Professional Documents
Culture Documents
PAPERS (SOLVED)
2004-2012
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SPECIAL SENSES
Mechanism:
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4:convergance of eyeballs
Nervous mechanism:
Afferent pathway :
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>and supply medial rectus
2:When excess retinal ,it is converted back into Vit.A and vice
versa .
Deficiency of Vit. A :
1:Outcome of Vit.A deficiency is Night blindness.
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4:It can be reversed in less than 1 hour by intravenous
injection of Vit. A.
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annual)
a.What is the cause of this disorder?
Vit.A deficiency
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of Rhodopsin ?
3:Much of the retinal of both rods and cones will have been
converted into Vit.A .
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1:If a person remains in the darkness for a long time , the
retinal and opsins in the rods and cones are converted back
into light sensitive pigments.
2:Furthermore,Vit.A is converted back into retinal to increase
light sensitive pigments , the final limit being determined by
the amount of opsind in the rods and cones to combine with
the retinal.This is called dark adaptation.
Significance:
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light .
MYOPIA
b:What is the cause of this error?
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lens , which will diverge rays.
3:These two oppose each other and thereby cause the entire
ossiculay system to develope increased rigidity , thus greatly
reducing the ossicular conduction of low frequency sound ,
mainly frequencies below 1000 cycles per second.
Significance:
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1:To protect the cochlea from damaging vibrations caused by
excessive loud sound.
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The articulation of the incus with the stapes causes the stapes
to push forward on the oval window and on the cochlear fluid
on the other side of window.
Significance:
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and perceptive deafness?(2004 annual)
Difference:
1:Rinne´s Test
2:Weber´s Test
3:Audiometry
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emergency reveals no auditory damage of deficit . Few
minutes later she has no complaint of hearing loss.
Prepared by :
Ayesha Arshad and Arshia Anjum
FMH College Of Medicine and Dentistry
Lahore.
NEUROPHYSIOLOGY
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Q:What are the features of upper motor neuron lesion?Give
one example of the lesion?
Ans:Features:
a)-Paralysed muscles are rigid(spastic paralysis)
b)-Deep reflexes are exagerrated(Hyper-reflexia)
c)-Abdominal and cremasteric reflexes are lost
d)-Plantar reflex becomes Babinski,s sign
e)-No wasting or little wasting of muscles
f)-Reaction of degeneration is absent
Example
Cerebral Palsy
Ans:Functions of CSF:
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i)-Acts as shock absorber
ii)-Acts as cushion between soft and delicate brain and rigid
cranium
iii)-Acts as a fluid buffer
iv)-Acts as a reservoir to regulate contents of cranium.
Ans:Tactile Receptors:
i)-Free nerve endings
ii)-Expanded tip endings
iii)-Merkel,s discs
iv)-Spray Endings
v)-Ruffini,s Endings
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vi)-Kraus,s endings
vii)-Meissner,s Endings
Ans:Analgesia System:
Brain can supress input of pain signals to the nervous system
by activating a pain control system,called the analgesia
system.
Components:
i)-The periaqueductal and periventricular areas of the
mesencephalon ant upper pons surround the aqueduct of
Sylvius and portions of the 3rd And 4th ventricles.Neurons
from these areas send signals to:
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ii)-The Raphe Magnus Nucleus, a thin midline nucleus located
in the lower pons and upper medulla and the nucleus
reticularis paragiganto cellularis.From these second order
signals are transmitted to:
iii)-A pain inhibitor complex located in the dorsal horns of the
spinal cord.
i)-Periventricular area
ii)-Medial forebrain bundle
Main transmitter substances involved are :
Enkaphalin and Serotonin
Enkaphalin is believed to cause both presynaptic
and post-synaptic inhibiton of incoming type C
and type A delta fibers.
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Area of the brainstem causes an extreme degree of analgesia
Ans.Functions:
i)-Planning and fine tunning of skeletal muscle contraction
ii)-Maintainance of posture and performance of voluntary
muscles
iii)-Facilitates smooth and co-ordinated voluntary movements
iv)-Ensures that force,contraction and extent of movements
are accurate.
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Q-Write the effects of sympathetic stimulation
on thoracic and abdominal viscera?
ORGAN EFFECT
HEART MUSCLES
Increased Rate
coronaries
Increased Force of
contraction
Dilated(beta
2),Constricted(alpha)
LUNGS
Bronchi Dilated
Mildly Constricted
Blood vessels
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kidney Decreasd urine output and
increased renin secretion
Bladder
The pathway for eliciting the flexor reflex passes first into the
spinal cord interneuoron pool of neurons and only
secondarily to the motor neurons.The shortest possible
curcuit is a 3 or 4 neuron pathway,however most of the
signals of the reflex transverse many more neurons and
invovle the following basic types of curcuits
i)-Diverging curcuits to spread the reflex to the necessary
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muscles for the withdrawal
ii)-Curcuits to inhibit the antagonist muscles
Q-What is the motor and sensory loss at and below the level
of hemisection of the spinal cord.
Ans:Effects at the level of lesion:
On the Same side:
Sensory Loss:
Complete anaesthesia to all forms of senses,because post
nerve root,post horn cells and lat and ventral spinothalamic
tracts crossing to the opposite side are all lost
Motor disturbances:
Paralysis of lower motor neuron type due to
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Damage to ant horn
On the opposite side:
Sensory Loss:
Nil or very slight
Motor Loss:
Nil or slight due to damage to small direct pyramidal fibers
of same side
ON OPPOSITE SIDE:
Sensory disturbances:
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Some loss of pain sensations.
Motor disturbances:
Nil or very slight.
Ans:Functions:
i)-Planning and fine tunning of skeletal muscle contraction
ii)-Maintainance of posture and performance of voluntary
muscles
SUPPLY 2006
Q-What is the nerve supply of the muscle spindle?How is it
stimulated?Enemurate its functions?
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Motor Innervation:
*The end portions of the intrafusal fibers are innervated by
gamma fibers
*Extrafusal fibers are innervated by alpha fibers
SENSORY INNERVATION:
Two types of sensory endings are found in the
STIMULATION:
i)-Lengthening of the whole muscle
ii)-Contraction of the end portions of the spindles of intra-
fusal fibers
Functions:
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i)-Muscle spindle constituets a feedback device that operates
to maintain muscle length
ii)-Simplest menifestation of muscle spindle function is stretch
reflex
iii)-Dynamic and static respons of muscle spindle performs
dampning function
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iv)-Plantar reflex is normal
v)-Marked wasting of muscles
vi)-Reaction of degeneration is present
vii)-Fasciculations
viii)-Small area of body is affected
Thalamic Syndrome:
It is a collection of symptoms resulting from damage of PLV
nucleus of thalamus due to occlusion of thalamo-geniculate
artery.
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*Effects occur on opposite side of body
*Loss of fine sensations
*Loss of crude sensations
*Exaggeration of pain sensations
*Hyptonia
*Chorea and athetosis
ANNUAL 2007
Q-Name the motor areas in the cerebral cortex.What are the
functions of Broca,s area?What is the effect of lesion in this
area?
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and larynx.
Effect of lesion:
It causes motor aphasia.The person is capable of
deciding what he wants to say but cannot make the vocal
system emit words
ORGAN EFFECT
Heart
Muscle Increased Rate
Increased Force of
Coronaries contraction
Dilated(beta
2),Constricted(alpha)
Lungs
Bronchi
Dilated
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Blood Vessels Mildly Constricted
Gut
Lumen Decreased peristalsis and
Sphincter tone
Increased Tone
Bladder
Detrusor Relaxed
Trigone Contracted
Penis Ejaculation
Q-What is the motor and sensory loss at and below the level
of hemisection of the spinal cord.
Ans:Effects at the level of lesion:
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On the Same side:
Sensory Loss:
Complete anaesthesia to all forms of senses,because post
nerve root,post horn cells and lat and ventral spinothalamic
tracts crossing to the opposite side are all lost
Motor disturbances:
Paralysis of lower motor neuron type due to
Sensory Loss:
Nil or very slight
Motor Loss:
Nil or slight due to damage to small direct pyramidal fibers
of same side
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fasciculi gracilis and cuneatous which do not cross
*Pain,temperature and crude touch are not lost because
lateral and ventral spinothalamic tracts cross to opposite sides
below the level of lesion
Motor Disturbances :
Paralysis of upper motor neuron lesion type
ON OPPOSITE SIDE:
Sensory disturbances:
Some loss of pain sensations.
Motor disturbances:
Nil or very slight.
ANNUAL 2008
Q-Explain the functions of cerebrocerebellum.Enemurate 8
features of the cerebellar disease?
Ans:Functions of Cerebrocerebellum:
a)-Facilitates smooth and co-ordinated movements
b)-Ensures that force,direction and extent of movements are
accurate.
8 Features:
i)-Dysmetria and ataxia
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ii)-Past Pointing
iii)-Dysdiadochokinesia
iv)-Dysarthia
v)-Intention tumor
vi)-Cerebellar Nystagmus
vii)-Hypotonia
viii)-Asthenia
ORGAN EFFECT
Heart
Muscle Increased Rate
Increased Force of
Coronaries contraction
Dilated(beta
2),Constricted(alpha)
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Lungs
Bronchi
Dilated
Blood Vessels
Mildly Constricted
Gut
Lumen Decreased peristalsis and
Sphincter tone
Increased Tone
Bladder
Detrusor Relaxed
Trigone Contracted
Penis Ejaculation
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Mental activity incresed
Q-A middle aged man was hit by a motor car resulting into
fracture dislocation of vertebrae.Later he developed effects
indicating right sided hemisection of the spinal
cord.Enumerate the features below and at the level of
hemisection.
Ans:Effects at the level of lesion:
On the Same side:
Sensory Loss:
Complete anaesthesia to all forms of senses,because post
nerve root,post horn cells and lat and ventral spinothalamic
tracts crossing
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Sensory Loss:
Nil or very slight
Motor Loss:
Nil or slight due to damage to small direct pyramidal fibers
of same side
ON OPPOSITE SIDE:
Sensory disturbances:
Some loss of pain sensations.
Motor disturbances:
Nil or very slight.
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Q-Mr.J of 58 years age with reting tremors of hand and lips
consulted his family doctor.On examination he was found to
have rigidity of limbs and expressionless face.He was having
short-stepped gait.
A)-From which disease Mr.J was suffering?
B)-What is the cause and mechanism of this disease
c)-Which drugs can be used to treat this disease?
a)-Parkinsons,s disease
b)-Cause:
*Dopamine secreted in the caudate nucleus and putamen is
an inhibitory transmitter,therefore the destruction of
dopaminergic neurons in the substantia nigra of the
parkinsonian patient would allow the caudate nucleus and
putamen to be overly excited leading to rigidity
*Some of the feedback curcuits might easily oscillate leading
to tremor.It is involuntary tremor
*Dopamine secretion in the limbic system,
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Especially in the nucleus accumbens is often decreased along
with its decrease in the basal ganglia.it might be the cause of
akinesia.
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ORGAN EFFECT
Lungs
Brochi
Constricted
Blood vessels
Dilated
Bladder
Detrusor
Contracted
Trigone
Relaxed
Eye Contracted
Pupil
Ciliary Muscle
Contracted
Penis erection
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Nasal,lacrimal,parotid, secretion
submandibular,gastric,pancreatic
Annual 2009
Q-Enlist 8 functions of the body controlled by brainstem?
Ans:Functions
The brain stem is its own master because it provides many
special control functions,such as:
i)-Control of respiration
ii)-Control of cardiovascular system
iii)-Partial control of gastrointestinal function
iv)-Control of many stereotyped movements of the body
v)-Control of equilibrium
vi)-Control of eye-movements
vii)-Serves as a way station for command signals from higher
centers
viii)-Provide support to the body against gravity
Q-A 60 year old man develops tremor in his hands and fingers
which become pronounced as he reaches for a glass of water
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or points towards an object,He has difficulty maintaining his
balance?
A)-Which component of the nervous system is involved?
B)-How are these tremors different fro other tremors due to
lesion of nervous system?
C)-Why this person has difficulty in maintaining
balance?
Ans:
a)-Cerebellum
b)-These tremors differ from other tumor because these occur
when a person tries to do so voluntary action.Thats why these
are callled voluntary or intentional tumors.In case of basal
ganglia lesion these are involuntary tremors.
c)-Post Spinocerebellar fibers receive muscle joint info from
the muscle spindles,tendon organs and joint receptors of the
trunk and lower limbs.This info concerning tension of muscle
tendons and the movements of muscles and joints is used by
the cerebellum in the
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cerebellar lesion the cerebellum cannot comprehend these
info and resultss in loss of balance
ANNUAL 2010
Q-A boxer at the age of 45 years was diagnosed to be
suffering from Parkinson,s disease.
A)-What are the characteristics of this disease?
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ii)-L-Deprenyl
iii)-transplanted fetal dopamine cells
*Neurotransmitter is glutamate.
Slow Pain:
*Long acting
*Mostly caused by chemical stimuli
*Carried by C fibers via paleospinothamlamic pathway
*Localization of pain is poor
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*Velocity=0.5 – 2 m/sec
*Neurotransmitter is substance P
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Therefore,this central portion does not contract when the
ends do.Instead ,it functuins as a sensory receptor.The end
portions that do contract are excited by gamma motor nerve
fibers that originate from small type A gamma motor neurons
in the ant horns of the spinal cord.Extrafusaled by fibers are
innervated by alpha fibrers
Functions:
i)-Muscle spindle constituets a feedback device that operates
to maintain muscle length
ii)-Simplest menifestation of muscle spindle function is stretch
reflex
iii)-Dynamic and static respons of muscle spindle performs
dampning function
iv)-Stabailizes body position during tense motor activity
v)-Maintains muscle tone
Annual 2012
Q- We experience different modalities of sensations (e.g
pain,touch etc) although the nerve fibers transmitonly
impulses.How is it that different nerve fibers transmit different
modalities of sensation?Give an example to explain?
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Ans:Each of the principle type of sensation that we can
experience-pain,touch,sight,sound and so forth-is called a
modality of sensation.
Each nerve tract terminates at a specific point in
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Q-A 67 yearsold man visits his neurologist and complains that
it is extremely difficult for him to stand up sitting position or
start walking from standing position.He also complains of
tremulous movements of the fingerswhuch disappear when
he starts doing something.
a)-what is the condtion called?
B)What is the lesion/damage located?
C)-What is the speculated cause of difficulty this man
experiences in intitiating a movement?
Ans: a)-Parkinson,s disease
b)-Basal ganglia
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Q-A man of 45 years received a gun short on his back.He
developed right sided hemisection of the spinal cord.
A)-Give the features below,above and at the level of lesion?
B)-What is Brown-Sequard Syndrome?
Ans:Effects at the level of lesion:
On the Same side:
Sensory Loss:
Complete anaesthesia to all forms of senses,because post
nerve root,post horn cells
Sensory Loss:
Nil or very slight
Motor Loss:
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Nil or slight due to damage to small direct pyramidal fibers
of same side
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EFFECT ABOVE LEVEL OF LESION:
On Same Side:
There is a narrow zone of hyperaesthesia or hypersensitive to
touch,pain and thermal stimuli due to irritation of upper cut
ends of damaged fibers.
Opposite side:
Hyperaesthesia may be referred.
B)-In Brown sequard syndrome there is complete hemisection
of spinal cord.Its features are
*Ipsilateral lower motor neuron paralysis in the segment of
lesion and muscular atrophy
*Ipsilateral spastic paralysis below the level of lesion
*Ipisilateral band of cutaneous anasthesia in the segment of
lesion.
*Ipsilateral loss of tactile discrimination, and of
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Q-What are the functions of spinocerebellum?Enemurate
features of cerebellar diseases?
Ans:Functions:
i)-Planning and fine tunning of skeletal muscle contraction
ii)-Maintainance of posture and performance of voluntary
muscles
PREPARED BY
AHSAN SARWAR
Lahore medical and dental college
Gastrointestinal Physiology
Question No: 1 What do you know about pharyngeal stage of
swallowing along with its nervous control? (Supplementary 2004)
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Answer: Chapter 63 (Guyton)
SWALLOWING
2nd Stage (Pharyngeal Stage)
1- Bolus stimulates the epithelial swallowing receptor areas
around opening of pharynx.
2- Soft palate is pulled upwards.
3- The palatopharyngeal folds and vocal cords are approximated.
4- Epiglottis swings backward over the opening of larynx.
5- Upward movement of larynx and opening of the upper
oesophageal sphinchter.
6- Contraction of pharyngeal muscles and propulsion of food by
peristalsis into oesophagus.
Nervous Control:
Sensory: Sensory portions of trigeminal and glossoharyngeal nerves
into the medulla, either into or closely associated with the tractus
solitaries.
Areas in the medulla and lower pons are called swallowing centre.
Motor: 5th,9th,10th and 12th cranial nerves and a few cervical nerves.
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A) Pharyngeal stage of swallowing
B) Actions of cholecystokinin (Annual 2005)
Answer:
A) Answer No 1 above.
B) 1- stimulates pancreatic enzyme secretion.
2- stimulates pancreatic bicarbonate secretion.
3- causes gallbladder contraction.
4- growth of exocrine pancreas.
5- inhibits gastric emptying.
6- Inhibits appetite.
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1- Inhibitory effect of enterogastric nervous reflexes from
duodenum:
2- Factors initiating enterogastric reflexes:
Degree of distention of duodenum
Presence of any irritation
Acidity and osmolality of the chyme
Presence of certain breakdown products in chyme
3- Hormonal feedback from duodenum:
CCK
Secretin
GIP (check the book for their detailed functions)
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Chop the chyme 2-3 times per minute
Frequency is determined by the electrical slow waves
normally it is 12/minute in duodenum and jejunum and
in ileum 8-9/minute.
Contractions can be blocked by atropine
2- Propulsive movements:
Peristalsis in small intestine: velocity is 0.5-2cm/sec
Control of peristalsis by nervous and hormonal signals
1- Stretch of duodenal wall
2- Gastroenteric reflex
3- Gastrin, cck, insulin, motilin and serotonin enhance
motility.
4- Secretin and glucagon inhibit motility
Question No: 6 List the motor functions of stomach? Wha are
hunger contractions? (annual 2006)
Answer: Chapter 63(guyton)
Motor Functions:
1- Storage function of somach:
Vagovagal reflex reduces the tone in the muscular wall of
body of stomach.
Stomach can store 0.8 – 1.5 litres of food.
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2- Mixing and propulsion of food- Basic electrical rhythm of
stomach wall:
Gastric juices secreted by gastric glands
Mixing waves begin in the mid two upper portions of
stomach and move towards the antrum
These waves are initiated by basic electrical rhythm
Powerful constrictor rings force the antral contents
towards pylorus
Retropulsion
3- Gastric emptying:
Answer no 4 above
Hunger Contractions:
* Contractions that occur when the stomach has been
empty for several hours.
* Duration 2-3 minutes.
* Intense in young people and those having low blood sugar
levels.
* Sometimes causes mild pain called hunger pangs
* Donot begin until 12-24 hours after last ingestion.
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Answer: Answer no 5 above.
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Achlasia:
Oesphageal sphinchter fails to relax during swallowing
Damage in neural network of myenteric plexus in lower
two thirds of oesophagus
Myenteric plexus loses its ability to cause receptive
relaxation of oesophageal sphinchter.
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Cranial portion by vagus nerve and sacral portion by
2nd,3rd,and 4th pelvic splanchnic nerves. Postganglionic
neurons are located in myenteric and submucosal plexus.
Enhances the activity of G.I.T functions.
Extensive near to oral cavity and anus.
Sympathetic:
Inhibits G.I.T activity.
Fibres originate in spinal cord between segments t5-l2.
Some fibres enter sympathetic chains and then pass to
celiac ganglion or
myenteric ganglion. Most of the post ganglionic neurons
are in these ganglion.
Innervates all the G.I.T
Secrete epinephrine and nor epinephrine
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2- In hemolytic jaundice unconjugated bilirubin is
increased whereas in obstructive conjugated bilirubin
is increased.
3- URobilinogen is increased in hemolytic jaundice and
decreased in obstructive jaundice.
4- Urine color is normal in hemolytic but it is dark in
obstructive jaundice due to conjugated bilirubin.
5- Stool color Is normal in hemolytic jaundice but pale in
obstructive jaundice.
6- Splenomegaly is present in hemolytic jaundice but
absent in obstructive jaundice.
Question no:13
A) Enumerate the factors that regulate gastric emptying?
B) Enumerate the factors that can excite enterogastric
reflexes from duodenum?
Answer: A) answer no 4 above for gastric emptying
B)Factors initiating enterogastric reflexes:
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a) What is pathophysiology of this disease?
b) How the intestine normally handles the excessive acidity in
chyme?
Answer: A) chapter 66(guyton)
Caused by:
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Acidic chyme entering duodenum inhibits gastric secretion and
peristalsis in stomach
Presence of acid in small intestine stimulates secretin secretion
which in turn stimulates bicarbonate secretion.
PREPARED BY
SALEHA RASHID & ZAINUB ARIF
FMH college of medicine & dentistry
ENDOCRINOLOGY
Q:How does cyclic Amp mediate hormonal action at cellular level?
which hormones obey the cyclic-Amp mechanism ? (ANNUAL
Paper 2004)
Ans:
Adenylyl Cyclase–cAMP Second
Messenger System
Binding of the hormones with the receptor
allows coupling of the receptor to a G protein ----->
G protein stimulates the adenylyl cyclase–cAMP
system, a membrane-bound enzyme----> Gs protein then catalyzes
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the conversion of a small amount of cytoplasmic
adenosine triphosphate (ATP) into cAMP inside the
cell.-----> This then activates cAMP-dependent protein
kinase, which phosphorylates specific proteins in the
cell, triggering biochemical reactions that ultimately
lead to the ell’s respo se to the hor o e.
Some Hormones That Use the Adenylyl Cyclase–cAMP
Second Messenger System
Adrenocorticotropic hormone (ACTH)
Angiotensin II (epithelial cells)
Calcitonin
Catecholamines (b receptors)
Corticotropin-releasing hormone (CRH)
Follicle-stimulating hormone (FSH)
Glucagon
Human chorionic gonadotropin (HCG)
Luteinizing hormone (LH)
Parathyroid hormone (PTH)
Secretin
Somatostatin
Thyroid-stimulating hormone (TSH)
Vasopressin (V2 receptor, epithelial cells)
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Ans: Dwarfism
=>dwarfism result from generalized
deficiency of anterior pituitary secretion (panhypopituitarism)
during childhood.
=>all the physical parts of the body develop in appropriate
proportion
to one another
=>dwarf does not pass through puberty
Cretinism
=>Cretinism is caused by extreme hypothyroidism during
fetal life, infancy or childhood
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Q:Explain various steps involved in the biosynthesis of Thyroid
hormones?(ANNUAL Paper 2005 & supplementary 2006)
Ans:
=>Formation and Secretion of Thyroglobulin by the Thyroid Cells
=>Oxidation of the Ion
The oxidation of iodine is promoted by the enzyme peroxidase
and its accompanying hydrogen peroxide, which
provide a potent system capable of oxidizing iodides.
=>Iodination of Tyrosine and Formation of the Thyroid Hormones—
Orga ifi atio of Th roglo uli
oxidized iodine is associated with an iodinase enzyme iodine binds
with about one sixth of the tyrosine amino acids within the
thyroglobulin molecule.Tyrosine is first iodized to
monoiodotyrosine and then to diiodotyrosine whic coupled to form
the thyroxine and triidotyrosin.
=>Storage of Thyroglobulin
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Q:What are different second messengers mechanisms of
hormonal actions?(ANNUAL Paper 2005)
Ans:Adenylyl Cyclase–cAMP Second
Messenger System
The Cell Membrane Phospholipid Second
Messenger System
Calcium-Calmodulin Second
Messenger Syste
GMP second messenger system
prostaglandins
Q:Name the hormones secreted from the thyroid gland. Explain
mechanism of action of steroid hormones? (ANNUAL Paper 2006)
Ans: thyroxine and
triiodothyronine, commonly called T4 and T3, respectively.
Calcitonin
Mechanism of action of steroid hormones:
=>steroid hormones, exerts its effects
by first interacting with intracellular receptors in target
cells.
. =>They can easily diffuse through the cell membrane. Once inside
the cell,
they binds with protein receptor in the cytoplasm,
and the hormone-receptor complex then interacts with
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specific regulatory DNA sequences, called glucocorticoid or
minerilocorticoid
response elements, to induce or repress gene transcription.
=>Other proteins in the cell, called transcription
factors, are also necessary for the hormone-receptor
complex to interact appropriately.
Q:Enumerate:
a) Features of Cushing's syndrome
b) Features of Tetany (supplementary 2006)
Ans; Features of cushing's syndrome:
hypersecretion of adrenal cortex.
-emotional disturbance
-Enlarged sella turcica
-moon face
-oteoporosis
-cardiac hypertrophy
-buffalo hump
-obesity
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-Amenorrhea
-muscle weakness
-purpura
-skin ulcers
Features of tetany:
low ECF calcium
-threshold for action potential is lowered
-Nervous system is in more excited state
-gait abnormality (scissor gait , spastic gait)
-movement disorders
-lack of cordination
-joint locking
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Q: A young man reported to his family doctor with the complaints
of palpitation, loss of weight in spite of increased appetite and
intolerance to heat. On examination he was having pulse rate
110/min, his eyes were prominent and there was swelling on the
anterior side of the neck.
a) From which disease he was suffering ?
b) Which investigations will you advise?
c)What is the cause of the disease? (Annual paper 2007)
Ans: a)Hyperthyroidism
b)The most accurate diagnostic test is
dire t easure e t of the o e tratio of free th ro i e
(and sometimes triiodothyronine) in the plasma. other tests
include
1. The basal metabolic rate which will be high in this case.
2. The concentration of TSH in the plasma. TSH is completely
suppressed by the
large amounts of circulating thyroxine and
triiodothyronine so there is almost no plasma
TSH.
3. The concentration of TSI is measured by
radioimmunoassay. This is usually high in
thyrotoxicosis but low in thyroid adenoma
.
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C)Hyperthyroid pateints have certain substances in the blood.
These substances
are immunoglobulin antibodies that bind with the
same membrane receptors that bind TSH. They induce
continual activation of the cAMP system of the cells,
with resultant development of hyperthyroidism. These
antibodies are called thyroid-stimulating immunoglobulin
and are designated TSI.
Throid adenoma also leads to hyperthyroidism.
Q: What are physiological actions of cortisol on proteins and
carbohydrate metabolism? Enumerate six features of Cushing's
syndrome? {Annual paper 2007 , 2008 (action on proteins) &
supplementary 2008 ( action on carbohydrates)}
Ans: Effect on carbohydrate metabolism:
=>increase gluconeogenesis
-Cortisol increases the enzymes required to convert
amino acids into glucose in the liver cells
-Cortisol causes mobilization of amino acids from
the extrahepatic tissues mainly from muscle. as the result more
amino acids are avialable for gluconeogenesis.
=>Decreased Glucose Utilization by Cells.
Effect on protein metabolism:
=>Reduction in Cellular Protein.
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This is caused by both
decreased protein synthesis and increased catabolism
of protein already in the cells
=>Cortisol Increases Liver and Plasma Proteins.
It is believed that this results from a possible effect of cortisol to
enhance amino acid transport into liver and to enhance the
liver enzymes required for protein synthesis
=>Increased Blood Amino Acids, Diminished Transport of Amino
Acids into Extrahepatic Cells, and Enhanced Transport into
Hepatic Cells
Q:What are physiological actions of cortisol on proteins ?How is
cortisol secretion regulated ? (Annual paper 2008)
Ans; Regulation of cortisol secretion:
fig 77-6
=>ACTH Stimulates Cortisol Secretion.
An important releasing factor controls ACTH secretion. This is
called corticotropin-
releasing factor (CRF). It is secreted into the
primary capillary plexus of the hypophysial portal
system in the median eminence of the hypothalamus
and then carried to the anterior pituitary gland, where
it induces ACTH secretion.
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=>ACTH Activates Adrenocortical Cells to Produce Steroids by
Increasing Cyclic Adenosine Monophosphate (cAMP).
The most important of all the ACTH-stimulated
steps for controlling adrenocortical secretion is activation
of the enzyme protein kinase A, which causes
initial conversion of cholesterol to pregnenolone. This
i itial o ersio is the rate-li iti g step for all the
adrenocortical hormones.
Q:A young female consulted her family physician . She
complained of frequent muscle spasms and numbness of arms
and legs. Her plasma calcium was 6.5mg/dl.
a) From which condition was she suffering ?
b) was her plasma calcium normal?
c)What was the mechanism of her frequent muscle spasms and
numbness? (Annual paper 2008)
Ans: a) Tetany
b) no , her plasma calcium level was lower. normal value is 9.8 to
11.5 mg/dl.
c) Her neurons are over excited , threshold for action potential is
decreased , even little sodium influx leads to sudden muscle
contraction ( muscle spasms ).
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Q: A boy of 10 years was brought by his father to a medical
specialist. The boy because of retarded growth appeared to be of
4-5 years. During talking the boy answered the question
intelligently. His body parts were proportionate but of smaller
size:
a) Fom which disorder the boy was suffering?
b) what was the cause of this disorder?
c)what are different types of this disorder? ( supplementary 2008)
Ans; a) Dwarfisim
b) insufficient growth hormone produced by the anterior pitutiary
hormone.
c) African pygmy , Lévi-Lorain dwarfism .
Q: a)What are physiological actions of cortisol on carbohydrates?
b) what is the difference between Cushing's syndrome and
Cushing's disease?( supplementary 2008)
Ans; a) see above questions
b) Hypersecretion by the adrenal cortex causes a complex
cascade of hormone effects called Cushi g’s sy dro e
Whe Cushi g’s s dro e is se o dar
to excess secretion of ACTH by the anterior
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pituitary, this is referred to as Cushi g’s disease
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d)why is she always thirsty ?
e) what are different types to this disorder? ( Annual paper 2009)
a. diabetes mellitus (type 2)
b. increased osmotic effect of glucose decreases tubular
reabsorption
c. impaired glucose uptake by cells for energy.
d. increased blood osmolarity stimulates the hypothalamus
osmotic receptors
e. type 1 and type 2
Q:a) what are the endocrine functions of pancrease?
b) Enlist the factors which increase insulin secretion?( Annual
paper 2010)
Ans: alpha cells glucagon
beta cells insulin
b. Increased blood glucose
• I reased lood free fatt a ids
• I reased lood a i o a ids
• Gastroi testi al hor o es
(gastrin, cholecystokinin, secretin,
gastric inhibitory peptide)
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• Glu ago , gro th hor o e,
cortisol
• Paras patheti sti ulatio ;
acetylcholine
• b-Adrenergic stimulation
• I suli resista e; o esit
• “ulfo lurea drugs gl uride,
tolbutamide)
Q: Give pathophysiology and features of 43 year old lady who is
diagnosed as a case of toxic goiter?( Annual paper 2010)
Symptoms of Hyperthyroidism
The symptoms of hyperthyroidism are obvious from the
preceding discussion of the physiology of the thyroid
hormones: (1) a high state of excitability, (2) intolerance
to heat, (3) increased sweating, (4) mild to extreme
weight loss (sometimes as much as 100 pounds), (5)
varying degrees of diarrhea, (6) muscle weakness, (7)
nervousness or other psychic disorders, (8) extreme
fatigue but inability to sleep, and (9) tremor of the
hands.
Exophthalmos
Q:How 24 hour blood glucose is regulated in normal person ?(
Annual paper 2011)
Growth Hormone Decreases
Carbohydrate Utilization
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Growth hormone causes multiple effects that
influence carbohydrate metabolism, including (1)
decreased glucose uptake in tissues such as skeletal
muscle and fat, (2) increased glucose production by
the liver, and (3) increased insulin secretion.
Glucose absorption
Gluconeogenesis
Glycogenolysis
insulin lowers glucagon increases
Q:Enumerate the specific effects of thyroid stimulating hormone
(TSH) on thyroid gland?( Annual paper 2011)
Increased proteolysis of the thyroglobulin that
has already been stored in the follicles, with
resultant release of the thyroid hormones into
the circulating blood and diminishment of the
follicular substance itself
2. Increased activity of the iodide pump, which
i reases the rate of iodide trappi g i the
glandular cells, sometimes increasing the ratio of
intracellular to extracellular iodide concentration
in the glandular substance to as much as eight
times normal
3. Increased iodination of tyrosine to form the
thyroid hormones
4. Increased size and increased secretory activity of
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the thyroid cells
5. Increased number of thyroid cells plus a change
from cuboidal to columnar cells and much
infolding of the thyroid epithelium into the
follicles
In summary, TSH increases all the known secretory
activities of the thyroid glandular cells.
PREPARED BY:
Waqar Sharif
CMH Medical College
REPRODUCTION
Q1. enumerate hormones that take part in lactation. explain the
action of prolactin. (annual 2004)
A. prolactin, oxytocin, estrogen and progesterone. production of
milk in breasts and breast enlargement
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A. spermatocytogenesis
spermatogonium a to spermatogaonia b to primary spermatocyte
to secondary spermatocyte via meiosis to spermatid
spermiogenesis
spermatid to sperm
testosterone, Lh, Fsh, Gh, estradiol
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increase in uerine size, glands, vascularity
inhibit Lh and Fsh
secondary sexual characteristics
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Q7. a. when a baby suckles a mothers breast, how is milk ejected
out into babys mouth. b. why in more than 50 % lactating women,
the lactating cycle is inhibited? (supp 2008)
baby suckels nipples - sensory impulses - hypothalamus - oxytocin
and prolactin - contraction of myoepithelium - milk ejection n let
down
inhibited because suckling - hypothalamus - suppreses Lhrh -
suppress Fsh Lh - ovarian cycle suppressed
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estrogen fr ductal system
progesterone fr glandular system
estrogen , progesterone, Gh, prolactin, cortisol, insulin
prepared by
Waqar Sharif
CMH Medical College
RENAL PHYSIOLOGY
Q: what is filtration pressure? How does auto
regulation of glomerular filtration rate (GFR) occur?
Answer: Filtration Pressure: the net driving force
which pushes fluid into tissue spaces and out of
vascular sites; the net result between capillary
osmotic pressure and intravascular hydrostatic
pressure. For example-it occurs in the kidneys for
the filtration purposes and in the capillaries where
starling forces act together to determine the
direction of going of fluid either into the capillary or
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out of it.
Auto regulation of glomerular filtration rate:
1. Role of Tubuloglomerular Feedback
In Auto regulation of GFR: The Tubuloglomerular
feedback mechanism has two components that act
together to control GFR:
(1) An afferent arteriolar feedback mechanism and
(2) an efferent arteriolar feedback mechanism.
These feedback mechanisms depend on special
delivery to the macula densa in these circumstances
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cells, causing them to contract. This contraction
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normal level while increasing the excretion of the
due to lesions?
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Addiso ’s disease . ausi g eta oli a idosis due to
ANSWER
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Second smaller quantities of ions are also transported into the
medullary interstitial fluid from the collecting duct for example
chloride ions are passively absorbed along with sodium ions
In presence of ADH water is reabsorbed from collecting duct
increasing urea concentration in collecting duct so urea diffuses from
collecting duct into medullary interstitium
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retransports this sodium chloride once again into the papillary
interstitium
These steps are repeated thus enhanced the medullary
hyperosmolality
ANSWER
Cs = Us * V / Ps
MEASUREMENT OF GFR
GFR = Us * V / Ps
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Creatinine clearance is also used to measure GFR accurately it is easier than
inuline clearance because creatinine is already present in body fluids
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of urine formed. The human kidney can
osmolarity of plasma.
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interstitium; from there it is carried away by
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of the renal papillae that project from the
countercurrent mechanism.
Bladder?
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urethra when this area begins to fill with urine
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bladder and posterior urethra, which causes a
pressure,
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micturition reflex occurs. As the bladder
centers include
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the brain stem, located mainly in the pons, and
micturition as follows:
micturition is desired.
presents itself.
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sphincter so that urination can occur.
bladder
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Filtration Rate?
glomerular capillaries.
Normal values:
Normal GFR=125ml/min
So Kf is 12.5 ml/min/mmHg
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versa.
zero.
the Urine?
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water in the ascending loop of Henle, DCT,and cortical
in the tubular fluid which then diffuses thru the UT1 and
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Q: what are features of METABOLIC ACIDOSIS?
How is it compensated?
body,
infusion of acids
(4) Loss of base from the body fluids, which has the same effect
HCO3 or both.
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acetoacetic acid levels can rise very high, causing severe
metabolic acidosis.
(8)Ingestion of acids
question)
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Q: Define renal threshold. How is glucose
glucose?
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proteins. For example, if plasma glucose
Glucose (g/day):
1. Amount filtered=180
3. Amount excreted=0
follows:
its tubules.
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3. Acid base balance: kidney through phosphate
of the body.
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occur in his water and electrolyte
balance?
as 50 mOsm/L.
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solutes. When the glomerular filtrate is
Proximal Tubule:
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tubular fluid reaches equilibrium with
inner medulla.
Loop of Henle:
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early distal tubule, with the osmolarity
of ADH:
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impermeable to water and the
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volume of dilute urine is excreted.
no.345-346.)
functions as follows:
D).
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when blood water level is low and vice
versa.
GFR.
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Glomerular Filtration Rate?
Answer:
capillaries.
Normal GFR=125ml/min
So Kf is 12.5 ml/min/mmHg
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increase in GFR.And vice versa.
proportional to GFR.
. Bo a ’s Capsule Pressure:
normally zero.
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kidney tubules. The reabsorption takes
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reabsorption of water in from the tubules in
ANSWER
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CALCIUM ION HOMEOSTASIS
When calcium ion concentration falls below normal parathyroid glands are
stimulated to promote increase secretion of PTH it regulates plasma
calcium concentration by stimulating activation of vitamin D.
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BUN(BLOOD UREA NITROGEN) = high, SERUM CREATININE= high PH= high
7.2
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QWHAT ARE THREE LINES OF DEFENCE AGAINST CHANGES IN H+ ION
CONCENTRATION OF BODY FLUIDS?
ANSWER
ANSWER
If more H+ are secreted than HCO3- is filtered there will be a loss of acid
from extracellular fluid if more HCO3- is filtered than H+ secreted there will
be a net loss of base.
1. Secretion of H+
2. Reabsorption of filtered HCO3-
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3. Production of new HCO3-
Hydrogen ion secretion and HCO3- reabsorption occur in all parts except
descending and ascending thin limbs of loop of henle
ANSWER
ANSWER
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1. An afferent arteriolar feedback mechanism
Little flow of glomerular filtrate causes decreased sodium and
chloride concentratin at macula densa. This causes afferent arteriolar
dilatation this allows increase blood flow which increases glomerular
pressure and increases the GFR back towards normal
Figure 26-19
ANSWER
ANSWER
It is determined by
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1. Hydrostatic and colloid osmotic forces across glomerular membrane
2. Glomerular capillary filtration co-efficient
GFR = Kf * (Pg – Pb –
INCREASING FACTORS
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1. Increase renal blood flow
2. Increase glomerular pressure
3. Increase blood pressure
4. Efferent arteriolar constriction
DECREASING FACTORS
Q. DRAW CYSTOMETROGRAM.
ANSWER
ANSWER
1. ATONIC BLADDER
Micturation reflex can not occur if the sensory nerve fibers from the
bladder to spinal cord are destroyed, preventing the transmittion of
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stretch signals from bladder common cause of atonic bladder is crush
injury to the sacral region of spinal cord.
2. AUTOMATIC BLADDER
If the spinal cord is damaged above the sacral region but the spinal
cord segments are still intact, typical micturatuon reflex can not occur
4. NOCTURNAL MICTURATION
It is the involuntary voiding of urine during night it is also known as
enuresis or bed wetting. It occurs due to the absence of voluntary
control of micturation.
Q. DEFINE
a) FILTRATION FRACTION
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b) FILTRATION CO-EFFICIENT
GFR in both kidneys per mmhg of filtration pressure is called filtration co-
efficient.
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Efferent impulses via pelvic nerve
Voiding of urine
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Acidosis resulting from excess accumulation of metabolic or fixed acids is
called metabolic acidosis. It causes a decrease in the ratio ofHCO3 to H+ in
renal tubular fluid.
ANSWER
Automatic bladder
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Durin the first stage after the damage to spinal cord because the state of
spinal shock micturation reflexes are suppressed caused by sudden loss of
facilitative impulses from the brain stem and cerebrum
Urinary bladder loses the tone and becomes atonic resulting in overflow
incontinence
During the second stage after shock period micturation reflex returns
however the voluntary control is lacking
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Bladder receives sympathetic innervations from the sympathetic chain
through the HYPOGASTRIC NERVES connecting mainly with the L2 segment
of spinal cord. These sympathetic fibers stimulate mainly the blood vessels.
PREPARED BY:
IMRAN ASHRAF (AIMC)
AREEZA RANA (FMHC)
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