Golden Note Anatomy & Physiology

Deepak Dhakal
Cell, Tissue & Cavities
Human Cell
o Cell is the basic unit, structural unit, functional unit, smallest unit of the
body.
o Cell + Cell – Tissue + Tissue- Organs + Organs - System + System = A
complete body.
o Cell is the Building block of body.
o Robert Hook – 1665 AD – Founder of cell.
o Cytology – Study of cell.
o Histology – Study of tissue
o Smallest cell of body – Spermatozoa – 2.5 – 3.5 um- Male Gametes
o Largest Cell of the body – Ovum – 18 – 28 mm
o Longest cell – Neurons
o Human body – start from Zygote – 23 Pairs or 46 chromosome
o Zygote – Spermatozoa (23) + Ovum (23)= Zygote (46)
o 21st Pairs + 1 extra X chromosome = 47 – Trisomy 21 – Down Syndrome
– Most common chromosomal defect in fetus
o Delayed Pregnancy after 35 yrs / Hormonal Therapy / Radiation
Exposure high – Down Syndrome
o
Cell has – 3 Parts:-
1. Cell Membrane 2. Cytoplasm 3. Nucleus
1. Cell Membrane- Immunological Identify.
2. Cytoplasm:- It contains 3 parts :-

Liquid Parts- Cytoplasmic Matrix eg. Intra Cellular Fluid eg. Potassium
High K+
 Non Living Parts- Cytoplasmic Inclusions eg. Vacuole, Fat droplets
 Living Parts:- Cytoplasmic Organelles

1. Mitochondria
 Power House of the cell. It produce the energy i.e called ATP
 Adenosine Try phosphate (ATP) – Energy
 Carbondioxide Production – Co2
 Glucose Utilization
 Cellular Respiration complete
a. Ribosome:- Protein Factory of Cell
b. Lysosome:- Suicide bag of the cell
c. ER – Endoskeleton System of Cell.- 2 types – Transportation
Smooth ER
Rough ER
3. Nucleus: - Excepts RBC
o Largest Parts of cell. Important parts of cell
o Brain of cell. Control all the activities of cell.
o Nucleus contains 23 pairs chromosome.
o 22 – Pairs – Autosome or Somatic Chromosome – Mitosis
o 1 – Pairs – Sex Chromosome – Meosis CD
o Chromosome – DNA - Gene – Genetic Character Transfer – Parents to
Children’s
o Gene is the smallest or functional unit of chromosomes.
o DNA (Gene)- Genetic Characters transfer to the fetus.
o 23 Pairs – 22 Pairs – Mitosis Cell Division- Autosome
o 1 Pairs – Sex Chromosome – Meosis Cell Division
o Karyokinesis – Nucleus division process
o Cytokinesis – Cytoplasm division process
Q. Which blood cells Abscent nucleus?
a. RBC
b. WBC
c. Platelets
d. All of the above

Tissue – Group of cell¸

Cell + Cell = Tissue
o It is composed by the group of cell. That acts as a specific function.
o Histology – study of tissue
Types of tissue :- Human body contains 4 types tissue
1. Epithelial Tissue – Fluid Production
2. Connective Tissue – Connection to organs – Most abundant tissue
3. Muscular Tissue – Motor of Body – Movement
4. Nervous Tissue – Sensation

Epithelial Tissue or Epithelium

o It is outer covering layer of human body & Inner Lining of human body.
o 2 types:-
1. Simple Epithelial Tissue:- Inner Lining of body is made by
2. Compound Epithelial Tissue:- Outer Layer of Body made by

Q. Skin is the example of …

a. Epithelial Tissue - Compound ET- Stratified ET – Keratinized ET
b. Connective Tissue
c. Muscular Tissue
d. Nervous Tissue

Simple ET- Inner lining body- 4 types

1. Squamous ET – Pavement ET- Heart, Blood Vessels, Alveoli
2. Cuboidal ET – Kidney / Nephron
3. Ciliated ET- Respiratory Tract/ Vas Deference/ Fallopian Tube
4. Columnar ET- Digestive system

A. Compound ET – 2 types – Outer covering Layer of body.

Dry/ Hard/ Protection of body
1. Stratified ET – It is classified into two groups
o Keratinized- Skin, Nail, Hairs – Keratin Protein – Blood Supply Minimum
– TB Not Found
o Non Keratinized- Eye Conjunctiva, Oral Mucosa, Rectal Mucosa, Vaginal
Mucosa etc
2. Transitional ET – Urinary Bladder – Pear shaped cells

ET - two types
1. SET- Squamous/Cuboidal/Ciliated & Columnar
2. CET – Stratified / Transitional
Startified – Keratinized & Non Keratinized

Functions of Epithelial Tissue

1. Fluid Production
2. Absorptions
3. Gas Exchange
4. Elimination of waste Product
5. Protection by skin
6. Digestion functions

Connective Tissue
o This is the most abundant tissue in body. It takes the 25 – 30% weight
of body.
o It is hardest tissue or defensive tissue or protective tissue of the body.
It is classified into three groups:- Lose CT, Dense CT & Specialized CT
1. Connective tissue Proper
2. Fluid CT eg. Blood & Lymph – Specialized CT
3. Skeletal CT eg. Bone & Cartilage

Connective Tissue Proper

o It is classified into following groups:- Areolar, Adipose, Elastic, Fibrous &
Lymphatic Tissue.
o Adipose tissue is also called fatty tissue. They act as a thermo insulator
functions.
3.5kg- Hypothermia
2kg – Hypothermia
o Very Low Weight – 2kg Low
o Lymphatic Tissue:- Lymph Node/ Thymus Glands
Lymphocytes Development- B & T lymphocyte
T – Lymphocytes – CD4 Cells
HIV – CD4 count – T Lymphocytes
Retro Virus – Kills – T Lymphocytes
Cluster Differentiation 4 Cells
HIV – 150 CD4 – AIDS Diagnosis

Cavities
1. It is a hollow space of the body, where the vital organs are placed.
(शर रको खो ो भाग जाँहा मह वपुण अगह सुर ीत पमा बसेको हु छन।)
2. It can be classified into groups:-
A. Ventral Cavity:- Front aspect of human body ( Thoracic & Abdominal-
pelvic cavity)
B. Dorsal Cavity:- Posterior portion of body (Cranial & Vertebral Canal)

Q. Ventral Cavity includes all excepts…

a. Cranial & Spinal Cord – Dorsal Cavity – Posterior portion of body
b. Thoracic
c. Abdominal
d. Pelvic
There are mainly 4 cavity:- Cranial, Thoracic, Abdominal & Pelvic cavity.
o Cranial:- Brain – Bony Parts surrounds cavity
o Thoracic Cavity:- Heart & Lungs – Bony & Muscle framework – Cavity –
Cage like – पजंडा
o Abdominal Cavity:- Liver, Kidney, Spleen, Gall Bladder etc
o Pelvic Cavity:- Uterus, Ovaries etc
It is upper part of trunk.- Thoracic cavity
यो Trunk भ दा माथी रहे को हु छ? – Cranial Cavity
Abdominal- Pelvic Cavity can be divided into 9 Region:-
1. Right Hypochondriac Region eg. Liver & GB
2. Epigastric Region
3. Left Hypochondriac Region eg. Spleen
4. Right Lumbar Region
5. Umbilical Region
6. Left Lumbar Region
7. Right Iliac Fossa eg. Vermiform Appendix - RIF
8. Hypogastric Region
9. Left Iliac Fossa

Abdomino-Pelvic Cavity can be classified into 4 Quadrants:-

1. Right Upper Quadrants eg. Liver & GB – Right Hypochondriac region
2. Left Upper Quadrants eg. Spleen – Left Hypochondriac region
3. Right Lower Quadrants eg. Vermiform Appendix – Right Iliac Fossa
4. Left Lower Quadrants

Golden Questions of Cell, Tissue & Membranes

Q.1. Power house of the cell is called to the….

a. Nucleus
b. Cell Membrane
c. Mitochondria
d. Ribosome – Protein factory
Q.2. Cell Division is founded by…
a. Robert Hook
b. Walther Fleming
c. Karls Landsteiner
d. Galio Galileo
Q.3. Which is not the part of epithelial tissue…..
a. Squamous tissue
b. Fibrous Tissue
c. Columnar tissue
d. Keratinized tissue
Q.4. Nucleus is absent in the following cell of the body
a. Neurons Cell
b. Red blood Cells - Non Nucleated Cells
c. Nephron
d. Spermatozoa

Q.6. Blood is a example of…..

a. Epithelial tissue
b. Connective tissue - Fluid CT- Specialized CT
c. Muscular tissue
d. Nervous tissue

Q.7. Muscle contains……water.

a. 20 %
b. 40 %
c. 50 %
d. 75 %

Q.8. The abnormal fluid collection in the peritoneum is defined….

a. Pericardial Effusion
b. Abdominal Effusion
c. Pleural Effusion
d. Ascites
Q.9. The Vermiform Appendix is found in ……..
a. Right Iliac Fossa - RIF
b. Left Iliac Fossa
c. Right Hypochondriac Region
d. Abdominal Cavity

Q.10. The cavity that is made by muscle and bony framework and looks like
a cage, it is ….
a. Cranial cavity
b. Thoracic cavity
b. Abdominal Cavity
d. Pelvic cavity

Q.11. The term ‘Cell’ was given by……

a. Leeuwenhoek
b. Robert Hook
c. Fleming
d. Robert Brown
Q.12. Genes are located on the ………of cells
a. Chromosomes
b. Nucleolus
c. Nuclear membrane
d. Plasma membrane
Q.13. Ribosome are the center for….
a. Protein Synthesis
b. ATP Synthesis
c. Fat Synthesis
d. Respiration

Q.14. The Largest Serous Membrane of body is….

a. Pleura
b. Peritoneum
c. Pericardium
d. None of the above

Q.15. The Crossing Over is related with the…

a. Mitosis Cell Division
b. Meosis Cell Division
c. Both of above
d. None of Above
Q.16. The Skin¸Nail and Hair are the example of……….
a. Epithelial Tissue
b. Connective Tissue
c. Muscular Tissue
d. Nervous Tissue
Q.17. Sarcomere is the unit of …
a. Epithelial Tissue
b. Connective Tissue
c. Muscular Tissue
d. Nervous Tissue
Q.18. Histology is the study of……
a. Muscle
b. Tissue
c. Cell
d. None of the above
Q.19. All are the example connective tissue excepts…
a. Areolar tissue
b. Ciliated epithelium
c. Adipose Tissue
d. Lymphatic tissue

Q.20. Loss of taste is indicate by…

a. Auegusia- Loss of taste
b. Anosmia – Loss of smell
c. Aphonia - Loss of producing sound
d. Aphasia

Digestive System
 It is also called alimentary system. It is start from mouth to anus.
 It made a track between through mouth to anus i.e called Alimentary
Canal.
 The total length of alimentary tract is 8 – 10 meter.
 Digestive system is made by 4 layers:-
 Serosa or Adventitia
 Muscular Layer
 Submucosal Layer
 Mucosal Layer – Goblet cells – Columnar Epithelium
 The inner lining of digestive system is made by columnar epithelium.
The main functions of digestive system are
o Ingestion
o Propulsion- Push of food
o Digestion
o Assimilation – Mix
o Absorption
o Elimination.
Ingestion ……Digestion……Absorption……Elimination
Digestive organs are classified into two groups:-
1. The main Organs:-
o Mouth or Oral Cavity
o Pharynx
o Esophagus
o Stomach
o Small Intestine
o Large Intestine
o Rectum & Anus
2. The Accessory Organs:-
o Salivary Glands
o Pancrease
o Liver
o Gall Bladder & Its duct
Mouth or Oral Cavity
 It is also called buccal cavity or Oral Cavity.
 It contains tongue & teeth
Tongue
 It is a voluntary muscular organ. It is also called Lingue.
 It is attached by a bone i.e. called hyoid bone. This bone is also known
as a unsocial or horse shoe shaped bone.
 Blood supply is by lingual artery & nerve supply is by the lingual nerve.
 Tongue has 3 types taste buds (Papillae):-
o Valate- Bitter Taste – Largest size
o Filliform- Sour Taste – Smallest size
o Fungiform- Sweat & salty – Umami taste – Delicious food
 5 types taste can be identify by tongue:-
o Bitter – By Valate
o Sour – By Filliform
o Sweat
o Salty
o Umami taste – Delicious Food
 Most sensitive taste is bitter taste & sensitive taste buds is Valate taste
buds.
 Auegusia is the loss of taste sensation (Glossopharyngeal Nerve- 9 th
cranial
 Glossitis is the infections & inflammation of tongue.
 Coated tongue – Typhoid - White patch
 Breast feeding – tongue – upthus ulcer – Fungal infection – GV paint
Teeth
 It is tool of mastication.
 The Masseter, Pterigoid & Temporalis are the muscle for the
mastication.
 Hardest tissue is dentine & substance is enamel.
 Pulp Cavity is found in the teeth (Pulpits).
 Periodontitis is the infection & Inflammation of teeth.
 Teeth can be classified by two ways:-
o Eruption Based (Primary & Secondary Teeth)
Structure Based (Incisor, Canine, Pre-molar & Molar)
Difference between primary & secondary teeth:-
 SN Primary Teeth Secondary Teeth
1 Total 10 + 10 = 20 16 + 16 = 32
2. Start from 6M & Complete in Start at 6 Y & Complete in 24th Y
24M
3. Formula - 2102 Formula - 2123
4. 1st Teeth is – Lower Central Last teeth is – 3rd Molars
Incisors
5. Abscent – Pre Molars Present Pre Molars
7. Temporary teeth Permanent teeth
8. Deciduas or Milk teeth Adult teeth

Wishdom teeth – 3rd molars – 17 y – 24 yrs – Non Functional Teeth –

Mastication

Pharynx:-
 It is a common passage for both respiratory & digestive system.
 12 – 14 cm long.
 Extend from base of skull to C6.
 It has 3 Parts:- Nasopharynx, Oropharynx & Laryngopharynx.
 The Real Common Passage is Oropharynx.
 Eustachian tube connects middle ear to Nasopharynx. Its 4 cm long.
 Pharynx contains 2 types of tonsils:- Pharyngeal (Adenoids) & Palatine
tonsils
 Quincy is the pus collection in the tonsils.
Esophagus:-
 It is narrowest part (2cm-Diameter) of digestive system.
 Its length is about 25 cm.
 Inferior thyroid artery supply pure blood to the esophagus.
 It has three parts:-
o Cervical
o Thoracic
o Abdominal
 It is also called food pipe or gullet.
 Diaphragm pierces to diaphragm at the level of T10.
 GERD – Gastro Esophageal Reflux disease
 Hiatus Hernia – Junction between esophagus & stomach

Stomach:-
 It is widest part of digestive system. Dilatable organ
 Gastric Artery or Coealic Artery – Blood Supply.
 Its length is about 25 cm.
 It has 3 parts:-
o Fundus
o Body
o Pyloric Antrum
2 Valve – Sphincters – Cardiac & Pyloric sphincters
 It is ‘J’ shaped organ.
 The inner layer of stomach contains gastric glands.
 Gastric glands secrete a fluid i.e. called Gastric Juice.
 PH Value of gastric juice is 1.5 – 3.5. It is produced 1.2 -1.5 lit/Day.
 Gastric Glands contains following cell:-
Parietal Cell – Hcl & Intrinsic factors
 It produced hydrochloric acid (hcl) & intrinsic factors.
Peptic Cell – Chief Cell – Pepsinogen/ Rennin
 It is also called Chief cell. It secretes Pepsinogen & Rennin.
 Rennin helps to digestion of milk & milk products.
 Renin- Kidney – Blood Pressure
Mucus Cell eg. Produce Mucus
Intrinsic Factors – B12 Absorption – Lack of intrinsic – Low level of b12 in
blood – Iron/Folic acid/B12 – Hemoglobin – Anemia – Pernicious

Small Intestine
 It is longest part of digestive system. Its length is about 5.25 meter. 5
meter
 It is the place where complete digestion & absorption is takes place.
 It contains solitary glands.- wall of Small Intestine
 Celiac trunk & superior mesenteric artery supplied the pure blood to
the small intestine. – ANS (Nerve Supply)
 Enteritis is the infection & Inflammation of Small Intestine.
Salmonella – Ileum – Payers Patches – Fever – Typhoid – Enteric Fever
 Intestinal Glands are found in intestine. It secretes intestinal juice
(Succus Entericus).
 Intestinal Juice also known as a -----Succus Entericus
Composition of Intestinal Juice
o Amount – 1.8 – 2.5 lit /Day
o pH value - 7.5 – 8
o Water – 98.5 %
o Solid Part – 0.5 %
o Enzyme :- Peptidase¸ Saccharase¸ Maltase¸ Lactase¸ Sucrase and Lipase
etc
 It has three parts:- Duodenum, Jejunum & Ileum

Duodenum
o It is about 25 cm long.
o It is C- Shaped organs.
o It has Brunner’s Glands.
o Ampulla of Vater opens into duodenum. Sphincter of Oddi controls it.
o Iron/Vit C are absorbed from duodenum. Fat-soluble Vitamin
absorption.
Jejunum
o It is about 2 meter long.
o Most of the villi (Unit of Food Absorption) are present in jejunum.
o Carbohydrate & Protein are mostly absorbed through Villi.
o Fat & Fat soluble vitamins are absorbed through lacteals (Lymphatic
Capillary).
o Most Important unit for food absorption …Villi
Ileum
o It is about 3 meter long.
o It is longest part of small intestine.
o It contains 20 – 30 lymphatic parts i.e. called Payer’s Patches.
o Ileum is most commonly affected during typhoid fever (Payer’s
Patches).- Ileum – Enteric Fever – Intestinal perforation – Complication

Large Intestine – Colon – Colitis

 It is about 1.5 meter long.
 Colitis is the infection & inflammation of Large Intestine.
 It contains Bacterial Flora. – Normal Flora ….Which helps to produces
Biotin (B), Vitamin K2 (Menoquanone) & Folic Acid. – Large Intestine
 These normal flora are Escherichia coli¸ Helicobacter Pylori¸
Lactobacillus etc
 The main functions of large Intestine is the absorption of fluid &
electrolyte
 Largest amount of fluid is absorbed through …..Small Intestine
20% - Stomach,
50 -60% water from SI,
20 – 30% L Intestine
 The main function of Large intestine is…
A. Absorption of food B. Absorption of water & electrolyte 60-70%
1lit Water in ORS – Mix
Water – Absorption – From SI
Electrolyte – Absorption – From Large Intestine
 Greater Omentum is also called Policeman of abdomen.

Large Intestine has six parts:-

 Caecum – 6.5 cm long / 7.5 cm –wide / Appendix – 13 cm – Vestigial
Organs
 Ascending colon – 15 cm long
 Transverse Colon – 45 cm lone – Longest part
 Descending colon – 30 cm long
 Sigmoid Colon – 40 cm long – Pelvic colon – S shaped colon- Stool
Storage
 Rectum and Anus – 13 cm & 3.8 cm Long
 Proctitis is the infection & inflammation of Rectum.
 Caecum connects to the Vermiform Appendix (13cm). This is also
known as a Vestigial Organs.

Accessory Organs:- Salivary Glands/Liver/Pancrease/GB

Salivary Glands
 They are accessory organ of digestive system. It is 3 pairs. They all have
duct so they are called exocrine glands.
1. Parotid Glands:- It is open at 2nd molar teeth with Stenson’s duct. ……SP
Stenson’s – Parotid
2. Sub Mandibular Glands:- It is open with Wharton’s Duct (70% Saliva
Production)
3. Sub Lingual Glands
o Parotitis is the infection & inflammation of parotid glands. It is mostly
due to mumps virus – salivary – Parotid glands
o Sialadenitis:-Infection & Inflammation of salivary glands.
o Sialalithiosis:- Stone in the salivary glands & duct.
o Mumps - Parotitis.
 They Produces saliva:- 0.5 – 1.5 lit/day.
Compositions of Saliva:- IgA, Blood Clotting factors, Amylase (Ptyalin) –
Mouth Low chance
 Water - 99 %
 pH Value :- 6.5 – 7.5 (6.7)
 Protein and Salts – 1%
 Mucus – Makes Food Lubricants
 Enzymes:-
 Ptyalin (Amylase):- Start the digestion of Carbohydrate form mouth.
 Fat digestions start from …..Duodenum or Small Intestine

o Immunoglobulin:- IgA – Body Fluid – Infection Prevention

o Blood Clotting Factors
Q. Stenson’s duct is found in…
a. Liver
b. Pancrease
c. Gall Bladder
d. Salivary Glands – SP – Parotid glands

Pancreas
 It is mixed glands of human body.
 It is about 12 – 15 cm long.
 It has 4 parts:- Head, Neck, Body & Tail.
 Head of Pancrease is covered by duodenum. So Pancrease is also
known as Romance of abdomen – Pancrease

Structure of Pancrease
 It has 2 types of cell:- Exocrine Cell & Endocrine Cell.
 Exocrine Cell:- 98% of total Parts – Pancreatic Juice
 Endocrine Cell:- 2% of total parts (Islets of Langerhans)
 Exocrine Cell secretes the pancreatic juice.
Composition of pancreatic juice:-
o Daily Production:- 1 – 2 lit/days
o Ph. Value :- Average 8
o It has:- Water, Cations, Anions, Digestive Enzyme (Amylase, Trypsin &
Chymotrypsin, Lipase)
Endocrine Cell (Islets of Langerhans) contains-
 Beta Cell:- Insulin Production (Decrease the blood Glucose Level)
 Alpha Cell:- Glucagon Production (Increase the blood glucose Level)
 Delta Cell:- Somatostatin Production ( Balance the Insulin & Glucagon
Action)
Insulin – Reduce blood Glucose level
Glucagon – Increase blood glucose level
Somatostatin – Balance

Q. Serum Amylase test is done in the case of…

a. Ac. Hepatitis
b. Ac. Intestinal Obstruction
c. Ac. Pancreatitis
d. Ac Appendicitis

Liver – Hepatic
 Hepatic – also Called
 Metabolic center of the body – Heat Productions
 Largest Glands of the human body – Largest Visceral Organs
 It is the hard working organ of body.
 Fastest Regenerate Organs
 Least – Low capacity of regeneration- Brain Cells
 It has 4 lobe:-
 Right Lobe
 Left Lobe
  Caudate
 Quadrate
 Physiologically – 2 Lobe Right – 90% & Left- 10%
 Anatomically or Structurally – 4 Lobe
 Weight - 1.2 – 2.2 kg (1500gm).
 Smallest unit - Acinus.
 Smallest cell - Hepatocytes.
 Fastest regenerative organ - Liver
 Macrophage - Kuffer’s Cell – Liver protective Cells
 Fetus Life – Blood cell Production – Liver
Q. The blood cells are mainly produced in fetus life is…
a. Liver b. spleen c. Bone Marrow d. Lungs
1st Choice – Bone Marrow
Hemolysis – Spleen

Functions of Liver:-
 Bile formation (500 – 1000 ml/Day)
 Convert indirect bilirubine – Fat soluble into direct bilirubine – water
RBC – Rupture – Bilirubine – Fat Soluble (Unconjugated)- Indirect
Bilirubine…………..Water or Conjugated or Direct Bilirubine
Stool …..70%... Sterocobilinogen
Urine ….15 – 20% …….Urobilinogen (Amber Colour)
 Detoxification of poison.
 Metabolic of Drugs¸ alcohol and Food etc
 Storage of Glycogen, Vitamin & Minerals etc
 Plasma protein Production eg Albumin, Globulins, Fibrinogens etc
 Blood clotting factors formation eg. Liver immature – Hemolysis – Vit K
injection
 Heat production
 Vitamin storage eg. Vit A (6-9 months), B12 (3-5 Yrs) , Vit K
 Formation of non-essential amino acids

Gall Bladder (GB)

 It is a pear shaped organ. It is about 7 – 10 cm long.
 Cystic artery – Pure Blood supply
 It has 3 parts:- Fundus , Body & Neck.
 It can store 30 – 60 ml bile.
 The infection & inflammation – Cholecystitis Cystitis – U. Bladder
 The stone formation - Cholelithiasis.
 The remove -Cholecystectomy.
 Cholingocarcinoma – Cancer of gall bladder
Oma – Cancer
Functions of GB & Bile:- 50 yrs Storage
o Its main function is storage of bile.
o GB helps to concentrate to bile.
o Bile acts as carriers organs of salmonella group – Typhoid – Marry Typhi
– Classical example of carriers – 1300 Transmit
o Helps to store Vitamin A, D, E, & K.
o Bile helps give the colour of stool (Bile Pigment – Bilirubine)
o Bile Pigment – Bilirubine
o Bile gives the smell of stool
o Bile helps to the digestion of fatty food.
Stool smell – Bile
Stool Colour –Bilirubine
Q. The type of jaundice with itching…
a. Hemolytic – Excessive RBC Rupture eg. Malaria
 b. Hepatocellular – Liver Infection/ alcohol
c. Obstructive – Stone / Tumor
Q. Most common type jaundice …..Hepatocellular Jaundice – alcohol

Digestion of Food
 The process of digestion is start from mouth & ends at small intestine.
 Digestion Process is complete by two ways:-
1. Mechanical Digestion:- Digestion By Teeth & Intestinal Movement
(Peristalsis Movement).
2. Chemical Digestion:- Digestion By the helps of Enzyme of digestive tract.

Digestion of Carbohydrate:-
 Start :- Mouth by the Help of Salivary Amylase
 Ends :- Small Intestine
 Main Enzyme:- Salivary Amylase & Pancreatic Amylase , Saccharase
 Smallest Unit:- Monosaccharide or Glucose
 Main Source of Carbohydrate is Starch – 4 kcal/gm energy अ न
 Indigestible Carbohydrate is Cellulose or Fiber Diet (Prevent
Constipation) 2 kcal/gm
Anemia – Gm
Bilirubin – mg
Digestion of Protein:-
 Start :- Stomach by the help of Hcl and Pepsin
 Ends :- Small Intestine
 Main Enzyme:- Pepsin¸ Trypsin, Chymotrypsin & Peptidase.
 Smallest unit:- Amino acids 4kcal/gm – Energy
 Main source of Protein – Pulses गेढागुडी
Digestion of Fats:-
 Start :- Small Intestine
 Ends :- Small Intestine
 Main Enzyme:- Lipase & Bile salts
 Smallest Unit:- Glycerol or Fatty acids
 9kcal/gm - Energy

Q. Start from….Mouth /Stomach/Intestine

Q. Main enzyme ….amylase/Pepsi/Lipase
Q. Smallest Unit…Monosaccharides/Glucose, Amino acids & Fatty acids
or Glycerol

Golden Questions of Digestive System

Q.1. Which Vitamin is absorbed through ileum….
a. Iron
b. Vitamin C
c. Vitamin A
d. Vitamin B12
Q.2. Most of the fat-soluble vitamins are absorbed from….
a. Duodenum
b. Jejunum
c. Ileum
d. None of the above

Q.3. Pepsinogen is converting into Pepsin by the help of………

a. Saliva
b. Gastric Juice
c. Hydrochloric Acid
d. Bile

Q.4. The Shape of human teeth is related with the…

a. Hetrodont
b. Thecodont
c. Diphyodont
d. All of the above

Q.5. The digestion of milk and milk product by the help of…
a. Amylase Enzyme
b. Trypsin Enzyme
c. Rennins Enzyme
d. Lipase Enzyme

Q.6. Which statement of function of liver is not related…………

a. Bile Production
b. Storage of Bile
c. Detoxification
d. Storage of Vitamin & Minerals

Q.7. The Mixed Gland of Body is ……

a. Pharynx
b. Liver
c. Adrenal Glands
d. Pancreases
Q.8. The parts of large intestine connects to the small intestine is…..
a. Caecum
b. Ascending Colon
c. Transverse Colon
d. Sigmoid Colon
Q.9. Cholelithiasis indicates the…
a. Stone in Urinary Bladder
b. Stone in Kidney
c. Stone in Gall Bladder
d. Stone in Ureter
Q.10. The GERD Stand for….
a. Gastro Emesis Reflux Disease
b. Gastro Esophageal Reflux Disease
c. Gas Esophageal reflux Disease
d. None of the above

Q.11. Mumps Virus commonly affects to the….

a. Salivary Glands
b. Liver
c. Pancreas
d. Lacrimal Gland
Q.12. The Digestion of Fatty Foods from the……….
a. Mouth
b. Stomach
c. Small Intestine – Duodenum
d. Large Intestine

Q.13. Tongue can identify ……taste.

a. 3 Types
b. 4 Types
c. 5 Types
d. 10 Types
Q.14. Proctitis is the infection of ……
a. Small Intestine
b. Large Intestine
c. Rectum
d. Anus
Q.15. Which one is related with colour of stool….
a. Bile - Smells
b. Bile Pigment – Bilirubine
c. Intestinal Juice
d. Hydrochloric Acid
Q.16. Whict statement is in correct order form…..
a. Duodenum¸ Ileum & Jejunum
b. Jejunum, Ileum & Duodenum
c. Ileum, Jejunum & Duodenum
d. Duodenum, Jejunum & Ileum
Q.17. The Smallest form of Protein is..
a. Monosaccharide
b. Glucose
c. Amino acid
d. Fatty Acids

Q.18. Police man of Abdomen is also called to the…..

a. Omentum
b. Pancrease – Romance of abdomen
c. Liver
d. Vermiform Appendix
Q.19. Solitary Glands are found in the wall of…..
a. Lungs
b. Kidney
c. Intestine
d. Brain
Q.20. Ampulla of Vater is opens at……..
a. Stomach
b. Duodenum
c. Jejunum
d. Caecum

Golden Note of Respiratory System

 Intake of O2 – Inspiration – Energy Loss – Active Process
 Output of CO2- Expiration – No Energy Loss – Passive Process
 Pause – 3 Steps – Cycle Cycle Complete
Inspiration (2s) ……..Expiration (3s)……Pause (3s) = 8 Second
Cardiac Cycle – 0.8 Second
 The mechanism of respiration is complete in 3 phase:- Inspiration,
Expiration & Pause
 Respiratory Cycle
Inspiration:-
Diaphragm …Contract ….Goes Downs -----तल जा छ
Diaphragm ….Downwards
Ribs & Intercostal Muscle ….Upwards & Outwards = Inspiration

Ribs/Intercostal Muscle….Outwards & Upwards बा हर र माथी

 Q. The which statement is not correct about inspiration….
a. Diaphragm goes down
b. Ribs Are goes outwards
c. Ribs are goes downwards
d. Ribs are goes upwards
 Acid – Base Balance is another main function of Respiratory System.
 The Organs of Respiratory System:-
Nose, Pharynx, Larynx, Trachea, Bronchi & Bronchioles, Lungs.
 The muscle of Respiratory System:-
Diaphragm, Intercostal muscle, Scalene & Sternomastoid muscle= Reserve
Muscle.
Diaphragm – 70% Role For Respiration
20 – 30% - Intercostal Muscle = Major Muscle for Respiration

Nose to Larynx – URT

Trachea to Lungs – LRT

Q. The Trachitis is the infection of …

a. URT
b. LRT

12 – 16 /minute – RR
Co2 high blood – blood Ph value – Acidic – Respiratory Acidosis
Co2 level low in blood – Alkaline – Respiratory Alkalosis

Q. In COPD ….
a. Hypercarbia……Blood Ph convert into acidic ……..Respiratory Acidosis
…..Blood PH …Low or High
b. Hypocarbia

Right Heart Failure – Due to the COPD ……..Cor Pulmonale

Nose
 Nose Supplied by 1st Cranial Nerve i.e. called Olfactory – Smell
 Loss of smelling - Anosmia.
 It contains Little’s area or Keisselbach’s plexus – Most Common site
Epistaxis.
Pharynx
 It is common passage. 12 – 14 cm. 3 parts

Larynx – Voice Box – 4.5 cm

 It is also called voice box.
 It has 2 vocal cords. Its length is about 4.5 cm.
 Hoarseness of Voice – वर धो ो हुनु – Laryngitis
It has 9 Irregular cartilage:- 6 Types … 3 Paird & 3 Unpaired
 Epiglottis-1- Leaf Shaped -
 Thyroid-1- Adam’s Apple – Largest size घ ट
 Cricoid-1- Ring Shaped- Cricoid Pressure
 Corniculate-2
 Cuineform-2
 Arytenoid-2 = 9 cartilage.
Q. How Many no of cartilage……….9
Q. How many types of …6
Q. Adam’s Apple is also called….
a. Larynx
b. Thyroid Cartilage
c. Cricoid Cartilage
d. Cuneiform
Epiglottis, Thyroid, Cricoid – Unpairs
Corniculate, Cuneiform & Arytenoid - Paired
 Laryngitis is the major cause of Hoarseness of voice.
Trachea
 Also called - Windpipe. Its length is about 10 -12 cm.
 It has 16 – 20 C- shaped cartilage.
 In T5 Level Trachea divided into 2 branches:- Right Bronchi & Left
Bronchi.
Bronchi and Bronchioles
 Trachea in T5 Level (Carina) divided into 2 branches i.e. called bronchi.
 Right Bronchi again divided into 3 Branches & Left Bronchi is divided
into 2 branches.
 Difference between right & left bronchi
S.N Right Bronchi Left Bronchi
1 It has 3 branches (Bronchioles) It has 2 Branches
(Bronchioles)
2 Its length is about 2.5 cm Its length is about 5 cm
3 It is short but wide It is long but narrow
4 Chance of Foreign Body entry is Low Chance
5 More chance of infection Low chance of infection

Lungs
 Major Organ of Respiratory System.
 Alveoli are the smallest & functional unit of lungs.
 Sputum is produced by Goblet Cell in the lining of respiratory organs.
 Sputum is moved by cilia i.e. found in the lining of respiratory organs.-
Ciliated epithelium
 Bronchial artery supplies the pure blood to the lungs.
 The space between two lungs is called Mediastinum, where the heart is
placed safely.
 Right Lungs is about 650 gm & Left Lungs is about 600 gm.
Q. Left lungs is small due to the…
Ans:- Due to the compression of heart
 Surfactant factor is found in the lungs of new born. This helps to
stimulate the reparation process in new born.

A. Dry & stimulate….. Abnormal/asphyxia/Not Good Cry

B. Dry & Wrap ……Normal Cry/Score/Colour

C. Surfactant therapy is used for the stimulation of respiratory system in

New Born baby.

Phototherapy- To Jaundice Management ---Blue

Surfactant Therapy- Gasping New born stimulate
NICU – Surfactant Therapy- To Established the Respiration

D. Right Lungs has 3 lobes (Oblique & Horizontal Fissure) & Left Lungs
(Oblique Fissure) has 2 Lobes.

Inspiration …Diaphragm…Down
Intercostal …Out & Upwards
E. Lungs are covered by pleura. It has 2 layers:-
1. Visceral ….Inner
2. Parietal Layer – Outer
APGAR Score…..
1st & 5 minutes …….Golden Minutes of Baby
1st minute of life is golden minute for new born baby. 1 & 5minutes
Extra Supports need ….Decide within one minute of births
3. Nitrogen is also called pain killer gas.
4. The process of exchange of gas is by diffusion process. It means the
gases transfer from higher concentration to lower concentration.
Q. What is diffusion process……
Active Process
Passive Process
 Transportation of Gas:-

1. Oxygen Transportation…..RBC (HB)

Alveoli……O2 + Hemoglobin ….Oxyhemoglobin 98.5% 02…….Carry
to Cell (Mitochondria)
Q. The Oxygen carry is major by…..
a. RBC (Hemoglobin) b. WBC c. Platelets d.
Plasma
2. Carbondioxied Transportation
Cell (Mitochondria) Co2…By Bicarbonate Ion (70%)
……to alveoli
Q. The Co2 is mainly transferred by…
a. Plasma solution
b. Blood Cells
 c. Bicarbonate Ion
d. Plasma proteins

Q. The more binding capacity of hemoglobin with…

a. Oxygen
b. Carbondioxied
c. Nitrogen
d. Carbonmonoxide - CO

Carbonmonoxide Poisoning ……..100% High Flow Oxygen Supply

 Oxygen Transportation:- By Hemoglobin (98.5%) - RBC

 Carbondioxied transportation:- By Bicarbonate Ion (70%)
 RBC has more binding capacity with Carbonmonoxide than oxygen.
 Carbonmonoxide poisoning can occurs during Heater & Hot Flame
inside the close room = 100% oxygen with high flow management
 Chronic Bronchitis :- एक बषमा ३ म हना भ दा ब ढ यवस वासमा¸खोक
खकार र लगातार २ बष भएमा = Chronic Bronchitis + Emphysema = COPD
(Smoking)
Chronic Cough:- 4 wks in child & 8 wks in adult

Lungs Volume & Capacity – Spirometer

 Tidal Volume (TV)= Normal Rest …Inspiration or Expiration Air
500 ml….7 ml/kg
 Inspiratory Reserve Volume (IRV)….Forceful Inspiration….3000 ml
 Expiratory Reserve Volume (ERV)… Forceful Expiration ….1100 ml
 Vital Capacity मु य मता ….TV+IRV+ERV = VC= 500+3000+1100=
4600 ml
 ERV प छ बचेको हावाको मा ा …Residual Volume (RV)…1200 ml
 Total Lungs capacity (TLC)……VC + RV = 4600 + 1200 = 5800 ml
6 – 8 lit/minute

 The lungs volume & capacity is measured by Spirometer. The Normal

capacity of lungs are as follows:-
 Tidal Volume (TV):- This is the normal/ rest capacity of lungs during
inspiration & expiration. It is about 500 ml. आरम गरे को अव था लने वा
फा ने
 Inspiratory Reserve Volume (IRV):- Capacity of lungs that is taken by air
by forceful inspiration. This is about 3000 ml.
अ या धक बल गरे र लन स ने हावाको मा ा ३००० ml

 Expiratory Reserve Volume (ERV):- Capacity of lungs that is forceful

expiration. It is about 1100 ml.
अ या धक बल गरे र फा न स ने हावाको मा ा ११०० ml

 Residual Volume (RV):- It is remaining air volume after forceful

expiration (ERV). It is about 1200 ml.

 Vital Capacity (VC):- This is main capacity of lungs. It is the sum of TV,
IRV & ERV. It is about 4600 ml.
 Total Lungs Capacity (TLC):- It is sum of total of Vital capacity & Residual
Volume. It is about 5800 ml
 Anatomical Dead Space:- This is the air volume, which is not participate
any process of lungs. It is about 150 ml.

 Minet Ventilation:- This is the air volume that is taken by the lungs in
one minute. It is about 6 liter/ minute.
Air Volume taken by lungs in one minutes
12 X 500 ml = 6000 ml = 6lit /minutes
Unconscious – 6 – 8lit/minutes
12 – 15 minute
12 X 500 ml = 6000 ml = 6lit/minutes
12 – 20 normal
12 – 16 normal
12 – 15 normal

Types Of Respiration
.
 External or Pulmonary Respiration:- The exchange of gas between

Lungs Alveoli & Blood Capillaries.

O2 RBC/Hemoglobin
Lungs Alveoli Blood Capillaries (Blood)
CO2 Bicarbonate ion
 Internal or Cellular Respiration:- This is gas exchange between blood
Capillaries & Cell (Mitochondria).
RBC O 2
Blood Capillaries Cells (Mitochondria)
Q. External Respiration is called….…
a. Blood & Cell – Internal Respiration
b. Lungs & Cell
c. Lungs & Blood
d. Cell & Cell exchange
Types of respiration – 2 types – External & Internal Respiration
Mechanism of respiration – 3 phases complete
Respiratory Cycle complete in = 8 seconds
Cardiac Cycle – 0.8 seconds

MCQs of Respiratory System

Q.1. Normal Respiration Rate in human adult is about…..
a. 10 – 12 / minet
b. 12 – 16 /minet
c. 15- 22 /minet
d. 16 – 25 /minet
Q.2. Internal Respiration is complete in the ….
a. Cell Membrane
b. Ribosome
c. Mitochondria
d. Nucleus
Q.3. How many cartilages are found in larynx…
a. 6
b. 9
c. 12 – 14
d. 16 – 20
Q.4. The Major Respiratory Muscle for the respiration Process is…..
a. Diaphragm
b. Intercostal Muscle
c. Scalene
d. Sternomastoid

Q.5. The Mechanism of Respiration Complete in ….

a. 1 Phase
b. 2 Phases
c. 3 Phase
d. 4 Phases
Q.6. The Respiratory Cycle is complete in…
a. 1 Secnd
b. 3 Send
c. 0.8 Secnd
d. 8 Secnd
Q.7. The Golden Minet of Baby is defined to the…..
a. 1st Minet of Life
b. 1st 5 Minet of Life
c. 1st 15 Minet of Life
d. 1st 30 Minet of Life
Q.8. How many lobes are found in the right lungs…
a. 1 Lobes
b. 2 Lobes
c. 3 Lobes
d. 4 Lobes
Q.9. The respiration in the normal rest condition is defined by…
a. Tidal Volume
b. Vital Capacity
c. Total Lungs Capacity
d. Minet Ventilation
Q.10. Adam’s Apple is called to the…
a. Epiglottis
b. Thyroid Cartilage
c. Cricoid Cartilage
d. Arytenoids Cartilage
Q.11. Cricoid Pressure is used for the prevention of…..
a. Vomiting
b. Coughing
c. Sneezing
d. Aspiration
Q.12. Wind Pipe is also known as…..
a. Larynx
b. Pharynx
c. Trachea
d. Bronchi and Bronchioles
Q.13. The term Chronic Bronchitis is referred to the…..
a. Cough more than 14 days
b. Cough more than 1 month
c. Cough more than 3 months for a Year for Consecutive 2 years
d. None of the above
Q.14. The Trachea divided into bronchi into the level of……
a. T1 Level
b. T3 Level
c. T4 Level
d. T5 Level
Q.15. The Respiratory Center is found in the…..
a. Cerebrum
b. Cerebellum
c. Pons Varolii
d. Medulla Oblongata
Q.16. APGAR Scoring is taken at the….
a. 1 & 5 minet
b. 1 & 10 minet
c. 5 & 10 minet
d. 10 & 30 minet
Q.17. The Room Air contains the level of Oxygen is….
a. 16 % Oxygen
b. 21 % Oxygen
c. 26 % Oxygen
d. 100 % Oxygen

Q.18. The Pain Killer Gas is also called to the….

a. Oxygen
b. Carbondioxied
c. Nitrogen
d. Carbonmonoxide
Q.19.The instrument that is used for the assessment of Lungs Volume &
Capacity…..
a. Audiometer
b. Barometer
c. Thermometer
d. Spirometer
Q.20. The Air Collection in the Pleural Cavity is defined as a….
a. Pleural Effusion
b. Pneumothorax
c. Haemothorax
d. Pyothorax

Q. The mechanism of respiration is complete in …

a. Inspiration
b. Expiration
c. Pause
d. Al of the above
Q. The process of exchange of gas in lungs by…
a. Perfusion
b. Osmosis
c. Diffusion
d. Oncotic
Q. Hoarseness of voice is major due to the infection of…
a. Tonsillitis
b. Pharyngitis
c. Laryngitis
d. Trachitis

URTI – Nose to Larynx infection

LRTI- Trachea to lungs infection
Chronic Diarrhea or Persistent- > 14 days
Chronic Ear Infection - > 14 days
Chronic Fever - > 3 wks long Fever
Chronic Cough – 4 wks long in child & 8 wks long in adult
Chronic Bronchitis – 3 months in a year for consecutive 2 yrs

Skeletal System
 Bone/Cartilage/Joints/Tendon/ Ligament
 Bone – Strongest tissue/Connective tissue
 20% - Water
 Calcium 98% deposit in Bone…& Phosphorous deposit
 3 types of Cells is required for the bone development….
1. Osteoblast – Bone Forming Cells हाड बनाउने कोष
2. Osteoclast- Shape / Safety – Macrophage of Bone
3. Osteocytes:- Mature Cell of bone
 Bone are made from….
1. Cartilage – Cartilaginous Bone
2. Membrane – Membranous Bone
3. Tendon – Tendoneous Bone
 Classification of Bone:-
1. Axial Skeleton – 80 – Skull, Vertebrae, Ribs & Sternum
2. Appendicular Skeleton- 126…. Upper Limbs, Lower Limbs,
Scapula & Clavicle, Pelvic Bone
 Types of Bone:- 3 ways:-
1. Structure Based:- Spongy & Compact
2. Origin Based:- Cartilaginous/Membranous/Tendoneous
3. Size Based:- Long/Short/Irregular/Flat/Sesamoid
 Q. Types of bone is…….. a. 2 b. 3 c. 4 d. 5

Spongy Bone ायु हाड

 Honeycomb Structure Bone
 Cancellous Bone – Spongy- Trabeculae
 Red Bone Marrow – Blood Cells – Pluripotent Stem cells
 Epiphysis
Compact Bone ा र हत हाड
 Yellow Bone Marrow
 Dense Bone कडा
 Haversian canal – Yellow Bone Marrow
 Diaphysis
 Metaphysis:- Parts between Epiphysis & Diaphysis
 The Blood Supply to the bone………Nutrient Artery

Size Based Bone

1. Long Bone:- Tibia/Febula/Femur/Radius/Ulna/ Phalanges
/Clavicle
2. Flat Bone:-
Ribs Bone / Sternum/ Cranium/Pelvic/Scapula
3. Short Bone:-
Carpals/Metacarpals/Tarsal/Metatarsal
4. Irregular Bone:-
Facial Bone/Vertebrae
5. Sesamoid Bone:- Patella/Pisiform

Axial Skeleton
80 Bones in axial
Skulls – 22 + Vertebrae 33 + Ribs – 24 + Sternum 1 = 80
Q. Axial skeleton is not included …….
a. Upper Limbs b. Vertebrae c. Skull d. Sternum
Skull Bone
22 Bone – 14 Facial & 8 Cranial Bone
Cranial Bone:-
Frontal - 1
Occipital – 1
Temporal – 2
Parietal – 2
Ethmoidal – 1
Sphenoidal – 1 = Bat Wings or Butterfly shaped Bone
Sinus Bone:- Frontal/Maxillary/Ethmoidal/Sphenoidal
Frontal sinus….Abscent in Newborns
Largest…Maxillary

Sutures
Fibrous Tissue …Connects Cranial Bone
 Sutures Abscent ….Fontanels
1. Anterior Fontanels – 12 – 18 Months
2. Posterior Fontanels 2 – 3months
Types of sutures:-
1. Coronal Sutures:- Frontal & Parietal Connects
2. Sagittal Sutures:- Connects to Parietal Bone
3. Lamboidal sutures:- Parietal & Occipital Connects
4. Metopic Sutures:- 2 Frontal Bone
5. Frontal sutures:- Anterior Fontanels
Sagittal …2 Parietal
Coronal…F & P
Lamboidal….P & O

Facial Bone – 14
 They All Are Irregular Bone.
 Zygomatic/Maxilla/Nasal Bone/Palatine/Mandible/Vomer

Largest Facial Bone….Mandible

Only One movable bone of face…Mandible
U shaped Facial Bone ….Mandible
2nd Bone of life ………Mandible
Only One movable joints face… Temporomandibular Joints (TMJ)
L Shaped Bone….Palatine

Skull….
1. Total Bone ….22
2. Cranium – 8 & Facial 14 = 22 Bone
3. Movable Joints …..TMJ
4. Sinus Cavity …4
5. Sutures …..Fibrous Tissue …Connects to skull bone
6. Fontanels….2 major…Anterior …12 – 18 m…..
 7. Sagittal sutures ……..2 parietal bone
8. Lamboidal Sutures….Parietal & Occipital
9. Coronal Sutures…Frontal & parietal

Q. All are the facial bone excepts….

a. Ethmoidal/Sphenoidal/Frontal/Occipital/ Temporal/Parietal
b. Mandible
c. Palatine
d. Vomer
Vertebrae
1. Irregular Bone.
2. A Canal …Vertebral Canal…Contains Spinal Cords
3. Spinal Cords Extend…..Base of skull to L1 …....Adult
4. Cartilaginous Joints …. Slightly Movable Joints
5. Lumber Puncture…Spinal Anesthesia…..Intrathecal Route…..Most
Common site……L3 – L4 (CSF)
6. 33 Bone (26)….5 Parts … Spinal Nerves 31 Pairs
A. Cervical – 7 (8P)
B. Thoracic – 12 (12P)
C. Lumbar – 5 (5P)
D. Sacral – 5 (5P)
E. Coccyx – 4 (1P)
7. Cervical/Thoracic/Lumbar – 7+12+5 = 24 ….Movable
8. Sacral….5….Immovable…..1
9. Coccyx ….4…..immovable……1/ 26 Bone
Q. Total Movable bone in Vertebrae…
a. 5 b. 9 c. 24 d. 33
10. Largest Vertebrae… Lumbar
11. Body Balance ….Help …Lumbar…Lift…Body Movement
12. C1….Atlas….Yes Bone…Head Joints Formation….Pivot Joints
13. C2 …Axis
14. C7….Cervical Prominence
 Ribs
 Ribs are all flat bone.
 Origin….Cartilage….
 12 Pairs ….24
 11 Pairs …Intercostal Muscle
 Thoracic Cage …37 Bone ….Sternum +Ribs +Thoracic Vertebrae
(1+24+12)
 Ribs are classified into 3 groups…
1. True Ribs…1 to 7th pairs
2. False Ribs….8, 9, 10th Pairs
3. Floating Ribs…..11th & 12th Pairs
 1 to 7th Pairs connects with sternum by costal cartilage…

Q. Ribs/Sternum are…
a. Long Bone b. Flat Bone c. short Bone d. Irregular Bone
Q. Phalanges are….
a. Long b. short c. Flat d. irregular
 4 Ribs ….Nipple….Breast Ribs …
th

Sternum
 Flat Bone
 Breast Bone
 3 Parts…Manubrium/ Body/Xiphoid Process
 1st Ribs …Manubrium
 2 …10th …Body Connects
 Xiphi sternum or Xiphoid Process
 Bone Marrow aspiration …Sternum
Q. Which parts of bone not included in sternum…
a. Manubrium
b. Body
 c. Neck
d. Xiphoid Process

Axial skeleton….80 Bone

1. Skull – 22 Cranium – Flat Bone ….Facial Bone …Irregular Bone
2. Vertebrae…..33….Irregular Bone
3. Ribs ….24….Flat Bone
4. Sternum …1 …..Flat Bone

Skull ……..Fibrous Joints ….Immovable

Vertebrae………..Cartilaginous Joints …Slightly Moveable

Appendicular Skeleton - 126

1. Upper Limbs -60
2. Lower Limbs- 60
3. Shoulder Girdle – 4
Clavicle – 2 & Scapula – 2
Pelvic Girdle - 2/ 126 Bone Appendicular Skeleton – 126
1. Upper Limbs – 30 X 2 = 60
2. 3 Parts …..
A. Arm:- Shoulder Joint to Elbow Joints eg. Humerus – Funny Bone
B. Fore Arm:- Elbow to Wrist Joints eg. Radius & Ulna -2
C. Hand:-Below Wrist Joints eg. Carpals/Metacarpals/Phalanges –
8+5+14 = 27
3. Most Common Fracture ….Radius Bone ….Colie’s Fracture
4. Shoulder Joints …… Most Free Movable joints …..Dislocation …
5. Glenoid Cavity ….Shoulder Joint is made in …. Ball & Socket Joints
Q. Upper Limbs includes following bone excepts…
a. Carpals b. Metatarsals c. Humerus d. Metacarpals
 Shoulder Girdle
1. 4 Bone …2 Clavicle & 2 Scapula
2. Clavicle:-
 Beauty Bone / Collar Bone /1st Bone of Life (8th wks Fetus)
 2 Ossification site/Most easily Fracture Bone
 S Shaped Bone
 Long Bone
3. The most common fracture of bone in body….
a. Clavicle b. Radius
4. The easiest bone to fracture in body…
b. Clavicle b. Radius
5. The most common cause of fracture of bone in body…
a. Direct Force
b. Indirect Force
c. Pathological Fracture
d. Muscle incoordination
Scapula
 Flat Bone/ Shoulder Blade
 Triangular shaped
 Glenoid Cavity …Humerus Bone…. ......Joints …..Shoulder Joints
 Ball & socket Joints
 Acromion Process …Connects with clavicle…… Acromioclavicular
Joints (अधचल जोन )
 2 Types Joints …..Shoulder Joints & Acromioclavicular Joints

Lower Limbs
 30 X 2 = 60 Bones
 3 parts divide ….
  Thigh :- Femur Largest/Longest/Strongest- 18inch or 45 cm -
1
 Leg:- Febula/Tibia/ Patella - 3
 Foot:- Tarsal (7)/Metatarsal/Phalanges – 26
 Largest Joints….Knee Joints (Hinge Joints)
 Most Common Sprains……Ankle Joints
 Knee Cap ……..Patella
 Tibia …shin Bone
 Most Common Fracture in Players ….Tibia (Muscle Coordination)

Pelvic Girdle
1. 2 Hip Bone / Innominate Bone /Basin Like Structure
2. Flat Bone
3. Each Hip Bone contains 3 parts …
Ilium
Ischium
Pelvis
4. Sacroiliac Joints – अधचल
5. Symphysis Pubis …अधचल
6. Male or Female …..After skeleton …Death
7. Bone Graft …Most Common Used …Pelvic Bone
Joints
 Connection between 2 or more than 2 bone.
  Joints can be connected by three ways…
1. Fibrous Tissue:- Fibrous Joints
2. Cartilage:- Cartilaginous Joints
3. Synovial Membrane:- Synovial Joints
 Joints are three types:-
अचल जोन Fibrous Joints eg. Cranium/Teeth joints
अधचल जोन Cartilaginous Joints eg. Symphysis Pubis/Sacroiliac
Joints/Vertebrae/Acromioclavicular Joints
चल जोन Synovial Joints eg. Most of the free movable joints
Types of synovial Joints
1. Ball & Socket Joints eg. Shoulder/Hip Joints
2. Hinge Joints eg. Elbow/Knee Joints
3. Gliding Joints eg. Wrist/Ankle joints
4. Pivot Joints eg. Head & atlas joints
5. Chondyloid Joints eg. TMJ
6. Saddle Joints eg. Phalanges Joints
Bone to Bone Connection …….Ligaments
Bone to Muscle ….Tendon
Cartilage …three types …..Hyaline/Fibrous/Elastic
Large Amount of cartilage…Hyaline
Chondrocytes ….Cell of cartilage

3 Cells Bone….
Osteoblast….Bone Forming Cells
Osteoclast…..Macrophage of bone
Osteocytes ………..Matures cell of bone
Origin of Bone:-
1. Membrane
 2. Cartilage
3. Tendon

Red Bone Marrow – RBM…Spongy …..Pluripotent stem Cells

…Blood Cell Production
Haversian Canal …Bone… ……..Compact…..Yellow Bone Marrow
Nutrient artery…Blood Supply to the bone
4.

1. Ball & socket……Shoulder/Hip Joints

2. Hinge Joints….Elbow/Keen Joints
3. Gliding Joints…Wrist/Ankle
4. Pivot Joints…Head & Atlas
5. Chondyloid……..TMJ
6. Saddle Joints…Joints between finger

Circulatory System
 Also Called Cardiovascular System/ Transportation System.
 Blood/Heart/Blood Vessels
 William Harvey -1628. Blood Circulation- Founder
 Heart Transplant- Dr. Christian Barnard 1967
 Blood Group- Dr. Karls Landsteiner
Blood
 Specialized Connective tissue
 5lit/in Adult Body…..70ml/kg …..7- 8% of body weight.
 2 Components …1. Plasma 2. Blood Cells
 Plasma- Liquid Parts of Blood (55%)
 90 % Water
 Plasma Proteins (Liver)…Albumin ….Urine (Renal
failure)
 Proteinuria + HTN+ Edema = Pre-Eclampsia
 Blood Clotting Factors (Liver)
 Blood Cells- Solid Parts of Blood (45%)
 Blood Cells are produced by Red Bone Marrow (Spongy)
(Pluripotent Stem Cells – Stem cells)
3 Types Blood Cells ….Blood Corpuscles
S.N RBC WBC Platelets
1. Erythrocytes Leucocytes Thrombocytes
2. Oxygen Carry Defense/Fight Blood Clotting
3. 120 days- Life Span 8- 10 days 8 – 12 days
60 – 90 – Fetus
4. Longest Life Span Shortest Life Medium
Span
5. Nucleus Abscent Present Abscent
6. 7 micron size 14 – 16 micron 3.5 micron
7. Medium Largest Smallest
(Monocytes)
8. Erythrocytosis Leukocytosis Thrombocytosis
9. 45 – 55 lakh 4000 – 1.5 – 4
45 – 65 lakh/mm3 11000/mm3 lakh/mm3

45 lakh- 55 lakh/mm3 …..10 lakh = 1 million

4.5 – 5.5 million/mm3

Pancytosis……..Increased all blood cell count

Pancytopenia……..Decreased all blood count
Leukemia… Blood Cancer – Excessive high WBC count in body.
 Blood Group
 Determine by RBC surface antigen. Divided into 2 groups….
1. ABO System:- Blood Group A, B, AB & O
2. Rh. System:- Rh. Positive & Rh. Negative
Blood Group A + Rh Factors Present = A+
Blood Group A + Rh Factors Abscent = A-
BG B + Rh. Present = B+
BG B + Rh. Abscent = B-
BG AB + Rh Factors = AB+
BG AB + Rh. Factors Abscent = AB-
Surface Antigen Abscent + Rh Factors Present = O+
Surface Antigen Abscent + Rh Factors Abscent = O-
 Universal Donor……Blood Group O (O Negative)
 Universal Receiver ….Blood Group AB (AB Positive)
 Blood Donation Without Cross Match ……O Negative
 Emergency Blood group ….O Negative
 Smart Blood Group ….AB
 O Blood Group ….Most Common
 AB Negative ……Rarest Blood Group
 H antigen ….Bombay Blood Group
 85% Rh factors Present
 15 – 20% Rh factors Abscent …

Erythroblsatosis Fetalis… Rh. Incompatibility

Mother& Fetus …Do not matching the blood group
85 % - Positive
Mother (BG Negative)……….85% Chance Positive Fetus …..Antibody
Formation ……Fetus Ruptures …….Abortions
Anti D injection Apply to mother….72 hrs of delivery of fetus

Blood Cells ….7

5 WBC + RBC + Platelets = 7 types

Types of WBC……………5
WBC….Classified into 2 groups…..

1. Granulocytes:-
Neutrophils ….Acute Infection
Eosinophils……….Parasites effects (Albendazole)
Basophils …..allergic reaction
2. Agranulocytes
Lymphocytes
Monocytes
WBC – 10000 – Total Leucocytes Count – TLC
Differential Leucocytes Count – DLC

Neutrophils - 40 – 70% - Phagocytosis

Lymphocytes – 20 – 40% - Chronic Infection- Smallest
Monocytes – 2 – 10% - Macrophage – Largest WBC
Eosinophils – 1 – 6% - Parasites Effects
Basophils – 0 – 1% - Allergic Reaction

Q. All are the included in granulocytes excepts…

a. Neutrophils
b. Eosinophils
c. Lymphocytes
d. Basophils

Q. Smart Blood Group is also known to the…

a. A
b. B
c. AB
d. O

Q. The GI Ulcer is common to the….

a. A – Cancer Common
b. B
c. AB
d. O – Peptic Ulcer

Heart
 Busiest Organs of the body.
 10 – 12 cm long & weight is about 300 gm.
 250 – 300….275 gm
 300 – 350 gm ……..325 gm
 2nd Ribs – 6th Ribs & 1 prats in right & 2 prats in left side from
midline.
 The opposite placement of heart is called….Dextrocardia
 3 Layers …..Pericardium ……Myocardium…….Endocardium
 Thick Layers……बा लो प …….Myocardium ……..Cardiac
Muscle
 Most Important Layer…….Myocardium
 Myocardium Failure/Necrotize…..Ischemic ….…..Myocardial
Infarction- MI (Heart Attack) ….Due to the blockage of
Coronary Artery.
 Coronary Artery Blockage …High fat deposition in Coronary
Artery (Atherosclerosis)….Thrombosis……..Embolism
 Parts भाग in Heart…1. Right Parts 2. Left Parts
 Chamber कोठा in Herat ……..4
 Right Atrium …Impure Blood
Right ventricle…Impure Blood
Left Atrium….Pure Blood
Left Ventricle…..Pure Blood
 The pulmonary Valve is found in…..Right Ventricle
 The Aortic Valve is found in…….Left ventricle
 Tricuspid Valve is found in between……RA & RV
 Bicuspid Valve is found in ….. … LA & LV (Mitral Valve)
 4 valve inside the heart……1. Tricuspid 2. Bicuspid
3. Pulmonary Valve 4. Aortic Valve
 Semilunar Valve ……….Pulmonary & Aortic Valve
 1st sound…..Lub Sound …..is heard during the ….
1. Closer of Aortic & Pulmonary Valve
2. Closer of aortic & Tricuspid valve
3. Closer of Bicuspid & tricuspid valve
4. Closer of Aortic & Bicuspid Valve
 2nd sound of heart …Dup Sound …Aortic & Pulmonary Valve Close
 Extra than Lub & Dup Sound from heart……Murmur
 Abnormal Heart sound is called….Murmur
 Blood Supply ….Coronary Artery …………
1. Ascending Aorta
2. Arch of aorta
3. Descending Aorta
 Impure Blood carry from heart…….Coronary Sinus (Superior
Venacava)
 Nerve Supply….ANS (Sympathetic & parasympathetic)
 Heart receive the blood during the phase of………..
1. During Contraction
2. During Relaxation
 Cardiac Cycle:- Complete in 0.8 Second
Atrium Contraction- 0.1 second
Ventricle Contraction- 0.3 Second
Complete Relaxation – 0.4 Second
  Heart Beat…..0.8s…...One Cycle….60 Second…..72/minutes
 60 – 80/minutes -2nd best
 60 – 100/ minutes. Normal Range – 3 rd
 <60/minutes – Bradycardia
 >100/minutes – Tachycardia
 Conducting System of Heart …..SA Node (Right Atrium) ……Pace
Maker of the body.
 AV Node…..Secondary Pace Maker
 Stroke Volume & Cardiac Output
 Blood Volume expels by heart in a single contraction…..70
ml….Stroke Volume
 Stroke Volume X Heart Rate in One minute = Cardia Output
 70 ml X 72 = 4999 ml (5lit/minutes)
 In One contraction…..Blood Volume ….70 ml…..Stroke Volume
 In one minutes ….Blood Volume….70 X 72 = 5lit/minutes = Cardiac
Output

Pulse Rate & Heart rate

 Pulse rate is from peripheral artery of heart…….Fingers
 Central chest ….Heart Rate …......Stethoscope …. Apex Area
 Central Pulse Rate………..Carotid/Femoral Artery
 Types Blood Circulations….3 types ……Pregancy 4 types
1. Pulmonary Circulation – Two Ways Circulations
2. Systemic Circulation- Two Way Circulation
3. Portal Circulation- One Way Circulation
4. Fetal Circulation (Pregnancy)- two way circulation

Types of Blood Circulations

3 types…
1. Pulmonary Circulation is…
a. Exchange between lungs & Cells
b. Exchange Between Heart & Lungs
c. Exchange between Heart & Cell
 d. Exchange between Abdominal Organs to Heart
2. Systemic Circulations
Heart (LV)…….Aorta ……All cells & tissue
Cell/ Tissue ….SV/IV…..Heart (RA)
Heart & Cell/Tissue Exchange Process = Systemic/General
Circulations
3. Portal Circulation
Abdominal Organ …..Impure Portal vein …..Inferior
Venacava/Heart
Q. The exchange of blood between heart & Abdominal Organs
is…
a. Pulmonary
b. Systemic
c. Portal
Fetal Circulations
Start….2 wks …14 – 16 days
Umbilical Cords ….Vessels …….3 …….2 Artery & 1 Veins
Artery…… Who carries Impure blood……..Pulmonary/Umbilical artery
Veins…..Who Carries pure blood…….Pulmonary Vein/Umbilical veins
Fetal Circulations Oxygen Level…………80% Oxygenated (75 – 85%)

Atrial Septal defects …ASD…..Congenital Heart Defects

Opening between two atria……Foramen Ovale

Connection Between umbilical vein & Inferior Venacava……..Ductus
Venous
Connection Between Pulmonary artery & aorta ……Ductus Arteriosus

Q. The pregnancy ladies should be rest in the position after 16 wks ….

a. Supine
b. Lateral…..
c. Prone
d. Knee Chest Position
Fetus/Uterus…..…Pressure Over in aorta & Venacava……….Aorta Caval
Compression

Blood Vessels
3 types….
1. Artery……Blood caries away from heart….98%....Bright Red
2. Vein…..Blood carries towards the heart…..75%....Dark Red
3. Capillaries …..Exchange Between artery & vein…98% …Bright Red
Q. The capillaries is a part of…..3
a. artery- 98%
b. Vein ---75%
c. Both
d. None
The Layers of blood vessels are…… 3
The Layers of capillaries….1…..Made By single Layers
Layers….(Testes)
1. Tunica Adventitia
2. Tunica Media….Elastic Tissue …BP Determine
3. Tunica Intima
Blood Supply to vessels…..Vasovasorum
ANS – Nerve Supply
Differences between 3 Vessels
S.N Artery Vein Capillaries
1 Carry Blood From Carry Blood Exchange
Heart towards Heart
2 3 layers 3 layers Single layers
3 98% oxygen 75% Oxygen 98% Oxygen
4 No Valve Valve Present No valve
5 Most dangerous Bleeding Control Most Common
Bleeding itself
6. 12% Blood 60% Blood 5 – 10% Capillaries
Volume
7. Largest Largest
Artery…Aorta 45 cm Vein…Inf.
long Venacava
8. Longest artery Longest Vein
…aorta ……Great
Saphenous Vein
Arteritis Phlebitis…Infect
Pulsestile/Spurts Jets Continuous Oozing types
Bleeding

Blood Supply To the Vital Organs…

Basilar Artery Head……Circle of wills
Vertebral Artery Head
Carotid artery Head
Sub Clavian Artery Hands
Bronchial artery Lungs
Inferior Thyroid artery Esophagus
Coronary artery Heart
Nutrient Artery Bone
Phrenic Artery Diaphragm (Hiccough- Phrenic
Nerve)
Coealic Artery Stomach
Lingual Artery Tongue
Mesenteric Artery Intestine
Pudendal Artery Penis
Popliteal artery Knee area
Cystic artery Gall Bladder
External Iliac artery Thigh
Internal Iliac artery Uterus/ Reproductive Organs
Testes…Testicular artery
Anatomy & Physiology

Nervous System
o Chief Controlling/Regulating System of the body.
o Body’s Activities Control/Regulation/Balance ………..
o 1. Nervous 2. Endocrine System (Hormone)
o Smallest Unit …Neurons …..Longest Cells/ Largest Cell in Male
o Neurons….Abscent cell division …..Brains Can’t transplant to
other.
o Liver Fastest Regenerative Organs…….
o Least regenerative organ…….Brains ……Spinal Cord
…..Paralysis
o Types Of Neurons…….3 types
1. Sensory…….Information share to the brains from outer side
of body…. Outer Parts……….towards …..Brains ………Afferent
2. Motor ……..Information share to outer parts of body from
brains…………Efferent Neurons
3. Mixed Neurons…..Both Actions

Q. The loss of pains sensation is the failure of….

a. Sensory Neurons
b. Motor Neurons

Q. The power of limbs is loss due to injury…….It indicates…

a. Sensory Loss
b. Motor Loss…..Paralysis

Q. Pain & Power loss in limbs, it indicates….

 a. Motor Loss
b. Sensory Loss
c. Both Moter & sensory Power loss
d. None of the above

Q. The main Objectives of giving anesthesia is…

a. Pain Block…..process of loss of pain…
b. Power Block
c. Both Block
d. None of the above

Neurons has 2 parts….

1. Nerve Cells
2. Nerve Fibers …..two types……1. Dendrites 2. Axons
Synapses:- Process of exchange of information from one
neuron to another neurons….

Sensory Neurons Dendrites ……………………..Dendrite & Axons

…..Exchange the information …..Process is called Synapses

Types of Nervous System …..

Divided into 2 groups….
1. Central Nervous System- CNS
2. Peripheral Nervous System – PNS
Cranial Nerves – 12 P
Spinal Nerves – 31 Pairs
ANS………..2 Prats….

Sympathetic…………Thoracolumbar Outflow
 Parasympathetic …. ……Craniosacral Outflow
CNS
It includes Brains & Spinal Cords.
They are covered by a layer i.e called meninges
Meninges has a 3 layers….
1. Duramater
2. Arachnoid mater
3. Pia Mater
Subdural Space
Subarachnoid Space……….CSF ………Intrathecal Route

CSF…..
Production……….Choroid Plexuses….0.5 ml/minute….720 ml/days
600 ml …Absorbed …..Arachnoid Villis
Remains Unabsorbed 120 ml…………CSF…Determine the intracranial
Pressure – ICP……5 – 15 mm of hg
CSF Ph Value……7.31 – 7.32 (7)

CSF Functions…
1. Shock Absorber or Cushions
2. Nutrition Provides to the brains tissue
3. CSF helps to moist ….Prevent dry
4. ICP Maintains

Brains
Chief Organs of Nervous System
80- 85% …water
2% of body weight …1000 – 1500 gm …1- 1.5 kg
 5 Parts…….
1. Cerebrum…Largest Part of Brains
2. Cerebellum …Body balance & equilibrium
3. Mid Brains – Smallest Part of brains
4. Pons Varolii……….Pneumotoxic center
5. Medulla Oblongata

CNS…..
Brains & spinal Organs
They are covered by meninges….has 3 layers…
CSF…..Space between arachnoid & Pia mater
Brains
Chief organs of Nervous system
2% of body weight….1000 – 1500 gm – weight
80% Water
5 Parts…
1. Cerebrum…..Largest parts of Brain s
2. Cerebellum….Body Balance & equilibrium शर रको स तल
ु न
3. Mid Brains…..Smallest Parts
4. Pons Varolii मि तक सेतु eg. Pneumotoxic Center
5. Medulla Oblongata शस
ु ु ना शसक

Cerebrum ठुलो मि त क
Largest part of Brains.
Memory Power/Thinking Power/Intelligence……..
Has 2 Lobes……..These 2 lobes are connected by Corpus Callosum
1. Right Hemisphere
2. Left Hemisphere

Each hemisphere has a 4 lobe…….

1. Frontal Lobe…………Motor area (FM) /Taste Area – Insular Cortex
2. Parietal Lobe…………Sensory Area
3. Occipital Lobe………Visual Area/ Cortex
4. Temporal Lobe……..Auditory/Olfactory/ Memory area/Center
Speech Center……….Broca’s Area- Left hemisphere

Medulla Oblongata
2 cm long….
It has Vital center…..
1. Cardiac Center
2. Respiratory Center
3. Vasomotor Center
4. Reflux Center – Sneezing/Vomiting/Swallowing/Coughing Center

Ventricle……….4 Ventricle are present in Brains….

1. Right ventricles
2. Left ventricles
3. Third Ventricles
4. Fourth Ventricles
Thalamus:- Supports motor & language system – Permanent Coma
Secrete neurohormones….connects to hypothalamus (Brains) to
Endocrine
Hypothalamus:- Biological Clock of the body. Physiology of body
controlled by hypothalamus.
1. It regulate the sleeping & awaking Cycle
2. It regulate the hungers
3. It regulate the thirsty
4. It control the Pituitary Glands
5. It control the sexual desire
6. It control the heat regulating system
7. It balance the homeostasis (Fully Balanced state of body)
8. It control the hormonal actions

Spinal Cord सुषु ना

45 cm long
Start from medulla oblongata to L1 .
31 Pairs spinal Nerves ….62
Reflux action अका य या आगोले पो दा 1 second/2 second
Spinal Cord …Complete

Q. Reflux actions is complete by…

a. Brains
b. Spinal Cords
c. Peripheral Nerves
 d. All of the above

Q. Spinal Anesthesia or Lumbar Punctures is done at the level of….

a. L1 – L2
b. L2 – L3
c. L3 – L4
d. L4 – L5
L1 – Adult
L3 – Child ………….
Q. Contraindication of Anesthesia in Child……….
a. Spinal
b. General
c. Local
d. Regional
Q. The choice of anesthesia in LSCS…….
a. LA
b. GA
c. Spinal Anesthesia
d. None of the above

Q. The best position for the spinal anesthesia is…

a. Lateral
b. Supine
c. Dorsal Recumbent….PV/Catheterization/Vaginal Medicine (Douche)
d. Lateral Recumbent

Peripheral Nervous System - PNS

It includes-
1. Cranial Nerves – 12 Pairs (Brains)
 2. Spinal Nerves – 31 Pairs (Spinal Cords)
3. ANS:- Sympathetic & Parasympathetic

Cranial Nerves
12 Pairs or 24 – Cranial Nerves
1. Olfactory…….Smell…………Shortest Cranial Nerves
2. Optic ……….Vision
3. Oculomotor…..Eye Movement
4. Tracheal
5. Trigeminal……Largest Cranial Nerves
6. Abdscent
7. Facial
8. Vestibulochlear or auditory……….Hearing & Body balance
9. Glossopharyngeal…………..Taste
10. Vagus…….Longest Cranial Nerves ………Neurogenic Shock -
Vasovagal Syndrome
11. Accessory
12. Hypoglossal

Spinal Nerves
31 Pairs or 62 Nerve
Mixed Types – Both actions
Divided into 5 parts….
1. Cervical Nerves – 8 P
2. Thoracic Nerves – 12 P
3. Lumbar Nerves – 5 P
4. Sacral Nerves – 5
5. Coccygeal Nerves – 1 P
Sacral Nerves म ये १ जोडा लाई Sciatic Nerves (Thigh)…….…Longest
Nerves
Longest Cranial Nerves ….Vagus
Longest Nerves ………..Sciatic Nerves
Most suitable site for the IM inj……….Buttock (Outer & Upper Part)….
To prevent the injury of sciatic Nerves
Spinal Nerves …..Cauda Equine….
Cauda Equine………Lumbar + Sacral + Coccygeal = 11 Pairs

Autonomic Nervous System- ANS

Control of Involuntary Organs
Inner Organs + Liver + Lungs + Heart = ANS
Divided into 2 groups….
1. Sympathetic NS – Thoracolumbar Outflow
2. Parasympathetic NS – Craniosacral Outflow
They have opposite actions to each other………….Balance

Sympathetic ….Flight & Fright Response …Fear/Stress

Parasympathetic…………Rest/Cool/Sleep/Unconscious

Q. Exam Hall ……HB High ……it indicate…..Stress/Fear

a. Sympathetic Stimulation
b. Parasympathetic Stimulations

Difference between SNS & PSNS

S.N Sympathetic NS (Stress) Parasympathetic NS
Sleep/Rest/Como
1. Heart rate Increased Decreased
2. Saliva Decreased Increased
3. BP High Low
4. Eye Pupils Dilatation Constriction
5. Bronchus Dilate Constriction
6. Urine Decrease Increase
Productions
7. Intestinal Low Increase
Movement
8. Body Fluid Low Production High Production

 Flight & Fright Response ….Sympathetic Stimulations

 Thoracolumbar Outflow ……Sympathetic
 Craniosacral Outflow ……Parasympathetic

Q. Atropine helps to………….Bradycardia

a. Stimulate to sympathetic action

b. It stop the parasympathetic stimulations

Vagus Nerves 10th - Neurogenic Shock……..HR Low …BP Low

Craniosacral Outflow -----Parasympathetic ………Atropine

Special Sensory Organs

5 Special Organs……..
 1. Eye…..Sense of sight
2. Ear…..Sense of hearing
3. Skin……..Sense of touch
4. Tongue………Sense of taste
5. Nose ……Sense of smell

Eye
Orbital Cavity – Eye Placed
Weight – 7 gm
Diameter – 2.5 cm
Optic nerves – 2nd Cranial Nerves – sensory Neurons
Structure …There is 3 layers……
1. Outer Layer eg. Cornea & Sclera
2. Middle Layer eg. Iris, Ciliary Body & Choroid – Lens
3. Inner Layer eg. Retina
Outer Layer of Eye
Avascular Layer of eye.
It has 2 parts ………..1. Cornea 2. Sclera
Eye donation …..Cornea …..1/6th parts
Keratitis ……Inflammation of Cornea
Sclera….White portion of outer eye…….5/6th parts ……Jaundice seen
Transparent part of eye…. Cornea
Limbus ……Window of eye…..Junction point of cornea & Sclera

Middle Layer of Eye

Vascular Layer of Eye – Uveal Tract
It has 3 parts:
1. Iris….Colour full layer of eye………Eye Colour Determine ….Pupils
Contains in Iris
 2. Ciliary Body:- Fluid Production inside the eye. It holds the Lens
by the help of suspensory ligaments
Eye Contains following types of fluid….
1. Aqueous Fluid – Eye Pressure – IOP maintains (10 – 21 mm of
hg)- Tonometer
Tocometer – Uterine Power
2. Vitrous Fluid/Body:- Determine the shape of eye.

Accommodation of Eye:- The shape of lens become change

according to distance of objects i.e called accommodation eye
(ciliary Body)
3. Choroid

Inner layer of Eye

Nervous layer of Eye. It has 2 nerve cells…….Retina
1. Rods Cells 2. Cone Cells
Rods Cells …helps in night vision
Cone Cells …helps in days Vision
Nightblindness is related with the…. Rods Cells
Colour Separation is related with………Cones Cells
Colour Blindness is related with the…..Cone Cells
Most Sensitive colour for eye……….Green

Rods Cells ……..…Rhodopsin Pigment……Need Vit A…..Liver storage

…….
Sun Light ……Only work by Cones ……..Sun light damage to the
rhodopsin…..sudden entry in dark room…………..
Dark Adaptation……….Films Hall……….
Nightblindness ……..Vit A Abscent in Liver
Accommodation Eye

Presbyopia:- Loss of vision power in old age

Presbycusis:- Loss of hearing power in old age.
Q. The photoreceptor cell of eye….
Ans: Rods & Cones
Q. The normal IOP is…..
Ans:- 10 – 21 mm of hg…….Tonometer ----Aqueous Fluid
Q. The shape of eye is determine by….
A. Cornea
B. Aqueous Fluid
c. Vitrous Fluid
d. All of the above
The Opacity develop in lens is called……….Cataract
Cataract is most common cause of blindness in world
The most common cause of cataract ………Senile…….Age above 40 yrs
– Old age
What is the main cause of HTN…………Essential
Q. What is the definite treatment of cataract……
a. Antibiotics
b. Therapy
c. Surgery
d. Eye gaggle
Q. What is the best methods of prevention of cataract ….
a. Antibiotics
b. Therapy
c. Surgery
d. Regular Eye checkup
Q. The increment of pressure in eye is called……
a. Cataract
b. Glaucoma – Rainbow is common in glaucoma
c. Conjunctivitis
d. Trachoma
6 meter distance………..Eye vision test…Vision acuity test……….20
feet………..Snellen charts
Myopia….Nearsightedness…………Minus Power Lens……Concave
shaped
Hypermetropia…Long-sightedness….Plus Power Lens …Convex Shaped
Lens
Astigmatism ….Cylindrical Lens
Q. The Normal IOP is…..
a. 10 – 21 mm of hg
Q. The Limbus is found….
Ans. Outer: layer of eye
Q. The vascular layer of eye…
a. Outer
b. Middle- Uveal Tract
c. Inner
d. None of the above
Q. The Accommodation of eye is the process related with…
a. Outer
b. Middle- Uveal Tract
c. Inner
d. None of the above
Q. The most sensitive colour for eye…
a. Red
b. Green
c. Blue
d. Purple
Q. The keratitis is the infection of…
a. Cornea
b. Sclera
c. Choroid
d. Ciliary Body

Accessory Organs of Eye….

1. Conjunctiva
2. Lacrimal Glands
Dacrocystitis….Lacrimal Duct inflammation
Dacryoadenitis …Lacrimal Glands Inflammation
Almond shaped ........…Lacrimal Glands (Medial Canthus)
Nasal cavity opens ….Lacrimal Duct

3. Lacrimal duct
4. Eye Lashes
5. Eye Lids

Q. Blepharitis is the infections…

a. Inflammation of eyelids

Tear….6.5 – 7.6 Ph Value

Trichiasis
Trachoma……..SAFE Strategy
Surgical Correction
Antibiotics
Face Wash
 Environmental sanitation

Ear
 8th Cranial Nerves – Vestibulocochlear or Auditory Nerve –
Sensory
 Autoscope…….….Instruments to watch the ear…….
 Audiometer…Instruments to use the measurements of ear power.
 3 Parts:-
1. External Ear
2. Middle Ear
3. Inner Ear

External Ear included………..

1. Auricle or Pinna
 Helix
 Lobule ……Coolest part of body….Most chance of
mycobacterium leprae
2. External Aquastic Meatus
 S Shaped – 2.5 cm long
 2 types glands….
1. Ceruminous glands – Wax Production
2. Sebaceous glands
3. Tympanic Membrane कानको जाल
 It has 3 layers ….Ectodermal/Fibrous Layer/Mucosal
Layer
  It is a part of external ear
 It connects both external & middle ear
 Myringitis…..Inflammation of TM
 Otitis externa…..Inflammation of external ear
Middle Ear
 Also called tympanic cavity – Filled with air.
 Eustachian tube connect to the middle ear to nasopharynx.
 4 cm long.- URTI …..Chance to high middle ear infection
 Otitis media …Infection/Inflammation of middle ear
1. Chronic Suppurative Otitis Media – CSOM – > 14 days
2. Acute Suppurative Otitis Media – ASOM- <14 days
 If there is a pain……days does not matter …..it always refer to
Acute infection .
 A 24 months baby comes with the history of ear discharge from
28 days. Now he feels severe pain in ear. The most probable
diagnosis is….
A. ASOM
B. CSOM
 Middle ear contains smallest bone of the body. These are
also called Ossicle.
 These are Malleus/Incus/Stapes- MIS or Chain Of Ossicle
 Stapes is the smallest bone of the body.
 Malleus bone – Hammer shaped
 Stapedius Muscle …Smallest muscle of the body
 Occulostapedial Joints ….Smallest joints of the body
Q. The air filled in the following parts of ear…
a. External
b. Middle
c. Inner
d. All
Q. The fluid filled in the following parts of ear….
a. External
b. Middle
c. Inner – Perilymph & Endolymph
d. All
Inner Ear
 It included following three parts….
1. Semicircular Canal – 3
2. Vestibule – 1 – Body Balance (Cerebellum -1st for Body
Balance)
3. Cochlea -1
 Inner ear contains 2 types fluid……….Perilymph/Endolymph
 Organs of Corti…………True Hearing Center……….Hansen’s Cells
 8th Cranial Nerve is made from Vestibule & Cochlea……
 Labrinthnitis……Infection Inflammation of inner ear
 Presbycusis……Loss of hearing power in old age
 All sound are collected by organ of corti- True Hearing Center…
 8th cranial nerve receive the sound from organ of corti
 Auditory Area ….Temporal Lobe of brains

Hearing Power of Ear

 It is measured by audiometer
 Unit – Decibel or Hertz
WHO Classification:

20 - 20000 Hz – Normal Hearing Power

0 – 25 dB – Normal Hearing Power
26 – 40 dB – Mild Hearing Power Loss
41 – 60 dB – Moderate Hearing power loss
61 – 80 dB – Severe Hearing Power loss
> 80 dB – Profound Hearing Power Loss
Hospital Ward- 20 – 35 dB
Class Room – 20 – 30 dB

Threshold power of ear……सहनस ने …..<125 dB

Pains Ear……..> 125 dB …

Skin
 Largest Organs of body – Skin
 Largest glands – Liver
 Largest Visceral Organs – Liver
 Weight – 4kg in Adult
 Area – 1.5 – 2 sq.m2
 2 layers…….
1. Epidermis….made by Keratin…..
 Keratinized Epithelium …..Non Living Part of body
 No Tuberculosis:- Hair/Nain/Epidermis – Keratin
 No Blood Supply /Nerve Supply
 5 layers:-
1. Stratum Cornium
2. Stratum Lucidium
3. Stratum Granulosum
 4. Stratum Spinosum
5. Germinating Layer:-It contains Melanocytes Cells
…..Secrete melanin …Which responsible for skin colour
2. Dermis……
 It has rich blood /Nerve supply
 Arrector Pilli muscle found
 Sweat & Sebaceous glands are found
 Sweat Glands …Mostly ….Palm & Sole
 Sebaceous Glands …Mostly ….face
 Below the dermis …Fat layer Present…..Subcuneous Fat
…Hypodermis

 Functions of skins…..
1. Protection Function
2. Secretion Function
3. Regulation of body temperature
4. Excretion
5. Sensation
6. Absorption
7. Vit D Formation
8. Bilirubine Convert
Sweat
 A liquid that is secreted by sweat glands
 Composition:-
 99. 4% Water
 0.2 % salts
  0.4% Waste Products
 The Infection of sweat glands…. Hidradenitis
 Nail is started to form in fetus during the age of…….10 wks
 Tip of Finger is blood supplied by……Digital Artery
 Paronychia…infection of toenails or fingernails.

Nose
 1st part of respiratory system
 Ciliated epithelium
 Olfactory Cells
 1st Cranial Nerves ----Smell Information – Sensory
 Little’s area or Keisselbach’s plexus- Most common site for
epistaxis
Tongue – Lingue
 Voluntary Muscle
 Lingual artery – Blood Supply
 Lingual Nerve – Nerve Supply
 3 types taste buds ….Valate/Filiform/Fungiform
 Largest taste buds …..Valate……Bitter Taste
 Smallest taste buds …Filiform………Sour taste
 Most Number of taste buds …Filiform
 Lowest number of taste buds …Valate
 How many types of taste is founded by tongue…….5 types
 Bitter/Sour/Sweat/Salty/Umami taste
 Glossitis ….Infection of tongue
 Tongue is attached with….Hyoid Bone …Unsocial
Bone/Horse shoe shaped bone……
Endocrine System अ त ाब णाल
 They are glands. They are made by epithelial tissue. They
produce a liquid.
 Glands are - 2 types….
1. Exocrine Glands…….…Having Duct…….Enzymes
2. Endocrine Glands …………Without Duct ……..Hormones
 Exocrine (Duct)……….three types…….
1. Merocrine
2. Apocrine
3. Holocrine
 Q. The exocrine glands are…….
A. 2 types b. 3 types c. 4 types d. 6 types

Endocrine Glands
  They are ductless glands. They produce a fluid i.e called hormone
– Chemical Messengers
 Protein & Cholesterol –Hormone
 Types of endocrine glands……
1. Pituitary Glands
2. Pineal Glands
3. Thyroid Glands
4. Parathyroid Glands
5. Thymus Glands
6. Pancrease
7. Adrenal Glands
8. Testes
9. Ovaries

Pituitary Glands
 Master Glands. It is attached with the hypothalamus.
Hypophyseal Fossa (Sphenoid Bone)
 Hypothalamus release the hormone i.e
 Inhibiting Hormone - IH
 Releasing Hormone - RH
 IH & RH control the activities of pituitary glands.
 Pituitary Glands is regulated by….Hypothalamus - Head Master
 GHRH is released by……
1. Pituitary Glands
2. Hypothalamus
Q. ACTHIH is released by……
1. Pituitary Glands
2. Hypothalamus
  Pituitary glands divided into 3 parts ….
1. Anterior Lobe ……...Adenohypophysis
2. Posterior Lobe…….Neurohypophysis
3. Intermediate Lobe………Pars Intermedia
Small Pea shaped………केराउको ……500 mg
1. Anterior Lobe:- GH/TSH/ACTH/Prolactin/Gonadotrophic H
A. Growth Hormone – GH…………Skeletal Muscle/Bone Growth
B. Thyroid Stimulating Hormone - TSH ……..Thyroid Stimulate –
T3 & T4 Production
C. Adrenocorticotrophic Hormone - ACTH ……Adrenal Glands
D. Prolactin Hormone …………….Female Breast..
E. Gonadotrophic Hormone (FSH & LH)…..Testes & Ovaries
2. Posterior Lobe…..Oxytocin/ADH…
A. Oxytocin Hormone ……..Syntonic/Pitocin……..Breast & Uterus
B. Antidiuretic Hormone ADH/ Vasopressin…….Nephron/Blood
Vessels
3. Intermediate Lobe ……Melatonin Hormone
A. Melatonin Hormone…..Stop the reproductive organ
development…

Pineal Glands
It is located in Brain – Smallest glands/Smallest Organs
100 mg – weight …………7 – 10 mm size
Third Eye of brains…….
Night Activate………….Sleep Awake Cycle conduct
Melatonin Hormone Production……………Prevent the development of
growth of reproductive organs
Thyroid Glands
It is largest endocrine glands. It is about 25 gm weight.
It is butterfly shaped पत
ु ल आकारको
It has a C- Cells ……..Calcitonin Hormone production
Calcitonin is responsible for the reduction of calcium level in blood.
98% calcium in Bone. 2 % calcium in blood & Muscle
Q. High Production of calcitonin cause…..
1. Bone Strong
2. Osteoporosis
Q. High production of parathyroid hormone may cause……
1. Bone Strong
2. Bone Weak
Q. The osteoporosis is increase when the following hormone if high….
 Oxytocin
 GH
 PTH
 Calcitonin
Q. The chance of bone fracture is increase with the high production
of….
a. PTH
b. Calcitonin
Q. The chance of osteoporosis is high in menopausal stage due to
the…
a. PTH high
b. Calcitonin High
c. Ostrogen Imbalance
Thyroid Glands produced the following hormone………..
1. Calcitonin
2. Tri-iodothyronine (T3)
3. Thyroxin (T4)
They are released by the stimulation of TSH
TSH high ………..T3 & T4 level low……Hypothyroidism
TSH Low ………..T3 & T4 level high …….Hyperthyroidism

Q. TSH high indicate……

a. Hypothyroidism………..Thyroxin - T4 (Thyronorm)
b. Hyperthyroidism

T3 & T4 are mainly responsible for the metabolism process – T4 Major

Role
Heat Production ….
Menstrual Activities irregular
Growth Retardation
Cardiomyopathy
Infertility
T3& T4 production by thyroid glands…..For that thyroid glands need
iodine
Iodine Deficiency………….Less production of T3 & T4……Hypothyroidism
Q. Iodine deficiency may cause…
1. Goiter
2. Hypothyroidism
3. Cretinism & Myxedema
4. All of the above
Hypothyroidism…….T3/T4 Low……Low Heat Production……..Low
Metabolic rate…….Heat Production Low…….Cold Feel …….Cold
Intolerance चसो सहन नस ने ……Hashimoto’s Disease is main cause
of Hypothyroidism……BP Low /Bradycardia
Low Hunger…………….Weight Gain

Hyperthyroidism:- Grave’s Disease ………T3/ T4 Level high……..High

Metabolic rate…….Heat Production high………..Hot Feel……..तातो सहन
नस ने Heat Intolerance ……..BP High /Tachycardia
High Appetite…………..Weight Low ..…….Metabolic Rate………….Energy
Loss ….

Parathyroid Glands
 Four glands…They are found behind the lobe of thyroid glands.
 30 – 60 mg weight – Each
 Parathyroid Hormone ….Production
 Increase the blood Calcium level = Reduce the calcium level in
bone
 Osteoporosis = PTH
Smallest Endocrine glands …. Pineal 0.1gm (100mg)
Smallest Exocrine glands…. Goblet Cells
Exocrine largest glands …Pancrease (60 gm)
Largest Glands …………Liver
Largest Endocrine …Thyroid
Smallest Organs of the body…..Pineal Glands

Adrenal Glands
Supra Renal Glands……..4 cm long…….11.8 gm weight (Each)
Life Saving Glands ……..Emergency Glands …..Angry Glands …..4S
Glands
4S Glands:- Stands For…..
1. Salt Retention …….BP Increase
2. Sugar Metabolism …..Energy Production
3. Sex Hormone Release……Infertility or Fertility
4. Source of Energy
It has 2 parts…..
1. Adrenal Cortex …..90%
 Mineralocorticoids
 Glucocorticoids
 Androgen or Sex Hormone
2. Adrenal Medulla ……10%
 Adrenalin…………Prepare for Conflict & Danger ………Fight or
Flight Response
 Nor Adrenaline
Cortisol…..Stress Hormone …..Stress response Hormone
Aldosterone
1. Stress management
2. Salt Retention ….BP High
3. Heart Rate increase
4. Antiaallergic Response
5. Anti-inflammatory Response
6. Bronchodilation
7. Heat Production
8. Metabolism Control
9. Sex Hormone Release ======Life Saving Hormone
Q. Stress Hormone is called….
a. Cortisol
b. Aldosterone
c. Adrenalin
d. Nor Adrenaline
Q. The Emergency glands is called…
a. Adrenal
b. Pituitary Glands
c. Parathyroid
d. Testes
Q. The sex hormone is released from…
a. Ovaries
b. Testes
c. Adrenal Glands
d. All of the above
Q. The Fight or Flight Response is seen by the…
a. Thyroid
b. Adrenal
c. Parathyroid
d. Adrenalin

Thymus Glands
Found in Mediastinum. Behind the heart
Old age …Disappears
Child …10 – 20 gm…..
Adult 30 – 60 gm
Old age….Lost
Thymosine Hormone Production …….Lymphocyte & macrophage WBC-
T Lymphocyte …Immune System development

Q. 1. Exocrine glands are…

1. One types
2. 2 types
c. 3 types …..Apocrine/Merocrine/Holocrine
d. 4 types
Q.2. Pancreozymin hormone is released by…….
a. Liver
b. Pancrease
c. Duodenum
d. Hypothalamus
Q.3. 4S glands is called to the….
a. Adrenal
b. Thyroid
c. Thymus
d. Pineal
Q. 4. The Osteoporosis may cause by the high production of following
hormone…
a. Calcitonin……reduce the blood calcium level….Bone Strong
b. Parathyroid Hormone …..Increase the calcium level in Blood
c. Ostrogen…..Menopause Stage
d. Melatonin
Q.5. Islets of Langerhans is called to the…
a. Pituitary
b. Adrenal
c. Thyroid
d. Pancrease – 2% is endocrine cells …..Islets of Langerhans
Q. The King of Endocrine glands is called…
a. Pituitary – Master or King
b. Adrenal
c. Thyroid
d. Pancrease
Q.7. The Hormone are made by..
a. Protein
b. Carbohydrate
c. Cholesterol
d. A & C Both
Q. The target organs for the oxytocin is…
a. Breast
b. Uterus
c. A & b both
d. Ovaries
Q. Which hormone is responsible for the third eye of brains…
a. Growth Hormone
b. Melatonin – Pineal Glands …Third Eye of Brains
c. Oxytocin
d. Cortisol
Long Questions
1. List the endocrine glands of the body. Describe the function of
endocrine system.
2. List out the hormone released from pituitary glands.
3. Differences between exocrine & endocrine glands

Urinary System
Major Excretory System of the body. Major Excretory Organs – Kidney
Filtration System of the system
Divided into 2 parts:-
1. Upper Urinary Tract……..Kidney & Ureter
2. Lower Urinary Tract ……..Urinary bladder & urethra
Urethra to Kidney …….Urinary System
Kidney – 2……….Pyelonephritis
Ureter – 2 ………मु नल
Urinary Bladder – 1 ……Cystitis
Urethra -1………….. मु माग
Kidney
Renus….Major Excretory Organs
Major organs of urinary system
Filtration Organs of body
Bean Shaped Organs ….Red Colour…150 gm weight
12cm, 6cm & 3cm ….size
Q. Right Kidney is slightly lower than left kidney, this is why
because….
Ans:- Due to the pressure over by Liver
Male Weight ….150 gm
Female weight…135 gm
Kidney 2 parts…
1. Renal Cortex
2. Renal Medulla
 The Kidney contains more than 10 lakh nephrons
 Nephron filter the blood…..Urine Formation….that urine received
by renal pyramids……..Received by minor calyx……major
calyx……renal pelvis……Ureter…….Urinary Bladder
 The most common site for Nephrolithiasis is……….Renal Pelvis
Kidneys Functions
1. Vital Organs. So it dose the vital works
2. Kidney is a major excretory organs
3. Kidney act as a fluid & electrolyte balance
4. PH maintained or Acid Base Balance …Vital Role
5. Renin Production …….Blood Pressure Maintains …major Role
Renin + Angiotensin+ Aldosterone mechanism system = BP
Maintains
 Erythropetin secretion………..Helps in RBC production ….Reduce
the chance of anemia
  Kidney helps to inactive vit D to active vit D. So the Vitamin D is
called Kidney Vitamin
 Excretion of waste material
 Excretion of drugs
Q. The BP is control by…..
a. Brains b. Liver c. Kidney d. Heart
BP High ……….RFT Regular Need……..Serum Creatinine Level

Q. The anemia can happens when the failure of following organs…..

a. Brain Failure
b. Liver Failure
c. Kidney Failure
d. Spleen Failure
Q. The Vitamin D deficiency may cause due to the
a. Brain Failure
b. Liver Failure
c. Kidney Failure
d. Spleen Failure

Nephron
 This is the functional & smallest unit of kidney.
 Each Kidney has almost 10-lakh nephron.
 Nephron Has 4 parts……
1. Glomerulus Capsule or Bowman’s Capsule
2. Proximal Convoluted Tubule – PCT
3. Loop Of Henley – LH
4. Distal Convoluted Tubule – DCT & Collecting Tube
Q. Acute glomerulonephritis (AGN) is mainly caused by…
a. Gonococcus
b. E coli
c. Pseudomonas
d. Group A Beta Hemolytic Streptococcus

Acute Glomerulonephritis- AGN ……...Majorly Caused by …..Group A

Beta hemolytic Streptococcus

Rheumatic Heart Disease – RHD

Cardiac Disease due to the group a beta hemolytic streptococcus
John’s Criteria…
1. Major Criteria
2. Minor Criteria
3. Essential
RHD + AGN = cause By GAB hemolytic streptococcus
Urine Filtration Process
Complete in ….3 Phase
1. Simple Filtration
2. Selective Reabsorption
3. Secretion
Urine is normal production……….1500 ml /day
At least urine production………..500 ml/days
Oliguria means ………….<500 <400 ml <300 < 200
Anuria means………..< 500 ml < 200 ml < 100 ml < Not
formation of urine
पसाब ब दै नबनेको अव था वा १०० म ल भ दा कम एक दनमा उ पादन भएमा

Net Filtration Rate (NFR) = 55 mm of hg – 45 mm of hg = 10 mm of hg

Nephron Filter the 125 ml/minute or 180 lit/days…….
Q. Glomerular Filtration Rate (GFR)………..
1. 125 ml/minutes
2. 180 lit/days

Q. The Filtration process in kidney by…

a. Diffusion Process – The transfer from higher concentration or high
pressure to lower concentration or lower pressure
b. Osmosis Process
d. Hypo pressure Process
d. Oncotic Process