Phagocytosis : Ingestion of microbe by forming pseudopods.

Endothelium : Inner membrane of blood vessels.

Homeostasis : Maintenance of nearly constant condition in the internal environment.
Hemostatic plug : An aggregation of platelets formed during early stages of hemostasis in response to one or
more injuries to blood vessel walls.
Serology : Study of serum
Adenoid : Mass of lymphatic tissue (tonsil like) located at the posterior wall of pharynx.
Visceral : The inner layer of an enveloping sac that lines the outer surface of the enveloped structure.
Parietal : The layer that remains outer to visceral layer.
Myogenic : Developed from muscle
Baroreceptor : Pressure receptor
Pulmonary : Related to lung
Myocardial : Related to heart
Hemostasis : Blood coagulation process.
Lumen : The cavity of a tube-like structure
Baroreflex : Reflex that helps to maintain blood pressure at nearly constant levels.
Atheroma : Accumulation of fat like material in the inner layer of an arterial wall.
Thrombus : Blood clot that occurs inside the blood vessel.
Embolus : Blood clot that can travel through the blood stream.
Heart block : A condition when heart beat is 30-40 beats/min
Hematology : The branch of medical science deals with structure of blood formation of blood, blood
related diseases is called Hematology.
Ischemia : Lack of O2 supply to tissues due to O2 deficiency.
Infarction : Formation of necrotic region due to O2 lack for a long period of time.
Necrosis : Abnormal cell death due to O2 deficiency.
Blood
 Achievements in hematology:
Ancient Egyptian book The description of connection of heart to the arteries exists in Eber’s Papyrus book.
Sushruta (Indian Physician)Described how vital fluid circulate through the body.
Galen (Greek Physician) Detected how blood vessels carry blood & identified venous & arterial blood.
William Harvey First described human blood circulation (in 1628). (British scientist)
RD Vieussens First described the structure of the heart’s chambers and vessels.
Stephen Hales First measured blood pressure.
Rene Laennec Invented the stethoscope.
John Lewis First successfully did open heart surgery.
Christiaan Barnard First successfully transplanted a whole heart
Robert Jarvik Designed the first artificial heart
Willem De Vries First implanted artificial heart
[Ref: Alim]
 Blood Circulatory System: Consists of three parts- 1. blood 2. heart 3. blood vessels.
 William Harvey: First described human blood circulation (in 1628). (British scientist)
 Characteristics of blood:
Tissue type Blood is red colored specialized sticky fluid connective tissue which is opaque, salty
slightly alkaline in nature and heavier than water.
Amount About 5-6 L (8% or 7-8% of total body weight). In female 4-5 L or 4.5-5.5 L [A. Alim &
Meghnad]
pH 7.35-7.45 (Avg. 7.4)
Temperature 36-38C [All book] / 36-37C [A. Alim]
Specific gravity 1.065 [Azmal] / 1.05-1.06 [A. Alim] / 1.05-1.065 [Majeda]
Density 1.06 gm/ml or 1060 kg/m3 (heavier than water)
Taste It is salty because of the presence of inorganic salts.
Viscosity Blood is a non-Newtonian fluid. It does not obey Newton’s law of viscosity.
Specific viscosity 4-6
[Ref: Azmal, Majeda, A. Alim]

 The amount of blood may be expressed in 2 ways:

1. 90 ml/kg body weight (in new born baby)
2. 3.3 L/m2 surface area of body.

 One drop of blood contains:

(i) Half a drop of plasma
(ii) 5 million (50 lakh) RBC
(iii) 10 thousand WBC
(iv) 250 thousand (2.5 lakh) platelets. [Ref: Meghnad]
 Functions of blood:
1. Transport of respiratory gases. 7. Blood coagulation and wound healing
2. Transport of nutrition 8. Regulation of ion balance
3. Transport of hormones, enzymes, antibody, 9. Maintenance of homeostasis
vitamins, minerals, plasma protein etc. 10. pH control or acid-base balance.
4. Transport of waste products. 11. Regulation of water balance.
5. Regulation of temperature balance 12. Helps in diagnosis of disease.
6. Immunity & defense. 13. Food transportation from the storage organs

Components of blood
 Blood is separated into 2 layers after centrifuging in centrifugal machine at a rate of 3000 times/ min for 30
minutes.
 Derived slightly yellowish portion on the upper part of the test-tube is plasma, lower dark part is blood
corpuscle layer.
 Determining the ratio of different components of blood: Standard Weintraub methods.
 Blood

Plasma (55%) Blood corpuscles (45%)

Water (90-92%) Solid Substance (8-10%) Erythrocytes Leucocytes Thrombocytes

(RBC) (WBC) (Platelets)
Inorganic (0.9%) Organic (7-9%)
 Sodium Agranulocytes Granulocytes
 Potassium
Plasma proteins Non-protein Other organic
 Calcium Lymphocytes Neutrophil
*** nitrogenous matters
 Magnesium Substances Monocytes Basophil
 Albumin  Glucose
 Phosphorus  Urea Eosinophil
 Globulin  Lipid
 Copper
 Fibrinogen  Uric acid  Hormone
 Iron
 Prothrombin  Creatinine  Vitamin
 Xanthine  Enzyme
 Hypoxanthine  Bilirubin &
 Ammonia Biliverdin
(pigment) etc.

 Plasma Protein
All Good & Polite Friends are plasma proteins
   
Albumin Globulin Prothrombin Fibrinogen.
Non-protein Nitrogenous Substances: িক হ জামাই

িক হ জা Avgv ই
    
Creatinine Hypoxanthine Xanthine Ammonia Urea, Uric acid
 Plasma
 Slightly yellowish in color
 Average plasma volume in a healthy adult man: 3L (5% of total body weight) [A. Alim]
Characteristics  Concentration of protein in plasma: 6-8 gm/dl or 7 gm/dl or 7.5%
 pH: 7.4
 Density: 1.025 gm/ml
1. Nutrients: Glucose, amino acid, lipid, nucleotide, fat
2. Plasma proteins: Albumin, globulin, fibrinogen, prothrombin
3. lons: Na+, K+, Ca++, Mg++, Fe++, Cl-, HCO3- etc.
Components 4. Dissolved gases: O2, CO2, N2
5. Excretory products: Urea, uric acid, creatinine etc.
6. Protective materials: Immunoglobulin, lysozyme, anti-toxin, agglutinin.
7. Others: Heparin, hormone, enzyme, vitamin, pigments (bilirubin & biliverdin)
1. Transport of digested food materials.
2. Transport of waste products from tissue to kidney for excretion.
3. Transport of large amount of CO2 & small amount of O2.
4. Transport of hormone, enzyme, lipid, antibody etc. to different organs.
5. Regulation of acid-base balance (regulation of H+ level)
Functions of
6. Maintenance of fluidity of blood. Regulation of water balance.
plasma
7. Maintenance of plasma osmotic pressure through plasma proteins.
8. Holds the blood corpuscles.
9. Regulation of body temperature.
10. Fibrinogen and prothrombin of plasma helps in blood coagulation.
11. Helps in immunity.
12. Acts as a protein reservoir.

 Protects body from various infections and diseases by maintaining intercellular ionic balance.
 Simulated body Fluid (SBF) is a special type of solution, ionic constituent of which is similar like plasma. [Ref.
Azmal, A. Alim]
Blood Corpuscles
 They are called corpuscles but not cells because they are unable to self-division.
 They are called formed element due to absence of cellular organelles (Mitochondria, endoplasmic reticulum,
Golgi body, Centriole etc.)
 The process of making blood corpuscles is called hematopoiesis.
Mainly, there are 3 types of blood corpuscles:
1. Erythrocyte/Red Blood Corpuscle (RBC) / Hematid
2. Leucocyte / White blood corpuscle (WBC)
3. Thrombocyte / Platelet
 1. Erythrocyte or Hematid
RBC

Water (60-70%) Solid Substance (30-40%)

90% Hemoglobin 1%
 Protein
 Inorganic salt
 Phospholipid
 Cholesterol
 Inorganic phosphate
 Potassium etc.
 Red blood cell (Erythrocyte) or Hematid
The middle portion is much thinner than the edges

Thickness 2.2 m

Like a biconcave disc

Red colored round nucleusless

Diameter 7.3m

 Mature RBCs are non-nucleated, biconcave, elastic and disc shaped.

 Peripheral portion is smooth and thicker than center.
 Average diameter: 7.3 m and thickness 2.2m.
Structure  Nucleus, RNA, Golgi body & Mitochondria are absent in mature RBC.
 The immature RBCs have nucleus and they are called erythroblasts.
 During development, nucleus becomes inactive & gets expelled out of the cell by exocytosis.
 Plasma membrane of RBC: Specialized for exchange of CI- and HCO3-
Embryo 80-90 lacs / mm3 of blood
Child 60-70 lacs / mm3 of blood
RBC Count:
Adult male 50-54 lacs (Azmal) of 5.4 million / mm3 blood (Alim)
Adult female 44-49 lacs (Azmal) or 4.8 million / mm3 blood (Alim)
 In healthy adult, always approx. 20-30 trillion RBCs are present (70% of total cell number of body)
Abnormalities Polycythemia: RBC count is more than 65 lacs / mm3 of blood. Polycythemia
may occur in cholera, jaundice etc.
Anemia/ oligocythemia :RBC count is 25% less than 50 lacs / mm3 of blood.
Thalassemia: A genetic disease in which abnormal hemoglobin synthesis
occurs. In this case, hemolytic anemia occurs.
 The process of formation of RBC is called erythropoiesis. Time required in erythropoiesis: 7 days.
 When blood oxygen level is decreased, kidney secretes a hormone named erythropoietin
which stimulates production of RBC.
 RBC is produced from stem cell or hemocytoblast cell of bone marrow.
Generation Primary stage of embryo (at the age of From vascular tissue of yolk sac.
of RBC 3 weeks)
Production Secondary stage of embryo (up to 6 From liver and spleen.
sites months)
After birth From red bone marrow of sternum,
ribs, hipbone, vertebrae.
 Normally: 16 gm or 15-16 gm in 100 ml of blood.
 Hemoglobin: 4 molecule of heme (which contains 4 Fe2+ion) + 4 molecules of globin
(Polypeptide chain)
 Blood is red due to heme group.
 Total iron in all RBCs is 2.5 gm which 65% of the total iron in the body.
Hemoglobin
 Each RBC contains 280 (Azmal) or 270 (A. Alim) Millions of hemoglobin molecules.
 33% of the weight of an RBC is hemoglobin.
 1 gm hemoglobin can contain 1.36-1.40 ml oxygen.
 The percent ratio of the volume of RBC to the total volume of blood is called hematocrit.
 Value: In man-45% & in woman -40%
 A RBC travels about 1100 km path in circulation throughout its life span. It travels the whole
body once in 60s or 1 min.
 Lifespan of RBC is 120 days / 4 month.
 Dead RBCs are disintegrated in liver, spleen & bone marrow.
Fate of RBC
 The fragile RBCs towards the end of their lifespan are called poikilocytes.
 Heme group of fragile RBC is stored in the body as ferritin & hemosiderin.
 Pigments convert into bilirubin (a bile pigment)
 Liver and spleen are called the graveyard of RBC.

 Oxygen level decreases or RBC increases in: exercise, pregnancy, bleeding, staying in high altitude, damage
of bone marrow, low Hb.
1
 Erythropoietin 
O2
 That means, if blood O2 level increases, erythropoietin decreases, if blood O2 level decreases, erythropoietin
increases.
 ESR (Erythrocyte Sedimentation Rate): 5mm in 1st hour, 10mm in 2nd hour
 Piling up of RBC one upon another is called rouleaux formation. This is due to strong adhesive power of RBC.
 Nucleus is present in the RBC of camel – 1. There is a doubt in this information [Azmal: 182]
2. It is correct [Alim + Majeda]
 Functions of RBC:
1. Transport of most of the O2 (oxyhemoglobin) and small amount of CO2 (KHCO3).
2. Maintenance of concentration & viscosity of blood.
3. Acts as a buffer and thus maintains acid-base balance.
4. The antigen present in plasma membrane of RBC helps in blood grouping.
5. Produces bilirubin & biliverdin named pigments in blood.
6. RBC produces enzyme like NO which is used as L- arginine of endothelial cell and causes relaxation of
blood vessels.
7. Produces H2S that gives signal for contraction of blood vessels.

 Leucocytes (White blood cells)

 Mature WBC is amorphous, nucleated and Hb is absent.
 Monocyte is the largest blood cell.
 Leucocytes destroy germs by phagocytosis. so, they are called ‘mobile defensive
Structural unit’ of the body.
features  Synthesizes tryptone and fulfill the body’s nutrition, growth and loss of tissue.
 Average diameter 7.5 -20 m.
 They show amoeboid movement.
 The process of squeezing out of neutrophil from blood vessel into the tissue is called diapedesis.
Per L / mm3 blood 4,000 – 11,000 (Avg. 7500), or 5-8 Thousand [Azmal]
6-8 Thousand [Alim]
Count 5-8 Thousand [Majeda]
 Number of WBC increases in sickness and during childhood.
 RBC: WBC = 600:1
The process of formation of WBC is called leucopoiesis or myelopoiesis.
Production
Leucocytes are produced from: bone marrow, spleen, lymph nodes.
Average life Life span: 1-15 days
expectancy
Leukocytosis / Leucocythemia: Increase of numbers of WBC above normal range.
Leucopenia: Decrease of number of WBC below normal range.
Abnormalities
Leukemia: It is a blood cancer in which WBC count is abnormally raised (50,000-1,00,000 /
L) & RBCs get destroyed.

 Types of WBC:
Structurally and functionally WBCs are of two types:
Contain clear cytoplasm and a nucleus which is not lobed. They have no granules in
cytoplasm.
28% of total WBC is agranulocyte.
They are of two types based on their origin:
(i) Monocytes
(ii) Lymphocytes.
1) Agranulocytes.
 Monocyte is the largest blood cell of human body.
 Monocytes are also called rubbish collecting cell.
Monocytes  With age, monocyte nuclei appear like kidney or horse shoe shaped.
 Goes to tissue from blood and takes part in phagocytosis as macrophage.
 Originated from the monoblastic cell of bone marrow.
  Second largest WBC.
 They are called microscopic soldier of body.
 Lymphocytes are produced in the lymphatic, Unlike leukocytes, they are
not phagocyte
 Mostly found in lymphoid tissue (spleen, submucosa of alimentary canal,
thymus, tonsil, adenoid)
 Lymphocyte becomes fibroblast in the area of inflammation and helps in
Lymphocyte wound healing.
 There are 3types of lymphocytes in human blood:
 T cell: Originated from thymocytes of thymus gland. Plays a role in cell
mediated immunity.
 B cell: Originated from bone marrow. Produces antibody. Plays a role in
humoral immunity.
 NK (Natural Killer): Gives quick response to viral infection and remains
active up to 3 days of inflammation. Then NK cell produces tumor.
 Have granules in their cytoplasm.
 72% of WBC is granulocyte.
2) Granulocytes:
 Originated from myeloblast cell of bone marrow.
 They are of 3 types based on colour retention:
 The cytoplasm of neutrophil is fine granular, nucleus is 2-5 lobed,
neutral in color.
 Destroys germs by phagocytosis
 They are sometimes called microphage.
Neutrophil  Dead microorganisms and neutrophils together form pus.
 Among WBC, neutrophils constitute the largest number (40-60%)
 Neutrophils are capable of amoeboid movement and can be present in
infection site and tissue by penetrating capillary wall by shrinking. This
process is called diapedesis.
 Destroys worm larvae entered into the blood and allergic antibody.
 Destroys germs which cannot be destroyed by phagocytosis.
 Plays a role in immunity and hypersensitivity.
 They are found more in alimentary canal than blood vessels.
Eosinophil  The grains turn red in Eosin dye and the nucleus is bi-lobed.
Increases in: ***
 Allergic reaction.
 Parasitic infection
 Diseases of spleen and CNS
 Collagen disease.
 Lowest among WBC
 Secretes heparin & histamine.
 Heparin: prevents intravascular clotting.
Basophil
 Histamine: Helps to increase immunity.
 They become alkaline and turn blue.
 The cytoplasm of these cells are granular, comparatively less alkaline.
 At a Glance Of WBC:
Granulocytes Agranulocyte
Traits
Lymphocyte Monocyte Neutrophil Basophil Eosinophil
Percentage 24% or 25% 4% 60-70% or 70% 0-1% or 5% 1.5% or 2-4%
(%)
Amount / 1500-2700 or 1680 100-700 or 280 3000-6000 or 25-200 or 35 100-400
mm3 4900
Lifespan 7 days or 100-120 2-5 days or 10-12 12 hr.- 3 days or 12-15 days 3-5 days
days days 2-5 days
Nucleus Circular, large, Kidney/ Horse 2-5 lobes (avg. Kidney shaped 2 or 2-3 lobes
non-lobed shoe shaped, 3) & 2 lobes
non-lobed
Cytoplasm Less, bluish More, Bluish Pink, granules Bluish black Bluish,
grey are reddish granules granules are
reddish orange
origin Red bone marrow, Red bone marrow Red bone Red bone Red bone
liver, lymph monoblastic cell, marrow marrow marrow
liver, spleen
Nucleus(small) Nucleus(3 lobed) Bluish Black granule reddish orange granule
Cytoplasm(less)
Cytoplasm Dense
Nucleus(large)

Monocyte
Lymphocyte Neutrophil Basophil Eosinophil
In Eosin dye - - Violet Blue Red
[Ref: Azmal]
WBC

Granulocytes Agranulocytes

Neutrophil Eosinophil Basophil Lymphocyte Monocyte

B-lymphocyte T-lymphocyte NK-cell

 Platelet / Thrombocytes:
 Smallest of all blood cells
 Non-nucleated, contains actin, myosin, glycogen and lysosome in cytoplasm.
Structure  Enriched with protein and huge amount of cephalin (a phospholipid).
 Stored in spleen only.
 They are called cellular fragments.
1.5-4 lacs / mm3 of blood (Azmal) & 2.5-5 lacs / mm3 of blood (Alim); Number of platelets increases
Count
in sick body.
Origin From large megakaryocyte of red bone marrow
 5-9 days [Azmal]
Life span2.5-9 days [Alim]
3-10 days [Maghnad]
At the end of life, platelet is destroyed in spleen and other reticule endothelial cells.
Fate
Generates clotting enzyme thrombokinase.
Thrombocytosis: If the number of platelets in blood is higher than normal.
Thrombocytopenia: If the number of platelets in blood is lower than normal.
[Ref: Azmal, Alim]
 Functions of platelet:
1. Prevents hemorrhage by forming temporary platelet plug.
2. Helps in blood coagulation by the liberation of clotting factors.
3. Helps in clot retraction.
4. If pain occurs in any part of body, platelet secretes chemical substances to attract neutrophil and monocyte.
5. Releases growth factor for the protection of inner endothelial wall.
6. Secretes serotonin which causes contraction of blood vessels in order to reduce hemorrhage.
7. If platelets are present above normal range this can cause unnecessary clotting, even increases the risk of
stroke and heart attack.
8. Stores histamine & 5-Hydroxy tryptamine (5HT)
9. Produces an essential enzyme for blood clotting, thrombokinase.
10. Engulfs carbon particle, immune complex, bacteria, virus by Phagocytosis.
Note: 5HT = Serotonin [Ref: Azmal, A. Alim, Majeda]

1. In embryo, RBC is generated in- [M: 20-21]

A. Thymus B. Pancreas C. Spleen D. Bone marrow Ans. C
2. Blood is – [M: 20-21]
A. Slightly acidic B. Neutral C. Slightly alkaline D. Strongly acidic Ans. C
3. Which one reduces bleeding by contraction of blood vessels? [M: 19-20]
A. Heparin B. Histamine C. Thromboplastin D. Serotonin Ans. D
4. Which one produces and secretes heparin? [M: 18-19]
A. Lymphocyte B. Basophil C. Monocyte D. Neutrophil Ans. B
5. Formation of which corpuscle is known as erythropoiesis? [M: 17-18]
A. Red blood cell B. Platelet C. Plasma D. White blood cell Ans. A
6. Which one is agranulocyte? [M: 15-16; D: 17-18]
A. Neutrophil B. Monocyte C. Eosinophil D. Basophil Ans. B
7. Which cell is non-nucleated? [M: 16-17]
A. Cardiac myocyte B. Nerve cell C. WBC D. RBC Ans. D
8. What is the pH of human blood? [M: 14-15]
A. 5.4 B. 7.4 C. 6.4 D. 8.4 Ans. B
9. In which of the following organs, red blood cells are destroyed? [M: 11-12]
A. Spleen B. Liver C. Stomach D. Kidney Ans. A, B
10. Which cell secretes heparin? [D: 09-10]
A. Neutrophil B. Basophil C. Eosinophil D. Lymphocyte Ans. B
11. Nucleus of which leucocyte is bi-lobed? [D: 09-10]
A. Neutrophil B. Eosinophil C. Monocyte D. Lymphocyte Ans. B
12. Which one of the following is not a plasma protein? [M: 09-10]
A. Tyrosine B. Fibrinogen C. Prothrombin D. Albumin Ans. A
 Blood Coagulation
Blood coagulation: Formation of blood clots to block and then heal a lesion and stop the bleeding.
Thrombosis: Formation of a blood clot inside a blood vessel.
 Normal bleeding time: 1-4 minutes/ 4-5 minutes [Alim]
 Normal clotting time: 3-8 minutes / 4-5 minutes. However, in the case of diabetic patients, it may take more time.
 Total 13 factors are needed for blood coagulation. (12 factors – A. Alim).

4 essential factors:
Factor I Fibrinogen
Factor II Prothrombin
Factor III Thromboplastin
Factor VI Ca2+
 Thromboplastin is absent in plasma in normal state, it is present in platelet.
 Factor XIII helps in formation of fibrin mesh.
 The enzyme plasmin degrades fibrin mesh when regeneration of blood vessel takes place.
 The clear, pale-yellow liquid that is separated from the clot of blood, is called serum. Factor I, II, IV,
VIII are absent in serum. Concentration of serotonin is high in serum.
 Serology: The branch of medical science that deals with serum.

In blood bank, sodium oxalate & sodium citrate are used to prevent coagulation of blood. Sodium citrate is chiefly
used due to some toxic effects of oxalates. One bag contains 450 mL blood.
 Process of coagulation:
1. Thrombocyte of destroyed tissue & free blood.
Exposure to air
2. Thrombocyte  Thromboplastin  Inactivation of heparin
plasma enzyme (Factor VIIVIIIIXX Ca2+) Human Circulatory
3. Thromboplastin + prothrombin  Thrombin System
4. Thrombin + Fibrinogen  Fibrin monomer
5. Fibrin monomer  Fibrin polymer  Fibrin mesh
6. Fibrin mesh + confined RBC & WBC  Blood clot
 Factor of blood coagulation :
Factor Role in coagulation
1. Factor I or Fibrinogen It is globulin protein
2. Factor II or Prothrombin It is a plasma protein. Generated in liver in the
presence of vitamin-K
3. Factor III or Thromboplastin Released from destroyed tissue cell or broken platelet.
4. Factor IV or calcium ion Helps in thromboplastin formation and converts
prothrombin to thrombin.
5. Factor V or Labile factor or proaccelerin * Present in plasma * Protein in nature
* Converts prothrombin to thrombin
6. Factor VI or accelerin (Unstable factor) Does not exist (hypothesized)
7. Factor VII or Proconvertin (stable factor) * Present in plasma
8. Factor VIII or Antihemophilic factor A * Helps in formation of thromboplastin
9. Factor IX or Christmas Factor
10. Factor X or Stuart factor or Antihemophilic factor B Chemical component of this factor is as like as factor VII. In
the absence of this factor blood coagulation is interrupted.
 11. Factor XI or plasma thromboplastin antecedent Plays a role in thromboplastin formation.
12. Factor XII or Hagman factor / Glass factor / Activates kallikrein and increases permeability and
Antihemophilic factor C. expansibility of blood vessels by forming plasma kinin.
13. Factor XIII or Fibrin stabilizing factor Links the fibrin strand together to strengthen the clot
with the help of calcium ion, converts the soft blood
clot into insoluble solid state.
 Difference between plasma and serum:
Plasma Serum
1. Aqueous part of normal blood 1. Aqueous part from blood clot
2. Fibrinogen present 2. Fibrinogen absent
3. Blood cells present 3. Blood cells absent
4. Clotting factors present 4. Clotting factors absent.
5. Present in the lumen of blood vessel and 5. Absent in normal state in body.
chambers of heart.

 Blood does not clot while flowing inside the body. Because-
1. Presence of heparin (a protein).
2. High speed of blood flow.
3. Smoothness of inner wall of blood vessel.
4. Absence of thromboplastin
5. Antithrombin activity of fibrin
6. In normal state, anticoagulants dominant over the procoagulant factors.
7. Abstraction of active procoagulant factors by liver. [Ref: Majeda]

1. Which one is not a principal element of human blood clotting? [D: 17-18]
A. Ca2+ B. Lymph C. Fibrinogen D. Prothrombin Ans: B
2. Normal bleeding time in human is- [M: 16-17]
A. 5-7 min B. 12-14 min C. 1-4 min D. 45-55 min Ans: C
3. Which one has no role in blood coagulation?
A. Fibrinogen B. Prothrombin C. Thromboplastin D. Eosinophil Ans: D
4. Why blood coagulation doesn’t occur within the vessel during blood flow? [M: 09-10]
A. Blood flows slowly B. Presence of water in the blood
C. Rough surface of the vessel wall D. Presence of heparin Ans: D
5. Which one is not a principal element of blood clotting?
A. Fibrinogen B. Prothrombin C. Albumin D. Ca++ Ans: C
Lymph system
 Definition: colorless fluid present in the interstitial space.
 Danish scientist Olaus Redbeck & Thomas Bartholin first described the lymphatic system.
 Lymph volume: 4-8 L (Azmal) or two times of blood, 10-12 liters (A. Alim).
 Lymph is a pale fluid that contains white blood cells and that passes through channels in the body &
helps to keep bodily tissues healthy.
 10% of plasma remains as interstitial fluid around the cells of the body.
 The process of lymph production is called lymphogenesis.
 pH of lymph: 7.4-9
 Specific gravity: 1.01-1.06 (A. Alim)
 Lymph when enrich with fats, obtained from the lacteals of small intestine is appeared as a milky liquid.
At that time, this lymph is called chyle.
 Components of lymph:
Cellular material Acellular material
1. Mainly lymphocyte (Count: 500-75000/ml3) 1. Cellular components:
2. Few monocytes are present. 2. Water: 94%
3. Few RBC 3. Solid substances: 6%
4. Platelets absent  Carbohydrate: Glucose (120 – 132 gm of
glucose per 100 ml of lymph)
 Protein
 Lipid: Chylomicron
 Excretory wastes
 Others
Lymphatic system
It is also called second circulatory system. Lymphatic system has two main parts: lymph vessels and lymph glands.
Afferent  Lymph is transported towards lymph gland through afferent lymph vessel.
lymph vessel:
 It carries lymph from lymph gland to elsewhere.
 There are two main lymph vessels in the body.
Right  Lymph from the right side of the head and neck, right trunk
Lymph Efferent lymphatic & right arm drains into the right lymphatic duct.
vessels: lymph vessel: duct:  Right lymphatic duct opens in the junction of right subclavian
vein & right internal jugular vein.
 Lymph from the whole body except those parts which are
Thoracic primarily drained by right lymphatic duct drains into thoracic
duct: duct (lymph vessels of left side & lower part of the body).
 Thoracic duct drains into junction of the left subclavian vein &
left internal jugular vein.
 Cisterna chyli: The lower bulged portion of thoracic duct.
 Lacteals: The lymphatic vessels of intestinal wall.
 Lymph glands are abundant in neck, arm and groin of human. There are many (400-700) lymph
nodes in the body.
 There are 5 types of lymph glands is the body:
1. Lymph Node  Capsule like structure in the lymphatic vessels.
 Lymph is filtrated in lymph node.
 There are 400-700 lymph nodes.
 They are enriched in macrophage and lymphocyte.
 3types of tonsils are present-
(i) Palatine (ii) Adenoid (Pharyngeal) (iii) Lingual tonsil.
2. Tonsils  The palatine tonsils, commonly referred to as tonsils are covered by pale
reddish mucosa.
 Tonsilitis: Inflammation of tonsil.
 Tonsillectomy: Surgical removal of the tonsils.
 Largest lymphatic organ of the body. Weight is 170gm. Light violet in color.
 It is known as reservoir of blood or blood bank. It can store about 300 ml of
Lymph 3. Spleen blood.
glands:  Spleen acts as the main filter of blood.
 It is also known as graveyard of RBC.
 It is made of 2 types of pulps.
(i) Red pulp
(ii) White pulp
  Thymus is a pyramid shaped soft, bi-lobed organ that is located between
trachea and sternum.
4. Thymus  It remains large and active in children. During puberty, it becomes fat tissue
and in adulthood, it disappears.
(i) It secretes two types of hormones. (i) Thymopoietin, (ii) Thymosin
 T cell or T-lymphocyte: A type of lymphocyte that matures in the thymus gland.
 Sponge like, semi solid, red tissue situated inside bone.
 Stem cells of red bone marrow divide to form blood corpuscles till death.
5. Red Bone
 In children: red bone marrow is found in most of the bones.
Marrow
 In adult: red bone marrow is present in pelvis, vertebrae, sternum, skull,
clavicle, ribs and upper part of femur and humerus.
 Parasitic infection of filarial worm, Wucheria bancrofti causes extreme swelling of lymph vessels and lymph
nodes in the arms and legs. This symptom is referred to as Elephantiasis.
 Swelling up of tissue due to tissue fluid accumulation inside the lymphatic vessels is called edema.

 Difference between blood & lymph:

Traits Blood Lymph
01. Color Red Colorless
02. Flow Flows with specific pressure Flows with no pressure.
03. Composition Plasma, RBC, WBC, Platelet Plasma & WBC
04. Hemoglobin Present Absent
05. Protein, calcium & Phosphorus
More Less
06. Transport Respiratory gas and food particle Waste product and food particle (lipid)
(Carbohydrate, Protein)
 About 90% of the blood in the capillary network is reabsorbed by the process of osmosis.
[Ref: Majeda, Alim]

 Functions of lymph:
01. Transport of protein 06. Immunity
02. Transport of lipid 07. Redistribution of body fluid.
03. Supply of nutrition and O2 08. Preservation of structural integrity of tissue.
04. Absorption 09. Transport of antigen presenting cells (APC).
05. Defense (Lymphocytes & monocytes) 10. Lymph acts as a “mediator” in the body.

 Difference between Plasma and Lymph:

Traits Plasma Lymph
Cell Cell free Lymphocytes (mainly)
Medium of flow Blood vessel Lymphatic vessel
Coagulation Can coagulate Cannot coagulate
Function  Takes part in nutrition, excretion, respiration etc. by  Supplies nutrition to the tissue
transporting various materials. devoid of blood supply.
 Defense mechanism of the body by producing  Take part in fat absorption
antibodies.  Defense mechanism of the body.
 Blood Vessels

Difference between Artery and vein:

Traits Artery Vein
Origin & Termination Origin- in the heart Origin- From capillary tube
Termination- in capillary tube. Termination- in the heart
Direction of blood flow From heart to other parts of the body. From other parts of the body to
heart.
Nature of blood O2 rich (except pulmonary artery). Blood is CO2 rich (except pulmonary vein).
bright red in color. Blood is blackish in color.
Wall More thick and elastic. 3 layered: Less thick and inelastic
(a) Tunica adventitia or externa (connective
tissue)
(b) Tunica media (made of muscle fiber)
(c)Tunica intima (endothelium)
Lumen Small Large
Valve Absent Present (like semilunar valve)
Situation In the deep part of body. In the superficial part of body.
Blood pressure High Low
Pulse Present Absent
When cut Blood comes out excessively Blood doesn’t come out
excessively
Presence of waste Less More
product
 Difference between pulmonary artery and pulmonary vein.
Traits Pulmonary artery Pulmonary vein
Origin Right ventricle of the heart Capillary network of lung
Termination Capillary network of lung Left atrium of the heart
Wall Thick & elastic Thin & inelastic
Valve in the junction of heart Present Absent
Blood pressure More Less
Carries CO2 rich blood from right Carries O2 rich blood from lung to
Function
ventricle of the heart to lung. left atrium of the heart.

 Capillaries:  Made of only single layered endothelium.  Exchanges food particles and CO2 & O2 etc.
through diffusion.
Heart
 The human heart is a hollow muscular organ that pumps blood throughout the blood vessels.
 Heart beats about 2600 million times throughout the life each ventricle pumps 155 million litre blood (1.5 lakh
tons) in a man’s average lifespan.
 Heart pumps about 5-7L per minute, about 7600L per day or 2000 gallons per day.
 Heart beats about 1,00,000 times per day.
 Location: Above diaphragm between lungs (mediastinum) at the level of thoracic vertebrae T5-T8.
 Heart beat starts at the 6th week of embryonic life.
 In male: 250-390gm (0.45% of total body weight) [Azmal sir]
 In female: 200-275gm (0.40% of total body weight)
Weight
 250-350gm (if male / female not differentiated, this [A. Alim]
will be the answer)
 Heart is a reddish or reddish-brown somewhat triangular cone-shaped organ.
Size-  Length: 12 cm & breadth: 8 cm
Shape  Its broader upper end is called the base and narrow blunt end is called the apex.
 Apex is located at left 5th intercostal space.
 Heart is covered by pericardium.
 Serous pericardium is double-layered (visceral & parietal layer).
 Pericardial fluid is present between the 2 layers.
Coverings  Facilitates the contraction of the heart.
Functions of
 Protects heart from extra pressure, temperature and friction.
pericardial
fluid  Keeps the heart wet & moist.
 Regulation of heart beat.
(Pericardium Outer layer. Fat is sparsely connected
1. Epicardium
is not a layer of with this layer.
Wall of
heart, it acts as Middle layer. Plays an active role in
heart: 2. Myocardium
a covering of contraction and distention.
heart) Inner layer. Forms the inner wall of the
3 layers 3. Endocardium
heart and covers the heart valves.
 The human heart is four-chambered (2 atria & 2 ventricles).
 Ventricular wall is thicker than atrial wall. Wall of left ventricle is 3 times thicker than
that of right ventricle.
Heart
 This division of heart is externally visible as coronary sulcus.
chambers
 There are muscular ridges or columns projecting from the inner wall of heart ventricles called
alumnae cornea / trabeculae cornea.
 The valves are attached with papillary muscle by chordae tendinea.
 Features of cardiac muscle:
1. Rhythmic contraction & relaxation.
2. Controlled involuntarily.
3. Mononucleated (centrally placed nucleus).
4. Functional syncytium.
5. Intercalated discs (sarcolemma condenses and forms thick transverse disc).
6. Abundance of mitochondria.
7. Branch randomly and twined with each other, resembling a three-dimensional mesh.
8. Cardiac muscle forms the protective layer of heart. [Ref: Alim]
 Valves of the heart:
Name of the valve Number of Location
cusps / flaps
Bicuspid or mitral valve 2 Junction of left atrium and left ventricle
Tricuspid valve 3 Junction of right atrium and right ventricle
Pulmonary valve (Semilunar) 3 Junction of right ventricle and pulmonary artery.
Aortic valve (Semilunar) 3 Junction of left ventricle and aorta
Eustachian valve 3 Junction of inferior vena cava and right atrium.
Thebesian valve or coronary valve 3 Junction of coronary sinus and right atrium.
[Ref: Azmal, Alim, Majeda]

Major Blood Vessels Number Function

Inferior Vena cava 1 Carries deoxygenated blood from the lower part of the body to right atrium.
Superior Vena cava 1 Carries deoxygenated blood from the upper part of the body to right atrium.
Coronary sinus/ 1 Carries deoxygenated blood from the wall of the heart to right atrium.
Coronary vein
Pulmonary artery 2 Carries deoxygenated blood to lungs.
Pulmonary vein 4 Carries oxygenated blood from lungs to heart
Aorta 1 Carries oxygenated blood from heart to different parts of body
 Endocardium is folded to make valves.
 Superior vena cava (Opens into right atrium) and pulmonary veins (Opens into left atrium) have no valve at
their junction with heart.

1. When first heart beat starts during embryonic life? [M: 21-22]
A. at 10th week B. at 8th week C. at 6th week D. at 12th week Ans. C
2. In human heart, wall of which chamber is the thickest?
A. Left atrium B. Right ventricle C. Right atrium D. Left ventricle Ans. D
3. Which valve of heart does not have three cusps? [M: 18-19]
A. Right atrio- ventricular valve B. Left atrio- ventricular valve
C. Aortic valve D. Pulmonary valve Ans. B
4. Which valve is present at the junction of right atrium and right ventricle of heart? [M: 13-14]
A. Mitral valve B. Tricuspid valve C. Pulmonary valve D. Aortic valve Ans. B
5. Which one divides heart into different chambers? [D: 09-10]
A. Epicardium B. Pericardium C. Endocardium D. Myocardium Ans. C
6. Which of the following is the location of mitral valve? [M: 09-10]
A. At the base of right and left ventricle B. At the right atrio-ventricular aperture
C. At the left atrio- ventricular aperture D. At the opening of the aorta. Ans. C
 Cardiac cycle
 Normal heart rate in healthy adult man is 70-80 (72-75 in average) beats per minute.
 If heart rate is 75 beats per minute, the time required for one complete cardiac cycle is 60/75 = 0.8 sec.
 Systole: Contraction of heart chamber.
 Diastole: Relaxation of heart chamber.
 1 Systole + 1 Diastole = Heartbeat.
 Heart rate in Newborn: 140 150 beats/ min
 Heart pumps 60 – 70 ml blood per beat. This is called cardiac output.
 The average adult heart beats 72 times a minute; 100,000 times a day; 36,00,000 times a year; and 2.5 billion
times during a 70 years span.

Atrium Ventricle
Diastole Systole Diastole Systole
0.7 Sec. 0.1 Sec. 0.5 Sec. 0.3 Sec.
 Different stages of cardiac cycle
Atrial diastole  Bicuspid & tricuspid valve remains closed.
 The 1st half of atrial systole is dynamic phase (0.05 sec.)
Atrial systole  The 2nd half of atrial systole is adynamic phase (0.05 sec)
 Bicuspid valve & tricuspid valve remain open.
Ventricular  Bicuspid & tricuspid valve is closed, semilunar valve opens.
systole  Closure of bicuspid & tricuspid valves produce first heart sound ‘LUB’.
Ventricular  Bicuspid & tricuspid valve opens, semilunar valve closes.
diastole  Closure of semilunar valve produces 2nd heart sound ‘DUB’

Myogenic control of heart beat

 There are some specialized tissues in the heart which are concerned with generation of heart beat and
propagation of impulse. They are called Junctional tissues of heart. They are as follows-

1. Sino- Atrial Node (SAN)

2. Atrio- Ventricular Node (AVN)
3. Bundle of His (BH)
4. Right and left branches of BH
5. Purkinje fiber Conductive system of the Heart

[A. Alim]
 Sino-Atrial Node:
 Discovered by Martin Flack
 Location: In the wall of right atrium laterally to the entrance of superior vena cava.
 It is banana shaped. 10-15 mm in length, 3 mm in width and 1 mm in depth.
 SAN generates action potential which then generates electrical signal as a result heart beat starts.
 That is why SA node is called natural pace- maker.
 SA node is connected with AV node by 3 inter- nodal pathways.
 If the effectiveness of SA node is reduced, it causes tiredness & shortness of breath. This is called
ischemia.
 Atrio- Ventricular Node:
 Location: at the junction of right atrium and right ventricle.
 Conducts cardiac impulse from atrium to ventricle.
 Transmission of cardiac impulse from SAN to AVN takes by 0.15 second.
 It is known as reserve pacemaker. [Ref: Majeda, Azmal]
 Bundle of his: The special tissue of the heart originates from the AV node, extends to the posterior part of the
interventricular septum, and divides into right and left branches, joining the Purkinje fibers of the ventricle. It
receives stimuli from the AV node and transmits them to the ventricular wall.
 Purkinje fibers: These fibers originate from the Bundle of His and form a network in the ventricular wall. The
stimulus from the bundle of his spreads through the Purkinje fiber to the ventricular wall, causing contraction of
the two ventricles. Cardiac impulse spreads fastest and most effectively through Purkinje fibers.

 Sino- Atrial Node (SAN)  Natural pacemaker

 Atrio- Ventricular Node (AVN)  Reserve pacemaker
 Bundle of His (BH)  lies in the interventricular septum. Gives rise to fine Purkinje fibres.
 Contraction starts from the bottom of the heart and spread upwards.
 When a mammal’s heart is detached from its body and left in an O2-rich salt solution at 37C temperature,
the heart beat will continue for sometime without any external stimulation.

Pathway of myogenic control of heart: SAN  AVN  Bundle of His  Purkinje fibers
 Pacemaker rate (beats / min) of different  Duration of signal transmission:
junctional tissues: SAN  AVN 0.3 sec.
AV nodal delay 0.09 sec.
SA node 72 or 70-80 AVN  Ventricle 0.04 sec.
AV node 50 or 40-60 SAN  Ventricle 0.16 sec.
Bundle of His 36 [Ref: Majeda, Meghnad]
Purkinje fiber 30-35

Blood Pressure
 Speed of blood: In artery 40 cm/s & in vein 15 cm/s
 Blood pressure is the lateral pressure exerted by blood per unit area of vessel wall while flowing through it.
 Blood pressure depends on:
(i) Total volume of blood
(ii) Amount of blood ejected from heart
(iii) Viscosity of blood
(iv) Elasticity of artery
(v) Blood pressure measuring device: Sphygmomanometer.
 Pulse oximeter can measure heart rate & O2 level in blood.
 Normal blood pressure:
Blood pressure Alim Azmal
Systolic pressure (Avg. 120 mm Hg) 110-140 mmHg 100-139 mm Hg
Diastolic pressure (Avg. 80 mm Hg) 60-90 mm Hg 60-89 mm Hg
 Pulse pressure: Difference between systolic & diastolic pressure. It is 40 mmHg on average.
 When blood pressure is persistently above the normal level in normal condition, it is called hypertension /
High blood pressure.
 When blood pressure is persistently below the normal level, it is called hypotension / low blood pressure.
 Syncope: Disease due to low blood pressure is known as syncope.
 Abnormal blood pressure: (In mm Hg)
High blood pressure low blood pressure
Systolic >140 Systolic < 100
Diastolic > 90 Diastolic < 60
 Causes of High blood pressure:
1. Genetically inherited.
2. Increase in cholesterol level in blood due to intake of excess lipid-rich food.
3. Decrease in filtration power of kidney due to inflammation of kidney.
4. Increase in sodium ion level in blood due to increase in secretion of adrenaline, aldosterone & glucocorticoid
because of abnormalities of hormonal glands.
5. Excess body weight, obese body
6. Inadequate physical labor
7. Smoking, alcohol drinking or consumption of any other narcotic substance.
8. Anxiety, insomnia, stress, diabetes etc.
 Diseases related to high blood pressure:
 High blood pressure or hypertension is a dangerous disease of modern world.
 Low blood pressure is not as deadly as hypertension / high blood pressure, if the blood pressure drops
enough, various difficulties occur.
 Hypertension can cause various difficulties in human, like: stroke, paralysis, cardiomegaly, heart attack & heart
failure, angina, decreases renal function, visual disturbances (nearsightedness, papilledema, blindness) etc.
Baroreceptor
 Baroreceptors are sensory nerve ending that are stimulated by changes in pressure.
 The central nervous system plays a role in normalizing blood pressure by controlling heart rate and energy in
response to the stimuli that these nerve ending send to CNS by detecting abnormal blood pressure. This whole
process is called baroreflex.
 These are of 2 types:
A. High pressure baroreceptor / Arterial baroreceptor
B. Low pressure baroreceptor / Cardiopulmonary baroreceptor / volume receptor.
A. High pressure baroreceptor: Location: In the aortic arch and carotid sinuses of internal carotid artery.
Blood pressure (BP)  (+)  Stimulated
 (–)  Inhibited
Baroreceptor (+)  – Increase
 – decrease

Carotid Sinus Aortic

arch

Glossopharyngeal Vagus
nerve (ix) nerve (x)

Vasomotor center (–)

Parasympathetic > Sympathetic

Here, Parasympathetic is not increased, rather sympathetic is decreased. Parasympathetic and

sympathetic are like a scale of equal weight, they balance each other. So, if sympathetic
stimulation decreases, parasympathetic stimulation will increase.

Heart Rate (HR) Dilation of blood vessels

Cardiac output (CO) Total Peripheral Resistance (TPR)

Blood Pressure (BP)  [Decreases to normal]

Blood Pressure (BP) = Cardiac output (CO)  Total peripheral resistance (TPR)
  Carotid baroreceptors are not stimulated when the pressure is o to 50-60 mmHg. They are most stimulated
at 180 mmHg pressure.
 Aortic receptors are most effective at 30 mmHg pressure difference.
 High pressure baroreceptor can decrease the blood pressure through a mechanism. It can also increase
blood pressure through opposite mechanism. So, it is called buffer baroreceptor.
B. Low pressure baroreceptor or volume receptor:
 Location: In large systemic veins, pulmonary veins, walls of right atrium and ventricle.
 They regulate blood volume and determine the blood pressure inside the atrium.
 They play a role in both circulatory and renal system.

(R P S)

Right Atrium & ventricle Systemic vein

Pulmonary blood vessels

1. Which one can measure heart and O2 level in the blood? [M:21-22]
A. Pulse oximeter B. Thermometer
C. Sphygmomanometer D. Barometer Ans: A
2. Which junctional tissue of heart is called the pacemaker? [M:19-20]
A. AV node B. Bundle of his
C. Purkinje fiber D. SA node Ans: D
3. What type of baroreceptor helps in blood volume regulation? [M:18-19]
A. High-pressure baroreceptor B. Carotid baroreceptor
C. Low- pressure baroreceptor D. Atrial baroreceptor Ans: C
4. A heart beats 80 times in a min. What is the duration of its cardiac cycle? [D:16-17]
A. 0.05 sec B. 0.75 sec
C. 7.50 sec D. 0.8 sec Ans: B
5. What is the duration of diastole of atrium? [M:10-11]
A. 0.3 sec B. 0.7 sec
C. 0.1 sec D. 0.5 sec Ans: B
6. Which one is not a part of junctional tissues of heart? [D:09-10]
A. Pacemaker B. Myocardium
C. Bundle of his D. Purkinje fiber Ans: B
7. What is the duration of ventricular diastole? [M:09-10]
A. 0.7 sec B. 0.5 sec
C. 0.3 sec D. 0.1 sec Ans: B
 Blood pressure (Bp)  Hypothalamus

Pituitary gland
Blood volume 
Sympathetic nerve (+)

ADH
JG cell of nephron (+)

Water reabsorption in renal tubule

Renin secretion

Blood pressure 

Angiotensinogen (Inactive) Angiotensin I (active)

Angiotensin converting
Enzyme (ACE)

Angiotensin II

Contraction of Increase in H2O & salt Adrenal gland (+)

blood vessel retention in nephron

Aldosterone secretion

Na+ reabsorption
in nephron

Volume of blood

Blood Pressure (BP)  [Increases to normal]

  Angiotensinogen is produced in liver and ACE (Angiotensin converting Enzyme) is produced in lung.
[Ref. Azmal, Majeda, Meghnad]

Blood circulatory system

 The human blood circulatory system is of closed type, i.e. the blood vessels are not open ended.
 Human blood circulatory system is a double circuit circulation system.
 The human blood circulation is of 4 types:
01. Systemic circulation:
 Systemic circulation is the part of the cardiovascular system which carries oxygenated blood away from
the heart to the body, and returns deoxygenated blood back to the heart.
 It takes 25-30 seconds for the blood to complete one cycle in systemic circulation.

Left ventricle  Aorta  Organs  Vena cava  Right atrium  Right ventricle

02. Pulmonary circulation:

 The circulation in which blood reaches lung from right ventricle of the heart and returns back to right
atrium from lung is called pulmonary circulation.
 Pulmonary circulation commences from pulmonary artery, and pulmonary artery is originated from right ventricle.

Right ventricle  Pulmonary artery  Lung  Pulmonary vein  Left ventricle  Left atrium

03. Hepatic Portal circulation:

 In vertebrates, two types of portal circulation (i. e) (hepatic and renal) are seen.
 But renal portal circulation is absent in various mammals including human being.
 So, human has hepatic portal circulation.

Visceral organs hepatic portal vein  Liver  Hepatic vein  Inferior vena cava  Heart

 Importance of hepatic portal circulation:

 Absorbed simple food (glucose, amino acid, fatty acid etc) reaches liver form alimentary canal through
portal circulation.
 Nitrogenous waste product ammonia is converted to urea in liver and urea is excreted by kidney.
 Liver synthesizes plasma proteins and supplies them in blood.
Hepatic portal system:
Lino gastric vein Collects blood from stomach & spleen.
Coeliac vein Collects blood from stomach & intestine. [coeliac artery supplies stomach]
Duodenal vein Collects blood from duodenum and pancreas
Mesenteric vein Collects blood from different parts of intestine.
04. Coronary circulation:
 In this circulation, O2-rich blood is supplied to heart wall through artery which is originated from the root of
systemic artery and CO2-rich blood returns from heart wall through coronary vein.
Systemic artery coronary artery  Heart wall coronary vein Right atrium
 Blood flow is different in different tissues of the body.
Liver : 1350 ml/min (the highest)
Kidney : 1100 ml/min (2nd)
Brain : 700 ml/min (3rd)
 380 liters (100 gallons) of blood are pumped to the heart by coronary circulation, which is about 5% of the
total blood pumped by the heart.
[Ref: Alim]
 1. Blood flow is the highest in which organ? [M: 21-22]
A. Kidney B. Brain C. Liver D. Intestine Ans: C
2. Which one is not a part of pulmonary circulation? [M: 15-16]
A. Lung B. Right ventricle C. Aorta D. Left atrium Ans: C
3. Difference between systolic and diastolic pressure is called- [M: 09-10]
A. Osmotic Pressure B. Basal Pressure C. Mean Pressure D. Pulse Pressure Ans: D

Chest Pain

Types of chest pain Symptom/causes

1. Pleurisy
2. Pneumonia
3. Pulmonary embolism
4. Costochondritis
5. Rib fractures, muscle
strain
6. Nerve compression
7. Gall stones
8. Anxiety and panic attacks.
Pleuritis due to viral infection (inflammation of the pleura of the lungs)
Bacterial infection in lung: pleural pain
Entrance of clotted blood from veins of pelvic region or veins of lower limb to
lung, generation of pulmonary infarction, heavy chest pain and cough.
Inflammation in the junction of cartilage of ribs and sternum  Chronic chest
pain.
Heavy chest pain, difficulty in movements, difficulty in coughing.
Bone pressure in nerve root, pain in the back and upper part of the abdomen.
Pain in chest, back and upper part of abdomen.
Chest pain for a few minutes to a few days, frequent breathing, dizziness etc.

Cardiovascular disease

 Cardiovascular disease (CVD) also called heart disease is a class of diseases that involve the heart, the blood
vessels or both.
 CVDs are the number one cause of death globally. Cardiovascular disease includes.
 Diseases of the heart:
 Diseases of arteries supplying the heart, cardiac muscle and valves.
 Diseases of blood vessels.
 Congenital heart disease.
 Angina
 It is a chest pain due to problem in the heart.
 It is also known as angina pectoris.
 Angina is considered a precursor to heart attack.
1. Stable angina Pain is present during exertion or extreme emotional distress. The pain
goes away when you rest.
2. Unstable angina Pain occurs at rest. This angina occurs when arterial lumen is
Types 90-99% narrowed. This type of angina is an early symptom of heart
attack.
3. Prinz metal’s Pain occurs at rest, when sleeping or when exposed to cold
angina temperatures.
Causes  Narrowing of lumen due to deposition of high level of cholesterol in coronary artery.
 If O2 level decreases, anaerobic respiration occurs in cardiac muscle. As a result, lactic acid is
produced and accumulation of lactic acid causes pain.
 It can occur in 55 years old man and 65 or more than 65 years old woman.
 Pain of angina lasts 5 – 30 minutes.
Symptoms  Pain occurs in the chest behind the sternum.
 Pain may spread to neck, shoulder, jaw, teeth, arm and back.
 Indigestion and nausea
 Frequent breathing.
 Heaviness of shoulder and arm
 Sweating, dizziness, pale appearance of body
Treatment To decrease pain following measures should be taken-
 Patient should take rest
 Use of glyceryl trinitrate under the tongue
 Patient should take medicine
Heart Attack
 A heart attack occurs when blood flow to a part of heart is blocked for a long enough time that part of
the heart muscle is damaged or dies. The medical term for this is myocardial infarction.
 If high level of cholesterol accumulates in the inner wall of coronary artery, O2 supply stops. As a result, heart attack occurs.
 Normal cholesterol level in blood: 150 – 200 mg/dl or 150 – 200 mg/ 100 ml blood.
 Heart attack occurs when
 Blood platelet activity increases
 Blood fibrinogen & factor VIII increases
 In 75% of diabetic patients, no chest pain occurs during heart attack.
 Frequency of heart attack is maximum at late night and before 9 A. M.
 If heart beat doesn’t start within 5 minutes of heart attack, blood supply to the brain stops and the patent dies
within 5 minutes. This is known as ventricular fibrillation.
 Symptoms:
1. Chest discomfort, heavy and intolerable chest pain. 2. Discomfort in the other areas of upper body. 3. Frequent breathing.
4. Nausea 5. Sleep disturbance. A common symptom of heart attack is profuse sweating or cold sweat.
 Various tests to diagnose heart attack:
a) ECG b) Echocardiography c) Cardiac MRI d) Coronary angiogram e) Chest X-ray (radiograph)
 Vulnerable age:
 Man  More than 45 years.
 Woman  More than 55 years.
 Main 5 causes of heart attack:
1. Smoking 2. High blood pressure 3. Diabetes 4. Presence of excess fat in the blood 5. Positive family history.
 Treatment:
 When heart attack occurs, Angised tablet is given under the tongue immediately. It is a type of nitroglycerin.
 If serious condition occurs, 300 mg Aspirin is given. Aspirin maintains the fluidity of blood and prevent blood clotting.
 Some Beta blockers, anticoagulants are used. Like: Aspirin, Clopidogrel, Atenolol, Propranolol.
 Heart failure
 Heart failure is the condition when the heart loses its ability to pump blood efficiently through the
body.
 High cholesterol
 Diabetes
 Excess alcohol and smoking
 Ischemic heart disease, heart attack, cardiomyopathy
 Heart rhythm disturbances
 Endocrine disorders
Causes  High blood pressure
 Over work
 Obesity
 Diseases of the heart valves
 Hereditary
 Severe anemia
 Infection
 Shortness of breath together with a reduction in mobility (due to edema in lung)
 Shortness of breath occurs in any manual labor
Left sided  A dry cough may develop that doesn’t go away
heat failure  Fatigue
 Muscle weakness
Symptoms  Weight loss
 Swelling in the legs (edema)
Right sided  Edema may lead to dry skin on the lower part of the legs.
heat failure  There may be an eczema-type rash on legs, which can be complicated by ulcers
that do not heal.
 Accumulation of fluid in the abdominal cavity and organs.
[Ref. Azmal, Alim]
Diagnosis of heart diseases
 Doctors can easily diagnose heart diseases by the following symptoms-
1. Increase in heart rate 2. Heart murmurs 3. Swelling in the legs 4. Swelling in the neck vein 5. Hepatomegaly etc.
Test Usage / Importance
Chest X-ray To know about the condition of heart
ECG Preliminary diagnostic test of heart disease
Coronary angiogram To know if there is any block in coronary artery
MRI To know about the condition of cardiac muscle
BNP (Brain Confirmatory diagnostic test of heart failure
Natriuretic Peptide)
Investigation
ETT (Exercise To know about the condition and functional ability of heart
tolerance test)
Echocardiogram To understand the condition and functional ability of heart
Cardiac enzymes High level of Troponin, CK-MB (Creatine kinase- Muscle and Brain)
indicate heart attack. Troponin-I test is the confirmatory diagnostic
test of heart attack.
Pulse Oximeter Body’s blood oxygen concentration and heart rate measuring device.
Treatment 1. Lifestyle modification
(3 types) 2. Medicine (Angiotensin converting enzyme inhibitor, Angiotensin receptor blocker,  blocker)
3. Other treatments should be continued.
[Ref. Alim]
*** MRI: Magnetic Resonance Imaging
 Abnormalities of heart beat:
Abnormality Out come
Arrythmia Heart rate becomes slow, quick or irregular.
Tachycardia Heat rate becomes faster than normal (160 – 200 beats / in in adult)
Bradycardia Heart rate becomes slower than normal (less than 60 beats/mins)
Heart block Heart rate drops down to 30 – 40 beats / min.

Concept of treatment of heart disease

Pacemaker
 William Chardack and Wilson Greatbatch invented implantable artificial pacemaker in 1969.
 4 parts:
(i) A lithium battery (lifespan: 7 – 10 years)
(ii) A computerized generator
(iii) Amplifier
(iv) Wires with sensors
 Insulated 1 – 3 wires are present in pacemaker. Wires of pacemaker are called pacing leads. Sensors are called electrodes.
 Pacemaker weighs about 30 – 130 gm.
 Irregular heart beat (Arrhythmia) can be controlled by artificial pacemaker.
 Artificial pacemaker is of 3 types:
Single – chamber pacemaker Lead is attached to right atrium or right ventricle.
Dual – chamber pacemaker Leads are attached to right atrium and right ventricle.
Triple- chamber pacemaker Leads are attached to right atrium, right ventricle and left ventricle.
 The parts of pacemaker are confined in a box made of Ti. Pacemaker is usually placed below the left
clavicle in between the skin and muscle.
 1 – 5 watts / min electricity is required to keep the heart active.
 Digital pacemaker can observe temperature of blood, rate of respiration and heart rate.
Open Heart Surgery
 It was invented by Dr. Wilfred G. Bigelow of the University of Toronto in 1950.
 Coronary bypass, also known as coronary artery bypass graft (CABG) surgery is a surgical procedure in which one or more
blocked coronary arteries are bypassed by a blood vessel graft to restore normal blood flow to the heart.
 Doctors use open heart surgery to:
1. Perform a coronary artery bypass graft (CABG)
2. Repair or replace heart valves, which control blood flow through the heart.
3. Repair abnormal or damaged structures in the heart.
4. Implant medical devices that help to control the heart beat or support heart function and blood flow.
5. Replace a damaged heart with a healthy heart from a donor.
 Open heart surgery is done in 3 (Azmal) / 4 (Majeda) ways:
1. On-pump surgery:
 A heart-lung machine is used.
 The Surgeon operates on an inactive heart which does not contain blood. Inactive heart means heart beat is absent.
 This is the traditional type of open heart surgery.
2. Beating heart or off-pump surgery:
 Heart-lung machine is not used.
 The surgeon operates on an actively beating heart.
 Heart beat is slowed by medicine or some other means. It is also known as OPCAB Surgery.
3. Minimally invasive surgery: It is also known as MIDCAB surgery. [Majeda]
4. Robot – assisted surgery: Subtle and accurate.

Another name of heart-lung machine = Cardio-pulmonary bypass, Pump oxy generator.

 Coronary bypass surgery (CABG)
 Yellowish lipid material (cholesterol) can be accumulated in coronary artery. Fiber accumulates in this matter
and makes it harder. Then it becomes calcareous matter. This process is called arteriosclerosis. Accumulated
matters are called atheromatous plaques.
 When the lumen of coronary artery becomes 50-70% narrow, there is a decrease in O2-rich blood flow to the
cardiac muscle and chest pain (Angina) is felt.
 If lumen of coronary artery becomes 90-99% narrow – unstable angina occurs.
 Coronary bypass surgery is a surgical procedure in which one or more blocked coronary arteries are bypassed
by a blood vessel graft (like: Great saphenous vein of leg, internal mammary artery, radial artery of wrist)
to restore normal blood flow to the heart.
 It takes 3-5 hours for bypass surgery. Heart – lung machine is used in most cases.
 OPCAB (Off Pump Coronary Artery Bypass): OPCAB surgery allows surgeons to perform surgery while the
heart is still beating. The heart-lung machine is not used.
 MIDCAB: The surgeon performs the surgery through a small incision (about 3 inches) in the chest.
[Ref. Alim]

Angioplasty
 Angioplasty or coronary angioplasty is a treatment to widen narrowed sections of the coronary arteries.
 Angioplasty was first performed by Dr. Andreas Gruntzig.
 It can be done in treatment of angina, heart attack, heart failure etc.
 4 types of angioplasty:
i. Ballon angioplasty ii. Laser angioplasty iii. Coronary atherectomy iv. Coronary stenting: It is very
much useful for weak coronary artery.
 If balloon and stenting method are used simultaneously, the probability of reappearance of plaques decreases.
 Stenting was first performed by Dr. Ulrich Siegwart.
 A coronary angioplasty usually takes 30-40 minutes.
[Ref: Azmal, Alim]

 ICD – Implantable cardioverter defibrillator

 ICU – Intensive care unit
 PCI – Percutaneous coronary intervention
 CABG – Coronary Artery Bypass Grafting [Ref: Azmal, Alim]
 Stroke
 Stroke is a serious life threatening medical condition that happens when the blood supply to the part of the brain
is cut off.
 A ruptured blood vessel can also cause stroke.

 Clot formation in any cerebral artery due to accumulation of cholesterol.

 Uncontrolled contraction of any cerebral artery due to high blood pressure.
 Intake of high lipid and cholesterol-rich food.
Causes
 Uncontrolled diabetes, chronic kidney disease.
 Smoking or drinking alcohol.
 Sedentary lifestyle, old age, obesity, stress etc.
 Severe headache, restlessness, physical weakness, insomnia, nausea, swelling of blood vessels of
both sides of the neck.
Symptom
 Stroke can cause amnesia, expressive aphasia, loss of consciousness, paralysis, bleeding through
nose and mouth, even sudden death of a patient.

1. For what purpose, “Heart-Lung Machine” is used? [M:17-18]

A. Angioplasty B. Coronary bypass surgery
C. Blood pressure control D. Pacemaker implantation Ans: B
2. Which device is used for measuring O2 concentration of blood and heartbeat? [M:16-17]
A. Thermometer B. Sphygmomanometer
C. Pulse-oximeter D. Barometer Ans: C
3. Which one is the preliminary test to diagnose cardiac disease? [M:16-17]
A. Angiogram B. Lipid profile C. ECG D. ETT Ans: C
4. How can you diagnose a narrow coronary artery? [D:16-17]
A. Echocardiogram B. Angiogram C. ETT D. ECG Ans: B
5. What is the main cause of anemia in the world? [D:16-17]
A. Deficiency of Vit-C B. Deficiency of iron
C. Congenital D. Deficiency of Vit-B12 Ans: B
6. Which one is not a coronary heart disease? [M:08-09]
A. Angina pectoris B. Myocardial infarction
C. Unstable angina D. Stroke Ans: D
1. Which factor plays a role in fibrin mesh C. 0.2 sec D. 0.25 sec
formation? 16. AV node is connected to SA node by how many
A. XIII B. VIII internodal pathways?
C. Ca2+ D. V A. 2 B. 3 C. 4 D. 5
2. Which one preserves structural integrity of 17. Which one is the location of high-pressure
tissue? baroreceptor?
A. Blood corpuscle B. Plasma A. Pulmonary vessel
C. Lymph D. All of the above B. Wall of right ventricle
3. Amount of water in lymph is- C. Transverse aortic arch
A. 85% B. 90% D. Large systemic vein
C. 94% D. 90-92% 18. Which one is the pulse pressure in adult man?
4. Amount of blood flow through heart is- A. 40 mm Hg B. 50 mm Hg
A. 1200 L B. 7600 L C. 60 mm Hg D. 80 mm Hg
C. 1600 L D. 1800 L 19. If blood pressure increases, signal goes to
5. Which one plays an active role in contraction medulla from aortic baroreceptor by which
nerve?
and dilation of heart?
A. Glossopharyngeal B. Vagus
A. Epicardium B. Myocardium
C. Trigeminal D. Fascial
C. Endocardium D. All of the above
20. Which artery supplies blood to the stomach?
6. In female, weight of heart is- A. Brachial artery B. Phrenic artery
A. 300 gm B. 100 gm C. Mesenteric artery D. Coeliac artery
C. 200 gm D. 400 gm 21. Which one is the number one cause of death
7. Which one is the strongest muscle of heart? globally?
A. Pericardium B. Myocardium A. Heart disease B. Pneumonia
C. Endocardium D. Epicardium C. Diabetes D. All of the above
8. Which one is the location of bicuspid valve? 22. Pain of angina lasts for-
A. At the junction of right atrium & right ventricle A. 2 – 15 min B. 15 – 25 min
B. At the junction of left atrium & left ventricle C. 5 – 30 min D. 10 – 25 min
C. At the junction of coronary sinus & right atrium 23. Which one helps in diagnosis of preliminary
D. At the junction of aorta and left ventricle heart disease?
9. Which one is connected to right atrium of heart? A. ETT B. Angiogram
A. Systemic aorta B. Pulmonary aorta C. X-ray D. ECG
C. Superior & inferior D. Pulmonary vein 24. Angina is considered a precursor to-
vena cava vena cava A. Heart failure B. Stroke
10. Which one is the heart rate in adult man? C. Heart attack D. A+C
A. 60 – 70 B. 75 – 85 25. Which one is not a symptom of heart attack?
C. 70 – 80 D. 80 – 90 A. Chest discomfort B. Nausea
11. Which one is the duration of cardiac cycle?
C. Slow breathing D. Sleep disturbance
A. 0.3 sec B. 0.5 sec C. 0.1 sec D. 0.8 sec
Answer
12. What is the duration of atrial systole?
A. 0.3 sec B. 0.7 sec C. 0.1 sec D. 0.8 sec 01. A 02. C 03. C 04. B 05. B 06. C 07. B
13. 1st heart sound ‘Lub’ is generated in which 08. B 09. C 10. C 11. D 12. C 13. B 14. C
phase? 15. B 16. B 17. C 18. A 19. B 20. D 21. A
A. Ventricular diastole B. Ventricular systole
22. C 23. D 24. C 25. C
C. Atrial systole D. Atrial diastole
14. Which one is the location of pacemaker? 26. In embryo, which one is the amount of RBC in
A. Left atrium B. Right ventricle per cubic mm of blood?
A. 80-90 lacs B. 70-80 lacs
C. Right atrium D. Left ventricle
C. 60-70 lacs D. 50-60 lacs
15. Time needed to reach cardiac impulse from SAN
27. How much hemoglobin is present in 100 ml of
to AVN is-
blood?
A. 0.1 sec B. 0.15 sec
 A. 16 gm B. 16 mg C. Tonsil D. Thymus
C. 90 gm D. 90 mg 40. Which one prevents outward rotation of heart
28. Which one is agranulocyte? valve?
A. Eosinophil B. Neutrophil A. Papillary muscle B. Intercalated disc
C. Basophil D. Monocyte C. Chordae tendinea D. Pacemaker
29. Which one increases in allergic reaction, 41. What is the duration of atrial diastole?
parasitic infection, diseases of spleen and CNS? A. 0.7 sec B. 0.1 sec C. 0.5 sec D. 0.3 sec
A. Basophil B. Eosinophil 42. Where does volume receptor send signals?
C. Lymphocyte D. Monocyte A. Pons B. Medulla
30. Which blood corpuscle produces immunoglobulin? C. Hypothalamus D. Pituitary gland
A. Monocyte B. Lymphocyte 43. Which one is the confirmatory diagnostic test of
C. Platelet D. Basophil heart failure?
31. Which one is the normal bleeding time? A. ETT B. ECG
A. 1-4 sec B. 3-8 sec C. BNP D. Angiogram
C. 3-8 min D. 1-4 min 44. Which one is not a part of mechanical pacemaker?
32. Apex of the heart is located in which intercostal A. Lithium battery B. Generator
space? C. Lead D. Switch
A. 4th B. 5th 45. Unstable angina occurs when lumen of coronary
C. 6th D. 7th artery becomes_______ % narrow?
33. Which valve is present in between coronary A. 50 – 70% B. 90 – 99%
sinus and right atrium? C. 80 – 90% D. 70 – 80%
A. Bicuspid B. Thebesian 46. Angioplasty is of _____ types?
C. Tricuspid D. Eustachian A. 2 B. 3
34. In leukemia, which blood corpuscle increases C. 4 D. 5
abnormally? 47. Which one is the confirmatory diagnostic test of
A. RBC B. WBC myocardial infarction?
C. Platelet D. Thrombocyte A. ECG B. MRI
35. Which one is true in case of blood clotting factor? C. BNP D. Troponin-I
A. Factor I : Fibrin 48. Signal goes to brain from aortic baroreceptor by
B. Factor II : Ca2+ which nerve?
C. Factor III : Thromboplastin A. Glossopharyngeal B. Vagus
D. Factor IV : Thrombin C. Abducens D. Intercostal
36. Which metallic ion takes part in blood coagulation? 49. Which one is the elaboration of PCI?
A. Ca2+ B. Cu2+ A. Periarterial carotid intervention
2+
C. Mg D. Fe2+ B. Percutaneous coronary invention
37. The percent ratio of the volume of RBC to the C. Percutaneous coronary intervention
volume of blood is called- D. Percutaneous carotid invention
A. Hematopoiesis B. Erythropoiesis 50. Which one is not a type of angina?
C. Hematocrit D. Leucopenia A. Stable angina B. Unstable angina
38. How many platelets are present in 1 ml of blood? C. Prinz metal angina D. Cardiothoracic angina
A. 100 thousands B. 150 thousands 26. A 27. A 28. D 29. B 30. B 31. D 32. B
C. 250 thousands D. 400 thousands 33. B 34. B 35. C 36. A 37. C 38. C 39. B
39. Which one is the largest lymph gland in human
body? 40. C 41. A 42. C 43. C 44. D 45. B 46. C
A. Liver B. Spleen 47. D 48. B 49. C 50. D
 Effusion : Accumulation of fluid
Paranasal sinus : Air filled spaces within the bones of our face that open up into the nasal cavity.
Otitis media : Inflammation of the middle ear.
Acute : Severe but duration is short.
Chronic : Prolonged.
Respiratory pigment : Pigments which help in respiration
Tidal volume : The volume of air that moves into or out of the lungs during a normal breath.
Bronchitis : Inflammation of the bronchus

Respiratory system
 Respiration:
 Special type of biological and oxidative process where food substance is oxidized.
 Potential energy of living cell is transformed into kinetic and heat energy.
 CO2 and H2O are released as by-product and oxygen is used.
 Chemical reaction of respiration:
Enzyme
C6H12O6 + 6O2  6CO2 + 6H2O + 38 ATP (686 Kcal)

The respiratory system can be divided into following parts:

Human respiratory system

Upper respiratory tract Lower respiratory tract Respiratory zone

(Inhalation and (Air conduction region)
exhalation region)

Area of entry & exit of air Area of air conduction

1. Anterior nostrils 7. Trachea 10. Respiratory Bronchiole
2. Vestibule 8. Bronchi 11. Alveolar Duct
3. Nasal cavity 9. Terminal Bronchiole 12. Atrium
4. Posterior nostrils 13. Alveolar sac
5. Nasopharynx 14. Alveolus
6. Larynx
[Ref: Alim]
 Overall functions of respiratory system:
1. Exchange of respiratory gas CO2 and O2 2. Production of energy.
3. Water balance: 400 – 600 ml (Azmal) or 600-800 ml (Alim) of water is daily removed from body by respiratory
system. 4. Heat regulation.
5. Control of pH or acid-base balance. 6. Generation of sound.
7. Homeostasis. 8. Excretion of volatile gas (Chloroform, Ether, Ammonia).
9. Prevention of entry of pollutants. 10. Purification of blood and prevention of sluggishness of circulation.
11. Regulation of hormone & ion concentration.
[Ref: Azmal, Alim]
 Structure & Function of different parts of Respiratory System
 Nose:
 It is a hollow organ made of bones, cartilages, muscles and connective tissue situated above mouth cavity.
 Different Parts of the Nose:
Parts Function Work
 The two holes situated at the front of the nose is  Air enters and exits the body
Anterior Nostril/
called anterior nostrils. through this.
External Nostril
 Always remain open.
 2 nostrils are separated by nasal septum.
Vestibule  Inner part of nose posterior to nostrils.  The hairs filter air.
 The inner wall of vestibule contains many hairs.
 The part after the vestibule  Makes the entering air humid.
Nasal Cavity
 Ciliated wall the wall of nasal cavity contains  Dust and germs are trapped in
mucous secretory and olfactory cells. ciliated nasal mucosa.
 Olfactory cells receive sensation
of olfaction.
Posterior Nostrils /  The two orifices at the end of nasal cavity that  Air enters the pharynx through
Internal Nostrils opens into nasopharynx. These are called it.
‘choanae’.
[Ref: Azmal, Majeda]
 Nasopharynx:
 It is situated after posterior nostrils.
 It is the common part of alimentary tract and respiratory tract.
 After this the oro-pharynx is located.
 At the upper part of the backside Uvula is present.
Function: Air moves into larynx and food material moves into esophagus through nasopharynx.
 Larynx:
Length: In male: 4.4 cm and in female: 3.6 cm
Position Situated just below the hyoid bone at the 4th, 5th, 6th cervical vertebral (C4 – C6) region.
Name &  Arytenoid (2), Corniculate (2), Cuneiform (2), Thyroid (1), Cricoid (1),
Number Epiglottis (1)
Thyroid Thyroid is the largest cartilage of larynx and in male it bulges forward at the
cartilage throat. It is called “Adam’s Apple”.
Cartilage
Epiglottis is tongue shaped which covers/closes the larynx during swallowing.
Epiglottis
It is formed by elastic cartilage.
Glottis The thin opening between the vocal cords at the top of the larynx.
 In laryngeal cavity, there are 6 elastic vocal cords.
Vocal cord
 The pitch of the tone depends on tension of vocal cords and distance between them.
Function Vibration of vocal cord produces sound.
* C  Cervical vertebrae [Ref: Azmal, Alim, Majeda]
 Trachea:
 It is also known as wind pipe.
 The tube extends from next to the larynx up to 5th thoracic vertebra.
 It is a hollow tube which is composed of 15-20 in number, “C” shaped (semicircular) hyaline cartilage.
 It is 12 cm long and 2 cm wide.
 Inner wall of trachea has ciliated mucosal covering. It also has Goblet Cell.
 Trachea doesn’t collapse due to presence of hyaline cartilage.
Functions:
 The air enters and leaves the body easily through trachea as it doesn’t collapse.
 The cilia of inner wall of trachea prevents entry of unwanted foreign particles. (Dust particle, food particle,
bacteria)
 Bronchi:
 Trachea divides into Rt. & Lt. bronchi at the level of 4th – 5th thoracic vertebra. (T4  T5). The point at
which trachea divides into bronchi is called Carina.
 Rt. bronchus is wider but shorter than Lt. bronchus.
 Rt. bronchus is divided into 3 branches and Lt bronchus is divided into 2 branches.
 The branches of bronchus are called bronchioles.
 Bronchioles are of two types: respiratory bronchioles and terminal bronchioles
 Inflammation of bronchus is called bronchitis. Bronchitis is also known as English disease.
Function: Air is transported from trachea to lungs through bronchi.

* T  Thoracic Vertebrae

 Different organs of human body, whose length is 12 cm.

Hearts Problem causes Kidney Failure
  
Heart, Trachea Kidney Fallopian tube Rectum

 Differences between epiglottis and uvula:

Epiglottis Uvula
Part of larynx Part of soft palate
Made of elastic cartilage Made of muscles
Prevents food particles from entering into the Prevents food particles from entering into nasal cavities
larynx

Lungs
Site 2 lungs are situated in the thoracic cavity above the diaphragm at the two sides of heart.
Appearance Sponge like, light pink colored soft organ.
Functional unit Alveolus / Lobule
Covering  Covered by a bilayered covering named Pleura.
 Outer layer is parietal pleura, inner layer is visceral Pleura.
 There is a fluid named ‘serous fluid’ present in between the 2 layers.
 Serous fluid protects the lungs from frictional injury.
Weight Right and left lung together weigh approximately 2.9 pounds.
Hilum  The portion of lung through which bronchus enters into it.
 Artery enters and vein and lymphatics exit the lungs through hilum.

Pulmonary root  Bronchus, blood vessels and lymphatics are together covered by connective tissue
or lung root membrane and form pulmonary root or lung root.
 The lungs are suspended in thoracic cavity by means of pulmonary roots.
[Ref: Azmal, Majeda]
 Traits Right lung Left lung
Size Large (weight: 625 gm) Small (weight: 565 gm)
Lobe 3 2
Fissure 2 (Horizontal fissure & oblique 1 (oblique fissure)
fissure)
Broncho-pulmonary segment 10 8
Cardiac notch Absent Present
[Ref. Azmal, Majeda]

 Bronchial tree:
Trachea

Primary bronchus (Enters each lung)  (Total: 2)

Secondary bronchus (Enters each lobe)  (Total: 5)

Tertiary bronchus (Enters each segment)  (Total: 18)

Terminal bronchiole

Respiratory bronchiole

Alveolar duct

Atria

Alveolar sac

Alveolus

 The path of motion of airflow in respiratory system:

Trachea  Bronchus  Bronchiole  Alveolar duct  Atrium  Alveolar sac  Alveolus
 Alveolus
Alveolus is gaseous sac which is the structural and functional unit of lung and region of
Definition
exchange of respiratory gases (O2 and CO2)
 In lungs of an infant: 20 millions
Number  In children of 8 years: 300 millions [Azmal]
 Total number in adults: 480 millions Range: 274-790 millions [Alim]
Diameter 0.2 mm [Alim]
Thickness of wall 0.2 m / 0.1 m
Composition of  The wall of alveoli is made of simple squamous epithelium.
wall  The wall is elastic due to presence of collagen & elastin.
Surface area All alveoli together form about 11,800 cm2 respiratory surface area.
 Alveolar wall is surrounded by numerous capillary blood vessels.
Capillary
 These capillaries arise from pulmonary artery & together form pulmonary vein.
1) Type-I alveolar cell Helps in gaseous exchange.
2) Type-II alveolar cell (septal cell) Secretes surfactant.
Cells: 5 types of 3) Alveolar macrophage Has phagocytic ability.
cell are present
4) Endothelial cell
5) Red blood cell

 The wall of bronchiole is non-cartilaginous.

 Bronchi filters air.
 More smooth muscles are present in bronchiole.
 Bronchus & bronchiole both are lined by ciliated columnar epithelium.
 Total length of capillaries present in human lung is 1600 km.
 Alveolar macrophage degenerates due to smoking and SiO2.

 Surfactant:
 A detergent like phospholipid compound called “surfactant” is secreted from type-2 epithelial cells or septal
cells of alveolar wall which decrease surface tension of the alveolar wall.
 The chemical compound of surfactant is dipalmitoyl lecithin.
 Secretion of surfactant starts at the 23rd week (5th month) of intra-uterine life (Gestation).
 For this reason, before 24 weeks the embryo is not independent or viable.
 If surfactant is not produced, children face a disease related to shortness of breath. It is RDS (Respiratory
Distress Syndrome)
Function:
(i) Reduces surface tension of fluids in alveolar wall. Prevents collapse of the alveoli. Thereby facilitates
inspiration and expiration.
(ii) Helps in rapid exchange of O2 & CO2.
(iii) Kills/destroys microorganisms. [Ref: Azmal, Alim]
 Function of lung:
1. Lung is the principal respiratory organ in human.
2. In alveolus of lung, respiratory gas exchange occurs through diffusion.
3. Different types of protein, fat and carbohydrates are synthesized in lung.
4. Lung excretes respiratory waste product (CO2) from the body.
5. It helps in temperature regulation, water balance and sound production.
6. Lung tissue releases serotonin and histamine.
7. It secretes immunoglobulins. It converts angiotensin I into angiotensin II.
8. Lung tissue synthesizes and removes brandy kinin and prostaglandins.
9. It inactivates Adrenaline and Nor-Adrenaline. [Ref: Alim]
 Section through lung:
 The interior of the section contains numerous bubblelike alveoli.
 Alveoli are separated by membranes called trabeculae.
 Air ductules or bronchioles with numerous fine cilia are seen.
 Blood vessels are located between the alveoli and bronchioles. [Ref: Azmal]
 Air holding capacity of lungs:
Quantity/
Subject Definition
Volume
The amount of air that goes into the lungs during normal 500 ml
Tidal Volume breathing of the amount of air that comes out of the lungs (at rest)
during exhalation.
Inspiratory Reserve The extra volume of air that can be inspired with maximal 2-3.3 liters
Volume effort after reaching the end of a normal, quiet inspiration.
The extra volume of air that can be expired with maximum 1000 ml
Expiratory Reserve
effort beyond the level reached at the end of a normal, quiet
Volume
expiration. Its quantity reduced in Asthma.
Functional residual capacity is the volume of air present in the 1500 ml
Residual Volume lungs at the end of passive expiration. Its quantity increased
in Emphysema.
Normal 4500 ml
Vital Capacity Total air holding capacity of the lungs
The runner 6000 ml
[Ref: Alim]
Physiology of respiration
Respiration is a complex process. It has 2 phases: External respiration and internal
respiration
i. External respiration: The process by which gaseous exchange occurs in lungs.
ii. Internal respiration: The exchange of O2 and CO2 between blood and tissue & production of energy by
oxidation of food in cell.
 Difference between internal and external respiration:
Traits External respiration Internal respiration
1. Nature It is a physiochemical process. It’s a biochemical process.
2. Site Occurs in lungs Occurs in cell & blood
3. Role of enzyme No enzyme is required Enzyme plays essential role
4. Steps Inspiration and expiration Gas transport, Glycolysis, Krebs cycle etc.
5. Energy No energy is produced Energy is produced.
[Ref: Alim]
Regulation of Respiration
Human breathing mechanism is controlled in 2 ways:
i. Neurological control
ii. Chemical control
Respiratory centre is located in the medulla and controls the basic rhythm of breathing.
 Neurological control: Breathing is controlled from 4 centers located in the brain.
a. Inspiratory center or the Dorsal Causes inspiration
Medulla oblongata respiratory group of neurons.
(lateral side) b. Expiratory center or the ventral Causes expiration
respiratory group of neurons.
c. Pneumotaxic center Controls respiratory type & rate.
Decreases inspiration
Pons (Lateral side) d. Apneustic center Stimulates inspiration center.
Inhibits expiratory center.
Interrupted by pneumotaxic & stretch receptor.
[Ref. Azmal, Alim]
Inspiration and Expiration process
 Inspiration process at rest: Expiration process at rest:

Nerve impulse Nerve impulse through Nerve impulse Nerve impulse

through phrenic intercostal nerve through phrenic through intercostal
nerve nerve nerve

Diaphragm Impulse isn’t

Intercostal muscle transmitted to Impulse isn’t
diaphragm transmitted to
intercostal muscle
Contraction of
diaphragm Contraction of intercostal
(Vertical diameter of the muscle
thorax increases) The volume of the
thoracic cavity Impulse isn’t
decreases transmitted to
longitudinally intercostal muscle
Transverse diameter
of the thorax
Overall, increase
increases
vertical diameter of
thoracic cavity Relaxation of Relaxation of
diaphragm intercostal muscle
(Vertical (Transverse
diameter of the diameter of the
thorax decreases thorax decreases)
Volume of lung is
increase
Overall, decreases in the diameter of
thoracic cavity
Volume of lung is
increase Volume of the lung is
decreased
Air enters lung
from external Air exits lung to external
environment environment
 Some information:
Inspiration is an active process.
 Expiration is a passive process.
 Eleven pairs of intercostal muscles are present.
 Composition of inhaled air: O2  20.9% and CO2  0.04%
 Composition of exhaled air: O2  13.7% and CO2  5.2%
 According to modern ideas, respiration is regulated by some neural networks named Pre-brotzinger
complex located in medulla. They display pacemaker activity. They are located just above the medullary
center.
 Respiratory muscle  Diaphragm and intercostal muscle
[Ref: Ashraf, Alim]

[Ref. Alim]
Chemical regulation of respiration
 Never centers are sensitive to the concentration of O2, CO2 & H+ (pH) in blood. They detect these chemicals
and send signal to respiratory centre.
 Chemoreceptors are located in aortic arch carotid and aortic bodies of circulatory system and in respiratory
centers of brain. They play a role in respiration.
 The main chemical stimulus that controls respiration is the concentration of CO2 in blood in comparison with
the concentration of O2.
 0.25% increase of CO2 concentration in air  Respiratory rate will be double.
 Decrease of O2 concentration in air from 20% to 5%  Respiratory rate will be double.
 Chemoreceptors are stimulated by increased CO2 in blood, lack of O2, increased H+ concentration.
 Increased CO2 stimulates apneustic center.
 The rate of respiration is determined by the concentration of CO2 in blood and CSF.
[Ref: Azmal, Alim]

 The volume of thoracic cavity is increased or decreased by the action of 2 types of muscles.
(i) Diaphragm (ii) Intercostal muscle
 Basic rhythm of respiration is controlled by medulla oblongata.
 Inspiratory & expiratory centers communicate with intercostal muscle by intercostal nerve, with diaphragm by
phrenic nerve.
 Signal is sent to the brain from bronchi & bronchiole of lungs by vagus nerve.
 Carbonic anhydrase enzyme stimulates inspiration.
 Respiratory rate in infants: 40 breaths/min.
 Respiratory rate in adult in resting state: 14-18 (Azmal) or 16-18 (Alim)
 1 gm Hb contains 1.36-1.37 ml O2 (Ashraf)
 1 gm Hb bears 1.34 ml O2 (Parvin)
 Humans yawn as a response to low O2 level in blood, and thereby receives more oxygen.
[Ref: Azmal, Alim, Majeda]
Reflex action

Reflex action nerves Information

Stimulation of mucous membrane of nasal cavity initiates this
Sneezing reflex Olfactory nerve
reflex. Signal transmitted to brain by olfactory nerve.
If any foreign particle enters trachea, then mucous membrane of
Cough reflex Vagus nerve trachea is stimulated and this initiates cough reflex by vagus
nerve.
Gag reflex or Glossopharyngeal If the swallowing is impaired, the nerve of pharyngeal wall
pharyngeal reflex nerve glossopharyngeal nerve initiates this reflex.
Reflex action as a result of contraction and dilatation of lung.
Hering Breuer reflex Vagus nerve The rhythm of respiration is regulated by this reflex. Signal is
transmitted to brain by vagus nerve.
[Ref: Alim]
Gaseous Transportation

 O2 transportation:
i. As physical solution: 0.2 ml O2 in every 100 ml blood is transported or physical solution (2% of total
transport)
 The dissolved part is responsible for creating 100 mm Hg pressure.
ii. As chemical compound:
 About 98%. of total O2 is transported in the blood or chemical compound.
 O2 combines with hemoglobin to form an unstable reversible compound called oxyhemoglobin.
 19 ml O2 is transported n 100 ml blood. 1 hemoglobin molecule can carry 4 molecules of O2.
 In raised pH level of blood, affinity of hemoglobin to O2 is increased.
 Hb4 + 4O2  4HbO2. This reaction occurs very rapidly. In less than 0.01 second.
 Temperature, pH & diphosphoglycerate of RBC influence this reaction.
 CO2 transportation:
CO2 level in blood is 23-29 mEq/L. CO2 is transported in 3 ways by blood-
i. As physical solution:
 Nearly 5% of total CO2
 CO2 dissolves in plasma and is transported as simple carbonic acid solution.
 1 molecule of CO2 within 1000 is transported as physical solution (carbonic acid).
 CO2 + H2O  H2CO3. Carbonic anhydrase enzyme catalysis reaction.
 This enzyme is found only in RBC.
ii. As carbamino compound:
 About 27% of CO2 is transported as carbamino compound. (In Majeda Maam’s book 10%)
 In 100 ml blood 3 ml is transported as carbamino compound.
 Among which 2 ml as. Carbamino-hemoglobin & 1 ml as carbamino-protein.
iii. As bicarbonate compound:
 65% (85% Majeda) of total CO2 is transported by this way. Among this:
✓ As NaHCO3 in plasma.
✓ As KHCO3 in RBC

 Hamburger shift/Chloride shift: Shifting of HCO–3 from RBC to plasma and equimolar Cl from plasma to
RBC is called Chloride shift or Hamburger’s reaction. It was trust discovered by Hartog Jacob Hamburger.
[Azmal, Alim, Majeda]
 Partial pressure of O2 in alveolar air is 104 mm Hg.
 Partial pressure of O2 at pulmonary capillary is 40 mm Hg.
 O2 is diffused into capillaries from alveolus until the pressure of O2 at capillaries becomes 100 mm Hg.
 Partial pressure of CO2 at capillary blood: 46 mm Hg.
 Partial pressure of CO2 in alveolus: 40 mm Hg.
[Ref: Azmal, A. Alim]
O2 O2
Alveolus  Capillaries of alveolus  RBC
O2

CO2 CO2
 RBC  Tissue/cell

4 factors influence the gas exchange:

(i) Volume, thickness and structure of respiratory surface.
(ii) Partial pressure of O2 & CO2 in alveolus.
(iii) Solubility of O2 & CO2.
(iv) Physiological relationship between gas in alveolus & blood. [Ref: Alim]

Cellular respiration
 It is completed in 4 steps:
Step Location Reaction
Glycolysis Cytoplasm Breakdown of 1 molecule glucose produces 2 molecules
pyruvic acid.
Pyruvate oxidation Cytoplasm Pyruvic acid joins with co-enzyme and forms acetyl coA.
Kreb’s cycle Mitochondrial ATP & H+ are formed from acetyl-coA and oxalo-acetate
matrix
Oxidative Inner ATP and water are formed from ATP.
phosphorylation/Electron mitochondrial
transport system membrane
[Ref: Majeda]
 Respiratory pigment: The 4 most common respiratory pigments are:
Pigment Example Pigment Example
Mollusca &
Hemoglobin Vertebrates Hemocyanin
Arthropoda
Hemoerythrin Sipunculids, Brachipods Chlorocruorin Polychaetes
[Ref: Abdul Alim]
 Hemoglobin:
 Chemical formula of hemoglobin in (C712 H1130 O245 N214 S2 Fe)4 and molecular weight is 64,450D.
 The heme and globin exist in the blood at the ratio of 1:25. 33.33% of heme is iron (Fe).
 Each hemoglobin molecule consists of 5% Heme (iron containing pigment) & 95% globin (polypeptide protein)
 One molecule of hemoglobin consists of 4 heme unit and 4 polypeptide chain.
  Total iron in human blood is only 4-5 gm.
 Due to presence of 4 heme group in 1 hemoglobin molecule, it can add 4 oxygen molecule by 4 ferrous ion
(Fe2+).
 Hemoglobin mainly plays a role in oxygen transport. It transports O2 from oxygen rich area to oxygen lack
area.
 So, it is called Robin hood molecule. It also plays some role in CO2 transport.
 Hemoglobin is measured by haemoglobinometer.
[Ref: Azmal, Alim]

01. Internal respiration- [M: 22-23]

A. Is carried out in cell and blood B. Creates a definite amount of energy
C. Is not stimulated by enzyme D. Is a chemical process Ans. A, B
02. Which one is the amount of CO2 in inspired air? [M: 20-21]
A. 5.2% B. 13.7% C. 20.0% D. 0.4% Ans. Blank
(Correct: 0.04%)
03. Oxygen is transported from alveolus to blood through which method? [M: 20-21]
A. Osmosis B. Respiration C. Transpiration D. Diffusion Ans. D
04. Gas exchange takes place in which part of respiratory system? [M: 19-20]
A. Trachea B. Bronchiole C. Alveolus D. Bronchus Ans. C
05. Which one is not a medium of CO2 transport in blood? [M: 18-19]
A. Carbonic acid B. Bicarbonate compound
C. Carbon monoxide D. Carbamino compound Ans. C
06. Which of the following is not a region of air conduction in the respiratory system of the human body
[M: 18-19]
A. Trachea B. Bronchus C. Terminal bronchioles D. Alveolar duct Ans: D
07. Surfactant is found in – [M: 17-18]
A. Larynx B. Respiratory duct C. Alveolus D. Bronchus Ans: C
08. What is the respiratory rate of an adult at rest? [D: 17-18]
A. 20-25 min B. 14-15 min C. 7-10 min D. 30-40 min Ans. B
09. Which is Adam’s Apple found? [D: 16-17]
A. Larynx B. respiratory duct C. Bronchus D. Lungs. Ans: A

Problems of Respiratory Tract

Problem of respiratory tract: 2 types of respiratory tract infection are seen (RTI):
(1) Upper RTI:
 Nose, ear, sinus and throat are usually affected.
 Common cold, Tonsilitis, Sinusitis, Laryngitis, Otitis media (ear) etc.
 Main symptom is cough.
(2) Lower RTI:
 Manly infection of trachea & lungs.
 Flu, Bronchitis, Pneumonia, Tuberculosis etc.
 Main symptom is cough.
[Ref: Azmal, Alim]
 Sinusitis

Paranasal sinuses are air filled spaces within the bones of our face that open into nasal cavity.
There are 4 pairs of sinuses:
 Humans have four pairs of sinuses (paranasal). These are-
Name Location
1. Maxillary sinus Maxillary region (cheek)
2. Frontal sinus Above the eyes (Front of the forehead)
3. Ethmoidal sinus In between two eyes (Above the nose)
4. Sphenoidal sinus Behind ethmoidal sinus (Near to forehead)
 Inflammation of sinus due to virus, bacteria or fungal infection or allergy is called sinusitis.
 According to durability, sinusitis is of 2 types:

Type of sinusitis Durability

Acute sinusitis 4 to 8 weeks.
More than 8 weeks or 2 months/ More than 2/3
Chronic sinusitis
months (Majeda)
[Ref: Azmal, Alim, Majeda]
 Cause of disease:
1. Sinusitis occurs by attack of viruses (Human respiratory syncytial virus, Parainfluenza virus, Corona virus
and Influenza virus), bacteria (Streptococcus pnemoniae, Haemophilus influenza, Morazella catarrholis)
or fungi (Aspergillus and Mucor species).
2. If nasal bone is curved, due to nasal polyp formation.
3. Due to the cold, allergy.
4. From infection of teeth.
5. Due to abnormality of eustachian tube.
6. Due to cystic fibrosis.
 Complications of sinusitis:
1. Inflammation of brain can cause meningitis, brain abscess.
2. Inflammation of eye can cause orbital & periorbital cellulitis.
3. Convulsion, blindness may occur.
[Ref. Azmal, Majeda]

Otitis Media
 Inflammation of the middle ear is called otitis media.
 If for some reasons, germ comes to the middle ears through eustachian tube causes inflammation, then the
condition is called otitis media.
 Children are more affected than the adults.
 Cause of disease:
 Otitis media occurs by mainly viruses (Respiratory syncytial virus, Influenza virus, Rhino virus), bacteria
(Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) or by fungi.
 When eustachian tube is swollen and closed.
 Swelling of the adenoids.
 Children have low immunity. So, otitis media occurs due to the cold or infection in the ear.
[Ref. Azmal, Alim]
 In case of children there are 3 types of otitis media. (Azmal- 2 types)
1. Acute otitis media Last for 2-4 weeks.
2. Chronic otitis media Lasts for 1 month or more
3. Adhesive otitis media Ear drum get attached with any part or bones of middle
ear.
 Most affected group:
1. Children of 4 months- 4 years age.
2. In day care centers or this type of place where many children grow up together.
3. Children who are bottle fed in low lying position.
4. Children who live in areas where air pollution and cigarette smoking is common.
5. If a family member is affected children of that family is at risk. [Ref. Azmal]
 Complications:
1. Mastoiditis: If the inflammation is spread out to mastoid bone.
2. Meningitis: If the inflammation is spread out to meninges of brain & spinal cord.
3. Perforation of tympanic membrane.
4. Fluid secretion from middle ear through perforation.
5. Deafness
6. Delaying in gaining verbal communication skill of the children due to impaired hearing.
 Cure:
1. Taking Antibiotic, using Antihistamine type medication, paracetamol may be used as a pain reliever.
2. Putting warm mineral oil in ear, putting warm compress on ear.
3. Taking modern treatment with tympanostomy tube. If the ear drum ruptures then Myringoplasty is done.

Otitis Inflammation of the ear. Otitis media Inflammation of the middle ear.
Otitis externa Inflammation of the Otitis interna Inflammation of the inner ear.
external ear.

Bad effects of smoking

 About 4000 chemicals are present in a cigarette stick. Cigarette smoke contains about 500 types of
harmful chemicals. The most damaging components are- nicotine, tar, carbon monoxide, arsenic, methane,
ammonia, hydrogen cyanide etc. They mainly create complications and other problems of human respiratory
organs.
1. Nicotine and tar present in cigarette smoke cause lung cancer, carbon monoxide causes bronchitis.
Bronchitis is also called English disease.
2. Smoke causes rupture of the alveolar wall. This results in increased alveolar volume, reduced elasticity and
some point of alveolus burst and form space in the lung. As a result, respiratory surface area is markedly
reduced and creates huge complications in gas exchange. This condition is called emphysema.
3. Carbon monoxide reduces affinity of hemoglobin to O2. As a result, less oxygen is carried by the blood. It
also helps in cholesterol deposition in arterial wall. This increases risk of stroke and heart attack due to
blockages of the blood supply.
4. Risk of oral, throat & esophageal cancer is 5-10 times more in the smokers.
5. Women who smoke are more likely to be infertile.
6. Due to long term smoking, it causes COPD (Chronic Obstructive Pulmonary Disorder)
[Ref. Azmal, Majeda]
 Respiratory complications due to air pollution
1. Cold-cough: There is possibility of cold-cough if abnormal dust is present in the air.
2. Pneumonia: Diplococcus pneumoniae can cause pneumonia. Symptoms are- cough, shortness of breath,
chest pain, fever.
3. Tuberculosis: Mycobacterium tuberculosis bacteria can cause tuberculosis B.C.G vaccine must be given
to a child for the prevention of tuberculosis.
4. Asthma: This disease is not caused by any germs. Dust intake can cause asthma. Main symptom is
shortness of breath.
5. Pleurisy: Each lung is covered by pleura. When it is inflamed, it swells up and there is accumulation of
lymphatics in breathing due to heavy pain. This fluid pus limits the overall movement of affected lung.
Fever occurs in pleurisy. It is relieved by penicillin.
6. Bronchitis: Inflammation of the bronchus causes bronchitis. Symptoms are- fever, whooping cough,
shortness of breath. [Ref. Majeda]
 X-ray of human lung compared to smoker and non-smoker lung:
Traits Lung of non-smoker Lung of smoker
X-ray images of the lungs show a clear The black spots on the lungs become
Black &
distinction between black spots and indistinct.
white spot
white spots.
X-ray of Lung and Alveolar wall looks Lung and alveolar wall thinning is
Wall
normal and healthy observed in X-ray.
Lung X-ray shows no signs of X-ray images of the lungs show signs of
Emphysema
emphysema. emphysema
Tumor Tumor growth can’t be seen. Small tumor growth can be seen.
A lung X-ray shows uniform X-ray image of the lungs shows the
Transparency
transparency of the alveoli. absence of cilia in the alveolar wall.
No cancerous cells on lung X-ray. Lung X -rays often show signs of
Cancer cells
cancerous cells.
[Ref: Alim]

01. Which one is not a para-nasal sinus? [M: 16-17]

A. Frontal sinus B. Maxillary sinus C. Sphenoidal sinus D. Occipital sinus Ans. D

 CPR (cardiopulmonary resuscitation): If due to accident inspiration expiration or heart-beat of a person stops
then to keep the person alive this process is immediately applied. The person who applies CPR is called rescuer.
 Process of conducting artificial respiration:
1. Mouth to Mouth
2. Mouth to Nose
3. In case of children putting mouth over both nose and mouth
4. Putting mask on patient
5. Putting a balloon type mask on patient
6. By using ventilator
 Respiratory quotient: The ratio of O2 & CO2 gas exchange during respiration is called Respiratory
quotient.
01. Which % of total O2 is dissolved in the plasma 14. Which paranasal sinus is absent in human?
and transported as physical solution? A. Maxillary sinus B. Frontal sinus
A. 0.1% B. 0.3% C. Ethmoidal sinus D. Mandibular sinus
C. 2.0% D. 10.1% 15. Which reflex is originated by vagus nerve?
02. Alveolus turns into which color due to smoking? A. Coughing reflex B. Gag reflex
A. Whitish B. Reddish C. Tendon reflex D. Sneezing reflex
C. Yellowish D. Blackish 16. Which one is the partial pressure of O2 at alveolus?
03. How long does the treatment of chronic sinusitis last? A. 44 mm Hg B. 104 mm Hg
A. 1-2 weeks B. 2-3 weeks C. 87 mm Hg D. 10 mm Hg
C. 3-4 weeks D. 4-8 weeks 17. Internal respiration mainly occurs in which
04. Another name of posterior nostril is- region of cell?
A. Choana B. Vestibule A. Plasma membrane B. Nucleus
C. Larynx D. Vocal cord C. Mitochondria D. Cell vacuole
05. Which one is the lining epithelium of alveolar wall? 18. O2 is transported in the blood mainly as which
A. Non ciliated columnar compound?
B. Ciliated columnar epithelium A. Carbamino compound B. Bicarbonate compound
C. Cuboidal epithelium C. Physical solution D. Oxyhemoglobin
D. Squamous epithelium 19. Vocal cord is present in which part of respiratory system?
06. How many pairs of paranasal sinuses are present? A. Pharynx B. Larynx
A. 3 B. 5 C. Epiglottis D. Bronchus
C. 4 D. 6 20. In human, thoracic and abdominal cavity are
separated by which one?
07. Septal cell is present in which part of respiratory system?
A. Glisson’s capsule B. Pleura
A. Nasal cavity B. Vestibule
C. Peritoneum D. Diaphragm
C. Trachea D. Alveoli
21. Sodium bicarbonate is transported in the blood by-
08. In hemoglobin, which ion helps in transport of oxygen?
A. Plasma B. Red blood cell
A. Fe3+ B. Cl
C. Lymph D. White blood cell
C. Na+ D. Fe2+ 22. Which nerve causes contraction of the diaphragm?

09. In chloride shift, Cl ion is replaced instead of A. Occulomotor B. Auditory
which ion? C. Phrenic D. Vagus
A. Na+ B. SO2–
4 23. Surfactant starts to be released from-
A. 21 weeks B. 22 weeks
C. HCO– 3 D. NO–3 C. 23 weeks D. 24 weeks
10. H2O + CO2  H2CO3; which one is the catalyst 24. In which region of respiratory system, oxygen &
in this reaction? carbon dioxide exchange takes place?
A. Dehydrogenase B. Transferase A. Tracheole B. Trachea
C. Carbonic anhydrase D. Carboxylase C. Bronchus D. Alveolus
11. Alveoli are separated by- 25. The maximum amount of air a person can inhale
A. Pleura B. Vermis after a maximum exhalation is called-
C. Falciform ligament D. Trabeculae A. Vital capacity B. Tidal volume
12. How much iron is present in adult human blood? C. Tidal air D. Residual volume
A. 4-5 gm B. 3-4 gm Answer
C. 7-8 gm D. 1-2 gm 01. C 02. D 03. C 04. A 05. D 06. C 07. D
13. Which one contains pneumotaxic center? 08. D 09. C 10. C 11. D 12. A 13. C 14. D
A. Cerebrum B. Lung 15. A 16. B 17. C 18. D 19. B 20. D 21. A
C. Pons D. Carotid body 22. C 23. C 24. D 25. A
26. How many segments are present in left lung? 39. Which one is called Robin Hood molecule?
A. 10 B. 8 A. Antibody B. Hemoglobin
C. 6 D. 4 C. RBC D. WBC
27. Which part of respiratory system produces 40. Which one is absent in pulmonary root?
sound?
A. Artery B. Vein
A. Lung B. Bronchus
C. Larynx D. Trachea C. Lymphatic duct D. Trachea
28. Inflammation of ear is called- 41. Which one is the diameter of lung alveolus?
A. Sinusitis B. Otitis A. 0.1 m B. 0.1 mm
C. Pleurisy D. Emphysema C. 0.2 mm D. 0.2 m
29. Inflammation of lung is called- 42. Which cell is absent in alveolar wall?
A. Otitis media B. Sinusitis A. Type-I alveolar cell B. Type-II alveolar cell
C. Pneumonitits D. Emphysema
C. Macrophage D. Columnar epithelium
30. Olfactory cell is present in which part of the
human respiratory system? 43. Which one is not a respiratory pigment?
A. Nasal cavity B. Vestibule A. Hemoglobin B. Hemocyanin
C. Nasopharynx D. Alveoli C. Chlorocyanin D. Chlorocruorin
31. The heme and globin exist in the blood at the 44. Which part of bronchial tree takes part in gas
ratio of- exchange?
A. 1 : 25 B. 1 : 33 A. Secondary bronchus B. Tertiary bronchus
C. 15 : 3 D. 25 : 1 C. Terminal bronchiole D. Alveolar duct
32. One molecule of Hb is made of how many
45. Which one is the amount of hemoglobin in RBC?
polypeptide chains?
A. 25 B. 33 A. 27% B. 30%
C. 4 D. 10 C. 33% D. 37%
33. Which one is not the inflection of lower 46. Which blood cell helps in oxygen transport?
respiratory tract? A. Lymphocyte B. Monocyte
A. Pneumonia B. Tuberculosis C. Erythrocyte D. Thrombocyte
C. Tonilitis D. Flu 47. Which one is the functional unit of lung?
34. Which one is called ‘voice organ’? A. Trachea B. Bronchiole
A. Lung B. Nasal cavity C. Alveolar duct D. Alveolus
C. Bronchi D. Larynx
48. Cartilage is absent in which one of the
35. Which one is the main respiratory organ in
human? followings?
A. Lungs B. Trachea A. Bronchus B. Trachea
C. Nostrils D. Vestibule C. Bronchiole D. Larynx
36. How many ferrous ions are present in each 49. Intracellular food is oxidized by which gas?
hemoglobin molecule? A. Hydrogen B. Oxygen
A. 3 B. 2 C. Carbon dioxide D. Ammonia
C. 4 D. 1 50. Which part of respiratory system acts as a filter?
37. Which one causes lung cancer?
A. Anterior nostril B. Trachea
A. Chloroform B. Ammonia
C. Nicotine D. Carbon monoxide C. Nasal cavity D. Vestibule
38. Which one is the elaboration of CPR? Answer
A. Coronary pulmonary resuscitation 26. B 27. C 28. B 29. C 30. A 31. D 32. C
B. Cardiopulmonary resuscitation 33. C 34. D 35. A 36. C 37. C 38. B 39. B
C. Continuous percutaneous resuscitation 40. D 41. C 42. D 43. C 44. D 45. C 46. C
D. Coronary percutaneous resuscitation 47. D 48. C 49. B 50. D