or decreased a control system initiates
negative feedback which consists of series of changes which
bring back activity towards the normal.
Here the initial stimulus produces a response which
depresses the stimulus, i.e. stimulus and response are opposite
to each other.
Fig. 4: Erythropoiesis
Stages of Development
Answer Refer to Ans 3 of the same chapter.
Site of Formation
♦ It is produced by juxtaglomerular apparatus of kidney.
♦ It is also produced by liver and cells of tissue macrophages
system, specially when hypoxia is marked.
Classification of Anemia
It is classified by the two methods:
A. Morphological classification.
B. Etiological classification.
Morphological Classification or Wintrobe’s Classificaion
On basis of size and hemoglobin content of RBC, it is classified
into four types:
1. Normocytic normochromic anemia: In it, the size of RBC
and hemoglobin content of RBC is normal. Only RBC count
is reduced.
2. Macrocytic normochromic anemia: The RBCs are larger in
size and due to this RBC count is reduced. The hemoglobin
content is reduced.
3. Macrocytic hypochromic anemia: The RBCs are immature
and are larger in size and hemoglobin content in cell is less.
4. Microcytic hypochromic anemia: The RBCs are smaller
in size. The hemoglobin content in RBCs is less.
Etiological Classification or Whitby’s Classification
On basis of cause, it is divided into four types:
1. Hemorrhagic.
2. Hemolytic.
(Apr 2007, 5 Marks) 3. Nutrition deficiency.
Ans. After a lifespan of 120 days, RBC is destroyed in the 4. Aplastic.
reticuloendothelial system in spleen. Hemoglobin is 5. Anemia due to chronic diseases.
phagocytized by reticuloendothelial cell and splits into 1. Hemorrhagic anemia: It occurs in conditions like accident,
globin, iron and porphyrin. ulcer, excessive uterine bleeding, purpura and hemophilia.
1. Iron: It is stored in body as ferritin and hemosiderin. It occurs in both chronic and acute hemorrhagic conditions.
2. Globin: It is utilized for re-synthesis of hemoglobin. 2. Hemolytic anemia: It occurs due to excessive destruction
3. Porphyrin: of RBC. It occurs in the following conditions:
i. By chemical poisoning, e.g. lead, coal, etc.
a. It is converted to a green pigment called bili-
ii. Infections like malaria and septicemia.
verdin. In human beings most of biliverdin is
iii. Presence of chemical hemolysins.
converted to yellow pigment bilirubin. iv. Presence of isogglutinins.
b. These pigments enter the blood and are carried v. Congenital or acquired default in shape of RBCs, e.g.
by plasma protein α-globulin. sickle cell anemia and thalassemia.
c. When the bile pigments enter the liver, they are 3. Nutrition deficiency anemia: The deficiency of iron, pro-
released from plasma protein then conjugate tein and vitamins such as vitamin C, folic acid and vitamin
with glucoronic acid. The conjugated pigments B12 causes nutrition deficiency anemia, e.g. iron deficiency
are carried to gallbladder by bile. anemia, protein deficiency anemia and pernicious anemia.
Physiology 291
Name of Diameter of
WBC Cell Nucleus Cytoplasm Diagram
Neutrophils 10–14 µm • Nucleus of neutrophil is horse Cytoplasm of neutrophil is pale blue in
shoe shaped and it become colour and consists of fine granules.
lobed as cell grows Granules acquire both acidic and basic
• Nucleus of mature neutrophil stain and are violet pink in color
is purple in colour and
is multilobed that’s why
neutrophils are known as (For colour version see Plate 19)
polymorphonuclear leucocytes
• Lobes of nucleus are conn-ected
by chromatin filaments
Eosinophils 10–14 µm • Nucleus of an eosinophil is • Cytoplasm is acidophilic and
purple in colour and is bilobed. appear as bright pink in colour
• Both the lobes are connected by • Cytoplasm of eosinophil has
chromatin strand and appear as coarse, deep red staining granules
spectacle shaped. which do not cover nucleus
• Some eosinophils have three • Granules in eosinophils consist
lobes of basic protein and stain more (For colour version see Plate 19)
intensely for peroxidase
• Granules of eosinophils have
histamine, lysosomal enzymes and
ECF – A i.e. eosinophil chemotactic
factor of anaphylaxis
Basophils 8–10 µm Nucleus of basophil is irregular • Cytoplasm of basophils is slightly
and it can be either bilobed or basophilic and is full of granules
trilobed. Boundary of nucleus • Granules of basophils are coarse
cannot be clearly appreciated due and stain deep purple
to overcrowding of coarse granules • Granules are numerous, they
completely fill the cell and overload
the nucleus (For colour version see Plate 19)
• Granules of basophils consists of
heparin, histamine and serotonin
Lymphocytes Large Nucleus of lymphocytes is large, • Cytoplasm is very less and its
lymphocyte: round and single which almost amount is less than the amount of
12–16 µm completely fills the cell. Nucleus nucleus. It appears as crescent of
Small appears deep blue giving an ink spot clear light blue colour around the
lymphocyte: appearance. Nuclear chromatin is nucleus. Cytoplasm lack visible
7–10 µm coarsely clumped and shapeless. granules.
(For colour version see Plate 19)
Monocytes 14–18 µm Nucleus of the cell is large, single Cytoplasm of monocyte is abundant,
and is eccentric in its position. pale blue and is clear. It can consists
Nucleus can be notched or indented of fine purple, dust like granules known
i.e. horseshoe or kidney shaped. as azure granules which can be few or
numerous
(For colour version see Plate 19)
292 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Functions of WBCs
Stages of Development
Pluripotent stem cells (Hemocytoblast): These cells are
converted into colony forming units known as CFU –M
or colony forming unit-megakaryocyte.
Megakaryoblast: This is the most earliest precursor of
platelets in bone marrow.
• Diameter of megakaryoblast is 20 to 30μm.
• Cytoplasm of cell is non-granular and hematoxyphilic.
• Nucleus is oval or kidney-shaped and consists of
nucleoli.
Promegakaryocyte: Megakaryoblast get converted to
promegakaryocyte.
• Megakaryoblast does endoreduplication of nuclear
chromatin and leads to the formation of a large cell
which consists of 32 times the normal diploid content
of nuclear DNA.
Fig. 6: Platelets
• When nuclear replication caeses cytoplasm get
Function of Platelets granular.
• Granules of cytoplasm are basophilic.
1. They play an important role in blood clotting for formation
of intrinsic prothrombin activator. Megakaryocyte: Maturation of promrgakaryocyte occurs
2. They undergo clot retraction, the blood cells including and there is formation of megakaryocyte.
platelets are entrapped in between fibrin threads. • This cell is of 30 to 90μm in diameter.
3. They play role in prevention of blood loss. • Nucleus of cell is single and is multilobed (4 to 16
Q.14. Describe platelets under the following headings: lobes) with coarsely clumped chromatin.
i. Normal range and morphology • Abundant cytoplasm is present and has red-purple
ii. Stages of development granules.
iii. Functions • Margins of cell are irregular and show multiple
iv. Clinical conditions resulting from lack of platelets. pseudopodia.
(Apr 2010, 5 Marks) • Platelets formed from these pseudopodes of mega-
Ans. Normal Range and Morphology. karyocyte which become detached in bloodstream.
Refer to Ans 13 of the same chapter. • One megakaryocyte form atleast 4000 platelets.
Functions
Refer Ans 13 of the same chapter. (Mar 2000, 15 Marks)
Clinical Condition Resulting from Lack of Platelets Or
The clinical condition resulting from lack of platelets is
Write short answer on hemostasis.
known as thrombocytopenia. It occurs in the following
conditions such as acute infections, acute leukaemia, (Apr 2018, 3 Marks)
aplastic and pernicious anemia, chickenpox, smallpox, Ans. Spontaneous arrest or prevention of bleeding by
splenomegaly, scarlet fever, typhoid and tuberculosis. physiological process is known as hemostasis.
Physiology 295
(Dec 2009, 15 Marks)
thromboplastin which contain protein, phospholipid When factor XII comes in contact with collagen, it is
and glycoprotein which act as proteolytic enzymes. converted to active factor XII.
The glycoprotein and phospholipid component of The active factor XII converts inactive factor XI to
thromboplastin convert factor X into activated factor active factor XI in presence of kininogen.
X, in presence of factor VIII. The activated factor XI activates factor IX in presence
Activated factor X reacts with factor V and phospholipid of calcium ions.
content of tissue thromboplastin to form prothrombin Activated factor IX activates factor X in presence of
activator in presence of calcium. factor VIII and calcium.
Factor V is activated by thrombin formed from When platelet comes in contact with collagen of
prothrombin. This factor V now accelerates formation damaged blood vessel, it releases phospholipids.
of prothrombin activator. Now, active factor X reacts with platelet phospholipid
and factor V to form prothrombin activation in
presence of calcium ions.
Factor V is activated by positive feedback method.
Conversion of Prothrombin into Thrombin
Prothrombin activator converts prothrombin into thrombin
in presence of calcium by positive feedback mechanism. This
accelerates formation of extrinsic and intrinsic prothrombin
activator.
• If antigen B is present in RBC, the blood group is B. Determination of the ABO Group
• If no antigen is present in RBC, the blood group is O. ♦ It is also known as blood grouping or blood typing or
• Another blood group is discovered by De Castallo. blood matching.
• If both antigen is present in RBC. Blood group is AB. ♦ The blood typing is done on the basis of agglutination i.e. col-
• Other blood groups are: lection of separate particles like RBCs into clumps or masses.
- Levis blood group. ♦ Agglutination occurs if an antigen is mixed with its cor-
- MNS blood group. responding antibody which is called isoagglutinin.
♦ Agglutination occurs when A antigen is mixed with anti
Landsteiner’s Law
A or when B antigen is mixed with anti B.
♦ If an agglutinogen is present in RBC of a person, the cor-
responding agglutinin may be absent. Determination of Blood Group of a Person
♦ If an agglutinogen is absent in RBC, the corresponding For determination of blood group of a person, suspension of
agglutinin must be present. his RBC and testing antisera is required. Suspension of RBC is
prepared by mixing blood drops with isotonic saline (0.9%).
Mismatched Blood Transfusion
Test sera are:
Antigen Antibody Blood Group ♦ Antiserum A; containing anti A.
A antigen Beta antibody A ♦ Antiserum B, containing anti B.
B antigen Alpha antibody B Procedure
A and B antigen – AB ♦ One drop of antiserum A is placed on one end of a glass
– Alpha and Beta antibody O slide (or a tile) and one drop of antiserum B on the other end.
♦ One drop of RBC suspension is mixed with each antiserum.
The slide is slightly rocked for 2 minutes. The presence or
absence of agglutination is observed by naked eyes and if
necessary it is confirmed by using microscope.
♦ Presence of agglutination is confirmed by the presence of
thick masses (clumping) of RBCs
♦ Presence of agglutination is confirmed by clear mixture
with dispersed RBCs.
Results
♦ If agglutination occurs with antiserum A: The antiserum
A contains anti A or α antibody. The agglutination occurs
if the RBC contains A antigen. So, the blood group is A.
♦ If agglutination occurs with antiserum B: The antiserum
B contains anti B or B antibody. The agglutination occurs
if the RBC contains B antigen. So, the blood group is B.
♦ If agglutination occurs with both anti-sera A and B: The
RBC contains both A and B antigens to cause agglutination
(Oct 2007, 5 Marks) and, the blood group is AB.
♦ If agglutination does not occur either with anti-serum A or
Ans. ABO Blood Group System
anti-serum B: The agglutination does not occur if the RBC
Based on the presence or absence of antigen A and does not contain antigen. The blood group is O.
antigen B, blood is divided into four groups, i.e.
Q.19. Write a short note on Rh factor.
1. A group.
2. B group. (Oct 2016, 5 Marks) (May/June 2009, 5 Marks)
3. AB group. Or
4. O group. Write briefly about Rh blood group.
• Blood consisting of antigen A is known as A group (Aug 2016, 2 Marks)
and it has β antibody in serum. Ans. Rh factor is an antigen present in the RBC. The antigen was
• Blood consisting of antigen B is known as B group found in Rhesus monkey, so it was named as Rh factor.
and it has α antibody in serum. There are many Rh antigens but D is more antigenic.
• If both antigens are present the blood group is called • The persons having D antigen are called Rh positive
as AB group and it has no antibodies. and those without D antigen are Rh negative.
• If both antigens are absent the blood group is called • Among Asian population, 85% of people are Rh
as O group and it has both α and β antibodies. positive and 15% are Rh negative.
298 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• Unlike ABO system, there is no corresponding an- ♦ If father is Rh positive and mother is Rh negative and
tibody present for Anti-D. fetus is Rh positive, then fetal RBCs may enter mother s
• Rh positive person can receive Rh negative blood blood and stimulate antibody production. This is normally
without the risk of developing complications. possible during first delivery and complications do
• Sometimes, when Rh negative mother carries Rh not arise during first delivery. But now antibodies are
positive fetus, the first child escapes from complica- developed. During second pregnancy antibodies cross
tions of Rh incompatibility because Rh agglutinogen through the placenta and, enter fetus and produce
cannot pass from fetal blood into mother s blood hemolysis. This leads to erythroblastosis fetalis.
through placental barrier.
However, at the time of delivery, the Rh antigen from
fetal blood leaks into mother’s blood within a month after
delivery, the mother develops Rh antibody in her blood.
Now, at the time of second fetus, if it is again Rh positive,
the antibody from mother s blood crosses placental
barrier and enters fetal blood. So, the Rh agglutinins,
which enter fetus cause agglutination of fetal RBC and
hemolysis. The severe hemolysis causes jaundice in fetus.
To compensate hemolysis, there is rapid production of
RBCs. Now, more numbers of large and immature cells
in proerythroblastic stage are released in circulation.
Because of this disease is called erythroblastosis fetalis.
Rh blood group is also known as Rhesus blood group
♦ Rh blood group was discovered by Landsteiner and Weiner
in 1940.
♦ RBCs of Rhesus monkeys when injected to rabbits, the
rabbits respond to presence of an antigen in these cells by
forming an antibody which agglutinates Rhesus RBCs.
♦ If immunized rabbit s serum is tested against human RBCs,
agglutination occur in 85% of people which are known as
Rh positive and their serum has no Rh antibody whereas
in 15% of people no agglutination occur, these are known
as Rh negative and their serum also does not consists of
Rh antibody.
♦ Rh blood group system has not been detected in tissues
other than RBCs.
♦ Rh antigen is known as D and its antibody is known as
anti D.
♦ Three genotype combinations are present i.e. DD, Dd
and dd
♦ DD and Dd are Rh positive while dd is Rh negative.
Antibodies to D antigen develop only when Rh negative
individual is given Rh positive blood or Rh positive fetal
RBC enter accidentally Rh negative mother. So these (Aug/Sep 1998, 5 Marks)
antibodies are not natural but are acquired. Ans. Blood is a connective tissue. Blood containing the formed
♦ In Rh system, Rh antibodies are of IgG type and antigen- elements called as blood cells and liquid protein plasma.
antibody reaction occur best at body temperature. So Rh 1. Blood cells also known as formed elements:
antibodies are known as warm antibodies. Antibodies a. Red blood cell: Erythrocytes are mononucleo-
being IgG types can cross the placenta. tides; the red color of these is due to hemoglobin.
b. White blood cell: They are colorless, nucleated
Significance of Rh Blood Grouping
formed elements. They play an important role
♦ At the time of first transfusion of Rh positive blood to an Rh in defense mechanism.
negative person, complications do not arise but antibodies c. Thrombocytes: They are small colorless non-
are produced. During next transfusion antibodies which nucleated and play an important role in blood
are developed react with Rh positive cells and produces clotting.
reaction. So Rh positive blood should not be transfused to - Blood cells form 45% of blood and 55% of
Rh negative individuals. blood is formed by plasma.
Physiology 299
Causes
♦ Impaired platelet production
Generalized marrow failure
– Aplastic anemia
– Leukemia
– Megaloblastic anemia
– Marrow infiltration.
Selective suppression of platelet production
It is due to drugs like quinine, thiazides, etc.
♦ Increased consumption or destruction of platelets
Disseminated intravascular coagulation
Thrombolytic thrombocytopenic purpura
Idiopathic thrombocytopenic purpura
Viral infections.
♦ Splenic sequestration: It is due to hypersplenism.
Q.25. Define and classify immunity. Describe cellular
immunity in detail.
(Oct 2007, 15 Marks) (Apr 2010, 5 Marks)
Ans. Resistance to the body against the pathogenic agents is
know as “Immunity”.
Classification of Immunity
Role of Folic Acid in Erythropoiesis The cellular immunity is by the activation of T-lymphocytes,
which destroy the organisms, entering the body.
This is also essential for maturation. This is necessary for
♦ This is also called “cell mediated immunity” or “T-cell
synthesis of DNA. In absence of folic acid, the synthesis
immunity”.
of DNA is reduced causing failure of maturation of
♦ This is the major defense mechanism against infections by
RBCs. The anemia due to folic acid deficiency is called
virus, fungi and few bacteria like tubercle bacillus.
as megaloblastic anemia in which cells are large and
♦ Cellular immunity is also responsible for delayed allergic
appear in megaloblastic stage.
reactions and the rejection of tissues transplanted from
Q.24. Write a short note on thrombocytopenia. other s body.
(Mar 2006, 5 Marks) ♦ The exposure or presentation of antigen to the lymphocytes
Ans. This is a quantitative disorder of platelets. This disorder is is an important process during development of immunity.
characterized by diminished platelet count, i.e. less than It is done by some special type of cells called antigen
1,50,000/mm3 and is known as thrombocytopenia. presenting cells.
300 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Antigen Presenting Cells Q.26. Describe different types of blood groups. Add a note
1. Macrophages - Phagocyte. on blood transfusion. (Dec 2010, 20 Marks)
2. Dendrite cells - Nonphagocyte. Ans. Following are the types of blood groups:
1. ABO Blood Group
Role of Antigen Presenting Cells 2. Rhesus (Rh) Blood Group
When foreign organisms invade the body, the macrophages 3. M and N Blood group
or other antigen presenting cells kill them mostly by means of 4. Lewis Blood Group
phagocytosis. 5. Auber group
♦ Later the antigen from the organisms is digested into 6. Diego group
polypeptides. 7. Bombay group
♦ These polypeptide products are presented to T-lympho- 8. Duffy Group
cytes along with human leukocyte antigens. 9. Lutheran group
♦ The antigen products activate the helper T cells and B- 10. P group
lymphocytes. 11. Kell group
♦ The macrophages also secrete interlukin-1. This causes 12. I group
activation and proliferation of lymphocytes. 13. Kidd group
♦ The activated helper T-lymphocytes are proliferated and 14. Sulter XG group.
released into circulation from lymphoid tissues. For ABO blood group refer to Ans 18 of same chapter.
For Rhesus (Rh) blood group refer to Ans 19 of same
Role of Helper T-lymphocytes
chapter.
♦ These lymphocytes are also called helper T-cells because
these cells help in promoting the various activities of im- M and N Blood Group
mune system.
M and N factors depend on two minor genes. Each person
♦ These cells stimulate the other T-cell and the B-cell by
carries two of the gene of M and N group,. i.e. M + M (= M)
secreting interleukin 2 and B cell growth factor.
N + N (= N)
Other T-cells M + N (= MN)
Interleukin 2 secreted by helper T-cells activates the cytotoxic This blood group is antigenic to rabbit.
T-cells and suppressor T-cells.
Bombay Blood Group
On B-lymphocytes ♦ The first person that was discovered to have the Bombay
B cell growth factor secreted by the helper T-cells and produces: phenotype seemed to have an interesting blood type that
1. Activation of B-lymphocytes. reacted to other blood types in a way never seen before.
2. Proliferation of plasma cells. ♦ The serum contained antibodies that reacted with all red
3. Production of more amount of antibodies by B-lymphocytes. blood cells normal ABO phenotypes.
♦ The red blood cells appeared to lack all of the ABO blood
Role of Cytotoxic T-lymphocytes group antigens plus an additional antigen that was previ-
The cytotoxic T-cells activated by the interleukin 2, directly ously unknown.
attack the microorganisms or other invading organisms and ♦ Individuals with the rare Bombay phenotype (hh) do not
destroy them. express H antigen (also called substance H), the antigen
which is present in blood group O. As a result, they can-
Role of Suppressor T-lymphocytes not make A antigen (also called substance A) or B antigen
The suppressor T-cells are also called regularly T-cells. These (substance B) on their red blood cells, whatever alleles they
T-cells suppress the activities of the killer T-cells. may have of the A and B blood-group genes, because A
antigen and B antigen are made from H antigen.
Role of Memory T-lymphocytes ♦ For this reason people who have Bombay phenotype can
♦ T-lymphocytes are an antigen remain in lymphoid tissue in- donate RBCs to any member of the ABO blood group sys-
stead of entering circulation, these are called memory T-cells. tem (unless some other blood factor gene, such as Rhesus,
♦ Later when the body is exposed to the same organism is incompatible), but they cannot receive blood from any
second time, the memory cells activate the other T-cells. So member of the ABO blood group system (which always
the invading organism is destroyed very quickly. contains one or more of A and B and H antigens), but only
from other people who have Bombay phenotype.
Specificity of T-lymphocytes ♦ Receiving blood which contains an antigen which has
♦ Each T-lymphocytes is activated only by one type of an- never been in the patient’s own blood causes an immune
tigen, it is capable of developing immunity against that reaction due to the immune system of a hypothetical
antigen only. receiver producing immunoglobulins not only against
♦ This property is called the specificity of T-lymphocytes. antigen A and B, but also against H antigen.
Physiology 301
Blood Transfusion
Blood transfusion is the process of transferring blood or blood
components from one person to another.
in the blood are taken by the tissues during the conditions l. Deficiency of clotting factors.
like starvation, fluid loss, electrolyte loss, etc. 2. Vitamin K deficiency.
9. Defensive: The WBCs in the blood provide the defense 3. Anticoagulant overdose.
mechanism and protect the body from the invading organ-
isms. Neutrophils and monocytes engulf the bacteria by Hemophilia A
phagocytosis. Lymphocytes provide cellular and humoral ♦ It is caused by an abnormality or deficiency of factor VIII.
immunity Eosinophils protect the body by detoxification, ♦ It is an inherited sex-linked anomaly due to an abnormal
disintegration and removal of foreign proteins. gene on X-chromosome.
Q.30. Write in brief functions of platelets. (Nov 2012, 3 Marks) ♦ It is transmitted by females to males who manifest signs
Ans. Function of Platelets of the disease.
1. In blood clotting: Platelets are responsible for the ♦ The gene responsible for hemophilia is present in the
formation of intrinsic prothrombin activator. This X-chromosomes.
substance is responsible for the onset of blood clotting ♦ In the presence of another normal X-chromosome the
2. In clot retraction: In the blood clot, the blood cells gene acts as a recessive i.e. the individual has no sign of
including platelets are entrapped in between the hemophilia but can transmit the disease.
fibrin threads. The cytoplasm of platelets contains ♦ The condition is characterized by a marked increase in
the contractile proteins namely actin, myosin and the coagulation time (CT), normal CT is 3-8 minutes. The
thrombosthenin which are responsible for clot bleeding time (BT) is normal; normal BT is 2-5 minutes.
retraction ♦ Normal blood collected after venopuncture clots in 5-10
3. In prevention of blood: Platelets accelerate hemo- minutes, while hemophilic blood may take 1-12 hours and
stasis by three ways:
may form only the soft clot.
i. Platelets secrete 5 HT, which causes the constric-
tion of blood vessels. Treatment
ii. Due to the adhesive property, the platelets seal
♦ Fresh blood transfusion, because factor VIII is lost rapidly
the damage in blood vessels like capillaries.
on storage, or
iii. By formation of temporary plug also platelets
seal the damage in blood vessels. ♦ Injecting factor VIII and IX, prepared from fresh frozen
4. In repair of ruptured blood vessel: The platelet plasma i.e. cryoprecipitates ; or
derived growth factor (PDG F) formed in cytoplasm ♦ Injecting thrombin or thromboplastin.
of platelets helps in the repair of the endothelium Von-Willebrand’s Disease
and other structures of the ruptured blood vessels.
5. Role in defense mechanism: By the agglutination, ♦ It is caused due to deficiency of Von-Willebrand’s factor.
platelets encircle the foreign bodies and destroy ♦ This factor plays important role in platelet adhesion and
them by phagocytosis. regulates circulating effects of factor VIII.
Q.31. Describe briefly the mechanism of coagulation of Afibrinogenemia
blood. What is Rh factor. (Jan 2012, 11 Marks)
Ans. For mechanism of coagulation of blood refer to Ans 16 It is inherited blood disorder in which the blood does not clot
of same chapter and for Rh factor refer to Ans 19 of same normally due to a lack of or a malfunction involving fibrinogen,
chapter. a protein necessary for coagulation.
Q.32. Describe in brief bleeding disorders. Parahemophilia
(Dec 2010, 5 Marks)
Ans. These are also known as hemorrhagic disorders. ♦ Parahemophilia is caused due to deficiency of Factor V.
♦ Factor V is a protein of the coagulation system, rarely
Major causes of bleeding disorders are classified as:
referred to as proaccelerin or labile factor.
A. Defective blood clotting due to.
♦ In contrast to most other coagulation factors, it is not
1. Deficiency of clotting factors, i.e. Factor I, II, V,
VIII, IX, X. enzymatically active but functions as a cofactor.
2. Deficiency of vitamin K. ♦ Deficiency leads to predisposition for hemorrhage, while
3. Anticoagulant overdosage. some mutations predispose for thrombosis.
B. Defective capillary contractility, i.e. Purpura. Deficiency of Vitamin K
C. Combined defect.
Vitamin K is required for the synthesis of prothrombin (factor
Defective Blood Clotting II) and factors VII, IX and X in the liver. Vitamin K in liver acts
In this disorder a firm clot is not formed following an injury on certain receptor sites to form all the factors. Anticoagulants
during period of capillary contraction. When the capillaries act by substrate competition by occupying vitamin K receptor
finally open up once more, oozing will recur. sites.
Physiology 303
Causes
♦ Obstructive jaundice.
♦ Chronic diarrheas.
♦ Liver diseases, i.e. Cirrhosis, hepatitis, malignancy.
Treatment
Injection of Vitamin K should be a good cure.
♦ Thalassemia: It is an inherited disorder characterized by Q.37. Write short note on phagocytosis. (Aug 2012, 5 Marks)
abnormal hemoglobin. In normal hemoglobin, the number Ans. Phagocytosis means cell eating.
of α and β chains is equal. In thalassemia the number of Phagocytosis is defined as the process through which
these chains is not equal. This causes the precipitation of the extracellular substances, i.e. bacteria, dead tissue,
the polypeptide chains leading to defective formation of
foreign particles, etc. get engulfed by cells.
RBCs or hemolysis of the matured RBCs. It is also known
as Cooley s anemia or Mediterranean anemia. Thalassemia Events in Phagocytosis
is of two types α and β thalassemia.
♦ Margination: At the place of infection neutrophils get
Nutrition Deficiency Anemia marginated i.e. they attached towards the capillary en-
♦ Iron deficiency anemia: It is the most common type of dothelium and strat rolling along its surface. This is known
anemia. It develops due to inadequate availability of iron as margination or pavementing.
for hemoglobin synthesis. The RBCs are microcytic and ♦ Emigration and diapedesis: Marginated neutrophils emi-
hypochromic. grated in large number from blood at infection area. These
♦ Protein deficiency anemia: Protein deficiency decreases are motile and move via diapedesis in tissues by passing
the hemoglobin synthesis and the RBCs become macrocytic through junction between endothelial cells of blood vessels.
and hypochromic in nature. ♦ Chemotaxis: This is the process through which neutrophils
♦ Vitamin B12 deficiency or pernicious anemia: Vitamin are attracted towards bacteria at the site of inflammation.
B12 is a maturation factor for RBC and deficiency of this This process of chemotaxis is mediated by chemotactic agents
causes pernicious anemia which is also called Addison’s known as chemokines which get released from infected area.
anemia. It occurs because of less intake of vitamin B12 or ♦ Opsonization: It is the process of coating of bacteria by
poor absorption of vitamin B12. Vitamin B12 is absorbed opsonins through which bacteria become tasty to phago-
from the stomach with the help of intrinsic factor of Castle cytes. The principal opsonins are IgG opsonin and opsonin
which is secreted in the gastric mucosa. Decrease in the
fragment of complement protein.
production of intrinsic factor causes poor absorption of
♦ Engulfment stage: Neutrophils project pseudopodia in all
vitamin B12. RBCs are macrocytic and normochromic.
directions around opsonized particle which is bound to sur-
Aplastic Anemia face of neutrophil. Pseudopodia meet each other on opposite
side and fuse. This leads to formation of enclosed chamber
It occurs due to the bone marrow disorder. In this red bone
with engulfed material. It breaks away from membrane to
marrow is reduced and replaced by fatty tissues. RBCs are
normocytic and normochromic. It occur due to repeated form phagocytic vesicle. Cellular lysosomes get fuse with
exposure to X-ray, tuberculosis, hepatitis, etc. phagocytic vesicle and form phagolysosome or phagosome.
♦ Secretion stage: As bacteria get engulfed, lysosomes
Q.36. Write in brief about edema. (Aug 2012, 5 Marks) pour their enzymes in vesicle and in interstitial space.
Ans. Decrease in plasma protein level leads to decrease in This process is known as degranulation. Large number of
colloidal osmotic pressure which leads to increase in proteolytic enzymes are secreted for digesting bacteria.
filtration at arterial end and decrease in absorption of Lysosomes of macrophages also have lipases which digest
fluid at venous end which causes abnormal collection thick lipid membranes possessed by various bacterias.
of fluid in interstitial spaces known as edema. ♦ Killing or degradation stage: Neutrophils and mac-
For mechanism of formation of edema refer to Ans 1 of rophages consists of bactericidal agents which can kill
same chapter. most of the bacterias.
Fig. 8: Phagocytosis
Physiology 305
Q.38. Write in brief on erythroblastosis fetalis. Q.39. Describe in brief on plasma proteins.
(Mar 2013, 3 Marks) (Sep 2013, 5 Marks)
Ans. It is also known as erythroblastemia. Ans. Plasma proteins are serum albumin, serum globulin and
When anemia occur in child within few days after its fibrinogen. Out of these serum globulin is of three types
i.e. α-globulin, β-globulin and γ-globulin.
birth the excessive destruction of RBCs is compensated
• In embryonic stage plasma proteins are synthesized
by normoblastic response of marrow associated with
by Mesenchymal cells; in adults from reticuloen-
high reticulocyte count and presence of many nucleated
dothelial cells of liver, from spleen, bone marrow,
RBCs in circulation. This is known as erythroblastosis disintegrating blood cells and general tissue cells.
fetalis. • Normal total plasma protein concentration is 6.4 to
There are two main causes of erythroblastosis fetalis: 8.3 gm/dl of blood.
Rh incompatibility and ABO incompatibility. Both are • Albumin controls the colloidal osmotic pressure and
associated with blood type. helps in transport of anion, cation etc.
• Globulin regulates and control iron absorption form
Mechanism of Occurrence of Erythroblastosis Fetalis GIT; protect iron intoxication and helps in iron
transport.
When a mother is Rh negative and fetus is Rh positive (the Rh
• Fibrinogen helps in blood clotting.
factor being inherited from the father), usually the first child
For functions of plasma protein in detail refer to Ans 1
escapes the complications of Rh incompatibility. This is because
of same chapter.
the Rh antigen cannot pass from fetal blood into the mother s
blood through the placental barrier. Q.40. Write short note on hemophilia. (Oct 2014, 3 Marks)
However, at the time of parturition (delivery of the child) Ans. Hemophilia is an inherited sex linked anomaly due
to abnormal gene on X chromosome. It is invariably
the Rh antigen from fetal blood may leak into mother s blood
transmitted by females to males who manifest signs of
because of placental detachment. During postpartum period, i.e.
the disease.
within a month after delivery, the mother develops Rh antibody
Hemophilia is a bleeding disorder which is caused due
in her blood. When the mother conceives for the second time
to the defect in blood clotting which leads to prolonged
and if the fetus happens to be Rh positive again, the Rh antibody clotting time.
from mother s blood crosses placental barrier and enters the
Because of prolonged clotting time even if minor injury
fetal blood.
occur, it leads to excessive bleeding which leads to death.
Thus, the Rh antigen cannot cross the placental barrier
whereas Rh antibody can cross it. The Rh agglutinins which Cause/Etiology
enter the fetus cause agglutination of fetal RBCs resulting in It occurs due to deficiency of factor VIII, IX and Factor XI.
hemolysis. The severe hemolysis in the fetus causes jaundice. To
compensate the hemolysis of more and more number of RBCs, Types
there is rapid production of RBCs, not only from bone marrow ♦ Hemophilia A or Classic Hemophilia: It occurs due to the
but also from spleen and liver. deficiency of factor VIII.
Now, many large and immature cells in proerythroblastic ♦ Hemophilia B or Christmas Disease: It is due to the defi-
stage are released into circulation. Because of the disease is ciency of factor IX.
called erythroblastosis fetalis. ♦ Hemophilia C: It is due to the deficiency of factor XI. It
is very rare.
Complications of Erythroblastosis Fetalis
Diagnosis
Ultimately due to excessive hemolysis severe complications
♦ There is marked increase in clotting time.
develop, such as severe anemia, hydrops fetalis and
♦ Bleeding time is normal.
kernicterus.
Q.41. Write in brief functions of lymph. (Apr 2008, 5 Marks)
♦ Severe anemia: Excessive hemolysis results in anemia. The
Ans. Following are the functions of lymph:
infant dies when anemia becomes severe.
It leads to transportation of proteins i.e. Approxi-
♦ Hydrops fetalis: It is a serious condition in fetus character-
mately 95% of the proteins lost per day from vas-
ized by edema. Severe hemolysis results in development
cular system to interstitial fluid which are returned
of edema, enlargement of liver, spleen and cardiac failure. to blood through lymphatics via pinocytosis and
When this condition becomes more severe it may lead to endothelial gaps.
intrauterine death of fetus. It leads to the transportation of absorbed long chain
♦ Kernicterus: Kernicterus is the form of brain damage in fatty acids as well as cholesterol from intestine
infants caused by severe jaundice. If the baby survive ane- through lymphatics in blood.
mia in erythroblastosis fetalis then kernicterus develops • Lymph transport RBCs, WBCs and bacteria to
because of high bilirubin content. regional lymph node.
306 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• Lymph causes transportation of antibiotics. many times as compared to first one. Due to this hemoglobin
It helps in the formation of maximum concentrated reacts with oxygen rapidly. Deoxygenation of hemoglobin
urine by maintaining the osmotic gradient between is also very rapid.
medullary interstitium and vasa recta. ♦ Transport of carbon dioxide from tissues to lungs: Carbon
• Lymph supply nutrition and oxygen to those parts dioxide from tissues is transported by combining with
where blood is unable to reach. amino acids of globin part. Deoxygenated hemoglobin
• It enhances efficiency of immune system. form carbamino hemoglobin more readily than oxygenated
Q.42 Describe structure, functions and fate of hemoglobin. hemoglobin. Due to this venous blood is suitable for
(Nov 2008, 15 Marks) transport of carbon dioxide from tissues to lungs
Ans. Structure of Hemoglobin ♦ It controls pH of blood: Hemoglobin consists of most
important acid-buffer system of blood. Hemoglobin has six
times buffering capacity as compared to the plasma proteins.
For fate of hemoglobin in detail refer to Ans 6 of same
chapter.
myosin filaments. The process involved in between Formation of Actin – Myosin Complex
the excitation and contraction of muscle is called ♦ Head of myosin molecule binds with adenosine triphos-
excitation-contraction coupling. phate. The ATPase activity of myosin head immediately
• When the impulse through a motor neuron reaches causes breaking of ATP to adenosine diphosphate (ADP)
the neuromuscular junction, acetylcholine is and Pi cleavage products which remain bound to the
released. myosin head. The head of myosin becomes energized.
• The acetylcholine causes opening of ligand gated Activated myosin head extends perpendicularly towards
sodium channels. So, sodium ions enter neuromus- the actin filament and gets attached to actin filament.
cular junction. This leads to development of endplate ♦ Formation of the actin—myosin—ADP Pi complex leads
potential. The endplate potential causes the genera- to the following events:
Release of the Pi and ADP from the complex.
tion of action potential from muscle fiber.
A conformational change in the myosin head causing
• The action potential spreads over sarcolemma and
it to flex towards the arm of the cross-bridge. The
also into the muscle fiber through the “T” tubules.
flexion of the myosin head from the high-energy
• When the action potential reaches the cisternae of 90° conformation to low-energy 45° conformation
“L” tubules, these cisternae are released into the generates mechanical force (the power stroke).
sarcoplasm.
• The calcium ions from the sarcoplasm move towards Detachment of Head of a Cross Bridge from Active Site
the actin filaments to produce the contraction. of an Actin Filament
• Thus, the calcium ions are linking or coupling ma- Release of ADP and Pi allows a fresh ATP molecule to bind the
terials between the excitation and the contraction of myosin head. Myosin—ATP complex has a low affinity for actin
muscle. and, therefore, it results in the dissociation of myosin head from
• Hence the calcium ions are said to form the basis of the actin filament.
excitation-contraction coupling.
Reactivation of Myosin Head
Energy for Muscular Contraction Freshly bound ATP molecule splits again and myosin head is
The energy for movement of myosin head (Power stroke) is reactivated for the next cycle to begin.
obtained by the breakdown of adenosine triphosphate (ATP). So with each cross-bridge cycle there is movement of actin
filament towards center of myosin to small degree. Repeated
Q.4. Write briefly on sliding filament theory of muscle cross bridge cycling causes movement of actin filament of either
contraction (skeletal). (Mar. 2005, 5 Marks) side towards center of myosin filament of sarcomere leading to
Ans. This theory explains that sliding of filaments is brought muscle contraction.
about by repeated cycle of formation of cross bridges Q.5. Write a short note on Myasthenia gravis.
between head of myosin and actin molecules. (Mar 2006, 5 Marks) (May/June 2009, 5 Marks)
(Mar 2013, 3 Marks)
Steps of Cross Bridge Cycling
Ans. Myasthenia gravis a serious and sometimes a fatal
Initiation of Cross Bridge Cycling disease in which skeletal muscles are weak and tired
easily. (See Fig. 13)
♦ At the time of resting stage, troponin I is lightly bound
• It is caused by the formation of circulating antibodies
to actin and tropomycin molecules are located inside
due to nicotinic acetylcholine receptors.
the grooves between strands of actin filaments in such a • These antibodies destroy some of the receptors and
manner that they block myosin binding sites on actin. So bind others to neighboring receptors, triggering their
during resting stage, no actin myosin cross bridges are removal by endocytosis.
formed, Thus, the troponin tropomyosin complex so- • The reason for development of autoimmunity to ace-
called relaxing proteins inhibit the interaction between tylcholine receptors in this disease is still unknown.
actin and myosin. • Another condition which resembles to myasthenia
♦ When activation takes place, the Ca2+ ions released in gravis is Lambert-Eaton syndrome.
cytosol from the terminal cisterns of the sarcoplasmic Q.6. Write a short note on tetany. (Feb 2003, 5 Marks)
reticulum and get attached to troponin-C subunit of the Ans. It is a condition characterized by hyperexcitability of
protein troponin. It results in a change which causes nerves and skeletal muscles resulting in muscular spasm
tropomyosin molecule to move laterally, uncovering the particularly in feet and hand. The increased neural
binding sites on the actin molecules for head of the myosin excitability results in convulsion. There are two types
molecules. Seven myosin binding sites on the actin filament of tetany.
are uncovered for each molecule of troponin that binds 1. Hypocalcemic tetany: If plasma calcium level falls
a Ca2+ ion. Thus the cross-bridge cycle is initiated by the below 6 mg% from its normal value of 9.4 mg%, the
lateral movement of the tropomyosin. hypocalcemic tetany occurs.
Physiology 309
The signs and symptoms of hypocalcemic tetany are: These cells act together to perform the functions of the
i. Carpopedal spasm. specific muscle of which they are a part.
ii. Laryngeal stridor, i.e. contraction of laryngeal Periosteum: Periosteum is the outer layer of bone. It is
muscles. to this layer that ligaments and tendons are attached.
iii. Dilatation of heart. Tendon: Tendons attach muscle to bone.
iv. Decreased permeability of cell membrane.
They are tough pale colored (whitish) cords formed
2. Latent tetany: Hypocalcemia causes hyperexcit-
from many parallel bundles of collagen fibers. Tendons
ability even before onset of tetany. It is called latent
are flexible (they bend around other tissues, changing
tetany.
position as they move), yet inelastic.
It is characterized by general weakness and cramps
Fascia: The word “fascia” means bandage—a fitting
in feet and hand.
analogy as the tissue called fascia takes the form of sheets
Q.7. Describe structure and function of skeletal muscles. or broad bands of fibrous connective tissue that cover
Add a note on molecular mechanism of muscle contrac- muscles or organs, forming an outer-wrapping.
tion and neuromuscular transmission.
There are two types of fascia: (1) Superficial fascia and
(Dec 2010, 15 Marks)
(2) Deep fascia.
Or
Superficial fascia consists of areolar connective tissue
Describe structure of skeletal muscle and mechanism and adipose tissue, and may also be referred to as the
of muscle contraction. (Aug 2011, 20 Marks) “subcutaneous layer” of the skin. Deep fascia is more
Ans. Structure of Skeletal Muscle relevant to the study of muscle structures because it is
Skeletal muscles consist of 100,000s of muscle cells that deep fascia that holds the muscles together. It consists
are also known as “muscle fibers”. of dense fibrous connective tissue.
310 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Molecular Mechanism of Muscle Contraction causes breaking of ATP to adenosine diphosphate (ADP)
and Pi cleavage products which remain bound to the
Molecular mechanism of muscle contraction is explained on the
myosin head. The head of myosin becomes energized.
basis of Sliding filament mechanism.
Activated myosin head extends perpendicularly towards
Sliding filament theory explains that sliding of filaments is
the actin filament and gets attached to actin filament.
brought about by repeated cycle of formation of cross bridges
♦ Formation of the actin—myosin—ADP Pi complex leads
between head of myosin and actin molecules.
to the following events:
Steps of Cross Bridge Cycling Release of the Pi and ADP from the complex.
A conformational change in the myosin head causing
Initiation of Cross Bridge Cycling
it to flex towards the arm of the cross-bridge. The
♦ At the time of resting stage, troponin I is lightly bound flexion of the myosin head from the high-energy
to actin and tropomycin molecules are located inside the 90° conformation to low-energy 45° conformation
grooves between strands of actin filaments in such a manner generates mechanical force (the power stroke).
that they block myosin binding sites on actin. So during
resting stage, no actin myosin cross bridges are formed, Detachment of Head of a Cross Bridge from Active Site
Thus, the troponin tropomyosin complex so-called relaxing of an Actin Filament
proteins inhibit the interaction between actin and myosin. Release of ADP and Pi allows a fresh ATP molecule to bind the
♦ When activation takes place, the Ca2+ ions released in cytosol myosin head. Myosin—ATP complex has a low affinity for actin
from the terminal cisterns of the sarcoplasmic reticulum and and, therefore, it results in the dissociation of myosin head from
get attached to troponin-C subunit of the protein troponin. the actin filament.
It results in a change which causes tropomyosin molecule
to move laterally, uncovering the binding sites on the actin Reactivation of Myosin Head
molecules for head of the myosin molecules. Seven myosin
Freshly bound ATP molecule splits again and myosin head is
binding sites on the actin filament are uncovered for each mol-
ecule of troponin that binds a Ca2+ ion. Thus the cross-bridge reactivated for the next cycle to begin.
cycle is initiated by the lateral movement of the tropomyosin. So with each cross-bridge cycle there is movement of actin
filament towards center of myosin to small degree. Repeated
Formation of Actin-Myosin Complex cross bridge cycling causes movement of actin filament of either
♦ Head of myosin molecule binds with adenosine triphos- side towards center of myosin filament of sarcomere leading to
phate. The ATPase activity of myosin head immediately muscle contraction.
‘T’ Tubules
♦ They are also known as transverse tubules.
♦ Transverse tubules are narrow and are formed by invagina-
tion of sarcolemma.
♦ Transverse tubules penetrate from one side of muscle fiber
to another side.
♦ T tubules open to exterior of muscle cell and so the ECF
runs through their lumen.
♦ T tubules cause rapid transmission of impulse in the form
of action potential from sarcolemma to myofibrils.
‘L’ Tubules
♦ These are also known as longitudinal tubules.
♦ Longitudinal tubules are the closed tubules which run
to the long axis of muscle fiber forming the sarcoplasmic
reticulum.
♦ They form a close tubular system around each myofibril
and do not open exterior to muscle cell.
♦ Till complete length of lyofibrils at each regular interval
L tubules dilate to form a pair of lateral sacs known as
terminal cisternae.
♦ Each pair of terminal cisternae lies in close contact with
T tubule.
♦ ‘T’ tubule along with cisternae on both sides is known as
triad of skeletal muscle.
♦ ‘L’ tubules store large quantity of calcium ions.
♦ When action potential reaches at cisternae of ‘L’ tubule
calcium ions are released in sarcoplasm. Calcium ions
trigger excitation contraction coupling.
Q.11. Describe the ionic basis of action potential.
(Aug 2012, 15 Marks)
Ans. Following is the ionic basis of action potential.
(Aug 2012, 5 Marks)
Or
Write very short answer on muscle spindle.
(Aug 2018, 2 Marks)
Ans. Muscle spindles are sensory receptors within the belly
of a muscle that primarily detect changes in the length
of this muscle.
They convey length information to the central nervous
system via sensory neurons.
This information can be processed by the brain to
determine the position of body parts.
The responses of muscle spindles to changes in length
also play an important role in regulating the contraction
of muscles, by activating motoneurons via the stretch
reflex to resist muscle stretch.
Muscle spindles are found within the belly of muscles,
embedded in extrafusal muscle fibers.
Muscle spindles are composed of 3-12 intrafusal muscle
fibers, of which there are four types:
• Dynamic nuclear bag fibers (bag1 fibers)
• Static nuclear bag fibers (bag2 fibers)
• Nuclear chain fibers.
Axons of sensory neurons.
Axons of gamma motoneurons also terminate in muscle
spindles; they make synapses at either or both of the
ends of the intrafusal muscle fibers and regulate the
sensitivity of the sensory afferents, which are located in
the non-contractile central (equatorial) region.
Muscle spindles are encapsulated by connective tissue,
and are aligned parallel to extrafusal muscle fibers,
unlike Golgi tendon organs, which are oriented in series.
The muscle spindle has both sensory and motor
Fig. 16: Ionic basis of action potential components.
314 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Myosin Molecule
♦ Molecular weight of myosin molecule is 4,80,000.
♦ It consists of six polypeptide chains, two heavy chains and
four light chains.
♦ Two heavy chains twist around each other to form double
helix which constitute tail and body of myosin molecule.
♦ Light chains combine to the terminal part of heavy chains (May 2017, 2 Marks)
and form globular head of myosin molecule. Ans. There are three types of muscles present in our body:
♦ Myosin molecule present in the skeletal muscle consists 1. Skeletal muscle
of two heads and is known as myosin II. 2. Cardiac muscle
♦ At the time of muscle contraction head forms cross bridging. 3. Smooth muscle
Contd...
Q.16. Write very short answer on resting membrane potential. (Jan 2018, 5 Marks)
(Aug 2018, 2 Marks) Or
Ans. Resting membrane potential is defined as the electrical
potential difference across the cell membrane under
resting condition.
• It is also known as membrane potential, transmem-
brane potential, transmembrane potential difference
or transmembrane potential gradient.
• When two electrodes are connected to cathode-ray
oscilloscope via a suitable amplifier and is placed (Aug 2016, 5 Marks)
over surface of muscle fiber, there should be no
Ans.
potential difference, i.e. zero potential difference. But
if one electrode is inserted into the interior of muscle Functions of Saliva
fiber, potential difference is seen across sarcolemma. 1. Cleaning of mouth: Since saliva is watery it produces a
So there is negativity inside and positivity outside flushing action on the teeth which helps in removing the
the muscle fiber. Usually this potential difference
food debris as well as non-adherent forms of bacteria which
is constant and is known as resting membrane
collects over the teeth.
potential.
2. Lubrication and Deglutition: Saliva provides lubrication
Condition of muscle during resting membrane
to oral tissues by mucus and various other glycoproteins
potential is known as polarized state.
which help provide lubrication at time of speech. It also
In human skeletal muscle, resting membrane
helps in formation of bolus which can easily slide into the
potential is -90 mV.
oesophagus.
3. Antimicrobial function: Saliva consists of various com-
4. DIGESTIVE SYSTEM ponents which produce antimicrobial activity. The com-
ponents are lysozyme, lactoferrin, histatins and salivary
Q.1. Write on the composition and functions of saliva. peroxidases. Saliva also consists of immunoglobulin such
(Sept 2001, 5 Marks) (Apr 2008, 4 Marks) as IgA which provides antimicrobial action by agglutinat-
ing certain microorganisms and preventing their adher-
Or ence to the oral mucosa.
Write a short note on function of saliva. 4. Buffering function: Saliva consists of bicarbonate ions
(Sept 2006, 5 Marks) (Aug 2005, 5 Marks) which neutralize the acids which are produced by bacteria,
(Jan 2012, 5 Marks) (Feb 2014, 5 Marks) these acids can cause dissolution of teeth and cause dental
316 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
caries. So due to its buffering action saliva dissolve the acid bacterial acids and loss of dissolved calcium and phosphate
and prevent caries. ions.
5. Digestive function: Saliva consists of digestive enzymes ♦ Mucins: Mucus consists of large, heavily glycosylated
such as amylase and lipase. These enzymes causes start proteins. It forms 5-10% of salivary proteins. Mucus
digestion of food from oral cavity. E.g. Enzyme amylase acts as diffusion barrier against contact with noxious
and lipase break starch into maltase and lipids into diglyc- substances. It also act as a lubricant too, minimising
erides and free fatty acids. shear stresses.
6. Mineralization: Tooth surface is always coated with sa- ♦ Lingual lipase: It is secreted by von Ebner’s glands as
liva. Since saliva consists of calcium and phosphate ions, well as parotid gland. It helps in the digestion of milk fat
they increase the surface hardness of teeth which provide in newborns.
resistance of teeth to demineralisation. ♦ Statherins: Statherin has very high affinity for calcium
7. Taste: Saliva dissolves the food substances so that they can and phosphate minerals. They stop precipitation of su-
be perceived by the receptors located in the taste buds. persaturated calcium phosphate in ductal saliva as well
8. Tissue repair: Saliva consists of epidermal growth factor as in oral fluid.
and vascular endothelial growth factor which leads to ♦ Lysozyme: These enzymes play important role in anti-
repair and regeneration of oral tissues. bacterial action.
9. Excretion: Many substances from blood reaches saliva and ♦ Lactoferrin: It has antibacterial properties. The oxi-
saliva is considered as the route of excretion. dized iron part of the lactoferrin oxidizes bacteria by
formation of peroxides which causes break down of
Composition of Saliva cell membrane.
♦ Histatins: They have anti-fungal properties. They also
Saliva contains 99% of water, 1% organic and inorganic
disrupt the cell cycle and causes generation of reactive
substances.
oxygen species.
Inorganic Contents of Saliva Other Organic Components
♦ Calcium and Phosphate: They protect mineralized enamel ♦ Various blood group antigens are secreted in the saliva.
surface form dissolution. Calcium ion concentration in ♦ Sugars like glucose are secreted in the saliva.
saliva is 1.5 mmol/L. Phosphate ion concentration is 5.6 ♦ Steroid hormones like cortisol, oestrogen and testosterone
mmol/L. are secreted in minimal quantities.
♦ Fluoride: Fluoride promotes remineralisation of teeth ♦ Ammonia and urea are also present in very less quantities.
which are decaying by dental caries. Fluoride concentra-
tion is about 1.5 mM/L. Q.2. Write briefly on functions of stomach.
(Apr 2010, 5 Marks)
♦ Hydrogen carbonate: It acts as buffering agent in saliva.
Concentration of hydrogen carbonate is 2.9 mM/L. It neu- Ans. Following are the functions of stomach
tralizes the acids released by bacteria. 1. Storage: The food is stored in the stomach for a long
♦ Thiocyanate: Thiocyanate is oxidised by salivary peroxides period before entering the intestine. The maximum
and it get converted to hypothiocyanate. Hypothiocyanate capacity of stomach is 1.5 L.
acts as an antibacterial agent. Its concentration in saliva is 2. Mechanical: The peristaltic movements of the stom-
about 2.5 mM/L. ach mix the bolus with gastric juice and convert it
into chyme.
Other Inorganic Components 3. Digestive: The gastric juice is secreted by gland of
stomach and contains the enzymes which act on
♦ Sodium ions are in very less quantity in saliva. Its con-
protein.
centrations increase along with the increase in flow rate.
4. Protective: The HCl present in gastric juice destroys
♦ Potassium ions are the major inorganic ions in saliva, as
many bacteria entering the body along food.
they are secreted throughout the ductal system.
5. Hemopoietic: The intrinsic factor of castle present
♦ Other inorganic components such as lead, cadmium and
in gastric juice is necessary for absorption of vita-
copper.
min B12 which is called extrinsic factor. Vitamin
Organic Contents of Saliva B12 is an important maturation factor during
erythropoiesis.
The organic contents of saliva are as follows: 6. Excretory: Many substances like toxins, alkaloids
♦ Amylase: It constitutes the major component of salivary and metals are excreted through gastric juice.
proteins, i.e. about 50% amylase digests the starch. Mostly
Q.3. Describe composition, function of various important
salivary amylase is secreted from parotid gland.
components and control of secretion of gastric juice.
♦ Proline-rich proteins: They constitute about 40 to 45%
(Sep 2000, 15 Marks)
of salivary proteins. They reside in the salivary pellicle.
Or
Pellicle act as diffusion barrier, and slows the attacks by
Physiology 317
Write briefly on functions and composition of gastric Gastric Lipase: It is the weak lipolytic enzyme, it
juice. (Mar 2006, 4 Marks) (June 2012, 5 Marks) converts lipids into fatty acids and glycerol.
Or ♦ Hemopoietic function: The intrinsic factor present in gastric
juice plays an important role in erythropoiesis. It is neces-
Describe composition and function of various impor- sary for absorption of extrinsic factor from GIT into blood.
tant components and secretion of gastric juice. ♦ Protective function: The mucus present in gastric juice is
(Sept 2005, 10 Marks) responsible for protection of wall of stomach. The func-
Or tions of mucus are:
Describe composition and function of gastric juice. The mucus lubricates gastric mucosa and protects it
Give mechanism and regulation of gastric secretion. from the mechanical injury.
(Aug 2012, 5 Marks) It prevents digestive action of pepsin on gastric mucosa.
Or ♦ Action of HCl: The HCl present in gastric juice has the
following functions:
Write short note on regulation of gastric juice. Activates pepsinogen to pepsin.
(Feb 2014, 3 Marks) Has bacteriolytic action.
Or Provides acidic medium for function of enzymes.
Write short note on functions of gastric juice.
(Oct 2014, 3 Marks) Mechanisms of Secretion of Gastric Juice
Or ♦ Secretion of pepsinogen
Write about composition and functions of gastric juice. Pepsinogen is synthesized from amino acids.
(Sep 2018, 5 Marks) (Sep 2015, 7 Marks) The pepsinogen molecules are packed into zymogen
Or granules by Golgi apparatus.
When zymogen granule is secreted into stomach from
Write on composition, mechanism of secretion of chief cells, the granule is dissolved and pepsinogen is
gastric juice and its functions. (Apr 2017, 5 Marks) released into gastric juice.
Ans. Composition of Gastric Juice Pepsinogen is activated into pepsin by HCl.
It contains 99.5% of water and 0.5% of solids. The solids ♦ Secretion of HCl
are organic and inorganic substances. HCl secretion is an active process taking place in
canaliculi of parietal cells.
The organic substances in gastric juice are:
The energy is derived from oxidation of glucose. In
1. Gastric enzymes: The enzymes present in gastric parietal cell all the CO2 combines with H2O to form
juice are: carbonic acid.
a. Pepsin: It is main proteolytic enzyme in gastric Carbon dioxide is derived from the metabolic activities
juice. in the cell. The carbonic acid is formed in presence
b. Rennin: It is a milk curdling enzyme and is not of carbonic anhydrase. It is present in the high
present in man.
concentration in parietal cells. Carbonic acid is most
c. Gastric lipase: It is a weak lipolytic enzyme.
unstable compound.
d. Other gastric enzymes: The other enzymes of
Immediately it splits into hydrogen and bicarbonate
gastric juice are gelatinase and urease.
ion. The hydrogen ion is actively pump into canaliculi
2. Gastric mucus: It is secreted by neck cells of gastric
of parietal cell.
glands. It is a flexible gel covering gastric mucus
Simultaneously the chloride ion is also pumped
membrane.
into canaliculi actively. The chloride is derived
3. Intrinsic factor: This is necessary for absorption of
from sodium chloride of blood. Now, hydrogen ion
extrinsic factor.
The inorganic substances in gastric juice are: HCl, combines with chloride ion to form hydrochloric acid.
sodium, calcium, potassium, chloride, bicarbonate, To compensate loss of chloride ion, the bicarbonate
phosphate and sulphate. ion from parietal cell enters the blood and combines
with sodium to form sodium bicarbonate.
Functions of Gastric Juice
Regulation of Gastric Secretion
♦ Digestive function: The gastric juice acts on proteins;
and enzymes acting on proteins are pepsin, rennin and The regulation of gastric secretion occurs in three phases:
gastric lipase. 1. Cephalic phase: This is purely under nervous control;
Pepsin: It is the main proteolytic enzyme in gastric while taking food, the secretion of gastric juice starts before
juice. It converts protein into proteases, peptones and food enters the stomach. The impulses are sent from head
polypeptides. and this phase is called cephalic phase.
Rennin: It is a milk curdling enzyme present in This causes gastric secretion where food is placed in
animals and not in man. mouth. Afferent impulses arising from taste buds and other
318 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Enzymes of Pancreatic Juice nal mucous membrane. Once formed trypsin also activates
trypsinogen by means of “autocatalytic reaction”.
Pancreatic juice plays an important role in digestion of proteins
and lipids. It also digests carbohydrate. Trypsin and chymotrypsin is an endopeptidase because it
♦ Digestion of proteins: Digestion of proteins is carried by breaks interior bond of protein molecule by “hydrolysis”.
the following proteolytic enzymes present in the pancre- Trypsin
Protein Peptones + Polypeptide
atic juice. Chymotrypsin
1. Trypsin and Chymotrypsin: They are secreted as inac-
2. Carboxy peptidase: Procarboxy peptidase is precursor
tive tripsinogen and chymotrypsinogen respectively.
of carboxypeptidase activated by trypsin.
Enterokinase 3. Nucleases: The nucleases in pancreatic juice are ribo-
Trypsinogen Trypsin (active)
nuclease and deoxyribonuclease which are responsible
Trypsin for digestion of nucleic acids. These enzymes convert
Chymotrypsinogen Chymotrypsin
(active) nucleic acid into mononucleotides.
Nucleases
Enterokinase is secreted by brush bordered cell or duode- Nucleic acid Mononucleotide
Physiology 319
3. Defensive and detoxification function: The buffer ♦ Formation of Micelle: Bile salts combine with products of
cells of liver play a major role in defense mechanism; hydrolysis of triglycerides and form micelle which gets
liver is also involved in detoxification of foreign transported to brush border of epithelial cells for absorption.
bodies. ♦ Absorption of fat soluble vitamins: Bile salts form com-
4. Metabolic function: Liver is an organ where maxi- plexes which are more soluble in water.
mum metabolic actions are carried out. Metabolism ♦ Laxative action: Intestinal motility is stimulated by the bile
of carbohydrates, proteins, lipids and nutrients occur salts. This action bile salts help in defecation.
in liver. ♦ Choleretic action: Bile stimulates liver to secrete more bile
which leads to fat digestion.
5. Hemopoietic function: In this, fetus blood cells are
♦ Bile salts keep cholesterol in soluble form in gall bladder
produced in liver.
bile. This prevents formation of gallstones.
6. Heat Production: Due to metabolic actions, heat is
produced in liver.
7. Excretory functions: Certain exogeneous dyes like
bromsulphthalein and rose Bengal dye are excreted
through liver cells.
8. Synthesis function: Liver is the site for synthesis of:
- Plasma proteins mainly albumin and to some
extent α and β globulins.
- Liver causes conversion of preprothrombin to
active prothrombin in presence of vitamin K.
It also secretes other clotting factors such as
fibrinogen, factor V, VII, IX and X.
- It secretes various enzymes such as alkaline phos-
phatase, serum glutamic oxaloacetic transami-
nase, serum glutamic pyruvic transaminase.
- Liver removes ammonia from body to synthesize
urea.
9. Miscellaneous functions: Fig. 17: Formation of bile salts from bile acids
- Liver act as reservoir of blood and stores 650 ml Q.8. Write a short note on enterohepatic circulation.
of blood. It also regulates blood volume. (Sept 2000, 4 Marks)
- Liver leads to inactivation of some hormones Ans. Flow of blood from intestine to liver through portal vein
such as insulin, glucagon, vasopressin. is known as enterohepatic circulation.
- Destruction of RBCs also occurs in the liver.
Q.7. Write a short note on bile salts. (Mar 1998, 5 Marks)
Ans. Bile salts are the sodium and potassium salts of bile acids
which are conjugated with taurine or glycine.
Bile acids are of two types, i.e. primary and secondary.
1. Primary bile acids are cholic acid and chenodeoxy-
cholic acid which are synthesized by hepatocytes
from cholesterol.
2. Secondary bile salts are deoxycholic acid and litho-
cholic acid which are formed from primary bile salts
in colon by action of intestinal bacteria.
In liver bile acids are conjugated with glycine or taurine
and form conjugated bile acids.
Conjugated bile acids, i.e. glycocholic acid and taurocholic
acid form bile salts in combination with sodium or Fig. 18: Enterohepatic circulation
potassium.
The total bile salts which enter the duodenum, out of
Functions of Bile Salts them 90 to 95% of bile salts are reabsorbed from terminal
ileum in portal vein and return to the liver to excrete
The bile salts are required for digestion and absorption of fat again, this is enterohepatic circulation.
in intestine.
Enterohepatic circulation bile salts are necessary due to
♦ Emulsification of fats: Bile salts break large fat drops into the limited amount of bile salts present for digestion and
smaller drops. absorption of fats.
Physiology 321
Q.9. Write in brief on deglutition. (Mar 1996, 5 Marks) Q.10. Write in brief on gastric emptying.
Or (Aug/Sep 1998, 10 Marks)
Ans. Slow transfer of food from stomach to intestine is called
Write brief on IInd stage of deglutition.
gastric emptying.
(Mar 1994, 5 Marks)
Ans. Deglutition or swallowing is a process that transfers chewed Causes
food from mouth to stomach. It occurs in three stages:
1. Oral stage ♦ The peristaltic waves arising in pyrolic part of stomach.
2. Pharyngeal stage ♦ Simultaneous relaxation of pyrolic sphincter.
3. Oesophageal stage.
Factors Affecting Gastric Emptying
Oral Stage ♦ Volume of gastric content: If the content of stomach is
When the chewed food is ready for swallowing, it is voluntary, more, a large amount is emptied into intestine.
rolled back into pharynx by backward and upward pressure of ♦ Consistency of gastric content: Emptying of stomach is
tongue against palate. proportional to consistency of contents. Water is emptied
into intestine as soon as it is swallowed, then liquid and
Pharyngeal Stage solid after being converted to fluid.
In pharyngeal stage, bolus is pushed from pharynx into
esophagus.
♦ It is an involuntary stage.
♦ Following are the events occurring during movement of
bolus from pharynx into the esophagus:
Oral cavity closes from the pharynx due to approxi-
mation of posterior pillars of fauces.
Nasopharynx is closed due to upward movement of soft
palate this prevents regurgitation of food in nasal cavity.
Palatopharyngeal folds get pulled medially and
make slit like opening for food which allow properly
masticated food to pass through.
Vocal cords approximate stopping the breathing
temporarily.
Larynx is elevated and pushed anteriorly by neck
muscles which lead to enlarging of opening of
esophagus, epiglottis swing backward to close laryngeal
opening. This guides the food towards esophagus and
prevents its entry in trachea.
Upper esophageal sphincter normally remain contracted
open up and allow bolus of food to be pushed in upper
part of esophagus due to peristaltic contraction wave of
pharynx which also continues in esophagus.
As bolus of food pass in esophagus, contraction of
cricopharyngeous occur, vocal cords open up which
allow normal breath to resume and upper esophageal
Fig. 19: Phases of deglutition
sphincter come in tonic contraction.
♦ This stage gets completed in 1-2 seconds.
♦ Chemical composition: The gastric content with more
Esophageal Stage carbohydrate leaves the stomach more rapidly then content
♦ It is an involuntary stage. with the protein. Protein leaves the stomach more rapidly
♦ The function of esophagus is to transport the food from than fat.
pharynx to stomach. ♦ pH of gastric content: The strong acid content leaves
♦ When bolus reaches the esophagus, the peristaltic waves the stomach slowly. The emptying of such content is
are initiated which pushes the bolus into stomach. accelerated by neutralizing acid.
♦ Two types of peristaltic contraction start in esophagus: ♦ Osmolar concentration of gastric content: The gastric
1. Primary peristaltic contraction content which is isotonic to blood, leaves stomach
2. Secondary peristaltic contraction. rapidly.
322 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
ii. Acceleration of movements of stomach. ♦ Pepsin acts on protein and converts it into peptone,
iii. Growth of mucus of stomach. proteases and polypeptides.
2. Secretin
Source of secretin: This was the first ever hormone
discovered and is secreted by S cells of duodenum,
jejunum and ileum.
Stimulant for secretin: It is first produced in its
inactive form known as prosecretin and gets con-
verted into its active form, i.e. secretin by acidity
of chyme. The stimulant for release and activation
of prosecretin is acidic chyme entering duodenum
from stomach.
Action of secretin:
i. Alkaline pancreatic juice protects intestinal (Dec 2004, 5 Marks)
mucus from acid chyme by neutralizing it. Ans. Digestion and absorption of carbohydrates.
ii. It inhibits secretion of gastric juice
iii. It inhibits motility of stomach In Mouth
3. CCK or Cholecystokinin or Pancreozymin
In saliva, the salivary amylase or ptylin is an enzyme which
Source of secretion: It is secreted by I cell in mucosa
helps in digestion of carbohydrates. In mouth, the food stays
of duodenum and jejunum.
for shorter time, so the action of ptylin continues for one hour
Stimulant for secretion: The stimulant for release of after reaching stomach, cooked starch and end products are
this hormone is acidic chyme containing digestive disaccharides, i.e. dextrins and maltose.
products of fats and proteins.
Action of CCK: In Stomach
i. It leads to secretion of pancreatic juice which is
In stomach, gastric juice releases enzyme known as gastric
rich in enzymes.
amylase, it is weak enzyme and its action is negligible.
ii. It causes contraction of gallbladder to release
bile. In Small Intestine
iii. It potentiates effect of secretin to secrete more
alkaline pancreatic juice. Here pancreatic juice contains pancreatic amylase which acts on
iv. It enhances the secretion of enterokinase from polysaccharides and disaccharides and end product is disaccha-
duodenum. rides, i.e. dextrins, maltose, maltriose and monosaccharides.
v. CCK inhibits gastric motility. In small intestine succus entricus is present which releases
vi It enhances motility of large and small intestine. sucrose, maltose, lactase, dextrinase and trehalase, the enzymes
vii. It increases pancreatic growth. act on sucrose, maltose lactose, dextrin and trehalase and the
viii. It is seen in neurons of brain where it is involved end product is glucose, fructose and galactose.
in regulation of food intake. Q.15. Write a short note on hemolytic jaundice.
Q.13. Summarize digestion of proteins. (Mar 1998, 5 Marks) (Sept 2006, 5 Marks)
Ans. • The foodstuff containing high protein content are Ans. In hemolytic jaundice the excretory function of liver is
meat, milk, egg, fish and pulses. normal but there is excessive destruction of RBCs and
• Different types of protein which are found in diet are thus the bilirubin level in blood is increased and the liver
albumin, globulin, nucleoprotein casein, collagen, cells cannot excrete that much bilirubin rapidly.
gelatin, mucin and elastin. • In this jaundice there is increased level of free bili-
• Proteins are observed in the form of amino acid, so rubin in the blood.
proteins are digested to amino acids prior to their • The urobilinogen and stercobilinogen is present in
absorption. the excess.
• Protein digestion starts in stomach and ends in • In hemolytic jaundice the anemia is present.
intestine. • In this type of jaundice the hemoglobin level get
• Enzymes responsible for digestion of proteins are decreased.
proteolytic enzymes. • In it the value of SGOT is slightly elevated.
Digestion of Protein in Stomach Q.16. Describe in brief digestion and absorption of proteins.
(Oct 2007, 5 Marks)
♦ Pepsin is the most important proteolytic enzyme of gastric
juice. Or
♦ Optimum pH for activity of pepsin is 2 to 3 which is Describe digestion of protein in various parts of
provided by HCl present in gastric juice. gastrointestinal tract. (Nov 2008, 15 Marks)
324 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦ Fat digestion in stomach occurs in exceptional circum- Ans. For composition and function refer to Ans 5 of same
stances, i.e. when pancreatic lipase may regurgitate into chapter.
the stomach from the duodenum and in achlorhydria.
Regulation of Secretion
Digestion of Fats in Small Intestine
The secretion of bile from the liver and release of bile from the
♦ Pancreatic lipase and bile salts enter the second part of gallbladder are influenced by some chemical factors which are
duodenum and start the fat digestion. categorized into three groups:
♦ Pancreatic juice is alkaline and converts and adjusts the 1. Choleretics.
highly acidic chyme to chyme at pH slightly above 7.0, 2. Cholagogue.
which is optimal pH for lipase activity. 3. Hydrocholeretic agents.
♦ Bile salts play an important role in activating lipase and
produces a detergent action by its hydrotropic action Choleretics: These are the substances, which increase the
and lowers the surface tension, this leads to emulsification secretion of bile from liver, are known as choleretics. The
of fats and provides a greater surface area for the lipase effective choleretic compounds are acetylcholine, secretin,
enzyme to digest. cholecystokinin, acid chyme in intestine and bile salts.
♦ Lipase acts at the interface between the fat particles and Cholagogues: Cholagogue is a compound, which increases the
water and successively hydrolyzes the double and triple release of bile from gallbladder into the intestine by contracting
bonds of the triglycerides into diglycerides and monoglyc- the gallbladder. The common cholagogue are bile salts,
erides and releases the fatty acids. calcium, fatty acids, amino acids, inorganic acids. All the above
♦ Dietary cholesterol remains in the form of cholesterol substances stimulate the secretion of cholecystokinin, which, in
esters and the pancreatic bile salt activate lipase and turn causes action of gallbladder and flow of bile into intestine.
cholesterol esterase of succus entericus which hydrolyzes
Hydrocholeretic agents: Hydrocholeretic agent is a substance,
these esters in the intestinal lumen and finally convert it
which causes secretion of bile from liver with large amount
to the cholesterol.
of water and less amount of solids. Hydrochloric acid is a
Absorption of Fats hydrocholeretic agent.
♦ Monoglycerides, pancreatic electrolytes, fatty acids and Q.21. Write about phases of gastric secretion.
bile salts interact to form polymolecular aggregates called (Jan 2012, 8 Marks)
as micelles. Ans. Phases of Gastric Secretion
♦ Fat content of micelles consist of monoglycerides and fatty Gastric juice is secreted in three different phases:
acids. In the intestinal wall, they act in following ways: 1. Cephalic phase.
Fatty acids and monoglycerides with greater than 14 2. Gastric phase.
carbon atoms become re-esterified to triglycerides in the 3. Intestinal phase.
mucosal cell, thus they are then coated with a layer of 4. In human beings, a fourth phase called interdigestive
α-lipoprotein, cholesterol and phospholipids forming phase exists.
chylomicrons or esterified fatty acids of approx l– nm All the above phases are regulated by neural mechanism
diameter. Chylomicrons thus enter the lymphatics and or hormonal mechanism or both.
via thoracic duct enter into the bloodstream.
Short chain fatty acids with less than 12 14 carbon Cephalic Phase
atoms pass from mucosal cell in the villous of blood
♦ Secretion of gastric juice by the stimuli arising from head
capillaries and get transported as free fatty acid also region (cephalus) is called cephalic phase.
known as non-esterified fatty acids or unesterified ♦ This phase is regulated by nervous mechanism.
fatty acids. They get attached to albumin in blood ♦ During this phase, the gastric secretion occurs even with-
stream. out the presence of food in the stomach.
♦ Fat absorption is greatest in the upper part of the small ♦ The quantity of the juice is less but it is rich in enzymes
intestine but appreciable amounts are also absorbed from and hydrochloric acid.
the ileum. ♦ The nervous mechanism that regulates cephalic phase
operates through reflex action.
Two types of reflexes occur:
1. Unconditioned reflex
2. Conditioned reflex.
Unconditioned Reflex
It is the inborn reflex. When food is placed in the mouth, it induces
(Aug 2012, 5 Marks) salivary secretion. Simultaneously, gastric secretion also occurs.
326 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Stages of the reflex action: impulses through the motor (efferent) fibers of vagus back
♦ Presence of food in the mouth stimulates the taste buds to stomach and cause secretion of gastric juice. Since, both
and other receptors in the mouth. afferent and efferent impulses pass through vagus, this
♦ Sensory impulses from mouth pass via afferent nerve fibers reflex is called vagovagal reflex.
of glossopharyngeal and facial nerves to appetite center Hormone Mechanism
present in amygdala and hypothalamus.
♦ From here, efferent impulses pass through dorsal nucleus ♦ Gastrin is a gastrointestinal hormone secreted by the G cells
of vagus and vagal efferent nerve fibers to the wall of the which are present in pyloric glands of stomach.
stomach. ♦ Small amount of gastrin is also secreted in mucosa of
♦ Acetylcholine is secreted at the vagal efferent nerve end- upper small intestine.
ings stimulates gastric glands to increase the secretion. ♦ Gastrin is a polypeptide containing G14, G17 or G34
This is experimentally proved by Pavlov s pouch and amino acids.
sham feeding. ♦ Gastrin is released when food enters stomach.
♦ The mechanism involved in the release of gastrin may be
Conditioned Reflex the local nervous reflex or vagovagal reflex.
♦ The nerve endings release the neurotransmitter called
Conditioned reflex is the reflex response acquired by previous
gastrin releasing peptide which stimulates the G cells to
experience. Presence of food in the mouth is not necessary to
secrete gastrin.
elicit this reflex. The sight, smell, hearing or thoughts of food
which induce salivary secretion also induce gastric secretion. Intestinal Phase
Stages of the reflex action: ♦ Intestinal phase is the secretion of gastric juice when chyme
♦ Impulses from the special sensory organs (eye, ear and nose) enters the intestine. When chyme enters the intestine
pass through afferent fibers of neural circuits to the cerebral initially the gastric secretion increases and later it stops.
cortex. Thinking of food stimulates cerebral cortex directly. Intestinal phase of gastric secretion is under both nervous
♦ From cerebral cortex the impulses pass through dorsal nu- and hormonal control.
cleus of vagus and vagal efferents and reach stomach wall. ♦ During initial stage of intestinal phase the chyme entering
♦ The vagal nerve endings secrete acetylcholine. It stimulates intestine stimulates the duodenal mucosa to release gastrin
the gastric glands and increases its secretion. which is transported to stomach through blood. There,
Conditioned reflex of gastric secretion is proved by it increases gastric secretion. On later stage of intestinal
Pavlov s pouch and bell dog experiment. phase after the initial increase, there is decrease or com-
plete stoppage of secretion of gastric juice. Two factors are
Gastric Phase responsible for the inhibition:
♦ The secretion of gastric juice when the food enters the 1. Enterogastric reflex.
stomach is called gastric phase. 2. Gastointestinal hormones.
♦ This phase is regulated by both nervous and hormonal Enterogastric Reflex
mechanisms.
♦ The gastric juice secreted during this phase is rich in pep- It is a reflex that inhibits the secretion and movements of
sinogen and hydrochloric acid. stomach due to the distention or irritation of intestinal mucosa. It
♦ The mechanisms involved in this phase are: is mediated by myenteric nerve (Auerbach’s) plexus and vagus.
Nervous mechanism through local myenteric reflex
Gastrointestinal Hormones
and vagovagal reflex
Hormonal mechanism through gastrin. The presence of chyme in the intestine stimulates the secretion
of many gastrointestinal hormones from intestinal mucosa
Nervous Mechanism
and other structures. All these hormones inhibit the gastric
♦ Local myenteric reflex: It reflex is elicited by stimulation secretion. Some of these hormones inhibit the gastric motility
of myenteric nerve plexus in stomach wall. After entering also. Gastrointestinal hormones which inhibit gastric secretion:
stomach, the food particles stimulate the local nerve plexus ♦ Secretin: Secreted by the presence of acid chyme in the
present in the wall of the stomach. These nerve fibers re-
intestine.
lease acetylcholine, which stimulates the gastric glands and
♦ Cholecystokinin: Secreted by the presence of chyme con-
secrete a large quantity of gastric juice. Simultaneously,
acetylcholine stimulates G cells to secrete gastrin. taining fats and amino acids in intestine.
♦ Vasovagal reflex: Vasovagal reflex is the reflex in which ♦ Gastric inhibitory peptide: Secreted by the presence of
both afferent and efferent vagal fibers are involved. Pres- chyme containing glucose and fats in the intestine.
ence of food in stomach stimulates the sensory (afferent) ♦ Vasoactive intestinal polypeptide: Secreted by the presence
nerve endings of vagus which generate sensory impulses. of acidic chime in intestine.
The sensory impulses are transmitted to the brainstem via ♦ Peptide YY: Secreted by the presence of fatty chyme in
sensory fibers of vagus. Brainstem in turn sends efferent intestine.
Physiology 327
In addition to these hormones, pancreas also secretes a ♦ Trypsin activates other enzymes of pancreatic juice, e.g.
hormone called somatostatin during intestinal phase. Chymotrypsinogen into chymotrypsin, procarboxy-
It also inhibits gastric secretion. The intestinal phase peptidases into carboxypeptidases, proelastase into
of gastric secretion is demonstrated by Farrell and elastase, etc.
Ivy pouch. ♦ Trypsin also activates collagenase, phospholipase A and
phospholipase B.
Interdigestive Phase
♦ Secretion of small amount of gastric juice in between Chymotrypsin
meals (or during period of fasting) is called interdiges- ♦ Digestion of proteins: Chymotrypsin is also an endopepti-
tive phase. dase and it breaks the proteins into polypeptides.
♦ Gastric secretion during this phase is mainly due to the ♦ Digestion of milk: Chymotrypsin digests casein faster
hormones like gastrin. than trypsin. The combination of both enzymes causes
♦ This phase of gastric secretion is demonstrated by Farrell more rapid digestion of milk.
and Ivy pouch.
Carboxypeptidases
Q.22. Describe composition and functions of pancreatic juice.
(June 2010, 15 Marks) Carboxypeptidases split the polypeptides and other proteins
Ans. Composition of Pancreatic Juice into amino acids.
Trypsin Phospholipase A
♦ Digestion of proteins: Trypsin is the most powerful pro- Phospholipase A digest phospholipids namely lecithin and
teolytic enzyme. It is an endopeptidase and breaks the cephalin and converts them into lysolecithin and lysocephalin.
interior bonds of the protein molecules. It converts proteins
into proteoses and polypeptides. Phospholipase B
♦ Curdling of milk: It converts caseinogens in the milk Phospholipase B is also activated by trypsin. This enzyme
into casein. converts lysolecithin and lysocephalin into phosphoryl choline
♦ Trypsin accelerates blood clotting. and free fatty acids.
328 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Contd...
Q.30. Write in brief on CCK (Cholicystokinin-Pancreozymin). Q.31. Write briefly about secretin. (Oct 2016, 2 Marks)
(Nov 2008, 5 Marks) Ans. Secretin was the first hormone to be discovered by Bayliss
Ans. CCK is a polypeptide which consists of 33 amino acids. and Starling in 1922.
Source of secretion: It is secreted by endocrinal I cell Structure: Secretin is a polypeptide hormone consist-
located in mucosa of duodenum and jejunum. ing of 27 amino acids.
Source: Secretin is produced by argentaffin or S cells
Actions in crypts of mucosa of upper part of small intestine
♦ It leads to secretion of pancreatic juice which is rich in i.e. duodenum and jejunum.
enzymes. Secretion: Secretin is secreted as prosecretin, which
♦ It causes contraction of gallbladder to release bile. is an inactive form, this inactive form is converted
♦ It potentiates effect of secretin to secrete more alkaline to active form i.e. secretin by gastric HCl and salts
pancreatic juice. of fatty acids.
♦ It enhances the secretion of enterokinase from duodenum. Mechanism of action: Secretin acts on adenylate
♦ CCK inhibits gastric motility. cyclase on cell membrane and increases cytosolic
♦ It enhances motility of large and small intestine. formation of cAMP.
♦ It increases pancreatic growth. Regulation of secretion: Secretin secretion is
♦ It is seen in neurons of brain where it is involved in regula- increased by acidic chyme and products of protein
tion of food intake. digestion which enter upper part of intestine.
Secretin stimulates water and alkaline pancreatic
Regulation of CCK Secretion
secretion. When watery and alkaline pancreatic
It occurs via positive feedback mechanism: juice enters intestine, acidic content of upper small
intestine is neutralized. Increase in pH of duodenal
and upper jejunal content decreases secretin
secretion by feedback mechanism.
Functions
♦ Secretin increases secretion of pancreatic juice rich in
bicarbonate.
♦ It also increases alkaline bile secretion.
Physiology 331
Metabolism
Gastrin is secreted from G cells, enter the general circulation.
In blood half-life of gastrin is less. It is inactivated inside the
intestine and degraded in kidney.
(Feb 2014, 8 Marks)
Mechanism of Action Or
Primary function of gastrin is to stimulate the acid secretion Write short note on glomerular filtration.
from parietal cells of stomach. Gastrin act on gastrin or CCK (Aug 2016, 5 Marks)
receptors on parietal cells and increases intracellular calcium Ans. Glomerular filtration is the process by which the blood
concentration via second messenger, IP3. Increased cytosolic that passes through gromerular capillaries is filtered via
calcium activates protein kinase which stimulates H+ K+ ATPase filtration membrane. This is the first process of urine
to promote acid secretion. formation.
Functions Filtration membrane consists of three layers, i.e.
1. Glomerular capillary membrane: It is formed by the
♦ Primary function of gastrin is the stimulation of gastric
single layer of endothelial cells which are attached to
acid and pepsin secretion. ln fact, gastrin is the most potent
basement membrane. Capillary membrane consists
natural stimulator of HCl secretion from parietal cells of
of many pores known as fenestra or filtration pores.
stomach. Therefore, hypergastrinemia causes peptic ulcer.
These pores has diameter of about 0.1 μ.
♦ Gastrin stimulates growth of gastric mucosa and mucosa
2. Basement membrane: Basement membrane of
of intestine. This is called trophic action of gastrin.
glomerular capillaries fuses with the basement
♦ It stimulates gastric motility.
membrane of visceral layer of Bowman’s capsule.
♦ It causes contraction of muscles at the gastroesophageal
This basement membrane separates the endothelium
junction (lower esophageal sphincter ). Therefore, it
of glomerular capillary and the epithelium of
prevents reflux esophagitis.
♦ It stimulates exocrine pancreatic secretion. visceral layer of Bowman’s capsule.
♦ It also stimulates insulin secretion. 3. Visceral layer of Bowman’s capsule: It consists of
♦ It stimulates mass movement of large intestine. single layer of flat epithelial cells which rest on the
♦ It causes colonic contraction that initiates gastrocolic reflex basement membrane. Each cell get connected with
after a meal. Therefore, usually defecation is activated the basement membrane by cytoplasmic extensions
after a meal. known as pedicle or feet. These pedicles are arranged in
♦ It stimulates histamine secretion from ECL (enterochro- the interdigitating manner leaving small cleft like space
maffin like cells) in Gl mucosa. in between. This cleft like space is known as slit pore.
Filtration takes place through these slit pores. Epithelial
cells with their pedicles are known as podocytes.
5. RENAL PHYSIOLOGY AND SKIN Procedure of Glomerular Filtration
As blood passes via glomerular capillaries, plasma is filtered in
(Mar 1998, 5 Marks) Bowman’s capsule. All substances of plasma are filtered except
Ans. By the excretion of hydrogen ion and retention of plasma proteins. This filtrate is known as glomerular filtrate. It
bicarbonate ion, kidney plays an important role in is also known as ultrafiltration as minute particles get filtered.
maintaining acid-base balance in body fluid. But plasma proteins due to their large size cannot be filtered
Normally, urine is acidic in nature at pH of 6. The from slit pores. So this filtrate consists of all substances of plasma
urine becomes acidic because of tubular secretion of except plasma proteins.
Physiology 333
Tubuloglomerular Feedback
Tubuloglomerular feedback is the mechanism that regulates
GFR through renal tubule and macula densa. Macula densa
of juxtaglomerular apparatus in the terminal portion of thick
ascending limb is sensitive to the sodium chloride in the tubular
fluid. When glomerular filtrate passes through the terminal
portion of thick ascending segment, macula densa acts like a
sensor. It detects the concentration of sodium chloride in the
tubular fluid and accordingly alters the glomerular blood flow
and GFR.
manner leaving small cleft like space in between. This ♦ Potassium is secreted actively by sodium potassium pump
cleft like space is known as slit pore. Filtration takes place in proximal and distal convoluted tubules and in collect-
through these slit pores. Epithelial cells with their pedicles ing ducts.
are known as podocytes. ♦ Ammonia is secreted in proximal convoluted tubule.
♦ Hydrogen ions are secreted in PCT and DCT. Maximum
Procedure of Glomerular Filtration hydrogen ion secretion occurs in PCT.
As blood passes via glomerular capillaries, plasma is filtered in ♦ So urine formation occurs in nephron by process of glomer-
Bowman’s capsule. All substances of plasma are filtered except ular filtration, selective reabsorption and tubular secretion.
plasma proteins. This filtrate is known as glomerular filtrate. It
is also known as ultrafiltration as minute particles get filtered.
But plasma proteins due to their large size cannot be filtered
from slit pores. So this filtrate consists of all substances of plasma
except plasma proteins.
Tubular Reabsorption
When the glomerular filtrate passes through the tubular portion
of nephron, both quantitative and qualitative changes occur.
Large quantity of water, electrolytes and other substances are
reabsorbed by tubular epithelial cells. The substances which
are reabsorbed pass into interstitial fluid of renal medulla, and
from here substances move into blood in peritubular capillaries.
As substances are taken back into blood, the entire process is
called tubular reabsorption.
The tubular cells of kidney selectively, reabsorb the
substances present in glomerular filtrate, according to need of
body. So, it is also called as selective reabsorption.
Fig. 23: Urine formation
Mechanism of Reabsorption
Q.4. Write in brief on countercurrent multiplier exchange
It occur by active and passive reabsorption: system of concentrated urine. (Mar 2009, 5 Marks)
♦ Active reabsorption: It is the movement of molecules
Or
against electrochemical gradient and it needs liberation of
energy which is derived from ATP. Substances resorbed Write short note on countercurrent mechanism.
actively in renal tubule are sodium, calcium, potassium, (Oct 2014, 3 Marks)
phosphate, sulphate, bicarbonate, glucose, amino acid, Ans. The countercurrent system is a system of “U” shaped
ascorbic acid, uric acid and ketone bodies. tubules in which the flow of fluid is in opposite direction
♦ Passive reabsorption: It is the movement of molecules in different limbs of “U” shape tubules. In kidney, the
along electrochemical gradient. This process does not structures which forms the countercurrent system are
need any energy. Substances resorbed are chloride, urea loop of Henle and vasa recta. The loop of Henle forms
and water. countercurrent multiplier, and vasa recta forms the
countercurrent exchangers.
Reabsorption of substances occurs in all segments of tubular
• Countercurrent multiplier: The operation of each
portion of nephron:
loop of Henle as countercurrent multiplier depends
♦ Substances resorbed from PCT: It resorbs 67% of the on active transport of sodium and chloride out of the
filtered water, Na+, Cl , K+ and other solutes. All glucose thick ascending limb, the high permeability of this thin
and amino acids are filtered by glomerulus. Total of the descending limb to water and inflow of tubular fluid
88% filtrate is resorbed in PCT. Brush border of epithelial form proximal tubule, with outflow in distal tubule.
cell in PCT increases surface area and facilitate resorption. In juxtamedullary nephrons with longer loops and
♦ Substances resorbed in loop of Henle: 20% of filtered Na+ thin ascending limbs, the osmotic gradient is spread
and Cl , 15% of filtered water and cations, i.e. K+, Ca2+, Mg2+ over a greater distance, and osmolality at tip of loop
get resorbed in loop of Henle. is greater. This is because thin ascending limb is rela-
♦ Substances resorbed in DCT and CT: 7% of filtered NaCl tively impermeable to water but permeable to sodium
and 8 to 17% of water is resorbed in these segments. and chloride. Therefore sodium and chloride move
down their concentration gradient into interstitium
Tubular Secretion
and there is additional passive countercurrent multi-
♦ It is the process by which the substances are transported plication. The greater the length of loop of Henle, the
from blood into renal tubules. greater is osmolality which reaches to the tip.
Physiology 335
Its normal value is 125 ml/min i.e. 170 to 180 L/day. Constriction of Efferent Arteriole
Its value is 10% less in females as compared to males. If efferent arteriole is constricted, initially the GFR increases
At the rate of 125 ml/min kidneys filter 4 times total because of stagnation of blood in the capillaries. Later when all
body water, 15 times the extra cellular fluid volume and the substances are filtered from this blood, further filtration does
60 times the plasma volume. not occur because, the efferent arteriolar constriction prevents
outflow of blood from glomerulus and no fresh blood enters
Procedure of Glomerular Filtration the glomerulus for filtration.
As blood passes via glomerular capillaries, plasma is filtered in
Systemic Arterial Blood Pressure
Bowman’s capsule. All substances of plasma are filtered except
plasma proteins. This filtrate is known as glomerular filtrate. It Renal blood flow or GFR are not affected till the mean arterial
is also known as ultrafiltration as minute particles get filtered. blood pressure is between 60 and 180 mm Hg. lt is due to the
autoregulation mechanism. Variation in pressure above 180
But plasma proteins due to their large size cannot be filtered
mm Hg or below 60 mm Hg affects the renal blood flow and
from slit pores. So this filtrate consists of all substances of plasma
GFR accordingly because the autoregulatory mechanism fails
except plasma proteins. beyond this range.
Factors Affecting Glomerular Filtration Rate Surface Area of Capillary Membrane
Renal Blood Flow GFR is directly proportional to the surface area of the capillary
It is the most important factor that is necessary for glomerular membrane. If the glomerular capillary membrane is affected as
in the cases of some renal diseases, the surface area for filtration
filtration. GFR is directly proportional to renal blood flow. The
decreases. So there is suction in GFR.
renal blood flow itself is controlled by autoregulation.
Permeability of Capillary Membrane
Tubuloglomerular Feedback
GFR is directly proportional to the permeability glomerular
Tubuloglomerular feedback is the mechanism that regulates capillary membrane. In many abnormal conditions like hypoxia,
GFR through renal tubule and macula densa. Macula densa lack of blood supply, presence of toxic agents, etc. the permeability
of juxtaglomerular apparatus in the terminal portion of thick of the capillary membrane increases. In such conditions, even
ascending limb is sensitive to the sodium chloride in the tubular plasma proteins are filtered and excreted in urine.
fluid.
Q.8. Draw a labeled diagram of structure of nephron.
When glomerular filtrate passes through the terminal portion
of thick ascending segment, macula densa acts like a sensor. It (Sep 2004, 5 Marks)
detects the concentration of sodium chloride in the tubular fluid Ans.
and accordingly alters the glomerular blood flow and GPR.
Ans. Following are the functions of skin ♦ They are innervated by sympathetic nerve fibers. They
1. Protective function: Skin forms the covering of all release rennin in response to sympathetic discharge.
organs of body and protects these organs from: ♦ These cells acts as baroreceptors and produce their action
a. Bacteria and toxic substances in response to changes occurring in the transmural pres-
b. Mechanical blow sure gradient between afferent arterioles and interstitium.
c. UV rays. ♦ They act as vascular volume receptors and monitor renal
2. Role of skin as sense organ: It is the largest sense perfusion pressure, they are stimulated by hypovolemia
organ in body. It consists of cutaneous receptors or decrease renal perfusion pressure.
which are stimulated by sensation of touch, pain,
temperature and pressure and convey these sensa-
tions to brain.
3. Storage function: It stores fat, water, chloride and
sugar. It also stores blood during dilatation of blood
vessels.
4. Regulation of body temperature: Skin plays an
important role in regulation of body temperature.
Excessive heat is lost from body through skin by
radiation. Sweat glands of skin take active part in
heat loss by secreting sweat.
5. Secretory function: Skin secretes sweat through
sweat glands and sebum through sebaceous glands.
By secreting sweat, skin regulates body temperature
and water balance. Sebum keeps skin smooth and
moist.
6. Synthesis of vitamin D: It is secreted in skin by
action of UV rays on cholesterol. Fig. 25: Juxtaglomerular apparatus
7. Excretory function: Skin regulates water balance
and electrolyte balance by excreting water and salts Macula Densa Cells
through sweat.
♦ These are specialized renal tubular epithelial cells of short
8. Absorptive function: Skin absorbs fats, soluble
segment of thick ascending limb of loop of Henle.
substances and some ointments.
♦ These cells are in direct contact with mesangial cells and
Q.10. Describe countercurrent system. Add note to GFR. in close contact with JG cells.
(Mar 2006, 15 Marks) ♦ These cells have prominent nuclei and they act as chemo-
Ans. For countercurrent mechanism refer to Ans 4 of the same receptors. They are stimulated by decreased sodium ion
chapter and for GFR refer to Ans 7 of the same chapter. load causing increase in rennin release.
Q.11. Write a short note on juxtaglomerular apparatus. ♦ Macula densa cells are not innervated.
(Feb 2003, 5 Marks) (Aug 2005, 5 Marks)
Mesangial Cells or Lacis Cells
(Dec 2010, 5 Marks)
Ans. Juxtaglomerular apparatus is the collection of specialized ♦ These are the supporting cells of juxtaglomerular appara-
cells which is located near to glomerulus. tus and are seen between capillary loops.
It forms the major component of rennin-angiotensin- ♦ They are in contact with the JG cells and macula densa cells.
aldosterone system. ♦ These cells are contractile and play an important role in
regulation of glomerular filtration.
Juxtaglomerular apparatus consists of three types of cells:
a. Juxtaglomerular cells.
b. Macula densa cells.
c. Mesangial cells.
(Sep 2006, 4 Marks)
Juxtaglomerular Cells or JG Cells Ans. The functions of distal convoluted tubule are:
♦ JG cells are the specialized myoepithelial cells which are 1. They are involved in sodium reabsorption.
located in media of afferent arteriole in region of juxtaglo- 2. They are involved in vasopressin stimulated water
merular apparatus. reabsorption.
♦ Juxtaglomerular cells synthesize, store and releases the 3. They are concerned with acid secretion and bicar-
enzyme known as rennin which is stored inside the secre- bonate transport.
tory cells of juxtaglomerular cells. 4. They causes hypertonicity of urine.
338 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.13. Enlist the functions of kidney. Describe the role of Ans. Functions of ADH
kidney in regulation of blood pressure. 1. The major function of ADH is retention of water in
(Sep 2006, 15 Marks) ECF by acting on kidney.
Ans. Functions of Kidney 2. It increases water reabsorption from DCT and col-
1. They regulate and maintain volume and composition lecting duct in absence of ADH.
of body fluids by regulating secretion of ADH from 3. It causes constriction of blood vessels.
posterior pituitary. 4. It increases blood pressure.
2. The kidneys retain certain useful substances by 5. It reduces the osmolarity of ECF.
maintaining threshold called as renal threshold.
Diabetes Insipidus
3. The kidneys are main excretory organs. They nor-
mally excrete waste products, i.e. urea, uric acid, The disorder of ADH causes diabetes insipidus. This disease
creatinine. is characterized by excessive excretion of water through urine.
4. They play a role in homeostasis of sodium, potas-
Causes
sium, magnesium, calcium, phosphorus, hydrogen
and bicarbonate ions. This is a syndrome developed due to the deficiency of ADH
5. Kidney performs certain metabolic and hormonal of posterior pituitary. The deficiency occurs due to following
functions like they secrete an enzyme known as reasons:
renin which causes regulation of blood pressure. It ♦ Injury or degeneration of supraoptic and paraventricular
also produces a hormone called as erythropoietin nuclei of hypothalamus.
which stimulates erythropoiesis in bone marrow. ♦ Leison in hypothalamohypophyseal tract.
6. They regulate the osmotic pressure (osmolality) of ♦ Atrophy of posterior pituitary.
the body fluids by excreting osmotically dilute or ♦ It can also occur due to the inability of renal tubules to give
concentrated urine. response to ADH. This condition is called as nephrogenic
7. They play an essential role in acid base balance by diabetic insipidus.
excreting H+ when there is excess acid or HCO3-
Types of Diabetes Insipidus
when there is excess base.
8. They regulate the volume of the ECF by controlling ♦ Central or neurogenic: It is due to complete or partial
Na+ and water excretion. failure of ADH secretion.
9. They remove many drugs (e.g. penicillin) and ♦ Nephrogenic: It is due to complete or partial failure of
foreign or toxic compounds. collecting tubules to respond to ADH. It occurs due to
10. They are the major sites of production of V2 receptor unresponsiveness or due to mutation of
certain hormones, including erythropoietin and aquaporin 2.
1,25-dihydroxy vitamin D3.
Signs and Symptoms
11. They degrade several polypeptide hormones,
including insulin, glucagon, and parathyroid ♦ Polyurea: Excretion of large quantity of dilute urine with
hormone. increased frequency of voiding is known as polyuria. Daily
12. They synthesize ammonia, which plays a role in output of urine is between 4 and 12 litres.
acid-base balance. ♦ Polydipsia: Intake of excess water is known as polydipsia.
13. They synthesize substances that affect renal blood Loss of water due to polyurea stimulates the thrist center
flow and Na+ excretion, including arachidonic acid in hypothalamus which results in intake of large quantity
derivatives (prostaglandins, thromboxane A2) and of water.
kallikrein (a proteolytic enzyme that results in the ♦ Dehydration: Thirst center in hypothalamus is affected.
production of kinins). Water intake decrease in these patients and loss of water
through urine is not compensated. This leads to dehydra-
For the role of kidney in regulation of blood pressure refer
tion. Signs and symptoms of dehydration are dry tongue,
to Ans 13 of chapter CARDIOVASCULAR SYSTEM.
xerostomia, hypotension and loss of consciousness.
Q.14. What are the functions of ADH? What is diabetes
Q.15. Discuss in brief renal tubular functions.
insipidus? (Aug 2005, 7 Marks)
(Oct 2007, 10 Marks)
Or
Ans. Refer to Ans 3 of the same chapter.
Write very short answer on functions of ADH.
Q. 16. Describe in short about acidification of urine.
(Apr 2018, 2 Marks) (Mar 2007, 4 Marks)
Or Ans. Urine is acidic in nature with a pH of 6.
Answer in brief functions of ADH. • The urine becomes acidic because of tubular
(Sep 2017, 2 Marks) secretion of hydrogen ions.
Physiology 339
• Hydrogen ions are secreted in exchange of sodium • It opens towards urethra, at the other end of urethra
ions in the proximal and distal convoluted tubules there is eternal urethral sphincter.
and by the formation of ammonia.
Nerve Supply to Urinary Bladder and Sphincters
Excretion of Hydrogen in Exchange to Sodium Ions ♦ Urinary bladder and internal sphincter are supplied by
♦ In proximal convoluted tubule: both sympathetic and parasympathetic nerves.
Proximal convoluted tubule contains large quantity ♦ The external sphincter is supplied by somatic nerve.
of sodium bicorbonate, which associates into sodium ♦ Sympathetic nerve: Causes relaxation of detrusor muscle
and bicarbonate and contraction of internal sphincter so causes filling of
Simultaneously CO2 enters the cells from tubular fluid. urinary bladder.
In tubular cells, CO2 combines with H2O to form ♦ Parasympathetic nerve (pelvic nerve): Causes contraction
carbonic acid which dissociates into hydrogen and of detrusor muscle and relaxation of the internal sphincter
bicarbonate ions. leading to emptying of urinary bladder.
When sodium ion is resorbed from the tubular fluid ♦ Somatic nerve (pudendal nerve): It maintains the tonic
into tubular cell, hydrogen ion is secreted from the cell contraction of the skeletal muscle fibers forming external
into the tubular fluid in exchange for sodium ion. sphincter.
♦ In distal convoluted tubule:
In tubular cell, CO2 and H2O combine to form H2CO3 Micturition Reflex
which dissociate into H+ and HCO3
This H + is secreted into tubular lumen from the Filling of urinary bladder
exchange of sodium ion.
Sodium ion absorbed into tubular cell under the Stimulation of stretch receptors in urinary bladder
influence of aldosterone.
The hydrogen ion combines with sodium hydrogen Afferent impulses via pelvic nerve
phosphate to form sodium dihydrogen phosphate
which causes the acidity of urine. Sacral segments of spinal cord
Excretion of Hydrogen Ions by the Formation of Ammonia
Urinary bladder
♦ Kidney increases the excretion of hydrogen ions, by the
formation of ammonia. Relaxation of
♦ In tubular cells, ammonia is formed when glutamine is destrusor muscle internal sphincter
converted into glutamic acid.
♦ Ammonia is also formed by the deamination of some of Flow of urine in urethra and stimulation of stretch receptors
the amino acids like glycine and alanine.
♦ The ammonium formed in tubular cells is released into tubu- Efferent impulses via pelvic nerve
lar luman and here it combines with a hydrogen ion to form
ammonium, which combines with sodium acetoacetate to
form ammonium acetoacetate which excreted through urine. Inhibition of pudendal nerve
♦ Thus, hydrogen ions enter the urine in the form of
ammonium compounds and causes acidity of urine. Relaxation of external sphincter
Q.17. Write briefly about micturition.
(Apr 2008, 4 Marks) (Mar 2009, 5 Marks) Voiding of urine
Ans. Micturition is a process by which urine is voided from
Q.18. Write short note on body temperature and functions
the urinary bladder.
of skin. (Aug 2011, 6 Marks)
• It is a reflex process.
Ans. Body Temperature
The functional anatomy and nerve supply of urinary
bladder are essential for the process of micturition. Body temperature can be measured by placing the
• Urinary bladder consists of the body, neck and clinical thermometer in different parts of the body
internal urethral sphincter. such as mouth, axilla, rectum, over the skin.
The smooth muscle forming the body of bladder is The normal body temperature in human is 37°C
called detrusor muscle. (98.6°F) when measured by placing the clinical
• At the posterior surface of the bladder wall, there is thermometer in the mouth.
a triangular area called trigone. At the upper angles
Variations of Body Temperature
of this trigone, two ureters enter the bladder.
• The lower part of bladder is narrow and forms the neck. 1. Age: In infants, the body temperature varies in accordance
The distal end of this has a internal sphincter made to environmental temperature for the first few days after
by detrusor muscle. birth. In children the temperature is slightly (0.5°C) more
340 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
than in adults because of more physical activities. In old Constriction of Afferent Arteriole
age, since the heat production is less, the body temperature
The constriction of afferent arteriole reduces the blood flow to
decreases slightly.
the glomerular capillaries which in turn reduces GFR.
2. Sex: ln females, the body temperature is less because of
low basal metabolic rate when compared to that of males. Constriction of Efferent Arteriole
During menstrual phase it decreases slightly.
If efferent arteriole is constricted, initially the GFR increases
3. Diurnal variation: In early morning, the temperature is
because of stagnation of blood in the capillaries. Later when all
1°C less. In the afternoon, it reaches the maximum.
the substances are filtered from this blood, further filtration does
4. After meals: The body temperature rises slightly (0.5°C)
not occur because, the efferent arteriolar constriction prevents
after meals.
outflow of blood from glomerulus and no fresh blood enters
5. Exercise: During exercise, the temperature raises due to
the glomerulus for filtration.
production of heat in muscles.
6. Sleep: During sleep, the body temperature decreases by Systemic Arterial Blood Pressure
0.5°C.
Renal blood flow or GFR are not affected till the mean arterial
7. Emotion: During emotional conditions, the body tempera-
blood pressure is between 60 and 180 mm Hg. lt is due to the
ture increases.
autoregulation mechanism.Variation in pressure above 180 mm
For functions of skin refer to Ans 10 of same chapter.
Hg or below 60 mm Hg affects the renal blood flow and GFR
Q.19. Write about factors affecting glomerular filtration rate. according because the autoregulatory mechanism fails beyond
(Feb 2013, 7 Marks) this range.
Ans. Following are the factors affecting glomerular filtration
Surface Area of Capillary Membrane
rate:
GFR is directly proportional to the surface area of the capillary
Renal Blood Flow membrane. If the glomerular capillary membrane is affected as
It is the most important factor that is necessary for glomerular in the cases of some renal diseases, the surface area for filtration
filtration. GFR is directly proportional to renal blood flow. The decreases. So there is suction in GFR.
renal blood flow itself is controlled by autoregulation.
Permeability of Capillary Membrane
Tubuloglomerular Feedback GFR is directly proportional to the permeability glomerular
Tubuloglomerular feedback is the mechanism that regulates capillary membrane. In many abnormal conditions like hypoxia,
GFR through renal tubule and macula densa. Macula densa lack of blood supply, presence of toxic agents, etc. the permeability
of juxtaglomerular apparatus in the terminal portion of thick of the capillary membrane increases. In such conditions, even
plasma proteins are filtered and excreted in urine.
ascending limb is sensitive to the sodium chloride in the tubular
fluid. When glomerular filtrate passes through the terminal portion Q.20. Write in detail structure and functions of kidney.
of thick ascending segment, macula densa acts like a sensor. It (Dec 2010, 6 Marks) (Aug 2011, 8 Marks)
detects the concentration of sodium chloride in the tubular fluid Ans. Structure of kidney.
and accordingly alters the glomerular blood flow and GPR.
Gross Structure
Glomerular Capillary Pressure ♦ The two kidneys, each weighing 150 gm in adults are
The GFR is directly proportional to glomerular capillary located retroperitoneally in the upper dorsal region of the
pressure. The capillary pressure, in turn depends upon the renal abdominal cavity, on either side of the vertebral column.
blood flow and arterial blood pressure. The kidneys are bean-shaped organs, approx 10 cm long,
5 cm wide and 2.5 cm thick. The right kidney is usually
Colloidal Osmotic Pressure slightly lower than the left because of the considerable
space occupied by the liver. Vertical section of the kidneys
The GFR is inversely proportional to colloidal osmotic pressure
shows:
which is exerted by plasma proteins in the glomerular capillary
Outer cortex: Reddish in color
blood. When colloidal osmotic pressure increases as in case of
Inner Medulla: Pale in color. It contains 10 15
dehydration or increased plasma protein level, GFR decreases. Pyramids which terminate medially in the renal
During hypoproteinemia, colloidal osmotic pressure is low and papillae. Papillae projects into calyces ; such 10 15
GFR increases. minor calyces join to form two major calyces which
come out through the pelvis of kidney to the widened
Hydrostatic Pressure in Bowman’s Capsule
end of the ureter.
GPR is inversely proportional to this. The hydrostatic pressure ♦ The ureters exit from the hilum of the kidney and pass
in Bowman’s capsule increases in conditions like obstruction of to the bladder. The blood vessels, lymphatics and nerves
urethra and edema of kidney beneath renal capsule. enter into or exit from the kidney via the hilum.
Physiology 341
Q.24. Write down names of different tissues present in the ♦ Supported by connective tissue: Attachment to a layer of
body. Describe epithelial tissue. (June 2010, 15 Marks) connective tissue at the basal surface forms a layer called
Or the basement membrane, an adhesive layer formed by secre-
tions from the epithelial cells and the connective tissue cells.
Write in brief on epithelial tissue. ♦ Avascular: Epithelium typically lacks its own blood supply.
(Nov 2008, 5 Marks) ♦ Regeneration: Epithelium cells can regenerate if properly
Ans. Human body is composed of four basic types of tissues: nourished.
1. Epithelium: Lines and covers surfaces Classification of epithelium is based on the shape of the cells
2. Connective tissue: Protect, support, and bind together and the arrangement of the cells within the tissue.
3. Muscular tissue: Produces movement
Typically, the arrangement of the cells is stated first, then the
4. Nervous tissue: Receive stimuli and conduct impulses
shape, and is followed by “epithelium” to complete the naming,
(e.g. simple squamous epithelium).
Arrangements
♦ Simple: Cells are found in a single layer attached to the
basement membrane.
♦ Stratified: Cells are found in 2 or more layers stacked atop
each other.
♦ Pseudostratified: A single layer of cells that appears to be
multiple layers due to variance in height and location of
the nuclei in the cells.
♦ Transitional: Cells are rounded and can slide across one
another to allow stretching.
Shapes
♦ Squamous: Flat, thin, scale like cells.
♦ Cuboidal: Cells that have a basic cube shape. Typically
the cell’s height and width are about equal.
♦ Columnar: Tall, rectangular or column shaped cells. Typi-
cally taller than they are wide.
Contd...
344 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Contd...
Q.25. Describe in brief diabetes insipidus. Q.27. Describe structure and functions of a nephron.
(Aug 2011, 5 Marks) (Sep 2013, 10 Marks)
Or Or
Write short note on diabetes insipidus.
Write on structure and function of nephron.
(Apr 2008, 5 Marks)
(Apr 2017, 5 Marks)
Ans. Refer to Ans 14 of same chapter.
Ans. Nephron is defined as the structural and functional unit
Q.26. Write short note on micturition reflex. of kidney.
(Jan 2012, 5 Marks) (Feb 2014, 3 Marks)
Nephron is formed by two parts, i.e.
Ans. Micturition reflex is the reflex by which micturition occurs.
1. Renal corpuscle or malphigian corpuscle.
Mechanism of Micturition Reflex 2. Renal tubule.
Filling of urinary bladder Renal Corpuscle
Stimulation of stretch receptors in urinary bladder It is sphaeroidal and slightly flattened structure with diameter
of 200 μ.
Afferent impulses via pelvic nerve Renal corpuscle is formed by two portions, i.e.
1. Glomerulus.
Sacral segments of spinal cord 2. Bowman’s Capsule.
Glomerulus
Urinary bladder
Relaxation of
Glomerulus is 200 μm in diameter, it is formed by invagination
destrusor muscle internal sphincter of tuft of capillaries in Bowman’s capsule. These capillaries
are supplied by afferent arteriole and blood leaves through
Flow of urine in urethra and stimulation of stretch receptors
efferent arteriole. Diameter of efferent arteriole is lesser than
the afferent arteriole. The capillaries are made up of single layer
Efferent impulses via pelvic nerve of endothelial cells which are attached to basement membrane.
Endothelium consists of pores which are known as fenestra or
filtration process.
Inhibition of pudendal nerve
Bowman’s Capsule
Relaxation of external sphincter
It is the dilated part of nephron. Its epithelial cell lining 5 μm
thick. Bowman’s capsule encloses the glomerulus. Diametere
Voiding of urine
of capsule is 200 µ. It is formed by two layers, i.e.
Physiology 345
1. Inner visceral layer: This layer is close to the loops of capil- Descending Limb
laries and surrounds each loop over all the sides.
♦ Descending limb of loop of Henle is made by thick descending
2. Outer parietal layer: It forms outer lining of glomerulus
segment and thin descending segment.
and is continuous with proximal convoluted tubule.
♦ Thick descending segment is the direct continuation of
In between both the layers a space is present which is known
proximal convoluted tubule.
as Bowman’s space.
♦ It descends in medulla.
Structures intervening blood in capillary loop in Bowman’s ♦ Thick descending segment of Henle s loop is in continua-
space is known as glomerular membrane. tion with thin descending segment.
Glomerular membrane is a thin membrane and consists of
following layers: Hairpin Bend
♦ Ist Layer: Foot processes of podocyte: Capillaries are ♦ Thin descending segment is continued as hairpin bend
covered by visceral cell layer which is not continuous all of loop.
over. It produces a series of processes known as pedicles ♦ It is continued as the ascending segment of loop of Henle.
which interdigitate on capillary surfaces and form filtration
slit over capillary wall. Ascending Limb
♦ IInd Layer: Outer cement layer: Foot processes of podo- ♦ It consists of two parts, i.e. thin ascending segment and
cytes overlie this layer. thick ascending segment.
♦ IIIrd Layer: Lamina Densa: Dense portion of basement ♦ Total length of thin descending segment, hairpin bend and
membrane is known as lamina densa. thin ascending segment of Henle s loop is 10 to 15 mm.
♦ IVth Layer: Inner cement layer: This layer provides bed ♦ Thin ascending segment continues as thick ascending seg-
for capillary endothelium. ment. It is 9 mm long and 30 μm in diameter.
♦ Vth Layer: Endothelial cell layer: This layer is fenestrated ♦ Thick ascending segment ascend to cortex and continue
100 nm pores which allows plasma filtration. as distal convoluted tubule.
♦ The glomerular capillaries form a freely branching anasto- ♦ Length of loop of H enle varies in both the nephrons,
motic network. Each glomerulus contains six lobules and in cortical nephrons length is short and hairpin bend
each of these consists of 3 6 capillary loops, i.e. 20 40 loops penetrate upto outer medulla while in juxtamedullary
in all. Many anastomoses occur between the capillaries nephrons length is long and hairpin bend extends deep
within any one lobule. in inner medulla.
♦ The major function of glomerular membrane is to produce
an ultrafiltrate, i.e. the glomerular filtrate will contain all Distal Convoluted Tubule
the constituents of plasma except proteins. ♦ Distal convoluted tubule is the continuation of thick
ascending segment and occupies cortex of kidney.
Tubular Portion
♦ It continues as collecting duct.
It is the continuation of Bowman’s capsule and consists of ♦ The tubule consists of low cuboidal epithelium.
three parts: ♦ This tubule is close to glomerulus and establishes close
a. Proximal convoluted tubule. proximity to afferent and efferent arterioles of glomerulus.
b. Loop of Henle. Here the cells become columnar and get crowded, this part
c. Distal convoluted tubule. is known as macula densa.
♦ Macula densa and adjacent juxtaglomerular part of afferent
Proximal Convoluted Tubule
arterial wall form juxtaglomerular apparatus.
♦ It is continuous with Bowman’s capsule.
♦ It is 14 mm long and 55 μm in diameter. Collecting Tubule
♦ It consists of single layer of cuboidal cells with brush ♦ Distal convoluted tubule continues as initial or arched
border formed by multiple microvilli. collecting duct which lies in cortex.
♦ Cells of proximal convoluted tubule get united at apex by ♦ Lower part of the collecting duct lies in medulla.
tight junctions and base of the cell is extended in extracel- ♦ Seven to ten initial collecting ducts unite to form straight
lular surface. collecting duct which passes through medulla.
♦ Proximal convoluted tubule is divided into two parts, i.e. ♦ Collecting duct is formed by cuboidal or columnar epi-
pars convolute and pars recta. thelial cells.
♦ Epithelial cells are of two types, i.e. Principal cells or
Loop of Henle
P cells and Intercalated or I cells.
It consists of three parts, i.e. ♦ Pcells increases permeability of collecting tubule to water
1. Descending limb. in presence of ADH hormone by enhancing pore size.
2. Hairpin bend. ♦ I cells releases acid which helps in transport of bicarbonate
3. Ascending limb. ions and leads to acidic urine.
346 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Normal GFR
♦ Normal GFR refers to the volume of glomerular filtrate
formed each minute by all the nephrons in both the kidneys.
♦ Its normal value is 125 mL/min i.e. 170 to 180 L/day. Its
value is 10% less in females as compared to males.
(Sep 2015, 7 Marks)
Ans. Following are the differences between cortical and
juxtamedullary nephron.
Juxtamedullary
Features Cortical nephron nephron
Location of In upper region of At near junction of
glomerulus cortex cortex and medulla
Total percentage of 85 to 86% 14 to 15%
nephron
Size of glomeruli Size is small Size is larger
Fig. 28: Structure of nephron
Size of loop of Henle Size is small. It Size is larger. It
Functions of Nephron extends to outer layer extend deep in
of medulla. medulla
Functions of nephron are conducted by its various parts which Descending limb Thin segment Thin segment
are as follows. of loop of Henle
consists of
Part Function
Ascending limb Thick segment Thin segment
Renal Filtration of water and dissolved substances from of loop of Henle
corpuscle plasma consists of
Glomerulus Receive glomerular filtrate Efferent arterioles Diameter is large and Diameter is small
break up in peritubu- and continue as vasa
Proximal • Reabsorption of glucose, amino acids, creatinine, lar capillaries recta
convoluted lactic acid, citric acid, uric acid and ascorbic acid
tubule • Reabsorption of proteins by pinocytosis Rate of filtration It is slow It is fast
• Reabsorption of water by osmosis Function Excretion of waste Concentration of
• Reabsorption of chloride ions and other negatively products in dissolved urine by countercur-
charged ions by electrochemical attraction form in urine rent system
• Active secretion of substances such as penicillin,
histamine, creatinine and hydrogen ions Q.30. Write short note on renal function test.
Descending Reabsorption of water by osmosis (Feb 2016, 3 Marks)
limb Ans. Renal function tests are done for assessing the functional
capacity of kidneys and to detect renal impairment as
Ascending Reabsorption of sodium, potassium and chloride ions
limb by active transport early as possible.
Renal function tests are divided into the following
Distal • Reabsorption of sodium ions by active transport. groups:
convoluted • Reabsorption of water by osmosis
1. Urine examination.
tubule • Active secretion of hydrogen ions
• Secretion of potassium ions both actively and by 2. Blood examination.
electrochemical attraction 3. Renal clearance tests.
4. Miscellaneous tests
Collecting Reabsorption of water by osmosis
duct Urine Examination
Urine examination is limited for assessing the kidney
Q.28. Discuss in brief mechanism of glomerular filtration. functioning. Patients who are suspected for renal disorder
How much is normal GFR. (Apr 2007, 10 Marks) in them urine examination is done for volume, specific
Ans. For mechanism of glomerular filtration refer to Ans 2 of gravity, osmolality, pH, abnormal constituents, microscopic
same chapter. examination.
Physiology 347
When urine is centrifuged at the rate of 3000 rpm for 15 min Test for Tubular Functions
urinary segments are obtained which consists of: Reabsorptive and secretory functions of renal tubules can be
♦ 1 to 2 WBC or pus cells/HPF: These cells are slightly larger tested by following tests:
than normal WBCs.
♦ Urine concentration test: Ability of tubules to concentrate
♦ Nonsquamous epithelial cells or hyaline casts are occasion-
urine is assessed by measuring specific gravity of urine
ally seen. These are clear, colorless cast of tubule. They are
either after 12 hour of water deprivation or 12 hour after
seen as small cylinders with round ends, pale, transparent
and homologus bodies. injection of vasopressin. In either case if specific gravity is
♦ Granular casts are the hyaline casts embedded with RBCs more than 1.020 tubular function is normal.
or WBCs or they are degenerated glomerular cells or ♦ Urine dilution test: In this test patient is asked to drink
tubular epithelial cells which are numerous. 1L of water and urine sample get collected in every 1 hour
♦ Presence of granular cast, RBC, bacteria, glucose, albumin for next 4 hours. Normally 750 mL of urine is excreted
and ketone bodies in urine is abnormal. during this period.
♦ Urine acidification test: In this patient is given ammonium
Blood Examination chloride orally in the dose of 0.1 gm/Kg and pH of urine
♦ Examination of blood is carried out to measure the sub- is tested in sample collected after 6 hour. Normally pH of
stances in blood which are normally excreted by kidney. urine is below 5.3.
348 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Miscellaneous Tests
6. ENDOCRINE SYSTEM
♦ Intravenous pyelography: Agents such as diodrast are
rapidly excreted by the kidney and are opaque to X rays.
Q.1. Write a short note on growth hormone.
15 gm of agent in 20 ml of 10% glucose is given IV and X
(Aug 2005, 5 Marks)
ray is taken. A pyelogram is obtained in 2 to 10 min. In
renal insufficiency this is delayed for hours. Or
♦ Arteriography: After administration of radio-opaque dye Write in brief on growth hormone. (Sep 2007, 4 Marks)
in any artery X-ray is taken. This provides data about renal (Jan 2012, 3 Marks) (Dec 2009, 5 Marks)
vasculature and obstruction in it. Ans. Growth hormone is also known as somatotropin.
♦ Ultrasonography: Shape as well as size of kidney and pres- • Structure: Growth hormone is a protein which consists
ence of any cyst/tumor/stone can be diagnosed. of single chain polypeptide with 191 amino acids.
♦ Renal biopsy: A special needle is inserted in back, biopsy • Synthesis: It is synthesized by the acidophilic cells
specimen of kidney is taken for histological and cytological or somatotrophs of anterior pituitary.
examination. This is also known as fine needle aspiration • Plasma level: Its plasma level varies from 2 to 4 ng/mL.
cytology. It is widely used to detect kidney dysfunctions. • Circulation: Circulating growth hormone bounds
Q.31. Write briefly about renin. (Oct 2016, 2 Marks) to growth hormone binding protein.
Ans. Renin is an acid protease or proteolytic enzyme secreted, • Half life: Its half life in humans is 0 to 20 min.
stored and released from juxtaglomerular cells of kidney. • Metabolism: It is rapidly metabolized mostly in part
This is a glycoprotein having the molecular weight of of the liver.
37,326. Regulation of Growth Hormone Secretion
Like other peptide hormones, it is synthesized as
preprorenin (406 amino acids), prorenin (383 amino Regulation of growth hormone occurs by two ways, i.e.
acids), that finally becomes renin (340 amino acids). ♦ Hypothalamic control
When rennin is released into blood, it acts on a specific ♦ Negative feedback control of growth hormone secretion.
plasma protein known as angiotensionogen. By activity Hypothalamic Control
of renin, angiotensinogen is converted into angiotensin
I. ♦ Hypothalamus controls the secretion of growth hormone
by releasing two hormones, i.e. growth hormone releasing
Regulation of Renin Secretion hormone and growth hormone release inhibiting hormone.
♦ Growth hormone releasing hormone stimulates secretion
Renin activates the renin-angiotensin system, which is essential
of growth hormone from anterior pituitary.
for regulation of ECF volume, blood volume and blood pressure.
♦ Growth hormone release inhibiting hormone inhibits re-
Control of extracellular fluid volume is closely related to control
of plasma electrolyte concentration, especially Na+, Cl and K+. lease of growth hormone from anterior pituitary.
Therefore, change in plasma concentration of these solutes ♦ Negative feedback control of growth hormone secretion
affects renin secretion. Blood volume and pressure are also ♦ It consists of role of somatomedins, growth hormone and
affected by sympathetic activity, circulating catecholamine growth hormone releasing hormone.
and ADH. Therefore, alteration in these factors alters rennin ♦ Negative feedback control by somatomedins: Somato-
secretion. medins are produced when growth hormone causes its
action on target tissues. Somatomedin inhibits secretion
Factors that Increase Renin Secretion of growth hormone directly or by stimulating secretion
♦ Decreased blood volume and/or pressure of somatostatin from hypothalamus.
♦ Decreased plasma Na+ concentration, increased K+ con- ♦ Negative feedback control by growth hormone: Growth
centration hormone inhibits its own secretion by stimulating secretion
♦ Increased sympathetic activity (stimulation of juxtaglo- of somatostatin from hypothalamus.
merular cells via renal nerve) ♦ Negative feedback control by growth hormone releasing
♦ Increased circulating catecholamines hormone: Growth hormone releasing hormone inhibits its
♦ Prostaglandins. own secretion from hypothalamus.
♦ Hyposecretion of growth hormone: Hyposecretion of ♦ Kyphosis: Periosteal growth of vertebrae leads to bowing
growth hormone in children leads to dwarfism while hypose- of spine.
cretion of growth hormone in adults leads to mild anemia. ♦ Prominent brows: There is enlargement of frontal,
Q.2. Write a short note on acromegaly. mastoid, ethmoid and maxillary sinuses causing prominent
(Nov 2008, 5 Marks) (Dec 2004, 5 Marks) brows.
Or ♦ Hypertrophy of body tissues: There is hypertrophy of body
tissues such as heart cardiomegaly, liver hepatomegaly,
Write briefly on acromegaly. (Oct 2016, 2 Marks) kidney renomegaly, spleen splenomegaly, tongue and
Ans. Acromegaly is a clinical condition which occurs due to muscles.
excessive secretion of growth hormone in adults and leads
♦ Acral part abnormalities: It consists of large spade like
to excessive growth in those areas where cartilage persists.
hands, thick wide fingers, large feet with increase in size
Acromegaly occurs after the epiphyseal closure of long
of shoes. Build of patient is stout and stocky.
bones.
It occurs due to acidophilic cell tumor of anterior ♦ Increased sympathetic activity: This leads to increase in
pituitary which causes excessive secretion of growth sweating and hypertension.
hormone in adults. ♦ Scalp of patient is thickened and is thrown into fold and
wrinkles like bulldog scalp.
Clinical Features ♦ Presence of general overgrowth of body hair.
♦ Acromegalic face: This is characterized by thick lips, ♦ Thyroid gland, parathyroid gland and adrenal glands
macroglossia, broad and thick nose, prominent eyebrows, show hyperactivity.
thick skin and coarse facial features. ♦ Presence of hyperglycemia and glucosuria which results
♦ Mandibular prognathism: Elongation and widening of in diabetes mellitus.
mandible which leads to underbite and increased inter- ♦ Presence of visual disturbances such as bitemporal hemia-
dental spaces. nopia.
Q.3. Write a short note on dwarfism. Vasoconstrictor effect: In high doses it leads to vasoconstriction
(Mar 2001, 5 Marks) (Mar 2006, 3 Marks) and causes rise in blood pressure. It also plays an important
Ans. The dwarfism is a disorder in children and is characterized role in blood pressure homeostasis by causing constriction
by stunted growth. of splanchnic vascular bed. ADH bind to V1 A receptors on
arterial smooth muscles and leads to vasoconstriction.
Causes of Dwarfism
Regulation of ADH
♦ Deficiency of growth hormone releasing hormone from
hypothalamus. ADH secretion is regulated through:
♦ Atrophy or degeneration of acidophilic cell in anterior ♦ Plasma osmolality: Change in plasma osmolality causes
pituitary. ADH regulation. Deprivation of water stimulates ADH
♦ Tumor of the chromophobes: It is a non-functioning tumor secretion while the water load decreases ADH secretion.
which composes and destroys normal cells secreting growth ♦ Changes in blood volume: Changes in circulating blood
hormone. volume, central blood volume, cardiac output and blood
pressure affect secretion of ADH.
Clinical Features of Dwarfism ♦ Other factors affecting ADH secretion:
♦ Presence of short stature, i.e. patient shows stunted skel- Emotional stress, stress of pain and surgical procedure
etal growth. leads to increase in ADH secretion which decreases
♦ Patient appear plumpy, i.e. fatty. urine formation.
♦ Pitutary dwarf has immature face and delicate extremities. Adrenaline decreases ADH secretion.
♦ Absence of sexual maturity when it is associated with
Abnormalities of ADH Secretion
gonadotropin deficiency (panhypopituitarism).
♦ Mental activity is normal. ♦ Syndrome of inappropriate hypersecretion of ADH or
Q.4. Write a short note on antidiuretic hormone. Dilution syndrome.
(Sept 2004, 5 Marks) ♦ Diabetes insipidus.
Ans. Antidiuretic hormone prevents diuresis and mainly Q.5. Summarize formation and secretion of thyroid hormones.
conserves the body water. (Mar 1998, 5 Marks)
Antidiuretic hormone also known as vasopressin as it Ans. Formation or Synthesis of Thyroid Hormones
leads to vasoconstriction. Iodine and tyrosine are essential for formation of thyroid
• Structure: ADH is a polypeptide with molecular hormone. Iodine and tyrosine are consumed through
weight of 1000, it is rapidly metabolized in liver and diet and are absorbed from GIT. Various stages which
kidneys. and involved in the formation of thyroid hormones are:
• Synthesis: It is synthesized in the cell bodies of • Iodine trapping: Thyroid gland undergoes uptake
magnocellular neurons of both paraventricular and of iodide which occur against chemical and electrical
supraoptic nuclei of hypothalamus. gradient, it is an energy gaining process.
• Storage: ADH is stored in pars nervosa. • Synthesis and secretion of thyroglobulin: Thy-
• Secretion: It is released when a nerve impulse is roglobulin is synthesized on rough endoplasmic
transmitted from cell body in hypothalamus down reticulum of thyroid epithelial cells and release in
the axon where it depolarizes neurosecretory vesicles. lumen of follicle. Each molecule of thyroxine has 140
• Biological half-life: Its biological half life is 16 to 20 tyrosine residues.
min. • Oxidation of iodide: Iodine in thyroid gland rap-
idly moves to apical surface of the epithelial cells,
Action of ADH from here they get move into the lumen of follicles
by a transporter known as pendrin. Iodide is now
Action of ADH occurs via three types of receptors:
oxidized to iodine by peroxidase enzyme.
1. V1—A receptors: They produce vasoconstrictor effect of • Organification of thyroglobulin: It is the iodina-
ADH tion of tyrosine residues present in thyroglobulin
2. V1—B receptors: They play role in action of ADH on molecule. This reaction occurs at apical membrane
anterior pituitary of cell and need thyroid peroxidase. Tyrosine get first
3. V1—C receptors: They play role in action of ADH on iodinated at position 3 to form monoiodotyrosine
kidney and then at position 5 to form diiodotyrosine.
Action on kidney: ADH regulates water balance on body by • Coupling reaction: Two molecules of diiodotyrosine
acting on kidney where it decreases excretion of free water. get coupled to form thyroxine (T4). One molecule of
Action on anterior pituitary: ADH reaches to anterior pituitary monoiodotyrosine when coupled to one molecule of
through portal veins and get combine with V1 – B receptors and diiodotyrosine, triiodothyronine (T3) is produced.
enhances ACTH secretion. Enzyme peroxidase is necessary for coupling.
Physiology 351
• Storage: As thyroglobulin is iodinated it is stored in ♦ On gonads: T4 is essential for normal menstrual cycle and
lumen of follicle as colloid for several months. fertility. Alteration thyroxine impairs fertility in women.
♦ On carbohydrate metabolism
Secretion of Thyroid Hormones T4 increases the peripheral utilization of glucose and
Follicular cells of thyroid gland send pseudopodia like leads to hypoglycemia.
extension, which close around thyroglobulin hormones T4 can also leads to hyperglycemia as it enhances
complex. This forms pinocytic vesicles. Then, lysosomes of absorption of glucose from intestine; increases
cells which contain digestive enzymes like proteinase which glycogenolysis; causes breakdown of insulin;
fuses with vesicles. The enzymes digest the thyroglobulin and decreases secretion of insulin.
release the hormones. Now, the hormones diffuse through base ♦ On lipid metabolism
of follicular cells and enter capillaries. On cholesterol: T4 increases synthesis of cholesterol
Q.6. Describe synthesis, action and regulation of thyroxin. in liver
Write a short note on endemic goiter. On lipids: T4 stimulates synthesis of lipids. It also
(Sep 2004, 10 + 5 Marks) leads to mobilization and degradation of lipids by
Ans. The thyroxine is also known T4. increasing activity of lipase.
♦ On growth and development
Synthesis of the Thyroxin T4 produce normal body growth and skeletal
maturation as it increases protein synthesis and can
Refer to Ans 5 of the same chapter.
lead to increased release and action of growth hormone.
Actions of Thyroxin (T4) • T4 also causes tissue differentiation and maturation.
♦ On nervous system
Following are the actions of thyroxin on various tissues of the On central nervous system: Deficiency of T4 after
body: birth leads to mental retardation. In adults deficiency
♦ On protein metabolism of thyroxine leads to myxoedema madness. Excess
Thyroxin at its physiological dose enhances protein of T4 in adults leads to increase in responsiveness to
synthesis which leads to positive nitrogen balance. catecholamines which stimulate reticular activating
Thyroxin at its pharmacological dose causes protein system.
catabolism because of increase in basal metabolic rate On peripheral nervous system: T4 stimulates muscle
which leads to negative nitrogen balance, enhances spindle and causes contraction of muscles. Deficiency
potassium excretion in urine. of T4 decreases impulse conduction in muscle fibers
Thyroxine at its pharmacological dose also produces and also there is decrease in muscle contraction and
catabolic effect on muscles which leads ot muscle relaxation.
weakness and fatigability. ♦ On gastrointestinal system: T4 modifies motility of
Thyroxine leads to mobilization of bone proteins intestine. Deficiency of thyroxine decreases intestinal
which decreases bone mass and increases calcium
motility and also decreases food intake which causes
ion loss in urine.
constipation. Excess of thyroxine leads to diarrhea.
♦ On cardiovascular system
♦ On water and mineral metabolism
T4 along with catecholamines increases the heart
Administration of thyroxine leads to:
rate, increases force of myocardial contraction and
In myxedematous patients there is diuresis with
decreases the circulation time.
excretion of NaCl.
T4 increase the body temperature and leads to
In nomal persosns there is mild diuresis with loss of
vasodilatation so increases the blood flow produces
potassium ions.
warm and moist skin and also decreases peripheral
In hyperthyroidism there is mild diuresis with
resistance which lowers the diastolic blood pressure.
potassium and calcium ion excretion in urine.
♦ On bone marrow metabolism
Deficiency of T4 causes anemia due to decreased bone Regulation of Thyroxin
marrow metabolism which decreases erythropoiesis.
There is also decrease in absorption of vitamin B12 Secretion of thyroxin is regulated through following mecha-
from GIT which leads to megaloblastic anemia. nisms, i.e.
Excess of T4 stimulates erythropoiesis. ♦ Negative feedback mechanism through hypothalamus
♦ On vitamins: T4 leads to hepatic conversion of β-carotene anterior pituitary thyroid gland axis.
to vitamin A and convert vitamin A to retinene. So in T4 ♦ Autoregulation by thyroid gland.
deficiency blood carotene level rises which provides yel-
Regulation via Negative Feedback Mechanism
low colour to skin.
♦ On lactation: T4 is very important for maintainence of ga- This mechanism operates via hypothalamo anterior pituitary
lactopoiesis. When thyroxine decreases lactation decreases – thyroid gland axis which controls secretion of various thyroid
and vice versa. hormones as:
352 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Blood volume in circulation is increased due to the T4 and T3. Amount of T3 is so low as compared to T4
vasodilatation effect. and T3 does not contribute in protein bound iodine.
If there is moderate increase in the level of thyroid Butanol extractable iodine: Its normal value is 3 to 5
hormones force of cardiac contraction is increased. µgm/dL. Its value increases in hyperthyroidism and
Cardiac output gets increased because of increased decreases in hypothyroidism.
blood volume, increased heart rate and increased Radioactive iodine uptake: Its normal value is 20
force of contraction. to 40%. Its value increases in hyperthyroidism and
♦ On nervous system: decreases in hypothyroidism.
On central nervous system: Thyroxine enhances T3 suppression test: It is very useful in suspected
various stimulus. Thyroid hormones maintain normal cases of thyrotoxicosis. Thyroxine is given orally for
emotional tone. two days. In euthyroids radioactive iodine decreases
On peripheral nervous system: Thyroid hormone because of T3 suppression while in thyrotoxicosis
enhances speed and amplitude of peripheral nerve value of T3 does not decrease.
reflexes. Serum thyroid hormone and TSH levels: Its normal
♦ Effect on gastrointestinal tract: Thyroid hormones value is 2.3µU/mL. In primary hypothyroidism
increases appetite and enhances food intake; enhances its value increases by 10 folds while in secondary
gastrointestinal motility and enhances rate of secretion of hypothyroidism its value decreases. In hyperthyroidism
digestive juices. its value decreases or remains undetectable.
♦ On skeletal muscles: Thyroid hormones in excess Q.8. Write a short note on hypothyroidism.
causes weakening of muscles due to increase in protein (Mar 2000, 5 Marks)
catabolism. Or
♦ On reproductive system:
Give an account of hypofunction of thyroid gland in
In males decrease in thyroid hormones leads to loss of
children and adult. How does it differ and why?
libido and excess of thyroid hormones causes impotence.
(Feb 2003, 15 Marks) (Apr 2010, 15 Marks)
In females decrease in the thyroid hormones lead to
Ans.
menorrhagia and polymenorrhagia.
♦ On other endocrine glands Hypothyroidism
Production of growth hormone is increased and of ♦ Hypothyroidism occurs due to autoimmune disease which
prolactin get decreased. causes destruction of gland.
Ratio of estrogen and androgen in males get increased. ♦ In most of the patients, it starts as glandular inflammation
This leads to gynecomastia in males during hypert- called thyroidism. This results in fibrosis of gland.
hyroidism. ♦ Hypothyroidism leads to cretinism in children and myx-
Parathyroid hormone and vitamin D get decreased edema in adults.
as compensatory effect of thyroid hormone on bone
resorption. Myxedema
This is due to hypothyroidism in adults and is also known as
Assessment of Thyroid Functions
Gull s disease.
Thyroid functions are assessed by thyroid function tests:
Causes
♦ Based on metabolic effects of T4
Basal metabolic rate: It indicates the consumption Complete lack of thyroid hormones.
of oxygen by patient under physical and mental
rest. Its normal value is ± 20%. Its value increases in Symptoms
hyperthyroidism and decreases in hypothyroidism. ♦ Swelling of face, scaliness of skin
Blood sugar: Its normal value is 70 to 90 mg/dL. Its ♦ Mental struggishness
value increases in hyperthyroidism and decreases in ♦ Increased body weight
hypothyroidism. ♦ Constipation
Serum cholesterol: Its normal value is 150 to 240 ♦ Nonpitting type of edema
mg/dL. Its value increases in hypothyroidism and ♦ Depressed hair growth.
decreases in hyperthyroidism.
Cretinism
Serum creatinine: Its normal value is 0.6 mg/dl. Its
value increases in hyperthyroidism and decreases in Hypothyroidism in children.
hypothyroidism.
Causes
♦ Based on handling of iodine
Protein bound iodine: Its normal value is 3.5 to 7.5 Congenital absence of thyroid gland, genetic disorder or lack
µgm/dL. This test shows index of circulating level of of iodine in diet.
354 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Vitamin Metabolism
Thyroxine increases the formation of many enzymes. Since, the
vitamins form the essential parts of the enzymes, it is believed
that the vitamins may be utilized during the formation of
the enzymes. Hence, vitamin deficiency is possible during
hypersecretion of thyroxine.
On Blood
Thyroxine increases the production of RBCs. It is one of the
important general factors necessary for erythropoiesis. Thus,
thyroxine increases erythropoietic activity and blood volume.
Cardiovascular System
♦ Thyroxine increases overall activity of cardiovascular
system.
♦ It acts directly on heart and increases rate and force of
contraction.
♦ Thyroxine causes vasodilatation by increasing the meta-
bolic activity.
♦ During metabolic activity, production of metabolites is
increased.
♦ The metabolites cause vasodilatation and increase the
blood flow.
♦ Thyroxine increases systolic blood pressure by increasing
rate and force of contraction of the heart, blood volume
and cardiac output.
♦ At the same time it decreases diastolic pressure by it (Dec 2010, 5 Marks)
vasodilator effect.
Ans. Action of Insulin on Carbohydrate Metabolism
♦ So only the pulse pressure increases and the mean pres-
Insulin is the only hormone in the body that reduces
sure is not altered.
blood sugar level. Insulin reduces the blood sugar level
Respiratory System by its following actions on carbohydrate metabolism.
Thyroxine increases the rate and force of respiration indirectly. Increases Transport and Uptake of Glucose by the Cells
The increased metabolic rate increases the demand for oxygen
and formation of excess carbon dioxide. These two factors ♦ Insulin facilitates the transport of glucose from the blood
stimulate respiratory centers to increase the rate and force of into the cells by increasing the permeability of cell mem-
respiration. brane to glucose.
♦ Insulin stimulates the rapid uptake of glucose by all the
Gastrointestinal Tract tissues particularly liver, muscle and adipose tissues.
♦ Insulin also increases the number of glucose transporters
Generally, thyroxine increases the appetite and food intake. It
called GLUT 4 in the cell membrane.
also increases the secretions and movements of gastrointestinal
tract. Promotes Peripheral Utilization of Glucose
Central Nervous System Insulin helps in the peripheral utilization of glucose. In the
♦ Thyroxine is very essential for the development and main- presence of insulin, glucose which enters the cell is oxidized
tenance of normal functioning of central nervous system. immediately. Rate of utilization depends upon intake of glucose.
♦ Thyroxine is very important to promote growth and devel-
Promotes Storage of Glucose, i.e. Glycogenesis
opment of the brain during fetal life and during the first
few years of postnatal life. Thyroid deficiency in infants Insulin promotes the rapid conversion of glucose into glycogen,
results in mental retardation. which is stored in muscle and liver. Thus, glucose is stored in
♦ Thyroxine is a stimulating factor for the brain so normal these two organs in the form of glycogen. Insulin activates the
functioning of the brain needs presence of thyroxine. enzymes, which are necessary for glycogenesis. In liver, when
♦ Thyroxine also increases the blood flow to brain. Thus, glycogen content increases beyond its storing capacity, insulin
during the hypersecretion of thyroid there is excess causes conversion of glucose into fatty acids.
358 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦ On intestine: Aldosterone increases sodium absorption adrenal cortex. The androgens secreted by adrenal cortex are:
from the intestine, especially from the colon and prevents ♦ Dehydroepiandrosterone
loss of sodium through feces. ♦ Androstenedione
♦ Testosterone.
Glucocorticoids
Dehydroepiandrosterone is the most active adrenal
Glucocorticoids are the corticosteroids which act mainly on androgen.
glucose metabolism. Glucocorticoids are secreted mainly The androgens, in general, are responsible for
by zona fasciculata of adrenal cortex. A small quantity of masculine features of the body. But in normal
glucocorticoids is also secreted by zona reticularis. conditions, the adrenal androgens have insignificant
Glucocorticoids are: physiological effects, because of the low amount of
1. Cortisol secretion both in males and females.
2. Corticosterone
Adrenaline and Noradrenaline
3. Cortisone.
Actions
Functions
On Metabolism
Life saving hormone: Like aldosterone, cortisol is also essential
for life but in a different way. Aldosterone is a life saving Adrenaline acts through both alpha and beta receptors equally.
hormone, whereas cortisol is a life protecting hormone because, Noradrenaline acts mainly through alpha receptors and
it helps to withstand the stress and trauma in life. occasionally through beta receptors. Adrenaline influences the
♦ On carbohydrate metabolism: Glucocorticoids increase metabolic functions more than noradrenaline.
the blood glucose level by two ways: 1. General metabolism: Adrenaline increases oxygen con-
1. By promoting gluconeogenesis in liver from amino sumption and carbon dioxide removal. It increases basal
acids. metabolic rate. So, it is said to be a calorigenic hormone.
2. By inhibiting glucose uptake and utilization by 2. Carbohydrate metabolism: Adrenaline increases the blood
peripheral cells. glucose level. It is by increasing the glycogenolysis in liver and
♦ On protein metabolism: Glucocorticoids promote catabo- muscle. So, a large quantity of glucose enters the circulation.
lism of proteins leading to decrease in cellular proteins 3. Fat metabolism: Adrenaline causes mobilization of free
and increase in plasma amino acids and protein content fatty acids from adipose tissues. Catecholamines need the
in liver by the following methods: presence of glucocorticoids for this action.
Glucocorticoids decrease the protein in the body cells
On Blood
except liver cells by accelerating protein catabolism
and release of amino acids from the tissues. Adrenaline decreases blood coagulation time. It increases RBC
Glucocorticoids increase the transport of amino acids count in blood by contracting smooth muscles of splenic capsule
into hepatic cells. In hepatic cells, the amino acids are and releasing RBCs from spleen into circulation.
used for synthesis of proteins, plasma proteins and
On Heart
for gluconeogenesis.
♦ On fat metabolism: Glucocorticoids cause mobilization Adrenaline has stronger effects on heart than noradrenaline. It
and redistribution of fats. The actions on fats are: increases overall activity of the heart, i.e.
Mobilization of fatty acids from adipose tissue i. Heart rate
Increasing the concentration of fatty acids in blood ii. Force of contraction
Increasing the utilization of fat for energy. iii. Excitability of heart muscle
♦ On water metabolism: Glucocorticoids accelerate the iv. Conductivity in heart muscle.
excretion of water and play an important role in the main-
tenance at water balance. On Blood Vessel
♦ On mineral metabolism: Glucocorticoids enhance the Noradrenaline has strong effects on blood vessels. It causes
retention of sodium and to a lesser extent increase the constriction of blood vessels throughout the body via alpha
excretion of potassium. Glucocorticoids decrease blood receptors. So it is called general vasoconstrictor . The
calcium by inhibiting absorption of calcium from intestine vasoconstrictor effect of noradrenaline increases total peripheral
and increasing the excretion of calcium through urine. resistance.
Acromegaly
It is the disorder characterized by the enlargement, thickening
and broadening of bones, particularly in the extremities of the
body.
Cause
Acromegaly is due to hypersecretion of growth hormone in
adults after the fusion of epiphysis with shaft of the bone.
Hypersecretion of growth hormone is due to adenomatous
tumor of anterior pituitary involving the acidophil cells.
Symptoms Myxedema
♦ A major feature of Simmonds disease is the rapidly It is the hypothyroidism in adults characterized by generalized
developing senile decay. Thus, a 30 years old person looks edematous appearance.
like a 60 years old person.
♦ There is loss of hair over the body and loss of teeth. Causes for Myxedema
♦ The skin on face becomes dry and wrinkled. So, there is Myxedema occurs due to diseases of thyroid gland, genetic
shrunken appearance of facial features. It is the most com- disorder or iodine deficiency. In addition, it is also caused
mon feature of this disease. by deficiency of thyroid stimulating hormone or thyrotropic
Q.24. Write about diseases related to thyroid hormones. releasing hormone.
(Feb 2013, 5 Marks)
Ans. Diseases related to thyroid hormones. Signs and Symptoms of Myxedema
Typical feature of this disorder is an edematous appearance
Hyperthyroidism
throughout the body. It is associated with the following
Grave’s Disease symptoms:
♦ Swelling of the face
Grave s disease is an autoimmune disease. Normally,
thyroid stimulating hormone (TSH) combines with surface ♦ Bagginess under the eyes
receptors of thyroid cells and causes the synthesis of thyroid ♦ Nonpitting type of edema, i.e. when pressed, it does not
hormones. make pits and the edema is hard.
♦ Atherosclerosis: It is the hardening of the walls of arteries
In Graves’ disease the B lymphocytes (plasma cells)
because of accumulation of fat. In myxedema it occurs be-
produce autoimmune antibodies called thyroid stimulating
autoantibodies. These antibodies act like TSH by binding with cause of increased plasma level of cholesterol which leads
membrane receptors of TSH and activating cAMP system of the to deposition of cholesterol on the walls of the arteries.
thyroid follicular cells. This results in hypersecretion of thyroid ♦ Other general features of hypothyroidism in adults are
hormones. anemia, fatigue and muscular sluggishness, extreme
somnolence, menorrhagia and polymenorrhea, increase in
Thyroid Adenoma body weight, constipation, mental sluggishness, depressed
Sometimes, a localized tumor develops in the thyroid tissue. It hair growth, scaliness of the skin, frog like husky voice,
is known as thyroid adenoma and it secretes large quantities cold intolerance.
of thyroid hormones. Cretinism
Signs and Symptoms Cretinism is the hypothyroidism in children characterized by
♦ Intolerance to heat because production more heat during stunted growth.
increased basal metabolic rate caused by hyperthyroidism
Causes for Cretinism
♦ Increased sweating due to vasodilatation
♦ Decreased body weight due to fat mobilization Cretinism occurs due to congenital absence of thyroid gland,
♦ Diarrhea due to increased motility of gastrointestinal tract genetic disorder or lack of iodine in the diet.
362 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Thyroid gland is situated infront of larynx and is Q.30. Enumerate the endocrine glands in order of location
bilobed. from head downwards. Describe the actions of growth
Thyroid gland is connected by a bridge of tissue hormone in details. (Aug 2012, 15 Marks)
known as isthmus. Ans. Enumeration of Endocrine Glands in Order of Location
Thyroid gland is larger in females as compared to from Head Downwards
males.
Name Location
Histology of Thyroid Gland 1. Pineal gland Head
♦ Thyroid gland is composed of large number of closed fol- 2. Pituitary-anterior posterior Head
licles which are 50 to 500 µm in diameter. 3. Thyroid and parathyroid Throat
♦ Approximately 40 follicles group together to form a lobule.
4. Thymus Upper chest
♦ The follicular epithelium consists of single layer of cuboi-
dal cells. 5. Pancreas Solar plexus region
♦ Lumen is filled with clear pink material known as colloid. 6. Adrenals-cortex medulla Behind the kidneys
Colloid is thyroglobulin containing iodine. 7. Gonads Lower abdomen
♦ Thyroid cells are the highly vascular cells and their micro-
villi project in colloid. Actions of Growth Hormone
♦ Follicular cells secrete T4 and T3. On Metabolism
♦ In between follicles parafollicular cells are present.
Growth hormone causes synthesis of proteins, mobilization of
Functions of Thyroid Gland lipids and conservation of carbohydrates.
♦ Thyroid gland maintains level of oxidative metabolism. ♦ Effect on protein metabolism
♦ Gland helps to regulate fat and carbohydrate metabolism. It increases amino acid transport via cell membrane.
♦ Thyroid gland is necessary for tissue differentiation, nor- It increases translation of RNA due to which
mal growth and maturation. ribososmes are activated and more of the proteins
are synthesized.
Q.29. Enumerate the hormones secreted by the posterior
It increases transcription of DNA to RNA which
pituitary and actions of any one hormone.
accelerates synthesis of proteins in cells.
(Jan 2012, 10 Marks)
It decreases catabolism of proteins.
Ans. Hormones secreted by posterior pituitary are anti-
It promotes anabolism of proteins by the release of
diuretic hormone and oxytocin.
insulin which has anabolic effect on proteins.
Action of Oxytocin ♦ Effect on fat metabolism: Growth hormone mobilizes fat
from adipose tissue. Due to this concentration of fatty acids
♦ Oxytocin causes contraction of smooth muscle cell which
increases in body fluid and these fatty acids are used for
lines the duct of mammary glands and causes milk ejec-
production of energy by cells.
tion from breast. The process by which the milk is ejected
♦ Effect on carbohydrate metabolism
from alveoli of mammary glands is known as milk ejec-
Growth hormone decreases the peripheral utilization
tion reflex.
of glucose for the energy.
♦ Oxytocin stimulates contraction of smooth muscle of
It increases deposition of glucose in form of glycogen
the uterus. Myometrium is sensitive to the exogeneous
in cells.
oxytocin at the time of pregnancy and as the pregnancy
advances the sensitivity increases. Oxytocin causes Decrease uptake of glucose by cells. As deposition of
contraction of uterus and helps in expulsion of fetus. glycogen increases the cells become saturated with
It also stimulates release of prostaglandins in placenta. glycogen.
Prostaglandins intensify uterine contraction induced by Diabetogenic effect: Increase in secretion of growth
oxytocin. hormone causes increase in blood glucose level. It
♦ Oxytocin facilitates the transport of transport of sperm leads to stimulation of β cells of langerhans in pancreas
through female genital tract upto the fallopian tube by and increases insulin secretion. Growth hormone also
producing uterine contraction during sexual intercourse. stimulates β cells of islets in pancreas directly and
♦ Oxytocin at high doses causes relaxation of blood vessels causes secretion of insulin. Due to this stimulation the
causes fall in blood pressure. β cells are burn out at one stage. This causes deficiency
♦ In males oxytocin receptors are found in testis, epididy- of insulin and diabetes occur.
mus and prostrate gland, so at the time of ejaculation
On Bone
oxytocin facilitates transport of sperms towards urethra
by causing increased contraction of smooth muscle of ♦ During embryonic stage growth hormone is responsible
vas deferens. for the differentiation and development of bone cells.
364 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• Action on intestine: Parathormone increases cal- 5. It causes increase in conversion of 25 hydroxy chole-
cium and phosphate absorption from intestine, this calciferol to 1,25-dihydroxycholecalciferol in kidney.
happens indirectly by increasing synthesis of 1,25 6. It leads to the activation of adenyl cyclase in the
dihydroxycholecalciferol in kidney. target tissues.
Q.38. Name the hormones secreted by adrenal gland. Write Q.41. Write on functions of thyroid hormones and its disorders.
down the functions of mineralocorticoids. (Apr 2017, 5 Marks)
(Nov 2008, 5 Marks) Ans. For functions of thyroid hormones refer to Ans 7 of same
Ans. Hormones secreted by adrenal gland are: chapter.
I. Hormones secreted from adrenal cortex. Disorders of thyroid hormones
A. Mineralocorticoids i.e. aldosterone and 11-
For disorders of thyroid hormones refer to Ans 24 of
deoxycorticosterone.
same chapter.
B. Glucocorticoids, i.e. cortisol and corticosterone.
C. Sex steroids, i.e. androgen, oestrogen and
progesterone.
II. Hormones secreted from adrenal medulla.
7. REPRODUCTIVE SYSTEM
A. Adrenaline or epinephrine.
B. Noradrenaline or Norepinephrine. Q.1. Write a short note on spermatogenesis.
C. Dopamine. (Mar 1998, 5 Marks) (Sept 2001, 5 Marks)
(Apr 2015, 3 Marks) (Mar 2008, 4 Marks)
Functions of Mineralocorticoids Ans. Spermatogenesis is a process by which spermatozoa are
For functions refer to Ans 22 of same chapter. developed from the primitive germ cells. This occurs in
four stages:
Q.39. Describe the effects of growth hormone in the body.
1. Stage of proliferation: The spermatogonia near
Write in brief on clinical conditions resulting from
basement membrane of semniferous tubules are
hypersecretion of hormone. (Apr 2015, 8 Marks)
larger. Each one contains diploid number of chro-
Ans. For effects of growth hormone in the body refer to the
mosomes. One member of each pair is from maternal
heading actions of growth hormone in Ans 30 of same
origin and other from paternal origin.
chapter.
During proliferative stage, the spermatogonia
Clinical Conditions Resulting from Hypersecretion of divide by mitosis without any change of chromo-
Hormone some number. In man, there are seven generation
of spermatogonia. The last generation enters stage
Hypersecretion of hormone Clinical condition of growth as primary spermatocyte.
Growth hormone a. Gigantism 2. Stage of growth: The primary spermatocyte grows
b. Acromegaly
into larger cell.
Antidiuretic hormone Syndrome of inappropriate
hypersecretion of ADH
Thyroid hormone a. Grave’s disease
b. Toxic nodular goiter
Parathormone Hyperparathyroidism
Glucocorticoid Cushing’s syndrome
Aldosterone Hyperaldosteronism
Adrenal androgens Adrenogenital syndrome
Catecholamines Pheochromocytoma
(epinephrine and norepinephrine)
3. Stage of maturation: After reaching full size, the The commencement of menstrual cycle is called
spermatocyte quickly undergoes miotic division menarche and permanent cessation of menstrual
which occurs in two stages. cycle in old age is called menopause.
In the first stage, two secondary spermatocytes There are various changes during the menstrual
are formed. In the second stage, each secondary cycle in uterus, which are in following phases.
spermatocyte divides into two spermatids. The im-
Menstural Phase
portant result of two stages of maturation division
is, each spermatid receives haploid chromosomes. ♦ Ovum which is shed during ovulation does not fertilize
4. State of transformation: The spermatids do not di- and bleeding from female genital canal begins which last
vide further but are transformed into spermatozoa for 3 to 5 days.
by spermatogenesis. ♦ During menstrual phase secretion of progesterone and
estrogen fall rapidly due to degeneration of corpus luteum.
Q.2. Write in brief on functions of testes.
♦ Bleeding and shedding of superficial two-third of endome-
(Apr 2010, 5 Marks)
trium which occur in its different parts because of spasm
Ans. The functions of testes are as follows: of spiral arteries for several hours leading to endometrial
1. Gametogenic function: The production of gamete necrosis.
cells is called gametogenic functions. Refer to Ans 1 ♦ As the vessels relax the shedding of necrotic endometrium,
of same chapter for detail. leakage of blood and release of mucus make debris lost
2. Endocrine function: The testes secrete the male during menstruation.
sex hormones called androgens. The androgens ♦ Menstural blood clot in uterus and is liquefied by fibrinoly-
are testosterone, dihydrotestosterone and sin in vagina.
androstenedione. For detail refer to Ans 15 of same ♦ Total blood loss is 10 to 80 ml.
chapter. ♦ Menstural blood contains prostaglandins.
Q.3. Write in brief on menstrual cycle. Proliferative or estrogenal Phase
(Dec 2009, 5 Marks) (June 2010, 5 Marks)
Ans. The cyclic events that take place in rhythmic fashion ♦ This phase presents restoration of epithelium from the
during reproductive period of women’s life is called menstruation.
♦ Estrogen is secreted from the developing ovarian follicles
menstrual cycle.
under influence of follicular stimulating hormone which
The menstrual cycle starts at age of 13 to 15 years
leads to this phase.
which marks onset of puberty.
♦ As the bleeding ends endometrium becomes thin, i.e. less
than 2 mm thick and has ciliated columnar epithelium
which is dipped in a loose stroma for forming simple
tubular glands.
♦ From 5th to 14th day endometrium get thick and start
proliferating and becomes 4 mm thick. Uterine glands
increase in length but do not secrete.
♦ Cervical secretion increases in volume and become alka-
line as well as watery. The secretion causes survival and
transport of sperms.
Ovulatory Phase
♦ It occurs at 14th day.
♦ Ovulatory phase occurs due to rise in luteinizing hormone
secretion secondary to rise in estrogen concentration.
♦ At 14th day ovulation occur and during this cervical mucus
increases in volume and become watery and so there is very
small vaginal discharge of cervical fluid which is watery.
♦ Cervical mucosa is thinnest during ovulation and so is
easily penetrated by spermatozoa.
iii. Thyroid: The size and secretory activity of Advantages of Immunological Test for Pregnancy
thyroid gland increase during pregnancy. The
♦ The test is more accurate.
increased secretion of thyroxine helps in prepa-
♦ The result is obtained within a few minutes.
ration of mammary glands for lactation. It is also
♦ The test is carried out easily. The procedure is not cumber-
responsible for increase in metabolic activities.
some.
Q.13. Write in brief on pregnancy test. ♦ Recently available immunological tests are more sensi-
(Mar 2001, 5 Marks) (June 2010, 5 Marks) tive and involve single step method. These tests can be
Ans. The basis of pregnancy test is to determine the presence performed during the first few days of conception.
of hormone human chorionic gonadotropin in urine of Q.14. Write a short note on oral contraceptives.
women suspected for pregnancy. Both biological and (Aug 2005, 5 Marks)
immunological tests are available to test presence of Or
hCG in women.
• Biological tests: These tests are performed by Write short note on contraceptives.
using experimental animals. The biological tests for (May/June 2009, 5 Marks)
pregnancy can be performed after 2 to 3 weeks of Ans. The oral contraceptives are used to prevent maturation
conception so that concentration of hCG in urine is of follicles and ovulation. Prevention of follicular growth
sufficient to show the result, e.g. Kupperman test, and ovulation can be done by suppressing the secretion
Friedman test, etc. of gonadotropin from the pituitary. This is done by
• Immunological test: The presence of hCG can be using some synthetic substances. The method of fertility
determined by using immunological techniques. The control is called pill method. These pills alter menstrual
immunological tests are based on double antigen- cycle and prevent maturation of follicles and ovulation.
antibody reactions. The most commonly performed So the menstrual cycle becomes anovulatory cycle. The
immunological test is Gravindex test. pills containing synthetic estrogen and progesterone are
called oral contraceptives. The pills are of three types:
Gravindex Test 1. Classical or combined pills: They consist of moder-
Principle ate dose of synthetic estrogen and mild dose of syn-
thetic progesterone. The pills are taken daily from
It is to determine agglutination of RBCs of sheep coated with 5th to 25th day of menstrual cycle. The withdrawal
hCG. Latex particles could also be used instead of RBCs of sheep. of pills after 25th day causes menstrual bleedings.
During continuous intake of pills, there is rela-
Requisites
tively large amount of estrogen and progesterone in
♦ Antiserum from rabbit: Urine from a pregnant women is blood. This suppresses release of gonadotropins FSH
collected and hCG is isolated from urine. The hCG is in- and LH from pituitary by means of feedback mecha-
jected to the rabbit and rabbit develops antibodies against nism. The lack of FSH and LH prevents maturation
hCG. These antibodies are called Anti-hCG. The rabbits se- of follicle and ovulation. In addition, progesterone
rum containing hCG antibody is known as hCG antiserum. increases the thickness of mucosa which is not fa-
♦ RBC from sheep: The RBCs are obtained from sheep s vorable for transport of sperm.
blood. These cells are coated with pure hCG obtained 2. Sequential pills: They contain high dose of oestro-
from urine of pregnant woman. Now-a-days, instead of gen along with moderate dose of progesterone.
sheep s RBC, the rubberised synthetic particles called latex 3. Mini pills: They contain only low dose of progester-
particles are used. one. They are taken throughout menstrual cycle. This
♦ Urine: Urine of woman who needs to confirm pregnancy. prevents pregnancy without affecting ovulation.
Procedure Q.15. Write a short note on the functions of testosterone.
(Mar 2005, 5 Marks)
♦ One drop of hCG antiserum is taken on a glass slide. One
Or
drop of urine from woman who wants to confirm preg-
nancy is added to this and both are mixed well. If urine Write very short answer on functions of testosterone.
contains hCG, all antibodies of antiserum are used for (Apr 2018, 2 Marks)
agglutination of hCG molecules. Or
♦ Now, one drop of latex particles is added to this and mixed. Enumerate functions of testosterone.
(Sep 2018, 5 Marks)
Observation and Result Ans. The functions of testosterone are:
If urine contains hCG, it gets agglutinated by antibodies • Testosterone with follicular stimulating hormone
of antiserum and all antibodies are fully used up. No free maintains spermatogenesis.
antibodies is available and absence of agglutination of latex • Testosterone promotes and maintains the motility
particles confirms pregnancy. and fertilizing power of sperms.
372 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Other Factors
♦ Temperature: In scrotum the temperature is about 2°C
less than that of body, this low temperature is essential
for spermatogenesis.
♦ Infectious disease: Such as mumps causes degeneration
of seminiferous tubules and absence of sperma-
togenesis.
Q.17. Write in brief of maternal changes during pregnancy.
(Dec 2010, 6 Marks)
Ans. Following are the maternal changes during pregnancy:
Changes in Cardiovascular System ♦ Protein metabolism: When balanced diet is given there is
♦ Position of heart: Uterus pushes the diaphragm upwards nitrogen retention and positive nitrogen balance. Proteins
which changes the position of heart. get deposited in uterus, breast, fetus and placenta.
♦ Heart rate: Heart rate increases by 10 to 12 beats/min. ♦ Carbohydrate metabolism: There is an increase in blood
♦ Cardiac output: There is an increase in cardiac output from glucose level. Glycosuria is present due to increase in GFR
5L/min to 7L/min during 20 weeks of gestation. and decrease in renal threashold for glucose. Ketosis can
♦ Blood pressure: Systolic blood pressure remains normal occur due to anorexia and excessive vomiting.
while diastolic blood pressure decreases and by 16 to 20 ♦ Fat metabolism: 3 to 4 Kg of fat gets deposited during
weeks of pregnancy its value is lowest, after this it starts pregnancy. There is an increase in plasma concentration
increasing and becomes normal. of cholesterol, phospholipids and triglycerides.
♦ Blood flow: There is an increase in blood flow to skin, ♦ Mineral metabolism: In pregnancy mother retains 50 gm
uterus and kidneys to meet the demands. of extra calcium and 30 to 40 gm of phosphorus. These
♦ Venous pressure: Gravid uterus applies pressure on pel- minerals are deposited in fetus and retained in mother
vic vein, abdominal vein and femoral vein in this way it stores. Requirement of iron also increases.
increases the venous pressure.
Changes in Endocrine System
Changes in Respiratory System
All endocrine glands of pregnant lady react substantially during
♦ Hyperventilation: As there are high levels of plasma pregnancy. Due to increased metabolic load and due to the
progesterone at the time of pregnancy this increases the hormones produced by placenta and fetus.
sensitivity of respiratory neurons to carbon dioxide which
leads to hyperventilation. Changes in the Skin
♦ Gas exchange: Exchange of gases across alveoli is en- ♦ Hyperpigmentation: It occurs on face, areola, nipple,
hanced due to marked increase in pulmonary blood flow. midline of abdomen. It is due to the increased secretion
♦ Consumption of oxygen: It get increased by 15% to meet
of ACTH and MSH at the time of pregnancy.
demands of growing fetus and for extra work of heart,
♦ Stria gravidarum: Presence of linear scars on lower abdo-
uterus and other tissue.
men due to stretching of skin.
Changes in Urinary System
Changes in Psychology
♦ Renal blood flow: Renal blood flow gets increased.
♦ Glomerular filtration rate: It increases by 50% as there is Nervous system show mild changes in form of craving for
increase in renal blood flow. particular type of food items, alteration in behavior and mood.
♦ Renal tubular absorptive capacity for sodium and chloride Q.18. Write short note on corpus luteum.
ions increases by 50% as high levels of steroid hormones (June 2010, 5 Marks)
are secreted by placenta and adrenal cortex. Ans. It is also known as yellow body.
♦ Proteinuria: There is presence of proteinuria.
It is a glandular yellow body which is developed from
♦ Water balance: In last months of pregnancy there is pres-
ruptured graffian follicle after the release of ovum.
ence of water retention.
♦ Acid-base balance: Hyperventilation at the time of preg- Formation and Fate of Corpus Luteum
nancy leads to respiratory alkalosis. Kidneys compensate
this by excreting bicarbonate ions in urine. ♦ Following ovulation as ruptured graffian follicle is filled
with the blood it is known as corpus hemorrhagicum.
Changes in Gastrointestinal System ♦ The luteinizing hormone neutralizes leutinization inhibit-
♦ GIT secretions: Hypochlorhydria is present as gastric ing factor in initiates leutinization.
secretions are reduced. ♦ Granulosa and theca cells show fat droplet in cytoplasm and
♦ GIT motility: Motility decreases under the influence of the structure appears yellow in color. Both the cells now
hormones which causes delayed gastric emptying. are known as granulose leutin cells and theca leutin cells.
♦ Gall bladder functions: Size of gallbladder increases and ♦ Corpus luteum produce large amount of estrogen and
empties it contents at slow rate. progesterone under the influence of luteinizing hormone.
♦ Liver functions: They get altered during pregnancy. ♦ If fertilization occur corpus luteum produce these
There is an increase in fibrinogen synthesis and decrease hormones as placenta take over the function.
in albumin synthesis so plasma albumin to globulin ratio ♦ If fertilization has not occurred corpus luteum produce
is decreased. hormones at high level till 24th day and from 25th day
secretion of hormones decreases and reaches to its basal
Metabolic Changes level at 28th day.
♦ Basal metabolic rate: BMR increases to 15% in pregnancy ♦ Corpus luteum degenerates and is known as corpus
during later half of pregnancy. albicans.
374 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
I. Menstural Phase
♦ Ovum which is shed during ovulation does not fertilize
and bleeding from female genital canal begins which last
for 3 to 5 days.
♦ During menstrual phase secretion of progesterone and
(Jan 2012, 10 Marks) estrogen fall rapidly due to degeneration of corpus luteum.
Physiology 375
8. CARDIOVASCULAR SYSTEM
Contd...
substance minus the venous level (A – V difference) times the is measured by determining the resultant change in blood
blood flow i.e. amount of substance taken per min = (A – V) temperature in pulmonary artery.
difference of the substance × blood flow per min.
Physical Methods
Amount of substance taken/min
Blood flow/min = Following are the physical methods used to measure cardiac
(A – V) difference of the substance
output:
Fick’s principle is used to determine cardiac output, So
Echocardiography
Amount of oxygen consumed by the
whole body per unit time It is the ultrasonic evaluation of cardiac functions. It involves
LV Output =
(A – V) oxygen difference across the lungs B-scan ultrasound frequency of 2.25 MHz using a transducer
which act as receiver for the reflected waves. The recording of
As arterial blood has same oxygen content in all parts of the the echoes displayed against time on an oscilloscope provides
body, the arterial oxygen content can be measured in sample the complete record of:
obtained from any convenient artery. Sample of venous blood ♦ Movement of both ventricular wall and septum along with
in pulmonary artery is obtained by cardiac catheter which is valves during cardiac cycle.
inserted via a foramen vein and its tip is guided in right atrium ♦ When this procedure gets combined with the Doppler
by fluoroscope and through right ventricle in pulmonary artery. techniques, echocardiography is used to measure velocity
Oxygen consumption is determined by the close circuit spirometry. and volume of flow through valves.
Calculation of cardiac output is as follows: ♦ So it is useful in evaluating end diastolic volume, end
systolic volume, cardiac output and valvular defects.
Resting oxygen consumption in body (mL/min)
LV output =
[AO2] [VO2]
250 mL/min
=
19 mL/dL arterial blood – 14 mL/dL venous
blood in pulmonary artery
250 mL/min
=
5 mL/dL
250 × 100
=
5
= 5000 mL/min or 5 L/min.
Chronotropic action: It is the effect on the heart rate. • The baroreceptors are situated in the carotid sinus.
Two types of chronotropic actions are: These receptors are also situated in wall of arch of aorta.
I. Tachycardia, i.e. increase in heart rate. Baroreceptors in carotid sinus are supplied by Her-
ing s nerve. The baroreceptors in arch of aorta are
II. Bradycardia, i.e. decrease in heart rate. supplied by aortic nerve.
The cardiac centers are mainly responsible for regulation • When the blood pressure is increased, the barorecep-
of heart rate. There are two centers: tors are stimulated and send stimulatory impulses to
1. Cardioinhibitory center: It is situated in reticular cardioinhibitory center. The vagal tone is increased
formation of medulla oblongata. The cardioinhibi- and heart rate is reduced. When pressure is less, the
tory center reduces the heart rate. It sends inhibitory baroreceptors do not sent impulses and heart rate is
impulses through vagus nerve fibers and causes dila- not decreased.
tation of blood vessels. Stimulation of this center with Q.11. Describe short-term regulation of blood pressure.
weak electric stimulus causes reduction in heart rate. (Sep 2001, 7.5 Marks) (Feb 2003, 7.5 Marks)
2. Cardioaccelerator center: It is situated in reticular (Feb 2016, 10 Marks)
formation of medulla in floor of IVth ventricle. The Or
center accelerates the heart rate by inhibiting cardi-
Describe nervous regulation of blood pressure.
oinhibitory centers. It causes constriction of blood
(Mar 2005, 8 Marks)
vessels. Stimulation of center causes tachycardia.
- The baroreceptors decrease the heart rate. Or
Whenever blood pressure is increased, they are Describe in brief nervous control of blood pressure.
stimulated and send stimulatory impulses to (Mar 2007, 4 Marks)
cardioinhibitory centers and causes bradycardia.
- The chemoreceptors on the other hand increase
the heart rate. Whenever there is hypoxia, hyper-
capnia on increased hydrogen ion concentra-
tion in blood these receptors send inhibitory
impulses to cardioinhibitory center. Vagal tone
is reduced and heart rate is increased. (July 2016, 5 Marks)
Q.10. Write briefly on baroreceptors. Ans. • The nervous regulation is called short-term
(Aug 2012, 5 Marks) (Sep 2006, 4 Marks) regulation of blood pressure. It is very rapid among
Ans. • The receptors which give response to change in blood all mechanism involved in regulation of blood
pressure are called baroreceptors or pressoreceptors. pressure.
• The nervous mechanism regulates the blood pres-
sure by causing constriction and dilatation of vessels.
• The nervous mechanism constitutes the vasomotor
system. Vasomotor system consists of:
1. Vasomotor center
2. Vasoconstrictor fibers
3. Vasodilator fibers.
Vasomotor Center
Bilaterally situated in reticular formation of medulla oblongata
and lower part of pons. Vasomotor center has three areas:
1. Vasoconstrictor area.
2. Vasodilator area.
3. Sensory area.
Vasoconstrictor Area
It is also called pressure area and is situated in the anterior part
of vasomotor center in medulla oblongata.
♦ This area sends impulses to vessels through sympathetic
vasoconstrictor fiber.
♦ Stimulation of this area causes vasoconstrictor area and
Fig. 36: Baroreceptors increases blood pressure.
♦ The area also concerned with heart rate.
Physiology 383
Vasodilator Area
It is also called depressor area and is situated in the upper part systole
in medulla and suppresses the vasoconstrictor area and causes
vasodilation. It is also concerned with cardioinhibition. diastole
3. Pulse pressure : Difference between systolic
Sensory Area and diastolic pressure.
4. Mean pressure : Average pressure exerting
♦ It is situated in the posterior part of vasomotor center
on vessels.
which is situated in medulla and pons.
♦ This receives sensory impulses from glossopharyngeal and • When blood pressure is decreased the extraglomeru-
vagal nerve and from baroreceptor. lar apparatus secretes the hormone renin. When
Vasoconstrictor Fibers renin is released into blood, it acts on specific plasma
protein called angiotensinogen and convert it into
♦ The nerve fibers which cause constriction of blood vessels decapetide called angiotensin I. This is converted to
are called vasoconstrictor fibers. angiotensin II by activity of converting enzyme in
♦ The vasoconstrictor fibers belong to sympathetic division lungs.
of autonomic nervous system. • Angiotensin II acts in two ways to increase the blood
♦ The fibers cause vasoconstriction by release of neurotrans- pressure:
mitter substance noradrenaline. 1. It causes vasoconstriction in the body so that
Vasodilator Fibers peripheral resistance is increased and blood
pressure rises.
The nerve fibers which cause dilatation of blood vessels are 2. Angiotensin II also stimulates adrenal cortex
called vasodilator fibers. They are of three types: to stimulate aldosterone. This increases reab-
1. Parasympathetic vasodilation fibers sorption of sodium from renal tubules. Sodium
2. Sympathetic vasodilation fibers reabsorption is followed by water reabsorption
3. Antidromatic vasodilation fibers. and thereby ECF volume is increased and blood
The vasomotor center regulates blood pressure by receiving pressure becomes normal.
in from baroreceptors.
Q.14. Write a short note on triple response.
Q.12. Write in brief on vasovagal attack. (Mar 2009, 6 Marks) (Mar 2000, 5 Marks)
Ans. The severe emotional disturbances may cause fainting, Ans. It is the response by blood vessels of skin to a mechanical
this is known as vasovagal attack. stimulus. This is called triple response. It constitutes
• This is due to activation of sympathetic vasodilator three reactions which occur one after another. The three
fibers, which causes dilatation of peripheral blood reactions of this response are:
vessels and fall in blood pressure. 1. Red reaction: If a pointed instrument is drawn firmly
• Simultaneously, cardioinhibitory center is stimu- over the surface of skin, a red line appears instead of
lated. This increases vagal tone and reduced heart white line. This is called red reaction. The reaction
rate. occurs over the line of stroke. Red reaction is because
• The reduced blood pressure and heart rate leads to of dilatation of capillaries produced by mechanical
ultimate result in reduction of blood flow to brain stimulus. The reaction is purely a local response. It
which causes fainting. occurs mostly due to release of histamine substances.
• The vasovagal attack is a neurogenic shock due to 2. Flare: If a stroke is applied with little more force or
decreased vascular capacity. if stroke is repeated on same line, the red reaction
Q.13. Write about the role of renin angiotensin aldosterone spreads around line of stroke. It spreads for about
system in long-term regulation of blood pressure. 10 cm from line of stroke. This is called flare
(Mar 1998, 5 Marks) or spreading flush. Flare is due to dilatation of
Or arterioles. This is due to axon reflex.
3. Wheal: If the intensity of stimulus is severe, the
Describe in brief renin angiotensin mechanism for surface of skins on line of stroke is interrupted. A
regulation of blood pressure. (Mar 2006, 10 Marks) small elevation or swelling is seen on surrounding
Or area up to height of 2 mm. This is called wheal or
Write on long-term regulation of blood pressure. local edema. Wheal appears due to leakage of fluid
(Apr 2017, 5 Marks) from capillaries.
Ans. Blood pressure is the lateral pressure exerted by blood Q.15. Write in brief on hemorrhagic shock.
on the vessel walls while flowing through it. The blood (Apr 2007, 10 Marks)
pressure is expressed in different terms. (Aug/Sep 1998, 6 Marks) (Sep 2007, 4 Marks)
384 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
2. On heart rate: Heart rate increases during Q.18. Write in brief on Fick’s principle.
exercise. The heart rate increase during (Mar 2006, 3 Marks)
exercise is due to vagal withdrawal. Ans.
3. On cardiac output: During exercise, the As per the Fick’s principle the amount of substance taken up
cardiac output is increased because of by an organ per unit time is equal to the arterial level of the
increase in heart rate and stroke volume. substance minus the venous level (A–V difference) times the
Increased heart rate is because of vagal blood flow i.e. amount of substance taken per min = (A–V)
withdrawal and increase stroke volume is difference of the substance × blood flow per min.
because of increase in force of contraction.
4. On blood pressure: During moderate Amount of substance taken/min
Blood flow/min =
isotonic exercise, the systolic pressure is (A—V) difference of the substance
elevated. This is due to increased heart rate
and stroke volume. Diastolic pressure is not Fick’s principle is used to determine cardiac output, So
altered since peripheral resistance is not LV Output = Amount of Oxygen consumed by the whole
changed during moderate isotonic.
body per unit time
Respiratory adjustment during exercise: On the
basis of severity, the exercise is classified into three (A—V) oxygen difference across the lungs
types: As arterial blood has same oxygen content in all parts of the
1. Severe exercise: It includes strenous muscle ac- body, the arterial oxygen content can be measured in sample
tivity but severity can be maintained for severe obtained from any convenient artery. Sample of venous blood
duration. Complete exhausion occurs at end of in pulmonary artery is obtained by cardiac catheter which is
severe exercise. inserted via a foramen vein and its tip is guided in right atrium
2. Moderate exercise: It does not involve strenous by fluoroscope and through right ventricle in pulmonary
muscular activity. So this type of exercise is artery. Oxygen consumption is determined by the close circuit
performed for longer period. Exhaustion does spirometry.
not occur at the end of moderate exercise.
Calculation of cardiac output is as follows:
3. Mild exercise: This is very simple form of
exercise. Little or no changes occur in respiratory LV output = Resting oxygen consumption in body (mL/min)
system during this exercise. So exhaustion does [AO2] [VO2]
not occur during mild exercise.
= 250 mL/min
Effects of Exercise on Respiratory System
19 mL/dL arterial blood – 14 mL/dL venous
1. Effect on pulmonary ventilation: It is the
blood in pulmonary artery
amount of air that enters and lungs being in one
minute. During exercise, hyperventilation occurs = 250 mL/min
causing increase in rate and force of respiration. 5 mL/dL
The factors which undergo adjustments during
= 250 ×100
increase in pulmonary ventilation are higher
centers, chemoreceptors, proprioceptors, body 5
temperature and acidosis. = 5000 mL/min or 5L/min.
2. Effects on diffusing capacity for oxygen: During
exercise, blood flow through pulmonary capillaries Disadvantages
is increased. Because of this, diffusing capacity of ♦ As this technique is invasive so risk of hemorrhage and
alveoli for oxygen is increased. infection is present.
3. Effect on consumption of oxygen: The oxygen ♦ As patient get conscious about the whole technique so
consumed by the tissues particularly by skeletal cardiac output of the patient can be somewhat higher as
muscles is greatly enhanced during exercise. compared to the normal.
Because of vasodilatation in muscles during ♦ During this method ventricular fibrillation may occur
exercise, more amount of blood flows through which is a fatal complication. This occurs if the indwell-
muscles, so more amount of oxygen diffuses ing catheter irritates the ventricular walls specially when
into muscles from blood and amount of oxygen cardiac output is being measured during heavy exercise.
utilized by muscles is directly proportional to
amount of oxygen available. Q.19. Write a short note on brain bridge reflex.
4. Effects on respiratory quotient: It is the ratio be- (Dec 2004, 5 Marks)
tween the volume of CO2 evolved and volume of Ans. It is also called as cardioaccelerator reflex.
oxygen consumed. It increases during exercises. • Increase in venous return causes stretching of the
Its value during exercise is 1.5 to 2 and at resting wall of right atrium and big veins. Stretch receptors
condition is 0.8. are stimulated in the wall.
386 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦ High-pressure baroreceptors are located in the ventricle When Blood Pressure Increases
and arterial side of circulation, and the low-pressure
baroreceptors are mainly present in the atria and
pulmonary circulation (cardiopulmonary baroreceptors).
♦ Receptors for baroreceptor reflex are high-pressure baro-
receptors that are present in the wall of the carotid sinus
and aortic arch.
♦ These receptors are branched, knobby and intertwined
terminals of myelinated nerve fibers.
♦ Baroreceptors detect change in pressure in blood vessels
in the wall of which they are located.
♦ The increase in blood pressure causes distension of carotid
sinus and aortic arch and stimulates receptors as they
respond to stretch of the organ. Conversely, decreased
pressure decreases the receptor stimulation.
Afferent Pathways
Ninth cranial (glossopharyngeal) nerve is the afferent from
carotid sinus and tenth cranial (vagus) nerve is the afferent
from aortic arch.
♦ The fibers from carotid sinus in the glossopharyngeal nerve
form a distinct branch called carotid sinus nerve. This is
also called as buffer nerve as it buffers blood pressure when
blood pressure changes.
♦ The fibers in the vagus nerve that carry sensation from
aortic arch form the aortic nerve.
♦ Distension of carotid sinus and aortic arch causes stretch-
ing of the baroreceptors and increases the firing (nerve
traffic) in IX and X cranial nerves respectively.
Responses
Responses depend on the nature of change (increase or decrease)
in blood pressure. Responses also depend on degree and rate
of change in blood pressure.
Physiology 389
Pressure Range for Responses Events in Cardiac Cycle Explaining Pressure and Volume
Changes
Baroreceptors regulate blood pressure in the pressure range of
50 to 200 mm Hg. However, a linear relationship is observed Arterial Systole
for the change in blood pressure and the baroreceptor discharge
♦ Its duration is of 0.1 second.
between pressure range of 70 to 140.1 mm Hg. No response is ♦ During this phase arterial pressure rises along with the
detected when pressure is less than 50 mm Hg and no further ventricular pressure. Right arterial pressure rises up to 4 to
increase in response occurs when pressure is more than 200 6 mm Hg while left arterial pressure rises to 7 to 8 mm Hg.
mm Hg. ♦ This increases approximate 30% of blood volume in ven-
tricles.
Types of Responses
Baroreceptors respond to change in pulse pressure and change Ventricular Systole
in mean arterial pressure. It consists of two major phases, i.e. isovolumetric ventricular
♦ Response to change in pulse pressure is called phasic or contraction and ventricular systole proper.
dynamic response and response to change in sustained
pressure is called tonic or static response. Isovolumetric Ventricular Contraction
♦ Decrease in pulse pressure without change in mean arterial ♦ Its duration is of 0.05 seconds.
pressure decreases carotid sinus discharge, and decrease ♦ As atrial contraction is off, pressure in both atria and
in mean arterial pressure without change in pulse pressure ventricles decreases. The ventricles get invaded by excita-
also decreases sinus nerve discharge. tion process. Ventricular contraction start and pressure in
♦ However changes in pulse pressure and mean arterial ventricles increases which exceed atrial pressure rapidly
pressure usually occur simultaneously. causing closure of AV valves.
♦ Pressure in ventricles rises at the time of isometric phase.
Physiological Significance of Baroreceptor Reflex ♦ Onset of ventricular systole leads to bulging of AV valve in
♦ When blood pressure falls, baroreceptor reflex operates atrium which causes sharp rise in atrial pressure.
within few seconds to correct the pressure, which is essen- Ventricular Systole Proper
tial and life saving in acute hypotension and hemorrhage.
♦ Its duration is of 0.25 sec.
This is also life saving in day-to-day activities
♦ When pressure in left ventricle exceed pressure of aorta,
♦ Baroreceptor reflex regulates blood pressure when pres-
i.e. 80 mm of Hg and pressure in right ventricle exceed
sure change is within the range of 50 to 200 mm Hg. So,
pressure in pulmonary artery, i.e. 10 to 12 mm of Hg the
baroreceptors and their reflex pathway constitute a feed- semilunar valves open.
back mechanism to stabilize blood pressure over a wide ♦ As semilunar valves open, ejection phase occur. In this
range of fluctuation in pressure. phase articular and ventricular pressure are close to each
♦ Baroreceptor reflex explains the physiological basis for other. This is subdivided in three phases
Marey's law, which states that heart rate is inversely pro- 1. Initial phase or rapid ejection phase
portional to blood pressure. – Its duration is of 0.1 second.
♦ Baroreceptor resetting occurs in chronic hypertension. – Pressure inside the ventricles rises to 120 mm
Q.26. Write in brief on atherosclerosis. of Hg in left ventricle and 25 mm of Hg in right
(May/June 2009, 5 Marks) ventricle which causes increase in output of ven-
Ans. Atherosclerosis is the condition which is characterized tricular volume.
by infiltration of cholesterol under the tunica intima of – Around two-third of stroke volume is ejected in
arterial wall. this phase.
– As there is opening of semilunar valves the AV
• This causes the changes in smooth muscle cells,
valves regain their position and blood pressure falls.
platelets, macrophages and inflammatory mediators
2. The Summit or Peak of ventricular curve occurs
which produce proliferative lesions which ulcerate
when aortic or pulmonary artery pressure exceeds
and calcify.
ventricular pressure.
• The above changes predisposes to myocardial infarc- 3. Final phase or slow ejection phase
tion, cerebral thrombosis, etc. – Its duration is 0.15 sec.
Q.27. Describe cardiac cycle in detail, explaining pressure – Ventricular pressure decreases as ventricular
and volume changes during various phases. contraction subsides with slow ejection of blood
(Nov 2009, 8 Marks) from ventricles to arteries.
Ans. Sequence of changes in pressure and flow in heart Volume of blood which is ejected by each ventricle per
chambers and blood vessels in between the two stroke at rest is 70 to 80 ml and is known as stroke volume.
subsequent cardiac contractions is known as cardiac End diastolic ventricular blood volume is 120 to
cycle. 140 ml and leaves 50 ml of blood in each ventricle at end
390 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
of systole which is known as end systolic ventricular • AV node is a muscular bridge which connects atrium
blood volume. and ventricular musculature.
• From AV node the conduction of impulse is slow
Ventricular Diastole which is known as AV nodal delay. Conduction
It consists of four phases: velocity is 0.05 m/sec.
• From AV node impulse travel via bundle of His and
Protodiastole stimulates ventricular myocardium. The conduction
♦ It is of 0.04 sec duration. velocity is 1 m/sec.
♦ At end of ventricular systole the ventricular pressure • Middle part of interventricular septum over left side
decreases rapidly. is the first region in ventricle to be stimulated.
♦ During protodiastole arterial pressure is sustained and • From here impulse passes via septum to the right
immediately it increases. This causes closure of semilunar side and then it spread to apex over other side.
valves and produces second heart sound. • In ventricle, the impulse is conducted by purkinje
fibers at velocity of 4 m/sec. Conduction of impulse
Isovolumetric Ventricular Relaxation Phase is at rate 1 m/sec.
Its duration is of 0.08 sec.
♦ Q.29. Write in brief on regulation and measurement of BP.
In this pressure inside the ventricles drop rapidly and
♦ (Dec 2010, 6 Marks)
ventricular muscles relax, but there is no change in the Ans. For regulation of blood pressure refer to Ans 11 and 13
volume of ventricles. of same chapter.
Measurement of Blood Pressure
Arterial pressure is most commonly measured via a sphyg-
momanometer.
For each heartbeat, BP varies between systolic and diastolic
pressures. Systolic pressure is peak pressure in the arteries, which
occurs near the end of the cardiac cycle when the ventricles
are contracting. Diastolic pressure is minimum pressure in the
arteries, which occurs near the beginning of the cardiac cycle
when the ventricles are filled with blood. An example of normal
measured values for a resting, healthy adult human is 120 mm
Hg systolic and 80 mm Hg diastolic (written as 120/80 mm Hg).
Measuring pressure invasively, by penetrating the arterial
wall to take the measurement, is much less common and usually
restricted to a hospital setting.
Non-invasive
The non-invasive auscultatory and oscillometric measurements
are simpler and quicker than invasive measurements, require less
expertize, have virtually no complications, are less unpleasant and
less painful for the patient. However, non-invasive methods may
yield somewhat lower accuracy and small systematic differences
in numerical results. Non-invasive measurement methods are
more commonly used for routine examinations and monitoring.
Auscultatory
Auscultatory method aneroid sphygmomanometer with
stethoscope.
(June 2010, 5 Marks)
Ans. Following is the conduction of cardiac impulse in heart:
• Cardiac impulse originates in SA node and travel to
the myocardium of atrium in radial direction.
• Conduction velocity of impulse in SA node is 0.05
m/sec. Impulse spread to left atrium through the
common musculature which encircles it.
• Conduction velocity of impulse in atrium is 1 m/sec.
• Impulse is now conducted to AV node by atrial
muscle or internodal tract. Fig. 37: Sphygmomanometer with stethoscope
Physiology 391
(Jan 2012, 15 Marks)
Ans. Blood pressure is defined as the pressure of column of
blood in the arterial system.
Its normal value is 120/80 mm Hg.
Age
Both systolic and diastolic blood pressure increases with age.
Systolic blood pressure increases more than diastolic blood
pressure because of decreased distention of arteries. Diastolic
blood pressure decreases after 50 to 60 years of age.
Sex
In females before the menopause systolic blood pressure is
4 to 5 mm Hg less as compared to males of same age. After the
menopause systolic blood pressure 4 to 5 mm Hg more than
males of same age.
Body Built
In obese individuals brachial arterial pressure is high.
Climate
♦ In colds both systolic and diastolic blood pressures are high.
♦ In summer both systolic and diastolic blood pressures are
low as compared to winter season. (May 2014, 5 Marks)
Ans. Refer to Ans 27 of same chapter.
Diurnal Variation
In systolic blood pressure diurnal variation of 5 to 10 mm Q.33. Write about factors affecting heart rate.
Hg is common in systolic blood pressure. Peak values are (Sep 2005, 5 Marks)
seen at the time of afternoon and low values are seen at early Ans. Following are factors affecting heart rate:
morning. • Age: As age advances vagal tone increases and heart
rate decreases but in old age heart rate is slightly
Exercise higher because of fall in the vagal tone.
At the time of exercise blood pressure is high while at the time • Sex: Heart rate is slightly higher in females as com-
when exercise is stopped blood pressure come to its normal pared to males.
level within 5 min. • Body temperature: Due to rise in temperature there
is increase in the heart rate while with fall in body
Emotions temperature there is decrease in the heart rate.
• Drugs: Epinephrine increases heart rate because of
Worry excitement and fear increases systolic blood pressure.
direct action on the heart. Nor-epinephrine increases
Hereditary heart rate due to direct action on heart but its pressor
action leads to fall in heart rate.
Family tendencies of high or low blood pressure is common. • Respiration: With inspiration there is an increase in
the heart rate while during expiration the heart rate
Meals
decreases this is known as sinus arrhythmia.
Changes in systemic blood pressure is seen due to: • Emotional stimuli: Emotions such as excitement,
♦ Pressure over heart because of distended abdomen increases fear, anger, etc. increases heart rate while shock,
heart rate. grief, apprehension leads to decrease in heart
♦ Increase in epinephrine release from adrenal medulla. rate.
The above both factors increases systolic blood pressure by • Exercise: Along with the severity of exercise there
5 to 6 mm of Hg upto 1 hour after meals. is increase in the heart rate.
Physiology 393
Name of ECG
wave Cause of production of wave
P wave It is produced due to depolarization of atrial musculature
QRS complex It is caused by ventricular depolarization
T wave It is caused due to ventricular repolarization
U wave It occurs due to slow repolarization of papillary muscle
(Feb 2013, 6 Marks)
Ans. Origin of Heart Beat
• Part of heart from which rhythmic impulses for heart
beat generated is known as pacemaker.
• SA node acts as pacemaker as the rate of impulse
generation is highest by SA node.
• Whenever there is blockage of transmission of im-
pulse from SA node to AV node pacemaker activity
shifts from SA node to other sites such as AV node.
This is known as ectopic pacemaker.
♦♦ Stage II: Subject is asked to breadth out maximally after TLC = Tidal + Inspiratory + Expiratory + Residual
normal expiration. volume reserve reserve volume
Sum of stage I and stage II volumes give two stage vital capacity. volume volume
= 500 + 3300 + 1000 + 1200
Q.4. Describe various lung volumes and capacities. = 6000 ml.
(Jan 2012, 10 Marks)
Ans. Lung volumes and capacities are divided into two parts: Dynamic Lung Volume and Capacities
A. Static lung volume and capacities 1. Timed vital capacity or forced vital capacity: Forced
B. Dynamic lung volume and capacities. vital capacity is the maximum volume of air which is
breathed out as forcefully and rapidly as possible following
Static Lung Volume and Capacities
maximum inspiration. So timed vital capacity is similar to
Lung Volumes vital capacity except that there is special stress on “rapid,
forcible and complete exhalation.
♦♦ Tidal volume: The volume of air breathed in and out in a
single normal quite respiration. Tidal volume signifies the Components of timed vital capacity:
normal depth of respiration. Its value is 500 ml in normal • FEV1: It is the forced expiratory volume in 1 sec. It
adult male. is the volume of forced vital capacity in first second
♦♦ Inspiratory reserve volume: The additional amount of of exhalation. Its normal value is 80% of forced vital
capacity.
air that can be inspired forcefully often tidal volume is
• FEV2: It is the forced expiratory volume in 2 sec. It is
called inspiratory reserve volume. Its value is 3,300 ml in
the volume of forced vital capacity in first two seconds
normal adult male.
of exhalation. Its normal value is 95% of forced vital
♦♦ Expiratory reserve volume: The additional amount of air capacity.
that can be expelled out forcefully beyond tidal volume • FEV3: It is the forced expiratory volume in 3 sec. It
is called expiratory reserve volume. Its value is 1000 ml is the volume of forced vital capacity in first three
in normal adult male. seconds of exhalation. Its normal value is 98 to 100%
♦♦ Residual volume: Some amount of air always remain in of forced vital capacity.
lungs, this remaining amount of air after forceful respi- • Timed vital capacity distinguishes between restrictive
ration is called residual volume. Its value is 1,200 ml in and obstructive lung disorders.
normal adult male. 2. Expiratory flow during 25 to 75% of expiration: It is the
Lung Capacities mean expiratory flow rate during middle 50% of forced
vital capacity. Its normal value is 300 L/min. This is the
♦♦ Inspiratory capacity: It is the maximum amount of air sensitive indicator of small airway disease where most of
which is inspired starting from end of expiration. chronic obstructive pulmonary diseases start.
Inspiratory capacity = Tidal reserve volume + Inspiratory 3. Forced expiratory flow during 200 to 1200 mL of expira-
reserve volume tion: It is the mean expiratory flow rate between 200 to
= 500 + 3300 1200 mL segment of forced vital capacity. Its normal value
= 3800 ml. is 350 L/min.
♦♦ Expiratory capacity: It is the maximum amount of air 4. Minute ventilation or pulmonary ventilation: It is the
which is expired starting from end of inspiration. volume of air expired or inspired by lungs in one min. Its
Expiratory capacity = Tidal reserve volume + Expiratory normal value is 6 L/min.
reserve volume 5. Peak expiratory flow rate: It is the expiratory flow rate
= 500 + 1000 during peak of forced vital capacity. It normal value ranges
= 1500 ml. from 400 to 450 L/min. It is the simple test of ventilator
♦♦ Vital capacity: The maximum amount of air which is ex- function which is used in the clinical practice.
pelled out after forceful inspiration. It includes: 6. Maximum breathing capacity or maximum voluntary
= Tidal volume + Inspiratory reserve volume + Expira- ventilation or maximum ventilation volume: It is the larg-
tory reserve volume est volume of air which is moved in and out of the lungs
= 500 + 3300 + 1000 in one minute by maximum voluntary effort. Its normal
= 4800 ml. value ranges from 90 to 170 L/min.
♦♦ Functional residual capacity: The maximum amount of 7. Pulmonary reserve or breathing reserve: It is the maxi-
air in lung after normal expiration. It includes mum amount of air above the pulmonary ventilation which
FRC = Expiratory reserve volume + Residual volume can be breathed in and out of lungs in one min.
= 1000 + 1200 It is computed as maximum ventilation volume—pulmo-
= 2200 ml. nary ventilation. Its value is expressed in percentage. Its
♦♦ Total lung capacity: The amount of air present in lung value ranges from ≥ 60–70%. If value is less than 60% it is
after maximum inspiration. suggestive of presence of dyspnea.
396 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.5. Explain how CO2 is picked up by tissue capillary and Ans. Oxygen Transport or Carriage in Blood
then discharge into alveoli. (Sep 2009, 5 Marks) The oxygen is transported by blood from alveoli to tissue.
Ans. 1. Diffusion of carbon dioxide from tissues capillary The oxygen is transported in blood in two forms:
into blood: Due to continuous metabolic activity, 1. As simple physical solution/by plasma
carbon dioxide is produced constantly in the cells 2. In combination with hemoglobin.
of tissue. So partial pressure of carbon dioxide in the 1. Transport of oxygen as simple solution: Oxygen
cells is high, i.e. 46 mm Hg, and the partial pressure dissolves in water of plasma and transported in its
of carbon dioxide in arterial blood is 40 mm Hg. The physical form:
pressure gradient of 6 mm Hg is responsible for - The transport of oxygen in this form is less than
diffusion of carbon dioxide from tissues to blood. 3%.
2. From blood into alveoli: The partial pressure of - This type of transport is important in condi-
carbon dioxide in alveoli is 40 mm Hg, whereas in tion like muscular exercise to meet the excess
blood it is 45 mm Hg. The pressure gradient of 5 mm demand of oxygen by tissues.
Hg is responsible for diffusion of carbon dioxide 2. Transport of oxygen in combination of hemoglobin.
from blood into alveoli. Oxygen combines with hemoglobin in blood and
So, the above methods suggest that how CO2 is picked is transported as oxyhemoglobin. The transport
up by tissue capillary and then discharge into alveoli. of oxygen in this form is very important because
Q.6. Describe how CO2 is transported from tissues to lungs. as much as 97% of oxygen is transported by this
Write a note on periodic breathing. method.
(Sep 2004, 10 + 5 Marks) Oxygen combined with hemoglobin only such as a
Ans. The transport of CO2 from tissues to lungs is described physical combination. No oxidation takes place. It
in Ans 5 of the same chapter. is only oxygenation. The advantage of this type of
combination is that oxygen can be readily released
Periodic breathing: The abnormal or uneven respiratory
from hemoglobin when it is needed.
rhythm is called periodic breathing. There are two types Oxygen combines with the iron of heme part of
of periodic breathing: hemoglobin which is present in ferrous form. Each
1. Cheyne-stokes breathing: This is the most common iron combines with oxygen and remains in ferrous
type of periodic breathing. It is marked by two al- form. So the combination of hemoglobin with oxy-
ternate periods, which are: gen is a physical process. No oxidation takes place. 1
i. Rapid deep respiration, i.e. hyperemic period gm of hemoglobin carries 1.34 gm of oxygen, this is
ii. Complete cessation of respiration, i.e. apenic known as oxygen-carrying capacity of hemoglobin.
period
This type of breathing occurs during deep sleep; Carbon Dioxide Carriage in Blood
in newborn babies; in high attitude, during in-
Carbon dioxide is transported by blood from tissues into alveoli;
creased intracranial pressure. During advance
carbon dioxide is transported in blood in the following ways:
cardiac diseases leading to cardiac failure and
♦♦ Dissolved form: CO2 diffuses into blood and dissolves in
during advance renal diseases leading to uremia.
2. Bitot’s breathing: This is another form of periodic fluid of plasma forming a simple solution. This is about
breathing. This is characterized by period of apnea 7% of CO2 in blood.
and hyperpnea. It occurs in condition involving ♦♦ As carbonic acid: Part of dissolved carbon dioxide in
nervous disorders, due to lesions or injuries to brain. plasma, combines with water to form carbonic acid.
♦♦ Transport of carbon dioxide as bicarbonate: About 63%
Q.7. Write about oxygen transport in body. of CO2 is transported as bicarbonate. From, plasma CO2
(Mar 1998, 5 Marks) enters the RBCs. Inside RBCs, it combines with water
Or to form carbonic acid. This is carried out in presence of
Describe in brief transport of oxygen in blood. carbonic anhydrase. The carbonic acid is unstable and
(Oct 2007, 5 Marks) (Mar 2008, 4 Marks) breaks into bicarbonate and hydrogen ions. The increased
(Dec 2009, 5 Marks) concentration of bicarbonate inside RBC causes diffusion
Or of bicarbonate ions through cell membrane into plasma.
Write on transport of oxygen and carbon dioxide by Q.8. Write a short note on oxygen dissociation curve and
blood. (Feb 2013, 7 Marks) (June 2010, 2.5 Marks) factors affecting it. (Sep 2000, 5 Marks)
Or Or
Write short note on transport of respiratory gases in Write short note on oxygen hemoglobin dissociation
blood. (Feb 2013, 7 Marks) curve. (Oct 2014, 3 Marks)
Or Or
Write short answer on oxygen transport in blood. Write about O2 hemoglobin dissociation curve.
(Aug 2018, 5 Marks) (Sep 2015, 7 Marks)
Physiology 397
Q.12. Write a short note on cyanosis. ♦ Central cyanosis: It is seen in the earlobes and the mucus
(Apr 2003, 5 Marks) (Aug 2012, 5 Marks) membranes of lips and tongue.
Ans. Cyanosis is clinical condition in which the skin and Q.13. Write a short note on acclimatization at high altitude.
mucous membrane assume a bluish color. It is due to (Aug/Sep 1998, 5 Marks) (Mar 2001, 5 Marks)
large amounts of reduced hemoglobin in blood. The Or
quantity of hemoglobin should be at least 5 to 7 g% in Describe in brief acclimatization to high altitude.
the blood to cause cyanosis. (Aug 2005, 7.5 Marks)
Distribution of cyanosis: When it occurs, cyanosis is Ans. While staying at high altitude for several days to several
distributed over whole body. But it is more marked in month, a person gets slowly adapted or adjusted to low
certain region where the skin is thin. These areas are lips, oxygen tension so that hypoxia causes lesser and lesser
cheek, nose, ear, lips and finger tips above the base of nail. effect on the body.
1. Inadequate oxygenation of blood in the lungs, i.e. Following changes occur in body during acclimatization.
a. Disease of lungs 1. Blood: During acclimatization, the hematocrit value rises
b. Collapse of lungs from 49 to 59%, the hemoglobin concentration in blood
increases from 15 to 20% g. So oxygen-carrying capacity
c. Carbon monoxide poisoning
of blood also increases thus the more oxygen is carried to
d. Heart failure.
the tissue.
2. Admixture of arterial and venous blood: This takes place
During hypoxia, erythropoietin is released from
in certain congenital heart diseases. juxtaglomerular apparatus and it stimulates bone marrow
3. Greater reduction of oxyhemoglobin: formation and causes formation of RBC, so that RBC count
a. Venous obstruction: This will restore the local circulation increases in the blood.
and allow more time for greater reduction of hemoglobin. 2. Cardiovascular system: There is increase in heart rate,
b. Local chilling. cardiac output, and vascularity is increased in the body.
There is increase in blood flow in vital organs of body.
Types of Cyanosis
3. Respiratory center: Due to increase in pulmonary ventila-
♦♦ Peripheral cyanosis: It is seen in nail beds and is sugges- tion and increased blood flow, the diffusion capacity of
tive of stagnant hypoxia. gases increase in alveolar level.
400 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.14. Write a short note on Hering-Breuer reflex. - Diffusion is directly proportional to solubility.
(Dec 2004, 5 Marks) - Carbon dioxide get diffuses with high rate as its
Ans. Hering-Breuer Reflex solubility is more than oxygen.
• The impulses from the lungs bring about a respira- 3. Molecular weight of gas: Diffusion is inversely
tory reflex called Hering-Breuer reflex. proportional to molecular weight of gas.
• Wall of the bronchi and bronchiole contain stretch 4. Alveolocapillary membrane: The thickness of
receptors, which give response to stretch of lung alveolocapillary membrane is 0.2-0.5 µm.
tissues. - Gas diffusion is inversely proportional to thick-
• So, during inspiration when there is stretching of ness.
lung tissues due to expansion, the stretch recep- - Increase in thickness of alveolocapillary mem-
tors or Hering-Breuer are stimulated and produce brane is seen in pulmonary edema and fibrosis
impulses. of lung.
• The impulses are carried by vagal afferent fibers to - Diffusion is directly proportional to permeability
respiratory centers. The impulses actually inhibited of membrane.
inspiratory center and so inspiration stops expiration - Fibrosis leads to decrease in permeability.
starts. - Diffusion is directly proportional to surface area
This reflex is a protective reflex, it restricts the inspiration of alveolocapillary membrane.
and limits over stretching of lung tissues. This is called - Surface area decreases in lung collapsation.
Hering-Breuer inflation reflex. The reverse of this reflex Q.17. Write in detail about physiology of respiration.
is called Hering-Breuer deflation reflex. (Aug 2011, 11 Marks)
Q.15. Write a short note on spirometry. (Sep 2006, 5 Marks) Or
Ans. The method by which lung volumes and capacities are Write in brief mechanics of respiration.
measured is called as spirometry. (Apr 2008, 5 Marks)
The simple instrument is used for this purpose is Ans. Following is the physiology of respiration: Main
called as spirometer. function of respiratory system is to remove oxygen
from atmosphere and to deliver it to tissues and to
Spirometer remove carbon dioxide from tissues and discharge it in
It is made up of metal, it contain two chambers outer and atmosphere.
inner. Outer chamber is filled with water. The drum is counter • Lungs expand and the atmospheric air which con-
balanced by a weight which is attached to the inner drum. A long sists of oxygen enters inside the lungs.
metal tube passes through the inner chamber from the bottom • Oxygen is extracted and is transferred to blood
towards the up. A rubber tube is connected to the outer end of present in pulmonary capillaries.
the metal tube and a mouthpiece is attached to the other end • Oxygenated blood is circulated to the tissues all
through which subject respires. throughout the body.
When the subject breathes with the spirometer, during • At the level of tissue blood deliver oxygen to the
inspiration the drum moves up and the counter weight tissues which utilizes oxygen and produce carbon
comes down and reverse of this occur during inspiration. dioxide. Carbon dioxide is delivered back into the
The upward and downward movement of the counter weight blood.
can be recorded in the form of a graph paper by attaching a • Deoxygenated blood brings carbon dioxide to lungs
pen with ink to the counter weight. The upward curve of the whereas carbon dioxide is diffused out of lungs.
graph shows inspiration and the downward deflection denotes • Lungs deflate and discharge impure air which is
expiration. The spirometer can be used only for a single breath. carbon dioxide to atmosphere.
Repeated cycle cannot be recorded due to accumulation of CO2 • Physiology of respiration is divided in three divisions:
in spirometer. 1. External respiration, i.e. breathing: Absorption
of oxygen and removal of carbon dioxide from
Q.16. Write in brief factors affecting diffusion of gases. body.
(Dec 2010, 5 Marks) 2. Transport of gases in blood.
Ans. Factors affecting diffusion of gases are as follows: 3. Internal respiration, i.e. utilization of oxygen
1. Pressure gradient and production of carbon dioxide by cells and
2. Solubility of gases gaseous exchange between cells and their fluid
3. Alveolocapillary membrane mechanism.
4. Molecular weight of gas
External Respiration
1. Pressure gradient: Higher pressure gradient leads
to the better diffusion. Inspiration
2. Solubility of gas: Diffusion get increased with in- ♦♦ At the time of inspiration the thoracic cavity expands in three
crease in the solubility of gas in water. dimensions, i.e. vertical, transverse and anteroposterior.
Physiology 401
♦♦ Diaphragm contracts and leads to increase in vertical alveoli through thin pulmonary and capillary endothelium
dimension, this causes increase in thoracic cavity. in plasma so the arterial blood leaves the lungs almost fully
♦♦ Contraction of intercoastal muscle leads to increase in saturated with oxygen.
anterioposterior and transverse dimensions of thorax.
♦♦ Upper six ribs leads to the increase in anteroposterior and Carriage of Carbon Dioxide in Blood
transverse dimensions of the thorax. ♦♦ Carbon dioxide content of arterial blood is 48 mL /dL
♦♦ Seven, eighth and tenth rib causes increase in transverse and that of venous blood is 52 mL/dL. So each 100 mL of
dimension. arterial blood which passes through tissue pick 4 mL of
carbon dioxide.
Expiration
♦♦ Carbon dioxide get accommodated in plasma, when
♦♦ It is a passive process. plasma is fully saturated carbon dioxide get accumulated
♦♦ Contraction of anterior abdominal muscles causes increase in in RBCs. So total 4 mL/dL of carbon dioxide is transported
intra-abdominal pressure and pull lower ribs down and me- in blood, 2.4 mL/dL is transported in plasma and remain-
dially, pushing diaphragm upwards and causing expiration. ing 1.6 mL/dL within RBC.
♦♦ Carbon dioxide is carried in plasma and RBCs in three
Transport of Gases in Blood
forms, i.e. dissolved form, as carbamino compound and
Transport of Oxygen as bicarbonate.
Oxygen is carried in blood in two forms, i.e. Carriage of Carbon Dioxide in Lungs
1. In dissolved form
2. In combination with hemoglobin Partial pressure of carbon dioxide in venous blood is 46mm of
Hg with carbon dioxide content 52 ml/dl whereas alveolar air
In dissolved form the amount of oxygen is 0.3 ml per 100 ml of
partial pressure of carbon dioxide is 40 mm Hg with carbon
blood per 100 mm Hg partial pressure of oxygen. The quantity
dioxide content 48 ml/dl. For each 100 ml of venous blood while
of dissolved oxygen increases in linearity with arterial partial
passing through lungs releases 4 ml of carbon dioxide.
pressure of oxygen. Tension exerted by a gas in blood is the
property of dissolved gas. Part of carbon dioxide from dissolved solution and
carbamino compound break to liberate carbon dioxide.
Single hemoglobin molecule consists of iron in ferrous form.
Hemoglobin becomes oxygenated forming oxyhemoglobin
Six valency bond of each ferrous iron combines with 1 mole
which increases the acidity of cell to mobilize chloride shift
of oxygen. So four moles of oxygen combine with one mole
in the reverse order. Chloride comes out of cell reacts with
of oxygen. Oxygen carrying power of hemoglobin is given by
bicarbonate in plasma forming sodium chloride and liberating
oxygen hemoglobin dissociation curve.
bicarbonate. Bicarbonate from plasma enters cell and combine
Transport of Carbon Dioxide with free potassium ion forming potassium bicarbonate. Within
RBC the oxyhemoglobin being stronger acid than carbonic acid
Tissue produces carbon dioxide which enters the blood because of:
releases hydrogen from hemoglobin. Released hydrogen joins
♦♦ Difference in partial pressure of carbon dioxide between with bicarbonate released from potassium bicarbonate forming
arterial blood and tissues. Arterial partial pressure of bicarbonic acid and free potassium ion with oxyhemoglobin
carbon dioxide is 40 mm Hg and tissue partial pressure
forms potassium oxyhemoglobin. Bicarbonic acid is broken
of carbon dioxide is 46 mm Hg.
up by carbonic anhydrase in RBC in water and carbon dioxide.
♦♦ Carbon dioxide has high diffusion coefficient, i.e. 20 times
Carbon dioxide diffuses in plasma and there is nothing to fix it
more than oxygen; therefore even this small pressure gradi-
so carbon dioxide is liberated through lungs along the pressure
ent of 6 mm Hg is sufficient for transport of carbon dioxide.
gradient.
♦♦ Decrease in oxygen content shift carbon dioxide dissociation
curve to left leading to further loading of carbon dioxide Q.18. Describe pulmonary ventilation. (Sep 2013, 5 Marks)
from tissues to blood. Ans. It is also known as minute ventilation.
• Pulmonary ventilation is the volume of air expired
Internal Respiration
or inspired by the lungs in one minute.
Carriage of Oxygen in Tissues • Normal pulmonary ventilation is 6 L/min.
• In moderate exercise it increases to about 60 L/min.
At rest due to partial pressure gradient tissues remove 5 mL of
• In severe exercise it increases to about 100 L/min.
oxygen for each 100 mL of blood passing through it. 250 mL of
oxygen per minute is transported from blood to body tissues Q.19. Write short note on Bohr’s effect. (Feb 2014, 3 Marks)
and this is called as oxygen consumption of whole body at rest. Ans. This phenomenon was given by Bohr in 1904.
• In the tissues the metabolic activities shift oxygen-
Carriage of Oxygen in Lungs
hemoglobin dissociation curve to right decrease the
In lungs venous blood partial pressure of oxygen is 40 mm Hg affinity of hemoglobin for oxygen, so carbon dioxide
and alveolar air partial pressure of oxygen is 100 mm Hg. So enters the blood from tissues and causes unloading
because of the pressure gradient oxygen rapidly diffuses from of oxygen. This is called as Bohr’s effect.
402 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
through them. As cardiac output is 5 liter/minute, so ♦ Accumulation of carbon dioxide leads to hyperventilation
approximately 250 mL of oxygen per minute is transported which lowers partial pressure of carbon dioxide.
from blood to body tissues known as oxygen consumption ♦ Decreased partial pressure of carbon dioxide eliminates
of whole body at rest. carbon dioxide drive on ventilation and produces apnea,
♦ During activity: At the time of activity changes taking place which consequently increases partial pressure of carbon
in the body are: dioxide again.
Increase in carbon dioxide production ♦ Increase sensitivity of respiratory mechanism to partial
Rise in the body temperature pressure of carbon dioxide produces hyperventilation and
Increase in hydrogen ion concentration the cycle continues.
Increase capillary density
Local arteriolar dilatation: Increased capillary density
along with local arteriolar dilatation increase blood 10. NERVOUS SYSTEM
flow to tissues.
Depending on the degree of activity, oxygen tension
inside the tissues may fall to zero. This causes very
steep oxygen pressure gradient between blood and
tissues, thereby leading to rapid diffusion of oxygen.
So, coefficient of oxygen utilization varies from 65
to 80%
Increase in RBC count due to splenic contraction:
Increase in capillary density and increase in RBC count
due to splenic contraction leads to increase in delivery
of oxygen to tissues by 5 times. This along with three
times more oxygen extraction by tissues eventually
increases oxygen transport to tissues by 15 times.
3. The myelin sheath is formed by cells of Schwann slowly. The Mechanism of Saltatory Conduction
cell looses the excess fluid and nucleus occupy central position.
The myelin sheath is not permeable to ions. So the entry
Q.3. Write a short note on saltatory conduction. of sodium from ECF into nerve fibers occurs only in node
(Mar 2000, 5 Marks) of Ranvier, where myelin sheath is absent. This causes
Ans. The conduction of impulse through a myelinated depolarization in node.
nerve fiber is 50 times faster than non-myelinated Thus, the depolarization occurs at successive nodes. So,
nerve fiber. This is because myelin sheath forms on action potential jump from one node to another. Hence, it is
effective insulation, and flow of current through this called saltatory conduction.
sheath is negligible, but action potential jump from one Q.4. Write in tabular form different receptors and their
node to another node of Ranvier. So velocity of conduction functions. (Sep 2013, 5 Marks)
is faster. This type of jumping of action potential from one Ans. The different receptors and their functions are as
node to another is called saltatory conduction. follows:
Receptors Functions
1. Extroceptors 1. Give response to stimuli arising from outside the body
a. Cutaneous receptors a. They give response to mechanical stimulus
i. Touch receptors i. Give response towards touch
ii. Pressure receptors ii. Give response towards pressure
iii. Temperature receptors iii. Give response towards temperature
iv. Nociceptors iv. Give response towards pain
b. Chemoreceptors b. Give response towards chemical stimuli
c. Telereceptors c. Give response to stimuli arising away from body
i. Phonoreceptors i. Give response to auditory sensation
ii. Photoreceptors ii. Give response to visual sensation
2. Introceptors 2. They give response to stimuli arising within the body
a. Visceroreceptors a. They give response to stimuli arising from viscera
i. Stretch receptors i. Give response towards stretch
ii. Baroreceptors ii. Give response towards blood pressure changes
iii. Chemoreceptors iii. Give response towards chemical stimuli from inside the body
b. Proprioceptors b. They give response to change in position of different parts of body
i. Muscle spindle i. It is the receptor organ for stretch reflex
ii. Golgi tendon organ ii. It gives response to change in force of tension developed in skeletal muscle during contraction
iii. Pacinian corpuscle iii. It gives response to pressure changes
iv. Free nerve ending iv. It gives response to pain sensation
Q.5. Write briefly on synaptic transmission. is influx of calcium ions from ECF into axon termi-
(Mar 1998, 7.5 Marks) (Mar 2008, 3 Marks) nals. Now there is opening of vesicle and release of
Or neurotransmitter acetylcholine. The neurotransmitter
passes through presynaptic membrane and synaptic
Write short note on synapse. (Dec 2010, 5 Marks) cleft and reaches postsynaptic membrane.
Ans. • The junction between two neurons is called synapse.
• Synapse is formed by presynaptic and postsynaptic
neuron, the spaces between the two neurons is called
synaptic cleft.
• Synaptic transmission
The main function of the synapse is to transmit the
impulse, i.e. action potential from one neuron to another.
When the action potential reaches presynaptic axon
terminal, the following events occur in synaptic
transmission:
1. Presynaptic neuron: As the action potential reaches
the axon terminal, the voltage gated calcium channels
get opened in presynaptic neuron/membrane. There Fig. 41: Synapse
Physiology 405
2. Postsynaptic neuron: Now, here the binding of 5. Effector organ: The effector organs like muscle or
acetylcholine with receptor protein of postsynaptic gland show response to stimulus.
membrane and formation of acetylcholine receptor
complex takes placed. The ligand gated sodium
channels in postsynaptic membrane get opened and
there is influx of sodium from ECF. Now develop-
ment of excitatory postsynaptic potential takes place.
The influx of sodium from ECF and development
of action potential take place. The action potential
through the axon of postsynaptic neuron spreads.
In this way synaptic transmission takes place.
Q.6. Write a short note on properties of synapse.
(Sep 2004, 5 Marks) (Jan 2012, 6 Marks)
Fig. 42: Reflex arc
Ans.
Properties of Synapse Q.8. Write briefly on conditioned reflex. (Sep 2004, 5 Marks)
Ans. • Conditioned reflex is a reflex response acquired or
♦♦ One way conduction: According to Ball Magendie law, the learnt by experience. It is the basis of learning. The
impulses are transmitted only in one direction in synapse, conditioned reflex is acquired after the birth.
i.e. from presynaptic neuron to postsynaptic neuron. • The conditioned reflex are of two types:
♦♦ The synaptic delay: During transmission of impulses via 1. Classical conditioned reflex: These reflexes are
the synapse, there is a little delay in transmission. This is those reflexes which can be established by a con-
called synaptic delay. This may be due to time taken for: ditioned stimulus followed by an unconditioned
• Release of neurotransmitter stimulus. They are divided into two groups:
• Movement of neurotransmitter from axon terminal to a. Positive or excitatory conditioned reflex:
postsynaptic membrane. They are of three types:
• Action of neurotransmitter to open the ionic channels i. Primary conditioned reflex: The develop
in postsynaptic membrane. ment of conditioned reflex with one
♦♦ Fatigue: The fatigue at synapse is due to depletion of unconditioned reflex stimulus and one
neurotransmitter substance, i.e. acetylcholine. After pro- conditioned stimulus is called primary
ducing the action, the neurotransmitter is destroyed by conditioned reflex.
acetylcholinesterase. ii. S econdary conditioned reflex: The
♦♦ Summation: When many members of presynaptic excita-
development of a conditioned reflex with
tory terminals are stimulated simultaneously or when sin-
one unconditioned stimulus and two
gle presynaptic terminal is stimulated repeatedly there is
conditioned stimulus is called secondary
summation, i.e. there is progressive increase in excitatory
conditioned reflex.
postsynaptic potential. It is of two types:
iii. Tertiary conditioned reflex: The develop
1. Spatial summation: This occurs when many pre
ment of a conditioned reflex with one
synaptic terminals are stimulated simultaneously.
unconditioned stimulus and three
2. Temporal summation: It occurs when one presynaptic
conditioned stimulus is called tertiary
terminal is stimulated repeatedly.
conditioned reflex.
♦♦ Electrical property: The electrical properties of synapse are
b. Negative or inhibition conditioned reflex:
excitatory and inhibitory postsynaptic potential.
This is of two types:
Q.7. Write a short note on reflex arc. (Mar 1997, 5 Marks) i. External or indirect inhibitions: The
Ans. The anatomical nervous pathway for a reflex action is established conditioned reflex is inhibited
called reflex arc. In a simple reflex arc, there are five by some form of stimulus, which is quite
components: different from conditioned stimulus. It is
1. Receptor: It is the end organ which receives the not related to conditioned stimulus.
stimulus; when the receptor is stimulated, impulses ii. I nternal or direct inhibition: It is
are generated in afferent nerve. abolished by four ways, i.e. extinction
2. Afferent Nerve: Afferent or sensory nerve transmits of conditioned reflex, conditioned
sensory impulses from receptor to center. inhibition, delayed conditioned reflex
3. Center: The center receives the sensory impulses via and differential inhibition.
afferent nerve fibers and sends it to motor impulses. 2. Instrumental conditioned reflex: These are those
It may be in the brain or spinal cord. reflexes in which behavior of a person is instrumen-
4. Efferent Nerve: It transmits motor impulses from tal. This type of a reflex is developed by conditioned
center to effector organ. stimulus followed by reward or punishment.
406 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.9. Draw the TS of spinal cord showing ascending and ♦♦ Dorsal spinocerebellar tract: This is constituted by
descending tract. (Apr 2007, 4 Marks) second-order neuron fibers of pathway for subconscious
Ans. kinesthetic sensation.
Function: The tract carries impulses of such conscious
kinesthetic sensation which are known as nonsensory
impulses.
Lesion: This leads to unilateral loss of subconscious
kinesthetic sensation.
♦♦ Spinotectal tract: It is a considered as component of
spinothalamic tract. This is constituted by second-order
neurons.
Function: The tract is concerned with spinovisual reflex.
Lesion: It leads to loss of spinovisual reflex.
♦♦ Fasiculus dorsolateralis: It is constituted by fibers of first-
order neurons.
Function: The fibers of tract carry impulses of pain and
thermal sensation.
Fig. 43: TS of spinal cord Lesion: Due to lesion, there is loss of impulses of pain and
thermal sensation.
Q.10. Write in brief on function of ascending tract. ♦♦ Spino reticular tract: The fibers of tract arise from inter-
(Mar 1998, 7.5 Marks) mediolateral cell column.
Or Function: The fibers of tract are concerned with conscious-
Write a short note on ascending tracts and their func- ness and awareness.
tions. (Mar 2000, 5 Marks) Lesion: There is loss in sensation consciousness and aware-
Or ness.
Describe in brief the ascending tracts of spinal cord. ♦♦ Spino-olivary tract: From this tract, the neurons project
(Sep 2007, 4 Marks) (Mar 2008, 3 Marks) into cerebellum, origin of fibers is not specific.
Ans. Ascending Tracts Function: The tract is concerned with proprioception.
Lesion: There is loss in sensation of proprioception.
Ascending tracts in anterior white funiculus:
♦♦ Spinovestibular tract: The fibers arise from all seg-
♦♦ Anterior spinothalamic tract: It is formed by fibers of
ments of spinal cord and terminate in lateral vestibular
second-order neuron of pathway for crude touch.
apparatus.
Function: It carries impulses for crude touch sensation.
Function: The tract is concerned with sensation of proprio-
Lesion: The bilateral lesion of tract leads to loss of crude
ception.
touch sensation and loss of sensation like itching and
tickling. Lesion: There is loss in sensation of proprioception.
♦♦ Fasciculus cuneatus and fasciculus gracilis: These both
Ascending tracts in lateral white funiculus: are constituted by fibers of first-order neurons of sensory
♦♦ Lateral spinothalamic tract: It is formed by the second- pathway.
order neurons of pathway for sensation of pain and
Function: They convey impulses to the following sensa-
temperature.
tions, i.e. tactile sensation, tactile discrimination, tactile
Function: The fibers of tract carry impulses of pain and localization, vibratory sensation and conscious kinesthetic
thermal sensations.
sensation.
Lesion: The unilateral lesion causes loss of pain and tem-
Lesion: There is loss in sensations of tactile discrimina-
perature below level of lesion of opposite side. The bilateral
tion, tactile localization, vibratory sensation and conscious
lesion of this tract leads to loss of pain and temperature
kinesthetic sensation.
sensation on both sides.
♦♦ Ventral spinocerebellar tract or Gower’s tract: This is Q.11. Write a short note on spinothalamic tracts.
constituted by fibers of second-order neurons of pathway (Aug 2012, 5 Marks)
for subconscious kinesthetic sensation along with Ans. There are two spinothalamic tracts:
dorsospinal cerebellar tract. 1. Anterior spinothalamic tract
Lesion: It leads to loss of subconscious kinesthetic sensa- 2. Lateral spinothalamic tract.
tion mostly in opposite side. Both are described in Ans 10 of the same chapter.
Physiology 407
Q.12. Trace the path for pain, temperature and crude touch Lesions: During lesion, the increased and loss
with help of diagram. (Oct 2000, 5 Marks) in posture.
Ans. 3. Lateral vestibulospinal tract: It originates
from lateral vestibular nucleus. The fibers are
uncrossed and extend to all segments.
Lesion: The lesion in this tract affects the position
of head and body during acceleration.
4. Reticulospinal tract: It originates from reticular
formation of pons and medulla. The fibers are
mostly uncrossed.
Lesion: The lesion to this tract causes disturbance
in voluntary and reflex movements. The muscle
tone is increased. And the control over respira-
tion and blood vessels is lost.
5. Tectospinal tract: The fibers originate from
superior colliculus. The fibers extend up to lower
cervical segments.
Lesion: The lesion of this tract causes distur-
bances in movement of head in response to
visual and auditory impulses.
6. Rubrospinal tract: The fibers originate from red
nucleus. These fibers extend upto thoracic seg-
ments.
Lesion: The control over flexor muscle tone is lost.
7. Olivospinal tract: The fibers originate from in-
Fig. 44: Path for pain temperature and crude touch ferior olivary nucleus. Their extension or coarse
is not clear.
Q.13. Write in brief on motor tracts and their lesions.
(Sep 1996, 6 Marks) Lesion: There is loss of control over movements
Ans. Motor Tracts and their Lesions arising due to proprioception.
The motor tract of spinal cord are of two types: Q.14. Write in brief on functions of descending tract.
A. Pyramidal tract: They are concerned with voluntary (Apr 2003, 7 Marks)
motor activities of body. They are of two types: Ans. Functions of descending tracts
1. Anterior corticospinal tract
A. Pyramidal tracts
2. Lateral corticospinal tract
They originate from Betz cells and other cells 1. Anterior corticospinal tract
of motor area. They originates uncrossed of 2. Lateral corticospinal tract
anterior corticospinal tract and crossed of lateral Function: The pyramidal tracts are concerned
corticospinal tract. with voluntary movements of body.
Lesion: B. Extrapyramidal tracts
1. Voluntary movements of body are very much
1. Median longitudinal fasciculus
affected during lesion in this tract.
2. The muscle tone is increased leading to Function: The tract is responsible for coordina-
spasticity of muscles. tion of reflex ocular movements and integration
3. All superficial reflexes are lost and Babinski’s of movements of eyes and neck.
sign is positive. 2. Anterior vestibulospinal tract
B. Extrapyramidal tract: They are as follows: Function: It maintains muscle tone and posture.
1. Medial longitudinal fasciculus: It originates 3. Lateral vestibulospinal tract
from cell of Cajal the fibers are uncrossed which
Function: It is concerned with position of head
extend up to upper cervical segments.
and body during acceleration.
Lesion: The movements of body are affected
during lesion. 4. Reticulospinal tract
2. Anterior vestibulospinal tract: It originates from Functions: It controls voluntary and reflex
lateral; vestibular nucleus. The fibers are mostly movements, muscle tone, respiration and blood
uncrossed. vessels.
408 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
temperature. The heat loss center is in anterior 10. Regulation of sleep and wakefulness: Mammil-
hypothalamus and heat gain center is in posterior lary body in posterior hypothalamus is considered
hypothalamus. as wakefulness center. Stimulation of mammillary
Apart from temperature receptors, some are heat body causes wakefulness and its lesion leads to
sensitive cell in preoptic area. The thermoreceptors sleep.
of hypothalamus are stimulated and causes heat loss 11. Role in response to smell: Posterior hypothalamus
in two ways: along with hippocampus and brainstem nuclei is
a. Peptic thermoreceptors stimulate sweat gland responsible for autonomic responses of body to
and increases sweat secretion. olfactory stimuli. These responses include feeding
b. Preoptic thermoreceptors inhibit posterior activities and emotional responses like fear, excite-
hypothalamus which control SNS. This leads to ment and pleasure.
cutaneous vasodilation and increase in blood 12. Role in circadian rhythm: Circadian rhythm is
flow to skin, due to increase in blood flow, more regular recurrence of physiological processes or
heat is lost. activities which occur in cycle of 24 hours. It is known
Now, when body temperature is reduced, heat loss as diurnal rhythm. Cyclic changes taking place in
is prevented and production of heat is increased. various physiological process are set by means of
a. When body temperature is decreased, the hypothetical internal clock known as biological
preoptic thermoreceptors are not activated so clock. Suprachiasmatic nucleus of hypothalamus
posterior hypothalamus is not inhibited and set biological clock by its connection with retina via
blood flow to skin is reduced and heat loss is retinohypothalamic fibers. By efferent fibers it send
prevented. circadian signals to different parts and maintain
b. Whenever the body temperature is decreased, circadian rhythm of sleep, thirst, hunger, etc.
activity of posterior hypothalamus is increased
and muscular activity is enhanced leading to Q.21. Write a short on mechanism of heat loss.
shivering due to which more heat is produced. (Feb 2002, 5 Marks)
5. Regulation of water balance: Hypothalamus regulate Ans. Refer to Ans 20 of same chapter in function number 4,
water balance of body by two ways: i.e. regulation of body temperature by hypothalamus.
a. By causing sensation of thirst leading to intake Q.22. Write a short note on regulation of body temperature.
of water by activating thirst center. (Apr 2003, 5 Marks) (Jan 2012, 5 Marks)
b. By regulation of excretion of water through urine (Feb 2013, 6 Marks)
by ADH. Or
6. Control of adrenal cortex: Hypothalamus control
adrenal cortex through anterior pituitary. Anterior Write short note on role of hypothalamus in tempera-
pituitary regulate adrenal cortex by secreting ture regulation. (Oct 2007, 5 Marks)
adrenocorticotropic hormone. ACTH secretion (Apr 2008, 3 Marks) (Sep 2006, 3 Marks)
is regulated by corticotropic releasing hormone Or
which is secreted by paraventricular nucleus of
Write a short note on regulation of body temperature
hypothalamus.
in man. (Mar 2006, 5 Marks)
7. Control of adrenal medulla: Dorsomedial and
Ans. Refer to Ans 20 of the same chapter in function no. 4, i.e.
posterior hypothalamic nuclei are excited by
regulation of body temperature by hypothalamus.
emotional stimuli. These hypothalamic nuclei send
impulses to adrenal medulla through sympathetic Q.23. Write short note on function of cerebellum.
fibers and cause release of catacholamines which are (Sep 2006, 5 Marks) (Nov 2009, 3 Marks)
essential to cope up with emotional stress. Ans. Functions of cerebellum are as follows:
8. Regulation of autonomic nervous system: Hypo 1. Vestibulocerebellum or archicerebellum plays an
thalamus control autonomic nervous system. important role in maintenance of tone, posture and
Sympathetic division of autonomic nervous equilibrium because of its connection with vestibu-
system is regulated by posterior and lateral nuclei lar apparatus, vestibular nuclei and spinal motor
of hypothalamus. Parasympathetic division of neurons.
autonomic nervous system is controlled by anterior 2. Spinocerebellum or paleocerebellum is receiving
group of nuclei. area for tactile, proprioceptive, auditory and visual
9. Regulation of blood pressure: Hypothalamus impulses.
regulates blood pressure by acting on vasomotor 3. Spinocerebellum regulates posture reflexes by modi-
center. Stimulation of posterior and lateral fying muscle tones.
hypothalamic nuclei increases arterial blood 4. Corticocerebellum or neocerebellum is concerned
pressure and stimulation of preoptic area decreases with integration and regulation of well coorindated
blood pressure. muscular activities.
Physiology 411
5. Corticocerebellum receives nerve fibers from pro- Physiological significance of stretch reflex:
prioceptors in muscles. Thus, it receives feedback 1. This is a basic reflex which involves in maintenance
system from muscles during muscular activity. of posture.
Q.24. Write a short note on functions of basal ganglia. 2. The reflex maintains the body in upright position.
(Mar 2000, 5 Marks) Q.26. Write briefly on functional areas of cerebral cortex.
Or (Sep 2004, 5 Marks)
Ans. The functional areas of cerebral cortex are as follows:
Write on functions of basal ganglia.
1. The motor area: It is located in precentral gyrus on
(Jan 2018, 5 Marks)
superolateral surface of hemisphere and in anterior
Ans. Functions of basal ganglia are as follows: part of paracentral lobule. The electrical stimulation
1. Control of voluntary motor activity: The movements of the area 4 causes discrete isolated movements in
during voluntary motor activity are initiated by opposites sides of body.
cerebral cortex. However, these movements are 2. The premotor area: It lies anterior to motor area. It
controlled by basal ganglia. Basal ganglia control occupies the posterior part of superior, middle and
motor activities because of presence of circuits inferior frontal gyri. It is concerned with postural
between basal ganglia and brain involving in motor movements and send motor signals to axial muscles.
activity. It has areas 6, 8, 44 and 45.
2. Control of reflex muscle activity: The visual and The area 6 is concerned with isolated movements in
labyrinthin reflexes are important in maintenance body in opposite side.
of posture. The co-ordination and integration of The area 8 causes conjugate movements of eyeball
impulses for these activities depend on basal ganglia. to opposite side, opening and closure of eyelids,
3. Control of muscle tone: The gamma motor neurons, papillary dilatation and lacrimation.
muscle spindle and muscle tone are all controlled 3. The motor speech area or broca’s area: It is motor
by basal ganglia. area for speech. This has areas 44 and 45. The area
4. Control of autonomic associated movements: is responsible for movements of tongue, lips and
Swinging of arms during walking, appropriate larynx, which are involved in speech.
facial expressions while doing any work and other 4. The sensory area: It is located in postcentral gyrus.
movements associated with motor activities are It also extends in posterior part of paracentral lobule.
called autonomic associated movements. These are It has areas 3, 1, 2, 5 and 7.
controlled by basal ganglia. The area 1 is concerned with sensory perception.
5. Role in arousal mechanism: Globus pallidus and red The areas 2 and 3 are involved in integration of these
nucleus are involved in arousal mechanism because sensations.
of their connection with reticular formation. Exten- The areas 5 and 7 are concerned with synthesis of vari-
sive lesion in globus pallidus causes drowsiness ous sensations prescribed by primary sensory area.
leading to sleep. 5. The visual area: It is located in occipital lobe, mainly
on medial surface both above calcarine sulcus. It
Q.25. Write significance of stretch reflex.
consists of three areas:
(Apr/Sep 1998, 5 Marks)
a. Primary visual area—Area 17
Or b. Visual association area—Area 18
Write in brief on stretch reflex. (Apr 2003, 4 Marks) c. Occipital eye field—Area 19
Or Functions
Write short note on stretch reflex.(Nov 2008, 5 Marks) a. Area 17 is concerned with perception of visual
impulses.
Ans. When a muscle is stretched, it responds by contracting.
b. Area 18 is concerned with interpretation of visual
It is called as stretch reflex. It is a myotactic reflex.
impulses.
Mode of action of stretch reflex: Stretching the muscle c. Area 19 is concerned with movement of eyes.
fibers stimulates muscle spindle which are specialized 6. The acoustic area: It is located in temporal lobe. It
sensory end organs lying parallel to muscle fibers. lies partly on surface of temporal lobe. It has 3 parts:
Muscle spindle send impulses to spinal cord through a. Primary auditory area: It includes areas 41, 42
sensory fibers. Sensory nerve fibers from muscles reach and Wernicke’s area. The areas 41 and 42 are
to spinal cord, via posterior nerve roots. Within spinal concerned with perception of auditory impulses.
cord these impulses are transferred over single synapse However, the interpretation of sound occur
to motor cells of anterior grey horn. The motor cells in through Wernicke’s area.
turn send impulses through motor nerve fibers to muscle. b. Auditopsychic area: This occupies superior
The impulses from anterior motor cell causes contraction temporal gyrus. This is called as Area 22.
of muscles. This type of reflexes are more pronounced This is concerned with interpretation of auditory
in extensor muscles. impulses.
412 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
- Afferents from the vestibular apparatus pass directly or foot with firm tactile stimulus (form heel towards the
after relay in the vestibular nuclei to the floculonodular lower toe and then medially across metatarsus) in normal
lobe. healthy individuals it produces downward movement
- The efferent impulses therefore return back to the ves- (planter flexion) of great toes and small toes. This is due
tibular nuclei. to contraction of flexor hallucis longus.
- From these nuclei the vestibulospinal tract connects • Babinski plantar response appears with the toe
with the spinal motor neurons. development of pyramidal tracts. Therefore, its pres-
2. Control of muscle tone and stretch reflexes: The medial ence indicates development of these tracts. Normally
part of anterior lobe of cerebellum inhibits the muscle tone it is flexor response.
(stretch reflex), where as the lateral parts of anterior lobe • Babinski’s sign if one become positive, will remain
facilitates the muscle tone. positive for rest of life there after. In some normal
- Normally, the influence of the cerebellum of the muscle individuals it is always positive.
tone and stretch reflexes is inhibition. • Individuals with positive babinski’s sign neither can
- Pathway: The anterior lobe inhibits the muscle tone rules faster nor can travel long distances.
(mainly in the extensor muscle) of the same side of the
body. Causes of Positive Babinski’s Sign
- The effects are mediated via the fastigial nucleus to the ♦♦ Infants (below 1 year of age) as the pyramidal treats are
ipsilateral vestibular nuclei and to the bulbar reticular not developed till child starts walking.
formation. ♦♦ During deep sleep
- These nuclei in turn relay the effects to the spiral motor
♦♦ Inhibition of pyramidal tracts
neurons.
♦♦ Cheyne-stroke respiratory due to hypoxia.
3. Control of movements: The cerebellum does not initiate
♦♦ Babinski’s sign is not elicited in lower motor neuron
movements, rather it cordinates movements that are initi-
lesion.
ated in the motor systems.
♦♦ Babinski’s sign is positive in upper motor neuron lesion,
- Co-ordination of movements is the result of appropri-
stroking outer age of sole of foot with firm tactile stimulus
ate regulation of time, rate range force and direction of
produces first on upward movement of great toe and
muscular activity.
fanning out of small toes. This is due to contraction
a. Control of involuntary movements: The afferent
of extensor hallucis longus physiologically a flexor
pathways to the cerebellum transmit propriocep-
response.
tive, kinesthetic and sensory information from all
parts of the body. Q.37. Write, in brief, on conditioned reflexes.
- The cerebellar integrates these impulses and (Oct 2007, 5 Marks)
provides feedback impulses starting from the deep Or
cerebellar nuclei back to the motor cortex, basal Write short note on conditional reflex.
ganglia and reticular formation that correct the (June 2010, 5 Marks)
error in the involuntary movements. Ans. Conditional reflex is a reflex response acquired or learnt
b. Control of voluntary movements: The cerebellum by experience.
control and guides all the voluntary movements, i.e.
It is a basis of learning.
movements accompanied by a conscious awareness
of an individual. The movements produced are Types of Conditioned Reflex
accurate in time, rate, range, force and direction.
♦♦ Classical Conditioned reflex.
- The cerebellum receives a representation of
corticospinal activity which is transmitted to the ♦♦ Instrumental Conditional reflex.
muscle and the representations of the result in terms Classical conditioned reflex
of the muscle movement from the proprioceptors
of the muscle. These are those reflexes, which are established by conditioned
4. Other functions: stimulus followed by unconditioned stimulus.
a. Functions of pyramis: It is concerned with movement
Types of Classical Conditioned Reflexes
of eyeball because its stimulation causes upward eye
movements to the ipsilateral side. A. Positive conditional reflexes
b. Uvula: It has vestibular function, its removal produces B. Negative conditional reflexes
disturbance of equilibrium. A. Positive conditioned reflexes
Q.36. Write a short note on Babinski’s sign. i. Primary conditioned reflexes: The development of
(Mar 2007, 3 Marks) (Aug 2012, 5 Marks) conditioned reflex with one unconditioned stimulus
Ans. Babinski’s sign is the response obtained by stroking (to and one conditioned stimulus is called as primary
pass gently in one direction) outer edge of sole of the conditioned reflex.
Physiology 415
Presynaptic neuron
tegrated myelin sheath. So, the neurilemmal tube Opening of calcium channels in presynaptic membrane
becomes empty. Later it is filled by the cytoplasm of
Schwann cell. All these changes take place for about
Influx of calcium ions from ECF into the axon terminal
2 months from the day of injury.
Q.48. Define synapse. Describe the structure and mechanism
Opening of vesicles and release of Ach
of synaptic transmission. (Feb 2014, 8 Marks)
Or
Define synapse. Draw a labelled diagram of synapse. Passage of Ach through synaptic cleft
(May 2017, 2 Marks) Formation of Ach–receptor complex
Ans. Synapse is the junction where the axon of one cell
terminates on the dendrites or some other portion of Opening of sodium channels and influx of sodium ions from ECF
another cell. Neuron which send messages is known as
Postsynaptic neuron
presynaptic cell and the neuron which receives messages
is known as postsynaptic neuron. Development of EPSP
Following is the structure of synaptic transmission: 1. Atonia or hypotonia: Muscle tone is lost or decreases
over the affected side because of loss of facilitatory effect
A. Synaptic knob: It is the terminal bulbous ending of presyn-
of neocerebellum.
aptic axon which is devoid of neurofilaments and contain
2. Attitude: Face gets rotated over the opposite side.
i. Synaptic vesicles: Presynaptic cytoplasm consists of
Homolateral shoulder is lowered. Leg become abducted
vesicles which are 50 nm in diameter. They accumu-
and rotated outwards.
late near the membrane. They have small packet of
3. Spontaneous deviation: If eyes are closed and arms are
chemical transmitter which causes excitation. They are
held straight in front of body, homolateral arms bend.
transferred to axon along with microtubules.
4. Nystagmus: When a person concentrates his/her eyes on
ii. Mitochondria containing large amount of ATP. an object tremor occur in eyeballs.
iii. Microtubules 5. Deep reflexes: The deep reflexes become weak and pendular.
iv. Presynaptic membrane is the nerve membrane which
is close to the membrane of postsynaptic cell. Disturbance in Voluntary Movement
B. Subsynaptic and postsynaptic membrane: It is the surface 1. Asthenia: There is feebleness of movements. Voluntary
of cell membrane which causes synapsis and is known as movements become slow.
subsynaptic membrane. Remainder of motor neuron cell is 2. Ataxia: There is incoordination of movement. So there is
called as postsynaptic membrane. • Decomposition of the movement
C. Synaptic cleft: It is a gap of 20 to 30 nm which separates • Asynergia: There is lack of coordination between
pre and postsynaptic membranes. protagonists, antagonists and synergists.
420 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• Dysmetria: The movement is poorly carried out in ♦♦ Infatigability: A nerve fiber cannot be fatigued even if it
direction, range as well as force, so the movements is stimulated continuously for a long time. This is because
shoot their intended mark. nerve fiber can conduct only one action potential at a time.
3. Intention tremor: The patients cannot perform the move- ♦♦ All or None Law: This law states that when a nerve fiber
ments freely. Movements of patients are jerky and accom- is stimulated by stimulus it give maximum response or
panied by oscillating, to and fro tremors which become does not give any response at all.
more marked. Q.53. Write short note on wallerian and retrograde degenera-
Q.51. Write about withdrawal reflex. (Dec 2014, 5 Marks) tion in nerves. (Apr 2007, 5 Marks)
Ans. Withdrawal reflex is a polysynaptic reflex which occurs Ans. For Wallerian degeneration of nerves refer to Ans 49 of
in response to a noxious stimulus. As noxious stimulus same chapter.
is applied to a limb, it causes:
Retrograde Degeneration in Nerves
a. It contracts flexor muscles and inhibits extensor
muscles. So the limb which is stimulated is flexed ♦♦ Retrograde degeneration are the pathological changes
and is withdrawn from stimulus. It is known as which occur in nerve cell body and axon proximal to the
flexor reflex. cut end.
b. A powerful stimulus is added to flexor reflex which ♦♦ Retrograde degeneration begins within 48 hours of nerve
leads to extension of opposite limb. This is known section and reach to maximum by 15 to 20 days.
as cross extensor reflex response. ♦♦ Following are the retrograde changes:
Withdrawal reflex is a protective reflex as the flexor a. Chromatolysis: Nissl granules disintegrate and loose
responses are produced by nondamaging stimulation their staining reaction after 15 to 20 days and cell be-
of skin or stretching of muscle while the powerful flexor come colorless. This process starts in the zone around
responses with withdrawal are produced by nociceptive nucleus and spreads to periphery of cell.
b. Golgi apparatus, mitochondria and neurofibrils get
stimuli. So as the stimulated limb gets withdrawn to be
fragmented and disappear gradually.
away from source of stimulus. Extension of other limb
c. Cell draws more fluid and lost its polygonal shape and
supports body.
gets rounded.
Q.52. Write about function and properties of nerve fibers. d. Nucleus increases in size become oval in shape and
(Dec 2014, 5 Marks) get displaced towards the periphery. Nucleus can be
Ans. Function of Nerve Fibers completely thrown out of the cell in cases with cell
♦♦ Sensory or afferent nerve fibers carry sensory impulses atrophy and finally the cell death occurs.
from different parts of body to CNS. Q.54. Write short note on endocrinal functions of hypothala-
♦♦ Motor or efferent nerve fibers carry motor impulses from mus. (Apr 2007, 5 Marks)
CNS to different parts of body. Ans. Following are the endocrinal functions of hypothalamus:
Properties of Nerve Fiber A. Control of anterior pituitary: Hypothalamus leads to
following functions through the releasing hormones:
♦♦ Excitability: It is defined as the physiochemical change • It controls the metabolism by controlling thyroid
which occurs in a tissue when stimulus is applied. Stimulus gland.
is the external agent which causes excitability in tissues. • As its influence is over the adrenal cortex it
When nerve fiber is stimulated action potential develops. controls the metabolism of different foodstuffs
♦♦ Conductivity: It is the ability of nerve fibers to transmit and maintains electrolyte balance.
impulse from the area of stimulation to other areas. Ac- • It causes inhibition of gonads till physical growth
tion potential is transmitted through nerve fiber as nerve get complete. As physical growth gets complete
impulse. this inhibition is removed and gonads start func-
♦♦ Refactory period: It is the period at which the nerve does tioning and gametes are produced.
not give any response to a stimulus. • It controls the formation of milk by breast by
♦♦ Summation: When one subliminal stimulus is applied controlling prolactin secretion.
it does not produce any response in nerve fiber because B. Regulation of posterior pituitary functions: Neural
subliminal stimulus is weak. But if two or more subliminal control of posterior pituitary with secretion of
stimuli are applied in a short interval of 0.5 m/sec the re- ADH in regulation of water balance by controlling
sponse is produced. It is because the subliminal stimuli are regulation of water secretion by kidneys.
summed up together to become strong enough to produce C. Regulation of uterine contractility and regulation
response. This is known as summation. of milk ejection from breast: Secretion of oxytocin
♦♦ Adaptation: As nerve fiber is stimulated continuously the enhances the contractility of uterus at the end of
excitability of nerve fiber is more in beginning and later pregnancy and helps during parturition. It contracts
on it decreases and finally nerve fiber does not show any myoepithelial cells which surrounds alveoli of breast
response. It is known as adaptation or accommodation. and leads to milk ejection.
Physiology 421
Q.55. Write short note on neuroglia. (Nov 2008, 5 Marks) Clinical Features of Cerebellar Lesions
Ans. Neuroglia is also known as glial cells. Cerebellar
• Neuroglia is the supporting cells present in the brain Lesion Clinical features
and spinal cord. Disturbances • Atonia or hypotonia: Loss of tone in muscles
• Neuroglia are numerous and are 10 times more than in tone and or muscle tone is markedly decreased over the
neurons. posture affected side
• Glial cells can multiply by mitosis. • Attitude: Trunk get bend with concavity towards
• Glial cells are divided on the basis of their opposite side; face get rotated towards opposite
side; homolateral shoulder become lower as
distribution into two types, i.e. central neuroglial compared to normal shoulder; leg become
cells and peripheral neuroglial cells abducted and rotated outwards
• Nystagmus: Tremor occurs in eyeballs when
Central Neuroglial Cells patient fix his eye on an object
In CNS they are of three types, i.e. astrocytes, microglia and • Deviation movement: When eyes get closed
and both arms held straight in front of the body,
oligodendrocytes.
bending is seen in homolateral arms
Astrocytes • Effect on deep reflexes: Deep reflexes become
weak and pendular
They are star shaped neuroglial cells present in all parts of brain. Disturbances • Asthenia: There is feebleness of movements.
They are of two type, i.e. fibrous astrocytes and protoplasmic in voluntary Muscles get tired and voluntary movements
astrocytes. movements become slow
• Ataxia: There is marked incoordination of
Functions of Astrocytes movement. So there is
a. Decomposition of movement
They help in support, transport mechanisms, inflammatory and b. Asynergia, i.e. there is lack of coordination
reparative reactions. between protagonists, antagonists and
♦♦ They help in the formation of blood brain barrier. synergists
♦♦ They help in maintaining optimal concentration of ions c. Dysmetria, i.e. movement poorly occurs
in direction, range and force so there is
and neurotransmitters in brain neurons. hypermetria or hypometria
• Intention tremor: In this patient is unable to
Microglia
perform movements smoothly. Movements become
They are the small glial cells which are mesodermal in origin. jerky and there are oscillating, to and fro tremors
They have flattened cell body and short processes. These are which increase as hand approaches the object
• Gait: Patient has difficulty in maintaining the
more numerous in grey matter as compared to white matter.
balance as gait appears drunken. Patient walks
They act as phagocytes and become active after damage to in a zig zag line and deviates to affected side
nervous tissue by trauma or disease. because of hypotonia
• Speech: It is slow and lalling like a baby
Oligodendrocytes
They are neuroglial cells which produce myelin sheath around Q.57. Write briefly about synaptic inhibition.
nerve fibers in CNS. They provide myelination around nerve (Oct 2016, 2 Marks)
fibers in CNS where Schwann cells are absent. Ans. Synaptic inhibition is of five types, i.e.
1. Postsynaptic or direct inhibition
Peripheral Neuroglial Cells 2. Presynaptic or indirect inhibition
They are of two types, i.e. Schwann cells and satellite cells. 3. Negative feedback
a. Schwann cells: They are major glial cells in peripheral nerv- 4. Feedforward inhibition
5. Reciprocal inhibition
ous system. These cells provide myelination around nerve
fibers in peripheral nervous system. These cells remove Postsynaptic or Direct Inhibition
cellular debris during regeneration by their phagocytic
activity. It is the type of synaptic inhibition that occur due to release
b. Satellite cells: They are the glial cells present on the exterior of an inhibitory neurotransmitter from presynaptic terminal
instead of an excitatory neurotransmitter substance. It is also
surface of peripheral nervous system neurons. They provide
called as direct inhibition.
physical support to PNS neurons.
Q.56. Describe the functions of the cerebellum. Briefly Presynaptic Inhibition or Indirect Inhibition
describe the clinical features of cerebellar lesions. It occurs due to failure of presynaptic axon terminal to release
(Apr 2015, 8 Marks) sufficient quantity of excitatory neurotransmitter substance. It
Ans. For functions of cerebellum refer to Ans 23 of the same is also known as indirect inhibition. Presynaptic inhibition is
chapter. mediated by axoaxonic synapses.
422 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Causes
It is commonly seen in:
♦♦ Primary or idiopathic, i.e. condition occurring without
apparent cause
♦♦ In cerebral arteriosclerosis
♦♦ Complication of encephalitis Fig. 48: Upper motor neurons
♦♦ Complication of tranquilizer drugs such as phenothiazine
which block D2 dopamine receptors.
Physiology 423
1. Rinne’s test: Base of the vibrating tuning fork is Q.15. Describe in brief taste sensation. (Apr 2008, 4 Marks)
placed on the mastoid process, until the subject Ans. Situations of Taste Buds
no longer feels the vibration and hears the sound. Taste buds are located in the walls of papillae. Papillae
When the subject does not hear the sound any more, are of four types, i.e.
the tuning fork is held in air in front of ear of same a. Fungiform papillae: They are rounded in shape
side. Normal person hears vibration in ear even and are most numerous near the tip of tongue. They
after bone conduction is ceased because in normal consist of 5 taste buds per papilla and these taste
conditions air conduction is better than the bone buds are located at top of papilla.
conduction. b. Filiform papillae: These are small conical papillae
2. Weber’s test: Base of vibrating tuning fork is placed which are arranged in diverging rows to right and
on the vertex of skull or the middle of the forehead. left of midline and are confined to back edge of the
Normal person hears the sound equally on both the tongue. Taste buds are missing in these papillae.
sides. In unilateral condition deafness, the sound is c. Circumvallate papillae: They are prominent papillae
heared louder in the diseased ear. In unaffected ear, arranged in the form of V at back of the tongue. These
there is masking effect of environmental noise. So papillae are 10 to 12 in number and consist of 100 taste
the sound through bone conduction is not heared buds which are located along the sides of papillae.
as clearly as on the effected side. In affected side d. Foliate papillae: They are occasionally found on the
sound is louder due to absence of masking effect of posterolateral surfaces of tongue.
environmental noise.
3. Audiometry: The nature as well as extent of
auditory defect could be determined by the
technique called as audiometry. An instrument
called as audiometer is used. The instrument is an
electronic function generator or oscillator connected
to an ear phone. This instrument is capable of
generating sound waves of different frequencies
form lowest to highest. Before calibrating the
instrument, the minimum volume or intensity or
loudness for each frequency of sound heared by
normal person is determined. This intensity is set
in the instrument as zero. Now, while testing the
patient the loudness can be increased above zero
level. The intensity of sound is expressed in decibel
(dB).
Q.14. Write briefly on color vision. (Sep 2005, 5 Marks)
Ans. The human eye can recognize about 150 different colors Fig. 53: Taste bud
in the visual spectrum.
• The discrimination and appreciation of colors Structure of Taste Bud
depends upon the ability of receptors in retina. ♦♦ Taste buds are oval cluster of cells inside the epithelial
• Many theories are available to explain the mechanism layer with small pore opening on the surface which allows
of perception of color vision like Thomas-Young’s substances to reach interior of the taste bud.
trichromatic theory according to which there are ♦♦ It measures 60 to 80 µm in length and 40 µm in diameter.
three types of cones in retina each of the three types ♦♦ Cells inside the taste buds are of two type, i.e. gustatory
of cones gives response to one of the primary colors. receptor cells and supporting or sustentacular cells.
Red, green and blue. ♦♦ All cells in taste bud are sensory but in different stages of
• The different color sensation is produced by the development. Only gustatory receptor cells make synaptic
stimulation of various combinations of three types connection to sensory nerve fibers.
of receptors. ♦♦ Taste cells are formed from the epithelial cells. They sur-
• Retinal areas sensitive to colors. round the taste bud and migrate towards the center as they
1. The peripheral part of retina is devoid of cones mature and final degenerate in 10 days. Each gustatory
and is insensitive to colors and gives sensation receptor cell ends in microvilli at the top near the pore.
of white, black and grey only.
Primary Taste Sensations
2. The central portion of retinal fovea centralic has
more cones so it is more sensitive to colors. The four primary or fundamental taste sensations are:
• Applied physiology: Color blindness refer to Ans 5 1. Sweet
of same chapter. 2. Salt
428 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
3. Sour 4. Synaptic terminal: A thick fiber arising from the cell body
4. Bitter. passes to outer plexiform layer and ends in a small and
- The receptors and salt and sweet tastes are more at the enlarged synaptic terminal and body.
tip of the tongue.
- Receptors of bitter are more in the posterior part and Structure of Cone Cell
those of sour taste are more at the sides of tongue. ♦♦ Cone cell is flask shaped
♦♦ The cone in the fovea are long, narrow and almost similar
Taste Pathway
to rods.
1. Receptors: Receptors for taste sensation are in taste buds. ♦♦ In the periphery of retina, the cones are short and broad.
2. First-order neuron: They are in the nuclei of three different It is also formed by four parts:
cranial nerves.
1. Outer segment
a. Chorda tympani fibers of facial nerve run from taste
2. Inner segment
bud on anterior two-third of tongue.
3. Cell body
b. Glossopharyngeal nerve fibers run from posterior one
4. Synaptic terminal.
third of tongue.
c. Vagal fiber runs from taste buds in other region. 1. Outer segment: It is smaller and conical.
- First-order neurons run together in medulla oblongata 2. Inner segment: The inner segment is connected to the outer
and terminate in the nucleus of tractus solitarius. segment by a modified cilium.
3. Second-order neuron - This segment synthesize photosensitive pigment of
- Second-order neurons are in the nucleus of tractus cone.
solitarius. 3. Cell body: In the inner nuclear layer the cone fibers form
- Axons of the second order neurons cross the midline, the cell body or cone granules that posses the nucleus.
run through medial lemniscus and terminate in poster- 4. Synaptic terminals: The fibers from the cell body of the cone
oventral nucleus of thalamus. leaves the inner nuclear layer and enters the outer flexiform
4. Third-order neuron layer, here it ends in the form of an enlarge synaptic termi-
- The third-order neurons are in the posteroventral nal.
nucleus of thalamus. - Rods are extremely sensitive to light so responsible for
- The axons from these neuron project into parietal lobe the dim light vision or the night vision. The vision by
of the cerebral cortex. the rod is black, white or in combination of black and
5. Taste center: The lower part of postcentral gyrus. white.
Q.16. Describe in brief visual receptors. - Cone have sensitivity only to bright light, so called
(Apr 2008, 3 Marks) (Sep 2009, 5 Marks) receptors of bright light vision or day light or pho-
topic vision.
Ans. Rods and cones which are present in the retina of the
- The cones are responsible for acuity of vision and
eye, form the visual receptors. The impulses from rods
the colour vision.
and cones reach the cerebral cortex through optic nerve.
Q.17. Draw pathway of taste sensation and well labeled
Structure of Rod Cell diagram of taste buds. (Apr 2007, 5 Marks)
Rod cells are cylindrical structure. Each rod is composed of four Ans. For diagram of pathway of taste sensation refer to Ans 7
structures, namely of same chapter and for labeled diagram of taste buds
1. Outer segment refer to Ans 15 of same chapter.
2. Inner segment Q.18. Write short note on myopia. (Nov 2008, 5 Marks)
3. Cell body Or
4. Synaptic terminal
1. Outer segment Write briefly about myopia. (Feb 2016, 2 Marks)
- This is long and slender. Ans. Myopia is an error of refraction.
- This segment is in close contact with the pigment epi- • Myopia is also known as short sightedness.
thelial cells. • In myopia the parallel rays of light from distant
- It is formed by modified cilia. object are focused in front of retina. This occurs
- It contains the pigment rhodopsin. because either the length of eyeball is too long,
2. Inner segment i.e. axial myopic eye or refractive power of lens
- The inner segment is connected to the outer segment increases, i.e. refractive myopic eye.
by means of modified cilia.
Characteristic Features
- The rhodopsin is synthesized in the inner segment.
3. Cell body: Rod fiber which arises from the inner segment of ♦♦ Person who is affected by myopia cannot see the distant
rod cell enlarge to form cell body or rod granule that consist object.
of nucleus. ♦♦ Far point of vision is at definite distance from the eye.
Physiology 429
♦♦ Near point of vision becomes nearer as axial length of ♦♦ Optic nerve: Lesion of one optic nerve causes total
eyeball increases. blindness or anopia in the corresponding visual field.
♦♦ As far and near point are closely approximated the range Lesion occurs due to increased intracranial pressure.
of accommodation decreases. ♦♦ Optic chiasma: The defect depends upon the fibers
involved.
Correction of Myopia • Pressure of uncrossed lateral fibers by aneurysmal
It is corrected by the concave glasses which lead to divergence dilatation of carotid artery leads to blindness in
of incident rays. The power of lens required gives a measure temporal part of retina of same side, i.e. retina cannot
of degree of myopia. receive light stimulus from objects in nasal half of same
visual field. So there is development of hemianopia
Q.19. Write briefly about hypermetropia. which is known as left or right nasal hemianopia.
(Aug 2016, 2 Marks) • If lateral fibers of both sides are affected, vision is lost
Ans. Hypermetropia is also known as far sightedness. in nasal half of both visual fields leading to binasal
• Hypermetropia is a refractive error in which parallel hemianopia.
rays of light from a distant object are brought into • Compression of nasal fibers i.e. crossed fibers by
a focus behind the retina when the accommodation pituitary tumor causes bitemporal hemianopia.
is at rest. ♦♦ Optic tract: If the lesion is on the right side it causes
• It occurs due to decreased anteroposterior diameter left homonymous hemianopia and if the lesion is on
of the eye. the left optic tract it leads to right lateral homonymous
• Hypertrophy of ciliary muscles occurs because indi- hemianopia. The damage of fibers connecting the optic
vidual will be using the accommodation all the time tract with pretectal nucleus leads to loss of light reflex
for seeing the far object. Sustained accommodation is with normal accommodation reflex known as Argyll
tiring and can lead to severe headache and blurring Robertson pupil.
of vision. ♦♦ Optic radiation:
• Prolonged convergence of visual axes is associated • Damage to medial fibers leads to homonymous lower
with accommodation, finally leads to squint. quadrant anopia.
• It can be corrected by using spectacles with biconvex • Damage to lateral fibers leads to homonymous upper
lens that converges the incident rays before they quadrant anopia.
strike the cornea. Near point is farther than the nor- ♦♦ Visual cortex: Damage to this leads to homonymous
mal, so the patient need biconvex lens at an earlier hemianopia with macula sparing i.e. macula is not affected
age. as it has a larger area of representation and is also supposed
Q.20. Trace optic pathway and add a note on effect of lesion to have bilateral representation.
at different sites of tract. (Jan 2018, 5 Marks) Injury to any part of the optic pathway leads to visual
Ans. The effects of lesions on field of vision at different level defect, site and severity of the injury decides the nature of
of visual pathway are as follows: defect.
• Loss of vision in one visual field is referred as anopia.
• Loss of vision in one-half of the visual field is called
hemianopia. It is two types, i.e. homonymous
hemianopia and heteronymous hemianopia.
• Loss of vision in one quarter of visual field is known
as quadrantanopia.
Q.21. Write on functions of rods and cones.
(Sep 2018, 5 Marks)
Ans. Functions of Rods
Rods are very sensitive to light and have low threashold. So
these are responsible for the dim light vision or night vision or
scotopic vision. Vision by rod is black, white or in combination
of black and white, namely gray. Therefore, color objects appear
faded or grayish in twilight.
Functions of Cones
They have high threshold for light stimulus, so cones are
sensitive only to the bright light. So the cone cells are called as
receptors of bright light vision or day light vision or photopic
vision. Cones are also responsible for the acuity of vision and
Fig. 54: Optic pathway color vision.
430 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
1. In developing erythrocyte hemoglobin first appears at 9. The root value of knee jerk is:
the stage of: a. C5,6
a. Proerythroblast b. C6, 7
b. Early normoblast c. L2,3,4
c Intermediate normoblast d. L5 S1
d. Late normoblast
10. Neurons present in posterior horn of spinal cord are:
2. The disorder in which bleeding time is prolonged but a. Gamma motor neurons
coagulation time is normal is:
b. Alpha motor neurons
a. Purpura
c. Renshaw cells
b. Hemophilia
d. None of these
c. Christmas disease
d. All of these 11. The process of erythropoises takes:
a. 7 days
3. Muscle fatigue occurs due to:
b. 7 hours
a. Accumulation of lactic acid
c. 7 months
b. Exhaustion of stores of glycogen
d. 7 weeks
c. Exhaustion of stores of ATP
d. All of these 12. In isotonic contraction:
4. All are examples of positive feedback mechanism except: a. Length of muscle increases
a. LH surge b. Tone of muscle changes
b. Coagulation of blood c. Tone remains same
c. Regulation of thyroxine secretion d. Length remains same
d. Uterine contraction during labor 13. Action potential in a motor nerve has the following
5. Surfactant is synthesised by: phases except:
a. Type I pneumatocytes a. Depolarization
b. Type II pneumatocytes b. Repolarization
c. Alveolar macrophages c. Hyperpolarization
d. Epithelial cells d. Plateau
6. Synthesis of thyroxine requires: 14. The pacemaker of human heart is:
a. Iron a. SA node
b. Iodine b. AV node
c. Cooper c. Sinus venosus
d. Manganese d. Bundle of His
7. All are contents of gastric juice except: 15. Conducting system of heart has following parts except:
a. Pepsinogen a. SA node
b. Trypsinogen b. AV node
c. HCl c. Mossy fibers
d. Intrinsic factor d. Purkinje fibers
8. Normal GFR in mL/min is: 16. Normal cardiac output is:
a. 125 a. 5–6 mL/min
b. 170 b. 70–80 mL/min
c. 650 c. 5–6 L/min
d. 1200 d. 20–30 L/min
Answers: 1. c 2. a 3. d 4. c
5. c 6. b 7. d 8. a
9. c 10. d 11. a 12. d
13. d 14. a 15. c 16. c
432 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
17. The substance used for the estimation of GFR is: 26. Increased vagal tone causes:
a. Insulin a. Hypertension
b. Inulin b. Tachycardia
c. Renin c. Bradycardia
d. Rennin d. Increase in cardiac output
18. The hormone acting on kidney is: 27. Hering-Breur reflex in humans:
a. Aldosterone a. Decrease rate of respiration
b. Thyroxine b. Is not activated until tidal volume increases above
c. Secretin 1.5 L.
d. Erythropoietin c. Is important for normal control of respiration
d. Is activated when tidal volume is below 1.0 L
19. Recording basal body temperature is a test for:
a. Pregnancy 28. Basal ganglia are primarily concerned with:
b. Mensturation a. Sensory integration
c. Ovulation b. Short term memory
d. Menarche c. Control of movement
d. Endocrine control
20. Ovulation is associated with sudden rise in:
a. Prolactin 29. Excessive growth hormone secretion in adults causes:
b. Luteinizing hormone a. Acromegaly
c Oxytocin b. Gignatism
d Testosterone c. Graves Disease
d. Cretinism
21. The unique feature in mitochondria is:
30. Sexually transmitted diseases are best prevented by
a. Myosin
using:
b. Actin
a. IUD
c. DNA
b. Spermatocides
d. Prothrombin
c. Condom
22. Myelin sheath is produced by: d. RU 486
a. Axoplasm
31. Facilitated diffusion depends on:
b. Mitochondria
a. Activity of Na-K ATPase pumps
c. Schwann cell
b. Concentration gradient
d. Muscle cell
c. V-Max
23. Majority of clotting factors are produced in: d. Availability of carrier proteins
a. Liver 32. A plateau is present in action potential curve of:
b. Kidney a. Skeletal muscle fiber
c. Heart b. Vascular smooth muscle fiber
d. Brain c. SA node
24. Cell mediated immunity is due to: d. Cardiac muscle fiber
a. B-lymphocytes 33. Stroke volume output of heart is:
b. T-lymphocytes a. 5 L/Stroke
c. Neutrophils b. 3 L/Stroke
d. Eosinophils c. 70 mL/Stroke
25. In the heart, within physiological limits force of con- d. 170 mL/Stroke
traction is directly proportional to: 34. Insulin clearance test is used to determine:
a. Pacemaker activity a. Renal plasma flow
b. AV nodal delay b. Renal blood flow
c. Initial length of cardiac muscle c. pH of urine
d. Respiratory rate d. GFR
35. Amount of air that moves in and out with each breadth 44. Tetany develops when there is fall in:
is: a. Ionic serum calcium level
a. Respiratory volume b. Protein bound serum calcium level
b. Tidal volume 45. Ovulation in a normal menstrual cycle usually occurs:
c. Inspiratory volume a. On about 14th day
d. Expiratory volume b. On about 28th day
36. Chemosensitive area of grain is mainly sensitive to: c. On the 1st day of bleeding phase
a. Carbon dioxide 46. Stretch of great vein results in increased heart rate. This
b. H+ ions relationship is explained by:
c. Carbonic acid a. Brain-bridge reflex
d. Oxygen b. Marey’s reflex
37. To perceive whole range of colours, there are: c. Starling’s law
a. 3 types of cones d. Laplace law
b. 5 types of cones 47. Cardiac output is measured by the following methods
c. 7 types of cones except:
d. Only single type of cone a. Dye-dilution method
38. Hormone oxytocin is secreted by: b. Thermo-dilution method
a. Pancreas c. Fick’s principle
b. Anterior pituitary gland d. Inulin clearance
c. Posterior pituitary gland 48. Following are the properties of cardiac muscle
d. Adrenal cortex except:
39. The main pituitary hormone in postovulatory phase is: a. Fatigue
a. Estrogen b. Excitability
b. Progesterone c. Conductivity
c. LH d. Contractility
d. FSH 49. The chemical agents increasing urination are called:
40. Safety center is located in: a. Anesthetics
a. Cerebral cortex b. Antidiuretics
b. Cerebellum c. Cathartics
c. Thalamus d. Diuretics
d. Hypothalamus 50. Inability of the kidney to respond to ADH results
41. Rise of plasma concentration of K+ ions can cause: in:
a. Heart block a. Nephrogenic diabetes
b. Inhibition of myocardial contractility b. Renal glycosuria
c. Both c. Diabetes insipidus
d. None d. Diabetes mellitus
42. Deficiency of glucose-6-phosphate dehydrogenase may 51. Disappearance of Nissl granules during nerve injury
lead to: is termed as:
a. Damage of RBC glutathione a. Chromatolysis
b. Hemolysis following consumption of some drugs b. Autolysis
c. Both c. Hemolysis
d. None d. Proteolysis
43. Lymph is rich in: 52. Following are the parts of muscle spindle except:
a. Antibodies a. Nuclear bag fibers
b. Proteins b. Nuclear chain fibers
c. Both c. Annulospiral ending
d. None d. Mossy fibers
53. Somatosensory cortex corresponds to Broadmann’s 62. Shivering is initiated by stimulation of:
area number: a. Anterior hypothalamus
a. 3, 1, 2 b. Posterior hypothalamus
b. 4, 6 c. Paraventricular nucleus
c. 8 d. Preoptic area
d. 17 63. Growth hormone:
54. UMN includes: a. Affect almost all the tissues
a. Anterior horn cells b. Is a steroid hormone
b. Pyramidal cells c. Has a protein catabolic effect
c. Glial cells d. All of the above
d. Schwann cells 64. Which of the following substances is important in skeletal
55. Process of union of male and female gamete is called muscle contraction but not in smooth muscle contraction?
as: a. Actin
a. Luteinization b. Myosin
b. Implantation c. Myosin ATPase
c. Neutralization d. Troponin
d. Fertilization 65. Acromegaly:
56. Pancreatic lipase action is at pH: a. Occurs in children
a. 4.8 b. Causes enlargement of membranous bones
b. 7.34 c. Causes a person to become a giant
c. 8.6 d. Causes reduction in blood glucose level
d. 1.20 66. Saltatory conduction:
57. Antibodies are: a. Occurs in a myelinated fiber
a. Globins b. Has a faster rate of conduction
b. Hormones c. Requires lesser energy
c. Globulins d. All of the above
d. Histones 67. Goiter:
a. Means greatly enlarged thyroid gland
58. Approximate glomerular filtration rate is:
b. Caused due to iodine deficiency in diet
a. 80 mL/mt
c. Is due to excessive secretion of TSH
b. 200 mL/hr
d. All of the above
c. 15 mL/mt
d. 120 mL/mt 68. Plateau potential is not seen in:
a. Purkinje fibers of the heart
59. RBC maturation requires:
b. Smooth muscle fibers of gut
a. Folic acid
c. Cardiac muscle fibers
b. Iron
d. Skeletal muscle fibers
c. Zinc
d. All 69. Entire period of spermatogenesis (from genital cell to
sperm) is:
60. Testosterone increases: a. 8 days
a. Muscle mass b. 74 days
b. Bone length c. 700 days
c. Blood volume d. 2 days
61. Na+ – K+ pump 70. Function of placenta include:
a. Is an example of secondary active transport a. Endocrine function
b. Does not require energy b. Diffusion of nutrients and oxygen to fetal blood
c. Pumps two Na+ ions outward and three K+ ions c. Diffusion of carbon dioxide from fetal to maternal
inward with each cycle blood
d. Is an example of primary active transport mechanism d. All of the above
1. Name the scientist who had coined the term cell. 18. At birth all bone marrow is red but with age above 20
Ans. Robert Hooke. year red marrow gets slowly replace by yellow marrow.
2. Name the cells in which there is only cell membrane Which are the areas where this does not occur?
and no cell wall. Ans. Flat bones, cranium, ribs and vertebrae
Ans. Animal cell. 19. Name the tissues produces RBC and granulocytes.
3. Which is the major component of cell membrane? Ans. Myeloid
Ans. Phospholipid 20. Name the lymphoid tissues.
4. In which organelle does DNA replication occurs? Ans. Lymph nodes, thymus, spleen
Ans. Nucleus 21. What is normal erythroid : myeloid ratio?
5. Which organelle is known as powerhouse of the cell? Ans. 3:1
Ans. Mitochondrion
22. Name the stage of RBC development at which hemo-
6. At what temperature blood is stored? globin appears.
Ans. + 4°C Ans. Intermediate normoblast
7. Stored blood is rich in which of the ions. 23. What is the normal plasma level of Vit B l2?
Ans. Potassium ions Ans. 200 to 900 Hg/l
8. How much is resting membrane potential. 24. Name the vitamin whose deficiency produces a block
Ans. – 70mV in the metabolism of folic acid resulting in abnormal
9. How much is the volume of blood present in a human erythropoiesis.
adult? Ans. Vitamin B12
Ans. 5 liters
25. How much is the life span of RBC in healthy persons?
10. Name the blood which is free from formed elements. Ans. 120 days
Ans. Plasma
26. How much is the normal RBC count.
11. What is plasma minus fibrin? Ans. In males it is 5.5 million/mm3 of blood. In females it is
Ans. Serum 4.5 million/mm3 of blood
12. Name the condition in which the biconcavity of RBC 27. How much is the normal hemoglobin level?
is lost.
Ans. 15 g/100 mL of blood
Ans. Spherocytosis
28. How much is normal packed cell volume.
13. Name the protein which maintains the biconcave shape
Ans. 45 ml/100 ml of blood.
of RBC.
Ans. Spectrin 29. How much is normal mean corpuscular volume (MCV)?
14. Name the protein present on the cell membrane con- Ans. 80 to 94 fL
taining the blood group antigens. 30. How much is normal mean corpuscular hemoglobin
Ans. Glycophorin (MCH)?
15. At what time does erythropoiesis starts? Ans. 27 to 32 pg
Ans. 3rd week of intrauterine life 31. How much is normal mean corpuscular hemoglobin
16. At what period erythropoiesis occurs in the mesoderm concentrate (MCHC)?
of the yolk sack? Ans. 32 to 36 g/dL
Ans. From 3rd week to 3rd month 32. How much is normal value of ESR in Westergren’s
17. At what period erythropoiesis occurs in the liver and method?
spleen? Ans. In males it is 0 to 10 mm in males and in females it is
Ans. 3rd and 5th month of intrauterine life 0 to 5 mm
Physiology 437
33. Name the enzyme which keeps iron in the ferrous state. 53. What does macrophages of the spleen bone marrow
Ans. Methemoglobin reductase are known as?
34. Name the class of compounds to which heme belongs. Ans. Reticulum cells
Ans. Protoporphyrins 54. What does macrophages of liver known as?
35. Which is the condition in which there is excess hemo- Ans. Kupffer’s cells
siderin in the body. 55. Where do the platelets gets stored?
Ans. Bronze diabetes Ans. Spleen
36. How many peptide chains are present in hemoglobin A? 56. How much is the normal platelet count?
Ans. Two alpha and two beta chains Ans. Normal platelet count is 1,50,000 to 4,00,000/mm3 of
37. How many peptide chains are present in hemoglobin F? blood
Ans. Two alpha and two gamma 57. How much is the critical count of platelet?
38. What is the name of β thalasesemia major. Ans. 40,000/mm3 of blood
Ans. Cooley’s anemia
58. What is the shape of activated platelets?
39. Name the anemia in which count of RBC is low, MCV Ans. Spherical
is low and reticulocyte count is high.
59. Which structure consists of alpha granules, dense
Ans. Hemolytic anemia.
granules and glycogen granules?
40. How much is the total WBC count? Ans. Platelets
Ans. 4000 to 11000 per cumm of blood
60. When platelets get activated, dense granules present
41. Which stain differentiates WBC into granulocyte and in them release which component?
agranulocyte?
Ans. ATP, ADP and serotonin
Ans. Romanowsky stain
61. Name the platelets which are developed from giant cells.
42. Which are the major components of granulocytes?
Ans. Megakaryocytes
Ans. Neutrophils
62. What is the normal life span of platelet?
43. What does the granules of basophils consists of?
Ans. 7 to 12 days
Ans. Histamine and heparin
44. During parasitic invasion and allergic conditions which 63. Name the cells which releases heparin.
cell shows rise in count. Ans. Mast cells
Ans. Eosinophils 64. How much is the clotting time according to Lee and
45. When a monocyte enters the tissue what it is known as? White method?
Ans. Tissue macrophage Ans. 9 to 11 min
46. Which cell form the first line of defense? 65. How much is the normal prothrombin time?
Ans. Neutrophils Ans. 14 to 16 seconds.
47. Which cell forms second line of defense? 66. Which agent is the carrier of albumin?
Ans. Monocytes Ans. Ceruloplasmin
48. Cell mediated immunity is achieved by which cells? 67. When and who discovered the blood grouping?
Ans. T—lymphocytes Ans. In 1900, Karl Landsteiner
49. Which cell mediates the humoral immunity? 68. Most of the antibodies of blood group are of which
Ans. B—Lymphocytes variety?
50. Which special type of lymphocytes are killer cells and Ans. IgM
natural killer cells? 69. In kernicterus bilirubin deposition occur in which part
Ans. T—Lymphocytes of the brain.
51. In AIDS which lymphocytes are destroyed. Ans. Basal ganglia.
Ans. Helper T lymphocytes 70. In classical hemophilia which coagulation factor is
52. Which cells mediates the non-specific immunity? deficient?
Ans. Neutrophils Ans. Factor VIII
438 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
71. Which clotting factor acts both in extrinsic as well as 88. In a healthy man how much liters of oxygen is stored
intrinsic pathways? in his myoglobin.
Ans. Factor V Ans. 1.5 litre
72. Name the anticoagulant commonly used in laborato- 89. Which enzyme is found in RBC, pancreas, renal tubular
ries. and gastric mucosa?
Ans. Citrate dextrose solution Ans. Carbonic anhydrase
73. Which epithelium lines the trachea? 90. What do you mean by hypercapnia?
Ans. Pseudostratified ciliated columnar Ans. Increase in carbon dioxide.
74. Which is the principle muscle of inspiration? 91. What do you meant by asphyxia?
Ans. Diaphragm Ans. Lack of oxygen and retention of carbon dioxide.
75. Name the muscles of expiration. 92. In which condition cyclic events of apnea and hyper-
Ans. Abdominal muscle and internal intercoastal muscles apnea are seen?
Ans. Cheyne-Stokes breathing
76. Name the cells which secrete surfactant.
Ans. Type II alveolar cells. 93. Name the disease to which cotton and jute workers are
predisposed to.
77. During normal breathing expiration is how much time
Ans. Byssinosis
longer than inspiration?
Ans. 1.4 times 94. Which is the best test for measuring ventilatory
efficiency?
78. How much is the tidal volume? Ans. Peak expiratory flow rate
Ans. 500 mL
95. Sweat glands are referred to as which type of glands.
79. How much is the respiratory minute volume for healthy Ans. Eccrine glands
man?
96. Which line divides each myofibril into a number of
Ans. 5 liter/min
compartment.
80. Name the reflex which is an important cause of rhyth- Ans. Z line
micity of respiration.
97. Name the scientist who had given theory of muscle
Ans. Hering-Breuer’s reflex
contraction.
81. What is the term for the complete collapse of lung? Ans. HE Huxley and AF Huxley
Ans. Atelectasis
98. Which type of contraction is known when a muscle is
82. Aortic body and carotid body are examples of which stimulated and gets prevented from shortening?
type of chemoreceptors? Ans. Isometric
Ans. Peripheral chemoreceptors
99. Which type of contraction is known when a muscle is
83. If there is stimulation of gyrus linguli what happens stimulated and allowed to shorten?
then? Ans. Isotonic
Ans. Cessation of respiration
100. Name the epithelium lining the olfactory area.
84. How much is the partial pressure of oxygen at arterial Ans. Pseudostratified columnar epithelium
end.
101. What is the term for the complete absence of smell
Ans. 95 mm Hg
sense.
85. How much is the partial pressure of carbon dioxide at Ans. Anosmia
arterial end?
102. Which is the end organ of taste sensation?
Ans. 40 mm Hg
Ans. Taste buds
86. How much time greater is the diffusion capacity of
103. What does normal eye is referred as.
carbon dioxide as compare to oxygen?
Ans. Emmetropic eye
Ans. 20 times.
104. By use of which lens myopia is corrected?
87. Transfer of oxygen and carbon dioxide across the
Ans. Concave lens
alveolar capillary membrane is by which law of
diffusion of gases. 105. By use of which lens astigmatism is corrected?
Ans. Fick’s law Ans. Cylindrical lens
Physiology 439
106. Name the clinical condition common in old age in 116. If Babinski’s sign is negative what does this states?
which the lens becomes opaque and fails to transmit Ans. Patient is not suffering from pyramidal tract lesion.
light due to coagulation of lens protein. 117. Name the scientist who had introduces gate control
Ans. Cataract theory.
107. What are the end organs of vision? Ans. Melzack and Wall
Ans. Rods and cones 118. In oral cavity vitamin A deficiency leads to.
108. Name the blind spot in the retina. Ans. Enamel hypoplasia.
Ans. Optic disc 119. In oral cavity deficiency of vitamin C leads to.
109. Who have no green sensitive cones? Ans. Scorbutic gingivitis
Ans. Deuteranopes 120. From where does the ventricular muscle receive im-
pulses?
110. Name the chart used for testing color blindness.
Ans. Purkinje system
Ans. Ishihara
121. How much is the typical pulmonary artery systolic and
111. How many neurons does CNS have?
diastolic pressures.
Ans. 10 thousand million neurons. Ans. 24/9 mm of Hg
112. By which structure CSF from lateral ventricles com- 122. By which structure does the distribution of blood flow
municates into the third ventricle? mainly regulates.
Ans. Foramen of Monro Ans. Arterioles
113. By which structure CSF from third ventricle commu- 123. Name the gland which secretes calcitonin.
nicates into the 4th ventricle? Ans. Thyroid gland
Ans. Aqueduct of Sylvius
124. Which hormone inhibits the activity of osteoclasts?
114. Why nerve fibers of CNS do not regenerate? Ans. Calcitonin
Ans. They have neurilemma
125. Excess secretion of growth hormone during childhood
115. Which reflex is an important clinical test in neurology? leads to.
Ans. Plantar reflex Ans. Gigantism
440 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Additional Matter
Various Phases of Gastric Secretion Types of Threshold Substances
Heidenhain’s It demonstrate role of sympathetic nerve and First heart • Occur because of closure of atrioventricular
pouch hormonal regulation of gastric secretion after the sound valves (i.e. Mitral and tricuspid valves)
vagotomy • It is long, soft and low pitched and sound like
LUBB
Pavlov’s It demonstrate cephalic phase of gastric secretion • This is produced at the time of isometric con-
pouch traction and the earlier part of ejection period.
Normal Values of Intrapleural Pressure Second heart • It occur due to closure of the semilunar valves
sound (i.e. Pulmonary and aortic valves)
During start of inspiration and at end of expiration – 2 mm of Hg • This is short, sharp, high pitch and sounds like
DUBB
At end of inspiration and start of expiration – 6 mm of Hg • It is produced at the onset of diastole
At end of forced inspiration along with closed glottis – 70 mm of Hg Third heart This is produced at the time of rapid filling period
i.e. Muller’s maneuver sound and is inaudible by stethoscope
At end of forced expiration – 30 mm of Hg Fourth heart It is produced at the time of atrial systole and is
At end of forced expiration along with closed glottis + 50 mm of Hg sound inaudible
i.e. Valsalva maneuver
Events in the Cardiac Cycle
Information About Urine
Name of the
Normal urinary output is 1.15 lts event Important points
Increased urinary output is called as Polyuria Atrial systole • During this there is contraction in the atria and
small amount of blood enter the ventricles.
Reduced urinary output is called as Oliguria • AV valves are opened and semilunar valves
Stoppage of urine formation is called as Anuria are closed
• Its duration is 0.11 seconds
Proteins in urine is called as Proteinuria
Isometric • In this all of the valves get closed.
RBCs in urine is known as Hematuria
contraction • Pressure in the ventricles is elevated
Excess accumulation of urea and Creatinine Uremia • Its duration is 0.05 seconds
is known as
Contd...
Excess glucose in urine is called as Glucosuria
Physiology 441
Contd... Contd...
Name of the tissue Conduction rate (m/sec) Various Hemophilias and their Deficiency Factors
SA node 0.05
Name of hemophilia Deficient factor
Atrial pathway 1
Classical hemophilia or Hemophilia A Factor VIII
AV node 0.02 – 0.05
Christmas disease or hemophilia B Factor IX
Purkinje system 4
Hemophilia C Factor XI
Bundle of His 1
Von Willebrand disease Von Willebrand factor
Ventricular muscle 1
Differential Leucocyte Count
Various Nerve Fibers and their Functions
Name of the nerve fiber Functions Neutrophils 50 to 70%
Biochemistry
1. Carbohydrates: Chemistry, Metabolism and 10. Detoxification, Free Radicals and Antioxidants
Regulation 11. Organ Function Tests
2. Amino Acids and Proteins: Chemistry, 12. Vitamins
Metabolism and Regulation
13. Plasma Proteins
3. Proteins and Nucleic Acids: Chemistry,
14. Water, Electrolyte and Acid-Base Balance
Metabolism and Regulation
15. Cancer
4. Lipids: Chemistry, Metabolism and Regulation
16. Tissue Proteins and Body Fluids
5. Mineral Metabolism
6. Biological Oxidation Multiple Choice Questions as per DCI and
7. Enzymology Examination Papers of Various Universities
Various Mucopolysaccharides Ans. Also known a citric acid cycle, or tricarboxylic acid cycle.
♦♦ Hyaluronic acid: This is found in the ground substance of • It is the most important metabolic pathway for the
synovial fluid of joints and vitreous humor of eyes. It also energy supply to the body (See Fig. 3).
present as ground substance in connective tissue. It serves • Citric acid cycle is the final common oxidative path-
as lubricant and shock absorbent in joints. way for carbohydrate, fats and amino acid.
♦♦ Chondroitin sulfate: This is the constituent of mammalian
Formation of Citric Acid
tissues. It has enormous capacity to retain water.
♦♦ Heparin: It is an anti–coagulant which occurs in blood, 4-carbon structure, i.e. oxaloacetate condensed with 2-carbon
lung, liver and kidney. It leads to the release of enzyme structure, i.e. acetyl, CoA to form 6-carbon structure, i.e.
lipoprotein lipase which clears turbidity of lipemic plasma. citrate. The reaction is catalyzed by enzyme citrate synthase.
♦♦ Dermatan sulfate: It is most commonly occur in skin. It
also provides transparency to cornea and maintains overall Formation of Isocitrate
shape of an eye. Citrate is isomerized to isocitrate by the enzyme aconitase. This
Q.6. Write a short note on Cori’s cycle. (Apr 2010, 10 Marks) reaction is a two stage process. First stage is of dehydration,
Ans. Cori’s cycle is also known as lactic acid cycle. i.e. one water molecule is removed from citrate forming cis,
aconitate. In second stage, hydration occur, i.e. one water
Carl Cori and Gerty Cori had given the concept of Cori’s
molecule is added to aconitate to form isocitrate.
cycle. Both of them were awarded by Nobel prize in year
1947. Formation of Alpha-Ketoglutarate
Lactate is produced in skeletal muscles during anaerobic
♦♦ This reaction is a two-step process. Both the steps are
oxidation of glucose.
catalyzed by isocitrate dehydrogenase.
Under anaerobic conditions, pyruvate is reduced to ♦♦ In the first part of the reaction, isocitrate is dehyrogenated
lactate by lactate dehydrogenase. As plasma membrane to form oxalosuccinate. Oxalosuccinate undergoes
is permeable to lactate, lactate is carried from skeletal spontaneous decarboxylation to form alpha-ketoglutarate.
muscle via blood to liver, where it get oxidized to
♦♦ NADH generated at this step gets later oxidized in electron
pyruvate. Pyruvate which is produced gets converted to
transport chain and generate 3 ATPs.
glucose by gluconeogenesis which is then transported to
♦♦ 6-carbon structure isocitrate undergoes oxidative
skeletal muscle. So the cycle which involves synthesis of
decarboxylation to form alpha-ketoglutarate which is a
glucose in liver from skeletal muscle lactate and reuse of
5-carbon structure.
glucose which is synthesized by muscle for producing
♦♦ In this reaction, one molecule of CO2 is liberated.
energy is known as Cori’s cycle or lactic acid cycle.
Formation of Succinyl-CoA
♦♦ Alpha-ketoglutarate through oxidative decarboxylation
and is catalysed by enzyme alpha-ketoglutarate dehydro
genase to form succinyl-CoA.
♦♦ NADH generated at this step enters into electron transport
chain for generation of 3 ATPs.
♦♦ One molecule of CO2 is liberated in this step.
♦♦ The enzyme alpha-ketoglutarate dehydrogenase is
dependent on five co-factors, i.e. TPP, lipoamide, NAD+,
FAD and CoA.
Formation of Succinate
Succinyl-CoA is converted to succinate by succinate thiokinase.
This reaction is coupled with the phosphorylation of GDP to
GTP. This is a substrate level phosphorylation. GTP is converted
Fig. 2: Cori’s cycle or lactic acid cycle to ATP by phosphokinase enzyme.
Q.7. Write a short note on Krebs cycle. GTP + ADP → GDP + ATP
(Sep 1999, 5 Marks) (Mar 2009, 10 Marks) Formation of Fumarate
Or
Succinate is dehydrogenated to fumarate by succinate
Write a short note on TCA Cycle.(Dec 2014, 10 Marks) dehydrogenase. The hydrogen atoms are accepted by FAD.
Or FADH2 then enters into ETC to generate 2 ATPs. The enzyme
Describe Krebs cycle with energetic and regulation. is a flavoprotein. The succinate dehydrogenase is competitively
(Apr 2018, 10 Marks) inhibited by malonate.
Biochemistry 449
Formation of Malate
Formation of malate from fumarate is catalysed by fumarase.
Regeneration of Oxaloacetate
♦♦ Malate is oxidized to oxaloacetate by malate dehydrogenase.
♦♦ The coenzyme is NAD+.
♦♦ NADH is generated in this step which enters the electron
transport chain, when 3 ATPs are produced.
♦♦ Oxaloacetate can further condense with another acetyl-
CoA molecule and the cycle continues.
♦♦ Oxaloacetate may be viewed as a catalyst which enters into
the reaction, causes complete oxidation of acetyl-CoA and
comes out of it without any change.
Interpretation
♦♦ Fasting plasma glucose level is <100 mg/dL in normal
persons. On taking oral glucose the concentration increases
and the peak value, i.e. <150 mg/dL is reached in less than
a hour which returns to normal by 2 hours. Glucose is not
detected in urine samples.
♦♦ In individuals with impaired glucose tolerance the fasting
as well as 2 hour glucose levels of plasma glucose levels
are elevated. These subjects solely develop frank diabetes.
Q.9. Write a short note on hypoglycemia. (Sep 2009, 5 Marks)
Ans. Hypoglycemia means decrease in the blood glucose level
Fig. 5: Glucose tolerance curve below 45 mg/dL.
Biochemistry 451
Q.13. What are energy liberating metabolic pathways in our ♦♦ Depresses glycogen synthesis
body. Describe one of them. (Sep 2013, 10 Marks) ♦♦ Inhibits glycolysis.
Ans. Energy liberating metabolic pathways in our body are:
Cortisol or Hyperglycemic Hormone
1. Citric acid cycle
2. Cori’s cycle ♦♦ Increases blood sugar level
3. Glycolysis ♦♦ Increases gluconeogenesis
4. Gluconeogenesis ♦♦ Releases amino acids from the muscle.
5. Hexose monophosphate shunt Adrenaline or Epinephrine
6. Oxidative phosphorylation
♦♦ Increases blood sugar level
7. b-Oxidation of fatty acid.
♦♦ Promotes glycogenolysis
For citric acid cycle in detail refer to Ans 7 of same chapter. ♦♦ Increases gluconeogenesis
Q.14. How is blood glucose level regulated. (Sep 2013, 4 Marks) ♦♦ Favors uptake of amino acids.
Or Growth Hormone
Write on regulation of blood sugar. (Apr 2017, 5 Marks) ♦♦ Increases blood sugar level
Ans. Regulation of blood glucose level is also known as ♦♦ Decreases glycolysis
homeostasis of blood glucose. ♦♦ Mobilizes fatty acids from adipose tissue.
Q.15. What is Krebs cycle? Why it is so called? What is the
Regulation of Blood Glucose Level During Fasting
alternate name of the cycle? Justify the name. State very
After 2 to 2½ hours after meal, blood glucose level fall to briefly the steps of Krebs cycle. (Oct 2014, 8 Marks)
fasting level. It can go down further but this is prevented by Ans. Krebs cycle is the most important carbohydrate metabolic
processes which contribute glucose to blood. For the next 3 pathway for energy supply to body. It utilizes 2/3rd of
hours the glycogenolysis takes care of blood sugar level. Then total oxygen consumed by the body. About 65 to 70% of
gluconeogenesis take part. Liver supplies the glucose for ATPs are generated in Krebs cycle.
maintenance of blood glucose level. It is known as Krebs cycle because it was proposed by
Sir Hans Krebs. So the cycle is named after him. It is also
Regulation of Blood Glucose Level Post Prandially
known as tricarboxylic acid because at outset of the cycle,
After a meal, glucose get absorbed from intestine and enter in tricarboxylic acids, i.e. citrate, cis-aconitate and isocitrate
blood. Rise in the blood glucose level also stimulate secretion of participates.
insulin through beta cells of islet of langerhans. Uptake of glucose It is also known as Krebs cycle or tricarboxylic acid (TCA)
by extrahepatic tissues except brain depends on insulin. Insulin also cycle or citric acid cycle.
helps conversion of glucose into glycogen or its conversion to fat. For krebs cycle in detail refer to Ans 7 of same chapter.
Role of Kidney in Blood Glucose Level Regulation Q.16. Write a short note on polysaccharides.
(Feb 2013, 7 Marks)
♦♦ Filtration of glucose occurs continuously by glomeruli.
♦♦ Glucose is resorbed and return to the blood. Ans. Polysaccharides consists of repeat units of monosa-
ccharides or their derivatives which are held together
♦♦ If levels of glucose in blood exceed 160-180 mg/dL, glucose
by glycosidic bonds.
is excreted in urine. This value is renal threashold of glucose.
♦♦ Maximum ability of renal tubules to resorb glucose per Types
minute is known as tubular maximum for glucose (TmG).
Its value is 350 mg/min. Polysaccharides are of two types, i.e. homopolysaccharides and
Also refer to Ans 19 of same chapter. heteropolysaccharides.
Energetics of Glycolysis
Under aerobic conditions, 7 molecules of ATP are produced as
per new concept, while in anerobic glycolysis only 2 molecules
of ATP are produced per mole of glucose. Fig. 6: Regulation of glycolysis
Biochemistry 457
Hexokinase and Glucokinase ♦♦ By stimulating the active transport of glucose across cell
♦♦ Inhibition of hexokinase is done by glucose-6–phosphate. membranes of muscle and adipose tissue but not the
♦♦ Hexokinase prevents accumulation of glucose-6– liver. Glucose is rapidly taken up into liver as it is freely
phosphate due to product inhibition. permeable to glucose.
♦♦ Glucokinase specifically phosphorylate glucose is an ♦♦ In the liver, insulin increases the use of glucose by
inducible enzyme. Substrate glucose via involvement of glycolysis by inducing the synthesis of key glycolytic
insulin induces glucokinase and its synthesis decrease in enzymes, i.e. glucokinase, phosphofructokinase, pyruvate
response to glucagon. kinase.
♦♦ In the muscle and liver, insulin stimulates glycogenesis
Phosphofructokinase-I by stimulating glycogen synthase and thereby leading to
♦♦ Phosphofructokinase-I is the regulatory enzyme in suppression of glycogenolysis.
glycolysis. ♦♦ Insulin inhibits gluconeogenesis by suppressing the
♦♦ This enzyme catalyses rate limiting committed step. action of key enzymes of gluconeogenesis, e.g. pyruvate
♦♦ It is an allosteric enzyme which is regulated by alloesteric carboxylase, phosphoenol pyruvate carboxykinase,
effectors. Fructose 1,6—bisphosphatase, glucose-6-phosphatase.
♦♦ Phosphofructokinase-I is activated by AMP, fructose 6– ♦♦ In adipose tissue, glucose is converted to the glycerol
phosphate, fructose 2, 6–biphosphate and insulin. 3-phosphate needed for the formation of triacylglycerol
♦♦ Phosphofructokinase-I is inhibited by ATP, citrate and (lipogenesis).
glucagon. ♦♦ Insulin increases protein synthesis and decreases protein
Pyruvate Kinase catabolism, thereby releasing amino acids. All these
mechanisms are responsible for a drop in blood glucose
♦♦ This enzyme is activated by fructose–1, 6–bisphosphate level (hypoglycemia).
feedforward stimulation and insulin.
♦♦ This enzyme is inhibited by ATP and glucagon.
Q.23. Mention the reference value of plasma glucose in fast-
ing and 2 hours postprandial state. List the hormones
released in fasting and fed state. Explain in detail blood
glucose maintenance in the fed state.
(May 2017, 10 Marks)
Ans. Reference value of plasma glucose in fasting and 2 hours
postprandial state are as follows:
Reference value of plasma glucose in fasting is 70 to 100
mg/dL
Reference value of plasma glucose 2 hours postprandial Fig. 7: Role of insulin in regulation of blood glucose level
is 120 to 140 mg/dL.
Q.24. Answer in brief reducing nature of sugars.
Hormones Release in Fasting and Fed State
(Sep 2017, 2 Marks)
1. Hormones released in fasting state are: Ans. Reducing property of sugar is attributed to free aldehyde
• Glucagon or keto group of anomeric carbon.
• Epinephrine or adrenaline
• On treatment with dilute aqueous alkalis, both
• Glucocorticoids
aldoses and ketoses change to enediols.
• Growth hormone and adrenocorticotropic hormone
• Enediols are good reducing agents due to which they
(ACTH)
form basis of benedict’s or Fehling’s test.
• Thyroxine
• So, alkali enolizes the sugar and causes them to be
2. Hormones released in fed state is:
strong reducing agents.
• Insulin
• Reducing effect is much more efficient in alkaline
Blood Glucose Maintenance in the Fed State medium as compared to acidic medium.
• In Benedict’s test enediol form of sugars reduces
In fed state blood glucose is maintained by insulin. Insulin
cupric (Cu2+) ions of copper sulfate to cuprous
reduces blood glucose level in hyperglycemic condition.
(Cu+) ions which form yellow precipitate of cuprous
Normally, there is an increased blood glucose level shortly hydroxide or red precipitate of cuprous oxide.
after each meal, a postprandial hyperglycemia. Increased level
of blood glucose releases insulin by β—cells of the Islet of the Q.25. Write about Krebs cycle and its importance.
Langerhans. This hormone reduces the blood glucose level in (Jan 2018, 5 Marks)
a number of ways as follows: Ans. For Krebs cycle refer to Ans 7 in detail.
458 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Reactions of Glycogenesis
Following are the steps of glycogenesis:
♦♦ Synthesis of uridine diphosphate glucose: Enzymes
hexokinase present in muscle and enzyme glucokinase
present in liver convert glucose to glucose-6–phosphate.
Enzyme phosphoglucomutase catalyses conversion of
glucose-6–phosphate to glucose-1–phosphate. Uridine
diphosphate glucose is synthesized from glucose
1–phosphate and uridine triphosphate by uridine
diphosphate–glucose pyrophosphorylase.
♦♦ Primer required to initiate glycogenesis: Small fragment
of pre–existing glycogen act as primer which initiate
glycogen synthesis.
♦♦ Synthesis of glycogen by glycogen synthase: Glycogen
synthase causes formation of 1,4–glycosidic linkages.
This enzyme lead to transfer of glucose from uridine
diphosphate glucose to nonreducing end of glycogen to
form α–1, 4 linkages.
Fig. 8: Glycogenesis
Biochemistry 459
♦♦ Formation of branches in glycogen: Formation of form of this sugar in solution cyclize into rings. An
branches is due to action of branching enzyme, i.e. glucosyl additional asymmetric center is created when glucose
α–4–6 transferase. This enzyme causes transfer of small cyclizes.
fragment of 5 to 8 glucose residues from nonreducing Carbon–l of glucose in the open chain form becomes
end of glycogen chain to another glucose residue where an asymmetric carbon in the ring form and two ring
it is linked by α–1, 6 bond. Now this leads to formation of structures can be formed. These are:
a new nonreducing end, beside the existing one. Further
• α –D – glucose
elongation and branching of glycogen occur by enzyme
glycogen synthetase and glucosyl 4–6 transferase. • β – D – glucose
So, final reaction of glycogen synthesis for addition of each The designation α means that the hydroxyl group attached to
glucose residue is: C l is below the plane of the ring, β means that it is above the
(Glucose)n + Glucose + 2 ATP → (Glucose)n + 1 + 2 ADP + Pi plane of the ring. The C l carbon is called the anomeric carbon
The two ATPs which are utilized, out of these one is atom and so, α and β forms are anomers.
needed for phosphorylation of glucose and other is needed for
conversion of uridine diphosphate to uridine triphosphate. Q.29. Write very short answer on optical activity.
Q.27. Write very short answer on epimers. (Apr 2018, 2 Marks) (Aug 2018, 2 Marks)
Ans. When two monosaccharides differ from each other in Ans. Ordinary light propagates in all the directions. But as
their configuration around a single specific carbon atom, ordinary light is passed via Nicol prism, the plane of
they are referred to as epimer to each other. polarized light vibrates in single direction only. This is
For example, glucose and galactose are epimers with optical activity.
regard to carbon 4, i.e. they differ in arrangement of - OH • Various organic compounds such or optical
group at 4th carbon. isomers which undergo optical activity rotate
Another example is glucose and mannose is epimers plane of polarized light either to the left or to
with regard to 2nd carbon. the right side.
Q.28. Write very short answer on anomers. • Levorotatory is the term which is given to the sub-
(Aug 2018, 2 Marks) stances which rotate plane of polarized light to left.
Ans. α and β cyclic forms of D-glucose are known as anomers. • Dextrorotatory is the term given to the substances
The predominant form of glucose and fructose in a which rotate plane of polarized light to right.
solution are not an open chain. Rather, the open chain • Racemic mixture is the term given to equal concen-
tration of both levo and dextroforms which cannot
rotate the plane of polarized light.
D-Glucose
(open chain formula or
fisher projection
(<0–1% in solution)
Q.1. Classify amino acids on structural basis. Describe urea ornithine cycle in detail. (Nov 2009, 8 Marks)
Ans. Classification of Amino Acids on Basis of Structure
2. Alanine Ala A
Cystine — — Disulfide
Contd…
Biochemistry 461
Contd…
Contd…
462 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Contd…
The amino acids which are neutral in solution are monoamino— Dicarboxylic Acid and their Amides
monocarboxylic acids (i.e. having one amino group and one
Amino acids having carboxylic group in their side chain, e.g.
carboxylic group), e.g. are:
♦♦ Glutamic acid
♦♦ Glycine ♦♦ Serine ♦♦ Phenylalanine ♦♦ Glutamine (amide of glutamic acid)
♦♦ Alanine ♦♦ Threonine ♦♦ Tyrosine ♦♦ Aspartic acid
♦♦ Valine ♦♦ Cysteine ♦♦ Tryptophan ♦♦ Aspargine (amide of aspartic acid).
♦♦ Leucine ♦♦ Methionine ♦♦ Aspargine
Diamino Acids
♦♦ Isoleucine ♦♦ Proline ♦♦ Glutamine
Amino acids having amino group (-NH2) in the side chain, e. g.
Acidic Amino Acid
♦♦ Lysine
These are acidic in solution and are monoamino dicarboxylic ♦♦ Arginine
acids, e. g. ♦♦ Histidine.
464 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Among the ten essential amino acids; arginine and histidine Classification Based on Nature or Polarity of Side Chain
are known as semi—essential amino acids since these amino of Amino Acid
acids are synthesized partially in human body and inadequate According to this type of classification, amino acids are classified
to support growth of children. into two major classes:
Arginine and histidine become essential in diet during 1. Hydrophilic or polar amino acids
periods of rapid growth as in childhood and pregnancy. 2. Hydrophobic or nonpolar amino acids.
Biochemistry 465
Significance of Transamination
♦♦ This reaction provides a mechanism for collecting the
amino groups from many different amino acids into Fig. 13: Secondary structure
Biochemistry 469
♦♦ α-helix is the spiral structure of protein and it has rigid Q.13. Write about biological importance of proteins.
arrangement of polypeptide chain. (Feb 2013, 5 Marks)
♦♦ β-pleated sheet are composed of two or more segments Ans.
of fully extendable peptide chains. In β-pleated sheet,
the hydrogen bonds are formed between the neighboring Biological Importance of Proteins
segments of polypeptide chains. ♦♦ Proteins are the essence of life processes.
♦♦ They are the fundamental constituents of all protoplasm
Tertiary Structure
and are involved in the structure of living cell and in its
♦♦ Three dimensional arrangement of protein structure is function.
referred to as tertiary structure. ♦♦ Enzymes are made up of proteins.
♦♦ Tertiary structure is the compact structure with hydrophobic ♦♦ Many of the hormones are proteins.
side chains held interior, while the hydrophilic groups are ♦♦ The cement substances and the reticulum which bind or hold
on the surface of protein molecule. the cells as tissues or organs are made up partly of proteins.
♦♦ Hydrogen bonds, disulphide bonds, ionic interactions ♦♦ They execute their activities in the transport of oxygen
and hydrophobic interactions also contribute to tertiary and carbon dioxide by hemoglobin and special enzymes
structure of proteins. in the red cells.
♦♦ They function in the homeostatic control of the volume
of the circulating blood and that of the interstitial fluids
through the plasma proteins.
♦♦ They are involved in blood clotting through thrombin,
fibrinogen and other protein factors.
♦♦ They act as the defence against infections by means of
protein antibodies.
♦♦ They perform hereditary transmission by nucleoproteins
of the cell nucleus.
Q.14. Name the specialized products synthesized by tyrosine.
Fig. 14: Tertiary structure
(Aug 2016, 2 Marks)
Ans. Following are the specialized products synthesized by
tyrosine:
Quaternary Structure
• Catecholamines
♦♦ It results when the protein consisting of two or more – Dopamine
polypeptide chains are held together by noncovalent – Norepinephrine
forces. – Epinephrine
♦♦ Some of the proteins consist of two or more polypeptides • Melanin pigment
which are identical or unrelated. These are known as • Thyroxine
oligomers and possess quaternary structure.
♦♦ Individual polypeptide chains are known as monomers,
protomers or subunits.
♦♦ A dimer consists of two polypeptides, while a tetramer
has four polypeptides.
♦♦ Oligomer proteins play an important role in the regulation
of metabolism and cellular function.
Basically phenylalanine is converted to tyrosine. The dihydrobiopterin produced is reduced back to H4-
Phenylalanine gets hydroxylated at para position by biopterin by dihydrobiopterin reductase.
phenylalanine hydroxylase to produce tyrosine in ♦♦ The next step is transamination of tyrosine with α–
the presence of coenzyme biopterin. Active form of ketoglutarate to P–hydroxyphenyl pyruvate, catalyzed by
biopterin is tetrahydrobiopterin. In phenylalanine tyrosine transaminase.
hydroxylase reaction tetrahydrobiopterin is oxidized to ♦♦ P-hydroxyphenylpyruvate then reacts with O2 to form
dihydrobiopterin reductase.
homogentisate. This reaction is catalyzed by P-hydroxy—
Tyrosine is incorporated into proteins and is involved in phenylpyruvate hydroxylase is called as dioxygenase
synthesis of variety of biologically important compounds,
because both atoms of oxygen become incorporated into
i.e. epinephrine, norepinephrine, dopamine, thyroid
product.
hormones and melanin pigment.
♦♦ Homogentisate is then cleaved by oxygen to yield
Metabolism of Tyrosine 4—maleylacetoacetate. This reaction is catalyzed by
homogentisate oxidase.
Phenylalanine metabolism is initiated by its oxidation to
♦♦ 4—maleylcetoacetate is then isomerized to 4-fumarylace-
tyrosine which then undergoes oxidative degradation. Thus,
catabolic pathway for phenylalanine and tyrosine is same as toacetate, by an enzyme maleylacetoacetate isomerase that
follows: uses glutathione as a cofactor.
♦♦ The first step is the hydroxylation of phenylalanine ♦♦ Finally, 4—fumarylacetoacetate is hydrolyzed by
to tyrosine, a reaction catalyzed by phenylalanine fumarylacetoacetate hydrolase to fumarate, a glucogenic
hydroxylase. This enzyme requires tetrahydrobiopterin intermediate and acetoacetate, a ketogenic intermediate.
(H4-biopterin) as a cofactor. The cofactor is oxidized to Phenylalanine and tyrosine are therefore, both glucogenic
dihydrobiopterin (H2-biopterin) during this reaction. and ketogenic.
Q.16. Mechanism for removal of nitrogen from amino acids. Mechanism of Transcription
(Jan 2018, 5 Marks)
It involves three steps, i.e.
Ans. Removal of nitrogen from amino acids occurs via 1. Initiation
oxidative deamination and transamination.
2. Elongation
Transamination 3. Termination
Fig. 18: Process of transcription in prokaryotes. A. Recognition of promoter by sigma factor; B. Bnding of core enzyme and starts the
synthesis of RNA; C. Elongation continues until termination region is reached; D. Termination of transcription by Rho factor; E. Newly
syntherized RNA (primary transcript)
Steps of Translation ♦♦ The acceptor arm: This arm is capped with a sequence
♦♦ Stage 1: Activation of amino acids: Amino acids are CCA. The amino acid is attached to the acceptor arm.
activated by attaching amino acid to a tRNA in first stage of ♦♦ The anticodon arm: This arm, with the three T specific
protein synthesis. Each of the 20 amino acids is covalently nucleotide bases, is responsible for the recognition of triplet
attached to a specific tRNA at the expense of ATP codon of mRNA. The codon and anticodon are comple
energy using Mg2+ dependent, aminoacyl tRNA mentary to each other.
synthetases. ♦♦ The D arm: It is so named due to the presence of
♦♦ Stage 2: Initiation: The mRNA which consists of codons dihydrouridine.
for the protein to be synthesized binds to the smaller ♦♦ The TψC arm: This arm contains a sequence of
ribosomal subunits and to the initiating aminoacyl tRNA. ribothymidine (T) and pseudouridin (ψ, Psi).
The large ribosomal subunit then binds to form an initiation ♦♦ The variable arm: This arm is the most variable arm
complex. The initiating aminoacyl tRNA base pairs because it vary in size. It is found between anti-codon
with the mRNA codon AUG and signals the beginning and Tψ C arm.
of polypeptide synthesis. This process which requires
GTP is promoted by cytosolic proteins known as initiation
factors.
♦♦ Stage 3: Elongation: The nascent polypeptide is lengthened
by covalent (peptide bond) attachment of successive
amino acid units, each carried to the ribosome and
correctly positioned by its tRNA, which base pairs
to its corresponding codon in the mRNA. Elongation
requires elongation factors. The binding of each incoming
aminoacyl tRNA and the movement of ribosome along the
mRNA are facilitated by GTP as each residue is added to
the growing polypeptide.
♦♦ Stage 4: Termination and ribosome recycling: Completion
of the polypeptide chain is signaled by a termination codon
in the mRNA. The new polypeptide is released from the
ribosome aided by release factors, and the ribosome is
recycled for another round of synthesis.
♦♦ Stage 5: Folding and post-translational processing:
In order to achieve its biologically active form, the
new polypeptide must fold into its proper three-
dimensional configurations. Before or after folding, the
new polypeptide may undergo enzymatic processing,
including removal of one or more amino acids (usually
form the amino terminus), addition of acetyl, phosphoryl,
methyl, carboxyl, or other groups to certain amino acid
residues, proteolytic cleavage; and/or attachment of Fig. 20: Structure of tRNA
oligosaccharides or prosthetic groups.
Q.2. Write short note on tRNA. (Nov 2009, 3 Marks) Function of tRNA
Ans. Transfer RNA molecule contains 74–95 nucleotides with It carry amino acids in an activated form to ribosome for
a molecular weight of about 25,000. synthesis of proteins.
In eukaryotic cells, 10 to 20% of nucleotides of tRNA may
Q.3. Write short note on DNA. (Dec 2010, 5 Marks)
be modified and are known as unusual nucleotides. For
(Aug 2011, 6 Marks) (June 2010, 5 Marks)
example:
• Dihydrouridine (D): In this one of double bond of Ans. DNA is a polymer of deoxyribonucleotides.
the base is reduced. • It is composed of monomeric units namely
• Ribothymidine (T): In this methyl group is added to deoxyadenylate (dAMP), deoxyguanylate (dGMP),
uracil to form thymine. deoxycytidylate (dCMP) and deoxythymidylate
• Pseudouridine (φ): In this uracil is added to ribose (dTMP).
by carbon–carbon bond rather than nitrogen bond. • The double helical structure of DNA was proposed
by James Watson and Francis Crick in 1953.
Structure of tRNA • The structure of DNA double helix is comparable to a
tRNA contains mainly four arms, each arm contains base twisted ladder. The salient features of Watson-Crick
paired stem. model of DNA are as follows:
Biochemistry 475
1. DNA is a right handed double helix. It consists ♦♦ The stress produced due to unwinding by helicase is
of two polydeoxyribonucleotide chains (strands) released by topoisomerases by cutting either one or both
twisted around each other on a common axis. DNA strands.
2. Two strands are anti-parallel, i.e. one strand runs ♦♦ The single stranded binding (SSB) protein stabilizes the
in the 5’ to 3’ direction while the other in 3’ to 5’ separated strands and prevents their reassociation.
direction. ♦♦ To initiate the DNA synthesis by DNA polymerase III, it
3. Width of a double helix is 20 Aº. requires RNA primer. The RNA primers are short pieces
4. Each turn of the helix is 34 Aº with 10 pairs of of RNA (some 5-50 nucleotides in length) formed by the
nucleotides, each pair placed at a distance of enzyme primase (RNA polymerase) using DNA as a
template.
about 3.4 A°.
5. The two strands are held together by hydrogen
bonds formed by complementary base pairs. The
A-T pair has 2 hydrogen bonds while G—C pair
has 3 hydrogen bonds. The G—C is stronger by
about 50% than A = T.
6. The complementary base pairing in DNA helix
proves Chargaff’s rule. The content of adenine
equals to that of thymine (A = T), and guanine
equals to that of cytosine (G = C).
Q.4. Write short note on DNA replication.
(Nov 2012, 3 Marks)
Ans. Replication of DNA
During cell division, each daughter cell gets an exact copy
of the genetic information of the mother cell. This process of
copying the DNA is known as DNA replication.
In the daughter cell, one strand is derived from the mother
Fig. 21: Replicating fork
cell; while the other strand is newly synthesised. This is called
semi-conservative type of DNA replication. Elongation
♦♦ mRNA carries the genetic information in the form of • Nucleic acids are macromolecules present in all
codons. Codons are a group of three adjacent nucleotides living cells in combination with protein to form nu-
that code for the amino acids of protein. cleoproteins. The protein is usually protamine and
♦♦ In eukaryotes mRNAs have some unique characteristics, histone. Genetic information is encoded in nucleic
e.g. the 5’ end of mRNA is "capped" by a 7-methyl- acid molecule.
guanosine triphosphate. • Nucleic acids are built up by the monomeric units,
♦♦ The cap is involved in the recognition of mRNA in i.e. nucleotides.
protein biosynthesis and it helps to stabilize the mRNA • Nucleic acids are of two types, i.e. deoxyribonucleic
by preventing attack of 5’-exonucleases. acid (DNA) and ribonucleic acid (RNA).
♦♦ A poly (A) “tail” is attached to the other 3’—end of mRNA. • DNA is present in nuclei and small amount are also
This tail consists of series of adenylate residues, 20-250 present in mitochondria whereas 90% of RNA is
nucleotides in length joined by 3' to 5’ phosphodiester present in cell cytoplasm and 10% in nucleolus.
bonds. • Nucleic acids serve as repositories and transmitters
♦♦ The function of poly A tail is not fully understood, but it of genetic information.
seems that it helps to stabilize mRNA by preventing the
attack of 3’-exonuclease. Functions of Nucleotides
♦♦ If the mRNA codes for only one peptide, the mRNA Nucleotides carry out various biological functions, i.e.
is monocistronic. If it codes for two or more different ♦♦ They are activated precursors of DNA and RNA.
polypeptides, the mRNA is polycistronic. In eukaryotes ♦♦ In addition to their roles as the subunit of nucleic acids,
most mRNA are monocistronic. nucleotides have a variety of other functions in every cell
Transfer RNA (tRNA) as:
• They act as energy carriers, e.g. ATR GTP, CTP and
Refer to Ans 2 of same chapter. UTP.
• Components of enzyme cofactors, e.g. adenine
Ribosomal RNA (rRNA)
nucleotide are component of three major coenzymes
♦♦ RNA of ribosome is known as rRNA. NAD+, FAD+ and CoA.
♦♦ Ribosome is a cytoplasmic nucleoprotein which acts as • Chemical messengers, e.g. cAMP, and cGMP.
machinery for synthesis of proteins. One of the most common is adenosine 3`, 5'-cyclic
♦♦ Ribosome is a spheroidal particle which consists of a large monophosphate (cAMP), serves regulatory functions
and small nucleoprotein subunit. in virtually every cell.
♦♦ Eukaryotic ribososmes consists of 60S and 40S subunits. • Activator of metabolic intermediates: Nucleotides
Each subunit consists of one or more strand of rRNA and are needed for activation of intermediates in many
various numerous protein molecules. biosynthetic pathways, e.g. UDP-glucose and CDP—
♦♦ 60S subunit consists of 28S rRNA, 5S rRNA and 5.8S rRNA, diacylglycerol are precursors for glycogen and
the 40S subunit contains 18S rRNA. phospholipid synthesis.
Functions of RNA Q.8. Write on biological importance of nucleotides.
(May 2014, 5 Marks)
Type of RNA Function Ans. Following is the biological importance of nucleotides:
mRNA It carry genetic information from DNA to cytosol, • They are the building blocks or monomeric units in
where it is used for synthesis of proteins the nucleic acid structure.
• They are the structural components of various co-
tRNA It serves as “adaptor” molecule which carry specific
amino acid to site of protein synthesis enzymes of B-complex vitamins e.g. FAD, NAD+,
NADP+, etc.
rRNA • In association with the protein, it serves as site
for protein synthesis. • Nucleotides are the carriers of high energy interme-
• It provides catalytic activities diates during biosynthesis of carbohydrates, lipids
and proteins.
Hn RNA This serves as precursor for mRNA
• They are involved in the energy reactions of the cell.
Sc RNA This RNA is involved in recognition of signal
• They control several metabolic reactions by acting
sequence on protein synthesis on membrane bound
ribososmes. as allosteric regulators.
• Cyclic AMP and cyclic GMP are the second mes-
Sn RNA It involves in excising introns and splicing axons
sengers in hormone function.
Q.7. Write short note on nucleic acids.( June 2010, 5 Marks) Q.9. Write about structure and functions of DNA.
Ans. Nucleic acids are the polymers of nucleotides which are (Jan 2018, 5 Marks) (Sep 2015, 7 Marks)
held by 3’ and 5’ phosphate bridges. (Sep 2018, 5 Marks)
478 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Ans. Structure of DNA each other. Wherever adenine occurs in one chain,
Primary Structure of DNA thymine is found in the other; similarly wherever
guanine occurs in one chain cytosine is found in the
• DNA is a very long, thread like macromolecule
other.
made up of a large number of deoxyribonucleotides;
each composed of a nitrogenous base, a sugar and • The DNA double helix or duplex is held together
phosphate group. by two forces: hydrogen bonding between comple-
• The sugar in a deoxyribonucleotide is deoxyribose. mentary base pairs and base stacking interactions.
• The nitrogenous base purines in DNA are adenine • The Watson-Crick structure is also referred to as
(A), and guanine (G) and pyrimidines are thymine B-form DNA or B-DNA. The B—form is the most
(T) and cytosine (C). stable structure of DNA under physiological condi-
• In a deoxyribonucleotide, the C-l carbon atom of tions. The structured variants that have been well
deoxyribose is bonded to N-1 of pyrimidine or N-9 characterized are the A-form and Z-form.
of purine by N- glycosidic linkage. The backbone of
DNA consists of many deoxyribonucleotides linked
covalently by 3’,5’ phosphodiester bonds.
• The sequence of bases along a polynucleotide chain
is not restricted in any way; the precise sequence of
bases carries the genetic information. The resulting
long, unbranched DNA chain has polarity.
• One end of the chain has a 5’—phosphate group and
the other a 3’—hydroxy group that is not linked to
another nucleotide. The base sequence located along
the resulting DNA chain is written from 5’ end of
the chain to the 3’ end (5’—>3’ direction).
Secondary Structure of DNA
In 1953, James Watson and Francis Crick postulated a
three dimensional model of DNA structure.
• It consists of two helical DNA chains vound around
the same axis to form a right handed double helix.
• The hydrophilic backbones of alternating
deoxyribose and phosphate groups are on the
outside of the double helix facing the surrounding
water. The purine and pyrimidine bases of both
strands are sacked inside the double helix with their
hydrophobic ring structures very close together and
perpendicular to the long axis.
• Each nucleotide base of one strand is paired with a Fig. 22: Structure of DNA
base of the other strand. Watson and Crick found
thatA (Adenine) bonds specifically to T (Thymine)
Functions of DNA
and G (Guanine) bonds to C (Cytosine). Adenine is
always paired with thymine in DNA by formation DNA is the store of genetic information. Genetic information
of two hydrogen bonds: guanine is always paired stored in DNA serves two functions:
with cytosine by formation of three hydrogen bonds. 1. It is the source of information for synthesis of all protein
The balance pairing of the two strands creates a molecules of the cell.
major groove and minor groove on the surface of 2. It provides the information inherited by daughter cells
the duplex.
or offspring.
• The two strands of DNA are anti–parallel, their 3’,
5’— phosphodiester bonds run in the opposite struc- Q.10. Write similarity and differences between DNA and
ture of DNA directions. Adjacent bases are separated RNA. (Feb 2016, 2 Marks)
by 3.4Å along the helix axis and the helical structure Or
repeats after ten residues on each chain, that is at
intervals of 34Å. The diameter of the helix is 20Å. Answer in brief on similarities and differences between
• The two antiparallel polynucleotide chains of double DNA and RNA. (May 2017, 2 Marks)
helical DNA are not identical in either base sequence Ans. Following are the similarities and differences between
or composition. Instead they are complementary to DNA and RNA:
Biochemistry 479
Similarities between RNA and Differences between RNA and Degradation of cAMP
DNA DNA It undergoes rapid hydrolysis which is catalysed by enzyme
DNA and RNA are made up of DNA is double-stranded, RNA is phosphodiesterase to 5’ AMP which is inactive.
monomers called nucleotides single-stranded
DNA and RNA both contain DNA contains a pentose sugar Functions of cAMP
pentose sugars deoxyribose, RNA contains the ♦♦ It acts as second messenger for the most of polypeptide
pentose sugar Ribose. A pentose hormones.
is a 5-carbon sugar molecule
♦♦ It enhances the degradation of storage fuels like fat and
DNA and RNA both have 3 DNA is limited to the nucleus, glycogen by stimulating lipolysis, glycogenolysis. cAMP
nitrogenous bases: Adenine, RNA is made in the nucleus, but serve regulatory function in every cell.
Cytosine and Guanine can travel outside of it
♦♦ It inhibits aggregation of blood platelets.
DNA and RNA both have a DNA has a nitrogenous base ♦♦ cAMP increases the secretion of acid by gastric mucosa.
phosphate groups in their called Thymine, but RNA does
nucleotides. Sometimes called not. Instead, RNA has uracil. In Q.12. Write short note on cAMP as second messenger.
phosphoric acid DNA thymine pairs with adenine, (Apr 2015, 3 Marks)
but in RNA uracil pairs with Or
adenine
Write briefly about second messenger.
They both have the base pair of There is only one type of DNA (Oct 2016, 2 marks)
Guanine and Cytosine but 3 kinds of RNA (messenger,
Ans. cAMP act as second messenger for many of the
transfer and ribosomal RNA)
polypeptide hormones.
They are both necessary for the RNA synthesis does not require ♦♦ Once cAMP is produced it elicit biochemical responses as
cell to produce proteins a primer strand in contrast to
a second messenger.
DNA synthesis
♦♦ cAMP activates protein kinase A. Protein kinase A is a
Direction of both RNA and DNA DNA synthesis is semi heterotetramer which consists of two regulatory subunits
synthesis is conservative while RNA
(R) and two catalytic subunits (C). cAMP binds to inactive
5’ → 3’ synthesis is fully conservative
protein kinase and lead to the dissociation of R and C
Hydrolysis of No exonuclease activity has been subunits.
pyrophosphatetakes place in recorded in RNA polymerase.
4cAMP + R2C2 → R2 (4 cAMP) + 2C
both the cases DNA polymerase has both 3’ →
5’and 5’ → 3’ exonuclease activity (Inactive) (Inactive) (Active)
Phosphodiester linkage takes Active subunit (C) catalyses phosphorylation of proteins.
place just as during DNA It is the phosphoprotein which leads to biochemical
synthesis. The nucleophilic attacks response.
of 3’–OH terminus is common ♦♦ Various hormones which use cAMP as second messenger
are calcitonin, chorionic gonadotropin, corticotrophin,
Q.11. Write about cyclic AMP. (Dec 2014, 5 Marks) epinephrine, follicle stimulating hormone, glucagon,
Ans. It is represented as cAMP. luteinizing hormone, melanocyte stimulating hormone,
♦♦ It is also known as second messenger since it acts as second norepinephrine, parathyroid hormone, thyroid stimulating
messenger for the most of polypeptide hormones. hormone and vasopressin.
♦♦ It is a ubiquitous nucleotide. Q.13. Name four biologically important nucleotides.
♦♦ cAMP contains adenine, ribose and a phosphate linkage. (Aug 2016, 2 Marks)
♦♦ ATP is converted to cyclic AMP by enzyme adenylate Ans. Biologically important nucleotides are:
cyclase. ♦♦ ATP or Adenosine triphosphate
♦♦ cAMP is hydrolysed by phosphodiesterase to 5’- AMP. ♦♦ ADP or Adenosine diphosphate
Action of Cyclic AMP ♦♦ cAMP or Cyclic Adenosine 3’, 5’ monophosphate
♦♦ GTP or Guanosine triphosphate
♦♦ It elicits biological responses as second messenger. ♦♦ GDP or Guanosine Diphosphate
♦♦ cAMP activates protein kinase A. Protein kinase A is a ♦♦ cGMP or Cyclic Guanosine 3’, 5’ monophosphate
heterotetramer which consists of two regulatory subunits ♦♦ UDP or Uridine diphosphate
(R) and two catalytic subunits (C). cAMP binds to inactive ♦♦ CTP or Cytidine triphosphate
protein kinase and lead to the dissociation of R and C ♦♦ CDP or Cytidine diphosphate
subunits.
Q.14. Write a short note on gout. (Dec 2010, 5 Marks)
4cAMP + R2C2 → R2 (4 cAMP) + 2C
(Feb 2014, 3 Marks) (Feb 2016, 3 Marks)
(Inactive) (Inactive) (Active)
Active subunit (C) catalyses phosphorylation of proteins. It Or
is the phosphoprotein which leads to biochemical response. Answer in brief on gout. (May 2017, 2 Marks)
480 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Gout is of two types, i.e. primary gout and secondary gout. Causes of Mutations
♦♦ In deletion frameshift mutation, deletion of a single ♦♦ Enzyme pyrophosphatase leads to hydration of PPi
nucleotide from coding strand of a gene leads to altered to phosphate (Pi). The immediate elimination of
reading frame in mRNA. As there is no punctuation pyrophosphate makes this reaction totally irreversible.
in reading of codons, translating machinery does noit
recognize that a base is missing. There frameshifts result in Transport of Acyl-CoA in Mitochondria
production of entirely different protein after transcription
and translation. Inner mitochondrial membrane is impermeable to fatty acids.
♦♦ Insertion frameshift mutation can be of one or two A special carnitine carrier system transport activated fatty acids
nucleotides. Insertion of nucleotide in genes leads to severe from cytosol to mitochondria.
frameshift mutation, e.g. thalassemia. Activated long chain fatty acids are carried across the inner
♦♦ If number of nucleotides involves in deletion or insertion mitochondrial membrane by carnitine, (β-hydroxy γ-trimethyl-
is three or multiples of three, frameshift does not occur, ammonium butyrate) formed from lysine and methionine in
instead an abnormal protein is synthesized. liver and kidney. This occurs in four steps as follows:
1. The acyl group of acyl-CoA is transferred to the carnitine to
form acylcarnitine. This reaction is catalyzed by carnitine
4. LIPIDS: CHEMISTRY, METABOLISM acyltransferase-I (CAT-I) which is located on the cytosolic
AND REGULATION face of inner mitochondrial membrane.
2. Acylcarnitine is then transported across the inner
Q.1. Describe β-oxidation of palmitic acid (18 carbons) along mitochondrial membrane by an enzyme translocase.
with its energetics. (Nov 2009, 8 Marks) 3. The acyl group is transferred back to CoA in the
Or mitochondrial matrix by the enzyme carnitine acyl
transferase-II (CAT-II), located on the inside of the inner
Describe beta-oxidation of fatty acids in brief. mitochondrial membrane.
(Dec 2010, 10 Marks) 4. Acyl-CoA is reformed in the mitochondrial matrix with
Or liberation of carnitine which is returned to the cytosolic
Give an account of metabolism of fat with particular side by the translocase in exchange for an incoming acyl-
reference to beta-oxidation. (Feb 2014, 8 Marks) carnitine.
Or β-Oxidation Proper
Write about β-oxidation of fatty acids. After penetration of acyl-CoA in mitochondria, it undergoes
(Sep 2015, 7 Marks) β-oxidation.
Or Each cycle of β-oxidation, liberate a two carbon unit acetyl
CoA which occur in sequence of four reactions, i.e.
Write on beta-oxidation of fatty acids and its energetics
(Apr 2017, 5 Marks) 1. Oxidation: Acyl-CoA undergoes dehydrogenation by an
FAD dependent flavoenzyme, acyl-CoA dehydrogenase.
Ans. Beta-oxidation of Fatty Acids
There is formation of double bond between α and β
This process is known as β-oxidation, because the
carbons.
oxidation and splitting of two carbon units occur at the
β-carbon atom. The oxidation of the hydrocarbon chain 2. Hydration: Enoyl-CoA hydratase causes hydration of
occurs by a sequential cleavage of two carbon atoms double bond to form β-hydroxyacyl CoA.
(Fray Knoop, 1904).
β-oxidation can be defined as oxidation of fatty acids on
the β carbon atom.
Stages of β-Oxidation
β-oxidation of fatty acids consists of three stages, i.e. fatty
acid activation, Transport of acyl CoA in mitochondria and
β-oxidation proper in mitochondrial matrix.
Site of Synthesis and Functions of Lipoproteins • Sitosterol decreases the intestinal absorption of
exogenous and endogenous cholesterol and there
Name of Site of by lower the blood cholesterol level.
lipoprotein synthesis Function
Q.6. Describe in brief classification of lipids.
Chylomicrons Intestine It transport dietary lipids from
intestine of the peripheral tissues (Mar 2006, 4 Marks)
Or
VLDL Liver It transport triacylglycerol from
liver to peripheral tissues Write a short note on classification of lipids.
LDL Plasma VLDL It transport cholesterol from liver (Feb 2013, 6 Marks)
to peripheral tissues Ans. Lipids are regarded as organic substances relatively
HDL Liver and It transport free cholesterol from soluble in water, soluble in organic solvents (alcohol,
intestine peripheral tissues to liver ether, etc.) actually or potentially related to fatty acids
and is utilized by living cells.
Importance Lipids are broadly classified as simple, complex, derived
and miscellaneous.
♦♦ To transport and deliver lipid to tissue.
♦♦ To maintain structural integrity of cell surface and sub Simple Lipids
cellular particles like mitochondria and microsomes.
♦♦ Lipoprotein function increase in severe diabetes mellitus, These are the esters of fatty acids with alcohol. Simple lipids
atherosclerosis, etc. hence it is of diagnostic importance. are of two types, i.e.
1. Fats and oils (triglycerides): These are esters of fatty acid
Q.5. Write about biomedical importance of fats in the diet. with glycerol. As they are uncharged, they are known as
(Apr 2003, 6 Marks) neutral fat. Fat we eat are mostly triglycerides. Fat in liquid
Ans. • The high concentration of polyunsaturated fatty state is known as oil.
acids in the lipids of gonads are important in 2. Waxes: True waxes are esters of fatty acid with high
reproductive functions. molecular weight monohydric long chain alcohols other
• They are best reserve of food material in the human than glycerol.
body.
• They act as insulator for the loss of body heat. Complex Lipids
• They act as a padding material for protecting internal These are the esters of fatty acid with alcohols which consists
organs. of additional groups, i.e. phosphate, nitrogenous base,
• Deficiency of essential fatty acids causes skin lesions, carbohydrate, protein, etc. Complex lipids are subdivided into:
abnormal pregnancy and lactation in adult females, ♦ Phospholipids: Lipids consisting of phosphoric acid and
fatty liver, kidney damages. frequently a nitrogenous base. This is in addition to alcohol
• Absence of dipalmitoyl lecithin (DPL) in premature and fatty acids. Phospholipids are classified on the basis of
fetus produces respiratory distress syndrome type of alcohol present in them as glycerophospholipids
(hyaline membrane disease). and sphingophospholipids.
normality of cholesterol metabolism may lead to Choline is the main lipotropic factor and various other
cardiovascular accidents and heart attacks. lipotropic agents act by producing choline in the body. For
• Cell membranes: Cholesterol is a component of example, betaine and methionine possessing methyl groups
membranes and has a modulating effect on the fluid are donated to ethnolamine to form choline.
state of the membrane. Choline is needed for formation of phospholipid, lecithin
• Nerve conduction: Cholesterol is a poor conductor which in turn is an essential component of lipoprotein. Formation
of electricity, and is used to insulate nerve fibers. of lipoprotein is important for disposal of triacylglycerol.
• Bile acids and bile salts: The 24 carbon bile acids
Vitamin B12 and folic acid can also produce lipotropic effect
are derived from cholesterol. Bile salts are important
as they lead to formation of methionine from homocysteine.
for fat absorption.
• Steroid hormones: 21-carbon glucocorticoids, Q.13. Write about mechanism of hormone actions.
19-carbon androgens and 18-carbon estrogens are (Feb 2013, 5 Marks)
synthesized from cholesterol. Ans. Mechanism of Hormone Actions
• Vitamin D: It is synthesized from cholesterol. Hormone act in two ways:
Q.12. Write briefly on fatty liver and lipotropic factors.
(Sep 2009, 5 Marks) Mechanism of Action of Peptide Hormones
Ans. Hormones that are derivatives of amino acids, polypeptides or
proteins are formed of large molecules. These being insoluble
Fatty Liver
in lipids cannot enter the target cell. These act at the surface
Liver is not a fat storage organ. In some conditions there is of target cell as primary messengers and bind to cell surface
excessive accumulation of fat mainly triacylglycerols in liver receptor forming hormone receptor complex. Mechanism of
which leads to fatty liver. hormone action involves following steps:
1. Hormone is called as first messenger attaches to the cell
Causes of Fatty Liver
surface receptor protein on the outer surface of plasma
There are two main causes of fatty liver, i.e. membrane of the target cell forming hormone receptor
1. Increased synthesis of triacylglycerol complex.
2. Impairment of lipoprotein synthesis 2. Thic complex activates the enzyme adenylyl cyclase.
3. Adenylyl cyclase catalyses the conversion of ATP to cyclic
Increased Triacylglycerol Synthesis AMP on the inner surface of plasma membrane.
As free fatty acids get mobilized from adipose tissue and their 4. Cyclic AMP (cAMP) serves as the ‘second messenger’ or
influx in the liver is higher than their utilization. This causes intracellular hormone mediator delivering information
overproduction of triacylglycerol and they get accumulate inside the target cells. This activates appropriate cellular
inside the liver. Various conditions such as diabetes mellitus, enzyme system by cascade effect and induces the cell
starvation, alcoholism and high fatty diet are associated with machinery to perform its specialized function.
increase in mobilization of fatty acids which leads to fatty liver. 5. Ca2+ ions may be involved along with cyclic AMP.
Alcohol is also one of the important factor which inhibit fatty 6. Cyclic AMP has a very short existence. It is rapidly
acid oxidation, promotes fat synthesis and its deposition. degraded by cyclic AMP phosphodiesterase.
• Water soluble hormones (amines, peptides, proteins
Impaired Synthesis of Lipoproteins
and glycoproteins) exert their control through cyclic
Synthesis of very low density lipoproteins actively occur AMP. These are quick acting hormones, i.e. they
inside the liver. Formation of VLDL needs phospholipids and produce immediate effect.
apoprotein B. Causation of fatty liver by impaired lipoprotein
synthesis can be due to: Mechanism of Action of Steroid Hormones
♦♦ Defect in phospholipid synthesis Steroid hormones and thyroid hormones do not bind to
♦♦ Block in apoprotein formation cell surface receptors. Being lipid soluble these are able to
♦♦ Failure in formation or secretion of lipoprotein. enter the cells and their nuclei and influence the gene action.
Lipotropic Factors The hormone binds to receptors forming hormone receptor
complex. It binds to the transcription factors that in turn
Lipotropic factors are the substances deficiency of which leads binds to DNA and particular gene or genes are activated.
to fat, i.e. triacylglycerol to accumulate in the liver. Their transcription leads to the synthesis of a specific protein
Lipotropic factors prevent the accumulation of fat in liver. to influence the metabolism of recipient cell. Thus peptide
Various important lipotropic factors are choline, betaine, hormones activate existing enzymes in the cell, while steroid
methionine and inositol. Apart from these folic acid, vitamin hormones bring about the synthesis of new enzymes. Steorid
B12, glycine and serine also serve as lipotropic factors to some hormones act slowly than peptides but have a more sustained
extent. effect on metabolism.
488 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Classification of Lipids
Refer to Ans 6 of same chapter.
Functions of Lipids
♦♦ They are the storage form of energy.
♦♦ Lipids such as phospholipids and cholesterol are the
structural component of biomembranes.
♦♦ Lipids such as prostaglandins and steroid hormones are
metabolic regulators.
♦♦ Amphipathic lipids function as surfactants, detergents and
emulsifying agents.
♦♦ It function as electric insulators in neurons.
♦♦ Subcutaneous fat provides insulation against changes in
external temperature.
♦♦ It provide contour and shape to body.
♦♦ It protect internal organs by providing cushioning effect.
♦♦ It absorb fat soluble vitamins.
♦♦ It improve taste as well as palatability to food.
Q.15. Describe fatty acid synthesis. (Mar 2013, 8 Marks)
Ans. De Novo, i.e. new synthesis of fatty acid occur in liver,
kidney, adipose tissue and lactating mammary glands.
• Enzyme for the synthesis of fatty acids is located in
cytosomal fraction of cell.
• Acetyl-CoA acts as a source for carbon atoms during
synthesis of fatty acids.
• NADPH gives reducing equivalents during synthe-
sis of fatty acids.
• ATP gives energy for fatty acid formation during
synthesis of fatty acids.
• Major fatty acid synthesized de novo is palmitic acid
which is the 16 carbon saturated fatty acid.
Fatty acid synthesis occur in following steps which
are as follows:
Step II: Three-Carbon and Two-Carbon Units are Added • Certain enzymes require tightly bound phospho-
lipids for their actions, e.g. mitochondrial enzyme
♦♦ II-A: Acetyl transacylase catalyzes the transfer of the
system involved in oxidative phosphorylation.
acetyl group (2-carbons) to the cysteinyl SH group of the
• It play an essential part in the blood coagulation
condensing enzyme (CE) of the other monomer of the fatty
process. Required at the stage of:
acid synthase complex.
– Conversion of prothrombin to thrombin by ac-
♦♦ II-B: One molecule of acetyl-CoA (2-carbon) and one
tive factor X.
molecule of malonyl-CoA (3-carbon) bind to the fatty acid
– Possibly also in the activation of factor VIII by
synthetase complex. Malonyl transacylase transfers the
activated factor IX.
malonyl group to the SH group of the acyl carrier protein – Platelets provide the chief source of phospho-
of one monomer of the enzyme. lipids and that part of total lipid content of the
Step III: Condensation platelets which contributes to intrinsic blood
coagulation process and is called as platelet
The acetyl (2-carbon) and malonyl (3-carbon) units are factor 3.
condensed to form beta-ketoacyl-ACP or acetoacetyl ACP • Lecithin lowers the surface tension of water and
(4-carbon). During this process one carbon is lost as CO2. The aids in emulsification of lipid water mixtures, a
enzyme is called condensing enzyme. prerequisite in digestion and absorption of lipids
from gastrointestinal tracts.
Step IV: Reduction • Exogenous triglycerides is carried as lipoprotein
Acetoacetyl ACP is reduced by NADPH dependent beta-keto- complex, chylomicrons in which phospholipids
acyl reductase to form beta-hydroxy fatty acyl ACP. takes an active part.
• Endogenous triglycerides are carried from liver
Step V: Dehydration to various tissues as lipoprotein complex Pre-β-
lipoprotein (VLDL), phospholipid is required for
It is then dehydrated by a dehydratase (DH) to form enoyl-ACP
the formation of the lipoprotein complex.
otherwise known as (alpha-beta unsaturated acyl-ACP). • Probably phospholipid help to couple oxidation with
Step VI: Second Reduction phosphorylation and maintain electron transport
enzymes in active conformation and proper relative
Enoyl ACP is again reduced by enoyl reductase (ER) utilizing positions.
a 2nd molecule of NADPH to form butyryl ACP. The butyryl • Choline acts as a lipotropic agent as it can prevent
group (4-carbon) is now transferred to the SH group of the formation of fatty liver. As lecithin it can provide
condensing enzyme on the other monomer and a 2nd malonyl- choline and acts as lipotropic agent.
CoA molecule binds to the phosphopantothenyl SH group. • Phospholipids are in some way implicated in the
The sequence of reactions, namely condensation, reduction, mechanism of secretion is suggested by the observa-
dehydration and reduction (steps II, IV, V, VI) are repeated. tion that phospholipids, specially phosphatidic acid
The cycles are repeated a total of seven times, till the 16-carbon and phosphoinositides turnover is proportional to
palmitic acid is formed. the rate of secretion of cells liberating such products
as hormones, enzymes, mucins and other proteins.
Step VII: Palmitic Acid is Released • Phospholipids of membrane are hydrolyzed by
Thioesterase or deacylase activity releases palmitate from phospholipase A2 and provide unsaturated fatty
multienzyme complex. The end point is palmitic acid acid, arachidonic acid which is utilized for synthesis
of prostaglandins and leukotrienes.
(16-carbon) in liver and adipose tissue. In lactating mammary
• Phospholipids of myelin sheaths provide the insula-
gland end products are capric acid (10-carbon) and lauric acid
tion around the nerve fibers.
(12-carbon).
• They are required as a cofactor for the activity of the
Q.16. Write about biomedical importance of phospholipids. enzyme lipoprotein lipase and triacylglycerol lipase.
(Sep 2015, 7 Marks) Q.17. Write briefly about atherosclerosis.
Ans. Following is the biomedical importance of phospholipids: (Oct 2016, 2 Marks)
• Phospholipids participate in the lipoprotein com- Ans. Atherosclerosis is characterized by hardening and
plexes which are thought to constitute the matrix narrowing of arteries due to deposition of lipids mainly
of cell walls and membranes, myelin sheath and of cholesterol, free and esterified lipids.
such structures as mitochondria and microsomes. In • Deposition of cholesterol and other lipids in the inner
this role, they impart certain physical characteristics: arterial wall leads to the formation of plaque (sticky
• Unexpectedly high permeability towards certain deposit) and results in the endothelial damage and
nonpolar (hydrophobic) molecules. narrowing of the arterial lumen.
• Lysis by surface active agents—detergents, bile • Hardening and narrowing of coronary arteries result
salts, etc. in coronary heart disease.
490 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Hyperlipo- Increased
proeinemia plasma Increased Probable metabolic
type lipoprotein plasma lipid defect Risk of atherosclerosis Suggested treatment
I Chylomicrons Triacylglycerols Deficiency of Can increase Take low fat diet
lipoprotein lipase
IIa LDL Cholestrol Deficiency of LDL Very high Low cholesterol fat diet
receptor (in coronary artery)
IIb LDL and VLDL Triacylglycerols Overproduction of Very high Low cholesterol fat diet
and cholestrol apolipoprtein E (in coronary artery)
III IDL Triacylglycerols Abnormality in Very high Low fat and low calorie diet;
and cholestrol apolipoprtein E (in peripheral vessels) clofibrate
IV VLDL Triacylglycerols Overproduction of Can or cannot increase Low fat and low calorie diet; niacin
triglycerides
V Chylomicrons Triacylglycerols – Can or cannot increase Low fat and low calorie diet; niacin
and VLDL
Biochemistry 491
Description the crystal increases and the reactivity decreases greater stability
♦♦ Type I: It occurs due to familial lipoprotein lipase of the crystal impart lower solubility and greater resistance to
deficiency. Enzyme defect leads to increase in plasma dissolution in acids.
chylomicron and triacylglycerol levels.
Acid Solubility
♦♦ Type IIa: It is also called as hyperbetalipoproteinemia
and occurs due to defect in LDL receptors. This disorder Fluorapatite or fluoridated hydroxyapatite is less soluble than
is mainly characterized by hypercholesterolemia. hydroxyapatite and have greater stability.
♦♦ Type IIb: Both LDL as well as VLDL elevated with rise
in plasma cholesterol. It is due to overproduction of Enzyme Inhibition
apolipoprotein B. Fluoride has enolase inhibition effect and it also inhibits glucose
♦♦ Type III: It is also known as broad beta disease and is
transport. Enolase is a metalloenzyme that requires a divalent
characterized by appearance of broad β band which
cation for its activity; fluoride due to its increased reactivity
corresponds to intermediate density lipoprotein (IDL)
forms a complex with this cation thus inhibits the enzyme. It
during electrophoresis.
♦♦ Type IV: This occurs because of overproduction of also inhibits nonmetalloenzymes like phosphatases thus leading
endogenous triacylglycerols with concomitant rise in to reduced acid production.
VLDL.
Suppressing the Flora
♦♦ Type V: In this both chylomicrons as well as VLDL get
raised. It is a secondary condition. Stannous fluoride is a potent suppressor of the bacterial growth
because it oxidizes the thiol group present in bacteria and
inhibits bacterial metabolism.
5. MINERAL METABOLISM
Antibacterial Action
Q.1. Write the role of fluorine in dental care. Concentration of fluoride above 2 ppm in solution progressively
(Sep 2009, 5 Marks) decreases the transport of uptake of glucose into cells of oral
Ans. Fluorine is an essential trace element. streptococci and also reduces ATP synthesis.
Source Decreasing Free Surface Energy
Fluoride is solely derived in humans from “drinking water” Fluoride incorporated in enamel by substitution of hydroxyl
Requirement—1 ppm. ions reduces the free surface energy and thus indirectly reduces
Role in Dental Care the deposition of pellicle and subsequent plaque formation.
Fluoride increases the size of crystal and leads to less strain Hydroxyapatite crystals are amphoteric with both positive and
in crystal lattice. This takes place when there is conversion negative receptor sites. Acidic protein group binds protein and
of amorphous calcium phosphate into crystalline hydroxy bacteria to calcium site and basic to phosphate site. Fluoride
phosphate. inhibits the binding of acidic protein to hydroxyapatite thereby
displaying its beneficial effects.
Void Theory
Alteration in Tooth Morphology
Incorporation of fluoride leads to formation of larger and more
stable crystals. Fluoride replaces hydroxyl ion from the center Dentition in fluoridated communities showed a tendency
of calcium triangle. It forms strong covalent interaction forces towards rounded cusps, shallow fissures due to selective
with calcium, thereby decreasing the dimension of this axis. morphology inhibition of ameloblasts.
Hydroxyapatite crystals are known to have inherent voids
Q.2. Write a short note on fluorine. (Sep 2001, 5 Marks)
due to missing hydroxyl groups which makes it unstable.
(May/June 2009, 5 Marks) (Dec 2010, 3 Marks)
In hydroxyapatite crystal hydroxyl group is present slightly
above or below the plane formed by calcium ion. To maintain Ans. Fluorine is a trace element.
symmetry equal number of hydroxyl ions should be present
Sources
on both the sides of calcium plane. At times when hydrogen
of adjacent hydroxyl groups point towards each other, this For humans, drinking water is the main sources of fluorine.
results in stearic interference resulting into the elimination of
Daily Requirements
one hydroxyl group, thereby forming a void in the place. Voids
in the crystal decreases the stability and increases chemical Fluorine is present in small amount in normal bones and teeth
reactivity. When these voids are filled by fluoride, the stability of 1-2 ppm per day or 1.5 to 4 mg/day.
492 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.5. Write briefly on calcium and phosphate metabolism. proteins in intestinal epithelial cells. These proteins
(Mar 2001, 5 Marks) act as carrier proteins for facilitated diffusion by
Ans. Calcium Metabolism which calcium ions are transported. The proteins
Following is the calcium metabolism: remain in cells for several weeks after 1, 25-dihydroxy-
cholecalciferol has been removed from body, thus
Calcium Absorption causing prolonged effect on calcium absorption.
Calcium is absorbed in duodenum by energy dependent active b. It increases the synthesis of calcium-induced ATP in
process. Following are the factors which influences absorption: intestinal epithelium.
A. Factors promoting calcium absorption: c. It increases the synthesis of alkaline phosphates in
• Vitamin D induces synthesis of calcium binding intestinal epithelium.
protein in intestinal epithelial cells and promotes the 3. Calcitonin: It is secreted by parafollicular cells of thyroid. It
calcium absorption. is a calcium lowering hormone. It decreases blood calcium
• Parathyroid hormone enhances calcium absorption level by decreasing reabsorption. It reduces blood calcium
through increased synthesis of cholesterol. level by acting on bone, kidney and intestine.
• Acidity is favorable for calcium absorption. a. On bones: It facilitates deposition of calcium on bones.
• Lactose promote calcium uptake via intestinal cells. It suppresses the activity of osteoclasts which are
• Arginine and lysine facilitate absorption of calcium. responsible of calcium from bones.
B. Factors inhibiting calcium absorption: b. On kidney: It increases excretion of calcium through
• Phytates and oxalates lead to the formation of urine by inhibiting reabsorption of calcium from renal
insoluble salts and interfere with the absorption of tubules.
calcium. c. On intestine: It prevents the absorption of calcium
• High content of dietary phosphate leads to the from intestine into blood.
formation of insoluble calcium phosphate and prevent
Other Hormones Involved in Calcium Metabolism
uptake of calcium.
• Free fatty acids react with calcium to form insoluble ♦♦ Growth hormone: It increases absorption of calcium from
calcium soaps. intestine and enhances protein synthesis in bone.
• Alkaline condition is unfavorable for calcium absorp- ♦♦ Insulin: It is an anabolic hormone which favors bone
tion. formation.
• High content of dietary fiber interfere with calcium ♦♦ Sex hormones: These hormones increases calcium
absorption. absorption, decreases calcium excretion and enhances
bone mineralization. Estrogen has direct effect on bone
Excretion of Calcium resorption.
Calcium is excreted in feces as well as in urine. In feces, it is ♦♦ Prolactin: It increases calcitriol production and increases
excreted through exfoliated gastrointestinal tract cells and in calcium absorption during lactating period.
urine, it is excreted as calcium phosphate and calcium chloride. ♦♦ Thyroid hormone: It increases in levels of thyroid
hormone which is accompanied by osteoporosis and
Regulation of Calcium Level hypercalcinuria.
The regulation of blood calcium level took place through three Phosphate Metabolism
hormones:
1. Parathormone: It is secreted by parathyroid gland and Following is the phosphate metabolism:
its main function is to increase the blood calcium level by
Absorption
mobilizing calcium from bone. Parathormone maintains
blood calcium level by following actions on bones, kidney ♦♦ Phosphate absorption occurs from the jejunum.
and gastrointestinal tract (GIT). ♦♦ Inorganic phosphorus in duodenum and in other parts
a. By increasing reabsorption of calcium from bones. of small intestine get absorbed by active transport and
b. By decreasing excretion of calcium through kidneys. passive diffusion.
c. By increasing absorption of calcium from GIT. ♦♦ Calcitriol promote uptake of phosphate along with
2. 1, 25-dihydroxycholecalciferol: It is a steroid hormone calcium.
synthesized from vitamin D by means of hydroxylation ♦♦ There is optimum absorption of phosphorus and calcium
reactions in liver and kidneys. The main action is to when ratio between calcium and phosphorus is between
increase the blood calcium level by increasing calcium 1:2 and 2:1.
absorption from small intestine. The main actions of 1,
Distribution and Fate
25-dihydroxycholecalciferol are:
a. It increases the absorption of calcium from intestine. It ♦♦ Approximately 3 mg/kg/day of phosphorus ion enter inside
does this by increasing formation of calcium-binding the bone with equal amount leaving via reabsorption.
494 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦♦ Inorganic phosphorus in plasma get filtered in glomeruli ♦♦ Coagulation: Calcium is known as factor IV in blood
of which 85 to 95% become reabsorbed actively in proximal coagulation cascade. Prothrombin contains gamma-
convoluted tubule. Excretion of phosphate in urine: carboxy glutamate residues which are chelated by Ca2+
• Increases by vitamin D excess, hyperparathyroidism during the thrombin formation.
and high phosphate diet. ♦♦ Bone and teeth: Bulk quantity of calcium is used for bone
• Decreases by growth hormone, during lactation, and teeth formation. Bones also act as reservoir for calcium
hypoparathyroidism and low phosphate diet. in the body.
Q.6. Write a short note on calcium. Q.7. Describe functions and clinical importance of calcium.
(Nov 2012, 3 Marks) (Jan 2012, 3 Marks) (Aug 2012, 4 Marks)
Ans. Total calcium in the human body is about 1 to 1.5 kg. Ans. For function of calcium refer to Ans 6 and for clinical
importance of calcium refer to Ans 11 of same chapter.
Sources of Calcium
Q.8. Describe nutritional importance of minerals in brief.
Best sources: Milk and the milk products
(Mar 2007, 4 Marks) (Apr 2010, 3.5 Marks)
Good sources: Beans, leafy vegetables, fish, cabbage, egg yolk. Ans. The mineral elements are supplied by the diet. Minerals
Daily Requirement of Calcium play important role in body function.
a. By increasing reabsorption of calcium from bones. • Cytochromes and various nonheme proteins are
b. By decreasing excretion of calcium through kidneys. needed for electron transport chain as well as oxida-
c. By increasing absorption of calcium from GIT. tive phosphorylation.
2. 1, 25-dihydroxycholecalciferol: It is a steroid hormone • Peroxidase which is a lysosomal enzyme is needed
synthesized from vitamin D by means of hydroxylation for phagocytosis as well as killing of bacteria by
reactions in liver and kidneys. The main action is to neutrophils.
increase the blood calcium level by increasing calcium • Iron is associated with the effective immunocompe-
absorption from small intestine. The main actions of 1, tence of the body.
25-dihydroxycholecalciferol are:
a. It increases the absorption of calcium from intestine. Q.16. Mention normal serum sodium and potassium levels.
It does this by increasing formation of calcium- (Aug 2016, 2 Marks)
binding proteins in intestinal epithelial cells. Ans.
These proteins act as carrier proteins for facilitated
diffusion by which calcium ions are transported. System of
Normal serum international units Conventional
The proteins remain in cells for several weeks after analysis (SI units) units
1, 25-dihydroxycholecalciferol has been removed
Serum sodium level 136 to 146 mmol/L 136 to 146 mEq/l
from body, thus causing prolonged effect on calcium
absorption. Serum potassium level 3.5 to 5 mmol/L 3.5 to 5 mEq/l
b. It increases the synthesis of calcium-induced ATP in
intestinal epithelium. Q.17. Describe the biochemical functions, dietary requirements,
c. It increases the synthesis of alkaline phosphates in sources and metabolism of calcium.
intestinal epithelium. (Aug 2016, 10 Marks)
3. Calcitonin: It is secreted by parafollicular cells of thyroid. It Ans.
is a calcium lowering hormone. It decreases blood calcium
Biochemical Functions of Calcium
level by decreasing reabsorption. It reduces blood calcium
level by acting on bone, kidney and intestine. ♦♦ Development of bones and teeth: Calcium with phosphate
a. On bones: It facilitates deposition of calcium on bones. is needed for the formation and physical strength of
It suppresses the activity of osteoclasts which are skeletal tissue. Bones in dynamic state serve as reservoir
responsible of calcium from bones. for calcium.
b. On kidney: It increases excretion of calcium through ♦♦ Contraction of muscle: Interaction of calcium with
urine by inhibiting reabsorption of calcium from renal troponin C triggers muscle contraction. Calcium also
tubules. causes activation of ATPase. It also increases interaction
c. On intestine: It prevents the absorption of calcium between actin as well as myosin.
from intestine into blood. ♦♦ Coagulation of blood: Some reactions in blood clotting
Other Hormones Involved in Calcium Metabolism process depends on calcium, i.e. factor IV.
♦♦ Nerve transmission: Calcium leads to transmission of
♦♦ Growth hormone: It increases absorption of calcium from nerve impulses.
intestine and enhances protein synthesis in bone. ♦♦ Membrane integrity and permeability: Calcium influences
♦♦ Insulin: It is an anabolic hormone which favors bone the structure of membrane as well as transport of water and
formation. several ions across it.
♦♦ Sex hormones: These hormones increases calcium
♦♦ Enzyme activation: Calcium is needed for direct activation
absorption, decreases calcium excretion and enhances
of enzymes such as lipase, ATPase and succinate dehydro
bone mineralization. Estrogen has direct effect on bone
genase.
resorption.
♦♦ Calmodulin mediated action of calcium: Calmodulin is
♦♦ Prolactin: It increases calcitriol production and increases
calcium binding regulatory protein. Calcium calmodulin
calcium absorption during lactating period.
complex activate some enzymes, e.g. adenylate cyclase and
♦♦ Thyroid hormone: It increases in levels of thyroid
calcium dependent protein kinases.
hormone which is accompanied by osteoporosis and
♦♦ As intracellular messenger: Various hormones exert their
hypercalcinuria.
action via mediation of calcium. Calcium is regarded as
Q.15. Write briefly about biological role of iron. second messenger for such hormonal action. Calcium also
(Feb 2016, 2 Marks) serves as third messenger for some hormones. Antidiuretic
Ans. Following is the biological role of iron: hormone act through cAMP and then by calcium.
• It exerts its functions via compounds in which it is ♦♦ Release of hormones: Release of various hormones,
present. Hemoglobin and myoglobin are needed for i.e. insulin, parathyroid hormone and calcitonin from
transport of oxygen and carbon dioxide. endocrine glands is facilitated by calcium.
498 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
I. Nicotinamide Nucleotides electron transport chain the transported electrons, free protons
and the molecular oxygen combine to produce water.
Two coenzymes, i.e. NAD+ and NADP+ derived from vitamin
niacin, NAD+ is more actively involved in the electron Free energy is utilized to generate ATP from ADP and Pi at
transport chain. Reduction of NAD+ occur to NADH + H+ by the following sites:
dehydrogenases along with the removal of two hydrogen atoms 1. Oxidation of FMNH2 by CoQ
from the substrate. The substrates include glyceraldehyde-3- 2. Oxidation of cytochrome b by cytochrome c1
phosphate, pyruvate, isocitrate, α—ketoglutarate, and malate. 3. Cytochrome oxidase reaction.
AH2 + NAD+ → A + NADH + H+ The respiratory chain or electron transfer chain can be
blocked by site-specific inhibitors like rotenone, amytal
2. Flavoproteins piericidin, pierecidin A, antimycin A, 2,3—dimercaptopropanol
(BAL), sodium azide, cyanide and carbon monoxide, etc.
Enzyme NADH dehydrogenase is a flavoprotein with FMN as
the prosthetic group. Coenzyme FMN receives two electrons Q.2. Write a short note on biological oxidation.
and a proton which form FMNH2. NADH dehydrogenase is a (Dec 2009, 5 Marks)
complex enzyme which is closely associated with nonheme iron Ans. Biological oxidation is defined as the transfer of electrons
proteins or iron–sulphur (FeS) proteins from reduced coenzymes through respiratory chain to
NADH + H+ + FMN → NAD+ + FMNH2 oxygen.
• Biological oxidation is exergonic.
3. Iron–Sulfur Proteins • Example is interconversion of ferrous ion to ferric
ion.
Iron–sulfur proteins exist in either oxidized or in the reduced
• During biological oxidation, the reacting chemical
state. About half a dozen of iron–sulfur proteins connect with
systems move from higher energy level to a lower
the respiratory chain are identified. Mechanism of action of
one and there is liberation of energy.
iron–sulfur protein in electron transfer chain is not clear.
• It provides energy for the aerobic metabolism. The
4. Coenzyme Q energy is released when electrons are transferred
from fuel molecules to oxygen.
Coenzyme Q is also called as ubiquinone. This is a quinone • It effect the transfer of energy in controlled way.
derivative with a variable isoprenoid side chain. The • Energy released during biological oxidation is
mammalian tissues possess a quinone with 10 isoprenoid units, trapped as ATP.
which are known as coenzyme Q10 (CoQ10). Q—cycle facilitates • Formation of ATP from ADP and Pi is known as
switching from ubiquinol, a two electron carrier, to cytochrome phosphorylation, as phosphorylation is coupled
c, a single electron carrier. with biological oxidation, it is known as biological
oxidative phosphorylation.
5. Cytochromes • Electron lost in oxidation is accepted by acceptor
Cytochrome c is a small conjugated protein containing 104 which is said to be reduced.
amino acids and a heme group. It is a central member of electron
transport chain with an intermediate redox potential. The iron of
heme in cytochromes is alternately oxidized (Fe3+) and reduced
7. ENZYMOLOGY
(Fe2+), which is essential for the transport of electrons in the
electron transport chain. Q.1. Describe in brief classification of enzymes.
(Jan 2012, 6 Marks) (May 2014, 5 Marks)
The electrons are transported from coenzyme Q to
(Dec 2014, 5 Marks)
cytochromes b, c1, c, a and a3 in an orderly manner.
Or
The property of reversible oxidation—reduction of heme
iron present in cytochromes allows them to function as effective Write briefly about enzyme definition and classifica-
carriers of electrons in electron transfer chain. In the final stage of tion. (Feb 2016, 2 Marks)
500 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Classification of Enzymes
In 1964, according to International Union of Biochemistry and
molecular biology (IUBMB) enzymes are classified on the basis
of their function, i.e.
♦♦ EC 1: Oxidoreductases: These are the enzymes which
catalyze oxidation–reduction reaction, e.g. lactate
dehydrogenase, glucose–6–phosphate dehydrogenase and
cytochrome oxidase.
♦♦ EC 2: Transferases: These are the enzymes which catalyze
transfer of group such as amino, carboxyl, methyl or Fig. 30: Effect of enzyme concentration on enzyme velocity
phosphoryl, etc. from one molecule to another, e.g.
aspartate aminotransminase, alanine aminotransaminase Concentration of Substrate
and hexokinase.
♦♦ EC 3: Hydrolases: Enzymes of this class catalyze the cleavage Increase in the concentration of substrate gradually increases
of C–O, C–N, C–C and some another bonds with addition of the velocity of an enzyme reaction within the limited range of
water, e.g. lipase, α-amylase, trypsin, lactase, sucrose, pepsin. substrate levels. When velocity is plotted against the substrate
♦♦ EC 4: Lyases: Enzymes catalyze the cleavage of C–O, concentration, a rectangular hyperbola is obtained. Graph
C–N and C–C bonds by means other than hydrolysis or demonstrates three phases of reaction:
oxidation, giving rise to compound with double bond Enzyme kinetics and km value: Enzyme (E) and substrate
or catalyze reverse reaction, by addition of group to a (S) both of them combine with each other and form an unstable
double bond, e.g. aldolase, argininosuccinase, carbonic enzyme–substrate complex (ES) for the formation of product (P).
anhydrase.
♦♦ EC 5: Isomerases: Enzymes involved in all the isomerization
reactions, e.g. phosphoglucomutase, triphosphate
isomerase and phosphohexose isomerase
♦♦ EC 6: Ligases: Enzymes catalyzing the synthetic reactions
of linking together of two compounds, e.g. glutamine
synthetase, pyruvate carboxylase and DNA ligases.
In above mentioned classification each class is subdivided
into many subclasses which are further divided. A four digit
enzyme commission (EC) number is assigned to each enzyme
representing the class (first digit), subclass (second digit),
sub–subclass (third digit) and the individual enzyme (fourth
digit). For an instance an example is given, i.e. enzyme alcohol
dehydrogenase is given code as 1.1.1.1, this means alcohol
dehydrogenase is first enzyme of subclass 1, sub–subclass 1
and of the class 1.
Q.2. Classify enzymes. Describe factors affecting rate of
reaction. (Dec 2004, 7.5 Marks) Fig. 31: Effect of substrate concentration on enzyme velocity
Or
Describe factors affecting enzyme activity in brief.
(Sep 2006, 4 Marks)
Here in this above equation K1, K2, K3 represent the velocity
Ans. Classification: Refer to Ans 1 of same chapter.
constants for their respective reactions.
Factors Affecting Rate of Reaction/Enzymes Activity Km is the Michaelis–Menten constant which is given by the
Concentration of an Enzyme formula:
substrate and binds at the active site of the enzyme but does not non-competitive inhibitor generally binds with the enzyme as
undergo any catalysis. As long as the competitive inhibitor holds well as the ES complex. For non-competitive inhibition, the Km
the active site, the enzyme is not available for the substrate to value is unchanged, while Vmax is lowered.
bind. In competitive inhibition, the Km value increases, whereas
Vmax remains unchanged. The enzyme succinate dehydrogenase
(SDH) is a classical example of competitive inhibition with
succinic acid as its substrate.
For example, first enzyme δ-aminolevulinic acid synthase is ♦♦ They are mostly synthesized in liver and enter in the
an allosteric enzyme in heme synthesis is inhibited by its end circulation. For example, lipoprotein lipase, plasmin,
product heme. thrombin, choline, esterase, ceruloplasmin etc.
Q.6. Write a short note on properties of enzymes. ♦♦ Default in liver function or genetic disorders decrease the
(Dec 2009, 5 Marks) activities of plasma functional enzymes.
Ans. Properties of Enzymes Nonplasma Specific Enzymes
a. Solubility: Enzymes as proteins are soluble in water
♦♦ These enzymes are either totally absent or present at low
or dilute salt solution.
concentrations in plasma as compared to the tissues.
b. Molecular weight: Enzymes have increased
♦♦ Digestive enzymes of gastrointestinal system in plasma
molecular weight
are known as secretory enzymes.
c. Enzymes are charged molecules: Due to the
presences of amino acids, each enzyme has a charge. ♦♦ Other plasma enzymes which are associated with
The charge depends on the pH of the solution. At metabolism of cell are known as constitutive enzymes.
very low pH the amino acids are fully protonated ♦♦ Activation of these enzymes is important for diagnosis and
and there is a positive charge on the proteins; as pH prognosis of various diseases.
is increased, the protein losses a proton to neutralize Interpretations of Enzymes
the OH- group and become a zwitter ion charges.
As more alkali is added, the NH3+ group gives its ♦♦ Normal serum level of enzyme indicates the balance
H+ and protein becomes positively charged. between synthesis and release of routine cell turnover.
d. Enzymes have buffering capacity: They are ♦♦ High serum level or low serum level of enzyme indicates
amphoteric molecules, i.e. behave both as acids and the cellular damage, increased cellular turnover and
bases. They act as buffer. At pKa they make the most proliferation of cells.
efficient buffer. Q.8. Write short note on isoenzymes. (Feb 2014, 3 Marks)
e. Each enzyme has a specific Isoelectric pH: It is Ans. • Isoenzymes are also known as isozymes.
the pH at which the net charge on protein equal to • Multiple forms of an enzyme which catalyses the
zero so they do not move in an electric field. Above same reaction are known as isoenzymes.
isoelectric pH negatively charged can move in an • Isoenzymes have different physical and chemical
electric field. Below isoelectric pH positive charged properties which includes structure, electrophoretic,
and can move under an electric field. immunological properties, Km and Vmax values, pH
f. Denaturation: When proteins are heated, or subjected optimum and degree of denaturation.
to extremes of temperature, high salt, organic solvents,
etc. the noncovalent bonds break, changing the native Isoenzymes of Lactate Dehydrogenase
structure to random coil. This unfolding of protein ♦♦ Lactate dehydrogenase have five isoenzymes, i.e. LDH1,
is due to loss of secondary, tertiary and quaternary
LDH2, LDH3, LDH4, LDH5.
structure. It does not affect the primary structure.
♦♦ All the above isoenzymes are separated by electrophoresis.
g. Absorption spectra: Enzymes are proteins which
♦♦ LDH1 is positively charged and fastest in electrophoretic
give maximum absorption at 280 nm (due to their
mobility, while LDH5 is the slowest of all.
content of aromatic amino acids).
♦♦ Isoenzymes of lactate dehydrogenase have diagnostic
Q.7. Write a short note on clinically important enzymes. value in heart and liver related disorders.
(Aug 2011, 5 Marks) ♦♦ In healthy individual, activity of LDH2 is higher than
Ans. Enzymes in biological fluids, i.e. plasma or serum are of LDH1 in serum.
clinical importance and help in diagnosis. ♦♦ In myocardial infarction, LDH1 is greater than LDH2
Clinically important enzymes are divided into two within 12–24 hours after infarction.
groups, i.e. ♦♦ Increased activity of LDH5 in serum is indicator of liver
1 Plasma specific or plasma functional enzymes. diseases.
2 Nonplasma specific or plasma nonfunctional
Isoenzymes of Creatinine Phosphate
enzymes.
♦♦ Creatine kinase catalyses interconversion of phospho-
Plasma Specific Enzymes creatine to creatine.
♦♦ Various enzymes are normally present in plasma and they ♦♦ Creatine kinase has three isoenzymes, i.e. CPK1, CPK2,
perform specific functions. CPK3.
♦♦ Activity of plasma specific enzymes is higher in plasma ♦♦ In healthy individuals, CPK2 is undetectable.
than in tissues. ♦♦ CPK2 increases in serum after myocardial infarction within
♦♦ These enzymes are in plasma than in tissues. 6-18 hours.
Biochemistry 505
Isoenzymes of Alkaline Phosphatase Ans. Normal serum level of an enzyme is indicative of balance
its synthesis and release in routine cell turnover.
♦♦ There are six isoenzymes of alkaline phosphatase.
Raised serum enzyme level can be due to cellular
♦♦ Most important isoenzymes of alkaline phosphatase are
damage, increased rate of cell turnover, proliferation of
α1-ALP, α2-heat labile ALP, α2-heat stable ALP, pre-β cell, increased synthesis of enzymes, etc.
ALP, γ-ALP. Serum enzymes are easily used as markers to detect
♦♦ Increase in α2-heat labile ALP suggests hepatitis. the cellular damage which helps in diagnosis of disease.
♦♦ Increase in Pre-β ALP suggests bone disease.
Various Serum Enzymes Elevated in Respective Diseases
Isoenzymes of Alcohol Dehydrogenase
♦♦ It has two heterodimer isoenzymes, i.e. αβ1 and αβ2 Elevated serum enzyme Name of the disease
♦♦ αβ1 is predominant in white Americans and Europeans Acid phosphatase Cancer of prostrate gland
♦♦ αβ2 is predominant in Japenese and Chinese. Alkaline phosphatase Rickets and obstructive jaundice
♦♦ Increased susceptibility to alcohol is seen in Japenese and
Aldolase Muscular dystrophy
in Chinese because of αβ2.
Amylase Acute pancreatitis
Q.9. Write a short note on coenzyme.
(Oct 2014, 3 Marks) (Sep 2015, 5 Marks) Creatinine phosphokinase Early marker in myocardial
infarction
Or
Lactate dehydrogenase Heart attack and liver diseases
Write about coenzymes. (Sep 2015, 7 Marks)
Serum glutamine pyruvate Liver diseases
Ans. Nonprotein, organic, low molecular weight and transaminase (SGPT)
dialyzable substance which is associated with enzyme
Serum glutamate oxaloacetate Heart attack
function is known as coenzyme.
transaminase (SGOT)
Functional enzyme is referred as holoenzyme which is
5–nucleotidase Hepatitis
made of protein part, i.e. apoenzyme and a nonprotein
part, i.e. coenzyme. Q.12. Write about enzymes and their clinical significance.
• Coenzyme is essential for the biological activity of (Aug 2018, 10 Marks)
the enzyme. Ans. For definition and classification of enzymes refer to Ans
• One molecule of coenzyme is able to convert a large 1 of same chapter.
number of substrate molecules. For properties of enzymes refer to Ans 6 of same chapter.
• Coenzymes are the second substrates or cosubstrates For factors affecting enzyme activity refer to Ans 2 of
because they have affinity with enzyme comparable same chapter.
with that of substrate. During the enzymatic
For enzyme inhibition refer to Ans 5 of same chapter.
reactions coenzyme undergo alteration which later
For importance of enzyme refer to Ans 7 and Ans 4 of
on regenerated.
same chapter.
• It participate in various reactions, such as transfer
of atoms of groups like aldehyde, keto, amino, etc.
• They play a decisive role in enzyme function. 8. HEMOGLOBIN AND PORPHYRIN
• Most of the coenzymes are derivatives of B-complex
vitamins, the biochemical functions of B-complex Q.1. Write a short note on transport of iron.
vitamins are exerted by coenzymes. (Dec 2010, 5 Marks)
• Various substances which have no relation with Ans. Transport of iron includes three steps, i.e.
vitamins but function as coenzymes are known as 1. Transport of iron across brush border of enterocyte
nonvitamin coenzyme, e.g. ATP, CDP, etc. 2. Fate of iron in enterocyte.
• Some coenzyme posses nitrogenous base, sugar 3. Transport of iron in blood.
and phosphate these are known as nitrogenous co- 1. Transport of iron across brush border of enterocyte: In
enzymes, e.g. NAD+, NADP+, FMN, etc. diet iron is present as heme derived (from non-vegetarian
Q.10. Write on classification of enzymes and their diagnostic food) or nonheme derived (vegetarian food).
importance. (Apr 2017, 5 Marks) a. Absorption of heme iron: Heme iron is the iron
Ans. For classification of enzymes refer to Ans 1 of same present in myoglobin, hemoglobin and related
chapter. compounds. From these compounds heme is released
by proteolytic enzymes in gut. From the lumen, heme
For diagnostic importance of enzyme refer to Ans 4 of
same chapter. is transported inside the enterocyte across brush
border membrane by a heme transport protein. Inside
Q.11. Answer in brief diagnostic importance of serum enzymes. the cell, the ferrous iron (Fe2+) is released from heme
(Sep 2017, 2 Marks) by enzyme hemeoxygenase.
506 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Evaluation
♦♦ Increased levels of conjugated and unconjugated bilirubin
in the serum.
♦♦ Dark colored urine due to the excessive excretion of
bilirubin and urobilinogen.
♦♦ Increased activities of alanine transaminase (SGPT) and
aspartate transaminase (SGOT) released into circulation
due to damage to hepatocytes.
♦♦ The patients pass pale, clay colored stools due to the
absence of stercobilinogen.
♦♦ The affected individuals experience nausea and anorexia
(loss of appetite).
Q.2. Write a short note on generation of ATP. Q.3. Write a short note on balance diet.
(Mar 2005, 5 Marks) (Oct 2007, 5 Marks) (Aug 2011, 5 Marks)
Or (Apr 2008, 5 Marks)
Write a short note on ATP. (Jan 2012, 5 Marks) Or
Ans. ATP is adenosine triphosphate. It is a nucleotide. It is Write a short note on balanced diet. (Feb 2014, 3 Marks)
also known as energy coin of the cell because it is the Or
storage site for chemical energy which is stored in the
bond which is known as phospho disaster bond. Write on balanced diet. (Apr 2017, 5 Marks)
• Pure form of ATPs is generated in glycolysis, TCA Ans. Balanced diet is defined as the diet which consists
cycle, beta-oxidation and other pathways in a small of different types of food, possessing the nutrients—
quantity. This cannot fulfill the normal requirement carbohydrates, fats, proteins, vitamins and minerals in
of energy in cell, that’s why reducing equivalent like a proportion to meet requirements of the body.
NADH, FAD, GDP are being converted into ATP. A balanced diet supply little more of each nutrient than
• The above reducing equivalent is finally converted the minimum requirement to withstand short duration
into pure ATPs in a complex pathway which is called of leanness and keep the body in state of good health.
as chemo-osmotic mechanism which occur in mito
Dietary pattern varies in different parts of the world.
chondria with the help of four steps:
a. Conversion of NADH into electron and hydro- Balanced diet is generally developed according to the
gen ions. (NADH is derived from metabolic following:
pathway, i.e. glycolysis, TCA cycle, etc.) • Kinds of food produced
b. Transfer of electron from one protein to another • Economic capacity
protein which are present in mitochondrial • Religion
membrane. For example, cytochrome oxidase, • Customs
FMN, etc. • Taste and habits of people
c. Conversion of ADP → ATP by a knob like protein Indian Council of Medical Research (ICMR) has
known as ATP synthetase or ATPase. suggested balanced diet for different age groups, sex
d. Then ATP is transferred from mitochondrial and under various occupations for physical activity.
matrix to cytoplasm of cell which is utilized by
the various anabolic pathways. Balanced Diet Suggested by ICMR
When balanced diet is not consumed by the person for Write a short note on BMR. (Aug 2011, 5 Marks)
sufficient length of time, it leads to nutritional deficiencies
Or
known as malnutrition.
Q.4. Write briefly about basic metabolic rate (BMR ) Write a short note on basal metabolic rate.
(Dec 2009, 5 Marks) (Jan 2012, 5 Marks)
Or Or
510 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Define BMR. What are the factors that affect BMR. Ans. It is also known as protein calories malnutrition.
(May 2017, 5 Marks) • Protein-energy malnutrition is the nutritional
Or disorder of developing countries.
• It is mostly seen in infants and preschool children.
Define BMR. (Apr 2018, 2 Marks)
• Forms of protein-energy malnutrition are Marasmus
Ans. Basic metabolic rate is defined as minimum amount of
and Kwarshiorkor.
energy required by the body to maintain life at complete
physical and mental rest in post absorptive state, i.e. 12 Marasmus or Nonedematous PEM
hours after last meal.
♦♦ Meaning of marasmus is to waste.
Under basal conditions, body appears to be in rest state
♦♦ It occurs due to the deficiency of calories.
but various functions under the body occur continuously
♦♦ It is caused due to early weaning and repeated infection.
such as working of heart, conduction of nerve impulses,
♦♦ Symptoms include growth retardation, muscle wasting,
reabsorption of renal tubules, etc.
anemia and weakness.
Normal value of BMR for adult man is 35-38 cal/sq.m/ ♦♦ Child is irritable and feartful.
hr and for adult woman it is 32-35 cal/sq.m/hr. ♦♦ Serum albumin of child is 2 to 3 g/dL.
Some of the authors represent BMR as cal/day. So, for ♦♦ Serum cortisol is increased in marasmus.
an adult man BMR is 1600 cal/day, while for an adult
women it is 1400 cal/day. Kwashiorkor or Edematous PEM
Factors Affecting BMR ♦♦ Kwashiorkor occurs in a child when next baby is born.
♦♦ It occurs due to the deficiency of protein.
The BMR differs among different individuals. It depends on ♦♦ It is caused due to starchy diet after weaning and it is also
many factors as follows: precipitated by acute infection.
♦♦ Gender or sex: The BMR of males is slightly higher than ♦♦ Symptoms include stunted growth, edema, diarrhea,
that of females. This is due to the greater proportion of discoloration of skin and hair, anemia, moon face and
lean muscle mass in females. apathy.
♦♦ Age: In infants and growing children consists of lean ♦♦ Child is lethargic and apathetic.
muscle mass, BMR is higher in them. In adults, there is ♦♦ Serum albumin of child is less than 2 g/dL.
decrease in BMR, i.e. about 2% per decade of life.
♦♦ Serum cortisol is decreased in kwashiorkor.
♦♦ Nutritional state: BMR is low in starvation and under
nourishment as compared to wellfed state. Starvation Q.6. What are the main constituents of diet? Give their
leads to an adaptive decrease in BMR which results from nutritional importance. (Sep 2013, 6 Marks)
a decrease in lean body mass. Ans. Diet consists of a number of food items which taken
♦♦ Body size or surface area: BMR is directly proportional together to provide the body with right amount of
to the surface area of the subject. Larger the surface area nutrients. Also eating of variety of foods is very important
more will be the heat loss and equally higher will be the because each food differs a little in the nutrients it
heat production and BMR. provides. Each nutrient has its own special work to do.
♦♦ Body composition: The BMR is proportionate to lean Main constituents of diet are: Cereals, protein foods,
body mass. Lean body mass is the body weight minus protective vegetables and fruits, other vegetables and
nonessential (storage triacylglycerol) weight. Higher the fats, oils and sugars.
percentage of adipose tissue in the body, lower the BMR/
kg body weight. Nutritional Importance of Constituents of Diet
♦♦ Endocrinological or hormonal state: Thyroid has stimula-
Cereals
tory effect on metabolism of the body. So BMR is increased
in hyperthyroidism and decreased in hypothyroidism. It includes wheat, rice, maize, jowar, bajra, tapioca, potato,
♦♦ Environmental temperature or climate: In colder climate, sweet potato, etc. Enough cereals should be included in diet
BMR is higher and in tropical climates the BMR is to meet the protein need. They are also the main source of
proportionally low. carbohydrates which give energy to the body.
♦♦ Disease states: Elevation of BMR is seen in various
infections, fever, burns and cancer. Protein Foods
Q.5. Write a short note on protein-energy malnutrition. This group includes milk and milk products (cheese, curd,
(Mar 2013, 3 Marks) khoa, etc. nuts, pulses (dal, beans), eggs and meat. Food from
Or this group provides proteins and sufficient amount of food
from this group should be chosen.
Write a short note on protein calorie malnutrition.
(May 2014, 5 Marks) Protective Vegetables and Fruits
Or This includes leafy green vegetables (sag, cabbage, etc.) yellow
Write a short note on PEM. (Apr 2015, 3 Marks) or orange fruits and vegetables (carrot, papaya, mango, etc.)
Biochemistry 511
and vitamin C rich fruits and vegetables (amla, orange, tomato, ♦♦ It provides the raw material for synthesis of certain
cabbage, ber, guava, drumstick, and cauliflower and cashew substances, e.g. antibodies, hemoglobin, enzymes,
fruit). Fruits and vegetables from this group must be included hormones and plasma proteins.
in the diet daily to provide minerals and vitamins to the body. ♦♦ It provide 10–15% of the energy during emergencies such
as starvation, inadequate food intake.
Other Vegetables
Sources of Proteins
This includes flowers, fruits and stems of plants, brinjal, lady
finger, beans, peas, cucumber, gourds, onions, etc. Liberal ♦♦ Animal source: Milk and milk products, eggs, meat, fish, etc.
amounts of vegetables from this group ensures sufficient ♦♦ Plant sources: Pulses, cereals, dry fruits, nuts, beans, etc.
intake of minerals and vitamins into the body.
Daily Requirements of Protein
Fats, Oils and Sugars The protein intake should be 1.0 g/kg body weight for an adult,
It includes butter, groundnut, ghee, vanaspati oil, nuts, and some of it in the form of animal protein. An extra amount of
animal fat from meat, sugar, honey and jaggery. Food from protein (1.5–2 g/kg body weight) should be added in debilitating
this group gives energy and adds flavor and taste to the food. diseases; children and in pregnant and lactating women.
Q.7. What are the daily calorie requirements of normal hu- Fats
man being. Write in detail about human nutrition.
Fats consist of fatty acids and contain carbon, hydrogen and
(Feb 2013, 10 Marks)
oxygen. They are concentrated sources of energy. 1 g of fat
Ans. There are wide variations in individual calorie require yields approx 9 kcal of energy.
ment. Total calorie requirement for Indian at rest is:
For men: 38 to 40 kcal/hour/m2. Body surface area (BSA) Functions of Fats
= 1500 to 2000 kcal/day. ♦♦ Fats improve the flavor as well as taste of the food.
For women: 33 to 35 kcal/hour/m2. Body surface area ♦♦ They are essential for absorption of fat soluble vitamins
(BSA) = 1200 to 1500 kcal/day. such as vitamins A, D, E and K.
♦♦ They provide support to body internal vital organs, such
Human Nutrition as heart, kidneys, lungs, brain and liver.
Human nutrition process by which substances in food are ♦♦ Stored fats beneath the skin provides insulation against
transformed into body tissues and provide energy for the full cold, i.e. prevents heat loss from the body.
range of physical and mental activities that make up human life. ♦♦ They provide essential fatty acids (EFA) which help in
growth promotion, maintenance of skin integrity and
The six classes of nutrients found in foods are proteins, fats,
reduce blood cholesterol.
carbohydrates, vitamins, minerals, dietary fiber and water.
Most of the foods contain all these constituents but in varying Sources of Fats
proportion. Food can be classified on the basis of their
i. Animal sources: Ghee, butter, fish, oils. In general, they are
predominant function as:
poor sources of essential fatty acids but are good sources of
♦♦ Energy yielding foods: These foods are rich in carbohydrates retinol and cholecalciferol (vitamins A and D, respectively).
and fat, e.g. cereals, sugars, oil. ii. Plant sources: Groundnut, mustard, cotton seed, rape seed and
♦♦ Body building foods: These foods are rich in proteins, e.g. coconut oil. These are all rich sources of essential fatty acids.
milk and its products, pulses, meat, etc.
When vegetable oils are hydrogenated, the liquid oils are
♦♦ Protective foods: These foods are rich in proteins, vitamins
converted into semisolid and solid fat known as vanaspati oil,
and minerals, e.g. milk, egg, green leafy vegetables, fruits ghee (e.g. dalda, rath, etc.). The disadvantage of hydrogenation
etc. is that the content of the valuable ‘essential fatty acids’ present
in vegetable oils is drastically reduced. When natural fats are
Proteins
treated with steam, alkalies, etc. the free fatty acid, and rancid
Proteins are complex organic nitrogenous compounds. They are material present in oils are removed, the process is known as
indispensable constituents of the diet because they are the only ‘refining’ and refined oils are produced. Refining improves the
source of the amino acids which include essential amino acids. quality and taste of oil. Refined oils are free from odor and color
and are as safe as raw oils.
Functions of Proteins
Daily Requirements of Fats
♦♦ They build up new tissues at the time of growth or
pregnancy and lactation. The fat should provide at least 20% of the total energy in a day.
♦♦ Proteins are essential for repair and maintenance of worn This could come to 10 to 20 g of fat per day. Young children
out body tissues. needs 25% extra amount of fats.
512 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Normal Balanced Diet Chart for Women by ICMR Q.10. Answer in brief on dietary fibers.
(May 2017, 2 Marks)
Adult woman Ans. Dietary fiber is the name given collectively to indigestible
Sedentary Moderate Heavy carbohydrates present in foods.
Food item work work work These carbohydrates consist of cellulose, pectin, gum
Quantity gram per day and mucilage.
Cereals 410 440 575 The dietary fiber is not digested by the enzyme of the
human gastrointestinal tract where most of the other
Pulses 40 45 50 carbohydrates like starch, sugars are digested and
Leafy vegetables 100 100 100 absorbed. Plant foods are the only sources of dietary
fiber. It is found in vegetables, fruits, and grains.
Others vegetables 40 40 50
Roots and tubers 50 50 60 Importance of Fiber
Milk 100 150 200 ♦♦ Water holding capacity: The dietary fibers have a property
Oil and fat 20 25 40
of holding water and swell like sponge with a concomitant
increase in viscosity. Thus, fiber adds bulk to the diet and
Sugar or jaggery 20 20 40 increases transit time in the gut (gastric emptying time)
due to high viscosity.
Additional Allowances During Pregnancy ♦♦ Physiological effects: Dietary fiber exerts its influence
along the entire gastrointestinal tract from ingestion to
Food item During pregnancy (g/day) Calories (kcal) excretion.
Cereals 35 118 ♦♦ Adsorption of organic molecules: The organic molecules
like bile acids, neutral sterols, carcinogens, and toxic
Pulses 15 118
compounds can be adsorbed on dietary fiber and facilitates
Milk 15 83 its excretion.
Fat - - ♦♦ Increases stool bulk: The fiber absorbs water and increases
Sugar 10 40 the bulk of the stool and helps to reduce the tendency
towards constipation by increasing bowel movements.
Total - 293
♦♦ Hypoglycemic effect of fiber: Recent studies have shown
that gum present in fenugreek seeds (it contains 40% gum)
Q.9. Mention four differences between kwashiorkor and are most effective in reducing blood sugar and cholesterol
marasmus. (Aug 2016, 2 Marks) levels.
Ans. Following are the differences between kwashiorkor and ♦♦ Hypocholesterolemic effects of fiber: Fiber has cholesterol
marasmus: lowering effect. Fiber binds bile acids and cholesterol,
increasing their fecal exertion, and thus, decreasing plasma
Features Kwashiorkor Marasmus
and tissue cholesterol level.
Age of onset 1 to 5 years Below 1 year
Cause Starchy diet after weaning, Early weaning and
Significance of Dietary Fiber in Medicine
precipitated by an acute repeated infection High fiber diet is associated with reduced incidence of a number
infection of diseases like:
Edema Present Absent ♦♦ Coronary heart disease (CHD)
Serum Hypoalbuminemia Normal or slightly ♦♦ Colon cancer
albumin decreased ♦♦ Diabetes
Serum Decreased Increased ♦♦ Diverticulosis
cortisol ♦♦ Hemorrhoids (piles)
Fatty liver Present Absent Adverse Effect of Dietary Fiber
Muscle Absent or mild Severe
Dietary fiber also has some adverse effects on nutrition by
wasting
binding some mineral elements and preventing their proper
Fat reserves Normal to mildly diminishing Absent absorption. Thus, high dietary fiber intake may lead to deficiency
Deficiency of Protein Calorie of mineral elements.
Growth Present Marked Q.11. Write on beneficial effects of fibers in diet.
retardation (Sep 2018, 5 Marks)
Attitude Lethargic Irritable Ans. Following are the beneficial effects of fibers in diet:
Appetite Anorexia Normal ♦♦ Prevent constipation: Fibers maintain normal motility of
gastrointestinal tract and prevents constipation.
514 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦♦ Water holding capacity: The dietary fibers have a property ♦♦ It provides the raw material for synthesis of certain
of holding water and swell like sponge with a concomitant substances, e.g. antibodies, hemoglobin, enzymes,
increase in viscosity. Thus, fiber adds bulk to the diet and hormones and plasma proteins.
increases transit time in the gut (gastric emptying time) ♦♦ It provides 10–15% of the energy during emergencies such
due to high viscosity. as starvation, inadequate food intake.
♦♦ Physiological effects: Dietary fiber exerts its influence
along the entire gastrointestinal tract from ingestion to Sources of Proteins
excretion. ♦♦ Animal source: Milk and milk products, eggs, meat, fish, etc.
♦♦ Adsorption of organic molecules: The organic molecules ♦♦ Plant sources: Pulses, cereals, dry fruits, nuts, beans, etc.
like bile acids, neutral sterols, carcinogens, and toxic
compounds can be adsorbed on dietary fiber and facilitates Daily Requirements of Protein
its excretion.
The protein intake should be 1.0 g/kg body weight for an adult,
♦♦ Increases stool bulk: The fiber absorbs water and increases
some of it in the form of animal protein. An extra amount of
the bulk of the stool and helps to reduce the tendency
protein (1.5–2 g/kg body weight) should be added in debilitating
towards constipation by increasing bowel movements.
♦♦ Hypoglycemic effect of fiber: Recent studies have shown diseases; children and in pregnant and lactating women.
that gum present in fenugreek seeds (it contains 40% gum) Fats
are most effective in reducing blood sugar and cholesterol
levels. Fats consist of fatty acids and contain carbon, hydrogen and
♦♦ Hypocholesterolemic effects of fiber: Fiber has cholesterol oxygen. They are concentrated sources of energy. 1 g of fat
lowering effect. Fiber binds bile acids and cholesterol, yields approx 9 kcal of energy.
increasing their fecal exertion, and thus, decreasing plasma
and tissue cholesterol level. Functions of Fats
♦♦ Decreases GIT cancer: Low incidence of cancer of GIT in ♦♦ Fats improve the flavor as well as taste of the food.
vegetarians as compared to non-vegetarians is credited ♦♦ Fats are essential for absorption of fat soluble vitamins
to dietary fibers. such as vitamins A, D, E and K.
♦♦ Satiety value: Fibers in the diet add to weight of foodstuff ♦♦ They provide support to body internal vital organs, such
ingested and provide sensation of stomach fullness. as heart, kidneys, lungs, brain and liver.
Q.12. What are macronutrients. (Aug 2018, 5 Marks) ♦♦ Stored fats beneath the skin provides insulation against
Ans. Proteins, fats and carbohydrates are the macronutrients cold, i.e. prevents heat loss from the body.
and they form main bulk of food. ♦♦ They provide essential fatty acids which help in growth
In an Indian dietary they contribute to total energy intake promotion, maintenance of skin integrity and reduce blood
in following proportions: cholesterol.
Proteins: 7 to 15%
Sources of Fats
Fats: 35 to 45%
♦♦ Animal sources: Ghee, butter, fish, oils. In general, they are
Carbohydrates: 50 to 70%.
poor sources of essential fatty acids but are good sources of
♦ Proteins, fats and carbohydrates are sometimes re-
retinol and cholecalciferol (vitamins A and D, respectively).
ferred to as proximate principle. They are oxidized
♦♦ Plant sources: Groundnut, mustard, cotton seed, rape
in the body to yield energy which the body needs.
seed and coconut oil. These are all rich sources of essential
♦ Although proteins provide energy their primary
function is to provide essential and nonessential fatty acids.
amino acids for building of body proteins. When vegetable oils are hydrogenated, the liquid oils are
♦ Fats particularly the vegetable oils, besides being converted into semisolid and solid fat known as vanaspati oil,
concentrated source of energy provide essential fatty ghee (e.g. dalda, rath, etc.). The disadvantage of hydrogenation
acids which have a vitamin like function in the body. is that the content of the valuable ‘essential fatty acids’ present
in vegetable oils is drastically reduced. When natural fats are
Proteins treated with steam, alkalies, etc. the free fatty acid, and rancid
Proteins are complex organic nitrogenous compounds. They are material present in oils are removed, the process is known as
indispensable constituents of the diet because they are the only ‘refining’ and refined oils are produced. Refining improves the
source of the amino acids which include essential amino acids. quality and taste of oil. Refined oils are free from odor and color
and are as safe as raw oils.
Functions of Proteins
Daily Requirements of Fats
♦♦ They build up new tissues at the time of growth or
pregnancy and lactation. The fat should provide at least 20% of the total energy in a day.
♦♦ Proteins are essential for repair and maintenance of worn This could come to 10 to 20 g of fat per day. Young children
out body tissues. needs 25% extra amount of fats.
Biochemistry 515
Q.1. Write a short note on detoxification. ♦♦ Plasma antioxidants, e.g. β-carotene, ascorbic acid,
(June 2010, 5 Marks) bilirubin, uric acid, ceruloplasmin, transferrin.
♦♦ Cell membrane antioxidants, e.g. α-tocopherol.
Ans. Detoxification refers to the series of biochemical
♦♦ Intracellular antioxidants, e.g. superoxide dismutase,
reactions occurring in the body to convert the foreign
catalase, glutathione peroxidase.
compounds to nontoxic or less toxic and more easily
excretable forms. Based on the Nature and Action
Detoxification reaction occurs most commonly in the
♦♦ Enzymatic antioxidants, e.g. superoxide dismutase,
liver which consists of numerous enzymes. Kidney and
catalase, glutathione peroxidase, glutathione reductase.
other organs are sometimes involved. Products formed
♦♦ Nonenzymatic antioxidants:
after detoxification is mainly excreted by kidneys.
a. Nutrient antioxidants, e.g. carotenoids, α-tocopherol,
Phases of Detoxification ascorbic acid, selenium.
b. Metabolic antioxidants, e.g. glutathione, ceruloplasmin,
There are two types of phases, i.e. Phase I and Phase II. albumin, bilirubin, transferrin, ferritin, uric acid
Phase I Reaction Antioxidant Enzyme System
In this, there is the alteration of foreign molecule to add a Antioxidant enzymes scavange the free radicals. Various
functional group. These reactions form compounds with enzymes are:
decreased toxicity. Phase I reactions include hydroxylation, ♦♦ Superoxide dismutase: This enzyme converts superoxide
oxidation, reduction, hydrolysis, dealkylation, epoxidation. to hydrogen peroxide and is the first line of defense to
♦♦ Oxidative reaction: Oxidative reactions are either aromatic protect cells from the injurious effects of superoxide.
or aliphatic. These reactions include sulfoxidation, ♦♦ Catalase: Hydrogen peroxide produced by superoxide
N-oxidation and epoxidation. Oxidation and detoxification dismutase is metabolized by catalase
of alcohol is the function of liver. Alcohol dehydrogenase ♦♦ Glutathione peroxidase: It detoxifies hydrogen peroxide
oxidizes alcohol to aldehyde and aldehyde dehydrogenase to water and reduced glutathione gets converted to
oxidizes aldehyde to acid. oxidized glutathione. Reduced glutathione can be
♦♦ Reductive reaction: Nitro compounds are reduced regenerated by the enzyme glutathione reductase utilizing
to amines, while aldehydes or ketones are reduced to NADPH. The hexose monophosphate shunt is the major
alcohols. Example is reduction of nitrobenzene to aniline. source of NADPH.
516 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
pregnancy. In absence of bone disease and pregnancy elevated phosphatase levels are an indicator of hepatobiliary disease.
alkaline phosphatase levels are an indicator of hepatobiliary Alkaline phosphatase also increases in liver cirrhosis and
disease. Alkaline phosphatase also increases in liver cirrhosis hepatic tumors. Its normal value is 3–13 KA units/dL/100 mL.
and hepatic tumors. Its normal value is 3–13 KA units/dL/100
mL. Clinical Interpretation
♦♦ Greatest elevation occurs in obstructive jaundice. Enzyme
Clinical Interpretation
alkaline phosphatase is normally excreted through bile.
♦♦ Greatest elevation occurs in obstructive jaundice. Enzyme Obstruction to flow of bile leads to regurgitation of enzyme
alkaline phosphatase is normally excreted through bile. in blood resulting in increased serum concentration.
Obstruction to flow of bile leads to regurgitation of enzyme ♦♦ Slight to moderate increase is seen in hepatitis and
in blood resulting in increased serum concentration. cirrhosis.
♦♦ Slight to moderate increase is seen in hepatitis and ♦♦ In hemolytic jaundice normal serum alkaline phosphatase
cirrhosis. values are seen.
♦♦ In hemolytic jaundice normal serum alkaline phosphatase
values are seen. γ–Glutamyltranspeptidase
investigation. Its analysis, therefore, is important in evaluating ♦♦ Creatinine is freely filtered at the glomerulus and is not
kidney function. The standard urine analysis includes: reabsorbed by the tubules. A small amount of creatinine
♦♦ Physical examination: Assessment of volume, color, odor, is secreted by tubules. Because of these properties, the
appearance, specific gravity and pH creatinine clearance can be used to estimate the GFR.
♦♦ Chemical examination: Checking for the presence of ♦♦ Creatinine clearance is defined as the volume of plasma
protein, reducing sugar, ketone bodies, blood, bile salts (in mL) that would be completely cleared off creatinine
and bile pigments. per minute.
♦♦ Microscopic examination of urine: Checking for the ♦♦ The creatinine clearance is determined by collecting
presence of WBCs, RBCs and casts. urine over a 24 hour period and a sample of blood is
drawn during the urine collection period. The clearance
Serum Creatinine and Urea of creatinine from plasma is directly related to the GFR,
which is calculated as follows:
♦♦ Serum urea and creatinine are the markers of renal
function. Both these substances are primarily excreted Creatinine clearance = GFR = U × V
in the urine. Deterioration of renal function is therefore P
Where,
associated with increase in the serum levels of these
U is urinary creatinine (mg/dL)
substances.
♦♦ Creatinine is considered a better marker of renal function P is plasma creatinine (mg/dL)
than urea because urea is affected by dietary protein intake V is volume of urine excreted (mL/minute).
and liver function.
Clinical Interpretation
♦♦ An impaired glomerular filtration results in retention of
urea and creatinine which causes in elevation of blood ♦♦ The normal range for creatinine clearance is 90 to 120 mL/
urea (normal range 20–40 mg/dL) and creatinine (normal minute.
range 0.5–1.5 mg/dL). An increase of these end products ♦♦ A decreased creatinine clearance is a very sensitive
in the blood is called azotemia. indicator of a decreased glomerular filtration rate.
♦♦ The reduced filtration rate may be caused by acute or
Estimation of Glomerular Filtration Rate chronic damage to the glomerulus or any of its components.
♦♦ Reduced blood flow to the glomeruli may also produce a
These tests are performed to assess the glomerular filtration rate
decreased creatinine clearance.
(GFR). GFR provides a useful index of the status of functioning
glomeruli. Renal clearance tests are performed to determine Urea Clearance Test
GFR. ♦♦ Urea is the end product of protein metabolism.
♦♦ Urea clearance may also be employed as a measure of the
Clearance Test
GFR. But urea clearance is not as sensitive as creatinine
Clearance test is performed to assess the glomerular filtration clearance.
rate. ♦♦ Urea clearance is defined as the volume of plasma (in mL)
Clearance is defined as the volume of plasma (in mL) that that would be completely cleared off urea per minute.
could be completely cleared off a substance per minute and is ♦♦ It is calculated by the formula:
expressed as milliliter per minute. It may also be defined as Urea clearance = U × V
that volume of plasma (in mL) which contains the amount of P
Where,
the substance which is excreted by kidney in urine in 1 minute.
U is urinary urea (mg/dL)
Renal clearance (C) is calculated by using following formula:
P is plasma urea (mg/dL)
C=U×V V is volume of urine in mL excreted per minute.
P
Where, Clinical Interpretation
C: Renal clearance: GFR of a substance in mL/minute ♦♦ The normal value of urea clearance is 75 mL/minute.
U: Concentration of substance in urine (mg/100 mL) ♦♦ Urea clearance between 40-70 mL/min indicates mild
V: Volume of urine in mL excreted per minute impairment, between 20-40 mL/min indicates moderate
impairment and below 20 mL/min indicates severe
P: Concentration of substance in plasma (mg/100 mL). impairment of renal function.
Creatinine Clearance Test Inulin Clearance Test
♦♦ Creatinine clearance test is the renal function test which is ♦♦ Inulin clearance is the method of choice when accurate
based on the rate of excretion of creatinine by the kidneys. determination of GFR is required.
♦♦ Creatinine is an excretory product derived from creatine ♦♦ Inulin is a polysaccharide of fructose which is filtered
phosphate. The excretion of creatinine is not influenced by the glomerulus but not reabsorbed, secreted or
by metabolism or dietary factors. metabolically altered by the renal tubule.
Biochemistry 519
♦♦ The normal value of inulin clearance is 120 mL/min ♦♦ A decreased creatinine clearance is a very sensitive
♦♦ Inulin clearance is calculated by the following formula: indicator of a decreased glomerular filtration rate.
♦♦ The reduced filtration rate may be caused by acute or
Inulin clearance = U × V chronic damage to the glomerulus or any of its components.
P
Where, ♦♦ Reduced blood flow to the glomeruli may also produce a
U is urinary inulin (mg/dL) decreased creatinine clearance.
P is plasma inulin (mg/dL)
V is volume of urine in mL excreted per minute.
12. VITAMINS
Tests of Renal Tubular Function
Q. 1. Write a short note on vitamin C.
♦♦ Assessment of the concentrating and diluting ability of the
(Sep 2001, 5 Marks) (Apr 2008, 3 Marks),
kidney can provide the most sensitive means of detecting
(Mar 2008, 3 Marks) (Dec 2010, 3 Marks)
early impairment in renal function.
(Sep 2013, 5 Marks) (Apr 2015, 3 Marks)
♦♦ The ability to concentrate or dilute urine is dependent
upon renal tubular reabsorption function and presence Or
of antidiuretic hormone (ADH). Describe sources, absorption, storage, daily require
♦♦ The kidneys fail to concentrate urine either due to renal
ment, physiological and biochemical functions, deficiency,
tubular damage or due to ADH deficiency (endocrine
symptoms and hypervitaminosis of vitamin C.
disorder).
♦♦ The urinary specific gravity and osmolality are used to (Nov 2009, 8 Marks)
measure the concentrating and diluting ability of the Or
tubules. Write in detail about vitamin C giving its chemistry,
♦♦ Various renal tubular function tests are water deprivation
daily requirement, sources, history, physiological/
test, urine dilution test, urine acidification test.
biochemical functions, etc. (Aug 2011, 11 Marks)
Q.4. Write very short answer on creatinine clearance test.
Or
(Apr 2018, 2 Marks)
Ans. Creatinine clearance test is the renal function test which Describe sources biological role and manifestation of
is based on the rate of excretion of creatinine by the vitamin C deficiency. (Feb 2016, 3 Marks)
kidneys. Or
• Creatinine is an excretory product derived from
creatine phosphate. The excretion of creatinine is Define vitamins. Write in detail about chemistry, bio-
not influenced by metabolism or dietary factors. chemical functions, history, daily requirement, etc. of
• Creatinine is freely filtered at the glomerulus and is vitamin C. (Feb 2013, 10 Marks)
not reabsorbed by the tubules. A small amount of Or
creatinine is secreted by tubules. Because of these
Describe sources, biological role and manifestation of
properties, the creatinine clearance can be used to
vitamin C deficiency. (May 2017, 5 Marks)
estimate the GFR.
• Creatinine clearance is defined as the volume of Or
plasma (in mL) that would be completely cleared Describe sources, functions and deficiency disorders
off creatinine per minute. of vitamin C. (July 2016, 5 Marks)
• The creatinine clearance is determined by collecting
urine over a 24 hour period and a sample of blood is Or
drawn during the urine collection period. The clear- Write on functions of vitamin C and scurvy.
ance of creatinine from plasma is directly related to (Dec 2014, 5 Marks)
the GFR which is calculated as follows:
Or
Creatinine clearance = GFR = U × V
P Write on functions of vitamin C and effects of its
Where, deficiency. (Sep 2018, 5 Marks)
U is urinary creatinine (mg/dL) Ans.
P is plasma creatinine (mg/dL)
V is volume of urine excreted (mL/minute). Sources of Vitamin C
♦♦ Citrus fruits, gooseberry (amla), guava, green vegetables
Clinical Interpretation such as cabbage and spinach, tomato and potato.
♦♦ The normal range for creatinine clearance is 90 to 120 mL/ ♦♦ High content of vitamin C is found in adrenal gland and
minute. gonads.
520 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Absorption and Storage of Vitamin C ♦♦ Bone formation: Tissues of bone possess an organic
♦♦ Ascorbic acid is easily absorbed from the small intestine, matrix, collagen and the inorganic calcium, phosphate,
peritoneum and subcutaneous tissues. etc. Vitamin C is essential for bone formation.
♦♦ It is not stored in any particular organ and is spread ♦♦ Iron and hemoglobin metabolism: Ascorbic acid leads
throughout the body. to iron absorption by placing it in the ferrous form. This
is mainly caused by reducing the property of vitamin C.
Daily Requirements ♦♦ Tryptophan metabolism: Vitamin C is essential for the
♦♦ Recommended daily allowance of vitamin C is about 60 hydroxylation of tryptophan enzyme hydroxylase to
to 70 mg. hydroxytryptophan in the synthesis of serotonin.
♦♦ Additional intake is needed for women during pregnancy ♦♦ Tyrosine metabolism: Ascorbic acid is required for the
and lactation. oxidation of p-hydroxyphenylpyruvate to homogentisic
acid in tyrosine metabolism.
History ♦♦ Folic acid metabolism: The active form of the vitamin
In the winter of 1556, there was a scurvy epidemic that plagued folic acid is tetrahydrofolate. Vitamin C is needed for the
in Europe. Little did the population know that the lack of fruits formation of folic acid.
and vegetables in those winter months had caused the outbreak. ♦♦ Sparing action of other vitamins: Ascorbic acid is a strong
While this was one of the earliest noted scurvy epidemics, not antioxidant. It spares vitamin A, vitamin E, and some
much research was done in effort to cure this disease until B-complex vitamins from oxidation.
many centuries later. Jacques Cartier, an established explorer, ♦♦ lmmunological function: Vitamin C enhances the
curiously noted that his sailors who had digested oranges, synthesis of immunoglobulins (antibodies) and increases
limes, and berries did not get scurvy, and those who had the the phagocytic action of leukocytes.
disease recovered. ♦♦ Synthesis of corticosteroid hormones: Since adrenal gland
possess high levels of ascorbic acid mainly in the period
In 1742, James Lind, a British doctor, was the first person to
establish that there was a definite connection between the diet of stress. So, it is believed that vitamin C is necessary for
and scurvy. hydroxylation reaction in the synthesis of corticosteroid
hormones.
While this was used often at sea, its applicable daily dietary
♦♦ Preventive action on chronic diseases: As during normal
benefits were not fully understood. In the late 1800s, infants
metabolism free radicals are constantly secreted, they cause
were dying from scurvy, and no one knew why. In the early
damage to proteins, lipids, DNA and cell membrane which
1900s, studies showed that the vitamin C found in the babies’
causes development of cancer, heart diseases and aging.
milk was being destroyed in the routine pasteurization of that
Since vitamin C is a strong biological antioxidant which
milk.
prevent these chronic diseases.
In 1912, studies showed that when scurvy was injected into
guinea pigs (one of the few animals who can contact the disease),
Symptoms of Vitamin C Deficiency
several doses of vitamin C cured the guinea pigs. In this present
day, the governments recommended daily allowance of vitamin ♦♦ Gross deficiency of vitamin C results in scurvy.
C, a mere 60 mg will only prevent the public from contracting ♦♦ In severe cases of scurvy, the gum becomes painful,
this horrible disease. swollen, and spongy. Pulp is separated from the dentine
and finally teeth are lost. Wound healing may be delayed.
Chemistry of Vitamin C ♦♦ In ascorbic acid deficiency, collagen is abnormal and the
♦♦ Ascorbic acid is a six carbon derivative and it closely intercellular cement substance is brittle. So capillaries are
resembles monosaccharides in structure. fragile leading to the tendency to bleed even under minor
♦♦ The acidic property of vitamin C is due to the enolic pressure. Subcutaneous hemorrhage may be manifested
hydroxyl groups. as petechiae in mild deficiency and as ecchymoses or even
♦♦ It is a strong reducing agent. hematoma in severe conditions.
♦♦ L-ascorbic acid undergoes oxidation to form dehydro ♦♦ In severe cases, hemorrhage may occur in the conjunctiva
ascorbic acid and this reaction is reversible. and retina. Internal bleeding may be seen as epistaxis,
♦♦ On hydration, dehydroascorbic acid is irreversibly hematuria or malena.
converted to 2, 3-diketogulonic acid which is inactive. ♦♦ In the bones, the deficiency results in the failure of the
osteoblasts to form the intercellular substance, osteoid.
Physiological and Biochemical Functions Without the normal ground substance, the deposition
♦♦ Collagen formation: Vitamin C plays the role as coenzyme of bone is arrested. The resulting scorbutic bone is weak
in hydroxylation of proline and lysine, while protocollagen and fractures easily. There may be hemorrhage into joint
get converted to collagen. The hydroxylation reaction is cavities. Painful swelling of joints may prevent locomotion
catalyzed by lysyl hydroxylase and prolyl hydroxylase and of the patient.
they get converted to hydroxyproline and hydroxylysine. ♦♦ In vitamin C deficiency microcytic, hypochromic anemia
This reaction is dependent on vitamin C. is seen.
Biochemistry 521
Hypervitaminosis of Vitamin C of epidermis. In the skin, ultraviolet light breaks the bond
♦♦ Occasional large intakes of vitamin C may cause stomach to give rise the provitamin, secosterol. The cis double bond
cramps, nausea, and diarrhea in some fasting subjects but between is then isomerized to a trans bond to form vitamin D3
have no long-term adverse effects. or cholecalciferol.
♦♦ It has been specifically proposed that megadoses of So, vitamin D is called the “sun-shine vitamin”. As sun-shine
vitamin C: is less in winter months, vitamin deficiency is seen in winter.
• Increase oxalate production (thereby increasing the
formation of renal stones). Activation of Vitamin D
• Competitively inhibit renal reabsorption of uric acid. Vitamin D acts like a prohormone. The cholecalciferol
• Enhance the destruction of vitamin B12 in the gut. which is the inactive form is first transported to liver where
Intensify the enteric absorption of nonhem iron, thus hydroxylation at 25th position occurs which is catalyzed by
leading to iron overload. enzyme hydrolase, to form 25-hydroxycholecalciferol. This is
• Result in mutagenic effects. the major storage form.
• Increase in vitamin C catabolism that would persist
In the kidney, it is further hydroxylated at the 1st position
after returning to lower intakes of the vitamin.
by α–hydroxylase enzyme. Thus 1, 25-dihydroxycholecalciferol
Q.2. Write a short note on vitamin D. is generated. Since it contains three hydroxyl groups at 1, 3 and
(Apr 2003, 5 Marks) (Dec 2010, 5 Marks) 25 positions, it is also called calcitriol. The calcitriol thus formed
(Aug 2012, 5 Marks) (Oct 2014, 3 Marks) is the active form of vitamin, it act as a hormone.
Or
Biochemical Functions or Role of Vitamin D in Calcium
Describe in brief about vitamin D.
Metabolism
(Apr 2008, 4 Marks) (Mar 2008, 3 Marks)
(Apr 2010, 5 Marks) (Nov 2009, 3 Marks) Calcitriol acts at 3 different levels (intestine, kidney and bone)
Or to maintain plasma calcium (normal 9–11 mg/dL).
Write in detail about vitamin D. (Aug 2011, 11 Marks) 1. Action of calcitriol on the intestine: Calcitriol increases
the intestinal absorption of calcium and phosphate. In the
Or
intestinal cells, calcitriol binds with a cytosolic receptor
Describe sources, daily requirement, symptoms of to form a calcitriol-receptor complex. This complex then
vitamin D deficiency. What is role of vitamin D in approaches the nucleus and interacts with a specific DNA
calcium metabolism? leading to the synthesis of a specific calcium binding
(Aug 2012, 6 Marks) (Aug 2011, 20 Marks) protein. This protein increases the calcium uptake by the
Or intestine.
Write on functions of Vitamin D and rickets. 2. Action of calcitriol on the bone: In the osteoblasts of
(Dec 2014, 5 Marks) bone, calcitriol stimulates calcium uptake for deposition
Ans. Vitamin D is also known as calciferol due to its role in as calcium phosphate. Thus calcitriol is essential for bone
calcium metabolism and antirachitic factor. formation.
3. Action of calcitriol on the kidney: Calcitriol is also
Structure involved in minimizing the excretion of calcium and
Vitamin D is a steroid compound and there are two forms of phosphate through the kidney by decreasing their
vitamin D, i.e. excretion and enhancing reabsorption.
1. Naturally produced vitamin D3 or cholecalciferol. It Sources
is obtained from animal sources in diet or made in
skin by action of ultraviolet light from sunlight on ♦♦ Best sources for vitamin D are cod liver oil, fish oils and
7–dehydrocholesterol. sunlight induced synthesis of vitamin D3 in skin.
2. Another is artificially produced from D2 or ergocalciferol. ♦♦ Egg yolk and liver are good sources.
This form is made in laboratory by irradiating plant sterol,
i.e. ergosterol. Daily Requirement
♦♦ Daily requirement of vitamin D is 400 IU or 10 µg of
Absorption and Transport
cholecalciferol.
Dietary vitamin D is absorbed in duodenum along with lipids ♦♦ In countries with good sunlight recommended daily
and is transported to liver via chylomicron. requirement is 200 IU or 5 µg of cholecalciferol.
Rickets Or
♦♦ It is characterized by the formation of soft and pliable bones Write a short note on sources and functions of vitamin A.
due to poor mineralization and calcium deficiency. Due to (Oct 2007, 5 Marks)
softness, the weight bearing bones are bent and deformed. Or
♦♦ Main features of the rickets are a large head with
protruding forehead, pigeon chest, bow legs, (curved Write down source, requirement and action of vitamin
legs), knock knees and abnormal curvature of the spine A. What is the effect of deficiency of vitamin A on hu-
(kyphosis). man being. (Nov 2008, 5 Marks)
♦♦ Rachitic children are usually anemic or prone to infections. Ans. Vitamin A is a fat soluble vitamin.
Rickets can be fatal when severe.
♦♦ Rickets is characterized by low plasma levels of calcium Structure
and phosphorus and high alkaline phosphatase activity. Vitamin A contains of a single 6-membered ring with attached
Osteomalacia (Adult Rickets) 11–carbon side chain is attached. Vitamin A is an alcohol
(retinol), but can be converted into an aldehyde (retinal), or an
♦♦ Deficiency of vitamin D in adults causes osteomalacia. This acid (retinoic acid).
is a condition similar to that of rickets.
♦♦ Osteomalacia is characterized by demineralization of Active Form
previously formed bones, demineralization of bones makes
♦♦ Vitamin A consists of three biologically active molecules
them soft and susceptible to fractures.
known as retinoids, i.e. retinol, retinal and retinoic acid.
Renal Rickets (Renal Osteodystrophy) ♦♦ Each of these compounds are derived from plat precursor
molecule, i.e. β–carotene.
♦♦ In chronic renal failure synthesis of calcitriol in kidney is
♦♦ β–carotene has two molecules of retinal linked at their
impaired. As a result, the deficiency of calcitriol occurs
aldehyde ends also known as provitamin form of vitamin
which leads to hypocalcemia and hyperphosphatemia.
A.
♦♦ It can be treated by oral or intravenous administration of
♦♦ Retinol and retinal are interconverted by enzyme retinal
calcitriol (active form of vitamin D).
aldehyde reductase. Retinoic acid is formed by oxidation of
Vitamin D Resistant Rickets retinal. Retinoic acid cannot be reduced to retinol or retinal.
♦♦ It is a disease which does not respond to the treatment Absorption Transport and Mobilization
with vitamin D.
♦♦ Dietary retinal esters are hydrolyzed by enzyme pancreatic
♦♦ There are various possible causes of this condition and all
or intestinal brush border hydrolases in the intestine,
involve a defect in the metabolism or mechanism of action
releasing retinol and free fatty acids.
of 1,25-dihydroxycholecalciferol as follows:
♦♦ Carotenes get hydrolyzed by β–carotene 15-15’-dioxygenase
• Due to defective vitamin D receptor
of intestinal cells and release two moles of retinal which is
• Due to a defective 1, α-hydroxylase activity in kidney
reduced to retinol.
• Due to liver disease and kidney failure as the
♦♦ Inside the intestinal mucosal cells, retinol get re-esterified
production of 25-hydroxycholecalciferol and
to long chain fatty acids, incorporated into chylomicrons
1,25-dihydroxycholecalciferol respectively will be
and transferred to the lymph. The retinol esters of
inefficient in the damaged tissue.
chylomicrons are taken up by the liver and stored.
Hypervitaminosis D ♦♦ Transportation of retinol occurs in the circulation by the
plasma retinol binding protein.
♦♦ Vitamin D is stored mostly in liver and slowly metabolized. ♦♦ Many cells of target tissues contain a cellular retinol-
♦♦ Among the vitamins, vitamin D is the most toxic in binding protein that carries retinol to the nucleus and
overdoses. binds to the chromatin (DNA). It is here that retinol exerts
♦♦ Toxic effects of hypervitaminosis D include demineraliza- its f function in a manner analogous to that of a steroid
tion of bones (resorption) and increased calcium absorp- hormone.
tion from the intestine leading to elevated calcium in
plasma (hypercalcemia). Hypervitaminosis D may lead to Biochemical Functions or Actions of Vitamin A
the formation of stones in kidneys (renal calculi).
♦♦ Vitamin A is needed for variety of functions, such as
♦♦ High consumption of vitamin D is associated with the loss
vision, cell differentiation and growth, reproduction and
of appetite, nausea, increased thirst, loss of weight.
maintenance of epithelial cells.
Q.3. Write a short note on vitamin A. ♦♦ Retinol as well as retinoic acid function like steroid
(Mar 2000, 5 Marks) (Mar 2001, 5 Marks) hormones. Both of them regulate protein synthesis and are
(Mar 2009, 5 Marks) (Mar 2009, 5 Marks) involved in both cell growth and differentiation.
(June 2010, 2.5 Marks) (Feb 2014, 3 Marks) ♦♦ Vitamin A maintains healthy epithelial tissue.
Biochemistry 523
♦♦ Moreover, the conversion of all trans-retinal to 11-cis Ans. Fat Soluble Vitamins
retinal is incomplete. So, most of the all-trans-retinal is • The fat soluble vitamins are a polar hydrophobic
transported to the liver and converted into all—trans molecules.
retinol by an enzyme alcohol dehydrogenase. • They have isoprene derivatives.
♦♦ The all-trans-retinol undergoes isomerization to 11-cis • Bile salts and fats are essential for their absorp-
retinol which is then oxidized to 11-cis retinal to participate
tion.
in the visual cycle.
• They are generally stored in liver.
Q.5. Write a short note on fat soluble vitamin. • Normally, they are not excreted in urine.
(Apr 2010, 5 Marks) (Dec 2009, 5 Marks) • Fat soluble vitamins are vitamin A, D, E and K.
Or • Fat soluble vitamins function as coenzymes, hor-
Describe in brief fat soluble vitamins. mones and antioxidants.
• Fat soluble vitamins are toxic and even lethal when
(Jan 2012, 4 Marks)
they are taken in excessive quantities.
Or Following are some of the details of fat soluble vitamins
Write on fat soluble vitamins. (Apr 2017, 5 Marks) which are as follows:
Daily Deficiency
Name Active form Source requirements Functions manifestations
Vitamin A Retional, Fish liver oils, milk, 800–1,000 Retinal and retinol are involved in vision. Night blindness,
retinal, retinoic milk products, green retinol Retinoic acid regulates the expression xerophthalmia formation of
acid leafy vegetables, equivalents of gene during growth and development. Bitot’s spots, dry rough and
carrots, yellow and Antioxidant scaly skin. Retardation of
red fruits growth in children
Vitamin D 1,25-Dihydroxy- Cod liver oil, sunlight 200–400 IU Regulation of the plasma level of Rickets (in children),
(cholecalciferol) cholecalciferol induced synthesis calcium and phosphorus, calcification osteomalacia (in adults)
of vitamin D3 in skin, of bone
egg yolk
Vitamin E a-tocopherol Soya and corn oils, 8–10 mg Natural antioxidant and acts as a Hemolytic anemia,
(a-tocopherol) germ oil, fish oil, scavenger of free radicals. Protects the retrolental fibroplasia (RLF)
eggs, alfalfa RBCs from hemolysis. in premature infants
Prevents peroxidation of PUFA in cell
membrane
Vitamin K Phylloquinone Green leafy 70–140 mg Required for activation of blood clotting Hemorrhagic disorder,
(Vitamin K1) vegetables, factors. Required for g-carboxylation of increased clotting time
Menaquinone tomatoes, cheese, glutamic acid, carboxylation of glutamic
(Vitamin K2) meat, egg yolk acid residue in clotting and osteocalcin
proteins
Q.6. Write short note on vitamin B1. (Aug 2005, 5 Marks) Dietary Sources
Or ♦♦ Rich sources: Polishing rice, wheat jaw and yeast
Functions of vitamin B1 and effects of its deficiency. ♦♦ Good source: Cereals, pulses, nuts, oil, seeds
(Jan 2018, 5 Marks) ♦♦ Fair sources: Meat, fish, egg, milk, vegetables and fruits.
Ans. Vitamin B1 is also known as Thiamine.
Biochemical Functions or Functions of Vitamin B1
Chemistry ♦♦ Vitamin B1 is required for carbohydrate metabolism.
Thiamine consists of pyrimidine ring and a thiazole ring which is ♦♦ Thiamine pyrophosphate is the coenzyme involved
held by a methylene bridge. Alcohol group of thiamine is esterified in various enzymatic reactions mainly for oxidative
by the phosphate to form the coenzyme, i.e. thiamine pyrophos- decarboxylation and transketolase reactions as follows:
phate. Pyrophosphate moiety is donated by ATP and reaction is • Thiamine pyrophosphate is a coenzyme for
catalyzed by an enzyme thiamine pyrophosphate transferase. pyruvate dehydrogenase complex which catalyzes
conversion of pyruvate into acetyl-CoA by oxidative
Recommended Dietary Allowance
decarboxylation. Acetyl-CoA is a precursor for
Daily requirement of thiamine depends on the intake of synthesis of neurotransmitter acetylcholine and also
carbohydrate. for synthesis of myelin. So, thiamine is needed for
Daily intake of 1 to 1.5 mg/day is recommended for adults. normal functioning of nervous system.
Biochemistry 525
• Thiamine pyrophosphate is a coenzyme for α– ♦♦ In chronic alcoholics, the nutritional deficiencies result
ketoglutarate dehydrogenase which catalyzes the from either poor intake of food or malabsorption of
conversion of α–ketoglutarate to succinyl–CoA in nutrients from intestine.
TCA cycle. Wernicke-Korsakoff syndrome is characterized by
• Thiamine pyrophosphate is the coenzyme for an anorexia, nausea, vomiting, nystagmus, depression, ataxia,
enzyme transketolase, in pentose phosphate pathway loss of memory, mental confusion, peripheral paralysis,
of glucose oxidation. muscular weakness, etc.
Q.7. Write a short note on vitamin B12 or write a short note
Deficiency of Vitamin B1
on cyanocobalamin. (Sep 2000, 5 Marks)
Deficiency of vitamin B1 results in a condition known as (Sep 2007, 3 Marks) (Sep 2009, 5 Marks)
beriberi. Deficiency of thiamine occurs in population who Ans. Vitamin B12 is also known as antipernicious anemia
consume exclusively polished rice as staple food. Polishing of vitamin.
rice removes thiamine.
♦♦ The early symptoms of thiamine deficiency are anorexia, Chemistry
nausea, mental confusion, peripheral neuritis, muscle Vitamin B12 has a complex corrin ring which is lniked to cobalt
fatigue and irritability. atom held in the center of corrin ring by four coordination
♦♦ Thiamine deficiency leads to three types of beriberi, i.e. bonds with nitrogen of pyrrole groups. Remaining coordination
1. Dry beriberi bonds of cobalt are linked to nitrogen of dimethylbenzimidazole
2. Wet beriberi nucleotide and sixth bond is linked to either methyl or (5’–
3. Infantile beriberi deoxyadenosyl) or hydroxyl group to form methylcobalamin,
adenosylcobalamin or hydroxycobalamin.
Dry Beriberi (Neuritic Beriberi)
Active forms of vitamin B12 are methylcobalamin and
♦♦ It develops when the diet chronically contains slightly less 5-deoxyadenosylcobalamin.
than the thiamine requirements.
♦♦ This form of beriberi is characterized primarily by Absorption, Transport and Storage
peripheral neuritis, severe muscular weakness and fatigue. ♦♦ Vitamin B12 from intestine needs an intrinsic factor, which
Other symptoms of dry beriberi include dry skin, mental is a glycoprotein secreted by parietal cell of stomach.
confusion and poor appetite. ♦♦ Intrinsic factor binds to dietary vitamin B12 to form
vitamin B12–intrinsic factor complex. This complex binds
Wet Beri-beri (Cardiac Beri-beri) to specific receptors on surface of mucosal cells of ileum.
♦♦ It develops when the deficiency is more severe in ♦♦ As the complex bind to the receptor, bound vitamin B12
which cardiovascular system is affected in addition to gets released from complex and enters ileal mucosal cells
neurological symptoms. via Ca2+ dependent process.
♦♦ Wet beri-beri is characterized primarily by edema of ♦♦ Vitamin inside the mucosal cells gets converted to its
extremities, heart enlargement and cardiac insufficiency. main plasma transport form to methylcobalamin. Now it
♦♦ Other symptoms include tachycardia or bradycardia and is transported by vitamin B12 binding protein known as
palpitation. transcobalamins, i.e. TC–I and TC–II.
♦♦ Both forms of beri-beri may overlap to a varying degree ♦♦ Methylcobalamin in excess is taken up by the liver and is
and patients of beri-beri may die due to heart failure, if stored in deoxyadenosyl B12 form.
not treated. ♦♦ Liver can store 4 to 5 mg of vitamin B12 in adults.
Functions
Infantile Beriberi
♦♦ Conversion of homocysteine to methionine: Vitamin
♦♦ Infantile beriberi is observed in breast fed infants born to
B12, as methylcobalamin is used in the conversion of
mother suffering from thiamine deficiency. The breast milk homocysteine to methionine. This is an important reaction
of these mothers is deficient in thiamine. which involves N5–methyltetrahydrofolate from which
♦♦ Infantile beriberi is characterized by cardiac dilation tetrahydrofolate is liberated. This metabolic step shows
(enlargement of heart), tachycardia, convulsions, edema the relation between vitamin B12 and folic acid.
and gastrointestinal disturbances such as vomiting, ♦♦ Isomerization of methylmanlonyl-CoA to Succinyl–CoA:
abdominal colic, etc. In acute condition, the infant may Degradation of odd chain fatty acids of certain amino acids
die due to cardiac failure. and pyrimidines produce effect or through mediation of
propionyl-CoA. This is converted to succinyl-CoA in the
Wernicke-Korsakoff Syndrome
presence of B12 coenzyme, deoxyadenosylcobalamin. The
♦♦ It is also known as cerebral beriberi and mostly seen in reaction involves hydrogen transfer and intramolecular
alcoholics. rearrangement.
526 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Vitamin D Chemistry
Helps in the absorption of calcium in the human body. Calcium ♦♦ Vitamin E consists of eight naturally occurring tocopherols,
is found in the body in large measures and plays a role in the of which α–tocopherol is most active form.
growth and development of healthy teeth. ♦♦ Tocopherols are the derivatives of 6–hydroxylchromane
ring with isoprenoid side chain. Antioxidant property is
Vitamin A
mainly due to chromane ring.
♦♦ Structure of the enamel contains a substance called keratin,
which needs vitamin A in order to be created. Vitamin A Absorption, Transport and Storage
plays an important role in the human immunity and fight Vitamin E is absorbed from intestine along with dietary lipid. It
against infections. is incorporated in chylomicrons. Vitamin E is delivered to liver
♦♦ Vitamin A helps in maturation of ameloblasts during via chylomicron. Liver can export vitamin E in VLDL to target
amelogenesis. cells. In cells, tocopherols are distributed where anti–oxidant
Vitamin K activity is needed. Major site of vitamin E storage is adipose
tissue.
Plays a role in the binding of calcium within the teeth. Leads to
better dental structure and helps the defense of the teeth against Dietary Sources
the attack of acids. Rich sources: Vegetable oils
Vitamin B Good sources: Wheat gram oil, cotton seed oil, peanut oil, corn
oil and sunflower oil.
Deficit of vitamin B causes toothache, retraction of the gum
Also present in milk, meat, butter and egg.
and tooth and gum sensitivity.
Q.10. Write a short note on scurvy. (Apr 2008, 5 Marks) Recommended Dietary Allowance
(Aug 2011, 5 Marks) (Aug 2012, 4 Marks)
Daily consumption for man is 10 mg or 15I U
(Oct 2016, 5 Marks)
Daily consumption for woman is 8 mg or 12I U
Ans. Scurvy is caused due to deficiency of vitamin C.
Biochemical Functions
Clinical Features
♦♦ It acts as a natural antioxidant by scavenging free radicals
♦♦ Lassitude, anorexia, painful limbs and enlargement of
and molecular oxygen.
costochondral junction.
♦♦ Hair follicle rises above the skin and there are perifollicular ♦♦ It is important for preventing polyunsaturated fatty acids
hemorrhages, i.e. tiny points of bleeding occurring around from peroxidation reaction.
the orifice of hair follicles with heaping of keratin like ♦♦ Vitamin E protects erythrocyte membrane from an oxidant.
material. It protects RBCs from hemolysis.
♦♦ Hemorrhage may occur in the joint, into nerve sheath under ♦♦ Vitamin E is associated with reproductive functions and
the nails or conjunctiva. Petechial hemorrhage occurs in prevents sterility. This vitamin preserves and maintains
buttocks, abdomen, legs, arms, ankle and nail beds. There germinal epithelium of gonads for proper reproductive
is also epistaxis, anemia and delayed wound healing. function.
♦♦ Scorbutic child usually assumes a frog like’ position and ♦♦ Vitamin E prevent liver from being damage by toxic
this may reflect as subperiosteal hemorrhage. compound, i.e. carbon tetrachloride.
♦♦ This vitamin works along with other vitamins, i.e. vitamin
Oral Manifestations A, C and β-carotene, and delays the onset of cataract.
♦♦ In oral cavity it occurs in gingival and periodontal region. ♦♦ High intake of vitamin E, i.e. 200 to 300 mg/day protects
♦♦ Interdental and marginal gingiva is bright red, swollen, the development of heart diseases. Vitamin E prevents the
smooth, shiny surface producing an appearance known as oxidation of LDL since the oxidized LDL is implicated to
‘scurvy bad’. In fully developed scurvy, gingiva becomes promote heart disease.
boggy, ulcerated and bleeds easily. Deficiency of Vitamin E
♦♦ Color changes to violaceous red.
♦♦ Typical fetid breath of the patient with fusospirochetal Vitamin deficiency is associated with sterility, degenerative
stomatitis. changes in muscle, megaloblastic anemia and changes in central
nervous system.
Q.11. Write a short note on vitamin E. (June 2010, 2.5 Marks)
Ans. Vitamin E is also known as tocopherol. It is a naturally Q.12. Write a short note on calcitriol. (June 2010, 5 Marks)
occurring antioxidant. Vitamin E is also known as Ans. Calcitriol is also known as 1, 25-dihydroxycholecalciferol.
antisterility vitamin. It is the hormonally active metabolite of vitamin D.
528 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Daily Deficiency
Name Active form Source requirements Functions manifestations
Water-soluble vitamins
Thiamine TPP Cereals, meat, nuts, 1.0–1.5 mg Coenzyme for oxidative decarboxyl- Beriberi, Wernicke-
(vitamin B1) green vegetables, eggs ation and transketolase reactions Korsakoff syndrome
Riboflavin FMN, FAD Yeast, germinating 1.3–1.7 mg Coenzyme for oxidation-reduction Cheilosis, glossitis
(vitamin B2) seeds, green leafy reactions dermatitis,
vegetables, milk, eggs, vascularization of
liver, meat cornea
Niacin NAD+ and NADP+ Yeast, legumes, liver, 15–20 mg Coenzyme for oxidation-reduction Pellagra
(vitamin B3) meat reactions
Pantothenic acid Coenzyme A, Wheat germs, cereals, 5–10 mg Acyl carrier Burning feet syndrome
(vitamin B5) (CoA-SH) yeast, liver, eggs
Pyridoxin PLP Yeast, unrefined 1.6–2 mg Coenzyme for transamination, Epileptic convulsions,
(vitamin B6) cereals, pulses, decarboxylation, non-oxidative dermatits, hypochromic
vegetables, meat, fish, deamination, trans-sulfuration microcytic anemia
egg yolk reactions
Biotin Biocytin (enzyme Liver, kidney, egg yolk, 150–300 mg Coenzyme for carboxylation Rare dermatitis
(vitamin B7) bound biotin) vegetables reactions
Folic acid Tetrahydrofolic Green leafy vegetable, 200 mg Carrier of one carbon unit. Synthesis Megaloblastic anemia,
(vitamin B9) acid (THF) liver, yeast of methionine, purines and pyrimidines neural tube defects
Cynocobalamin Methylcobalamin, Only animal origin, 3 mg Coenzyme for reactions: Pernicious anemia,
(vitamin B12) deoxyadenoslco- meat, egg, liver, fish Homocysteine to methioine. megaloblastic anemia,
balamin Methylmalonyl-CoA to succinyl-CoA neuropathy (dementia),
methylmalonic aciduria
Ascorbic acid Ascorbic acid Citrus, fruits, amla, 60–70 mg Antioxidant involved in hydroxylation Scurvy
(vitamin C) leafy vegetables, reactions in the synthesis collagen,
tomatoes steroid hormones, adrenaline, etc.
facilitates absorption of iron from
intestine
Biochemistry 529
Q.14. Write on biochemical functions of water soluble vitamins. (May 2014, 5 Marks)
Or
Write on functions of water-soluble vitamins.
(Dec 2014, 5 Marks)
Ans. Following are the biochemical functions of water-soluble vitamins:
Water soluble
vitamin Biological function
Vitamin C It acts as a coenzyme in hydroxylation of proline and lysine
It is required for the formation of bone
It enhances iron absorption by keeping it in ferrous form
It is essential for hydroxylation of tryptophan to hydroxytryptophane in synthesis of serotonin
It is a strong antioxidant and spare vitamin A, E and B-complex vitamins
Vitamin B1 (thiamine) Thiamine consist of enzyme thiamine pyrophosphate which activate enzyme pyruvate dehydrogenase which catalyzes
conversion of pyruvate to acetyl-CoA
Transketolase depends on thiamine pyrophosphate for its action in hexose monophosphate shunt.
Thiamine pyrophosphate plays an important role in the transmission of nerve impulse.
Vitamin B2 (riboflavin) Flavin coenzymes, i.e. FAD and FMN participate in many redox reactions which leads to the production of energy.
Vitamin B3 (niacin) The coenymes NAD+ and NADP+ are involved in oxidation-reduction reactions. They accept hydride ion and undergo
reduction in pyridine ring. This causes neutralization of positive charges
Vitamin B6 (pyridoxine) Pyridoxal phosphate is the coenzyme of vitamin B6 which is involved in transamination reaction and converts amino
acids to ketoacids.
Some α-amino acids leads to decarboxylation and form amine which is carried by enzyme decarboxylase which are
dependent on pyridoxal phosphatase.
Enzyme pyridoxal phosphate is required for the synthesis of δ-amino levulinic acid which is the precursor of heme
synthesis.
Pyridoxal phosphate is required by hydroxyl group of amino acids which undergo deamination.
Vitamin B7 (biotin) or Biotin act as a biotin-dependent pyruvate carboxylase causes the conversion of pyruvate to oxaloacetate
vitamin H
Pantothenic acid Its functions are carried out by coenzyme A or CoA. Coenzyme A is involved in the metabolism of carbohydrate, lipid
and protein
Folic acid Folic acid secretes tetrahydrofolate which is involved in one carbon metabolism
Vitamin B12 It causes the synthesis of methionine from homocysteine. It also carry out the isomerization of methymalonyl-CoA
(cyanocobalamin) to succinyl-CoA
Q.15. Write about biomedical importance of vitamin C. • Tryptophan metabolism: Vitamin C is essential
(Sep 2015, 7 Marks) for the hydroxylation of tryptophan enzyme
Ans. Following is the biomedical importance of vitamin C: hydroxylase to hydroxytryptophan in the synthesis
• Collagen formation: Vitamin C plays the role as of serotonin.
coenzyme in hydroxylation of proline and lysine, • Tyrosine metabolism: Ascorbic acid is required
while protocollagen get converted to collagen. for the oxidation of p-hydroxyphenylpyruvate to
The hydroxylation reaction is catalyzed by lysyl homogentisic acid in tyrosine metabolism.
hydroxylase and prolyl hydroxylase and they get • Folic acid metabolism: The active form of the vi-
converted to hydroxyproline and hydroxylysine. tamin folic acid is tetrahydrofolate. Vitamin C is
This reaction is dependent on vitamin C. needed for the formation of folic acid.
• Bone formation: Tissues of bone possess an organic • Sparing action of other vitamins: Ascorbic acid is
matrix, collagen and the inorganic calcium, phos- a strong antioxidant. It spares vitamin A, vitamin E,
phate, etc. Vitamin C is essential for bone formation. and some B-complex vitamins from oxidation.
• Iron and hemoglobin metabolism: Ascorbic acid leads • Immunological function: Vitamin C enhances the
to iron absorption by placing it in the ferrous form. This synthesis of immunoglobulins (antibodies) and
is mainly caused by reducing property of vitamin C. increases the phagocytic action of leukocytes.
530 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
remaining three quarter is constant heavy chain, i.e. CH–1, Various Types of Antibodies and their Functions
CH–2 and CH–3.
Name of
♦♦ Amino acid sequence of variable region of both light and
antibody Functions
heavy chain are responsible for the specific binding of
antibody with antigen. IgG It neutralizes bacterial toxins and bind to microorganisms
making them easier to phagocytize
♦♦ Each antibody has hinge region between CH–1 and CH–2
which allows better fit with antigen surface. IgA It prevent attachment of bacteria and viruses to mucous
membranes and helps to protect mucous surface from
♦♦ Variable regions of both light and heavy chains form
the antigenic attack
antigen binding site.
♦♦ Enzyme digestion splits antibody molecule into two IgM It promotes phagocytosis and causes lysis of antigenic
cells
fragments, i.e. fragment for antigen binding (Fab) and
crystallizable fragment or fragment for complement IgD It may function as an antigen receptor. There is no known
antibody function
binding (Fc).
IgE • It act as antiallergic and antiparasitic
- • It mediates immediate hypersensitivity by causing
release of histamine
At the pH of blood ratio of bicarbonate to carbonic acid is 20:1. and are exchanged with sodium ion. Na + along with
So, bicarbonate concentration is much higher as compared to bicarbonate ion is resorbed into the blood. By this acid are
carbonic acid in the blood. This is also known as alkali reserve eliminated from the body with simultaneous generation
and responsible for effective burning of hydrogen ions which of bicarbonate ion.
are generated in the body. In normal conditions concentration ♦♦ H+ ion combines with noncarbonate base and get excreted
of bicarbonate and carbonic acid determine pH of the blood. in urine.
Sodium dihydrogen phosphate and disodium hydrogen By this the blood bicarbonate is conserved with excretion of H+
phosphate forms the phosphate buffer. It is an intracellular ions. The normal urine become free of bicarbonate.
buffer and is of less importance in plasma because of its low
Excretion of Titratable Acid
concentration.
Titratable acidity is the measure of acid excreted in urine by
Protein Buffer System kidney. This is assessed by titrating urine back to normal pH of
Plasma proteins and hemoglobin forms the protein buffer blood. Titratable acidity reflects H+ ions excreted in urine which
system of blood. The buffering capacity of proteins depends leads to fall of pH. The excreted hydrogen ions are buffered in
on pK of ionizable groups of amino acids. urine by phosphate buffer.
♦♦ Respiratory system is the rapid mechanism for maintaining This is the method to buffer hydrogen ions which are secreted
the acid-base balance. in tubular fluid. H+ ion get combine with ammonia to form
♦♦ Regulation occurs by regulating the concentration of ammonium ion. Renal tubular cells deamidate glutamine to
bicarbonate in the blood. glutamate and ammonia and the reaction is catalyzed by the
♦♦ Large amount of carbon dioxide is produced by cellular enzyme glutaminase.
metabolic activity which endangers acid-base equilibrium Ammonia liberated in this reaction diffuses in tubular lumen
of the body. and get combine to H+ ion to form ammonium ion. Ammonium
♦♦ In normal conditions all carbon dioxide get eliminated ions do not diffuse into tubular cells and are excreted in urine.
from the body via expired air through lungs. Ammonium is a major urine acid.
♦♦ Respiration is controlled by respiratory center, this center Q.2. Give a short account of acidosis. (Sep 2013, 5 Marks)
is sensitive to changes in the pH of blood. Decrease in pH Ans. Acidosis is an acid-base disorder. Acidosis means decline
leads to hyperventilation to remove carbon dioxide and in the pH of blood.
decreases carbonic acid concentration. Hyrdrogen ions are
eliminated as water. Types
♦♦ Respiratory mechanism is rapid but a short-term regulatory
♦♦ Respiratory acidosis, i.e. primary excess of carbonic acid
process as hyperventilation remains for a short time.
♦♦ Metabolic acidosis, i.e. primary excess of bicarbonate
Renal Mechanism for Acid Base Regulation
Causes
Kidneys regulate the acid-base balance by maintaining alkali ♦♦ Diabetic ketoacidosis and lactic acidosis
reserve. ♦♦ Respiratory acidosis in pneumonia
Enzyme carbonic anhydrase is the main component in renal ♦♦ Reduced glomerular infiltrate
regulation of acid and base which occur from following ♦♦ Addison’s disease
mechanisms: ♦♦ Diarrhea; When bicarbonate is excreted.
a. Excretion of H+ ions
b. Reabsorption of bicarbonate Respiratory Acidosis
c. Excretion of titratable acid ♦♦ In this excess of carbonic acid is present due to retention
d. Excretion of ammonium ions. of CO2.
♦♦ Acute form occurs due to broncheopneumonia or asthma.
Excretion of H+ ions
♦♦ Chronic form occurs due to chronic obstructive pulmonary
♦♦ Through kidney H+ ion is eliminated from the body. disease.
Excretion of H+ ion occur in proximal convoluted tubules ♦♦ In this renal compensation occur which generate more
and is coupled with regeneration of bicarbonate ions. bicarbonate and excrete more H+ ion.
♦♦ Carbonic anhydrase act as a catalyst in the production
of carbonic acid from carbon dioxide and water in renal Metabolic Acidosis
tubular cell. Carbonic acid then dissociate to H + ion ♦♦ In this excess of bicarbonate is present and occur due to
and HCO3- ion. H+ ions are secreted into tubular lumen the formation of acid or gain in base.
Biochemistry 533
♦♦ Loss of acid is due to severe vomiting or gastric aspiration Ans. The shape of the titration curve of any weak acid is
which leads to the loss of chloride and acid. described by the Henderson-Hasselbalch equation which
♦♦ Hypokalemia is closely related to metabolic alkalosis. is important for understanding the buffer action and
This is because in alkalosis there is an attempt to conserve acid-base balance in the blood and tissues of vertebrates.
hydrogen ions by kidney in exchange of K+. • This equation is simply a useful way of restating the
♦♦ Respiratory center is depressed by high pH causing expression for the dissociation constant of an acid.
hypoventilation. • It is used to calculate pH in the buffer system.
♦♦ Metabolic acidosis is compensated by hyperventilation • For the dissociation of a weak acid HA into H and A,
of lungs which causes increase elimination of CO2 from the Henderson- Hasselbalch equation can be derived
the body. as follows:
♦♦ Renal compensation sets in 3 to 4 days and H+ ions are General equation for the buffer is:
excreted as NH4+ ions. HA H+ A-
Q.3. Write a short note on blood buffers. (May 2014, 5 Marks) A represents any anion from the buffer.
-
♦♦ It is an intracellular buffer. So, pH = pK. So most effective buffers in the body are those with
♦♦ Sodium dihydrogen phosphate and disodium hydrogen pK close to pH in which they operate.
phosphate constitute the phosphate buffer. ♦♦ This equation fits the titration curve of all weak acids and
♦♦ Its concentration in plasma is very low. enables us to deduce a number of important quantitative
Protein Buffer System relationships.
♦♦ Henderson-Hasselbalch equation also allows to:
♦♦ Plasma proteins and hemoglobin constitute the protein • Calculate pK, given pH and the molar ratio of proton
buffer system of blood. donor and acceptor.
♦♦ Buffering capacity of protein is depend on pK of ionizable • Calculate pH, given pK and the molar ratio of proton
group of amino acid. donor and acceptor.
Q.4. Write briefly about Henderson–Hasselbalch equation. • Calculate the molar ratio of proton donor and acceptor,
(Feb 2016, 2 Marks) given pH and pK.
534 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.5. Describe metabolic acidosis. (July 2016, 5 Marks) in cell proliferation. So various factors which cause
Ans. A fall in blood pH due to a decrease in bicarbonate levels cancer may all act through their effects on proto–
of plasma is called metabolic acidosis. oncogenes.
• Various products of oncogenes, such as growth factors
Causes stimulate the proliferation of normal cells. They
♦♦ Decrease in bicarbonate concentration is due to decrease regulate cell division by transmitting the message
its utilization in buffering H + ions, loss in urine or across plasma membrane to interior of cell. It is believed
gastrointestinal tract or failure to be regenerated. that growth factors play a key role in carcinogenesis.
♦♦ Most important cause of metabolic acidosis is due to Q.2. Write a short note on carcinogens. (Mar 2013, 3 Marks)
excessive production of organic acids which combine with Ans. Group of chemicals which cause cancer in man and
bicarbonate ion and deplete the alkali reserve. animals collectively are known as carcinogens.
Metabolic Acidosis in Various Diseases Carcinogens are a variety of external agents which are
divided into three groups:
♦♦ Increased production of acids. In uncontrolled diabetes 1. Chemical carcinogens
mellitus and starvation, there is an excessive production 2. Physical carcinogens
of acetoacetic acid and β–hydroxybutyric acid. These acids 3. Biologic carcinogens.
are buffered by utilizing base component (i.e. HCO3) of
the bicarbonate buffer. Consequently, the concentration of Chemical Carcinogens
bicarbonate ions fall giving rise to bicarbonate deficit and Depending upon the mode of action of carcinogenic chemicals,
results in metabolic acidosis (ketoacidosis). they are divided into two groups:
♦♦ Excessive loss of bicarbonate occurs in the urine in renal
1. Initiators of carcinogenesis
tubular dysfunction and from gastrointestinal tract in
2. Promoters of carcinogenesis.
severe diarrhea.
Initiators of Carcinogenesis
Compensatory Mechanisms
These are the chemical carcinogens which can initiate the
Metabolic acidosis is compensated by: process of abnormal new growth of cells. These are further
♦♦ Increasing rate of respiration to wash out CO2 (hence classified into two subgroups:
H2CO3) faster. Consequently, the ratio HCO3– : H2CO3 is
elevated. Indirect Acting Carcinogens
♦♦ Increasing excretion of H+ ions as NH4+ ions.
Indirect acting carcinogens need prior metabolism to become
♦♦ Increasing elimination of acid (H2PO4) in the urine.
carcinogenic. One or more enzyme catalyzed reactions convert
All these compensatory mechanisms tend to reduce carbonic procarcinogens to active carcinogens. This is called as metabolic
acid to keep the pH in the normal range and a compensated activation of procarcinogens. Examples of procarcinogens are:
acidosis results. ♦♦ Aromatic hydrocarbons, e.g. benzo[a]pyrene, tobacco,
smoke, industrial and atmospheric pollutants.
♦♦ Aromatic amines, e.g. benzidine, β—naphthylamine, azo
15. CANCER dyes used in rubber industries.
♦♦ Naturally occurring products, e.g. aflatoxin B1.
Q.1. Write a short note on oncogenes. (Dec 2010, 5 Marks) ♦♦ Inorganic compounds, e.g. vinyl chloride, asbestos, metals
Ans. Oncogenes are the genes which are capable of causing like nickel, lead, chromium, etc.
cancer. ♦♦ Nitrosamine compounds, e.g. dimethylnitrosamine,
• Discovery of oncogenes were in tumor causing virus. Diethylnitrosamine found in whisky, new car interiors,
• Proto-oncogenes encode for growth regulating tobacco smoke.
proteins.
Direct Acting Carcinogens
• Viral oncogenes were found to be closely similar to
various genes present in normal host cells known as They do not need metabolic activation. These include mainly
proto-oncogenes. various anticancer drugs, e.g. cyclophosphamide, nitrosourea,
• The activation of proto-oncogenes to oncogenes is acetylimidazole, etc.
an important step in carcinogenesis.
• Oncogenes encode for certain proteins, i.e. Action of Chemical Carcinogens
oncoproteins. These proteins are altered versions Direct or indirect acting carcinogens are usually electrophiles,
of their normal counterparts and are involved in i.e. they are deficient in electrons (free radicals). These free
transformation and multiplication of cells. radical carcinogens may covalently bind to purines, pyrimidines
• When oncogenes are expressed, they produce and phosphodiester bonds of DNA leading to unrepairable
mutated protein, e.g. growth factors, receptors, damage. This unrepaired damage causes mutations in DNA
transcription factors and other proteins involved and mutation in DNA can cause cancer.
Biochemistry 535
Physical Carcinogens ♦♦ Mode of action of RNA Oncogenic virus: The RNA viruses
use RNA as the genome. The RNA gets copied by reverse
Physical carcinogenic agent is radiant energy both ultraviolet
transcriptase to produce single strand of viral DNA. Single
light and ionizing radiation, i.e. X–rays, α, β and γ rays.
strand of viral DNA is then copied to form another strand
These rays damage DNA which is the basic mechanism of of complementary DNA resulting in double stranded viral
carcinogenicity with radiant energy. DNA or provirus. The provirus is then integrated into the
♦♦ The main source of UV radiation is sunlight, others are UV DNA of the host cell genome and may transform the cell
lamps, welders arcs, etc. In humans exposure of UV rays into cancer cell.
can cause various forms of skin cancers.
♦♦ Ionizing radiation of all can cause skin cancer.
16. TISSUE PROTEINS AND BODY FLUIDS
Action of Radiation
♦♦ Ultraviolet light and ionizing radiation differ in their Q.1. Write very short answer on CSF. (Aug 2018, 2 Marks)
mode of action. Ans. CSF
♦♦ UV rays damage the DNA by the formation of pyrimidine ♦♦ CSF is also known as cerebrospinal fluid.
dimers in DNA or by the formation of apurinic or ♦♦ It is a clear, colorless liquid which is formed inside the
pyrimidine sites in DNA while ionizing radiations cause cavities of brain and around the spinal cord.
the formation of highly reactive free radicals that can ♦♦ CSF originates inside the choroid plexus and return to
interact with DNA leading to molecular damage. blood via arachnoid villi.
♦♦ 500 mL of cerebrospinal fluid is formed everyday.
Biologic Carcinogens
Functions of CSF
Biologic carcinogens are chiefly viruses, parasites and bacteria.
The role of viruses in the causation of cancer is more significant. ♦♦ It serves as hydraulic shock absorber by diffusing the force
Oncogenic (carcinogenic) viruses contain either DNA or RNA from hard blow to skull that can cause severe injury.
as their genome. The two types of carcinogenic viruses are: ♦♦ CSF helps in regulating the intracranial pressure.
Collection of CSF
DNA Oncogenic Viruses
♦♦ DNA oncogenic viruses are classified into five subgroups, CSF is collected by the spinal puncture for biochemical analysis.
i.e. papovavirus, herpes viruses, adenoviruses, pox- Composition of CSF in Health and Disease
viruses, hepadnaviruses.
♦♦ Mode of action of DNA oncogenic virus: The DNA virus Name of Color and Total cell
infects the host cell. Then, DNA virus binds tightly to host disease appearance count Protein Glucose
cell DNA and causes alterations in gene expression of host In normal Clear and 0 to 5 × 15 to 45 45 to 85
cell DNA and thus causes cancer by altering the types of person colorless 106/l mg/dL mg/dL
protein made in cell. Viral oncoproteins bind to tumor Tubercular Opalescent It get It get It is low
suppressors and inactivate them. meningitis and slightly increased increased
yellow
RNA Oncogenic Viruses Bacterial Opalescent It is It is It is
♦♦ The RNA viruses use RNA as the genome. RNA oncogenic meningitis and turbid markedly markedly markedly
viruses are retroviruses as they contain the enzyme reverse increased increased decreased
transcriptase. All retroviruses are not oncogenic. The Subarachnoid Slightly Presence It is It is almost
examples of RNA oncogenic viruses are Rous sarcoma hemorrhage bloody color of RBC increased normal
and WBC
virus, Leukemia sarcoma virus, etc.
536 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
1. The reaction involving the conversion of succinyl-CoA 12. The following amino acid acts as a conjugating agent
to succinate requires: in detoxification reaction:
a. NADP+ b. GDP a. Glycine b. Cysteine
c. NAD+ d. FAD c. Glutamine d. All of the above
2. The nitrogenous base present in cephalin: 13. The reaction involving the conversion of succinyl-CoA
a. Ethanolamine b. Choline to succinate requires:
c. Serine d. Sphingosine a. NAD b. NADP
3. The example of metalloprotein: c. GDP d. FAD
a. Mucin b. Siderophilin 14. The following trace element is involved in wound
c. Glutenin d. Vitellin
healing:
4. The ‘methyl donor’ with biochemically labile methyl a. Iron b. Copper
groups: c. Zinc d. Selenium
a. Active methionine b. Choline
15. Glycogen synthetase activity is depressed by:
c. Betaine d. All of the above
a. Glucose b. Insulin
5. The molecular weight of hemoglobin: c. Cyclic AMP d. UDP-glucose
a. 44,456 b. 54,456
c. 64,456 d. 74,456 16. The tumor markers are:
a. Proteins b. Hormones
6. Serum alkaline phosphatase activity is elevated in:
c. Enzymes d. All of the above
a. Rickets b. Hyperparathyroidism
c. Paget’s disease d. All of the above 17. The substrate concentration at which an enzyme
exhibits half the maximum velocity is known as:
7. The hormonal regulation of plasma calcium occurs by
the action of: a. Vmax b. [S]
a. Calcitriol b. Parathyroid hormone c. Km d. Keq
c. Calcitonin d. All of the above 18. Normal serum level is:
8. Vitamin K regulates the synthesis of following ‘blood a. 135-145 mEq/L b. 135-145 mg/dL
clotting factors’: c. 120-130 mEq/L d. 120-130 mg/dL
a. VII, VIII, IX b. VII, IX, X 19. Symptoms of scurvy are:
c. VII, X, IX d. VII, X, XI a. Poor healing of wounds
9. Cancer is caused by the groups of: b. Loosening of teeth
a. Radiant energy b. Chemical compounds c. Anemia
c. Viruses d. All of the above d. All of the above
10. Transcription is the process of synthesis of: 20. Which of the pathway occurs in part in the mitochondria
a. RNA b. DNA and part in the cytosol?
c. Protein d. All of the above a. Urea cycle
11. D-galactose and D-mannose are grouped as: b. TCA cycle
a. Anomers b. Enantiomers c. Glycolysis
c. Epimers d. Isomers d. Oxidative phosphorylation
Answers: 1. b 2. a 3. b 4. d
5. c 6. d 7. d 8. b
9. d 10. a 11. c 12. d
13. c 14. c 15. c 16. d
17. c 18. a 19. d 20. a
Biochemistry 537
21. The only glycerophospholipid having antigenic prop- 33. D-Galactose and D-mannose are:
erty is: a. Enantiomers of each other
a. Cephalin b. Lecithin b. Isomers of each other
c. Plasminogen d. Cardiolipin c. Anomers of each other
22. The reaction involving the conversion of succinyl-CoA d. Epimers of each other
to suicinate requires: 34. Normal serum sodium level is:
a. NAD b. NADP+ a. 135 -145 m Eq/L
c. GDP d. FAD b. 130-160 m Eq/L
23. The example of phosphoprotein is: c. 120-130 m Eq/L
a. Casein b. Mucin d. 170-180 m Eq/L
c. Ovomucoid d. Globulin 35. The example of phosphoprotein is:
24. The poor source of vitamin D is: a. Mucin b. Globulin
a. Eggs b. Milk c. Casein d. Ovomucoid
c. Butter d. Liver 36. The number of double bonds present in arachidonic
25. Transaminase activity needs the coenzyme: acid:
a. B6-PO4 b. NAD a. One b. Two
c. FAD d. Coenzyme–Q c. Three d. Four
26. Sickle cell anemia results from a point mutation that 37. The amino acid containing sulphur is:
causes a replacement of: a. Methionine b. Threonine
a. Glutamate at position 6 c. Leucine d. Alanine
b. Aspartate at position 6
38. The example of chromoprotein:
c. Arginine at position 4
a. Salmine b. Catalase
d. Glutamate at position 4
c. Zein d. Gliadin
27. One molecule of FADH2 produces how many number
39. Trypsin attack peptide linkages containing the amino
of ATPs:
a. 4 b. 1 acid residue of:
c. 2 d. 3 a. Arginine b. Glycine
c. Tryptophan d. Serine
28. The following are lipotropic factors except:
a. Betaine b. Choline 40. The BMR is higher than normal in:
c. Methionine d. Leucine a. Diabetes insipidus b. Leukemia
c. Polycythemia d. All of the above
29. Chaulmoogric acid is used in the treatment of:
a. Nephritis b. Diabetes mellitus 41. One molecule of urea is synthesized at the expanse of
c. Leprosy d. Hepatitis the molecules of ATP:
a. 2 b. 3
30. Which of the following is a storage and transport form
c. 4 d. 5
of fatty acid?
a. Cholesterol b. Triacylglycerol 42. Salivary amylase is activated by:
c. Phospholipid d. Proline a. Na+ b. K+
c. HCO3- d. Cl– ions
31. Which of the following non-protein can act as an
enzyme? 43. Gluconeogenesis does not occur in one of the tissues:
a. DNA b. RNA a. Kidney b. Liver
c. Phospholipid d. Glycolipid c. Heart d. Erythrocytes
32. Which of the following vitamin is involved in ETC? 44. The normal level of plasma calcium is:
a. Thiamine b. Folic acid a. 9–11 mg/dL b. 0.9-1.1 g/dL
c. Riboflavin d. Cobalamin c. 0.9–1.1 mg/dL d. 9–11 g/dL
45. Which of the following non-protein can act as an 57. Following is an epimer of glucose:
enzyme? a. Fructose b. Maltose
a. DNA b. RNA c. Galactose d. Lactose
c. Phospholipid d. Glycolipid 58. The degree of unsaturation of fats is determined by:
46. The number of double bonds present in arachidonic a. Acid number b. Iodine number
acid are: c. Acetic number d. Saponification number
a. One b. Two 59. The protein part of enzyme is:
c. Three d. Four a. Isoenzyme b. Apoenzyme
47. The amino acid containing hydroxyl group is: c. Holoenzyme d. Coenzyme
a. Alanine b. Reucine 60. Pellagra is due to the deficiency of:
c. Threonine d. Methionine a. Riboflavin b. Pyridoxine
48. Pellagra is caused by deficiency of which vitamin: c. Thiamine d. Niacin
a. Thiamine b. Riboflavin
61. Glycogenolysis is promoted by all of the following
c. Niacin d. Pyridoxine
except:
49. Which of the following is the storage and transport a. Insulin b. Glucagon
form of fatty acid? c. Epinephrine d. Corticosteroids
a. Cholestrol b. Triacylglycerol
62. Some people “Eat and do not get fat” because:
c. Phospholipid d. Glycerol
a. Fat synthesis is defective
50. Translation is the process of synthesis of: b. Absorption defect
a. RNA b. DNA c. Contain more brown adipose tissue
c. Protein d. All of the above d. Fast metabolism
51. The following hormones have hyperglycemic effect 63. Brain detoxify ammonia by:
except: a. Urea formation
a. Glucagon b. Insulin b. Glutamine formation
c. Thyronine d. Epinephrine c. Asparagine formation
52. Which of the following nucleotide base is not present d. Creatine formation
in codons? 64. Bilirubin is conjugated with:
a. Adenine b. Guanine a. Glycine b. Benzoic acid
c. Thymine d. Cytosine c. Glucoronic acid d. Cysteine
53. All are useful substances produced from cholesterol 65. Mutations are due to:
except: a. Change in base sequence of DNA
a. Vitamin D b. Bile salts b. Change in base sequence of RNA
c. Bile pigments d. Cortisol c. Change in nucleosides
54. All of the following are nonessential amino acids d. Change in nucleotides
except: 66. Hyaluronic acid consists of:
a. Tyrosine b. Lysine a. N-acetylglucosamine and glucoronic acid
c. Valine d. Phenylalanine b. N-acetylglucosamine-6-sulphate and glucoronic acid
55. The metal present in vitamin B12 is: c. D-glucosamine-N-sulfate and sulfate ester of
a. Copper b. Cobalt glucoronic acid
c. Chromium d. Manganese d. N-acetylglucosamine, galactose and sulfuric acid
56. Protein present in muscles is: 67. Ketone bodies are synthesized in:
a. Keratin b. Collagen a. Kidney b. Muscle
c. Actin d. Globulin c. Heart d. Liver
6. What does human brain utilize as the one and only 22. Which vitamin is also known as antiinfective vitamin?
fuel? Ans. Vitamin A
Ans. Glucose 23. Deficiency of which vitamin leads to beriberi.
7. When glucose is converted into two molecules of py- Ans. Vitamin B
ruvic acid, how many ATP are generated? 24. Name the amino acid which is converted into niacin.
Ans. 8 ATPs Ans. Tryptophan
8. How many molecules of ATP are produced when 1 25. Name the vitamin which is known as vitamin H.
molecule glucose is completely oxidized to CO2 and Ans. Pyridoxine
H2O?
Ans. 38 ATPs 26. Name the vitamin which helps in healing of wound
and iron absorption.
9. How much is the value for plasma cholesterol? Ans. Vitamin C
Ans. 140 to 250 mg per 100 mL
27. Which vitamin is a steroid derivative?
10. Name the process by which fatty acids are catabolized.
Ans. Vitamin D
Ans. Beta-oxidation
28. What does active form of vitamin D known as?
11. How much is the normal plasma concentration of
Ans. 1,25-dihydroxycholecalciferol
ketone bodies?
Ans. 1 mg per 100 mL 29. Which vitamin is known for its antioxidant property?
Ans. Vitamin E
12. In which tissues synthesis of phospholipids does not
occur. 30. What is the another name of vitamin K?
Ans. In blood and skin Ans. Phylloquinone
13. Name the general formula of amino acids. 31. Give some examples of monosaccharides.
Ans. RCH NH2 COOH Ans. Glucose, fructose, galactose and mannose
14. Which amino acid is optically inactive? 32. Give some examples of disaccharides.
Ans. Glycine Ans. Sucrose, lactose and maltose
15. Name the amino acid which belongs to the ketogenic 33. Which is the major source of energy for muscles when
amino acid group. muscle tissue lacks oxygen?
Ans. Leucine Ans. Anaerobic glycolysis
Biochemistry 541
34. Name the key enzymes of gluconeogenesis. 49. Which is the universal currency of energy?
Ans. Pyruvate carboxylase, Phosphoenolpyruvate carboxy- Ans. ATP
kinase, fructose 1,6-bisphosphotase and glucose-6- 50. How much is the daily requirement of calcium for adult.
phosphotase. Ans. 500 mg
35. Polyuria, polydypsia, polyphagia and weight loss are 51. Which form of iron is absorbed in the body.
the cardinal symptoms of which of the disease. Ans. Ferrous form
Ans. Diabetes mellitus
52. Name free radical scavenger enzyme systems.
36. How much is the total volume of saliva produced each Ans. Superoxide dismutase, glutathione peroxidase,
day in an adult. glutathione reductase
Ans. 500 to 1500 mL.
53. What are buffers?
37. Which is the major carbohydrate secreted in saliva? Ans. Buffers are solutions which can resist changes in pH
Ans. Glucose. when acid or alkali is added.
38. Name the major salivary enzyme. 54. Which is the most important buffer system in plasma?
Ans. Alpha-amylase Ans. Bicarbonate carbonic acid system
39. Name the proteins with antibacterial activities in saliva. 55. By which linkage nucleotides are combined to produce
Ans. Lysozyme, Immunoglobulin A, lactoferrin lengthy DNA molecule.
Ans. Phospho diester linkages
40. Name the calcium-binding proteins in saliva.
Ans. Statherins, proline rich proteins 56. How base sequence in DNA is written?
Ans. 5’ to 3’ end
41. How much is the safety limit of fluoride in water?
57. Which component is required for starting DNA syn-
Ans. 1 ppm
thesis?
42. Name the nitrogen containing phospholipids. Ans. RNA primer
Ans. Lecithin
58. What is the shape of structure of tRNA?
43. Name the essential fatty acids. Ans. Clover leaf
Ans. Linoleic acid and linolenic acid
59. Name the base absent in DNA?
44. How many ATPs are yield by palmitic acid in Beta- Ans. Uracil
oxidation?
60. Which virus leads to AIDS?
Ans. 129 ATPs
Ans. HIV I and HIV II
45. Name the test which helps in identifying ketone bodies 61. Name cancer suppressor genes.
in urine.
Ans. Retinoblastoma and p53 gene.
Ans. Rothera’s test
62. Name the important liver function tests.
46. Name the molecule synthesizing cholesterol. Ans. Serum bilirubin; urine bile pigments, bile salts, urobilino-
Ans. Acetyl-CoA gen; alanine amino transferase; alkaline phosphatase;
47. How much is the normal urea level in blood? serum total proteins; serum albumin
Ans. 20 to 40 mg/dL 63. What is the normal value of plasma calcium?
48. How much high energy bonds are produced per turn Ans. 9 to 11 mg/dL
of citric acid cycle? 64. What is the normal value of ionized calcium in plasma?
Ans. 12 Ans. 4 to 5 mg/dL
542 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Additional Matter
Effects of Insulin Contd...
Folic acid Aminopterin and methotrexate Smooth endoplasmic reticulum Lipid and glycogen synthesis
Biotin Biotin sulphonic acid, Desthiobiotin Mitochondria Produce as well as store energy
Powerhouse of the cell
Various Inorganic Substances and their Normal Serum Name fat soluble vitamins A, D, E, K
Level Name water soluble vitamins B and C
Heat stable and light sensitive vitamins or Vitamin K and B12
Inorganic substance Normal serum level vitamins involved in electron transfer
Sodium 135 to 145 mEq/L Heat labile vitamins Vitamin C, folic acid,
biotin
Potassium 3.5 to 5 mEq/L
Anti-oxidant vitamins Vitamin A, E and C
Phosphorus 3 to 4.5 mg/dL
• Vitamins needed for tooth development A and D
Iron 50 to 150 µg/dL and calcification
Bicarbonate 24 to 30 mEq/L • Deficiency of vitamins causing enamel
hypoplasia
Calcium 9 to 11 mg/dL • Vitamins which undergo
Chloride 95 to 105 mEq/L hypervitaminosis
Gingiva affected commonly due to Vitamin C
deficiency of
Various Metabolic Pathways and their Rate Limiting • Vitamin stored in fat Vitamin D
Enzymes • Vitamin synthesized in skin
• Action of vitamin similar to hormone
Name of metabolic pathway Rate limiting enzyme Vitamin stored in liver A, D, K, B12 and folate
Glycolysis Phosphofructokinase Vitamin present in cereals Thiamine
Glycogenesis Glycogen synthase Water soluble vitamin synthesized in body Pantothenic acid
Vitamin present in animal food is Vitamin B12 and D
Glycogenolysis Phosphorylase
Deficiency of vitamin leading to raw beef Niacin
Gluconeogenesis Fructose 1,6 bisphosphatase tongue and bald tongue of Sandwith
Cholesterol synthesis and ketone HMG CoA reductase Magenta colored tongue is seen in Riboflavin
bodies deficiency of
Fatty acid synthesis Acetyl-CoA carboxylase Hunter’s glossitis seen in deficiency of Vitamin B12
Urea synthesis Carbamoyl phosphate synthetase Vitamin associated with neonatal jaundice Vitamin K
Vitamin associated with peripheral neuritis Vitamin B1, B12, B6
Citric acid cycle Isocitrate dehydrogenase
and E
Porphyrin synthesis Aminolevulinate synthase Vitamin needed for healing of wound Vitamin A and C
Bile acids 7 alpha hydroxylase Vitamin for energy releasing reactions Thiamin (B1)
7
SECTION
Dental Anatomy
• Oblique ridge is reduced in height in center of Define ridges. Explain oblique ridge and transverse
occlusal surface. ridge. (May 2018, 2 Marks)
• Sometimes oblique ridge is crossed by a develop Or
mental groove that partially joins two major fossa
by means of its shallow sulcate grooves. Write short answer on ridges and grooves.
(Aug 2018, 3 Marks)
Q.4. Write short note on nomenclature of teeth.
Ans. Ridge
(Sep 2006, 5 Marks)
A ridge is any linear elevation on the surface of crown.
Ans. Nomenclature or the system of names is used to describe
or classify the material included in the dentistry. Ridges are named on the basis of their location or form.
Following are the types of ridges:
• The term mandibular refers to lower jaw or mandible
♦♦ Labial ridge: It is the ridge which runs cervicoincisally to
and the term maxillary refer to the upper jaw or
the center of labial surface of canines. The ridge extends
maxilla.
from cusp tip to cervical ridge of tooth. The ridge is promi-
• Deciduous tooth or milk tooth which is defined as one
nent in maxillary canines.
of the temporary teeth of a mammal that are replaced
by permanent teeth. The term primary can indicate a
first dentition and the term deciduous indicates the
first dentition is not permanent but not unimportant.
• The term succedaneous can be used to describe
successor dentition and does not suggest permance,
where the term permanent suggests a permanent
dentition.
• Application of nomenclature:
- Tooth numbers 1 to 8 indicating teeth in a
quadrant.
- Tooth surface related to the tongue (lingual),
cheek (buccal), lip (labial) and face (facial) apply Fig. 4: Labial ridge
to the four quadrants. ♦♦ Buccal ridge: It is the ridge on buccal surface of tooth which
- The teeth away from the midline is called as run cervico-occlusally from buccal cusp tip to the cervical
distal and towards midline is called as mesial. line. The ridge is prominent in first premolar.
• Central incisor (first incisor), lateral incisor (second
incisor), canine (cuspid), first premolar (bicuspid),
second premolar (second bicuspid), Ist molar, IInd
molar, IIIrd molar. There are eight tooth names
included in each quadrant of dental arches, they
are repeated to include right, left, maxillary and
mandibular making a total of 32 teeth in all.
♦♦ Lingual ridge: It is the ridge on lingual surface of tooth ridge run vertically in cervicoincisal direction and in pos-
which run cervicoincisally from lingual cusp of canine terior teeth they run in buccolingual direction.
to the cervical region, thereby dividing lingual fossa into
two parts. This ridge is prominent in maxillary canines.
♦♦ Oblique ridge: It is the ridge which crosses occlusal surface ♦♦ They are sometimes found on the lingual surface of
of maxillary molars occlusally. Oblique ridge extends from maxillary incisor at edge of lingual fossa where marginal
triangular ridge of distobuccal cusp to distal cusp ridge of ridges and cingulum meets.
mesiolingual cusp. ♦♦ Central fossa is found on occlusal surface of molar teeth.
Grooves
These are sharply defined narrow and linear depressions. In this formula each tooth is represented by its initial letter.
Usually seperating lobes or major portion of a tooth formed I for incisor, C for canine and M for molar.
during the development of the tooth. These grooves are named • Each letter is followed by a horizontal line and the
according to their location. number of each type of tooth is placed above the line
Various types of groove are: for maxilla and below the line for the mandible.
♦♦ Buccal developmental groove: It is the groove separating • The formula includes one side only. The above formula
the buccal cusps on the occlusal aspect of molar teeth and should be read thus:
extending onto the buccal surface for a short distance. • Incisors: Two maxillary and two mandibular.
♦♦ Central developmental groove: This groove separates the • Canines: One maxillary and one mandibular.
occlusal aspect of posterior teeth. • Molars: Two maxillary and two mandibular.
♦♦ Lingual developmental groove: This groove separates So a total of 10 teeth are present on one side whether
the lingual cusps on the occlusal aspect of mandibular right or left.
and maxillary molars as well as mandibular second • Similarly for permanent dentition, the dental formula
premolars. It extends to the lingual surface for a short is as follows:
distance.
♦♦ Supplemental groove: These are shallow linear depression
usually less distinct and more variable than developmental
groove. It does not marks junction of lobs or major por- • In this premolars have now been added to the formula.
tion of tooth. • Once again as in the case of primary teeth, the formula
should be read as:
Fossa –– Incisors: Two maxillary and two mandibular.
♦♦ A fossa is an irregular depression or concavity. –– Canines: One maxillary and one mandibular.
♦♦ Lingual fossa are on the lingual surface of incisors. Central –– Premolars: Two maxillary and two mandibular.
fossa are on the occlusal surface of molars. –– Molars: Three maxillary and three mandibular.
♦♦ They are formed by convergence of ridges terminating So a total of 16 teeth are present on one side
at the central point in the bottom of depression where whether right or left.
junction of grooves occurs. To understand dental anatomy, the nomenclature
♦♦ Triangular fossa are found on molars and premolars. should be read first.
Dental Anatomy 551
Q.7. Write briefly on class, arch and set traits. Line Angles for Mandibular Lateral Incisors
(Nov 2009, 5 Marks) 1. Mesiolabial line angle
Ans. Traits are the characteristic features or attributes to 2. Mesiopalatal/mesiolingual line angle
distinguish one form of dentition from the other form. 3. Distolabial line angle
• Class trait: These traits are those which differentiate 4. Distopalatal/distolingual line angle
four categories of teeth, i.e. incisors, canine, molars 5. Labioincisal line angle
and premolars, i.e. incisors are used for cutting, 6. Linguoincisal line angle
canines for piercing, premolars for grinding and Q.10. Describe elevation and depressions on crown.
molars for crushing. (Dec 2010, 10 Marks)
• Arch trait: These traits are those which differentiate Ans. Following are the elevations and depressions on the
maxillary teeth from mandibular teeth. Example is surface of crown.
maxillary first molar consists of cusp of Carabelli
while it is absent in mandibular first molar. Elevations on Crown
• Set trait: These traits are the features that differentiate Cusp: A cusp is an elevation or mound on the crown portion
teeth in primary dentition from the teeth in of a tooth making up a divisonal part of the occlusal surface.
permanent dentition, e.g. primary teeth are white
in color while permanent teeth are yellowish white
in color.
Q.8. Define set trait, class and type trait.
(Nov 2010, 3 Marks)
Ans. For set trait and class trait refer to Ans 7 of same chapter.
Type trait: These traits differentiate teeth within one
class, i.e. differentiation of incisors but between maxillary
central or lateral incisors.
Q.9. What are line angles? Enumerate line angles for
mandibular lateral incisors. (Feb 2013, 5 Marks)
Or
What are line angles. Enumerate line angles for Fig. 18: Cusp
mandibular lateral incisors.
Tubercle: A tubercle is a smaller elevation on the some portion
(May 2014, 5 Marks)
of the crown produced by an extraformation of enamel.
Ans. A line angle is an angle formed by union of two
Deviations from the typical form are evident, e.g. cusp of
surfaces.
Carabelli is a tubercle.
Depression on Crown
Fossa: A fossa is an irregular depression or concavity. Lingual
fossae are on the lingual surface of incisors. Central fossae are Fig. 23: Developmental groove Fig. 24: Supplemental grooves
on the occlusal surface of molars. They are formed by the
Pits: Pits are small pinpoint depressions located at the
convergence of ridges terminating at a central point in the bottom
junction of developmental grooves or at terminals of those
of the depression where a junction of grooves occurs. Triangular
grooves. For instance, central pit is a term used to describe a
fossae are found on molars and premolars on the occlusal surfaces
landmark in the central fossa of molars where developmental
mesial or distal to marginal ridges. They are sometimes found on
grooves join.
the lingual surfaces of maxillary incisors at the edge of the lingual
fossae where the marginal ridges and the cingulum meet.
Example, incisors are used for cutting, canines for piercing, Fossa: Fossa is defined as a depression or a concavity
premolars for grinding and molars for crushing. on lingual surface of anteriors and occlusal surface of
Type traits: These traits differentiate teeth within one class, posteriors, e.g. lingual fossa, triangular fossa, central
i.e. differentiation of incisors but between maxillary central or fossa.
lateral incisors, e.g. mesiodistal width of maxillary permanent Cingulum: A cingulum, or girdle, is the lingual lobe of
central incisor is wider while the width of maxillary permanent an anterior tooth and makes up the bulk of the cervical
lateral incisor is narrow. third of the lingual surface. Its convexity mesiodistally
resembles a girdle encircling the lingual surface at the
Q.12. Write about the definitions of ridge, cusp, fossa, pit
cervical third, e.g. cingulum in maxillary central incisor.
and groove. (May/June 2009, 5 Marks)
Or Q.15. Write short note on developmental lobes.
(Oct 2014, 3 Marks)
Define cusp, ridge, cingulum, fossa and pit.
(Aug 2012, 5 Marks) Ans. Developmental lobe is one of the growth center during
development of crown.
Or • Developmental lobes appear as cusps and mamelons
Define cusp and fossa. (Dec 2014, 3 Marks) on the tooth surface.
Ans. Ridge: Ridge is defined as any linear elevation on the • Permanent anterior teeth develop from four lobes,
surface of tooth. i.e. labial, lingual, mesial and distal.
Cusp: Cusp is defined as an elevation of crown of tooth • All primary incisors develop from a single lobe.
making up a divisional part of occlusal surface. • Deciduous posteriors develop from 5 lobes, i.e. three
facial lobes and two lingual lobes.
Fossa: Fossa is defined as a depression or a concavity
• All premolars except mandibular second premolar
on lingual surface of anteriors and occlusal surface of
develop from four lobes, i.e. buccal, lingual, mesial
posteriors.
and distal.
Pit: Pit is defined as small pin point depression located • Second mandibular premolar develops from five
at junction of two or more developmental grooves. lobes, i.e. buccal, mesiolingual, distolingual, mesial
Groove: A groove is defined as a line separating the lobes and distal.
or primary part of crown or root. • All first molars of maxillary and mandibular arches
Cingulum: Cingulum is defined as a mound on cervical develop from five lobes and rest all molars develop
third of lingual surface of anterior teeth. from four lobes. Naming of lobes of molars are done
on the names of their cusps.
.13. Write short note on line angle. (June 2010, 2 Marks)
Q
Ans. A line angle is formed by junction of two surfaces. Various Permanent Teeth Along with their Number of Lobes
• A line angle is named by combination of its two
surfaces which join each other. Name of the teeth Number of lobes
• Example is the junction of distal and buccal walls of Maxillary and mandibular central incisors, lateral 4 lobes
tooth is known as distobuccal line angle. incisors, canines
• Anterior tooth consists of six line angles and Maxillary first and second premolars and 4 lobes
posterior tooth consists of eight line angles. mandibular first premolar
Mandibular second premolar 5 lobes
Line angles of anterior teeth Line angles of posterior teeth
Maxillary and mandibular first molar 5 lobes
• Mesiolabial • Mesiobuccal
Maxillary and mandibular second and third 4 lobes
• Mesiopalatal or mesiolingual • Distobuccal molars
• Distolabial • Mesiolingual
• Distolingual or distopalatal • Distolingual
Q.16. Write short note on line angles and point angles of
• Labioincisal • Mesio-occlusal
anterior teeth. (Oct 2014, 3 Marks)
• Linguoincisal • Disto-occlusal
• Bucco-occlusal Ans. Line Angle
• Linguo-occlusal A line angle is formed by the union of two surfaces.
• Anterior teeth consists of six line angles, i.e.
Q.14. Define cusp, fossa and cingulum with example. 1. Mesiolabial line angle
(May 2014, 2 Marks) 2. Mesiopalatal/mesiolingual line angle
Ans. Cusp: Cusp is defined as an elevation of crown of tooth 3. Distolabial line angle
making up a divisional part of occlusal surface. Example, 4. Distopalatal/distolingual line angle
premolars consists of two cusps, i.e. buccal cusp and 5. Labioincisal line angle
lingual cusp. 6. Linguoincisal line angle.
554 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Transverse Ridge
The ridge crosses occlusal surface of posterior teeth transversely
and forms when there is union of buccal and lingual triangular
ridges.
Point Angle
A point angle is formed by union of three surfaces.
• Anterior teeth consist of four point angles, i.e.
1. Mesio-labio-incisal point angle
2. Mesio-palato-incisal/Mesio-linguo-incisal point
angle
3. Disto-bucco-occlusal point angle Fig. 29: Transverse ridge in mandibular first molar
4. Disto-palato-occlusal/Disto-linguo-occlusal Q.18. Define ridge and enumerate the type of ridges.
point angle. (Sep 2015, 2 Marks)
Or
Enumerate ridges. (Sep 2018, 2 Marks)
Ans. Ridge is defined as any linear elevation on the surface
of crown and is named according to its situation.
Enumeration of Type of Ridges
1. Labial ridge
2. Buccal ridge
3. Incisal ridge
4. Lingual ridge
5. Linguo-incisal ridge
6. Cervical ridge
7. Marginal ridge
8. Cusp ridge
9. Triangular ridge
10. Transverse ridge
11. Oblique ridge
Q.19. Write short note on transverse and oblique ridge.
(July 2016, 3 Marks)
Fig. 27: Point angle of anterior teeth Ans. Transverse ridge
♦♦ Transverse ridge is the union of two triangular ridges
Q.17. Define oblique ridge and transverse ridge. crossing the occlusal surface of posterior tooth in trans-
(Dec 2014, 2 Marks) verse direction.
Ans. Oblique Ridge ♦♦ It is created when buccal and lingual triangular ridges join.
Oblique ridge is the ridge which crosses occlusal surface ♦♦ Example is transverse ridge between buccal and lingual
of maxillary molars obliquely. The ridge extends from cusps on premolar.
Dental Anatomy 555
Q.2. Write about FDI and Palmer tooth numbering system. Right Left
(Nov 2008, 5 Marks) (Apr 2010, 5 Marks) 55 54 53 52 51 61 62 63 64 65
Or
85 84 83 82 81 71 72 73 74 75
Define FDI system of tooth nomenclature.
Midsagittal plane
(Dec 2014, 3 Marks)
Dental Anatomy 557
Advantages
Palmer Tooth Numbering System
♦♦ The notation produces a graphical image of dentition,
It is also known as Zsigmondy-Palmer system or Symbolic
due to this presentation the anomalies such as edentulous
system or Quadrant system or Grid system or Angular System. spaces, etc. are represented using Zsigmondy cross.
♦♦ It is the oldest and one of the popular most system in use ♦♦ It is user friendly.
during 20th century. ♦♦ Quadrants can easily be identified by symbols.
♦♦ Hungarian dentist Adolf Zsigmondy develops it in 1861 ♦♦ Orthodontists use this system as it allow discussion of
and later on he modified the system for denoting primary particular tooth, which need treatment.
dentition in 1874. Corydon Palmer in 1870 invented the
system independently. Disadvantages
♦♦ In this system, oral cavity is divided into 4 sections which ♦♦ It is not compatible with computers as well as word pro-
are known as quadrants. cessing systems.
♦♦ Palmer system uses a unique ‘L’ shaped symbol or grid ♦♦ Verbal communication is very difficult.
for mentioning in which quadrant a particular specific ♦♦ Chances of error are there while designating the tooth.
tooth is present.
Q.3. Write about universal and FDI numbering systems.
♦♦ Vertical line of symbol corresponds to patient’s midline
(Jan 2012, 5 Marks)
and horizontal line corresponds to occlusal plane which
Or
separates upper as well as lower arches.
♦♦ Counting begins at midline and continue backwards. Describe universal tooth numbering system.
♦♦ Symbols denoting quadrants in Zsigmondy-Palmer system (Aug 2011, 5 Marks)
in both deciduous and permanent teeth are as follows: Ans. Universal Tooth Numbering System
a. For maxillary right quadrant • Universal tooth numbering system was given by
b. For maxillary left quadrant Parreidt in year 1882.
c. For mandibular right quadrant • American Dental Association (ADA) officially
d. For mandibular left quadrant adapted it in year 1975.
• Universal tooth notation is widely used by dentists
Palmer Tooth Numbering System for Permanent Teeth in USA.
♦♦ Permanent teeth are represented by numerical 1 to 8 in all
Universal Numbering System for Permanent Teeth
four quadrants.
♦♦ Numbering starts from midline and go backwards. ♦♦ In permanent dentition numerical 1 to 32 denotes the teeth.
♦♦ Symbols represents the respective quadrants. ♦♦ Numbering of tooth starts from posterior most tooth in
♦♦ Following is the Zsigmondy-Palmer notation for upper right quadrant, i.e. right maxillary third molar
permanent dentition: which is denoted as #1 and ends at lower right quadrant,
i.e. right mandibular third molar which is denoted as #32.
Upper Right Upper Left ♦♦ Following is the universal tooth notation system for
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 permanent teeth.
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 Right Left
Lower Right Lower Left 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
MidSagittal plane 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17
Midsagittal plane
Palmer Tooth Numbering System for Deciduous Teeth
♦♦ Deciduous teeth are represented by alphabets, i.e. upper Universal Numbering System for Deciduous Teeth
case English letters from A to E are used for representing ♦♦ Deciduous dentition is denoted by upper case english
primary teeth in all four quadrants. letters for each primary teeth.
♦♦ Numbering starts from midline and move backwards. ♦♦ Maxillary teeth are designated from letters A to J, A is right
♦♦ Following is the Zsigmondy palmer notation for maxillary second molar tooth while mandibular teeth are
permanent dentition: designated from K to T.
558 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
1 3
First premolar 1 − 1 years 5–6 years 10–11 years 12–13 years
2 4
1
Second premolar 2−2 years 6–7 years 10–12 years 12–14 years
4
1
First molar At birth 2 –3 years 6–7 years 9–10 years
2
1
Second molar 2 –3 years 7–8 years 12–13 years 14–16 years
2
Third molar 7–9 years 12–16 years 17–21 years 18–25 years
3
First premolar 1 –2 years 5–6 years 10–12 years 12–13 years
4
1 1
Second premolar 2 −2 years 6–7 years 11–12 years 13–14 years
4 2
1
First molar At birth 2 –3 years 6–7 years 9–10 years
2
1
Second molar 2 –3 years 7–8 years 11–13 years 14–15 years
2
Third molar 8–10 years 12–16 years 17–21 years 18–25 years
Q.2. Write short note on sequence of eruption of permanent • Mandibular central incisors erupt at age of 6 to 7
teeth. (June 2010, 5 Marks) years followed by lateral incisors.
Ans. Eruption of teeth occurs earlier in females. • Maxillary central incisor erupts at age of 7 to 8 year
• Mandibular teeth erupt earlier than maxillary teeth. and maxillary lateral incisors at age of 8 to 9 years.
• Eruption sequence in maxillary arch is 6-1-2-4-3-5- • Mandibular canine erupt at age of 9 to 10 years while
7-8 Or 6-1-2-4-5-3-7-8
maxillary canine erupts at age of 11-12 years.
• Eruption sequence in mandibular arch is 6-1-2-3-4-
5-7-8 Or 6-1-2-4-3-5-7-8 • Premolars erupt at age of 10 to 12 years.
• First permanent tooth to erupt is first molar at the • Second molars erupt at the age of 12 years.
age of 6 years. • Third molars erupt at the age of 17 to 21 years.
560 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.3. Write briefly on eruption sequence of deciduous and • Spaces that widen out from the area of contact
permanent teeth. (Aug 2012, 5 Marks) labially or buccally and lingually are called labial
Ans. Eruption Sequence of Deciduous Teeth or buccal and lingual interproximal embrasures.
• Mandibular central incisor • Embrasures are continuous with the interproximal
• Maxillary central incisor spaces between the tooth.
• Maxillary lateral incisor
• Mandibular lateral incisor
• Maxillary and mandibular first molar
• Maxillary canine
• Mandibular canine
• Mandibular second molar
• Maxillary second molar.
According to Zsigmondy/Palmer notation of teeth,the Fig. 30: Embrasure
order of eruption of primary teeth in one quadrant is
denoted as A B D C E. • Above the contact areas incisally and occlusally, the
spaces which are bounded by the marginal ridges
Eruption Sequence of Permanent Teeth as they join the cusps and incisal ridge are called as
the incisal or occlusal embrasures. Incisal or occlusal
♦♦ Maxillary and mandibular first molar.
embrasures, and the labial or buccal and lingual
♦♦ Mandibular central incisor
embrasures are continuous.
♦♦ Maxillary central incisor
• Fourth triangular space which is cervical to the
♦♦ Mandibular lateral incisor
contact area is filled with interdental or gingival
♦♦ Maxillary lateral incisor
papilla which is known as interproximal space or it
♦♦ Mandibular canine
is also referred to as gingival or cervical embrasure.
♦♦ Maxillary first premolar
♦♦ Mandibular first premolar Functions of Embrasures
♦♦ Maxillary second premolar
♦♦ They provide the spillway for escapement of food during
♦♦ Mandibular second premolar the mastication.
♦♦ Maxillary canine ♦♦ They reduce the forces on teeth during the reduction of
♦♦ Mandibular second molar hard food material.
♦♦ Maxillary second molar ♦♦ Prevents food from being entering in the contact area.
♦♦ Maxillary and mandibular third molar ♦♦ Provides self-cleansing action to teeth.
According to Zsigmondy/Palmer notation of teeth, the order of ♦♦ Protects gingiva from trauma.
eruption of permanent teeth in one quadrant is 6 1 2 4 5 3 7 8.
Applied Aspect
While giving the proximal restoration to teeth or if prosthesis is
4. FORM AND FUNCTION OF given over crown over or under contouring of proximal surface
OROFACIAL COMPLEX should strictly not be done because this results in food impaction.
Q.2. Write a note on interproximal space.
Q.1. Write a short note on spillway space. (Sep 2000, 5 Marks) (Mar 2009, 5 Marks)
(Feb 2005, 5 Marks) (Mar 2000, 5 Marks) Ans. Interproximal Space
(Sep 2003, 5 Marks) (Apr 2010, 5 Marks) • Interproximal space between the teeth are triangular-
Or shaped space.
Write a note on embrasures. (Apr 2007, 5 Marks) • Base of triangle is the proximal surface of the
(Sep 2007, 5 Marks) (Apr 2008, 5 Marks) connecting teeth.
Or • Apex of the triangle is in the area of contact.
• Interproximal spaces are normally filled gingival
Write short note on embrasures. (Nov 2010, 3 Marks)
tissue (gingival papillae)
(June 2010, 5 Marks) (Feb 2014, 3 Marks)
Or
Answer in brief embrasures. (Oct 2016, 2 Marks)
Or
Describe embrasures. (Apr 2017, 5 Marks)
Ans. Embrasures or Spillway Space
• When two teeth in the same arch are in contact, their
curvature adjacent to contact areas form V shaped
spaces called embrasures or spillway spaces Fig. 31: Interproximal space
Dental Anatomy 561
♦♦ The cusp is formed by two cuspal ridges, i.e. mesial cuspal Mesial Aspect
ridge and distal cuspal ridge which joins at an acute angle. ♦♦ Crown is wedge shaped when viewed from this aspect.
♦♦ Distal cuspal ridge is short and convex and have a steep- ♦♦ Labial outline from the lingual aspect is convex in cervical
inclination from cuspal tip. 1/3rd and flat in incisal and middle 1/3rd.
♦♦ Distal cuspal ridge is shorter than mesial cuspal ridge ♦♦ Lingual outline from mesial aspect is S shaped. It is convex
and is concave. Due to this variation the cusp of canine is at cingulum and concave at mesial marginal ridge and is
placed distally. convex at cuspal region.
♦♦ Labial surface has a ridge known as canine ridge which run ♦♦ Crest of curvature of cervical line is semicircular with
from cervical line to the cuspal tip and is placed distally. convexity facing cusp.
♦♦ A slender, long and single root is present which have a ♦♦ Mesial contact area is seen in middle one-third of crown.
blunt apex. A very slight distal inclination of root is seen
at apical one-third of root.
Lingual/Palatal Aspect
♦♦ Crown is diamond shaped when viewed from palatal
aspect.
♦♦ Mesiodistal width of crown is less when compared to labial
aspect, this is due to the palatal convergence of distal and
mesial sides of crown.
♦♦ Mesial ouline from lingual aspect is convex from cervical
line to mesial contact area.
♦♦ Distal outline from lingual aspect is convex and is more
rounded than mesial aspect.
♦♦ Crest of curvature of cervical line is semicircular with
convexity facing root apex.
♦♦ On incisal aspect a sharp cusp is evident which is formed by
mesial and distal cuspal ridges which joins at an acute angle.
♦♦ Lingual surface of the crown is irregular. Fig. 36: Deciduous maxillary canine-mesial aspect
♦♦ Lingual surface has palatal fossa and prominent ridges, Distal Aspect
i.e. mesial marginal ridge and distal marginal ridge. Distal
♦♦ Crown appears to be wedge shaped when viewed from
marginal ridge is longer than mesial marginal ridge.
distal aspect.
♦♦ Cingulum appears to be prominent.
♦♦ Crest of curvature of cervical line is semicircular with
♦♦ Palatal ridge is placed distally and it extend from cuspal
convexity towards incisal ridge.
tip to the cingulum. Palatal ridge divide palatal fossa into
♦♦ Distal surface is smooth.
mesial palatal fossa and distal palatal fossa.
♦♦ Distal contact area lies in middle 1/3rd of crown.
♦♦ Root is same as on labial aspect. ♦♦ Root when viewed from the distal side is wider labio-
♦♦ Lingual surface of root is smooth with ridge extending lingually in cervical and middle one-third and tapers at
from cervical line to apex. incisal one-third.
Fig. 35: Deciduous maxillary canine-lingual aspect Fig. 37: Deciduous maxillary canine-distal aspect
564 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦♦ Distal surface has a developmental depression in middle Describe various differences between permanent and
one-third and cervical one-third of root. deciduous dentition. (Sep 2003, 15 Marks)
(Sep 1999, 15 Marks)
Incisal Aspect
Or
♦♦ Crown appears to be of diamond shaped.
♦♦ Labiolingual width of the mesial half of crown is more Give differences between deciduous and permanent
than distal half. teeth. (Mar 2008, 7.5 Marks) (June 2010, 10 Marks)
(Feb 2013, 10 Marks) (Aug 2011, 10 Marks)
Or
Describe microscopic and macroscopic differences
between permanent and deciduous teeth.
(Sep 2009, 15 Marks)
Or
Describe morphological and histological differences
between permanent and deciduous dentition.
(Nov 2010, 6 Marks)
Or
Write short note on morphological differences between
deciduous and permanent dentition.
Fig. 38: Deciduous maxillary canine-incisal aspect (Mar 2013, 3 Marks)
Or
♦♦ Labial outline of crown from this aspect is smoothly con-
vex and broad mesiodistally. A prominent canine ridge is Describe the differences in deciduous and permanent
seen in centre. dentition in detail. (May 2017, 10 Marks)
♦♦ Lingual outline from incisal aspect is narrow as compared Or
to labial aspect.
Describe differences between deciduous and
♦♦ Cingulum is prominent and is extended mesiodistally.
permanent teeth. (July 2016, 10 Marks)
♦♦ Mesial and distal outlines from incisal aspect appears to
Ans.
be broad.
For morphological features of permanent maxillary Importance of Primary Dentition
canine refer to Ans 1 of chapter THE MAXILLARY AND ♦♦ Mastication of food: As primary occlusion gets estab-
MANDIBULAR CANINES. lished, child is able to chew the food efficiently. For
Q.3. Write very short answer on four differences between masticatory phenomenon neuromuscular co-ordination
is required which is established during primary dentition
deciduous and permanent canine.
stage by itself.
(Aug 2018, 2 Marks)
♦♦ Taking of proper diet: Deciduous teeth are the only teeth
Ans. Following are the four differences between deciduous present from six months to six years of age so it is neces-
and permanent canine: sary to maintain them so that child can get comfortable
Deciduous canine Permanent canine functional occlusion. Child with the missing or decayed
primary teeth feels difficulty in chewing the food and he/
It is shorter in size It is larger in size
she may reject the food which is difficult to chew.
It is conical in shape It is less conical in shape ♦♦ Maintains normal facial appearance: A good maintained
Cusp tip is more pointed and sharp Cusp tips are less pointed set of deciduous dentition contributes to normal facial
It erupts at 19 months of age It erupts at 11 to 12 years of age appearance as well as normal psychological and cognitive
development of the child. Prematurely lost or carious front
teeth diminish child’s self-confidence.
♦♦ Provides clear speech: Anterior teeth are essential for
6. DIFFERENCES BETWEEN PRIMARY normal speech of some vowels such as ‘S’, ‘C’ etc. If teeth
are lost they can lead to the defective speech of the child.
AND PERMANENT DENTITION ♦♦ Prevention of deciduous teeth from infection: It is
important to treat dental caries and prevent primary
Q.1. Give importance of deciduous dentition. Give teeth from further periapical abscess formation and
difference between permanent and deciduous dentition. possible complications because they can affect underlying
(Feb 2002, 16 Marks) (Mar 2009, 15 Marks) permanent tooth germs and may lead to Turner’s
Or hypoplasia, i.e. brown spots of crowns of permanent teeth.
Dental Anatomy 565
♦♦ Maintenance of normal eruption of permanent successors: physiologic spacing in primary dentition leads to the
As primary teeth are lost prematurely due to caries or development of normal occlusal relations in permanent
trauma the normal eruption schedule of permanent teeth dentition. If primary teeth lost prematurely, the adjacent
gets which can lead to malocclusion. teeth migrate into the available space leading to a decrease
♦♦ Maintenance of space for normal eruption of permanent in the arch length which causes a lack of space in the arch
successor teeth: Primary teeth preserves the space for for the erupting permanent successors and results in the
eruption of their permanent successor teeth. Adequate development of malocclusion.
Morphological (macroscopic) and histological (microscopic) differences in deciduous and permanent dentition
Features Primary/deciduous dentition Permanent dentition
General features
Number 20 teeth 32 teeth
In each jaw 10 teeth and in each quadrant 5 teeth In each jaw 16 teeth and in each quadrant 8 teeth
Teeth present 2 incisors, 1 canine, 2 molars in each quadrant 2 incisors, 1 canine, 2 premolars, 3 molars in each quadrant
Dental formula I 2/2 C1/1 M2/2 I 2/2 C1/1 PM2/2 M3/3
Duration of eruption Start from 6 months to 3 years Start from 6 years to end up at 12 years except for third molars
and its completion
Duration of dentition From 6 months to 6 years 12 years and beyond
Eruption sequence A B D C E Maxillary teeth: 6 1 2 4 3 5 7 or 6 1 2 4 5 3 7
A B D CE Mandibular teeth: 6 1 2 3 4 5 7
Macroscopic features
Crown
Size Small in dimensions Larger in dimension
Color Light in color. Appear bluish white. Darker in color yellowish, white or grayish white
Placement in jaws Placed perpendicular in relation to jaws Placed oblique in relation to jaws
Shape More bulbous Less bulbous
Cervical constriction More Less
Contd…
566 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Contd…
Morphological (macroscopic) and histological (microscopic) differences in deciduous and permanent dentition
Surface In deciduous anterior teeth facial surface is flat above In permanent teeth facial and lingual surfaces are flat
the level of cervical ridge till incisal surface. In posterior
teeth lingual surface is flat above the level of cervical
ridge till occlusal surface.
Incisors
Mamelons Deciduous incisors have no mamelons Newly erupted permanent incisors have mamelons
Contd…
Dental Anatomy 567
Contd…
Morphological (macroscopic) and histological (microscopic) differences in deciduous and permanent dentition
Occlusal plane Flat More curved contour and more intricate design
Grooves Supplemental grooves are more Supplemental grooves are less
Cusps Short, sharp and pointed Blunt
Contact areas Contact areas between primary molars are flat, Contact areas between permanent molars are broad and situated
narrow and situated gingivally occlusally
Contd…
568 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Contd…
Morphological (macroscopic) and histological (microscopic) differences in deciduous and permanent dentition
Upper first molar Has 3 cusps Has 4 cusps and 1 accessory cusp
Upper second Has 4 cusps and 1 accessory cusp Has 4 cusps
Molar
Lower first molar Has 4 cusps Has 5 Cusps
Lower second molar Has 5 cusps Has 4 cusps
Root
Crown root ratio Roots are longer when compared to size of crown Roots are not long as compared to size of crown.
Size Roots are long and more slender Roots are short and bulkier
Contd…
Dental Anatomy 569
Contd…
Morphological (macroscopic) and histological (microscopic) differences in deciduous and permanent dentition
Flaring Roots flare out from cervical area to their tips. Marked flaring of roots is absent.
Resorption Undergo physiologic resorption Physiologic resorption is absent.
Pulp
Pulp chamber Larger when compared to crown size. Smaller when compared to crown size
Pulpal outline Follows DEJ more closely Follows DEJ less closely
Pulp horn Pulpal horns are higher and closer to outer surface. Pulpal horns are lower and away from outer surface.
Root canals Root canals are ribbon like, follow thin tortuous and Root canals are well defined and less branching.
branching path.
Accessory canals Accessory canals in pulp chambers of primary molars Floor of pulp chambers do not have many accessory canals.
directly lead to inter-radicular furcation areas.
Apical foramen Wider Narrower
Microscopic/histologic features
Enamel
Thickness Thickness of dentin is half that of permanent teeth. Thickness is more over pulpal roof
Dentinal tubules Less regular More regular
Inter-globular dentin Absent Present beneath the mantle layer of dentin
Pulp
Blood supply Blood supply is abundant Blood supply is less
Nerve supply Less densely innervated, nerve fibers terminate near Densely innervated. Nerve fibers terminate among odontoblasts
odontoblastic zone as free nerve endings and even passes beyond predentin
Cementum Cementum is thin and is made up of only primary Cementum is thick and both primary and secondary cementum
cementum. are present.
Mineral content Enamel and dentin are less mineralized and less dense Enamel and dentin are more mineralized
Neonatal line Present in all primary teeth both in enamel and dentin Seen only in first molar.
Q.2. Describe importance of primary dentition. Ans. Set trait: These traits are the features that differentiate teeth
(Jan 2012, 5 Marks) (May 2014, 2 Marks) in primary dentition from the teeth in permanent dentition.
Ans. For importance of deciduous dentition refer to Ans 1 of Arch trait: These traits are those which differentiate
same chapter.
maxillary teeth from mandibular teeth.
Q.3. Define set traits and arch traits and describe differences
For differences between deciduous and permanent teeth
between deciduous and permanent teeth.
refer to Ans 1 of same chapter.
(Nov 2010, 7.5 Marks)
570 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦♦ Cingulum is the convexity which encirlces the lingual ♦♦ From mesial aspect the incisal outline is formed by a
surface of anteriors at the cervical one third. Cingulum rounded incisal ridge in a newly erupting tooth while a
forms the bulk of cervical third of the lingual surface. flat incisal edge is seen in a functional tooth.
♦♦ Cingulum is convex and smooth both cervicoincisally and ♦♦ From mesial aspect, the cervical line over mesial surface of
central incisor curves incisally approximately 3 to 4 mm.
mesiodistally.
♦♦ Incisal ridge is the rounded incisal portion of a newly
♦♦ Marginal ridges extend from cingulum forming the mesial
erupted incisor, which merges with the mesioincisal and
and distal borders of lingual fossa. The marginal ridge distoincisal angles and the labial and lingual surfaces.
extending mesially is known as mesial marginal ridge ♦♦ Angle formed by linguoincisal surface and labial surface
while the marginal ridge extending distally is known as is known as incisal edge. It is not seen in newly erupted
distal marginal ridge. incisor tooth.
♦♦ Usually two developmental grooves extend from cingulum
into the lingual fossa; especially on canines and maxillary
incisors.
♦♦ Lingual Fossa is a concavity in the center of lingual aspect
of all anterior teeth.
♦♦ Lingual fossa is bordered mesially by mesial marginal
ridge, distally by distal marginal ridge, cervically by
cingulum, and incisally by incisal ridge.
Mesial Aspect
♦♦ Geometric shape from this aspect is wedge shaped or
triangular.
♦♦ Base of the triangle lies at cervix while the apex of triangle
lies towards the incisal ridge.
♦♦ Mesial surface is convex labiolingually and cervicoincis-
ally. Less convexity is seen at the cervical area. Fig. 42: Maxillary central incisor-distal aspect
♦♦ Mesial contact area lies at incisal one third, immediately
beside the incisal edge. Distal Aspect
♦♦ Geometric Shape from this aspect is wedge shaped or
triangular.
♦♦ Distal surface is just similar to mesial surface except
that the crown appears thicker towards the incisal
third.
♦♦ Distal contact area lies at the junction of incisal and middle
thirds of the crown.
♦♦ From distal aspect labial outline is convex from cervix to
the incisal ridge.
♦♦ From distal aspect lingual outline is concavo convex.
♦♦ From distal aspect the incisal outline is straight
♦♦ Curvature of cervical line is less, i.e. 1 mm shorter in extent
on distal surface as compared to mesial surface.
Incisal Aspect
♦♦ It is triangular in shape.
♦♦ Mesiodistal dimension of the crown is slightly greater than the
buccolingual dimension. Incisal ridge extending mesiodistally
Fig. 41: Maxillary central incisor-mesial aspect provides an illusion of much greater mesiodistal dimension.
♦♦ Crown appears bulkier from incisal aspect.
♦♦ From mesial aspect the labial outline is convex. It curves ♦♦ From incisal aspect the labial surface is more convex
smoothly from cervical line towards the incisal ridge and cervically and flatter incisally.
the height of labial contour of crown is at the cervical third. ♦♦ Cingulum forms a smaller convex arc and the crown tapers
♦♦ From mesial aspect the lingual outline is irregular. A rapidly from the labial surface towards the cingulum.
convexity is formed by cingulum at the cervical portion ♦♦ Mesiolabial and distolabial line angles are prominent from
and a concavity is formed by lingual fossa towards at the incisal aspect.
incisal portion. Height of lingual contour of the crown lies ♦♦ Incisal edge is seen from this aspect which is sloping
at cervical third. lingually perpendicular to labiolingual bisecting line.
572 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.2. Compare and contrast the morphology of permanent maxillary central incisor and lateral incisor.
(Mar 2000, 15 Marks)
Or
Differentiate permanent maxillary central and maxillary lateral incisor. (Jan 2018, 5 Marks)
Ans.
Features Permanent maxillary central incisor Permanent maxillary lateral incisor
Crown
Labial Aspect
Contd…
Dental Anatomy 573
Contd…
Labial and lingual contours Curvature of contours is more. Curvature of contours is less.
Height of contour It lies at cervical 1/3rd It lies at cervical 1/3rd
Contd…
574 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Contd…
Geometric form From incisal aspect it is triangular. From incisal aspect it is ovoid/rounded.
Dimensions Crown is wider mesiodistally when compared with Dimensions of crown are same mesiodistally and
labiolingual dimensions. labiolingually.
Root
Number Single root is present Single root is present
Size Root is thick in size Root is slender in size
Developmental groove It is absent. It can be present on mesial or distal surfaces of root.
Curvature It is straight. Curvature at labial and distal surfaces is at apical 1/3rd
is same.
Cross section of root at cervix It is triangular It is ovoid
Pulp horns From labial view 3 pulpal horns are seen. From labial view 2 pulpal horns are seen.
Pulp canals Single pulpal canal is present Single pulpal canal is present
Q.3. Write short note on type traits of mandibular inci- Ans. Here type traits of mandibular incisors means differen-
sors. (July 2016, 3 Marks) tiating teeth within one class, i.e. differences between
mandibular central and mandibular lateral incisors.
Contd…
Characteristics Mandibular permanent central incisor Mandibular permanent lateral incisor
Crown
Labial aspect
Contd…
576 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Contd…
Characteristics Mandibular permanent central incisor Mandibular permanent lateral incisor
Incisal aspect
Incisal ridge/edge It is at right angle to labiolingual bisecting line It is at angle to labiolingual bisecting line. This is twisted
labiolingually on root base for confirming mandibular arch
curvature
Cingulum Centered mesiodistally It is positioned distally
Root
Size Short and small Long and large
Developmental Present on mesial and distal surfaces. Groove is deep on Present on mesial and distal surfaces.
grooves distal surface
Pulp canals One or two are also possible One
Morphology of Crown
Labial Aspect
♦♦ Geometric shape of the crown from labial aspect is
trapezoidal or pentagonal form.
♦♦ From this aspect, the maxillary permanent canine resem-
bles as premolar tooth.
♦♦ As compared to the maxillary central incisor the crown
of canine is smaller mesiodistally by 1 mm and at cervix
it is much narrower.
♦♦ Labial surface is generally smooth and convex except for
the shallow depressions mesially and distally dividing
the three lobes.
♦♦ Middle labial lobe shows more development than other
lobes and forms a linear elevation which extends from Fig. 44: Maxillary canine-labial aspect
Dental Anatomy 577
♦♦ From labial aspect distal outline is convex, but it gets ♦♦ The entire labial outline from mesial aspect exhibits more
concave between cervical line and distal contact area. convexity from cervical line to the cusp tip.
Maximum convexity of the distal outline, i.e. at distal ♦♦ Cusp tip of maxillary canine does not lie in center
contact area is at the middle of middle third of the with the root. Cusp tip is placed labial to the vertical
crown. root axis.
♦♦ From labial aspect, the incisal outline is made up by two ♦♦ Mesial contact area lies at the junction of incisal and middle
slopes which extends from mesial and distal contact areas one-third of the crown cervicoincisally and labiolingually
and meet the cuspal tip at midline. These slopes are known it lies at the center.
as mesial and distal cuspal ridges. ♦♦ From mesial aspect, the labial outline is more convex due
♦♦ Mesial cusp ridge is concave while the distal cusp ridge is to the presence of prominent labial ridge from cervical line
longer and is slightly rounded. to cusp tip. Height of contour labially lies at cervical third.
♦♦ From labial aspect the cervical line is convex and point
Height of contour is located on cingulum.
apically.
Lingual Aspect
♦♦ Geometric shape of maxillary canine from this aspect is
trapezoidal or pentagonal.
♦♦ On lingual aspect, the cervical line is more convex and is
pointed apically.
Incisal Aspect ♦♦ Cusp tip lies labial to the center of the crown labiolingually
as well as mesial in the center mesiodistally.
♦♦ Geometric shape of permanent maxillary canine from this
♦♦ From incisal aspect labially the cervical portion is convex.
aspect is diamond shaped. ♦♦ From incisal aspect labial ridge appears to be prominent.
♦♦ From this aspect labiolingual dimension of crown appears Labial ridge is more convex at cervical third and gets
to be greater than the mesiodistal dimension. flattened at incisal third.
♦♦ Crown is asymmetrical with mesial half of crown smaller ♦♦ Lingual fossa, lingual ridge and marginal ridges which
than distal half. borders the lingual fossa are seen.
Morphology of Root ♦♦ Mesial as well as distal surfaces are flat and have developmental
♦♦ Permanent maxillary canine consists of a single root. depressions which cover the major part of root.
♦♦ Root of maxillary permanent canine is longest of all teeth. ♦♦ Developmental depression over the distal surface is
♦♦ Shape of the root is conical. It is narrow mesiodistally and deeper as compared to developmental depression on
is wider labiolingually. mesial surface.
♦♦ Root of permanent maxillary canine has lingual convergence. ♦♦ At apical third of root distal curvature is present.
♦♦ Labial and lingual surfaces of root are smoothly convex. ♦♦ Root apex is usually blunt.
Dental Anatomy 579
Q.2. Compare and contrast permanent maxillary canine with permanent mandibular canine. (Apr 2010, 15 Marks)
Or
Compare and contrast morphology of permanent maxillary and mandibular canine teeth. (Feb 2006, 15 Marks)
Ans.
Mesiodistal width Mesiodistally crown is broad and short Mesiodistally crown is long and narrow
Labial surface More convex Convex
Cusp Well-developed, sharp Not so well developed
Cuspal ridges Mesial cuspal ridge is concave while distal is straight Both cuspal ridges are straight
Labial ridge Prominent Less prominent.
Outline of crown Mesial outline is convex Mesial outline is straight
Mesioincisal angle Less pronounced More pronounced
Tilt of crown It is upright over root base Crown is tilted distally over root base
Contact areas
Mesial contact At junction of incisal and middle 1/3rd It is just nearer to mesioincisal angle
Distal contact At center of middle 1/3rd At junction of incisal and middle 1/3rd
Contd…
580 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Contd…
Contd…
♦♦ Crown of mandibular canine appears longer as compared ♦♦ Cuspal tip is in line along with vertical root axis. Both the cusp
to maxillary canine. This is because the mesiodistal width ridges are straight. Mesial cusp ridge is shorter than distal.
of mandibular canine is narrow and contact areas are ♦♦ Cervical line, labially has semicircular curvature apically.
placed more incisally.
♦♦ Well defined mesioincisal and distoincisal angles are Lingual Aspect
present. ♦♦ Geometric shape is trapezoidal.
♦♦ Labial ridge extending from cervical area to the cusp tip ♦♦ Lingual surface is narrower as compared to labial surface
is less prominent. as the crown tapers lingually.
♦♦ Crown of permanent mandibular canine is tilted distally ♦♦ Lingual surface has less concavity and it is flattened.
over the base of root. This is due to the straight mesial ♦♦ Lingual fossa of permanent mandibular canine is shallow.
surface and curved distal surface. ♦♦ Lingual ridge is seen. Two small fossae are present, i.e.
♦♦ From labial aspect tooth appears like a lateral incisor if mesial and distal lingual fossae.
cusp tip is deteriorated. ♦♦ Lingual ridge is also less well-developed.
♦♦ Cingulum is poorly developed.
♦♦ Marginal ridges appear to be less prominent.
♦♦ From labial aspect, the mesial outline is straight. Mesial Fig. 50: Mandibular canine-lingual aspect
outline is in line with the mesial outline of root, it joins the
Mesial Aspect
mesial cusp. Mesial contact area lies at incisal third near
to the mesioincisal angle. ♦♦ Geometric shape of mandibular permanent canine is
♦♦ From labial aspect, the distal outline is less convex. Distal triangular. Base of triangle lies at cervix while the apex
contact area is located more incisally. lies at cusp tip.
♦♦ Cusp tip lies in the center or lingual to the straight root axis. ♦♦ Cingulum is smaller when compared to maxillary canine.
♦♦ From mesial aspect, labial outline appears to be less convex ♦♦ Cuspal tip and cuspal ridges has lingual inclination while
near to the cervical line. cuspal ridges of maxillary canine extend straight for bisect-
♦♦ From mesial aspect, lingual outline has a less convex ing mesial and distal contact areas.
cingulum as well as less concave lingual fossa.
♦♦ From incisal aspect the cusp tip appears to be thin and Morphology of Root
pointed. Cuspal ridge appears to be thin labiolingually ♦♦ Single root is commonly present but at times root
♦♦ Cervical line has more curvature incisally when compared bifurcation is seen.
to maxillary canine. ♦♦ It is shorter in size by l to 2 mm.
♦♦ Root is conical in shape. It is wider labiolingually and
Distal Aspect
thinner mesiodistally.
♦♦ Geometric shape of the crown is triangular or wedge ♦♦ Developmental depression is present on both mesial and
shaped. distal surfaces. Impression of developmental depression
♦♦ Curvature of cervical line is less over distal aspect. is more deeper on mesial surface of the root.
♦♦ Distal aspect is very much similar to mesial aspect. ♦♦ Root tip of mandibular canine is more pointed.
♦♦ Distal contact area is more cervically located than mesial ♦♦ Root is mostly straight and at times it may show mesial
contact area and lies at junction of incisal and middle third. curvature at apical third.
Q.5. Write four differences between deciduous and per-
manent maxillary canines. Describe its labial, lingual,
mesial, distal and incisal aspect in detail with diagram.
(Apr 2017, 2 + 6 + 2 Marks)
Ans. Four differences between deciduous and permanent
maxillary canine.
Mesial Aspect
♦♦ Geometric shape of crown is trapezoidal.
♦♦ Mesial surface of crown display both cusps. The cuspal
tips are within the confines of root trunk.
♦♦ Lingual cusp is smaller than buccal cusp by l mm or more.
♦♦ There is presence of concavity in center of the mesial
surface which is cervical to the contact area and is known
as mesial developmental depression. Mesial developmental
depression extends apically and crosses the cervical line and
meets the developmental depression between the two roots.
♦♦ Deep developmental groove which crosses mesial marginal
ridge is known as mesial marginal developmental groove.
♦♦ Mesial marginal groove extends from occlusal surface,
crosses marginal ridge and end at the mesial surface after
Fig. 54: Maxillary first premolar-buccal aspect running a short distance.
Dental Anatomy 585
♦♦ Mesial contact area lies occlusal to the center of crown Occlusal Aspect
cervico-occlusally.
♦♦ Geometric shape of tooth from occlusal aspect is hexagonal.
♦♦ From mesial aspect the buccal outline is convex near
♦♦ The maxillary first premolar tooth is divided into six sides
cervical line and is straight as it reaches at buccal cusp tip.
as its geometric shape is hexagonal. The six sides are
♦♦ From mesial aspect the lingual outline is more convex from
Mesiobuccal, Mesial, Mesiolingual, Distolingual, Distal,
cervical line to tip of lingual cusp. Mesial contact area lies
Distobuccal.
at the center of middle third.
♦♦ Mesiobuccal aspect is slightly shorter as compared to
♦♦ Mesial marginal ridge forms the occlusal outline which is
distobuccal aspect.
slightly concave.
♦♦ Mesiolingual aspect is more shorter as compared to
♦♦ Triangular ridges of buccal and lingual cusp are also seen
distolingual aspect.
converging cervically toward the center of occlusal surface.
♦♦ From occlusal aspect the buccolingual dimensions are
♦♦ Crest of curvature of cervical line is slightly curved
occlusally. greater than mesiodistal dimensions.
♦♦ Two well developed cusps are present, i.e. buccal cusp
Distal Aspect and lingual cusp.
♦♦ Geometric shape is trapezoidal. ♦♦ Buccal cusp is located slightly distal to the midline while
♦♦ Distal surface is convex. the lingual cusp tip is placed mesial to midline.
♦♦ Distal marginal ridge is smooth and does not consist of ♦♦ Mesial contact area is less buccally placed as compared to
any grooves. distal contact area.
♦♦ Distal contact area lies at the same level as mesial contact ♦♦ Buccal outline from occlusal aspect is convex.
area. ♦♦ Lingual outline is convex too but dimensions are lesser
♦♦ Distal contact area is more broader and more buccally than buccal aspect.
placed buccolingually as compared to mesial contact area. ♦♦ Mesial as well as distal outlines are straight. Mesial outline
is bordered by mesial marginal ridge while distal outline
♦♦ Cervical line is straight.
is bordered by distal marginal ridge.
Occlusal Aspect within its Boundaries
Within the boundaries, occlusal aspect consists of:
Cusps and Cuspal Ridges
Permanent maxillary first premolar has two well developed
cusps, i.e. buccal cusp and lingual cusp.
Buccal Cusp
♦♦ It is longer and well formed.
♦♦ Mesiobuccal and distobuccal cuspal ridges are seen which
are well defined and form a relatively straight line.
♦♦ A well-defined buccal triangular ridge is present which
extends from tip of buccal cusp lingually to the central
developmental groove.
♦♦ Inclined planes at buccal cusp lie on either side of the
triangular ridge which slopes towards the central groove.
Fig. 57: Maxillary first premolar-distal aspect
586 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Marginal Ridges Q.2. Compare and contrast the morphology of maxillary first
Permanent maxillary first premolar consists of two marginal premolar and second premolar. (Oct 2008, 4 Marks)
ridges, i.e.: Ans.
Dental Anatomy 587
Lingual cusp Short and narrow as compared to buccal cusp Lingual cusp is of same length and width as buccal cusp
Crown length Appear shorter from lingual aspect. Appear longer from lingual aspect
Lingual surface Less convex More convex
Lingual convergence Crown tapers more towards lingual aspect. Crown tapers less towards lingual aspect.
Mesial aspect
Contd…
588 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Contd…
Q.3. Write a short note on occlusal aspect of maxillary first ♦♦ Mesial contact area lies occlusal to the center of the crown
premolar. (Sept 2006, 5 Marks) and placed cervico-occlusally.
Or ♦♦ From buccal aspect the distal outline is concave nearby
cervix and it becomes convex as it connects with occlusal
Write a short note on occlusal surface of maxillary first outline.
premolar. (Aug 2011, 5 Marks) ♦♦ Distal contact area is broad and lies cervico-occlusally.
Or ♦♦ From buccal aspect the occlusal outline is presented by
buccal cusp. Buccal cusp tip is sharp.
Write short note on morphology of occlusal surface of
♦♦ Both the cuspal ridges, i.e. mesiobuccal and distobuccal
maxillary first premolar. (May 2017, 3 Marks)
cusp ridges are slightly concave.
Or ♦♦ Mesial cusp ridge is shorter than the distal cusp ridge.
Write about occlusal aspect of permanent maxillary ♦♦ Cervical line is curved apically.
first premolar. Draw well labelled diagram for it.
Lingual Aspect
(Jan 2018, 3+2 Marks)
Ans. Refer to Ans l of the same chapter. ♦♦ Geometric shape is trapezoidal.
♦♦ From lingual aspect, there is presence of marked lingual
Q.4. Describe the permanent mandibular first premolar. convergence of crown which leads to narrow lingual
(Apr 2007, 15 Marks) surface.
Or ♦♦ Lingual sloping of occlusal surface is present because of
Describe the morphology of mandibular first premolar shorter lingual cusp. Due to this inclined planes of buccal
cusp buccal, triangular ridge, marginal ridge and mesial
in detail. (July 2016, 10 Marks)
and distal fossae are seen.
Ans. Following is the morphology of permanent mandibular
♦♦ Tip of lingual cusp is pointed. Lingual cusp is in line with
first premolar:
buccal triangular ridge.
Morphology of Crown ♦♦ A mesiolingual developmental groove is present which
extend from mesial developmental groove of occlusal
Buccal Aspect surface to the lingual surface mesially.
♦♦ Geometric shape of tooth from buccal aspect is trapezoidal. ♦♦ Mesial, distal and cervical outline are same as seen in
♦♦ Crown of permanent mandibular first premolar seems to buccal aspect.
be broader with narrow cervix. ♦♦ From lingual aspect, the occlusal outline is formed by the
♦♦ Buccal aspect of tooth is convex. cusp tip of lingual cusp as well as cusp ridges of lingual cusp.
♦♦ Well developed middle buccal lobe is present. It is ♦♦ Notching of occlusal outline is seen by a groove which
passes in between mesial marginal ridge and mesiolingual
presented as a long buccal cusp and prominent buccal
cusp ridge.
ridge.
♦♦ Buccal cusp tip is in line with straight root axis while the ♦♦ Buccal and lingual outlines are same as that of mesial aspect.
lingual cusp tip is in line with lingual outline of root. ♦♦ Occlusally, distal marginal ridge lies perpendicular to
♦♦ Sloping of mesial marginal ridge is present in lingual long axis of tooth.
direction. ♦♦ Distal marginal ridge is at higher level as compared to
♦♦ Mesial contact area lies occlusally in center of crown, and mesial marginal ridge.
lies in line with buccal cusp tip. ♦♦ Cervical line is nearly straight.
♦♦ Buccal outline from mesial aspect is convex from cervical
area to buccal cusp tip. Occlusal Aspect
♦♦ Lingual outline from mesial aspect is convex. ♦♦ Geometric shape is of diamond shape or circular.
♦♦ Buccally the height of contour lies at cervical third while ♦♦ Buccal outline is convex and bordered by mesial and distal
lingually the height of contour lies at middle third of crown.
slopes of buccal cusp.
♦♦ Occlusal outline from mesial aspect is concave.
♦♦ Mesial marginal ridge shows sloping in lingual direction. ♦♦ Lingual outline is convex with mesial and distal marginal
♦♦ Cervical line shows a slight curvature in occlusal direction. ridges converging towards lingual cusp.
Occlusal Aspect within its Boundaries
Fig. 61: Mandibular 1st premolar-mesial aspect Fig. 63: Mandibular 1st premolar-occlusal aspect
2. Distal developmental groove is situated in distal fossa. It ♦♦ From buccal aspect, distal outline is convex from cervical
is longer. area to contact area.
3. Mesiolingual developmental groove: It is a prominent
developmental groove. It extends between mesial mar-
ginal ridge and mesiolingual cusp ridge over the lingual
surface mesially.
Pit
Mesial and distal pits are present in mesial and distal fossa.
Marginal Ridges
♦♦ Mesial marginal ridge is short as compared to distal
marginal ridge. It is constricted and slopes sharply
lingually in cervical direction.
♦♦ Distal marginal ridge is prominent than mesial marginal
ridge.
Morphology of Root
Fig. 64: Mandibular 2nd premolar-buccal aspect
♦♦ Mandibular premolar has a single root.
♦♦ Root is conical in shape and it tapers evenly from cervical ♦♦ Distal contact area lies at middle third of crown.
area to apex. ♦♦ From buccal aspect crown is short and bulky.
♦♦ Root is wider buccolingually in dimensions as compared ♦♦ Buccal surface is convex and smooth too.
mesiodistally. ♦♦ Buccal ridge is prominent and extends from cervical line
♦♦ Buccal and lingual surfaces of root are convex. Mesial and to cusp of buccal tip.
distal surfaces are flat. ♦♦ Tip of buccal cusp is blunt.
♦♦ Towards lingual surface root tapers acutely. ♦♦ Cervical line has slight apical curvature.
♦♦ Developmental depression is present on both mesial and
distal roots. Developmental depression on the mesial Lingual Aspect
surface is deeper than on the distal surface. ♦♦ Geometric shape of tooth from lingual aspect is trapezoidal.
♦♦ Apex of root is pointed. ♦♦ From lingual aspect crown appears bulky.
♦♦ Distal curvature is seen over apical third of root. ♦♦ Little bit of proximal surfaces are visible from this aspect.
Q.5. Write about occlusal aspect of permanent mandibular ♦♦ Small portion of buccal cusp is visible from this aspect.
first premolar. (Nov 2008, 4 Marks)
Ans. Refer to Ans 4 of the same chapter.
Q.6. Describe in brief the morphological characteristics of
mandibular second premolar. (Jan 2012, 10 Marks)
Or
Describe the morphology of maxillary second premolar
in detail. (Aug, 2011, 15 Marks)
Or
Describe the morphology of mandibular second
premolar in detail with schematic presentation of its
occlusal anatomy. (Aug 2018, 10 Marks)
Ans. Following is the morphology of permanent mandibular
second premolar:
Morphology of Crown
Fig. 65: Mandibular 2nd premolar-lingual aspect
Buccal Aspect
♦♦ From lingual aspect the occlusal outline is formed by
♦♦ Geometric shape of tooth from buccal aspect is trapezoidal. lingual cusp and cuspal ridges of lingual cusp.
♦♦ From buccal aspect, the mesial outline is convex from ♦♦ Mandibular premolar show variation as it presents two
cervical line to mesial contact area. types of cusp patterns i.e three cusp pattern and two cusp
♦♦ Mesial contact area lies at middle third of crown. pattern.
592 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Grooves
♦♦ Three developmental grooves are present which converges
at central pit and form a ’Y’ shaped pattern.
♦♦ Few supplementary grooves are present.
♦♦ Mesial developmental groove is long. It extends from
central pit mesiobuccally to the mesial triangular fossa.
♦♦ Distal developmental groove is a short. It extends from
central pit to the distal triangular fossa.
♦♦ Lingual developmental groove is centered over root. It
extends in a lingual direction between two lingual cusps
and ends on the lingual surface of the crown.
Pits
♦♦ Mesial pit is present in mesial triangular fossa.
♦♦ Distal pit is present in distal triangular fossa.
Fig. 67: Mandibular 2nd premolar-distal aspect ♦♦ Central pit is present in centre of occlusal surface.
Dental Anatomy 593
Morphology of Root
♦♦ Broad and strong root is present which is longer than
mandibular first premolar tooth.
♦♦ Root is conical in shape and is single.
♦♦ Root is wider mesiodistally when compared buccolin-
gually.
♦♦ Buccal and lingual surface of root are convex while mesial
and distal surfaces are flat.
♦♦ Root apex is blunt.
Fig. 69: U pattern ♦♦ Root can be straight or it can show distal curvature too.
Q.7. Write in brief occlusal aspect of permanent mandibular
Grooves
second premolar. (Apr 2008, 7.5 Marks)
♦♦ Central developmental groove is present which give rise to Ans. Refer to Ans 6 of same chapter.
two patterns, i.e. when U pattern is present central groove
is crescent shaped and when H pattern is present central Q.8. Describe the morphology of permanent maxillary first
groove is straight connecting mesial and distal fossa. premolar. Write arch traits of maxillary first premolar.
(Feb 2013, 10 Marks)
Ans. For morphology of maxillary permanent first premolar
refer to Ans 1 of same chapter.
For arch traits of maxillary first premolar refer to the
table given in Ans 9 of same chapter.
Q.9. Describe the morphology of permanent mandibular
first premolar. Write arch traits of mandibular first
premolar. (Feb 2013, 10 Marks)
Ans. For mandibular permanent first premolar refer to Ans 4
of same chapter.
For arch traits of mandibular first premolar refer to the
table.
Q.10. Define and enumerate different type of traits. Describe central incisor is wider while the width of maxillary permanent
morphology of maxillary first premolar, including its lateral incisor is narrow.
endodontic anatomy. (Feb 2014, 8 Marks) For morphology of maxillary first premolar refer to Ans 1 of
Ans. Following are the different types of traits: same chapter.
1. Set trait. For endodontic anatomy of maxillary first premolar refer to
2. Arch trait. Ans 2 of chapter PULP MORPHOLOGY.
3. Class trait. Q.11. Write short note on arch traits of mandibular premolars.
4. Type trait. (Dec 2014, 3 Marks)
Set trait: These traits are the features that differentiate teeth in Ans. Refer to Ans 9 of same chapter.
primary dentition from the teeth in permanent dentition, e.g.
Q.12. Define traits. Describe the different types of traits. Give
primary teeth are white in color while permanent teeth are
a detail account of right mandibular second premolar
yellowish white in colour.
occlusal anatomy. (Oct 2016, 10 Marks)
Arch trait: These traits are those which differentiate maxillary Ans. A trait is a distinguishing characteristic, quality or attribute.
teeth from mandibular teeth, e.g. maxillary first molar consists
of cusp of Carabelli while it is absent in mandibular first molar. Different Types of Trait
Class trait: These traits are those which differentiate four Following are the different types of trait:
categories of teeth, i.e. incisors, canine, molars and premolars, 1. Set traits
e.g. incisors are used for cutting, canines for piercing, premolars 2. Arch traits
for grinding and molars for crushing. 3. Class traits
Type trait: These traits differentiate teeth within one class, 4. Type traits.
i.e. differentiation of incisors but between maxillary central or ♦♦ Set trait: These traits are the features that differentiate teeth
lateral incisors, e.g. mesiodistal width of maxillary permanent in primary dentition from the teeth in permanent dentition.
Dental Anatomy 595
e.g. primary teeth are white in color while permanent teeth Describe the morphology of buccal, lingual, mesial,
are yellowish white in color. distal and occlusal aspect of permanent maxillary first
♦♦ Arch trait: These traits are those which differentiate max- molor. (Jan 2018, 2 + 2 + 2 + 2 + 2 Marks)
illary teeth from mandibular teeth, e.g. is maxillary first Ans. Introduction
molar consists of cusp of Carabelli while it is absent in • Maxillary first molar is normally the largest tooth
mandibular first molar. in maxillary area.
♦♦ Class trait: These traits are those which differentiate four • It has four well developed functional cups and one
categories of teeth, i.e. incisors, canine, molars and premo- supplemental cusp called as cusp of carabelli.
lars, e.g. incisors are used for cutting, canines for piercing, • C rown of the tooth is wider buccolingually than
premolars for grinding and molars for crushing. mesiodistally.
♦♦ Type trait: These traits differentiate teeth within one class, Following is the morphology of permanent maxillary
i.e. differentiation of incisors but between maxillary cen- first molar:
tral or lateral incisors, e.g. mesiodistal width of maxillary
permanent central incisor is wider while the width of Morphology of Crown
maxillary permanent lateral incisor is narrow. Buccal Aspect
For detail account of right mandibular second premolar
♦♦ Geometric shape of maxillary first molar is trapezoidal.
occlusal anatomy refer to Ans 6 of same chapter. For
♦♦ From buccal aspect, mesial outline is mostly straight except
diagram of occlusal anatomy of right mandibular second that it become slight convex when it is connecting with
premolar refer to figure 68 of Ans 6 of same chapter. occlusal outline.
Q.13. Write differences between maxillary first premolar and ♦♦ Mesial contact area lies at the junction of occlusal and
mandibular first premolar tooth. (Feb 2016, 3 Marks) middle third of crown.
♦♦ From buccal aspect, distal outline is convex from occlusal
Or surface to cervix.
Write the differences between maxillary and ♦♦ Distal contact area lies in middle third.
mandibular permanent first premolar. ♦♦ From buccal aspect, occlusal outline is bounded by
(Sep 2018, 5 Marks) mesiobuccal and distobuccal cusps as well as their slopes.
Ans. For differences between maxillary first premolar and
mandibular first premolar tooth refer to Ans 9 of same
chapter.
Mesial Aspect
♦♦ Geometric shape of crown is trapezoidal.
♦♦ From mesial aspect the buccal outline is convex from cusp
tip to the cervix.
Occlusal Aspect
♦♦ Geometric shape of tooth is rhomboidal.
♦♦ Buccolingual dimensions of crown are larger as compared
to mesiolingual dimensions.
♦♦ Taper of crown is more towards distal side.
♦♦ From occlusal aspect, buccal outline is convex.
♦♦ Lingual outline is more convex and rounded.
♦♦ Mesial outline is straight and longer.
Fig. 73: Maxillary 1st molar-mesial aspect
♦♦ Distal outline is slightly convex.
Dental Anatomy 597
♦♦ Palatal root is wide mesiodistally and is narrow buccoling ♦♦ From buccal aspect the occlusal outline shows three buccal
ually. Palatal root extends lingually and stretches beyond cusps, i.e. mesiobuccal, distobuccal and distal cusps.
the boundation of crown before bending in buccal direction ♦♦ From buccal surface almost all cusps are seen.
at apical third. ♦♦ Buccal surface is constituted by mesiobuccal and
♦♦ Mesiobuccal root is broader buccolingually. distobuccal cusps along with distal cusp.
♦♦ Mesiobuccal root is straight while the distobuccal root ♦♦ Mesiobuccal cusp is wide and sharp as compared to
has distal tilt. distobuccal cusp.
♦♦ All roots are seen from buccal as well as lingual aspect. ♦♦ Mesial and distal cusp ridges of both buccal cusps are flat
♦♦ From mesial aspect only palatal and mesiobuccal roots can and meet at an obtuse angle.
be seen. Since distobuccal root is smaller so it is not seen.
♦♦ From distal aspect, palatal and distal roots are prominent
while the mesiobuccal root is seen in background.
♦♦ A deep groove is present at start of bifurcation of two
buccal roots and extends towards cervix.
♦♦ A depression is present at bifurcation of palatal and
mesiobuccal root which run lingually at cervix.
♦♦ All three roots have round apices which are blunt.
Q.2. Describe the morphology of occlusal surface of
permanent maxillary first molar tooth.
(Sep 2009, 15 Marks)
Ans. Refer to Ans 1 of the same chapter.
Q.3. Describe the morphology of permanent mandibular
first molar. (Sep 1999, 15 Marks) (Mar 2001, 15 Marks)
(Feb 2005, 15 Marks) (Nov 2008, 15 Marks)
(Dec 2010, 10 Marks) (Nov 2010, 8 Marks)
(Feb 2013, 15 Marks) (Jan 2012, 15 Marks)
Fig. 76: Mandibular 1st molar-buccal aspect
Or
Describe the morphology of mandibular first molar. ♦♦ Mesiobuccal developmental groove separates the
(June 2010, 10 Marks) mesiobuccal and distobuccal cusps. Mesiobuccal groove
Ans. Introduction runs till middle third of buccal surface and ends at buccal
Mandibular molars are larger than any other mandibular pit and is placed slightly mesial to bifurcation of root.
teeth. ♦♦ Distobuccal developmental groove separates distobuccal
and distal cusps and extends till middle third of buccal
• They are three in number on each side of mandible.
surface.
• Mandibular first molar is the largest tooth in the
♦♦ Lingual cusps are seen backwards and they lie at higher
mandibular arch.
level as compared to buccal cusps.
• It has five well developed cusp, i.e. two buccal, two
♦♦ Buccal surface is convex at occlusal third and cervical
lingual and one distal cusp.
third region.
• It has two well developed roots one mesial and one
♦♦ Cervical line is commonly regular and shows a dip apically
distal. at root bifurcation.
Following is the morphology of permanent mandibular
first molar: Lingual Aspect
♦♦ Geometric shape of tooth at lingual aspect is trapezoidal.
Morphology of Crown ♦♦ Mesial as well as distal aspect is similar to the buccal aspect.
Buccal Aspect ♦♦ Occlusal outline is formed by sharp lingual cusps and
their cuspal ridges.
♦♦ Geometric shape of mandibular first molar is trapezoidal.
♦♦ From lingual aspect both mesiolingual and distolingual
♦♦ From buccal aspect, mesial outline is convex but at cervix cusps are seen along with the small portion of distal cusp.
it is concave. ♦♦ From lingual aspect tapering of crown is seen which leads
♦♦ Mesial contact area lies at junction of occlusal and middle to narrowing of buccal surface.
third. ♦♦ A part of distal cusp as well as mesial and distal surfaces
♦♦ From buccal aspect distal outline is straight starting from of crown is visible from this aspect.
cervical line and it become convex at distal contact area. ♦♦ Tip of mesiolingual cusp is higher than distolingual cusp.
♦♦ Distal contact area lies at junction of occlusal and middle ♦♦ Lingual developmental groove run in between both the
third. lingual cusps and extends to a short distance.
Dental Anatomy 599
♦♦ Lingual surface is smooth and convex in occlusal third and ♦♦ Mesial surface is smooth and convex but a shallow
flat in cervical third. concavity is seen just below contact area.
♦♦ A concavity is seen at center of lingual surface in middle ♦♦ Mesial contact area lies at junction of occlusal and middle
third part. third.
♦♦ Cervical line is irregular and show slight apical curvature ♦♦ Cervical line is almost straight with crest of curvature 1mm
at root bifurcation. towards occlusal surface.
Distal Aspect
♦♦ Geometric shape of tooth is rhomboidal from this aspect.
♦♦ Buccal outline shows slight convexity from cervix to distal
cusp tip.
Mesial Aspect
Fig. 79: Mandibular 1st molar-distal aspect
♦♦ Geometric shape of tooth is rhomboidal from this aspect.
♦♦ From mesial aspect, buccal outline of crown is more convex ♦♦ Lingual outline is straight from cervix to middle third and
from cervix to middle third and it is slightly convex till flat slight convex from middle third to tip of distolingual cusp.
mesiobuccal cusp tip. ♦♦ Occlusal outline show distal convergence of crown and
♦♦ Height of buccal contour lies at cervical third. short distal marginal ridge. Distal marginal ridge lie
♦♦ From mesial aspect, lingual outline is evenly convex from lingual to centre of crown buccolingually.
cervix to mesiolingual cusp tip. ♦♦ Distal surface is smooth and convex. It is narrow as
♦♦ Height of lingual contour lies at middle third. compared to mesial surface.
♦♦ Occlusal outline presents sharp mesiolingual cusp tip ♦♦ Distolingual and distal cusps are visible which are present
which lies at higher level as compared to flat mesiobuccal in line.
cusp tip. ♦♦ Distobuccal cusp consists of distobuccal developmental
♦♦ From mesial aspect, mesiobuccal and mesiolingual cusps groove.
are seen. ♦♦ Distal contact area lies at junction of occlusal and middle
third.
♦♦ Cervical outline is almost straight.
Occlusal Aspect
♦♦ Geometric shape of tooth is roughly hexagonal from this
aspect.
♦♦ Mesiodistal width of crown is more than buccolingual
width.
♦♦ Crown shows convergence towards the distal side due to
which crown looks wider on mesial and narrow on distal side.
♦♦ Of all the cusps, mesiobuccal cusp is the largest cusp, then Fossae
are mesiolingual as well as distolingual cusps which are
Permanent mandibular first molar consists of one major fossa
of same length, then is the distobuccal cusp and shortest and two minor fossae. Major fossa is central fossa and minor
of all is distal cusp. fossae are mesial and distal triangular fossa.
♦♦ Cuspal ridges of buccal and distal cusps are flat while those ♦♦ Central fossa: It is a circular depression which is visible
of lingual cusp are sharp. at center of occlusal surface between buccal and lingual
♦♦ Triangular ridge is present with all the cusps along with cusp ridges.
two inclined planes. Triangular ridges of lingual cusp are ♦♦ Mesial triangular fossa: It is a small depression whose base
well defined. is formed by mesial marginal ridge and apex by mesial pit.
Its sides consist of mesiobuccal and mesiolingual cusps.
Grooves
♦♦ Distal triangular fossa: It is a more smaller depression
♦♦ Four developmental grooves are present along with some compared to mesial triangular fossa. Its base is formed by
supplementary grooves. distal marginal ridge, apex by distal pit and sides consists
♦♦ Central developmental groove: It originates at central of distal slopes of distolingual cusp and distal cusp.
pit and run both mesially and distally and ends in mesial
and distal pits. Marginal Ridges
♦♦ Mesiobuccal developmental groove: It starts at central pit ♦♦ Mesial marginal ridge: Present on occlusal outline of
and extends between mesiobuccal and distobuccal cusps mesial aspect.
and ends on buccal surface. ♦♦ Distal marginal ridge: Present on occlusal outline of
♦♦ Distobuccal developmental groove: It starts at central pit distal aspect.
and extend between distobuccal and distal cusps and ends ♦♦ Mesial marginal ridge is longer and lies at higher level
on buccal surface. than distal marginal ridge.
♦♦ Lingual developmental groove starts at central pit and
extends in between mesiolingual and distolingual cusps Morphology of Root
and ends at lingual surface. ♦♦ Permanent mandibular first molar consists of two roots
namely mesial root and distal root.
Pits
♦♦ Both roots are of same length.
♦♦ Central pit is a narrow depression which is visible in ♦♦ Root trunk of tooth is short and bifurcation is near to cervix.
central fossa. ♦♦ Developmental depressions are present on buccal and
♦♦ Mesial pit is seen in mesial triangular fossa. lingual surfaces of root trunk which run from bifurcation
♦♦ Distal pit is seen in distal triangular fossa. to the cervix.
Dental Anatomy 601
♦♦ Mesial root is straight upto half of its length and in its ♦♦ Central developmental groove run from central pit to
apical half it shows distal curvature. mesial and distal sides and end in mesial and distal pit.
♦♦ Slanting of distal root is present distally from root base. ♦♦ Buccal developmental groove begins at central pit and
♦♦ Developmental depressions over mesial and distal surface extend between mesiobuccal and distobuccal cusps and
lie over the whole length of roots. ends at buccal surface.
♦♦ Apex of mesial root is blunt while apex of distal root is sharp. ♦♦ Lingual developmental groove begins at central pit and
Q.4. Describe occlusal surface of permanent mandibular extend between mesiolingual and distolingual cusps and
second molar of right side? (Mar 1995, 16 Marks) ends at lingual surface.
Ans Pits
Occlusal Aspect ♦♦ Central pit is a narrow depression which is visible in
♦♦ Geometric shape of crown is rectangular. central fossa.
♦♦ Mesiodistal width of crown is more than buccolingual ♦♦ Mesial pit is seen in mesial triangular fossa.
width. ♦♦ Distal pit is seen in distal triangular fossa.
♦♦ Tooth appears wider lingually as compared to buccal side. Fossae
♦♦ Mesial outline of crown is less rounded as compared to
distal outline. ♦♦ It consists of mesial and distal fossa.
♦♦ Near the mesiobuccal line angle cervically a prominence ♦♦ Mesial fossa is small depression adjacent to mesial
is seen. marginal ridge.
♦♦ Distal fossa is small depression adjacent to distal marginal
ridge.
♦♦ Both the fossae are equal in size.
Marginal Ridges
Mesial and distal marginal ridges are present which forms base
of mesial and distal triangular fossa.
Q.5. Write a note on cusp of carabelli. (Mar 2000, 5 Marks)
Or
Write in briefly on cusp of Carabelli.
(June 2010, 10 Marks)
Ans. Cusp of carabelli is also known as fifth cusp.
• It is the characteristic feature of lingual surface of
permanent maxillary first molar.
• Cusp of carabelli is present on the mesiolingual cusp.
• It can be well developed or can be graded down to
Fig. 81: Mandibular second molar-occlusal aspect a series of grooves and depressions.
• If fifth cusp is well developed fifth cusp is separated
Occlusal Surface within its Boundaries from mesiolingual cusp by groove.
Cusp and Cusp Ridges • Cusp of carabelli is the supplemental cusp.
Q.6. Describe with diagram pit and groove pattern of per-
♦♦ The tooth consists of four cusps, i.e. mesiobuccal,
manent mandibular first molar. (Mar 2009, 5 Marks)
distobuccal, mesiolingual and distolingual.
♦♦ Mesiobuccal and distobuccal cusps are of equal length. Ans. Refer to Ans 3 of same chapter.
♦♦ Buccal and lingual mesial cusps are larger than their Q.7. Write a short note on occlusal surface of maxillary first
counterparts. molar. (Mar 2006, 5 Marks)
♦♦ Lingual cusp ridges are well defined while buccal cusp Or
ridges are more flattened. Write about occlusal aspect of permanent maxillary
♦♦ All the four cusps consist of triangular ridges which con- first molar.` (Feb 2013, 5 Marks)
verge in center of occlusal surface.
Ans. Refer to Ans 1 of the same chapter.
Grooves Q.8. Discuss briefly arch traits of molars and describe the
♦♦ Groove pattern of permanent mandibular second molar morphology of permanent mandibular first molar.
forms a plus mark ‘+’ in center of occlusal aspect dividing (Mar 2006, 15 Marks)
it in four parts. Ans. Refer to Ans 1 of the same chapter.
602 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Contd...
Q.9. Write in detail differences between deciduous and per- Describe the morphology of permanent mandibular
manent teeth. Describe the occlusal aspect of maxillary first molar. Write arch traits of mandibular first molar.
first molar. (Dec 2012, 8 Marks) (May 2014, 10 Marks)
Ans. For differences refer to Ans 1 of chapter DIFFERENCES Ans. For morphology of permanent maxillary first molar refer
BETWEEN PRIMARY AND PERMANENT to Ans 1 of same chapter. For morphology of permanent
DENTITION. mandibular first molar refer to Ans 3 of same chapter.
For arch traits of permanent maxillary molar and permanent
For occlusal aspect of maxillary first molar refer to Ans
mandibular molar refer to Ans 8 of same chapter.
1 of same chapter.
Q.11. Write short note on type traits of maxillary first
Q.10. Describe the morphology of permanent maxillary first
permanent molar. (Dec 2014, 2 Marks)
molar. Write arch traits of maxillary first molar.
Ans. Following are the type traits of maxillary first permanent
Or molar:
Features Maxillary Ist molar Maxillary IInd molar Maxillary IIIrd molar
General features
Size of tooth Largest of all Smaller as compared to first molar Smallest of all
Variability in shape Show least variability Has two shapes, i.e. rhomboidal and Show lot of variation
heart shaped
Lobes 5 4 Either 3 or 4
Cusps 5 4 Either 4 or 3
Crown
Buccal aspect
Width of crown Widest of all Width of crown is moderate In width it is smallest of all three
Height of buccal cusps Both cusps, i.e. mesiobuccal and Mesiobuccal cusp is slightly longer Mesiobuccal cusp is much longer than
distobuccal cusps are of same than distobuccal cusp distobuccal cusp
height
Height of the crown Distally height of crown is slightly Distally height of crown is much less Distally height of crown is much less as
less as compared to mesial as compared to mesial compared to mesial
Distal tilt of crown Crown is upright over root base It shows slight distal tilt It shows more distal tilt
Contd...
604 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Contd...
Features Maxillary Ist molar Maxillary IInd molar Maxillary IIIrd molar
Slanting of occlusal Horizontal It slant cervically from mesial surface It slant more cervically from mesial
surface towards distal surface surface towards distal surface
Buccal groove Long Short Shortest
Buccal pit It is more marked It is less marked It can be absent
Lingual aspect
Width of crown It is wider lingually as compared to It is narrower lingually as compared It is narrower on lingual surface as
buccal aspect to buccal aspect compared to buccal surface
Lingual convergence No lingual convergence is present Slight More
Distolingual cusp Always present Absent in three cusp type Absent
Cusp of Carabelli Present Rarely present Absent
Mesial aspect
Total cusps seen from 3, i.e. mesiobuccal, mesiolingual 2, i.e. mesiobuccal, mesiolingual 2, i.e. mesiobuccal, mesiolingual
mesial aspect and cusp of carabelli
Contact area Mesial contact area is narrower as Both contact areas are equally broad Mesial contact area is broad and distal
compared to distal contact area. contact area is absent
Distal aspect
Surface area Short Narrow and short Narrow and short
Occlusal aspect
Geometric shape Rhomboidal in shape Rhomboidal in shape Heart shaped
Oblique ridge More prominent Less prominent Variable
Size of distolingual cusp Large Small Smallest
Q.12. Give the chronology of right maxillary first permanent Q.13. Define cusp, fossa and groove. Write the differences
molar. Describe the occlusal aspect of it in detail with between permanent maxillary and mandibular first molar
diagram. (Apr 2017, 3+5+2 Marks) with well labeled diagrams. (Sep 2018, 3 + 7 Marks)
Ans. Chronology of right maxillary first permanent molar Ans. Cusp: Cusp is defined as an elevation of crown of tooth
making up a divisional part of occlusal surface.
First evidence of calcification At birth Fossa: Fossa is defined as a depression or a concavity
Enamel completion 3 to 4 years
on lingual surface of anteriors and occlusal surface of
posteriors.
Eruption 6 to 7 years
Groove: A groove is defined as a line separating the lobes
Roots completed 9 to 10 years or primary part of crown or root.
For occlusal aspect of right maxillary first permanent molar Differences between Permanent Maxillary and Mandibular
along with diagram refer to Ans 1 of same chapter. First Molar with Well Labeled Diagrams
Contd...
Dental Anatomy 605
Contd...
Relative crown dimensions Crown is buccolingually broader than mesiodistally Crown is mesiodistally broader than buccolingually
Cusps It consists of two buccal cusps, i.e. mesiobuccal cusp It consists of three buccal cusps, i.e. mesiobuccal cusp,
and distobuccal cusp distobuccal cusp and distal cusp
Height of cusps Mesiobuccal cusp and distobuccal cusp are of same Mesiobuccal cusp is largest
height
Buccal surface It is relatively flat Buccal surface is convex and is inclined lingually
Crown height Crown height over distal is slightly lesser than on mesial Crown appears shorter due to its greater mesiodistal
width.
Crown is shorter at distal than mesial side
Buccal pit It is more pronounced, buccal groove often ends in It is commonly present. Dental caries may occur.
buccal pit. This is the most common site of caries Mesiobuccal developmental groove terminates in this
buccal pit
Mesial and distal outlines Mesial and distal crown outlines are nearly equal sized Mesial and distal outlines taper noticeably from contact
areas to cervical line
Lingual aspect
Lingual convergence Least or no lingual convergence present Marked lingual convergence is present
Number of cusps on lingual Two lingual cusps are present, i.e. mesiolingual and Two lingual cusps are present, i.e. mesiolingual and
aspect distolingual cusps. One accessory cusp is also present, distolingual cusps
i.e. cusp of Carabelli
Size of lingual cusps Lingual cusps are of different sizes, i.e. large mesiolingual Lingual cusps are of equal size
and small distolingual cusp.
Cusp of carabelli It is the additional cusp lingual to mesiolingual cusp. It It is not present
is the characteristic feature
Contd...
606 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
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At occlusal surface, in the center access cavity is oval shaped ♦♦ At cervical level root canal is rhomboidal with three canal
which provide access to buccal and lingual canals. orifices.
608 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦♦ At mid root level palatal canal is round; distobuccal canal ♦♦ Tooth consists of four pulp horns.
is oval shaped and mesiobuccal canal is kidney shaped. ♦♦ Lingual pulp horns are long and lie at higher level while
buccal pulp horns are short and lie at lower level.
♦♦ Floor of pulp chamber lie below cervical margin.
Fig. 86: Pulp chamber and root canals in mesiodistal section of Fig. 88: Pulp chamber and root canals in mesiodistal section of
permanent maxillary first molar permanent mandibular first molar
Access Cavity
Root Canals
♦♦ Access cavity opening should be triangular with the round
corners which extend at mesiobuccal cusp tip, mesial
marginal ridge and the oblique ridge.
♦♦ When second mesiobuccal canal is present access cavity
is rhomboidal shaped.
Fig. 87: Access cavity of permanent maxillary first molar ♦♦ The tooth consists of two roots and three canals. In this,
mesial tooth has two root canals namely mesiobuccal canal
Q.4. Describe morphology of permanent mandibular first and mesiolingual canal.
molar from all aspects. Write a note on its endodontic ♦♦ Distal root canal is oval in shape. Sometimes distal root
anatomy. (Oct 2014, 8 Marks) can show two canals.
Ans. For morphology of permanent mandibular first molar
refer to Ans 3 of chapter THE MAXILLARY AND Cross-section
MANDIBULAR MOLARS. ♦♦ At cervical level tooth is quadrilateral in shape.
Following is endodontic anatomy of permanent ♦♦ At mid-root level mesial canal is slight oval while distal
mandibular first molar: canal is long and oval shaped.
Ans. Occlusion is defined as the “static and dynamic contact ♦♦ Graf Von Spee and Ferdin were the first to discover curve
relationship between the occlusal surface of teeth during of spee. They had explained the relationship of mandibular
function” Glossary of prosthodontic terminology (GPT). teeth in sagittal plane.
♦♦ When viewing from the point which lies perpendicular
Occlusion in Primary Teeth to first molar a curvature of mandibular occlusal plane is
♦♦ Mesial surface of maxillary and mandibular central incisors present which starts at incisal edges as well as tip of lower
are in line with each other at the midline. canine and follow buccal cusp of premolars and molars,
♦♦ Maxillary central incisor occludes with mandibular central this curvature is continuous till ramus and is known as
incisor and the mesial third of the mandibular lateral incisor. Curve of Spee or Curve of Von Spee.
♦♦ Maxillary lateral incisor occludes with the distal two third ♦♦ The ideal curve of spee is aligned in a way that curvature
of the mandibular lateral incisor and the median portion should extend through condyles and form a segment of
of mandibular canine from tip of cusp. Maxillary canine circle with radius of 4 inches.
occludes with that portion of the mandibular canine distal to
the cusp tip and the mesial third of the mandibular first molar.
♦♦ M axillary first molar occludes with the distal third of
mandibular first molar and mesial portion of mandibular
second molar.
♦♦ Maxillary second molar occludes with the remainder of
the mandibular second molar.
♦♦ Distal surface of maxillary molar projecting slightly over
the distal portion of the mandibular second molar.
♦♦ Increasing the curve of spee can compensate for smaller ♦♦ It is also called as first factor of occlusion.
maxillary anterior teeth, especially lateral incisors while ♦♦ This is the only factor which can be recorded from the
reducing the curve of spee can reduces the vertical overlap patient.
of the tooth. ♦♦ This is the mandibular guidance which is generated by
condyles traversing the contours of glenoid fossa.
Curve of Monson
♦♦ This is duplicated on the articulator. Extent of duplication
♦♦ Monson in 1932 has discovered a cusp which is known as depends on articulators capability whether it is semi-
Curve of Monson. adjustable or fully-adjustable.
♦♦ Monson has observed the occlusal plane which is three ♦♦ Protrusive condylar guidance is taken by using protrusive
dimensional spherical curve and involves right and left records while lateral condylar guidance is obtained by
incisors, cuspid, bicuspid, molars and condyles whose Hanau’s formula.
centre lies at glabella. ♦♦ Condylar guidance is expressed in degrees.
♦♦ Curve of Monson is a segment of a sphere of 4 inches radius. ♦♦ Increase in the condylar guidance increases the jaw separa-
♦♦ As per Monson, all incisal edges as well as buccal cusps tion during protrusion.
of mandibular teeth are segment of this sphere and ♦♦ This factor cannot be modified. All the other four factors
masticatory forces converge at center, i.e. Glabella. of occlusion should be modified to compensate the effects
♦♦ The concept given by Monson was later on discarded by of this factor.
Dempster et al. who proved that there is no convergence of ♦♦ Shallow condylar guidance lead to less posterior tooth
longitudinal axis of roots of teeth toward a common center. separation in protrusion and requires teeth with short
cusps and flat fossa to achieve balanced occlusion than a
steep guidance.
Incisal Guidance
♦♦ It is defined as “the influence of the contacting surfaces
of the mandibular and the maxillary anterior teeth on
mandibular movements”. —GPT 8th Edition
♦♦ It is also called as second factor of occlusion.
♦♦ It is determined by the dentist and customized for patient
during anterior try-in.
♦♦ Incisal guidance acts as a controlling path for the move-
ment of casts in an articulator.
♦♦ It should be set depending upon the desired overjet and
overbite planned for the patient. If the overjet is increased;
then the inclination of the incisal guidance is decreased.
Fig. 92: Curve of monson If the overbite is increased, then the incisal inclination
increases.
Q.3. Define occlusion. Describe the factors governing ♦♦ Incisal guidance has more influence on the posterior teeth
occlusion. (Mar 2007, 8 Marks) (Sep 2009, 5 Marks) than the condylar guidance, because the action of the in-
cisal inclination is closer to the teeth than the action of the
Or condylar guidance.
Write about factors governing occlusion of teeth. ♦♦ The angle formed by this protrusive path to the horizontal
(Aug 2012, 10 Marks) plane is called as the protrusive incisal path inclination or
Ans. Occlusion is defined as the “static and dynamic contact the incisal guide angle. This influences the shape of the
relationship between the occlusal surface of teeth during posterior teeth.
function” Glossary of prosthodontic terminology ♦♦ If the incisal guidance is steep, then steep cusps or a steep
(GPT). occlusal plane or a steep compensatory curve is needed to
produce balanced occlusion.
Factors Governing Occlusion of Teeth
Orientation of Occlusal Plane
Factors governing occlusion are as follows:
♦♦ It is defined as “An imaginary surface which is related ana-
Condylar Guidance tomically to the cranium and which theoretically touches
♦♦ Condylar guidance is defined as “the mechanical form the incisal edges of the incisors and the tips of the occluding
located in the upper posterior region of an articulator surfaces of the posterior teeth. It is not a plane in the true
which controls movement of its mobile member”. —GPT sense of the word, but represents the mean curvature of
8th Edition the surface”.—GPT
Dental Anatomy 611
♦♦ It is established anteriorly by the height of the lower canine, • During lateral movement, the mandibular lingual
which nearly coincides with the commissure of the mouth cusps on the working side should slide along the
and posteriorly by the height of the retromolar pad. inner inclines of the maxillary buccal cusp. In the
♦♦ It is usually parallel to the ala-tragus line or Camper’s line. balancing side, the mandibular buccal cusps should
♦♦ It can slightly be altered. contact the inner inclines of the maxillary palatal cusp.
♦♦ Tilting the plane of occlusion beyond l0° is not advisable. This relationship forms a balance, only if the teeth are
set following the Monson’s curve, then there will be
Compensating Curves
lateral balance of occlusion.
♦♦ It is defined as “The anteroposterior and lateral curvatures ♦♦ Compensating curve for Anti-Monson or Wilson’s Curve
in the alignment of the occluding surfaces and incisal edges • It is defined as ‘A curve of occlusion which is convex
of artificial teeth which are used to develop balanced oc- upwards’—GPT
clusion”.—GPT • This curve runs opposite to the direction of the
♦♦ It is an important factor for establishing balanced occlu- Monson’s curve.
sion and is determined by the inclination of the posterior • It is followed when the first premolars are arranged,
teeth and their vertical relationship to the occlusal plane. so that they do not produce any interference to lateral
♦♦ There are two types of compensating curves, namely: movements.
1. Anteroposterior Compensating curves.
♦♦ Reverse curve
2. Lateral compensating curves.
• It defined as “A curve of occlusion which in transverse
Curve of Spee, Wilson’s curve, and Monson’s curve are cross-section confirms to a line which is convex
associated with natural dentition.
upward”. GPT
In complete dentures, compensating curves similar to these
• It improves the stability of the denture.
curves should be incorporated to produce balanced occlusion.
• It is explained in relation to mandibular posterior
Anteroposterior Compensating Curves teeth.
• The reverse curve was modified by Max Pleasure to
These are compensatory curves running in an anteroposterior
form the pleasure curve.
direction and helps in abtaining protrusive balance. They
♦♦ Pleasure curve
compensate for the curve of Spee seen in natural dentition.
• It is defined as “A curve of occlusion which in
♦♦ Compensating curve for curve of spee
transverse cross-section confirms to a line which is
• Curve of Spee is defined as, “Anatomic curvature of
convex upward except for the last molars”. —GPT
the occlusal alignment of teeth beginning at the tip of
• It was proposed by Max. Pleasure to balance the
the lower canine and following the buccal cusps of
occlusion and increase the stability of the denture.
the natural premolars and molars, and continuing to
• Here, the first molar is horizontal and the second
the anterior border of the ramus as described by Graf
von Spee’—GPT premolar is buccally tilted.
• It is an imaginary curve joining the buccal cusps of the • The second molar independently follows the
mandibular posterior teeth starting from the canine anteroposterior compensating curve and is lingually
passing through the head of the condyle. tilted.
• It is seen in the natural dentition and should be • This curve runs from the palatal cusp of the first
reproduced in a complete denture. premolar to the distobuccal cusp of the second molar.
• The significance of this curve is that when the patient • The second molar gives occlusal balance and the
moves his mandible forward, the posterior teeth set second premolar gives lever balance.
on this curve will continue to remain in contact. If the Cuspal Inclination
teeth are not arranged according to this curve. There
will be disocclusion during protrusion of the mandible ♦♦ It is defined as “The angle made by the average slope of
(Christensen’s phenomenon). a cusp with the cusp plane measured mesiodistally or
buccolingually”. —GPT
Lateral Compensating Curves ♦♦ The mesiodistal cusps which lock the occlusion and
These curves run transversely from one side of the arch to the repositioning of teeth do not occur due to settling of the
other. The following curves fall in this category: denture base. So to prevent the locking of occlusion the
♦♦ Compensating curve for Monson’s curve mesiodistal cusps are reduced during occlusal reshaping.
• It is defined as “The curve of occlusion in which In the absence of mesiodistal cusps, the buccolingual cusps
each cusp and incisal edge touches or conforms to a are considered as a factor for balanced occlusion.
segment of a sphere of 8 inches in diameter with its ♦♦ In patients having shallow overbite, the cuspal angle
center in the region of the Glabella”.—GPT should be reduced to balance the incisal guidance, so that
• This curve runs across the palatal and buccal cusps of the jaw separation will be less. Teeth with steep cusps will
the maxillary molars. produce occlusal interference in these cases.
612 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦♦ In patients with deep bite (steep incisal guidance), the jaw Q.5. Write a short note on curve of spee and leeway space
separation is more during protrusion. Teeth with high cus- of Nance. (Sep 2006, 5 Marks)
pal inclines are required in these cases to produce posterior Or
contact during protrusion.
Write short note on leeway space of Nance.
Q.4. Write short note on functions of teeth. (July 2016, 3 Marks) (Nov 2010, 2 Marks)
(Mar 2007, 8 Marks) (Apr 2010, 5 Marks)
Or
Or
Write short note on leeway space. (May 2014, 2 Marks)
Write about tooth functions. (Jan 2012, 5 Marks)
Or
Ans.
Write very short answer on leeway space of Nance.
Chewing (Aug 2018, 2 Marks)
Chewing is the main function of teeth. Teeth are part of the Ans. For curve of spee refer to Ans 2 of the same chapter.
digestive system; chewing is the first stage of the process of
Leeway Space of Nance
digestion. Food needs to be broken down and chewed before
entering the digestive system so that the body can easily ♦♦ Combined mesiodistal crown dimension of primary
absorb nutrients from them. In the absence of teeth, digestion canine and primary first and second molars is larger than
is hampered leading to significant disturbances in food combined mesiodistal crown dimension of their successor,
absorption. Depending on their position and type, teeth have i.e. permanent canine and first as well as second premolars.
a role in shearing, tearing or grinding food. So the amount of space gained by their difference in the
posterior segment is known as leeway space of Nance.
Esthetics ♦♦ Leeway space is seen in both the arches.
Teeth, especially those located in visible areas, have an important ♦♦ Measurement of leeway space for maxillary and man-
aesthetic role. The position, shape and shade of teeth have a dibular arches is:
pronounced impact in shaping each individual personality. 1. For maxilla: Leeway space in each quadrant of maxilla
is 0.9 mm, so total leeway space in maxilla is 1.8 mm
Pronunciation 2. For mandible: Leeway space in each quadrant of
mandible is 1.7 mm, so total leeway space in mandible
Teeth can help us pronounce accurately as they have an
is 3.4 mm.
important role in the pronunciation of consonants. When teeth
are missing (especially upper front teeth), the normal speech Significance of Leeway Space of Nance
can be severally affected.
♦♦ Leeway space is a favorable feature as it provides the
Various Teeth and their Specific Functions mesial movement of permanent molars.
lar first molar to move mesially more than maxillary first ♦♦ Improper overjet in posterior segment leads to cheek bite.
premolar. This arrangement leads to the change in molar ♦♦ Excessive overjet and overbite in anterior segment affect
relationship from end on in early mixed dentition phase aesthetics.
to Class I relation in late mixed dentition phase. ♦♦ Excessive incisal overjet is often seen in deciduous denti-
Q.6. Describe overjet and overbite. (June 2010, 5 Marks) tion. This excessive overjet is corrected by forward growth
of mandible.
Or
Q.7. Write a short note on flush terminal plane.
Write short note on overjet and overbite.
(Oct 2008, 2 Marks) (Dec 2010, 2 Marks)
(Apr 2015, 3 Marks)
Ans.
Ans. When the overlap of maxillary and mandibular teeth
is measured in sagittal plane between incisal edge of ♦♦ It is also known as straight terminal plane.
maxillary incisor and labial surface of mandibular ♦♦ Mesiodistal dimension of mandibular second molar is
incisor, it is known as overjet or horizontal overlap. greater than that of maxillary second molar, leaving the
♦♦ Normal overjet is 1 to 2 mm. distal surface of two teeth in same plane. This is known
♦♦ When the overlap of maxillary and mandibular teeth is as Flush terminal relationship.
measured in vertical plane between incisal edge of maxil- ♦♦ This is a normal feature of the deciduous dentition.
lary and mandibular incisors, it is known as overbite or ♦♦ Flush terminal plane is seen in 76% of children.
horizontal overbite or vertical overlap. ♦♦ Flush terminal plane is considered to be the ideal kind of
♦♦ Normal overbite is 2 to 3 mm. molar relationship in primary dentition.
♦♦ Overbite and overjet are such that they allow jaw function ♦♦ Significance of flush terminal plane relationship is that
without interference. it leads to normal eruption of maxillary and mandibular
permanent first molars and their occlusion.
Q.9. Write short note on compensatory curves. • Balanced occlusion is not present in natural
(Oct 2016, 3 Marks) (Aug 2012, 4 Marks) dentition.
Or • Balanced occlusion affects the stability of denture.
• Balanced occlusion possess following characteristics,
Describe in brief compensating curves of dental arches. i.e.
(Jan 2012, 5 Marks) (May 2014, 5 Marks) 1. Simultaneous contact of teeth occurs at the time
Or of protrusion.
Answer in brief compensatory curves. 2. Teeth present over working side glide evenly
(Aug 2016, 2 Marks) against opposite teeth without any interference.
Ans. The compensatory curves are curve of spee, curve of 3. Contacts should present over the balancing
Monson and curve of Wilson. side, the contacts over balancing side should not
interfere with gliding movements of working
For curve of Spee and curve of Monson in detail refer to
side.
Ans 2 of same chapter.
Q.11. Define occlusion. Write in short about overjet and
overbite. (Sep 2015, 1 + 4 = 5 Marks)
Ans. Occlusion is defined as the “static and dynamic contact
relationship between the occlusal surfaces of teeth during
function”. Glossary of prosthodontic terminology.
For overjet and overbite in detail refer to Ans 6 of same
chapter.
Q.12. Write short note on ugly duckling stage.
(Apr 2015, 3 Marks)
Ans. It is also known as Broadbent phenomenon since H
Broadbent discovered it in 1937.
• It commonly occurs at the time of second transitional
Fig. 97: Curve of Wilson period.
• It is seen at the age of 9 to 11 years or at the time
Curve of Wilson when canine erupt.
♦♦ Curve of Wilson is a mediolateral curve which contacts • Ugly duckling stage is indicative of unaesthetic
buccal and lingual cusp tips of each side of arch. appearance of child at this period of age.
♦♦ Generally posterior teeth in maxillary arch have slight • It is a self correcting anomaly. As canine erupts fully
buccal inclination while mandibular posterior teeth have the condition get correct by itself.
slight lingual inclination. If a line is drawn through buccal • Clinical significance of this stage is that the
and lingual cusp tips of both right and left posterior teeth orthodontic treatment should not be carried out
a curved plane of occlusion is observed. This curvature during this period.
is convex in maxillary arch and concave in mandibular
Events Occurring in Development of Ugly Duckling Stage
arch. When arches come in occlusion both these curvatures
match perfectly. This curvature in occlusal plane is seen
from frontal view and is known as curve of Wilson.
♦♦ Curve of Wilson permit mediolateral jaw movements
during mastication and provides easy access to occlusal
table as tongue lay food over the occlusal surfaces of teeth.
Q.10. Write short note on balanced occlusion.
(May 2014, 2 Marks)
Or
Answer in brief balanced occlusion.
(Oct 2016, 2 Marks)
Ans. Balanced occlusion is defined as “ Simultaneous contact
of maxillary and mandibular teeth on right and left sides
in anterior and posterior occlusal areas in centric and
eccentric positions, developed to lessen or limit tipping
or rotating of denture base in relation to supporting
structures”. GPT (Glossary of Prosthodontic terms)
Dental Anatomy 615
Q.15. Define occlusion. What is key of occlusion. the mesial surface of the mesial marginal ridge of the
(Apr 2017, 5 Marks) mandibular second permanent molar.
Ans. Occlusion is defined as the “static and dynamic contact ♦♦ The mesiolingual cusp of the maxillary first permanent
relationship between the occlusal surface of teeth during molar seats in the central fossa of the mandibular first
function” Glossary of prosthodontic terminology (GPT). permanent molar.
For Key of occlusion refer to Ans 13 of same chapter. ♦♦ This is the normal molar relation.
Q.16. Write a short note on types of dentition. Add a note on Class II Relation
Leeway space of Nance. (Sep 2017, 3 Marks)
♦♦ In this mesiobuccal cusp of maxillary first molar is aligned
Ans. Types of dentition directly over embrasure area between mandibular second
Humans consist of three types of dentition, i.e. primary, premolar and first molar.
mixed/transitional and permanent dentition. ♦♦ Distobuccal cusp of maxillary first molar is in line with
mesiobuccal groove of mandibular first molar.
Primary Dentition ♦♦ Mesiobuccal cusp of mandibular first molar occludes
Tooth start to erupt in oral cavity from 8 months and complete with the central fossa of maxillary first molar, while the
by 30th month after birth when primary molars are in occlusion. distolingual cusp of maxillary first molar occludes in the
Once the primary dentition is established there are no significant central fossa area of mandibular first molar.
changes occur intraorally during primary dentition. There are Class III Relation
all over 20 deciduous teeth present.
♦♦ In this mandibular molars are mesial to maxillary molar as
Mixed or Transitional Dentition compared to class I relation. So mesiobuccal cusp of maxil-
lary first molar is found to be situated over the embrasure
This period starts from 6 years of age and last till 12 years of
area between mandibular first and second molar.
age. It is a transition stage when primary teeth are exfoliated
♦♦ Distobuccal cusp of mandibular first molar is situated in
in a sequential manner, followed by the eruption of their embrasure between maxillary second premolar and first
permanent successors. In first transitional period, eruption of molar, whereas mesiolingual cusp of maxillary first molar
permanent first molars and replacement of primary incisors by is situated in mesial pit of mandibular second molar.
the permanent incisors occur. The second transitional period
involves replacement of the primary molars and canines by the
permanent premolars and canine; respectively, and emergence
of second permanent molars.
Permanent Dentition
This stage is established by about 12 to 14 years of age excluding
the third molars.
For note on leeway space of Nance refer to Ans 5 of same Fig. 99 Molar relation in permanent dentition
chapter.
Q.18. Write short answer on curve of S pee and curve of
Q.17. Define occlusion. Discuss molar relation, overjet and
Wilson. (Aug 2018, 3 Marks)
overbite in permanent dentition. (May 2018, 3 Marks)
Ans. For curve of Spee refer to Ans 2 of same chapter.
Ans. Occlusion is defined as the “static and dynamic contact
For curve of Wilson refer to Ans 9 of same chapter.
relationship between the occlusal surface of teeth during
function” Glossary of prosthodontic terminology (GPT)
For overjet and overbite refer to Ans 6 of same chapter 13. REVIEW OF TOOTH MORPHOLOGY
Molar Relation in Permanent Dentition
Q.1. Describe and illustrate the status of dentition at the age
Molar relation of permanent teeth can be Class I, Class II or of 10 years. (Feb 2005, 1.5 Marks) (Sep 2007, 15 Marks)
Class III as described by Angle. Key teeth for this classification (Apr 2010, 15 Marks)
are permanent first molars. Or
A child of 10 years reports to you for examination.
Class I Relation
Show with the help of diagram only the teeth which
♦♦ The mesiobuccal cusp of the maxillary first permanent are present in oral cavity and the teeth which will be
molar falls within the groove between the mesial and embedded in jaw with degree of calcification?
middle cusps of the mandibular first permanent molar. (Mar 2001, 15 Marks)
♦♦ The distal surface of the distal marginal ridge of the max- Ans. At 10 years it is a stage of late childhood. It is a school
illary first permanent molar contacts and occludes with stage.
Dental Anatomy 617
Deciduous teeth present at the stage of 10 years: Permanent mandibular dentition present at the stage of 7 years
1. Maxillary canine 1. In mandible the central incisor completely erupts and the
2. Maxillary first molar root is completely formed.
3. Mandibular first molar. 2. Crown of lateral incisor is slightly erupted and root forma-
tion is incomplete.
3. Crown of canine is embedded in the jaw and root forma-
tion does not take place.
4. In first and second premolar crown formation is complete
but they are embedded in the jaw.
5. Crown formation of first molar is complete but the root
completion does not take place.
7. Articular disc or meniscus: A fibrocartilage disc articulating surface of temporal bone. It divides joint into
divides the joint, it increases the range of the superior and inferior compartments.
movement, e.g. ♦♦ Articular ligaments: TMJ has one major and three minor
- Palanar joint: Joint between first rib and sternum. ligaments. Temporomandibular is major ligament, while
- Hinge joint: Elbow, ankle and interphalangeal sphenomandibular, stylomandibular and pterygoman-
joint. dibular raphae are minor ligaments.
- Condylar joint: Knee joint, temporomandibular ♦♦ Muscles: Muscle which is closest to the TMJ is lateral
joint pterygoid muscle. It helps in the protrusion of mandible.
- Saddle joint: Sternoclavicular, calcaneocuboid Q.3. Enumerate the components of temporomandibular
joint joint. (Sept 2015, 2 Marks)
- Ball and socket joint: Hip joint, shoulder joint, Ans. Following are the components of TMJ:
incudostapedius joint.
1. Bone or hard tissue components
Q.2. Write a short note on components of TMJ. a. Condyles of mandible
(Nov 2010, 3 Marks) (Dec 2014, 2 Marks) b. Glenoid fossa of temporal bone
Or c. Articular eminence
Write briefly on components of TMJ. 2. Soft tissue components
(Apr 2017, 2 Marks) a. Articular capsule
Or b. Articular disc
Write a short note on anatomy of TMJ. c. Articular ligaments
(Sep 2017, 2 Marks) d. Muscles.
Ans. Temporomandibular joint has two types of components: Q.4. Write a short note on ligaments associated with tem-
1. Bone or hard tissue components poromandibular joint. (Aug 2016, 3 Marks)
2. Soft tissue components. Or
Bone or Hard Tissue Components Answer in brief on ligaments of temporomandibular
joint. (May 2017, 2 Marks)
The hard tissue components of TMJ are:
Ans.
♦♦ Condyles of mandible: They are ovoid, convex pro-
cesses which are broader laterally and narrower medially. Ligaments of Temporomandibular Joint
Condyles are connected with the body of mandible by Following are the ligaments of temporomandibular joint:
narrow stalk on both the sides.
Fibrous Capsule
♦♦ It is attached above to the articular tubercle, circumference
of mandibular fossa and squamotympanic fissure and
below the neck of mandible.
♦♦ It is loose above intra-articular disc and tight below it.
Temporomandibular Ligament or Lateral Ligament
♦♦ Temporomandibular ligament is a major ligament.
♦♦ It is the fan-shaped ligament which is present on the lateral
aspect of articular capsule.
♦♦ This ligament extends as thickening of capsule obliquely
in backward and downward direction from lateral aspect
Fig. 102: Components of temporomandibular joint of articular eminence to posterior part of condylar neck.
♦♦ This ligament has two parts, i.e. outer part and the inner
♦♦ Glenoid fossa of temporal bone: Articular surface of
part.
temporal bone is situated on the inferior surface of squa-
♦♦ This ligament helps to prevent displacement of tempo-
mous part of temporal bone. It articulates with mandibular
romandibular ligament in both posterior and inferior
condyle and is known as glenoid fossa.
directions.
♦♦ Articular eminence: It binds mandibular fossa anteriorly
♦♦ Since temporomandibular joint is bilateral, temporoman-
and form anterior root of zygomatic process.
dibular ligament prevent lateral displacement of one joint
Soft Tissue Components and medial displacement of another joint.
♦♦ This ligament is the remnant of the dorsal part of Meckel’s Q.5. Draw well labeled diagram of TMJ.
cartilage (Jan 2018, 2 Marks)
♦♦ This ligament limits distension of mandible in inferior
Ans.
direction.
1. Oblique ridge of maxillary Ist molar connects: 8. In FDI system of notation ‘64’ refers to:
a. Mesiobuccal to distopalatal a. Deciduous maxillary right first molar
b. Mesiopalatal to distobuccal cusp b. Deciduous maxillary left first molar
c. Mesial to distal cusp c. Deciduous mandibular right first molar
d. None of the above d. Deciduous mandibular left first molar
2. Elevation on the teeth surface are: 9. Acute angled cusps in permanent maxillary first molar
a. Cusp and ridge are:
b. Fossa and groove a. Distobuccal and mesiolingual
c. Both a and b b. Mesiobuccal and distobuccal
d. None of the above c. Mesiobuccal and distolingual
3. Eruption age of permanent maxillary canine is: d. Mesiolingual and distolingual
a. 9–10 years 10. For speech the essential component is:
b. 8–9 years a. Inspired air
c. 11–12 years
b. Expired air
d. 12–13 years
c. Heart beats
4. In ideal intercuspation, maxillary canine articulate d. Temperature
with:
11. All anterior teeth are formed by:
a. Mandibular canine and Ist premolar
a. 1 developmental lobe
b. Mandibular canine and lateral incisor
b. 2 developmental lobes
c. Mandibular Ist and 2nd premolar
c. 3 developmental lobes
d. Mandibular canine only
d. 4 developmental lobes
5. Cusp of Carabelli is seen on:
12. The first succedaneous tooth to erupt in oral cavity is:
a. Mandibular premolar
b. Mandibular canine a. Maxillary central incisor
c. Mandibular Ist molar b. Mandibular central incisor
d. Maxillary Ist molar c. Mandibular first molar
d. Mandibular canine
6. Eruption age of permanent maxillary central incisor is:
a. 6–7 years 13. Mesial contact area of permanent canine is at:
b. 7–8 years a. Middle third
c. 8–9 years b. Junction of incisal and middle third
d. 10–11 years c. Junction of middle and cervical third
d. None of the above
7. Curve passing through buccal and lingual tip of man-
dibular buccal teeth: 14. Mandibular first premolar erupts between:
a. Wilson curve a. 9–10 years
b. Curve of Spee b. 8–9 years
c. Monsoon curve c. 10–12 years
d. Anti-monsoon curve d. 11–12 years
Answers: 1. b 2. a 3. a 4. a
5. d 6. b 7. a 8. b
9. d 10. b 11. d 12. c
13. b 14. c
Dental Anatomy 621
15. Which of the following are the functions of contact 22. The permanent mandibular second molar occludes
area? with:
a. Distribution of occlusal stresses a. Maxillary 1st and 2nd molar
b. Protection of periodontium b. Maxillary 2nd premolar and 1st molar
c. Stabilization of dental arches c. Maxillary 2nd and 3rd molar
d. All of the above d. Maxillary 1st and 2nd premolars
16. In FDI system of notation ‘45’ refers to: 23. Muscles of mastication are supplied by:
a. Permanent maxillary right second premolar a. First part of maxillary artery
b. Permanent maxillary left second premolar b. Facial artery
c. Permanent mandibular right second premolar c. Third part of maxillary artery
d. Permanent mandibular left second premolar d. Second part of maxillary artery
17. Major fossae on occlusal surface of permanent maxil- 24. Anterior marginal articular disc and capsule of TMJ is
lary first molar are: the site of insertion for:
a. Mesial and distal triangular fossa a. Masseter
b. Central and distal fossa b. Temporalis
c. Distal and distal triangular fossa c. Medial pterygoid
d. Central and mesial fossa d. Lateral pterygoid
18. In all of the following teeth mesial slope of buccal cusp 25. Lingual cusp of premolar develops from:
is shorter than distal slope except: a. Mesial lobe
a. Permanent mandibular canine b. Distal lobe
b. Mandibular first premolar c. Middle lobe
c. Maxillary second premolar d. Lingual lobe
d. Maxillary first premolar 26. Curve of spee touches each cusp and incisal edges to
19. Which of the following permanent tooth is bilaterally confirm to a segment of:
symmetrical when viewed from incisal aspect? a. Ellipse
a. Mandibular lateral incisor b. Square
b. Mandibular canine c. Sphere
c. Mandibular central incisor d. Rectangle
d. Maxillary central incisor 27. As compared to permanent dentition the pulp horn
20. The crown of primary upper second molar has: and chambers in deciduous teeth are:
a. 2 cusps a. High and small
b. 3 cusps b. High and large
c. 4 cusps c. Low and small
d. 5 cusps d. Low and large
21. Mesiolingual groove is seen in: 28. Teeth that have no distal contact are:
a. Maxillary 1st premolar a. Central incisor
b. Mandibular 1st premolar b. Deciduous canine
c. Maxillary 2nd premolar c. Permanent third molar
d. Mandibular 2nd premolar d. Both b and c
1. Junction of three surfaces of tooth is called as……………. 4. Eruption of primary tooth starts off……………………
Ans. Point angle Ans. At 6 months
2. Lingual lobe of an anterior tooth is known as……………
5. Principle jaw opening muscle is…………………………
Ans. Cingulum
Ans. Digastric muscle
3. Number of roots and root canals in permanent man-
dibular first molar is…………….
Ans. Two roots and three canals
Dental Anatomy 623
1. Name the system which is acceptable to computer 15. When does calcification of primary dentition begins.
languages. Ans. 13 to 16 weeks
Ans. Universal system 16. How much time does permanent tooth take for com-
2. Two digit system for primary or permanent dentition plete formation?
is also known as. Ans. 8 years
Ans. FDI system 17. What is the sequence of permanent teeth eruption?
3. Who had proposed two digit system? Ans. 6 – 1 – 2 – 4 – 3 – 5 – 7 – 8
Ans. Dederation dentaire internationale 18. In how much time does transition from primary to
4. Name the linear elevation on the surface of a tooth. permanent dentition begins?
Ans. Ridge Ans. 6 years
5. Which type of ridge descends from the tips of the cusps 19. Who described the formation of permanent teeth oc-
of molars and premolars towards the central part of the curring in cluster?
occlusal surface? Ans. Schour and Massaler
Ans. Triangular ridge 20. Which is the first tooth of the permanent dentition to
6. Which ridge is formed by the union of the triangular emerge through the gingiva?
ridge of the distobuccal cusp and the distal cusp ridge Ans. First molar
of the mesiolingual cusp of maxillary molar? 21. Name other synonyms of primary teeth.
Ans. Oblique ridge Ans. Deciduous, milk, temporary, baby
7. Which is the one of the primary sections of formation 22. Name the tooth which is unique in that it has a crown
in the development of the crown? form unlike that of any permanent tooth?
Ans. Lobe Ans. Deciduous mandibular molar tooth
8. Which angle is formed by the junction of two surfaces? 23. In which dentition the crowns of anterior teeth are
Ans. Line angle wider mesiodistally in comparison with their crown
9. Which angle is formed by the junction of three surfaces? lengths.
Ans. Point angle Ans. Deciduous dentition
10. Who had given the specifications used for carving 24. In which tooth mesial slope of the cusp is longer than
individual teeth for the permanent dentition. the distal slope.
Ans. GV Black Ans. Canine
11. Who had given the dental age assessment based on the 25. How is the cusp of the primary canine as compared to
basis of the number of teeth at each chronological age? permanent canine?
Ans. Demerjian Ans. Long and sharp
12. Who had given dental age assessment based on the 26. From the incisal aspect the crown of which tooth is
stages of formation of crowns and roots of teeth? diamond shaped.
Ans. Smith Ans. Primary canine
13. Who had given dental age assessment in the mixed 27. Where does the bifurcation of the roots of the primary
first molar begins.
dentition based on the amount of resorption of roots
of primary teeth and amount of development of per- Ans. Cervical line
manent teeth? 28. Which cusp of the maxillary first molar is most promi-
Ans. Proffit nent longest and sharpest?
14. Who had mentioned that tooth formation that may be Ans. Maxillary first deciduous molar
divided approximately into a number of stages that 29. Crown of which primary molar resembles a permanent
covers continuously the development of teeth? maxillary premolar.
Ans. Nolla Ans. Maxillary first deciduous molar
624 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
30. Name the primary tooth which resembles the perma- 46. When does first evidence of calcification of maxillary
nent maxillary first molar. lateral incisor occurs.
Ans. Primary second molar Ans. 1 year
31. Name the tooth on which cusp of Carabelli’s of the 47. Which is the smallest tooth in the dental arch?
deciduous dentition is present. Ans. Mandibular central incisor
Ans. Primary maxillary second molar 48. When does first evidence of calcification of mandibular
32. Name the tooth who has a sharp and prominent me- central incisor occurs.
siolingual cusp which is almost entered lingually but Ans. 3 to 4 months
in line with the mesial root. 49. Which is the longest tooth in the mouth?
Ans. Primary first mandibular molar Ans. Maxillary canine
33. Name the largest cusp of the primary mandibular first 50. When does the first evidence of calcification of maxil-
molar. lary canine occur.
Ans. Mesiolingual Ans. 4 to 5 months
34. When the maxillary and mandibular primary teeth 51. When does the root completion of maxillary canines
occlude all the teeth occlude with two teeth in the op- occur.
posite jaw. Name the teeth which do not occlude with
Ans. 12 to 14 years
two teeth.
Ans. Mandibular central incisor and maxillary second molar 52. Name the anterior tooth most likely to have a bifurcated
root.
35. At what age does the separation of primary anterior Ans. Mandibular canine
teeth due to growth of the jaws is usually seen?
Ans. 4 to 5 years 53. When does the enamel completion of maxillary first
premolar occur.
36. Who had described the arrangement of natural teeth? Ans. 5 to 6 years
Ans. Graf von Spee
54. Name the distinguishing feature between the first and
37. In which animal triangular stage or tritubercular molars second maxillary premolar from the mesial aspect and
are seen. is present on the first premolar.
Ans. Dogs Ans. Mesial developmental groove
38. In whom quadritubercular molar are seen? 55. When does the first evidence of calcification of maxil-
Ans. Humans lary second premolar occur.
39. Which is the only tooth which is wider lingually than Ans. 2 to 2.5 years
buccally? 56. Name the largest tooth in the maxillary arch.
Ans. Maxillary first molar Ans. Maxillary first molar
40. Which is the most prominent teeth in the mouth? 57. Name the tooth which is considered to be the corner
Ans. Maxillary central incisor stone of the dental arches.
41. Which is the widest teeth mesiodistally among the Ans. First molars
anteriors? 58. Which root is the longest in the maxillary first molar
Ans. Maxillary central incisor tooth?
42. When does the first evidence of calcification of maxil- Ans. Lingual root
lary central incisor occur. 59. Which cusp is the smallest in the maxillary first molar
Ans. 3 to 4 months tooth?
43. When does enamel completion of the maxillary central Ans. Distobuccal root
incisor occur. 60. The cusp of Carabelli is usually found lingual to which
Ans. 4 to 5 years cusp of the maxillary first molar.
44. When does the root completion of maxillary central Ans. Mesiopalatal cusp
incisor occurs. 61. When does the enamel completion of maxillary first
Ans. 10 years molar occur.
45. Name the tooth that varies in form more than any other Ans. 3 to 4 years
tooth in the mouth with the exception of third molar. 62. When does root completion of maxillary first molar occur?
Ans. Lateral incisor Ans. 9 to 10 years
Dental Anatomy 625
63. Name the tooth in the maxillary arch in which the 77. How mandibular canal is directed?
crown is wider mesially then distally and wider lin- Ans. Upward, backward and laterally
gually than buccally.
78. Name the triangular shallow fossa which lies posterior
Ans. Maxillary first molar
to the third molar.
64. The maxillary molar primary cusp triangle supposition Ans. Retromolar triangle
follows which of the hypothesis of tooth origin.
Ans. Cope-Osborn 79. What is the another name for discomalleolar ligament?
Ans. Pinto's ligament.
65. During what age root completion of the maxillary
second molar gets completed. 80. Name the otomandibular ligaments which connect the
Ans. 14 to 16 years middle ear and the temporomandibular joint.
Ans. Discomalleolar ligament and temporomandibular
66. During which age the first evidence of calcification of
ligament
maxillary third molar occurs.
Ans. 7 to 9 years 81. What does pantograph and kinesiograph used to record?
Ans. Mandibular movements
67. What is the shape of mandibular first molar when seen
from the occlusal aspect? 82. How much is the maximum opening of the TMJ?
Ans. Hexagonal Ans. 50 to 60 mm.
68. How is the form of mandibular first molar from buccal 83. How much is the maximum lateral opening in the
aspect? absence of TMJ muscle dysfunction?
Ans. Trapezoidal Ans. 10 to 12 mm.
69. Who had given the morphological categories used to 84. How much is the maximum protrusive movement?
describe the occlusal surfaces of mandibular molar Ans. 8 to 11 mm
which are based upon a topology?
Ans. Gregory and Hellman 85. Which of the two muscles partly cover the masseter
muscle?
70. What is the other name of maxillary sinus?
Ans. Platysma and risorius
Ans. Antrum of Highmore
86. Name the muscle which is the principle positioner of
71. Major portion of the canine fossa is directly above the
the mandible during elevation.
roots of which tooth.
Ans. Temporalis
Ans. Premolar
87. At what age group function occlusion is common?
72. Name the muscle whose some of the fibers originate
from maxillary tuberosity. Ans. Above age of 30 years
Ans. Medial pterygoid 88. If all of the teeth get extracted what happens to centric
73. Which are the two canals which open laterally into the occlusion.
incisive foramen. Ans. Centric occlusion gets lost
Ans. Foramina of Stensen and Foramina of Scarpa. 89. Name the tooth which consists of palatogingival
74. Name the structure to whom foramen of stensen accom groove.
modates. Ans. Maxillary lateral incisor
Ans. Nasopalatine nerves and vessels 90. If any of the molar has no occluding teeth, what is the
75. Which is the heaviest and strongest bone of the head? effect on its position.
Ans. Mandible Ans. It get extruded
76. Name the structure present between the condyle and 91. Name the teeth which most commonly show morpho-
the coronoid process. logical variations.
Ans. Mandibular notch Ans. Lateral incisors
626 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Additional Matter
Various Types of Dentitions Contd...
Type of dentition Meaning Longest crown present in the mandibular Mandibular canine
arch or the longest crown present inside (11 mm)
Monophyodont In this there is presence of one set of dentition
the oral cavity
for the entire life
Diphyodont In this there is presence of two sets of Maximum root length present inside Maxillary canine
dentition, e.g. humans maxillary arch or longest root present (17 mm)
inside the oral cavity
Polyphyodont In this there is presence of greater than two
sets of dentition Maximum root length present inside Mandibular canine
mandibular arch (16 mm)
Homodont In this all teeth have same without any
distinction such as central incisor or lateral Shortest tooth of all the dentition Maxillary second molar
incisor or premolars or molars or shortest tooth present inside the (6.5 + 11 mm)
maxillary arch
Heterodont In this, there is presence of various different
groups of teeth Shortest tooth present inside mandibular Second molar
Bunodont This dentition consists of various primitive arch (7 + 13 mm)
types of teeth which are seen in primates such Shortest crown present dentition or Maxillary second molar
as dogs, cats etc shortest crown present in the maxillary (6.5 mm)
Haplodont They are simplest cone form of teeth with arch
single root, e.g. crocodile Shortest crown present in mandibular Second molar
Triconodont This dentition is present in early mammals. In arch (7 mm)
this three of the cusps are arranged in line with Shortest root present in maxillary arch or Maxillary second molar
the largest cusp in center shortest root in oral cavity (11 mm)
Tritubercular In this three of the cusps are arranged in form Shortest root present in mandibular arch Central incisor
stage of triangle (12.5 mm)
Quadritubercular In this there is formation of the fourth cusp
Largest mesiodistal diameter of crown Maxillary central incisor
stage and an occlusal contact relationship between
present in anterior teeth
maxilla and mandible is established
Largest mesiodistal diameter of crown Mandibular first molar
Various Teeth Along with the Shapes of their Occlusal present in oral cavity
Surfaces Largest labiolingual diameter of crown Maxillary canine
present inside the anterior teeth
Shape of the occlusal
Largest labiolingual diameter of crown Maxillary first molar
Name of the tooth surface
present inside the oral cavity
Permanent maxillary first premolar Hexagonal
Largest mesiodistal diameter present Mandibular second
Permanent mandibular first premolar Diamond inside the deciduous dentition molar
Permanent mandibular second premolar Square Largest buccolingual diameter present Maxillary second molar
inside the deciduous dentition
Permanent maxillary first molar and Rhomboidal
deciduous maxillary second molar First succedaneous tooth which erupt in Mandibular central
oral cavity incisor
Permanent maxillary second molar Rhomboidal having more
obtuse angles First non-succedaneous tooth to erupt in Mandibular first molar
oral cavity
Permanent maxillary third molar Heart shape
Last succedaneous tooth to erupt in oral Maxillary canine
Permanent mandibular first molar Hexagonal/trapezoidal
cavity
Deciduous maxillary first molar Rectangular
Longest tooth present in the oral cavity • Maxillary canine Name of teeth Lobes present
(10 + 17 mm) Permanent incisors 4
• Mandibular canine
Permanent canines
(11 + 16 mm)
Permanent premolars
Longest crown present in the maxillary Central incisor
arch (10.5 mm) Three cusp type mandibular second premolar 5
Contd... Contd...
Dental Anatomy 627
Dental Histology
♦♦ Further growth of mandible until birth is influenced ♦♦ Distal proliferation of dental lamina is responsible for
strongly by the appearance of three secondary cartilages, location of germs of permanent molars.
i.e. condylar cartilage, coronoid cartilage and symphyseal ♦♦ Successors of deciduous teeth develop from lingual
cartilage as well as the development of neural, alveolar and extension of free end of dental lamina opposite to enamel
muscular attachments. organ of each deciduous tooth.
♦♦ Dental lamina provides the arising of permanent molars
from its distal extension during development of jaws.
2. DEVELOPMENT AND Q. 3. Discuss and illustrate the various stages of development
GROWTH OF TEETH of tooth. (Sep 2002, 16 Marks)
Or
Q.1. Write a note on dental lamina.
(Oct 2006, 2 Marks) (Apr 2007, 5 Marks) Describe process of development of tooth.
(Feb 2013, 5 Marks) (June 2010, 2 Marks) (Sep 1999, 15 Marks) (Apr 2008, 15 Marks)
(Oct 2008, 6 Marks)
Or
Or
Write short answer on dental lamina.
(May 2018, 3 Marks) Describe with diagram various stages of tooth
development. (Mar 2009, 5 Marks)
Ans. Dental Lamina
• Dental lamina is the band of the epithelium that has Or
invaded underlying ectomesenchyme along each of Explain various stages in development of tooth in detail
horse shoe shaped future dental arches. with suitable diagrams. (Feb 2016, 10 Marks)
• Dental lamina serves as primordium for ectodermal Ans. Tooth development is a continuous process. Following
portion of deciduous teeth. are the stages which take part in development of tooth.
• Later, during development of jaws primary molars
arise directly from distal extension of dental lamina.
Distal proliferation of dental lamina is responsible
for location of germs of permanent molars in ramus
of mandible and tuberosity of maxilla.
• Successors of deciduous teeth develop from lingual
extension or successional lamina of free end of dental
lamina opposite to enamel organ of each deciduous
tooth.
Q. 2. Describe development, function and fate of dental
lamina. (Sep 1997, 5 Marks) (Mar 2009, 5 Marks)
Ans. Development of Dental Lamina
Two or three weeks after the rupture of buccopharyn-
geal membrane, when the embryo is about six weeks
old, certain areas of basal cells of ectoderm proliferate
more rapidly than do cells of adjacent areas. This leads
to development of dental lamina.
condensation immediately subjacent to enamel organ is dental ♦♦ Enamel organ may have a double attachment to the
papillae. The cells of dental papillae forms tooth pulp and overlying oral epithelium enclosing ectomesenchyme
dentin. The condensed ectomesenchyme which surrounds known as enamel niche.
tooth bud and dental papillae is called as dental sac. The ♦♦ Polygonal cells located in center of epithelial enamel organ,
cells in dental sac will form the cementum and periodontal between outer and inner enamel epithelia begin to separate
ligament. as more intercellular fluid is produced and form a cellular
network called as stellate reticulum. The stellate reticulum
is a cushion like consistency that may support and protect
the delicate enamel forming cells.
♦♦ Cells in centre of enamel organ are densely packed. These
cells form knob like extension which extends to underlying
dental papilla. This is known as enamel knot. Vertical
extension of enamel knot is known as enamel cord. As
enamel cord extends and meet outer enamel epithelium it
is known as enamel septum. Depression present at junction
of enamel septum and outer enamel epithelium is known
as enamel navel. Its shape is similar to shape of umbilicus.
Enamel knot and cord acts as reservoir of dividing cells
for growth of enamel organ. Enamel knot also plays an
important role as signaling center. It also determine the
shape of the tooth.
Fig. 4: Bud stage ♦♦ Under organizing influence of proliferating epithelium
(For colour version see Plate 20) of enamel organ, the ectomesenchyme which is partially
enclosed by invaginated portion of inner enamel epithelium
Cap Stage proliferates. It condenses to form dental papilla, which is
formative organ of dentin and primordium of pulp.
♦♦ As the tooth bud proliferates it does not expand uniformly
♦♦ With the development of enamel organ and dental papilla
into the larger sphere. The unequal growth in different
there is a marginal condensation in ectomesenchyme
parts of tooth bud leads to cap stage which is characterized
surrounding enamel organ and dental papilla. The cells
by shallow invagination on deep surface of bud.
of dental sac are important for the formation of cementum
and periodontal ligament.
outer enamel epithelium and stratum intermedium by ♦♦ As first layer of dentin is laid down the short columnar
desmosomes. inner epithelial cells become functional ameloblasts, i.e.
♦♦ Stellate reticulum protect underlying inner enamel become tall columnar cells which reverse their polarity.
epithelial cells. ♦♦ These ameloblasts produce organic matrix of enamel
♦♦ As a layer of dentin is laid down, inner enamel epithelial against newly formed dentin. Matrix proceed pulpally
cells cut off from their nutritional supply from dental and apically and mineralizes later.
papilla. Before enamel formation begins stellate reticulum ♦♦ This organic matrix mineralizes to form enamel.
disappears bringing capillaries closer in dental follicle close ♦♦ As enamel formation proceeds from dentinoenamel
to inner enamel epithelial cells for providing nutrition. junction towards outer surface, the ameloblasts move away
♦♦ Outer enamel epithelium has cuboidal cells which are from dentin coronally and cervically.
connected to adjacent cells by junctional complexes. As ♦♦ In addition the cervical portion of enamel gives rise to the
stellate reticulum disappears before enamel formation, the epithelial root sheath of Hertwig.
outer enamel epithelium is laid in folds. Between the folds
capillary loops provide rich nutritional supply for intense
metabolic activity of avascular enamel organ.
• Enamel organ of deciduous teeth in bell stage show
successional lamina and its permanent successor teeth
in bud stage.
• Invagination formed by enamel organ encloses dental
papilla. As inner enamel epithelium begins to form
enamel, the peripheral mesenchymal cells of dental
papilla differentiate in odontoblasts. First these cells
form cuboidal form and later on columnar form and
are liable to form dentin.
• Basement membrane separating enamel organ and
dental papilla before the formation of dentin is known
as membrane preformative.
• Dental sac show circular arrangement of fibers and
resembles as capsule.
Fig. 7: Advanced bell stage
(For colour version see Plate 20)
Advanced Bell Stage Write briefly on bell stage. (Apr 2007, 5 Marks)
Ans. Refer to Ans 3 of the same chapter.
♦♦ Advance bell stage usually is characterized by the
beginning of the mineralization and root formation. Q. 6. Write a short note on advanced bell stage of tooth
♦♦ During advanced bell stage, boundary between inner development.(Sep 1999, 5 Marks) (Nov 2008, 5 Marks)
enamel epithelium and odontoblasts outline the future (Nov 2010, 3 Marks) (Aug 2011, 5 Marks)
DEJ. Or
♦♦ As odontoblasts start to differentiate they increase the Write short note on advanced bell stage.
organic matrix of dentin along DEJ in region of future cusp. (Apr 2015, 3 Marks)
Dental Histology 635
Or
Describe advanced bell stage with well labelled
diagram. (Sep 2018, 3 + 2 = 5 Marks)
Ans. • Advance bell stage usually is characterized by the
beginning of the mineralization and root formation.
• During advanced bell stage, the boundary between
inner enamel epithelium and odontoblasts outline
the future DEJ.
• As odontoblasts start to differentiate they increase
the organic matrix of dentin along DEJ in region of
future cusp. Matrix proceed pulpally and apically
and mineralises later.
• As first layer of dentin is laid down the short
columnar inner epithelial cells become functional Fig. 9: Epithelial diaphragm (For colour version see Plate 21)
ameloblasts, i.e. become tall columnar cells which
reverse their polarity. • Inner enamel epithelial layer of root sheath influence
• These ameloblasts produce organic matrix of enamel formation of odontoblasts from outer portion of
against newly formed dentin. radicular dental papilla. These odontoblasts lead
• This organic matrix mineralizes to form initial layer to the formation of first layer of radicular dentin.
of enamel. • As the first layer of radicular dentin is laid down,
• As enamel formation proceeds from dentinoenamel Hertwig’s epithelial root sheath lost its continuity
junction towards outer surface, the ameloblasts and the cells of dental follicle or dental sac invade
move away from dentin coronally and cervically. double layer of Hertwig epithelial root sheath, root
• In addition the cervical portion of enamel gives rise sheath degenerates to form epithelial islands.
to the epithelial root sheath of Hertwig. • Now the root sheath move away and allow connective
tissue of dental follicle to come in contact with newly
formed radicular dentin. This causes differentiation
of cementoblasts from dental follicle which deposit
cementum on newly formed radicular dentin.
Q.8. Write a short note on enamel pearls.
(Feb 2002, 5 Marks)
Ans. If cells of epithelial root sheath remains adherent to dentin
surface, they may differentiate into fully functioning
ameloblasts and produce enamel, such droplets of enamel
are called as enamel pearls. They are sometimes found in
area of furcation of roots of permanent molars.
Fig. 8: Advanced bell stage (For colour version see Plate 20)
Q.9. Write a short note on ameloblasts.(Sep 1997, 5 Marks) Q.12. Enumerate the stages of tooth development. Write
Ans. The inner enamel epithelium consists of single layer of about bud and early bell stage. (Sep 2007, 7.5 Marks)
cells that differentiate prior to amelogenesis into tall Ans. Refer to Ans 3 of the same chapter.
columnar cells called as ameloblasts.
Q.13. Write a short note on gubernacular canal.
(Mar 2008, 2 Marks) (Dec 2010, 2 Marks)
(Jan 2012, 2 Marks) (Feb 2013, 2 Marks)
Ans. Gubernacular canal may seen during the eruptive phase
of tooth eruption.
• In case of a tooth that replaces a deciduous tooth the
histological findings are slightly different.
• Dental follicle that surrounds the tooth is connected
to lamina propria of oral mucous membrane by a
strand of fibrous tissue called gubernacular cord.
• The cord of tissue is believed to be a remnant of the
dental lamina.
• When a dried skull is examined, holes are seen in
lingual aspect of deciduous tooth to accommodate
the gubernacular cord.
Fig. 11: Ameloblasts • These are gubernacular canals and act as pathways
(For colour version see Plate 21) for sucessional tooth to erupt.
• As the permanent tooth starts eupting through the
• These cells are also called as enamel forming cells.
They form unmineralized enamel. gubernacular canal, local osteoclastic activity is seen
• These cells are 4 to 5 micrometer in diameter and about around the canal to widen it so that tooth passes into
40 micrometer high. the oral cavity.
• These elongated cells are attached to each other by
junctional complexes laterally and to cells in stratum
intermedium by desmosomes.
Q.10. Write a short note on early bell stage of tooth
development? (Feb/Mar 2006, 5 Marks)
Ans. Refer to Ans 3 of the same chapter.
Enumerate morphological stages of tooth development. ♦♦ Histodifferentiation is observed during bell stage just
Describe bell stage in detail. (Aug 2012, 10 Marks) before formation and apposition of dentin and enamel.
Or ♦♦ At bell stage, the inner enamel epithelium influences
Enumerate physiological and morphological stages of adjacent cells of dental papilla which get differentiate into
development of tooth. (July 2016, 3 Marks) odontoblasts. These odontoblasts laid down dentinal matrix.
♦♦ With formation of dentin cells of inner enamel epithelium
Ans. Morphologic Stages
differentiate into ameloblasts and enamel matrix is laid
• Bud stage down opposite to dentin.
• Cap stage ♦♦ Differentiation of epithelial cell proceed which is essential
• Early Bell stage for differentiation.
• Advanced Bell stage.
Physiologic Stages Morphodifferentiation
• Initiation ♦♦ Basic form and size of the future tooth, i.e morphology
• Proliferation of tooth is determined by morphodifferentiation or
• Histodifferentiation differential growth.
• Morphodifferentiation ♦♦ Dentinocemental junction and dentinoenamel junction
• Apposition. determine shape of crown and root.
For bell stage in detail refer to Ans 3 and Ans 6 of chapter ♦♦ Both the junctions get established before the formation
development of tooth. of hard tissue.
♦♦ As per the shape of dentinoenamel and dentinocemental
Q.15. Describe various morphological and physiologic stages
junction the ameloblasts, odontoblasts and cementoblasts
of tooth development. (Apr 2008, 15 Marks)
deposit enamel, dentin and cementum and thus provide
Ans. Morphologic Stages
the tooth its respective form and size.
• Bud stage
• Cap stage Apposition
• Early Bell stage
♦♦ Apposition refers to the deposition of matrix of dental
• Advanced Bell stage.
hard structures.
For morphologic stages in detail refer to Ans 3 of same ♦♦ This stage is characterized by certain periods of activity
chapter. and rest.
Ans. Physiologic Stages ♦♦ During appositional growth of enamel and dentin
• Initiation deposition of extracellular matrix occur in layers.
• Proliferation ♦♦ The stage consists of regular and rhythmic deposition of
• Histodifferentiation extracellular matrix which provides tooth its final shape.
• Morphodifferentiation Q.16. Write in brief on enamel knot and cord.
• Apposition. (June 2010, 5 Marks)
Initiation Or
♦♦ Initiation of tooth development starts with beginning of Write about enamel knot, cord, septum and navel.
epithelial-ectomesenchymal interaction. (Jan 2012, 5 Marks)
♦♦ Specific cells in horse shoe shaped dental lamina has Ans. Enamel knot: During cap stage, cells present in the centre
potential to form enamel organ of teeth by responding to of concavity of cap of enamel organ are densely packed.
the factors which induce tooth development. These cells form knob like extension which extends to
♦♦ Different teeth initiate at definite times. underlying dental papilla. This is known as enamel knot.
Enamel cord: Vertical extension of enamel knot is known
Proliferation as enamel cord.
♦♦ Initiation leads to the formation of enamel organ which Enamel septum: As enamel cord extends and meets outer
proliferates and the crown of tooth attain its final size as enamel epithelium it is known as enamel septum.
well as shape. Enamel navel: Depression present at junction of enamel
♦♦ Disturbance during proliferation stage produce entirely septum and outer enamel epithelium is known as enamel
different effects depending on the time and stage at which navel. Its shape is similar to shape of umbilicus.
disturbance occur. Enamel knot and cord acts as reservoir of dividing cells
for growth of enamel organ.
Histodifferentiation Enamel knot also plays an important role as signaling
♦♦ Cells continue to proliferate and undergo morphologic and center. It also determine the shape of the tooth.
functional changes. This is known as histodifferentiation. Enamel knot, cord, septum and naval are the transient
♦♦ During histodifferentiation, a cell loose some of its properties structures in tooth development or odontogenesis which
and restrict some of its functions and assume new function. disappears as enamel formation starts.
638 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.17. Write briefly on transient structures in odontogenesis. Morphological stage Physiological stage
(Aug 2012, 5 Marks) Dental Iamina Initation (of tooth germ)
Or Bud stage Proliferation (= cell division)
Write short note on transitory structures in tooth Cap stage Beginning of histodifferentiation
development. (Aug 2016, 3 Marks)
Bell stage Morphodifferentiation
Ans. Enamel knot, cord, septum and naval are the transient Histodifferentiation (prominent)
structures in tooth development or odontogenesis which
Early crown stage Apposition (formation of dentin and enamel)
disappears as enamel formation starts.
Late crown stage Continued apposition of dentin and enamel
For detail refer to Ans 16 of same chapter. (including enamel maturation)
Q.18. Enumerate stages of odonotgenesis and describe
advanced bell stage in detail. (Aug 2012, 10 Marks) For bell stage of development of tooth refer to Ans 3 and Ans
6 of same chapter.
Or
Enumerate various stages of tooth development. Q.20. Enumerate the morphological and histological stages
Describe in detail about advanced bell stage in detail. of development of tooth. Describe in detail about cap
(Mar 2013, 8 Marks) and bell stage. Draw well labeled diagram of cap stage.
Ans. For enumeration of stage of odontogenesis refer to (Sep 2015, 4 + 4 + 2 Marks)
Ans 14 of same chapter. Ans. Enumeration of morphological and histological stages
For description of advanced bell stage in detail refer to of tooth development
Ans 6 of same chapter.
Q.19. Corelate morphological and physiological stages of Morphological Stages
tooth development. Describe bell stage of development ♦♦ Bud stage
of tooth. (Feb 2014, 8 Marks) ♦♦ Cap stage
Ans. Both morphologic and physiological stages of tooth ♦♦ Early Bell stage
development take part in progressive development of ♦♦ Advanced Bell stage
teeth.
• The physiological stages overlap considerably Histological Stages
and many of physiological stages are continuous ♦♦ Initiation
throughout morphological stages of odontogenesis. ♦♦ Proliferation
• Initiation of tooth development starts with beginning ♦♦ Histodifferentiation
of epithelial-ectomesenchymal interaction. Specific ♦♦ Morphodifferentiation
cells in horse shoe shaped dental lamina have ♦♦ Apposition.
potential to form enamel organ of teeth by responding For cap and bell stages in detail refer to Ans 3 of same chapter.
to the factors which induce tooth development.
For diagram of cap stage refer to Ans 3 of same chapter.
• Proliferation results successively in bud, cap and
bell stages of tooth development. Any disturbance Q.21. Write short note on gubernacular cord.
in the proliferation will have effect on developed (Apr 2015, 3 Marks)
tooth depending on the stage, i.e. bud, cap and bell Ans. Gubernaecular cord is also known as gubernaculum
at which the disturbance occur. dentis.
• Histodifferentiation is observed during bell stage • The fibrous extension of dental sac which connects
just before the formation of enamel and dentin the permanent tooth germ to oral mucosa is known
matrix. At bell stage, the inner enamel epithelium as gubernacular cord.
influences adjacent cells of dental papilla which get • Gubernacular cord is formed of fibrous tissue and
differentiate into odontoblasts. These odontoblasts may contain epithelial cells.
laid down dentinal matrix. With formation of • Gubernacular foramina are found lingual to anterior
dentin cells of inner enamel epithelium differentiate primary teeth and are the site of gubernacular cords
into ameloblasts and enamel matrix is laid down • It is also believed that gubernacular cord guides the
opposite to dentin. tooth in its eruptive movements.
• Morphodifferntiation is seen in bell stage and • After the eruption of deciduous teeth gubernacular
its peak activity is seen in advanced bell stage cord lie in the bony canals i.e. gubernacular canals.
as it provides basic form and size of the future For diagram refer to Ans 13 of same chapter.
tooth, i.e morphology of tooth is determined by
morphodifferentiation or differential growth. Q.22. Answer in brief stellate reticulum.
• Apposition refers to the deposition of matrix of (Aug 2016, 2 Marks)
dental hard structures. The stage consists of regular Or
and rhythmic deposition of extracellular matrix Write very short answer on stellate reticulum.
which provides tooth its final shape. (May 2018, 2 Marks)
Dental Histology 639
Ans. Stellate reticulum is the layer of star shaped cells which • Teeth can develop in the abnormal locations, e.g.
is present at center of enamel organ of cap and bell stage in ovary or in hypophysis. In these mentioned
of tooth development. conditions tooth undergoes stages of development
• Meaning of stellate is star shaped and meaning of similar to jaws.
reticulum is branch like network. • During vitamin A deficiency ameloblasts fail to
• Cells of stellate reticulum are star shaped with long differentiate, since their organizing influence
processes that’s why it is known as stellate reticulum. over adjacent mesenchymal cells is disturbed and
• These star shaped cells are connected to each other osteodentin is formed.
and to cells of outer enamel epithelium and stratum • Various endocrine disturbances affect size or
intermedium by the desmosomes. form of crown of teeth if such effects occur in
• Stellate reticulum is a cushion like consistency morphodifferentiation, i.e. either in utero or in
that may support and protect the delicate enamel first year of life. Size and the shape of root may be
forming cells. altered by disturbances in later periods. Abnormal
• As layer of dentin forms, inner enamel epithelial cells curvatures in roots known as dilacerations can be
deprive of nutritional supply from dental papilla. due to the trauma which is sustained at the time of
• Stellate reticulum gets collapse before formation of development of root.
enamel during bell stage and bring capillaries in • Disturbances during the morphodifferentiation can
dental follicle close to inner enamel epithelial cells affect form and the size of tooth without impairing
to provide nutrition. function of ameloblast or odontoblast. New parts
can be differentiated such as supernumerary cusps
Q.23. Define odontogenesis. Enumerate various physiological or roots.
stage of development of tooth. Describe advanced bell • Twinning, i.e. two similar teeth can be produced due
stage with diagram. (Apr 2017, 1+2+5+2 Marks) to splitting of one tooth germ.
Ans. Odontogenesis: It is defined as complex process by • Fusion, i.e. teeth become fused which are produced
which tooth form from embryonic cells, grow and erupt from two tooth germ joined together before
into the mouth or odontogenesis is defined as entire mineralization may occur.
process of tooth formation which include amelogenesis, • An abnormality in shape can lead to peg or
dentinogenesis and cementogenesis. malformed tooth with enamel and dentin which are
Enumeration of various physiological stages of normal in their structure.
development of tooth. • Peg shaped teeth or screw driver shaped tooth
• Initiation with permanent maxillary central incisor showing
• Proliferation a notched incisal edge can be seen in individuals
• Histodifferentiation born with congenital syphilis. This is also called as
• Morphodifferentiation hutchinson’s incisor.
• Apposition • Various both genetic and environmental factors can
For advance bell stage with diagram in detail refer to Ans 6 of disturb normal synthesis and secretion of organic
same chapter. matrix of enamel which lead to enamel hypoplasia.
• If organic matrix is normal but its mineralization
Q.24. Enumerate morphological stages of tooth development. become defective, then enamel or dentin is
(May 2017, 2 Marks) hypocalcified or hypomineralized. This occurs
Ans. Following are the morphological stages of tooth because insult is produced to the cells which are
development: responsible for apposition stage of tooth development.
• Bud stage
• Cap stage
• Early bell stage 3. ENAMEL
• Late bell stage.
Q.25. Write short answer on clinical consideration of Q.1. Mention physical and chemical properties of enamel.
odontogenesis. (Aug 2018, 3 Marks) Describe hypocalcifled structures of enamel.
Ans. Following is the clinical consideration of odontogenesis: (Apr 2008, 5 Marks)
• Lack of initiation leads to the absence of either a Ans. Physical Properties of Enamel
single tooth or multiple teeth, i.e. partial anodontia, • On the cusps of human molars and premolars attain
mainly the permanent lateral upper incisors, third a maximum thickness of about 2 to 2.5 mm.
molars and lower second premolars are involved. • Because of its high content of mineral salts and their
There can also be complete loss of all teeth, i.e. crystalline arrangement enamel is highest calcified
anodontia. Moreover abnormal initiation can lead to tissue in the body.
development of single or multiple supernumerary • Structure and hardness of enamel render it brittle.
teeth. Specific gravity of enamel is 2.8.
640 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• DEJ also prevent shearing of enamel while function Write in brief on life cycle of ameloblast.
ing. (Sep 2006, 5 Marks) (Nov 2008, 10 Marks)
• Scalloping of junction is seen more in occlusal (Aug 2011, 10 Marks)
portion where masticatory stress are high. Or
Q.8. Write a short note on enamel organ. (Sep 1996, 5 Marks) Write about life cycle of ameloblast.
Ans. Enamel Organ (Feb 2013, 10 Marks)
• The epithelial enamel organ originates from the Or
stratum epithelium of the primitive oral cavity.
Write short note on life cycle of ameloblasts.
• It has got four layers, i.e. outer enamel epithelium, (Feb 2016, 3 Marks)
stellate reticulum, stratum intermedium and inner
Ans. Life Cycle of Ameloblasts
enamel epithelium.
There are six stages in life cycle of ameloblasts, namely:
Outer Enamel Epithelium 1. Morphogenic
♦♦ In the early stage of development of enamel organ the 2. Organizing
outer enamel epithelium consists of a single layer of 3. Formative
cuboidal cells. 4. Maturative
♦♦ Prior to the formation of hard structures, the regular 5. Protective
arrangement of outer enamel epithelium is maintained 6. Desmolytic.
only in the cervical part of the enamel organ. The differentiation of ameloblasts is most advanced
♦♦ At the point of highest convexity of enamel organ cell of in region of incisal edges and tips of cusps. It is least
the outer enamel epithelium are irregular in shape and advanced in region of cervical loop.
cannot be distinguish easily from the cells of outer portion Morphogenic Stage
of stellate reticulum.
♦♦ Capillaries in the connective tissue surrounding the enamel ♦♦ Ameloblasts interact between adjacent mesenchymal cells
organ proliferate and protrude towards it. which determine the shape of DEJ.
♦♦ During this stage, cells are short and columnar with large
Stellate Reticulum oval nuclei which almost fill the cell body. Golgi apparatus
♦♦ It is found between outer enamel epithelium and stratum and centrioles are located in proximal end of cell and
intermedium. mitochondria are dispersed in cytoplasm.
♦♦ It forms the middle part of enamel organ. ♦♦ During differentiation of ameloblasts, terminal bars appear
♦♦ Cells are star shaped with long processes. along with margin of mitochondria to basal region of cell.
♦♦ Cells are separated by intercellular substance. ♦♦ Terminal bars are points of close contact between cells.
♦♦ Structure of stellate reticulum renders it elastic and Organizing Stage
resistant. It acts as buffer against physical forces.
♦♦ The size of stellate reticulum reduces in thickness to ♦♦ In this stage of development, inner enamel epithelium
decrease the distance between capillaries of dental sac interact with adjacent connective tissue cells which
and ameloblasts. differentiate to odontoblasts.
♦♦ This stage is characterized by change in appearance of cells
Stratum Intermedium of inner enamel epithelium.
♦♦ Cells of stratum intermedium are situated between the ♦♦ Cells become longer and nucleus free zones and distal end
of cells become as long as proximal parts. During terminal
stellate reticulum and inner enamel epithelium.
phase of organizing stage, the formation of dentin by
♦♦ These cells are flat to cuboid in shape.
odontoblasts begin. The first appearance of dentin seems
♦♦ They are arranged in 1 to 3 layers. These cells contain
to be critical phase in life cycle.
mitochondria, RER. Its function is unknown, but it is
♦♦ As long as inner enamel epithelium is in contact with
believed that it playa role in production of enamel.
connective tissue of dental papillae it receive nutrient
Inner Enamel Epithelium material from blood vessels of this tissue.
♦♦ When dentin forms it cut off ameloblasts from their original
♦♦ Cells of inner enamel epithelium are derived from the basal
source of nourishment. From then on they are supplied by
cell layer of oral epithelium.
capillaries that surround and may penetrate inner enamel
♦♦ The cells are tall, columnar and differentiates into
epithelium.
ameloblasts that produce enamel matrix.
♦♦ This reversal of nutritional source is characterized by
Q.9. Describe life cycle of ameloblasts. proliferation of capillaries of dental sac and by gradual
(Mar 1998, 15 Marks) (Oct 2014, 8 Marks) reduction and disappearance of stellate reticulum.
(Sep 2009, 15 Marks) ♦♦ Thus, distance between capillaries, stratum inter-medium
Or and ameloblasts layers shorten.
Dental Histology 643
Q.20. Enumerate stages of life cycle of ameloblasts and ♦♦ Distal portion of Tome’s process penetrates in enamel and
describe amelogenesis. (Nov 2010, 7.5 Marks) extends up to the first layer of enamel.
Or ♦♦ Cytoplasm of the Tome’s process remain continuous with
that of body of ameloblasts.
Discuss amelogenesis. (Jan 2012, 10 Marks) ♦♦ Formation of the inter-rod substance occurs first by the
Ans. There are six stages in life cycle of ameloblasts, namely: proximal end of the Tome’s process.
1. Morphogenic ♦♦ Inter-rod substance surrounds the pit into which the distal
2. Organizing portion of the Tomes’ process secretes the rod.
3. Formative ♦♦ As more of enamel is being formed, the distal portion of
4. Maturative the Tome’s process lengthens, as do the enamel rods. The
5. Protective long axes of the ameloblasts lie at a considerable angle to
6. Desmolytic. the direction of rods.
The differentiation of ameloblasts is most advanced ♦♦ Though the rod and inter-rod enamel are identical in
in region of incisal edges and tips of cusps. It is least their composition, they differ in the orientation of their
advanced in region of cervical loop. crystallites. This arrangement means that no enamel rod
Amelogenesis is related to a single ameloblast.
Generally two processes are involved in the development of Mineralization and Maturation of Enamel Matrix
enamel, i.e. organic matrix formation and mineralization.
As soon as enamel matrix get calcified removal of organic
Formation of Enamel Matrix material and water occurs. It takes place in two stages, i.e.
♦♦ Immediate partial mineralization in which mineralization
♦♦ Ameloblasts start their secretory activity when a layer of
occurs in matrix segments and the interprismatic substance
dentin is laid down.
as they are laid down. No matrix vesicles are seen in
♦♦ Ameloblasts lose their projections which had penetrated
enamel formation.
basal lamina separating it from predentin. Islands of
♦♦ Maturation: It is characterized by gradual completion of
enamel matrix are deposited along predentin.
♦♦ As enamel deposition continues the thin layer of enamel mineralization. It starts from height of crown and progress
is formed along dentin. cervically. At each level, maturation seems to begin at
♦♦ Amelogenin is the major component of enamel matrix dentinal end of rods. Maturation begins before matrix has
proteins which undergo extracellular degradation by reached its full thickness. The advancing front is at first
proteolytic enzymes. parallel to DEJ and later to outer enamel surface. Following
♦♦ Ameloblastin and enamelin are other important proteins this pattern the occlusal and incisal regions reach maturity
of enamel matrix. They help in nucleation and growth of level ahead of cervical regions. Tuftelin and other proteins
crystals. regulate enamel mineralization by binding to specific
♦♦ Tuftelin is other protein which helps in cell signaling. surfaces of crystal and inhibiting further deposition.
♦♦ Amelotin which is a new protein helps in enamel Crystal size increase further after tooth eruption due to
formation. ion exchange with saliva.
Q.21. Write short note on Nasmyth’s membrane.
Development of Tome’s Process
(Jan 2012, 5 Marks)
♦♦ Tome’s process is basically a pyramidal, cytoplasmic Ans. It is also known as primary enamel cuticle.
extension at the distal part of each ameloblast which is partly • It is a membrane like structure covering entire
delineated from the cell by the distal junctional complex. crown of newly erupted teeth except cervical area
♦♦ Tome’s process consists of microfilaments, secretory of the tooth.
granules, microtubules, mitochondria and lysosomes. • It is basically lost due to mastication.
♦♦ Enamel secretion occurs at two sites in the Tomes’ process i.e. • It is an organic covering which is 1 µm thick.
the proximal end of the Tome’s process which contributes to • It is secreted by ameloblasts as enamel formation
the formation of inter-rod enamel and distal end of Tome’s is complete.
process contributes to the formation of the rod.
• It resembles like basal lamina.
♦♦ When the first layer of enamel is laid down, Tomes’ process
consists only of the proximal portion and the initial enamel Q.22. Enumerate the structures of enamel in detail.
is rodless. (Nov 2010, 8 Marks)
♦♦ As soon as the first layer of enamel forms, ameloblasts Ans.
move away from the surface of the dentin which leads to Structures of Enamel
development of distal portion of Tomes’ process.
♦♦ Extension from the distal terminal bar apparatus to the Enamel is composed of:
surface enamel is the proximal portion of the Tome’s ♦♦ Enamel Rods: Refer to Ans 2 of same chapter
process, while the distal portion is an outgrowth of the ♦♦ Striations
proximal portion. ♦♦ Hunter-Schreger Bands
648 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦♦ Incremental line of retzius: Refer to Ans 13 of same chapter para zones. In discs where rods run in opposite direction,
♦♦ Aprismatic Enamel light reflecting from sides of the rods produce light bands
♦♦ Perikymata: Refer to Ans 11 of same chapter known as dia zones.
♦♦ Enamel caps, broachs and pits ♦♦ When ground sections are viewed and the light is allowed
♦♦ Enamel lamellae: Refer to Ans 4 of same chapter to fall on opposite side, position of light and dark bands
♦♦ Enamel Tufts: Refer to Ans 5 of same chapter is reversed which confirm that it is purely an optical
♦♦ Enamel Spindles: Refer to Ans 11 of same chapter phenomenon.
♦♦ Enamel Cuticle/Naysmyth’s membrane: Refer to Ans 21 ♦♦ Angle between dia zone and para zone is 40 degree.
of same chapter ♦♦ These bands are functional adaptation to occlusal
♦♦ Neonatal Line: Refer to Ans 12 of same chapter. masticatory forces.
Striations Aprismatic Enamel
♦♦ Each enamel rod is built up of segments separated by dark ♦♦ Structureless layer of enamel which is approximately 30
lines that give it a striated appearance. µm thick.
♦♦ The cross striations demarcates rod segments and become ♦♦ Found commonly on the cervical areas and less commonly
more visible by the action of mild acids. on cusp tips.
♦♦ The striations are more pronounced in enamel, i.e. ♦♦ It is very heavily mineralized.
insufficiently calcified. ♦♦ It occurs due to absence of Tome’s process on ameloblasts
♦♦ The cross striations seen in light microscope is suggested in final stages of enamel formation.
to be due to a diurnal rhythm in the enamel formation and ♦♦ In this region apatite crystals are parallel to each other and
that in these areas rods show varicosities and variations are perpendicular to incremental line of retzius.
in composition.
♦♦ These diurnal being formed every 24 hours parallel to Enamel Caps, Broaches and Pits
secretory phase of ameloblast. Small elevations 10–15 µm across or depressions are also found
Hunter-Schreger Bands particularly on lateral surfaces. The caps are thought to result
from the enamel deposition on the top of small deposits of non
♦♦ They are the optical phenomenon which is produced due mineralizable debris late in development. The focal holes result
to the changes in direction of enamel rods. from the loss of cap and underlying material by abrasion and
attrition.
Larger surface elevations, enamel brochs, 30–50 µm in
diameter, also occur occasionally and consist of radiating groups
of crystals. They seem to be more common in premolars but are
of unknown origin.
In cervical areas where the reduced enamel epithelium
persists for sometime after eruption the small pits are seen
within perikymata. These are the impression of the ameloblast
ends and are 1–1.5 µm in depth.
Q.23. Write physical and chemical properties of enamel.
Describe in detail about structure of enamel.
Fig. 23: Hunter-Schreger bands
(Feb 2013, 10 Marks)
♦♦ Hunter-Schreger bands are alternating dark and light Ans. For physical and chemical properties refer to Ans 1 of
zones of varying intensity under oblique reflected light. same chapter.
♦♦ These are the curved bands having concavity which faces For structure of enamel refer to Ans 22 of same chapter.
towards the root and commence near DEJ.
Q.24. Write about enamel spindles and enamel tufts.
♦♦ These bands are viewed in inner two third of enamel
(May/June 2009, 5 Marks)
thickness.
♦♦ It is suggested that these alternating light and dark bands Or
may represent portion of enamel having variation in Describe briefly enamel spindles.
calcification and differ slightly in permeability or having (June 2010, 5 Marks)
difference in organic material content.
Or
♦♦ If an oblique section is made by cutting middle part of the
rods, they pass from cut surface to the right and to left Write short note on enamel spindles.
in alternating discs. Disc which coincide with obliquely (Sep 2017, 2 Marks)
directed light allow light to pass through the rods. These Ans. For enamel spindle refer to Ans 11 of same chapter. For
areas absorb light and appear as dark bands also called as enamel tufts refer to Ans 5 of same chapter.
Dental Histology 649
Q.25. Write about surface structures of enamel. - They extend from varying distance along the
(Aug 2012, 5 Marks) surface, at right angle to DEJ from which they
Ans. Following are the surface structures: originate.
• Perikymata - They are evenly spaced.
- They are transverse groove like structures. - Some of them are less than a millimeter in length,
- They are continuous around the tooth and some are long and few reaches to occlusal or
incisal surface.
usually lie parallel to each other and to CEJ.
- Ordinarily there are about 30 Perikymata per Q.26. Write short note on Hunter-Schreger bands.
millimeter in region of CEJ. (Aug 2012, 5 Marks) (May 2014, 2 Marks)
- Their course is regular, but in cervical region it Ans. Refer to Ans 22 of same chapter.
is irregular. Q.27. Enumerate the types of enamel lamellae. Write its
- They are believed to be the external manifestations clinical significance. (Sep 2015, 3+2= 5 Marks)
of striae of retzius. Ans. Enumeration of types of enamel lamellae:
- At times perikymatas are referred as imbrications Type A: Lamellae composed of poorly calcified rod
lines of Pickril. segments
- Perikymatas are more in number in cervical Type B: Lamellae consisting of degenerated cells
region as compared to occlusal and incisal areas. Type C: Lamellae arising in erupted teeth where cracks
• Enamel Caps and Brochs are filled with organic matter, presumably originating
- Ultrastrucuturiy enamel is uneven. It shows pits from saliva.
as well as elevations.
- Pits are about 1–1.5 µm in diameter. Pit Clinical Significance of Enamel Lamellae
represents the ends of ameloblasts. ♦♦ Enamel lamellae may be a site of weakness in a tooth and
- Small elevations of about 10–15 µm are present may form a road of entry for bacteria that initiate caries.
which occur due to deposition of enamel over ♦♦ Enamel lamellae are also susceptible for cracking.
organic debris. These are known as enamel caps.
Q.28. Enumerate physical properties of enamel.
- Larger enamel elevations measure approximately
(Sep 2015, 2 Marks)
30–50 µm in width and are known as enamel
Ans. Enumeration of physical properties of enamel
brochs.
• Color: Enamel is slightly yellow to grayish white
in color.
• Hardness: Hardness of enamel is 343 KHN.
• Brittleness: Enamel is highly brittle due to less tensile
strength.
• Thickness: Thickness of enamel is maximum at cusp
tip or incisal edge and thinnest at cervix.
• Permeability: Enamel is semipermeable
• Density: Density of enamel decreases from surface
to DEJ and from incisal to cervical region.
Fig. 24: Enamel caps • Refractive index: Enamel is birefringent. Its refractive
index is 1.62.
• Solubility: Enamel is soluble in acids.
• Specific gravity: It is 2.8.
Q.29. Write the composition of enamel.
(Jan 2018, 2 Marks) (Sep 2015, 2 Marks)
Or
Write short note on composition of enamel.
(Oct 2016, 3 Marks)
Ans. Following is the composition of enamel:
I. Composition of enamel by weight
96% inorganic substances
1% organic substances
Fig. 25: Enamel brochs 3% water.
II. Composition of enamel by volume
• Cracks 89% inorganic substances
- They are the outer edges of lamellae and are 2% organic substances
narrow fissure like structures. 9% water.
650 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Organic substances are amelogenins and enamelins • Arrangement of enamel rod in permanent teeth in
Inorganic substances are calcium phosphate, calcium their occlusal one third region is similar to deciduous
carbonate, magnesium, potassium, sodium and fluoride. tooth. But in cervical region of permanent tooth, rods
deviate from the horizontal in an apical direction.
Q.30. Write short note on structures arising from dentino
• Rods follow wavy course from dentin to enamel
enamel junction. (Aug 2016, 3 Marks)
surface.
Ans. Structures arising from dentino enamel junction are: • Enamel rods forming developmental pit and fissures
• Enamel tufts: For details refer to Ans 5 of same converge in their outward course.
chapter
• Enamel spindles: For details refer to Ans 11 of same
chapter
• Incremental lines of Retzius: For details refer to Ans
13 of same chapter
• Hunter-Schreger bands: For details refer to Ans 22 of
same chapter.
Q.31. Define amelogenesis and list stages in life cycle of
ameloblast. (Sep 2017, 2 Marks)
Ans. Amelogenesis is the formation of enamel on teeth and
begins when the crown is forming during the advanced
bell stage of tooth development after dentinogenesis or
amelogenesis is defined as process of production and
development of enamel. A B
Stages in Life Cycle of Ameloblast Fig. 26: Direction of enamel rods. A. In deciduous tooth;
B. In permanent tooth
There are six stages in life cycle of ameloblasts, namely:
1. Morphogenic stage Q.35. Enumerate hypocalcified structures of enamel. Write
2. Organizing stage composition of an enamel. Describe enamel lamellae
3. Formative stage and incremental line of Retzius with well labeled
4. Maturative stage diagram. (Sep 2018, 2 + 2 + 3 + 3 =10 Marks)
5. Protective stage Ans. For enumeration of hypocalcified structures of enamel
6. Desmolytic stage. refer to Ans 11 of same chapter.
Q.32. Enumerate stages of amelogenesis. (Apr 2017, 2 Marks) For composition of enamel refer to Ans 29 of same chapter.
Ans. Enumeration of stages of amelogenesis For enamel lamellae with diagram refer to Ans 4 of same
• Presecretory stage chapter.
• Secretory stage For incremental lines of Retzius refer to Ans 13 of same
• Maturation stage chapter.
Q.33. Enumerate hypocalcified areas of enamel.
(Jan 2018, 2 Marks)
Ans. Enumeration of hypocalcified areas of enamel 4. DENTIN
• Enamel lamellae
• Enamel tufts Q.1. Describe the structure of dentin. (Feb 1999, 15 Marks)
• Enamel spindle
• Surface structures Or
– Perikymata Write in brief on structure of dentin.
– Rod ends (Sep 2006, 5 Marks)
– Cracks Ans. Structure of Dentin
Q.34. Write very short answer on direction of enamel rods. • Dentinal matrix of collagen fibers are arranged in
(May 2018, 2 Marks) the random network. The bodies of odontoblast are
Ans. Generally enamel rods are oriented at right angle to arranged in layer of pulpal surface of dentin.
dentin surface. • Structure of dentin consist of:
• In cervical and central parts of deciduous tooth – Dentinal tubules
crown, enamel rods are horizontal. Near the incisal – Peritubular dentin or intratubular dentin
edge or tip of cusps they change gradually to an – Intertubular dentin
increasingly oblique direction and they are almost – Predentin
vertical in region of incisal edge or tip of cusps. – Odontoblasts processes.
Dental Histology 651
4. Predentin
♦♦ It is first form dentin and is not mineralized.
♦♦ It is located adjacent to pulp tissue.
♦♦ As the collagen fibers undergo mineralization at predentin
Fig. 27: Dentinal tubules
junction, predentin becomes dentin and new layer of
(For colour version see Plate 22)
predentin forms circumpulpally.
2. Peritubular Dentin or Intratubular Dentin
♦♦ It is the zone of hypermineralized dentin which surrounds
the dentinal tubule.
♦♦ It is known as intratubular dentin as it is formed by
deposition along inner aspect of dentinal tubules.
♦♦ It differ from intertubular dentin in its composition that it
is 5 to 12% more mineralized and lacks collagenous fibrous
matrix as compared to intertubular dentin.
♦♦ Width of peritubular dentin is highest near DEJ and
decreases in pulpward direction.
♦♦ Apatite crystals of peritubular dentin are more compact
and smaller as compared to intertubular dentin.
♦♦ A thin organic membrane which is rich in glycosaamino-
glycans known as lamina limitans seen over inner aspect
of peritubular dentin. Fig. 29: Predentin
♦♦ Space between odontoblastic process and peritubular (For colour version see Plate 22)
dentin is known as periodontoblastic space. This space
consists of dentinal fluid, movement of which make basis 5. Odontoblast Processes
of dentinal sensitivity. ♦♦ They are cytoplasmic extensions of odontoblasts. They
3. Intertubular Dentin reside in peripheral pulp.
♦♦ Major bulk of dentin lie between the dentinal tubules, i.e. ♦♦ They are largest in diameter near pulp and taper to
between zones of peritubular dentin known as intertubular approximately micrometer further into dentin.
dentin. ♦♦ It is appropriate to consider that some odontoblast
♦♦ It is less mineralized as compared to peritubular dentin. processes traverse thickness of dentin.
♦♦ Thickness of intertubular dentin is highest at DEJ where ♦♦ Odontoblast process divides near DEJ and may extend to
the dentinal tubules are widely separated. enamel in enamel spindles.
652 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦♦ This dentin forms in the crowns of teeth in the circumpulpal • Loss of odontoblasts may also occur in teeth
dentin just below the mantle dentin, and it follows the containing vital pulp as a result of caries, attrition,
incremental pattern. abrasion, cavity preparation or erosion.
♦♦ The dentinal tubules pass uninterruptedly through • Where reparative dentin seals dentinal tubules at
interglobular dentin. their pulpal ends, dentinal tubules fill with fluid or
♦♦ In dry ground sections some of the globular dentin may be gaseous substances.
lost, and a space results that appears black in transmitted • In ground sections such groups of tubules may
light. entrap air and appear black in transmitted and white
in reflected light.
• The dead tracts demonstrate decreased sensitivity
and appear to a greater extent in older teeth.
Q.10. Describe various type of dentin which take part in
protection of pulp. How dentin differs from enamel
in composition? (Mar 2001, 15 Marks)
Ans. Types of Dentin which Take Part in Protection of Pulp
♦♦ Primary Dentin
Primary dentin can be divided into.
• Mantle dentin: It is first formed dentin in the crown.
–– It lies underlying the DEJ in crown and granular
layer in root. It is 20 microns thick.
Fig. 33: Interglolular dentin –– It is composed mainly of Type III collagen fibers
(For colour version see Plate 23) which are argyrophilic and are known as Von
Korff’s fibers.
Q.9. Write a short note on dead tracts. –– This dentin differs from remaining portion of
(Mar 1998, 5 Marks) (Sep 2002, 5 Marks) primary dentin in following ways:
(Oct 2007, 5 Marks) (Nov 2009, 5 Marks) - This dentin is less mineralized.
(June 2010, 5 Marks) (Dec 2014, 3 Marks) - It consists of large collagen fibers which are
Or oriented perpendicular to DEJ.
- It undergoes mineralization in presence of
What are dead tracts. Draw a well labelled diagram.
(Sep 2015, 3 + 2 = 5 Marks) matrix vesicles.
- This dentin show branching of dentinal tubules.
Or - Mantle dentin show few defects as compared
Write short answer on dead tracts. (Aug 2018, 3 Marks) to circumpulpal dentin.
Ans. Dentinal areas are characterized by the degenerated • Circumpulpal dentin: It forms the remaining primary
odontoblasts processes which give rise to dead tracts. dentin or bulk of the tooth. Circumpulpal dentin
• In dried ground sections of normal dentin the formed before root completion.
odontoblast processes degenerate and empty tubules –– The collagen fibers in circumpulpal dentin are
are filled with air. They appear black in transmitted much smaller and are more closely packed.
and white in reflected light. –– Circumpulpal dentin may contain slightly more
mineral than mantle dentin.
♦♦ Secondary Dentin
• Secondary dentin is a narrow band of dentin bordering
the pulp.
• Secondary dentin is formed after the root completion.
• This dentin contains fewer tubules than primary
dentin.
• Secondary dentin formed more slowly and not
uniformly.
• It protects the pulp from exposure in older teeth.
♦♦ Tertiary Dentin
• Tertiary dentin takes part in protection of pulp by
reparative process.
• Secondary dentin protects the pulp of older teeth
Fig. 34: Dead tract (For colour version see Plate 23) from exposure.
Dental Histology 655
Difference between Composition of Enamel and Dentin • The dentinal tubules are enlarged by destructive
action of the microorganism.
Composition Enamel Dentin • Dentin sensitivity or pain may not be a symptom
By weight • 96% Inorganic • 70% inorganic of caries until the pulp is infected and respond by
substances substances process of inflammation leading to toothache.
• 1% organic • 20% organic substances
• Caries, operative procedure, abrasion, erosion
substances • 10% water
• 3% water stimuli stimulate the reparative dentin production.
• Teeth with deep penetrating carious lesion can be
By volume • 89% Inorganic • 47% inorganic treated by pulp capping.
substances substances
• 2% organic • 32% organic substances Q.13. Write a short note on theories of dentin sensitivity.
substances • 21% water (Oct 2014, 3 Marks) (Sep 2005, 5 Marks)
• 9% water (Oct 2008, 2 Marks) (Nov 2008, 10 Marks)
Organic • Amelogenins • Collagen Type I and II (Aug 2011, 10 Marks) (Aug 2012, 5 Marks)
substances • Enamelins • Phosphoproteins (Feb 2014, 3 Marks)
• Carboxyglutamate
Or
containing proteins
• Acidic glycoproteins Write about theories of pain transmission in dentin.
• Plasma proteins (Nov 2008, 10 Marks)
• Lipids Or
• Growth related factors
Inorganic • Calcium phosphate • Calcium phosphate
Write about pain sensation theories of dentin.
substances • Calcium carbonate (hydroxyapatite) small (Aug 2012, 5 Marks)
• Magnesium crystals Or
• Potassium • Trace amount of fluoride
• Sodium and carbonate
Write on theories of dentin sensitivity.
• Fluoride (Apr 2017, 5 Marks)
Ans. There are three basic theories of pain conduction through
Q.11. Describe hypocalcified area in dentin. dentin.
(Sep 2009, 5 Marks) • Direct neural stimulation: In this theory stimuli reach
Ans. Hypocalcified Area in Dentin from nerve ending in the dentinal tubule and they
are directly stimulated causing sensitivity or pain.
• Contour lines: Occasionally some of the incremental
• Fluid or hydrodynamic theory: It is most popular theory.
lines are accentuated because of disturbances in
- Various stimuli such as heat, cold, air blast
the matrix and mineralization process. These lines
desiccation or mechanical or osmotic pressure
represent hypocalcified bands with X-ray.
affect fluid movement in the dentinal tubules.
• Neonatal line: Neonatal line separates the prenatal
- This fluid movement stimulates pain mechanism
and postnatal dentin.
in the tubules by the mechanical disturbance
- This line reflects the abrupt changes in environ
of the nerve, thus nerve endings may act as
ment that occurs at birth.
mechanoreceptor.
- The dentin matrix formed prior to birth is usually
• Transduction theory: In this theory the odontoblast
of better quality than formed after birth, and a process is the primary structure excited by the
neonatal line may be a zone of hypocalcification. stimulus and that impulses are transmitted to the
• Interglobular dentin: Refer to Ans 9 of same chapter. nerve endings in the inner dentin.
• Predentin: Predentin is located adjacent to the pulp - This theory is not popular since there are no
tissue. neurotransmitter vesicles in the odontoblast
- It is first formed dentin and is not mineralized. process to facilitate synapse.
- As predentin is mineralized it becomes dentin
and a new layer of predentin is formed. Q.14. Write a notes on reparative dentin and dead tracts.
(Feb 2005, 5 Marks)
Q.12. Describe clinical consideration of dentin.
Or
(Aug/Sep 1998, 5 Marks)
Ans. Cells of the exposed dentin should not be insulted by Write short note on reparative dentin and dead tract.
bacterial toxins, strong drugs, undue operative trauma (Aug 2011, 5 Marks)
or irritating restorative materials. Ans. For reparative dentin refer to Ans 4 of the same chapter.
For dead tracts refer to Ans 9 of the same chapter.
• Rapid penetration and spread of caries in the dentin
is the result of the tubules. Q.15. Describe the process of dentinogenesis and mention in
• Dentinal tubules provide a passage for invading brief age changes seen in dentin. (Feb 2006, 15 Marks)
bacteria and their products, through either a thin Ans. For dentinogenesis refer to Ans 5 of the same chapter.
or thick dentinal layers. For age changes refer to Ans 6 of the same chapter.
656 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.16. Write short note on primary and secondary dentin. Q.17. Write notes on type of dentin.
(Mar 2006, 5 Marks) (Oct 2006, 2 Marks) (Dec 2012, 3 Marks)
Or Or
Discuss primary and secondary dentin. Draw a well Write about types of dentin. (Jan 2012, 5 Marks)
labelled diagram for it. (Jan 2018, 3 + 2 Marks) Or
Ans. • Primary dentin: Primary dentin can be divided into: Write the classification of dentin. (Sep 2015, 2 Marks)
i. Mantle dentin: It is first formed dentin in the crown. Or
– It is underlying the DEJ in crown and Answer in brief types of dentin. (Aug 2016, 2 Marks)
granular layer in root. It is 20 microns thick. Ans.
– It is composed mainly of Type III collagen
fibers which are argyrophilic and are known On Basis of Location
as Von Korff’s fibers. ♦♦ Intertubular dentin: It is found around and in between
– This dentin differs from remaining portion dentinal tubules.
of primary dentin in following ways: ♦♦ Intratubular dentin: It is found and formed within
- This dentin is less mineralized. dentinal tubules.
- It consists of large collagen fibers which ♦♦ Mantle dentin: It is formed initially in the crown and outer
are oriented perpendicular to DEJ. coronal dentin.
- It undergoes mineralization in presence of ♦♦ Circumpulpal dentin: It lies nearest to pulp and is formed
matrix vesicles. in crown after mantle dentin has been deposited.
- This dentin show branching of dentinal
tubules. On Basis of Pattern of Mineralization
- Mantle dentin show few defects as com- ♦♦ Globular dentin: It is formed from calcospherites.
pared to circumpulpal dentin. ♦♦ Interglobular dentin: It is a hypomineralized dentin
ii. Circumpulpal dentin: It forms the remaining between mantle and circumpulpal dentin. It is normally
primary dentin or bulk of the tooth. Circumpulpal found in coronal dentin.
dentin formed before root completion. ♦♦ Tomes granular layer: It is the hypomineralized layer in
- Collagen fibers in circumpulpal dentin are
root dentin.
much smaller and are more closely packed.
♦♦ Sclerotic dentin: This dentin is hypermineralized. It
- Circumpulpal dentin may contain slightly
occludes intertubular dentin.
more mineral than mantle dentin.
• Secondary dentin On Basis of Developmental Pattern
- Secondary dentin is a narrow band of dentin
bordering the pulp. ♦♦ Primary dentin: It is formed prior to and during active
- Secondary dentin is formed after the root eruption.
completion. ♦♦ Secondary dentin: It is formed when tooth first comes
- This dentin contains fewer tubules than primary into occlusion.
dentin. ♦♦ Tertiary dentin: It is formed as a result of pathologic
- Secondary dentin formed more slowly and not response. It can be reactionary or reparative.
uniformly. Q.18. Write notes on secondary dentin. (Oct 2006, 5 Marks)
- It protects the pulp from exposure in older teeth. Ans. Refer to Ans 16 of the same chapter.
Q.19. Write short note on osteodentin. (Sep 2006, 5 Marks)
Ans. Osteodentin is an atypical dentin that develops due
to deficiency of vitamin A. The ameloblast is not
differentiated properly, as a result the proliferation of
mesenchymal cells is disturbed and atypical dentin is
formed known as osteodentin.
Q.20. Write notes on Tome’s granular layer and Tome’s
process. (Sep 2007, 2.5 Marks)
Ans. For Tome’s granular layer refer to Ans 3 of the same
chapter and for Tome’s process refer to Ans 16 of chapter
ENAMEL.
Q.21. Enumerate hypocalcified structures of enamel. Write
about types of dentin. (Apr 2008,7.5 Marks)
Ans. For hypocalcified structures of enamel refer to Ans 11
Fig. 35: Secondary dentin of chapter ENAMEL.
(For colour version see Plate 22) For types of dentin refer to 17 of the same chapter.
Dental Histology 657
Q.22. Draw diagram of dead tract and diffuse calcification. • Refractive indices of dentin in which the tubules
(Mar 2008, 2.5 Marks) are occluded are equalized and such areas become
Or transparent.
• Transparent dentin can be observed in the teeth of
Draw a well labelled diagram of dead tract. elderly people, specially in the roots.
(Jan 2018, 2 Marks) • Sclerosis reduces the permeability of the dentin and
Ans. may prolong pulp vitality.
• Mineral density in this area of dentin is greater as
shown radiographically.
• It appears transparent or light in transmitted light
and dark in reflected light.
somewhat harder than bone but considerably softer than Q.28. Write short note on intertubular dentin.
enamel. (June 2010, 2 Marks)
♦♦ Dentin hardness varies slightly between tooth types and Ans. The main body of dentin is composed of intertubular
between crown and root dentin. dentin.
♦♦ Dentin is somewhat harder in its central part than near the • It is located between dentinal tubules or between
pulp or on its periphery. zones of peritubular dentin.
♦♦ Dentin of primary teeth is slightly less hard than that of • It is highly mineralized.
permanent teeth. • It is made up of Type I collagen fibrils of diameter
♦♦ Lower content of mineral salts in dentin renders it more 50–200 nm which are arranged at right angles to
radiolucent than enamel.
dentinal tubules.
Chemical Properties Q.29. Write short note on contents of dentinal tubule.
♦♦ Dentin consists of 70% inorganic material, 20% organic (Feb 2013, 2 Marks)
material and 10% water by weight, and 45%, 33% and 22% Ans. Odontoblastic process is the primary occupant of the
respectively by volume. dentinal tubule.
♦♦ Organic substance consists of collagenous fibers embedded • Fine cytofilaments are most characteristic finding.
in the ground substance of mucopolysaccharides • Microtubules are cytoskeletal features of odonto
(proteoglycans and glycosaminoglycans). blastic processes.
♦♦ Type I collagen is the principal type of collagen found in • Beside odontoblastic processes other cellular
the dentin. processes found in dentinal tubules are nerve fibers.
♦♦ The important constituents of the ground substance • Nerve endings are variable feature of dentinal
are the proteoglycans—chondroitin sulphates, decorin tubules.
and biglycan glycoproteins—dentin sialoprotein (DSP), • Some nerve endings in dentinal tubules have
osteonectin, osteopontin; phosphoproteins—dentin singular enlargements while other have alternating
phosphoprotein (DPP) d-carboxyglutamate containing dilations and constrictions with odontoblastic
proteins (Gla-proteins) are phospholipids. processes.
♦♦ The protein of dentin matrix and bone are similar, but • Dentinal tubule has an organic coating or inner
dentin sialoprotein and dentin phosphoprotein are present lining which consists of glycosaminoglycans. This
only in dentin. layer is also known as lamina limitans.
♦♦ In addition, the matrix contain growth factors like
transforming growth factor (TGF) fibroblast growth Q.30. Write short note on physical properties of dentin.
factor (FGF), insulin like growth factors (IGFs) and bone (May 2014, 2 Marks)
morphogenic proteins (BMPs). The matrix components Ans. For physical properties of dentin refer to Ans 26 of same
have important roles to play in mineralization of dentin. chapter.
♦♦ The inorganic component consists of hydroxyapatite, as Q.31. Write about the tertiary dentin. (Feb 2013, 5 Marks)
in bone, cementum and enamel. Ans. Tertiary dentin is also known as irregular secondary
♦♦ Each hydroxyapatite crystal is composed of several dentin or reactive dentin or reparative dentin.
thousand unit cells. The unit cells have a formula of 3Ca3
• Tertiary dentin is formed in response to stimuli, i.e.
(PO4)2.Ca(OH)2. The crystals are plate shaped and much
attrition, abrasion, erosion, cavity preparation, etc.
smaller than the hydroxyapatite crystals in enamel.
• Tertiary dentin is deposited on the pulpal surface of
♦♦ Dentin also contains small amounts of phosphates,
dentin only in affected area.
carbonates, and sulfates. The crystals are poor in calcium
• Appearance of tertiary dentin varies as it is formed
but rich in carbon when compared to enamel.
only by odontoblasts which are directly affected by
Q.27. Write a short note on dental lymph. stimulus and depends on intensity and duration of
(Oct 2008, 3 Marks) (Dec 2010, 3 Marks) stimulus.
(Mar 2013, 3 Marks) • Tertiary dentin is subclassified as reactionary or
Ans. Dental lymph is a fluid which is present in the reparative dentin.
periodontoblastic space in dentin. • Difference between the reactionary and reparative
• It is a transudate of extracellular fluid, mainly cytoplasm dentin is former is deposited by preexisting
of odontoblastic processes, from the dental pulp via odontoblasts and later by newly differentiated
the dentinal tubules. odontoblast like cells.
• Dental lymph, apparently nourishes teeth, keeps • Cells forming the tertiary dentin line its surface
them supplied with the mineral salts which make or become included in dentin. When the cells are
them hard and impervious to bacteria and bits of included in dentin the dentin is known as osteodentin.
food which cause decay. • Tertiary dentin is different from other forms of
• Malnutrition is one of the factors which disturbs this dentin that in tertiary dentin, dentin phosphophoryn
protective activity of the dental lymph. is not present.
Dental Histology 659
Q.32. Enumerate hypocalcified structures of dentin. Q.35. Write briefly on composition of dentin.
(Sep 2015, 2 Marks) (Apr 2017, 2 Marks)
Ans. Following are the hypocalcified structures in dentin: Ans. Following is the composition of dentin:
1. Contour lines ♦♦ Composition of dentin by weight
2. Neonatal line • 70% inorganic substances
3. Interglobular dentin • 20% organic substances
4. Predentin. • 10% water
For details refer to Ans 11 of same chapter. ♦♦ Composition of dentin by volume
• 47% inorganic substances
Q.33. Define dentinogenesis. Describe the types of dentine • 32% organic substances
with well labeled diagrams. (Oct 2016, 10 Marks) • 21% water
Ans. Dentinogenesis is defined as process of dentin formation Organic substances are Collagen Type I and Type II,
during development of teeth. phosphoproteins, carboxyglutamate containing proteins, acidic
glycoproteins, plasma proteins, lipids, growth related factors.
Types of Dentin
Inorganic substances are calcium phosphate (hydroxyapa-
♦♦ On basis of location tite) small crystals, trace amount of fluoride and carbonate.
• Intertubular dentin: For details refer to Ans 1 of same Q.36. Enumerate the theories of dentin sensitivity.
chapter (Oct 2016, 2 Marks)
• Intratubular dentin or peritubular dentin: For details refer Or
to ans1 of same chapter Enumerate theories of dentin hypersensitivity.
• Mantle dentin: For details refer to Ans 10 of same
(Jan 2018, 2 Marks)
chapter
Ans. Enumeration of theories of dentin sensitivity or dentin
• Circumpulpal dentin: For details refer to Ans 10 of
hypersensitivity.
same chapter.
• Direct neural stimulation or direct innervation theory
♦♦ On basis of pattern of mineralization
• Fluid or hydrodynamic theory
• Globular dentin: It is formed from calcospherites
• Transduction theory.
• Interglobular dentin: For details refer to Ans 8 of same
chapter Q.37. Write classification of dentin. Write in short about pain
• Tomes granular layer: For details refer to Ans 3 of same transmission theories of dentin.
chapter (Sep 2018, 2 + 3 = 5 Marks)
• Sclerotic dentin: For details refer to Ans 23 of same Ans. For classification of dentin refer to Ans 17 of same chapter.
chapter. For pain transmission theories refer to Ans 13 of same
♦♦ On basis of developmental pattern chapter.
• Primary dentin: For details refer to Ans 16 of same
chapter
• Secondary dentin: For details refer to Ans 16 of same 5. PULP
chapter
• Tertiary dentin: For details refer to Ans 32 of same Q.1. Write a short note on composition of pulp.
chapter (Feb/Mar 2004, 5 Marks) (Mar 2009, 5 Marks)
Q.34. Enumerate the types of dentin. (Apr 2017, 2 Marks) Ans. Pulp composed of:
Ans. Enumeration of types of dentin • Odontoblasts
• Cell free zone or Weil’s zone
♦♦ On basis of location
• Cell rich zone.
• Intertubular dentin
• Odontoblasts: Refer to Ans 3 of same chapter.
• Intratubular dentin • Cell free zone: It is a space in which the odontoblast
• Mantle dentin may move pulp ward during tooth development
• Circumpulpal dentin and later to the limited extent in functional teeth.
♦♦ On basis of pattern of mineralization • Cell rich zone: This layer is composed principally
• Globular dentin of fibroblasts and undifferentiated mesenchymal
• Interglobular dentin cells. The latter are distinctive because they lack a
• Tomes granular layer ribosome studded ER and have mitochondria with
• Sclerotic dentin discernable cisternae. During early dentinogenesis
♦♦ On basis of developmental pattern there are many young collagenous fibers in this zone.
• Primary dentin Besides this the pulp also consists of intercellular
• Secondary dentin substance, fibers, defense cells, blood vessels, lymph
• Tertiary dentin vessels, nerves and nerve endings.
660 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• The cell bodies of odontoblasts are columnar in usually associated with small blood vessels and
appearance with large oval nuclei which fill basal capillaries. Both lymphocytes and eosinophills are
part of the cell. found extravascularly in the normal pulp during
inflammation they increase in number.
• Mast cells are also seen along vessels in inflamed
pulp. Their number increases during inflammation
of pulp.
• Plasma cells are seen during inflammation of pulp.
In it the chromatin of nucleus give cart wheel
arrangement. The plasma cell performs the function
of production of antibodies.
Q.5. Enumerate all functions of human dentinal pulp.
Describe in detail structural elements of pulp.
(Mar 2008, 5 Marks)
Or
List four functions of pulp. (Aug 2016, 2 Marks)
Ans. Functions of Dentinal Pulp
• Inductive function: The primary role of pulp analge
is to interact with oral epithelium cells which cause
differentiation of dental lamina and enamel organ
formation.
– Pulp analge also interacts with developing
enamel organ as it determines particular type
of tooth.
Fig. 40: Odontoblasts • Formative function: Pulp organ cells produce dentin
which surrounds and protect the pulp.
• Immediately adjacent to nucleus basally is RER and
• Nutritive function: Pulp nourishes the dentin through
Golgi apparatus.
odontoblasts and their processes and by means of
• Further towards the apex of cell appears an
blood the vascular system of pulp.
abundance of RER. Near the pulpal predentin
• Protective function: Sensory nerves in the tooth
junction the cell cytoplasm is devoid of organelles.
respond with pain to all stimuli. The nerve also
• At cellular junction the cell constrict to diameter of
initiates the reflexes that control circulation in the
3 to 4 micrometer where the cell process enters the
pulp. The sympathetic function is reflex, providing
predentinal tubules. The process of cell contains
stimulation to visceral motor fibers terminating on
no endoplasmic reticulum but during the early
muscles of blood vessels.
period of dentinogenesis it does contain occasional
• Defensive or reparative function: It responds to
mitochondria and vesicles.
irritation whether mechanical, thermal, chemical
• The form and arrangement of bodies of odontoblasts
or bacterial by producing reparative dentin and
are not uniform throughout pulp. They are most
mineralizing affected tubules.
cylindrical and tall columnar in crown, more cuboid
– P u l p h a s m a c r o p h a g e s , l y m p h o c y t e s ,
in middle of root, close to apex odontoblasts are
neutrophils, monocytes, plasma and mast cells
ovoid and spindle shaped.
all of which aid in the process of repair of pulp.
Q.4. Write note on defense cells of pulp. For structural elements of dental pulp refer to Ans 3 of
(Sep 1999, 5 Marks) (Sep 2006, 5 Marks) same chapter.
(Jan 2012, 2 Marks)
Q.6. Describe histology of pulp tissue.
Ans. Defense Cells of Pulp
(Mar 2000, 15 Marks) (Apr 2010, 15 Marks)
• The cells which are important for defense of pulp
Ans. Answer refer to Ans 2 of same chapter.
are histiocytes or macrophages, mast cells and
plasma cells. In addition there are blood vascular Q.7. Write a note on pulp stones.
elements such as neutrophil, basophil, lymphocytes (Feb 2006, 5 Marks) (Oct 2014, 3 Marks)
and monocytes. Or
• The above blood vessel elements emigrate from
pulpal blood vessel and develop characteristic in Write a short note on denticles.
response to inflammation. (Sep 2005, 5 Marks) (Jan 2012, 2 Marks)
• Histiocyte or macrophage is an irregular shaped (Feb 2013, 5 Marks) (Nov 2010, 3 Marks)
cell with short blunt processes. These cells are Or
662 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Describe pulp stones. (Aug 2011, 5 Marks) ♦♦ They appear as concentric circles or calcified tissue. In
Or center of these concentric layers of calcified tissue there
maybe remnants of necrotic and calcified tissue.
Answer in brief pulp stones. (Aug 2016, 2 Marks) ♦♦ Pulp stones are classified as free, attached and embedded
depending on their relation to dentin of the tooth.
Ans. Pulp Stones
• Free denticles: They are entirely surrounded by pulp
• Pulp stones or denticles, are nodular calcified masses tissue.
appearing in either or both the coronal and root • Attached denticles: They are partly fused with dentin.
portion of pulp organ. • Embedded denticles: They are entirely surrounded by
• They often develop in teeth that appear to be quite dentin.
normal in other aspects. They have been seen in ♦♦ All above denticles form free in pulp and later to become
functional as well as embedded unerupted teeth. attached or embedded as dentin formation progresses.
• Pulp stones are classified according to their ♦♦ The size of pulp stone increases as the age advances.
structures as: Q.8. Write a note on age changes in dental pulp.
– True denticles (Sep 2003, 5 Marks) (Dec 2010, 5 Marks)
– False denticles (Feb 2013, 5 Marks) (Feb 2014, 3 Marks)
(May 2014, 5 Marks)
True Denticles
Or
Write short note on age changes of pulp.
(Sep 2017, 3 Marks)
Or
Describe age changes in pulp. (Dec 2014, 3 Marks)
Or
Write very short answer on age changes of pulp.
(Aug 2018, 2 Marks)
Ans. Age Changes in Dental Pulp
• The cells are characterized by decrease in size and
number of cytoplasmic organelles.
• The fibroblasts in aging pulp exhibit less perinuclear
Fig. 41: True pulp stone cytoplasm and posses long thin cytoplasmic processes.
(For colour version see Plate 24) • As age advances fibroblasts may result leading to
increase in collagen fiber content in pulp organ.
♦♦ The remnants of epithelial root sheath induce the cells of • Collagen increase is noticed in the medial and
pulp to differentiate into odontoblasts which then form adventitial layers of blood vessel as well.
the dentin masses called as true pulp stones. • The increase in collagen fiber may be more apparent
♦♦ They are rare and found near the apical foramen. than actual being attributed to decrease in size of pulp.
• Pulp Stones: (See Ans 7 of same chapter).
False Denticles
• Diffuse calcifications appear as irregular calcific
deposits in pulp tissue, usually following collagenous
fibrous bundles or blood vessels. These calcifications
are found in root canal. The diffuse calcification are
also characterized as dystrophic calcification.
Q.9. Enumerate the function of pulp. Describe the regressive
changes of pulp. (Feb. 2006, 7.5 Marks)
Ans. For functions refer to Ans 5 of the same chapter. For
regressive changes of pulp refer to Ans 8 of the same
chapter.
Q. 10. Write a short note on functions of pulp.
(Mar 2007, 3 Marks) (June 2010, 8 Marks)
(July 2016, 3 Marks) (Aug 2012, 5 Marks)
Or
Fig. 42: False pulp stone Describe the functions of pulp shortly.
(For colour version see Plate 24) (Mar 2007, 4 Marks)
Dental Histology 663
Fig. 44: Pulp at periphery (For colour version see Plate 24)
neutrophils, eosinophils, basophils, lymphocytes ♦♦ Cell free zone consists of network of nerve fibers which lost
and monocytes are also seen. their myelin sheath and are known as Plexus of Rashkow.
For fibroblasts refer to Ans 2 of same chapter.
For undifferentiated cells refer to Ans 2 of same chapter. Cell Rich Zone
For defense cells refer to Ans 4 of same chapter. ♦♦ It is situated below the cell free zone.
Q.19. Enumerate the cells of pulp. Write the age changes of ♦♦ Cell rich zone is the narrow zone having high density of
pulp (any two). (Sep 2015, 2+3 = 5 Marks) cells rich capillary network.
Ans. Enumeration of Cells of Pulp ♦♦ This zone is seen in both coronal and radicular pulp.
1. Fibroblasts ♦♦ Cell rich zone has fibroblasts, undifferentiated mesen-
2. Undifferentiated mesenchymal cells chymal cells, macrophages, immunocompetent cells and
3. Odontoblasts young collagen fibers.
4. Defense cells ♦♦ Cell rich zone act as a reservoir for replacing destroyed
a. Histiocytes or macrophages odontoblasts.
b. Dendritic cells
c. Mast cells Pulp Core or Pulp Proper
d. Plasma cells
♦♦ Connective tissue located in center of coronal and radicular
e. Blood vascular elements, i.e. neutrophils,
pulp is known as pulp core.
eosinophils, basophils, lymphocytes, monocytes
5. Pulpal stem cells. ♦♦ This is a core of loose connective tissue with rich cellular
For age changes in pulp (any two) refer to Ans 8 of same elements and also consists of large nerves and blood vessels
chapter. which branches towards the peripheral pulp area.
♦♦ In the younger pulp, core consists of more of cells while
Q.20. Enumerate zones of dental pulp. (Sep 2015, 2 Marks)
in older pulp more of fibrous components are present.
Ans. Histologically four distinct zones of pulp are seen:
1. Odontoblastic zone Q.22. Enumerate cells of pulp. Add a note on functions of
2. Cell free zone pulp. (Jan 2018, 2 + 3 Marks)
3. Cell rich zone Ans. Enumeration of cells of pulp
4. Pulp core or pulp proper. 1. Fibroblasts
Q.21. Write short note on zones of pulp. 2. Undifferentiated mesenchymal cells
(Feb 2016, 3 Marks) 3. Odontoblasts
Or 4. Defense cells
Answer in brief zones of pulp. (May 2017, 2 Marks) a. Histiocytes or macrophages
Ans. Histologically four distinct zones of pulp are seen: b. Dendritic cells
A. Odontoblastic zone c. Mast cells
B. Cell free zone d. Plasma cells
C. Cell rich zone e. Blood vascular elements, i.e. neutrophils,
D. Pulp core or pulp proper. eosinophils, basophils, lymphocytes, monocytes
Odontoblastic Zone 5. Pulpal stem cells
For functions of pulp refer to Ans 5 of same chapter.
♦♦ This zone is present at the periphery of pulp and contains
cell bodies of odontoblasts. Q.23. Enumerate regressive changes of pulp. Write functions
♦♦ Cell bodies of odontoblasts lie in continuous row near the of pulp. (Sep 2018, 3 + 2 = 5 Marks)
dentinal end of pulp. Ans. Enumeration of regressive changes of pulp.
♦♦ Many of the nerve fibers enter odontoblastic zone and get • Pulp stones or denticles
terminated between the odontoblasts. • Diffuse calcification
♦♦ Odontoblastic layer as well as subodontoblastic nerve • Size: As age advances there is decrease in pulp size
network combines to form sensory complex which envelop due to continuous secondary dentin deposition.
the central pulp core.
• Cellular and fibrous components: With ageing
Cell Free Zone fibrous component becomes more prominent and
there is reduction in number of cells.
♦♦ Below the odontoblastic zone a layer of 40 µ is seen which
does not consists of cells. This layer is known as zone of • Changes in blood supply and innervations: There is
Weil or sub odontoblastic layer. decrease in blood supply and there is degeneration
♦♦ Cell free zone is prominently seen in the coronal pulp. of myelinated and unmyelinated axons.
♦♦ Cell free zone decreases in size when dentin formation • Decrease in sensitivity and healing potential.
occurs at rapid rate. For functions of pulp refer to Ans 5 of same chapter.
Dental Histology 665
♦♦ Since rate of formation of this cementum is slow this allows ♦♦ It is formed in apical one third portion of root.
sufficient time to cementoblasts to move away due to ♦♦ It is of two types i.e. cellular mixed fiber cementum and
which these cells are not entrapped in matrix and primary cellular intrinsic fiber cementum.
cementum is acellular. ♦♦ Cellular mixed fiber cementum forms bulk of secondary
♦♦ In the ground section acellular cementum appear cementum and occupies apical interradicular regions while
structureless without any entrapped cells. cellular intrinsic fiber cementum is present in middle and
♦♦ In this incremental lines can be seen as dark lines which apical third areas.
run parallel to root surface and are close to each other ♦♦ Cellular mixed fiber cementum helps to reshape the root
because of slow deposition. surfaces in physiologic and pathologic drifting of teeth in
♦♦ Sharpey’s fibers can be seen as fine striations which lie tooth socket while cellular intrinsic fiber cementum form
perpendicular to root surface. Sharpey’s fibers are more as a result of repair and regeneration process.
in acellular cementum as compared to cellular cementum ♦♦ Rate of cellular cementum deposition is faster which leads
but they are less distinct in acellular cementum as they to entrapment of cementoblasts in matrix and they remain
become fully mineralized. as resting cementocytes in mineralized cementum.
♦♦ Inner most portion of cementum of 15 to 20µ adjacent ♦♦ Cells which are incorporated in this cementum are
to dentin consists of only collagen fibers secreted by cementocytes which lie in lacunae.
cementoblasts. So this part is known as primary acellular
♦♦ A cementocyte consists of many cell processes or canaliculi
intrinsic fiber cementum.
which radiates from its cell body. These processes can
♦♦ Remaining part of cementum consists of fibers secreted by
branch and anastomose with neighboring cells. Most of
periodontal ligament fibroblasts, so this part is known as
these processes are directed to PDL from where they derive
primary acellular extrinsic fiber cementum. This is because
nutrition while some are directed inward also.
primary cellular cementum is formed by extrinsic fibers
because it is secreted after formation of PDL. ♦♦ Cellular cementum also show incremental lines of Salter
which run parallel to root surface and are far apart due
to increase thickness of each increment which is due to
faster deposition.
♦♦ Cellular cementum always consists of peripheral layer of
cementoid which is lined by cementoblasts.
♦♦ At light microscopic level lacunae in deep layers of
cementum appear to be empty suggesting of degeneration
of cementocytes present in these layers.
Q.4. Write short note on cementocytes.(Feb 1999, 6 Marks)
Or
Write notes on cementocytes. (Mar 2007, 2.5 Marks)
Ans. Cementocytes are the cells that are incorporated into
A cellular cementum.
• Cementocytes are spider like cells.
• Cementocytes are similar to osteocytes.
• They lie in lacunae.
• A typical cementocyte has numerous cell processes
or canaliculi, radiating from its cell body.
Cellular Cementum
♦♦ Cellular cementum is also known as secondary cementum
because it is formed after acellular extrinsic fiber Fig. 47: Cementocytes
cementum. (For colour version see Plate 25)
Dental Histology 667
• These processes may branch and anastomose with Q.6. Write short note on cementoenamel junction.
those of neighboring cells. (July 2016, 3 Marks) (Nov 2008, 5 Marks)
• Most of the processes are directed towards the Or
periodontal surface of cementum.
Write short note on types of CEJ. (Oct 2014, 3 Marks)
• Cytoplasm of cementocytes in deeper layer of
cementum contains few organelles. Or
• Endoplasmic reticulum appears dilated and Write about cementoenamel junction.
mitochondria are sparse. (Sep 2015, 5 Marks)
• These characteristics indicate that cementocytes are
Or
either degenerating or marginally active cells.
• In deeper layer cementocytes show signs of Write in brief about types of cementoenamel junction.
degeneration such as cytoplasmic clumping and (May 2017, 2 Marks)
vesiculation. Ans. Relation between cementum and enamel at cervical
• In more deeper layer of cementum lacunae appear region of teeth is called as cementoenamel junction.
empty and suggesting complete degeneration of
cementocytes.
Q.5. Write note on Sharpey’s fiber. (Mar 1998, 5 Marks)
(Feb/Mar 2004, 5 Marks) (Feb 2006, 5 Marks)
Or
Write short note on Sharpey’s fibers.
(Jan 2012, 5 Marks) (May 2014, Marks)
Or
Write very short answer on Sharpey’s fibers.
(Aug 2018, 2 Marks) (May 2018, 2 Marks)
Ans. Sharpey’s Fibers
• Discrete bundles of collagen fibers which are seen Fig. 49: Butt junction (For colour version see Plate 25)
in tangential section, these bundles are known as
sharpey’s fiber. Types of Cementoenamel Junction
• Sharpey’s fibers makes up the substantial portion ♦♦ End-to-end approximating junction (Butt Junction): In
of cementum. approximately 30% of all teeth cementum meets the
• When cementum remains relatively thin these cervical end of enamel in a relatively sharp line.
sharpey’s fibers crosses the entire thickness of ♦♦ Overlapping junction
cementum. • The cementum overlapping the enamel:
• With further apposition of cementum the large part
In approximately 60% of teeth, cementum overlaps
of fiber is incorporated in cementum.
the cervical end of enamel for short distance.
• Cemental surfaces with actively mineralizing fronts
This occurs when the enamel epithelium degenerates
have numerous small openings that correspond to
at its cervical termination permitting connective tissue
site where individual sharpey’s fibers enter the tooth.
to come in direct contact with enamel surface which
• The openings represent unmineralized core of fibers.
produce a laminated, electron dense, reticular material
termed as afibrillar cementum.
Fig. 48: Sharpey’s fibers Fig. 50: Cementum overlapping enamel junction
(For colour version see Plate 25) (For colour version see Plate 25)
668 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• In most cases of cemental repair the outline of root Write short answer on cellular cementum.
is re-established, this is called as anatomic repair. (Aug 2018, 3 Marks)
• In some cases of repair the outline of alveolar bone Ans. For cellular cementum refer to Ans 3 of same chapter.
follows that of root surface so that a functional For classification of cementum refer to Ans 17 of same
relationship will result, this change is called as chapter.
functional repair.
Q.11. Write short note on DE Junction and CE Junction.
• Transverse fracture of the root may occur after
(Oct 2007, 5 Marks)
trauma, and these may heal by formation of new
Ans. For DEJ refer to Ans 7 of ENAMEL chapter and for CEJ
cementum.
refer to Ans 6 of the same chapter.
• The PDL pockets, plaque and its by products can
cause numerous alteration in the physical, chemical Q.12. Write a note on cementogenesis.(Sep 2007, 2.5 Marks)
and structural characteristic of cementum. Ans. Cementum is the hard tissue that is deposited on the
• The surface of pathologically exposed cementum surface of dentin.
becomes hypermineralized because of incorporation
of calcium, phosphorus and fluoride from oral
environment.
Q.9. Write a short note on anatomic and functional repair.
(Sep 2005, 5 Marks)
Ans.
Anatomic Repair
♦♦ In most cases of cemental repair outline of root is
re-established known as anatomic repair.
♦♦ In cementum the resorbed area is filled completely by
cementum and continuity of root surface periodontal
attachment is re-established.
Functional Repair
♦♦ In some cases of cemental repair outline of alveolar bone
follows that of root surface so functional relationship will
result known as functional repair. Fig. 55: Differentiation of cementoblasts
(For colour version see Plate 26)
♦♦ In cementum the resorbed area is filled partially and there
is a presence of bay like defect over the root surface. In
functional repair the alveolar bone create a bony projection
for establishing normal physiologic width of periodontal
attachment.
• Cementoblasts have numerous mitochondria, Q.14. Describe afibrillar and intermediate cementum.
well formed golgi apparatus and large amount of (Feb 2013, 5 Marks)
granular endoplasmic reticulum. Ans.
• Cementoblasts synthesize collagen and protein
polysaccharides which are made up of organic Afibrillar Cementum
matrix of cementum. ♦♦ It is the cementum without collagen fibrils.
• After some cementum matrix is laid down, its ♦♦ It is seen over the enamel near the CEJ.
mineralization begins. ♦♦ Though the cementum is called as afibrillar, it contains
• The uncalcified matrix is called as cementoid.
fiber in its matrix but they lack characteristic collagen
• Calcium and phosphate ions present in tissue fluids
periodicity.
are deposited into the matrix and are arranged as
♦♦ If afibrillar cementum remains in contact with connective
unit cells of hydroxyapetite.
tissue cells for long time, the fibrillar cementum with
• Mineralization of the cementoid is the highly
collagen fibrils get deposited on its surface and thickness
ordered event.
of cementum which overlies enamel increases.
• As the new layer of cementoid is formed, the old
one calcifies. Intermediate Cementum
• Connective tissue fibers from the PDL pass between
the cementoblasts and cementum, these fibers serve ♦♦ It is also known as hyaline layer of Hopewell Smith
to attach the tooth to surrounding bone. ♦♦ Sometimes dentin gets separated from cementum by zone
• Their embedded portions are known as Sharpey’s called as intermediate cementum.
fibers. ♦♦ It does neither exhibit characteristics of cementum nor
Q.13. Write a note on cells of cementum.(Oct 2008, 3 Marks) of dentin.
♦♦ It is also known as hyaline layer, this is because it appears
Or to be structureless.
Write short note on cementoblast and cementocytes. ♦♦ It is prominently visible in apical two-thirds of roots of
(Feb 2013, 2 Marks) (May 2014, 2 Marks) molars and premolars.
Ans. Following are the cells of cementum: ♦♦ This layer represents areas where cells of Hertwig’s
• Cementoblasts epithelial sheath get entrapped in rapidly deposited dentin
• Cementocytes or cementum matrix.
Cementoblasts ♦♦ This layer is considered to be of dentinal origin.
♦♦ They synthesize collagen and protein polysaccharides Q.15. Write short note on junctions of tooth.
which make up the organic matrix of the cementum. (Jan 2012, 2 Marks)
♦♦ These cells have numerous mitochondria, a well Ans. Following are the junctions of tooth:
formed golgi apparatus and large amounts of granular • Dentinoenamel junction (DEJ)
endoplasmic reticulum. - It is the junction between enamel and dentin
♦♦ These cells secrets the cementum. which is scalloped in shape.
- The concavities of scallope faces towards the
Cementocytes dentin while concavities faces towards the
Refer to Ans 4 of the same chapter. enamel.
- Membrana preformativa is seen between enamel
and dentin at the time of tooth development.
During calcification this membrane disappear
and interface is known as dentinoenamel
junction.
• Predentin Pulp junction: This is formed by dense
collagenous fibers and is present between uncalcified
dentin and pulp.
• Dentin-Predentin junction: Dentin-predentin
junction is the junction between dentin and
predentin.
• Cementoenamel Junction (CEJ)
- Junction between cementum and enamel
at cervical region of tooth is known as
cementoenamel junction.
Fig. 57: Cementoblast and cementocyte - It is of clinical importance during root scaling
(For colour version see Plate 26) procedures.
Dental Histology 671
• Cementodentinal Junction (CDJ) Q.17. Write about types of cementum. (Jan 2012, 5 Marks)
- Apical area of cementum where it joins Ans. Following are the types of cementum:
the internal root canal dentin is known as • Based on cellularity:
cementodentinal junction. – Acellular cementum: Cementum present with
- Its width is 2–3 µm. out the cells.
- It is smooth junction between dentin and – Cellular cementum: Cementum consisting of
cementum. cells.
- Its clinical importance is that when RCT is • Based on time of origin:
performed the filling material should end up at – Primary cementum: First formed cementum. It
CEJ.
is acellular. It consist of PDL.
Q.16. Write differences between cellular and acellular – Secondary cementum: It forms after tooth
cementum. (Aug 2016, 3 Marks) (Dec 2014, 2 Marks) reaches occlusal plane.
(May 2017, 3 Marks) • Based on presence of collagen fiber:
Or – Afibrillar cementum: Cementum does not
Write differences between cellular and acellular consist of fibers.
cementum. (Sep 2018, 2 Marks) – Fibrillar cementum: Cementum consisting of
Ans. fibers.
• Based on origin of cementum matrix fibers:
S. – Extrinsic cementum: Cementum consisting of
No. Acellular cementum Cellular cementum
matrix fibers derived from periodontal ligament.
1. Located from cervical to apical Located in apical third and – Intrinsic cementum: Cementum consisting of
third furcations matrix fibers derived from cementoblasts.
2. It is formed earlier and is Formed later and during – Mixed fiber cementum: Cementum containing
known as primary cementum repair and is known as both extrinsic and intrinsic matrix fibers.
secondary cementum
Q.18. Describe afibrillar cementum. (Dec 2014, 5 Marks)
3. It consists of noncollagenous Noncollagenous proteins
Ans. When cementoblasts come under contact with enamel
protein-tenascin, fibronectin are present
and osteocalcin are absent they produce laminated, electron dense, reticular
material known as afibrillar cementum.
4. Growth factors TGF β and IGF Growth factors are seen
• It is seen over the enamel near cementoenamel
are not seen
junction.
5. Proteoglycans, i.e. versican, These proteoglycans are • This cementum is named as afibrillar but it consists
decorin, biglycan and lumican seen in the matrix
of fibers in its matrix, but the fibers lack main
were not identified in the
matrix. characteristic of collagen fibers i.e. 64 nm banding.
• If afibrillar cementum comes in contact with the
6. Cementoid is usually absent Cementoid is seen on the connective tissue cells for the long time, fibrillar
surface
cementum with collagen fibrils may subsequently
7. It contains only extrinsic fibers Contains only intrinsic get deposited on its surface and thickness of
of the periodontal ligament fibers produced by cementum which overlie enamel increases.
formed by fibroblast cementoblast
• It does not play any role in tooth attachment since
8. Probably the only type of May be absent in single it lack collagen fibers.
cementum in single rooted rooted teeth • It is also known as coronal cementum since it can
teeth
be seen on occlusal fissures and other sites where
9. Its main function is anchorage Main function is adaptation break in reduced enamel epithelium has occurred.
and repair
Q.19. Define cemental hypertrophy and cemental hyperplasia.
10. It is formed slowly It is formed rapidly (Sep 2015, 2 Marks)
11. Incremental lines are closer to Incremental lines therefore Ans. Cemental hypertrophy: When excessive deposition of
each other further apart cementum improves the function of tooth, it is known
12. Cementocytes are not seen Cementocytes, viable as cemental hypertrophy.
to varying degrees and Cemental hyperplasia: Excessive deposition of
depths seen cementum in a nonfunctional tooth is known as cemental
13. Cementoblasts are suggestive Cementoblast suggested hyperplasia.
to be derived from hertwig to be derived from inner
epithelial root sheath cells of dental follicle Q.20. Write briefly on cemental repair. (Apr 2017, 2 Marks)
Ans. Resorption of cementum occurs after trauma or excessive
14. Cementocytes do not express Cementoblasts express
occlusal forces. But as resorption is ceased, damage
parathormone receptors parathormone receptor
get repaired either by formation of cellular or acellular
672 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
cementum or by alternate formation of both of them ♦♦ Noncollagenous proteins present are alkaline phosphatases,
which is known as cemental repair. osteonectin, osteocalcin, sialoprotein, osteopontin,
Cemental repair is of two type, i.e. anatomic repair and proteoglycans and growth factors (BMP, PDGF, FGF).
functional repair. These proteins help in regeneration and remineralization
In most cases of repair former outline of root surface has of cementum.
tendency to re-establish which is known as anatomic ♦♦ Polypeptides, i.e. cementum derived attachment
repair. protein and cementum derived growth factor is
In cases where thin layer of cementum is deposited expressed in cementum matrix. These promote
on surface of deep resorption, root outline is not attachment of Mesenchymal cells and also play role in
reconstructed and a bay like recess remains. In these cementogenesis.
areas sometimes periodontal space is restored to its For cementoenamel junctions along with their diagrams
normal width by formation of bony projection so proper refer to Ans 6 of same chapter.
functional relationship will occur. Outline in such cases
Q.23. Write any four differences between dentin and
follows root surface which is known as functional repair.
cementum. (Sep 2018, 2 Marks)
Q.21. Write differences in cementum and bone. Ans. Following are the four differences between dentin and
(Apr 2017, 2 Marks) cementum:
Ans. Following are differences between cementum and bone:
Feature Dentin Cementum
Features Cementum Bone
Composition • 45% inorganic material • 67% inorganic Composition • 70% inorganic • 45% inorganic
• 33% organic material material substances material
• 22% water • 33% organic material • 20% organic • 33% organic material
substances • 22% water
Non- Cementum attachment Cementum attachment • 10% water
collagenous protein present; protein absent;
proteins fibromodulin as well as fibromodulin as well as Dentinal Present Absent
lamican are present lamican are absent tubules
Rate of 0.005 to 0.01 µm per day 1 to 2 µm per day Cementocytes Absent Present
apposition and
cementoblasts
Vascularity Avascular Vascular
Incremental • Incremental lines of • Incremental lines of
Nerve supply Lacks nerve supply Rich nerve supply
lines dentin are known as cementum are known
Ability to Limited Effective incremental lines of as incremental lines
remodel Von Ebner. of Salter.
Resistance It is resistant Resorbs quickly under • These lines reflect • Incremental lines
to resorption hormonal influences the daily rhythmic, separate the cellular
recurrent deposition and acellular
of dentin matrix as cementum into
Q.22. Classify cementum. Write composition of cementum. well as a hesitation layers which indicate
Describe cementoenamel junction in detail. Draw well in the daily periodic formation.
labeled diagrams of CEJs. formative process.
(Jan 2018, 2 + 2 + 4 + 2 Marks)
Ans. For classification of cementum refer to Ans 17 of same
chapter.
7. PERIODONTAL LIGAMENT
Composition of Cementum
Q.1. Describe briefly the cellular elements of PDL.
Cementum consists of:
(Mar 2000, 15 Marks)
♦♦ Inorganic components – 45 to 50%
Ans. Following are the cellular elements of periodontal
♦♦ Organic components and water – 50 to 55%
♦♦ Inorganic portion consists of calcium and phosphate in ligament:
form of hydroxyapatite crystals. Other trace elements are • Synthetic cells, i.e. fibroblasts, osteoblasts and
copper, iron, fluoride, magnesium, sodium, zinc, silica cementoblasts
and potassium are present in varying amounts. Fluoride • Resorptive cells, i.e. osteoclasts, fibroblasts and
ions are present in highest concentrations in cementum as cementoclasts
compared to any another hard tissue of body. • Progenitor cells
♦♦ Organic portion consists of Type I collagen which forms • Epithelial cell rest of malassez
90% of organic matrix. Small amount of other types of • Defense cells, i.e. mast cells, eosinophils and
collagen present are Type III, V, VI, XII, XIV. macrophages
Dental Histology 673
• Alveologingival group: They radiate from bone of • They are the most numerous cells of connective tissue.
alveolar crest and extend to to lamina propria of free • Fibroblasts are fixed cells and they are nonmobile.
and attached gingiva. • Resting fibroblast is an elongated or spindle shaped
• Circular group: These small groups of fibers form cell with little cytoplasm and flattened nucleus
a band around neck of tooth interlacing with other containing condensed chromatin. Active fibroblasts
group of fibers in free gingiva and help in binding of are oval, having pale staining nucleus and a great
free gingiva to tooth. amount of cytoplasm. When seen from the surface,
• Dentoperiosteal group: They run apically from the cell shows branching process.
cementum over periosteum of outer cortical plates of • Fibroblasts become very active when there is need to
alveolar process, these fibers insert in alveolar process lay down collagen fibers, e.g. in wound healing. When
or the vestibular muscle and floor of mouth. need arises, fibroblasts undergo division, give rise to
♦♦ Trans-septal fibers: They run interdentally from cementum more fibroblasts and are regarded as specialized cells.
just apical to base of junctional epithelium of one tooth over
alveolar crest and insert in comparable region of cementum
of adjacent tooth. Togetherly these fibers constitute trans
septal fiber system collectively forming an interdental
ligament which connect all teeth of arch.
Oxytalan Fibers
♦♦ These fibers are present inside the periodontal ligament.
♦♦ These fibers run in an axial direction and their one end
is embedded in cementum or bone and other end in the
wall of blood vessel.
♦♦ These fibers play a part in supporting blood vessels of PDL.
♦♦ These fibers are more thick and numerous in teeth which
are subjected to high loads. Fig. 61: Fibroblast
Q.14. Enumerate principle fibers of PDL. (Dec 2014, 2 Marks)
• Fibroblasts form specialized focal contacts with
(Aug 2018, 2 Marks)
components of extracellular matrix. In such a focal
Or
contact, they are also known as fibronexus.
Enumerate principle group of periodontal ligament. • Fibroblast is the predominant cell in the periodontal
(Sep 2018, 2 Marks) ligament. These fibroblasts origin in part from the
Ans. Enumeration of principal fibers of PDL ectomesenchyme of investing layer of dental papilla
• Apical group and from the dental follicle and are different from
• Oblique group cells in connective tissue in a number of aspects.
• Horizontal group • Fibroblasts near alveolar bone are derived from
• Alveolar crest group perivascular mesenchyme.
• Inter-radicular group.
Functions
Q.15. Enumerate functions of periodontal ligament principle
♦♦ Fibroblasts undergo connective tissue formation.
group fibers. (Sep 2015, 2 Marks)
♦♦ Fibroblasts undergo remodeling of periodontal ligament.
Ans. Enumeration of functions of periodontal ligament of ♦♦ Fibroblasts undergo wound repair.
principle group of fibers: ♦♦ Fibroblasts also secrete biological active molecules such as
a. Supportive proteinases, cytokines, growth factors and inflammatory
b. Sensory mediators. It includes IL-1,6,8 tumor necrosis factor α,
c. Nutritive Progtaglandin E2. platelet derived growth factor, insulin
d. Homeostatic like growth factor-1, transforming growth factor β,
e. Eruptive. vascular endothelial growth factor, basic fibroblast growth
For details refer to Ans 2 of same chapter. factor, hepatocyte and keratinocyte growth factor.
Q.16. Answer in brief fibroblast. (Feb 2016, 2 Marks) Q.17. Define periodontium. What are the structures which
constitute periodontium. Discuss the principal fibers
Or
of periodontal ligament. Add a note on functions of
Write very short answer on fibroblast. periodontal ligament. (Aug 2016, 10 Marks)
(May 2018, 2 Marks) Ans. Periodontium is a connective tissue organ which is
Ans. Fibroblast is the principle cell of connective tissue. covered by epithelium that attaches the teeth to bone of
• Fibroblasts originate from undifferentiated jaws and provides continually adapting apparatus for
mesenchymal cells. support of teeth during function.
678 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
4. Secretory zone: From this region the resorbed products ♦♦ It is known as bundle bone because bundles of principal
and degraded bone matrix is pushed out of the cell. fibers continue inside the bone as sharpey’s fibers.
It consists of numerous mitochondria, abundant ♦♦ Bundle bone consists of few fibrils as compared to
golgi complex, rough endoplasmic reticulum and lamellated bone because of this, it appears dark in routine
lysosomes. Hematoxylin and Eosin stained sections.
♦♦ Formation of bundle bone is in areas of recent bone
Functions of Alveolar Bone apposition.
♦♦ It provide house to the roots of teeth. ♦♦ Bundle bone show lines of rest.
♦♦ Provide anchorage to the roots of teeth. ♦♦ Radiographically bundle bone is known as lamina dura
♦♦ Helps in movement of tooth for better occlusion. due to its increased radiopacity.
♦♦ It absorbs and distributes occlusal forces created during
tooth contact.
♦♦ It supply various vessels to PDL.
♦♦ It supports deciduous teeth and protect budding
permanent teeth.
♦♦ Eruption of deciduous and permanent teeth is organized
by alveolar bone.
Q.2. Write a note on alveolar bone. (Mar 2001, 5 Marks)
Or
Write short note on alveolar bone.
(Nov 2009, 5 Marks) (Nov 2010, 5 Marks)
(Dec 2014, 4 Marks) (May 2017, 3 Marks)
Or
Write briefly on alveolar bone. (Aug 2012, 5 Marks) Fig. 63: Parts of alveolar bone—Proximal view
Or
List parts of alveolar bone with diagrammatics
representation. (Sep 2017, 2 Marks)
Or
Write very short answer on parts of alveolar bone.
(Aug 2018, 2 Marks)
Ans. Alveolar bone is also known as alveolar process.
Alveolar bone may be defined as that part of the maxilla
and the mandible that forms and supports sockets of the
teeth.
Alveolar bone is divided into two parts i.e.
1. Alveolar bone proper
– Lamellated bone
– Bundle bone
2. Supporting alveolar bone
– Cortical plates Fig. 64: Alveolar bone from occlusal view
– Spongy bone
Cribriform Plate
Alveolar Bone Proper
♦♦ Alveolar bone proper which forms inner wall of socket
Alveolar bone proper when viewed microscopically consists which is perforated by many of the openings which carry
partly of lamellated and partly of bundle bone. branches of interalveolar nerves and blood vessels in PDL.
This is known as cribriform plate.
Lamellated Bone
♦♦ Cribriform plate is a compact bone.
Lamellae of this bone are arranged parallel to the surface of
adjacent marrow spaces while others form haversian system. Interdental Septum
♦♦ Bone between the teeth is known as interdental septum.
Bundle Bone ♦♦ Interdental septum consists mainly of cribriform plate.
♦♦ It is the bone which consists of principal fibers of ♦♦ The interdental and inter-radicular septa contain the
periodontal ligament anchored in it. perforating canals of Zukerkandl and Hirschfeld (Nutrient
Dental Histology 681
Canals) which house the interdental and inter-radicular • These fibers are arranged at right angles to Sharpey’s
arteries, veins, lymph vessels and nerves. fibers.
• Bundle bone contains fewer fibrils than does
Supporting Alveolar Bone lamellated bone.
This part is a bone that surrounds the alveolar bone proper and • Bundle bone appears dark in routine hematoxylin
gives support to the socket. and eosin stained section.
The alveolar process or bone consists of two parts: • In some areas the alveolar bone proper consists
mainly of bundle bone.
Cortical Plates • Bundle bone contains more calcium salt per unit area
than other types of bone tissues.
♦♦ This part consists of compact bone and forms the outer
and inner plates of the alveolar processes. • It is formed in the areas of recent bone apposition.
♦♦ Cortical plates are continuous with the compact layers of • Bundle bone show lines of rest.
the maxillary and mandibular body. • Radiographically bundle bone is known as lamina
♦♦ Cortical plates are much thinner in maxilla than in the dura due to its increased radiopacity. Increased
mandible. They are thickest in the region of molar and radiopacity is due to the presence of thick bone
premolar in mandible. without trabeculae that X–rays must penetrate.
♦♦ In the maxilla, the outer cortical plate is perforated by Q.4. Write a note on resting and reversal lines of bone.
many small openings for blood and lymph vessels passage. (Sep 2003, 5 Marks)
♦♦ In lower jaw the cortical bone of the alveolar process is Or
dense. Write about resting and reversal lines.
♦♦ Bone which underlies gingiva is known as cortical plate. (May/June 2009, 5 Marks) (June 2010, 2 Marks)
Cortical plate is a compact bone. Ans. Resting and reversal lines appear during reconstruction
Spongy Bone of alveolar bone.
♦♦ This part fills the area between the cortical plates and the Resting Line
alveolar bone proper.
Bone is laid down rhythmically and there are periods of active
♦♦ According to the radiographs spongiosa of alveolar process
deposition and quiescence which leads to formation of regular
is divided into two main types, i.e.
parallel incremental lines known as resting lines. Resting lines
1. In type I spongy bone, the interdental and inter-
are formed in the period of quiescence. Resting line is regular.
radicular trabeculae are regular and horizontal in
ladder like arrangement. Reversal Line
2. Type II spongy bone, shows irregularly arranged,
numerous, delicate interdental and inter-radicular The cement line which consists of little or no collagen and is
trabeculae. strongly basophilic due to its high content of glycoproteins
♦♦ Type I is common in mandible and Type II is common in and proteoglycans, marks the limit of bone erosion prior to
maxilla. formation of osteon and is known as reversal line. Reversal
♦♦ Marrow spaces present in alveolar bone may consists of line is highly irregular as it is formed by scalloped outline of
hemopoietic marrow but mainly they have fatty marrow. Howship’s lacunae. Old and the new bone is separated by this
distinct curved hematoxophilic line, i.e. reversal line with its
♦♦ In condylar process, angle of mandible, maxillary
convexity facing the old bone. Reversal lines are the indicators
tuberosity and in various other isolated foci, hematopoietic
of continuous remodeling of bone.
cellular marrow is found.
Q.3. Write a note on bundle bone in detail.
(Sep 1998, 6 Marks) (Sep 1999, 5 Marks)
(Mar 2000, 5 Marks)
Or
Write in short on bundle bone. (Apr 2007, 5 Marks)
Or
Describe briefly bundle bone. (June 2010, 5 Marks)
Ans. Bundle bone: Bundle bone is that bone in which the
principal fibers of the periodontal ligament are anchored.
• The term ‘’bundle bone” was chosen because the
bundles of the principal fibers continue into the bone
Sharpey’s fibers.
• Bundle bone is characterized by the scarcity of the
fibrils in the intercellular substance. Fig. 65: Resting lines of bone (For colour version see Plate 27)
682 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.5. Write a note on cells of bone. 3. Basolateral zone: It is an area which receives regulatory
(Feb 2006, 2.5 Marks) (Dec 2010, 2 Marks) signals from adjacent cells.
Ans. The cells of bone are osteoblast, osteocytes and osteoclast. 4. Secretory zone: From this region the resorbed products
and degraded bone matrix is pushed out of the cell. It
Osteoblast consists of numerous mitochondria, abundant golgi
♦♦ Osteoblasts are round or polygonal in shape. complex, rough endoplasmic reticulum and lysosomes.
♦♦ They lie over the outer surface of bone.
♦♦ They are uninucleated whose nucleus is eccentrically
placed.
♦♦ Osteoblasts secrete type I collagen as well as the non-
collagenous matrix of bone.
♦♦ Osteoblast contains prominent Golgi apparatus, rough
endoplasmic reticulum, mitochondria, nucleoli and many
secretory vesicles and vacuoles.
♦♦ Osteoblats secrete cytokine which regulate cellular
metabolism.
♦♦ They have high levels of alkaline phosphatase which create
an alkaline environment for bone formation.
♦♦ As osteoblasts secrete the organic matrix of bone, it is at
first devoid of minerals salts, it is called osteoid tissue.
Fig. 66: Osteoblast, osteocyte, osteoclast
Osteocytes (For colour version see Plate 27)
♦♦ Resting osteoblasts are known as osteocytes. Q.6. Write shortly about incremental lines of enamel,
♦♦ As osteoblasts seceret extracellular matrix, they become dentin, cementum and alveolar bone.
small in size and are known as osteocytes. (Mar 2007, 3 Marks)
♦♦ Osteocytes lie in osteocytic lacunae. Or
♦♦ Osteocytes are interconnected with each other by the Write about incremental lines of enamel, dentin and
cytoplasmic processes. cementum. (Nov 2008, 10 Marks)
♦♦ Osteocytes help in calcium homeostasis by mobilizing Ans. For incremental lines of enamel refer to Ans 13 of chapter
calcium in and out of bone matrix.
ENAMEL.
Osteoclasts
Incremental Lines of Dentin
♦♦ Osteoclasts are cells that resorb bone and tend to be large
♦♦ They are also known as incremental lines of von Ebner.
and multinucleated but can also be small or mononuclear.
♦♦ Multinucleated osteoclasts are formed by the fusion of These incremental lines or imbrication lines appear as fine
circulating monocytes. lines or striations in dentin.
♦♦ These multinucleated cells exhibit eosinophilic cytoplasm. ♦♦ They run at right angles to dentinal tubules.
♦♦ The cell body is irregularly oval or club-shaped and may ♦♦ These lines reflect the daily rhythmic, recurrent deposition
show many branching processes. of dentin matrix as well as a hesitation in the daily
♦♦ Osteoclasts are found in bay like depression in the bone formative process.
called Howship’s lacunae. ♦♦ The course of the line indicates growth pattern of the dentin.
♦♦ Osteoclast has prominent mitochondria, lysosome,
vacuoles and little rough endoplasmic reticulum. Their
nuclei have condensed chromatin and single nucleus.
♦♦ Osteoclasts are the physiological giant cells.
♦♦ Osteoclasts consist of four zones, i.e.
1. Ruffled border: Part of osteoclast causing resorption
is known as ruffled border, it is made up of finger like
processes which extend in part of bone which has to be
resorbed. It consists of tightly packed microvili. Ruffled
border provides large surface area for resorption.
2. Sealing zone: This zone is present in outer region of
ruffled border. It forms close contact with the bone
and create microenvironment in which resorption take
place without liberating hydrolytic enzymes produced Fig. 67: Incremental lines of von Ebner
by cell. This prevents adjacent tissue from damaging. (For colour version see Plate 27)
Dental Histology 683
Or Osteoid Tissue
Write short answer on osteoclast.(May 2018, 3 Marks) ♦♦ Osteoid tissue is an organic matrix of bone devoid of
Ans. mineral salts.
• Osteoclasts are cells that resorb bone and tend to be ♦♦ It is formed by osteoblasts.
large and multinucleated but can also be small or ♦♦ It stains pink in routine hematoxylin and eosin stains.
mononuclear. ♦♦ In area of bone formation, mineralization always lag
• Multinucleated osteoclasts are formed by the fusion behind the production of bone matrix and therefore in such
of circulating monocytes. areas a superficial layer of osteoid tissue is always seen.
• These multinucleated cells exhibit eosinophilic Q.9. Write short note on lamina dura. (Jan 2012, 2 Marks)
cytoplasm. Ans. Radiographically bundle bone is known as lamina dura
• The cell body is irregularly oval or club-shaped and due to increased radiopacity. Increased radiopacity is
may show many branching processes. due to the presence of thick bone without trabeculations
• Osteoclasts are found in bay like depression in the that X–rays must penetrate. Lamina dura is the thin layer
bone called Howship’s lacunae. of compact alveolar bone which lines the tooth socket.
684 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• Lamina dura forms the continuous white or • Eruption of deciduous and permanent teeth is
radiopaque line around the root of the tooth. organized by alveolar bone.
• It is perforated by many small openings that carry
branches of intra-alveolar nerves and vessels to PDL Components of Alveolar Bone
and cementum of tooth. Components of alveolar bone includes:
• Thickened lamina dura at the apical region of a 1. Alveolar bone proper: It consists of lamellated bone and
developing tooth is a sign of tooth eruption. partly bundle bone
• Thinning or absence of lamina dura is seen in pulpal 2. Supporting alveolar bone
and periodontal diseases. a. Buccal and lingual cortical plates
Q.10. Describe woven bone. (June 2010, 3 Marks) b. Central spongy bone.
Ans. It is also known as immature bone.
Classification of Bone
• It is characterized by interwining of collagen fibers
which are oriented in many directions. I. Classification based on shape
• Bony spicules lengthen into longer anastomoting 1. Long bones
structures known as trabeculae. Trabeculae extends 2. Short bones
in a radial pattern and enclose blood vessels. This 3. Flat bones
early membrane bone is known as woven bone. 4. Irregular bones
• External to woven bone there is a condensation of 5. Sesamoid bones
mesenchyme known as periosteum. II. Classification based on development
• Woven bone consists of greater amount of 1. Endochondral bones
interfibrillar space which is filled by mineral crystals. 2. Intramembranous bones
• Woven bone has high proteoglycans content and III. Classification based on the microscopic structure
that is why it appears more blue when stained with 1. Mature bone
H&E stain. a. Compact bone
• Woven bone is enriched in bone acidic glycoprotein-75 b. Cancellous bone
and bone sialoprotein. 2. Woven or immature bone.
• Woven bone consists of low mineral density and Q.13. Write short note on alveolar bone proper.
high water content.
(Oct 2016, 3 Marks)
Q.11. Write about concentric, interstitial and circumferential Ans. Alveolar bone proper consists of thin lamella of bone
lamellae of bone. (Jan 2012, 5 Marks) that surround the root of tooth and give attachment to
Ans. Concentric lamellae: Deep to circumferential lamellae, principal fibers of periodontal ligament.
the lamellae are arranged in concentric layers around the Alveolar bone proper when viewed microscopically
haversian canal. These are known as concentric lamellae. consists partly of lamellated and partly of bundle bone.
Haversian canal and concentric lamellae collectively are
known as osteon. Lamellated Bone
Interstitial lamellae: Adult bones between the osteons
Lamellae of this bone are arranged parallel to the surface of
consists of inetrstitial lamellae. Interstitial lamellae are
adjacent marrow spaces while others form haversian system.
the remnants of osteons. These are left behind during
remodeling. Bundle Bone
Circumferential lamellae: At periosteal and endosteal
♦♦ It is the bone which consists of principal fibers of
surfaces, the lamellae are arranged in parallel layers
periodontal ligament anchored in it.
which surrounds the bony surface and are known as
♦♦ It is known as bundle bone because bundles of principal
circumferential lamellae.
fibers continue inside the bone as sharpey’s fibers.
Q.12. Write the functions of alveolar bone. Write the ♦♦ Bundle bone consists of few fibrils as compared to
components of alveolar bone. Give the classification lamellated bone because of this, it appears dark in routine
of bone. (Sep 2015, 2+1+2 Marks) hematoxylin and eosin stained sections.
Ans. Functions of alveolar bone ♦♦ Formation of bundle bone is in areas of recent bone
• It provides house to the roots of teeth. apposition.
• Provide anchorage to the roots of teeth. ♦♦ Bundle bone show lines of rest.
• Helps in movement of tooth for better occlusion. ♦♦ Radiographically bundle bone is known as lamina dura
• It absorbs and distributes occlusal forces created due to its increased radiopacity.
during tooth contact.
• It supply various vessels to PDL. Cribriform Plate
• It supports deciduous teeth and protect budding ♦♦ Alveolar bone proper which forms inner wall of socket
permanent teeth. which is perforated by many of the openings which carry
Dental Histology 685
Interdental Septum
♦♦ Bone between the teeth is known as interdental septum.
♦♦ Interdental septum consists mainly of cribriform plate.
♦♦ The interdental and inter-radicular septa contain the
perforating canals of Zukerkandl and Hirschfeld (Nutrient
Canals) which house the interdental and inter-radicular
arteries, veins, lymph vessels and nerves.
Q.14. What is periodontium. Enumerate the hard and soft
tissue comprising of it. Describe alveolar bone in detail
with diagram. (Apr 2017, 1 + 2 + 5 + 2 Marks)
Ans. Periodontium is a connective tissue organ which is
covered by epithelium that attaches the teeth to bone of
jaws and provides continually adapting apparatus for
support of teeth during function.
Fig. 70: Compact bone (transverse section)
Enumeration of Hard and Soft Tissue
♦♦ So, haversian canal and concentric lamellae are together
Constituting Periodontium
known as haversian system or osteon. Osteon is referred
♦♦ Hard tissue to as basic metabolic unit of bone.
• Cementum ♦♦ A cement line of mineralized matrix which is strongly
• Alveolar bone basophilic delineates haversian system. This line marks
♦♦ Soft tissue limit of bone erosion prior to formation of osteon, also
• Gingiva known as reversal line. The line is highly irregular.
• Periodontal ligament ♦♦ Bone is laid down rhythmically and there are periods of
For alveolar bone in detail along with diagram refer to Ans 2 active deposition and quiescence which leads to formation
and Ans 1 of same chapter. of regular parallel incremental lines known as resting
lines. Resting line denotes the period of rest during bone
Q.15. Describe histology of compact bone. Draw well labeled formation.
diagram of histology of compact bone. ♦♦ Adjacent haversian canals are interconnected by Volkmann’s
(Jan 2018, 3 + 2 Marks) canals which consisting of blood vessels.
Ans. ♦♦ Between the concentric lamellae are lacunae which consist
Histology of Compact Bone of osteocytes.
♦♦ Radiating canaliculi from lacunae connect haversian canal
♦♦ Outer aspect of compact bone is surrounded by condensed with all lacunae present in an osteon.
fibrocollagen layer, i.e. periosteum which has two layers: ♦♦ Older bone tissue is constantly replaced by new bone tissue.
1. Outer layer: Dense irregular connective tissue fibrous Due to this fragments of older osteons are seen in areas
layer. between osteons. These areas show lamellar arrangement of
2. Inner layer: Lies next to bone surface consisting of bone, i.e. between lamellae are lacunae which are occupied
bone cells their precursors and rich vascular supply. by osteocytes. Radiating from lamellae are canaliculi. These
♦♦ Inner surface of compact bone is covered by thin cellular lamellae are known as interstitial lamellae.
layer called as endosteum. Q.16. Enumerate cells of bone. (Sep 2018, 2 Marks)
♦♦ At periosteal and endosteal surfaces, lamellae are arranged Ans. Cells of bone are:
in parallel layers surrounding bony surface known as
• Osteoblast
circumferential lamellae.
• Osteocyte
♦♦ Circumferential lamellae are of two types, i.e. outer • Osteoclast
circumferential lamellae and inner circumferential
lamellae. Outer circumferential lamellae are present on
outer surface of bone just below periosteum and they 9. ORAL MUCOUS MEMBRANE
completely encircle the bone while inner circumferential
lamellae encircle marrow cavity. Q.1. Write a note on lamina propria.
♦♦ Deep to the circumferential lamellae, lamellae are arranged (Mar 1998, 5 Marks) (Apr 2008, 5 Marks)
as small concentric layers, i.e. concentric lamellae around Ans. The connective tissue component of oral mucosa is
central vascular canal or haversian canal. termed as lamina propria.
686 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• Lamina propria is a connective tissue of variable Q.3. Enumerate the differences between oral mucosa of
thickness that supports the epithelium. lining and masticatory types. Describe histological
• It is divided into two parts papillary and reticular. features of hard palate. (Sep 1999, 15 Marks)
• Papillary portion is named for papillae and reticular Ans. The oral mucous membrane depending on their
portion for the reticular fibers. functional adaptation classified into masticatory, lining
• Papillary portion is between the epithelial ridges and specialized mucosa.
and reticular portion lies below it. The differences between lining and masticatory mucosa
• Reticular portion as well as the papillary portion are:
contains reticular fibers.
Lining mucosa Masticatory mucosa
• Two portions are not separate, they are continuous.
• Reticular zone is always present. The papillary zone Masticatory mucosa is keratinized Lining mucosa is nonkeratinized
may be absent in some areas such as the alveolar Masticatory mucosa is found Lining mucosa is found in lip,
mucosa when the papillae are either very short or on hard palate and gingiva cheek, vesicular fornix, soft
palate, floor of mouth and
lacking.
alveolar mucosa
• Interlocking arrangement of connective tissue
papilla, epithelial ridges and the finer unduelations Lining mucosa covers the Masticatory mucosa covers the
muscles bone
and projections found at base of each epithelial cell
increases area of contact between lamina propria and It is loosely attached to It is tightly bound to underlying
underlying structures structures
epithelium. This additional area leads to exchange
of material between epithelium and blood vessels It is stretchable to adapt the It is nonstretchable
in connective tissue. contraction and relaxation of
underlying muscles
• Ground substance present in lamina propria consists
of glycoproteins and proteoglycans. Turnover rate is fast Turnover rate is slow
• Cells such as fibroblasts, mast cells and macrophages Lamina propria is less dense Lamina propria is dense
are present in lamina propria. Distinct submucosa is present Submucosa can or cannot be
• Collagen fibers Type I and Type III are present in which vary in thickness present
lamina propria. Rete ridges are short and Rete ridges are long and narrow
• The lamina propria may attack to the periosteum of irregular
the alveolar above, or it may overlay the submucosa Epithelium is thick Epithelium is less thicker
in some region of mouth such as soft palate and floor
Three layers are seen, i.e. Four layers are seen, i.e. stratum
of the mouth.
stratum basale, stratum basale, stratum spinosum,
Q.2. Write a note on keratinization of epithelium. intermedium, stratum stratum granulosum and stratum
(Sep 2002, 5 Marks) (Mar 2009, 5 Marks) superficiale corneum
Ans. Keratinizing oral epithelium has four cell layer, i.e.
Histological Features of Hard Palate
stratum basal, stratum spinosum, stratum granulosum
and stratum corneum. ♦♦ Hard palate is covered by keratinized mucosa.
• Stratum basal undergoes mitosis and providing new ♦♦ Keratinized stratified squamous epithelium which lines
cells, the basal cells. the mucosa consists of four different layers, i.e. stratum
basale, stratum spinosum, stratum granulosum and
• New basal cell migrates and pushed upward.
stratum corneum.
• It is called as spinous cell just beyond the basal layer
in stratum spinosum.
• Spinous cell is larger than basal cell.
• In stratum granulosum, cells become wider and
contain basophilic keratohyalin granules, these cells
show signs of degradation of nucleus.
• In stratum corneum, the cells become keratinized
and squamated which are larger and flatter than
granular cells.
• The epithelial cells that ultimately keratinize are
called “keratocyte” or “keratinocytes”
• This whole process from the onset of determination
is called as “keratinization”.
• During the migration, basal cell undergoes chemical
and morphologic changes and forms a keratinized Fig. 71: Anterolateral zone of hard palate
squama a dead cell “keratinocyte”. (For colour version see Plate 27)
Dental Histology 687
♦♦ Due to functional adaptation, to bear with masticatory 1. Keratinized: In which the superficial cells form scales
stress, cells in hard palate show more dense tonofilaments, of keratin and loose their nuclei.
increased number and length of desmosomes, etc. - A stratum granulosum is present
♦♦ Epithelium connective tissue interface of hard palate is - It is found in 15% of population.
irregular with many long regular epithelial ridges which 2. Parakeratinization: In which the superficial cells retain
interdigitate with connective tissue papillae. “pyknotic nuclei” and show some signs of being
keratinized.
- Stratum granulosum is generally absent.
- Gingiva is parakeratinized in 75% of people.
3. Nonkeratinized: In which the surface cells are nucleated.
- This mucous membrane does not show signs of
keratinization.
- Nonkeratinized gingiva is found in 10% of
people.
- Nonkeratinized epithelium contains basal layer,
stratum intermedium and stratum superficial.
For description of oral mucous membrane of gingiva refer to
Ans 16 of same chapter.
Q.5. Write a note on lip. (Feb 1999, 5 Marks)
Or
Fig. 72: Posterolateral zone of hard palate Describe with diagram of lip. (Mar 2009, 5 Marks)
(For colour version see Plate 28) Ans. Lip
Lip is a muscular structure found on the opening of oral
♦♦ Lamina propria is dense all through the hard palate, it is
cavity.
thicker in anterior region as compared to posterior region.
♦♦ In the region of rugae the connective tissue core is dense • Lip is covered by nonkeratinized, lining mucosa.
with interwoven collagen fibers. Incisive or palatine papilla • Epithelium of mucosa of the lip is stratified
composed of dense connective tissue. This consists of squamous nonkeratinized epithelium.
remnants of nasopalatine duct which is lined by pseudo- • Lamina propria of the mucosa consists of dense
stratified squamous epithelium. connective tissue and has short, irregular papillae.
♦♦ Frequently the ducts are surrounded by small, irregular • Submucous layer connects the lamina propria to the
islands of hyaline cartilage. thin fascia of the muscles.
♦♦ Structure of submucosa show variation in different regions of • Submucosa consists of strands of densely grouped
palate. Submucosa is completely absent in the peripheral zone collagen fibers.
of palate adjacent to the teeth, i.e. the gingival zone and in • There is loose connective tissue containing fat and
the mid palatine raphae. In these regions, the lamina propria small mixed glands.
is tightly bound to the periosteum of bone which is called • Strands of collagen fibers limit the mobility of
as mucoperiosteal attachment. In between the gingival zone mucous membrane.
and mid palatine raphae, the palate has distinct submucosa. • This prevents the mucous membrane of the lips
♦♦ Submucosa in the anterior region of hard palate is filled lodging between the biting surface of the teeth
with adipose tissue and in posterior region with mucous during mastication.
glands. So anterolateral part of hard palate is known as fatty • Minor mixed salivary glands are found in sub-
zone and posterolateral part is known as glandular gone. mucosa of lip.
♦♦ In spite of presence of thick submucosa in some regions, Refer to Ans 6 of same chapter for diagram.
mucosa of the hard palate is tightly fixed to the underlying Q.6. Write a note on soft palate. (Feb 2002, 6 Marks)
bone and is immobile. This is due to dense vertical band Ans. Soft palate is found on the roof of oral cavity behind the
of connective tissue which leads to attachment of mucosa hard palate.
firmly to the periosteum of palatal bone. These dense bands
• Soft palate is covered by lining mucosa which is
of connective tissue are at right angle to surface and divide
nonkeratinized stratified squamous epithelium.
submucosa into compartments.
• Mucous membrane on the oral surface of the soft
♦♦ At the junction of alveolar process and horizontal plate palate is highly vascularized and reddish in color.
of hard palate there is presence of loose connective tissue • Soft palate is differentiated from the pale color of
which carries anterior palatine vessels and nerves. the hard palate by its reddish color.
Q.4. Classify and describe with the diagrams, oral mucous • Epithelium may show presence of some taste buds.
membrane of gingiva. (Sept 2002, 16 Marks) • Epithelium connective tissue interface is irregular
Ans. Oral mucous membrane of gingiva on the basis of with short and thick rete ridges and connective
epithelial surface are of three types: tissue papillae.
688 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• Lamina propria shows distinct layer of elastic fibers ♦♦ Body and the base of the tongue differ widely in the
separating it from submucosa. structure of the mucous membrane.
• Papilla of connective tissue are few and are short. • A small depression or pit is present at the point where
• Submucosa consists of diffuse loose connective two arms of ‘V’ meet. This depression is known as
tissue containing numerous mucous minor salivary
foramen ceacum.
glands.
• Free-border of soft palate is replaced by nasal • Filiform papillae are cone shaped papillae which are
mucosa with its pseudostratified ciliated columnar present on the dorsal surface. They are numerous.
epithelium. • Fungiform papillae are present between the filiform
Q.7. Write a short note on palatal mucosa. papillae on the dorsal aspect mainly on the tip and
(Oct 2007, 5 Marks) lateral margins of tongue.
Ans. Palate forms the roof of oral cavity. • Fungiform papillae appear as red round, projections.
• Palate consists of two part: • Circumvallate papillae are 8–12 large papillae which
1. Hard palate lie anterior to sulcus terminalis.
2. Soft palate. • Circumvallate papillae are partly submerged. They
• For hard palate: Refer to Ans 3 of same chapter. do not project above the surface of tongue and are
• For soft palate: Refer to Ans 6 of same chapter.
surrounded by a ‘V’ shaped sulcus.
Q.8. Classify the oral mucous membrane and describe the • In the posterior region of anterior 2/3rd of tongue,
macroscopic and microscopic features of dorsum of
on the lateral margin foliate papillae are seen which
tongue. (Nov 2008, 15 Marks) (Nov 2009, 10 Marks)
consists of series of folds forming clefts.
Or • Foliate papillae are rudimentary papillas in humans.
Define and classify mucous membrane. Describe in • Posterior l/3rd of the tongue has an irregular surface
detail about dorsum of tongue with well labelled with round projection, the lingual follicles consist of
diagrams. (Aug 2011, 15 Marks)
lymphoid component.
Or
• Mucous membrane lining the posterior 1/3rd does not
Give classification of oral mucous membrane. Write in show papillae and is relatively smoother.
detail on dorsal surface of tongue. (Apr 2015, 8 Marks)
Or
Classify oral mucous membrane. Describe in detail
papillae of tongue. (June 2010, 15 Marks)
(Feb 2014, 8 Marks) (Oct 2014, 8 Marks)
Ans. Oral Mucous Membrane
Lining of oral cavity is called as oral mucous membrane.
It consists of epithelium and connective tissue known as
lamina propria.
Fungiform Papillae
♦♦ They are mushroom shaped structure.
♦♦ They project above the surface of the tongue.
♦♦ They are located between the filiform papillae.
♦♦ Epithelium covering the fungiform papillae is thin non-
keratinized stratified squamous epithelium.
♦♦ Superficial surface of papillae contains few taste buds.
• Gingiva does not join the tooth at the gingival margin. –– The musculature of the tongue is derived from
• It forms small enfolding known as “sulcus”. the occipital myotomes which are supplied by
• Sulcus extending from the free gingival margin to the hypoglossal nerve.
the dentogingival junction. –– Connective tissue develops from the local mes-
• Sulcus epithelium is nonkeratinized. enchyme.
• It lacks epithelial ridges and so form a smooth
interface with the lamina propria.
• It is thinner than the epithelium of gingiva.
• The sulcular epithelium is continuous with the
gingival epithelia and the attachment epithelium.
Q.13. Write a short note on zone of hard palate.
(Mar 2006, 5 Marks)
Ans.
♦♦ Gingival region: This region is found adjacent to the teeth.
♦♦ Mid-palatine raphae: This is the narrow zone in midline
of the hard palate which extends from incisive papilla
posteriorly.
Or Attached Gingiva
Define and classify oral mucous membrane. Describe ♦♦ Fine, resilient and immobile part of the gingiva which
the macroscopic and microscopic structure of gingiva. tightly bounds to the alveolar bone is known as attached
(Feb 2016, 10 Marks) gingiva.
Or ♦♦ Attached gingiva extends from free gingival groove to
mucogingival junction.
Write short note on gingiva. (Dec 2014, 5 Marks)
♦♦ At the palatal surface, attached gingiva merges with palatal
Or mucosa.
Write a note on gingiva. (Sep 2000, 5 Marks) ♦♦ In maxilla width of attached gingiva ranges from 3.5–4.5 mm
(Sep 2003, 5 Marks) while in mandible it is 3.3–3.9 mm.
Or ♦♦ Surface of the attached gingiva is irregular. It consists of
Write a note on histology of gingiva. some elevations and some depressions.
♦♦ Elevations and depressions of attached gingiva create
(Mar 2001, 5 Marks) (Apr 2008, 5 Marks)
orange peel appearance which is known as stippling.
Ans. For definition and classification refer to Ans 11 of the
♦♦ Loss of stippling is the initial sign of gingival inflammation.
same chapter.
♦♦ Gingiva can show mild vertical depression in between the
Morphology of Gingiva/Macroscopic Structure of Gingiva alveolar bone eminences of adjacent teeth which are known
as interdental grooves.
♦♦ Gingiva provides coverage to alveolar process and
completely surrounds neck of the tooth. Histology of Gingiva/ Microscopic Structure of Gingiva
♦♦ It is tightly bound to buccal and lingual plates of alveolar
In Oral Region
process.
♦♦ Gingiva extends from the dentogingival junction to ♦♦ Epithelium lining is keratinized or parakeratinized
alveolar mucosa. stratified squamous epithelium and consists of four
♦♦ It is pink in color with some degree of melanin pigmenta- layers, i.e. stratum basale, stratum spinosum, stratum
tion. granulosum and stratum corneum. Gingival epithelium
♦♦ Anatomically gingiva is divided into three parts, i.e. is parakeratinized in 75% of people.
marginal gingiva, interdental papilla and attached gingiva. ♦♦ A shallow ‘V’ shaped notch on the surface is seen which
corresponds to the heavy epithelial ridge which is known
Marginal Gingiva as free gingival groove.
♦♦ Unattached portion of gingiva which surrounds the teeth ♦♦ Epithelial connective tissue interface is irregular with
in collar like fashion is known as attached gingiva. numerous long and slender rete ridges. These rete ridges
♦♦ Marginal gingiva follows a scalloped line on facial and interdigitate with long connective tissue papillae.
lingual surface of the teeth.
♦♦ Marginal gingiva forms the soft tissue wall of gingival Sulcular Epithelium
sulcus. It is separated from attached gingiva by a free ♦♦ Sulcular epithelium consists of thin layer of non-
gingival groove. keratinized epithelium.
♦♦ Junction which lies in between epithelium and connective
Gingival Sulcus tissue is flat and is devoid of rete ridges.
It is a ‘V` shaped space seen around the tooth. Gingival sulcus is
bounded on one side by tooth surface on other side by marginal Junctional Epithelium
gingiva. ♦♦ It consists of stratified squamous epithelium which is of
l5 to 30 cell layer thickness at the cervical portion and 3 to
Interdental Papilla 4 cell layer thick at the apical margin.
♦♦ Part of the gingiva which fills the interdental space between ♦♦ It consists of flattened cells which lie parallel to the tooth
two adjacent teeth is known as interdental papilla. surface.
♦♦ It appears pyramidal or triangular from the facial and ♦♦ Epithelial connective tissue interface is flat.
lingual aspect along with its lateral borders. Tip of the ♦♦ Its characteristic feature is presence of basal lamina on
pyramid is formed by continuation of marginal gingiva both sides, i.e. at the junction of epithelium and connective
of adjacent teeth. tissue and also on the surface adjacent to the tooth.
♦♦ In the posterior region interdental gingiva has a ‘tent’ shape.
Connective Tissue of Gingiva
♦♦ Facial as well as lingual portions of interdental papillae
forms the concave or valley like area which fits below the ♦♦ Connective tissue beneath the gingival epithelium consists
contact area. The valley like area is known as col. of lamina propria with two layes, i.e. papillary and reticular
♦♦ Col or gingival col is lined by nonkeratinized epithelium. layer.
Dental Histology 693
♦♦ Gingiva consists of dense collagen fibers which are ♦♦ On either side of lingual frenum, prominent lingual veins
arranged in bundles. These fiber groups are known as are seen.
secondary fibers of periodontal ligament or gingival fibers ♦♦ Lateral part of ventral surface has two folds which are
of periodontal ligament. known as plica fimbriata. They run forward and medially
♦♦ In addition to collagen fibers, oxytalan fibers and elastic to the tip of the tongue.
fibers are also present in gingival connective tissue.
♦♦ The gingival fibers include: Microscopic Features of Tongue
• Dentogingival: Extends from the cervical cementum For microscopic features of dorsal surface of tongue refer to
into the lamina propria of the gingiva. These groups Ans 8 of same chapter.
are most numerous.
• Alveologingival: The fibers arise from the alveolar Microscopic Features of Ventral Surface of Tongue
crest and extend into the lamina propria. ♦♦ Ventral aspect is lined by non-keratinized stratified
• Circular: A small group of fibers that circle the tooth squamous epithelium.
and interlace with the other fibers. ♦♦ Mucosa is tightly bound to underlying musculature.
• Dentoperiosteal: These fibers run from the cementum ♦♦ Thin epithelium is present with short rete ridges.
into the periosteum of alveolar bone. ♦♦ Lamina propria is thin and shows loose arrangement of
• Interdental ligament: These are extended inter collagen fibers.
proximally between adjacent teeth.
♦♦ Gingiva also contains some cells in epithelium other than Q.18. Write about the histological features of vermilion
keratinocytes, i.e. border of lip and buccal mucosa. (Mar 2008, 7.5 Marks)
• Melanocytes: They are found in basal layer and give the Or
pigmentation of gingiva either pink, brown or black. Write a note on histology of vermilion border of lip.
• Langerhans cells: These are involved in the immune (Feb 2006, 2.5 Marks)
system. Ans. Vermilion border of lip: Vermilion zone is the
• Merkel cell: These are specialized neural pressure transitional zone between skin of the lip and mucous
sensitive receptor cell. membrane of the lip. Line which separates skin from
• Lymphocytes: Also found in gingiva. vermilion zone is known as vermilion border.
Histology
♦♦ Skin on the outer surface of lip is covered by moderately
thick, keratinized stratified squamous epithelium with all
appendages i.e. hair follicles, sweat glands and sebaceous
glands.
♦♦ Transitional region is characterized by thick but mildly
keratinized epithelium and numerous densely arranged,
long papillae of lamina propria which reach deep into the
epithelium and carry large capillary loops close to surface.
♦♦ Inner aspect of lip is thicker nonkeratinized labial mucosa.
♦♦ Central most region of lip show orbicularis oris muscle.
Fig. 81: Gingiva (For colour version see Plate 28) Buccal Mucosa
♦♦ Buccal mucosa contains lining mucosa.
Q.17. Classify oral mucous membrane. Describe macroscopic
♦♦ Epithelium of cheek is stratified squamous nonkeratinized
and microscopic structures of tongue.
having three layers, i.e. stratum basale, stratum inter
(Mar 2008, 7.5 Marks)
medium and stratum superficiale.
Ans. For oral mucous membrane refer to Ans 8 of same
♦♦ Lamina propria of the buccal mucosa consists of dense
chapter.
connective tissue and has short irregular papillae.
Macroscopic Features of Tongue ♦♦ Submucus layer connects the lamina propria to the thin
For macroscopic features of dorsal surface of tongue refer to fascia of muscles and consists of strands of densly grouped
Ans 8 of same chapter. collagen fibers.
♦♦ There is loose connective tissue containing fat and small
Macroscopic Features of Ventral Surface of Tongue mixed glands between these strands.
♦♦ Ventral aspect of the tongue consists of smooth mucous ♦♦ Mixed minor salivary glands in cheek are larger and
membrane. usually found between the bundles of buccinator muscle.
♦♦ Papillae are absent on ventral aspect of tongue. ♦♦ Cheek, lateral to the corner of mouth may contain isolated
♦♦ Lingual frenum joins the inferior surface to the floor of sebaceous glands called fordyce’s spots.
the mouth. For diagram refer to Ans 20 of the same chapter.
694 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Fig. 82: Vermilion border of lip (For colour version see Plate 28)
Q.19. Write in short gingival group of fibers. to tooth surface and to which cells are attached by
(Oct 2007, 5 Marks) (Mar 2009, 5 Marks) hemidesmosomes.
Ans. Gingiva contains dense fibers of collagen, sometimes • Epithelial attachment is submicroscopic approxi-
refered to as gingival ligaments mately 40 nm wide and is formed by the attachment
• They are divided into the following major groups: epithelium.
–– Dentogingival: It extends from the cervical • Secondary attachment epithelium consists of cells which
cementum to the lamina propria of the gingiva. are derived from oral epithelium forms an epithelial
• Fibers of the gingival ligament constitute the most attachment which is identical to primary attachment
numerous group of gingival fibers. epithelium, i.e. basal lamina and hemidesmosomes.
–– Alveologingival: The fibers arise from the alveo- • At electron microscopic level both reduced
lar crest and extend into the lamina propria. ameloblasts and gingival epithelial cells have
–– Circular: A small group of fiber that circles the shown basal lamina on enamel and cementum.
tooth and interlace with the other fibers. Hemidesmosomes of these cells attach to basal
–– Dentoperiosteal: These fibers can be followed lamina in same manner as all the basal cells. This
from the cementum into the periosteum of the basal lamina is known as internal basal lamina.
alveolar crest and of the vestibular and oral sur- Q.21. Classify oral mucous membrane. Write about
faces of alveolar bone. specialized mucosa in detail. (Nov 2010, 8 Marks)
Apart from above mentioned fibers there are also certain Or
fiber groups, i.e. interdental, semicircular, vertical and
transgingival fiber groups. Define and classify oral mucous membrane. Write in
detail about specialized mucosa.(Nov 2008, 15 Marks)
• Interdental fibers connect buccal and lingual papillae
• Vertical fibers run coronally from alveolar mucosa or Or
attached gingiva to marginal gingiva or interdental Write short note on specialized mucosa.
papillae. (Apr 2007, 5 Marks)
• Semicircular fibers connect cementum on one side Ans. Moist lining of oral cavity is known as oral mucous
of tooth to opposite side opposite side after coursing membrane.
through free gingiva.
For classification refer to Ans 8 of same chapter.
• Transgingival fibers pass from cementum of one
tooth to marginal gingiva of adjacent tooth merging Specialized mucosa consists of dorsum of tongue and
with circular and semicircular fibers. taste bud.
Q.20. Write short note on epithelial attachment. For dorsum of tongue refer to Ans 8 and for taste bud
(Nov 2009, 5 Marks) refer to Ans 11 of same chapter.
Ans. The most superficial layer provides the actual attachment Q.22. Write in short vermilion border of lip.
of gingiva to tooth surface by means of a structural (Nov 2010, 5 Marks)
complex known as epithelial attachment. The complex Or
consists of an inner basal lamina which is formed Write about vermilion border of lip. Draw a well
and maintained by flat superficial cells which adhere labelled diagram of lip. (Jan 2018, 3 + 2 Marks)
Dental Histology 695
Ans. It is the transitional zone between the skin of the lip and Ans. Both orthokeratinization and parakeratinization is seen
the mucous membrane of the lip. in stratum corneum.
• It is red zone.
• In this region, a transition between the keratinized Orthokeratinization
epithelium of the skin and the nonkeratinized ♦♦ Keratinization squamae are larger and flatter than
epithelium of oral mucosa occurs. compared to granular cells.
• It is seen only in humans. ♦♦ All the nuclei and the other organelles such as ribosomes
• Skin on the outer surface of lip is covered by and mitochondria are disappeared.
moderately thick keratinized epithelium with thick ♦♦ Layer is acidophilic and is histologically amorphous.
stratum corneum. ♦♦ Keratohyalin granules are disappeared.
• The red appearance of the vermilion border is due to ♦♦ Cells consist of closely packed tonofilaments coated by
epithelium being thin and the underlying connective protein filaggrin. It is strongly cross linked by disulphide
tissue being highly vascular. bonds which give mechanical and chemical resistance.
• The transitional region is characterized by ♦♦ As the desmosomes become weaker and disappear the
numerously, dense arranged, long papillae of cells of this layer desquamate or shed.
lamina propria, reaching deep into the epithelium
and carrying large capillary loops close to the Parakeratinization
surface. In this layer cells retain pyknotic as well as condensed nuclei
• Transitional zone contains only the occasional and other partially lysed cell organells till they undergo the
sebaceous glands, it is subject to drying and therefore process of desquamation.
requires moistening by the tongue.
Q.24. Enumerate the derivatives of branchial arches and
For diagram of lip refer to Ans 5 of same chapter.
pouches. Describe in detail development of tongue.
Q.23. Write short note on ortho and parakeratinization. (Dec 2012, 8 Marks)
(Nov 2010, 2 Marks) Ans.
Q.25. Write short note on nonkeratinocytes. ♦♦ Langerhans cell is the cell of hematopoietic origin
(Apr 2017, 2 Marks) (Dec 2010, 2 Marks) ♦♦ Langerhans cell consists of convoluted nucleus and
(Jan 2012, 5 Marks) (May 2014, 5 Marks) characteristic rod like granules in cytoplasm known as
(Aug 2016, 3 Marks) Birbeck granules.
Or ♦♦ These cells penetrate epithelium from lamina propria and
Write short answer on nonkeratinocytes. are also involved in immune response.
(May 2018, 3 Marks) ♦♦ If antigenic challenge is produced by bacterial plaque,
Ans. Epithelium consists of small population of cells which these cells migrate to gingiva.
do not possess cytokeratin filaments, so due to this these ♦♦ These cells present antigen to specific helper T cells and
cells are not able to keratinize. Such cells are known as are known as antigen presenting cells.
nonkeratinocytes. Merkel Cells
• Nonkeratinocytes do not show mitotic activity and
undergo maturative changes or desquamate. ♦♦ Merkel cells are seen among the basal cells.
• Nonkeratinocytes are not attached in layers and do ♦♦ Merkel cells consist of nerve tissue immediately subjacent
not form desmosomal attachments with adjacent and are presumed to be specialized neural pressure
keratinocytes. sensitive receptor cells. Due to this merkel cells respond
• Nonkeratinocytes are dendritic and appear unstained to touch sensation.
or clear in routine hematoxylin and eosin stain. ♦♦ Merkel cells are commonly seen in masticatory mucosa.
• Non-keratinocytes migrate to oral epithelium from ♦♦ Unlike other nonkeratinocytes, these cells lack dendritic
either neural crest or bone marrow. processes.
• In oral epithelium nonkeratinocytes are melanocytes, ♦♦ Under electron microscope the nucleus of cell shows deep
langerhans cell and Merkel cells. Inflammatory cells invagination and a characteristic rodlet. The cell consists
often seen in certain regions such as lymphocytes are of electron dense granules which are located at the side
considered as nonkeratinocytes. of cytoplasm in contact with axon terminals. Function of
these granules is unknown.
Melanocytes
♦♦ Melanocytes are the melanin secreting cells and they reside Inflammatory Cells
in the basal cell layer. ♦♦ Inflammatory cells such as lymphocytes are found at
♦♦ These cells are derived from embryologic neural crest cells various levels of epithelium.
and migrate to the epithelium. ♦♦ These cells are basically the transient which can pass via
♦♦ Each single melanocyte establishes its contact with 30 to epithelium to surface.
40 keratinocytes via their dendritic processes. ♦♦ Both keratinocytes and lymphocytes interact with each
♦♦ Melanin produced by melanocyte is transferred via their other.
dendritic processes to adjacent basal keratinocytes which ♦♦ Keratinocytes may activate lymphocyte via production of
store pigment in form of melanosomes. interleukin – 1. Keratinocytes can also inhibit lymphocyte
♦♦ Melanin pigment present in connective tissue is proliferation too.
phagocytosed by macrophages and these cells are known ♦♦ Stimulated lymphocytes lead to production of gamma
as melanophages. interferons. These gamma interferons can stimulate
♦♦ After staining by hematoxylin stain, these cells appear clear keratinocytes to express HLA–DR antigen.
cells or dendritic cells.
Q.26. Write short note on keratinocytes and non-keratinocytes.
Langerhans Cell (Feb 2013, 2 Marks)
♦♦ It is the clear or dendritic cell seen in upper layer of Ans. Keratinocytes
skin and mucosal epithelium, restricted to zones of Epithelial cells that ultimately get keratinize are called
orthokeratinization. as keratinocytes.
Dental Histology 697
• These cells undergo cell division, maturate and • The barrier forms at the junction of cornified and
desquamate. granular layers.
• These cells increase in volume during each successive Q.30. Write a short note on nerve supply and blood supply
layer from basal to granular. of tongue. (Dec 2010, 2 Marks) (Feb 2013, 2 Marks)
• These cornified cells are smaller in volume than (May 2014, 2 Marks)
granular cells. Or
For nonkeratinocytes refer to Ans 25 of same chapter. Write short note on nerve supply of tongue.
Q.27. Write short note on function of oral mucous membrane. (Jan 2012, 5 Marks)
(Feb 2013, 2 Marks) (May 2014, 2 Marks) Ans. Arterial Supply of Tongue
Ans. Following are the functions of oral mucous membrane: It is chiefly supplied by lingual artery and a branch of
• Defense: Structural integrity of oral epithelium is an external carotid artery.
effective barrier for the invasion of microorganism.
Infection occurs if the epithelial integrity is broken Venous Drainage
down which leads to bacterial attack. Oral mucous ♦♦ Deep lingual vein is largest and principal vein of tongue.
membrane also secrets antibodies and has an It is visible on inferior surface of tongue.
efficient humoral and cell mediated immunity. ♦♦ The arrangement of veins of tongue is variable. Two venae
• Protection: It helps in protection of the tissues by consist accompany lingual artery and one venae commits
mechanical forces which result due to mastication. the hypoglossal nerve.
• Lubrication: Oral mucous membrane has numerous ♦♦ These veins unite at posterior border of hyoglossus to form
salivary glands which keeps oral cavity moist, this lingual vein which ends in internal jugular vein.
helps in prevention of oral mucosa from drying.
Moistness leads to easy speech, swallowing, Nerve Supply
mastication and perception of taste. ♦♦ Motor supply: All extrinsic and intrinsic muscles except
• Sensory: It is sensitive to touch, pressure, pain and palatoglossal are supplied by hypoglossal nerve.
temperature. Sensation of taste is unique sensation • Palatoglossal is supplied by cranial part of accessory
and is felt in anterior 2/3rd of tongue. nerve.
Q.28. Classify oral mucous membrane. Give a detailed ♦♦ Sensory innervations
account of microscopic features of tongue. • Lingual nerve is general nerve of sensation and chorda
(Feb 2013, 10 Marks) tympani is nerve for taste for anterior 2/3.
Ans. For classification refer to Ans 8 of same chapter. • For posterior 1/3 the glossopharyngeal nerve is nerve
for both general taste and sensation.
For microscopic features refer to Ans 17 of same chapter.
• Posterior most part is supplied by vagus nerve.
Q.29. Write a short note on Odland body. Q.31. Write about classification of oral mucous membrane
(Sep 2017, 2 Marks) (Dec 2010, 2 Marks) and describe vermilion border of lip.
Ans. In the stratum granulosum, the cell surface become (May/June 2009, 10 Marks)
more regular and more closely applied to adjacent cell Ans. For classification refer to Ans 8 of same chapter. For
surfaces. At the same time the lamellar granule, a small vermilion border of lip refer to Ans 22 of same chapter.
organelle known as keratinosome or Odland body or Q.32. Classify oral mucosa. Discuss nonkeratinocytes.
membrane coated granule forms in the upper spinous (June 2010, 10 Marks)
layers and granular cell layers. Ans. For classification refer to Ans 8 of same chapter.
• Odland body is present in both keratinized and
For nonkeratinocytes refer to Ans 25 of same chapter.
nonkeratinized epithelium.
• In keratinizing epithelium the odland body appears Q.33. Write short note on keratohyalin granules.
as ovoid membrane bound organelle of 0.25 µ in (June 2010, 2 Marks)
length which consists of series of parallel internal Ans. Keratohyaline granules are seen in the cytoplasm of
lamellae consisting of alternate electron lucent stratum granulosum cells.
and electro dense bands while in non–keratinized • In keratinized epithelium size of granule is 0.1 to
epithelium odland bodies appear as spherical 1.5µ.
membrane bound organelles of 0.2 µ diameter. This • Size and number of granules increases as cell moves
structure has an electron dense core from which from granular layer.
delicate radiating strands are observed. • They are angular or irregular in shape.
• The membrane coating granules are glycolipids. It • Keratohyaline granules are basophilic when stained
has an internal lamellated structures. with H and E stain.
• Lamellar granules discharge their contents in the • These granules are related to the ribososmes.
intercellular space forming an intercellular lamellar • They consists of sulphur rich proteins, i.e. profilagrin
material, which contribute to the permeability which form the matrix and bind keratin filaments
barrier. together.
698 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• They also have involucrin and loricrin protein which ♦♦ They interdigitate with few short irregular connective
thickens the cell membrane and form resistant tissue papillae.
cornified cell envelope. ♦♦ Lamina propria is thick and has less dense collagen fibers.
Q.34. Classify oral mucous membrane. Describe in detail the ♦♦ Submucosa consists of mixed salivary glands, adipose
anatomy and histology of tongue. (Aug 2012, 15 Marks) tissue, etc.
Ans. For classification and histology of dorsal surface of ♦♦ Strands of dense connective tissue makes submucosa
tongue refer to Ans 8 of same chapter. For histology of which binds lamina propria to fascia covering the muscles.
ventral surface of tongue refer to Ans 17 of same chapter. Histology of Cheek Mucosa
Anatomy of Tongue For histology refer to Ans 15 of same chapter.
Tongue is a muscular organ which lies in floor of mouth. Characteristic Features and Histology of Gingiva
Tongue is divided into dorsal part (superior part) and ventral
part (inferior part). Refer to Ans 16 of same chapter.
Q.36. Write about the basal lamina. (Feb 2013, 5 Marks)
Dorsal Part
Or
♦♦ It is convex in all directions.
♦♦ A V shaped sulcus divides this surface into anterior two Write short note on basal lamina. (Oct 2016, 3 Marks)
third, posterior one third and posteriomost part. Ans. Ultrastructurally basement membrane is known as basal
♦♦ A small pit seen where the two arms of ‘V’ meet. This is lamina.
known as foramen caecum. • Layer of basal lamina adjacent to basal cell is 45 nm
♦♦ Anterior two third of tongue is known as papillary part. thick and appears electronlucent. This layer is known
♦♦ Most numerous are fine pointed, cone shaped, i.e. filiform as lamina lucida.
papillae which are distributed all through the dorsal • Beneath the lamina lucida an electron dense layer of
surface. 55 nm thickness is seen which is known as lamina densa.
♦♦ Fungiform papillae are distributed between the filiform
• Anchoring fibrils which consists of Type VII collagen
papillae. They are the round projections.
form loops and are inserted in lamina densa. Lamina
♦♦ Anterior to sulcus terminalis lies the 8 to 12 large papillae
densa also consists of Type IV collagen which has
known as circumvallate papillae.
heparin sulphate in chicken wire configuration.
♦♦ Circumvallate papillae are partly submerged and they
should not come above the surface of tongue. They are • Lamina lucida is a 20 to 40 nm wide glycoprotein layer
surrounded by V shaped sulcus. margins of papillae lie and it consists of type IV collagen and an antigen which
above the surface. is bounded by an antibody KF – 1. Lamina lucida also
♦♦ At the border of anterior two third and posterior one third consists of laminins and bullous pemphigoid antigen.
of tongue over lateral margin lie the foliate papillae.
Functions of Basal Lamina
♦♦ Foliate papillae has series of folds and form clefts.
♦♦ Posterior one third is irregular and has rounded projections, ♦♦ Structural attachment: Basal lamina provides attachment
i.e. lingual follicles which has lymphoid component. So between epithelium and connective tissue.
posterior one third is known as lymphoid region. ♦♦ Compartmentalization: Basal lamina isolates epithelial
and connective tissue.
Ventral Part ♦♦ Filtration: Basal lamina transport materials from the
♦♦ Papilla are absent over inferior surface. connective tissue.
♦♦ It is attached to floor of mouth by loose lingual frenum. ♦♦ Tissue scaffolding: Basal lamina act as scaffold at the time
♦♦ On both sides of lingual frenum lies the prominent lingual of regeneration of epithelium.
veins. ♦♦ Polarity induction: Epithelial cells get arranged in their
♦♦ Inferior surface consists of lateral part which consists of normal layers if they are supported by basal lamina.
two folds known as plica fimbriata. Q.37. Define oral mucous membrane. Classify it on the basis
♦♦ Plica fimbriata run medial and forward to tip of tongue. of functional criteria and keratinization. Enumerate
Q.35. Give classification of oral mucous membrane. Write the functions of oral mucous membrane. Describe
about characteristic features and histology of cheek the different epithelial layers of keratinized and non–
mucosa and gingiva. (Mar 2013, 8 Marks) keratinized mucosa with well labeled diagrams.
Ans. For classification refer to Ans 8 of same chapter. (Sep 2015, 1+3+2+4 Marks)
Ans. Moist lining of oral cavity is called as oral mucous
Charactersitic Features of Cheek Mucosa membrane. It consists of an epithelium and connective
♦♦ Cheek mucosa is lined by non-keratinized epithelium. tissue known as lamina propria.
♦♦ At interface between the epithelium and connective tissue For classification on basis of functional criteria and
rete ridges are seen which are small and irregular. keratinization refer to Ans 8 of same chapter.
Dental Histology 699
Enumeration of Functions of Oral Mucous Membrane ♦♦ Basal cells consist of tonofilaments which are few in
1. Defense: Integrity of oral epithelium act as barrier for entry number.
of microorganisms. Stratum Intermedium
2. Lubrication: Secretion of salivary glands keeps the oral
cavity moist. Light Microscopic Features
3. Sensory: Oral mucous membrane is sensitive to touch, ♦♦ This layer consists of polyhedral cells which are located
pressure, pain and temperature. above the basal cell layer.
4. Protection: It protects deeper tissues from mechanical forces ♦♦ Cytoplasm of these cells takes eosinophilic stain and is
due to mastication. differentiated easily from basal cells which have basophilic
Different Epithelial Layers of Keratinized Mucosa cytoplasm.
♦♦ Cells consist of centrally placed round nucleus.
For details refer to Ans 42 of same chapter. ♦♦ Cells of stratum intermedium are larger as compared to
Different Epithelial Layers of Nonkeratinized Mucosa stratum spinosum and are closely apposed to each other.
These cells in contrast to stratum spinosum lack prickly
Nonkeratinized mucosa consists of three layers, i.e. stratum appearance.
basale, stratum intermedium and stratum superficiale.
Electron Microscopic Features
♦♦ There is increase in the size of cell and nucleus in stratum
intermedium of nonkeratinized epithelium.
♦♦ Nucleus consists of evenly distributed chromatin with 2 to
3 nucleoli and cytoplasm is rich in organelles for protein
synthesis.
♦♦ Tonofilaments found here are in unbundled form.
♦♦ Cells are attached to each other by desmosomes but with
of intercellular space are less.
♦♦ As the cells move superficially the number of desmosomes
decreases.
♦♦ Odland bodies are seen in this layer which is different
from odland bodies found in keratinized mucosa. In non-
keratinized epithelium odland bodies appear as spherical
membrane bound organelles of 0.2 µ diameter. This
Fig. 83: Nonkeratinized mucosa (H and E Stain)
(For colour version see Plate 29)
structure has an electron dense core from which delicate
radiating strands are observed.
Stratum Basale ♦♦ Cells of this layer consist of intermediate keratin filaments
Light Microscopic Features but these filaments differ biochemically from those in
keratinizing mucosa and are sparsely distributed in cells.
♦♦ It consists of single layer of cuboidal cells.
♦♦ Basal cells have basophilic cytoplasm and centrally placed Stratum Superficiale
nucleus which is hyperchromatic and is larger occupying
Light Microscopic Features
one-third of cytoplasm.
♦♦ It is the most superficial layer of nonkeratinized mucosa.
Electron Microscopic Features ♦♦ It consists of few layers of flat nucleated cells.
♦♦ Basal cells consist of nucleus which occupy one third of ♦♦ Nucleus of these cells is flattened with long axis parallel
cell with evenly distributed chromatin and 2 to 3 nucleoli. to outer surface of epithelium.
♦♦ Since basal cells are involved in synthesis of proteins,
so their cytoplasm consists of rich cellular organelles Electron Microscopic Features
i.e. rough endoplasmic reticulum, mitochondria, golgi ♦♦ In this layer cells increase in their size.
complex, few lysosomes etc. ♦♦ Cells are flat with long axis parallel to epithelial surface.
♦♦ Basal cell layer consists of two populations of cells. ♦♦ Nucleus is flat and show pyknotic changes.
One population is serrated and heavily packed with ♦♦ Cells consist of less number of tonofilaments in unbundled
tonofilaments. These cells are adapted for the attachment.
form and lack keratohyaline granules.
Another population is non-serrated and is composed of
♦♦ Cytoplasmic organelles decrease in number.
slowly cycling stem cells. These cells undergo division
♦♦ Desmosomes decrease in size and number. Intercellular
and provide cells for maturing compartment.
♦♦ Basal cells attach to each other by the desmosomes and to contacts of desmosome become more condensed.
basement membrane by hemidesmosomes. ♦♦ Cells ultimately desquamate as do cornified squamae.
700 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.38. Write short note on dentogingival junction. • Junctional epithelium is nondifferentiating, non
(Feb 2016, 3 Marks) keratinizing tissue which lacks gradient of change
Ans. Dentogingival junction is the junction between gingiva in cell types.
and the tooth. • Junctional epithelium consists of intermediate
• Epithelium of gingiva which get attached to tooth is filaments which express cytokeratins such as 5,
known as junctional or attachment epithelium. Union 14 and 19 these cytokeratins are expressed in non
between junctional epithelium and tooth is known as differentiating tissues.
epithelial attachment. • Junctional epithelium extends till 2 mm on surface
• Firmness and mechanical strength is attributable to of the tooth.
connective tissue attachment. • The junctional epithelium has highest turnover
• Dentogingival junction decreases the affect of mechanical rate of 5 to 6 days, and that’s why it regenerates
forces and bacterial attack. rapidly.
• Junctional epithelium is highly permeable and
Development of Dentogingival Junction consists of large intercellular spaces, due to which
♦♦ As ameloblast completes the formation of enamel matrix, neutrophils have an easy passage in and out of
they left a thin membrane on surface of enamel, i.e. primary epithelium.
enamel cuticle. • Junctional epithelium also provides easy flow of
♦♦ As primary enamel cuticle is formed, ameloblasts get gingival crevicular fluid.
shorten and epithelial enamel organ is decreased to few Q.40. Enumerate the zones of keratinized oral mucosa.
layers of flat cuboidal cells which is known as reduced (Oct 2016, 2 Marks)
enamel epithelium. Ans.
♦♦ In normal circumstances reduced enamel epithelium
Enumeration of Zones of Keratinized Oral Mucosa
covers the complete enamel surface and extends to CEJ.
♦♦ At the time of eruption, tip of tooth approaches the oral Following is the keratinized oral mucosa:
mucosa, reduced enamel epithelium and oral epithelium ♦♦ Masticatory mucosa, i.e. gingiva and hard palate
meet and fuse. ♦♦ Vermilion zone.
♦♦ Epithelium which covers the tip of crown degenerates
in centre and crown emerges via this perforation in oral Zones of Hard Palate
cavity. ♦♦ Gingival region
♦♦ Reduced enamel epithelium is attached to the part of enamel ♦♦ Palatine raphe
which is not erupted. As tip of the crown get emerged ♦♦ Anterolateral area or fatty zone
reduced enamel epithelium is known as primary attachment ♦♦ Posterolateral or glandular zone.
epithelium and is in continuation with oral epithelium.
Q.41. What is junctional epithelium. Describe passive
♦♦ Reduced enamel epithelium shortens to expose the crown
eruption with diagram. (Apr 2017, 5 Marks)
of tooth completely and get slowly replaced by oral
Ans. The epithelium of gingiva which gets attached to the
epithelium. Attachment epithelium is derived from oral
tooth is known as junctional epithelium or attachment
epithelium and is referred to as secondary attachment
epithelium.
epithelium.
Q.39. Write short note on junctional epithelium. Passive Eruption with Diagram
(Aug 2016, 3 Marks)
The separation of primary attachment epithelium from the
Ans. The epithelium of gingiva which gets attached to the
enamel is termed as passive eruption.
tooth is known as junctional epithelium or attachment
Crown exposure involving passive eruption and further
epithelium.
recession is described in four stages.
• Junctional epithelium resembles to reduced enamel
epithelium in its structure. First Stage
• Junctional epithelium is a stratified squamous
epithelium which is 15 to 30 cell layer thick at Bottom of gingival sulcus lies in the region of enamel covered
cervical portion and 3 to 4 cell layer thick at apical crown for sometime and apical end of attachment epithelium
margin. lie at cementoenamel junction. This relationship occurs in
• Epithelium connective tissue interface is flat. deciduous tooth till one year of age before shedding and in
• The most important feature which differentiates permanent teeth till 20 or 30 year of age. In this stage clinical
junctional epithelium from other epithelium is crown is shorter as compared to anatomic crown. (Part of
presence of basal lamina over the both sides, i.e. at tooth covered by enamel is known as anatomical crown and
junction of epithelium and connective tissue and on the part of tooth exposed to oral cavity is known as clinical
surface adjacent to tooth. crown).
Dental Histology 701
Fourth Stage
This stage represents the gingival recession. During this stage
the attachment epithelium migrates apically on surface of
cementum and bottom of gingival sulcus lies on cementum
surface exposing a part of root. During this stage clinical crown
is longer than anatomic crown. Rate of crown exposure and
recession vary in different persons. In some people fourth stage
occur during 20 years and in others at 50 years of age or older.
The above mentioned first two stages are physiological
while the third and fourth stages are either physiological or
pathological.
Q.42. Define and classify oral mucous membrane. Write in Fig. 85: Keratinized mucosa (H and E stain)
(For colour version see Plate 29)
detail about keratinized epithelium.
(May 2017, 10 Marks) Ultrastructure or Electron Microscopic Features
Ans. Moist lining of oral cavity is known as oral mucous
♦♦ Basal cells consist of nucleus which occupy one-third of
membrane.
cell with evenly distributed chromatin and 2 to 3 nucleoli.
For classification of oral mucous membrane refer to ♦♦ Since basal cells are involved in synthesis of proteins,
Ans 8 of same chapter. so their cytoplasm consists of rich cellular organelles
Keratinizing Epithelium in Detail i.e. rough endoplasmic reticulum, mitochondria, G olgi
complex, few lysosomes, etc.
Keratinized epithelium consists of four different layers, i.e. ♦♦ Basal cell layer consists of two populations of cells.
stratum basale, stratum spinosum, stratum granulosum and One population is serrated and heavily packed with
stratum corneum. tonofilaments. These cells are adapted for the attachment.
702 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Another population is non–serrated and is composed of ♦♦ Amount of tonofilaments are found to be more in this
slowly cycling stem cells. These cells undergo division and layer.
provide cells for maturing compartment. ♦♦ In this layer cell surfaces are more regular and are more
♦♦ Basal cells attach to each other by the desmosomes and to closely applied to adjacent cell surfaces.
basement membrane by hemidesmosomes. ♦♦ In upper spinous and granular cell layers a new organelle is
♦♦ Basal cells consists of tonofilaments which course toward seen known as odland body or keratinosome or membrane
and in some way are attached to attachment plaques. coating granule.
♦♦ The odland body is a glycolipid which has an internal
Stratum Spinosum
lamellated structure. In keratinizing epithelium the odland
Light Microscopic Features body appears as ovoid membrane bound organelle of
♦♦ Stratum spinosum consists of spinous cells which form 0.25 µ in length which consists of series of parallel internal
this layer. Spinous cells are irregularly polyhedral and are lamellae consisting of alternate electron lucent and electro
larger as compared to basal cells. dense bands.
♦♦ As these cells pass from basal layer to prickle cell layer ♦♦ Lamellar granules discharge their content in the intercellular
their basophilia decreases. space forming an intercellular lamellar material which
♦♦ Nucleus in spinous cells is centrally placed and is round contributes to permeability barrier. Barrier is formed at
or ovoid in shape. the junction of granular and cornified cell layers.
♦♦ These cells are also known as prickle cell layer as in ♦♦ During differentiation, inner cell unit of cell membrane
histological sections they have spiny or prickly appearance. thickens and form cornified cell envelope. Various proteins
♦♦ On light microscopic examination it appears that cells are contribute to this structure such as involucrin. This protein
joined by intercellular bridges. provide constituents for cell membrane thickening and
♦♦ As cell matures in this layer, it moves superficially and make it resistsnt to the chemical solvents.
increases in size and cell become more flattened with ♦♦ Structure of desmosomes is maintained in this layer but
flattened nucleus. the intercellular contact layer of desmosomes becomes
more condensed.
Ultrastructure or Electron Microscopic Features
♦♦ Cytoplasm of stratum granulosum cells shows
♦♦ Overall size of the cell and nucleus increases as it passes keratohyaline granules. In keratinized epithelium their
to spinous cell layer. size ranges from 0.1 to 1.5 µ.
♦♦ Nucleus of the cell consists of evenly distributed chromatin ♦♦ Keratohyaline granules are angular or irregular and
with two to three nucleoli. are associated with ribosomes. These granules have
♦♦ On electron microscopic examination intercellular bridges sulphur rich proteins fillagrin and loricrin which provide
are the desmosomes and tonofibrils are the bundle of and embedding matrix for tonofilaments and help in
tonofilaments. aggregation of tonofilaments.
♦♦ Desmosome attachment plaque consists of polypeptides
desmoglobin and plakoglobin. Intercellular spaces consist Stratum Corneum
of glycoprotein, glycosaminoglycans and fibronectin. Light Microscopic Features
♦♦ Intercellular spaces of spinous cells in keratinizing epithelia
are large or distended, so desmosomes look prominent. ♦♦ It is the most superficial layer found in the keratinized
epithelium.
Stratum Granulosum ♦♦ The layer is made up of keratinized squamae which are large
Light Microscopic Features and flat as compared to the cells of stratum granulosum.
♦♦ This layer appears eosinophilic amorphous layer in
♦♦ Stratum granulosum consists of flat and wider cells which histological sections.
are larger in size as compared to spinous cell layer.
♦♦ Cells in this layer undergo degeneration.
♦♦ Stratum granulosum is named for the basophilic
♦♦ If the nucleus is completely absent in surface layer, pattern
keratohyalin granules that it contains. Cytoplasm of the
of maturation is known as orthokeratinization but if there
cells in this layer is filled with the basophilic granules
is retention of pyknotic and condensed nuclei in all or some
known as keratohyaline granules
of squames this is known as parakeratinization.
♦♦ Nucleus of the cell is flat with long axis parallel to the
outer epithelium. Ultrastructure or Electron Microscopic Features
Ultrastructure or Electron Microscopic Features ♦♦ Ultrastructurally this layer composed of the cells which
♦♦ In this layer size of the cell increases. resembles to hexagonal discs known as squames.
♦♦ Cell is flat with long axis parallel to epithelial surface. ♦♦ All the nuclei and other organelles such as ribosomes and
Nucleus of the cell is flattened and show pykonsis and mitochondria are disappeared.
signs of degeneration. ♦♦ Keratohyalin granules are disappeared.
♦♦ Cells show decrease in number of cytoplasmic organelles ♦♦ Ultrastructurally cells of stratum corneum are composed
because of protein synthesis. of densely packed filaments which develop from tonofila
Dental Histology 703
ments, altered and coated by basic protein of keratohyalin ♦♦ Cell surface and desmosomes are altered while the plasma
granule known as filaggrin. membrane remains denser and thicker.
♦♦ Cross linking of tonofilaments by disulphide bonds ♦♦ As the cell passes to superficial layer, desmosomes
facilitate close packing of filaments and provide mechanical degenerate resulting in desquamation of the cell.
and chemical resistance to this layer. Q.43. Write short note on desmosome. (Sep 2017, 3 Marks)
♦♦ Keratinized cell become compact and dehydrated and Ans. Desmosomes are the intercellular bridges or intercellular
cover greater surface area. junctions seen in epithelial cells.
• Ultrastructurally, they are circular or ovoid area of • Traversing filaments from both the cells come and
0.2 to 0.5 µ in which plasma membrane of adjacent attach to intercellular contact layer which helps in
cell remains in juxta position to each other with retaining the attachment between cells.
distance of 25 to 30 nm. • The desmosomes and tonofilament network form a
• This space present between plasma membrane tensile supporting system for the epithelium.
consists of electron dense lamina known as • Intercellular spaces of spinous cells in keratinizing
intercellular contact layer. This layer has protein
epithelium are large or distended so desmosomes are
particles of 5 nm diameter which are arranged in
made more prominent and these cells give prickly
a row.
• Over the cytoplasmic side, plasma membrane of appearance.
each adjoining cell consists of thickening known • Size of desmosome is wider in prickle cell layer as
as attachment plaque and this consists of proteins compared to basal cell layer.
catenins, i.e. desmoplakin, plakoglobin and • In granular layer cells desmosomes maintain their
plakophilin. This plaque serves as an attachment structure while the intercellular contact layer of
site for cytoskeletal components which in case of desmosome becomes more condensed.
desmosomes are intermediate filaments. • Desmosomes become less distinct in stratum
• Tonofilaments which are present in cytoplasm of corneum.
each cell run in attachment plaque and loop out • As cell passes to superficial layer desmosomes tend
again. These tonofilaments are not attached to to degenerate which lead to desquamation of cell.
plasma membrane.
• This arrangement of tonofilaments dissipates Q.44. Write short note on microscopic and macroscopic
physical forces from attachment site throughout features of hard palate. (Sep 2017, 3 Marks)
the cell. Ans.
• Other smaller filaments which consists of protein Microscopic Features of Hard Palate
cadherins i.e. desmoglein and desmocollin attach
tonofilament to plasma membrane and penetrate cell ♦♦ Hard palate is covered by keratinized mucosa.
membrane. Such filaments are known as traversing ♦♦ Keratinized stratified squamous epithelium which lines
filaments. Interaction of cadherins with those the mucosa consists of four different layers i.e. stratum
from adjacent cell result in dense line in middle of basale, stratum spinosum, stratum granulosum and
intercellular space at desmosome stratum corneum.
704 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦♦ Due to functional adaptation, to bear with masticatory • Mid-palatine raphae: This is the narrow zone in
stress, cells in hard palate show more dense tonofilaments, midline of the hard palate which extends from incisive
increased number and length of desmosomes, etc. papilla posteriorly.
♦♦ Epithelium connective tissue interface of hard palate is • Anterolateral zone: It is also known as fatty zone.
irregular with many long regular epithelial ridges which It lies between mid palatine raphae and gingiva. It
interdigitate with connective tissue papillae. consists of fat tissue in submucosa.
♦♦ Lamina propria is dense all through the hard palate, it is • Posterolateral zone: It is also known as glandular
thicker in anterior region as compared to posterior region. zone. It lies between mid palatine raphae and gingiva.
♦♦ In the region of rugae the connective tissue core is dense
It consists of minor salivary glands in submucosa.
with interwoven collagen fibers. Incisive or palatine papilla
♦♦ Palatine rugae: They radiate outward from palatine
composed of dense connective tissue. This consists of
raphae in anterior region of hard palate. They are irregular
remnants of nasopalatine duct which is lined by pseudo-
stratified squamous epithelium. transverse palatine ridges known as palatine rugae. These
♦♦ Frequently the ducts are surrounded by small, irregular ridges play role in suckling in infants and also help in
islands of hyaline cartilage. backward movement of food during mastication.
♦♦ Structure of submucosa show variation in different regions of ♦♦ Fovea palatine: This is an elongated depression of few
palate. Submucosa is completely absent in the peripheral zone millimeters deep in posterior part of palate on either side
of palate adjacent to the teeth, i.e. the gingival zone and in of midline.
the mid palatine raphae. In these regions, the lamina propria Q.45. Write short answer on histology of soft palate.
is tightly bound to the periosteum of bone which is called
as mucoperiosteal attachment. In between the gingival zone (May 2018, 3 Marks)
and mid palatine raphae, the palate has distinct submucosa. Ans. Following is the histology of soft palate:
♦♦ Submucosa in the anterior region of hard palate is filled • Soft palate is lined by nonkeratinized stratified
with adipose tissue and in posterior region with mucous squamous epithelium.
glands. So anterolateral part of hard palate is known as fatty • Epithelium can show presence of few taste buds.
zone and posterolateral part is known as glandular gone. • Lamina propria is highly vascular.
♦♦ In spite of presnce of thick submucosa in some regions, • Epithelium connective tissue interface is irregular
mucosa of the hard palate is tightly fixed to the underlying with thick and short rete ridges and connective
bone and is immobile. This is due to dense vertical band tissue papillae.
of connective tissue which leads to attachment of mucosa • A distinct layer of elastic fibers is seen which
firmly to the periosteum of palatal bone. These dense bands separate lamina propria from submucosa.
of connective tissue are at right angle to surface and divide • Submucosa consists of diffuse loose connective tissue
submucosa into compartments.
consists numerous minor salivary glands.
♦♦ At the junction of alveolar process and horizontal plate
of hard palate there is presence of loose connective tissue Q.46. Classify oral mucosa. Differentiate between keratinized
which carries anterior palatine vessels and nerves. and nonkeratinized mucosa with the help of diagram.
(Aug 2018, 10 Marks)
Macroscopic Features of Hard Palate Ans. For classification of oral mucosa refer to Ans 8 of same
♦♦ Hard palate is divided into various different zones i.e. chapter.
• Gingival region: This region is found adjacent to the Differences between keratinized and non-keratinized
teeth. mucosa.
Contd...
Fig. 87: Keratinized mucosa (H and E stain) Fig. 88: Nonkeratinized mucosa (H and E Stain)
(For colour version see Plate 29) (For colour version see Plate 29)
Q.47. Define oral mucous membrane. Write functions and Orthokeratinized Stratified Squamous Epithelium
classifications of oral mucous membrane. Describe
♦♦ Orthokeratinized stratified squamous epithelium is one
orthokeratinized stratified squamous epithelium with
well labeled diagram. of the type of keratinized stratified squamous epithelium.
♦♦ Straum corneum layer represents the orthokeratinization.
(Sep 2018, 1 + 2 + 2 + 3 + 2 = 10 Marks)
Ans. For definition of oral mucous membrane refer to Ans 37 ♦♦ Orthokeratinized surface results when cells lost their nuclei
of same chapter. and cytoplasm has been displaced by large number of
For function of oral mucous membrane refer to Ans 37 keratin filaments. This pattern of maturation is known as
of same chapter. orthokeratinization.
For classification of oral mucous membrane refer to ♦♦ Orthokeratinized surface can only be produced when there
Ans 8 of same chapter. is well defined stratum granulosum.
706 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• Apex of the cell appears empty except for their Statherins: Statherin has very high affinity for calcium and
strands of cytoplasm forming a tubercular network. phosphate minerals. They stop precipitation of supersaturated
The nucleus and a thin rim of cytoplasm are calcium phosphate in ductal saliva as well as in oral fluid.
compressed against the base of the cell. Lysozyme: These enzyme play important role in antibacterial
• Mucous cell is seen to be filled with pale, electron- action.
lucent territory droplets. Lactoferrin: It has antibacterial properties. The oxidized
• These droplets are usually longer than serous granules iron part of the lactoferrin oxidizes bacteria by formation of
and may be irregular on compressed in shape. peroxides which causes breakdown of cell membrane.
• Nucleus of the mucous cell is oval or flattened Histatins: They have antifungal properties. They also disrupt
in shape and located just above the basal plasma the cell cycle and causes generation of reactive oxygen species.
membrane.
• The RER, mitochondria and other organelles are also Other Organic Components
limited to a narrow band of cytoplasm. ♦♦ Various blood group antigens are secreted in the saliva.
♦♦ Sugars like glucose are secreted in the saliva.
Composition of Saliva
♦♦ Steroid hormones like cortisol, estrogen and testosterone
Saliva contain 99% of water 1% organic and inorganic substances. are secreted in minimal quantities.
♦♦ Ammonia and urea are also present in very less quantities.
Inorganic Contents of Saliva
Q.2. Write a note on function of saliva.
Calcium and phosphate: They protect mineralized enamel (Feb 2005, 5 Marks) (Sep 2007, 5 Marks)
surface form dissolution. Calcium ion concentration in saliva is (Apr 2008, 5 Marks)
1.5 mmol/L. Phosphate ion concentration is 5.6 mmol/L. Or
Fluoride: Fluoride promotes remineralization of teeth which Write short note on functions of saliva.
are decaying by dental caries. (Nov 2009, 5 Marks), (Nov 2010, 5 Marks)
Fluoride concentration is about 1.5 mM/L. (May/June 2009, 10 Marks) (Mar 2013, 3 Marks)
Hydrogen carbonate: It acts as buffering agent in saliva. (Dec 2014, 2 Marks)
Concentration of hydrogen carbonate is 2.9 mM/L. It neutralizes Or
the acids released by bacteria. Write very short answer on functions of saliva.
Thiocyanate: Thiocyanate is oxidized by salivary peroxides and (Aug 2018, 2 Marks)
it get converted to hypothiocyanate. Hypothiocyanate acts as an Ans.
antibacterial agent. Its concentration in saliva is about 2.5 mM/L.
Functions of Saliva
Other Inorganic Components
♦♦ Cleaning of mouth: Since saliva is watery it produces a
♦♦ Sodium ions are in very less quantity in saliva. Its flushing action on the teeth which helps in removing the
concentrations increase along with the increase in flow rate. food debris as well as non-adherent forms of bacteria which
♦♦ Potassium ions are the major inorganic ions in saliva, as collects over the teeth.
they are secreted throughout the ductal system. ♦♦ Lubrication and deglutition: Saliva provides lubrication
♦♦ Other inorganic components such as lead, cadmium and to oral tissues by mucus and various other glycoproteins
copper. which help provide lubrication at time of speech. It also
helps in formation of bolus which can easily slide into the
Organic Contents of Saliva esophagus.
Organic contents of saliva are as follows: ♦♦ Antimicrobial function: Saliva consists of various
Amylase: It constitute the major component of salivary proteins, components which produce antimicrobial activity. The
i.e. about 50%. Amylase digests the starch. Mostly salivary components are lysozyme, lactoferrin, histatins and salivary
amylase is secreted from parotid gland. peroxidases. Saliva also consists of immunoglobulin
such as IgA which provides antimicrobial action by
Proline-rich proteins: They constitute about 40 to 45% of
agglutinating certain microorganisms and preventing their
salivary proteins. They reside in the salivary pellicle. Pellicle
adherence to the oral mucosa.
function as diffusion barrier, and slows the attacks by bacterial
♦♦ Buffering function: Saliva consists of bicarbonate ions
acids and loss of dissolved calcium and phosphate ions. which neutralize the acids which are produced by bacteria,
Mucins: Mucus consists of large, heavily glycosylated proteins. these acids can cause dissolution of teeth and cause dental
It forms 5–10% of salivary proteins. Mucous acts as diffusion caries. So due to its buffering action saliva dissolve the acid
barrier against contact with noxious substances. It also act as a and prevent caries.
lubricant foo minimizing shear stresses. ♦♦ Digestive function: Saliva consists of digestive enzymes
Lingual lipase: It is secreted by von Ebner’s glands as well as such as amylase and lipase. These enzymes causes start
parotid gland. It helps in the digestion of milk fat in newborns. digestion of food from oral cavity, e.g. enzyme amylase and
708 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
lipase break starch into maltase and lipids into diglycerides • Duct of parotid gland, i.e. Stenson’s duct open into
and free fatty acids. cavity on the buccal mucosa opposite the maxillary
♦♦ Mineralization: Tooth surface is always coated with saliva. second molar.
Since saliva consists of calcium and phosphate ions, they • Parotid gland is a fine serous gland.
increase the surface hardness of teeth which provide • All acinal cells are similar in structure to serous cells.
resistance of teeth to demineralization. • Electron microscopic study indicates that the serous
♦♦ Taste: Saliva dissolves the food substances so that they can granules may have a dense central core.
be perceived by the receptors located in the taste buds. • The intercalated ducts of the parotid are long and
♦♦ Tissue repair: Saliva consists of epidermal growth factor branching and the pale staining striated ducts are
and vascular endothelial growth factor which leads to numerous and stand out conspicuously against more
repair and regeneration of oral tissues. densely stained acini.
♦♦ Excretion: Many substances from blood reaches saliva and • The connective tissue septa in the parotid contain
saliva is considered as the route of excretion. numerous fat cells.
Q.3. Write a short note on composition and function of Light Microscopic Structure of Parotid Gland or Serous Gland
saliva. (Feb/Mar 2004, 5 Marks)
Parotid gland is the largest salivary gland. It has a well-defined
Or
capsule. Septa divide the gland into lobes and lobules.
Write a note on composition and function of saliva.
♦♦ Secretory acini: Acini are purely serous in nature and
(Oct 2006, 5 Marks)
that’s why they are known as serous acini. Serous acini
Or
are compound alveolar, small in size and rounded in
Describe composition of saliva. (Feb 2013, 5 Marks) shape. They show very small lumen or mostly the lumen is
Or obliterated. Serous acinus is lined by small pyramidal cells
and their number within an acinus is more. Serous acini
Write about saliva composition and function.
stain dark. Serous acini are surrounded by thin contractile
(Feb 2013, 10 Marks)
myoepithelial (basket) cells.
Or ♦♦ Serous cells: They are pyramidal in shape. They are small
Write composition of saliva and enumerate functions in size compared to mucous cells. Serous cells stain dark
of saliva. (Sep 2018, 3 + 2 marks) when stained with hematoxylin and eosin stain. Nuclei
Or are rounded and situated in center more toward basal part
of cell. Apical portion contains large number of secretory
Write functions and composition of saliva. granules, i.e. zymogen granules. Base of serous cell is
(Aug 2018, 2 + 3 marks) basophilic (blue) and apical portion is acidophilic (pink).
Ans. Refer to Ans 1 for composition and 2 for function of ♦♦ Ducts: Interlobular ducts are present in the connective
saliva. tissue septa. These ducts may be lined by simple columnar
or pseudostratified columnar epithelium. The intralobular
Q.4. Write note on saliva. ducts are seen between acini. The intercalated ducts are
(Sept 2000, 5 Marks) (Jan 2012, 5 Marks) lined by simple squamous to low cuboidal epithelium.
Ans. Refer to Ans 1 and 2 of the same chapter. They are long and branching in parotid gland. The striated
Q.5. Write a short note on properties and function of Saliva. ducts are lined by simple low columnar epithelium and
(Sept 2002, 6 Marks) show basal striations. Striations are responsible for bright
Ans. Refer to Ans 2 of the same chapter. eosinophilic (acidophilic) staining reaction of these ducts.
Adipose tissue may be seen among acini and smaller ducts.
Q.6. Write short note on parotid gland.(Feb 2002, 6 Marks) In between the lobules in connective tissue septa aretrioles,
Or venules and interlobular excretory ducts are located.
Write short note on serous gland (Oct 2016, 3 Marks) Q.7. Write a short note or Stenson’s duct?
Or (Feb 2002, 6 Marks)
Ans. Stenson’s duct is main excretory duct of parotid gland.
Write short note on light microscopic features of • Stenson’s duct carries the secretion of parotid gland
serous salivary gland. (May 2017, 3 Marks) into the oral cavity.
Ans. Parotid gland is largest major salivary gland. • Stenson’s duct open into oral cavity on the buccal
• Parotid gland is bilaterally paired major salivary mucosa opposite the maxillary second molar.
gland. • Opening is usually marked by a small papilla.
• Parotid gland is enclosed within a well formed • Main duct (Stenson’s duct) is formed by the union
connective tissue. of striated ducts, which are formed by smallest
• Location: Its superficial part lying in front of the intercalated ducts.
external ear and its deeper part lies behind ramus of • Intercalated ducts found in terminal secretory unit, i.e.
mandible filling the retero-mandibular fossa. serous acini in parotid gland and collect their secretion.
Dental Histology 709
- Molars and premolars help in mastication, they Describe serous demilunes. (Aug 2011, 5 Marks)
are grinding teeth Ans. The meaning of demilune is “Half moon”:
• Teeth also help in speech • In routine tissue preparation, the serous cells are
• Teeth provide the shape of face. more removed from the lumen of acinus and are
Q.12. Write briefly major salivary gland. (Oct 2007, 5 Marks) shaped as demilunes, at periphery of mucus acinus.
Ans. The major salivary glands are: • In routine H and E preparations, mucous acini have
• Parotid: Refer to Ans 6 of the same chapter a cap of serous cells which are thought to secrete into
• Submandibular: Refer to Ans 8 of the same chapter. the highly convoluted intercellular space between
• Sublingual Salivary Gland: mucous cells. Because of their appearance in histologic
- It is the smallest of all the major salivary glands. sections, such caps are called as serous demilunes.
- It is of almond shape. • Serous demilunes are the artifacts of the traditional
- It lies in between the floor of mouth below fixation method.
mucosa and above mylohyoid muscle. Formation of Demilune
- The duct of sublingual gland is Bartholin’s gland.
- Bartholin duct open near the submandibular The process of demilune formation can be explained by
duct. expansion of mucinogen, a major component of secretory
- It is a mixed gland. granules, during routine fixation. This expansion increases
- Mucous secretory units are greater in number the volume of mucous cells and displaces serous cells from
than serous units. their original position thus creating demilune effect. A similar
- Gland receives its blood supply from sublingual phenomenon is seen in intestinal mucosa.
and submental arteries. Q.15. Write a short note on myoepithelial cell.
- Lymphatic drainage of the gland is to subman- (Dec 2010, 2 Marks) (June 2010, 5 Marks)
dibular lymph node.
Or
Q.13. Write about histology of mixed salivary gland.
Write on myoepithelial cell. (Apr 2017, 3 Marks)
(Nov 2008, 5 Marks)
Ans. Or
♦♦ Mixed salivary gland consists of both serous and mucous Answer in brief myoepithelial cells. (Oct 2016, 2 Marks)
acini.
Or
♦♦ At places mucous acini are capped by the serous acini
which present half moon appearance in some of the Write short answer on myoepithelial cells.
sections. These are known as serous demilunes. (Aug 2018, 3 Marks)
♦♦ Interlobular ducts are lined by simple columnar or Ans. Myoepithelial cells are closely related to seceretory and
pseudostratified columnar epithelium. intercalated duct cells.
♦♦ Intralobular ducts are seen in between acini. • They are stellate or spider like with a flattened
♦♦ Striated ducts are large and branching and are present in nucleus, scanty perinuclear cytoplasm and long
between acini. branching processes that embrace the secretory and
♦♦ Striated ducts are lined by simple low columnar epithelium duct cells.
and they show basal striations. • In case of intercalated duct the myoepithelial cells
have a more fusiform shape and are elongated
with a few short processes. The processes in the
acini lie gutters hence the outline of acini appears
smooth but in the intercalated ducts the processes
run longitudinally on the surface creating a bulge.
• Their appearance is reminiscent of a basket cradling
the secretory unit, hence the term ‘basket cell”.
• Myoepithelial cells are similar to smooth muscle
cells but are derived from epithelium. These cells
are located around the terminal secretory units and
the first portion of duct system.
• They lie between the basal lamina or basement
membrane of the parenchyma cells and are joined
to the cells by desmosomes.
Fig. 93: Mixed salivary gland (For colour version see Plate 30)
The myoepithelial cells actively can:
Q.14. Write short note on demilunes. (Oct 2008, 2 Marks) • Accelerate the initial outflow of saliva from the acini
Or • Reduce luminal volume
Dental Histology 711
♦♦ Cells of intercalated duct consists of few secretory granules, ♦♦ Intercalated ducts provide some secretory materials to
some rough endoplasmic reticulum, mitochondria and a saliva, i.e. lysozymes and lactoferrin.
round or oval centrally placed nucleus. ♦♦ Intercalated and striated ducts resorb some proteins.
♦♦ Intercalated ducts are supported by basement membrane ♦♦ Striated ducts provide glycoprotein and kallikrein to saliva.
and adjacent cells are attached to each other by inter- ♦♦ Striated duct modify electrolyte concentration of saliva.
cellular junctions. ♦♦ Excretory duct along with striated duct modify tonicity
♦♦ Myoepithelial cells are found between basal plasma of saliva.
membrane of lining cells and supporting basement ♦♦ Excretory duct releases mucin in saliva.
membrane. Q.20. Classify salivary gland. Add a note on mixed major
♦♦ They consist of lysozymes, lactoferin and various unknown salivary gland. (Apr 2015, 8 Marks)
components which are stored in their secretory granules.
Ans. Classification of salivary gland
All these components are contributed to saliva.
I. Based on size
Striated Duct 1. Major salivary gland: Parotid, submandibular and
sublingual glands
♦♦ Striated ducts are the next largest intralobular type and are
2. Minor salivary gland: Group of small glands in oral
located between intercalated ducts and excretory ducts.
mucosa. These are named according to their location
♦♦ Lumen of striated ducts is large and is lined by single layer
i.e. buccal, labial, lingual, palatine and glossopalatine.
of columnar cells.
II. Based on location
♦♦ Cells of striated duct has rounded nucleus which is
1. Extra oral: Three pairs of major salivary glands situated
centrally placed and abundant eosinophilic cytoplasm.
outside oral cavity
♦♦ Basal portion of cell produce striated appearance, hence it
2. Intra oral: Group of minor salivary glands distributed
is known as striated duct.
in oral mucosa
♦♦ Electron microscopy shows abundant large mitochondria
III. Based on nature of secretion
which is radially oriented and is located in portion of
1. Serous glands: Parotid and Von Ebner’s glands
cytoplasm between membrane infoldings. This combination
2. Mucous glands: Sublingual gland and all minor salivary
of mitochondira and infolding leads to striations.
glands except Von Ebner’s glands
♦♦ Apical part of plasma membrane show microvilli which
3. Mixed glands: Submandibular glands
project in the lumen.
♦♦ Few basal cells and oncocytes too are seen. Oncocytes have For note on major mixed salivary gland i.e. submandibular
dark eosinophilic granular cytoplasm. gland refer to Ans 8 of same chapter.
Q.21. Enumerate the functions of saliva.
Excretory Duct (Sep 2015, 2 Marks)
♦♦ Striated ducts join each other to form large intralobular Or
ducts, i.e. excretory duct. List four functions of saliva. (Aug 2016, 2 Marks)
♦♦ These ducts increase in the size and consists of increasing
layers of connective tissue. Or
♦♦ As excretory ducts enlarges it consists of two layes, i.e. Enlist functions of saliva. (May 2017, 2 Marks)
mucosa and outer connective tissue adventitia. (Jan 2018, 2 Marks)
♦♦ Mucosal epithelium consists of pesudostratified columnar Ans. Enumeration of functions of saliva:
epithelial cells. Occasional goblet cells and ciliated cells 1. Cleaning of mouth
can be seen. 2. Lubrication and deglutition
♦♦ Ductal epithelium undergoes a transition from stratified 3. Antimicrobial function
epithelium to cuboidal epithelium and finally to stratified
4. Buffering function
squamous epithelium.
5. Digestive function
♦♦ Excretory ducts also consist of tuft or brush cells with long
6. Mineralisation
stiff microvilli and apical vesicles.
7. Taste
♦♦ At times cells with pale cytoplasm and dense nuclear
8. Tissue repair
chromatin are visible towards base of duct epithelium
9. Excretion.
which are known as lymphocytes and macrophages.
♦♦ Dendritic cells are also seen with long branching processes Q.22. Write the difference between mucous and serous
which extend between epithelial cells. salivary gland acini with well labeled diagrams.
(Sep 2015, 5 Marks)
Functions of Ductal System
Or
♦♦ Ductal system is a passage by which saliva is secreted by
acini and reaches oral cavity. Saliva secreted by acini is Write differences between mucous and serous acini.
known as primary saliva and it undergo modification by (Apr 2017, 3 Marks)
various ducts to form secondary saliva. Or
Dental Histology 713
Classify salivary gland. Discuss differences between • Saliva has a pH normal range of 6.2–7.6 with 6.7 being the
serous and mucous acini. (May 2018, 10 Marks) average pH. Resting pH of mouth does not fall below 6.3.
Ans. For classification of salivary gland refer to Ans 16 of same In the oral cavity, the pH is maintained near neutrality
chapter. (6.7–7.3) by saliva.
Difference between mucus and serous salivary gland acini • The saliva contributes to maintenance of the pH by
two mechanisms. First, the flow of saliva eliminates
Mucous acini Serous acini carbohydrates that could be metabolized by bacteria
They are compound tubular They are compound alveolar and removes acids produced by bacteria. Second, acidity
It is oval or tubular in shape It is circular or rounded in from drinks and foods, as well as from bacterial activity,
shape is neutralized by the buffering activity of saliva.
It is larger in size compared to It is smaller in size compared to
serous acini mucous acini Q.25. Write short note on antimicrobial properties of saliva.
It has more number of cells It has less number of cells (Aug 2016, 3 Marks)
compared to serous acini compared to mucous acini Ans. Saliva consists of many antimicrobial substances i.e.
Lumen of mucous acini is wide Lumen of serous acini is small antibacterial agents lysozyme, lactoferrins, calprotectin,
Cells of mucous acini are Cells of serous acini are lactoperoxidase, immunoglobulins, chromogranin A,
columnar in shape pyramidal in shape cystatins, histatins, Von Ebner’s gland protein, Secretory
Nucleus is flattened in shape Nucleus is rounded in shape leukocyte proteinase inhibitor.
and is placed at basal plasma and is placed at basal 1/3rd • Antimicrobial properties of saliva are produced by
membrane of cell part of cell the serous secretor cells of both major and minor
Apically the cytoplasm is empty in Apically cytoplasm is salivary glands.
H and E stained sections eosinophilic in H and E stained • Some of the high molecular weight salivary
sections due to presence of glycoproteins aggregate specific strains of oral
zymogen granules microorganisms and prevent their adhesion to the
For diagram refer to Ans 1 of For diagram refer to Ans 1 of oral tissues which facilitate their oral clearance.
same chapter same chapter
• Acinar cells secrete peroxidase enzyme while ductal
system secrete thyocyanate, both these enzymes
Q.23. Answer in brief Von Ebner’s gland. establish bactericidal system in saliva.
(Feb 2016, 2 Marks) • Enzyme salivary peroxidase in presence of hydrogen
Ans. Von Ebner’s glands are the minor salivary glands peroxidase and thiocyanate form hypothiocyanate
• They are the posterior lingual serous glands. ion which inhibits bacteria.
• They are the extensive group of purely serous glands • Lysozyme an antibacterial protein hydrolyzes
which are located in between muscle fibers of tongue polysaccharide of bacterial cell wall which leads to
below circumvallate papillae. lysis of bacteria.
• Ducts of these glands open in trough of vallate • Important group of defensive substances in saliva
papillae and rudimentary foliate papillae on side are immunoglobulins. Most prominent salivary
of tongue. immunoglobulin is IgA. Salivary immunoglobulins
• Secretions of Von Ebner’s gland wash the trough of can act primarily through their ability to inhibit the
vallate papillae and prepare taste receptors for new adherence of microorganisms to oral tissues.
stimulus. • Lactoferrin an iron binding protein is an antibacterial
• Von Ebner’s gland secretes antibacterial enzymes substance, in presence of specific antibody enhances
peroxidase and lysozyme. the inhibitory effect of antibody on microorganisms.
• Von Ebner’s gland also secretes an enzyme known • Antiviral action is caused by cystatins, mucins,
as lingual lipase which along with pancreatic lipids immunoglobulins and Secretory leukocyte pro
help in the digestion of lipids. teinase inhibitor.
• Antifungal action is caused by histatins, chro
Q.24. Answer in brief pH of saliva. (Feb 2016, 2 Marks) mogranin A and immunoglobulins.
Ans. pH of saliva shows great deal of variation and it falls in
Q.26. Enumerate ducts of salivary glands.
a narrow range for most of the individuals.
(Jan 2018, 2 Marks)
• pH at which any particular saliva ceases to be saturated Ans.
with calcium and phosphate is referred to as critical pH.
Its value is 5.5. Below critical pH the inorganic content Enumeration of Ducts of Salivary Glands
of tooth starts dissolving. ♦♦ Intralobular ducts
• Bicarbonate ions in saliva provide buffering action. • Intercalated ducts
Bicarbonate ions neutralize the acids produced by • Striated ducts
bacteria which leads to dissolution of teeth and protect ♦♦ Interlobular ducts
teeth from dental caries and also maintains pH of saliva. • Excretory ducts
714 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.27. Write very short answer on striated duct of salivary Eruptive Tooth Movement/Phase
gland. (May 2018, 2 Marks)
During the phase of eruptive tooth movement, the tooth moves
Ans. Striated ducts receive saliva from intercalated ducts.
from its position within the bone of the jaw to its functional
• Striated ducts form the largest portion of ductal position in occlusion, and the principal direction of movement
system which constitute intralobular component of
is occlusal or axial.
ductal system.
♦♦ During the eruptive phase of tooth movement significant
• Striated ducts are lined by a layer of tall columnar
epithelial cells with large, spherical, centrally placed development events occur that are associated with eruptive
nuclei. tooth movement.
• Cytoplasm is abundant and eosinophilic and show ♦♦ They include the formation of roots, periodontal ligament
prominent striations at basal ends of the cells, and dentogingival junction.
perpendicular to basal surface. ♦♦ Significant histological changes also occur in the tissues
• Under electron microscope abundant large mito overlying the eruptive tooth.
chondria, usually radially oriented, are located in ♦♦ Bone removal is necessary for permanent tooth to erupt.
portion of cytoplasm between membrane infoldings. ♦♦ As the deciduous tooth erupts, the permanent tooth germ
Combination of infoldings and mitochondria becomes situated specially and is entirely enclosed by
account for striations seen in light microscope. bone, except for a small canal (Gubernacular canal) that is
• Striated ducts are site of electrolyte reabsorption filled with connective tissues and often contains epithelial
especially of sodim and chloride and secretion of remnants of the dental lamina.
potassium and bicarbonate. ♦♦ This connective tissue mass is termed as the Gubernacular
• Striated ducts modify the organic content of primary cord. It may have a function in guiding the permanent
saliva. tooth as it erupts.
• Single layered epithelium of striated ducts consists of
simple cytokeratin intermediate filaments 8 and 18. Posteruptive Tooth Movement/Phase
Posteruptive tooth movements are those that:
11. TOOTH ERUPTION ♦♦ Maintains the position of the erupted tooth while the jaw
continues to grow
Q.1. Describe the process of eruption of teeth. ♦♦ Compensate for occlusal and proximal wear.
(Sep 2000, 15 Marks) • The principal movement is an axial direction.
Or • It is associated with condylar growth, which separates
Define eruption and write about phases of eruption. the jaws and teeth.
(Nov 2008, 10 Marks) • Bone deposition occurs at the alveolar crest and on
Ans. Eruption means the axial or occlusal movement of the the socket floor.
tooth from its developmental position within the jaw to • The movement to compensate occlusal and proximal
its functional position in the occlusal plane. Eruption of wear of the tooth is generally assumed that the
tooth involves following tooth movement: continuous deposition of cement around the apices
1. Pre-eruptive tooth movement/phase. of the roots of the teeth is sufficient to compensate
2. Eruptive tooth movement/phase for occlusal wear.
3. Posteruptive tooth movement/phase. Wear also takes place at the contact points and to
maintain tooth content proximal drift takes place. The
Pre-eruptive Tooth Movement/Phase
drift is seen as a selective deposition and resorption
When deciduous tooth germs first differentiate, they are very of bone on socket walls by osteoblast and osteoclast.
small and a good deal of space is between them.
♦♦ This space is soon used because of rapid growth of the
tooth germ, and crowding results.
♦♦ Crowding is then relieved by growth of the jaws in length,
which permits drifting of the tooth germs. The drifting or
growth of the tooth germ, demand remodeling of the bony
wall of the crypt.
♦♦ Remodeling is achieved by the selective deposition and
removal of bone by osteoblastic and osteoclastic activity.
♦♦ Permanent teeth with deciduous predecessors also move
before they reach the position from which they will erupt.
♦♦ The permanent molars, which have no deciduous
predecessors, also exhibit movement of the upper
permanent molar, first have their occlusal surfaces facing
distally and swing around only when the maxilla is grown. Figs 96A and B: Tooth movement of anterior teeth
Dental Histology 715
Stage II: This is also physiologic stage. In this, the bottom Q.7. Write short note on periodontal ligament traction
of gingival sulcus lies on the enamel but the apical end theory. (Dec 2012, 3 Marks)
of attachment of epithelium has shifted from cemento Or
enamel junction to the cementum.
Write short note on ligament traction theory.
Stage III: In this stage, anatomical crown is fully exposed
(Feb 2016, 3 Marks)
in oral cavity. The bottom of the gingival sulcus shift to
Ans. Refer to Ans 10 of same chapter.
the cementoenamel junction. The epithelial attachment
also entirely shift on the cementum. Q.8. Theories of eruption. Write on any one in brief.
Stage IV or Gingival Recession: This stage represents (Feb 2013, 5 Marks)
gingival recession. Recession can be defined as exposure Ans. Theories of Tooth Eruption
of the root surface by an apical shaped in the position As related to mechanism of tooth movement many of
gingiva. the theories have been put forward for the explanation
For theories of eruption refer to Ans 2 of the same chapter. of eruption. Following are the theories of tooth eruption:
• Bone remodeling theory
Q.5. Define eruption and shedding and describe the various
• Root formation theory
theories of eruption. (Sep 2006, 15 Marks)
• Vascular pressure theory
Or • Periodontal ligament traction theory.
Define eruption and shedding. (Oct 2016, 2 Marks) For periodontal ligament traction in detail refer to Ans
Ans. Eruption means the axial or occlusal movement of the 6 of same chapter.
tooth from its developmental position within the jaw to Q.9. Write short note on active and passive eruption.
its functional position in the occlusal plane. (Aug 2011, 5 Marks)
The physiologic process resulting in the elimination Or
of the deciduous dentition is called “shedding” or “
Answer in brief on active and passive eruption.
exfoliation”.
(Feb 2016, 2 Marks)
For theories of eruption refer to Ans 2 of the same
chapter. Or
Q.6. Write in brief bloodless eruption.(Sep 2006, 5 Marks) Write short answer on active and passive eruption.
Ans. (Aug 2018, 3 Marks)
♦♦ Bloodless eruption is explained by the periodontal Ans. For active and passive eruption refer to Ans 4 of same
ligament traction theory. chapter.
♦♦ The ligament traction theory proposed that “the cells and Q.10. Enumerate the different phases of eruption of teeth.
fibers of ligament pull the tooth into occlusion.” Describe in brief theories of tooth eruption.
♦♦ Periodontal ligament consists of myofibroblasts which (Jan 2012, 10 Marks) (May 2014, 10 Marks)
have contractile property.
Ans. Phases of Eruption of Teeth
♦♦ Fibroblasts get attached to one another and secrete a
• Pre-eruptive phase
protein known as fibronectin.
• Eruptive phase
♦♦ Network of myofibroblasts and binding material is known
• Post-eruptive phase.
as fibronexus.
♦♦ Myofibroblasts contracts and the contractile forces created Theories of Tooth Eruption
by many other cells are combined because of intercellular
attachments. As related to mechanism of tooth movement many of the
♦♦ Now the combined forces are transferred through theories have been put forward for the explanation of eruption.
fibronexus on collagen fibers bundles which are aligned in Following are the theories of tooth eruption:
an appropriate inclination by root formation which causes ♦♦ Bone remodeling theory
tooth movement. ♦♦ Root formation theory
♦♦ As the axial movement begins, dental follicle above the ♦♦ Vascular pressure theory
formed tooth structure make way for the tooth. Release ♦♦ Periodontal ligament traction theory.
of the enzymes degenerate collagen fibers above the
Bone Remodeling Theory
erupting tooth.
♦♦ Reduced enamel epithelium combine with gingival ♦♦ Bone remodeling theory states that eruption of tooth is
epithelium and this lead to the formation of soft tissue due to selective deposition and resorption of bone which
channel in which the tooth enters and emerge in oral cavity occur around the developing tooth.
without causing bleeding. ♦♦ The resorption of bone at site of pressure and deposition
♦♦ This theory is the most accepted theory of tooth eruption of bone at site of tension results in tooth eruption.
Dental Histology 717
♦♦ Pressure exerted by growing tooth germ in axial direction ♦♦ Now the combined forces are transferred through
leads to remodeling of bone which forms a path for fibronexus on collagen fibers bundles which are aligned in
erupting tooth. an appropriate inclination by root formation which causes
♦♦ Osteoblasts and osteoclasts both actively take part in bone tooth movement.
remodeling which causes tooth eruption. ♦♦ As the axial movement begins, dental follicle above the
♦♦ Osteoblasts secrete the collagenase and various other formed tooth structure make way for the tooth. Release
proteolytic enzymes which leads to the dissolution of the of the enzymes degenerate collagen fibers above the
osteoid layer which expose the mineralized bone, this erupting tooth.
attracts the osteoclasts which causes bone resorption. ♦♦ Reduced enamel epithelium combine with gingival
epithelium and this lead to the formation of soft tissue
Root Formation Theory
channel in which the tooth enters and emerge in oral cavity
♦♦ Root formation theory states that eruption of tooth occurs without causing bleeding.
due to occlusal or axial movement of tooth because of the ♦♦ This theory is the most accepted theory of tooth eruption
formation of root.
Q.11. Define eruption of tooth and describe various theories of
♦♦ The occurrence of these two events provides the impression
tooth eruption. (Aug 2011, 10 Marks) (Oct 2014, 8 Marks)
that root formation leads to eruption of tooth.
♦♦ Various points which contradict the theory are: Or
• If root formation leads to pushing force for the Write about theories of tooth eruption.
eruption of teeth, root has to form on a fixed base. (Jan 2012, 10 Marks)
If this happens then only the root can exert force in Ans. Eruption is defined as the axial or occlusal movement
opposite direction. Histology of root formation does of the tooth from its developmental position within the
not support this. Some investigators suggested that jaw bone to its functional position in the occlusal plane.
cushion-hammock ligament act as a fixed base at apex
For theories of tooth eruption refer to Ans 10 of same
of forming tooth. But this concept is not accepted.
chapter.
• In various developmental disorders tooth remain
rootless, but teeth erupt in oral cavity. This explains Q.12. Enumerate theories of eruption. (Dec 2014, 2 Marks)
that root formation occur with eruption might not the (Sep 2018, 2 marks) (Jan 2018, 2 Marks)
only factor which influences eruption. Or
Vascular Pressure or Hydrostatic Theory Define tooth eruption. List theories of tooth eruption.
(Sep 2017, 2 Marks)
♦♦ Vascular pressure theory states that local increase in tissue
fluid pressure in periapical region of the tooth causes the Ans. Eruption means the axial or occlusal movement of the
occlusal movement of the tooth. tooth from its developmental position within the jaw to
♦♦ Periapical tissue has rich blood supply and consists of its functional position in the occlusal plane.
many blood vessels. Active fluid movement from these Enumeration of theories of tooth eruption
vessels in local periapical tissue leads to the swelling of • Bone remodeling theory
tissue. As periapical tissue is a closed space, swelling of • Root formation theory
tissue leads to local increase in pressure which is exerted on • Vascular pressure theory
tooth and causes tooth eruption. As the pressure difference • Periodontal ligament traction theory.
is transient the theory is doubtful. Q.13. Define eruption. Enumerate theories of eruption. Write
♦♦ Reduced eruption rate following the severity of blood in detail about the most accepted theory for eruption.
vessels to periapical region is observed. Role of vascular (Feb 2013, 15 Marks)
eruption is not confirmed by this because lack of blood Ans. The movement of teeth from the developmental position
supply affects other factors such as tissue growth which inside the jaw to their functional position in the oral
leads to decrease in eruption rate. cavity is known as eruption.
Periodontal Ligament Traction Theory
Theories of Eruption
♦♦ The ligament traction theory proposed that “the cells and
fibers of ligament pull the tooth into occlusion.” Following are the theories of eruption:
♦♦ Periodontal ligament consists of myofibroblasts which ♦♦ Root formation theory
have contractile property. ♦♦ Bone remodeling theory
♦♦ Fibroblasts get attached to one another and secrete a ♦♦ Vascular pressure theory
protein known as fibronectin. ♦♦ Ligament traction theory.
♦♦ Network of myofibroblasts and binding material is known Most Accepted Theory for Eruption
as fibronexus.
♦♦ Myofibroblasts contracts and the contractile forces created Ligament traction theory is the most accepted theory for
by many other cells are combined because of intercellular eruption.
attachments. For details refer to Ans 10 of same chapter.
718 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Odontoclasts
12. SHEDDING OF DECIDUOUS TEETH
♦♦ These are the multinucleated giant cells which lie in
resorption bays on dental hard tissue.
Q.1. Describe the process of shedding of deciduous tooth.
(Sept 2003, 15 Marks) ♦♦ Odontoclasts are derived from monocytes.
Ans. Physiologic process resulting in the elimination of ♦♦ Cytoplasm of odontoclasts is vacuolated and they have
the deciduous dentition is called “shedding” or “ ruffled border and multiple mitochondria which show
exfoliation”. increase phosphatase activity.
• Shedding of deciduous teeth is the result of ♦♦ They can resorb all dental hard tissue including enamel.
progressive resorption of roots of teeth and their
Pressure
supporting tissue, the periodontal ligament.
– Multinuclear cells similar to osteoclasts, i.e. Pressure from underlying permanent teeth play an important
odontoclast. role in resorption. This causes weakening of supporting tissues
– Pressure generated by the growing and erupting of primary teeth due to shortening of roots by resorption by
permanent tooth. odontoclasts.
Process / Mechanism of Resorption and Shedding For mechanism of shedding refer to Ans 1 of same chapter.
♦♦ Pressure from the erupting successional tooth plays a key Complications of Shedding of Deciduous Teeth
role in shedding because the odontoclasts appear at the
predicted sites of pressure. ♦♦ Deciduous teeth remanents: At times roots of deciduous
♦♦ For resorption to begin the hormones and cytokines have teeth are not in path of eruption, these fragments instead
to disrupt the cementoblast surface. of being resorbed get embedded in jaws.
♦♦ Odontoclast then attaches to the hard tissue surface ♦♦ Retained deciduous teeth
peripherally through the clear zone, thereby creating a In some cases deciduous teeth does not undergo resorption
sealed space lined by the ruffled border of the cell. In this because of shedding time. The retention is due to:
way a microenvironment results. • Impacted permanent teeth: At times permanent canine
♦♦ Membrane of the ruffled border acts as a proton pump, are impacted which causes retention of deciduous
adding hydrogen ions to the extracellular environment and canine tooth.
acidifying it so that mineral dissolution occurs. • Congenital missing of underlying permanent tooth:
♦♦ Broken minerals are engulfed by odontoclasts and are Permanent maxillary lateral incisors and mandibular
digested inside cytoplasmic vacuoles. second premolars sometimes are congenitally missing
♦♦ Primary lysosomes secrete their enzymatic contents into so the deciduous maxillary lateral incisors and
same environment to degrade the organic matrix. deciduous mandibular second molars may be retained
• Resorption occurs with the periods of activity followed
for the longer duration.
by rest.
• Ankylosis of tooth: This occurs due to the union of
• The pressure from erupting permanent successor
causes resorption of deciduous teeth. Other factors repairing cementum and adjacent bone. This lead to
also involves in tooth resorption. the prevention of eruption of underlying permanent
• Another factor which plays an important role in successor.
resorption of deciduous teeth apart from pressure ♦♦ Submerged tooth: Deciduous tooth get ankylosed due
exerted by erupting successor is the forces of to trauma or repair, it exhibit movement when there is
mastication which are applied to the deciduous tooth. an increase in height of alveolar bone. Due to this the
• Forces of mastication are also capable of initiating tooth appear at lower level when compared with adjacent
the resorption. tooth. These submerged teeth should be extracted
• With the increased growth of face as well as jaws, since they lead to prevention of eruption of permanent
there is increase in the size and strength of masticatory successor.
muscles. Periodontal ligament does not withstand
the excessive force which leads to trauma to the Q.3. Write short note on mechanism of shedding.
periodontal ligament and that initiate resorption. (Mar 2013, 3 Marks)
♦♦ In case of periodontal ligament it has been demonstrated Ans. Refer to Ans 1 of same chapter.
that apoptotic cell death is involved. This form of cell
Q.4. Write short note on mechanism of resorption and
death involves shrinkage of the cells so that they can be
shedding. (Feb 2014, 3 Marks)
phagocytosed by neighboring cells.
Ans. Refer to Ans 1 of same chapter.
Q.2. Describe in detail factors and mechanism of shedding
and complications of shedding of deciduous teeth. Q.5. Write short note on odontoclast. (Aug 2016, 3 Marks)
(Nov 2010, 8 Marks) Ans. Cells which are responsible for removal of dental hard
Ans. Following are the factors in shedding of deciduous teeth: tissue are known as odontoclasts.
Dental Histology 719
• Odontoclasts are probably derived from tartrate- Ans. Temporomandibular joint (TMJ) on each side of head is
resistant acid phosphatase (TRAP) positive formed by articulation between the articular eminence
circulating monocytes. and anterior part of glenoid fossa of temporal bone above
• Odontoclasts are commonly found on surfaces of and condylar head of mandible below.
roots in relation to advancing pemanent tooth. • It is a synovial joint.
• Histologically odontoclasts are similar to bone
resorbing osteoclasts. Parts of TMJ
• Under light microscope odontoclasts are identified Bony Structure
as large, multinucleated cells which occupy the
resorption bays on surface of dental hard tissue. ♦♦ Condyle of the mandible is composed of cancellous bone
Cytoplasm of cell is vacuolated and surface of the covered by thin layer of compact bone.
cell adjacant to resorbing hard tissue forms ruffled ♦♦ Roof of glenoid fossa consists of their compact layer of
border. bone.
• Under electron microscope ruffled border is seen ♦♦ Articular eminence consists of spongy bone covered by a
as extensive folding on cell membrane in the series thin layer of compact bone.
of invagination which are 2 to 3 µm deep, with
mineralized crystals under the depth of invagination.
Peripheral to ruffled border lies the clear zone in
which cytoplasm lack organelles but have numerous
filaments which consists of contractile proteins i.e.
actin and myosin.
• Clear zone represents the attachment apparatus of
odontoclasts.
• Cytoplasm of odontoclast consists of high content Fig. 99: Temporomandibular joint
of mitochondria and many vacuoles which are
concentrated at ruffled border. Articular Fibrous Covering
• Odontoclasts fuse with each other to form multi A thick layer of fibroelastic tissue containing fibroblast and
nucleated giant cell as they attached to resorbing variable number of chondrocytes covers the condyle and
surface. articular eminence.
The fibrous covering of mandibular condyle is thick and
consist of strong collagen fibers in superficial layer.
♦♦ Fibrous layer covering the articulating surface of temporal
bones is thin in glenoid fossa and thickens on the articular
eminence.
♦♦ Articular disc: TMJ contains fibrous articular disc that is
found between articular surfaces.
♦♦ It function as shock absorber.
The disk is biconcave.
♦♦ The disk composed of dense fibrous tissue. Fibroblasts in
the disc are elongated and have flat cytoplasmic processes.
Synovial Membrane
The articular capsule is lined by synovial membrane.
♦♦ Synovial membrane form folds to form synovial villi that
is projecting into the joint spaces.
♦♦ Synovial membrane contains internal cells.
♦♦ A small amount of a clear, straw colored viscous fluid
Fig. 98: Odontoclast
(synovial fluid) is found in the articular spaces.
♦♦ It acts as lubricant and also as nutrient fluid. Secreted by
synovial cells.
13. TEMPOROMANDIBULAR JOINT Q.2. Write the capsular ligament of TMJ.
(Sep 2002, 5 Marks) (Apr 2009, 5 Marks)
Q.1. Write a short note on temporomandibular joint.
Ans. A joint capsule covers the TMJ
(Feb/Mar 2004, 5 Marks) (Sep 2007, 3 Marks)
♦♦ The joint capsule is a fibrous elastic sac.
Or ♦♦ Attachment of fibroelastic sac:
Write briefly on temporomandibular joint. • Anteriorly: Attaches to the ascending slope of articular
(Oct 2007, 5 Marks) eminence.
720 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• Posteriorly: To the lips of the squamotympanic fissure. ♦♦ The epithelium is pseudostratified columnar and ciliated
• Superiorly: To the margins of the glenoid fossa. and is derived from the olfactory epithelium of middle
• Inferiorly: To the neck of condyle of mandible. nasal meatus.
–– The posterior capsule is highly vascular and ♦♦ In addition, there are basal cells, columnar nonciliated cells
sometimes is called ‘Pis vasculosa’. and mucous producing, secretory goblet cells.
–– Parotid gland is usually found in the posterior ♦♦ Ciliated cells: The ciliated cells enclosed the nucleus and
capsule of joint. electronlucent cytoplasm with numerous mitochondria
–– Lateral aspect of the capsule is strengthened by and enzyme containing organelles.
temporomandibular ligament. ♦♦ The basal bodies, which serve as the attachment of ciliary
–– Anterior surface is ill defined. microtubules.
–– Inner surface of capsule is smooth and glisten- ♦♦ Cilia are typically composed of 9+1 pair of microtubules.
ing because of pressure of a synovial membrane ♦♦ Cilia provide the motile apparatus.
lining. • Goblet cell: They contain all the characteristic features
of secretary cells.
♦♦ Basal segment contains nucleus.
14. MAXILLARY SINUS ♦♦ Cytoplasm also contains RER and SER and the Golgi
apparatus, all of which are involved in the synthesis of
Q.1. Write a short note on histology and function of the secretory mucous substance.
maxillary sinus. (Feb 2002, 6 Marks) Subendothelial gland: These are located in the subepithelial
layers of the sinus and reach the sinus lumen by way of excretory
Or
duct.
Draw well labelled diagram of histology of maxillary ♦♦ The subendothelial gland contain both serous and mucous
sinus. Add a note on its functions. cells.
(Jan 2018, 3 + 2 Marks)
Myoepithelial cells: Surrounded the acini. It composed of
Ans. Maxillary sinus is the pneumatic space that is lodged
either both secretory cells or a pure population of cells or either
inside the body of the maxilla and that communicate
secretory types.
with the environment by way of the middle nasal
meatus and nasal vestibule. Functions of Maxillary Sinus
• Base of pyramid is facing medially towards the nasal
cavity and the apex of which is pointed laterally ♦♦ Maxillary sinus help in both the functions olfactory as
towards the body of zygomatic bone. well as respiratory.
• The four sides are related to the surface of the maxilla ♦♦ It causes humidification and warming of inspired air and
in the following manner: contribution to the olfactory.
a. Anterior, to the facial surface of the body. ♦♦ It is possible that if air is arrested in the sinus for a certain
b. Posterior, to the infratemporal surface. time, it quickly reaches the body temperature thus protects
c. Superior, to the orbital surface. the internal structure, particularly the brain against
d. Inferior, to the alveolar and zygomatic processes. exposure of cold air.
♦♦ Other contribution in the response of voice, lightening of
Microscopic I Histological Features skull weight, enhancement of the faciocranial resistance
to mechanical shock, and the production of bacteriocidal
lysozyme to nasal cavity.
Q.2. Write note on maxillary sinus.
(Oct 2006, 2 Marks) (Oct 2007, 5 Marks)
(Dec 2010, 5 Marks)
Or
Write short note on maxillary sinus.
(Apr 2007, 5 Marks) (Sep 2006, 5 Marks)
Ans. Refer to Ans 1 of the same chapter.
Q.3. Write notes on anatomy of maxillary sinus.
(Sep 2007, 2.5 Marks)
Ans. It is the largest sinus which lies in body of maxilla, also
known as antrum of Highmore.
Fig. 100: Maxillary sinus (For colour version see Plate 31)
Shape and Boundaries
♦♦ Three microscopically distinct layers surround the space
of the maxillary sinus, the epithelial layer, basal layer and ♦♦ Pyramidal base formed by lateral wall of nose.
subepithelial layer. ♦♦ Apex pointing laterally in the root of the zygoma.
Dental Histology 721
♦♦ Upper wall or roof is thin and forms floor of the orbit. Q.6. Describe functions of maxillary sinus.
♦♦ Floor of the sinus formed by alveolar process of maxilla. (June 2010, 5 Marks)
♦♦ Anteriolateral wall of the antrum is formed by the canine Or
fossa. Write briefly on functions of maxillary sinus.
♦♦ Posterior lateral wall separate the antrum from infra- (Aug 2012, 5 Marks)
temporal fossa. Or
Give four functions of maxillary sinus.
Ostium (Oct 2016, 2 Marks)
♦♦ The antrum opens into the nasal cavity through a small Or
ostium in middle meatus. Write short note on functions of sinus of Highmore.
♦♦ It is 3–4 mm in diameter. (Apr 2017, 2 Marks)
♦♦ Communication with other paranasal sinus through lateral Or
wall of the nose. Write short answer on functions of maxillary sinus.
♦♦ Lined byciliated epithelium and is also known as (May 2018, 3 Marks)
schneiderian epitheliun. Or
Write short note on functions of maxillary sinus.
Relations (Sep 2018, 2 Marks)
♦♦ Posterior superior alveolar nerve is situated at posterior Ans. Following are the functions of maxillary sinus:
wall. • It causes humidification and warming of inspired
♦♦ Infraorbital nerve at roof. air and contribution to the olfactory.
♦♦ Roots of maxillary posterior teeth at floor. • It is possible that if air is arrested in the sinus for a
certain time, it quickly reaches the body temperature
Nerve Supply thus protects the internal structure, particularly the
♦♦ Superior dental nerve brain against exposure of cold air.
♦♦ Infraorbital nerve • It lightens the weight of skull.
♦♦ Greater palatine nerve. • It enhances the faciocranial resistance to mechanical
shock.
Blood Supply • It leads to the production of bacteriocidal lysozyme
Internal maxillary artery via to nasal cavity.
• It acts as a resonating box for production of voice.
♦♦ Infraorbital artery
♦♦ Posterior superior dental artery Q.7. Write about definition and functions of maxillary sinus
♦♦ Anterior superior dental artery. with a brief note on its histology. (Aug 2012, 10 Marks)
Ans. Definition
Venous Drainage
Maxillary sinus is the pneumatic space which is lodged
Inferior ophthalmic vein inside the body of maxilla and that communicates with
Anterior facial vein. the environment by way of the middle nasal meatus and
the nasal vestibule.
Lymphatic Drainage • For functions refer to Ans 6 of same chapter.
• For histology refer to Ans 1 of same chapter.
Submandibular lymph node.
Q.4. Write the structure, histology and functions of
maxillary sinus. (Oct 2008, 5 Marks) 15. HISTOCHEMISTRY OF ORAL TISSUES
Ans. For structure refer to Ans 3 of same chapter. For
histology and functions of maxillary sinus refer to Q.1. Write notes on hematoxylin and eosin stain.
Ans 1 of same chapter. (Mar 1998, 5 Marks) (Mar 2009, 5 Marks)
(Feb. 2013, 2 Marks) (May 2014, 2 Marks)
Q.5. Write short note on microscopic features of maxillary
Or
sinus. (Feb 2013, 2 Marks)
Answer in brief on hematoxylin and eosin stain.
Or
(Feb 2016, 2 Marks)
Write short note on histology of maxillary sinus lining. Ans. Hematoxylin stain is also called as H and E stain.
(Aug 2016, 3 Marks) • Hematoxylin and eosin stain is the most popular
Or stain used in the histology.
Answer in brief histology of maxillary sinus. • The method involves application of basic dye, i.e.
(May 2017, 2 Marks) hematoxylin which colour acidic structures with
Ans. For microscopic features refer to histology part of blue-purple colour and alcohol based Eosin-Y which
Ans 1 of same chapter. colour eosinophilic structures bright pink.
722 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
tooth is held firmly against the rotating wheel till Q.6. Write short note on fixatives.
the desired section thickness is reached. (Dec 2010, 2 Marks) (Feb 2013, 2 Marks)
• To avoid abrading the fingers and sections flying (May 2011, 2 Marks)
off, the sections are attached on to the wooden block Ans.
with the help of adhesive tape. ♦♦ Fixation is defined as the process which attempts to
• To remove the adhesive, ground section is soaked preserve the tissues in a life like condition and prevent
in ether and then dried, then section is mounted autolysis of cells.
on a slide. ♦♦ It involves series of chemical events which stabilizes
• A drop of mountant is placed on the slide with proteins and tissue become resistant to damage during
a camel’s hair brush, the section is put on the processing and visualization.
mountant and a cover slip is placed on top of it. ♦♦ Fixatives are the chemical which causes fixation of tissue.
• After hardening of the mountant the section is ready ♦♦ Most commonly used fixative is 10% formalin.
to be examined under the microscope.
♦♦ Fixatives are divided in three main groups:
• After cutting the tooth into two, one side being held
1. Microanatomical
securely between the fingers, it is grounded on the
2. Cytological
Arkansas stone using a paste of pumice in water to
3. Histochemical.
dissipate the heat produced.
• The section is grounded till the desired thickness Microantomical Fixatives
and then mounted in same way.
They preserve anatomy of tissue with accurate relationship
Q.5. Write a short note on Mallory stain. of tissue layers. Fixatives of this group are Buffered formalin,
(Oct 2008, 2 Marks) Gluteraldehyde, Zenker’s fluid, Acrolein etc.
Or
Draw well labelled diagram of Mallory stain. Cytological Fixatives
(Sep 2018, 2 Marks) They preserve the intracellular structures and inclusions.
Ans. It is a special stain used for staining the keratin layer. Fixatives of this group are Carnoy’s fluid, Muller’s fluid,
After staining by Mallory stain, organelles appear as Clarke’s fluid etc.
follows:
Histochemical Fixatives
• Keratin layer–Bright orange
• Granular layer–Violet They are used to demonstrate a particular substance. Fixatives of
• Spinous cell layer–Violet this group are Absolute alcohol, formol saline, cold acetone, etc.
• Nucleous–Dark Violet Q.7. Write short note on ground section.
• Basal Cell Layer–Dark Violet (Oct 2016, 3 Marks) (Dec 2014, 2 Marks)
• Basement Membrane–Dark Violet
• Blood Vessel–Blue Or
• Fibroblast–Blue Write short note on ground section preparation.
• Muscle Fiber–Orange (Aug 2012, 5 Marks)
• Ground Substance–Sky Blue. Or
Answer in brief ground section. (Oct 2016, 2 Marks)
Ans.
♦♦ Decalcification of bone and teeth often obscures the
structures.
♦♦ Teeth in particular are damaged because tooth enamel,
being about 96% mineral substance, is usually completely
destroyed by ordinary methods of decalcification.
♦♦ Undecalcified teeth and undecalcified bone may be studied
by making thin ground sections of the specimens.
♦♦ Sticky side of the adhesive tape should be directed outward ♦♦ As mounting is completed the ground section should be
while using. studied under light microscope.
♦♦ Tooth is sticked with adhesive tape over the wooden block Q.9. Write short note on process of decalcified tissue
and is pressed to the rotating wheel of lathe so the tooth
processing and staining. (Dec 2014, 3 Marks)
become thin.
Ans. Processing of decalcified tissue
♦♦ Change the coarse wheel to fine wheel and continue
grinding till the section become sufficiently thin. • Mineralized tissue to be decalcified should be fixed
♦♦ Section removed from the adhesive tape is mounted over in 10% formalin.
the glass slide by mounting medium. • Place the mineralized tissue in the container with
acid of choice, i.e. commonly used acid solution is
Q.8. Write briefly on methods of studying mineralized
5% nitric acid.
tissue. (Aug 2012, 5 Marks)
• Solution should be changed everyday for few days
Ans. For studying mineralized tissues following procedures
and specimen is tested for decalcification.
can be opted for i.e. decalcified sections and ground
• As demineralization occur the hard tissue specimens
sections.
become soft and yellowish and are easily penetrated
Decalcified Sections by needle right up to the centre when it get
completely decalcified. The hard tissue specimens
♦♦ Decalcification is the process through which the calcium is
are now treated like routine soft tissue specimens.
removed from the mineralized tissue, this causes softening
• After completion of decalcification, the tissue
of mineralized tissue to make thin sections.
should be washed thoroughly in running tap water
♦♦ Enamel is not studied by this method because it is highly
mineralized and is lost completely by decalcification. overnight.
♦♦ Decalcification is done after fixation of tissue and before • As the tissue gets decalcified routine tissue
tissue processing. processing steps are to be followed:
♦♦ Acids such as 5% nitric acid, 10% formic acid and 1. Dehydration: Water is removed from tissue so
hydrochloric acids are used to decalcify the mineralized that wax can penetrate the tissue and make it
tissues. hard enough so that it can be sectioned. In this
step ascending grades of alcohol are used, i.e.
Procedure for Decalcification of Mineralized Tissue 70%, 75%, 80%, 90% and absolute alcohol are
♦♦ Mineralized tissue to be decalcified should be fixed in used. Time is half an hour to two hours in each
10% formalin. grade of alcohol.
♦♦ Place the mineralized tissue in the container with acid of 2. Clearing: Tissue is dipped in clearing agent so
choice, i.e. commonly used acid solution is 5% nitric acid. that it appears clear. Xylene is the commonly
♦♦ Solution should be changed everyday for few days and used clearing agent. Two changes of xylene are
specimen is tested for decalcification. done for 1 to 2 hours.
As demineralization occur the hard tissue specimens become 3. Impregnation: Tissue is immersed in molten
soft and yellowish and are easily penetrated by needle right upto paraffin wax and is kept in wax bath which is
the centre when it get completely decalcified. The hard tissue thermostatically operated for few hours. In this
specimens are now treated like routine soft tissue specimens. step two changes of wax are made.
4. Embedding: Now tissue is removed from the
Ground Section wax bath and is embedded in wax block. For
♦♦ Tooth is grinded by the use of laboratory lathe. doing this Leuckhart’s L-shaped metallic pieces
♦♦ Initial grinding is carried out by holding tooth in fingers are used to form square of desired size and
and pressing it against the rotating course abrasive wheel molten wax is poured in it. Impregnated tissue is
of lathe. kept in centre using preheated forceps and wax
♦♦ When the tooth become thin it is difficult to hold it with is allowed to harden. Tissue should be oriented
the fingers, so it is tucked over the wooden block wrapped in right direction i.e. epithelium and connective
with adhesive tape. tissue are included in cutting surface of block.
♦♦ Sticky side of the adhesive tape should be directed outward 5. Sectioning: As wax block is prepared it is
while using. attached to microtome which cut sections at 3 to
♦♦ Tooth is sticked with adhesive tape over the wooden block 5µm thickness. As thin section is obtained it is
and is pressed to the rotating wheel of lathe so the tooth spreaded on water bath. Glass slides which are
become thin. coated with the albumin and glycerine mixture
♦♦ Change the coarse wheel to fine wheel and continue in centre are introduced in water. Thin section is
grinding till the section become sufficiently thin. lifted on the slide and is dried for 15 min on slide
♦♦ Section removed from the adhesive tape is mounted over warmer. Albumin coagulate and fixes section
the glass slide by mounting medium. onto glass slide.
Dental Histology 725
1. Remnants of Meckle’s cartilage are: 9. Butt junction in cementoenamel junction seen in ...........
a. Stylohyoid and stylomandibular ligament cases.
b. Incus and malleus a. 10%
c. Condyle and coronoid process b. 30%
d. None of the above c. 60%
d. 90%
2. Which papillae does not contain taste buds?
a. Fungiform papillae 10. Dentin formed after root completion is called as:
b. Circumvallate papillae a. Tertiary dentin
c. Filiform papillae b. Reparative dentin
d. Foliate papillae c. Secondary dentin
d. Sclerotic dentin
3. Remnants of dental lamina are called as:
a. Bohn’s nodules 11. Mean volume of a single adult human pulp is:
b. Cementicles a. 0.01 cc
c. Epithelial rests of Malassez b. 0.02 cc
d. Cell rests of serres c. 0.03 cc
d. 0·04 cc
4. Enamel is derived from:
a. Endoderm 12. Mucosa covering gingiva and hard palate is called as:
a. Lining mucosa
b. Ectomesenchyme
b. Reflecting mucosa
c. Ectoderm
c. Specialized mucosa
d. All of the above
d. Masticatory mucosa
5. Enamel knot is seen in:
13. Enzyme in saliva causes cell wall lysis is:
a. Cap stage
a. Lactoferrin
b. Bell stage
b. Peroxidase
c. Bud stage c. Lysozyme
d. Any of the above d. Hyaluronidase
6. First hard tissue to be formed is: 14. Basic structural unit of enamel is called as:
a. Enamel a. Enamel sheath
b. Dentin b. Enamel cuticle
c. Cementum c. Enamel lamellae
d. Both (a) and (b) d. Enamel rod
7. New taste sensation is called as: 15. Dentinogenesis starts from which part of tooth:
a. Sour a. Cervical part
b. Umami b. Cusp tip
c. Bitter c. Root
d. None of the above d. Crown
8. Dentinoenamel junction is: 16. Cells of the pulp include all except:
a. Flat a. Fibroblast
b. Concave b. Osteoblast
c. Scalloped c. Odontoblast
d. Convex d. Plasma Cells
Answers: 1. d 2. c 3. d 4. c
5. a 6. b 7. b 8. c
9. b 10. c 11. b 12. d
13. c 14. b 15. b 16. b
Dental Histology 727
17. The cells of enamel organ are important in the 25. Disturbance of saliva production from the parotid
formation of: gland is likely to result from damage to which of the
a. Dentin following ganglia:
b. Bone a. Gasserian
c. Enamel b. Geniculate
d. Cementum c. Otic
18. Incremental lines of enamel are called as: d. Pterygopalatine
a. Sauer e. Trigeminal
b. Lines of retzius 26. A 20-year-old man falls down and chips the incisal edge
c. Von ebner of his maxillary central incisor, reducing the length of
d. None of the above the crown. A dentist informs him that the tooth may
19. The projection of ameloblast into the enamel matrix erupt a little to compensate for the loss. This tooth
have been named: movement is likely to result in increase in size of which
of the following dental tissues:
a. Tome’s granular layer
a. Cementum
b. Tome’s process
b. Dentin
c. Dental lamina
c. Enamel
d. Basal lamina
d. Periodontal ligament
20. Overlap CEJ is seen in: e. Pulp
a. 10%
27. A patient complains of loss of taste, and a numb
b. 30%
sensation in the left half of his tongue, after removal
c. 60%
of his left lower wisdom tooth. Which of the following
d. None of the above
nerves is most likely to have been injured during
21. Cellular cementum is seen on: removal of this tooth:
a. Apical 1/3 rd a. Facial nerve
b. Apex b. Glossopharyngeal nerve
c. From cervical to apical 1/3rd c. Inferior alveolar nerve
d. None of the above d. Lingual nerve
22. Myoepithelial cells have contractile function because e. Mandibular nerve
they contain: 28. DEJ during tooth development is called as:
a. Prostaglandin a. Membrana preformativa
b. Histamine b. Basement membrane
c. Actin c. Lamina densa
d. Actin and myosin d. Lamina lucida
23. Fate of dental lamina is: 29. Hardest structure in human body is:
a. 5 days a. Cementum
b. 5 months b. Dentin
c. 5 years c. Bone
d. 50 years d. Enamel
24. Radiographically bundle bone is called as: 30. Chemical composition of dihydroxyapetite crystal is:
a. Alveolar bone a. Ca12PO4OH
b. Lamina dura b. 2CaPO
c. Spongy bone c. Ca10(PO4)6OH2
d. All of the above d. None of the above
48. Nyasmyth’s membrane of primary enamel cuticle is 56. Exfoliation of deciduous tooth occurs by:
actually: a. Continuous resorption of roots
a. A thin layer of connective tissue derived from follicle. b. Alternate resorption and apposition
b. A thin layer of inner enamel epithelium which covers c. Continuous apposition only
newly erupted tooth d. None of the above
c. Basal lamina secreted by ameloblasts when enamel 57. The name of first branchial arch is:
formation is completed a. Maxillary
d. A derivative of pellicle b. Mandibular
49. Weil’s zone is also called as: c. Hyoid
a. Cell rich zone d. None of the above
b. Cell free zone 58. Bitter and sour taste sensations in posterior part of the
c. Odontoblastic zone tongue is mediated by:
d. All of the above a. Lingual nerve
50. Gnarled enamel is seen: b. Chorda tympani nerve
a. When cut in oblique plane at cervical region c. Glossopharyngeal nerve
b. When cut in longitudinal plane at cervical region d. None of the above
c. When cut in oblique plane near dentin in regions of 59. Disturbances during morphodifferentiation stage of
cusp and incisal edges teeth development will result in:
d. When cut in longitudinal plane near dentin in a. Changes in number of teeth
regions of cusp and incisal edges b. Ameloblastoma
51. Development of permanent teeth is initiated by: c. Changes in form and shape of tooth
a. Dental lamina d. Hypoplasia
b. Enamel organ 60. The Weil’s zone is also called as:
c. New teeth bud a. Cell rich zone
d. Successional lamina b. Cell free zone
52. In PDL, cell of epithelial origin are: c. Odontoblastic layer
a. Rest of Malassez d. All of the above
b. Fibroblasts 61. Enamel spindles are nothing but:
c. Cementoblasts a. Odontoblast processes which through dentinoenamel
d. None junction into the enamel
53. Type I alveolar bone is found in: b. Enamel rods which appear hypermineralized
a. Maxilla c. Part of dentinoenamel junction
b. Mandible d. Hypocalcified rod segments
c. Both 62. Contour lines of Owen are:
d. None a. Incremental lines of dentin
54. Osteoclasts are rich in: b. Accentuated incremental lines of dentin
a. Acid phosphatase c. Neonatal lines of dentin
b. Alkaline phosphatase d. Hypermineralized areas of dentin
c. Peroxidase 63. Collagen fibers are embedded into the cementum on
d. Dehydrogenase one side of periodontal space and alveolar bone on
55. The first hard tissue to form is: other are called as:
a. Enamel a. Sharpey’s fibers
b. Cementum b. Elastin fibers
c. Dentin c. Oxytalan fibers
d. All simultaneously formed d. Intermediate plexus
64. Periodontal ligament contains epithelial cells which 72. Most calcified part of dentin is:
are: a. Intertubular dentin
a. Rest of Serres b. Interglobular dentin
b. Rest of Malassez c. Intratubular dentin
c. Inner enamel epithelium d. Peritubular dentin
d. Outer enamel epithelium 73. Dentin formed after root completion is known as:
65. Dentinoenamel junction has a scalloped border; the a. Primary
convexities of scallops are directed towards: b. Secondary
a. Enamel c. Tertiary
b. Dentin d. Sclerotic
c. All of the above 74. The fiber group without alveolar attachment:
d. None of the above a. Oblique
66. Excretory duct of parotid gland is: b. Horizontal
a. Wharton’s duct c. Trans-septal
b. Bartholin’s duct d. Dentoperiosteal
c. Stenson’s duct 75. The hypocalcified structure running from DEJ to
d. Duct of Ravinous enamel in a group is:
67. Taste buds are absent in: a. Spindle
b. Tufts
a. Filiform papillae
c. Lamellae
b. Fungiform papillae
d. Grooves
c. Circumvallate papillae
d. All of the above 76. The epithelium type seen in maxillary sinus is:
a. Stratified squamous
68. Enamel tuft consists of:
b. Keratocuboidal
a. Hypocalcified enamel rods and interprismatic
c. Pseudostratified
substance
d. Both (b) and (c)
b. Organic debris
c. Hypermineralized structures 77. The cartilage of first arch is:
d. All of the above a. Meckel
b. Reichart
69 Upper and lower lips are formed from which embryonic c. Laryngeal
processes:
d. Cricopharyngeal
a. Maxillary and mandibular
b. Maxillary and median nasal 78. Fordyce’s spots are collection of:
c. Maxillary, mandibular lateral nasal and median a. Sweat glands
nasal b. Lacrimal glands
d. Mandible and median nasal c. Salivary glands
d. Sebaceous glands
70. Neonatal line is absent in:
a. Deciduous 2nd maxillary molar 79. Plexus of Raschkow is present in:
b. Permanent 2nd maxillary molar a. Odontoblastic zone
c. Deciduous 1st mandibular molar b. Cell free zone
d. Permanent mandibular first molar c. Cell rich zone
d. Pulp proper
71. Unilateral cleft lip occurs due to failure of:
a. Fusion of lateral nasal process 80. Rest of malassez are remnants of:
b. Fusion of median and lateral nasal process a. HERS
c. Failure of fusion of median and lateral nasal process b. Oral mesoderm
d. Fusion of median nasal process with maxillary c. Dental papilla
process d. Oral endoderm
81. Membrane present in dentinal tubule is: 90. Pericytes are the capillary associated cells present in
a. Lamina lucida pulp are:
b. Lamina densa a. Fibroblast
c. Lamina limitans b. Myoepithelial cells
d. Lamina dura c. Histiocytes
d. Nerve cell
82. Most accepted dentin sensitivity theory is:
a. Neuronal 91. Overjet is defined as:
b. Transduction a. Horizontal overlap
c. Hydrodynamic b. Vertical overlap
d. Traction c. Transverse plane discrepancy
d. All of the above
83. Perikymatas are external manifestations of:
a. Enamel rod 92. Enamel pulp is:
b. Incremental line of retzius a. Dental papilla
c. Cementum b. Stratum intermedium
d. Nasmyth membrane c. Stellate reticulum
d. Inner enamel epithelium
84. Incremental line of Salter is seen in:
a. Enamel 93. Maxillary sinus communicates with the environment
b. Cementum via the:
c. Dentin a. Superior nasal meatus
b. Middle nasal meatus
d. Pulp
c. Inferior nasal meatus
85. Weil’s zone of pulp is: d. None of the above
a. Cell rich zone
94. Permanent maxillary canine erupts by:
b. Cell free zone
a. 10 to 12 years
c. Cell degenerated zone
b. 9 to 10 years
d. Cell regenerated zone
c. 13 to 14 years
86. The fibers of periodontium which provide maximum d. 11 to 12 years
support to masticatory forces are:
95. Layer which is absent in nonkeratinizing epithelium is:
a. Trans-septal a. Stratum corneum
b. Oblique b. Stratum superficial
c. Apical c. Straitum intermedium
d. Horizontal d. Straitum basale
87. Primitive dentinoenamel junction is known as: 96. Structure nonevident at light microscopic level is:
a. Buccopharyngeal membrane a. Basal lamina
b. Membrana preformativa b. Dermis
c. Reduced enamel epithelium c. Lamina propria
d. Perikymata d. Epithelium
88. Organic lining of calcified tubule is also known as: 97. Periodontal ligament is thinnest at:
a. Lamina propria a. Apex
b. Lamina lucida b. Coronal third
c. Lamina limitans c. Middle third
d. Lamina densa d. Apical third
89. First appearance of tooth formation occurs at: 98. Neural crest cells arise from:
a. 6th week of IUL a. Midbrain
b. 2nd week of IUL b. Midbrain and 2 Rhombomeres
c. 4th week of IUL c. Hindbrain and 2 Rhombomeres
d. 9th week of IUL d. Notochord
1. The average diameter of enamel rod is …………………….. 17. Rounded protuberances found on incisal edge of a
Ans. 4 µm newly erupted permanent incisor are …………….
2. Incremental lines of enamel are known as …………… Ans. Mammelon
Ans. Incremental line of retzius 18. Merkel cells are believed to have …………..
3. A pulp stone entirely surrounded by dentin……………… Ans. Synaptic contacts
Ans. Embedded pulp stone 19. Shape of maxillary sinus is ……………………….
4. The average rate of formation of dentin per day is (in Ans. Pyramidal
microns)………………….. 20. Synonyms of sclerotic dentin ………………….
Ans. 3.5 µ
Ans. Transparent dentin
5. The uncalcified matrix of bone is called as…………………
21. Other name of bundle bone ……………….
Ans. Osteoid
Ans. Lamina dura
6. Inorganic content of fully developed enamel is
about………………….. 22. Salivary gland is which type of gland ……………..
Ans. 96% Ans. Compound exocrine gland
7. Weil’s zone in pulp organ is known as……………….. 23. Submerged tooth is …………………
Ans. Cell Free Zone Ans. Mandibular second molars
8. In most cases CEJ is of which type……………………… 24. Shape of maxillary sinus is …………………….
Ans. Overlapping Junction Ans. Pyramidal
9. S u p p o r t i n g c e l l s o f t a s t e b u d s a r e c a l l e d 25. Which tooth have three cusps………………………..
as………………………. Ans. Mandibular second premolars
Ans. Sustentacular Cell
26. The first primary tooth to erupt is ………………….
10. Osteoclasts are rich in……………………….. Ans. Mandibular central incisor
Ans. Acid phosphatase
27. Transverse ridge is the union of …………………….
11. Successional lamina gives rise to the formation Ans. Buccal and lingual triangular ridges
of………………….
Ans. Enamel organ 28. Tooth having longest root ………………………….
Ans. Maxillary canine
12. During amelogenesis, projections of ameloblasts into
the enamel matrix is known as………………… 29. Types of mandibular second premolars occlusally
Ans. Tome’s processes ……………………
Ans. 3 types
13. Organic lining of calcified dentinal tubule is known
as………………….. 30. Thickness of ground section of tooth should be ……….
Ans. Lamina Limitans Ans. 30-50 microns
14. Vermilion border of lip is …………………….. 31. Color of dead tracts in transmitted light is ……………
epithelium. Ans. Black
Ans. Keratinized stratified squamous epithelium
32. Oblique ridge in maxillary first molars joins which
15. Incremental lines of cementum are known as…………… cusps …………………………
Ans. Incremental lines of salter Ans. Mesio lingual and distobuccal
16. Serous gland on dorsum of tongue is called as 33. First formed component in tooth deposition is
………………. ………………………
Ans. Von-Ebner’s Glands Ans. dentin
Dental Histology 733
1. Skull bone is derived from which layer. 18. If a tooth develops at an abnormal location which stage
Ans. Ectomenix of tooth development get disturbed?
Ans. Initiation
2. Name the first bone to ossify in human body.
Ans. Clavicle 19. Why accessory canals are formed?
Ans. Due to early removal of Hertwig’s epithelial root sheath
3. Which type of cartilage is condylar cartilage?
Ans. Secondary cartilage 20. What do you mean by hypoplasia?
Ans. Disturbance in matrix formation.
4. At the time of development condylar head increases
by which types of growth. 21. Which is the hardest calcified tissue in human body?
Ans. Appositional and Interstitial growth Ans. Enamel
5. Name the structure by which cheeks are developed. 22. At which part of tooth the thickness of enamel is
highest?
Ans. Maxillary process
Ans. Cusp tip
6. Name the structure by which the bridge of nose is
23. How much is the thickness of enamel at cusp of molars
developed.
and premolars?
Ans. Frontonasal process
Ans. 2 to 2.5 mm
7. Name the first paranasal air sinus to develop.
24. How much is the inorganic content of enamel?
Ans. Maxillary sinus
Ans. 96%
8. Which structure is known as opening of thyroid 25. How much is the average diameter of enamel rod?
diverticulum.
Ans. 4 µm
Ans. Foramen Cecum
26. What is the direction fo enamel rods at cervical region?
9. Name the structure by which epiglottis is derived. Ans. Horizontal
Ans. Hypobranchial eminence
27. Which structure extends over full thickness of enamel
10. Name the structure by which primary palate is derived. from DEJ?
Ans. Globular process Ans. Enamel lamella
11. What is the function of primary epithelial band? 28. From which layer is the enamel derived?
Ans. It gives rise to dental lamina and vestibular lamina. Ans. Ectoderm
12. Name the structures by which the tooth germ is formed. 29. How much is the specific gravity of enamel?
Ans. Enamel organ, dental papilla and dental sac Ans. 2.8
13. When does development of first permanent molar is 30. Name the main bulk component of the tooth.
initiated? Ans. Dentin
Ans. At birth 31. At what age does the highest peak of dental caries occur?
14. What is the age at which last successional lamina forms? Ans. 13 years
Ans. 5 years 32. Name the mineralized structures of enamel.
15. In which of the layer of enamel organ alkaline Ans. Enamel rods, structureless enamel, perikymata lines,
phosphatase activity is high? Gnarled enamel
Ans. Stratum intermedium 33. What is the composition of dentin by weight?
16. Name the cells between which reciprocal induction is Ans. 20% organic and 70% inorganic
seen. 34. What is the shape of dentinal tubules?
Ans. Ameloblast and Odontoblast Ans. S shaped
17. Where does the cell rest of malaseez are seen? 35. What is interglobular dentin?
Ans. Periodontal ligament Ans. It is the dentin present between odontoblastic processes
734 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
36. Which is the collagen seen prominently in dentin? 56. Which is the most important property of periodontal
Ans. Type I collagen ligament?
37. What does incremental lines of dentin are known as? Ans. Proprioception
Ans. Lines of Von Ebner 57. What does incremental lines of cementum are known
38. What is secondary dentin? as?
Ans. It is the dentin formed after root completion Ans. Incremental lines of Salter
39. How do dead tracts appears? 58. Due to presence of which cells secondary cementum
Ans. They appear white in reflected light and dark in is known as cellular cementum?
transmitted light. Ans. Cementocytes
40. What are calcospherites? 59. Which is the commonest type of cementoenamel
Ans. They are isolated spheroid islands of enamel. junction.
Ans. Overlapping
41. How much is the average size of apical foramen in
maxillary teeth? 60. Which layer covers the intermediate cementum?
Ans. 0.4 mm Ans. Hyaline layer of Hopewell Smith.
42. How much is the average size of apical foramen in 61. Name the cementum which is predominantly involved
mandibular teeth? in the process of attachment with the periodontal
Ans. 0.3 mm ligament.
43. What is pulp? Ans. Acellular cementum
Ans. Pulp is a muscle tissue. 62. Which component in cementum regulates minerali
44. How many pulp organs are present in huans? zation.
Ans. 52 Ans. Osteopontin
45. Where does cell body of odontoblast resides? 63. What is the composition of bone?
Ans. In pulp Ans. 67% organic and 33% inorganic
46. Name the cell free zone. 64. Name the bone which appears as sponge.
Ans. Zone of Weil Ans. Spongy bone
47. Which is the most abundant cell of the pulp? 65. By what alveolar bone proper is made of?
Ans. Undifferentiated Mesenchymal cell Ans. Bundle bone and lamellated bone
48. Name the nerve plexus of pulp. 66. What is lamina dura?
Ans. Plexus of Whatson Ans. It is the radiographic appearance of alveolar bone proper.
49. As the age advances what happens to the cell population 67. Where does the density of alveolar bone is more?
of pulp?
Ans. In anterior region of maxilla and mandible.
Ans. It decreases
68. How much is the distance between CEJ and crestal
50. How much is the total volume of permanent teeth pulp?
margin of alveolar bone?
Ans. 0.38 cc
Ans. 1.5 to 2mm
51. How much is the mean volume of single adult human
69. Which is the lining mucosa of oral cavity?
pulp.
Ans. Dorsum of tongue
Ans. 0.02 cc
52. Name the tissues which support and invest the teeth 70. Which epithelium lines the oral mucosa?
in maxilla and mandible. Ans. Stratified squamous epithelium
Ans. Periodontium 71. Which part of oral mucosa shows mucoperiosteal
53. Where is the width of PDL space higher? attachment.
Ans. Apex Ans. Gingiva
54. Name the types of collagen present in PDL. 72. What is the importance of hemidesmososmes?
Ans. Type I and Type III Ans. They provide adhesion between epithelium and
connective tissue
55. Name the fibers of PDL which prevent intrusion of
teeth. 73. Which layer of oral epithelium shows odland body?
Ans. Oblique fibers. Ans. Stratum spinosum
Dental Histology 735
74. Which is the most prominent finding in stratum 93. Where does glenoid fossa is present?
granulosum. Ans. In squamous part of temporal bone
Ans. Keratohyaline granules
94. What is the shape of maxillary sinus in adults?
75. Which type of collagen does basal lamina have? Ans. Pyramidal
Ans. Type IV collagen
95. What do you mean by pneumatization of maxillary
76. Which papilla of tongue does not consists of taste bud? sinus?
Ans. Foliate papillae Ans. Expansion of sinus
77. Which cell of salivary gland shows zymogen granules? 96. Where does accessory ostia seen?
Ans. Serous cell Ans. In posterior fontanelle
78. Which cell consists of basket cell? 97. Name the membrane lining the maxillary sinus.
Ans. Myoepithelial cells Ans. Schneiderian membrane
79. Which areas of oral cavity do not consists of salivary
98. Name the epithelium which lines the sinus.
glands?
Ans. Pseudostratified columnar epithelial cell
Ans. Gingiva and anterior hard palate
99. What does apical surface of goblet cell have?
80. How much saliva is produced by salivary glands?
Ans. Microvilli
Ans. 1200 ml
81. Which glands secrete lingual lipase enzyme? 100. Which is the most commonly used fixative?
Ans. Parotid and Von Ebner’s gland Ans. 10% neutral buffered formalin
82. How much is the optimum pH level of saliva? 101. Name the clearing agent.
Ans. 6.5 to 7.5 Ans. Xylene
83. Name the enzyme which plays major role in starch 102. Which is the embedding medium?
digestion. Ans. Paraffin wax
Ans. Amylase 103. Which is the mountant?
84. Name the widely accepted theory of eruption of tooth. Ans. DPX
Ans. Periodontal ligament traction theory 104. Name the instrument used to obtain the thin
85. Name the cell which resorbs dentin. sections.
Ans. Odontoclast Ans. Microtome
86. Name the most commonly retained primary tooth. 105. How much is the thickness of section obtained in
Ans. Maxillary lateral incisor routine tissue processing?
87. Name the first tooth which erupts in oral cavity. Ans. 3 to 5 µm
Ans. Deciduous mandibular central incisor 106. Which is the decalcifying agent used?
88. Odontoclasts originates from which cell. Ans. Nitric acid
Ans. Circulating monocytes 107. How much is the thickness of ground section?
89. What is ankylosis? Ans. 50 µm
Ans. It is the union of cementum and bone 108. Name the instrument used to get frozen sections.
90. Which is the most common congenitally missing tooth? Ans. Cryostat
Ans. Permanent upper lateral incisor 109. Which is the best method to demonstrate carbohy-
91. Which type of joint is temporomandibular joint? drates?
Ans. Synovial joint Ans. PAS method
92. Name the layer which covers the condyle. 110. Name the fixative used to demonstrate nucleic acid.
Ans. Lamina splendens Ans. Carnoy’s solution
736 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Additional Matter
Some Details About Histological Structures of Tooth
Various Stages of Tooth Development and Results of Various Types of Cementum and their Locations
their Disturbances
Type of cementum Location
Stages Disturbances Acellular afibrillar cementum Cervical cementum
Initiation • Lack of initiation lead to absence of single tooth Acellular extrinsic fiber cementum Cervical margin to apical third
or multiple teeth, i.e. anodontia. Maxillary lateral
incisor followed by third molars and mandibular Cellular intrinsic fiber cementum Middle, apical third and furcations
second premolars are commonly involved. Cellular mixed fiber cementum Apical inter-radicular regions
• Abnormal initiation can lead to development of
supernumerary teeth. Mesiodens is the most Cellular mixed stratified cementum Apical and furcation
common type of supernumerary teeth.
• Sometimes fused or geminated teeth are formed. Various Salivary Glands, their Ducts and Location
Histo • This stage has highest development in bell Name of the
differentiation stage of enamel organ. gland Name of its duct Opening of duct
• Dentinogenesis imperfecta occur in this stage
Parotid gland Stensen’s duct Duct opens near to maxillary
Morpho • Advanced bell stage occurs during second molar inside the
differentiation morphodifferentiation. This stage provides buccal mucosa
morphologic pattern or basic form and relative
size of future tooth. Submandibular Wharton’s duct Duct opens at the side of
• Talon cusp or root, twinning, loss of cusp or root, gland lingual frenulum
Hutchinson’s incisor Sublingual • Bartholin’s duct Duct open along sublingual
Apposition duct • Several minor fold
ducts
Oral Physiology
Q.2. Write short note on inferior alveolar nerve. A. Factors promoting calcium absorption
(Aug 2016, 3 Marks) • Vitamin D induces synthesis of calcium binding
Ans. Inferior alveolar nerve is the largest branch of mandibular protein in intestinal epithelial cells and promotes the
nerve. calcium absorption.
Inferior alveolar nerve along with the inferior alveolar • Parathyroid hormone enhances calcium absorption
artery enters the mandibular foramen to run anteriorly through increased synthesis of cholesterol.
and downward below the teeth in mandibular canal, till • Acidity is favorable for calcium absorption.
it reaches mental foramen. At mental foramen the nerve • Lactose promote calcium uptake via intestinal cells.
terminates by giving off two branches, i.e. incisive and • Arginine and lysine facilitate absorption of calcium.
mental. Various branches of inferior alveolar nerve and B. Factors inhibiting calcium absorption
their innervations are as follows: • Phytates and oxalates lead to the formation of insoluble
salts and interfere with the absorption of calcium.
• Mylohyoid nerve: This branch arises from inferior
• High content of dietary phosphate leads to the
alveolar nerve before it enters in mandibular
information of insoluble calcium phosphate and
foramen. This nerve runs anteroinferiorly over the
prevent uptake of calcium.
medial surface of mandible to reach mylohyoid
• Free fatty acids react with calcium to form insoluble
muscle. This nerve pierces sphenomandibular
calcium soaps.
ligament to supply mylohyoid muscle and anterior
• Alkaline condition is unfavorable for calcium
belly of digastric muscle.
absorption.
• Alveolar branches: They supply the teeth. Nerve
• High content of dietary fiber interfere with calcium
twigs which arises from inferior alveolar nerve
absorption.
corresponding to every tooth. These nerve twigs
enter the pulp of teeth via apical foramen present Excretion of Calcium
at root tips.
Calcium is excreted in feces as well as in urine. In feces, it is
• Incisive branch: This is one of the terminal branch of
excreted through exfoliated gastrointestinal tract cells and in
inferior alveolar nerve. This branch runs anteriorly
urine, it is excreted as calcium phosphate and calcium chloride.
in inferior alveolar canal to supply both canine and
incisors. Regulation of Calcium Level
• Mental nerve: This is also the terminal branch of
The regulation of blood calcium level took place through three
inferior alveolar nerve. It comes out from inferior
hormones.
alveolar nerve via mental foramen. Mental nerve
emerges through it and divide in three branches 1. Parathormone: It is secreted by parathyroid gland and its
which supply the skin over chin and skin as well as main function is to increase blood calcium level by mobilizing
mucus membrane of lower lip. calcium from bone. Parathormone maintains blood calcium
level by following actions, on bones, kidney and GIT:
Q.3. List branches of inferior alveolar nerve. a. By increasing reabsorption of calcium from bones.
(Sep 2017, 2 Marks) b. By decreasing excretion of calcium through kidneys.
Ans. Following is the listing of branches of inferior alveolar c. By increasing absorption of calcium from GIT.
nerve: 2. 1, 25-dihydroxycholecalciferol: It is a steroid hormone
• Mylohyoid nerve synthesized from vitamin D by means of hydroxylation
• Alveolar or dental branch reactions in liver and kidneys. The main action is to
• Incisive branch increase blood calcium level by increasing calcium
• Mental nerve absorption from small intestine. The main actions of 1,
25-dihydroxycholecalciferol are:
a. It increases the absorption of calcium from intestine.
2. CALCIUM AND It does this by increasing the formation of calcium-
PHOSPHORUS METABOLISM binding proteins in intestinal epithelial cells. These
proteins act as carrier proteins for facilitated diffusion
by which calcium ions are transported. The proteins
Q.1. Write short note on calcium metabolism.
remain in cells for several weeks after 1, 25-dihydroxy
(Sep 2017, 3 Marks) (Feb 2016, 3 Marks)
cholecalciferol has been removed from the body, thus
Ans. Following is the calcium metabolism: causing prolonged effect on calcium absorption.
b. It increases the synthesis of calcium-induced ATP in
Calcium Absorption
intestinal epithelium.
Calcium is absorbed in duodenum by energy dependent active c. It increases synthesis of alkaline phosphates in
process. Following are the factors which influences absorption: intestinal epithelium.
Oral Physiology 743
3. Calcitonin: It is secreted by parafollicular cells of thyroid. It ♦♦ Anterior part of tongue is raised and pressed against hard
is a calcium lowering hormone. It decreases blood calcium palate by intrinsic muscles of tongue.
level by decreasing reabsorption. It reduces blood calcium ♦♦ The movement takes place from anterior to posterior side.
level by acting on bone, kidney and intestine. This pushes food bolus to oropharynx.
a. On bones: It facilitates deposition of calcium on bones. ♦♦ Nasopharynx gets shut due to upward movement of soft
It suppresses the activity of osteoclasts which are palate and forward movement of posterior pharyngeal
responsible of calcium from bones. wall. This prevents regurgitation of food in nose.
b. On kidney: It increases excretion of calcium through
Pharyngeal Phase
urine by inhibiting reabsorption of calcium from renal
tubules. ♦♦ This phase is involuntary in character.
c. On intestine: It prevents the absorption of calcium ♦♦ During this the food is pushed from oropharynx to lower
from intestine into blood. part of laryngopharynx, i.e. hypopharynx.
♦♦ Constrictors of pharynx move upward and forward and
Other Hormones Involved in Calcium Metabolism propel bolus through pharynx by contractions.
♦♦ Growth hormone: It increases absorption of calcium from ♦♦ Simultaneously upper esophageal sphincter opens and
intestine and enhances protein synthesis in bone. bolus enter esophagus.
♦♦ Insulin: It is an anabolic hormone which favors bone ♦♦ During this phase laryngeal vestibule closes due to move-
formation. ment of epiglottis.
♦♦ Sex hormones: These hormones increases calcium ♦♦ Epiglottis move to horizontal position due to elevation of hyoid
absorption, decreases calcium excretion and enhances bone and larynx as well as contraction of thyrohyoid muscle.
bone mineralization. Estrogen has direct effect on bone ♦♦ Epiglottis directs the bolus in piriform sinuses around
resorption. opening of airway in esophagus.
♦♦ Prolactin: It increases calcitriol production and increases Esophageal Phase
calcium absorption during lactating period.
♦♦ Thyroid hormone: It increases in levels of thyroid As food reaches the upper end of esophagus its sphincter contracts
hormone which is accompanied by osteoporosis and and leads to peristaltic contractions which pass bolus to stomach.
hypercalcinuria. Lower esophageal sphincter allows bolus in stomach.
Q.2. Describe in brief pharyngeal phase of deglutition.
(June 2010, 5 Marks) (May 2014, 2 Marks)
3. DEGLUTITION Ans. Refer to Ans 1 of same chapter.
Q.3. Enumerate stages of deglutition. (Sep 2015, 2 Marks)
Q.1. Write a short note on deglutition. (Feb 2016, 3 Marks)
Ans. Following are the stages of deglutition:
(Mar 2007, 3 Marks) (Sep 2006, 5 Marks)
1. Preparatory phase
(Dec 2010, 5 Marks) (Feb 2014, 3 Marks)
2. Oral or buccal phase
Or
3. Pharyngeal phase
Write on phases of deglutition. (Feb 2013, 5 Marks) 4. Esophageal phase.
Or Q.4. Define deglutition. Enumerate phases of deglutition
Answer in brief stages of deglutition. and write the importance. (Sep 2018, 1 + 2 + 2 Marks)
(Aug 2016, 2 Marks) Ans. Deglutition is defined as the act of swallowing.
Or
Phases of Deglutition and Their Importance
Write short answer on deglutition. (May 2018, 3 Marks)
Ans. Deglutition is defined as the act of swallowing. Name of phase
of deglutition Importance of phase of deglutition
Mechanism of deglutition or swallowing of food occurs
in following phases: Preparatory In this phase, there is formation of food bolus
phase which is the preparatory event for swallowing
Preparatory Phase Oral or buccal In this phase, bolus is propelled from oral cavity
phase to pharynx
♦♦ In this phase formation of bolus occur.
Pharyngeal In this phase, bolus is transported from
♦♦ Bolus is a round or oval shaped mass of food formed in phase oropharynx into esophagus by a peristaltic
mouth after chewing. wave caused by contraction of pharyngeal
constrictor muscle
Oral or Buccal Phase
Esophageal In this phase, bolus moves down the length of
♦♦ As bolus takes its position on dorsum of tongue, oral phase esophagus to stomach. This is an involuntary
phase begins. phase. Esophagus helps to move food from
♦♦ This phase is voluntary in character. pharynx to stomach
744 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Or
4. MASTICATION Describe muscles of mastication.( June 2010, 10 Marks)
Ans. The muscles of mastication are:
Q.1. Write a short note on muscles of mastication. 1. Temporalis.
(Feb 2002, 6 Marks) (Feb/Mar 2004, 5 Marks) 2. Masseter.
(Feb 2006, 5 Marks) (Dec 2010, 5 Marks) 3. Lateral pterygoid.
(May 2017, 3 Marks) (July 2016, 3 Marks) 4. Medial pterygoid.
Muscles of mastication
S. No. Muscle Origin Insertion Nerve supply Action
1. Masseter a. Superficial layer: From anterior a. Superficial layer: Into lower Anterior division a. Elevates mandible to
2/3 of lower border of zygomatic part of lateral surface of of mandibular close the mouth to bite
arch adjoining zygomatic proc- ramus of mandible nerve b. It clenches the teeth
ess of maxilla b. Middle layer: Into middle
b. Middle layer: From anterior 2/3 part of ramus
of deep surface and posterior c. Deep layer: Into upper part
1/3 of lower border of zygomatic of ramus and coronoid
arch process of mandible
c. Deep layer: From deep surface
of zygomatic arch
2. Temporalis a. Temporal fossa a. Margins and deep surface Two deep a. Elevates mandible
b. Temporal fascia of coronoid process temporal b. Posterior fibers retract
b. Anterior border of branches from protruded mandible
protruded mandible anterior division of c. Helps in side to side
mandibular nerve grinding movement
3. Lateral a. Upper head: From intratemporal a. Pterygoid fovea on the A branch from a. Depresses mandible to
pterygoid surface and crest of greater anterior surface of neck of anterior division open mouth with supra-
wings of sphenoid mandible of mandibular hyoid muscle
b. Lower head: From lateral b. Anterior margin of nerve b. Lateral and medial ptery-
surface of lateral pterygoid plate articular disc and capsule goid protrude mandible
of temporomandibular c. Left lateral pterygoid and
joint right medial pterygoid turn
the chin to left side as a
part of grinding movement
4. Medial a. Superficial head: From Roughned area of Nerve to medial a. Elevates mandible
pterygoid tuberosity of maxilla and medial surface of angle pterygoid, branch b. Helps in protruding
adjoining bone and adjoining ramus of of the main trunk mandible
b. Deep head: From medial surface mandible below and behind of mandibular c. Right medial pterygoid with
of lateral pterygoid plate and mandibular foramen and nerve left lateral pterygoid turn
adjoining process of palatine bone mylohyoid groove the chin to left side
Q.2. Write a note on temporalis muscle. (Mar 2001, 5 Marks) 3. Lateral pterygoid.
Ans. Refer to Ans 1 of same chapter. 4. Medial pterygoid.
Q.3. Define occlusion. Write in detail about muscle of mas- Q.5. Define mastication and deglutition.
tication. (Dec 2012, 8 Marks) (Apr 2017, 2 Marks)
Ans. Occlusion is defined as the “static and dynamic contact Ans.
relationship between the occlusal of teeth during Mastication
function.” Glossary of prosthodontic terminology (GPT).
For muscles of mastication refer to Ans 1 of same chapter. It is defined as act of chewing food, and it consists of coordinated
function of various parts of oral cavity to prepare the food for
Q.4. Enumerate the muscles of mastication. swallowing and digestion.
(Jan 2018, 2 Marks) (Sep 2015, 2 Marks)
Ans. Following are the muscles of mastication: Deglutition
1. Temporalis. Deglutition is the process by which food is passed in stomach
2. Masseter from oral cavity or deglutition is defined as the act of swallowing.
Oral Physiology 745
Page 3, Q. 1: Nerves and vessels related to mandible Page 7, Q. 1: Venous drainage of scalp
Page 82, Q. 3: Ciliary ganglion and its roots Page 88, Q. 8: Anatomy of pharynx
Page 100, Q. 6: Paranasal air sinuses Page 110, Q. 1: Arterial supply of tongue
Plate 3
Page 146, Q. 1: Floor of the fourth ventricle Page 148, Q. 3: Roof of fourth ventricle
Plate 6
Page 153, Q. 8 and Page 156, Q. 11: Superolateral surface of cerebral hemisphere showing sulci and gyri
Page 166, Q. 1: Boundaries of cubital fossa Page 167, Q. 1: Contents of cubital fossa
Plate 8
A B A B
Page 172, Q. 4: Right bronchopulmonary segment Page 172, Q. 5: Left bronchopulmonary segment
A. Costal aspect, B. Medial surface A. Costal aspect, B. Medial surface
Page 188, Q. 1: External features and subdivisions of stomach Page 189, Q. 3: Structures forming stomach bed
Page 232, Q. 8: Zones of differentiation of cartilage cells Page 233, Q. 8: Formation of bone collar
Page 233, Q. 8: Formation of periosteal bud Page 233, Q. 8: Formation of medullary cavity
Page 244, Q. 1 and Q. 2: Cardiac muscle Page 245, Q. 3: Transverse section of muscle
Page 250, Q. 2 and Page 689 Q. 8: Filiform papillae Page 250, Q. 2 and Page 689 Q. 8: Fungiform papillae
Page 251, Q. 2 and Page 689, Q. 8: Circumvallate papillae Page 252, Q. 5: Submandibular gland
B
A
Page 254, Q. 1A: Liver Page 254, Q. 1B: Liver
Page 256, Q. 1: Pitiutary gland adenohypophysis (pars distalis) Page 256, Q. 1: Pars nervosa
Page 634, Q. 3: Bell stage Page 634, Q. 3 and Page 635, Q. 6: Advanced bell stage
Plate 21
Page 636, Q. 10: Early bell stage Page 640, Q. 2: Enamel rods showing keyhole pattern
Page 646, Q. 13: Incremental line of Retzius Page 651, Q. 1: Dentinal tubule
Page 651, Q. 1: Predentin Page 652, Q. 2 and Page 656, Q. 16: Secondary dentin
Plate 23
Page 654, Q. 8: Interglobular dentin Page 654, Q. 9 and Page 657, Q. 22: Dead tract
Page 657, Q. 22: Diffuse calcification Page 657, Q. 23: Transparent dentin
Plate 24
Page 662, Q. 7: True pulp stone Page 662, Q. 7: False pulp stone
A B
Page 666, Q. 3A: Cellular cementum Page 666, Q. 3B: Acellular cementum
Plate 25
Page 667, Q. 6: Butt junction Page 667, Q. 6: Cementum overlapping enamel junction
Page 668, Q. 6: Enamel overlapping cementum junction Page 668, Q. 6: Gap junction
Plate 26
Page 669, Q. 12: Differentiation of cementoblasts Page 669, Q. 12: Cementum deposition
Page 675, Q. 3: Apical group of fibers Page 675, Q. 3: Inter-radicular group of fibers
Plate 27
Page 683, Q. 6: Incremental lines of Salter Page 686, Q. 3: Anterolateral zone of hard palate
Plate 28
Page 687, Q. 3: Posterolateral zone of hard palate Page 690, Q. 11: Taste Bud